Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study

PURPOSE

To evaluate the long-term visual and refractive outcomes of hyperopic excimer ablation using alcohol-assisted photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).

SETTING

American University of Beirut Medical Center, Beirut, Lebanon.

DESIGN

Retrospective, matched comparative study.

METHODS

Eyes that underwent alcohol-assisted PRK were compared to matched eyes that underwent FS-LASIK. All patients were followed up for at least 3 years after surgery. The refractive and visual outcomes of each group were compared at different postoperative time points. The main outcome measures were spherical equivalent deviation from target (SEDT), manifest refraction, and visual acuity.

RESULTS

83 eyes underwent alcohol-assisted PRK and 83 matched eyes underwent FS-LASIK. Preoperative manifest refraction spherical equivalent was 2.44 ± 1.18 diopters (D) and 2.20 ± 0.87 D ( P = .133) in the PRK and FS-LASIK groups, respectively. Preoperative manifest cylinder was -0.77 ± 0.89 D and -0.61 ± 0.59 D ( P = .175) for the PRK and LASIK groups, respectively. 3 years postoperatively, SEDT was 0.28 ± 0.66 D and 0.40 ± 0.56 D for the PRK and LASIK groups, respectively ( P = .222), whereas manifest cylinder was -0.55 ± 0.49 D and -0.30 ± 0.34 D for PRK and LASIK, respectively ( P < .001). The mean difference vector was 0.59 ± 0.46 for PRK and 0.38 ± 0.32 for LASIK ( P < .001). 13.3% of PRK eyes and 0% of LASIK eyes had >1 D of manifest cylinder ( P = .003).

CONCLUSIONS

Both alcohol-assisted PRK and FS-LASIK are safe and effective for the treatment of hyperopia. PRK induces slightly more postoperative astigmatism than LASIK. Larger optical zones and recently introduced ablation profiles that lead to a smoother ablation surface might improve the clinical results of hyperopic PRK.

Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism

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.

Refractive Effect of Epithelial Remodelling in Myopia after Transepithelial Photorefractive Keratectomy

(1) Introduction: We analysed epithelial changes after the treatment of moderate myopia with transepithelial photorefractive keratectomy. (2) Materials and Methods: We used optical coherence tomography data and analysed changes in the stroma and epithelium after ablation. We aimed to ascertain how much epithelium hyperplasia occurred after TransPRK; for this, we used data from 50 eyes treated with TransPRK with the AMARIS 1050 Hz, with a minimum follow-up of 4 months. (3) Results: The measured epithelial changes corresponded to a less than 0.1 ± 0.2D of spherical effect, less than 0.2 ± 0.2D of astigmatic effect, and less than 0.5 ± 0.2D of comatic effect. (4) Conclusions: The changes in epithelial thickness after aberration-neutral transepithelial photorefractive keratectomy for moderate myopia were very small, indicating a low level of epithelial hyperplasia without resembling a regression-inducing lentoid.

[Regression and ablation profiles in corneal refractive surgery]

Regression after corneal refractive surgery is a complex phenomenon which seems inevitable. The choice of surgical technique has very little influence on regression for low myopia or myopic astigmatism. However, LASIK and SMILE are the two techniques of choice in the correction of high myopia. LASIK is also better for the correction of hyperopia, hyperopic astigmatism and mixed astigmatism. Intraoperatively, the choice of a wide optical zone and adherence to a thick residual stromal bed provide stability. Regression may also be reduced by modulating anti-inflammatory therapy, treating dry eye, and using mitomycin C in PKR. In all cases, obtaining keratometry during patient follow-up helps to identify the cause of the regression. The objective of this review is to synthesize recent data from the literature on regression in refractive surgery as a function of the ablation profiles used.

Preliminary effects of treating the half of high latent hyperopia on refractive and visual results of femtosecond laser-assisted in situ keratomileusis in subjects with hyperopia

BACKGROUND

To evaluate the preliminary effects of treating the half of high latent hyperopia on refractive and visual outcomes of femtosecond laser-assisted in situ keratomileusis (LASIK) in young subjects with hyperopia.

METHODS

This non-randomized comparative study includes 120 eyes of 60 subjects who underwent femtosecond LASIK to correct hyperopia. Group 1 (n = 60) includes subjects with ≤ 1D algebraic difference (DRSE) between cycloplegic (CRSE) and manifest (MRSE) refraction spherical equivalents and was treated by entering manifest refraction values. Group 2 includes subjects with > 1D DRSE and was treated by entering the mean manifest and cycloplegic refraction values. Refractive and subjective outcomes obtained at the 1-, 3-, and 6-month postoperative visits were compared.

