Six-month results of hyperopic and astigmatic LASIK in eyes with primary and secondary hyperopia.

Abstract PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism and develop a LASIK nomogram for primary hyperopia or hyperopia secondary to myopic refractive surgery using the VISX STAR S2. METHODS: Prospective evaluation of LASIK in 46 primary eyes and 29 secondary eyes with fogged manifest sphere from +0.5 diopters (D) to +6.0 D and cylinder from 0 to +5.0 D. RESULTS: Mean manifest spherical equivalent (SE) in patients with primary hyperopia was +2.50 D +/- 0.93 preoperatively and +0.70 D +/- 1.19 at 6 months. At 6 months, 79% of primary hyperopes had uncorrected visual acuity (UCVA) of 20/40 or better; 63% were within +/- 1 D of emmetropia. One primary hyperope lost 2 lines of best spectacle-corrected vision (BCVA) at 1 month. Complications included transient epithelial defect (6.5%), epithelial cells in the interface (4.3%), diffuse lamellar keratitis (4.3%), haze (2.2%), and mild irregular astigmatism (2.2%). In those with secondary hyperopia, mean manifest SE was +1.70 D +/- 0.82 preoperatively and -0.27 D +/- 0.95 at 6 months. At 6 months, 83% of secondary hyperopes had UCVA of 20/40 or better; 74% were within +/- 1 D of emmetropia. No secondary hyperope lost > or = 2 lines of BCVA. Complications included intraoperative bleeding (3.4%), intraoperative epithelial defect (3.4%), transient interface debris (3.4%), significant dry eye (3.4%), blood in interface (3.4%), irregular astigmatism (6.9%), slight decentration (6.9%), trace haze (6.9%), mild epithelial ingrowth not requiring removal (3.4%), or corneal irregularity (3.4%). CONCLUSION: These early data suggest that LASIK for hyperopia from +0.5 to +6 D and astigmatism from 0 to +5 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery and is safe and effective. Patients with secondary hyperopia achieved more correction than those with primary hyperopia, although the accuracy and predictability of LASIK in both groups has improved with the nomogram adjustments.