Faik Orucov, MD, Sinan Goker,MD, Abraham Solomon, MD, Joseph Frucht-Pery, MD *Refractive Surgery Department, ISTANBUL SURGERY HOSPITAL Istanbul,

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Faik Orucov*, MD, Sinan Goker*,MD, Abraham Solomon**, MD, Joseph Frucht- Pery**, MD Comparison of Tecnolas and Allegretto laser in situ keratomileusis.

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Faik Orucov*, MD, Sinan Goker*,MD, Abraham Solomon**, MD, Joseph Frucht-Pery**, MD *Refractive Surgery Department, ISTANBUL SURGERY HOSPITAL Istanbul, Turkey Comparison of Tecnolas and Allegretto Laser in Situ Keratomileusis Outcomes in Hyperopia ** Hadassah University Hospital, Jerusalem, Israel Authors have no financial interests in any of the mentioned products or companies

Hyperopia Hyperopia ≥ 2D 6% of population Low Hyperopia good vision in young poor vision in adults Hyperopia affects both distance and near vision and is compounded by presbyopia

Hyperopic Correction Thermokeratoplasty Hexogonal keratotomy Keratophakia Helmium laser KeratomileusısCKH-PRKH-LASIK Phakic IOLs RLE

PROBLEMS IN HYPEROPIA Pt’s age > 40 - Dry eyes - BMD - More epithelial defects Flap size 9.5 mm - Small eyes and pannus (limbal bleeding)

PROBLEMS IN HYPEROPIA Large area of treatment Long ablation time Centration is critical

PROBLEMS IN HYPEROPIA Initial overcorrection (myopia) Slow regression [1 y. in high hyperopia] Enhancement is complicated Final K-reading < 50 [D]

Hyperopic correction is significantly more likely to regressregress Regression greater than myopic correction. The possibility of regression; hyperplastic healing response of the cornea to fill in this ablated step between the treated and untreated zones, thereby not only resulting in loss of effect over time but also inducing an astigmatic error in case of uneven fill-ins. i s t a n b u l c e r r a h i h a s t a n e s i

PURPOSE To compare visual outcome measurements in laser in situ keratomileusis (LASIK) for hyperopia using the Technolas 217 and Allegretto excimer laser.

METHODS Two-center retrospective study H-LASIK by the Technolas 217; 50 eyes (Hadassah Medical Organization, Jeruasalem, (2003 and 2005)) H-LASIK by Allegretto excimer laser ; 42 eyes (Istanbul Surgery Hospital, Istanbul, (2004 and 2005)) Mean follow-up 23.1±13.7 months with Technolas 19.3±8.8 months with Allegretto. Inclusion criteria; - SE up to 4.00 diopters (D) of sycloplegic hyperopia, - Minimum F/U 12 months Exclusion criteria; - Incomplete documentation

RESULTS Technolas Allegretto P SE (Mean) Preoperative +2.51±0.78 (D) +2.37±0.81 (D) Postoperative ± ± Optical zone & Ablation depth Technolas Allegretto P Optical zone (Mean) 6.0±0.1mm 6.8±0.25 <0.001 Ablation depth (Mean) 68.1±21.2μ 49.8±18.3μ <0.001 SE

Stability Higher Myopic overcorrection on the next day Greater regression observed during first month Regression (month 1 to last visit) : Technolas D Allegretto D (P=0.247)

UCVA The postoperative UCVA was significantly lower in eyes treated with Tecnolas on postoperative month 1 (P=.037). At 3, 6,12 months and at last visit postoperatively, no significant differences were noted in UCVA between the two lasers (P=.065 to.473). Technolas Allegretto P UCVA 1 Month 0,69 ± 0,25 0,81 ± 0,26 0, Months 0,80 ± 0,18 0,85 ± 0,18 0,473 Last visit 0,80 ± 0,22 0,86 ±0,17 0,126

BCVA 0.97± ± ± ±0.15 P= 0.239P= 0.144

Predictability i s t a n b u l c e r r a h i h a s t a n e s i Postoperative (last visit) Technolas Allegretto UCVA ≥ 20/ % 69.0% ±0.50 D 69.0% 78.7%, BSCVA loss of ≥ 1 lines 11.4% 4.8% gain of ≥ 1 lines 19.2% 16.7%. Efficacy & Safety Efficacy & Safety Technolas Allegretto P Safety 1.03± ± Efficacy 0.87± ±

CONCLUSION Ablation depth was greater with Technolas laser. Visual and refractive results were similar between the Technolas and Allegretto laser systems after 3 months of the procedure.