Refractive Rehabilitation: Predictors Of Wavefront-Guided Laser Efficacy In Irregular Corneas
Published 2025 - 43rd Congress of the ESCRS
Reference: FP30.04 | Type: Free paper | DOI: 10.82333/qj1b-kj89
Authors: Benjamin Stern* 1 , Damien Gatinel 2 , Georges Nicolaos 3 , Alice Grise-Dulac 2
1Ophthalmology,Hadassah-Hebrew University Medical Center,Jerusalem,Israel;Anterior Segment and Refractive Surgery,Rothschild Foundation Hospital,Paris,France, 2Anterior Segment and Refractive Surgery,Rothschild Foundation Hospital,Paris,France, 3Pharmacy,Rothschild Foundation Hospital,Paris,France
Purpose
To evaluate the predictive factors influencing the effectiveness of wavefront-guided customized excimer laser treatments (WG-CT) in corneas with significant aberrations.
Setting
Vissum Grupo Miranza, Alicante, Spain
Methods
The study examined outcomes following WG-CT using the Amaris excimer laser. Included were patients with severe corneal irregularities with significant higher-order aberrations (HOAs). The investigation focused on refractive accuracy, HOA and LOA modifications and visual acuity improvements. Statistical models were applied to determine key predictors of success in technical (HOA and LOA -based) and refractive outcomes. A reduction of 0.1 μm in RMS of total HOAs and coma-like or spherical-like aberrations was considered a success in correcting HOAs. No refractive surprise of more than 1.5 diopters (D) was found in spherical or cylindrical outcomes was considered a success in correcting LOAs.
Results
Among the HOA correction group (N=73),patients were classified in two groups successful reduction of HOAs group 48 eyes, while 25 eyes were classified as failure. A multivariate regression model identified predictors for successful HOA correction:Age (OR=0.66,p=0.042),higher preoperative K-Flat Axis (OR=1.08, p=0.039), and increased preoperative asphericity at 4.5 mm(OR = 1.73,p = 0.028).In the LOA correction group (N=86), successful correction group includes 70 eyes, while 16 eyes were classified as failures. A multivariate regression model was performed with the following predictors:lower preoperative RMS Coma (OR=0.33,p =0.0346),and corneal Zernike coefficient Z(4,-4)(OR=0.02,p=0.0302),where associated with improved correction outcomes.
Conclusions
Successful HOA correction following wavefront-guided customized treatments is influenced by age, higher preoperative K-Flat Axis values, and increased preoperative asphericity, all of which are independently associated with improved outcomes. Similarly, lower preoperative RMS coma values and reduced preoperative corneal Zernike coefficient Z(4,-4) are linked to greater success in LOA correction. Identifying these favorable predictors may help refine patient selection and optimize treatment strategies to enhance both HOA and LOA correction outcomes.