LASIK for high hyperopia

Session Details

Session Title: Hyperopic corrections

Session Date/Time: Sunday 14/09/2014 | 16:30-18:00

Paper Time: 16:39

Venue: Boulevard B

First Author: : T.Archer UK

Co Author(s): :    D. Reinstein   G. Carp   M. Gobbe        

Abstract Details

Purpose:

Report the visual outcomes of high hyperopic LASIK using the MEL80 excimer laser.

Setting:

London Vision Clinic, London, UK

Methods:

Retrospective analysis of 798 consecutive high hyperopic LASIK procedures (651 patients) using the MEL80 excimer laser and either the Hansatome microkeratome or VisuMax femtosecond laser. Inclusion criteria were attempted maximum hyperopic meridian ≥+4.00D, CDVA 20/20 or better, and minimum follow-up of 1 year. Standard outcomes analysis, including contrast sensitivity, was performed for the primary procedure and including retreatments. The primary procedure was a partial correction in 160 eyes (20%), of which 81 (51%) have undergone a retreatment to date. Of the 637 eyes intended for full correction, 220 (35%) have undergone a retreatment. Prior to retreatment, epithelial thickness and residual stromal thickness were measured by Artemis VHF digital ultrasound. A retreatment was performed if the predicted residual stromal thickness was >250 µm at the location of the maximum ablation and the minimum epithelial thickness was >30 µm. A review of comparable published literature was performed comparing hyperopic LASIK to clear lens exchange for hyperopia.

Results:

Mean attempted SEQ was +4.00±0.90D (+2.00 to +7.64D) for the primary procedure, and +4.69±1.03D (+2.00 to +9.50D) including all procedures. Mean attempted maximum hyperopic meridian including all procedures was +5.21±1.03D (+4.00 to +9.75D). Preoperatively, mean refractive astigmatism was 1.04±0.86D (0.00 to 5.25D), mean age was 51±12 years (18 to 70 years), mean average keratometry was 43.3±1.5D (38.7 to 48.3D). After all treatments, SEQ relative to the intended target was +0.10±0.69D (-2.38 to +3.46D) with 67% ±0.50D, 89% ±1.00D. Mean SEQ was 0.00D at 3 months, +0.11D at 6 months, +0.24D at 1 year and +0.43D at 2 years. UDVA was 20/20 or better in 76% and 20/40 or better in 98% of eyes. There was a loss of 1 line of CDVA in 26%, 2 lines in 0.5% of eyes, and no eyes lost >2 lines. Contrast sensitivity was decreased (p<0.05) by <1 patch at 3 and 6 cpd, and by 1 patch at 12 and 18 cpd. Postoperatively, mean average keratometry was 46.7±1.9D (41.0 to 52.7D). Two patients (3 eyes) experienced diurnal fluctuation in refraction proven by VHF digital ultrasound to be due to diurnal epithelial remodelling overnight and unrelated to maximum postop SimK induced (range 46.0-51.3D).

Conclusions:

LASIK ablation for hyperopia up to +9.50 D with the MEL80 excimer laser was found to demonstrate good safety, similar or superior efficacy to clear lens exchange alone and stability for the two year follow-up period.

Financial Interest:

One or more of the authors... has significant investment interest in a company producing, developing or supplying product or procedure presented, One or more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented