Prospective contralateral eye study to compare conventional and wavefront-guided laser in situ keratomileusis.

PURPOSE: To compare outcomes of customized/wavefront guided with conventional ablation in myopic patients with or without astigmatism undergoing laser in situ keratomileusis. METHODS: A prospective, comparative, contralateral eye study was performed. Sixty-eight eyes of 34 myopic patients with similar refractive error in both eyes were included. One eye was randomly selected to undergo conventional and the fellow eye customized ablation. Surgery was performed using the Technolas 217z laser (Bausch & Lomb, Surrey, UK). Uncorrected visual acuity, manifest refractive spherical equivalent (MRSE), astigmatism, aberrometry and contrast sensitivity were recorded pre and 3 months postoperatively. RESULTS: Mean MRSE treated in the conventional and customized groups were 3.77 ± 1.61 dioptres and -3.83 ± 1.59 dioptres respectively. Three months postoperatively there was no significant difference between the groups in mean MRSE (p = 0.99) or cylinder (p = 0.56). The factor increase in postoperative total higher order aberrations (HOAs) was less in the customized (1.32) compared with the conventional (1.54) treatment group but did not reach statistical significance (p = 0.08). Scotopic contrast sensitivity decreased significantly postoperatively in the conventional but not in the customized treatment group. CONCLUSION: Visual acuity and refractive error outcomes were similar in both treatment group and no patient preference was observed. Customized ablation was associated with a smaller but not statistically significant postoperative increase in HOAs, better preservation of scotopic contrast sensitivity, quicker treatment time and removal of less corneal tissue.

5-year prospective follow-up of Artisan phakic intraocular lenses for the correction of myopia, hyperopia and astigmatism.

AIM: To determine the efficacy and safety of Artisan phakic intraocular lenses (IOLs) for refractive error correction. METHODS: A prospective study was conducted on patients undergoing Artisan phakic IOL implantation for myopia, hyperopia or astigmatism from 2002 to 2008. Visual acuity, manifest refractive spherical equivalent (MRSE), endothelial cell counts and higher order aberrations were recorded pre- and postoperatively. RESULTS: One hundred and fifty-one (84 patients) myopic (mean MRSE -11.2 +/- 4.1 D) and 14 (7 patients) hyperopic eyes (mean MRSE 7.1 +/- 1.3 D) were treated. Twenty eyes (11 patients) had toric IOLs to correct astigmatism (mean MRSE -9.05 +/- 6.13 D, mean astigmatism 4.06 +/- 1.26 D). Three months postoperatively, mean MRSE in 37.6% of eyes was within +/-0.5 D, 61.8% within +/-1.0 D and 91.4% within +/-2.0 D. 18.5% underwent keratorefractive surgery to correct residual refractive error. A 1.56-fold increase occurred in 4th order spherical aberration. Endothelial cell loss was 1.45% at 1 year and negligible at 5 years. Fifty-four eyes (29.2%) gained one or more lines of best corrected visual acuity and no eye lost a line. CONCLUSION: Artisan phakic IOLs are safe and effective for refractive error correction.