51
|
Muftuoglu O, Ayar O, Hurmeric V, Orucoglu F, Kılıc I. Comparison of multimetric D index with keratometric, pachymetric, and posterior elevation parameters in diagnosing subclinical keratoconus in fellow eyes of asymmetric keratoconus patients. J Cataract Refract Surg 2015; 41:557-65. [PMID: 25708211 DOI: 10.1016/j.jcrs.2014.05.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 05/06/2014] [Accepted: 05/08/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the multimetric D index and other keratoconus-screening parameters in patients with clinical keratoconus in 1 eye and subclinical keratoconus in the fellow eye. SETTING Medipol University Hospital and Birinci Eye Hospital, Istanbul, Turkey. DESIGN Retrospective case-control study. METHODS Patients with clinical keratoconus in 1 eye and subclinical keratoconus in the fellow eye and eyes of normal subjects were evaluated with a rotating Scheimpflug imaging system (Pentacam). Parameters included anterior curve analysis, keratometry (K) values, minimum corneal thickness, pachymetric progression index, Ambrósio relational thickness, posterior elevation, back difference elevation, and D-index values. The receiver operating characteristic (ROC) curves were analyzed to evaluate the area under curve (AUC), sensitivity, and specificity of each parameter. RESULTS Forty-five patients and 67 normal subjects were evaluated. The pachymetric progression indices, posterior elevation, and the D-index measurements were statistically significantly higher whereas corneal thickness and Ambrósio relational thickness measurements were significantly lower in eyes with keratoconus or subclinical keratoconus than in eyes of normal subjects (P < .05). Using the ROC analysis, the AUC values of the mean steep K, minimum corneal thickness, pachymetric progression index minimum, Ambrósio relational thickness maximum, posterior elevation, back difference elevation, and D index to distinguish between subclinical keratoconus from control subjects were 0.52, 0.64, 0.71, 0.72, 0.71, 0.76, and 0.83, respectively. CONCLUSION The new multimetric D index seems to be better than other single-metric parameters in diagnosing keratoconus and subclinical keratoconus with good specificity. However, the sensitivity levels of all parameters were relatively limited in the diagnosis of subclinical keratoconus. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Orkun Muftuoglu
- From the Department of Ophthalmology (Muftuoglu), Medipol University, Birinci Eye Hospital (Orucoglu), and Istanbul Egitim Arastirma Hastanesi (Kılıc), Istanbul, the Department of Ophthalmology (Ayar), Zonguldak Bülent Ecevit University, Zonguldak, and Dunya Eye Hospital (Hurmeric), Ankara, Turkey.
| | - Orhan Ayar
- From the Department of Ophthalmology (Muftuoglu), Medipol University, Birinci Eye Hospital (Orucoglu), and Istanbul Egitim Arastirma Hastanesi (Kılıc), Istanbul, the Department of Ophthalmology (Ayar), Zonguldak Bülent Ecevit University, Zonguldak, and Dunya Eye Hospital (Hurmeric), Ankara, Turkey
| | - Volkan Hurmeric
- From the Department of Ophthalmology (Muftuoglu), Medipol University, Birinci Eye Hospital (Orucoglu), and Istanbul Egitim Arastirma Hastanesi (Kılıc), Istanbul, the Department of Ophthalmology (Ayar), Zonguldak Bülent Ecevit University, Zonguldak, and Dunya Eye Hospital (Hurmeric), Ankara, Turkey
| | - Faik Orucoglu
- From the Department of Ophthalmology (Muftuoglu), Medipol University, Birinci Eye Hospital (Orucoglu), and Istanbul Egitim Arastirma Hastanesi (Kılıc), Istanbul, the Department of Ophthalmology (Ayar), Zonguldak Bülent Ecevit University, Zonguldak, and Dunya Eye Hospital (Hurmeric), Ankara, Turkey
| | - Ilkay Kılıc
- From the Department of Ophthalmology (Muftuoglu), Medipol University, Birinci Eye Hospital (Orucoglu), and Istanbul Egitim Arastirma Hastanesi (Kılıc), Istanbul, the Department of Ophthalmology (Ayar), Zonguldak Bülent Ecevit University, Zonguldak, and Dunya Eye Hospital (Hurmeric), Ankara, Turkey
| |
Collapse
|
52
|
Bamashmus MA, Hubaish K, Alawad M, Alakhlee H. Functional outcome and patient satisfaction after laser in situ keratomileusis for correction of myopia and myopic astigmatism. Middle East Afr J Ophthalmol 2015; 22:108-14. [PMID: 25624684 PMCID: PMC4302464 DOI: 10.4103/0974-9233.148359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose was to evaluate subjective quality of vision and patient satisfaction after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism. Patients and Methods: A self-administered patient questionnaire consisting 29 items was prospectively administered to LASIK patients at the Yemen Magrabi Hospital. Seven scales covering specific aspects of the quality of vision were formulated including; global satisfaction; quality of uncorrected and corrected vision; quality of night vision; glare; daytime driving and; night driving. Main outcome measures were responses to individual questions and scale scores and correlations with clinical parameters. The scoring scale ranged from 1 (dissatisfied) to 3 (very satisfied) and was stratified in the following manner: 1-1.65 = dissatisfied; 1.66-2.33 = satisfied and; 2.33-3 = very satisfied. Data at 6 months postoperatively are reported. Results: This study sample was comprised of 200 patients (122 females: 78 males) ranging in age from 18 to 46 years old. The preoperative myopic sphere was − 3.50 ± 1.70 D and myopic astigmatism was 0.90 ± 0.82 D. There were 96% of eyes within ± 1.00 D of the targeted correction. Postoperatively, the uncorrected visual acuity was 20/40 or better in 99% of eyes. The mean score for the overall satisfaction was 2.64 ± 0.8. A total of 98.5% of patients was satisfied or very satisfied with their surgery, 98.5% considered their main goal for surgery was achieved. Satisfaction with uncorrected vision was 2.5 ± 0.50. The main score for glare was 1.98 ± 0.7 at night. Night driving was rated more difficult preoperatively by 6.2%, whereas 79% had less difficulty driving at night. Conclusion: Patient satisfaction with uncorrected vision after LASIK for myopia and myopic astigmatism appears to be excellent and is related to the residual refractive error postoperatively.
Collapse
Affiliation(s)
- Mahfouth A Bamashmus
- Department of Eye, Faculty of Medicine and Health Sciences, Sana'a University, Khartoum, Sudan ; Department of Cornea and Refractive Surgery, Cornea and Refractive Surgery Unit, Magrabi Eye Hospital, Sana'a, Republic of Yemen, Khartoum, Sudan
| | - Khammash Hubaish
- Department of Cornea and Refractive Surgery, Cornea and Refractive Surgery Unit, Magrabi Eye Hospital, Sana'a, Republic of Yemen, Khartoum, Sudan
| | - Mohammed Alawad
- Department of Optometry, Al Nilein University, Khartoum, Sudan
| | - Hisham Alakhlee
- Department of Cornea and Refractive Surgery, Cornea and Refractive Surgery Unit, Magrabi Eye Hospital, Sana'a, Republic of Yemen, Khartoum, Sudan
| |
Collapse
|
53
|
Tan J, Lytle GE, Marshall J. Consecutive laser in situ keratomileusis and accelerated corneal crosslinking in highly myopic patients: preliminary results. Eur J Ophthalmol 2014; 25:0. [PMID: 25588591 DOI: 10.5301/ejo.5000543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the preliminary results of an evaluation of the safety and predictability of Lasik Xtra, a technique combining laser in situ keratomileusis (LASIK) and accelerated corneal crosslinking, in highly myopic patients. METHODS In this consecutive comparative case series, 70 consecutive eyes undergoing LASIK for correction of high myopia (-8.00 D to -19.00 D manifest refractive spherical equivalent) were prospectively recruited and treated with Lasik Xtra and compared with a retrospective consecutive control group of 64 eyes who had undergone LASIK alone for correction of high myopia. The follow-up was 3 months. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. RESULTS A total of 61% of LASIK only eyes achieved UDVA of 20/25 or better, compared to 98% of Lasik Xtra eyes (p<0.001) at 3 months. A greater percentage of eyes were within ±0.50 of the intended correction in the Lasik Xtra group (88%) than in the LASIK only group (65%) at 3 months (p = 0.005). Linear regression of the scatterplot of attempted versus achieved correction reveals a coefficient of determination of 0.83 in the LASIK only group vs 0.99 in the Lasik Xtra group. A trend (p = 0.051) towards greater refractive drift in the LASIK group (-0.13 D) vs the Lasik Xtra group (-0.04 D) was observed. No adverse events were observed in either group. CONCLUSIONS Lasik Xtra did not reduce the refractive accuracy of the LASIK procedure. The addition of crosslinking may induce early stabilization of the cornea after LASIK, improving the predictability of refractive outcomes in highly myopic subjects.
