Purpose: To improve the predictability, accuracy and stability of laser in-situ keratomileusis (LASIK), by evaluating the clinical, procedural and tissue response factors that affect refractive outcomes. Methods: Myopic LASIK surgeries (n=5,978) were carried out using the Technolas planoscan and Nidek EC-5000 excimer lasers. Clinical variables associated with a refractive outcome of within ??0.50 D of the target were identified using regression analysis. Possible procedural variations such as the timing of the procedure and accuracy of both the chosen keratome and excimer laser were evaluated. The predictability and accuracy of the ablation was assessed by measuring changes in corneal thickness during and after the procedure. Factors influencing the stability of refractive outcome were assessed. Results: Clinical factors associated with a refractive outcome of within ??0.50 D of the target included; corrections less than 5.00 DS (OR 0.21x, 95% CI 0.11-0.40x compared with corrections over -5.00 DS[referent]), patients younger than 40 years (patients over 50 OR 8.27x, 95% CI 3.41-20.03x, patients 40 to 50 years OR 1.93x, 95% CI 0.96-3.90x, compared with patients under 40[referent]) and average pre-operative curvatures between 43.50 and 45.50D (OR 0.39x, 95% CI 0.18-0.83 compared with curvatures of less than 43.50D [referent]). Refractive stability was improved using optic zone sizes between 5.5-6.0 mm, reduced myopic corrections, flatter pre-operative corneal curvatures and thicker corneal flaps (R??=25%, p<0.001). Procedural factors associated with poorer outcomes included: thinner measured flap thickness, deeper ablations and the use of the automated corneal shaper (ACS) microkeratome with a novice surgical team (R??=34%, p < 0.001). Delaying the ablation from 20 to 90 seconds (s) after flap lift was associated with a more stable refractive outcome at three months (p=0.017). In the 90 s following flap lift, the cornea thinned by 5??3%. The ablation rate per scan varied between procedures, however, the effect on refractive outcome was small (r=0.15, p=0.267). Changes in central corneal thickness indicated refractive stability (p=0.039). Conclusions: Applying the optimal clinical and procedural factors as described afforded a refractive outcome in a further 8% of cases, resulting in 94% to 96% of cases within ??0.50 DS of target. Refractive predictability was limited due to the inability of the keratome to produce a consistent corneal flap thickness and unexpected changes in corneal thickness. The accuracy of refractive outcome will decrease with larger ablations. The degree of refractive inaccuracy with high refractive corrections (> -10.00 D) can be over 1.00 D.
| Identifer | oai:union.ndltd.org:ADTP/282114 |
| Date | January 2004 |
| Creators | Feltham, Mark Hayes, Optometry & Vision Science, Faculty of Science, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Optometry and Vision Science |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Mark Hayes Feltham, http://unsworks.unsw.edu.au/copyright |
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