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Klin Monbl Augenheilkd 2017; 234(05): 706-712
DOI: 10.1055/s-0042-102061
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Einfluss unterschiedlicher Ablationsfrequenzen auf die klinischen Ergebnisse bei photorefraktiver Keratektomie unter Verwendung derselben Excimer-Laser-Plattform: Ein kontralateraler Vergleich

Influence of Different Ablation Frequencies on the Clinical Results of Photorefractive Keratectomy Using the Same Excimer Laser Platform: A Contralateral Eye Study
T. Tandogan
1   International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg
,
R. Khoramnia
1   International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg
,
H. J. Gye
2   Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Department of Ophthalmology, Seoul, Republic of Korea
,
G. U. Auffarth
1   International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg
,
D. Kim
3   Department of Electrical Engineering, Kyung Hee University, Seoul, Republic of Korea
,
C. Y. Choi
1   International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg
2   Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Department of Ophthalmology, Seoul, Republic of Korea
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Publikationsverlauf

eingereicht 09. November 2015

akzeptiert 22. Januar 2016

Publikationsdatum:
30. April 2016 (online)

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Zusammenfassung

Hintergrund Klinische Evaluation der postoperativen Ergebnisse nach photorefraktiver Keratektomie (PRK) mit unterschiedlichen Ablationsfrequenzen.

Patienten und Methoden In diese prospektive, kontralaterale Augenstudie wurden 56 Augen von 28 Patienten mit Myopie oder myopem Astigmatismus eingeschlossen. Mithilfe des MEL90 Excimer-Lasers (Carl Zeiss Meditec, Deutschland) wurde eine PRK durchgeführt. Hierbei wurde ein Auge jedes Patienten mit einer Ablationsfrequenz von 250 Hz und das Partnerauge mit einer Ablationsfrequenz von 500 Hz behandelt. Die Behandlungsmuster in der 250-Hz- und 500-Hz-Gruppe unterschieden sich lediglich hinsichtlich der Ablationsfrequenz; Pulsenergie, Spotgröße und das Abtragungsprofil waren identisch. Nachuntersuchungen wurden 3 und 7 Tage sowie 1, 3 und 6 Monate nach dem Eingriff durchgeführt. Untersucht wurden u. a. die folgenden Parameter: unkorrigierter Fernvisus (UDVA), bestkorrigierter Fernvisus (CDVA), Aberrationen höherer Ordnung (HOAs), Reepithelisierungsdauer der Kornea und kornealer Haze.

Ergebnisse Die Ablationstiefe war bei beiden Repetitionsraten proportional zur Anzahl der Laserpulse. Sechs Monate nach dem Eingriff erreichten 100,0% der Augen in der 250-Hz- und 96,4% der Augen in der 500-Hz-Gruppe einen UDVA von 0,00 logMAR oder besser. Jeweils 100% der Augen in beiden Gruppen lagen innerhalb von ± 1,00 dpt der Zielrefraktion. Alle Augen erreichten postoperativ einen CDVA von 0,00 logMAR oder besser. Zwischen beiden Behandlungsgruppen zeigte sich postoperativ kein signifikanter Unterschied hinsichtlich der HOAs, der Reepithelisierungsdauer der Kornea und kornealem Haze.

Schlussfolgerung Bei der Korrektur der Myopie mittels PRK zeigte sich bei Anwendung der Repetitionsraten 250 Hz und 500 Hz ein vergleichbares Ergebnis hinsichtlich Wirksamkeit, Sicherheit und Vorhersagbarkeit. Trotz Anwendung einer hohen Repetitionsrate traten keine signifikanten Komplikationen (z. B. kornealer Haze) auf.

Abstract

Background The objective of this study was to evaluate postoperative clinical outcomes of photorefractive keratectomy (PRK) using different ablation frequencies.

