title: Topographically supported customized ablation for the management of decentered laser in situ keratomileusis.
abstract: OBJECTIVE
  To evaluate the efficacy, predictability, and safety of topographically supported customized ablations (TOSCAs) for decentered ablations following laser in situ keratomileusis (LASIK).
  
  
  METHODS
  Prospective nonrandomized clinical trial.
  
  
  METHODS
  Nine patients (11 eyes) with LASIK-induced decentered ablations underwent TOSCA following flap lifting. Topographically supported customized ablation was performed using a corneal topographer to obtain a customized ablation profile, combined with a flying spot laser.
  
  
  RESULTS
  Mean follow-up was 9.22 +/- 2.82 months (range 6-12 months). No intra- or postoperative complications were observed. Manifest refraction (spherical equivalent) did not change significantly (pre-TOSCA: -0.14 +/- 1.58 diopters [range, -1.75 to +3.00 diopters] to +0.46 +/- 1.02 diopters [range, -1.00 to +1.75 diopters]; P =.76), whereas there was a statistically significant reduction in the refractive astigmatism (pre-TOSCA: -1.55 +/- 0.60 diopters [range, -3.00 to -0.75 diopters] to -0.70 +/- 0.56 diopters [range, -2.00 to -0.25 diopters]; P =.003). Mean uncorrected visual acuity improved significantly (P <.001) from 0.45 +/- 0.16 (range, 0.2-0.7) to 0.76 +/- 0.29 (range, 0.2-1.2) at last follow-up. Mean best-corrected visual acuity improved from 0.74 +/- 0.22 (range, 0.4-1.0) to 0.95 +/- 0.20 (range, 0.6-1.2; P =.002). Eccentricity showed a statistically significant reduction after TOSCA treatment (pre-TOSCA: 1.59 +/- 0.46 mm [range, 0.88-2.23 mm]; post-TOSCA: 0.29 +/- 0.09 mm [range, 0.18-0.44 mm]; P <.001).
  
  
  CONCLUSIONS
  In our small sample, enhancement LASIK procedures with TOSCA appear to improve uncorrected and best-corrected visual acuity as well as eccentricity in patients with LASIK-induced decentered ablation.
authors.affiliation: Vardinoyannion Eye Institute of Crete, Department of Ophthalmology, University of Crete Medical School, 71110 Heraklion, Crete, Greece. kymionis@med.uoc.gr
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Sophia I
authors.initials: SI
authors.lastname: Panagopoulou
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Aslanides
authors.forename: Sotiris
authors.initials: S
authors.lastname: Plainis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Astyrakakis
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Pallikaris
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000601:surgery*; D003315:Cornea / Q000601:surgery*; D019781:Corneal Topography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D054140:Refractive Surgical Procedures; D012086:Reoperation; D012449:Safety; D013524:Surgical Flaps; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000601:surgery*; D014792:Visual Acuity