Topography-guided Laser in situ Keratomileusis (TOPOLINK) to Correct Irregular Astigmatism After Previous Refractive Surgery

ABSTRACT PURPOSE: To assess whether topography-driven laser in situ keratomileusis (LASIK) can correct induced corneal irregular astigmatism. METHODS: A prospective non-comparative case series of 41 eyes (38 patients) with irregular astigmatism following corneal refractive surgery, included two groups: Group 1 (26 eyes) with a defined topographic pattern and Group 2 (15 eyes) with no pattern. Ablation was performed using the Technolas 217C excimer laser with a software ablation program (TOPOLINK) based on corneal topography. Uncorrected and best spectacle-corrected visual acuity, manifest and cycloplegic refraction, corneal topography, superficial corneal surface quality, and image distortion were measured. RESULTS: At 6 months follow-up in Group 1 eyes (defined topographic pattern) mean preoperative BSCVA improved from 0.16 ± 0.11 LogMAR (0.4 to 0) to 0.09 ± 0.10 LogMAR (0.2 to 0) (P=.001) (safety index of 1.1). In Group 2 eyes (no pattern), mean preoperative BSCVA was 0.18 ± 0.11 LogMAR (0.4 to 0), similar to the postoperative BSCVA of 0.17 ± 0.10 LogMAR (0.3 to 0) (safety index of 0.98). Mean postoperative UCVA was 3*0.3 LogMAR in 25 eyes (96.2%) in Group 1 (efficacy index of 0.8) and 7 eyes (46.6%) in Group 2 (efficacy index of 0.5). Both superficial corneal surface quality and image distortion significantly improved in Group 1; there were no significant changes in Group 2. We reoperated nine eyes (21.9%). CONCLUSIONS: Topographic-assisted LASIK was helpful in selected cases where irregular astigmatism showed a pattern. It was ineffective in undefined irregular astigmatism. Partial correction of the irregularity and regression of the obtained effect was common. [J Refract Surg 2003;19:516-527]