Hyperopic photorefractive keratectomy with the erodible mask and axicon system: two year follow-up.
OBJECTIVE
To evaluate efficacy and long-term stability of hyperopic photorefractive keratectomy (H-PRK) using the erodible mask and Axicon system.


METHODS
Department of Ophthalmology, St. Thomas' Hospital, London, England.


METHODS
Forty-three patients (43 eyes), with a mean preoperative refraction (spherical equivalent) of +4.54 diopters (D) (range +1.75 to +7.50 D), were treated using an Apex Plus(R) excimer laser (Summit Technology). This uses an erodible mask to ablate a 6. 50 mm diameter hyperopic correction and an Axicon to fashion a 1.50 mm blend zone around the correction. The overall ablation diameter was 9.50 mm. Follow-up was 2 years.


RESULTS
At 2 years, the mean manifest refraction was +0.16 D (range +4.125 to -4.000 D), with the induced correction appearing stable after 9 months. Based on the Munnerlyn algorithm, predictability was acceptable for corrections up to +4.50 D, with 68% of eyes within +/-1.00 D of the predicted correction. It was poorer for +6.00 D corrections, with 33% of eyes within +/-1.00 D of that expected. Patient satisfaction was high. Forty eyes (93%) had an improvement in uncorrected near visual acuity and 37 (86%), an improvement in uncorrected distance acuity. A peripheral ring of haze, 6.5 mm in diameter, appeared in all eyes 1 month postoperatively. Its intensity was maximal at 3 to 9 months and then diminished over time. There were no significant differences in measurements of the central corneal transparency at 12 and 24 months and those preoperatively. Measurements of flicker contrast sensitivity, forward light scatter (glare), and scotopic halos showed no significant differences between preoperative values and those measured after 6 months.


CONCLUSIONS
Achieved H-PRK corrections with the erodible mask and Axicon system agreed closely with the Munnerlyn algorithm, with refractive stability after 9 months. Predictability was acceptable for corrections up to +4.50 D. Axial corneal transparency was not compromised and visual performance, in terms of best spectacle-corrected visual acuity, forward light scatter, and night halos, was not impaired.
O'Brart
D P
DP
Department of Ophthalmology, United Medical and Dental Schools, St. Thomas' Hospital, London, England, UK.
Stephenson
C G
CG
Baldwin
H
H
Ilari
L
L
Marshall
J
J
D000328:Adult; D000368:Aged; D015350:Contrast Sensitivity; D003315:Cornea / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D019466:Glare; D006801:Humans; D006956:Hyperopia / Q000601:surgery*; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity