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Fu M, Li M, Wei R, Zhang C, Huang Y, Niu L, Wang X, Zhang H, Zhou X. Long-term visual quality after small incision lenticule extraction (SMILE) and laser assisted subepithelial keratomileusis (LASEK) for low myopia. BMC Ophthalmol 2022; 22:347. [PMID: 35978275 PMCID: PMC9386982 DOI: 10.1186/s12886-022-02568-8] [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: 06/19/2021] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have reported the visual outcomes of small-incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK) for myopia correction. This study aims to compare the visual quality and corneal wavefront aberrations after SMILE and LASEK for low-myopia correction. Methods In this prospective study, we included 29 eyes of 29 patients who received SMILE and 23 eyes of 23 patients who received LASEK between June 2018 and January 2019. The following measurements were assessed: uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, corneal wavefront aberrations, and subjective visual quality. All patients were followed up for two years. Results All procedures were uneventful. An efficacy index of 1.19 ± 0.17 was established in the SMILE group and 1.23 ± 0.20 in the LASEK group. No eyes lost more than two lines of CDVA. We found that 93% (27/29) of the treated eyes in the SMILE group and 91% (21/23) in the LASEK group had spherical equivalent (SE) within ± 0.25D. The increases in the total corneal spherical aberration and the corneal front spherical aberration were lower in the SMILE group than in the LASEK group (P < 0.01). In contrast, the increases in the total corneal vertical coma and the corneal front vertical coma in the SMILE group were greater than those in the LASEK group (P < 0.01). Conclusion Both SMILE and LASEK have good safety, stability, and patient-reported satisfaction for low myopia. SMILE induced less corneal spherical aberration but greater vertical coma than LASEK.
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Affiliation(s)
- Mengjun Fu
- Department of Ophthalmology, Weifang Eye Hospital, No.139 Xingfu Road, Kuiwen District, Weifang, 261000, Shandong, People's Republic of China.,State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Chuanwei Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yangyi Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lingling Niu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Haorun Zhang
- Department of Ophthalmology, Weifang Eye Hospital, No.139 Xingfu Road, Kuiwen District, Weifang, 261000, Shandong, People's Republic of China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Bagherian H, Zarei-Ghanavati S, Momeni-Moghaddam H, Wolffsohn JS, Sedaghat MR, Naroo SA, Monfared N. Masked comparison of two silicone hydrogel bandage contact lenses after photorefractive keratectomy. Cont Lens Anterior Eye 2020; 43:244-249. [PMID: 32098716 DOI: 10.1016/j.clae.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the efficiency and safety of two bandage contact lenses after photorefractive keratectomy (PRK). METHODS In this double-blind study, 45 patients (90 eyes) received PRK in both eyes and wore bandage contact lenses (BCLs), PureVision (Bausch & Lomb, Rochester, NY, USA) in one eye and PureVision2 (Bausch & Lomb, Rochester, NY, USA) in the other eye, randomly assigned. The medication regimen after surgery was the same for both eyes. The epithelial defect's size, conjunctival hyperemia and lens centration were graded objectively using slit-lamp biomicroscopy on days 1, 3 and 5 after surgery. Also ocular symptoms of discomfort including tearing, photophobia, foreign body sensation and visual fluctuations were assessed subjectively at each visit. RESULTS The mean epithelial defect size on the first day after operation was similar in eyes fitted with PureVision (30.08 ± 5.30 mm²) and PureVision2 (30.25 ± 5.72 mm2) lenses. (p = 0.79) Contact lens deposits and bulbar hyperaemia on days 1 and 3 after PRK were similar between the two eyes, but were significantly greater on day 5 for PureVision2 lenses. (p = 0.02; p = 0.04 respectively) There was no difference in contact lens decentration, and discomfort symptoms including pain, tearing, foreign body sensation, photophobia and visual fluctuations between the eyes fitted with PureVision and PureVision2. (p > 0.05) CONCLUSIONS: PureVision and PureVision2 contact lenses are equivalent as bandage lenses in important aspects such as corneal re-epithelialization and subjective comfort., although PureVision2 led to a higher incidence of contact lens deposits and conjunctival hyperemia early post-PRK.
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Affiliation(s)
- Homa Bagherian
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamed Momeni-Moghaddam
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - James S Wolffsohn
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | | | - Shehzad A Naroo
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Naeemeh Monfared
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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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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Leccisotti A. Laser-Assisted Subepithelial Keratectomy (LASEK) without Alcohol versus Photorefractive Keratectomy (PRK). Eur J Ophthalmol 2018; 13:676-80. [PMID: 14620170 DOI: 10.1177/112067210301300802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate epithelial healing and visual outcome after laser-assisted subepithelial keratectomy (LASEK) without alcohol de-epithelialization and to compare this technique to photorefractive keratectomy (PRK) in myopia. METHODS In a series of 1953 patients undergoing bilateral myopic PRK, an epithelial flap could be obtained by manual de-epithelialization in the left eye of 56 patients without alcohol exposure. The right eye was treated by PRK and the left by LASEK (i.e., repositioning the viable flap after surface ablation). The two eyes were compared in terms of pain, uncorrected visual acuity (UCVA) in decimals, correction achieved, and haze. The epithelial healing pattern was assessed in the LASEK eyes. RESULTS The flap remained viable, showing a peripheral junction, in 25 eyes (45%). Pain was higher in the PRK eye in 11/56 patients (20%), higher in the LASEK eye in 23/56 patients (41%), and the same in both eyes in 22/56 patients (39%). UCVA at one week was slightly better in the LASEK eyes (median 0.7 versus 0.6, p = 0.002 with Wilcoxon test), but was the same in PRK and LASEK eyes after 1 month (median 0.9 in both). Median haze at 6 months was 0.5 in the PRK eyes and 0 in the LASEK eyes (Wilcoxon p = 0.007). Median postoperative defocus equivalent at 9 months was 0.5 diopters in both the PRK and the LASEK eyes. CONCLUSIONS Although our study might have selected patients with loose epithelium, LASEK performed by manual de-epithelialization in the absence of alcohol exposure is not less painful than PRK, even in case of flap survival. Visual recovery speed, as well as haze, is slightly better than in PRK, although the difference is clinically negligible.
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Affiliation(s)
- A Leccisotti
- Ophthalmic Surgery Unit, Casa di Cura Rugani, Siena, Italy.
