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.     

Long-term outcomes of photorefractive keratectomy in eyes with previous epikeratophakia for keratoconus

PURPOSE: To determine the long-term safety and effectiveness of photorefractive keratectomy (PRK) in the treatment of refractive errors after epikeratophakia (EP) for keratoconus. METHODS: Ten patients (14 eyes) who had refractive errors after EP for keratoconus received PRK surgery. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive error, corneal astigmatism, pachymetry, corneal topography, and complications were monitored. RESULTS: Mean follow-up after PRK was 63.4 +/- 19.8 months. Mean spherical equivalent was -5.5 +/- 3.9 D before PRK, -0.9 +/- 0.5 D at 1 month after PRK, and -1.5 +/- 1.0 D at 3 years. Mean astigmatism was 4.2 +/- 2.1 D before PRK, 1.2 +/- 0.5 D at 1 month after PRK, and 1.5 +/- 0.6 D at 3 years. Thirteen (93%) eyes had an UCVA <20/40, and 12 (86%) had a BSCVA of 20/40 or better before PRK. At 1 year, the UCVA was 20/40 or better in 8 (57%) eyes, and the BSCVA was 20/40 or better in all eyes. Mean central corneal thickness was 749 +/- 35 microm before PRK and 621 +/- 56 mum at 3 years. During the follow-up period, haze (grade no more than 1.0) was observed in 2 eyes. No immune rejection episode or recurrent keratoconus was found. CONCLUSIONS: PRK appears to be reliable and safe for the correction of residual ametropia after EP for keratoconus, and the visual acuity can remain stable after PRK for a long time.     

Photorefractive keratectomy for residual myopia after cataract surgery

PURPOSE: To evaluate the effectiveness, predictability, and safety of photorefractive keratectomy (PRK) for correcting residual myopia and myopic astigmatism after cataract surgery with intraocular lens implantation. SETTING: Refractive Surgery and Cornea Unit, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: Thirty consecutive eyes (30 patients) had PRK for residual myopia after cataract surgery. Surface PRK with a VISX Twenty-Twenty excimer laser was used in all patients. Follow-up was 1 year. RESULTS: Before PRK, no eye had an uncorrected visual acuity (UCVA) of 20/40 or better. Twelve months after PRK, 16 eyes (53.33%) had a UCVA of 20/40 or better. After PRK, best corrected visual acuity (BCVA) improved 1 line or more in 14 eyes (46.66%) over the preoperative values, and 15 eyes (50.00%) had the same BCVA as before PRK. Mean pre-PRK refraction of -5.00 diopters (D) +/- 2.50 (SD) decreased significantly to -0.25 +/- 0.50 D at 12 months (P < .001). At 12 months, the spherical equivalent was within +/- 1.00 D of emmetropia in 27 eyes (90.00%). No vision-threatening complications occurred. CONCLUSION: Photorefractive keratectomy was an effective, predictable, and safe procedure for correcting residual myopia and myopic astigmatism after cataract surgery.     

Wavefront-guided laser in situ keratomileusis retreatment for consecutive hyperopia and compound hyperopic astigmatism

PURPOSE: To evaluate the efficacy, predictability, and safety of wavefront-guided laser in situ keratomileusis (LASIK) using the Visx CustomVue excimer laser (Advanced Medical Optics) in eyes with consecutive hyperopia and compound hyperopic astigmatism after LASIK. SETTING: Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA. METHODS: This retrospective analysis included 19 eyes of 16 patients who had wavefront-guided LASIK for consecutive hyperopia and compound hyperopic astigmatism after initial LASIK surgery. Primary outcome variables, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), higher-order aberration (HOA) analysis, and spherical equivalence, were evaluated at 1 and 3 months. Nine eyes of 7 patients were available for all visits. RESULTS: The mean patient age was 51.7 years +/- 3.77 (SD) (range 44 to 55 years). The mean preoperative manifest refractive spherical equivalent (MRSE) was 0.99 +/- 0.32 diopters (D) (range 0.50 to 1.50 D) and the mean 3-month postoperative MRSE, -0.04 +/- 0.66 D (range -1.50 to 0.75 D). At 1 month, 57.9% of eyes had a UCVA of 20/20 or better and 78.9% of 20/25 or better; 84.2% were within +/-1.00 D of emmetropia. At 3 months, 66.7% of eyes had a UCVA of 20/20 or better and 88.9% of 20/25 or better; 88.9% were within +/-1.00 D of emmetropia. No eye lost 2 or more lines of BSCVA at 1 or 3 months. CONCLUSION: Wavefront-guided LASIK was an effective, predictable, and safe procedure for consecutive hyperopia and compound hyperopic astigmatism after LASIK.     

后房型有晶状体眼散光型人工晶状体植入术矫正散光的临床研究

目的研究后房型有晶状体眼散光型人工晶状体（TICL）植入术矫正散光的疗效和安全性。方法对57例（100只眼）近视散光患者行后房型有晶状体眼散光型人工晶状体植入术。术前近视（-4,75～-23．0）D,平均（-11．23±3．92）D。散光（1．25—6．50）D,平均（2．61±0．92）D。随访6—24个月,主要观察手术前后视力、屈光状态、角膜内皮计数、角膜曲率、眼压、前房、人工晶状体柱镜轴位和自身晶状体等情况。结果术后6个月,残余散光（0-2．5）D,平均（0．78±0．67）D,35只跟随访2年,散光度变化在0．5D以内。95％眼裸眼视力（UCVA）和99％眼最佳矫正视力（BCVA）均达到或优于术前BCVA。术后3个月,TICL旋转大于30。占9．09％。3只眼眼压一过性升高,经降眼压治疗,1周内恢复正常。结论TICL可提高患者视觉质量,矫正散光效果准确,可预测性强,并具有良好的旋转稳定性。     

Photorefractive keratectomy for post-penetrating keratoplasty myopia and astigmatism

PURPOSE: To determine the safety, effectiveness, and predictability of photorefractive keratectomy (PRK) for the correction of myopia and astigmatism after penetrating keratoplasty. SETTING: Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey. METHODS: Photorefractive keratectomy was performed in 16 eyes of 16 patients with postkeratoplasty myopia and astigmatism who were unable to wear glasses due to anisometropia and were contact lens intolerant. They were examined for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and corneal transplant integrity before and after surgery. RESULTS: The mean follow-up after PRK was 26.0 months +/- 15.7 (SD) (range 12 to 63 months). The mean preoperative spherical equivalent refraction of -4.47 +/- 1.39 diopters (D) was -3.39 +/- 1.84 D (P >.05) at the last postoperative visit and the mean preoperative cylinder of -5.62 +/- 2.88 D was -3.23 +/- 1.70 D (P <.05); refractive regression correlated with the amount of ablation performed. The BSCVA decreased in 3 eyes (18.8%), and the UCVA decreased in 2 (12.5%). Six eyes (37.5%) had grade 2 to 3 haze, which resolved spontaneously in 4 eyes within a relatively long time but caused a decrease in BSCVA in 2 (12.5%). Two of the eyes (12.5%) had a rejection episode after PRK and were successfully treated with topical steroids. CONCLUSIONS: Photorefractive keratectomy to correct postkeratoplasty myopia and astigmatism appears to be less effective and less predictable than PRK for naturally occurring myopia and astigmatism. Corneal haze and refractive regression are more prevalent, and patient satisfaction is not good.     

Photorefractive keratectomy with mitomycin C versus LASIK in custom surgeries for myopia: a bilateral prospective randomized clinical trial

PURPOSE: To compare photorefractive keratectomy (PRK) with prophylactic use of mitomycin C (MMC) and LASIK in custom surgeries for myopic astigmatism. METHODS: Eighty-eight eyes of 44 patients with a minimum estimated ablation depth of 50 microm were randomized to receive PRK with MMC 0.002% for 1 minute in one eye and LASIK in the fellow eye. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, slit-lamp microscopy, contrast sensitivity, specular microscopy, aberrometry, and a subjective questionnaire were evaluated. Forty-two patients completed 6-month follow-up. RESULTS: Mean spherical equivalent refraction error before surgery and mean ablation depth were -3.99+/-1.20 diopters (D) and 73.09+/-14.55 microm in LASIK eyes, and -3.85+/-1.12 D and 70.7+/-14.07 microm in PRK with MMC eyes, respectively. Uncorrected visual acuity was significantly better in PRK with MMC eyes 3 months (P=.04) and 6 months (P=.01) after surgery. Best spectacle-corrected visual acuity and spherical equivalent refraction did not differ significantly in the groups during follow-up (P>.05). Significant haze was not observed in any PRK with MMC eye. Mean higher order aberration was lower in PRK with MMC eyes postoperatively compared with LASIK eyes (P=.01). Better contrast sensitivity was observed in PRK with MMC eyes than LASIK eyes (P<.05). The endothelial cell count did not differ significantly between groups (P=.65). In terms of visual satisfaction, PRK with MMC eyes were better rated. CONCLUSIONS: Photorefractive keratectomy with MMC appears to be more effective than LASIK in custom surgery for moderate myopia. During 6-month follow-up, no toxic effects of MMC were evident. Long-term follow-up is necessary to attest its safety.     

Photorefractive keratectomy for myopia with the Meditec MEL 70G-Scan flying spot laser

PURPOSE: To evaluate the efficacy, predictability, stability, and safety of the Meditec MEL 70G-Scan flying spot excimer laser. METHODS: One hundred thirty myopic eyes were treated with the Aesculap Meditec Mel 70G-Scan ArF flying spot excimer laser with photorefractive keratectomy (PRK). Patient groups: low myopia (Group 1) from -1.50 to -6.00 D (90 eyes), medium myopia (Group 2) from -6.10 to -9.00 D (31 eyes), high myopia (Group 3) from -9.10 to -14.00 D (9 eyes). RESULTS: At 12 months in the low myopia group, uncorrected visual acuity (UCVA) of 20/40 or better was achieved in 95.5% (86 eyes), 20/20 or better in 77.7% (70 eyes); 2.2% (two eyes) lost two or more lines of best spectacle-corrected visual acuity (BSCVA); 73.3% (66 eyes) were within +/-0.50 D of the target correction and 98.8% (89 eyes) were within +/-1.00 D. In the medium myopia group, UCVA of 20/40 or better was achieved in 74.2% (23 eyes), 20/20 or better in 25.8% (eight eyes); 3.2% (one eye) lost two lines, 61% (19 eyes) were within +/-0.50 D of desired correction and 83.8% (26 eyes) were within +/-1.00 D. In the high myopia group, UCVA of 20/40 or better was achieved in 22.2% (two eyes); 20/25 or better in 11.1% (one eye); none of the eyes achieved 20/20 UCVA; 22.2% (two eyes) lost two lines of BSCVA; 44.4% (four eyes) were within +/-0.50 D and 66.6% (six eyes) were within +/-1.00 D of the target correction. Refractive stability was achieved between 3 and 6 months. Increased intraocular pressure was detected overall in 7.69%. CONCLUSIONS: The results of predictability, safety, and efficacy in low and medium myopia with the Meditec MEL 70G-Scan flying spot excimer laser were good, but poorer predictability, regression, and a significant loss of BSCVA were observed in the high myopia group.     

Laser-assisted subepithelial keratectomy and photorefractive keratectomy for the correction of hyperopia. Results of a 2-year follow-up

PURPOSE: To evaluate and compare the efficacy, safety, predictability, and stability of laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for low to moderate hyperopia with a 2-year follow-up. SETTING: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: This prospective comparative single-surgeon study included 216 eyes of 108 patients with hyperopia who received PRK in 1 eye and LASEK in the contralateral eye. The mean patient age was 38.3 years (range 25 to 58 years). The mean preoperative spherical equivalent (SE) cycloplegic refraction was +3.67 diopters (D) +/- 1.15 (SD) (range +2.00 to +5.00 D), and astigmatism was less than 1.00 D. In each patient, PRK was performed in 1 eye (Group A) and LASEK was performed in the other eye (Group B) using the Nidek EC-5000 excimer laser. Postoperative uncorrected visual acuity (UCVA), best corrected visual acuity, contrast sensitivity, manifest and cycloplegic refractions, refractive stability and predictability, postoperative pain, and corneal haze were examined and statistically analyzed. A P value less than 0.05 was considered significant. RESULTS: At 1 week, the UCVA was 20/40 or better in 58% of PRK eyes and 85% of LASEK eyes (P =.037); at 2 years, it was 20/40 or better in 81% and 91%, respectively (P =.076). At 2 years, the UCVA for near was N8 or better in 73% of PRK eyes and 89% of LASEK eyes (P =.064). No patient lost 2 or more lines of Snellen visual acuity. The safety index was 1.03 in PRK eyes and 1.08 in LASEK eyes. Refractive stability was achieved at 6 months in LASEK eyes and at 12 months in PRK eyes. The mean SE cycloplegic refraction decreased from +3.58 D (PRK eyes) and +3.76 D (LASEK eyes) at baseline to +0.74 D and +0.32 D, respectively, at 2 years; in 57% and 78% of eyes, respectively, the refraction was within +/-0.50 D of the targeted refraction. Peripheral corneal haze scores at 3 to 9 months and pain scores at 1 to 3 days were significantly lower in the LASEK group than in the PRK group. CONCLUSIONS: Laser-assisted subepithelial keratectomy for hyperopia up to +5.00 D provided good visual and refractive results. It significantly reduced postoperative pain, grade of peripheral ring-shaped corneal haze, and regression of hyperopia. Hyperopic LASEK provided quicker visual recovery and achieved better efficacy, predictability, and refractive stability than hyperopic PRK.     

Wavefront-supported photorefractive keratectomy: 12-month follow-up

PURPOSE: To evaluate safety, efficacy, predictability, and stability of wavefront-supported photorefractive keratectomy (PRK) for correction of myopia and myopic astigmatism, with 12-month follow-up. METHODS: Thirty eyes of 23 patients with myopia less than -8.00 D (mean -3.76 +/- 1.90 D) and cylinder less than -3.50 D (mean -0.81 +/- 0.71 D) were selected. Aberrometry measurements were taken with the Asclepion aberrometer in order to perform customized wavefront-supported PRK. Eyes were treated with the Asclepion MEL 70 excimer laser and were followed for 12 months. RESULTS: UCVA of 20/16 or better was achieved by 47% (14 eyes) at 1 month, 67% (20 eyes) at 3 months, 77% (23 eyes) at 6 months, 90% (27 eyes) at 9 months, and 83% (25 eyes) after 1 year. No eye lost more than 1 line of BSCVA at 3, 6, 9, or 12 months. Two eyes (7%) gained more than 2 lines 1 month postoperatively, and 13% (4 eyes) gained more than 2 lines at 6, 9, and 12 months postoperatively. BSCVA of 20/10 or better was achieved in nine eyes (30%) at 1 and 12 months. Visual acuity under low contrast at 3 and 12 months after PRK was unchanged in 87% (26 eyes). Visual acuity under glare remained unchanged at 3 months after PRK in 86% (26 eyes) and at 12 months in 83% (25 eyes). CONCLUSION: Excimer laser wavefront-supported PRK with the Asclepion MEL 70 laser was safe and effective for the treatment of myopia and myopic astigmatism. Daylight visual acuity and mesopic visual acuity outcomes remained stable over 1 year.     

Wavefront-guided photorefractive keratectomy for myopia and myopic astigmatism

PURPOSE: To evaluate the results of wavefront-supported customized ablation (WASCA) in eyes treated with photorefractive keratectomy (PRK) to correct spherical myopia and myopic astigmatism. METHODS: One-hundred fifty eyes of 104 patients (mean age 33.4 +/- 4.4 years) were included in the study. An Asclepion Shack-Hartmann wavefront aberrometer was used to assess lower and higher order refractive aberrations of eyes, and customized PRK treatments were carried out using the Asclepion-Meditec MEL 70 G-Scan excimer laser. Follow-up time was 6 months. RESULTS: The mean preoperative spherical equivalent refraction was -4.02 +/- -1.04 D, and mean uncorrected visual acuity (UCVA) was 0.06 +/- 0.02. Postoperatively, mean UCVA was 1.04 (better than 20/20), mean best spectacle-corrected visual acuity was 1.22 (20/16), and average spherical equivalent refraction was -0.12 D; 98.6% (148 of 150 eyes) were within +/-0.50 D of intended refraction, and 100% were within +/-1.00 D. Concerning safety, in 71.1% of eyes (107 of 150) BSCVA was the same as preoperatively, and in 8.2% (11 of 150) it increased by two or more Snellen lines. None of the eyes lost two or more lines of BSCVA. The root mean square value for higher order aberrations increased 1.4 times following PRK. CONCLUSIONS: WASCA-guided PRK was efficacious, safe and predictable; BSCVA may be improved by the WASCA method compared to results achievable with a traditional PRK technique, in spite of an increase in the root mean square value for higher-order aberrations.     

