1. Faik Orucov*, MD, Sinan Goker*,MD, Abraham Solomon**, MD, Joseph Frucht- Pery**, MD Comparison of Tecnolas and Allegretto laser in situ keratomileusis outcomes in hyperopia *Refractive Surgery Department, ISTANBUL SURGERY HOSPITAL Istanbul, Turkey ** Hadassah University Hospital, Jerusalem, Israel

2. 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

3. Hyperopic Correction Thermokeratoplasty Hexogonal keratotomy Keratophakia Keratomileusıs Holmium laser CK H-PRK H-LASIK Phakic IOLs RLE

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

5. PROBLEMS IN HYPEROPIA Large area of treatment (Flap size 9.5 mm) Long ablation time Centration is critical

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

7. Hyperopic correction is significantly more likely to regress regress 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.

8. PURPOSE To compare visual outcome measurements in laser in situ keratomileusis (LASIK) for hyperopia using the Technolas 217 and Allegretto excimer laser. Authors have no financial interests in any of the mentioned products or companies

9. 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 METODS

10. SE Technolase Allegretto P SE (Mean) Preoperative +2.51±0.78 (D) +2.37±0.81 (D) 0.386 Postoperative -0.01 ±0.58 -0.003 ±0.41 0.912 Technolase 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 Optical zone & Ablation depth

11. Higher Myopic overcorrection on the next day Greater regression observed during first month Regression (month 1 to last visit) : Technolase +0.48 D Allegretto +0.36 D (P=0.247) Stability

12. 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). Technolase Allegretto P UCVA 1 Month 0,69 ± 0,25 0,81 ± 0,26 0,032 12 Months 0,80 ± 0,18 0,85 ± 0,18 0,473 Last visit 0,80 ± 0,22 0,86 ±0,17 0,126

13. PREOPERATIVE LAST VISIT 0.92±0.15 0.96±0.09 0.94±0.15 0.97±0.10 P= 0.144 P= 0.239 BCVA

14. Postoperative (last visit) Technolas Allegretto UCVA 20/25 55.8% 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 Technolas Allegretto P Safety 1.03±0.12 1.01±0.05 0.409 Efficacy 0.87±0.21 0.90±0.16 0.444 Predictability

15. 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.