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Laser refractive surgery effective in eyes with superior corneal steepening
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Corneal refractive surgery yielded satisfactory visual and refractive outcomes in eyes with superior corneal steepening and no associated ocular pathology, a study found.
“The results demonstrate significant improvement in postoperative [uncorrected distance visual acuity] in all eyes when compared to preoperative values, with high safety and satisfactory efficacy,” the study authors said.
The retrospective study included 29 eyes of 16 patients with persistent topographic corneal steepening who underwent laser refractive surgery; 22 eyes underwent PRK and seven eyes underwent LASIK. Mean patient age was 31.6 years.
Preoperatively, the mean inferior to superior keratometric difference was 1.61 D. Mean spherical equivalent refraction was 4.45 D; mean topographic corneal astigmatism was 1.44 D; mean logMAR uncorrected distance visual acuity was 1.57; and mean corrected distance visual acuity was 0.02.
The Allegretto Wave 200 Hz excimer laser (Alcon) was used in all procedures. The Carriazo-Pendular microkeratome (Schwind) was used to create all LASIK flaps. Mean follow-up was 27.38 months.
Study results showed that mean postoperative spherical equivalent refraction was –0.09 D. The change was statistically significant (P < .05). Mean postoperative topographic corneal astigmatism was 0.66 D at 3 months; the decrease was statistically significant (P < .05). Topographic astigmatism remained stable throughout the follow-up interval.
Mean postoperative uncorrected distance visual acuity was 0.00; mean corrected distance visual acuity was –0.02. Both gains were statistically significant (P < .05).
Mean steep keratometry diminished significantly, from 43.44 D preoperatively to 39.20 D at 3 months postoperatively (P < .05). Steep keratometry remained stable at 12 months and 24 months.
No intraoperative or postoperative complications were reported.
Perspective
Back to TopDavid R. Hardten, MD
Kymionis and co-authors describe an interesting set of patients with superior corneal steepening that had LASIK or PRK with non-wavefront driven excimer ablations. These patients had acceptable results, although not as good as we would expect in general with modern corneal refractive surgery. It is important to rule out other reasons for superior steepening in patients as the authors point out, and common reasons are contact lens warpage, ocular surface disease, and ptosis. Asymmetry can also be seen in patients with superficial corneal scars, and superior keratoconus has been reported, although is very rare. My experience in patients like this has also been quite good, especially with custom wavefront driven treatments, often with improvement in topographic irregularity, rather than the persistence of superior steepening as seen in their topographic examples. I have preferred PRK, as often I have missed on the slit lamp examination subtle corneal scars or basement membrane dystrophy that may also lead to topographic abnormalities such as these.
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J Refract Surg. 2012;28(7):462-467.
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