Collapse
|
54
|
Ide T, Toda I, Fukumoto T, Watanabe J, Tsubota K. Outcome of a 10-year follow-up of laser in situ laser keratomileusis for myopia and myopic astigmatism. Taiwan J Ophthalmol 2014. [DOI: 10.1016/j.tjo.2014.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
55
|
Kanellopoulos AJ, Asimellis G, Karabatsas C. Comparison of prophylactic higher fluence corneal cross-linking to control, in myopic LASIK, one year results. Clin Ophthalmol 2014; 8:2373-81. [PMID: 25473264 PMCID: PMC4251572 DOI: 10.2147/opth.s68372] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To compare 1-year results: safety, efficacy, refractive and keratometric stability, of femtosecond myopic laser-assisted in situ keratomileusis (LASIK) with and without concurrent prophylactic high-fluence cross-linking (CXL) (LASIK-CXL). Methods We studied a total of 155 consecutive eyes planned for LASIK myopic correction. Group A represented 73 eyes that were treated additionally with concurrent prophylactic high-fluence CXL; group B included 82 eyes subjected to the stand-alone LASIK procedure. The following parameters were evaluated preoperatively and up to 1-year postoperatively: manifest refractive spherical equivalent (MRSE), refractive astigmatism, visual acuity, corneal keratometry, and endothelial cell counts. We plotted keratometry measurements pre-operatively and its change in the early, interim and later post-operative time for the two groups, as a means of keratometric stability comparison. Results Group A (LASIK-CXL) had an average postoperative MRSE of −0.23, −0.19, and −0.19 D for the 3-, 6-, and 12-month period, respectively, compared to −6.58±1.98 D preoperatively. Flat keratometry was 37.69, 37.66, and 37.67 D, compared to 43.94 D preoperatively, and steep keratometry was 38.35, 38.36, and 38.37 D, compared to 45.17 D preoperatively. The predictability of Manifest Refraction Spherical Equivalent (MRSE) correction showed a correlation coefficient of 0.979. Group B (stand-alone LASIK) had an average postoperative MRSE of −0.23, −0.20, and −0.27 D for the 3-, 6-, and 12-month period, respectively, compared with −5.14±2.34 D preoperatively. Flat keratometry was 37.65, 37.89, and 38.02 D, compared with 43.15 D preoperatively, and steep keratometry was 38.32, 38.57, and 38.66 D, compared with 44.07 D preoperatively. The predictability of MRSE correction showed a correlation coefficient of 0.970. The keratometric stability plots were stable for the LASIK CXL group and slightly regressing in the standard LASIK group, a novel stability evaluation metric that may escape routine acuity and refraction measurements. Conclusion Application of prophylactic CXL concurrently with myopic LASIK surgery appears to contribute to improved refractive and keratometric stability compared to standard LASIK. The procedure appears safe and provides a new potential for LASIK correction.
Collapse
Affiliation(s)
- Anastasios John Kanellopoulos
- LaserVision.gr Clinical and Research Eye Institute, Athens, Greece ; New York University Medical School, New York, NY, USA
| | - George Asimellis
- LaserVision.gr Clinical and Research Eye Institute, Athens, Greece
| | | |
Collapse
|
56
|
Alió JL, Soria F, Abbouda A, Peña-García P. Laser in situ keratomileusis for -6.00 to -18.00 diopters of myopia and up to -5.00 diopters of astigmatism: 15-year follow-up. J Cataract Refract Surg 2014; 41:33-40. [PMID: 25465210 DOI: 10.1016/j.jcrs.2014.08.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 08/05/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for high myopia with or without astigmatism. SETTING Vissum Instituto Oftalmologico de Alicante and Miguel Hernandez University, Alicante, Spain. DESIGN Retrospective-prospective case series. METHODS Laser in situ keratomileusis was performed using the Visx 20/20 excimer laser. The minimum follow-up was 15 years. The main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. RESULTS This study included 40 patients (40 eyes) with a mean age of 51.08 years ± 6.67 (SD) (range 41 to 60 years) with high myopia (-6.00 to -18.00 diopters [D]). At 15 years, the safety index was 1.23 and the efficacy index, 0.95. During the follow-up, a significant increase in the dioptric power of all keratometric variables was detected (P≤.028, Friedman test), the most notable increase occurring between 3 months and 1 year (P≤.005). At 15 years, 46.15% of the eyes were within ±1.00 D of the attempted spherical equivalent and 64.10% were within ±2.00 D. The UDVA at 15 years was 20/25 or better in 43.59% of eyes and 20/40 or better in 64.10% of eyes. The postoperative CDVA was significantly better than preoperatively (P<.001). The postoperative complications were minor except in 1 eye in which ectasia occurred. CONCLUSIONS Laser in situ keratomileusis for high myopia was safe over the long term. However, significant myopic regression with time was detected. Low preoperative pachymetry and low residual stromal bed were predictors of keratometric regression. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Jorge L Alió
- From Vissum Instituto Oftalmologico de Alicante (Alió, Soria, Abbouda) and the Division of Ophthalmology (Alió, Peña-García), Universidad Miguel Hernández, Alicante, Spain.
| | - Felipe Soria
- From Vissum Instituto Oftalmologico de Alicante (Alió, Soria, Abbouda) and the Division of Ophthalmology (Alió, Peña-García), Universidad Miguel Hernández, Alicante, Spain
| | - Alessandro Abbouda
- From Vissum Instituto Oftalmologico de Alicante (Alió, Soria, Abbouda) and the Division of Ophthalmology (Alió, Peña-García), Universidad Miguel Hernández, Alicante, Spain
| | - Pablo Peña-García
- From Vissum Instituto Oftalmologico de Alicante (Alió, Soria, Abbouda) and the Division of Ophthalmology (Alió, Peña-García), Universidad Miguel Hernández, Alicante, Spain
| |
Collapse
|
57
|
Clinical outcomes between optical path difference custom aspheric treatment and optimized prolate ablation photorefractive keratectomy in myopia exceeding 8 diopters. Eye (Lond) 2014; 29:356-62. [PMID: 25397788 DOI: 10.1038/eye.2014.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 10/02/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Comparison of visual acuity, refractive, and wavefront outcomes associated with optimized prolate ablation (OPA) and optical path difference custom aspheric treatment (OPDCAT) algorithms for correction of myopia exceeding 8 diopters (D). PATIENTS AND METHODS Patients were randomly assigned to have photorefractive keratectomy (PRK) with OPA (n=32) or OPDCAT (n=21) algorithms. Visual acuity, manifest refraction, ocular and corneal higher-order aberrations, corneal asphericity, modulated-transfer function, and point-spread function were compared 1, 3, and 6 months postoperatively. RESULTS Mean manifest-refraction spherical equivalents at 6 months were -0.24 D in both groups. All patients in both groups had an uncorrected-distance visual acuity of 20/20 or better. Predictability (±1 D from intended refraction) at 6 months was 94% in the OPA group, and in the OPDCAT group it was 86%. The OPA group had less induced corneal and ocular spherical aberrations (SAs) than the OPDCAT group. Postoperative corneal asphericity change was lowest in the OPA group. Both the groups exhibited significantly-improved AreaRatio-Total value and insignificantly deteriorated AreaRatio-HO value throughout the postoperative period. The OPA group had significantly-higher AreaRatio-Total compared with OPDCAT group at both 1 and 6 months after the operation. Six months after surgery, the Strehl ratio had decreased in both groups, and there was no significant difference between the groups. CONCLUSION The OPA algorithms yielded higher-objective visual quality and predictability, induced less corneal and ocular SAs, and preserved more preoperative-corneal asphericity than the OPDCAT algorithms.
Collapse
|
58
|
Impact of laser refractive surgery on ocular alignment in myopic patients. Eye (Lond) 2014; 28:1321-7. [PMID: 25190533 DOI: 10.1038/eye.2014.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/10/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the impact of myopic keratorefractive surgery on ocular alignment. METHODS This prospective study included 194 eyes of 97 myopic patients undergoing laser refractive surgery. All patients received a complete ophthalmic examination with particular attention to ocular alignment before and 3 months after surgery. RESULTS Patients with a mean age of 26.6 years and a mean refractive error of -4.83 diopters (D) myopia were treated. Asymptomatic ocular misalignment was present preoperatively in 46 (47%) patients: a small-angle heterophoria (1-8 prism diopters, PD) in 36%; and a large-angle heterophoria (>8 PD)/heterotropia in 11%. Postoperatively, the change in angles of 10 PD or greater occurred in 3% for distance and 6% for near fixation: in 7% of the patients with orthophoria, in 3% of those with a small-angle heterophoria, and in 18% of those with a large-angle heterophoria/heterotropia. No patient developed diplopia. The preoperative magnitude of myopia or postoperative refractive status was not related to the change in ocular alignment. The higher anisometropia was associated with a decrease in deviation (P=0.041 for distance and P=0.002 for near fixation), whereas the further near point of convergence tended to be related with an increase in near deviation (P=0.055). CONCLUSIONS Myopic refractive surgery may cause a change in ocular alignment, especially in cases with a large-angle heterophoria/heterotropia. There is also a chance of improvement of misalignment in patients with anisometropia.
