Results of photorefractive keratectomy for low, moderate, and high myopia.

PURPOSE: To compare the predictability, safety, and stability of photorefractive keratectomy (PRK) in patient groups with low, moderate, and high myopia. The astigmatic component of these corrections was also evaluated. METHODS: In 110 patients, 110 consecutive eyes were operated with a VISX 20/20 excimer laser using standard settings and a 6 mm ablation zone for PRK. The eyes were divided into three groups. In low myopia group (N = 52) the intended correction ranged from -1.50 to -6.00 D (mean -4.28 +/- 1.29 D), in the moderate myopia group (N = 34) from -6.10 to -8.00 D (mean -7.05 +/- 0.70 D), and in the high myopia group (N = 24) from -8.10 to -11.50 D (mean -9.40 +/- 1.13 D). Twenty-seven eyes had 0.75 D of preoperative myopic astigmatism. All patients were followed for 12 months and 36% (N = 40) were available for the 24-month follow-up examination. RESULTS: At 12 months the spherical equivalent manifest refraction was within 0.50 D of intended refraction in 58% (N = 30) of eyes in the low myopia group, 50% (N = 17) in the moderate myopia group, and 29% (N = 7) in the high myopia group. Eighty-seven percent (N = 45) in low, 79% (N = 27) in moderate, and 67% (N = 16) in the high myopia group were within 1.00 D of intended refraction. At 12 months, 88% (N = 46) of the eyes with low myopia, 68% (N = 23) with moderate myopia, and 68% (N = 16) with high myopia achieved uncorrected visual acuity of 20/40 or better, while 6% (N = 16) of the eyes lost and 4% (N = 4) gained two or more lines of Snellen visual acuity. Uncorrected visual acuity of 20/20 or better at 12 months was achieved by 58% (N = 30) of low myopes, 26% (N = 9) of moderate myopes, and 33% (N = 8) of high myopes; 20/25 or better by 71% (N = 37) of low myopes, 39% (N = 13) of moderate myopes, and 42% (N = 10) of high myopes. Overcorrection (> 0.25 D) was detected at 12 months in 31% (N = 16) with low, 38% (N = 13) with moderate, and 67% (N = 16) with high baseline myopia, with statistically significant differences between the low and high myopia groups. CONCLUSION: In all groups, the safety of PRK was satisfactory, without major complications; in the high myopia group where corrections exceeded 8.0 D (mean -9.40 +/- 1.13 D) the procedure was only slightly more unpredictable than in low and moderate myopia at 1 year.

Photoastigmatic keratectomy for correction of astigmatism in corneal grafts.

BACKGROUND: The efficacy and safety of excimer laser photoastigmatic refractive keratectomy (PARK) for treatment of astigmatism after penetrating keratoplasty (PKP) was evaluated in this study. METHODS: A VisX 20/20 excimer laser was used to correct the regular astigmatic component of the grafts. The epithelium was removed manually in seven cases and in three patients with the PTK mode of the laser. The results were analyzed for uncorrected visual acuity (UCVA), best corrected acuity (BCVA), haze, and changes in the cylinder and axis. The vectorial change in astigmatism was measured using Alpins' method. RESULTS: Preoperative astigmatism ranged from 3.50 to 11.25 D (mean, 5.98 +/- 2.28) and the mean attempted correction of astigmatism was 6.28 +/- 1.56 D (range, 3.50-9.00 D). The induced reduction of net corneal astigmatism was 48.1%. The vector-corrected astigmatism, which was 6.40 +/- 3.49 D at 1 month postoperatively, was reduced at 12 months to 4.28 +/- 2.42 D. The Alpin Success Index varied in the range 0.06 to 1.0. Although the UCVA improved by > or = 2 lines in 60% of the eyes, the BCVA decreased in 40% of the eyes and three patients required a reoperation. CONCLUSION: Although PARK is relatively safe and effective in reducing post-PKP cylinder and improves UCVA, the frequently and surprisingly late-developing corneal haze often impairs the BCVA.

Effect of photorefractive keratectomy on the accuracy of pneumatonometer readings in rabbits.

