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.     

Conventional and wavefront-guided myopic LASIK retreatment

PURPOSE: To assess the clinical outcomes of conventional and wavefront-guided myopic laser in situ keratomileusis (LASIK) retreatment. DESIGN: Retrospective, nonrandomized case series. METHODS: The study comprised a cohort of 97 eyes having LASIK retreatment for residual myopia after primary LASIK. The eyes were divided into two groups: conventional retreatment (CR) group (n = 74) and wavefront-guided retreatment (WR) group (n = 23). The retreatment LASIK was performed using LADARVison 4000 with/without CustomCornea (Alcon Surgical, Orlando, Florida, USA). The mean follow-up was 8.9 +/- 5.8 months after retreatment (range three to thirty-six months). RESULTS: The mean pre-retreatment spherical equivalent (SE) was -0.93 +/- 0.41 diopters in the CR group and -0.84 +/- 0.48 diopters in the WR group (P = .409). At the last visit, the mean SE was -0.19 +/- 0.28 diopters and +0.32 +/- 0.47 diopters, respectively (P < .001). An SE of +/- 0.50 diopters was achieved in 92% (68 of 74) of CR eyes and 65% (15 of 23) of WR eyes. In the CR group, 85% eyes had a uncorrected visual acuity (UCVA) > or = 20/20 and 99% > or = 20/40, and in the WR group, 35% and 100%, respectively. None of the CR eyes and 17% (4 of 23) of WR eyes lost two lines of best spectacle-corrected visual acuity (BSCVA). Nine percent (7 of 74) of CR eyes and 30% of WR eyes (7 of 23) had optical symptoms before retreatment, the number was reduced to 1% (1 of 74) and 4% (1 of 23), respectively. CONCLUSIONS: In the study period with the current equipment, our results showed that conventional LASIK retreatment was superior to wavefront-guided LASIK retreatment in both efficacy and safety.     

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.     

Surface ablation after laser in situ keratomileusis: retreatment on the flap

PURPOSE: To evaluate the safety and efficacy of superficial laser ablation on the flap as a treatment for residual ametropia after laser in situ keratomileusis (LASIK). SETTING: Private practice refractive surgery center, Utrecht, The Netherlands. METHODS: This retrospective study comprised 18 eyes of 15 patients who had alcohol-assisted photorefractive keratectomy (PRK) or laser-assisted subepithelial keratectomy (LASEK) retreatment for residual ametropia after LASIK. All patients who had retreatment on the flap between June 2004 and June 2005 were included in the study. Retreatments were performed by wavefront-guided excimer laser surface ablation using the Visx Star S4 laser. Outcome measures included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), subjective refraction, and biomicroscopy at the 3-, 6-, and 12-month postoperative visits. RESULTS: The preoperative spherical equivalent (SE) refraction was -0.63 diopter (D) +/- 0.87 (SD) (range -2.00 to +1.38 D). The mean amount of ablated cornea was 21.3 +/- 7.4 microm. At 3 months, the mean UCVA was 0.83 +/- 1.5 lines (range 0.40 to 1.25), yielding an efficacy index of 0.87. At 6 months, the mean UCVA increased to 0.98 +/- 0.8 line (range 0.63 to 1.25) and the efficacy index, to 1.03. At 12 months, 6 eyes were lost to follow-up. The mean UCVA was 0.83 +/- 2.2 lines (range 0.20 to 1.25), with an efficacy index of 0.87. The mean BSCVA was 0.98 +/- 0.9 line (range 0.80 to 1.25) at 3 months and 1.05 +/- 0.6 line (range 0.80 to 1.25) at 6 months, yielding a safety index of 1.03 and 1.11, respectively. At 12 months, the mean BSCVA was 0.95 +/- 1.0 line (range 0.63 to 1.25), with a safety index of 1.0. At 6 months, no eye had lost lines of BSCVA, 11 eyes had no change, and 7 eyes gained 1 line. At 12 months, 2 eyes lost 1 line of BSCVA, 8 eyes had no change, and 2 eyes gained 1 line. The mean SE refraction was +0.10 +/- 0.27 D (range -0.25 to +0.63 D) at 3 months, +0.06 +/- 0.37 D (range -0.50 to +1.13 D) at 6 months, and +0.15 +/- 0.39 D (range -0.50 to +0.88 D) at 12 months. On biomicroscopic examination, 1 eye had prolonged grade 1 haze that disappeared before 6 months. Two eyes of 1 patient who had hyperopic retreatment developed late-onset haze 8 months postoperatively. Eyes with microstriae in the flap before retreatment showed significant improvement after retreatment. There were no sight-threatening complications. CONCLUSION: Wavefront-guided LASEK or alcohol-assisted PRK retreatment on the surface of a LASIK flap was safe and effective in correcting small amounts of residual myopia.     

Laser-in-situ-Keratomileusis zur Korrektur von Hyperopie und hyperopem Astigmatismus mit Scanning-Spot-Excimer-Laser

PURPOSE: The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications of LASIK for the treatment of hyperopia and hyperopic astigmatism using a scanning spot excimer laser. PATIENTS AND METHODS: A total of 64 consecutive LASIK operations (37 patients, mean age 41 years, range 22-68 years) have been evaluated. The Hansatome microkeratome producing a superior hinge (flap diameter 9.5 mm) and a scanning spot excimer laser with an optical zone of 6.0 mm were used. Examinations were performed preoperatively, after 1 day, 7 days, 1 month, 4 and 12 months. RESULTS: One year after the primary procedure only 1 eye lost 2 or more lines of best-corrected visual acuity, 91% were within +/-1 line and 4 eyes gained 2 lines. Of these eyes 50 (86%) reached an uncorrected visual acuity of > or=0.5, 32 (55%) > or=0.8, 16 (28%) > or=1.0, 24 eyes (41%) needed a refractive correction of +/-0.5 D, 44 eyes (76%) of +/-1.0 D and 55 eyes (95%) of +/-2.0 D. The mean spherical equivalent after 1 year was +0.17+/-0.85 D. CONCLUSIONS: LASIK is suitable for the correction of hyperopia (up to a maximum of +5 D) and for hyperopic astigmatism (up to a maximum of -5 D). However, results were better in lower hyperopia (up to +3 D) than in the moderate hyperopia. The refractive results showed overall a good stability during the 12-month study period, but higher regression occurred in a few cases.     

Comparison between LASEK with mitomycin C and LASIK for the correction of myopia of -7.00 to -13.75 D

PURPOSE: To compare laser epithelial keratomileusis (LASEK) and LASIK for the correction of high myopia. METHODS: A prospective, single-masked study was conducted. Patients treated with LASEK to correct myopia > or = -7.00 diopters (D) (spherical equivalent manifest refraction) with a cylinder < or = -3.50 D (LASEK group) were compared to patients treated with LASIK (LASIK group) using the same excimer laser (Technolas 217C). Mitomycin C (MMC) 0.02% was applied for 1 minute in all LASEK-treated eyes. RESULTS: A total of 228 consecutive eyes were included in the study (114 in each group, matched for preoperative refraction). The mean preoperative spherical equivalent manifest refraction was -8.72 +/- 1.20 D in the LASEK group and -8.74 +/- 1.20 D in the LASIK group (range: -7.00 to -13.75 D) (P = .9). Uncorrected visual acuity (UCVA) was significantly lower in LASEK eyes 1, 7, and 30 days postoperatively (P = .0001 for each comparison). No significant differences were found at 3 months postoperatively in UCVA (P = .3), best spectacle-corrected visual acuity (BSCVA) (P = .2), or in the safety (P = .6) and efficacy (P = .8) indices. Uncorrected visual acuity was 1.0 or better in 34.2% of LASEK eyes and 44.7% of LASIK eyes. Spherical refraction was +0.25 +/- 0.6 D after LASEK and -0.06 +/- 0.5 D after LASIK (P = .0001). Sixty-eight percent of LASEK eyes and 79% of LASIK eyes were within +/- 0.50 D of intended refraction. No LASEK eye versus 7 LASIK eyes lost 2 lines of BSCVA. Eight LASEK eyes gained 2 or more lines of BSCVA versus 1 LASIK eye. CONCLUSIONS: Visual improvement after LASEK with intraoperative MMC was significantly slower than after LASIK. Visual outcomes (UCVA, BSCVA, and safety and efficacy indices) 3 months after surgery were similar with both techniques for the correction of high myopia. Ten percent more eyes after LASIK were within +/- 0.50 D of intended refraction.     

Correlation of visual outcome and patient satisfaction with preoperative keratometry after hyperopic laser in situ keratomileusis

PURPOSE: To prospectively study the dependence of visual outcomes and patient satisfaction on corneal keratometry (K) in hyperopic laser in situ keratomileusis (LASIK). SETTING: John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: Twenty-six patients (49 eyes) who had hyperopic LASIK from January to October 2005 were prospectively studied. Twelve patients (24 eyes) with a preoperative K value less than 43.0 diopters (D) (Group 1) were compared with 14 patients (25 eyes) with a preoperative K value greater than 44.0 D (Group 2). RESULTS: The mean preoperative hyperopia was +3.44 D (range +1.57 to +5.25 D). Ten patients in Group 2 and 1 patient in Group 1 lost 2 or more lines of best spectacle-corrected visual acuity (BSCVA). There was a statistically significant difference in subjective patient satisfaction (scale 1 to 4; 4=most satisfied) between Group 1 and Group 2 (mean 2.75+/-0.61 and 1.52+/-0.66, respectively) (P<.0001). Group 2 had a statistically significantly higher dryness score (scale 0 to 3; 3=severe) (mean 1.84+/-0.70 versus 0.17+/-0.38) (P<.0001). There was no between-group difference in the degree of preoperative hyperopia or keratometric change. CONCLUSIONS: An increased incidence of loss of BSCVA and decreased patient satisfaction was associated with a preoperative K value greater than 44.0 D in hyperopic LASIK, indicating caution is required when performing LASIK in eyes with moderate to high hyperopia and steep preoperative corneal keratometry.     

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.     

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.     

LASIK for hyperopia with the WaveLight excimer laser

PURPOSE: To evaluate the safety and efficacy of the ALLEGRETTO WAVE excimer laser system (WaveLight Laser Technologie AG, Erlangen, Germany) in LASIK for hyperopia and hyperopic astigmatism. METHODS: One hundred twenty consecutive LASIK cases for hyperopia with or without astigmatism treated with the ALLEGRETTO WAVE excimer laser were prospectively evaluated up to 12 months postoperatively. Patients were allocated into three groups according to their refractive sphere and cylinder: a low hyperopia group, with up to +3.00 diopters (D) sphere and astigmatism < or = +1.00 D (n = 52); a moderate hyperopia group with +3.25 to +5.00 D sphere and astigmatism of < or = +1.00 D (n = 45); and a high hyperopia/toric group with sphere > or = +5.25 D or cylinder > or = +1.25.D (n = 23). Flaps were created with the Moria M2 microkeratome (Moria, Antony, France). Parameters evaluated were pre- and postoperative refractive error, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), higher order aberration change, and contrast sensitivity. RESULTS: One hundred twelve eyes (93%) were available for follow-up at 12 months. Of the eyes in the low hyperopia group, 92% were within +/- 0.50 D of the refractive goal. For the moderate sphere group and the high hyperopia/toric group, 79% and 71% of eyes, respectively, were within +/- 0.50 D of the refractive goal. No eye lost > or = 2 lines of BSCVA. An increase in higher order aberrations was noted in the high hyperopia/toric group from 0.47 microm (+/- 0.096) to 0.94 microm (+/- 0.167) (P < .001). No significant changes in higher order aberrations were noted in the low and moderate hyperopia groups. CONCLUSIONS: Hyperopic LASIK using the WaveLight ALLEGRETTO WAVE excimer laser appears to be safe and effective in the correction of low, moderate, and high hyperopia and hyperopic astigmatism.     

准分子激光原位角膜磨镶术治疗儿童高度远视屈光参差性弱视的效果

目的评价准分子激光原位角膜磨镶术（LASIK）矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后弱视治疗效果的影响。方法采用前瞻性自身对照法观察42例高度远视屈光参差性弱视儿童病例,年龄范围6～14岁。使用SVS Apex plus准分子激光系统（其中联合L型mask盘矫正单纯远视9例,联合P型mask盘矫正远视合并散光12例）及鹰视世纪波准分子激光系统（21例）,在局部麻醉或全身麻醉下对患儿高度远视眼行LASIK,术后进行弱视治疗。术后对视力、屈光度和双眼视功能进行分析。随访时间6～24个月。结果矫治屈光度数为＋3．00-＋7．50D,术后2年66．6％术眼残余屈光度数在预计矫正屈光度数±1．00D的范围内。术后随访发现睫状肌麻痹下等值球镜屈光度数波动范围为＋0．99～＋0．67D。最佳戴镜矫正远、近视力均不丢失。术后2年平均最佳戴镜矫正远视力为0．40±0．28,平均最佳戴镜矫正近视力为0．78±0．39。经规范弱视治疗,双眼不等像、同时视、融合、立体视及隐斜均得以改善。结论对患有高度远视性屈光参差且不能耐受戴镜矫治的儿童,采用LASIK矫治屈光参差是安全、有效的,具有良好的可预测性和稳定性,且这一手术有助于提高高度远视屈光参差性弱视的治愈率。     

Laser in situ keratomileusis versus lens-based surgery for correcting residual refractive error after cataract surgery

