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.     

Laser in situ keratomileusis for correction of hyperopia and hyperopic astigmatism with the Technolas 117C

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correction of hyperopia and hyperopic astigmatism. METHODS: Fifty-four hyperopic eyes of 35 patients with a spherical equivalent refraction between +1.00 and +6.00 D were followed for at least 12 months following LASIK. All surgery was performed with the scanning Chiron Technolas Keracor 117C excimer laser. Data on uncorrected and spectacle-corrected visual acuity, predictability, stability of refraction, and complications were analyzed. RESULTS: At 12 months, the average residual refraction was +0.29 +/- 0.78 D; 83.3% of eyes (45 eyes) were in the range of +/- 1.00 D and 61.1% of eyes (33 eyes) were within +/- 0.50 D of emmetropia. Fifty eyes (92.6%) had uncorrected visual acuity of 20/40 or better and 34 (63.0%) eyes had 20/20 or better. One eye (1.9%) lost two lines of best spectacle-corrected visual acuity and two eyes (3.7%) gained two or more lines. Two patients (two eyes, 3.7%) had complaints of halos and one patient (one eye, 1.9%) had glare at 12 months after LASIK for hyperopia. CONCLUSIONS: LASIK was used to treat hyperopia from +1.00 to +6.00 D with good predictability and safety. Primary and second hyperopia require different nomograms, according to our experience.     

Photorefractive keratectomy using the meditec MEL 70 G-scan laser for hyperopia and hyperopic astigmatism

PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) using Gaussian flying spot technology in the treatment of hyperopia and hyperopic astigmatism. METHODS: Two hundred eyes were evaluated with 12-month follow-up. An Asclepion-Meditec MEL 70 G-scan flying spot ArF excimer laser with a Gaussian scanner was used (6.0-mm treatment zone and 9.0-mm transition zone). Eyes were divided into four groups: Group 1 (spherical hyperopia up to +3.50 D and astigmatism less than 1.00 D, n=62); Group 2 (hyperopia up to +3.50 D and astigmatism of 1.00 D or more, n=44); Group 3 (hyperopia greater than +3.50 D and astigmatism less than 1.00 D, n=56); and Group 4 (hyperopia greater than +3.50 D and astigmatism of 1.00 D or more, n=38). RESULTS: In Group 1, 82.2% (51/62 eyes) were within +/-0.50 D of target refraction; 88.7% (55/62 eyes) had 20/20 or better uncorrected visual acuity; 1.6% (1/62 eye) lost two or more lines, 3.2% (2/62 eyes) gained two or more lines of spectacle-corrected visual acuity. In Group 2, 68.1% (30/44 eyes) were within +/-0.50 D; 77.2% (34/44 eyes) had 20/20 or better uncorrected visual acuity; 9.1% (4/44 eyes) lost two or more lines of spectacle-corrected visual acuity. In Group 3, 76.8% (43/56 eyes) were within +/-0.50 D; 78.6% (44/56 eyes) had 20/20 or better uncorrected visual acuity; 5.4% (3/56 eyes) lost two or more lines of spectacle-corrected visual acuity. In Group 4, 42% (16/38 eyes) were within +/-0.50 D; 60.5% (23/38 eyes) had 20/20 or better uncorrected visual acuity; 15.8% (6/38 eyes) lost two or more Snellen lines. CONCLUSION: PRK with the flying spot Meditec MEL 70 G-scan was most safe and effective for low hyperopia.     

Laser in situ keratomileusis for hyeropia and hyperopic astigmatism.

PURPOSE: To evaluate the efficacy, stability, and safety of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism using a prospective clinical trial. METHODS: LASIK was performed using the Automatic Corneal Shaper and the Keracor 117C excimer laser on 192 hyperopic eyes with astigmatism of less than 1.00 D (spherical group) and 164 hyperopic eyes with corneal astigmatism of 1.00 to 7.50 D (toric group). RESULTS: At 12 months after LASIK, 110 eyes were available for follow-up examination. In low spherical hyperopia (+1.00 to +3.00 D), 13 eyes (55%) were within +/-0.50 D of emmetropia and none lost 2 or more lines of spectacle-corrected visual acuity. In low toric hyperopia (+1.00 to +3.00 D), 14 eyes (61%) were within +/-0.50 D and none lost 2 or more lines of spectacle-corrected visual acuity. In moderate spherical hyperopia (+3.10 to +5.00 D) 9 eyes (44%) were within +/-0.50 D and none lost 2 or more lines of spectacle-corrected visual acuity and in moderate toric hyperopia (+3.10 to +5.00 D) 5 eyes (36%) were within +/-0.50 D and 2 eyes (14%) lost 2 or more lines of spectacle-corrected visual acuity. In high spherical hyperopia (+5.10 to +9.00 D), 6 eyes (38%) were within +/-0.50 D and 2 eyes (13%) lost 2 or more lines of spectacle-corrected visual acuity, and in high toric hyperopia (+5.10 to +9.50 D) 4 eyes (31%) were within +/-0.50 D and 2 eyes (15%) lost 2 or more lines of spectacle-corrected visual acuity. CONCLUSIONS: LASIK seems to be reasonably effective and safe in spherical hyperopia of +1.00 to +5.00 D but less effective for hyperopic astigmatism. For hyperopia greater than +5.00 D, loss of spectacle-corrected visual acuity occurred in a significant number of eyes and accuracy was sufficiently poor to advise against LASIK in these eyes.     

