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. 2013:7:93-8.
doi: 10.2147/OPTH.S38959. Epub 2013 Jan 10.

Increased preference of surface ablation over laser in situ keratomileusis between 2008-2011 is correlated to risk of ecatasia

Elad Moisseiev  1 , Tzahi Sela, Liza Minkev, David Varssano
Affiliations

Increased preference of surface ablation over laser in situ keratomileusis between 2008-2011 is correlated to risk of ecatasia

Elad Moisseiev et al. Clin Ophthalmol. 2013.

Abstract

Purpose: To evaluate the trends in corneal refractive procedure selection for the correction of myopia, focusing on the relative proportions of laser in situ keratomileusis (LASIK) and surface ablation procedures.

Methods: Only eyes that underwent LASIK or surface ablation for the correction of myopia between 2008-2011 were included in this retrospective study. Additional recorded parameters included patient age, preoperative manifest refraction, corneal thickness, and calculated residual corneal bed thickness. A risk score was given to each eye, based on these parameters, according to the Ectasia Risk Factor Score System (ERFSS), without the preoperative corneal topography.

Results: This study included 16,163 eyes, of which 38.4% underwent LASIK and 61.6% underwent surface ablation. The risk score correlated with procedure selection, with LASIK being preferred in eyes with a score of 0 and surface ablation in eyes with a score of 2 or higher. When controlling for age, preoperative manifest refraction, corneal thickness, and all parameters, the relative proportion of surface ablation compared with LASIK was found to have grown significantly during the study period.

Conclusions: Our results indicate that with time, surface ablation tended to be performed more often than LASIK for the correction of myopia in our cohort. Increased awareness of risk factors and preoperative risk assessment tools, such as the ERFSS, have shifted the current practice of refractive surgery from LASIK towards surface ablation despite the former's advantages, especially in cases in which the risk for ectasia is more than minimal (risk score 2 and higher).

Keywords: LASIK; PRK; ectasia; myopia correction; surface ablation.

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Figures

Figure 1
Figure 1
The distribution of the risk score in the eyes included in the study. Note: Values are presented in percentages. Abbreviation: EFRSS, Ectasia Risk Factor Score System.
Figure 2
Figure 2
The distribution of LASIK and surface ablation procedures according to the risk score of (A) RSB; (B) MRSE; (C) age; and (D) CT. Note: The relative proportion of the procedures for each risk score is presented in percentages. Abbreviations: LASIK, laser in situ keratomileusis; RSB, residual stromal bed thickness; MRSE, manifest refraction spherical equivalent; CT, corneal thickness.
Figure 3
Figure 3
The distribution of LASIK and surface ablation procedures according to the overall risk score. Note: The relative proportion of the procedures for each score is presented in percentages. Abbreviations: EFRSS, Ectasia Risk Factor Score System; LASIK, laser in situ keratomileusis.
Figure 4
Figure 4
The relative proportions of LASIK and surface ablation procedures by quarters, from 2008 to 2011. Note: values are presented in percentages. Abbreviation: LASIK, laser in situ keratomileusis.
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