Collapse
|
59
|
Blum M, Flach A, Kunert KS, Sekundo W. Five-year results of refractive lenticule extraction. J Cataract Refract Surg 2014; 40:1425-9. [DOI: 10.1016/j.jcrs.2014.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/18/2013] [Accepted: 01/07/2014] [Indexed: 11/24/2022]
|
60
|
Mushawiahti M, Shaw A, Chiu D. Retinal detachment associated with posterior chamber phakic intraocular lens implantation. Clin Exp Optom 2014; 97:471-2. [PMID: 24898822 DOI: 10.1111/cxo.12153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/07/2014] [Indexed: 11/30/2022] Open
|
61
|
|
62
|
Igarashi A, Shimizu K, Kamiya K. Eight-year follow-up of posterior chamber phakic intraocular lens implantation for moderate to high myopia. Am J Ophthalmol 2014; 157:532-9.e1. [PMID: 24239774 DOI: 10.1016/j.ajo.2013.11.006] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the long-term clinical outcomes of Implantable Collamer Lens (Visian ICL; STAAR Surgical) implantation for moderate to high myopia. DESIGN Retrospective observational case series. METHODS This study evaluated 41 eyes of 41 patients with myopic refractive errors of -4.00 to -15.25 diopters (D) who underwent ICL implantation and routine postoperative examinations. Before surgery, and 1 and 6 months and 1, 4 and 8 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery. RESULTS The safety and efficacy indices were 1.13 ± 0.27 and 0.83 ± 0.36. At 8 years, 68.3% and 85.4% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of -0.32 ± 0.73 D occurred between 1 month and 8 years. The mean endothelial cell loss from preoperative levels was 6.2% at 8 years. Two eyes (4.9%) developed clinically significant symptomatic cataract during the follow-up period. Simultaneous lens extraction and phacoemulsification with IOL implantation was successfully performed in these 2 eyes. CONCLUSIONS According to our experience, ICL implantation was overall good in measures of safety, efficacy, predictability, and stability for the correction of moderate to high myopia during the 8-year observation period, suggesting its long-term viability as a surgical option for the treatment of such eyes.
Collapse
Affiliation(s)
- Akihito Igarashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.
| | - Kimiya Shimizu
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| |
Collapse
|
63
|
Kim G, Christiansen SM, Moshirfar M. Change in keratometry after myopic laser in situ keratomileusis and photorefractive keratectomy. J Cataract Refract Surg 2014; 40:564-74. [PMID: 24568721 DOI: 10.1016/j.jcrs.2013.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 09/24/2013] [Accepted: 09/29/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the change in keratometry (K), spherical equivalent (SE), and visual acuity after myopic laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). SETTING Academic tertiary care center. DESIGN Retrospective review. METHODS The postoperative K, SE, and uncorrected and corrected distance visual acuities were measured 6 months, 9 months, 1 year, 2 years, 3 years, 4 to 5 years, 6 to 7 years, and 8+ years postoperatively. A difference (Δ) for each variable was calculated from its 6-month postoperative baseline. The rates of change were grouped based on the magnitude of myopic correction (0.00 to 2.99 diopters [D]; 3.00 to 5.99 D; 6.00 to 8.99 D), type of surgery (LASIK versus PRK), and age (<34 years; 34 to 45 years; >45 years). RESULTS Statistically significant differences were found in the rates of change between low and moderate corrections to high corrections for ΔKavg (P=.0472 and P=.0091, respectively) and ΔSE (both P<.0001). Statistically significant differences were found in the rate of change in ΔKavg between all 3 ages groups (P=.0330, P=.0051, and P<.0001) and in ΔSE between ages less than 34 years and 34 to 45 years to ages over 45 years (P=.0158 and P=.0015, respectively). There was no significant difference in the rate of change in ΔKavg and ΔSE between LASIK and PRK (P=.3599 and P=.9403, respectively). CONCLUSION There was keratometric and refractive regression for myopic LASIK, with the rate of regression depending on treatment magnitude and age. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Gene Kim
- From the John A. Moran Eye Center (Kim, Christiansen, Moshifar), University of Utah, Salt Lake City, Utah, and the Ruiz Department of Ophthalmology and Visual Science (Kim), University of Texas Medical School at Houston, and the Robert Cizik Eye Clinic (Kim), Houston, Texas, USA
| | - Steven M Christiansen
- From the John A. Moran Eye Center (Kim, Christiansen, Moshifar), University of Utah, Salt Lake City, Utah, and the Ruiz Department of Ophthalmology and Visual Science (Kim), University of Texas Medical School at Houston, and the Robert Cizik Eye Clinic (Kim), Houston, Texas, USA
| | - Majid Moshirfar
- From the John A. Moran Eye Center (Kim, Christiansen, Moshifar), University of Utah, Salt Lake City, Utah, and the Ruiz Department of Ophthalmology and Visual Science (Kim), University of Texas Medical School at Houston, and the Robert Cizik Eye Clinic (Kim), Houston, Texas, USA.
| |
Collapse
|
64
|
Abstract
PURPOSE In myopia, biometry including the axial length is important, along with the refractive data. We compared the rates of myopic regression 3 years after phakic intraocular lens (pIOL) implantation and laser in situ keratomileusis (LASIK) after matching the preoperative axial length in highly myopic eyes of Japanese patients. METHODS This retrospective nonrandomized study included 133 eyes of 84 patients with myopia exceeding -6.00 diopters (D) who underwent implantation of two iris-fixated pIOLs (pIOL group, 66 eyes/46 patients) or myopic LASIK (LASIK group, 67 eyes/38 patients) who were followed for more than 3 years postoperatively. The patient age, preoperative refraction, and preoperative axial length were matched between the study groups. RESULTS There were no significant differences preoperatively between the groups in age, intraocular pressure, refraction, keratometry, or axial length. The mean regression values after 3 years compared with the 1-month postoperative refractions were -0.12 ± 0.47 (SD) D in the pIOL group and -0.82 ± 0.69 D in the LASIK group (p < 0.001). The differences in the mean regression rates between 1 and 12 months, 12 and 24 months, and 24 and 36 months of follow-up were, respectively, 0.09 ± 0.38 D, -0.11 ± 0.35 D, and -0.11 ± 0.30 D in the pIOL group and -0.57 ± 0.84 D, -0.24 ± 0.47 D, and 0.00 ± 0.53 D in the LASIK group (p < 0.001, p = 0.07, p = 0.15, respectively). CONCLUSIONS There was a significant difference in myopic regression 3 years postoperatively between the groups matched for preoperative axial length in Japanese patients. This result has the potential to elucidate myopia in the future.
Collapse
|
65
|
Bamashmus MA, Saleh MF. Post-LASIK interface fluid syndrome caused by steroid drops. Saudi J Ophthalmol 2013; 27:125-8. [PMID: 24227974 DOI: 10.1016/j.sjopt.2013.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 03/18/2013] [Accepted: 03/25/2013] [Indexed: 10/27/2022] Open
Abstract
Interface fluid syndrome after laser in situ keratomileusis (LASIK) is a rare but visually threatening postoperative complication. In this case series we present 8 post-LASIK eyes that developed interface fluid syndrome after prolonged steroid use. Patients presented with signs mimicking diffuse lamellar keratitis (DLK) that worsened with steroid treatment. Slit-lamp examination revealed corneal haze and an optically clear fluid-filled space between the flap and stroma. The IOP was high in all cases. Topical steroids were stopped and replaced with topical and systemic anti-glaucoma medications resulting in a dramatic improvement in visual acuity.
Collapse
Affiliation(s)
- Mahfouth A Bamashmus
- Eye Department, Faculty of Medicine and Health Sciences, Sana'a University, Republic of Yemen ; Refractive Unit, Magrabi Eye Hospital, Sana'a, Republic of Yemen
| | | |
Collapse
|
66
|
Optical and visual simulation of standard and modified spherical aberration implantable Collamer lens post myopic LASIK surgery. Eur J Ophthalmol 2013; 24:330-7. [PMID: 24057938 DOI: 10.5301/ejo.5000372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual quality achieved in patients undergoing standard or modified implantable Collamer lens (ICL) to correct residual myopic error after laser-assisted in situ keratomileusis (LASIK) surgery. METHODS The adaptive optics visual simulator was used to simulate LASIK surgery of moderate and high myopia with a myopic regression corrected by a standard and modified ICL. Visual acuity (VA) and contrast sensitivity (CS) were measured in 14 subjects at 3- and 4.5-mm pupil. Point spread function and simulated retinal images were calculated. RESULTS Comparing LASIK plus standard ICL and LASIK plus modified ICL simulations, for moderate myopia, VA improvement was less than 1 line in all VA contrasts and both pupils evaluated. No statistically significant differences were found in CS between the simulations at any spatial frequency evaluated and for 3-mm pupil (p>0.05), but differences were significant at 4.5-mm pupil (p<0.05). For high myopia, the VA improvement was less than 1 line at 3-mm pupil, although it increased 2 or more lines at 4.5-mm pupil. Statistically significant differences were found in CS between the simulations for all spatial frequencies and both pupils evaluated (p<0.05), except for low and medium spatial frequencies at 3-mm pupil (p>0.05). CONCLUSIONS These outcomes suggest that an ICL is a good option to correct the myopic residual error after myopic LASIK. When the ICL's spherical aberration is modified, the post-LASIK eyes of high myopia are the most benefited, as these eyes are more aberrated than after moderate myopic LASIK.
Collapse
|
67
|
Muftuoglu O, Ayar O, Ozulken K, Ozyol E, Akıncı A. Posterior corneal elevation and back difference corneal elevation in diagnosing forme fruste keratoconus in the fellow eyes of unilateral keratoconus patients. J Cataract Refract Surg 2013; 39:1348-57. [PMID: 23820305 DOI: 10.1016/j.jcrs.2013.03.023] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/02/2013] [Accepted: 03/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate posterior corneal elevation and back difference corneal elevation in patients with keratoconus in 1 eye and forme fruste keratoconus in the fellow eye. SETTING Kudret Eye Hospital, Ankara, Turkey. DESIGN Case-control study. METHODS This study retrospectively reviewed patients with keratoconus in 1 eye and forme fruste keratoconus in the fellow eye and eyes of normal subjects. All subjects were evaluated with a rotating Scheimpflug imaging system (Pentacam), including sagittal and tangential anterior curve analysis, keratometry, and posterior elevation. The back difference elevation values were extrapolated from the difference maps of the Belin-Ambrosió enhanced ectasia display of the Scheimpflug system. The receiver operating characteristic (ROC) curves were analyzed to evaluate the sensitivity and specificity of the parameters. RESULTS The corneal power, pachymetric progression index, and posterior corneal elevation (posterior elevation and back difference elevation) measurements were statistically significantly higher in eyes with keratoconus or forme fruste keratoconus than in eyes of normal control subjects (P<.05). Using ROC analysis, the area under the curve values of mean keratometry, steepest point on the tangential curve, minimum corneal thickness, pachymetric progression index, Ambrósio's relational thickness, posterior elevation, and back difference elevation to distinguish forme fruste keratoconus from control subjects were 0.51, 0.84, 0.65, 0.81, 0.72, 0.68, and 0.76, respectively. CONCLUSIONS Back difference elevation was better than posterior elevation in diagnosing forme fruste keratoconus. However, as sole parameters, both had limited sensitivity and specificity to differentiate between forme fruste keratoconus eyes and normal control eyes.
Collapse
Affiliation(s)
- Orkun Muftuoglu
- Department of Ophthalmology (Muftuoglu), Medipol University, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
68
|
Bamashmus MA, Mohamed AA, Alakhlee HA. A retrospective analysis of the first Yemeni experience on Artisan phakic intraocular lens for the treatment of moderate and high myopia. Oman J Ophthalmol 2013; 5:175-80. [PMID: 23439933 PMCID: PMC3574514 DOI: 10.4103/0974-620x.106098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the outcome and safety of the iris-fixated Artisan phakic intraocular lens (PIOL) for the correction of moderate and high myopia. MATERIALS AND METHODS A retrospective non-controlled clinical study of the data of patients who underwent Artisan PIOLs between March 2006 and July 2008 was evaluated. Pre-operative examination included age, gender, refraction, uncorrected (UCVA) and best spectacle corrected (BSCVA) visual acuity, predictability and safety were analyzed. Post-operative time course ranged from 12 to 36 months. RESULTS An Artisan myopia lens was implanted in 62 eyes of 39 patients. The mean pre-operative spherical equivalent (SE) was -13.17 ± 5.62 D. The pre-operative myopia ranged from -4.5 to -24 D. Mean patient age was 25.44 ± 5.22 years. At last follow-up visit, residual SE was within ±1.00 D in 36 eyes (58.1%) and ±2.00 D in 56 eyes (90.3%). In the last visit UCVA was equal to or better than pre-operative BSCVA in 57 (91.9%) of the eyes. One eye (1.6%) lost one Snellen line, three eyes (4.8%) lost two or more Snellen lines and one eye lost vision (1.6%). Post-operative complications included anterior chamber reaction in one eye, rise in intraocular pressure in two eyes and retinal detachment in one eye. CONCLUSION When laser keratorefractive surgery is not an option, implantation of Artisan PIOL to correct moderate to high myopia results in a stable and good refractive result with few complications that must be kept in mind.
Collapse
Affiliation(s)
- Mahfouth A Bamashmus
- Department of Eye, Faculty of Medicine and Health Sciences, Sana'a University, Republic of Yemen ; Refractive Surgery Unit, Magrabi Eye Hospital, Sana'a, Republic of Yemen
| | | | | |
Collapse
|
69
|
Uthoff D, Hebestedt K, Duncker GIW, Spörl E. [Influence of corneal biomechanical properties on myopic regression after laser in situ keratomileusis]. Ophthalmologe 2013; 110:41-7. [PMID: 23329119 DOI: 10.1007/s00347-012-2633-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laser in situ keratomileusis is a safe and accepted method for correcting myopia. The operational results in terms of accuracy as well as the subjective acceptance of patients for corrections to - 8 D are now considered to be promising (Seiler, Refraktive Chirurgie der Hornhaut, 2000); however, postoperative results show individual patient problems in long-term stability. It is believed that the preoperative condition of the cornea (e.g. thickness, biomechanical properties) could have an influence on postoperative problems such as myopic regression. METHOD This study included a total of 46 eyes from 25 patients. At 3 months postoperatively, 15 patients (19 eyes) showed a SEQ of -0.50 D or more. Within this group, 11 patients (15 eyes) developed a regression (regression group) within the first 3 postoperative months. The remainder of the total group did not show any regression (stability group). The subjects of this study were on average 33 ± 8 years (stability group) and 31 ± 7 years old (regression group). The corneal thickness was tested and refractive error, visual acuity (BCVA/UCVA) and intraocular pressure was measured. In addition, the corneal hysteresis (CH) and corneal resistance factor (CRF) were determined. RESULTS The mean preoperative spherical equivalent refraction was -3.14 D ± 1.41 D (SE) in the stability group and - 6.47 D ± 1.40 D (p = 0.001)in the regression group. Also, the postoperative spherical equivalents were statistically significant different (p < 0.05). In contrast, the mean preoperative corneal thickness showed no differences in both groups (p = 0.96) (stability group 563 ± 36 µm and regression group 563 ± 28 µm). CONCLUSIONS The aim of the study to detect a possible causal relationship between myopia regression after LASIK and the biomechanical properties of the cornea and corneal thickness could not be clearly identified.
Collapse
Affiliation(s)
- D Uthoff
- Augenklinik Bellevue, Lindenallee 21, 24105 Kiel.
| | | | | | | |
Collapse
|
70
|
Brenner LF, Alió JL, Vega-Estrada A, Baviera J, Beltrán J, Cobo-Soriano R. Indications for intrastromal corneal ring segments in ectasia after laser in situ keratomileusis. J Cataract Refract Surg 2012; 38:2117-24. [DOI: 10.1016/j.jcrs.2012.07.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 06/20/2012] [Accepted: 07/17/2012] [Indexed: 11/17/2022]
|
71
|
Vega-Estrada A, Alió JL, Arba Mosquera S, Moreno LJ. Corneal higher order aberrations after LASIK for high myopia with a fast repetition rate excimer laser, optimized ablation profile, and femtosecond laser-assisted flap. J Refract Surg 2012; 28:689-96. [PMID: 23061998 DOI: 10.3928/1081597x-20120921-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/28/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate corneal higher order aberrations (HOAs) after LASIK for the correction of high myopia using a new generation of excimer laser (500-Hz repetition rate) and optimized ablation profiles. METHODS Retrospective consecutive study including 29 eyes from 17 patients (age range: 24 to 61 years) with high levels of myopia (spherical equivalent refraction ≥8.50 diopters). All cases underwent LASIK using the sixth-generation Amaris (SCHWIND eye-tech-solutions) excimer laser and flap creation with the IntraLase (Abbott Medical Optics) femtosecond laser. Postoperative changes in corneal HOAs and corneal asphericity were analyzed during 6-month follow-up. RESULTS Significant improvement in uncorrected distance visual acuity and spherical equivalent was observed (P<.01). Corrected distance visual acuity did not change after surgery (P=.37). Significant increases in corneal root-mean-square (RMS) HOA, RMS spherical aberration (SA), and RMS coma were observed 6 months after surgery (P<.01). Corneal asphericity for the 4.5-mm (Q45) and 8-mm (Q8) corneal diameter also increased significantly during the postoperative period (P<.01). Significant correlations were found between postoperative RMS HOA and RMS SA and RMS coma (r(2)=0.375, P=0.000 and r(2)=0.596, P=.000, respectively). Linear regression analysis showed a significant relationship between postoperative Q45 and preoperative pachymetry and treatment optical zone (R(2)=0.24, P<.05). A correlation was also found between postoperative Q8 and preoperative sphere and treatment ablation zone (R(2)=0.459, P<.006). CONCLUSIONS A significant induction of corneal HOAs still exists with the latest generation Schwind excimer laser. Linear regression analysis will help predict postoperative asphericity obtained when using LASIK for the correction of high myopia.
Collapse
Affiliation(s)
- Alfredo Vega-Estrada
- Department of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain
| | | | | | | |
Collapse
|
72
|
Alió JL, Plaza-Puche AB, Martinez LM, Torky M, Brenner LF. Laser in situ keratomileusis using optimized aspheric profiles and cyclotorsion control to treat compound myopic astigmatism with high cylinder. J Cataract Refract Surg 2012; 39:28-35. [PMID: 23128029 DOI: 10.1016/j.jcrs.2012.07.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/26/2012] [Accepted: 07/26/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the visual outcomes after laser in situ keratomileusis (LASIK) surgery to correct primary compound myopic astigmatism with high cylinder performed using a fast-repetition-rate excimer laser platform with optimized aspheric profiles and cyclotorsion control. SETTING Vissum Corporation and Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain. DESIGN Retrospective consecutive observational nonrandomized noncomparative case series. METHODS Eyes with primary compound myopic astigmatism and a cylinder power over 3.00 diopters (D) had uneventful LASIK with femtosecond flap creation and fast-repetition-rate excimer laser ablation with aspheric profiles and cyclotorsion control. Visual, refractive, and aberrometric outcomes were evaluated at the 6-month follow-up. The astigmatic correction was evaluated using the Alpins method and Assort software. RESULTS The study enrolled 37 eyes (29 patients; age range 19 to 55 years). The significant reduction in refractive sphere and cylinder 3 months and 6 months postoperatively (P<.01) was associated with improved uncorrected distance visual acuity (P<.01). Eighty-seven percent of eyes had a spherical equivalent within ±0.50 D; 7.5% of eyes were retreated. There was no significant induction of higher-order aberrations (HOAs). The targeted and surgically induced astigmatism magnitudes were 3.23 D and 2.96 D, respectively, and the correction index was 0.91. The safety and efficacy indices were 1.05 and 0.95, respectively. CONCLUSIONS Laser in situ keratomileusis for primary compound myopic astigmatism with high cylinder (>3.00 D) performed using a fast-repetition-rate excimer laser with optimized aspheric profiles and cyclotorsion control was safe, effective, and predictable and did not cause significant induction of HOAs.
