1
|
|
2
|
Abstract
Purpose Mitomycin C after photorefractive keratectomy (PRK) is used to reduce the development of haze and regression in higher intended corrections. The aim of this study was to investigate the safety, stability, and efficacy of EpiLASIK with mitomycin C. Methods Fifty eyes of 29 patients underwent EpiLASIK with the Gebauer EpiLift microkeratome. The mean preoperative spherical equivalent was −6.89 D (SD ±0.63, range −6.0 to −8.0 D). After the laser ablation, mitomycin C 0.02% was applied for 30 seconds on a sterile filter paper. Preoperatively and 1, 3, 6, and 12 months after surgery, a full ophthalmic examination was performed. Results In 42 of 50 eyes, the bandage contact lens was removed at day 3. Twelve months after surgery, 96% of all eyes were within ±1.0 D and 82% were within ±0.5 D of intended correction. Five percent of all patients lost 1 line of best-corrected Snellen visual acuity, 42% were stable, and 56% gained 1 or more lines. In most patients, the cornea was clear during the whole follow-up, and in 10% only trace haze was visible. The uncorrected visual acuity was at least 1.0 in 86% of all patients, and all patients reached 0.5. Conclusions EpiLASIK with mitomycin C with higher intended corrections seems to be an effective and safe procedure. With the application of mitomycin C, only minimal haze appears.
Collapse
Affiliation(s)
| | - Ramin Khoramnia
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Mathias Maier
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Chris P. Lohmann
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| |
Collapse
|
3
|
Urgancioglu B, Bilgihan K, Engin D, Cirak MY, Hondur A, Hasanreisoglu B. Topical N-acetylcysteine Reduces Interleukin-1-alpha in Tear Fluid after Laser Subepithelial Keratectomy. Eur J Ophthalmol 2018; 19:554-9. [DOI: 10.1177/112067210901900406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the effect of topical N-acetylcysteine (NAC) on interleukin 1-alpha (IL-1α) levels in tear fluid after myopic laser subepithelial keratectomy (LASEK) and its possible role in modulating corneal wound healing. Methods Twenty-six eyes of 13 patients who underwent myopic LASEK were divided into 2 groups. Group 1 (n=10 eyes) was used as a control group. All patients received topical lomefloxacin and dexamethasone postoperatively. Additionally, patients in Group 2 received topical NAC for 1 month postoperatively. Tear fluid samples were collected with microcapillary tubes preoperatively, on the first and on the fifth postoperative day, and the release of IL-1α in tear fluid was calculated. Haze grading and confocal microscopic examination were performed at 1 and 3 months postoperatively. Results The mean IL-1-α release values were 0.285±0.159 pg/min in Group 1 and 0.235±0.142 pg/min in Group 2 preoperatively. In Group 1, the values were 0.243±0.155 pg/min on day 1 and 0.164±0.125 pg/min on day 5. In Group 2, the mean IL-1α release values were 0.220±0.200 pg/min on day 1 and 0.080±0.079 pg/min on day 5. The difference between the groups was significant only for day 5 (p<0.05). Mean corneal haze score and grey scale value in confocal microscopy were significantly higher (p<0.05) in Group 1 at 1 month. However, at 3 months there was no difference between groups (p>0.05). Conclusions NAC seems to have an additive effect to steroids in suppressing IL-1α levels in tear fluid and may be clinically advantageous in modulating corneal wound healing during the early postoperative period after LASEK.
Collapse
Affiliation(s)
| | - Kamil Bilgihan
- Department of Ophthalmology, Gazi University Medical School, Ankara
| | - Doruk Engin
- Department of Microbiology, Gazi University Medical School, Ankara
| | | | - Ahmet Hondur
- Dinar State Hospital, Dinar, Afyonkarahisar - Turkey
| | | |
Collapse
|
4
|
Photorefractive Keratectomy for Residual Myopia after Myopic Laser In Situ Keratomileusis. J Ophthalmol 2017; 2017:8725172. [PMID: 28168049 PMCID: PMC5266848 DOI: 10.1155/2017/8725172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/01/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the safety, efficacy, and predictability of photorefractive keratectomy (PRK) on the corneal flap for correction of residual myopia following myopic laser in situ keratomileusis (LASIK). Patients and Methods. A retrospective study on eyes retreated by PRK on the corneal flap for residual myopia after LASIK. All eyes had no enough stroma after LASIK sufficient for LASIK enhancement. Data included spherical equivalent (SE), uncorrected and best corrected visual acuity (UCVA and BCVA), central pachymetry, corneal higher order aberrations (HOAs), corneal hysteresis (CH), corneal resistance factor (CRF), and corneal haze. Results. The study included 64 eyes. Before PRK, the mean central pachymetry was 400.21 ± 7.8 μm, the mean SE was -1.74 ± 0.51 D, and the mean UCVA and BCVA were 0.35 ± 0.18 and 0.91 ± 0.07, respectively. 12 months postoperatively, the mean central corneal thickness was 382.41 ± 2.61 μm, the mean SE was -0.18 ± 0.32 D (P < 0.01), and the mean UCVA and BCVA were 0.78 ± 0.14 (P = 0.01) and 0.92 ± 0.13 (P > 0.5), respectively. The safety index was 1.01 and the efficacy index was 0.86. No significant change was observed in corneal HOAs. Conclusions. Residual myopia less than 3 D after LASIK could be safely and effectively treated by PRK and mitomycin C with a high predictability. This prevents postoperative ectasia and avoids the flap related complications but has no significant effect on HOAs.
Collapse
|
5
|
Corneal Haze Following Refractive Surgery: A Review of Pathophysiology, Incidence, Prevention, and Treatment. Int Ophthalmol Clin 2016; 56:111-25. [PMID: 26938342 DOI: 10.1097/iio.0000000000000112] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
|
7
|
Contralateral-eye study of surface refractive treatments: Clinical and confocal microscopy evaluation. J Cataract Refract Surg 2014; 40:224-31. [DOI: 10.1016/j.jcrs.2013.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/18/2022]
|
8
|
McGrath LA, Lee GA. Techniques, indications and complications of corneal debridement. Surv Ophthalmol 2013; 59:47-63. [PMID: 24239444 DOI: 10.1016/j.survophthal.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 03/24/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022]
Abstract
The cornea is the most exposed surface of the eye and, as such, is vulnerable to external trauma and the risk of infection. Many corneal diseases alter shape, surface, and transparency and thus result in reduced vision. The external position of the cornea, however, lends itself to diagnostic and therapeutic maneuvers that are commonly performed and readily done in the clinic. More sophisticated techniques require the use of complex equipment such as excimer and femtosecond laser. Complications that develop from poor healing and/or secondary infection are best avoided with appropriate technique, antisepsis, and modification of wound healing. We review corneal debridement in the management of corneal disease.
