An 80-year-old male presented upon referral for possible contact lens fitting. He had a history of corneal refractive surgery in both eyes in 1992. He complained that his vision had been getting increasingly blurry OS > OD. He had been diagnosed with cataracts, but his ophthalmologist did not feel that they were a significant part of his visual issues. His unaided vision at presentation was 20/70 OD and 20/800 OS. Best-corrected acuity with refraction was 20/50 OD and 20/150 OS with a myopic and astigmatic correction. Upon slit lamp evaluation, the left cornea had the appearance noted in Figure 1. The right eye looked similar.
WHAT TYPE OF SURGERY HAS THIS PATIENT HAD?
The patient has a history of hexagonal keratotomy, with subsequent vascularization within the corneal incisions. Hexagonal keratotomy was a fairly uncommon procedure done in the era of radial keratotomy, but to treat hyperopia rather than myopia. This creates a steepening of the corneal shape but can also lead to consecutive myopia as well as irregular astigmatism and vision fluctuations.
Vascularization to wound sites in cases of incisional corneal refractive surgery is not uncommon. In this case, the vascularization follows the hexagon pattern of the incisions, and may have been related to chronic ocular surface disease.
The patient was fitted in scleral lenses for both eyes to improve the vision. With scleral lenses, his vision was 20/25 OD and 20/30 OS, limited most likely by cataracts. The lenses were fitted with the highest Dk material possible and with a low vault to minimize the risk of hypoxia and limit the spread of vascularization.
The patient has continued in his lenses for the last five years with no complications or progression of the vascularization of the cornea. He had cataract surgery two years later as the vision slowly deteriorated, and was refitted with new lenses, improving the vision to 20/20 OD and 20/25 OS.