Wavefront-guided Enhancements Using the WaveLight Excimer Laser in Symptomatic Eyes Previously Treated With LASIK

Abstract

To describe our clinical experience in wavefront-guided LASIK enhancements using the WaveLight ALLEGRETTO system (WaveLight Technologie AG, Erlangen, Germany) for symptomatic eyes previously treated with standard LASIK. Twenty-six eyes of 20 patients with residual myopia, hyperopia, or mixed astigmatism and/or night vision symptoms after primary standard LASIK were considered for wavefront-guided customized retreatment using the WaveLight ALLEGRETTO WAVE 200 Hz excimer laser system (model 106). Preoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, topography with the ALLEGRETTO Topolyzer, wavefront analysis using the ALLEGRETTO WAVE Tscherning Analyzer, and contrast sensitivity were compared to postoperative (enhancement) measurements. Twenty-two of the original 26 eyes underwent wavefront-guided enhancement, 4 were excluded because they did not meet wavefront-guided treatment inclusion guidelines of this study. Mean follow-up was 8 months (range: 6 to 13 months, standard deviation [SD] 2). All patients were within +/- 0.50 diopters (manifest refraction) of intended postoperative refraction. The mean preoperative BSCVA improved from 20/25 (SD +/- 0.12) to 20/18 (SD +/- 0.1) postoperatively. All patients gained at least one line of BSCVA, and a maximum of three lines. There was no loss of BSCVA in any patient. The total amount of high order aberrations (RMSH) decreased from an average of 1.04 (SD +/- 0.22) to 0.46 (SD +/- 0.14) microm. Patients also had a mean improvement in low contrast sensitivity of 59%. Based on this small series, customized wavefront-guided enhancements using the WaveLight ALLEGRETTO system in patients who underwent previous LASIK appear to be safe and effective in correcting residual refractive error, reducing high order aberrations, and improving visual symptoms when reliable and reproducible measurements are achieved.