非球面优化单眼视准分子激光手术治疗近视合并老视的短期临床观察

目的探讨非球面优化单眼视准分子激光治疗近视合并老视的安全性和有效性。方法选择2017年3~11月在我院视光中心行非球面优化单眼视准分子激光治疗的患者30例(60只眼)。主视眼实施常规模式的准分子激光原位角膜磨镶术(LASIK)矫正全部屈光度,非主视眼实施Q值调整的非球面切削的LASIK。术后随访观察患者术后1 d、1个月、3个月的裸眼远近视力、对比敏感度、角膜地形图变化情况。结果所有患者手术均顺利,无角膜瓣有关的并发症;术后所有患者均没有角膜水肿、Haze反应、高眼压等术后并发症。术后1 d、1个月、3个月,主视眼远视力分别为1.02±0.28、1.10±0.15及1.07±0.20;非主视眼远视力分别为0.8±0.17、1.03±0.26及1.09±0.18。术后1个月至3个月患者远视力趋于稳定。非主视眼术后1 d为0.37±0.10,术后1个月时达到0.51±0.19,3个月时基本稳定。术后3个月时非主视眼中有90%(27/30)≥0.33,70%(21/30)≥0.5。主视眼术后1、3个月的Q值向正值方向发展,分别为0.44±0.20、0.40±0.26,与术前比较差异有统计学意义(P<0.05)。非主视眼术后1、3个月的Q值分别为-0.55±0.26、-0.48±0.29。患者术后1、3个月患者的对比敏感度逐步达到术前水平。结论非球面优化单眼视准分子激光治疗近视合并老视是安全性和有效性的。     

多焦点准分子激光原位角膜磨镶术治疗老视前近视的对比研究

目的 探讨多焦点准分子激光原位角膜磨镶术(LASIK)治疗老视前近视的可行性.方法 前瞻性对照研究.共32例(64只眼)近视眼患者,平均年龄(38.5 ±2.7)岁;主视眼行常规LASIK,非主视眼行多焦点LASIK.检测项目:远近视力、屈光度、角膜地形图、眼压、超声角膜厚度、对比敏感度、调节幅度、焦深、波阵面像差等.对计量资料计算均数和标准差,检验水准α为0.05,对数据进行双侧检验.将调节增幅和术后角膜多焦点指数、手术前后球差改变进行相关分析.结果 随访6～11个月,平均(7±3)个月.非主视眼术前近视力为(LogMAR-0.082±0.220),术后6个月为(LogMAR-0.004±0.213),术后较术前提高(t=4.108,P=0.009);主视眼术前近视力(LogMAR-0.055±0.218),术后6个月为(LogMAR-0.034±0.187),差异无统计学意义(t=1.051.P=0.334).术后6个月6 mm拟合球面Q值,非主视眼平均为(0.08±0.27),主视眼平均为(0.46±0.27),两组差异有统计学意义(t=4.301,P=0.000).非主视眼术后角膜中央区出现高屈光力范围(手术预期视近区域),平均为(5.64±3.05)mm2;术后6个月,非主视眼4只眼(12.5%)出现正球差,平均均方根值为(-0.204±0.195)μm,与术前比较差异无统计学意义(t=0.532,P=0.600);主视眼无正球差出现,均方根值为-0.791～-0.083μm,平均(-0.470±0.208)μm,和术前相比负球差明显增加,差异有统计学意义(t=12.622,P=0.000),术后两组的差异有统计学意义(t=9.214,P=0.000).非主视眼术后6个月调节幅度较术前增加(0.84±0.61)D,主视眼较术前降低(0.10±0.67)D.非主视眼手术后调节力增幅和术后角膜多焦点指数、球差改变具有相关关系.结论 多焦点准分子激光原位角膜磨镶术治疗老视前近视安全、有效.多焦点准分子激光原位角膜磨镶术后能够得到一定程度的伪调节,角膜多焦点性质和非球面性是手术后伪调节产生的根源,伪调节和术后负球差的减少有关.     

