Intacs and Topography-Guided Photorefractive Keratectomy for Treatment of Incomplete LASIK Flap-Induced Irregular Corneal Topography: A Case Report

Abstract

Purpose: To report a case of irregular corneal astigmatism and decreased visual function secondary to excimer ablation over an incomplete laser in situ keratomileusis (LASIK) flap treated with Intacs (CorneaGen) implantation and topography-guided (TG-PRK) and wavefront-optimized (WF-PRK) photorefractive keratectomy. Methods: The patient underwent Intacs implantation, TG-PRK, and WF-PRK enhancement in the right eye, with 4 to 6 months between procedures. Principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, topographic maximum keratometry, and inferior-superior value. Results: UDVA changed from 20/40 to 20/100 after Intacs implantation, but improved to 20/50 after TG-PRK and 20/25 at 4 months after WF-PRK. CDVA declined from 20/40 to 20/50 after Intacs implantation, but improved to 20/20 after TG-PRK and 20/15 after WF-PRK. Overall, maximum keratometry flattened from 53.20 to 47.00 diopters (D) and inferior-superior value improved from 11.60 to 2.40 D. Conclusions: This case illustrates the successful use of sequential Intacs implantation and TG-PRK after an irregular LASIK ablation to improve irregular astigmatism and loss of visual function. [ Journal of Refractive Surgery Case Reports. 2023;3(2):e14–e18.]