Transepithelial Topography-Guided Ablation Assisted by Epithelial Thickness Mapping for Treatment of Regression After Myopic Refractive Surgery

Abstract

To evaluate the outcomes of transepithelial, topography-guided, epithelial mapping-assisted ablation in the treatment of regression after myopic refractive surgery. A retrospective consecutive case series of 70 eyes of 52 patients with regression after previous corneal refractive surgery for treatment of myopic and compound myopic astigmatism underwent re-treatment using transepithelial topography-guided and epithelial mapping-assisted custom ablation with a wide and smooth transition zone design. The ablation profile was based on data from corneal topography, whereas the epithelial ablation depth was decided by corneal epithelial mapping obtained by optical coherence tomography. The mean follow-up time after re-treatment was 13.6 ± 9.4 months (range: 6 to 51 months). At the patients' last follow-up visit, 98.5% and 76.5% had uncorrected distance visual acuity of 20/40 and 20/20 or better. Safety and efficacy indexes were 1.05 and 0.92, respectively. The mean spherical equivalent was reduced from -1.10 ± 0.65 to -0.16 ± 0.34 diopters. Both total root mean square, odd-order, and even-order higher order aberrations improved significantly (P = .021, .040, and .030, respectively), whereas corneal asphericity remained unchanged (P = .662). Epithelial thickness profile showed significant smoothing between the central 2-mm and 2- to 5-mm paracentral areas. Transepithelial topography-guided and epithelial mapping-assisted custom re-treatment with a wide and smooth transition zone design is safe and effective for addressing myopic regression in patients who have previously undergone myopic refractive surgery. [J Refract Surg. 2019;35(8):525-533.].