Corneal Hydration Affects Ablation During Laser in Situ Keratomileusis Surgery

Background: Studies in animal eyes indicate that the level of corneal hydration affects the ablation rate of laser surgery; the greater the hydration is, the less the ablation for a given laser pulse. Our study is an assessment in human eyes comparing the effects on ablation by blotting the corneal stromal surface under a corneal flap created for laser in situ keratomileusis (LASIK) procedures between sets of excimer laser pulses, with ablation depth in eyes not blotted between sets of laser pulses.

Methods: We modified the surgical technique for LASIK procedures to assess the effects of the level of hydration on excimer laser ablation depth per pulse. In group 1, 40 eyes underwent LASIK surgery without any modification. Group 2 was composed of 36 eyes having LASIK procedures, but the corneal surfaces were kept relatively dry by blotting of the stromal surface between sets of laser pulses.

Results: Six months after surgery, the mean spherical equivalent refractive change was from -8.38 diopters (D) to -1.44 D in group 1 and from -7.93 D to -0.09 D in group 2. For predictability, the deviation from the target refraction after surgery was assessed. Thirty-three percent (13 of 40) in group 1 and 25% (9 of 36) in group 2 were within +/-0.5 D. Forty-eight percent (19 of 40) in group 1 and 50% (18 of 36) in group 2 were within +/-1 D. Six months after surgery, 80% or more in both groups were within +/-2 D. There was myopic regression in all patients. Three months after surgery, regression averaged -0.71 D in group 1 and -1.15 D in group 2.

Conclusions: Corneal hydration levels affect the efficiency of laser ablation in LASIK procedures. With less hydrated corneas, ablation effects were greater than for corneas not blotted during the procedure, but these patients appear to undergo greater myopic regression.