Photorefractive keratectomy to correct hyperopic shift after radial keratotomy

Laser vision correction after radial keratotomy: systematic review and meta-analysis

Laser vision correction for residual refractive errors in patients with previous radial keratotomy (RK) presents a challenging task. Different techniques have been used with varying outcomes. This study aimed to systematically review published articles on refractive surgeries in post-RK patients by conducting a search on PubMed, Scopus, and Web of Science. The final analysis included 35 studies that described a total of 888 eyes. Our systematic review and meta-analysis demonstrated a significant improvement in uncorrected distance visual acuity (UDVA) for photorefractive keratectomy (PRK), topography-guided PRK, wavefront-guided PRK, and femtosecond laser-assisted in situ keratomileusis (LASIK) while mechanical microkeratome LASIK did not yield such significant improvements. Moreover, our results suggest that post-RK patients with hyperopia had a significant improvement in UDVA, whereas no such improvement was observed in patients with myopia.

Pinhole pupilloplasty after previous radial keratotomy

The multiple radial stromal deep corneal incisions placed in radial keratotomy (RK) lead to higher-order aberrations and pose a surgical challenge to performing any further corrective procedure on the cornea because of fear of inducing an incisional dehiscence. A method to perform pinhole pupilloplasty (PPP) in the setting of previous RK is presented. Application of pinhole optics by performing PPP leads to significant improvement in image quality and helps to optimize visual potential in post-RK cases.

Correction of hyperopia with astigmatism following radial keratotomy with daily disposable plus spherical contact lens: a case report

Purpose

To report the refractive correction in a case of hyperopia and astigmatism following radial keratotomy.

Methods

A case report.

Results

A 47-year-old woman, who had undergone refractive surgery for radial keratotomy in both eyes 22 years before the present study, presented to our clinic with blurred vision. Her best corrected visual acuity, with spectacle correction of +3.50 DS/−1.50 DCX130° in the right eye and +3.75 DS/−1.50 DCX80° in the left eye, was 0.2 logMAR and 0.3 logMAR, respectively. Her keratometric readings were 35.75 D/36.75 D at 74° and 35.25 D/36.25 D at 61°, respectively. Prompted by intolerance to glasses, the patient requested for contact lenses. First, we applied a rigid, gas-permeable contact lens. However, we noted poor fitting due to central corneal flattening. Subsequently, we applied a conventional plus spherical soft contact lens (PSSCL), which is thick in the center and can therefore correct hyperopia and low-grade astigmatism simultaneously. The conventional PSSCL showed slightly inferior decentration, with good movement, and the patient was satisfied with it. After ascertaining the patient’s living habits, we decided that a daily disposable soft contact lens would most meet her needs. The final prescription was a daily disposable PSSCL; the patient was satisfied with her corrected visual acuity of 0.0 logMAR in the right eye and 0.0 logMAR in left eye. Her daily disposable PSSCL-corrected visual acuity was stable during the 10-month follow-up.

Conclusion

For patients displaying hyperopia with astigmatism following radial keratotomy, the PSSCL may confer better corrected visual acuity and acceptability.

Photorefractive keratectomy in the management of postradial keratotomy hyperopia and astigmatism

Background:

The aim of this study is to evaluate the results of photorefractive keratectomy (PRK) in the management of postoperative hyperopia and astigmatism in patients with history of radial keratotomy (RK).

Materials and Methods:

This prospective nonrandomized noncomparative interventional case series enrolled consecutive eyes treated with PRK after RK. In cases, in which (1) wavefront (WF) scan was undetectable during primary examinations; and/or, (2) WF data were not transferable to the excimer laser device, patients were treated with the tissue-saving (TS) mode. Patients with detectable/transferable WF were assigned to WF-guided advanced personalized treatment (APT).

Results:

Thirty-two and 47 eyes were managed by APT and TS modes, respectively. Pooled analysis of both APT and TS groups showed improvement in uncorrected distant visual acuity and corrected distant visual acuity. The amount of sphere, cylinder, corneal cylinder, spherical equivalent, defocus equivalent, and total aberration showed improvement as well.

Conclusion:

PRK seems to bring favorable outcome and safety profile in the management of post-RK hyperopia and astigmatism. It is crucial for practitioners to warn their patients about the fact that they may still have progressive refractive instability regardless of their choice on the laser method of vision correction.

Implantation of Implantable Collamer Lenses After Radial Keratotomy

PURPOSE

To assess the predictability, efficacy, and safety of posterior chamber phakic implantable collamer lens (ICL) implantation after radial keratotomy.

METHODS

In a retrospective non-comparative interventional case series, outcomes in 6 consecutive eyes of 4 patients with residual refraction after radial keratotomy were analyzed after the implantation of ICLs. All of the lenses were implanted to correct the residual refractive error, ranging from -12.00 to +3.50 diopters (D) for sphere and from -0.75 to -3.75 D for cylinder.

RESULTS

The mean uncorrected distance visual acuity after ICL implantation was 0.31 ± 0.36 logMAR and the corrected distance visual acuity was 0.12 ± 0.10 logMAR. The mean efficacy index was 0.86. No eyes lost lines of visual acuity, two eyes did not change after surgery, two eyes gained one line, and two eyes gained two lines. The mean safety index was 1.17. No intraoperative complications were found and ICL explantation or repositioning was not required during the follow-up. No cases of cataract, pigment dispersion glaucoma, pupillary block, or other vision-threatening complications were found.

CONCLUSIONS

ICL implantation may be considered a reasonable surgical procedure for correcting residual refractive errors after radial keratotomy. [J Refract Surg. 2017;33(6):395-398.].

One-Year Outcomes of Femtosecond Laser-Assisted LASIK Following Previous Radial Keratotomy

PURPOSE

To report the 1-year outcomes of LASIK in patients with previous radial keratotomy using a novel femtosecond laser platform.

METHODS

The charts of 27 eyes of 18 patients who underwent femtosecond laser-assisted LASIK with the WaveLight FS200 laser (Alcon Laboratories, Inc., Fort Worth, TX) for consecutive hyperopia following previous radial keratotomy were retrospectively reviewed at a single private practice location. The preoperative characteristics, intraoperative details, and postoperative results were evaluated.

RESULTS

All 27 eyes had successful femtosecond laser flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity significantly improved postoperatively to 0.13 ± 0.13 logMAR at 12 months of follow-up (P < .0001). Postoperative spherical equivalent averaged 0.11 ± 0.53 diopters. None of the patients lost any lines of corrected distance visual acuity during the postoperative period.

CONCLUSIONS

The femtosecond laser technique described by this study resulted in a safe and effective way to deliver LASIK following previous radial keratotomy. Future investigations are needed to further validate the outcomes of this study.

Femtosecond-assisted laser in situ keratomileusis for consecutive hyperopia after radial keratotomy

PURPOSE

To evaluate femtosecond-assisted laser in situ keratomileusis (LASIK) for the treatment of hyperopic shift after radial keratotomy (RK).

SETTING

Private practice, Siena, Italy.

DESIGN

Prospective case series.

METHODS

Eyes with a spherical equivalent (SE) of +1.0 diopters (D) to +4.0 D after RK with 6 or 8 incisions had LASIK. The flap (nominal thickness 130 μm) was created with a femtosecond laser (LDV Z2); the refractive ablation was performed with an excimer laser (217P). The flap was dissected in a centrifugal fashion along previous RK cuts.

RESULTS

Eighteen eyes of 10 patients were treated. Preoperatively, the mean defocus equivalent was 3.13 diopters (D) ± 0.71 (SD); the corrected distance visual acuity (CDVA) was 0.09 ± 0.06 logMAR. At 9 months, the mean defocus equivalent was 0.51 ± 0.47 D (P < .05), with 13 eyes (72%) having 0.50 D or less of defocus equivalent and 16 eyes (89%) having 1.0 D or less of defocus equivalent. The mean CDVA was 0.04 ± 0.06 logMAR (P < .05). No lines of logMAR CDVA were lost. The mean uncorrected distance visual acuity was 0.11 ± 0.10 logMAR. The safety index was 1.11; the efficacy index was 0.97. No retreatments were performed. Flap complications were limited to an RK incision opening larger than 2 mm in 3 eyes and 1 case of a small, self-limiting epithelial ingrowth.

CONCLUSION

Laser in situ keratomileusis with a low-energy femtosecond laser was a safe and effective approach to treat post-RK hyperopia, causing no relevant inflammation.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Femtosecond Laser Flap Creation for Laser In Situ Keratomileusis in the Setting of Previous Radial Keratotomy

PURPOSE

The aim of the study was to report the outcomes of laser in situ keratomileusis (LASIK) in subjects with previous radial keratotomy (RK) using a novel femtosecond laser setting on a proprietary femtosecond laser platform.

DESIGN

This was a retrospective, consecutive chart review of patients at a single private practice institution.

METHODS

The medical records of 16 eyes of 8 subjects who underwent femtosecond-assisted LASIK for consecutive hyperopia after RK were retrospectively reviewed. The preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed.

RESULTS

All 16 eyes had successful femtosecond laser flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity significantly improved postoperatively (P = 0.0142) and remained stable through the final follow-up interval at 9 to 12 months postoperatively. None of the subjects lost any lines of best spectacle-corrected visual acuity in the postoperative period.

CONCLUSIONS

The novel femtosecond laser technique described in this study can provide a safe and effective method for patients undergoing LASIK after previous RK. Future investigations are required to further validate the findings reported in this study.

Long-Term Outcomes of Radial Keratotomy, Laser In Situ Keratomileusis, and Astigmatic Keratotomy Performed Consecutively over a Period of 21 Years

Purpose. To describe a case of 3 refractive procedures performed in one eye over 2 decades. Methods. Case report. Results. A 41-year-old patient presented for refractive surgery evaluation. His ocular history includes bilateral radial keratotomy performed 21 years ago for moderate myopia: spherical equivalence of −4.25 D bilaterally. Postoperative uncorrected visual acuity (UCVA) was 20/30; however, over time he developed a hyperopic shift and UCVA decreased to 20/40 in the right eye. Thus, laser-assisted in situ keratomileusis (LASIK) was performed at an outside institution 6.5 years later, and the patient had initial improvement of UCVA to 20/25. Due to a change in refractive error, the patient underwent uneventful astigmatic keratotomy 13 years after LASIK in the right eye, and 1.5 years after surgery best-corrected visual acuity was 20/25 with manifest refraction of −1.00 + 5.50 × 134°.  Conclusion. We report the outcomes and natural refractive progression in a patient who underwent three corneal refractive procedures over two decades. This case underlines the difficulties of long-term management of post-RK hyperopia and astigmatism.

Collagen crosslinking after radial keratotomy

PURPOSE

The aim of this study was to report the outcomes of corneal collagen crosslinking (CXL) after previous radial keratotomy (RK) in patients with decreasing visual acuity and/or diurnal visual fluctuations.

METHODS

The charts of all patients who had undergone CXL because of a worsening corrected distance visual acuity (CDVA) and/or diurnal visual fluctuations after RK were reviewed retrospectively. Uncorrected distance visual acuity, CDVA, manifest refraction, and corneal topography were recorded preoperatively and at 1, 3, 6, and 12 months after the procedure.

RESULTS

Nine eyes of 6 patients that had undergone an RK 15 to 23 years before the CXL were included in the study. In 5 patients (8 out of 9 eyes), discontinuation of diurnal visual fluctuation was reported between 6 and 12 months after the CXL. The mean uncorrected distance visual acuities pre and 12 months after the CXL were 0.7 logarithm of the minimum angle of resolution (logMAR) and 0.6 logMAR, respectively (P = 0.3). The mean CDVAs pre and 12 months after the CXL were 0.2 logMAR and 0.1 logMAR (P = 0.5), respectively. The mean average keratometry pre and 12 months after the CXL were 40.1 and 39.1 diopters (P = 0.06), respectively. The mean corneal astigmatism values pre and 12 months after the CXL were 2.3 and 1.9 diopters (P = 0.06), respectively. The mean manifest refraction spherical equivalents (MRSEs) before and 12 months after the CXL were +1.4 and +2.5 (P = 0.1), respectively.

CONCLUSIONS

CXL is a safe and effective method to restore corneal stability in eyes with a history of RK. However, some of the effect that was achieved at the 6-month visit was blunted at the 12-month visit. Therefore, a longer follow-up is necessary to validate these findings.

Corneal crosslinking with riboflavin and ultraviolet A. Part II. Clinical indications and results

Changes in the biomechanical properties of the human cornea play an important role in the pathogenesis of corneal ectatic diseases. A variety of conditions in primary acquired (keratoconus and pellucid marginal degeneration) or secondary induced (iatrogenic keratectasia after excimer refractive laser surgery) corneal ectatic disorders lead to reduced biomechanical resistance. Corneal collagen crosslinking (CXL) has emerged as a promising technique to slow or even to stop the progression of these corneal ectatic pathologies. In this procedure, riboflavin (vitamin B2) is administered in conjunction with ultraviolet A light (UVA, 365 nm). This interaction causes the formation of reactive oxygen species, leading to the formation of additional covalent bonds between collagen molecules, with consequent biomechanical stiffening of the cornea. Although this method is not yet accepted as an evidence-based medicine modality for the treatment of corneal primary or secondary ectasias, the results of prospective, randomized studies of CXL used in the treatment of these pathologic entities show significant changes in the properties of corneal tissue. This procedure is currently the only etiopathogenetic approach in ectatic eyes that can delay or stop the process of cornea destabilization, reducing the necessity for keratoplasty. Despite promising results, CXL is associated with issues that include long-term safety and duration of the stabilizing effect. Combination of CXL with vision-improving procedures, such as topography-guided custom ablation and implantation of intracorneal ring segments of phakic intraocular lenses, may expand the indications for this procedure.

Wavefront-guided photorefractive keratectomy in eyes with prior radial keratotomy: a multicenter study

PURPOSE

To investigate the outcomes of wavefront-guided photorefractive keratectomy (WG PRK) using prophylactic mitomycin C (MMC) in eyes that had previously undergone radial keratotomy (RK).

DESIGN

Retrospective, observational, consecutive case series.

PARTICIPANTS

Thirty-two eyes of 27 patients with previous RK that underwent WG PRK with MMC.

METHODS

The records were reviewed of consecutive RK patients whose eyes underwent WG PRK with MMC in 4 centers with postoperative follow-up of 6 months or longer (range, 6-21 months). Eyes were divided into myopic WG PRK and hyperopic WG PRK groups based on their preoperative spherical equivalent (SE). Preoperative best spectacle-corrected visual acuity (BSCVA) was compared with postoperative uncorrected visual acuity (UCVA) and BSCVA to ascertain efficacy and safety. Change in SE and attempted versus achieved SE were evaluated. Incidences of haze and other complications were recorded.

MAIN OUTCOME MEASURES

Uncorrected visual acuity, BSCVA, SE, corneal haze, and other complications.

RESULTS

In the myopic WG PRK group (n = 9), UCVA improved by 3 lines on average (P = 0.015) with UCVA of > or =20/20 in 56% and > or =20/40 in 100% of eyes; 55% were within 0.5 diopter (D), and 100% were within 1 D of attempted refraction. In the hyperopic WG PRK group (n = 23), UCVA improved for 3 lines on average (P<0.001), with UCVA of > or =20/20 in 48% and > or =20/40 in 100% of eyes; 57% were within 0.5 D and 74% were within 1 D of attempted refraction. One eye lost 2 lines of BSCVA as a result of the development of mild to moderate haze, but recovered in 4 months. No eyes lost more than 2 lines of BSCVA. Six eyes (19%; 6/32) experienced the development of haze in the postoperative course, with mild to moderate haze in 1 eye and trace haze in the other 5 eyes. No other complications were noted.

CONCLUSIONS

Wavefront-guided PRK with MMC in eyes with prior RK improved the UCVA significantly and was safe over the short follow-up of this series. Although haze occurred, no eye suffered persistent visual loss of 2 or more lines.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Customized topography-guided photorefractive keratectomy with the MEL-70 platform and mitomycin C to correct hyperopia after radial keratotomy

PURPOSE

To evaluate topography-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy (RK).

METHODS

Prospective study of 12 consecutive patients (19 eyes) who were treated with topography-guided PRK with 0.02% mitomycin C using an Asclepion-Meditec MEL-70 excimer laser with a 9.5-mm ablation zone. All eyes were operated by the same surgeon and followed for 1 year.

RESULTS

Thirteen eyes had complete epithelialization by day 7 and all eyes by day 10. At 1 year, uncorrected visual acuity was 20/25 or better in 42.1% of eyes and 20/40 or better in 68.4%. Preoperative mean spherical equivalent refraction was +3.80+/-2.47 diopters (D) and +0.24+/-2.36 D (P<.001) 1 year postoperative, with 47.4% of eyes being within +/-1.00 D and 73.7% within +/-2.00 D. Preoperative mean cylinder was -2.30+/-1.41 D and -0.62+/-0.73 D (P<.001) 1 year postoperative. At 1 year, 68.4% of eyes gained at least 1 line of best-spectacle corrected visual acuity, 36.8% gained more than 1 line, and only 2 eyes lost 1 line (one due to corneal haze). Three eyes developed central haze. Mean regression from 6 to 12 months in these 3 eyes was +1.83 D and in the remaining 16 eyes was -0.50 D.

CONCLUSIONS

Topography-guided PRK with mitomycin C was safe and reasonably effective for the treatment of hyperopia after RK.

Complicated Flap Creation With Femtosecond Laser After Radial Keratotomy

PURPOSE

To report a case of laser in situ keratomileusis (LASIK) that used the Intralase femtosecond laser 14 years after radial keratotomy (RK) for residual myopic astigmatism.

METHODS

A 39 year-old male patient had undergone a bilateral RK operation for myopic correction. The manifest refraction was -1.25 -3.00 x 175 D, with uncorrected visual acuity (UCVA) of 20/50 and best-corrected visual acuity (BCVA) of 20/20. The central and thinnest pachymetry measurements were 582 and 576 mum, respectively, by Orbscan II.

RESULTS

Intralase was used for LASIK, and initially, a loss of suction was seen during flap formation. The flap could be created again at the same intracorneal plane. During flap lifting, the RK incisions were separated, and one of the RK incisions progressed to the corneal center with the force applied by the blunt spatula. No piece was separated completely from the flap. Excimer laser treatment and flap repositioning could be done without any problems. At the fifth postoperative month, his UCVA was 20/20. All RK incisions seemed well aligned. There was no haze or epithelial ingrowth.

CONCLUSIONS

This case showed that the Intralase femtosecond laser not only has no unique benefit as opposed to the mechanical keratome for post-RK eyes but also can lead to serious complications. We recommend that femtosecond laser flap formation not be used in post-RK eyes.

Komplikationen nach refraktiver Chirurgie im Ausland

BACKGROUND

In this article a retrospective analysis of patients presenting at a German university following refractive surgery abroad is presented.

PATIENTS AND METHODS

A total of 20 cases of patients who had undergone treatment between 1998 and 2006 in China (1 case), Greece (1 case), Iran (1 case), Russia (2 cases), Switzerland (1 case), Slovakia (1 case), Spain (2 cases), South Africa (3 cases), Turkey (6 cases) and the USA (2 cases) were analyzed retrospectively.

RESULTS

The following complications were observed: epithelial ingrowth into the interface with or without melting of the flap (6 cases), corneal ectasia (2 cases), dislocation of a phakic posterior chamber intraocular lens and prolapse into the anterior chamber with endothelial cell loss (1 case), secondary increase of intraocular pressure following implantation of a phakic intraocular lens (1 case), flap-related complications following laser-in-situ keratomileusis (LASIK) (2 cases), keratitis (1 case), dislocation of the complete flap (1 case), diffuse lamellar keratitis (DLK) grade IV (1 case), hyperopia as a consequence of radial keratotomy (1 case), and under correction/over correction and poor optical quality following laser epithelial keratomileusis (LASEK) and LASIK for high myopia (5 cases) with possible early corneal ectasia.

CONCLUSIONS

There are four important problems arising from refractive surgery abroad, often referred to as "LASIK tourism": wrong indications, insufficient management of complications, lack of postoperative care and the health economic aspect.

Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy

PURPOSE

To assess the use of the femtosecond laser for laser in situ keratomileusis (LASIK) in eyes with consecutive hyperopia after radial keratotomy (RK).

SETTING

Private ambulatory surgical center, Valencia, Spain.

