Ten-year follow-up of laser in situ keratomileusis for myopia of up to -10 diopters

PURPOSE: To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for myopia of up to -10 diopters (D). DESIGN: A long-term (10-year) follow-up retrospective, interventional case series. METHODS: The study included 97 eyes of 70 patients with a preoperative spherical equivalent (SE) of up to -10 D treated with myopic LASIK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA) and the Automated Corneal Shaper microkeratome (Chiron Vision, Irvine, California, USA). All patients were evaluated three months, one year, two years, five years, and 10 years after surgery. The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS: At 10 years, 71 (73%) of 97 eyes were within +/- 1.00 D and 89 (92%) were within +/- 2.00 D. Twenty eyes (20.8%) underwent retreatments because of overcorrection, undercorrection, regression, or both. The mean SE slightly decreased (myopic regression) over 10 years, with a mean myopic regression of -0.12 +/- 0.16 D per year. Fifty-four (54.6%) of 97 eyes demonstrated an increase in best spectacle-corrected visual acuity (BSCVA) after 10 years. No eye developed corneal ectasia in the long-term, and only three eyes lost more than two lines of BSCVA because of complications that were not attributable to the LASIK procedure. CONCLUSIONS: LASIK for myopia of up to -10 D is a safe and effective procedure with slight myopic regression that slows down with time and a high rate of BSCVA increase in the long-term.     

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.     

Ten-year follow-up of photorefractive keratectomy for myopia of less than -6 diopters

PURPOSE: To evaluate the long-term outcomes of excimer laser myopic photorefractive keratectomy (PRK) for myopia of less than -6 diopters (D). DESIGN: Long-term (10-year) follow-up retrospective, interventional case series. METHODS: The study included 225 eyes of 138 myopic patients with spherical equivalent (SE) between 0 and -6 D treated with myopic PRK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA). The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS: At 10 years, 169 (75%) of 225 eyes were within +/- 1.00 D and 207 (92%) were within +/- 2.00 D. Ninety-five (42%) eyes underwent retreatments because of overcorrection, regression, or both. The mean SE slightly decreased (myopic regression) with a mean magnitude of -0.10 +/- 1.08 D over 10 years (-0.01 +/- 0.11 D per year). Forty-one (58%) of 225 eyes demonstrated increase in best spectacle-corrected visual acuity after 10 years. Only one eye lost eight lines because of significant cataract, and two eyes lost vision (one lost seven lines and the other lost four lines) because of posterior segment-related complications. The mean corneal haze score gradually decreased from 0.22 +/- 0.39 at three months to 0.01 +/- 0.09 at 10 years. CONCLUSIONS: Photorefractive keratectomy for myopia of less than -6 D is a safe and effective procedure in the long-term.     

Ten-year follow-up of photorefractive keratectomy for myopia of more than -6 diopters

PURPOSE: To evaluate the long-term outcomes of excimer laser myopic photorefractive keratectomy (PRK) for myopia higher than -6 diopters (D). DESIGN: A long-term (10-year) follow-up retrospective, interventional case series. METHODS: The study included 267 eyes of 191 patients with myopia with spherical equivalent (SE) of more than -6 D treated with myopic PRK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA). All patients were evaluated three months, one year, two years, five years, and 10 years after surgery. The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS: At 10 years, 156 (58%) of 267 eyes were within +/- 1.00 D and 209 (78%) were within +/- 2.00 D. One hundred and twenty-four eyes (46.4%) underwent retreatments because of overcorrection, regression, or both. The mean SE decreased (myopic regression) in eyes that did not undergo retreatment, with a mean magnitude of -1.33 +/- 2.0 D over 10 years (-1.13 +/- 0.20 D per year). One hundred and twenty-one (48.3%) of 267 eyes demonstrated increase in best spectacle-corrected visual acuity, and only eight eyes lost lines of vision because of cataract and posterior segment-related complications. The mean corneal haze score decreased gradually from 0.48 +/- 0.69 at three months to 0.09 +/- 0.33 at 10 years. CONCLUSIONS: PRK for myopia of more than -6 D is a safe and effective procedure in the long-term.     

Laser in situ keratomileusis in patients with corneal guttata and family history of Fuchs' endothelial dystrophy

PURPOSE: To report 1-year results of laser in situ keratomileusis (LASIK) in 7 eyes with corneal endothelial guttata and a family history of Fuchs' endothelial dystrophy. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: A retrospective chart review was performed of 4 patients (7 eyes) who had trace to 1+endothelial guttata and a family history of Fuchs dystrophy and then had uneventful LASIK for the correction of myopia and myopic astigmatism. Preoperative and postoperative measurements included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, endothelial cell density (ECD), manifest refraction, and spherical equivalent. The changes in ECD, pachymetry, and spherical equivalent after LASIK were subjected to statistical analysis using a paired Student t test to determine significance. RESULTS: Transient corneal edema was noted in the early postoperative period in 3 eyes of 2 patients. At 1 year, 6 of the 7 (86%) eyes had lost > or =2 lines of BSCVA. A statistically significant decrease in ECD of 12.4% +/- 2.7% was observed at 1 year compared with baseline (P < .001). An increase in corneal thickness (P = .006) and a statistically significant myopic shift in spherical equivalent (P = .017) was also noted at 1 year compared with 3 months. CONCLUSIONS: Patients with mild corneal guttata and a family history of Fuchs' dystrophy are prone to transient corneal edema, loss of BSCVA, endothelial cell loss, and myopic regression after uneventful LASIK for correction of myopia and myopic astigmatism.     

Nomogram adjustment of laser in situ keratomileusis for myopia and myopic astigmatism with the Alcon LADARVision system

PURPOSE: To evaluate the visual and refractive results of conventional (non-wavefront) laser in situ keratomileusis (LASIK) for treatment of myopia and myopic astigmatism using the Alcon LADARVision 4000 excimer laser system and nomogram adjustment techniques. METHODS: A retrospective analysis of 499 eyes that had LASIK for myopia and myopic astigmatism was performed. Preoperative manifest spherical equivalent refraction ranged from -0.43 to -6.00 D and preoperative astigmatism ranged from 0 to -4.75 D. Patients were evaluated during 3 months following surgery. RESULTS: One month after surgery, 72% of eyes examined (298/415 eyes) had uncorrected visual acuity (UCVA) of 20/20 or better. Three months after surgery, 83% of eyes examined (216/261 eyes) had UCVA of 20/20 or better. One and three months after surgery, 82% and 83% of eyes, respectively, were within +/-0.50 D of attempted correction; 97% of eyes were within +/-1.00 D at both 1 and 3 months. No eye lost more than 1 line of best spectacle-corrected visual acuity (BSCVA) at 3 months after surgery. At the 3-month examination, 83% of eyes had UCVA better than or equal to preoperative BSCVA. CONCLUSIONS: Conventional LASIK to correct myopia and myopic astigmatism was safe and effective using the Alcon LADARVision 4000 excimer laser system. Outcomes were substantially improved throughout development of an accurate nomogram, derived from continually updated regression analysis of previous refractive results.     

