Noncontact laser photothermal keratoplasty. II: Refractive effects and treatment parameters in cadaver eyes.

BACKGROUND Noncontact laser photothermal keratoplasty may provide a new alternative for the treatment of myopia, hyperopia, and astigmatism. The purpose of this article is to study the refractive effect that laser photoablation keratoplasty is capable of producing on a normal human cadaver cornea, including the relationship between the keratometric changes and laser treatment parameters. METHODS The human cadaver eyes were treated with a holmium laser (pulsed Ho:YAG, 2.10 microns, 250 microseconds) coupled to a maskable, polyprismatic delivery system mounted on either an optical bench or a slit-lamp microscope. Using a topographic videokeratography system, we first investigated the refractive effect that noncontact laser photothermal keratoplasty would produce on a normal cadaver cornea. We then studied the keratometric changes produced by different radiant exposure levels at a fixed treatment pattern, as well as by different treatment patterns at a fixed radiant exposure level. Finally, we studied the possible therapeutic application of laser photothermal keratoplasty for correcting high postoperative astigmatism on a cadaver eye model. RESULTS For the single-pulse 3-millimeter ring of eight-spot treatment, the keratometric power of the cornea initially increased with the radiant exposure and peaked at 26 J/cm2. The refractive effect was increased by projecting an additional set of eight spots equidistant between the first eight spots on the same diameter ring. Eighteen J/cm2 was the minimal radiant exposure required to produce consistent and predictable keratometric changes. The corneas were flattened using treatment patterns smaller than or equal to 3 mm in diameter and steepened using treatment patterns larger than or equal to 5 mm in diameter. A transition zone between 4 and 5 mm was observed in which minimal and unpredictable keratometric changes of the central cornea occurred. The surgically-induced astigmatism (> 10.00 D) was corrected by progressive laser photothermal keratoplasty treatments. CONCLUSIONS Laser photothermal keratoplasty can acutely steepen and flatten the cornea in human cadaver eyes.