Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: long-term experience with the 400 Hz eye-Q excimer platform

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of topography-guided ablation using the WaveLight 400 Hz excimer laser in laser-assisted in situ keratomileusis (LASIK) for hyperopia and/or hyperopic astigmatism. METHODS: We prospectively evaluated 208 consecutive LASIK cases for hyperopia with or without astigmatism using the topography-guided platform of the 400 Hz Eye-Q excimer system. The mean preoperative sphere value was +3.04 ± 1.75 (range 0.75–7.25) diopters (D) and the mean cylinder value was −1.24 ± 1.41 (−4.75–0) D. Flaps were created either with Intralase FS60 (AMO, Irvine, CA) or FS200 (Alcon, Fort Worth, TX) femtosecond lasers. Parameters evaluated included age, preoperative and postoperative refractive error, uncorrected distance visual acuity, corrected distance visual acuity, flap diameter and thickness, topographic changes, higher order aberration changes, and low contrast sensitivity. These measurements were repeated postoperatively at regular intervals for at least 24 months. RESULTS: Two hundred and two eyes were available for follow-up at 24 months. Uncorrected distance visual acuity improved from 5.5/10 to 9.2/10. At 24 (8–37) months, 75.5% of the eyes were in the ±0.50 D range and 94.4% were in the ±1.00 D range of the refractive goal. Postoperatively, the mean sphere value was −0.39 ± 0.3 and the cylinder value was −0.35 ± 0.25. Topographic evidence showed that ablation was made in the visual axis and not in the center of the cornea, thus correlating with the angle kappa. No significant complications were encountered in this small group of patients. CONCLUSION: Hyperopic LASIK utilizing the topography-guided platform of the 400 Hz Eye-Q Allegretto excimer and a femtosecond laser flap appears to be safe and effective for correction of hyperopia and/or hyperopic astigmatism. The results are impressive for refractive error correction and stability and for improvement of both uncorrected and corrected distance visual acuity.