Long-term evaluation of hyperopic laser in situ keratomileusis

Refractive surgery as a treatment tool for strabismus: systematic review

The impact refractive surgery has on preoperative horizontal strabismus is rapidly evolving, and this knowledge can provide valuable clinical context when considering refractive surgery as a treatment for strabismus. 515 studies were identified, of which 26 met the inclusion criteria. Analysis indicated that refractive surgery resulted in an overall decrease in the mean uncorrected postoperative angle of deviation caused partially or fully due to refractive error and highlighted the varied outcome of refractive surgery on nonaccommodative horizontal strabismus with limited evidence to suggest refractive surgery for this type of strabismus. Efficacy of refractive surgery in reducing concomitant horizontal strabismus depends on several factors: type of horizontal ocular deviation, patient age, and extent of refractive error. Refractive surgery can be an effective treatment for refractive accommodative horizontal strabismus in patients with stable, mild to moderate myopia or hyperopia and should be considered with careful patient selection for optimum outcome.

Sterile Excimer Laser Shaped Allograft Corneal Inlay for Hyperopia: One-year Clinical Results in 28 Eyes

Purpose: This study aimed to evaluate the one-year clinical results of an allograft corneal inlay (ACI) implantation in a case series of 28 hyperopic eyes of 16 patients.Methods: Patients with manifest refraction spherical equivalent (MRSE) between +1.00 and +6.00 D and having a cylindrical refraction of less than 1 D were included in this prospective study. The refractive powers of excimer laser-shaped ACIs were determined based on the refractive error of the individual subject's eyes. After the creation of a femtosecond flap, the inlays were centered on the pupillary axis. Visual acuities, refractive results, and other clinical findings were reported for the 6- and 12-month follow-up exams.Results: The mean age of the patients included in the study was 36.2 ± 12.4 years (range 22-65 years). The mean pre-operative MSRE of 3.6 ± 1.51 D decreased to 0.21 ± 0.56 D (P < .001). The uncorrected distance and near visual acuity increased from 0.33 ± 0.22 and 0.17 ± 0.13 to 0.75 ± 0.22 (P < .001) and 0.72 ± 0.19 (P < .001), respectively. The corrected distance visual acuity remained unchanged (pre-OP: 0.79 ± 0.22; post-OP: 0.80 ± 0.21; P = .916), and the corrected near visual acuity increased from 0.78 ± 0.22 to 0.84 ± 0.20 (P = .003). The mean K-value and central corneal thickness increased from 42.57 ± 0.81 D and 557.5 ± 43.0 µm to 44.8 ± 1.4 D (P < .001) and 597.1 ± 58.1 µm (P < .001), respectively. No significant postoperative complications such as diffuse lamellar keratitis, epithelial ingrowth, or decentralization were observed.Conclusion: Excimer laser-shaped ACI offers an alternative treatment modality for patients with hyperopia. Acceptable visual results and similar regression rates were observed with ACI implantation compared with other laser refractive procedures.

Femtosecond-LASIK outcomes using the VisuMax®-MEL® 80 platform for hyperopia and hyperopic astigmatism refractive surgery

The present study evaluated the efficacy, the safety and the predictability of the Femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) procedure for hyperopia and hyperopic astigmatism. We retrospectively analyzed the postoperative 12-month evolution of 593 eyes with hyperopia and hyperopic astigmatism that underwent Femto-LASIK treatment. The procedure was predictable and effective. No eye lost 2 lines of corrected distance visual acuity (CDVA), demonstrating a safety profile of the procedure. Nine percent of the eyes gained at least one line of CDVA. The accuracy of the spherical equivalent after 12 months was 74% within ±1.0 diopter (D) of emmetropia. The refractive outcomes were stable during the follow-up period. There were no significant complications during the procedure. Femto-LASIK using the VisuMax^®-MEL^® 80 platform was demonstrated to be a suitable option to correct selected cases of hyperopia and hyperopic astigmatism. A longer follow-up period is required to better assess the refractive results and to detect any further regression.

Hyperopic laser keratorefractive surgery: Do steep corneas have worse outcomes?

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), K_min (46.04 ± 1.50 D vs 44.12 ± 1.76 D, p < 0.001) and K_max (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.

Long-term assessment of visual and refractive outcomes of laser in situ keratomileusis for hyperopia using the AMARIS® 750S Excimer laser

PURPOSE

To evaluate the long-term efficacy and safety of hyperopic laser in situ keratomileusis (LASIK) using the AMARIS^® 750S (Schwind, Eye-tech-solutions, GmbH) excimer laser.

