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Evaluation of photorefractive keratectomy retreatments after regressed myopic laser in situ keratomileusis.

Authors: F, Carones; L, Vigo; A V, Carones; R, Brancato;

Evaluation of photorefractive keratectomy retreatments after regressed myopic laser in situ keratomileusis.

Abstract

To evaluate the results of photorefractive keratectomy (PRK) enhancements in eyes previously treated by myopic laser in situ keratomileusis (LASIK) showing an undercorrection due to either a refractive regression or a primary undercorrection, when an in-the-bed enhancement was not advisable because of residual stromal thickness limitations.Noncomparative, prospective, interventional case series.Seventeen eyes of 17 patients previously treated by LASIK for a spherical equivalent (SE) correction of -8.125 to -12.50 diopters (D; mean, -9.45 +/- 1.01 D), that after a follow-up of 6 to 14 months ended up with a refraction of -1.50 to -3.75 D (SE; mean, -2.48 +/- 0.74 D). Intended flap thickness was 160 microm for all eyes. In all cases, the residual stromal bed under the flap was considered too thin (255-305 microm) to allow an in-the-bed enhancement without exceeding an assumed safety thickness limit (250 microm).Eyes were treated by PRK at least 6 months after LASIK. The PRK ablation parameters (diameter, attempted correction) were selected to avoid theoretical flap perforation. The deepest ablation was 60 microm, for a -3.75-D correction. We used a Bausch & Lomb 217 C excimer laser (Bausch & Lomb, Rochester, New York).Refraction, uncorrected and best-corrected visual acuity (BCVA), slit-lamp evidence of corneal opacity or other visible complications, and corneal topography.Although the initial postoperative period was characterized by very satisfactory refractive results (mean SE error at 1 month, -0.04 +/- 0.37 D; range, +0.75 to -0.625 D), during follow-up, a dense haze (grade 3 and 4) developed in 14 eyes (82.3%) that induced a further myopic regression (SE, -1.725 to -5.50 D; mean, -3.11 D) and BCVA loss (two to six lines). These 14 eyes underwent a further surgical treatment to remove the severe haze at 3 to 10 months after PRK.Based on these results, we strongly advise against PRK as a possible option to correct eyes previously treated by myopic LASIK that resulted in an undercorrection.

Keywords

Adult, Male, Reoperation, Keratomileusis, Laser In Situ, Visual Acuity, Corneal Topography, Middle Aged, Refraction, Ocular, Photorefractive Keratectomy, Cornea, Postoperative Complications, Treatment Outcome, Recurrence, Myopia, Humans, Female, Lasers, Excimer, Prospective Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
74
Top 10%
Top 10%
Top 10%
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