Analysis of planning strategies in primary eyes gaining a line or more of visual acuity after topography-guided laser in situ keratomileusis

• Published in: Journal of cataract and refractive surgery Vol. 45; no. 3; pp. 321 - 327
• Main Authors: De Stefano, Vinicius S., Meister, Caio, Ehlke, Germano L., Krueger, Ronald R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2019
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2018.10.040

To analyze planning strategies for eyes that gained 1 or more lines of corrected distance visual acuity (CDVA) after topography-guided custom treatment (TCAT).
Refractive Surgery Clinic, Cleveland Clinic, Ohio, USA.
Retrospective case series.
Eyes having TCAT by the same surgeon between February 2016 and June 2017 were enrolled. The corneal shape was captured with the Wavelight Allegretto Topolyzer diagnostic device coupled with refraction, generating an ablation profile. The cylinder magnitude and axis of laser entry were decided by the surgeon based on the manifest and measured values, assisted by additional data from the Pentacam Scheimpflug tomographer and Ladarwave ocular wavefront aberrometer.
The study comprised 256 eyes. At 3 months, uncorrected distance visual acuity was 20/20 or better in 95.7% and 20/15 or better in 81.4%; 25.6% gained 1 or more lines of CDVA. The measured and manifest axes differed by less than 15 degrees in 59%, between 15 degrees and 30 degrees in 18%, and by more than 30 degrees in 23%. When it differed by at least 5 degrees, the measured axis was treated in 79%, 75%, and 73% of eyes, respectively. In eyes with higher measured cylinder, 75% were treated between the manifest and measured values, with 7% at full measured value. When the manifest value was greater, 60% were treated at the total measured value and 40% in between. Whole-eye aberrometry showed a small increase in coma, spherical aberration and the total root mean square (all P < .001).
The TCAT procedure achieved visual acuity better than the preoperative CDVA in more than 25.0% of eyes. Tomography and wavefront aberrometry assisted in the selection process to achieve optimum visual outcomes.