Hyperopic laser in situ keratomileusis - Primary and secondary treatments are safe and effective

Purpose. To retrospectively analyze the safety and efficacy of hyperopic la ser in situ keratomileusis (LASIK) treatment of eyes with primary hyperopia and consecutive hyperopia after initial myopic treatment, Methods. Thirty- two eyes of 19 patients with primary hyperopia (group 1) and 37 eyes of 26 patients with consecutive hyperopia after initial myopic LASIK overcorrecti on (group 2) that had LASIK for hyperopia with the Hansatome microkeratome and VISX 52 Smoothscan excimer laser with 6 months' follow-up after surgery were analyzed. Uncorrected visual acuity, best spectacle-corrected visual acuity, fogged manifest refraction, and corneal topography with corneal irr egularity measurement (CIM) were evaluated 1 month. 3 months, and 6 months after surgery. Results. In group 1, the mean preoperative cycloplegic spher ical equivalent was +4.0 +/-4.5 diopters (D) (range: +1.5 to + 8.75 D) and the 6-month postoperative cycloplegic spherical equivalent was. +0.26 +/- 1 .74 D (range, -3.00 to +2.75 D), Fifty-three percent of eyes (n = 17) in gr oup 1 were within 1 D of emmetropia. Sixty-six percent of eyes (n = 21) had uncorrected visual acuity of at least 20/40. Three eves (9%) lost two line s of best spectacle-corrected visual acuity. Changes in uncorrected visual acuity, best spectacle-corrected visual acuity, spherical equivalent, and t he CIM topographic index 6 months after surgery were statistically signific ant compared with the preoperative values;. In group 2, the mean preoperati ve cycloplegic spherical equivalent was +1.58 + 0.35 D (range, +0.125 to +2 .75 D), and the mean postoperative cycloplegic spherical equivalent was -0. 48 +/- 0.46 (range, -2.75 to +0.38 D). Eighty-six percent of eyes (n = 32) were within 1 D of emmetropia. Eighty-four percent of eves (n = 31) in grou p 2. had uncorrected visual acuity of at least 20/40. One eye (2.7%) lost t wo lines of best spectacle-corrected visual acuity. Complications included an epithelial nest that resolved 3 months after surgery in one eve in group 2, Conclusions. LASIK is a relatively safe treatment of primary hyperopia and hyperopia resulting from overcorrection after initial LASIK treatment o f myopia (consecutive hyperopia). Patients with high hyperopia (>5 D) are a t risk for loss of two lines of best spectacle-cornered visual acuity. A re duction in the level of attempted con action appears to be necessary in the treatment of consecutive hyperopia.