AIM:To evaluate and compare the efficacy of the astigmatic correction achieved with laser in situ keratomileusis(LASIK)in eyes with myopic astigmatism using wavefront-guided(WFG)and wavefront-optimized(WFO)ablation pr...AIM:To evaluate and compare the efficacy of the astigmatic correction achieved with laser in situ keratomileusis(LASIK)in eyes with myopic astigmatism using wavefront-guided(WFG)and wavefront-optimized(WFO)ablation profiles.METHODS:Prospective study included 221 eyes undergoing LASIK:99 and 122 eyes with low and moderate myopic astigmatism(low and moderate myopia groups).Two subgroups were differentiated in each group according to the ablation profile:WFG subgroup,109 eyes(45/64,low/moderate myopia groups)treated using the Advanced Custom Vue platform(Abbott Medical Optics Inc.),and WFO subgroup,112 eyes(54/58,low/moderate myopia groups)treated using the EX-500 platform(Alcon).Clinical outcomes were evaluated during a 6-month follow-up,including a vector analysis of astigmatic changes.RESULTS:Significantly better postoperative uncorrected visual acuity and efficacy index was found in the WFG subgroups of each group(P≤0.041).Postoperative spherical equivalent and cylinder were significantly higher in WFO subgroups(P≤0.003).In moderate myopia group,a higher percentage of eyes with a postoperative cylinder≤0.25 D was found in the WFG subgroup(90.6%vs 65.5%,P=0.002).In low and moderate myopia groups,the difference vector was significantly higher in the WFO subgroup compared to WFG(P〈0.001).In moderate myopia group,the magnitude(P=0.008)and angle of error(P〈0.001)were also significantly higher in the WFO subgroup.Significantlyless induction of high order aberrations were found with WFG treatments in both low and moderate myopia groups(P≤0.006).CONCLUSION:A more efficacious correction of myopic astigmatism providing a better visual outcome is achieved with WFG LASIK compared to WFO LASIK.展开更多
Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery.Many different combinations of primary treatment methods and retreatment techniques have be...Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery.Many different combinations of primary treatment methods and retreatment techniques have been studied,however,few studies have investigated wavefront-optimized(WFO)technology for retreatment following primary refractive surgery.This study aimed to report the outcomes of WFO photorefractive keratectomy(PRK)retreatments of refractive error following previous laser refractive surgery with PRK,laser in situ keratomileusis(LASIK),or laser-assisted subepithelial keratectomy(LASEK).Methods:We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System(Alcon Surgical)between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center.Outcomes were recorded in terms of uncorrected distance visual acuity(UDVA),manifest refraction spherical equivalent(MRSE),corrected distance visual acuity(CDVA),and complications at 1 month(M),3 M,and 6 M post-op.Results:Seventy-eight patients(120 eyes)underwent WFO PRK retreatment during the study period.Primary surgery was surface ablation in 87 eyes(78 PRK,9 LASEK)and LASIK in 33 eyes.The mean spherical equivalent before retreatment was−0.79±0.94 D(−3.00 to 1.88 D).UDVA was≥20/20 in 69 eyes(60.0%)at 1 M,54 eyes(71.1%)at 3 M,and 27 eyes(73.0%)at 6 M follow-up.MRSE was within±0.50 D of emmetropia in 78 eyes(67.8%)at 1 M,59 eyes(77.6%)at 3 M,and 25 eyes(67.6%)at 6 M follow-up.CDVA was maintained within±1 line of pre-op in 113 of 115 eyes(98.3%)at 1 M,74 of 76 eyes(97.4%)at 3 M,and 37 eyes(100%)at 6 M follow-up.Conclusion:Although follow-up was limited beyond 3 M,WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure.Further studies are necessary to determine the long-term safety and stability of outcomes.展开更多
