LASIK for Hyperopia Using an Aberration-Neutral Profile With an Asymmetric Offset Centration.

PURPOSE: To investigate refractive outcomes and induction of corneal higher order aberrations (HOAs) in eyes with large pupil to corneal vertex offset that underwent LASIK for hyperopia using an aberration-neutral profile with corneal vertex centration and asymmetric offset.

METHODS: In this retrospective consecutive review, 26 patients (46 eyes) who underwent LASIK performed by one surgeon using the AMARIS 750S excimer laser platform and Carriazo-Pendular microkeratome (both from SCHWIND eye-tech-solutions, Kleinostheim, Germany) for flap creation were retrospectively analyzed. Only eyes targeted for plano and with a pupil to corneal vertex offset greater than 200 µm were included. The preoperative metrics were correlated with the outcomes at 3 and 6 months postoperatively.

RESULTS: The mean spherical equivalent was +3.43 ± 1.30 diopters (D) preoperatively and +0.21 ± 0.61 D at last postoperative visit (P < .0001). Mean refractive astigmatism was 1.09 ± 1.06 D preoperatively, and 0.39 ± 0.43 D at last postoperative visit. Postoperative uncorrected distance visual acuity of 20/25 or better was achieved in 74%, 65%, and 79% of eyes at 1, 3, and 6 months, respectively, compared to 85% corrected distance visual acuity of 20/25 or better preoperatively. Statistically significant correlation was observed between preoperative and postoperative aberration values for vertical trefoil (P < .0005), vertical coma (P < .0005), oblique tetrafoil (P < .0001), secondary cardinal astigmatism (P < .05), cardinal tetrafoil (P < .05), and secondary vertical trefoil (P < .05).

CONCLUSIONS: LASIK for high levels of hyperopia using corneal vertex centration with asymmetric offset was safe and predictable. Maintaining postoperative keratometry less than 49.00 D after hyperopic LASIK and centering on corneal vertex may reduce the induction of coma compared to other profiles or centration strategies.