Myopic keratomileusis with the excimer laser: one-year follow up

The possibility of using an argon fluoride excimer laser to perform the refractive incision in keratomileusis spurred us to develop the present surgical technique of using a microkeratome to make a primary corneal incision that yields a corneal disc, then making the refractive excision of stroma with excimer laser ablation, and finally suturing the corneal disc in place.

We describe the procedures and a prospective study of 30 consecutive eyes from 22 consecutive patients with high myopia (range, -11.20 D to -24.50 D) who underwent excimer laser myopic keratomileusis. A plano corneal disc was cut with a BKS 1000 microkeratome, followed by argon fluoride excimer laser ablation of the stroma with the Summit Eximed UV 200LA laser (Summit Technology, Inc, Waltham, Mass), either of the resected disc (28 eyes) or in situ on the stromal bed (two eyes).

By 3 weeks after surgery, 83% of the corneas were considered clear. In 17 eyes (57%), the difference between the intended and achieved refraction was < 1.00 D; in 9 eyes (30%), the difference was 1.00 to 3.00 D; in 4 eyes (13%), the difference was 3.00 to 6.00 D. At 12 months after surgery, uncorrected visual acuity was 20/40 or better in 3 (10%) eyes, and 20/50 to 20/100 in the remaining 27 (90%) eyes, in contrast to 100% of eyes that saw worse than 20/200 before surgery. Two eyes had a very deep ablation of the lenticule that led to irregularities in Bowman's layer.

Excimer laser myopic keratomileusis is an effective way to correct high myopia and may be more accurate than other methods of keratomileusis. A new nomogram for the procedure is presented.