Photorefractive Keratectomy for -1.25 to -25.00 Diopters of Myopia

BACKGROUND

We evaluated prospectively the efficacy, predictability, stability, and safety of photorefractive keratectomy (PRK) for myopia.

METHODS

Three hundred sixty-nine eyes of 257 patients were treated with an Aesculap-Meditec MEL 60 excimer laser. Treated eyes were divided into 3 groups: low myopes (-1.25 to -6.00 D), 226 eyes; medium myopes (-6.10 to -10.00 D), 104 eyes; high myopes (-10.10 to -25.00 D), 39 eyes. Follow-up at 12 months was available for 348 eyes (94%).

RESULTS

One year after surgery the number of eyes within +/- 1.00 D of emmetropia was 182 (86.7%) for low myopes, 43 (40.5%) for medium myopes, and 12 (30.8%) for high myopes. Values for +/- 0.50 D were low: 142 (67.6%), medium: 29 (29.3%), and high: 9 (23.1%). Three eyes with low myopia (1.4%) and 5 eyes with medium myopia (5.1%) lost 2 or more lines of spectacle-corrected visual acuity. None of the high myopes lost 2 or more lines. Uncorrected visual acuity of 20/20 or better was achieved in 82 eyes (39%) with low myopia; 20/40 or better was achieved in 183 eyes (87.1%). Five eyes (5.1%) of medium myopes achieved 20/20 or better; 52 eyes (52.5%) with medium myopia achieved 20/40 or better. Zero eyes with high myopia achieved 20/20 or better; 11 eyes (28.8%) achieved 20/40 or better.

CONCLUSION

Photorefractive keratectomy proved to be an effective method to correct myopia up to -6.00 D. For myopia greater than -6.00 D, good results were achieved in most eyes when myopia was less than -10.00 D, but efficacy and predictability decrease. To avoid systematic undercorrection, slight overcorrection must be attempted with the Aesculap-Meditec MEL 60 excimer laser for the treatment of myopia.

Removal of Corneal Epithelium with Phototherapeutic Technique during Multizone, Multipass Photorefractive Keratectomy

BACKGROUND

The therapeutic mode of the VISX 20/20 excimer laser was used to remove the corneal epithelium prior to performing photorefractive keratectomy (PRK) with a multizone, multipass technique.

METHODS

A retrospective analysis was performed of 120 eyes of 90 patients that were treated for preoperative spherical refractive errors from -1.00 to -7.00 diopters (D) (mean -3.90 D, SD 1.54) by one surgeon (DGJ) over 7 months.

RESULTS

Six-month follow-up was obtained in 76 eyes (63%). Sixty-nine eyes (91%) achieved a spherical equivalent refraction within +/-1.00 D of emmetropia. Regression of effect averaged -0.35 D (SD 0.53 D) from 1 to 6 months after surgery. Mean postoperative uncorrected visual acuity at 6 months was 20/25 (range 20/15 to 20/200). Seventy-three eyes (96%) achieved uncorrected visual acuity of 20/40 or better, 67 (88%) achieved uncorrected visual acuity of 20/25 or better, and 76 (71%) achieved 20/20 or better. Three eyes (4%) lost one line of spectacle-corrected visual acuity; no eye lost more than one line. There were no significant surgical complications.

CONCLUSION

Removal of corneal epithelium with the Summit Excimed UV 200 LA excimer laser using multizone, multipass photoablation yields visual and refractive results that compare favorably with published PRK series with excellent short-term stability.

Excimer Laser Photorefractive Keratectomy for Hyperopia

OBJECTIVE

Excimer laser photorefractive keratectomy (PRK) has been shown to be an effective method in the treatment of refractive errors, especially myopia. We evaluated prospectively the efficacy, predictability, stability, and safety of excimer laser PRK in the treatment of hyperopia.

METHODS

Thirty-four hyperopic eyes were treated with an Aesculap-Meditec (MEL 60) excimer laser. The patients were divided into two groups. In the low-moderate hyperopia group, baseline spherical equivalent refraction was between +1.50 and +6.00 diopters (D) (mean, +4.20 +/- 1.30 D) and in the high hyperopia group between +6.25 and +9.75 D (mean, +7.70 +/- 1.30 D). Follow-up visits occurred 1, 3, 6, and 12 months after surgery.

