Advanced topography-guided (OcuLink) treatment of irregular astigmatism after epikeratophakia in keratoconus with the WaveLight excimer laser.

PURPOSE: To evaluate the feasibility, safety, and predictability of treatment for high irregular astigmatism with advanced topography-guided laser epithelial keratomileusis in symptomatic eyes after epikeratophakia (EP) for keratoconus.

METHODS

In a prospective case series, 10 consecutive eyes (10 patients) with high irregular astigmatism after epikeratophakia for keratoconus received OcuLink laser-assisted subepithelial keratectomy (LASEK) using the Allegretto Wave excimer laser. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifestation and refraction, corneal topographic examination with asphericity, and regularity were evaluated. All patients could not tolerate contact lens wear and had subjective symptoms.

RESULTS

The UCVA improved from 0.61 ± 0.27 logarithm of the minimum angle of resolution (logMAR) (range, 0.3-1.0 logMAR) to 0.27 ± 0.07 logMAR (range, 0.2-0.4 logMAR), and the BSCVA improved from 0.25 ± 0.14 to 0.15 ± 0.09 logMAR (range, 0-0.3 logMAR) at 6 months after surgery. One patient had reduced UCVA (1 line), but no patients had reduced BSCVA. The refractive cylinder improved from -3.82 ± 2.43 diopters (D) (range, -0.75 to -7.75 D) to -1.43 ± 0.95 D (range, -0.25 to -2.50 D). The index of surface variance (an indicator of corneal surface irregularity) reduced from 115.1 ± 21.1 (range, 90-153) to 68.4 ± 18.2 (range, 39-95). Subjective symptoms, such as glare, halos, ghost images, starbursts, and monocular diplopia, were either not present or obviously alleviated.

CONCLUSIONS

Advanced topography-guided (OcuLink) LASEK can significantly reduce irregular astigmatism and increase the UCVA and BSCVA.