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Moshirfar M, Tukan AN, Bundogji N, Liu HY, McCabe SE, Ronquillo YC, Hoopes PC. Ectasia After Corneal Refractive Surgery: A Systematic Review. Ophthalmol Ther 2021; 10:753-776. [PMID: 34417707 PMCID: PMC8589911 DOI: 10.1007/s40123-021-00383-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/02/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The incidence of ectasia following refractive surgery is unclear. This review sought to determine the worldwide rates of ectasia after photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) based on reports in the literature. METHODS A systematic review was conducted according to modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications were identified by a search of eight electronic databases for relevant terms between 1984 and 2021. Patient characteristics and preoperative values including manifest refractive spherical refractive equivalent (MRSE), central corneal thickness (CCT), anterior keratometry, postoperative residual stromal bed (RSB), and percent tissue altered (PTA) were summarized. In addition, annual rates of each refractive surgery were determined, and incidence of post-refractive ectasia for each type was calculated using the number of ectatic eyes identified in the literature. RESULTS In total, 57 eyes (70 eyes including those with preoperative risk factors for ectasia) were identified to have post-PRK ectasia, while 1453 eyes (1681 eyes including risk factors) had post-LASIK ectasia, and 11 eyes (19 eyes including risk factors) had post-SMILE ectasia. Cases of refractive surgery performed annually were estimated as 283,920 for PRK, 1,608,880 for LASIK, and 96,750 for SMILE. Reported post-refractive ectasia in eyes without preoperative identifiable risk factors occurred with the following incidences: 20 per 100,000 eyes in PRK, 90 per 100,000 eyes in LASIK, and 11 per 100,000 eyes in SMILE. The rate of ectasia in LASIK was found to be 4.5 times higher than that of PRK. CONCLUSION Post-refractive ectasia occurs at lower rates in eyes undergoing PRK than LASIK. Although SMILE appears to have the lowest rate of ectasia, the number of cases already reported since its recent approval suggests that post-SMILE ectasia may become a concern. Considering that keratoconus is a spectrum of disease, pre-existing keratoconus may play a larger role in postoperative ectasia than previously accounted for in the literature.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA.
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
| | - Alyson N Tukan
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Nour Bundogji
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Harry Y Liu
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
- Mission Hills Eye Center, Pleasant Hill, CA, USA
| | - Yasmyne C Ronquillo
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
| | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
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Feizi S, Javadi MA, Fekri Y. Use of deep anterior lamellar keratoplasty (DALK) for keratoconus: indications, techniques and outcomes. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1222904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salouti R, Nowroozzadeh MH, Makateb P, Zamani M, Ghoreyshi M, Melles GRJ. Deep anterior lamellar keratoplasty for keratectasia after laser in situ keratomileusis. J Cataract Refract Surg 2014; 40:2011-8. [PMID: 25457380 DOI: 10.1016/j.jcrs.2014.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/20/2014] [Accepted: 04/07/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the efficacy of deep anterior lamellar keratoplasty (DALK) for treating post-LASIK keratectasia. SETTING Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. DESIGN Retrospective interventional cases series. METHODS The same surgeon performed all DALK procedures using the Melles manual technique. The preoperative and postoperative corrected distance visual acuity (CDVA), spherical equivalent (SE) refraction, keratometry (K) readings, and endothelial cell profiles were compared. RESULTS The cohort comprised 20 eyes of 18 patients (72% women) with a mean age of 29 years ± 4 (SD). The mean follow-up was 31.8 ± 17.0 months (range 6 to 60 months). The mean Snellen CDVA improved significantly from 20/191 before DALK to 20/23 after DALK (P < .001). The mean of the modulus of SE refraction was 11.9 ± 6.6 diopters (D) and 11.4 ± 4.3 D, respectively (P = .446). The mean K value was 52.2 ± 7.0 D before DALK and 46.0 ± 1.9 D after DALK (P = .001); the mean apical K value, 59.5 ± 5.1 D and 49.9 ± 2.8 D, respectively (P < .001); and the mean keratometric astigmatism, 4.3 ± 2.4 D and 1.9 ± 1.2 D, respectively (P = .003). The endothelial cell profile did not change significantly, and no major complications related to DALK occurred. Twelve eyes had additional refractive procedures to correct residual ametropia. CONCLUSION Deep anterior lamellar keratoplasty using the Melles manual technique was effective and safe in restoring CDVA in patients with post-LASIK keratectasia; however, high residual ametropia was a common finding.
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Affiliation(s)
- Ramin Salouti
- From Poostchi Ophthalmology Research Center (Salouti, Nowroozzadeh, Makateb, Ghoreyshi), Shiraz University of Medical Sciences, and Salouti Eye Research Center (Salouti, Zamani, Ghoreyshi), Salouti Eye Clinic, Shiraz, Iran; the Netherlands Institute for Innovative Ocular Surgery (Melles), Rotterdam, the Netherlands
| | - Mohammad H Nowroozzadeh
- From Poostchi Ophthalmology Research Center (Salouti, Nowroozzadeh, Makateb, Ghoreyshi), Shiraz University of Medical Sciences, and Salouti Eye Research Center (Salouti, Zamani, Ghoreyshi), Salouti Eye Clinic, Shiraz, Iran; the Netherlands Institute for Innovative Ocular Surgery (Melles), Rotterdam, the Netherlands
| | - Payam Makateb
- From Poostchi Ophthalmology Research Center (Salouti, Nowroozzadeh, Makateb, Ghoreyshi), Shiraz University of Medical Sciences, and Salouti Eye Research Center (Salouti, Zamani, Ghoreyshi), Salouti Eye Clinic, Shiraz, Iran; the Netherlands Institute for Innovative Ocular Surgery (Melles), Rotterdam, the Netherlands
| | - Mohammad Zamani
- From Poostchi Ophthalmology Research Center (Salouti, Nowroozzadeh, Makateb, Ghoreyshi), Shiraz University of Medical Sciences, and Salouti Eye Research Center (Salouti, Zamani, Ghoreyshi), Salouti Eye Clinic, Shiraz, Iran; the Netherlands Institute for Innovative Ocular Surgery (Melles), Rotterdam, the Netherlands
| | - Maryam Ghoreyshi
- From Poostchi Ophthalmology Research Center (Salouti, Nowroozzadeh, Makateb, Ghoreyshi), Shiraz University of Medical Sciences, and Salouti Eye Research Center (Salouti, Zamani, Ghoreyshi), Salouti Eye Clinic, Shiraz, Iran; the Netherlands Institute for Innovative Ocular Surgery (Melles), Rotterdam, the Netherlands.
| | - Gerrit R J Melles
- From Poostchi Ophthalmology Research Center (Salouti, Nowroozzadeh, Makateb, Ghoreyshi), Shiraz University of Medical Sciences, and Salouti Eye Research Center (Salouti, Zamani, Ghoreyshi), Salouti Eye Clinic, Shiraz, Iran; the Netherlands Institute for Innovative Ocular Surgery (Melles), Rotterdam, the Netherlands
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Tomita M, Watabe M, Mita M, Waring GO. Long-term observation and evaluation of femtosecond laser-assisted thin-flap laser in situ keratomileusis in eyes with thin corneas but normal topography. J Cataract Refract Surg 2014; 40:239-50. [PMID: 24461499 DOI: 10.1016/j.jcrs.2013.07.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 07/04/2013] [Accepted: 07/26/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of thin-flap laser in situ keratomileusis (LASIK) in eyes with thin corneas (central corneal thickness [CCT] <500 μm) but normal topography. SETTING Private center, Tokyo, Japan. DESIGN Retrospective randomized comparative study. METHOD The efficacy, safety, predictability, and topography of LASIK were evaluated in eyes with a CCT of less than 500 μm but with normal topography (thin-cornea group) to 6 years postoperatively. The LASIK outcomes in the thin-cornea group were compared with those in eyes with a CCT of 500 μm or greater (control group). Analysis was performed to determine whether there were differences between the groups at the last checkup 3 to 4 years postoperatively. RESULTS In the thin-cornea group (291 eyes; 146 patients), no significant differences were observed in LASIK outcomes when eyes were subdivided by the time of final checkup (3, 4, and ≥ 5 years). There was a significant difference in visual and refractive outcomes between 3 months postoperatively and the last checkup in the thin-cornea group and the control group (371 eyes; 193 patients). No significant difference in visual, refractive, or topography outcomes was observed between the 2 groups at the last checkup. CONCLUSIONS Laser in situ keratomileusis in eyes with thin corneas was as safe and effective as and showed similar long-term stability in eyes with a CCT of 500 μm or greater. No eye in either group had a postoperative complication. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Minoru Tomita
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA.
| | - Miyuki Watabe
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA
| | - Mariko Mita
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA
| | - George O Waring
- From Shinagawa LASIK Center (Tomita, Watabe, Mita), Chiyoda-ku, Tokyo, Japan; Wenzhou University (Tomita), Wenzhou, China; Storm Eye Institute (Waring), Medical University of South Carolina, and Magill Vision Center (Waring), Charleston, South Carolina, USA
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Brenner LF, Alió JL, Vega-Estrada A, Baviera J, Beltrán J, Cobo-Soriano R. Indications for intrastromal corneal ring segments in ectasia after laser in situ keratomileusis. J Cataract Refract Surg 2012; 38:2117-24. [DOI: 10.1016/j.jcrs.2012.07.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 06/20/2012] [Accepted: 07/17/2012] [Indexed: 11/17/2022]
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Nita M, Strzałka-Mrozik B, Grzybowski A, Romaniuk W, Mazurek U. Ophthalmic transplantology: anterior segment of the eye - part I. Med Sci Monit 2012; 18:RA64-72. [PMID: 22534721 PMCID: PMC3560631 DOI: 10.12659/msm.882723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Transplantology is a quickly developing field of ophthalmology. It currently is able to treat many inherited, degenerative, inflammatory, traumatic, and cancerous diseases. This review outlines recent concepts and methods of treating ocular diseases with tissue and cell grafts. Ocular transplants related to the anterior part of the eye, including the conjunctiva and the cornea, are reviewed in Part 1. Material/Methods The scientific literature dated from January 2005 to July 2011 was thoroughly searched using Medline and PubMed. Publications dated 2009, 2010, and 2011 were analyzed in detail. Search terms were as follows: auto-, homo-, heterologous transplantation, eyeball, ocular adnexa, anterior segment of the eye, cornea, lamellar keratoplasty, stem cells, cultured cells. Further data were found at the website of the Eye Bank Association of America. Results Nearly all tissues of the anterior segment of the eye (the conjunctiva, sclera, eye muscles, and cornea) are transplanted. Because of the recent significant progress in the field, cornea transplantation was analyzed in more detail, specifically procedures such as limbus grafts and anterior and posterior lamellar keratoplasty. Indications, advantages, and drawbacks of the transplant techniques were also reviewed. Conclusions Recent progress in the field of cornea transplants allows treatment at the level of the endothelium and the use of cultured limbal epithelial stem cell grafts. However, compared with previous techniques, modern and multilayered transplant techniques of the cornea require much more expertise and longer training of the surgeon, as well as expensive and technologically advanced equipment. The availability of donor tissue is still the main limitation affecting all transplants. Therefore, cell culturing techniques such as stem cells, as well as artificial cornea projects, seem to be very promising.
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Affiliation(s)
- Małgorzata Nita
- Domestic and Specialized Medicine Centre Dilmed, Katowice, Poland
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