Prospective study of photorefractive keratectomy for hyperopia using an axicon lens and erodible mask.

PURPOSE: To evaluate prospectively the long-term safety, efficacy, and visual performance following photorefractive keratectomy (PRK) for hyperopia using an erodible mask and axicon lens system.

METHODS: Eighteen eyes of 9 patients with a mean preoperative spherical equivalent refraction of +2.26 +/- 0.82 D (range, +1.13 to +4.00 D) underwent PRK with the Summit Apex Plus excimer laser following manual scraping of the epithelium. Eyes were prospectively evaluated 1, 3, 6, 9, 12, 18, and 24 months following the procedure. Primary outcome variables included cycloplegic refraction and uncorrected visual acuity (UCVA). Visual performance was determined by contrast sensitivity measurements under scotopic (21 lux) and photopic (324 lux) conditions and best spectacle-corrected visual acuity (BSCVA) under scotopic, photopic, and glare conditions.

RESULTS: For 18 eyes, 98.2% of the mean preoperative spherical equivalent refraction was corrected to +0.04 +/- 0.87 D (range, -1.38 to +2.00 D) at 24 months after PRK. Twelve eyes (67%) were within +/-0.50 D of attempted correction and 15 eyes (83%) were within +/-1.00 D. Stability within +/-0.50 D was achieved after 6 months. Two eyes (11%) experienced almost complete regression of the refractive effect. There was no statistically significant decrease in contrast sensitivity under scotopic or photopic conditions. (P > .05). Best spectacle-corrected visual acuity showed progressive improvement in the early postoperative period. By 24 months, 0 eyes (0%) lost 2 or more lines of BSCVA under scotopic and photopic conditions and 1 eye (5.5%) lost 2 or more lines under glare conditions. Fourteen eyes (78%) had grade 1 to 3 anterior stromal haze at 24 months which was characteristically mid-peripheral and did not adversely affect visual performance.

CONCLUSION: Photorefractive keratectomy with the the Summit Apex Plus excimer laser for low to moderate hyperopia resulted in an effective reduction of hyperopia without compromising long-term visual performance. Stability and recovery of distance uncorrected and best spectacle-corrected visual acuity took approximately 6 months.