METHODS

The medical records of one hundred eleven eyes of 62 patients who underwent LASIK for hyperopia using the AMARIS^® 750S excimer laser were reviewed retrospectively. Patients were divided into three groups based on preoperative spherical equivalent (SE) refraction: low hyperopia (less than +2.50 diopters [D]), moderate hyperopia (+2.75D to +4.00D), and high hyperopia (over +4.00D). Uncorrected and best corrected visual acuity (BCVA), long-term stability of refraction, and complications were evaluated.

RESULTS

Of the entire sample, the mean preoperative SE was +3.64D±1.22D. The mean age was 37.4±11.2 years (20-59). The mean follow-up for all eyes was 51 months. At the last visit, the mean SE was +0.85D±0.34D (SD) in the low hyperopia group, +1.09D±0.43D in the moderate hyperopia group, and +1.63D±0.47D in the high hyperopia group. (+1.15D±0.49D overall). Preoperative uncorrected visual acuity (UCVA) was 0.52±0.34 logMAR and increased to 0.18±0.15 logMAR at 4 years follow-up (P<0.01). There was no statistically significant difference between preoperative and postoperative BCVA. The UCVA was 0.30 logMAR or better in 100% of eyes in the low hyperopia group, 93.7% in the moderate hyperopia group, and 69.9% in the high hyperopia group (%89.2 overall).

CONCLUSIONS

LASIK is safe and effective for correcting hyperopia in the short term; however, the efficacy of the procedure is limited in the patients with high hyperopia and longer follow-up.

Risk Factors for Re-treatment Following Hyperopic LASIK

PURPOSE

To determine the risk factors for re-treatment following LASIK in hyperopic eyes.

METHODS

In this retrospective study, consecutive hyperopic eyes underwent LASIK at the Care Vision Laser Centers, Tel-Aviv, Israel, between January 2000 and October 2014. Patients were divided into two groups according to whether or not they underwent additional refractive surgery (re-treatment). Logistic regression was performed to determine predictors of re-treatment.

RESULTS

Overall, 1,776 eyes of 888 patients were included, of which 82 (4.6%) needed re-treatment. Eyes that underwent re-treatment were of older age (49.1 ± 7.5 vs 46.9 ± 10.3 years, P = .01), had better preoperative CDVA (1.0 ± 0.14 vs 0.95 ± 0.15 decimal, P = .001), were treated more often with the Allegretto EX200 (Alcon Laboratories, Inc., Fort Worth, TX) as opposed to the EX-500 (90.2% vs 63.7%, P < .001), and were treated with a Moria M2-90 microkeratome (Moria S.A., Antony, France) as opposed to Moria SBK-90 (66.7% vs 36.4%, P < .001). Multiple logistic regresison analysis demonstrated that treatment with Allegretto EX200 (odds ratio: 2.67, P = .04), and Moria M2-90 microkeratome (odds ratio: 2.23, P = .04) and older age (odds ratio: 1.03, P = .03) were significant risk factors for re-treatment.

CONCLUSIONS

Factors associated with a higher risk of re-treatment following hyperopic LASIK include type of laser, type of microkeratome used, and older age. Identifying such factors may aid in reducing future retreatment rates in hyperopic LASIK. [J Refract Surg. 2018;34(5):316-320.].

Refractive regression after laser in situ keratomileusis

Uncorrected refractive errors are a leading cause of visual impairment across the world. In today's society, laser in situ keratomileusis (LASIK) has become the most commonly performed surgical procedure to correct refractive errors. However, regression of the initially achieved refractive correction has been a widely observed phenomenon following LASIK since its inception more than two decades ago. Despite technological advances in laser refractive surgery and various proposed management strategies, post-LASIK regression is still frequently observed and has significant implications for the long-term visual performance and quality of life of patients. This review explores the mechanism of refractive regression after both myopic and hyperopic LASIK, predisposing risk factors and its clinical course. In addition, current preventative strategies and therapies are also reviewed.

Outcomes of retreatment after hyperopic laser in situ keratomileusis

PURPOSE

To evaluate the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) retreatment in eyes with hyperopia.

SETTING

Multicenter refractive surgery centers and University Hospital, Germany.

DESIGN

Retrospective case series.

METHODS

This multicenter study included hyperopic patients with a preoperative difference between cycloplegic and manifest refraction of 1.00 diopter (D) or less who had LASIK retreatment based on manifest refraction. The refractive outcome was analyzed according to standard graphs for reporting the efficacy, predictability, and safety of refractive surgery.

RESULTS

One hundred thirteen eyes of 113 consecutive hyperopic patients were enrolled. Efficacy (P < .001) and safety (P = .004) were statistically significantly improved by retreatment without being negatively influenced by preoperative manifest spherical equivalent (SE), manifest cylinder, or keratometry. In cases still showing a trend toward undercorrection, retreatment resulted in 88 eyes (78.0%) being within ±0.50 D of the attempted correction. The optical zone (OZ) diameter of the retreatment did not correlate with efficacy, predictability, or safety.

