Title: Laser%20in%20situ%20keratomileusis%20for%20correction%20of%20residual%20astigmatism%20after%20cataract%20surgery
1Laser in situ keratomileusis for correction of
residual astigmatism after cataract surgery
- Eun Chul Kim, M.D. , Man Soo Kim,M.D.
- Department of Ophthalmology and Visual Science,
- College of Medicine,
- The Catholic University of Korea, Seoul, Korea
No financial relationship
2Introduction
- high amount of corneal astigmatism after cataract
surgery - delays visual recovery
- compromises the ultimate optical outcome.
- Spectacle correction
- distortion due to meridional magnification,
- difficulties with binocular function.
- Contact lenses
- not all patients can tolerate contact lenses
3Introduction To reduce corneal astigmatism
- Intraoperative method
- variation in size, location, and type of incision
- adjust suture depth
- preplaced sutures to facilitate wound closure
- use of surgical keratometers
- suture adjustment technique
- selective suture cutting
- Postoperative method
- Wound revision
- Corneal wedge resection
- Tensioning suture
- Astigmatic keratotomy
- Transverse keratotomy
- Photorefractive keratectomy (PRK)
- Laser in situ keratomileusis(LASIK)
4Purpose
- To evaluated the effect of laser assisted in
situ keratomileusis (LASIK) procedure on eyes
with residual astigmatism after cataract surgery.
5Methods
- Retrospectively reviewed the medical records of
11 eyes of 11 patients who had undergone cataract
surgery from March 2002 to November 2005. - Cataract Operation
- 10 eyes Phacoemulsification PCL
implanatation - 1 eye Extracapsular cataract extraction PCL
transscleral fixation ant. vitrectomy - LASIK (11 eyes) was performed on 11 eyes
- The ablation zone 6.0 mm
- the transition zone 8.0 mm
- minimum of 250 µm of the stromal bed was
maintained
6Methods
- Inclusion criteria of astigmatic correction
- refractive myopic or mixed astigmatism over 2.0D
- Stable refraction (change less than 0.50 D
between two consecutive examinations) - symptomatic anisometropia,
- Inability to wear spectacles
- Contact lens intolerance
- no history of systemic collagen vascular disease
- no history of ocular disease(e.g. glaucoma,
retinopathy) - central corneal thickness greater than 500 µm
7Results Refraction and visual acuity
Before eximer laser surgery Before eximer laser surgery Before eximer laser surgery 6 Months After eximer laser surgery 6 Months After eximer laser surgery 6 Months After eximer laser surgery
NO Age /Sex Procedure UCVA Manifest Refraction BCVA UCVA Manifest Refraction BCVA
1 86/M LASIK 0.1 1.00 -5.5 x 180 0.4 0.63 0.50 -1.25 x 180 0.8
2 59/F LASIK 0.25 0.75 -3.5 x 150 1.0 1.0 0.50 -0.25 x 150 1.0
3 66/M LASIK 0.2 -2.50 -2.00 x 85 0.8 0.63 -0.50 -0.75 x 90 0.8
4 52/F LASIK 0.2 -1.75 -3.00 x 175 1 0.63 -0.50 -0.75 x 170 1.0
5 78/F LASIK 0.1 -3.00 -4.50 x 180 0.32 0.4 -0.25 -1.00 x 180 0.63
6 60/M LASIK 0.5 1.00 -2.50 x 25 1.0 0.8 0.50 -0.50 x 30 1.0
7 67/M LASIK 0.3 0.50 -3.50 x 155 0.8 0.63 -0.25 -1.25 x 155 0.8
8 68/M LASIK 0.4 -1.25 -2.50 x 175 0.8 0.8 -0.50 sphere 0.8
9 20/M LASIK 0.08 -2.00 -5.75 x 165 0.4 0.5 -0.75 -1.50 x 165 0.8
10 72/F LASIK 0.2 -1.5 -3.25 x 95 0.5 0.4 -1.00 -1.00 x 90 0.63
11 57/M LASIK 0.4 0.25 -2.75 x 30 1.0 0.8 -0.50 -0.50 x 30 1
UCVA uncorrected visual acuity, BCVA best
corrected visual acuity At 6 months after
refactive surgery, best corrected visual acuity
was equal to or better than preoperatively
8Spherical equivalent refraction and cylinderical
refraction
Spherical equivalent and cylinderical refraction
decreased significantly after LASIK. ( p
lt0.05)
9Postoperative visual acuity
UCVA and BCVA were improved at 2 weeks after
surgery and were stable until 6 months after
surgery. ( plt0.05)
The final BCVA was improved by 1 line in 4 eyes
(36.4) and was unchanged in 7 eyes (63.6) at 6
months.
10Change of astigmatism
NO Preoperative Astigmatism (D) Postoperative Astigmatism (D) Net Decrease in Astigmatism (D) Reduction of Astigmatism()
1 -5.5 x 180 -1.25 x 180 4.25 77.27
2 -3.5 x 150 -0.25 x 150 3.25 92.86
3 -2.00 x 85 -0.75 x 90 1.25 62.50
4 -3.00 x 175 -0.75 x 170 2.25 75.00
5 -4.50 x 180 -1.00 x 180 3.5 77.78
6 -2.50 x 25 -0.50 x 30 2 80.00
7 -3.50 x 155 -1.25 x 155 2.25 64.29
8 -2.50 x 175 0 2.5 100.00
9 -5.75 x 165 -1.50 x 165 4.25 73.91
10 -3.25 x 95 -1.00 x 90 2.25 69.23
11 -2.75 x 30 -0.50 x 30 2.25 81.82
MeanSD -3.521.17 -0.800.44 2.730.96 77.7011.20
The mean percentage of astigmatic correction was
77.7011.20 (range 64.29 to 100) at 6 months
after refactive surgery
11Predictablility for refraction and astigmatism
Follow up 0.25 D 0.25 D 0.50 D 0.50 D 0.75 D 0.75 D 1.00 D 1.00 D
Follow up SE C SE C SE C SE C
2weeks 4(36.4) 4(36.4) 7(63.6) 9(81.8) 10(90.9) 10(90.9) 11(100) 11(100)
1month 3(27.3) 3(27.3) 6(54.5) 6(54.5) 7(63.6) 8(72.7) 8(72.7) 10(90.9)
2months 1(9.1) 1(9.1) 5(45.4) 7(63.6) 8(72.7) 9(81.8) 9(81.8) 10(90.9)
6months 2(18.2) 2(18.2) 4(36.4) 4(36.4) 6(54.5) 6(54.5) 9(81.8) 8(72.7)
SE spherical equivalent refraction,
Cylinder refraction After 6 months after
surgery, 4 eyes (36.4) had a spherical
equivalent refraction within 0.50 D, and 9 eyes
(81.8) were within 1.00 D. Four eyes (36.4)
had a cylinder refraction within 0.50 D and 8
eyes (72.7) were within 1.00D.
12Conclusion
- LASIK
- an effective, predictable, stable procedure
for correction of residual myopic or mixed
astigmatism over 2.0 D with a low spherical
component after cataract surgery.