Correction of hyperopia with astigmatism following radial keratotomy with daily disposable plus spherical contact lens: a case report
International Ophthalmology
October 2018, Volume 38, Issue 5, pp 2199–2204 | Cite as
Correction of hyperopia with astigmatism following radial keratotomy with daily disposable plus spherical contact lens: a case report
AuthorsAuthors and affiliations
Yun-Wen ChenJiahn-Shing LeeChiun-Ho HouKen-Kuo Lin
Open Access
Case Report
First Online: 30 August 2017
Received: 05 June 2017
Accepted: 23 August 2017
593 Downloads
Abstract
Purpose
To report the refractive correction in a case of hyperopia and astigmatism following radial keratotomy.
Methods
A case report.
Results
A 47-year-old woman, who had undergone refractive surgery for radial keratotomy in both eyes 22 years before the present study, presented to our clinic with blurred vision. Her best corrected visual acuity, with spectacle correction of +3.50 DS/−1.50 DCX130° in the right eye and +3.75 DS/−1.50 DCX80° in the left eye, was 0.2 logMAR and 0.3 logMAR, respectively. Her keratometric readings were 35.75 D/36.75 D at 74° and 35.25 D/36.25 D at 61°, respectively. Prompted by intolerance to glasses, the patient requested for contact lenses. First, we applied a rigid, gas-permeable contact lens. However, we noted poor fitting due to central corneal flattening. Subsequently, we applied a conventional plus spherical soft contact lens (PSSCL), which is thick in the center and can therefore correct hyperopia and low-grade astigmatism simultaneously. The conventional PSSCL showed slightly inferior decentration, with good movement, and the patient was satisfied with it. After ascertaining the patient’s living habits, we decided that a daily disposable soft contact lens would most meet her needs. The final prescription was a daily disposable PSSCL; the patient was satisfied with her corrected visual acuity of 0.0 logMAR in the right eye and 0.0 logMAR in left eye. Her daily disposable PSSCL-corrected visual acuity was stable during the 10-month follow-up.
Conclusion
For patients displaying hyperopia with astigmatism following radial keratotomy, the PSSCL may confer better corrected visual acuity and acceptability.
KeywordsRadial keratotomy Hyperopia Astigmatism
Introduction
Radial keratotomy (RK) is performed using radial incisions in the corneal stroma, producing a wound that is associated with midperipheral bulging of the cornea, compensatory central corneal flattening, and decreased refractive power. For this reason, progressive hyperopia after RK is not uncommon [1, 2]. In fact, in the Prospective Evaluation of Radial Keratotomy (PERK) study, hyperopic shift after RK continued in many patients at an average rate of +0.21 diopters (D) per year for the first 6 months to 2 years after the surgery, and at +0.06 D per year between the second and tenth years after surgery [3, 4]. Therefore, patients who have undergone RK may present with hyperopia many years after the procedure; in such patients, this condition may be related to the corneal incisions, lens aging (including cataract formation), or both [5]. With regard to ocular surgical treatment for RK patients presenting with hyperopia, laser-assisted in situ keratomileusis (LASIK) and surface ablation have been effective [6, 7]. In terms of non-surgical correction methods, contact lenses, including rigid gas-permeable contact lenses (RGPCLs), orthokeratology-designed RGPCLs (OD-RGPCLs), hybrid lenses, and soft contact lenses (SCLs) [8, 9], may improve vision. In the present report, we present a case of hyperopia with astigmatism in a woman who had undergone RK 22 years previously; her vision was well refractive corrected using a plus spherical SCL (PSSCL).
Case report
A 47-year-old woman visited our outpatient clinic complaining of progressive blurred vision in both eyes. In 1994, she had undergone refractive surgery for RK in both eyes at the age of 25 years, and her preoperative refractive error values were −6.5 D in the right eye and −8.5 D in the left eye. Her uncorrected visual acuity was 0.4 logMAR in both eyes, and her autorefraction (Topcon RM6000, Japan) was +3.75 DS/−1.50 DCX129° in the right eye and +4.00 DS/−1.25 DCX82° in the left eye. Her best corrected visual acuity (BCVA) with spectacle correction of +3.50 DS/−1.50 DCX130° in the right eye and +3.25 DS/−1.00 DCX80° in the left eye was 0.2 logMAR in the right eye and 0.3 logMAR in the left eye. Her keratometric readings were 35.75 D/36.75 D at 74° in the right eye and 35.25 D/36.25 D at 61° in the left eye.
Slit lamp examination revealed a clear cornea with eight radial incisional scars in both eyes; both lenses were clear. Her optic zone after the RK procedure measured 2.4–2.5 mm in the right eye and 2.2–2.3 mm in the left eye. A fundus examination was unremarkable. The intraocular pressure was 19 mmHg in both eyes. The corneal topography of both eyes was obtained using the Oculus Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany; Figs. 1, 2); corneal central flattening with refractive powers of 27–30 (...truncated)