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RA Adler, R Weinberg, H Lai, T O'Brien, J Iliff; Induction of Astigmatism Following Treatment of Hyperopia with Non-Contact Laser Thermal Keratoplasty . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2070.
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Purpose: With the increasing popularity of refractive surgery, techniques to correct hyperopia are in greater demand. Early surgical attempts at hyperopic correction were met with limited success and disappointingly unpredictable outcomes. With the introduction of Laser Thermal Keratoplasty (LTK) however, came the hope of obtaining safe, effective, and stable hyperopic refractive correction with a novel surgical approach. Methods: A retrospective analysis was conducted of eleven patients who underwent hyperopic refractive correction via LTK at the Wilmer Eye Institute between April 2001 and September 2001. Pre-operative astigmatic refractive values were compared with post-operative astigmatic values at each follow-up, from 1 day to as long as 5 months post-LTK treatment. Best-corrected visual acuity at each follow-up interval was assessed as well. Results: A total of 11 white female patients (20 eyes) aged 47-70 (meansd: 57.36.7) years were included in this study. At 1 week post-LTK, mean changes in astigmatism from pre-operative values were 0.6460.789 D (P=0.047) and 0.5650.587 D (P=0.016) in the right and left eyes, respectively. At 1 month, the mean changes were 1.1611.224 D (P=0.008) and 0.7680.385 D (P=0.016) in the right and left eyes, respectively. At 5 months, the mean changes were 0.5250.652 D (P=0.187) and 0.4000.163 D (P=0.062) in the right and left eyes, respectively. Up to 4 D of induced astigmatism was noted, however 74.2% of all person-visits demonstrated the induction of between 0.25 and 1.25 D of astigmatism. Although the magnitude of astigmatism decreased over time, all the subjects (100%) were left with a post-operative astigmatism not present pre-operatively. Conclusions: LTK represents a new strategy in hyperopic laser vision correction. Early results indicate that the correction of hyperopia via LTK is associated with the induction of unwanted astigmatism. As even low degrees of induced astigmatism can undermine desired refractive outcomes and patient satisfaction, this post-operative complication requires careful consideration by both refractive surgeons and patients prior to engaging in LTK for hyperopic correction.
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