Corneal laser surgery has important role in therapeutic treatment
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SAN FRANCISCO — Improved technologies and advanced techniques have given corneal laser surgery a valuable role in therapeutic treatment, according to a presentation here.
At Refractive Surgery Subspecialty Day at the American Academy of Ophthalmology meeting, Simon P. Holland, MD, FRCSC, MRCP, FRCOph, said recent advances in epithelial thickness measurements have changed the way he approaches therapeutic cases.
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“The considerations we’re using in topography-guided laser surgery for therapeutic reasons ... we want consistent symptoms and topography and sufficient pachymetry,” he said. “The more complex the treatment, the less predictable the outcome, at least in our hands.”
Holland said therapeutic laser surgery has several important applications, including in post-LASIK ectasia, irregular astigmatism with corneal scar and corneal dystrophies.
In his clinic, Holland said therapeutic laser surgery has found its greatest use in the treatment of keratoconus. Holland and colleagues conducted a retrospective case series that included 54 patients who underwent topo-guided PRK with corneal cross-linking for keratoconus.
At 24 months, 26% of patients experienced at least two lines of improvement in corrected distance visual acuity. Additionally, about half of patients had 20/40 vision or better, Holland said.
“We can get reasonable results using this technique,” Holland said. “We use a transepithelial, so it’s an epi-off method.”
Holland said therapeutic corneal laser surgery has given surgeons another option to perform procedures that were previously only possible with blades and sutures.
“We believe there is a valuable role when we use the lasers for therapeutic reasons,” Holland said. “We find that cross-linking can extend the range of potential treatments in thin or ectatic corneas.”
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Holland SP, et al. Therapeutic laser surgery. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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