PURPOSE: To describe the treatment of highly aberrated eyes due to previous excimer laser surgery or trauma.METHODS: Three eyes (three patients) with reduced visual quality due to previous decentration or corneal laceration (one eye) underwent topography-guided ablation using the CXIII excimer laser (NIDEK Co Ltd) to correct residual refractive error and/or wavefront aberrations.RESULTS: Postoperatively, one patient had a one-line increase in corrected distance visual acuity (CDVA) with a reduction in visual symptoms. At 2 months postoperatively, one patient maintained CDVA, increased uncorrected distance visual acuity from 20/20 to 20/15, and reported resolution of monocular diplopia. In all cases, the functional optical zone increased and wavefront aberrations decreased with selective fl attening of the intended corneal region.CONCLUSIONS: Topography-guided ablation is an effective treatment of severe corneal aberrations due to surgery or trauma and can be selectively used to treat higher order aberrations with or without refractive error. [J Refract Surg. 2010;26(6):453-457.] doi:10.3928/1081597X-20100212-05 T he induction of higher order aberrations (HOA) due to surgery or corneal trauma may cause a reduction in visual quality.1,2 Topographyguided treatment appears to be a predictable modality to address such cases.3,4 Wavefront-guided treatments may not be appropriate for highly aberrated eyes due to measurement artifacts of Hartmann-Shack aberrometers such as crossover of centroids and data smoothing of clinically signifi cant irregularities. 5,6 Severely aberrated eyes due to corneal leukoma and central islands have been treated with corneal topography-guided aspheric algorithms. 3,4 In the current study, we describe the use of the Custom Aspheric Treatment zone algorithm (CATz) (NIDEK Co Ltd, Gamagori, Japan) with the NIDEK Advanced Vision Excimer Laser Platform (NAVEX) to treat eyes with reduced visual quality due to decentered ablations and corneal laceration.
CASE REPORTSIn all cases, Final Fit software version 1.11T 3,4 (NIDEK Co Ltd) was used to plan treatments based on corneal topography data acquired with the OPD Scan II (NIDEK Co Ltd). The CATz algorithm delivers aspheric treatment zones combined with the treatment of corneal elevation irregularities or corneal wavefront (at the surgeon's discretion). The CATz ablation algorithm uses a combination of optical and transition zones that gradually taper the corneal curvature paracentrally and peripherally, blending together to create a single treatment zone or ablation zone. The Final Fit software allows selection of eight ablation profi les that gradually increase in asphericity as the profi le number increases. A number of treatment parameters can be manipulated during surgical planning, including laser treatment zones, ablation profi le, volume of corneal irregularity to be removed, and reduction of corneal irregularity with or without treatment of refractive error.
RETREATMENT OF DECENTRATIONSCase 1. A 35-year-old woman was referr...