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Sella R, Sorkin N, Safir M, Beylin Y, Sela T, Munzer G, Kaiserman I, Mimouni M. Hyperopic LASIK and postoperative corneal steepness: revisiting the 49-diopter limit. J Cataract Refract Surg 2024; 50:550-557. [PMID: 38305328 PMCID: PMC11146188 DOI: 10.1097/j.jcrs.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To compare corrected distance visual acuity (CDVA) outcomes of hyperopic laser in situ keratomileusis (LASIK) with a postoperative corneal steepness above vs below 49 diopters (D). SETTING Care-Vision Laser Centers, Tel-Aviv, Israel. DESIGN Retrospective study. METHODS This study included consecutive patients who underwent hyperopic LASIK between January 2013 and December 2019. Hyperopic patients were divided into 2 groups based on postoperative corneal steepness with steep corneas defined >49.0 D and the control group ≤49.0 D. Adjustments were performed to account for differences in baseline and intraoperative parameters. RESULTS Overall, 1703 eyes of 1703 patients were included. Mean age was 48.3 ± 10.0 years, and 45.3% were male. Preoperatively, the steep group (2.4%, n = 41/1703) had steeper mean (44.6 D vs 43.1 D, P < .001) and steep (45.1 D vs 43.5 D, P < .001) keratometry, worse logMAR CDVA (0.07 vs 0.04, P = .02), and higher sphere (4.9 D vs 2.9 D, P < .001). Intraoperatively, they had a higher spherical treatment (4.6 D vs 2.8 D, P < .001). After hyperopic LASIK, the steep group had worse logMAR CDVA (0.10 vs 0.06, P = .01). However, after accounting for differences in baseline and spherical treatment, no significant differences were found in postoperative logMAR CDVA (0.06 vs 0.06, P = .99). The factors that remained associated with worse postoperative CDVA were higher spherical treatment (0.01 logMAR per 1 D, P < .001) and preoperative CDVA (0.60 logMAR per 1.00 logMAR, P < .001). CONCLUSIONS Postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK. However, lower preoperative visual potential and higher spherical treatment applied are associated with worse outcomes. The 49 D cutoff should be revisited.
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Affiliation(s)
- Ruti Sella
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Nir Sorkin
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Margarita Safir
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Yonatan Beylin
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Tzahi Sela
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Gur Munzer
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Igor Kaiserman
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
| | - Michael Mimouni
- From the Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Sella); Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Sella, Sorkin); Care Vision Laser Centers, Tel-Aviv, Israel (Sella, Sela, Munzer, Kaiserman, Mimouni); Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel (Sorkin); Department of Ophthalmology, Itzhak Shamir Medical Center, Beer Yaakov, Israel (Safir); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Beylin, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni)
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Biscevic A, Bohac M, Ahmedbegovic-Pjano M, Pidro A, Bejdic N, Patel S. The relationship between patient age and residual refractive error after uneventful laser in situ keratomileusis for moderate-to-high hyperopia. Eur J Ophthalmol 2020; 31:1725-1732. [PMID: 32597207 DOI: 10.1177/1120672120937658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine if the manifest sphero-cylindrical residual refractive error, at various time points over a 12-month postop period after laser in situ keratomileusis (LASIK) was associated with patient age at time of surgery. METHODS Patients with moderate to high hyperopia (3.00-7.00 DS) and astigmatism ⩽2 DC underwent LASIK using Wavelight Allegretto Eye Q (400 Hz). Treatments were centered on corneal vertex, flaps were made with Moria M2 mechanical microkeratome. Pre-and postoperative uncorrected and corrected distant visual acuity, best corrected spherical equivalent (SEQ) were measured. Measurements were taken at 1 week, 1, 3, 6, and 12 months after the surgery. Target refraction was emmetropia. Total of 161 patients were treated. In binocular cases, data from the right eyes were included for analysis. In this article, we report on refraction data only. Raw data were subjected to several permutations to elicit any links between refractive outcomes and patient age. RESULTS The key findings were as follows y = postop SEQ (diopters), x = patient age (years), ln(x) = natural logarithm of patient age: At 1 month, y = x[0.049 -0.011.ln(x)] (R = -0.205, p = 0.001, n = 161). At 3 months, y = x[0.077 -0.017.ln(x)] (R = -0.355, p < 0.001, n = 161). At 6 months, y = x[0.088 -0.020.ln(x)] (R = -0.382, p < 0.001, n = 161). At 12 months, y = x[0.093 -0.021.ln(x)] (R = -0.409, p < 0.001, n = 161). There was no significant association between x and y at 1 week (p > 0.05). CONCLUSION Residual postop refractive error after LASIK for hyperopia has a logarithmic association with patient age at time of surgery. In younger patients there is tendency toward undercorrection, the opposite occurs in older patients and this persists 1 year after treatment.
