Corneal Apical Scar After Hyperopic Excimer Laser Refractive Surgery: Long-term Follow-up of Treatment With Sequential Customized Therapeutic Keratectomy

Abstract

Long-term results demonstrate that SCTK can treat this sight-threatening complication of hyperopic excimer laser refractive surgery, achieving significant improvements in visual acuity and in many corneal morphological parameters. [J Refract Surg. 2018;34(2):113-120.].

Sequential Customized Therapeutic Keratectomy for Reis-Bücklers' Corneal Dystrophy: Long-term Follow-up

“…The SCTK technique features a multi-step procedure and intraoperative monitoring. [10][11][12] SCTK was performed with the Nidek EC-5000 excimer laser between 2001 and February 2013. All surgical procedures required more than one phase on the same day, as described below.…”

“…Key to this approach was intraoperative topography, a powerful and accurate method to assess the preoperative and intraoperative corneal irregularities and elaborate, when necessary in sequential, repeated steps, a topography-guided ablation aimed at regularizing corneal surface. [10][11][12] A key tool in our surgical treatment of Reis-Bücklers' corneal dystrophy was smoothing with masking fluid. Since 1998, we have demonstrated that phototherapeutic-like smoothing improved corneal stromal surface regularity immediately after PRK and provided better refractive and optical outcomes.…”

“…• The masking fluid is continuously distributed over the corneal surface during ablation using a spatula (eg, Buratto's spatula; ASICO, Westmont, IL). [10][11][12] • The masking fluid is added and evenly distributed with the spatula to maintain a thin layer of fluid and avoid the formation of dry areas.…”

“…We previously published that intraoperative, epithelium-free topography-based corneal aberrometry is a feasible option for custom ablation in highly aberrated eyes. 12 Even if corneal edema might occur, because it is diffused, it is not expected to change the overall shape of the cornea, but only its thickness.…”

“…We previously introduced custom PTK with intraoperative topography (called sequential customized therapeutic keratectomy [SCTK]), for the treatment of irregular corneas. [10][11][12] This surgical technique features a multi-step procedure and intraoperative monitoring. Customized transepithelial excimer laser photoablation and smoothing are applied to remove irregularities and intraoperative topography is performed to verify attained corneal regularity.…”