Refractive Surgical Problem

摘要

A 50-year-old man came for consultation reporting polyopia in the right eye. He had cataract surgery in both eyes elsewhere with simultaneous correction of high hyperopia (approximately +7.00 diopters [D] in both eyes) 18 months previously. He required a reoper-ation in the right eye 2 months later to correct unexpected residual ametropia. The patient says that since the second surgery, he perceives multiple images in the right eye and he is seeking a solution. His surgeon has proposed corneal refractive surgery (laser in situ keratomileusis [LASIK]) to correct the residual astigmatism; the patient now seeks a second opinion.An examination showed uncorrected visual acuity (UCVA) in the right eye of 20/200 and best corrected visual acuity (BCVA) of 20/30 with +2.50 -1.00 x 155. In the left eye, the UCVA was 20/30 with a residual cylinder of -0.50 x 60. Rigid contact lens overrefractiondid not improve visual acuity in either eye. Slitlamp examination showed uncomplicated pseudophakiaand a normal corneal and ocular surface in both eyes. Applanation tonometry and fundus examination were also normal in both eyes. Corneal topography and a double-pass examination (Optical Quality Analysis System, Visiometrics) were performed to evaluate optical quality in the right eye. Taking into account the available information, what other test would you perform and what would your therapeutic approach be?