ESCRS - PP06.08 - A Case Of Unexpected Cylindrical Error Following Uncomplicated Lasik Surgery

A Case Of Unexpected Cylindrical Error Following Uncomplicated Lasik Surgery

Published 2022 - 40th Congress of the ESCRS

Reference: PP06.08 | Type: Case report | DOI: 10.82333/a5pe-zx96

Authors: Rony Wiener 1 , David Zadok 1 , Sara Sella* 1

1Department of Ophthalmology,Shaare Zedek Medical Center, affiliated to the Hebrew University,Jerusalem,Israel

Report the findings of a case of unexpected cylindrical error following uncomplicated LASIK surgery, presenting the leading mechanisms that may explain this result, as well as treatment considerations and options.

 

Refractive service at the ophthalmology department, Shaare Zedek medical center, Jerusalem, Israel. A multi-disciplinary, tertiary hospital, Affiliated with the Hebrew University of Jerusalem. A Collaboration with Laser refractive surgery service of Assuta Optic Medical Center, Jerusalem.

 

We present the case of a 45 y.o. computer worker who presented for evaluation for refractive surgery at our clinic. Patient presented with low myopia BE, mild astigmatism RE and moderate astigmatism LE, both Against The Rule (ATR).

Patient pre-op refraction was:

RE: -1.00 -1.50D X108°

LE: -0.50 -1.75D X84°

Target refraction was set at:

RE (near): -1.25 +0.00D X110°

LE: 0.00D +0.00D X80°

Both eyes underwent uncomplicated LASIK surgery, with max depth 19micron(RE) and 38micron(LE), with the hinge located at the 90 degree position and at 50 degree angle.

At Post Operative Day 1 follow up, refraction was:

RE: -0.75 -1.00D X109°

LE: -0.25D -3.00D X178°

Cycloplegic refraction yielded comparable results.

At two months following surgery, refraction was:

RE: -1.75D

LE:0.00 -2.75 X9°

With refractive correction, BCVA of 20/20 was achieved in both eyes.

Central pachymetry for both corneas was consistent with topography expected from the patient's baseline pachymetry and surgical plan, yet which is inconsistent with the final refraction.


 

We present a case of a young man presenting for vision corrective surgery, with mild myopia and mild astigmatism ATR. Following uneventful LASIK surgery, his right eye achieves target refraction. His left eye exhibited worsening astigmatism, with greater amplitude and at an angle of 75° to its original axis: from pre-operative -1.75D X84° to post-operative -2.75 X9°, all with non-elucidating pachymetry results and preserved visual acuity. We present the leading mechanisms that may explain this result, as well as the options for further management.