T opography-guided excimer ablation uses highresolution corneal topographic height maps to generate a customized ablation profile consisting of anterior corneal higher order aberrations (HOAs) and an accurate measure of the anterior corneal astigmatism (ACA). Topography-guided custom ablation treatment (T-CAT, now called Contoura) (Alcon Laboratories, Inc., Fort Worth, TX; Contoura in the United States) has been approved by the U.S. Food and Drug Administration (FDA) for primary laser in situ keratomileusis (LASIK) in myopic and myopic astigmatism eyes, with resulting good efficacy and safety. 1 However, this trial and its subsequent publication excluded eyes with naturally occurring irregular astigmatism. Healthy corneas with skewed radial axes, non-orthogonal cylinder, and asymmetric bowties were excluded to standardize the preoperative cohort, maximize outcomes, and avoid refractive surprises. 1,2 T-CAT refractive predictability can be a concern with increasing corneal irregularities and elevated anterior corneal HOAs. 3 Eyes with greater cylinder magnitude, particularly those with irregular astigmatism, have more anterior corneal HOAs. 4,5 They also have a greater discrepancy between subjective refractive astigmatism and topography-measured ACA, 6

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Thromboembolic events in the context of carbon monoxide (CO) exposure have been well described in the literature. Six cases of clinically significant coronary thrombosis following CO exposure were previously reported. However, factors affecting the development of coronary thrombus in CO exposure are poorly understood, and the significance of this finding in a forensic context is not clear. This article discusses a case of coronary thrombosis found at autopsy following a death in which CO poisoning was suspected. A 67-year-old man was found dead in his garage with four vehicles with their ignition in the "on" position and their tanks empty. At autopsy, severe coronary atherosclerosis and an acute nonocclusive coronary thrombus were found. Given the dissimilarities among cases and the presence of CO exposure, it was suggested that the coronary artery thrombosis is likely due to the inherent prothrombotic mechanism of CO, the only common denominator in all the cases.

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