Customized Wavefront Guided Photo-Therapeutic-Keratectomy For The Treatment Of Irregular Astigmatism And Corneal Opacities
Published 2023 - 41st Congress of the ESCRS
Reference: FP11.10 | Type: Free paper | DOI: 10.82333/m77z-x424
Authors: Mohamed Ghaly* 1 , Lydia van der Star 1 , Indre Vasiliauskaite 1 , Otto Wolter 1 , Stefanie Voncken Santana 1 , Achraf Laouani 1 , Gerrit Melles 2 , Korine van Dijk 1 , Silke Oellerich 3 , Viridiana Kocaba 4
1Netherlands Institute for Innovative Ocular Surgery ,Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands, 2Netherlands Institute for Innovative Ocular Surgery ,Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands;Amnitrans Eye Bank,Rotterdam,Netherlands, 3Netherlands Institute for Innovative Ocular Surgery ,Rotterdam,Netherlands, 4Netherlands Institute for Innovative Ocular Surgery ,Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands;Amnitrans Eye Bank,Rotterdam,Netherlands;Tissue Engineering and Cell Therapy Group,Singapore Eye Research Institute,Singapore,Singapore
Purpose
Corneal opacities and irregular astigmatism can cause diminution of visual acuity with glare and halos. The current therapies depending on the opacity scar and degree of irregular astigmatism are phototherapeutic keratectomy (PTK), anterior lamellar or penetrating keratoplasty. The objective of this study was to evaluate the safety and efficacy of customized transepithelial wavefront guided PTK (custom-PTK) for the correction of corneal opacities and irregular astigmatism secondary to keratoplasty, infectious keratitis or anterior surface degenerations.
Setting
Methods
Sixteen patients (16 eyes) with a mean age of 62±15 years were included. Using the Schwind ORK-CAMsoftware, a customized corneal wavefront ablation profile was calculated based on pyramidal Zernike polynomials individually for aberration to minimize second and higher order aberrations (HOAs), reduce the correct manifest refraction and corneal opacities. All ablations were performed using the 1050hz Schwind Amaris excimer (SchwindEye-Tech-Solutions GmbH &Co.KG.). Outcome data was collected preoperatively and at the 1, 3-, and 6-months follow-up visits including uncorrected visual acuity(UCVA), best-corrected visual acuity(BCVA), manifest refraction, corneal topography, pachymetry, lower and higher order aberrations, and corneal backscatter.
Results
Mean UCVA and BCVA (LogMAR) significantly improved from preoperatively 0.67±0.47 and 0.23±0.24, respectively, to 0.32±0.33 and 0.09±0.13 at 6-month postoperatively (P=0.008 and P=0.049). Corneal backscatter significantly improved for all zones of the anterior layer. In the central 0-2 mm zone, corneal backscatter improved from 44.20 ±19.65 Gray Scale Units (GSU) preoperatively to 33.68 ±17.48 GSU at 6-month postoperatively (P<0.001), corresponding to a decrease of 24%. The corneal front regularity significantly improved from pre- to 6-month postoperatively in the root mean square (RMS) of the lower order aberrations, the RMS of all aberrations, and the spherical aberration (all P<0.05).
Conclusions
Our results suggest that custom-PTK is a safe and effective minimally invasive approach for the treatment of corneal opacities and irregular astigmatism secondary to keratoplasty, infectious keratitis and anterior surface degenerations. Custom-PTK significantly reduced the aberration and improved UCVA and BCVA.