Collapse
Affiliation(s)
- Lindsay A McGrath
- City Eye Centre, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Ophthalmology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
| |
Collapse
|
9
|
Woreta FA, Gupta A, Hochstetler B, Bower KS. Management of post-photorefractive keratectomy pain. Surv Ophthalmol 2013; 58:529-35. [DOI: 10.1016/j.survophthal.2012.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 11/15/2022]
|
10
|
Yuksel N, Bilgihan K, Hondur AM, Yildiz B, Yuksel E. Long term results of Epi-LASIK and LASEK for myopia. Cont Lens Anterior Eye 2013; 37:132-5. [PMID: 24128385 DOI: 10.1016/j.clae.2013.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/15/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia. SETTING Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey. DESIGN Retrospective study. METHODS Twenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes. RESULTS Preoperative myopic spherical equivalent refraction was -4.65 ± 1.74 D in the LASEK and -3.87 ± 1.30 D in the Epi-LASIK-treated eyes (p=0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p=0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p=0.42). CONCLUSIONS Both LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term.
Collapse
Affiliation(s)
- Nilay Yuksel
- Kahramanmaras Necip Fazil City Hospital, Department of Ophthalmology, Kahramanmaras, Turkey.
| | - Kamil Bilgihan
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Ahmet M Hondur
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Burcin Yildiz
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Erdem Yuksel
- Kahramanmaras Necip Fazil City Hospital, Department of Ophthalmology, Kahramanmaras, Turkey
| |
Collapse
|
11
|
Shaher A, Al-Gassaly Y, Alansy H, Alkhatib T. Comparison of clinical results between flap-on and flap-off techniques of epithelial-laser in situ keratomileusis in correction of low to moderate myopia in eyes with thin corneas. Saudi J Ophthalmol 2013; 27:31-5. [PMID: 23964184 DOI: 10.1016/j.sjopt.2012.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/31/2012] [Accepted: 06/09/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To prospectively compare flap-on and flap-off techniques of epithelial-laser in situ keratomileusis (epi-LASIK) for the correction of low to moderate myopia in patients with thin corneas. METHODS In this randomized, interventional study, the cohort was comprised of 88 eyes (44 patients) with myopia which underwent epi-LASIK. The epithelium was separated as a 9 mm flap with 2-4 mm nasal hinge with epikeratome (Lasatom, Gebauer Medizintechnik GmbH, Neuhausen, Germany) and the ablation was performed with the MEL 80 excimer laser (Carl Zeiss, Meditec, Jena, Germany). Thirty-eight eyes underwent flap-on Epi-LASIK where the flap was repositioned after ablation (flap-on group) and 50 eyes underwent flap-off Epi-LASIK where the epithelial flap was discarded (flap-off group). Pre- and post-operative uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and spherical equivalent (SE) were collected for each group. Post-operative pain, time to epithelialization, and corneal haze were also collected postoperatively. Variables were compared with the paired t-test, chi-squared test and one-way analysis of variance. Statistically significance was indicated by p < 0.05. RESULTS The mean preoperative SE was -3.89 ± 1.9 diopters (D) for the flap-on group and -3.92 ± 2.17 D for the flap-off group (p = 0.96). The mean follow-up was 12 months. The mean pain score was comparable on all postoperative days except the 2nd postoperative day where the flap-on had significantly lower mean pain scores (p = 00). Time for epithelial healing was 4.39 ± 0.49 days in flap-on group and 4.64 ± 0.69 days in flap-off group (p = 0.07). There was no significant difference in the postoperative UCVA between groups (p = 0.77). Corneal haze at the end of postoperative follow-up was not different between groups (p = 0.217). CONCLUSION There is no significant difference in the clinical outcomes between flap-on and flap-off techniques of Epi-LASIK for the correction of low to moderate myopia.
Collapse
Affiliation(s)
- Aziz Shaher
- Ophthalmology Center, Al-Thawra Modern General Teaching Hospital, Faculty of Medicine, Sana'a University, PO Box 12272, Sana'a, Yemen
| | | | | | | |
Collapse
|
12
|
Zhang L, Wang Y, Yang X. Ablation depth and its effects on corneal biomechanical changes in laser in situ keratomileusis and epipolis laser in situ keratomileusis. Int Ophthalmol 2013; 34:157-64. [PMID: 23749287 DOI: 10.1007/s10792-013-9798-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
Abstract
To assess the corneal biomechanical parameters prior to and following laser in situ keratomileusis (LASIK) and epipolis laser in situ keratomileusis (epi-LASIK) and evaluate the probable correlative factors. Corneal hysteresis (CH), corneal resistance factor (CRF) and other biomechanical metrics were measured and evaluated with an ocular response analyzer preoperatively and 1 month postoperatively. Compared with preoperative values, CH and CRF decreased significantly after surgery in both groups (P = 0.000). The LASIK group exhibited a positive correlation between ablation depth (AD) and ∆CH/∆CRF with a strong r value (r = 0.543, P = 0.000; r = 0.574, P = 0.000). In the epi-LASIK group, however, the correlation was much weaker (r = -0.090, P = 0.682; r = 0.093, P = 0.673), although there were no significant differences between LASIK and epi-LASIK groups in postoperative CH (P = 0.730) and CRF (P = 0.736), and in the changes between CH (P = 0.539) and CRF (P = 0.881). Corneal biomechanical changes correlated with AD in LASIK but not in epi-LASIK, and it appeared that patients with identical demographics and similar attempted corrections are more likely to face a greater danger when undergoing LASIK than epi-LASIK. Therefore, the surface ablation procedure was recommended instead of lamellar ablation especially for correcting high myopia from a biomechanical viewpoint.
