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Planned two-step treatment for high hyperopic astigmatism: femtosecond laser-assisted astigmatic keratotomy combined with LASIK

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Session Details

Session Title: LASIK Outcomes II

Session Date/Time: Tuesday 16/09/2014 | 14:00-16:00

Paper Time: 14:40

Venue: Capital Hall B

First Author: : S.Goker TURKEY

Co Author(s): :    B. Ayoglu   M. Saylik   B. Toksu        

Abstract Details


The purpose of this study was to evaluate a different technique for the correction of high hyperopic astigmatism and present the results .


Istanbul Surgery Hospital


The study includes the hyperopic eyes with cylinder over 4.00 D. Instead of performing initially cross-cylinder Lasik, the patients underwent first Astigmatic Keratotomy with Femtosecond-Laser (Victus FS, Baush+Lomb,Technolas) and after 6 months the last refraction was corrected with LASIK (Laser Assisted insitu Keratomileusis ). The paired astigmatic incisons was placed at 8.5-8.7 mm optical zone at a depth %80 of corneal periphery thickness. The arc length was chosen from the Nichamin's nomogram modifed for Femtosecond laser. After 6 months the patients refraction with cycloplegia, uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA) with Snellen chart ,topography , corneal thickness measurements were repeated. As a planned second step, corneal ablation performed with Wavelight Allegretto, Eye-Q Excimer Laser ( Alcon). After the second step the patients examined 1st day, 1 st month and 6th month and after 1 year with one year intervals. On each follow-up examination UCVA, BCVA,refraction and topographic data was recorded.


: 31 eyes of 19 patients with high hyperopic astigmatism were treated with two-step technique and followed- up 6 months or more. Mean age was 29,7± 7(21-46) years, and mean follow-up time was 12,4±11 (6-36)months.The mean astigmatism-5,25±0,8 (-4.00/-7.00) reduced to -3,4± 1,1D(-1,25/-5,25) after AK and reduced to -1,3 ± 1 (-0,50/-2,25) after 6 months and to -1,6± 0,9 at last follow-up, respectively.Before AK the mean hyperopic sphere value was +4,9± 2,3D(1,25/ 8,50)and after AK reduced to +4,2± 2,4D(0,75/8,00D) but after Lasik significant decrease observed as 0,75± 0,8 (-0,50/1,25)at final examination. UCVA improved from 0,1± 0,5(0,1/0,2) to mean 0,6±0,2(0,2/0,8) p=0,001. BCVA remained same on %61,4 eyes, %19,3 eyes gained 1 line and %19,3 eyes lost one line but none of the eyes lost 2 or more lines.


For the correction of high hyperopia and astigmatism Lasik results are not always predictable and regression is an issue. Enhancement treatment with Lasik may not be possible because of high ablation tissue amount and steepened cornea. First AK flattens the cornea , reduces the astigmatism and decreases hyperopia slightly without ablating any tissue from the cornea. Performing Lasik after Ak is an effective and safe 2-step technique and the results appear to be predictable.

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