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Gogri PY, Vaddavalli PK, Bhalerao SA. Central toxic keratopathy leading to epithelial ingrowth following femtosecond LASIK. BMJ Case Rep 2024; 17:e256508. [PMID: 38719245 PMCID: PMC11085700 DOI: 10.1136/bcr-2023-256508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
We report a case of a woman in her 30s who underwent femtosecond LASIK (laser-assisted in situ keratomileusis) in both eyes to correct her simple myopic astigmatism. After the surgery, both eyes developed diffuse lamellar keratitis, and intensive topical steroids were initiated to control the same. Subsequently, central toxic keratopathy (CTK) developed bilaterally. Three weeks after the surgery, the right eye showed signs of progressive epithelial ingrowth involving the pupillary area. Surgical intervention in the form of flap relift followed by debridement of the epithelial cells and an alcohol interface wash were performed to treat the same. This is the first report of an epithelial ingrowth following CTK after femtosecond LASIK.
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Affiliation(s)
| | - Pravin Krishna Vaddavalli
- Shantilal Shanghvi Cornea Institute (SSCI), L V Prasad Eye Institute,Kallam Anji Reddy (KAR) Campus, Hyderabad, Telangana, India
| | - Sushank Ashok Bhalerao
- Shantilal Shanghvi Cornea Institute (SSCI), L V Prasad Eye Institute, Kode Venkatadri Chowdary (KVC) Campus, Vijayawada, Andhra Pradesh, India
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2
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Mandal S, Namdev V, Sen S, Sinha R. Bilateral post-LASIK exacerbation of granular corneal dystrophy with epithelial ingrowth. BMJ Case Rep 2023; 16:e254328. [PMID: 37316286 PMCID: PMC10277075 DOI: 10.1136/bcr-2022-254328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
A male patient in his 30s, with a history of bilateral microkeratome-assisted myopic laser-assisted in situ keratomileusis (LASIK) 8 years ago at another centre, presented to us with gradually progressive diminution of vision and glare in both eyes for the last 4 years. On presentation, uncorrected distance visual acuity (UDVA) was 6/24 and 6/15 in the right eye and left eye, respectively, with normal intraocular pressures. Slit-lamp examination and anterior segment optical coherence tomography revealed well-defined white deposits, limited to an area within the LASIK flap. The deposits were confluent, at the level of the LASIK flap interface, and few discrete opacities were present in the posterior stroma. His father also had a similar clinical picture in both eyes. A diagnosis of both eyes post-LASIK exacerbation of granular corneal dystrophy with epithelial ingrowth was made. He underwent right eye femtosecond laser-assisted sutureless superficial anterior lamellar keratoplasty. At 6-month follow-up, UDVA improved to 6/12 with graft clarity of 4+ and coexistent grade 1 epithelial ingrowth.
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Affiliation(s)
- Sohini Mandal
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vaibhav Namdev
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Seema Sen
- Ocular Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajesh Sinha
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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3
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Kaur M, Nair S, Mazumdar SA, Titiyal JS. Intraoperative optical coherence tomography-guided management of post-laser-assisted in situ keratomileusis epithelial ingrowth. Indian J Ophthalmol 2021; 70:288-291. [PMID: 34937257 PMCID: PMC8917524 DOI: 10.4103/ijo.ijo_1173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We describe a modified technique of intraoperative optical coherence tomography (iOCT)-guided removal of post-laser-assisted in situ keratomileusis (LASIK) epithelial ingrowth with interface ethyl alcohol and mitomycin C application to prevent a recurrence. Epithelial ingrowth was visualized as hyperreflective deposits in the interface on iOCT, and the location and extent were noted at the beginning of the procedure. A simple dimple-down maneuver was performed to help identify the circumference of the LASIK flap. iOCT helped to delineate the flap edge and ensure dissection in the correct plane with complete removal of epithelial cell nests. Real-time visualization of the interface helped in on-table decision making regarding the extent of lifting the flap to encompass the entire region of hyperreflective epithelial ingrowth, as well as the need for additional interventions to ensure complete flap apposition at the end of surgery. All patients gained an uncorrected visual acuity of 20/20–20/25 with no recurrence.
