Total Corneal Wavefront-guided Ablation for Optical Improvement of a Patient After Radial Keratotomy and Before Cataract Surgery.

Purpose: To report a case in which a corneal wavefront-guided ablation to regularize the cornea years after radial keratotomy was used as corneal optical improvement before cataract surgery.

Methods: A 68-year-old woman presented with an earlier radial keratotomy treatment and the presence of a nuclear cataract in both eyes. Her uncorrected distance visual acuity (UDVA) was 20/160 or worse in both eyes with J10 or worse for uncorrected near visual acuity, with a correction of +3.50 -1.50 × 110 in the right eye and +4.25 diopter sphere in the left eye. Corrected distance visual acuity (CDVA) improved to 20/40- and 20/50+, respectively. The grading of the cataract was according to Lens Opacities Classification System III: nuclear opalescence (NO) 1.8, cortical cataract (C) 1, and posterior subcapsular (P) cataract 0 in both eyes. A therapeutic corneal wavefront-guided minimized ablation protocol to regularize the cornea years after radial keratotomy was used as corneal optical improvement before cataract surgery. Ablation was performed using the SCHWIND AMARIS excimer laser (SCHWIND eye-tech-solutions). Preoperative and postoperative corneal wave aberrations were analyzed using the MS-39 anterior segment optical coherence tomographer (CSO).

Results: Refraction improved in both eyes, with refractive astigmatism corrected to subclinical levels. UDVA improved to 20/32, CDVA improved to 20/25, and aberrations were reduced by more than 60% compared to preoperative baseline levels. For corneal aberrations, coma, spherical aberration, and tetrafoil were reduced by 38% and 62% (coma), 98%, and 86% (spherical aberration), and 75% and 33% (tetrafoil), in the right and left eyes, respectively. The patient was so satisfied with the outcome after ablation that she decided to refuse/delay/postpone the cataract surgery.

Conclusions: Eliminating most corneal higher order aberrations may recover visual function in highly aberrated eyes with cataract to an extent that may help some patients to postpone the cataract surgery. The used protocol improved corneal optics while minimizing tissue removal in refractive surgery, but further clinical evaluations are needed to confirm preliminary results.