J Korean Ophthalmol Soc.  2015 Dec;56(12):1991-1996. 10.3341/jkos.2015.56.12.1991.

Laser Refractive Surgery Using an Active Eye-Tracking System in Congenital Nystagmus

• Kim YH
• Kang SY
• Choi JY
• Yang HS
• Chung SA

• KMID: 2148767
• DOI: http://doi.org/10.3341/jkos.2015.56.12.1991

Abstract

PURPOSE
Nystagmus is not considered a good indication for laser refractive surgery. However, we report 2 cases with congenital nystagmus that underwent a safe procedure due to improvement of laser firing rate and eye tracker.
CASE SUMMARY
Two myopic patients with congenital nystagmus underwent transepithelial photorefractive keratectomy with the Schwind Amaris laser platform using an eye tracker. The laser ablations were performed under topical anesthesia without any mechanical eyeball fixation. A 30-year-old man with a history of muscle surgery at 11 years of age had a conjugate, 4 Hz right beating jerk nystagmus. His preoperative refractive error was -8.50 D sph = -0.50 D cyl x 160degrees x 20/30) in the right eye, and -6.00 D sph = -0.75 D cyl x 30degrees x 20/25) in the left eye. A 19-year-old man had a conjugate, 3 Hz pendular nystagmus. His refractive error was -5.25 D sph = -2.50 cyl x 175degrees x 20/30) in the right eye, and -4.25 D sph = -2.50 D cyl x 180degrees x 20/30) in the left eye. Both patients underwent a well-centered laser ablation without any problems. Six months after surgery, uncorrected visual acuity was 20/25 or better, and refractive error was within +/-0.50 D in all 4 eyes. In addition, the 19-year-old man showed decreased nystagmus amplitude.
CONCLUSIONS
In some patients with congenital nystagmus, laser refractive surgery may be safely and accurately performed under topical anesthesia using an active tracking system. The best uncorrected visual acuity may improve in certain patients postoperatively.

Keyword

Congenital nystagmus; Eye-tracking system; Laser refractive surgery

MeSH Terms

Adult
Anesthesia
Fires
Humans
Laser Therapy
Nystagmus, Congenital*
Nystagmus, Pathologic
Photorefractive Keratectomy
Refractive Errors
Refractive Surgical Procedures*
Visual Acuity
Young Adult

Figure

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  Figure 1. Case 1. (A) Fundus photography showing myopic tilted disc in both eyes (left upper column) and pre-operative corneal topography (left lower column). Optical coherence tomography for analysis of retinal nerve fiber layer thickness showing horizontal distortion and noise due to horizontal nystagmus (right column). (B) Intraoperative eye tracking on the treatment printout showing large magnitude of horizontal movement in the both eyes. (C) Corneal topography showing well-centered ablation 2 months after surgery. T = temporal aspect; N = nasal aspect.

• 

  Figure 2. Case 2. (A) Fundus photography showing myopic disc in both eyes (left upper column) and pre-operative corneal top-ography (left lower column). Optical coherence tomography for analysis of retinal nerve fiber layer thickness showing horizontal distortion and noise due to horizontal nystagmus (right column). (B) Intraoperative eye tracking on the treatment printout showing horizontal and some vertical movement in both eyes. (C) Corneal topography showing well-centered ablation 2 months after surgery. T = temporal aspect; N = nasal aspect.

Reference

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