First Author: F.Aguilera USA
Co Author(s): J. Lopez
Purpose:
To present a case in which wavefront technology helped establish the diagnosis of patient after a wavefront based femtosecond LASIK. The patient came with complaints related to different aspects of the optical system of the eye.
Setting:
Dept of Ophthalmology, Academic Medical Center, AMC, affiliated with the University of Amsterdam, the Netherlands and Retina Total Eye Care, private refractive surgery clinic, Driebergen, the Netherlands
Methods:
A case report of a 40 year old woman who came for an academic second opinion with complaints of blurred vision, more in the left eye after a FemtosecondLASIK procedure. This procedure was a wavefront based ablation for a refraction of S+0,25 C-2,00 x 88 in the OD and a refraction of OS S-0,75 C-1,25 x 79 OS. The patient reported that the surgery had been paused because of gasbubble breakthrough into the anterior chamber. She was very worried that something had gone wrong with her treatment. Her complaints were of blurry vision, more in the left eye and floaters in both eyes.
Results:
On examination the patients visual acuity was uncorrected od 0.06 LogMar and os 0.1 LogMar. The corrected visual acuity was -0.04 LogMar od with S+0,50 C-0,50 x 87 and 0.00 LogMar os with S+0,50 C-0,50 x 104. The orbscan shows an oblate regular cornea, with post-LASIK thinning in the pachymetry in both eyes. The zywave scan shows a total HOA of 0.43 µ od and total HOA of 0.30 µ os at a pupil of 6 mm.Localized opacities of the lens of the left eye and floaters could be seen in the vitreous cavity of both eyes. Were these opacities a consequence of the gasbubble breakthrough? The iTracey was now used as an additional diagnostic tool, because it can differentiate between the total, corneal and internal aberrations. With this apparatus we showed, that the total aberration was minimal in both eyes, while the internal versus external aberrations clearly cancelled each other out. The diagnosis was that the lens opacities were most probably present ahead of the laser treatment, and not caused by the laser treatment or the gasbubble breakthrough. Otherwise the total wavefront would have shown increased total aberrations and not the cancelling out the internal versus the corneal optics.
Conclusions:
In complaints of dissatisfaction after laser refractive surgery new technology, like the ITracey, can help establish the diagnosis and rule out complications secondary to the laser surgery. The availability of different diagnostic modalities allow for accurate diagnosis and the possibility of reassuring the patient, that in this case her lenticular opacities most probably already existed. Some of her complaints were mainly caused by excessive worrying and some were due to the status of her eyes. We could rule out the femtoLASIK procedure as the cause of her complaints. FINANCIAL DISCLOSURE?: ... receives consulting fees, retainer, or contract payments from a competing company, ... research is funded, fully or partially, by a competing company
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