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Abstract
Purpose Mitomycin C after photorefractive keratectomy (PRK) is used to reduce the development of haze and regression in higher intended corrections. The aim of this study was to investigate the safety, stability, and efficacy of EpiLASIK with mitomycin C. Methods Fifty eyes of 29 patients underwent EpiLASIK with the Gebauer EpiLift microkeratome. The mean preoperative spherical equivalent was −6.89 D (SD ±0.63, range −6.0 to −8.0 D). After the laser ablation, mitomycin C 0.02% was applied for 30 seconds on a sterile filter paper. Preoperatively and 1, 3, 6, and 12 months after surgery, a full ophthalmic examination was performed. Results In 42 of 50 eyes, the bandage contact lens was removed at day 3. Twelve months after surgery, 96% of all eyes were within ±1.0 D and 82% were within ±0.5 D of intended correction. Five percent of all patients lost 1 line of best-corrected Snellen visual acuity, 42% were stable, and 56% gained 1 or more lines. In most patients, the cornea was clear during the whole follow-up, and in 10% only trace haze was visible. The uncorrected visual acuity was at least 1.0 in 86% of all patients, and all patients reached 0.5. Conclusions EpiLASIK with mitomycin C with higher intended corrections seems to be an effective and safe procedure. With the application of mitomycin C, only minimal haze appears.
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Affiliation(s)
| | - Ramin Khoramnia
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Mathias Maier
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Chris P. Lohmann
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
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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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Comparison of 3 silicone hydrogel bandage soft contact lenses for pain control after photorefractive keratectomy. J Cataract Refract Surg 2014; 40:1798-804. [DOI: 10.1016/j.jcrs.2014.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 11/23/2022]
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Lakshminarayanan R, Chaurasia SS, Anandalakshmi V, Chai SM, Murugan E, Vithana EN, Beuerman RW, Mehta JS. Clinical and genetic aspects of the TGFBI-associated corneal dystrophies. Ocul Surf 2014; 12:234-51. [PMID: 25284770 DOI: 10.1016/j.jtos.2013.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 11/16/2022]
Abstract
Corneal dystrophies are a group of inherited disorders localized to various layers of the cornea that affect corneal transparency and visual acuity. The deposition of insoluble protein materials in the form of extracellular deposits or intracellular cysts is pathognomic. Mutations in TGFBI are responsible for superficial and stromal corneal dystrophies. The gene product, transforming growth factor β induced protein (TGFBIp) accumulates as insoluble deposits in various forms. The severity, clinicopathogenic variations, age of the onset, and location of the deposits depend on the type of amino acid alterations in the protein. Until 2006, 38 different pathogenic mutants were reported for the TGFBI-associated corneal dystrophies. This number has increased to 63 mutants, reported in more than 30 countries. There is no effective treatment to prevent, halt, or reverse the deposition of TGFBIp. This review presents a complete mutation update, classification of phenotypes, comprehensive reported incidents of various mutations, and current treatment options and their shortcomings. Future research directions and possible approaches to inhibiting disease progression are discussed.
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Affiliation(s)
- R Lakshminarayanan
- Singapore Eye Research Institute, Singapore; SRP Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore
| | - Shyam S Chaurasia
- Singapore Eye Research Institute, Singapore; SRP Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Shu-Ming Chai
- Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore
| | | | - Eranga N Vithana
- Singapore Eye Research Institute, Singapore; SRP Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger W Beuerman
- Singapore Eye Research Institute, Singapore; SRP Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore National Eye Centre, Singapore; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
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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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de Benito-Llopis L, Teus MA. Epi-LASIK versus LASEK and PRK. J Cataract Refract Surg 2012; 38:732; author reply 732-3. [DOI: 10.1016/j.jcrs.2012.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Indexed: 10/28/2022]
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Jung BJ, Oh TH, Chung SK. Eight-Year Follow-up of Laser Epithelial Keratomileusis for Correcting Moderate and High Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.10.1438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Byung Ju Jung
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Hoon Oh
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Kun Chung