CONCLUSIONS

Retreatment after hyperopic LASIK resulted in high efficacy, predictability, and safety outcomes. The efficacy and safety of the retreatment were not affected by preoperative manifest SE, manifest cylinder, keratometry, or OZ diameter.

Assessment of refractive outcome of femtosecond-assisted LASIK for hyperopia correction

INTRODUCTION

Laser vision correction for hyperopia is challenging. The purpose of the study was to assess the refractive outcomes of femtosecond-assisted laser in situ keratomileusis (LASIK) for hyperopic correction using wavefront-optimized ablation profiles.

METHODS

This retrospective case series study included 20 Egyptian patients (40 eyes) with hyperopia or hyperopic astigmatism with a mean manifest refraction spherical equivalent (MRSE) of +2.55D±1.17 (range from +1.00 to +6.00) who had uneventful femtosecond-a assisted LASIK with wavefront-optimized aspheric ablation profile using refractive surgery suite (WaveLight FS200 Femtosecond Laser and WaveLight EX500 Excimer Laser) performed in the Research Institute of Ophthalmology and International Eye Hospital, Giza, Egypt. Statistical analysis was done using Microsoft Excel (Microsoft Corporation, Seattle, WA, USA).

RESULTS

The procedure significantly reduced the MRSE and cylinder post-operatively (95% were ± 0.50D and 100% ± 1.00 D), with stability of refraction and UDVA over the follow-up period (up to 12 months) after surgery. No eye lost any line of the CDVA, which reflects the excellent safety profile of the procedure; on the other hand, one eye (5%) gained one line and one eye (5%) even gained two lines. There were no significant complications during the procedure.

CONCLUSIONS

Femtosecond-assisted laser in situ keratomileusis for hyperopia showed predictable, effective, and safe refractive outcomes that were stable through 12 months. Longer follow-up period is required to detect any further regression.

Role of preoperative cycloplegic refraction in LASIK treatment of hyperopia

BACKGROUND

Previous studies have suggested that, to improve refractive predictability in hyperopic LASIK treatments, preoperative cycloplegic or manifest refraction, or a combination of both, could be used in the laser nomogram. We set out to investigate (1) the prevalence of a high difference between manifest and cycloplegic spherical equivalent in hyperopic eyes preoperatively, and (2) the related predictability of postoperative keratometry.

METHODS

Retrospective cross-sectional data analysis of consecutive treated 186 eyes from 186 consecutive hyperopic patients (mean age 42 [±12] years) were analyzed. Excimer ablation for all eyes was performed using a mechanical microkeratome (SBK, Moria, France) and an Allegretto excimer laser platform. Two groups were defined according to the difference between manifest and cycloplegic spherical equivalent which was defined as ≥1.00 diopter (D); the data was analyzed according to refractive outcome in terms of refractive predictability, efficacy, and safety.

RESULTS

In 24 eyes (13 %), a preoperative difference of ≥1.00D between manifest spherical equivalent and cycloplegic spherical equivalent (= MCD) occurred. With increasing preoperative MCD, the postoperative achieved spherical equivalent showed hyperopic regression after 3 months. There was no statistically significant effect of age (accommodation) or optical zone size on the achieved spherical equivalent.

CONCLUSIONS

A difference of ≥1.00D occurs in about 13 % of hyperopia cases. We suggest that hyperopic correction should be based on the manifest spherical equivalent in eyes with preoperative MCD <1.00D. If the preoperative MCD is ≥1.00D, treatment may produce manifest undercorrection, and therefore we advise that the patient should be warrned about lower predictability, and suggest basing conclusions on the arithmetic mean calculated from the preoperative manifest and cycloplegic spheres.

Correction of moderate to high hyperopia with an implantable collamer lens: medium-term results

PURPOSE

To evaluate the medium-term results of phakic posterior chamber implantable collamer lens implantation to correct moderate and high hyperopia.

METHODS

In this retrospective study, patients were treated for hyperopia with the Visian Implantable Collamer Lens (ICH model V3; STAAR Surgical AG, Nidau, Switzerland). Examined parameters were manifest refraction spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, vault, anterior chamber depth, anterior chamber angle width, endothelial cell density, intraocular pressure, patient satisfaction, and complications.

