Abstract
PURPOSE:
To evaluate the visual outcomes of myopic LASIK performed with the MEL 90 excimer laser (Carl Zeiss Meditec AG, Jena, Germany) using the Triple-A profile with a 500-Hz pulse rate.
METHODS:
Retrospective analysis of the first 286 myopic LASIK procedures (147 patients) by two experienced surgeons in which the VisuMax femtosecond laser and MEL 90 excimer laser (Carl Zeiss Meditec) were used following a standardized surgical technique. Inclusion criteria were preoperative spherical equivalent refraction (SEQ) up to −10.38 diopters (D), cylinder up to 5.00 D, and corrected distance visual acuity (CDVA) of 20/25 or better. No nomogram adjustments were made. Patients were observed for 3 months. Flap thickness was between 80 and 110 µm and optical zone was between 6 and 7 mm. Standard outcomes analysis was performed.
RESULTS:
Preoperatively, mean SEQ was −3.83 ± 1.83 D (range: −0.13 to −10.38 D) and mean cylinder was −0.94 ± 0.86 D (range: 0.00 to −5.00 D). Mean age was 36.4 years (range: 18.2 to 74.1 years) with 50% female patients. Of this population, 138 eyes were treated by one surgeon and 148 eyes by another. The mean predictability of SEQ was −0.13 ± 0.34 D (range: −1.00 to +1.00 D). Postoperative SEQ was ±0.50 D in 88% and ±1.00 D in 100% of eyes. Preoperative CDVA was 20/20 or better in 97% of eyes. Postoperative uncorrected distance visual acuity was 20/20 or better in 92% and 20/25 or better in 99% of eyes. One line of CDVA was lost in 6% of eyes and no eyes lost two or more lines. There was statistically significant improvement in mesopic contrast sensitivity (CSV-1000) at 3 (P = .021), 6, 12, and 18 (all P ≤.001) cycles per degree.
CONCLUSIONS:
The MEL 90 excimer laser using the Triple-A ablation profile with a 500-Hz pulse rate was found to achieve a small but real increase in contrast sensitivity and high efficacy for myopia up to −10.00 D and cylinder up to 5.00 D without the need for a nomogram adjustment.
[J Refract Surg. 2015;31(5):316–321.]
- 1.Reinstein DZ, Archer TJ, Gobbe M. LASIK for myopic astigmatism and presbyopia using non-linear aspheric micro-monovision with the Carl Zeiss Meditec MEL 80 Platform. J Refract Surg. 2011; 27:23–37.
10.3928/1081597X-20100212-04 Link, Google Scholar - 2.Reinstein DZ, Yap TE, Carp GI, Archer TJ, Gobbe M. Reproducibility of manifest refraction between surgeons and optometrists in a clinical refractive surgery practice. J Cataract Refract Surg. 2014; 40:450–459.
10.1016/j.jcrs.2013.08.053 Crossref Medline, Google Scholar - 3.Reinstein DZ, Gobbe M, Archer TJ. Coaxially sighted corneal light reflex versus entrance pupil center centration of moderate to high hyperopic corneal ablations in eyes with small and large angle kappa. J Refract Surg. 2013; 29:518–525.
10.3928/1081597X-20130719-08 Link, Google Scholar - 4.Reinstein DZ, Archer TJ, Gobbe M, Johnson N. Accuracy and Reproducibility of Artemis central flap thickness and visual outcomes of LASIK with the Carl Zeiss Meditec VisuMax femtosecond laser and MEL 80 excimer laser platforms. J Refract Surg. 2010; 26:107–119.
10.3928/1081597X-20100121-06 Link, Google Scholar - 5.Blum M, Kunert K, Gille A, Sekundo W. LASIK for myopia using the Zeiss VisuMax femtosecond laser and MEL 80 excimer laser. J Refract Surg. 2009; 25:350–356.
10.3928/1081597X-20090401-01 Link, Google Scholar - 6.Vetter JM, Holzer MP, Teping C, Intraocular pressure during corneal flap preparation: comparison among four femtosecond lasers in porcine eyes. J Refract Surg. 2011; 27:427–433.
10.3928/1081597X-20101210-01 Link, Google Scholar - 7.Issa A, Al Hassany U. Femtosecond laser flap parameters and visual outcomes in laser in situ keratomileusis. J Cataract Refract Surg. 2011; 37:665–674.
10.1016/j.jcrs.2010.10.049 Crossref Medline, Google Scholar - 8.Reinstein DZ, Carp GI, de Benedictis D, Standardization of LASIK surgical technique evaluated by comparison of procedure time between two experienced surgeons. J Cataract Refract Surg. In press. Google Scholar
- 9.Reinstein DZ, Archer TJ, Randleman JB. JRS standard for reporting astigmatism outcomes of refractive surgery. J Refract Surg. 2014; 30:654–659.
10.3928/1081597X-20140903-01 Link, Google Scholar - 10.Marshall J, Raven AL, Welford WT, Ness KM. Surface Erosion Using Lasers. US patent 4941093. July10, 1990. Google Scholar
- 11.Lipshitz I, Fisher L, Dotan G, Lazar M, Loewenstein A. Comparison of photorefractive keratectomy on one eye and laser in situ keratomileusis on the other eye of the same patient. J Refract Surg. 1999; 15(2 suppl):S225–S226. Abstract, Google Scholar
- 12.Fiore T, Carones F, Brancato R. Broad beam vs. flying spot excimer laser: refractive and videokeratographic outcomes of two different ablation profiles after photorefractive keratectomy. J Refract Surg. 2001; 17:534–541. Link, Google Scholar
- 13.O’Donnell CB, Kemner J, O’Donnell FE. Ablation smoothness as a function of excimer laser delivery system. J Cataract Refract Surg. 1996; 22:682–685.
10.1016/S0886-3350(96)80302-6 Crossref Medline, Google Scholar - 14.Argento C, Valenzuela G, Huck H, Cremona G, Cosentino MJ, Gale MF. Smoothness of ablation on acrylic by four different excimer lasers. J Refract Surg. 2001; 17:43–45. Link, Google Scholar
- 15.Doga AV, Shpak AA, Sugrobov VA. Smoothness of ablation on polymethylmethacrylate plates with four scanning excimer lasers. J Refract Surg. 2004; 20(5 suppl):S730–S733. Abstract, Google Scholar
- 16.Wygledowska-Promienska D, Zawojska I, Gierek-Ciaciura S. New generation of excimer laser--Asclepion Meditec MEL 70 G-Scan [article in Polish]. Klin Oczna. 2000; 102:373–375. Medline, Google Scholar
- 17.Alessio G, Boscia F, La Tegola MG, Sborgia C. Topography-driven photorefractive keratectomy: results of corneal interactive programmed topographic ablation software. Ophthalmology. 2000; 107:1578–1587.
10.1016/S0161-6420(00)00224-4 Crossref Medline, Google Scholar - 18.Seitz B, Langenbucher A, Kus MM, Harrer M. Experimental correction of irregular corneal astigmatism using topography-based flying-spot-mode excimer laser photoablation. Am J Ophthalmol. 1998; 125:252–256.
10.1016/S0002-9394(99)80102-0 Crossref Medline, Google Scholar - 19.Iseli HP, Mrochen M, Hafezi F, Seller T. Clinical photoablation with a 500-Hz scanning spot excimer laser. J Refract Surg. 2004; 20:831–834. Link, Google Scholar
- 20.Tomita M, Watabe M, Yukawa S, Nakamura N, Nakamura T, Magnago T. Safety, efficacy, and predictability of laser in situ keratomileusis to correct myopia or myopic astigmatism with a 750 Hz scanning-spot laser system. J Cataract Refract Surg. 2014; 40:251–258.
10.1016/j.jcrs.2013.07.043 Crossref Medline, Google Scholar - 21.Khoramnia R, Salgado JP, Wuellner C, Donitzky C, Lohmann CP, Winkler von Mohrenfels C. Safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK) with a 1000-Hz scanning spot excimer laser. Acta Ophthalmologica. 2012; 90:508–513.
10.1111/j.1755-3768.2010.02052.x Crossref Medline, Google Scholar - 22.Bohac M, Biscevic A, Koncarevic M, Anticic M, Gabric N, Patel S. Comparison of Wavelight Allegretto Eye-Q and Schwind Amaris 750S excimer laser in treatment of high astigmatism. Graefes Arch Clin Exp Ophthalmol. 2014; 252:1679–1686.
10.1007/s00417-014-2776-2 Crossref Medline, Google Scholar - 23.Reinstein DZ, Neal DR, Vogelsang H, Optimized and wavefront guided corneal refractive surgery using the Carl Zeiss Meditec platform: the WASCA aberrometer, CRS-Master, and MEL80 excimer laser. Ophthalmol Clin North Am. 2004; 17:191–210.
10.1016/j.ohc.2004.03.005 Crossref Medline, Google Scholar
