ABSTRACT
PURPOSE: To describe a new, single-step, transepithelial and trans-LASIK flap topography-guided surface ablation technique in a case of recurrent epithelial ingrowth with visual disturbances caused by irregular astigmatism, scattering, and decreased corneal transparency after LASIK. METHODS: Custom ablation through both the epithelium and the LASIK flap performed by 1-kHz flying spot excimer laser was used to transform an irregular corneal surface into a regular aspheric surface and in the same continuous process to ablate the epithelial ingrowth causing the irregularity. RESULTS: Visual rehabilitation was achieved, the corneal surface was regularized, and epithelial ingrowth was removed within the ablation. CONCLUSIONS: The transepithelial topography-guided surface ablation technique was safe and effective in this case of visually disturbing epithelial ingrowth after LASIK, and may also be applied to treat other types of flap/interface complications.
Subject(s)
Corneal Diseases/surgery , Corneal Topography , Epithelium, Corneal/surgery , Lasers, Excimer/therapeutic use , Postoperative Complications , Adult , Corneal Diseases/etiology , Epithelium, Corneal/pathology , Female , Humans , Keratomileusis, Laser In Situ , Recurrence , Surgical Flaps , Vision Disorders/rehabilitationABSTRACT
PURPOSE: To evaluate a combination of topography-guided custom ablation and corneal collagen cross-linking (CXL) in a single procedure for the treatment of keratectasia. METHODS: Twelve eyes of 12 patients with keratectasia were treated with topography-guided custom ablation and CXL. Topography-guided custom ablation was performed using a transepithelial technique with the iVIS Suite 1 kHz flying spot excimer laser. Collagen cross-linking was performed immediately after topography-guided custom ablation, according to standard protocol. Postoperative follow-up examinations were performed at 1, 3, 6, and 12 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive change, corneal topography, and pachymetry were analyzed pre- and postoperatively. RESULTS: Mean UCVA increased from 20/1000 preoperatively to 20/125 12 months postoperatively. Mean BSCVA increased from 20/57 to 20/35, with no loss of lines of visual acuity. Mean astigmatism was reduced from 5.40+/-2.13 diopters (D) to 2.70+/-1.44 D, and keratometric asymmetry decreased from 6.38+/-1.02 D to 2.76+/-0.73 D. Only minor changes in posterior corneal surface elevation and stability of refraction were found, confirming that no progression of ectasia occurred during the observation time. CONCLUSIONS: A combination of topography-guided custom ablation and CXL improved patients' visual, refractive, and topography outcomes and halted the progression of keratectasia within the observation period of 12 months. This method may postpone or eliminate the need for corneal transplantation in suitable cases with keratectasia.
Subject(s)
Collagen/metabolism , Corneal Dystrophies, Hereditary/therapy , Corneal Topography , Keratoconus/therapy , Lasers, Excimer , Photochemotherapy , Adult , Combined Modality Therapy , Corneal Dystrophies, Hereditary/drug therapy , Corneal Dystrophies, Hereditary/metabolism , Corneal Dystrophies, Hereditary/surgery , Corneal Stroma/metabolism , Female , Humans , Keratoconus/drug therapy , Keratoconus/metabolism , Keratoconus/surgery , Male , Middle Aged , Photosensitizing Agents/therapeutic use , Ultraviolet Rays , Visual AcuityABSTRACT
PURPOSE: To compare treatments with wavefront optimized and custom-Q ablations. METHODS: Two consecutive groups of eyes were treated for myopia and astigmatism with surface ablation. One group was treated with wavefront optimized ablation and the second group was treated with custom-Q ablation. Preoperative and 3-month postoperative Q-values, higher order aberrations, low contrast visual acuity, and classic outcome parameters were analyzed. RESULTS: The wavefront optimized ablation group was comprised of 46 eyes of 23 patients with a mean spherical equivalent refraction (SE) of -3.64 diopters (D) (range: -1.15 to -8.25 D); mean Q-value changed from -0.33 preoperatively to 0.06 postoperatively. The custom-Q ablation group was comprised of 42 eyes of 21 patients with a mean SE of -3.24 D (range: -1.47 to -8.00 D); mean Q-value changed from -0.36 preoperatively to -0.03 postoperatively. A statistically significant difference in postoperative change in Q-values (P = .049) between the two groups was noted, but there was no such difference in higher order aberrations, low contrast visual acuity, or classic outcome parameters. CONCLUSIONS: Custom-Q ablation resulted in a mean postoperative asphericity that was closer to preoperative compared to wavefront optimized ablation, whereas the other outcome parameters showed no statistically significant differences.
