Corneal wavefront–guided enhancement for high levels of corneal coma aberration after laser in situ keratomileusis

PURPOSE: To evaluate the improvement in visual and optical performance after corneal wavefront-guided laser in situ keratomileusis (LASIK) enhancement in patients with high levels of corneal coma aberration and complaints about quality of vision. SETTING: Vissum-Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: Corneal wavefront-guided LASIK enhancement was performed in 34 symptomatic eyes of 29 patients aged 26 to 64 years with previous LASIK surgery and a significant level of primary coma aberration. The ablation design was calculated using ORK-CAM software (Schwind eye-tech-solutions). The follow-up period was 6 months. Changes in refraction, corneal aberrometry, and subjective symptoms were analyzed. RESULTS: At 6 months, the mean efficacy index was 0.88 +/- 0.12 and the mean safety index, 1.03 +/- 0.16. The reduction in sphere and cylinder at 1 month was statistically significant (P<.01). Of all eyes, 97.06% had a spherical equivalent within +/-1.00 diopter. At 1 month, statistically significant changes were observed: total (P = .01), and primary coma root mean square reduction (P<.01), and negativization of the primary spherical aberration coefficient (P<.01). At 6 months, patient perception of halos and glare was reduced or eliminated in a high percentage of cases. CONCLUSION: Corneal wavefront-guided enhancements with the ORK-CAM system are a useful tool for the correction of the second order refractive errors and for the reduction of the corneal primary coma induced by previous keratorefractive procedures.