E-POSTER DETAIL | 11th Asia Pacific Tele Ophthalmology Society Symposium

Title
Balancing Precision and Safety: Application of Wavefront-Guided T-PRK in Visual Rehabilitation for Corneal Opacity Following Viral Keratitis

Authors
Mingyang Hu

Presenting
Mingyang Hu

PURPOSE:
For patients with corneal opacity accompanied by irregular astigmatism and high-order aberrations following viral keratitis, single-step wavefront-guided T-PRK treatment was implemented to evaluate its postoperative outcomes.

METHODS:
A 32-year-old male with bilateral vision decline for over 10 years and a history of left eye herpes simplex virus keratitis (quiescent for >1 year). Preoperative exam: UCVA 0.1, BCVA 0.5 (-1.50 DS/-2.75 DC × 170°), 3.5mm×4.0mm sheet-like inferior-central corneal opacity. Wavefront analysis: total high-order aberration RMS 0.78μm, coma 0.62μm. Perioperative management: oral valacyclovir starting 3 days pre-op and continued for 2 weeks post-op, plus topical antibiotics, corticosteroids, and ganciclovir gel. Procedure: wavefront-guided T-PRK.

METHODS:

A 32-year-old male with bilateral vision decline for over 10 years and a history of left eye herpes simplex virus keratitis (quiescent for >1 year). Preoperative exam: UCVA 0.1, BCVA 0.5 (-1.50 DS/-2.75 DC × 170°), 3.5mm×4.0mm sheet-like inferior-central corneal opacity. Wavefront analysis: total high-order aberration RMS 0.78μm, coma 0.62μm. Perioperative management: oral valacyclovir starting 3 days pre-op and continued for 2 weeks post-op, plus topical antibiotics, corticosteroids, and ganciclovir gel. Procedure: wavefront-guided T-PRK.

RESULTS:
At 1 year post-op, UCVA reached 1.0 (+0.25 DS/-0.25 DC × 165°) with the original corneal opacity nearly transparent. Corneal topography showed regular, smooth surface with significantly reduced astigmatism. Preoperative diplopia and glare resolved completely. Total high-order aberration RMS decreased from 0.78μm to 0.19μm, coma from 0.62μm to 0.08μm. The procedure was uneventful, with epithelial healing within 4 days. No recurrence of viral keratitis or significant haze during 1-year follow-up.

RESULTS:

At 1 year post-op, UCVA reached 1.0 (+0.25 DS/-0.25 DC × 165°) with the original corneal opacity nearly transparent. Corneal topography showed regular, smooth surface with significantly reduced astigmatism. Preoperative diplopia and glare resolved completely. Total high-order aberration RMS decreased from 0.78μm to 0.19μm, coma from 0.62μm to 0.08μm. The procedure was uneventful, with epithelial healing within 4 days. No recurrence of viral keratitis or significant haze during 1-year follow-up.

CONCLUSIONS:
T-PRK integrates traditional PTK and PRK, completing epithelial removal, lesion ablation, and refractive correction in one procedure. Wavefront-guided technology enables precise elimination of high-order aberrations. Perioperative antiviral management is crucial for safety, as adequate medication coverage reduces HSV recurrence risk. In summary, for patients with corneal opacity and visual quality deterioration following quiescent viral keratitis, wavefront-guided T-PRK is a promising option that effectively removes lesions, corrects refractive errors, and restores high-quality visual function.

CONCLUSIONS:

T-PRK integrates traditional PTK and PRK, completing epithelial removal, lesion ablation, and refractive correction in one procedure. Wavefront-guided technology enables precise elimination of high-order aberrations. Perioperative antiviral management is crucial for safety, as adequate medication coverage reduces HSV recurrence risk. In summary, for patients with corneal opacity and visual quality deterioration following quiescent viral keratitis, wavefront-guided T-PRK is a promising option that effectively removes lesions, corrects refractive errors, and restores high-quality visual function.