Scientific Article Summary
Ten Year Follow-up of Laser In Situ Keratomileusis for High Myopia.
Authors: Jorge L
, Orkun Muftuoglu, Dolores Ortiz, Juan Jose Pérez-Santonja, Alberto
Artola, Maria Jose Ayala, Maria Jose Garcia and Gracia Castro de Luna.
American Journal of Ophthalmology
Volume 145, Issue 1, January 2008, Pages 55-
Laser In Situ Keratomileusis (LASIK) became the preferred procedure for correcting low to
moderate myopia due several advantages: increased diopter (D) range of surgery, fast recovery,
minimal post-operative discomfort, and the ability to correct severe myopia without much post-
operative corneal haze. However, LASIK was suggested to have limitations for high myopia,
such as causing ectasia with progressive increase in myopia that may result from excessive
photoablation. Long-term outcomes for moderate myopia were unknown. Thus, this study aims
to evaluate the long-term (10 year period) effect of LASIK procedure for up to -10D myopic
eyes. It also focuses on analyzing the regression and change between eyes with and without
294 eyes of 178 patients underwent LASIK between April 1, 1992 and December 31, 1995, and
were evaluated at follow-up sessions. This study includes only 196 eyes with up to -10 D myopic
spherical equivalent (SE) whose information were collected at all the follow-up sessions or just
at 10 years visit. Subjects are about 33.2 years old on average; 33 males, 36 females. They have a
mean sphere standard of about -6.53 D, cylinder of -1.44 D, and spherical equivalent of -7.27 D.
Inclusion criteria: suspension of contact lens wear, having a stable refraction, normal peripheral
retina or treated with photocoagulation, and no history of eye surgery, corneal diseases,
glaucoma or ocular trauma. Exclusion criteria: having evidenced or suspected keratoconus,
having active eye disease, a thin corneal residual stromal bed (RSB), pregnant or nursing.
Several eyedrops and topical anasthesia were administered before the surgery. Three surgeons
used the same technique and protocol, creating a corneal flap for all subjects using a 193-nm
VISX 20/20 laser (calibrated at the beginning of every session) for ablating the cornea. An
average of 5.95mm optical zone and 91 μm ablation depth was made. Tobramycin and
diclofenac 0.1% drops were used post-surgery. Four times a day, Dexamethasone 0.1% and
fluorometholone 0.25% were used, and the latter is based on refraction and intraocular pressure.
The steroid dosage was gradually reduced.
Retreatment criteria: SE of -1.00 D or more, uncorrected visual acuity (UCVA) of 20/40 or less,
or patient dissatisfaction with his/her sight. An SE of -1.00 D after 3 months is considered
undercorrection while a 0.50D or more myopic shift (without retreatment and between follow-
ups) is a regression. Retreatments were done by lifting the flap using a flat spatula, and