Corneal Apical Scar After Hyperopic Excimer Laser Refractive Surgery: Long-term Follow-up of Treatment With Sequential Customized Therapeutic Keratectomy.

PURPOSE To evaluate long-term results of sequential customized therapeutic keratectomy (SCTK) in highly aberrated corneas with apical scars consequent to hyperopic excimer laser refractive surgery. METHODS Fifteen eyes of 12 patients treated with SCTK for a corneal apical scar after hyperopic excimer laser refractive surgery were retrospectively evaluated. SCTK is a sequence of custom therapeutic excimer laser keratectomies where the results are monitored step-by-step by intraoperative corneal topography. In the preoperative and postoperative course, corrected distance visual acuity (CDVA), corneal topography and aberrometry, Scheimpflug tomography, and anterior segment optical coherence tomography were compared before and after SCTK. RESULTS The postoperative follow-up comprised 7 patients with 1 year and 8 patients with more than 2 years of follow-up. Functional results showed a significant increase of CDVA from 0.36 ± 0.31 to 0.14 ± 0.25 logMAR at the last available follow-up. Mean sphere did not change significantly from the baseline, demonstrating that SCTK does not induce hyperopic shift. Higher order aberrations decreased significantly from 2.57 ± 1.92 to 0.80 ± 0.42 µm at the last follow-up. Topographic indexes (irregular astigmatism index, surface asymmetry index, and surface regularity index) showed a significant improvement after SCTK. Pachymetry 3 months postoperatively showed no significant reduction during the entire follow-up in either minimum or central thickness. CONCLUSIONS Long-term results demonstrate that SCTK can treat this sight-threatening complication of hyperopic excimer laser refractive surgery, achieving significant improvements in visual acuity and in many corneal morphological parameters. [J Refract Surg. 2018;34(2):113-120.].