Immediate Sequential Bilateral Implantable Collamer Lens Surgery Is Safe and Effective.

PURPOSE: To assess the clinical outcomes and safety profiles of patients who underwent immediate sequential bilateral phakic lens surgery. METHODS: This retrospective multicenter study included 254 consecutive patients (508 eyes) who underwent bilateral same-day Implantable Collamer Lens (ICL) (STAAR Surgical) surgery. The authors focused on 1-year postoperative clinical outcomes and adverse events. RESULTS: In the initial cohort, 176 patients (352 eyes) met inclusion criteria. Of these, 335 eyes underwent myopic ICL placement, and 17 eyes received a hyperopic ICL. Notably, 87% of eyes achieved ±0.50 diopters (D) and 95% achieved ±1.00 D of the intended refraction. One year postoperatively, 78% of eyes demonstrated optimal vaulting (250 to 750 µm), with a significant 19% reduction in vaulting observed over the 12 months (P < .001). Only minor adverse events, including early cataract formation (1 case), secondary toric ICL rotation (3 cases), and ICL exchange due to inappropriate vaulting (6 cases), were noted. CONCLUSIONS: The findings corroborate the safety and efficacy of immediate sequential bilateral phakic lens surgery and indicate its potential as a treatment option. The low incidence of minor adverse events further reinforces its favorable safety profile. [J Refract Surg. 2024;40(5):e313-e320.].

Uneven Corneal Epithelial Redistribution After Femtosecond Laser-Assisted Lenticule Intrastromal Keratoplasty in Correcting Moderate-to-High Hyperopia.

PURPOSE: To evaluate the characteristic of corrective epithelial thickness after femtosecond laser-assisted lenticule intrastromal keratoplasty (LIKE) to correct moderate-to-high hyperopia. METHODS: The prospective case series study of the LIKE procedure was performed to correct moderate-to-high hyperopia. The epithelial thickness map was generated by anterior segment optical coherence tomography (AS-OCT) in the corneal central 9-mm zone. Keratometry and corneal higher order aberrations were analyzed by Pentacam (Oculus Optikgeräte GmbH) preoperatively and postoperatively. RESULTS: In the 26 eyes of 13 participants who underwent the LIKE procedure for moderate-to-high hyperopia, the attempted spherical equivalence (SEQ) was +6.50 ± 1.09 diopters (D). Compared to the preoperative epithelial thickness maps, the postoperative epithelial thickness had become significantly thinner in the central 5-mm zone; the difference was 6 to 7 µm. The paracentral epithelium performed nonuniform remodeling; the thinnest epithelial thickness was located in the inferotemporal section, which has the greatest difference from the superonasal; the difference between these two was approximately 3 µm. Through correlation analysis, it was found that the sections with thinner epithelium were significantly related to corneal curvature and corneal vertical coma. CONCLUSIONS: The LIKE procedure can be used to correct moderate-to-high hyperopia. This study further indicated the epithelial remodeling characteristic after the LIKE procedure: the central and paracentral corneal epithelial thickness becomes thinner, and the epithelial thickness distributes non-uniformly, which may be the important factor of the postoperative curvature asymmetric distribution and induction of corneal vertical coma. [J Refract Surg. 2024;40(5):e321-e327.].

Hyperopic LASIK and postoperative corneal steepness: revisiting the 49-diopter limit.