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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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Kuryan J, Cheema A, Chuck RS. Laser-assisted subepithelial keratectomy (LASEK) versus laser-assisted in-situ keratomileusis (LASIK) for correcting myopia. Cochrane Database Syst Rev 2017; 2:CD011080. [PMID: 28197998 PMCID: PMC5408355 DOI: 10.1002/14651858.cd011080.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Near-sightedness, or myopia, is a condition in which light rays entering the eye along the visual axis focus in front of the retina, resulting in blurred vision. Myopia can be treated with spectacles, contact lenses, or refractive surgery. Options for refractive surgery include laser-assisted subepithelial keratectomy (LASEK) and laser-assisted in-situ keratomileusis (LASIK). Both procedures utilize a laser to shape the corneal tissue (front of the eye) to correct refractive error, and both create flaps before laser treatment of corneal stromal tissue. Whereas the flap in LASEK is more superficial and epithelial, in LASIK it is thicker and also includes some anterior stromal tissue. LASEK is considered a surface ablation procedure, much like its predecessor, photorefractive keratectomy (PRK). LASEK was developed as an alternative to PRK to address the issue of pain associated with epithelial debridement used for PRK. Assessing the relative benefits and risks/side effects of LASEK and LASIK warrants a systematic review. OBJECTIVES To assess the effects of LASEK versus LASIK for correcting myopia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register (2016, Issue 10); MEDLINE Ovid (1946 to 24 October 2016); Embase.com (1947 to 24 October 2016); PubMed (1948 to 24 October 2016); LILACS (Latin American and Caribbean Health Sciences Literature Database; 1982 to 24 October 2016); the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), last searched 20 June 2014; ClinicalTrials.gov (www.clinicaltrials.gov); searched 24 October 2016; and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 24 October 2016. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We considered only randomized controlled trials (RCTs) for the purposes of this review. Eligible RCTs were those in which myopic participants were assigned randomly to receive either LASEK or LASIK in one or both eyes. We also included paired-eye studies in which investigators randomly selected which of the participant's eyes would receive LASEK or LASIK and assigned the other eye to the other procedure. Participants were men or women between the ages of 18 and 60 years with myopia up to 12 diopters (D) and/or myopic astigmatism of severity up to 3 D, who did not have a history of prior refractive surgery. DATA COLLECTION AND ANALYSIS Two review authors independently screened all reports and assessed the risk of bias in trials included in this review. We extracted data and summarized findings using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. In the absence of clinical and methodological heterogeneity across trials, we used a random-effects model to calculate summary effect estimates. We used a fixed-effect model when including fewer than three trials in a meta-analysis. When clinical, methodological, or statistical heterogeneity was observed across trials, we reported our findings in a narrative synthesis. MAIN RESULTS We identified four eligible trials with 538 eyes of 392 participants for the review, but only three trials (154 participants) provided outcome data for analysis. We found no ongoing trials. Two of four trials were from China, one trial was from Turkey, and the location of one trial was not reported. The risk of bias for most domains was unclear due to poor reporting of trial methods; no trial had a protocol or trial registry record. Three trials enrolled participants with mild to moderate myopia (less than -6.50 D); one trial included only participants with severe myopia (more than -6.00 D).The evidence showed uncertainty in whether there is a difference between LASEK and LASIK in uncorrected visual acuity (UCVA) at 12 months, the primary outcome in our review. The RR and 95% confidence interval (CI) at 12 months after surgery was 0.96 (95% CI 0.82 to 1.13) for UCVA of 20/20 or better and 0.90 (95% CI 0.67 to 1.21) for UCVA of 20/40 or better based on data from one trial with 57 eyes (very low-certainty evidence). People receiving LASEK were less likely to achieve a refractive error within 0.5 diopters of the target at 12 months follow-up (RR 0.69, 95% CI 0.48 to 0.99; 57 eyes; very low-certainty evidence). One trial reported mild corneal haze at six months in one eye in the LASEK group and none in the LASIK group (RR 2.11, 95% CI 0.57 to 7.82; 76 eyes; very low-certainty evidence). None of the included trials reported postoperative pain score or loss of visual acuity, spherical equivalent of the refractive error, or quality of life at 12 months.Refractive regression, an adverse event, was reported only in the LASEK group (8 of 37 eyes) compared with none of 39 eyes in the LASIK group in one trial (low-certainty evidence). Other adverse events, such as corneal flap striae and refractive over-correction, were reported only in the LASIK group (5 of 39 eyes) compared with none of 37 eyes in the LASEK group in one trial (low-certainty evidence). AUTHORS' CONCLUSIONS Overall, from the available RCTs, there is uncertainty in how LASEK compares with LASIK in achieving better refractive and visual results in mildly to moderately myopic participants. Large, well-designed RCTs would be required to estimate the magnitude of any difference in efficacy or adverse effects between LASEK and LASIK for treating myopia or myopic astigmatism.
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Affiliation(s)
- Jocelyn Kuryan
- Albert Einstein College of Medicine, Montefiore Medical CenterDepartment of Ophthalmology and Visual Sciences3332 Rochambeau Avenue, 3rd FloorNew YorkNew YorkUSA10467
| | - Anjum Cheema
- Albert Einstein College of Medicine, Montefiore Medical CenterDepartment of Ophthalmology and Visual Sciences3332 Rochambeau Avenue, 3rd FloorNew YorkNew YorkUSA10467
| | - Roy S Chuck
- Albert Einstein College of Medicine, Montefiore Medical CenterDepartment of Ophthalmology and Visual Sciences3332 Rochambeau Avenue, 3rd FloorNew YorkNew YorkUSA10467
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Qian Y, Huang J, Zhou X, Wang Y. Comparison of femtosecond laser small-incision lenticule extraction and laser-assisted subepithelial keratectomy to correct myopic astigmatism. J Cataract Refract Surg 2016; 41:2476-86. [PMID: 26703499 DOI: 10.1016/j.jcrs.2015.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/05/2015] [Accepted: 05/17/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the efficacy of correcting myopic astigmatism with femtosecond laser small-incision lenticule extraction (SMILE, Carl Zeiss Meditec AG) versus laser-assisted subepithelial keratectomy (LASEK). SETTING The study was conducted at the Ophthalmology Department, Eye and ENT Hospital, Shanghai, China. DESIGN A retrospective, cross-sectional study. METHODS This study included patients who underwent small-incision lenticule extraction or LASEK for the correction of myopia and myopic astigmatism. Preoperative and 6-month postoperative astigmatism values were analyzed. The efficacies of the 2 surgeries to correct astigmatism were compared. RESULTS A total of 180 right eyes of 180 patients (small-incision lenticule extraction: n = 113, LASEK: n = 67) were included. No significant difference was found between the 2 groups in the preoperative astigmatism (small-incision lenticule extraction: 1.16 ± 0.85D, LASEK: 1.16 ± 0.83D, P > .05) or the postoperative astigmatism (small-incision lenticule extraction: 0.35 ± 0.37D; LASEK: 0.31 ± 0.42D, P > .05), determined by manifest refraction. No significant difference was found between the 2 groups in surgically induced astigmatism vector (small-incision lenticule extraction: 1.13 ± 0.83D, LASEK: 1.01 ± 0.65D, P > .05). The correction index was higher for the small-incision lenticule extraction group (1.05 ± 0.53) than for the LASEK group (0.95 ± 0.21, P = .045). The postoperative astigmatism was significantly higher for the small-incision lenticule extraction group when the preoperative astigmatism was 1.0 D or less (small-incision lenticule extraction: 0.26 ± 0.30D, LASEK: 0.12 ± 0.20D, P = .007) and lower for the small-incision lenticule extraction group when the preoperative astigmatism was more than 2.0 D (small-incision lenticule extraction: 0.48 ± 0.37D, LASEK: 0.89 ± 0.46D, P = .002). CONCLUSIONS An adjustment of nomograms for correcting low astigmatism (≤1.0 D) by small-incision lenticule extraction is suggested due to the tendency toward overcorrection, whereas a nomogram adjustment for tissue-saving ablation profile is needed for the correction of high astigmatism (>2.0 D) by LASEK due to the tendency toward undercorrection. FINANCIAL DISCLOSURE The authors declare that they have no competing financial interests.
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Affiliation(s)
- Yishan Qian
- From the Department of Ophthalmology (Qian, Huang, Zhou), Eye and ENT Hospital, Fudan University, Shanghai, China; Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Zhou), China; Johns Hopkins University School of Medicine (Wang), Baltimore, Maryland, USA
| | - Jia Huang
- From the Department of Ophthalmology (Qian, Huang, Zhou), Eye and ENT Hospital, Fudan University, Shanghai, China; Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Zhou), China; Johns Hopkins University School of Medicine (Wang), Baltimore, Maryland, USA
| | - Xingtao Zhou
- From the Department of Ophthalmology (Qian, Huang, Zhou), Eye and ENT Hospital, Fudan University, Shanghai, China; Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Zhou), China; Johns Hopkins University School of Medicine (Wang), Baltimore, Maryland, USA.
