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.     

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.     

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.     

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.     

Hyperopic LASIK retreatments with the Technolas laser

PURPOSE: To evaluate the safety, efficacy, and predictability of hyperopic LASIK retreatments. METHODS: This retrospective, consecutive, non-comparative, observational study included 85 eyes that underwent hyperopic LASIK retreatment with 1-year follow-up. Complete ophthalmic examination included distance uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, and pachymetry. Patients were divided into two groups according to the preoperative spherical equivalent refraction: group 1, < or = +3.9 diopters (D) and group 2, > or = +4.0 D. RESULTS: The UCVA improved from 0.31 +/- 0.2 to 0.7 +/- 0.2 in group 1 and from 0.2 +/- 0.2 to 0.6 +/- 0.2 in group 2 following retreatment. Mean spherical equivalent refraction improved from +2.8 +/- 0.85 to +0.2 +/- 0.9 in group 1 and from +5.3 +/- 0.9 to +0.3 +/- 1.3 in group 2 after retreatment. In group 1, 32 (72.7%) of 44 eyes had BSCVA > or = 20/25, and in group 2, 24 (58.5%) of 41 eyes had BSCVA > or = 20/25. After primary hyperopic LASIK, 25 (56.8%) of 44 eyes in group 1 and 19 (46.3%) of 41 eyes in group 2 maintained BSCVA or gained > or = 1 lines postoperatively in contrast to 21 (47.7%) of 44 eyes in group 1 and 22 (53.9%) of 41 eyes in group 2 after retreatment. In group 1, 11 (25%) of 44 eyes lost > or = 2 lines of BSCVA after initial hyperopic LASIK compared to 14 (31.8%) of 44 eyes after retreatment. In group 2, 10 (24.4%) of 41 eyes lost > or = 2 lines of BSCVA after initial hyperopic LASIK compared to 12 (29.2%) of 41 eyes after retreatment. After hyperopic LASIK retreatment, 31 (70.5%) of 44 eyes in group 1 and 19 (46.4%) of 41 eyes in group 2 were within +/- 0.5 D of emmetropia. Safety was 0.9 in both groups and efficacy was 0.8 and 0.7 in groups 1 and 2, respectively. Complications included epithelial ingrowth of 1 to 3 mm (30%) and flap edge melting (2%). CONCLUSIONS: Hyperopic LASIK retreatment improved the refractive results of initial hyperopic LASIK surgery with 20% to 30% of eyes gaining > or = 1 lines of BSCVA. The loss of BSCVA was greater after primary hyperopic LASIK than after retreatment.     

Laser in situ keratomileusis for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser

PURPOSE: To evaluate the safety, efficacy, predictability, and visual results of laser in situ keratomileusis (LASIK) using the Bausch & Lomb Technolas(R) 217 scanning-spot laser for the treatment of myopia and compound myopic astigmatism. SETTING: Stanford Eye Laser Center, Stanford, California, USA. METHODS: In a prospective study, 110 eyes of 58 patients with a mean spherical equivalent (SE) of -4.87 diopters (D) +/- 2.5 (SD) (range -1.0 to -11.4 D) had LASIK for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser. The primary outcome variables included preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), achieved versus attempted correction, vector analysis of astigmatism, and complications. RESULTS: One hundred ten eyes were available for analysis at 3 months. The mean SE refraction was reduced 95% (mean -0.23 +/- 0.4 D), and astigmatism was reduced 70% (mean 0.28 +/- 0.3 D). One day postoperatively, 100% of eyes had a UCVA of 20/40 or better, 96% had 20/25 or better, 77% had 20/20 or better, and 39% had 20/15 or better. At the 3-month examination, 100% of eyes had a UCVA of 20/40 or better, 95% had 20/25 or better, 83% had 20/20 or better, and 48% had 20/15 or better. Ninety percent of eyes were within +/-0.5 D of emmetropia. No eye lost 2 or more lines of BSCVA. CONCLUSIONS: The Technolas 217 scanning-spot laser produced excellent postoperative UCVA and BSCVA. It was predictable, safe, and effective for the treatment of myopia and compound myopic astigmatism. Long-term follow-up is needed to assess the stability of the procedure.     

