[Decrease of retinal image contrast after photorefractive keratectomy, improvement within the scope of surface restitution].

Abstract

Photorefractive keratectomy (PRK) with the ArF excimer lasers in current use usually approximates the intended corneal curvature by a mean of a delicate step-type pattern that is smooth off afterwards by reepithelialization and tear film. The present study was based on a model eye with axial myopia of -6 D but otherwise the optical and geometric properties of the Gullstrand model eye and was designed to investigate to what extent. (1) corneal step patterns can reduce retinal image contrast and (2) smoothing effects can restore such a loss. METHODS. The corneal surface resulting from PRK in the case of a myopia of -6 D (optical zone diameter 6 mm) is calculated for the parameters of the model eye. The retinal image contrasts of bar patterns are calculated by PSF (point spread function) analysis: varying size of pupil, wavelength, bar width, ablation step height and degree of smoothing. RESULTS. Step height influences retinal image contrast crucially. With step heights above 0.4 micron a massive loss of retinal image contrast must be expected, which can, however, be corrected to a useful extent by surface-smoothing effects. CONCLUSION. This study indicates that PRK with excimer lasers should be performed with low fluence and correspondingly low corneal step heights.