Clinical Evaluation of LASEK for High Myopia Correction between the Triple-A Profile and the Zyoptix Tissue Saving Profile

Purpose. To compare the effects of correcting high myopia using the MEL®90 Triple-A profile LASEK at a 500 Hz pulse rate (Triple-A group) versus the Zyoptix tissue-saving ablations of Technolas 217z laser platform at 100 Hz (TS group). Methods. This retrospective study included 50 eyes in the Triple-A group and 42 eyes in the TS group with manifest refraction spherical equivalent (MRSE) of −6 diopters (D) to −10 D. We compared uncorrected distance visual acuity, MRSE, corrected distance visual acuity, and postoperative complications at 1 month, 3 months, and 6 months. Results. At 6 months after refractive surgery, the efficacy index of Triple-A group was significantly higher than that of the TS group (1.03 ± 0.12 vs 1.00 ± 0.11, P=0.04). The MRSE postoperatively in the Triple-A group was significantly lower than that in the TS group (0.25 ± 0.18 vs 0.38 ± 0.23, P<0.01). The safety indices in the two groups were almost the same after 6 months of surgery (1.03 ± 0.07 vs 1.04 ± 0.11, P=0.63). The proportion of eyes which achieved ±0.13 D was significantly higher in the Triple-A group than that in the TS group at 1 month (80% vs 59.5%, P=0.03), 3 months (82% vs 61.9%, P=0.03) and 6 months (84% vs 64.3%, P=0.03). The changes in refraction 6 months after surgery comparing with 1 month after surgery were 0.12 ± 0.10 D in the Triple-A group and 0.13 ± 0.08 D in the TS group (P=0.56). All (100%) of the patients in the Triple-A group and 50% of the patients in the TS group had a UDVA of 20/16 at 6 months after surgery (P<0.01). The induced spherical aberrations and total HOAs in the Triple-A group were significantly lower than those in the TS group (0.17 ± 0.02 μm vs 0.23 ± 0.02 μm, P<0.01; 0.20 ± 0.04 μm vs 0.39 ± 0.03 μm, P<0.01) at 6 months after surgery. The mean reduced corneal thickness was 113.06 ± 10.5 μm in the Triple-A profile group and 121.43 ± 23.46 μm in the TS group (P=0.02). No patient in either group had haze and high intraocular pressure 6 months after surgery. Conclusion. For treatment of high-myopia patients, the Triple-A profile was more effective, predictable, and accurate than the Zyoptix tissue-saving profile. Meanwhile, the Triple-A profile had less induced spherical aberrations, total HOAs, and cornea ablation depth than the Zyoptix tissue-saving profile. Patients in the Triple-A group with 500 Hz pulse rate treatment achieved superior results. The two surgical procedures were equivalent in terms of safety and stability.

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Short-Term Outcomes of Small-Incision Lenticule Extraction (SMILE) for Low, Medium, and High Myopia

European Journal of Ophthalmology ◽

10.5301/ejo.5000849 ◽

2016 ◽

Vol 27 (2) ◽

pp. 153-159 ◽

Cited By ~ 12

Author(s):

Joaquín Fernández ◽

Almudena Valero ◽

Javier Martínez ◽

David P. Piñero ◽

Manuel Rodríguez-Vallejo

Keyword(s):

Visual Acuity ◽

High Myopia ◽

Small Incision Lenticule Extraction ◽

Distance Visual Acuity ◽

Small Incision ◽

Uncorrected Distance Visual Acuity ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Lenticule Extraction