RESULTS

The mean age of the subjects was 26.2 ± 3.5 and 26.2 ± 5.2 years for Group 1 and Group 2, respectively. The male-to-female ratios were 10/10 in both groups. Demographic values of the groups were similar (p > 0.05). Preoperative MRSE values were similar (p = 0.924), while CRSE and DRSE values were significantly higher in Group 2 (p < 0.001). At the 1- and 3-month postoperative visits, MRSE was higher and uncorrected distance visual acuity (UDVA) was lower in Group 2 (p < 0.001). Subjective visual parameters and quality of vision scores were also worse in Group 2 during these visits (p < 0.001); however, at the 6-month visit, all outcomes for Group 2 improved, and MRSE, UDVA, some subjective visual parameters, and quality of vision scores became similar between groups (p > 0.05).

CONCLUSION

At the 6-month visit after treating the half of > 1D latent hyperopia with femtosecond LASIK, refractive and visual outcomes like MRSE, UDVA, subjective visual parameters, and quality of vision scores become similar to those obtained in ≤ 1D latent hyperopia.

Stability of corneal topography and aberrometry after hyperopic laser in situ keratomileusis with a 500-Hz excimer laser platform: A 3-year follow-up study

PURPOSE

The aim of this study is to analyze the long-term stability of the corneal topography, the functional optical zone, and the refractive stability throughout 3 years following laser in situ keratomileusis surgery for hyperopia using a 500-Hz excimer laser system.

METHODS

This retrospective consecutive observational case series study comprised 66 eyes that underwent laser in situ keratomileusis to correct hyperopia with a postoperative follow-up of 3 years. Laser in situ keratomileusis procedures were performed using the SCHWIND Amaris 500-Hz excimer laser. Main outcomes measured were stability of the functional optical zone at corneal topography and corneal aberrometry.

RESULTS

Statistically significant differences were found in simulated keratometry (K2 (steep meridian) and Km (mean keratometry)) between 3 and 36 months postoperatively (p ⩽ 0.01); these differences disappeared at 12 and 36 months (p ⩾ 0.18). No statistically significant changes were observed in the horizontal and vertical diameter of the functional optical zone throughout the whole follow-up (p ⩾ 0.07). A statistically significant difference was found in the spherical aberration between 3 and 36 months (p = 0.02); this difference disappeared when compared between 12 and 36 months (p = 0.72). Statistically significant correlations were detected between the vertical functional optical zone and coma root mean square (r = -0.510, p < 0.01) and between the vertical functional optical zone and spherical aberration (r = 0.441, p = 0.02) 36 months after surgery.

CONCLUSION

Following 3 years of hyperopic laser in situ keratomileusis with a 500-Hz Amaris excimer laser, keratometry, functional optical zone, and corneal aberrations remain stable from 1 year after surgery. Topographical regression is not observed in hyperopic laser in situ keratomileusis with this excimer laser technology from 1 year after surgery.

Six-Month Outcomes After High Hyperopia Correction Using Laser-Assisted In Situ Keratomileusis With a Large Ablation Zone

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.

Three-year outcomes after high hyperopia correction using photorefractive keratectomy with a large ablation zone

Aim

To evaluate refractive and visual outcomes of photorefractive keratectomy (PRK) to treat high hyperopia using an aberration-neutral profile and large ablation zone.

Methods

This was a retrospective, consecutive observational case series at the Oftalmika Eye Hospital, Bydgoszcz, Poland. We included 51 consecutive eyes of 34 patients who underwent alcohol-assisted PRK to correct hyperopia within the range of +3.6 to +6.15 D (mean+4.61±0.67 D). Procedures were performed with an Amaris 750S excimer laser (Schwind eye-tech-solutions GmbH, Kleinostheim, Germany) using an aberration-neutral profile and a 10 mm total ablation zone. Refractive results, predictability, safety and efficacy were evaluated 3 years postoperatively.

Results

At 1-year postsurgery, the mean manifest refraction spherical equivalent (MRSE) was −0.002±0.43 D and mean cylinder was −0.181±0.31 D, while the values were +0.09±0.46 D and −0.15±0.26 D, respectively, at 2 years (MRSE p<0.001) and +0.15±0.44 D and −0.15±0.26 D, respectively, at 3 years (MRSE p<0.001). 78% of eyes were within ±0.50 D of the attempted spherical equivalent correction. Three years postoperatively, 22% of eyes lost one line of corrected distance visual acuity and 27% gained a line or two. The change in the mean corneal spherical aberrations for the 6 mm zone was from 0.27±0.07 to 0.08±0.13 µm.