PURPOSE: To compare corrected distance visual acuity (CDVA) outcomes of hyperopic laser in situ keratomileusis (LASIK) with a postoperative corneal steepness above vs below 49 diopters (D). SETTING: Care-Vision Laser Centers, Tel-Aviv, Israel. DESIGN: Retrospective study. METHODS: This study included consecutive patients who underwent hyperopic LASIK between January 2013 and December 2019. Hyperopic patients were divided into 2 groups based on postoperative corneal steepness with steep corneas defined >49.0 D and the control group ≤49.0 D. Adjustments were performed to account for differences in baseline and intraoperative parameters. RESULTS: Overall, 1703 eyes of 1703 patients were included. Mean age was 48.3 ± 10.0 years, and 45.3% were male. Preoperatively, the steep group (2.4%, n = 41/1703) had steeper mean (44.6 D vs 43.1 D, P < .001) and steep (45.1 D vs 43.5 D, P < .001) keratometry, worse logMAR CDVA (0.07 vs 0.04, P = .02), and higher sphere (4.9 D vs 2.9 D, P < .001). Intraoperatively, they had a higher spherical treatment (4.6 D vs 2.8 D, P < .001). After hyperopic LASIK, the steep group had worse logMAR CDVA (0.10 vs 0.06, P = .01). However, after accounting for differences in baseline and spherical treatment, no significant differences were found in postoperative logMAR CDVA (0.06 vs 0.06, P = .99). The factors that remained associated with worse postoperative CDVA were higher spherical treatment (0.01 logMAR per 1 D, P < .001) and preoperative CDVA (0.60 logMAR per 1.00 logMAR, P < .001). CONCLUSIONS: Postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK. However, lower preoperative visual potential and higher spherical treatment applied are associated with worse outcomes. The 49 D cutoff should be revisited.

Factors Predicting Slow Visual Recovery Following Hyperopic LASIK.

PURPOSE: To identify factors predicting slow visual recovery following hyperopic laser in situ keratomileusis (LASIK). METHODS: The study included consecutive patients who underwent hyperopic LASIK between January 2005 and December 2019 at a single medical center. Patients were divided into two groups according to whether they experienced normal recovery of visual acuity (1-week visit) or slow visual recovery (1-month visit). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected distance visual acuity / preoperative corrected distance visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery. RESULTS: Overall, 861 eyes of 861 patients were included. Mean age was 48.0 ± 9.5 years and 55.9% were women. Two hundred forty-nine patients (28.9%) experienced slow visual recovery. Younger age (P = .01), a larger preoperative spherical equivalence (P = .002), and greater maximum ablation depth (P = .002) were predictors of slow visual recovery. In binary logistic regression, female gender (P = .036) and greater spherical equivalence (P = .007) remained significant predictors of slow visual recovery. CONCLUSIONS: Female gender and greater preoperative spherical equivalence were associated with slow visual recovery. Patients may be advised accordingly. [J Refract Surg. 2024;40(1):e42-e47.].

Factors Predicting Slow Visual Recovery Following Hyperopic LASIK.

PURPOSE: To identify factors predicting slow visual recovery following hyperopic laser in situ keratomileusis (LASIK). METHODS: The study included consecutive patients who underwent hyperopic LASIK between January 2005 and December 2019 at a single medical center. Patients were divided into two groups according to whether they experienced normal recovery of visual acuity (1-week visit) or slow visual recovery (1-month visit). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected distance visual acuity / preoperative corrected distance visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery. RESULTS: Overall, 861 eyes of 861 patients were included. Mean age was 48.0 ± 9.5 years and 55.9% were women. Two hundred forty-nine patients (28.9%) experienced slow visual recovery. Younger age (P = .01), a larger preoperative spherical equivalence (P = .002), and greater maximum ablation depth (P = .002) were predictors of slow visual recovery. In binary logistic regression, female gender (P = .036) and greater spherical equivalence (P = .007) remained significant predictors of slow visual recovery. CONCLUSIONS: Female gender and greater preoperative spherical equivalence were associated with slow visual recovery. Patients may be advised accordingly. [J Refract Surg. 2024;40(1):e42-e47.].

Epithelial thickness remodeling after small incision lenticule intrastromal keratoplasty in correcting hyperopia measured by RTVue OCT.

PURPOSE: To characterize the in vivo corneal epithelial thickness (CET) remodeling profile in a population of eyes after small incision lenticule intrastromal keratoplasty (SMI-LIKE) for hyperopia. METHODS: The CET profile was measured by RTVue-100 Fourier-domain OCT system across the central 6-mm diameter of the cornea of 17 eyes from 12 subjects (five males and seven females) who accepted corneal stromal lens implantation surgery for correcting hyperopia. The CET were measured at positions with a radius of 0-1.0 mm, 1.0-2.5 mm (divided into eight quadrants) and 2.5-3.0 mm (divided into eight quadrants) from the corneal center. Corneal maximum simulated keratometry (Km) was measured by Pentacam HR anterior segment analyzer to analyze CET changes. The examination data of subjects were collected in four time periods, which were preoperative, short-term postoperative (one week after surgery), mid-term postoperative (the last review within 3-6 months after surgery), and long-term postoperative (the last review over 1-2.5 years after surgery). The changes of CET were compared and analyzed in the four time periods. RESULTS: Mean CET in 0-1.0 mm, 1.0-2.5 mm and 2.5-3.0 mm of the cornea decreased in one week after surgery, respectively, as compared to CET in the preoperative period, which turned from 55.06 ± 0.82 µm、54.42 ± 0.75 µm、53.46 ± 0.60 µm to 51.18 ± 1.05 µm (P = 0.005), 49.38 ± 0.70 µm (P = 0.000), 51.29 ± 0.59 µm (P = 0.025). In the mid-term postoperative period, mean CET in 0-1.0 mm and 1.0-2.5 mm areas kept thinner than mean CET in the preoperative period, CET in 0-1.0 mm is 50.59 ± 0.76 µm (P = 0.000),CET in 1.0-2.5 mm is 50.23 ± 0.57 µm (P = 0.000), while mean CET in 2.5-3.0 mm area recovered to the same thickness as the preoperative level, which is 54.36 ± 0.66 µm (P = 1.000), until the long-term period, CET stabilized in the above doughnut pattern. CONCLUSIONS: After stromal lenticule implantation for hyperopia, CET showed a remodeled form of thinning in the 0-2.5 mm area and thickening in the 2.5-3.0 mm area, and remained stable within one year after surgery.

Factors Predicting Loss of Best-Corrected Visual Acuity After Hyperopic Laser-Assisted In Situ Keratomileusis.

PURPOSE: The aim of this study was to identify risk factors for the loss of corrected distance visual acuity (CDVA) after uncomplicated hyperopic laser-assisted in situ keratomileusis (LASIK). METHODS: A retrospective study including hyperopic patients who underwent microkeratome-assisted LASIK between January 2000 and December 2019 at Care-Vision Laser Centers, Tel-Aviv, Israel. Loss of CDVA was defined as ≥ 2 lines (0.20 logarithm of the minimum angle of resolution [logMAR] increase). Excluded were patients who had loss of CDVA because of intraoperative or postoperative complications or developed cataract at their final visit. RESULTS: Overall, 1998 eyes of 1998 patients were included in the study, of which 35 eyes (1.75%) had CDVA loss at final follow-up (mean 387 days). The vision-loss group had a significantly greater spherical treatment (3.4 vs. 2.8 D, P = 0.02), ablation depth (69.4 vs. 53.8 µm, P = 0.01), a higher proportion of treatments with a smaller optic zone (6.0 mm) (31.4% vs. 13.4%, P = 0.002), treatment with the EX200 (Alcon) excimer rather than the EX500 (Alcon) (74.3% vs. 39.0%, P < 0.001), and treatment with the Moria M2-90 microkeratome rather than the Moria Sub-Bowman's keratomileusis (SBK) microkeratome (65.7% vs. 29.6%, P < 0.001). In multivariate binary logistic regression, factors that remained significant predictors of CDVA loss were a greater spherical treatment (per 1 D treatment, odds ratio = 1.42, 95% CI, 1.11-1.81, P = 0.004) and the use of the Moria M2-90 microkeratome (odds ratio = 4.66, 95% CI, 2.30-9.45, P < 0.001). CONCLUSIONS: In patients undergoing uncomplicated hyperopic LASIK, a greater spherical hyperopic treatment is associated with a higher risk for vision loss. Transition to a newer microkeratome model significantly reduced vision loss rate.

Transient Light Sensitivity Syndrome (TLSS) Incidence Following Femtosecond LASIK for Myopic and Hyperopic Eyes and Femtosecond SMILE for Myopic Eyes.

PURPOSE: To evaluate and compare the incidence of transient light sensitivity syndrome (TLSS) after myopic laser in situ keratomileusis (LASIK), hyperopic LASIK, and myopic small incision lenticule extraction (SMILE). METHODS: A retrospective analysis was performed of consecutive LASIK and myopic SMILE cases, performed with the VisuMax femtosecond laser and MEL 80 or MEL 90 excimer laser (both Carl Zeiss Meditec AG) between January 2010 and February 2021 at London Vision Clinic, London, United Kingdom. A chart review was performed to find cases of clinically significant TLSS, identified as patients prescribed anti-inflammatory medications between 2 weeks and 6 months after surgery to manage photophobia. The incidence of TLSS was calculated for three groups: myopic SMILE, myopic LASIK, and hyperopic LASIK. The incidence of TLSS was then calculated for three subgroups within each treatment type based on spherical equivalent refraction treated. For myopic SMILE and myopic LASIK, it was 0.00 to -4.00 diopters (D) (low), -4.01 to -8.00 D (moderate), and -8.01 to -14.00 D (high). For hyperopic LASIK, it was 0.00 to +2.00 D (low), +2.01 to +4.00 D (moderate), and +4.01 to +6.50 D (high). RESULTS: The range of treatment for myopia was similar between the LASIK and SMILE groups. The incidence of TLSS was 1.2% for the myopic SMILE group, 5.3% for the myopic LASIK group, and 9.0% for the hyperopic LASIK group. The difference was statistically significant between all groups (P < .001). For myopic SMILE, the incidence of TLSS was independent of spherical equivalent refraction for low (1.4%), moderate (1.0%), and high (1.1%) myopia (P > .05). Similarly, for hyperopic LASIK, the incidence was similar for low (9.4%), moderate (8.7%), and high (8.7%) hyperopia (P > .05). In contrast, for myopic LASIK, the incidence of TLSS was "dose-dependent" on refractive error treated, with an incidence of 4.7% for low, 5.8% for moderate, and 8.1% for high myopia (P < .001). CONCLUSIONS: The incidence of TLSS was higher after myopic LASIK than after myopic SMILE, higher after hyperopic than myopic LASIK, and "dose-dependent" for myopic LASIK but did not vary by correction in myopic SMILE. This is the first report describing the phenomenon of late TLSS occurring between 8 weeks and 6 months after surgery, [J Refract Surg. 2023:39(6):366-373.].

Visual Outcomes of Cataract Surgery in Patients With Keratoconus Using Toric and Non-toric Lenses.

PURPOSE: To compare the accuracy and outcomes of different intraocular lens (IOL) power calculation formulas in eyes with keratoconus undergoing cataract surgery with toric and non-toric IOLs. METHODS: This was a consecutive retrospective case series study including patients from the Cornea Service at the Department of Ophthalmology and Visual Sciences at the University of British Columbia, Vancouver, Canada, from 2000 to 2020. Keratoconus was diagnosed based on corneal topography and clinician opinion. Patients who underwent topography-guided photorefractive keratectomy, intracorneal ring segments implantation, or corneal transplant were excluded. The manifest spherical equivalent, prediction errors, and median absolute errors were calculated. Descriptive statistics were expressed as mean ± standard deviation. RESULTS: There were 160 eyes from 101 patients; 136 eyes received non-toric lenses and 24 eyes received toric lenses. Most patients had mild disease (< 48.00 diopters [D]) when stratified by steep keratometry values. Patients with severe disease (> 53.00 D) were significantly more hyperopic following surgery (P < .05). The Barrett Universal II (0.26 D, inter-quartile range [IQR] = 0.4), Holladay 2 (0.31, IQR = 1.2), and SRK/T (0.42, IQR = 0.86) formulas had the lowest median absolute error. The postoperative prediction error following toric lens insertion was not significantly different than following non-toric lens insertion, and the mean absolute astigmatism was significantly reduced with toric lenses. CONCLUSIONS: The Barrett Universal II, Holladay 2, and SRK/T were the most accurate IOL power calculation formulas in patients with keratoconus undergoing cataract surgery. Hyperopic surprise was increased in severe keratoconus. Toric IOLs may be considered in patients with mild keratoconus. [J Refract Surg. 2023;39(5):319-325.].

Symmetric offset versus asymmetric offset ablation with transepithelial refractive keratectomy.

BACKGROUND: In eyes with hyperopia, astigmatism, and mixed astigmatism Transepithelial photorefractive keratectomy (TransPRK) is a modality of surface ablation surgery. We center on the corneal vertex for all our treatments (all have an offset to the center of the pupil) and wanted to compare the visual results of symmetrical profile treatments versus asymmetrical profile treatments (the center of the treatment on the vertex and the boundaries with the pupil center) using TransPRK as corneal refractive surgery. METHODS: We retrospectively analyzed two consecutive groups of eyes treated with TransPRK in the Aurelios Augenlaserzentrum Recklinghausen: 47 eyes treated with symmetrical offset and 51 eyes treated with asymmetrical offset. The intergroup comparisons were assessed using unpaired Student's T-tests, whereas preoperative to postoperative changes were assessed using paired Student's T-tests. RESULTS: Refractive outcomes were good for both groups. 83 and 88% of eyes were within the spherical equivalent of 0.5 D from the target in the symmetric and asymmetric offset groups, respectively. 85 and 84% of eyes had a postoperative astigmatism of 0.5 D or lower in the symmetric and asymmetric offset groups, respectively. CONCLUSION: We have not found a significant difference in the refractive outcomes between the symmetric group and the asymmetric group of eyes treated both with TransPRK for preoperatively hyperopic or mixed astigmatism.

Visual outcomes and corneal densitometry after allogenic and autologous lenticule intrastromal keratoplasty for the correction of moderate-to-high hyperopia.

AIM: This study aimed to evaluate the visual outcomes and corneal densitometry (CD) after allogenic lenticule intrastromal keratoplasty (AL-LIKE) and autologous lenticule intrastromal keratoplasty (AU-LIKE) for the correction of moderate-to-high hyperopia. METHODS: Ten subjects (14 eyes) underwent AL-LIKE and eight (8 eyes) underwent AU-LIKE. Patients were examined preoperatively and 1 day, 1 month, and 6 months postoperatively. The visual outcomes and CD for both surgical methods were evaluated. RESULTS: No postoperative complications were observed with either method. The efficacy index was 0.85±0.18 and 0.90±0.33 in the AL-LIKE and AU-LIKE groups, respectively. The safety indices were 1.07±0.21 and 1.25±0.37 in the AL-LIKE and AU-LIKE groups, respectively. The CD values of the anterior, central, and posterior layers in the AL-LIKE group increased significantly at 1 day postoperatively (all P < 0.05). The CD values of the anterior and central layers remained significantly higher than the preoperative values at 6 months postoperatively (all P < 0.05). The CD values of the anterior layer in the AU-LIKE group increased significantly 1 day postoperatively (all P < 0.05) and decreased to preoperative values (all P > 0.05) 1 month postoperatively. CONCLUSION: Both AL-LIKE and AU-LIKE exhibit good efficacy and safety in correcting hyperopia. However, AU-LIKE may have a smaller affected area and faster recovery time than those associated with AU-LIKE related to changes in corneal transparency.

Therapeutic visual rehabilitation in a patient with high hyperopia and flat cornea years after radial keratotomy.

A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why?

Refractive outcomes after DMEK: meta-analysis.

In this meta-analysis and systematic literature review of refractive outcomes after Descemet membrane endothelial keratoplasty (DMEK), the extent of the refractive shift and an overview of reasons for refractive shift after DMEK are provided. The PubMed library was screened for articles containing the terms "Descemet membrane endothelial keratoplasty," "DMEK," "Descemet membrane endothelial keratoplasty combined with cataract surgery," "triple-DMEK" combined with "refractive outcomes," "refractive shift," and "hyperopic shift." The refractive outcomes after DMEK were analyzed and compared using a fixed and random effects model. The overall mean change of the spherical equivalent outcome when compared with the preoperative value in cases of DMEK or when compared with the preoperative target refraction in cases of DMEK combined with cataract surgery was +0.43 diopters (D) (95% CI, 0.31-0.55). When DMEK is combined with cataract surgery, a target refraction of -0.5 D is recommended to achieve emmetropia. Changes in the posterior corneal curvature are identified as the main cause of the refractive hyperopic shift.

Anterior eye parameters and lens thickness measured by an intraoperative OCT and a swept-source OCT: comparison of hyperopic, emmetropic and myopic eyes.

PURPOSE: To evaluate if anterior chamber depth (ACD) and lens thickness (LT) measured by two different devices are affected by different eye lengths. METHODS: ACD and LT of 251 eyes (44 hyperopic, 60 myopic, 147 emmetropic) of 173 patients received with an iOCT-guided femtosecond laser-assisted lens surgery (FLACS) and the IOL Master 700 were compared. RESULTS: ACD measured with the IOL Master 700 was -0.026 ± 0.125 mm smaller (p = 0.001) than that with the iOCT for all eye-groups (hyperopic: p = 0.601, emmetropic: p = 0.003; myopic: p = 0.094). However, differences in all groups were not clinically relevant. LT measurements (all eyes: -0.0642 ± 0.0504 mm) shows a statistically significant difference in all evaluated groups (p < 0.001). Only myopic eyes showed a clinically relevant difference in LT. CONCLUSION: The two devices show no clinically relevant differences in the eye-length groups (myopic, emmetropic, and hyperopic) for all ACD measurements. LT data shows a clinically relevant difference only for the group of myopic eyes.

Long-term surgical outcomes of basic-type exotropia in patients with hyperopia.

BACKGROUND: To investigate the surgical outcomes of basic-type exotropia in patients with hyperopia. METHODS: The medical records of patients who underwent surgery for basic-type exotropia and had been followed up for ≥ 2 years were retrospectively recruited. Patients with myopia and spherical equivalent (SE) < -1.0 diopters (D) were excluded. The patients were classified according to the SE: group H had a SE ≥ + 1.0 D, and group E had -1.0 ≤ SE < + 1.0 D. The surgical success rate and sensory outcome were compared. Surgical success was defined as exodeviation ≤ 10 prism diopters (PD) and esodeviation ≤ 5 PD at 6 m fixation. Stereoacuity was measured using the Titmus Preschool Stereoacuity Test. RESULTS: Seventy-five patients (24 males and 51 females, mean age 5.1 ± 2.6 years, range 2.7-14.8) were included. The SE ranged from -0.9 to 4.4 and 21 patients were classified into group H and 54 into group E. The success rates were higher in group H than in group E during the entire follow-up period, but the differences were significant only at the final examination. At the final follow-up, 11 of the 21 (52.4%) patients in group H and 15 of the 54 (27.7%) in group E maintained successful alignment, whereas 10 (47.6%) and 38 (70.4%) patients exhibited recurrence. Overcorrection was exhibited in one (1.9%) patient in group E. Sensory results were comparable between the groups. The follow-up period did not differ between the two groups. The survival analysis showed no difference in the surgical results between the two groups. CONCLUSIONS: Surgery for basic-type intermittent exotropia resulted in superior outcomes in patients with hyperopia compared to those with emmetropia.

Comparison of Visual Outcomes and Higher-order Aberrations Between FS-LASIK and SMI-LIKE for Moderate to High Hyperopia: A 2-Year Result.

PURPOSE: The aim of the study was to evaluate and compare the long-term visual outcomes and higher-order aberrations (HOAs) between femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule intrastromal keratoplasty (SMI-LIKE) in the correction of moderate to high hyperopia. METHODS: In this study, 16 subjects (20 eyes) underwent FS-LASIK and 7 subjects (10 eyes) underwent SMI-LIKE. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, mean keratometry (Km), anterior asphericity (Q), and HOAs preoperatively and 2 years postoperatively were obtained in both procedures. RESULTS: The efficacy indices of the FS-LASIK group and the SMI-LIKE group were 0.85 ± 0.14 and 0.87 ± 0.17, respectively. The safety indices of the FS-LASIK and SMI-LIKE groups were 0.99 ± 0.15 and 1.08 ± 0.24, respectively. No significant difference in safety index or efficacy index was found between the FS-LASIK and SMI-LIKE groups (all P > 0.05). The correlation coefficient of the attempted versus achieved spherical equivalent postoperatively was 0.69 ( P < 0.01) and 0.89 ( P < 0.01) in the FS-LASIK group and SMI-LIKE groups, respectively. The front Km, negative Q value, negative spherical aberrations (SAs), coma, and total HOAs significantly increased postoperatively in the 2 groups ( P < 0.05). The FS-LASIK group had greater changes in Q value and SA postoperatively than the SMI-LIKE group ( P < 0.01). CONCLUSIONS: SMI-LIKE had similar safety and efficacy to FS-LASIK in the correction of moderate to high hyperopia. However, SMI-LIKE may equip better visual quality postoperatively for its lower Q value and SA changes than FS-LASIK.

Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study.

PURPOSE: To evaluate the long-term visual and refractive outcomes of hyperopic excimer ablation using alcohol-assisted photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). SETTING: American University of Beirut Medical Center, Beirut, Lebanon. DESIGN: Retrospective, matched comparative study. METHODS: Eyes that underwent alcohol-assisted PRK were compared to matched eyes that underwent FS-LASIK. All patients were followed up for at least 3 years after surgery. The refractive and visual outcomes of each group were compared at different postoperative time points. The main outcome measures were spherical equivalent deviation from target (SEDT), manifest refraction, and visual acuity. RESULTS: 83 eyes underwent alcohol-assisted PRK and 83 matched eyes underwent FS-LASIK. Preoperative manifest refraction spherical equivalent was 2.44 ± 1.18 diopters (D) and 2.20 ± 0.87 D ( P = .133) in the PRK and FS-LASIK groups, respectively. Preoperative manifest cylinder was -0.77 ± 0.89 D and -0.61 ± 0.59 D ( P = .175) for the PRK and LASIK groups, respectively. 3 years postoperatively, SEDT was 0.28 ± 0.66 D and 0.40 ± 0.56 D for the PRK and LASIK groups, respectively ( P = .222), whereas manifest cylinder was -0.55 ± 0.49 D and -0.30 ± 0.34 D for PRK and LASIK, respectively ( P < .001). The mean difference vector was 0.59 ± 0.46 for PRK and 0.38 ± 0.32 for LASIK ( P < .001). 13.3% of PRK eyes and 0% of LASIK eyes had >1 D of manifest cylinder ( P = .003). CONCLUSIONS: Both alcohol-assisted PRK and FS-LASIK are safe and effective for the treatment of hyperopia. PRK induces slightly more postoperative astigmatism than LASIK. Larger optical zones and recently introduced ablation profiles that lead to a smoother ablation surface might improve the clinical results of hyperopic PRK.