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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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Abdel-Radi M, Rateb M, Saleh MGA, Aly MOM. Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism. EYE AND VISION (LONDON, ENGLAND) 2023; 10:7. [PMID: 36855211 PMCID: PMC9976533 DOI: 10.1186/s40662-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Conventional mechanical or alcohol-assisted photorefractive keratectomy (PRK) techniques for correction of hyperopia and hyperopic astigmatism were associated with inconsistent results. The aim of this study is to evaluate the 12-month visual and refractive outcomes of the relatively new single-step transepithelial photorefractive keratectomy (TE-PRK) for moderate hyperopia and hyperopic astigmatism. METHODS This is a prospective interventional study. Forty-eight eyes of 30 patients with moderate hyperopia or hyperopic astigmatism with a cycloplegic spherical equivalent refraction (SEQ) between 2.0 and 4.5 diopters (D) underwent single-step StreamLight® TE-PRK using EX500 excimer laser (Alcon Laboratories, USA). The main outcome measures were recorded at 6 and 12 months postoperatively including assessment of logarithm of the minimum angle resolution (logMAR) uncorrected and corrected distance visual acuity (UDVA, CDVA), cycloplegic refraction, corneal topographic changes as well as post-PRK peripheral haze grading. RESULTS The mean preoperative cycloplegic SEQ was significantly reduced from 3.21 ± 0.61 D to 0.35 ± 0.04 D and 0.41 ± 0.04 D at 6 and 12 months, respectively (P < 0.001). The mean preoperative UDVA significantly improved from 0.53 ± 0.02 logMAR to 0.07 ± 0.01 logMAR and 0.08 ± 0.01 logMAR at 6 and 12 months, respectively (P < 0.001) while the mean preoperative logMAR CDVA showed non-significant change over time throughout the study (P = 0.135). At the end of the study, 41 eyes (85.4%) achieved UDVA of 20/25 or better and no eye lost any lines of CDVA. Thirty-eight eyes (79.1%) had a postoperative cycloplegic cylinder of 0.5 D or less at 12 months. The mean preoperative mean keratometry showed significant increase at 6 and 12 months postoperatively (P < 0.001) while there was no significant change between the two postoperative visits denoting topographic stability (P = 0.058). The mean postoperative Q value at 6 and 12 months showed a significant prolate shift (P < 0.001). No haze was observed in 62.5% and 85.4% of the enrolled eyes at 6 and 12 months, respectively. CONCLUSIONS Single-step StreamLight® TE-PRK for moderate hyperopia and hyperopic astigmatism achieved acceptable visual and refractive outcomes. TRIAL REGISTRATION (Clinicaltrials.gov): NCT05261685, 2 March 2022, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05261685.
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Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516, Assiut, Egypt.
