Customized laser vision correction for irregular cornea post-refractive surgery.

Ablation-related complications following the refractive procedures are a major challenge for a refractive surgeon, considering the elective nature of the procedure. The use of topography-guided customized ablation has revolutionized the management of irregular corneas postrefractive surgery. This preferred practice highlights various hurdles encountered while managing cases of decentered ablation, small ablation zones, and planning a cataract surgery in patients with irregular corneas. It will give insight to the refractive surgeon on the planning of corneal regularization on various modern-day refractive platforms available, such as the WaveLight® EX-500 (Alcon Laboratories, Inc., Fort Worth, TX, USA), Schwind Amaris 1050 (Peramis; SCHWIND eye-tech-solutions, Kleinostheim, Germany), and Technolas Teneo 317 model 2 excimer laser (Bausch & Lomb, Rochester, NY, USA). The algorithmic approach outlined will enable the refractive surgeon to choose between the wavefront optomized and the topography-guided ablations.

Topography-Based Removal of Corneal Epithelium for Keratoconus: A Novel and Customized Technique.

PURPOSE: To report 3 cases of management of keratoconus with a novel topography-based removal of corneal epithelium in keratoconic eyes combined with corneal crosslinking. METHODS: Case report and technique description. RESULTS: Three eyes were imaged with the Sirius topographer (Schwind Eye-Tech-Solutions, Germany). Single-step transphototherapeutic keratectomy was performed. After removal of epithelium with laser, 4-mm diameter ablation was performed centered at the location of the maximum anterior tangential curvature point. An ellipsoid ablation pattern was used for all eyes. The stromal ablation depth did not exceed 25 µm. Next, epithelium over the remaining central 8-mm cornea was manually scraped. Accelerated crosslinking (9 mW/cm for 10 min) of the central 8-mm cornea was performed. After 3 months, spherical equivalent, maximal anterior curvature, and root mean square of higher-order aberrations decreased by 1.75 D, 2.0 D, and 0.15 µm, respectively, in the first eye. The spherical equivalent, maximal anterior curvature, and root mean square decreased by 2.75 D, ∼4.0 D, and 0.36 µm, respectively, in the second eye. In the third eye, the decrease was 0.75 D, 8.3 D, and 1.0 µm, respectively. After 3 months, improvement in visual acuity was significant in 2 of the 3 eyes. In 1 eye, there was a slight reduction in corrected distance visual acuity mostly because of ongoing remodeling of the cornea and delayed vision stabilization. CONCLUSIONS: A novel technique named topography-based removal of corneal epithelium in keratoconic eyes was described. This combined technique ablated less stroma and achieved outcomes comparable to those of existing techniques.