Two Cases of Treatment of Extreme Myopia using combined Anterior Chamber Phakic Intraocular Lens and Laser In Situ Keratomileusis

PURPOSE: For patient with extreme myopia outside the suspected limit of single procedure alone, we performed Lasik as a secondary procedure for the correction of residual refractive error following phakic IOL implantation. METHODS: First, we made a corneal flap using ACS(Bauch & Lomb surgical/Chirom vision, Irvine, CA) due to the potential risk of endothelial damage by cornea-IOL contact during the flap dissection. One month later, phakic IOLs, Nuvita MA20 (Bauch & Lomb surgical/Chiron vision, Irvine, CA) implantation were done, and 4 months after IOL implantation, stromal ablation was performed with the eximer laser by using previously formed flap. RESULTS: Preoperative spherical equivalent refraction was -25.0 D of Rt eye, -24.0 D of Lt eye, and preoperative visual acuity was 20/500 (best spectacle corrected visual acuity; BSCVA: 20/50) of Rt eye, 20/200 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction following phakic IOL implantation was -4.25 D of Rt eye, -3.75 D of Lt eye and refractive cylinder was -1.0 D cyl x90 A, visual acuity was 20/100 (BSCVA: 20/40) of Rt eye, 20/100 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction at the last examination following LASIK was -0.75 D of Rt eye, -0.5 D of Lt eye and visual acuity was 20/25 (BSCVA: 20/25) of Rt eye, 20/25 (BSCVA: 20/25) of Lt eye. CONCLUSIONS: Bioptics by combined anterior chamber phakic intraocular lens and laser in situ keratomileusis is one of the effective methods for patients with refractive error of extreme myopia outside the suspected limits of single procedure alone. Longer follow-up of large number of cases is needed to fully assess the safety and complications.

Laser in Situ Keratomileusis to Treat Low to Moderate Myopia

Laser in Situ keratomileusis(LASIK) has advantages over other refractive surgery. In particular, the refractive outcome to correct high myopia is relatively good. However, photorefractive keratectomy(PRK) is more widely used to treat low to moderate myopia than LASIK procedure. This study was a retrospective analysis of the surgical results after LASIK in the low to moderate myopia(-0.75D~-6.00D). Mean spherical equivalent refractive error was -0,12D, six month postoperatively, which was changed from mean spherical equivalent refractive error -5.07D preoperatively. Mean uncorrected visual acuity showed 0.91. None of the patients have lost their best corrected VA. Retreatment with LASIK enhancement for residual myopia was necessary in 6 eyes, because of undercorrection. This results showed that LASIK can be recommend to treat low to moderate myopia.