Laser subepithelial keratomileusis for the correction of high myopia with the Schwind ESIRIS scanning spot laser

PURPOSE: To investigate the efficacy of laser subepithelial keratomileusis (LASEK) for the correction of high myopia with the Schwind ESIRIS scanning spot laser (Schwind eye-tech-solutions Gmbh & Co, Kleinostheim, Germany). METHODS: Fifty-one patients (76 eyes) were treated with a mean preoperative spherical equivalent refraction of -7.55 diopters (D) (range: -6.0 to -10.75 D). All eyes received a LASEK technique using 15% alcohol with a 20-second application. RESULTS: An intact epithelial flap was obtained in 73 (96%) eyes. At 1 week, uncorrected visual acuity (UCVA) was > or =20/30 in 53 (70%) eyes and > or =20/60 in all eyes. At 6 months (n=76), the mean SE was +0.08 D (range: -1.00 to +1.875 D) with 73 (96%) eyes within +/-1.0 D of the intended correction and 60 (79%) eyes within +/-0.5 D. At 12 months (n=46), the mean SE was -0.07 D (range: -1.375 to +2.0 D) with 44 (96%) eyes within +/-1.0 D of the intended correction and 37 (80%) eyes within +/-0.5 D. Myopic cylindrical corrections were attempted in 68 eyes (range: -0.25 to -4.25 D) with vector analysis demonstrating a mean 85% correction. At last follow-up, UCVA was > or =20/20 in 47 (62%) eyes, > or =20/25 in 63 (83%) eyes, and > or =20/40 in 75 (99%) eyes. Three (4%) eyes gained two lines of Snellen decimal equivalent best spectacle-corrected visual acuity compared to preoperative levels, 68 (89%) eyes showed no change or gained one line, and 5 (7%) eyes lost one line. None lost more than one line. Only 2 (3%) eyes at 6 to 12 months had more than +1 axial corneal haze and 50 (66%) showed no evidence of haze on slit-lamp examination. CONCLUSIONS: Laser subepithelial keratomileusis for myopia up to -11.00 D with the Schwind ESIRIS laser provides good refractive and visual outcomes, with acceptable visual recovery and minimal complications.     

Prediction of corneal haze using an ablation depth/corneal thickness ratio after laser epithelial keratomileusis

PURPOSE: To investigate the usefulness of ablation depth/corneal thickness (AD/CT) ratio to predict corneal haze after laser epithelial keratomileusis (LASEK) using a retrospective, comparative, interventional case series. METHODS: Fifty patients (90 eyes; mean age 40.9 years) with myopia, hyperopia, and/or astigmatism underwent bilateral or unilateral LASEK for correction of refractive error. After epithelial flaps were created using an 18% alcohol solution, bilateral or unilateral LASEK was performed using the Alcon Autonomous LADARVision 4000 excimer laser. Visual acuity (best spectacle-corrected and uncorrected) and refractive error were measured before and after LASEK. Corneas were assessed by two independent evaluators under a slit-lamp biomicroscope with broad tangential illumination. The relative haze scale was quantitated: 0 (clear), 0.5+ (trace), 1+ (mild), 2+ (moderate), 3+ (marked), and 4+ (severe). RESULTS: Mean preoperative spherical equivalent refraction was -5.46 +/- 3.74 D (range -12.375 to +5.00 D), mean ablation depth was 93.04 +/- 45.03 microm (range 21.2 to 207.2 microm), and mean AD/CT ratio was 0.18 +/- 0.09 (range 0.04 to 0.41). Of 90 eyes, 40 eyes had a higher ablation depth (AD/CT ratio > 0.18) and 50 eyes had a lower ablation depth (AD/CT ratio < 0.18); 92.5% of eyes in the higher ratio group developed clinically significant haze (1+ or greater). In the lower ratio group, 94% of eyes developed no more than 1+ corneal haze, if any. CONCLUSION: The ablation depth/corneal thickness ratio is useful for predicting corneal haze after LASEK. An AD/CT ratio of 0.18 or more suggests that patients have a high risk of developing clinically significant haze (1+ or more) after LASEK.     

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.     

