1
|
Mohammadpour M, Heirani M, Khorrami-Nejad M, Ambrósio R. Update on Pain Management After Advanced Surface Ablation. J Refract Surg 2021; 37:782-790. [PMID: 34756143 DOI: 10.3928/1081597x-20210809-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To provide an update for postoperative pain control strategies to help ophthalmic surgeons establish a more effective management plan for patients who underwent advanced surface ablation surgeries. METHODS Google Scholar, Scopus, ScienceDirect, and PubMed were the main resources used to search the medical literature. RESULTS The postoperative cornea's healing process is accompanied by intense pain as the chief complaint in the first days after the operation. Several strategies were developed to relieve postoperative pain after surface ablation procedures. These strategies included different preoperative, intraoperative, and postoperative methods. Considering the preoperative demographic and emotional factors, underlying dry eye, alternative epithelial removal techniques, bandage contact lenses, and topical or oral therapeutic agents are some examples of postoperative pain treatments after surface ablation procedures. CONCLUSIONS The current review revealed that despite the development of numerous protocols to relieve postoperative pain following surface ablations, the best approach could be a combination of different strategies. In practice, no validated and standardized strategy is available for total elimination of postoperative pain following advanced surface ablation surgeries. [J Refract Surg. 2021;37(11):782-790.].
Collapse
|
2
|
Afsharpaiman S, Zare M, Yasemi M, Jamialahmadi T, Sahebkar A. The Prevalence of Infectious Keratitis after Keratorefractive Surgery: A Systematic Review and Meta-Analysis Study. J Ophthalmol 2020; 2020:6329321. [PMID: 32774907 PMCID: PMC7407012 DOI: 10.1155/2020/6329321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The keratorefractive surgeries (KRS) are one of the most common ocular surgeries. One of the dangerous complications of these surgeries is infectious keratitis (IK), which is the second cause of blindness after cataract surgery. The purpose of this study was to estimate the prevalence of IK after KRS in different parts of the world. METHODS In order to obtain relevant studies, all national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, PubMed, Scopus, Cochrane, Embase, Web of Science, and Google Scholar were searched using standard keywords. RESULTS IK prevalence after KRS was 0.000496% (0.000145% for the left eye and 0.000149% for the right eye). IK prevalence after KRS in the United States, Europe, and Asia was 0.000667%, 0.000473%, and 0.000045%, respectively, in all of which the common microorganisms were Staphylococci. Meta-regression showed no significant association between IK after KRS and either sample size or publication year of the studies. IK prevalence after KRS in the right eye was more than that in the left one. Also, the probability of IK incidence after LASIK surgery was more than PRK and LASEK. In the evaluation of continents, IK after KRS in the United States was more frequent compared with Europe and Asia. CONCLUSIONS This study provided data as to the overall prevalence of IK following KRS and its variations according to the types of eye, surgery, pathogenic microorganism, and geographical location.
Collapse
Affiliation(s)
- Shahla Afsharpaiman
- Health Research Center, Life Style Institute, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - Musa Zare
- Department of Ophthalmology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Masoud Yasemi
- Health Research Center, Life Style Institute, Bagiyatallah University of Medical Sciences, Tehran, Iran
| | - Tannaz Jamialahmadi
- Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan, Iran
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
3
|
Clinical Evaluation of LASEK for High Myopia Correction between the Triple-A Profile and the Zyoptix Tissue Saving Profile. J Ophthalmol 2019; 2019:6936042. [PMID: 31061728 PMCID: PMC6466896 DOI: 10.1155/2019/6936042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the effects of correcting high myopia using the MEL®90 Triple-A profile LASEK at a 500 Hz pulse rate (Triple-A group) versus the Zyoptix tissue-saving ablations of Technolas 217z laser platform at 100 Hz (TS group). Methods This retrospective study included 50 eyes in the Triple-A group and 42 eyes in the TS group with manifest refraction spherical equivalent (MRSE) of -6 diopters (D) to -10 D. We compared uncorrected distance visual acuity, MRSE, corrected distance visual acuity, and postoperative complications at 1 month, 3 months, and 6 months. Results At 6 months after refractive surgery, the efficacy index of Triple-A group was significantly higher than that of the TS group (1.03 ± 0.12 vs 1.00 ± 0.11, P=0.04). The MRSE postoperatively in the Triple-A group was significantly lower than that in the TS group (0.25 ± 0.18 vs 0.38 ± 0.23, P < 0.01). The safety indices in the two groups were almost the same after 6 months of surgery (1.03 ± 0.07 vs 1.04 ± 0.11, P=0.63). The proportion of eyes which achieved ±0.13 D was significantly higher in the Triple-A group than that in the TS group at 1 month (80% vs 59.5%, P=0.03), 3 months (82% vs 61.9%, P=0.03) and 6 months (84% vs 64.3%, P=0.03). The changes in refraction 6 months after surgery comparing with 1 month after surgery were 0.12 ± 0.10 D in the Triple-A group and 0.13 ± 0.08 D in the TS group (P=0.56). All (100%) of the patients in the Triple-A group and 50% of the patients in the TS group had a UDVA of 20/16 at 6 months after surgery (P < 0.01). The induced spherical aberrations and total HOAs in the Triple-A group were significantly lower than those in the TS group (0.17 ± 0.02 μm vs 0.23 ± 0.02 μm, P < 0.01; 0.20 ± 0.04 μm vs 0.39 ± 0.03 μm, P < 0.01) at 6 months after surgery. The mean reduced corneal thickness was 113.06 ± 10.5 μm in the Triple-A profile group and 121.43 ± 23.46 μm in the TS group (P=0.02). No patient in either group had haze and high intraocular pressure 6 months after surgery. Conclusion For treatment of high-myopia patients, the Triple-A profile was more effective, predictable, and accurate than the Zyoptix tissue-saving profile. Meanwhile, the Triple-A profile had less induced spherical aberrations, total HOAs, and cornea ablation depth than the Zyoptix tissue-saving profile. Patients in the Triple-A group with 500 Hz pulse rate treatment achieved superior results. The two surgical procedures were equivalent in terms of safety and stability.
Collapse
|
4
|
Sáles CS, Manche EE. Prospective evaluation of a novel silicone corneal shield after PRK: 6-month efficacy, safety, and predictability outcomes. Clin Ophthalmol 2019; 13:115-121. [PMID: 30662255 PMCID: PMC6327892 DOI: 10.2147/opth.s183120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to report the 1-week and 6-month refractive outcomes of eyes treated with a novel silicone corneal shield designed to improve visual recovery after photorefractive keratectomy (PRK). Patients and methods This prospective, observational clinical trial recruited 45 myopic eyes with or without astigmatism at a university eye clinic to undergo wavefront-guided PRK followed by application of an investigational silicone corneal shield that was removed on postoperative day 4. The primary outcome measures were efficacy, predictability, and safety at the 6-month visit. The secondary end points included short-term uncorrected distance visual acuity (UDVA) and pain. Results No adverse outcomes occurred using the device. At 6 months, 79.5% of eyes achieved UDVA >20/20, 94.9% achieved ≥20/25, and 97.4% achieved ≥20/40. Also, 2.6% lost one line of corrected distance visual acuity and none lost two lines; 71.8% and 97.4% measured within ±0.25 and ±0.50 D of emmetropia, respectively. During the first week, preoperative UDVA improved from 1.34 logarithm of the minimum angle of resolution (logMAR; <20/400 Snellen) to 0.14 logMAR (>20/30) on postoperative day 1 (P<0.0001) and remained stable on days 2-3 (all P>0.05). After removal of the shield on day 4, UDVA declined by two lines before rebounding to 0.16 logMAR (>20/30) on day 7 (both P<0.001). Subjective metrics of pain all peaked between days 2 and 3 before declining. Conclusion The investigational silicone corneal shield is safe and effective when used after PRK and may aid early visual recovery and patient comfort, but comparative studies are needed to validate these preliminary findings. Precis One-week and 6-month refractive outcomes of a novel silicone corneal shield used after PRK show that the device is not only safe and effective but may also speed visual recovery.
Collapse
Affiliation(s)
- Christopher S Sáles
- Weill Cornell Medical College, Department of Ophthalmology, New York, NY, USA
| | - Edward E Manche
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA,
| |
Collapse
|
5
|
Wen D, Tu R, Flitcroft I, Wang Q, Huang Y, Song B, Yu A, Hu L, Zhao Y, Bao F, Yu Y, Lian H, Hoffart L, Kramm RL, Skiadaresi E, O'Brart D, Pallikaris I, Marshall J, McAlinden C, Huang J. Corneal Surface Ablation Laser Refractive Surgery for the Correction of Myopia: A Network Meta-analysis. J Refract Surg 2018; 34:726-735. [PMID: 30428092 DOI: 10.3928/1081597x-20180905-01] [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] [Received: 03/10/2018] [Accepted: 08/30/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To systematically compare the efficacy, predictability, safety, postoperative haze, pain scores, and epithelial healing time of four corneal surface ablation procedures. METHODS PubMed, Embase, Cochrane Library, and the U.S. trial registry were searched up to June 2018. Randomized controlled trials were selected. Efficacy (uncorrected distance visual acuity of 20/20 or better), predictability (refractive spherical equivalent within ±0.50 diopters [D] of the target), and safety (loss of two or more lines of spectacle corrected distance visual acuity) were set as primary outcome measures. Haze, pain scores, and epithelial healing time were set as secondary outcome measures. RESULTS Eighteen studies involving 1,423 eyes were included. According to the Grading of Recommendations Assessment, Development, and Evaluation, the quality of outcomes were moderate to high (70.6%). There were no differences in efficacy, predictability, safety, haze, day 1 pain, and epithelial healing time between treatments. Epithelial laser in situ keratomileusis (epi-LASIK) had statistically significantly higher pain scores on day 3 compared to photorefractive keratectomy (PRK) (weighted mean differences [WMD] = 2.2, 95% credible intervals [CrI] = 0.19 to 4.01) and transepithelial PRK (T-PRK) (WMD = 2.7, 95% CrI = 0.51 to 4.84). The surface under the cumulative ranking curve ranking results (best to worst) showed laser epithelial keratomileusis (LASEK) ranked highest for efficacy, predictability, safety, and day 1 pain scores. Epi-LASIK ranked best for grade 1 haze scores. T-PRK ranked best for haze of 0.5 or higher, haze scores day 3 pain scores, and epithelial healing time. CONCLUSIONS Surface laser refractive surgeries are comparable in terms of efficacy, predictability, safety, and postoperative haze except for day 3 pain scores, with epi-LASIK being more painful compared to PRK and T-PRK. [J Refract Surg. 2018;34(11):726-735.].
