Preoperative Manifest Refraction Spherical Equivalent Research Articles

The LADAR6000: Results in Highly Myopic and Highly Astigmatic Eyes

To investigate the early clinical outcomes of the Alcon LADAR6000 system in treating two difficult patient populations: those with high myopia and those with high astigmatism. Two series of eyes were of interest and subsequently enrolled in the study. Thirty-three eyes with preoperative manifest refraction spherical equivalent (MRSE) > -6.00 diopters (D) (high myopia group) and 25 eyes with preoperative myopic astigmatism > -1.50 D (high myopic astigmatism group) were enrolled. Mean patient age was 35 years in the high myopia group and 33 years in the astigmatism group. For the high myopia group, the mean preoperative MRSE was -8.13 D (range: -6.25 to -12.5 D). For the high myopic astigmatism group, the mean preoperative astigmatism was -1.89 D (range: -1.50 to -4.50 D). All LASIK flaps were made using a femtosecond laser with superior hinge position. Stromal ablation was performed using the LADAR6000 system for conventional treatment. All eyes were targeted for emmetropia. Both groups of eyes experienced excellent clinical outcomes with 100% of eyes within +/-1.00 D of attempted correction at 1 month. For the high myopia group, mean postoperative MRSE was -0.10 D at 1 month. For the high myopic astigmatism group, mean postoperative MRSE was -0.06 D at 1 month. The LADAR6000 system produced excellent early clinical outcomes in two challenging patient groups using LASIK with femtosecond laser flaps.

Corneal Ectasia After Laser In Situ Keratomileusis in Patients Without Apparent Preoperative Risk Factors

To evaluate patients who developed ectasia with no apparent preoperative risk factors. Potential cases of patients who developed ectasia without apparent risk factors were identified by contacting participants in the Kera-Net (n = 580), ASCRS-Net (n = 450), and ISRS/AAO ISRS-Net (n = 525) internet bulletin boards from April to October 2003. Cases were included if ectasia developed after laser in situ keratomileusis in the absence of apparent preoperative risk factors. Reported cases were excluded for the following reasons: (1) calculated residual stromal bed less than 250 microm, (2) preoperative central pachymetry less than 500 microm, (3) any keratometry reading greater than 47.2 diopters (D), (4) a calculated inferior-superior value greater than 1.4, (5) more than 2 retreatments, (6) attempted initial correction greater than -12.00 D, (7) an Orbscan II "posterior float" (if obtained) greater than 50 microm, and (8) surgical/flap complications. A total of 27 eyes of 25 patients were submitted for consideration. Eight eyes (8 patients) met our inclusion criteria. Mean age was 27.7 years (range, 18-41 years). Preoperative manifest refraction spherical equivalent was -4.61 D (range, -2.00 to -8.00 D); steepest keratometric reading was 43.86 D (range, 42.50-46.40 D); keratometric astigmatism was 0.93 D (range, 0.25-1.90 D); and preoperative central pachymetry was 537 microm (range, 505-560 microm). The mean calculated ablation depth was 82.8 microm (range, 21-125.4 microm), and mean calculated residual stromal bed was 299.5 microm (range, 254-373 microm). Mean time to recognition of ectasia onset was 14.2 months (range, 3-27 months) postoperatively. At the time of ectasia diagnosis, the mean manifest refraction spherical equivalent was -1.23 D (range, +0.125 to -3.00) with a mean of 2.72 D (range, 0.75-4.00 D) of astigmatism. Ectasia can occur after an otherwise uncomplicated laser in situ keratomileusis procedure, even in the absence of apparent preoperative risk factors.

Long-term follow-up of Intacs from a single center

Purpose: To evaluate the long-term visual results in patients having Intacs placement for the correction of mild myopia. Setting: Department of Ophthalmology, Mount Sinai School of Medicine and the Mount Sinai Hospital of Mount Sinai NYU Health, New York, New York, USA. Methods: Patients with mild myopia (spherical equivalent between −0.75 and −4.50 diopters [D]) were enrolled to have Intacs placement between May 1995 and March 1999 under United States Food and Drug Administration Phase II and Phase III clinical trials for intrastromal corneal ring segments (ICRS). Six insert thicknesses were evaluated: 0.21, 0.25, 0.30, 0.35, 0.40, and 0.45 mm. The long-term results evaluated were uncorrected visual acuity (UCVA), maintenance of best spectacle-corrected visual acuity (BSCVA), predictability and stability of the refractive effect, induced manifest refraction cylinder, slitlamp findings, self-reported visual symptoms, and maintenance of mesopic contrast sensitivity. Results: One hundred fourteen eyes of 73 patients were enrolled; 113 eyes of 72 patients received Intacs. There were no serious intraoperative or postoperative complications. The mean follow-up was 17.5 months ± 8.9 (SD). At the end of this period (number of eyes evaluated = 100), the UCVA was 20/40 or better in 95 eyes (95.0%), 20/20 or better in 72 (72%), and 20/16 or better in 41 (41%). None of the 113 eyes lost 10 or more letters or 2 or more lines of preoperative BSCVA. The mean change in the cycloplegic refraction spherical equivalent for the 6 insert thicknesses was as follows: −0.75 ± 0.00 D for 0.21 mm; −1.17 ± 0.42 D for 0.25 mm; −2.00 ± 0.54 D for 0.30 mm; −2.59 ± 0.53 D for 0.35 mm; −3.09 ± 0.54 D for 0.40 mm; and −3.82±0.80 D for 0.45 mm. The refractive correction was within ±1.0 D of the predicted outcome in 103 eyes (92.0%) and within ±0.5 D in 72 eyes (63.7%). Intacs were removed from 6 eyes (5.3%). All 4 eyes for which data were available 3 months after removal returned to within ±0.5 D of their preoperative manifest refraction spherical equivalent. Intacs were exchanged because of undercorrection in 2 eyes (1.8%). These eyes gained 3 and 5 lines of UCVA 12 months and 18 months, respectively, after the exchange procedure. Overall, 85.7% (36/42) of the patients were satisfied with the results of the Intacs procedure. Conclusions: Intacs safely and effectively corrected mild myopia. Placement is a brief, easy outpatient procedure. The refractive effect was predictable and stable over long-term follow-up. Results from a limited number of removal and exchange procedures indicate that Intacs are removable and adjustable.

One year results of european multicenter study of intrastromal corneal ring segments : Part 2: complications, visual symptoms, and patient satisfaction

Purpose To assess intraoperative and postoperative complications, visual symptoms, and patient satisfaction after implantation of intrastromal corneal ring segments (ICRS®, KeraVision, Inc.) for the correction of myopia and to demonstrate the reversibility and adjustability of refractive corrections with this method. Setting Twelve European investigational sites. Methods Patients with myopia of –1.0 to –6.0 diopters (D) were assigned to receive 1 of 5 ICRS thicknesses (0.25, 0.30, 0.35, 0.40, or 0.45 mm). Complications and visual symptoms were noted, and patient satisfaction was assessed at each postoperative visit (1 and 7 days and 1, 2, 3, 6, and 12 months). Refractive data were assessed after removal or exchange of the ICRS. Results Of 163 eyes of 110 patients enrolled, 159 eyes of 107 patients were implanted with an ICRS (52 patients had bilateral implantation). Intraoperative complications occurred in 2% of eyes (4/163 eyes in 3 patients) that were withdrawn from the study: 3 eyes had anterior surface perforations and 1 had a posterior microperforation into the anterior chamber. Most patients had no visual symptoms at 12 months; symptoms usually occurred rarely or sometimes and were mild in severity. At 12 months, good or excellent patient satisfaction was reported for 94% of eyes. Twelve ICRSs (8%) were removed, mainly because of undercorrection and induced astigmatism, and 2 were exchanged. All eyes were within ±1.00 D of the preoperative manifest refraction spherical equivalent. Conclusions The ICRS was safe for correction of low to moderate myopia. Severe postoperative visual symptoms were rare, and patient satisfaction was high. The refractive correction was largely reversible.

Photorefractive keratectomy versus laser in situ keratomileusis for moderate to high myopia: A randomized prospective study

Objective This report presents the results of a randomized clinical trial of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK). Design A randomized, prospective, multicenter clinical trial. Participants A total of 220 eyes of 220 patients entered the study cohort: 105 randomized to PRK and 115 to LASIK. The mean preoperative manifest refraction spherical equivalent was −9.23 diopters (D) in the PRK group and −9.30 D in the LASIK group. Intervention All patients received a one-pass, multizone excimer laser ablation as part of either a PRK or LASIK procedure using the Summit Apex excimer laser. Attempted corrections ranged from 6.00 to 15.00 D. Main outcome measures Data on uncorrected and spectacle-corrected visual acuity, predictability, and stability of refraction, corneal haze, and flap complications were analyzed. Patients were observed for up to 6 months. Results One day after surgery, 0 (0.0%) and 3 (4.5%) eyes in the PRK group saw 20/20 and 20/40 or better uncorrected, respectively, while 7 (10%) and 48 (68.6%) eyes in the LASIK group saw 20/20 and 20/40 or better, respectively. At 6 months after PRK, 13 (19.1%) and 45 (66.2%) eyes saw 20/20 and 20/40 or better, respectively, while after LASIK, 16 (26.2%) and 34 (55.7%) eyes saw 20/20 and 20/40 or better, respectively (odds ratio = 0.56 for likelihood of uncorrected visual acuity <20/40 for PRK vs. LASIK, 95% confidence interval [CI] = 0.31–1.19). After PRK, 39 eyes (57.4%) were within 1.0 D of attempted correction compared with 24 eyes (40.7%) in the LASIK group (odds ratio = 0.50 for likelihood of undercorrection 1.0 D for PRK vs. LASIK, 95% CI = 0.24–1.04); however, the standard deviation of the predictability was similar between groups: 1.01 D for PRK and 1.22 D for LASIK. From months 1 to 6, there was an average regression of 0.89 D in the PRK group and 0.55 D in the LASIK group. After PRK, eight eyes (11.8%) had a decrease in spectacle-corrected visual acuity of two Snellen lines or more; after LASIK, two eyes (3.2%) had a decrease of two lines or more (odds ratio = 3.89 for risk of loss of spectacle-corrected visual acuity for PRK vs. LASIK, 95% CI = 0.71–21.30). Only two eyes had postoperative spectacle-corrected visual acuity less than 20/32, however. Conclusions Although improvement in uncorrected visual acuity is more rapid in LASIK than in PRK, efficacy outcomes in the longer term generally are similar between the two procedures. There is a greater tendency toward undercorrection in LASIK eyes using the specific laser and nomogram in this study, but the scatter in achieved versus attempted correction is similar, suggesting little difference in the accuracy of the two procedures. A suggestion of decreased propensity for loss of spectacle-corrected visual acuity in LASIK eyes requires further investigation.