Difference map or single elevation map in the evaluation of corneal forward shift after LASIK

Purpose: Forward shift of the cornea after excimer laser refractive surgery has been assessed on a difference map generated from two elevation maps of the scanning-slit corneal topography. The current study was conducted to test whether similar evaluation is possible on a postoperative color-coded elevation map alone. Design: Prospective, noncomparative case,series. Participants: One hundred sixty-three eyes of 86 patients with myopic refractive errors of -1 to -13.50 diopters. Intervention: LASIK was performed. Corneal topography of the posterior corneal surface was obtained with the scanning-slit topography system before and 1 month after surgery. Main Outcome Measures: The amount of forward shift of the posterior corneal surface was determined at the center of the difference map generated from preoperative and postoperative elevation maps. For surface alignment in the difference map, the 3-mm wide peripheral annular fit-zone was used. The eyes were classified into two groups depending on the amount of forward shift, using 50 mum as the threshold. Next, on the single postoperative color-coded elevation map, which is drawn relative to the individual best-fit sphere, the eye was judged to be abnormal (with significant forward shift) when more than three colors (discriminant number) were found within the central 3-mm area, and sensitivity and specificity were calculated. By varying the discriminant number from 3 to 9, receiver operator characteristic (ROC) curves were created. Results: The ROC curve analyses demonstrated that sufficient true positive ratio (sensitivity) and false-positive ratio (100-specificity [%]) could not be obtained with any discriminant color number when judgments were made on a single color-coded map. There was a weak, but significant, correlation between the amount of corneal forward shift and the radius of curvature of the posterior best-fit sphere (Pearson r = -0.170; P = 0.030), indicating that a cornea with greater forward shift tended to be drawn on a steeper best-fit sphere, and thus the forward protrusion of the posterior surface failed to be depicted. Conclusions: Forward shift of the cornea after excimer laser surgery should be evaluated on the difference map generated from two elevation maps, such as preoperative and postoperative maps. (C) 2003 by the American Academy of Ophthalmology.