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Affiliation(s)
- Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sridevi Nair
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saima A Mazumdar
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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4
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Lucena MA, Alves EDM, Krause HB, Alves MMDM, Aquino PLDR. Tratamento de crescimento epitelial persistente pós-Lasik com debridamento mecânico, uso de álcool a 20% e cola de fibrina. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Liu M, Shi W, Liu X, Li N, Chen T, Gao H. Postoperative corneal biomechanics and influencing factors during femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and laser-assisted subepithelial keratomileusis (LASEK) for high myopia. Lasers Med Sci 2021; 36:1709-1717. [PMID: 33891212 DOI: 10.1007/s10103-021-03320-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to compare the postoperative corneal biomechanics and assess the influence factors after femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and laser-assisted subepithelial keratomileusis (LASEK) for high myopia. In this retrospective study, patients who completed 1-year follow-up were included. The corneal biomechanical parameters, including deformation amplitude ratio 2.0 mm (DA ratio 2.0 mm), integrated inverse radius (IntInv Rad), stiffness parameter at first applanation (SP-A1), and Ambrosio relational thickness through the horizontal meridian (ARTh), were measured with Corvis STII. We also investigated the relationship between these biomechanics and preoperative or intraoperative variables. Thirty eyes had FS-LASIK and 30 eyes had LASEK. The changes in DA ratio 2.0 mm, IntInv Rad, and SP-A1 after surgery were significantly smaller in the LASEK group than in the FS-LASIK group, while the change in the ARTh was not significantly different between groups. No significant differences were detected in the mean values of postoperative DA ratio 2.0 mm, IntInv Rad, and SP-A1 between LASEK and FS-LASIK, while significant difference was detected in the mean value of postoperative ARTh. There was a significant correlation between the resident stromal bed thickness and the postoperative DA ratio 2.0 mm, IntInv Rad, or SP-A1. The postoperative ARTh has shown significant correlation with postoperative central corneal thickness and the amount of myopic correction. The effect of LASEK on corneal biomechanics was smaller than FS-LASIK when the same central corneal thickness was consumed. LASEK may be performed with a lower risk of postoperative corneal ectasia than FS-LASIK.
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Affiliation(s)
- Mingna Liu
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.,State Key Laboratory Cultivation Base Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Weiyun Shi
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.,State Key Laboratory Cultivation Base Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xin Liu
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.,State Key Laboratory Cultivation Base Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Na Li
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.,State Key Laboratory Cultivation Base Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Tong Chen
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.,State Key Laboratory Cultivation Base Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Hua Gao
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China. .,State Key Laboratory Cultivation Base Eye Institute, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China.
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6
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Gros-Louis P, Charest S, Légaré ME. Late-onset bilateral epithelial ingrowth following rapid corneal decompensation owing to amantadine. Can J Ophthalmol 2021; 56:e137-e139. [PMID: 33745871 DOI: 10.1016/j.jcjo.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - Stéphane Charest
- Centre Intégré Universitaire de Santé et Service Sociaux de la Mauricie et du Centre du Québec, Trois-Rivières, Que
| | - Marie Eve Légaré
- Laval University, Quebec City, Que.; CHU de Québec, Quebec City, Que..
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7
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Moshirfar M, Shah TJ, Masud M, Linn SH, Ronquillo Y, Hoopes PC. Surgical options for retreatment after small-incision lenticule extraction: Advantages and disadvantages. J Cataract Refract Surg 2019; 44:1384-1389. [PMID: 30368350 DOI: 10.1016/j.jcrs.2018.07.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
Abstract
Since the inception of small-incision lenticule extraction (SMILE), many surgeons have speculated the lack of an adequate and standard retreatment procedure will impede its popularity. However, more than 1 million patients worldwide have had this surgery, with visual outcomes nearly equivalent to current laser in situ keratomileusis (LASIK) results. With the procedure's growing popularity, some patients will inevitably have a postoperative residual refractive error from regression, overcorrection, undercorrection, and astigmatic induction and will require retreatment. To our knowledge, literature reviewing major retreatment options is limited. Options include surface ablation, thin-flap LASIK, secondary small-incision lenticule extraction, and a cap-to-flap procedure (CIRCLE) in which a femtosecond laser is use to create cuts that convert the small-incision lenticule extraction cap into a LASIK flap. This review discusses major advantages and disadvantages of these options and compares the visual outcomes based on the existing literature. An algorithmic approach created from this analysis is presented to guide retreatment decision-making.
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Affiliation(s)
- Majid Moshirfar
- From the John A. Moran Eye Center (Moshirfar, Hoopes) and the University of Utah (Masud), Salt Lake City, Utah Lions Eye Bank (Moshirfar), Murray, and the HDR Research Center (Moshirfar, Linn, Ronquillo, Hoopes), Hoopes Vision, Draper, Utah; Department of Ophthalmology, University of Arizona College of Medicine-Phoenix (Shah), Phoenix, Arizona, USA.
| | - Tirth J Shah
- From the John A. Moran Eye Center (Moshirfar, Hoopes) and the University of Utah (Masud), Salt Lake City, Utah Lions Eye Bank (Moshirfar), Murray, and the HDR Research Center (Moshirfar, Linn, Ronquillo, Hoopes), Hoopes Vision, Draper, Utah; Department of Ophthalmology, University of Arizona College of Medicine-Phoenix (Shah), Phoenix, Arizona, USA
| | - Maliha Masud
- From the John A. Moran Eye Center (Moshirfar, Hoopes) and the University of Utah (Masud), Salt Lake City, Utah Lions Eye Bank (Moshirfar), Murray, and the HDR Research Center (Moshirfar, Linn, Ronquillo, Hoopes), Hoopes Vision, Draper, Utah; Department of Ophthalmology, University of Arizona College of Medicine-Phoenix (Shah), Phoenix, Arizona, USA
| | - Steven H Linn
- From the John A. Moran Eye Center (Moshirfar, Hoopes) and the University of Utah (Masud), Salt Lake City, Utah Lions Eye Bank (Moshirfar), Murray, and the HDR Research Center (Moshirfar, Linn, Ronquillo, Hoopes), Hoopes Vision, Draper, Utah; Department of Ophthalmology, University of Arizona College of Medicine-Phoenix (Shah), Phoenix, Arizona, USA
| | - Yasmyne Ronquillo
- From the John A. Moran Eye Center (Moshirfar, Hoopes) and the University of Utah (Masud), Salt Lake City, Utah Lions Eye Bank (Moshirfar), Murray, and the HDR Research Center (Moshirfar, Linn, Ronquillo, Hoopes), Hoopes Vision, Draper, Utah; Department of Ophthalmology, University of Arizona College of Medicine-Phoenix (Shah), Phoenix, Arizona, USA
| | - Phillip C Hoopes
- From the John A. Moran Eye Center (Moshirfar, Hoopes) and the University of Utah (Masud), Salt Lake City, Utah Lions Eye Bank (Moshirfar), Murray, and the HDR Research Center (Moshirfar, Linn, Ronquillo, Hoopes), Hoopes Vision, Draper, Utah; Department of Ophthalmology, University of Arizona College of Medicine-Phoenix (Shah), Phoenix, Arizona, USA
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8
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Caster AI. Flap-Lift LASIK 10 or More Years After Primary LASIK. J Refract Surg 2018; 34:604-609. [PMID: 30199564 DOI: 10.3928/1081597x-20180703-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/20/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of flap-lift LASIK performed 10 or more years after the original LASIK procedure. METHODS All patients who were treated with flap-lift LASIK 10 or more years after primary LASIK for whom records of the primary treatment could be obtained and at least 45-day follow-up refractions after re-treatment were available were included in this study. A total of 23 eyes of 20 patients were identified. The median time between primary LASIK and flap-lift LASIK was 13.9 years (range: 10 to 18.7 years). RESULTS A total of 22 of 23 eyes (96%) retained the same corrected distance visual acuity (CDVA) postoperatively that was present preoperatively. One of 23 eyes (4%) experienced a loss of CDVA from 20/20 to 20/25 as the result of clinically significant epithelial ingrowth requiring multiple treatments followed by photorefractive keratectomy (PRK) treatment. One additional eye experienced clinically significant epithelial ingrowth that required a single surgical treatment. Fourteen of 20 eyes with a goal of plano achieved uncorrected distance visual acuity (UDVA) of 20/20 or better and 6 eyes achieved UDVA of 20/25 (2 of these eyes had preoperative CDVA of 20/25). For the eyes with a goal of plano, 16 of 20 eyes (80%) achieved UDVA equal to the preoperative CDVA. CONCLUSIONS Flap-lift LASIK is an effective treatment for refractive error when performed between 10 and 18.7 years after the initial flap was created. Epithelial ingrowth is the major complication, occurring to a clinically significant degree in 9% of the eyes. [J Refract Surg. 2018;34(9):604-609.].
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Friehmann A, Mimouni M, Nemet AY, Sela T, Munzer G, Kaiserman I. Risk Factors for Epithelial Ingrowth Following Microkeratome-Assisted LASIK. J Refract Surg 2018; 34:100-105. [PMID: 29425388 DOI: 10.3928/1081597x-20180105-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the incidence and risk factors associated with epithelial ingrowth following uncomplicated microkeratome-assisted LASIK. METHODS All patients who underwent microkeratome-assisted LASIK between January 2006 and December 2014 in a single surgical center were reviewed. Epithelial ingrowth cases were identified and associated factors were assessed. RESULTS Overall, 149 (0.49%) of 30,574 cases developed epithelial ingrowth. The epithelial ingrowth group was older compared to controls (35.3 ± 12.3 vs 31.7 ± 10.3 years, P = .001) and had a higher percentage of moderate to high hyperopia (13.7% vs 5.3%, P < .001), early postoperative flap slippage requiring flap repositioning (9.4% versus 2.8%, P < .001), or flap lifting for enhancement (48.6% vs 4.3%, P < .001), were treated with a smaller optic zone (6 mm) (37.7% vs 15.2%, P < .001), with a Moria M2 microkeratome (Moria SA, Antony, France) (70.1% vs 55.5%, P = .02), by low volume surgeons (n < 1,000) (5.8% vs 1.3%, P < .001), in a lower operating room temperature (22.3 ± 1.8 vs 22.8 ± 1.6, P = .005), and with a greater maximum ablation depth (67.3 ± 29.7 vs 57.3 ± 30.3, P < .001). There was a high incidence of epithelial ingrowth in the enhancement group compared to primary LASIK (4.8% vs 0.2%, P < .001). The time between treatments (primary and enhanced LASIK) was significantly greater in the epithelial ingrowth group (mean: 1,110 ± 870 vs 626 ± 662 days, P < .001). There was a significant rise in epithelial ingrowth rates as time between primary and enhancement LASIK increased, peaking at 4 to 5 years (P < .001). In multivariate analysis, flap lifting for enhancement (odds ratio [OR] = 19.5, P < .001), 6-mm optic zone (OR = 2.2, P < .001), moderate to severe hyperopia (OR = 2.4, P = .005), greater ablation depth (OR = 1.005, P < .001), and low volume surgeon (OR = 3.9, P = .01) were associated with epithelial ingrowth (total R2 = 15.4). CONCLUSIONS The potential risk factors described above may forewarn surgeons as to which individuals merit closer observation for this complication. [J Refract Surg. 2018;34(2):100-105.].
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Ting DSJ, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes. BMJ Open Ophthalmol 2018; 3:e000133. [PMID: 29657982 PMCID: PMC5895975 DOI: 10.1136/bmjophth-2017-000133] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/03/2018] [Accepted: 03/02/2018] [Indexed: 11/28/2022] Open
Abstract
The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%–3.9% in primary treatment to 10%–20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.