RESULTS

The mean age of 15 patients (28 eyes) was 28 years (range: 18 to 36 years), with a mean follow-up period of 3.6 years (range: 3 to 6 years). The mean manifest refraction spherical equivalent decreased from +6.30 ± 1.42 diopters (D) (range: +4.25 to +8.50 D) preoperatively to -0.37 ± 0.56 D (range: -1.25 to +1.00 D) at 3 years postoperatively. The mean uncorrected distance visual acuity improved from 0.77 ± 0.38 logMAR (range: 0.16 to 1.30 logMAR) to 0.20 ± 0.17 logMAR (range: 0.00 to 0.48 logMAR) at the 3-year follow-up. Postoperatively, 62% of eyes gained one line of corrected distance visual acuity or remained unchanged. The mean vault reduced from 367.1 ± 253.6 μm (range: 70.0 to 1,190.0 μm) at 1 month postoperatively to 283.6 ± 210.0 μm (range: 75.0 to 915.0 μm) at the last follow-up visit (P = .005). The mean preoperative anterior chamber depth and anterior chamber angle width also decreased at the last follow-up visit (P = .037 and < .0001, respectively). The mean endothelial cell loss was 4.91% (P = .089). No serious complications occurred. Thirteen (87%) patients were satisfied with the outcomes and no patient was dissatisfied.

CONCLUSIONS

Implantation of a posterior chamber implantable collamer lens is a safe, effective, predictable, and stable method for the correction of moderate and high hyperopia in highly selected patients. No case of cataract or anterior subcapsular opacities formation was recorded in relation to the decrease of vault over the studied period and low vault in some eyes.

Long-Term Followup of Laser In Situ Keratomileusis for Hyperopia Using a 213 nm Wavelength Solid-State Laser

Purpose. To evaluate the long-term efficacy, accuracy, stability, and safety of hyperopic laser in situ keratomileusis (LASIK) using a 213 nm wavelength solid-state laser. Methods. This prospective noncomparative case series consisted of 34 eyes of 17 patients which underwent hyperopic LASIK using a 213 nm solid-state laser (Pulzar Z1, CustomVis) at an outpatient refractive surgery center in Manila, Philippines. The preoperative and postoperative examinations included uncorrected distance visual acuity (UDVA), subjective manifest refraction, corrected distance visual acuity (CDVA), cycloplegic refraction, slitlamp biomicroscopy, and keratometry (K). Main Outcome Measures. Accuracy, efficacy, stability, and safety of the refractive procedure. Results. Mean follow-up was 25.18 ± 13.79 months. At the end of follow-up, 26.47% had a UDVA of 20/20 and 94.12% had a UDVA of ≥20/40. Manifest refractive spherical equivalent (MRSE) was within ±0.50 D of the target refraction in 55.88% and within ±1.0 D in 85.30% of the study eyes. Refractive stability was noted in the 1st postoperative month while hyperopic regression was noted after the 3rd postoperative year. No eye lost more than 2 lines of CDVA. Conclusion. Our results show that the 213 nm solid state laser system is safe, effective, accurate, and predictable for the treatment of hyperopia.

Laser in situ keratomileusis for high hyperopia (>5.0 diopters) using optimized aspheric profiles: efficacy and safety

PURPOSE

To evaluate the clinical outcomes of laser in situ keratomileusis (LASIK) for high hyperopia using an excimer laser and optimized aspheric profiles.

SETTING

Vissum Corporation and Miguel Hernández University, Alicante, Spain, and Research Institute of Ophthalmology, Giza, Egypt.

DESIGN

Case series.

METHODS

Eyes of patients with high hyperopia or hyperopic astigmatism (spherical equivalent [SE] ≥ 5.64 diopters [D]) had uneventful LASIK with an aspheric optimized ablation profile centered on the corneal vertex using an Amaris 500 kHz excimer laser and a femtosecond platform for flap creation with a temporal hinge.

RESULTS

There was a significant improvement in uncorrected distance visual acuity 3 months postoperatively (P<.01), with no significant changes afterward (P=.72). At 6 months, the corrected distance visual acuity (CDVA) remained unchanged or improved in 90.48% of eyes; 2 eyes (9.52%) lost 2 lines of logMAR CDVA. The postoperative SE was within ± 0.50 D of emmetropia in 70.37% of eyes. The LASIK enhancement rate at the end of the follow-up was 29.4%. Significant induction of corneal primary spherical aberration and coma was found with 6.0 mm pupils (P<.01). The safety index was 0.94 and the efficacy index, 0.85.

CONCLUSION

Laser in situ keratomileusis for high hyperopia using optimized aspheric profiles requires further improvement in terms of safety but was still an effective and a predictable procedure.

[Laser in situ keratomyleusis (LASIK) for correction of myopia and hypermetropia--our one year experience]

BACKGROUND/AIM

Laser in situ keratamileusis (LASIK) is the most commonly used refractive surgical method worldwide. The aim of this study was to examine the effectiveness and safety of LASIK in the correction of myopia and hyperopia.