Collapse
Affiliation(s)
- Lin Zhang
- Tianjin Eye Hospital and Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No. 4. Gansu Rd, Heping District, Tianjin, 300020, China
| | | | | |
Collapse
|
13
|
Visual and Refractive Outcome of Epi-LASIK for Myopia in Thin Corneas: a 12-Month Follow-Up. Eur J Ophthalmol 2012; 22:911-9. [DOI: 10.5301/ejo.5000170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/20/2022]
Abstract
Purpose. A nonrandomized, retrospective, cohort, single-center study was designed to examine the visual and refractive outcome of epi–laser-assisted in situ keratomileusis (LASIK) for myopia (with and without astigmatism) in patients with thin corneas (less than 500 µm), and to compare these results with those of a group of patients with normal corneal thickness. Methods. Uncorrected distance visual acuity (UCVA), spherical and cylindrical residual refractive error, mean keratometry readings (Km), and pupil diameter were measured postoperatively at 24 hours, 1 week, 1 month, 3 months, and 12 months in a group of 28 eyes with thin corneas (group 1) and a second age- and gender-matched group of 28 eyes with normal corneal thickness (group 2). In addition, the efficacy index was calculated at every postoperative examination. Results. Postoperative central corneal thickness was 464.14±50.40 µm in group 1 and 421.89±26.63 µm in group 2 (p<0.001). No statistically significant difference was found in UCVA, efficacy index, and spherical and cylindrical residual error between both groups, with an evolution towards stability over time in all cases. Statistically significant between-group differences in Km at all follow-up examinations were explained by between-group differences in ablation depth and attempted spherical correction. Conclusions. A 12-month follow-up revealed epi-LASIK for myopia (with and without astigmatism) to be a safe and predictable surface ablation procedure, with good visual and refractive outcome in patients with thin corneas, as compared with a group of patients with normal corneal thickness.
Collapse
|
14
|
Ramírez M, Hernández-Quintela E, Naranjo-Tackman R. Epi-LASIK: A Confocal Microscopy Analysis of the Corneal Epithelium and Anterior Stroma. Ophthalmic Surg Lasers Imaging Retina 2012; 43:319-22. [DOI: 10.3928/15428877-20120618-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 03/18/2012] [Indexed: 11/20/2022]
|
15
|
Sharma N, Jindal A, Bali SJ, Titiyal JS. Recalcitrant Pseudomonas keratitis after epipolis laser-assisted in situ keratomileusis: case report and review of the literature. Clin Exp Optom 2012; 95:460-3. [PMID: 22591252 DOI: 10.1111/j.1444-0938.2012.00727.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a case of recalcitrant microbial keratitis after epipolis laser-assisted in situ keratomileusis (epi-LASIK) surgery caused by Pseudomonas aeruginosa and review the literature on resistant Pseudomonas keratitis after excimer laser surgery. Microbial keratitis occurred two weeks after epi-LASIK surgery and was resistant to fluoroquinolones, aminoglycosides and macrolides but sensitive to meropenem. The patient had total corneal melting and required therapeutic penetrating keratoplasty. The globe could be salvaged and the distance visual acuity was 6/60 in the right eye. Recalcitrant Pseudomonas keratitis might require a therapeutic graft and necessitate the use of intravenous meropenem to prevent recurrence of infection.
Collapse
Affiliation(s)
- Namrata Sharma
- Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | |
Collapse
|
16
|
Sia RK, Coe CD, Edwards JD, Ryan DS, Bower KS. Visual Outcomes After Epi-LASIK and PRK for Low and Moderate Myopia. J Refract Surg 2012; 28:65-71. [DOI: 10.3928/1081597x-20111004-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 08/08/2011] [Indexed: 11/20/2022]
|
17
|
Taneri S, Oehler S, Koch J, Azar D. Effect of repositioning or discarding the epithelial flap in laser-assisted subepithelial keratectomy and epithelial laser in situ keratomileusis. J Cataract Refract Surg 2011; 37:1832-46. [DOI: 10.1016/j.jcrs.2011.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 04/07/2011] [Accepted: 05/02/2011] [Indexed: 11/16/2022]
|
18
|
Feng YF, Chen SH, Stojanovic A, Wang QM. Comparison of clinical outcomes between 'on-flap' and 'off-flap' epi-LASIK for myopia: a meta-analysis. Ophthalmologica 2011; 227:45-54. [PMID: 21952499 DOI: 10.1159/000331280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/29/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine possible differences in clinical outcomes between off-flap and on-flap epipolis laser in situ keratomileusis (epi-LASIK) for myopia. METHODS Pertinent studies were selected by extensive searches. A total of 9 studies reporting on a total of 958 eyes were included in the present meta-analysis. Statistical analysis was performed using RevMan 5.0 software. RESULTS There were no significant differences in the final refractive spherical equivalent (p = 0.38), manifest refractive spherical equivalent within ±0.50 D of the target (p = 0.76), final uncorrected visual acuity (p = 0.90), loss of ≥1 line of best spectacle-corrected visual acuity (p = 0.99), and corneal haze at 3 months postoperatively (p = 0.96) or more than 6 months (p = 0.64). More patients felt severe pain in the on-flap group than in the off-flap group, although this finding was not statistically significant (p = 0.05). However, off-flap epi-LASIK had a better mean uncorrected visual acuity at 3 days (p = 0.04) and 5 days (p = 0.01), and faster re-epithelialization (p < 0.00001) after surgery. CONCLUSIONS According to the available data, off-flap and on-flap epi-LASIK had equal visual and refractive outcomes for the treatment of myopia. Off-flap epi-LASIK had more rapid re-epithelialization and visual recovery compared to on-flap epi-LASIK.
Collapse
Affiliation(s)
- Yi-fan Feng
- Affiliated Eye Hospital of Wenzhou Medical College, Zhejiang, China
| | | | | | | |
Collapse
|
19
|
Long-term outcome of epi-LASIK for high myopia. Eur J Ophthalmol 2011; 22 Suppl 7:S98-105. [PMID: 21928261 DOI: 10.5301/ejo.5000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of epipolis laser-assisted in situ keratomileusis (epi-LASIK) for high myopia. METHODS High myopic patients who underwent epi-LASIK during 2004 and 2005 were included in this study. Epi-LASIK was performed with an automatically rotational epikeratome (KM-5000D). Postoperative visual acuity, manifest refraction, and haze formation were assessed 3 mo, 6 mo, 1 y, and 3 y after surgery. Results were compared by dividing patients into 2 groups according to preoperative mean refractive spherical equivalent (MRSE): group A (≥-6 D to -10 D; group B ≥-10 D). The differences within groups were analyzed using mixed model for continuous variables. The differences between groups were analyzed using t test or rank sum test for continuous variables, and Pearson χ² or Fisher exact probabilities for categorical variables. RESULTS A total of 20 patients (33 eyes) were followed up for more than 3 years with 17 eyes in group A (MRSE -8.15 ± 1.41 D) and 16 eyes in group B (MRSE -12.95 ± 2.91 D). While postoperative refraction regression occurred in both groups, it was more prominent in group B (p<0.05). The long-term predictability is good in group A with 14 eyes (82.35%) within ±1 D of attempted correction at 3 years while the percentage in group B was 18.75%. The efficacy index was significantly different between the 2 groups (p<0.05): 0.84 ± 0.29 for group A and 0.61 ± 0.47 for group B at 3 years. The safety index was above 1.0 at each timepoint in both groups. Haze was at low level and faded with time after epi-LASIK. CONCLUSIONS Epi-LASIK had a satisfactory long-term effect for high myopia of less than -10 D. Myopic regression limited the satisfaction of epi-LASIK in eyes with myopia of more than -10.0 D.
