Abstract
Purpose:
Report the visual outcomes of high hyperopic LASIK using the MEL80 excimer laser.
Methods:
Retrospective analysis of 798 consecutive high hyperopic LASIK procedures (651 patients) using the MEL80 excimer laser and either the Hansatome microkeratome or VisuMax femtosecond laser. Inclusion criteria were attempted maximum hyperopic meridian ≥+4.00D, CDVA 20/20 or better, and minimum follow-up of 1 year. Standard outcomes analysis, including contrast sensitivity, was performed for the primary procedure and including retreatments. The primary procedure was a partial correction in 160 eyes (20%), of which 81 (51%) have undergone a retreatment to date. Of the 637 eyes intended for full correction, 220 (35%) have undergone a retreatment. Prior to retreatment, epithelial thickness and residual stromal thickness were measured by Artemis VHF digital ultrasound. A retreatment was performed if the predicted residual stromal thickness was >250 µm at the location of the maximum ablation and the minimum epithelial thickness was >30 µm.
Results:
Mean attempted SEQ was +4.00±0.90D (+2.00 to +7.64D) for the primary procedure, and +4.69±1.03D (+2.00 to +9.50D) including all procedures. Mean attempted maximum hyperopic meridian including all procedures was +5.21±1.03D (+4.00 to +9.75D).Preoperatively, mean refractive astigmatism was 1.04±0.86D (0.00 to 5.25D), mean age was 51±12 years (18 to 70 years), mean average keratometry was 43.3±1.5D (38.7 to 48.3D). After all treatments, SEQ relative to the intended target was +0.10±0.69D (-2.38 to +3.46D) and was ±0.50D in 67% and ±1.00D in 89% of eyes. Over time, mean SEQ was 0.00D at 3 months (n=753), +0.11D at 6 months (n=600), +0.24D at 1 year (n=736) and +0.43D at 2 years (n=452). Postoperatively, refractive astigmatism was 0.77±0.58 D (0.00 to 3.50 D). UDVA was 20/20 or better in 76% and 20/40 or better in 98% of eyes. There was a loss of 1 line of CDVA in 26%, 2 lines in 0.5% of eyes, and no eyes lost >2 lines. Contrast sensitivity was decreased (p<0.05) by <1 patch at 3 and 6 cpd, and by 1 patch at 12 and 18 cpd. Postoperatively, mean average keratometry was 46.7±1.9D (41.0 to 52.7D). Two patients (3 eyes) experienced diurnal fluctuation in refraction proven by VHF digital ultrasound to be due to diurnal epithelial remodelling overnight and unrelated to maximum postop SimK induced (range 46.0-51.3D).
Conclusions:
LASIK for hyperopia up to +9.50 D with the MEL80 excimer laser was found to be safe, effective and stable.
Keywords: 547 hyperopia •
683 refractive surgery: LASIK