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Feng Y, He R, Qu M, Ma Q, Tian H. Sub-Bowman keratomileusis versus femtosecond laser in situ keratomileusis on the long-term visual recovery: A comparative study. Indian J Ophthalmol 2023; 71:1899-1903. [PMID: 37203052 PMCID: PMC10391504 DOI: 10.4103/ijo.ijo_1543_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To explore the long-term visual quality of the same subjects after sub-Bowman keratomileusis (SBK) or femtosecond laser in situ keratomileusis (FS-LASIK). Methods This prospective study included patients screened for corneal refractive surgery at the Refractive Surgery Center of our Hospital between November 2017 and March 2018. One eye underwent SBK, while the other eye underwent FS-LASIK. Total higher-order aberrations, coma aberrations, and clover aberrations were evaluated before and at 1 month and 3 years after the procedure. The visual satisfaction of both eyes was investigated, respectively. The participants completed a surgical satisfaction questionnaire. Results Thirty-three patients were included. There were no significant differences in total higher-order aberrations, coma aberrations, and clover aberrations between the two procedures before and 1 month and 3 years after surgery (all P > 0.05), except for the total coma aberrations in FS-LASIK were significantly higher compared with the SBK group at 1 month after surgery [0.51 (0.18, 0.93) vs. 0.77 (0.40, 1.22), P = 0.019]. The surgical satisfaction questionnaire scores of the SBK group and the FS-LASIK group were 9.8 ± 0.8 and 9.8 ± 0.8, respectively, at 1 month, and 9.7 ± 0.9 and 9.7 ± 1.0, respectively, at 3 years (all P > 0.05). Conclusion There were no differences in corneal aberrations and satisfaction between SBK and FS-LASIK procedures at 1 month and 3 years.
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Affiliation(s)
- Yi Feng
- Shanxi Eye Hospital, Shanxi Eye Hospital, Taiyuan, China
| | - Rui He
- Shanxi Eye Hospital, Shanxi Eye Hospital, Taiyuan, China
| | - Min Qu
- Shanxi Eye Hospital, Shanxi Eye Hospital, Taiyuan, China
| | - Qiuxia Ma
- Shanxi Eye Hospital, Shanxi Eye Hospital, Taiyuan, China
| | - Huiqin Tian
- Shanxi Eye Hospital, Shanxi Eye Hospital, Taiyuan, China
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Yusef YN, Ermakova SV, Sheludchenko VM, Alkharki L. [Complications of femto-LASIK and features of cavitation injuries]. Vestn Oftalmol 2023; 139:119-125. [PMID: 37379118 DOI: 10.17116/oftalma2023139031119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Modern approach to refractive laser surgery features three main types of lamellar surgery. Two of them are types of open laser keratomileusis (LASIK and femtosecond laser-assisted LASIK), and the third - closed (SMILE). All of these techniques allow achieving good clinical outcomes but differ in possible complications. This article reviews the complications of femto-LASIK and specifically the post-operative cavitation injuries, describes the mechanism of their occurrence, variants of their course, and presents the prevention measures.
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Affiliation(s)
- Yu N Yusef
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S V Ermakova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | | | - L Alkharki
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Dan TT, Liu TX, Liao YL, Li ZZ. Delayed diffuse lamellar keratitis after small-incision lenticule extraction related to immunoglobulin A nephropathy: A case report. World J Clin Cases 2022; 10:4131-4136. [PMID: 35665110 PMCID: PMC9131215 DOI: 10.12998/wjcc.v10.i13.4131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/09/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffuse lamellar keratitis (DLK) is a complication of laser-assisted in situ keratomileusis (LASIK). This condition can also develop after small-incision lenticule extraction (SMILE) with a distinctive appearance. We report the case involving a female patient with delayed onset DLK accompanied by immunoglobulin A (IgA) nephropathy.
CASE SUMMARY A 22-year-old woman was referred to our department for DLK and a decline in vision 1 mo after undergoing SMILE. The initial examination showed grade 2 DLK in the flap involving the central visual axis of the right eye. She was immediately administered with a large dose of a topical steroid for 30 d. However, the treatment was ineffective. Her vision deteriorated from 10/20 to 6/20, and DLK gradually worsened from grade 2 to 4. Eventually, interface washout was performed, after which her vision improved. DLK completely disappeared 2 mo after washout. Six months after SMILE, the patient was diagnosed with IgA nephropathy due to a 4-year history of interstitial hematuria.
CONCLUSION DLK is a typical complication of LASIK but can also develop after SMILE. Topical steroid therapy was ineffective in our patient, and interface washout was required. IgA nephropathy could be one of the factors contributing to the development of delayed DLK after SMILE.
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Affiliation(s)
- Ting-Ting Dan
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Tai-Xiang Liu
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Yi-Lu Liao
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Zong-Ze Li
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Update and Review of Diagnosis and Management of Post-Refractive Surgery Ectasia. J Cataract Refract Surg 2021; 48:487-499. [PMID: 34486581 DOI: 10.1097/j.jcrs.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Post-Refractive Surgery Ectasia is a serious, sight-threatening, and highly - avoided complication seen after the following procedures: Laser in situ Keratomileusis, Photorefractive Keratectomy, Small Incision Lenticule Extraction, Radial and/or Arcuate Keratotomy. Specific risk factors may include age, corneal thickness, degree of refractive error, corneal topographic changes including irregular astigmatism, percent tissue ablation, and residual stromal bed. Biomarkers may be a new option to help indicate who is at greatest risk for ectasia. Visual aids including glasses or contacts lenses are often required to achieve optimal vision. Collagen crosslinking is the only treatment thought to stop progression of ectasia and prevent keratoplasty. Other surgical options may include topography-guided phototherapeutic keratectomy and intrastromal corneal ring segments. Ultimately an "ounce of prevention is a pound of cure" so careful preoperative screening and ultimately offering the safest and most effective treatments for patients is arguably the most important job of the refractive surgeon.
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Kahuam-López N, Navas A, Castillo-Salgado C, Graue-Hernandez EO, Jimenez-Corona A, Ibarra A. Laser-assisted in-situ keratomileusis (LASIK) with a mechanical microkeratome compared to LASIK with a femtosecond laser for LASIK in adults with myopia or myopic astigmatism. Cochrane Database Syst Rev 2020; 4:CD012946. [PMID: 32255519 PMCID: PMC7137867 DOI: 10.1002/14651858.cd012946.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Laser-assisted in-situ keratomileusis (LASIK) is a surgical procedure that corrects refractive errors. This technique creates a flap of the outermost parts of the cornea (epithelium, bowman layer, and anterior stroma) to expose the middle part of the cornea (stromal bed) and reshape it with excimer laser using photoablation. The flaps can be created by a mechanical microkeratome or a femtosecond laser. OBJECTIVES To compare the effectiveness and safety of mechanical microkeratome versus femtosecond laser in LASIK for adults with myopia. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 2); Ovid MEDLINE; Embase; PubMed; LILACS; ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions. We searched the reference lists of included trials. We searched the electronic databases on 22 February 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) of LASIK with a mechanical microkeratome compared to a femtosecond laser in people aged 18 years or older with more than 0.5 diopters of myopia or myopic astigmatism. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 16 records from 11 trials enrolling 943 adults (1691 eyes) with spherical or spherocylindrical myopia, who were suitable candidates for LASIK. Five hundred and forty-seven participants (824 eyes) received LASIK with a mechanical microkeratome and 588 participants (867 eyes) with a femtosecond laser. Each trial included between nine and 360 participants. In six trials, the same participants received both interventions. Overall, the trials were at an uncertain risk of bias for most domains. At 12 months, data from one trial (42 eyes) indicates no difference in the mean uncorrected visual acuity (logMAR scale) between LASIK with a mechanical microkeratome and LASIK with a femtosecond laser (mean difference (MD) -0.01, 95% confidence interval (CI) -0.06 to 0.04; low-certainty evidence). Similar findings were observed at 12 months after surgery, regarding participants achieving 0.5 diopters within target refraction (risk ratio (RR) 0.97, 95% CI 0.85 to 1.11; 1 trial, 79 eyes; low-certainty evidence) as well as mean spherical equivalent of the refractive error 12 months after surgery (MD 0.09, 95% CI -0.01 to 0.19; 3 trials, 168 eyes [92 participants]; low-certainty evidence). Based on data from three trials (134 eyes, 66 participants), mechanical microkeratome was associated with lower risk of diffuse lamellar keratitis compared with femtosecond laser (RR 0.27, 95% CI 0.10 to 0.78; low-certainty evidence). Thus, diffuse lamellar keratitis was a more common adverse event with femtosecond laser than with mechanical microkeratome, decreasing from an assumed rate of 209 per 1000 people in the femtosecond laser group to 56 per 1000 people in the mechanical microkeratome group. Data from one trial (183 eyes, 183 participants) indicates that dry eye as an adverse event may be more common with mechanical microkeratome than with femtosecond laser, increasing from an assumed rate of 80 per 1000 people in the femtosecond laser group to 457 per 1000 people in the mechanical microkeratome group (RR 5.74, 95% CI 2.92 to 11.29; low-certainty evidence). There was no evidence of a difference between the two groups for corneal haze (RR 0.33, 95% CI 0.01 to 7.96; 1 trial, 43 eyes) and epithelial ingrowth (RR 1.04, 95% CI 0.11 to 9.42; 2 trials, 102 eyes [50 participants]). The certainty of evidence for both outcomes was very low. AUTHORS' CONCLUSIONS Regarding the visual acuity outcomes, there may be no difference between LASIK with mechanical microkeratome and LASIK with femtosecond laser. Dry eye and diffuse lamellar keratitis are likely adverse events with mechanical microkeratome and femtosecond laser, respectively. The evidence is uncertain regarding corneal haze and epithelial ingrowth as adverse events of each intervention. The limited number of outcomes reported in the included trials, some with potentially significant risk of bias, makes it difficult to draw a firm conclusion regarding the effectiveness and safety of the interventions investigated in this review.
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Affiliation(s)
- Nicolás Kahuam-López
- Universidad Anáhuac México, Campus Norte, Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Av. Universidad Anáhuac 46, Huixquilucan, Mexico, Mexico, 52786
- Instituto de Oftalmología Fundación Conde de Valenciana, Cornea and Refractive Surgery Department, Chimalpopoca 14, Mexico City, Mexico City, Mexico, 06800
| | - Alejandro Navas
- Instituto de Oftalmología Fundación Conde de Valenciana, Cornea and Refractive Surgery Department, Chimalpopoca 14, Mexico City, Mexico City, Mexico, 06800
| | - Carlos Castillo-Salgado
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Room E-6136, Baltimore, Maryland, USA, 21205
| | - Enrique O Graue-Hernandez
- Instituto de Oftalmología Fundación Conde de Valenciana, Cornea and Refractive Surgery Department, Chimalpopoca 14, Mexico City, Mexico City, Mexico, 06800
| | - Aida Jimenez-Corona
- Instituto de Oftalmología Fundación Conde de Valenciana, Ocular Epidemiology and Visual Sciences Department, Chimalpopoca 14 Col Obrera del Cuauhtemoc, Mexico City, Mexico, 06800
| | - Antonio Ibarra
- Universidad Anáhuac México, Campus Norte, Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Av. Universidad Anáhuac 46, Huixquilucan, Mexico, Mexico, 52786
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Abstract
PURPOSE OF REVIEW To review the efficacy of intrastromal corneal ring segments (ICRS) for keratoconus and with other interventions such as contacts lens, keratoplasty, and corneal collagen cross-linking. RECENT FINDINGS Changes in ICRS thickness and size, combination of procedures, and the adaptation of a more sophisticated classification system have broadened our application of ICRS. Recent studies have shown the long-term efficacy of ICRS in visual acuity, keratometry, and astigmatism. SUMMARY Studies have demonstrated the short-term and long-term efficacy of ICRS implantation in patients with keratoconus.
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Pajic B, Vastardis I, Pajic-Eggspuehler B, Gatzioufas Z, Hafezi F. Femtosecond laser versus mechanical microkeratome-assisted flap creation for LASIK: a prospective, randomized, paired-eye study. Clin Ophthalmol 2014; 8:1883-9. [PMID: 25284975 PMCID: PMC4181739 DOI: 10.2147/opth.s68124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare a femtosecond laser with a microkeratome for flap creation during laser in situ keratomileusis (LASIK) in terms of flap thickness predictability and visual outcomes. Patients and methods This was a prospective, randomized, masked, paired-eye study. Forty-four patients (34 females) who received bilateral LASIK were included. Patients were stratified by ocular dominance, and they then underwent randomization of flap creation using the femtosecond laser on one eye and undergoing the microkeratome procedure on the other one. The visual outcome differences between the corrected distance visual acuity (CDVA) at baseline and the uncorrected distance visual acuity (UDVA) on the first day postoperatively were set as the efficiency index for both groups. All visual acuity outcome results and the deviation of flap thickness were evaluated. P-values <0.05 were considered statistically significant. Results The index of efficiency regarding the postoperative visual outcomes in the microkeratome group was lower (P<0.0001). This result was correlated with the difference between intended and achieved flap thickness (P=0.038; r=0.28), and a negative relationship in the regression analysis was confirmed (P<0.04; R2=0.1428). The UDVA in the microkeratome group improved significantly by the end of the first month (P<0.0271) in comparison to the baseline CDVA. The deviation between intended and postoperative flap thickness using either optical coherence pachymetry or Heidelberg Retinal Tomography II confocal microscopy was statistically significant (paired t-test; P<0.001) between the groups. The flap thickness deviation in the microkeratome group was higher. In the femtosecond laser group, the efficiency index was stable postoperatively (P=0.64) The UDVA improved significantly by the end of the first postoperative week (P=0.0043) in comparison to the baseline CDVA. Six months after surgery, improvement in the UDVA was significant in both groups (all P<0.001; one way analysis of variance). Conclusion Femtosecond laser was superior to microkeratome-assisted LASIK in terms of flap thickness predictability and the speed of visual acuity recovery. A negative relationship in the regression analysis between increasing flap thickness deviation and visual acuity recovery was confirmed.
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Affiliation(s)
- Bojan Pajic
- Swiss Eye Research Foundation, Eye Clinic ORASIS, Reinach, Switzerland ; Division of Ophthalmology, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland ; Eye Hospital VIDAR-ORASIS Swiss, University of Novi Sad, Faculty of Physics, Novi Sad, Serbia ; Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Iraklis Vastardis
- Swiss Eye Research Foundation, Eye Clinic ORASIS, Reinach, Switzerland ; Eye Hospital VIDAR-ORASIS Swiss, University of Novi Sad, Faculty of Physics, Novi Sad, Serbia
| | | | - Zisis Gatzioufas
- Division of Ophthalmology, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Farhad Hafezi
- Division of Ophthalmology, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland ; Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Zhang YL, Liu L, Cui CX, Hu M, Li ZN, Cao LJ, Jing XH, Mu GY. Comparative study of visual acuity and aberrations after intralase femtosecond LASIK: small corneal flap versus big corneal flap. Int J Ophthalmol 2013; 6:641-5. [PMID: 24195040 DOI: 10.3980/j.issn.2222-3959.2013.05.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 07/24/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To study the effect of different flap sizes on visual acuity, refractive outcomes, and aberrations after femtosecond laser for laser in situ keratomileusis (LASIK). METHODS In each of the forty patients enrolled, 1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap, defined as the small flap, while the other eye was treated with a 8.6mm diameter corneal flap, defined as the big flap. Refractive errors, visual acuity, and higher-order aberrations were compared between the two groups at week 1, month 1 and 3 postoperatively. RESULTS The postoperative refractive errors and visual acuity all conformed to the intended goal. Postoperative higher-order aberrations were increased, especially in spherical aberration (Z12) and vertical coma (Z7). There were no statistically significant differences between the two groups in terms of postoperative refractive errors, visual acuity, root mean square of total HOAs (HO-RMS), trefoil 30° (Z6), vertical coma (Z7), horizontal coma (Z8), trefoil 0° (Z9), and spherical aberration (Z12) at any point during the postoperative follow-up. CONCLUSION Both the small and big flaps are safe and effective procedures to correct myopia, provided the exposure stroma meets the excimer laser ablations. The personalized size corneal flap is feasible, as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error.
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Affiliation(s)
- Ya-Li Zhang
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwuweiqi Road, Jinan 250021, Shandong Province, China ; Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan 250001, Shandong Province, China
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Wang Y, Li J, Liu Y, Xie L. Intraocular Straylight After Thin-Flap LASIK With a Femtosecond Laser Versus a Mechanical Microkeratome. J Refract Surg 2013; 29:534-9. [DOI: 10.3928/1081597x-20130719-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 04/18/2013] [Indexed: 11/20/2022]
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Mayer WJ, Grueterich M, Wolf AH, Lackerbauer CA, Eibl K, Kampik A, Kook D. Corneal cell response after flap creation using a mechanical microkeratome or a 200 kHz femtosecond laser. J Cataract Refract Surg 2013; 39:1088-92. [DOI: 10.1016/j.jcrs.2013.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/13/2012] [Accepted: 01/04/2013] [Indexed: 10/26/2022]
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Zhang Y, Chen YG, Xia YJ. Comparison of corneal flap morphology using AS-OCT in LASIK with the WaveLight FS200 femtosecond laser versus a mechanical microkeratome. J Refract Surg 2013; 29:320-4. [PMID: 23659230 DOI: 10.3928/1081597x-20130415-03] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 02/26/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate and compare the thickness and the morphology of femtosecond and mechanical microkeratome LASIK flaps using anterior segment optical coherence tomography (AS-OCT). METHODS Bilateral LASIK was performed in 132 eyes from 61 myopic patients. Flaps were created in 72 eyes using the WaveLight FS200 femtosecond laser (Wave-Light GmbH, Erlangen, Germany) and in 50 eyes using the Moria microkeratome (Moria SA, Antony, France). AS-OCT was used 1 week postoperatively to evaluate the thickness of 17 points across each flap, which were 0, 2, and 3.5 mm to the corneal vertex on the horizontal, vertical, 45°, and 135° meridians. RESULTS The mean central flap thickness was 105.53 ± 5.86 μm in the WaveLight group and 132.96 ± 13.91 μm in the Moria group (P < .001). The difference between the achieved and the intended flap thickness (accuracy) was 6.17 ± 3.98 and 23.60 ± 12.64 μm, respectively (P < .001). The standard deviation within individual flap (uniformity) was smaller in the WaveLight group. The symmetry and regularity were also better in the WaveLight group. Flap morphology showed a more regular planar shape in the WaveLight group and a meniscus shape in the Moria group. CONCLUSIONS AS-OCT showed that the flaps created by the WaveLight femtosecond laser were more accurate, reproducible, and uniform than those created by the Moria microkeratome.
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Affiliation(s)
- Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
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