Management Of High Myopia With Astigmatism : Bioptics With Lasik Flap First Followed By Implantable Collamer Lens (Icl) Implantation Followed By Laser Ablation.

To report visual and refractive outcome following bilateral bioptics procedure for high myopia in a single patient. To report predictability of alternate bioptocs sequence (Femtosecond LASIK flap creation-ICL implantation-Laser ablation)

Cure Sight Laser Centre, Ahmedabad, India. 

Twenty one year old female presented with bilateral high myopia. Her manifest refraction was -20 D sphere and -5 D cylinder in each eye. Thorough ophthalmological examination was done including IOP, indirect ophthalmoscopy, topography, pentacam and endothelial cell density (ECD) measurement. Her BCVA was 0.2 LogMAR in both eyes. In first stage, bilateral femtosecond LASIK flaps were created. ICL implantation of -18 D was done after 1 and 3 days in right and left eye respectively. At day 15, post ICL, UDVA was 0.5 LogMAR and 0.3 LogMAR in right and left eye respectively and manifest refraction was -4.5 D cylinder in right eye and -3 D cylinder in left eye. Post operative vault was normal. Twenty days post ICL, laser ablation to stromal bed was done. at 1 month, 3 months and 1 year follow up post laser ablation, patient maintained 0.2 LogMAR UDVA in both eyes. Post operative ECD and vault were normal. Patient reported minimal dry eye symptoms and glare/halos as compared to initial post op visists.

The modification of sequence of the bioptics procedure is safe and predictable. It also allows early visual rehabilitation of the patient with minimal subjective symptoms.