Innovations in refractive laser surgery 2014 [Innovationen in der refraktiven Laserchirurgie 2014]

Background: Within less than 30 years refractive laser surgery has been developed from an experimental technique to one of the most frequently applied procedures in ophthalmology worldwide. Results: Regarding the success rate of refractive results, myopia correction has reached a level (95 % within ± 0.5 D) that is comparable to manifest refraction so that there is not much room for improvement. The most recently developed technique is femtosecond laser lenticule extraction which was introduced in 2007 in Germany. Early clinical results were very promising but the awaited bilateral comparative studies are still lacking. Although new laser types that will be able to provide improved profiles are on the horizon, the problem of reoperations has not yet been solved. Topography-guided ablation is notoriously plagued by undercorrection so that topography-guided treatment is planned as a two step-procedure. The reason for the undercorrection is the leveling effect of the epithelium. Perspectives: The evolution of refractive surgery has slowed down during the last years, however, some important innovations are at the advent. © 2014 Springer-Verlag Berlin Heidelberg.