Purpose To determine the safety, efficacy, and predictability of small-incision lenticule extraction at 6-month follow-up, depending on the level of the myopic refractive error. The surgeries were performed by a surgeon new to this technique. Methods Seventy-one subjects with a mean age of 31.86 ± 5.57 years were included in this retrospective observational study. Subjects were divided into 3 groups depending on the preoperative spherical equivalent (SE): low group from -1.00 D to -3.00 D, medium from -3.25 D to -5.00 D, and high from -5.25 D to -7.00 D. Manifest refraction, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) were measured before surgery and at 6 months after the treatment. Results In total, 1.4% of the eyes lost 1 line of CDVA after the procedure, whereas 95.8% remained unchanged and 2.8% gained 1 line. A significant undercorrection (p = 0.031) was found in the high myopia group (median -0.50 D), whereas the low and medium groups remained near to emmetropia. In terms of efficacy, no statistically significant intergroup differences for postoperative UDVA (p = 0.282) were found. The vector analysis also showed undercorrection of the preoperative cylinder, even though the standard deviations decreased from 0.9 D in the x axis and 0.7 D in the y axis to 0.24 D and 0.27 D, respectively. Conclusions Small-incision lenticule extraction might be a safe, effective, and predictable procedure even for inexperienced surgeons. No differences in efficacy were found among myopia levels even though undercorrections were found for SE and cylinder in high myopia.

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Five-year outcomes of EVO implantable collamer lens implantation for the correction of high myopia and super high myopia

Eye and Vision ◽

10.1186/s40662-021-00264-0 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Xun Chen ◽

Xuanqi Wang ◽

Yilin Xu ◽

Mingrui Cheng ◽

Tian Han ◽

...

Keyword(s):

Visual Acuity ◽

Refractive Error ◽

Axial Length ◽

High Myopia ◽

Implantable Collamer Lens ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Corneal Endothelial Cell Density ◽

Safety Indices

Abstract Background To evaluate the long-term safety, efficacy, predictability, and stability of implantable collamer lens with a central hole (EVO ICL) implantation for correcting high myopia (HM) and super high myopia (SHM). Methods This prospective study evaluated 83 eyes of 46 patients who were divided into groups based on their spherical equivalent refractive error (SE): HM group (− 12 D ≤ SE < − 6 D) and SHM group (SE < − 12 D). They were followed up for 5 years after ICL implantation; assessments of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive error, axial length, intraocular pressure, corneal endothelial cell density, and vault were conducted, and a questionnaire was administered. ResuIts At 5 years postoperatively, the safety indices of the HM and SHM groups were 1.03 ± 0.10 and 1.32 ± 0.39, and the efficacy indices were 0.83 ± 0.25 and 0.86 ± 0.32, respectively. In the HM group, 60.47% and 79.07% of the eyes were within ± 0.50 D and ± 1.00 D of the attempted correction, while it was achieved for 22.50% and 47.50% of the eyes in the SHM group, respectively. The SE of the HM group decreased from − 9.72 ± 1.41 D preoperatively to 0.04 ± 0.39 D 1 month postoperatively and − 0.67 ± 0.57 D 5 years postoperatively, while in the SHM group, it decreased from − 15.78 ± 3.06 D preoperatively to − 0.69 ± 0.97 D 1 month postoperatively and − 1.74 ± 1.19 D 5 years postoperatively. Conclusion EVO ICL implantation is safe, effective, and predictable for correcting HM and SHM. CDVA improved more after surgery for SHM, but the growth of axial length still needs attention.

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Long-term Stability of Ectasia in a Young Patient with Asymmetric Keratoconus

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1102 ◽

2015 ◽

Vol 4 (2) ◽

pp. 66-68

Author(s):

Rosane de Oliveira Corrêa ◽

Ana Laura Caiado Canedo ◽

Rozalia Beildeck ◽

Marcella Quaresma Salomão ◽

Penelope Burle de Politis

Keyword(s):

Visual Acuity ◽

Young Patient ◽

Distance Visual Acuity ◽

Long Term Stability ◽

Uncorrected Distance Visual Acuity ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Ring Segment ◽

Intracorneal Ring Segment ◽

The Right

ABSTRACT Purpose To report the clinical course of a typical young patient presenting with asymmetric keratoconus (KC), that demonstrates that stabilization of the ectatic process is possible without cross-linking (CXL) procedure. Methods Case report and review of the literature. Results A 17-year-old male patient was referred due to the diagnosis of keratoconus. Patient complained of loss of vision in the left eye (OS). Uncorrected distance visual acuity (UDVA) was 20/25+ in the right eye (OD) and 20/80 in the left eye; wavefront-assisted manifest refraction gave best corrected distance visual acuity (CDVA) of 20/20 in OD and 20/40 in OS. The diagnosis of keratoconus was confirmed with Placido disk-based topography (Oculus Keratograph 4), and Pentacam HR corneal tomography (Oculus Optikgeräte GmbH, Wetzlar, Germany). Femtosecond laser-assisted intracorneal ring segment (ICRS) implantation was performed in the left eye and treatment for allergy was prescribed for both eyes, along with patient education and advice not to rub the eyes. After 3 months, significant improvement was observed on UDVA (20/30) and CDVA (20/20) in the left eye. Topometric and tomographic stability of ectasia was observed in the right eye in a 4-year follow-up. Conclusion Intracorneal ring segment caused significant regularization of the corneal shape and improvement on visual acuity. Ectasia stability was achieved with no need for CXL, despite the patient's young age. This case raises the point that the indication of CXL for every keratoconic patient should be reconsidered. How to cite this article de Oliveira Corrêa R, Canedo ALC, Beildeck R, Salomão MQ, de Politis PB, Ambrósio R Jr. Longterm Stability of Ectasia in a Young Patient with Asymmetric Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):66-68.

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Small incision lenticule extraction for the correction of high myopia

European Journal of Ophthalmology ◽

10.1177/1120672119861481 ◽

2019 ◽

Vol 30 (5) ◽

pp. 917-927

Author(s):

Suphi Taneri ◽

Saskia Kießler ◽

Anika Rost ◽

Tim Schultz ◽

H Burkhard Dick

Keyword(s):

Visual Acuity ◽

High Myopia ◽

Case Series ◽

Small Incision Lenticule Extraction ◽

Distance Visual Acuity ◽

Small Incision ◽

Refractive Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Lenticule Extraction

Purpose: Excimer laser-based refractive procedures can have less predictable results when used for correcting high myopia than when used for moderate myopia. Small incision lenticule extraction might overcome this weakness. However, small incision lenticule extraction is only Food and Drug Administration approved for use in myopic eyes up to −8 D with astigmatism of −3 D or less. We report outcomes of small incision lenticule extraction in highly and moderately myopic eyes and compare these to modern laser-assisted in situ keratomileusis. Methods: Retrospective, observational consecutive case series. Inclusion criteria: attempted myopic spherical correction ⩾−8 or−3 to −7.75 D with astigmatism ⩽−3 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Results: A total of 62 highly myopic and 407 moderately myopic eyes were included. At 3 months postoperatively, the highly myopic eyes had a mean spherical equivalent refraction of −0.28 ± 0.41 D (range: −1.13 to +0.75 D). Mean uncorrected distance visual acuity was 1.0. Mean efficacy index was 0.84. Mean safety index was 1.03. Uncorrected distance visual acuity same or better than corrected distance visual acuity: 61%. Astigmatism was ⩽0.5 D in 90% and ⩽1 D in 100%. The results in the moderately myopic eyes were comparable. Conclusion: We found equally good visual and refractive outcomes after small incision lenticule extraction for the correction of high and of moderate myopia combined with an astigmatic correction of up to 3 D, respectively.

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Comparison of outcomes after topography-modified refraction versus wavefront-optimized versus manifest topography-guided LASIK

BMC Ophthalmology ◽

10.1186/s12886-020-01459-0 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Jaeryung Kim ◽

Sung-Ho Choi ◽

Dong Hui Lim ◽

Gil-Joong Yoon ◽

Tae-Young Chung

Keyword(s):

Visual Acuity ◽

Vector Analysis ◽

Laser In Situ Keratomileusis ◽

Distance Visual Acuity ◽

Postoperative Astigmatism ◽

Uncorrected Distance Visual Acuity ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Myopic Astigmatism

Abstract Background To compare the outcomes of myopia and myopic astigmatism corrected with topography-modified refraction laser in situ keratomileusis (TMR-LASIK), wavefront-optimized (WFO) LASIK, and topography-guided (TG) LASIK with a correction target based on the manifest refraction (manifest TG-LASIK). Methods This observational, retrospective cohort study included patients who underwent LASIK using the WaveLight® EX500 excimer laser to correct myopia and myopic astigmatism between August 2016 and July 2017. Patients who underwent TMR-LASIK (85 patients), WFO-LASIK (70 patients), or manifest TG-LASIK (40 patients) were enrolled, and only one eye from each patient was analyzed. All participants underwent measurement of the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), manifest refraction, vector analysis of astigmatic change, corneal topography, and corneal wavefront analysis at baseline and at every posttreatment visit. Results Three months postoperatively, a UDVA of 0.0 logMAR or better and manifest refraction spherical equivalent (MRSE) within ±0.5 diopters (D) did not differ across the TMR-, WFO-, and manifest TG-LASIK groups. However, the residual cylinder in the TMR group was significantly larger than that in the WFO and manifest TG groups. The magnitude of error in the TMR group measured using astigmatism vector analysis was significantly higher than that in the WFO and manifest TG groups. Conclusions Although these three LASIK platforms achieved the predicted surgical outcomes, TMR-LASIK overcorrected astigmatism and showed a higher residual postoperative astigmatism compared with WFO- and manifest TG-LASIK.

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Comparison of Visual Outcomes for Myopia after Refractive Surgery using Femtosecond Laser-Assisted and Flap-off Epi-LASIK

10.21203/rs.2.13808/v3 ◽

2020 ◽

Author(s):

JUNJIE PIAO ◽

Woong-Joo Whang ◽

Choun-Ki Joo

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Refractive Surgery ◽

Distance Visual Acuity ◽

Visual Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Significant Difference ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Corneal Asphericity

Abstract Background This study clinically evaluated the visual outcomes after refractive surgery for myopia using femtosecond laser-assisted in situ keratomileusis (femto-LASIK) and epi-LASIK (flap-off). Methods In this prospective cohort study, 40 eyes of 27 patients were divided into two groups depending on the technique used for refractive surgery. Femto-LASIK flaps and epi-LASIK flaps (flap-off) were created using femtosecond laser and Epi-K TM epikeratome, respectively. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), corneal asphericity (Q-value), and corneal higher-order aberrations (HOAs) were assessed pre- and postoperatively. Results The improvement in LogMAR UDVA after refractive surgery was statistically significant for both groups ( P < 0.001 for all groups); it was significantly improved in the femto-LASIK group, 1 day and 1 week postoperatively ( P < 0.001, P = 0.019, respectively). With regard to the front and total corneal HOAs, there were significant differences in spherical aberrations (Z 4,0 ) between the femto-LASIK and flap-off epi-LASIK groups ( P = 0.016 and P = 0.017, respectively). With regard to the back corneal HOAs, there were significant differences in vertical coma (Z 3,-1 ) aberration, 0.027 ± 0.027 μm (femto-LASIK) and 0.001 ± 0.034 μm (flap-off epipolis LASIK); horizontal secondary astigmatism (Z 4,2 ) aberration, -0.008 ± 0.012 μm (femto-LASIK) and 0.007 ± 0.018 μm (flap-off epipolis LASIK); oblique tetrafoil (Z 4,-4 ) aberration, -0.008 ± 0.029 μm (femto-LASIK) and 0.015 ± 0.026 μm (flap-off epi-LASIK), respectively ( P = 0.018, P = 0.007, and P = 0.022, respectively). However, the back corneal HOA changes did not have a significant effect on the total corneal HOA changes. Conclusion Femto-LASIK yielded better early visual outcomes than did flap-off epi-LASIK, but there was no significant difference between the outcomes of the two procedures, 1 week postoperatively.

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Three-year Clinical Outcomes of Aspheric Micro-monovision LASIK for Correction of Presbyopia and Myopic Astigmatism

10.21203/rs.2.15661/v2 ◽

2020 ◽

Author(s):

Fang Liu ◽

Ting Zhang ◽

Quan Liu

Keyword(s):

Visual Acuity ◽

Spherical Equivalent ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

High Satisfaction ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Uncorrected Visual Acuity ◽

Registration Number ◽

Myopic Astigmatism

Abstract Background: To investigate the long-term safety and efficacy of aspheric micro-monovision LASIK for the correction of presbyopia and myopic astigmatism. Methods: In total, 114 eyes of 57 patients with a mean age of 48 ± 4.05 years (range: 43 to 62 years) who were undergoing aspheric micro-monovision LASIK treatment were enrolled. Visual acuity, manifest refraction, amplitude of accommodation, contrast sensitivity, entire eye aberrations and patients’ subjective ratings were evaluated from 1 day to 3 years postoperatively. Results: None of the eyes showed a spherical equivalent change of over 0.75 D between 3 months and 3 years, while 95% of the eyes were within ±0.50 D of the target correction of the spherical equivalent. The percentage of patients showing monocular uncorrected distance visual acuity ≥20/20 was 95%, and all eyes achieved a visual acuity of 20/25 or better. The percentage of patients showing binocular uncorrected near visual acuity ≥J2 was 93%, and all patients achieved a visual acuity of J4 or better. Ninety-one percent of the patients had an uncorrected visual acuity of 20/20 in both eyes and J2 or better binocular visual acuity. Six of 108 eyes (6%) lost 1 line, and no eyes lost 2 lines of corrected distance visual acuity. The overall satisfaction score for surgery was 93 ± 6. Conclusions: Aspheric micro-monovision LASIK using the Carl Zeiss Meditec MEL 80 Platform was an efficacious option for older myopic patients with presbyopia. Three-year postoperative outcomes in the Chinese population indicated improvements in uncorrected binocular vision at far and near distances with high satisfaction. Trial registration: The registration number is ChiCTR-IPC-15005842, and the date of registration is January 16, 2015.

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3 Years Clinical Outcomes of Aspheric Micro-monovision LASIK for Correction of Presbyopia and Myopic Astigmatism

10.21203/rs.2.15661/v1 ◽

2019 ◽

Author(s):

Fang Liu ◽

Ting Zhang ◽

Quan Liu

Keyword(s):

Visual Acuity ◽

Subjective Rating ◽

Spherical Equivalent ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

High Satisfaction ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Near Visual Acuity

Abstract Background: To investigate long term safety and efficacy of aspheric micro-monovision LASIK for correction of presbyopia and myop ic astigmatism. Methods: One hundred and fourteen eyes of 57 patients with a mean age 48 ± 4.05 years (range: 43 to 62 years) undergoing aspheric micro-monovision LASIK treatment using the MEL 80 excimer laser (Carl Zeiss Meditec AG, Jena, Germany) were enrolled. Visual acuity, manifest refraction, amplitude of accommodation and patients’ subjective rating was evaluated from 1 day to 3 years postoperatively. Results: There were no eyes in which spherical equivalent changed by over 0.75D between 1 day and 3 years. Ninety five percent of eyes were within ±0.50 D of target correction of spherical equivalent. The percentage of monocular uncorrected distance visual acuity ≧20/20 was 95%,and all eyes achieved 20/25 or better. The percentage of binocular uncorrected near visual acuity ≧J2 was 93%,and all patients achieved J4 or better. Ninety one percent of the patients could see uncorrected both 20/20 and J2 or better binocularly. Six percent (6/108) eyes lost 1 line and no eyes lost 2 lines of corrected distance visual acuity. The overall satisfaction score for surgery was 93±6. Conclusions: The aspheric micro-monovision LASIK using the Carl Zeiss Meditec MEL 80 Platform was an efficacious option for older myopia patients with presbyopia. Three years postoperative outcomes in Chinese population indicated improvements in uncorrected binocular vision at far and near distances with high satisfaction.

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Efficacy of progressive thickness intrastromal corneal ring segments in the treatment of duck phenotype keratoconus

European Journal of Ophthalmology ◽

10.1177/11206721211001722 ◽

2021 ◽

pp. 112067212110017

Author(s):

Juan G Arbelaez ◽

Maria C Arbelaez

Keyword(s):

Visual Acuity ◽

Clinical Outcomes ◽

Effective Means ◽

Study Cohort ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Intrastromal Corneal Ring ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Belo Horizonte

Purpose:To evaluate clinical outcomes in patients with asymmetric duck phenotype keratoconus implanted with asymmetric progressive thickness intrastromal corneal ring segments (PT-ICRS, Keraring AS, Mediphacos, Belo Horizonte, Brazil), and to demonstrate improved visual acuity and symmetry in corneal flattening.Methods:This single-center, retrospective, observational study evaluated the clinical outcomes at 1, 3, and 6 months after implantation of PT-ICRS in patients with duck phenotype keratoconus. After creating the intrastromal tunnel with a femtosecond laser, one 160-degree arc length PT-ICRS, either 150/250 µm or 200/300 µm, was implanted. Changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), manifest refraction spherical equivalent (MRSE), mean keratometry (Kmean), maximum keratometry (Kmax), Coma@5mm, and manifest and topographical astigmatism were documented.Results:The study cohort included 23 eyes of 17 patients with a mean age of 24.6 years. From baseline to 6 months following implantation, mean UDVA improved from 0.70 logarithm of the minimum angle of resolution (logMAR) (20/100 Snellen) to 0.22 logMAR (20/33 Snellen), CDVA improved from 0.33 logMAR (20/42 Snellen) to 0.14 logMAR (20/27 Snellen), the mean sphere and MRSE decreased from −1.05 diopters (D) and −2.70 D to −0.25 D and −0.80 D, respectively, and the Kmean and Kmax improved from 46.5 D and 53.7 D to 44.6 D and 48.7 D, respectively.Conclusions:The Keraring AS ICRS offers a safe, effective means of improving visual acuity while reducing refractive error, mean and max keratometry, and aberrations in patients with duck phenotype keratoconus.

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Femtosecond-Assisted Elliptical LASIK Flap for the Correction of Post-Arcuate Keratotomy Residual Astigmatism

Case Reports in Ophthalmology ◽

10.1159/000504288 ◽

2019 ◽

Vol 10 (3) ◽

pp. 379-383

Author(s):

Nafsika Voulgari ◽

Michael A. Grentzelos ◽

George A. Kontadakis ◽

Erwin Samutelela ◽

George D. Kymionis

Keyword(s):

Visual Acuity ◽

Arc Length ◽

Slit Lamp ◽

Slit Lamp Examination ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Ablation Pattern

We report the application of an elliptical femtosecond laser-assisted in situ keratomileusis (LASIK) flap for the management of post-arcuate keratotomy (AK) residual astigmatism. An 82-year-old male was referred to our institute for evaluation of his right eye due to residual regular astigmatism 1 year after AK. On examination, uncorrected distance visual acuity (UDVA) was 20/50 and corrected distance visual acuity was 20/25 (+3.25 –5.50 × 125). Slit-lamp examination revealed two 70-arc length peripheral corneal incisions at the 7.50-mm zone. The patient underwent femtosecond-assisted LASIK for the correction of residual astigmatism. An elliptical LASIK flap was adjusted intraoperatively with a 2-dimension diameter of 7.98 × 6.69 mm in order to avoid intersection of the flap with the AK incisions. The short flap diameter was placed along the meridian of the incisions and the long diameter in the perpendicular meridian, corresponding to the excimer laser astigmatic ablation pattern. No intraoperative or postoperative complications were encountered. Six months postoperatively, UDVA improved to 20/25 with a manifest refraction of pl –0.75 × 5. No AK incision flap-related complications were observed.

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