Toric to monofocal intraocular lens exchange in patient with subepithelial fibroplasia after radial keratotomy. Clinical case

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Abstract

This clinical case demonstrates the toric to monofocal intraocular lens exchange due to the erroneous assessment of corneal topography in a patient with radial corneal scars after keratotomy. Toric intraocular lens power calculation was performed using initial parameters, when its central optical area was transparent, and at the mid-periphery, approximately 4–5 mm from the central optical area in the upper temporal quadrant, there was a subepithelial fibroplasia present. Postoperative refractive result was not optimal; residual astigmatism was noted, and it was decided to eliminate it by scarification of the epithelium in the area of fibroplasia. This lead to a significant change in keratometry and to practically total restoration of corneal spherical form. IOL exchange was performed, which caused an increase in visual function.

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About the authors

Boris E. Malyugin

S. Fyodorov Eye Microsurgery Federal State Institution; Russian University of Medicine; Jules Stein Eye Institute

Author for correspondence.
Email: boris.malyugin@gmail.com
ORCID iD: 0000-0001-5666-3493
SPIN-code: 8906-2787

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Chairman of the Society of Ophthalmologists of Russia

Russian Federation, Moscow; Moscow; Los Angeles, USA

Svetlana Yu. Kalinnikova

S. Fyodorov Eye Microsurgery Federal State Institution

Email: svkalinnikova@gmail.com
ORCID iD: 0000-0002-9109-2400
SPIN-code: 6733-2260

MD

Russian Federation, Moscow

Ivan S. Tkachenko

S. Fyodorov Eye Microsurgery Federal State Institution

Email: dr.ivan.tka@gmail.com
ORCID iD: 0000-0003-1756-7911
SPIN-code: 9756-8239

MD

Russian Federation, Moscow

Anastasia A. Khaletskaya

S. Fyodorov Eye Microsurgery Federal State Institution

Email: khaletskaya261@gmail.com
ORCID iD: 0000-0002-4775-9423

MD

Russian Federation, Moscow

Pavel D. Melovatskiy

Russian University of Medicine

Email: melovatskiy.pavel@gmail.com
ORCID iD: 0000-0002-3500-2220

MD

Russian Federation, Moscow

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2. Fig. 1. Preoperative aspect of the patient’s left eye through the eyepieces of the Lumera 700 (Carl Zeiss) microscope. The radial scars are thin, almost invisible. Arrows indicate the area of subepithelial fibroplasia located in the upper-nasal quadrant of the corneal periphery

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3. Fig. 2. Preoperative results of Scheimpflug keratopography obtained using the Pentacam (Oculus, Germany) device. Black arrow indicates the area of fibroplasia. Maps of the anterior surface of the cornea show a local increase in optical power (up to 50 diopters), thickening of the epithelium (elevation of the anterior surface is +43 µm), and local thickening of all layers of the cornea (up to 708 µm). Astigmatism of the anterior surface is 1.5 D

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4. Fig. 5. Photographies of the left eye in 1 month after the IOL exchange surgery. Biomicroscopic examination shows that the IOL is in the center of the pupil, in the capsular bag

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