Two-Step Therapeutic Treatment Of A Patient With Corneal Scarring And Cataract: Corneal Wavefront Guided Phototherapeutic Keratectomy Followed By Aberation Free Iol Implantation

This study aims to assess the outcomes of a two-step therapeutic treatment in a patient with corneal scarring and cataract. The treatment included Corneal Wavefront Guided Phototherapeutic Keratectomy (PTK) to reduce corneal irregularities and High Order Aberrations (HOAs), followed by cataract surgery with Aberation free intraocular lens (IOL) implantation. Preoperative and postoperative assessments of corneal topography, HOAs, and visual acuity were recorded.

Eye Clinic Svjetlost Sarajevo

A 68-year-old male patient presented with poor visual acuity in his right eye. He had history of herpetic keratitis 25 years ago. During a slit-lamp biomicroscope examination, corneal scarring and cataract were observed in his right eye with best-corrected visual acuity (BCVA) of 20/60. Preoperative and postoperative corneal abberrations  were evaluated using high resolution corneal topography device with an aberrometer (Schwind Peramis). Central corneal thickness was 524 microns with stromal opacities at a depth of 170 micorns performed with OCT nxl30 Optopol. Corneal Wavefront Guided PTK was performed using the Schwind Amaris 1050R as a first step in treatment. The laser beam was applied with an epithelial ablation diameter of 9.0 mm and a central ablation depth of 135 microns. Ablation was followed by a 30-second application of Mitomycin-C (0.02%). Month after PTK cataract surgery was performed with the implantation of an aberation free IOL (EnVista Bausch˛&Lomb) to optimize refractive outcomes and visual acuity. Postoperatively, the patient demonstrated a reduction in High Order Aberrations (HOA 1.08 vs. 0.79), as indicated by improved topographic measurements. Visual acuity improved from preoperative BCVA 20/60 to postoperative 20/40. Following PTK, the aberation free IOL implantation contributed to further visual clarity and reduced optical distortions, resulting in BCVA 20/20 postoperatively.

Corneal wavefront guided phototherapeutic keratectomy is an effective approach to reduce corneal irregularities and high-order aberrations in patients with corneal scarring and cataract. Combined with cataract surgery and aspheric IOL implantation, this sequential approach provides significant improvements in visual acuity and quality, offering patients optimal refractive outcomes and a better quality of life.