Combined Post-keratoplasty LASIK/AK to Treat High Astigmatism
Refractive unpredictability and postoperative astigmatism are common complications following penetrating keratoplasty [1–5]. High astigmatism may result in decreased visual acuity, anisometropia, image distortion, and monocular diplopia, thus challenging
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Joann J. Kang and Dimitri T. Azar
Contents
Why Is This Case Relevant for the Refractive Surgeon?
Why Is This Case Relevant for the Refractive Surgeon? ..................................
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Case Background ...................................................
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Main Problem to Solve ..........................................
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Ancillary Tests ........................................................
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Surgical/Medical Intervention ..............................
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Outcome ..................................................................
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What to Learn from This Case .............................
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References ...............................................................
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Refractive unpredictability and postoperative astigmatism are common complications following penetrating keratoplasty [1–5]. High astigmatism may result in decreased visual acuity, anisometropia, image distortion, and monocular diplopia, thus challenging the visual rehabilitation of patients [1]. Spectacle correction or soft contact lenses are used to manage small amounts of cylinder, while rigid gas permeable lenses are effective for higher levels of regular astigmatism or in the presence of irregular astigmatism [1]. However, contact lenses may not be successful for all patients due to a variety of factors including corneal abnormalities, dry eye, lid abnormalities, or contact lens intolerance. Therefore, when conservative methods fail, other refractive treatments for post-keratoplasty astigmatism are needed.
Case Background
J.J. Kang, MD (*) Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA e-mail: [email protected] D.T. Azar, MD, MBA Department of Ophthalmology and Visual Sciences Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA e-mail: [email protected]
An 83-year-old retired high school teacher was referred for a “corneal problem.” He had a past medical history of mild asthma, arthritis, and migraine headaches and also underwent removal of a gastrointestinal tumor and prostate surgery. His medications included aspirin, Asmanex, and Cafergot. The patient’s past ocular history included bilateral cataract extraction 9 years prior to presentation and subsequent penetrating
J.L. Alió et al. (eds.), Difficult and Complicated Cases in Refractive Surgery, DOI 10.1007/978-3-642-55238-0_10, © Springer-Verlag Berlin Heidelberg 2015
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J.J. Kang and D.T. Azar
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keratoplasty in the right eye 1 year later and in the left eye seven years later for presumed pseudophakic bullous keratopathy. He also reported a history of corrective surgery one year prior for astigmatism of the left eye. Using his current spectacles, his vision in the right eye was 20/100 with a −5.00 +4.25 × 015 correction and 20/200 with −6.25 +5.50 × 022 correction. Manifest refraction improved his vision to 20/25 in the right eye with a −5.00 +4.25 × 032 correction and 20/25−3 in the left eye with −12.75 +12.00 × 180 correction. His corneal pachymetry was 612 and 616 μm in the right and
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