Wavefront-supported photorefractive keratectomy with the Bausch & Lomb Zyoptix in patients with myopic astigmatism and suspected keratoconus.

Purpose: To evaluate the safety, efficacy, and visual outcome of wavefront-supported photorefractive keratectomy (PRK) for the correction of myopia and myopic astigmatism in patients with suspected keratoconus.

Methods: Forty eyes of 20 patients with myopia -4.0 to -8.0 diopters (D) (mean: -6.25 +/- 1.04 D), cylinder -1.0 to -2.50 D (mean: -1.61 +/- 0.71 D), and corneal thickness 440 to 488 microm were treated with wavefront-supported PRK. Corneal topography evaluation revealed a significantly irregular cylinder (inferior-superior difference > 1.5 D) with possible mild or forme fruste keratoconus. Aberrometry was performed with the Hartmann-Shack aberrometer, and corneal data were evaluated with the Orbscan system. Eyes were treated with the Technolas 217z Bausch & Lomb excimer laser and followed for a minimum of 40 months.

Results: Following surgery, mean spherical equivalent refraction was +0.33 +/- 0.8 D. It was within +/- 0.5 D of the intended refraction in 95% of eyes and within +/- 1.0 D in 100% of eyes. Mean uncorrected visual acuity improved from 20/400 preoperatively to 20/25 postoperatively. Mean best spectacle-corrected visual acuity (BSCVA) remained unchanged (20/20) or improved to 20/20 in 92.5% of eyes and to 20/25 in 7.5% of eyes. Individually, BSCVA did not change in 28 (70%) eyes and increased by > or = 2 Snellen lines in 9 (22.5%) eyes; 3 (7.5%) eyes lost 1 Snellen line because of corneal haze. Laser treatment induced a significant flattening of the preoperative inferior corneal steepness in all eyes. Wavefront analysis demonstrated a significant decrease in high order aberrations (total root-mean-square and coma).

Conclusions: Wavefront-supported PRK appears to be effective for the treatment of myopia and astigmatism in patients with suspected keratoconus and thin, irregular corneas. Longer follow-up is needed to prove the safety of the procedure in this patient population.