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Customized photoastigmatic refractive keratectomy using combined topographic and refractive data for myopia and astigmatism in eyes with forme fruste and mild keratoconus

Noel Alpins, FRACO, FRCOphth, FACS, George Stamatelatos, BScOptom

PURPOSE: To examine the outcomes of photoastigmatic refractive keratectomy using corneal and refractive parameters for myopia and astigmatism in eyes with forme fruste and mild keratoconus.
SETTING: Private practice, Melbourne, Australia.
METHODS: Photoastigmatic refractive keratectomy was performed with a Star 1 or Star 2 laser (Visx) in 45 eyes with forme fruste or mild keratoconus using the Alpins vector planning technique. Inclusion requirements were best corrected visual acuity (BCVA) 20/40 or better, no slitlamp signs of keratoconus, mean keratometry less than 50.00 diopters (D), and corneal and refractive stability for at least 2 years.
RESULTS: Thirty-two eyes had follow-up of 5 years and 9 eyes, of 10 years. Preoperatively, the mean refractive astigmatism was 1.39 DC G 1.08 (SD) (range 0.45 to 5.04 DC) and the mean corneal astigmatism was 1.52 G 1.18 D (range 0.35 to 4.75 D) by manual keratometry and 1.70 G 1.42 D (range 0.32 to 5.32 D) by topography. Twelve months postoperatively, the mean refractive astigmatism was 0.43 G 0.40 D and the mean corneal astigmatism was 1.05 G 0.85 D by keratometry and 1.02 G 0.83 D by topography. At 12 months, the uncorrected visual acuity was 20/20 or better in 56% of eyes and 20/40 or better in all eyes. The BCVA was 20/20 or better in 89% of eyes and 20/30 or better in all eyes. Seven eyes had a loss of BCVA, and 16 eyes had a gain. There were no cases of keratoconus progression.
CONCLUSIONS: Photoastigmatic refractive keratectomy in eyes with forme fruste and mild keratoconus was safe and effective for myopia and astigmatism in carefully selected patients with refractive and corneal stability. The incorporation of the corneal astigmatism data into the applied treatment parameters may improve visual and total astigmatism results.
J Cataract Refract Surg 2007; 33:588–599 Q 2007 ASCRS and ESCRS