Hyperopic laser in situ keratomileusis: primary and secondary treatments are safe and effective.

PURPOSE: To retrospectively analyze the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) treatment of eyes with primary hyperopia and consecutive hyperopia after initial myopic treatment.

METHODS: Thirty-two eyes of 19 patients with primary hyperopia (group 1) and 37 eyes of 26 patients with consecutive hyperopia after initial myopic LASIK overcorrection (group 2) that had LASIK for hyperopia with the Hansatome microkeratome and VISX S2 Smoothscan excimer laser with 6 months' follow-up after surgery were analyzed. Uncorrected visual acuity, best spectacle-corrected visual acuity, fogged manifest refraction, and corneal topography with corneal irregularity measurement (CIM) were evaluated 1 month, 3 months, and 6 months after surgery.

RESULTS: In group 1, the mean preoperative cycloplegic spherical equivalent was +4.0 +/- 4.5 diopters (D) (range, +1.5 to + 8.75 D) and the 6-month postoperative cycloplegic spherical equivalent was +0.26 +/- 1.74 D (range, -3.00 to +2.75 D). Fifty-three percent of eyes (n= 17) in group 1 were within 1 D of emmetropia. Sixty-six percent of eyes (n= 21) had uncorrected visual acuity of at least 20/40. Three eyes (9%) lost two lines of best spectacle-corrected visual acuity. Changes in uncorrected visual acuity, best spectacle-corrected visual acuity, spherical equivalent, and the CIM topographic index 6 months after surgery were statistically significant compared with the preoperative values. In group 2, the mean preoperative cycloplegic spherical equivalent was +1.58 +/- 0.35 D (range, +0.125 to +2.75 D), and the mean postoperative cycloplegic spherical equivalent was -0.48 +/- 0.46 (range, -2.75 to +0.38 D). Eighty-six percent of eyes (n= 32) were within 1 D of emmetropia. Eighty-four percent of eyes (n= 31) in group 2 had uncorrected visual acuity of at least 20/40. One eye (2.7%) lost two lines of best spectacle-corrected visual acuity. Complications included an epithelial nest that resolved 3 months after surgery in one eye in group 2.

CONCLUSIONS: LASIK is a relatively safe treatment of primary hyperopia and hyperopia resulting from overcorrection after initial LASIK treatment of myopia (consecutive hyperopia). Patients with high hyperopia (>5 D) are at risk for loss of two lines of best spectacle-corrected visual acuity. A reduction in the level of attempted correction appears to be necessary in the treatment of consecutive hyperopia.