Photorefractive keratectomy for hyperopic and mixed astigmatism

The correction of astigmatism with photorefractive keratectomy has been recommended in simple and myopic astigmatism. Therefore in this study the excimer laser was used to correct compound hyperopic and mixed astigmatism.

We present a prospective clinical study of photorefractive keratectomy in 30 eyes of 24 patients with compound hyperopic astigmatism with a mean spherical equivalent of +4.30 D and mean astigmatism of 2.33 D (group I) and in 17 eyes of 15 patients with mixed astigmatism with a mean spherical equivalent refraction of +0.46 D and mean astigmatism of 4.75 D (group II). The excimer laser used in this study was an MEL 60 (Aesculap-Meditec). In both groups an 18-month follow-up study was performed.

In the compound hyperopic astigmatism group after 18 months, 14 of 17 treated eyes (82.3%) were within +/-1.00 D, and 11 (64.7%) were within 60.50 D of the intended correction. In the mixed astigmatism group after 18 months, 10 of 11 eyes (90.9%) were within +/-1.00 D, 8 eyes (72.7%) were within +/-0.50 D of the intended correction. In regard to the stability the 1 year regression of spherical equivalent in the compound hyperopic astigmatism group is 0.78 D and in the mixed astigmatism group 0.37 D. At 18 months, spectacle corrected visual acuity in the compound hyperopic astigmatism group was unchanged or improved in 14 eyes (87.5%); 2 eyes (12.5%) had lost one line. In the mixed astigmatism group at 18 months, spectacle corrected visual acuity was unchanged or improved in 9 eyes (81.8 %); 2 eyes (18.1%) lost one line. Preoperatively, the mean uncorrected visual acuity was 20/100 in the compound hyperopic astigmatism group and the mixed astigmatism group. At 18 months, 14 eyes (93.3%) in the compound hyperopic astigmatism group had an uncorrected visual acuity of 20/40 or better; 4 (26.6%) eyes had an uncorrected visual acuity of 20/20 or better. In the mixed astigmatism group, 9 (81.8%) eyes had an uncorrected visual acuity of 20/40 or better; 4 (36.3%) eyes had an uncorrected visual acuity of 20/20 or better.

Photorefractive keratectomy is an efficient and relatively safe procedure for reducing or eliminating compound hyperopic and mixed astigmatism up to 6.00 D.