title: Excimer laser in situ keratomileusis under a corneal flap for myopia of 2 to 20 diopters.
abstract: OBJECTIVE
  We studied the efficacy and safety of a recent technique of keratomileusis for myopia, excimer laser in situ keratomileusis.
  
  
  METHODS
  We studied retrospectively 88 eyes of 63 patients who received excimer laser in situ keratomileusis with the Chiron Automated Corneal Shaper and the Summit OmniMed laser under a hinged corneal flap without sutures.
  
  
  RESULTS
  Mean follow-up was 5.2 months. Mean spherical equivalent of the manifest refraction before surgery was -8.24 diopters (range, -2.00 to -20.00 diopters). Mean spherical equivalent refraction after surgery was +0.22 +/- 1.42 diopters. Of 40 eyes with a baseline refraction from -2.00 to -6.00 diopters, 25 eyes (63%) had refraction within +/- 0.50 diopter of emmetropia, and 37 eyes (93%) had refraction within +/- 1.00 diopter. In eyes with baseline refraction of -6.12 to -12.00 diopters, postoperative refraction was within +/- 1.00 diopter in 19 (65%) of 29 eyes. In eyes with baseline refraction of -12.10 to -20.00 diopters, postoperative refraction was +/- 1.00 diopter in eight (43%) of 19 eyes. Overall, 64 (72.8%) of 88 eyes had a refraction within +/- 1.00 diopter after surgery. Between three weeks and five months after surgery the change in the mean spherical equivalent refraction was -0.61 diopter in the myopic direction. Uncorrected visual acuity after surgery was 20/20 or better in 31 eyes (36%) and 20/40 or better in 61 eyes (71%). Three eyes (3.6%) lost two lines or more of spectacle-corrected visual acuity, two from progressive myopic maculopathy and one from irregular astigmatism. No eyes had vision-threatening complications.
  
  
  CONCLUSIONS
  Excimer laser in situ keratomileusis under a corneal flap can be an effective method of reducing myopia between -2.00 and -20.00 diopters, with minimal complications. Current surgical algorithms need modification to improve predictability of outcome. Stability of refraction after surgery requires further study.
authors.affiliation: Medical Library, El Maghraby Eye Hospital, Jeddah, Saudi Arabia.
authors.forename: T
authors.initials: T
authors.lastname: Salah
authors.forename: G O
authors.initials: GO
authors.lastname: Waring
authors.forename: A
authors.initials: A
authors.lastname: el Maghraby
authors.forename: K
authors.initials: K
authors.lastname: Moadel
authors.forename: S B
authors.initials: SB
authors.lastname: Grimm
mesh_terms: D000293:Adolescent; D000328:Adult; D003319:Corneal Stroma / Q000502:physiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D012029:Refraction, Ocular; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity