Using PubMed and our internal database, we extensively reviewed the literature on the technological advancements in calibration systems, with a motive to present an account of the development history, and latest developments in calibration systems used in refractive surgery laser systems. As a second motive, we explored the clinical impact of the error introduced due to the roughness in ablation and its corresponding effect on system calibration. The inclusion criterion for this review was strict relevance to the clinical questions under research. The existing calibration methods, including various plastic models, are highly affected by various factors involved in refractive surgery, such as temperature, airflow, and hydration. Surface roughness plays an important role in accurate measurement of ablation performance on calibration materials. The ratio of ablation efficiency between the human cornea and calibration material is very critical and highly dependent on the laser beam characteristics and test conditions. Objective evaluation of the calibration data and corresponding adjustment of the laser systems at regular intervals are essential for the continuing success and further improvements in outcomes of laser vision correction procedures.
The objective is to characterize the impact of different ablation parameters on the thermal load during corneal refractive surgery by means of excimer laser ablation on porcine eyes. One hundred eleven ablations were performed in 105 porcine eyes. Each ablation was recorded using infrared thermography and analyzed mainly based on the two tested local frequencies (40 Hz, clinical local frequency; 1000 Hz, no local frequency). The change in peak corneal temperature was analyzed with respect to varying ablation parameters [local frequency, system repetition rate, pulse energy, optical zone (OZ) size, and refractive correction]. Transepithelial ablations were also compared to intrastromal ablations. The average of the baseline temperature across all eyes was 20.5°C±1.1 (17.7°C to 22.2°C). Average of the change in peak corneal temperature for all clinical local frequency ablations was 5.8°C±0.8 (p=3.3E−53 to baseline), whereas the average was 9.0°C±1.5 for all no local frequency ablations (p=1.8E−35 to baseline, 1.6E−16 to clinical local frequency ablations). A logarithmic relationship was observed between the changes in peak corneal temperature with increasing local frequency. For clinical local frequency, change in peak corneal temperature was comparatively flat (r2=0.68 with a range of 1.5°C) with increasing system repetition rate and increased linearly with increasing OZ size (r2=0.95 with a range of 2.4°C). Local frequency controls help maintain safe corneal temperature increase during excimer laser ablations. Transepithelial ablations induce higher thermal load compared to intrastromal ablations, indicating a need for stronger thermal controls in transepithelial refractive procedures.
Complications may arise due to the decentered ablations during refractive surgery, resulting from human or mechanical errors. Decentration may cause over-/under-corrections, with patients complaining about seeing glares and halos after the procedure. Customized wavefront-guided treatments are often used to design retreatment procedures. However, due to the limitations of wavefront sensors in precisely measuring very large aberrations, some extreme cases may suffer when retreated with wavefront-guided treatments. We propose a simple and inexpensive numerical (nonwavefront-guided) algorithm to recenter the optical zone (OZ) and to correct the refractive error with minimal tissue removal. Due to its tissue-saving capabilities, this method can benefit patients with critical residual corneal thickness. Based on the reconstruction of ablation achieved in the first surgical procedure, we calculate a target ablation (by manipulating the achieved OZ) with adequate centration and an OZ sufficient enough to envelope the achieved ablation. The net ablation map for the retreatment procedure is calculated from the achieved and target ablations and is suitable to expand, recenter, and modulate the lower-order refractive components in a retreatment procedure. The results of our simulations suggest minimal tissue removal with OZ centration and expansion. Enlarging the OZ implies correcting spherical aberrations, whereas inducing centration implies correcting coma. This method shows the potential to improve visual outcomes in extreme cases of retreatment, possibly serving as an uncomplicated and inexpensive alternative to wavefront-guided retreatments.
The calculation of corneal asphericity as a 3-D fit renders more accurate results when it is based on the corneal wavefront aberrations rather than on the corneal topography of the principal meridians. A more accurate prediction could be obtained for hyperopic treatments compared to myopic treatments. We evaluate a method to calculate corneal asphericity and asphericity changes after refractive surgery. Sixty eyes of 15 consecutive myopic patients and 15 consecutive hyperopic patients (n=30 each) are retrospectively evaluated. Preoperative and 3-month-postoperative topographic and corneal wavefront analyses are performed using corneal topography. Ablations are performed using a laser with an aberration-free profile. Topographic changes in asphericity and corneal aberrations are evaluated for a 6-mm corneal diameter. The induction of corneal spherical aberrations and asphericity changes correlates with the achieved defocus correction. Preoperatively as well as postoperatively, asphericity calculated from the topography meridians correlates with asphericity calculated from the corneal wavefront in myopic and hyperopic treatments. A stronger correlation between postoperative asphericity and the ideally expected/predicted asphericity is obtained based on aberration-free assumptions calculated from corneal wavefront values rather than from the meridians. In hyperopic treatments, a better correlation can be obtained compared to the correlation in myopic treatments. Corneal asphericity calculated from corneal wavefront aberrations represents a 3-D fit of the corneal surface; asphericity calculated from the main topographic meridians represents a 2-D fit of the principal corneal meridians. Postoperative corneal asphericity can be calculated from corneal wavefront aberrations with higher fidelity than from corneal topography of the principal meridians. Hyperopic treatments show a greater accuracy than myopic treatments.