Hyperopic Laser In Situ Keratomileusis Research Articles

The role of presbyopia-correcting intraocular lenses after laser in situ keratomileusis

There is a growing number of patients who wish to remain spectacle independent after cataract surgery, and this number includes some of the millions of people worldwide who have undergone laser in situ keratomileusis (LASIK). This article reviews the evidence of the use of presbyopia-correcting intraocular lenses (IOLs) in patients who have previously undergone LASIK. Small studies have demonstrated that the use of hybrid refractive-diffractive multifocal IOLs in eyes with previous myopic or hyperopic LASIK can result in good refractive results. However, refractive surprise can be common and may require further intervention, such as laser surgery enhancement, to achieve satisfactory results. The use of these IOLs can also result in lost lines of vision, and visual quality may be poorer under mesopic or glare conditions. No reports were found regarding the use of accommodating IOLs in such patients. There is a surprising paucity of literature on this topic, given the millions that have undergone LASIK. Further and timelier research is needed to assess the use of newer multifocal and accommodating IOLs in post-LASIK eyes, the effect of IOL asphericity on visual quality, and patients' experience, satisfaction and level of spectacle independence after surgery.

Visual quality after diffractive intraocular lens implantation in eyes with previous hyperopic laser in situ keratomileusis

To evaluate distance, intermediate, and near visual quality in eyes with diffractive intraocular lens (IOL) implantation after previous hyperopic laser in situ keratomileusis (LASIK). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Cohort study. Corrected distance visual acuity (CDVA) at 12.5%, 25.0%, and 100% contrast levels under photopic and mesopic conditions; uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity, defocus curves, and corneal higher-order aberrations (HOAs) were measured in eyes that had AcrySof Restor SN60D3 spherical IOL implantation (study group) and in phakic eyes (control group) after hyperopic LASIK. Under photopic conditions at 100% contrast, there were no statistically significant differences between the 2 groups (P > .01) and the CDVA was 0.1 logMAR or better (approximately 20/25) in both groups. At 25.0% and 12.5% contrast, there were no statistically significant differences between the 2 groups (P > .01). Under mesopic conditions, the control group had better CDVA than the study group without glare at all contrasts (P < .01). In the study group, the mean UNVA was 0.017 logMAR ± 0.030 (SD) (approximately 20/20) and the mean DCNVA, 0.009 ± 0.030 logMAR. There was statistically significant worsening of visual acuity as a function of the distance to the test (P < .01). There were no statistically significant differences in HOAs between the 2 groups (P > .01). In eyes with previous hyperopic LASIK, the diffractive IOL provided good visual quality at distance, comparable to that obtained in phakic eyes under photopic conditions, although visual performance was slightly poorer under mesopic conditions. No author has a financial or proprietary interest in any material or method mentioned.

Outcomes of wavefront-guided laser in situ keratomileusis for hyperopia

To determine the impact of wavefront-guided laser in situ keratomileusis (LASIK) for hyperopia on corrected distance visual acuity (CDVA), contrast sensitivity, and higher-order aberrations (HOAs). Centre for Contact Lens Research, University of Waterloo, Waterloo, Ontario, Canada. Case series. This study comprised patients who had LASIK for hyperopia. The HOAs up to the 4th order (5.0 mm pupil) in right eyes were analyzed. The study enrolled 31 patients. The preoperative mean values were sphere, +2.60 diopters (D) ± 1.15 (SD) (range +1.00 to +5.00 D); astigmatism, -0.87 ± 0.74 D (range 0.00 to -3.75 D); and spherical equivalent (SE), +2.16 ± 1.00 D (range +0.63 to +4.50 D). The postoperative refractive SE was within ±0.50 D in 71.0% of eyes. The uncorrected distance visual acuity was 20/20 or better in 87.2% of eyes. There was no significant change in CDVA or contrast sensitivity (all P>.05). There was a significant change in Zernike coefficients Z(0,4), Z(-1,3), Z(-3,3), and Z(3,3) (range of mean absolute change ± SEM: 0.092 ± 0.013 μm to 0.208 ± 0.018 μm; all P<.001). Coefficients Z(-1,3) and Z(3,3) increased and Z(0,4) and Z(-3,3) decreased in magnitude; each had a reversal of sign. The only significant postoperative association was between low-contrast CDVA and Z(0,4) (r=0.617, P<.001). Low-contrast CDVA after LASIK surgery for hyperopia was correlated with Z(0,4). There were no significant changes in CDVA or contrast sensitivity. The relative risk for losing low-contrast CDVA increased if more than 1 Zernike term had a sign change.

Femtosecond Laser vs Mechanical Microkeratome for Hyperopic Laser In Situ Keratomileusis

To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser vs a mechanical microkeratome for the correction of low to moderate hyperopia. Retrospective, nonrandomized, interventional, comparative case series. settings: Vissum Santa Hortensia, Madrid, Spain.study population and procedures: Patients who had undergone LASIK to correct their hyperopia using the 60-kHz IntraLase femtosecond laser were compared to age- and refraction-matched patients in whom the Moria M2 microkeratome was used. Visual and refractive results 3 months postoperatively were compared between both groups. A total of 144 eyes were analyzed (72 in each group). Mean preoperative sphere was +3.45 ± 1.0 diopters (D) in the IntraLase group vs +3.18 ± 1.3 D in the M2 group (P = .1). Results 3 months postoperatively were: mean residual sphere, +0.44 ± 0.6D vs +0.72 ± 0.8 D (P = .02), respectively; uncorrected visual acuity (UCVA), 0.89 ± 0.2 vs 0.80 ± 0.2 (P = .04); best spectacle-corrected visual acuity (BSCVA), 0.96 ± 0.2 vs 0.92 ± 0.2 (P = .2); safety index, 0.97 ± 0.1 vs 0.98 ± 0.1 (P = .5); efficacy index, 0.89 ± 0.2 vs 0.84 ± 0.2 (P = .3). Hyperopic LASIK performed with the IntraLase femtosecond laser seems to achieve better refractive results 3 months after the surgery compared to the M2 microkeratome, without significant differences in safety between both procedures.

Bilateral loss in the quality of vision associated with anterior corneal protrusion after hyperopic LASIK followed by intrastromal femtolaser-assisted incisions

A patient was treated bilaterally for hyperopia (twice in the right eye and 3 times in the left eye) using laser in situ keratomileusis (LASIK) and achieved stable vision. Preoperatively, there was no known risk factor for ectasia. Three years after the last LASIK enhancement treatment, intrastromal femtolaser-assisted incisions (Intracor procedure using the Technolas femtosecond laser) were made bilaterally. After the procedure, a severe loss in the corrected distance visual acuity and in the quality of vision occurred, associated with a topography pattern suggestive of isolated anterior central protrusion. This case suggests that intrastromal femtosecond incisions in eyes that have had hyperopic LASIK should be done with caution, as there is no certainty about how the treated corneas will respond.

Straylight before and after hyperopic laser in situ keratomileusis or laser-assisted subepithelial keratectomy

To compare straylight values before and 3 months after hyperopic laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) and determine the cause of any change. Private refractive surgery clinic, Driebergen, The Netherlands. Comparative case series. Straylight (by definition the measure for glare disability) was measured preoperatively and postoperatively with a C-Quant straylight meter and recorded as log(s). The main outcome measures were the difference between postoperative and preoperative straylight values. The mean increase in straylight from preoperatively to postoperatively was 0.051 log(s) ± 0.158 (SD) in the LASIK group (39 eyes) and 0.031 ± 0.146 log(s) in the LASEK group (26 eyes). Although neither change was statistically significant, it was clinically significant in some cases. Haze or interface debris was seen in some eyes with increased straylight. The mean postoperative spherical equivalent refraction was -0.05 ± 0.27 diopter. Although straylight increased slightly after hyperopic LASIK and LASEK, the increase was not statistically significant. Some eyes with increased straylight had haze or interface debris. The cause of the increased straylight could not be determined in some cases.

Comparison between Pascal dynamic contour tonometer and Goldmann applanation tonometer after different types of refractive surgery

To evaluate and compare the recorded IOP values of the Pascal dynamic contour tonometer (PDCT) and the Goldmann applanation tonometer (GAT) after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). Three groups of 84, 182 and 43 patients each were treated by PRK for myopia, LASIK for myopia and LASIK for hyperopia respectively. Intraocular pressure (IOP) measurements were performed in all eyes 1 day before and 1, 3, 6 and 12 months after treatment with PDCT and GAT. Ultrasound pachymetry was performed in all eyes preoperatively and at 1st month postoperatively. Preoperatively and postoperatively, GAT readings were lower than PDCT in all groups (all p < 0.05). Postoperatively in the PRK group, compared to the preoperative value, the mean differences of IOP recorded with GAT at 1st, 3rd, 6th and 12th month were -1.4 mmHg, -1.7 mmHg, -1.7 mmHg and -1.9 mmHg respectively (all p < 0.05). In the myopic LASIK group; the corresponding values with GAT were -3.6 mmHg, -3.6 mmHg, -3.6 mmHg and -3.5 mmHg (all p < 0.05), while in the hyperopic LASIK group the corresponding values were -1.1 mmHg, -0.7 mmHg, -1.1 mmHg and -0.9 mmHg (all p < 0.05). The mean IOP difference (GAT-PDCT) for myopic PRK, myopic LASIK and hyperopic LASIK were respectively -3.8 mmHg, -4.1 mmHg and -1.5 mmHg at the 12-month follow-up. No statistically significant changes were found for any group with the PDCT. GAT-determined IOP values were significant lower at all time-points after hyperopic LASIK, as well as myopic PRK or LASIK. The Pascal tonometry values remained unaffected for all groups.

Differences in the early biomechanical effects of hyperopic and myopic laser in situ keratomileusis

To compare changes in corneal hysteresis (CH) and the corneal resistance factor (CRF) in myopic and hyperopic laser in situ keratomileusis (LASIK) and evaluate their relationship to the number of photoablative pulses delivered, a surrogate for ablation volume. Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA. Preoperative and 1-week postoperative Ocular Response Analyzer measurements in eyes that had femtosecond-assisted LASIK were studied retrospectively. Changes in CH and CRF were compared and tested for correlation with the number of excimer laser pulses. Thirteen myopic eyes and 11 hyperopic eyes were evaluated. Preoperative corneal thickness, CH, CRF, programmed correction magnitude, flap thickness, and total number of fixed spot-size photoablative pulses were similar in the 2 groups (P>.1). Decreases in CH and CRF were greater after myopic LASIK than after hyperopic LASIK (P<.005), and changes in CRF were correlated with the number of excimer laser pulses in the myopic group only (r = -0.63, P = .02). Regardless of ablation profile, changes in CH were more strongly correlated with preoperative CH values than with attempted ablation volume. With comparable flap thickness and attempted ablation volumes, myopic photoablation profiles were associated with greater decreases in CRF and CH than hyperopic profiles. Results indicate that preoperative corneal biomechanical status, ablation volume, and the spatial distribution of ablation are important factors that affect corneal resistance and viscous dissipative properties differently. Preferential tissue removal in the natively thicker paracentral cornea in hyperopia may partially account for the rarity of ectasia after hyperopic LASIK.

