Managing highly distorted corneas with topography-guided treatment

Article

Topography-guided LASIK, used with a comprehensive eye scanner (Pentacam, Oculus), has been very successful in minimizing severe corneal distortions and offers reliable registration in most cases.

Topography-guided LASIK, used with a comprehensive eye scanner (Pentacam, Oculus), has been very successful in minimizing severe corneal distortions and offers reliable registration in most cases, according to John Kanellopoulos, MD, in private practice in New York City and Athens.

Dr. Kanellopoulos has been using topography-guided software (Allegretto Wave Topolyzer, WaveLight) for 5 years at his clinic in Athens to treat extreme primary and surgery-induced irregularities.

This experience has taught Dr. Kanellopoulos that topography-guided customized ablation may require nomogram manipulation to adjust sphere, as the topographer does not read the refractive error in the eye. He and his colleagues also have found that corneal cross-linking either before or after the procedure may be effective in stabilizing the iatrogenic ectasias of keratoconus and, in the future, may reduce the number of transplants necessary to treat keratoconus.

Dr. Kanellopoulos has used topography-guided custom ablation in cases such as enlargement of the optical zone in re-treatment of residual hyperopia and severe irregularities caused by contact lens scarring. The technique was also used in an eye that had undergone four LASIK recuts, one of which may have resulted in loss of a corneal sliver. In this instance, Dr. Kanellopoulos performed topography-guided PRK.

While it seems to be safe and effective, topography-guided ablation also is likely to raise debates about when it is most appropriately used.

"For someone who has this technology available to them, there are ethical questions such as whether there will be treatment of early ectasias in order to avoid a corneal transplant in the future," Dr. Kanellopoulos said.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
At the American Society of Cataract and Refractive Surgeons annual meeting, Sheng Lim, MD, FRCOphth discusses the benefit of endoscopic cyclophotocoagulation for patients with primary open angle glaucoma and cataracts in the CONCEPT study
A photo of Seville, Spain, with the Congress on Controversies in Ophthalmology logo superimposed on it. Image credit: ©francovolpato – stock.adobe.com; logo courtesy COPHy
Anat Loewenstein, MD, Professor and Director, Department of Ophthalmology, Tel Aviv Medical Center, discusses the Congress on Controversies in Ophthalmology (COPHy)
Anat Loewenstein, MD, speaks about the 22nd Annual Angiogenesis, Exudation, and Degeneration Meeting in February 2025 and shares her global forecast for AI-driven home OCT
Sarah M. Thomasy, DVM, PhD, DACVO, a veterinary ophthalmologist at UC Davis, talks about how her research at the Glaucoma 360 symposium
I. Paul Singh, MD, an anterior segment and glaucoma specialist, discusses the Glaucoma 360 conference, where he participated in a panel discussion on the use of artificial intelligence (AI) in glaucoma care.
Charles Wykoff, MD, PhD, discusses his Floretina ICOOR presentation topic, retinal non-perfusion in diabetic retinopathy, with David Hutton, editor of Ophthalmology Times
Elizabeth Cohen, MD, discusses the Zoster Eye Disease study at the 2024 AAO meeting
Victoria L Tseng, MD, PhD, professor of ophthalmology and glaucoma specialist, UCLA
© 2025 MJH Life Sciences

All rights reserved.