title: Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy.
abstract: OBJECTIVE
  To assess the use of the femtosecond laser for laser in situ keratomileusis (LASIK) in eyes with consecutive hyperopia after radial keratotomy (RK).
  
  
  METHODS
  Private ambulatory surgical center, Valencia, Spain.
  
  
  METHODS
  This prospective noncomparative interventional case series study included 13 eyes of 9 patients with secondary hyperopia after previous RK. The patients were operated on with the IntraLase femtosecond laser (IntraLase Corp.) and the Star S2 excimer laser (Visx, Inc.). Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, flap thickness, flap diameter, and complications were evaluated at 6 months.
  
  
  RESULTS
  The mean spherical equivalent (SE) decreased from 2.00 diopters (D)+/-0.40 (SD) to -0.41+/-0.61 D, with 8 eyes (61.5%) within+/-0.50 D of the targeted refraction. Twelve eyes (92.3%) had a UCVA of 20/40 or better, and 3 eyes (23.1%) lost 1 line of BSCVA. A mean change in SE of 0.10 D was observed at the 6-month follow-up. The mean flap thickness and diameter were 117+/-14 microm and 9.18+/-0.12 mm, respectively. Most complications were in eyes with more than 8 RK incisions than in eyes with 8 RK incisions. These complications were multiple intraoperative incision openings (100% versus 28.6%, respectively), interface inflammation (66.6% versus 0%, respectively), haze (83.3% versus 14.3%, respectively), and loss of BSCVA (50% versus 0%, respectively).
  
  
  CONCLUSIONS
  The femtosecond laser provided large, thin corneal flaps for hyperopic LASIK. However, the procedure should be avoided in eyes with more than 8 RK incisions because of the increased risk for multiple intraoperative incision openings, interface inflammation, haze, and loss of BSCVA.
authors.affiliation: Refractive Surgery Department, Centro Oftalmológica Marqués de Sotelo and Hospital NISA Virgen del Consuelo, Valencia, Spain. gon.munoz@ono.com
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Muñoz
authors.forename: César
authors.initials: C
authors.lastname: Albarrán-Diego
authors.forename: Hani F
authors.initials: HF
authors.lastname: Sakla
authors.forename: Jaime
authors.initials: J
authors.lastname: Javaloy
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000601:surgery*; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ; D007646:Keratotomy, Radial; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular; D013524:Surgical Flaps; D016896:Treatment Outcome; D014792:Visual Acuity