Purchase this article with an account.
K. S. Bower, D. Sediq, C. Coe, J. Edwards, J. Eaddy, C. Kuzmowych, R. Stutzman, M. Wagner, M. Mines, K. Wroblewski; Off Label but on Target: Wavefront Optimized PRK in the US Army Using the ALLEGRETTO WAVE Eye-Q Laser. Invest. Ophthalmol. Vis. Sci. 2009;50(13):582.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The ALLEGRETTO WAVE Eye-Q 400 Hz excimer laser (Wavelight AG, Erlangen, Germany) has FDA approval in the US only for LASIK. Its use in photorefractive keratectomy (PRK) is considered "off label" but is commonly performed in the US Army. The objective of this study is to evaluate safety and efficacy following PRK in over 1000 eyes using this laser platform.
Retrospective study of 610 US Army soldiers who underwent PRK between 10 Jan 2008 and 03 Nov 2008 for myopia or myopic astigmatism. LASIK cases, hyperopic treatments, and re-treatments were excluded from this review. Epithelial removal was performed with the Amoils epithelial scrubber (BRUSH) or using 20% alcohol (ETOH) for 25 to 35 seconds (surgeon preference). Prophylactic mitomycin-C (MMC) was used for treatments with ablation depth >75µ. Emmetropia was the target in all cases. All treatments were wavefront optimized (WFO) using a nomogram provided by the manufacturer. No nomogram adjustment was done during this follow-up period. Testing pre-op and at 1M, 3M, and 6M post-op included uncorrected visual acuity (UCVA), manifest refraction, best spectacle-corrected visual acuity (BSCVA), IOP, and slit lamp biomicroscopy.
1202 eyes of 610 patients, 498 (81.6%) male and 112 (18.4%) female, were analyzed. Mean age was 31.8+/-8.1 (range 19 to 57). Mean pre-op manifest spherical equivalent (MSE) was -3.48+/-1.78D (range -0.75 to -10.00D); mean CYL was 0.74+/-0.70D (range 0 to 4.50D). Epithelial removal was by BRUSH in 682/1202 (57.0%) and ETOH in 517/1202 (43.0%) of eyes. MMC was used in 225/1202 (18.7%) of eyes. There were no intraoperative complications. At 1M post-op UCVA was 20/15 or better in 26.3% and 20/20 or better in 73.0% of eyes. At 3M 55.9% and 90.8% of eyes achieved UCVA 20/15 and 20/20 or better, respectively. This improved to 68.5% 20/15 and 95.4% 20/20 by 6M post-op. At 1M BSCVA was unchanged or better in 74.8% of eyes while 26.2% lost one or more lines, most commonly due to induced astigmatism (10.5%) and dry eye (9.0%). By 6M the number who lost 1 line BSCVA was 4.2%, 67.5% were unchanged and 28.8% gained 1 or more lines BSCVA from pre-op. No eye lost more than 1 line BSCVA from any cause. At 6M MSE was +/- 0.50D in 91.9% and +/- 1.00D in 100% of eyes. There was no difference between BRUSH and ETOH in terms of visual recovery or final outcomes.
This PDF is available to Subscribers Only