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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024; 47:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [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: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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Sahay P, Bafna RK, Reddy JC, Vajpayee RB, Sharma N. Complications of laser-assisted in situ keratomileusis. Indian J Ophthalmol 2021; 69:1658-1669. [PMID: 34146007 PMCID: PMC8374806 DOI: 10.4103/ijo.ijo_1872_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/19/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is one of the most commonly performed kerato-refractive surgery globally. Since its introduction in 1990, there has been a constant evolution in its technology to improve the visual outcome. The safety, efficacy, and predictability of LASIK are well known, but complications with this procedure, although rare, are not unknown. Literature review suggests that intraoperative complications include suction loss, free cap, flap tear, buttonhole flap, decentered ablation, central island, interface debris, femtosecond laser-related complications, and others. The postoperative complications include flap striae, flap dislocation, residual refractive error, diffuse lamellar keratitis, microbial keratitis, epithelial ingrowth, refractive regression, corneal ectasia, and others. This review aims to provide a comprehensive knowledge of risk factors, clinical features, and management protocol of all the reported complications of LASIK. This knowledge will help in prevention as well as early identification and timely intervention with the appropriate strategy for achieving optimal visual outcome even in the face of complications.
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Affiliation(s)
- Pranita Sahay
- Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India
| | - Rahul Kumar Bafna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jagadesh C Reddy
- Cataract and Refractive Surgery Services, Cornea Institute, L V Prasad Eye Institute, L V Prasad Marg, Roan No-2, Banjara Hills, Hyderabad, Telangana, India
| | - Rasik B Vajpayee
- Vision Eye Institute, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Friehmann A, Mimouni M, Assad N, Rabina G, Spierer O, Nemet A, Kaiserman I. Risk factors for early flap misalignment following microkeratome-assisted laser in situ keratomileusis: A retrospective large database analysis. Eur J Ophthalmol 2019; 31:385-389. [PMID: 31813266 DOI: 10.1177/1120672119892431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine factors associated with early flap misalignment following microkeratome-assisted laser in situ keratomileusis. MATERIALS AND METHODS This retrospective study included the right eyes of consecutive patients who underwent laser in situ keratomileusis procedure between 2005 and 2016 at Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into two groups according to whether or not they subsequently developed early flap misalignment. RESULTS A total of 14,582 eyes (mean age of patients: 32.4 ± 10.3 years) were included. Post-laser in situ keratomileusis early flap misalignment developed in 158 eyes (1.1%). Misalignment was more frequent during the spring (32.3% vs 22.8%, p = 0.003) and in a higher operating room temperature (23.34 ± 1.06 vs 22.98 ± 1.26, p < 0.001). In addition, in the misalignment group, there was a higher rate with the of use of the a Moria M2 microkeratome (rather than sub-Bowman's keratomileusis microkeratome) head (55.2% vs 40.5%, respectively, p < 0.001). In a multivariable analysis adjusted for surgeon and year of surgery, high operating room temperature (odds ratio = 1.22, p = 0.006), treatment zone of 9.0 mm (as opposed to smaller treatment zones, odds ratio = 1.54, p = 0.04), and springtime (odds ratio = 1.58, p = 0.02) were associated with flap misalignment. There was a significant difference in misalignment rates between surgeons (p = 0.02). CONCLUSION This study found that larger treatment zones, higher operating room temperature, operating during the spring, and the use of Moria M2 microkeratome were associated with increased flap misalignment rates. The association with operating room temperature and seasonal variation is of interest and merits further research.
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Affiliation(s)
- Asaf Friehmann
- Department of Ophthalmology, Meir Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Negme Assad
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gilad Rabina
- Division of Ophthalmology, Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Achia Nemet
- Department of Ophthalmology, Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Kaiserman
- Care-Vision Laser Centers, Tel Aviv, Israel
- Department of Ophthalmology, Barzilai Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Verma S, Kehrer T, Hesser J, Arba Mosquera S. Analysis of Impact of Humidity and Temperature on Excimer Laser Ablation of Polyethylene Terephthalate, Polymethylmethacrylate, and Porcine Corneal Tissue. Lasers Surg Med 2019; 52:627-638. [PMID: 31758590 DOI: 10.1002/lsm.23190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES To analyze the impact of humidity and temperature on excimer laser ablation of polyethylene terephthalate (PET), polymethylmethacrylate (PMMA) and porcine corneal tissue, and an ablation model to compensate for the temperature and humidity changes on ablation efficiency. STUDY DESIGN/MATERIALS AND METHODS The study was conducted using an AMARIS 1050RS (Schwind eye-tech-solutions) placed inside a climate chamber at ACTS. Ablations were performed on PET, PMMA, and porcine cornea. The impact of a wide range of temperature (~18°C to ~30°C) and relative humidity (~25% to ~80%) on laser ablation outcomes was tested using nine climate test settings. For porcine eyes, change in defocus was calculated from the difference of post-ablation to pre-ablation average keratometry readings. Laser scanning deflectometry was performed to measure refractive change achieved in PMMA. Multiple linear regression was performed using the least square method with predictive factors: temperature, relative humidity, time stamp. Influence of climate settings was modeled for pulse energy, pulse fluence, ablation efficiency on PMMA and porcine cornea tissue. RESULTS Temperature changes did not affect laser pulse energy, pulse fluence (PET), and ablation efficiency (on PMMA or porcine corneal tissue) significantly. Changes in relative humidity were critical and significantly affected laser pulse energy, high fluence and low fluence. The opposite trend was observed between the ablation performance on PMMA and porcine cornea. CONCLUSIONS The proposed well-fitting multi-linear model can be utilized for compensation of temperature and humidity changes on ablation efficiency. Based on this model, a working window for optimum operation has been found (temperature 18°C to 28°C and relative humidity 25% to 65%) for a maximum deviation of ±2.5% in ablation efficiency in PMMA and porcine corneal tissue. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Shwetabh Verma
