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Primary Topography-Guided LASIK: A Comparative Study Comparing Treating the Manifest versus the Topographic Astigmatism.

ABSTRACT: Purpose: To investigate if topography-guided laser in situ keratomileusis (LASIK) depending on the topographic astigmatism which is measured using the Topolyzer leads to a better refractive outcome when compared to treatment of the manifest refractive astigmatism in cases of myopic astigmatism.

Methods: This was a prospective non-masked, randomized study (block randomization) of postoperative vision and refraction of patients with myopic astigmatism that had LASIK using Contoura vision software. They were divided into three groups according to the treatment strategy, treating the manifest astigmatism in one group, the topographic astigmatism with compensation for the spherical power in the second group and treating the topographic astigmatism without changing the spherical power in the third group. It was conducted at Kasr Alainy Hospital and Dar Eloyon Hospital.

Results: The postoperative uncorrected distant visual acuity (UDVA) in each group separately was better than the preoperative corrected distant visual acuity (CDVA) (58% (n=35) had UDVA better than 20/20 and gained 1 line or more); however, eyes treated with the topographic astigmatism without changing the spherical power showed the statistically best results (75% (n=15) had UDVA better than 20/20). The residual anterior corneal astigmatism was lower in this group (the mean 0.47 vs 0.95 and 0.59). No significant difference was noted in the residual refractive astigmatism, but it was also the least in that group.

Conclusion: Topography-guided LASIK is a safe and effective ablation profile for treatment of myopic astigmatism. Treating according to the topographic astigmatism shows the best outcome as regards the vision and residual astigmatism.

SUBMITTER: Aboalazayem F

PROVIDER: S-EPMC7718986 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Primary Topography-Guided LASIK: A Comparative Study Comparing Treating the Manifest versus the Topographic Astigmatism.

Aboalazayem Fayrouz F Hosny Mohamed M Zaazou Cherif C Anis Mohamed M

Clinical ophthalmology (Auckland, N.Z.) 20201201

<h4>Purpose</h4>To investigate if topography-guided laser in situ keratomileusis (LASIK) depending on the topographic astigmatism which is measured using the Topolyzer leads to a better refractive outcome when compared to treatment of the manifest refractive astigmatism in cases of myopic astigmatism.<h4>Methods</h4>This was a prospective non-masked, randomized study (block randomization) of postoperative vision and refraction of patients with myopic astigmatism that had LASIK using Contoura vis ...[more]

PMID: 33293787

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Project description:Purpose of the studyTo compare visual outcome, higher order aberrations (HOAs) of topography guided and Q value adjusted ablation in the fellow eye of patients undergoing photorefractive keratectomy (PRK) for the correction of myopia and myopic astigmatism.MethodsProspective randomized controlled interventional clinical study. The eyes of 52 patients undergoing PRK for myopia and astigmatism were included, that is, 104 eyes in total. In each patient, eyes were randomly allocated to group I: one eye received topography guided PRK using Contoura ablation software, or group II: the other eye received Q value adjusted PRK using Custom Q ablation software.Follow-upSix months.ResultsAt the end of 6 months, LogMAR UDVA was -0.04 ± 0.12 and -0.05 ± 0.11 (p = 0.688), while LogMAR CDVA was -0.06 ± 0.09 and -0.06 ± 0.1 in group I and group II, respectively (p = 0.972). Both groups showed a progressive oblate shift with time. This oblate shift was insignificantly less in group I by Topolyzer at 6mm, 15° and 30° at 6 months (p = 0.102, p = 0.138, p = 0.245, respectively). Topolyzer identified a significant difference between the change in coma and trefoil in both groups at 6 months (p<0.001 and p = 0.001, respectively). This was caused by the significant worsening of coma in group II (p<0.001) and the significant improvement of trefoil in group I (p = 0.007). No significant difference was found between groups in the change of ISV or ABR (p = 0.955 and 0.982, respectively). Ablation depth is a significant predictor of ΔQ at 6mm, 15° and 30° (p = 0.009, 0.039 and 0, respectively). No significant difference was found in the Strehl ratio or contrast sensitivity, although they were insignificantly better in group I (p = 0.785 and p = 0.745, respectively).ConclusionTG PRK and CQ PRK yielded similar results regarding UDVA, CDVA, MRSE, safety, predictability and contrast sensitivity. Both groups showed a progressive oblate shift, which was less in the TG group but the difference was statistically insignificant. TG PRK showed significantly improved trefoil HOA as compared to CQ PRK.

Project description:BackgroundCorneal refractive surgery for myopia results in an oblate shift with increased postoperative aberrations inversely affecting the quality of vision. Aspheric ablation profiles have been introduced to minimize such a problem. The aim of this study was to compare changes in corneal asphericity, central and mid-peripheral pachymetry between the Q-value customized and the wavefront-optimized (WFO) ablation profiles.MethodsA prospective, comparative non-randomized fellow eye study was conducted. Eighty eyes of 40 eligible patients underwent femtosecond laser-assisted laser in situ keratomileusis for myopia and myopic astigmatism. In each patient, the more myopic eye was included in the custom-Q ablation experimental group and the other less myopic eye was included in the WFO control group. For the custom-Q group, the target asphericity was set to the preoperative Q-value. Corneal asphericity, central and mid-peripheral pachymetric changes and the root mean square of corneal higher-order aberrations (RMSh) were assessed 6 months following surgery. Visual and refractive outcomes were also evaluated in both platforms 6 months postoperatively.ResultsThe mean preoperative refractive spherical equivalent was significantly more myopic in the custom-Q group than in the WFO group (P = 0.001). The mean Q-value changed from - 0.2 ± 0.1 to 0.6 ± 0.7 and from - 0.2 ± 0.1 to 0.4 ± 0.5 in the custom-Q and WFO groups, respectively. The oblate shift in corneal asphericity was not significantly different between both treatment groups (P = 0.094). The mean ablation depth at the pupillary center was significantly greater in the custom-Q group (P = 0.011), while there was no significant difference at the mid-peripheral pachymetry (P = 0.256). The RMSh significantly increased in both treatment profiles (P < 0.001) with no significant difference between the two groups (P = 0.06). The uncorrected distance visual acuity (UDVA) and the manifest refraction spherical equivalents (MRSE) significantly improved in both treatment groups (P < 0.001).ConclusionsThe custom-Q treatment profile with target asphericity set at the preoperative Q-value achieved comparable outcomes vs. the WFO profile in terms of postoperative corneal asphericity and mid-peripheral pachymetry despite the greater amount of ablation, the smaller optical zone, and the resulting increase in postoperative corneal flattening in the custom-Q group. Trial registration (Clinicaltrials.gov): NCT04738903, 4 February 2021- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04738903.

Project description:BACKGROUND:Hyperopia, or hypermetropia (also known as long-sightedness or far-sightedness), is the condition where the unaccommodating eye brings parallel light to a focus behind the retina instead of on it. Hyperopia can be corrected with both non-surgical and surgical methods, among them photorefractive keratectomy (PRK) and laser assisted In situ keratomileusis (LASIK). There is uncertainty as to whether hyperopic-PRK or hyperopic-LASIK is the better method. OBJECTIVES:The objectives of this review were to determine whether PRK or LASIK leads to more reliable, stable and safe results when correcting a hyperopic refractive error. SEARCH METHODS:We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 2), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 17 February 2012. When trials are included in the review we will search the reference lists of the studies included in the review for information about further trials. We will use the Science Citation Index to search for papers that cite any studies included in this review. We did not handsearch journals or conference proceedings specifically for this review. SELECTION CRITERIA:We planned to include only randomised controlled trials (RCTs) comparing PRK against LASIK for correction of hyperopia and then perform a sensitivity analysis of pre- and post-millennial trials since this is the mid-point in the history of both PRK and LASIK. DATA COLLECTION AND ANALYSIS:We did not identify any studies that met the inclusion criteria for this review. MAIN RESULTS:As no studies met the inclusion criteria for this review, we discussed the results of non-randomised trials comparing hyperopic-PRK with hyperopic-LASIK. AUTHORS' CONCLUSIONS:No robust, reliable conclusions could be reached, but the non-randomised trials reviewed appear to be in agreement that hyperopic-PRK and hyperopic-LASIK are of comparable efficacy. High quality, well-planned open RCTs are needed in order to obtain a robust clinical evidence base.

Dataset Information

Primary Topography-Guided LASIK: A Comparative Study Comparing Treating the Manifest versus the Topographic Astigmatism.

Publications

Primary Topography-Guided LASIK: A Comparative Study Comparing Treating the Manifest versus the Topographic Astigmatism.

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