MANAGEMENT AND TREATMENT OF CENTRAL STEEP ISLANDS AFTER EXCIMER-LASERPHOTOREFRACTIVE KERATECTOMY

BACKGROUND: Permanent central steep islands are an undesirable phenome non that cause distorted images and a significant reduction in visual acuity. We describe treatment of central steep islands with repeat exc imer laser photoablation in the central cornea. METHODS: Three patient s with preoperative refractions of -7.50 -2.50 x 170 degrees D (right eye), -8.00 -2.25 x 10 degrees D (right eye) and -6.00 -1.50 x 90 degr ees (right eye) developed central steep islands which persisted more t han 12 months. All patients lost more than two lines of spectacle-corr ected visual acuity and complained of visual disturbances. We retreate d the central steep islands with a VISX 20/20 excimer laser PRK ablati on that matched the size of the central island measured on videokerato graphy. RESULTS: Symptomatic glare and distortion were significantly r educed and the central steep islands were resolved. Several weeks afte r reablation, spectacle-corrected visual acuity improved to the preope rative level. CONCLUSION: Central steep island, an infrequent complica tion of excimer laser photorefractive keratectomy, can be safely remov ed with a repeat laser ablation that matches the central circular stee p area.