Management and treatment of central steep islands after excimer laser photorefractive keratectomy.
BACKGROUND
Permanent central steep islands are an undesirable phenomenon that cause distorted images and a significant reduction in visual acuity. We describe treatment of central steep islands with repeat excimer laser photoablation in the central cornea.


METHODS
Three patients with preoperative refractions of -7.50 -2.50 x 170 degrees D (right eye), -8.00 -2.25 x 10 degrees D (right eye) and -6.00 -1.50 x 90 degrees (right eye) developed central steep islands which persisted more than 12 months. All patients lost more than two lines of spectacle-corrected visual acuity and complained of visual disturbances. We retreated the central steep islands with a VISX 20/20 excimer laser PRK ablation that matched the size of the central island measured on videokeratography.


RESULTS
Symptomatic glare and distortion were significantly reduced and the central steep islands were resolved. Several weeks after reablation, spectacle-corrected visual acuity improved to the preoperative level.


CONCLUSIONS
Central steep island, an infrequent complication of excimer laser photorefractive keratectomy, can be safely removed with a repeat laser ablation that matches the central circular steep area.
Castillo
A
A
Department of Ophthalmology, Hospital General de Móstoles, Madrid, Spain.
Romero
F
F
Martin-Valverde
J A
JA
Diaz-Valle
D
D
Toledano
N
N
Sayagues
O
O
D000328:Adult; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D054018:Lasers, Excimer; D008297:Male; D009216:Myopia / Q000209:etiology / Q000601:surgery*; D018903:Photorefractive Keratectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000601:surgery*; D012030:Refractive Errors / Q000209:etiology; D054140:Refractive Surgical Procedures; D012086:Reoperation; D014792:Visual Acuity