Strategic planning in topography-guided ablation of irregular astigmatism after laser refractive surgery.

PURPOSE To identify an optimal customized ablation strategy in the treatment of eyes with secondary irregular astigmatism. METHODS Corneal anterior surface elevation maps of 50 eyes with secondary irregular astigmatism after decentered laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) and 50 virgin eyes were used for customized ablation simulations. Two ablation simulations with targeted postoperative surfaces perpendicular to either the visual or corneal morphological axis were made for each eye. All ablations were programmed for correction of corneal irregularities, including corneal astigmatism. The manifest refractive error was not corrected. Optical diameter was 6.5 mm and total diameter was 7.5 mm. Maximum ablation depths and maximum transition zone gradients were registered and analyzed. RESULTS In eyes with secondary irregular astigmatism, mean maximum ablation depth was 48.21 +/- 25.96 microm and 26.31+/- 14.08 microm, whereas mean maximum transition zone gradient was 29.07 +/- 25.15 microm and 9.88 +/- 6.41 microm in ablation simulations based on the visual and corneal morphological axes, respectively. The difference between the ablation strategies was highly statistically significant for both parameters (P < .001). In virgin eyes, only a minor difference was noted between the visual and corneal morphological axis ablation simulations (P = .15 for maximum ablation depths and P=.19 for maximum transition zone gradient). CONCLUSIONS In secondary irregular astigmatism, ablation based on the corneal morphological axis appears to minimize corneal tissue consumption and allows a smoother transition zone.