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Yuan J, Zhuang YY, Liu X, Zhang Y, Li K, Chen ZJ, Li D, Chen H, Liang J, Yao Y, Yu X, Zhuo R, Zhao F, Zhou X, Yu X, Qu J, Su J. Exome-wide association study identifies KDELR3 mutations in extreme myopia. Nat Commun 2024; 15:6703. [PMID: 39112444 PMCID: PMC11306401 DOI: 10.1038/s41467-024-50580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Extreme myopia (EM), defined as a spherical equivalent (SE) ≤ -10.00 diopters (D), is one of the leading causes of sight impairment. Known EM-associated variants only explain limited risk and are inadequate for clinical decision-making. To discover risk genes, we performed a whole-exome sequencing (WES) on 449 EM individuals and 9606 controls. We find a significant excess of rare protein-truncating variants (PTVs) in EM cases, enriched in the retrograde vesicle-mediated transport pathway. Employing single-cell RNA-sequencing (scRNA-seq) and a single-cell polygenic burden score (scPBS), we pinpointed PI16 + /SFRP4+ fibroblasts as the most relevant cell type. We observed that KDELR3 is highly expressed in scleral fibroblast and involved in scleral extracellular matrix (ECM) organization. The zebrafish model revealed that kdelr3 downregulation leads to elongated ocular axial length and increased lens diameter. Together, our study provides insight into the genetics of EM in humans and highlights KDELR3's role in EM pathogenesis.
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Affiliation(s)
- Jian Yuan
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China
| | - You-Yuan Zhuang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyu Liu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yue Zhang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Kai Li
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
| | - Zhen Ji Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dandan Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - He Chen
- School of Biomedical Engineering, Hainan University, Haikou, China
| | - Jiacheng Liang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yinghao Yao
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China
| | - Xiangyi Yu
- Institute of PSI Genomics, Wenzhou, China
| | - Ran Zhuo
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fei Zhao
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiangtian Zhou
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China
| | | | - Jia Qu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China.
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China.
- School of Biomedical Engineering, Hainan University, Haikou, China.
| | - Jianzhong Su
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China.
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China.
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China.
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Ortega-Usobiaga J, González-López F, Peng Y, Bilbao-Calabuig R, Beltrán-Sanz J, Larrubia JR, Llovet-Osuna F. Visual outcomes of combined use of implantable collamer lens implantation and laser corneal visual correction for myopia over -18.00 diopters. J Cataract Refract Surg 2024; 50:733-738. [PMID: 38446490 DOI: 10.1097/j.jcrs.0000000000001438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To explore visual outcomes in patients with extreme myopia receiving an implantable collamer lens (ICL) at -18.00 diopters (D), with central port, followed by bioptics by laser vision correction (laser in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]) to address residual myopia or myopic astigmatism. SETTING Clínica Baviera (Aier Eye Hospital Group), Bilbao, Spain. DESIGN Retrospective analysis of cases. METHODS The study assessed uncorrected distance visual acuity, corrected distance visual acuity (CDVA), predictability, safety, efficacy, and patient satisfaction after implantation of the ICL and bioptics. The model implanted was V4c and EVO, with a correction of -18.00 D. Bioptics were performed at least 3 months after implantation, and patients were followed up for at least 3 months after LASIK or PRK. RESULTS The analysis included 125 eyes from 90 patients. Of these, 51.2% underwent LASIK and 48.8% PRK. Mean time from implantation to bioptics was 5.9 ± 9.4 months. Patients were followed up for a mean of 40.2 ± 37.9 months after bioptics. Median manifest refractive spherical equivalent was -2.89 D before bioptics and -0.49 D after. Median CDVA was 0.18 logMAR before bioptics and 0.17 after. The mean safety and efficacy indices were 2.22 ± 1.88 and 2.06 ± 1.85, respectively. CONCLUSIONS Visual outcomes and safety indices after ICL implantation and subsequent LASIK or PRK in patients with extreme myopia are excellent.
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Affiliation(s)
- Julio Ortega-Usobiaga
- From the Department of Cataract and Refractive Surgery, Clínica Baviera (Aier Eye Hospital Group), Bilbao, Spain (Ortega-Usobiaga); Department of Cataract and Refractive Surgery, Miranza IOA, Madrid, Spain (González-López); Department of Ophthalmology, Chongqing Aier-Mega Eye Hospital (Aier Eye Hospital Group), Chongqing, China (Peng); Department of Cataract and Refractive Surgery, Clínica Baviera (Aier Eye Hospital Group), Madrid, Spain (Bilbao-Calabuig, Llovet-Osuna); Department of Research and Development, Clínica Baviera (Aier Eye Hospital Group), Valencia, Spain (Beltrán-Sanz); Health Sciences Research Unit, Guadalajara University Hospital, University of Alcalá, Alcalá de Henares, Spain (Larrubia)
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Gan ATL, Fenwick EK, Ang M, Mehta JS, Lamoureux EL. Bilateral sequential small-incision lenticule extraction and LASIK result in similar short-term quality-of-life outcomes. J Cataract Refract Surg 2023; 49:305-311. [PMID: 36730347 DOI: 10.1097/j.jcrs.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/16/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare quality of life (QoL) between patients who receive bilateral small-incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) vs bilateral sequential SMILE-LASIK (BSSL) surgery. SETTING Singapore National Eye Centre, Singapore. DESIGN Retrospective cohort study. METHODS 2 patient cohorts were recruited (2010-2012; 2014-2016). The bilateral SMILE (BS) and bilateral LASIK (BL) groups comprised patients (mean ± SD age: 30.3 ± 6.5, 50% male) from a prospective nonrandomized study who chose SMILE and LASIK, respectively. The BSSL group comprised patients (mean ± SD age: 28.6 ± 6.2, 64.3% male) randomized to receive SMILE in 1 eye and LASIK in the other. Rasch-scaled scores of the QoL Impact of Refractive Correction questionnaire between groups postoperatively at 1 and 3 months were compared. RESULTS At month 1, scores on 3 QoL without emotional well-being items were worse in the BSSL (n = 70) compared with the BL group (n = 25), specficially, "using sunglasses" (β: -20.6, 95% CI, -34.3 to -6.9), "reliance on refractive correction" (-23.1, 95% CI, -40.9 to -5.4), and "medical complications from optical correction" (β: -14.8, 95% CI, -27.9 to -1.7). Emotional well-being (overall), and items "feeling able to do things" (β: 11.0, 95% CI, 1.6-20.4) and "feeling eager to try new things" (β: 14.1, 95% CI, 3.6-24.6) were better in the BSSL compared with the BS group (n = 25). No substantive differences were observed at month 3. CONCLUSIONS Refractive correction-related QoL differences at month 1 between BSSL and BS/BL patients attenuated by month 3. Bilateral sequential SMILE-LASIK surgery appeared unlikely to negatively affect QoL beyond 3 months.
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Affiliation(s)
- Alfred T L Gan
- From the Singapore Eye Research Institute and Singapore National Eye Centre, Singapore (Gan, Fenwick, Ang, Mehta, Lamoureux); Duke-NUS Medical School, Singapore (Fenwick, Ang, Mehta, Lamoureux); National University of Singapore, Singapore (Lamoureux); Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Australia (Lamoureux)
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González-Cruces T, Villarrubia A, Sánchez Ventosa Á, Palacín Miranda E, Castillo Eslava R, Gomera Martinez A, García Párrizas JA, Torres Huelva P, Sánchez-González JM, Cano-Ortiz A. Comparison Between the Wavefront-Optimized and Custom-Q Aspheric Ablation Profiles in Myopic Eyes With Two Different Q-targets: A Contralateral Eye Study. J Refract Surg 2022; 38:698-707. [DOI: 10.3928/1081597x-20221005-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laser In Situ Keratomileusis (LASIK) Combined with Prophylactic Corneal Cross-Linking for Correction of Myopia: Regional Analysis of Corneal Morphology. Ophthalmol Ther 2022; 11:1423-1439. [PMID: 35532880 PMCID: PMC9253232 DOI: 10.1007/s40123-022-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction Methods Results Conclusions
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Gao Y, Qi Y, Huang Y, Li X, Zhou L, Zhao S. Lipidomics Analysis of the Tears in the Patients Receiving LASIK, FS-LASIK, or SBK Surgery. Front Med (Lausanne) 2021; 8:731462. [PMID: 34778293 PMCID: PMC8579130 DOI: 10.3389/fmed.2021.731462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/24/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose: Tear film lipid layer (TFLL) plays a vital role in maintaining the tear film stability and, thus, the lipid composition of the tears could greatly affect the physiological function and biophysical integrity of the tear film. The objective of this study is to assess the tear lipid composition of the patients receiving laser-assisted in situ keratomileusis (LASIK), femtosecond LASIK (FS-LASIK), or sub-Bowman's keratomileusis (SBK) surgery preoperatively and postoperatively. Methods: Tear samples were collected from the left eye of the patient who receiving LASIK (n = 10), FS-LASIK (n = 10), or SBK (n = 10) surgery in week 0, week 1, week 4, and week 52. A rapid direct injection shotgun lipidomics workflow, MS/MSALL (<2 min/sample), was applied to examine the tear lipidome. Results: In week 52, the SBK group demonstrated a similar lipidome profile compared to week 0, while the FS-LASIK and LASIK groups shifted away from week 0. Two lipids, ganglioside (GD3) 27:4 and triacylglycerol (TAG) 59:3, were found to be associated with the lipidome changes preoperatively and postoperatively. No statistical significance was found in the overall lipid classes from the FS-LASIK group. The LASIK group showed significant alteration in the phospholipid and sphingolipid over time, while the SBK group demonstrated a significant difference in the (O-acyl)-ω-hydroxy fatty acid (OAHFA) and phospholipid. Conclusion: LASIK showed the greatest impact on the tear lipidome changes over time, while SBK demonstrated minimal impact among the three types of refractive surgeries after 1 year.