Laser in situ keratomileusis for the correction of hyperopia from +1.25 to +5.00 diopters with the Technolas Keracor 117C laser

PURPOSE: To assess the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) in patients with hyperopia and to evaluate the visual and refractive results of the procedure. METHODS: LASIK was performed on 85 eyes of 53 patients for correction of hyperopia, with a preoperative mean manifest spherical equivalent refraction of +3.31 +/- 0.69 D (range, +1.25 to +5.00 D) and mean refractive astigmatism of +0.91 +/- 1.06 D (range, 0 to +3.00 D). The Carriazo-Barraquer (Moria) manual microkeratome was used to create the corneal flap, and laser ablation was performed using the Technolas Keracor 117C excimer laser with an ablation zone diameter of 6.0 mm and a transition zone diameter to 9.0 mm. Follow-up was 12 months for all patients. RESULTS: Refraction was stable by 3 months after surgery. At 1 year after LASIK, the mean manifest spherical equivalent refraction was +0.43 +/- 0.57 D (range, -1.25 to +2.00 D) and refractive astigmatism was reduced to a mean of 0.36 +/- 0.30 D (range, 0 to 1.00 D). Fifty-two eyes (61.2%) had a manifest spherical equivalent refraction within +/- 0.50 D of emmetropia, and 76 eyes (89.4%) were within +/- 1.00 D. Uncorrected visual acuity was 20/20 in 21 eyes (24.7%) and 20/40 or better in 79 eyes (92.9%). Spectacle-corrected visual acuity was reduced by two lines in one eye (1.2%) and improved by two lines in five eyes (5.9%). There were no significant complications. CONCLUSION: LASIK was an effective, safe, and predictable procedure for the correction of hyperopia up to +5.00 D and hyperopic astigmatism up to +3.00 D with the Technolas Keracor 117C excimer laser. The large size of the corneal flap obtained by the Carriazo-Barraquer (Moria) manual microkeratome facilitated laser ablation entirely in the exposed corneal stromal bed.     

Laser epithelial keratomileusis for the treatment of low to moderate myopia: preliminary results

PURPOSE: To analyze the refractive outcome and the postoperative pain and corneal haze following laser epithelial keratomileusis (LASEK) for the treatment of low to moderate myopia. METHODS: A monocentric prospective noncomparative study was started in June 2000, after informed consent was obtained from patients with a spherical equivalent of less than -5 diopters (D). This study actually was part of another prospective comparative study where the contralateral eye underwent photorefractive keratectomy. An epithelial debridement was performed using diluted ethanol, the epithelial flap was lifted, photoablation was performed, the flap was put back in place, and secured by a bandage contact lens. The refractive outcome was assessed, and postoperative pain and haze were graded using an analogical visual scale from 0 to 10 and a scale of 0 to 4, respectively. RESULTS: We included 17 eyes of 16 patients. LASEK was performed successfully in 15 eyes (88.2%). One of these eyes could not be assessed for the refractive outcome and postoperative haze because the epithelial flap was torn during contact lens removal. The mean postoperative pain level during the night following the procedure was 5.7+/-2.0. The mean preoperative spherical equivalent (SE) was -2.5+/-1.0 D, and after a 2-month follow-up, the mean postoperative SE was +0.26+/-0.6 D. Twelve eyes (85.7%) and 10 eyes (71.4%) were within +/-1.0 D and +/-0.5 D from the attempted correction, respectively. The corneal haze grade was less than 1 in 12 eyes (85.7%) and equal to 1 in two eyes (14.3%). No complications and no loss of postoperative best-corrected visual acuity were noted. CONCLUSIONS: LASEK appears to be a reliable and reproducible technique for the treatment of myopia-associated SE of less than -5 D. Postoperative pain is moderate and flap-related complications of LASIK are avoided.     

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.     

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.     

单眼行LASIK或LASEK术后疗效观察

目的:探讨单眼行准分子激光原位角膜磨镶术(laserin situkeratomileusis,LASIK)或准分子激光上皮下角膜磨镶术(laser epithelial keratomileusis,LASEK)治疗单眼近视所致屈光参差的效果。方法:采用对单眼等效球镜度>-2.50D的近视性屈光参差患者62例,进行单眼LASIK或LASEK手术。术眼及非术眼手术前后平均屈光度、屈光参差度数、最佳矫正视力和裸眼视力进行评价,术后随访6~24mo。结果:术眼术前平均等值球镜度数为-3.66(-2.50~-6.25)D,术后减少至-0.62(0.00~-1.00)D。LASIK或LASEK对平均等值球镜改变为-3.38(-2.50~-5.50)D。术前两眼平均屈光参差为-3.25(-2.50~-6.25)D,术后减少至-0.85(0.00~-1.75)D。术前术后最佳矫正视力(BCVA)范围均为0.6~1.0,平均最佳矫正视力从术前0.8提高到1.04;术后裸眼视力≥1.0者59眼,平均裸眼视力从术前的0.1提高至术后的1.0。非术眼术前平均等值球镜度数为-0.85(+0.25~-1.50)D,术后平均等值球镜度数为-1.85(-0.50~-3.50)D,平均裸眼视力从术前的0.5术后下降至0.1。结论:单眼LASIK或LASEK治疗近视性屈光参差虽然能提高患眼的最佳矫正视力和裸眼视力,解除单眼近视、散光所致的屈光参差对眼镜或角膜接触镜不能耐受的痛苦,而且对恢复双眼单视功能具有积极意义,但是同时我们也发现术后非术眼有近视加深的趋势,而且非术眼原近视度数越高近视加深越快越多。     

Early clinical results of laser epithelial keratomileusis

PURPOSE: To evaluate the efficacy of laser epithelial keratomileusis (LASEK). SUBJECTS AND METHOD: LASEK was performed on 82 eyes of 42 patients whose spherical refraction ranged from -0.75 to -12.00 D (mean, -6.09 D) and cylindrical refraction ranged from 0 to -5.00 D (mean, -0.95 D). LASEK is a method of making a epithelial flap using 20% ethanol and repositioning the flap after excimer laser ablation. The clinical results of postoperative refraction and complications were examined. RESULTS: At 1 week and 1 month after the operation, 69 eyes(84.1%) and 79 eyes(96.3%) achieved an uncorrected visual acuity of 20/20 or better. At 1 week and 1, 3 months after the operation, the mean spherical refraction was +0.09 +/- 0.49(mean +/- standard deviation) D, +0.29 +/- 0.47 D, +0.13 +/- 0.46 D. At 1 month 65 eyes (79.3%) were within +/- 0.5 D and 78 eyes(95.1%) were within +/- 1.0 D. 51 eyes (62.2%) had the complication of corneal haze. CONCLUSION: LASEK achieved good uncorrected visual acuity, but there were some complications such as postoperative pain, the delayed recovery of visual acuity, and corneal haze, so that a long and careful follow-up seems necessary.     

Effectiveness of laser-assisted subepithelial keratectomy to treat residual refractive errors after laser in situ keratomileusis

PURPOSE: To evaluate the effectiveness of laser-assisted subepithelial keratectomy (LASEK) to treat residual refractive errors after laser in situ keratomileusis (LASIK). SETTINGS: Isik Eye Clinic, Ankara, Turkey. METHODS: This retrospective study included 24 eyes of 15 patients who had retreatment by LASEK for residual refractive errors after myopic LASIK. All patients had examinations that included slitlamp biomicroscopy, subjective and cycloplegic refractions, uncorrected visual acuity (UCVA), best corrected visual acuity, corneal topography, and pachymetry preoperatively and postoperatively. Postoperative examinations were performed at 1 week and 1, 3, and 6 months. RESULTS: The patient cohort comprised 9 men and 6 women. The median spherical equivalent (SE) of attempted correction for retreatment with LASEK was -1.25 diopters (D). The median follow-up after LASEK was 11.5 months (range 6 to 16 months). At the end of the follow-up, the median SE of the refractive error was -0.38 D. The median UCVA increased from 20/45 before LASEK to 20/25 at the last follow-up visit, which was statistically significant (P<.001). After LASEK, significant postoperative haze developed in 5 eyes. In all 5 eyes, the estimated ablation depth was more than 40 mum and the SE of attempted correction was -2.00 D or greater. CONCLUSIONS: Laser-assisted subepithelial keratectomy retreatment in eyes with myopic regression after LASIK resulted in a significant improvement in UCVA that was comparable to the improvement after flap lifting. An SE of attempted correction greater than -2.00 D was associated with a significant rate of haze.     

Topography-guided customized laser-assisted subepithelial keratectomy for the treatment of postkeratoplasty astigmatism

PURPOSE: To assess topography-assisted corneal wavefront excimer laser surface ablation for the correction of ametropia and irregular astigmatism after keratoplasty. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: In this pilot study, 15 patients (16 eyes) who were intolerant of spectacle and contact lens correction due to astigmatic anisometropia after keratoplasty (15 penetrating and 1 lamellar) had topography-assisted customized excimer laser treatments. Corneal topographic data using a Keratron Scout, Placido disk system allowed for preoperative analysis of wavefront anomalies of the anterior corneal surface from which a customized excimer laser correction of both lower-order aberrations (LOAs) and higher-order aberrations (HOAs) was prepared (ORK software) for treatment with a Schwind Esiris flying-spot laser. All eyes had laser-assisted subepithelial keratectomy (LASEK) using 15% alcohol with a 20-second to 30-second application. Four eyes received an application of mitomycin-C (MMC) 0.2 mg/mL for 1 minute after stromal ablation. RESULTS: The mean preoperative spherical equivalent (SE) was -3.50 diopters (D) +/- 3.97 (SD) (range +1.625 to -9.25 D). The preoperative cylindrical error was -7.2 D (range -2.75 to -13.5 D). The programmed laser correction was -3.14 D (range +1.62 to -9 D) with a maximum attempted cylindrical correction of -7 D. Adherent LASEK epithelial flaps along suture lines and the graft-host junction were noted in 9 eyes (56%), although it was possible to obtain and replace a partial flap. A follow-up of 18 months was achieved in all eyes. At the final follow-up visit, the mean postoperative SE was -1.08 +/- 1.85 D (range +3 to -4.78 D) (P<.01, F<.01). Ten eyes (62.5%) were within +/-1 D of the intended correction. The mean postoperative cylindrical error was -2.72 D (range -0.5 to -6.5 D) (P<.001), with vector analysis demonstrating a mean 6.23 D correction. Analysis of HOAs using a 6.0 mm pupil size demonstrated a significant reduction of higher-order root mean square (RMS) (P<.002), trefoil (P<.005), and 4th-order spherical aberration (P<.02) at 18 months compared with preoperative values. Uncorrected visual acuity improved in all eyes (P<.0001). Best spectacle-corrected visual acuity was unchanged or improved in 13 eyes (81%) and worse in 2 eyes by 1 line; 1 eye lost 3 lines due to an increase in preexisting cataract. In eyes that did not receive MMC, corneal haze (grade II to IV) was encountered in 3 eyes (27%). One eye required phototherapeutic keratectomy with MMC application at 12 months. Of the 4 eyes treated with MMC, 1 had trace haze and 3 had no detectable haze. There were no reported cases of epithelial instability, ectasia, or graft rejection. CONCLUSIONS: Topography-assisted customized LASEK was effective in the correction of postkeratoplasty astigmatism. A significant improvement of both LOAs and HOAs was obtained with good refractive stability for over 18 months. Iatrogenic haze typically occurred but appeared to be minimized with adjunctive use of intraoperative MMC.     

Laser epithelial keratomileusis: outcome of initial cases performed by an experienced surgeon

PURPOSE: To evaluate refractive outcome and objective clinical data, and determine efficacy, predictability, and safety of laser epithelial keratomileusis (LASEK) for myopic treatments. METHODS: We performed a retrospective non-comparative single-surgeon case series on the first 20 LASEK procedures (Alcon LADARVision 4000 laser). Mean patient age was 41.2 years (range 21 to 60 yr): 13 men and 7 women. Mean preoperative spherical equivalent refraction was -6.47+/-2.78 D. Corneal haze, uncorrected and spectacle-corrected visual acuity and manifest refraction were evaluated. RESULTS: Of 20 eyes studied, 3 were corrected for monovision. In the non-monovision group, 20/40 or better visual acuity was achieved in 94% (16 eyes) at 1 month, 100% (13 eyes) at 3 months, and 91% (10 eyes) at 6 months after LASEK; 20/20 or better was achieved in 12% (2 eyes) at 1 month, 46% (6 eyes) at 3 months, and 45% (5 eyes) at 6 months. Corneal haze at 1 month was grade 0.5 in 35% (7 eyes), 1 in 20% (4 eyes) and 2 in 10% (2 eyes). At 3 months, 62% (12 eyes) had grade 0.5 and 31% (6 eyes) had grade 1. At 6 months, 58% (12 eyes) had grade 0.5, 25% (5 eyes) had grade 1, and 8% (2 eyes) had grade 2. CONCLUSIONS: LASEK is a challenging procedure. Creating the epithelial flap is not simple and may have contributed to the high haze incidence in our study.     

Laser epithelial keratomileusis for myopia

PURPOSE: To describe a new technique for excimer laser corneal surgery: laser epithelial keratomileusis (LASEK). METHODS: We report 76 eyes with spherical equivalent refractive myopia ranging from -8.00 to -22.00 D (mean -11.00 +/- 3.00 D). Using ethanol applied over an 8.5-mm-diameter area for 20 seconds, the epithelium was detached and photorefractive keratectomy (PRK) was performed. The epithelium was reapplied to the ocular surface and covered with a therapeutic soft contact lens. Treatments were carried out with the Nidek EC-5000 excimer laser. RESULTS: At a mean of 803 days after LASEK, mean spherical equivalent refraction was -1.80 +/- 2.40 D (range -9.27 to +2.00 D). Stability was reached in approximately 60 days. Fifty-nine percent of the epithelial flaps were easy to detach intact during surgery and 62.7% of patients reported no postoperative pain. Eighty-four percent of eyes had the therapeutic bandage lens removed by the fourth postoperative day. Twelve percent of eyes had incomplete epithelial flap removal. Epithelium can fall off the cornea during the healing phase. No significant subepithelial haze was seen in 95% of eyes. CONCLUSION: With LASEK, it may be possible to treat a larger diameter ablation zone in thinner corneas without the problems of a LASIK stromal flap and with less postoperative pain than PRK, with minimal subepithelial haze.     

Effectiveness of laser-assisted subepithelial keratectomy without mitomycin-C for the treatment of high myopia

PURPOSE: To evaluate the effectiveness and therapeutic range of laser-assisted subepithelial keratectomy (LASEK) without mitomycin-C (MMC) to treat high myopia. SETTING: Isik Eye Clinic, Ankara, Turkey. METHODS: This study comprised 31 highly myopic eyes (19 patients) that had LASEK. Before primary LASEK treatment and 1, 3, 6, 12, and 24 months after, all patients had a complete ophthalmic examination including visual acuity, refractive outcomes, and biomicroscopy. RESULTS: The mean spherical equivalent (SE) was -9.01 diopters (D) +/- 2.66 (SD) preoperatively and -1.00 +/- 1.15 D at the end of follow-up. At 24 months, the mean SE was within +/-1.00 D of the intended correction in 23 eyes (74.19%). The median uncorrected visual acuity (UCVA) increased from 20/606 preoperatively to 20/28.6 at 24 months and the median best corrected visual acuity, from 20/25 to 20/22, respectively. Total higher-order and spherical aberrations increased significantly at the end of follow-up. All 14 eyes that had ablations greater than -8.62 D developed varying degrees of haze. Significant myopic regression (>1.00 D) leading to UCVA loss occurred in all eyes with a preoperative SE of -12.00 D or greater. CONCLUSIONS: The results of LASEK without MMC were excellent in eyes with up to -8.6 D of SE. All eyes with a preoperative SE between -8.6 and -12.0 D developed haze but had acceptable refractive and visual outcomes. Haze and myopic regression limited the success of LASEK in eyes with a preoperative SE of -12.0 D and greater.     

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

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

Hyperopic 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.     

Excimer laser subepithelial ablation (ELSA) or laser epithelial keratomileusis (LASEK) - a new kerato-refractive procedure for myopia. Surgical technique and first clinical results on 24 eyes and 3 months follow-up

BACKGROUND: Laser epithelial keratomileusis (LASEK) is a new keratorefractive surgical procedure to treat myopia and possibly other refractive errors, which combines the advantages while eliminating the disadvantages of both PRK (pain, corneal haze) and LASIK (flap complications, interface complications). Our results with LASEK are very promising and because this technique is currently not very popular in Germany we here with introduce the surgical technique and our first clinical results. PATIENTS AND METHODS: We treated 24 eyes (18 patients) by LASEK. The preoperative myopia was between - 1.50 and - 6.00 D with an astigmatism less than 1.00 D. Surgery starts with an incision in the epithelium by using a special microtrephine. After the application of 20 % ethanol for 20 seconds a hinged epithelial flap is created and the laser ablation performed with a Keracor 117 excimer laser. Finally, the epithelial flap is repositioned and secured using a bandage contact lens and artificial tears for 3 days. RESULTS: In all eyes the creation of the epithelial flap and its repositioning presented no problems. None of the eyes showed any postoperative epithelial instability. However, one eye lost the contact lens and the epithelial flap during the first postoperative day. Postoperatively, none of the patients complained of significant pain; however, the contact lens caused some foreign body sensation. After 3 months all eyes were within +/- 1.0 D and 20/24 eyes (84 %) within +/- 0.50 D of emmetropia (spherical equivalent). None of the eyes showed significant haze. CONCLUSIONS: Although, the number of treated eyes is small and the postoperative follow-up is short LASEK seems to be an effective and safe procedure for the treatment of myopia.     

