LASIKsurgeryafterradialkeratotomy 窑ClinicalResearch窑 LASIKsurgeryinpatientswithresidualrefractive errorsafterradialkeratotomy

DepartmentofOphthalmology,SadoughiHospital,YazdMedical andundoubtedlyisstillperformedtodayincertainpartsof SciencesUniversity,Yazd,Iran theworld.Themostimportantproblemofthisoperationis Correspondence to: AbolghasemRastegar.Departmentof undercorrectionorovercorrectionoftheinitialrefractive ,SadoughiHospital,YazdMedical Sciences error,unstablevisionandhyperopicormyopicshift [1].The University,Yazd,[email protected] Received:2010-03-24Accepted:2010-05-03 methodsusedforcorrectionofpostRKrefractiveerrors includeuseofspectacles,contactlenses,repeatedRK,laser Abstract epithelial (LASEK), photorefractive keratectomy(PRK)andlaser keratomileusis(LASIK) · AIM:TostudytheresultsandcomplicationsofLASIK surgery.InthepresentstudyLASIKsurgerypostRKhas surgeryafterradialkeratotomy. beenstudied,eventhoughPRKandLASEKarealso ·METHODS:ThisdescriptivestudywascarriedoutinYazd appropriatechoices.TheeffectsofLASIKsurgeryfor LASIKCenter,Yazd,Iran.Casesincludedallpatientswhohad correctionofprimary refractiveerrorshaveopulent beenoperatedbetweenApril2003andSeptember2006.Data resources,buttherearelimitedstudiesontheusefulnessof werecollectedviaaspecialquestionnaireandanalyzedby SPSSsoftwareandpaired -test. LASIKintreatmentofresidualrefractiveerrorsinpatients undergoingrefractivesurgeriesfortheirprimaryproblems [1,2]. · RESULTS:Samplesincluded33eyesof23patientsof Theaimofthepresentstudywastostudytheresultsand whom11(47.8%)werewomenand12(52.2%)weremen. Theiragerangedfrom28to49yearsoldandthemeanage evaluatecomplicationsifhappenedofLASIKsurgeryin was31.6yearsold.Twocases(6.1%)hadopeningsofthe patientswithresidualrefractiveerrors(&myopic previousradialkeratotomyincisionsduringflapliftingandone )followingradialkeratotomy.Ifthefirstand case(3%)hadmoderatenon-infectiouskeratitis.Themean foremostinclusioncriterionispatientdemand,thuspatients preoperativesphericalequivalent(SE)was-2.17D± 0.94SD, whoarenotsatisfiedwithoutcomeofRKshouldbe whilethepostoperativeSEwas-0.17D ± 0.19SD,the consideredforLASIKorsurfaceablationenhancement. differenceofwhichwassignificant(=0.0001).Mean preoperativeuncorrectedvisualacuity(UCVA)was0.07 ± Consideringthatrefractivekeratotomyhasdevelopedsince 0.02SD(logMAR)andthepostoperativewas0.880.16SD(log 1980s,theprocedurehasseveralmodificationssinceits MAR),thedifferenceofwhichwasalsosignificant(= introduction.Iftheoutcomeshavebeensatisfactoryinmany 0.0001).Themeanbestspectaclecorrectedvisualacuityprior casesandalsoagreatnumberofcomplicationsand totheoperationwas0.930.08SD(logMAR)and0.920.08SD unwillingresultsareareality,thisproblemiscontraryto (logMAR)aftertheoperation,thedifferenceofwhichwasnot expectationofthosewhounderwenttheprocedureand significant( =0.268). wishedtodoaspossibleastogainbetterconditionofvision. · CONCLUSION:LASIKsurgerycouldimproveresidual What'smore,thesurgeonhasmoralobligationtohis myopia aftertheradialkeratotomywithoutmajor patients,ifthenecessityofsecondprocedureiscontroversial complicationsduringorpostoperation,butnecessityofthe andpondering. secondproceduremustbeponderingandrequirecarefulcase selectionandassessment. MATERIALSANDMETHODS Thiswasadescriptivestudy,andthepopulationunderstudy ·KEYWORDS:LASIK;radialkeratotomy;refractivesurgery; includedallthepatientsundergoingLASIKsurgeryfor residualmyopia correctionofresidualmyopiamostly,aswellasmyopic DOI:10.3980/j.issn.2222-3959.2010.02.19 astigmatismnothyperopicshiftforitslesspredictability