Patients and Methods In this prospective, contralateral eye study, 56 eyes of 28 patients with myopia or myopic astigmatism were included. PRK was performed using the MEL90 excimer laser system (Carl Zeiss Meditec, Germany). One eye of each patient was treated with a repetition rate of 250 Hz, while the other one was treated with a repetition rate of 500 Hz. The treatment pattern in the 250 Hz and 500 Hz group only differed in terms of ablation frequency; there was no difference in laser pulse energy, spot size or ablation profile. Postoperative follow-ups were at 3 and 7 days and 1, 3 and 6 months. The following parameters were assessed: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), corneal re-epithelisation time and corneal haze.

Results Ablation depth was proportional to laser pulse counts at both frequencies. At 6 months, 100.0% of the eyes in the 250 Hz group and 96.4% in the 500 Hz group had a UDVA of 0.00 logMAR or better; 100% of the eyes in both groups were within ± 1.00D of the attempted correction. All eyes had a postoperative CDVA of 0.00 logMAR or better. There was no difference between the groups in postoperative HOAs, corneal re-epithelisation time or corneal haze.

Conclusions Photorefractive keratectomy with a repetition rate of 250 Hz and 500 Hz showed comparable efficacy, safety and predictability in the correction of myopia. There were no significant complications due to the high repetition rate, such as postsurgical corneal haze.

Schlüsselwörter

refraktive Chirurgie - Myopie - Repetitionsrate - Ablationsfrequenz - Excimer-Laser - PRK

Key words

refractive surgery - myopia - repetition rate - ablation frequency - excimer laser - PRK
 

  • Literatur

  • 1 Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol 1983; 96: 710-715
    CrossrefPubMedGoogle Scholar
  • 2 Sakimoto T, Rosenblatt MI, Azar DT. Laser eye surgery for refractive errors. Lancet 2006; 367: 1432-1447
    CrossrefPubMedGoogle Scholar
  • 3 Kymionis GD, Diakonis VF, Kounis G. et al. Effect of excimer laser repetition rate on outcomes after photorefractive keratectomy. J Cataract Refract Surg 2008; 34: 916-919
    CrossrefPubMedGoogle Scholar
  • 4 Winkler von Mohrenfels C, Khoramnia R, Lohmann CP. Comparison of different excimer laser ablation frequencies (50, 200, and 500 Hz). Graefes Arch Clin Exp Ophthalmol 2009; 247: 1539-1545
    CrossrefPubMedGoogle Scholar
  • 5 Buratto L, Ferrari M, Genisi C. Myopic keratomileusis with the excimer laser: one-year follow up. Refract Corneal Surg 1993; 9: 12-19
    PubMedGoogle Scholar
  • 6 Gartry DS, Kerr Muir MG, Marshall J. Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. Refract Corneal Surg 1991; 7: 420-435
    PubMedGoogle Scholar
  • 7 Seiler T. [Current evaluation of myopia correction with the excimer laser]. Ophthalmologe 1995; 92: 379-384
    PubMedGoogle Scholar
  • 8 Tomita M, Watabe M, Yukawa S. et al. Safety, efficacy, and predictability of laser in situ keratomileusis to correct myopia or myopic astigmatism with a 750 Hz scanning-spot laser system. J Cataract Refract Surg 2014; 40: 251-258
    CrossrefPubMedGoogle Scholar
  • 9 Mrochen M, Wuellner C, Rose K. et al. Experimental setup to determine the pulse energies and radiant exposures for excimer lasers with repetition rates ranging from 100 to 1050 Hz. J Cataract Refract Surg 2009; 35: 1806-1814
    CrossrefPubMedGoogle Scholar
  • 10 Fantes FE, Hanna KD, Waring 3rd GO. et al. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol 1990; 108: 665-675
    CrossrefPubMedGoogle Scholar
  • 11 Khoramnia R, Salgado JP, Wuellner C. et al. Safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK) with a 1000-Hz scanning spot excimer laser. Acta Ophthalmol 2012; 90: 508-513
    CrossrefPubMedGoogle Scholar
  • 12 Tomita M, Waring 4th GO, Magnago T. et al. Clinical results of using a high-repetition-rate excimer laser with an optimized ablation profile for myopic correction in 10 235 eyes. J Cataract Refract Surg 2013; 39: 1543-1549
    CrossrefPubMedGoogle Scholar
  • 13 Winkler von Mohrenfels C, Khoramnia R, Salgado J. et al. [Wavefront-guided and wavefront-optimised LASEK–comparison of clinical results]. Klin Monatsbl Augenheilkd 2009; 226: 839-843
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Winkler von Mohrenfels C, Khoramnia R, Wüllner C. et al. First clinical results of epithelial laser in situ keratomileusis with a 1000 Hz excimer laser. J Cataract and Refract Surg 2010; 36: 449-455
    CrossrefPubMedGoogle Scholar
  • 15 Winkler von Mohrenfels C, Salgado JP, Khoramnia R. et al. [Epi-LASIK with a 1000 hertz excimer laser]. Klin Monatsbl Augenheilkd 2011; 228: 621-625
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Arba-Mosquera S, Klinner T. Improving the ablation efficiency of excimer laser systems with higher repetition rates through enhanced debris removal and optimized spot pattern. J Cataract Refract Surg 2014; 40: 477-484
    CrossrefPubMedGoogle Scholar
  • 17 Shraiki M, Arba-Mosquera S. Simulation of the impact of refractive surgery ablative laser pulses with a flying-spot laser beam on intrasurgery corneal temperature. Invest Ophthalmol Vis Sci 2011; 52: 3713-3722
    CrossrefPubMedGoogle Scholar
  • 18 De Ortueta D, Magnago T, Triefenbach N. et al. In vivo measurements of thermal load during ablation in high-speed laser corneal refractive surgery. J Refract Surg 2012; 28: 53-58
    CrossrefPubMedGoogle Scholar
  • 19 Iseli HP, Mrochen M, Hafezi F. et al. Clinical photoablation with a 500-Hz scanning spot excimer laser. J Refract Surg 2004; 20: 831-834
    PubMedGoogle Scholar
  • 20 Bende T, Seiler T, Wollensak J. Side effects in excimer corneal surgery. Corneal thermal gradients. Graefes Arch Clin Exp Ophthalmol 1988; 226: 277-280
    CrossrefPubMedGoogle Scholar
  • 21 Mrochen M, Schelling U, Wuellner C. et al. Influence of spatial and temporal spot distribution on the ocular surface quality and maximum ablation depth after photoablation with a 1050 Hz excimer laser system. J Cataract Refract Surg 2009; 35: 363-373
    CrossrefPubMedGoogle Scholar
  • 22 Mohan RR, Hutcheon AE, Choi R. et al. Apoptosis, necrosis, proliferation, and myofibroblast generation in the stroma following LASIK and PRK. Exp Eye Res 2003; 76: 71-87
    CrossrefPubMedGoogle Scholar
  • 23 Wilson SE, Kim WJ. Keratocyte apoptosis: implications on corneal wound healing, tissue organization, and disease. Invest Ophthalmol Vis Sci 1998; 39: 220-226
    PubMedGoogle Scholar
  • 24 Khoramnia R, Lohmann CP, Wuellner C. et al. Effect of 3 excimer laser ablation frequencies (200 Hz, 500 Hz, 1000 Hz) on the cornea using a 1000 Hz scanning-spot excimer laser. J Cataract Refract Surg 2010; 36: 1385-1391
    CrossrefPubMedGoogle Scholar
  • 25 Winkler von Mohrenfels C, Khoramnia R, Maier M. et al. EpiLASIK with mitomycin C. Eur J Ophthalmol 2010; 20: 55-61
    CrossrefPubMedGoogle Scholar
  • 26 Kohnen T, Neuhann T, Knorz MC. [Assessment and quality assurance of refractive surgical interventions by the DOG (German Society of Ophthalmology) and the BVA (Professional Association of German Ophthalmologists): Update January 2014]. Ophthalmologe 2014; 111: 320-329
    CrossrefPubMedGoogle Scholar