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Br J Ophthalmol. 1996 March; 80(3): 224–234.
PMCID: PMC505433

Effect of ablation profile on wound healing and visual performance 1 year after excimer laser photorefractive keratectomy.


BACKGROUND: Early photorefractive keratectomy ablations were of limited diameter and depth to maintain the integrity of the globe and to minimise postoperative haze. This study evaluated the effects of deeper, larger diameter wounds on refractive stability and corneal haze, and investigated the effects of ablation profile on wound healing and visual performance. METHODS: One hundred patients undergoing -3.00D and -6.00D corrections were randomised to receive 5 mm, 6 mm, or multizone treatments. The multizone treatment was 6 mm in diameter, but only the depth of the 5 mm treatment. Outcome was measured by Snellen visual acuity, residual refractive error, objective techniques for haze and halos, pupil diameter, subjective night vision, and requirement for retreatment. RESULTS: Overall, the results of 6 mm treatments were superior to those of 5 mm and multizone treatments: they had a smaller hyperopic shift (p < 0.01), a more predictable (p < 0.001) and stable refractive outcome, less haze (p < 0.05), smaller halos (p < 0.05), fewer subjective night vision problems, and fewer patients required retreatment. CONCLUSIONS: Analysis of these data and a literature review of corneal wound healing demonstrated that the improved outcome associated with the 6 mm beam did not relate to the depth of ablation. The factor with greatest apparent influence on the development of haze and regression was the slope of the wound surface over the entire area of the ablation. Tapering the wound edge provided no additional benefit, and contributed to night vision problems. It is, therefore, recommended that small diameter or multizone treatments should not be used in low and moderate myopia.

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  • Seiler T, Kahle G, Kriegerowski M. Excimer laser (193 nm) myopic keratomileusis in sighted and blind human eyes. Refract Corneal Surg. 1990 May-Jun;6(3):165–173. [PubMed]
  • Zabel RW, Sher NA, Ostrov CS, Parker P, Lindstrom RL. Myopic excimer laser keratectomy: a preliminary report. Refract Corneal Surg. 1990 Sep-Oct;6(5):329–334. [PubMed]
  • Gartry DS, Kerr Muir MG, Marshall J. Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. Refract Corneal Surg. 1991 Nov-Dec;7(6):420–435. [PubMed]
  • Seiler T, Wollensak J. Myopic photorefractive keratectomy with the excimer laser. One-year follow-up. Ophthalmology. 1991 Aug;98(8):1156–1163. [PubMed]
  • Sher NA, Chen V, Bowers RA, Frantz JM, Brown DC, Eiferman R, Lane SS, Parker P, Ostrov C, Doughman D, et al. The use of the 193-nm excimer laser for myopic photorefractive keratectomy in sighted eyes. A multicenter study. Arch Ophthalmol. 1991 Nov;109(11):1525–1530. [PubMed]
  • McDonald MB, Liu JC, Byrd TJ, Abdelmegeed M, Andrade HA, Klyce SD, Varnell R, Munnerlyn CR, Clapham TN, Kaufman HE. Central photorefractive keratectomy for myopia. Partially sighted and normally sighted eyes. Ophthalmology. 1991 Sep;98(9):1327–1337. [PubMed]
  • Gartry DS, Kerr Muir MG, Marshall J. Excimer laser photorefractive keratectomy. 18-month follow-up. Ophthalmology. 1992 Aug;99(8):1209–1219. [PubMed]
  • Tengroth B, Epstein D, Fagerholm P, Hamberg-Nyström H, Fitzsimmons TD. Excimer laser photorefractive keratectomy for myopia. Clinical results in sighted eyes. Ophthalmology. 1993 May;100(5):739–745. [PubMed]
  • Litwin KL, Moreira H, Ohadi C, McDonnell PJ. Changes in corneal curvature at different excimer laser ablative depths. Am J Ophthalmol. 1991 Mar 15;111(3):382–384. [PubMed]
  • Marshall J, Trokel SL, Rothery S, Krueger RR. Long-term healing of the central cornea after photorefractive keratectomy using an excimer laser. Ophthalmology. 1988 Oct;95(10):1411–1421. [PubMed]
  • Goodman GL, Trokel SL, Stark WJ, Munnerlyn CR, Green WR. Corneal healing following laser refractive keratectomy. Arch Ophthalmol. 1989 Dec;107(12):1799–1803. [PubMed]
  • McDonald MB, Frantz JM, Klyce SD, Beuerman RW, Varnell R, Munnerlyn CR, Clapham TN, Salmeron B, Kaufman HE. Central photorefractive keratectomy for myopia. The blind eye study. Arch Ophthalmol. 1990 Jun;108(6):799–808. [PubMed]
  • Liu JC, McDonald MB, Varnell R, Andrade HA. Myopic excimer laser photorefractive keratectomy: an analysis of clinical correlations. Refract Corneal Surg. 1990 Sep-Oct;6(5):321–328. [PubMed]
  • Gartry DS, Muir MG, Lohmann CP, Marshall J. The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy. A prospective, randomized, double-blind trial. Arch Ophthalmol. 1992 Jul;110(7):944–952. [PubMed]
  • O'Brart DP, Corbett MC, Lohmann CP, Kerr Muir MG, Marshall J. The effects of ablation diameter on the outcome of excimer laser photorefractive keratectomy. A prospective, randomized, double-blind study. Arch Ophthalmol. 1995 Apr;113(4):438–443. [PubMed]
  • Buzard KA. Biomechanics of the cornea--who needs it? Refract Corneal Surg. 1992 Mar-Apr;8(2):125–126. [PubMed]
  • Tavola A, Brancato R, Galli L, Carones F, Esente S. Photorefractive keratectomy for myopia: single vs double-zone treatment in 166 eyes. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S48–S52. [PubMed]
  • Cho YS, Kim CG, Kim WB, Kim CW. Multistep photorefractive keratectomy for high myopia. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S37–S41. [PubMed]
  • Waring GO, 3rd, Lynn MJ, McDonnell PJ. Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. Arch Ophthalmol. 1994 Oct;112(10):1298–1308. [PubMed]
  • Caubet E. Course of subepithelial corneal haze over 18 months after photorefractive keratectomy for myopia [corrected]. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S65–S70. [PubMed]
  • O'Brart DP, Gartry DS, Lohmann CP, Patmore AL, Kerr Muir MG, Marshall J. Treatment of band keratopathy by excimer laser phototherapeutic keratectomy: surgical techniques and long term follow up. Br J Ophthalmol. 1993 Nov;77(11):702–708. [PMC free article] [PubMed]
  • Sher NA, Bowers RA, Zabel RW, Frantz JM, Eiferman RA, Brown DC, Rowsey JJ, Parker P, Chen V, Lindstrom RL. Clinical use of the 193-nm excimer laser in the treatment of corneal scars. Arch Ophthalmol. 1991 Apr;109(4):491–498. [PubMed]
  • Munnerlyn CR, Koons SJ, Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery. J Cataract Refract Surg. 1988 Jan;14(1):46–52. [PubMed]
  • O'Brart DP, Gartry DS, Lohmann CP, Muir MG, Marshall J. Excimer laser photorefractive keratectomy for myopia: comparison of 4.00- and 5.00-millimeter ablation zones. J Refract Corneal Surg. 1994 Mar-Apr;10(2):87–94. [PubMed]
  • O'Brart DP, Lohmann CP, Klonos G, Corbett MC, Pollock WS, Kerr-Muir MG, Marshall J. The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. A prospective, randomized, observer-masked study. Ophthalmology. 1994 Sep;101(9):1565–1574. [PubMed]
  • Corbett MC, O'Brart DP, Marshall J. Do topical corticosteroids have a role following excimer laser photorefractive keratectomy? J Refract Surg. 1995 Sep-Oct;11(5):380–387. [PubMed]
  • Lohmann CP, Timberlake GT, Fitzke FW, Gartry DS, Muir MK, Marshall J. Corneal light scattering after excimer laser photorefractive keratectomy: the objective measurements of haze. Refract Corneal Surg. 1992 Mar-Apr;8(2):114–121. [PubMed]
  • Lohmann CP, Fitzke FW, O'Brart D, Muir MK, Marshall J. Halos--a problem for all myopes? A comparison between spectacles, contact lenses, and photorefractive keratectomy. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S72–S75. [PubMed]
  • Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol. 1983 Dec;96(6):710–715. [PubMed]
  • Marshall J, Trokel S, Rothery S, Schubert H. An ultrastructural study of corneal incisions induced by an excimer laser at 193 nm. Ophthalmology. 1985 Jun;92(6):749–758. [PubMed]
  • Puliafito CA, Steinert RF, Deutsch TF, Hillenkamp F, Dehm EJ, Adler CM. Excimer laser ablation of the cornea and lens. Experimental studies. Ophthalmology. 1985 Jun;92(6):741–748. [PubMed]
  • Simon G, Ren Q. Biomechanical behavior of the cornea and its response to radial keratotomy. J Refract Corneal Surg. 1994 May-Jun;10(3):343–356. [PubMed]
  • Bryant MR, Szerenyi K, Schmotzer H, McDonnell PJ. Corneal tensile strength in fully healed radial keratotomy wounds. Invest Ophthalmol Vis Sci. 1994 Jun;35(7):3022–3031. [PubMed]
  • Hanna KD, Pouliquen Y, Waring GO, 3rd, Savoldelli M, Cotter J, Morton K, Menasche M. Corneal stromal wound healing in rabbits after 193-nm excimer laser surface ablation. Arch Ophthalmol. 1989 Jun;107(6):895–901. [PubMed]
  • Krueger RR, Trokel SL. Quantitation of corneal ablation by ultraviolet laser light. Arch Ophthalmol. 1985 Nov;103(11):1741–1742. [PubMed]
  • Campos M, Wang XW, Hertzog L, Lee M, Clapham T, Trokel SL, McDonnell PJ. Ablation rates and surface ultrastructure of 193 nm excimer laser keratectomies. Invest Ophthalmol Vis Sci. 1993 Jul;34(8):2493–2500. [PubMed]
  • Dehm EJ, Puliafito CA, Adler CM, Steinert RF. Corneal endothelial injury in rabbits following excimer laser ablation at 193 and 248 nm. Arch Ophthalmol. 1986 Sep;104(9):1364–1368. [PubMed]
  • Carones F, Brancato R, Venturi E, Morico A. The corneal endothelium after myopic excimer laser photorefractive keratectomy. Arch Ophthalmol. 1994 Jul;112(7):920–924. [PubMed]
  • Holme RJ, Fouraker BD, Schanzlin DJ. A comparison of en face and tangential wide-area excimer surface ablation in the rabbit. Arch Ophthalmol. 1990 Jun;108(6):876–881. [PubMed]
  • McDonald MB, Beuerman R, Falzoni W, Rivera L, Kaufman HE. Refractive surgery with the excimer laser. Am J Ophthalmol. 1987 Mar 15;103(3 Pt 2):469–469. [PubMed]
  • Srinivasan R, Sutcliffe E. Dynamics of the ultraviolet laser ablation of corneal tissue. Am J Ophthalmol. 1987 Mar 15;103(3 Pt 2):470–471. [PubMed]
  • Sinbawy A, McDonnell PJ, Moreira H. Surface ultrastructure after excimer laser ablation. Expanding vs contracting apertures. Arch Ophthalmol. 1991 Nov;109(11):1531–1533. [PubMed]
  • Sher NA, Barak M, Daya S, DeMarchi J, Tucci A, Hardten DR, Frantz JM, Eiferman RA, Parker P, Telfair WB, 3rd, et al. Excimer laser photorefractive keratectomy in high myopia. A multicenter study. Arch Ophthalmol. 1992 Jul;110(7):935–943. [PubMed]
  • Heitzmann J, Binder PS, Kassar BS, Nordan LT. The correction of high myopia using the excimer laser. Arch Ophthalmol. 1993 Dec;111(12):1627–1634. [PubMed]
  • Scialdone A, Carones F, Bertuzzi A, Brancato R. Randomized study of single vs double exposure in myopic PRK. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S41–S43. [PubMed]
  • Kim JH, Hahn TW, Lee YC, Sah WJ. Clinical experience of two-step photorefractive keratectomy in 19 eyes with high myopia. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S44–S47. [PubMed]
  • Dausch D, Klein R, Schröder E, Dausch B. Excimer laser photorefractive keratectomy with tapered transition zone for high myopia. A preliminary report of six cases. J Cataract Refract Surg. 1993 Sep;19(5):590–594. [PubMed]
  • Fantes FE, Hanna KD, Waring GO, 3rd, Pouliquen Y, Thompson KP, Savoldelli M. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Arch Ophthalmol. 1990 May;108(5):665–675. [PubMed]
  • Taylor DM, L'Esperance FA, Jr, Del Pero RA, Roberts AD, Gigstad JE, Klintworth G, Martin CA, Warner J. Human excimer laser lamellar keratectomy. A clinical study. Ophthalmology. 1989 May;96(5):654–664. [PubMed]
  • O'Brart DP, Lohmann CP, Fitzke FW, Smith SE, Kerr-Muir MG, Marshall J. Night vision after excimer laser photorefractive keratectomy: haze and halos. Eur J Ophthalmol. 1994 Jan-Mar;4(1):43–51. [PubMed]
  • O'Brart DP, Lohmann CP, Fitzke FW, Klonos G, Corbett MC, Kerr-Muir MG, Marshall J. Disturbances in night vision after excimer laser photorefractive keratectomy. Eye (Lond) 1994;8(Pt 1):46–51. [PubMed]
  • Roberts CW, Koester CJ. Optical zone diameters for photorefractive corneal surgery. Invest Ophthalmol Vis Sci. 1993 Jun;34(7):2275–2281. [PubMed]
  • MAURICE DM. The structure and transparency of the cornea. J Physiol. 1957 Apr 30;136(2):263–286. [PubMed]
  • Seiler T, Matallana M, Sendler S, Bende T. Does Bowman's layer determine the biomechanical properties of the cornea? Refract Corneal Surg. 1992 Mar-Apr;8(2):139–142. [PubMed]
  • Lee RE, Davison PF, Cintron C. The healing of linear nonperforating wounds in rabbit corneas of different ages. Invest Ophthalmol Vis Sci. 1982 Nov;23(5):660–665. [PubMed]
  • Davison PF, Galbavy EJ. Connective tissue remodeling in corneal and scleral wounds. Invest Ophthalmol Vis Sci. 1986 Oct;27(10):1478–1484. [PubMed]
  • Buratto L, Ferrari M, Rama P. Excimer laser intrastromal keratomileusis. Am J Ophthalmol. 1992 Mar 15;113(3):291–295. [PubMed]
  • Eggli P, Boulton M, Marshall J. Growth characteristics of central and peripheral bovine corneal epithelial cells in vitro. Graefes Arch Clin Exp Ophthalmol. 1989;227(3):263–270. [PubMed]
  • Tuft S, Eggli P, Boulton M, Marshall J. Assessment of corneal wound repair in vitro. Curr Eye Res. 1989 Jul;8(7):713–719. [PubMed]
  • Gasset AR, Dohlman CH. The tensile strength of corneal wounds. Arch Ophthalmol. 1968 May;79(5):595–602. [PubMed]
  • Melles GR, Binder PS. Effect of wound location, orientation, direction, and postoperative time on unsutured corneal wound healing morphology in monkeys. Refract Corneal Surg. 1992 Nov-Dec;8(6):427–438. [PubMed]
  • Yanoff M, Cameron JD. Human cornea organ cultures: epithelial-endothelial interactions. Invest Ophthalmol Vis Sci. 1977 Apr;16(4):269–273. [PubMed]
  • Marshall J, Trokel S, Rothery S, Krueger RR. A comparative study of corneal incisions induced by diamond and steel knives and two ultraviolet radiations from an excimer laser. Br J Ophthalmol. 1986 Jul;70(7):482–501. [PMC free article] [PubMed]
  • Brancato R, Carones F, Trabucchi G, Scialdone A, Tavola A. The erodible mask in photorefractive keratectomy for myopia and astigmatism. Refract Corneal Surg. 1993 Mar-Apr;9(2 Suppl):S125–S130. [PubMed]
  • Taylor HR, Guest CS, Kelly P, Alpins NA. Comparison of excimer laser treatment of astigmatism and myopia. The Excimer Laser and Research Group. Arch Ophthalmol. 1993 Dec;111(12):1621–1626. [PubMed]
  • Dougherty PJ, Wellish KL, Maloney RK. Excimer laser ablation rate and corneal hydration. Am J Ophthalmol. 1994 Aug 15;118(2):169–176. [PubMed]
  • Seiler T, Genth U, Holschbach A, Derse M. Aspheric photorefractive keratectomy with excimer laser. Refract Corneal Surg. 1993 May-Jun;9(3):166–172. [PubMed]
  • Fleming JF. Should refractive surgeons worry about corneal asphericity? Refract Corneal Surg. 1990 Nov-Dec;6(6):455–457. [PubMed]
  • Seiler T, Reckmann W, Maloney RK. Effective spherical aberration of the cornea as a quantitative descriptor in corneal topography. J Cataract Refract Surg. 1993;19 (Suppl):155–165. [PubMed]
  • Camp JJ, Maguire LJ, Cameron BM, Robb RA. A computer model for the evaluation of the effect of corneal topography on optical performance. Am J Ophthalmol. 1990 Apr 15;109(4):379–386. [PubMed]
  • Applegate RA, Gansel KA. The importance of pupil size in optical quality measurements following radial keratotomy. Refract Corneal Surg. 1990 Jan-Feb;6(1):47–54. [PubMed]
  • Holladay JT, Lynn MJ, Waring GO, 3rd, Gemmill M, Keehn GC, Fielding B. The relationship of visual acuity, refractive error, and pupil size after radial keratotomy. Arch Ophthalmol. 1991 Jan;109(1):70–76. [PubMed]
  • Durrie DS, Lesher MP, Cavanaugh TB. Classification of variable clinical response after photorefractive keratectomy for myopia. J Refract Surg. 1995 Sep-Oct;11(5):341–347. [PubMed]

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