eMedicine Specialties > Ophthalmology > Refractive Disorders

Hyperopia, LASIK: Treatment

Author: Arun C Gulani, MD, Director, Gulani Vision Institute
Contributor Information and Disclosures

Updated: Nov 24, 2008

Treatment

Preoperative Details

This study included the first consecutive 49 eyes with preoperative hyperopia ranging from +1.25 D to +6.25 D with less than 0.75 D astigmatism and followed for 6 months postoperatively. A Lambda Physik 193-nm argon fluoride excimer laser at a fluence of 130 mJ/cm² was used for these cases.

Every patient underwent protocol preoperative ophthalmic tests that included a thorough slit lamp biomicroscopy, manual keratometry and autokeratometry, corneal topography, corneal pachymetry, specular microscopy, cycloplegic refraction, and recorded uncorrected and best-corrected visual acuity.

Intraoperative Details

All eyes were operated on under topical anesthesia. The corneal flap was created using the Chiron automated corneal shaper after making an epithelial mark with the Gulani LASIK marker and checking the intraocular pressure with the Barraquer tonometer. The flap was deliberately decentered nasally. The flap was gently lifted and reflected on itself nasally.

With the patient fixating at the fixation light, the Gulani triple lens marker was used to mark the anterior stroma with 3 concentric rings of 4.5-, 4-, and 3.5-mm diameters, respectively. Using a specially designed cupped lens forceps, the 4.5-mm lens was placed onto the stomal bed on the 4.5-mm mark and gently tapped into place (see Media file 3).

The flap hinge protector was used to prevent inadvertent ablation of the corneal flap hinge. In some cases, the globe stabilizer was used for apprehensive patients with excessive eye movements despite good visibility of the fixation light. The pretested and calibrated laser performed nomogram-directed ablation with a beam diameter of 7 mm.

A suction nozzle was held close to the eye by an assistant during ablation to address the plume and other unwanted products of the laser-corneal interaction. Following this first stage of hyperopic laser ablation, the 4.5-mm lens was lifted off the cornea and replaced by a 4-mm lens, which was then centered within the ablation edge of the previous laser-corneal interaction. Ablation is continued, followed by the final stage using the 3.5-mm lens.

After completing the hyperopic ablation using these 3 lenses successively, the surgeon can appreciate the concentric ring pattern of 3 rings with smooth edges under high magnification (see Media files 4-5). The stromal bed is now irrigated with balanced salt solution using the Gulani triple function LASIK cannula, while the corneal flap is floated back into position in alignment with the previously placed epithelial marks. Then, the flap is squeegeed gently using the bulbous tip of the cannula and air dried at the edges for 1 minute. The flap adherence is tested by applying the striae test, and, after speculum removal, it is tested by the blink test.

Postoperative Details

Dry eye is common after LASIK, and over-the-counter preservative-free lubricants are important.

Follow-up

Patients usually are seen the day after surgery, 2 weeks after surgery, and then as needed.

For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Vision Correction Surgery.

Complications

Complications include displaced flap, corneal perforation, interface debris, and diffuse lamellar keratitis.

More on Hyperopia, LASIK

Overview: Hyperopia, LASIK
Treatment: Hyperopia, LASIK
Follow-up: Hyperopia, LASIK
Multimedia: Hyperopia, LASIK
References
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References

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Further Reading

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Keywords

hyperopic LASIK, hyperopia, farsightedness, laser refractive surgery, distance vision, excimer laser, laser in situ keratomileusis

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Contributor Information and Disclosures

Author

Arun C Gulani, MD, Director, Gulani Vision Institute
Arun C Gulani, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Daniel S Durrie, MD, Director, Department of Ophthalmology, Division of Refractive Surgery, University of Kansas Medical Center
Daniel S Durrie, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Louis E Probst, MD, Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers
Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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