To evaluate the efficacy, predictability, and safety of topographically supported customized ablations (TOSCAs) for decentered ablations following laser in situ keratomileusis (LASIK).

Prospective nonrandomized clinical trial.

Nine patients (11 eyes) with LASIK-induced decentered ablations underwent TOSCA following flap lifting. Topographically supported customized ablation was performed using a corneal topographer to obtain a customized ablation profile, combined with a flying spot laser.

Mean follow-up was 9.22 ± 2.82 months (range 6–12 months). No intra- or postoperative complications were observed. Manifest refraction (spherical equivalent) did not change significantly (pre-TOSCA: −0.14 ± 1.58 diopters [range, –1.75 to +3.00 diopters] to +0.46 ± 1.02 diopters [range, −1.00 to +1.75 diopters]; P = .76), whereas there was a statistically significant reduction in the refractive astigmatism (pre-TOSCA: –1.55 ± 0.60 diopters [range, −3.00 to −0.75 diopters] to –0.70 ± 0.56 diopters [range, −2.00 to −0.25 diopters]; P = .003). Mean uncorrected visual acuity improved significantly (P < .001) from 0.45 ± 0.16 (range, 0.2–0.7) to 0.76 ± 0.29 (range, 0.2–1.2) at last follow-up. Mean best-corrected visual acuity improved from 0.74 ± 0.22 (range, 0.4–1.0) to 0.95 ± 0.20 (range, 0.6–1.2; P = .002). Eccentricity showed a statistically significant reduction after TOSCA treatment (pre-TOSCA: 1.59 ± 0.46 mm [range, 0.88–2.23 mm]; post-TOSCA: 0.29 ± 0.09 mm [range, 0.18–0.44 mm]; P < .001).

In our small sample, enhancement LASIK procedures with TOSCA appear to improve uncorrected and best-corrected visual acuity as well as eccentricity in patients with LASIK-induced decentered ablation.