J Korean Ophthalmol Soc.  2008 Jul;49(7):1061-1070. 10.3341/jkos.2008.49.7.1061.

Long-Term Results of Presbyopic Corneal Surface Ablation with Eximer Laser

• Chun YS
• Lee HI
• Dausch D
• Kim JC

• KMID: 1476959
• DOI: http://doi.org/10.3341/jkos.2008.49.7.1061

Abstract

PURPOSE: To evaluate the efficacy, safety, and subjective symptoms of patients who underwent presbyopic corneal surface ablation.
METHODS
Excimer laser surgery with MEL80 for refractive errors and presbyopia was performed on 128 eyes of 67 patients. Uncorrected and best-corrected visual acuity, distance-corrected near-visual acuity, spectacle near-addition for Jaeger 1, depth of focus, spherical aberration, and subjective symptoms were evaluated before surgery and 1 year after surgery.
RESULTS
This study consisted of a myopia group (56 eyes), an emmetropia group (spherical equivalent < or = +/-0.75D, 19 eyes), and a hyperopia group (53 eyes). Presbyopic corneal ablation improved distance and near uncorrected visual acuity, and distance-corrected near visual acuity at postoperative 12 months. There was no significant change in best-corrected visual acuity but there was a significant decrease in the emmetropia only group. Useful near visual acuity (> or =20/40) was found in 96 eyes (75%) and spectacle near addition for Jaeger 1 decreased. Our results showed a significant increase of spherical aberration (from -0.19 micrometer to 0.11 micrometer) and depth of focus (from 1.45D to 1.69D). A significant positive correlation was found between spherical aberration and uncorrected far and near visual acuity and depth of focus. Loss of two lines of best corrected visual acuity occurred in 11 eyes (8.5%) at far vision and in 7 eyes (5.5%) at near vision. In general, patient satisfaction was good.
CONCLUSIONS
Presbyopic corneal ablation with MEL80 showed good distant and near visual results and a wide depth of focus induced by increased spherical aberration.

Keyword

Depth of focus; MEL80; Presbyopia; Spherical aberration

MeSH Terms

Emmetropia
Eye
Humans
Hyperopia
Lasers, Excimer
Myopia
Patient Satisfaction
Presbyopia
Refractive Errors
Vision, Ocular
Visual Acuity

Figure

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  Figure 1. The changes of visual acuity in 128 eyes with presbyopic corneal ablation with MEL80. There was a significant increase of uncorrected distance visual acuity until postoperative 3 months. Uncorrected near visual acuity and distance corrected near visual acuity showed a significant increase at postoperative 1 month. Increased DUCVA and DCNVA were maintained until the postoperative 12 months. UCNVA showed a mild decrease until postoperative 12 months, but there was a significant increase in vision compared with preoperative value.

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  Figure 2. Percentage frequency distribution of uncorrected near visual acuities (Jaeger J series) in the 128 eyes. A useful near visual acuity (more than J3) was found in 96 eyes (75%).

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  Figure 3. Spectacle near addition for Jaeger 1 (A, B) showed a significant decrease. Depth of focus (C, D) and Spherical aberration (E, F) showed a significant increase at postoperative 12 months. There were the most effective changes in hyperopia group in three categories (B, D, F) by ANOVA test, Tukey’s comparison test.

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  Figure 4. Changes in contrast sensitivity in patients with correction of presbyopia with MEL80. (A) In photopic condition, there was no significant changes of contrast sensitivity after surgery except increased contrast sensitivity at 12 and 18 cycles/degrees at postoperative 12 months. (B) In scotopic condition, there was no significant changes of contrast sensitivity except increased contrast sensitivity at 18 cycles/degrees at postoperative 3 and 6 months.* p <0.05 by paired t-test.

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  Figure 5. Stability of spherical equivalent (SE) refraction. Spherical equivalent of myopia group at postoperative 1 month remained until 12 months postoperatively. In emmetropia group, there was no significant change between preoperative values and postoperative 12 months values. In hyperopia group, there was a myopic change at postoperative 1 month (-0.9D) and regression continued to the postoperative 12 months (0.3D).

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  Figure 6. Correlation between spherical aberration and logMAR visual acuity. (A), (B) There was a negative correlation between spherical aberration and logMAR DUCVA (distance uncorrected near visual acuity), logMAR UCNVA (uncorrected near visual acuity). (C) There was no correlation between logMAR DUCVA and logMAR UCNVA. (D) There was positive correlation between DOF (depth of focus) and spherical aberration.

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  Figure 7. Subjective symptoms of quality of vision and dryness in patients with correction of presbyopia with MEL80 at 12 months postoperatively.

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  Figure 8. Corneal topography in emmetropic patient, with refraction of +1.5 Dsph -1.25 Dcyl X 90 o at preoperatively (A). After eximer laser, refraction was -0.25 Dsph postoperative 12 months (B). There was a central prolaticity but not a central island.

Reference

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