Mechanical methods in refractive corneal surgery.

Keratorefractive surgery has developed rapidly over the past decade. For patients with aphakia, however, posterior chamber lenses are safer and more predictable than refractive corneal surgery; myopia is the greatest challenge to this type of surgery. No technique as yet has an accuracy that is adequate for the general treatment of myopia. Keratotomy is the most common procedure currently performed for the correction of mild myopia and astigmatism. Results are less accurate and less stable with myopic than with aphakic epikeratoplasty. Although it is technically more difficult, keratomileusis seems to be more predictable than epikeratophakia. Nonfreeze lamellar corneal surgery accelerates wound healing. Synthetic lenses and ring-shaped implants are also being developed to modify corneal refraction. Current research is directed toward laser stromal keratomileusis on discs that are removed from the cornea using a microkeratome.