| | - Yutung Wang
- From the Department of Ophthalmology (Qian, Huang, Zhou), Eye and ENT Hospital, Fudan University, Shanghai, China; Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Zhou), China; Johns Hopkins University School of Medicine (Wang), Baltimore, Maryland, USA
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Galindo J, Fadlallah A, Robinson S, Chelala E, Melki SA. Risk factors for loss of epithelial flap integrity in laser-assisted subepithelial keratectomy surgery. J Cataract Refract Surg 2016; 42:591-5. [PMID: 27113883 DOI: 10.1016/j.jcrs.2016.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate risk factors leading to loss of epithelial flap integrity in laser-assisted subepithelial keratectomy (LASEK). SETTING Boston Eye Group, Brookline, Massachusetts, USA. DESIGN Retrospective case study. METHODS This retrospective chart review was performed for LASEK surgeries that occurred between January 2009 and October 2013. Logistic regression was performed to determine whether epithelium preservation was correlated with age, sex, sphere, cylinder, spherical equivalent (SE), keratometry, and central corneal thickness (CCT). RESULTS The study reviewed 1009 eyes of 509 patients with a mean age of 29.1 years ± 12.2 (SD). The mean preoperative spherical refraction was -4.7 ± 2.5 diopters (D), and the mean preoperative cylinder was -1.1 ± 0.8 D. The mean preoperative decimal corrected distance visual acuity was 1.01 ± 0.07. Single-sheet mobilization of the loosened epithelium flap was found in 72.3% of cases. Fragmented preservation events occurred in 17.6% of cases; the flap was discarded in 10.0% of cases. Epithelium preservation was significantly correlated with age (P = .048) but not with other parameters (P > .05 for sex, sphere, cylinder, SE, keratometry, CCT, and surgeon experience). Epithelial flap dissection was less likely to lead to a single epithelial sheet in patients older than 50 years than in younger patients (56.3% versus 74.9%). The mean postoperative decimal uncorrected distance visual acuity (UDVA) at 3 months was 0.98 ± 0.08. There was no statistical difference in postoperative UDVA between the undiscarded flap group and discarded flap group (P = .128). CONCLUSION Successful dissection of single-sheet epithelial flap diminished with age. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Joanna Galindo
- From the Boston Eye Group (Galindo, Fadlallah, Robinson, Melki), Harvard Medical School (Fadlallah, Melki), and the Massachusetts Eye & Ear Infirmary (Fadlallah, Melki), Harvard Medical School, Boston, Massachusetts, USA; Faculty of Medicine (Chelala), Saint-Joseph University, Beirut, Lebanon
| | - Ali Fadlallah
- From the Boston Eye Group (Galindo, Fadlallah, Robinson, Melki), Harvard Medical School (Fadlallah, Melki), and the Massachusetts Eye & Ear Infirmary (Fadlallah, Melki), Harvard Medical School, Boston, Massachusetts, USA; Faculty of Medicine (Chelala), Saint-Joseph University, Beirut, Lebanon
| | - Steve Robinson
- From the Boston Eye Group (Galindo, Fadlallah, Robinson, Melki), Harvard Medical School (Fadlallah, Melki), and the Massachusetts Eye & Ear Infirmary (Fadlallah, Melki), Harvard Medical School, Boston, Massachusetts, USA; Faculty of Medicine (Chelala), Saint-Joseph University, Beirut, Lebanon
| | - Elias Chelala
- From the Boston Eye Group (Galindo, Fadlallah, Robinson, Melki), Harvard Medical School (Fadlallah, Melki), and the Massachusetts Eye & Ear Infirmary (Fadlallah, Melki), Harvard Medical School, Boston, Massachusetts, USA; Faculty of Medicine (Chelala), Saint-Joseph University, Beirut, Lebanon
| | - Samir A Melki
- From the Boston Eye Group (Galindo, Fadlallah, Robinson, Melki), Harvard Medical School (Fadlallah, Melki), and the Massachusetts Eye & Ear Infirmary (Fadlallah, Melki), Harvard Medical School, Boston, Massachusetts, USA; Faculty of Medicine (Chelala), Saint-Joseph University, Beirut, Lebanon.
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The Effect of Silicone Hydrogel Bandage Soft Contact Lens Base Curvature on Comfort and Outcomes After Photorefractive Keratectomy. Eye Contact Lens 2015; 41:77-83. [DOI: 10.1097/icl.0000000000000067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ma F, Xu M, Qian Y, Gao G, Dai J. Impact of long-term soft contact lens wear on epithelial flap production and postoperative recovery in laser-assisted subepithelial keratomileusis. Acta Ophthalmol 2015; 93:e67-73. [PMID: 25043677 DOI: 10.1111/aos.12499] [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: 01/09/2014] [Accepted: 06/17/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the impact and postoperative clinical recovery of long-term soft contact lens wear on the epithelial flap made during laser-assisted subepithelial keratomileusis (LASEK). METHODS In a prospective study, 371 patients (589 eyes) who underwent LASEK were divided into four groups (G1, G2, G3, G4) according to their length of soft contact lens wear. After the contact lens (CL) was removed 1 week after surgery, various symptoms - uncorrected visual acuity (UCVA), oedema of the corneal epithelium, spherical equivalent (SE) and haze degree - were recorded on day 1, and at 1 and 3 months postoperatively. RESULTS There were no significant differences in corneal flap production among the first three groups that wore CLs, but various symptoms and UCVA were all different from the fourth group that did not wear CLs. There were statistically significant differences in oedema of corneal epithelium among the first three groups, and the degree of oedema was positively correlated with the CL wearing time. There were no significant differences in postoperative SE and haze in all four groups. CONCLUSIONS Long-term soft CL wear can affect production of the epithelial flap and postoperative recovery, including various symptoms, oedema of the central corneal epithelium and visual acuity. In contrast, there was no effect of long-term CL wear on postoperative mean refractive spherical equivalent (MRSE) and haze.
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Affiliation(s)
- Fei Ma
- Department of Ophthalmology; Jinling Hospital; School of Medicine; Nanjing University; Nanjing China
| | - Man Xu
- Department of Ophthalmology; Xi'an No. 4 hospital; Xi'an China
| | - Yifeng Qian
- Department of Ophthalmology; the First Affiliated Hospital of Soochow University; Suzhou China
| | - Guohong Gao
- Department of Ophthalmology; Eye & ENT Hospital; Fudan University; Shanghai China
- Key Laboratory of Myopia; Ministry of Health PR China; Shanghai China
| | - Jinhui Dai
- Department of Ophthalmology; Eye & ENT Hospital; Fudan University; Shanghai China
- Key Laboratory of Myopia; Ministry of Health PR China; Shanghai China
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Qian Y, Huang J, Chu R, Zhou X, Olszewski E. Influence of intraocular astigmatism on the correction of myopic astigmatism by laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2014; 40:558-63. [PMID: 24581997 DOI: 10.1016/j.jcrs.2013.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/20/2013] [Accepted: 09/14/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the influence of the origin of astigmatism on the correction of myopic astigmatism by laser-assisted subepithelial keratectomy (LASEK). SETTING Ophthalmology Department, Eye and ENT Hospital, Shanghai, China. DESIGN Prospective study. METHODS Patients having LASEK to correct myopia or myopic astigmatism were divided into 2 groups according to their ocular residual astigmatism (ORA). Patients were examined preoperatively and 1 and 3 months postoperatively. The efficacy of LASEK was compared between those with and those without a significant amount of intraocular astigmatism. RESULTS The study comprised 54 eyes of 54 patients. The mean index of success (ratio of magnitude of remaining uncorrected astigmatism to that of initial preoperative astigmatism) in the high ORA group (n=21) and low ORA group (n=33) was 0.85 and 0.48, respectively, 1 month after surgery (t=2.17, P=.04) and 0.88 and 0.32, respectively, 3 months after surgery (t=2.18, P=.04). The Zernike coefficient of horizontal coma, Z(3,+1), increased more after surgery in the high ORA group than in the low ORA group (1 month versus preoperative, t=2.32, P=.024; 3 months versus preoperative, t=2.07, P=.048). CONCLUSIONS Nine percent and 2% of the eyes had minimal corneal haze at 1 month and 3 months, respectively. Laser-assisted subepithelial keratectomy was less effective in correcting myopic astigmatism when astigmatism was mainly located at the internal optics. Horizontal coma increased more after LASEK in patients with higher ORA. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Yishan Qian
- From the Department of Ophthalmology (Qian, Huang, Chu, Zhou), Eye and ENT Hospital, Fudan University, and the Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Chu, Zhou), Shanghai, China; the Department of Surgery (Olszewski), Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jia Huang
- From the Department of Ophthalmology (Qian, Huang, Chu, Zhou), Eye and ENT Hospital, Fudan University, and the Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Chu, Zhou), Shanghai, China; the Department of Surgery (Olszewski), Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Renyuan Chu
- From the Department of Ophthalmology (Qian, Huang, Chu, Zhou), Eye and ENT Hospital, Fudan University, and the Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Chu, Zhou), Shanghai, China; the Department of Surgery (Olszewski), Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Xingtao Zhou
- From the Department of Ophthalmology (Qian, Huang, Chu, Zhou), Eye and ENT Hospital, Fudan University, and the Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Chu, Zhou), Shanghai, China; the Department of Surgery (Olszewski), Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Emily Olszewski
- From the Department of Ophthalmology (Qian, Huang, Chu, Zhou), Eye and ENT Hospital, Fudan University, and the Key Laboratory of Myopia of State Health Ministry (Qian, Huang, Chu, Zhou), Shanghai, China; the Department of Surgery (Olszewski), Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Al-Tobaigy FM. Efficacy, predictability, and safety of laser-assisted subepithelial keratectomy for the treatment of myopia and myopic astigmatism. Middle East Afr J Ophthalmol 2012; 19:304-8. [PMID: 22837624 PMCID: PMC3401800 DOI: 10.4103/0974-9233.97931] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The purpose was to report the refractive and visual outcomes of laser-assisted subepithelial keratectomy (LASEK) for the treatment of myopia. Materials and Methods: A retrospective, noncomparative consecutive case series of 173 of 91 patients who had undergone LASEK is presented. Primary outcome variables included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, epithelialization time, pain, haze, and complications. Results: Preoperatively, the mean spherical equivalent (SE) was –3.71 ± 1.63 D (range, –0.875 D to 8.25 D), and the mean LogMAR BSCVA was –0.0374 ± 0.0767 D (range, –0.47 D to 0.00 D). On the final visit, the mean SE was –0.05 ± 0.335 D (range, –1.63 D to 1.00 D), the mean LogMAR UCVA was 0.04674 ± 0.0771 D (range, –0.3010 D to 0.1249 D) and the mean LogMAR BSCVA was –0.0164 ± 0.0497 (range –0.3010 to 0.124). All eyes achieved vision of 20/40 or better, and 83.2% of the eyes achieved a vision of 20/25 or better. One 64 (94.94%) and all the eyes were within ± 0.50 D and ± 1.00 D of the attempted correction respectively. Complete epithelialization occurred in 4.70 ± 2.09 days (range, 2-10 days). At the final visit, 79.7% of eyes had a clear cornea. Grade 1 haze developed in 17.34% of the eyes, grade 2 haze developed in 2.89% of eyes developed; no eyes developed grade 3 or 4 haze. Conclusions: LASEK is a safe, effective, and predictable method for the treatment of myopia and myopic astigmatism.