RESULTS

One-year results were available for a total 27 eyes (79%): 15 eyes with low to moderate hyperopia and 12 eyes with high hyperopia. One year after PRK in the low-moderate group, six eyes (40%) had a refractive error within +/- 1.00 D of emmetropia, but in the high hyperopia group only two eyes (17%) were within +/- 1.00 D of emmetropia; three eyes (20%) and one eye (8%) were within +/- 0.50 D, respectively. The stability of the refractive change was better in the low to moderate hyperopia group; in the high hyperopia group there was still some regression after 6 months. At 12 months, 10 eyes (67%) in the low-moderate and one eye (8%) in the high hyperopia group had postoperative uncorrected visual acuity of 20/40 or better. One eye in the low-moderate hyperopia group saw 20/20 without correction. Only one eye lost two lines of spectacle-corrected visual acuity. Haze was more intense in the high hyperopia group, but it did not reduce visual acuity. No vision-threatening complications were observed.

CONCLUSIONS

When low to moderate hyperopia up to +6.00 D is treated, excimer laser PRK with the Aesculap Meditec MEL60 laser is safe and moderately effective, and refraction stabilizes after 3 months in most eyes. However, PRK is not sufficient to treat high hyperopia in an effective and predictable way.

Photorefractive Keratectomy for Myopia With a 6-mm Beam Diameter

BACKGROUND

Earlier studies have reported clinical outcomes for up to 2 years following photorefractive keratectomy (PRK) using a 5.0-mm treatment zone with the Summit excimer laser. We present results of PRK using a 6-mm ablation zone with the same laser.

METHODS

Forty-five eyes of 45 patients underwent excimer laser PRK for correction of myopia using a 6-mm excimer laser beam diameter. Attempted corrections ranged from 1.50 diopters (D) to 6.00 D. Data on outcomes of uncorrected visual acuity, spectacle-corrected visual acuity, predictability, corneal haze, subjective glare/halo effects, and patient satisfaction with the procedure were analyzed over a follow-up period of 6 months.

RESULTS

All patients obtained a postoperative uncorrected visual acuity of at least 20/40; 28 eyes (62%) achieved at least 20/20. Postoperative spectacle-corrected visual acuity was at least 20/20 in all patients; no patients lost more than one Snellen line of spectacle-corrected visual acuity. Twenty-eight patients (62.2%) achieved within +/-0.50 D of the attempted correction; 40 patients (84.4%) achieved within +/-1.00 D. Mean spherical equivalent refraction was -4.99 D preoperatively and +0.44 D at 1 month, +0.04 D at 3 months, and +0.09 D at 6 months. At 6 months, 40 eyes (88.9%) were graded as clear, 4 eyes (8.9%) as having trace subepithelial haze, and 1 eye (2.2%) as having mild subepithelial haze. The mean glare/halo index for all of the patients was 0.59 on a scale of 0 to 5. Mean subjective patient satisfaction was 4.68 (on the same scale).

CONCLUSIONS

Clinical outcomes following excimer laser PRK for myopia using a 6-mm treatment zone are encouraging. Postoperative subjective glare/halo were minimal, suggesting an optical advantage in using the larger ablation zone.

Regional Variation in Corneal Topography and Wound Healing Following Photorefractive Keratectomy

BACKGROUND

After excimer laser photorefractive keratectomy, corneal epithelial and anterior stromal wound healing may produce corneal haze and variability in refractive results among patients and eyes.

METHODS

We report a retrospective study of 17 selected eyes that received excimer laser photorefractive keratectomy with one of three brands of laser and that exhibited regional variations in corneal wound healing as observed with slit-lamp microscopy and videokeratography (Tomey TMS) within the ablation zone.

RESULTS

All 17 eyes were selected to show that the clear areas in the ablation zone corresponded with flat zones on the videokeratographs and the areas of subepithelial haze corresponded with steeper zones. Spectacle-corrected visual acuity was measured in 12 or the 17 eyes, and was 20/20 or better in 58% and 20/30 or better in 100%, indicating that the regional variation did not severely degrade Snellen visual acuity. Further studies are needed to determine how often regional variability occurs and to better define the relationship of corneal haze and corneal curvature.

CONCLUSION

Regional variations in corneal topography and haze can occur within the ablation zone in an individual cornea after photorefractive keratectomy.