Topoguided Lasik: The Road Less Taken

To report challenges in a case undergoing refractive surgery (LASIK) for myopia with high astigmatism

Cornea and Refractive Services of Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

A 22-years old male with refractive error -5.50DS/ -4.50DC x90 OD and -6.0DS/-4.75DCx80 OS desired refractive surgery. Pentacam was normal with thinnest pachymetry 536µm OD, 542µm OS. Horizontal WTW was 11.00mm OU. With such high astigmatism there was a concern of low residual stromal bed thickness and high percentage tissue ablation (~46%) after LASIK/ SMILE. ICL was contraindicated as patient’s ACD was 2.91mm OD and 2.77mm OS. Therefore, topo-guided LASIK was done in view of lesser tissue ablation than standard LASIK. Flap diameter was adjusted not to involve limbus, thickness was reduced to 90µm with nasal hinge to not interfere vertically oblong ablation profile for correcting against the rule astigmatism and ablation optic zone increased slightly to 6.3mm. Postoperatively, patient’s uncorrected vision was 6/6 OU with no residual refractive error or any other complications.

Appropriate planning and customization of operative parameters is necessary for satisfactory outcomes even with the availability of advanced technologies. Topo- guided LASIK remains a powerful yet often under- utilized option in these scenarios.