Outcomes for Hyperopic LASIK With the MEL 90® Excimer Laser.

PURPOSE: To report the outcomes of laser in situ keratomileusis (LASIK) for hyperopia using the Triple-A ablation profile with the MEL 90 excimer laser (Carl Zeiss Meditec, Jena, Germany). METHODS: This retrospective analysis included 1,383 eyes treated by LASIK for hyperopia using the Triple-A ablation profile with the MEL 90 at London Vision Clinic, London, United Kingdom, between September 2013 and December 2016. Inclusion criteria were attempted hyperopic correction of +0.25 diopters (D) or higher and corrected distance visual acuity (CDVA) of 20/40 or better. Patients were observed for 1 year after surgery. Standard outcomes analysis was performed. RESULTS: One-year data were available for 1,350 (97%) eyes. Mean attempted spherical equivalent refraction (SEQ) was +2.77 ± 1.34 D (range: +0.13 to +6.50 D) and mean cylinder was -0.67 ± 0.66 D (range: 0.00 to -5.00 D). Mean age was 54 ± 11 years (range: 21 to 75 years), and 57% were female. Postoperative spherical equivalent was ±0.50 D in 73% and ±1.00 D in 93% of eyes. Uncorrected distance visual acuity was 20/20 or better in 75% of eyes, relative to 93% with preoperative CDVA of 20/20 or better. One line of CDVA was lost in 17% of eyes and two lines were lost in 0.6% of eyes. There was a clinically insignificant but statistically significant increase (P < .01) in contrast sensitivity at 3 and 6 cycles per degree (cpd) and no change for 12 and 18 cpd. CONCLUSIONS: LASIK for hyperopia with the MEL 90 excimer laser was found to satisfy accepted criteria for safety, efficacy, and stability. [J Refract Surg. 2018;34(12):799-808.].

Changes to corneal aberrations and vision after Presbylasik refractive surgery using the MEL 80 platform.

PURPOSE: To investigate changes to corneal surface aberrations and vision between PresbyLASIK and LASIK for correction of presbyopia using the MEL 80 platform (Carl Zeiss Meditec, Jena, Germany). METHODS: The retrospective data of 31 patients who underwent PresbyLASIK (the PresbyLASIK group) between January 2009 and November 2011 and 20 matched patients who underwent LASIK (the LASIK group) were analyzed for changes to refraction, corrected distance visual acuity, and corneal surface wavefront aberrations calculated over 4- and 6-mm pupils. Outcomes at the 3-month follow-up visit were compared to data collected immediately prior to surgery and between PresbyLASIK and LASIK correction. Associations between induced corneal aberrations and best spherical equivalent refraction were explored. RESULTS: PresbyLASIK and LASIK significantly reduced refractive error in both myopes and hyperopes. Residual refractive error was not significantly different between treatment groups, except for spherical equivalent refraction, which was significantly more myopic following LASIK treatment compared to PresbyLASIK in myopes. There was no significant difference in postoperative corrected distance visual acuity between groups. LASIK and PresbyLASIK induced positive spherical aberration in myopes and negative spherical aberration in hyperopes, with significant differences between treatments only apparent in myopes when analyzed over a 4-mm pupil (PresbyLASIK group: 0.07 ± 0.06 µm; LASIK group: 0.03 ± 0.04 µm, P < .05). In hyperopes, induced spherical aberration was more highly associated with refractive change after LASIK (r = 0.82, P < .05) than PresbyLASIK (r = 0.64, P < .001); instead PresbyLASIK led to a more consistent shift of approximately 0.3 µm independent of induced change to refraction. CONCLUSIONS: PresbyLASIK using the MEL 80 platform induced significant changes in spherical aberration in myopes and hyperopes. PresbyLASIK appears to offer an improved response over LASIK when correcting myopes due to an apparent increase in depth of focus resulting from changes in spherical aberration. For hyperopes, PresbyLASIK provides a more consistent spherical aberration effect independent of refractive change.

LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform.

PURPOSE: To evaluate the monocular and binocular outcomes of LASIK for a micro-monovision protocol for the correction of hyperopic astigmatism and presbyopia. METHODS: A prospective non-comparative case series included 258 eyes of 129 consecutive patients with hyperopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the Carl Zeiss Meditec MEL80 excimer laser. The target refraction was piano for distance eyes (dominant eye) and between -1.00 and -1.50 diopters (D) for near eyes. Patients were followed for 1 year. RESULTS: Mean attempted spherical equivalent refraction (SE) correction was +2.54+/-1.16 D (range: +0.25 to +5.75 D). Mean attempted cylinder was -0.52+/-0.49 D (range: -0.00 to -3.25 D). Median age was 56 years (range: 44 to 66 years). Median follow-up was 12.5 months (range: 3.3 months [early retreatment] to 18.2 months). The retreatment rate was 22%. Outcome measures after all treatments were as follows. Mean deviation from the intended SE correction was +0.09+/-0.48 D, with 79% of eyes within +/-0.50 D and 95% within +/-1.00 D. The cylinder correction ratio was 1.23+/-0.63 and the error ratio was 0.67+/-0.65. Of the distance eyes, 86% achieved uncorrected visual acuity of 20/20 and 100% achieved 20/40. Binocularly, 95% of patients achieved 20/20 and 100% achieved 20/40. Eighty-one percent of patients could read J2 and 100% could read J5. Binocularly, 95% of patients achieved 20/20 and could read J5. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. A statistically significant increase was noted in contrast sensitivity at 3 and 6 cycles per degree (cpd), with no reduction at 12 and 18 cpd. The average change in refraction between 3 months and 1 year was +0.11+/-0.36 D with a change of >1.00 D in 2.6% of eyes. CONCLUSIONS: This hyperopic micro-monovision protocol was a well-tolerated and effective procedure for treating patients with presbyopia in moderate to high hyperopia with corrections ranging up to +5.75 D. Contrast sensitivity was improved and the distance vision of near eyes was found to contribute positively to binocular distance vision compared to distance eyes monocularly.

Role of cysteine in corneal wound healing after photorefractive keratectomy.

AIMS: To evaluate the efficacy of cysteine oral supplements in corneal wound healing after photorefractive keratectomy (PRK). METHODS: A total of 200 eyes (100 patients) underwent PRK. We divided patients into 2 groups; each group was composed of 50 patients (100 eyes). Group 1 patients were assigned to use oral L-cysteine, with a daily dose of 200 mg (100-mg pills to be taken twice a day) for a duration of 14 days, starting from the week preceding the operation; the patients in group 2 were used as a control, and received the oral supplementation of 40-mg placebo pills to be taken twice a day for a duration of 14 days, starting from the week preceding the operation. RESULTS: All the eyes of patients treated with cysteine oral supplements showed shorter times to re-epithelization than the eyes of the control group. The mean time of corneal wound healing observed in group 1 was 102 +/- 15 h, compared to an average of 159 +/- 9 h in group 2. CONCLUSION: Our research showed that oral cysteine supplementation, in a daily dose of 200 mg, reduces mean corneal wound healing time in patients after PRK.

Customized topography-guided photorefractive keratectomy with the MEL-70 platform and mitomycin C to correct hyperopia after radial keratotomy.

PURPOSE: To evaluate topography-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy (RK). METHODS: Prospective study of 12 consecutive patients (19 eyes) who were treated with topography-guided PRK with 0.02% mitomycin C using an Asclepion-Meditec MEL-70 excimer laser with a 9.5-mm ablation zone. All eyes were operated by the same surgeon and followed for 1 year. RESULTS: Thirteen eyes had complete epithelialization by day 7 and all eyes by day 10. At 1 year, uncorrected visual acuity was 20/25 or better in 42.1% of eyes and 20/40 or better in 68.4%. Preoperative mean spherical equivalent refraction was +3.80+/-2.47 diopters (D) and +0.24+/-2.36 D (P<.001) 1 year postoperative, with 47.4% of eyes being within +/-1.00 D and 73.7% within +/-2.00 D. Preoperative mean cylinder was -2.30+/-1.41 D and -0.62+/-0.73 D (P<.001) 1 year postoperative. At 1 year, 68.4% of eyes gained at least 1 line of best-spectacle corrected visual acuity, 36.8% gained more than 1 line, and only 2 eyes lost 1 line (one due to corneal haze). Three eyes developed central haze. Mean regression from 6 to 12 months in these 3 eyes was +1.83 D and in the remaining 16 eyes was -0.50 D. CONCLUSIONS: Topography-guided PRK with mitomycin C was safe and reasonably effective for the treatment of hyperopia after RK.

Optics of conductive keratoplasty: implications for presbyopia management.

PURPOSE: To define the corneal optics of conductive keratoplasty (CK) and assess the clinical implications for hyperopia and presbyopia management. METHODS: Four analyses were done. (1) Multifocal effects: In a prospective study of CK, uncorrected visual acuity (UCVA) for a given refractive error in 72 postoperative eyes was compared to control eyes. (2) Surgically induced astigmatism (SIA): 203 eyes were analyzed for magnitude and axis of SIA. (3) Higher-order optical aberrations: Corneal higher-order optical aberrations were assessed for 36 eyes after CK and a similar patient population after hyperopic laser in situ keratomileusis (LASIK). (4) Presbyopia clinical trial: Visual acuity, refractive result, and patient questionnaires were analyzed for 150 subjects in a prospective, multicenter clinical trial of presbyopia management with CK. RESULTS: (1) 63% and 82% of eyes after CK had better UCVA at distance and near, respectively, than controls. (2) The mean SIA was 0.23 diopter (D) steepening at 175 degrees (P < .001); mean magnitude was 0.66 D (SD, 0.43 D). (3) After CK, composite fourth- and sixth-order spherical aberration increased; change in (Z12) spherical aberration alone was not statistically significant. When compared to hyperopic LASIK, there was a statistically significant increase in composite fourth- and sixth-order spherical aberration (P < .01) and spherical aberration (Z12) alone (P < .02); spherical aberration change was more prolate after CK. (4) After the CK monovision procedure, 80% of patients had J3 or better binocular UCVA at near; 84% of patients were satisfied. Satisfaction was associated with near UCVA of J3 or better in the monovision eye (P = .001) and subjectively good postoperative depth perception (P = .038). CONCLUSIONS: CK seems to produce functional corneal multifocality with definable introduction of SIA and higher-order optical aberrations, and development of a more prolate corneal contour. These optical factors may militate toward improved near vision function.

Conductive keratoplasty: a radiofrequency-based technique for the correction of hyperopia.

PURPOSE: To evaluate the data on the safety, effectiveness, and stability of conductive keratoplasty (CK), a thermal, radiofrequency-based technique for treating 0.75 to 3.00 diopters (D) of spherical hyperopia. METHODS: A prospective, consecutive series, multicenter clinical trial involving 400 hyperopic eyes was conducted by 19 surgeons at 12 centers. The treatment goal was emmetropia. Cohort follow-up was up to 2 years. RESULTS: At 12 months postoperatively, data were available for 97.5% (354/363) of eyes for efficacy variables and 98% (391/400) of eyes for safety variables. A total of 54% of the CK eyes showed 20/20 or better uncorrected visual acuity, and 92% showed 20/40 or better at 12 months. The mean postoperative manifest refractive spherical equivalent was within 0.50 D in 61% and within 1.00 D in 88%. After CK, eyes were approximately 0.50 D myopic at month 1 and effectively emmetropic at 6 months. At 24 months, there was a 20% loss of initial effect. Safety results showed a 2-line loss of best-corrected visual acuity in 2% of the CK-treated eyes. The incidence of induced cylinder of 2.00 D or greater was below 1%. CONCLUSION: The CK technique corrects low to moderate hyperopia effectively and safely and with acceptable stability. It spares the visual axis, does not require the creation of a large flap, and is not associated with postoperative dry eye. CK has value as an alternative to hyperopic LASIK for patients with hyperopia.

Two-year follow-up of noncontact holmium laser thermokeratoplasty for the correction of low hyperopia.

PURPOSE: To summarize the 2-year results of laser thermal keratoplasty with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser and the Sunrise Corneal Shaping System and assess the procedure's safety, efficacy and predictability in correcting hyperopia in a phase III clinical intervention case series. METHODS: The Ho:YAG laser was used to correct low hyperopia (manifest spherical equivalent of +0.75 to +2.50 dioptres [D], with manifest cylinder of 1.00 D or less) in 38 eyes of 28 patients 40 years of age or older. Laser pulses were delivered to the cornea in 2 radially placed, concentric, 8-spot rings 6.0 and 7.0 mm in diameter. The last follow-up was at 2 years. RESULTS: The preoperative uncorrected visual acuity (UCVA) at distance was less than 20/40 in 82% of the eyes and at near was less than 20/32 in 42%. At 2 years the distance UCVA was 20/40 or better in 100% of the eyes and 20/20 or better in 84%, and the near UCVA was 20/32 or better in 97% of the eyes and 20/20 or better in 8%. The difference between the preoperative and postoperative UCVA was statistically significant (p < 0.01). The correction at 2 years was within 0.50 D of that intended in 92% of the eyes and within 1.00 D in 100%. The reduction in mean spherical equivalent at 2 years was statistically significant (p < 0.0001). No loss of 2 lines or more in best-corrected visual acuity occurred after the 1st month of follow-up. INTERPRETATION: The Ho:YAG Sunrise Corneal Shaping System is safe and effective for the treatment of low hyperopia and astigmatism. It provides a predictable refractive outcome at 2 years of follow-up. However, our results show a tendency towards regression by 2 years.

Clear corneal cataract surgery and the correction of myopia, hyperopia, and astigmatism.

PURPOSE: Advances in cataract removal using topical anesthesia through a clear corneal microincision have created a new opportunity to fully correct refractive errors at the time of cataract surgery. This study was undertaken to assess the effectiveness of keratolenticuloplasty (KLP), the simultaneous modification of the cornea at cataract removal to create emmetropia with lens implantation. METHODS: Data were analyzed for 690 consecutive cataract procedures performed between March 1993 and March 1995, with follow-up of 12 to 24 months. Each patient underwent cataract removal with topical anesthesia, clear corneal incision fashioned as an arcuate keratotomy to correct pre-existing astigmatism, intercapsular phacoemulsification, and microinjection of a single-piece elastic intraocular lens (IOL) into the capsular bag to correct spherical error. RESULTS: Preoperative best-corrected visual acuity was worse than 20/50 in all patients; 58% were myopic, 32% were hyperopic, and 57% had astigmatism of greater than 1 diopter (D). Postoperatively, spectacle independence was achieved with uncorrected visual acuity of 20/40 or better in 87% of eyes. The sphere was fully corrected in 78%, within 1 D in 17%, and within 2 D in 5%. No patients were overcorrected. The cylinder was fully corrected in 72%, within 1 D in 26%, and within 2 D in 2%. Of those with residual astigmatism, there was no significant postoperative shift in cylinder axis. There were no sight-threatening complications. All patients were able to resume normal unrestricted activities within 24 hours of undergoing the procedure. CONCLUSIONS: The KLP technique can correct spherical and astigmatic refractive errors, helping individuals become free of eyeglasses after clear corneal cataract surgery.