contact lens case reports
An RGP Solution for LASIK Gone Wrong
BY PATRICK J. CAROLINE,
FAAO, & MARK P. ANDRÉ, FAAO
Patient BR, a 38-year-old female, underwent LASIK surgery in October 1999 for correction of her 6.50D myopia OU. On the right eye, the improperly-seated microkeratome blade resulted in a deep 370 micron flap. (Normal flap thickness is approximately 140 to 160 microns.) Laser surgery in progress on the right eye was aborted when aqueous was observed seeping through the cornea. LASIK surgery was never performed on the left eye.
The right cornea developed a paracentral ectasia with K readings of 52.87@170/ 52.25@80 (Figure 1). The myopia subsequently increased to 15.00D, and her best corrected spectacle VA was 20/80.
Figure 1. Corneal map OD post-LASIK, note the paracentral ectasia.
Scheinpflug photography showed a focal area of thinning in the right eye just temporal to the central cornea (Figures 2 and 3). Slit lamp examination revealed fine microstriae inferiorly, and a faint, linear stromal haze extended from the posterior to the anterior stroma in a radiating fashion (Figure 4).
Figure 2. Scheinpflug photography right eye, post-LASIK.
Figure 3. Normal, unoperated left eye.
We attempted numerous RGP diagnostic lenses on the patient's right eye to lessen her symptoms of intense glare, halos and monocular diplopia. However, traditional RGP lens designs failed to center adequately and were quite uncomfortable.
A Temporary RGP Solution
We eventually fitted the patient with the RGP MacroLens (C&H Contact Lens), base curve 6.75mm, power 11.25D, diameter 14.2mm (Figure 5). For the past six months, she has reported excellent lens comfort with a wearing time of 12 to 14 hours a day and a best corrected VA of 20/60.
Figure 4. Slit lamp view post-op, note the fine microstriae and faint linear stromal haze.
Figure 5. 14.2mm RGP MacroLens OD.
Due to the status of the anterior topography and many intracorneal changes, the patient will eventually require a corneal transplant. However, the MacroLens has allowed her to function by dramatically lessening her symptoms of glare, multiple images and severe headaches.
Patrick Caroline is an associate professor of optometry at Pacific University and an assistant professor of ophthalmology at the Oregon Health Sciences University.
Mark André is director of contact lens services at the Oregon Health Sciences University.