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• W2005491154 abstract "I would like to comment on the article by Güell and Vazquez regarding the correction of high degrees of astigmatism using a combination of astigmatic keratotomy (AK) followed by laser in situ keratomileusis (LASIK).1 I, too, have found this approach to be very useful for reducing high levels of astigmatism but with one subtle difference—intralimbal relaxing incisions (LRIs) are used instead of pure corneal (optical zone [OZ] = 6.5 to 7.0 mm.) incisions. Similar to many other surgeons, I have found that these more peripheral incisions are more forgiving, with less tendency to induce irregular corneal flattening and astigmatism; they are less likely to shift the resultant astigmatic axis and to overcorrect (L.D. Nichamin, MD, “Peripheral Arcuate Astigmatic Relaxing Incisions,” presented at the Symposium on Cataract, IOL and Refractive Surgery, Boston, Massachusetts, USA, May 2000). They are, however, less powerful than conventional corneal astigmatic incisions, but when combined with LASIK, nearly all encountered levels of astigmatism are approachable. I have found this combined approach particularly helpful in the following 3 clinical scenarios: (1) the absolute amount of cylinder exceeds the limit for laser ablation; (2) the absolute amount of cylinder could be addressed by excimer treatment, but the resulting elliptical OZ could present potential problems; and (3) until recently approved by the U.S. Food and Drug Administration, the treatment of hyperopic astigmatism. Unpublished data for this combined technique of hyperopic LASIK and LRIs seemed to compare favorably with the most recent reports of hyperopic astigmatic LASIK; the technique spared more tissue than the “double-carding” approach (spherical hyperopic correction followed by myopic cylinder ablation) practiced by some U.S. surgeons. In my experience, an additional advantage of intralimbal arcuate relaxing incisions over smaller OZ AK is their more consistent 1:1 coupling ratio, with little effect on the resulting spheroequivalent (SE). Güell and Vazquez report that the SE refraction changed from −1.66 ± 2.65 diopters (D) to 0.30 ± 1.27 D in the naturally occurring astigmatic groups and from −6.12 ± 6.89 D to −1.87 ± 1.50 D in the surgically induced group, indicating a substantial hyperopic shift. It is presumed that this shift in SE was intentionally accomplished during the second ablation step. (Final mean SE was an impressive −0.09 ± 1.50 D.) The change in SE after AK alone was not reported; however, given the superior results of laser ablation for myopic astigmatism compared to hyperopic astigmatism, it would seem preferable that the initial relaxing incisions not induce a hyperopic shift, which in my experience can occur (quite inconsistently) with AK at the 6.0 to 7.0 mm OZ. I congratulate these authors on recognizing the usefulness of combining astigmatic relaxing incisions with LASIK to treat higher levels of astigmatism. With refinements in ablation technique such as crossed-cylinder treatment (with further tissue sparing), this combined approach may become unnecessary. Louis D Nichamin MD aBrookville, Pennsylvania, USA" @default.
• W2005491154 created "2016-06-24" @default.
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• W2005491154 date "2001-05-01" @default.
• W2005491154 modified "2023-09-25" @default.
• W2005491154 title "Combined Technique: AK and LASIK" @default.
• W2005491154 cites W1964848365 @default.
• W2005491154 doi "https://doi.org/10.1016/s0886-3350(01)00885-9" @default.
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