Collapse
Affiliation(s)
- Jorge L Alió
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt.
| | - Ana B Plaza-Puche
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| | - Lorena M Martinez
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| | - Magda Torky
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| | - Luis F Brenner
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| |
Collapse
|
73
|
Shojaei A, Eslani M, Vali Y, Mansouri M, Dadman N, Yaseri M. Effect of timolol on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis: a prospective randomized clinical trial. Am J Ophthalmol 2012; 154:790-798.e1. [PMID: 22935601 DOI: 10.1016/j.ajo.2012.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of timolol on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis (LASIK) with a control-matched group. DESIGN Prospective, randomized, parallel-controlled, double-masked clinical trial. A computer-generated randomization list based on random block permutation (length 4 to 8) was used for treatment allocation. METHODS setting: Basir Eye Center, Tehran, Iran. PATIENT POPULATION Of 124 eyes with myopic regression after LASIK using Technolas 217-Z, 45 eyes in each group were analyzed. INTERVENTION Patients were randomly assigned into either Group 1, who received timolol 0.5% eye drops, or Group 2, who received artificial tears for 6 months. MAIN OUTCOME MEASURE Spherical equivalent (SE) at 6 months posttreatment. RESULTS In Group 1, SE improved from -1.48 ± 0.99 diopter (D) before treatment to -0.88 ± 0.91 D and -0.86 ± 0.93 D 6 months after treatment and 6 months after timolol discontinuation, respectively (P < .001). In Group 2, it was -1.57 ± 0.67 D, -1.83 ± 0.76 D, and -1.91 ± 0.70 D, respectively (P < .001). SE was significantly better in Group 1 6 months after treatment and 6 months after discontinuation of treatment (P < .001 for both comparisons). There was a 0.26 D decrease in SE improvement every 4 months after the surgery in the Group 1 (P < .001). CONCLUSIONS Timolol application is effective for the treatment of myopic regression after LASIK compared with control group. Its effects last for at least 6 months after its discontinuation.
Collapse
|
74
|
Brenner LF, Alió JL, Vega-Estrada A, Baviera J, Beltrán J, Cobo-Soriano R. Clinical grading of post-LASIK ectasia related to visual limitation and predictive factors for vision loss. J Cataract Refract Surg 2012; 38:1817-26. [PMID: 22920505 DOI: 10.1016/j.jcrs.2012.05.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate and characterize the main clinical features of post-laser in situ keratomileusis (LASIK) ectasia, propose a grading system based on visual limitation, and identify predictive factors related to the degree of visual loss. SETTING Vissum Corp., Alicante, Spain. DESIGN Retrospective case series. METHODS This study comprised consecutive eyes with corneal ectasia after LASIK from 1996 to 2010. Main outcomes were post-LASIK ectasia corrected distance visual acuity (CDVA), CDVA loss, spherical equivalent (SE), and the corneal bulge (delta K). These outcomes were correlated with the residual stromal bed, ablation depth, ablation ratio (ablation depth:pachymetry), corneal depth (flap + ablation depth), and corneal ratio (corneal depth:pachymetry) to characterize their role in the severity of the disease. RESULTS The mean post-LASIK ectasia CDVA, CDVA loss, SE, and delta K were 0.20 logMAR ± 0.18 (SD), -0.13 ± 0.15 logMAR, -3.80 ± 3.86 diopters (D), and 4.77 ± 4.23 D, respectively. The ablation ratio had the strongest correlation with post-LASIK ectasia CDVA (ρ = 0.477 and P<.001), whereas the corneal ratio had the strongest correlation with the post-LASIK ectasia SE and delta K (ρ = -0.614 and ρ = 0.453, respectively: P<.001). The ablation ratio was the main predictive factor for post-LASIK ectasia CDVA loss (relative risk, 2.04; P=.049). CONCLUSIONS The grading system based on visual limitation was consistently represented by differences in CDVA loss, SE, and delta K. A high amount of tissue removed by the refractive procedure was associated with greater corneal biomechanical destabilization, increased corneal steepening, and a worse prognosis.
Collapse
Affiliation(s)
- Luis F Brenner
- Vissum Instituto Oftalmologico de Alicante, Alicante, Spain
| | | | | | | | | | | |
Collapse
|
75
|
Igarashi A, Kamiya K, Shimizu K, Komatsu M. Time course of refractive and corneal astigmatism after laser in situ keratomileusis for moderate to high astigmatism. J Cataract Refract Surg 2012; 38:1408-13. [PMID: 22814047 DOI: 10.1016/j.jcrs.2012.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 02/11/2012] [Accepted: 03/03/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the time course of refractive and corneal astigmatism after laser in situ keratomileusis (LASIK) in eyes with moderate to high astigmatism. SETTING Department of Ophthalmology, Kitasato University, Kanagawa, Japan. DESIGN Retrospective case series. METHODS Keratometric readings and corneal astigmatism were determined with an autokeratometer in consecutive patients who had LASIK for moderate to high astigmatism (≥2.00 diopters [D]). RESULTS The study enrolled 48 eyes of 35 patients with a mean age of 34.0 years ± 8.1 (SD), a mean spherical error of -5.10 ± 2.11 D, and a mean cylindrical error of -2.74 ± 0.99 D. Postoperatively, the mean spherical refraction changed significantly from 0.38 ± 0.80 D at 1 week to -0.13 ± 0.90 D at 1 year (P<.001, Wilcoxon signed-rank test). The mean cylindrical refraction showed no significant change (-0.67 ± 0.54 D at 1 week to -0.63 ± 0.63 D at 1 year) (P=.54). There were significant increases in the flattest and steepest keratometry readings at 1 week and at 1 year. However, no significant change in corneal astigmatism was found at either time point (P=.10). CONCLUSIONS After LASIK, there was significant refractive regression in the spherical component but not in the cylindrical component. This suggests that refractive regression occurs by corneal steepening in the spherical component and that astigmatic regression does not occur, even in moderately to highly astigmatic eyes. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Akihito Igarashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.
| | | | | | | |
Collapse
|
76
|
McAlinden C. Corneal refractive surgery: past to present. Clin Exp Optom 2012; 95:386-98. [PMID: 22672114 DOI: 10.1111/j.1444-0938.2012.00761.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/07/2012] [Accepted: 04/17/2012] [Indexed: 12/20/2022] Open
Abstract
There have been many historical corneal refractive techniques and procedures developed over the years. From early techniques of radial keratotomy to modern excimer laser techniques, the field of refractive surgery is one of the most rapidly developing in ophthalmology. This review details the historical aspects of the many early techniques up to current techniques used on millions of eyes around the world.
Collapse
Affiliation(s)
- Colm McAlinden
- University of Ulster, United Kingdom and Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
| |
Collapse
|
77
|
Knox Cartwright NE, Tyrer JR, Jaycock PD, Marshall J. Effects of Variation in Depth and Side Cut Angulations in LASIK and Thin-flap LASIK Using a Femtosecond Laser: A Biomechanical Study. J Refract Surg 2012; 28:419-25. [DOI: 10.3928/1081597x-20120518-07] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 04/24/2012] [Indexed: 11/20/2022]
|
78
|
Ondategui JC, Vilaseca M, Arjona M, Montasell A, Cardona G, Güell JL, Pujol J. Optical quality after myopic photorefractive keratectomy and laser in situ keratomileusis: comparison using a double-pass system. J Cataract Refract Surg 2012; 38:16-27. [PMID: 22153091 DOI: 10.1016/j.jcrs.2011.07.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 07/11/2011] [Accepted: 07/17/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To use a double-pass system to compare the optical quality after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for mild to moderate myopia. SETTING Universitat Politècnica de Catalunya, Terrassa, Barcelona Institute of Ocular Microsurgery, Barcelona, Spain. DESIGN Comparative case series. METHODS Optical quality was assessed with a clinical double-pass system preoperatively and 3 months after PRK or LASIK. The modulation transfer function (MTF), retinal image quality parameters (MTF cutoff frequency, Strehl ratio), and intraocular scattering (objective scatter index [OSI]) were calculated. RESULTS This study evaluated 34 eyes that had PRK and 55 eyes that had LASIK. Both PRK and LASIK had a statistically significant impact on retinal image quality, although no significant differences between the techniques were observed. The MTF at 30 cycles per degree decreased by a factor of 1.50 in the PRK group and by a factor of 1.32 in the LASIK group. The MTF cutoff frequency decreased by a factor of 1.04 in the PRK group and by a factor of 1.06 in the LASIK group. The Strehl ratio decreased by a factor of 1.10 and 1.07, respectively. Photorefractive keratectomy and LASIK increased the objective scatter index by factors of 1.48 and 1.57, respectively. Significant correlations between the preoperative refraction and the OSI were found. CONCLUSIONS Retinal image quality was similarly reduced with PRK and LASIK, with no significant differences between the 2 methods. Some PRK patients had a residual refractive error that might have been related to corneal-wound healing still present 3 months postoperatively.
Collapse
Affiliation(s)
- Juan C Ondategui
- Universitat Politècnica de Catalunya, Terrassa, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
79
|
Zhang ZW, Niu WR, Ma MM, Jiang KLM, Ke BL. Time course of Q value after myopic laser-assisted in situ keratomileusis. ACTA ACUST UNITED AC 2012; 26:141-5. [PMID: 22207921 DOI: 10.1016/s1001-9294(11)60038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the time course of Q value after myopic laser-assisted in situ keratomileusis (LASIK) and preliminarily evaluate the determinants of the difference of Q value between before and after LASIK. METHODS We performed a retrospective, longitudinal investigation on patients undergoing wavefront optimized LASIK therapy for emmetropization. A total of 418 eyes from 222 cases were examined preoperatively, and partly followed up at one week (172 eyes), one month (134 eyes) and three months (51 eyes) after surgery. The horizontal, vertical and total Q values of cornea were calculated from eccentricity measured at the central 6-mm corneal zones respectively. Potential determinants of the change of Q value were analyzed using multiple linear regressions. RESULTS The mean Q value was -0.17 +/- 0.13 preoperatively, and 0.99 +/- 0.70, 0.97 +/- 0.66, and 0.86 +/- 0.41 one week, one and three months postoperatively, respectively. One way analysis of variance (ANOVA) demonstrated significant differences between measurements made before surgery and at all postoperative times (at one week, one and three months; all P<0.0001, Bonferroni post hoc), but no significant differences were found among postoperative groups. Significant differences of Q values between horizontal and vertical meridians were found before surgery and at all postoperative times (all P<0.0001). Multiple regression analysis revealed that change of Q value significantly correlated with manifest refraction spherical equivalent (r=0.116, P<0.0001) and axial length (r=0.264, P<0.0001). CONCLUSIONS Over the study period, the primary changes in Q value occur within 1 week after surgery, and then become slightly decreased and nearly stable. Manifest refraction spherical equivalent and axial length play a significant role in the change of postoperative Q value.
Collapse
Affiliation(s)
- Zheng-Wei Zhang
- Department of Ophthalmology, First People's Hospital of Shanghai Affiliated to Shanghai Jiaotong University, Shanghai 200080, China
| | | | | | | | | |
Collapse
|
80
|
Zhang ZH, Jin HY, Suo Y, Patel SV, Montés-Micó R, Manche EE, Xu X. Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia: Metaanalysis of randomized controlled trials. J Cataract Refract Surg 2011; 37:2151-9. [DOI: 10.1016/j.jcrs.2011.05.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 05/18/2011] [Accepted: 05/23/2011] [Indexed: 10/15/2022]
|
81
|
Laser-assisted in situ keratomileusis in high levels of myopia with the amaris excimer laser using optimized aspherical profiles. Am J Ophthalmol 2011; 152:954-963.e1. [PMID: 21871602 DOI: 10.1016/j.ajo.2011.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 05/06/2011] [Accepted: 05/10/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of laser-assisted in situ keratomileusis (LASIK) surgery for the correction of high myopia using a new generation of excimer laser (500-Hz repetition rate) and optimized aspherical profiles. DESIGN Retrospective interventional case series. METHODS Retrospective study including 51 eyes of 32 patients (age range 23-61 years) with high levels of myopia or myopic astigmatism (spherical equivalent ≥8.5 diopters [D]). All cases underwent uneventful LASIK surgery using the sixth-generation excimer laser Amaris from Schwind and a femtosecond platform for flap creation. Postoperative changes in visual acuity and refraction were recorded and analyzed during a 6-month follow-up. RESULTS A significant improvement of about 15 logMAR lines was observed in uncorrected distance visual acuity (UCDVA) at 3 months after surgery (P < .01), with no significant changes afterwards (P = .61). This improvement was consistent with a significant reduction of manifest refraction (P < .01). Best corrected distance visual acuity (BCDVA) remained unchanged or improved in 98% of eyes at 3 months postoperatively, with only 1 eye losing 1 logMAR line of BCDVA. A similar distribution of BCDVA data was observed at 6 months postoperatively. A total of 84.3% of eyes had a postoperative spherical equivalent within ±0.50 D of emmetropia. A limited but significant induction of primary spherical aberration and coma was also found (P < .01). LASIK enhancement was required during the follow-up in only 4 eyes (7.8%). CONCLUSIONS LASIK for high myopia using optimized aspherical profiles and the Amaris excimer laser is a safe, effective, and predictable procedure.
Collapse
|
82
|
Correction of high myopia with a phakic intraocular lens: Interim analysis of clinical and patient-reported outcomes. J Cataract Refract Surg 2011; 37:1426-33. [DOI: 10.1016/j.jcrs.2011.02.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 11/18/2022]
|
83
|
Alió JL, Wolter NV, Piñero DP, Amparo F, Sari ES, Cankaya C, Laria C. Pediatric Refractive Surgery and Its Role in the Treatment of Amblyopia: Meta-Analysis of the Peer-Reviewed Literature. J Refract Surg 2011; 27:364-74. [DOI: 10.3928/1081597x-20100831-01] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 07/15/2010] [Indexed: 11/20/2022]
|
84
|
Vilaseca M, Padilla A, Ondategui JC, Arjona M, Güell JL, Pujol J. Effect of laser in situ keratomileusis on vision analyzed using preoperative optical quality. J Cataract Refract Surg 2010; 36:1945-53. [PMID: 21029904 DOI: 10.1016/j.jcrs.2010.05.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 05/18/2010] [Accepted: 05/18/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect on vision of laser in situ keratomileusis (LASIK) based on preoperative optical quality. SETTING Universitat Politècnica de Catalunya, Terrassa, and Barcelona Institute of Ocular Microsurgery, Barcelona, Spain. DESIGN Comparative case series. METHODS The relative change in optical quality and visual acuity were evaluated in eyes that had LASIK for myopia. The optical quality was assessed before and 3 months after surgery using parameters provided by a double-pass system. Patients were classified into 4 groups by preoperative optical quality: low (Group 1), moderate (Group 2), high (Group 3), and very high (Group 4). RESULTS The study evaluated 25 patients (50 eyes). The optical quality parameters improved postoperatively in Group 1 and Group 2, with the improvement ranging from 15% to 21% and from 13% to 17%, respectively. The preoperative and postoperative optical quality in Group 3 was similar. The optical quality in Group 4 worsened significantly by percentages ranging from -20% to -26%. Although visual acuity had the same trend, there were no statistically significant changes. CONCLUSION The changes in optical quality after LASIK surgery depended on the patient's preoperative optical quality; visual acuity showed the same trend, although no change was significant.
Collapse
Affiliation(s)
- Meritxell Vilaseca
- Centre for Sensors, Universitat Politècnica de Catalunya, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
85
|
Zalentein WN, Tervo TMT, Holopainen JM. Long-term follow-up of photorefractive keratectomy for myopia: Comparative study of excimer lasers. J Cataract Refract Surg 2010; 37:138-43. [PMID: 21067894 DOI: 10.1016/j.jcrs.2010.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 07/21/2010] [Accepted: 07/21/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the long-term results of photorefractive keratectomy (PRK) for low to moderate myopia performed using a broad-beam laser system or a scanning-slit laser system. SETTING Department of Ophthalmology, University of Helsinki, Helsinki, Finland. DESIGN Case-control study. METHODS This follow-up study comprised eyes with myopia (-1.25 to -7.00 diopters [D]) or myopic astigmatism (astigmatism lower than -2.50 D) corrected by PRK using a broad-beam (Visx) or scanning-slit (Nidek) laser. Follow-up included a visit at 3 months and at more than 8 years. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were recorded. RESULTS The broad-beam group comprised 27 eyes and the scanning-slit group, 34 eyes. At the last postoperative follow-up, the UDVA was 0.0 or better in 55% of eyes in the broad-beam group and 65% of eyes in the scanning-slit group. The CDVA was 0.0 or better in all eyes in the broad-beam group and 96% of eyes in the scanning-slit group. Regarding predictability, 48% and 73% of the eyes, respectively, were within ±0.50 D of the intended spherical equivalent refraction. There were no statistically significant differences between the 2 laser groups in any preoperative or postoperative parameter. CONCLUSION There were no significant differences in UDVA, CDVA, or SE after PRK for low to moderate myopia between the broad-beam laser system and the scanning-slit laser system. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
|
86
|
Muftuoglu O, Dao L, Mootha VV, Verity SM, Bowman WR, Cavanagh DH, McCulley JP. Apodized diffractive intraocular lens implantation after laser in situ keratomileusis with or without subsequent excimer laser enhancement. J Cataract Refract Surg 2010; 36:1815-21. [DOI: 10.1016/j.jcrs.2010.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/06/2010] [Accepted: 05/07/2010] [Indexed: 11/27/2022]
|
87
|
Bamashmus M, Saleh MF, Abdulrahman M, Al-Kershy N. Reasons for not performing LASIK in refractive surgery candidates in Yemen. Eur J Ophthalmol 2010; 20:858-64. [PMID: 20383849 DOI: 10.1177/112067211002000508] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine and analyze the reasons that laser in situ keratomileusis (LASIK) was not performed in patients who requested refractive surgical correction of their refractive errors. METHODS A retrospective observational study was performed in Yemen Magrabi Hospital between June 2005 and October 2006; the case records of 1596 new consecutive patients who presented for refractive surgery at our refractive surgery unit were reviewed. Data on the ocular status, refractive problems, and investigations performed were analyzed. The reasons for not performing LASIK in the cases that were rejected were recorded and analyzed. RESULTS A total of 1191 patients (74.6%) were advised to have LASIK of the 1596 patients examined. LASIK was not advised in 405 patients (25.4%). The most common reasons for rejecting LASIK were suboptimal central corneal thickness (25.9%), high myopia >-11.00 D (17.0%), keratoconus (15.5%), cataract (11.4%), and suspicious corneal topography (forme fruste keratoconus) (9.4%). CONCLUSIONS Patients who request refractive surgery have a variety of problems and attention must be given to these patients. Suboptimal corneal thickness, high amount of refractive error, and keratoconus were found to be the leading causes of not performing LASIK in Yemeni patients.
Collapse
Affiliation(s)
- Mahfouth Bamashmus
- Eye Department, Faculty of Medicine and Health Sciences, Sana'a University, Magrabi Eye Hospital, Sana'a, Republic of Yemen.
| | | | | | | |
Collapse
|
88
|
Rosman M, Alió JL, Ortiz D, Pérez-Santonja JJ. Refractive stability of LASIK with the Visx 20/20 excimer laser vs ZB5m phakic iol implantation in patients with high myopia (>-10.00 d): a 10-year retrospective study. J Refract Surg 2010; 27:279-86. [PMID: 20672763 DOI: 10.3928/1081597x-20100707-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/17/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the long-term outcomes of LASIK and ZB5M phakic intraocular lens implantation (PIOL) (Domilens) for high myopia (>-10.00 diopters [D]). METHODS This long-term (10 years) follow-up retrospective interventional case series study included 126 eyes that underwent LASIK and 52 eyes that underwent ZB5M angle-supported PIOL implantation. Both groups of eyes were similar in terms of preoperative spherical equivalent refraction (SE), corrected distance visual acuity (CDVA), and age. RESULTS Mean preoperative SE was -14.33 D in the LASIK group and -14.84 D in the PIOL group. At 10-year follow-up, mean postoperative SE was -1.47±2.00 D in the LASIK group and -1.01±1.36 D in the PIOL group (P=.21). In the LASIK group, 67% of eyes were within ±1.00 D of emmetropia at 2 years after surgery, compared to 42% at 10 years. In the PIOL group, 68% of eyes were within ±1.00 D of emmetropia 2 years after implantation compared to 53% at 10 years. In the LASIK group, 43.5% of eyes achieved UDVA of 20/40 or better 10 years after surgery compared to 67.9% in the PIOL group (P=.02). CONCLUSIONS The ZB5M angle-supported PIOL was shown to have better predictability and stability compared to LASIK over 10 years. However, reductions in endothelial cell count over time were observed in eyes with PIOLs.
Collapse
Affiliation(s)
- Mohamad Rosman
- Vissum/Instituto Oftalmológico de Alicante. Alicante, Spain
| | | | | | | |
Collapse
|
89
|
Calvo R, McLaren JW, Hodge DO, Bourne WM, Patel SV. Corneal aberrations and visual acuity after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome. Am J Ophthalmol 2010; 149:785-93. [PMID: 20227675 DOI: 10.1016/j.ajo.2009.12.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/10/2009] [Accepted: 12/12/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare corneal high-order aberrations and visual acuity after laser in situ keratomileusis (LASIK) with the flap created by a femtosecond laser (bladeless) to LASIK with the flap created by a mechanical microkeratome. DESIGN Prospective, randomized, paired-eye study. METHODS Fellow eyes of 21 patients with myopia or myopic astigmatism were randomized by ocular dominance. Corneal topography and visual acuity were measured before and at 1, 3, 6, 12, and 36 months after LASIK. Wavefront errors from the anterior corneal surface were calculated from the topography data over 4- and 6-mm-diameter pupils and decomposed into Zernike polynomials to the 6th order. RESULTS There were no differences in corneal total high-order aberrations, spherical aberration, coma, or trefoil between methods of flap creation at any examination over 4- and 6-mm-diameter pupils. Over a 6-mm pupil, total high-order aberrations increased by 1 month after LASIK with both treatments (P <or= .001) and remained increased through 36 months (P <or= .001). Uncorrected and best-corrected visual acuity did not differ between methods at any examination and remained stable postoperatively through 3 years; the minimum detectable difference in visual acuity between treatments was <or=0.1 logMAR (<or=1 line of vision, alpha = 0.05/6, beta = 0.20, n = 21). CONCLUSIONS The planar configuration of the femtosecond laser flap did not offer any advantage in corneal high-order aberrations or visual acuity through 3 years after LASIK. Corneal high-order aberrations remain stable through 3 years after LASIK.
Collapse
|
90
|
Koshimizu J, Dhanuka R, Yamaguchi T. Ten-year follow-up of photorefractive keratectomy for myopia. Graefes Arch Clin Exp Ophthalmol 2010; 248:1817-25. [PMID: 20300767 DOI: 10.1007/s00417-010-1312-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 12/29/2009] [Accepted: 01/18/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the long-term (10-year) outcome of excimer laser photorefractive keratectomy (PRK) on myopic eyes. METHODS This retrospective study included 42 eyes of 29 patients (13 male, 16 female; mean age 33.4 years, range 21 to 60) who were treated with myopic PRK at St. Luke's International Hospital, Tokyo, Japan, from May 1 1995 to December 31 1998, and followed up for more than 10 years. The main outcome measures were efficacy, predictability, stability, safety, and complications. We also evaluated the progress of intraocular pressure, corneal thickness, and endothelial cell density after the surgery. The cases of retreatments were excluded from this study. RESULTS Ten years after the surgery, 17 eyes (40%) had 20/20 vision or better, and 35 eyes (81%) had 20/40 or better. With regard to the refractive predictability, 55 percent of the eyes were within ± 1.0D and 76% were within ± 2.0D, 10 years after the surgery. There was myopic regression with a mean change in refraction of-0.51 ± 1.78D. Best spectacle-corrected visual acuity (BCVA) was unchanged or improved in 95%, and only two eyes lost 1 line of BCVA. The mean corneal haze score was 0.19 ± 0.40, and the decreasing rate of endothelial cell was 8.30 ± 9.94% at 10 years, which was slightly higher than the spontaneous decreasing rate with age. CONCLUSIONS PRK is safe and effective in refraction even 10 years after surgery; however, further long-term follow-up is needed to evaluate the decreasing of endothelial cells.
Collapse
Affiliation(s)
- Junko Koshimizu
- Department of Ophthalmology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba-ken, 279-0021, Japan.
| | | | | |
Collapse
|
91
|
Yuen LH, Chan WK, Koh J, Mehta JS, Tan DT. A 10-year prospective audit of LASIK outcomes for myopia in 37,932 eyes at a single institution in Asia. Ophthalmology 2010; 117:1236-1244.e1. [PMID: 20153899 DOI: 10.1016/j.ophtha.2009.10.042] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 10/25/2009] [Accepted: 10/26/2009] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study evaluates the efficacy, predictability and safety of LASIK surgery as a treatment for myopia performed as part of a large-scale, prospective clinical audit spanning 10 years in an Asian study population and to evaluate the outcomes and trends. DESIGN Prospective, nonrandomized, single-center, multisurgeon study. PARTICIPANTS We included 37,932 eyes of 19,753 patients that underwent myopic LASIK at the Singapore National Eye Centre between 1998 and 2007. METHODS All eyes underwent LASIK as a treatment for myopia. Pre- and postoperative refractions, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were documented. MAIN OUTCOMES MEASURES Safety, efficacy, refractive predictability, treatment trends, retreatment rates, and complications for mild, moderate, and high myopia according to spherical equivalence (SE) of less than -5.00 diopters (D), -5.00 D or more to less than -10.0 D, and -10.00 D or more, respectively. RESULTS Patients' median age was 32 years (mean, 33.0+/-7.9 years); there were 6832 males (34.6%) and 12,921 females included. Patients were predominantly ethnic Chinese (90.5%). Mean follow-up time was 68.8 days. The mean spherical error corrected was -5.90+/-2.57 D (median, -5.625 D), and outcomes were categorized into low, moderate, or high myopia. The UCVA achieving > or =20/40 has been consistently above 90% since 2000, with 72.8% achieving > or =20/20. More than 93.0% of eyes achieved within +/-1.00 D target in the last 4 years. An improvement in safety was observed since the start of the study, with the best outcomes observed in 2007; loss of 1 and 2 Snellen line BCVA postoperatively was 2.4% and 0.1%, respectively. The overall retreatment rate was 3.8%; 91% of retreated eyes achieved UCVA of > or =20/30. Between 1998 and 2007, there was a significant improvement in postoperative UCVA and BCVA (P<0.001). CONCLUSIONS Myopic LASIK performed in Asian eyes within a comprehensive LASIK clinical program with appropriate clinical audit governance can be safe and effective, with high refractive predictability. Improvements in the nomograms to prevent undercorrection and to compensate for myopic regression have led to better efficacy after LASIK, with an increasing percentage of patients achieving 20/15 visual acuity postoperatively.
