Laser in situ keratomileusis for hyperopia and hyperopic astigmatism with the Nidek EC-5000 Excimer laser.

PURPOSE: We evaluated the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism. METHODS: A retrospective study was performed for 92 eyes of 62 consecutive patients to evaluate uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA) and manifest refraction before and 3 and 6 months after LASIK (Moria LSK-ONE microkeratome, Nidek EC-5000 excimer laser). Eyes were divided into groups: Group 1 (low hyperopia) for spherical correction of +1.00 to +3.00 D (22 eyes), Group 2 (low hyperopic astigmatism) for toric correction with spherical equivalent refraction of +1.00 to +3.00 D (18 eyes), Group 3 (moderate hyperopia) for spherical correction of +3.25 to +6.00 D (10 eyes), and Group 4 (moderate hyperopic astigmatism) for toric correction with spherical equivalent refraction between +3.25 and +6.00 D (18 eyes). RESULTS: At 3 and 6 months after LASIK, 68 eyes (73.9%) were available for follow-up examination. Percentage of eyes with a spherical equivalent refraction within +/-0.50 D of emmetropia for Group 1 was 54.5% (12 eyes); Group 2, 50% (9 eyes); Group 3, 40% (4 eyes), and Group 4, 38.8% (7 eyes). UCVA > or =20/20 in Group 1 was 14% and in Groups 2, 3, and 4, 0%. One eye (5.5%) lost two lines of BSCVA. CONCLUSION: LASIK with the Moria LSK-ONE microkeratome and the Nidek EC-5000 excimer laser reduced low and moderate hyperopia and was within +/-0.50 D of target outcome in approximately 50% of eyes. Undercorrection was evident in all groups. The procedure was safe.     

Hyperopic laser in situ keratomileusis to treat overcorrected myopic LASIK

PURPOSE: To evaluate the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) in treating hyperopia caused by overcorrected myopic LASIK and to evaluate a new technique to place the hyperopic treatment after lifting the initial myopic flap. SETTING: Open-access outpatient excimer laser surgical facility. METHODS: A retrospective analysis was performed of 54 eyes in 47 patients who had spherical hyperopic LASIK by 21 surgeons for the treatment of significant hyperopia after overcorrected LASIK for myopia. In 42 eyes, the initial LASIK flaps were lifted and in 12 eyes, new flaps were cut. The mean age of the 25 men (53%) and 22 women (47%) was 48.2 years +/- 8.4 (SD). Outcome measures included refractive error, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications. The mean follow-up was 2.97 months. RESULTS: In eyes in which postoperative emmetropia was attempted (n = 45), the mean spherical equivalent improved from +1.21 +/- 0.49 diopters (D) preoperatively to -0.38 +/- 0.50 D postoperatively (P <.001). The mean UCVA improved from 20/38.6 +/- 16.3 to 20/27.4 +/- 9.4 (P <.001). At the last follow-up, 69% of eyes were within +/-0.5 D and 96% were within +/-1.0 D of emmetropia; 42% had a UCVA of 20/20 and 96% had a UCVA of 20/40 or better. No eyes lost 2 or more lines of BSCVA. No vision-threatening complications occurred. Results in patients who had initial flaps lifted and those who had new flaps cut were statistically indistinguishable. On average, achieved hyperopic corrections were 18% greater than intended. CONCLUSION: Hyperopic LASIK was safe, predictable, and effective in the treatment of hyperopia caused by overcorrected myopic LASIK. Results were similar whether the original flap was lifted or a new one was cut.     

Laser in situ keratomileusis for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser

PURPOSE: To evaluate the safety, efficacy, predictability, and visual results of laser in situ keratomileusis (LASIK) using the Bausch & Lomb Technolas(R) 217 scanning-spot laser for the treatment of myopia and compound myopic astigmatism. SETTING: Stanford Eye Laser Center, Stanford, California, USA. METHODS: In a prospective study, 110 eyes of 58 patients with a mean spherical equivalent (SE) of -4.87 diopters (D) +/- 2.5 (SD) (range -1.0 to -11.4 D) had LASIK for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser. The primary outcome variables included preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), achieved versus attempted correction, vector analysis of astigmatism, and complications. RESULTS: One hundred ten eyes were available for analysis at 3 months. The mean SE refraction was reduced 95% (mean -0.23 +/- 0.4 D), and astigmatism was reduced 70% (mean 0.28 +/- 0.3 D). One day postoperatively, 100% of eyes had a UCVA of 20/40 or better, 96% had 20/25 or better, 77% had 20/20 or better, and 39% had 20/15 or better. At the 3-month examination, 100% of eyes had a UCVA of 20/40 or better, 95% had 20/25 or better, 83% had 20/20 or better, and 48% had 20/15 or better. Ninety percent of eyes were within +/-0.5 D of emmetropia. No eye lost 2 or more lines of BSCVA. CONCLUSIONS: The Technolas 217 scanning-spot laser produced excellent postoperative UCVA and BSCVA. It was predictable, safe, and effective for the treatment of myopia and compound myopic astigmatism. Long-term follow-up is needed to assess the stability of the procedure.     

Laser in situ keratomileusis for spherical hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser

PURPOSE: To assess the efficacy, predictability, and safety of LASIK for the surgical correction of low to moderate hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser. METHODS: In a multicenter United States Food and Drug Administration (FDA) regulated study of LASIK, 7 centers enrolled 293 eyes with manifest refraction sphere that ranged from +0.50 to +6.00 diopters (D) with or without astigmatism up to 3.00 D. The intended outcome was plano in all eyes. Patients were treated bilaterally. One year postoperative outcomes are reported. RESULTS: The mean spherical equivalent refraction (MRSE) for all eyes changed from +2.61 +/- 1.19 D (range: +0.50 to +6.63 D) preoperatively to +0.35 +/- 0.54 D (range: -1.63 to +2.00 D) 1 year postoperatively. Overall, 61% (170/279) of eyes achieved distance uncorrected visual acuity (UCVA) of 20/20 or better, 82% (228/279) of eyes saw 20/25 or better, and 99% (277/279) of eyes saw 20/40 or better. Refractive accuracy was demonstrated as 63.1% (176/279) of eyes achieved a MRSE within +/- 0.50 D and 90.3% (252/279) of eyes within +/- 1.00 D. Less than 2% (4/279) of eyes lost 2 lines of distance best spectacle-corrected visual acuity. Stability of refraction was demonstrated by 6 months, with a mean hyperopic shift of < 0.03 D from 3 to 6 months. CONCLUSIONS: The NIDEK EC-5000 corrected hyperopia and hyperopic astigmatism with UCVA, refractive accuracy, 1-year stability, and safety that surpassed all FDA criteria.     

Early results of hyperopic and astigmatic laser in situ keratomileusis in eyes with secondary hyperopia

PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for secondary hyperopia and hyperopic astigmatism and to develop a VISX STAR S2 LASIK nomogram (VISX Inc., Santa Clara, CA) for consecutive hyperopia after prior myopic refractive surgery. DESIGN: Prospective, nonrandomized, self-controlled interventional study. PARTICIPANTS: Thirty patients with consecutive hyperopia or hyperopia and astigmatism after LASIK, photorefractive keratectomy, automated lamellar keratoplasty, or radial keratotomy. INTERVENTION/METHODS: Prospective evaluation of LASIK in 30 secondary eyes with fogged manifest sphere from +0.5 to +6.0 diopters (D) and cylinder from 0 to +5.0 D. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalent (SE). RESULTS: Mean manifest SE was +1.73 +/- 0.79 D before surgery, -0.13 +/- 1.00 D at 6 months after surgery, and -0.18 +/- 1.08 D at 1 year after surgery. At 6 months, 84% of patients with secondary hyperopia had UCVA of 20/40 or better; 76% were within +/-1 D of emmetropia. At 1 year, 85% had UCVA of 20/40 or better and 85% were within +/-1 D of emmetropia. No patients with secondary hyperopia lost 2 or more lines of BCVA at 1 year. Complications included intraoperative bleeding (3.3%), intraoperative epithelial defect (3.3%), transient interface debris (3.3%), significant dry eye (3.3%), blood in interface (3.3%), irregular astigmatism (6.7%), slight decentration (6.7%), trace haze (6.7%), or mild epithelial ingrowth not requiring removal (3.3%). CONCLUSIONS: These early data suggest that LASIK for consecutive hyperopia from +0.5 to +5.50 D and astigmatism from 0 to +2.75 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery, and is safe and effective.     

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.     

LASIK correction of spherical hyperopia,hyperopic astigmatism,and mixed astigmatism with the LADARVision excimer laser system

OBJECTIVE: To assess the safety and effectiveness of the LADARVision active tracking narrow beam excimer laser system (Alcon Surgical, Orlando, FL) using laser in situ keratomileusis (LASIK) for correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism. DESIGN: A multicenter, prospective non-randomized (self-controlled) comparative trial. PARTICIPANTS: A total of 360 eyes, including 152 spherical hyperopic, 143 hyperopic astigmatic, and 65 mixed astigmatic, were treated for up to +6.00-diopter (D) sphere with up to -6.00-D cylinder. INTERVENTION: Treatments were performed at six sites in the United States using a 6-mm optic zone with a 1.5-mm peripheral blend zone for a maximum ablation zone diameter of 9 mm. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), manifest refraction, vector analysis, best spectacle-corrected visual acuity (BSCVA), complications and adverse reactions, subjective symptoms, and patient satisfaction. RESULTS: Six and 12 months of follow-up, respectively, were available on 143 and 117 spherical hyperopic eyes, 124 and 74 hyperopic astigmatic eyes, and 57 and 38 mixed astigmatic eyes, respectively. For spherical hyperopes at 6 and 12 months, UCVA was 20/40 or better in 93.4% and 93.9% of eyes, respectively. The manifest refraction spherical equivalent (MRSE) was within 0.50 D of intended in 65.0% and 74.1% of eyes, respectively, and within 1.00 D in 87.4% and 91.4%, respectively. Refractive stability was demonstrated in 94.2% or more of eyes between the intervals of 1 to 3 months and 3 to 6 months and in 95.3% or more of eyes to 12 months. A loss of two lines of BSCVA occurred in 3.5% and 3.4%, respectively, and no eyes lost more than two lines. For hyperopic astigmats at 6 and 12 months, UCVA was 20/40 or better in 90.9% and 93.8% of eyes, respectively. The MRSE was within 0.50 D of intended in 60.5% and 73.0% of eyes, respectively, and within 1.00 D in 88.7% and 89.2% of eyes, respectively. Refractive stability was demonstrated in 96.5% or more of eyes, respectively, between the intervals of 1 to 3 months and 3 to 6 months and 95.5% or more to 12 months. A loss of two lines of BSCVA occurred in 5.8% and 1.4% of eyes, respectively, and no eyes lost more than two lines. For mixed astigmats at 6 and 12 months, UCVA was 20/40 or better in 92.6% and 94.4% of eyes, respectively. The MRSE was within 0.50 D of intended in 64.9% and 73.7% of eyes, respectively, and within 1.00 D in 87.7% and 94.7% of eyes, respectively. Refractive stability was demonstrated in 100% of eyes between the intervals of 1 to 3 months and 3 to 6 months and in 97.0% or more to 12 months. A loss of two lines of BSCVA occurred in 1.9% and 0.0% of eyes, respectively, and no eyes lost more than two lines. CONCLUSIONS: The data support safety and effectiveness of the LASIK correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism with the LADARVision system.     

Laser in situ keratomileusis enhancement for consecutive hyperopia after myopic overcorrection.

PURPOSE: To assess the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) for the treatment of consecutive hyperopia after myopic LASIK. SETTING: Stanford University School of Medicine, Stanford, California, USA. METHODS: In a retrospective study, 36 eyes of 30 patients with consecutive hyperopia after myopic LASIK had LASIK retreatment using the VISX S2 excimer laser. Primary outcome variables including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, complications, and vector analysis were evaluated preoperatively and 1 day and 3 months postoperatively. RESULTS: The mean spherical equivalent decreased from +1.52 diopters (D) +/- 0.55 (SD) (range +0.63 to +2.63 D) preoperatively to -0.10 +/- 0.52 D (range -1.25 to +1.50 D) 3 months after retreatment. The UCVA was 20/20 or better in 24 eyes (66.7%) and 20/40 or better in 34 eyes (94.4%). Twenty eyes (55.5%) were within +/-0.5 D of the intended correction and 34 eyes (94.4%), within +/-1.0 D. No eye lost 2 or more lines of BSCVA. One eye (2.8%) developed diffuse lamellar keratitis that resolved without sequelae, and 2 eyes (5.6%) developed nonprogressive epithelial ingrowth that did not require removal. CONCLUSIONS: Laser in situ keratomileusis retreatment for consecutive hyperopia following myopic LASIK was an effective, predictable, and safe procedure. Long-term follow-up is needed to assess stability.     

