A randomized comparison of pupil-centered versus vertex-centered ablation in LASIK correction of hyperopia

Dynamic distribution and correlation analysis of the angle kappa in myopia patients undergoing femtosecond-assisted laser in situ keratomileusis

PURPOSE

To explore the offset distribution of pupillary centres, the offset between the pupil centre and the coaxially sighted corneal light reflex (P-Dist) and their correlation in femtosecond laser combined with excimer laser in situ keratomileusis.

METHODS

Randomly selected 194 patients (398 eyes) who underwent femtosecond-assisted laser in situ keratomileusis with preoperative use of WaveLight Allegro Topolyzer Corneal Topography (WaveLight Laser Technologies AG, Erlangen, Germany) to measure the pupil size and centre position. The P-Dist of the patients was recorded by the X and Y axis eyeball tracking adjustment program of the WaveLight Eagle Vision EX500 excimer laser system.

RESULTS

The P-Dist was 0.214 ± 0.092 mm in the right eyes and 0.228 ± 0.105 mm in the left eyes (P = .041). Under scotopic conditions, the pupil centre of left eye X-axis was -0.046 ± 0.091 mm, the right eye was -0.152 ± 0.084 mm, with significant differences (P = .015), and the Y-axis direction showed no significant changes (P = .062). The white to white was positively correlated with changes of pupil diameter (scotopic pupil diameter-photopic pupil diameter) (r = 0.270, P < .001). The equivalent spherical mirror and measured centroid shift were negatively correlated (r = -0.214, P = .002).

CONCLUSION

The angle kappa of the right eye is smaller than that of the left eye and from scotopic to photopic condition, the pupil centroid shift of both eyes to the nasal inferior side. If the cornea is too large, the low illumination environment should be maintained during the operation to improve the efficiency of pupil matching.

Optical quality comparison between laser ablated myopic eyes with centration on coaxially sighted corneal light reflex and on entrance pupil center

This paper aims to compare the image quality between centration on the coaxially sighted corneal light reflex (CSCLR) and on the entrance pupil center (EPC). Myopic laser ablation was simulated on eye models, and the optical performances were compared. Centration on the EPC leads to higher wavefront aberrations and lower modulation transfer function. The two centration methods give nearly identical retinal images for angle kappa less than 5°. Because of less tissue removal, centration on the EPC is probably preferable for angle kappa less than 5°, but CSCLR centration may be preferable for angle kappa larger than 5°. The degree of tilt of the post-surgery anterior corneal surface explains the differences between the two methods.

Coaxially sighted corneal light reflex versus entrance pupil center centration of moderate to high hyperopic corneal ablations in eyes with small and large angle kappa

PURPOSE

To determine whether centering ablations on the coaxially sighted corneal light reflex (CSCLR) in eyes with large angle kappa leads to poor visual outcomes when compared to patients with eyes with negligible angle kappa that by default would be centered on the entrance pupil. In eyes with no angle kappa, the CSCLR coincides with the entrance pupil center, whereas eyes with large angle kappa possess an offset between the CSCLR and the entrance pupil center.

METHODS

This study was a retrospective case series of consecutive patients treated by hyperopic LASIK using the MEL80 excimer laser (Carl Zeiss Meditec, Jena, Germany). All ablations were centered on the CSCLR using the standard non-wavefront-guided ablation profile. Angle kappa was classified according to pupil offset defined as the distance in the corneal plane between the entrance pupil center and the corneal vertex. Eyes were divided into two discrete groups according to the pupil offset: small angle kappa for pupil offset of 0.25 mm or less (n = 30) and large angle kappa for pupil offset of 0.55 mm or greater (n = 30). Safety, accuracy, cylinder vector analysis, contrast sensitivity, vertex centered corneal aberrations, entrance pupil centered whole eye aberrometry, and night vision disturbances were compared between the two groups.

RESULTS

There were no statistically significant differences in safety, accuracy, induced astigmatism, contrast sensitivity, or night vision disturbances between the two groups. There was also no statistically significant difference between groups for vertex centered corneal aberrations; however, as expected, coma was higher in the large angle kappa group for entrance pupil centered aberrometry because the treatment had been centered on the CSCLR rather than the entrance pupil center.

CONCLUSION

Refractive outcomes of high hyperopic LASIK were not found to be worse for eyes where ablation was centered more than 0.55 mm from the entrance pupil as determined by CSCLR in eyes with large angle kappa. The absence of poor quality visual outcomes in cases, which by entrance pupil centration are considered significantly "decentered," supports the notion that centration relative to the CSCLR may be preferable. This provides evidence that refractive corneal ablation should not be systematically aligned with the entrance pupil center.