PURPOSE: To determine whether measurement of intraocular pressure (IOP) using a pneumatonometer is reliable after myopic 5 or 15 D excimer laser photoablation in rabbits. METHODS: Ten rabbits underwent 5 D myopic photorefractive keratectomy (PRK) of the left eye. Another seven rabbits underwent 15 D PRK: The right eye served as a control. The diameter of each PRK was 5 mm. Rabbits were examined 2.5 to 3 months later under general anesthesia. Eyes were cannulated, and the IOP was maintained at 5 to 40 mm Hg and measured using an intracameral manometer and a pneumatonometer at each pressure level; approximately 50 pressure points were formed. Readings of the two techniques were compared. RESULTS: Linear regression analysis comparing manometric and pneumatonometric readings revealed the following data in eyes with 5 D corrections (n = 10): correlation coefficient (r) = 0.926, slope = 1.058, and intercept = -3.133. The values of the unoperated control eyes were: r = 0.900, slope = 0.962, and intercept = -1.010. The following results were obtained in eyes with 15 D photoablation (n = 7): r = 0.876, slope 1.133, and intercept -3.147. Values for the control eye were: r = 0.885, slope = 1.175, and intercept = -3.497. When the manometer and pneumatonometer readings of all animals were compared, the adjusted squared correlation coefficient was 79%. When the variabilities associated with the animals and the PRK procedure (pooled 5 and 15 D corrections) were taken into account, adjusted squared correlation coefficient increased from 8% to 87%. CONCLUSIONS: Photorefractive keratectomy as high as 15 D/5 mm had only a minor effect on pneumatonometer readings in rabbits, indicating that the elastic properties of the cornea related to the accuracy of pneumatonometry were not significantly altered. Postoperative IOP monitoring with tonometers, based on flattening of the cornea under pressure, is accurate after PRK.

Schirmer test values and the outcome of photorefractive keratectomy.

PURPOSE: To evaluate whether relative tear deficiency, indicated by low standardized Schirmer test values, influences the outcome of photorefractive keratectomy (PRK). SETTING: Department of Ophthalmology, University of Heisinki, Finland. METHODS: Sixty-two patients were pair-matched by age and attempted myopic correction. They were divided into two groups: Group 1 (n = 31) comprised patients with standardized, eye-closed Schirmer test values of < or = 6 mm/5 min; Group 2 (n = 31), patients with Schirmer test values of > or = 10 mm/5 min. None of the eyes showed clinical signs of dry eye on slitlamp examination. Follow-up was 12 months. RESULTS: At 1 year, the visual acuity was 0.5 or better in 68.4% of Group 1 eyes and in 78.9% of Group 2 eyes. In Groups 1 and 2, 55.6% of eyes and 52.6%, respectively, were within 1.50 diopter (D) of attempted correction and 83.3% and 89.5%, respectively, were within 1.00 D. At 6 months, the mean overcorrection was + 1.32 +/- 1.13 D in Group 1 and + 0.77 +/- 0.57 D in Group 2 and at 1 year, + 0.96 +/- 1.13 D and +0.58 +/- 0.37 D, respectively. There was no difference between the two groups in visual acuity and obtained refractive correction or haze score at any postoperative examination. The minor tendency toward overcorrection in Group 1 could not be confirmed statistically. CONCLUSION: Subclinical tear deficiency indicated by low Schirmer test values did not influence the PRK outcome in patients matched by age and magnitude of refractive correction.

Excimer laser phototherapeutic keratectomy for corneal diseases: a follow-up study.

We performed phototherapeutic keratectomy (PTK) in 39 eyes of 38 patients with various corneal diseases. Patients were divided into four diagnostic entities: group 1 consistent of 11 eyes with postinfectious or posttraumatic corneal scars; 15 eyes with various corneal dystrophies or keratopathies comprised group 2; group 3 consisted to two eyes with recurrent corneal erosion; and 11 eyes with either primary or recurrent pterygia composed group 4. Postoperative follow-up ranged from 3 to 15 months (mean: 9 months). The goals of PTK (visual improvement, ocular comfort, or visibility for cataract extraction) were set individually for each patient and were achieved in 19 of 38 eyes (50%); one patient was lost to follow-up. Preoperatively, best corrected visual acuity improved two or more Snellen lines in nine of 31 eyes (29%). Both cases of recurrent corneal erosions were successfully treated. One eye lost two Snellen lines because of increased irregular astigmatism after PTK. In two eyes, corneal decompensation was observed 1 month after the operation, but no other serious complications were observed. The excimer laser was combined with surgical abrasions or use of topical EDTA, with good results. The excimer laser is a valuable tool for treating anterior corneal irregularities. It can also be combined with existing surgical methods. However, results can be improved with better patient selection criteria and by evaluating PTK on the basis of visual expectations and type and location of corneal pathology.