Collapse
|
20
|
Wavefront-guided epithelial laser in situ keratomileusis with mitomycin-C for myopia and myopic astigmatism: flap-on versus flap-off technique. J Cataract Refract Surg 2011; 37:1133-9. [PMID: 21596257 DOI: 10.1016/j.jcrs.2010.12.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/22/2010] [Accepted: 12/22/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the postoperative pain, visual recovery, and outcomes of flap-on and flap-off epithelial laser in situ keratomileusis (epi-LASIK) with mitomycin-C (MMC). SETTING Asian Eye Institute, Makati, Philippines. DESIGN Case-control study. METHODS Patients with myopia up to 9.00 diopters had wavefront-guided epi-LASIK with MMC. After randomization, the epithelium was removed in 1 eye (flap off) and repositioned in the other eye (flap on). Questionnaires were used to evaluate postoperative pain and visual recovery in each eye during the first postoperative week. Visual results, refractive outcomes, contrast sensitivity, and higher-order aberrations (HOAs) were compared and analyzed. RESULTS The study evaluated 48 eyes. The mean pain scores were lower and better vision was perceived in the flap-off group during the first postoperative week. One year postoperatively, the mean uncorrected distance visual acuity was -0.088 logMAR in the flap-on group and -0.036 logMAR in the flap-off group (P = .918). The spherical equivalent was within ± 0.50 D in 92% of eyes in both groups (P > .05). Forty-six percent in the flap-on group and 38% in the flap-off group gained 1 line of corrected distance visual acuity (P = .915). Contrast sensitivity tests under daytime and nighttime conditions were comparable. There was no statistically significant difference in the mean change in HOAs between groups. CONCLUSIONS Wavefront-guided epi-LASIK with MMC was effective, safe, and predictable in treating myopia and myopic astigmatism. Eyes that had flap-off epi-LASIK had less pain and faster visual recovery. Visual results, refractive outcomes, contrast sensitivity, and HOAs were comparable between groups. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
|
21
|
Taneri S, Weisberg M, Azar DT. Surface ablation techniques. J Cataract Refract Surg 2011; 37:392-408. [PMID: 21241926 DOI: 10.1016/j.jcrs.2010.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 11/25/2022]
Abstract
The ongoing quest for a safe, simple, effective, minimally invasive, and stable refractive surgical procedure to correct refractive errors has stimulated the development of surface ablation techniques and laser in situ keratomileusis. In this review, we describe the history, patient assessment, techniques, outcomes, and complications of surface ablation (photorefractive keratectomy, laser-assisted sub-epithelial keratectomy, epithelial laser-assisted in situ keratomileusis) and compare the results of various surface techniques. Surface ablation procedures will continue to evolve, with potential improvements in outcomes accompanying future sophisticated ablation profiles and laser technology.
Collapse
Affiliation(s)
- Suphi Taneri
- Center for Refractive Surgery, St Franziskus Hospital, Münster, Germany
| | | | | |
Collapse
|
22
|
Angunawela RI, Winkler von Mohrenfels C, Kumar A, O’Brart DP, Marshall J. Live or Let Die: Epithelial Flap Vitality and Keratocyte Proliferation Following LASEK and Epi-LASIK in Human Donor and Porcine Eyes. J Refract Surg 2011; 27:111-8. [DOI: 10.3928/1081597x-20100330-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 02/04/2010] [Indexed: 11/20/2022]
|
23
|
Surface Ablation. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Cho NS, Kim DH, Jin KH. Factors Associated with Incomplete Cleavage of the Corneal Epithelium in Alcohol-Assisted LASEK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.6.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nam Suk Cho
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dong Hee Kim
- Department of Ophthalmology, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Kyung Hyun Jin
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
25
|
Yokogawa H, Kobayashi A, Tagawa K, Sugiyama K. In Vivo Laser Confocal Microscopic Analysis of Corneal K-Structures After Keratorefractive Surgery (LASIK and Epi-LASIK). Ophthalmic Surg Lasers Imaging Retina 2010; 41:494-8. [DOI: 10.3928/15428877-20100625-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 03/26/2010] [Indexed: 11/20/2022]
|
26
|
Bilateral Comparison of Conventional Epithelial Laser In Situ Keratomileusis and Lamellar Epithelial Debridement for Moderate to High Myopia. Cornea 2010; 29:853-7. [DOI: 10.1097/ico.0b013e3181ca33e6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Kim JH, Lee J, Kim JY, Tchah H. Early postoperative pain and visual outcomes following epipolis-laser in situ keratomileusis and photorefractive keratectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:143-7. [PMID: 20532139 PMCID: PMC2882076 DOI: 10.3341/kjo.2010.24.3.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 05/03/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare early postoperative pain and visual outcomes after epipolis-laser in situ keratomileusis (epi-LASIK) and photorefractive keratectomy (PRK) in the treatment of myopia. Methods A retrospective chart review was designed and included 49 eyes in 30 patients who underwent epi-LASIK and 54 eyes in 29 patients who underwent PRK. During the early postoperative period (days 1 to 5), pain, uncorrected visual acuity (UCVA), and time to epithelial healing were recorded. Visual outcomes were followed for up to six months. Results Mean preoperative spherical equivalent refraction for the epi-LASIK group was -3.99±1.39 diopters (D) and that of the PRK group was -3.54±1.27 D. The pain scores on the fourth postoperative day were significantly higher in the epi-LASIK group than in the PRK group (p=0.017). Duration of pain in the epi-LASIK group was longer than in the PRK group (p=0.010). Mean healing time was significantly longer in the epi-LASIK group than in the PRK group (p<0.000). In addition, UCVA in the epi-LASIK group at postoperative days 1 and 3 were significantly lower than those in the PRK group (p=0.021 and p<0.000, respectively). Uncorrected visual acuity at one week and one month after epi-LASIK were lower than those after PRK (p=0.023 and p=0.004, respectively). Conclusions In the epi-LASIK patients, pain relief, corneal healing, and visual recovery seemed to be slower during the early postoperative period compared to those of the PRK patients. With longer duration of follow-up, however, there were no significant differences in visual outcome between the two groups.
