Eighteen-year follow-up of hyperopic photorefractive keratectomy

PURPOSE: To investigate the long-term efficacy of hyperopic photorefractive keratectomy (PRK). SETTING: University Hospital, London, United Kingdom. DESIGN: Prospective case series. METHODS: Patients with a follow-up of 18 years ± 0.7 (SD) attended for examination. All had spherical corrections with a 6.5 mm optical zone and 1.5 mm blend zone. RESULTS: Twenty-five patients (45 eyes) were included. The mean preoperative spherical equivalent (SE) refractive error was +4.11 ± 1.8 diopters (D) (range +1.125 to +7.25 D). Between 1 year and 18 years, in eyes that had no cataract surgery (n = 34), there was a +1.14 ± 1.48 D increase in the mean SE (P < .0002). The increase between 7.5 years and 18.0 years did not reach clinical significance (P = .1). Uncorrected distance visual acuity improved at 18 years (P < .02). Corrected distance visual acuity (CDVA) was reduced (P < .001). The efficacy index was 0.47, and the safety index was 0.83. Six eyes (18%) lost 2 lines of CDVA, of which 4 eyes had preexisting cataract. Keratometry remained stable between 1 year and 18 years (P = .2). Forty percent still had traces of peripheral haze, and 4 (9%) had Salzmann-like changes. Eleven eyes (24%) had cataract surgery and 4 (9%) had laser iridotomy. There was no evidence of ectasia. CONCLUSIONS: Hyperopic PRK showed an increase in hyperopic SE between 1.0 year and 7.5 years but was generally stable thereafter. The efficacy was limited. Peripheral haze was evident in 40% of cases with Salzmann-like changes in some. Ocular comorbidity in relationship to cataract was common and reduced CDVA. FINANCIAL DISCLOSURE: Dr. Marshall was a consultant to Summit Technology, Inc. No author has a financial or proprietary interest in any material or method mentioned.