Refractive Outcomes After LASIK for the Treatment of Mixed Astigmatism with the Allegretto WaveLight EX500.

INTRODUCTION: Treatment of mixed astigmatism with laser in situ keratomileusis (LASIK) is complex as the correction requires flattening the cornea in one meridian while steepening the cornea in the other meridian. The bitoric technique has become the most popular approach and has been tested across a variety of platforms. This study is the first to evaluate the results of mixed astigmatism treatment using the Allegretto WaveLight® EX500. METHODS: This study was a single-center, retrospective, noncomparative analysis of 400 eyes that underwent LASIK to correct for mixed astigmatism utilizing the EX500 excimer laser. Data on uncorrected distance visual acuity, corrected distance visual acuity, and spherical equivalent was analyzed at consecutive intervals (1, 3, 6, 9, and 12 months). Refractive measurements were used to perform a vector analysis. RESULTS: Three and 12 months postoperatively, 71% and 74% of eyes had an uncorrected distance visual acuity (UDVA) of 20/20 or better and 99% and 100% of eyes had a UDVA of 20/40 or better, respectively. The postoperative UDVA was within one line of the corrected distance visual acuity (CDVA) in 88% and 93% of eyes at 3 and 12 months, respectively. At 3 months, 78% of eyes achieved refractive astigmatism no greater than 0.50 diopters and at 12 months, 80% achieved this. The mean spherical equivalent refraction was - 0.36 ± 0.57 D at 12 months after surgery. At the 12-month follow-up, the mean refractive cylinder was reduced by 87%, from - 2.79 to - 0.37 diopters. On vector analysis, 99% of eyes had an angle of error within ± 15° from the intended target at 3 and 12 months. CONCLUSION: Treatment of mixed astigmatism using the Allegretto WaveLight® EX500 laser exceeded the industry standards of safety, efficacy, stability, and accuracy.

CHARGE Syndrome Associated with Ocular Abnormalities: A Case Report with Treatment of Amblyopia and Refractive Correction.

CHARGE syndrome is a rare genetic disorder associated with many ocular anomalies including amblyopia, strabismus and high refractive errors. It has been found that the visual acuity of patients with CHARGE syndrome is typically lower than 20/60. After reviewing the literature, there has been a lack of detailed information about the assessments of visual function. Thus, this case report illustrates the strategy plan to treat amblyopia and refractive correction for a young girl with CHARGE syndrome.

[Significant Increase in Astigmatism after Cycloplegia in Two Children].

Two cases with high corneal astigmatism and mixed astigmatism were reported. Both cases showed significantly increased astigmatism after cycloplegia. Combined with the patients' refractive error, corneal topography and wavefront aberration changes, the possible causes were analyzed. Aberration changes caused by pupil dilation, corneal astigmatism differences in different diameter ranges, and changes in lens astigmatism before and after cycloplegia may lead to increased astigmatism after cycloplegia. It was found that cycloplegic refraction may not accurately reflect the refractive status in daily life for children with high corneal astigmatism, especially mixed astigmatism. Because children need refractive correction in the state of natural pupil, it is recommended that the cycloplegic refraction result could not be directly used as prescription for such children. The final prescription should be based on the topography and the refraction result under natural pupil.

Scheimpflug topographical changes after Femtosecond LASIK for mixed astigmatism - theoretical aspects and case study.

Objective: To evaluate the corneal topographical changes after Femtosecond-LASIK surgery in eyes with mixed astigmatism. Methods: We present the analysis of the corneal Scheimpflug topographies of a patient treated with Femtosecond-LASIK technique for bilateral mixed astigmatism. Results: Three-dimensional reconstruction maps and differential anterior curvature maps were used to demonstrate the ablation profile and its stability in time. Conclusions: Visual and refractive results were very good after surgery, being topographically confirmed by the corneal reshaping which was performed as planned, the achieved ablation being stable during the one-year follow-up period.

Refractive change after mydriasis optometry combined with amblyopia treatment in children with mixed astigmatism and amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of mydriasis optometry combined with amblyopia treatment on refraction and amblyopia changes in children with mixed astigmatism and amblyopia.METHODS: Totally 163 children (289 eyes) of mixed astigmatism and amblyopia from January 2010 to May 2011 were treated.All of the patients received mydriatic optometry and spectaculars with amblyopia therapy and were followed up for 5a to observe amblyopia efficacy and refractive status changes.RESULTS: With 5a, main diameter diopter at distant vision decreased year by year, average decline in the first year was 0.55DS, 0.56DS in the second year, 0.72DS in the third year, 0.95DS in the fourth year, 1.89DS in the fifth year.The spherical equivalent changed from 1.12DS at distant to 0.78DS at near.The corrected visual acuity of all the patients at first visit was 0.2-0.8 with varying degrees amblyopia.After a 5-year treatment, it was effective in 268 eyes (92.7%), in which 165 eyes (57.1%) improved, 103 eyes (35.6%) cured, the results was better as the period of spectaculars wearing was longer.There was 36 eyes (37.5%) improved and 60 eyes (62.5%) cured in 1.50-2.50DC group;118 eyes (74.2%) improved, 41 eyes (25.8%) cured in 2.50-3.50DC group;11 eyes (32.3%) improved, 2 eyes (5.9%) cured, 21 eyes (61.8%) useless in >3.50DC Group.The differences of efficacy among the groups were significant (all P<0.05).CONCLUSION: Appropriate spectaculars is the basic for amblyopia treatment.It is effective for most children with mixed astigmatism and amblyopia to take mydriasis optometry and amblyopia treatment.

