Hyperopic Laser-assisted In Situ Keratomileusis Results With LADARVision, Visx Star S2, and Visx Star S3

LASIK for the Correction of High Hyperopic Astigmatism With Epithelial Thickness Monitoring

PURPOSE

To evaluate outcomes of high hyperopic LASIK using the MEL 80 excimer laser (Carl Zeiss Meditec, Jena, Germany).

METHODS

Retrospective analysis of 830 consecutive high hyperopic LASIK procedures using the MEL 80 excimer laser and either the VisuMax femtosecond laser (Carl Zeiss Meditec) or zero compression Hansatome microkeratome (Bausch & Lomb, Rochester, NY). Inclusion criteria were attempted hyperopic correction of +4.00 diopters [D] or higher in one axis and corrected distance visual acuity (CDVA) of 20/20 or better. Patients were observed for a minimum of 1 year. Epithelial thickness monitoring by Artemis very high-frequency (VHF) digital ultrasound (ArcScan Inc., Morrison, CO) was used to evaluate potential for further steepening as a re-treatment.

RESULTS

One-year data were available for 785 eyes. Mean attempted spherical equivalent refraction (SEQ) was +4.52 ± 0.84 D (range: +2.00 to +6.96 D) for the primary treatment and mean cylinder was 1.05 ± 0.86 D (range: 0.00 to 5.25 D). Mean age was 50 ± 12 years (range: 18 to 70 years) and 61% were women. Postoperative SEQ was ±0.50 D in 50% and ±1.00 D in 77% of eyes after primary treatment. After re-treatment, 67% of eyes were within ±0.50 D and 89% were within ±1.00 D. Uncorrected distance visual acuity was 20/20 or better in 76% of eyes after final treatment. One line of CDVA was lost in 25% of eyes and two lines were lost in 0.4%. There was a clinically insignificant but statistically significant decrease (P < .05) in contrast sensitivity (CSV-1000) by less than 1 log unit at 3 and 6 cycles per degree (cpd) and by 1 log unit at 12 and 18 cpd. Diurnal fluctuation in refraction was identified in 2 eyes, proven by VHF digital ultrasound to be due to diurnal epithelial remodeling overnight and unrelated to maximum postoperative keratometry induced.

CONCLUSIONS

LASIK for hyperopia by cumulative treatment of up to +8.33 D with the MEL 80 excimer laser was found to satisfy accepted criteria for safety, efficacy, and stability when applying specialized protocols, including epithelial monitoring. [J Refract Surg. 2017;33(5):314-321.].

Outcomes of PermaVision intracorneal implants for the correction of hyperopia

PURPOSE

To report the clinical and visual outcomes of a series of patients implanted with the PermaVision intracorneal lens (ReVision Optics Inc, Lake Forest, California, USA) for correction of hyperopia.

DESIGN

Prospective, nonrandomized, clinical trial study.

METHODS

Fifteen patients were implanted with the intracorneal lens for correction of spherical hyperopic refractive errors ranging from 1.00 to 5.00 diopters (D) (mean, 2.45 D). All eyes were correctable to 20/20 before surgery. Patients were followed up to 3 years with measurements of residual refractive error, uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA).

RESULTS

For patients with follow-up of 1 year or more, the mean logarithm of the minimum angle of resolution BSCVA was 0.15 (20/28 Snellen equivalent; range, 0.1 to 0.6) with an average change of -2.5 lines of BSCVA (range, 1 to -6 lines). Only 3 eyes (25%) achieved 20/20 or better UCVA. Two patients experienced early adverse events and 1 patient experienced a late-onset adverse event requiring eventual removal of the implant. Nine patients elected to have the implant removed, with dissatisfaction with the quality of vision as the most frequent reason for removal.

CONCLUSIONS

The quality of visual and refractive outcomes with this device was less than satisfactory for most of the patients in our series. Although the problems of early onset migration or extrusion of the device are possible, late-onset ulceration noted in one of our patients most likely represents a neurotropic melt. Further research to improve the safety and quality of refractive result with intracorneal implants is needed.

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.