Laser in Situ Keratomileusis for High Hyperopia with Corneal Vertex Centration and Asymmetric Offset

Abstract

Purpose To investigate refractive outcomes and induction of corneal higher order aberrations (HOA) in eyes that underwent laser-assisted in situ keratomileusis (LASIK) for high hyperopia correction using an aberration neutral profile with corneal vertex centration and asymmetric offset. Methods A total of 24 consecutive patients (38 eyes) who underwent LASIK by one surgeon using AMARIS 750S excimer laser and a Carriazo-Pendular microkeratome for flap creation were retrospectively analyzed. Eyes targeted for plano and with correction in the maximum hyperopic meridian strictly higher than +4D were included in the retrospective analysis. Patients were reviewed at 1, 3, and 6 months postoperatively. Postoperative monocular corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, and corneal wavefront aberrations were compared with respective preoperative metrics. Results Mean preoperative spherical equivalent and refractive astigmatism was +4.07 ± 0.90 D and 1.37 ± 1.26 D, respectively, reducing to +0.28 ± 0.58D (p<0.0001) and 0.49 ± 0.47 D (p = 0.0001) at the last postoperative visit. Six months postoperatively, 78% of eyes achieved a UDVA of 20/25 or better. No eye lost more than 2 Snellen lines of CDVA at any follow-up. There was a statistically significant induction of vertical trefoil (+0.104 ± 0.299 µm, p<0.05), vertical coma (-0.181 ± 0.463 µm, p<0.01), horizontal coma (+0.198 ± 0.663 µm, p<0.05), spherical aberration (-0.324 ± 0.281 µm, p<0.0001), secondary vertical trefoil (+0.018 ± 0.044 µm, p<0.01), and secondary horizontal coma (+0.026 ± 0.083 µm, p<0.05) Conclusions Laser-assisted in situ keratomileusis for high hyperopia using corneal vertex centration with asymmetric offset results in significant improvement in refraction and visual acuity although affected by significant induction of some higher order aberrations.