Journal of Refractive Surgery

Femtosecond Laser–Assisted LASIK in Children With Hyperopia and Anisometropic Amblyopia: 7 Years of Follow-up

Irina Leonidovna Kulikova; Nikolay Petrovich Pashtaev; Yevgeniy Nikolayevich Batkov. Et all

PURPOSE:

To analyze clinical and functional results of femtosecond laser–assisted laser in situ keratomileusis (FSLASIK) in children with hyperopia and unilateral anisome-tropic amblyopia.

METHODS:

The study included 24 patients (24 eyes) aged 5 to 15 years. Before the surgery, the mean manifest refractive spherical equivalent (MRSE) of amblyopic eyes was +3.90 ± ۱.۶۰ diopters (D) (range: +1.50 to +6.80 D) and the mean refractive anisometropia was 3.06 ± ۱.۶۴ D (range: 0.87 to 7.50 D). Every patient had at least 1 year of ineffective traditional amblyopia treatment before surgery. The mean follow-up period was 7 years (range: 6.9 to 7.4 years).

RESULTS:

At the final follow-up visit, the mean MRSE of operated eyes was +0.41 ± ۱.۳۵ D (range: −۱.۱۳ to +3.88 D) (P < .001) and anisometropia in MRSE notation was 1.39 ± ۱.۱۵ D (range: 0.00 to 4.63 D). Postoperative spherical equivalent was within ±۰.۵۰, ±۱.۰۰, and ±۲.۰۰ D in 31%, 38%, and 92%, respectively. There were no complications. All patients showed a one to seven line gain of corrected distance visual acuity.

CONCLUSIONS:

FS-LASIK was an effective method of hyperopia correction in this cohort of children with amblyopia, resulting in reduction in anisometropia, restoration of refractive balance, and functional improvement in the amblyopic eye when traditional methods failed.

Outcomes Comparison Between Wavefront-Optimized and Topography-Guided PRK in Contralateral Eyes With Myopia and Myopic Astigmatism

Fernando Faria-Correia,; Sara Ribeiro; Bernardo T. Lopes. Et all

PURPOSE:

To compare clinical outcomes between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) photorefractive keratectomy (PRK) in fellow eyes of myopic patients.

METHODS:

Forty-six eyes of 23 patients who underwent PRK were included. WFO ablation was performed in one eye (WFO group) and TCAT in the fellow eye (TCAT group). The customized treatment plan was based on the Topolyzer Vario topography system (Alcon Laboratories, Inc) data. The patients were observed for 12 months after the procedure.

RESULTS:

One year after the surgery, there was no significant difference in the manifest refraction spherical equivalent, sphere, or cylinder variables between the two groups (P > .05). In both groups, 96% of eyes achieved an uncorrected distance visual acuity of 20/20 or better at 12 months postoperatively. Accuracy, safety, and efficacy of the refractive and visual outcomes were similar in the two groups. The postoperative higher order aberrations magnitude was lower in the TCAT group, but this was not statistically significant (P > .05). During the 12-month follow-up, no patient described any symptoms related to glare, halos, or starbursts in either eye. Other postoperative complications, such as infection or cor-neal infiltrates, did not occur in either group.

CONCLUSIONS:

TCAT and WFO ablations provided similar outcomes after PRK for myopia and myopic astigmatism correction. There were no statistically significant differences in postoperative corneal wavefront analysis.

Refractive Changes After Corneal Stromal Filler Injection for the Correction of Hyperopia

Christian M. Wertheimer; Katharina Brandt, ; Steffen Kaminsky. Et all

PURPOSE:

To evaluate a new non-ablative and adjustable procedure for laser ablative refractive corneal surgery in hyperopia using the injection of a biocompatible liquid filler material into a stromal pocket.

METHODS:

A total of 120 stromal pockets were created using a clinical femtosecond laser system in 96 rabbit corneoscleral discs and 24 whole globes. Pockets were cut at a depth of 120 or 250 µm below the epithelial surface. Hyaluronic acid was injected manually into the pocket. To determine the refractive changes, three-dimensional optical coherence tomography images and a specifically developed picture recognition Matlab (The Mathworks) routine were used.

RESULTS:

After injection, a steepening of the anterior and flattening of the posterior corneal surface was observed, which led to hyperopic correction. The two main factors determining the amount of correction were the pocket depth and the injected volume. After the pocket was homogeneously filled, an initial refractive increase was observed, followed by a linear relation between the injected volume and the refraction increase.

CONCLUSIONS:

This possible clinical protocol for controlled refraction correction of hyperopia suggests a potential readjustable clinical application.

Intrastromal Lenticule Rotation for the Treatment of High Astigmatism

Pavel Stodulka,; Jesper Hjortdal, DMSci; Martin Slovak, ME

PURPOSE:

To describe the first clinical case using intrastromal lenticule rotation to surgically correct high astigmatism in an amblyopic eye.

METHODS:

A 31-year-old woman with mixed astigmatism of +2.00 −۵.۰۰ × ۱۰° (spherical equivalent −۰.۵۰ diopters [D]) in her left eye, uncorrected distance visual acuity (UDVA) of 0.8 logMAR, and corrected distance visual acuity (CDVA) of 0.7 logMAR underwent refractive lenticule rotation surgery.

RESULTS:

Postoperative refractive astigmatism changed to 0.00 D cylinder. There was a postoperative myopic shift and her spherical equivalent refraction was −۴.۰۰ D at 1 week, −۳.۷۵ D at 1 month, and −۳.۲۵ D at 3 and 6 months. The patient noted a slight improvement in UDVA and a significant improvement in her uncorrected near visual acuity from Jaeger 13 (> 1.0 logMAR) to Jaeger 5 (0.3 logMAR) at 1 and 3 months and subsequently to Jaeger 2 (0.1 logMAR).

CONCLUSIONS:

To the best of the authors’ knowledge, this is the first clinical case of astigmatism correction using small incision lenticule extraction lenticule rotation. This case of an amblyopic eye demonstrates that the procedure is capable of correcting both corneal and refractive astigmatism, and the short-term result seems stable.