Hyperopic LASIK retreatments with the Technolas laser

PURPOSE: To evaluate the safety, efficacy, and predictability of hyperopic LASIK retreatments. METHODS: This retrospective, consecutive, non-comparative, observational study included 85 eyes that underwent hyperopic LASIK retreatment with 1-year follow-up. Complete ophthalmic examination included distance uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, and pachymetry. Patients were divided into two groups according to the preoperative spherical equivalent refraction: group 1, < or = +3.9 diopters (D) and group 2, > or = +4.0 D. RESULTS: The UCVA improved from 0.31 +/- 0.2 to 0.7 +/- 0.2 in group 1 and from 0.2 +/- 0.2 to 0.6 +/- 0.2 in group 2 following retreatment. Mean spherical equivalent refraction improved from +2.8 +/- 0.85 to +0.2 +/- 0.9 in group 1 and from +5.3 +/- 0.9 to +0.3 +/- 1.3 in group 2 after retreatment. In group 1, 32 (72.7%) of 44 eyes had BSCVA > or = 20/25, and in group 2, 24 (58.5%) of 41 eyes had BSCVA > or = 20/25. After primary hyperopic LASIK, 25 (56.8%) of 44 eyes in group 1 and 19 (46.3%) of 41 eyes in group 2 maintained BSCVA or gained > or = 1 lines postoperatively in contrast to 21 (47.7%) of 44 eyes in group 1 and 22 (53.9%) of 41 eyes in group 2 after retreatment. In group 1, 11 (25%) of 44 eyes lost > or = 2 lines of BSCVA after initial hyperopic LASIK compared to 14 (31.8%) of 44 eyes after retreatment. In group 2, 10 (24.4%) of 41 eyes lost > or = 2 lines of BSCVA after initial hyperopic LASIK compared to 12 (29.2%) of 41 eyes after retreatment. After hyperopic LASIK retreatment, 31 (70.5%) of 44 eyes in group 1 and 19 (46.4%) of 41 eyes in group 2 were within +/- 0.5 D of emmetropia. Safety was 0.9 in both groups and efficacy was 0.8 and 0.7 in groups 1 and 2, respectively. Complications included epithelial ingrowth of 1 to 3 mm (30%) and flap edge melting (2%). CONCLUSIONS: Hyperopic LASIK retreatment improved the refractive results of initial hyperopic LASIK surgery with 20% to 30% of eyes gaining > or = 1 lines of BSCVA. The loss of BSCVA was greater after primary hyperopic LASIK than after retreatment.     

First clinical experience with the Alcon LADAR 6000 excimer laser

PURPOSE: To evaluate the reliability and ergonomics and to assess the first clinical results provided by the new LADAR 6000 excimer laser used to correct myopia and astigmatism, both by conventional and wavefront-guided ablation. METHODS: Seventy-four consecutive eyes from 37 patients underwent LASIK as the first field evaluation protocol of the Alcon LADAR 6000 excimer laser. Forty-six eyes were treated by wavefront-guided ablation to correct a manifest spheroequivalent refractive error (MSRE) of -0.50 to -9.75 diopters (D) (mean: -4.19 D, cylinder range: 0.0 to -3.50 D). Twenty-eight eyes were treated by conventional ablation to correct MSRE of -1.00 to -7.00 D (mean: -3.11 D, cylinder range: 0.0 to -1.75 D). Uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), MSRE, and wavefront measurements were assessed. Follow-up was 3 months for all eyes. RESULTS: Three months after surgery, all eyes were within +/- 1.00 D of intended correction. Forty-three (93.5%) eyes treated with wavefront-guided ablation and 25 (89.3%) eyes treated with conventional ablation were within +/- 0.50 D. All eyes reached > or = 20/25 UCVA. UCVA > or = 20/20 was reached in 45 (97.8%) wavefront-guided eyes and 26 (92.9%) conventional eyes; 37 (80.4%) wavefront-guided eyes and 17 (60.7%) conventional eyes had 20/16 UCVA. None of the eyes treated lost > or = 2 lines of BSCVA. CONCLUSIONS: The LADAR 6000 excimer laser results proved to be at least as accurate, predictable, and safe as the results currently achieved with the LADARVision4000 excimer laser. The improved microscope illumination enhances visibility for better consistency and ease of use. The better ergonomics and software design of this platform improved patient flow.     

Hyperopic LASIK with Esiris/Schwind technology

PURPOSE: To investigate the refractive and visual outcomes of hyperopic LASIK using Esiris/Schwind technology. METHODS: This retrospective non-comparative observational study included 106 eyes (65 patients) operated with the Esiris/Schwind laser for hyperopia. Eyes were divided into two groups: group 1, < or = +3.99 diopters (D) and group 2, > or = +4.0 D (up to +7.0 D). Visual outcome for distance and near uncorrected (UCVA) and best spectacle-corrected visual acuities (BSCVA) (decimal values), cycloplegic refraction, keratometry (K), pachymetry, and complications were evaluated. RESULTS: In group 1, mean UCVA was 0.4 +/- 0.1 preoperatively and 0.8 +/- 0.2 6 months postoperatively. Mean BSCVA was 0.9 +/- 0.1 preoperatively and 0.9 +/- 0.1 6 months postoperatively. Safety index was 1.1 and efficacy index was 0.97. Mean spherical equivalent refraction was +2.33 +/- 0.9 D preoperatively and +0.3 +/- 0.3 D 6 months postoperatively. Mean K reading was 43.7 +/- 1.1 D preoperatively and 45.0 +/- 1.6 D 6 months postoperatively. In group 2, mean UCVA was 0.3 +/- 0.1 preoperatively and 0.8 +/- 0.2 6 months postoperatively. Mean BSCVA was 0.9 +/- 0.1 preoperatively and 0.9 +/- 0.1 6 months postoperatively. Safety index was 0.98 and efficacy index was 0.92. Mean spherical equivalent refraction was +5.1 +/- 0.9 D preoperatively and +0.4 +/- 0.5 D 6 months postoperatively. Mean K reading was 43.1 +/- 1.6 D preoperatively and 46.0 +/- 1.4 D 6 months postoperatively. Forty-six (90.2%) of 51 eyes in group 1 and 47 (85.5%) of 55 eyes in group 2 were within +/- 0.5 D of emmetropia. At 6-month follow-up, 40 (78%) of 51 eyes in group 1 had UCVA of 20/20 compared to 41 (75%) of 51 eyes in group 2. One (2%) of 51 eyes in group 1 and 4 (7.3%) of 55 eyes in group 2 lost < or = 2 lines of BSCVA. No eye lost >2 lines of BSCVA. CONCLUSIONS: Hyperopic LASIK with Esiris/Schwind technology is effective and safe in the correction of hyperopia up to + 7.0 D. Although a slight statistical significance was found for low hyperopia, visual and refractive results obtained in high hyperopia were encouraging.     

Surgical outcomes of photorefractive keratectomy and laser in situ keratomileusis by inexperienced surgeons

PURPOSE: To investigate the results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) procedures performed by novice ophthalmologists and compare the results with those of experienced refractive surgeons. SETTING: Doheny Eye Institute, University of Southern California, Los Angeles, and Department of Ophthalmology, University of California, Irvine, California, USA. METHODS: In this retrospective case series, data were examined from the first PRK procedures by 33 consecutive ophthalmologists and the first LASIK procedures by 19 consecutive ophthalmologists. Preoperative and postoperative uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), as well as intraoperative and early postoperative complications, were recorded. RESULTS: In the PRK group, 33.3% of eyes achieved a UCVA of 20/20 and 87.8%, 20/40 or better; 54.5% were within +/-0.5 diopter (D) of emmetropia and 87.8%, within +/-1.0 D. Two eyes with a preoperative spherical equivalent of greater than -11.0 D lost 2 lines of BSCVA. If eyes with low myopia (相似文献   

Artisan phakic iris claw intraocular lens for high primary and secondary hyperopia

PURPOSE: To evaluate the efficacy, predictability, and safety of the Artisan iris claw phakic intraocular lens for the correction of high primary and secondary hyperopia. METHODS: Fifty-seven eyes were divided into two groups: 29 eyes had primary hyperopia (mean refraction 6.06 +/- 1.26 D, and 28 eyes had secondary hyperopia, (mean refraction 5.88 +/- 1.88 D) induced or residual following a previous corneal refractive procedure. Consecutive implantation of the Artisan iris claw phakic intraocular lens was performed. Main outcome measures recorded were BSCVA, UCVA, refraction, and astigmatic change, intraocular inflammation, and endothelial cell loss. RESULTS: Primary hyperopic group: Preoperatively, mean UCVA was 0.4 +/- 0.7 and mean BSCVA was 0.2 +/- 0.6. After implantation, mean UCVA was 0.3 +/- 0.6 and BSCVA was 0.1 +/- 0.6. Mean cycloplegic residual spherical refractive error after surgery was 0.10 +/- 0.57 D (range -1 to +2 D). Mean surgically induced astigmatism was 1.48 +/- 0.89 D. Safety index was 1.11. Efficacy index was 0.83. Secondary hyperopic group: Preoperatively, mean UCVA was 0.5 +/- 0.7 and mean BSCVA was 0.2 +/- 0.6. Postoperatively, mean UCVA was 0.4 +/- 0.7 and mean BSCVA was 0.2 +/- 0.6. Mean cycloplegic residual spherical refractive error was 0.55 +/- 1.49 D. Mean surgically induced astigmatism was 1.85 +/- 1.19 D. Safety index was 1.05. Efficacy index was 0.7. Postoperative iridocyclitis was observed in one eye (3.4%) in the primary group and in three eyes (10.7%) in the secondary group. Overall corneal endothelial cell loss at 1 year of follow-up was 9.4%. CONCLUSION: The Artisan iris claw phakic intraocular lens was reasonably safe and predictable for correcting high hyperopia.     