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Wavefront-guided epithelial laser in situ keratomileusis with mitomycin-C for myopia and myopic astigmatism: flap-on versus flap-off technique. J Cataract Refract Surg 2011; 37:1133-9. [PMID: 21596257 DOI: 10.1016/j.jcrs.2010.12.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/22/2010] [Accepted: 12/22/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the postoperative pain, visual recovery, and outcomes of flap-on and flap-off epithelial laser in situ keratomileusis (epi-LASIK) with mitomycin-C (MMC). SETTING Asian Eye Institute, Makati, Philippines. DESIGN Case-control study. METHODS Patients with myopia up to 9.00 diopters had wavefront-guided epi-LASIK with MMC. After randomization, the epithelium was removed in 1 eye (flap off) and repositioned in the other eye (flap on). Questionnaires were used to evaluate postoperative pain and visual recovery in each eye during the first postoperative week. Visual results, refractive outcomes, contrast sensitivity, and higher-order aberrations (HOAs) were compared and analyzed. RESULTS The study evaluated 48 eyes. The mean pain scores were lower and better vision was perceived in the flap-off group during the first postoperative week. One year postoperatively, the mean uncorrected distance visual acuity was -0.088 logMAR in the flap-on group and -0.036 logMAR in the flap-off group (P = .918). The spherical equivalent was within ± 0.50 D in 92% of eyes in both groups (P > .05). Forty-six percent in the flap-on group and 38% in the flap-off group gained 1 line of corrected distance visual acuity (P = .915). Contrast sensitivity tests under daytime and nighttime conditions were comparable. There was no statistically significant difference in the mean change in HOAs between groups. CONCLUSIONS Wavefront-guided epi-LASIK with MMC was effective, safe, and predictable in treating myopia and myopic astigmatism. Eyes that had flap-off epi-LASIK had less pain and faster visual recovery. Visual results, refractive outcomes, contrast sensitivity, and HOAs were comparable between groups. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Qu XM, Dai JH, Jiang ZY, Qian YF. Clinic study on silicone hydrogel contact lenses used as bandage contact lenses after LASEK surgery. Int J Ophthalmol 2011; 4:314-8. [PMID: 22553670 DOI: 10.3980/j.issn.2222-3959.2011.03.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/25/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the clinical performance of two types of silicon hydrogel contact lenses used as bandage lenses after LASEK surgery. METHODS A prospective, double-masked study was conducted on 42 eyes of 21 patients who received binocular LASEK surgeries. The interocular difference in spherical equivalent power was less than -1.50D. Patients were randomly assigned to wear Galyfilcon A (Lens A) bandage contact lens in one eye and Balafilcon A (Lens B) in the fellow eye after the surgery. The responses to a subjective questionnaire on comfort of wearing, corneal epithelial status, conjunctival hyperemia, limbal neovascularization, lens fitting and contact lens debris were assessed 1 and 5 days postoperatively. Corneal endothelium was assessed before and 5 days after the surgery upon bandage lens removal. RESULTS There was no difference between the two groups in terms of conjunctival hyperemia, limbal neovascularization, contact lens fitting, corneal epithelial status, corneal endothelium cell density (CD) and endothelium cell size (CS) at any postoperative visit. Complaints of discomfort, including foreign body sensation, pain and intolerance were statistically more among Lens B wearers at any postoperative visit (P<0.05). Lens B appeared to attract much more debris than Lens A at the 5-day post-operative follow-up visit (P<0.01). CONCLUSION The two types of silicon hydrogel lenses investigated in this study demonstrated similar clinical performance in terms of corneal responses and lens fitting. However, Lens A showed a better performance in terms of comfort of wearing and deposit resistance.
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Affiliation(s)
- Xiao-Mei Qu
- Department of Ophthalmology, Eye and ENT Hospital Affiliated to Fudan University, Shanghai 200031, China
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12
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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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13
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Arbelaez MC, Vidal C, Arba Mosquera S. Comparison of LASEK and LASIK with Thin and Ultrathin Flaps After Excimer Laser Ablation with the SCHWIND Aspheric Ablation Profile. J Refract Surg 2011; 27:38-48. [DOI: 10.3928/1081597x-20100406-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 02/18/2010] [Indexed: 11/20/2022]
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Kim SK, Kim JH, Kim EK, Na KS, Tchah H, Hyon JY, Cho EY, Jung SY, Jang EJ, Kim TI. Long-Term Quality of Life after Myopic Laser Refractive Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.8.922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Se Kyung Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hoon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sun Na
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Sun Young Jung
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Eun Jin Jang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Zhang ZY, Chu RY, Zhang XR, Hoffman MR, Zhou XT. Effects of femtosecond laser-assisted multilayer intrastromal ablation in the midperipheral cornea. J Cataract Refract Surg 2010; 36:1807-10. [PMID: 21029884 DOI: 10.1016/j.jcrs.2010.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 05/26/2010] [Accepted: 06/05/2010] [Indexed: 11/29/2022]
Abstract
We describe the femtosecond laser-assisted midperipheral multilayer intrastromal ablation technique, which combines the benefit of radial keratotomy, ie, not disturbing the optical zone, with currently available technology to correct myopia. The technique was performed in 2 patients, both of whom experienced a decrease in mean corneal power. In 1 patient, the manifest refraction improved, with a 1-line increase in uncorrected visual acuity 1 day postoperatively. The multilayer intrastromal ablation technique, which flattens the cornea and decreases corneal power, can be used to correct moderate myopia without injuring the corneal epithelium.