Collapse
|
6
|
Murueta-Goyena A, Cañadas P. Visual outcomes and management after corneal refractive surgery: A review. JOURNAL OF OPTOMETRY 2018; 11:121-129. [PMID: 29183707 PMCID: PMC5904824 DOI: 10.1016/j.optom.2017.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 05/04/2023]
Abstract
Corneal refractive surgery procedures are widely performed to permanently correct refractive errors. Overall, refractive surgeries are safe, predictable and present high rates of satisfaction. Nevertheless, the induced epithelial, stromal and nerve damage alters corneal integrity and function, triggering a regenerative response. Complications that arise from corneal wound healing process might directly impact on visual outcomes of keratorefractive procedures. Most of these complications can be prevented or effectively treated with minimal consequences and minor impact on optical quality. Nevertheless, it is crucial to accurately and timely identify these corneal regeneration-related complications for successful counseling and management. Optometrists, as primary eye care providers, play an essential role in detecting anatomic and functional alterations in vision. It is therefore of great interest for optometrists to be familiar with the principal postoperative complications derived from alterations in regenerative process after corneal laser refractive surgeries. This review aims to provide a basis for optometrists to better understand, identify and manage the main wound healing-related complications after refractive surgery.
Collapse
Affiliation(s)
- Ane Murueta-Goyena
- Deparment of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - Pilar Cañadas
- Instituto de Oftalmobiología Aplicada (IOBA) Grupo de Superficie Ocular, Universidad de Valladolid, Valladolid, Spain; Departamento de Física Teórica Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Epithelial Erosions and Refractive Results After Single-Step Transepithelial Photorefractive Keratectomy and Alcohol-Assisted Photorefractive Keratectomy in Myopic Eyes: A Comparative Evaluation Over 12 Months. Cornea 2017; 37:45-52. [DOI: 10.1097/ico.0000000000001428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Quinto GG, Camacho W, Combs JC, Vedula SS, Myrowitz EH, Chuck RS. Mitomycin C for prevention of postoperative haze following excimer laser surface ablation in moderate to high myopia. Hippokratia 2016. [DOI: 10.1002/14651858.cd007418.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Guilherme G Quinto
- Johns Hopkins University School of Medicine; Wilmer Eye Institute; 600 N. Wolfe Street 255 Woods Building Baltimore Maryland USA 21287
| | - Walter Camacho
- Johns Hopkins University School of Medicine; Wilmer Eye Institute; 600 N. Wolfe Street 255 Woods Building Baltimore Maryland USA 21287
| | - Juan-Castro Combs
- Johns Hopkins School of Medicine; The Wilmer Ophthalmological Institute; Baltimore MD USA
| | | | - Elliott H Myrowitz
- Johns Hopkins University School of Medicine; Wilmer Eye Institute; 600 N. Wolfe Street 255 Woods Building Baltimore Maryland USA 21287
| | - Roy S Chuck
- Albert Einstein College of Medicine, Montefiore Medical Center; Department of Ophthalmology and Visual Sciences; 3332 Rochambeau Avenue Centennial, Room 306 New York NY USA 10467
| |
Collapse
|
11
|
|
12
|
Epipolis-laser in situ keratomileusis versus photorefractive keratectomy for the correction of myopia: a meta-analysis. Int Ophthalmol 2015; 35:757-63. [DOI: 10.1007/s10792-015-0109-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
|
13
|
Protective effects of trehalose on the corneal epithelial cells. ScientificWorldJournal 2014; 2014:717835. [PMID: 25045743 PMCID: PMC4090450 DOI: 10.1155/2014/717835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/15/2014] [Accepted: 05/27/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Aim of the present work was to evaluate the effects of the trehalose on the corneal epithelium undergoing alcohol delamination. METHODS Twelve patients undergoing laser subepithelial keratomileusis (LASEK) were consecutively included in the study. The right eyes were pretreated with 3% trehalose eye drops, whilst left eyes were used as control. Epithelial specimens were processed for cells vitality assessment, apoptosis, and light and transmission electron microscopy; a morphometric analysis was performed in both groups. RESULTS In both trehalose-untreated eyes (TUE) and trehalose-treated eyes (TTE), the percentage of vital cells was similar and no apoptotic cells were observed. In TUE, the corneal epithelium showed superficial cells with reduced microfolds, wing cells with vesicles and dilated intercellular spaces, and dark basal cells with vesicles and wide clefts. In TTE, superficial and wing cells were better preserved, and basal cells were generally clear with intracytoplasmatic vesicles. The morphometric analysis showed statistically significant differences between the two groups: the TTE epithelial height was higher, the basal cells showed larger area and clearer cytoplasm. The distribution of desmosomes and hemidesmosomes was significantly different between the groups. CONCLUSIONS Trehalose administration better preserved morphological and morphometric features of alcohol-treated corneal epithelium, when compared to controls.
Collapse
|
14
|
Kang H, Choe CM, Choi TH, Kim SK. Comparison of Clinical Results between Transepithelial Photorefractive Keratectomy and Brush Photorefractive Keratectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.9.1284] [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]
|
15
|
McGrath LA, Lee GA. Techniques, indications and complications of corneal debridement. Surv Ophthalmol 2013; 59:47-63. [PMID: 24239444 DOI: 10.1016/j.survophthal.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 03/24/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022]
Abstract
The cornea is the most exposed surface of the eye and, as such, is vulnerable to external trauma and the risk of infection. Many corneal diseases alter shape, surface, and transparency and thus result in reduced vision. The external position of the cornea, however, lends itself to diagnostic and therapeutic maneuvers that are commonly performed and readily done in the clinic. More sophisticated techniques require the use of complex equipment such as excimer and femtosecond laser. Complications that develop from poor healing and/or secondary infection are best avoided with appropriate technique, antisepsis, and modification of wound healing. We review corneal debridement in the management of corneal disease.