METHODS

This prospective noncomparative interventional case series study included 13 eyes of 9 patients with secondary hyperopia after previous RK. The patients were operated on with the IntraLase femtosecond laser (IntraLase Corp.) and the Star S2 excimer laser (Visx, Inc.). Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, flap thickness, flap diameter, and complications were evaluated at 6 months.

RESULTS

The mean spherical equivalent (SE) decreased from 2.00 diopters (D)+/-0.40 (SD) to -0.41+/-0.61 D, with 8 eyes (61.5%) within+/-0.50 D of the targeted refraction. Twelve eyes (92.3%) had a UCVA of 20/40 or better, and 3 eyes (23.1%) lost 1 line of BSCVA. A mean change in SE of 0.10 D was observed at the 6-month follow-up. The mean flap thickness and diameter were 117+/-14 microm and 9.18+/-0.12 mm, respectively. Most complications were in eyes with more than 8 RK incisions than in eyes with 8 RK incisions. These complications were multiple intraoperative incision openings (100% versus 28.6%, respectively), interface inflammation (66.6% versus 0%, respectively), haze (83.3% versus 14.3%, respectively), and loss of BSCVA (50% versus 0%, respectively).

CONCLUSIONS

The femtosecond laser provided large, thin corneal flaps for hyperopic LASIK. However, the procedure should be avoided in eyes with more than 8 RK incisions because of the increased risk for multiple intraoperative incision openings, interface inflammation, haze, and loss of BSCVA.

Corneal Suture for the Correction of Hyperopia Following Radial Keratotomy

PURPOSE

To report the visual and refractive changes observed after double concentric corneal suture to correct hyperopic shift after radial keratotomy (RK).

METHODS

This retrospective consecutive case series comprised 17 eyes (15 patients) that underwent two concentric corneal sutures (modified Grene Lasso suture) to correct hyperopic shift after RK. All surgeries were performed by the same surgeon between 2000 and 2003.

RESULTS

The mean time after RK was 11.6 +/- 3.2 years. The mean follow-up was 20.3 +/- 11.3 months. The spherical equivalent refraction was reduced from a preoperative mean of +4.38 +/- 2.87 diopters (D) to -0.54 +/- 2.59 D at last postoperative follow-up (P < .001). No statistically significant difference was observed in mean refractive astigmatism before and after the corneal suture (P = .15). Before surgery, no eye presented with best spectacle-corrected visual acuity (BSCVA) > or = 20/20. At final follow-up, 3 (17.6%) eyes attained this level. Seven (41.2%) eyes improved their BSCVA by > or = 2 Snellen lines. One (5.9%) eye lost 2 Snellen lines of BSCVA.

CONCLUSIONS

Corneal suture can be used to correct RK-induced hyperopia, improving the corneal asphericity in an attempt to stabilize these corneas. It appeared to be effective even for high degrees of hyperopia and in cases with associated irregular astigmatism or open incisions.

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.

Hyperopic laser in situ keratomileusis in eyes with previous radial keratotomy

PURPOSE

To assess the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK).

SETTING

Zale Lipshy University Hospital Laser Center for Vision, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

METHODS

Thirty-eight eyes of 25 patients were treated with LASIK for secondary hyperopia after RK using a Visx Star S2, S3, S4, or LADARVision excimer laser. Retreatment was done in 7 eyes. The main outcome measures were manifest refraction spherical equivalent (MRSE), uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of treatment, and complications.

RESULTS

Preoperative mean MRSE was +2.39 diopters (D) +/- 1.28 (SD) (range +0.87 to +6.00 D). At the last visit (25 eyes with minimum follow-up of 12 months, including retreatments), the mean follow-up was 23.3 +/- 7.3 months (range 12 to 34 months), the mean MRSE was +0.11 +/- 0.71 D, and the UCVA was 20/40 or better in 24 eyes (96%). Although no significant change in the mean MRSE was observed, the postoperative mean refractive cylinder showed a gradual increase over the follow-up period. No eye lost more than 2 lines of BSCVA.

CONCLUSIONS

Laser in situ keratomileusis was a safe and effective treatment with good predictability for the correction of consecutive hyperopia after RK. Cylindrical errors were difficult to correct, and astigmatic correction tended to regress over time. Retreatments are safe when old flaps were relifted.