Very high-frequency digital ultrasound evaluation of topography-wavefront-guided repair after radial keratotomy

We report a topography-wavefront-guided repair procedure in a patient with a decentered optical zone and significant higher-order aberrations (HOAs) following radial keratotomy 14 years previously. The CRS-Master custom ablation software was used to generate a topography-wavefront-guided ablation profile based on Atlas front corneal surface topography data, and the MEL 80 excimer laser was used to treat the patient. Very high-frequency digital ultrasound scanning (Artemis) was performed before and after surgery to measure epithelial and stromal thickness changes to evaluate the anatomical congruity of the planned and achieved irregular ablation. Nine months postoperatively, the optical zone centration was topographically improved and HOAs were significantly lower, with a 90% reduction in spherical aberration. The stromal thickness change map demonstrated that the profile of stromal tissue removed matched the irregular ablation profile. However, the measured stromal thickness change at the maximum point was 33% higher than the predicted ablation depth. The epithelial thickness change measured in this case indicates that topography-guided treatments could be improved by taking epithelial thickness changes into account.