The treatment of trauma with topographic-guided ablation depends on the level of scarring caused by the trauma, the position of the scarring, and the amount of corneal tissue available for correction. Doctors must evaluate all repair cases individually and trauma cases even more so, as the extent and depth of corneal scarring must be determined to see if they can improve. We have treated corneas punctured, ruptured, and damaged by scissors, animal claws, skateboarding accidents, flying metal, and more.
Infection repair can be similar to trauma repair, as it depends on the level and position of scarring and how much tissue was lost due to the infection. Again, we must evaluate this individually for each patient. We have treated a variety of infection-caused corneal damage.
Critical is the amount of tissue available and the depth of the scarring. Even scars that are determined to be “full thickness” by doctors many times are not, and improvement can be achieved by removing enough tissue to allow for vision while leaving enough for structural integrity.
The CREATE Protocol here is still applicable, as many of these cases have significant epithelial compensation and must be treated concerning this. In many ways, these patients require a more individualized approach than other repairs.
The second case on this page was a traumatic flap loss of a prior LASIK. This correction was performed before topographic guided ablation was available, so normal aspheric ablation laser correction was performed. It is included here as an interesting case to show that even flap loss does not mean a patient cannot have a good outcome for their vision.
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