改良单眼视LASIK手术矫正老视的疗效

目的 评价Custom-Q引导的改良单眼视准分子激光角膜磨镶术(LASIK)治疗患有近视、散光的老视患者的疗效.方法 前瞻性系列病例研究.收集2009年6月至2010年2月在华西医院近视中心实施改良单眼视LASIK手术的老视患者10例,主视眼屈光度全矫,实施传统LASIK切削;非主视眼保留-1.50 D球镜度数,实施“Custom-Q”引导的非球面性切削,实现改良的单眼视,分别于术后1周、1个月、3个月、6个月及1年进行随访,观察非主视眼和双眼的远、近视力,通过问卷调查,评估患者手术前后用眼舒适度、眼镜的依赖程度及术后满意度.分别对结果进行单因索方差分析、配对t检验和Wilcoxon秩和检验.结果 ①视力:与术前相比,术后非主视眼单眼的裸眼远、近视力差异均有统计学意义(P＜0.01),双眼同时视的裸眼远、近视力差异均有统计学意义(P均＜0.01).②稳定性:非主视眼的单眼和双眼裸眼视力在术后各时间点,差异均无统计学意义.③安全性:术中、术后无严重并发症发生,非主视眼最佳矫正视力术后较术前差异无统计学意义.④满意度:术后主观评分8.40±0.88,问卷调查显示用眼舒适度和眼镜依赖度评分术前和术后差异具有统计学意义(Z=-2.527、-2.609,P＜0.05).结论 运用Custom-Q改良的高级单眼视可用于矫正患有近视、散光的老视人群,可同时获得较好的远、近视力,患者满意度较高.     

Q值优化Micro-Monovision矫正近视合并老视的短期临床效果

探讨Q值优化Micro-monovision准分子激光手术矫正近视合并老视的安全性、有效性及预测性。方法：前瞻性临床研究。收集2017 年8 月至2018 年5 月在青岛大学附属医院行Q值优化Micro-monovision准分子激光手术的近视合并老视患者35例（70眼）。术后3个月观察单眼和双眼的远、近视力（logMAR视力）、屈光状态、对比敏感度（CS）及立体视，并进行近距离工作视觉疲劳问卷及满意度调查。采用配对t检验对手术前后数据进行分析。结果：35例患者术前双眼视远最佳矫正视力（BCVA）为0.01±0.06，术后3个月为-0.04±0.21，且术后无一眼BCVA下降1行及以上。术后主视眼裸眼视力（UCVA）为-0.04±0.19，非主视眼UCVA为0.04±0.13。所有患者主视眼视近UCVA 均达20/25及以上，非主视眼均达20/20。所有术眼实际获得等效球镜度（SE）与预期切削SE的差值均在±1.00 D以内，而差值在±0.50 D以内为60眼（86%）。术后3个月CS在昼+周边眩光条件下18.0 c/d频段较术前显著提高（t=-2.504，P=0.017）；在昼1.5、6.0、18.0 c/d频段，昼+周边眩光6 c/d频段，夜1.5 c/d频段，夜+周边眩光18.0 c/d频段CS均较术前显著下降（P<0.05），其他各条件频段CS均恢复至术前水平。立体视术后3个月与术前比较差异均无统计学意义。所有患者术后均未出现近距离工作后头痛、恶心、阅读模糊及视近困难。所有患者对手术效果均表示满意，满意度为100%。结论：Q值优化Micro-monovision准分子激光手术矫正近视合并老视，可同时获得较好的双眼远、近视力及双眼视功能，是一种安全、有效且预测性好的手术方法。     

