Emerging trends for procedure selection in contemporary refractive surgery: consecutive review of 200 cases from a single center.

Purpose: To quantify emerging refractive surgery trends in a single refractive surgery practice.
Methods: A retrospective chart review was performed of 200 consecutive candidates (377 eyes) for refractive surgery from July 20, 2007 to October 31, 2007. Patient age, manifest refraction spherical equivalent, pachymetry at the thinnest location (CCT), topographic symmetry patterns, and comeal apex location were analyzed. Patients were recommended sub-Bowman's keratomileusis (SBK), photorefractive keratectomy (PRK), conductive keratoplasty (CK), phakic intraocular lens implants (PIOL) or refractive lens exchange (RLE). Corneal excimer procedures were either wavefront-optimized or wavefront-guided ablations.
Results: Mean patient age for refractive surgery was 44+/-12 years (range: 18 to 68 years). The mean MRSE was -2.78+/-3.37 diopters (D) (range: -12.75 to +6.25 D). Of the 200 patients, 75% (n=151, 288 eyes) were recommended corneal excimer procedures. Of these, the mean CCT was 548+/-36 microm (range: 466 to 628 microm). Symmetric topographic patterns were observed in 54% (n=155) of eyes, whereas 32% (n=92) were borderline and 14% (n=41) were asymmetric. The corneal apex was centered in 79% (n=226) of eyes, whereas 18% (n=51) were borderline and 3% (n=10) were decentered (>2.5 mm from the center). Overall, 69% (n=139) of patients were recommended SBK, 16% (n=32) RLE, 6% (n=12) PRK, 5% (n=9) CK, and 4% (n=8) PIOL. Of the corneal excimer group, 88% (n=132) were scheduled for wavefront-optimized ablations and 12% (n=18) for wavefront-guided ablations.
Conclusions: Sub-Bowman's keratomileusis was the predominant refractive surgical procedure offered in this practice, followed by RLE, PRK, CK, and finally PIOL. Of the corneal excimer procedures recommended, the majority of patients were scheduled for a wavefront-optimized ablation.