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Hein JC, Tauber J, Shrivastava A. Refractive surgery for the glaucoma suspect. Curr Opin Ophthalmol 2023; 34:290-295. [PMID: 36995100 DOI: 10.1097/icu.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide an update on perioperative considerations in the evaluation and management of patients undergoing primary corneal and intraocular refractive procedures who are at risk for progressive glaucomatous optic neuropathy. RECENT FINDINGS The necessity of a comprehensive baseline assessment prior to refractive procedures with structural and functional testing, along with documentation of preoperative intraocular pressure (IOP) measurements, is highlighted in recent literature. Substantiation of the increased risk of postoperative IOP elevation in keratorefractive procedures in patients with higher baseline IOP and lower baseline CCT, but not necessarily the degree of myopia, has been variably evidenced. Tonometry methods which are less influenced by postoperative corneal structural change should be considered in patients undergoing keratorefractive procedures. Vigilence in postoperative monitoring for progressive optic neuropathy is suggested given evidence of an increased risk of steroid-response glaucoma in these patients. Additional evidence for the IOP-lowering impact of cataract surgery in patients with an increased risk of glaucoma is provided, irrespective of intraocular lens choice. SUMMARY Performing refractive procedures on patients at risk for glaucoma remains controversial. Definitive steps to optimize patient selection along with vigilance in disease state monitoring with longitudinal structural and functional testing can help mitigate potential adverse events.
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Affiliation(s)
| | - Jenna Tauber
- Montefiore Medical Center, New York City, New York, USA
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Jiang Y, Wang Z, Li Y, Li Y, Lu TC. Retinal Nerve Fibre Layer Thickness Change Following Femtosecond Laser-Assisted in situ Keratomileusis. Front Med (Lausanne) 2021; 8:778666. [PMID: 34912833 PMCID: PMC8666688 DOI: 10.3389/fmed.2021.778666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the effect of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) on retinal fovea thickness, volume, and retinal nerve fibre layer (RNFL) thickness. Methods: Thirty-seven eyes (37 patients) undergoing FS-LASIK were included in this prospective study. Optical coherence tomography (OCT) was performed 1 day before, 1 h and 1 day after FS-LASIK surgery. Result: Eighteen male and nineteen females were enrolled. Mean patient age was 22.94 ± 4.22 years. One hour postoperatively, macula fovea thicknesses, macula fovea volume, macula parafovea thickness, macula parafovea volume, macula perifovea thickness, macula perifove volume, temporal RNFL thickness, and superior RNFL thickness measures showed significant decrease (t = 6.171, 6.032, and 9.837, 9.700, 2.532, 4.393, 4.926, 2.265; p = 0.000, 0.000, 0.000, 0.000, 0.016, 0.000, 0.000, and 0.011). Day 1 post-operation, macula fovea thicknesses, macula fovea volume, macula parafovea thickness, macula parafovea volume, and inferior RNFL thickness measures showed significant change compared to preoperative measures (t = 3.620, 3.220, 2.901, 2.910, 3.632; p = 0.001, 0.003, 0.006, 0.006, and 0.001). Conclusion: Our data suggest there are alterations in retinal foveal and RNFL measurements by OCT 1 h and 1 day after FS-LASIK surgery.
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Affiliation(s)
- Yang Jiang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhonghai Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yong Li
- Department of Ophthalmology, Xi'an Fourth Hospital, Xi'an, China
| | - Thomas Chengxuan Lu
- School of Medicine, University of New South Wales, Kensington, NSW, Australia
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Effects of SMILE Surgery on Intraocular Pressure, Central Corneal Thickness, Axial Length, Peripapillary Retinal Nerve Fiber Layer, and Macular Ganglion Cell Complex Thickness. J Ophthalmol 2020. [DOI: 10.1155/2020/4934196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate the change in intraocular pressure (IOP), central corneal thickness (CCT), axial length, peripapillary retinal nerve fiber layer (RNFL) thickness, and macular ganglion cell complex (GCC) thickness after small incision lenticule extraction (SMILE) surgery. Methods. This prospective observational study was conducted in Espace Nouvelle Vision, Ophthalmological Clinic, Paris, France. Fifty eyes of 25 patients were enrolled in this study and underwent SMILE surgeries. IOP, central corneal thickness (CCT), axial length (AL), peripapillary RNFL thickness, and macular GCC thickness were measured before and at 3 months after SMILE. Results. The mean preoperative spherical equivalent was −3.15 ± 1.50 diopters (D), and the mean postoperative value was 0.15 ± 0.28 D. After SMILE surgery, IOP decreased from 15.03 ± 2.79 mmHg to 11.02 ± 2.73 mmHg and 10.02 ± 2.21 mmHg at 1 and 3 months, respectively (
for both comparisons). The mean decrease in measured IOP as a function of ablation depth was 0.065 ± 0.031 mmHg/μm. CCT decreased from 545.98 ± 26.61 μm to 478.40 ± 30.26 μm after SMILE surgery (
). AL decreased from 24.80 ± 0.84 mm to 24.70 ± 0.83 mm (
). There was no statistically significant change in mean peripapillary RNFL or mean GCC thickness after SMILE surgery. Conclusions. SMILE surgery modified IOP measurement, CCT, and AL but did not change peripapillary RNFL and macular GCC thicknesses. The postoperative drop in measured IOP might be explained by the decreased CCT. An accurate re-evaluation of AL should be performed before cataract surgery among post-SMILE patients.
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Shpak AA, Kostenev SV, Mushkova IA, Korobkova MV. [Effect of corneal refractive surgery on optical coherence tomography measurements]. Vestn Oftalmol 2019; 134:48-53. [PMID: 30499539 DOI: 10.17116/oftalma201813405148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effect of significant changes in corneal power after refractive surgery on the parameters of optical coherence tomography (OCT) has not been sufficiently studied. PURPOSE To study effects of corneal refractive surgery on optical coherence tomography (OCT) measurements in patients with moderate and high myopia. MATERIAL AND METHODS OCT was performed in 62 patients (62 eyes) with myopia over 4 D before and one month after LASIK. The changes in 14 parameters of the thickness of the retina, ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) were analyzed. RESULTS The mean refractive effect was 7.07±2.02 D (4.0 to 11.75 D). Postoperative changes in the parameters analyzed were insignificant, averaging not more than 1.3% of the baseline value with the exception of pRNFL thickness in the temporal quadrant (2.2%). Only six of the 14 parameters were statistically significant - retinal thickness in the central subfield and the inner nasal quadrant, average and minimum thickness of GCIPL, and pRNFL thickness (mean and in the temporal quadrant). Individual changes of the parameters in most patients did not exceed the error of method. CONCLUSION In patients with moderate to high myopia, LASIK operation has only a slight effect on the OCT parameters of the retina and pRNFL. Only in patients with very high myopia, the decrease over 10 D in corneal refractive power creates an optical effect of increasing the average thickness of pRNFL and GCIPL by 2-3 μm. This should be taken into account when examining such patients for glaucoma.
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Affiliation(s)
- A A Shpak
- S. Fyodorov Eye Microsurgery Federal State Institution, 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - S V Kostenev
- S. Fyodorov Eye Microsurgery Federal State Institution, 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - I A Mushkova
- S. Fyodorov Eye Microsurgery Federal State Institution, 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - M V Korobkova
- S. Fyodorov Eye Microsurgery Federal State Institution, 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
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Changes in Retinal Vasculature and Thickness after Small Incision Lenticule Extraction with Optical Coherence Tomography Angiography. J Ophthalmol 2019; 2019:3693140. [PMID: 31236290 PMCID: PMC6545814 DOI: 10.1155/2019/3693140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the changes in retinal vessel density and thickness after small incision lenticule extraction (SMILE) with optical coherence tomography angiography (OCTA) in myopic patients. Methods In this prospective study, SMILE surgeries were done in 46 eyes of 24 patients with spherical equivalent (SE) more than −6.0 diopters (D). Retinal vessel density and thickness at the macula and optic nerve were recorded with OCTA before and 1 day, 2 weeks, and 1 month after surgery. Intraocular pressure (IOP), uncorrected distance visual acuity (UDVA), and refraction were taken at the same time. Results The superficial retinal vessel density and deep foveal retinal vessel density 1 day after surgery were less than those before surgery; however, the changes at any timepoints were not statistically significant (p=0.2736 and p=0.1590, respectively). Both the superficial vessel density and deep vessel density at the parafoveal and perifoveal regions decreased significantly 1 day postoperatively (all p < 0.05) and then returned to the preoperative level at 2 weeks and stabilized thereafter. There were no significant changes in any of the 4 vessel densities in the area of peripapillary before and 1 day, 2 weeks, and 1 month after surgery (p=0.3345). No statistically significant differences between preoperative and postoperative retinal thickness were detected for the area of macula and optic nerve (all p > 0.5). Conclusions The vessel density at the parafoveal and perifoveal regions decreased at 1 day after SMILE with no effect on the visual acuity and relieved within 2 weeks. Decreased ocular blood flow in response to the spike in IOP may account for such changes.
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Katsanos A, Arranz-Marquez E, Cañones R, Lauzirika G, Rodríguez-Perez I, Teus MA. Retinal nerve fiber layer thickness after laser-assisted subepithelial keratomileusis and femtosecond LASIK: a prospective observational cohort study. Clin Ophthalmol 2018; 12:1213-1218. [PMID: 30013314 PMCID: PMC6038866 DOI: 10.2147/opth.s168033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Based on the assumption that high levels of intraocular pressure (IOP) during femtosecond laser-assisted in situ keratomileusis (FS-LASIK) may compromise the retinal nerve fiber layer (RNFL), newer femtosecond platforms that operate without causing significant IOP elevation have been developed in recent years. However, this assumption has not been adequately tested. The aim of the current study was to evaluate possible changes in RFNL thickness in nonglaucomatous myopic patients undergoing FS-LASIK using the 60 KHz IntraLase® device that significantly elevates the IOP for an appreciable period of time vs an advanced surface ablation technique (laser-assisted subepithelial keratomileusis, LASEK) that does not induce any IOP elevation. Methods This was a prospective, observational, controlled cohort study. One randomly selected eye of 114 consecutive eligible patients was analyzed. Inclusion criteria were myopia up to -6.00 diopters and astigmatism up to -2.00 diopters. As clinically indicated, 50 patients underwent LASEK and 64 underwent FS-LASIK. The RNFL thickness was determined with a spectral-domain optical coherence tomography device preoperatively and 3 months postoperatively by the same masked observer. Results There was no significant difference in preoperative refractive error, age, or sex between the groups. Preoperatively, central corneal thickness was significantly lower in the LASEK group (529.1±36.1 vs 562.4±31.6 µm, P=0.001). For the LASEK group, there was no significant difference between preoperative and postoperative RNFL thickness in the studied sectors (superior-temporal, temporal, inferior-temporal, average). For the FS-LASIK group, compared to preoperative RNFL measures, statistically significant thicker postoperative values were found for the average RNFL (mean difference: 0.67 µm, 0.7% increase, P=0.008) and the inferior-temporal sector (mean difference: 0.92 µm, 0.6% increase, P=0.02). Conclusion LASIK with a femtosecond platform that induces high intraoperative IOP did not cause RNFL thinning. The observed differences between preoperative and postoperative values are below the axial resolution limit of optical coherence tomography devices.
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Affiliation(s)
- Andreas Katsanos
- Clínica Novovisión, Madrid, Spain, .,Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain, .,Department of Ophthalmology, University of Ioannina, Ioannina, Greece,
| | - Esther Arranz-Marquez
- Clínica Novovisión, Madrid, Spain, .,Ophthalmology Clinic, Rey Juan Carlos Universitary Hospital, Móstoles, Madrid, Spain
| | - Rafael Cañones
- Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain,
| | | | | | - Miguel A Teus
- Clínica Novovisión, Madrid, Spain, .,Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain,
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The Effect of LASIK Procedure on Peripapillary Retinal Nerve Fiber Layer and Macular Ganglion Cell-Inner Plexiform Layer Thickness in Myopic Eyes. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8923819. [PMID: 29018820 PMCID: PMC5605783 DOI: 10.1155/2017/8923819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the effect of applied suction during microkeratome-assisted laser in situ keratomileusis (LASIK) procedure on peripapillary retinal nerve fiber layer (RNFL) thickness as well as macular ganglion cell-inner plexiform layer (GC-IPL) thickness. Methods 89 patients (124 eyes) with established myopia range from −3.0 to −8.0 diopters and no associated ocular diseases were included in this study. RNFL and GC-IPL thickness measurements were performed by spectral domain optical coherence tomography (SD OCT) one day before LASIK and at 1 and 6 months postoperatively. Results Mean RNFL thickness prior to LASIK was 93.86 ± 12.17 μm while the first month and the sixth month postoperatively were 94.01 ± 12.04 μm and 94.46 ± 12.27 μm, respectively. Comparing results, there is no significant difference between baseline, one month, and six months postoperatively for mean RNFL (p > 0.05). Mean GC-IPL thickness was 81.70 ± 7.47 μm preoperatively with no significant difference during the follow-up period (82.03 ± 7.69 μm versus 81.84 ± 7.64 μm; p > 0.05). Conclusion RNFL and GC-IPL complex thickness remained unaffected following LASIK intervention.
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Abstract
PURPOSE OF REVIEW Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. RECENT FINDINGS Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. SUMMARY Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.
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The Effect of Corneal Refractive Surgery on Glaucoma. J Ophthalmol 2017; 2017:8914623. [PMID: 28491472 PMCID: PMC5401744 DOI: 10.1155/2017/8914623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/09/2017] [Indexed: 11/17/2022] Open
Abstract
Laser-assisted refractive procedures have become very popular in the last two decades. As a result, a "generation" of patients with altered corneal properties is emerging. These patients will require both cataract extraction and glaucoma follow-up in the future. Since the glaucoma examination largely depends on the corneal properties, the reshaped postrefractive surgery cornea poses a challenge in the diagnosis, follow-up, and management of the glaucomatous patient. In order to overcome this problem, every patient who is planned to undergo corneal refractive surgery must have a thorough glaucoma examination in order for the ophthalmologist to be able to monitor their patients for possible glaucoma development and/or progression. Some examinations such as tonometry are largely affected by the corneal properties, while others such as the evaluation of the structures of the posterior pole remain unaffected. However, the new imaging modalities of the anterior segment in combination with the most recent advances in tonometry can accurately assess the risk for glaucoma and the need for treatment.
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Aristeidou A, Taniguchi EV, Tsatsos M, Muller R, McAlinden C, Pineda R, Paschalis EI. The evolution of corneal and refractive surgery with the femtosecond laser. EYE AND VISION 2015; 2:12. [PMID: 26605365 PMCID: PMC4655461 DOI: 10.1186/s40662-015-0022-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/20/2015] [Indexed: 01/12/2023]
Abstract
The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. With accuracy, safety, and repeatability, eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures; laser in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), penetrating keratoplasty (PKP), insertion of intracorneal ring segments, anterior and posterior lamellar keratoplasty (Deep anterior lamellar keratoplasty (DALK) and Descemet's stripping endothelial keratoplasty (DSEK)), insertion of corneal inlays and cataract surgery. As the technology matures, it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored. As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay. This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.
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Affiliation(s)
| | - Elise V Taniguchi
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
| | | | - Rodrigo Muller
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
| | - Colm McAlinden
- Flinders University, Adelaide, South Australia Australia ; Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Roberto Pineda
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
| | - Eleftherios I Paschalis
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
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Zhang J, Zhou Y, Zheng Y, Liu Q, Zhai C, Wang Y. Effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis. J Cataract Refract Surg 2014; 40:1994-2001. [DOI: 10.1016/j.jcrs.2014.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 10/24/2022]
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Lee TH, Park JW, Jeong SH, Park SW. The Change of Retinal Nerve Fiber Layer Thickness after Posterior Chamber Phakic Intraocular Lens Implantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.5.702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Tae Hee Lee
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Won Park
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Se Hyung Jeong
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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Hosny M, Zaki RM, Ahmed RA, Khalil N, Mostafa HM. Changes in retinal nerve fiber layer thickness following mechanical microkeratome-assisted versus femtosecond laser-assisted LASIK. Clin Ophthalmol 2013; 7:1919-22. [PMID: 24109171 PMCID: PMC3792930 DOI: 10.2147/opth.s51774] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To study the influence of the transient elevation of intraocular pressure during suction in laser-assisted in situ keratomileusis (LASIK) on the retinal nerve fiber layer (RNFL) thickness both in microkeratome assisted and femotsecond (FS) LASIK. Patients and methods An interventional case series that included 40 eyes suffering from myopia who were candidates for LASIK. All underwent Wave Front Guided LASIK by the same surgeon using the VisX CustomVue platform. A corneal flap was created in 20 eyes using a mechanical microkeratome Moria M2 (MMK), while the IFS IntraLase™ was used in the remaining 20 eyes. Mean suction time was recorded from “Suction ON” to “Suction OFF” time. Optic cube and RNFL thickness analysis using Spectral Domain Optical Coherence Tomography (SD-OCT) Cirrus-HD was completed before, and 1 month after LASIK. Results The study included 40 eyes of 20 patients. All were females with mean age 33.5 ± 6.4 years. Mean preoperative spherical equivalent was −3.62 ± 2.31D. Average preoperative RNFL thickness was 94.6 ± 12.1μm in MMK group while the postoperative average thickness was 95.1 ± 11.9 um with no statistically significant difference (P-value: 0.37). Average preoperative RNFL thickness was 108.28 ± 8.4 μm in FS group compared to 108.38 ± 11.2 μm in the postoperative average with no statistically significant difference (P-value: 0.94). Mean “Suction ON” to “Suction OFF” time was 22 seconds in the MMK group compared to 41 seconds in the FS group. Conclusion The rise of intraocular pressure during application of suction ring in LASIK surgery does not affect the RNFL thickness as measured by SD-OCT, whether the flap is created by MMK or FS.
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Affiliation(s)
- Mohamed Hosny
- Department of Ophthalmology, Cairo University, Cairo, Egypt
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Abstract
PURPOSE OF REVIEW Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucoma patients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols. RECENT FINDINGS As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested. SUMMARY As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
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Bibliography. Refractive surgery. Current world literature. Curr Opin Ophthalmol 2011; 22:304-5. [PMID: 21654397 DOI: 10.1097/icu.0b013e3283486839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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