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Eighteen year follow-up of hyperopic photorefractive keratectomy

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Session Details

Session Title: Photoablation Outcomes I

Session Date/Time: Monday 07/09/2015 | 16:30-18:30

Paper Time: 17:06

Venue: Room 17

First Author: : V.Wagh UK

Co Author(s): :    R. Dave   D. O'Brart   P. Patel   C. Tam   J. Lee   J. Marshall     

Abstract Details


Eighteen year follow-up of Hyperopic Photorefractive Keratectomy


University Hospital, Keratoconus Research Institute, Department of Ophthalmology, St. Thomas' Hospital, London


25 patients (45 eyes) who had H-PRK with a mean follow-up of 18 years (range 16 to 20 years) attended for examination. All had corrections using an iris diaphragm laser and an Axicon with a 6.50 millimeter (mm) optical zone and a 1.50mm blend zone. Mean age at time of correction was 53 years (range 21-65 years). Mean pre-operative spherical equivalent refractive error (SEQ) was +4.12 diopters (D) (range +1.125D to +7.25D). Programmed correction was +4.07DD (range +1.50 to +6.00D).


Between 1 and 18 years, in eyes that not undergone cataract surgery (n=33), there was a +0.97D increase in mean SEQ (range -1.625 to +4.75) (p=0.002). Between 1 and 5 years there was a there was a mean +0.65D increase in SEQ (p=0.02). There was no difference in SEQ between 5 years and 18 years (p=0.09). Keratometry remained stable between 5 and 18 years (p=0.2). Uncorrected distance visual acuity was improved at 18 years compared to pre-operative values (p=0.005) but corrected distance visual acuity (CDVA) was reduced (p=0.005). Efficacy index was 0.45. Safety index was 0.89.. Eleven eyes lost 2 lines of CDVA at 18 years, 8 of these eye had pre-existing cataract.


H-PRK showed a significant increase in hyperopic SEQ between 1 and 5 years after surgery but was generally stable 5 years after the procedure. At 18 years the efficacy of the procedure was limited. Peripheral haze was still evident in a large number of eyes with the development of clinically significant Salzmanoid changes in some eyes but there was no evidence of ectasia. Ocular co-morbidity in relation to cataract and glaucoma was common in these hyperopic, middle-aged patients over the 18-year follow-up periods. Nineteen patients (76%) were happy they had undergone the procedure.

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