[Intrastromal keratectomy in high myopia. 1 year results]

Photorefractive keratectomy (PRK) by excimer laser is now a scientifically established treatment method in low and moderate myopia. In high and very high myopia, however, the formation of severe corneal haze or scars and a considerable regression of refraction remain obstacles to the use of PRK. One approach to these two problems is to perform an intrastromal keratectomy. PATIENTS AND METHOD. Between September 1992 and September 1994 intrastromal keratectomy was carried out in 42 eyes with myopia between -8.625 and -36 D. Twenty-one eyes (spherical equivalent of pre-operative refraction between -12.12 and -36 D) were treated by keratomileusis in situ, and 21 eyes (spherical equivalent of pre-operative refraction between -8.625 and -29.25 D) by intrastromal excimer laser keratectomy. Thirty-two eyes were followed up for at least 12 months. RESULTS. The post-operative refraction (spherical equivalent) ranged between +1.375 D and -5.0 D in the keratomileusis in situ group and between +1.5 D and -3.0 D in the intrastromal excimer laser keratectomy group. Nearly all patients regained their pre-operative visual acuity quickly. In the long-term follow-up (1 year) no significant regression of refraction occurred; the pre-operative visual acuity was regained in both groups after 1 year. Significant astigmatism was not induced. CONCLUSIONS. Intrastromal keratectomy is able to correct even very high myopias quite precisely and without regression of the refractive outcome. In addition, considerable haze can be avoided. For these reasons, in high and very high myopia intrastromal keratectomy seems to be superior to conventional anterior photorefractive keratectomy (PRK) by excimer laser.