engleski

Presbyopia treatment by lens surgery versus Laser in situ keratomileusis

PURPOSE: To evaluate the effectiveness in presbyopia treatment of two surgical methods: lens surgery versus Laser in situ keratomileusis. ----- METHODS: Patients were separated into two groups according to the surgical procedure which they were treated — lens surgery with multifocal intraocular lens implantation (MFIOL group) and Lasik in situ keratomileusis procedure on the cornea (LASIK group). Within each group, the treated eyes were further subdivided according to the type of diopter: myopic or hypermetropic patients. A total of 200 eyes (100 patients) were included in the MFIOL group. There were 110 eyes (54 patients) with hypermetropia and 90 eyes (45 patients) with myopia who underwent lens surgery. A total of 198 eyes (99 patients) were included in the Lasik in situ keratomileusis group. There were 98 eyes (49 patients) with hypermetropia and 100 eyes (50 patients) with myopia. Patients were followed up for 6 months on time points 1st day, 1st week, 1st month, 3rd month and finally 6th month, when manifested refraction in spherical equivalent (SE), uncorrected near visual acuity and uncorrected distant visual acuity (UCNVA, UCDVA), best corrected near visual acuity and best corrected distant visual acuity (BCNVA, BCDVA), were analyzed and statistically compared. Satisfaction questionnaire was given preoperatively and on 1st month, 3rd month and 6th month postoperatively. ----- RESULTS: Both groups of patients were presbyopes with average age in MFIOL group of 52 years, and in LASIK 48, 8 years old, respectively. Thus, when comparing hyperopes in MFIOL group versus LASIK group we observed: 1. Manifest refraction in MFIOL was 0.38±0.79D (0.75-1.25) as compared to 0.51±0.53D (-0.88-1.75) in LASIK 6 months postoperatively, which was not statistically significant (p=0.08). 2. Six months postoperative UCNVA in MFIOL was 1.16±0.37J (1-2) versus 1.45±0.62J (1-3) in LASIK group, which was statistically significant (p=0.0002). MFIOL group had statistically better UCNVA than LASIK group. 3. Six months postoperative UCDVA was greater in MFIOL with 0.95±0.07 (0.65-1) versus 0.87±0.15 (0.40-1) in LASIK group, which was statistically significant (p=0.000004). 4. Patients satisfaction score in MFIOL group was 4.48+/-0.69 (3-5) versus 3.58±0.59 (2-4) in LASIK group, which was statistically significant (p=0.01). When comparing myopes in MFIOL group versus LASIK group we observed: 1. Manifest refraction in MFIOL was 0.32±0.65D (1.25-2.00) as compared to -0.61±0.37D (-1.75-0) in LASIK 6 months postoperatively, which was statistically significant (p=3.72E-23). LASIK myopes were in slightly more minus diopter than MFIOL group. 2. Six months postoperative UCNVA in MFIOL was 1.43±0.47 (1-3) versus 1.06±0.23 (1-2) in LASIK group, which was statistically significant (p=5.59E-10). LASIK group had statistically better UCNVA than MFIOL group. 3. Six months postoperative UCDVA was greater in MFIOL with 0.94±0.08 (0.65-1) versus 0.87±0.17 (0.30-1) in LASIK group, which was statistically significant (p=0.000003). 4. Patient satisfaction score in MFIOL group was 3.54±0.79 (2-4) versus 4.54±0.89 (3-5) in LASIK group, which was statistically significant (p=0.009). Myopes in LASIK group were more satisfied than myopes in MFIOL group. ----- CONCLUSION: Both surgical procedures: MFIOL implantation and LASIK surgical procedures had proven to be effective and safe with a low rate of complications. Overall manifest refraction as well as manifest refraction in subgroups of hyperopes and myopes in both procedures were significantly decreased 6 months postoperatively. Uncorrected near visual acuity was statistically different between subgroups of hyperopes and myopes in MFIOL group and in LASIK group. uncorrected near visual acuity in hyperopic group was statistically better than uncorrected near visual acuity in myopic group in the MFIOL procedure. However, in LASIK group it was vice versa in favor of myopes. Additionally, there was statistical difference between uncorrected near visual acuity of hyperopes in MFIOL versus hyperopes in LASIK group, and myopes in MFIOL versus myopes in LASIK group. The hyperopes in MFIOL group had better uncorrected near visual acuity than in LASIK group. Similarly, myopes in LASIK group had better uncorrected near visual acuity than myopes in MFIOL group.

adults ; middle aged ; keratomileusis

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