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Parafita-Fernandez A, Garcia-Gonzalez M, Gros-Otero J, Alvarez-Rementería Capelo L, Blázquez Sánchez V, Teus M. Evolution of visual acuity, flap thickness, and optical density after laser in situ keratomileusis performed with a femtosecond laser. J Cataract Refract Surg 2021; 46:260-266. [PMID: 32126040 DOI: 10.1097/j.jcrs.0000000000000008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the postoperative evolution of visual acuity, flap morphology, and stromal optical density femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). SETTING Clínica Rementería, Madrid, Spain. DESIGN Prospective case series. METHODS The study comprised 44 consecutive eyes that had FS-LASIK performed with the WaveLight FS200 and the Allegretto excimer laser to correct myopia. Visual outcomes, flap thickness, and stromal optical density were assessed 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS A statistically significant improvement in the mean uncorrected distance visual acuity at 1 day (0.94 ± 0.2) and 1 week (0.93 ± 0.2) to 1 month (1.04 ± 0.2) and 3 months (1.11 ± 0.1) postoperatively (P < .05). At 3 months postoperatively, the femtosecond laser had good outcomes in efficacy (0.98 ± 0.1), safety (0.98 ± 0.1), and predictability (100% of eyes were within ± 0.5 D of emmetropia). The femtosecond-created flaps were slightly thicker than intended, the mean SD intraflap was 7.1 μm, the range between the thickest and thinnest points in each flap was 25.4 μm, and the mean flap thickness homogeneity was 7.6 μm at 3 months postoperatively. A progressive decrease in the optical density of the flap stroma and the residual stromal bed was detected during follow-up. CONCLUSIONS The femtosecond laser study appears to be a safe, effective, and predictable platform to obtain LASIK flaps. The flaps were planar and homogeneous but slightly thicker than intended. The optical density of the flap stroma was slightly higher at early follow-up and decreased over time.
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Affiliation(s)
- Alberto Parafita-Fernandez
- From Complexo Hospitalario Universitario de Pontevedra (Parafita-Fernandez), Pontevedra, Clínica Oftalmológica Dr Parafita (Parafita-Fernandez), Ribeira, Clínica Rementería (Garcia-Gonzalez, Gros-Otero, Alvarez-Rementería Capelo; Blázquez Sánchez), Madrid, Clínica Novovisión (Garcia-Gonzalez, Teus), Madrid, Universidad Europea de Madrid (Garcia-Gonzalez), Madrid, Universidad Complutense de Madrid, Madrid (Blázquez Sánchez), and Hospital Universitario Príncipe de Asturias, University of Alcalá (Teus), Alcalá de Henares, Madrid, Spain
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Doga AV, Mushkova IA, Karimova AN, Kechin EV. [Clinical and functional outcomes of correcting low to moderate myopia with FemtoLASIK performed with Russian and Swiss femtolaser platforms]. Vestn Oftalmol 2019; 135:13-23. [PMID: 31714508 DOI: 10.17116/oftalma201913505113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the effectiveness, safety, predictability and stability of FemtoLASIK procedure in low to moderate myopia using Femto Visum and Femto LDV Z6 femtosecond laser platforms and to evaluate the effect of these procedures on corneal higher-order aberrations. MATERIAL AND METHODS Russian femtolaser platform (1 MHz) was used to form the corneal flap in the main group consisting of 98 patients (98 eyes) with mean spherical equivalent (SE) of -3.73±1.42 D. Swiss femtolaser platform (5 MHz) was used in the control group (94 patients, 94 eyes; mean SE -3.81±1.44 D). Excimer laser ablation was performed using the Russian platform (500 Hz) in both groups. All patients underwent complete ophthalmological examination. The follow-up period was 12 months. RESULTS Twelve month postoperatively, in the '1 MHz' group uncorrected visual acuity (UCVA) of 1.0 or better was achieved in 91.8% of patients, and in the '5 MHz' group - in 90.4% (p>0.05). There were no registered losses of 2 or more lines of best-corrected visual acuity (BCVA) in either group. In the '1 MHz' group, predictability of targeted refraction within ±0.5 D was achieved in 91.8% of patients, within ±1.0 D - in 99.0%; in the '5 MHz' group - in 91.5% and 98.9% of patients, respectively (p>0.05). Root-mean-square (RMS) deviation of corneal higher-order aberrations in the 6-mm optical zone was increased by 0.072 μm (by 1.21 times) and by 0.077 μm (by 1.22 times) in the '1 MHz' and '5 MHz' groups (p>0.05), respectively. CONCLUSION The FemtoLASIK procedures performed using Russian (1 MHz) and Swiss (5 MHz) femtosecond laser platforms are effective, safe, predictable, have stable postoperative visual and refractive outcomes, and lead to increase in RMS of corneal higher-order aberrations using both platforms in patients with low to moderate myopia. There were no statistically significant differences between the two femtolaser platforms (p>0.05) for all examined parameters.
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Affiliation(s)
- A V Doga
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - I A Mushkova
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - A N Karimova
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - E V Kechin
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
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Niparugs M, Tananuvat N, Chaidaroon W, Tangmonkongvoragul C, Ausayakhun S. Outcomes of LASIK for Myopia or Myopic Astigmatism Correction with the FS200 Femtosecond Laser and EX500 Excimer Laser Platform. Open Ophthalmol J 2018; 12:63-71. [PMID: 29872485 PMCID: PMC5960747 DOI: 10.2174/1874364101812010063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/28/2018] [Accepted: 04/25/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the efficacy, predictability, stability and safety of laser in situ keratomileusis (LASIK) using the FS200 femtosecond laser and EX500 excimer laser platform. Methods: The outcomes of 254 eyes of 129 consecutive patients with myopia or myopic astigmatism who underwent full correction femtosecond laser-assisted LASIK at CMU LASIK Center were assessed. Pre-operative and post-operative parameters including manifest refraction, Uncorrected Distance Visual Acuity (UDVA), Best Corrected Distance Visual Acuity (BDVA), corneal topography and tomography were analyzed. The results between low to moderate myopia and high myopia were compared up to 12 months. Results: Mean pre-operative Spherical Equivalent (SE) was -5.15±2.41 Diopters (D) (range -0.50 to -11.50 D) and -0.13±0.28 D, -0.13±0.27 D, -0.13±0.28 D and -0.14±0.30 D at 1, 3, 6, and 12 months, post-operatively. At 12 months, the propor¬tion of eyes achieving UDVA ≥ 20/20 was 90.0% and ≥20/40 was 98.8%. The proportion of eyes achieving post-operative mean SE ±0.5 D, and ±1 D was 91.3%, and 98.5%. No eyes lost more than two lines of BDVA. The low to moderate myopic group had a statistically significant better UDVA at one (p=0.017) and three months (p=0.014) but no difference at six (p=0.061) and 12 months (p=0.091). The mean post-operative SE was better in low to moderate myopic group at every follow-up visit (p=0.001, 0.007, <0.001 and <0.001). Conclusion: One-year clinical results of LASIK with the FS200 femtosecond laser and EX500 excimer laser showed high efficacy, predictability, stability and safety.
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Affiliation(s)
- Muanploy Niparugs
- Chiang Mai University LASIK Center, Center for Medical Excellence, and Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napaporn Tananuvat
- Chiang Mai University LASIK Center, Center for Medical Excellence, and Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Winai Chaidaroon
- Chiang Mai University LASIK Center, Center for Medical Excellence, and Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chulaluck Tangmonkongvoragul
- Chiang Mai University LASIK Center, Center for Medical Excellence, and Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somsanguan Ausayakhun
- Chiang Mai University LASIK Center, Center for Medical Excellence, and Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Zhang J, Zhou YH, Zheng Y, Liu Q. Comparison of visual performance recovery after thin-flap LASIK with 4 femtosecond lasers. Int J Ophthalmol 2017; 10:1566-1572. [PMID: 29062777 DOI: 10.18240/ijo.2017.10.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 07/11/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the speed of visual recovery following myopic thin-flap LASIK with four femtosecond lasers. METHODS Eighty-eight eyes of 46 patients who were consecutively scheduled for bilateral LASIK with the IntraLase FS60 (Group 1), Femto LDV Crystal Line (Group 2), Wavelight FS200 (Group 3) and VisuMax (Group 4) femtosecond lasers were enrolled in. Monocular uncorrected distance visual acuity (UDVA), best-corrected distant visual acuity (CDVA), refraction, contrast sensitivity and higher-order aberrations (HOAs) were evaluated at 1, 3d, 1wk and 1mo postoperatively. RESULTS Sixteen eyes (72.7%) achieved 20/16 and 8 eyes (36.4%) were 20/12.5 at 1d in Group 2, which was significantly more than other 3 groups. At 1wk, 20 eyes (90.9%) achieved 20/16 in Groups 2 and 4. At 1mo, 20 eyes (90.9%) achieved 20/16 in Group 2 and Group 4, which were significantly more than other two groups. While by 1 mo, the difference of the residual spherical equivalent (SE) was not statistically significant among 4 groups (P=0.121). The induction of spherical aberration (SA) were significantly less for Groups 2, 3, 4 than for Group 1 one day after surgery (P=0.015). The differences among 4 groups were not statistically significant before and after surgery on every time points (all P>0.05). CONCLUSION The thin-flap LASIK procedure using the Femto LDV Crystal Line and VisuMax femtosecond laser show faster visual performance recovery.
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Affiliation(s)
- Jing Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yue-Hua Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yan Zheng
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qian Liu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Mifflin MD, Mortensen XM, Betts BS, Gross C, Zaugg B. Accuracy of Alcon WaveLight ® EX500 optical pachymetry during LASIK. Clin Ophthalmol 2017; 11:1513-1517. [PMID: 28860701 PMCID: PMC5566874 DOI: 10.2147/opth.s138459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the accuracy and reliability of optical pachymetry using the Alcon WaveLight EX500 during laser-assisted in situ keratomileusis (LASIK). Materials and methods This was a retrospective chart review of 90 eyes from 45 patients who had undergone LASIK (mean age 35.2±8.2 years; 19 males, 26 females). The WaveLight FS200 femtosecond laser was programmed to cut LASIK flaps at a desired depth of 120 μm. Optical low-coherence reflectometry (WaveLight EX500) was used to measure central corneal thickness prior to lifting the flap, and the residual stromal bed immediately after excimer ablation. Flap thickness (FT) was calculated using simple subtraction. Optical coherence tomography (OCT) was used to measure central corneal thickness, flap thickness, and residual stromal bed in the postoperative period and the results compared to intraoperative measurements. Results Mean programmed FS200 FT was 119 μm. Mean FT using EX500 optical pachymetry was 109 μm. The difference between FS200- programmed and EX500-measured FT was 9 μm (P<0.001). There was also a significant difference between the EX500 and OCT FT (109 μm vs 119 μm, respectively; P<0.001). Conclusion FT values calculated using intraoperative EX500 optical pachymetry were significantly lower than programmed FS200 values or OCT measurements.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Xavier M Mortensen
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brent S Betts
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Cole Gross
- University of Nevada School of Medicine, Reno, NV, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
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Huhtala A, Pietilä J, Mäkinen P, Uusitalo H. Femtosecond lasers for laser in situ keratomileusis: a systematic review and meta-analysis. Clin Ophthalmol 2016; 10:393-404. [PMID: 27022236 PMCID: PMC4788361 DOI: 10.2147/opth.s99394] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to review and meta-analyze whether there are differences between reported femtosecond (FS) lasers for laser-assisted in situ keratomileusis (LASIK) in terms of efficacy, predictability, and safety as primary outcomes and corneal flap thickness measurements and pre- and postoperative complications as secondary outcomes. Methods A comprehensive literature search of PubMed, Science Direct, Scopus, and Cochrane CENTRAL Trials Library databases was conducted to identify the relevant prospective randomized controlled trials of FS lasers for LASIK. Thirty-one articles describing a total of 5,404 eyes were included. Results Based on efficacy, IntraLase FS 10 and 30 kHz gave the best results. Based on predictability and safety, there were no differences between various FS lasers. FEMTO LDV and IntraLase FS 60 kHz produced the most accurate flap thicknesses. IntraLase and Wavelight SF200 had the fewest intraoperative complications. IntraLase, Visumax, and Wavelight FS200 had the most seldom postoperative complications. Conclusion There were dissimilarities between different FS lasers based on efficacy and intraoperative and postoperative complications. All FS lasers were predictable and safe for making corneal flaps in LASIK.
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Affiliation(s)
- Anne Huhtala
- Silmäasema Eye Hospital, School of Medicine, School of Medicine, University of Tampere, Tampere, Finland
| | - Juhani Pietilä
- Silmäasema Eye Hospital, School of Medicine, School of Medicine, University of Tampere, Tampere, Finland; SILK, Department of Ophthalmology, School of Medicine, University of Tampere, Tampere, Finland
| | - Petri Mäkinen
- Silmäasema Eye Hospital, School of Medicine, School of Medicine, University of Tampere, Tampere, Finland; SILK, Department of Ophthalmology, School of Medicine, University of Tampere, Tampere, Finland
| | - Hannu Uusitalo
- Silmäasema Eye Hospital, School of Medicine, School of Medicine, University of Tampere, Tampere, Finland; SILK, Department of Ophthalmology, School of Medicine, University of Tampere, Tampere, Finland; TAUH Eye Center, Tampere University Hospital, Tampere, Finland
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Tomida D, Yamaguchi T, Ogawa A, Hirayama Y, Shimazaki-Den S, Satake Y, Shimazaki J. Effects of corneal irregular astigmatism on visual acuity after conventional and femtosecond laser-assisted Descemet's stripping automated endothelial keratoplasty. Jpn J Ophthalmol 2015; 59:216-22. [PMID: 26028117 DOI: 10.1007/s10384-015-0388-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare short-term outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) using a graft prepared with either a femtosecond laser or a microkeratome. METHODS Thirty-eight patients underwent DSAEK with grafts prepared with either a femtosecond laser (f-DSAEK; 21 eyes) or a microkeratome (m-DSAEK; 17 eyes). Visual acuity, endothelial cell density, regular astigmatism and irregular astigmatism were compared between the two groups preoperatively and at 1, 3, and 6 months post-operatively. Fourier analysis was conducted to calculate astigmatism of the anterior and posterior surfaces, and total cornea, using anterior segment optical coherence tomography (AS-OCT). RESULTS Visual acuity (logMAR) improved from 1.20 ± 0.60 to 0.43 ± 0.25 after m-DSAEK (P < 0.001) and from 1.20 ± 0.57 to 0.77 ± 0.33 after f-DSAEK (P = 0.0028) at 6 months following DSAEK. Visual acuity after m-DSAEK was significantly better than after f-DSAEK at 1, 3, and 6 months (P < 0.05). AS-OCT corneal images revealed greater irregularities on the posterior surfaces of f-DSAEK grafts compared to m-DSAEK grafts. Irregular astigmatism of the total cornea and the posterior surface was significantly larger after f-DSAEK than after m-DSAEK, although there was no significant difference in irregular astigmatism of the anterior surface at 6 months. Postoperative visual acuity was significantly correlated with the postoperative irregular astigmatism of the total cornea (r = 0.6657 and P < 0.001) and the anterior (r = 0.416, P = 0.016) and posterior surfaces (r = 0.7046, P < 0.001). CONCLUSIONS Visual outcomes after f-DSAEK were poor compared to conventional m-DSAEK due to an increase in irregular astigmatism caused by posterior surface irregularities.
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Affiliation(s)
- Daisuke Tomida
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
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Maus M, Fawzy N, Pei R. Retrospective analysis of femtosecond laser flap accuracy in patients having LASIK. J Cataract Refract Surg 2014; 40:2158-60. [PMID: 25465693 DOI: 10.1016/j.jcrs.2014.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Indexed: 11/17/2022]
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Kymionis GD, Tsoulnaras KI, Tsakalis NG, Grentzelos MA. Diffuse lamellar keratitis in the femtosecond-assisted LASIK flap tunnel. Clin Ophthalmol 2014; 8:1065-7. [PMID: 24940043 PMCID: PMC4051804 DOI: 10.2147/opth.s64253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Here we report a case of a 29-year-old myopic female who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) and, on the first postoperative day slit-lamp examination revealed a dense, white, granular reaction with the presence of some blood droplets (stage I diffuse lamellar keratitis [DLK]) in her left eye, specifically localized into the femtosecond LASIK flap tunnel (not extended to the flap interface). The patient received intensive treatment with topical corticosteroids and 5 days later the granular reaction had completely resolved. A new site of DLK, ie, the flap tunnel, in femtosecond-assisted LASIK is presented. DLK into the flap tunnel could be managed with corticosteroids if detected early, without affecting the flap interface.
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Affiliation(s)
- George D Kymionis
- Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece ; Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Konstantinos I Tsoulnaras
- Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos G Tsakalis
- Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Michael A Grentzelos
- Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
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