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.     

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.     

The safety and efficacy of photorefractive keratectomy after laser in situ keratomileusis

PURPOSE: To determine the safety and efficacy of performing photorefractive keratectomy (PRK) in corneas previously treated with laser in situ keratomileusis (LASIK) surgery. METHODS: Fifteen eyes of 14 patients who had initially received LASIK for the treatment of myopia and compound myopic astigmatism were evaluated. Variables included existence of and/or type of flap complication associated with the original LASIK procedure, refractions before and after (3 and 6 months) PRK, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and the development of complications after PRK such as haze, scarring, double vision, or ghosting. RESULTS: All 15 eyes were available for analysis at 6 months. Eleven eyes had experienced flap complications during the initial LASIK procedure and 4 eyes had experienced complications in the LASIK postoperative period. Characteristics prior to performing PRK included 11 myopic and 4 hyperopic eyes. By 6 months after PRK treatment, 87% of eyes had UCVA > or = 20/40, 53% had > or = 20/25, and 40% had > or = 20/20. All eyes had BSCVA of > or = 20/30, with 73% being > or = 20/20. No eye had lost 2 lines of BSCVA and only 1 eye lost 1 line of BSCVA. Sixty percent of eyes were within 1.0 diopters (D) of emmetropia, and 40% were within 0.5 D of emmetropia. A trend towards undercorrection and surgical induction of astigmatism as confirmed by vector analysis was noted. No eye developed significant haze or scarring. CONCLUSIONS: Photorefractive keratectomy may be a safe procedure to perform in corneas previously treated with LASIK surgery. Results show good reduction of refractive error and improvement of UCVA and BSCVA. A significant undercorrection of astigmatism was attributed to surgically induced astigmatism. Further studies are necessary to determine the long-term safety and stability of outcomes.     

Hyperopic laser in situ keratomileusis in eyes with previous radial keratotomy

PURPOSE: To assess the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK). SETTING: Zale Lipshy University Hospital Laser Center for Vision, University of Texas Southwestern Medical Center, Dallas, Texas, USA. METHODS: Thirty-eight eyes of 25 patients were treated with LASIK for secondary hyperopia after RK using a Visx Star S2, S3, S4, or LADARVision excimer laser. Retreatment was done in 7 eyes. The main outcome measures were manifest refraction spherical equivalent (MRSE), uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of treatment, and complications. RESULTS: Preoperative mean MRSE was +2.39 diopters (D) +/- 1.28 (SD) (range +0.87 to +6.00 D). At the last visit (25 eyes with minimum follow-up of 12 months, including retreatments), the mean follow-up was 23.3 +/- 7.3 months (range 12 to 34 months), the mean MRSE was +0.11 +/- 0.71 D, and the UCVA was 20/40 or better in 24 eyes (96%). Although no significant change in the mean MRSE was observed, the postoperative mean refractive cylinder showed a gradual increase over the follow-up period. No eye lost more than 2 lines of BSCVA. CONCLUSIONS: Laser in situ keratomileusis was a safe and effective treatment with good predictability for the correction of consecutive hyperopia after RK. Cylindrical errors were difficult to correct, and astigmatic correction tended to regress over time. Retreatments are safe when old flaps were relifted.     

Early results of hyperopic and astigmatic laser in situ keratomileusis in eyes with secondary hyperopia

PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for secondary hyperopia and hyperopic astigmatism and to develop a VISX STAR S2 LASIK nomogram (VISX Inc., Santa Clara, CA) for consecutive hyperopia after prior myopic refractive surgery. DESIGN: Prospective, nonrandomized, self-controlled interventional study. PARTICIPANTS: Thirty patients with consecutive hyperopia or hyperopia and astigmatism after LASIK, photorefractive keratectomy, automated lamellar keratoplasty, or radial keratotomy. INTERVENTION/METHODS: Prospective evaluation of LASIK in 30 secondary eyes with fogged manifest sphere from +0.5 to +6.0 diopters (D) and cylinder from 0 to +5.0 D. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalent (SE). RESULTS: Mean manifest SE was +1.73 +/- 0.79 D before surgery, -0.13 +/- 1.00 D at 6 months after surgery, and -0.18 +/- 1.08 D at 1 year after surgery. At 6 months, 84% of patients with secondary hyperopia had UCVA of 20/40 or better; 76% were within +/-1 D of emmetropia. At 1 year, 85% had UCVA of 20/40 or better and 85% were within +/-1 D of emmetropia. No patients with secondary hyperopia lost 2 or more lines of BCVA at 1 year. Complications included intraoperative bleeding (3.3%), intraoperative epithelial defect (3.3%), transient interface debris (3.3%), significant dry eye (3.3%), blood in interface (3.3%), irregular astigmatism (6.7%), slight decentration (6.7%), trace haze (6.7%), or mild epithelial ingrowth not requiring removal (3.3%). CONCLUSIONS: These early data suggest that LASIK for consecutive hyperopia from +0.5 to +5.50 D and astigmatism from 0 to +2.75 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery, and is safe and effective.     

Laser in situ keratomileusus for mixed and simple myopic astigmatism with the Nidek EC-5000 Laser

PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) for mixed and simple myopic astigmatism using bitoric ablation. METHODS: A retrospective study was performed in 65 eyes of 38 consecutive patients to evaluate uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA) and cyclopegic and manifest refraction, before and 3 and 6 months after LASIK (Moria LSK-ONE microkeratome, Nidek EC-5000 excimer laser). RESULTS: At 3 and 6 months after LASIK, 40 eyes of 24 patients (64.5%) were available for follow-up examination. Mean age was 25.9 +/- 6.6 years (range 18 to 43 yr). Mean preoperative manifest spherical equivalent refraction was -1.40 +/- 0.80 D (range -3.80 to +0.50 D) mean preoperative cylinder was -3.30 +/- 1.30 D (range -1.00 to -6.00 D). At 6 months follow-up, mean manifest spherical equivalent refraction was +0.30 +/- 0.46 D (range -0.38 to +1.88 D), mean cylinder was -0.73 +/- 0.61 D (range -2.25 to 0 D). There was a 77.8% decrease in astigmatism magnitude. According to vector analysis, mean achieved vector magnitude was 80% of intended. Fifty percent (20 eyes) had a cylinder within +/- 0.50 D of emmetropia. Twenty-three eyes (57.5%) had a spherical component within +/- 0.50 D. Eighty-five percent (34 eyes) had postoperative UCVA of 20/40 or better. Ten percent (four eyes) lost two lines of Snellen BSCVA, whereas 35% (14 eyes) gained one or more lines. CONCLUSIONS: Bitoric LASIK with the Moria LSK-ONE microkeratome and Nidek EC-5000 excimer laser was effective and safe for the reduction of cylinder in mixed and simple myopic astigmatism. Moderate undercorrection of the cylinder was evident.     

Five-year follow-up of laser in situ keratomileusis for hyperopia using the Technolas Keracor 117C excimer laser

PURPOSE: To evaluate safety, predictability, efficiency, and long-term stability of laser in situ keratomileusis (LASIK) for spherical hyperopia. METHODS: This study was a retrospective 5-year analysis of 67 patients (125 eyes) who had LASIK for spherical hyperopia; preoperative mean manifest spherical equivalent refraction was +3.84+/-1.13 D (range +1.00 to +6.50 D) and mean astigmatism was 0.37+/-0.27 D (range 0 to 1.00 D). Preoperative spherical equivalent refraction for the low hyperopia group was +1.00 to +2.75 D; medium hyperopia group, +3.00 to +4.25 D, and high hyperopia group, +4.50 to +6.50 D. All surgeries were performed using the scanning Chiron Technolas Keracor 117C excimer laser. Uncorrected and best spectacle-corrected visual acuity, predictability, long-term stability of refraction, and complications were analyzed. RESULTS: At 5 years after hyperopic LASIK, mean spherical equivalent refraction for the low hyperopia group was +0.48D+/-0.79 D; medium hyperopia group, +1.52+/-1.45 D; high hyperopia group C, +3.39+/-1.98 D. The percentage of eyes with a spherical equivalent refraction within +/-0.50 D of emmetropia for the low hyperopia group was 63% (37 eyes); medium hyperopia group, 42% (20 eyes); high hyperopia group, 22% (4 eyes). Eyes with chronic dry eye symptoms had a mean difference in spherical equivalent refraction from target refraction of +1.43 D compared with +0.84 D for eyes without dry eye symptoms. Five eyes (4%) lost 2 lines of BSCVA at 5 years. CONCLUSION: LASIK was safe, effective, and stable for primary hyperopia between +1.00 and +3.00 D. Higher amounts of hyperopia had poor long-term stability, especially eyes with more than +4.25 D. Chronic dry eye symptoms were associated with regression over time.     

