Significant haze after photorefractive keratectomy in a cornea with previous arcuate keratotomy

摘要

It was perfectly reasonable to address the original residual refractive error with PRK. Although the incidence of post-PRK haze has decreased significantly with the use of MMC, the risk is not negligible and surgeons have to be prepared to address this known, albeit less common, complication of PRK.1. It is always easier to consider an alternative in hindsight. The information presented states that before PRK, in 2014, the patient presented with a CDVA of 20/30. Was the patient not correctable to 20/20 because of an incipient cataract? Assuming a clear central cornea and stable refractive error at plano —3.00 x 115 with topographic confirmation of corneal astigmatism, cataract extraction with a toric intraocular lens (IOL) could certainly have been an option. A recent randomized controlled study2 compared the outcomes of phacoemulsification with toric IOL implantation versus phacoemulsification with monofocal IOL implantation followed by PRK for correction of preexisting astigmatism. That study found that although PRK yielded slightly less residual cylinder (toric IOL Z —0.5 D vs monofocal with PRK Z 0.0 D; P Z 0.02), it caused greater postoperative pain, corneal aberrations, and poor glare acuity. Emmetropia is an achievable goal, especially now in the era of intraoperative guidance systems that can help fine-tune IOL power selections and toric IOL alignment.