Refractive lensectomy in extreme myopia

Abstract

Although combined refractive lensectomy and LASIK is gaining acceptance worldwide, we have a few observations about the patient selection, biometric study, and final procedure in this case report. A closer look at the biometric data shows that the keratometry was 44.50/43.75 × 42 in the right eye and 45.00/43.37 × 174 in the left eye, with axial lengths of 29.19 mm and 30.14 mm, respectively, and anterior chamber depths of 4.26 mm and 4.41 mm, respectively. It appears that the SRK/T formula predicted a postoperative spherical equivalent of −3.00 D in the right eye and −1.25 D in the left eye, with a +6.0 D IOL, which was grossly incorrect. It was probably the other way around in each eye. Despite this predicted undercorrection, the postoperative refraction went the other way: −0.75 −1.50 × 30 in the right eye and −2.50 −1.00 × 155 in the left eye. It is not clear why the right eye was chosen for LASIK to create anisometropia in a young 46-year-old patient; this invariably would have led to a loss of binocularity. Why wasn't the left eye treated first and targeted for binocular rather than monocular vision? The authors state that the patient complained of anisometropia, which was quite predictable. Despite the patient's complaint, the LASIK procedure in the left eye was targeted for a monovision of −1.0 D. This would obviously not have given the patient good near visual acuity, which the authors claim it did. We think the authors did not follow the proper protocol to treat this case, and the results were not anticipated according to the treatment performed. N. Nachiketa MD, FRCSEd V. Munshi MD, FRCSEd aKettering, United Kingdom