Autologous Astigmatic Lenticule Reshaping And Rotation For Correcting -11.0D Degree Astigmatism: A Case Report

To introduce a case of correcting ultra-high astigmatism up to -11.0D through autologous astigmatism lens reshaping and rotation surgery

An 18-year-old male came to our hospital for surgery to correct his astigmatism. The patient complained of high astigmatism since childhood and no history of wearing glasses. Uncorrected distance visual acuity (UDVA): R: 0.05, L: 0.15. Subjective refraction: R: -4.00/-6.75×175=1.0-, L:+1.00/-11.00×175=0.8. Appearance: Narrow and elongated eyelid fissures. The slit lamp examination showed no obvious abnormalities.

The patient was diagnosed with high astigmatism, anisometropia and suspected keratoconus. Frame glasses and follow up regularly was requested. One year later, the corneal curvature of both eyes increased compared to before, and transepithelial corneal cross-linking surgery was performed on both eyes. One year later, the patient went back with a little increase of corneal curvature, and transepithelial corneal cross-linking surgery was performed on both eyes. Two years later, the patient was followed up again and requested surgical correction with a stability of corneal curvature. It was decided to use the autologous astigmatism lenticule reshaping and rotation surgery for correction: first, femtosecond laser was used to product the astigmatic lenticule, then excimer laser was used to reshape the lens, then the lens was rotated, and finally, the corneal flap was attached to complete the surgery. The postoperative UDVA remained stable at 0.8 from 1 month after surgery, and the best corrected visual acuity (BCVA) remained stable compared to preoperative. The subjective refraction was R: 0/-1.25×100=1.0, L:+1.50/-1.50×150=0.8.

For patients with high astigmatism, it is necessary to use various methods and long-term follow-up to determine whether they are diagnosed with keratoconus and whether there is a risk of postoperative corneal dilation disease. For those in doubt, transepithelial corneal cross-linking surgery can be attempted to stabilize the corneal condition. For ultra-high astigmatism that is difficult to correct with conventional surgical methods, under stable corneal conditions, autogenous astigmatism lenticule reshaping and rotation surgery can be attempted, and satisfactory visual effects can also be achieved.