Topography-assisted correction of superficial irregularities of the cornea with the excimer laser

Abstract

A retinal image performance distorted by an asymmetric or irregular corneal surface cannot be compensated for with spherocylindric glasses completely. The best-corrected visual acuity is markedly decreased and contact lens fitting often impossible. The purpose of this study was to calculate the differential height between corneal topography raw data and any regular surface with mathematical methods in order to ablate the differential height with a computer-controlled laser beam, thereafter. A Zernike decomposition of radial degree n = 16 was realized within a clinically relevant central corneal area of 8 mm in diameter based on corneal topography raw height data of a commercially available topographer (TMS-1, Tomey, Erlangen). Any target surface could be defined by varying weighting of the Zernike coefficients. The calculated differential height ablation between the raw data and the target surface given in a polar grid was transformed to a Cartesian grid to evaluate the sleeping time at each grid position considering the characteristic ablation curve for the intended ablation of the height difference. Subsequently, differential height ablation was simulated using an automated laser beam control for a modified excimer laser (MEL60, Aesculap-Meditec, Jena). We developed software tools for Zernike decomposition of corneal topography raw height data and time-regulated automatic laser beam control of the grid positions in the higher programming language C (Borland C++ 3.1, Borland Inc., München). Definition of a target surface can be realized alternatively by selecting a set of Zernike coefficients or defining a spherical or spherocylindrical surface by superposition of parabolic terms in a fixed proportion creating a best-fit target surface to the raw data. In originally "relatively flat" areas, the differential height profile indicates a "relatively deep" ablation resulting in relative steepening towards the periphery of the ablation zone. The resolution of the mechanical unit of the laser beam control consisting of two linear stepping motors is 9 microns in the focal plane with a reproducibility of 5 microns. The software unit is guiding the laser beam in a meandering fashion within the ablation area considering the calculated sleeping time for each grid position. Mean overlap of the 1 mm laser spots is 70%. The laser beam diameter of 1 mm effects a peripheral transition zone of 0.5 mm. Zernike decomposition of corneal topography height data is an efficient tool for localizing and quantifying superficial irregularities and for directly calculating an ablation profile from created differential height data. With an automatic laser beam control a well-defined laser ablation of superficial corneal irregularities is possible, subsequently.