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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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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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Mimura T, Azar DT. Current Concepts, Classification, and History of Refractive Surgery. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00015-9] [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] Open
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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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Kramarevsky N, Hardten DR. Excimer Laser Photorefractive Keratectomy. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sharma N, Kaushal S, Jhanji V, Titiyal JS, Vajpayee RB. Comparative evaluation of ‘flap on’ and ‘flap off’ techniques of Epi-LASIK in low-to-moderate myopia. Eye (Lond) 2008; 23:1786-9. [PMID: 19079146 DOI: 10.1038/eye.2008.367] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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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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Nishi Y, Nishi O, Nishi K, Auffarth G. Pain reduction after epi-LASIK with a simple surgical procedure. J Cataract Refract Surg 2007; 33:555-7. [PMID: 17321416 DOI: 10.1016/j.jcrs.2006.09.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 09/25/2006] [Indexed: 10/23/2022]
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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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Jang SW, Chung ES, Chung TY. Comparison of Hydrogel and Silicone Hydrogel Bandage Contact Lens after LASEK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.10.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung Won Jang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eui Sang Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi SK, Park HY, Kim YH, Chung SK. Comparison of Laser Epithelial Keratomileusis Versus Epipolis-Laser in Situ Keratomileusis for Moderate to High Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.9.1196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Suk Kyue Choi
- Department of Ophthalmology, Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Young Park
- Department of Ophthalmology, Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hee Kim
- Department of Ophthalmology, Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Kun Chung
- Department of Ophthalmology, Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tobaigy FM, Ghanem RC, Sayegh RR, Hallak JA, Azar DT. A control-matched comparison of laser epithelial keratomileusis and laser in situ keratomileusis for low to moderate myopia. Am J Ophthalmol 2006; 142:901-8. [PMID: 17157575 DOI: 10.1016/j.ajo.2006.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 07/31/2006] [Accepted: 08/01/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the visual and refractive outcomes of laser epithelial keratomileusis (LASEK) and laser in situ keratomileusis (LASIK) for the treatment of low to moderate myopia. DESIGN Retrospective, nonrandomized, control-matched study. METHODS The charts of 2257 eyes that underwent LASEK or LASIK treatment were reviewed. Patients who were 21 years of age or older having between -0.75 and -6.00 diopters (D) of myopia with up to -2.25 D of astigmatism were included. One hundred twenty-two LASEK-treated eyes were matched with 122 LASIK-treated eyes having preoperative spheres, cylinders, and spherical equivalent (SE) within +/-0.50 D. Both groups had similar preoperative best spectacle-corrected visual acuity (BSCVA), laser platform, and follow-up durations. Outcome measures were visual and refractive results. RESULTS Preoperatively, the mean SE was -3.50 +/- 1.40 D for LASEK and -3.50 +/- 1.42 D for LASIK (P = .59). Postoperatively, the mean logarithm of minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) was 0.01 +/- 0.08 (20/21) for LASEK and 0.06 +/- 0.12 (20/23) for LASIK; the mean SE was -0.15 +/- 0.40 D for LASEK and -0.37 +/- 0.45 D for LASIK; and the mean logMAR of BSCVA was -0.03 +/- 0.06 (20/19) for LASEK and -0.02 +/- 0.05 (20/19) for LASIK. No eye lost 2 or more lines of BSCVA in both groups. CONCLUSIONS Slight differences in the visual and refractive results between LASEK and LASIK were observed, despite the use of the same nomogram. Both procedures were safe, effective, and predictable. Nomogram adjustment may be necessary for LASIK surgeons adopting surface ablation.
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Affiliation(s)
- Faisal M Tobaigy
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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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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Netto MV, Mohan RR, Sinha S, Sharma A, Gupta PC, Wilson SE. Effect of Prophylactic and Therapeutic Mitomycin C on Corneal Apoptosis, Cellular Proliferation, Haze, and Long-term Keratocyte Density in Rabbits. J Refract Surg 2006; 22:562-74. [PMID: 16805119 PMCID: PMC2756017 DOI: 10.3928/1081-597x-20060601-08] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the mechanism through which topical mitomycin C prevents and treats corneal haze after photorefractive keratectomy (PRK) and to examine the effects of dosage and duration of exposure. METHODS In 224 New Zealand rabbits, -9.0 diopter PRK with mitomycin C or balanced salt solution was performed. Haze level was graded at the slit-lamp. Rabbits were sacrificed at 4 hours, 24 hours, 4 weeks, or 6 months after surgery and immunohistochemistry was performed with TUNEL assay, Ki67, and alpha-SMA. RESULTS TUNEL-positive apoptotic cells marginally increased in all mitomycin C groups whereas Ki67-positive mitotic cells decreased significantly following mitomycin C application. A greater decrease in myofibroblasts was noted with prophylactic mitomycin C treatment than therapeutic mitomycin C treatment. There was, however, an anterior stromal acellular zone (approximately 20% of the total stroma) in eyes treated with mitomycin C, which persisted to the maximum follow-up of 6 months. CONCLUSIONS Mitomycin C treatment induces apoptosis of keratocytes and myofibroblasts, but the predominate effect in inhibiting or treating haze appears to be at the level of blocked replication of keratocytes or other progenitor cells of myofibroblasts. Treatment with 0.002% mitomycin C for 12 seconds to 1 minute appears to be just as effective as higher concentrations for longer duration in the rabbit model. However, a persistent decrease in keratocyte density in the anterior stroma could be a warning sign for future complications and treatment should be reserved for patients with significant risk of developing haze after PRK.
