Case Reports

Immediate sequential bilateral cataract surgery and monovision in a patient suffering of primary infantile exotropia and suspected keratoconus

Case Report Details

First Author: S.Giugno ITALY

Co Author(s):                        

Abstract Details

Purpose:

Primary infantile exotropia is a rare strabismus disorder in which outward deviation of one or both eyes is present: Onset is before age 6 months and is very rare ( 0.00006%). The goal consists in treating associated amblyopia and squint surgery within the first 6 months of life to maximize potential for attaining single binocular vision with stereopsis: nevertheless it is achieved in only 29% of patients . The purpose of my work was to obtain spectacles independence in a patient suffering of primary infantile exotropia, absence of binocular vision, alternate fixation of gaze.

Setting:

Studio Oculistico, Dr. Salvatore Giugno, Viale Mario Gori 63, 93015 Niscemi (CL) Italy

Report of Case:

I assessed a 49-year-old patient suffering from primary infantile exotropia, an alternate fixation gaze and the absence of stereopsis which requires the independence of the glasses both from a distance and from near; he is an engineer and must see very well at 45-50 cm (working distance from computer and tablet). BCVA was 0 Log MAR in both eyes from afar with 0.75 sphere. The right eye is dominant, while the left eye is for fixing closely. The crystalline lens is clear and I considered performing a femtolasik procedure in both eyes, with the aim of emmetropia in the right eye and moderate myopia (-2 diopters) in the left one. Unfortunately, after performing topography and tomography (Sirius, CSO) I assessed a suspicious keratoconus in both eyes; at this point I explained to the patient the risk of a femtolasik procedure and proposed RELEX with a monofocal IOL aimed at emmetropia in the right eye and moderate myopia (-2 diopters) in the left eye. Immediate sequential bilateral cataract surgery was performed using a standard technique. After surgery, the incorrect visual acuity was -0.1 log MAR from distance vision in the right eye, BCVA was -0.10 log MAR with -2 sphere in the left eye, near Jaeger 1 with + 2 sphere in the right eye and Jaeger 1 without correction in the left eye.

Conclusion/Take Home Message:

However, nowadays the extended depth of focus IOL and the trifocal IOL can offer excellent results in terms of glasses independence; in selected patients with alternate gaze fixation, without stereopsis and diplopia, immediate bilateral sequential cataract surgery with monofocal IOL corrects one eye from distance vision and the other near vision. I consider this technique really effective to obtain the independence of the glasses without glare, halos and no reduction in sensitivity to contrast.

Financial Disclosure:

None