The safety and efficacy of photorefractive keratectomy after laser in situ keratomileusis

PURPOSE: To determine the safety and efficacy of performing photorefractive keratectomy (PRK) in corneas previously treated with laser in situ keratomileusis (LASIK) surgery. METHODS: Fifteen eyes of 14 patients who had initially received LASIK for the treatment of myopia and compound myopic astigmatism were evaluated. Variables included existence of and/or type of flap complication associated with the original LASIK procedure, refractions before and after (3 and 6 months) PRK, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and the development of complications after PRK such as haze, scarring, double vision, or ghosting. RESULTS: All 15 eyes were available for analysis at 6 months. Eleven eyes had experienced flap complications during the initial LASIK procedure and 4 eyes had experienced complications in the LASIK postoperative period. Characteristics prior to performing PRK included 11 myopic and 4 hyperopic eyes. By 6 months after PRK treatment, 87% of eyes had UCVA > or = 20/40, 53% had > or = 20/25, and 40% had > or = 20/20. All eyes had BSCVA of > or = 20/30, with 73% being > or = 20/20. No eye had lost 2 lines of BSCVA and only 1 eye lost 1 line of BSCVA. Sixty percent of eyes were within 1.0 diopters (D) of emmetropia, and 40% were within 0.5 D of emmetropia. A trend towards undercorrection and surgical induction of astigmatism as confirmed by vector analysis was noted. No eye developed significant haze or scarring. CONCLUSIONS: Photorefractive keratectomy may be a safe procedure to perform in corneas previously treated with LASIK surgery. Results show good reduction of refractive error and improvement of UCVA and BSCVA. A significant undercorrection of astigmatism was attributed to surgically induced astigmatism. Further studies are necessary to determine the long-term safety and stability of outcomes.     

Laser in situ keratomileusis for hyeropia and hyperopic astigmatism.

PURPOSE: To evaluate the efficacy, stability, and safety of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism using a prospective clinical trial. METHODS: LASIK was performed using the Automatic Corneal Shaper and the Keracor 117C excimer laser on 192 hyperopic eyes with astigmatism of less than 1.00 D (spherical group) and 164 hyperopic eyes with corneal astigmatism of 1.00 to 7.50 D (toric group). RESULTS: At 12 months after LASIK, 110 eyes were available for follow-up examination. In low spherical hyperopia (+1.00 to +3.00 D), 13 eyes (55%) were within +/-0.50 D of emmetropia and none lost 2 or more lines of spectacle-corrected visual acuity. In low toric hyperopia (+1.00 to +3.00 D), 14 eyes (61%) were within +/-0.50 D and none lost 2 or more lines of spectacle-corrected visual acuity. In moderate spherical hyperopia (+3.10 to +5.00 D) 9 eyes (44%) were within +/-0.50 D and none lost 2 or more lines of spectacle-corrected visual acuity and in moderate toric hyperopia (+3.10 to +5.00 D) 5 eyes (36%) were within +/-0.50 D and 2 eyes (14%) lost 2 or more lines of spectacle-corrected visual acuity. In high spherical hyperopia (+5.10 to +9.00 D), 6 eyes (38%) were within +/-0.50 D and 2 eyes (13%) lost 2 or more lines of spectacle-corrected visual acuity, and in high toric hyperopia (+5.10 to +9.50 D) 4 eyes (31%) were within +/-0.50 D and 2 eyes (15%) lost 2 or more lines of spectacle-corrected visual acuity. CONCLUSIONS: LASIK seems to be reasonably effective and safe in spherical hyperopia of +1.00 to +5.00 D but less effective for hyperopic astigmatism. For hyperopia greater than +5.00 D, loss of spectacle-corrected visual acuity occurred in a significant number of eyes and accuracy was sufficiently poor to advise against LASIK in these eyes.     

