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Application of ReLEx SMILE technique in a patient with myopia previously treated with photorefractive keratectomy

Poster Details

First Author: Z.Pávková CZECH REPUBLIC

Co Author(s):    H. Mensikova   R. Havranek   J. Kacerovska              

Abstract Details

Purpose:

The aim of this case-report is to support the notion of using different surgical approaches to treat recurrent myopia. A male patient was treated at the age of 20 with photorefractive keratectomy (PRK) for bilateral moderate myopia (-5.00 D). Twenty-six years later, at the age of 46, he asked for a new surgery due to progressive worsening of vision at distance. The best corrected visual acuity at distance was 0.9 bilaterally, with applied correction -1.5=-1.25/76 to the right, and -1.0=-1.0/130 to the left eye. Based on his age, subjective requirements and ophthalmic values, various modern refraction surgery approaches were discussed.

Setting:

The Eye clinic in Horn�Ã�­ Po�Ä�ernice, Prague, Czech Republic

Methods:

To select the best surgical approach for myopic regression after PRK, the following objective as well subjective parameters were considered: measured values of the postoperative corneal pachymetry; dioptric values for the best correction at distance and near vision; ablation corneal profile after the previous PRK; corneal and lens transparency; retinal state; and the patient�â�€�™s personal wishes related to his age, occupation and hobbies. The range of the surgical approaches available at our clinic includes: PRK, femto-LASIK and ReLEx SMILE for cornea and implantation of either phakic posterior chamber intraocular lens or aphakic monofocal or trifocal intraocular lens.

Results:

After consultation with the patient and obtaining his written consent, corneal surgery using ReLEx SMILE technique was performed on the right dominant eye only by means of VisuMax device (Zeiss, Germany) with substraction of -1.5=-1.25/130 D. The total corneal thickness was 480. On the first day after surgery uncorrected visual acuity at distance was 0.7; after one week it was 0.8, and after one month it was 0.9. Binocular uncorrected visual acuity for short distance was 1.0 and residual corneal thickness was 436 �Â�µm. Pentacam examination confirmed centred ablation profile without any signs of postoperative ectasia.

Conclusions:

ReLEx SMILE technique is one of the most recent corneal refraction procedures. Despite its limited indications it can be used to treat patients with thinner corneas. Our patient refused implantation of intraocular lens due to its higher surgical risk. Neither repetition of PRK (due to potential worsening of scar changes as corneal haze) nor Femto-LASIK (due to higher risk of postoperative ectasia and worse tear film) were recommended. Surgery was performed only in the dominant eye due to initial presbyopia. The patient was informed about the long-term neuroadaptation of the treated eye and was satisfied with the final result.

Financial Disclosure:

NONE

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