PURPOSE: To evaluate and compare the efficacy and safety of laser in situ keratomileusis (LASIK) versus lens-based surgery (intraocular lens [IOL] exchange or piggyback IOL) for correcting residual refractive error after cataract surgery. SETTING: Private eye center, Salt Lake City, Utah, USA. METHODS: This retrospective study included 57 eyes of 48 patients who had LASIK (28 eyes) or lens-based correction (29 eyes) for residual refractive error after cataract surgery. The visual and refractive outcomes were evaluated at a mean follow-up of 20 to 24 months. RESULTS: In the LASIK group, the mean spherical equivalent (SE) was reduced from -1.62 +/- 0.80 diopters (D) preoperatively to +0.05 +/- 0.38 D postoperatively in myopic eyes and from +0.51 +/- 1.25 D to +0.19 +/- 0.35 D in hyperopic eyes. Ninety-two percent of eyes were within +/-0.50 D of intended correction. In the lens group, the mean SE was reduced from -3.55 +/- 2.69 D preoperatively to -0.20 +/- 0.50 D postoperatively in myopic eyes and from +2.07 +/- 2.38 D to +0.07 +/- 0.85 D in hyperopic eyes. Eighty-one percent of eyes had postoperative SE within +/-0.50 D of the intended correction. The UCVA improved significantly in both groups. No eye lost more than 1 line of BSCVA. With a similar length of follow-up, no significant difference in postoperative SE was found between the 2 groups (P = .453). CONCLUSIONS: The results showed efficacy, safety, predictability, and merits of LASIK and lens-based approaches for correcting different types of residual refractive error after cataract surgery.     

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.     

Retreatment of hyperopia after primary hyperopic LASIK

PURPOSE: To evaluate factors that influence retreatment results after primary hyperopic LASIK. METHODS: Restrospective study of 86 eyes of 61 patients that underwent LASIK to correct primary hyperopic spherical equivalent refraction and a second hyperopic retreatment due to undercorrection. All procedures were performed with the Technolas Keracor 217C excimer laser, lifting the preexisting flap for the retreatment. Preoperatively, under cycloplegia, mean spherical equivalent refraction of the series was +3.05 +/- 0.99 diopters (D). RESULTS: At last follow-up, mean spherical equivalent refraction was -0.07 +/- 0.50 D. Efficacy of the retreatment procedure was better when the primary LASIK attempted spherical equivalent refraction correction was < +3.00 D (P < .05). Safety of retreatment was lower when attempted spherical equivalent refraction correction was > +1.00 D (P < .05) and when attempted spherical equivalent refraction correction of both procedures combined was >+4.00 D (P < .05). CONCLUSIONS: Efficacy, safety, and predictability of retreatments secondary to undercorrection after primary hyperopic LASIK may be affected depending on the amount of diopters corrected in the primary procedure, in the retreatment procedure, and in both primary and retreatment procedures combined.     

LASIK in children with hyperopic anisometropic amblyopia

PURPOSE: To evaluate the results of LASIK for hyperopia in pediatric eyes with amblyopia resulting from anisometropia. METHODS: Thirty-two children with anisometropic amblyopia in whom conventional therapy was unsuccessful underwent unilateral LASIK between 1999 and 2005. Mean patient age was 10.3 +/- 3.1 years (range: 4 to 15 years), and mean follow-up was 20.1 +/- 15.1 months (range: 12 to 60 months). At the last follow-up examination, spherical equivalent refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications were recorded. RESULTS: Mean preoperative and postoperative manifest spherical equivalent refraction of the treated eyes was 5.17 +/- 1.65 and 1.39 +/- 1.21 diopters (D), respectively (P < .01). Mean UCVA was 0.06 +/- 0.09 (range: 0.01 to 0.5) preoperatively and 0.27 +/- 0.23 (range: 0.05 to 0.8) postoperatively (P < .01). Mean BSCVA was 0.20 +/- 0.17 (range: 0.01 to 0.8) preoperatively and 0.35 +/- 0.25 (range: 0.1 to 1.0) postoperatively (P < .01). Six eyes gained > or = 4 lines of BSCVA, 4 eyes gained 2 to 3 lines, 12 eyes gained 1 line, and 9 eyes were unchanged; only 1 eye lost 1 line of BSCVA due to haze in the flap-stroma interface. None of the patients reported halos or glare. There were no intraoperative or postoperative flap complications. CONCLUSIONS: LASIK seems to be an effective and safe procedure for the management of hyperopic anisometropic amblyopia in select cases. Visual acuity improved in the amblyopic eyes and was associated with decreased anisometropia. The refractive response to hyperopic LASIK in children appears to be similar to that of adults with comparable refractive errors.     

