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Walker NJ, Apel AJG. Effect of hinged lamellar keratotomy on post-keratoplasty astigmatism and vision. Clin Exp Ophthalmol 2004; 32:147-53. [PMID: 15068430 DOI: 10.1111/j.1442-9071.2004.00800.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To show that hinged lamellar keratotomy alone affects refraction and vision in post-keratoplasty eyes. METHODS A retrospective, non-comparative, interventional case series was conducted on 28 eyes of 26 patients who had two-stage laser in situ keratomileusis (LASIK) after penetrating keratoplasty. Records were reviewed with respect to the hinged lamellar keratotomy component of the procedure. The interval between keratoplasty and keratotomy was at least 1 year, and the follow-up period averaged 29 +/- 10 days. The Automated Corneal Shaper with nasal hinge was used. In addition to basic empirical astigmatism calculations, the Alpins method of astigmatism analysis was also employed to ensure that the influence of changes in cylinder axis were correctly taken into account when calculating the refractive change. RESULTS Surgically induced astigmatism from hinged lamellar keratotomy was not statistically significant in this series; however, the range in values (-9.06 to +7.57 D) has potential clinical ramifications. Nearly 70% of cases studied experienced surgically induced astigmatism of at least 2 D. Mean preoperative uncorrected vision was logMAR 1.06 +/- 0.41, which improved marginally postoperatively to logMAR 1.03 +/- 0.44 (P = 0.36). Best spectacle-corrected visual acuity averaged logMAR 0.21 +/- 0.16 preoperatively, improving to logMAR 0.09 +/- 0.15 (range -0.18 to 0.42) postoperatively, which was a statistically significant improvement (P < 0.01). No difference in refractive or visual outcomes was identified when those with keratoconus were compared to those with other underlying corneal disease processes. CONCLUSION Although mean surgically induced astigmatism was not statistically significant, hinged lamellar keratotomy caused considerable changes in astigmatism in nearly 70% of post-keratoplasty eyes studied. This suggests that clinically significant inaccuracies may result if a one-stage LASIK procedure is performed on such patients. The authors suggest that reassessment of refraction after keratotomy may improve refractive outcomes.
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Affiliation(s)
- Nathan J Walker
- Ophthalmology Department, Cairns Base Hospital, Cairns, Queensland, Australia.
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Barraquer C C, Rodriguez-Barraquer T. Five-Year Results of Laser In-Situ Keratomileusis (LASIK) After Penetrating Keratoplasty. Cornea 2004; 23:243-8. [PMID: 15084856 DOI: 10.1097/00003226-200404000-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the long-term refractive results of LASIK after penetrating keratoplasty. PLACE Clinica Barraquer de América. METHODS Retrospective review of 46 eyes of 38 patients that underwent LASIK for the correction of refractive errors after penetrating keratoplasty. RESULTS The mean interval between keratoplasty and LASIK was 7 years. The preoperative defocus equivalent refraction (DEQ) was 2.0 to 7.0 D in 56% (26/46) of eyes and 8.0 to 24.0 D in the remaining 20 eyes. Five years after LASIK, DEQ was 1.0 to 7.0 D in all eyes. Seventy-five percent of eyes had a refractive error within 2.00 D of emmetropia. Thirty-two percent had uncorrected visual acuity of 20/40 or better, and 59% of eyes gained more than 1 line of best spectacle-corrected visual acuity at 5 years. Vector analysis showed a success index of 60% at 5 years. The refraction in eyes with keratoconus remained stable. CONCLUSION LASIK is safe and effective for the correction of refractive errors in eyes that have previously undergone corneal transplantation.
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Affiliation(s)
- Carmen Barraquer C
- Department of Refractive Surgery, Instituto Barraquer de América, Bogotá, Colombia
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Abstract
PURPOSE Media publicity has made patients increasingly aware that surgical vision correction is available. This article gives an overview on refractive surgery and contact lenses. METHODS Contact lens and refractive surgery possibilities are highlighted for patients with myopia, hyperopia, astigmatism, presbyopia, aphakia, and keratoconus. Therapeutic, pediatric, and cosmetic indications are discussed. RESULTS Refractive surgery is beneficial for low refractive errors. The use of contact lenses is mandatory in cases of monovision and strabismus before refractive surgery and beneficial for therapeutic use postoperatively. CONCLUSION Although many patients are always best corrected with contact lenses, only the right synergism of contact lenses and refractive surgery will benefit patients.
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Affiliation(s)
- Ursula Vogt
- Contact Lens Department, Western Eye Hospital, London, United Kingdom
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Vajpayee RB, Sharma N, Sinha R, Bhartiya P, Titiyal JS, Tandon R. Laser in-situ keratomileusis after penetrating keratoplasty. Surv Ophthalmol 2003; 48:503-14. [PMID: 14499818 DOI: 10.1016/s0039-6257(03)00085-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Laser in situ keratomileusis (LASIK) after penetrating keratoplasty has been used more commonly for the correction of myopia or myopic astigmatism and less so for hypermetropia or hyperopic astigmatism. The primary goal after LASIK in such cases is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and decrease anisometropia. All sutures should be removed prior to LASIK and the interval between penetrating keratoplasty and LASIK should be a minimum of 1 year. Preoperative evaluation includes refraction, slit-lamp biomicroscopy, corneal topography, and specular microscopy. The technique of LASIK surgery after penetrating keratoplasty is similar to the standard procedure. However, many variations have been described. These include maneuvers during surgery such as augmentation with arcuate cuts on the stromal bed and topographically guided LASIK. Other variations are relaxing incisions followed by LASIK surgery and sequential treatment by LASIK, that is, raising of the flap as a first stage procedure followed by ablation if required, 4 to 6 weeks later after relifting the flap in the second stage. Improvement in both uncorrected visual acuity and spectacle-corrected visual acuity, as well as a decrease in spherical equivalent, cylinder, and anisometropia, has been reported in various studies. All grafts were clear and no occurrence of wound dehiscence has been reported. Intraoperative complications include hemorrhage, microkeratome failure, flap buttonhole, dislocation, and perforation. Postoperative complications include undercorrection, decentered ablation, and regression. Re-enhancements after LASIK following keratoplasty are possible with acceptable visual outcome.
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Affiliation(s)
- Rasik B Vajpayee
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chang SM, Su CY, Lin CP. Correction of astigmatism after penetrating keratoplasty by relaxing incision with compression suture: a comparison between the guiding effect of photokeratoscope and of computer-assisted videokeratography. Cornea 2003; 22:393-8. [PMID: 12827041 DOI: 10.1097/00003226-200307000-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the results of astigmatism correction after penetrating keratoplasty by relaxing incision with compression suture and to compare the guiding ability of a photokeratoscope with that of computer-assisted videokeratography. METHODS In the two independent retrospective series, 11 eyes received a relaxing incision with compression suture guided by photokeratoscope or computer-assisted videokeratography. RESULTS In 22 eyes, the relaxing incision with compression suture showed a mean 56% reduction in astigmatism and 78% reduction in vector-calculated astigmatism. The mean postoperative visual acuity was improved 2.92 Landolt lines. The 11 eyes in which treatment was guided by photokeratoscope demonstrated a mean reduction of 50% and 71% in astigmatism and vector-calculated astigmatism, respectively, and visual acuity increased 2.44 Landolt lines. Another 11 eyes in which treatment was guided by computer-assisted videokeratography achieved a mean reduction of 67% and 90% in astigmatism and vector-calculated astigmatism, respectively, together with 3.41 Landolt lines improvement in visual acuity. There were no significant differences in astigmatism correction and visual acuity improvement between the two groups. CONCLUSION The results demonstrate that the relaxing incision with compression suture is an effective and safe procedure for correcting high astigmatism after penetrating keratoplasty. The two instruments have no significant difference in their guiding capacities for this procedure.
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Affiliation(s)
- Sheng-Ming Chang
- Department of Ophthalmology, Yuan's General Hospital, Kaoshing, Taiwan
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Dursun D, Forster RK, Feuer WJ. Surgical technique for control of postkeratoplasty myopia, astigmatism, and anisometropia. Am J Ophthalmol 2003; 135:807-15. [PMID: 12788120 DOI: 10.1016/s0002-9394(02)02287-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We previously demonstrated that selective suture removal reduces keratoplasty astigmatism; however, a myopic shift was induced with the increasing number of interrupted sutures removed. This study is an attempt to determine the effects of a modified surgical technique on postkeratoplasty myopia, astigmatism, and anisometropia. DESIGN A cohort study compared with historical controls. METHOD Optical penetrating keratoplasties were performed on 92 eyes of 84 patients. The study group consisted of 92 consecutive penetrating keratoplasties performed using 12 interrupted 10-0 nylon sutures and a tight 12-bite continuous suture and an average K reading of 46.00 diopters for eyes undergoing combined and intraocular lens exchange procedures. All patients had refraction, keratometry, and videokeratoscopy postoperatively starting at 6 weeks and at the completion of selective suture removal. RESULTS Before suture removal, the average spherical equivalent was -0.160 +/- 3.59 diopters; it was -1.58 +/- 3.66 diopters at the completion of suture removal at 1 year and -1.44 +/- 3.72 at the last follow-up visit, averaging 20.7 months. Final refractive, keratometric, and videokeratoscopy astigmatism was 2.81 +/- 1.82, 4.19 +/- 2.94, and 3.58 +/- 2.03 diopters, respectively. Anisometropia, using the spherical equivalent of the operated and fellow eyes, was 2.49 +/- 2.25 diopters at completion of the study. A best-corrected visual acuity of 20/50 or better was achieved in 59% of patients. CONCLUSIONS Low myopic spherical equivalent and anisometropia were achieved using a K reading of 46 diopters for calculation of intraocular lens power. The use of tighter continuous sutures and selective removal of fewer interrupted sutures only served to increase final astigmatism, with no significant effect on the final spherical equivalent.
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Affiliation(s)
- Dilek Dursun
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, School of Medicine, Miami, Florida 33101, USA
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Busin M, Zambianchi L, Garzione F, Maucione V, Rossi S. Two-stage Laser in situ Keratomileusis to Correct Refractive Errors After Penetrating Keratoplasty. J Refract Surg 2003; 19:301-8. [PMID: 12777025 DOI: 10.3928/1081-597x-20030501-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of a two-stage laser in situ keratomileusis (LASIK) procedure on eyes with high astigmatism and/or anisometropia after penetrating keratoplasty. METHODS Eleven postoperative penetrating keratoplasty eyes were included in a prospective, non-controlled study. All patients had at least 4.00 D of astigmatism and/or at least 3.00 D of anisometropia and were spectacle and contact lens intolerant. Two-stage LASIK was performed; in the first stage a hinged corneal flap 160 microm in thickness and 9 mm in diameter was created. After stabilization of corneal shape (1 to 3 months after keratotomy), the corneal flap was lifted and laser refractive treatment (second stage) was performed. RESULTS After the first stage, a statistically significant reduction in refractive astigmatism (P<.01) was recorded. In all eyes but one, best spectacle-corrected visual acuity was maintained or improved after the procedure. Three months after the second stage, refractive astigmatism in 8 of 11 eyes (73%) was within +/- 1.00 D, and spherical equivalent refraction in 9 of 11 eyes (82%) was within +/- 1.00 D of intended correction. Preoperative irregular astigmatism persisted in three patients (3 eyes) who could not be corrected within +/- 1.00 D of refractive astigmatism and/or +/- 1.00 D of intended spherical equivalent refraction. In one eye, an interface infiltrate developed shortly after creation of the flap, and resulted in limited melting. CONCLUSIONS A two-stage LASIK procedure improved visual acuity and refraction in postoperative penetrating keratoplasty eyes with high astigmatism and/or anisometropia. Complications were uncommon but can lead to loss of vision.
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Affiliation(s)
- Massimo Busin
- Villa Serena Hospital, Department of Ophthalmology, Forli, Italy.
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Abstract
PURPOSE To present a case of successful laser in situ keratomileusis (LASIK) performed on a patient with residual hyperopic astigmatism and symptomatic anisometropia after previous epikeratoplasty (epikeratophakia). METHODS LASIK was used successfully to treat hyperopic astigmatism after regression of epikeratophakia performed 16 years earlier. RESULTS Visual acuity improved to 20/30 without correction, and best-corrected visual acuity was 20/25 at the 3-month postoperative visit. CONCLUSIONS LASIK can be used successfully as an alternative treatment to correct residual refractive error after epikeratoplasty.
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Affiliation(s)
- W Barry Lee
- Department of Opthalmology, University of California, Davis, Sacramento, California 95817-23087, USA
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Lee GA, Pérez-Santonja JJ, Maloof A, Ficker LA, Dart JKG. Effects of lamellar keratotomy on postkeratoplasty astigmatism. Br J Ophthalmol 2003; 87:432-5. [PMID: 12642305 PMCID: PMC1771601 DOI: 10.1136/bjo.87.4.432] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the changes in postkeratoplasty astigmatism induced by lamellar keratotomy. METHODS A prospective, non-randomised comparative trial of patients undergoing a hinged lamellar corneal flap for treatment of significant astigmatism after penetrating keratoplasty. Uncorrected visual acuity, best corrected visual acuity, refraction, and corneal topography were assessed at 1 and 3 months after the lamellar keratotomy. RESULTS 17 eyes in 16 patients (13 M, 3F) were included in the study (mean age 48.2 years; range 20-86 years). Six of 17 eyes (35.3%) changed more than 1 dioptre (D) in spherical equivalent by 3 months. Nine of 17 eyes (52.9%) changed more than 1 D in sphere by 3 months. 12 of 17 eyes (70.6%) changed more than 1 D in refractive cylinder. Seven patients of 15 (46.7%) changed more than 1 D in corneal power as measured topographically. Five of 17 eyes (29.4%) changed in refractive cylinder axis more than 15 degrees and this was similar to the change measured topographically of four of 15 eyes (26.7%). Vector analysis showed 60% of eyes had a surgically induced astigmatism (SIA) vector of more than 1 D, including a net corneal astigmatism decrease of more than 1 D in four eyes and increase of more than 1 D in two eyes at 3 months after surgery. Complications of the lamellar keratotomy included two partial buttonholes and one partial wound dehiscence. CONCLUSIONS The creation of a lamellar flap alone can have significant effects on the astigmatism following penetrating keratoplasty. LASIK for correction of postkeratoplasty astigmatism may be more accurately performed as a two stage procedure rather than a single stage, after the corneal effects of the lamellar keratotomy have stabilised.
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Affiliation(s)
- G A Lee
- Cornea and External Disease Service, Moorfields Eye Hospital, London, UK.
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60
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Donnenfeld ED, Solomon R, Biser S. Laser in situ keratomileusis after penetrating keratoplasty. Int Ophthalmol Clin 2002; 42:67-87. [PMID: 12409923 DOI: 10.1097/00004397-200210000-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eric D Donnenfeld
- Ophthalmic Consultants of Long Island, Rockville, Centre, NY 11570, USA
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61
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Malecha MA, Holland EJ. Correction of myopia and astigmatism after penetrating keratoplasty with laser in situ keratomileusis. Cornea 2002; 21:564-9. [PMID: 12131031 DOI: 10.1097/00003226-200208000-00006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated whether laser in situ keratomileusis (LASIK) was a safe and effective treatment for myopia and astigmatism after penetrating keratoplasty (PK). METHODS We performed a retrospective review of medical records of all the patients who underwent LASIK following PK at the University of Minnesota between January 1999 and March 2000. RESULTS Seventeen patients (20 eyes) underwent LASIK following PK between January 1999 and March 2000. Mean age of the patients at the time of LASIK was 37 years (range, 20-62). Keratoconus was the indication for PK in the majority of the eyes (73.7%). Anisometropia and/or contact lens intolerance was the indication for LASIK following PK. No intraoperative complications occurred. Following LASIK, the best spectacle-corrected visual acuity remained within 1 line of preoperative visual acuity in 94.7% of the eyes. The mean sphere was reduced by 3.93 diopters (80.0%) and the mean cylinder was reduced by 2.83 diopters (69.9%) from the preoperative values at the last follow-up visit. Uncorrected visual acuity became 20/40 or better in 73.7% of the eyes after LASIK. CONCLUSIONS LASIK is a safe procedure in eyes in which PK has previously been performed. LASIK is effective in the treatment of myopia and astigmatism following PK.
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Affiliation(s)
- Monika A Malecha
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA.
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63
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Lee DH, Seo SJ, Shin SC. Topography-guided excimer laser ablation of irregular cornea resulting from penetrating injury. J Cataract Refract Surg 2002; 28:186-8. [PMID: 11777729 DOI: 10.1016/s0886-3350(01)00803-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A 26-year-old woman with irregular astigmatism caused by ocular perforation became aphakic in the injured left eye 2 years after the initial trauma. The initial corneoscleral wound repair was performed without intraocular lens implantation. The patient's uncorrected visual acuity in the right eye was 20/20 and in the left eye, counting fingers at 50 cm. The vision in the left eye could not be corrected with a spectacle because of high corneal astigmatism so a rigid gas-permeable contact lens was tried. With a contact lens, the acuity improved to 20/80; however, the patient could not wear the lens because of intolerance and severe astigmatism. As an alternative, topography-guided ablation was performed to correct the corneal astigmatism. Treatment of the irregular central cornea reduced the astigmatism. Three months postoperatively, the corrected visual acuity was 20/20 with a refraction of +8.00 -1.50 x 26. This case indicates that topography-guided ablation can be a useful surgical method for correcting surgically induced irregular astigmatism.
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Affiliation(s)
- Do-Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University Medical College, 2240 Dae Wha-dong, Ilsan-ku, Koyang, Kyunggyi-do, 411-410, Korea.
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Lima G da S, Moreira H, Wahab SA. Laser in situ keratomileusis to correct myopia, hypermetropia and astigmatism after penetrating keratoplasty for keratoconus: a series of 27 cases. CANADIAN JOURNAL OF OPHTHALMOLOGY 2001; 36:391-6; discussion 396-7. [PMID: 11794388 DOI: 10.1016/s0008-4182(01)80083-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Excimer laser treatment has been shown to be effective and safe in correcting anisometropia following penetrating keratoplasty (PKP). In this report we review our experience with excimer laser in situ keratomileusis (LASIK) to correct refractive myopia, hypermetropia and astigmatism in patients who had undergone PKP for keratoconus. METHODS We reviewed the records of 22 patients (27 eyes) who had undergone LASIK to correct myopia, hypermetropia or astigmatism, in simple or combined forms, following corneal transplantation for keratoconus. LASIK was performed at a hospital in Curitiba, Brazil, between September 1998 and February 2000. The eyes were classified into two groups: those with a negative spherical equivalent and those with a positive spherical equivalent. LASIK was performed using the Moria LSK microkeratome and the Nidek EC-5000 excimer laser. RESULTS The mean length of follow-up was 9.52 months for the 23 eyes with myopia and 5.75 months for the 4 eyes with hypermetropia. The mean refractive spherical equivalent in the myopic eyes was -5.27 (standard deviation [SD] 1.91) dioptres before LASIK and -0.45 D (SD 1.68 D) at the last follow-up visit. The corresponding values in the eyes with hypermetropia were +5.18 D (SD 1.46 D) and + 1.18 D (SD 0.94 D). The rate of regression of astigmatism in the myopic eyes was 76%. After surgery 18 (78%) of the myopic eyes and all the hypermetropic eyes had an uncorrected visual acuity of 20/40 or better. The best spectacle-corrected visual acuity was better than 20/25 in 22 (95.7%) of the myopic eyes and all the hypermetropic eyes. One eye lost 1 line of best spectacle-corrected Snellen visual acuity, and one eye lost 6 lines secondary to epithelial ingrowth. Wound dehiscence, intraoperative flap complications, graft rejection or other complications did not develop in this series. INTERPRETATION In this series, LASIK proved to be relatively safe and effective in correcting refractive errors after PKP for keratoconus.
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Affiliation(s)
- S Lima G da
- Hospital de Olhos do Paraná, Curitiba, Brazil
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Busin M, Arffa RC, Zambianchi L, Lamberti G, Sebastiani A. Effect of hinged lamellar keratotomy on postkeratoplasty eyes. Ophthalmology 2001; 108:1845-51; discussion 1851-2. [PMID: 11581060 DOI: 10.1016/s0161-6420(01)00702-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism. DESIGN Noncomparative, interventional case series. PARTICIPANTS A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant. INTERVENTION A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery. MAIN OUTCOME MEASURES Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. RESULTS At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications. CONCLUSIONS Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.
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Affiliation(s)
- M Busin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Abstract
Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By examining the etiology, management, and prevention of these complications, the refractive surgeon may be able to improve visual outcomes and prevent vision-threatening problems. Reporting outcomes and mishaps of LASIK surgery will help refine our approach to the management of emerging complications.
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Affiliation(s)
- S A Melki
- Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Boston, MA 02114, USA
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67
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Kwitko S, Marinho DR, Rymer S, Ramos Filho S. Laser in situ keratomileusis after penetrating keratoplasty. J Cataract Refract Surg 2001; 27:374-9. [PMID: 11255048 DOI: 10.1016/s0886-3350(00)00642-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the outcomes of laser in situ keratomileusis (LASIK) after penetrating keratoplasty (PKP). SETTING Hospital de Clínicas de Porto Alegre, Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. METHODS Fourteen eyes of 13 patients who had LASIK after PKP were retrospectively reviewed. The interval between LASIK and PKP was at least 1 year, and the follow-up after LASIK was also at least 1 year. All patients had a stable refractive error for a minimum of 6 months after all sutures were removed, regular and symmetric topographic astigmatism, and a minimal ultrasonic central corneal pachymetry of 500 microm. The Chiron Automatic Corneal Shaper and the Meditec Aesculap MEL 60 excimer laser were used. RESULTS At 12 months, mean myopia decreased from -5.33 diopters (D) +/- 4.22 (SD) to 0.19 +/- 1.71 D, mean hyperopia decreased from +5.04 +/- 3.32 D to + 0.42 +/- 0.46 D, and mean astigmatism decreased from 5.37 +/- 2.12 D to 2.82 +/- 2.42 D (47.5% of mean percentage reduction). Retreatment was necessary in 42.9% of eyes because of cylindrical undercorrection. Uncorrected visual acuity improved in 11 eyes (78.6%). Best spectacle-corrected visual acuity improved in 6 eyes (42.8%) and was maintained in 4 eyes (28.6%); 5 eyes (35.7%) lost 1 Snellen line. Intraoperative complications included 1 buttonhole flap. Postoperative complications included interface epithelial ingrowth at the periphery (2 eyes) and pseudophakic retinal detachment 2 years after LASIK (1 eye). CONCLUSION Laser in situ keratomileusis after PKP safely and predictably corrected the spherical component of the refraction. However, the predictability of LASIK in correcting post-PKP astigmatism was poor.
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Affiliation(s)
- S Kwitko
- Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
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68
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Affiliation(s)
- N Preschel
- Unidad Oftalmologica de Caracas, Centro Profesional Santa Paula, Caracas, Venezuela
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69
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Davis EA, Hardten DR, Lindstrom RL. Laser in situ keratomileusis after intracorneal rings. Report of 5 cases. J Cataract Refract Surg 2000; 26:1733-41. [PMID: 11134872 DOI: 10.1016/s0886-3350(00)00704-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the results of laser in situ keratomileusis (LASIK) after removal of intracorneal ring (ICR) segments. SETTING Active refractive surgery practice. METHODS The effect of ICR (0.45 mm) placement, the rapidity of refractive recovery after explantation, and the results of subsequent LASIK were examined in 5 eyes. RESULTS Four eyes developed induced astigmatism after ICR implantation. In 2 of these eyes, retained astigmatism was evident by manifest refraction or corneal topography even after ICR explantation. In 1 eye, the ICR procedure was aborted because of an intraoperative complication. All 5 eyes had subsequent uneventful LASIK. CONCLUSIONS Intracorneal rings can induce astigmatism that may be retained even after explantation. Careful wound manipulation may reduce the incidence of this complication. Laser in situ keratomileusis after ICR removal appears to be safe and effective.
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Affiliation(s)
- E A Davis
- Minnesota Eye Laser and Surgery Centers, Minneapolis, MN, USA
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70
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Rashad KM. Laser in situ Keratomileusis for Correction of High Astigmatism After Penetrating Keratoplasty. J Refract Surg 2000; 16:701-10. [PMID: 11110310 DOI: 10.3928/1081-597x-20001101-05] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) for correction of high astigmatism after penetrating keratoplasty, and to assess the refractive results and predictability of the procedure. METHODS LASIK was performed on 19 patients (19 eyes) with high astigmatism after penetrating keratoplasty, using the Chiron Automated Corneal Shaper and the Chiron-Technolas Keracor 116 excimer laser. The amount of preoperative refractive astigmatism ranged from 6.50 to 14.50 D (mean, 9.21 +/- 1.95 D) and the spherical component of manifest refraction ranged from -7.00 to +1.25 D (mean, -2.14 +/- 2.11 D). All patients completed a minimum follow-up of 12 months. RESULTS Refraction was stable after 3 months. At 1 year after LASIK, the amount of refractive astigmatism was reduced to a mean of 1.09 +/- 0.33 D (range, 0.50 to 1.75 D), with 57.9% of the eyes within +/- 1.00 D of refractive astigmatism. The mean percent reduction of astigmatism was 87.9 +/- 3.7%. The postoperative spherical component of manifest refraction ranged from -1.00 to +1.75 D with a mean of +0.43 +/- 0.82 D. Vector analysis showed that the mean amount of axis deviation was 1.1 +/- 1.3 degrees and the mean percent correction of preoperative astigmatism was 92.6 +/- 8.4%. There were no intraoperative complications. Spectacle-corrected visual acuity was not reduced in any eye, and improved by 2 or more lines in 42.1% of eyes after LASIK. CONCLUSION LASIK with the Chiron-Technolas Keracor 116 excimer laser was effective for correction of both astigmatism and myopia after penetrating keratoplasty. The procedure proved to be safe and gave fairly predictable and stable refractive results.
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Affiliation(s)
- K M Rashad
- Ophthalmology Department, Alexandria University, Egypt
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71
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Abstract
PURPOSE To determine the safety, efficacy, predictability, and stability of laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism in eyes with prior penetrating keratoplasty. METHODS Eight eyes of 8 patients with penetrating keratoplasty had significant postoperative refractive error. Each eye received LASIK 1 year or more after penetrating keratoplasty. All were followed for 6 months or more. All patients were treated with the Chiron Technolas 217 excimer laser and the Automated Corneal Shaper microkeratome. RESULTS Mean spherical equivalent refraction decreased from -4.50 D (range, -3.00 to -7.25 D) to -0.75 D (range, -1.50 to +0.50 D) and the mean preoperative astigmatism decreased from 3.50 D (range, 1.50 to 5.00 D) to 1.25 D (range, 0.75 to 2.00 D). Uncorrected visual acuity improved by at least two Snellen lines in all eyes. Best spectacle-corrected visual acuity did not change in four eyes (50%) and improved in three eyes (37.5%). CONCLUSION LASIK effectively reduced low and moderate myopia and myopic astigmatism following penetrating keratoplasty.
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Affiliation(s)
- B R Nassaralla
- Goiania Eye Institute, Department of Cornea and Refractive Surgery, GO, Brazil.
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72
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Koay PY, McGhee CN, Weed KH, Craig JP. Laser in situ Keratomileusis for Ametropia After Penetrating Keratoplasty. J Refract Surg 2000; 16:140-7. [PMID: 10766382 DOI: 10.3928/1081-597x-20000301-06] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of excimer laser in situ keratomileusis (LASIK) in the treatment of refractive errors after penetrating keratoplasty. METHODS Eight eyes underwent LASIK after a mean 71 months (SD 60) following the initial penetrating keratoplasty. A full ophthalmic assessment was performed before LASIK and at 1 week, 1, 3, 6, and 12 months after surgery. Mean follow-up was 8.6 months (SD 3.2). RESULTS No eyes lost any Snellen lines of best spectacle-corrected visual acuity at the latest follow-up. Mean reduction in spherical equivalent refraction was 91% from -6.79 D (SD 4.17) to -0.64 D (SD 1.92) and mean reduction of cylinder was 72% from -6.79 D (SD 3.28) to -1.93 D (SD 1.17) at 6 months. Mean surgically induced astigmatism was 5.50 D (SD 2.42) and the index of surgically induced astigmatism divided by the initial cylinder expressed as a percentage was 81%. Mean outcome indices were: correction index 0.87, index of success 0.31, and angle of error 0.95 degrees. Three eyes (43%) achieved a spherical equivalent refraction of +/-0.50 D and 4 eyes (57%) achieved a spherical equivalent refraction of +/-1.00 D of emmetropia. CONCLUSIONS The efficacy of LASIK after penetrating keratoplasty was good compared to incisional or surface based excimer laser methods and has the advantage of reducing the myopic spherical equivalent refraction in addition to astigmatism, thus improving the uncorrected visual acuities.
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Affiliation(s)
- P Y Koay
- Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Scotland, United Kingdom.
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73
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Laser In Situ Keratomileusis to Correct Postkeratoplasty Refractive Errors. J Cataract Refract Surg 1999. [DOI: 10.1016/s0886-3350(99)00173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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