Collapse
Affiliation(s)
- Lindsay A McGrath
- City Eye Centre, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Ophthalmology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
| |
Collapse
|
16
|
Yuksel N, Bilgihan K, Hondur AM, Yildiz B, Yuksel E. Long term results of Epi-LASIK and LASEK for myopia. Cont Lens Anterior Eye 2013; 37:132-5. [PMID: 24128385 DOI: 10.1016/j.clae.2013.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/15/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia. SETTING Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey. DESIGN Retrospective study. METHODS Twenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes. RESULTS Preoperative myopic spherical equivalent refraction was -4.65 ± 1.74 D in the LASEK and -3.87 ± 1.30 D in the Epi-LASIK-treated eyes (p=0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p=0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p=0.42). CONCLUSIONS Both LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term.
Collapse
Affiliation(s)
- Nilay Yuksel
- Kahramanmaras Necip Fazil City Hospital, Department of Ophthalmology, Kahramanmaras, Turkey.
| | - Kamil Bilgihan
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Ahmet M Hondur
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Burcin Yildiz
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey
| | - Erdem Yuksel
- Kahramanmaras Necip Fazil City Hospital, Department of Ophthalmology, Kahramanmaras, Turkey
| |
Collapse
|
17
|
Wen D, Huang J, Li X, Savini G, Feng Y, Lin Q, Wang Q. Laser-assisted subepithelial keratectomy versus epipolis laser in situ keratomileusis for myopia: a meta-analysis of clinical outcomes. Clin Exp Ophthalmol 2013; 42:323-33. [PMID: 24024483 DOI: 10.1111/ceo.12205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 08/25/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND To identify possible differences between laser-assisted subepithelial keratectomy and epipolis laser in situ keratomileusis for myopia. DESIGN Meta-analysis. PARTICIPANTS Patients from previously reported comparative studies treated by laser-assisted subepithelial keratectomy versus epipolis laser in situ keratomileusis. METHODS A systematic literature retrieval was conducted in the MEDLINE, EMBASE and Cochrane Library, up to January 2013. The included studies were subject to a meta-analysis using a RevMan 5.1 version software. MAIN OUTCOME MEASURES The differences in efficacy, predictability, safety, epithelial healing time, pain perception and corneal haze formation. RESULTS A total of six studies involving 517 eyes were included. There were no statistically significant differences in the final proportion of eyes with uncorrected visual acuity of 6/6 or better (P = 0.43), mean postoperative uncorrected visual acuity (P = 0.53), final proportion of eyes with refraction within ± 0.50 D (P = 0.62) and ± 1.00 D (P = 0.16) of target, final proportion of eyes losing two or more lines of best spectacle-corrected visual acuity (P = 1.00), healing time of corneal epithelium (P = 0.58), final proportion of eyes with corneal haze grade 0.5 or higher (P = 0.26), and corneal haze levels (P = 0.36). CONCLUSIONS There were no significant differences in efficacy, predictability, safety, epithelial healing time and corneal haze formation between laser-assisted subepithelial keratectomy and epipolis laser in situ keratomileusis, but the result was limited. Future more data are required to detect the potential differences between the two procedures.
Collapse
Affiliation(s)
- Daizong Wen
- Department of Ophthalmology, No.180 Hospital of Chinese PLA, Quanzhou, Fujian, China
| | | | | | | | | | | | | |
Collapse
|
18
|
Chen J, Chen Y, Han SN. Comparison of TGF-β1 in tears and corneal haze following Epi-LASIK with and without mitomycin C. Int J Ophthalmol 2013; 6:312-5. [PMID: 23826524 DOI: 10.3980/j.issn.2222-3959.2013.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/28/2013] [Indexed: 12/22/2022] Open
Abstract
AIM To compare transforming growth factor-β1 (TGF-β1) levels in tears and the degree of corneal haze formation following epithelial laser in situ keratomileusis (Epi-LASIK) with and without the use of mitomycin C (MMC) and to investigate the effect of MMC on corneal wound healing. METHODS Thirty-two patients (64 eyes) with high myopia underwent Epi-LASIK surgery, and MMC was randomly used in one eye in each patient. The epithelialization process was observed, and the TGF-β1 level in tears was measured at 1 day, 3, and 7 days postoperatively for comparison with baseline. Corneal haze was graded at 1 month, 3, and 6 months after surgery. RESULTS Mean preoperative spherical equivalent refraction was -8.24±2.18D (range -6.00 to -10.50D) in the MMC group and -7.82±1.55D (range -6.00 to -9.75D) in the non-MMC group. There was no significant difference between the two groups (P=0.38). Mean epithelialization time was (5.02±0.68) days in the MMC group and (4.86±0.57) days in the non-MMC group (P=0.31). Tear fluid TGF-β1 levels were similar before surgery (P=0.34), but were significantly higher in the non-MMC group at 1 day, 3, and 7 days postoperatively (P=0.004, 0.008, and 0.012, respectively). Corneal haze scores 1 month after surgery were significantly higher in the non-MMC group (P=0.03), and similar at 3 and 6 months after surgery (P=0.28 and 0.62, respectively). CONCLUSION MMC did not delay epithelialization. In early postoperative period, lower TGF-β1 levels in tears and a lower grade of corneal haze were observed in the MMC group. Our findings suggest that the ability of MMC to inhibit Epi-LASIK-induced haze might be mediated through TGF-β1 suppression.
Collapse
Affiliation(s)
- Jing Chen
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China
| | | | | |
Collapse
|
19
|
Wound healing after keratorefractive surgery: review of biological and optical considerations. Cornea 2013; 31 Suppl 1:S9-19. [PMID: 23038040 DOI: 10.1097/ico.0b013e31826ab0a7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The introduction of the excimer laser for keratorefractive surgery in the 1990 s permanently reshaped the treatment landscape for correcting refractive errors, such as myopia, hyperopia, and astigmatism. Until that point, these treatments had relied on less predictable techniques, such as radial keratotomy and automated lamellar keratectomy. In recent years, other new technologies, along with increased understanding of the basic science of refractive errors, higher-order aberrations, biomechanics, and the biology of corneal wound healing, have allowed for a reduction in the surgical complications of keratorefractive surgery. Novel technologies, such as eye tracking, anterior segment imaging, the femtosecond laser, and asphericity-optimized and wavefront-guided custom laser in situ keratomileusis, have assisted refractive surgeons in achieving greater predictability of their laser vision correction procedures. Understanding the cascade of events involved in the corneal wound healing process and examination of how corneal wound healing influences corneal biomechanics and optics are crucial to improve the efficacy and safety of laser vision correction.
Collapse
|
20
|
Katbab A, Owji SM, Eghtedari M. Morphologic Changes of Corneal Epithelial Flap: Ethanol-mediated versus Mechanical Removal. Ultrastruct Pathol 2012; 36:400-3. [DOI: 10.3109/01913123.2012.729880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Visual and Refractive Outcome of Epi-LASIK for Myopia in Thin Corneas: a 12-Month Follow-Up. Eur J Ophthalmol 2012; 22:911-9. [DOI: 10.5301/ejo.5000170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/20/2022]
Abstract
Purpose. A nonrandomized, retrospective, cohort, single-center study was designed to examine the visual and refractive outcome of epi–laser-assisted in situ keratomileusis (LASIK) for myopia (with and without astigmatism) in patients with thin corneas (less than 500 µm), and to compare these results with those of a group of patients with normal corneal thickness. Methods. Uncorrected distance visual acuity (UCVA), spherical and cylindrical residual refractive error, mean keratometry readings (Km), and pupil diameter were measured postoperatively at 24 hours, 1 week, 1 month, 3 months, and 12 months in a group of 28 eyes with thin corneas (group 1) and a second age- and gender-matched group of 28 eyes with normal corneal thickness (group 2). In addition, the efficacy index was calculated at every postoperative examination. Results. Postoperative central corneal thickness was 464.14±50.40 µm in group 1 and 421.89±26.63 µm in group 2 (p<0.001). No statistically significant difference was found in UCVA, efficacy index, and spherical and cylindrical residual error between both groups, with an evolution towards stability over time in all cases. Statistically significant between-group differences in Km at all follow-up examinations were explained by between-group differences in ablation depth and attempted spherical correction. Conclusions. A 12-month follow-up revealed epi-LASIK for myopia (with and without astigmatism) to be a safe and predictable surface ablation procedure, with good visual and refractive outcome in patients with thin corneas, as compared with a group of patients with normal corneal thickness.
Collapse
|
22
|
Ramírez M, Hernández-Quintela E, Naranjo-Tackman R. Epi-LASIK: A Confocal Microscopy Analysis of the Corneal Epithelium and Anterior Stroma. Ophthalmic Surg Lasers Imaging Retina 2012; 43:319-22. [DOI: 10.3928/15428877-20120618-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 03/18/2012] [Indexed: 11/20/2022]
|
23
|
Sia RK, Ryan DS, Stutzman RD, Psolka M, Mines MJ, Wagner ME, Weber ED, Wroblewski KJ, Bower KS. Alcohol versus brush PRK: Visual outcomes and adverse effects. Lasers Surg Med 2012; 44:475-81. [DOI: 10.1002/lsm.22036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2012] [Indexed: 11/08/2022]
|
24
|
Abstract
PURPOSE To provide an overview of the safety and efficacy of mitomycin C (MMC) as adjuvant therapy after refractive surgery procedures. METHODS Literature review. RESULTS Over the past 10 years, MMC has been used by refractive surgeons to prophylactically decrease haze after surface ablation procedures and therapeutically in the treatment of preexisting haze. Development of MMC treatments has had a significant role in the revival of surface ablation techniques. We reviewed the literature regarding mechanism of action of MMC, its role in modulating wound healing after refractive surgery, and its safety and efficacy as adjuvant therapy applied after primary photorefractive keratectomy surgery or after photorefractive keratectomy re-treatment after laser in situ keratomileusis and other corneal surgeries and disorders. The drug is a potent mitotic inhibitor that effectively blocks keratocyte activation, proliferation, and myofibroblast differentiation. Many studies have suggested that MMC is safe and effective in doses used by anterior surface surgeons, although there continue to be concerns regarding long-term safety. After initial depletion of anterior keratocytes, keratocyte density seems to return to normal 6 to 12 months after the use of MMC when corneas are examined with the confocal microscope. Most clinical studies found no difference between preoperative and postoperative corneal endothelial cell densities when MMC 0.02% was applied during refractive surgery, with exposure time of 2 minutes or less. CONCLUSIONS After more than 10 years of use, MMC has been found to be effective when used for prevention and treatment of corneal haze. Questions remain regarding optimal treatment parameters and long-term safety.
Collapse
|
25
|
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]
|
26
|
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.