Predictability and stability of refraction with increasing optical zone diameter in hyperopic LASIK

We undertook a prospective nonrandomized study to assess refractive outcome and patient satisfaction with hyperopic laser in situ keratomileusis (LASIK) using variable optical zone diameters in correction of hyperopia of more than 4.00 diopters. Fourteen adults (comprising 28 hyperopic eyes) underwent hyperopic LASIK correction for hyperopia of more than 4.00 diopters. The sample was divided into two groups. Group 1 included the right eyes of the 14 patients who underwent hyperopic LASIK using a 6.5 mm optical zone diameter. Group 2 comprised the left eyes of the same patients with the only difference being that the optical zone diameter was 6.0 mm. The mean age of the patients was 36.42 +/- 5.10 years. Group 1 eyes had a median (range) preoperative uncorrected visual acuity (UCVA) of 0.79 (0.52) and best-corrected visual acuity (BCVA) of 0.15 (0.08). Group 2 had a median preoperative UCVA of 0.79 (0.60) and BCVA of 0.15 (0.08). The median postoperative UCVA in Group 1 was 0.17 (0.21) and BCVA was 0.15 (0.13). In Group 2, the median postoperative UCVA was 0.30 (0.32) and BCVA was 0.15 (0.26). Group 1 had a median preoperative refraction of +5.37 (1.75) diopters and the median postoperative refraction at one week was -0.23 (1.25) diopters, at three months was +0.75 (0.75) diopters, and at six months was +0.75 (1.00) diopters. Group 2 had a median preoperative refraction of +5.00 (1.75) diopters, and the median postoperative refraction at one week was +0.13 (1.5) diopters, at three months was +1.00 (0.75) diopters and at six months +1.25 (1.25) diopters. The difference was statistically significant between groups 1 and 2. The difference within each group was also significant. Group 1 eyes were stabilizing after the three-month period in contrast with Group 2 in which the refractive changes continued throughout the follow-up period. Larger optical zone diameter in correction of hyperopia of more than 4.00 diopters was more predictable, stable and safe.

Bilateral acute angle closure glaucoma after hyperopic LASIK correction

Acute angle closure glaucoma is unexpected complication following laser in situ keratomileusis (LASIK). We are reporting a 49-years-old lady that was presented to the emergency department with acute glaucoma in both eyes soon after LASIK correction. Diagnosis was made on detailed clinical history and examination, slit lamp examination, intraocular pressure measurement and gonioscopy. Laser iridotomy in both eyes succeeded in controlling the attack and normalizing the intraocular pressure (IOP) more than 6 months of follow-up. Prophylactic laser iridotomy is essential for narrow angle patients before LASIK surgery if refractive laser surgery is indicated.

Refractive lens exchange with spherical diffractive intraocular lens implantation after hyperopic laser in situ keratomileusis

To assess the safety, efficacy, and predictability in eyes that had refractive lens exchange (RLE) with implantation of a spherical diffractive intraocular lens (IOL) after previous hyperopic laser in situ keratomileusis (LASIK). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. This prospective study evaluated eyes that had RLE and implantation of an AcrySof ReSTOR SN60D3 IOL after hyperopic LASIK. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and residual refractive errors were analyzed using vector analysis and recorded preoperatively and 6 months postoperatively. The study evaluated 41 eyes of 23 patients. The mean UDVA was 0.189 logMAR +/- 0.175 (SD) preoperatively and 0.113 +/- 0.101 logMAR 6 months postoperatively (P = .009) and the mean CDVA, 0.049 +/- 0.071 logMAR and 0.046 +/- 0.063 logMAR, respectively (P = .44). At 6 months, the efficacy index was 0.87 and the safety index, 1.00. The mean UNVA was 0.014 +/- 0.026 logMAR, with an efficacy index of 1.00. There were no differences in corrected near visual acuity between preoperatively (with spectacle addition) and postoperatively (P = .3); the safety index was 1.01. All eyes were within +/-1.25 diopters (D) of the targeted refraction and 73.17% were within +/-0.50 D. The mean postoperative spherical equivalent was -0.064 +/- 0.513 D. Implantation of a spherical multifocal IOL after hyperopic LASIK was safe, effective, and predictable.

