Clinical Outcome of Retreatment after Refractive Surgery

Eun Jung Lee; Dong Hui Lim; Ja Young You; Tae Young Chung; Eui Sang Chung

doi:10.3341/jkos.2015.56.2.180

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Lee, Lim, You, Chung, and Chung: Clinical Outcome of Retreatment after Refractive Surgery

Original Article

J Korean Ophthalmol Soc 2015;56(2):180-189.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.180

Clinical Outcome of Retreatment after Refractive Surgery

Eun Jung Lee, MD, Dong Hui Lim, MD, Ja Young You, MD, Tae Young Chung, MD, PhD, Eui Sang Chung, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Seoul, Korea

Address reprint requests to Eui Sang Chung, MD, PhD, Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea, Tel: 82-2-3410-3565, Fax: 82-2-3410-0029 E-mail: eschung@skku.edu

Received 8 March 201418 June 2014 Accepted 28 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical outcome of retreatment after refractive surgery.

Methods

Retrospective analysis of 38 eyes of 24 patients who received retreatment surgery after refractive surgery from August 2008 to May 2013 was performed. Preinitial surgery characteristics and the reason for retreatment were investigated, and pre- and post-retreatment uncorrected visual acuity, best corrected visual acuity, safety index, efficacy index, predictability, and post-operative complication were also investigated.

Results

Age at initial refractive surgery and retreatment were 28.50 ± 7.29 years (17-49 years) and 31.21 ± 6.49 years (21-49 years). Reasons for retreatment were myopic regression in 36 eyes (94.7%) and overcorrection in two eyes (5.3%). Methods of retreatment were laser subepithelial keratomileusis (LASEK) in 31 eyes (81.6%) and laser-assisted in situ keratomileusis (LASIK) in seven eyes (18.4%). Safety index values for all were above 1.0 and efficacy index values were 0.92, 0.93, and 0.95 in postoperative examination at 1 month, 3 months, and 6 months, respectively. No eye showed a decrease in best corrected visual acuity. One eye had transient hyperopia after retreatment, and two eyes had postoperative corneal opacity, but no eye experienced significant alteration in visual prognosis.

Conclusions

Retreatment after refractive surgery was an efficient and safe clinical course in our clinic. No long-term complica-tions were observed, and uncorrected visual acuity and refractive errors significantly improved after retreatment. In particular, LASEK can be considered as a safe and efficient retreatment modality without risk of keratectasia.

Keywords: LASEK, LASIK, Myopic regression, Refractive surgery, Retreatment

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Figure 1.

Change in BCVA from preinitial surgery and the last visit. BCVA = best-corrected visual acuity.

Figure 2.

Safety index and efficacy index at post-retreatment 1 month, 3 months, and at last visit (values are based on 33, 23, and 34 eyes, respectively). SI = safety index, defined as post-retreatment best-corrected visual acuity/pre-retreatment best-corrected visual acuity; EI = efficacy index, defined as post-retreatment uncorrected visual acuity/best-corrected visual acuity.

Figure 3.

Predictability of post-retreatment spherical equivalent (values are based on 36, 38, 33, 23, and 13 eyes, re-spectively). D = diopter.

Figure 4.

Predictability of post-retreatment spherical equivalent over time (at post-retreatment 1 month, 3 months, and 6 months). SE = spherical equivalent; D = diopter.

Table 1.

Patient’s characteristics of pre-initial surgery in retreatment group

Contents	Values
F:M (eyes)	6:18
Age at initial refractive surgery (years)	28.50 ± 7.29 (17-49)
Age at retreatment surgery (years)	31.21 ± 6.49 (21-49)
Refractive data at preinitial surgery
UCVA	0.11 ± 0.17 (0.01-0.9)
BCVA	0.96 ± 0.08 (0.8-1.0)
Spherical equivalent (D, n = 38)	-6.4 ± 2.1 (-10.0~-2.4)
0~-5.0 D	N = 13
-5.0~-8.0 D	N = 12
-8.0 D~	N = 13
Reason of retreatment (n = 38) (%)
Myopic regression (n = 36)	94.7
Overcorrection (n = 2) Interval to onset of myopic regression (months)^∗	5.37.70 ± 11.08 (1-47)

Values are presented as mean ± SD unless otherwise indicated. UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; D = diopter; N = number of eyes.

^∗ 5 eyes were excluded due to incomplete follow up records.

Table 2.

Types of initial and retreatment surgery

Type of initial surgery	Type of retreatment	N	Percentage (%)
LASIK	LASIK	7	18.4
	LASEK	11	29.0
LASEK	LASEK	19	50.0
PRK	LASEK	1	2.6
Total		38	100

N = number of eyes; LASIK = laser in situ keratomileusis; LASEK = laser epithelial keratomileusis; PRK = photorefractive keratectomy.

Table 3.

Patient characteristics between LASIK and LASEK group as initial refractive surgery

Type of initial surgery	LASIK	LASEK	p-value
Preinitial surgery SE (D) (after exclusion of 2 eyes)	-7.0 ± 2.14 (-8.9~-2.4)	-5.9 ± 2.07 (-10.1~-2.4)	0.126^∗
		-5.4 ± 1.58 (-7.8~-2.4)^‡	0.018^‡^∗
Retreatment percentage (%)	2.66	1.70	0.077^†
Correction amount of retreatment (D)	-0.96 ± 0.92 (-2.2~2.1)	-0.99 ± 0.93 (-2.5~1.88)	0.933^∗
Analysis of cases with myopic regression (n = 36)
Preinitial surgery SE (D) (after exclusion of 2 eyes)	-7.18 ± 2.05 (-8.9~-2.4)	6.1 ± 1.92 (-10.1~-3.1)	0.132^∗
		-5.37 ± 1.58 (-7.8~-2.4)^‡	0.016^‡^∗
Retreatment percentage (%)	2.00	1.28	0.173^†
Correction amount of retreatment (D)	-1.17 ± 0.55 (-2.2~-0.45)	-1.15 ± 0.64 (-2.5~-0.2)	0.900^∗

Values are presented as mean ± SD unless otherwise indicated. LASIK = laser in situ keratomileusis; LASEK = laser epithelial keratomileusis; SE = spherical equivalent; D = diopter; N = number of eyes.

^∗ p-value by independent t-test

^† p-value by Chi-square test

^‡ Data from 2 eyes of same patient were excluded as choice for initial refractive surgical modality had been made upon patient’s personal preference against our decision.

Table 4.

Refraction data in retreatment patients

	Preinitial surgery	Pre-retreatment	Post-retreatment
	Preinitial surgery	Pre-retreatment	1 month	3 months	6 months	Last visit
N (eyes)	38	38	33	23	22	34
UCVA	0.11 ± 0.17	0.63 ± 0.3	0.91 ± 0.21	0.93 ± 0.15	0.94 ± 0.13	0.95 ± 0.12
	(0.01-0.9)	(0.15-1.2)	(0.3-1.5)	(0.3-1.0)	(0.5-1.0)	(0.5-1.0)
BCVA	0.96 ± 0.08	0.98 ± 0.06	1.00 ± 0.02	1.00 ± 0.00	1.00 ± 0.00	1.0 ± 0.00
	(0.8-1)	(0.8-1.2)	(0.9-1.0)	(1.0)	(1.0)	(1.0)
Sph (D)	-5.8 ± 2.11	-0.9 ± 0.83	0.19 ± 0.41	0.12 ± 0.30	-0.1 ± 0.61	0.05 ± 0.17
	(-9.25~-1.25)	(-2.0~2.0)	(-1.0~1.25)	(-0.25~1.0)	(-2.0~+0.5)	(-0.25~0.75)
Cyl (D)	-1.3 ± 1.27	-0.3 ± 0.46	0.01 ± 0.13	0.08 ± 0.19	-0.10 ± 0.33	0.02 ± 0.18
	(-4.5~1.0)	(-1.25~0.75)	(-0.5~0.5)	(0.0-0.75)	(-1.0~0.75)	(-0.5~0.5)
SE (D)	-6.4 ± 2.1	-1.0 ± 0.93	0.19 ± 0.43	0.16 ± 0.39	-0.10 ± 0.67	0.06 ± 0.21
	(-10.0~-2.4)	(-2.5~2.13)	(-1~1.25)	(-0.25~1.38)	(-2.38~0.38)	(-0.38~0.75)

Values are presented as mean ± SD unless otherwise indicated.

N = number of eyes; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; Sph = spherical manifested refraction; Cyl = cylindrical manifested refraction; SE = spherical equivalent; D = diopter.

Table 5.

Predictability of mean manifest spherical equivalent

Time	Refraction data		Within (%)
Time	N	mean SE ± SD (range) (D)	±1.0 D	±0.5 D
Preinitial surgery	38	-6.4 ± 2.1 (-10.0~-2.4)	-	-
Pre-retreatment	38	-1.0 ± 0.93 (-2.5~2.13)	50	18
Post-retreatment period
1 month	33	0.19 ± 0.43 (-1~1.25)	94	79
3 months	23	0.16 ± 0.39 (-0.25~1.38)	96	61
6 months	22	-0.10 ± 0.67 (-2.38~0.38)	92	63
12 months	34	0.06 ± 0.21 (-0.38~0.75)	100	97

N = number of eyes; SE = spherical equivalent; SD = standard deviation; D = diopter.

Table 6.

Characteristics of LASEK retreatment group and intraoperative data

Type of initial surgery	Number of eyes		Percentage (%)
LASEK	19		61.29
LASIK	11		35.48
PRK	1		3.23
Total	31		100
Intraoperative characteristics
Use of MMC (n)
Yes		20
No		11
Duration of MMC application (s)^∗		27.19 ± 6.82 (20-40)
Alcohol ablation time (s)^†		36.50 ± 4.08 (28-45)

Values are presented as mean ± SD unless otherwise indicated. LASEK = laser epithelial keratomileusis; LASIK = laser in situ keratomileusis; PRK = photorefractive keratectomy; MMC = mitomycin C; N = number of eyes; S = seconds.

^∗ Intraoperative data were available for the analysis in 22 eyes

^† Intraoperative data were available for the analysis in 20 eyes.

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