1
|
Rymer P, Moscovici BK, Freitas MMS, Schor P, Campos M. Comparative outcomes of mechanical and transepithelial PRK on the same excimer laser: A contralateral eye study. Eur J Ophthalmol 2024:11206721241278395. [PMID: 39169780 DOI: 10.1177/11206721241278395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE Compare refractive results between mechanical PRK (mPRK) and transepithelial PRK (tPRK) with WaveLight Allegretto EX500 excimer laser system (Alcon Laboratories, Fort Worth, TX, USA). SETTING Department of Ophthalmology of the Federal University of Sao Paulo, Brazil. DESIGN Prospective and randomized study. METHODS In 151 eyes of 73 patients with astigmatism and myopia, both eyes had similar refraction before surgery, with a maximum of 15-µm difference in ablation who underwent mPRK in one eye and tPRK in the contralateral eye. The mean age of the patients in this study was 31.45 ± 6.97 years (range, 22 to 54 years). RESULTS A comparison was made with all variables between the two groups, and we found that UDVA and SE were worse in the tPRK group at six months than in the mPRK group. In the mPRK group, there was a higher frequency in the +/- 0.50 range and a lower frequency in the +/- 1.50 range. In the tPRK group, however, there was a lower frequency in the +/- 0.50 range and a higher frequency in the +/- 1.50 range. Concerning gain or loss of lines of sight, there was no association between the two groups (chi-square test, p = 0.887). CONCLUSION Both mPRK and tPRK appear to have similar safety. However, mPRK was associated with significantly better UDVA and SE six months post-operatively.
Collapse
Affiliation(s)
- Priscila Rymer
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo UNIFESP, São Paulo, Brazil
| | - Bernardo Kaplan Moscovici
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo UNIFESP, São Paulo, Brazil
- Department of Ophthalmology, Hospital Visão Laser, Santos, Brazil
| | - Marcela Mara Silva Freitas
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo UNIFESP, São Paulo, Brazil
| | - Paulo Schor
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo UNIFESP, São Paulo, Brazil
| | - Mauro Campos
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo UNIFESP, São Paulo, Brazil
| |
Collapse
|
2
|
Aramberri J, Lauzirika G, Illarramendi I, Mendicute J. Comparison between a new transepithelial PRK vs. conventional alcohol-assisted PRK: Corneal densitometry and aberrometry study. Eur J Ophthalmol 2024:11206721241267360. [PMID: 39147728 DOI: 10.1177/11206721241267360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE To describe and compare corneal densitometry, subjective refraction, visual acuity, and corneal higher order aberrations (HOA) after corneal refractive surgery using either alcohol-assisted photorefractive keratectomy (aaPRK) or single-step transepithelial PRK (tPRK). METHODS We conducted a retrospective and observational study. We analyzed 120 right eyes from 120 healthy consecutive myopic patients who underwent aaPRK or tPRK to correct myopia of up to 6 diopters and astigmatism of up to 2 diopters. The WaveLight EX500 excimer laser (Alcon Laboratories, Inc.) was used in all cases. Visual acuity, subjective refraction, and Pentacam AXL® measurements were performed at the preoperative visit and at 6-months follow-up visit. Pentacam AXL® software was used to assess corneal optical density in various annuli for different corneal depths and anterior corneal HOA (6 mm area of analysis). RESULTS Preoperative spherical equivalent values were similar between groups preoperatively (-3.07 ± 1.52 and -3.38 ± 1.46 in the aaPRK and tPRK groups, respectively). There were no statistically significant differences in visual acuity and postoperative refraction between groups. Postoperative corneal densitometry did not show statistically significant differences in any of the areas studied and both surgical procedures obtained similar results. However, analysis of HOA showed statistically significant differences between the techniques (1.42 ± 0.39 and 1.80 ± 0.62 for the aaPRK and tPRK groups, respectively; p = 0.000). CONCLUSIONS Both aaPRK and single-step tPRK gave comparable visual, refractive, and corneal density outcomes. Some differences were observed in HOA but were not clinically relevant.
Collapse
Affiliation(s)
- Jaime Aramberri
- Miranza Begitek, Donostia-San Sebastián, Spain
- Miranza Ókular, Vitoria-Gasteiz, Spain
| | - Gorka Lauzirika
- Miranza Begitek, Donostia-San Sebastián, Spain
- Miranza Group R&D Department, Spain
| | | | - Javier Mendicute
- Miranza Begitek, Donostia-San Sebastián, Spain
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| |
Collapse
|
3
|
Kim S, Na S, Choi S, Choi SH. Comparison of Outcomes after Wavefront-optimized and Topography-guided Transepithelial Photorefractive Keratectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:275-283. [PMID: 38897594 PMCID: PMC11321827 DOI: 10.3341/kjo.2024.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE To evaluate the outcomes of wavefront-optimized (WFO) and topography-guided (TG) transepithelial photorefractive keratectomy (transPRK) in the treatment of myopia and myopic astigmatism. METHODS Patients who underwent transPRK using the WaveLight EX500 excimer laser for the correction of myopia and myopic astigmatism between January 2022 and March 2023 were divided into groups of WFO transPRK (77 eyes of 36 patients) or TG transPRK (63 eyes of 31 patients) in this retrospective, observational cohort study. The preoperative and postoperative 3-month refractive and visual outcomes of the two groups were analyzed. RESULTS In both groups, the uncorrected distance visual acuity was 0.0 logarithm of the minimum angle of resolution or better in 95% of eyes 3 months postoperatively, and the mean manifest refraction spherical equivalent was within ±1.0 diopter in 90% of eyes. No significant differences were observed between the groups in terms of the uncorrected distance visual acuity or astigmatism. A significant induction of higher order aberrations (HOAs) was observed in both groups. However, the induction of total corneal HOAs (p = 0.014) and spherical aberrations (p < 0.001) was significantly lower in the TG group than that in the WFO group. CONCLUSIONS WFO and TG transPRK effectively improved the visual and refractive outcomes; however, the induction of total corneal HOAs and spherical aberration was lesser following the TG ablation.
Collapse
Affiliation(s)
- SooJin Kim
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul,
Korea
| | | | - Sangkyung Choi
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul,
Korea
| | | |
Collapse
|
4
|
Ho T. Clinical Outcomes of Transepithelial Photorefractive Keratectomy Performed with Smart Pulse Technology for the Correction of Moderate to High Myopia. J Clin Med 2024; 13:3058. [PMID: 38892769 PMCID: PMC11173154 DOI: 10.3390/jcm13113058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose: To evaluate the safety and efficacy of the transepithelial photorefractive keratectomy (TransPRK) performed using smart pulse technology (SPT) in myopic eyes with refractive error ranging from -5.25 D to -9.75 D. Methods: This retrospective study evaluated the outcomes of SPT-assisted TransPRK in 150 eyes performed using a 1050 Hz AMARIS excimer laser. Results: At 6 months postoperative, 98% of eyes achieved uncorrected distance visual acuity (UDVA) of 20/25 or better, and postoperative UDVA within one line of preoperative corrected distance visual acuity (CDVA). No eyes lost any line of CDVA. Residual spherical equivalent refraction and cylinder within ±0.50 D of intended correction were achieved in 72% and 67% of eyes, respectively. Ninety-seven percent of eyes reported no halos and glare. Conclusions: TransPRK using a 1050 Hz excimer laser with SPT showed excellent predictability, safety, and efficacy for moderate to high myopia correction.
Collapse
Affiliation(s)
- Tony Ho
- Mount Elizabeth Medical Centre, Singapore 228510, Singapore
| |
Collapse
|
5
|
Maskin SL, Toland C. Meibomian Gland Probing Stimulates a Proliferative Epithelial Response Resulting in Duct Regeneration. Clin Ophthalmol 2024; 18:631-645. [PMID: 38445253 PMCID: PMC10913816 DOI: 10.2147/opth.s452549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose To demonstrate that the meibomian gland ductal basement membrane and basal epithelial cell layer are in continuity with and may derive from lid margin orifice-associated rete ridge epithelial/basement membrane structures (OARREBS) and to characterize changes in the distal duct microanatomy after meibomian gland probing (MGP) using in vivo confocal microscopy (IVCM). Patients and Methods Pre/post-MGP IVCM examinations were performed on upper lids. Thirty-six identical glands from 20 lids of 16 patients (49.24 ±17.11 y/o with 13:3 F:M) were identified, analyzed, and compared to control cases. Statistical analyses were performed using ImageJ software and IBM SPSS version 27. All MGPs were performed within 12 weeks of the initial examination. Post-MGP follow-up exams occurred at 5.03 ±4.48 months. Results Post-MGP images showed more superficially organized OARREBS with accelerated and more superficial basement membrane formation, and an average increase of 32.2%, 25.4%, 32.04%, 77.7%, and 81.3% in duct wall epithelial cell layers (DWECL) (p < 0.001, compared to control (CTC) p < 0.001), distal duct wall thickness (DWT) (p < 0.001, CTC p < 0.001), proximal DWT (p < 0.001, CTC p < 0.001), distal lumen area (p < 0.001, CTC p = 0.037), and proximal lumen area (p < 0.001, CTC p = 0.007), respectively. The increase in the distal DWT and lumen area correlated with the months of follow-up (p = 0.004 and p = 0.010, respectively). Immediate post-MGP imaging revealed the probe track confined to the ductal epithelial compartment. Conclusion MGP appears to stimulate a proliferative epithelial response characterized by an accelerated more superficial formation of ductal basement membrane with increased DWECL as well as DWT and lumen area at two separate duct foci. These findings suggest activation of lid margin meibomian gland precursor cells and confirm that MGP stimulates an epithelial regenerative phenomenon, not a fibrotic one.
Collapse
|
6
|
Saad A, Saad A, Frings A. Refractive results of photorefractive keratectomy comparing trans-PRK and PTK-PRK for correction of myopia and myopic astigmatism. Int Ophthalmol 2024; 44:111. [PMID: 38403780 PMCID: PMC10894757 DOI: 10.1007/s10792-024-02999-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/19/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE To compare refractive outcomes after transepithelial photorefractive keratectomy (tPRK) and combined phototherapeutic keratectomy (PTK-PRK) procedure using two different excimer laser platforms for correction of myopia and myopic astigmatism. METHODS In this retrospective multicenter study, we compared the results of two different PRK methods. The first group received a tPRK treatment with the Amaris750 excimer laser (Schwind eye-tech solutions). The second group received a combined PTK-PRK treatment with the MEL90 excimer laser (Carl Zeiss). Only healthy eyes with no previous surgery and a spherical equivalent (SE) of -1 to -8 diopters (D) were included. Preoperative spherical equivalent (SE), age, and sex were matched among the two groups. All treatments were performed by the same surgeon in different clinics. This study was approved by the local Ethics Committee (No. 2022-1980). RESULTS We included 154 eyes of 86 patients in our study. There was no difference in predictability of SE between the two groups. Efficacy and safety indices were equally high in both groups. Similarly, no significant differences were seen in change of higher order aberrations (HOA) between the two groups (p > 0.05). No complications occurred. CONCLUSION Both investigated methods provide safe and effective refractive results. The combination of PTK with PRK may be a suitable option to the already used one-step tPRK for the correction of myopia.
Collapse
Affiliation(s)
- Ahmed Saad
- Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany
| | - Amr Saad
- Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany
| | - Andreas Frings
- Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany.
- Augenlaser-Zentrum Kärnten, Klagenfurt am Wörthersee, Klagenfurt, Austria.
- Augenheilkunde and Augenlaser Zentrum PD Dr. med. A. Frings, Nuremberg, Germany.
| |
Collapse
|
7
|
Weng TH, Chang YM, Lin FH, Weng ZX, Wang TW, Chen YH, Tai MC, Chen JT, Liang CM, Lin TY. Investigation of corneal epithelial thickness and irregularity by optical coherence tomography after transepithelial photorefractive keratectomy. Clin Exp Optom 2024; 107:23-31. [PMID: 37078178 DOI: 10.1080/08164622.2023.2197107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
CLINICAL RELEVANCE Corneal epithelial healing after refractive surgery is a clinically significant issue, especially for surface ablation procedures, and this can be monitored using optical coherence tomography (OCT). BACKGROUND The aim of this work is to investigate the corneal epithelial thickness and irregularity by OCT after transepithelial photorefractive keratectomy (t-PRK) and analyse its correlation with visual and refractive outcomes. METHODS Patients aged ≥18 years with myopia, with or without astigmatism, who underwent t-PRK between May 2020 and August 2021 were included. All participants were subjected to complete ophthalmic examinations and OCT pachymetry at every follow-up visit. Patients were followed up at 1 week and 1, 3, and 6 months postoperatively. RESULTS A total of 67 patients (126 eyes) were enrolled in this study. One month postoperatively, spherical equivalent refraction and visual acuity achieved preliminary stability. However, central corneal epithelial thickness (CCET) and standard deviation of the corneal epithelial thickness (SDcet) took 3-6 months to progressive recovery. Patients with higher baseline spherical equivalent refraction were associated with slower epithelial recovery. At every follow-up time point, a significant superior-inferior difference in the minimum corneal epithelial thickness area was observed. Higher stromal haze was correlated with higher spherical equivalent refraction (both baseline and residual) but had no relation with visual outcomes. There was a significant correlation between higher CCET with a better uncorrected distance visual acuity and lower corneal epithelial thickness irregularity. CONCLUSIONS CCET and SDcet measured by OCT seem to be a good auxiliary indicator for reflecting the status of corneal wound recovery after t-PRK surgery. However, a well-designed randomised control study is needed to confirm the study results.
Collapse
Affiliation(s)
- Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Zi-Xuan Weng
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Tai-Wen Wang
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| |
Collapse
|
8
|
Abdel-Radi M, Shehata M, Mostafa MM, Aly MOM. Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques. Eye (Lond) 2023; 37:1545-1552. [PMID: 35864163 PMCID: PMC10219954 DOI: 10.1038/s41433-022-02174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. METHODS A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. RESULTS Preoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. CONCLUSION The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. CLINICAL TRIALS REGISTRY (Clinical Trials.gov Identifier): NCT04710082.
Collapse
Affiliation(s)
| | - Mohamed Shehata
- Department of Ophthalmology, Assiut University, Assiut, Egypt
| | | | | |
Collapse
|
9
|
Ip CS, Jones DK, Weinlander E, Gudgel B, Lin A, Yazdani H, Pierce J, Holubkov R, Jensen H, Church M, Mifflin MD. Phase I/II randomized, double-masked, placebo-controlled study of processed amniotic fluid drops after PRK. J Cataract Refract Surg 2023; 49:299-304. [PMID: 36730463 DOI: 10.1097/j.jcrs.0000000000001100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/14/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of processed amniotic fluid (pAF) used postoperatively after photorefractive keratectomy (PRK). SETTING University of Utah, Moran Eye Center, Salt Lake City, Utah. DESIGN Randomized, double-masked, placebo-controlled prospective study. METHODS 61 participants were randomized to receive either placebo or pAF drops, which were instilled 4 times per day for 1 week after PRK along with routine postoperative medications. The primary outcome measure was time to full re-epithelialization in days. Secondary measures included visual acuity at 30 days and postoperative pain scores during the first week. RESULTS There was no significant difference in time to re-epithelialization, with a median of 5 days for both groups. There were no difference in pain indicator scores during the first week and no difference in corneal staining scores at day 30 between the 2 groups. There were no adverse events. CONCLUSIONS This pilot study evaluating the safety and efficacy of pAF as an additional postoperative topical medication for PRK demonstrated that pAF did not improve the rate of epithelial healing after PRK. pAF may be safely studied in other ocular conditions to determine its effect on epithelial healing.
Collapse
Affiliation(s)
- Colin S Ip
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Ip, Jones, Weinlander, Gudgel, Lin, Yazdani, Church, Mifflin); Cell Therapy and Regenerative Medicine, University of Utah, Salt Lake City, Utah (Pierce); Department of Pediatrics, University of Utah, Salt Lake City, Utah (Holubkov, Jensen)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Zhang Y, Li T, Li Z, Dai M, Wang Q, Xu C. Clinical outcomes of single-step transepithelial photorefractive keratectomy and off-flap epipolis-laser in situ keratomileusis in moderate to high myopia: 12-month follow-up. BMC Ophthalmol 2022; 22:234. [PMID: 35606707 PMCID: PMC9128200 DOI: 10.1186/s12886-022-02443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy (TPRK) and off-flap epipolis-laser in situ keratomileusis (Epi-LASIK) in moderate to high myopia. METHODS In this prospective self-control study, we included patients with moderate to high myopia who were randomized to undergo TPRK in one eye and Epi-LASIK in the other eye. Twelve-month follow-up results for visual acuity, refraction, ocular high-order aberrations, contrast sensitivity, postoperative pain, epithelial healing, and haze grade were assessed. RESULTS A total of 64 eyes (32 patients) were enrolled in the study. More eyes completed re-epithelialization in the TPRK group than in the Off-flap Epi-LASIK group 3-4 days postoperatively, while all eyes completed re-epithelialization by 7 days. More eyes achieved a visual acuity (both UDVA and CDVA) of better than 20/20 in the TPRK group than in the Off-flap Epi-LASIK group. The ±0.50 D predictability for correction of the spherical equivalent (SE) was higher in the eyes of the TPRK group (91%) than in those of the off-flap Epi-LASIK group (80%) 12 months after surgery. No significant differences in ocular aberrations, including coma, spherical, and trefoil, were found between the two groups at 12 months. There were also no significant differences in visual acuity, contrast sensitivity, pain, and haze grading between the two groups. CONCLUSIONS Both TPRK and off-flap Epi-LASIK are safe, effective, and predictable treatments for moderate to high myopia with comparable surgical outcomes. TRIAL REGISTRATION This study was retrospectively registered on ClinicalTrial.gov ( NCT05060094 , 17/09/2021).
Collapse
Affiliation(s)
- Yunjie Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Tiankun Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Zhangliang Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Mali Dai
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Qinmei Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Chenchen Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
| |
Collapse
|
11
|
Hashemi H, Alvani A, Aghamirsalim M, Miraftab M, Asgari S. Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial. BMC Ophthalmol 2022; 22:68. [PMID: 35148689 PMCID: PMC8832736 DOI: 10.1186/s12886-022-02293-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background To assess transepithelial photorefractive keratectomy (tPRK) in terms of corneal epithelial healing rate, postoperative pain, postoperative discomfort, and visual and refraction outcomes compared to mechanical epithelial debridement PRK (mPRK) and alcohol-assisted PRK (aaPRK). Methods In this double-masked, randomized clinical trial, thirty-nine patients underwent tPRK in one eye and mPRK in the fellow eye (arm A), and 33 patients underwent tPRK in one eye and aaPRK in the contralateral eye (arm B). All surgical procedures were done using the Schwind Amaris excimer laser. The area of corneal epithelial defect in all eyes was captured and analyzed using ImageJ software. Results Mean epithelial healing time was respectively 3.74 ± 0.82 and 3.59 ± 0.79 days in tPRK versus mPRK (P = 0.21) in arm A, and 3.67 ± 0.92 and 3.67 ± 0.74 days in tPRK versus aaPRK (P = 1.00) in arm B. Accounting for the initial corneal epithelial defect area, the epithelial healing rate was faster in conventional PRK groups compared to tPRK (both P<0.001) in both arms. However, there was no significant difference in safety, efficacy, spherical equivalent refractive accuracy, or corneal haze development between tPRK and conventional PRK groups (all P > 0.05). Conclusions All three methods are effective in terms of visual and refractive outcomes. However, although time to complete re-epithelialization was similar with the three methods, the epithelial healing rate was faster in conventional PRK considering the initial corneal epithelial defect area, and the patients experienced less pain and discomfort in the first postoperative day. Trial registration IRCT, IRCT20200317046804N1. Retrospectively registered 5 May 2020.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran
| | - Azam Alvani
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran.
| | | | - Mohammad Miraftab
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran
| |
Collapse
|
12
|
Moshfeghi S, Razmjou H, Peyman A, Kateb H, Naderan M. A comparison between wavefront-optimized and wavefront-guided photorefractive keratectomy in patients with moderate-to-high astigmatism: A randomized clinical trial. J Curr Ophthalmol 2022; 34:194-199. [PMID: 36147260 PMCID: PMC9487005 DOI: 10.4103/joco.joco_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose: Methods: Results: Conclusion:
Collapse
|
13
|
Kate A, Basu S. Amniotic Membrane Granuloma in a Case of Ocular Chemical Injury: Clinical Features, Histopathology, and Outcomes. Cureus 2021; 13:e19171. [PMID: 34873514 PMCID: PMC8632734 DOI: 10.7759/cureus.19171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/17/2022] Open
Abstract
This report describes the clinical features of a granuloma within the layers of amniotic membranes (AM) along with its surgical management and outcome. An eight-year-old boy underwent an AM graft in the right eye for an acute chemical injury. As there was slow healing of the ocular surface, the eye was subjected to a simple limbal epithelial transplantation (SLET). Although the corneal surface was well epithelialized, a superior symblepharon was noted six weeks following SLET. Excision of the fibrotic tissue with an AM graft was carried out. Growth of a grayish-white fibrotic lesion in the visual axis of the cornea was noted eight months after the second AM graft. The optical coherence tomography line scan revealed the location of the lesion to be anterior to the retained SLET AM. This lesion progressively increased in size, so an excision biopsy was carried out. The lesion excised in toto with the AM, and an optically clear plane was noted. Histopathology of the tissue revealed the presence of myofibroblasts, which possibly originated from the AM fibroblasts. At the three-year follow-up period, there was no recurrence of the growth, and the final visual acuity was 20/40. This is a rare report of a granuloma case arising within the layers of an AM. The underlying etiopathogenesis could be due to the multiple AM grafts that the patient underwent. These repeated grafts can incite an immune response and lead to the formation of a granuloma. The special staining and the restoration of the corneal clarity with a stable ocular surface suggest the AM origin of the mass lesion. Removal of the layer of the AM with the granuloma has good outcomes, with no recurrence on long-term follow-up.
