Correlation among refractive, keratometric and topographic astigmatism after myopic photorefractive keratectomy.
BACKGROUND
Photorefrative keratectomy can be used to flatten the curvature of the anterior cornea and reduce the myopic refraction of the eye. This leads to unphysiological topographical changes of the cornea and may alter the conditions for examinations of corneal surface topography. The purpose of this study was to check for mutual agreement of three different methods of assessment of astigmatism before and after myopic photorefractive keratectomy (PRK).


METHODS
Forty-seven eyes of 28 patients (age 32.7+/-6.6 years) following PRK using an 193-nm excimer laser were included in this study. 37 eyes were treated for pure myopia (-4.9+/-2.4 D) and 10 eyes for myopic astigmatism (sphere -2.0 to -7.0 D, cylinder -1.0 to -3.0 D). Preoperatively and at 18 months postoperatively, subjective refractometry, keratometry and topography analysis were performed. The axes of topographic and keratometric cylinder were standardized periodically (180 degrees) with respect to the refractive cylinder axis.


RESULTS
Pre- and postoperatively, the absolute astigmatism values correlated highly significantly between all three methods (P< or =0.001). The mean refractive cylinder was 0.65+/-0.61 D preoperatively and 0.46+/-0.41 D postoperatively (P=0.2). The mean keratometric astigmatism was 1.14+/-0.64 D before and 0.94+/-0.50 D after PRK treatment (P=0.2). Among the three methods, the mean topographic astigmatism was the highest (P<0.001) preoperatively (1.31+/-0.56 D) and postoperatively (1.21+/-0.52 D) (P=0.3). In eyes treated for pure myopia, no difference between pre- and postoperative refractive, keratometric and topographic astigmatism was detected (P>0.5). The axes of both topographic and keratometric astigmatism correlated highly significantly with the refractive cylinder axis (R> or =30.9, P<0.0001).


CONCLUSIONS
Up to 2 years after myopic PRK, the difference between refractive and keratometric astigmatism does not differ from the preoperative value, indicating an even corneal surface. The absolute astigmatism values and the cylinder axis correlated well between subjective and objective methods of astigmatism assessment. Thus, objective measurements may be helpful in determining the cylinder component of best spectacle correction after PRK. However, topographic analysis overestimates astigmatism values systematically before and after PRK.
Nguyen
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NX
Augenklinik und Poliklinik der Universität Erlangen-Nürnberg, Germany. nhung.nguyen@augen.imed.unierlangen.de
Langenbucher
A
A
Viestenz
A
A
Küchle
M
M
Seitz
B
B
D000328:Adult; D001251:Astigmatism / Q000175:diagnosis* / Q000209:etiology; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography; D006801:Humans; D054018:Lasers, Excimer; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D015588:Observer Variation; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D012029:Refraction, Ocular; D014792:Visual Acuity