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PubMed2003

Intrastromal corneal ring implantation for the correction of myopia: 12-month follow-up.

PURPOSE: To evaluate the efficacy, predictability, and stability of refraction obtained after intrastromal corneal ring segment (ICRS) implantation for low to moderate myopia. SETTING: Single-center clinical practice. METHODS: In this prospective 2-surgeon study, 9 patients (15 eyes) with low to moderate myopia were recruited to receive ICRS implants. RESULTS: At 1 day, 10 of the 15 eyes had an uncorrected visual acuity (UCVA) of 20/40 or better. At 12 months, all eyes had this UCVA and 66.6% had 20/25 or better. The mean manifest refraction stabilized after the first week at <-0.5 diopter (D). At 12 months, all eyes were within +/-1.0 D of the intended manifest refraction; 67% were within +/-0.5 D. Sixty percent of eyes had no change from the preoperative best corrected visual acuity; 13.3% improved by 1 line, and 26.6% lost 1 line. The postoperative complications included lamellar channel deposits (n = 12), ICRS dislocation (n = 2), corneal infiltrates (n = 2), bleeding in the positioning ring hole (n = 1), 0.3 mm segment decentration (n = 1), and prolonged wound healing (n = 1). CONCLUSIONS: Intrastromal corneal ring segment implantation for the correction of low to moderate myopia afforded good visual recovery and efficacy similar to that with laser in situ keratomileusis and superior to that with photorefractive keratectomy. However, light or blunt trauma and insufficient hygiene can have serious consequences and there is the potential for induced astigmatism. Corneal infiltrates can occur and must be treated immediately. The ring implantation technique is demanding. Advantages of ICRS implantation include rapid and stable visual recovery as well as reversibility.

Adult↗
PubMed2003

Laser-assisted subepithelial keratectomy for myopia: two-year follow-up.

PURPOSE: To assess and compare the clinical results (efficacy, safety, stability, and postoperative pain or discomfort) of laser-assisted subepithelial keratectomy (LASEK) and conventional photorefractive keratectomy (PRK) for the correction of low to moderate myopia. SETTING: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: A prospective comparative study was performed in 184 eyes of 92 patients who had surface excimer ablation for the correction of myopia. The preoperative mean spherical equivalent (MSE) was -4.65 diopters (D) +/- 3.14 (SD) (range -1.75 to -7.50 D). In each patient, LASEK was performed in 1 eye and PRK in the fellow eye by the same surgeon. The first eye treated and the surgical method used in the first eye were randomized. Both procedures were performed with the Nidek EC-5000 excimer laser using the same parameters and nomogram. The postoperative pain level, visual recovery, complications (haze), uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and refractive outcome were evaluated and compared. All eyes completed a 24-month follow-up. RESULTS: The postoperative MSE was -0.18 +/- 0.53 D in the PRK eyes and -0.33 +/- 0.46 D in the LASEK eyes. At 1 week, the mean UCVA was 0.64 +/- 0.21 and 0.87 +/- 0.23, respectively. No LASEK eye lost a line of BSCVA. There were no statistically significant differences between PRK and LASEK eyes in the safety and efficacy indices at 2 years. The mean pain level was significantly lower on days 1 to 3 in the LASEK eyes (P <.05). The mean corneal haze level was lower in the LASEK eyes (0.21) than in the PRK eyes (0.43) (P <.05). Seventy-nine patients preferred LASEK to PRK. CONCLUSIONS: Laser-assisted subepithelial keratectomy provided significantly quicker visual recovery, eliminated post-PRK pain, and reduced the haze level in eyes with low to moderate myopia compared with conventional PRK. It provided good visual and refractive outcomes. There were no serious complications.

Adolescent↗
PubMed2003

Laser-assisted subepithelial keratectomy enhancement of residual myopia after primary myopic LASEK: six-month results in 10 eyes.

PURPOSE: To determine whether residual myopia after primary laser-assisted subepithelial keratectomy (LASEK) can be corrected by repeated LASEK and whether this procedure is safe and effective. SETTING: University Eye Clinic, University of Regensburg, Regensburg, Germany. METHODS: Laser-assisted subepithelial keratectomy was performed in 10 eyes that had had primary LASEK for myopia. The initial mean spherical equivalent (SE) was -6.2 diopters (D) (range -2.5 to -8.0 D), and the residual mean SE was -1.6 D (range -1.0 to -3.0 D). The retreatment ratio was 7.6%. The exposure time of the corneal epithelium to alcohol (20% ethanol) was 30 seconds plus an additional 10 to 15 seconds in cases of strong epithelial adherence. Laser ablation was performed with a Keracor 117 excimer laser (Chiron Technolas). The follow-up after the second LASEK treatment was 6 months. RESULTS: The epithelial flap for repeated LASEK was successfully created in all 10 eyes. The postoperative course in the eyes was uneventful. Six months after LASEK enhancement, the SE refraction was within +/-0.5 D in all eyes. No eye lost more than 1 line of best corrected visual acuity, and the uncorrected visual acuity was 20/20 or better in 8 eyes. Significant haze was not observed after repeated LASEK (mean 0.35 before and 6 months after LASEK enhancement). CONCLUSIONS: Laser-assisted subepithelial keratectomy enhancement appears to be safe and effective for the correction of residual myopia after primary LASEK. Repeated epithelial flap preparation is possible without technical modifications.

Adult↗
PubMed2003

Angle-supported phakic intraocular lenses in eyes with keratoconus and myopia.

PURPOSE: To evaluate the visual results and complications of angle-supported phakic intraocular lenses (IOLs) to correct myopia associated with early-stage keratoconus. SETTING: Private practice, Siena, Italy. METHODS: In a prospective noncomparative single-surgeon interventional case series, outcomes in 12 consecutive eyes of 8 patients with stage I to II keratoconus, myopia from -6.50 to -14.00 diopters (D), and astigmatism from -1.00 to -5.00 D were analyzed after the implantation of angle-supported phakic IOLs (ZSAL-4, Morcher). The minimum follow-up was 12 months. Implantation was performed through a sclerocorneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, after which a surgical basal iridectomy was created. RESULTS: The spherical error in all cases was corrected within +/-1.00 D. Astigmatism magnitude did not significantly improve. The uncorrected visual acuity (UCVA) was 20/40 or better in all cases. The best spectacle-corrected visual acuity (BSCVA) was equal or improved in all cases. The safety index (postoperative BSCVA/preoperative BSCVA) was 1.18; the efficacy index (postoperative UCVA/preoperative BSCVA) was 0.77. Three eyes had significant halos that improved considerably over 3 months. Spectacles were permanently used by 1 patient (2 eyes in the study) and only for driving by 5 patients. Complications were limited to 3 cases of mild pupil ovalization and 1 case of IOL rotation. Endothelial loss at 12 months was 7.2%. CONCLUSIONS: Implantation of angle-supported phakic IOLs to correct myopia in patients with keratoconus stage I to II was an effective procedure. Although astigmatism did not improve by the creation of the incision, it was well tolerated by most patients. Long-term endothelial safety must be assessed.

Adult↗
PubMed1993

Excimer laser photorefractive keratectomy with tapered transition zone for high myopia. A preliminary report of six cases.

To improve the stability of refraction after photorefractive keratectomy (PRK) to correct myopia, we developed a new ablation profile with a 1.5 mm wide tapered transition zone bordering the refractive zone. The treated area's total diameter was 7 mm, the diameter of the refractive zone, 4 mm. The effect of the tapered transition zone on refraction stability was investigated in a 12-month follow-up study of six eyes of six patients. All eyes were partially sighted, with corresponding fundus changes and myopia of between -12.0 diopters (D) and -24.0 D. The therapeutic goal was to reduce myopia by 10.0 D to 13.0 D. All patients were treated unilaterally. The change in refraction in five eyes 12 months after surgery was < or = 1.0 D as compared with the first month postoperatively. In one case the change after 12 months was 2.75 D. There was less regression after PRK with the transition zone than with a conventional ablation profile (i.e., stability was improved). However, epithelial healing took longer.

Adult↗
PubMed1993

Ischemic optic neuropathy after intraocular lens implantation to correct high myopia in a phakic patient.

