Customized laser vision correction for irregular cornea post-refractive surgery

Ablation-related complications following the refractive procedures are a major challenge for a refractive surgeon, considering the elective nature of the procedure. The use of topography-guided customized ablation has revolutionized the management of irregular corneas postrefractive surgery. This preferred practice highlights various hurdles encountered while managing cases of decentered ablation, small ablation zones, and planning a cataract surgery in patients with irregular corneas. It will give insight to the refractive surgeon on the planning of corneal regularization on various modern-day refractive platforms available, such as the WaveLight® EX-500 (Alcon Laboratories, Inc., Fort Worth, TX, USA), Schwind Amaris 1050 (Peramis; SCHWIND eye-tech-solutions, Kleinostheim, Germany), and Technolas Teneo 317 model 2 excimer laser (Bausch & Lomb, Rochester, NY, USA). The algorithmic approach outlined will enable the refractive surgeon to choose between the wavefront optomized and the topography-guided ablations.