Laser in situ keratomileusis after penetrating keratoplasty

PURPOSE: To assess the outcomes of laser in situ keratomileusis (LASIK) after penetrating keratoplasty (PKP). SETTING: Hospital de Clínicas de Porto Alegre, Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. METHODS: Fourteen eyes of 13 patients who had LASIK after PKP were retrospectively reviewed. The interval between LASIK and PKP was at least 1 year, and the follow-up after LASIK was also at least 1 year. All patients had a stable refractive error for a minimum of 6 months after all sutures were removed, regular and symmetric topographic astigmatism, and a minimal ultrasonic central corneal pachymetry of 500 microm. The Chiron Automatic Corneal Shaper and the Meditec Aesculap MEL 60 excimer laser were used. RESULTS: At 12 months, mean myopia decreased from -5.33 diopters (D) +/- 4.22 (SD) to 0.19 +/- 1.71 D, mean hyperopia decreased from +5.04 +/- 3.32 D to + 0.42 +/- 0.46 D, and mean astigmatism decreased from 5.37 +/- 2.12 D to 2.82 +/- 2.42 D (47.5% of mean percentage reduction). Retreatment was necessary in 42.9% of eyes because of cylindrical undercorrection. Uncorrected visual acuity improved in 11 eyes (78.6%). Best spectacle-corrected visual acuity improved in 6 eyes (42.8%) and was maintained in 4 eyes (28.6%); 5 eyes (35.7%) lost 1 Snellen line. Intraoperative complications included 1 buttonhole flap. Postoperative complications included interface epithelial ingrowth at the periphery (2 eyes) and pseudophakic retinal detachment 2 years after LASIK (1 eye). CONCLUSION: Laser in situ keratomileusis after PKP safely and predictably corrected the spherical component of the refraction. However, the predictability of LASIK in correcting post-PKP astigmatism was poor.     

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.     

Bilateral simultaneous laser in situ keratomileusis with the Aesculap Meditec MEL 60 laser

PURPOSE: To report the outcome of bilateral simultaneous excimer laser in situ keratomileusis (LASIK) with the Aesculap Meditec MEL 60 laser for the correction of myopia and hyperopia. METHODS: This retrospective study included 338 eyes of 169 patients who had bilateral simultaneous LASIK performed by one surgeon (D.L.V.). RESULTS: Postoperatively, 20/20 or better visual acuity was achieved by 78.5% (186 eyes) in the <-6.00-D group, and 55.6% (54 eyes) in the > or = -6.00-D group. Postoperatively, the mean spherical equivalent refraction was within +/- 0.50 D for 78% (185 eyes) in the <-6.00-D group (range, -2.25 to +1.25 D), 55% (53 eyes) in the > or = -6.00-D group (range, -2.38 to +1.13 D), and one eye in the hyperopic group. Complications at 3 months included regression in five eyes (1.4%), infiltrates in six eyes (1.7%), primary undercorrection in two eyes (0.6%), superficial punctate keratitis in four eyes (1.1%), ten eyes (2.9%) underwent enhancement, two eyes (0.6%) underwent refractive lensectomy, and four eyes (1.1%) underwent astigmatic keratotomy 3 months postoperatively. Two eyes lost two lines of best spectacle-corrected visual acuity. CONCLUSION: Bilateral simultaneous LASIK with the Aesculap Meditec MEL 60 laser was effective and predictable. It was more economical and convenient for the patient than unilateral LASIK and binocular visual rehabilitation was rapidly restored. No sight threatening complications occurred in this group of patients.     