A 33-year-old patient had uncomplicated anterior chamber intraocular lens implantation (Worst-Fechner biconcave myopia lens) to correct high myopia. Immediately after surgery, she developed anterior ischemic optic neuropathy likely associated with increased intraocular pressure and systemic hypotension. To our knowledge, this is the first documented case of anterior ischemic optic neuropathy after anterior chamber intraocular lens implantation to correct high myopia in a phakic eye.

Adult↗
PubMed1995

Long-term results of surgical treatment of high myopia with Worst-Fechner intraocular lenses.

This retrospective study evaluated the results in 90 eyes that had a minuspower anterior chamber intraocular lens implanted to correct high myopia. Preoperative myopia ranged from -7.00 to -24.00 D. Postoperative spherical equivalent was -0.50 D; 80.5% of eyes were within 1.00 D of emmetropia. Two years postoperatively, no cataract formation, retinal detachment, glaucoma, or significant endothelial damage had occurred. We conclude that minus-power lenses can rapidly, safely, and predictably correct high myopia in phakic patients.

Adult↗
PubMed1995

Excimer laser photorefractive keratectomy for high myopia.

One hundred and thirty-three eyes of 103 patients had photorefractive keratectomy with a slit scan mode excimer laser for myopia ranging from -6.00 to -22.00 diopters (D). The epithelium was removed with 20% ethanol, and the ablation was done with a tapered profile surrounding the optical zone. Patients were divided into two groups based on preoperative myopia: Group A, -6.00 D to -12.00 D (88 eyes); Group B, -12.50 D to -22.00 D (45 eyes). In Group A, mean preoperative refraction was -9.59 +/- 1.79 D. Mean postoperative refraction was -0.29 +/- 1.47 D at one month, -0.85 +/- 1.68 D at three months, -1.17 +/- 2.04 D at six months, and -0.56 +/- 0.74 D at one year. Anterior stromal haze was greatest at the end of the first month; it diminished thereafter. This haze did not reduce the best corrected visual acuity in any eye in Group A. Mean preoperative refraction in Group B was -14.69 +/- 5.27 D. Mean postoperative refraction was -1.34 +/- 2.02 D at one month, -0.76 +/- 2.08 D at three months, -3.88 +/- 2.32 D at six months, and -5.50 +/- 5.00 D at one year. Three eyes in Group B lost one or two lines of best corrected visual acuity as a result of severe stromal haze and epithelial scarring. Group A's results were similar to those obtained in eyes with low myopia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effect of postoperative steroids on the refractive outcome of photorefractive keratectomy for myopia with the Summit excimer laser.

To assess the role of topical steroids following excimer laser photorefractive keratectomy (PRK) for myopia, we compared the refractive outcome in 100 eyes that did not receive steroids in the immediate postoperative period (untreated eyes) with 100 eyes that were treated with topical dexamethasone for three months postoperatively. Photorefractive keratectomy was performed with the Summit laser, using 4.3 mm and 4.5 mm ablation zones. At three months after surgery, the untreated eyes had a mean refraction of -0.97 +/- 1.15 diopters (D), significantly different (P < .01) from the mean refraction (+0.46 +/- 0.74 D) of the steroid-treated eyes. By six months postoperatively, 86% of the untreated eyes had regressed to a myopia of at least 0.50 D, whereas only 23% of the steroid-treated eyes had regressed. In a second study, we compared the results in 25 patients whose first PRK eye was treated with steroids after surgery but whose second eye was not. At three months postoperatively, mean refraction in the steroid-treated eyes was +1.23 +/- 0.71 D, significantly different (P < .01) from the mean of -0.45 +/- 1.29 D in the untreated eyes. The refractive results in PRK eyes treated with the Summit unit and with relatively small ablation zone diameters showed that eyes that received dexamethasone postoperatively were less likely to regress to myopia.

Administration, Topical↗
PubMed1996

Long-term results of clear lens extraction for severe myopia.

