March consultation #6

To have a clear idea of what happened with this patient more information from preoperative Scheimpflug topography for K measurements and corneal thickness measurements is necessary. In the patient’s clinical history, were the following possibilities investigated: previous ocular trauma, inflammatory episodes, or even pregnancy, which could have been interrupted? I think that this patient was not a good candidate for refractive surgery because of the observed difference of cycloplegic and subjective refraction of 1.00 D. It would be advisable to check the reasons for such a difference and wait. On the other hand, even though I do not know the preoperative corneal thickness and K measurements, I would have to consider an ICL for this patient. The RSB is very low. What was the thickness of the lenticule? Was surgery performed by microkeratome or femtosecond laser? Possible primary causes for this overcorrection are corneal microstriae (a theoretical cause but unlikely), a technical problem with the excimer laser (I have had this problem twice), or medication. Topiramate, for example, can induce myopia. With the suspension of the drug, hyperopia would be induced. My advice for correction of the refractive error for this patient is implantation of an ICL.