A Case Of Topography-Guided Enhancement Surgery After Innoveyes Sightmap Light-Trace Guided Excimer Laser Surgery

Poor visual acuity was noted in the left eye following InnovEyes Sightmap light-trace guided excimer laser surgery. The patient complained of significant inferior ghosting, with no improvement in visual function during 6 months of follow-up. A topography-guided enhancement excimer laser surgery was performed to improve visual acuity and quality of vision.

Tianjin Aier Eye Hospital

The postoperative refraction of the left eye was 0/−1.25 DS × 88°.
Sightmap examination showed that under a 4‑mm pupil, total ocular higher‑order aberrations were 0.237, spherical aberration −0.056, and coma 0.237.Pentacam examination revealed corneal higher‑order aberrations of 0.748 under a 4‑mm pupil, with relatively high curvature in the inferocentral cornea.

Six months after the primary surgery, after refraction stability was achieved, topography‑guided (TOPO‑G) ablation was performed on the left eye to eliminate total corneal aberrations and compensate lower‑order aberrations using C12 compensation.
Repeated manifest refraction demonstrated a large discrepancy between subjective refraction and the cylinder power and axis derived from the topography‑guided mode.

According to the C12 compensation principle, spherical compensation of +0.06 D was applied.
The final surgical plan was as follows: optical zone 6.5 mm, spherical power −0.34 D, cylindrical power 0.

The procedure was performed by relifting the original corneal flap. After flap lifting, the treatment plan was loaded, iris registration was performed, and customized excimer laser ablation was conducted. The corneal interface was irrigated, and the corneal flap was repositioned to complete the procedure.

After the enhancement surgery, uncorrected visual acuity of the left eye reached 1.0, with refraction +0.50/−1.25 DS × 85°. Inferior ghosting resolved completely.

Total ocular higher-order aberrations and corneal higher-order aberrations were significantly decreased after the enhancement surgery, and corneal morphology became more regular. The patient was satisfied with the postoperative outcome.

Topography-guided ablation for enhancement surgery after InnovEyes surgery can effectively correct irregular corneal morphology, reduce corneal aberrations, and improve visual acuity.
Although visual acuity was restored postoperatively, the patient still had against-the-rule astigmatism, which requires long-term follow-up.