Factors Predicting Successful Customized Excimer Laser Treatment In Irregular Corneas

Purpose: To identify factors associated with a successful wavefront-guided customized treatment (WG-CT) with an excimer laser in highly aberrated corneas.Setting: VISSUM Alicante Spain.Design: Retrospective consecutive noncomparative case series.Methods: Treatment was performed with the WG-CT Amaris excimer laser using the ORK-CAM software for the calculation of the ablation profile. Eyes of patients with significantly aberrated corneas, including postrefractive and keratoplasty procedures or high irregular astigmatism with significant higher-order aberrations (HOAs) that had WG-CT were included. Refractive outcomes, HOAs, and visual outcomes were recorded. Statistical analysis was performed to identify factors associated with technical (based on HOAs) or refractive outcome success.Results: The study included 55 treatments of 51 eyes (35 patients). The postoperative uncorrected distance visual acuity was 0.2 logarithm of the minimum angle of resolution or better in 72% of the eyes, and the postoperative residual manifest refraction spherical equivalent was +/- 0.50 diopter in 56% of the eyes, whereas 11% of the eyes lost 1 line or more in corrected distance visual acuity. Successful reduction in the total root mean square (RMS) of HOAs occurred in 36 eyes (65%), and these eyes had a significantly higher preoperative RMS of HOAs (1.45 +/- 0.93 mu vs 0.91 +/- 0.34 mu, P = .003) and preoperative coma-like aberrations (1.09 +/- 0.83 mu vs 0.55 +/- 0.28 mu, P = .001). In multivariate analysis, posthyperopic treatment eyes were less likely to achieve refractive outcome success (odds ratio = 0.09, P = .02).Conclusions: WG-CT in highly aberrated corneas had a limited refractive predictability. Eyes with preoperative coma-like aberrations are more likely to benefit from a reduction in HOAs. Post-hyperopic treatment is associated with a higher rate of refractive surprises. Copyright (C) 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS