A Data-Integrated Strategy (Dilated Wavefront + Ms-39 + Scc + Foresight) To Restore Vision In A Post-Ctk Irregular Cornea 6 Years After Prk

To report a complex visual rehabilitation case demonstrating how dilated ocular wavefront capture, combined with static cyclotorsion compensation (SCC), MS-39–based diagnostic navigation, and Foresight simulation, can improve outcomes in an irregular cornea following an adverse post-PRK course consistent with central toxic keratopathy (CTK).

Tertiary cornea/refractive practice.

A patient presented with persistent reduced visual quality and irregular astigmatism after an adverse reaction following PRK performed 6 years earlier, with clinical features consistent with CTK-related corneal irregularity and symptomatic glare/ghosting. Conventional wavefront measurements were limited under natural pupil conditions. A strategy using pharmacologically dilated wavefront capture was employed to improve aberration sampling and repeatability. Corneal shape and layer information were integrated using MS-39 anterior segment imaging to support centration, assess surface regularity, and guide a conservative treatment plan. Foresight planning was used to preview the anticipated postoperative corneal optics and verify tissue safety. Treatment delivery incorporated SCC to reduce rotational misalignment risk in an eye with complex optics.

Post-treatment, the patient experienced a meaningful improvement in corrected visual function and subjective quality of vision (reduced glare/ghosting and improved day-to-day visual usability). Diagnostic follow-up demonstrated improved corneal regularity and a more favorable optical aberration profile. No intraoperative complications or unexpected postoperative adverse events were observed over follow-up of 8 months. This integrated workflow may be valuable for select irregular cornea retreatments where standard measurements are unreliable.