PMC3280100_01
(A) Slit-lamp image of the OD at presentation, showing a significant horizontal cornea scar. (B) Slit-lamp picture of the OS; there was central corneal scarring similar to the OD. (C) The treatment plan on the wavelight excimer platform for topography-guided partial PRK employed for the OD treatment. The treatment plan, pivotal to the application of the Athens Protocol, combines a myopic ablation over the elevated cornea and a partial hyperopic application peripheral to the flattened (by scarring) inferior cornea. This combination treatment enhances the normalization of the severe irregularity with small ablation (35 mum) over the thinnest cornea. (D) Tomography maps (Oculyzer, Wavelight, Erlangen, Germany) of the OD and OS preoperative to the Athens Protocol. (E) Tomography maps of the OD and OS postoperative to the Athens Protocol, 15 months following the OD and 8 months following the OS. (F) Slit-lamp picture of the OD, 15 months following treatment; cornea regularity and improvement in translucency is evident (when compared to A). (G) Slit-lamp picture of the OS, 8 months following treatment; cornea regularity and improvement in translucency is evident (when compared to B). (H) The treatment plan on the wavelight excimer platform employed for topography-guided partial PRK of the OS.. Abbreviations: OD, right eye; OS, left eye; PRK, photorefractive keratectomy.
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Slit lamp biomicroscopy revealed severe horizontal central corneal scars in both eyes (see Figure 1A is the right eye and B the left eye). Tomographic evaluation (Oculyzer II, Wavelight, Erlangen, Germany) of both eyes is noted in Figure 1D and shows the thinnest pachymetry of 467 mum in the right eye and 448 mum in the left eye, respectively. The excimer laser treatment plan for both eyes was designed on the wavelight excimer laser platform and is demonstrated in Figure 1C and H. The postoperative slit-lamp photos of the anterior segment are seen in Figure 1 (right eye: F and left eye: G). His tomographic keratometry in the right eye has improved to 44.3, 59.0 at 13.7 and in the left eye to 35.4, 38.4 at 166.3 (Figure 1E shows the right eye on the left and the left eye on the right).
Preoperative cornea OCT showing the dense, deep stromal scarring (hyper-reflective spots) along with the very irregular stromal surface, partly masked by epithelium thinning over the peaks and thickening over the deep valleys.. Abbreviation: OCT, optical coherence tomography.
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The preoperative cornea optical coherence tomography (OCT) is shown in Figure 2 and the postoperative in Figure 3.
Picture showing the same portion of cornea as in Figure 2, in a cornea OCT 12 months following the treatment. The scar has been significantly reduced, the stromal surface smoothed, the epithelium has become more uniform in thickness, and the overall cornea thickness has been reduced.. Abbreviation: OCT, optical coherence tomography.
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The preoperative cornea optical coherence tomography (OCT) is shown in Figure 2 and the postoperative in Figure 3.