METHODS

The study included myopic and hyperopic eyes with preoperative best corrected visual acuity (BCVA) = 1 (20/20), of the total number of 322 divided into 2 groups--1) myopic eyes (n = 241) which were divided into 4 subgroups according to the myopia strength: a) < or = -1.75 D (n = 23), b) from -2 to -3.75 D (n = 81), c) from -4 to -6.75 D (n = 113), d) > or = -7 D (n = 24); 2) hyperopic eyes (n = 81) which were divided into 3 subgroups according to the hyperopia strength: a) < or = +1.75D (n = 10), b) from +2 to +3.75 D (n = 46), c) > or = +4 D (n = 25). Myopic and hyperopic eyes with preoperative BCVA < or = 0.9 (eyes with ambliopia) were excluded from the study, as well as eyes with astigmatism > 1.5 D. To assess the effectiveness of LASIK we examined the percentage of eyes in the mentioned subgroups, which derived uncorrected visual acuity (UCVA) 6 month after the intervention to the following: a) UCVA = 1 (20/20) and b) UCVA > or = 0.5 (20/40). To assess the safety of LASIK we examined the frequency of intraoperative and postoperative complications. A prospective study was performed in a 6-months follow-up period. RESULTS. Refractive spherical equivalent (RSE) of myopic eyes was in the range from -0.75 D to -12 D. In the first subgroup preoperative mean value of RSE with standard deviation (mean RSE +/- SD) was -1.39 +/- 0.36 D, and 6 months after the LASIK 100% of the eyes had UCVA = 20/20. In the second subgroup preoperative mean RSE +/- SD was -2.85 +/- 0.50 D, and 6 months after LASIK 93% of the eyes had UCVA = 20/20, but 100% of the eyes had UCVA > or = 20/40. In the third subgroup preoperative mean RSE +/- SD was -5.03 +/- 0.75 D, and 6 months after the LASIK 90% of the eyes had UCVA = 20/20, but 100% of the eyes had UCVA > or = 20/40. In the fourth subgroup preoperative mean RSE +/- SD was -7.68 +/- 1.03 D, and 6 months after the LASIK 96% of the eyes had UCVA = 20/20, but 100% of eyes had UCVA > or = 20/40. Refractive spherical equivalent of hyperopic eyes was in the range from +1 D to +6 D. In the first subgroup preoperative mean RSE +/- SD was +1.50 +/- 0.30 D, and 6 months after the LASIK 90% of the eyes had UCVA = 20/20, but 100% of the eyes had UCVA > or = 20/40. In the second subgroup preoperative mean RSE +/- SD was +2.65 +/- 0.46 D, and 6 months after the LASIK 87% of the eyes had UCVA = 20/20, but 96% of the eyes had UCVA > or = 20/40. In the third subgroup preoperative mean RSE +/- SD was +4.62 +/- 0.68 D, and 6 months after the LASIK 64% of the eyes had UCVA = 20/20, but 100% of the eyes had UCVA > or = 20/40. In our study intraoperative complications appeared in 6 eyes (1.86%): thin flap in 2 eyes (0.62%) and epithelial defects in 4 eyes (1.24%), yet postoperative complications appeared in 10 eyes (3.10%): flap folds in 2 eyes (0.62%), epithelial ingrowth in 4 eyes (1.24%) and regression in 4 eyes (1.24%).

CONCLUSION

LASIK is effective and safe refractive surgical method for correcting myopia up to -12 D and hyperopia up to +6 D.

Advances in technologies for laser-assisted in situ keratomileusis (LASIK) surgery

Laser-assisted in situ keratomileusis (LASIK) has become the most widely used form of refractive surgery today. The objective of this surgical technique is to modify the anterior corneal shape by ablating tissue from the stroma by means of the excimer laser after creating a hinged corneal flap. This way, we are able to change the refractive status of the patient, providing better unaided vision. Continuous improvements in the original technique have made the surgical procedure safer, more accurate and repeatable. These progressions are due to the development of novel technologies that are the responsible for new surgical instrumentation, which makes the surgical procedure easier for the surgeon, and better excimer laser ablation algorithms, which increase the optical quality of the ablation and thus the safety of the vision correction procedure. This article aims to describe the more relevant advances in LASIK that have played an important role in the spread and popularity of this technique.

Corneal aberrations and objective visual quality after hyperopic laser in situ keratomileusis using the Esiris excimer laser

PURPOSE

To evaluate the changes in visual performance and ocular optical quality after hyperopic laser in situ keratomileusis (LASIK) using the Esiris excimer laser (Schwind eye-tech-solutions).

SETTING

Vissum-Instituto Oftalmológico de Alicante, Alicante, Spain.

METHODS

Excimer laser surgery was performed with the Esiris laser in 51 eyes of 29 patients with hyperopia or hyperopic astigmatism. The follow-up was 6 months. Changes in visual acuity, refraction, and corneal and ocular wavefront aberrations (6.0 mm pupil) were recorded and analyzed.

