title: Treatment of irregular astigmatism with a broad beam excimer laser.
abstract: BACKGROUND
  Four basic types of irregular astigmatism are described: central elevation, central flat area, eccentric elevation, and eccentric flat area.
  
  
  METHODS
  The importance of the Munnerlyn formula is shown for the treatment of irregular astigmatism. A new diagnostic entity is described, the steep/flat ratio, modeled on the inferior/superior ratio described previously in keratoconus. Calculation of the steep/flat ratio is described using the cross sectional view of videokeratography, leading to specific treatments for the four types of irregular astigmatism. Surgical technique using the VISX Star excimer laser for repeated laser in situ keratomileusis (LASIK) is described.
  
  
  RESULTS
  Case studies are given for each of the forms of irregular astigmatism showing improved topographic appearance and indicating treatment parameters. In each case, improvement of both uncorrected and spectacle-corrected visual acuity is demonstrated.
  
  
  CONCLUSIONS
  Irregular astigmatism is an important complication of refractive surgery. Four basic forms of irregular astigmatism can be treated with a broad beam excimer laser.
authors.affiliation: Buzard Eye Institute, Department of Surgery, University of Nevada School of Medicine, Las Vegas, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Buzard
authors.forename: B R
authors.initials: BR
authors.lastname: Fundingsland
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D053685:Laser Therapy; D008875:Middle Aged; D009216:Myopia / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012029:Refraction, Ocular; D014792:Visual Acuity