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Affiliation(s)
- Yan Gao
- Ocular Proteomics Platform, Singapore Eye Research Institute, Singapore, Singapore
| | - Yuanyuan Qi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yue Huang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Lei Zhou
- Ocular Proteomics Platform, Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Ophthalmology and Visual Sciences Academia Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis. Diagnostics (Basel) 2021; 11:diagnostics11091588. [PMID: 34573930 PMCID: PMC8468565 DOI: 10.3390/diagnostics11091588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (LASIK) and LASIK using mechanical microkeratomes (MMKs). This study compares the flap thickness and risk of complications related to flap creation using femtosecond lasers and MMKs. METHODS PubMed and the Web of Science are used to search the medical literature. An extensive search is performed to identify the flap thickness and complications of LASIK as reported up to 15 July 2021. The following keywords are used in various combinations: Corneal flap, femtosecond laser, laser in situ keratomileusis, laser-assisted in situ keratomileusis, LASIK, mechanical microkeratome. RESULTS After removing duplicates and irrelevant studies, 122 articles were included for review. Pooled differences for intended vs. postoperative flap thickness using MMKs and femtosecond laser were -4.07 μm (95% CI: -19.55, 3.24 μm) in studies on the MMK and 5.43 μm (95% CI: 2.30, 7.84 μm; p < 0.001), respectively. After removing the studies evaluating outcomes of the old generation Hansatome MMKs (which had a significantly greater variation of flap thickness), the pooled difference for newer MMKs was 4.97 μm (95% CI: 0.35, 9.58 μm; p < 0.001), but the results still favored the femtosecond laser. Uncommon and mild complications unique for the femtosecond LASIK are epithelial gas breakthrough, opaque bubble layer, transient light sensitivity syndrome, and rainbow glare. A single study reported a very low, but stastically different risk of postoperative flap slippage (0.033% for MMK LASIK, and 0.003% for femtosecond LASIK, respectively). CONCLUSION In both manual microkeratome and femtosecond LASIK, intra- and postoperative complications were uncommon. The evidence of the superiority of one technique in terms of complications over another cannot be indisputably stated.
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Comparison of 1-Year Outcomes Between Small Incision Lenticule Extraction With Prophylactic Cross-Linking and Femtosecond Laser-Assisted In Situ Keratomileusis With Prophylactic Cross-Linking. Cornea 2021; 40:12-18. [PMID: 33214416 DOI: 10.1097/ico.0000000000002547] [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 compare small incision lenticule extraction with prophylactic cross-linking (SMILE Xtra) and femtosecond laser-assisted in situ keratomileusis with prophylactic cross-linking (FS-LASIK Xtra) in their safety, efficacy, predictability, and stability. METHODS This is a prospective cohort study. Forty-eight eyes subjected to SMILE Xtra and 90 eyes subjected to FS-LASIK Xtra were enrolled. The enrolled eyes exhibited either borderline corneal topography or high myopia with thin cornea. The following parameters were evaluated before surgery and at 1 day; 1 week; and 1, 3, 6, and 12 months after surgery: corrected distance visual acuity, uncorrected distance visual acuity, manifest refractive spherical equivalent (MRSE), keratometry values, and thinnest corneal thickness. RESULTS After 1 month, no eye showed loss of 1 or more lines of corrected distance visual acuity. At 12 months, uncorrected distance visual acuity was 20/20 or better for 98% and 99% eyes in the SMILE Xtra and FS-LASIK Xtra groups, respectively (P = 0.657). For 93.8% eyes in the SMILE Xtra group and 90% eyes in the FS-LASIK Xtra group, the achieved MRSE was within ±0.50 diopter of the intended MRSE (P = 0.669). The correlation coefficients for predictability of MRSE correction by SMILE Xtra and FS-LASIK Xtra were 0.987 and 0.983, respectively. The mean MRSE values, keratometry values, and thinnest corneal thickness measured at the different time points showed no significant intra- or intergroup differences. CONCLUSIONS Our evaluations of 1-year outcomes suggest that the safety, efficacy, predictability, and stability of SMILE Xtra are comparable with those of FS-LASIK Xtra.
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Kim JY, Lee H, Joo CK, Hyon JY, Kim TI, Kim JH, Kim JK, Cho EY, Choi JE, Lee NR, Tchah HW. Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population. J Pers Med 2021; 11:jpm11050419. [PMID: 34065718 PMCID: PMC8156820 DOI: 10.3390/jpm11050419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022] Open
Abstract
This multi-center cohort study included 3401 myopic laser in situ keratomileusis (LASIK) procedures conducted in 1756 myopia patients between 2002 and 2005. Pre- and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction spherical equivalent (SE) were recorded. Factors predicting low postoperative efficacy (defined as a postoperative UCVA < 0.5) were identified using univariate and multivariate logistic regression analysis. Compared with 1 month postoperatively, logMAR UCVA at 3 months postoperatively was significantly decreased (p = 0.002) and that at 2 and 3 years was significantly increased (p < 0.001). LogMAR BCVA at 2 years postoperatively was significantly decreased compared with 1 month postoperatively (p = 0.008). Over the 3-year postoperative period, overall refractive predictability within ±1.00 D and ±0.50 D ranged from 69.0% to 86.2% and from 43.3% to 67.8%, respectively. This also decreased from 1 month to 6 months postoperatively (p < 0.005). Multivariate logistic regression analysis using generalized estimating equations, revealed that higher preoperative SE (odds ratio [OR], 2.58 and 7.23; p < 0.001) and lower preoperative BCVA (OR, 2.44; p = 0.003) were predictive of a low postoperative efficacy. In summary, myopic LASIK can be effective and safe with a high refractive predictability in a Korean population, but myopic regression occurs over time. Higher preoperative SE and lower preoperative BCVA are predictive of a low postoperative efficacy.
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Affiliation(s)
- Jae-Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Kangnam St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Joon-Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jin-Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University of Korea, Koyang 10380, Korea;
| | - Jin-Kuk Kim
- B&VIIT Eye Center, Seoul 06615, Korea; (J.-K.K.); (E.-Y.C.)
| | - Eun-Young Cho
- B&VIIT Eye Center, Seoul 06615, Korea; (J.-K.K.); (E.-Y.C.)
| | - Ji-Eun Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea; (J.-E.C.); (N.-R.L.)
| | - Na-Rae Lee
- National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea; (J.-E.C.); (N.-R.L.)
| | - Hung-Won Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
- Correspondence:
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Zhang YL, Xu XH, Cao LJ, Liu L. Corneal curvature, asphericity, and aberrations after transepithelial photorefractive keratectomy and femtosecond laser-assisted in situ keratomileusis for myopia: A prospective comparative study. Indian J Ophthalmol 2021; 68:2945-2949. [PMID: 33229675 PMCID: PMC7856998 DOI: 10.4103/ijo.ijo_1106_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose: We aimed to compare transepithelial photorefractive keratectomy (TPRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia treatment by analyzing corneal curvature, asphericity (Q-value), and corneal aberration. Methods: Corneal topography was measured before and 6 months after the TPRK or FS-LASIK surgery. We measured and compared corneal curvature (sagittal curvature in the 1- to 7-mm zones), change in keratometric measurements (Kmpost – Kmpre, ΔK), Q-values (from the vertex of the 6-, 7-, 8-, and 9-mm zones), higher-order aberration (HOA), vertical and horizontal trefoil (Z3-3 and Z33), vertical and horizontal coma (Z3-1 and Z31), and spherical aberration (Z40) between the two surgery groups. Results: The sagittal curvature Δ K in the 1-mm zone after TPRK was significantly higher than after FS-LASIK. The Δ K/ΔSE (ΔSE [spherical equivalent] = SEpre – SEpost) ratio in the 1- to 4-mm diameter zones was significantly higher after TPRK than after FS-LASIK. The preoperative Q-values of the 6- and 7-mm zones did not differ between the treatment groups, but postoperative values were significantly higher following FS-LASIK than following TPRK. HOA, Z40, and Z3-1 were all significantly higher after surgery in both groups. Postoperative Z3-3 was significantly higher following TPRK but not following FS-LASIK. There were no postoperative differences in aberrations in either group; however, the change in HOA and Z3-1 was significantly greater following FS-LASIK. Conclusion: TPRK changes the corneal curvature to a greater extent and the visual quality (Q-value, aberrations) to a lesser extent than FS-LASIK.
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Affiliation(s)
- Ya-Li Zhang
- Department of Ophthalmology, The Second People's Hospital of Jinan, Jinan, China
| | - Xiang-Hui Xu
- Department of Ophthalmology, The Second People's Hospital of Jinan, Jinan, China
| | - Li-Jun Cao
- Department of Ophthalmology, The Second People's Hospital of Jinan, Jinan, China
| | - Lei Liu
- Department of Ophthalmology, The Second People's Hospital of Jinan, Jinan, China
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Rush SW, Rush RB. Femtosecond-Assisted Laser in situ Keratomileusis with de novo Flap Creation Following Previous Microkeratome Laser in situ Keratomileusis. Clin Ophthalmol 2021; 15:1813-1818. [PMID: 33958854 PMCID: PMC8096443 DOI: 10.2147/opth.s301450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcomes of laser in situ keratomileusis (LASIK) in patients with previous microkeratome LASIK using a femtosecond laser platform to create a de novo flap. Methods The charts of 17 patients that underwent femtosecond-assisted LASIK with de novo flap creation for consecutive refractive error following previous microkeratome LASIK were retrospectively reviewed at a single private practice institution. The baseline characteristics, intraoperative findings and postoperative outcomes were analyzed. Results All 17 eyes underwent femtosecond-assisted LASIK with de novo flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity improved postoperatively (p<0.0001) and remained stable at 6 months follow-up. None of the subjects lost any lines of best spectacle corrected visual acuity or developed epithelial ingrowth during the postoperative period. Conclusion The femtosecond laser technique described in this report can provide a safe and effective method to deliver LASIK following previous microkeratome LASIK. Future investigations are required to further validate the findings in this study.
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Affiliation(s)
- Sloan W Rush
- Panhandle Eye Group, Amarillo, TX, 79106, USA.,Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
| | - Ryan B Rush
- Panhandle Eye Group, Amarillo, TX, 79106, USA.,Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, 79106, USA.,Southwest Retina Specialists, Amarillo, TX, 79106, USA
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Abstract
Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries. Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence. To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed.
