Elsevier

Ophthalmology

Volume 115, Issue 5, May 2008, Pages 839-844.e2
Ophthalmology

Original article
Five-Year Outcome of LASIK for Myopia

https://doi.org/10.1016/j.ophtha.2007.07.012Get rights and content

Purpose

To investigate the efficacy and safety of LASIK over a 5-year postoperative period.

Design

Observational case series.

Participants

We examined 779 eyes in 402 patients with myopia or myopic astigmatism who underwent LASIK to correct their refractive errors and received regular postoperative assessments for 5 years.

Methods

Postoperative examinations were performed 1 day; 1 week; 1, 3, and 6 months; and 1, 2, 3, 4, and 5 years after LASIK surgery.

Main Outcome Measures

We evaluated changes in uncorrected visual acuity (UCVA) (logarithm of the minimum angle of resolution [logMAR]), manifest refraction, best-corrected visual acuity (BCVA) (logMAR), intraocular pressure, corneal thickness, corneal endothelial cell counts, and complications.

Results

Preoperative UCVA of 1.27 improved to −0.03 at 1 day after surgery and −0.08 at 1 month and revealed minimal but significant decreases thereafter. Postoperative manifest refraction was also improved by surgery, showing minimal but significant regression after 1 year. Final BCVA loss was seen in 10 eyes of 7 patients; in 7 cases, there were obvious reasons such as the progression of cataracts in 3 eyes, epithelial disintegrity due to dry eye in 2 eyes, irregular astigmatism due to flap striae in 1 eye, and age-related macular dystrophy in 1 eye. Intraocular pressure and corneal thickness decreased by 4.0 mmHg and 76.9 μm, respectively, due to surgery, but remained stable throughout the follow-up period. Corneal endothelial cell counts (2689.0±232.9 cells/mm2 before surgery) showed a statistically significant decrease at 5 years after surgery (2658.0±183.1 cells/mm2; 1.2% loss for 5 years), likely within the range due to physiological age-related loss. No serious, vision-threatening, irreversible complication such as keratectasia or progressive endothelial cell loss was observed.

Conclusion

LASIK surgery is an effective and safe procedure for correcting myopia/myopic astigmatism as long as inclusion and exclusion criteria are strictly respected. However, minimal regression occurred during the 5-year investigative period.

Section snippets

Patients

The study protocol was conducted in accordance with the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients.

Seven hundred seventy-nine eyes of 402 patients (221 male, 181 female; mean age, 34.6±8.3 years; mean subjective refraction, −6.40±2.58 diopters [D]; range of subjective refraction, −0.75 to −14.50 D) who underwent LASIK between December 1997 and March 2002 at Minamiaoyama Eye Clinic and regularly returned for postoperative examination were

Diameter of the Ablation Zones

The spherical equivalent (SE) of the target for the correction of refractive error was −6.30±2.59 D (range, −0.5 to −14.0). In 765 eyes (98.2%), the laser ablation was planned to target full correction. Mean diameters of the ablated area were 6.06±0.22 mm (range, 5.00–6.50) in the optical area and 6.97±0.17 mm (range, 5.70–7.50) when the transitional area was included.

Visual Acuity

The UCVA (logarithm of the minimum angle of resolution [logMAR]) of the patients was 1.27 (range, 0.2–2.0) preoperatively and

Discussion

Post-LASIK refractive results continued to be stable for a long time after the initial surgery, although minimal regression was observed by 1 year after surgery. The maintenance of postoperative refractive error within ±1.0 D in about 90% and within ±2.0 D in 97.9% of all operated eyes indicated that the predictability and stability of the surgery were good. A decreased BCVA of >2 lines was observed in 10 eyes (1.3%); however, in 7 of these, there were obvious causes other than LASIK (e.g.,

References (46)

  • N. Asano-Kato et al.

    Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms

    Am J Ophthalmol

    (2002)
  • M.Y. Wang et al.

    Epithelial ingrowth after laser in situ keratomileusis

    Am J Ophthalmol

    (2000)
  • E.J. Linebarger et al.

    Diffuse lamellar keratitis: diagnosis and management

    J Cataract Refract Surg

    (2000)
  • T. Seiler et al.

    Iatrogenic keratectasia after LASIK in a case of forme fruste keratoconus

    J Cataract Refract Surg

    (1998)
  • C.K. Joo et al.

    Corneal ectasia detected after laser in situ keratomileusis for correction of less than −12 diopters of myopia

    J Cataract Refract Surg

    (2000)
  • Y. Hori-Komai et al.

    Reasons for not performing refractive surgery

    J Cataract Refract Surg

    (2002)
  • J.T. Holladay et al.

    Functional vision and corneal changes after laser in situ keratomileusis determined by contrast sensitivity, glare testing, and corneal topography

    J Cataract Refract Surg

    (1999)
  • N. Asano-Kato et al.

    Experience with the Artisan phakic intraocular lens in Asian eyes

    J Cataract Refract Surg

    (2005)
  • M. Elder et al.

    New Zealand cataract and refractive surgery survey 2004

    Clin Experiment Ophthalmol

    (2006)
  • C. Yo

    Asian Americans: myopia and refractive surgery

    Int Ophthalmol Clin

    (2003)
  • R.J. Duffey et al.

    US trends in refractive surgery: 2004 ISRS/AAO survey

    J Refract Surg

    (2005)
  • A. Ivarsen et al.

    LASIK induces minimal regrowth and no haze development in rabbit corneas

    Curr Eye Res

    (2005)
  • H.C. Baldwin et al.

    Growth factors in corneal wound healing following refractive surgery: a review

    Acta Ophthalmol Scand

    (2002)
  • Cited by (0)

    Manuscript no. 2007-417.

    Drs Kato and Toda contributed equally to the work.

    View full text