Topographically-guided Photo-refractive Keratectomy Is An Effective Treatment For Complications Of Refractive Surgery

1. Dr. David T.C Lin^1,2
2. Dr. Simon Holland^1,2

¹Pacific Laser Eye Centre, Vancouver, British Columbia, Canada
²University of British Columbia, Eye Care Centre, Vancouver, British Columbia, Canada

Purpose: To evaluate highly aberrated eyes with decentered ablation (DA) zones after previous laser refractive surgery and radial keratotomy (RK) using the Wavelight Allegretto Laser.

Methods: Retrospective consecutive case series involving 94 eyes with decentered ablations and 49 eyes with hyperopic astigmatism following RK surgery, underwent topography-guided retreatment with the Wavelight Laser. Follow up at 6 months and 1 year post-operative. Symptom score, BSCVA, UCVA, and topography were evaluated.

Results: 94 eyes with previously decentered optical zones had an improvement. Predictability of centration from 0.92mm to 0.30mm post-operatively relative to pupil center (p<0.01). 24% gained 1 or more lines, whereas 71% had no change in BSCVA with 5% losing more than one line. All were symptomatic prior to surgery with 81% asymptomatic after. 21% improved vision of at least 1 line, 75% had no change in BSCVA, and 6% lost one line. All eyes had improvement of astigmatism with a range of 1.25D – 6.75 D.

Conclusion: Treatment of highly aberrated eyes with topographic-guided ablation using the Wavelight Allegretto has potential for resolving or improving symptoms in patients with complications of laser refractive surgery. Safety is acceptable for decentered ablation retreatments, but treatment planning is challenging due to the induced refractive error.