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Affiliation(s)
| | - Sathish Srinivasan
- Department of Ophthalmology, University Hospital Ayr, Ayr, UK.,Faculty of Medicine, University of Glasgow, Glasgow, UK
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El-Naggar MT, Hovaghimian DG. Assessment of refractive outcome of femtosecond-assisted LASIK for hyperopia correction. Electron Physician 2017; 9:3958-3965. [PMID: 28461870 PMCID: PMC5407228 DOI: 10.19082/3958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/18/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Laser vision correction for hyperopia is challenging. The purpose of the study was to assess the refractive outcomes of femtosecond-assisted laser in situ keratomileusis (LASIK) for hyperopic correction using wavefront-optimized ablation profiles. METHODS This retrospective case series study included 20 Egyptian patients (40 eyes) with hyperopia or hyperopic astigmatism with a mean manifest refraction spherical equivalent (MRSE) of +2.55D±1.17 (range from +1.00 to +6.00) who had uneventful femtosecond-a assisted LASIK with wavefront-optimized aspheric ablation profile using refractive surgery suite (WaveLight FS200 Femtosecond Laser and WaveLight EX500 Excimer Laser) performed in the Research Institute of Ophthalmology and International Eye Hospital, Giza, Egypt. Statistical analysis was done using Microsoft Excel (Microsoft Corporation, Seattle, WA, USA). RESULTS The procedure significantly reduced the MRSE and cylinder post-operatively (95% were ± 0.50D and 100% ± 1.00 D), with stability of refraction and UDVA over the follow-up period (up to 12 months) after surgery. No eye lost any line of the CDVA, which reflects the excellent safety profile of the procedure; on the other hand, one eye (5%) gained one line and one eye (5%) even gained two lines. There were no significant complications during the procedure. CONCLUSIONS Femtosecond-assisted laser in situ keratomileusis for hyperopia showed predictable, effective, and safe refractive outcomes that were stable through 12 months. Longer follow-up period is required to detect any further regression.
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12
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Moshirfar M, Jehangir N, Fenzl CR, McCaughey M. LASIK Enhancement: Clinical and Surgical Management. J Refract Surg 2017; 33:116-127. [DOI: 10.3928/1081597x-20161202-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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13
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Vaddavalli PK, Yoo SH, Diakonis VF, Canto AP, Shah NV, Haddock LJ, Feuer WJ, Culbertson WW. Femtosecond laser–assisted retreatment for residual refractive errors after laser in situ keratomileusis. J Cataract Refract Surg 2013; 39:1241-7. [DOI: 10.1016/j.jcrs.2013.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 03/05/2013] [Accepted: 03/08/2013] [Indexed: 11/17/2022]
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14
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Sutton G, Lawless M, Hodge C. Laser in situ keratomileusis in 2012: a review. Clin Exp Optom 2013; 97:18-29. [PMID: 23786377 DOI: 10.1111/cxo.12075] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 11/08/2012] [Accepted: 12/14/2012] [Indexed: 11/25/2022] Open
Abstract
Laser in situ keratomileusis (LASIK) is a safe and effective treatment for refractive error. A combination of technological advances and increasing surgeon experience has served to further refine refractive outcomes and reduce complication rates. In this article, we review LASIK as it stands in late 2012: the procedure, indications, technology, complications and refractive outcomes.
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Affiliation(s)
- Gerard Sutton
- Vision Eye Institute, Chatswood, New South Wales, Australia; Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
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15
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Randleman JB, Shah RD. LASIK interface complications: etiology, management, and outcomes. J Refract Surg 2012; 28:575-86. [PMID: 22869235 DOI: 10.3928/1081597x-20120722-01] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/16/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE To describe the etiology, diagnosis, clinical course, and management of LASIK interface complications. METHODS Literature review. RESULTS Primary interface complications include infectious keratitis, diffuse lamellar keratitis, central toxic keratopathy, pressure-induced stromal keratopathy (PISK), and epithelial ingrowth. Infectious keratitis is most commonly caused by Methicillin-resistant Staphylococcus aureus (early onset) or atypical Mycobacterium (late onset) postoperatively, and immediate treatment includes flap lift and irrigation, cultures, and initiation of broad-spectrum topical antibiotics, with possible flap amputation for recalcitrant cases. Diffuse lamellar keratitis is a white blood cell infiltrate that appears within the first 5 days postoperatively and is acutely responsive to aggressive topical and oral steroid use in the early stages, but may require flap lift and irrigation to prevent flap necrosis if inflammation worsens. In contrast, PISK is caused by acute steroid response and resolves only with cessation of steroid use and intraocular pressure lowering. Without appropriate therapy PISK can result in severe optic nerve damage. Central toxic keratopathy mimics stage 4 diffuse lamellar keratitis, but occurs early in the postoperative period and is noninflammatory. Observation is the only effective treatment, and flap lift is usually not warranted. Epithelial ingrowth is easily distinguishable from other interface complications and may be self-limited or require flap lift to treat irregular astigmatism and prevent flap melt. CONCLUSIONS Differentiating between interface entities is critical to rapid appropriate diagnosis, treatment, and ultimate visual outcome. Although initial presentations may overlap significantly, the conditions can be readily distinguished with close follow-up, and most complications can resolve without significant visual sequelae when treated appropriately.