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Affiliation(s)
- Faisal M Al-Tobaigy
- Department of Ophthalmology, College of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
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McAlinden C. Corneal refractive surgery: past to present. Clin Exp Optom 2012; 95:386-98. [PMID: 22672114 DOI: 10.1111/j.1444-0938.2012.00761.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/07/2012] [Accepted: 04/17/2012] [Indexed: 12/20/2022] Open
Abstract
There have been many historical corneal refractive techniques and procedures developed over the years. From early techniques of radial keratotomy to modern excimer laser techniques, the field of refractive surgery is one of the most rapidly developing in ophthalmology. This review details the historical aspects of the many early techniques up to current techniques used on millions of eyes around the world.
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Affiliation(s)
- Colm McAlinden
- University of Ulster, United Kingdom and Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
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Taneri S, Oehler S, Koch J, Azar D. Effect of repositioning or discarding the epithelial flap in laser-assisted subepithelial keratectomy and epithelial laser in situ keratomileusis. J Cataract Refract Surg 2011; 37:1832-46. [DOI: 10.1016/j.jcrs.2011.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 04/07/2011] [Accepted: 05/02/2011] [Indexed: 11/16/2022]
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Long-term outcome of epi-LASIK for high myopia. Eur J Ophthalmol 2011; 22 Suppl 7:S98-105. [PMID: 21928261 DOI: 10.5301/ejo.5000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of epipolis laser-assisted in situ keratomileusis (epi-LASIK) for high myopia. METHODS High myopic patients who underwent epi-LASIK during 2004 and 2005 were included in this study. Epi-LASIK was performed with an automatically rotational epikeratome (KM-5000D). Postoperative visual acuity, manifest refraction, and haze formation were assessed 3 mo, 6 mo, 1 y, and 3 y after surgery. Results were compared by dividing patients into 2 groups according to preoperative mean refractive spherical equivalent (MRSE): group A (≥-6 D to -10 D; group B ≥-10 D). The differences within groups were analyzed using mixed model for continuous variables. The differences between groups were analyzed using t test or rank sum test for continuous variables, and Pearson χ² or Fisher exact probabilities for categorical variables. RESULTS A total of 20 patients (33 eyes) were followed up for more than 3 years with 17 eyes in group A (MRSE -8.15 ± 1.41 D) and 16 eyes in group B (MRSE -12.95 ± 2.91 D). While postoperative refraction regression occurred in both groups, it was more prominent in group B (p<0.05). The long-term predictability is good in group A with 14 eyes (82.35%) within ±1 D of attempted correction at 3 years while the percentage in group B was 18.75%. The efficacy index was significantly different between the 2 groups (p<0.05): 0.84 ± 0.29 for group A and 0.61 ± 0.47 for group B at 3 years. The safety index was above 1.0 at each timepoint in both groups. Haze was at low level and faded with time after epi-LASIK. CONCLUSIONS Epi-LASIK had a satisfactory long-term effect for high myopia of less than -10 D. Myopic regression limited the satisfaction of epi-LASIK in eyes with myopia of more than -10.0 D.
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McAlinden C, Moore J. Laser-assisted subepithelial keratectomy retreatment surgery. J Cataract Refract Surg 2011; 37:358-63. [DOI: 10.1016/j.jcrs.2010.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/13/2010] [Accepted: 08/18/2010] [Indexed: 11/26/2022]
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Vasaiwala R, Jackson WB, Azar DT, Al-Muammar A. Excimer Laser Surface Treatment. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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René Moreno N, Miguel Srur A, Carlos Nieme B. Cirugía refractiva: indicaciones, técnicas y resultados. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70614-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Astle WF, Huang PT, Ereifej I, Paszuk A. Laser-assisted subepithelial keratectomy for bilateral hyperopia and hyperopic anisometropic amblyopia in children. J Cataract Refract Surg 2010; 36:260-7. [DOI: 10.1016/j.jcrs.2009.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 06/26/2009] [Accepted: 08/10/2009] [Indexed: 11/29/2022]
Affiliation(s)
- William F Astle
- Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8, Canada.
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Grentzelos MA, Plainis S, Astyrakakis NI, Diakonis VF, Kymionis GD, Kallinikos P, Pallikaris IG. Efficacy of 2 types of silicone hydrogel bandage contact lenses after photorefractive keratectomy. J Cataract Refract Surg 2009; 35:2103-8. [DOI: 10.1016/j.jcrs.2009.07.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/23/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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Bucher C, Zuberbuhler B, Goggin M, Esterman A, Schipper I. Corneal limbal marking in the treatment of myopic astigmatism with the excimer laser. J Refract Surg 2009; 26:505-11. [PMID: 19715268 DOI: 10.3928/1081597x-20090814-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 07/23/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether preoperative marking of the limbal cornea improves treatment of myopic astigmatism with the excimer laser. METHODS Retrospective study on 108 eyes with myopic astigmatism that underwent LASIK or laser epithelial keratomileusis (LASEK) with the Technolas 217 (Bausch & Lomb) excimer laser. Preoperative limbal marking was performed in 47 eyes (marked group). The 12-month results were used for refractive and visual analysis. RESULTS The achieved cylinder reduction, spherical reduction, and refractive predictability were similar for the marked and unmarked groups in the overall study collective, in the LASIK and LASEK subgroup analysis, and in a higher astigmatism (> 1.25 diopters) subgroup analysis. Limbal marking showed no influence on the refractive results, and vector analysis showed no significant difference in angle of error among groups. CONCLUSIONS Corneal limbal marking failed to improve the refractive outcome in LASIK and LASEK for myopic astigmatism.
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Ang EK, Couper T, Dirani M, Vajpayee RB, Baird PN. Outcomes of laser refractive surgery for myopia. J Cataract Refract Surg 2009; 35:921-33. [DOI: 10.1016/j.jcrs.2009.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 02/19/2009] [Accepted: 02/19/2009] [Indexed: 11/30/2022]
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Comparison of early postoperative clinical outcomes of photorefractive keratectomy and lamellar epithelial debridement. J Cataract Refract Surg 2009; 35:703-9. [PMID: 19304092 DOI: 10.1016/j.jcrs.2008.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 12/08/2008] [Accepted: 12/09/2008] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare early postoperative clinical outcomes of photorefractive keratectomy (PRK) and lamellar epithelial debridement (LED). SETTING Department of Ophthalmology, Kangbuk Samsung Hospital, Seoul, Korea. METHODS This prospective study was of patients randomly assigned to have PRK or LED. In the LED group, an epithelial flap was created using an Amadeus II epikeratome. Postoperative follow-up was at 1, 3, and 7 days and 1, 3, and 6 months. The outcome parameters were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), higher-order aberrations (HOAs), epithelial healing time, and corneal haze. RESULTS The study comprised 39 patients (76 eyes). The mean preoperative spherical equivalent (SE) was -3.96 diopters (D) +/- 1.24 (SD) in the PRK group and -4.06 +/- 1.39 D in the LED group. Postoperative UCVA was significantly better in the LED group 1 day postoperatively. The UCVA was 20/20 or better in 14.6% in the PRK group and 42.9% in the LED group (P = .006); 20/25 or better in 41.5% and 82.9%, respectively (P = .000); and 20/40 or better in 80.5% and 100%, respectively (P = .006). On subsequent follow-up visits, the UCVA was comparable between groups. No eye lost lines of BCVA at 3 months. There was no difference between groups in postoperative SE refraction, HOAs, or corneal haze. CONCLUSIONS Lamellar epithelial debridement and PRK had comparable safety and efficacy in the surgical correction of low to moderate myopia. The UCVA was significantly better after LED than after PRK 1 day postoperatively and equivalent thereafter.
