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. 1996 Mar;80(3):224–234. doi: 10.1136/bjo.80.3.224

Effect of ablation profile on wound healing and visual performance 1 year after excimer laser photorefractive keratectomy.

M C Corbett 1, S Verma 1, D P O'Brart 1, K M Oliver 1, G Heacock 1, J Marshall 1
PMCID: PMC505433  PMID: 8703860

Abstract

BACKGROUND: Early photorefractive keratectomy ablations were of limited diameter and depth to maintain the integrity of the globe and to minimise postoperative haze. This study evaluated the effects of deeper, larger diameter wounds on refractive stability and corneal haze, and investigated the effects of ablation profile on wound healing and visual performance. METHODS: One hundred patients undergoing -3.00D and -6.00D corrections were randomised to receive 5 mm, 6 mm, or multizone treatments. The multizone treatment was 6 mm in diameter, but only the depth of the 5 mm treatment. Outcome was measured by Snellen visual acuity, residual refractive error, objective techniques for haze and halos, pupil diameter, subjective night vision, and requirement for retreatment. RESULTS: Overall, the results of 6 mm treatments were superior to those of 5 mm and multizone treatments: they had a smaller hyperopic shift (p < 0.01), a more predictable (p < 0.001) and stable refractive outcome, less haze (p < 0.05), smaller halos (p < 0.05), fewer subjective night vision problems, and fewer patients required retreatment. CONCLUSIONS: Analysis of these data and a literature review of corneal wound healing demonstrated that the improved outcome associated with the 6 mm beam did not relate to the depth of ablation. The factor with greatest apparent influence on the development of haze and regression was the slope of the wound surface over the entire area of the ablation. Tapering the wound edge provided no additional benefit, and contributed to night vision problems. It is, therefore, recommended that small diameter or multizone treatments should not be used in low and moderate myopia.

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Selected References

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  1. Applegate R. A., Gansel K. A. The importance of pupil size in optical quality measurements following radial keratotomy. Refract Corneal Surg. 1990 Jan-Feb;6(1):47–54. [PubMed] [Google Scholar]
  2. Brancato R., Carones F., Trabucchi G., Scialdone A., Tavola A. The erodible mask in photorefractive keratectomy for myopia and astigmatism. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S125–S130. [PubMed] [Google Scholar]
  3. Bryant M. R., Szerenyi K., Schmotzer H., McDonnell P. J. Corneal tensile strength in fully healed radial keratotomy wounds. Invest Ophthalmol Vis Sci. 1994 Jun;35(7):3022–3031. [PubMed] [Google Scholar]
  4. Buratto L., Ferrari M., Rama P. Excimer laser intrastromal keratomileusis. Am J Ophthalmol. 1992 Mar 15;113(3):291–295. doi: 10.1016/s0002-9394(14)71581-8. [DOI] [PubMed] [Google Scholar]
  5. Buzard K. A. Biomechanics of the cornea--who needs it? Refract Corneal Surg. 1992 Mar-Apr;8(2):125–126. [PubMed] [Google Scholar]
  6. Camp J. J., Maguire L. J., Cameron B. M., Robb R. A. A computer model for the evaluation of the effect of corneal topography on optical performance. Am J Ophthalmol. 1990 Apr 15;109(4):379–386. doi: 10.1016/s0002-9394(14)74602-1. [DOI] [PubMed] [Google Scholar]