Collapse
Affiliation(s)
- Anahita Kate
- Cornea, L V Prasad Eye Institute, Vijayawada, IND
| | - Sayan Basu
- Cornea, L V Prasad Eye Institute, Hyderabad, IND
| |
Collapse
|
14
|
Mohammadpour M, Rezaei F, Heirani M, Khorrami-Nejad M. Comparison of Postoperative Symptoms of Alcohol-Assisted Versus Mechanical Epithelial Removal in Photorefractive Keratectomy: A Contralateral Double Blind Clinical Trial. Eye Contact Lens 2021; 47:655-659. [PMID: 34393178 DOI: 10.1097/icl.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the short-term complaints of postoperative pain, and other ocular discomfort symptoms in patients who underwent photorefractive keratectomy (PRK) with alcohol-assisted epithelial removal in one eye versus mechanical debridement in the other eye. METHOD A prospective, interventional, contralateral double blind clinical trial was performed on 164 eyes of 82 candidates of PRK surgery. The patients were divided into two groups. The first group was alcohol-assisted PRK group in which the epithelial removal was performed on their right eye. The second group was mechanical PRK group in which epithelial removal was performed on their left eye. A numerical rating scale was given to the patients to describe the severity of postoperative pain on the first day following PRK. Postoperative discomfort symptoms including the complaints of light sensitivity, tearing, blurring, and foreign body sensation was also provided by the survey form. RESULTS One day following PRK, the mean pain score of the alcohol-assisted PRK group and the mechanical PRK group was 3.4±3.1 and 4.1±3.3, respectively (P=0.019). The highest scores recorded for alcohol-assisted and mechanical treated groups were burning (5.22) and light sensitivity (5.46), respectively. Sixty-eight (82.9%) of all patients experienced postoperative pain, and in 52 (76.5%) of them, the time of pain onset was less than 2 hrs. CONCLUSION We found less pain and discomfort using alcohol-assisted technique compared with mechanical epithelial removal that was provided by a detailed pain and ocular discomfort symptoms assessment one day following PRK surgery.
Collapse
Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center (M.M., F.R., M.H., M.K.-N.), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; and School of Rehabilitation (M.K.-N.), Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
15
|
Corneal Epithelial Removal with a Newly Designed Epithelial Brush. J Ophthalmol 2021; 2021:4668056. [PMID: 35154818 PMCID: PMC8828349 DOI: 10.1155/2021/4668056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate and compare the effectiveness of a newly developed epithelial removal brush with conventional methods in a rabbit model of corneal epithelial defects. The corneal epithelia of thirty-seven rabbits were removed by three different methods including blades (blade group), newly developed epithelial brushes (Ocu group), and conventional rotating brushes (Amo group). The defect area was measured with light microscopy immediately and at 4, 18, 24, and 50 hours after removal. Corneas were obtained immediately and at 24 and 50 hours and subjected to hematoxylin and eosin (H&E) and immunofluorescence staining using proliferating cell nuclear antigen (PCNA) and phosphorylated heat shock protein 27 (pHSP27) antibodies. The residual stromal surface was observed by scanning electron microscopy (SEM). In the Ocu group, epithelia were significantly recovered at 18, 24, and 50 hours compared with immediately after removal, and in the blade and Amo groups, epithelia were significantly recovered only at 50 hours after epithelial removal. The expression levels of PCNA and pHSP27 did not differ among three groups. There was significantly more inflammatory cell infiltration in the blade group than in the other groups. SEM showed a more regular and uniform residual stromal surface in the Ocu group than in the other groups. The newly developed epithelial brush showed better polishing ability and led to earlier significant epithelial recovery and a more regular and uniform stromal surface than conventional methods in this rabbit model of epithelial defects. Accumulation of clinical data is expected to expand the scope of application of new brushes for laser surface ablation.
Collapse
|
16
|
Mohammadpour M, Heirani M, Khorrami-Nejad M, Ambrósio R. Update on Pain Management After Advanced Surface Ablation. J Refract Surg 2021; 37:782-790. [PMID: 34756143 DOI: 10.3928/1081597x-20210809-02] [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: 11/20/2022]
Abstract
PURPOSE To provide an update for postoperative pain control strategies to help ophthalmic surgeons establish a more effective management plan for patients who underwent advanced surface ablation surgeries. METHODS Google Scholar, Scopus, ScienceDirect, and PubMed were the main resources used to search the medical literature. RESULTS The postoperative cornea's healing process is accompanied by intense pain as the chief complaint in the first days after the operation. Several strategies were developed to relieve postoperative pain after surface ablation procedures. These strategies included different preoperative, intraoperative, and postoperative methods. Considering the preoperative demographic and emotional factors, underlying dry eye, alternative epithelial removal techniques, bandage contact lenses, and topical or oral therapeutic agents are some examples of postoperative pain treatments after surface ablation procedures. CONCLUSIONS The current review revealed that despite the development of numerous protocols to relieve postoperative pain following surface ablations, the best approach could be a combination of different strategies. In practice, no validated and standardized strategy is available for total elimination of postoperative pain following advanced surface ablation surgeries. [J Refract Surg. 2021;37(11):782-790.].
Collapse
|
17
|
Tangmonkongvoragul C, Supalaset S, Tananuvat N, Ausayakhun S. Two-Step Transepithelial Photorefractive Keratectomy with WaveLight EX500 Platform for Adolescents and Adults with Low to Moderate Myopia: A 12-Month Comparative Evaluation. Clin Ophthalmol 2021; 15:4109-4119. [PMID: 34675478 PMCID: PMC8520963 DOI: 10.2147/opth.s336727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the visual and refractive results obtained after two-step TransPRK using an EX500 excimer laser for low to moderate myopic correction in adolescents and adults. Patients and Methods Retrospectively, 91 eyes of 52 patients were categorized into four groups based on age and level of myopia. The demographics, data of efficacy, safety, predictability, stability, and post-operative complications were evaluated at 1, 3, 6, and 12 months post-operatively. Results At 1-month, adolescents with low myopia achieved the highest mean efficacy index (P =0.034). The efficacy indices continuously increased during the 1-year follow-up in all groups, except in adolescents with moderate myopia. The highest safety and efficacy indices were recorded in adolescents with low myopia at 1-year. Post-operative spherical equivalent within ±0.50 D at 1 year was 48.75% of all treated eyes; however, the final mean refractive spherical equivalent (MRSE) was under-corrected in all groups. By month 3, the percentage of eyes that had grade 0.5 haze was most prevalent in adolescents with moderate myopia (P <0.001). Conclusion two-step TransPRK using an EX500 proved to be an effective, predictable, stable and safe procedure for the correction of low to moderate myopia with or without astigmatism at 1 year. Adolescents with low myopia achieved the best-post-operative UDVA, efficacy and safety indices. Adolescents tolerated night visual problems and dry eye symptoms better than adults.
Collapse
Affiliation(s)
- Chulaluck Tangmonkongvoragul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,CMU LASIK Center, Center of Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sumet Supalaset
- Department of Ophthalmology, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Napaporn Tananuvat
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,CMU LASIK Center, Center of Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,CMU LASIK Center, Center of Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
18
|
Three-year outcomes of mixed astigmatism correction with single-step transepithelial photorefractive keratectomy with a large ablation zone. J Cataract Refract Surg 2021; 47:450-458. [PMID: 33252566 DOI: 10.1097/j.jcrs.0000000000000476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate refractive and visual outcomes of single-step transepithelial photorefractive keratectomy (transPRK) in the treatment of mixed astigmatism with the use of an aberration-neutral profile and large ablation zone. SETTING Nicolaus Copernicus University and Oftalmika Eye Hospital, Bydgoszcz, Poland. DESIGN Retrospective, observational case series. METHODS This study included patients who underwent transPRK to correct mixed astigmatism and completed the 3-year follow-up. Procedures were performed with an Amaris 750S excimer laser using an aberration-neutral profile and optical zone of 7.2 mm or more. RESULTS A total 48 eyes of 39 patients were included. Preoperatively, mean spherical manifest refraction was +1.37 ± 0.98 diopter (D) (0.25 to 4.00 D), and astigmatism was -4.00 ± 0.76 D (-2.25 to -6.00 D). Three years postsurgery, it was -0.17 ± 0.26 D and -0.41 ± 0.44 D, respectively. Attempted spherical equivalent correction within ±0.50 D was achieved in 45 eyes (94%) and cylindrical correction in 34 (71%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 38 eyes (79%), and postoperative uncorrected was 20/20 or better in 29 eyes (60.0%). No eye had lost 2 or more Snellen lines of CDVA, whereas 3 eyes (6%) gained 2 or more lines. In 4 eyes (8%), haze of low intensity was observed at the periphery, with scores between 0.5 and 1.0, and only 1 eye getting a score of 2 in 0- to 4-degree scale. CONCLUSIONS Mixed astigmatism correction with large-ablation-zone transPRK provided good results for efficacy, safety, predictability, and visual outcomes in a 3-year follow-up.
Collapse
|
19
|
Comparison of Refractive and Visual Outcomes after Transepithelial Photorefractive Keratectomy (TransPRK) in Low versus Moderate Myopia. PHOTONICS 2021. [DOI: 10.3390/photonics8070262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Is it possible to obtain good results in myopia of 2 or fewer diopters (D) with transepithelial photorefractive keratectomy (TransPRK) changing the optical zone and epithelium thickness? We retrospectively analyzed two groups of 296 eyes with a minimum follow-up of 4 months. Group A had 2 or less D, treated with an optical zone (OZ) 0.2 mm bigger than recommended, and a central epithelium thickness of 60 microns, and group B had 2 D to 5 D, with the recommended optical zone, and a 55-micron epithelium ablation at the center. The outcomes were not different between the two myopic ranges; the postop uncorrected distance visual acuity was 20/20 ± 4 in both groups (p = 0.2), which was −0.3 ± 0.8 lines worse than the preoperative corrected distance visual acuity in both groups (p = 0.5). The safety of the treatments resulted in a change of 0.0 ± 0.7 lines in the low myopia group, versus a gain of +0.1 ± 0.8 lines in the moderate myopia group (p = 0.1). The deviation from the intended target was −0.04 ± 0.33 D in the low myopia group and +0.07 ± 0.32 D in the moderate myopia group (p < 0.0001); the postoperative spherical equivalent was 0.00 ± 0.33 D in the low myopia group and +0.10 ± 0.31 D in the moderate myopia group (p < 0.0001). The postop refractive astigmatism was 0.32 ± 0.16 D in both groups (p = 0.5). In conclusion, the refractive and visual outcomes after TransPRK are comparable in low myopia changing the optical zone and epithelium thickness versus moderate myopia with standard optical zone and epithelium thickness.
Collapse
|
20
|
Pertiwi ANS, Mahayana IT, Supartoto A, Goenawan W, Suhardjo. Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values. Int J Ophthalmol 2021; 14:744-749. [PMID: 34012891 DOI: 10.18240/ijo.2021.05.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate demographic and preoperative factors increasing the risk of ametropia following transepithelial photorefractive keratectomy (transPRK) in myopia and myopic astigmatism. METHODS This retrospective cohort study included myopic eyes (-0.50 to -8.75 D) with or without astigmatism (up to 3.50 D) enrolled at Dr. Yap Eye Hospital Yogyakarta. TransPRK was performed using Technolaz 217z100 excimer laser. Subjects were clustered into ametropia and emmetropia group based on uncorrected distance visual acuities (UDVA) 3mo post-operatively. Multiple preoperative and intraoperative parameters were analyzed using Logistic regression to obtain their effect on ametropia risk following transPRK. RESULTS A total of 140 eyes of 87 consecutive subjects were studied. Prevalence of ametropia following transPRK was 20 (14.29%) eyes. Subjects in ametropia group were significantly older than the emmetropia group (31.80±14.23 vs 18.88±2.41, respectively; P<0.001). Bivariate Logistic regression analysis showed that older age (OR=1.23), higher preoperative spherical equivalent (>-6 D; OR=12.78), steeper anterior keratometric readings (Kmax>45 D and mean K>44 D; OR=4.28 and 4.35, respectively) increased the risk of ametropia following transPRK. Adjusted multivariate Logistic regression analysis showed that age was the strongest predictor for the incidence of ametropia following transPRK. Complications of transPRK were overcorrection, suspected posterior keratoectasia and accommodation insuffiency. CONCLUSION Older age can be the strongest factor for increasing ametropia risk following transPRK. Cut-off points of Kmax and mean K at 45 and 44 D respectively are proposed as the predictors for ametropia following transPRK.
