Custom phototherapeutic keratectomy with intraoperative topography.
OBJECTIVE
Treatment of highly aberrated eyes with opacities or irregularities consequent to previous refractive treatment, ulcers, keratitis, trauma, or corneal dystrophies remains a challenge for refractive surgeons. We evaluated the results of custom phototherapeutic keratectomy (CPK) with intraoperative corneal topography-based aberrometry and custom ablation in highly aberrated eyes.


METHODS
We prospectively evaluated eyes undergoing custom phototherapeutic keratectomy (CPK) with custom ablation for corneal opacities and/or irregularities due to previous refractive treatment, keratitis, trauma, or dystrophies. Customization was planned according to corneal topography-based aberrometry, performed intraoperatively after removal of corneal epithelium.


RESULTS
We treated 35 eyes of 34 patients. Mean preoperative haze was 1.6 +/- 1.4 in eyes with previous refractive surgery. Mean preoperative pachymetry was 425.7 +/- 119.3 microm. Mean preoperative spherical equivalent refraction was -1.60 +/- 3.65 D ranging from -9.38 to +10.00 D. No eye reached 20/15 best spectacle-corrected visual acuity (BSCVA), and only 63% could see 20/30 BSCVA. At final 6-month examination, mean spherical equivalent refraction was -0.71 +/- 4.01 D, ranging from -11.25 to +5.25 D. All eyes reached 20/30 or better BSCVA, and 19% had 20/15 or better BSCVA.


CONCLUSIONS
Intraoperative, epithelium-free topography-based corneal aberrometry proved to be a feasible option for custom ablation in highly aberrated eyes. This approach widens the applications of PTK, providing a new procedure, custom PTK, that can be a successful solution for eyes that would otherwise require penetrating keratoplasty.
Vinciguerra
Paolo
P
Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milano, Italy. pvinciguerra@vincieye.it
Camesasca
Fabrizio I
FI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods*; D003316:Corneal Diseases / Q000601:surgery*; D019781:Corneal Topography; D003949:Diagnostic Techniques, Surgical; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000175:diagnosis* / Q000503:physiopathology; D054140:Refractive Surgical Procedures; D016896:Treatment Outcome; D014792:Visual Acuity