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Brar S, Gautam M, Sute SS, Ganesh S. Refractive surgery with simultaneous collagen cross-linking for borderline corneas - A review of different techniques, their protocols and clinical outcomes. Indian J Ophthalmol 2020; 68:2744-2756. [PMID: 33229650 PMCID: PMC7856924 DOI: 10.4103/ijo.ijo_1709_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Simultaneous corneal cross-linking (CXL) has been proposed as an adjunct therapy to corneal refractive procedures to prevent future ectasia, especially when performed in borderline corneas. This review analyses the currently available literature (minimum follow-up 6 months) on corneal refractive surgery and simultaneous CXL (PRK Xtra, LASIK Xtra, and SMILE Xtra) to evaluate the overall results including the safety, efficacy, and potential complications associated with these procedures. A comprehensive literature search of various electronic databases (PubMed, PubMed Central, Cochrane database, and MEDLINE) was performed up to 20th May 2020. Four relevant studies were found for PRK Xtra, 12 for LASIK Xtra, and 3 for SMILE Xtra. The total number of eyes included in this review was 1,512: 294 for PRK Xtra, 221 for PRK-only, 446 eyes for LASIK Xtra, 398 eyes for LASIK-only, 91 for SMILE Xtra and 62 for SMILE-only. Current literature suggests that refractive surgery and simultaneous CXL is generally safe and delivers comparable results in terms of visual and refractive outcomes than refractive surgery alone. However, there is no consensus on a standard cross-linking protocol, and complications such as diffuse lamellar keratitis, central toxic keratopathy, and corneal ectasia following Xtra procedures have been reported. It is therefore suggested that surgeons exercise caution in case-selection and counsel their patients regarding the potential risks and benefits with Xtra procedures. Also, further studies are required to standardize the UV-A irradiation protocols and to evaluate the long-term effect on safety, refractive predictability, and stability of these procedures.
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Affiliation(s)
- Sheetal Brar
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Megha Gautam
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Smith Snehal Sute
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sri Ganesh
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Lim L, Lim EWL, Rosman M, Koh JCW, Htoon HM. Three-Year Outcomes of Simultaneous Accelerated Corneal Crosslinking and Femto-LASIK for the Treatment of High Myopia in Asian Eyes. Clin Ophthalmol 2020; 14:2865-2872. [PMID: 33061271 PMCID: PMC7526743 DOI: 10.2147/opth.s260088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the long-term visual outcomes of simultaneous femtosecond laser-assisted laser in situ keratomileusis (femto-LASIK) and accelerated cross-linking (CXL) [LASIK Xtra] for the treatment of high myopia. Patients and Methods All 163 consecutive eyes of 85 patients who underwent LASIK Xtra for the treatment of high myopia and/or myopic astigmatism (spherical equivalent ≥ −6.00 D) in Singapore National Eye Centre from the years 2013 to 2017 were included in this retrospective case series. Post-operative follow-up was up to 3 years. Results Of the 163 eyes, 67 were followed up for 1 year (mean 12.9 months), 69 for 2 years (mean 24.0 months) and 43 for 3 years (mean 36.4 months). Overall mean follow-up was 22.8 months (9–46 months). The mean pre-operative spherical equivalent (SE) was −8.60 ± 1.47 D [range: −11.75 to −4.75] (n = 163) and mean attempted correction SE was −8.84 ± 1.41 D [range: −11.88 to −5.25]. Most eyes (>95%) maintained an uncorrected distance visual acuity of 6/12 or better over 3 years. Visual outcomes were predictable with ≥95% of eyes achieving a SE correction within ± 1D of attempted correction over 3 years. There was a mild regression in SE refraction over 3 years with a mean of −0.10 ± 0.45 D three years post-operatively (p = 0.03). The safety index was >1.05 at 3 years follow-up. There were no significant post-operative complications though 24 eyes had mild haze and 2 eyes had grade 1 diffuse lamellar keratitis that resolved within 1 month. Conclusion Our 3-year LASIK Xtra results show favorable safety, efficacy, predictability and stability outcomes in Asian patients with high myopia.
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Affiliation(s)
- Li Lim
- Singapore National Eye Centre, Singapore 168751, Singapore.,Singapore Eye Research Institute, Singapore 169856, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
| | - Elizabeth Wen Ling Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Mohamad Rosman
- Singapore National Eye Centre, Singapore 168751, Singapore.,Singapore Eye Research Institute, Singapore 169856, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
| | | | - Hla Myint Htoon
- Singapore National Eye Centre, Singapore 168751, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
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15
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Ang M, Farook M, Htoon HM, Mehta JS. Randomized Clinical Trial Comparing Femtosecond LASIK and Small-Incision Lenticule Extraction. Ophthalmology 2020; 127:724-730. [DOI: 10.1016/j.ophtha.2019.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022] Open
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16
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Schallhorn JM, Schallhorn SC, Teenan D, Hannan SJ, Pelouskova M, Venter JA. Incidence of Intraoperative and Early Postoperative Adverse Events in a Large Cohort of Consecutive Laser Vision Correction Treatments. Am J Ophthalmol 2020; 210:97-106. [PMID: 31634446 DOI: 10.1016/j.ajo.2019.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the incidence of adverse events (AE) following laser vision correction. DESIGN Retrospective case series. METHODS Optical Express, UK. Patients/study population: patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between July 1, 2014, and June 30, 2016. Intervention/observation procedures: all AEs recorded in the electronic medical record were extracted and retrospectively reviewed. The total incidence of AE and serious adverse events (SAE) was calculated. Loss of 2 or more lines of corrected distance visual acuity (CDVA) was calculated for the entire cohort of patients that attended a minimum of 3 months follow-up. MAIN OUTCOME MEASURES AEs; Preoperative and last available postoperative clinical data. RESULTS A total of 31,921 (61,833 eyes) were included in the study for LASIK and 5,016 (9,467 eyes) for PRK. The total number of AE was 850 for LASIK (occurring in 783 eyes of 657 patients; incidence of 1.3% or 1:79 eyes) and 227 for PRK (occurring in 218 eyes of 170 patients; incidence of 2.3% or 1:43 eyes). In the LASIK group, there were 287 SAEs (271 eyes of 226 patients; incidence of 0.4% or 1:228 eyes), and the number of SAEs in PRK group was 65 (65 eyes of 39 patients; incidence 0.7% or 1:146 eyes). Combining LASIK and PRK data, the loss of 2 or more lines of CDVA was recorded in 0.37% of eyes. CONCLUSIONS Contemporary LASIK and PRK are safe procedures with a low incidence of serious adverse events.
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Louie A, Meyerle C, Francomano C, Srikumaran D, Merali F, Doyle JJ, Bower K, Bloom L, Boland MV, Mahoney N, Daoud Y, Singman EL. Survey of Ehlers-Danlos Patients' ophthalmic surgery experiences. Mol Genet Genomic Med 2020; 8:e1155. [PMID: 31989797 PMCID: PMC7196452 DOI: 10.1002/mgg3.1155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 01/24/2023] Open
Abstract
Background Ehlers‒Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients. Methods Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists. Results Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%‐refractive, 33%‐lens/cataract, 33%‐retina, 59%‐strabismus, 23%‐ oculoplastics, 0%‐cornea, and 25%‐glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis. Conclusions Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery.
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Affiliation(s)
- Anita Louie
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Clair Francomano
- Harvey Institute for Medical Genetics of Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Farhan Merali
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Kraig Bower
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Michael V Boland
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas Mahoney
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yassine Daoud
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric L Singman
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
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18
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Bao F, Huang W, Zhu R, Lu N, Wang Y, Li H, Wu S, Lin H, Wang J, Zheng X, Huang J, Li Y, Wang Q, Elsheikh A. Effectiveness of the Goldmann Applanation Tonometer, the Dynamic Contour Tonometer, the Ocular Response Analyzer and the Corvis ST in Measuring Intraocular Pressure following FS-LASIK. Curr Eye Res 2019; 45:144-152. [PMID: 31869261 DOI: 10.1080/02713683.2019.1660794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To test the performance of the four tonometers in providing IOP measurements that were free of the effects of corneal biomechanics changes caused by refractive surgery.Methods: Four tonometers were employed to provide IOP measurements for 65 participants who accepted Femtosecond laser-assisted LASIK (FS-LASIK). The measurements included GAT-IOP by the Goldmann Applanation Tonometer, DCT-IOP by the Dynamic Contour Tonometer, Goldmann-correlated IOP (ORA-IOPg) and corneal-compensated IOP (ORA-IOPcc) by the Ocular Response Analyzer, and uncorrected IOP (CVS-IOP) and biomechanically corrected IOP (CVS-bIOP) by the Corvis ST. Statistical analyses were performed to assess the association of the differences in IOP caused by FS-LASIK with central corneal thickness (CCT), mean corneal curvature (Km), age, refractive error correction (REC), optical zone diameter (OZD), ablation zone diameter (AZD), residual stromal bed thickness (RSB) and RSB ratio (RSB/CCT). Multiple linear regression models were constructed to explore factors influencing IOP changes.Results: All four tonometers exhibited significant differences between IOP measurements taken pre and post-surgery except for CVS-bIOP in the low to moderate myopia group (t = 1.602, p = .12). CVS-bIOP, followed by DCT-IOP, provided the best agreement between pre and post-FS-LASIK measurements with the lowest differences in IOP and the narrowest limits of agreement. The pre-post IOP differences were also significantly associated with the reduction in CCT in only GAT-IOP, ORA-IOPg, and CVS-IOP. CVS-bIOP and ORA-IOPcc were the only measurements that were not correlated with CCT, Km or age both before and after FS-LASIK.Conclusions: The biomechanically corrected bIOP from the Corvis ST provided post-FS-LASIK measurements that were in closest agreement with those obtained before surgery. In comparison, GAT-IOP, ORA-IOPg, ORA-IOPcc, and CVS-IOP appeared to be more influenced by the changes in corneal biomechanics caused by FS-LASIK.
