Faik Orucov*, MD, Sinan Goker*,MD,

Abraham Solomon**, MD, Joseph Frucht-Pery**, MD

*Refractive Surgery Department,*Refractive Surgery Department,ISTANBUL SURGERY HOSPITALISTANBUL SURGERY HOSPITALIstanbul, TurkeyIstanbul, Turkey

Comparison of Tecnolas and Allegretto Comparison of Tecnolas and Allegretto LLaser in aser in SSitu itu KKeratomileusis eratomileusis OOutcomes in utcomes in HHyperopiayperopia

** Hadassah University ** Hadassah University Hospital, Jerusalem, IsraelHospital, Jerusalem, Israel

Authors have no financial interests in any of the mentioned products or companies

Hyperopia

Hyperopia ≥ 2D 6% of populationLow Hyperopia

good vision in youngpoor vision in adults

Hyperopia affects both distance and near vision and is compounded by presbyopia

Hyperopic Correction

ThermokeratoplastyThermokeratoplastyHexogonal keratotomyHexogonal keratotomyKeratophakiaKeratophakiaHelmium laserHelmium laserKeratomileusısKeratomileusısCKCKH-PRKH-PRKH-LASIKH-LASIKPhakic IOLsPhakic IOLsRLERLE

PROBLEMS IN HYPEROPIA

Pt’s age > 40- Dry eyes- BMD- More epithelial defects

Flap size 9.5 mm- Small eyes and pannus

(limbal bleeding)

PROBLEMS IN HYPEROPIA

Large area of treatment Long ablation time Centration is critical

PROBLEMS IN HYPEROPIA

Initial overcorrection (myopia)

Slow regression [1 y. in high hyperopia]

Enhancement is complicated Final K-reading < 50 [D]

Hyperopic correction is significantly more likely to regress Regression greater than myopic correction. The possibility of regression;

hyperplastic healing response of the cornea to fill in this ablated step between the treated and untreated zones, thereby not only resulting in loss of effect over time but also inducing an astigmatic error in case of uneven fill-ins.

i s t a n b u l c e r r a h i h a s t a n e s i

PURPOSE

To compare visual outcome measurements in laser in situ keratomileusis (LASIK) for hyperopia using the Technolas 217 and Allegretto excimer laser.

METHODS

Two-center retrospective studyH-LASIK by the Technolas 217; 50 eyes(Hadassah Medical Organization, Jeruasalem, (2003 and 2005)) H-LASIK by Allegretto excimer laser ; 42 eyes (Istanbul Surgery Hospital, Istanbul, (2004 and 2005))Mean follow-up 23.1±13.7 months with Technolas

19.3±8.8 months with Allegretto.Inclusion criteria; - SE up to 4.00 diopters (D) of sycloplegic

hyperopia, - Minimum F/U 12 months

Exclusion criteria; - Incomplete documentation

RESULTS

Technolas Allegretto P

SE (Mean) Preoperative +2.51±0.78 (D) +2.37±0.81 (D) 0.386 Postoperative -0.01 ±0.58 -0.003 ±0.41 0.912

Optical zone & Ablation depth

Technolas Allegretto P

Optical zone (Mean) 6.0±0.1mm 6.8±0.25 <0.001Ablation depth (Mean) 68.1±21.2μ 49.8±18.3μ <0.001

SE

Stability

Higher Myopic overcorrection on the next dayGreater regression observed during first monthRegression (month 1 to last visit) : Technolas +0.48 D

Allegretto +0.36 D (P=0.247)

UCVA

The postoperative UCVA was significantly lower in eyes treated with Tecnolas on postoperative month 1 (P=.037) . At 3, 6 ,12 months and at last visit postoperatively, no significant differences were noted in UCVA between the two lasers (P=.065 to .473).

Technolas Allegretto P

UCVA 1 Month 0,69 ± 0,25 0,81 ± 0,26 0,032 12 Months 0,80 ± 0,18 0,85 ± 0,18 0,473 Last visit 0,80 ± 0,22 0,86 ±0,17 0,126

BCVA

0.97±0.10

0.94±0.15

0.96±0.09

0.92±0.15

P= 0.239P= 0.144

Predictability

i s t a n b u l c e r r a h i h a s t a n e s i

Postoperative (last visit) Technolas AllegrettoUCVA ≥ 20/25 55.8% 69.0%

±0.50 D 69.0% 78.7%,

BSCVAloss of ≥ 1 lines 11.4% 4.8%

gain of ≥ 1 lines 19.2% 16.7%.

Efficacy & SafetyEfficacy & Safety Technolas Allegretto P

Safety 1.03±0.12 1.01±0.05 0.409

Efficacy 0.87±0.21 0.90±0.16 0.444

CONCLUSION

Ablation depth was greater with Technolas laser.

Visual and refractive results were similar between the Technolas and Allegretto laser systems after 3 months of the procedure.