Hyperopic laser-assisted in situ keratomileusis for radial keratotomy induced hyperopia

PURPOSE: To evaluate hyperopic laser in situ keratomileusis (H-LASIK) for radial keratotomy (RK)-induced hyperopia. DESIGN: Noncomparative interventional retrospective nonconsecutive case series. PARTICIPANTS: Sixty-nine eyes of 47 patients who had undergone RK and were seen with induced hyperopia. METHODS: H-LASIK was performed with an excimer laser. MAIN OUTCOME MEASURES: The mean refractive error, in spherical equivalents (SE), uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) before and after H-LASIK are reported. Safety was analyzed using a mean follow-up time of 6.6 plus minus 3.24 months. RESULTS: Preoperative mean SE was +3.4 plus minus 1.6 diopters (D). Postoperative mean SE was -0.32 plus minus 1.2 D. A high percentage of eyes (79.7%; n = 55) were between plus minus1.0 D of emmetropia and 88% within plus minus 2.0 D. Preoperative BSCVA was 20/20 in 53.6% of eyes (n = 37) and 20/40 or better in 100% (n = 69). Postoperative BSCVA was 20/20 in 55% of eyes (n = 38) and 20/40 or better in 95.6% (n = 66) of eyes. Preoperative UCVA was less-than-or-equal20/50 in 52 cases (75.4%). Postoperative UCVA was 20/20 in 13 cases (18.8%) and greater-than-or-equal20/40 in 45 cases (65.2%). Four eyes lost 2 Snellen lines because of epithelial ingrowth in the interface (n = 3) and diffuse lamellar keratitis (Sands of the Sahara syndrome; n = 2). One of the eyes with Sahara syndrome also had epithelial ingrowth and flap necrosis. Thirteen eyes lost 1 Snellen line, and 50 eyes maintained or gained Snellen lines. The only intraoperative complication was incision opening (n = 8) while the flap was lifted; there were no further complications. These patients did not lose any Snellen lines of their BSCVA. CONCLUSIONS: H-LASIK can be used successfully to correct RK-induced hyperopia.     

Femtosecond laser in situ keratomileusis after radial keratotomy

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

Photorefractive keratectomy and LASIK for the correction of hyperopia: 2-year follow-up

PURPOSE: To evaluate the efficacy and safety of photorefractive keratectomy (PRK) and LASIK in the correction of hyperopia. METHODS: A retrospective study was conducted on 100 eyes of 56 patients with a mean hyperopia of +2.85 +/- 1.1 diopters (D) undergoing PRK and 100 eyes of 50 patients with a mean hyperopia of +4.49 +/- 1.2 D undergoing LASIK. A Zeiss Meditec MEL 70 G scan laser was used. RESULTS: After 24-month follow-up in the PRK group (100 eyes), the mean manifest refractive spherical equivalent (MRSE) was +0.34 +/- 0.92 D (36% +/- 0.5 D). Mean uncorrected visual acuity (UCVA) was 0.87 +/- 0.1; 8 (8%) eyes gained 1 line, 80 (80%) eyes had no loss or gain of lines, 10 (10%) eyes lost 1 line, and 2 (2%) eyes lost 2 lines. In the LASIK group (100 eyes), at 24-month follow-up, the mean MRSE was +0.29 +/- 0.66 D (70% +/- 0.5 D). Mean UCVA was 0.89 +/- 0.1; 6 (6%) eyes gained 2 lines, 10 (10%) eyes gained 1 line, 78 (78%) eyes had no loss or gain of lines, and 6 (6%) eyes lost 1 line. CONCLUSIONS: Photorefractive keratectomy and LASIK were both effective and safe in the correction of hyperopia. However, PRK manifested an initial temporary myopic overshoot followed by a hyperopic regression over 24-month follow-up (P < .01) whereas LASIK was associated with a faster refractive stability.     

