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Klin Monbl Augenheilkd 2009; 226(2): 101-109
DOI: 10.1055/s-2008-1027838
Klinische Studie

© Georg Thieme Verlag KG Stuttgart · New York

Asphärische Ablationsprofile zur Myopiekorrektur: klinische Ergebnisse nach LASIK mit dem Bausch & Lomb 217 Z 100 Excimer-Laser

Aspheric Ablation for the Correction of Myopia: Clinical Results after LASIK with a Bausch & Lomb 217 Z 100 Excimer LaserS. Taneri1 , S. Stottmeister1
  • 1Zentrum für Refraktive Chirurgie, Augenklinik am St.-Franziskus-Hospital, Münster
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Publication History

Eingegangen: 9.5.2008

Angenommen: 18.8.2008

Publication Date:
10 February 2009 (online)

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Zusammenfassung

Hintergrund: Beurteilung der ersten klinischen Ergebnisse einer LASIK mit dem neuen asphärischen Ablationsmodus des Bausch & Lomb 217 Z 100 Lasers. Dieser Algorithmus berücksichtigt die präoperative Asphärizität der Hornhaut (Q-Wert), die Hornhautkrümmung (K-Wert) und die subjektive Refraktion, um ein Ablationsmuster zu berechnen, welches die natürliche Asphärizität bewahren soll. Methoden: Drei Gruppen wurden miteinander verglichen: Gruppe TS: 20 mit Zyoptix Tissue-Saving (refraktions- und keratometriebasiert) behandelte Augen; Gruppe AS: 54 mit Zyoptix Aspheric behandelte Augen; Gruppe PT: 20 mit Zyoptix Personalized Treatment (aberrationsgesteuert) behandelte Augen. Zusätzlich zu den konventionellen Ausschlusskriterien für eine LASIK-Behandlung wurden Augen mit einem höheren subjektiven Astigmatismus als –1,75 Dioptrien (dpt) und überdurchschnittlichen Aberrationen höherer Ordnung (HOA RMS > 0,35 µm, ungeachtet der sphärischen Aberrationen) ausgeschlossen. Ergebnisse: Nach initialer Nomogrammanpassung um –0,25 Dioptrien zeigte sich eine sehr gute Vorhersagbarkeit der sphäro-zylindrischen Korrektur (Sphäre 0,02 ± 0,50 dpt, Zylinder –0,35 ± 0,30 dpt) nach 3 Monaten. Die natürliche sphärische Aberration (Z400) blieb im Mittel erhalten. Die unkorrigierte Kontrastempfindlichkeit ohne und unter Blendung blieb auf präoperativ brillenkorrigiertem Niveau. Der unkorrigierte Niedrigkontrastvisus entsprach ungefähr dem brillenkorrigierten Niedrigkontrastvisus vor der Behandlung. Mit einer AS-LASIK konnte die natürliche Asphärizität der Kornea am besten erhalten werden (Anstieg des Q-Wertes im Mittel um 0,31 ± 0,22). Die Wirksamkeit war in diesem Kollektiv identisch mit der aberrationsgesteuerten Ablation (0,94). Schlussfolgerung: Zyoptix Aspheric ohne Zyklorotations-Eyetracker führte bei Augen mit unterdurchschnittlichen Aberrationen höherer Ordnung und niedrigem Astigmatismus zu genauso guten Ergebnissen wie die wellenfrontgeführte Ablation unter Zyklorotationskontrolle auf derselben Excimer-Laserplattform.

Abstract

Background: The aim of this study was to evaluate the clinical performance of the new aspheric ablation mode (Zyoptix Aspheric) in laser in situ keratomileusis (LASIK) using the Bausch & Lomb 217 Zyoptix 100 laser. This algorithm incorporates the asphericity of the cornea (Q-value), the corneal curvature (K-values) and the manifest refractive error to create an ablation pattern. Patients and Methods: Clinical outcomes of three ablation patterns were compared: Group TS: 20 eyes treated with Zyoptix tissue-saving (refraction and keratometry based); Group AS: 54 eyes treated with Zyoptix Aspheric; Group PT: 20 eyes treated with Zyoptix personalised treatment (wavefront aberration-guided). In addition to our conventional exclusion criteria for LASIK, eyes with an astigmatic error of more than –1.75 diopter (D) and above-average higher-order aberrations (HOA RMS > 0.35 µm, excluding spherical aberrations) were excluded. Results: After an initial nomogram adjustment of –0.25 D in the AS group, good refractive predictability was observed at the 3-month visit (mean spherical error 0.02 ± 0.50 D, mean cylinder –0.35 ± 0.30 D). Natural spherical aberrations could be maintained. Uncorrected contrast sensitivity with and without glare remained at spectacle-corrected levels before AS LASIK. The uncorrected low contrast visual acuity after AS LASIK was as good as the spectacle-corrected low contrast visual acuity before. The asphericity of the cornea was best preserved with AS. The efficacy index was 0.94 in both AS and PT, 0.86 in TS. Conclusions: AS without cyclorotational eye tracking has a clinical performance equivalent to PT with cyclorotational eye tracking and better than TS in eyes with low astigmatism and below average HOA.

Schlüsselwörter

refraktive Chirurgie - Kornea - LASIK - asphärische Ablation - Excimer-Laser - Myopiekorrektur

Key words

refractive surgery - cornea - LASIK - aspheric ablation - excimer laser - myopia correction

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Dr. Suphi Taneri

Zentrum für Refraktive Chirurgie, Augenklinik am St.-Franziskus-Hospital

Hohenzollernring 57

48145 Münster

Phone: ++ 49/2 51/9 87 78 90

Fax: ++ 49/2 51/9 87 78 98

Email: taneri@refraktives-zentrum.de

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