Eighteen-year follow-up of hyperopic photorefractive keratectomy

Abstract

Dr. Marshall was a consultant to Summit Technology, Inc. No author has a financial or proprietary interest in any material or method mentioned.

Sixteen-year follow-up of hyperopic laser in situ keratomileusis

“…This is similar to the results of H-PRK we reported at 18 years (26) and is in contrast to the outcomes in this cohort at 12 months when 90% of eyes were within +/-1.0D of emmetropia and 68% within +/-0.5D. This reduction in efficacy with time, given the stable changes in keratometry after 12 months, is probably due to the shift in lenticular hyperopic refractive error as discussed above ( figures 1 and 2, table 1).…”

“…The concept that the hyperopic drift after H-LASIK with time is, at least after the first few years after surgery, due to physiological lenticular changes rather than regression of correction at the level of the cornea is supported by the fact that the keratometry remained stable in this cohort between 1 and 16.5 years and is similar to our long-term findings after H-PRK (26) . It should, however, be borne in mind that that 5 eyes (15%) developed visually significant cataract during the 16.5 year follow-up period and that the increase in hyperopic refractive error with time was less in older compared to younger patients (figure 4).…”

“…In similarity to our recent study of H-PRK (26) , this hyperopic shift was more apparent during the first few years after surgery, with a mean change of +0.56D (+0.14D per year) between 1 and 5 years and +0.9D (+0.08D per year) between 5 and 16.5 years. (table 1, figure 1).…”

“…The mean age at time of surgery of our cohort was 51.6 years. Bengtsson reported a hyperopic shift of 0.6 D (0.06D per year) every 10 years between 50 and 70 years (25) , with a similar trend of hyperopic shift between 50 to 65 yrs followed by myopic drift after 65 years seen in the Blue Mountains Eye Study (26) and by Saunders (27) .…”

“…Since the introduction of excimer laser refractive surgery, possible late long-term complications such as impairment of transparency, biomechanical instability, regression and limbal stem cell irregularities have been postulated and reinforced the need for long-term followup for decade's not just years (22)(23) . We have recently published studies of myopic and H-PRK and have confirmed refractive stability at the level of the cornea with stable keratometry, maintenance of corneal transparency and biological integrity and no late complications attributable to the treatment at [18][19][20] years (24)(25)(26) . However, such studies investigating the long-term outcomes of H-LASIK have not been published to date and this present investigation was conducted to address these issues.…”