Friedman MD, Bittenson S, Brodsky L
… +5 more, Dansereau J, Gauthier V, Greco M, Johnsson F, Krauss R
J Refract Corneal Surg
· 1994 · PMID 7517315
Clinical experience has shown the emphasis erodible mask to be an effective method for performing photorefractive keratectomy (PRK) using an eyecup placed in contact with the corneal surface. A new system (OmniMed II) wh...Clinical experience has shown the emphasis erodible mask to be an effective method for performing photorefractive keratectomy (PRK) using an eyecup placed in contact with the corneal surface. A new system (OmniMed II) which incorporates the erodible mask as an element in the optical delivery system has been developed for performing photorefractive keratectomy. With this new configuration the eyecup is no longer used. We describe in detail the advantages of the erodible mask, the associated hardware of the optical delivery system, and the mask shape transfer process.
Niizuma T, Ito S, Hayashi M
… +3 more, Futemma M, Utsumi T, Ohashi K
J Refract Corneal Surg
· 1994 · PMID 7517314
Complaints after photorefractive keratectomy (PRK) include both severe pain and a decrease in quality of vision due to corneal subepithelial haze. We suspect that one of the causes of these troubles is a temperature rise...Complaints after photorefractive keratectomy (PRK) include both severe pain and a decrease in quality of vision due to corneal subepithelial haze. We suspect that one of the causes of these troubles is a temperature rise at the corneal surface during ablation. We cooled down the eye with cold balanced salt solution before and after photorefractive keratectomy. Postoperatively, this reduced severe pain, subepithelial corneal haze and any damage to the corneal endothelium.
Poirier L, Coulon P, Williamson W
… +1 more, Verin P
J Refract Corneal Surg
· 1994 · PMID 7517313
We performed an experiment with the MEL 60 excimer laser (Aesculap Meditec Technology) to demonstrate the variations of energy of the laser beam that could happen during a refractive surgical procedure. In order to quant...We performed an experiment with the MEL 60 excimer laser (Aesculap Meditec Technology) to demonstrate the variations of energy of the laser beam that could happen during a refractive surgical procedure. In order to quantify such variations, we measured the whitening of a photographic paper after a series of exposures to the laser beam with the X rite 400 B/W reflection densitometer. The energy fluctuations noted between two series of pulses averaged 11.02% (minimum 0; maximum 46). These fluctuations tended to decrease progressively during the procedure. The energy of the laser beam decreased with time. At the end of the experiment, the total loss of energy was 45.16%. These results suggest that clinically meaningful energy variations could happen during the photorefractive keratectomy and reduce refractive predictability.
Overcorrection, regression and haze are some side-effects found after excimer laser photorefractive keratectomy (PRK) for high myopia. A new method attempts to avoid photoablation through Bowman's layer, using the stroma...Overcorrection, regression and haze are some side-effects found after excimer laser photorefractive keratectomy (PRK) for high myopia. A new method attempts to avoid photoablation through Bowman's layer, using the stroma to flatten the cornea without use of a microkeratome. Manual surgical instruments such as the diamond blade, spatula, Pierce forceps, and Vannas scissors are used to remove a disc of anterior cornea. Minimal topical corticosteroids are used, avoiding the complications of prolonged corticotherapy. Six eyes underwent manual excimer laser keratomileusis-in-situ. Postoperatively, the epitheliums in these eyes initially were dry and excoriated. By the twentieth day, however, the eyes had re-epithelialized and recovered. The optical effect is the same as when keratomileusis is used. No more than three-fourths of the pre-existing myopia was used in the program as some undercorrection was desired.
