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Six-Month Outcomes After High Hyperopia Correction Using Laser-Assisted In Situ Keratomileusis With a Large Ablation Zone. Cornea 2019; 38:1147-1153. [PMID: 31169605 DOI: 10.1097/ico.0000000000002011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate refractive and visual outcomes of laser-assisted in situ keratomileusis (LASIK) to treat high hyperopia using an aberration-neutral profile and large ablation zone. METHODS This was a retrospective, consecutive observational case series at Helios Ophtalmologie, St. Jean-de-Luz, France. One hundred forty-six consecutive eyes of 77 patients who underwent LASIK with mechanical microkeratome to correct hyperopia with correction in the maximum hyperopic meridian strictly higher than +5 D (mean + 6.6 ± 1.0 D) were included. Procedures were performed with an Amaris 750S excimer laser (Schwind eye-tech-solutions GmbH, Kleinostheim, Germany) using an aberration-neutral profile, a 6.7 ± 0.1 mm optical zone, and a 9.2 ± 0.1 mm total ablation zone. Refractive results, predictability, safety, and efficacy were evaluated at 6 months postoperatively. RESULTS At 6 months postsurgery, the mean manifest refraction spherical equivalent was -0.06 ± 0.83 D and the mean cylinder was 0.42 ± 0.35 D. Sixty-six percent of eyes were within ±0.50 D of the attempted spherical equivalent correction. Six months postoperatively, 60% of eyes achieved an uncorrected distance visual acuity of 20/20 or better. Ten percent of eyes lost 1 line of corrected distance visual acuity and 4% gained a line. No eyes lost more than 2 Snellen lines of corrected distance visual acuity at any follow-up. CONCLUSIONS High hyperopia correction with LASIK using an aberration-neutral profile and large ablation zone provides good efficacy, safety, predictability, and visual outcomes.
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Freidank S, Vogel A, Anderson RR, Birngruber R, Linz N. Correction of hyperopia by intrastromal cutting and liquid filler injection. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-7. [PMID: 31124345 PMCID: PMC6992961 DOI: 10.1117/1.jbo.24.5.058001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
Correction of hyperopia requires an increase of the refractive power by steepening of the corneal surface. Present refractive surgical techniques based on corneal ablation (LASIK) or intrastromal lenticule extraction (SMILE) are problematic due to epithelial regrowth. Recently, it was shown that correction of low hyperopia can be achieved by implanting intracorneal inlays or allogeneic lenticules. We demonstrate a steepening of the anterior corneal surface after injection of a transparent, liquid filler material into a laser-dissected intrastromal pocket. We performed the study on ex-vivo porcine eyes. The increase of the refractive power was evaluated by optical coherence tomography (OCT). For a circular pocket, injection of 1 μl filler material increased the refractive power by +4.5 diopters. An astigmatism correction is possible when ellipsoidal intrastromal pockets are created. Injection of 2 μl filler material into an ellipsoidal pocket increased the refractive power by +10.9 dpt on the short and +5.1 dpt on the long axis. OCT will enable to monitor the refractive change during filler injection and is thus a promising technique for real-time dosimetry.
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Affiliation(s)
- Sebastian Freidank
- University of Luebeck, Institute of Biomedical Optics, Peter-Monnik Weg 4, Luebeck, Germany
| | - Alfred Vogel
- University of Luebeck, Institute of Biomedical Optics, Peter-Monnik Weg 4, Luebeck, Germany
| | - R. Rox Anderson
- Wellman Center for Photomedicine and Harvard Medical School, Massachusetts General Hospital, Research Institute, Department of Dermatology, Boston, Massachusetts, United States
| | - Reginald Birngruber
- University of Luebeck, Institute of Biomedical Optics, Peter-Monnik Weg 4, Luebeck, Germany
- Wellman Center for Photomedicine and Harvard Medical School, Massachusetts General Hospital, Research Institute, Department of Dermatology, Boston, Massachusetts, United States
| | - Norbert Linz
- University of Luebeck, Institute of Biomedical Optics, Peter-Monnik Weg 4, Luebeck, Germany
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Reinstein DZ, Pradhan KR, Carp GI, Archer TJ, Gobbe M, Sekundo W, Khan R, Dhungana P. Small Incision Lenticule Extraction (SMILE) for Hyperopia: Optical Zone Diameter and Spherical Aberration Induction. J Refract Surg 2017; 33:370-376. [DOI: 10.3928/1081597x-20170331-01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/09/2017] [Indexed: 11/20/2022]
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Sixteen-year follow-up of hyperopic laser in situ keratomileusis. J Cataract Refract Surg 2016; 42:717-24. [DOI: 10.1016/j.jcrs.2016.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/13/2016] [Accepted: 03/22/2016] [Indexed: 11/20/2022]
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Eighteen-year follow-up of hyperopic photorefractive keratectomy. J Cataract Refract Surg 2016; 42:258-66. [DOI: 10.1016/j.jcrs.2015.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/17/2015] [Accepted: 09/09/2015] [Indexed: 11/19/2022]
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Shalchi Z, O’Brart DP, McDonald RJ, Patel P, Archer TJ, Marshall J. Eighteen-year follow-up of excimer laser photorefractive keratectomy. J Cataract Refract Surg 2015; 41:23-32. [DOI: 10.1016/j.jcrs.2014.05.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/20/2014] [Accepted: 05/03/2014] [Indexed: 10/24/2022]
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Pradhan KR, Reinstein DZ, Carp GI, Archer TJ, Gobbe M, Gurung R. Femtosecond laser-assisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor. J Refract Surg 2014; 29:777-82. [PMID: 24203809 DOI: 10.3928/1081597x-20131021-07] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/13/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe endokeratophakia in which a small incision lenticule extraction (SMILE) lenticule from a myopic patient is implanted into a recipient eye through a small incision to correct hyperopia. METHODS A 23-year-old aphakic woman presented following cataract surgery to remove a childhood congenital cataract with hyperopia of +12.00 -1.50 × 155, corrected distance visual acuity of counting fingers, and exotropia. A SMILE procedure using the VisuMax femto-second laser (Carl Zeiss Meditec, Jena, Germany) was performed on a donor patient with high myopia and the extracted lenticule was stored (power -10.50 diopter sphere, optical zone 5.75 mm, central lenticule thickness 127 μm). In the recipient eye, a pocket lamellar incision was created using the VisuMax SMILE software. The upper interface was separated and the donor lenticule was inserted through the small incision. RESULTS One year postoperatively, retinoscopy refraction was +7.50 -3.00 × 150, a spherical equivalent refraction reduction of 5.25 diopters. Mean keratometric power increased by 2.91 diopters. The posterior surface elevation changed significantly with a central bulge into the anterior chamber. Central corneal thickness by Pentacam (Oculus Optikgeräte, Wetzlar, Germany) increased by 121 μm. Central lenticule thickness was 130 μm and central epithelial thickness was 43 μm measured by RTVue OCT (Optovue Inc., Fremont, CA). The cornea remained clear over the 1-year postoperative period. CONCLUSIONS Endokeratophakia appears to be a viable procedure for correcting hyperopia on the cornea by implantation of an extracted myopic SMILE lenticule from a donor patient. However, posterior surface changes and epithelial remodeling resulted in only 50% of the intended correction. No adverse side effects were observed following implantation of donor tissue for 1 year.
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O'Brart DPS. Excimer laser surface ablation: a review of recent literature. Clin Exp Optom 2013; 97:12-7. [PMID: 23656608 DOI: 10.1111/cxo.12061] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 12/25/2012] [Accepted: 01/08/2013] [Indexed: 11/27/2022] Open
Abstract
The aim was to review the recently published literature on excimer laser surface ablation procedures, including photorefractive keratectomy (PRK), laser sub-epithelial keratomileusis (LASEK), microkeratome-assisted PRK (epi-LASIK) and trans-epithelial (laser-assisted) PRK, to help elucidate where and how surface ablation may best fit into current refractive surgical practice. The emphasis was on publications within the last three years and included systemic reviews, meta-analyses and randomised controlled trials. Where such evidence did not exist, selective large series cohort studies, case-controlled studies and case series with follow-up preferably greater than six months were examined and included. Refractive and visual outcomes are excellent and comparable to those after LASIK even in complex cases after previous corneal surgery. Indeed, surface ablation combined with corneal collagen cross-linking may be used in selected eyes with biomechanical instability, where LASIK is contraindicated. In addition, there is evidence to suggest that there may be less induction of higher order aberrations with surface techniques. Long-term stability and safety appear to be extremely satisfactory. The literature supports the use of modern excimer laser surface treatments, with outcomes comparable to those after LASIK and evidence of less induction of higher-order aberrations. Follow-up studies at 10 to 20 years indicate excellent stability and safety.
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Affiliation(s)
- David P S O'Brart
- Keratoconus Research Institute, Department of Ophthalmology, St. Thomas Hospital, London, United Kingdom.
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Laser in situ keratomileusis for high hyperopia (>5.0 diopters) using optimized aspheric profiles: efficacy and safety. J Cataract Refract Surg 2013; 39:519-27. [PMID: 23375692 DOI: 10.1016/j.jcrs.2012.10.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/17/2012] [Accepted: 10/21/2012] [Indexed: 11/22/2022]
Abstract
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.
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McAlinden C. Corneal refractive surgery: past to present. Clin Exp Optom 2012; 95:386-98. [PMID: 22672114 DOI: 10.1111/j.1444-0938.2012.00761.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/07/2012] [Accepted: 04/17/2012] [Indexed: 12/20/2022] Open
Abstract
There have been many historical corneal refractive techniques and procedures developed over the years. From early techniques of radial keratotomy to modern excimer laser techniques, the field of refractive surgery is one of the most rapidly developing in ophthalmology. This review details the historical aspects of the many early techniques up to current techniques used on millions of eyes around the world.
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Affiliation(s)
- Colm McAlinden
- University of Ulster, United Kingdom and Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
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Camellin M, Arba Mosquera S. Aspheric Optical Zones in hyperopia with the SCHWIND AMARIS. JOURNAL OF OPTOMETRY 2011; 4:85-94. [PMCID: PMC3974388 DOI: 10.1016/s1888-4296(11)70047-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 08/29/2011] [Indexed: 10/07/2023]
Abstract
Purpose To evaluate the corneal Functional Optical Zone (FOZ) and the Effective Optical Zone (EOZ) of the ablation, among eyes that underwent LASEK/Epi-LASEK treatments for hyperopic astigmatism. Methods Twenty LASEK/Epi-LASEK treatments with mean defocus +2.21 ± 1.28 D performed using the SCHWIND AMARIS were retrospectively evaluated at 6-month follow-up. In all cases pre-/post-operative Corneal-Wavefront analyses using the Keratron-Scout (OPTIKON2000) were performed. FOZ-values were evaluated from the Root-Mean-Square of High-Order Wave-Aberration (RMSho), whereas EOZ-values were evaluated from the changes of Root-Mean-Square of High-Order Wave-Aberration (ΔRMSho) and Root-Mean-Square of the change of High-Order Wave-Aberration (RMS(ΔHOAb)). Correlations of FOZ and EOZ with Planned Optical Zone (POZ) and Defocus correction (SEq) were analyzed using a bilinear function. Results At six-month, defocus was −0.04 ± 0.44 D, ninety percent eyes were within ± 0.50 D from emmetropia. Mean RMSho increased 0.18 ± 0.22 μm, SphAb −0.30 ± 0.18 μm, and Coma 0.07 ± 0.18 μm 6-month after treatment (6-mm diameter). Mean FOZPre was 7.40 ± 1.48 mm, mean POZ was 6.76 ± 0.22 mm, whereas mean FOZPost was 5.53 ± 1.18 mm (significantly smaller, p < 0.0001; bilinear correlation p < 0.005), mean EOZΔRMSho 6.47 ± 1.17 mm (bilinear correlation p < 0.005), EOZRMS(ΔHOAb) 5.67 ± 1.23 mm (significantly smaller, p < 0.0005; bilinear correlation p < 0.05). EOZ positively correlates with POZ and declines steadily with SEq. A treatment of +3 D in 6.50-mm POZ results in 5.75-mm EOZ (7.75-mm NPOZ), treatments in 7.00-mm POZ result in about 6.25-mm EOZ (8.25-mm nomogrammed POZ). Conclusions FOZPost was significantly smaller than FOZPre. EOZΔRMSho was similar to POZ, whereas EOZRMS(ΔHOAb) was significantly smaller. Differences were larger for smaller POZ or larger Defocus. SEq up to +2 D result in EOZ, at least, as large as POZ. For SEq higher than +2 D, a nomogram for OZ can be applied.
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Affiliation(s)
| | - Samuel Arba Mosquera
- Grupo de Investigación de Cirugía Refractiva y Calidad de Visión, Instituto de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain
- SCHWIND eye-tech-solutions, Kleinostheim, Germany
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McAlinden C, Skiadaresi E, Moore JE. Hyperopic LASEK Treatments with Mitomycin C Using the SCHWIND AMARIS. J Refract Surg 2011; 27:380-3. [DOI: 10.3928/1081597x-20101104-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/19/2010] [Indexed: 11/20/2022]
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Effect of 3 excimer laser ablation frequencies (200 Hz, 500 Hz, 1000 Hz) on the cornea using a 1000 Hz scanning-spot excimer laser. J Cataract Refract Surg 2010; 36:1385-91. [PMID: 20656164 DOI: 10.1016/j.jcrs.2010.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 12/22/2009] [Accepted: 01/31/2010] [Indexed: 11/21/2022]
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Reynolds A, Moore JE, Naroo SA, Moore CBT, Shah S. Excimer laser surface ablation - a review. Clin Exp Ophthalmol 2010; 38:168-82. [DOI: 10.1111/j.1442-9071.2010.02230.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Affiliation(s)
- Michael O'Keefe
- Department of Refractive Surgery, Mater Private Hospital, Dublin, Ireland.