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Laser Subepithelial Keratomileusis (LASEK) and Epi-LASIK. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Benito-Llopis L, Teus MA, Hernández-Verdejo JL. Comparison between three- and six-month postoperative refractive and visual results after laser epithelial keratomileusis with mitomycin C. Am J Ophthalmol 2009; 147:71-76.e2. [PMID: 18774546 DOI: 10.1016/j.ajo.2008.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/07/2008] [Accepted: 07/09/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the residual refraction and visual results between the three- and six-month postoperative visits to detect the optimal moment for enhancement after myopic laser epithelial keratomileusis (LASEK) with mitomycin C (MMC). DESIGN Nonrandomized, interventional, prospective study. METHODS One hundred and forty-one consecutive eyes that underwent LASEK with MMC to correct their myopia using the Esiris excimer laser (Schwind Eye Tech Solutions, Kleinostheim, Germany), and that showed three months postoperatively a residual defect or a suboptimal uncorrected visual acuity (UCVA) or best spectacle-corrected visual acuity (BSCVA) were included in the study. We compared the residual spherical refraction and cylinder, the UCVA, and the BSCVA between the three- and six-month postoperative examinations. RESULTS Preoperative spherical refraction was -5.2 +/- 2.90 diopters (D). Preoperative cylinder was -1.66 +/- 1.20 D. The residual sphere was +0.43 +/- 0.90 D three months and +0.21 +/- 0.90 D six months after surgery (P = .0001). The cylinder was -0.71 +/- 0.60 D and -0.67 +/- 0.60 D, respectively (P = .4). The UCVA was 0.75 +/- 0.2 and 0.81 +/- 0.2 (P = .0001) and the BSCVA was 0.94 +/- 0.1 and 1.01 +/- 0.1 (P = .0001), respectively. Those patients with a myopic defect (sphere or cylinder) three months postoperatively did not show any significant change in UCVA or refractive defect six months after surgery, while those with a hyperopic defect (sphere or cylinder) showed an improvement in UCVA and residual refraction six months postoperatively (P < .05). CONCLUSIONS Our results suggest that retreatment after myopic LASEK with MMC may be performed three months after surgery when the residual refraction is myopic, but it seems wise to wait at least six months after surgery when the residual refraction is hyperopic.
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Abstract
PURPOSE OF REVIEW Since their introduction in the mid-1990s, surface ablation techniques have continued to evolve, enabling surgeons to give patients better quality of vision with less postoperative pain. The purpose of this chapter is to discuss that evolution, the common techniques used today, and how to address potential complications. RECENT FINDINGS Advanced surface ablation techniques offer advantages over laser in situ keratomileusis, including expanded potential patient profiles, reduced haze and pain postoperatively, and increased quality of vision. Haze reduction via preserved epithelial flaps, smoother stromal beds, and introduction of mitomycin-C intraoperatively have all improved safety outcomes of advanced surface ablation. SUMMARY Experience has shown us that virtually all patients who are candidates for laser in situ keratomileusis can be candidates for surface ablation, but patients with specific ocular conditions, such as epithelial basement membrane dystrophy, superficial corneal scars, and previous radial keratotomy will have the best outcomes with surface ablation. Surface ablation and laser in situ keratomileusis are comparable in terms of safety and quality of vision. Wavefront-guided photorefractive keratectomy offers better acuity and less induction of higher order aberrations than wavefront-guided laser in situ keratomileusis.
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Effectiveness of laser-assisted subepithelial keratectomy without mitomycin-C for the treatment of high myopia. J Cataract Refract Surg 2008; 34:1280-7. [DOI: 10.1016/j.jcrs.2008.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 04/26/2008] [Indexed: 11/24/2022]
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Hosny M, Awadalla MA. Comparison of higher-order aberrations after LASIK using disposable microkeratome 130 and 90 micron heads. Eur J Ophthalmol 2008; 18:332-7. [PMID: 18465711 DOI: 10.1177/112067210801800302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyze and compare higher-order aberrations (HOAs) in cases of laser in situ keratomileusis (LASIK) flaps made using the Moria M2 disposable 130-micronm head with those made using the 90-micronm head. METHODS Consecutive prospective comparative clinical trial. Ninety-four consecutive eyes of 48 patients were enrolled in this study. They were divided into two equal groups of 47 eyes that underwent wavefront-guided LASIK using VISX CustomVue (VISX, Santa Clara, CA) system. Corneal flap was created using the disposable Moria M2 130 micronm in the first group and the 90 micronm head in the second one. All patients were followed up for 6 months. Wavefront aberrations were measured at baseline, 1 month, and 6 months after surgery using the WaveScan (VISX Inc.) aberrometer. Root mean square (RMS) of HOAs, coma, and spherical aberration (SA) values were analyzed and compared in the two groups. RESULTS At 6 months, values of RMS of HOAs, coma, and SA obtained from the 130-micronm head group were 0.32+/-0.10 micronm, 0.20+/-0.11 micronm, and 0.18+/-0.08 micronm, respectively. Values of RMS of HOAs, coma, and SA obtained from 90-micronm head group were 0.33+/-0.12 micronm, 0.19+/-0.10 micronm, and 0.15+/-0.08 micronm, respectively. Analyzing the data obtained revealed no statistically significant differences between the two groups. In each group, there was a significant decay of higher-order RMS and coma values from 1 month to 6 months. CONCLUSIONS HOAs following use of Moria M2 disposable 90 micronm head are similar to those arising following use of the 130 micronm.
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Affiliation(s)
- M Hosny
- Department of Ophthalmology, Cairo University, Cairo, Egypt
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Kato N, Toda I, Hori-Komai Y, Sakai C, Tsubota K. Five-Year Outcome of LASIK for Myopia. Ophthalmology 2008; 115:839-844.e2. [PMID: 17900692 DOI: 10.1016/j.ophtha.2007.07.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 06/18/2007] [Accepted: 07/09/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of LASIK over a 5-year postoperative period. DESIGN Observational case series. PARTICIPANTS We examined 779 eyes in 402 patients with myopia or myopic astigmatism who underwent LASIK to correct their refractive errors and received regular postoperative assessments for 5 years. METHODS Postoperative examinations were performed 1 day; 1 week; 1, 3, and 6 months; and 1, 2, 3, 4, and 5 years after LASIK surgery. MAIN OUTCOME MEASURES We evaluated changes in uncorrected visual acuity (UCVA) (logarithm of the minimum angle of resolution [logMAR]), manifest refraction, best-corrected visual acuity (BCVA) (logMAR), intraocular pressure, corneal thickness, corneal endothelial cell counts, and complications. RESULTS Preoperative UCVA of 1.27 improved to -0.03 at 1 day after surgery and -0.08 at 1 month and revealed minimal but significant decreases thereafter. Postoperative manifest refraction was also improved by surgery, showing minimal but significant regression after 1 year. Final BCVA loss was seen in 10 eyes of 7 patients; in 7 cases, there were obvious reasons such as the progression of cataracts in 3 eyes, epithelial disintegrity due to dry eye in 2 eyes, irregular astigmatism due to flap striae in 1 eye, and age-related macular dystrophy in 1 eye. Intraocular pressure and corneal thickness decreased by 4.0 mmHg and 76.9 microm, respectively, due to surgery, but remained stable throughout the follow-up period. Corneal endothelial cell counts (2689.0+/-232.9 cells/mm(2) before surgery) showed a statistically significant decrease at 5 years after surgery (2658.0+/-183.1 cells/mm(2); 1.2% loss for 5 years), likely within the range due to physiological age-related loss. No serious, vision-threatening, irreversible complication such as keratectasia or progressive endothelial cell loss was observed. CONCLUSION LASIK surgery is an effective and safe procedure for correcting myopia/myopic astigmatism as long as inclusion and exclusion criteria are strictly respected. However, minimal regression occurred during the 5-year investigative period.