Laser-assisted subepithelial keratectomy for low to high myopia and astigmatism

PURPOSE: To evaluate the safety and efficacy of laser-assisted subepithelial keratectomy (LASEK) for the treatment of low to high myopia and astigmatism. SETTING: Solo private practice, Mountain View, California, USA. METHODS: Laser-assisted subepithelial keratectomy was performed in 146 eyes of 83 consecutive patients with myopia or myopic astigmatism using a VISX Star S2 excimer laser (72 eyes) or a Nidek EC-5000 excimer laser (74 eyes). The mean preoperative myopic spherical equivalent was -5.32 diopters (D) (range -1.25 to -14.38 D). Data were collected prospectively with a follow-up of 1 to 12 months. Outcome measurements included uncorrected visual acuity (UCVA), manifest refraction, best spectacle-corrected visual acuity (BSCVA), corneal haze, and complications. RESULTS: After 6 and 12 months, no eye lost 2 or more lines of BSCVA. After 6 months, the UCVA was 20/20 in 57% of eyes and 20/40 or better in 96%. After 12 months, it was 20/20 in 56% of eyes and 20/40 or better in 96%. No eye developed corneal haze that affected visual acuity. There were no serious or vision-threatening complications. CONCLUSIONS: Laser-assisted subepithelial keratectomy was safe and effective in treating a wide range of myopia and astigmatism. The potential advantages of LASEK over laser in situ keratomileusis (LASIK) include the elimination of stromal flap complications and greater choice in patient selection. The disadvantages include varying degrees of pain for 2 days and blurry vision for several days postoperatively.     

LASIK for myopia with the Zeiss meditec MEL 80

PURPOSE: To prospectively evaluate a new high-speed, small spot-scanner laser for the correction of myopia and myopic astigmatism. METHODS: Seventy-six consecutive eyes with myopia and myopic astigmatism between -1.00 and -8.25 diopters (D) and up to -2.75 D astigmatism underwent LASIK treatment using the MEL 80 laser (Carl Zeiss Meditec, Jena, Germany). Parameters evaluated were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), residual refractive error, regression of correction, and aberrometry. RESULTS: Mean preoperative BSCVA was 20/20, which improved to 20/18 postoperatively. Postoperative UCVA was 20/20 at 1 month and 20/18 at 1 year. Uncorrected visual acuity > or = 20/20 was achieved in 58 (83%) of 70 eyes at 1 month and in 60 (88%) of 68 eyes at 1 year. The average refractive error before LASIK was -4.41 +/- 1.98 D. The mean residual refractive error was 0.14 +/- 0.31 D at 1 month and 0.13 +/- 0.30 D at 1 year. At 1-month and 1-year follow-up, respectively, 66 (94%) of 70 eyes and 65 (96%) of 68 eyes were within +/- 0.50 D of intended refractive correction. No eye lost two lines. At 1 month 17% of eyes and at 1 year 13% of eyes gained two lines or more. Between 1-month and 1-year follow-up, 100% of eyes were stable. Mean root-mean-square high order aberration changed from 0.20 microm preoperatively to 0.28 microm postoperatively. CONCLUSIONS: The MEL 80 is effective and safe in the treatment of myopia and myopic astigmatism.     

准分子激光原位角膜磨镶术治疗超高度近视远期疗效分析

目的探讨准分子激光原位角膜磨镶术(LASIK)治疗超高度(等效球镜度数>-10.00 D)近视的远期效果和安全性.方法对99例(173只眼)超高度近视行LASIK矫正,术前屈光度数-10.00～-23.50 D,平均(-13.7±3.6)D(等效球镜),其中-15.00 D以上41只眼.常规行裂隙灯显微镜、三面镜眼底检查、OrbscanⅡ眼前段分析系统、眼压、A超、角膜测厚、电脑验光、散瞳检影、主观验光等检查.术后随访18个月以上.结果术后18个月时裸眼视力≥0.5者148只眼(85.6%),最佳矫正视力高于或等于术前最佳矫正视力者147只眼(84.4%),未见术后最佳矫正视力较术前最佳矫正视力低于2行以上的眼;屈光度数稳定在±1.00 D以下者109只眼(63.0%),术前屈光度数在-14.75 D以下和-15.00 D以上达到±1.00 D内者的百分数分别为73.5%(97只眼/132只眼)和29.3%(12只眼/41只眼).术后角膜后表面前移,术后3个月时后表面顶点距理想球面的距离为(0.069±0.031)mm,18个月为(0.065±0.025)mm,均大于术前的(0.029±0.010)mm;角膜微皱褶2只眼,诉暗视力下降眩光6例(10只眼).结论 LASIK矫正超高度近视有效安全,同时在选择手术适应证方面应谨慎从之.对于屈光度数太高而角膜厚度偏薄者行LASIK应慎重,可考虑其他方法矫正如晶状体屈光手术或联合手术.(中华眼科杂志,2004,40816-818)     

Laser in situ keratomileusis for compound myopic astigmatism using the Meditec MEL 70 G-Scan excimer laser

PURPOSE: To determine the safety, efficacy, predictability, and stability of laser in situ keratomileusis (LASIK) in treating patients with myopic astigmatism using the Meditec MEL 70 G-Scan excimer laser. METHODS: Seventy-four eyes of 42 patients with myopia ranging from -4.50 to -9.88 D and astigmatism ranging from 0.50 to 4.00 D who underwent LASIK with the Meditec MEL 70 G-Scan excimer laser and the Summit Krumeich-Barraquer microkeratome were studied. Patients were followed for 1 year. RESULTS: Mean baseline spherical equivalent refraction was -7.12 +/- 1.70 D and cylinder was 1.62 +/- 1.72 D. At 12 months, mean postoperative spherical equivalent refraction was -0.49 +/- 0.57 D and mean refractive cylinder was 0.59 +/- 0.32 D. Mean change in spherical equivalent refraction between 1 and 12 months after surgery was -0.09 +/- 0.31 D, toward myopia. At baseline, no eyes had best spectacle-corrected visual acuity (BSCVA) of 20/20 or better, and 65% had 20/40 or better. At 12 months after surgery, 10% of eyes had BSCVA of 20/20 or better and 88% of eyes had 20/40 or better. The unusually low postoperative BSCVA results were thought to be due to amblyopia or existence of a higher percentage of some optical aberrations in this group of eyes. Mean uncorrected visual acuity was -1.38 +/- 0.42 LogMAR units (20/400) at baseline and -0.29 +/- 0.25 LogMAR units (20/40) at the 12-month postoperative examination. No eyes lost two or more lines of spectacle-corrected visual acuity. No vision threatening complications were observed. CONCLUSIONS: LASIK with the Meditec MEL 70 G-Scan excimer laser appeared to be safe, effective, reasonably predictable, and stable for correction of myopic astigmatism with a spherical component between -4.25 and -8.25 D and a cylindrical component between 0.50 and 4.00 D. However, astigmatism was slightly undercorrected with the algorithm used.     

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.     

Laser in situ keratomileusis for high myopia with the VISX star laser

PURPOSE: To evaluate the results of laser in situ keratomileusis (LASIK) for spherical and spherocylindrical myopia (range, 9-22 diopters [D]) with the VISX Star laser, (VISX Inc., Santa Clara, CA). DESIGN: Non-comparative, single-surgeon interventional case series. PARTICIPANTS: Two hundred ninety eyes of 175 patients. METHODS: Consecutive patients who underwent LASIK in the study range with the VISX Star laser were evaluated for early (approximately 1 month) and late (after 9 months) outcomes. Both single procedure outcomes and results after reoperation for refractive enhancement were included. MAIN OUTCOME MEASURES: Outcome measures included uncorrected visual acuity, manifest refraction, refractive predictability, refractive stability, best spectacle-corrected visual acuity (BSCVA), results of reoperations, and complications. RESULTS: At the early postoperative examination, approximately 1 month after surgery, 285 of 290 eyes (98.3%) were examined. Uncorrected visual acuity of 20/40 or better occurred in 209 of 285 (73.3%) eyes, and 198 of 285 (69.5%) eyes had a manifest spheroequivalent between +/-1.00 D. Subsequently, 60 eyes (20.7%) underwent reoperation for refractive enhancement. Late results, beyond 8 months from the initial surgery and including reoperations, were available in 195 of 290 eyes (67.2%). Uncorrected visual acuity results of 20/40 or better were found in 166 of 195 eyes (85.1%) and of 20/25 or better in 99 of 195 eyes (50.8%). Manifest spheroequivalent results were +/-2.00 D in 187 of 195 eyes (95.9%) and +/-1.00 D in 148 of 195 eyes (75.9%). In a paired-cohort analysis of 131 single-procedure eyes seen at both intervals, refractive stability (change in manifest refractive spheroequivalent of less than 1.00 D) was present in 101 of 131 eyes (77.1%) between the two observation intervals. Overall, approximately 3.6% eyes lost 2 lines or more of BSCVA, and other complications (flap wrinkling and epithelial ingrowth) were reported in 2% of eyes. Improvement in BSCVA of 1 line or more occurred in 5.6% eyes. CONCLUSIONS: Laser in situ keratomileusis for high myopia with the VISX Star laser provided satisfactory refractive and visual results that compare well with other reports in the literature. Subjective results and other measures of visual function need further evaluation.     

