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Özbilen KT, Altinkurt E, Ceylan NA, Bilgin GS, Gözüm N. Effect of Myopic Femtosecond Laser-Assisted LASIK on Anterior Chamber Inflammation (Flare Values) and Corneal Endothelium: A Prospective before and after Study. J Ophthalmol 2021; 2021:2395028. [PMID: 34868671 PMCID: PMC8642012 DOI: 10.1155/2021/2395028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to investigate whether femtosecond laser-assisted LASIK (FS-LASIK) surgery causes inflammation in the anterior chamber and to analyze its effect on endothelial cells. METHODS This prospective, longitudinal study included left eyes of 30 patients (19 females) who had undergone FS-LASIK surgery due to myopia and myopic astigmatism. Endothelial cell density (ECD) and morphological measurements were performed using a specular microscopy, and laser flare photometry was used to measure the anterior chamber flare values on the day of surgery. iFS™ Advanced FS and VISX STAR S4-IR Wavescan Excimer Laser platforms were used. Flare measurements were repeated on the postoperative 1st day and 7th day and the 1st and 3rd months. The endothelial measurements were repeated in the 3rd month. RESULTS Preoperatively, the mean flare was 5.59 ± 1.24 photons/ms; it was 6.49 ± 2.42 on the postoperative 1st day, 5.87 ± 2.27 on the 7th day, 5.68 ± 1.66 on the 1st month, and 5.35 ± 1.24 on the 3rd month. A significant difference was observed only between the preoperative and postoperative 1st day flare values (p=0.047). The decrease in the ECD was clinically insignificant but statistically significant, with an average of 97.0 ± 209.9 cell count/mm2 (3.3%, p=0.017). However, there was no significant change in the coefficient of variation (p=0.448) and hexagonality (p=0.096). No significant correlation was found between the increase in the flare value on the postoperative 1st day and variables. A significant correlation was found between the decrease in ECD and the preoperative ECD (r = 0.356, p=0.027). CONCLUSION FS-LASIK caused minimal inflammation in the anterior chamber on only the 1st postoperative day; additionally, a minimal decrease of cell count with no morphological changes were noted in the endothelial cells on postoperative 3rd month. This trial is registered with NCT04899258.
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Affiliation(s)
- Kemal Turgay Özbilen
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Emre Altinkurt
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Nihan Aksu Ceylan
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Gizem Sayar Bilgin
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Nilüfer Gözüm
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
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Rocha-de-Lossada C, Rachwani-Anil R, Colmenero-Reina E, Borroni D, Sánchez-González JM. Laser refractive surgery in corneal dystrophies. J Cataract Refract Surg 2021; 47:662-670. [PMID: 33149045 DOI: 10.1097/j.jcrs.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Twenty-eight case reports and case series published between 2000 and 2019 concerning laser refractive surgery in patients with corneal dystrophies, resulting in 173 eyes from 94 patients, were included in this systematic review. Best results were achieved in posterior corneal polymorphous and Cogan dystrophy. Unfavorable results were found in Avellino dystrophy and Fuchs endothelial corneal dystrophy (FECD). Photorefractive keratectomy was not indicated in Meesmann and Avellino dystrophy. Laser in situ keratomileusis was indicated in posterior polymorphous corneal dystrophy but not in FECD, Avellino, or Cogan dystrophy. Small-incision lenticule extraction and other dystrophies such as lattice, fleck, Lisch, or François did not achieve enough scientific evidence to report any recommendation.
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Affiliation(s)
- Carlos Rocha-de-Lossada
- From the Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain (Rocha-de-Lossada); Department of Ophthalmology, Regional University Hospital of Malaga, Malaga, Spain (Rachwani-Anil); Department of Ophthalmology and Optometry, Vistalaser Clinic, Malaga, Spain (Colmenero-Reina); Department of Doctoral Studies, Riga Stradins University, Riga, Latvia (Borroni); Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, United Kingdom (Borroni); Department of Physics of Condensed Matter, Optics Area. University of Seville, Seville, Spain (Sánchez-González); Department of Ophthalmology, Tecnolaser Clinic Vision, Refractive Surgery Centre, Seville, Spain (Sánchez-González)
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Kim BK, Chung YT. Small Incision Lenticule Extraction (SMILE) in Patients with Corneal Guttae. Clin Ophthalmol 2020; 14:2485-2490. [PMID: 32904630 PMCID: PMC7457713 DOI: 10.2147/opth.s267847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report 12-month results of small incision lenticule extraction (SMILE) in the treatment of myopia with corneal guttae (CG). Methods We conducted a retrospective analysis of 12 eyes from six patients who had preoperative CG without clinical sign of Fuchs’ endothelial corneal dystrophy (FECD) and had SMILE for correction of myopia. Preoperative and 12-month postoperative measurements included uncorrected distance visual acuity (UDVA), spherical equivalent (SE), endothelial cell density (ECD), the coefficient of variation (CV), the percentage of hexagonal cells (HEX), and central corneal thickness (CCT). The changes in ECD, CV, HEX, and CCT after SMILE were subjected to statistical analysis. Results Twelve months postoperatively, the mean SE was −0.10 ± 0.32 D and all eyes had a UDVA of 0 logMAR or better. No eyes developed corneal edema or other complication during the follow-up period. There were no significant changes in the ECD, CV, or HEX at 12 months (all p>0.05). Conclusion SMILE yielded improvement in visual acuity and no adverse effects to corneal endothelial cells were found when correcting myopia or myopic astigmatism in patients with CG. However, studies with a greater number of patients and longer follow-up periods are needed to establish the long-term outcomes and safety.
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Affiliation(s)
- Bu Ki Kim
- Onnuri Smile Eye Clinic, Gangnam-Daero 65 Gil, Seoul, Seocho-gu, Republic of Korea
| | - Young Taek Chung
- Onnuri Eye Hospital, Baekje-Daero, Wansan-Gu, Jeonju-si, Jeollabuk-do, Republic of Korea
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Galvis V, Berrospi RD, Tello A, Santaella G. Interface Fluid Syndrome (IFS) following Toxic Anterior Segment Syndrome (TASS): not related to high intraocular pressure but to endothelial failure. Saudi J Ophthalmol 2018; 33:88-93. [PMID: 30930670 PMCID: PMC6424685 DOI: 10.1016/j.sjopt.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/29/2018] [Indexed: 11/19/2022] Open
Abstract
We describe the case of a 52-year-old female with past history of LASIK, 21 years earlier, without Fuchs’ endothelial dystrophy, who underwent phacoemulsification and intraocular lens (IOL) implantation. During the early postoperative period severe corneal edema, anterior chamber cellularity and iris inflammation presented, accompanied by a clear space along the LASIK interface. Those findings were interpreted as part of a Toxic Anterior Segment Syndrome (TASS) and secondary interface fluid syndrome (IFS). When interface fluid was present, intraocular pressure (IOP) measured in the center of the cornea yielded very low values. In addition, applanation tonometry performed in the corneal periphery, as well as Schiotz tonometry and digital tonometry also indicated that the IOP was not high. Fluid in the interface persisted until a DMEK was carried out 11 months after the phacoemulsification surgery. Five days postoperatively the IFS resolved, confirmed by OCT imaging. The origin of IFS in this case was corneal edema secondary to endothelial cell dysfunction and it was not related to high IOP. This is the first reported case of IFS following TASS, the third case published of DMEK procedure used to solve endothelial failure-related IFS, and the case with the longest time of presentation after LASIK.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
- Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Colombia
| | - Rubén D. Berrospi
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
- Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
- Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Universidad Autónoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Colombia
- Corresponding author at: Centro Oftalmológico Virgilio Galvis, Centro Médico Ardila Lulle, Module 7, Floor 3, El Bosque, Floridablanca, Santander, Colombia. Fax: +57 7 6392626.
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Interface Fluid Syndrome After Laser In Situ Keratomileusis (LASIK) Because of Fuchs Endothelial Dystrophy Reversed by Descemet Membrane Endothelial Keratoplasty (DMEK). Cornea 2016; 35:1658-1661. [DOI: 10.1097/ico.0000000000000971] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LASIK and surface ablation in corneal dystrophies. Surv Ophthalmol 2014; 60:115-22. [PMID: 25307289 DOI: 10.1016/j.survophthal.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 11/22/2022]
Abstract
Corneal dystrophies are a rare group of hereditary disorders, that are bilateral, non-inflammatory, and progressive. Clinically, they can be classified based on the anatomic layer of the cornea affected. Refractive surgery and phototherapeutic keratectomy (PTK) can be performed with caution in patients with certain corneal dystrophies, but should be avoided in others. For epithelial basement membrane dystrophy, photorefractive keratectomy (PRK) is the procedure of choice for treatment of refractive error, and PTK may be performed for the treatment of recurrent erosions or irregular astigmatism. PRK and laser-assisted in situ keratomileusis (LASIK) have been associated with exacerbation of combined granular-lattice corneal dystrophy. LASIK and PRK appear to be safe in mild forms of posterior polymorphous corneal dystrophy, whereas LASIK should be avoided in Fuchs dystrophy. The safety of refractive surgery and PTK in the remainder of epithelial, Bowman layer, and stromal dystrophies has yet to be established.
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Zoega GM, Arnarsson A, Sasaki H, Söderberg PG, Jonasson F. The 7-year cumulative incidence of cornea guttata and morphological changes in the corneal endothelium in the Reykjavik Eye Study. Acta Ophthalmol 2013; 91:212-8. [PMID: 22339815 DOI: 10.1111/j.1755-3768.2011.02360.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To examine the corneal endothelium and establish the 7-year cumulative incidence of cornea guttata (CG). METHODS Population-based prospective cohort study with 573 participants (third wave of the Reykjavik Eye Study (RES) in 2008). Four hundred and thirty-seven subjects had either right or left eyes available for analysis after excluding confounding eye conditions. The baseline for eyes at risk for developing CG is the second wave of the RES in 2001. Participants underwent specular microscopy and a standardized eye examination. RESULTS The cumulative 7-year incidence of CG in either eye was estimated as a 95% confidence interval for the expected value for both genders combined (15-23%), for males (8-18%) and for females (19-29%). In right eye only, the 7-year cumulative incidence for both genders combined was estimated to be 6-11%. For genders combined and for males only, the data indicated no correlation between 7-year cumulated incidence and age at baseline. In women, however, the change of 7-year incidence for CG in at least one eye appeared to be correlated to age at baseline. Reduction of endothelial cell density for corneas with CG at baseline was found [CI (0.95)-132 ± 94]. CONCLUSION The cumulative 7-year incidence of primary central CG for a middle-aged and older Caucasian population without history of potentially confounding eye disease has been established. Women tend to have higher incidence if onset occurs at middle age. If CG is present, the cell density and the cell size variation decrease within a 7-year period.
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Affiliation(s)
- Gunnar M Zoega
- Gullstrand Lab, Ophthalmology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Interface Fluid Syndrome in Routine Cataract Surgery 10 Years After Laser In Situ Keratomileusis. Cornea 2012; 31:706-7. [DOI: 10.1097/ico.0b013e3182254020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Muñoz G, Albarrán-Diego C, Sakla HF, Ferrer-Blasco T, Javaloy J. Effects of LASIK on Corneal Endothelium Using the 15-kHz IntraLase Femtosecond Laser. J Refract Surg 2011; 27:672-7. [PMID: 21563730 DOI: 10.3928/1081597x-20110415-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/01/2011] [Indexed: 11/20/2022]
Affiliation(s)
- Gonzalo Muñoz
- Refractive Surgery Department, Clinica Oftalmologica Marques de Sotelo, Valencia, Spain.
