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Janbatian HY, Fadlallah A, Liu S, Chu T, Melki S. Femtosecond-assisted LASIK flaps resistant to lift secondary to corneal epithelial defects: Case reports and ex vivo studies. J Cataract Refract Surg 2018; 44:1503-1506. [PMID: 30297232 DOI: 10.1016/j.jcrs.2018.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate why epithelial defects created before femtosecond laser ablation result in laser in situ keratomileusis (LASIK) flaps resistant to lift. SETTING Boston Eye Group, Brookline, Massachusetts, USA. DESIGN Case reports and ex vivo studies. METHODS To examine the mechanism of resistance to flap lift after epithelial defects, flap creation with a femtosecond laser was performed in 30 fresh porcine eyes. Before ablation, the eyes were assigned to 3 groups. Group 1 was a control group with intact corneal epithelium. In Group 2, a central 2.0 mm corneal epithelial defect was created by marking it with a 2.0 mm trephine. In Group 3, a peripheral 2.0 mm epithelial defect was created similarly. After the femtosecond laser procedure was performed, the flaps were lifted and the resistance to lift was documented. The corneas were further examined using anterior segment optical coherence tomography. RESULTS In Group 1, no resistance was felt during flap lifts. In Group 2, significant resistance was encountered at the edge of the epithelial defects and the flaps could not be lifted in 7 of 10 eyes. In Group 3, similar significant resistance was encountered in all 10 eyes. Six of 10 flaps could not be lifted. Anterior segment optical coherence tomography from a representative cornea from Group 2 demonstrated a deeper dissection plane in the area where the overlying epithelium was missing. CONCLUSION Epithelial defects can interfere with proper LASIK flap creation with the femtosecond laser. This seems to be attributable to a deeper cutting plane under the area of the epithelial defects compared with the surrounding area with intact epithelium.
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Affiliation(s)
- Hrag Yervant Janbatian
- From the Boston Eye Group (Janbatian, Fadlallah, Melki), Brookline, Harvard Medical School (Janbatian, Fadlallah, Liu, Chu, Melki), and Massachusetts Eye and Ear Infirmary (Janbatian, Fadlallah, Liu, Melki), Harvard Medical School, Boston, Massachusetts, and the Eugene and Marilyn Glick Eye Institute (Liu), Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ali Fadlallah
- From the Boston Eye Group (Janbatian, Fadlallah, Melki), Brookline, Harvard Medical School (Janbatian, Fadlallah, Liu, Chu, Melki), and Massachusetts Eye and Ear Infirmary (Janbatian, Fadlallah, Liu, Melki), Harvard Medical School, Boston, Massachusetts, and the Eugene and Marilyn Glick Eye Institute (Liu), Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shaohui Liu
- From the Boston Eye Group (Janbatian, Fadlallah, Melki), Brookline, Harvard Medical School (Janbatian, Fadlallah, Liu, Chu, Melki), and Massachusetts Eye and Ear Infirmary (Janbatian, Fadlallah, Liu, Melki), Harvard Medical School, Boston, Massachusetts, and the Eugene and Marilyn Glick Eye Institute (Liu), Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tsai Chu
- From the Boston Eye Group (Janbatian, Fadlallah, Melki), Brookline, Harvard Medical School (Janbatian, Fadlallah, Liu, Chu, Melki), and Massachusetts Eye and Ear Infirmary (Janbatian, Fadlallah, Liu, Melki), Harvard Medical School, Boston, Massachusetts, and the Eugene and Marilyn Glick Eye Institute (Liu), Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Samir Melki
- From the Boston Eye Group (Janbatian, Fadlallah, Melki), Brookline, Harvard Medical School (Janbatian, Fadlallah, Liu, Chu, Melki), and Massachusetts Eye and Ear Infirmary (Janbatian, Fadlallah, Liu, Melki), Harvard Medical School, Boston, Massachusetts, and the Eugene and Marilyn Glick Eye Institute (Liu), Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Abstract
PURPOSE The field of refractive surgery is changing quickly in the areas of screening, treatment, and postoperative management. The objective of this study was to review advances in the field of refractive surgery as reported in the peer-reviewed literature during the previous year. DESIGN This was a literature review. METHODS In this article, we highlight the progression in the field from May 2013 to the end of June 2014. This article is organized as preoperative, intraoperative, and postoperative considerations. RESULTS The growing use of newer modalities of treatment, such as small-incision lenticule extraction (SmILE) and phakic intraocular lenses, and their safety and efficacy add to the armamentarium in treating refractive error. This past year has seen many studies, which show these procedures to be safe and effective. Also, structurally, SmILE may result in a more biomechanically stable cornea, so that we may be able to safely treat higher refractive errors. CONCLUSIONS While laser-assisted in situ keratomileusis is the predominant surgical procedure, photorefractive keratectomy is still an appropriate choice in certain scenarios (higher risk for ectasia postrefractive surgery and patient choice) with safe, predictable results, and patient satisfaction. Many of the new developments in laser-assisted in situ keratomileusis have focused on flap creation with femtosecond lasers. Histopathology and in vivo optical coherence tomography studies have shown that the stromal bed is smoother, the side cuts are vertical, and the flap has predictable thickness. New surgical modalities, such as femtosecond lenticule extraction and SmILE, are increasingly being used.