RESULTS

The mean preoperative sphere was +4.45 diopters (D)+/-1.08 (SD) (range +2.50 to +7.25 D) and the mean preoperative cylinder, -0.55+/-0.36 D (range 0.00 to 1.00 D). Ten eyes (19.61%) had a LASIK enhancement during the follow-up for the correction of the residual refractive error and were excluded from the refractive analysis. Of the 41 remaining eyes, 95.12% had the same or improved distance best spectacle-corrected visual acuity (BSCVA) 6 months after surgery; 90.25% had no change or a gain of lines of near BSCVA. Moreover, 80.50% of eyes were within +/-0.50 D of emmetropia. Regarding corneal aberrations, statistically significant changes were observed in higher-order aberrations (HOAs), coma-like aberrations, and the primary spherical aberration coefficient Z(4,0), which changed from positive to negative values (all P<.01). Regarding total ocular aberrations, statistically significant changes were observed in total and higher-order root-mean-square values (P<.01).

CONCLUSIONS

Hyperopic LASIK using the Esiris excimer laser for the correction of 2nd-order aberrations was safe and effective. Ocular and corneal HOAs increased significantly postoperatively.

Surgical Correction of Hyperopia

Surgical attempts to correct hyperopia have yielded varying results over the last 130 years. These techniques include the reshaping of the cornea through incisions, burns, or lamellar cuts with removal of peripheral tissue; the addition of central inlays; laser ablations; and the replacement of the crystalline lens. By examining the success of each surgical technique, the refractive surgeon may be able to make an informed decision on its indications and limitations, based on the specific patient's characteristics. Reporting the outcomes and complications of hyperopic surgery will help refine our approach to the management of an increasingly hyperopic and presbyopic population.

Treatment options for anisohyperopia

PURPOSE

To investigate the success of conventional methods in the treatment of anisohyperopic amblyopia.

METHODS

A retrospective chart review of all patients with anisohyperopic amblyopia seen at the UCSD/ Ratner Children's Eye Center during a 42-month period was performed. The charts of 35 patients aged 3 to 14 years (mean age, 6.8 years) with 1.5 to 6.5 diopters of anisohyperopia were reviewed. Main outcome measures were the difference in refractive error and the pre- and post-treatment Snellen equivalent distance acuities. Treatment consisted of one or a combination of the following: spectacles, contact lenses, patching, and atropine. Binocularity was determined using the Titmus test. Compliance to treatment also was rated.

RESULTS

Thirteen (37.1%) patients were treated with spectacles alone, 11 (31.5%) were treated with a combination of atropine and patching, 8 (22.8%) were treated with patching alone, 2 (5.7%) received blurring contact lenses, and 1 (2.9%) patient was treated with atropine alone. The average pretreatment visual acuity was 20/108, with an improvement to an average of 20/27 at the termination of treatment. Ninety-four percent of the patients obtained a visual acuity of 20/40 or better.

CONCLUSIONS

Conventional methods of treatment are effective in improving vision and binocular status in anisohyperopia. Depending on the patient, only spectacles may be required.

Optical Factors in Increased Best Spectacle-corrected Visual Acuity After LASIK

PURPOSE

To study the factors that correlate with improved best spectacle-corrected visual acuity (BSCVA) after LASIK.

METHODS

This was a nonrandomized, prospective clinical trial of 850 eyes from 480 patients undergoing LASIK for myopia, hyperopia, and mixed astigmatism. The mean preoperative spherical equivalent refraction was -3.75+/-4.82 diopters (D) (range: -13.88 to 6.00 D). From this population, 72 eyes (including 22 amblyopic eyes) from 43 patients were found to have improved BSCVA 6 months after LASIK. All patients underwent LASIK with the NAVEX platform. These eyes were analyzed to evaluate factors that correlated with improved BSCVA. Pre- and postoperative BSCVA, refraction, pupil diameter, corneal topography, asphericity (Q value), total aberrations, and higher order wavefront aberrations were analyzed. All wavefront aberrations were measured using the NIDEK Optical Path Difference Scan aberrometer (OPD-Scan) preoperatively and at 6 months postoperatively.

RESULTS

Postoperatively, the mean sphere was -0.44 1.30 D (range: -4.50 to +2.50 D). The mean increase in BSCVA was 0.15+/-0.09 logMAR. A statistically significant negative correlation was observed between the increase in BSCVA and the preoperative BSCVA (P<.01). Mixed astigmatic and highly myopic eyes are more likely to gain BSCVA after LASIK than moderately myopic (P<.05) and hyperopic eyes (P<.001). In patients with myopia, the amount of BSCVA improvement correlated with the magnitude of the correction (P<.05). The induction of spherical aberration negatively correlated with the increase in BSCVA (P<.05). There were no significant differences between normal eyes and amblyopic eyes with respect to postoperative improvement in BSCVA (P>.05).