Background:Corneal refractive surgery for myopia results in an oblate shift with increased postoperative aberrations inversely affecting the quality of vision.Aspheric ablation profiles have been introduced to minimiz...Background:Corneal refractive surgery for myopia results in an oblate shift with increased postoperative aberrations inversely affecting the quality of vision.Aspheric ablation profiles have been introduced to minimize such a problem.The aim of this study was to compare changes in corneal asphericity,central and mid-peripheral pachymetry between the Q-value customized and the wavefront-optimized(WFO)ablation profiles.Methods:A prospective,comparative non-randomized fellow eye study was conducted.Eighty eyes of 40 eligible patients underwent femtosecond laser-assisted laser in situ keratomileusis for myopia and myopic astigmatism.In each patient,the more myopic eye was included in the custom-Q ablation experimental group and the other less myopic eye was included in the WFO control group.For the custom-Q group,the target asphericity was set to the preoperative Q-value.Corneal asphericity,central and mid-peripheral pachymetric changes and the root mean square of corneal higher-order aberrations(RMSh)were assessed 6 months following surgery.Visual and refractive outcomes were also evaluated in both platforms 6 months postoperatively.Results:The mean preoperative refractive spherical equivalent was significantly more myopic in the custom-Q group than in the WFO group(P=0.001).The mean Q-value changed from−0.2±0.1 to 0.6±0.7 and from−0.2±0.1 to 0.4±0.5 in the custom-Q and WFO groups,respectively.The oblate shift in corneal asphericity was not significantly different between both treatment groups(P=0.094).The mean ablation depth at the pupillary center was significantly greater in the custom-Q group(P=0.011),while there was no significant difference at the mid-peripheral pachymetry(P=0.256).The RMSh significantly increased in both treatment profiles(P<0.001)with no significant difference between the two groups(P=0.06).The uncorrected distance visual acuity(UDVA)and the manifest refraction spherical equivalents(MRSE)significantly improved in both treatment groups(P<0.001).Conclusions:The custom-Q treatment profile with target asphericity set at the preoperative Q-value achieved comparable outcomes vs.the WFO profile in terms of postoperative corneal asphericity and mid-peripheral pachymetry despite the greater amount of ablation,the smaller optical zone,and the resulting increase in postoperative corneal flattening in the custom-Q group.展开更多
基金Partially supported by a grant from Abbott Medical Optics
文摘AIM:To evaluate and compare the efficacy of the astigmatic correction achieved with laser in situ keratomileusis(LASIK)in eyes with myopic astigmatism using wavefront-guided(WFG)and wavefront-optimized(WFO)ablation profiles.METHODS:Prospective study included 221 eyes undergoing LASIK:99 and 122 eyes with low and moderate myopic astigmatism(low and moderate myopia groups).Two subgroups were differentiated in each group according to the ablation profile:WFG subgroup,109 eyes(45/64,low/moderate myopia groups)treated using the Advanced Custom Vue platform(Abbott Medical Optics Inc.),and WFO subgroup,112 eyes(54/58,low/moderate myopia groups)treated using the EX-500 platform(Alcon).Clinical outcomes were evaluated during a 6-month follow-up,including a vector analysis of astigmatic changes.RESULTS:Significantly better postoperative uncorrected visual acuity and efficacy index was found in the WFG subgroups of each group(P≤0.041).Postoperative spherical equivalent and cylinder were significantly higher in WFO subgroups(P≤0.003).In moderate myopia group,a higher percentage of eyes with a postoperative cylinder≤0.25 D was found in the WFG subgroup(90.6%vs 65.5%,P=0.002).In low and moderate myopia groups,the difference vector was significantly higher in the WFO subgroup compared to WFG(P〈0.001).In moderate myopia group,the magnitude(P=0.008)and angle of error(P〈0.001)were also significantly higher in the WFO subgroup.Significantlyless induction of high order aberrations were found with WFG treatments in both low and moderate myopia groups(P≤0.006).CONCLUSION:A more efficacious correction of myopic astigmatism providing a better visual outcome is achieved with WFG LASIK compared to WFO LASIK.
文摘Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery.Many different combinations of primary treatment methods and retreatment techniques have been studied,however,few studies have investigated wavefront-optimized(WFO)technology for retreatment following primary refractive surgery.This study aimed to report the outcomes of WFO photorefractive keratectomy(PRK)retreatments of refractive error following previous laser refractive surgery with PRK,laser in situ keratomileusis(LASIK),or laser-assisted subepithelial keratectomy(LASEK).Methods:We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System(Alcon Surgical)between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center.Outcomes were recorded in terms of uncorrected distance visual acuity(UDVA),manifest refraction spherical equivalent(MRSE),corrected distance visual acuity(CDVA),and complications at 1 month(M),3 M,and 6 M post-op.Results:Seventy-eight patients(120 eyes)underwent WFO PRK retreatment during the study period.Primary surgery was surface ablation in 87 eyes(78 PRK,9 LASEK)and LASIK in 33 eyes.The mean spherical equivalent before retreatment was−0.79±0.94 D(−3.00 to 1.88 D).UDVA was≥20/20 in 69 eyes(60.0%)at 1 M,54 eyes(71.1%)at 3 M,and 27 eyes(73.0%)at 6 M follow-up.MRSE was within±0.50 D of emmetropia in 78 eyes(67.8%)at 1 M,59 eyes(77.6%)at 3 M,and 25 eyes(67.6%)at 6 M follow-up.CDVA was maintained within±1 line of pre-op in 113 of 115 eyes(98.3%)at 1 M,74 of 76 eyes(97.4%)at 3 M,and 37 eyes(100%)at 6 M follow-up.Conclusion:Although follow-up was limited beyond 3 M,WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure.Further studies are necessary to determine the long-term safety and stability of outcomes.
文摘Background:Corneal refractive surgery for myopia results in an oblate shift with increased postoperative aberrations inversely affecting the quality of vision.Aspheric ablation profiles have been introduced to minimize such a problem.The aim of this study was to compare changes in corneal asphericity,central and mid-peripheral pachymetry between the Q-value customized and the wavefront-optimized(WFO)ablation profiles.Methods:A prospective,comparative non-randomized fellow eye study was conducted.Eighty eyes of 40 eligible patients underwent femtosecond laser-assisted laser in situ keratomileusis for myopia and myopic astigmatism.In each patient,the more myopic eye was included in the custom-Q ablation experimental group and the other less myopic eye was included in the WFO control group.For the custom-Q group,the target asphericity was set to the preoperative Q-value.Corneal asphericity,central and mid-peripheral pachymetric changes and the root mean square of corneal higher-order aberrations(RMSh)were assessed 6 months following surgery.Visual and refractive outcomes were also evaluated in both platforms 6 months postoperatively.Results:The mean preoperative refractive spherical equivalent was significantly more myopic in the custom-Q group than in the WFO group(P=0.001).The mean Q-value changed from−0.2±0.1 to 0.6±0.7 and from−0.2±0.1 to 0.4±0.5 in the custom-Q and WFO groups,respectively.The oblate shift in corneal asphericity was not significantly different between both treatment groups(P=0.094).The mean ablation depth at the pupillary center was significantly greater in the custom-Q group(P=0.011),while there was no significant difference at the mid-peripheral pachymetry(P=0.256).The RMSh significantly increased in both treatment profiles(P<0.001)with no significant difference between the two groups(P=0.06).The uncorrected distance visual acuity(UDVA)and the manifest refraction spherical equivalents(MRSE)significantly improved in both treatment groups(P<0.001).Conclusions:The custom-Q treatment profile with target asphericity set at the preoperative Q-value achieved comparable outcomes vs.the WFO profile in terms of postoperative corneal asphericity and mid-peripheral pachymetry despite the greater amount of ablation,the smaller optical zone,and the resulting increase in postoperative corneal flattening in the custom-Q group.