Initial results of photorefractive keratectomy and laser in situ keratomileusis performed by a single surgeon.

PURPOSE: To determine the safety and efficacy of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) early in a surgeon's experience. SETTING: Ophthalmology Department, John A. Moran Eye Center, Salt Lake City, Utah, USA. METHODS: Between October 1995 and April 1997, a retrospective analysis was performed of 200 eyes in 128 patients who had PRK or LASIK with a follow-up of at least 3 months. The mean age was 38.1 years +/- 10.4 (SD) in the PRK group and 42.3 +/- 10.1 years in the LASIK group. There were 36 women and 30 men in the former and 32 women and 30 men in the latter. Photorefractive keratectomy, PRK/astigmatic keratotomy (AK), LASIK, or LASIK/AK was performed with the Summit Omnimed excimer laser. Preoperative evaluation included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, tonometry, and computerized videokeratography. At 1, 3, and 6 months, UCVA, BSCVA, mean spherical equivalent (SE), astigmatism, corneal haze, subjective vision (day, night, glare, and halo), and complications were measured. RESULTS: Mean SE was 0.16 +/- 0.82 diopter (D) in the PRK group and -0.09 +/- 0.63 D in the LASIK group at 1 month (P < .05), -0.18 +/- 0.66 D and -0.16 +/- 0.58 D, respectively, at 3 months, and -0.33 +/- 0.73 D and -0.09 +/- 0.62 D, respectively, at 6 months. Achieved correction was similar in the 2 groups. Mean BSCVA was 22.8 +/- 6.0 in the PRK group and 22.2 +/- 5.3 in the LASIK group at 1 month, 21.1 +/- 6.0 and 21.1 +/- 3.1, respectively, at 3 months, and 19.8 +/- 3.5 and 22.9 +/- 5.2, respectively, at 6 months (P < .005). Mean surface regularity index was 0.68 +/- 0.40 in the PRK group and 0.86 +/- 0.41 in the LASIK group at 1 month, 0.54 +/- 0.26 and 0.72 +/- 0.37, respectively, at 3 months (P < .05), and 0.49 +/- 0.27 and 0.84 +/- 0.42, respectively, at 6 months. Mean surface asymmetry index was 0.71 +/- 0.43 in the PRK group and 0.55 +/- 0.21 in the LASIK group at 1 month (P < .05), 0.53 +/- 0.24 and 0.51 +/- 0.23, respectively, at 3 months, and 0.46 +/- 0.19 and 0.64 +/- 0.54, respectively, at 6 months. The subjective parameters between the groups were significantly different only at 6 months; patients in the PRK group reported better day and night vision. CONCLUSION: With careful preparation and proper training, PRK and LASIK appear to be safe and efficacious even during the surgeon's early learning phases.     