- Biomedical Engineering Office, Research and Development, SCHWIND eye-tech-solutions, Kleinostheim, D-63801, Germany.,Experimental Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, D-68167, Germany.,Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, 69120, Germany.,Central Institute for Computer Engineering (ZITI), Heidelberg University, Heidelberg, 69120, Germany
| | - Tobias Kehrer
- Department of Theoretical Physics III, University of Würzburg, Würzburg, 97074, Germany
| | - Jürgen Hesser
- Experimental Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, D-68167, Germany.,Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, 69120, Germany.,Central Institute for Computer Engineering (ZITI), Heidelberg University, Heidelberg, 69120, Germany
| | - Samuel Arba Mosquera
- Biomedical Engineering Office, Research and Development, SCHWIND eye-tech-solutions, Kleinostheim, D-63801, Germany
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Mifflin MD, Mortensen XM. Intraoperative optical pachymetry in photorefractive keratectomy. J Cataract Refract Surg 2019; 45:495-500. [PMID: 30819562 DOI: 10.1016/j.jcrs.2018.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/24/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effect of variables on the accuracy and reliability of the optical pachymeter built into the WaveLight EX500 excimer laser during photorefractive keratectomy (PRK). SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Retrospective case series. METHODS A chart review of 352 eyes (181 patients) that had excimer laser PRK was performed. Programmed excimer laser residual stromal bed (RSB) measurements, optical pachymeter measurements after ablation, and Scheimpflug pachymetry measurements (Pentacam) at the 1-year follow-up were compared. Variables included ablation time, preoperative spherical equivalent (SE), 1-year SE, mitomycin-C use, operating room temperature and humidity, and programmed monovision. RESULTS The mean programmed RSB was 27 μm greater than the optical pachymetry post-ablation measurement (P < .001). Of patients with a 1-year follow-up, the 1-year Scheimpflug pachymetry RSB was 24 μm greater than the optical pachymetry post-ablation RSB (P < .001). Comparison of the programmed RSB with the optical pachymetry post-ablation RSB showed that the preoperative SE and ablation time had a Pearson correlation coefficient of -0.36 and 0.30, respectively (P < .001). There was no correlation between operating room temperature, humidity, or programmed monovision with these differences. CONCLUSIONS The RSB post-ablation values measured by optical pachymetry during PRK were significantly lower than the programmed excimer laser RSB value and 1-year Scheimpflug pachymetry RSB value. Intraoperative pachymetry during PRK underpredicted the actual long-term RSB thickness. The greater temporary drying effect associated with increased ablation time in higher myopic corrections might have caused this error.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
| | - Xavier M Mortensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
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Zhao PF, Zhou YH, Zhang J, Wei WB. Analysis of Macular and Retinal Nerve Fiber Layer Thickness in Children with Refractory Amblyopia after Femtosecond Laser-assisted Laser In situ Keratomileusis: A Retrospective Study. Chin Med J (Engl) 2018; 130:2234-2240. [PMID: 28875960 PMCID: PMC5598337 DOI: 10.4103/0366-6999.213959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Localized macular edema and retinal nerve fiber layer (RNFL) thinning have been reported shortly after laser in situ keratomileusis (LASIK) in adults. However, it is still unclear how LASIK affects the retina of children. This study aimed to investigate the macular retina and RNFL thickness in children with refractive amblyopia who underwent femtosecond laser-assisted LASIK (FS-LASIK). Methods: In this study, we included 56 eyes of 32 patients with refractive amblyopia who underwent FS-LASIK in our hospital from January 2012 to December 2016. Foveal (foveal center retinal, parafoveal retinal, and perifoveal), macular inner retinal (superior and inferior), and peripapillary RNFL thicknesses (superior, inferior, temporal, and nasal) were measured using Fourier-domain optical coherence tomography before surgery and 1 day, 3 days, and 1 week after surgery. We divided these patients into three groups based on their refractive error: High myopic group with 22 eyes (equivalent sphere, >6.00 D), mild myopic group with 19 eyes (equivalent sphere, 0–6.00 D), and hyperopic group with 15 eyes (equivalent sphere, >+0.50 D). We compared the macular retina and RNFL thickness before and after LASIK. A paired simple t-test was used for data analysis. Results: One week after surgery, the visual acuity for all 56 eyes of the 32 patients reached their preoperative best-corrected vision. Visual acuity improved two lines or better for 31% of the patients. The residual refractive errors in 89% of the patients were within ±0.5 D. In the high myopic group, the foveal center retinal and parafoveal retinal thicknesses were thicker 1 day and 3 days after surgery than before surgery (t = 2.689, P = 0.012; t = 2.383, P = 0.018, respectively); no significant difference was found 1 week after surgery (P > 0.05). The foveal center retinal and parafoveal retinal thicknesses were greater 1 day after surgery than they were before surgery (P = 0.000 and P = 0.005, respectively) in the mild myopic and hyperopic groups. No significant difference was found 3 days or 1 week after surgery (P > 0.05). In all three groups, no significant difference was found in the macular inner retinal or peripapillary RNFL thickness 1 day, 3 days, or 1 week after surgery (P > 0.05). Conclusions: The foveal center retinal edema after FS-LASIK is mild and reversible in children, that mostly occurred in the high myopic group with no effect on the visual acuity, and is always relieved within 1 week.
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Affiliation(s)
- Peng-Fei Zhao
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yue-Hua Zhou
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jing Zhang
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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