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Utility of epithelial mapping in diagnosis and management of irregular astigmatism after surface ablation

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First Author: C.Perez-Straziota USA

Co Author(s):    J. Randleman                    

Abstract Details


To report the diagnosis and management of postoperative irregular astigmatism using ocular coherence tomography (OCT) based epithelial thickness mapping.


US Academic Medical Center


Case report


A 41 year old female complained of blurred vision in the right eye that was not correctible with spectacles. Past history was significant for uneventful LASIK in both eyes 20 years prior, with PRK retreatment 1 year prior to presentation with subsequent enhancement performed with conductive keratoplasty (CK) applied in the corneal periphery. Examination of the affected eye was notable for well positioned LASIK flap with faint peripheral opacities corresponding to previous CK. Scheimpflug tomography was notable for central flattening in an irregular pattern, with a seemingly displaced flattest point outside the visual axis and more than 2 diopters of central curvature irregularity. Epithelial thickness mapping obtained with OCT displayed an irregular thickening pattern corresponding to the least flat central region. The maximal thinnest total thickness point was well centered. Instead of topography-guided retreatment, superficial keratectomy without ablation was performed, resulting in resolution of central irregularity, near regularization of the epithelial thickness pattern, and uncorrected acuity of 20/20 in the affected eye.


Epithelial thickness mapping from OCT revealed the appropriate diagnosis of irregular epithelial hypertrophy from previous CK rather than decentered ablation and guided appropriate management that resulted in optimal visual recovery. Without epithelial mapping a topography-guided ablation may have been undertaken, which would have resulted in a suboptimal outcome.

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