  7. Campos M., Wang X. W., Hertzog L., Lee M., Clapham T., Trokel S. L., McDonnell P. J. Ablation rates and surface ultrastructure of 193 nm excimer laser keratectomies. Invest Ophthalmol Vis Sci. 1993 Jul;34(8):2493–2500. [PubMed] [Google Scholar]
  8. Carones F., Brancato R., Venturi E., Morico A. The corneal endothelium after myopic excimer laser photorefractive keratectomy. Arch Ophthalmol. 1994 Jul;112(7):920–924. doi: 10.1001/archopht.1994.01090190068023. [DOI] [PubMed] [Google Scholar]
  9. Caubet E. Course of subepithelial corneal haze over 18 months after photorefractive keratectomy for myopia [corrected]. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S65–S70. [PubMed] [Google Scholar]
  10. Cho Y. S., Kim C. G., Kim W. B., Kim C. W. Multistep photorefractive keratectomy for high myopia. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S37–S41. [PubMed] [Google Scholar]
  11. Corbett M. C., O'Brart D. P., Marshall J. Do topical corticosteroids have a role following excimer laser photorefractive keratectomy? J Refract Surg. 1995 Sep-Oct;11(5):380–387. doi: 10.3928/1081-597X-19950901-15. [DOI] [PubMed] [Google Scholar]
  12. Dausch D., Klein R., Schröder E., Dausch B. Excimer laser photorefractive keratectomy with tapered transition zone for high myopia. A preliminary report of six cases. J Cataract Refract Surg. 1993 Sep;19(5):590–594. doi: 10.1016/s0886-3350(13)80005-3. [DOI] [PubMed] [Google Scholar]
  13. Davison P. F., Galbavy E. J. Connective tissue remodeling in corneal and scleral wounds. Invest Ophthalmol Vis Sci. 1986 Oct;27(10):1478–1484. [PubMed] [Google Scholar]
  14. Dehm E. J., Puliafito C. A., Adler C. M., Steinert R. F. Corneal endothelial injury in rabbits following excimer laser ablation at 193 and 248 nm. Arch Ophthalmol. 1986 Sep;104(9):1364–1368. doi: 10.1001/archopht.1986.01050210118037. [DOI] [PubMed] [Google Scholar]
  15. Dougherty P. J., Wellish K. L., Maloney R. K. Excimer laser ablation rate and corneal hydration. Am J Ophthalmol. 1994 Aug 15;118(2):169–176. doi: 10.1016/s0002-9394(14)72896-x. [DOI] [PubMed] [Google Scholar]
  16. Durrie D. S., Lesher M. P., Cavanaugh T. B. Classification of variable clinical response after photorefractive keratectomy for myopia. J Refract Surg. 1995 Sep-Oct;11(5):341–347. doi: 10.3928/1081-597X-19950901-10. [DOI] [PubMed] [Google Scholar]
  17. Eggli P., Boulton M., Marshall J. Growth characteristics of central and peripheral bovine corneal epithelial cells in vitro. Graefes Arch Clin Exp Ophthalmol. 1989;227(3):263–270. doi: 10.1007/BF02172760. [DOI] [PubMed] [Google Scholar]
  18. Fantes F. E., Hanna K. D., Waring G. O., 3rd, Pouliquen Y., Thompson K. P., Savoldelli M. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol. 1990 May;108(5):665–675. doi: 10.1001/archopht.1990.01070070051034. [DOI] [PubMed] [Google Scholar]
  19. Fleming J. F. Should refractive surgeons worry about corneal asphericity? Refract Corneal Surg. 1990 Nov-Dec;6(6):455–457. [PubMed] [Google Scholar]
  20. Gartry D. S., Kerr Muir M. G., Marshall J. Excimer laser photorefractive keratectomy. 18-month follow-up. Ophthalmology. 1992 Aug;99(8):1209–1219. doi: 10.1016/s0161-6420(92)31821-4. [DOI] [PubMed] [Google Scholar]
  21. Gartry D. S., Kerr Muir M. G., Marshall J. Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. Refract Corneal Surg. 1991 Nov-Dec;7(6):420–435. [PubMed] [Google Scholar]
  22. Gartry D. S., Muir M. G., Lohmann C. P., Marshall J. The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy. A prospective, randomized, double-blind trial. Arch Ophthalmol. 1992 Jul;110(7):944–952. doi: 10.1001/archopht.1992.01080190050028. [DOI] [PubMed] [Google Scholar]
  23. Gasset A. R., Dohlman C. H. The tensile strength of corneal wounds. Arch Ophthalmol. 1968 May;79(5):595–602. doi: 10.1001/archopht.1968.03850040597020. [DOI] [PubMed] [Google Scholar]
  24. Goodman G. L., Trokel S. L., Stark W. J., Munnerlyn C. R., Green W. R. Corneal healing following laser refractive keratectomy. Arch Ophthalmol. 1989 Dec;107(12):1799–1803. doi: 10.1001/archopht.1989.01070020881031. [DOI] [PubMed] [Google Scholar]
  25. Hanna K. D., Pouliquen Y., Waring G. O., 3rd, Savoldelli M., Cotter J., Morton K., Menasche M. Corneal stromal wound healing in rabbits after 193-nm excimer laser surface ablation. Arch Ophthalmol. 1989 Jun;107(6):895–901. doi: 10.1001/archopht.1989.01070010917041. [DOI] [PubMed] [Google Scholar]
  26. Heitzmann J., Binder P. S., Kassar B. S., Nordan L. T. The correction of high myopia using the excimer laser. Arch Ophthalmol. 1993 Dec;111(12):1627–1634. doi: 10.1001/archopht.1993.01090120049021. [DOI] [PubMed] [Google Scholar]
  27. Holladay J. T., Lynn M. J., Waring G. O., 3rd, Gemmill M., Keehn G. C., Fielding B. The relationship of visual acuity, refractive error, and pupil size after radial keratotomy. Arch Ophthalmol. 1991 Jan;109(1):70–76. doi: 10.1001/archopht.1991.01080010072036. [DOI] [PubMed] [Google Scholar]
  28. Holme R. J., Fouraker B. D., Schanzlin D. J. A comparison of en face and tangential wide-area excimer surface ablation in the rabbit. Arch Ophthalmol. 1990 Jun;108(6):876–881. doi: 10.1001/archopht.1990.01070080120048. [DOI] [PubMed] [Google Scholar]
  29. Kim J. H., Hahn T. W., Lee Y. C., Sah W. J. Clinical experience of two-step photorefractive keratectomy in 19 eyes with high myopia. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S44–S47. [PubMed] [Google Scholar]
  30. Krueger R. R., Trokel S. L. Quantitation of corneal ablation by ultraviolet laser light. Arch Ophthalmol. 1985 Nov;103(11):1741–1742. doi: 10.1001/archopht.1985.01050110137042. [DOI] [PubMed] [Google Scholar]
  31. Lee R. E., Davison P. F., Cintron C. The healing of linear nonperforating wounds in rabbit corneas of different ages. Invest Ophthalmol Vis Sci. 1982 Nov;23(5):660–665. [PubMed] [Google Scholar]
  32. Litwin K. L., Moreira H., Ohadi C., McDonnell P. J. Changes in corneal curvature at different excimer laser ablative depths. Am J Ophthalmol. 1991 Mar 15;111(3):382–384. doi: 10.1016/s0002-9394(14)72335-9. [DOI] [PubMed] [Google Scholar]
  33. Liu J. C., McDonald M. B., Varnell R., Andrade H. A. Myopic excimer laser photorefractive keratectomy: an analysis of clinical correlations. Refract Corneal Surg. 1990 Sep-Oct;6(5):321–328. [PubMed] [Google Scholar]
  34. Lohmann C. P., Fitzke F. W., O'Brart D., Muir M. K., Marshall J. Halos--a problem for all myopes? A comparison between spectacles, contact lenses, and photorefractive keratectomy. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S72–S75. [PubMed] [Google Scholar]
