Photoastigmatic refractive keratectomy for compound myopic astigmatism with a Nidek laser

With advances in the delivery of excimer laser energy to the cornea, spherocylindrical ablations are now possible. The refractive and visual outcome of eyes undergoing photoastigmatic refractive keratectomy with a minimum of 12 months follow-up are presented.

A retrospective analysis of 160 consecutive eyes that underwent photoastigmatic refractive keratectomy using the Nidek EC5000 excimer laser was undertaken. One year follow-up data were available on 89 eyes. Vector analysis of the change in cylindrical error, by the Alpins method, was performed. Before surgery, the mean spherical equivalent refraction was -5.68 diopters (D) (SD 2.67 D) with a mean cylinder power of -1.40 D (SD 0.75).

At 1 year after surgery, the mean spherical equivalent was -0.44 D (SD 0.87). Seventy-one eyes (79.8%) had a spherical equivalent within 1.00 D of the target refraction and 79 eyes (89%) achieved 6/12 or better, unaided. Four of 89 eyes (4.5%) lost more than two lines of spectacle-corrected visual acuity with 9 eyes (10%) gaining Snellen acuity, comparing preoperative spectacle-corrected acuity with postoperative uncorrected visual acuity. The mean coefficient of adjustment (targeted induced astigmatism vector magnitude divided by surgically induced astigmatism vector magnitude) was 1.11 (SD 1.33), indicating undercorrection of the cylinder. The mean angle of error was 0.73 degree (+/- 10.91).

Refractive visual acuity outcome after photoastigmatic refractive keratectomy was good. Current algorithms undercorrect the cylinder power, but are adequately aligned. Algorithms for toric ablations in the Nidek EC5000 need to be improved.