Poor LASIK outcome re-treated with surface CustomCornea

A 27-year-old man complains of poor vision with ghost images in his right eye.

Issue: September 1, 2004

ByBarrie D. Soloway, MD

History: The patient is a 27-year-old Asian man who presented with a poor result after prior LASIK surgery in his right eye. Records showed the original prescription was —4.00 —1.50 × 10, BCVA 20/20 and normal topography (Figure 1). He underwent uneventful LASIK on June 4, 1999, with the Visx Star laser and Bausch & Lomb Hansatome, resulting in a superiorly decentered ablation (Figure 2). He complained of poor vision with ghost images, especially at night, consistent with the elevated levels of higher-order aberrations of coma and spherical aberration as measured on the LADARWave aberrometer (Figure 4). Aberrometry and laser treatment algorithm (Figure 6) were stable over the 5-month period from June to October 2003. This algorithm showed treatment for the coma as well as expansion of the optical zone for spherical aberration reduction. Due to a pachymetry of 444 (Orbscan) and 433 (ultrasound), a surface CustomCornea treatment using mitomycin-C and an offset of +0.5 D was performed on Oct. 31, 2003.

Preoperative examination:
UCVA: 20/40
Manifest refraction: +0.50 –1.00 × 20
Visual acuity: 20/40 with complaints of glare and halo
Procedure: Surface LADARVision CustomCornea (Alcon) offset +0.5 D re-treatment of prior LASIK with mitomycin-C 0.02%

Postoperative examination:
UCVA: 20/25
Refraction: Plano –0.75 × 120
BCVA: 20/20
Lower-order aberrations (sphere and cylinder): Reduced by 79%
Vertical and horizontal coma: Reduced by 74%
Spherical aberration: Reduced by 64%

Discussion: The patient’s outcome using the CustomCornea treatment is terrific. He has 20/25 UCVA and 20/20 BCVA. More important, he no longer reports the non-acuity related visual disturbances that he had before the re-treatment, and he is able to drive at night again. Postoperative topography (Figure 3) shows recentration and enlargement of the optical zone. Postoperative LADARWave higher-order aberrometry (Figure 5) shows the decrease in coma and spherical aberration. The ability of the LADARWave to capture accurate large diameter wavefront data in a postoperative eye and the registration of this information with CustomCornea were clearly advantages for this patient. He was able to significantly correct his vision in a way that was not possible with spectacles and contact lenses.

Topography before any treatment.	Topography of the decentered post-LASIK eye.
Topography of the post CustomCornea re-treatment.
LADARWave study of the decentered treatment.	LADARWave study of the post CustomCornea treatment.
CustomCornea treatment for recentration and enlargement of the optical zone. Images: Soloway BD

For Your Information:

Barrie D. Soloway, MD, FACS, is the director of vision correction at The New York Eye and Ear Infirmary and an assistant professor of ophthalmology at The New York Medical College. He can be reached at 160 E. 56th St., Ninth Floor, New York, NY 10022; 212-758-3838; fax: 212-758-4175; e-mail: bsolowaymd@pol.net; Web site: www.ihateglasses.com. Dr. Soloway is a Medical Advisory Board Member of Alcon Labs.