A Novel Sequential Docking Technique: Use of Femtosecond Arcuate Keratotomy and Femtosecond Assisted Cataract Surgery Using a Pupil Expansion Ring on a Patient with Intraoperative Floppy Iris Syndrome

Hung-Yuan Lin; Ting-Yu Lin; Ya-Jung Chuang; Li-Ju Lai; Pi-Jung Lin

doi:10.2147/IMCRJ.S243809

A Novel Sequential Docking Technique: Use of Femtosecond Arcuate Keratotomy and Femtosecond Assisted Cataract Surgery Using a Pupil Expansion Ring on a Patient with Intraoperative Floppy Iris Syndrome

Int Med Case Rep J. 2020 Apr 23:13:139-144. doi: 10.2147/IMCRJ.S243809. eCollection 2020.

Authors

Hung-Yuan Lin^{1

2

3}, Ting-Yu Lin⁴, Ya-Jung Chuang⁵, Li-Ju Lai⁶, Pi-Jung Lin⁷

Affiliations

¹ Department ofOpthalmology, Universal Eye Center, Zhong-Li, Taiwan, Republicof China.
² Department of Optometry, Central Taiwan University of Science and Technology, Taichung City, Taiwan, Republicof China.
³ Department of Ophthalmology, Shanghai Ruidong Hospital, Shanghai, People's Republic ofChina.
⁴ Department of Chemistry, Barnard College, Columbia University New York, New York, NY, USA.
⁵ Department of Ophthalmology, Universal Eye Center, Long-Tan, Taiwan, Republicof China.
⁶ Department of Ophthalmology, Universal Eye Center, Chia-Yi, Taiwan, Republic ofChina.
⁷ Department of Ophthalmology, Universal Eye Center, Taipei, Taiwan, Republic ofChina.

Abstract

Purpose: The purpose of this study was to evaluate the efficacy of a novel double-docking technique, incorporating the use of femtosecond laser arcuate keratotomy (FSAK) in correcting low-degree astigmatism and Malyugin ring, in a patient with intraoperative floppy iris syndrome (IFIS).

Methods: A case report of a 72-year-old man with grade 4 cataract, low-degree astigmatism (<2D), and IFIS (pupil size <4 mm, intraoperatively) is presented. The patient underwent cataract surgery using a femtosecond laser to treat low-degree astigmatism because the patient requested for the use of a multifocal intraocular lens (IOL). The first docking was performed to complete arcuate keratotomy, produce the mainparacentesis incisions, and create clear corneal incisions. Insertion of the Malyugin ring was performed after the first docking, whereas the second one was executed to complete continuous curvilinear capsulotomy and lens fragmentation. The patient's uncorrected visual acuity (UCVA) was measured pre- and post-operatively. The complications were evaluated post-operatively and 3 months later during the follow-up visit.

Results: The patient's UCVA for distance improved from 0.3 (6/12 Snellen equivalent) to 0 (6/6 Snellen equivalent) logMAR post-operatively. During the follow-up visit, the patient's uncorrected near visual acuity was at J2. His corneal astigmatism changed from -1.0 Diopter @177° pre-operative to -0.12 D @173° post-operative. No other intraoperative or post-operative complications were observed.

Conclusion: The double-docking technique, with the use of FSAK, and Malyugin ring produced successful surgical outcomes for the patient. The benefits of this technique allow surgeons to avoid changing the shape of the patient's cornea from the injection of the viscoelastic device into the anterior chamber, which could lower the femtosecond laser's precision and docking location.

Keywords: Malyugin ring; astigmatism; femtosecond laser arcuate keratotomy; intraoperative floppy iris syndrome; low-degree.

Publication types

Case Reports

Grants and funding

This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.