Laser Reconstructive Corneal Repair Utilizing Contoura Topographic Guided Corneal Ablation
Laser Reconstructive Corneal Repair became possible in the United States when it topographic guided ablation was FDA approved. This type of procedure selectively removes irregularities in the cornea, which is the main focusing part of the eye. Irregularity and warpage that has been caused to the cornea from past surgery (Radial Keratotomy or RK, AK, LASIK, PRK, LASEK, ALK), traumatic corneal distortion, or disease caused corneal irregularity can now be corrected by reconstructing the cornea rather than just correcting it. It can also be combined with corneal cross linking to treat Keratoconus and other forms of corneal ectasia. In fact, the use of this procedure invented by John Kanellopoulos, MD and termed the Athens Protocol, has become the gold standard worldwide and helped many patients avoid the need for corneal transplants.
The Wavelight Contoura system is the best recognized and most powerful topographic system available in the United States. It has been used in the rest of the world for over a decade to treat corneal irregularities, but only certain doctors worldwide perform the procedure. In the United States, the system was first FDA approved for use in primary laser correction patients, those who had never had any form of surgery before. The FDA approval does include the use of Contoura for corneal repair and treatment of irregularity and warpage as a precaution to the surgeon, which literally means the surgeon should understand that corneal repair treatments are not the same procedure as primary laser correction treatments.
Dr. Motwani first developed the LYRA Protocol (Layer Yolked Reduction of Astigmatism) to utilize the full power of Contoura, and demonstrated how a more uniform cornea could be made utilizing the FDA approved Contoura system. These principles were applied to corneal repairs, resulting in the San Diego Protocol which was published by Dr. Motwani for corneal reconstructive repairs.
This website contains medical imaging, technical data, and notes that are designed to not only be resource for prospective patients, but also eye surgeons who wish to better understand these procedures. It is therefore far more technical than most refractive surgery websites.
Severe De-Centration of Excimer Laser Ablation.
63 year old female with monovision LASIK performed 9 years prior with severe de-centration of the ablation in the distance eye.
Pre-op Manifest Rx: +2.00, -1.00 x 175
Pre-op T-CAT Measured Correction: plano, -1.23 x 161 followed by WFO +1.50
C4 and C12 compensation: +0.50; Astigmatism compensation +0.015; +2.00- 0.65 = 1.35 rounded up to +1.50 for WFO treatment
Post-op 1 year: 20/20 and refraction of plano
- Patient with significant de-centration of laser performed in 1998/99.
- Contoura performed with Measured Astigmatism, c4/c12 equalization, followed by a WFO to treat the hyperopic correction.
- Procedure was performed utilizing original LASIK flap.
- Patient topography shows de-centration elimination and 20/20 vision at one year with plano refraction.
CASE 2 – OD
53 year old male, T-CAT OD
Pre-Op Manifest; OD: -1.00-1.75X100 BCVA 20/20
T- Cat Treatment; OD: -0.45-1.43X102
3 month post op; OD Refraction: PLANO and 20/15
CASE 2 – OS
53 year old male, T-CAT OS w/Kamra Inlay
Preop Manifest; OS: -1.75-0.50X080 BCVA 20/20
T- Cat Treatment; OS: -1.19-0.47X080
3 month post op; OS Refraction: -0.75 D/S and 20/20
- 53 y.o. male who had LASIK performed in 2001 with enhancement in OD 2014. Laser de-centration both eyes, OD worse than left. Pt had searched for many years for a way to repair the de-centration.
- Contoura correction done both eyes, with KAMRA corneal inlay placement in the left eye all done at the same time
- Patient at 3 months was 20/15 OD, 20/20 OS with J2 reading vision
CASE 3 – OS
64 year old male, OS Lasik T-Cat
Preop Manifest; OD: OS: +1.75-0.50X035 BCVA 20/20
T- Cat Treatment; OS: +0.00-0.10X084
ESX T-CAT OS at 2 months; -2.75-0.32X117.
3 month post op; OD Refraction: OS: +0.75-0.25X070 and 20/25 with correction to 20/20.
- 64 y.o. male who had myopic LASIK performed in 1998, and ended up significantly hyperopic.
- De-centration of the ablation appears to have led to epithelial hyperplasia that led to hyperopic correction.
- Refractive correction as well as aberration repair with c4/c12 equalization was attempted, but patient ended up significantly myopic and did not change.
- We theorized that the epithelial hyperplasia through the corneal vertex which was directly next to the sloped area of the de-centration led to a the hyperopic correction.
- With repeat Contoura, pt did much better with elimination of de-centration.