Collapse
Affiliation(s)
- Amanda Nur Shinta Pertiwi
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia
| | - Indra Tri Mahayana
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia
| | - Agus Supartoto
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| | - Wasisdi Goenawan
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| | - Suhardjo
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| |
Collapse
|
21
|
Fogla R, Luthra G, Chhabra A, Gupta K, Dalal R, Khamar P. Preferred practice patterns for photorefractive keratectomy surgery. Indian J Ophthalmol 2021; 68:2847-2855. [PMID: 33229660 PMCID: PMC7856967 DOI: 10.4103/ijo.ijo_2178_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Over the past two decades, excimer laser-based refractive surgery procedures have been successfully established for their safety and satisfactory visual outcomes. Surface ablation procedures or photorefractive keratectomy (PRK) are practised commonly for the correction of refractive errors including myopia, astigmatism and hyperopia. Satisfactory visual outcomes are achieved in majority of cases, although a very small percentage have issues related to corneal haze, regression, and its associated visual disturbances. To ensure optimal outcomes and to minimize complications, certain keys to success have been designed on the basis of the current review of literature on surface ablation procedures.
Collapse
Affiliation(s)
- Rajesh Fogla
- Senior Consultant, Cataract, Cornea and Laser Refractive Surgeon, Director Cornea Clinic, Apollo Hospitals, Hyderabad, Telangana, India
| | - Gaurav Luthra
- Cataract and Refractive Surgeon, Director, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Aishwarya Chhabra
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Krati Gupta
- Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ritika Dalal
- Refractive Surgeon and Dry Eye Specialist, Dr Dalal's Clinic, Mumbai, Maharashtra, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| |
Collapse
|
22
|
Sánchez-González JM, Alonso-Aliste F, Borroni D, Amián-Cordero J, De-Hita-Cantalejo C, Capote-Puente R, Bautista-Llamas MJ, Sánchez-González MC, Rodríguez-Calvo-de-Mora M, Rocha-de-Lossada C. Plasma Rich in Growth Factors (PRGF) in Transepithelial Photorefractive Keratectomy (TPRK). J Clin Med 2021; 10:jcm10091939. [PMID: 33946455 PMCID: PMC8124326 DOI: 10.3390/jcm10091939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/13/2023] Open
Abstract
To evaluate the usage of plasma rich in growth factor (PRGF) in transepithelial photorefractive keratectomy (TPRK) in low and moderate myopia, patients who underwent myopic and astigmatism TPRK with PRGF were involved in this retrospective, observational study. Subjects underwent a surgical procedure between February 2019 and June 2019. A three-month follow-up was recorded. Pain score was assessed with a visual analogue scale (0–10) and re-epithelialization time recorded. A total of 48 eyes from 24 patients were recruited. Mean uncorrected distance visual acuity (UDVA) was 20/20.31 (0.00 ± 0.02 LogMAR). A total of 98% of eyes did not change corrected distance visual acuity (CDVA) lines. Two percent of eyes lost one line of CDVA. Preoperative spherical equivalent was −2.67 ± 1.37 D and after three months changed to −0.21 ± 0.34 D, and 2% of eyes changed 0.50 D or more between one and three months. Pain score was 3.29 ± 0.61 (3 to 6) score points at day one and 0.08 ± 0.27 score points at day seven. Finally, re-epithelialization time was 2.50 ± 1.20 days. PRGF addition to conventional refractive treatment such as TPRK seems to alleviate immediate postoperative pain and positively contribute to corneal re-epithelization time.
Collapse
Affiliation(s)
- José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
- Department of Ophthalmology, Tecnolaser Clinic Vision, 41018 Seville, Spain; (F.A.-A.); (J.A.-C.)
- Correspondence:
| | - Federico Alonso-Aliste
- Department of Ophthalmology, Tecnolaser Clinic Vision, 41018 Seville, Spain; (F.A.-A.); (J.A.-C.)
| | - Davide Borroni
- The Veneto Eye Bank Foundation, 30174 Venice, Italy;
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
| | - Jonatan Amián-Cordero
- Department of Ophthalmology, Tecnolaser Clinic Vision, 41018 Seville, Spain; (F.A.-A.); (J.A.-C.)
| | - Concepción De-Hita-Cantalejo
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | - María-José Bautista-Llamas
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | | | - Carlos Rocha-de-Lossada
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, 04120 Almería, Spain;
- Department of Ophthalmology, University Hospital Virgen de las Nieves, 18014 Granada, Spain
- Department of Ophthalmology, Ceuta Medical Center, 51001 Ceuta, Spain
| |
Collapse
|
23
|
Gharieb HM, Awad-Allah MAA, Ahmed AA, Othman IS. Transepithelial Laser versus Alcohol Assisted Photorefractive Keratectomy Safety and Efficacy: 1-Year Follow-up of a Contralateral Eye Study. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:142-152. [PMID: 33596623 PMCID: PMC8046614 DOI: 10.3341/kjo.2020.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up. Methods A prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity. Results Epithelial healing was complete by the 3rd day in 62.1% of AAPRK eyes and in 89.7% of TPRK eyes. First day postoperative pain was higher in TPRK group (p = 0.0134). The decimal uncorrected visual acuity at 12 months was 1.47 ± 0.39 and 1.57 ± 0.38 in the AAPRK and TPRK groups respectively (p = 0.3719). Post-photorefractive keratectomy haze reached a final level of 0.04 ± 0.14 and 0.02 ± 0.1 in AAPRK and TPRK groups respectively (p = 0.5607). Contrast sensitivity was comparable in low and high frequency cycles per degree. Vector analysis of astigmatic correction showed correction index at one year of 0.99 and 1.05 for AAPRK and TPRK groups respectively. Conclusions Alcohol assisted and transepithelial photorefractive keratectomy have comparable results regarding safety and efficacy.
Collapse
Affiliation(s)
- Hesham Mohamed Gharieb
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Eye World Hospital, Dokki, Giza, Egypt
| | | | - Anas Adel Ahmed
- Eye World Hospital, Dokki, Giza, Egypt.,Department of Ophthalmology, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ihab Saad Othman
- Eye World Hospital, Dokki, Giza, Egypt.,Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| |
Collapse
|
24
|
[Excimer laser in keratoconus management]. J Fr Ophtalmol 2021; 44:564-581. [PMID: 33573798 DOI: 10.1016/j.jfo.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022]
Abstract
Visual rehabilitation in keratoconus is a challenge, notably because of the significant irregular astigmatism and optical aberrations that it induces. Many surgical techniques have been developed in addition to, or in the case of failure of, spectacles and rigid gas permeable contact lenses: intracorneal ring segments, intraocular lenses, excimer laser and, as a last resort, keratoplasty. Excimer laser photoablates the cornea, allowing remodeling of its surface. There are various treatment modes (wavefront-optimized, wavefront-guided and topography-guided), allowing performance of a customized treatment if needed. Its use in keratoconus has been described since the 2000s, alone or in combination with other procedures. For example, the combination of photoablation and corneal cross linking, a technique that increases corneal rigidity and in so doing can slow or even stop the progression of keratoconus, proved its efficacy and safety in many studies, and various protocols have been described. A triple procedure, including intracorneal ring segments, excimer laser and cross linking, has also given some very promising results in progressive keratoconus, providing a significative improvement in visual acuity and topographic data. The combination of excimer laser and intraocular lenses remains a poorly explored lead that might provide some satisfactory results. The objective of this review is to summarize the recent data on excimer laser in keratoconus management.
Collapse
|
25
|
Transepithelial Photorefractive Keratektomy after a Clear Lens Exchange. Vision (Basel) 2021; 5:vision5010008. [PMID: 33546149 PMCID: PMC7930984 DOI: 10.3390/vision5010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We evaluated the refractive visual outcomes and efficacy of Transepithelial Photorefractive Keratectomy (TransPRK) using Smart Pulse Technology with static and dynamic cyclotorsion and the AMARIS 1050 Hz RS laser platform from Schwind in the eyes after a refractive lens exchange. Setting/Venue: Aurelios Augenlaserzentrum, Recklinghausen. METHODS We retrospectively evaluated the data of 552 consecutive eyes treated with refractive lens exchange between 2016 and 2019. A total of 47 eyes (8.5%) required a touch up after the clear lens exchange. From 43 eyes of 43 patients, we obtained a minimum follow up of 3 months. In all cases, we performed a TransPRK with a minimum optical zone of 7.2 mm, centering the ablation on the vertex of the cornea. RESULTS The average age of the treated eyes was 57 years old, with a range between 48 and 68 years. The mean treated sphere was 0.42 diopters (D), with a range between -1.0 and +1.75 D. The mean astigmatism was 1.06 D. Postoperatively, after laser vision correction, we reduced the sphere to a mean of 0.11 D (range -0.5 to +0.75 D), and, postoperatively, the mean astigmatism was 0.25 D (range -0.75 to 0 D). The predictability for a spheric equivalent (SEQ) of 0.5 D was 91%, and for 1 D it was 100% of the cases. No eye lost more than one Snellen line. CONCLUSIONS TransPRK with smart pulse was predictable for correcting ametropia after Clear Lens Surgery.
Collapse
|
26
|
Gershoni A, Reitblat O, Mimouni M, Livny E, Nahum Y, Bahar I. Femtosecond laser assisted in situ keratomileusis (FS-LASIK) yields better results than transepithelial photorefractive keratectomy (Trans-PRK) for correction of low to moderate grade myopia. Eur J Ophthalmol 2020; 31:2914-2922. [PMID: 33307790 DOI: 10.1177/1120672120980346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the outcomes of transepithelial photorefractive keratectomy (Trans-PRK) with femtosecond laser assisted in situ keratomileusis (FS-LASIK) for the correction of low to moderate myopia. METHODS A retrospective cohort study design was used. The study group included patients with myopia less than -6.0 D, with or without concomitant astigmatism under 2.0 D, who were treated with FS-LASIK or Trans-PRK in 2013 through 2014. Background, clinical and outcome data were collected from the patient files. A comparison between eyes treated with FS-LASIK or Trans-PRK was performed. RESULTS The Trans-PRK group was comprised of 1793 eyes and the FS-LASIK group of 666 eyes. Mean ± SD spherical equivalent (SE) refraction prior to surgery was -3.43 ± 1.27 D in the Trans-PRK group and -3.18 ± 1.34 D in the FS-LASIK group (p < 0.001). Efficacy index values were 0.95 ± 0.14 in the Trans-PRK group and 0.98 ± 0.12 in the FS-LASIK group (p < 0.001), and corresponding safety index values were 0.96 ± 0.13 and 0.99 ± 0.12 (p < 0.001). Distance from target refraction was 0.45 ± 0.42 D in Trans-PRK group and 0.43 ± 0.38 D in the FS-LASIK group (p = 0.537); 71.6% and 74.2% of eyes were within ±0.5 D of attempted correction, respectively (p = 0.193). CONCLUSIONS Both Trans-PRK and FS-LASIK demonstrated excellent results, mostly comparable with the current literature. FS-LASIK achieved better results than Trans-PRK surgery in the efficacy and safety parameters.
