Topographically Guided Excimer Laser Photorefractive Keratectomy to Treat Superficial Corneal Opacities

Objective: To demonstrate the efficacy and safety of topographically guided excimer laser photorefractive keratectomy (PRK) in treating superficial corneal opacities.

Design: Prospective, noncomparative interventional case series.

Methods: Twenty-six eyes of 24 patients with postinfectious (n = 6), post-traumatic (n = 18), and post-PRK (n = 2) scars were treated with an excimer laser linked to a computerized videokeratography unit with a topographically supported customized ablation workstation.

Main Outcome Measures: Manifest spectacle refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), change of corneal clarity, and topographic indexes of surface regularity.

Results: The mean follow-up period was 7.7+/-2.1 months (+/- standard deviation) (range = 6-12). Corneal clarity and corneal topography patterns improved in all eyes. Uncorrected visual acuity improved from 0.7+/-0.8 logarithm of the minimum angle of resolution (logMAR) to 0.4+/-0.5 logMAR (P = 0.008), and BSCVA improved from 0.3+/-0.6 logMAR to 0.1+/-0.6 logMAR (P<0.001). The BSCVA increased in all eyes (>/=2 lines in 76.9% of eyes and 1 line in 23.1%). The mean spherical equivalent refraction changed from -0.125+/-2.77 diopters (D) to +1.33+/-1.28 D (P = 0.019).

Conclusions: The use of topographically guided PRK with the topographically supported customized ablation method resulted in significant increases of UCVA and BSCVA and improved corneal clarity in all patients. The technique seems to be safe and effective for treating various superficial corneal diseases, including postinfectious, post-traumatic, and post-PRK scars.