First Author: A.Frings AUSTRIA
Co Author(s): C. Wohlfart E. Wenzl B. Vidic N. Ardjomand
Purpose:
Surgical techniques for astigmatism correction have been controversial for decades. Although some studies have offered conflicting findings about the postoperative visual recovery and pain profile of laser-assisted subepithelial keratomileusis (LASEK), most previously published data point out its safety and efficacy for low to moderate myopia and low astigmatism. However, observations for myopic astigmatism greater than +2.00 diopters (D) have rarely been discussed.
This study was initiated to assess the visual and refractive outcome of LASEK in eyes with high myopic astigmatism.
Setting:
Department of Ophthalmology, Medical University of Graz, Graz, Austria.
Methods:
This retrospective study comprised 49 eyes of 30 patients (n= 23 female, n= 7 male, mean age at surgery 37 ±8.3 years) with myopic astigmatism ? +2.50 D (range, 2.50 to 4.80 D) that were treated with LASEK (MEL 80, Zeiss, Germany) for myopic corneal astigmatism correction. Clinical parameters including manifest and cycloplegic refraction, uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA) were examined pre- and postoperatively by slit-lamp biomicroscopy, corneal topography (Orbscan, Bausch&Lomb, Germany) and wavefront analysis (WASCA, Carl Zeiss Meditec, Germany).
Results:
Preoperative BSCVA resulted in a mean value of 0.02 ±0.10 logMAR (range, 0.40 to -0.10 logMAR). At last followup, logMAR was determined as -0.01 ±0.08 (range, 0.10 to -0.10). None of our patients lost one line of best-corrected visual acuity (0.00 logMAR pre- and postoperatively). Refractive astigmatism could be reduced by -2.53 ±0.80 D from preexisting -3.04 ±0.63 D to a mean value of -0.49 ±0.60 D postoperatively. Topographic astigmatism assessed by corneal topography was reduced by 52% from +3.18 ±0.70 D (range, 1.40 to 4.40 D) to 1.52 ±0.72 D (range, 0.50 to 2.90 D). The mean reduction of spherical equivalent (SE) from -4.75 ±2.00 preoperatively to -0.22 ±0.62 at the time of last follow-up was statistically not significant. Larger ablation zones (7.0mm) resulted in low standard deviation and range for refractive predictability.
Conclusions:
The data reported herein contribute to the notion that LASEK with Zeiss MEL 80 Excimer laser with additional use of MMC provides a safe and effective technique for the correction of myopic astigmatism up to +5.00 D. A longer follow-up in a larger study is required to address the question if the use of larger ablation diameters is appropriate in order to achieve better and more predictable results in astigmatism reduction as well as less long-term regression. FINANCIAL DISCLOSURE?: No
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