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Refractive Surgical Problem
CONSULTATION SECTION
Refractive Surgical Problem Edited by Jose´ L. Gu¨ell, MD
A 31-year-old white man came for consultation seeking refractive surgery. The subjective refraction was 6.50 3.00 10 in the right eye and 6.00 4.00 170 in the left eye and the corrected distance visual acuity (CDVA), 20/20 and 20/25, respectively. The corneal topography (Orbscan, Bausch & Lomb) was normal (Figure 1), as was the rest of the ophthalmologic examination. The patient was scheduled for laser in situ keratomileusis (LASIK). During LASIK, the 120 mm flaps were created using an Amadeus II microkeratome (Ziemer). The ablation was performed with a MEL 80 excimer laser (Carl Zeiss Meditec) using an aspheric optimized profile. The procedure was uneventful in both eyes. Two hours after surgery, the patient returned because of a sudden loss of vision in the right eye. The flap was inferiorly dislocated, presumably because of
Figure 2. Slitlamp photographs of the right eye. A: Wide-field photography. B: Iris-reflex photography.
Figure 1. Corneal topography. A: Right eye. B: Left eye.
Q 2009 ASCRS and ESCRS Published by Elsevier Inc.
an unknown blunt trauma. Immediately, the flap was replaced surgically and a bandage contact lens applied. One hour later, a similar complication occurred in the left eye and the same therapeutic strategy was used. At the first consultation 24 hours later, the patient was very happy. The uncorrected distance visual acuity (UDVA) was 20/30 in the right eye and 20/25 in the left eye. Slitlamp examination showed a completely normal left eye; however, long striae and peripheral folds were seen in the right eye (Figure 2). What specific evaluations would you perform, and what would be your strategy to treat and manage this patient? What are the potential risk factors for these complications in an otherwise completely normal and cooperative patient? 0886-3350/09/$dsee front matter doi:10.1016/j.jcrs.2009.04.019
1317
Refractive Surgical Problem Edited by Jose´ L. Gu¨ell, MD
A 31-year-old white man came for consultation seeking refractive surgery. The subjective refraction was 6.50 3.00 10 in the right eye and 6.00 4.00 170 in the left eye and the corrected distance visual acuity (CDVA), 20/20 and 20/25, respectively. The corneal topography (Orbscan, Bausch & Lomb) was normal (Figure 1), as was the rest of the ophthalmologic examination. The patient was scheduled for laser in situ keratomileusis (LASIK). During LASIK, the 120 mm flaps were created using an Amadeus II microkeratome (Ziemer). The ablation was performed with a MEL 80 excimer laser (Carl Zeiss Meditec) using an aspheric optimized profile. The procedure was uneventful in both eyes. Two hours after surgery, the patient returned because of a sudden loss of vision in the right eye. The flap was inferiorly dislocated, presumably because of
Figure 2. Slitlamp photographs of the right eye. A: Wide-field photography. B: Iris-reflex photography.
Figure 1. Corneal topography. A: Right eye. B: Left eye.
Q 2009 ASCRS and ESCRS Published by Elsevier Inc.
an unknown blunt trauma. Immediately, the flap was replaced surgically and a bandage contact lens applied. One hour later, a similar complication occurred in the left eye and the same therapeutic strategy was used. At the first consultation 24 hours later, the patient was very happy. The uncorrected distance visual acuity (UDVA) was 20/30 in the right eye and 20/25 in the left eye. Slitlamp examination showed a completely normal left eye; however, long striae and peripheral folds were seen in the right eye (Figure 2). What specific evaluations would you perform, and what would be your strategy to treat and manage this patient? What are the potential risk factors for these complications in an otherwise completely normal and cooperative patient? 0886-3350/09/$dsee front matter doi:10.1016/j.jcrs.2009.04.019
1317