June consultation #1

Area of Science:

• Ophthalmology
• Corneal Surgery
• Refractive Surgery

Background:

• A 21-year-old male presented with spectacle dependence and poor visual quality in his right eye post-penetrating keratoplasty (PKP) for advanced keratoconus.
• The patient experienced poor visual acuity (20/400 uncorrected, 20/50 corrected) and contact lens intolerance in the right eye.

Observation:

• The right eye had a clear corneal graft, but topographic and tomographic maps revealed significant residual refractive error, specifically high astigmatism (-2.75 -8.00 x 165).
• The left eye exhibited frank keratoconus with uncorrected visual acuity of 20/200 and corrected visual acuity of 20/100, with manifest refraction of -6.0 -4.75 x 95.

Findings:

• The case presents a clinical scenario requiring evaluation of refractive surgery options to improve vision after PKP.
• Potential interventions discussed include excimer laser ablation, intrastromal corneal ring segments (ICRS), and phakic intraocular lenses (pIOLs).

Implications:

• This case highlights the challenges in managing post-keratoplasty refractive errors and astigmatism.
• Determining the appropriate refractive surgery modality and setting realistic visual outcome expectations are crucial for patient satisfaction.