Conclusions

High hyperopia correction with PRK using an aberration-neutral profile and large ablation zone provides good efficacy, safety, predictability and visual outcomes. Relatively low change of corneal spherical aberrations and low increase of hyperopia in the first three postoperative years were observed.

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.

Corneal Stability following Hyperopic LASIK with Advanced Laser Ablation Profiles Analyzed by a Light Propagation Study

Purpose

To assess anterior corneal surface stability 12 months following hyperopic LASIK correction with a light propagation algorithm.

Setting

Vissum Instituto Oftalmológico de Alicante, Universidad Miguel Hernández, Alicante, Spain.

Methods

This retrospective consecutive observational study includes 37 eyes of 37 patients treated with 6th-generation excimer laser platform (Schwind Amaris). Hyperopic LASIK was performed in all of them by the same surgeon (JLA) and completed 12-month follow-up. Corneal topography was analyzed with a light propagation algorithm, to assess the stability of the corneal outcomes along one year of follow-up.

Results

Between three and twelve months postoperatively, an objective corneal power (OCP) regression of 0.39 D and 0.41 D was found for 6 mm and 9 mm central corneal zone, respectively. Subjective outcomes at the end of the follow-up period were as follows: 65% of eyes had spherical equivalent within ±0.50 D. 70% of eyes had an uncorrected distance visual acuity 20/20 or better. 86% of eyes had the same or better corrected distance visual acuity. In terms of stability, 0.14 D of regression was found. No statistically significant differences were found for all the study parameters evaluated at different postoperative moments over the 12-month period.

Conclusions

Light propagation analysis confirms corneal surface stability following modern hyperopic LASIK with a 6th-generation excimer laser technology over a 12-month period.

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.

Laser in Situ Keratomileusis for High Hyperopia with Corneal Vertex Centration and Asymmetric Offset

Purpose

To investigate refractive outcomes and induction of corneal higher order aberrations (HOA) in eyes that underwent laser-assisted in situ keratomileusis (LASIK) for high hyperopia correction using an aberration neutral profile with corneal vertex centration and asymmetric offset.

Methods

A total of 24 consecutive patients (38 eyes) who underwent LASIK by one surgeon using AMARIS 750S excimer laser and a Carriazo-Pendular microkeratome for flap creation were retrospectively analyzed. Eyes targeted for plano and with correction in the maximum hyperopic meridian strictly higher than +4D were included in the retrospective analysis. Patients were reviewed at 1, 3, and 6 months postoperatively. Postoperative monocular corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, and corneal wavefront aberrations were compared with respective preoperative metrics.

Results

Mean preoperative spherical equivalent and refractive astigmatism was +4.07 ± 0.90 D and 1.37 ± 1.26 D, respectively, reducing to +0.28 ± 0.58D (p<0.0001) and 0.49 ± 0.47 D (p = 0.0001) at the last postoperative visit. Six months postoperatively, 78% of eyes achieved a UDVA of 20/25 or better. No eye lost more than 2 Snellen lines of CDVA at any follow-up. There was a statistically significant induction of vertical trefoil (+0.104 ± 0.299 µm, p<0.05), vertical coma (-0.181 ± 0.463 µm, p<0.01), horizontal coma (+0.198 ± 0.663 µm, p<0.05), spherical aberration (-0.324 ± 0.281 µm, p<0.0001), secondary vertical trefoil (+0.018 ± 0.044 µm, p<0.01), and secondary horizontal coma (+0.026 ± 0.083 µm, p<0.05)

Conclusions

Laser-assisted in situ keratomileusis for high hyperopia using corneal vertex centration with asymmetric offset results in significant improvement in refraction and visual acuity although affected by significant induction of some higher order aberrations.

Corneal Thickness Profile Changes After Femtosecond LASIK for Hyperopia

Purpose:

To compare changes in the corneal thickness profile before and 6 months after femtosecond laser in situ keratomileusis (LASIK) for hyperopia.

Methods:

In a prospective noncomparative case series study, 24 eyes of 20 hyperopic patients undergoing femtosecond LASIK were examined preoperatively and 6 months postoperatively. Corneal profile was measured using Pentacam HR device. Paired t test was used to compare preoperative and postoperative values. Spearman correlation analysis was performed to evaluate the relationship between the central corneal thickness changes and attempted spherical equivalent refraction (SER).