Laser in situ keratomileusis for myopia and hyperopia using the Lasersight 200 laser in 300 consecutive eyes

PURPOSE: To evaluate effectiveness, safety, predictability, and short-term stability of laser in situ keratomileusis (LASIK) using the LaserSight Compac-200 Mini excimer laser with software version 9.0, for all refractive errors. METHODS: One hundred fifty consecutive patients (300 eyes) that received bilateral LASIK for myopia, hyperopia, and astigmatism were studied prospectively. A new 9.0 software version applying a modified nomogram that takes advantage of bilateral surgery was used. Follow-up at 6 months was available for 267 eyes (89%). RESULTS: Six months postoperatively, 131 eyes (96.32%) in the low to moderate myopia group (-1.00 to -5.99 D; n=136) had a spherical equivalent refraction within +/-1.00 D, and 123 eyes (90.44%) were within +/-0.50 D of emmetropia. In the high to extreme myopia group (-6.00 to -25.00 D; n=114), 97 eyes (87.08%) had a spherical equivalent refraction within +/-1.00 D and 78 eyes (68.42%) were within +/-0.50 D of emmetropia. In the hyperopia group (+1.00 to +6.00 D; n=50), 44 eyes (88%) had a postoperative spherical equivalent refraction within +/-1.00 D, and 31 eyes (62%) were within +/-0.50 D of emmetropia. Mean change in spherical equivalent refraction at 6 months was less than -0.50 D in the low to high myopia groups and -1.16 +/- 0.55 D in the extreme myopia group. At 6 months follow-up, uncorrected visual acuity was 20/20 or better in 73 eyes (54%) in the low to moderate myopia groups and 21 eyes (18%) in the high to extreme myopia groups. In the hyperopia group at 6 months follow-up, uncorrected visual acuity was 20/20 or better in 31 eyes (62%) and 20/40 or better in 41 eyes (82%). Only two eyes had a temporary loss of two or more lines of spectacle-corrected visual acuity due to corneal folds that were surgically treated. Six months after LASIK, no eye had lost any lines of best spectacle-corrected visual acuity in this series. CONCLUSIONS: Our modified LASIK nomogram with the 9.0 software of the LaserSight 200 excimer laser (with a larger and smoother ablation pattern) resulted in safe and effective outcomes for the treatment of low to high myopia, astigmatism, and hyperopia.     

Laser in situ keratomileusis for spherical hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser

PURPOSE: To assess the efficacy, predictability, and safety of LASIK for the surgical correction of low to moderate hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser. METHODS: In a multicenter United States Food and Drug Administration (FDA) regulated study of LASIK, 7 centers enrolled 293 eyes with manifest refraction sphere that ranged from +0.50 to +6.00 diopters (D) with or without astigmatism up to 3.00 D. The intended outcome was plano in all eyes. Patients were treated bilaterally. One year postoperative outcomes are reported. RESULTS: The mean spherical equivalent refraction (MRSE) for all eyes changed from +2.61 +/- 1.19 D (range: +0.50 to +6.63 D) preoperatively to +0.35 +/- 0.54 D (range: -1.63 to +2.00 D) 1 year postoperatively. Overall, 61% (170/279) of eyes achieved distance uncorrected visual acuity (UCVA) of 20/20 or better, 82% (228/279) of eyes saw 20/25 or better, and 99% (277/279) of eyes saw 20/40 or better. Refractive accuracy was demonstrated as 63.1% (176/279) of eyes achieved a MRSE within +/- 0.50 D and 90.3% (252/279) of eyes within +/- 1.00 D. Less than 2% (4/279) of eyes lost 2 lines of distance best spectacle-corrected visual acuity. Stability of refraction was demonstrated by 6 months, with a mean hyperopic shift of < 0.03 D from 3 to 6 months. CONCLUSIONS: The NIDEK EC-5000 corrected hyperopia and hyperopic astigmatism with UCVA, refractive accuracy, 1-year stability, and safety that surpassed all FDA criteria.     

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

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

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 keratomileusis enhancement after radial keratotomy

PURPOSE: To present results of laser in situ keratomileusis (LASIK) enhancement after radial keratotomy (RK). METHODS: Sixteen eyes of 10 patients were treated with LASIK for residual myopia and hyperopia after RK. Mean preoperative spherical equivalent refraction was -3.14+/-3.04 D (range, -6.675 to +6.00 D). Best spectacle-corrected visual acuity was 20/20 in 9 eyes, 20/25 in 6 eyes, and 20/30 in 1 eye. Uncorrected visual acuity was better than 20/40 in only 2 eyes. Patients were followed at 1 day, 1 week, 1, 3, and 6 months, and 1 year. Mean follow-up was 8.3 months (range, 1 to 17 mo). RESULTS: All eyes received one LASIK enhancement. Mean final spherical equivalent refraction was +0.16+/-0.68 D (range, -1.00 to +1.75 D). No eyes experienced any visual loss. Five eyes gained 1 line of best spectacle-corrected visual acuity. Uncorrected visual acuity was 20/20 in 9 eyes, 20/25 in 6 eyes, and 20/30 in 1 eye. Two eyes of one patient had the previous RK incisions open. CONCLUSION: LASIK was an effective treatment for correction of residual myopia and hyperopia after RK.     

Laser in situ keratomileusis for correction of induced astigmatism from cataract surgery

PURPOSE: To evaluate the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) to correct residual astigmatism after cataract surgery. METHODS: LASIK was performed on 20 eyes of 20 patients with refractive myopic or mixed astigmatism (3.00 to 6.00 D) at least 1 year after extracapsular cataract extraction with posterior chamber intraocular lens implantation without complication. Each eye received bitoric LASIK with the Nidek EC-5000 excimer laser and the Automated Corneal Shaper microkeratome. RESULTS: At 6 months after LASIK, mean refractive cylinder decreased from 4.64+/-0.63 D to 0.44+/-0.24 D (P<.001). Mean percent reduction of astigmatism was 90.4+/-5.0% (range 80% to 100%). Mean spherical equivalent refraction decreased from -2.19+/-0.88 D (range -1.00 to -3.88 D) to -0.32+/-0.34 D (range -1.25 to +0.38 D) (P<.001). Vector analysis showed that the mean amount of axis deviation was 0.7+/-1.2 degrees (range 0 degrees to 4.3 degrees) and the mean percent correction of preoperative astigmatism was 92.1+/-5.9% (range 85.6% to 108%). Eighty-five percent of all eyes had a mean spherical equivalent refraction and mean cylinder within +/-0.50 D of emmetropia. Change in spherical equivalent refraction and cylinder from 2 weeks to 6 months was < or = 0.50 D in 90% (18 eyes) and 95% (19 eyes), respectively. Spectacle-corrected visual acuity was not reduced in any eye. Diffuse lamellar keratitis occurred in three eyes (15%) after LASIK, and were treated successfully with eyedrops. CONCLUSION: LASIK was an effective, predictable, stable, and safe procedure for correction of residual myopic or mixed astigmatism ranging from 3.00 to 6.00 D with a low spherical component after cataract surgery.     

Phakic refractive lens (Medennium) for correction of +4.00 to +6.00 diopters: 1-year follow-up

PURPOSE: To study the efficacy and safety of phakic refractive lens (PRL) implantation to correct high hyperopia. METHODS: Inclusion criteria for this prospective, observer-masked, interventional study were spherical equivalent > or =+4.00 diopters (D) of cycloplegic hyperopia, best spectacle-corrected visual acuity (BSCVA) > or =0.5, anterior chamber depth > or =3 mm, and mesopic pupil size < or =6 mm. Lenses were implanted in all cases under regional anesthesia using forceps. RESULTS: Sixteen eyes of nine patients were included in the study. Mean preoperative spherical equivalent refraction was +5.65+/-1.41 D (range: +3.25 to +5.75 D). Mean 1-year postoperative spherical equivalent refraction was +0.07+/-0.43 D (range: -0.50 to 0.75 D). Fifteen (93.75%) eyes were within +/-0.50 D of emmetropia, and 16 (100%) eyes were within +/-1.00 D of emmetropia. Safety and efficacy indexes were 0.9 and 0.8, respectively. Eight (50%) eyes needed LASIK to correct residual astigmatism. Five (31.25%) eyes lost one line of BSCVA; no eye lost two or more lines of BSCVA. The BSCVA did not increase in any eye. No significant intraocular complications developed. CONCLUSIONS: Phakic refractive lens implantation to correct high hyperopia seems to be a safe and accurate procedure. A mild but significant loss in BSCVA can be anticipated.     

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.     

Comparison of photorefractive keratectomy and laser in situ keratomileusis for myopia of -6 D or less using the Nidek EC-5000 laser

PURPOSE: We compared the efficacy, predictability, and safety of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for the surgical correction of low and moderate myopia. METHODS: A retrospective study was performed to evaluate uncorrected and spectacle-corrected visual acuity, and manifest refraction 1 year after PRK or LASIK. All procedures were done using an automatic microkeratome (Chiron Ophthalmic) and the Nidek EC-5000 excimer laser. RESULTS: PRK was performed in 75 eyes of 45 patients and LASIK in 133 eyes of 77 patients. Mean age for PRK patients was 32.8 years (range, 18 to 52 yr) and LASIK patients was 29.6 years (range, 18 to 49 yr). Mean preoperative spherical equivalent refraction for PRK patients was -3.28 D (range, -1.00 to -6.00 D) and LASIK, -3.86 D (range, -1.00 to -6.00 D). One year after surgery, mean spherical equivalent refraction for Group 1 (baseline, -1.00 to -3.00 D) PRK eyes was -0.18 +/- 0.61 D (range, -1.50 to +0.75 D) and for LASIK eyes, -0.08 +/- 0.61 D (range, -1.50 to +1.62 D), with no statistically significant difference. For Group 2 eyes (baseline, -3.25 to -6.00 D), mean spherical equivalent refraction for PRK eyes was -0.44 +/- 0.87 D (range, -2.00 to +2.12 D) and for LASIK eyes, -0.09 +/- 0.83 D (range, -1.50 to +1.75 D), with no statistically significant difference. The antilogarithm of the mean UCVA (antilogUCVA) in Group 1 for PRK was 0.79 +/- 0.21 (20/25) and for LASIK was 0.87 +/- 0.19 (20/23), with no statistically significant difference. The antilogUCVA in Group 2 for PRK eyes was 0.70 +/- 0.24 (20/28) and for LASIK eyes was 0.83 +/- 0.18 (20/24), with a statistically significant difference (0.7 vs. 0.83, P < .005). The percentage of eyes with a postoperative UCVA >20/40 in Group 1 for PRK was 91.5% (38 eyes) and for LASIK was 95% (50 eyes) (no statistically significant difference), and in Group 2 for PRK eyes, it was 82% (27 eyes) and 97.5% (78 eyes) for LASIK (statistically significant difference, P < .05). CONCLUSION: PRK and LASIK with the Nidek EC-5000 excimer laser are effective and safe for correcting low to moderate myopia, but LASIK eyes showed better results for moderate myopia in terms of uncorrected visual acuity.     

Treatment of simple hyperopia: comparison of laser in situ keratomileusis and laser thermal keratoplasty

PURPOSE: To evaluate and compare the efficacy, stability, and safety of laser in situ keratomileusis (LASIK) and laser thermal keratoplasty (LTK) for the treatment of simple hyperopia. SETTING: John Hill Eye and Laser Centre, Cape Town, South Africa. METHODS: This retrospective study comprised consecutive patients having primary treatment of simple hyperopia of up to 3.0 diopters (D) with astigmatism of 0.5 D or less. Treatment methods were as follows: Group 1 (81 eyes), LASIK with the Nidek EC-5000 excimer laser; Group 2 (69 eyes), LASIK with the LaserSight LSX excimer laser; and Group 3 (84 eyes), LTK with the Sunrise holmium:YAG laser. RESULTS: The hyperopia decreased in all 3 groups. Both LASIK groups were stable by 1 month; there was continued regression in the LTK group for up to 18 months. The percentage of eyes achieving uncorrected visual acuities of 20/20 and 20/40 at 3 months were Nidek, 41% and 92%, respectively; LaserSight, 50% and 90%, respectively; and LTK, 21% and 89%, respectively. No eye lost more than 2 lines of best spectacle-corrected visual acuity. Surgically induced astigmatism (SIA) was evident in all 3 groups; it was highest in the LTK group. The mean posttreatment astigmatism was -0.47 D +/- 0.40 (SD) (range 0 to -1.50 D) in the Nidek group, -0.45 +/- 0.40 D (range 0 to -1.25 D) in the LaserSight group, and -0.81 +/- 0.51 D (range 0 to -2.25 D) in the LTK group. The enhancement rates were 16.75%, 22.57%, and 38.30%, respectively. Because of the SIA, 61% of the LTK enhancements were corrected with LASIK. CONCLUSIONS: All 3 treatment methods corrected hyperopia, but stability was achieved early in both LASIK groups, allowing early enhancement when necessary. Because LTK cannot currently correct astigmatism, many of the LTK repeat treatments required LASIK procedures. For these reasons, LASIK remains my preferred method to treat simple hyperopia up to +3.0 D.     

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.     

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.