Use Of Ocular Wavefront Guided T-Prk For Treatment Of Corneal Scar 11 Years After Injury - Ucva From Cf To 20/25 In 30 Seconds

To present a case of 37 year old male patient who had an injury by pine needles over 10 years ago. Using advanced ocular wavefront planning software the patient was treated with a single transepithelial procedure and his VA improved from counting fingers to 20/25.

Universty Eye Clinic Svjetlost, Zagreb, Croatia

Due to the hastily performed debridement during the emergency room visit and low usage of topical steroids a corneal scar was formed in his left eye. This caused an area of partial corneal melting and permanent hazing and scaring 3 mm temporally from the pupil center. The scar was 3mm long, 3mm wide and up to 200 micrometers deep. Anterior elevation maps showed up to 56 microns of depression from an 8 mm BFS. There was also a thinning of the epithelial layer, 40 microns over the damaged area. His UCVA was CF and BCVA with +3.00/-10.00x85 was 20/30 but with pronounced shadows. Ocular wavefront analysis showed very high coma values. Corneal Wavefront RMS was 1.80 microns at 6 mm, ocular wavefront RMS was 0.93. The patient was advised by other centers his only option was to perform a corneal transplant but we presented the option of using custom ablation to attempt to reduce the corneal irregularity and improve his UCVA, BCVA and quality of vision. After a single step  transepithelial procedure on the Schwind Amaris 1050RS using Peramis for ocular wavefront the patient recovered within 5 days. At day 5 his UCVA was 20/25 and BCVA with +1.00/-1.00x85 was 20/15. At follow up visit after 3M he was still 20/25 and has regained full use of his other eye. He has also recovered his stereo acuity and is able to use both eyes. 

We wanted to present this case as based on usual parameters he was advised corneal transplant but we strongly believe there is a large amount of people how would benefit from a low risk wavefront guided treatment as a safe alternative before proceeding with corneal transplant. Our take home message is try a novel procedure even when there is no guarantee of success as a corneal transplant can always be performed.