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Affiliation(s)
- Naoko Kato
- Minamiaoyama Eye Clinic, Tokyo, Japan.; Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
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Comparison Between LASEK With Mitomycin C and LASIK for the Correction of Myopia of –7.00 to –13.75 D. J Refract Surg 2008; 24:516-23. [DOI: 10.3928/1081597x-20080501-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Astle WF, Rahmat J, Ingram AD, Huang PT. Laser-assisted subepithelial keratectomy for anisometropic amblyopia in children: Outcomes at 1 year. J Cataract Refract Surg 2007; 33:2028-34. [DOI: 10.1016/j.jcrs.2007.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 07/12/2007] [Indexed: 11/16/2022]
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Ghadhfan F, Al-Rajhi A, Wagoner MD. Laser in situ keratomileusis versus surface ablation: Visual outcomes and complications. J Cataract Refract Surg 2007; 33:2041-8. [PMID: 18053901 DOI: 10.1016/j.jcrs.2007.07.026] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 07/28/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Faisal Ghadhfan
- Anterior Segment Division, Department of Ophthalmology, Research Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
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Teus MA, de Benito-Llopis L, Sánchez-Pina JM. Learning curve of laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2007; 33:1381-5. [PMID: 17662428 DOI: 10.1016/j.jcrs.2007.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 04/18/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the effect of the learning curve of laser-assisted subepithelial keratectomy (LASEK) on the visual and refractive results. METHODS This retrospective study comprised 56 eyes that had LASEK for myopia. The eyes were among the first 143 that had LASEK by the same surgeon with the same excimer laser and same nomogram. The 56 eyes were separated into 2 groups. Group 1 included the first 28 eyes to have LASEK by the surgeon. Group 2 comprised the last 28 eyes in the series whose refractive error could be matched with that in Group 1. The outcomes in the 2 groups were compared. RESULTS The mean preoperative spherical refraction was -3.90 diopters (D) +/- 1.90 (SD) in Group 1 and -3.70 +/- 2.53 D in Group 2 (P = .2). There were no significant differences in preoperative cylinder or best spectacle-corrected visual acuity (BSCVA) between groups. The postoperative uncorrected visual acuity (UCVA) was significantly worse in Group 1 on 1 day and 7 days postoperatively (P = .02 and P = .03, respectively); there was no significant difference at 1 month and 3 months. The safety index (postoperative BSCVA/preoperative BSCVA) and efficacy index (postoperative UCVA/preoperative BSCVA) were better in Group 2, although the difference was not statistically significant. The spherical refraction 3 months postoperatively was +0.50 +/- 0.83 D in Group 1 and +0.10 +/- 0.27 D in Group 2 (P = .02); 75.00% of eyes and 96.42% of eyes, respectively, were within +/-0.50 D of the intended correction (P = .01). Seven percent of eyes in Group 1 and no eye in Group 2 lost 2 or more lines of BSCVA. CONCLUSIONS Results indicate that the outcomes of LASEK depend on surgeon experience. Thus, caution is advised when interpreting LASEK results without knowing the surgeon's level of experience.
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Teus MA, de Benito-Llopis L, Sánchez-Pina JM. LASEK Versus LASIK for the Correction of Moderate Myopia. Optom Vis Sci 2007; 84:605-10. [PMID: 17632309 DOI: 10.1097/opx.0b013e3180dc9a4f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the results of laser subepithelial keratomileusis (LASEK) and laser in situ keratomileusis (LASIK) for the correction of moderate myopia. METHODS We performed a retrospective, single-masked, interventional study of 80 consecutive eyes. Forty eyes that had undergone LASEK to correct myopia of -2.0 to -6.0 D were compared with age and refraction matched patients treated with LASIK. All eyes had been operated by the same experienced surgeon using the same laser (Technolas 217). Mitomycin C was not used in any patient. RESULTS Eighty eyes were reviewed (40 treated with LASEK, 40 treated with LASIK). The preoperative mean sphere was -3.8 D (range -2 to -6D) and mean cylinder was -0.7 D (range 0 to -2 D) in both groups. Postoperative uncorrected visual acuity was worse in LASEK eyes 1 and 7 days postoperatively (p = 0.0001), although the difference 7 days postoperatively (<one letter) was not clinically meaningful. No significant differences were noted 3 months postoperatively either in the uncorrected visual acuity, in the best-spectacle corrected visual acuity, or in the residual refractive error. Nine LASEK-treated eyes showed a postoperative refraction of +1 D or more. These cases had a higher preoperative sphere (-4.5 D) compared with the nonovercorrected LASEK-treated eyes (-3.5 D) (p = 0.03). One eye after LASEK and four eyes after LASIK needed retreatment (p > 0.05). CONCLUSIONS LASEK and LASIK seem to be similar in terms of safety and efficacy for the correction of moderate myopia. Nevertheless, a trend toward overcorrection was found in the LASEK group in correlation with a higher preoperative refractive error.
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Affiliation(s)
- Miguel A Teus
- Vissum Madrid, and Department of Opthamology, Universidad de Alcalá, Madrid, Spain
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Katsanevaki VJ, Kalyvianaki MI, Kavroulaki DS, Pallikaris IG. One-Year Clinical Results after Epi-LASIK for Myopia. Ophthalmology 2007; 114:1111-7. [PMID: 17320960 DOI: 10.1016/j.ophtha.2006.08.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 08/17/2006] [Accepted: 08/17/2006] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the clinical results of epi-LASIK for the treatment of low to moderate myopia and myopic astigmatism. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Two hundred thirty-four eyes of 138 patients underwent epi-LASIK for the correction of low to moderate myopia. Mean preoperative spherical equivalent ranged from -1.0 to -7.25 diopters (D) (-3.74+/-1.46, mean+/-standard deviation [SD]) and baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) from 0.10 to -0.18 (mean+/-SD, 0.00+/-0.06). METHODS All enrolled eyes underwent epi-LASIK using the Centurion SES epikeratome (Norwood Abbey EyeCare, Victoria, Australia) and the Allegretto (Wavelight Laser Technologie AG, Erlangen, Germany) laser platform. The enrolled patients were followed up daily until the epithelial healing was complete as well as at the 1-, 3-, 6-, and 12-month postoperative intervals. MAIN OUTCOME MEASURES The main parameters assessed were subjective evaluation of postoperative pain, uncorrected visual acuity (UCVA) and BSCVA, manifest refraction, haze grade, and contrast sensitivity of the operated eyes. RESULTS The mean epithelial healing time was 4.70+/-0.87 days (range, 3-7 days), with mean logMAR UCVA on the day of reepithelization of 0.26+/-0.14 (range, 0.7-0.0). One year after the treatment, the spherical equivalent of the treated eyes (n = 222) ranged from -1.25 to +0.625 D (mean+/-SD, -0.18+/-0.6 D), with 80.33% of the eyes within 0.5 D (96.72% within 1 D) of the attempted correction. At the same interval, 86% of the eyes had clear corneas and 14% clinically insignificant (trace) haze, whereas 60% of the eyes had a line gain of 1 or more lines of BSCVA. Mean logMAR contrast sensitivity of the treated eyes at 4 different spatial frequencies was improved or remained unchanged throughout the follow-up period. CONCLUSIONS One-year visual and refractive results after epi-LASIK suggest that it is a safe and efficient method for the correction of low to moderate myopia and myopic astigmatism.
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de Benito-Llopis L, Teus MA, Sánchez-Pina JM, Hernández-Verdejo JL. Comparison Between LASEK and LASIK for the Correction of Low Myopia. J Refract Surg 2007; 23:139-45. [PMID: 17326353 DOI: 10.3928/1081-597x-20070201-06] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the refractive results of laser epithelial keratomileusis (LASEK) and laser in situ keratomileusis (LASIK) for the correction of low myopia. METHODS A prospective, interventional, non-randomized, observer-masked study was performed of patients with myopia of < or = -2.50 diopters (D) (cylinder < or = 1.50 D) who had undergone either LASEK or LASIK. Refractive analysis was performed by a masked observer preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS Seventy-nine eyes that fulfilled the inclusion criteria in each group were included in the study. No statistically significant differences were noted in age, gender, or preoperative refractive error between groups. Postoperative uncorrected visual acuity (UCVA) was significantly lower in LASEK eyes 1 and 7 days postoperatively (P = .0001). At 1 and 3 months postoperatively, no significant differences were noted between the groups in UCVA (P = .07), but best spectacle-corrected visual acuity 3 months postoperatively was significantly better in LASEK eyes (P = .01). The refractive error was similar in both groups (P = .3). CONCLUSIONS Visual improvement after LASEK for low myopia is significantly slower than after LASIK. Visual outcomes at 3 months postoperatively were similar with both techniques for the correction of low myopia.
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Torres LF, Sancho C, Tan B, Padilla K, Schanzlin DJ, Chayet AS. Early Postoperative Pain Following Epi-LASIK and Photorefractive Keratectomy: A Prospective, Comparative, Bilateral Study. J Refract Surg 2007; 23:126-32. [PMID: 17326351 DOI: 10.3928/1081-597x-20070201-04] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare postoperative pain associated with epi-LASIK versus photorefractive keratectomy (PRK). METHODS This prospective observer-masked randomized study included 40 eyes of 20 patients with myopia and astigmatism who received epi-LASIK (Moria Epi-K) in one eye and PRK in the contralateral eye. Corneal ablation was done using the NIDEK EC-5000 excimer laser. Patients were seen at days 1, 3, and 6 to rate their pain via three measuring tools: 1) a global subjective rating, 2) a 10-cm visual analog scale, and 3) an 11-point numeric scale of pain. RESULTS On postoperative day 1, 19 of 20 patients reported pain in both eyes. Using the global subjective rating scale, patients reported more pain for those eyes treated by PRK. Although clinically relevant, this difference was not statistically significant (P = .56). Based on the 11-point numeric scale of pain and visual analog scale, mean pain scores were similar for both groups. On day 3, using the global subjective rating scale, 11 of 12 patients who had pain reported more in the epi-LASIK treated eye (P = .0005). In addition, epi-LASIK eyes demonstrated higher mean pain scores based on the other two scales (visual analog scale, P = .045 and 11-point numeric scale of pain, P = .023). Only 6 patients reported minimal pain on day 6. It was more frequently reported and slightly more marked in epi-LASIK eyes, but did not reach statistical significance. CONCLUSIONS Epi-LASIK and PRK have similar pain on postoperative day 1, but epi-LASIK demonstrated statistically more pain than PRK on days 3 and 6.
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Argento C, Cosentino MJ, Ganly M. Comparison of Laser Epithelial Keratomileusis With and Without the Use of Mitomycin C. J Refract Surg 2006; 22:782-6. [PMID: 17061715 DOI: 10.3928/1081-597x-20061001-08] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the results of prophylactic intraoperative use of mitomycin C (MMC) in laser epithelial keratomileusis (LASEK). METHODS A retrospective analysis of 30 LASEK cases that received MMC 0.02% intraoperatively (MMC group) was performed and compared to the results obtained in 28 LASEK cases not receiving MMC (no MMC group). Mitomycin C was placed in contact with the ablation zone for 75 seconds with an imbibed microsponge. Both groups received postoperative fluorometholone for 3 months. Preoperative spherical equivalent refraction was -5.72 +/- 2.82 diopters (D) in the MMC group and -5.81 +/- 2.74 D in the no MMC group. Best spectacle-corrected visual acuity was 0.88 +/- 0.12 in the MMC group and 0.88 +/- 0.13 in the no MMC group. RESULTS Spherical equivalent refraction at 6 months postoperatively was +0.11 +/- 0.13 D in the MMC group and +0.09 +/- 0.37 D in the no MMC group. Best spectacle-corrected visual acuity was 0.90 +/- 0.13 in the MMC group and 0.88 +/- 0.13 in the no MMC group. Uncorrected visual acuity (UCVA) > or = 20/40 was obtained in 93.3% of cases in the MMC group and in 89.3% of cases in the no MMC group; UCVA > or = 20/25 was achieved in 76.6% of cases in the MMC group and in 71.4% of cases in the no MMC group. Haze incidence for the MMC group was: trace: 0%, Grades I: 0%, II: 0%, III 0%, IV: 0%, and for the no MMC group: trace: 17.9%, Grades I: 3.6%, II: 0%, III: 0%, IV: 0%. A statistically significant difference (P<.001) was noted in haze intensity between the MMC group and no MMC group. CONCLUSIONS Prophylactic use of intraoperative MMC in LASEK significantly decreases haze incidence.
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Qazi MA, Johnson TW, Pepose JS. Development of late-onset subepithelial corneal haze after laser-assisted subepithelial keratectomy with prophylactic intraoperative mitomycin-C. J Cataract Refract Surg 2006; 32:1573-8. [PMID: 16931277 DOI: 10.1016/j.jcrs.2006.04.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 04/05/2006] [Indexed: 01/18/2023]
Abstract
We present a case of dense, visually significant reticular haze that developed approximately 17 months after uneventful laser-assisted subepithelial keratectomy with mitomycin-C (MMC). The patient was successfully treated with manual debridement coupled with phototherapeutic keratectomy and intraoperative MMC.
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Affiliation(s)
- Mujtaba A Qazi
- Pepose Vision Institute, Washington University School of Medicine, St. Louis, Missouri, USA
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Pirouzian A, Thornton J, Ngo S. One-year Outcomes of a Bilateral Randomized Prospective Clinical Trial Comparing Laser Subepithelial Keratomileusis and Photorefractive Keratectomy. J Refract Surg 2006; 22:575-9. [PMID: 16805120 DOI: 10.3928/1081-597x-20060601-09] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare laser subepithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) in different eyes of the same patients in terms of visual acuity, refractive error, and complications over 1 year. METHODS This prospective, randomized, double-masked study comprised 30 active-duty military personnel with myopia who underwent LASEK in one eye and PRK in the other eye. RESULTS Twenty-eight patients' results were available for 1-year follow-up. The primary outcome measures were visual acuity and refractive error. The mean visual acuity for the LASEK group was 1.56 and 1.67 for the PRK group (z = -0.18, P = .15). The mean spherical equivalent refraction for the LASEK group was -0.007 D and +0.124 D for the PRK group (t = 0.982, P = .40). No significant differences were noted in visual acuity or refractive error in the eyes that had LASEK versus the eyes that had PRK. CONCLUSIONS After 1-year follow-up, LASEK and PRK show similar levels of visual acuity and refractive error.
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Affiliation(s)
- Amir Pirouzian
- Department of Ophthalmology, San Diego Children's Hospital, University of California, San Diego, Calif, USA.
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Argento C, Cosentino MJ. Laser in situ keratomileusis: ablation on the flap and stromal bed in a primary treatment. J Cataract Refract Surg 2006; 32:590-4. [PMID: 16698477 DOI: 10.1016/j.jcrs.2006.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Accepted: 05/13/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze outcomes of laser in situ keratomileusis (LASIK) performed on the flap and on the stromal bed at the same time in a primary treatment. SETTING Instituto de la Visión, Buenos Aires, Argentina. METHODS Twenty-two cases (13 female, 9 male) were studied retrospectively; the mean age of the patients was 33.15 years +/- 10.44 (SD). Inclusion criteria were low pachymetry or topographic asymmetry. Twenty cases (90.9%) presented with low pachymetry (512.2 +/- 21.40 mum), and 2 cases (9.1%) presented with topographic asymmetry (inferior-superior difference more than 1.5 diopters [D]). Ablation was performed on the flap from the back and on the bed. The flap was made using the Technolas Hansatome microkeratome and the ablation by the Technolas 217z excimer laser (both by Bausch & Lomb). Preoperatively, the spherical equivalent (SE) was -5.61 +/- 1.72 D, the cylinder was -1.78 +/- 1.24 D, and the best spectacle-corrected visual acuity (BSCVA) was 0.77 +/- 0.19. Difficulties and complications of the technique, efficacy and safety index, and aberrations were analyzed. RESULTS According to the surgical plan and our nomogram, diopters corrected on the flap were -1.73 +/- 1.08 and on the bed were -4.77 +/- 1.89. The mean follow-up was 8.28 +/- 2.19 months. At 6 months, the SE was -0.21 +/- 0.39, vectorial change was 1.69 +/- 0.74, and the BSCVA was 0.77 +/- 0.20. Postoperatively, no eye had an increase in refractive astigmatism. Uncorrected visual acuity was 20/40 or better in all cases (100%) and 20/25 or better in 13 cases (59.1%). Regarding gained and lost lines of BSCVA, 54.5% conserved the lines, 18.2% lost 1 line, 9.1% gained 1 line, and 18.2% gained 2 lines. CONCLUSIONS Simultaneous ablation on the flap and on the bed in cases of low pachymetry or topographical asymmetry was predictable, effective, and safe.