Q值优化非球面切削单眼视LASIK术后视觉效果分析

目的：评价利用Q值优化的非球面切削单眼视LASIK手术方式矫正近视散光联合老视的单眼及双眼视觉效果。 方法：选择2006-08-01/2009-03-31之间在我院利用Carl Zeiss Meditec CRS-Master软件及MEL80准分子激光进行Q值优化的非球面切削单眼视LASIK手术的近视或者近视散光联合老视的40名连续随访患者（80眼）,术后1d;1wk;1,3,6mo及1a进行验光、单眼及双眼视近及视远裸眼视力、角膜曲率、像差检查,术后1wk;1,3,6mo及1a进行对比敏感度及立体视觉检查进行视觉质量评估, 并在术后6mo进行患者近距离工作视觉疲劳问卷调查。 结果：Q值优化的非球面切削单眼视LASIK术后视觉质量研究结果如下：术后6mo等效球镜屈光度与目标屈光度相比92%在±0.50D以内,99%在±1.00D,术后3mo~1a的屈光值的变化为-0.06±0.37D。术后1mo主视眼的裸眼远视力95%达到20/20;双眼裸眼近视力87.5%达到J2,100%达到J5。术后1wk, 双眼对比敏感度与术前矫正后相比有下降趋势,术后1~3mo逐渐恢复。术后1wk时,近立体视锐度有所降低(P<0.05),其他立体视锐度均无明显改变(均为P>0.05)。术后患者近距离工作视疲劳症状明显改善。 结论：Q值优化的非球面切削单眼视LASIK手术方式,对于中度近视至高度近视及散光联合老视患者,是一种耐受性好,稳定安全有效的治疗方法。     

单眼视LASIK治疗伴有老视的屈光不正临床观察

目的:探讨单眼视准分子激光原位角膜磨镶术(单眼视LASIK)治疗伴有老视的屈光不正对患者视觉质量、生活质量的影响。方法:屈光不正伴老视的患者172例中124例施行单眼视LASIK(主视眼按最佳矫正远视力完全矫正,非主视眼近视者低矫-0.75~-2.00D,远视者过矫0.75~2.00D),35例放弃手术,13例患者双眼全部矫正。观察术后1d;1wk;3mo时的检查结果。结果:术后3mo单眼视LASIK组124例患者双眼远视力0.7~1.2,双眼近视力J1~J3。无因为难以耐受的不适而需要戴镜补充矫正或再次手术者。双眼完全矫正组术后双眼远视力0.7~1.2,双眼近视力J3~J6,8例(62%)视近困难,需配近用眼镜。结论:单眼视LASIK治疗伴有老视的屈光不正安全有效。单眼视治疗在设计手术方案时需根据患者年龄及调节能力、近附加度数、阅读距离、工作性质等综合考虑。     

高度近视眼行准分子激光非球面切削的临床观察

目的观察高度近视眼行准分子激光非球面切削与普通球面切削的视力、Q值和像差差异，探讨非球面切削对提高视觉质量的作用。方法高度近视眼病例56例（112眼）分为两组，分别行非球面切削（52眼）与普通球面切削（60眼），对两组术后10d，1、3、6个月的视力、Q值以及术后6个月的像差变化进行分析。结果两组术后各时期裸眼视力均可达到术前最佳矫正视力（P〉0．05），普通球面切削组术后各时期Q值均较术前显著增加（P〈0．01），非球面切削组术后10d、1个月Q值较术前显著增加（P〈0．01），3个月、6个月Q值较术前增加（P〈0．05），两组各时期Q值差异有统计学意义（P〈0．05），术后6个月两组的球差均较术前增加，而球面切削组像差增加又明显高于非球面切削组（P〈0．05）。结论使用非球面切削在一定程度上可以解决准分子激光原位角膜磨镶术（LASIK）术后高阶像差增加的问题，对提高术后视觉质量有一定意义。     

大龄近视患者行LASIK的体会

目的:探讨大龄近视伴调节力下降患者行准分子激光原位角膜磨镶术(LASIK)的手术设计对视力的影响。方法:屈光不正伴老视的患者32例63眼中27例53眼行单眼LASIK主视眼按最佳矫正远视力完全矫正,非主视眼近视欠矫-0.5～-2.00D,5例10眼双眼远视力全部矫正。观察术后3mo视力。结果:术后3mo,27例53眼远视力主视眼1.0～1.2,非主视眼0.3～0.6;近视力主视眼0.6,非主视眼1.0。5例10眼双眼远视力完全矫正。结论:LASIK矫正大龄调节力下降患者,在设计手术方案时需按患者要求、年龄等综合考虑。     