Secondary laser in situ keratomileusis 1 year after primary LASIK for high myopia

PURPOSE: To report the results of the laser in situ keratomileusis (LASIK) using a second-cut hinged corneal flap to treat regression 1 year after primary LASIK for high myopia. SETTING: Istanbul University, Eye Research Center, Istanbul, Turkey. METHODS: Six eyes of 4 patients who had a mean myopic regression of -6.20 diopters (D) +/- 1.10 (SD) 1 year after primary LASIK were retreated with secondary LASIK performed using the Automated Corneal Shaper (Chiron Vision) and a 193 nm excimer laser (Chiron Technolas, Keracor 116). Fluence was 130 mJ/cm2 and the repetition rate, 10 Hz. RESULTS: Mean follow-up was 12.16 +/- 0.75 months. At the last follow-up, the mean spherical equivalent was -0.18 +/- 0.77 D (range +0.12 to -1.25 D). Two eyes (33.3%) remained within +/- 0.50 D of emmetropia; 5 eyes (83.3%) were within +/- 1.00 D of emmetropia. No patient lost best spectacle-corrected visual acuity. No complications occurred such as detachment of the former corneal flap and rolling, irregularity, or tearing of the new corneal flap. CONCLUSION: Secondary LASIK was an effective, safe method to treat regression after primary LASIK for high myopia.     

Eight-year follow-up of photorefractive keratectomy for myopia

PURPOSE: We evaluated 8-year results of excimer laser photorefractive keratectomy (PRK) for myopia in terms of stability and late complications. METHODS: Ninety-two myopic eyes of 55 patients were treated with a single-step method using an Aesculap-Meditec MEL 60 excimer laser with a 5.0-mm ablation zone. Treated eyes were divided into three groups according to preoperative refraction: low myopes (< or = -6.00 D), medium myopes (-6.10 to -10.00 D), and high myopes (>-10.00 D). RESULTS: Change in myopic regression stabilized in all myopia groups within 12 months, although a small myopic shift occurred up to 8 years after PRK. Mean change in refraction between 2 and 8 years was -0.42 +/- 0.48 D for low myopes, -0.37 +/- 0.34 D for medium myopes, and -0.41 +/- 0.50 D for high myopes. The percentage of eyes within +/- 1.00 D of emmetropia 8 years after PRK was 78.3% in the low myopia group, 68.8% in the medium myopia group, and 57.1% in the high myopia group. One eye lost 2 lines of best spectacle-corrected visual acuity due to irregular astigmatism. In 13.0% of eyes, a residual trace corneal haze was observed, which had no effect on visual acuity. Apart from the loss of 2 lines of BSCVA in one eye, there were no other late complications during the study period. CONCLUSIONS: The mean change in refraction between 2 and 8 years was less than -0.50 D, regardless of preoperative refraction, and may be attributed to natural age-related refractive change. The appearance of residual corneal haze after 8 years correlated with the amount of myopic correction. PRK was a safe and stable surgical procedure in this group of patients.     

Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy for the correction of high myopia

PURPOSE: To compare the visual and refractive outcomes of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) in the treatment of high myopia. SETTING: Institute of Vision Research, Department of Ophthalmology, College of Medicine, Yonsei University, and Balgeunsesang Ophthalmology Clinic, Seoul, South Korea. METHODS: Four hundred seventy eyes of 240 patients with manifest refraction spherical components greater than -6.00 diopters (D) were assigned to 2 groups: 324 eyes (167 patients) were treated with LASIK and 146 eyes (73 patients), with LASEK. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), remaining refractive error, corneal haze, and complications were followed in both groups for 12 months. RESULTS: At 12 months, the mean spherical equivalent (SE) was within +/-0.50 D of emmetropia in 205 eyes (63.3%) in the LASIK group and 81 eyes (55.5%) in the LASEK group and within +/-1.00 D in 261 eyes (80.6%) and 104 eyes (71.2%), respectively. The UCVA was 20/25 or better in 269 LASIK eyes (83.0%) and 111 LASEK eyes (76.0%). There was more than a 1-line loss of BSCVA in 4 LASIK eyes (1.2%) and 21 LASEK eyes (14.3%). The between-group differences in SE, magnitude of cylinder, UCVA, and haze were statistically significant (P<.05). CONCLUSIONS: Both LASIK and LASEK were safe and effectively treated eyes with high myopia. Laser in situ keratomileusis provided superior results in visual predictability and corneal opacity.     

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.     

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.     

Results of laser in situ keratomileusis for myopia of -10 to -19 diopters with a Technolas 217 laser

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correcting myopia greater than -10.00 D. METHODS: Sixty-five eyes of 37 patients with myopia greater than -10.00 D underwent LASIK. Patients were evaluated on day 1, 1 week, 1, 3, and 6 months after surgery. Parameters evaluated were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), residual refractive error, regression of correction, and presence of any complication. RESULTS: Mean preoperative BSCVA was 0.745 +/- 0.234, which improved to 0.8070 +/- 0.237 postoperatively. The average preoperative UCVA was 0.022 +/- 0.02; postoperative UCVA at 6 months was 0.536 +/- 0.255. UCVA of 20/40 or better was achieved in 58% (38 eyes) and 20/20 or better in 26% (17 eyes). The average refractive error before LASIK was -12.64 +/- 2.16 D (range -10.00 to -19.00 D). Mean residual refractive error 1 week following LASIK was -0.63 +/- 1.36 D, which regressed to a mean -1.78 +/- 2.08 D at the end of 6 months. Nineteen eyes (29%) were within +/-0.50 D of intended refractive correction. CONCLUSION: LASIK was partially effective in the correction of high myopia. An initial overcorrection may be programmed to offset the effect of refractive regression.     

LASIK in myopic patients with dermatological keloids

PURPOSE: To evaluate the visual and refractive out come of LASIK in myopic patients with a known history of dermatological keloid scar. METHODS: This retrospective case series included 10 eyes of 5 white patients with a known history of dermatological keloids. All patients had low to moderate myopia with no corneal or limbal keloid. All underwent uneventful bilateral LASIK. Postoperatively, visual outcomes, refractive outcomes, and complications were evaluated. Minimum 1-year follow-up was indicated for all patients in this study. RESULTS: Mean preoperative uncorrected visual acuity (UCVA) was 20/320 and 1 year postoperative 20/20. Mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 and 1 year postoperative was 20/20. The mean preoperative spherical equivalent refraction was -5.00 +/- 2.6 diopters (D) and +0.1 +/- 0.2 D 1 year postoperative. The safety index was 1.02 and the efficacy index was 1.02. None of the included in this study underwent retreatment for correction of residual error or regression up to 1 year postoperatively. No sight-threatening complications were reported. No patient reported postoperative haze, severe dry eye syndrome, or flap-related problems. CONCLUSIONS: LASIK is a safe, effective, and predictable technique for correcting low and moderate myopia in patients with dermatological keloids.