Wavefront Optimized Retreatment after Prior Wavefront Optimized Retreatment after Prior WavefrontWavefront

CustomizedCustomized LASIK for MyopiaLASIK for MyopiaJuan C. Arciniega, MD; Engy Mohamed, MD; James P. McCulley, MD, FRCOphth (UK); Juan C. Arciniega, MD; Engy Mohamed, MD; James P. McCulley, MD, FRCOphth (UK);

Wayne Bowman, MD. Wayne Bowman, MD.

Department of Ophthalmology, The University of Texas Southwestern Medical Department of Ophthalmology, The University of Texas Southwestern Medical

Center at Dallas, Texas. USA.Center at Dallas, Texas. USA.

JCA and EM have no financial interest to disclose.JCA and EM have no financial interest to disclose.

JPM and WB are consultants of Alcon Inc.JPM and WB are consultants of Alcon Inc.

Financial Disclosure:Financial Disclosure:

This study was supported in part by grants NIH EY12430, EY016664 and an unrestricted This study was supported in part by grants NIH EY12430, EY016664 and an unrestricted

grant from the Research to Prevent Blindness, New York, New York. grant from the Research to Prevent Blindness, New York, New York.

Laser in situ keratomileusis (LASIK) is a popular technique for

correcting myopia, myopic astigmatism, and mild to moderate

hypermetropia.

Although the predictability is high, undercorrection and/or regression

is inevitable in some eyes.1,2

Re-treatments may be necessary and useful to refine the results

obtained after the first surgery. 2

1) Perez-Santonja JJ, Bellot J, Claramonte P, Ismail MM, Alio JL. Laser in situ keratomileusis to correct high myopia. J Cataract Refract Surg 1997;23:372-85.

2) O’Doherty M. O’Keeffe M, Kelleher C. Five year follow-up of laser in situ keratomileusis for all levels of myopia. Br J Ophthalmol 2006;90:20-3.

BackgroundBackground

To assess the visual outcomes, refractive error, and safety of

Wavefront-Optimized (WFO) LASIK retreatment after previous

Wavefront- Customized (WFC) LASIK in myopic patients.

PurposePurpose

MethodsMethods

• A retrospective chart review of 18 eyes from 13 patients whom underwent WFO LASIK retreatment after previous WFC LASIK was performed.

• All primary LASIK procedures were done using the Visx CustomVueTM laser platform (Abbott Medical Optics, Illinois, USA).

• All eyes underwent LASIK retreatments using the Wavelight AllegrettoTM Eye-Q 400 excimer laser platform (Alcon Inc., Hünenberg, Switzerland).

• Ophthalmic examinations, including uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), refractive error (RE), and complications were performed preoperatively and postoperatively at 1, 3, and 6 months.

• Pre-retreatment total root mean square (RMS) from third to sixth order- Zernike polynomials was calculated.

Pre-retreatment total high order aberrations (HOA).

ResultsResults

Pre-operative and post-operative values of RE

Pre-operative POM 1 POM 3 POM 6

Spherea -0.56±1.4 -0.31±0.5 -0.24±0.36 -0.39±0.35

Range -3.0 to 1.5 -1.25 to 0.5 -1.25 to 0.25 -1.5 to 0

Astigmatisma 0.7±0.5 0.14±0.29 0.14±0.29 0.17±0.24

Range 0 to 2 0 to 0.75 0 to 0.75 0 to 0.75

POM= Post-operative month. aValues expressed as mean ± standard deviation.

Table 1.

ResultsResults

Comparison between Pre-operative and Post-operative values of RE.

ResultsResults

UCVA, BSCVA and SE over follow-up time

Preoperative POM 1 POM 3 POM 6

UCVA 0.27±0.16 0.062±0.12 0.06±0.12 0.02±0.05

BSCVA 0.01±0.03 -0.01±0.03 -0.01±0.03 -0.03±0.05

SE -0.211±1.4 -0.23±0.4 -0.16±0.29 -0.30±0.29

POM = postoperative month; UCVA = uncorrected visual acuity; SE = spherical equivalent

BSCVA = best spectacle corrected visual acuity; UCVA & BSCVA = logMAR scale

Table 2.

ResultsResults

Comparison between Pre-operative BSCVA and Post-operative UCVA at 6 months

ResultsResults

Pre-retreatment spherical equivalent changed from -0.21 ± 1.4 D (range from 1.63 to -3.0) to -0.29 ± 0.3 D (range from 0 to -1.0) at 6 months.

ResultsResults

• The pre-retreatment total HOA was 0.48±0.21 (0.24 to 1.01µm) and

did not show correlation with the visual outcomes postoperatively.

•At 6 months all eyes were within ±0.50D of target refraction.

• The efficacy index (UCVA post-operative/BSCVA pre-operative) was 1.0 at 6

months.

• The safety index (BSCVA post-operatively/BSCVA pre-operatively) was 1.08 at 6

months.

• No intraoperative or postoperative complications were reported.

ResultsResults

Our findings suggest that Wavefront-Optimized ablation retreatment

after primary Wavefront-Customized LASIK is safe and predictable,

with positive visual and refractive outcomes achieved at 6 months

post-treatment.

In addition, no correlation between the degree of pre-retreatment

total RMS and visual outcomes postoperatively was detected.

ConclusionConclusion