Intraocular lens power adjustment nomogram after laser in situ keratomileusis

To develop a nomogram for improving the accuracy of intraocular lens (IOL) power calculation at the time of cataract surgery based on the manifest refraction spherical equivalent (MRSE) change produced by laser in situ keratomileusis (LASIK). University-based clinical practice, Jules Stein Eye Institute, Los Angeles, California, USA. This was a retrospective review of the records of consecutive patients who had cataract surgery after LASIK. Spherical equivalent refractive data before and after LASIK and cataract surgery were recorded. The differences between the targeted postoperative refractive errors after cataract surgery and the achieved refractive errors were plotted against the LASIK-induced MRSE change, yielding postoperative refractive errors to target during IOL power calculation to achieve emmetropia. Thirty-two eyes of 23 patients were identified; 25 eyes had myopic LASIK and 7, hyperopic LASIK. Regression analysis yielded the following polynomial relationship: target postoperative refractive error (D) to achieve emmetropia during IOL power calculation = -0.018(MRSE Change)(2) + 0.192(MRSE Change) - 0.062. The outcomes in 97% of eyes fell within +/-1.00 D of the value predicted by this formula. A 2nd-order polynomial relationship was found between LASIK-induced MRSE change and the MRSE error after cataract surgery. From this equation, a simple adjustment nomogram was generated and put into a look-up table format. The formula and nomogram should improve IOL power calculation accuracy in post-LASIK eyes when the MRSE change is known.

Laser In Situ Keratomileusis Disrupts the Aberration Compensation Mechanism of the Human Eye

To study how changes induced on corneal optics by myopic and hyperopic laser in situ keratomileusis (LASIK) refractive surgery affect the aberration compensation mechanism. Interventional case series and modeling theory. We measured ocular, corneal, and internal aberrations for a 6-mm pupil in 15 myopic and 6 hyperopic eyes with similar age range before and 6 months after standard LASIK. Ocular aberrations were measured using our own developed Hartmann-Shack wavefront sensor, whereas corneal aberrations were calculated by using the elevation data obtained by corneal topography. Ocular, corneal, and internal root mean square (RMS), spherical aberration (SA), coma, and compensation factor were compared for each patient. After myopic LASIK, we obtained an average 1.6-fold increase in ocular RMS, mainly positive SA, and coma, associated with a similar increase in corneal aberrations. In the hyperopes, we found a higher (2.3-fold) induction of ocular aberrations after surgery, mainly negative SA and coma, but without net increases of corneal aberrations. Aberration compensation clearly decreased or even inverted after hyperopic LASIK, decreasing the ocular optical quality in a higher level than myopic LASIK. Although ocular aberrations after myopic LASIK usually were smaller than corneal aberrations because of partial compensation of SA, after hyperopic LASIK, because of induction of negative SA and change in coma, disruption of the compensation mechanism lead to a larger increase of ocular aberrations. Customized procedures should maintain the natural compensation to achieve improved visual outcomes.

Nonarteritic Ischemic Optic Neuropathy After LASIK With Femtosecond Laser Flap Creation

Non-arteritic ischemic optic neuropathy (NAION) has been reported after laser in situ keratomileusis (LASIK) performed with a microkeratome flap (1,2). Its occurrence has been attributed to the pressure elevation caused by the suction ring. The suction ring placed during hyperopic LASIK transiently elevates the intraocular pressure (IOP) to levels exceeding 65 mm Hg. We examined a 53-year-old man who developed unilateral NAION after bilateral simultaneous uncomplicated hyperopic LASIK in which flap creation was performed using the IntraLase femtosecond laser (IntraLase Corp., Irvine, CA) with a low-pressure suction ring. To the best of our knowledge, NAION has not been reported in this setting. Preoperative refractive errors were +5.50 +0.50 ×105 for the right eye and +5.25 +0.50 ×90 for the left eye with best-corrected visual acuities of 20/20 in both eyes. Preoperatively, IOPs were normal and family history was negative for glaucoma. The LASIK surgeon reported that results of a preoperative dilated fundus examination was unremarkable except for small optic discs and cup/disc ratios. The procedure was uneventful. In each eye, the IntraLase femtosecond laser was used to create superiorly hinged flaps of 110 μm thickness, and stromal ablation was performed. Corneal topography after LASIK surgery revealed a hyperopic LASIK ablation pattern. On the first postoperative day, best-corrected visual acuities were 20/20 in the right eye and 20/200 in the left eye. The right optic disc was normal, and the left optic disc was edematous. There was a relative afferent pupillary defect in the left eye. Visual field examination showed a dense nerve fiber bundle defect in the left eye (Fig. 1).FIG. 1: On postoperative day 1 after bilateral hyperopic LASIK procedures with femtosecond flap creation, fundus photographs (A) show left segmental optic disc edema, and visual fields (B) show a corresponding left eye defect.In the two reported cases of NAION after LASIK surgery (1,2), flap creation was performed using a mechanical microkeratome, with an associated sudden increase in IOP to 60-70 mm Hg, followed by a rapid IOP decrease upon suction release. Our patient is unusual because during IntraLase laser treatment, the IOP did not exceed 30-40 mm Hg (3,4). The mechanism of NAION under these circumstances is unknown. Ahmet Maden, MD Safiye Yilmaz, MD Nazife Sefi Yurdakul, MD Department of Ophthalmology Izmir Atatürk Training and Research Hospital Izmir, Turkey [email protected]

Correlation of visual outcome and patient satisfaction with preoperative keratometry after hyperopic laser in situ keratomileusis

To prospectively study the dependence of visual outcomes and patient satisfaction on corneal keratometry (K) in hyperopic laser in situ keratomileusis (LASIK). John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. Twenty-six patients (49 eyes) who had hyperopic LASIK from January to October 2005 were prospectively studied. Twelve patients (24 eyes) with a preoperative K value less than 43.0 diopters (D) (Group 1) were compared with 14 patients (25 eyes) with a preoperative K value greater than 44.0 D (Group 2). The mean preoperative hyperopia was +3.44 D (range +1.57 to +5.25 D). Ten patients in Group 2 and 1 patient in Group 1 lost 2 or more lines of best spectacle-corrected visual acuity (BSCVA). There was a statistically significant difference in subjective patient satisfaction (scale 1 to 4; 4=most satisfied) between Group 1 and Group 2 (mean 2.75+/-0.61 and 1.52+/-0.66, respectively) (P<.0001). Group 2 had a statistically significantly higher dryness score (scale 0 to 3; 3=severe) (mean 1.84+/-0.70 versus 0.17+/-0.38) (P<.0001). There was no between-group difference in the degree of preoperative hyperopia or keratometric change. An increased incidence of loss of BSCVA and decreased patient satisfaction was associated with a preoperative K value greater than 44.0 D in hyperopic LASIK, indicating caution is required when performing LASIK in eyes with moderate to high hyperopia and steep preoperative corneal keratometry.

Corneal aberrations and objective visual quality after hyperopic laser in situ keratomileusis using the Esiris excimer laser

