Wavefront-Guided Photorefractive Keratectomy in the Treatment of High Astigmatism Following Keratoplasty

Abstract

Purpose: To report the outcome of wavefront-guided photorefractive keratectomy (WG-PRK) in the treatment of high astigmatism following keratoplasty. Methods: A retrospective, interventional analysis including patients with high astigmatism following either penetrating keratoplasty or deep anterior lamellar keratoplasty, who underwent WG-PRK. Results: Thirteen eyes (7 right eyes) of 12 patients (10 male) aged 35.1 ± 5.9 years were included. Preoperative astigmatism ranged between 3.00 and 5.00 D. Average follow-up time was 14.0 ± 6.2 months. Uncorrected distance visual acuity (UDVA) improved from 0.97 ± 0.58 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent ∼20/187) preoperatively to 0.13 ± 0.15 logMAR (Snellen equivalent ∼20/27) at 6 months and 0.14 ± 0.16 logMAR (Snellen equivalent ∼20/28) at the final follow-up (P = 0.001 and P = 0.002, respectively). UDVA ≥20/40 increased from 1 eye (7.7%) preoperatively to 13 eyes (100%) at 6 months and 12 eyes (92.3%) at the final follow-up (P < 0.001 for both). UDVA ≥20/25 increased from 1 eye (7.7%) preoperatively to 6 eyes (46.2%) at 6 months and at the final follow-up (P = 0.027 for both). Mean astigmatism improved from −3.98 ± 0.75 D to −1.27 ± 0.82 D and −1.40 ± 1.04 at 6 months and at the last follow-up, respectively (P = 0.001 for both). Preoperative astigmatism was ≥3.00 D in all eyes and was reduced to ≤2.50 D in all eyes at 6 months postoperatively, with 7 eyes (63.6%) having ≤1.00 D of astigmatism at both 6 months and the final follow-up. Conclusions: WG-PRK was safe and effective in the treatment of high and regular postkeratoplasty astigmatism.

Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: prospective study

“…16–21 Although 5 published studies of PRK for PKA compared favorably with ours, our subjects' initial corrected vision was significantly worse. 14,22–35…”

Visual outcomes of photorefractive keratectomy in the treatment of moderate to high astigmatism

“…Furthermore, the two wavefront-optimized and wavefront-guided methods in PRK were compared and found that both methods are appropriate and effective for correcting moderate to high astigmatism, but in wavefront-guided method, astigmatism axis correction is more predictable and less aberration was induced [18]. A study by Sorkin et al showed that wavefront-guided is appropriate and effective in the treatment of high and regular astigmatisms after keratoplasty [19], and other studies showed that non-wavefront-guided PRK in the treatment of moderate to high astigmatism resulted in excellent visual outcomes [20].…”

Aberrometric, Keratometric, and Visual Outcomes After Trans-Epithelial Topography-Guided Phototherapeutic Keratectomy for the Treatment of Irregular Corneas

“…Only few groups have studied aberrometric changes with TG-PRK for irregular astigmatism after keratoplasty. [15][16][17][18][19] In our study, not only post-keratoplasty patients were included. In our cohort there was a significant decrease in coma from 1.25±1.17 preoperative to 0.84±0.71 at 6 months (P<0.01); these changes remained stable at final follow-up.…”