Laser in situ keratomileusis for recurrent hyperopia following laser thermal keratoplasty

PURPOSE: Laser thermal keratoplasty (LTK) has its main indication in the correction of hyperopia. However, regression of refractive effect following LTK is a limitation. Laser in situ keratomileusis (LASIK) may provide a good alternative to correct residual refractive errors. METHODS: Fifty hyperopic eyes with varying amounts of regression after LTK underwent LASIK. The Chiron Automated Corneal Shaper microkeratome was used to make a flap of 160 microm and laser ablation was performed with the Technolas 217 Planoscan excimer laser. Postoperative follow-up was 6 months. RESULTS: Mean spherical equivalent refraction improved from +2.92+/-1.60 D to +0.36+/-1.48 D. Mean best spectacle-corrected visual acuity changed from 0.78+/-0.14 before LASIK to 0.76+/-0.16 D 6 months after LASIK. Mean uncorrected visual acuity changed from 0.37+/-0.16 to 0.66+/-0.24. Forty-two percent (21 eyes) were within +/-0.50 D of intended correction, 60% (30 eyes) were within +/-1.00 D, and 76% (38 eyes) were within +/-2.00 D. After LASIK, confluent haze between previous LTK spots was observed in most eyes, as LASIK ablation took place at the sites of the LTK spots. CONCLUSIONS: LASIK after LTK is a good alternative for hyperopic regression. Predictability and efficacy are less than with primary LASIK for hyperopia, but the procedure is equally safe.     

Early clinical results of laser epithelial keratomileusis

PurposeTo evaluate the efficacy of laser epithelial keratomileusis (LASEK).Subjects and methodLASEK was performed on 82 eyes of 42 patients whose spherical refraction ranged from −0.75 to −12.00 D (mean, −6.09 D) and cylindrical refraction ranged from 0 to −5.00 D (mean, −0.95 D). LASEK is a method of making an epithelial flap using 20% ethanol and repositioning the flap after excimer laser ablation. The clinical results of postoperative refraction and complications were examined.ResultsAt 1 week and 1 month after the operation, 69 eyes (84.1%) and 79 eyes (96.3%) achieved an uncorrected visual acuity of 20/20 or better. At 1 week and 1 and 3 months after the operation, the mean spherical refraction was +0.09±0.49 (mean±standard deviation) D, +0.29±0.47 D, +0.13±0.46 D, At 1 month 65 eyes (79.3%) were within ±0.5 D and 78 eyes (95.1%) were within ±1.0 D; 51 eyes (62.2%) had the complication of corneal haze.ConclusionLASEK achieved good uncorrected visual acuity, but there were some complications such as postoperative pain, the delayed recovery of visual acuity, and corneal haze, so that a long and careful follow-up seems necessary.     

Conductive keratoplasty for the correction of residual hyperopia after LASIK

PURPOSE: To report the 6-month results concerning efficacy, safety, predictability, and stability of conductive keratoplasty for the correction of residual hyperopia after corneal refractive surgery. METHODS: A total of 35 eyes (26 patients) with residual hyperopia after corneal refractive surgery ranging between +1.00 to +4.75 diopters (D) of spherical equivalent refraction were enrolled in the study and underwent conductive keratoplasty following a modified nomogram. RESULTS: Variables and data were available for all eyes at 6 months postoperatively. A total of 24 (69%) eyes had uncorrected visual acuity (UCVA) of > or = 20/40, and 10 (29%) eyes had UCVA of 20/20. Manifest refractive spherical equivalent was within +/- 0.50 D in 17 (49%) eyes and within +/- 1.00 D in 25 (71%) eyes in cases of previous hyperopic LASIK; the optical zone was significantly increased. CONCLUSIONS: Using a modified nomogram, conductive keratoplasty for correction of residual hyperopia was effective, but predictability was not satisfactory and safety needs to be established.