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Llovet F, Galal A, Benitez-del-Castillo JM, Ortega J, Martin C, Baviera J. One-year results of excimer laser in situ keratomileusis for hyperopia. J Cataract Refract Surg 2009; 35:1156-65. [PMID: 19545802 DOI: 10.1016/j.jcrs.2009.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 03/01/2009] [Accepted: 03/03/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the visual and refractive results of hyperopic LASIK. SETTING Clínica Baviera Instituto Oftalmológico Europeo, Madrid, Spain. METHODS This retrospective consecutive noncomparative observational study evaluated hyperopic LASIK results over 1 year. Outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), cycloplegic refraction, and corneal topography. Surgery was performed using an MEL 80-G excimer laser. Results were analyzed by preoperative spherical equivalent (SE) (Group 1: <or=+3.50 diopters [D]; Group 2: >or=+3.60 D). RESULTS The mean UDVA improved from 0.50 +/- 0.3 (SD) to 0.90 +/- 0.2 in Group 1 and from 0.50 +/- 0.3 to 0.80 +/- 0.2 in Group 2 and the mean CDVA, from 0.86 +/- 0.2 to 0.93 +/- 0.1 and from 0.80 +/- 0.2 to 0.90 +/- 0.2, respectively. The mean cycloplegic SE improved from +2. 5+/- 0.8 to +0.1 +/- 0.5 in Group 1 and from +4.5 +/- 0.6 to +0.4 +/- 0.6 in Group 2; 70.9% of eyes and 63.3% of eyes, respectively, were within +/-0.50 D of emmetropia. Postoperatively, 92.8% of eyes in Group 1 and 87.8% in Group 2 maintained or gained 1 or more lines of CDVA; 1.7% and 4.0%, respectively, lost 2 or more lines. The safety index was 1.1 in both groups and the efficacy index, 1.01 in Group 1 and 0.98 in Group 2. The enhancement rate was 20.0% and 18.4%, respectively. CONCLUSION Excimer laser LASIK was safe and effective for treating hyperopia up to +6.25 D with no further loss of CDVA lines after enhancement.
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Affiliation(s)
- Fernando Llovet
- Clínica Baviera/Instituto Oftalmológico Europeo, Madrid, Spain
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Abstract
Mitomycin C has played a deciding role in the current revival of excimer laser surface ablation techniques. We review the literature regarding mechanism of action of mitomycin C, histological effects on the cornea, and indications, dose, exposure time, and toxicity of mitomycin C in corneal refractive surgery. Mitomycin C is an alkylating agent with cytotoxic and antiproliferative effects that reduces the myofibroblast repopulation after laser surface ablation and, therefore, reduces the risk of postoperative corneal haze. It is used prophylactically to avoid haze after primary surface ablation and therapeutically to treat pre-existing haze. There is no definite evidence that establishes an exact diopter limit or ablation depth at which to apply prophylactic mitomycin C. It is usually applied at a concentration of 0.2mg/ml (0.02%) for 12 to 120 seconds over the ablated stroma, although some studies suggest that lower concentrations (0.01%, 0.002%) could also be effective in preventing haze when treating low to moderate myopia. This dose of mitomycin C has not been associated with any clinically relevant epithelial corneal toxicity. Its effect on the endothelium is more controversial: two studies report a decrease in endothelial cell density, but the majority of reports suggest that the endothelium is not altered. Regarding mitomycin C's effect on keratocyte population, although animal studies report keratocyte depletion after its use, longer follow-up suggested that the initial keratocyte depletion does not persist over time.
