Case Report Of A Persistent Epithelium Defect After Presbylasik Procedure

this study aims to report a case of rarely severe dry eye disease following Presbyond LBV laser procedure in a hyperopic presbyopic female patient, analyzing its pathogenic factors, and provide clinical insights for preoperative and postoperative management of similar cases.

this case report was conducted at a clinical ophthalmology setting specialized in laser refractive surgery, where the patient received surgical treatment and regular postoperative follow-ups. 

a 43-year-old hyperopic presbyopic female patient sought for surgical approach to get rid of reading glasses. Preoperative examination results were as follows: manifest refraction(MR) right eye +0.75ds-0.50dc*90→1.0, left eye +3.00ds-0.50dc*80→0.8, ADD +2.00D, UDVA R 0.8, L0.1, UNVA R 0.63, L0.16, NPA/PRA +2.25/-1.00, CCT R 558μm, L558μm, normal corneal topography. This patient had asymptomatic MGD-type dry eye: BUT R 6s, L7s; Schirmer's test R 9mm, L10mm; OSDI score 19. The patient underwent uneventful Prebyond LBV correction with dominant eye target plano, and undominant eye target at -1.50D. At the 3-week postoperative follow-up, patient's UDVA, UNVA, BUDVA, BUNVA, MR were all within target range. However, undominant eye developed first epithelium defect, and afterwards the other eye, the condition get worse and affected patient's BCVA and refractive status. Initial treatment including continuous anti-inflammatory therapy, lubricating eye drops, and conventional medications failed to control the symptoms. Subsequently, autologous serum, cyclosporine, corneal bandage contact lenses were administrated, however, the patient's condition worsened instead of improving. The patient's corneal healing, VA, refractive status did not return to normal and ideal levels until 6-month postoperatively, when PFHO(a medication for MGD-type DED) was initiated in combination with low-concentration steroid only.  

high hyperopia LASIK ablation and preoperative MGD were potential risk factors for the severe dry eye in this case. Postoperative dry eye can lead to hyperopic shift, fluctuations or even continuous decline in patient's visual acuity, thereby affecting surgical satisfaction.Special attention should be paid to hyperopic LASIK ablation and asymptomatic MGD existing before surgery. Early initiation of relevent dry eye treatment is crucial for patient's prognosis and satisfaction.