| | - Mahmoud Rateb
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
| | - Mohamed G. A. Saleh
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
| | - Mohamed Omar M. Aly
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
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Cheng SM, Tu RX, Li X, Zhang JS, Tian Z, Zha ZW, Ruan KW, Yu AY. Topography-Guided Versus Wavefront-Optimized LASIK for Myopia With and Without Astigmatism: A Meta-analysis. J Refract Surg 2021; 37:707-714. [PMID: 34661478 DOI: 10.3928/1081597x-20210709-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the differences in efficacy, predictability, safety, and visual quality between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) for the treatment of myopia with and without astigmatism. METHODS A comprehensive literature search of PubMed, Embase, the Cochrane library, Web of Science, and ClinicalTrials was used to identify randomized controlled trials (RCTs) comparing TCAT-LASIK with WFO-LASIK for myopia with and without astigmatism up to September 2020. The references of all searched literature were checked as supplements. Literature was screened according to the inclusion and exclusion criteria and relative data were extracted. RevMan software version 5.3.0 (Cochrane Collaboration) was used for meta-analysis. RESULTS A total of seven RCTs (1,168 eyes) were included. There were no statistically significant differences in the ratio of uncorrected distance visual acuity of 20/20 or better (relative risk [RR] = 1.01, 95% CI [0.97 to 1.06], P = .64) and 20/16 or better (RR = 0.96, 95% CI [0.80 to 1.16], P = .69). Compared with WFO-LASIK, TCAT-LASIK achieved a higher proportion of postoperative manifest refractive spherical equivalent within ±0.50 diopters of the target (RR = 1.06, 95% CI [1.02 to 1.11], P = .003) and less surgically induced higher order aberrations (weighted mean difference [WMD] = -0.11, 95% CI [-0.15 to -0.0], P < .00001), spherical aberrations (WMD = -0.04, 95% CI [-0.05 to -0.03], P < .00001), and coma (WMD = -0.15, 95% CI [-0.28 to -0.01], P = .03). No patient lost two or more lines of distance-corrected visual acuity postoperatively in the two groups. CONCLUSIONS This meta-analysis suggests that both TCATLASIK and WFO-LASIK show excellent efficacy, predictability, and safety for myopia. TCAT-LASIK exhibited more accurate postoperative refraction predictability and less surgically induced higher order aberrations, spherical aberrations, and coma. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term. [J Refract Surg. 2021;37(10):707-714.].
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Moshirfar M, Megerdichian A, West WB, Miller CM, Sperry RA, Neilsen CD, Tingey MT, Hoopes PC. Comparison of Visual Outcome After Hyperopic LASIK Using a Wavefront-Optimized Platform Versus Other Excimer Lasers in the Past Two Decades. Ophthalmol Ther 2021; 10:547-563. [PMID: 34009511 PMCID: PMC8319246 DOI: 10.1007/s40123-021-00346-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/10/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Laser-assisted in-situ keratomileusis (LASIK) for the correction of hyperopia and hyperopic astigmatism is challenging and has been less studied than for the correction of myopia and myopic astigmatism. The aim of this study was to analyze the refractive outcomes of LASIK in hyperopia and hyperopic astigmatic eyes using a wave-front optimized laser platform (the Allegretto EX500 laser) and perform a historical comparison with other excimer lasers within the past two decades. Methods A one-center (Tertiary Refractive Center, Draper, Utah), retrospective, non-comparative study was conducted on 379 eyes treated with LASIK for hyperopia and hyperopic astigmatism. The data retrieved on these eyes were analyzed using uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalents. A literature search of excimer platforms in use in the past 20 years and a comparison of US Federal Drug Administration-approved platforms for hyperopia were performed. Results At 3 and 12 months postoperatively, 142 (66%) and 81 (69%) eyes had a UDVA of 20/20 or better and 207 (96%) and 114 (97%) eyes had a UDVA of 20/40 or better, respectively. The mean refractive spherical equivalent was − 0.52 ± 0.78 D at 3 months and − 0.46 ± 0.79 D at 12 months. At 12 months, 181 (96%) eyes achieved a spherical equivalent within ± 1.00 D of the intended target. Studies published before 2005 reported lower rates of UDVA 20/20 or better (32%) compared to those published after (68%); however, this discrepancy was less evident for UDVA 20/40 or better. A similar trend towards improved accuracy was noted in the literature with postoperative manifest refractive spherical equivalent within ± 0.50 D before and after 2005. Conclusion There has been significant improvement in safety, efficacy, stability, and accuracy of LASIK treatment for hyperopia and hyperopic astigmatism within the past two decades. Newer excimer lasers meet industry standards and in particular, the Allegretto EX500 used in this study exceeded industry standards.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Draper, UT, USA. .,Moran Eye Center University of Utah, Salt Lake City, UT, USA. .,Utah Lions Eye Bank, Murray, UT, USA.
| | - Alin Megerdichian
- College of Medicine, California Northstate University, Sacramento, CA, USA
| | - William B West
- School of Medicine, University of Utah, Salt Lake City, UT, USA
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