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Custom upgrade used on patient with shadows and ghosting

Previous surgeries did not decrease aberrations in left eye of 50-year-old man.

Issue: February 15, 2005

ByDaniel S. Durrie, MD

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History: A 50-year-old man presented for a second opinion after having multiple surgeries in his left eye. He had undergone LASIK in both eyes in 1997 (nasal hinge) and a re-cut LASIK enhancement in the left eye in 1998 (superior hinge) that resulted in “double vision, halos, ghosting and every imaginable aberration.” He wore a rigid gas permeable contact lens in the left eye until 2002, when over a 3-month period the eye underwent a lift-flap/smooth procedure for striae, a superficial keratectomy and a lift-flap LASIK enhancement. He presented complaining of “shadows and ghosting.” Six-month postoperative results are presented.

Preoperative examination:

• Uncorrected visual acuity: 20/30-1
• Manifest refraction: –0.25 –0.50 × 110 = 20/25

Procedure: Lift-flap enhancement upgrade with Alcon CustomCornea Wavefront System

Postoperative refraction:

• Uncorrected visual acuity: 20/25-1
• Manifest refraction: –0.25 –0.25 × 180 = 20/25
• Higher-order RMS: Reduced from 1.35 µm to 0.73 µm
• Vertical coma: Reduced from 0.52 µm to –0.05 µm
• Horizontal coma: Reduced from 0.74 µm to –0.14 µm
• Tetrafoil: Reduced from 0.35 µm to 0.05 µm
• Spherical aberration: Reduced from 0.69 µm to 0.38 µm

Discussion: The patient reports improved quality of vision in the left eye after the custom upgrade procedure. This case demonstrates that Alcon custom upgrades can reduce higher-order aberrations and improve quality of vision in appropriately selected patients.

For Your Information:

• Daniel S. Durrie, MD, can be reached at Durrie Vision, 5520 College Blvd., Suite 200, Overland Park, KS 66211; 913-491-3737; fax: 913-491-9650; e-mail: ddurrie@durrievision.com. Dr. Durrie is a paid consultant for Alcon.