  35. Lohmann C. P., Timberlake G. T., Fitzke F. W., Gartry D. S., Muir M. K., Marshall J. Corneal light scattering after excimer laser photorefractive keratectomy: the objective measurements of haze. Refract Corneal Surg. 1992 Mar-Apr;8(2):114–121. [PubMed] [Google Scholar]
  36. MAURICE D. M. The structure and transparency of the cornea. J Physiol. 1957 Apr 30;136(2):263–286. doi: 10.1113/jphysiol.1957.sp005758. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Marshall J., Trokel S. L., Rothery S., Krueger R. R. Long-term healing of the central cornea after photorefractive keratectomy using an excimer laser. Ophthalmology. 1988 Oct;95(10):1411–1421. doi: 10.1016/s0161-6420(88)32997-0. [DOI] [PubMed] [Google Scholar]
  38. Marshall J., Trokel S., Rothery S., Krueger R. R. A comparative study of corneal incisions induced by diamond and steel knives and two ultraviolet radiations from an excimer laser. Br J Ophthalmol. 1986 Jul;70(7):482–501. doi: 10.1136/bjo.70.7.482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Marshall J., Trokel S., Rothery S., Schubert H. An ultrastructural study of corneal incisions induced by an excimer laser at 193 nm. Ophthalmology. 1985 Jun;92(6):749–758. doi: 10.1016/s0161-6420(85)33961-1. [DOI] [PubMed] [Google Scholar]
  40. McDonald M. B., Beuerman R., Falzoni W., Rivera L., Kaufman H. E. Refractive surgery with the excimer laser. Am J Ophthalmol. 1987 Mar 15;103(3 Pt 2):469–469. doi: 10.1016/s0002-9394(14)77774-8. [DOI] [PubMed] [Google Scholar]
  41. McDonald M. B., Frantz J. M., Klyce S. D., Beuerman R. W., Varnell R., Munnerlyn C. R., Clapham T. N., Salmeron B., Kaufman H. E. Central photorefractive keratectomy for myopia. The blind eye study. Arch Ophthalmol. 1990 Jun;108(6):799–808. doi: 10.1001/archopht.1990.01070080041033. [DOI] [PubMed] [Google Scholar]
  42. McDonald M. B., Liu J. C., Byrd T. J., Abdelmegeed M., Andrade H. A., Klyce S. D., Varnell R., Munnerlyn C. R., Clapham T. N., Kaufman H. E. Central photorefractive keratectomy for myopia. Partially sighted and normally sighted eyes. Ophthalmology. 1991 Sep;98(9):1327–1337. doi: 10.1016/s0161-6420(91)32128-6. [DOI] [PubMed] [Google Scholar]
  43. Melles G. R., Binder P. S. Effect of wound location, orientation, direction, and postoperative time on unsutured corneal wound healing morphology in monkeys. Refract Corneal Surg. 1992 Nov-Dec;8(6):427–438. [PubMed] [Google Scholar]
  44. Munnerlyn C. R., Koons S. J., Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery. J Cataract Refract Surg. 1988 Jan;14(1):46–52. doi: 10.1016/s0886-3350(88)80063-4. [DOI] [PubMed] [Google Scholar]
  45. O'Brart D. P., Corbett M. C., Lohmann C. P., Kerr Muir M. G., Marshall J. The effects of ablation diameter on the outcome of excimer laser photorefractive keratectomy. A prospective, randomized, double-blind study. Arch Ophthalmol. 1995 Apr;113(4):438–443. doi: 10.1001/archopht.1995.01100040054026. [DOI] [PubMed] [Google Scholar]
  46. O'Brart D. P., Gartry D. S., Lohmann C. P., Muir M. G., Marshall J. Excimer laser photorefractive keratectomy for myopia: comparison of 4.00- and 5.00-millimeter ablation zones. J Refract Corneal Surg. 1994 Mar-Apr;10(2):87–94. [PubMed] [Google Scholar]
  47. O'Brart D. P., Gartry D. S., Lohmann C. P., Patmore A. L., Kerr Muir M. G., Marshall J. Treatment of band keratopathy by excimer laser phototherapeutic keratectomy: surgical techniques and long term follow up. Br J Ophthalmol. 1993 Nov;77(11):702–708. doi: 10.1136/bjo.77.11.702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. O'Brart D. P., Lohmann C. P., Fitzke F. W., Klonos G., Corbett M. C., Kerr-Muir M. G., Marshall J. Disturbances in night vision after excimer laser photorefractive keratectomy. Eye (Lond) 1994;8(Pt 1):46–51. doi: 10.1038/eye.1994.9. [DOI] [PubMed] [Google Scholar]
  49. O'Brart D. P., Lohmann C. P., Fitzke F. W., Smith S. E., Kerr-Muir M. G., Marshall J. Night vision after excimer laser photorefractive keratectomy: haze and halos. Eur J Ophthalmol. 1994 Jan-Mar;4(1):43–51. doi: 10.1177/112067219400400108. [DOI] [PubMed] [Google Scholar]
  50. O'Brart D. P., Lohmann C. P., Klonos G., Corbett M. C., Pollock W. S., Kerr-Muir M. G., Marshall J. The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. A prospective, randomized, observer-masked study. Ophthalmology. 1994 Sep;101(9):1565–1574. doi: 10.1016/s0161-6420(94)38032-8. [DOI] [PubMed] [Google Scholar]
  51. Puliafito C. A., Steinert R. F., Deutsch T. F., Hillenkamp F., Dehm E. J., Adler C. M. Excimer laser ablation of the cornea and lens. Experimental studies. Ophthalmology. 1985 Jun;92(6):741–748. doi: 10.1016/s0161-6420(85)33962-3. [DOI] [PubMed] [Google Scholar]
  52. Roberts C. W., Koester C. J. Optical zone diameters for photorefractive corneal surgery. Invest Ophthalmol Vis Sci. 1993 Jun;34(7):2275–2281. [PubMed] [Google Scholar]
  53. Scialdone A., Carones F., Bertuzzi A., Brancato R. Randomized study of single vs double exposure in myopic PRK. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S41–S43. [PubMed] [Google Scholar]
  54. Seiler T., Genth U., Holschbach A., Derse M. Aspheric photorefractive keratectomy with excimer laser. Refract Corneal Surg. 1993 May-Jun;9(3):166–172. [PubMed] [Google Scholar]
  55. Seiler T., Kahle G., Kriegerowski M. Excimer laser (193 nm) myopic keratomileusis in sighted and blind human eyes. Refract Corneal Surg. 1990 May-Jun;6(3):165–173. [PubMed] [Google Scholar]
  56. Seiler T., Matallana M., Sendler S., Bende T. Does Bowman's layer determine the biomechanical properties of the cornea? Refract Corneal Surg. 1992 Mar-Apr;8(2):139–142. [PubMed] [Google Scholar]
  57. Seiler T., Reckmann W., Maloney R. K. Effective spherical aberration of the cornea as a quantitative descriptor in corneal topography. J Cataract Refract Surg. 1993;19 (Suppl):155–165. doi: 10.1016/s0886-3350(13)80400-2. [DOI] [PubMed] [Google Scholar]
  58. Seiler T., Wollensak J. Myopic photorefractive keratectomy with the excimer laser. One-year follow-up. Ophthalmology. 1991 Aug;98(8):1156–1163. doi: 10.1016/s0161-6420(91)32157-2. [DOI] [PubMed] [Google Scholar]
  59. Sher N. A., Barak M., Daya S., DeMarchi J., Tucci A., Hardten D. R., Frantz J. M., Eiferman R. A., Parker P., Telfair W. B., 3rd Excimer laser photorefractive keratectomy in high myopia. A multicenter study. Arch Ophthalmol. 1992 Jul;110(7):935–943. doi: 10.1001/archopht.1992.01080190041027. [DOI] [PubMed] [Google Scholar]
  60. Sher N. A., Bowers R. A., Zabel R. W., Frantz J. M., Eiferman R. A., Brown D. C., Rowsey J. J., Parker P., Chen V., Lindstrom R. L. Clinical use of the 193-nm excimer laser in the treatment of corneal scars. Arch Ophthalmol. 1991 Apr;109(4):491–498. doi: 10.1001/archopht.1991.01080040059027. [DOI] [PubMed] [Google Scholar]
  61. Sher N. A., Chen V., Bowers R. A., Frantz J. M., Brown D. C., Eiferman R., Lane S. S., Parker P., Ostrov C., Doughman D. The use of the 193-nm excimer laser for myopic photorefractive keratectomy in sighted eyes. A multicenter study. Arch Ophthalmol. 1991 Nov;109(11):1525–1530. doi: 10.1001/archopht.1991.01080110061035. [DOI] [PubMed] [Google Scholar]
  62. Simon G., Ren Q. Biomechanical behavior of the cornea and its response to radial keratotomy. J Refract Corneal Surg. 1994 May-Jun;10(3):343–356. [PubMed] [Google Scholar]
  63. Sinbawy A., McDonnell P. J., Moreira H. Surface ultrastructure after excimer laser ablation. Expanding vs contracting apertures. Arch Ophthalmol. 1991 Nov;109(11):1531–1533. doi: 10.1001/archopht.1991.01080110067036. [DOI] [PubMed] [Google Scholar]
  64. Srinivasan R., Sutcliffe E. Dynamics of the ultraviolet laser ablation of corneal tissue. Am J Ophthalmol. 1987 Mar 15;103(3 Pt 2):470–471. doi: 10.1016/s0002-9394(14)77775-x. [DOI] [PubMed] [Google Scholar]
  65. Tavola A., Brancato R., Galli L., Carones F., Esente S. Photorefractive keratectomy for myopia: single vs double-zone treatment in 166 eyes. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S48–S52. [PubMed] [Google Scholar]
  66. Taylor D. M., L'Esperance F. A., Jr, Del Pero R. A., Roberts A. D., Gigstad J. E., Klintworth G., Martin C. A., Warner J. Human excimer laser lamellar keratectomy. A clinical study. Ophthalmology. 1989 May;96(5):654–664. doi: 10.1016/s0161-6420(89)32836-3. [DOI] [PubMed] [Google Scholar]
  67. Taylor H. R., Guest C. S., Kelly P., Alpins N. A. Comparison of excimer laser treatment of astigmatism and myopia. The Excimer Laser and Research Group. Arch Ophthalmol. 1993 Dec;111(12):1621–1626. doi: 10.1001/archopht.1993.01090120043019. [DOI] [PubMed] [Google Scholar]
  68. Tengroth B., Epstein D., Fagerholm P., Hamberg-Nyström H., Fitzsimmons T. D. Excimer laser photorefractive keratectomy for myopia. Clinical results in sighted eyes. Ophthalmology. 1993 May;100(5):739–745. doi: 10.1016/s0161-6420(93)31581-2. [DOI] [PubMed] [Google Scholar]
  69. Trokel S. L., Srinivasan R., Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol. 1983 Dec;96(6):710–715. doi: 10.1016/s0002-9394(14)71911-7. [DOI] [PubMed] [Google Scholar]
  70. Tuft S., Eggli P., Boulton M., Marshall J. Assessment of corneal wound repair in vitro. Curr Eye Res. 1989 Jul;8(7):713–719. doi: 10.3109/02713688909025806. [DOI] [PubMed] [Google Scholar]
  71. Waring G. O., 3rd, Lynn M. J., McDonnell P. J. Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. Arch Ophthalmol. 1994 Oct;112(10):1298–1308. doi: 10.1001/archopht.1994.01090220048022. [DOI] [PubMed] [Google Scholar]
  72. Yanoff M., Cameron J. D. Human cornea organ cultures: epithelial-endothelial interactions. Invest Ophthalmol Vis Sci. 1977 Apr;16(4):269–273. [PubMed] [Google Scholar]
  73. Zabel R. W., Sher N. A., Ostrov C. S., Parker P., Lindstrom R. L. Myopic excimer laser keratectomy: a preliminary report. Refract Corneal Surg. 1990 Sep-Oct;6(5):329–334. [PubMed] [Google Scholar]

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