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Affiliation(s)
- Fangjun Bao
- Eye Hospital, WenZhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Wei Huang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Rong Zhu
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Nanji Lu
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Yuan Wang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Hechen Li
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Songan Wu
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Huini Lin
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Junjie Wang
- Eye Hospital, WenZhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Xiaobo Zheng
- Eye Hospital, WenZhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - JinHai Huang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Yiyu Li
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Qinmei Wang
- Eye Hospital, WenZhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,School of Biological Science and Biomedical Engineering, Beihang University, Beijing, China
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19
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Mariacher S, Mariacher M, Seuthe AM, Szurman P, Seitz B, Boden KT. Impact of Patient Interface Diameter and Vacuum Level on Suction Stability Using a Flat Applanating Interface for Femtosecond Laser-Assisted LASIK. Curr Eye Res 2019; 45:789-796. [PMID: 31810388 DOI: 10.1080/02713683.2019.1701688] [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: 10/25/2022]
Abstract
PURPOSE To investigate the impact of different patient interface (PI) diameters and different vacuum levels on the suction stability during vacuum application for femtosecond laser-assisted LASIK. METHODS Break-away forces as a marker for suction stability were measured by an automated test bench set-up. The test bench was based on a customized stamp connected to a digital load cell. Three flat applanating PI with different diameters (8.5, 9.5 and 10.0 mm) and four different vacuum levels (500, 600, 700 and 800 mbar) were investigated using the FEMTO LDV Z8 (Ziemer Ophthalmic Systems AG, Switzerland). RESULTS Mean break-away force was 5.23N (±0.99N) using the 8.5 mm PI and 500 mbar vacuum, 8.18N (±1.39N) using the 8.5 mm PI and 800 mbar, 3.37N (±0.56N) using the 10.0 mm PI and 500 mbar, and 6.14N (±0.68N) using the 10.0 mm PI and 800 mbar vacuum (p < .001; CI95%). Increasing the PI diameter from 8.5 to 10.0 mm resulted in a 28.89% (+1.97 ± 1.02N) lower break-away force (p < .001) when using default vacuum settings (700 mbar) compared to increasing vacuum from 500 to 800 mbar, which resulted in a 60.37% (+1.95 ± 1.40N) higher mean break away force (p < .001). CONCLUSION The vacuum level and the diameter of the PI showed significant impact on suction stability measured as break-away force during flat applanating docking for corneal and refractive surgery. Break-away forces were inversely related to the PI diameter and directly to the vacuum level. Increasing the PI diameter by one step or reducing vacuum by 100 mbar resulted in a comparable decrease of break-away forces. Therefore, the surgeon could potentially maintain stabile suction by increasing vacuum when choosing a larger PI diameter to obtain a larger treatment zone. Furthermore, reduction of the PI diameter and/or increasing vacuum could help improving suction stability in situations of poor suction and in situations with increased risk of suction loss during LASIK.
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Affiliation(s)
| | - Martina Mariacher
- Knappschaft Eye Clinic, Knappschaft Hospital Saar GmbH , Sulzbach, Germany
| | | | - Peter Szurman
- Knappschaft Eye Clinic, Knappschaft Hospital Saar GmbH , Sulzbach, Germany.,Centre for Ophthalmology, University Eye Hospital Tuebingen , Tuebingen, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS , Homburg, Germany
| | - Karl Thomas Boden
- Knappschaft Eye Clinic, Knappschaft Hospital Saar GmbH , Sulzbach, Germany
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Abstract
PURPOSE To compare clinical outcomes of patients undergoing first re-treatment by flap relift with those re-treated by surface ablation on the flap after an initial myopic laser-assisted in situ keratomileusis (LASIK) procedure. METHODS This is a retrospective cohort analysis of consecutive patients who underwent myopic LASIK and required re-treatment between January 2007 and December 2016. Cases re-treated by flap relift were propensity score matched with cases re-treated by surface ablation, and clinical outcomes were compared. One eye from each patient was included. RESULTS A total of 1,234 out of 21,191 cases required re-treatment after myopic LASIK during the follow-up period. Surface ablation was performed in 75% of cases and relift in 25%. Patients re-treated by surface ablation were more commonly male (61.8% vs. 48.1%, P < 0.001), were younger (33.2 ± 7.8 vs. 35.2 ± 10 years, P = 0.005), and had thinner corneas (483 ± 46 vs. 502 ± 43 μm, P < 0.001). Propensity score matching was performed for 416 eyes (208 from each group). After matching, differences in baseline characteristics became nonsignificant (P > 0.05). Cases re-treated by surface ablation had a worse safety index (0.98 ± 0.12 vs. 1.02 ± 0.17, P = 0.049), yet better predictability (0.14 ± 0.6 vs. 0.35 ± 0.5 diopters of deviation, P = 0.009), a similar efficacy index (0.92 ± 0.2 vs. 0.93 ± 0.3, P = 0.814), higher rates of haze (5.8% vs. 0.5%, P = 0.002), and a lower risk for epithelial ingrowth (0.5% vs. 8.2%, P < 0.001). CONCLUSIONS Re-treatment after myopic LASIK with surface ablation resulted in worse safety and higher rates of haze, yet more predictable outcomes and reduced ingrowth rates, compared with re-treatment with flap relift.
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21
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Zhou J, Gu W, Li S, Wu L, Gao Y, Guo X. Predictors affecting myopic regression in - 6.0D to - 10.0D myopia after laser-assisted subepithelial keratomileusis and laser in situ keratomileusis flap creation with femtosecond laser-assisted or mechanical microkeratome-assisted. Int Ophthalmol 2019; 40:213-225. [PMID: 31571091 DOI: 10.1007/s10792-019-01179-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the predictive factors of postoperative myopic regression among subjects who have undergone laser-assisted subepithelial keratomileusis (LASEK), laser-assisted in situ keratomileusis (LASIK) flap created with a mechanical microkeratome (MM), and LASIK flap created with a femtosecond laser (FS). All recruited patients had a manifest spherical equivalence (SE) from - 6.0D to - 10.0D myopia. METHODS This retrospective, observational case series study analyzed outcomes of refraction at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Predictors affecting myopic regression and other covariates were estimated with the Cox proportional hazards model for the three types of surgeries. RESULTS The study enrolled 496 eyes in the LASEK group, 1054 eyes in the FS-LASIK group, and 910 eyes in the MM-LASIK group. At 12 months, from - 6.0D to - 10.0D myopia showed that the survival rates (no myopic regression) were 52.19%, 59.12%, and 58.79% in the MM-LASIK, FS-LASIK, and LASEK groups, respectively. Risk factors for myopic regression included thicker postoperative central corneal thickness (P ≦ 0.01), older age (P ≦ 0.01), aspherical ablation (P = 0.02), and larger transitional zone (TZ) (P = 0.03). Steeper corneal curvature (Kmax) (P = 0.01), thicker preoperative central corneal thickness (P < 0.01), smaller preoperative myopia (P < 0.01), longer duration of myopia (P = 0.02), with contact lens (P < 0.01), and larger optical zone (OZ) (P = 0.02) were protective factors. Among the three groups, the MM-LASIK had the highest risk of postoperative myopic regression (P < 0.01). CONCLUSIONS The MM-LASIK group experienced the highest myopic regression, followed by the FS-LASIK and LASEK groups. Older age, aspheric ablation used, thicker postoperative central corneal thickness, and enlarging TZ contribute to myopic regression; steeper preoperative corneal curvature (Kmax), longer duration of myopia, with contact lens, thicker preoperative central corneal thickness, lower manifest refraction SE, and enlarging OZ prevent postoperative myopic regression in myopia from - 6.0D to - 10.0D.
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Affiliation(s)
- Jihong Zhou
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China. .,School of Public Health, Capital Medical University, Beijing, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Wei Gu
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Shaowei Li
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Lijuan Wu
- School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yan Gao
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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22
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Femtosecond Laser-Assisted In Situ Keratomileusis Treatment of Residual Refractive Error following Femtosecond Laser-Enabled Keratoplasty. J Ophthalmol 2019; 2019:8520183. [PMID: 31559093 PMCID: PMC6735192 DOI: 10.1155/2019/8520183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the safety and effectiveness of femtosecond laser-assisted in situ keratomileusis (LASIK) in the treatment of residual myopia and astigmatism following femtosecond laser-enabled keratoplasty (FLEK). Design Retrospective case review. Methods Chart review of all patients with prior FLEK who subsequently underwent femto-LASIK surgery after full suture removal was performed at the Gavin Herbert Eye Institute at the University of California, Irvine. A total of 14 eyes in 13 patients met this criterion, and their comprehensive examinations performed at standard intervals were reviewed. Main outcome measures include uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), manifest refractive astigmatism, and spherical equivalent. Results From the preoperative visit to the 3 month visit, all 14 eyes significantly improved in UDVA (logMAR, 0.93 ± 0.23 to 0.44 ± 0.32, P = 0.002) with no loss of CDVA (logMAR, 0.26 ± 0.19 to 0.18 ± 0.23, P = 0.50). All 14 eyes showed significant improvement in manifest refractive astigmatism (4.71 ± 1.77 to 2.18 ± 1.45 diopters (D), P = 0.003) and spherical equivalent (−2.57 ± 2.45 to −0.48 ± 0.83 D, P = 0.0007). There were no flap or graft complications as a result of femto-LASIK. Conclusions Our findings suggest that femto-LASIK on eyes with prior FLEK is safe and effective in improving visual acuity and reducing residual astigmatism.
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23
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Lim EWL, Lim L. Review of Laser Vision Correction (LASIK, PRK and SMILE) with Simultaneous Accelerated Corneal Crosslinking - Long-term Results. Curr Eye Res 2019; 44:1171-1180. [PMID: 31411927 DOI: 10.1080/02713683.2019.1656749] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Laser in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE) are safe and effective refractive surgical procedures. However, complications include regression of treatment and iatrogenic keratectasia which can be severe and sight-threatening. In order to reduce these complications, simultaneous corneal cross-linking (CXL) is currently being added to these refractive procedures. This review analyses current long-term literature (≥ 1 year follow-up) on refractive surgery and simultaneous CXL (LASIK Xtra, PRK Xtra and SMILE Xtra) to determine its overall safety and efficacy.Methods: A comprehensive literature search of various electronic databases (PubMed, PubMed Central and MEDLINE) was performed up to 9th February 2019. Efficacy and safety indices are calculated where possible.Results: Ten relevant studies were found for LASIK Xtra, 4 for PRK Xtra and 1 for SMILE Xtra. The total number of eyes included in this review was 1,189: 347 eyes for LASIK Xtra, 300 eyes for LASIK-only, 298 for PRK Xtra, 204 for PRK-only, 40 for SMILE Xtra and none for SMILE-only. Current studies show that refractive surgery and simultaneous CXL produces comparable or better results in terms of refractive and keratometric stability than refractive surgery alone. However, case reports of complications such as corneal ectasia, diffuse lamellar keratitis and central toxic keratopathy have also recently been published.Conclusions: Simultaneous accelerated CXL and refractive surgery is effective for the treatment of myopia. However, it is as yet unclear if the additional CXL step reduces the incidence of iatrogenic keratectasia. Further long-term comparative studies would be useful in evaluating safety and efficacy of this procedure. More research should also be performed to titrate the UV-A irradiation settings for an optimal outcome.
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Affiliation(s)
| | - Li Lim
- Department of Corneal and External Eye Disease, Singapore National Eye Centre, Singapore.,Adjunct Clinical Investigator, Singapore Eye Research Institute, Singapore.,Adjunct Associate Professor, Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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24
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Liu M, Gao H, Shi W. Factors Affecting Myopic Regression after Laser in Situ Keratomileusis and Laser-Assisted Subepithelial Keratectomy for High Myopia. Semin Ophthalmol 2019; 34:359-364. [PMID: 31257965 DOI: 10.1080/08820538.2019.1632353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To evaluate the factors affecting the amount of myopic regression after laser refractive surgery for high myopia, we retrospectively reviewed medical records of 1591 eyes with high myopia treated by laser in situ keratomileusis or laser-assisted subepithelial keratectomy at Shandong Eye Hospital between January 2008 and December 2012. Thirty-five eyes suffering a postoperative myopic shift of manifest spherical equivalent (MSE) of 0.25 diopter (D) or greater were included in this study. The mean refractive error was -9.34 ± 1.89 D before surgery, and the mean regression was -1.22 ± 0.70 D. Correlation analysis and multiple regression analysis were performed to assess the factors that were associated with the refractive regression. The age displayed a negative correlation with the diopter of regression (R = -0.404, P = .016), while the optical zone diameter had a positive correlation with it (R = 0.406, P = .016). Explanatory variables relevant to the diopter of regression were age (partial regression coefficient B = -0.045, P = .016) and optical zone diameter (partial regression coefficient B = 0.979, P = .014). Advanced-age patients with small optical zones were more predisposed to a larger amplitude of regression after laser refractive surgery for high myopia.
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Affiliation(s)
- Mingna Liu
- a Refractive Surgery Department, Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences , Jinan , China
| | - Hua Gao
- a Refractive Surgery Department, Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences , Jinan , China
| | - Weiyun Shi
- a Refractive Surgery Department, Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences , Jinan , China
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25
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Yoo TK, Ryu IH, Lee G, Kim Y, Kim JK, Lee IS, Kim JS, Rim TH. Adopting machine learning to automatically identify candidate patients for corneal refractive surgery. NPJ Digit Med 2019; 2:59. [PMID: 31304405 PMCID: PMC6586803 DOI: 10.1038/s41746-019-0135-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022] Open
Abstract
Recently, it has become more important to screen candidates that undergo corneal refractive surgery to prevent complications. Until now, there is still no definitive screening method to confront the possibility of a misdiagnosis. We evaluate the possibilities of machine learning as a clinical decision support to determine the suitability to corneal refractive surgery. A machine learning architecture was built with the aim of identifying candidates combining the large multi-instrument data from patients and clinical decisions of highly experienced experts. Five heterogeneous algorithms were used to predict candidates for surgery. Subsequently, an ensemble classifier was developed to improve the performance. Training (10,561 subjects) and internal validation (2640 subjects) were conducted using subjects who had visited between 2016 and 2017. External validation (5279 subjects) was performed using subjects who had visited in 2018. The best model, i.e., the ensemble classifier, had a high prediction performance with the area under the receiver operating characteristic curves of 0.983 (95% CI, 0.977-0.987) and 0.972 (95% CI, 0.967-0.976) when tested in the internal and external validation set, respectively. The machine learning models were statistically superior to classic methods including the percentage of tissue ablated and the Randleman ectatic score. Our model was able to correctly reclassify a patient with postoperative ectasia as an ectasia-risk group. Machine learning algorithms using a wide range of preoperative information achieved a comparable performance to screen candidates for corneal refractive surgery. An automated machine learning analysis of preoperative data can provide a safe and reliable clinical decision for refractive surgery.
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Affiliation(s)
- Tae Keun Yoo
- B&VIIt Eye Center, Seoul, South Korea.,2Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore.,5Department of Ophthalmology, Yonsei University College of Medicine, Graduate School, Seoul, Korea
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26
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Vega-Estrada A, Alio JL. Femtosecond-assisted laser in situ keratomileusis for high myopia correction: Long-term follow-up outcomes. Eur J Ophthalmol 2019; 30:446-454. [PMID: 30845834 DOI: 10.1177/1120672119834478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Report the outcomes of laser in situ keratomileusis (LASIK) for high myopia correction after long-term follow-up. METHODS Retrospective, consecutive, clinical study including 70 eyes that underwent LASIK using a 500 Hertz (Hz) repetition rate excimer laser and femtosecond technology for flap creation. Visual, refractive, corneal aberrations, and correlation among the variables were evaluated during 3 years. In addition, 34 eyes were followed during 5 years. RESULTS Significant improvement of 17 logMAR lines was observed in uncorrected vision at 5 years (p < 0.01). This was consistent with spherical equivalent reduction that came from mean preoperative -7.79 diopters (D) to 5 years postoperative -0.24 D (p < 0.01). Significant induction of primary spherical aberration and coma aberration was also found (p < 0.01) at 3 months with levels of 0.61 µm and 0.47 µm, respectively, with no further changes at 5 years (p > 0.05). Pearson correlation showed that the amount of high-order aberrations at 3 months postoperativeley was significantly correlated with the changes in the keratometry throughout the 5 years (delta K) (R2 0.242 p = 0.05). Finally, preoperative corneal asphericity showed an inverse correlation with the delta K (R2 -308 p = 0.01). CONCLUSIONS Results from this study suggests that LASIK for high myopia correction using 500 Hz repetition rate excimer laser provides stable visual, refractive and aberrometric results after 5 years of follow-up. A more prolate cornea and the amount of higher-order aberrations induced after LASIK are factors that negatively impact in the long-term stability of the procedure.
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Affiliation(s)
- Alfredo Vega-Estrada
- Department of Cornea and Refractive Surgery, Vissum, Alicante, Spain.,Department of Research and Development, Vissum, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Elche, Spain
| | - Jorge L Alio
- Department of Cornea and Refractive Surgery, Vissum, Alicante, Spain.,Department of Research and Development, Vissum, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Elche, Spain
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27
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Damgaard IB, Riau AK, Liu YC, Tey ML, Yam GHF, Mehta JS. Reshaping and Customization of SMILE-Derived Biological Lenticules for Intrastromal Implantation. Invest Ophthalmol Vis Sci 2019; 59:2555-2563. [PMID: 29847663 DOI: 10.1167/iovs.17-23427] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the feasibility of excimer laser reshaping of biological lenticules available after small incision lenticule extraction (SMILE). Methods Fresh and cryopreserved SMILE-derived human lenticules underwent excimer laser ablation for stromal reshaping. The treatment effects in the lasered group were compared with the nonlasered group with respect to changes in surface functional groups (by Fourier transform infrared spectroscopy [FTIR]) and surface morphology (by scanning electron microscopy [SEM] and atomic force microscopy [AFM]). Ten SMILE-derived porcine lenticules, five nonlasered (107-μm thick, -6 diopter [D] spherical power) and five excimer lasered (50% thickness reduction), were implanted into a 120-μm stromal pocket of 10 porcine eyes. Corneal thickness and topography were assessed before and after implantation. Results FTIR illustrated prominent changes in the lipid profile. The collagen structure was also affected by the laser treatment but to a lesser extent. SEM exhibited a more regular surface for the lasered lenticules, confirmed by the lower mean Rz value (290.1 ± 96.1 nm vs. 380.9 ± 92.6 nm, P = 0.045) on AFM. The lasered porcine lenticules were thinner than the nonlasered controls during overhydration (132 ± 26 μm vs. 233 ± 23 μm, P < 0.001) and after 5 hours in a moist chamber (46 ± 3 μm vs. 57 ± 3 μm, P < 0.001). After implantation, the nonlasered group showed a tendency toward a greater increase in axial keratometry (6.63 ± 2.17 D vs. 5.60 ± 3.79 D, P = 0.613) and elevation (18.6 ± 15.4 vs. 15.2 ± 5.5, P = 0.656) than the lasered group. Conclusions Excimer laser ablation may be feasible for thinning and reshaping of SMILE-derived lenticules before reimplantation or allogenic transplantation. However, controlled lenticule dehydration before ablation is necessary in order to allow stromal thinning.
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Affiliation(s)
- Iben Bach Damgaard
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Andri Kartasasmita Riau
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,School of Materials Science and Engineering, Nanyang Technological University, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
| | - Min Li Tey
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gary Hin-Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
| | - Jodhbir Singh Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,School of Materials Science and Engineering, Nanyang Technological University, Singapore.,Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore
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28
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Khamar P, Dalal R, Chandapura R, Francis M, Shetty R, Nelson EJR, Nuijts RMMA, Sinha Roy A. Corneal tomographic features of postrefractive surgery ectasia. JOURNAL OF BIOPHOTONICS 2019; 12:e201800253. [PMID: 30191680 DOI: 10.1002/jbio.201800253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/04/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to evaluate the tomographic features of postrefractive surgery eyes. This was a retrospective evaluation of clinical data. Three patients with post-LASIK (laser-assisted in situ keratomileusis) and two patients with post-SMILE (small incision lenticule extraction) ectasia were imaged with Scheimpflug imaging (SI, Pentacam) and optical coherence tomography (OCT, RTVue). Curvature and wavefront aberrations of the air-epithelium interface (A-E) and epithelium-Bowman's layer interface (E-B) were derived. OCT of normal and keratoconic eyes from an earlier study were compared with the data of the ectasia eyes. Curvature and aberrometry of the A-E interfaces were statistically similar between SI and OCT. However, OCT revealed a steeper and more aberrated E-B interface than A-E though correlation between them was inferior to the correlation for keratoconic eyes. Furthermore, the magnitude of differences between the A-E and E-B interfaces was greater in the ectasia eyes than the keratoconic eyes. OCT could possibly assist better in selecting appropriate treatment plan for postrefractive surgery ectasia eyes than conventional tomographers.
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Affiliation(s)
- Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ritika Dalal
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Rachana Chandapura
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
| | - Mathew Francis
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
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29
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Pérez-Izquierdo R, Rodríguez-Vallejo M, Matamoros A, Martínez J, Garzón N, Poyales F, Fernández J. Influence of Preoperative Astigmatism Type and Magnitude on the Effectiveness of SMILE Correction. J Refract Surg 2019; 35:40-47. [DOI: 10.3928/1081597x-20181127-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/26/2018] [Indexed: 11/20/2022]
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30
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Predictive factors for efficacy and safety in refractive surgery for myopia. PLoS One 2018; 13:e0208608. [PMID: 30550575 PMCID: PMC6294382 DOI: 10.1371/journal.pone.0208608] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/20/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the predictive factors for safety and efficacy in laser refractive surgery for myopia Setting A singular refractive surgery center, at a University-affiliated tertiary medical center. Design Retrospective cohort study Methods Study population—A total 8,775 eyes having laser refractive laser procedures for myopia (in4,623 patients). Observation procedures–Using a prospective database of refractive procedures performed over the span of 13 years, variables such as gender, age, type of surgery, date of surgery, pre-operative corneal thickness and Spherical Equivalent (SEQ) were evaluated. Main outcome measures—Proportion of patients with Safety index higher than 0.85 and Efficacy index higher than 0.80. Results 91.9% and 86.0% of all evaluated eyes were above the safety and efficacy cut-off levels, respectively. Younger age was significantly correlated with safety and efficacy indices above the cut-off levels (p<0.001). Male gender was significantly correlated with efficacy above the cut-off level (p<0.001). Myopic eyes with lower SEQ were associated with both safety (p = 0.002) and efficacy (p<0.001) indices above the cut-offs. The surgical procedure was found to significantly affect the outcome only using univariate analysis: Safety was higher in Photorefractive Keratectomy (PRK), while Efficacy was higher in Laser Assisted In Situ Keratomileusis (LASIK) (p<0.001, respectively) but no difference was found using multivariate analysis. Safety index above the cut-off level increased over the years (p<0.001). Conclusions Efficacy in refractive surgery for myopia is correlated with younger age, male gender and low myopia. Safety is correlated with younger age, low myopia and increases over the years. Multivariate analysis found no differences between PRK and LASIK regarding safety and efficacy.
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31
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Zhang YL, Cao LJ, Chen HW, Xu XH, Li ZN, Liu L. Comparison of changes in refractive error and corneal curvature following small-incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis surgery. Indian J Ophthalmol 2018; 66:1562-1567. [PMID: 30355861 PMCID: PMC6213686 DOI: 10.4103/ijo.ijo_366_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare visual acuity, refractive error, corneal curvature, and the stability of these parameters during the early postoperative period following small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery. Methods One hundred and five eyes and 110 eyes were enrolled in SMILE and FS-LASIK group, respectively. Uncorrected and best-corrected distance visual acuity (UCVA and BCVA), manifest refraction, corneal curvature, intraocular pressure, and slit-lamp examinations were performed preoperatively, 1 day, 1 week, 1 month, and 3 months postoperatively. Results No significant differences in postoperative UCVA or BCVA were observed between the SMILE and FS-LASIK groups at any time point. SMILE group had significant better postoperative spherical equivalent (SE) values than FS-LASIK group at 1 day, 1 week, and 1-month follow-up. However, there was no significant difference in postoperative SE values at 3-month follow-up. Significant differences in mean postoperative corneal curvature were observed during all follow-up examinations. Conclusion SMILE surgery was associated with more accurate postoperative refractive correction up to 1 month following surgery. SMILE surgery also resulted in less significant corneal curvature changes than FS-LASIK. Furthermore, FS-LASIK was associated with decreased stability of postoperative refractive error and corneal curvature relative to SMILE.
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Affiliation(s)
- Ya L Zhang
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Li J Cao
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Hong W Chen
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Xiang H Xu
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Zhao N Li
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Lei Liu
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
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Chua D, Htoon HM, Lim L, Chan CM, Mehta JS, Tan DTH, Rosman M. Eighteen-year prospective audit of LASIK outcomes for myopia in 53 731 eyes. Br J Ophthalmol 2018; 103:1228-1234. [PMID: 30355717 DOI: 10.1136/bjophthalmol-2018-312587] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/28/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND To assess the outcomes of laser-assisted in situ keratomileusis (LASIK) performed for the treatment of myopia in terms of safety, efficacy and predictability in an 18-year clinical audit. METHOD In this single-centre, prospective, non-randomised study, preoperative and postoperative refractions, uncorrected (UCVA), best-corrected Snellen visual acuity (BCVA) and complications of all eyes undergoing myopic LASIK were recorded. Safety, efficacy, refractive predictability, treatment trends, retreatment rates and complication rates were evaluated. RESULTS Between 1998 and 2015, 53 731 eyes of 27312 patients underwent myopic LASIK. Patients' median age was 31.6 years (mean, 32.6±7.3 years); there were 9703 males (35.5%). Patients were predominantly ethnic Chinese (87.4%). Mean follow-up time was 78±75.6 days (median, 86 days). Overall efficacy index was 0.91 with >99% of eyes achieving UCVA of ≥20/40 and >70% achieving 20/20 since 2010. 95.43% of eyes had no loss of vision postoperatively and 4.2% and 0.37% lost 1 and ≥2 lines BCVA, respectively. From 2010 the safety index has been >1.05. More than 94.0% of eyes achieved within ±1.0 D of target refraction and at least 70% achieved within ±0.50 D of target from 2010 onwards. Retreatment rate was 2.55% and after retreatment 98.4% of eyes achieved ≥20/40 UCVA and 63.5% achieved ≥20/20 UCVA. The overall complication rate is 0.98%, and since 2010, the annual complication rate has been <0.8%. CONCLUSIONS Myopic LASIK performed in Asian eyes is safe and effective with high refractive predictability in a comprehensive LASIK programme with appropriate clinical audit.
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Affiliation(s)
- Daniel Chua
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Hla Myint Htoon
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Li Lim
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Cordelia Ml Chan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Mohamad Rosman
- Singapore National Eye Centre, Singapore, Singapore .,Singapore Eye Research Institute, Singapore, Singapore
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Naderi M, Sabour S, Khodakarim S, Daneshgar F. Studying the factors related to refractive error regression after PRK surgery. BMC Ophthalmol 2018; 18:198. [PMID: 30107828 PMCID: PMC6092795 DOI: 10.1186/s12886-018-0879-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/07/2018] [Indexed: 12/02/2022] Open
Abstract
Backgtound Photorefractive keratectomy (PRK) is used for a wide range of refractive errors such as low to moderate myopia, hyperopia and astigmatism. While many improvements have been made in laser application and accuracy as well as the modes of corneal flap removal, and although the results are somewhat predictable, regression of refractive errors is still a common complaint among the patients undergoing refractive surgery with Excimer Laser. We aimed to determine related factors of regression following photorefractive keratectomy (PRK) in different types of refractive errors. Methods This cross-sectional study included patients who had undergone PRK more than 6 months previously and investigated refractive error regression and related factors. The participants were those who had PRK eye surgery for the first time from 2013 to 2016 using Technolas 217z100. A refraction value of spherical equivalent > 0.75 D after cycloplegic refraction was defined as refractive error regression. Results A total of 293 eyes on 150 subjects were studied. The preoperative refractive error of the eyes were as follows: 5.5% were myopic, 1% were hyperopic, 4.8% had astigmatism, 76% had myopic astigmatism and 12.6% had hyperopic astigmatism. Regressed and non-regressed eyes were assessed using the generalized estimating equations for the probabilistic variables of demographic characteristics, topography and eye refraction. The variables of simulated keratometry astigmatism (simK) (OR = 2.8; p = 0.04), 5 mm irregularity (OR = 3.56; p = 0.01) and sphere value (OR = 1.98; p = 0.01) were significantly related to refractive error regression. There was no significant relationship between the regressed and non-regressed eyes of the same person (p ≥ 0.05). Conclusion There was a positive relationship between the increase of 5 mm irregularity, simK, sphere value before surgery and refractive error regression. Age, sex and type of refraction error of the patient and the expertise of the PRK surgeon could change the general results; therefore, not all cases should be dealt with identically.
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Affiliation(s)
- Mehdi Naderi
- Department of Clinical Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, I.R, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, I.R, Iran.
| | - Soheila Khodakarim
- Department of Clinical Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, I.R, Iran
| | - Farid Daneshgar
- Department of Ophthalmology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Artini W, B Riyanto S, Hutauruk JA, D Gondhowiardjo T, Kekalih A. Predictive Factors for Successful High Myopia Treatment Using High-Frequency Laser- In-Situ Keratomileusis. Open Ophthalmol J 2018; 12:214-225. [PMID: 30123384 PMCID: PMC6062894 DOI: 10.2174/1874364101812010214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/18/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
Aim To evaluate the predictive factors of LASIK procedure for high myopia with or without astigmatism using a combination of high-frequency femtosecond-assisted LASIK followed by an excimer laser. Methods This study was a retrospective interventional case series study to evaluate myopic eyes undergoing high platform LASIK with FEMTO LDV Z2 intervention, followed by WaveLight®EX500 excimer laser machine. Subjects were divided into 2 groups: high myopia (SE of -6.01 to -9.00 D) and very high myopia (SE of -9.01 D or higher). Myopic eyes (Spherical Equivalent/SE) less than -13 D were included in this study. Visual Acuity (VA) was evaluated 1 day and 60 days after the procedure. Predictive factors, such as age, degree of sphere, degree of astigmatism, keratometric reading and axial length were analyzed to detect any influences affecting the final VA results. Results A total of 316 myopia eyes underwent intervention, mean age: 25.3±3.8 years. Target treatment was achieved in 96.1% of patients with high myopia and 69.9% of patients with very high myopia. High degree of sphere and astigmatism constitutes an important factor influencing final VA. Conclusion Modern machines provide a more promising efficacy and success of LASIK procedure in high myopia: important predictive factors were a high degree of sphere and astigmatism for achieving the optimal final outcome.