Collapse
Affiliation(s)
- Assaf Gershoni
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Reitblat
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Eitan Livny
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Nahum
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
27
|
Dhami NB, Dhami A, Dhami GS. Anterior uveitis after transepithelial photorefractive keratectomy: Demographics and clinical characteristics - a one-year analysis. Eur J Ophthalmol 2020; 31:2932-2937. [PMID: 33238750 DOI: 10.1177/1120672120974946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case series of anterior uveitis after Transepithelial Photorefractive Keratectomy (TransPRK) and determine its incidence, demographics and associated clinical features over a study period of 1 year. METHODS This retrospective case series comprised of 200 eyes (100 patients) which underwent elective TransPRK surgery for ametropia correction at a tertiary eye care center by two refractive surgeons over 1 year. TransPRK was performed on Streamlight software (EX500, Alcon Wavelight, Inc.). Postoperatively, all patients received topical antibiotic and steroid eye drops and tapered over 4 weeks. RESULTS The mean age of study patients was 25.76 ± 4.29 years with a pre-operative mean refractive spherical equivalent (MRSE) of -3.49 ± 2.12 diopter (D); 11.76% eyes had simple myopia and 88.23% had compound myopic astigmatism, mean ablation depth of 61.99 ± 24.27 um. Four patients (seven eyes) developed anterior uveitis with mean age of 25 ± 3.53 years, mean MRSE -2.91 ± 0.32 D, ablation depth 44.75 ± 5.29 um with a mean onset at 33.28 days postoperatively after surgery and 5.28 days after the routine postoperative topical steroid withdrawal. Laboratory and immunological tests were negative in all four patients. The incidence of TransPRK-related anterior uveitis was 3.5% over 1 year. CONCLUSION Anterior uveitis after TransPRK is infrequent. It could be due to intraocular transmittance of high frequency excimer laser beams used for longer durations to provide continuous, single step ablation in this novel type of PRK surgery. Further studies are needed to investigate the mechanisms of this association.
Collapse
|
28
|
Wilson SE. Biology of keratorefractive surgery- PRK, PTK, LASIK, SMILE, inlays and other refractive procedures. Exp Eye Res 2020; 198:108136. [PMID: 32653492 DOI: 10.1016/j.exer.2020.108136] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
The outcomes of refractive surgical procedures to improve uncorrected vision in patients-including photorefractive keratectomy (PRK), laser in-situ keratomileusis (LASIK), Small Incision Lenticule Extraction (SMILE) and corneal inlay procedures-is in large part determined by the corneal wound healing response after surgery. The wound healing response varies depending on the type of surgery, the level of intended correction of refractive error, the post-operative inflammatory response, generation of opacity producing myofibroblasts and likely poorly understood genetic factors. This article details what is known about these specific wound healing responses that include apoptosis of keratocytes and myofibroblasts, mitosis of corneal fibroblasts and myofibroblast precursors, the development of myofibroblasts from keratocyte-derived corneal fibroblasts and bone marrow-derived fibrocytes, deposition of disordered extracellular matrix by corneal fibroblasts and myofibroblasts, healing of the epithelial injury, and regeneration of the epithelial basement membrane. Problems with epithelial and stromal cellular viability and function that are altered by corneal inlays are also discussed. A better understanding of the wound healing response in refractive surgical procedures is likely to lead to better treatments to improve outcomes, limit complications of keratorefractive surgical procedures, and improve the safety and efficiency of refractive surgical procedures.
Collapse
Affiliation(s)
- Steven E Wilson
- Cole Eye Institute, I-32, Cleveland Clinic, 9500, Euclid Ave, Cleveland, OH, United States.
| |
Collapse
|
29
|
Özülken K, İlhan Ç. Comparison of Higher-Order Aberrations After Single-Step Transepithelial and Conventional Alcohol-Assisted Photorefractive Keratectomy. Turk J Ophthalmol 2020; 50:127-132. [PMID: 32630998 PMCID: PMC7338746 DOI: 10.4274/tjo.galenos.2019.14554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To compare the asphericity and higher-order aberration (HOA) outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and conventional alcohol-assisted PRK (aaPRK) in patients with myopia and myopic astigmatism. Materials and Methods: Of the 108 eyes of 54 patients enrolled in the study, tPRK was performed on 54 (50%) eyes and aaPRK was performed on 54 (50%) eyes. The following parameters were compared: corrected distance visual acuity (CDVA), spherical equivalent (SE), flat and steep keratometry, intraocular pressure, central corneal thickness, asphericity, and HOAs including horizontal and vertical coma, horizontal and vertical trefoil, spherical aberration, second-order vertical coma, and aberration coefficient. Results: The demographic and baseline characteristics were similar between the two groups (p>0.05, for all). The aberration coefficient value was significantly lower in patients treated with aaPRK compared to patients treated with tPRK at postoperative 3 months, 6 months, and 1 year (p=0.022, p=0.019, and p=0.017, respectively). Differences in the other variables were statistically insignificant (p>0.05 for all). Conclusion: Both tPRK and aaPRK procedures obtain similar postoperative CDVA, SE, asphericity, and HOA outcomes, except the aberration coefficient value.
Collapse
Affiliation(s)
- Kemal Özülken
- TOBB ETU Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Çağrı İlhan
- Hatay State Hospital, Clinic of Ophthalmology, Hatay, Turkey
| |
Collapse
|
30
|
de Ortueta D, von Rüden D, Verma S, Arba-Mosquera S. TransPRK treatment for residual refractive error and induced aberrations in eye undergone SMILE treatment. Eur J Ophthalmol 2020; 31:NP22-NP25. [PMID: 32530753 DOI: 10.1177/1120672120934393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this case report, we propose to correct refractive errors after SMILE a refractive lenticule surgery technique with transepithelial Photorefractive keratectomy (TransPRK).The advantage of this technique is that the measured aberrations with topography o the Cornea are also treated on the Surface of the Cornea.
Collapse
|
31
|
Gadde AK, Srirampur A, Katta KR, Mansoori T, Armah SM. Comparison of single-step transepithelial photorefractive keratectomy and conventional photorefractive keratectomy in low to high myopic eyes. Indian J Ophthalmol 2020; 68:755-761. [PMID: 32317441 PMCID: PMC7350485 DOI: 10.4103/ijo.ijo_1126_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the visual outcome, safety, safety index, efficacy, efficacy index and corneal transparency between single-step transepithelial photorefractive keratectomy (t-PRK) and conventional photorefractive keratectomy (PRK) with manual debridement of epithelium in eyes with low to high simple myopia and compound myopic astigmatism. Methods In this retrospective ,case control study, we analysed and compared the postoperative uncorrected visual acuity(UCVA), postoperative best corrected visual acuity (BCVA) , safety, safety index,efficacy,efficacy index and the corneal transparency between t-PRK and PRK with 6th-generation Amaris excimer 500E laser (Schwind eye-tech-solutions) in 115 eyes of 59 patients. Results Preoperative Mean Refractive Spherical Equivalent (MRSE) was - 3.88 + 0.23 Diopters(D) and -4.73 + 0.23D in PRK and t-PRK group respectively(p=0.09). In both the groups , none of the eyes lost postoperative BCVA at the end of mean follow-up period of 3.5 months . All the eyes achieved post operative UCVA of 20/40 or better in both the groups. Incidence of trace corneal haze was high in t-PRK group at the end of 3.5 months (P = 0.003). Conclusion Single-step t-PRK and PRK provide similar results at the end of mean follow-up period of 3.5 months postoperatively with regards to post-operative UCVA, post operative BCVA, safety, safety index, efficacy and efficacy index. There was high incidence of trace haze in t- PRK eyes. Both the procedures are predictable, effective, and safe for correction of low to high myopia.
Collapse
Affiliation(s)
- Aruna Kumari Gadde
- Department of Cataract and Refractive Services, Anand Eye Institute, Hyderabad, Telangana, India
| | - Arjun Srirampur
- Department of Cataract and Refractive Services, Anand Eye Institute, Hyderabad, Telangana, India
| | - Kavya Reddy Katta
- Department of Cataract and Refractive Services, Anand Eye Institute, Hyderabad, Telangana, India
| | - Tarannum Mansoori
- Department of Glaucoma Services, Anand Eye Institute, Hyderabad, Telangana, India
| | - Seth Mensah Armah
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| |
Collapse
|
32
|
Mounir A, Mostafa EM, Ammar H, Mohammed OA, Alsmman AH, Farouk MM, Elghobaier MG. Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population. Int J Ophthalmol 2020; 13:129-134. [PMID: 31956581 DOI: 10.18240/ijo.2020.01.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the safety and efficacy of transepithelial photorefractive keratectomy (t-PRK) with adjuvant mitomycin C (MMC) versus femtosecond laser assisted keratomileusis (Femto-LASIK) in correction of high myopia. METHODS Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction (SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12mo postoperatively. RESULTS The preoperative mean SER was -8.86±1.81 and -9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively (P=0.99) which improved to -0.65±0.43 D and -0.69±0.50 D at 12mo follow up. Mean SER remained stable during the 12mo of follow-up, with no statistically significant difference between the two groups (P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze (one reversible haze grade 2, while the other had dense irreversible haze grade 4). CONCLUSION t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.
Collapse
Affiliation(s)
- Amr Mounir
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Engy Mohamed Mostafa
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Hatem Ammar
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Osama Ali Mohammed
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Alahmady Hamad Alsmman
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Mahmoud Mohamed Farouk
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | | |
Collapse
|
33
|
Jun I, Kang DSY, Tan J, Choi JY, Heo W, Kim JY, Lee MG, Kim EK, Seo KY, Kim TI. Comparison of clinical outcomes between wavefront-optimized versus corneal wavefront-guided transepithelial photorefractive keratectomy for myopic astigmatism. J Cataract Refract Surg 2019; 43:174-182. [PMID: 28366363 DOI: 10.1016/j.jcrs.2016.11.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate and compare the clinical outcomes, including visual acuity, refractive errors, and aberrations, between aberration-free transepithelial photorefractive keratectomy (PRK) and corneal wavefront-guided transepithelial PRK in eyes with myopic astigmatism. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN Retrospective comparative case series. METHODS Patients with myopic astigmatism were treated with aberration-free transepithelial PRK or corneal wavefront-guided transepithelial PRK using a 1050 Hz high-repetition excimer laser. The safety, efficacy, predictability, and corneal aberrations were compared preoperatively and 1, 2, 3, and 6 months postoperatively. RESULTS The study comprised 188 patients (188 eyes); 91 eyes had aberration-free transepithelial PRK and 97 eyes corneal wavefront-guided transepithelial PRK. Six month after surgery, the mean uncorrected distance visual acuity was comparable (-0.06 logMAR ± 0.07 [SD] aberration-free group; -0.06 ± 0.06 logMAR wavefront-guided group). The safety, efficacy, and predictability of refractive and visual outcomes were also comparable between groups. Corneal total root-mean-square (RMS) higher-order aberrations (HOAs) increased after treatment in both groups, although fewer RMS HOAs were induced in the corneal wavefront-guided group than in the aberration-free group. Spherical aberration increased similarly after treatment in both groups. However, coma and trefoil increased only in the aberration-free group. CONCLUSIONS Aberration-free transepithelial PRK and corneal wavefront-guided transepithelial PRK were safe and effective for correction of myopic astigmatism without difference in visual acuity and refractive outcomes. However, the corneal wavefront-guided profile induced fewer corneal aberrations than the aberration-free profile.
Collapse
Affiliation(s)
- Ikhyun Jun
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - David Sung Yong Kang
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Jerry Tan
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Jin Young Choi
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Woon Heo
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Joo Young Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Min Goo Lee
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Eung Kweon Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Kyoung Yul Seo
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Tae-Im Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore.
| |
Collapse
|
34
|
Abstract
OBJECTIVE To analyze and assess the refractive outcome after transepithelial photorefractive keratectomy (TransPRK). MATERIAL AND METHODS The treatment was performed with the AMARIS 1050RS laser (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany). The method used an aspheric, aberration-neutral ablation profile and a standardized epithelial tissue removal of 55 µm in the center and 65 µm at a radius of 4 mm as well as SmartPulse technology. Only spherical and/or cylindrical refraction values were treated. Only untreated eyes with preoperative best corrected visual acuity equal to or better than 0.8 were included in the cohort. Follow-up examinations were performed after 1 and 4 days, after 1 and 3 months and after 1 year RESULTS: A total of 939 consecutive TransPRK laser treatments performed in the period from December 2014 to December 2016 were retrospectively analyzed. The mean age of the patients was 34 years. The preoperative sphere had a range of -7.75 D up to +3.00 D and cylinders up to 5.00 D. The 3‑month follow-up control was performed in 728 eyes (77.5%). The predictability showed 89% of eyes within the target correction of less than 0.50 D and 99% of eyes less than 1.00 D. The astigmatic correction showed 91% of eyes with less than 0.50 D. In the safety 1% of eyes showed a visual loss of 2 Snellen lines because of haze. In 26 eyes (2.7%) follow-up treatment was performed with renewed TransPRK laser treatment, in the myopic cohort in 1.8% and in the hyperopic cohort in 13.0%. A residual refraction occurred in 20 eyes without haze and 6 eyes showed a residual refraction with signs of haze. CONCLUSION The TransPRK led to similar results to intrastromal refractive surgery techniques but with fewer clinical complications.
Collapse
|
35
|
Clinical outcomes of mechanical and transepithelial photorefractive keratectomy in low myopia with a large ablation zone. J Cataract Refract Surg 2019; 45:977-984. [PMID: 31029476 DOI: 10.1016/j.jcrs.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/22/2019] [Accepted: 02/09/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the clinical outcomes, vector parameters, and aberrations between mechanical photorefractive keratectomy (PRK) and transepithelial PRK in eyes with low myopia. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, Korea. DESIGN Retrospective, comparative case series. METHODS Eighty-four eyes of 84 patients with low myopia (≤2.00 diopters) were treated with mechanical or transepithelial PRK (41 eyes and 43 eyes, respectively), with the application of a large optical zone (OZ). Visual acuity, manifest refraction, slitlamp evaluation, autokeratometry, corneal topography, and the evaluation of corneal wavefront aberrations were measured preoperatively and at 1, 3, and 6 months after surgery. The efficacy, predictability, vector parameters, corneal aberrations, and safety at 6 months after surgery were compared between the two treatment groups. RESULTS The mean uncorrected distance visual acuity was comparable, at -0.13 ± 0.05 (SD) and -0.15 ± 0.05, in the mechanical and transepithelial PRK groups, respectively, at 6 months after surgery. The safety and efficacy indices, vector parameters, and aberrometric values were also comparable between the two groups. The OZ was large in both groups (7.09 ± 0.20 mm and 7.12 ± 0.27 mm in the mechanical PRK and transepithelial PRK groups, respectively), and showed no significant difference between groups. The corneal total root-mean-square higher-order aberrations and coma significantly reduced after treatment in both groups, and spherical aberrations significantly decreased after transepithelial PRK. CONCLUSIONS Mechanical and transepithelial PRK with a large OZ provided effective and safe outcomes for the correction of low myopia without differences in visual acuity and refractive outcomes between procedures.
Collapse
|
36
|
Zarei-Ghanavati S, Shandiz JH, Abrishami M, Karimpour M. Comparison of mechanical debridement and trans-epithelial myopic photorefractive keratectomy: A contralateral eye study. J Curr Ophthalmol 2019; 31:135-141. [PMID: 31317090 PMCID: PMC6611919 DOI: 10.1016/j.joco.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare clinical outcomes between mechanical debridement photorefractive keratectomy (m-PRK) and trans-epithelial photorefractive keratectomy (t-PRK) in myopic patients. Methods Eighty eyes of 40 myopic patients with age between 18 and 55 years were included in this study. In each patient, one eye was randomly assigned for t-PRK, using the Amaris laser's ORK-CAM software and the other eye for m-PRK, using a spatula. Stromal ablation was done by Schwind Amaris 750S. Uncorrected and best corrected visual acuity (BCVA), refractive outcomes, epithelial healing, pain, and discomfort were compared between the groups on day 1, 3, 7 and month 1, 3, and 6. Results Preoperative spherical equivalent (SE) were −3.97 ± 2.08 diopter (D) and −3.98 ± 2.06 D in m-PRK and t-PRK eyes, respectively (P = 0.981). Operation time was significantly shorter in the t-PRK group than m-PRK (P < 0.001). Postoperative pain was experienced significantly higher in the t-PRK group measured by 11-point numeric scale of pain questionnaire on the first postoperative day (P < 0.001). Photophobia, tearing, and vision fluctuation were also significantly higher in the t-PRK group postoperatively. However epithelial defect size and re-epithelialization time were lower in the t-PRK group (P = 0.012 and P < 0.001, respectively). Postoperative parameters including SE, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and contrast acuity did not show any significant difference between the two groups during all intervals. Conclusions Although epithelial defect size and epithelial healing time were lower in t-PRK, postoperative pain, photophobia, and vision fluctuation were significantly less in the m-PRK group in the first postoperative days. There was no statistically significant difference between the groups after one week, and both mechanical and trans-epithelial techniques were shown to be safe and effective.
Collapse
Affiliation(s)
| | - Javad Heravian Shandiz
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Karimpour
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
37
|
Comparison between Transepithelial Photorefractive Keratectomy versus Alcohol-Assisted Photorefractive Keratectomy in Correction of Myopia and Myopic Astigmatism. J Ophthalmol 2018; 2018:5376235. [PMID: 30538854 PMCID: PMC6260527 DOI: 10.1155/2018/5376235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of the study was to compare visual acuity, refractive results, safety, and efficacy of TPRK with AAPRK as primary outcomes and surgical time, pain scores, haze levels, and healing time as secondary outcomes in TPRK and AAPRK groups. Setting Security Forces Hospital, Ophthalmology Department, Riyadh, Kingdom of Saudi Arabia. Design Prospective, nonrandomized case-control comparative study. Methods A total of 200 eyes of 100 consecutive patients were included. One hundred eyes underwent TPRK in the right eye (study group), and 100 eyes underwent AAPRK in the left eye (control group). Ablations were performed with the Schwind Amaris excimer LASER750S. Clinical outcomes during 6 months' follow-up were compared. Results The mean age of patients was 28.3 ± 6.3, 77 were females and 23 males. The mean surgical time was 162.17 ± 14.827 s and 243.24 ± 98.69 s, respectively. At day 1, the UDVA mean was 0.7 in 87% of eyes in the TPRK group while it was 0.5 in 45% of eyes in AAPRK; at week 1, it was 0.9 in 88% of eyes in the TPRK group and 0.6 in 60% of eyes in AAPRK. The mean pain scores were less and lower incidence of corneal haze in the TPRK. Complete epithelial healing time was shorter in TPRK, 3.20 ± 0.686 and 4.60 ± 1.969 days, respectively. Conclusions TPRK and AAPRK produce similar results 6 months postoperatively. However, in the early postoperative period, there were significant differences in UDVA, pain score, level of haze, and complete epithelial healing time. The pain scores were lower, level of haze was less, and healing time was shorter in the TPRK group which provided patient better felling and comfort in this period. Both of procedures are effective and safe for correction of myopia and compound myopic astigmatism. This trial is registered with NCT03569423.
Collapse
|
38
|
Ang BCH, Foo RCM, Lim EWL, Tan MMH, Nah GKM, Thean LSY, Tan CWT, Zhao PSB. Risk factors for early-onset corneal haze after photorefractive keratectomy in an Asian population: Outcomes from the Singapore Armed Forces Corneal Refractive Surgery Programme 2006 to 2013. J Cataract Refract Surg 2018; 42:710-6. [PMID: 27255247 DOI: 10.1016/j.jcrs.2016.01.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/06/2016] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the incidence and risk factors for early corneal haze after myopic photorefractive keratectomy (PRK). SETTING Tertiary eye center, Singapore. DESIGN Retrospective case series. METHODS The refractive results and corneal haze severity 3 months after PRK were analyzed. Eyes were categorized into 4 groups based on haze severity. Multivariate ordinal logistic regression analysis adjusting for age, ethnicity, sex, use of intraoperative mitomycin-C (MMC), preoperative sphere, and preoperative cylinder was performed. RESULTS The study reviewed data from 177 patients (347 eyes) with a mean age of 22.6 years ± 4.1 (SD). The majority of the patients were Chinese (98.3%) and men (98.3%). The mean preoperative spherical equivalent (SE) was -3.34 ± 1.19 diopters (D). One hundred thirty-five eyes (38.9%) had PRK with MMC. Ten eyes (2.9%) had enhancement surgery. The overall efficacy index was 0.88 and the safety index was 1.07. At 3 months, 187 eyes (53.9%) had no haze, 76 eyes (21.9%) had a haze grade of more than 0 and less than 1, 76 eyes (21.9%) had a haze grade of 1 or more and less than 2, and 8 eyes (2.3%) had grade 2 haze. Higher degrees of myopia (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.13-1.63; P = .001) and astigmatism (OR, 1.56; 95% CI, 1.09-2.24; P = .014) were associated with increased severity of corneal haze, whereas older age (OR, 0.94; 95% CI, 0.88-0.99; P = .023) had a protective effect. CONCLUSION Myopia and astigmatism were associated with increased severity of haze, and older age was protective against early corneal haze development after PRK in an Asian population. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Bryan Chin Hou Ang
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Reuben Chao Ming Foo
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Edmund Wei Long Lim
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Mellisa Mei Hui Tan
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Gerard Kwang Ming Nah
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Lennard See Yin Thean
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Clement Woon Teck Tan
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore
| | - Paul Song Bo Zhao
- From the Vision Performance Centre (Ang, Lim, Nah, Tan, Zhao), the Military Medicine Institute, Singapore Armed Forces, National Healthcare Group Eye Institute (Ang), Tan Tock Seng Hospital, the Singapore National Eye Centre (Foo), the DSO National Laboratories (Tan), Defence Medical and Environmental Research Institute, the W Eye Clinic (Nah), the Department of Ophthalmology (Nah, Thean, Tan, Zhao), the National University Health System, and the Department of Ophthalmology (Thean), Jurong Health Services, Singapore.
| |
Collapse
|
39
|
Adib-Moghaddam S, Soleyman-Jahi S, Salmanian B, Omidvari AH, Adili-Aghdam F, Noorizadeh F, Eslani M. Single-step transepithelial photorefractive keratectomy in myopia and astigmatism: 18-month follow-up. J Cataract Refract Surg 2018; 42:1570-1578. [PMID: 27956283 DOI: 10.1016/j.jcrs.2016.08.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/01/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the long-term quantitative and qualitative optical outcomes of 1-step transepithelial photorefractive keratectomy (PRK) to correct myopia and astigmatism. SETTING Bina Eye Hospital, Tehran, Iran. DESIGN Prospective interventional case series. METHODS Eyes with myopia with or without astigmatism were evaluated. One-step transepithelial PRK was performed with an aberration-free aspheric optimized profile and the Amaris 500 laser. Eighteen-month follow-up results for refraction, visual acuities, vector analysis, higher-order aberrations, contrast sensitivity, postoperative pain, and haze grade were assessed. RESULTS The study enrolled 146 eyes (74 patients). At the end of follow-up, 93.84% of eyes had an uncorrected distance visual acuity of 20/20 or better and 97.94% of eyes were within ±0.5 diopter of the targeted spherical refraction. On vector analysis, the mean correction index value was close to 1 and the mean index of success and magnitude of error values were close to 0. The achieved correction vector was on an axis counterclockwise to the axis of the intended correction. Photopic and mesopic contrast sensitivities and ocular and corneal spherical, cylindrical, and corneal coma aberrations significantly improved (all P < .001). A slight amount of trefoil aberration was induced (P < .001, ocular aberration; P < .01, corneal aberration). No eye lost more than 1 line of corrected distance visual acuity. No eye had a haze grade of 2+ degrees or higher throughout the follow-up. CONCLUSIONS Eighteen-month results indicate the efficacy and safety of transepithelial PRK to correct myopia and astigmatism. It improved refraction and quality of vision. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Soheil Adib-Moghaddam
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Saeed Soleyman-Jahi
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bahram Salmanian
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amir-Houshang Omidvari
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fatemeh Adili-Aghdam
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Farsad Noorizadeh
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Medi Eslani
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
40
|
Siran W, Ghezzi CE, Cairns DM, Pollard RE, Chen Y, Gomes R, McKay TB, Pouli D, Jamali A, Georgakoudi I, Funderburgh JL, Kenyon K, Hamrah P, Kaplan DL. Human Corneal Tissue Model for Nociceptive Assessments. Adv Healthc Mater 2018; 7:e1800488. [PMID: 30091220 DOI: 10.1002/adhm.201800488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/28/2018] [Indexed: 12/13/2022]
Abstract
New in vitro tissue models to mimic in vivo conditions are needed to provide insight into mechanisms involved in peripheral pain responses, potential therapeutic strategies to address these responses, and to replace animal models for such indications. For example, the rabbit cornea Draize test has become the standard method used for decades to screen ophthalmic drug and consumer product toxicity. In vitro tissue models with functional innervation have the potential to replace in vivo animal testing and provide sophisticated bench tools to study ocular nociception and its amelioration. Herein, full thickness, innervated, 3D human corneal tissues are grown under physiologically relevant culture conditions to study nociceptive-related responses, by mimicking ocular environmental cues, including intraocular pressure (IOP) and tear flow (TF). Capsaicin, a chili pepper-derived irritant known to cause a burning sensation in mammalian tissues is utilized as a nociceptive stimulant to induce pain, while subsequent serum treatment is used to mimic healing. Pain mediators released upon capsaicin stimulation and cell regrowth after serum treatment are characterized to assess ocular responses in this new, innervated, human corneal tissue system for comparison of outcomes to established animal and related responses.
Collapse
Affiliation(s)
- Wang Siran
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Chiara E. Ghezzi
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Dana M. Cairns
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Rachel E. Pollard
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Ying Chen
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Rachel Gomes
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
- School of MedicineDepartamento de Oftalmologia da Escola Paulista de MedicinaFederal University of São Paulo Botucatu, 822 – Vila Clementino São Paulo –SP 04023‐062 Brazil
| | - Tina B. McKay
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Dimitra Pouli
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - Arsia Jamali
- New England Eye CenterTufts Medical Center 260 Tremont St, 9th Floor Boston MA 02111 USA
| | - Irene Georgakoudi
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| | - James L. Funderburgh
- Eye & Ear InstituteDepartment of OphthalmologyUniversity of Pittsburgh 203 Lothrop Street, Room 1011 Pittsburgh PA 15213 USA
| | - Kenneth Kenyon
- New England Eye CenterTufts Medical Center 260 Tremont St, 9th Floor Boston MA 02111 USA
| | - Pedram Hamrah
- New England Eye CenterTufts Medical Center 260 Tremont St, 9th Floor Boston MA 02111 USA
| | - David L. Kaplan
- Department of Biomedical EngineeringTufts University 4 Colby Street Medford MA 02155 USA
| |
Collapse
|
41
|
Efficacy and safety of transepithelial photorefractive keratectomy. J Cataract Refract Surg 2018; 44:1267-1279. [PMID: 30172569 DOI: 10.1016/j.jcrs.2018.07.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022]
Abstract
Transepithelial photorefractive keratectomy (PRK) was introduced to prevent complications from conventional PRK and femtosecond laser-assisted laser in situ keratomileusis (LASIK). In the 2-step platform, phototherapeutic keratectomy is followed by PRK. It did not show notable safety or efficacy superiorities over conventional PRK. In the conventional single-step transepithelial PRK, ablation of epithelium and stroma occurs in a single continuous session by an Amaris laser. It showed better comparative safety results. Reverse single-step transepithelial PRK and the platform using smart-pulse technology were recent improvements in the single-step Amaris laser. They provide a smoother postablative stromal bed counter. In the refined single-step platform, a modified nomogram is used for determination of ablation parameters, along with modifications in postablative measures. It yielded better comparative results in hyperopia. Controlled trials comparing reverse, smart-pulse technology-equipped, or refined platforms of single-step transepithelial PRK with other modern laser-assisted methods could provide more robust evidence on the topic. Some key elements with significant roles in post-transepithelial PRK outcomes are discussed.
Collapse
|
42
|
Comparison between Wavefront-optimized and corneal Wavefront-guided Transepithelial photorefractive keratectomy in moderate to high astigmatism. BMC Ophthalmol 2018; 18:154. [PMID: 29940974 PMCID: PMC6020237 DOI: 10.1186/s12886-018-0827-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the clinical outcomes of wavefront-optimized (WFO) transepithelial photorefractive keratectomy (trans-PRK) and corneal wavefront-guided (CWFG) trans-PRK for myopic eyes with moderate to high astigmatism. METHODS One hundred ninety-six eyes (196 patients) with moderate to high astigmatism (≥ 1.75 D) treated with WFO or CWFG trans-PRK (101 and 95 eyes, respectively) were retrospectively registered. Safety, efficacy, predictability, vector analysis, and corneal aberrations were compared between groups preoperatively and at 6 months postoperatively. RESULTS At postoperative 6 months, the mean logMAR uncorrected distance visual acuity was similar in the WFO (- 0.07 ± 0.08) and CWFG (- 0.07 ± 0.07) groups. Safety, efficacy, and predictability of refractive and visual outcomes were also similar. The correction indices were 1.02 ± 0.14 and 1.03 ± 0.13 in the WFO and CWFG groups, respectively, with no significant difference. The absolute values of the angle of error were significantly higher in the WFO group (2.28 ± 2.44 vs. 1.40 ± 1.40; P = 0.002). Corneal total root mean square higher-order aberrations and corneal spherical aberrations increased postoperatively in both groups; however, the change was smaller in the CWFG group. Corneal coma showed a significant increase postoperatively only in the WFO group. CONCLUSIONS WFO and CWFG trans-PRK are safe and effective for correcting moderate to high astigmatism. However, CWFG trans-PRK provides a more predictable astigmatism correction axis and fewer induced corneal aberrations.
Collapse
|
43
|
Li S, Xie H, Xu M, Li M, Liu C, He J, Han T, Zhou X. Comparison of pain after subepithelial versus conventional accelerated corneal collagen cross-linking for keratoconus. Int Ophthalmol 2018; 39:1249-1254. [DOI: 10.1007/s10792-018-0935-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/21/2018] [Indexed: 02/07/2023]
|
44
|
Epithelial Erosions and Refractive Results After Single-Step Transepithelial Photorefractive Keratectomy and Alcohol-Assisted Photorefractive Keratectomy in Myopic Eyes: A Comparative Evaluation Over 12 Months. Cornea 2017; 37:45-52. [DOI: 10.1097/ico.0000000000001428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Comparison of visual and refractive results after transepithelial and mechanical photorefractive keratectomy in myopia. Int Ophthalmol 2017; 38:627-633. [DOI: 10.1007/s10792-017-0501-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/13/2017] [Indexed: 12/14/2022]
|
46
|
Adib-Moghaddam S, Soleyman-Jahi S, Adili-Aghdam F, Arba Mosquera S, Hoorshad N, Tofighi S. Single-step transepithelial photorefractive keratectomy in high myopia: qualitative and quantitative visual functions. Int J Ophthalmol 2017; 10:445-452. [PMID: 28393038 DOI: 10.18240/ijo.2017.03.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/08/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) in high myopia. METHODS In a prospective interventional case-series, 30 eyes with high myopia (-6.00 to -8.75 D) with (up to -3.00 D) or without astigmatism were enrolled from Bina Eye Hospital, Tehran, Iran. One-step TransPRK was performed with aberration-free aspherical optimized profile and SCHWIND AMARIS 500 laser. One-year follow-up results for refraction, visual acuities, vector analysis, ocular wave-front (OWF) and corneal wave-front (CWF) higher order aberrations (HOA), contrast sensitivity (CS), and post-operative haze were assessed. RESULTS After the surgery, both photopic and mesopic CSs significantly improved (both P<0.001). We detected significant induction of OWF coma and trefoil (P<0.001 for both) HOAs; CWF coma (P=0.002), spherical (P<0.001), and tetrafoil (P=0.003) HOAs in 6 mm analysis diameter; and CWF trefoil (P=0.04) HOA in 4 mm analysis diameter. The range of mean induction observed for various HOAs was 0.005-0.11 µm. The 86.7% of eyes reached an uncorrected distance visual acuity of 20/20 or better; 96.7% of eyes were within ±0.5 D of targeted spherical refraction. In vector analysis, mean correction index value was 1.03 and mean index of success was 0.22. By 12mo after the operation, no eye lost any number of corrected distance visual acuity lines. We detected no corneal haze greater than 1+ throughout the follow-up. CONCLUSION Our findings show promising effects of single-step TransPRK on quality of vision in high myopic eyes. It also improves refraction and visual acuity.
