The treatment of trauma with topographic guided ablation is dependent on the level of scarring caused by the trauma, the position of the scarring, and the amount of corneal tissue available for correction. All repair cases must be evaluated individually, and trauma cases even more so as the extent and depth of corneal scarring must be determined to see if improvement can be made. We have treated scissors going through the cornea, animal claw caused corneal ruptures, skateboarding accident corneal damage, flying metal damage, and others.

Infection repair can be similar to trauma repair, as it depends on the level and position of scarring, and how much tissue was lost due to the infection. Again, this must be evaluated individually for each patient. We have treated a variety of infection-caused corneal damage. Critical is the amount of tissue available, and the depth of the scarring. Even scars that are determined to be “full thickness” by doctors many times are not, and improvement can be achieved by removing enough tissue to allow for vision while leaving enough for structural integrity.

The CREATE Protocol here is still useful, as many of these cases do have significant epithelial compensation and must be treated with regard to this. In many ways, these patients require a more individualized approach in comparison to other repairs.

The second case on this page was a traumatic flap loss of a prior LASIK, and correction of this was performed before topographic guided ablation was available, so normal aspheric ablation laser correction was performed. It is included here as an interesting case to show that even flap loss does not mean that a patient cannot have a good outcome of their vision.