International Medical Case Reports Journal (Apr 2020)
A Novel Sequential Docking Technique: Use of Femtosecond Arcuate Keratotomy and Femtosecond Assisted Cataract Surgery Using a Pupil Expansion Ring on a Patient with Intraoperative Floppy Iris Syndrome
Abstract
Hung-Yuan Lin,1– 3 Ting-Yu Lin,4 Ya-Jung Chuang,5 Li-Ju Lai,6 Pi-Jung Lin7 1Department ofOpthalmology, Universal Eye Center, Zhong-Li, Taiwan, Republicof China; 2Department of Optometry, Central Taiwan University of Science and Technology, Taichung City, Taiwan, Republicof China; 3Department of Ophthalmology, Shanghai Ruidong Hospital, Shanghai, People’s Republic ofChina; 4Department of Chemistry, Barnard College, Columbia University New York, New York, NY, USA; 5Department of Ophthalmology, Universal Eye Center, Long-Tan, Taiwan, Republicof China; 6Department of Ophthalmology, Universal Eye Center, Chia-Yi, Taiwan, Republic ofChina; 7Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, Republic ofChinaCorrespondence: Ya-Jung Chuang Tel + 886-983308370Email [email protected]: The purpose of this study was to evaluate the efficacy of a novel double-docking technique, incorporating the use of femtosecond laser arcuate keratotomy (FSAK) in correcting low-degree astigmatism and Malyugin ring, in a patient with intraoperative floppy iris syndrome (IFIS).Methods: A case report of a 72-year-old man with grade 4 cataract, low-degree astigmatism (< 2D), and IFIS (pupil size < 4 mm, intraoperatively) is presented. The patient underwent cataract surgery using a femtosecond laser to treat low-degree astigmatism because the patient requested for the use of a multifocal intraocular lens (IOL). The first docking was performed to complete arcuate keratotomy, produce the mainparacentesis incisions, and create clear corneal incisions. Insertion of the Malyugin ring was performed after the first docking, whereas the second one was executed to complete continuous curvilinear capsulotomy and lens fragmentation. The patient’s uncorrected visual acuity (UCVA) was measured pre- and post-operatively. The complications were evaluated post-operatively and 3 months later during the follow-up visit.Results: The patient’s UCVA for distance improved from 0.3 (6/12 Snellen equivalent) to 0 (6/6 Snellen equivalent) logMAR post-operatively. During the follow-up visit, the patient’s uncorrected near visual acuity was at J2. His corneal astigmatism changed from − 1.0 Diopter @177° pre-operative to − 0.12 D @173° post-operative. No other intraoperative or post-operative complications were observed.Conclusion: The double-docking technique, with the use of FSAK, and Malyugin ring produced successful surgical outcomes for the patient. The benefits of this technique allow surgeons to avoid changing the shape of the patient’s cornea from the injection of the viscoelastic device into the anterior chamber, which could lower the femtosecond laser’s precision and docking location.Keywords: femtosecond laser arcuate keratotomy, Malyugin ring, low-degree, astigmatism, intraoperative floppy iris syndrome