RastegarA.LASIKsurgeryinpatientswithresidualrefractiveerrors followingRKduetoregressionorundercorrectionatthe afterradialkeratotomy. 2010;3(2):172-174 LASIKcenterofYazd,IranfromApril2003toSeptember 2006.Inthestudy,33eyesof23patientswhohadundergone INTRODUCTION RKonlyformyopiacorrectionwithoutmajorcomplication adialkeratotomy(RK)waspreviouslythemost intra-andpost-operatively,rangingfrom-2.00to-5.50 R commonrefractivesurgeryforcorrectionofmyopia sphericalequivalentdiopterswith8incisionsand90%depth, 172 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 3熏晕燥援 2袁 Jun.18, 圆园10 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押陨允韵援圆园园园岳员远猿援糟燥皂 hadopticalzonediameterof3to4mm.Factorsshouldbe 0.94SDandthemeancylindricalerrorswas-1.05 0.43SD, 依 consideredincludedsituationofrefractiveerror,age,gender, whilethepostoperativeSEwas-0.17 0.19SDandbyusing 依 intraocularpressure,cornealthicknessandupto5years Paired test,thedifferencewassignificant( =0.0001).The beforethesecondaryprocedure.Theseeyeswereoperated meanpreoperativeuncorrectedvisualacuity(UCVA)was uponbystandardmethodusinganautomaticmicrokeratome 0.07 0.02SDandthepostoperativevisualacuitywas0.88 依 依 (Hansatome)andTechnolasexcimerlasermachine.Thirteen 0.16SD,differenceofwhichwasalsosignificantonusing caseshad160 mflapthicknessandtwentycaseshad paired test( =0.0001).Themeanbestspectaclecorrected 滋 180 mflapthicknesswithadiameterof8.5-9.5mm.Since visualacuity(BSCVA)priortotheoperationwas0.93 滋 依 theRKincisionsneverhealcompletelyandthecorneanever 0.08SDand0.92 0.08SD (logMAR)aftertheoperation, 依 regainspreoperativestrength,theflapcreationwashandled differenceofwhichwasinsignificant( =0.268).Inaddition, withawidespatulaandextremecarewastakentoavoid 55%oftheeyeswereametropicwithinthe0.50diopter splittingopenoftheincisionsandflapdevastation.In range.Amongthetotal33eyes,only2cases(6.1%)had patientswhosebotheyesrequiredLASIKoperation(10 intraoperativecomplicationsintheformofsmalland cases),eacheyewasoperateduponseparatelywithagapof moderateopeningsofoneortwopreviousRKincisions atleast2monthsaftertheinitialeyewasstabilized. duringflapliftingandpostoperativelyonecase(3.03%)had Medicationaftertheoperationincludedtopicalantibioticand moderatenon-infectiousdiffuselamellarkeratitis(DLK)one corticosteroid4timesdailyappliedbetweenonetotwo weekaftertheoperation,whichwastreatedwithtopical weeksaccordingtopatientprocedurecondition.Eachcase steroids.Therewereafewminorotherearlyorlate hasbeenfollowed3days,oneweek,twoweeks,onemonth complicationslikemildburningand/orpainintheeyes, andthenmonthlyfor6months.Patientsenrolledinthestudy headache,sensitivitytosunlight,dryeye,glare,sight mettheconditionswhichincludedconsultationandfull fluctuationduringfollow-upondayone,oneweek,one discussionregardingtherisks,benefits,alternativesofthe month,6monthsandsofarpostoperationbutnoneofthem operationandanaccurateclinicalexaminationusingaslit wereimportantorproblematic. lamp.Theexaminationinvolvedthepreviousincisionsite, DISCUSSION epithelialplaques,opticalzone,regularityorirregularityof Inthepresentstudy,theresultsofLASIKsurgeryinpatients the gaps,fundusassessmentand intraocularpressure withresidualmyopiaandmyopicastigmatismwhohad measurement,aswellasthebestvisionwithandwithout initiallyundergoneradialkeratotomy(RK)werestudiedfor spectaclescorrectionanddegreeofrefractiveerror. stateofrefractiveerrors,visualacuityoutcomes,patient Excludingcriteriaincludedepithelialdefects,unstable satisfaction,difficultiesand complicationsofLASIK ,macroormicrocornealperforationsduringRK,deep procedure.Therewasasignificantdifferenceinregardtothe vascularization,unstablerefraction,flatcornea(K<40D)and meanrefractiveerroranduncorrectedvisualacuity(UCVA) cornealthicknesslessthan500μ m.Inthisstudy8patients beforeandafterLASIK,whereasthedifferencebetween (11eyes)wereexcludedfromthestudyforthecausesof preoperativeandpostoperativebestspectaclescorrected irregularastigmatism,morethan8incisions,flatcorneaand visualacuity(BSCVA)wasnotsignificant.Intermsofintra deepvascularization.Themeanpachymetryofthepatients operativecomplications,onlytwocaseshadopeningsatthe underthestudywas549 m (533-611 m).Aspecially siteoftheincisionofthepreviousoperation;oneincisionin 滋 滋 formattedquestionnaireforthepurposeaswellasthe onecaseandtwoincisionsintheothercase.Therewasno consentletterwasfilledanddatawereevaluatedand othernoticeableintraoperativecomplication.During analyzedthroughSPSSsoftwareprogramandpaired test postoperativefollow-up,onlyonecasehadnon-infectious wasused. <0.05wasconsideredstatisticallysignificant. DLKoneweekafteroperationthatwastreatedcompletely RESULTS withtopicalsteroidapplication.Besides,afewtransient ThepatientsunderwentLASIKsurgeryandwerefollowed minorcomplicationswereseen. upforcorrectionoftheirresidualmyopiafromApril2003to InthestudybyMunoz [3] inSpainintheyear2006on September2006.Ofthetotalsubjects,11(47.8%)weremen 11eyesof7patientswithresidualmyopiaafterRK,allof and12(52.2%)werewomen.Theiragerangedbetween28 thesitesoftheincisionsofthepreviousoperationopened and49yearsoldandthemeanagewas31.6yearsold. duringflapliftingusinglaser(femtosecond),butthe Accordingtostatisticalconsultantrecommendationinstances operationwassuccessful.Themeanrefractiveerrorpriorto forbetteranalysisofageandsexweredividedinto3age theoperationwas-2.51 0.62Dwhilethemeanrefractive 依 groups:28-31years,32-34yearsand35-49years.The erroraftertheoperationwas-0.52 0.28D.Ofthetotal, 依 maximumnumberofcaseswasinthe28-31yearsagegroup 63.6%(7eyes)werewithinthe0.50diopterrange,100%(11 andtheminimumnumberwasinthe36-38yearsagegroup. )within1.00diopterrangeand2eyes(18.1%)lostone Themeanpreoperativesphericalequivalent(SE)was-2.17 lineofthevisionchart.Thereductioninresidualrefractive 依 173 LASIKsurgeryafterradialkeratotomy errorandcorrectionrangeofthestudywereinlinewiththe inthesphericalequivalentinbothover-correctedand presentstudy,buttheopeningsofthesiteoftheprevious under-correctedgroups.91%ofeyesintheover-corrected incisionsduringflapliftingwerenotinaccordancewiththe groupand89%intheunder-correctedgroupwerewithin 1.0 依 presentstudy.InthestudyofLASIKoperationbyAgarwal diopteroftheintendedcorrection.Therewasalsoa [4] on10eyesof5patientsin2000forcorrectionof significantimprovementintheuncorrectedvisualacuityin residualmyopiaafterRK,therewasasignificantdifference bothgroups.Theresultsregardingrefractiveerrors,UCVA inrespectofthemeanrefractiveerrorandUCVAbeforeand andBCVAduringthefollow-uparesimilartothepresent aftertheoperation,whilethedifferenceinBSCVAbefore study. andafteroperationwasnotsignificant,whichistotallyin InthestudybyClausse [9] in2001on80eyesof56 linewiththepresentstudy.InthestudybyAgarwal [5] in patientswhohadundergoneradialkeratotomyformyopia, 2001on10eyeswithresidualmyopiaafterRK,LASIK hyperopiaandastigmatismandhadresidualrefractiveerrors, surgerywasperformedandtherewasasignificantdifference LASIKwasperformed.Therewasasignificantdifference inthemeanrefractiveerrorbeforeandafteroperation.There betweenthepre-andpost-operativemeanrefractiveerrors. werenopostoperativecomplicationsexcept2eyes(20%) Therewerenointraoperativecomplications,butduring requiredreplacementoftheflapduetoirregularitiesand follow-up6eyes(7.5%)hadBCVAreductioninonelineof foldsofthestroma.TherewasnodecreaseintheBSCVA Snellen'schart,oneeye(1.25%)hadreductionin2linesand duringpostoperativefollow-up.Theresultsofthisstudyare oneeye(1.25%)hadmorethan2linesreduction.Therewas similartothepresentstudywithregardtothedegreeof