Collapse
Affiliation(s)
- Jae-Hyung Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, #388-1 Pungnap 2-dong, Songpa-gu, Seoul, Korea
| | | | | | | |
Collapse
|
28
|
Comparison of higher-order aberration and optical quality after Epi-LASIK and LASIK for myopia. Graefes Arch Clin Exp Ophthalmol 2010; 249:281-8. [DOI: 10.1007/s00417-010-1394-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 03/16/2010] [Accepted: 04/11/2010] [Indexed: 10/19/2022] Open
|
29
|
Prakash G, Agarwal A, Kumar DA, Jacob S, Agarwal A, Maity A. Surface ablation with iris recognition and dynamic rotational eye tracking-based tissue saving treatment with the Technolas 217z excimer laser. J Refract Surg 2010; 27:223-31. [PMID: 20481413 DOI: 10.3928/1081597x-20100428-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/30/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual and refractive outcomes and expected benefits of Tissue Saving Treatment algorithm-guided surface ablation with iris recognition and dynamic rotational eye tracking. METHODS This prospective, interventional case series comprised 122 eyes (70 patients). Pre- and postoperative assessment included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, and higher order aberrations. All patients underwent Tissue Saving Treatment algorithm-guided surface ablation with iris recognition and dynamic rotational eye tracking using the Technolas 217z 100-Hz excimer platform (Technolas Perfect Vision GmbH). Follow-up was performed up to 6 months postoperatively. Theoretical benefit analysis was performed to evaluate the algorithm's outcomes compared to others. RESULTS Preoperative spherocylindrical power was sphere -3.62 ± 1.60 diopters (D) (range: 0 to -6.75 D), cylinder -1.15 ± 1.00 D (range: 0 to -3.50 D), and spherical equivalent -4.19 ± 1.60 D (range: -7.75 to -2.00 D). At 6 months, 91% (111/122) of eyes were within ± 0.50 D of attempted correction. Postoperative UDVA was comparable to preoperative CDVA at 1 month (P=.47) and progressively improved at 6 months (P=.004). Two eyes lost one line of CDVA at 6 months. Theoretical benefit analysis revealed that of 101 eyes with astigmatism, 29 would have had cyclotorsion-induced astigmatism of ≥ 10% if iris recognition and dynamic rotational eye tracking were not used. Furthermore, the mean percentage decrease in maximum depth of ablation by using the Tissue Saving Treatment was 11.8 ± 2.9% over Aspheric, 17.8 ± 6.2% over Personalized, and 18.2 ± 2.8% over Planoscan algorithms. CONCLUSIONS Tissue saving surface ablation with iris recognition and dynamic rotational eye tracking was safe and effective in this series of eyes.
Collapse
Affiliation(s)
- Gaurav Prakash
- Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India
| | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Soma T, Nishida K, Yamato M, Kosaka S, Yang J, Hayashi R, Sugiyama H, Maeda N, Okano T, Tano Y. Histological evaluation of mechanical epithelial separation in epithelial laser in situ keratomileusis. J Cataract Refract Surg 2009; 35:1251-9. [PMID: 19545817 DOI: 10.1016/j.jcrs.2009.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 02/13/2009] [Accepted: 02/19/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of mechanical epithelial separation with an epikeratome on the histologic ultrastructure of epithelial flaps and stromal beds from human corneas. SETTING Departments of Ophthalmology, Osaka University Medical School, Osaka, and Tohoku University School of Medicine, Sendai, and Institute of Advanced Biomedical Engineering and Science and Medical Research Institute, Tokyo Women's Medical University, Tokyo, Japan. METHODS Eye-bank eyes were deepithelialized using an Epi-K epikeratome. Epithelial flaps and stromal beds were assessed by light and electron microscopy. Immunofluorescence staining for types IV and VII collagens, integrins alpha(6) and beta(4), and laminin 5 was also performed. RESULTS Four eyes were evaluated. On scanning electron microscopy, the cleavage planes of epithelial flaps and stromal beds were relatively smooth. On transmission electron microscopy, epithelial flaps were separated partially within the lamina fibroreticularis and partially within the lamina lucida. Immunofluorescence showed positive staining for type VII collagen and discontinuous staining for type IV collagen in stromal beds. Discontinuous linear staining for types IV and VII collagens was observed in epithelial flaps. Staining for integrins alpha(6) and beta(4) was positive in some regions and discontinuous in other regions of epithelial flaps. In stromal beds, integrins alpha(6) and beta(4) had a patchy expression pattern. Staining for laminin 5 was intermittently positive along the basal side of epithelial flaps and stromal beds. CONCLUSIONS Epithelial flaps created with an epikeratome were mechanically separated partly within the lamina fibroreticularis and partly within the lamina lucida. Stromal beds had relatively smooth surfaces with no obvious trauma to Bowman layer.
Collapse
Affiliation(s)
- Takeshi Soma
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Excision of an inadvertent stromal flap after laser ablation in epipolis laser in situ keratomileusis. Jpn J Ophthalmol 2009; 53:180-182. [PMID: 19333705 DOI: 10.1007/s10384-008-0633-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
|
33
|
Comparison of early postoperative clinical outcomes of photorefractive keratectomy and lamellar epithelial debridement. J Cataract Refract Surg 2009; 35:703-9. [PMID: 19304092 DOI: 10.1016/j.jcrs.2008.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 12/08/2008] [Accepted: 12/09/2008] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare early postoperative clinical outcomes of photorefractive keratectomy (PRK) and lamellar epithelial debridement (LED). SETTING Department of Ophthalmology, Kangbuk Samsung Hospital, Seoul, Korea. METHODS This prospective study was of patients randomly assigned to have PRK or LED. In the LED group, an epithelial flap was created using an Amadeus II epikeratome. Postoperative follow-up was at 1, 3, and 7 days and 1, 3, and 6 months. The outcome parameters were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), higher-order aberrations (HOAs), epithelial healing time, and corneal haze. RESULTS The study comprised 39 patients (76 eyes). The mean preoperative spherical equivalent (SE) was -3.96 diopters (D) +/- 1.24 (SD) in the PRK group and -4.06 +/- 1.39 D in the LED group. Postoperative UCVA was significantly better in the LED group 1 day postoperatively. The UCVA was 20/20 or better in 14.6% in the PRK group and 42.9% in the LED group (P = .006); 20/25 or better in 41.5% and 82.9%, respectively (P = .000); and 20/40 or better in 80.5% and 100%, respectively (P = .006). On subsequent follow-up visits, the UCVA was comparable between groups. No eye lost lines of BCVA at 3 months. There was no difference between groups in postoperative SE refraction, HOAs, or corneal haze. CONCLUSIONS Lamellar epithelial debridement and PRK had comparable safety and efficacy in the surgical correction of low to moderate myopia. The UCVA was significantly better after LED than after PRK 1 day postoperatively and equivalent thereafter.
Collapse
|
34
|
Mimura T, Azar DT. Current Concepts, Classification, and History of Refractive Surgery. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
35
|
Laser Subepithelial Keratomileusis (LASEK) and Epi-LASIK. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
36
|
Kalyvianaki MI, Kymionis GD, Kounis GA, Panagopoulou SI, Grentzelos MA, Pallikaris IG. Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia. Ophthalmology 2008; 115:2174-80. [PMID: 19041475 DOI: 10.1016/j.ophtha.2008.08.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 08/08/2008] [Accepted: 08/08/2008] [Indexed: 11/18/2022] Open
|
37
|
Choi SK, Kim JH, Lee D, Lee JB, Kim HM, Tchah HW, Hahn TW, Joo M, Ha CI. Different epithelial cleavage planes produced by various epikeratomes in epithelial laser in situ keratomileusis. J Cataract Refract Surg 2008; 34:2079-84. [PMID: 19027563 DOI: 10.1016/j.jcrs.2008.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 08/20/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the anatomic cleavage planes produced by various epikeratomes in epithelial laser in situ keratomileusis (epi-LASIK). SETTING Department of Ophthalmology, IIsan Paik Hospital, Goyang, Korea. METHODS Sixteen eyes (8 patients) were included in this study. Three epikeratomes, the Moria Epi-K, Centurion SES, and Amadeus II, were used to collect 4 epithelial flaps from 2 patients in the epi-LASIK procedure. Four epithelial flaps from 2 patients were also obtained by laser-assisted subepithelial keratectomy (LASEK). Immunohistochemical staining using monoclonal antibodies against integrin beta1, integrin beta4, laminin 5, and collagen type VII was performed. RESULTS Immunohistochemical staining showed expression of integrin beta1 and integrin beta4 in all epithelial flaps. In epi-LASIK, the expression of laminin 5 and collagen type VII had a linear or dotted pattern that differed based on the epikeratome used. In the epithelial flaps obtained using LASEK, the expression of laminin 5 and collagen type VII had a dotted pattern. CONCLUSIONS Each epikeratome yielded reproducible but different cleavage planes of corneal epithelium. The results suggest that further study is needed to elucidate the wound-healing process after epi-LASIK because different cleavage planes produced by different epikeratomes may influence the process.
Collapse
Affiliation(s)
- Suk Kyue Choi
- Department of Ophthalmology, Ilsan Paik Hospital, College of Medicine, Inje University, Ilsanseo-gu, Goyang, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Herrmann WA, Hillenkamp J, Hufendiek K, Prahs P, Lohmann CP, Helbig H, Kobuch K. Epi-laser in situ keratomileusis: comparative evaluation of epithelial separation with 3 microkeratomes. J Cataract Refract Surg 2008; 34:1761-6. [PMID: 18812130 DOI: 10.1016/j.jcrs.2008.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 06/06/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the cleavage plane, corneal cytoarchitecture, and cell vitality of separated corneal epithelial sheets created with 3 commonly used microkeratomes. SETTING Laboratories of the Regensburg University Medical Center, Regensburg, Germany. METHODS Mechanical separation of the epithelial layer in 10 porcine eyes and 2 human eyes was performed with 3 different microkeratomes (Amadeus II, Zyoptix XP, Epivision). Five of 10 porcine corneas and the 2 human corneas treated with each microkeratome were processed for histology, electron microscopy, and immunohistochemistry. In 5 of 10 porcine corneas, the corneal epithelial sheets were separated from the globe and cell vitality was assessed with the trypan blue dye vitality test. RESULTS A reproducible epithelial separation with a smooth surface was achieved in all eyes. The cleavage plane was located between the lamina lucida and the lamina densa. Damage to epithelial cells was mainly limited to the cut margins. CONCLUSIONS Mechanical separation of the epithelial sheet in epithelial laser in situ keratomileusis (epi-LASIK) was safe and reproducible with all evaluated microkeratomes. Immunohistochemistry and electron microscopy showed the cleavage plane in epi-LASIK was between the basal epithelium and the basement membrane at the level of the lamina lucida.
Collapse
Affiliation(s)
- Wolfgang A Herrmann
- Department of Ophthalmology, Regensburg University Medical Center, Regensburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
39
|
Teus MA, de Benito-Llopis L, García-González M. Comparison of visual results between laser-assisted subepithelial keratectomy and epipolis laser in situ keratomileusis to correct myopia and myopic astigmatism. Am J Ophthalmol 2008; 146:357-362. [PMID: 18614136 DOI: 10.1016/j.ajo.2008.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Revised: 05/06/2008] [Accepted: 05/12/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the visual results after laser-assisted subepithelial keratectomy (LASEK) and epipolis laser in situ keratomileusis (epi-LASIK) to correct myopia. DESIGN Retrospective, interventional, nonrandomized comparative study. METHODS Patients treated with LASEK to correct myopia < or = -9.00 diopters (D) were compared to age- and refraction-matched patients treated with epi-LASIK using the same excimer laser (Esiris; Schwind Eye Tech Solutions, Kleinostheim, Germany). The epithelial flap was replaced after the ablation in every case. The visual results after both procedures were compared at each postoperative visit (one day, one week, one and three months). RESULTS Ninety-four consecutive eyes were included in the study (47 in each group), matched for age and refraction. The preoperative spherical manifest refraction was -3.98 +/- 2.40 D in the LASEK group and -3.95 +/- 2.40 D in the epi-LASIK group (P = .9) (range -0.50 to -9.00 D). The uncorrected visual acuity (UCVA) one day postoperatively was 0.7 +/- 0.2 and 0.5 +/- 0.2 (P < .001), and one week after surgery it was 0.8 +/- 0.2 and 0.7 +/- 0.2, respectively (P = .1). The difference was again statistically significant one month after surgery (0.94 +/- 0.1 after LASEK, 0.82 +/- 0.1 after epi-LASIK, P < .001), but not three months postoperatively (1.06 +/- 0.21 and 1.03 +/- 0.18, respectively, P = .1). UCVA was > or =1.0 in 78.7% of LASEK eyes and 65.9% of epi-LASIK eyes three months after surgery. At that moment, the safety indices were 0.99 +/- 0.1 after LASEK and 0.93 +/- 0.1 after epi-LASIK (P = .04). The efficacy indices were 0.97 +/- 0.1 and 0.89 +/- 0.1, respectively (P = .01). CONCLUSIONS Our results suggest a faster visual rehabilitation and better safety and efficacy outcomes after LASEK compared to epi-LASIK with repositioning of the epithelial flap when correcting low to moderate myopia.
Collapse
|
40
|
Maldonado MJ, Nieto JC, Piñero DP. Advances in technologies for laser-assisted in situ keratomileusis (LASIK) surgery. Expert Rev Med Devices 2008; 5:209-29. [PMID: 18331182 DOI: 10.1586/17434440.5.2.209] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laser-assisted in situ keratomileusis (LASIK) has become the most widely used form of refractive surgery today. The objective of this surgical technique is to modify the anterior corneal shape by ablating tissue from the stroma by means of the excimer laser after creating a hinged corneal flap. This way, we are able to change the refractive status of the patient, providing better unaided vision. Continuous improvements in the original technique have made the surgical procedure safer, more accurate and repeatable. These progressions are due to the development of novel technologies that are the responsible for new surgical instrumentation, which makes the surgical procedure easier for the surgeon, and better excimer laser ablation algorithms, which increase the optical quality of the ablation and thus the safety of the vision correction procedure. This article aims to describe the more relevant advances in LASIK that have played an important role in the spread and popularity of this technique.
Collapse
Affiliation(s)
- Miguel J Maldonado
- Department of Ophthalmology, Clínica Universitaria, University of Navarra, Avda Pio XII, 36, 31080, Pamplona, Spain.
| | | | | |
Collapse
|
41
|
Hosny M, Awadalla MA. Comparison of higher-order aberrations after LASIK using disposable microkeratome 130 and 90 micron heads. Eur J Ophthalmol 2008; 18:332-7. [PMID: 18465711 DOI: 10.1177/112067210801800302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyze and compare higher-order aberrations (HOAs) in cases of laser in situ keratomileusis (LASIK) flaps made using the Moria M2 disposable 130-micronm head with those made using the 90-micronm head. METHODS Consecutive prospective comparative clinical trial. Ninety-four consecutive eyes of 48 patients were enrolled in this study. They were divided into two equal groups of 47 eyes that underwent wavefront-guided LASIK using VISX CustomVue (VISX, Santa Clara, CA) system. Corneal flap was created using the disposable Moria M2 130 micronm in the first group and the 90 micronm head in the second one. All patients were followed up for 6 months. Wavefront aberrations were measured at baseline, 1 month, and 6 months after surgery using the WaveScan (VISX Inc.) aberrometer. Root mean square (RMS) of HOAs, coma, and spherical aberration (SA) values were analyzed and compared in the two groups. RESULTS At 6 months, values of RMS of HOAs, coma, and SA obtained from the 130-micronm head group were 0.32+/-0.10 micronm, 0.20+/-0.11 micronm, and 0.18+/-0.08 micronm, respectively. Values of RMS of HOAs, coma, and SA obtained from 90-micronm head group were 0.33+/-0.12 micronm, 0.19+/-0.10 micronm, and 0.15+/-0.08 micronm, respectively. Analyzing the data obtained revealed no statistically significant differences between the two groups. In each group, there was a significant decay of higher-order RMS and coma values from 1 month to 6 months. CONCLUSIONS HOAs following use of Moria M2 disposable 90 micronm head are similar to those arising following use of the 130 micronm.
Collapse
Affiliation(s)
- M Hosny
- Department of Ophthalmology, Cairo University, Cairo, Egypt
| | | |
Collapse
|
42
|
Pallikaris IG, Kalyvianaki MI, Gkenos ES, Katsanevaki VJ. Epipolis-laser in situkeratomileusis (Epi-LASIK). EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
43
|
Hondur A, Bilgihan K, Hasanreisoglu B. A Prospective Bilateral Comparison of Epi-LASIK and LASEK for Myopia. J Refract Surg 2008; 24:928-34. [PMID: 19044234 DOI: 10.3928/1081597x-20081101-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ahmet Hondur
- Dinar State Hospital, Dinar, Afyonkarahisar, Turkey.
| | | | | |
Collapse
|
44
|
Alió JL, Muftuoglu O, Ortiz D, Artola A, Pérez-Santonja JJ, de Luna GC, Abu-Mustafa SK, Garcia MJ. Ten-year follow-up of photorefractive keratectomy for myopia of less than -6 diopters. Am J Ophthalmol 2008; 145:29-36. [PMID: 18154752 DOI: 10.1016/j.ajo.2007.09.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 08/29/2007] [Accepted: 09/08/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of excimer laser myopic photorefractive keratectomy (PRK) for myopia of less than -6 diopters (D). DESIGN Long-term (10-year) follow-up retrospective, interventional case series. METHODS The study included 225 eyes of 138 myopic patients with spherical equivalent (SE) between 0 and -6 D treated with myopic PRK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA). The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS At 10 years, 169 (75%) of 225 eyes were within +/- 1.00 D and 207 (92%) were within +/- 2.00 D. Ninety-five (42%) eyes underwent retreatments because of overcorrection, regression, or both. The mean SE slightly decreased (myopic regression) with a mean magnitude of -0.10 +/- 1.08 D over 10 years (-0.01 +/- 0.11 D per year). Forty-one (58%) of 225 eyes demonstrated increase in best spectacle-corrected visual acuity after 10 years. Only one eye lost eight lines because of significant cataract, and two eyes lost vision (one lost seven lines and the other lost four lines) because of posterior segment-related complications. The mean corneal haze score gradually decreased from 0.22 +/- 0.39 at three months to 0.01 +/- 0.09 at 10 years. CONCLUSIONS Photorefractive keratectomy for myopia of less than -6 D is a safe and effective procedure in the long-term.
