case_images: PMC4383406_01
case_images: Corneal Topography. Progression of corneal topography measured in patient's right eye: (a) preoperative topography (before radial keratotomy [RK]), (b) postoperative month 1 after RK, (c) postoperative month 5 after LASIK, (d) postoperative year 6 after LASIK, (e) postoperative month 4 after astigmatic keratotomy (AK), and (f) postoperative year 1.5 after AK.
case_images: CRIOPM2015-592495.001.jpg
case_images: PMC4383406_01_CRIOPM2015-592495.001.jpg
case_images: fig1
case_images: Preoperative topography showed a low amount of with-the-rule astigmatism (corneal cylinder (CC) = 0.40 D; Figure 1(a)). On postoperative month (POM) 1, UCVA was stable (Figure 1(b)). Three and a half years after LASIK and according to medical records, the patient presented with worsening VA (UCVA 20/50; MR of +1.25 + 2.75 x 119  with BCVA 20/20), which continued to deteriorate over the next 3 years (UCVA 20/400; MR -1.50 + 5.50 x 152  with BCVA 20/20; topography Figures 1(c) and 1(d)). On POM-4, BCVA was 20/25 and increased cylinder was noted (MR -1.00 + 6.00 x 128 , CC = 7.13 D, Figure 1(e)). A year and a half later, UCVA was 20/50 and astigmatism was stable (MR -1.00 + 5.50 x 134  with BCVA 20/20; Figure 1(f)).
case_images: Slit Lamp Photography. Patient's right eye detailing: (a) radial keratotomy incisions and (b) astigmatic keratotomy incision. Even though the patient had LASIK, it is difficult to appreciate the LASIK flap in these photos.
case_images: CRIOPM2015-592495.002.jpg
case_images: PMC4383406_01_CRIOPM2015-592495.002.jpg
case_images: fig2
case_images: With the diamond knife, 8 centripetal manual incisions were created in a Russian-order fashion, leaving a 4 mm optic zone (Figure 2(a)). Two arcuate incisions were made (135  and 315 ), each 70  in length, at a depth of 412 mum (Figure 2(b)).