Purpose. To describe a case of 3 refractive procedures performed in one eye over 2 decades. Methods. Case report. Results. A 41-\nyear-old patient presented for refractive surgery evaluation. His ocular history includes bilateral radial keratotomy performed 21\nyears ago for moderate myopia: spherical equivalence of ?4.25D bilaterally. Postoperative uncorrected visual acuity (UCVA) was\n20/30; however, over time he developed a hyperopic shift and UCVA decreased to 20/40 in the right eye.Thus, laser-assisted in situ\nkeratomileusis (LASIK) was performed at an outside institution 6.5 years later, and the patient had initial improvement of UCVA to\n20/25. Due to a change in refractive error, the patient underwent uneventful astigmatic keratotomy 13 years after LASIK in the right\neye, and 1.5 years after surgery best-corrected visual acuity was 20/25 with manifest refraction of ?1.00 + 5.50 Ã?â?? 134?. Conclusion.\nWe report the outcomes and natural refractive progression in a patient who underwent three corneal refractive procedures over\ntwo decades. This case underlines the difficulties of long-term management of post-RK hyperopia and astigmatism
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