Topography-guided neutralization technique for the Mx of fla
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Background:Laser in situ keratomileusis (LASIK) is the most popular surgical procedure for the correction of myopia, hyperopia, and astigmatism. Using a lamellar flap, LASIK provides faster visual recovery and comparatively less pain than photorefractive keratectomy. Flap loss is potentially devastating and can lead to haze formation and irregular epithelial growth.Topography - Guided Custom Ablation Treatment (TCAT) has been used to correct irregular astigmatism in highly aberrated and irregular corneas associated with keratoconus and post-LASIK ectasia. Case Report: A 29-year-old male was referred to us with complaints of diminution of vision in the right eye for the past 4 months after having undergone LASIK with a 90 Mu Moria-microkeratome head. While the surgery in the left eye had been uneventful, there was a flap loss in the right eye. Excimer laser ablation had not been performed, and a bandage contact lens placed until the epithelium healed before the referral. On presentation, his uncorrected distance visual acuity was 1.0 logMAR in the right eye and 0 logMAR in the left eye. Manifest refraction in the right eye was -2.0 DS-2.75 DC × 175° with a corrected distance visual acuity (CDVA) of 0.1 logMAR. Investigations and Treatment: Anterior segment optical coherence tomography showed an irregular epithelial thickness profile on epithelium thickness mapping and hyperreflectivity in the area of flap loss. On Pentacam HR, the right eye showed irregular corneal topography on the axial curvature map . On iTrace aberrometry, there was increased astigmatism along with increased higher order aberrations in the right eye. A topography-guided treatment for regularization of corneal topography was planned to correct the refractive error using the topographic neutralization technique (TNT) protocol. Corneal topography data were obtained from the Placido-based Allegretto Topolyzer. Phototherapeutic keratectomy (PTK) was chosen as the procedure of choice to remove the corneal epithelium before the topography-guided treatment.
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