Long-term assessment of visual and refractive outcomes of laser in situ keratomileusis for hyperopia using the AMARIS® 750S Excimer laser.

PURPOSE: To evaluate the long-term efficacy and safety of hyperopic laser in situ keratomileusis (LASIK) using the AMARIS® 750S (Schwind, Eye-tech-solutions, GmbH) excimer laser. METHODS: The medical records of one hundred eleven eyes of 62 patients who underwent LASIK for hyperopia using the AMARIS® 750S excimer laser were reviewed retrospectively. Patients were divided into three groups based on preoperative spherical equivalent (SE) refraction: low hyperopia (less than +2.50 diopters [D]), moderate hyperopia (+2.75D to +4.00D), and high hyperopia (over +4.00D). Uncorrected and best corrected visual acuity (BCVA), long-term stability of refraction, and complications were evaluated. RESULTS: Of the entire sample, the mean preoperative SE was +3.64D±1.22D. The mean age was 37.4±11.2 years (20-59). The mean follow-up for all eyes was 51 months. At the last visit, the mean SE was +0.85D±0.34D (SD) in the low hyperopia group, +1.09D±0.43D in the moderate hyperopia group, and +1.63D±0.47D in the high hyperopia group. (+1.15D±0.49D overall). Preoperative uncorrected visual acuity (UCVA) was 0.52±0.34 logMAR and increased to 0.18±0.15 logMAR at 4 years follow-up (P<0.01). There was no statistically significant difference between preoperative and postoperative BCVA. The UCVA was 0.30 logMAR or better in 100% of eyes in the low hyperopia group, 93.7% in the moderate hyperopia group, and 69.9% in the high hyperopia group (%89.2 overall). CONCLUSIONS: LASIK is safe and effective for correcting hyperopia in the short term; however, the efficacy of the procedure is limited in the patients with high hyperopia and longer follow-up.

Corneal flap assessment with Rondo microkeratome in laser in situ keratomileusis.

PURPOSE: To assess the accuracy of flap thickness in laser in situ keratomileusis (LASIK) with Rondo, Wavelight AG microkeratome and to examine factors that can influence flap thickness (FT). SETTING: The study took place at the Laser & Ophthalmos Eye Clinic, Thessaloniki, Greece. MATERIAL AND METHODS: Three hundred and sixty eyes from 180 patients underwent LASIK with Rondo microkeratome. Three surgeons (A, B and C) performed all surgeries with no previous experience of Rondo microkeratome. All patients were treated with the 130 µm plate. Central corneal thickness (CCT) and stromal bed thickness were measured by Scheimpflug and ultrasound pachymetry. Right eye (OD) was treated first. RESULTS: Mean FT for OD: 120 ± 19 µm (range 69-158 µm); for left eye (OS): 106 ± 17 µm (range 70-147 µm). Flaps in OD were significantly thicker than in OS (p < 0.001). FT was significantly correlated to the keratometric reading (K): r = 0.121; p = 0.02. No correlation was found between FT and CCT or between FT and the attempted refractive correction (SE) (p > 0.14). Mean FT was significantly lower than the manufacturer's 130 µm specification (Mean FT = 113 ± 19 µm; p < 0.001). FT between surgeons A, B and C was significantly different (analysis of variance between surgeons; p < 0.001). Scheimpflug and ultrasound CCT measurements were significantly correlated (r = 0.921; p < 0.001) with ultrasound measuring an average 4.5 µm higher than Scheimpflug (CCT (Oculyzer) = 553.96 ± 27 µm; CCT (Ultrasound) = 558.45 ± 28 µm). Mean flap diameter was 9.2 ± 0.2 mm. CONCLUSIONS: FT with Rondo microkeratome was significantly influenced by the mean preoperative K reading. First treated eye was significantly thicker than the fellow left eye, while both were significantly lower than the recommended 130 µm thickness. Gaining basic experience of Rondo microkeratome required an average of 90 flaps/surgeon.

[LASIK using a scanning spot excimer laser for the treatment of myopia and myopic astigmatism 3-Jahresergebnisse]. / Laser-in-situ-Keratomileusis mittels Scanning-Spot-Excimerablation zur Korrektur von Myopie und myopem Astigmatismus 3-Jahresergebnisse.

PURPOSE: The correction of refractive errors using laser in situ keratomileusis (LASIK) has become the primary refractive procedure worldwide. The purpose of this study was to evaluate LASIK within a retrospective cohort. PATIENTS AND METHODS: The mean preoperative spherical equivalent for the 34 consecutively treated eyes was -6.67+/-2.69 D. The LASIK operations were performed by a Hansatome microkeratome (Bausch and Lomb) and a scanning spot excimer laser (Technolas Keracor 217, Bausch and Lomb). For pre- and postoperative analysis the Datagraph med software (Version 2.7) was used. RESULTS: None of the treated eyes lost 2 or more lines of best-corrected visual acuity (BCVA). At the 36-month examination the spherical equivalent had changed to -0.47 D (mean increase of myopia: 0.13 D). No long-term complications were found in the study period. CONCLUSION: LASIK with superior hinge and scanning spot excimer ablation is an effective treatment for the correction of myopia and myopic astigmatism in the refractive range described above.

Quality assessment model of 3 different microkeratomes through confocal microscopy.

PURPOSE: To study the quality of the cut created by 3 microkeratomes from 2 different generations using corneal confocal microscopy. SETTING: Department of Refractive Surgery, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: Two different studies were conducted: Study 1 and Study 2. Study 1 was a prospective analysis using confocal microscopy examination data from 2 reference groups: Group A (control) with 20 nonoperated eyes of 20 healthy volunteers, and Group B with 50 eyes of 30 patients operated on with the Bausch & Lomb Automated Corneal Shaper (ACS) microkeratome. Study 2 was a prospective randomized double-masked study in which 40 eyes of 20 patients underwent myopic laser in situ keratomileusis by 1 surgeon. The right and left eyes of each patient were randomly and alternatively assigned to Group C, flap made with the Hansatome microkeratome, or Group D, flap made with the Moria M2. Immediately after surgery, the microscopic appearance of the cut was subjectively evaluated by the surgeon. One month postoperatively, flap thickness, particle density, and the subclinical confocal wound healing opacity (WHO) index were evaluated with the corneal confocal microscope. RESULTS: Surgeon handling comfort was nearly the same with the Hansatome as with the M2 (P =.540). However, the apparent quality of the resulting flap was better with the M2 microkeratome (P =.041). The depth of the cuts made by the 3 microkeratomes were significantly different (P<.001), with the ACS flaps being thinner than the flaps made with the Hansatome or the M2. Particle density at the interface was significantly poorer in the eyes operated on with the ACS, but in these cases the WHO index was significantly greater (P<.001 in both cases). CONCLUSIONS: Confocal microscopy is a very useful tool to evaluate the quality of the cut made by different microkeratomes. Overall, the predictability in flap thickness and the apparent quality of the cut made by the Moria M2 microkeratome are better than those obtained with the Hansatome or the ACS. The thin flap made by the ACS microkeratome produced a significantly greater WHO index than the thicker flaps created with the other 2 microkeratomes.