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Affiliation(s)
- Widya Artini
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Kirana Hospital, Jakarta, Indonesia.,Jakarta Eye Center Menteng Jakarta, Jakarta, Indonesia
| | | | | | - Tjahjono D Gondhowiardjo
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Kirana Hospital, Jakarta, Indonesia.,Jakarta Eye Center Menteng Jakarta, Jakarta, Indonesia
| | - Aria Kekalih
- Community Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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35
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Bao F, Wang J, Cao S, Liao N, Shu B, Zhao Y, Li Y, Zheng X, Huang J, Chen S, Wang Q, Elsheikh A. Development and clinical verification of numerical simulation for laser in situ keratomileusis. J Mech Behav Biomed Mater 2018; 83:126-134. [PMID: 29704827 DOI: 10.1016/j.jmbbm.2018.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
To develop and validate numerical models of the laser in situ keratomileusis (LASIK) procedure through considering its effect on corneal biomechanical behavior. 3D finite element models of the human eye were developed to simulate LASIK. The models' predictions of post-operative corneal elevation, corneal refractive power with vector decomposition (M-c-pos, J0-c-pos, J45-c-pos) and refractive error correction (M-rec, J0-rec, J45-rec) were compared against clinical data obtained for 28 eyes of 28 patients. A parallel exercise was conducted to estimate the post-operative corneal shape using a shape subtraction method (SSM) - which does not consider the effects of LASIK on corneal mechanical behavior - and the results are compared with the finite element method (FEM). A significant decrease in elevation differences between FEM predictions and clinical data was found compared with the differences between SSM results and clinical data (p = 0.000). In addition, there were no significant differences in post-operative equivalent sperical corneal refractive power between FEM results and corresponding clinical data (M-c-pos: p = 0.501), while SSM showed significant differences with clinical data (M-c-pos: p = 0.000). Further, FEM achieved a predicted value of M-c-pos within ± 1.00D accuracy in 100% of cases, compared with 57% achieved by the SSM. M-rec predicted by FEM was not significantly different from clinical results (p = 0.085), while SSM overestimated it (p = 0.000). The match between LASIK numerical model predictions with clinical measurements improved significantly when the procedure's effect on corneal biomechanical behavior was considered. This outcome has important implications on efforts to develop planning tools for refractive surgery.
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Affiliation(s)
- FangJun Bao
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China; The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - JunJie Wang
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China; The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - Si Cao
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China
| | - Na Liao
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China
| | - Bao Shu
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China
| | - YiPing Zhao
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China
| | - YiYu Li
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China
| | - XiaoBo Zheng
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China; The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China
| | - JinHai Huang
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China
| | - ShiHao Chen
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China.
| | - QinMei Wang
- Eye Hospital, WenZhou Medical University, Wenzhou 325027, China; The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province 325027, China.
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool L69 3GH, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Lee S, Choi DYD, Lim DH, Chung TY, Han JC, Kee C. Lamina Cribrosa Changes after Laser In Situ Keratomileusis in Myopic Eyes. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:95-102. [PMID: 29611373 PMCID: PMC5906408 DOI: 10.3341/kjo.2017.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/28/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia. METHODS Enhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators. RESULTS Forty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month. CONCLUSIONS The LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.
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Affiliation(s)
- Soomin Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Ye Diana Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Gros-Otero J, Garcia-Gonzalez M, Teus MA, Iglesias-Iglesias M, Gimenez-Vallejo C. Femtosecond laser-assisted sub-Bowman keratomileusis versus laser-assisted subepithelial keratomileusis to correct myopic astigmatism. JOURNAL OF OPTOMETRY 2018; 11:33-39. [PMID: 27751694 PMCID: PMC5777929 DOI: 10.1016/j.optom.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/12/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare femtosecond laser-assisted sub-Bowman keratomileusis (FSBK) versus laser-assisted subepithelial keratomileusis (LASEK) to correct moderate to high myopic astigmatism. METHODS Retrospective, nonrandomized, interventional, comparative case series. A total of eight hundred and fifty-two eyes with myopic astigmatism of -1.5 diopters (D) or higher were included in the study. We compared 427 eyes treated with FSBK versus 425 eyes treated with LASEK with or without mitomycin C. Visual and refractive results were evaluated 1 day, 1 week, 3 and 6 months postoperatively. RESULTS Six months postoperatively, the residual spherical defect was slightly but significantly higher in the LASEK group (+0.15±0.62D) than in the FSBK group (+0.09±0.35D) (P=0.05). The postoperative residual astigmatism was also slightly but significantly higher in the LASEK group (-0.38±0.52D) than in the FSBK group (-0.26±0.45D) (P=0.0005). No significant differences were found in the efficacy (0.98±0.17 versus 0.98±0.36, P=0.6) and safety indexes (1.04±0.16 versus 1.05±0.37, P=0.1) between FSBK and LASEK. The enhancement rate was significantly higher in the FSBK group (22.6%) than in the LASEK group (15.5%) (P=0.01). CONCLUSIONS Both FSBK and LASEK are safe and effective procedures to correct moderate to high myopic astigmatism. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 6-month follow-up.
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Affiliation(s)
- Juan Gros-Otero
- Clínica Rementería, C/Almagro 36, 28010 Madrid, Spain; Hospital Universitario "Príncipe de Asturias," University of Alcalá, Carretera de meco s/n, Alcalá de Henares, Madrid, Spain.
| | - Montserrat Garcia-Gonzalez
- Clínica Rementería, C/Almagro 36, 28010 Madrid, Spain; Clínica Novovisión, C/Castellana 54, 28046 Madrid, Spain
| | - Miguel A Teus
- Hospital Universitario "Príncipe de Asturias," University of Alcalá, Carretera de meco s/n, Alcalá de Henares, Madrid, Spain; Clínica Novovisión, C/Castellana 54, 28046 Madrid, Spain
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Abstract
Corneal collagen cross-linking has become the preferred modality of treatment for corneal ectasia since its inception in late 1990s. Numerous studies have demonstrated the safety and efficacy of the conventional protocol. Our understanding of the cross-linking process is ever evolving, with its wide implications in the form of accelerated and pulsed protocols. Newer advancements in technology include various riboflavin formulations and the ability to deliver higher fluence protocols with customised irradiation patterns. A greater degree of customisation is likely the path forward, which will aim at achieving refractive improvements along with disease stability. The use of cross-linking for myopic correction is another avenue under exploration. Combination of half fluence cross-linking with refractive correction for high errors to prevent post LASIK regression is gaining interest. This review aims to highlight the various advancements in the cross-linking technology and its clinical applications.
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Chan TCY, Ng ALK, Chan KKW, Cheng GPM, Wong IYH, Jhanji V. Combined application of prophylactic corneal cross-linking and laser in-situ keratomileusis - a review of literature. Acta Ophthalmol 2017; 95:660-664. [PMID: 27910295 DOI: 10.1111/aos.13324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
Abstract
Laser in-situ keratomileusis (LASIK) is safe and effective laser refractive procedures in treating refractive errors. However, regression of treatment and iatrogenic keratectasia remain to be a major concern, especially in treating thin cornea with high ametropia. Collagen cross-linking (CXL) is an effective method in stopping keratoconus progression through increasing the biomechanical strength of the cornea. Adjuvant cross-linking to refractive procedures can theoretically help prevent regression and reduce the risk of keratectasia development by increasing the mechanical stability of cornea. During the procedure, riboflavin is directly applied to the corneal stroma, thereby reducing the need of de-epithelialization as in the conventional protocol for keratoconus. Currently, there is still no consensus regarding the indication of CXL during refractive procedure, nor any standardized treatment protocol. This article aims to summarize the current evidence regarding the use of adjuvant CXL in LASIK.
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Affiliation(s)
- Tommy C. Y. Chan
- Hong Kong Eye Hospital; Kowloon Hong Kong
- Department of Ophthalmology and Visual Sciences; The Chinese University of Hong Kong; Kowloon Hong Kong
| | - Alex L. K. Ng
- Department of Ophthalmology; The University of Hong Kong; Hong Kong Hong Kong
| | - Karen K. W. Chan
- Department of Ophthalmology; Prince of Wales Hospital; New Territories Hong Kong
| | | | - Ian Y. H. Wong
- Department of Ophthalmology; The University of Hong Kong; Hong Kong Hong Kong
| | - Vishal Jhanji
- Hong Kong Eye Hospital; Kowloon Hong Kong
- Department of Ophthalmology and Visual Sciences; The Chinese University of Hong Kong; Kowloon Hong Kong
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Lloyd-McKernan A, Simo Mannion L, O’Dwyer V. The effect of previous soft contact lens wear on corneal refractive surgery outcomes. Cont Lens Anterior Eye 2017; 40:301-310. [DOI: 10.1016/j.clae.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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Iu LP, Fan MC, Chen IN, Lai JS. Predictability and stability of laser-assisted subepithelial keratectomy with mitomycin C for the correction of high myopia. Medicine (Baltimore) 2017; 96:e7076. [PMID: 28562575 PMCID: PMC5459740 DOI: 10.1097/md.0000000000007076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the predictability and stability of laser-assisted subepithelial keratectomy (LASEK) with mitomycin C (MMC) in correction of high myopia (≤-6.0 diopters [D]) as compared to low-to-moderate myopia (>-6.0 D).This is a retrospective, comparative, cohort study which included 43 eyes of 43 consecutive patients who underwent LASEK with MMC in a private hospital in Hong Kong by a single surgeon. Twenty-five eyes had high myopia (mean spherical equivalent [SE] = -8.53 ± 1.82 D) and 18 eyes had low-to-moderate myopia (mean SE = -3.99 ± 1.37 D) before surgery.In terms of refractive predictability, mean SE was significantly better in eyes with preoperative low-to-moderate myopia than high myopia at 6 months (0.04 ± 0.23 vs 0.31 ± 0.52 D, P = .035). In terms of refractive stability, between 1 and 3 months, both groups had mean absolute change of SE of around 0.25 D. Between 3 and 6 months, preoperative low-to-moderate myopia group had significantly less absolute change of SE compared to high myopia group (0.07 vs 0.23 D, P = .003). More eyes with preoperative high myopia changed SE by more than 0.25 D than those with low-to-moderate myopia between 3 and 6 months (32.0% vs 5.6%, P = .057).In conclusion, LASEK with MMC is more unpredictable and unstable in correction of high myopia than low-to-moderate myopia. The refractive outcome of most low-to-moderate myopia correction stabilizes at 3 months. Stability is not achieved until after 6 months in high myopia correction.