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.     

Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy

PURPOSE: To assess the use of the femtosecond laser for laser in situ keratomileusis (LASIK) in eyes with consecutive hyperopia after radial keratotomy (RK). SETTING: Private ambulatory surgical center, Valencia, Spain. METHODS: This prospective noncomparative interventional case series study included 13 eyes of 9 patients with secondary hyperopia after previous RK. The patients were operated on with the IntraLase femtosecond laser (IntraLase Corp.) and the Star S2 excimer laser (Visx, Inc.). Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, flap thickness, flap diameter, and complications were evaluated at 6 months. RESULTS: The mean spherical equivalent (SE) decreased from 2.00 diopters (D)+/-0.40 (SD) to -0.41+/-0.61 D, with 8 eyes (61.5%) within+/-0.50 D of the targeted refraction. Twelve eyes (92.3%) had a UCVA of 20/40 or better, and 3 eyes (23.1%) lost 1 line of BSCVA. A mean change in SE of 0.10 D was observed at the 6-month follow-up. The mean flap thickness and diameter were 117+/-14 microm and 9.18+/-0.12 mm, respectively. Most complications were in eyes with more than 8 RK incisions than in eyes with 8 RK incisions. These complications were multiple intraoperative incision openings (100% versus 28.6%, respectively), interface inflammation (66.6% versus 0%, respectively), haze (83.3% versus 14.3%, respectively), and loss of BSCVA (50% versus 0%, respectively). CONCLUSIONS: The femtosecond laser provided large, thin corneal flaps for hyperopic LASIK. However, the procedure should be avoided in eyes with more than 8 RK incisions because of the increased risk for multiple intraoperative incision openings, interface inflammation, haze, and loss of BSCVA.     

Laser in situ keratomileusis for consecutive hyperopia after myopic LASIK and radial keratotomy

PURPOSE: To evaluate and compare the efficacy, predictability, and safety of hyperopic laser in situ keratomileusis (H-LASIK) for the correction of consecutive hyperopia after myopic-LASIK (M-LASIK) and radial keratotomy (RK). SETTING: The Eye Institute of Utah, Salt Lake City, Utah, USA. METHODS: Seventy-seven eyes of 64 patients were studied. The eyes were divided into 2 groups based on the prior refractive procedures: in Group A (n = 34), H-LASIK was performed for overcorrection after M-LASIK and in Group B (n = 43), for overcorrection after RK. All eyes were included in the analysis of intraoperative and postoperative complications. Only eyes with a minimum follow-up of 6 months were included in the analysis of visual and refractive results. Among these 66 eyes, 30 were in Group A and 36 were in Group B. The mean follow-up in these eyes was 12.34 months +/- 5.95 (SD) (range 6 to 33 months). RESULTS: Overall, the mean spherical equivalent (SE) was +1.88 +/- 0.91 diopters (D) preoperatively and -0.37 +/- 0.65 D at the last visit. Eighty-three percent of eyes were within +/-1.00 D of emmetropia, and 66% were within +/-0.50 D. The uncorrected visual acuity (UCVA) was 20/20 in 39% of eyes and 20/40 or better in 92% of eyes. The preoperative SE was +1.43 +/- 0.59 D in Group A and +2.26 +/- 0.96 D in Group B; the difference in the preoperative SE was significant (P=.001). However, there was no statistically significant between-group difference in postoperative refraction and UCVA. One eye in Group B (3%) lost 2 or more lines of best corrected visual acuity. Corneal ectasia developed in 1 eye in Group B 11 months after H-LASIK. A sliver occurred in 1 eye in Group A after the flap was recut. CONCLUSION: Hyperopic LASIK was equally effective and predictable in treating consecutive hyperopia after overcorrected M-LASIK and overcorrected RK. The safety of the procedure in the RK group appeared to be inferior to that in the M-LASIK group. Although vision-threatening complications are rare after H-LASIK retreatment, corneal ectasia developed in 1 eye in the RK group.     

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.