非球面切削准分子激光角膜屈光手术的早期临床观察膊

目的 前瞻性研究非球面切削引导准分子激光角膜屈光手术的临床疗效.方法 将球镜-6.00D以下,柱镜0.00～2.00D的近视患者随机分成2组,Q调整组32例64眼行非球面切削引导准分子激光角膜屈光手术,对照组32例64眼行传统准分子激光原位角膜磨镶术(LASIK).观察术后裸眼视力,残余屈光度,高阶像差中的慧差、球差、总高阶像差均方根增加值和满意度等指标.结果 术后裸眼视力和残余屈光度两组比较差异无统计学意义,但Q调整组高阶像差的增加较对照组小,差异有统计学意义(P＜0.05).术后Q调整组患者的满意度情况比较,两组差异有统计学意义(P＜0.05).结论 非球面切削引导准分子激光角膜屈光手术可以减少术后角膜波面像差的增加,尤其是减少球差增加,明显改善视觉质量.     

准分子激光多焦点非球面切削模式治疗远视型老视术后2年临床评价

目的评价准分子激光多焦点非球面切削模式治疗远视型老视的安全性、有效性和可预测性。方法前瞻性自身对照研究。对36例（72眼）远视型老视患者采用飞秒激光制瓣后用准分子激光SUPRACORTM老视矫正技术矫正远视后在角膜中央区进行老视矫正,检测手术前后患者的裸眼远、近视力,屈光度,角膜形态学数据,眼压（IOP）,中央角膜厚度,角膜变形指数及患者术后主观感受,术后随访24个月。计量资料正态分布采用配对t检验及重复测量方差分析, 非正态分布资料手术前后比较采用Friedman秩和检验,两两比较用配对Wilcoxon符号秩和检验。结果手术均顺利,术后24个月裸眼远视力为0.1（0.5～-0.1）logMAR,与术前[0.2（1.0～0.0）logMAR]相比,差异有统计学意义（Z=-2.59,P＜0.01）;术后24个月裸眼近视力为0.2（0.8～-0.1）logMAR,较术前[0.55（1.3～0.3）logMAR]提高（6.75±1.81）行,差异有统计学意义（Z=-7.14,P＜0.01）。术后24个月球镜度为-0.25（-1.25～+1.25）D,柱镜度为-0.24（-1.25～0.00）D,与术前比较差异有统计学意义（Z=-12.14、-3.87,P＜0.01）,术眼屈光度由术前的远视状态变为轻度近视漂移。术后24个月角膜中央3 mm区屈光力（43.97±1.67）D,较术前的[（43.33±1.51）D]有所提高（t=16.85,P<0.01）,角膜中央5 mm屈光力及后表面屈光力与术前比较差异无统计学意义。手术前后IOP、中央角膜厚度差异无统计学意义,角膜变形指数术后大于术前（F=4.88,P＜0.01）,术后各时间点差异无统计学意义。术后6个月采用生活质量调查表对患者主观感受进行量化评价,得分为（80±16）分。结论准分子激光多焦点非球面模式切削治疗远视型老视术后能提高患者远、近视力,有较好的安全性、有效性和稳定性。     

