Elsevier

Ophthalmology

Volume 106, Issue 8, 1 August 1999, Pages 1461-1468
Ophthalmology

Simultaneous bilateral laser in situ keratomileusis: Safety and efficacy1

https://doi.org/10.1016/S0161-6420(99)90438-4Get rights and content

Abstract

Objective

To compare the safety and efficacy of simultaneous bilateral to sequential bilateral laser in situ keratomileusis (LASIK) surgery for the correction of myopia.

Design

Retrospective, nonrandomized, comparative trial.

Participants

A total of 2142 consecutive simultaneous and sequential bilateral myopic LASIK surgery eyes operated from March 1996 through June 1998 for the correction of myopia were reviewed.

Intervention

Two surgeons (HVG and JAV) performed myopic LASIK using the Nidek EC-5000 excimer laser and either the Chiron Automated Corneal Shaper or the Bausch & Lomb Hansatome microkeratome.

Main outcome measures

The incidence of intra- or perioperative complications for sequential and simultaneous bilateral LASIK for myopia was recorded. Refractive and visual outcomes at 3 to 6 months postoperative were analyzed. Deviations from targeted spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and retreatment rates are reported.

Results

Laser in situ keratomileusis was performed on the first eye of 1853 patients scheduled for simultaneous bilateral myopic LASIK. Of these, 28 (1.5%) first eyes had intraoperative or perioperative complications. The second eye surgery was cancelled in 11 cases, and 1842 second eyes completed simultaneous surgery; 13 (0.7%) intraoperative or perioperative complications occurred. Of these 41 complications in simultaneous cases, 1 eye lost 1 line of BCVA at 6 months follow-up. Two hundred eighty-nine patients were scheduled for sequential bilateral myopic LASIK. Five (1.8%) first eyes of the sequential cases had intraoperative complications compared with four (1.4%) sequential second eyes. There was no loss of BCVA in any sequential bilateral case with complications at a minimum at 6 months follow-up. There was no statistically significant difference between intra- and perioperative complication rates comparing simultaneous to sequential bilateral LASIK. Three to 6 months postoperative visual and refractive data were reviewed; except when comparing simultaneous first eye postoperative SE to sequential first eye, there was no statistically significant difference in refractive or visual outcomes, including deviation from targeted SE, UCVA, BCVA, and retreatment rates.

Conclusion

Simultaneous bilateral LASIK is as safe and effective as sequential surgery. Simultaneous bilateral LASIK may offer several benefits to the patient.

Section snippets

Design

We conducted a chart review of consecutive myopic bilateral simultaneous and sequential LASIK eye surgeries performed from March 1996 through June 1998. To avoid learning curve bias we excluded cases prior to March 1996, when only sequential cases were performed. The decision was made to offer bilateral simultaneous surgery once the surgeons had performed enough sequential LASIK surgeries to feel that bilateral simultaneous LASIK surgery would be a safe and effective alternative for the

Results

Since March 1996, 1853 patients were scheduled for simultaneous bilateral LASIK surgery and 289 patients for sequential bilateral LASIK surgery. Of these consecutive eyes, the mean age of patients presenting for simultaneous bilateral LASIK was 39.6 years of age and 38.2 for patients presenting for sequential surgery. In the simultaneous group, 1019 (55%) were women compared with 175 (61%) in the sequential group. The median preoperative SE for the sequential eyes was −7.19 D (range, −16.0 to

Discussion

At the Gimbel Eye Centre, LASIK was first performed in April 1995 by one surgeon (HVG). Simultaneous bilateral LASIK surgery was first performed in March 1996 (HVG); prior to March 1996, LASIK surgeries were exclusively sequential. Through February 1996, sequential bilateral surgery separated by a median of 4 days (ranging to 41 days) was performed. These eyes were operated during the learning curve by one surgeon (HVG) and included very high myopic eyes, many over 14 D, and during which time

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The authors have no proprietary or financial interest in the subject matter or materials discussed in the article.

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