Corneal wavefront-guided photorefractive keratectomy with mitomycin-C for consecutive hyperopia after radial keratotomy

Purpose: To assess the efficacy, predictability and stability of corneal wavefront-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy. Methods: In a prospective study, 60 eyes of 36 consecutive patients were treated with corneal wavefront-guided PRK with 0.02% mitomycin-C using an Esiris-Schwind excimer laser. Corneal epithelium was mechanically removed. All patients were followed-up for 12 months. Results: The mean time between radial keratotomy and PRK was 18.4 years +/- 3.8 (SD); mean spherical equivalent (SE) before radial keratotomy was -4.35 diopters (D) +/- 1.55. Before PRK, the mean sphere was +5.00 D +/- 2.28, mean astigmatism was -1.47 D +/- 1.06, mean SE was +4.27 D +/- 2.18, and the mean best-corrected visual acuity (BCVA) was 0.174 +/- 0.139 (logMAR). The planned laser SE correction was +4.74 D +/- 2.11. No intraoperative complications were noted. At 12 months, mean SE was +0.04 D +/- 1.03 (P<0.001), mean astigmatism was -1.03 +/- 0.75 D (P=0.015), mean UCVA was 0.265 +/- 0.197, and mean BCVA was 0.079 +/- 0.105 (P<0.001). There was a mean gain of 1 line of BCVA and 20 eyes (33.3%) gained 2 or more lines. Only one eye lost 2 lines. A significant decrease in coma (P=0.002), trefoil (P=0.004), spherical aberration (P<0.001) and quatrefoil (P=0.002) was observed. Forty eight eyes (80%) were within +/- 1.0 D of intended SE. Mean regression from 6 to 12 months was +0.17 +/- 0.67 D. Conclusion: Corneal wavefront-guided PRK was effective, predictable and stable after one year of follow-up for the treatment of hyperopia after radial keratotomy. A significant improvement in UCVA, BCVA and corneal aberrations was obtained.