Photorefractive keratectomy in a patient with Stargardt disease: Case report

Abstract

This case presents a successful outcome following photorefractive keratectomy surgery in a patient with Stargardt disease. A 23-year-old female with a history of Stargardt disease oculus uterque and high myopia oculus uterque presented for refractive surgery evaluation. The patient underwent photorefractive keratectomy oculus uterque. Before surgery, the patient’s refraction was −6.00 diopters oculus uterque. Visual acuity was 20/200 with correction oculus uterque. After photorefractive keratectomy, visual acuity improved to 20/100 oculus uterque without correction at 7 days post-op. At 1 year post-op, visual acuity remained stable at 20/100 +1 oculus dexter and 20/200 +1 oculus sinister without correction. Electroretinography pre- and postoperatively was stable. The patient reported subjective improvement in vision at all time points after the procedure, likely due to the resolution of minification from previous corrective lenses. While photorefractive surgery is not a definitive treatment for Stargardt disease, Stargardt disease is not a contraindication for photorefractive keratectomy surgery. This case presents successful refractive correction without retinal complications. We suggest that performing photorefractive keratectomy in a patient with Stargardt disease is unlikely to cause harm due to disease exacerbation based on this study and previous studies on the interaction of photorefractive keratectomy with corneal, lens, and retinal level outcomes. Though a soft visual endpoint may pose a unique challenge for refractive surgery in Stargardt disease, we report effective use of the iDesign 2.0 software. In all, we postulate that refractive surgery such as photorefractive keratectomy is likely to improve quality of life and vision in patients with Stargardt disease and possibly other inherited retinal pathologies as well.