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Affiliation(s)
- Lawrence P.L. Iu
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital
| | - Michelle C.Y. Fan
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital
| | - Ivan N. Chen
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Jimmy S.M. Lai
- Department of Ophthalmology, The University of Hong Kong, Grantham Hospital
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Pahuja NK, Shetty R, Deshmukh R, Sharma A, Nuijts RMMA, Jhanji V, Sethu S, Ghosh A. In vivo confocal microscopy and tear cytokine analysis in post-LASIK ectasia. Br J Ophthalmol 2017; 101:1604-1610. [PMID: 28450380 DOI: 10.1136/bjophthalmol-2016-309142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 01/23/2017] [Accepted: 03/21/2017] [Indexed: 11/03/2022]
Abstract
AIM Corneal keratectasia is one of the complications associated with laser in situ keratomileusis (LASIK) that results in vision impairment. The pathogenesis of post-LASIK ectasia (PLE) remains underexplored. We report the tear cytokine profile and in vivo confocal microscopy (IVCM) findings in eyes with PLE. METHODS This retrospective study included age-matched 7 (14 eyes) post-LASIK controls (PLCs) and 6 (12 eyes) PLE subjects. Corneal topography was used to categorise the subjects into PLC and PLE groups. Ocular Surface Disease Index (OSDI) scores obtained were based on standard questionnaire and IVCM images were used to determine corneal dendritic cells density (DCD) and sub-basal nerve plexus morphology. Inflammatory cytokines/chemokines in the tears were quantified using flow cytometry based cytometric bead array. RESULTS Pentacam-based scores, OSDI scores and corneal DCD were significantly (p<0.05) higher in patients with PLE compared with PLC. Discomfort-related subscale of OSDI score exhibited a positive correlation with total corneal DCD in the PLE cohort. The fold difference of chemokine (C-C motif) ligand/monocyte chemotactic protein-1 (CCL2/MCP1) (3.4±0.6) was found to be significantly (p<0.05) higher in the PLE cohorts and a positive correlation between CCL2/MCP1 levels and total corneal DCD was also observed in the PLE cohort. CONCLUSION The current study found a significant difference in the tear film cytokine profile between normal and PLE eyes. Presence of increased corneal dendritic cells and altered tear cytokines suggests an ongoing inflammatory response in PLE.
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Affiliation(s)
| | - Rohit Shetty
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | - Rashmi Deshmukh
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | - Anupam Sharma
- Narayana Nethralaya Foundation, GROW Research Laboratory, Bangalore, India
| | - Rudy M M A Nuijts
- Cornea Clinic, Department of Ophthalmology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,UPMC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Swaminathan Sethu
- Narayana Nethralaya Foundation, GROW Research Laboratory, Bangalore, India
| | - Arkasubhra Ghosh
- Narayana Nethralaya Foundation, GROW Research Laboratory, Bangalore, India.,Singapore Eye Research Institute, Singapore
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Mori Y, Miyata K, Ono T, Yagi Y, Kamiya K, Amano S. Comparison of laser in situ ketatomileusis and photorefractive keratectomy for myopia using a mixed-effects model. PLoS One 2017; 12:e0174810. [PMID: 28362808 PMCID: PMC5375153 DOI: 10.1371/journal.pone.0174810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/15/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the results of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for myopia using a mixed-effects model. Methods This comparative retrospective study was conducted in 1,127 eyes of 579 patients after LASIK and 270 eyes of 144 patients after PRK who had two or more postoperative follow-ups after 3 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refractive spherical equivalent (MRSE), percentage of eyes within ± 0.5 diopters (D) and ± 1.0 D of targeted refraction, and central corneal thickness were compared between PRK and LASIK groups using a mixed-effects model. Results Compared with the LASIK group, UCVA in the PRK group was significantly worse in the initial year but was significantly better after 4 years. The average BSCVA was not significantly different between the LASIK and PRK groups after 4 years. The average gain of BSCVA in the PRK group was significantly larger than that of the LASIK group after 2 years. MRSE in the LASIK and PRK groups showed a gradual myopic shift until 6 years after surgery. After 6 years, MRSE in the PRK group remained stable whereas MRSE in the LASIK group continued a myopic shift. The percentages of eyes within ± 0.5 D or ± 1.0 D in the LASIK group were significantly higher than those in the PRK group at 3 months but were significantly lower than those in the PRK group at 10 years. Conclusions PRK for myopia shows better efficacy than LASIK for myopia after 4 years.
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Affiliation(s)
| | | | | | | | - Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
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Kamiya K, Igarashi A, Hayashi K, Negishi K, Sato M, Bissen-Miyajima H. A Multicenter Prospective Cohort Study on Refractive Surgery in 15 011 Eyes. Am J Ophthalmol 2017; 175:159-168. [PMID: 28034710 DOI: 10.1016/j.ajo.2016.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the clinical outcomes of currently used refractive surgery procedures performed in 2015. DESIGN Prospective, multicenter cohort study. METHODS This prospective study included 15 011 eyes of 7622 consecutive patients who underwent laser in situ keratomileusis (LASIK), surface ablation, refractive lenticule extraction (ReLEx), or phakic intraocular lens (IOL) implantation at 42 major institutions. We determined the safety, efficacy, predictability, stability, and adverse events of these surgeries preoperatively and at 1 week and 1 and 3 months postoperatively. RESULTS Mean logMAR corrected distance visual acuity 3 months after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, or iris-supported phakic IOL implantation was -0.18 ± 0.07, -0.16 ± 0.08, -0.17 ± 0.09, -0.21 ± 0.08, and -0.10 ± 0.12, respectively; the corresponding values for logMAR uncorrected distance visual acuity were -0.15 ± 0.11, -0.12 ± 0.12, -0.12 ± 0.13, -0.15 ± 0.12, and 0.01 ± 0.21, respectively. The percentages within ±1.0 diopter (D) of the attempted correction were 96%, 93%, 97%, 99%, and 84% after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, and iris-supported phakic IOL implantation, respectively. Refractive change from 1 week to 3 months was -0.08 ± 0.07, 0.21 ± 0.63, -0.04 ± 0.41, 0.01 ± 0.31, and 0.01 ± 0.46 D, respectively. No vision-threatening complications occurred during the observation period. CONCLUSIONS Although more prolonged follow-up is still necessary, currently used refractive surgery procedures have good safety and efficacy outcomes, yielding predictable and stable results. Contemporary LASIK, surface ablation, ReLEx, and phakic IOL implantation appear to be feasible options for the treatment of refractive errors.
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Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.
| | | | - Ken Hayashi
- Department of Ophthalmology, Hayashi Eye Hospital, Fukuoka, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University, Tokyo, Japan
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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.
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Moshirfar M, Jehangir N, Fenzl CR, McCaughey M. LASIK Enhancement: Clinical and Surgical Management. J Refract Surg 2017; 33:116-127. [DOI: 10.3928/1081597x-20161202-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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Comparison of the Demarcation Line on ASOCT After Simultaneous LASIK and Different Protocols of Accelerated Collagen Crosslinking. Cornea 2017; 36:74-77. [DOI: 10.1097/ico.0000000000001012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE To identify the potential risk factors that increase the likelihood of requiring retreatment after refractive surgery. METHODS This retrospective study included patients who underwent laser in situ keratomileusis or photorefractive keratectomy between January 2005 and December 2012 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into 2 groups according to whether they underwent additional refractive surgery (retreatment) during the study period. RESULTS Overall, 41,504 eyes (n = 21,313) were included in the final analysis of this study. Throughout the study period, there was a significant reduction in the 2-year annual retreatment rates with a decline from 4.52% for primary surgeries done in 2005 to 0.18% for surgeries performed in 2012 (quadratic R = 0.96, P < 0.001). The retreatment group had significantly higher preoperative age, maximum keratometric power, sphere, cylinder, and better best-corrected visual acuity. They were more likely to have preoperative hyperopia, photorefractive keratectomy as opposed to laser in situ keratomileusis, intraoperative higher humidity conditions and lower temperature, and higher ablation depths. Significant differences in retreatment rates were found between the 5 high-volume surgeons (>1500 procedures performed) ranging from 0.48 to 3.14% (P < 0.0001). Multiple logistic regression analysis demonstrated that age, astigmatism, hyperopia, temperature, and surgeon's experience all significantly affected the need for retreatment. CONCLUSIONS The following factors significantly increase the need for refractive retreatment: older preoperative age, higher degrees of astigmatism, hyperopia, colder operating room temperature, and less surgeon experience. Some of these factors may be incorporated into nomograms to reduce future retreatment rates.
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Lellouch J, Saad A, Guilbert E, Gatinel D. [Evaluation of vision quality after laser vision correction in healthcare professionals]. J Fr Ophtalmol 2016; 39:849-858. [PMID: 27865691 DOI: 10.1016/j.jfo.2016.09.005] [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: 08/24/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Healthcare professionals require good quality of vision. The main objective of this study is to evaluate the satisfaction and vision quality after laser vision correction in healthcare professionals. METHODS This is a monocentric retrospective study. An online 25-question survey was sent to ametropic physicians, surgeons and nurses who underwent corneal refractive surgery with laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between July 2012 and February 2016. Questionnaire responses were recorded anonymously by the internet survey site. These patients' pre- and postoperative data were analyzed. RESULTS In total, 2491 laser vision corrections were performed during this time frame. One hundred and fifty-eight patients were healthcare providers; 131 received the survey, and 111 responded. Ninety-nine were surgeons, 60 were medical physicians, and 32 were nurses. Ninety-one percent reported that they were satisfied with their postoperative vision quality, 63.9% even reported an improvement in their quality of vision compared with their corrected preoperative vision, 92.8% reported that they would have the procedure again, and 94.6% would recommend the procedure to a family member or a patient. Visual outcomes showed high levels of efficacy and predictability. CONCLUSION While healthcare professionals require good quality of vision, those who had undergone laser vision correction reported the same satisfaction as the general population and would recommend the procedure to their family, friends and patients.
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Affiliation(s)
- J Lellouch
- Fondation ophtalmologique Adolphe de Rothschild, 29, rue Manin, 75019 Paris, France
| | - A Saad
- Fondation ophtalmologique Adolphe de Rothschild, 29, rue Manin, 75019 Paris, France
| | - E Guilbert
- Fondation ophtalmologique Adolphe de Rothschild, 29, rue Manin, 75019 Paris, France
| | - D Gatinel
- Fondation ophtalmologique Adolphe de Rothschild, 29, rue Manin, 75019 Paris, France.
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