Collapse
|
27
|
Du Z, Zhao W, Huang Z, Chang CK, Liu W, Liu X. Inhibition effect of tetrandrine on haze formation after Epi-LASIK surgery in rabbits. Curr Eye Res 2011; 36:699-705. [PMID: 21675845 DOI: 10.3109/02713683.2011.571359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To observe the inhibitory effect of tetrandrine on haze formation after Epi-LASIK surgery in rabbits. MATERIALS AND METHODS Twenty-seven healthy New Zealand rabbits were selected and underwent Epi-LASIK surgery. According to a self comparison principle, these rabbits were randomly divided into three groups. The first group was treated with tetrandrine eye drops (Tet), the second (negative control, NC) group was treated with pure solvent, and the third group was treated with fluorometholone (FML) solvent. Haze grades of each group were respectively observed by slit lamp exam at half-month, one month, and two months after surgery. After corneal tissues were extracted, optical microscopy, Sirius Red staining, immunohistochemistry, and semi-quantitative RT-PCR tests were conducted, in order to test collagen formation of operated eyes after surgery and expression of transformation growth factor beta 2 (TGF-β(2)) in corneal stroma. RESULTS At a half month and one month after surgery, haze grades and type III collagen expression in Tet and FML groups were significantly lower than that in NC groups (P < 0.01). No statistical difference was observed between Tet and FML groups. Immunohistochemistry showed that, at each time point after surgery, expressions of TGF-β(2) protein in Tet and FML groups were significantly lower than that in the NC group (P < 0.01), whereas there was no statistical difference between Tet and FML groups. The expression level of TGF-β(2) protein increased, reaching its peak one month after surgery. RT-PCR also showed that, at each point after surgery, the TGF-β(2) mRNA expression in Tet and FML groups was lower than that in the NC group (P < 0.01), nevertheless no statistical difference was observed between Tet and FML groups. CONCLUSIONS Like FML, Tet could inhibit haze formation in rabbits after Epi-LASIK surgery, possible through TGF-β(2)-collagen-III pathway.
Collapse
Affiliation(s)
- Zhiyu Du
- Department of Ophthalmology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
| | | | | | | | | | | |
Collapse
|
28
|
Taneri S, Weisberg M, Azar DT. Surface ablation techniques. J Cataract Refract Surg 2011; 37:392-408. [PMID: 21241926 DOI: 10.1016/j.jcrs.2010.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 11/25/2022]
Abstract
The ongoing quest for a safe, simple, effective, minimally invasive, and stable refractive surgical procedure to correct refractive errors has stimulated the development of surface ablation techniques and laser in situ keratomileusis. In this review, we describe the history, patient assessment, techniques, outcomes, and complications of surface ablation (photorefractive keratectomy, laser-assisted sub-epithelial keratectomy, epithelial laser-assisted in situ keratomileusis) and compare the results of various surface techniques. Surface ablation procedures will continue to evolve, with potential improvements in outcomes accompanying future sophisticated ablation profiles and laser technology.
Collapse
Affiliation(s)
- Suphi Taneri
- Center for Refractive Surgery, St Franziskus Hospital, Münster, Germany
| | | | | |
Collapse
|
29
|
Angunawela RI, Winkler von Mohrenfels C, Kumar A, O’Brart DP, Marshall J. Live or Let Die: Epithelial Flap Vitality and Keratocyte Proliferation Following LASEK and Epi-LASIK in Human Donor and Porcine Eyes. J Refract Surg 2011; 27:111-8. [DOI: 10.3928/1081597x-20100330-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 02/04/2010] [Indexed: 11/20/2022]
|
30
|
Cho NS, Kim DH, Jin KH. Factors Associated with Incomplete Cleavage of the Corneal Epithelium in Alcohol-Assisted LASEK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.6.665] [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)
- Nam Suk Cho
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dong Hee Kim
- Department of Ophthalmology, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
| | - Kyung Hyun Jin
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
31
|
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
|
32
|
Bilateral Comparison of Conventional Epithelial Laser In Situ Keratomileusis and Lamellar Epithelial Debridement for Moderate to High Myopia. Cornea 2010; 29:853-7. [DOI: 10.1097/ico.0b013e3181ca33e6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Kim JH, Lee J, Kim JY, Tchah H. Early postoperative pain and visual outcomes following epipolis-laser in situ keratomileusis and photorefractive keratectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:143-7. [PMID: 20532139 PMCID: PMC2882076 DOI: 10.3341/kjo.2010.24.3.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 05/03/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare early postoperative pain and visual outcomes after epipolis-laser in situ keratomileusis (epi-LASIK) and photorefractive keratectomy (PRK) in the treatment of myopia. Methods A retrospective chart review was designed and included 49 eyes in 30 patients who underwent epi-LASIK and 54 eyes in 29 patients who underwent PRK. During the early postoperative period (days 1 to 5), pain, uncorrected visual acuity (UCVA), and time to epithelial healing were recorded. Visual outcomes were followed for up to six months. Results Mean preoperative spherical equivalent refraction for the epi-LASIK group was -3.99±1.39 diopters (D) and that of the PRK group was -3.54±1.27 D. The pain scores on the fourth postoperative day were significantly higher in the epi-LASIK group than in the PRK group (p=0.017). Duration of pain in the epi-LASIK group was longer than in the PRK group (p=0.010). Mean healing time was significantly longer in the epi-LASIK group than in the PRK group (p<0.000). In addition, UCVA in the epi-LASIK group at postoperative days 1 and 3 were significantly lower than those in the PRK group (p=0.021 and p<0.000, respectively). Uncorrected visual acuity at one week and one month after epi-LASIK were lower than those after PRK (p=0.023 and p=0.004, respectively). Conclusions In the epi-LASIK patients, pain relief, corneal healing, and visual recovery seemed to be slower during the early postoperative period compared to those of the PRK patients. With longer duration of follow-up, however, there were no significant differences in visual outcome between the two groups.
