Corneal Remodeling Using Laser Asymmetric Keratectomy in Patients with Keratoconus Suspect

Background: To assess laser epithelial keratomileusis (LASEK) linked laser asymmetric keratectomy (L-LAK) treatment outcome for keratoconus suspect (KCS) by evaluating corneal regularity in order to avoid the postoperative corneal ectasia which is one of the leading challenges in laser refractive surgery. Methods: In this retrospective case control study, 34 eyes of 20 patients with KCS were studed before and 1-year after L-LAK. A new corneal remodeling technique with L-LAK could correct the original refractive errors (original ablation), and ablate on the thicker peripheral cornea with integration of Vision UP software® to make cornea to be symmetric, and ablate induced myopia due to LAK simultaneously (crescentic customized ablation). The main outcome measures between preoperative and postoperative 1-year were refraction, visual acuity (UDVA), keratometry, corneal symmetry evaluating as the total corneal central-thickness deviations in four directions on an Orbscan map (SUM) and the distance between the maximum posterior elevation (best-fit-sphere BFS) and the visual axis (DISTANCE). Results: 20 patients with KCS aged 41.0±13.5 years. Preoperatively the spherical equivalent (SE, D) -2.57±1.64, Kmax was +48.21±0.89D. At the postoperative 1-year, 79.4% (27/34) of eyes had an UDVA of 20/20 or better.SE and Kmax (D) were -0.40±0.43,44.47±1.38) (Ps=0.001, respectively), corneal symmetry increased markedly due to decrease SUM (µm) (from 141.88±48.24 to 66.21±15.22) and DISTANCE (mm) (from 1.11±1.14 to 0.46±0.40), No postoperative corneal ectasia was showed. Conclusions: L-LAK made cornea be symmetric by decreasing the SUM and DISTANCE, and decreased focal steepening, and showed good postoperative 1-year outcomes.