Faik Orucov*, MD, Sinan Goker*,MD, Faik Orucov*, MD, Sinan Goker*,MD, Abraham Solomon**, MD, Joseph Frucht-Abraham Solomon**, MD, Joseph Frucht-

Pery**, MD Pery**, MD

Comparison of Tecnolas and Allegretto laser in situ keratomileusis outcomes in hyperopia

*Refractive Surgery Department,*Refractive Surgery Department,ISTANBUL SURGERY HOSPITALISTANBUL SURGERY HOSPITALIstanbul, TurkeyIstanbul, Turkey

** Hadassah University Hospital, ** Hadassah University Hospital, Jerusalem, IsraelJerusalem, Israel

Hyperopia

Hyperopia ≥ 2D 6% of population Low Hyperopia

good vision in young

poor vision in adults Hyperopia affects both distance and near

vision and is compounded by presbyopia

Hyperopic Correction

Thermokeratoplasty Hexogonal keratotomy Keratophakia Keratomileusıs Holmium laser CK H-PRK H-LASIK Phakic IOLs RLE

PROBLEMS IN HYPEROPIA

Pt’s age > 40

- Dry eyes

- BMD

- More epithelial defects Flap size 9.5 mm

- Small eyes and pannus

(limbal bleeding)

PROBLEMS IN HYPEROPIA

Large area of treatment

(Flap size 9.5 mm) Long ablation time Centration is critical

PROBLEMS IN HYPEROPIA

Initial overcorrection

(myopia) Slow regression

[1 y. in high hyperopia] Enhancement is complicated Final K-reading < 50 [D]

Hyperopic correction is significantly more likely to regress

regression greater than myopic correction. The possibility of regression;

hyperplastic healing response of the cornea to fill in this ablated step between the treated and untreated zones, thereby not only resulting in loss of effect over time but also inducing an astigmatic error in case of uneven fill-ins.

PURPOSE

To compare visual outcome measurements in laser in situ keratomileusis (LASIK) for hyperopia using the Technolas 217 and Allegretto excimer laser.

Authors have no financial interests in any of the mentioned products or companies

•Two-center retrospective study•H-LASIK by the Technolas 217; 50 eyes (Hadassah Medical Organization, Jeruasalem, (2003 and 2005)) • H-LASIK by Allegretto excimer laser ; 42 eyes (Istanbul Surgery Hospital, Istanbul, (2004 and 2005))•Mean follow-up 23.1±13.7 months with Technolas 19.3±8.8 months with Allegretto.•Inclusion criteria; - SE up to 4.00 diopters (D) of sycloplegic hyperopia, - Minimum F/U 12 months•Exclusion criteria; - Incomplete documentation

METODS

SE

Technolase Allegretto P

SE (Mean) Preoperative +2.51±0.78 (D) +2.37±0.81 (D) 0.386

Postoperative -0.01 ±0.58 -0.003 ±0.41 0.912

Technolase Allegretto P

Optical zone (Mean) 6.0±0.1mm 6.8±0.25 <0.001

Ablation depth (Mean) 68.1±21.2μ 49.8±18.3μ <0.001

Optical zone & Ablation depth

Higher Myopic overcorrection on the next day

Greater regression observed during first month

Regression (month 1 to last visit) : Technolase +0.48 D

Allegretto +0.36 D (P=0.247)

Stability

UCVA

The postoperative UCVA was significantly lower in eyes treated with Tecnolas on postoperative month 1 (P=.037) . At 3, 6 ,12 months and at last visit postoperatively, no significant differences were noted in UCVA between the two lasers (P=.065 to .473).

Technolase Allegretto P

UCVA

1 Month 0,69 ± 0,25 0,81 ± 0,26 0,032

12 Months 0,80 ± 0,18 0,85 ± 0,18 0,473

Last visit 0,80 ± 0,22 0,86 ±0,17 0,126

PREOPERATIVE

LAST VISIT

0.92±0.150.96±0.09

0.94±0.15

0.97±0.10

P= 0.144 P= 0.239

BCVA

Postoperative (last visit) Technolas Allegretto

UCVA ≥ 20/25 55.8% 69.0%

±0.50 D 69.0% 78.7%,

BSCVA

loss of ≥ 1 lines 11.4% 4.8%

gain of ≥ 1 lines 19.2% 16.7%.

Efficacy & Safety Technolas Allegretto P

Safety 1.03±0.12 1.01±0.05 0.409

Efficacy 0.87±0.21 0.90±0.16 0.444

Predictability

CONCLUSION

• Ablation depth was greater with Technolas laser.

• Visual and refractive results were similar between the Technolas and Allegretto laser systems after 3 months of the procedure.