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de Ortueta D, Arba Mosquera S, Baatz H. Aberration-neutral ablation pattern in hyperopic LASIK with the ESIRIS laser platform. J Refract Surg 2009; 25:175-84. [PMID: 19241768 DOI: 10.3928/1081597x-20090201-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze refractive power changes, topographical changes, and aberrations induction after aberration-neutral (Aberration-Free") hyperopic LASIK using the SCHWIND ESIRIS laser platform. METHODS Thirty-three consecutive eyes of 19 patients were evaluated retrospectively. The outcomes were analyzed at 3 months. In all cases, standard examinations and pre- and postoperative topographical and corneal wavefront analysis with a Keratron topographer (OPTIKON 2000 SpA) were performed. The preoperative mean spherical equivalent refraction was +2.61 +/- 1.39 diopters (D) (range: +0.75 to +6.00 D) with a mean cylinder of 0.67 +/- 0.74 D (range: 0.00 to 4.00 D). Ablations were performed with the SCHWIND ESIRIS excimer laser system. Topographical changes of Maloney index, simulated keratometry (Sim-K), and K-readings at 5 and 7 mm were evaluated. RESULTS Corneal aberrations up to the seventh order (36 Zernike terms) were measured. Corneal spherical aberration was +0.197 +/- 0.144 microm preoperatively and -0.040 +/- 0.206 microm postoperatively at the 6-mm analysis diameter. At 3 months postoperatively, 88% of eyes were within +/-0.50 D manifest refraction. Changes in refraction, Maloney indices, and Sim-K indices postoperatively were correlated with the intended correction. Induction of negative corneal spherical aberrations and increased prolate asphericity were correlated with the achieved defocus correction. No other Zernike mode was significantly correlated. Topographically, a corneal multifocality of <0.25 D was also observed. CONCLUSIONS Analyzing the topographical maps, the corneal power change of the Maloney indices correlated with the intended correction. With the aberration-neutral (SCHWIND Aberration-Free) pattern, patients with hyperopia up to +5.00 D were treated safely and with good predictability. The induced corneal aberrations were less than those calculated with the classical profile and compared to the literature.
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Reinstein DZ, Couch DG, Archer TJ. LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform. J Refract Surg 2009; 25:37-58. [PMID: 19244952 DOI: 10.3928/1081597x-20090101-07] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the monocular and binocular outcomes of LASIK for a micro-monovision protocol for the correction of hyperopic astigmatism and presbyopia. METHODS A prospective non-comparative case series included 258 eyes of 129 consecutive patients with hyperopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the Carl Zeiss Meditec MEL80 excimer laser. The target refraction was piano for distance eyes (dominant eye) and between -1.00 and -1.50 diopters (D) for near eyes. Patients were followed for 1 year. RESULTS Mean attempted spherical equivalent refraction (SE) correction was +2.54+/-1.16 D (range: +0.25 to +5.75 D). Mean attempted cylinder was -0.52+/-0.49 D (range: -0.00 to -3.25 D). Median age was 56 years (range: 44 to 66 years). Median follow-up was 12.5 months (range: 3.3 months [early retreatment] to 18.2 months). The retreatment rate was 22%. Outcome measures after all treatments were as follows. Mean deviation from the intended SE correction was +0.09+/-0.48 D, with 79% of eyes within +/-0.50 D and 95% within +/-1.00 D. The cylinder correction ratio was 1.23+/-0.63 and the error ratio was 0.67+/-0.65. Of the distance eyes, 86% achieved uncorrected visual acuity of 20/20 and 100% achieved 20/40. Binocularly, 95% of patients achieved 20/20 and 100% achieved 20/40. Eighty-one percent of patients could read J2 and 100% could read J5. Binocularly, 95% of patients achieved 20/20 and could read J5. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. A statistically significant increase was noted in contrast sensitivity at 3 and 6 cycles per degree (cpd), with no reduction at 12 and 18 cpd. The average change in refraction between 3 months and 1 year was +0.11+/-0.36 D with a change of >1.00 D in 2.6% of eyes. CONCLUSIONS This hyperopic micro-monovision protocol was a well-tolerated and effective procedure for treating patients with presbyopia in moderate to high hyperopia with corrections ranging up to +5.75 D. Contrast sensitivity was improved and the distance vision of near eyes was found to contribute positively to binocular distance vision compared to distance eyes monocularly.
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Sanchez MJ, Mannsfeld A, Borkenstein AFM, Ehmer A, Limberger IJ, Holzer MP, Auffarth GU. [Wavefront analysis in ophthalmologic diagnostics]. Ophthalmologe 2008; 105:818-24. [PMID: 18758787 DOI: 10.1007/s00347-008-1822-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Modern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.
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Affiliation(s)
- M J Sanchez
- International Vision Correction Research Centre (IVCRC), Universitäts-Augenklinik Heidelberg, Ruprecht Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Deutschland.
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Laser in situ Keratomileusis for Spherical Hyperopia and Hyperopic Astigmatism Using the NIDEK EC-5000 Excimer Laser. J Refract Surg 2008; 24:123-36. [DOI: 10.3928/1081597x-20080201-02] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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