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Affiliation(s)
- Marcelo V Netto
- The Cole Eye Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA
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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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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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Rezende RA, Uchoa UC, Cohen EJ, Laibson PR, Rapuano CJ. Complications associated with anterior basement membrane dystrophy after laser in situ keratomileusis. J Cataract Refract Surg 2004; 30:2328-31. [PMID: 15519083 DOI: 10.1016/j.jcrs.2004.02.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the complications associated with anterior basement membrane dystrophy (ABMD) after laser in situ keratomileusis (LASIK). SETTING Cornea Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. METHODS In this noncontrolled retrospective case series, the medical records of all patients with LASIK complications seen in the Cornea Service at Wills Eye Hospital from January 1, 1998, to December 31, 2002, were reviewed. All patients who presented with ABMD changes after LASIK were included in the study. Patients with a history of trauma before or after surgery were excluded. RESULTS Thirty-five eyes of 18 patients were included. The mean age was 46.2 years. Thirteen eyes (37.1%) had a flap-lift procedure to remove epithelial ingrowth or for an enhancement. The most common reason for the visit was visual complaints, which were seen in 77.8% of patients. Seven patients (38.9%) had visual complaints alone; 27.8% had visual complaints associated with recurrent erosions and 11.1%, with dry eyes. Four patients (22.2%) had recurrent corneal erosions with no visual complaints. On examination, the most common finding was negative staining with fluorescein dye within the LASIK flap, which was seen in all patients. In addition to the ABMD changes, 25.7% had some degree of epithelial ingrowth and 45.7%, irregular astigmatism. CONCLUSIONS Anterior basement membrane dystrophy changes post LASIK were associated with visual complaints and/or recurrent erosions. Patients should be carefully screened for ABMD. Those who have ABMD signs or symptoms may not be ideal candidates for LASIK.
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Affiliation(s)
- Renata A Rezende
- Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA
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Partal AE, Rojas MC, Manche EE. Analysis of the efficacy, predictability, and safety of LASEK for myopia and myopic astigmatism using the Technolas 217 excimer laser. J Cataract Refract Surg 2004; 30:2138-44. [PMID: 15474827 DOI: 10.1016/j.jcrs.2004.02.083] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2004] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the efficacy, predictability, and safety of laser-assisted subepithelial keratectomy (LASEK) for the treatment of myopia and myopic astigmatism. SETTING Stanford University Eye Laser Center, Stanford, California, USA. METHODS This retrospective analysis comprised 102 eyes that had LASEK for myopia using the Bausch & Lomb Technolas 217 excimer laser. Primary outcome variables including uncorrected visual acuity (UCVA), best spectacle- corrected visual acuity (BSCVA), manifest refraction, and complications were evaluated at 3, 6, and 12 months. Vector analysis was performed on eyes that received astigmatic correction. RESULTS The mean spherical equivalent was -7.03 diopters (D) +/- 2.61 (SD) preoperatively, +0.19 +/- 0.64 D at 3 months, +0.23 +/- 0.82 D at 6 months, and +0.03 +/- 0.63 D at 12 months (P<.001). At 3, 6, and 12 months, the UCVA was 20/20 or better in 66%, 67%, and 83% of eyes, respectively, and 20/40 or better in 98%, 99%, and 100%; 74%, 70%, and 83%, respectively, were within +/-0.5 D of emmetropia, and 89%, 86%, and 97%, respectively, were within +/-1.0 D. No eye lost more than 2 lines of BSCVA. At 3, 6, and 12 months, 10.0%, 8.7%, and 0% of eyes, respectively, had trace corneal haze. Vector analysis found a success rate of approximately 78% to 80% in achieving the astigmatic surgical correction at the 3 postoperative visits. CONCLUSIONS Laser-assisted subepithelial keratectomy was an effective, predictable, and safe procedure for the treatment of myopia and myopic astigmatism. Further studies are needed to determine the role of LASEK in the refractive surgery spectrum.
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Vinciguerra P, Camesasca FI, Torres IM. One-year Results of Custom Laser Epithelial Keratomileusis With the Nidek System. J Refract Surg 2004; 20:S699-704. [PMID: 15521271 DOI: 10.3928/1081-597x-20040903-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate long-term results of custom laser epithelial keratomileusis (LASEK) for correction of myopia and hyperopia using the Custom Ablation Transition Zone (CATz) software and hyaluronic acid masking fluid (Laservis) for final corneal smoothing. METHODS We conducted a prospective study of 297 eyes of 167 patients. All eyes had LASEK for correction of myopia or hyperopia. The Nidek EC-5000 excimer laser, FinalFit software, and CATz ablation profile was used in all eyes. Laservis was used as masking fluid to remove corneal micro-irregularities during the final phase of the treatment. RESULTS Mean preoperative spherical equivalent refraction was -5.46 +/- 2.57 D (range -14.13 to +3.50 D). At 1 year after LASEK, mean spherical equivalent refraction was -0.15 +/- 0.50 D (range -4.00 D to +1.00 D). CONCLUSIONS LASEK with the Nidek EC-5000 excimer laser, FinalFit and Custom Ablation Transition Zone (CATz) software, with corneal smoothing, was safe and effective at 1 year after surgery.
