Wydanie 3/2004

Refractive surgery after previous optical surgery procedures

Iwona Liberek1, Jerzy Szaflik1,2

1LASER Eye Microsurgery Centre in Warsaw
2Department of Ophthalmology Medical University of Warsaw
Head: Jerzy Szaflik, MD, PhD

Summary: Obtained results indicate that TOSCA system enables to obtain good results in the majority of cases of irregular astigmatism related to previous surgery. The use of TOSCA system enables total reduction of glare and double vision and in most cases increases the vision quality. Laser treatment is a widely used and predictable method of correcting refractive errors (2,5,6). Unfortunately, in some cases it results in irregular astigmatism.(7,8) We deal with cases of irregular astigmatism also after previous ophthalmic procedures such as e.g. penetrating keratoplasty, extracapsular cataract extraction, radial keratotomy etc. Asymmetric astigmatism develops also in the process of haze-forming cornea injuries. These types of complications cannot be treated with standard ablation methods using baseline algorithms (1,9,10,11) which do not allow for customised reshaping of the cornea. The use of cornea topography to perform the procedure provides for customised ablation. The aim of refractive surgery after previous ophthalmic procedures is to eliminate the residual errors and, in complex cases, reduce the errors so that appropriate eyeglasses can be selected. The type and performance time of the correction depends on what procedure was performed earlier. The aim of our research has been to evaluate effectiveness and safety of topography-assisted cornea reshaping in treatment of irregular astigmatism developed after previous ophthalmic operations and also to apply this procedure to correct errors developed after lens implantation. Materials and methods: At the LASER Eye Microsurgery Centre in Warsaw, we performed 176 irregular astigmatism correction procedures between January 2002 and July 2004. The group covered by the research included 58 female and 46 male patients at an average age of 27 ? 4.2 (it ranged from 21 and 64 years) Patients qualified for TOSCA procedures included those with astigmatism developed after previous radial keratotomy (9 eyes), penetrating keratoplasty (12 eyes), extracapsular cataract extraction (25 eyes), with decentration after LASIK/LASEK/PRK (9 eyes), patients after previous phakic lens implantation (17 eyes) and patients with primary irregular astigmatism (104 eyes). The analysis covered only cases of astigmatism correction after previous ophthalmic procedures (72 eyes).

Keywords: Topography Supported Customised Ablation, customised ablation, irregular astigmatism.