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Custom Topographic Neutralizing Technique (TNT) with Topographically-Guided (TG) laser to correct complications

Custom Topographic Neutralizing Technique (TNT) with Topographically-Guided (TG) laser to correct complications. David T.C Lin Simon Holland ASCRS 2010 Boston, MA *no financial interests. Aim. Evaluate custom Topographic Neutralizing Technique (TNT) using the Allegretto Wavelight laser

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Custom Topographic Neutralizing Technique (TNT) with Topographically-Guided (TG) laser to correct complications

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  1. Custom Topographic Neutralizing Technique (TNT) with Topographically-Guided (TG) laser to correct complications David T.C Lin Simon Holland ASCRS 2010 Boston, MA *no financial interests

  2. Aim • Evaluate custom Topographic Neutralizing Technique (TNT) using the Allegretto Wavelight laser • Aberrated eyes including enlargement of small optical zones (OZ) and decentered ablation

  3. Methods • Retrospective consecutive case series • 53 eyes: decentered ablations • 62 eyes: symptomatic small optical zones, previously treated laser refractive surgery underwent topography-guided retreatment with Wavelight laser • Follow-up: 1, 3, and 6 months • Patient evaluation: symptom score, safety

  4. Results • Results at six months and one year: UCVA, BSCVA, topography, and predictability of centration from pupil center (0.92-0.30mm) • 24% of eyes ≥1 lines; 71% no change • 53 eyes with small optical zones: increase central monodioptric optical zone, 3.9-5.6mm • All eyes improved astigmatism, range 1.25-6.75D • Symptoms improved or resolved in 82% (n=47, DA and OZ), 18% no change

  5. TG LASIK Retreatment for OZ Enlargement 6 years post LASIK (-4 D) Pre-op : +1.00 6mths post-op BSCVA : 20/20 UCVA : 20/30 TGL Tx: +0.76 Rx :+0.50-0.50x90 20/20

  6. TG LASIK Retreatment for OZ Enlargement 9 years post LASIK (-5.25-2.25x2) Pre-op : -0.50-0.50x75 6 month pos-top BSCVA : 20/25 UCVA : 20/25- TGL Tx: -0.87 Rx :-0.25-0.25x60 20/20

  7. TG LASIK Retreatment for OZ Enlargement 5.5 years post LASIK (-5.25-1.00x10) Pre-op : -0.75-0.25x5 6 months post-op BSCVA : 20/20 UCVA : 20/20 TGL Tx: -0.99-0.24x180 Rx : -0.25 20/20

  8. TG LASIK Retreatment for Decentration 5 years post LASIK (-9.50-1.25x75) Pre-op : -1.25-0.75x70 3 months post-op BSCVA : 20/20 UCVA : 20/20 TGL Tx: -1.71-0.48x88 Rx : -0.25 20/20

  9. TG LASIK Retreatment for Decentration 3 years post LASIK (-9.00-0.50x180) Pre-op : -1.75 22 months post-op BSCVA : 20/20 UCVA : 20/20 TGL Tx: -2.19-0.24x170 Rx : +0.25 20/20

  10. TG LASIK Retreatment for Decentration 11 years post LASIK (-3.75) Pre-op : +1.50 1 month pos-top BSCVA : 20/250 UCVA : 20/25 TGL Tx: +1.53 Rx : -0.50-0.25x45 20/20

  11. Discussion: Challenges in Treating Irregular Astigmatism Treatment planning difficult Induced refractive error - Topographic Neutralization method (TNT) can usually avoid need for 2 stage treatment Patients need to have realistic expectations Presently may be best surgical option for symptomatic patients with DA and small OZ (e.g. when poor wavefront capture )

  12. Conclusions • Topographic-guided ablation using the Allegretto Wavelight laser is safe and effective in the management of highly aberrated corneas after laser refractive surgery • Treatment planning is challenging (predictability, Q factor correction), but can be improved by the Topographic Neutralization Technique

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