Results:

The mean uncorrected distance visual acuity significantly improved after surgery (P<0.001). Significant differences in central, midperipheral, ablative annular, and peripheral corneal thicknesses were observed from preoperatively to 6 months postoperatively (all P<0.001). There was no significant correlation between the changes in the central corneal thickness and attempted SER (P=0.23).

Conclusions:

The corneal thicknesses across the whole ablation zone including central corneal thickness, significantly decrease postoperatively compared with preoperatively.

Hyperopic laser in situ keratomileusis: comparison of femtosecond laser and mechanical microkeratome flap creation

PURPOSE

To evaluate and compare the refractive predictability and stability of laser in situ keratomileusis (LASIK) flap creation performed with a femtosecond laser and with a mechanical microkeratome to correct mild to moderate hyperopia.

SETTING

American University of Beirut Medical Center, Beirut, Lebanon.

DESIGN

Retrospective case series.

METHODS

Patients who had hyperopic LASIK treatment using the Amaris excimer laser were included. Eyes in which the LDV femtosecond laser was used for flap creation were compared with eyes in which the Moria M2 microkeratome was used.

RESULTS

The microkeratome group comprised 53 eyes and the femtosecond laser group, 72 eyes. Baseline characteristics were similar between groups (P > .05). The mean spherical equivalent (SE) deviation from target 1 week postoperatively was -0.08 diopter (D) ± 0.58 (SD) in the femtosecond laser group and -0.06 ± 0.87 D in the microkeratome group (P = .92). Thereafter, the mean SE deviation from target increased gradually and by 6 months postoperatively was +0.30 ± 0.50 D and +0.70 ± 0.71 D, respectively (P = .001). The correlation between the achieved and the attempted SE refraction was better in the femtosecond laser group (R(2) = 0.806) than the microkeratome group (R(2) = 0.671).

CONCLUSIONS

Using the same nomogram, the short-term refractive outcomes of hyperopic LASIK with flap creation performed with the femtosecond laser were comparable to those for the microkeratome; however, the femtosecond group showed significantly better stability over the 6-month follow-up and better predictability, as reflected by a lower standard deviation and stronger Pearson correlation.

FINANCIAL DISCLOSURE

Dr. Arba Mosquera is an employee of Schwind eye-tech-solutions GmbH and Co. KG. No other author has a financial or proprietary interest in any material or method mentioned.

LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable?

Purpose

To analyze the refractive and keratometric stability in hyperopic astigmatic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) during the first 6 months after surgery.

Patients and methods

This retrospective cross-sectional study included 97 hyperopic eyes; 55 were treated with LASIK and 42 with PRK. Excimer ablation for all eyes was performed using the ALLEGRETTO excimer laser platform using a mitomycin C for PRK and a mechanical microkeratome for LASIK. Keratometric and refractive data were analyzed during three consecutive follow-up intervals (6 weeks, 3 months, and 6 months). The corneal topography was obtained using Scheimpflug topography, and subjective refractions were acquired by expert optometrists according to a standardized protocol.

Results

After 3 months, mean keratometry and spherical equivalent were stable after LASIK, whereas PRK-treated eyes presented statistically significant (P<0.001) regression of hyperopia. In eleven cases, hyperopic regression of >1 D occurred. The optical zone diameter did not correlate with the development of regression.

Conclusion

After corneal laser refractive surgery, keratometric changes are followed by refractive changes and they occur up to 6 months after LASIK and for at least 6 months after PRK, and therefore, caution should be applied when retreatment is planned during the 1st year after surgery because hyperopic refractive regression can lead to suboptimal visual outcome. Keratometric and refractive stability is earlier achieved after LASIK, and therefore, retreatment may be independent of late regression.

No change in anterior chamber dimensions after femtosecond LASIK for hyperopia

Objective:

To compare the changes in anterior chamber volume (ACV), anterior chamber depth (ACD) and anterior chamber angle (ACA) before and 6 months after femtosecond laser in situ keratomileusis (LASIK) for hyperopia using the Pentacam HR device.

Methods:

A total of 24 eyes of 24 consecutive hyperopic patients undergoing femtosecond LASIK were examined preoperatively and 6 months postoperatively. Anterior chamber volume; ACDs in the central, superior, inferior, nasal, and temporal quadrants; and ACA were measured using the Pentacam HR device. Comparisons of preoperative versus postoperative values were performed using paired Student t test. Linear regression analysis was performed to evaluate correlations between ACV change, central ACD change, age, and attempted maximum ablation depth.

