Topography-guided laser refractive surgery

PURPOSE OF REVIEW: Topography-guided laser refractive surgery seeks to correct vision by altering the major refractive surface of the eye. Whereas results are not significantly different from current treatment options for primary surgery, topography-guided treatment is uniquely effective in eyes with corneal irregularity. This review highlights topography-guided ablations, emphasizing recent advances in treating highly aberrated eyes, including treatment for corneal ectasia in conjunction with collagen cross-linking (CXL). RECENT FINDINGS: Studies continue to document similar outcomes between topography-guided and wavefront-guided customized corneal ablations while exploring the indications for each modality. Topography-guided ablations demonstrate good outcomes for the correction of astigmatism after penetrating keratoplasty, laser-assisted in-situ keratomileusis (LASIK) flap or interface complications, post-radial keratotomy eyes, and other highly aberrated corneas, many of which are poor candidates for wavefront-guided therapy. The use of topography-guided ablations with CXL seeks to address both the refractive and structural abnormalities of corneal ectasias. This combination therapy has shown promising results for keratoconus, post-LASIK ectasia, and pellucid marginal degeneration. SUMMARY: Topography-guided customized corneal ablation is well tolerated and effective. Recent attention has been focused on the unique therapeutic benefits of this treatment for highly irregular and ectatic corneas with encouraging results.