contact lens case reports

Success with Refractive Surgery and Contact Lens Correction

BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO
August 2000

Patient C. H., a 39-year-old machinist, suffered a 4mm corneal laceration and penetrating metallic foreign body to his right eye in 1998 (Figure 1). The laceration was surgically repaired the day of the injury, with subsequent parsplana vitrectomy / lensectomy and removal of the foreign body five months later (Figure 2). With an aphakic soft lens OD, the post-operative visual acuity was best corrected to 20/70, while the left eye remained 20/15 without correction.

Figure 1. Full thickness corneal laceration OD.	Figure 2. B-Scan identification of the intraocular foreign body.

Post-operative central keratometric readings OD were 44.62 @ 58 / 48.37 @ 148 with an infronasal ectasia resulting in paracentral steepening of 56.00D (Figure 3).

The paracentral ectasia and asymmetrical astigmatism caused a number of optical problems, complicated by the patient's strong desire to correct his unilateral aphakia with a soft lens.

Taking Refractive Action

The patient elected for removal of the ectasia by photo-therapeutic keratectomy (PTK). One month post PTK, the patient's central cornea was significantly more spherical with a 6.00D reduction of the paracentral ectasia (Figure 4). Pre- and post-photokeratoscopy illustrates the reduction of irregular corneal astigmatism following PTK (Figure 5). The patient's manifest refraction was ultimately +15.00 ­ 1.25 x 48 with a visual acuity of 20/25.

Figure 3. Corneal mapping OD pre- PTK.	Figure 4. Corneal mapping OD post- PTK.

We successfully fit the patient with an aphakic soft lens. He enjoys all day lens wear with complete restoration of binocular vision. This case shows the successful utilization of a refractive surgery procedure to enhance contact lens correction.

Figure 5. Photokeratoscopy of OD pre-surgical (left) and post-surgical (right) PTK.

Patrick Caroline is an associate professor of optometry at Pacific University and an assistant professor of ophthalmology at the Oregon Health Sciences University. Mark André is director of contact lens services at the Oregon Health Sciences University.