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Affiliation(s)
- Naveen Mysore
- From the Department of Refractive Surgery, Cleveland Clinic, OH
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Vaddavalli PK, Diakonis VF, Canto AP, Culbertson WW, Wang J, Kankariya VP, Yoo SH. Complications of femtosecond laser-assisted re-treatment for residual refractive errors after LASIK. J Refract Surg 2013; 29:577-80. [PMID: 23799795 DOI: 10.3928/1081597x-20130620-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/25/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To report complications of femtosecond laser-assisted re-treatment by the creation of side cuts within the old flaps for residual refractive error after primary LASIK in two patients. METHODS Case report. RESULTS Three eyes of two patients had complications with a circumferential sliver of stromal tissue displaced during surgery due to overlap of old and new side cuts. The displaced tissue was repositioned and corneal anatomy was restored. Two of three eyes demonstrated improvement in the uncorrected visual acuity, whereas one eye lost two lines of corrected visual acuity due to loss of tissue at side cut resulting from flap manipulation, which was done at 1 week. CONCLUSIONS These cases demonstrate a complication of femtosecond laser-enabled side-cut for LASIK enhancement and factors that may lead to this complication and precautions to avoid it.
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Pietilä J, Huhtala A, Mäkinen P, Uusitalo H. Laser in situ keratomileusis enhancements with the Ziemer FEMTO LDV femtosecond laser following previous LASIK treatments. Graefes Arch Clin Exp Ophthalmol 2012; 251:597-602. [PMID: 22814527 DOI: 10.1007/s00417-012-2110-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/13/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The aim of this paper is to present the accuracy, predictability, and safety outcomes of LASIK enhancements performed with the FEMTO LDV femtosecond laser (Ziemer Ophthalmic Systems, Port, Switzerland) and the Allegretto Wave Concerto 500 Hz excimer laser (Wavelight AG, Erlangen, Germany), following previous LASIK treatments. METHODS FEMTO LDV was used for flap creation in 85 previously LASIK-treated eyes of 62 patients. The intended flap thickness was 90 μm in 81 eyes and 140 μm in 4 eyes. The size of the suction ring was 9.0 mm in 72 eyes and 9.5 mm in 13 eyes. Flap dimensions were measured and correlated to preoperative characteristics. RESULTS With the intended flap thickness of 90 μm in previously LASIK-treated eyes, the actual flap thickness was 90.2 ± 6.6 μm (range 80-122), and the flap diameter was 9.2 ± 0.2 mm (range 8.7-9.9). The mean hinge length was 4.0 ± 0.2 mm (range 3.0-4.8). Flap thickness correlated positively with patient age and hinge length. Complications were reported in 12 eyes (14.1 %). Most of the complications were very mild, and none of them prevented further refractive laser treatment. One eye lost two Snellen lines of best spectacle-corrected visual acuity. CONCLUSIONS Femtosecond LASIK enhancement is warranted only in rare cases. Surgical experience is needed and special caution must be practiced. For cases of a primary free cap, femtosecond LASIK is not recommended.
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Affiliation(s)
- Juhani Pietilä
- Department of Ophthalmology, Mehiläinen Hospital, Tampere, Finland
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Al-Mezaine HS, Al-Amro SA, Al-Fadda A, Al-Obeidan S. Outcomes of Retreatment after Aborted Laser In Situ Keratomileusis due to Flap Complications. Middle East Afr J Ophthalmol 2011; 18:232-7. [PMID: 21887080 PMCID: PMC3162737 DOI: 10.4103/0974-9233.84054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis (LASIK) due to flap complications. Materials and Methods: This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment. Results: Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes (66.7%), buttonhole flaps in 7 eyes (21.2%), free partial flaps in 3 eyes (9.1%), and a free complete flap in 1 eye (3.0%). Twenty-two eyes (66.7%) were retreated with LASIK, and 11 eyes (33.3%) were retreated with surface ablation. The mean spherical equivalent (SE) was –0.23 ± 0.72 D, the mean astigmatism was –0.65 ± 0.89 D, and the mean loss of the best corrected visual acuity (BCVA) was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation (P = 0.610). There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation (P = 0.756). There were no intraoperative complications and no eyes required a second retreatment. Conclusion: Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable.
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Affiliation(s)
- Hani S Al-Mezaine
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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