Q值引导与标准FS-LASIK术后角膜形态及对比敏感度比较

目的 比较Q值引导个体化与标准飞秒激光辅助制瓣准分子激光原位角膜磨镶术（FS-LASIK）前后角膜形态及不同条件下对比敏感度的差异,评价2种手术方式治疗近视的疗效。方法 前瞻性队列研究。随机选取2017年9月至2018年4月于安徽医科大学第一附属医院激光中心行近视激光矫正的中低度近视患者64例（126眼）,其中Q值引导组33例（64眼）,标准组31例（62眼）。于术前,术后1、3个月对患者的视力、Q值、角膜像差及对比敏感度值进行检测,比较2组手术前后各数据的差异性。采用重复测量方差分析、t检验和秩和检验对数据进行分析。结果 术前2组各项指标基本匹配,术后1、3个月2组裸眼视力差异无统计学意义（P>0.05）。角膜直径6.0 mm范围,术后3个月2组间角膜Q值、球差和彗差差异无统计学意义（P>0.05）;角膜直径4.5 mm范围,术后3个月Q值引导组球差、Q值小于标准组,差异有统计学意义（t_球差=2.00,P=0.04;t_Q值=2.28,P=0.03）。术后1个月,2组不同环境下各空间频率的对比敏感度基本恢复至术前水平,术后3个月趋于稳定。术后3个月,在暗环境+眩光条件下,Q值引导组中频区对比敏感度高于标准组,差异有统计学意义（Z_{3 c/d}=-2.0,P=0.044;Z_{6 c/d}=-2.1,P=0.034）。结论 Q值引导个性化手术具有良好的安全性、有效性,能够提高暗环境眩光条件下的视觉质量。     

Q值引导与波前引导的LASIK治疗近视的初步研究

目的:观察Q值引导与波前引导的LASIK治疗近视的疗效。方法:接受非球面切削与波前引导的LASIK治疗26例患者(52眼),每名患者的1眼使用Q值引导的切削,另1眼使用波前引导的个性化切削进行LASIK手术,分析2组的治疗效果。结果:术后3mo,2组手术眼视力矫正均满意,其间屈光度无差别(P>0.05);Q值引导组与波前引导组比较其术后角膜更倾向于长椭球形,Q值(0.24±0.32)低于波前引导组Q值(0.53±0.41)(P<0.01),当瞳孔直径为6mm时,两组术后高阶像差RMS均有增加,Q值引导组术后球差增加的幅度小于波前引导组,而彗差增加的幅度大于波前引导组。术后眩光发生率两组无显著性差异(P>0.05)。结论:使用Q值引导与波前引导的LASIK治疗近视及近视散光均是安全有效的,但仍存在不足,需要进一步改进、优化或整合。     

Recovery of uncorrected visual acuity after laser in situ keratomileusis or photorefractive keratectomy for low myopia

PURPOSE: To compare uncorrected visual acuity and refractive error in patients undergoing photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) between 1 week and 6 months after surgery. METHODS: All eyes underwent PRK or LASIK with the VisX StarS2 excimer laser. We retrospectively analyzed data from 77 random eyes of 77 patients in the PRK group and 76 eyes of 76 patients in the LASIK group. All eyes had a low myopic refractive error (spherical equivalent range, -0.88 diopters (D) to -5.13 D; mean PRK. -2.8 +/- 0.20 D: LASIK, -2.5 +/- 0.22 D). Uncorrected visual acuity and manifest refractive error were evaluated 1 week, 1 month, and 6 months after surgery. RESULTS: Each eye undergoing PRK was paired with an eye undergoing LASIK for a similar level of spherical equivalent. Mean uncorrected visual acuity after 1 week was 0.85 +/- 0.06 (20/25, logMAR 0.12 +/- 0.04) for the PRK group and 1.01 +/- 0.06 (20/20, logMAR 0.01 +/- 0.03) for the LASIK group (p < 0.001). Mean spherical equivalent after 1 week was 0.23 +/- 0.12 D for the PRK group and -0.02 +/- 0.07 D for the LASIK group (p = 0.02). Mean uncorrected visual acuity after 1 month was 1.03 +/- 0.05 (20/20, logMAR 0.02 +/- 0.03) for the PRK group and 1.05 +/- 0.05 (20/20. -0.02 +/- 0.03) for the LASIK group (p = 0.16). Mean spherical equivalent after I month was 0.19 +/- 0.10 D for the PRK group and -0.02 +/- 0.09 D for the LASIK group. This difference was statistically significant (p = 0.02), but was unlikely to be clinically significant. Mean uncorrected visual acuity after 6 months was 1.05 +/- 0.06 (20/20, logMAR -0.01 +/- 0.03) for the PRK group and 1.06 +/- 0.05 (20/20, logMAR -0.14 +/- 0.03) for the LASIK group (p = 0.41). Mean spherical equivalent after 6 months was 0.02 +/- 0.08 D for the PRK group and 0.00 +/- 0.08 D for the LASIK group (p = 0.35). CONCLUSION: Uncorrected visual acuity 1 week after surgery is significantly better in eyes undergoing LASIK than in eyes undergoing PRK. Both procedures provide functional vision by 1 week after surgery. The difference does not relate to refractive error, which was similar between the two groups, but to differences in healing of the epithelium. By 1 month after surgery, there is no difference in mean uncorrected visual acuity between eyes that undergo PRK or LASIK for low myopia.     

