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Published on: September 20, 2024
Predictors for retreatment following laser-assisted in situ keratomileusis for high myopia
Waseem Nasser1, Adir Sommer, Dror Ben Ephraim Noyman
1From the Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Nasser, Sommer, Ben Ephraim Noyman, Mimouni); Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Nasser, Sommer, Ben Ephraim Noyman, Mimouni); Clinical Research Institute at Rambam, Rambam Health Care Campus, Haifa, Israel (Nasser); Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel (Safir); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Safir, Cohen); Care-Vision Laser Center, Tel Aviv, Israel (Sommer, Ben Ephraim Noyman, Sela, Munzer, Kaiserman, Cohen, Mimouni); Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel (Kaiserman); Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel (Kaiserman); Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Cohen).
Purpose:
To identify risk factors for retreatment after laser-assisted in situ keratomileusis (LASIK) in eyes with high myopia.
Setting:
Care Vision Laser Center, Tel Aviv, Israel.
Design:
Retrospective comparative study.
Methods:
Data from eyes with myopia ≥6 diopters (D) treated between 2000 and 2022 were analyzed. Eyes were grouped according to retreatment status. Preoperative and intraoperative parameters were compared using t tests and chi-square tests. Generalized estimating equations (GEE) logistic regression accounting for intereye correlation, including variables with P < .1, was performed to identify independent predictors of retreatment.
Results:
The study included 2100 eyes (2020 controls and 80 retreatments). Retreatment eyes had shorter contact lens-free intervals ( P = .029) and a higher proportion of baseline cylinder <-1.0 D (32.5% vs 21.9%, P = .025). Significant differences were observed in uncorrected distance visual acuity ( P = .026) and corrected distance visual acuity ( P = .034). Intraoperatively, retreatment cases had higher treated cylinder ( P = .043), greater ablation depth (104.7 ± 14.8 vs 100.6 ± 12.5 μm, P = .004), and the optical-zone distribution differed between groups, with more 6.0 mm treatments and no 7.0 mm treatments in retreatment eyes ( P < .001). Retreatment was also associated with earlier surgical years ( P < .001) and use of the EX200 laser ( P = .01). GEE logistic regression identified 2 independent predictors: baseline cylinder <-1.0 D (odds ratio [OR] 2.208, 95% CI 1.126-4.330, P = .021) and EX200 laser use (OR 4.776, 95% CI 2.496-9.140, P < .001).
Conclusions:
LASIK retreatment in high myopia is independently associated with higher baseline refractive cylinder and older laser technology (EX200). Optimizing patient selection and adopting modern laser platforms may reduce the likelihood of additional procedures.
