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Golas L, Manche EE. Dry eye after laser in situ keratomileusis with femtosecond laser and mechanical keratome. J Cataract Refract Surg 2011; 37:1476-80. [PMID: 21684109 DOI: 10.1016/j.jcrs.2011.03.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 01/11/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To prospectively compare dry-eye symptoms after laser in situ keratomileusis (LASIK) with mechanical keratome-created flaps and femtosecond laser keratome-created flaps. SETTING Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA. DESIGN Randomized clinical trial. METHODS Fellow eyes were prospectively randomized to the mechanical keratome group and femtosecond laser keratome group. Patients had wavefront-guided LASIK using a mechanical keratome in 1 eye and a femtosecond laser keratome in the fellow eye. They completed dry-eye questionnaires preoperatively and 1, 3, 6, and 12 months postoperatively. The effect of laser ablation depth, sex, age, and flap thickness on dry-eye symptoms was also analyzed. RESULTS The study enrolled 51 patients. There was no statistically significant change in dry-eye symptoms except in the femtosecond group 1 month postoperatively (mean increase 1.08) (P=.03). There were no significant differences in symptoms between the 2 groups (P=.7). The dry-eye score was 1.3 points lower in women than in men (P=.01). Central ablation depth, flap thickness, and age did not significantly affect the reported dryness. CONCLUSION There appeared to be no statistically significant difference in self-reported dry-eye symptoms between the mechanical keratome group and the femtosecond laser keratome group.
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Affiliation(s)
- Liliya Golas
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California 94303, USA
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Dick HB, Willert A, Elling M. Real-time measurement of intraocular pressure during femtosecond laser enabled keratoplasty. J Refract Surg 2011; 27:399-400. [PMID: 21667894 DOI: 10.3928/1081597x-20110217-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kouassi FX, Blaizeau M, Buestel C, Schweitzer C, Gallois A, Colin J, Touboul D. [Comparison of Lasik with femtosecond laser versus Lasik with mechanical microkeratome: predictability of flap depth, corneal biomechanical effects and optical aberrations]. J Fr Ophtalmol 2011; 35:2-8. [PMID: 21676493 DOI: 10.1016/j.jfo.2011.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/01/2011] [Accepted: 03/09/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare the predictability of flap thickness, high-order optic aberrations (HOAs), and biomechanical properties of cornea between patients treated by Lasik with mechanical microkeratome versus patients treated by FemtoLasik. SETTING Department of ophthalmology, Pellegrin University Hospital, Bordeaux, France. PATIENTS AND METHODS We conducted a retrospective study on 53 myopic patients who underwent Lasik with either mechanical microkeratome (MK group) or femtosecond laser (FS group). Refraction, central corneal thickness, high-order optic aberrations (HOAs), corneal hysteresis (CH), and corneal resistance factor (CRF), were analysed pre- and postoperatively in both groups. The central corneal thickness was measured with OCT-Visante(®) (Carl-Zeiss, Meditec), biomechanical parameters with ORA(®) (Reichert), and optical aberrations with the Wave Scan(®) (AMO) aberrometer. RESULTS We included 44 eyes of 22 patients in the MK group and 62 eyes of 31 patients in the FS group. Preoperatively, the mean best-corrected visual acuity was 0.95 in both groups. In the MK group, the flap was significantly thicker than expected (162/130 μm), but in the FS group, there was no significant difference (117/120 μm). The biomechanical properties of the cornea were lower in both groups independently of the flap cutting technique. The HOAs increased after Lasik and were not influenced by the flap cutting technique. CONCLUSION Neither mechanical microkeratome, nor femtosecond laser for flap creation, increases HOAs and the biomechanical changes of the cornea, according to ORA(®), significantly after Lasik.
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Affiliation(s)
- F-X Kouassi
- Service d'Ophtalmologie, CHU Pellegrin, place Amélie-Rabat-Léon, 33000 Bordeaux, France.
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Reinstein DZ, Archer TJ, Gobbe M. LASIK Flap Thickness Profile and Reproducibility of the Standard vs Zero Compression Hansatome Microkeratomes: Three-Dimensional Display with Artemis VHF Digital Ultrasound. J Refract Surg 2011; 27:417-26. [DOI: 10.3928/1081597x-20101110-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 09/15/2010] [Indexed: 11/20/2022]
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Issa A, Al Hassany U. Femtosecond laser flap parameters and visual outcomes in laser in situ keratomileusis. J Cataract Refract Surg 2011; 37:665-74. [DOI: 10.1016/j.jcrs.2010.10.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Revised: 10/24/2010] [Accepted: 10/27/2010] [Indexed: 11/29/2022]
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Biebesheimer JB, Kang TS, Huang CY, Yu F, Hamilton DR. Development of an advanced nomogram for myopic astigmatic wavefront-guided laser in situ keratomileusis (LASIK). Ophthalmic Surg Lasers Imaging Retina 2011; 42:241-7. [PMID: 21410091 DOI: 10.3928/15428877-20110303-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 02/07/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To identify the relationship between preoperative parameters and postoperative overcorrection or undercorrection in eyes with myopic astigmatism treated with wavefront-guided laser in situ keratomileusis (LASIK), and to develop an advanced surgical nomogram. PATIENTS AND METHODS A retrospective chart review of 468 eyes that underwent wavefront-guided LASIK for myopia with astigmatism with the Alcon LADARVision 4000 (Alcon Laboratories, Fort Worth, TX), of which 235 had flaps created by microkeratome (OneUse; Moria Surgical, Doylestown, PA) and 233 by femtosecond laser (Intralase; AMO, Santa Ana, CA). Manifest sphere, cylinder, and spherical equivalent were recorded preoperatively and 3 months postoperatively. Various parameters from patient records were analyzed to identify which had greatest influence on outcomes. RESULTS Manifest spherical equivalent was the most important predictor of surgical overcorrection, with the second being spherical aberration. In both groups, there was a statistically significant (P < .0001) correlation of spherical aberration with the amount of overcorrection. Using these two parameters, compensatory nomograms were derived. CONCLUSION Surgical overcorrection in wavefront-guided LASIK for myopic astigmatism correlates positively with the amount of spherical equivalent treated and preoperative spherical aberration. Nomograms incorporating spherical aberration may improve accuracy of outcomes.
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Affiliation(s)
- Jesse B Biebesheimer
- Jules Stein Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA
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Gimeno FL, Chan CM, Li L, Tan DT, Mehta JS. Comparison of eye-tracking success in laser in situ keratomileusis after flap creation with 2 femtosecond laser models. J Cataract Refract Surg 2011; 37:538-43. [DOI: 10.1016/j.jcrs.2010.10.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 08/31/2010] [Accepted: 10/05/2010] [Indexed: 11/17/2022]
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Xu Y, Zhou X, Wang L, Xu H. A morphological study of corneal flap after thin-flap laser-assisted in situ keratomileusis by anterior segment optical coherence tomography. J Int Med Res 2011; 38:1952-60. [PMID: 21226998 DOI: 10.1177/147323001003800608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This prospective study assessed corneal flap morphology in 115 patients undergoing laser-assisted in situ keratomileusis (LASIK). Flaps were created using the Moria M2 90-μm or KM-5000D 110-μm microkeratomes. Flap thickness was measured using anterior segment optical coherence tomography at seven points in a 7-mm diameter zone 1 h, 1 day, 3 days, 1 week and 1 month after surgery. Flap accuracy, reproducibility, uniformity and changes over time were evaluated. The Moria M2 microkeratome created flaps with less accuracy in the centre than the KM-5000D microkeratome (114.06 ± 6.46 μm vs 128.39 ± 6.79 μm, respectively, at 1 week). For both microkeratomes, flap thickness varied between most of the peripheral areas and the central point. Both microkeratomes created flaps with good central predictability and reproducibility, but high variation and significant deviation from intended thickness were observed in peripheral flap thickness.
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Affiliation(s)
- Y Xu
- Department of Ophthalmology, Eye and ENT Hospital affiliated with Fudan University, Shanghai, China
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Kucumen RB, Yenerel NM, Gorgun E, Oral D, Altunsoy M, Utine CA, Ciftci F. AS-OCT as a Tool for Flap Thickness Measurement After Femtosecond-Assisted LASIK. Ophthalmic Surg Lasers Imaging Retina 2011; 42:31-6. [DOI: 10.3928/15428877-20101124-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 09/07/2010] [Indexed: 11/20/2022]
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Moshirfar M, Gardiner JP, Schliesser JA, Espandar L, Feiz V, Mifflin MD, Chang JC. Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison. J Cataract Refract Surg 2010; 36:1925-33. [PMID: 21029902 DOI: 10.1016/j.jcrs.2010.05.027] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 04/07/2010] [Accepted: 05/13/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the incidence of flap complications after creation of laser in situ keratomileusis (LASIK) flaps using a zero-compression microkeratome or a femtosecond laser. SETTING John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. DESIGN Evidence-based manuscript. METHODS The flap complication rate was evaluated during the initial 18 months of experience using a zero-compression microkeratome (Hansatome) or a femtosecond laser (IntraLase FS60) for flap creation. RESULTS The flap complication rate was 14.2% in the microkeratome group and 15.2% in the femtosecond laser group (P = .5437). The intraoperative flap complication rate was 5.3% and 2.9%, respectively (P = .0111), and the postoperative flap complication rate, 8.9% and 12.3%, respectively (P = .0201). The most common intraoperative complication in the microkeratome group was major epithelial defect/sloughing; the rate (2.6%) was statistically significantly higher than in the femtosecond laser group (P = .0006). The most common postoperative complication in both groups was diffuse lamellar keratitis (DLK) (6.0%, microkeratome; 10.6%, femtosecond laser) (P = .0002). CONCLUSION Although the total complication rates between the 2 groups were similar, the microkeratome group had significantly more epithelial defects intraoperatively and the femtosecond laser group had significantly more DLK cases postoperatively.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.
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Efficacy of Hydroxypropyl Cellulose Ophthalmic Inserts (LACRISERT) in Subsets of Patients With Dry Eye Syndrome: Findings From a Patient Registry. Cornea 2010; 29:1417-27. [DOI: 10.1097/ico.0b013e3181e3f05b] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou Y, Tian L, Wang N, Dougherty PJ. Anterior segment optical coherence tomography measurement of LASIK flaps: femtosecond laser vs microkeratome. J Refract Surg 2010; 27:408-16. [PMID: 21117541 DOI: 10.3928/1081597x-20101029-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 09/21/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the uniformity and accuracy of LASIK flaps created with a femtosecond laser versus a mechanical microkeratome using optical coherence tomography (OCT). METHODS A prospective study was performed on 72 consecutive patients who underwent LASIK in both eyes in alternating fashion with either the AMO IntraLase FS60 (72 eyes) or the Moria M2 microkeratome (72 eyes). One month after surgery, anterior segment OCT was performed on each eye to measure flap thickness at 20 locations and the results were assessed for uniformity and accuracy. RESULTS At 1 month after surgery, the microkeratome group flap ranges were greater than those found in the femtosecond laser group (P<.05). The meridian and radial flap uniformity in the femtosecond laser group were better, showing an almost planar configuration, than the meniscus-shaped flaps created with the microkeratome. Comparison of the nasal and temporal flap thickness revealed more regularity in the femtosecond laser group than the microkeratome group. The maximum deviation from the intended flap thicknesses was 7 μm in the femtosecond laser group compared to 26 μm in the microkeratome group. During the 1440 measurements of the 72 eyes, a difference >20 μm was observed in 0.42% of eyes in the femtosecond laser group and 15% of eyes in the microkeratome group. CONCLUSIONS LASIK flaps made with the IntraLase FS60 were more uniform with more accurate thickness than those created by the Moria M2 microkeratome.
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Affiliation(s)
- Yuehua Zhou
- Ophthalmic Center, Beijing Tongren Hospital, Capital Medical Univeristy, Beijing, China
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Mrochen M, Wüllner C, Krause J, Klafke M, Donitzky C, Seiler T. Technical Aspects of the WaveLight FS200 Femtosecond Laser. J Refract Surg 2010; 26:S833-40. [DOI: 10.3928/1081597x-20100921-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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67
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Femtosecond laser in laser in situ keratomileusis. J Cataract Refract Surg 2010; 36:1024-32. [PMID: 20494777 DOI: 10.1016/j.jcrs.2010.03.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 03/01/2010] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
Abstract
Flap creation is a critical step in laser in situ keratomileusis (LASIK). Efforts to improve the safety and predictability of the lamellar incision have fostered the development of femtosecond lasers. Several advantages of the femtosecond laser over mechanical microkeratomes have been reported in LASIK surgery. In this article, we review common considerations in management and complications of this step in femtosecond laser-LASIK and concentrate primarily on the IntraLase laser because most published studies relate to this instrument.
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Prakash G, Agarwal A, Yadav A, Jacob S, Kumar DA, Agarwal A, Akhtar R. A Prospective Randomized Comparison of Four Femtosecond LASIK Flap Thicknesses. J Refract Surg 2010; 26:392-402. [DOI: 10.3928/1081597x-20090728-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 06/09/2009] [Indexed: 01/29/2023]
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Lubatschowski H, Schumacher S, Fromm M, Wegener A, Hoffmann H, Oberheide U, Gerten G. Femtosecond lentotomy: generating gliding planes inside the crystalline lens to regain accommodation ability. JOURNAL OF BIOPHOTONICS 2010; 3:265-268. [PMID: 20437418 DOI: 10.1002/jbio.201000013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Based on Helmholtz Theory for accommodation the increasing sclerosis of lens nucleus and cortex is the main cause for the developments of presbyopia. Existing therapies, however, do not reverse the stiffness of the crystalline lens and thus do not regain real accommodation ability. A new approach to restore the flexibility of the lens could be realized by photodisruption using ultrafast laser pulses. This process, known as fs-lentotomy, was used to create micro-incisions which act as gliding planes inside the crystalline lens without opening the eye globe.
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Fontes BM, Ambrósio R, Jardim D, Velarde GC, Nosé W. Corneal Biomechanical Metrics and Anterior Segment Parameters in Mild Keratoconus. Ophthalmology 2010; 117:673-9. [DOI: 10.1016/j.ophtha.2009.09.023] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 08/29/2009] [Accepted: 09/14/2009] [Indexed: 10/19/2022] Open
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Smith RT, Waring GO, Durrie DS, Stahl JE, Thomas P. Corneal endothelial cell density after femtosecond thin-flap LASIK and PRK for myopia: a contralateral eye study. J Refract Surg 2010; 25:1098-102. [PMID: 20000291 DOI: 10.3928/1081597x-20091117-09] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 02/03/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the effect of femtosecond thinflap LASIK and photorefractive keratectomy (PRK) on postoperative endothelial cell density. METHODS In a prospective, randomized, contralateral, single-center clinical trial, 25 patients (mean age: 30+/-5 years [range: 21 to 38 years]) underwent PRK in one eye and thin-flap LASIK in the fellow eye for the correction of myopia using a wavefront-guided platform. The central corneal endothelial cell density was measured using the NIDEK Confoscan 4 preoperatively, and at 1 and 3 months postoperatively. Changes in endothelial cell density were analyzed over time between the two refractive techniques. RESULTS In PRK, the average preoperative endothelial cell density was 3011+/-329 cells/mm(2), which decreased to 2951+/-327 cells/mm(2) at 1 month (P=.5736) and 2982+/-365 cells/mm(2) at 3 months (P=.6513). In thinflap LASIK, the average preoperative endothelial cell density was 2995+/-325 cells/mm(2), which decreased to 2977+/-358 cells/mm(2) at 1 month (P=.5756) and 2931+/-369 cells/mm(2) at 3 months (P=.4106). No statistically significant difference was found between the two groups at 1 (P=.7404) or 3 (P=.3208) months postoperatively. CONCLUSIONS No statistically significant change was noted in endothelial cell density following either PRK or thin-flap LASIK for the treatment of myopia. Furthermore, no statistically significant difference was found between the two groups out to 3 months postoperatively, indicating that thin-flap LASIK is as safe as PRK with regards to endothelial health.
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Mechanical Penetration of a Femtosecond Laser-Created Laser-Assisted In Situ Keratomileusis Flap. Cornea 2010; 29:336-8. [DOI: 10.1097/ico.0b013e3181a2abc6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li H, Sun T, Wang M, Zhao J. Safety and effectiveness of thin-flap LASIK using a femtosecond laser and microkeratome in the correction of high myopia in Chinese patients. J Refract Surg 2010; 26:99-106. [PMID: 20163074 DOI: 10.3928/1081597x-20100121-05] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/10/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To establish safety and effectiveness of thin-flap LASIK using a femtosecond laser and microkeratome in correcting high myopia in Chinese patients. METHODS Two hundred seventy-four eyes of 148 Chinese patients with high myopia whose spherical equivalent refraction (SE) ranged from -6.12 to -15.75 diopters (D) received thin-flap LASIK with the VISX S4 IR excimer laser system. Corneal flaps were created with a femtosecond laser (15-kHz IntraLase, 134 eyes of 76 patients, target flap thickness 100 microm) and Moria M2 microkeratome (90-microm head, 140 eyes of 72 patients, target flap thickness 110 microm). Clinical outcomes were assessed with uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), manifest refraction, wavefront aberrometry, Schirmer tests, and tear break-up time (TBUT) at 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS At 3 months, both groups showed comparable clinical outcomes in most parameters assessed, including the percent of postoperative UCVA better than or equal to preoperative BSCVA (P=.642), mean residual spherical equivalent refraction (P=.448), mean Schirmer test (P=.950), and mean TBUT (P=.867). Postoperative coma, trefoil, and spherical aberration were similar in both groups (P=.202, P=.898, and P=.890, respectively). Both groups had a similar percent of eyes with a change of SE of <1.00 D (P=.284). CONCLUSIONS Thin-flap LASIK with a femtosecond laser and microkeratome are both safe and effective for the correction of high myopia in Chinese patients. Femtosecond laser shows similar predictability, stability, and induction of higher order aberrations to the microkeratome.
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Affiliation(s)
- Haiyan Li
- Department of Opthalmology, Shanghai AIER Eye Hospital, Shanghai, China.
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Pietilä J, Huhtala A, Jääskeläinen M, Jylli J, Mäkinen P, Uusitalo H. LASIK Flap Creation With the Ziemer Femtosecond Laser in 787 ConsecutiveEyes. J Refract Surg 2010; 26:7-16. [PMID: 20199007 DOI: 10.3928/1081597x-20101215-02] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 01/27/2009] [Indexed: 11/20/2022]
Affiliation(s)
- Juhani Pietilä
- Department of Ophthalmology, Mehiläinen Hospital, Tampere, Finland.
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Kim JS, Lee SB. Effects of Amount of Myopic Correction on Long-term Changes in Higher-order Wavefront Aberrations in ASA-PRK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.9.1184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin-Seon Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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de Benito-Llopis L, Teus MA, Gil-Cazorla R, Drake P. Comparison between femtosecond laser-assisted sub-Bowman keratomileusis vs laser subepithelial keratectomy to correct myopia. Am J Ophthalmol 2009; 148:830-6.e1. [PMID: 19781686 DOI: 10.1016/j.ajo.2009.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/06/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare femtosecond laser sub-Bowman keratomileusis (FSBK) vs laser subepithelial keratectomy (LASEK) to correct myopia. DESIGN Retrospective, nonrandomized, interventional, comparative case series. METHODS Two thousand one hundred and eight eyes were included in the study. We compared 1,072 eyes treated with FSBK vs 1,036 eyes treated with LASEK with or without mitomycin C (MMC). Visual and refractive results were evaluated 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS Preoperative mean sphere and best spectacle-corrected visual acuity (BSCVA) were -3.93 diopters (D) vs -3.87 D (P = .5) and 1.12 vs 1.12 (P = .8) in FSBK and LASEK, respectively. Uncorrected visual acuity (UCVA) was 0.92 vs 0.62, 0.98 vs 0.78, 0.96 vs 0.91, and 1.06 vs 1.03 in FSBK and LASEK, respectively, at 1 day, 1 week, and 1 and 3 months after surgery (P < .01 for all comparisons). Three months postoperatively, BSCVA was 1.13 and 1.10, respectively (P = .001). At that moment, 20 eyes (1.93%) in the LASEK group vs 9 eyes (0.84%) in the FSBK group had lost 2 or more lines of BSCVA. Ten eyes (0.96%) in the LASEK group gained 2 or more lines of BSCVA, whereas 3 eyes (0.28%) in the FSBK group gained 2 lines. Six months postoperatively, only 2 LASEK eyes (0.19%) showed loss of 2 or more lines of BSCVA, compared to 3 FSBK-treated eyes (0.28%). CONCLUSION Both FSBK and LASEK are safe and effective procedures to correct myopia. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 3-month follow-up.
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Pietilä J, Huhtala A, Mäkinen P, Seppänen M, Jääskeläinen M, Uusitalo H. Corneal flap thickness with the Moria M2 microkeratome and Med-Logics calibrated LASIK blades. Acta Ophthalmol 2009; 87:754-8. [PMID: 19456311 DOI: 10.1111/j.1755-3768.2008.01500.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to compare and study potential factors that affect the accuracy of corneal flap thickness created in laser-assisted in situ keratomileusis (LASIK) using the Moria model 2 (M2) head 130 microkeratome with the Med-Logics calibrated LASIK blades Minus 20 (ML -20) and Minus 30 (ML -30). METHODS Corneal thickness in 200 (164 myopic and 36 hyperopic) eyes (100 patients) was measured by ultrasonic pachymetry preoperatively and intraoperatively after flap cutting. A total of 100 eyes were treated with the ML -20 and 100 with the ML -30. The right eye was operated before the left eye in each patient, using the same blade. In an additional group of 40 eyes, the left eye was operated first. RESULTS Mean corneal flap thickness using the ML -20 blade for an intended flap thickness of 140 μm was 129.1 μm (standard deviation [SD] 15.6, range 104-165 μm) in right eyes and 111.5 μm (SD 14.5, range 78-144 μm) in left eyes. Mean corneal flap thickness using the ML -30 blade for an intended flap thickness of 130 μm was 127.1 μm (SD 16.6, range 90-168 μm) in right eyes and 109.9 μm (SD 16.8, range 72-149 μm) in left eyes. CONCLUSIONS Both microkeratome blade types cut thinner flaps than were intended. There was substantial variation in flap thickness. The first flap to be cut with a particular blade was considerably thicker than the second flap cut with the same blade. Based on these data, we recommend the use of disposable single-use microkeratomes rather than these ML blades.
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de Medeiros FW, Kaur H, Agrawal V, Chaurasia SS, Hammel J, Dupps WJ, Wilson SE. Effect of femtosecond laser energy level on corneal stromal cell death and inflammation. J Refract Surg 2009; 25:869-74. [PMID: 19835327 PMCID: PMC2769018 DOI: 10.3928/1081597x-20090917-08] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 09/23/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the effects of variations in femtosecond laser energy level on corneal stromal cell death and inflammatory cell influx following flap creation in a rabbit model. METHODS Eighteen rabbits were stratified in three different groups according to level of energy applied for flap creation (six animals per group). Three different energy levels were chosen for both the lamellar and side cut: 2.7 microJ (high energy), 1.6 microJ (intermediate energy), and 0.5 microJ (low energy) with a 60 kHz, model II, femtosecond laser (IntraLase). The opposite eye of each rabbit served as a control. At the 24-hour time point after surgery, all rabbits were euthanized and the corneoscleral rims were analyzed for the levels of cell death and inflammatory cell influx with the terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay and immunocytochemistry for monocyte marker CD11b, respectively. RESULTS The high energy group (31.9+/-7.1 [standard error of mean (SEM) 2.9]) had significantly more TUNEL-positive cells in the central flap compared to the intermediate (22.2+/-1.9 [SEM 0.8], P=.004), low (17.9+/-4.0 [SEM 1.6], P< or =.001), and control eye (0.06+/-0.02 [SEM 0.009], P< or =.001) groups. The intermediate and low energy groups also had significantly more TUNEL-positive cells than the control groups (P< or =.001). The difference between the intermediate and low energy levels was not significant (P=.56). The mean for CD11b-positive cells/400x field at the flap edge was 26.1+/-29.3 (SEM 11.9), 5.8+/-4.1 (SEM 1.6), 1.6+/-4.1 (SEM 1.6), and 0.005+/-0.01 (SEM 0.005) for high energy, intermediate energy, low energy, and control groups, respectively. Only the intermediate energy group showed statistically more inflammatory cells than control eyes (P=.015), most likely due to variability between eyes. CONCLUSIONS Higher energy levels trigger greater cell death when the femtosecond laser is used to create corneal flaps. Greater corneal inflammatory cell infiltration is observed with higher femtosecond laser energy levels.
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Affiliation(s)
- Fabricio Witzel de Medeiros
- Cleveland Clinic, Cole Eye Institute, Cleveland, Ohio
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Harmeet Kaur
- Cleveland Clinic, Cole Eye Institute, Cleveland, Ohio
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80
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Nuzzo V, Aptel F, Savoldelli M, Plamann K, Peyrot D, Deloison F, Donate D, Legeais JM. Histologic and Ultrastructural Characterization of Corneal Femtosecond Laser Trephination. Cornea 2009; 28:908-13. [DOI: 10.1097/ico.0b013e318197ebeb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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81
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Slade SG, Durrie DS, Binder PS. A Prospective, Contralateral Eye Study Comparing Thin-Flap LASIK (Sub-Bowman Keratomileusis) with Photorefractive Keratectomy. Ophthalmology 2009; 116:1075-82. [DOI: 10.1016/j.ophtha.2009.01.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 01/05/2009] [Accepted: 01/06/2009] [Indexed: 11/29/2022] Open
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82
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Bamba S, Rocha KM, Ramos-Esteban JC, Krueger RR. Incidence of rainbow glare after laser in situ keratomileusis flap creation with a 60 kHz femtosecond laser. J Cataract Refract Surg 2009; 35:1082-6. [DOI: 10.1016/j.jcrs.2009.01.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 01/27/2009] [Accepted: 01/30/2009] [Indexed: 10/20/2022]
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83
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Schumacher S, Fromm M, Oberheide U, Gerten G, Wegener A, Lubatschowski H. In vivo application and imaging of intralenticular femtosecond laser pulses for the restoration of accommodation. J Refract Surg 2009; 24:991-5. [PMID: 19044246 DOI: 10.3928/1081597x-20081101-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE According to the Helmholtz theory of accommodation, one major cause of the development of presbyopia is the increasing sclerosis of the crystalline lens. One concept for regaining the elasticity of the sclerosing lens is intralenticular treatment by femtosecond laser pulses. METHODS The feasibility of applying and imaging in vivo microincisions by femtosecond laser pulses was evaluated in five rabbit lenses with a new high repetition rate (100 kHz) femtosecond laser unit. The treated eyes were monitored using optical coherence tomography (OCT) and Scheimpflug imaging for localizing and studying the tissue effects of the incisions. The rabbits were investigated preoperatively, immediately postoperatively, and 14 days after treatment. RESULTS The procedure, termed femtosecond-lentotomy, was successfully applied to the left lens of each rabbit. The laser microincisions within the crystalline lens were detectable with OCT and Scheimpflug imaging, which emphasizes the integral role these technologies play in targeting and characterizing postoperative tissue effects. The imaging within the lens showed a progressive fading of the incisional opacities generated by the femtosecond laser after 14 days with no detectable cataract formation. CONCLUSIONS It is possible to create microincisions inside the crystalline lens within an acceptably short treatment time (<30 seconds). The 14-day follow-up did not show undesirable side effects, such as cataract formation, after intralenticular laser treatment.
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84
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von Jagow B, Kohnen T. Corneal architecture of femtosecond laser and microkeratome flaps imaged by anterior segment optical coherence tomography. J Cataract Refract Surg 2009; 35:35-41. [PMID: 19101422 DOI: 10.1016/j.jcrs.2008.09.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 08/20/2008] [Accepted: 09/06/2008] [Indexed: 10/21/2022]
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85
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86
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Haft P, Yoo SH, Kymionis GD, Ide T, O’Brien TP, Culbertson WW. Complications of LASIK Flaps Made by the IntraLase 15- and 30-kHz Femtosecond Lasers. J Refract Surg 2009; 25:979-84. [DOI: 10.3928/1081597x-20091016-02] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 10/29/2008] [Indexed: 12/17/2022]
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87
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Differences in the corneal biomechanical effects of surface ablation compared with laser in situ keratomileusis using a microkeratome or femtosecond laser. J Cataract Refract Surg 2008; 34:2049-56. [DOI: 10.1016/j.jcrs.2008.08.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Accepted: 08/06/2008] [Indexed: 11/17/2022]
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88
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Corneal biomechanical measurements before and after laser in situ keratomileusis. J Cataract Refract Surg 2008; 34:1886-91. [DOI: 10.1016/j.jcrs.2008.06.035] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 06/25/2008] [Indexed: 11/19/2022]
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89
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Deposit of glass fragments during femtosecond laser penetrating keratoplasty. Graefes Arch Clin Exp Ophthalmol 2008; 247:107-13. [DOI: 10.1007/s00417-008-0948-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 08/22/2008] [Accepted: 08/29/2008] [Indexed: 10/21/2022] Open
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90
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Maldonado MJ, Nieto JC, Piñero DP. Advances in technologies for laser-assisted in situ keratomileusis (LASIK) surgery. Expert Rev Med Devices 2008; 5:209-29. [PMID: 18331182 DOI: 10.1586/17434440.5.2.209] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laser-assisted in situ keratomileusis (LASIK) has become the most widely used form of refractive surgery today. The objective of this surgical technique is to modify the anterior corneal shape by ablating tissue from the stroma by means of the excimer laser after creating a hinged corneal flap. This way, we are able to change the refractive status of the patient, providing better unaided vision. Continuous improvements in the original technique have made the surgical procedure safer, more accurate and repeatable. These progressions are due to the development of novel technologies that are the responsible for new surgical instrumentation, which makes the surgical procedure easier for the surgeon, and better excimer laser ablation algorithms, which increase the optical quality of the ablation and thus the safety of the vision correction procedure. This article aims to describe the more relevant advances in LASIK that have played an important role in the spread and popularity of this technique.
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Affiliation(s)
- Miguel J Maldonado
- Department of Ophthalmology, Clínica Universitaria, University of Navarra, Avda Pio XII, 36, 31080, Pamplona, Spain.
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Montés-Micó R, Cerviño A, Ferrer-Blasco T. VisuMax ®femtosecond laser for corneal refractive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.4.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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92
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Ding L, Knox WH, Bühren J, Nagy LJ, Huxlin KR. Intratissue refractive index shaping (IRIS) of the cornea and lens using a low-pulse-energy femtosecond laser oscillator. Invest Ophthalmol Vis Sci 2008; 49:5332-9. [PMID: 18641284 DOI: 10.1167/iovs.08-1921] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the optical effect of high-repetition-rate, low-energy femtosecond laser pulses on lightly fixed corneas and lenses. METHODS Eight corneas and eight lenses were extracted postmortem from normal, adult cats. They were lightly fixed and stored in a solution that minimized swelling and opacification. An 800-nm Ti:Sapphire femtosecond laser oscillator with a 27-fs pulse duration and 93-MHz repetition rate was used to inscribe gratings consisting of 20 to 40 lines, each 1-microm wide, 100-microm long, and 5-microm apart, 100 mum below the tissue surface. Refractive index changes in the micromachined regions were calculated immediately and after 1 month of storage by measuring the intensity distribution of diffracted light when the gratings were irradiated with a 632.8-nm He-Ne laser. RESULTS Periodic gratings were created in the stromal layer of the corneas and the cortex of the lenses by adjusting the laser pulse energy until visible plasma luminescence and bubbles were no longer generated. The gratings had low scattering loss and could only be visualized using phase microscopy. Refractive index changes measured 0.005 +/- 0.001 to 0.01 +/- 0.001 in corneal tissue and 0.015 +/- 0.001 to 0.021 +/- 0.001 in the lenses. The gratings and refractive index changes were preserved after storing the micromachined corneas and lenses for 1 month. CONCLUSIONS These pilot experiments demonstrate a novel application of low-pulse-energy, MHz femtosecond lasers in modifying the refractive index of transparent ocular tissues without apparent tissue destruction. Although it remains to be verified in living tissues, the stability of this effect suggests that the observed modifications are due to long-term molecular and/or structural changes.
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Affiliation(s)
- Li Ding
- Institute of Optics, University of Rochester, Rochester, New York, USA
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93
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Control-matched analysis of laser in situ keratomileusis outcomes in high myopia. J Cataract Refract Surg 2008; 34:544-50. [DOI: 10.1016/j.jcrs.2007.11.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 11/09/2007] [Indexed: 11/18/2022]
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94
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95
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Corneal response to femtosecond laser photodisruption in the rabbit. Exp Eye Res 2008; 86:835-43. [PMID: 18395714 DOI: 10.1016/j.exer.2008.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Revised: 02/22/2008] [Accepted: 02/27/2008] [Indexed: 11/23/2022]
Abstract
In this report we evaluated the effect of femtosecond laser energy on the development of corneal haze and keratocyte activation in rabbits following intra-stromal photodisruption to create LASIK flaps using a modified commercial femtosecond surgical laser. Three groups of flap parameters were studied: 1.5 microJ/pulse with 10 microm spot separation and complete side cut (Group 1); 3.5 microJ/pulse with 14 microm spot separation and complete side cut (Group 2); 3.5 microJ/pulse with 14 microm spot separation and partial (50 microm) side cut (Group 3). All flaps were left attached without lifting to avoid epithelial contamination. Rabbits were then evaluated pre- and post-operatively by quantitative in vivo and ex vivo confocal microscopy. The achieved flap thickness 1 week after surgery averaged 88.9+/-12.8, 90.8+/-6.9 and 86.5+/-6.8 microm for Groups 1-3 respectively (p=NS). Interface thickness was significantly greater (p<0.05) in the higher energy groups averaging 40.0+/-11.2 and 37.7+/-5.7 microm for Groups 2-3 compared to 28.6+/-4.5 microm for Group 1. Corneal haze was barely detectible and not significantly different between groups, although haze was detected in the region of the side-cuts in Groups 1 and 2. No clinically significant changes in stromal or epithelial thickness were noted. Laser confocal microscopy showed the presence of small diameter cells within the flap interface that resided within disrupted regions of the corneal collagen lamellae. Keratocyte activation was only detected in regions of the 100% side cut and not over the flap interface. In conclusion, the results of this study indicate that photodisruption of the corneal stroma alone without flap elevation regardless of laser energy does not induce significant corneal haze in the rabbit. However, a thicker stromal interface was seen with the higher energy suggesting greater stromal damage.
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96
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Kim JH, Lee D, Rhee KI. Flap thickness reproducibility in laser in situ keratomileusis with a femtosecond laser: optical coherence tomography measurement. J Cataract Refract Surg 2008; 34:132-6. [PMID: 18165093 DOI: 10.1016/j.jcrs.2007.08.036] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare ultrasound (US) pachymetry, Orbscan, and optical coherence tomography (OCT) measurements of the central corneal thickness (CCT) before laser in situ keratomileusis (LASIK) and evaluate the reproducibility of flaps created with the IntraLase femtosecond laser (IntraLase, Inc.) using OCT. SETTING Department of Ophthalmology, IIsan Paik Hospital, Goyang, Korea. METHODS Central corneal thickness was measured using OCT, US pachymetry, and Orbscan in 59 eyes of 30 patients before femtosecond laser LASIK. The postoperative corneal flap thickness, measured using OCT, was compared with the preoperative intended thickness. RESULTS Optical coherence tomography, US pachymetry, and Orbscan measurements provided similar CCT values (P>.05). Corneal thickness values obtained using US or Orbscan correlated well with those obtained by OCT, with the correlation coefficient ranging from 0.804 to 0.889 (P<.05). The OCT measurements showed no significant difference between the postoperative flap thickness and the intended flap thickness (P>.05). CONCLUSIONS Optical coherence tomography was comparable to US pachymetry and Orbscan in cornea thickness measurement. Optical coherence tomography was easy and relatively accurate to use preoperatively and in the early postoperative period. The femtosecond laser created highly reproducible flaps that corresponded with the preoperative intended thickness.
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Affiliation(s)
- Jin-Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Korea.
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Measurement of corneal curvature change after mechanical laser in situ keratomileusis flap creation and femtosecond laser flap creation. J Cataract Refract Surg 2008; 34:238-42. [DOI: 10.1016/j.jcrs.2007.09.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/17/2007] [Indexed: 11/21/2022]
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98
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Tracking Difficulties After Femtosecond Laser Flap Creation With the LADARVision Excimer Laser System. J Refract Surg 2008; 24:953-6. [DOI: 10.3928/1081597x-20081101-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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99
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Sutton G, Hodge C. Accuracy and Precision of LASIK Flap Thickness Using the IntraLase Femtosecond Laser in 1000 Consecutive Cases. J Refract Surg 2008; 24:802-6. [PMID: 18856234 DOI: 10.3928/1081597x-20081001-06] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Gerard Sutton
- Auckland University, Save Sight and Eye Institute, Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.
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100
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Alió JL, Piñero DP. Very High-frequency Digital Ultrasound Measurement of the LASIK Flap Thickness Profile Using the IntraLase Femtosecond Laser and M2 and Carriazo-Pendular Microkeratomes. J Refract Surg 2008; 24:12-23. [PMID: 18269144 DOI: 10.3928/1081597x-20080101-03] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jorge L Alió
- Vissum/Instituto Oftalmológico de Alicante, Alicante, Spain.
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