Collapse
Affiliation(s)
- Jae-Hyung Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, #388-1 Pungnap 2-dong, Songpa-gu, Seoul, Korea
| | | | | | | |
Collapse
|
34
|
Affiliation(s)
- Michael O'Keefe
- Department of Refractive Surgery, Mater Private Hospital, Dublin, Ireland.
| | | |
Collapse
|
35
|
Determination of the Nerve Growth Factor Level in the Central Cornea After LASIK and Epi-LASIK Treatment in a Rabbit Model System. Cornea 2009; 28:1144-8. [DOI: 10.1097/ico.0b013e3181a2a7e3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Jung SW, Kwon YA, Lee MK, Song SW. Epidermophyton fungal keratitis following laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2009; 35:2157-60. [DOI: 10.1016/j.jcrs.2009.06.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 06/01/2009] [Accepted: 06/05/2009] [Indexed: 11/30/2022]
|
37
|
Soma T, Nishida K, Yamato M, Kosaka S, Yang J, Hayashi R, Sugiyama H, Maeda N, Okano T, Tano Y. Histological evaluation of mechanical epithelial separation in epithelial laser in situ keratomileusis. J Cataract Refract Surg 2009; 35:1251-9. [PMID: 19545817 DOI: 10.1016/j.jcrs.2009.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 02/13/2009] [Accepted: 02/19/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of mechanical epithelial separation with an epikeratome on the histologic ultrastructure of epithelial flaps and stromal beds from human corneas. SETTING Departments of Ophthalmology, Osaka University Medical School, Osaka, and Tohoku University School of Medicine, Sendai, and Institute of Advanced Biomedical Engineering and Science and Medical Research Institute, Tokyo Women's Medical University, Tokyo, Japan. METHODS Eye-bank eyes were deepithelialized using an Epi-K epikeratome. Epithelial flaps and stromal beds were assessed by light and electron microscopy. Immunofluorescence staining for types IV and VII collagens, integrins alpha(6) and beta(4), and laminin 5 was also performed. RESULTS Four eyes were evaluated. On scanning electron microscopy, the cleavage planes of epithelial flaps and stromal beds were relatively smooth. On transmission electron microscopy, epithelial flaps were separated partially within the lamina fibroreticularis and partially within the lamina lucida. Immunofluorescence showed positive staining for type VII collagen and discontinuous staining for type IV collagen in stromal beds. Discontinuous linear staining for types IV and VII collagens was observed in epithelial flaps. Staining for integrins alpha(6) and beta(4) was positive in some regions and discontinuous in other regions of epithelial flaps. In stromal beds, integrins alpha(6) and beta(4) had a patchy expression pattern. Staining for laminin 5 was intermittently positive along the basal side of epithelial flaps and stromal beds. CONCLUSIONS Epithelial flaps created with an epikeratome were mechanically separated partly within the lamina fibroreticularis and partly within the lamina lucida. Stromal beds had relatively smooth surfaces with no obvious trauma to Bowman layer.
Collapse
Affiliation(s)
- Takeshi Soma
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
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]
|
39
|
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.
Collapse
|
40
|
Kim DY, Kim MJ, Yoon SY, Shin CJ, Kim KH, Tchah H. Late-onset Hypertrophic Corneal Scars After Laser-assisted Subepithelial Keratectomy With Mitomycin C. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.2.308] [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)
- Dong Yoon Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myoung Joon Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sam Young Yoon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chul Jin Shin
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung Hoon Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
41
|
Sierra Wilkinson P, Davis EA, Hardten DR. LASIK. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00019-6] [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
|
42
|
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
|
43
|
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
|
44
|
Kalyvianaki MI, Kymionis GD, Kounis GA, Panagopoulou SI, Grentzelos MA, Pallikaris IG. Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia. Ophthalmology 2008; 115:2174-80. [PMID: 19041475 DOI: 10.1016/j.ophtha.2008.08.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 08/08/2008] [Accepted: 08/08/2008] [Indexed: 11/18/2022] Open
|
45
|
Choi SK, Kim JH, Lee D, Lee JB, Kim HM, Tchah HW, Hahn TW, Joo M, Ha CI. Different epithelial cleavage planes produced by various epikeratomes in epithelial laser in situ keratomileusis. J Cataract Refract Surg 2008; 34:2079-84. [PMID: 19027563 DOI: 10.1016/j.jcrs.2008.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 08/20/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the anatomic cleavage planes produced by various epikeratomes in epithelial laser in situ keratomileusis (epi-LASIK). SETTING Department of Ophthalmology, IIsan Paik Hospital, Goyang, Korea. METHODS Sixteen eyes (8 patients) were included in this study. Three epikeratomes, the Moria Epi-K, Centurion SES, and Amadeus II, were used to collect 4 epithelial flaps from 2 patients in the epi-LASIK procedure. Four epithelial flaps from 2 patients were also obtained by laser-assisted subepithelial keratectomy (LASEK). Immunohistochemical staining using monoclonal antibodies against integrin beta1, integrin beta4, laminin 5, and collagen type VII was performed. RESULTS Immunohistochemical staining showed expression of integrin beta1 and integrin beta4 in all epithelial flaps. In epi-LASIK, the expression of laminin 5 and collagen type VII had a linear or dotted pattern that differed based on the epikeratome used. In the epithelial flaps obtained using LASEK, the expression of laminin 5 and collagen type VII had a dotted pattern. CONCLUSIONS Each epikeratome yielded reproducible but different cleavage planes of corneal epithelium. The results suggest that further study is needed to elucidate the wound-healing process after epi-LASIK because different cleavage planes produced by different epikeratomes may influence the process.
Collapse
Affiliation(s)
- Suk Kyue Choi
- Department of Ophthalmology, Ilsan Paik Hospital, College of Medicine, Inje University, Ilsanseo-gu, Goyang, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Herrmann WA, Hillenkamp J, Hufendiek K, Prahs P, Lohmann CP, Helbig H, Kobuch K. Epi-laser in situ keratomileusis: comparative evaluation of epithelial separation with 3 microkeratomes. J Cataract Refract Surg 2008; 34:1761-6. [PMID: 18812130 DOI: 10.1016/j.jcrs.2008.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 06/06/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the cleavage plane, corneal cytoarchitecture, and cell vitality of separated corneal epithelial sheets created with 3 commonly used microkeratomes. SETTING Laboratories of the Regensburg University Medical Center, Regensburg, Germany. METHODS Mechanical separation of the epithelial layer in 10 porcine eyes and 2 human eyes was performed with 3 different microkeratomes (Amadeus II, Zyoptix XP, Epivision). Five of 10 porcine corneas and the 2 human corneas treated with each microkeratome were processed for histology, electron microscopy, and immunohistochemistry. In 5 of 10 porcine corneas, the corneal epithelial sheets were separated from the globe and cell vitality was assessed with the trypan blue dye vitality test. RESULTS A reproducible epithelial separation with a smooth surface was achieved in all eyes. The cleavage plane was located between the lamina lucida and the lamina densa. Damage to epithelial cells was mainly limited to the cut margins. CONCLUSIONS Mechanical separation of the epithelial sheet in epithelial laser in situ keratomileusis (epi-LASIK) was safe and reproducible with all evaluated microkeratomes. Immunohistochemistry and electron microscopy showed the cleavage plane in epi-LASIK was between the basal epithelium and the basement membrane at the level of the lamina lucida.
Collapse
Affiliation(s)
- Wolfgang A Herrmann
- Department of Ophthalmology, Regensburg University Medical Center, Regensburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
47
|
Teus MA, de Benito-Llopis L, García-González M. Comparison of visual results between laser-assisted subepithelial keratectomy and epipolis laser in situ keratomileusis to correct myopia and myopic astigmatism. Am J Ophthalmol 2008; 146:357-362. [PMID: 18614136 DOI: 10.1016/j.ajo.2008.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Revised: 05/06/2008] [Accepted: 05/12/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the visual results after laser-assisted subepithelial keratectomy (LASEK) and epipolis laser in situ keratomileusis (epi-LASIK) to correct myopia. DESIGN Retrospective, interventional, nonrandomized comparative study. METHODS Patients treated with LASEK to correct myopia < or = -9.00 diopters (D) were compared to age- and refraction-matched patients treated with epi-LASIK using the same excimer laser (Esiris; Schwind Eye Tech Solutions, Kleinostheim, Germany). The epithelial flap was replaced after the ablation in every case. The visual results after both procedures were compared at each postoperative visit (one day, one week, one and three months). RESULTS Ninety-four consecutive eyes were included in the study (47 in each group), matched for age and refraction. The preoperative spherical manifest refraction was -3.98 +/- 2.40 D in the LASEK group and -3.95 +/- 2.40 D in the epi-LASIK group (P = .9) (range -0.50 to -9.00 D). The uncorrected visual acuity (UCVA) one day postoperatively was 0.7 +/- 0.2 and 0.5 +/- 0.2 (P < .001), and one week after surgery it was 0.8 +/- 0.2 and 0.7 +/- 0.2, respectively (P = .1). The difference was again statistically significant one month after surgery (0.94 +/- 0.1 after LASEK, 0.82 +/- 0.1 after epi-LASIK, P < .001), but not three months postoperatively (1.06 +/- 0.21 and 1.03 +/- 0.18, respectively, P = .1). UCVA was > or =1.0 in 78.7% of LASEK eyes and 65.9% of epi-LASIK eyes three months after surgery. At that moment, the safety indices were 0.99 +/- 0.1 after LASEK and 0.93 +/- 0.1 after epi-LASIK (P = .04). The efficacy indices were 0.97 +/- 0.1 and 0.89 +/- 0.1, respectively (P = .01). CONCLUSIONS Our results suggest a faster visual rehabilitation and better safety and efficacy outcomes after LASEK compared to epi-LASIK with repositioning of the epithelial flap when correcting low to moderate myopia.
Collapse
|
48
|
Nakagawa T, Maeda N, Cekic O, Fujikado T, Tano Y, Murakami A, Yoshimura M, Mori Y, Sasaki T, Kitano H, Owa S. Corneal ablation with new 193 nm solid-state laser. J Cataract Refract Surg 2008; 34:1019-23. [DOI: 10.1016/j.jcrs.2008.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
|
49
|
Pallikaris IG, Kalyvianaki MI, Gkenos ES, Katsanevaki VJ. Epipolis-laser in situkeratomileusis (Epi-LASIK). EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
50
|
|