Excimer Laser Keratomileusis In Congenital Corectopia Pupillae: A Case Report

To present a case of laser-assisted in situ keratomileusis (LASIK) surgery for the correction of myopia and astigmatism in a patient with bilateral superonasal eccentric pupils

Patient underwent evaluation and surgery at Clínica Baviera, an ophthalmology clinic in Barcelona with expertise in refractive surgery.  Bilateral LASIK surgery was performed using the Allegretto Wave Eye-Q Excimer laser system. Surgical procedure was carried out by an experienced ophthalmic surgeon specializing in refractive surgery, supported by optometrist and nursing staff. Patient was closely monitored during the surgery and postoperative period to ensure optimal visual outcomes and safety.

A 27-year-old male presented to our clinic with a desire to correct his myopia and astigmatism for improved visual function and eliminate the need for glasses. His medical and ophthalmological history revealed no significant personal antecedents. Examination with slit lamp biomicroscopy revealed normal findings with the excepcion of a superonasal bilateral pupillary deviation. No other cases of eccentric pupils were known in the family. Gonioscopy showed a normally structured, open angle. The lenses were normal and no opacities were detectable. Funduscopy revealed a normal macula with an unremarkable optic disc. Astigmatism was found to be fully regular, symmetric, and in accordance with the rule. Due to the misalignment of the visual axis, pupillary axis and corneal apex refractive treatment was a significant challenge and a meticulous surgical approach was paramount. Measurement of the anterior chamber was smaller than required for the implantation of a phakic intraocular lens.Because of the marked and regular astigmatim it was decided to correct the refractive error by performing an ablation centered on the corneal apex instead of decentering to align with the pupillary axis. To achieve this, the eye tracker had to be deactivated. Postoperatively, patient experienced a remarkable improvement in visual acuity with very comfortable vision. Topography revealed complete regularization of the cornea indicating successful refractive correction. 

This case illustrates the challenges associated with refractive surgery in patients with congenital corectopia pupillae. Despite the misalignment of the visual axis, pupillary axis and corneal apex, LASIK surgery centered on the corneal apex resulted in successful visual outcomes and complete regularization of the cornea. Decentering the ablation to align with the pupillary axis was not feasible in this case due to the high and regular astigmatism. Such procedure would have resulted in corneal irregularity, potentially worsening the final prognosis. This case underscores the importance of individualized treatment planning and careful consideration of anatomical abnormalities in achieving optimal refractive outcomes in complex cases.