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Consultation section

September consultation #6

Alfonso, José F. MD, PhD

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Journal of Cataract & Refractive Surgery: September 2013 - Volume 39 - Issue 9 - p 1448
doi: 10.1016/j.jcrs.2013.07.011
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First, I believe that surgery should have been performed with the same technique in both eyes. In this case, I would implant a pIOL in both eyes. Much of the symptomatology is related to the use of 2 different techniques. The patient compares the vision in both eyes and can appreciate differences.

The sizing of the pIOL is correct because the vault (580 μm) is within the normal range. The anterior chamber is not compromised, and the pigment that appears on the pIOL can be considered normal. The IOP values are normal, with no medical treatment needed.

It is relatively common to make a mistake in determining refraction in cases of myopic anisometropia (overcorrection in the more myopic eye). For this reason, the patient should have been warned about the possibility of a reoperation (excimer laser enhancement or pIOL exchange).

The treatment of residual hyperopia in the left eye will improve binocular vision and halos. In this sense, there are 2 options. The first is to exchange the pIOL with another pIOL of less power, with the goal of reducing 1.00 D of hyperopia. The second option is an enhancement of +1.00 D of hyperopia using femtosecond laser–assisted LASIK.

Both options are valid, and the decision can be based on the surgeon’s experience. In my opinion, the pIOL should be exchanged without changing the sizing. Because femtosecond laser–assisted LASIK was used in the right eye, the same technique could be performed in the left eye. However, I would advise against this because of the ablation profile difference between the eyes.

If the refractive situation improves, the symptoms of halos will also improve. Therefore, one could consider the use of brimonidine tartrate eyedrops only occasionally and in certain situations, but not forever.

© 2013 by Lippincott Williams & Wilkins, Inc.