Collapse
Affiliation(s)
- Jorge L Alió
- Vissum-Instituto Oftalmológico de Alicante and Division of Ophthalmology, Miguel Hernandez University Medical School, Alicante, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Kim SK, Song JS, Kim HM. Postoperative Pain and Epithelial Wound Healing in Epi-LASIK With and Without an Epithelial Sheet Preservation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.12.1894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Kyoon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
46
|
Alió JL, Muftuoglu O, Ortiz D, Artola A, Pérez-Santonja JJ, de Luna GC, Abu-Mustafa SK, Garcia MJ. Ten-year follow-up of photorefractive keratectomy for myopia of more than -6 diopters. Am J Ophthalmol 2008; 145:37-45. [PMID: 18154753 DOI: 10.1016/j.ajo.2007.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 09/05/2007] [Accepted: 09/12/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of excimer laser myopic photorefractive keratectomy (PRK) for myopia higher than -6 diopters (D). DESIGN A long-term (10-year) follow-up retrospective, interventional case series. METHODS The study included 267 eyes of 191 patients with myopia with spherical equivalent (SE) of more than -6 D treated with myopic PRK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA). All patients were evaluated three months, one year, two years, five years, and 10 years after surgery. The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS At 10 years, 156 (58%) of 267 eyes were within +/- 1.00 D and 209 (78%) were within +/- 2.00 D. One hundred and twenty-four eyes (46.4%) underwent retreatments because of overcorrection, regression, or both. The mean SE decreased (myopic regression) in eyes that did not undergo retreatment, with a mean magnitude of -1.33 +/- 2.0 D over 10 years (-1.13 +/- 0.20 D per year). One hundred and twenty-one (48.3%) of 267 eyes demonstrated increase in best spectacle-corrected visual acuity, and only eight eyes lost lines of vision because of cataract and posterior segment-related complications. The mean corneal haze score decreased gradually from 0.48 +/- 0.69 at three months to 0.09 +/- 0.33 at 10 years. CONCLUSIONS PRK for myopia of more than -6 D is a safe and effective procedure in the long-term.
Collapse
Affiliation(s)
- Jorge L Alió
- Vissum Department of Refractive Surgery and Division of Ophthalmology, Instituto Oftalmológico de Alicante, Miguel Hernandez University, Medical School, Alicante, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Epi-LASIK using the Amadeus II microkeratome. J Cataract Refract Surg 2007; 33:2118-21. [PMID: 18053914 DOI: 10.1016/j.jcrs.2007.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 07/12/2007] [Indexed: 11/21/2022]
|
48
|
Alió JL, Rodriguez AE, Mendez MC, Kanellopoulos J. Histopathology of epi-LASIK in eyes with virgin corneas and eyes with previously altered corneas. J Cataract Refract Surg 2007; 33:1871-6. [PMID: 17964391 DOI: 10.1016/j.jcrs.2007.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 07/03/2007] [Indexed: 10/22/2022]
|
49
|
Tanioka H, Hieda O, Kawasaki S, Nakai Y, Kinoshita S. Assessment of epithelial integrity and cell viability in epithelial flaps prepared with the epi-LASIK procedure. J Cataract Refract Surg 2007; 33:1195-200. [PMID: 17586375 DOI: 10.1016/j.jcrs.2007.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the histological integrity and cell viability in epithelial flaps prepared with epikeratomes. SETTING Department of Ophthalmology, Kyoto Prefectural University of Medicine and The Baptist Eye Clinic, Kyoto, Japan. METHODS Epithelial flaps were prepared by epi-LASIK surgery. After immediate fixation, they were examined by light and electron microscopy. To assess cell viability in fresh epithelial flaps, biostaining experiments were performed using propidium iodide (PI), calcein-AM, and Hoechst 33342 dye. In addition, some epithelial flaps were organ-cultured for 24 hours. RESULTS Light and electron microscopy showed that most of the inspected areas showed nuclei and cytoplasm at significantly reduced density and discontinuity of the basement membrane. Biostaining experiments showed that approximately 90% of the basal cells in epithelial flaps were PI-positive dead cells; organ cultures showed detachment of basal cells from the epithelial flap after 24 hours of incubation. CONCLUSION Most basal cells in epithelial flaps prepared with different epikeratome devices were dead.
Collapse
Affiliation(s)
- Hidetoshi Tanioka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, and The Baptist Eye Clinic, Kyoto, Japan
| | | | | | | | | |
Collapse
|
50
|
Katsanevaki VJ, Kalyvianaki MI, Kavroulaki DS, Pallikaris IG. One-Year Clinical Results after Epi-LASIK for Myopia. Ophthalmology 2007; 114:1111-7. [PMID: 17320960 DOI: 10.1016/j.ophtha.2006.08.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 08/17/2006] [Accepted: 08/17/2006] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the clinical results of epi-LASIK for the treatment of low to moderate myopia and myopic astigmatism. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Two hundred thirty-four eyes of 138 patients underwent epi-LASIK for the correction of low to moderate myopia. Mean preoperative spherical equivalent ranged from -1.0 to -7.25 diopters (D) (-3.74+/-1.46, mean+/-standard deviation [SD]) and baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) from 0.10 to -0.18 (mean+/-SD, 0.00+/-0.06). METHODS All enrolled eyes underwent epi-LASIK using the Centurion SES epikeratome (Norwood Abbey EyeCare, Victoria, Australia) and the Allegretto (Wavelight Laser Technologie AG, Erlangen, Germany) laser platform. The enrolled patients were followed up daily until the epithelial healing was complete as well as at the 1-, 3-, 6-, and 12-month postoperative intervals. MAIN OUTCOME MEASURES The main parameters assessed were subjective evaluation of postoperative pain, uncorrected visual acuity (UCVA) and BSCVA, manifest refraction, haze grade, and contrast sensitivity of the operated eyes. RESULTS The mean epithelial healing time was 4.70+/-0.87 days (range, 3-7 days), with mean logMAR UCVA on the day of reepithelization of 0.26+/-0.14 (range, 0.7-0.0). One year after the treatment, the spherical equivalent of the treated eyes (n = 222) ranged from -1.25 to +0.625 D (mean+/-SD, -0.18+/-0.6 D), with 80.33% of the eyes within 0.5 D (96.72% within 1 D) of the attempted correction. At the same interval, 86% of the eyes had clear corneas and 14% clinically insignificant (trace) haze, whereas 60% of the eyes had a line gain of 1 or more lines of BSCVA. Mean logMAR contrast sensitivity of the treated eyes at 4 different spatial frequencies was improved or remained unchanged throughout the follow-up period. CONCLUSIONS One-year visual and refractive results after epi-LASIK suggest that it is a safe and efficient method for the correction of low to moderate myopia and myopic astigmatism.
Collapse
|