title: Astigmatism outcomes following spherical photorefractive keratectomy for myopia.
abstract: BACKGROUND
  Our aim was to examine the change in astigmatism after spherical photorefractive keratectomy (PRK). These effects are essential to optimizing photoastigmatic refractive keratectomy (PARK) to correct astigmatism to within fractions of a diopter.
  
  
  METHODS
  We retrospectively reviewed 98 eyes of 178 patients with mild to moderate myopia and cylinder < or = 1.00 diopter (D) treated with spherical PRK (VISX 20/20 STAR excimer laser system); 31 eyes had epithelium removed mechanically with a blade and 67 eyes by a laser-scrape technique.
  
  
  RESULTS
  Refractive astigmatism was reduced by greater than 0.25 D in 27 eyes (28%); refractive astigmatism was induced by greater than 0.25 D in 31 eyes (32%); the average vector-corrected difference between an eye's astigmatism before and after surgery was 0.01 +/- 0.52 D (P = .85). Eyes with high topographic astigmatism but low refractive cylinder before PRK showed an average of 0.07 +/- -0.60 D change in refractive cylinder after PRK. Refractive astigmatism of more than 0.25 D was induced in 16 eyes (44%) that received manual removal of epithelium versus 15 eyes (24%) that received laser removal of epithelium (odds ratio 2.51, P < .01).
  
  
  CONCLUSIONS
  When using PRK for astigmatism correction, refractive cylinder before surgery rather than topographic astigmatism may be the most appropriate method for targeting the astigmatism correction, especially when the two values are discordant. An unpredictable mild increase or decrease in astigmatism may be expected.
authors.affiliation: Department of Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: al-Abdulla
authors.forename: N S
authors.initials: NS
authors.lastname: Jabbur
authors.forename: T P
authors.initials: TP
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000503:physiopathology*; D003315:Cornea / Q000503:physiopathology / Q000601:surgery*; D019781:Corneal Topography; D019573:Epithelium, Corneal / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer; D008875:Middle Aged; D009216:Myopia / Q000150:complications / Q000601:surgery*; D018903:Photorefractive Keratectomy; D011379:Prognosis; D012029:Refraction, Ocular; D012086:Reoperation; D012189:Retrospective Studies