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Affiliation(s)
- Paolo Vinciguerra
- Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milano, Italy.
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Abstract
PURPOSE To assess the advantages and safety of using mitomycin C (MMC) with laser epithelial keratomileusis (LASEK) by measuring high order aberrations of the cornea. METHODS We analyzed the results of 86 eyes that had LASEK plus a brushstroke of MMC 0.01%. Another group of 100 eyes had LASEK only (control group). Mean follow-up was 312 days for the MMC group and 774 days for the control group. A Nidek EC-5000 laser was used in all eyes. We measured mean refractive error, best spectacle-corrected visual acuity (BSCVA), haze, and high order aberrations before and at 1 month and nearly 1 year after LASEK. RESULTS Mean baseline spherical equivalent refraction was -6.80 +/- 3.00 D for the MMC group and -6.00 +/- 3.10 D for the control group (P=.34). In eyes with low myopia (-1.20 to -10.80 D), a single ablation zone of 6 mm with a transition zone of 8 mm was used, and in the higher myopia group (-5.60 to -15.50 D), smoothing and a cross sphere procedure (+0.75 D) were used. Mean spherical equivalent refraction after LASEK for low myopia in the MMC group at last examination (mean follow-up 312 days) was +0.50 +/- 0.93, and 0 +/- 0.34 D for the control group. Mean spherical equivalent refraction after LASEK for high myopia in the MMC group at last examination (mean follow-up 312 days) was +0.50 +/- 1.03 D, and +0.40 +/- 0.78 D for the control group. Mean haze in the low myopia MMC group was 0.06 and in the control group, 0.11; in the high myopia MMC group it was 0.1, and in the control group, 0.27 (all differences P<.05). No differences between baseline and postoperative BSCVA were noted. Early and late overcorrection were noted in the MMC group. Increased high order aberrations were evident at 1 month and 1 year in the MMC groups. CONCLUSIONS The use of mitomycin C 0.01% with LASEK significantly decreased subepithelial haze. However, refractive outcome was less predictable. High order aberrations increased after LASEK with MMC. Additional studies with longer follow-up are necessary to evaluate long-term effects, and ideal MMC concentration and exposure time.
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Laube T, Wissing S, Theiss C, Brockmann C, Steuhl KP, Meller D. Decreased keratocyte death after laser-assisted subepithelial keratectomy and photorefractive keratectomy in rabbits. J Cataract Refract Surg 2004; 30:1998-2004. [PMID: 15342069 DOI: 10.1016/j.jcrs.2004.01.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare keratocyte loss in the corneal stroma after laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) in rabbits. SETTING Department of Ophthalmology, University of Essen, Essen, and the Institute of Anatomy, University of Bochum, Bochum, Germany. METHODS Laser-assisted subepithelial keratectomy and PRK were performed in rabbits and studied 1, 3, 10, and 20 days after surgery. Excimer photoablation was done unilaterally with a 6.0 mm ablation zone and an 80 microm depth, equivalent to -6.0 diopters. Keratocyte death was analyzed using DNA fragmentation-detecting terminal deoxynucleotidyl transferase deoxy-UTR-nick end labeling (TUNEL) assay and transmission electron microscopy. RESULTS Numerous TUNEL-positive keratocytes occurred 1 day after PRK; the number decreased significantly after 3 days. After LASEK, significantly fewer TUNEL-positive keratocytes were noted at the early time points (P<.001 at 1 day; P< or =.05 at 3 days). At 10 days, the number of TUNEL-positive keratocytes decreased in both groups but remained significantly higher after PRK than after LASEK (P<.001). Twenty days after both procedures, no significant signs of keratocyte death were found in the corneal stroma. Transmission electron microscopy revealed few apoptotic keratocytes after LASEK. After PRK, apoptotic keratocytes, characterized by chromatin condensation, apoptotic bodies, and cell shrinkage, were scattered in the stroma. The ultrastructural findings confirmed the results obtained with the TUNEL assay. CONCLUSIONS Laser-assisted subepithelial keratectomy induced significantly less apoptotic keratocyte death than PRK and promoted wound healing in the acute phase after photoablation. This procedure may offer the possibility of treating higher myopia with a decreased risk for developing wound healing-related complications known to occur after PRK.
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Affiliation(s)
- Thomas Laube
- Department of Ophthalmology, University of Essen, 45122 Essen, Germany
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Bilgihan K, Hondur A, Hasanreisoglu B. Laser Subepithelial Keratomileusis for Myopia of -6 to -10 Diopters With Astigmatism With the MEL60 Laser. J Refract Surg 2004; 20:121-6. [PMID: 15072310 DOI: 10.3928/1081-597x-20040301-05] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy, predictability, and safety of laser subepithelial keratomileusis (LASEK) for treatment of high myopia with astigmatism. METHODS LASEK was performed in 61 eyes of 36 consecutive patients with myopic spherical equivalent refraction of -6.00 to -10.00 D using the Aesculap-Meditec MEL60 excimer laser. Data were collected prospectively with a follow-up of 6 to 17 months. Main outcome measures recorded were UCVA, BSCVA, residual refractive error, corneal haze, and complications. RESULTS Ninety-six percent of eyes achieved 20/40 or better UCVA at 1 month. At 12 months, 64% of eyes achieved 20/20 and 92% achieved 20/40 or better UCVA. Two eyes lost 2 lines of BSCVA at 6 or 12 months. Accuracy of correction was +/- 0.50 D from emmetropia in 82% of eyes, and +/- 1.00 D in 90% at 12 months. No eye showed more than grade 1 haze. Grade 1 haze was observed in three eyes at 12 months. One patient had mild postoperative keratitis, which was successfully treated. CONCLUSIONS LASEK with the Aesculap-Meditec MEL60 excimer laser appeared to be safe, effective, and highly predictable in treating high myopia.
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Affiliation(s)
- Kamil Bilgihan
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey.
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Szaflik JP, Ambroziak AM, Szaflik J. Therapeutic Use of a Lotrafilcon A Silicone Hydrogel Soft Contact Lens as a Bandage After LASEK Surgery. Eye Contact Lens 2004; 30:59-62. [PMID: 14722473 DOI: 10.1097/01.icl.0000107181.42704.d8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Soft contact lenses may be used as a bandage after corneal refractive surgery. Silicone hydrogel contact lenses offer the advantage of increased oxygen permeability over conventional hydrogel lenses for this application. To evaluate a silicone hydrogel contact lens as a continuous wear bandage applied after laser-assisted sub-epithelial keratomileusis (LASEK). METHODS We conducted a prospective, open-label, non-randomized clinical trial involving thirty patients treated with unilateral LASEK. Patients were fitted with a lotrafilcon A (Focus NIGHT & DAY; CIBA Vision, Duluth, GA) silicone hydrogel soft contact lens that was worn continuously for 3 to 4 days post-operatively. Lens movement and slitlamp evaluations of conjunctival hyperemia 1, 2, and 3 days after surgery (DAS) were recorded, as was the condition of the corneal epithelium after lens removal. Subjective comfort was rated by the patients along with the presence of symptoms or pain. RESULTS Post-blink lens movement was evaluated by investigators as "very good" or "good" in 87% of eyes at 1 DAS, in 73% at 2 DAS, and in 60% at 3 DAS. Conjunctival hyperemia was assessed as normal or trace in 96% of eyes at 1 DAS, in 76% at 2 DAS, and in 67% at 3 DAS. An average of 80% of eyes showed normal or trace conjunctival hyperemia during the trial. The condition of the corneal epithelium after contact lens removal was rated as "very good" in 13% or "good" in 73% of eyes. An average of 77% of subjects reported "very good" or "good" comfort during the trial. Symptoms or pain were rated as "absent" or "mild" by all subjects at 1 DAS and 2 DAS and by 96% at 3 DAS. An average of 99% rated symptoms or pain as either "absent" or "mild" during the trial. CONCLUSIONS The lotrafilcon A lens was found to be an effective and well-tolerated bandage lens after LASEK.
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Affiliation(s)
- Jacek P Szaflik
- LASER Microsurgery Eye Center, ul. Boya 4A, 00-621 Warsaw, Poland.
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Autrata R, Rehurek J. Laser-assisted subepithelial keratectomy and photorefractive keratectomy for the correction of hyperopia: Results of a 2-year follow-up. J Cataract Refract Surg 2003; 29:2105-14. [PMID: 14670418 DOI: 10.1016/s0886-3350(03)00415-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate and compare the efficacy, safety, predictability, and stability of laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for low to moderate hyperopia with a 2-year follow-up. SETTING Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS This prospective comparative single-surgeon study included 216 eyes of 108 patients with hyperopia who received PRK in 1 eye and LASEK in the contralateral eye. The mean patient age was 38.3 years (range 25 to 58 years). The mean preoperative spherical equivalent (SE) cycloplegic refraction was +3.67 diopters (D) +/- 1.15 (SD) (range +2.00 to +5.00 D), and astigmatism was less than 1.00 D. In each patient, PRK was performed in 1 eye (Group A) and LASEK was performed in the other eye (Group B) using the Nidek EC-5000 excimer laser. Postoperative uncorrected visual acuity (UCVA), best corrected visual acuity, contrast sensitivity, manifest and cycloplegic refractions, refractive stability and predictability, postoperative pain, and corneal haze were examined and statistically analyzed. A P value less than 0.05 was considered significant. RESULTS At 1 week, the UCVA was 20/40 or better in 58% of PRK eyes and 85% of LASEK eyes (P =.037); at 2 years, it was 20/40 or better in 81% and 91%, respectively (P =.076). At 2 years, the UCVA for near was N8 or better in 73% of PRK eyes and 89% of LASEK eyes (P =.064). No patient lost 2 or more lines of Snellen visual acuity. The safety index was 1.03 in PRK eyes and 1.08 in LASEK eyes. Refractive stability was achieved at 6 months in LASEK eyes and at 12 months in PRK eyes. The mean SE cycloplegic refraction decreased from +3.58 D (PRK eyes) and +3.76 D (LASEK eyes) at baseline to +0.74 D and +0.32 D, respectively, at 2 years; in 57% and 78% of eyes, respectively, the refraction was within +/-0.50 D of the targeted refraction. Peripheral corneal haze scores at 3 to 9 months and pain scores at 1 to 3 days were significantly lower in the LASEK group than in the PRK group. CONCLUSIONS Laser-assisted subepithelial keratectomy for hyperopia up to +5.00 D provided good visual and refractive results. It significantly reduced postoperative pain, grade of peripheral ring-shaped corneal haze, and regression of hyperopia. Hyperopic LASEK provided quicker visual recovery and achieved better efficacy, predictability, and refractive stability than hyperopic PRK.
