How to address a LASIK 'do-over'

January 15, 2010

A dentist, aged 48 years, was referred for evaluation and management of loss of correctable acuity, disabling glare, and loss of binocular stereopsis following a series of complicated surgical procedures in his left eye.

A dentist, aged 48 years, was referred for evaluation and management of loss of correctable acuity, disabling glare, and loss of binocular stereopsis following a series of complicated surgical procedures in his left eye.

Over the subsequent 8 years, he underwent 10 enhancement procedures by the same surgeon to correct irregular astigmatism, epithelial ingrowth, interface debris, and, eventually, corneal haze. In that time, he developed corneal flap scarring, reduced contrast sensitivity, loss of correctable VA, and stereopsis.

Concerned patient

Initial examination revealed an athletic, articulate, male patient who maintained a composed and professional demeanor as he conveyed his concern and frustration while recounting his complicated eye history over the past 8 years.

His UCVA measured 20/25 in the right eye and 20/100 in the left eye.

Examination of his left eye revealed an irregular, distorted retinoscopic reflex consistent with our inability to correct his VA better than 20/70+2. The addition of a pinhole improved his VA to 20/50+2 with effort in his left eye.

He had a mild left upper eyelid ptosis. Pupils and motility testing were normal. Slit lamp examination of his right eye demonstrated a well-healed corneal LASIK flap.

His left eye however, was notable for diffuse central and mid-peripheral scarring and irregularity that appeared confined to the anterior 120 µm of his cornea. Corneal topography of his left eye demonstrated severe irregularity, and wavefront-guided analysis (WaveScan WaveFront, Abbott Medical Optics [AMO]) was not obtainable due to corneal scarring and irregularity.

A Scheimpflug camera (Pentacam, Oculus) identified profound apical decentration and marked irregularity on elevation mapping of the anterior and posterior surfaces measured against a best-fit sphere.

Our patient presented with one of the most significant challenges that can occur following elective LASIK surgery, namely, the loss of correctable vision.1

Fortunately, corneal haze with scarring is an uncommon complication after LASIK surgery.2 Unfortunately, in more extreme cases, as with our patient, additional surgery and medical treatment, including the application of mitomycin-C, often fails to restore corneal transparency.