Comparison of Tecnolas and Allegretto laser in situ keratomileusis outcomes in hyperopia Faik Orucov*, MD, Sinan Goker*,MD, Abraham Solomon**, MD, Joseph Frucht-Pery**, MD *Refractive Surgery Department, ISTANBUL SURGERY HOSPITAL Istanbul, Turkey ** Hadassah University Hospital, Jerusalem, Israel
Hyperopia • Hyperopia ≥ 2D 6% of population • Low Hyperopia good vision in young poor vision in adults • Hyperopia affects both distance and near vision and is compounded by presbyopia
Hyperopic Correction • Thermokeratoplasty • Hexogonal keratotomy • Keratophakia • Keratomileusıs • Holmium laser • CK • H-PRK • H-LASIK • Phakic IOLs • RLE
Pt’s age > 40 - Dry eyes - BMD - More epithelial defects Flap size 9.5 mm - Small eyes and pannus (limbal bleeding) PROBLEMS IN HYPEROPIA
PROBLEMS IN HYPEROPIA • Large area of treatment • (Flap size 9.5 mm) • Long ablation time • Centration is critical
PROBLEMS IN HYPEROPIA • Initial overcorrection • (myopia) • Slow regression • [1 y. in high hyperopia] • Enhancement is complicated • Final K-reading < 50 [D]
Hyperopic correction is significantly more likely to regress • regression greater than myopic correction. • The possibility of regression; hyperplastic healing response of the cornea to fill in this ablated step between the treated and untreated zones, thereby not only resulting in loss of effect over time but also inducing an astigmatic error in case of uneven fill-ins.
PURPOSE To compare visual outcome measurements in laser in situ keratomileusis (LASIK) for hyperopia using the Technolas 217 and Allegretto excimer laser. Authors have no financial interests in any of the mentioned products or companies
METODS • Two-center retrospective study • H-LASIK by the Technolas 217; 50 eyes • (Hadassah Medical Organization, Jeruasalem, (2003 and 2005)) • H-LASIK by Allegretto excimer laser ; 42 eyes • (Istanbul Surgery Hospital, Istanbul, (2004 and 2005)) • Mean follow-up 23.1±13.7 months with Technolas • 19.3±8.8 months with Allegretto. • Inclusion criteria; - SE up to 4.00 diopters (D) of sycloplegic hyperopia, • - Minimum F/U 12 months • Exclusion criteria; - Incomplete documentation
SE Optical zone & Ablation depth
Stability • Higher Myopic overcorrection on the next day • Greater regression observed during first month • Regression (month 1 to last visit) :Technolase +0.48 D Allegretto +0.36 D (P=0.247)
UCVA The postoperative UCVA was significantly lower in eyes treated with Tecnolas on postoperative month 1 (P=.037) . At 3, 6 ,12 months and at last visit postoperatively, no significant differences were noted in UCVA between the two lasers (P=.065 to .473).
BCVA P= 0.239 PREOPERATIVE P= 0.144 LAST VISIT 0.97±0.10 0.96±0.09 0.92±0.15 0.94±0.15
Predictability Efficacy & Safety
CONCLUSION • Ablation depth was greater with Technolas laser. • Visual and refractive results were similar between the Technolas and Allegretto laser systems after 3 months of the procedure.