Collapse
Affiliation(s)
- Leonard H Yuen
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore
| | | | | | | | | | | |
Collapse
|
92
|
|
93
|
Amoozadeh J, Aliakbari S, Behesht-Nejad AH, Seyedian MA, Rezvan B, Hashemi H. Confocal microscopy of corneal stroma and endothelium after LASIK and PRK. J Refract Surg 2009; 25:S963-7. [PMID: 19848379 DOI: 10.3928/1081597x-20090915-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare with confocal microscopy the changes in stromal keratocyte density and endothelial cell count due to photorefractive keratectomy (PRK) and LASIK. METHODS In this prospective study, 32 eyes (16 myopic patients) were examined with the NIDEK Confoscan 3 confocal microscope before and 6 months after PRK and LASIK. The preoperative mean myopia was -2.85+/-0.99 diopters (D) (range: -1.00 to -4.00 D) in 24 eyes that underwent PRK and -2.94+/-0.96 D (range: -2.00 to -4.25 D) in 8 eyes that underwent LASIK. Keratocyte density in the anterior and posterior stroma and the endothelial cell count were measured. Statistically significant changes were assessed using the t test. P<.05 was considered statistically significant. RESULTS Preoperative hexagonal cell percentage in the LASIK group was 52.17+/-11.43 and 51.33+/-10.98 in the PRK group. Postoperatively, the percentages were 52.96+/-7.55 and 53.34+/-10.2, respectively. Six months postoperatively, keratocyte density changed by 367.12+/-103.35 cells/mm(2) (34.7% reduction) in the anterior stroma (P<.05) and 9.25+/-28.28 cells/mm(2) (1.31% reduction) in the posterior stroma (P>.05) for the LASIK group. In the PRK group, these values were 319.71+/-83.45 cells/mm(2) (31.13% reduction) in the anterior stroma (P<.05) and 0.17+/-38.97 cells/mm(2) (0.02% reduction) in the posterior stroma (P>.05). The changes in keratocyte densities were not statistically significant between groups (P>.05). The mean number of keratocytes decreased by 37.2% in the retroablation zone of the LASIK group (P<.05). No changes were noted in endothelial cell counts. CONCLUSIONS A significant decrease occurred in the number of stromal keratocytes in the anterior stroma. Despite differences in surgery, the change in keratocyte density and endothelial cell counts were similar between LASIK and PRK groups (P>.05).
Collapse
Affiliation(s)
- Javad Amoozadeh
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
94
|
Comparison of the changes in corneal biomechanical properties after photorefractive keratectomy and laser in situ keratomileusis. Cornea 2009; 28:765-9. [PMID: 19574911 DOI: 10.1097/ico.0b013e3181967082] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the postoperative biomechanical properties of the cornea after photorefractive keratectomy (PRK) and after laser in situ keratomileusis (LASIK) in eyes with myopia. METHODS We retrospectively examined 27 eyes of 16 patients undergoing PRK and 31 eyes of 16 patients undergoing LASIK for the correction of myopia. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with Ocular Response Analyzer before and 3 months after surgery. We also investigated the relationship between these biomechanical changes and the amount of myopic correction. RESULTS The CH was decreased significantly from 10.8 +/- 1.3 (mean +/- SD) mmHg to 9.2 +/- 1.6 mmHg after PRK (P < 0.001), and from 10.8 +/- 1.4 mmHg to 8.6 +/- 0.9 mmHg after LASIK (P < 0.001). The CRF was also decreased significantly, from 10.3 +/- 1.5 mmHg to 8.4 +/- 1.8 mmHg after PRK (P < 0.001), and from 10.3 +/- 1.5 mmHg to 7.7 +/- 1.3 mmHg after LASIK (P < 0.001). The amount of decrease in CH and CRF was significantly larger after LASIK than after PRK (P = 0.04). There was a significant correlation between the amount of myopic correction and changes in biomechanical properties after PRK (r = -0.61, P < 0.01 for CH, r = -0.41, P < 0.05 for CRF) and LASIK (r = -0.37, P < 0.05 for CH, r = -0.45, P < 0.05 for CRF). CONCLUSIONS Both PRK and LASIK can affect the biomechanical strength of the cornea depending on the amount of myopic correction. The amount of biomechanical changes is larger after LASIK than after PRK. From a biomechanical viewpoint, PRK may be a less invasive surgical approach for the correction of myopia than LASIK.
Collapse
|
95
|
Sinha Roy A, Dupps WJ. Effects of altered corneal stiffness on native and postoperative LASIK corneal biomechanical behavior: A whole-eye finite element analysis. J Refract Surg 2009; 25:875-87. [PMID: 19835328 DOI: 10.3928/1081597x-20090917-09] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 11/20/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the impact of corneal elasticity on corneal shape changes before and after simulated LASIK with and without consideration of whole-eye biomechanics. METHODS A finite element whole-eye model of a human eye was constructed. The cornea was modeled as hyperelastic and incompressible using experimental data representing a range of corneal stiffness. The corneal response to intraocular pressure loading and LASIK for 2.00, 4.00, and 6.00 diopters of spherical myopia was analyzed as a function of corneal stiffness and limbal boundary conditions. RESULTS Myopic LASIK produced different degrees of central flattening and postoperative ametropia in low-stiffness and high-stiffness corneas. Although a cornea-only model demonstrated maximum stresses and displacements in the central cornea and predicted residual myopia, a whole-eye model with equivalent corneal stiffness predicted greater paracentral displacements and less myopic undercorrection. In a whole-eye model with a stiffer cornea, maximum displacements shifted further toward the limbus, favoring additional mechanically mediated central flattening and refractive overcorrection (hyperopia). In postoperative LASIK models thinned by high myopic corrections, corneal stiffening caused central cornea flattening. CONCLUSIONS Differences in the corneoscleral stiffness relationship affect simulated refractive outcomes after LASIK and may be a source of individual variation in refractive surgery outcomes. A whole-eye model allowing limbal motion illustrates a stiffness-dependent biomechanical balance between central corneal flattening and pre-ectatic weakening of the corneal apex not demonstrated in previous computational models and provides insight into under- and overcorrection in myopic LASIK and the previously unexplained phenomenon of corneal flattening after therapeutic collagen cross-linking for keratoconus.
Collapse
|
96
|
Sayegh FN. Age and refraction in 46,000 patients as a potential predictor of refractive stability after refractive surgery. J Refract Surg 2009; 25:747-51. [PMID: 19714800 DOI: 10.3928/1081597x-20090707-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the process of emmetropization and determine the potential for progression of refractive error following refractive surgery. METHODS The prevalence of refractive error was retrospectively examined in 46,384 consecutive patients (77,124 eyes) at an outpatient clinic in Amman, Jordan. Biometry was also obtained in 4240 eyes. Correlation of axial length and corneal power as a function of age was determined based on these data. RESULTS Patients were distributed into four distinct groups: emmetropia, hyperopia, low to moderate myopia, and high (> 6.00 diopters [D]) myopia. The prevalence of myopia was found to be 23.8%. High myopia occurred in 3.8% of patients, and 17.5% of patients were hyperopic. Patients with < 1.00 D of myopia at age 10 and < 3.00 D of myopia at the time of refractive surgery had a stable refraction at age 18. In patients with high myopia, 7.4% demonstrated a progression of corneal power and axial length that does not stabilize until age 30. Finally, the refractive error of hyperopic patients tended to progress from age 30 to age 50. CONCLUSIONS Myopes with < 1.00 D of myopia at age 10 and < 3.00 D of myopia at the time of refractive surgery are unlikely to progress. High myopes and hyperopes have potential to progress. Patients in which the axial length of the eye exceeds 26 mm in conjunction with higher corneal powers are likely in a state of decomposition and are at risk of marked progression of refractive error following refractive surgery. The likelihood of progression should be determined prior to surgery and explained to the patient.
Collapse
|
97
|
Laser in situ keratomileusis for residual refractive errors after apodized diffractive multifocal intraocular lens implantation. J Cataract Refract Surg 2009; 35:1063-71. [DOI: 10.1016/j.jcrs.2009.01.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/24/2009] [Accepted: 01/29/2009] [Indexed: 11/19/2022]
|
98
|
Vilaseca M, Padilla A, Pujol J, Ondategui JC, Artal P, Güell JL. Optical Quality One Month After Verisyse and Veriflex Phakic IOL Implantation and Zeiss MEL 80 LASIK for Myopia from 5.00 to 16.50 Diopters. J Refract Surg 2009; 25:689-98. [PMID: 19714793 DOI: 10.3928/1081597x-20090707-03] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Meritxell Vilaseca
- Centre de Desenvolupament de Sensors, Instrumentació i Sistemes (CD6), Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, 08222 Terrassa, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
99
|
Best-spectacle corrected visual acuity before excimer laser refractive surgery. Am J Ophthalmol 2008; 145:1109-10; author reply 1110. [PMID: 18503791 DOI: 10.1016/j.ajo.2008.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 03/05/2008] [Indexed: 11/23/2022]
|
100
|
Waring GO. Have you seen the 10-Year long-term safety data on laser in situ keratomileusis? Am J Ophthalmol 2008; 145:1-2. [PMID: 18154748 DOI: 10.1016/j.ajo.2007.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 10/18/2007] [Indexed: 11/29/2022]
|