Safety and effectiveness of the SUPRACOR presbyopic LASIK algorithm on hyperopic patients

Background:To evaluate the safety and effectiveness of the Supracor excimer laser algorithm to treat hyperopic presbyopic patients using laser in-situ keratomileusis(LASIK).Methods:This is a retrospective case review of patients diagnosed with hyperopia(Sphere≥+0.0 D and presbyopia reading add≥1.0 D)who underwent Supracor excimer laser treatment on at least one eye for presbyopia correction from year May 2011 to May 2013.Binocular vision was further analyzed after patients were subdivided into three groups:Group A(n=22 eyes,11 patients)had Supracor on both eyes;Group B(n=18 eyes,18 patients)had Supracor in one eye and hyperopic LASIK on fellow eye;and Group C(n=29 eyes,29 patients)had Supracor in one eye and no treatment on the fellow eye.Results:This study evaluated 58 patients wherein 69 eyes underwent Supracor presbyopic LASIK.Preoperatively,mean manifest refraction spherical equivalent(MRSE)of all eyes that underwent Supracor was+1.37±0.72 D with mean uncorrected distance visual acuity(UDVA),uncorrected intermediate visual acuity(UIVA),and uncorrected near visual acuity(UNVA)of 20/50(0.35 logMAR),20/50(0.35 logMAR),and J9(0.61 logMAR),respectively.At 6 months postoperatively,mean MRSE was−0.43±0.59 D with mean UDVA,UIVA and UNVA of 20/25(0.13 logMAR),20/20(0.01 logMAR),and J1(0.05 logMAR),respectively.Loss of two lines of best-corrected distance visual acuity(BCDVA)was seen in 6%of eyes.Mean corneal steepening of 1.0 D at the 3 mm zone and 0.7 D in the 5 mm zone was observed.Mean vertical coma increased from−0.02 to+0.10 while mean 4th order spherical aberration became more negative from 0.20 to−0.14.Mean binocular UDVA,UIVA,and UNVA are 20/20,20/20 and J1,respectively,in all treatment groups at the 6 month postoperative follow-up.No significant differences in binocular UDVA(p≥0.36),UIVA(p≥0.19)and UNVA(p≥0.56)among groups were seen.Conclusions:Supracor excimer laser algorithm is safe and effective for the treatment of presbyopia in hyperopes.Monolateral and bilateral Supracor treatments yielded similarly good binocular vision outcomes.

Higher incidence of steroid-induced ocular hypertension in keratoconus

Background:To compare intraocular pressure(IOP)changes following topical dexamethasone administration for 1 month in keratoconic versus normal eyes.Methods:This is a retrospective,single-center,non-randomized case series evaluation of 350 eyes.Two groups were formed:normal/control Group A(n_(A)=73),eyes that underwent excimer laser photorefractive keratectomy;and keratoconic(KCN)Group B(n_(B)=277),eyes that were subjected to partial laser photorefractive keratectomy combined with collagen cross-linking(The Athens Protocol).All eyes received the same post-operative regimen of topical dexamethasone 0.1%for at least 1 month.Goldmann applanation tonometry IOP readings and central corneal thickness(CCT)measurements were monitored.Cases with induced ocular hypertension(OHT,defined as post-operative IOP higher than 21 mmHg),were identified and correlated to refractive procedure,gender,and corneal thickness.Results:At 4 weeks postoperatively,OHT was noted on 27.4%(20/73 eyes)in Group A,and 43.7%(121/277 eyes)in KCN Group B,(p<0.01).Six months post-operatively(following 5-months of discontinuing topical dexamethasone treatment and commencing treatment of IOP-lowering medications),OHT rate was 1.8%in Group A and 3.9%in the KCN Group B.Conclusion:This study demonstrates a potentially significant pre-disposition of keratoconic eyes to the development of steroid-induced OHT.