Photorefractive keratectomy for myopia with a 15 Hz repetition rate

PURPOSE: To evaluate excimer laser photorefractive keratectomy (PRK) for myopia using a repetition rate of 15 Hz instead of 10 Hz. SETTING: The Cornea and Laser Eye Institute, Teaneck, and Department of Ophthalmology, UMDNJ-New Jersey Medical School, Newark, New Jersey, USA. METHODS: Photorefractive keratectomy using a 15 Hz repetition rate was performed in 23 eyes of 14 patients by a single surgeon at 1 center. The attempted corrections ranged from -2.8 diopters (D) to -5.5 D. Preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), predictability, corneal haze, and subjective glare/halo were evaluated over 6 months. RESULTS: At 6 months, UCVA was 20/32 or better in all eyes and at least 20/20 in 14 eyes (73.7%). Two eyes (10.5%) lost 2 or more Snellen lines of BSCVA; postoperative BSCVA was at least 20/25 in 100% of eyes and 20/20 or better in 95.0%. Fifteen eyes (78.9%) were within +/-0.5 D of attempted correction, and 19 (100%) were within +/-1.0 D. Mean spherical equivalent refraction was -4.62 D preoperatively, +0.15 D at 1 month, -0.09 D at 3 months, and -0.37 D at 6 months. At 6 months, 4 eyes (21.0%) had no corneal haze and 14 (73.7%) had trace subepithelial haze. Fifteen eyes (78.9%) had no glare/halo effect at 6 months, and 4 (21.0%) had minimal glare/halo effect. CONCLUSIONS: Clinical outcomes after excimer laser PRK for myopia using an increased repetition rate of 15 Hz were good and similar to those in studies conducted with a 10 Hz repetition rate.     

Limbal relaxing incisions for primary mixed astigmatism and mixed astigmatism after cataract surgery

PURPOSE: To evaluate the effect of limbal relaxing incisions (LRIs) in the treatment of primary mixed astigmatism and mixed astigmatism after cataract surgery. SETTING: Department of Ophthalmology, In?nü University, Malatya, Turkey. METHODS: Limbal relaxing incisions were performed to correct astigmatism in 37 eyes of 26 patients with mixed astigmatism. Twenty-four eyes had primary astigmatism, and 13 eyes had astigmatism after cataract surgery. The length, number, and depth of the incisions were determined using the Gills and Gayton nomogram. The manifest refractive astigmatism was measured preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Surgically induced astigmatism using the vector method, preoperative and postoperative uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were evaluated. Follow-up was at least 6 months in all cases. RESULTS: The mean preoperative and postoperative refractive astigmatism was 3.31 diopters (D) +/- 1.50 (SD) and 1.59 +/- 1.28 D, respectively (P <.001). The mean absolute change in refractive astigmatism was 1.72 +/- 0.81 D. No patient lost lines of UCVA or BSCVA. The safety index was 1.21 and the efficacy index, 0.88. The mean preoperative and postoperative UCVA was 0.29 +/- 0.22 and 0.54 +/- 0.31, respectively (P =.0001) and the mean BSCVA, 0.61 +/- 0.30 and 0.74 +/- 0.30, respectively (P =.0001). The mean vectorial magnitude was 2.32 +/- 1.36 D at the last follow-up. There were no serious postoperative complications. CONCLUSION: Limbal relaxing incisions are a simple, safe, and effective method to correct primary mixed astigmatism and mixed astigmatism after cataract surgery.     

Laser subepithelial keratomileusis for myopia of -6 to -10 diopters with astigmatism with the MEL60 laser

PURPOSE: To evaluate the efficacy, predictability, and safety of laser subepithelial keratomileusis (LASEK) for treatment of high myopia with astigmatism. METHODS: LASEK was performed in 61 eyes of 36 consecutive patients with myopic spherical equivalent refraction of -6.00 to -10.00 D using the Aesculap-Meditec MEL60 excimer laser. Data were collected prospectively with a follow-up of 6 to 17 months. Main outcome measures recorded were UCVA, BSCVA, residual refractive error, corneal haze, and complications. RESULTS: Ninety-six percent of eyes achieved 20/40 or better UCVA at 1 month. At 12 months, 64% of eyes achieved 20/20 and 92% achieved 20/40 or better UCVA. Two eyes lost 2 lines of BSCVA at 6 or 12 months. Accuracy of correction was +/- 0.50 D from emmetropia in 82% of eyes, and +/- 1.00 D in 90% at 12 months. No eye showed more than grade 1 haze. Grade 1 haze was observed in three eyes at 12 months. One patient had mild postoperative keratitis, which was successfully treated. CONCLUSIONS: LASEK with the Aesculap-Meditec MEL60 excimer laser appeared to be safe, effective, and highly predictable in treating high myopia.     

Topographic centration of ablation after LASIK for myopia using the CustomVue VISX S4 excimer laser

PURPOSE: To determine the ablation centration, efficacy, predictability, and safety of CustomVue LASIK using the VISX S4 excimer laser for the treatment of myopia and myopic astigmatism. METHODS: A retrospective review of 20 myopic eyes of 12 patients treated with LASIK CustomVue VISX S4 was conducted. Corneal topography was used to determine ablation centration. Primary outcome variables including manifest refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and complications were evaluated at 3 months postoperatively. RESULTS: Mean decentration (from ablation zone to entrance pupil) was 0.23 +/- 0.08 mm at 3 months postoperatively. No eyes were decentered > 0.5 mm. Preoperatively, the mean spherical equivalent refraction was -4.81 +/- 11.39 diopters (D) (range: -6.75 to -2.25 D). At 3 months postoperatively, mean spherical equivalent refraction was -0.63 +/- 0.25 D (range: -2.00 to 0.25 D). Nineteen (95%) of 20 eyes had UCVA of 20/40 and 16 (80%) of 20 eyes had UCVA of 20/20 at 3 months postoperatively. Fourteen (70%) eyes were within +/- 0.50 D and 18 (90%) eyes were within +/- 1.00 D of emmetropia. No eye lost > 1 line of BSCVA. CONCLUSIONS: Wavefront-guided LASIK using the CustomVue VISX S4 for myopic eyes results in minimal decentration ablation and effective, predictable, and safe visual outcomes.     

Laser in situ keratomileusis for myopic astigmatism with the Nidek EC-5000 laser

PURPOSE: We studied the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) for moderate to high simple and compound myopic astigmatism. METHODS: Ninety-two eyes of 46 consecutive patients who had LASIK for myopic astigmatism (64 eyes, astigmatism 3.00 to 9.00 D; myopia 0 to -20.00 D), or simple myopia (28 eyes, myopia -4.00 to -20.00 D; astigmatism 0 to 0.50 D) were retrospectively studied. Mean baseline spherical equivalent refraction (SE) in the myopia group was -8.11 +/- 3.94 D and in the astigmatism group, -8.55 +/- 4.49 D. All eyes underwent LASIK using the Nidek EC-5000 laser by the same surgeon. RESULTS: At 6 months after LASIK in the myopia group versus the astigmatism group, 24 eyes (85%) vs. 54 eyes (84%) were available for follow-up, 12 eyes (50%) vs. 13 eyes (24%) had uncorrected visual acuity (UCVA) of 20/20, 19 eyes (79%) vs. 44 eyes (81%) had UCVA of 20/40, 8 eyes (33%) vs. 18 eyes (33%) had SE within +/- 0.50 D, 15 eyes (62%) vs. 39 eyes (72%) had SE within +/- 1.00 D, and mean SE was -1.22 +/- 1.17 D vs. -0.74 +/- 1.46 D. Mean astigmatism (vertexed to the corneal plane) in the astigmatism group was 2.77 D at 0 degrees before surgery and 0.32 D at 7 degrees at 6 months. None of the myopic eyes and three of the astigmatic eyes (5%) lost > or = 2 lines of best spectacle-corrected visual acuity. CONCLUSION: LASIK with the Nidek EC-5000 laser for myopic astigmatism was reasonably effective, predictable, and safe. Astigmatism was under-corrected with the nomogram implemented in this study.     

Toric phakic intraocular lens: European multicenter study

OBJECTIVE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. DESIGN: Prospective, nonrandomized, comparative (self-controlled) multicenter trial. PARTICIPANTS: Seventy eyes of 53 patients (mean, 35 years; range, 22-59 years) with preoperative spherical equivalent between +6.50 and -21.25 diopters (D) and cylinder between 1.50 and 7.25 D. METHODS: Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up was 6 months in all cases. Lenses were available in powers ranging from +12.0 D to -23.5 D (spherical equivalent) in 0.5-D increments, with additional cylinder from 1.0 D to 7.0 D, also in 0.5-D increments. MAIN OUTCOME MEASURES: The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell count (ECC), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, subjective complaints, and patient satisfaction. RESULTS: Eyes were divided into group A, myopia (n = 48), with an average preoperative spherical equivalent of -8.90 +/- 4.52 D, and group B, hyperopia (n = 22), with an average preoperative spherical equivalent of +3.25 +/- 1.98 D. No eyes in either group experienced a loss in BSCVA, and 46 eyes gained 1 or more lines of their preoperative BSCVA. In 62 eyes (88.6%), UCVA was 20/40 or better. There was a significant reduction in spherical errors and astigmatism in all cases after surgery. All eyes of both groups were within +/-1.00 D of target refraction, and 51 eyes (72.9%) were within +/-0.50 D of target refraction. There was a 4.5% mean total loss of ECC during the first 6 months. No serious complications were observed. Overall patient satisfaction was very high. CONCLUSIONS: Six-month clinical trial results demonstrate that implantation of the Artisan TPIOL safely, predictably, and effectively reduced or eliminated high ametropia and astigmatism with one procedure. The refractive effect was stable at 6 months after surgery.     

Laser in situ keratomileusis for primary and secondary mixed astigmatism

PURPOSE: To evaluate and compare the efficacy, predictability, and safety of LASIK in the correction of primary and secondary mixed astigmatism after previous LASIK surgery. DESIGN: Retrospective, comparative case series. METHODS: The retrospective study included 118 eyes having LASIK with the LADARVison 4000 excimer laser (Alcon Surgical, Orlando, Florida) to correct mixed astigmatism. The eyes were divided into two groups: in group A (n = 64), LASIK was for primary mixed astigmatism and in group B (n = 54), LASIK was for secondary mixed astigmatism. Mean follow-up was 10.6 +/- 5.90 months. RESULTS: Overall, the postoperative UCVA was 20/20 in 51% of eyes and 20/40 or better in 97% of eyes at the last visit. The mean refractive cylinder was -2.18 +/- 0.94 D preoperatively and -0.56 +/- 0.56 D postoperatively. Sixty-one percent of eyes had a refractive cylinder of 0.50 D or less. One eye lost 2 lines of BSCVA (0.8%). None of the eyes had postoperative BSCVA worse than 20/25. The difference of preoperative cylinder was significant between group A and group B (P = .000). However, there was no statistical difference of postoperative refraction and UCVA between these two groups. At 12 months, the mean vector magnitude achieved was 93% of intended cylinder correction with a mean angle of error of -3.0 +/- 16 degrees. CONCLUSIONS: LASIK is a safe, effective, and predictable procedure to treat both primary and secondary mixed astigmatism. Nomogram adjustment with spherical and astigmatism components individually may improve refractive outcomes.     

Femtosecond laser in situ keratomileusis after radial keratotomy

PURPOSE: To assess the safety, efficacy, and predictability of femtosecond laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK). SETTING: Hospital Virgen del Consuelo de Valencia, Valencia, and Vissum Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective study comprised 11 eyes of 7 patients with residual low myopia after previous RK who had surgery with the IntraLase femtosecond laser (IntraLase Corp.) and the Star 2 excimer laser (Visx, Inc.). Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), defocus equivalent, refraction, flap thickness, flap diameter, and intraoperative complications were evaluated over a minimum 6-month follow-up. RESULTS: Although the RK incisions opened in all eyes when the flap was lifted, LASIK was successfully completed in all cases. Mean flap thickness was 119 microm +/- 13 (SD). There were no cases of slipped flaps, microstriae, or epithelial ingrowth. Defocus equivalent was reduced from a mean of 2.51 +/- 0.62 diopters (D) to 0.52 +/- 0.28 D; 7 eyes (63.6%) were within +/-0.50 D, and 11 eyes (100%) were within +/-1.00 D. All eyes had 20/40 or better UCVA, although 2 eyes (18.1%) lost 1 line of BSCVA. CONCLUSIONS: The femtosecond laser was safely used to create thin LASIK flaps in eyes with previous RK. An increased postoperative inflammatory response may explain the loss of BSCVA in some cases. Efficacy and predictability of the procedure were comparable to those of LASIK after RK with mechanical microkeratomes.