主视眼对LASIK术后视觉质量影响的研究

目的 探讨主视眼对准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后视觉质量的影响.方法 对66例(132只眼)近视患者行常规LASIK手术,术后随访3月.观察术前术后裸眼视力、最佳矫正视力、屈光度、像差、对比敏感度、眩光敏感度及主观视觉生活质量调查问卷评分并进行统计学分析.结果 ①主视眼发生改变的患者术后1月时有4例(6.06%)、术后3月时有3例(4.55%).②主视眼与非主视眼比较,裸眼视力、最佳矫正视力及眩光敏感度:术前、术后两者差异均无统计学意义(P>0.05);屈光度:术前主视眼低与非主视眼,差异有统计学意义(P<0.05),术后两者差异无统计学意义(P>0.05);高阶像差:术前两者差异无统计学意义(P>0.05),术后1周时彗差主视眼高于非主视眼,差异有统计学意义(P<0.05);对比敏感度:术前两者差异无统计学意义(P>0.05),术后1周时3.0c/d、12.0c/d频率对比敏感度主视眼高于非主视眼,差异有统计学意义(P<0.05,P<0.01).③术后主视眼未改变组主观视觉生活质量调查问卷各项结果均优于主视眼改变组,但这种优势只有在术后3月的视功能评价上有统计学意义(P<0.05).结论 ①LASIK术后极少数患者主视眼可发生改变.②除术后早期外,主视眼对LAISK术后的视觉质量无明显影响.③在LASIK手术时保持术前术后主视眼一致,能改善患者对视觉生活质量的主观评价.     

不同引导方法LASIK术后角膜非球面性改变及临床分析

目的：探讨不同引导方式LASIK术后角膜非球面性改变及临床分析。 方法：48例95眼行LASIK手术,其中45眼接受Q值引导LASIK,50眼接受非Q值引导的LASIK。术后1,3,6mo分别检查视力（visual acuity,VA）、屈光状态、角膜K值、Q值、球差、对比敏感度(contrast sensitivity function, CSF)等,并行统计分析。 结果：两组术后3,6mo在视力和有效指数方面无差异;术后3mo屈光状态在±0.50D范围Q值组和非Q值组分别为95%和90%,术后6mo,±0.50D两组分别为97%和98%;术后1,3和6mo Q值组CSF均较术前提高,差异有统计学意义（P<0.05）,而非Q值组术前术后差异无统计学意义。Q值组和非Q值组术后1,3和6mo的平均Q值分别为0.50±0.33和0.81±0.51、0.50±0.35和0.80±0.48、0.50±0.34和0.80±0.47,与术前比较差异均有统计学意义。Q值组和非Q值组术后6mo球差较术前平均增加分别为4倍和8.5倍;⊿Q与预矫屈光度高度正相关,与患者年龄、性别、术前角膜K值、Q值、球差无相关性;定量关系非Q值组为y= 0.18e^0.32x ,R²=0.72,Q值组为y=0.04x²-0.19x+0.54,R²=0.75。 结论：非球面引导的LASIK可以有效地减少近视屈光手术对角膜非球面性的影响,从而减少术后球差的增加,有利于术后视觉质量的提高。预计的目标Q值与实际的Q值之间存在较大差异。"     

Hyperopic laser in situ keratomileusis: primary and secondary treatments are safe and effective

