Refractive Surprise And Re-Klex Correction: A Case Report.

This report details a refractive surprise following femtosecond KLEx surgery, attributed to a data entry error, and its successful correction via a Re-KLEx enhancement. This case emphasizes the necessity of precise surgical planning, timely identification of errors, and the viability of Re-KLEx as a method to restore optimal visual acuity in refractive surgery patients.

Watany Eye Hospital with VisuMax 500 femtosecond laser platform, Carl Zeiss Meditec.

A 20-year-old patient with pre-existing myopia and mild astigmatism (OD: -4/-1 ×170, OS: -3/-2 ×175) underwent Keratorefractive Lenticule Extraction (KLEx), utilizing the Zeiss VisuMax 500 platform. Post-operative day one revealed a significant refractive error in the left eye (-0.25D -3.5D X 175), notably different from the right eye (-0.25D -0.25D X 10), despite clear corneal findings and a uniform corneal cap on slit-lamp and anterior segment OCT examinations. A review of the surgical data revealed a crucial transcription error by the optician, where the left eye's refraction was incorrectly entered as -3.0D +2.0 X 175, an error overlooked by the surgeon, leading to a CDVA of 1.0 (-3.5 D X 175) in the left eye. To rectify this, a corrective procedure was performed the following day using the same laser platform. The lenticule's center and boundaries were meticulously marked on the slit lamp with a non-UV blocking sterile marker, under the laser platform the patient interface (PI) was carefully centered on the previous KLEx treatment. The optic zone was reduced by 1.0mm compared to the initial surgery, the treatment was correctly set to -0.25D -3.5D x 175, and the cap depth matched the original surgery. Femtosecond laser lenticular cut was initiated and precisely stopped before the cap cut, allowing for easy identification and removal of the new lenticule. This corrective procedure successfully resolved the refractive error, resulting in a CDVA of 1.0 (+0.25D -0.25D x 168).

Although Re-KLEx is rarely performed, it is a viable option for correcting refractive surprises. This case underscores the importance of accurate preoperative data entry, early postoperative evaluation, and an in-depth understanding of corneal biomechanics and KLEx laser principles. With proper assessment and technique, Re-KLEx can be a safe and effective solution for unexpected refractive errors.