Topography-guided photorefractive keratectomy for correction of irregular astigmatism following penetrating keratoplasty

Session Details

Session Title: Advanced Surface Photoablation I

Session Date/Time: Sunday 08/10/2017 | 08:00-09:30

Paper Time: 08:51

Venue: Meeting Center Room I

First Author: : J.Hogden CANADA

Co Author(s): :    S. Holland   D. Lin   N. Davey              

Abstract Details

Purpose:

Post-keratoplasty eyes frequently have high and irregular astigmatism difficult to correct with rigid contact lenses possibly needing further surgery such as wedge resection. We aimed to evaluate the alternative of topography-guided Photorefractive Keratectomy (TG-PRK) for correction of irregular astigmatism following penetrating keratoplasty (PK) using Schwind Amaris 1050

Setting:

Laser Refractive Clinic

Methods:

Retrospective, non-randomized, consecutive series of contact lens intolerant eyes with irregular astigmatism following PK that underwent trans-epithelial TG-PRK with the Schwind Amaris SmartSurfACE Excimer Laser. Eyes with at least 12 months of follow-up were included. Data collected included pre-operative and post-operative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), topographic cylinder and the number of Snellen lines gained or lost. Any complications were recorded.

Results:

20 of 42 eyes had sufficient data at 12 months for analysis. 6/20 eyes (30%) showed UDVA ≥20/40 post-operatively with none pre-operatively. 10 eyes (50%) improved CDVA of ≥1 line, and 6 eyes (30%) gained ≥2 lines. 2 eyes (10%) lost ≥2 lines. The mean pre-operative topographic cylinder was 5.08±2.32D. Reduction in astigmatism (RIA) was 2.75±2.22D. Mean spherical equivalent improved from -1.99±3.40D to -0.98±2.42D. No patient showed regression up to 12 months post-operatively. There were no eyes with visually significant haze and no infection post-operatively. Five eyes had delayed epithelial healing without long term sequelae.

Conclusions:

Early results of trans-epithelial TG-PRK (Schwind Amaris Excimer Laser SmartSurface) showed satisfactory efficacy and safety for treatment of irregular astigmatism following corneal transplantation . Half had at least one line improved CDVA and 30% gained ≥2 lines. Nearly a third achieved ≥20/40 UCDA postoperatively but none before surgery. Mean reduction in astigmatism was 2.75D. The technique appears to be a good alternative treatment for highly symptomatic contact lens intolerant patients with irregular astigmatism following penetrating keratoplasty.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented