Excimer laser in situ keratomileusis.

We have been using a 193-nm excimer laser under protocol to ablate the corneal stromal bed after creating a hinged corneal flap with a microkeratome in order to reduce or eliminate refractive error. Thirty-one consecutive eyes are reviewed with a preoperative mean spherical equivalent refraction of -6.25 diopters (D) (range -3.50 to -11.75 D). Preoperative mean astigmatism was +0.87 D (range +0.25 to +2.75 D). At 6 months postoperatively, the mean spherical equivalent refraction was -0.50 D (range -3.50 to +2.00 D). Mean postoperative astigmatism was 0.64 D (range 0.25 to 3.50 D). A result within 1.00 D of attempted correction was achieved in 74.2% of eyes. Uncorrected visual acuity after a single procedure was 20/40 or better in 81% of eyes. Spectacle corrected visual acuity was unchanged in 26 (84%), decreased 1/2 line in 2 (6%), and increased 2 lines in 1 (3%). The incidence of postoperative complications was minimal. Excimer laser ablation in the stromal bed in combination with a hinged corneal flap seems to offer many advantages over excimer laser surface ablation with fewer complications.