Cornea Cases

Title:

Topoguided customised ablation for management of post-PRK scar

Case Report Details

First Author: S.Arun INDIA

Co Author(s):    D. Shetty   P. Khamar   D. Mullick   S. Gupta           

Abstract Details

Purpose:

To assess the outcomes of Topo-guided customised ablation for management of post Photo Refractive Keratectomy scar.

Setting:

Narayana Nethralaya, Bangalore.

Report of case or case series:

A 22 year old gentleman presented with blurred vision in his right eye, following photorefractive keratectomy done in both his eyes 9 months back. A thorough slit lamp examination revealed a corneal scar with a central clear area obscuring the visual axis, adversely affecting the quality of his vision. A detailed evaluation was done including Slit lamp imaging, Corneal Topography, Anterior Segment-Optical Coherence Tomography (AS-OCT) and Aberrometry. The central clear area was seen as an area of flattening on Topography and AS-OCT, inducing a high spherical aberration of -1.34 microns. The surrounding scar was seen as an area of steepening, inducing trefoil (-0.46 microns) and coma (0.63 microns). A large zone Photo Therapeutic Keratectomy (PTK) would further flatten the central flat area, making the cornea more negatively aspheric. Hence, we chose to do a customised ablation in the form of a small zone PTK with topo-guided treatment of only Higher Order Aberrations.This led to resolution of the scar, further improvement in vision, restoration of the asphericity of the cornea and reduction in higher order aberrations, thereby improving the quality of vision.

Conclusions/Take Home Message:

Traditionally, for a patient with corneal scar, the treatment modality available was a PTK, which improved the quantity of vision, however the quality remained poor. With this case, we can firmly say that, doing a customized topo-guided ablation along with specific treatment of higher order aberrations, improves both quantity as well as the quality of vision, providing better patient satisfaction.