Hyperopic Shift and Myopic Regression in a Patient 7 Years After Bilateral Refractive Keratotomy

Abstract

To report a patient who developed hyperopic progression in one eye and myopic regression in the other eye following bilateral, non-simultaneous refractive keratotomy. Uncorrected visual acuity improved to 20/25 and 20/25-2 in the right and left eyes, respectively, 3 months following refractive keratotomy (one procedure in the right eye, two procedures in the left eye). The visual acuity was not stable over time and almost 8 years after surgery, uncorrected distance visual acuity was 20/40- and 20/200. The spherical equivalent refraction of the right eye progressed from -0.50 diopter (D) 3 months after surgery to +1.25 D several years later. The left eye regressed from a spherical equivalent refraction of -0.75 D 3 months after the second surgery to -2.50 D more than 7 years postoperatively. Slit-lamp microscopy disclosed deeper, opaque incisions in the hyperopic eye, and shallower and more transparent incisions in the myopic eye. The shift toward hyperopia and myopia in an individual suggest that instability of the radial keratotomy wound may be related to local wound healing events that are, in part, related to incision depth.