title: Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes.
abstract: OBJECTIVE
  To analyze results of wavefront-guided laser vision correction retreatments performed either by lifting the original flap or by surface ablation over the flap.
  
  
  METHODS
  Optical Express, Glasgow, United Kingdom.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  This retrospective study included patients grouped according to whether they had flap lift enhancement or photorefractive keratectomy (PRK) performed over the LASIK flap. All retreatment procedures were performed with the Visx Star S4 IR excimer laser with wavefront-guided ablation profile derived from the iDesign aberrometer. Visual acuities, refractive outcomes, vector analysis of refractive cylinder and complications were analyzed in this study. The results of the last available clinical visit are presented.
  
  
  RESULTS
  This retrospective study included 290 eyes of 202 patients divided into 2 groups: 119 eyes that had flap lift enhancement (Group A), and 171 eyes in which photorefractive keratectomy (PRK) was performed over the LASIK flap (Group B). The mean follow-up was 4.0 ± 1.9 months in Group A and 4.2 ± 1.6 in Group B. The mean postoperative manifest spherical equivalent was -0.01 ± 0.35 D and +0.06 ± 0.39 D in Groups A and B, respectively. The percentage of eyes with postenhancement UDVA 20/20 or better was 87.4% in Group A and 79.5 % in Group B (P = .09). In Group A, 22 eyes (18.5%) developed epithelial ingrowth, of which surgical intervention was required in 2 eyes (1.7%). Grade 1 or less haze was noted in 9 (5.3%) eyes in Group B, and resolved in all cases within the first 6 postoperative months.
  
  
  CONCLUSIONS
  Both retreatment techniques were considered to be effective, predictable, and safe.
  
  
  BACKGROUND
  Steven C Schallhorn MD is a consultant to Abbott Medical Optics and Zeiss, and Global Medical Director for Optical Express. None of the other authors have a financial or proprietary interest in the products and materials presented in this paper.
authors.affiliation: From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom. Electronic address: scschallhorn@yahoo.com.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Schallhorn
authors.affiliation: From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Venter
authors.affiliation: From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Hannan
authors.affiliation: From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Hettinger
authors.affiliation: From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Teenan
mesh_terms: D057128:Aberrometry; D000328:Adult; D000368:Aged; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult