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Comparing PRK, Microkeratome LASIK, and IntraLASIK for Correction of Post Radial Keratotomy Refractive Errors. PERRY S. BINDER, MS MD* San Diego, California. *Dr. Binder is a paid consultant to Abbott Medical Optics, Inc. and is Owner of Outcomes Analysis Software. - PowerPoint PPT Presentation
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PERRY S. BINDER, MS MD*PERRY S. BINDER, MS MD*San Diego, California
*Dr. Binder is a paid consultant to Abbott Medical Optics, Inc. *Dr. Binder is a paid consultant to Abbott Medical Optics, Inc. and is and is
Owner of Outcomes Analysis SoftwareOwner of Outcomes Analysis Software
Purpose: To evaluate three approaches to treat post-radial keratotomy refractive errors: Surface Ablation, Mechanical Microkeratome LASIK, Femtosecond LASIK (IntraLASIK).
Methods: One surgeon. Retrospective database analysis of 105 eyes that received one of the three approaches: PRK (27 eyes), microkeratome LASIK (MK) (49 eyes), IntraLASIK (IL) (29 eyes). PRK performed with out MMC; mechanical MK and IntraLase w 160 um attempted flap thickness.
Results: 51 eyes w Hyperopic astigmatism: All 3 had improved UCVA and slight loss of 1-2 lines of BSCVA. PO MRSE was -0.21, -0.46 and -0.88 for PRK, MK, IL. Increase in Mean K was 1.45 D, 1.12 D and 3.06 IL. 34 w myopic astigmatism:Smallest loss of BSCVA w IL. PO MRSE was -0.41 D, -0.51 D, and -0.46 D for PRK, MK, and IL. Reduction in Mean K was 0.53 D, 0.73 D, and 2.04 D respectively. “Pizza pie” in 7 MK and 2 IL cases. Enhancements more difficult for LASIK cases.
Conclusions: All three procedures had a loss of 1-2 lines of BSCVA but significant improvement in UCVA with similar refractive errors; greatest change in Mean K with IL. PRK had best results for hyperopic astigmatism, IL for myopic astigmatism. No clear winner between these approaches based on analysis of a heterogeneous RK population (differences in time from RK to surgery, no. of incisions, original refractive errors, patient age, previous RK enhancements, etc.)
Methods Excimer Lasers: Summit Apex Plus,
LADARVision 4000, VISX S2-4, Allegretto 200
Microkeratomes: ACS, SKBM, BD 4000
160 um flaps were attempted
Femtosecond Laser: IntraLase 10-60 kHz
160 um flaps were attempted
Surgical Indications
Under or overcorrected RK/AK eyes >5 years after surgery
No external disease
No keratometry or pupil selection
No restriction based on BSCVA
No RK/AK wound epithelializationNo RK/AK wound epithelialization
Excluded cases with diurnal refractive change Excluded cases with diurnal refractive change >1 D>1 D
Results: Eyes OperatedHyperopic Astigmatism Presented
Total
Eyes
HyperopicAstigmatis
m
MyopicAstigmatis
m
Hyperop
ia
Myopia
PRK 27 18 7 1 1
MK LASIK
49 21 15 6 5
IntraLaseLASIK
29 12 12 1 3
Totals 105
51 34 8 9
Smaller is better
Smaller is better
Steeper is better
% %
Complications
• One slipped flap w SKBM MK• Three “Pizza Pie”: 2 MK, 1 IL• Enhancements:
• PRK = 5• MK = 7• IL = 2
Conclusions: Treatment of Refractive Errors after RK
• There are many variables in the PostOp RK eye to consider; a much larger series is
required to stratify these variables• Similar improvement in Mean K, UCVA BSCVA, SphEq. • Greater Loss ≥ 2 Lines BSCVA w IL and MK
vs PRK, but numbers too small to be statistically significant• PRK best ± 0.5 D for Hyperopic Cyl; IL best
for Myopic Astigmatism• IL with fewest enhancements• No clear “Winner”