A new method of cornea modulation with excimer laser for simultaneous correction of presbyopia and ametropia

作者：Uthoff Detlef^*; Poelzl Markus; Hepper Daniel; Holland Detlef

来源：Graefes Archive for Clinical and Experimental Ophthalmology, 2012, 250(11): 1649-1661.

DOI：10.1007/s00417-012-1948-1

• Presbyopia
• Ametropia
• Presbylasik
• LASIK

Purpose To investigate the outcomes of simultaneous correction of presbyopia and ametropia by a bi-aspheric cornea modulation technique, based on the creation of a central area hyperpositive for near vision and leaving the pericentral cornea for far vision in hyperopic, emmetropic, and myopic presbyopic patients.
Setting Sixty eyes of 30 patients were treated with the PresbyMAX technique by one surgeon (D.U.) at the Eye Hospital Bellevue, Kiel, Germany.
Methods Twenty eyes with hyperopic presbyopia, 20 eyes with emmetropic presbyopia, and 20 eyes with myopic presbyopia underwent Femto-Lasik, and were assessed up to 6 months postoperatively. All eyes underwent cornea treatment using the PresbyMAXA (R) software, delivering a bi-aspheric multifocal ablation profile developed by SCHWIND eye-tech-solutions (Kleinostheim, Germany). All flaps were created by Ziemer LDV Femtolaser (Port, Switzerland).
Results The mean binocular distance of uncorrected visual acuity (DUCVA) improved in the hyperopic group from 0.28 +/- 0.29 logMAR to -0.04 +/- 0.07 logMAR, in the emmetropic group from -0.05 +/- 0.07 logMAR to 0.02 +/- 0.11 logMAR, and in the myopic group from 0.78 +/- 0.27 logMAR to 0.09 +/- 0.08 logMAR. The mean binocular near uncorrected visual acuity (NUCVA) increased in the hyperopic group from 0.86 +/- 0.62 logRAD to 0.24 +/- 0.23 logRAD, and in the emmetropic group from 0.48 +/- 0.14 logRAD to 0.18 +/- 0.11 logRAD. The myopic presbyopes showed a decrease of the mean binocular NUCVA from 0.04 +/- 0.19 logRAD to 0.12 +/- 0.18 logRAD. The mean postoperative spherical equivalent for distance refraction was -0.13 +/- 0.61 D for the hyperopic presbyopia, -0.43 +/- 0.35 D for the emmetropic presbyopia, and -0.68 +/- 0.42 D for the myopic presbyopia group, whereas the software took aim at -0.50 D in all groups.
Conclusions In presbyopic patients without symptomatic cataracts, but refractive errors, PresbyMAXA (R) will decrease the presbyopic symptoms and correct far distance refraction in the same treatment, offering spectacle-free vision in daily life in most of the treated patients. Further investigation is necessary to evaluate the overall benefit of this procedure.

• 出版日期2012-11