Flap lift for LASIK retreatment in eyes with myopia

PURPOSE: To analyze the results achieved with LASIK retreatment after lifting the original flap in a large series of patients. DESIGN: Retrospective, noncomparative, interventional consecutive case series. PARTICIPANTS: Two thousand four hundred twenty-two consecutive eyes undergoing LASIK surgery for myopia, including 334 eyes submitted to flap lift for LASIK retreatment. MAIN OUTCOME MEASURES: Uncorrected visual acuity, best-corrected visual acuity, refractive error, and complications. RESULTS: LASIK retreatment was performed in 334 eyes (14%), and the mean time between initial procedure and retreatment was 8.2+/-6.2 months. The mean spherical equivalent (SE) improved from -1.2+/-0.6 diopters (D) (range, -4.2 to +1.2 D) before retreatment to +0.2+/-0.4 D (range, -3.1 to +1.1 D) after the retreatment. The uncorrected visual acuity (UCVA) after retreatment was 20/20 or better in 58% and 20/40 or better in 92% of eyes. The mean SE was within +/-1.0 D in 96% of the patients and within +/-0.5 D in 80.5% after retreatment. Eighteen eyes (5%) lost 1 line of best-corrected visual acuity, and 4 eyes (1%) lost 2 lines. CONCLUSIONS: LASIK retreatment surgery performed by relifting the flap was a useful procedure for correcting residual refractive errors after the primary LASIK procedure. It provided good uncorrected visual acuity, predictable results, good refractive stability, and few complications.     

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.     

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.     

Comparison of LASIK outcomes with the Alcon LADARVision4000 and the VISX STAR S2 excimer lasers using optimized nomograms

PURPOSE: To evaluate the difference in clinical outcomes between LASIK patients treated with the Alcon LADARVision4000 laser and the VISX STAR S2 laser using optimized nomograms. METHODS: Data from 572 LASIK surgeries of two groups that were sequentially performed by one surgeon were retrospectively reviewed. The first group of 286 eyes were the last cases performed with the VISX STAR S2 laser. Following these surgeries, a second group of 286 eyes were the first cases performed with the Alcon LADARVision4000 laser, after an initial 50-eye adaptation period. Treatments were guided by the Refractive Surgery Consultant software. RESULTS: For myopic eyes 3 months postoperatively, the percentage of eyes with uncorrected visual acuity (UCVA) > or = 20/20, accuracy of treatment within +/- 0.5 D, and loss of > or = 2 lines of best spectacle-corrected visual acuity (BSCVA) for the LADARVision4000 and STAR S2, respectively was: 89% vs 63%, 84% vs 80%, and 0.8% vs 3.8%. For hyperopic eyes 3 months postoperatively, the percentage of eyes with UCVA > or = 20/20, accuracy of treatment within +/- 0.5 D, and loss of > or = 2 lines of BSCVA for the LADARVision4000 and STAR S2, respectively was: 74% vs 33%, 69% vs 74%, and 2% vs 18.5%. CONCLUSIONS: Although good results are evident for both platforms, superior results were observed with the Alcon LADARVision4000 laser.     

Goldmann tonometry after hyperopic laser in situ keratomileusis: comparison between retreated and nonretreated patients

PURPOSE: To identify differences in applanation tonometry between retreated and nonretreated eyes (primary LASIK eyes) 6 months after hyperopic laser in situ keratomileusis. METHODS: In a prospective study 100 eyes (100 patients) underwent conventional hyperopic laser in situ keratomileusis under a 160-microm flap. Central Goldmann applanation tonometry was determined before and 6 months after surgery in 78 (78%) primary LASIK eyes and before surgery and 6 months after the retreatment date in 22 (22%) retreated eyes. RESULTS: Preoperative mean tonometry was 14.96 +/- 1.96 mm Hg and 15.30 +/- 1.95 mm Hg in primary LASIK and retreated eyes, respectively. Six months after surgery it was 12.99 +/- 2.03 mm Hg (P < 0.001) and 12.67 +/- 2.20 mm Hg (P < 0.001), respectively. No significant differences in mean tonometry were found between retreated and primary LASIK eyes 6 months after surgery (P = 0.537). Decreased tonometric values were found in 20 retreated eyes (90.91%) and in 62 primary LASIK eyes (79.48%). Increased tonometric values higher than 1 mm Hg were found in 3 primary LASIK eyes (3.84%), but no retreated eyes showed increased values 6 months after surgery. Two retreated eyes (9.09%) and 10 primary LASIK eyes (79.49%) presented the same tonometric values before surgery and at the end of the study. CONCLUSIONS: After hyperopic laser in situ keratomileusis there was no significant difference in Goldmann applanation tonometry between retreated and primary LASIK eyes.