Eyeworld

56 | EYEWORLD | DECEMBER 2021 by Ellen Stodola Editorial Co-Director About the physicians Shehzad Batliwala, DO Surgery Fellow ClearSight LASIK/43 Vision Oklahoma City, Oklahoma Luke Rebenitsch, MD Medical Director ClearSight LASIK/43 Vision Oklahoma City, Oklahoma Relevant disclosures Batliwala: None Rebenitsch: Carl Zeiss Meditec, Legrande, OSRX Pharmaceuticals, STAAR Surgical R EFRACTIVE 20/10 in the right eye, 20/25 in the left eye, 20/10 both eyes, and UNVA was 20/20. The patient enjoyed this level of vision until earlier this year, when he returned with com- plaints of reduced near vision. His UDVA was 20/20 in the right eye and 20/25 in the left. However, his UNVA was reduced to 20/50, and this was significantly limiting his quality of life. "Upon refraction, we found he had drifted hyperopic, which is common for a 50-year-old, to +0.75 in the right eye and +1.25 in the left eye, which would explain the loss of near vision," Dr. Rebenitsch said. This patient's goal was to obtain the most permanent vision correction procedure possible. Given the patient's current complaints, age, and diagnostic testing, the decision was made to do a refractive lens exchange in both eyes. The topography and higher order aberrations were within normal limits, Dr. Rebenitsch said, so he discussed with the patient the option of doing a multifocal lens in the dominant eye and a monofocal lens behind the existing KAMRA. S ometimes after initially picking a treatment option, a patient's vision can change over time, requiring anoth- er solution. Luke Rebenitsch, MD, described a case where he initially performed same-day hyperopic LASIK along with the KAMRA inlay (SightLife Surgical) for distance and presbyopia correction, respectively, in a 46-year-old patient. Several years later, Dr. Rebenitsch elected to implant IOLs in the pa- tient once he started experiencing a hyperopic shift and lens-associated degradation in vision. The patient was satisfied with both his distance and near vision. Dr. Rebenitsch noted that when he first saw this patient in 2017, he was a 46-year-old carpenter who was hyperopic and desired both distance and near vision. The patient's main goal was to gain independence from glasses. After discussion with the patient, the plan was made to perform bilateral hyperopic LASIK, targeting plano in the right (dominant) eye, and a –0.75 D in the left (non-dominant) eye. The left eye also received the KAMRA inlay. At the 1-month postoperative visit, the patient's UDVA was 20/12 in the right eye and 20/30 in the left eye, with UNVA at 20/30 as well. Fully healed 5 months later, his UDVA was RLE for a patient with a previous corneal inlay Scheimpflug view of the KAMRA inlay, showing that it is in deep cornea, about 250 microns away from the endothelium, which minimizes inflammation-induced haze due to a lower concentration of keratocytes Postoperative photo showing axial view of KAMRA inlay. The red circle outlines the inlay, and it is ideally located slightly nasal to the first Purkinje reflex. COMPLICATED CASES

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