PURPOSE: To evaluate the efficacy and safety of clear lens extraction in the management of severe myopia. SETTING: Seoul National University Hospital, Seoul, Korea. METHODS: This retrospective study comprised 24 eyes of 16 patients who had clear lens extraction to treat myopia of 12.00 diopters (D) or more. A scleral pocket incision and continuous curvilinear capsulorhexis were made followed by lens extraction by phacoemulsification and low-power posterior chamber intraocular lens implantation. Mean follow-up was 15 months. RESULTS: Fifteen eyes (62.0%) were within 1.00 D of targeted refractive error postoperatively; 22 (91.7%) were within +2.00 D. Uncorrected visual acuity improved in all eyes. All except 1 (95.8%) gained two or more Snellen lines. Best corrected visual acuity improved in 20 eyes (83.3%); 15 (75.0%) gained two or more lines. Best corrected visual acuity after surgery was 20/40 or better in 19 eyes (79.2%), a 37.5% increase over the preoperative number. Posterior capsule opacification developed in 1 eye; a neodymium: YAG laser posterior capsulotomy was performed at 4 months postoperatively. No retinal breaks, retinal detachments, or cystoid macular edema were observed during the follow-up. CONCLUSION: Clear lens extraction was effective in correcting severe myopia; however, longer follow-up of a large number of cases is needed to fully assess possible complications.

Adult↗
PubMed1996

Keratomileusis in situ for high myopia.

PURPOSE: To examine the safety and efficacy of myopic keratomileusis in situ (automated lamellar keratoplasty) using an automated microkeratome. SETTING: Jules Stein Eye Institute and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California. METHODS: A retrospective study was done on 135 consecutive eyes of 91 patients who had keratomileusis in situ for myopia by one surgeon between October 4, 1993, and February 23, 1995. Mean preoperative myopia was 8.30 +/- 2.50 diopters (D) (range 4.50 to 20.50). Follow-up ranged from 1 (108 eyes) to 6 months (52 eyes). No eye had enhancement surgery before 3 months; eyes were dropped from the study at the time of enhancement. RESULTS: Three months after myopic keratomileusis in situ, the mean difference between attempted and achieved correction was an undercorrection of 0.90 +/- 1.50 D; 32 of 83 eyes were within 1.00 D of attempted correction. Forty eyes were undercorrected by more than 1.00 D, and 11 were overcorrected by more than 1.00 D. Uncorrected visual acuity improved to 20/40 or better in 42 of 83 eyes at 3 months. Best spectacle-corrected visual acuity (BSCVA) declined by two or more lines in 8 of 83 eyes at 3 months and 1 of 52 eyes at 6 months. In eyes with 6 months of follow-up, a mean myopic shift of 0.40 D occurred between 3 and 6 months. Two eyes had clinically significant ingrowth into the interface. The variability in outcome (standard deviation in achieved less attempted correction) at 3 months was 1.70 D in the first 45 cases, 1.20 D in the second 45 cases, and 1.10 D in the last 45 cases. CONCLUSION: Myopic keratomileusis in situ is relatively effective and safe for the correction of high myopia; however, a mild loss of BSCVA is not uncommon in the early postoperative period. Surgeon experience may be important for refractive accuracy.

Adult↗
PubMed1996

Photorefractive keratectomy for residual myopia after radial keratotomy.

PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) to treat undercorrected radial keratotomy (RK). SETTING: Instituto de Oftalmologia Tadeu Cvintal, São Paulo, Brazil. METHODS: A consecutive series of 28 eyes that had PRK to treat residual myopia after RK were studied. Refractive visual and safety data were collected and evaluated. RESULTS: One year after PRK, 75% of eyes had an uncorrected visual acuity of 20/25 or better and 85%, 20/40 or better. All but one case maintained or improved best corrected visual acuity; one case decreased from 20/25 to 20/30. At 1 year, 75% of eyes were within 0.50 diopter (D) of emmetropia and 90% were within 1.00 D. Only one case was more than 1.00 D undercorrected (-1.125 D) at 1 year. Mean pre-RK myopia was -5.90 D (range -2.00 to 11.80 D). Mean spherical equivalent improved from the residual postoperative level of -2.71 D +/- 0.86 (SD) before PRK to -0.21 +/- 0.86 D 1 to 3 months after PRK and to -0.40 +/- 0.43 D 1 year after PRK. CONCLUSION: Photorefractive keratectomy was efficacious in correcting residual myopia after RK in a group of selected patients.

