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J. Frucht-Pery, F. Orucov, D. Landau, E. Strassman, A. Solomon; Long Term Control of Post-LASIK Myopic Shift in High Myopia With Topical Timolol Maleate. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5334.
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To describe the effects of topical timolol maleate on myopic regression after laser in-situ keratomielusis (LASIK).
Timolol maleate was used twice daily in 32 eyes of 19 patients (age 29.9 ± 7.9 years) who had myopic regression and decrease of visual acuity (spherical equivalent [SEQ] of -1.00 or more). The treatment began 2-36 months after uneventful LASIK, and followed up for 10-38 months. SEQ, uncorrected visual acuity (UCVA), intraocular pressure (IOP), pre-operative pachymetry, ablation depth and number of laser pulses were recorded. The main outcome measure was the SEQ reduction during treatment with topical timolol.
The pre-operative SEQ was -9.6 ± 2.9 D (range -5.75 to -14.75) in the right eye and -9.9±2.6 (range -6.87 to -14.25) in the left eye. After 2-36 months, a residual myopia of -1.87±0.77 D (range -1 to -2.75 D) was noted in 32 eyes, and topical timolol maleate was started. After 1.78 ± 1.23 months (range 1-6 months) the SEQ was reduced to -0.94 ± 0.57 D (range 0 to -1.75 D), p<0.0001 (Wilcoxon test). The UCVA improved from 0.34 ± 0.15 to 0.63 ± 0.23 (p<0.0001, Wilcoxon test). The IOP did not change and remained stable. The reduction in SEQ correlated with the pre-operative SEQ (r=-0.48, p=0.0059), and with the post-operative SEQ before treatment was started (r=-0.69, p<0.0001). It marginally correlated with the calculated residual stromal bed (r=-0.32, p=0.072), and the pre-operative central corneal thickness (r=-0.29, p=0.09). Patients who continued the timolol use maintained a lower SEQ at the last follow up visit, compared to those who decided to discontinue the treatment (-1.00 ± 0.43 D vs. -1.59 ± 0.66 D, respectively; p=0.025, Mann-Whitney test). The time between surgery and beginning of timolol treatment did not affect the SEQ reduction.
Long term treatment with topical timolol maleate reversed residual myopia and improved visual acuity after LASIK. The beneficial effect of timolol was maintained as long as the treatment continued.
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