No Abstract Available.
Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy*

Objective: To present the refractive and visual outcomes of refractive surgical treatment options in high myopia. Methods This was a retrospective review of patients diagnosed with high myopia (manifest refractive spherical equivalent [MRSE] ≥-6.00D) who underwent one of the following procedures: laser-in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), phakic IOL implantation with the Staar Implantable Collamer Lens (ICL), or Alcon Cachet Phakic IOL. Eyes with best corrected distance vision of less than 20/30 due to amblyopia or other eye pathologies were excluded.
Keratomileusis, Laser In Situ ; Photorefractive Keratectomy

PURPOSE: To investigate the preoperative characteristics and postoperative change of the higher-order wavefront aberrations (HOAs) in myopic photorefractive keratectomy (PRK). METHODS: Standard PRK was performed in 39 eyes (spherical equivalent -4.71+/-1.56D) using the VISX(R) STAR S4(TM) excimer laser system. Wavefront analysis was performed preoperatively and 6 months postoperatively using the VISX(R) WaveScan(TM) aberrometer. Statistical analysis was performed to assess the preoperative characteristics of the HOAs and the PRK-induced aberrations. RESULTS: The preoperative root mean square (RMS) value of the total HOAs was 0.291 micrometer: coma 0.159 micrometer, trefoil 0.157 micrometer, spherical aberration 0.093 micrometer. Among the 3 HOAs, only the spherical aberration showed moderate magnitude negative correlation with the spherical equivalent (p=0.012) and sphere (p=0.005). The magnitude of all of the HOAs, except trefoil, were significantly increased at postoperative 6 months: total HOAs 183% (0.533 micrometer, p<0.001), spherical aberration 341% (0.317 micrometer, p<0.001), coma 185% (0.294 micrometer, p<0.001), trefoil 104% (0.163 micrometer, p=0.681). In the postoperative correlation analysis, only the PRK-induced spherical aberration showed the increase of magnitude with increasing preoperative spherical equivalent (p=0.036) and sphere (p=0.019). CONCLUSIONS: The HOAs, especially spherical aberration and coma, were increased after PRK. Among the 3 HOAs, the spherical aberration showed the greatest increase of magnitude and percent change; it also showed a positive correlation with increasing preoperative spherical equivalent and sphere. Further software improvements in the wavefront-guided surface ablations need to have a diminution of PRK-induced spherical aberration.
Coma ; Lasers, Excimer ; Lotus ; Photorefractive Keratectomy

PURPOSE: To investigate the structural changes of anterior chamber after photorefractive keratectomy in myopic eyes, we assessed the changes of anterior chamber(AC) depth, angle and correlations with ablation depth at sixth postoperative month. METHODS: We performed photorefractive keratectomy on 77 eyes of 40 patients and divided them into 3 groups by the degree of preoperative myopia; less than -4.0 diopter, between -4.0 and -6.0 diopter and greater than -6.0 diopter. We assessed the changes of AC depth and angle using Scheimpflug camera(EAS-1000, Nidek, Japan) after 6 months. RESULTS: The average preoperative AC depth and angle were 3.59+/-0.27 mm, 44.20+/-2.58 and 3.53+/-0.27 mm, 43.29+/-1.65 at sixth postoperative month. The reductions in AC depth and AC angle were statistically significant(P<0.05), and there were no differences among three myopia groups(P>0.05). The changes of both AC depth and AC angle were not affected by ablation depth(P>0.05). CONCLUSIONS: Structural changes of anterior chamber were significant 6 months after photorefractive keratectomy and the changes were not affected by degree of myopia nor by ablation depth.
Anterior Chamber* ; Humans ; Myopia ; Photorefractive Keratectomy*

PURPOSE: To assess the refractive outcomes in photorefractive keratectomy (PRK) of two eximer lasers: Broad beam and Flying spot laser. METHODS: We compared the refractive outcomes of 74 eyes (group I) treated with a VISX 20/20(excimer laser (VISX Inc. USA) using broad beam laser with those of 96 eyes (group II) treated with a Technolas 217 C-Lasik(TM) (Bausch and Lomb, USA) using flying spot laser. Each patients had been followed up for more than 6 months after surgery. RESULTS: Corneal astigmatism at preoperation were 1.25 +/- 0.62D in group I and 1.03 +/- 0.51D in group II and at postoperative 6 months, decreased to 1.12 +/- 0.53D in group I and 0.60 +/- 0.83D in group II. Manifest refraction were outside +/- 1D of spherical lens or 0.5 D of cylinder lens in 23.6 % in group I and 13.5% in group II. CONCLUSIONS: We suggests that PRK using flying spot laser effectively more reduces corneal astigmatism and provided more satisfactory predictability in refractive results than that of broad beam laser.
Astigmatism ; Diptera* ; Humans ; Lasers, Excimer* ; Photorefractive Keratectomy*

PURPOSE: To investigate the relationship of refraction, geometry of the posterior corneal surface and the residual corneal thickness after excimer laser photorefractive keratectomy. METHODS: Thirty eyes of 15 patients were treated with Star S2 Smooth Scan (VISX, U.S.A.) and followed up for 3 months. The refractive, anteroposterior changes in the posterior corneal surface and residual corneal thickness were measured using slit-scanning topography, Orbscan IIR (Orbtek, Bausch & Lomb) at 1 week preoperatively, and 1 and 3 months postoperatively. RESULTS: Mean forward shift of the posterior cornea surface was 8.83+/-1.34 micrometer, 11.53+/-4.23 micrometer and 14.70+/-3.50 micrometer at 1 week, 1 month, and 3 months respectively. Mean spherical equivalence of posterior cornea was = -7.01+/-0.31 D preoperatively; it changed to -7.17+/-0.47 D, -7.22+/-0.21 D and -7.17+/-0.6 D at 1 week, 1 month and 3 months. The degree of forward shift of posterior corneal surface is correlated with the posterior corneal refractive changes (r=-0.808, P< 0.01). The forward shift of the posterior corneal surface is correlated with the residual corneal thickness (r=-0.483, P< 0.01). CONCLUSIONS: Photorefractive keratectomy significantly influenced the forward shift of the cornea, which is correlated with the residual corneal thickness.
Cornea ; Humans ; Lasers, Excimer ; Photorefractive Keratectomy*

PURPOSE: To compare the clinical results of photorefractive keratectomy using blade and those of using brush for epithelial removal. METHODS: We have followed up the forty four eyes which were deepithelized using blade(group 1) and the forty four eyes done using brush(group 2). RESULTS: The mean follow-up months was 8.09+/-0.02 in group 1 and 8.36+/-0.91 in group 2. The percentage of eyes which uncorrected visual acuity(UCVA) is better than 20/40 was 77%, 93%, 98% in group 1 and 86%, 97%, 100% in group 2, and better than 20/25 was 31%, 75%, 93% in group 1 and 38%, 77%, 100% in group 2 at 1 week, 2 and 6 months, respectively. And there is no statistical difference between group 1 and 2(p>0.05) about the percentage of eyes with UCVA better than 20/24 and 20/25. Postoperative mean spherical equivalent(D)(Mean +/-2SD) of group 1 was 0.63+/-0.11 and that of group 2 was -0.0038+/-0.93 at 1 week. This means that group 1 was significantly(p=0.004) more overcorrected than group 2 at 1 week. The predictability of operation(the percentage of eyes of which spherical equivalent was lesser than +/-0.5D) was 43%, 50%, 57% in group 1 and 55%, 64%, 67% in group 2 at 1 week, 2, and 6 months, respectively. Group 2 showed higher predictability of operation than group 1, but there was no statistical difference. Postoperative corneal thickness and IOP changes between the two groups was not statistically different(p>0.05). CONCLUSIONS: These results show that epithelial removal during PRK using brush was less overcorrected at early postoperative period, and could get as good refractive result and uncorrected visual acuity as that using blade.
Follow-Up Studies ; Photorefractive Keratectomy ; Postoperative Period ; Visual Acuity

Patients undergoing monocular excimer laser photorefractive keratectomy (PRK) for myopic correction can develop strabismus secondary to decompensated heterophorias. We experienced a case of ocular esodeviation and diplopia that developed 8 nionths after monocular excimer laser phtorefractive keratectomy. So, we report this case with 8 review of the literature.
Diplopia ; Esotropia ; Humans ; Lasers, Excimer ; Photorefractive Keratectomy* ; Strabismus

In order to get a good visual outcome following excimer laser photorefractive keratectomy(PRK) the centration of ablation is very important. In this study, the ablation center of excimer laser PRK using VISX 20/20 B(R) with VisionKeyTM(VISX, Inc. Santa Clara, CA) was evaluated by using corneal topography. Corneal topography was performed before operation and one month after operation to 190 eyes of 123 patients. The location and distance of center of ablation from center of the entrance pupil were calculated by using EyeSys Corneal Analysis System(R) with pupil-finding software(EyeSys Laboratories, Inc. Houston, TX). Supero-nasal displacement of ablation center occurred in 84 eyes(44%) after excimer laser PRK. The mean distance was 0.33 +/- 0.21mm(range: 0.02~1.36mm). The distance less than 0.5mm was found in 157 eyes(83%) and that between 0.5mm and 0.75mm was found in 26 eyes(14%). The decentering amount following excimer laser PRK was not depending on laterality(OD vs. OS), sex, age, amount of attempted correction(6D down vs. 6D up), type of software(ver 3.20 vs. 4.01) or type of procedure(PRK vs. PARK). In contrast, the second eye receiving excimer laser PRK showed a better centration of ablation than the first eye. And the centration results improved with surgeon's experience in the most recent 50 eyes(0.28 +/- 0.16mm). However, there was no relation between amount of decentration and visual improvement. In this study, it was found that decentering of ablation center less than 0.75mm did not influence the visual outcome in excimer laser PRK.
Cornea ; Corneal Topography ; Humans ; Lasers, Excimer* ; Photorefractive Keratectomy* ; Pupil

We have studied the overcorrection, undercorrection, astigmatic change and its incidence on time sequence after the excimer laser photorefractive keratectomy, and its relation with the degree of preoperative myopia, sex, and age. The study has been done with 429 eyes which we could assess for 6 months or more after excimer laser photorefractive keratectomy of myopia from July 1993 to march 1997. Overcorrection of more than -1D was common during the early postoperative periods and then gradually decreased with time. Overcorrection has been seen in 261 eyes(60.84%) after 1 month, but only 33 eyes(13.47%) after 1 year, and 13 eyes(11.02%) after 2 years. Undercorrection has been seen in 2 eyes(0.47%) after 1 month, but 25 eyes(10.20%) after 1 year, and 20 eyes(16.95%) after 2 years. Surgically induced astigmatism increased to 0.54+/-0.84D after 10 days and then decreased 0.19+/-0.75D after 12 months. Also, surgical induced astigmatism developed 1.13+/-1.10D in 247 eyes (57.58%) after 1 month, but decreased 0.89+/-0.45D in 107 eyes(43.67%) after 12 months. The occurrence of overcorrection and undercorrection was related to the severity of preoperative myopia(p<0.05), but with sex and age, it had no statistical correlation(p>0.05). The amount of postoperative astigmatism was related to preoperative astigmatism(p<0.05), but it had no statistical correlation with the degree of preoperative myopia, age, sex, and development and increase of surgically induced astigmatism(p>0.05).
Astigmatism ; Incidence ; Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy* ; Postoperative Period