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Corneal perforation during laser in situ keratomileusis after hyperopic electrothermal keratoplasty
María M Silva-Díaz1, Ashley Behrens, Francia Y Torres
1Department of Ophthalmology, Cornea, External Diseases and Refractive Surgery Service, Centro Médico Docente La Trinidad, Caracas, Venezuela.
Purpose:
To report a corneal perforation during laser in situ keratomileusis (LASIK) after previous electrothermokeratoplasty.
Design:
Interventional case report.
Methods:
A 49-year-old man presented with primary hyperopia in the right eye and residual hyperopia after electrothermokeratoplasty in the left eye. His refraction was +4.00 in the right eye and +7.00 -3.00 x 135 degrees in the left eye, with a central pachymetry of 535 microm and 549 microm, respectively. Phacoemulsification with intraocular lens (IOL) insertion in the right eye and a two-step keratophacorefractive procedure with a piggyback IOL insertion and LASIK in the left eye were proposed.
Results:
Postoperative refraction was -0.50 -0.50 x 150 degrees 20/20 in the right eye. Postphacoemulsification refraction was -4.75 -4.25 x 135 degrees in the left eye. Laser in situ keratomileusis was performed in the left eye, 4 months later, with uneventful astigmatic laser ablation. During the myopic ablation, a sudden outcome of aqueous humor in one of the temporal corneal scars was observed.
Conclusions:
Unpredictably thin areas after electrothermokeratoplasty may lead to unexpected corneal perforation during LASIK. The available pachymetry systems may be unreliable after electrothermal keratoplasty.