stromalopacityintwoeyes,epithelialdefectsintwoeyes, refractiveerror,UCVAandBSCVA.Inthepresentstudy, andepithelialingrowthinfoureyes.Theresultsofthisstudy therewasnoneedforflapreplacementbut2eyeshad aresimilartothepresentstudyinrespectofresultsof openingsofRKincisionsduringflapliftingintraoperatively refractiveerrorcorrectionandUCVA,butthecomplications andonecasehadmoderatenon-infectiousDLKafterthe ofLASIKarenotinlinewiththepresentstudy.Inthestudy operation. byLiu [10] in2000,LASIKwasperformedon70eyesof InthestudybyYong [6] on16eyesof10patientsinthe 36patients.Thirty-twoeyesof16patientshadundergone year2000,LASIKoperationwasdonefortheeyeswhich RK,and38eyesof20patientshadundergonePRK.There hadbeenoperateduponpreviouslyforrefractiveerror werenomajorintra-orpost-operativecomplications.The correctionbyradialkeratotomyandhadresidualrefractive UCVAafteroperationin70%ofthecaseswassimilartothe error.Therewasasignificantdifferencebetweenthemean correctedvisualacuitybeforetheoperationandin100%of refractiveerrorsbeforeandaftertheoperationandtheonly thecasescorrectedvisualacuityaftertheoperationwasthe complicationwasintraoperativeopeningofthepreviousRK sameascorrectedvisionbeforetheoperation,whichisin incisionsin2eyes.Theresultsofrefractiveerrorcorrection linefromvariouspointsbutnotsimilartothepresentstudy andUCVAinthestudyofYong [6] areinconsistent incertainways. withthepresentstudy.Regardingcomplications,theopening REFERENCES ofincisionsofthepreviousoperationwasseenin12.5%of 1BurattoL,BrintS.LASIK:SurgicalTechniquesandComplications.SLACK Incorporated2000:519-521,538 thecaseswhilethisfigurewas6.1%inthepresentstudy.In 2AzarDT,TuliS,BensonRA,HardtenDR.Photorefractivekeratectomyfor thelightofthetotalnumberofcases,theresultsarequite residualmyopiaafterradialkeratotomy.PRKafterRKStudyGroup. similar.Therewerenopostoperativecomplicationsinthe 1998;24:303-311 3Mu ozG,Albarr n-DiegoC,SaklaHF,Prez-SantonjaJJ,Ali JL. study,whileinthepresentstudytherewasonecase(3.03%) 觡 觃 佴 仵 Femtosecondlaser keratomileusisafterradialkeratotomy. ofmoderatenon-infectiousDLKoneweekafterthe 2006;32(8):1270-1275 operationandafewminortransientproblems.Inthestudy 4AgarwalS,PallikarisIG,AgarwalA.RefractiveSurgery.SLACK2000:317-322 byShah [7] inAmerica,9eyesof6patientswhohad 5AgarwalA,AgarwalT,BagmarA,AgarwalS.Laser keratomileusisfor residualmyopiaafterradialkeratotomyandphotorefractivekeratectomy. undergoneradialkeratotomymorethanoneyearagoand 2001;27(6):901-906 had8ormoregapswithresidualmyopiaandastigmatism 6YongL,ChenG,LiW,ChangJ,NganC,TongP,QunC.Laser underwentLASIKsurgery.Themeansphericalequivalent keratomileusisenhancementafterradialkeratotomy. 2000;16(2): 187-190 (SE)was0.156D 0.174SDanduncorrectedvisualacuity 依 7ShahSB,LinguaRW,KimCH,PetersNT.Laser keratomileusistocorrect (UCVA)posttheoperationwas20/25orbetterrespectively. residualmyopiaandastigmatismafterradialkeratotomy. Therewerenointra-orpost-operativecomplicationsandthe 2000;26(8):1152-1157 8AttiaWH,Ali JL,ArtolaA,Mu ozG,ShalabyAM.Laser keratomileusis questionnaireshowedcompletesatisfactionofallthepatients 佼 觡 forundercorrectionandovercorrectionafterradialkeratotomy. whichwasquitesimilartothepresentstudy.Inthestudyby 2001;27(2):267-272 Attia [8] in2001on20eyesof13patientswhowere 9ClausseMA,BoutrosG,KhanjianG,WagnerC,GarabetAL.Aretrospective sufferingfromoverandundercorrectionofrefractiveerrors studyoflaser keratomileusisafterradialkeratotomy. 2001; 17:200-201 followingRK,LASIKwasperformedandthepatientswere 10LiuL.TherapeuticeffectsofundercorrectionbyLASIKfollowingRKandPRK followedupfor6months.Therewasasignificantdecrease forcorrectionofhighmyopia. 2000;20(4):349-350 174