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Awad R, Awad K, Bakry A, Abdalla M. Femto-SMILE after photo-therapeutic keratectomy in an eye with failed LASIK flap: A case report. Am J Ophthalmol Case Rep 2023; 30:101852. [PMID: 37187955 PMCID: PMC10176169 DOI: 10.1016/j.ajoc.2023.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Purpose The aim of the study is to describe a case where Femtosecond Intrastromal Lenticule Extraction was used to address the refractive defect following topography-guided phototherapeutic keratectomy (topo-PTK) to regularise a scarred corneal surface after an initial LASIK flap formation attempt failed. Observations A 23-year-old female experienced a thin and irregular corneal flap, during a microkeratome LASIK surgery of the right eye. Subsequently, she experienced epithelial ingrowth. Three months postoperatively the cornea showed scarring and partial flap melting. Topo-PTK was employed to ablate the scarred surface rendering it regular. Treatment with Femtosecond Intrastromal Lenticule Extraction was performed to correct the final refractive error of Sph -5.50 Cyl -2.00 Axis 180° with a happy end of uncorrected visual acuity (UCVA) of 20/20. Conclusions and Importance Femtosecond Intrastromal Lenticule Extraction can be used for retreatment after surface ablation. Topo-PTK can be used to ablate post-operative LASIK-induced irregularities with a successful outcome.
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Affiliation(s)
- Ramy Awad
- Alexandria General Ophthalmology Hospital, Alexandria, Egypt
- Corresponding author. Elmoameron plaza Tower, Hilton St, Sidi Gaber, Alexandria, Egypt.
| | - Khaled Awad
- Alexandria General Ophthalmology Hospital, Alexandria, Egypt
| | - Ahmed Bakry
- Alexandria General Ophthalmology Hospital, Alexandria, Egypt
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Outcomes and Complications in Patients With Hypermobile Ehlers-Danlos Syndrome Who Have Undergone Laser In Situ Keratomileusis Surgery. Cornea 2023; 42:284-291. [PMID: 35389912 DOI: 10.1097/ico.0000000000003028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the safety and outcomes of myopic laser in situ keratomileusis (LASIK) in patients who were secondarily diagnosed with hypermobile Ehlers-Danlos syndrome (EDS). METHODS We conducted a case series study on patients with hypermobile EDS who underwent myopic LASIK surgery. Visual acuity, manifest refraction, a full dilated eye examination, biometry measurements, and Scheimpflug imaging were performed in the Wilmer outpatient clinic. RESULTS There were 24 eyes of 12 patients included in this study. All participants were White women with a mean age of 46.58 years (SD 8.91 years). Participants were seen at an average of 13.83 years (SD 4.3 years, range 6-21 years) after undergoing LASIK. None of the patients in the series had a diagnosis of hypermobile EDS before LASIK surgery. Overall, 92% of patients were happy they got LASIK. The uncorrected distance visual acuity was 20/20 or better in 68% of eyes, and the best-corrected visual acuity was 20/20 or better in 92% of eyes. Manifest refraction was within 1 diopter of plano in 79% of patients. Dry eye symptoms were present in 83% of patients, and 46% of eyes had either punctate epithelial erosions or decreased tear break-up time. One of the 12 patients developed corneal ectasia in both eyes. CONCLUSIONS Patients with hypermobile EDS are generally satisfied with myopic LASIK correction, with good visual acuity outcomes and low rates of myopic regression. However, the risk of corneal ectasia may prevent laser vision correction from being a viable treatment option in these patients. Further studies are needed to make a definitive recommendation.
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IOL Power Calculations after LASIK or PRK. J Cataract Refract Surg 2022; 48:784-789. [DOI: 10.1097/j.jcrs.0000000000000883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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Moshirfar M, Tukan AN, Bundogji N, Liu HY, McCabe SE, Ronquillo YC, Hoopes PC. Ectasia After Corneal Refractive Surgery: A Systematic Review. Ophthalmol Ther 2021; 10:753-776. [PMID: 34417707 PMCID: PMC8589911 DOI: 10.1007/s40123-021-00383-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/02/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The incidence of ectasia following refractive surgery is unclear. This review sought to determine the worldwide rates of ectasia after photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) based on reports in the literature. METHODS A systematic review was conducted according to modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications were identified by a search of eight electronic databases for relevant terms between 1984 and 2021. Patient characteristics and preoperative values including manifest refractive spherical refractive equivalent (MRSE), central corneal thickness (CCT), anterior keratometry, postoperative residual stromal bed (RSB), and percent tissue altered (PTA) were summarized. In addition, annual rates of each refractive surgery were determined, and incidence of post-refractive ectasia for each type was calculated using the number of ectatic eyes identified in the literature. RESULTS In total, 57 eyes (70 eyes including those with preoperative risk factors for ectasia) were identified to have post-PRK ectasia, while 1453 eyes (1681 eyes including risk factors) had post-LASIK ectasia, and 11 eyes (19 eyes including risk factors) had post-SMILE ectasia. Cases of refractive surgery performed annually were estimated as 283,920 for PRK, 1,608,880 for LASIK, and 96,750 for SMILE. Reported post-refractive ectasia in eyes without preoperative identifiable risk factors occurred with the following incidences: 20 per 100,000 eyes in PRK, 90 per 100,000 eyes in LASIK, and 11 per 100,000 eyes in SMILE. The rate of ectasia in LASIK was found to be 4.5 times higher than that of PRK. CONCLUSION Post-refractive ectasia occurs at lower rates in eyes undergoing PRK than LASIK. Although SMILE appears to have the lowest rate of ectasia, the number of cases already reported since its recent approval suggests that post-SMILE ectasia may become a concern. Considering that keratoconus is a spectrum of disease, pre-existing keratoconus may play a larger role in postoperative ectasia than previously accounted for in the literature.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA.
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
| | - Alyson N Tukan
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Nour Bundogji
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Harry Y Liu
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
- Mission Hills Eye Center, Pleasant Hill, CA, USA
| | - Yasmyne C Ronquillo
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
| | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
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Damgaard IB, Sejersen H, Ivarsen A, Hjortdal J. 7-Year Results of SMILE for High Myopia: Visual and Refractive Outcomes and Aberrations. J Refract Surg 2021; 37:654-661. [PMID: 34661473 DOI: 10.3928/1081597x-20210712-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the 7-year visual, refractive, and optical outcomes following small incision lenticule extraction (SMILE) for high myopia and myopic astigmatism. METHODS Sixty-nine eyes (69 patients) undergoing SMILE between March 2011 and January 2012 at Aarhus University Hospital were included. Preoperative, 3-month, 3-year, and 7-year evaluation included: manifest refraction and uncorrected (UDVA) and corrected (CDVA) distance visual acuities, total corneal refractive power (TCRP), average keratometry (Km), aberrations, and central corneal thickness (CCT). RESULTS Preoperative spherical equivalent averaged -7.53 ± 1.18 diopters (D). Twenty-seven eyes were targeted emmetropia. In the emmetropic eyes, the postoperative logMAR UDVA remained stable (P = .11). When including all eyes, UDVA became worse from 3 to 7 years (3 months: 0.050 ± 0.16 logMAR; 3 years: 0.044 ± 0.21 logMAR; 7 years: 0.131 ± 0.29 logMAR; P < .027), whereas CDVA remained stable (3 months: -0.07 ± 0.09 logMAR; 3 years: -0.09 ± 0.08 logMAR; 7 years: -0.09 ± 0.08 logMAR, P > .99). At 7 years, 59.4% and 81.2% were within ±0.50 and ±1.00 D of target refraction, respectively. Average refractive regression was significant from 3 months to 7 years (-0.34 ± 0.69 D) and from 3 to 7 years (-0.25 ± 0.41 D, P < .05). After exclusion of three outliers with high myopic correction (< 9.63 D) and considerable regression (<-1.50 D), the average regression over 7 years was -0.25 ± 0.49 D (P = .004) with no significant change from 3 to 7 years (P = .069). Average CCT, TCRP, and anterior Km significantly increased (P < .001), whereas the posterior Km and total corneal aberrations remained stable (P > .092). CONCLUSIONS The long-term visual outcome remained stable after SMILE, but with an average regression of -0.34 D over 7 years. A minor group with high myopic correction exhibited considerable refractive regression years after SMILE. [J Refract Surg. 2021;37(10):654-661.].
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Kanclerz P, Masters J. Should a pooled analysis of FDA trials be considered representative for a population? Ophthalmic Physiol Opt 2021; 41:1385-1386. [PMID: 34494679 DOI: 10.1111/opo.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Piotr Kanclerz
- Hygeia Clinic, Gdańsk, Poland.,Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jordan Masters
- Asheville Eye Associates, Asheville, North Carolina, USA
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Wu YTY, Ho A, Naduvilath T, Lim C, Carnt N, Keay LJ, Edwards KP, Stapleton F. Author's reply. Ophthalmic Physiol Opt 2021; 41:1387-1388. [PMID: 34496077 DOI: 10.1111/opo.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yvonne Tzu-Ying Wu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Arthur Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Thomas Naduvilath
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Chris Lim
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Nicole Carnt
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Lisa J Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Katie P Edwards
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia
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Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis. Diagnostics (Basel) 2021; 11:diagnostics11091588. [PMID: 34573930 PMCID: PMC8468565 DOI: 10.3390/diagnostics11091588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (LASIK) and LASIK using mechanical microkeratomes (MMKs). This study compares the flap thickness and risk of complications related to flap creation using femtosecond lasers and MMKs. METHODS PubMed and the Web of Science are used to search the medical literature. An extensive search is performed to identify the flap thickness and complications of LASIK as reported up to 15 July 2021. The following keywords are used in various combinations: Corneal flap, femtosecond laser, laser in situ keratomileusis, laser-assisted in situ keratomileusis, LASIK, mechanical microkeratome. RESULTS After removing duplicates and irrelevant studies, 122 articles were included for review. Pooled differences for intended vs. postoperative flap thickness using MMKs and femtosecond laser were -4.07 μm (95% CI: -19.55, 3.24 μm) in studies on the MMK and 5.43 μm (95% CI: 2.30, 7.84 μm; p < 0.001), respectively. After removing the studies evaluating outcomes of the old generation Hansatome MMKs (which had a significantly greater variation of flap thickness), the pooled difference for newer MMKs was 4.97 μm (95% CI: 0.35, 9.58 μm; p < 0.001), but the results still favored the femtosecond laser. Uncommon and mild complications unique for the femtosecond LASIK are epithelial gas breakthrough, opaque bubble layer, transient light sensitivity syndrome, and rainbow glare. A single study reported a very low, but stastically different risk of postoperative flap slippage (0.033% for MMK LASIK, and 0.003% for femtosecond LASIK, respectively). CONCLUSION In both manual microkeratome and femtosecond LASIK, intra- and postoperative complications were uncommon. The evidence of the superiority of one technique in terms of complications over another cannot be indisputably stated.
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Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK. J Clin Med 2021; 10:jcm10143067. [PMID: 34300233 PMCID: PMC8304683 DOI: 10.3390/jcm10143067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 01/01/2023] Open
Abstract
Femtosecond (FS) lasers initially had a higher incidence of diffuse lamellar keratitis (DLK) compared with microkeratome flap creation. It has been theorized that higher-frequency lower-energy (HFLE) FS lasers would reduce the incidence of DLK. Our study sought to evaluate the incidence of newer HFLE FS lasers with pulse frequencies above 60 kHz. It was a retrospective case-control study evaluating the incidence of DLK following flap creation with one of three FS lasers (AMO iFs, WaveLight FS200, Zeiss VisuMax). Uncomplicated LASIK cases were included as the control group (14,348 eyes) and cases of DLK were recorded in the study group (637 eyes). Of the 637 cases of DLK, 76 developed stage II, 25 progressed to stage III, and only three developed stage IV DLK. The overall incidence rate of DLK was 4.3%; it has fallen with the invention of newer HFLE FS lasers and is approaching the DLK incidence rates of DLK with microkeratome.
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Sivaraman V, Price HC, Hussaindeen JR, Ramani K, Allen PM. Nearwork-induced transient myopia and accommodation function before and after laser-assisted in situ keratomileusis surgery. Indian J Ophthalmol 2021; 69:1707-1711. [PMID: 34146011 PMCID: PMC8374790 DOI: 10.4103/ijo.ijo_3224_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To assess the change in Near Induced Transient Myopia (NITM) and other accommodation parameters, before and after undergoing LASIK surgery for myopia correction. Methods Twenty-nine myopic subjects were recruited from a tertiary eye hospital in India. Age range was 21 to 35 years with an average age of 26.1 ± 3.5 years. Mean spherical equivalent was -3.86 D ± 1.50 D presurgery. NITM, lag of accommodation, near point of convergence (NPC), accommodative amplitude (AA), and binocular near accommodative facility (AF) were measured. All data were collected 21 days prior to and 30 days after LASIK surgery. Results NITM, lag of accommodation and amplitude of accommodation were significantly lower (NITM -0.05 ± 0.15, Lag 0.38 ± 0.38, AA 10.27 ± 2.24) after surgery when compared to before (NITM 0.26 ± 0.12, Lag 0.77 ± 0.51, AA 12.18 ± 2.02; P < 0.001). Accommodative facility increased and near point of convergence was significantly more distal following surgery (AF 10.70 ± 2.29, NPC 7.96 ± 1.63) when compared to prior (AF 8.65 ± 2.74, NPC 5.62 ± 1.71; P < 0.001). Conclusion Significant changes in NITM and accommodation function should be expected in the short term following LASIK surgery. This study supports the importance of evaluating accommodative parameters and patient counselling prior to and following refractive surgery.
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Affiliation(s)
- Viswanathan Sivaraman
- Elite School of Optometry, Chennai, Tamil Nadu, India; Vision and Hearing Sciences Research Group, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Holly C Price
- Vision and Hearing Sciences Research Group, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | | | | | - Peter M Allen
- Vision and Hearing Sciences Research Group, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
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Kim JY, Lee H, Joo CK, Hyon JY, Kim TI, Kim JH, Kim JK, Cho EY, Choi JE, Lee NR, Tchah HW. Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population. J Pers Med 2021; 11:jpm11050419. [PMID: 34065718 PMCID: PMC8156820 DOI: 10.3390/jpm11050419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022] Open
Abstract
This multi-center cohort study included 3401 myopic laser in situ keratomileusis (LASIK) procedures conducted in 1756 myopia patients between 2002 and 2005. Pre- and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction spherical equivalent (SE) were recorded. Factors predicting low postoperative efficacy (defined as a postoperative UCVA < 0.5) were identified using univariate and multivariate logistic regression analysis. Compared with 1 month postoperatively, logMAR UCVA at 3 months postoperatively was significantly decreased (p = 0.002) and that at 2 and 3 years was significantly increased (p < 0.001). LogMAR BCVA at 2 years postoperatively was significantly decreased compared with 1 month postoperatively (p = 0.008). Over the 3-year postoperative period, overall refractive predictability within ±1.00 D and ±0.50 D ranged from 69.0% to 86.2% and from 43.3% to 67.8%, respectively. This also decreased from 1 month to 6 months postoperatively (p < 0.005). Multivariate logistic regression analysis using generalized estimating equations, revealed that higher preoperative SE (odds ratio [OR], 2.58 and 7.23; p < 0.001) and lower preoperative BCVA (OR, 2.44; p = 0.003) were predictive of a low postoperative efficacy. In summary, myopic LASIK can be effective and safe with a high refractive predictability in a Korean population, but myopic regression occurs over time. Higher preoperative SE and lower preoperative BCVA are predictive of a low postoperative efficacy.
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Affiliation(s)
- Jae-Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Kangnam St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Joon-Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jin-Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University of Korea, Koyang 10380, Korea;
| | - Jin-Kuk Kim
- B&VIIT Eye Center, Seoul 06615, Korea; (J.-K.K.); (E.-Y.C.)
| | - Eun-Young Cho
- B&VIIT Eye Center, Seoul 06615, Korea; (J.-K.K.); (E.-Y.C.)
| | - Ji-Eun Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea; (J.-E.C.); (N.-R.L.)
| | - Na-Rae Lee
- National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea; (J.-E.C.); (N.-R.L.)
| | - Hung-Won Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
- Correspondence:
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Lee MD, Chen LY, Tran EM, Manche EE. A Prospective Comparison of Wavefront-Guided LASIK versus Wavefront-Guided PRK After Previous Keratorefractive Surgery. Clin Ophthalmol 2020; 14:3411-3419. [PMID: 33116393 PMCID: PMC7585789 DOI: 10.2147/opth.s276381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/18/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the results of retreatment with wavefront-guided LASIK versus wavefront-guided PRK for residual refractive error following previous myopic keratorefractive surgery. Methods In this prospective study, 32 eyes of 28 patients after prior myopic keratorefractive surgery underwent retreatment with flap-lift wavefront-guided LASIK (n = 12) or wavefront-guided PRK (n = 20) for residual refractive error. Safety, efficacy, predictability, and wavefront outcomes were evaluated. Results At last follow-up, both LASIK and PRK retreatment resulted in similar improvement in visual acuity with respective mean ± standard deviation (SD) uncorrected distance visual acuity of −0.07 ± 0.11 logMAR and −0.06 ± 0.13 logMAR (p = 0.87). In the study, 16.7% of LASIK and 33.3% of PRK eyes gained one or more lines of best-corrected distance visual acuity (CDVA), while 16.7% and 9.5% of eyes lost one or more lines of CDVA with LASIK and PRK, respectively. One hundred % of LASIK eyes and 89.5% of PRK eyes were within ± 0.50 diopters of emmetropia. Wavefront analysis demonstrated similar reductions in total RMS error higher-order aberrations (p = 0.84) with no difference in coma, trefoil, or spherical aberration between eyes undergoing LASIK or PRK retreatment. Conclusion Wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery demonstrate similar safety, efficacy, and predictability with comparable wavefront outcomes.
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Affiliation(s)
- Michele D Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Lisa Y Chen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elaine M Tran
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Edward E Manche
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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Barnett V, Barsam A. Update on Laser Vision Correction Versus Intraocular Lens Options. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Could the percent tissue altered (PTA) index be considered as a unique factor in ectasia risk assessment? Int Ophthalmol 2020; 40:3285-3294. [PMID: 32720171 DOI: 10.1007/s10792-020-01514-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy, safety, predictability and stability of the percent tissue altered (PTA) formula in post-LASIK (laser-assisted in situ keratomileusis) ectasia risk assessment. METHODS One hundred and ninety-three eyes from 104 patients with low to moderate myopia that underwent femtosecond LASIK were included in this retrospective, observational and longitudinal study. Seventy-eight eyes were classified in the higher-PTA (> 40%) group and 115 eyes in the lower-PTA (< 40%) group. Spherical manifest refraction, cylinder manifest refraction, logMAR and Snellen previous corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), anterior face Baiocchi Calossi Versaci index (BCVf) and posterior face (BCVb), central corneal thickness (CCT), estimated residual stromal bed (RSB), spherical aberration (SA) and root mean square (RMS) were reported. All patients were followed up for 4 years. RESULTS In the higher-PTA group, 97% of eyes reported UDVA 20/20 or better, and in the lower-PTA group, all eyes achieved 20/20 or better. No group reported decreased visual acuity. The higher-PTA group obtained 55% of eyes within ± 0.50 D and 90% within ± 1.00 D; and the lower-PTA group obtained 63% of eyes within ± 0.50 D and 90% within ± 1.00 D. Both groups showed a refraction correction of 0.50 D or more in 36% and 31% of eyes, in the higher-PTA and the lower-PTA groups, respectively. CONCLUSION Percent tissue altered index should not be considered as a unique variable in post-LASIK ectasia risk assessment. Ectasia susceptibility screening should integrate tomography and biomechanical variables in order to help us to decide any refractive treatment choice and increasing refractive surgery safety.