CONCLUSIONS

Decreased preoperative BSCVA, lower total spherical aberration induction, and preoperative mixed astigmatism and high myopia correlate with an increase in BSCVA after LASIK.

Long-term results of conductive keratoplasty for low to moderate hyperopia

PURPOSE

To assess the long-term safety, efficacy, predictability, and stability of conductive keratoplasty (CK) for the treatment of low to moderate hyperopia and to evaluate the impact of the procedure on the quality of vision.

SETTING

University of Crete, Medical School, Vardinoyannion Eye Institute of Crete, Crete, Greece.

METHODS

In this prospective nonrandomized noncontrolled single-center study, 38 eyes of 26 patients (13 women and 13 men) were treated for hyperopia with a Refractec ViewPoint CK system and followed for 30 months. Preoperatively, the mean manifest refraction spherical equivalent (MRSE) was +1.89 diopters (D) +/- 0.6 (SD) (range +1.00 to +3.25 D), and the mean follow-up was 30.9 +/- 1.1 months. All eyes were treated with the regular CK nomogram for the treatment of spherical hyperopia. The treatment consisted of 8 to 32 spots applied to the periphery of the cornea. Mean age was 50.3 +/- 8.8 years (range 31 to 71 years). All treated eyes were analyzed for safety, efficacy, predictability, and stability.

RESULTS

At 12 months, the MRSE was -0.06 +/- 0.8 D and at 30 months was -0.02 +/- 0.7 D. At 30 months, the mean MRSE was within +/-0.50 D in 68%, within +/-1.00 D in 92%, and within +/-2.00 D in all eyes. At 30 months, uncorrected visual acuity was 20/20 or better in 52.5% and 20/40 or better in 89% of eyes. No eye lost 2 or more Snellen lines or had an induced cylinder of 2.00 D or greater. The procedure did not cause statistically significant changes in contrast sensitivity.

CONCLUSION

Results show that CK for low to moderate hyperopia is a safe, effective, predictable, and stable procedure.

Angle-supported phakic intraocular lenses in hyperopia

PURPOSE

To evaluate the efficacy and safety of angle-supported phakic intraocular lenses (PIOLs) in hyperopia.

SETTING

Private practice, Siena, Italy.

METHODS

A prospective noncomparative single-surgeon interventional case series comprised 42 consecutive hyperopic eyes of 22 patients having implantation of a type PIOL (Morcher) through a sclero-corneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, with surgical iridectomy. The mean preoperative defocus equivalent (DEQ) was 7.30 diopters (D) +/- 1.89 (SD). The mean spherical equivalent (SE) was 6.61 +/- 1.47 D (range 4.0 to 10.5 D), and the mean refractive astigmatism was 1.51 +/- 1.33 D (range 0 to 5 D). The mean age was 29.9 +/- 6.0 years (range 22 to 42 years). Thirteen patients (59%) were men.

RESULTS

Postoperative mean SE was 0.38 +/- 0.52 D (range 0 to 2 D); mean DEQ 0.93 +/- 0.98 D; mean astigmatism 0.95 +/- 1.17 D; mean surgically induced astigmatism (vector analysis) 0.67 +/- 0.58 D (95% confidence interval, 0.49-0.85); 38 eyes (90%) were within +/-2 D of DEQ, 34 eyes (81%) within +/-1 D, and 24 eyes (57%) within +/-0.5 D. Safety index was 1.05; efficacy index 0.85. Complications were night halos 10%; pupil ovalization 7%; pupillary block reversed by neodymium:YAG laser 7%; monocular anterior subcapsular opacity 5%; monocular iridocyclitis 5%; and intraocular pressure rise due to topical steroids 2%. Endothelial cell loss at 12 month was 6% (range +2.5% to -11%).

CONCLUSION

High hyperopia was corrected safely and predictably by an angle-supported PIOL with limited complications.

Clinical outcomes of phakic refractive lens in myopic and hyperopic eyes: 1-year results

PURPOSE

To confirm the safety, efficacy, and predictability of the surgical correction of myopia and hyperopia with the phakic refractive lens (PRL) (Medennium Inc.).

SETTING

St. Eriks Eye Hospital, Stockholm, Sweden.

METHODS

This was a prospective clinical study of 20 eyes, 14 myopic and 6 hyperopic, that had PRL implantation at St. Eriks Eye Hospital from April to November 2002. Examinations were performed preoperatively and 1 day, 1 week, 3 months, and 1 year postoperatively. Follow-up included evaluation of the PRL rotation with retroillumination photography, evaluation of the distance between the PRL and the crystalline lens with Scheimpflug image, laser flare, endothelial cell count, uncorrected (UCVA) and best corrected (BCVA) visual acuity, residual refractive error, refractive stability, intraocular pressure, and induced cataract.

