Trans Prk To The Rescue!

To present a case of rescue Trans-PRK after intraoperative complication during LASIK for myopia treatment

This case was managed in a tertiary care university hospital, in the department of corneal and refractive surgery. 

A 33 year old female patient was scheduled for bilateral LASIK for myopia correction. The preoperative refraction was -4.75 (-0.50)25° in the right eye and -3.50 (-0.25)130° in the left. Preoperative topography showed regular and thick corneas. Flap creation using femtosecond laser was uneventful in the first eye (right eye), however it was disrupted in the left eye. Multiple stromal adhesions made it impossible to dissect and lift the flap. LASIK procedure was completed in the right eye, however excimer correction was not performed in the left eye. Postoperatively, anterior stromal fibrosis was seen in corneal OCT of the left eye. Epithelium appeared regular and smooth. Secondary trans PRK was recommended to treat the initial myopia in the left eye. An epithelial ablation of 60 microns was programmed, and Trans PRK was performed using the Streamlight platform in the Alcon EX500 excimer laser. Mitomycine was applied and a bandage contact lens was placed. After epithelial healing, uncorrected distance visual acuity (UDVA) was 20/20 in the left eye, with a refraction of +0.25 (-0.50)85° at 1 month. Stromal fibrosis had disappeared. 

Trans PRK is an effective and safe option to treat myopia after complicated and unsuccessful LASIK flap creation, and subsequent stromal irregularities, by taking advantage of the natural masking effect of the epithelium.