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Affiliation(s)
- Alma Biscevic
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina.,University Eye Hospital "Svjetlost" Zagreb, School of Medicine University of Rijeka, Zagreb, Croatia
| | - Maja Bohac
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina.,University Eye Hospital "Svjetlost" Zagreb, School of Medicine University of Rijeka, Zagreb, Croatia
| | | | - Ajla Pidro
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina
| | - Nita Bejdic
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina
| | - Sudi Patel
- Eye Clinic "Svjetlost," Sarajevo, Bosnia and Herzegovina.,University Eye Hospital "Svjetlost" Zagreb, School of Medicine University of Rijeka, Zagreb, Croatia
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Spierer O, Mimouni M, Nemet A, Rabina G, Kaiserman I. Hyperopic laser keratorefractive surgery: Do steep corneas have worse outcomes? Int Ophthalmol 2020; 40:1885-1895. [PMID: 32274612 DOI: 10.1007/s10792-020-01360-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the visual and refractive outcomes of hyperopic patients undergoing laser keratorefractive surgery in preoperatively steep corneas versus a matched control group. METHODS Retrospective cohort study. All patients underwent photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) at Care-Vision Laser Centers, Tel-Aviv, Israel, between 1/2000 and 11/2016. Patients were divided into two groups: steep corneas (mean keratometry ≥ 44.00 D) and control group (mean keratometry < 44.00 D). The two study groups were matched by age, gender, sphere and cylinder. Only the right eye of each patient was included. Outcomes included postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), safety and efficacy indexes, refractive outcomes and retreatment rates. RESULTS Five hundred and two patients were included. Both groups were similar in demographic data, visual acuity and refraction. Postoperatively, the steep corneas group had a significantly higher mean keratometry as compared to the control group (46.52 ± 1.43 D vs 44.58 ± 1.68 D, p < 0.001), Kmin (46.04 ± 1.50 D vs 44.12 ± 1.76 D, p < 0.001) and Kmax (46.99 ± 1.51 D vs 45.03 ± 1.77 D, p < 0.001). Both groups had similar postoperative UDVA and CDVA and achieved a similar final sphere (0.64 ± 0.19 vs 0.54 ± 1.19, p = 0.44) and cylinder (- 0.89 ± 0.59 vs - 0.86 ± 0.72, p = 0.67). Both groups had a similar efficacy index (0.92 ± 0.22 vs 0.90 ± 0.25, p = 0.33) and similar retreatment rates (4.2% vs 3.5%, p = 0.74). None of the patients in either group underwent more than one retreatment throughout the follow-up period. CONCLUSIONS Hyperopic patients with steep corneas undergoing laser keratorefractive surgery can achieve adequate visual and refractive outcomes, similar to control group.
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Affiliation(s)
- Oriel Spierer
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Achia Nemet
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Rabina
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Igor Kaiserman
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.,Care-Vision Laser Centers, Tel-Aviv, Israel
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