Case Reports

IOL power calculation after multiple refractive surgery procedures in hyperopic patient

Case Report Details

First Author: A.Belodedova RUSSIA

Co Author(s):    O. Antonova   B. Malyugin                 

Abstract Details

Purpose:

To evaluate possibility and refractive outcomes of surgical treatment in patient with hypermetropy and previous history of numerous refractive surgery procedures

Setting:

S. Fyodorov Eye Microsurgery Federal Institution, Moscow, Russia

Report of Case:

A 48-year-old female patient arrived at the clinic complaining on her left eye visual acuity and problems with the eyes and unavailability of optical or contact correction. She underwent LASIK surgery for moderate hyperopia in her hometown about 5 years ago, and 6 month later additional procedure was performed to get rid of residual hyperopia. At the beginning of 2017, patient suffered from viral keratoconjunctivitis of her left eye, which resulted in a slight cloud-like corneal opacity located in para-optical zone. Due to this later in 2017, a phototherapeutic keratectomy (PTK) was performed on the OS. After performing and evaluating basic (VA, BCVA, tonometry, biometry, corneal pachymetry, endothelial cell density) and special (corneal topography, Pentacam) diagnostic procedures, it was planned to start the treatment with topography-guided photorefractive keratectomy (topo-PRK) and after several month of observation take a decision of phacoemulsification with toric IOL implantation. Before treatment VA was poor (about 0,02 and BCVA sph+8=0,3) and central corneal thickness was about 370 µm. After 11 months of observation post topo-PRK due to unstable keratometry of the para-optical zone we made a decision to implant monofocal IOL after performing it precise calculation taking in mind refractive index changes. As a result, next day after surgery patient showed VA 0,6.

Conclusion/Take Home Message:

A thorough history of patient’s refractive surgery procedures will help to avoid refractive «surprises» after cataract surgery. Measurements of the posterior corneal surface are mandatory as the corneal refractive index changes. For calculation it’s necessary to apply at least two formulas of the third generation (Shammas, HofferQ, Haigis-L).

Financial Disclosure:

None