Objetivos: Determinar os efeitos celulares e o mecanismo de ação da mitomicina C tópica na prevenção e tratamento da opacidade corneana em coelhos submetidos à ceratectomia fotorrefrativa (PRK). Métodos: Foram submetidos à cirurgia de PRK 224 coelhos para correção de -9 dioptrias esféricas, associada à aplicação de mitomicina C tópica ou solução salina balanceada. O nível de opacidade corneana foi avaliado por meio de análise à lâmpada de fenda. Os animais foram sacrificados quatro horas, 24 horas, quatro semanas e seis meses após a cirurgia. A análise imunohistoquímica foi realizada com as técnicas de TUNEL e foram utilizados os anticorpos Ki67 e alpha-SMA para a análise da apoptose celular, replicação celular e formação de miofibroblastos, respectivamente. Resultados: Todos os grupos submetidos à aplicação de mitomicina C apresentaram um maior número de células positivamente marcadas pelo ensaio com TUNEL (indicando maior taxa de apoptose celular) e um menor número de células positivamente marcadas pelo anticorpo Ki67 (indicando menor taxa de replicação celular). Uma menor quantidade de miofibroblastos (células positivamente marcadas pelo anticorpo alpha-SMA) foi identificada após a aplicação profilática da mitomicina C, comparada com sua aplicação com finalidade terapêutica. Além disso, identificou-se uma zona de acelularidade no estroma anterior de córneas tratadas com mitomicina C, persistente por um período mínimo de seis meses. Conclusões: A aplicação da mitomicina C diminuiu signficativamente a formação de opacidade corneana em coelhos. Apesar da mitomicina C ter induzido uma maior apoptose de ceratócitos e miofibroblastos, seu principal mecanismo de ação, responsável pela prevenção da opacidade corneana, decorreu do bloqueio da replicação dos ceratócitos ou outras linhagens celulares progenitoras dos miofibroblastos. A aplicação da mitomicina C na concentração de 0,002% mostrou-se tão eficiente quanto sua aplicação na concentração de 0,02%. Não obstante, uma persistente diminuição da densidade de ceratócitos no estroma anterior pode representar um sinal de alerta para possíveis complicações a longo prazo / Purpose: To determine cellular effects and the mechanism through which topical mitomycin C prevents and treats corneal haze after photorefractive keratectomy (PRK) in rabbits. Methods: Minus nine diopters PRK with mitomycin C or balanced salt solution was performed in two hundred and twenty four New Zealand rabbits. Haze level was graded at the slit lamp. Rabbits were sacrificed at 4 hours, 24 hours, 4 weeks or 6 months after surgery and immunohistochemistry was performed with TUNEL assay, Ki67 and alpha-SMA to analyze keratocyte cells apoptosis, keratocyte cells replication and myofibroblast cells formation, respectively. Results: TUNEL-positive cells increased in all mitomycin C groups (representing more keratocyte cells undergoing apoptosis) while Ki67-positive cells decreased significanlty (representing a decreased keratocyte cells replication) following mitomycin C application. A greater decrease in myofibroblasts was noted with prophylactic mitomycin C treatment than therapeutic mitomycin C treatment. There was, however, an anterior stromal acellular zone in eyes treated with mitomycin C that persisted out to the maximum follow-up of 6 months. Conclusion: Mitomycin C application significantly reduced corneal haze formation in rabbits. Its treatment induces apoptosis of keratocytes and myofibroblasts, but the predominate effect in inhibiting or treating haze appears to be at the level of blocked replication of keratocytes or other progenitor cells of myofibroblasts. Treatment with 0.002% mitomycin C appears to be just as effective as higher concentrations (0.02%) in the rabbit model. However, a persistent decrease in keratocyte cells density in the anterior stroma could be a warning sign for future complications

Objetivos: Determinar os efeitos celulares e o mecanismo de ação da mitomicina C tópica na prevenção e tratamento da opacidade corneana em coelhos submetidos à ceratectomia fotorrefrativa (PRK). Métodos: Foram submetidos à cirurgia de PRK 224 coelhos para correção de -9 dioptrias esféricas, associada à aplicação de mitomicina C tópica ou solução salina balanceada. O nível de opacidade corneana foi avaliado por meio de análise à lâmpada de fenda. Os animais foram sacrificados quatro horas, 24 horas, quatro semanas e seis meses após a cirurgia. A análise imunohistoquímica foi realizada com as técnicas de TUNEL e foram utilizados os anticorpos Ki67 e alpha-SMA para a análise da apoptose celular, replicação celular e formação de miofibroblastos, respectivamente. Resultados: Todos os grupos submetidos à aplicação de mitomicina C apresentaram um maior número de células positivamente marcadas pelo ensaio com TUNEL (indicando maior taxa de apoptose celular) e um menor número de células positivamente marcadas pelo anticorpo Ki67 (indicando menor taxa de replicação celular). Uma menor quantidade de miofibroblastos (células positivamente marcadas pelo anticorpo alpha-SMA) foi identificada após a aplicação profilática da mitomicina C, comparada com sua aplicação com finalidade terapêutica. Além disso, identificou-se uma zona de acelularidade no estroma anterior de córneas tratadas com mitomicina C, persistente por um período mínimo de seis meses. Conclusões: A aplicação da mitomicina C diminuiu signficativamente a formação de opacidade corneana em coelhos. Apesar da mitomicina C ter induzido uma maior apoptose de ceratócitos e miofibroblastos, seu principal mecanismo de ação, responsável pela prevenção da opacidade corneana, decorreu do bloqueio da replicação dos ceratócitos ou outras linhagens celulares progenitoras dos miofibroblastos. A aplicação da mitomicina C na concentração de 0,002% mostrou-se tão eficiente quanto sua aplicação na concentração de 0,02%. Não obstante, uma persistente diminuição da densidade de ceratócitos no estroma anterior pode representar um sinal de alerta para possíveis complicações a longo prazo / Purpose: To determine cellular effects and the mechanism through which topical mitomycin C prevents and treats corneal haze after photorefractive keratectomy (PRK) in rabbits. Methods: Minus nine diopters PRK with mitomycin C or balanced salt solution was performed in two hundred and twenty four New Zealand rabbits. Haze level was graded at the slit lamp. Rabbits were sacrificed at 4 hours, 24 hours, 4 weeks or 6 months after surgery and immunohistochemistry was performed with TUNEL assay, Ki67 and alpha-SMA to analyze keratocyte cells apoptosis, keratocyte cells replication and myofibroblast cells formation, respectively. Results: TUNEL-positive cells increased in all mitomycin C groups (representing more keratocyte cells undergoing apoptosis) while Ki67-positive cells decreased significanlty (representing a decreased keratocyte cells replication) following mitomycin C application. A greater decrease in myofibroblasts was noted with prophylactic mitomycin C treatment than therapeutic mitomycin C treatment. There was, however, an anterior stromal acellular zone in eyes treated with mitomycin C that persisted out to the maximum follow-up of 6 months. Conclusion: Mitomycin C application significantly reduced corneal haze formation in rabbits. Its treatment induces apoptosis of keratocytes and myofibroblasts, but the predominate effect in inhibiting or treating haze appears to be at the level of blocked replication of keratocytes or other progenitor cells of myofibroblasts. Treatment with 0.002% mitomycin C appears to be just as effective as higher concentrations (0.02%) in the rabbit model. However, a persistent decrease in keratocyte cells density in the anterior stroma could be a warning sign for future complications

Syfte: Studiens syfte var att undersöka hur refraktiv kirurgi ser ut i Sverige idag, vilka komplikationer som finns och vilka metoder som används genom att göra en kort redovisning av de vanligaste teknikerna FS-lasik, LASEK, TransPRK och RLE som finns inom refraktiv kirurgi och med hjälp av en enkät ta reda på de olika komplikationerna mellan olika åldersgrupper.  Metod: En enkätstudie inom refraktiv kirurgi i Sverige genomfördes. Enkäten var webbaserad och skapad i Google Docs (http://docs.google.com). Enkäten innehöll totalt 11 frågor som handlade om patientens tidiga refraktion, operationsmetod och ögonhälsa efter operationen. Enkäten spreds via sociala medier som Facebook, Instagram, Twitter, olika forumsiter, samt mail. En del av enkäten var även fördelad på två olika ögonkliniker i Lund. Resultat: Resultaten av enkäten visar att det finns inte någon skillnad i komplikationsgraden mellan de olika åldersgrupperna och komplikationerna efter kirurgin beror på typen av metod och patientens synfel och brytningsfel.  Slutsats: Vid de olika metoderna förekommer olika komplikationer och ju mer närsynt patienten är desto större är risken för komplikationer i samband med operationen. / Refractive surgery is an effective method for correcting visual refractive errors. The method has evolved quickly over the past decade. The aim of this study was to examine what refractive surgery is in Sweden today. What complications exist and which methods are used, are described by making a presentation of the refractive surgery techniques FS-LASIK, LASEK, TransPRK and RLE. This was done by a survey to find out the various complications between different age groups. A web-based survey was disseminated trough social media like Facebook, different forum sites and e-mail. The survey was also submitted to various eye clinics. The respondents were asked questions about their age, gender, the surgical method used and the complications after surgery. The results of the survey showed that there is no difference in the complication rate between the different age groups. Complications only depend on the type of method used and the patient’s refractive errors.

BACKGROUND: The human eye is an incredible organ, capable of focusing and detecting light that passes through its specialized structures. These organs are responsible for the sensation of vision and are crucial to the ability to function and operate during daily life. Loss of the sense of vision can result in serious deficits that greatly reduce the quality of a person’s life. One of the most prevalent causes of vision impairment in the world is refractive error. Although this is a common and relatively simple problem to fix with modern technology, ophthalmologists are continuously searching for new methods of treating people’s eyes to correct refractive errors and improve vision. There are several popular methods for correcting refractive errors, including traditional glasses, contact lenses, and laser vision correction. Laser vision correction is the most modern method for improving visual acuity deficits caused by refractive errors. The two most favored techniques for laser vision correction are laser assisted in site keratomileusis (LASIK) and photorefractive keratectomy (PRK). The performance of these procedures requires a laser treatment input to be calculated based on the patient’s refractive error. These laser treatment inputs are often determined using a nomogram. Nomograms are mathematical functions utilizing a graphical display to calculate a given value based on a set of parameters. Nomograms are crucial for safe and effective LASIK and PRK procedures and there is much interest in enhancing these algorithms to improve the refractive and visual acuity outcomes. OBJECTIVES: The objective of the study was to determine if a newer, more complex laser vision correction nomogram could generate laser treatment inputs better than another more traditional nomogram in terms of refractive and visual acuity outcomes. METHODS: The study included 109 eyes belonging to 59 patients. Fifty-one eyes belonging to 28 patients were operated on using the Wellington nomogram and 58 eyes belonging to 31 patients were operated on using the Internet-based refractive analysis (IBRA) nomogram. Visual acuity and refractive outcomes were recorded at a six-week follow-up evaluation. Data were analyzed using statistical tests to determine significant values. RESULTS: No statistically significant difference was found between the recorded visual acuity and refractive outcomes of eyes operated on using the Wellington and IBRA nomograms. CONCLUSIONS: The two nomograms were found to perform at equal efficacy and to reach the established standards for safety. Although no significant difference was found between the two nomogram outcomes it is possible that there were variables limiting the external validity of the statistical analysis. With extra time, additional cases, and better sample matching the study could be expanded and developed to provide a more reliable and more representative dataset to elucidate conclusions with greater impact. / 2022-06-07T00:00:00Z

INTRODUCTION: There are two main procedures responsible for correcting refractive error: laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). The most common postoperative complication of all laser vision correction (LVC) surgeries is keratoconjunctivitis sicca, or dry eye. In addition to physical irritation, dry eye can cause poor visual acuity and reduced quality of life. There are inconsistencies in the literature about which procedure results in higher rates of dry eye thus we explored the likelihood of a dry eye intervention within the first year after surgery. METHODS: Performing a retrospective chart review of all patients who underwent LVC procedures between 2009-2019 at a private Boston ophthalmology clinic, we were able to quantify the proportion of patients that required postoperative dry eye interventions within the 12 months following surgery. At this clinic, a dry eye intervention was defined as one of two treatments: punctal plug insertion or prescription medication (Restasis or Xiidra) use. RESULTS: A total of 11,175 LASIK eyes from 5,920 individuals, 1,549 LASEK eyes from 880 individuals, and 2,006 PRK eyes from 1,165 individuals were included in the analysis. Comparing the proportion of LASIK dry eye interventions to the proportion of PRK/LASEK dry eye interventions via a 2-sample z-test at an alpha level of significance of 0.05, yielded a z-value= 5.7 and a p-value= <0.0001 at a 95% CI (0.0102 - 0.0208). CONCLUSION: Our results suggest a greater incidence of postoperative dry eye interventions for PRK/LASEK patients compared to LASIK patients in the 12 months following LVC surgery. This study was limited in regards to both objective and subjective indicators of dryness; therefore future studies should attempt to be more comprehensive in evaluating postoperative dry eye. However, this study should help surgeons in the decision making process of which refractive eye surgery to recommend in order to reduce postoperative dry eye incidence and improve overall patient quality of life and satisfaction. / 2022-06-08T00:00:00Z

No / All forms of corneal refractive surgery can sometimes cause an increase in optical aberrations and scattered light, which can affect visual performance. The purpose of this study was to develop a suitable test that was sensitive to retinal image degradation in subjects who have undergone excimer laser refractive surgery and that was also relevant to visual demands in commercial aviation. Methods: Assessment of the visual environment and the tasks involved in piloting a commercial aircraft formed the basis for the selection of the test parameters. The new contrast acuity assessment (CAA) test covers a functional visual field of ±5° and is based on minimum spatial vision requirements for commercial pilots. Results: Data measured in 100 normal subjects were used to define the `standard normal observer' and the range of variation for the parameters of the test. This approach makes it possible to quickly establish whether a given subject's performance falls within the range of the standard normal observer. The test is also administered under low ambient illumination since flying at night involves mesopic levels of light adaptation when the pupil size is large and the effects of aberrations and scattered light are therefore more pronounced. Conclusion: The results of the test are simple to interpret and reveal visual performance that falls outside the normal range as a result of either significant degradation of retinal image quality (caused by increased aberrations and scattered light) or abnormal processing of visual information in the retina and/or the visual pathway.

Hintergrund: Die Excimer Laser PRK zur Korrektur der geringen bis moderaten Myopie wird als präzises Verfahren der refraktiven Chirurgie angesehen und weltweit angewandt. Die Genauigkeit der PRK nimmt jedoch mit steigender Korrektur ab. Das Ziel dieser Untersuchung bestand darin, den Einfluß unterschiedlicher Laserstrahlapplikations- und -formungssysteme auf die korneale Oberflächenstruktur, das Hornhautprofil und die Zielrefraktion zu untersuchen. Materialien und Methoden: Es wurden mit dem Meditec Mel 60 und dem Schwind Keratom, zwei Excimer Laser der Wellenlänge 193 nm, an jeweils 10 enukleierten Schweinehornhäuten eine PRK mit einer Zielkorrektur von -3, -6, -9 D mit einem Ablationsdurchmesser von 6 mm (5 mm - 9D) durchgeführt, ein Silikonabdruck von der Hornhautoberfläche angefertigt und mit einem dynamisch fokussierenden Topometrie System UBM Microfocus vermessen. Hornhautradius, Brechkraft der stromalen Oberfläche, Profilabweichungen von der idealen sphärischen Form sowie Rauheitsparameter der verschiedenen Zonen wurden ermittelt. Ergebnisse: Epithelfreie Hornhäute besitzen ein sphärisches Profil. Der Meditec Mel60 Laser erzielte nach PRK von -3, -6 und -9 D sphärische Profile mit einer durchschnittlichen Refraktionsänderung von -3.4, -6.7 und -8.7 D. Das Schwind Keratom erzeugte eine mittlere Refraktionsänderung von -3.5, -5.8 und 8.4 D, wobei das korneale Ablationsprofil in allen Korrekturgruppen erhebliche Profilabweichungen in Form von zentralen Profilkuppen aufwies. Die durchschnittliche Höhe der zentralen Profilkuppen betrug nach der -3 D PRK 7.39 (±0.34) µm und stieg auf 16.31 (±1.06) µm bzw. 15.06 (±0.96) µm in der -6 und in der -9 D Serie. Die Relation zwischen der Profilkuppenhöhe und der Abtragtiefe lag zwischen 21 - 25% und konnte durch eine Anti-Central-Island Programm (ACI 100%) nur um 4% auf 18-20 % der Abtragtiefe reduziert werden. Die stromale Oberfläche der unbehandelten, epithelfreien Kontrollgruppe hat eine glatte, homogene Struktur. Die Rauheit der stromalen Oberfläche nach Ablation mit dem Meditec Laser war um 50 % stärker ausgeprägt als beim Schwind Keratom. Diskussion: Die Beschaffenheit der stromalen Oberfläche nach der Excimer Laser PRK zur Korrektur der Myopie, wird durch die Rauheitsparameter quantitativ beschrieben und ermöglicht den direkten Vergleich zwischen den Lasersystemen. Die Rauheit ist positiv mit der Ablationstiefe und dem Ablationsdurchmesser korreliert. Je höher eine myope Korrektur angestrebt wird, desto rauher ist die stromale Oberfläche und damit das Risiko, dass sich eine epitheliale Hyperplasie und subepitheliale Trübungen entwickeln, die ursächlich mit den klinisch beobachteten Phänomenen der myopen Regression, der Abnahme der Kontrastsehschärfe, dem Verlust der bestkorrigierten Sehschärfe und monokularer Doppelbilder in Zusammenhang stehen. Ob der Unterschied der Rauheit von durchschnittlich 50% sich in der Inzidenz der klinischen Komplikationen widerspiegelt, können nur vergleichende Studien belegen. Sicher ist, das die Vorhersagbarkeit des refraktiven Ergebnisses durch die Ablation mit dem Aesculap Meditec MEL 60 Laser besser einzuschätzen ist, als das mit zentralen Profilkuppen komplizierte Ablationsprofil des Schwind Keratoms. / Purpose: To evaluate the predictability of refractive outcome, sphericitiy of corneal profiles and surface roughness parameters after myopic PRK with different, commercially available excimer laser beam delivery and beam shaping systems. Materials and Methods: Myopic Excimer Laser PRK of -3, -6 and -9 D in 6mm ablation zone (5 mm in -9 D) on performed on porcine eyes was performed with the Aesculap Meditec Mel 60, a slit scanning Laser and the Schwind Keratom I, a broad area laser with band mask beam shaping. A silicone replica was obtained to conserve the corneal profile and measured with a dynamic focusing topometry system (UBM Microfocus) to obtain radius, corrected corneal refraction and corneal surface roughness parameters. Results: Untreated corneas of the control group displayed spherical profiles. PRK of intended -3, -6 and -9 D correction with the slit scanning Aesculap Meditec Mel60 excimer laser achieved a refractive change of an average -3.4, -6.7 and -8.7 D respectively without major profile deviations. PRK with the Schwind Keratom, a broad area beam excimer laser resulted a refractive change of -3.5, -5.8 and -8.4 D respectively. The Ablation created considerable central profile deviations representing central islands of 7.39 (±0.34) µm after -3 D, 16.31 (±1.06) µm and 15.06 (±0.96) µm height after - 6 and -9 D PRK, respectively. Mean central island height was 21 - 25% of ablation depth and was reduced by anti-central-island-program to 18-20 % of ablation depth. Stromal surface roughness increased with ablation depth and was significantly rougher after scanning beam ablation compared to broad area ablation. Conclusions: Profile deviations increase with higher corrections and lessen the predictability of the refractive results. The Aesculap Meditec MEL60 Slit scanning system creates predictable spherical corneal profiles. The Schwind Keratom broad area laser create with band mask beam shaping central islands increasing with higher corrections. The application of an Anti-Central-Island Program does not eliminate the central profile elevations sufficiently. Stromal surface was rougher after scanning beam compared to broad area beam ablation.

OBJETIVO: Comparar os resultados de duas técnicas cirúrgicas guiadas pela análise de frente de onda, a ceratectomia fotorrefrativa (PRK) e a ceratomileusis in situ a laser (LASIK), para correção da miopia baixa a moderada, associada ou não ao astigmatismo. LOCAL: Setor de Cirurgia Refrativa da Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. MÉTODOS: Estudo prospectivo randomizado envolvendo 70 olhos (35 pacientes) submetidos ao LASIK personalizado em um olho e PRK personalizado no olho contralateral para correção de miopia até 5 dioptrias (D) e astigmatismo até 1,5D. Avaliou-se acuidade visual não-corrigida (AVNC), melhor acuidade visual corrigida (MAVC), resultados refratométricos, aberrometria, sensibilidade ao contraste fotópico e mesópico, acuidade visual de baixo contraste (AVBC), qualidade da imagem retiniana (Função de Transferência Modular e Strehl ratio) e espalhamento intraocular de luz (EIL) no período pré-operatório e no 1o, 3o, 6o e 12o mês pós-operatório. RESULTADOS: O equivalente esférico (EE) médio pré-operatório foi -2,57 ± 0,95D no grupo LASIK e, no grupo PRK, -2,52 ± 0,90D (p = 0,722). No 12o mês pósoperatório (PO), EE foi -0,06 ± 0,33D e -0,12 ± 0,41D, respectivamente (p = 0,438). No grupo LASIK, 60,0% dos olhos apresentaram AVNC 20/16 e 96,7% 20/20, e no grupo PRK, 66,6% e 96,7%, respectivamente (p = 0,667). No período pré-operatório, o total das aberrações de alta ordem (HOAs) foi 0,37 ± 0,09 m no grupo LASIK e 0,36 ± 0,11m no grupo PRK (p = 0,752). No 12o mês PO, o total das HOAs foi 0,46 ± 0,21m no grupo LASIK e 0,42 ± 0,14m no grupo PRK (p = 0,438). Tanto o teste de sensibilidade ao contraste fotópico como o mesópico apresentaram resultados semelhantes entre as técnicas, exceto pela freqüência 1,5 ciclos por grau (cpg) do teste mesópico no 12o mês PO, a favor do grupo PRK. Os índices de qualidade da imagem retiniana mostraram comportamento similar entre as técnicas ao longo do seguimento. Não houve aumento significativo do espalhamento intraocular da luz em ambos os grupos, quatro olhos cursaram com aumento transitório. CONCLUSÃO: Dentro das condições deste estudo, ambas as técnicas apresentaram excelentes resultados refratométricos e função visual semelhante. Apesar do tratamento personalizado guiado pela análise de frentes de onda, houve indução das HOAs, de forma similar, tanto no LASIK como no PRK. / PURPOSE: To compare clinical results of two wavefront-guided treatments, photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK), for low to moderate myopia correction, with or without astigmatism. SETTING: Refractive Surgery Service, General Hospital, University Of São Paulo, São Paulo, Brazil. METHODS: Prospective randomized study of 70 eyes (35 patients) submitted to custom LASIK and custom PRK (contralateral eye) for myopia up to 5D and astigmatism up to 1,5D. Uncorrected visual acuity (AVNC), best-corrected visual acuity (MAVC), refractive results, wavefront analysis, photopic and mesopic contrast sensitivity, low contrast visual acuity (AVBC), retinal image quality (Modulation Transfer Function and Strehl ratio) and intraocular straylight (EIL) were performed preoperatively and at one, three, six and twelve months postoperatively. RESULTS: The mean preoperative spherical equivalent (EE) was -2,57 ± 0,95D in the LASIK group and -2,52 ± 0,90D in the PRK group (p = 0,722). At twelve months postoperatively (PO), the mean EE was -0,06 ± 0,33D and -0,12 ± 0,41D, respectively (p = 0,438). In the LASIK group, 60,0% had AVNC 20/16 and 96,7% 20/20, and in the PRK group, 66,6% e 96,7%, respectively (p = 0,667). The mean pre-treatment total high-order aberrations (HOAs) was 0,37 ± 0,09 m in the LASIK group and 0,36 ± 0,11m in the PRK group (p = 0,752). At twelve months PO, the mean total HOAs was 0,46 ± 0,21m in the LASIK group and 0,42 ± 0,14 m in the PRK group (p = 0,438). No significant difference in photopic and mesopic contrast sensitivity between groups was noted, apart from the 1,5 cpg frequency of the mesopic test, favoring PRK, at the 12th month PO. Similar results were found for retinal image quality metrics during the follow-up. No significant increase of the intraocular straylight was found for both techniques, four eyes presented transitory elevations. CONCLUSION: In the conditions of this study, both techniques had excellent refractive results and similar visual function. In spite of the wavefront-guided treatments, HOAs were induced similarly after LASIK and PRK

OBJETIVO: Comparar os resultados de duas técnicas cirúrgicas guiadas pela análise de frente de onda, a ceratectomia fotorrefrativa (PRK) e a ceratomileusis in situ a laser (LASIK), para correção da miopia baixa a moderada, associada ou não ao astigmatismo. LOCAL: Setor de Cirurgia Refrativa da Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. MÉTODOS: Estudo prospectivo randomizado envolvendo 70 olhos (35 pacientes) submetidos ao LASIK personalizado em um olho e PRK personalizado no olho contralateral para correção de miopia até 5 dioptrias (D) e astigmatismo até 1,5D. Avaliou-se acuidade visual não-corrigida (AVNC), melhor acuidade visual corrigida (MAVC), resultados refratométricos, aberrometria, sensibilidade ao contraste fotópico e mesópico, acuidade visual de baixo contraste (AVBC), qualidade da imagem retiniana (Função de Transferência Modular e Strehl ratio) e espalhamento intraocular de luz (EIL) no período pré-operatório e no 1o, 3o, 6o e 12o mês pós-operatório. RESULTADOS: O equivalente esférico (EE) médio pré-operatório foi -2,57 ± 0,95D no grupo LASIK e, no grupo PRK, -2,52 ± 0,90D (p = 0,722). No 12o mês pósoperatório (PO), EE foi -0,06 ± 0,33D e -0,12 ± 0,41D, respectivamente (p = 0,438). No grupo LASIK, 60,0% dos olhos apresentaram AVNC 20/16 e 96,7% 20/20, e no grupo PRK, 66,6% e 96,7%, respectivamente (p = 0,667). No período pré-operatório, o total das aberrações de alta ordem (HOAs) foi 0,37 ± 0,09 m no grupo LASIK e 0,36 ± 0,11m no grupo PRK (p = 0,752). No 12o mês PO, o total das HOAs foi 0,46 ± 0,21m no grupo LASIK e 0,42 ± 0,14m no grupo PRK (p = 0,438). Tanto o teste de sensibilidade ao contraste fotópico como o mesópico apresentaram resultados semelhantes entre as técnicas, exceto pela freqüência 1,5 ciclos por grau (cpg) do teste mesópico no 12o mês PO, a favor do grupo PRK. Os índices de qualidade da imagem retiniana mostraram comportamento similar entre as técnicas ao longo do seguimento. Não houve aumento significativo do espalhamento intraocular da luz em ambos os grupos, quatro olhos cursaram com aumento transitório. CONCLUSÃO: Dentro das condições deste estudo, ambas as técnicas apresentaram excelentes resultados refratométricos e função visual semelhante. Apesar do tratamento personalizado guiado pela análise de frentes de onda, houve indução das HOAs, de forma similar, tanto no LASIK como no PRK. / PURPOSE: To compare clinical results of two wavefront-guided treatments, photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK), for low to moderate myopia correction, with or without astigmatism. SETTING: Refractive Surgery Service, General Hospital, University Of São Paulo, São Paulo, Brazil. METHODS: Prospective randomized study of 70 eyes (35 patients) submitted to custom LASIK and custom PRK (contralateral eye) for myopia up to 5D and astigmatism up to 1,5D. Uncorrected visual acuity (AVNC), best-corrected visual acuity (MAVC), refractive results, wavefront analysis, photopic and mesopic contrast sensitivity, low contrast visual acuity (AVBC), retinal image quality (Modulation Transfer Function and Strehl ratio) and intraocular straylight (EIL) were performed preoperatively and at one, three, six and twelve months postoperatively. RESULTS: The mean preoperative spherical equivalent (EE) was -2,57 ± 0,95D in the LASIK group and -2,52 ± 0,90D in the PRK group (p = 0,722). At twelve months postoperatively (PO), the mean EE was -0,06 ± 0,33D and -0,12 ± 0,41D, respectively (p = 0,438). In the LASIK group, 60,0% had AVNC 20/16 and 96,7% 20/20, and in the PRK group, 66,6% e 96,7%, respectively (p = 0,667). The mean pre-treatment total high-order aberrations (HOAs) was 0,37 ± 0,09 m in the LASIK group and 0,36 ± 0,11m in the PRK group (p = 0,752). At twelve months PO, the mean total HOAs was 0,46 ± 0,21m in the LASIK group and 0,42 ± 0,14 m in the PRK group (p = 0,438). No significant difference in photopic and mesopic contrast sensitivity between groups was noted, apart from the 1,5 cpg frequency of the mesopic test, favoring PRK, at the 12th month PO. Similar results were found for retinal image quality metrics during the follow-up. No significant increase of the intraocular straylight was found for both techniques, four eyes presented transitory elevations. CONCLUSION: In the conditions of this study, both techniques had excellent refractive results and similar visual function. In spite of the wavefront-guided treatments, HOAs were induced similarly after LASIK and PRK

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