BACKGROUND: Most excimer laser refractive procedures use a computer driven mechanical diaphragm to shape the laser beam. Studies are currently underway using an ablatable polymethylmethacrylate (PMMA) mask to transfer a...BACKGROUND: Most excimer laser refractive procedures use a computer driven mechanical diaphragm to shape the laser beam. Studies are currently underway using an ablatable polymethylmethacrylate (PMMA) mask to transfer a new spherical or toric curve to the cornea for the correction of myopia and astigmatism; it may leave a smoother corneal surface than diaphragm procedures. METHODS: As part of a Phase IIb FDA clinical study, 25 eyes of 25 patients underwent excimer laser photorefractive keratectomy using a hand held ablatable mask. Fifteen eyes had attempted spherical corrections of up to 6.00 diopters (D) and 10 had toric corrections of up to 6.00 D of sphere and 2.75 D of astigmatism. RESULTS: Seventy-four percent of all eyes achieved uncorrected visual acuity of 20/40 or better--86% in the spherical group and 63% in the astigmatism group. Sixty-nine percent of eyes were within +/- 1 D of the attempted correction. In eyes treated for astigmatism, mean astigmatism decreased from 1.48 D preoperatively to 0.86 D postoperatively. Approximately one half of the eyes treated for astigmatism had a decrease in cylinder of more than 0.5 D. One eye lost 2 Snellen lines of best spherical corrected visual acuity. Video keratography showed toric ablations to result in an elliptical optical zone. Analysis of centration of the procedure showed 66% of ablations centered within 1.0 mm of the center of the pupil aperture. CONCLUSIONS: The ablatable mask represents a promising modality for the treatment of eyes with both myopia and myopic astigmatism.
Gobbi PG, Carones F, Scagliotti F
… +2 more, Venturi E, Brancato R
J Refract Corneal Surg
· 1994 · PMID 7517310
BACKGROUND: Photorefractive keratectomy (PRK) using the current erodible mask technique is difficult to perform, because of the stringent requirements in the alignment of the eye to the mask and in the centration of the...BACKGROUND: Photorefractive keratectomy (PRK) using the current erodible mask technique is difficult to perform, because of the stringent requirements in the alignment of the eye to the mask and in the centration of the mask under the laser beam. The surgeon has to manually control the eye-cup over 5 degrees of freedom. If not accurately done this may lead to decentration of the ablation and bring about technical problems during treatment. The aim of this study was to find a way to improve and simplify the erodible mask procedure. METHOD: We used a modified non-contact mask eye-cup with a rigid mechanical support to obtain a precise and reliable positioning in space of the mask itself. Eye centration over the pupillary aperture was obtained with conventional patient fixation on the reference aiming light, coaxial to the laser beam path, and controlled using two He-Ne beams aimed at the corneal apex. RESULTS: Good reliability was demonstrated in the first 22 eyes operated on using this technique. All the masks were ablated with good centration of the laser beam over the polymethylmethacrylate (PMMA) button, and all the treatments were satisfactorily centered over the pupillary aperture. No complications or side effects were encountered during the treatments. CONCLUSIONS: Compared to the conventional erodible mask procedure, this technique proved much faster to perform, was more comfortable for both patient and surgeon, and was technically easier for the operator.
Cherry PM, Tutton MK, Bell A
… +2 more, Neave C, Fichte C
J Refract Corneal Surg
· 1994 · PMID 7517309
The Summit Technology erodible mask treatment of astigmatism does not alter the keratometric astigmatism significantly, even though the refractive astigmatism appears to improve by about 50%. Myopia is satisfactorily tre...The Summit Technology erodible mask treatment of astigmatism does not alter the keratometric astigmatism significantly, even though the refractive astigmatism appears to improve by about 50%. Myopia is satisfactorily treated with the erodible mask, but there is slightly more undercorrection compared to photorefractive keratectomy (PRK) using an expanding diaphragm. Increasing the minus power in ordering the mask cylinder improves the myopia result, but not the keratometric astigmatism result. The following factors do not influence the keratometric astigmatism result: 1) The type of astigmatism (with-, against-the-rule, or oblique); 2) The initial keratometry readings; and 3) The time from the commencement of epithelial removal to laser treatment.
Photorefractive keratectomy (PRK) was performed on 91 eyes of 71 patients who had previous radial keratotomy, radial combined with astigmatic keratotomy or astigmatic keratotomy alone (refractive keratotomy). Residual my...Photorefractive keratectomy (PRK) was performed on 91 eyes of 71 patients who had previous radial keratotomy, radial combined with astigmatic keratotomy or astigmatic keratotomy alone (refractive keratotomy). Residual myopia, prior to photorefractive keratectomy, ranged from -1.50 to -8.00 D (mean -3.62) and cylinder from 0 to 2.25 D (mean 0.78). Uncorrected visual acuity was 20/40 or better in 89.7% at one year. At the 12 month follow-up 75.9% of patients were within +/- 1.00 D of intended correction.
Murta JN, Proenca R, Van Velze RA
… +1 more, Travassos A
J Refract Corneal Surg
· 1994 · PMID 7517307
Photorefractive keratectomy (PRK) was performed on 98 consecutive normal myopic eyes with the Summit OmniMed laser System. The minimum follow-up was 3 months and 31 were followed for 6 months. Preoperative myopia ranged...Photorefractive keratectomy (PRK) was performed on 98 consecutive normal myopic eyes with the Summit OmniMed laser System. The minimum follow-up was 3 months and 31 were followed for 6 months. Preoperative myopia ranged from -1.25 to -12.00 D. The myopic eyes were divided into 4 groups according to the amount of myopia: group 1 (-1.25 to -3.00 D), 17 eyes; group 2 (-3.12 to -6.00 D), 42 eyes; group 3 (-6.12 to -9.00 D), 29 eyes and group 4 (> 9.00 D), 10 eyes. In group 1 mean uncorrected visual acuity was 0.87 at 3 months, 1.0 at 6 months and all of the eyes were within 0.50 D of the attempted correction. In group 2 mean uncorrected visual acuity was 0.76 at 3 months, 0.87 at 6 months and 92.3% of the eyes were within 0.50 D of the attempted correction. In group 3 mean uncorrected visual acuity was 0.65 and 0.66 at 3 and 6 months respectively and 77.8% of eyes were within 0.50 D of the attempted refractive correction. In group 4, mean uncorrected visual acuity was 0.46 and 0.7 at 3 and 6 months, respectively, and 100% were within 0.50 D of the attempted correction. Two eyes lost 2 lines and 4 eyes gained 2 or more lines of their preoperative best spectacle corrected visual acuity. Three eyes exhibited steroid induced rise in intraocular pressure that was controlled with topical timolol. No serious complications occurred. Despite the short follow-up, photorefractive keratectomy with the 193 nm excimer laser appears to be an effective and safe treatment for the correction of myopia.
We analyzed the data from 1821 patients (2920 eyes) who received photorefractive keratectomy (PRK) to investigate the postoperative complications which cause a significant decrease in visual acuity. A corneal haze of gra...We analyzed the data from 1821 patients (2920 eyes) who received photorefractive keratectomy (PRK) to investigate the postoperative complications which cause a significant decrease in visual acuity. A corneal haze of grade 2 or more developed in 9 patients (11 eyes, 0.38%) and corticosteroid-induced ocular hypertension occurred in 3 patients (4 eyes, 0.14%). Three patients (4 eyes) who had corneal haze of grade 2 or more underwent repeated photorefractive keratectomy and one patient (2 eyes) with steroid-induced ocular hypertension underwent trabeculectomies. A decrease of best spectacle corrected visual acuity of two lines or more was detected in 7 patients (8 eyes, 0.27%), caused by irregular astigmatism, steroid-induced cataract, incidental choroidal neovascular membrane, and an unknown origin. Good predictability and stabilization after photorefractive keratectomy was maintained at the 2 year follow-up. However, some subjective symptoms were reported by many patients and some complications occurred in a minority of eyes despite the excellent visual outcome in a large majority.
Cherry PM, Tutton MK, Adhikary H
… +7 more, Banerjee D, Garston B, Hayward JM, Ramsell T, Tolia J, Chipman ML, Bell A
J Refract Corneal Surg
· 1994 · PMID 7517305
The most effective management of the pain that follows excimer laser photorefractive keratectomy (PRK) appears to be the use of topical nonsteroidal anti-inflammatory agents. A bandage contact lens for 2 days after photo...The most effective management of the pain that follows excimer laser photorefractive keratectomy (PRK) appears to be the use of topical nonsteroidal anti-inflammatory agents. A bandage contact lens for 2 days after photorefractive keratectomy is additive to pain relief. The helpfulness of patching was not confirmed. Surprisingly, drops of local anesthetic were not an efficacious means of managing the pain. This was possibly because they were not used frequently enough. The findings showed trends, but were not statistically significant.
This is a report of a study of 40 eyes in which transverse keratotomy was performed in conjunction with spherical photorefractive keratectomy. The preoperative range of myopia was -1.50 to -13.50 diopters (D). The mean a...This is a report of a study of 40 eyes in which transverse keratotomy was performed in conjunction with spherical photorefractive keratectomy. The preoperative range of myopia was -1.50 to -13.50 diopters (D). The mean attempted cylindrical correction was -1.73 D (range -0.75 to -4.00). After 6 months 47.8% achieved unaided visual acuity of 6/6, 60% achieved 6/9 or better and 75% achieved 6/12 or better. The mean postoperative spherical equivalent refraction was -0.01 D at 6 months. The mean astigmatism postoperatively was 0.32 D. A group of 179 eyes with six months follow-up after photorefractive keratectomy who had not had transverse keratotomy was compared. Their mean postoperative spherical equivalent refraction was -0.07 D and mean astigmatism was 0.21 D. Uncorrected visual acuity was 6/12 or better in 93.3%. Until there is an improvement in the mechanism of the ablatable mask this combined procedure offers patients with significant astigmatism the opportunity of achieving good visual results.
Sabetti L, Spadea L, Furcese N
… +1 more, Balestrazzi E
J Refract Corneal Surg
· 1994 · PMID 7517303
BACKGROUND: Photorefractive keratectomy (PRK) has been used to treat myopia in human eyes since 1988. METHODS: We evaluated corneal ablation depth after excimer laser myopic photorefractive keratectomy with the Summit Te...BACKGROUND: Photorefractive keratectomy (PRK) has been used to treat myopia in human eyes since 1988. METHODS: We evaluated corneal ablation depth after excimer laser myopic photorefractive keratectomy with the Summit Technology ExciMed UV200LA laser. Preoperative refraction was: mean 9.58 diopters (D) +/- 2.01, (range 6 to 17). We used ultrasound pachometry (1640 m/sec) in 40 eyes of 33 patients. Mean follow-up was of 49.5 weeks (range 16 to 76). RESULTS: The measurement of the corneal thickness showed a reduction of the initial thickness followed by an inconsistent increase caused by wound healing and tissue proliferation. CONCLUSION: The data showed no direct correlation between diopters of refractive correction and the change in corneal thickness.
John ME, Martines E, Cvintal T
… +5 more, Mellor Filho A, Soter F, Barbosa de Sousa MC, Boleyn KL, Ballew C
J Refract Corneal Surg
· 1994 · PMID 7517302
We present 3 eyes that underwent photorefractive keratectomy (PRK) for residual myopia after penetrating keratoplasty, and 1 eye that was treated for recurrent granular dystrophy and myopia following penetrating keratopl...We present 3 eyes that underwent photorefractive keratectomy (PRK) for residual myopia after penetrating keratoplasty, and 1 eye that was treated for recurrent granular dystrophy and myopia following penetrating keratoplasty. The 3 refractive eyes experienced improvements in visual acuity and refractive error through 3 months postoperative, but exhibited regression of effect after 6 months postoperative. One eye also exhibited substantial corneal haze at three months postoperative that was not responsive to steroid retreatment. The eye with granular dystrophy obtained symptomatic relief as well as improvement in vision. We tentatively conclude that the corneal transplant reacts to photorefractive keratectomy in much the same way as a normal cornea. Eyes with substantial degrees of post-graft myopia exhibit regression of refractive effect, much like high myopes following primary photorefractive keratectomy. Photorefractive was unable to prevent the recurrence of granular dystrophy in the transplanted tissue. The eyes reported here achieved only modest long-term visual and refractive improvements.
Orssaud C, Ganem S, Binaghi M
… +5 more, Patarin D, Putterman M, Viens-Bitker C, Boye A, Dufier JL
J Refract Corneal Surg
· 1994 · PMID 7517301
Beginning in March 1992, 176 eyes from 176 patients underwent photorefractive keratectomy with the Summit Technology Eximed UV200LA. This study was designed to evaluate the efficacy of this method.Beginning in March 1992, 176 eyes from 176 patients underwent photorefractive keratectomy with the Summit Technology Eximed UV200LA. This study was designed to evaluate the efficacy of this method.
Perez-Santonja JJ, Meza J, Moreno E
… +2 more, Garcia-Hernandez MR, Zato MA
J Refract Corneal Surg
· 1994 · PMID 7517300
Clinical results show that photorefractive keratectomy (PRK) offers good predictability, efficacy, and safety. However, its potential risks on the human corneal endothelium are poorly known. We report the results of a pr...Clinical results show that photorefractive keratectomy (PRK) offers good predictability, efficacy, and safety. However, its potential risks on the human corneal endothelium are poorly known. We report the results of a prospective study conducted to evaluate the corneal endothelium changes after photorefractive keratectomy. Preoperative and serial postoperative specular microscopy was performed in 14 eyes undergoing excimer laser photorefractive keratectomy. The endothelium was analyzed for a variety of parameters, including cell density, coefficient of variation in cell size, and hexagonality. The follow-up was 6 months. The mean cell density was unchanged from 2463 cells/mm2 to 2498 cells/mm2 at 6 months after photorefractive keratectomy. The coefficient of variation of cell size (polymegathism) changed from 0.303 to 0.280 at 1 month, to 0.293 at 3 months, and to 0.290 at 6 months after surgery. The changes in this parameter were statistically significant when comparing pre- versus 1 month postoperative values. The hexagonality was unchanged from 72.08% at baseline to 73.35% at 6 months. No endothelial abnormalities were found after photorefractive keratectomy. Our results suggest a cell migration from the peripheral to central cornea after photorefractive keratectomy in contact lens wearing patients prior to photorefractive keratectomy.
Tavola A, Carones F, Galli L
… +2 more, Fontanella G, Brancato R
J Refract Corneal Surg
· 1994 · PMID 7517299
BACKGROUND: The aim of this study was to assess the role of surgeons' skill on the final results of photorefractive keratectomy (PRK) in the correction of myopia. METHODS: We evaluated the results of 160 consecutive unil...BACKGROUND: The aim of this study was to assess the role of surgeons' skill on the final results of photorefractive keratectomy (PRK) in the correction of myopia. METHODS: We evaluated the results of 160 consecutive unilateral treatments performed by four surgeons in a multicenter study group, with a one year follow up. Eighty-eight patients were males (55%) and 72 females (45%). Mean age was 33.7 years (median = 33, standard deviation = 10.22, range 18-65). Attempted correction ranged between -1.50 and -15.00 D. All the eyes received topical corticosteroid therapy postoperatively. At the one year follow up, we evaluated the following: uncorrected visual acuity lines gained and refractive error (spherical equivalent) as parameters of efficacy and predictability; best spectacle corrected visual acuity loss and corneal clarity as safety parameters. We also examined the centration or decentration of the ablation zone. In order to draw up a kind of learning curve, the mean values for each parameter were calculated by arbitrarily grouping the first 10 cases of each surgeon in the first group (40 patients), the second 10 cases in the second group (40 patients) and so on. RESULTS: We found that increase in uncorrected visual acuity, final refractive error and corneal clarity appeared to improve as the surgeon became more experienced, while loss of best spectacle corrected visual acuity was not significantly influenced by increased surgical experience. CONCLUSIONS: We think experience with photorefractive keratectomy in at least 40 eyes is necessary to obtain best results.
