Myopia Correction With Corneal Lenticule Extraction For Advanced Refractive Correction (Clear) In Patients With Corneal Scarring: A Case Series Study.

Corneal scarring is considered a controindication to Corneal Lenticule Extraction For Advanced Refractive Correction (CLEAR) for myopia correction because of the risk of incomplete corneal cut, difficult lenticule dissection, lenticule tear, and false plane creation. In this case series, we performed Clear in three myopic patients with corneal scarring by adjusting laser energy to enhanche laser cut.   

Centre for Research in Refractive Surgery (Poggibonsi, Italy)

Siena Eye Laser Clinic (Poggibonsi, Italy)

Our case series included three patients with corneal scarring caused by contact-lens-related ulcers. Best corrected visual acuity was 0.0 logMAR, the mean myopic error was -5.0±1.3D and the mean spherical equivalent refractive error (SER) was -5.7±1.1 D. Preoperatively we assessed corneal scarring with Anterior Segment Optical Coherence Tomography (AS-OCT) and we observed scar depth of 2011 microns, 209 microns and 149 microns. To perform Clear, we increased laser energy by 5 % for the anterior lenticule cut and 7% for the posterior lenticule cut with the Ziemer platform. All surgeries were completed with no complications. At post-operative day 1 uncorrected distance visual acuity was 0.0±0.1logMAR, and the mean spherical equivalent error was 0.37±0.5 D. 

This case series demonstrates that CLEAR surgery can represent a safe procedure in patients with corneal scarring for myopia correction. By titrating the laser energy power, we improved the lenticule dissection and reduced the risk of false plane dissection, lenticule tear, or incomplete lenticule cut. Further studies are needed to confirm these preliminary results.