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Affiliation(s)
- J Bradley Randleman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
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16
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Henry CR, Canto AP, Galor A, Vaddavalli PK, Culbertson WW, Yoo SH. Epithelial Ingrowth After LASIK: Clinical Characteristics, Risk Factors, and Visual Outcomes in Patients Requiring Flap Lift. J Refract Surg 2012; 28:488-92. [DOI: 10.3928/1081597x-20120604-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/22/2012] [Indexed: 11/20/2022]
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Littlechild SL, Brummer G, Zhang Y, Conrad GW. Fibrinogen, riboflavin, and UVA to immobilize a corneal flap--conditions for tissue adhesion. Invest Ophthalmol Vis Sci 2012; 53:4011-20. [PMID: 22589434 PMCID: PMC4625804 DOI: 10.1167/iovs.12-9515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/23/2012] [Accepted: 05/04/2012] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Laser-assisted in situ keratomileus (LASIK) creates a permanent flap that remains non-attached to the underlying laser-modified stroma. This lack of permanent adhesion is a liability. To immobilize a corneal flap, a protocol using fibrinogen (FIB), riboflavin (RF), and ultraviolet (UVA) light (FIB+RF+UVA) was devised to re-adhere the flap to the stroma. METHODS A model flap was created using rabbit (Oryctolagus cuniculus) and shark (Squalus acanthias) corneas. Solutions containing FIB and RF were applied between corneal strips as glue. Experimental corneas were irradiated with long wavelength (365 nm) UVA. To quantify adhesive strength between corneal strips, the glue-tissue interface was subjected to a constant force while a digital force gauge recorded peak tension. RESULTS In the presence of FIB, substantive non-covalent interactions occurred between rabbit corneal strips. Adhesiveness was augmented if RF and UVA also were applied, suggesting formation of covalent bonds. Additionally, exposing both sides of rabbit corneas to UVA generated more adhesion than exposure from one side, suggesting that RF in the FIB solution catalyzes formation of covalent bonds at only the interface between stromal molecules and FIB closest to the UVA. In contrast, in the presence of FIB, shark corneal strips interacted non-covalently more substantively than those of rabbits, and adhesion was not augmented by applying RF+UVA, from either or both sides. Residual RF could be rinsed away within 1 hour. CONCLUSIONS Glue solution containing FIB and RF, together with UVA treatment, may aid immobilization of a corneal flap, potentially reducing risk of flap dislodgement.
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Affiliation(s)
- Stacy L Littlechild
- Division of Biology, Kansas State University, Manhattan, Kansas 66506-4901, USA.
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Güell JL, Elies D, Gris O, Manero F, Morral M. Femtosecond laser-assisted enhancements after laser in situ keratomileusis. J Cataract Refract Surg 2012; 37:1928-31. [PMID: 22018361 DOI: 10.1016/j.jcrs.2011.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/22/2011] [Accepted: 06/27/2011] [Indexed: 11/17/2022]
Abstract
UNLABELLED We describe a technique of femtosecond laser-assisted enhancement after primary LASIK with a mechanical microkeratome-created flap. The vertical side-cut incision by the femtosecond laser creates a wound configuration that decreases mechanical trauma to the epithelium and prevents epithelial cell migration. These factors may decrease the risk for post-LASIK enhancement epithelial ingrowth. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
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Affiliation(s)
- Jose L Güell
- Cornea and Refractive Surgery Unit, Instituto Microcirugia Ocular, the Universitat Autonoma de Barcelona, Barcelona, Spain.
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Flaporhexis: Rapid and effective technique to limit epithelial ingrowth after LASIK enhancement. J Cataract Refract Surg 2012; 38:2-4. [DOI: 10.1016/j.jcrs.2011.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 09/20/2011] [Accepted: 09/21/2011] [Indexed: 11/17/2022]
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