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Alonso-Santander N, Ortega-Usobiaga J, Beltrán-Sanz J, Druchkiv V, Llovet-Osuna F, Baviera-Sabater J. Laser in situ keratomileusis and surface ablation in pregnancy. J Fr Ophtalmol 2023; 46:114-122. [PMID: 36670012 DOI: 10.1016/j.jfo.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Although corneal refractive surgery is contraindicated during pregnancy, some patients are unaware that they are pregnant when they undergo surgery. Our objectives were to determine the functional outcomes of corneal refractive surgery during pregnancy and to compare the results with those of nonpregnant women. METHODS We performed a multicenter, retrospective, interventional case series review of patients who were pregnant and who underwent laser in situ keratomileusis (LASIK) or surface ablation (photorefractive keratectomy, PRK) from September 11, 2002 to December 12, 2020 (group 1, n=82 eyes). Patients were included consecutively. Findings were compared with those of nonpregnant women (group 2, n=164 eyes). Functional (visual and refractive) outcomes are described. Follow-up was at least 550 days (control group, median [IQR], 990 days [715-1496]; study group, 895 days [709-1310]). The setting was Clínica Baviera, Spain, (AIER Eye Hospital Group). RESULTS A statistically significant difference was found between the groups in terms of efficacy index (EI). No complications of pregnancy or labor were reported. Similarly, a search of medical records revealed no adverse effects in the infants. CONCLUSIONS To the best of our knowledge, this is the first case series on pregnancy and refractive surgery. We do not recommend performing LASIK or surface ablation on pregnant women. Our objective in the present study was to present relevant scientific data obtained from women who underwent refractive surgery while unaware that they were pregnant.
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Affiliation(s)
| | | | - J Beltrán-Sanz
- Clínica Baviera, (AIER Eye Hospital Group), Burgos, Spain
| | - V Druchkiv
- Clínica Baviera, (AIER Eye Hospital Group), Burgos, Spain
| | - F Llovet-Osuna
- Clínica Baviera, (AIER Eye Hospital Group), Burgos, Spain
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Moshirfar M, Basharat NF, Bundogji N, Ungricht EL, Darquea IM, Conley ME, Ronquillo YC, Hoopes PC. Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK. J Clin Med 2022; 11:jcm11164832. [PMID: 36013070 PMCID: PMC9410252 DOI: 10.3390/jcm11164832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To evaluate the safety, efficacy, and predictability of laser-assisted in situ keratomileusis (LASIK) enhancement after primary LASIK and compare to Food and Drug Administration (FDA) criteria. Methods: Patients who underwent LASIK enhancement after primary LASIK between 2002 and 2019 were compared to those who underwent LASIK without retreatment. Patient demographics, preoperative characteristics, visual outcomes, and postoperative complications were compared between groups. Epithelial ingrowth (EI) development was stratified based on duration between primary and secondary procedures. Results: We compared 901 eyes with LASIK enhancement to 1127 eyes without retreatment. Age, sex, surgical eye, sphere, cylinder, and spherical equivalent (SE) were significantly different between groups (p < 0.05). At 12 months post-enhancement, 86% of the eyes had an uncorrected distance visual acuity of 20/20 or better and 93% of eyes were within ±0.50 D of the target. Development of EI (6.1%) demonstrated an odds ratio of 16.3 in the long-term compared to the short-term (95% CI: 5.9 to 45.18; p < 0.0001). Conclusions: Older age at primary LASIK, female sex, right eye, and larger sphere, cylinder and SE were risk factors for enhancement. Risk of EI significantly increased when duration between primary and enhancement procedures exceeded five years. LASIK enhancements produce favorable outcomes and meet FDA benchmarks for safety, efficacy, and predictability.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
- Correspondence: ; Tel.: +1-801-568-0200
| | - Noor F. Basharat
- University of Arizona College of Medicine—Phoenix, Phoenix, AZ 85004, USA
| | - Nour Bundogji
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | | | - Ines M. Darquea
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
| | - Matthew E. Conley
- University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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Zamorano-Martín F, Sánchez-González JM, García-Lorente M, Rachwani-Anil R, Peraza-Nieves J, Rodríguez-Calvo-de-Mora M, Borroni D, Rocha-de-Lossada C. Laser refractive surgery in pregnant or breastfeeding patients. J Cataract Refract Surg 2021; 47:1081-1087. [PMID: 34292893 DOI: 10.1097/j.jcrs.0000000000000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
This systematic review reported the outcomes of laser corneal refractive surgery in pregnant or breastfeeding patients. This study was performed by searching in PubMed, Web of Science, and Scopus databases, on June 15, 2020. Included were 128 eyes from a total of 64 patients, with the mean maximum follow-up was 39.2 ± 36.14 months. Time from surgery to complication ranged from 1 to 67 months, with a mean value of 23.42 ± 22.23 months. Photorefractive keratectomy and laser in situ keratomileusis surgery seem to be stable procedures that are not modified during pregnancy and safe to complete during breastfeeding. Nevertheless, the lack of weight prospective research avoids having a greater certainty on this matter, and because of transitory nature of pregnancy and breastfeeding, it could still be contemplated that surgery risk outweigh the benefits. Additional investigation will be necessary to clarify these issues.
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Affiliation(s)
- Francisco Zamorano-Martín
- From the Department of Ophthalmology, Regional University Hospital of Malaga, Malaga, Spain (Zamorano-Martín, García-Lorente, Rachwani-Anil); Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain (Sánchez-González); Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Centre, Seville, Spain (Sánchez-González); Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain (Peraza-Nieves); Department of Doctoral Studies, Riga Stradins University, Riga, Latvia (Borroni); Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, United Kingdom (Borroni); Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain (Rocha-de-Lossada); Department of Ophthalmology, University of Malaga, Malaga, Spain (Rocha-de-Lossada)
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Kanellopoulos AJ, Vingopoulos F. Does Pregnancy Affect Refractive and Corneal Stability or Corneal Epithelial Remodeling After Myopic LASIK? J Refract Surg 2020; 36:118-122. [DOI: 10.3928/1081597x-20200115-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/15/2020] [Indexed: 11/20/2022]
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Moshirfar M, Rosen DB, Heiland MB, Ronquillo YC, Hoopes PC. Should I Get LASIK If I'm Breastfeeding? Ophthalmol Ther 2019; 8:349-352. [PMID: 31254257 PMCID: PMC6692418 DOI: 10.1007/s40123-019-0195-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Indexed: 11/27/2022] Open
Abstract
Changes in keratometric values and refraction can occur during pregnancy. For this reason, changing a patient's refractive prescription or undergoing corneal refractive surgery is not recommended during pregnancy. However, the extent to which these corneal changes persist during lactation is not as well reported. Pregnancy and lactation lead to hormonal changes that affect the corneal structure. LASIK, or other types of refractive surgery, is not recommended until all of the following conditions are met: cessation of lactation, the return of regular menses, and a return to pre-pregnancy refraction. Additionally, patients should be cautioned that refractive regression may occur if they become pregnant within 1 year of LASIK. FUNDING: Research to Prevent Blindness, NY, USA.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA.
| | - David B Rosen
- The University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | - Phillip C Hoopes
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
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Tabibian D, de Tejada BM, Gatzioufas Z, Kling S, Meiss VS, Boldi MO, Othenin-Girard V, Chilin A, Lambiel J, Hoogewoud F, Hafezi F. Pregnancy-induced Changes in Corneal Biomechanics and Topography Are Thyroid Hormone Related. Am J Ophthalmol 2017; 184:129-136. [PMID: 29032108 DOI: 10.1016/j.ajo.2017.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify biomechanical and topographic changes of the cornea during pregnancy and the postpartum period and its association to hormonal changes. DESIGN Prospective single-center observational cohort study. METHODS Participants were 24 pregnant women (48 eyes), monitored throughout pregnancy and after delivery. Biomechanical and topographic corneal properties were measured using the Ocular Response Analyzer (ORA) and a Scheimpflug imaging system (Pentacam HR) each trimester and 1 month after delivery. At the same consultations blood plasma levels of estradiol (E2) and thyroid hormones (TSH, T3t, T4t) were also determined. A factorial MANCOVA was used to detect interactions between hormonal plasma levels and ocular parameters. RESULTS Significant differences in corneal biomechanical and topographic parameters were found during pregnancy in relation to T3t (p = .01), T4t (p < .001), T3t/T4t (P = .001), and TSH (p = .001) plasma levels. E2 plasma levels (p = .092) and time period of measurement (p = .975) did not significantly affect corneal parameters. TSH levels significantly affected the maximal keratometry reading (p = .036), the vertical keratometry reading (p = .04), and the index of height asymmetry (p = .014). Those results persist after excluding hypothyroidism patients from the statistical analysis. CONCLUSIONS Hormonal changes affecting corneal biomechanics and topography during pregnancy could be thyroid related. Dysthyroidism may directly influence corneal biomechanics and represents a clinically relevant factor that needs further investigation.
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Csutak A, Steiber Z, Tőzsér J, Jakab A, Berta A, Silver DM. Plasminogen activator activity in tears of pregnant women. PLoS One 2017; 12:e0177003. [PMID: 28472076 PMCID: PMC5417609 DOI: 10.1371/journal.pone.0177003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 04/20/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. Methods PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. Results Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. Conclusions Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.
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Affiliation(s)
- Adrienne Csutak
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- * E-mail:
| | - Zita Steiber
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - József Tőzsér
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Berta
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - David M. Silver
- Johns Hopkins University, Bethesda, Maryland, United States of America
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Edmonds JN, Moshirfar M. LASIK and Surface Ablation in the Modern Era: Trends and Novel Applications. CURRENT OPHTHALMOLOGY REPORTS 2013. [DOI: 10.1007/s40135-012-0004-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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