Wavefront-guided LASIK for myopia using the LADAR CustomCornea and the VISX CustomVue

PURPOSE: To evaluate the objective and subjective visual outcomes and refractive results of wavefront-guided LASIK with LADAR CustomCornea and VISX CustomVue. METHODS: This prospective randomized single-institution multisurgeon study comprised 100 eyes of 58 patients (50 eyes on each laser platform). Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction were measured postoperatively at 1 day, 1 week, 1 month, and 3 months. Contrast sensitivity, higher order aberrations measurement, and a subjective vision questionnaire were performed preoperatively and at 3 months. RESULTS: Preoperatively, the CustomCornea group had a mean manifest sphere of -3.58 +/- 1.61 diopters (D) (range: -0.50 to -7.25 D), cylinder of +0.64 +/- 0.45 D (range: 0 to +1.75 D), and manifest refractive spherical equivalent (MRSE) of -3.26 +/- 1.56 D. The CustomVue group had a manifest sphere of -4.00 +/- 1.69 D (range: -1.50 to -7.50 D), cylinder of +0.60 +/- 0.52 D (range: 0 to +2.00 D), and MRSE of -3.70 +/- 1.64 D. At 3 months, 94% of CustomCornea eyes and 84% of CustomVue eyes had UCVA > or = 20/20 (P = .20). Twenty-four percent of CustomVue eyes and 22% of CustomCornea eyes gained 1 line of BSCVA. In both groups, 96% of eyes were within 0.50 D of emmetropia. Mean CustomCornea glare contrast sensitivity improved (P = .04) whereas more eyes improved than worsened in both groups. Spherical aberration and total higher order aberrations increased, and trefoil decreased in both groups. A decrease in coma was noted in 70% of CustomCornea eyes. CONCLUSIONS: Wavefront-guided LASIK with both platforms is safe, effective, and delivers excellent visual results. CustomCornea improves contrast sensitivity under glare conditions.     

Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis

OBJECTIVE: To study photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) after clear lens extraction (CLE) with intraocular lens (IOL) implantation for hyperopia or astigmatism. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-five eyes (55 subjects) had CLE with posterior chamber IOL implants for hyperopia up to 12.25 diopters (D); 31 eyes were retreated with PRK, and 34 eyes were retreated with LASIK for residual ametropias. INTERVENTION: For PRK and LASIK, the refractive surgery was performed with the slit-scanning excimer laser Nidek EC-5000, Nidek Co., Tokyo, Japan. MAIN OUTCOME MEASURES: Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, haze, and halos were evaluated before surgery and at 1, 3, 6, and 12 months postoperative. RESULTS: Forty-seven eyes were evaluated at the 12-month postoperative examination: 96% of these eyes had spherical equivalents (SE) within +/-2 D of emmetropia, 79% of eyes had SE within +/-1 D of emmetropia and 51% of eyes had SE within +/-0.50 D of emmetropia. Eighty-five percent of the eyes at 12 months postoperative had uncorrected visual acuity of 20/40 or better, and 46% of eyes had uncorrected visual acuity of 20/20 or better. Eighty-seven percent of the eyes at 12 months postoperative had uncorrected visual acuity within 1 Snellen line of their initial best spectacle-corrected visual acuity (BSCVA) before all treatment. No eye lost 2 Snellen lines of BSCVA at 3, 6, or 12 months after PRK or after LASIK. CONCLUSIONS: IOL implantation for CLE, although an invasive technique, resulted in better refractive outcomes without laser-related clinical complications after PRK or LASIK adjustment.     

Comparison of LADARVision and Visx Star S3 laser in situ keratomileusis outcomes in myopia and hyperopia

PURPOSE: To compare visual outcomes with 2 commonly used excimer lasers, the Autonomous LADARVision (LV) (Alcon Laboratories Inc.) and the Visx Star S3 (S3), in the performance of myopic and hyperopic astigmatic laser in situ keratomileusis (LASIK). SETTING: Zale Lipshy University Hospital Laser Center for Vision, University of Texas Southwestern Medical Center, Dallas, Texas, USA. METHODS: In this retrospective single-center 3-surgeon cohort comparison, 100 consecutive LV-treated myopic eyes with a mean manifest refraction spherical equivalent (MRSE) of -3.22 diopters (D) (range 0 to -6.00 D) (mean astigmatism 0.95 D [range 0 to 4.00 D]) were compared with 100 consecutive S3-treated eyes with a similar MRSE (mean MRSE -3.19 D; mean astigmatism 0.66 D [range 0 to 2.75 D]). Forty-one consecutive LV-treated hyperopic eyes with a mean MRSE of +2.59 D (range +1.00 to +6.00 D) (mean astigmatism 0.89 D [range 0 to 3.50 D]) were compared with 25 consecutive S3-treated eyes with a similar MRSE (mean MRSE +2.70 D; mean astigmatism 0.87 D [range 0 to 2.75 D]). The following outcomes were compared: uncorrected visual acuity, refractive predictability and stability, gain or loss of best spectacle-corrected visual acuity, and need for enhancement. RESULTS: Statistically significant differences in outcomes were found between lasers in the treatment of hyperopia and hyperopic astigmatism. No outcome differences between lasers were found in the treatment of myopia and myopic astigmatism. CONCLUSION: The LV and S3 lasers yielded equivalent results in myopic LASIK between 0 and -6.00 D; however, the LADARVision yielded statistically significantly better results in hyperopic LASIK between +1.00 and +6.00 D.     

CustomVue laser in situ keratomileusis for myopia and myopic astigmatism using the Visx S4 excimer laser: Efficacy, predictability, and safety

PURPOSE: To evaluate the efficacy, predictability, and safety of custom laser in situ keratomileusis (LASIK) using the Visx wavefront platform CustomVue for the treatment of myopia and myopic astigmatism. SETTING: Stanford University Eye Laser Center, Stanford, California, USA. METHODS: This retrospective analysis was of the initial 140 eyes of 78 patients treated consecutively with LASIK for myopia using the Visx Star S4 excimer laser. Primary outcome variables, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and complications, were evaluated at 1 week and 1 and 3 months. Vector analysis was performed on eyes that received astigmatic correction. RESULTS: Mean preoperative spherical equivalent (SE) was reduced from -3.89 diopters +/- 1.48 (SD) to an SE of -0.21 +/- 0.36 D at 1 month and -0.28 +/- 0.36 D at 3 months (P < .001). At 1 and 3 months, UCVA was 20/20 or better in 84.3% and 87.9%, respectively. Eighty-six percent of eyes at 1 month and 81.4% of eyes at 3 months were within +/-0.5 D of emmetropia. No eyes lost more than 2 lines of BSCVA. Vector analysis yielded an index of success of 0.39, indicating a 61% success rate in achieving the astigmatic surgical correction at 3 months. The preoperative root-mean-square value of 0.28 +/- 0.08 microm increased slightly to 0.33 +/- 0.11 microm at 1 month and 0.34 +/- 0.11 microm at 3 months. CONCLUSION: Wavefront-guided LASIK using the Visx CustomVue system was effective, predictable, and safe for correction of low to moderate myopic refractive error.     

Comparison of the toric implantable collamer lens and custom ablation LASIK for myopic astigmatism

PURPOSE: To compare the results of wavefront-guided custom LASIK and the Toric Implantable Collamer Lens (TICL) in the correction of myopic astigmatism. METHODS: This observational, non-randomized study compared clinical efficacy results from the TICL's US Food and Drug Administration Clinical Trial and published Summaries of Safety and Effectiveness of two wavefront-guided lasers: STAR S4 CustomVue excimer laser system (VISX Inc) and LADARVision4000 CustomCornea excimer laser system (Alcon Laboratories Inc). Preoperative myopic refractive error was divided into two groups: -3.00 to -7.00 diopters (D) and -7.00 to -11.00 D. RESULTS: The percentage of eyes with uncorrected visual acuity (UCVA) of 20/20 and 20/40 and predictability of manifest refraction spherical equivalent within +/- 0.50 and +/- 1.00 D in the three groups was similar with only one statistically significant difference (TICL versus Alcon within +/- 1.00 D: 97% versus 82%; P = .008). The TICL had significantly better postoperative best spectacle-corrected visual acuity (BSCVA) compared to preoperative BSCVA than both the VISX CustomVue and Alcon CustomCornea (P < .001). The TICL postoperative UCVA outcomes compared to preoperative BSCVA were significantly better than Alcon CustomCornea outcomes (P < .001). Additionally, almost half (48%) of the TICL cases had improvement in postoperative UCVA compared to preoperative BSCVA, whereas only 23% of the Alcon CustomCornea eyes showed improvement. CONCLUSIONS: Although comparable in clinical efficacy outcomes, the TICL had a significantly better postoperative improvement in BSCVA and significantly better postoperative UCVA than preoperative BSCVA. The TICL can be considered as an alternative to LASIK through the full range of use.