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Affiliation(s)
- Carlos Argento
- Instituto de la Visión, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Richter-Mueksch S, Kaminski S, Kuchar A, Stifter E, Velikay-Parel M, Radner W. Influence of laser in situ keratomileusis and laser epithelial keratectomy on patients' reading performance. J Cataract Refract Surg 2005; 31:1544-8. [PMID: 16129289 DOI: 10.1016/j.jcrs.2005.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the influence of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) on reading performance regarding reading acuity, reading speed based on print size, maximum reading speed, and critical print size. SETTING Department of Ophthalmology, University of Vienna, Vienna, and Auge-und-Laser, Medicent Baden, Austria. METHODS Fifty-two eyes of 34 patients (26 eyes per group) were studied. Best corrected LogMAR visual acuity (Early Treatment Diabetic Retinopathy Study charts), reading acuity, and reading speed were tested monocularly before LASIK or LASEK and 3 weeks after surgery. Reading acuity (LogRAD) and reading speed were determined with the standardized Radner reading charts. RESULTS Preoperatively, the distance visual acuity and reading acuity were comparable between the LASIK and LASEK patients. Reading speed measurements also showed no statistical difference. Three weeks after refractive surgery, no statistically significant differences in the preoperative measures and between the 2 surgical procedures could be found in any tested parameters. The mean distance visual acuity was LogMAR -0.02 +/- 0.06 (SD) (LASIK) and LogMAR -0.05 +/- 0.07 (LASEK). The mean reading acuity was LogRAD 0.00 +/- 0.12 (97.7% of LogMAR) (LASIK) and LogRAD 0.04 +/- 0.16 (93.7% of LogMAR) (LASEK). The mean maximum reading speed was 235 +/- 35 words per minute (LASIK) and 240 +/- 37 words per minute (LASEK), and the mean critical print size was at LogRAD 0.48 +/- 0.19 (LASIK) and 0.49 +/- 0.17 (LASEK). CONCLUSIONS In a standardized reading test setting, no significant effects of LASIK and LASEK on individual reading performance could be evaluated. This indicates that patients can expect to retain their normal visual function after refractive surgery with these 2 procedures under full light conditions.
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Pallikaris IG, Kalyvianaki MI, Katsanevaki VJ, Ginis HS. Epi-LASIK: Preliminary clinical results of an alternative surface ablation procedure. J Cataract Refract Surg 2005; 31:879-85. [PMID: 15975451 DOI: 10.1016/j.jcrs.2004.09.052] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the clinical results of epi-LASIK, a new surface ablation surgical technique for the treatment of low myopia. SETTING Vardinoyannion Eye Institute of Crete, University of Crete, Greece. METHODS Forty-four eyes of 31 patients had epi-LASIK for the correction of low myopia. Mean preoperative spherical equivalent was 3.71 diopters (D) +/- 1.2 (SD) (range -1.75 to -7.00 D) and the mean baseline logMAR best spectacle-corrected visual acuity was -0.01 +/- 0.06 (range 0.10 to -0.10). All the epithelial separations were performed with the Centurion epikeratome (CIBA Surgical). The enrolled patients were followed daily until the epithelial healing was complete as well as at 1- and 3-month intervals. On the operative day, patients filled out a questionnaire grading visual performance and pain score of treated eyes every 2 hours for a total of 5 records. RESULTS The mean epithelial healing time was 4.86 +/- 0.56 days (range 3 to 5 days). The mean logMAR uncorrected visual acuity on the day of reepithelization was 0.19 +/- 0.09 (range 0.40 to 0.10). At 1 month, the mean was spherical equivalent of the treated eyes (N=44), -0.3 +/- 0.6 D (range -1.0 to 0.87 D), and at 3 months it was (N=37), -0.10 +/- 0.4 D (range -0.75 to 0.75 D); 97% of eyes had clear corneas or trace haze 3 months after treatment. CONCLUSIONS Preliminary clinical results suggest that epi-LASIK is a safe and efficient method for the correction of low myopia. Further studies will establish this method as an alternative surface ablation procedure.
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Yo C, Ariyasu RG. Racial Differences in Central Corneal Thickness and Refraction Among Refractive Surgery Candidates. J Refract Surg 2005; 21:194-7. [PMID: 15796227 DOI: 10.3928/1081-597x-20050301-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the preoperative central corneal thickness and refractive status of Caucasians, Hispanics, Asians, and African Americans in a refractive surgery patient population. METHODS In a retrospective case series, a total of 803 consecutive eyes, which had no history of anterior segment surgery, underwent central corneal thickness and refraction measurement as part of a preoperative evaluation for refractive surgery from December 1999 to October 2002. Preoperative central corneal thickness was measured by a DGH-550 ultrasonic pachymeter, and spherical equivalence was determined by manifest refraction. RESULTS This study included Caucasian (34.4%), Hispanic (34.5%), Asian (20.7%), African American (8.9%), and other (1.5%) patients. A one-way analysis of variance (ANOVA) revealed no significant differences in the central corneal thickness measurements among Asians, Hispanics, and Caucasians. However, mean central corneal thickness was 14 microm thinner in African Americans compared to Caucasians, and was significantly different at the 95% confidence interval. A one-way ANOVA revealed a significant difference in the preoperative spherical equivalence among the four groups (F=4.91; df=3; P<.05) but no significant differences were noted in the preoperative astigmatism among any of the four groups (F=1.08; df=3; P>.05). A significant difference was noted in age in the four preoperative groups. CONCLUSIONS Among the refractive population, African Americans were found to have thinner central corneal thickness than Caucasians. Asians were significantly (P<.05) more myopic compared to Caucasians, Hispanics, and African Americans. No difference was noted in the preoperative astigmatism among any of the four groups. Asians sought refractive surgery at a younger age whereas Caucasians sought it at an older age.
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Affiliation(s)
- Christopher Yo
- Department of Ophthalmology, University of Southern California-Los Angeles County Hospital, USA.
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Abstract
PURPOSE The aim of this study was to assess astigmatism magnitude and axis changes based on the dioptric power matrix in low to moderate levels of myopia and astigmatism treated with LASEK. PATIENTS AND METHODS This retrospective analysis included 54 myopic eyes treated with LASEK with a minimum follow-up of 12 months. An epithelial flap was created by 25-45 s of 20% alcohol exposure. The corneal surface was ablated using two different excimer lasers and nomogram adjustment. The flap was repositioned and a bandage applied to the contact lens. Main outcome measures were manifest refraction as calculated with the dioptric power matrix, UCVA, BSVCA, and retreatment rate. RESULTS Mean manifest refraction is shown in table 2 (Tabelle 2). UCVAs of 20/20 or better were found in 33% of eyes at 1 week and in more than 53% at 3 months to 1 year. The safety index remained > or =0.98 after postoperative week 4. The efficacy index varied between 0.91 and 0.98 after 1 month. CONCLUSION LASEK for correction of low to moderate myopia and astigmatism seems to be a safe, effective, and stable option.
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Affiliation(s)
- S Taneri
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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Vinciguerra P, Camesasca FI, Torres IM. Transition zone design and smoothing in custom laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2005; 31:39-47. [PMID: 15721695 DOI: 10.1016/j.jcrs.2004.10.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the results of custom laser-assisted subepithelial keratectomy (LASEK) with a specially designed transition zone and smoothing for the treatment of refractive errors. SETTING Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milan, Italy. METHODS This prospective study involved myopic eyes having refractive surgery with the butterfly LASEK technique and the Nidek EC-5000 excimer laser. The treatment was based on the surgeon's analysis of topographic and aberrometric data provided by Final Fit ablation software, which features the Custom Aspheric Transition Zone software algorithm. After the ablation, smoothing was performed to remove corneal microirregularities. RESULTS Fifty-five eyes of 38 patients were treated. The mean preoperative spherical equivalent (SE) refraction was -6.58 diopters (D) +/- 2.24 (SD) (range -12.13 to -1.75 D). At 1 year, the mean SE refraction was -0.26 +/- 0.79 D (range -4.00 to +0.75 D). CONCLUSION The surface ablation technique provided satisfactory results and took into account strategies to reduce unpredictability factors such as corneal biomechanical forces, haze induced by an irregular postoperative surface, and a high curvature gradient in the transition zone.
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Affiliation(s)
- Paolo Vinciguerra
- Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milan, Italy
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Laplace O, Bourcier T, Chaumeil C, Cardine S, Nordmann JP. Early bacterial keratitis after laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2004; 30:2638-40. [PMID: 15617940 DOI: 10.1016/j.jcrs.2004.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2004] [Indexed: 11/29/2022]
Abstract
We report a case of bacterial keratitis that occurred after laser-assisted subepithelial keratectomy. The patient presented with a decrease in visual acuity and pain 2 days after the procedure. Culture was positive for Staphylococcus haemolyticus. The infiltrate slowly resolved with topical antibiotics, and the best corrected visual acuity improved to 20/20. Although bacterial keratitis occurs rarely after refractive surgery, patients should be informed of the potential risk for visual loss caused by this infection.
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Affiliation(s)
- Olivier Laplace
- Quinze-Vingts National Center of Ophthalmology, Paris, France.
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