To evaluate the changes in visual performance and ocular optical quality after hyperopic laser in situ keratomileusis (LASIK) using the Esiris excimer laser (Schwind eye-tech-solutions). Vissum-Instituto Oftalmológico de Alicante, Alicante, Spain. Excimer laser surgery was performed with the Esiris laser in 51 eyes of 29 patients with hyperopia or hyperopic astigmatism. The follow-up was 6 months. Changes in visual acuity, refraction, and corneal and ocular wavefront aberrations (6.0 mm pupil) were recorded and analyzed. The mean preoperative sphere was +4.45 diopters (D)+/-1.08 (SD) (range +2.50 to +7.25 D) and the mean preoperative cylinder, -0.55+/-0.36 D (range 0.00 to 1.00 D). Ten eyes (19.61%) had a LASIK enhancement during the follow-up for the correction of the residual refractive error and were excluded from the refractive analysis. Of the 41 remaining eyes, 95.12% had the same or improved distance best spectacle-corrected visual acuity (BSCVA) 6 months after surgery; 90.25% had no change or a gain of lines of near BSCVA. Moreover, 80.50% of eyes were within +/-0.50 D of emmetropia. Regarding corneal aberrations, statistically significant changes were observed in higher-order aberrations (HOAs), coma-like aberrations, and the primary spherical aberration coefficient Z(4,0), which changed from positive to negative values (all P<.01). Regarding total ocular aberrations, statistically significant changes were observed in total and higher-order root-mean-square values (P<.01). Hyperopic LASIK using the Esiris excimer laser for the correction of 2nd-order aberrations was safe and effective. Ocular and corneal HOAs increased significantly postoperatively.

Long-term follow-up of hyperopic laser in situ keratomileusis correction using the Star S2 excimer laser

To prospectively evaluate the safety, efficacy, predictability, and long-term stability of hyperopic laser in situ keratomileusis (LASIK) using the Star S2 excimer laser (Visx). Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA. This study evaluated 41 eyes of 27 patients who had LASIK for the correction of spherical hyperopia. Patients were divided into 3 groups based on preoperative cycloplegic refraction: low hyperopia (less than +2.00 diopters [D]), medium hyperopia (+2.00 to +4.00 D), and high hyperopia (more than +4.00 D). In all eyes, the mean preoperative spherical equivalent (SE) was +2.53 D (range +0.75 to +5.25 D) and the mean attempted SE was +2.58 D (range +0.75 to +5.25 D). At the last visit (mean 5.29 years), the mean SE was +0.44 D +/- 0.69 (SD) in the low hyperopia group, +0.58 +/- 0.56 D in the medium hyperopia group, and +0.59 +/- 1.18 D in the high hyperopia group. The percentage of eyes within +/-1.00 D of emmetropia was 82.4%, 75.0%, and 66.7%, respectively (68.9% overall). The uncorrected visual acuity was 20/40 or better in 100% of eyes in the low hyperopia group, 91.7% in the medium hyperopia group, and 66.7% in the high hyperopia group (87.8% overall). The hyperopic shift between 1 year and the last visit was +0.18 D, +0.30 D, and +0.55 D, respectively (+0.40 D overall; range -1.25 to +2.63 D). Hyperopic LASIK using the Star S2 excimer laser was safe, effective, and predictable for hyperopia up to +4.10 D (mean of high group). A mild regression of the refractive effect was seen over the 5-year follow-up.

Photopic pupillometry–guided laser in situ keratomileusis for hyperopic presbyopia

To evaluate a method of surgically treating presbyopia in hyperopic patients having laser in situ keratomileusis (LASIK) by selecting excimer ablation optical zone diameters based on the photopic pupil. Private practice, Beverly Hills, California, USA. This prospective analysis comprised 46 patients having hyperopic LASIK for presbyopia. The distance-dominant eye was treated with a standard 6.0 mm optical and 9.0 mm outer zone for full distance correction with no nomogram adjustment from the final preoperative manifest refraction. In the nondominant eye, an algorithm was used to select the optical and blend zone diameters and the optical zone size-dependent programmed amount of correction augmentation. Variables evaluated at the 6-month postoperative visit included preoperative and postoperative manifest refractive spherical equivalent (MRSE), refractive cylinder, and monocular and binocular near and distance uncorrected visual acuities. Patient satisfaction and spectacle dependence were also evaluated. In the near-corrected eye, the mean preoperative and postoperative MRSE was +1.10 diopters (D) +/- 1.20 (SD) and -1.30 +/- 0.56 D, respectively, and the mean refractive cylinder, -0.76 +/- 0.91 D and -0.36 +/- 0.33 D, respectively (P<.05). The mean uncorrected near acuity in the near-corrected eye was J10 preoperatively and J1 postoperatively (P<.0001) and the binocular mean uncorrected near acuity, J10 and J1, respectively (P<.0001). The mean uncorrected logMAR distance acuity in the near-corrected eye was +0.38 +/- 0.31 (20/50) preoperatively and +0.36 +/- 0.25 (20/50) postoperatively (P>.05). The mean binocular uncorrected logMAR distance acuity was +0.30 +/- 0.30 (20/40) and +0.01 +/- 0.08 (20/20) (P<.0001), respectively. The mean overall patient satisfaction score was 8.8 (scale 1 to 10). After LASIK, no patient reported using spectacles full time for near or distance and 15% reported part-time use. Photopic pupillometry-guided LASIK may be an effective option when considering surgical treatment of presbyopia in hyperopic patients.

Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy

To assess the use of the femtosecond laser for laser in situ keratomileusis (LASIK) in eyes with consecutive hyperopia after radial keratotomy (RK). Private ambulatory surgical center, Valencia, Spain. This prospective noncomparative interventional case series study included 13 eyes of 9 patients with secondary hyperopia after previous RK. The patients were operated on with the IntraLase femtosecond laser (IntraLase Corp.) and the Star S2 excimer laser (Visx, Inc.). Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, flap thickness, flap diameter, and complications were evaluated at 6 months. The mean spherical equivalent (SE) decreased from 2.00 diopters (D)+/-0.40 (SD) to -0.41+/-0.61 D, with 8 eyes (61.5%) within+/-0.50 D of the targeted refraction. Twelve eyes (92.3%) had a UCVA of 20/40 or better, and 3 eyes (23.1%) lost 1 line of BSCVA. A mean change in SE of 0.10 D was observed at the 6-month follow-up. The mean flap thickness and diameter were 117+/-14 microm and 9.18+/-0.12 mm, respectively. Most complications were in eyes with more than 8 RK incisions than in eyes with 8 RK incisions. These complications were multiple intraoperative incision openings (100% versus 28.6%, respectively), interface inflammation (66.6% versus 0%, respectively), haze (83.3% versus 14.3%, respectively), and loss of BSCVA (50% versus 0%, respectively). The femtosecond laser provided large, thin corneal flaps for hyperopic LASIK. However, the procedure should be avoided in eyes with more than 8 RK incisions because of the increased risk for multiple intraoperative incision openings, interface inflammation, haze, and loss of BSCVA.

Varieties of Contact Lens Fittings After Complicated Hyperopic and Myopic Laser In Situ Keratomileusis

To determine whether contact lenses with a special back surface design can improve visual acuity after complicated laser in situ keratomileusis (LASIK). Fifteen eyes (six after myopic LASIK and nine after hyperopic LASIK) of eight patients were fitted with contact lenses with a special back surface design for optical rehabilitation. Four different types of lenses (aspheric, tricurve, keratoconus, and reverse) were used selectively, depending on the abnormal eccentricity (positive and exceeding 0.5-0.7 in all preoperatively hyperopic eyes, negative in all preoperatively myopic eyes) determined by videokeratoscope and on individual conditions. The patients were followed up retrospectively for an average period of 12.3 months. Lens tolerance and corrected visual acuity were evaluated and compared with the results obtained with spectacles. Visual acuity improved in nine (60%) of 15 eyes (three eyes by more than three lines and six eyes by three lines or fewer), with an absence of halos and ghost images in four (26.7%) of 15 eyes accompanied by good contact lens tolerance and a satisfactory contact lens fit. There were no noticeable complications. Contact lens fitting after LASIK is a safe and reliable procedure for improving visual acuity and reducing complications, such as ghost images or irregular corneal surface. Depending on the eccentricity and therefore on the preoperative refraction, contact lenses with a special back surface design can minimize problems in contact lens fitting and can improve tolerance and visual results.