We made a comprehensive study of 97 eyes that received photorefractive keratectomy (PRK) for myopia and followed them for one year. In 95 eyes, uncorrected visual acuity improved and best-corrected acuity remained unchan...We made a comprehensive study of 97 eyes that received photorefractive keratectomy (PRK) for myopia and followed them for one year. In 95 eyes, uncorrected visual acuity improved and best-corrected acuity remained unchanged. In eyes with myopia of more than -3.0 diopters (D), the postoperative refraction was within -1.0 D of attempted correction. Predictability decreased with higher myopia. We also examined the changes of both epithelium and endothelium with the specular microscope and found no significant changes after photorefractive keratectomy. Videokeratography showed an average of inferior decentration in most eyes by 0.51 mm +/- 0.31 (n = 60); only one clinical problem was noted--one eye experienced monocular diplopia for seven months. Pachometry showed a small percentage had corneal thinning--the amount depended on the degree of myopia. A rise in intraocular pressure over 21 mm Hg was observed in 8.9% of eyes but it was controlled without surgery. Haze was observed in most eyes, but faded gradually without significant problems. Reduced contrast sensitivity in night vision was noted and some patients experienced glare. Day vision contrast sensitivity was related to corneal haze.
Fourteen eyes treated by photorefractive keratectomy (PRK) for myopia required retreatment because of undercorrection. The mean preoperative refraction of these eyes had been -9.82 D (range 5.25 to 17.13). No eyes before...Fourteen eyes treated by photorefractive keratectomy (PRK) for myopia required retreatment because of undercorrection. The mean preoperative refraction of these eyes had been -9.82 D (range 5.25 to 17.13). No eyes before photorefractive keratectomy had low myopia, three eyes had myopia between -3.10 and -6.00 D, four were between -6.10 and -10.00 D, and seven had more than -10.00 D of myopia. Retreatment was required for manifest scars in association with regression, unresponsive to topical corticosteroids. The retreatments were performed using a Summit ExciMed UV200LA excimer laser with a dual ablation technique utilizing a phototherapeutic keratectomy followed by a photorefractive keratectomy. Follow-up ranged from 1 to 9 months. Eight eyes followed more than 3 months had a mean spherical equivalent refraction of -0.58 D (range -7.35 to +1.25).
Twenty-seven consecutive eyes of 18 patients with myopia of more than -10.00 diopters (D) were treated by photorefractive keratectomy (PRK) using the ExciMed UV200LA excimer laser and a double ablation technique in an at...Twenty-seven consecutive eyes of 18 patients with myopia of more than -10.00 diopters (D) were treated by photorefractive keratectomy (PRK) using the ExciMed UV200LA excimer laser and a double ablation technique in an attempt to achieve a refraction of plano. The preoperative mean spherical equivalent refraction was -13.32 D (standard deviation 2.54, range -10.25 to -20.50). Preoperative spectacle corrected visual acuity ranged from 6/6 to 6/60 and one eye had had two previous refractive keratotomies. Follow up ranged from 3 to 15 months (mean 8.9). At 6 months after surgery, the mean change in refraction was 11.03 D, from a preoperative mean of -13.32 D to a postoperative mean of -2.29 D. The mean keratometric flattening was 5.83 D, from a preoperative mean of 42.92 D to a postoperative mean of 39.09 D. The reason for this large difference is uncertain. At three months the mean spherical equivalent refraction was +0.07 D (SD 2.94, range -10.50 to +3.25). The 14 eyes that had achieved 12 months follow up had a mean spherical equivalent of -1.91 D (SD 3.87, range -11.00 to +2.50). Seven of these 14 eyes have been reablated for manifest scars in association with regression. All 14 eyes had best spectacle corrected visual acuity at or better than their preoperative level.