February 20, 2003
Refractive Challenge: Band Keratopathy Within a LASIK Flap
Cataract & refractive surgery today,Feb 2003
CASE PRESENTATION
A 37-year-old white male presented with complaints of decreased vision after a motor vehicle accident involving the deployment of an airbag in December 1999. He had undergone an uncomplicated bilateral LASIK procedure for moderate myopia in March 1999. Postoperatively, the patient had a UCVA of 20/25 OD and 20/20 OS.The fundus exam revealed a giant retinal tear with the macula off in the right eye and multiple horseshoe-shaped tears in the left eye. The patient subsequently underwent a laser retinopexy in the left eye and a scleral buckle procedure in the right eye. In May 2000, a recurrent retinal detachment of the right eye necessitated additional argon laser retinopexy. When a progressive retinal detachment occurred in the right eye later that month, a vitrectomy and lensectomy were performed and a C3F8 gas bubble placed
. One month later, the retina in his right eye redetached, so the patient underwent repeat vitrectomy, membrane peeling, and placement of silicone oil.The patient then developed rapid-onset band keratopathy within the LASIK flap of his right eye. Another ophthalmologist performed manual debridement. It is unknown whether EDTA chelation was also employed. During the next several months, the band keratopathy recurred. In October 2000, an additional surgical procedure was performed to remove more scar tissue from the retina and to fill the aphakic eye with silicone oil.
HOW WOULD YOU PROCEED?
1. Would you debride the calcific deposits from the cornea to allow for retinal surgery with a view through a debrided surface?
2. Amputate the flap, since the calcific deposits clinically appear to be limited to the flap itself and not present in the stromal bed?
3. Place a temporary keratoprosthesis in order to allow retinal surgery to proceed and complete the case as a penetrating keratoplasty?
Posted by mehdi khanlari at February 20, 2003 07:40 AM