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Smith RT, Waring GO, Durrie DS, Stahl JE, Thomas P. Corneal endothelial cell density after femtosecond thin-flap LASIK and PRK for myopia: a contralateral eye study. J Refract Surg 2010; 25:1098-102. [PMID: 20000291 DOI: 10.3928/1081597x-20091117-09] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 02/03/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the effect of femtosecond thinflap LASIK and photorefractive keratectomy (PRK) on postoperative endothelial cell density. METHODS In a prospective, randomized, contralateral, single-center clinical trial, 25 patients (mean age: 30+/-5 years [range: 21 to 38 years]) underwent PRK in one eye and thin-flap LASIK in the fellow eye for the correction of myopia using a wavefront-guided platform. The central corneal endothelial cell density was measured using the NIDEK Confoscan 4 preoperatively, and at 1 and 3 months postoperatively. Changes in endothelial cell density were analyzed over time between the two refractive techniques. RESULTS In PRK, the average preoperative endothelial cell density was 3011+/-329 cells/mm(2), which decreased to 2951+/-327 cells/mm(2) at 1 month (P=.5736) and 2982+/-365 cells/mm(2) at 3 months (P=.6513). In thinflap LASIK, the average preoperative endothelial cell density was 2995+/-325 cells/mm(2), which decreased to 2977+/-358 cells/mm(2) at 1 month (P=.5756) and 2931+/-369 cells/mm(2) at 3 months (P=.4106). No statistically significant difference was found between the two groups at 1 (P=.7404) or 3 (P=.3208) months postoperatively. CONCLUSIONS No statistically significant change was noted in endothelial cell density following either PRK or thin-flap LASIK for the treatment of myopia. Furthermore, no statistically significant difference was found between the two groups out to 3 months postoperatively, indicating that thin-flap LASIK is as safe as PRK with regards to endothelial health.
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Dawson DG, Schmack I, Holley GP, Waring GO, Grossniklaus HE, Edelhauser HF. Interface Fluid Syndrome in Human Eye Bank Corneas after LASIK. Ophthalmology 2007; 114:1848-59. [PMID: 17908592 DOI: 10.1016/j.ophtha.2007.01.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 01/06/2007] [Accepted: 01/09/2007] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the effects of corneal edema on human donor corneas that had previous LASIK using a laboratory model with histologic and ultrastructural correlations. DESIGN Experimental study. PARTICIPANTS Thirty human eye bank corneas from 15 donors (mean age +/- standard deviation, 49.9+/-8.9 years) who had had previous LASIK surgery (2-8 years before death). METHODS The corneas were mounted in an artificial anterior chamber and the corneal endothelium was perfused for up to 5.0 hours with 0.9% saline solution (endothelial cell damage group) or BSS Plus at a pressure of 15 mmHg (control group), or BSS Plus at a pressure of 55 mmHg (high-pressure group). The corneas were evaluated by confocal and specular microscopy before, during, and at the end of the experimental period. Subsequently, the specimens were evaluated by light and electron microscopy. MAIN OUTCOME MEASURES Corneal thickness, reflectivity, histology, and ultrastructure. RESULTS Endothelial cell damage resulted in an increased (141.5+/-38.8 microm) total corneal thickness relative to controls (52.3+/-33.7 microm), whereas high pressure resulted in a decreased thickness (24.8+/-14.1 microm) relative to controls. This ultimately was due to swelling of the LASIK interface in both groups and swelling of the residual stromal bed (RSB) in the endothelial cell damage group or compression of the RSB and, possibly, the flap in the high-pressure group. A significant increase in corneal reflectivity at the LASIK interface occurred in both groups, primarily due to varying degrees of fluid accumulation and associated hydropic keratocyte degeneration, as well as increased corneal reflectivity in the RSB only in the endothelial cell damage group. CONCLUSIONS After LASIK surgery, edematous corneas preferentially hydrate and swell in the paracentral and central interface wound, commonly resulting in a hazy corneal appearance primarily due to keratocyte hydropic degeneration. More severe corneal edema is characterized by the formation of an optically empty space corresponding to an interface fluid pocket. The spectrum of interface fluid syndrome can be described in 3 stages.
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Affiliation(s)
- Daniel G Dawson
- Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Frucht-Pery J, Landau D, Raiskup F, Orucov F, Strassman E, Blumenthal EZ, Solomon A. Early Transient Visual Acuity Loss After LASIK Due to Steroid-induced Elevation of Intraocular Pressure. J Refract Surg 2007; 23:244-51. [PMID: 17385289 DOI: 10.3928/1081-597x-20070301-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical course of early transient reduction of uncorrected visual acuity (UCVA) after LASIK surgery resulting from steroid-induced elevation of intraocular pressure (IOP). METHODS Twenty-nine eyes of 15 patients who received topical corticosteroids after uneventful myopic LASIK surgery and had a decrease in UCVA within the first 3 weeks were evaluated retrospectively. RESULTS Intraocular pressure increased by 4 to 30 mmHg from preoperative to postoperative days 4 to 20. Twenty-seven of 29 eyes had a decrease in UCVA and/or best spectacle-corrected visual acuity (BSCVA). All eyes, except one, had edema without evidence of inflammation in the interface or the remainder of the cornea. Discontinuation of topical corticosteroids and application of anti-glaucoma medications resulted in a decrease of IOP to normal levels, reduction or disappearance of the edema, and recovery of BSCVA. CONCLUSIONS Early onset steroid-induced elevation of IOP after LASIK may cause corneal edema and a sudden decrease in UCVA. Rapid diagnosis and treatment can control IOP and recover the visual loss.
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Affiliation(s)
- Joseph Frucht-Pery
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Abstract
PURPOSE To report the outcome of laser in situ keratomileusis (LASIK) in a patient with Fleck corneal dystrophy. METHODS Case report and literature review. RESULTS A 48-year-old Taiwanese man presented in November 2005, 6 years after bilateral myopic LASIK. He complained of loss of uncorrected distance visual acuity that was worse in the left eye. The patient did not report glare, halos, or other visual aberrations. Preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 OU, with a manifest refraction of -14 D OU. In November 2005, uncorrected visual acuity (UCVA) was 20/40 OD and 20/50 OS, and BSCVA was 20/25 in each eye with a manifest refraction of -1.00 sphere OD and -1.75 -1.25 x 115 OS. Slit-lamp examination was remarkable for several subtle, small, gray corneal opacities present throughout the corneal stroma. Confocal microscopy revealed refractile bodies within swollen keratocytes and normal surrounding stromal mileu. The clinical and confocal appearance was consistent with Fleck corneal dystrophy. CONCLUSION In this patient with Fleck corneal dystrophy, corneal clarity and BSCVA were maintained 6 years after bilateral myopic LASIK, suggesting that LASIK does not stimulate visually significant exacerbation of Fleck corneal dystrophy.
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Wykoff CC, Pineda R. Myopic laser in situ keratomileusis in eyes with thick corneas. J Cataract Refract Surg 2006; 32:900-1. [PMID: 16765817 DOI: 10.1016/j.jcrs.2006.01.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Indexed: 10/24/2022]
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Moshirfar M, Feiz V, Feilmeier MR, Kang PC. Laser in situ keratomileusis in patients with corneal guttata and family history of Fuchs' endothelial dystrophy. J Cataract Refract Surg 2006; 31:2281-6. [PMID: 16473218 DOI: 10.1016/j.jcrs.2004.05.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE To report 1-year results of laser in situ keratomileusis (LASIK) in 7 eyes with corneal endothelial guttata and a family history of Fuchs' endothelial dystrophy. SETTING John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS A retrospective chart review was performed of 4 patients (7 eyes) who had trace to 1+endothelial guttata and a family history of Fuchs dystrophy and then had uneventful LASIK for the correction of myopia and myopic astigmatism. Preoperative and postoperative measurements included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, endothelial cell density (ECD), manifest refraction, and spherical equivalent. The changes in ECD, pachymetry, and spherical equivalent after LASIK were subjected to statistical analysis using a paired Student t test to determine significance. RESULTS Transient corneal edema was noted in the early postoperative period in 3 eyes of 2 patients. At 1 year, 6 of the 7 (86%) eyes had lost > or =2 lines of BSCVA. A statistically significant decrease in ECD of 12.4% +/- 2.7% was observed at 1 year compared with baseline (P < .001). An increase in corneal thickness (P = .006) and a statistically significant myopic shift in spherical equivalent (P = .017) was also noted at 1 year compared with 3 months. CONCLUSIONS Patients with mild corneal guttata and a family history of Fuchs' dystrophy are prone to transient corneal edema, loss of BSCVA, endothelial cell loss, and myopic regression after uneventful LASIK for correction of myopia and myopic astigmatism.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
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Affiliation(s)
- Lewis R Groden
- Department of Ophthalmology, University of South Florida College of Medicine, MDC Box 21, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Affiliation(s)
- Marcelo V Netto
- The Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Wirbelauer C, Pham DT. Imaging interface fluid after laser in situ keratomileusis with corneal optical coherence tomography. J Cataract Refract Surg 2005; 31:853-6. [PMID: 15899468 DOI: 10.1016/j.jcrs.2004.08.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2004] [Indexed: 11/26/2022]
Abstract
A 41-year-old myopic patient who had laser in situ keratomileusis 6 months earlier was treated for a complete retinal detachment (RD) with proliferative vitreoretinopathy. Surgical treatment consisted of an encircling band, pars plana vitrectomy, and silicone oil filling. Postoperatively, the patient developed marked corneal edema with no increase in intraocular pressure (IOP) as measured by applanation tonometry. Interface fluid was confirmed by corneal optical coherence tomography. Quantification of the corneal structures revealed that corneal edema was in the residual posterior stroma predominantly. The epithelial and flap thickness did not change significantly. The case demonstrated that after vitreoretinal surgery for RD repair, transient corneal endothelial cell dysfunction developed, causing marked edema of the posterior corneal stroma and interface fluid accumulation. However, an increase in IOP cannot be excluded.
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Loh RS, Hardten DR. Noninflammatory flap edema after laser in situ keratomileusis associated with asymmetrical preoperative corneal pachymetry. J Cataract Refract Surg 2005; 31:922-9. [PMID: 15975457 DOI: 10.1016/j.jcrs.2004.08.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2004] [Indexed: 12/01/2022]
Abstract
PURPOSE To report persistent unilateral flap edema following laser in situ keratomileusis (LASIK) in patients with asymmetrical central corneal thickness. SETTING Minnesota Eye Consultants, Minneapolis, Minnesota. METHODS Retrospective, noncomparative interventional case series. RESULTS We examined 6 eyes of 3 patients with asymmetrical preoperative pachymetry who developed persistent unilateral flap edema after uneventful myopic LASIK in the eye with thicker preoperative pachymetry. All cases had asymmetrical preoperative pachymetry with flap edema developing in the eye with higher preoperative mean central corneal thickness (CCT) values, preoperative mean CCT subject eye 622 microm (range 556-664 microm) versus fellow eye 583 microm (range 510-621 microm). There was no associated ocular inflammation or rise in intraocular pressure. Significant flap edema resolved on a combination treatment of topical steroid and hypertonic saline. CONCLUSIONS Laser in situ keratomileusis can cause temporary endothelial cell dysfunction or stress, which manifests as temporary flap edema and subclinical corneal thickening. The edema appears to be limited to the actual flap and there was no loss of epithelial integrity in these eyes and no clinically noticeable interface fluid. This new clinical entity appears to occur in patients with asymmetrical preoperative corneal pachymetry and is associated with postoperative specular microscopy abnormalities. In cases with unexplained asymmetrical corneal thickness, preoperative evaluation should include specular microscopy to evaluate for risk features that may increase the chances of a slower postoperative recovery.
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Affiliation(s)
- Raymond S Loh
- Minnesota Eye Consultants, Minneapolis, Minnesota, USA
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Yuen HKL, Rassier CE, Jardeleza MSR, Green WR, de la Cruz Z, Stark WJ, Gottsch JD. A Morphologic Study of Fuchs Dystrophy and Bullous Keratopathy. Cornea 2005; 24:319-27. [PMID: 15778606 DOI: 10.1097/01.ico.0000148288.53323.b2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the morphologic features of Fuchs corneal dystrophy and compare them with those of bullous keratopathy. METHODS This was an observational case series. The study group consisted of 32 corneal buttons with a diagnosis of Fuchs dystrophy and the comparison group consisted of 22 corneal buttons with bullous keratopathy. Morphologic analysis was performed of corneal buttons from patients with the clinical diagnosis of Fuchs dystrophy or bullous keratopathy by light and electron microscopy. RESULTS The main outcome measure was identification of degenerated keratocytes, granular material in and around keratocytes, and lipid keratopathy. The overall morphologic features of Fuchs dystrophy and bullous keratopathy are similar to those described in previous literature. A high proportion of keratocytes exhibited degenerative changes (78.9% in Fuchs dystrophy versus 50.5% in bullous keratopathy). Granular material was identified in and around variably degenerated keratocytes in all cases of Fuchs dystrophy and in 14 of 22 (64%) of the corneas with bullous keratopathy. The percentage of keratocytes with granular deposits was higher in Fuchs dystrophy corneas as compared with corneas with bullous keratopathy (51.7% versus 14.1%, P < 0.0005). Lipid keratopathy was a common occurrence in both Fuchs dystrophy and bullous keratopathy (23/32 [72%] versus 12/22 [55%]). CONCLUSIONS Histopathologic changes in the corneal stroma and keratocytes occur in Fuchs dystrophy. Secondary lipid keratopathy ensues and may contribute to corneal haze. A higher proportion of keratocytes in Fuchs dystrophy have granular deposit than in bullous keratopathy. That a high proportion of keratocytes had degenerative changes in both Fuchs dystrophy and bullous keratopathy suggests that keratocytes may degenerate secondary to altered stromal microenvironment because of endothelial cell loss.
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Affiliation(s)
- Hunter K L Yuen
- Eye Pathology Laboratory, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-9248, USA
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Moshirfar M, Barsam CA, Tanner MC. Laser in situ keratomileusis in patients with posterior polymorphous dystrophy. Cornea 2005; 24:230-2. [PMID: 15725895 DOI: 10.1097/01.ico.0000139634.88153.bb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report short-term results of LASIK in 4 eyes with the vesicular form of posterior polymorphous dystrophy (PPMD). METHOD A review was performed of 2 patients with PPMD who underwent bilateral LASIK. Patients were asymptomatic at the time of presentation and had no prior ocular history. Preoperative measurements were made of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, and endothelial cell density (ECD). All 4 eyes underwent uneventful LASIK. Postoperative measurements of UCVA and BSCVA were performed at follow-up visits 1 day, 1 month, 3 months, and 1 year after surgery, along with pachymetry and ECD measurements at the 3-month and 1-year visits. Results were analyzed. RESULTS At 1 year, all eyes had an UCVA equal to or better than 20/25 and BSCVA equal to or better than 20/20. There was a small mean endothelial cell loss (2.3%) at 1 year. No adverse events were experienced. CONCLUSIONS Short-term results indicate efficacy and safety of LASIK on eyes with posterior polymorphous dystrophy. Further study is needed to assess long-term outcomes in a larger study population.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84121, USA.
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