Results:

Preoperative and postoperative mean ACVs were 153.6 and 158.2 μL, respectively. Preoperative and postoperative mean ACDs were 2.81, 2.28, 2.53, 2.16, and 2.61 mm, and 2.84, 2.31, 2.54, 2.16, and 2.65 mm, respectively. Preoperative and postoperative mean ACAs were 33.3° and 32.0°, respectively. There were not statistically significant differences in ACV, ACDs, and ACA from preoperatively to 6 months after femtosecond LASIK (all P>0.05). The change of central ACD was correlated significantly with age at 6 months postoperatively (R²=0.18, P=0.039).

Conclusions:

Anterior chamber profiles, including ACV, ACA, and central and peripheral ACDs did not significantly change after femtosecond LASIK for hyperopia.

One-year results of simultaneous laser in situ keratomileusis and small-aperture corneal inlay implantation for hyperopic presbyopia: comparison by age

PURPOSE

To compare by age the safety, efficacy, and patient satisfaction after simultaneous laser in situ keratomileusis (LASIK) and small-aperture corneal inlay implantation (Kamra) for hyperopic presbyopia.

SETTING

Shinagawa LASIK Center, Tokyo, Japan.

DESIGN

Retrospective comparative cohort study.

METHODS

Simultaneous LASIK and small-aperture corneal inlay implantation were performed in the nondominant eye of hyperopic presbyopic patients with astigmatism. Patients were divided into groups by age as follows: Group 1 (40 to 49 years), Group 2 (50 to 59 years), and Group 3 (60 to 65 years). The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected near visual acuity (UNVA), and patient questionnaire results were compared.

RESULTS

The study evaluated 277 eyes of 277 patients. All groups achieved a mean UDVA of 20/20, with Group 1, Group 2, and Group 3 gaining 1 line, 2 lines, and 3 lines, respectively. The mean UNVA was J2 with 4 lines gained in Group 1 and J3 with 5 lines gained in Group 2 and Group 3. The mean CDVA and corrected near visual acuity remained the same as at baseline.

CONCLUSIONS

Simultaneous LASIK and small-aperture corneal inlay implantation for hyperopic presbyopia was a safe and effective treatment option. Although the outcomes were comparable between groups, Group 3 had the largest gain in UDVA and UNVA and the highest patient satisfaction, despite having the lowest reduction in dependence on reading glasses. Taking age into account might help achieve optimum postoperative outcomes and improved patient satisfaction.

FINANCIAL DISCLOSURE

Dr. Tomita is a consultant to Ziemer Ophthalmic Systems AG, Acufocus, Inc., and Schwind eye-tech-solutions GmbH and Co. KG. Dr. Waring is a consultant to Acufocus, Inc.

Change in keratometry after myopic laser in situ keratomileusis and photorefractive keratectomy

PURPOSE

To compare the change in keratometry (K), spherical equivalent (SE), and visual acuity after myopic laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).

SETTING

Academic tertiary care center.

DESIGN

Retrospective review.

METHODS

The postoperative K, SE, and uncorrected and corrected distance visual acuities were measured 6 months, 9 months, 1 year, 2 years, 3 years, 4 to 5 years, 6 to 7 years, and 8+ years postoperatively. A difference (Δ) for each variable was calculated from its 6-month postoperative baseline. The rates of change were grouped based on the magnitude of myopic correction (0.00 to 2.99 diopters [D]; 3.00 to 5.99 D; 6.00 to 8.99 D), type of surgery (LASIK versus PRK), and age (<34 years; 34 to 45 years; >45 years).

RESULTS

Statistically significant differences were found in the rates of change between low and moderate corrections to high corrections for ΔKavg (P=.0472 and P=.0091, respectively) and ΔSE (both P<.0001). Statistically significant differences were found in the rate of change in ΔKavg between all 3 ages groups (P=.0330, P=.0051, and P<.0001) and in ΔSE between ages less than 34 years and 34 to 45 years to ages over 45 years (P=.0158 and P=.0015, respectively). There was no significant difference in the rate of change in ΔKavg and ΔSE between LASIK and PRK (P=.3599 and P=.9403, respectively).

CONCLUSION

There was keratometric and refractive regression for myopic LASIK, with the rate of regression depending on treatment magnitude and age.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.