UNIQUE METHOD OF TREATING A REFRACTIVE SURGERY ASPIRANT WITH HIGH REFRACTIVE ERROR. PHOTOREFRACTIVE KERATECTOMY CAN BE OF GREAT HELP IN CERTAIN SITUATIONS. WE MAY NOT BE ABLE TO TREAT THE ERROR COMPLETELY, BUT CAN GIVE A SATISFACTORY OUTCOME.

PRK can be an excellent tool in reducing the refractive load and give a satisfactory outcome to a patient,

although not completely corrected; in a situation where cornea is thin, anterior chamber is shallow, patient has high refractive error and not comfortable with toric contact lenses.

31 years old female with RE -5.0DS / -5.00 DC @ 15 ( 6/6 ) and LE -6.00 DS / -6.00 DC @ 170 ( 6/6 ) wants to get rid of glasses.

Pentacam corneal thickness RE 496 microns and LE 502 microns

ACD in RE 2.78 mm and LE 2.88 mm

Family history of Glaucoma

Patient scared of getting an ICL done

Not comfortable with Toric contact lenses.

Patient was proposed PRK with an aim of treating full astigmatism and as much as possible spherical error, within the safety threshold, so that cornea becomes astigmatically neutral and improves contact lens tolerance.

Refractive error treated in right eye -3.0 DS / -5.0 DC @ 15 and Left eye -5.00 DS / -5.00 DC @ 170

Streamlight Aspheric Treatment was performed with EX500 at 6.00 mm optic zone, 8.5 mm transition zone and standard application of mitomycin 0.02 %

Residual corneal thickness in right eye was 358 microns and 368 microns in left eye.

PRK procedure was uneventful

Three months Post-op

patients had a UCVA of 6/12 in both eyes and BCVA with -2.0 DS it was 6/6 in both eyes

Right eye corneal astigmatism reduced from 3.4 D to 0.6 D

Left eye corneal astigmatism reduced from 4.0 D to 0.8 D

Right eye total aberrations reduced from 3.725 to 1.651

Left eye total aberrations reduced from 3.135 to 1.052

Patient was comfortable with spherical contact lenses, with subjective experience of significant improvement in quality of vision in night.

This case experience, highlights that out of box thinking is necessary sometimes, to provide a reasonably safe outcome with high patient satisfaction,

which improves the patient's quality fo life and matches with their life goals. Altough from acedemic point of view, this outcome may not be 100 % satisfying for the clinician.

but Patient Safety and Patient Satisfaction Wins !