Oftalʹmologiâ (Jul 2018)
On the Possibility of Expanding Indications for Refractive Correction of Ametropia (4 Clinical Cases)
Abstract
Refractive surgery is a dynamically developing field of ophthalmic surgery, which requires studying new approaches for determining indications and contraindications for refractive surgery.Purpose. To investigate the possibility of expanding indications for refractive surgery in conditions related to contraindications on the example of four clinical cases.Material and methods. The study included 4 clinical cases of photorefractive operations in patients with relative contraindications who underwent refractive surgery (Femto-Lasik, photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK)).Results and discussion. Follow-up period of patients after Femto-Lasik, PRK and PTK was 1 year. During this period, stabilization of such parameters as intraocular pressure (IOP), progression of diabetic retinopathy, visual acuity was detected on all operated eyes. There were no postoperative complications. In the first clinical example, to avoid flap injury pneumotonometry was performed 72 hours after the surgery. IOP indices differed from preoperative ones and were 15 mm Hg because of the flap cut and the removal of part of the corneal tissue as a result of laser ablation. In the second clinical example, BCVA OU was 1.0 throughout the whole follow-up period. In the third clinical example recurrence of retinal detachment and any formations of new zones of peripheral vitreochorioretinal were not observed. BCVA improved up to 0.9–1.0. In the fourth clinical example, 3 months later, the patient complained for “misting” in the right eye. On examination, subepithelial fibroplasia of the 1st degree was revealed. After the course of treatment, the transparency of the cornea was restored. The data of the diagnostic examination after the surgery at the period of 1 month, 3 months did not differ and corresponded to preoperative ones. Diagnostic examination data 1 year after the operation: visual acuity: OD — 1.0; OS — 0.4 sph + 1.0Dcyl + 1.5Dax 45 = 0.8.Conclusion. The presented clinical examples allow us to reconsider the list of relative contraindications for performing refractive operations for compensated diabetes mellitus, glaucoma, retinal detachment, corneal opacities, as it can be performed safely and effectively with good refractive results.
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