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Affiliation(s)
- Rudolf Autrata
- Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic.
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Lohmann CP, von Mohrenfels CW, Herrmann W, Gabler B, Laube T, Marshall J. Elliptical ELSA (LASEK) instruments for the treatment of astigmatism. J Cataract Refract Surg 2003; 29:2174-80. [PMID: 14670428 DOI: 10.1016/s0886-3350(03)00408-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate newly designed, elliptical ELSA (excimer laser subepithelial ablation) instruments for the treatment of astigmatism. SETTING University Eye Clinic Regensburg, Regensburg, Germany, and the Rayne Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS The new ELSA instrument set consists of an elliptical microtrephine (11.0 mm x 8.0 mm) with a 70 microm calibrated blade and an elliptical alcohol cone (11.5 mm x 8.5 mm). With this instrument set, ELSA (the laser-assisted subepithelial keratectomy [LASEK] described by Camellin) was performed in 34 astigmatic eyes. The cylindrical correction was between 1.00 diopters (D) and 3.50 D and the spherical correction, between -0.75 D and -8.75 D. In all eyes, the follow-up was 6 months. The postoperative refractive outcome was analyzed using Alpins vector analysis. RESULTS Excimer laser subepithelial ablation was performed without intraoperative complications in all eyes. At 6 months, the mean spherical correction was -0.04 D +/- 0.27 (SD) (range +0.75 to -0.75 D) and the mean cylindrical correction, 0.27 +/- 0.23 D (range 0 to 0.75 D). The mean index of success was 0.18 +/- 0.15. CONCLUSIONS With the elliptical instruments, ELSA was an effective and safe surgical procedure for astigmatism.
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Pallikaris IG, Katsanevaki VJ, Kalyvianaki MI, Naoumidi II. Advances in subepithelial excimer refractive surgery techniques: Epi-LASIK. Curr Opin Ophthalmol 2003; 14:207-12. [PMID: 12888719 DOI: 10.1097/00055735-200308000-00007] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The reports of an increasing incidence of iatrogenic ectasia, the evolution of wavefront aberrometry, and the suggestion that the laser in situ keratomileusis flap could lead to unpredictable biomechanical corneal changes have renewed interest in surface ablation and have set the stage for the introduction of alternative photorefractive treatment modalities. The theoretical advantage of surface procedures, such as laser epithelial keratomileusis that preserve the epithelial button, stems from the repositioning of the epithelial flap over the laser-ablated corneal surface. This epithelial sheet is thought to act as a natural contact lens that decreases postoperative pain and haze formation. Epipolis laser in situ keratomileusis is an alternative modality of epithelial separation with the use of a device that features a blunt oscillating blade. This surgical approach does not require the use of alcohol for epithelial loosening.
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Pallikaris IG, Naoumidi II, Kalyvianaki MI, Katsanevaki VJ. Epi-LASIK: comparative histological evaluation of mechanical and alcohol-assisted epithelial separation. J Cataract Refract Surg 2003; 29:1496-501. [PMID: 12954295 DOI: 10.1016/s0886-3350(03)00348-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To compare the effect of mechanical and alcohol-assisted excision on the histological ultrastructure of epithelial disks from human corneas. Vardinoyiannion Eye Institute of Crete, University of Crete, Medical School, Crete, Greece. Ten eyes of 10 patients were deepithelialized by 1 of 2 two techniques. In 6 eyes, a customized instrument was used to mechanically separate the epithelial layer. In 4 eyes, the epithelial disks were obtained using the conventional laser-assisted subepithelial keratectomy (LASEK) technique; that is, with alcohol concentrations of 15% and 20%. All specimens were assessed by light and electron microscopy, and the histological findings of the 2 methods were compared. Transmission electron microscopy showed that when the epithelial disks were excised by mechanical separation, the lamina densa and lamina lucida were preserved and the hemidesmosomes had normal morphology along almost the entire length of the basement membrane. The basal epithelial cells of the separated epithelial disks showed minimal trauma and edema. Specimens obtained using 15% and 20% alcohol concentrations showed formation of cytoplasmic fragments of the basal epithelial cells, enlargement of the intercellular spaces, and extensive discontinuities in the basement membrane, which was excised at the level of the lamina lucida. Mechanical separation did not affect the normal cell morphology of the excised epithelial disks. Transmission electron microscopy of the specimens proved the manual technique is less invasive to epithelial integrity than LASEK using either alcohol concentration.