Collapse
Affiliation(s)
- Soheil Adib-Moghaddam
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Saeed Soleyman-Jahi
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Fatemeh Adili-Aghdam
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Samuel Arba Mosquera
- Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran; SCHWIND Eye-Tech-Solutions, Kleinostheim D-63797, Germany; Instituto de Oftalmobiología Aplicada, University of Valladolid, Valladolid 8-47002, Spain
| | - Niloofar Hoorshad
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Salar Tofighi
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| |
Collapse
|
47
|
Adib-Moghaddam S, Arba-Mosquera S, Walter-Fincke R, Soleyman-Jahi S, Adili-Aghdam F. Transepithelial Photorefractive Keratectomy for Hyperopia: A 12-Month Bicentral Study. J Refract Surg 2016; 32:172-80. [PMID: 27027624 DOI: 10.3928/1081597x-20160121-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 12/03/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the safety, efficacy, and stability of transepithelial photorefractive keratectomy (PRK) for hyperopia. METHODS This interventional case series study at two sites included 55 eyes (31 patients) with hyperopia (0.50 to 6.00 diopters [D]), with or without astigmatism (0.00 to -3.00 D), that underwent one-step transepithelial PRK with a Amaris 500-Hz excimer laser (SCHWIND eye-tech-solutions, Kleinostheim, Germany). A 12-month follow-up was conducted. Preoperative and successive postoperative visual acuity, manifest refraction, haze, and other complication data were analyzed. RESULTS The preoperative mean spherical equivalent of 2.56 ± 1.90 D improved to emmetropia (-0.08 ± 0.14 D) by 6 months, with subsequent slight mean regression of 0.024 D (range: -0.75 to 0.50) until month 12. Of the treated eyes, 75% and 76.2% were within the target refraction of ±0.50 D at 6 and 12 months postoperatively, respectively. The final mean cylindric refraction was comparable to the preoperative value (-0.94 ± 0.12 to -0.71 ± 0.12 D, P = .17); however, it was induced in 23% of eyes. The preoperative mean uncorrected distance visual acuity logMAR of 0.54 ± 0.05 significantly improved to 0.15 ± 0.03 by month 12 (P < .0001), and 64.2% of the treated eyes gained an uncorrected distance visual acuity of 20/25 or better. Ten eyes (23.8%) lost one line of preoperative corrected distance visual acuity (CDVA). No eye lost two or more lines of preoperative CDVA. Four eyes with a 3+ degree of haze were observed by the final visit. No other notable complications occurred. The low hyperopic eyes exhibited better overall results compared to the moderate hyperopic group. CONCLUSIONS One-step transepithelial PRK with the Amaris 500-Hz excimer laser provided reasonable outcomes for the correction of hyperopia with or without mild to moderate astigmatism.
Collapse
|
48
|
Comparison of bandage contact lens removal on the fourth versus seventh postoperative day after photorefractive keratectomy: A randomized clinical trial. J Curr Ophthalmol 2016. [PMID: 28626819 PMCID: PMC5463006 DOI: 10.1016/j.joco.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the outcomes of bandage contact lens (BCL) removal on the fourth versus seventh post-operative day following photorefractive keratectomy (PRK). METHODS This study recruited eyes of patients who underwent PRK surgery. The patients were randomly assigned to 2 groups. In Group 1 BCL was removed on the 4th postoperative day, while in Group 2, BCL was removed on the 7th postoperative day. After BCL removal, patients were asked to express their pain score and eye discomfort. At one and three months follow-up examinations, visual acuity scale was assessed. Slit-lamp examination was performed in all visits to evaluate complications. RESULTS 260 eyes of 130 patients underwent PRK. The age and sex ratio were not significantly different between the two groups. One month after the surgery, the logMAR uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly lower in Group 2 (P value = 0.016, 0.001 respectively), however, the UDVA and CDVA were not significantly different after 3 months (P > 0.05). In Group 1, filamentary keratitis (FK) was observed in 10 (7.6%) eyes, 6 (4.61%) eyes were diagnosed with recurrent corneal erosion (RCE) and corneal haze was detected in 3 (2.3%) eyes. However, in Group 2, RCE was observed in 4 (2.3%) and FK was noted in 4 (3.07%) eyes. No haze was seen in Group 2. The difference in rate of complications was statistically significant (14.6% and 6.1% in Groups 1 and 2, respectively, P = 0.02). Pain and eye discomfort scores were not significantly different (P > 0.05). There was no major complications including infectious keratitis in either groups. CONCLUSION Following PRK surgery, BCL removal on the seventh postoperative day yields faster visual rehabilitation and lower rate of postoperative complications with no increase in eye pain, discomfort or infection.
Collapse
|
49
|
Li S, Zhan S, Li S, Peng X, Hu J, Law HA, Wang N. Laser-assisted subepithelial keratectomy (LASEK) versus photorefractive keratectomy (PRK) for correction of myopia. Cochrane Database Syst Rev 2016; 2:CD009799. [PMID: 26899152 PMCID: PMC5032141 DOI: 10.1002/14651858.cd009799.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Myopia (near-sightedness or short-sightedness) is a condition in which the refractive power of the eye is greater than required. The most frequent complaint of people with myopia is blurred distance vision, which can be eliminated by conventional optical aids such as spectacles or contact lenses, or by refractive surgery procedures such as photorefractive keratectomy (PRK) and laser epithelial keratomileusis (LASEK). PRK uses laser to remove the corneal stroma. Similar to PRK, LASEK first creates an epithelial flap and then replaces it after ablating the corneal stroma. The relative benefits and harms of LASEK and PRK, as shown in different trials, warrant a systematic review. OBJECTIVES The objective of this review is to compare LASEK versus PRK for correction of myopia by evaluating their efficacy and safety in terms of postoperative uncorrected visual acuity, residual refractive error, and associated complications. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision group Trials Register) (2015 Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to December 2015), EMBASE (January 1980 to December 2015), Latin American and Caribbean Health Sciences (LILACS) (January 1982 to December 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 December 2015. We used the Science Citation Index and searched the reference lists of the included trials to identify relevant trials for this review. SELECTION CRITERIA We included in this review randomized controlled trials (RCTs) comparing LASEK versus PRK for correction of myopia. Trial participants were 18 years of age or older and had no co-existing ocular or systemic diseases that might affect refractive status or wound healing. DATA COLLECTION AND ANALYSIS Two review authors independently screened all reports and assessed the risk of bias of trials included in this review. We extracted data and summarized findings using risk ratios and mean differences. We used a random-effects model when we identified at least three trials, and we used a fixed-effect model when we found fewer than three trials. MAIN RESULTS We included 11 RCTs with a total of 428 participants 18 years of age or older with low to moderate myopia. These trials were conducted in the Czech Republic, Brazil, Italy, Iran, China, Korea, Mexico, Turkey, USA, and UK. Investigators of 10 out of 11 trials randomly assigned one eye of each participant to be treated with LASEK and the other with PRK, but did not perform paired-eye (matched) analysis. Because of differences in outcome measures and follow-up times among the included trials, few trials contributed data for many of the outcomes we analyzed for this review. Overall, we judged RCTs to be at unclear risk of bias due to poor reporting; however, because of imprecision, inconsistency, and potential reporting bias, we graded the quality of the evidence from very low to moderate for outcomes assessed in this review.The proportion of eyes with uncorrected visual acuity of 20/20 or better at 12-month follow-up was comparable in LASEK and PRK groups (risk ratio (RR) 0.98, 95% confidence interval (95% CI) 0.92 to 1.05). Although the 95% CI suggests little to no difference in effect between groups, we judged the quality of the evidence to be low because only one trial reported this outcome (102 eyes). At 12 months post treatment, data from two trials suggest no difference or a possibly small effect in favor of PRK over LASEK for the proportion of eyes achieving ± 0.50 D of target refraction (RR 0.93, 95% CI 00.84 to 1.03; 152 eyes; low-quality evidence). At 12 months post treatment, one trial reported that one of 51 eyes in the LASEK group lost one line or more best-spectacle corrected visual acuity compared with none of 51 eyes in the PRK group (RR 3.00, 95% CI 0.13 to 71.96; very low-quality evidence).Three trials reported adverse outcomes at 12 months of follow-up or longer. At 12 months post treatment, three trials reported corneal haze score; however, data were insufficient and were inconsistent among the trials, precluding meta-analysis. One trial reported little or no difference in corneal haze scores between groups; another trial reported that corneal haze scores were lower in the LASEK group than in the PRK group; and one trial did not report analyzable data to estimate a treatment effect. At 24 months post treatment, one trial reported a lower, but clinically unimportant, difference in corneal haze score for LASEK compared with PRK (MD -0.22, 95% CI -0.30 to -0.14; 184 eyes; low-quality evidence). AUTHORS' CONCLUSIONS Uncertainty surrounds differences in efficacy, accuracy, safety, and adverse effects between LASEK and PRK for eyes with low to moderate myopia. Future trials comparing LASEK versus PRK should follow reporting standards and follow correct analysis. Trial investigators should expand enrollment criteria to include participants with high myopia and should evaluate visual acuity, refraction, epithelial healing time, pain scores, and adverse events.
Collapse
Affiliation(s)
- Shi‐Ming Li
- Capital Medical University, Beijing Ophthalmology & Visual Science Key LaboratoryBeijing Tongren Eye Center, Beijing Tongren HospitalNo.1 DongijiaominxiangDongcheng DistrictBeijingChina100730
| | - Siyan Zhan
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan RoadHaidian DistrictBeijingChina100191
| | - Si‐Yuan Li
- Capital Medical University, Beijing Ophthalmology & Visual Science Key LaboratoryBeijing Tongren Eye Center, Beijing Tongren HospitalNo.1 DongijiaominxiangDongcheng DistrictBeijingChina100730
| | - Xiao‐Xia Peng
- Capital Medical UniversitySchool of Public HealthNo.10 West tou‐tiao‐waiFengTai DistrictBeijingChina100069
| | - Jing Hu
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics38 Xueyuan RoadHaidian DistrictBeijingChina100191
| | - Hua Andrew Law
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Ning‐Li Wang
- Capital Medical University, Beijing Ophthalmology & Visual Science Key LaboratoryBeijing Tongren Eye Center, Beijing Tongren HospitalNo.1 DongijiaominxiangDongcheng DistrictBeijingChina100730
| | | |
Collapse
|
50
|
Kaluzny BJ, Cieslinska I, Mosquera SA, Verma S. Single-Step Transepithelial PRK vs Alcohol-Assisted PRK in Myopia and Compound Myopic Astigmatism Correction. Medicine (Baltimore) 2016; 95:e1993. [PMID: 26871764 PMCID: PMC4753858 DOI: 10.1097/md.0000000000001993] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Transepithelial photorefractive keratectomy (tPRK), where both the epithelium and stroma are removed in a single-step, is a relatively new procedure of laser refractive error correction. This study compares the 3-month results of myopia and compound myopic astigmatism correction by tPRK or conventional alcohol-assisted PRK (aaPRK).This prospective, nonrandomized, case-control study recruited 148 consecutive patients; 93 underwent tPRK (173 eyes) and 55 aaPRK (103 eyes). Refractive results, predictability, safety, and efficacy were evaluated during the 3-month follow-up. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and mean refractive spherical equivalent (MRSE).Mean preoperative MRSE was -4.30 ± 1.72 D and -4.33 ± 1.96 D, respectively (P = 0.87). The 3-month follow-up rate was 82.1% in the tPRK group (n = 145) and 86.4% in aaPRK group (n = 90), P = 0.81. Postoperative UDVA was 20/20 or better in 97% and 94% of eyes, respectively (P = 0.45). In the tPRK and aaPRK groups, respectively, 13% and 21% of eyes lost 1 line of CDVA, and 30% and 31% gained 1 or 2 lines (P = 0.48). Mean postoperative MRSE was -0.14 ± 0.26 D in the tPRK group and -0.12 ± 0.20 D in the aaPRK group (P = 0.9). The correlation between attempted versus achieved MRSE was equally high in both groups.Single-step transepithelial PRK and conventional PRK provide very similar results 3 months postoperatively. These procedures are predictable, effective, and safe for correction of myopia and compound myopic astigmatism.
Collapse
Affiliation(s)
- Bartlomiej J Kaluzny
- From the Department of Optometry, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (BJK); Oftalmika Eye Hospital, Bydgoszcz, Poland (BJK, IC); and SCHWIND eye-tech-solutions, Kleinostheim, Germany (SAM, SV)
| | | | | | | |
Collapse
|