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Bilateral simultaneous LASIK is preferred, surgeon says
In a study of 1,000 consecutive cases, LASIK was found to be safe and predictable.
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BOSTON — Laser in situ keratomileusis (LASIK) can be performed to such a high standard of safety and efficacy that bilateral simultaneous surgery is justified.
“To determine the predictability and safety of LASIK, 1,000 consecutive cases were retrospectively studied. All procedures were performed by me during a 16-month period,” explained Kenneth R. Kenyon, MD, at the meeting of the American Society of Cataract and Refractive Surgery, held here.
All procedures were performed with the Visx Star S-2 and the Moria LSK-1 microkeratome. “For those of us who like reliability and visibility, the manual approach and the temporal approach are particularly attractive. I use minimal irrigation, and I punctum plug every patient in the standard postoperative regimen,” he explained.
Included were 892 myopes, 94 hyperopes and 14 patients who had already undergone a refractive procedure. All patients have at least 6 months of follow-up. Among those eligible for bilateral surgery, 91% were performed as such. “My overall enhancement rate is 18%, which is somewhat high. The rate is somewhat less in low to moderate myopes, as one might expect, and it is increased in more extreme cases,” Dr. Kenyon added.
Patient satisfaction
After LASIK, 94% of myopes are 20/40 or better, and 62% are 20/20. “The ultramyopes, of course, are less predictable, but are much more appreciative. Hyperopes up to +8.0 have a similar range of outcomes, and, of course, the presbyopes are the most satisfied. Those with prior surgeries also had a rather satisfactory improvement in acuity. While they had a higher enhancement rate, they had a surprisingly low complication rate,” he explained.
“In terms of deviation from target spherical equivalent, nearly 100% are within ±1.0, and approximately 75% are within ±0.5 at the lower levels. I don’t view enhancement as a dirty word, but rather a consequence of variable wound healing and, of course, the search for the perfect nomogram,” he said.
Low complication rates
Complication rates are low. Only three eyes out of 1,000 had difficulties with the flap. “No other major problems occurred. Importantly, no eye had less than 20/50 best spectacle-corrected acuity, and the overall problem rate was 3.4%,” he said.
“The Visx Star and the Moria LSK are very compatible using a minimalist technique. My technical complication rate is 0.3%. Predictability is certainly good, with 95% of patients seeing better than 20/40, and 60% seeing better than 20/20. Safety, of course, is always our concern. My overall complication rate is 3.4%, with a loss of acuity of only 1.8% and no eye worse than 20/50. My enhancement rate is 18%, but I also had a high success rate. Using a flap-lift-only technique, the complication rate is low. I have had LASIK myself, and I believe that laser vision correction is here to stay,” he added.
For Your Information:
- Kenneth R. Kenyon, MD, can be reached at 100 Charles River Plaza, Boston, MA 02114; (617) 523-2010; fax: (617) 523-4242.