https://doi.org/10.1177/1120672120945907 European Journal of Ophthalmology 1–7 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1120672120945907 journals.sagepub.com/home/ejo EJO European Journal of Ophthalmology Introduction Superficial corneal scars due to various causes are usually treated by phototherapeutic keratectomy (PTK) 1 or ante- rior lamellar keratoplasty procedures as sutureless anterior lamellar keratoplasty (SALK) 2 or femto assisted lamellar keratoplasty (FALK) depending on the depth and location of the lesion. 3 Some of the common indications for devel- oping visually significant corneal opacities are post-kerati- tis scarring, post corneal trauma, band shaped keratopathy, spheroidal degeneration, superficial corneal dystrophy, post photorefractive keratectomy (PRK) haze, or a LASIK flap associated scarring and/or epithelial ingrowth. A side-effect of PTK is a hyperopic shift due to ablation of the corneal tissue, which may require additional exci- mer laser treatment to counteract induced refractive errors. 1,4 PTK conventionally is a planar circular ablation within a 6 to 8 mm diameter; the deeper the ablation, the greater the chance of development of haze, and induced refractive change. 5,6 The shape of the ablation profile is always circular and not customized to the scar shape; therefore, the procedure often involves incorporation of relatively normal cornea. Though VISX S4 (AMO, Santa Topography-based customized trans-epithelial phototherapeutic keratectomy for anterior corneal scar removal Rohit Shetty 1 , Rushad Shroff 2 , Aishwarya Chhabra 1 , Ritu Arora 3 and Vaitheeswaran Ganesan Lalgudi 1 Abstract Purpose: To report a case of management of a post-LASIK superficial corneal scar using a novel single-step topography- based customized phototherapeutic keratectomy (PTK). Methods: Surgical technique description. Results: Ablation was planned using Schwind Amaris ® 1050RS excimer laser as decentered trans-epithelial PTK of 5 mm × 3.5 mm of 75 μm depth exactly over the area of the scar. UDVA, CDVA improved from 20/60 and 20/40 pre- operatively to 20/30 and 20/20p post-operatively. Refractive error improved from -2.5 DC @135 to +0.25 DS/-0.25 DC @75. Regularization of topography and stromal surface on ASOCT was noted with minimal hyperopic shift. Another step of ablation to address induced hyperopia was not required. Conclusion: Topography-based customized PTK appears to be an effective novel technique for the management of superficial corneal scars with minimal induced refractive change. This technique holds promise as an alternative in the targeted management of superficial corneal scars, traditionally treated by conventional PTK, without significant ablation of normal tissue. Keywords Anterior corneal scars, customized PTK, tissue sparing PTK Date received: 17 February 2020; accepted: 9 July 2020 1 Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India 2 Shroff Eye Centre, New Delhi, India 3 Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India Corresponding author: Vaitheeswaran Ganesan Lalgudi, Department of Cornea and Refractive surgery, Narayana Nethralaya, #121/C Chord road, 1st R block, Rajaji Nagar, Bangalore 560010, India. Email: kanthjipmer@gmail.com 945907EJO 0 0 10.1177/1120672120945907European Journal of OphthalmologyShetty et al. research-article 2020 Surgical technique