Irregular astigmatism after corneal refractive surgery an overview of the state of the Art

Irregular astigmatism is a challenging problem for the refractive surgeon. The aim of this paper is to describe the authors' experience and a present a literature review of the latest advances in the diagnosis and management of this difficult complication. We present a compilation of the different alternatives to treat irregular astigmatism secondary to corneal refractive surgery, as well as an innovative method to quantify the degree of irregular astigmatism, taking into account the clinical symptoms and the corneal aberrometric data. The outcome of the different choices to treat irregular astigmatism are presented, from contact lens fitting to the most recent ablative techniques based on corneal wavefront. Although irregular astigmatism is still one of the worst complications of refractive surgery, the better knowledge of the causes, the enhanced diagnostic devices and the improvement of the refractive surgical techniques have given the refractive surgeon a wide set of alternatives to improve the patients visual performance, and to avoid unwanted litigations.

Photorefractive corneal procedures in patients with systemic diseases

This retrospective, non-randomized, non-comparative clinical study included 14 eyes of 7 patients who underwent laser in situ keratomileusis [LASIK] and 4 eyes of 4 patients who underwent photorefractive keratectomy [PRK] as a primary procedure to correct their myopia and astigmatism. All patients had a history of controlled systemic autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, psoriasis and Behcet's disease. The visual acuity, refraction, keratometric readings, slit-lamp biomicroscopy and corneal topography were assessed in these eyes at regular follow-up periods of 1, 3 and 6 months postoperatively. The mean pre-LASIK/PRK spherical equivalent [SE] decreased from -4.01 D +/- 1.51 standard deviation [SD] preoperatively to - 0.31 D +/- 0.47 SD by the end of the sixth postoperative month which was statistically significant. The mean preoperative uncorrected visual acuity [UCVA] was less than 20/200. Six months after LASIK/PRK procedure, UCVA was 20/25 that was also statistically significant. Retreatment for regression was necessary in 5 [27.7%] eyes at variable periods of time following the primary procedure. The procedures were done easily without any unusual intraoperative complications. The postoperative symptom suggestive of dry eye were not more than usual with the exception of one eye which developed exaggerated symptoms