Refractive Corneal Lenticule Extraction on Previous Photorefractive Keratectomy, with Optical Coherence Tomography...

Area of Science:

• Ophthalmology
• Refractive Surgery

Background:

• Previous laser vision correction, specifically photorefractive keratectomy (PRK), can lead to regression and residual myopia.
• Retreatment options for post-PRK myopia are crucial for patients seeking improved visual acuity.

Observation:

• A 42-year-old female patient with moderate dry eye presented with residual myopia after bilateral PRK 19 years prior.
• CLEAR (corneal lenticule extraction) was employed as a retreatment technique for her left eye's residual myopia (-3.00 -0.50 x 159°).

Findings:

• The CLEAR procedure was uneventful, resulting in a regular laser pattern and successful lenticule dissection.
• Postoperatively, uncorrected visual acuity improved from 20/25 at day 1 to 20/20 at 3 months, with stable refraction (+0.25 x 115°).
• Optical coherence tomography revealed a well-centered treatment and regular interface, though the stromal surface was slightly corrugated, which was compensated by a smooth epithelial surface without affecting visual results or dry eye symptoms.

Implications:

• CLEAR serves as a viable retreatment option for myopia occurring after PRK.
• Epithelial remodeling can effectively compensate for minor irregularities in the stromal surface post-CLEAR retreatment.
• This case highlights the potential of CLEAR in managing complex refractive errors following prior laser vision correction.