Cohort Studies↗
PubMed1996

Astigmatic change 1 year after excimer laser treatment of myopia and myopic astigmatism. Melbourne Excimer Laser Group.

PURPOSE: To evaluate the surgically induced astigmatism (SIA) 1 year after excimer laser photorefractive astigmatic keratectomy (PARK) and photorefractive keratectomy (PRK). SETTING: Royal Victorian Ear and Eye Hospital, Melbourne, Australia. METHODS: This study comprised 333 PARK patients and 155 PRK patients treated with a VISX 20/20 excimer laser and followed prospectively for 12 months. Vector analysis of the change in astigmatism was used to calculate the SIA in the PRK group and the percentage of astigmatism corrected in the PARK group. RESULTS: Among patients with low cylinders astigmatic correction varied greatly, particularly in those treated for large amounts of myopia. The spherical PRK treatments yielded a mean induced postoperative astigmatism of 0.47 diopter. There was a linear relationship between this inadvertent SIA and increasing myopia. CONCLUSION: Excimer laser surgery for myopia creates a low degree of random, unpredictable SIA that may be the result of irregular epithelial thickening during postoperative healing. This creates a background noise of astigmatic change upon which the targeted astigmatic correction is superimposed.

Adult↗
PubMed1996

Posterior chamber myopia lenses in phakic eyes.

OBJECTIVE: To determine the best technique for implanting a hypernegative intraocular lens (IOL) in the posterior chamber of phakic eyes to neutralize high myopia and its results. SETTING: Robert Koch Hospital, Hannover-Gehrden, Germany. METHODS: We implanted the Chiron-Adatomed silicone myopia IOL in 69 eyes of 37 patients between June 1992 and August 1994 and followed them prospectively. RESULTS: To avoid marked decentration, the IOL should merely touch the ciliary sulcus. Its best length should equal the horizontal diameter of the cornea (white to white). Iritis from implantation trauma was avoided by intravenous administration of 250 mg prednisone preoperatively. When inserting the Chiron-Adatomed myopia IOL, we avoided putting pressure on the crystalline lens with the spatula. In 53 eyes, the difference between precalculated postoperative refraction and achieved postoperative refraction at 3 months was +0.07 +/- 1.05 diopters (D) (mean +/- SD). No eye deviated more than 2.80 D. Eleven of 69 eyes had a follow-up of fewer than 6 months and 13 had marked preoperative cortical opacities. Eight of the remaining 45 eyes with clear or almost clear cortexes showed a central subcapsular opacity after 1 to 2 years, probably IOL induced. CONCLUSION: Use of the Chiron-Adatomed IOL should be confined to older patients with early cataract until its role as the cause of opacities has been clarified by further observation.

Cataract↗
PubMed1997

Topographical analysis of ablation centration after excimer laser photorefractive keratectomy and laser in situ keratomileusis for high myopia.

PURPOSE: To evaluate the ablation centration after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for high myopia and to assess the association between decentration and best corrected visual acuity (BCVA), glare, monocular diplopia, and halo phenomenon. SETTING: Mater Private Hospital, Dublin, Ireland. METHODS: Corneal topography was used to analyze centration in two groups of patients with myopia of more than 6.0 diopters: 18 had PRK and 18, LASIK. A standardized questionnaire assessed the preoperative and postoperative prevalence of glare, monocular diplopia, and halo phenomenon. RESULTS: "Significant" ablation decentration (0.5 mm) in the LASIK group (1.33 mm) was almost twice that in the PRK group (0.75 mm). Glare increased from 27% preoperatively to 42% in the PRK group; monocular diplopia increased in the LASIK group. Halo phenomenon decreased after both procedures. CONCLUSION: Laser in situ keratomileusis represents a step forward in the surgical correction of high myopia, but the accuracy of the corneal ablation location must be improved. Suction ring fixation of the globe or real time tracking systems may help improve centration.

Adult↗
PubMed1997

Five years results of photorefractive keratectomy for myopia.