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Hardten DR, Hauswirth SG. Comparison of designs of laser systems utilized for refractive surgery. Curr Opin Ophthalmol 2003; 14:213-9. [PMID: 12888720 DOI: 10.1097/00055735-200308000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several different laser types are available on the market for the practitioner to use in refractive surgery. Each laser type has certain parameters that the surgeon must understand to obtain the best refractive outcomes. Studies published in peer-reviewed literature between February 2002 and March 2003 show that refractive results across all types of lasers have improved compared with those of several years ago. A difference in refractive outcomes between lasers is impossible to directly compare, as there are no randomized studies that hold surgeon or patient characteristics constant.
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Affiliation(s)
- David R Hardten
- Minnesota Eye Consultants, P.A. 710 East 24th Street, Suite 106, Minneapolis, MN 55404, USA.
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Gabler B, Winkler von Mohrenfels C, Herrmann W, Gora F, Lohmann CP. Laser-assisted subepithelial keratectomy enhancement of residual myopia after primary myopic LASEK: six-month results in 10 eyes. J Cataract Refract Surg 2003; 29:1260-6. [PMID: 12900230 DOI: 10.1016/s0886-3350(03)00253-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether residual myopia after primary laser-assisted subepithelial keratectomy (LASEK) can be corrected by repeated LASEK and whether this procedure is safe and effective. SETTING University Eye Clinic, University of Regensburg, Regensburg, Germany. METHODS Laser-assisted subepithelial keratectomy was performed in 10 eyes that had had primary LASEK for myopia. The initial mean spherical equivalent (SE) was -6.2 diopters (D) (range -2.5 to -8.0 D), and the residual mean SE was -1.6 D (range -1.0 to -3.0 D). The retreatment ratio was 7.6%. The exposure time of the corneal epithelium to alcohol (20% ethanol) was 30 seconds plus an additional 10 to 15 seconds in cases of strong epithelial adherence. Laser ablation was performed with a Keracor 117 excimer laser (Chiron Technolas). The follow-up after the second LASEK treatment was 6 months. RESULTS The epithelial flap for repeated LASEK was successfully created in all 10 eyes. The postoperative course in the eyes was uneventful. Six months after LASEK enhancement, the SE refraction was within +/-0.5 D in all eyes. No eye lost more than 1 line of best corrected visual acuity, and the uncorrected visual acuity was 20/20 or better in 8 eyes. Significant haze was not observed after repeated LASEK (mean 0.35 before and 6 months after LASEK enhancement). CONCLUSIONS Laser-assisted subepithelial keratectomy enhancement appears to be safe and effective for the correction of residual myopia after primary LASEK. Repeated epithelial flap preparation is possible without technical modifications.
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Affiliation(s)
- Bernhard Gabler
- University Eye Clinic, University of Regensburg, Regensburg, Germany.
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Serrano D, Hibino S, Nishida K, Maeda N, Tano Y. Electron microscopy of the epithelial flap created by ethanol treatment in the rabbit corneal epithelium. J Cataract Refract Surg 2003; 29:1389-96. [PMID: 12900251 DOI: 10.1016/s0886-3350(03)00251-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess the effect of corneal debridement with 25% ethanol on rabbit corneal epithelium by electron microscopy. SETTING Department of Ophthalmology, Osaka University School of Medicine, Osaka, Japan. METHODS Rabbit corneas were deepithelialized by applying 25% ethanol for 3 minutes, and a hinged epithelial flap was created and repositioned. Ten corneas were evaluated immediately after the epithelial debridement procedure and at 1, 3, and 7 days. Histological changes were evaluated using scanning and transmission electron microscopy. RESULTS Corneas treated with ethanol showed a decrease in microvilli, breaks in intercellular junctions, epithelial cell edema, and damage in basement membrane hemidesmosomes. These toxic changes recovered to an almost normal appearance after 24 hours and rapidly improved over the following week. An increase in desquamated cells was observed after debridement; this returned to normal after 1 week according to the normal cellular cycle. Wing cells showed no damage at any stage. CONCLUSIONS Although ethanol appeared to have a toxic effect on rabbit epithelial cells, the effect did not persist over time. The first signs of recovery were observed 24 hours after debridement, and full recovery was observed over the following week. The ethanol path to the central basement membrane appeared to be centripetally from a round cut through the basement membrane, leaving the wing cells intact.
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Affiliation(s)
- Daniel Serrano
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
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Azar DT, Ang RT. Laser subepithelial keratomileusis: evolution of alcohol assisted flap surface ablation. Int Ophthalmol Clin 2002; 42:89-97. [PMID: 12409924 DOI: 10.1097/00004397-200210000-00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dimitri T Azar
- Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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