Corneal wavefront-guided photorefractive keratectomy in patients with irregular corneas after corneal refractive surgery

PURPOSE: To evaluate the corrective potential of corneal wavefront-guided photorefractive keratectomy (PRK) in patients with high levels of corneal aberrations and symptoms after previous corneal refractive surgery. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: This study comprised 25 eyes (20 patients) that had 1 or more previous unsuccessful keratorefractive procedure. All eyes had PRK retreatment using the Esiris excimer laser and ORK-CAM software for customized ablation design. All eyes had a high preoperative level of corneal higher-order aberrations (HOAs) (coma-like or spherical-like root mean square [RMS] >0.5 microm). Changes in refractive outcomes, subjective symptoms, and corneal aberrometry were evaluated during a 6-month follow-up. RESULTS: Uncorrected visual acuity improved significantly from preoperatively (mean 0.48) to 6 months after retreatment (mean 0.75) (P<.01). The mean best spectacle-corrected visual acuity (BSCVA) also improved significantly, from 0.78 to 0.90, respectively (P<.01). Forty-four percent of patients gained 1 or more lines of BSCVA. The reduction in cylinder at 6 months was statistically significant (P= .01). Corneal aberrometry at 6 months showed a statistically significant reduction in total (P= .01), spherical-like (P<.01), coma-like (P= .02), and primary coma (P<.01) RMS. At 6 months, 72% of patients had low or no perception of halos and all reported no glare. CONCLUSION: Corneal wavefront-guided PRK enhancement with the ORK-CAM system minimized corneal HOAs in eyes with previous unsuccessful keratorefractive surgery.