Treatment of mixed astigmatism: early clinical outcomes withWaveLight and Technolas excimer lasers.

BACKGROUND/AIM: We aimed to compare the results of WaveLight Allegretto Wave Eye-Q 400 Hz and Technolas 217z100 excimer lasers in the treatment of mixed astigmatism. MATERIALS AND METHODS: Forty-nine patients who underwent laser in situ keratomileusis for mixed astigmatism were included in this retrospective study. Twenty-eight eyes of 21 patients were treated with WaveLight and 46 eyes of 28 patients were treated with the Technolas excimer laser. The patients' visual acuities and refractive values were evaluated on postoperative day 1 and at 1 and 3 months. RESULTS: In the WaveLight and Technolas groups, cylindrical refractive errors at month 3 were -0.92 ± 0.28 D and -0.88 ± 0.46 D, respectively. Spherical equivalent values for the groups at month 3 were -0.38 ± 0.73 D and -0.33 ± 0.20 D, respectively. There was no significant difference in postoperative uncorrected distance visual acuity at month 3 between the two groups (P = 0.671). At postoperative month 3, 70% of patients treated with WaveLight and 100% of patients treated with Technolas had an uncorrected distance visual acuity of 20/25 or better (P = 0.211). CONCLUSION: There were no significant differences in refraction and visual acuity between the WaveLight and Technolas groups during a 3-month follow-up period after laser in situ keratomileusis for mixed astigmatism.

Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: long-term experience with the 400 Hz eye-Q excimer platform.

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of topography-guided ablation using the WaveLight 400 Hz excimer laser in laser-assisted in situ keratomileusis (LASIK) for hyperopia and/or hyperopic astigmatism. METHODS: We prospectively evaluated 208 consecutive LASIK cases for hyperopia with or without astigmatism using the topography-guided platform of the 400 Hz Eye-Q excimer system. The mean preoperative sphere value was +3.04 ± 1.75 (range 0.75-7.25) diopters (D) and the mean cylinder value was -1.24 ± 1.41 (-4.75-0) D. Flaps were created either with Intralase FS60 (AMO, Irvine, CA) or FS200 (Alcon, Fort Worth, TX) femtosecond lasers. Parameters evaluated included age, preoperative and postoperative refractive error, uncorrected distance visual acuity, corrected distance visual acuity, flap diameter and thickness, topographic changes, higher order aberration changes, and low contrast sensitivity. These measurements were repeated postoperatively at regular intervals for at least 24 months. RESULTS: Two hundred and two eyes were available for follow-up at 24 months. Uncorrected distance visual acuity improved from 5.5/10 to 9.2/10. At 24 (8-37) months, 75.5% of the eyes were in the ±0.50 D range and 94.4% were in the ±1.00 D range of the refractive goal. Postoperatively, the mean sphere value was -0.39 ± 0.3 and the cylinder value was -0.35 ± 0.25. Topographic evidence showed that ablation was made in the visual axis and not in the center of the cornea, thus correlating with the angle kappa. No significant complications were encountered in this small group of patients. CONCLUSION: Hyperopic LASIK utilizing the topography-guided platform of the 400 Hz Eye-Q Allegretto excimer and a femtosecond laser flap appears to be safe and effective for correction of hyperopia and/or hyperopic astigmatism. The results are impressive for refractive error correction and stability and for improvement of both uncorrected and corrected distance visual acuity.

Efficacy of different LASIK mode for the correction of mixed astigmatism / 眼科

Objective To compare the efficacy and predictability of sphere-cylinder-combined LASIK and two-zone cross-cylinder LASIK for the correction of moderate and high astigmatism.Design Prospective,comparative case series.Participants 40 eyes of 35 patients with mixed astigmatism undergoing LASIK.Methods All patients were treated with Visx Star IV LASIK system.20 eyes of 19 cases were used for sphere-cylinder combined LASIK mode and 20 eyes of 16 cases for two-zone-cross-cylinder LASIK mode.All sub- jects were followed more than 6 months.Main Outcome Measures Uncorrected visual acuity (UCVA),best spectacle-corrected visual acuity (BSCVA),spherical diopter,residual astigmatism and corneal thickness.Results For the patients who received two-zone-cross-cylinder LASIK mode,the UCVA at 6 months after surgery was 0.5 or above,and 13 eyes (65.0%) were 1.0 or above. For the patients who received sphere-cylinder-combined LASIK mode,the UCVA at 6 months after surgery was 0.5 or above,and 11 eyes (55.0%) was 1.0 or above (P=0.683).The residual astigmatism for the patients received sphere-cylinder-combined LASIK mode was (1.15?1.00)D,while for the patients received cross-cylinder LASIK mode was (1.13?0.62)D(P=0.045).The remotion depth of cornea for sphere-cylinder-combined LASIK mode and cross-cylinder LASIK mode was (36.73?13.12)?m and (15.60?6.85)?m,respectively (P= 0.031).Condusion The UCVA,residual astigmatism and corneal thickness after surgery in two-zone-cross-cylinder LASIK mode were better than that in sphere-cylinder-combined LASIK mode for the correction of moderate and high astigmatism.