Small-incision lenticule extraction in a patient with congenital motor nystagmus: case report

Abstract

Introduction: In patients with congenital motor nystagmus, vision correction might be challenging, and laser refractive surgery is thought to be not advisable because of the patient's inability to fixate and uncontrollable eye movements. Patient and Clinical Findings: A 25-year-old man presented with congenital motor nystagmus and reported that he could not wear contact lenses and that spectacles gave him headaches. Diagnosis, Intervention, and Outcomes: Diagnosis of motor nystagmus was established clinically, with exclusion of other abnormalities, intact vision, and a history dating back decades. Small-incision lenticule extraction (SMILE) surgery using a 2000-kHz VisuMax 800 (VM800) femtosecond laser was performed successfully on both eyes. Preoperative uncorrected distance visual acuity (UDVA) was 6/24-1 in the right eye and 6/60-1 in the left eye, improving to 6/7.5+1 and 6/9-1, respectively, on postoperative day 1. At day 7, UDVA further improved to 6/6+2 and 6/7.5-1, and after 1 month, it reached 6/6 for the right eye and 6/7.5-1 for the left eye. The patient had a vision gain of 1 line compared with preoperative best spectacle-corrected visual acuity. Refraction at 1 month was right +0.25 diopter sphere and left +0.25 diopter sphere. No intraoperative complications were observed. Conclusions: SMILE surgery using VM800 proved effective for a patient with congenital motor nystagmus, resulting in a vision gain of 1 line compared with preoperative best spectacle-corrected visual acuity, with no intraoperative complications. Centration was within 0.2 mm of the target. These objective outcomes demonstrate the feasibility and effectiveness of SMILE surgery using a newer generation laser in this population.