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Lin E, Ke M, Tan B, Yao X, Wong D, Ong L, Schmetterer L, Chua J. Are choriocapillaris flow void features robust to diurnal variations? A swept-source optical coherence tomography angiography (OCTA) study. Sci Rep 2020; 10:11249. [PMID: 32647298 PMCID: PMC7347889 DOI: 10.1038/s41598-020-68204-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
We evaluated the impact of diurnal variation on choroidal and retinal microvasculature and structural measurements using a swept-source optical coherence tomography angiography machine (SS-OCTA; PLEX Elite 9,000, Carl Zeiss Meditec, Inc., Dublin, USA). Fourteen participants who were without ocular diseases underwent SS-OCTA imaging using 3 × 3-mm2 macular scan pattern on two separate days at five time points. Choriocapillaris flow voids were generated to determine its density (percentage), size (μm) and numbers. Perfusion densities of the large superficial vessels, as well as capillaries on superficial and deep vascular plexuses were generated from retinal angiograms. Subfoveal choroidal and retinal thicknesses were manually measured. Repeated-measures ANOVA was used to investigate the impact of diurnal variation on choroidal and retinal measurements. There was no observable diurnal pattern for any of the flow void features, in terms of the density, size and numbers. There was a significant diurnal pattern observed in the choroidal thickness, where it decreased progressively during the day (P < 0.005). As opposed to sub-foveal choroidal thickness, there does not appear to be significant diurnal variation in choriocapillaris flow voids in normal individuals. This suggests that alterations of choriocapillaris flow deficit seen in pathological eyes will not be confounded by the diurnal fluctuation.
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Affiliation(s)
- Emily Lin
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
| | - Mengyuan Ke
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore, Singapore
| | - Lirong Ong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore. .,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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16
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Wang F, Wang D, Song M, Zhou Q, Liao R, Wang Y. MiRNA-155-5p Reduces Corneal Epithelial Permeability by Remodeling Epithelial Tight Junctions during Corneal Wound Healing. Curr Eye Res 2019; 45:904-913. [PMID: 31852252 DOI: 10.1080/02713683.2019.1707229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Corneal epithelial cells play a vital role in the function of the cornea by forming a physical barrier to protect the eye from invasion by external pathogenic agents. A recent study showed that miR-155 promotes cutaneous wound healing. However, its function in corneal epithelial wound healing is unknown. The present study examined whether miR-155-5p reduces corneal epithelial permeability by remodeling epithelial tight junctions during corneal wound healing. MATERIALS AND METHODS Rat corneal wounds were produced by removing the central corneal epithelium with a blunt scalpel blade under a dissecting microscope. One eye of each rat was treated with topical miR-155-5p, and the other eye was treated with topical agomir negative control for 3 days before and after corneal epithelial wounding. Corneal epithelial permeability was assessed by the macromolecular osmosis method. Expression of zona occludens 1 (ZO-1), occludin, and myosin light chain kinase (MLCK) and phosphorylation of myosin light chain (MLC) were detected by Western blot. Human corneal epithelial (HCE) cells were cultured in the upper chamber of Transwell filters, and transepithelial electrical resistance (TER) was measured using a voltohmmeter. The distribution of ZO-1 and occludin in HCE cells treated with miR-155-5p was determined by immunofluorescence. RESULTS miR-155-5p significantly promoted the repair of corneal epithelial injury and reduced the permeability of the corneal epithelium. It significantly decreased expression of MLCK and phosphorylation of MLC and increased expression of the tight junction proteins ZO-1 and occludin in corneal epithelial cells during corneal wound healing. miR-155-5p significantly increased TER, decreased MLCK expression and MLC phosphorylation, increased ZO-1 and occludin expression, and promoted anchoring of tight junction proteins in the cell membrane and remodeling in HEC cells. CONCLUSIONS Our results suggest that miR-155-5p reduced corneal permeability and accelerated the recovery of corneal epithelial wounds by decreasing the expression of MLCK and phosphorylation of MLC and by remodeling tight junctions.
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Affiliation(s)
- Feng Wang
- Department of Ophthalmology, The First Affiliated Hospital, Anhui Medical University , Hefei, Anhui, P.R.China.,Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University , Hefei, Anhui, P.R.China
| | - Duomei Wang
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University , Hefei, Anhui, P.R.China
| | - Meng Song
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University , Hefei, Anhui, P.R.China
| | - Qing Zhou
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University , Hefei, Anhui, P.R.China
| | - Rongfeng Liao
- Department of Ophthalmology, The First Affiliated Hospital, Anhui Medical University , Hefei, Anhui, P.R.China
| | - Yuan Wang
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University , Hefei, Anhui, P.R.China
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