title: Eighteen-year follow-up of hyperopic photorefractive keratectomy.
abstract: OBJECTIVE
  To investigate the long-term efficacy of hyperopic photorefractive keratectomy (PRK).
  
  
  METHODS
  University Hospital, London, United Kingdom.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Patients with a follow-up of 18 years ± 0.7 (SD) attended for examination. All had spherical corrections with a 6.5 mm optical zone and 1.5 mm blend zone.
  
  
  RESULTS
  Twenty-five patients (45 eyes) were included. The mean preoperative spherical equivalent (SE) refractive error was +4.11 ± 1.8 diopters (D) (range +1.125 to +7.25 D). Between 1 year and 18 years, in eyes that had no cataract surgery (n = 34), there was a +1.14 ± 1.48 D increase in the mean SE (P < .0002). The increase between 7.5 years and 18.0 years did not reach clinical significance (P = .1). Uncorrected distance visual acuity improved at 18 years (P < .02). Corrected distance visual acuity (CDVA) was reduced (P < .001). The efficacy index was 0.47, and the safety index was 0.83. Six eyes (18%) lost 2 lines of CDVA, of which 4 eyes had preexisting cataract. Keratometry remained stable between 1 year and 18 years (P = .2). Forty percent still had traces of peripheral haze, and 4 (9%) had Salzmann-like changes. Eleven eyes (24%) had cataract surgery and 4 (9%) had laser iridotomy. There was no evidence of ectasia.
  
  
  CONCLUSIONS
  Hyperopic PRK showed an increase in hyperopic SE between 1.0 year and 7.5 years but was generally stable thereafter. The efficacy was limited. Peripheral haze was evident in 40% of cases with Salzmann-like changes in some. Ocular comorbidity in relationship to cataract was common and reduced CDVA.
  
  
  BACKGROUND
  Dr. Marshall was a consultant to Summit Technology, Inc. No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Wagh
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Reena
authors.initials: R
authors.lastname: Dave
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. Electronic address: davidobrart@aol.com.
authors.forename: David P S
authors.initials: DP
authors.lastname: O'Brart
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Wei S
authors.initials: WS
authors.lastname: Lim
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Parul
authors.initials: P
authors.lastname: Patel
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Connan
authors.initials: C
authors.lastname: Tam
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lee
authors.affiliation: From the Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000503:physiopathology; D003315:Cornea / Q000503:physiopathology / Q000601:surgery; D003318:Corneal Opacity / Q000503:physiopathology; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology / Q000601:surgery*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018903:Photorefractive Keratectomy / Q000379:methods*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult