Abstract
To examine the refractive and visual outcome of laser-assisted subepithelial keratomileusis (LASEK) with mitomycin C(MMC) in eyes with myopic astigmatism ≥2.00 diopters (D). This study comprised 82 eyes of 82 consecutive patients (37 male, 45 female; mean age at surgery 34.7 ± 9.0 years) with preoperative topographic astigmatism ≥2.00 D and mean preoperative spherical equivalent (SE) −4.50 ± 1.13 D. To assess whether the refractive results differed with the amount of corrected sphere, the data were separated by preoperative SE thereby defining two groups with SE < −5.00 D (−2.00 to −4.75 D) and ≥−5.00 D (−5.00 to −7.75 D). Mean manifest refraction spherical equivalent (MRSE) of −0.39 ± 0.52 D was obtained at the 6-months (5.4 ± 1.6 months) follow-up. The results were within ±1.00 D of the attempted correction in 89 % of patients. The mean postoperative corrected distant visual acuity was −0.02 ± 0.065 logMAR (range −0.10 to 0.15 logMAR). Sixty-seven (81.7 %) of all eyes did not change lines in safety. There was no statistically significant difference (P = 0.262) in safety between the SE groups. Mean efficacy was 0.89 ± 0.27. There was a statistically significant difference in efficacy (P = 0.024) between the preoperative SE groups. Larger ablation zones were associated with better visual outcome, confirmed by safety, efficacy and predictability. The data reported here demonstrated that LASEK using a Zeiss MEL 80 excimer laser with an additional application of MMC is a safe and efficient technique with predictable results for the correction of eyes with myopic astigmatism ≥2.00 D.
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References
Taneri S, Zieske JD, Azar DT (2004) Evolution, techniques, clinical outcomes, and pathophysiology of LASEK: review of the literature. Surv Ophthalmol 49:576–602
Alpins NA, Goggin M (2004) Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery. Surv Ophthalmol 49:109–122
Alpins N (2002) A re-analysis of astigmatism correction. Br J Ophthalmol 86:832
Alpins N (2001) Analysis of aggregate surgically induced refractive change, prediction error, and intraocular astigmatism. J Refract Surg 17:705–707
Wolffsohn JS, Bhogal G, Shah S (2011) Effect of uncorrected astigmatism on vision. J Cataract Refract Surg 37:454–460
Dupps WJ Jr, Kohnen T, Mamalis N, Rosen ES, Koch DD, Obstbaum SA et al (2011) Standardized graphs and terms for refractive surgery results. J Cataract Refract Surg 37:1–3
Azar DT, Ang RT, Lee JB, Kato T, Chen CC, Jain S et al (2001) Laser subepithelial keratomileusis: electron microscopy and visual outcomes of flap photorefractive keratectomy. Curr Opin Ophthalmol 12:323–328
Carones F, Vigo L, Scandola E, Vacchini L (2002) Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy. J Cataract Refract Surg 28:2088–2095
Leccisotti A (2008) Mitomycin C in photorefractive keratectomy: effect on epithelialization and predictability. Cornea 27:288–291
Netto MV, Mohan RR, Ambrosio R Jr, Hutcheon AE, Zieske JD, Wilson SE (2005) Wound healing in the cornea: a review of refractive surgery complications and new prospects for therapy. Cornea 24:509–522
Huang PY, Huang PT, Astle WF, Ingram AD, Hebert A, Huang J et al (2011) Laser-assisted subepithelial keratectomy and photorefractive keratectomy for post-penetrating keratoplasty myopia and astigmatism in adults. J Cataract Refract Surg 37:335–340
Zhao LQ, Wei RL, Cheng JW, Li Y, Cai JP, Ma XY (2010) Meta-analysis: clinical outcomes of laser-assisted subepithelial keratectomy and photorefractive keratectomy in myopia. Ophthalmology 117:1912–1922
Skevas C, Katz T, Wagenfeld L, Richard G, Linke S (2013) Subjective pain, visual recovery and visual quality after LASIK, EpiLASIK (flap off) and APRK—a consecutive, non-randomized study. Graefes Arch Clin Exp Ophthalmol 251:1175–1183
Gamaly TO, El Danasoury A, El Maghraby A (2007) A prospective, randomized, contralateral eye comparison of epithelial laser in situ keratomileusis and photorefractive keratectomy in eyes prone to haze. J Refract Surg 23:S1015–S1020
Fraunfelder FW, Wilson SE (2001) Laser in situ keratomileusis versus photorefractive keratectomy in the correction of myopic astigmatism. Cornea 20:385–387
Jabbur NS, Kraff C (2005) Visx Wavefront Study Group. Wavefront-guided laser in situ keratomileusis using the WaveScan system for correction of low to moderate myopia with astigmatism: 6-months results in 277 eyes. J Cataract Refract Surg 31:1493–1501
Lee VW (2006) The LADAR6000: results in highly myopic and highly astigmatic eyes. J Refract Surg 22:S980–S982
Venter J (2005) Wavefront-guided LASIK with the NIDEK NAVEX platform for the correction of myopia and myopic astigmatism with 6-months follow-up. J Refract Surg 21:S640–S645
Aizawa D, Shimizu K, Komatsu M, Ito M, Suzuki M, Ohno K, Uozato H (2003) Clinical outcomes of wavefront-guided laser in situ keratomileusis: 6-months follow-up. J Cataract Refract Surg 29:1507–1513
Salah T, Waring GO III, el-Maghraby A, Moadel K, Grimm SB. Excimer laser in situ keratomileusis (LASIK) under a corneal flap for myopia of 2–20 D. Trans Am Ophthalmol Soc 1995;93:163–183. discussion 184–190. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312056/pdf/taos00006-0189.pdf. Accessed 16 Oct 2012
Helmy SA, Salah A, Badawy TT, Sidky AN (1996) Photorefractive keratectomyand laser in situ keratomileusis for myopia between 6.00 and 10.00 diopters. J Refract Surg 12:417–421
Frings A, Katz T, Richard G, Druchkiv V, Linke SJ (2013) Efficacy and predictability of laser in situ keratomileusis (LASIK) for low astigmatism of 0.75 diopter or less. J Cataract Refract Surg 39:366–377
Ghadhfan F, Al-Rajhi A, Wagoner MD (2007) Laser in situ keratomileusis versus surface ablation: visual outcomes and complications. J Cataract Refract Surg 33:2041–2048
Lee JB, Seong GJ, Lee JH, Seo KY, Lee YG, Kim EK (2001) Comparison of laser epithelial keratomileusis and photorefractive keratectomy for low to moderate myopia. J Cataract Refract Surg 27:565–570
Dastjerdi MH, Soong HK (2002) LASEK (laser subepithelial keratomileusis). Curr Opin Ophthalmol 13:261–263
Sakimoto T, Rosenblatt MI, Azar DT (2006) Laser eye surgery for refractive errors. Lancet 367:1432–1447
Alpins NA (1997) Vector analysis of astigmatism changes by flattening, steepening, and torque. J Cataract Refract Surg 23:1503–1514
Holladay JT, Dudeja DR, Chang J (1999) Functional vision and corneal changes after laser in situ keratomileusis determined by contrast sensitivity, glare testing, and corneal topography. J Cataract Refract Surg 25:663–669
Talamo JH, Gollamudi S, Green WR, De La Cruz Z, Filatov V, Stark WJ (1991) Modulation of corneal wound healing after excimer laser keratomileusis using topical mitomycin C and steroids. Arch Ophthalmol 109:1141–1146
Hashemi H, Taheri SM, Fotouhi A, Kheiltash A (2004) Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy in high myopia: a prospective clinical study. BMC Ophthalmol 4:12
Carones F, Vigo L, Scandola E, Vacchini L (2002) Evaluation of the prophylactic use of Mitomycin-C to inhibit haze formation after photorefractive keratectomy. J Cataract Refract Surg 28:2008–2095
Yee RW, Yee SB (2004) Update on laser subepithelial keratectomy (LASEK). Curr Opin Ophthalmol 15:333–341
Vajpayee RB, Ghate D, Sharma N, Tandon R, Titiyal JS, Pandey RM (2008) Risk factors for postoperative cylindrical prediction error after laser in situ keratomileusis for myopia and myopic astigmatism. Eye (Lond) 22:332–339
Rajan MS, O’Brart D, Jaycock P, Marshall J (2006) Effects of ablation diameter on long-term refractive stability and corneal transparency after photorefractive keratectomy. Ophthalmology 113:1798–1806
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Frings, A., Vidic, B., El-Shabrawi, Y. et al. Laser-assisted subepithelial keratomileusis with mitomycin C for myopic astigmatism ≥2.00 diopters using a Zeiss MEL 80 Excimer. Int Ophthalmol 34, 225–233 (2014). https://doi.org/10.1007/s10792-013-9819-2
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DOI: https://doi.org/10.1007/s10792-013-9819-2