PURPOSE: To retrospectively analyze the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) treatment of eyes with primary hyperopia and consecutive hyperopia after initial myopic treatment. METHODS: Thirty-two eyes of 19 patients with primary hyperopia (group 1) and 37 eyes of 26 patients with consecutive hyperopia after initial myopic LASIK overcorrection (group 2) that had LASIK for hyperopia with the Hansatome microkeratome and VISX S2 Smoothscan excimer laser with 6 months' follow-up after surgery were analyzed. Uncorrected visual acuity, best spectacle-corrected visual acuity, fogged manifest refraction, and corneal topography with corneal irregularity measurement (CIM) were evaluated 1 month, 3 months, and 6 months after surgery. RESULTS: In group 1, the mean preoperative cycloplegic spherical equivalent was +4.0 +/- 4.5 diopters (D) (range, +1.5 to + 8.75 D) and the 6-month postoperative cycloplegic spherical equivalent was +0.26 +/- 1.74 D (range, -3.00 to +2.75 D). Fifty-three percent of eyes (n= 17) in group 1 were within 1 D of emmetropia. Sixty-six percent of eyes (n= 21) had uncorrected visual acuity of at least 20/40. Three eyes (9%) lost two lines of best spectacle-corrected visual acuity. Changes in uncorrected visual acuity, best spectacle-corrected visual acuity, spherical equivalent, and the CIM topographic index 6 months after surgery were statistically significant compared with the preoperative values. In group 2, the mean preoperative cycloplegic spherical equivalent was +1.58 +/- 0.35 D (range, +0.125 to +2.75 D), and the mean postoperative cycloplegic spherical equivalent was -0.48 +/- 0.46 (range, -2.75 to +0.38 D). Eighty-six percent of eyes (n= 32) were within 1 D of emmetropia. Eighty-four percent of eyes (n= 31) in group 2 had uncorrected visual acuity of at least 20/40. One eye (2.7%) lost two lines of best spectacle-corrected visual acuity. Complications included an epithelial nest that resolved 3 months after surgery in one eye in group 2. CONCLUSIONS: LASIK is a relatively safe treatment of primary hyperopia and hyperopia resulting from overcorrection after initial LASIK treatment of myopia (consecutive hyperopia). Patients with high hyperopia (>5 D) are at risk for loss of two lines of best spectacle-corrected visual acuity. A reduction in the level of attempted correction appears to be necessary in the treatment of consecutive hyperopia.     

Correlation of visual and refractive outcomes between eyes after same-session bilateral laser in situ keratomileusis surgery

PURPOSE: To determine whether between-eye refractive and visual outcomes after same-session laser in situ keratomileusis (LASIK) surgery are correlated, and to determine whether suboptimal visual and refractive outcomes in one eye are predictive of poor results in the fellow eye. DESIGN: Observational case series. METHODS: Retrospective chart review. A total of 484 eyes of 242 patients met inclusion criteria of having undergone same-day LASIK surgery and having 3-month refractive and visual acuity outcomes. Statistical comparisons of outcomes were performed, including between-eye Pearson correlation analysis and logistic regression models for predicting second-eye outcome. Main outcome measures were 1-month, 3-month, and 6-month uncorrected visual acuity and manifest refraction. RESULTS: Refractive outcomes at 1, 3, and 6 months between first (right) and second eyes were not found to be significantly different. No difference in uncorrected or best spectacle-corrected visual acuity was observed between first and second eyes Refractive outcomes of spherical equivalent, sphere, and cylinder and visual outcomes of uncorrected and best spectacle-corrected visual acuity were highly correlated between the two eyes. Analysis of cases with suboptimal outcomes (> or =1 diopter from intended correction or uncorrected acuity equal to or worse than 20/40) suggests that a poor refractive or visual outcome in the first eye increases the risk of a poor outcome in the second eye by approximately 20-fold. CONCLUSIONS: Retrospective analysis of refractive and visual outcomes from patients undergoing same-session bilateral LASIK demonstrates a high correlation of refractive and visual outcome between the eyes.