RESULTS

Postoperatively, 11 eyes (55%) gained 1 or more lines, 5 eyes (25%) had no change, and 4 eyes (20%) lost 1 line of BCVA. No eye lost 2 or more lines. Mean UCVA was 0.87+/- 0.29 postoperatively. Laser flare values were highest 1 day after operation with normalization at 3 months and without changes at 1 year (P<.05). A rotation of 10 degrees or more was found in 15 eyes (75%) during the first year. The distance between the PRL and crystalline lens was considerably less at 1 year than at baseline (P<.05). There was no statistically significant endothelial cell loss induced by the PRL (P<.05). No induced cataract, glaucoma, or inflammation was observed. In 1 hyperopic eye, horizontal iris transillumination defects were noticed at 1 year.

CONCLUSION

Safety and efficacy indexes were high at 1-year follow-up. The PRL rotated slightly in the posterior chamber. The distance between the PRL and the crystalline lens was considerably less at 1 year than at baseline.

Laser in situ keratomileusis for primary hyperopia

PURPOSE

To evaluate the efficacy, predictability, stability, and safety of hyperopic laser in situ keratomileusis (H-LASIK) over a 24-month period and analyze topographic changes after H-LASIK to assess topographic pseudokeratectasia (TPKE) following H-LASIK.

SETTING

Eye Institute of Utah, Salt Lake City, Utah, USA.

METHODS

This prospective study included 139 eyes of 77 patients having H-LASIK for primary hyperopia. The mean follow-up was 15.6 months +/- 7.6 (SD) (range 6 to 48 months). One hundred twenty-two eyes (88%) were followed at 1 year and 36 eyes (26%) at 24 months. Topographic pseudokeratectasia was defined as 1 or more positive keratoconus screening findings in an eye with topographic central or inferior steepening detected by the Topography Modeling System but without corneal thinning or progressive change.

RESULTS

The mean spherical equivalent manifest refraction was +2.39 +/- 0.99 diopter (D) preoperatively and -0.05 +/- 0.61 D at the last visit. Ninety-one percent of eyes were within +/-1.00 D of emmetropia and 71% of the eyes were within +/-0.50 D. Uncorrected visual acuity of 20/20 or better was present in 42%, 20/25 in 63%, and 20/40 or better in 93% of eyes. Loss of 2 lines of BSCVA occurred in 2 eyes (1.4%). In 1 eye, ischemic optic neuropathy occurred, and in another, choroidal neovascularization developed postoperatively. Topographic pseudokeratectasia was detected in 28% to 56% of eyes postoperatively. No significant difference between postoperative visual and refractive outcome, regression, or irregularity was found between the eyes with or without TPKE.

CONCLUSION

Hyperopic LASIK appears to be an effective, predictable, and safe procedure to correct low to moderate primary hyperopia. Topographic pseudokeratectasia, which was observed after H-LASIK with a keratoconus-like topographic pattern in otherwise normal eyes, may represent a relatively static condition.

5-year follow-up of LASIK for hyperopia

PURPOSE

To assess the long-term efficacy and stability of LASIK for hyperopia (+0.75 to +7.00 diopters [D]).

DESIGN

Retrospective follow-up study of a previous phase III multicenter clinical trial (unpublished data).

PARTICIPANTS

Patients who had been treated for hyperopia (33 individuals, 47 eyes) attended follow-up 5 years after surgery. The preoperative mean spherical equivalent at the spectacle plane was +3.58 D (range, +0.75 to 7.00 D), and the attempted mean spherical correction at the corneal plane was +3.18 D (range, +1.00 to +6.00 D).

INTERVENTION

Treatments were performed using a Moria LSK One microkeratome and a Summit Technology SVS Apex Plus excimer laser fitted with an Axicon.

MAIN OUTCOME MEASURES

Manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity, corneal transparency, complications, and patient satisfaction were recorded.

RESULTS

At 5 years, for treatments between +1.00 to +3.00 D, 71.0% of eyes were within +/-1.00 D of the intended correction, and for treatments between +3.5 to +6.0 D, 37.5% of eyes were within +/-1.00 D of intended correction. From 12 to 54 months after surgery for all patients, there was a hyperopic shift of +0.53 D (range, -0.13 to +3.13 D), with 51.1% of eyes experiencing an increase of +0.50 D or more and 27.7% of eyes showing a hyperopic shift of more than +1.00 D. This hyperopic shift was +0.67 D (range, 0 to +1.125 D) for patients younger than 40 years of age and +0.44 D (range, -1.33 to +1.50 D) for patients between 43 and 55 years of age.

CONCLUSIONS

LASIK was moderately effective for the correction of low degrees of hyperopia. However, there was regression throughout the 5-year follow-up that was greater than would be expected as a result of aging. Long-term stability of hyperopic LASIK refractive corrections, therefore, is uncertain.