PURPOSE: To evaluate the long-term stability, complications, and causative factors in eyes that had photorefractive keratectomy (PRK) for myopia. SETTING: Kangnam St. Mary's Hospital, Seoul, Korea. METHODS: This study evaluated the results of PRK in 201 myopic eyes with a consecutive 5 year follow-up. Preoperative myopia ranged from 2.25 to 12.50 diopters (D), with astigmatism of less than 1.50 D. The Excimer laser was set to a maximum correction of -6.50 D at a 5.0 mm diameter ablation zone. Patients with more than 7.00 D of myopia had double-pass PRK with two different ablation zone sizes (5.0 and 4.5 mm). The data were statistically analyzed using polynomial regression for evaluating long-term stability and myopic regression and Cox's proportional hazard model for evaluating causative factors. RESULTS: An uncorrected visual acuity better than 20/25 was achieved in 62.4% of eyes. The main complication after PRK was myopic regression. Mean refractive error 5 years after PRK was -2.43 +/- 1.90 D. It was -1.49 +/- 0.60 D in moderately myopic eyes (less than 6.50 D) and -3.55 +/- 2.31 D in highly myopic eyes (over 7.00 D). According to our evaluation, the possible causative factors for myopic regression were pre-PRK refraction (P < .0001) and post-PRK corneal haze (P = .01); their relative risks were 3.33 and 1.93, respectively. Multivariate analysis eliminated the corneal haze factor. CONCLUSION: Myopic regression occurred as long as 5 years after PRK, with the most important factor for myopic regression being pre-PRK refraction.

Adult↗
PubMed1998

Photorefractive keratectomy for residual myopia after radial keratotomy. PRK After RK Study Group.

PURPOSE: To evaluate the visual outcomes in patients having photorefractive keratectomy (PRK) to correct residual myopia after radial keratotomy (RK). SETTING: Nine refractive surgery centers in the United States and one in South Korea. METHODS: This retrospective analysis comprised 38 eyes of 32 patients treated with PRK after RK and followed for 12 months. Analysis was based on pre-RK and pre-PRK refraction as well as response to RK (pre-RK minus pre-PRK refractions). RESULTS: Mean pre-RK and pre-PRK refractions were -8.11 diopters (D) +/- 2.92 (SD) and -4.28 +/- 2.08 D, respectively. One month after PRK, mean refraction was +0.42 +/- 1.56 D and regressed to -0.95 +/- 1.24 D at 12 months. At 12 months, 65% of eyes had an uncorrected visual acuity of 20/40 or worse, and 11.1% lost 2 or more lines of best corrected acuity. Of eyes with an original erro of -6.00 or less, 81.8% were within +/- 1.00 D of intended correction at 12 months and of those with an original error of -9.12 to -20.00 D 50.0% (P = .004). All eyes with residual (pre-PRK) errors of -3.00 D or less and 42.9% with a residual error of -6.12 to -9.00 D were within +/- 1.00 D of intended correction (P = .07). There were no statistically significant differences in the response to PRK between eyes that had an RK response of 0 to 3.00, 3.12 to 6.00, or 6.12 to 12.00 D. CONCLUSION: Patients with lower original and residual myopia achieved better visual outcomes after PRK than those with higher myopia. The amount of myopic correction achieved using RK was not predictive of the amount of myopic correction using PRK.

Adult↗
PubMed1998

Radial keratotomy for residual myopia after photorefractive keratectomy.

PURPOSE: To evaluate the safety, efficacy, and complications of radial keratotomy (RK) after photorefractive keratectomy (PRK) for myopia. SETTING: Laser Ultravision Institute. Montreal, Canada. METHODS: Surgically induced refractive and visual acuity changes were retrospectively evaluated in 14 eyes of 10 patients treated with RK after PRK. All patients had simple myopia or compound myopic astigmatism. Minimum follow-up was 6 months. RESULTS: Three eyes (21%) had one PRK, 7 (50%) had two treatments, and 4 (29%) had three. Eleven eyes (79%) required four-incision RK and 3 (21%), eight-incision RK. All patients had improved uncorrected visual acuity. Six months after the RK retreatment, there was a significant reduction in spherical equivalent of 2.93 diopters +/- 1.53 (SD) (P < .05). No intraoperative or postoperative complications occurred except overcorrection (two cases). CONCLUSION: Radial keratotomy is an effective, safe method for treating undercorrected myopia after PRK. Further study and analysis of this series of patients are planned.

Adult↗