TRAUMA REPAIR

The treatment of trauma with topographic guided ablation is dependent on the level of scarring caused by the trauma, the position of the scarring, and the amount of corneal tissue available for correction. All repair cases must be evaluated individually, and trauma cases even more so as the extent and depth of corneal scarring must be determined to see if improvement can be made. We have treated scissors going through cornea, animal claw caused corneal ruptures, skateboarding accident corneal damage, flying metal damage, and others.

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, this must be evaluated 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 useful, as many of these cases do have significant epithelial compensation and must be treated with regard to this.  In many way, these patient require a more individualized approach in comparison to other repairs

The second case on this page was a traumatic flap loss of a prior LASIK, and correction of this 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 that a patient cannot have a good outcome of their vision.

CASE 1 – OD

46 year old male, OD T-CAT + WFO PRK.
Pre-Op Manifest; OD: +3.25-0.25X010 BCVA 20/40
T-CAT Treatment; OD: +0.00-0.25X054
WFO Treatment; OD: +1.00 D/S
1 ENH WFO; OD: +2.25 D/S
1 Year Post Op: OD Refraction: +1.00 and 20/25

CASE 1

• 46 year old male who had a scissors go through his central cornea when he was 3-4 years old. Patient had not ever corrected this eye, although it refracted to 20/40. Patients left eye was +1.75, -0.25 x 10, so a significant amount of anisometropia was present.
• PRK to remove the distortion from the central corneal scar was performed using Contoura and the San Diego Protocol. A small amount of hyperopia was initially corrected, and the rest corrected at 3 months utilizing WFO. Patient achieved best corrected vision of 20/25 and a refraction of +1.00 in the right eye. Enhancement of this is planned.

CASE 2

35 year old male, OD LASIK
Pre-Op Manifest; OD: -5.25-0.50X180 BCVA: 20/20
Pre-Op Pachymetry; OD: 560
PRK ENH 4 years later; OD: -5.00-1.25×090
Post Injury Pachymetry; OD: 462
2.5 year Post-Op; plano and 20/15

CASE 2 – OD

• 35 year old male firefighter who had LASIK performed in 2003 for myopia (OD: -5.25-0.50X180) with 20/20 visual result. Pt was working in a fire are during the 2007 firestorm in San Diego when he came around a fire truck and walked into a shovel, which cleaved his flap off and gave him a hyphema and iritis. He was seen at an ER by an ophthalmologist, and presented several days later at Dr. Motwani’s clinic. Patient at that time had a healing abrasion, residual hyphema, and developed some mild scarring and haze.
• After healing time of 2 months, patient refracted with a -5.00, -1.25 x 90 correction to 20/25. He had a pachymetry of 462, so PRK was undertaken to treat the refraction and remove the residual corneal haze that was present.
• Patient ended up with 20/15 vision and a Sheimpflug (Galleli) measured thickness of 362 microns. Patient was seen again 2.5 years post-op before manuscript of case was submitted for publication, and was still 20/15 and doing well.