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Advanced surface ablation superior to LASIK in post-keratoplasty patients at 3 months

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HONG KONG — Advanced surface ablation with mitomycin-C has shown a trend toward visual improvement in ametropic patients who have undergone penetrating keratoplasty, according to a presenter here.

Michael A. Lawless, MB, BS, FRACO, FRACS, FRCOphth, presented 3-month results from a study involving 44 eyes of 16 female patients and 26 male patients who had previous PK. Dr. Lawless and two colleagues, Gerard L. Sutton, MB, BS, FRACO, FRACS, and Christopher M. Rogers, MB, BS, FRACO, FRACS, performed surface ablation using two excimer lasers: the LADARVision 4000 and LADAR6000 platforms (Alcon) in 29 cases and the Allegretto (WaveLight) in 15 cases.

They applied MMC 0.02% with an 8-mm corneal sponge for an average of 35.45 seconds. Dr. Lawless reported on outcomes at 1 month and 3 months follow-up, noting an overall trend toward improvement. He also said 100% of patients remained in the study through the 3-month follow-up period.

"Our postoperative results at 1 and 3 months showed statistically significantly improvement of all parameters," Dr. Lawless said.

Preoperatively, patients had a mean sphere of –1.41 D, –4.93 D cylinder, –4.22 D spherical equivalent, 46.42 D average K value and 6.27 D central corneal thickness cylinder. At 3 months, mean sphere had improved to –0.64 D and cylinder was –2.26 D. Average K value was 44.28 D at 3 months and central corneal thickness cylinder was 4.85 D.

Dr. Lawless also said there was a trend toward improvement in best corrected visual acuity, in that 25% of eyes had 20/20 vision at 3 months postoperative compared with 10% preoperatively.

"There is a trend toward improvement in visual acuity, and that trend tends to increase with time," he said. "We had excellent follow-up at 3 months, and that tends to trail off, but anecdotally, certainly [the improvement in visual acuity] with surface treatment continues at 12 months."

Dr. Lawless compared these results to a previous study he helped conduct that evaluated LASIK to treat myopia and astigmatism after PK. That study, published in 1999 in the British Journal of Ophthalmology, evaluated 26 eyes that underwent LASIK with a variety of microkeratomes. In comparing the 3-month results of both studies, Dr. Lawless and colleagues found the results with advanced surface ablation to be superior.

"If you go to 3 months ... there is a statistically significant difference. [Advanced surface laser ablation] patients were statistically better than LASIK patients in spherical equivalent and refractive astigmatism," he said.

As more research is conducted in this area, one question that will need to be answered is whether or not topography-guided treatment would yield better results.