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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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Gershoni A, Reitblat O, Mimouni M, Livny E, Nahum Y, Bahar I. Femtosecond laser assisted in situ keratomileusis (FS-LASIK) yields better results than transepithelial photorefractive keratectomy (Trans-PRK) for correction of low to moderate grade myopia. Eur J Ophthalmol 2020; 31:2914-2922. [PMID: 33307790 DOI: 10.1177/1120672120980346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the outcomes of transepithelial photorefractive keratectomy (Trans-PRK) with femtosecond laser assisted in situ keratomileusis (FS-LASIK) for the correction of low to moderate myopia. METHODS A retrospective cohort study design was used. The study group included patients with myopia less than -6.0 D, with or without concomitant astigmatism under 2.0 D, who were treated with FS-LASIK or Trans-PRK in 2013 through 2014. Background, clinical and outcome data were collected from the patient files. A comparison between eyes treated with FS-LASIK or Trans-PRK was performed. RESULTS The Trans-PRK group was comprised of 1793 eyes and the FS-LASIK group of 666 eyes. Mean ± SD spherical equivalent (SE) refraction prior to surgery was -3.43 ± 1.27 D in the Trans-PRK group and -3.18 ± 1.34 D in the FS-LASIK group (p < 0.001). Efficacy index values were 0.95 ± 0.14 in the Trans-PRK group and 0.98 ± 0.12 in the FS-LASIK group (p < 0.001), and corresponding safety index values were 0.96 ± 0.13 and 0.99 ± 0.12 (p < 0.001). Distance from target refraction was 0.45 ± 0.42 D in Trans-PRK group and 0.43 ± 0.38 D in the FS-LASIK group (p = 0.537); 71.6% and 74.2% of eyes were within ±0.5 D of attempted correction, respectively (p = 0.193). CONCLUSIONS Both Trans-PRK and FS-LASIK demonstrated excellent results, mostly comparable with the current literature. FS-LASIK achieved better results than Trans-PRK surgery in the efficacy and safety parameters.
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Affiliation(s)
- Assaf Gershoni
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Reitblat
- Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Eitan Livny
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Nahum
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ortega-Usobiaga J, Llovet-Osuna F, Reza Djodeyre M, Cobo-Soriano R, Llovet-Rausell A, Baviera-Sabater J. LASIK and surface ablation in patients treated with amiodarone. ACTA ACUST UNITED AC 2016; 91:520-525. [PMID: 27350387 DOI: 10.1016/j.oftal.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/17/2016] [Accepted: 05/12/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the anatomical and functional outcomes of corneal refractive surgery in patients on amiodarone, a drug listed as being contraindicated in patients undergoing this procedure. MATERIAL AND METHODS A retrospective observational study was conducted on all consecutive patients who took amiodarone and who underwent LASIK or surface ablation from January 2003 to December 2014. Functional (visual and refractive) outcomes are described. RESULTS A total of 20 patients (33 eyes) were included. No significant intraoperative or postoperative complications were found. CONCLUSIONS In our experience, LASIK and surface ablation did not produce significant clinical complications in selected patients taking amiodarone. The absolute exclusion of certain systemic medications should be reconsidered.
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Moon CH. Four-year visual outcomes after photorefractive keratectomy in pilots with low-moderate myopia. Br J Ophthalmol 2015; 100:253-7. [PMID: 26135012 DOI: 10.1136/bjophthalmol-2015-306967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/13/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The photorefractive keratectomy (PRK) is approved for Air Force pilots in several nations. The occupational environments of pilots in the Air Force are unique, including extremely high altitude, low oxygen tension, high ultraviolet light exposure and high G-force load. The short-term efficacy and safety of PRK for pilots are documented. However, the study for long-term visual and refractive outcomes of PRK in pilots is limited. OBJECTIVE To investigate the long-term visual and refractive outcomes in a 4-year follow-up period after PRK in pilots with low to moderate myopia. METHODS Thirty-eight eyes of 20 subjects that underwent PRK and recruited to Air Force pilot were evaluated preoperatively and at 3, 6, 12, 24, and 48 months postoperatively. RESULTS The mean patient age was 21.42±0.75 years. The mean preoperative manifest refraction spherical equivalent (SE) was -1.51±1.15 diopters (D). At 4 years postoperatively, the mean SE was -0.29±0.51, 89.5% of eyes achieved 20/20 or better Snellen uncorrected visual acuity, 71.1% of eyes were within ±0.50 D of emmetropia. The refraction stabilised by 6 months and was maintained up to the 4-year follow-up stage. CONCLUSIONS PRK for pilots with low to moderate myopia is safe and effective in the long term. High-altitude environmental stress exposure has no effect on the refractive stability after PRK. TRIAL REGISTRATION NUMBER ROKAF-ASMC-2015-IRB-002.
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Affiliation(s)
- Chan Hee Moon
- Department of Ophthalmology, Aerospace Medical Center, Republic of Korea Air Force, Cheongju-si, Korea
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Sia RK, Ryan DS, Edwards JD, Stutzman RD, Bower KS. The U.S. Army Surface Ablation Study: Comparison of PRK, MMC-PRK, and LASEK in Moderate to High Myopia. J Refract Surg 2014; 30:256-64. [DOI: 10.3928/1081597x-20140320-04] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/02/2014] [Indexed: 11/20/2022]
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Shortt AJ, Allan BDS, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev 2013:CD005135. [PMID: 23440799 DOI: 10.1002/14651858.cd005135.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Myopia (also known as short-sightedness or near-sightedness) is an ocular condition in which the refractive power of the eye is greater than is required, resulting in light from distant objects being focused in front of the retina instead of directly on it. The two most commonly used surgical techniques to permanently correct myopia are photorefractive keratectomy (PRK) and laser-assisted in-situ keratomileusis (LASIK). OBJECTIVES To compare the effectiveness and safety of LASIK and PRK for correction of myopia by examining post-treatment uncorrected visual acuity, refractive outcome, loss of best spectacle-corrected visual acuity, pain scores, flap complications in LASIK, subepithelial haze, adverse events, quality of life indices and higher order aberrations. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 11), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2012), EMBASE (January 1980 to November 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to November 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 November 2012. We also searched the reference lists of the studies and the Science Citation Index. SELECTION CRITERIA We included randomised controlled trials comparing LASIK and PRK for the correction of any degree of myopia. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We summarised data using the odds ratio and mean difference. We combined odds ratios using a random-effects model after testing for heterogeneity. MAIN RESULTS We included 13 trials (1135 participants, 1923 eyes) in this review. Nine of these trials randomised eyes to treatment, two trials randomised people to treatment and treated both eyes, and two trials randomised people to treatment and treated one eye. None of the paired trials reported an appropriate paired analysis. We considered the overall quality of evidence to be low for most outcomes because of the risk of bias in the included trials. There was evidence that LASIK gives a faster visual recovery than PRK and is a less painful technique. Results at one year after surgery were comparable: most analyses favoured LASIK but they were not statistically significant. AUTHORS' CONCLUSIONS LASIK gives a faster visual recovery and is a less painful technique than PRK. The two techniques appear to give similar outcomes one year after surgery. Further trials using contemporary techniques are required to determine whether LASIK and PRK as currently practised are equally safe. Randomising eyes to treatment is an efficient design, but only if analysed properly. In future trials, more efforts could be made to mask the assessment of outcome.
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Affiliation(s)
- Alex J Shortt
- The Moorfields Eye Hospital/UCL Institute of Ophthalmology National Institute for Health Research Biomedical Research Centre,London, UK.
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Rosa N, De Bernardo M, Romano MR, Scarfato G, Verdoliva F, Mastropasqua R, Lanza M. Analysis of photoastigmatic keratectomy with the cross-cylinder ablation. Indian J Ophthalmol 2012; 60:283-7. [PMID: 22824597 PMCID: PMC3442463 DOI: 10.4103/0301-4738.98707] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim was to evaluate the safety and efficacy of the "cross-cylinder" technique in the correction of astigmatism. SETTING AND DESIGN A prospective interventional study from a university eye department was conducted. MATERIAL AND METHODS The photoastigmatic refractive keratectomy (PARK) using the "cross-cylinder" technique was performed in 102 eyes of 84 patients with at least 0.75 D of astigmatism. The study population was divided into two groups: in the first group the preoperative astigmatic power ranged from -0.75 D to -3.00 D (group 1), in the second group it ranged from -3.25 D to -6.00 D (group 2). Group 1 included 82 eyes of 67 patients (29 males and 38 females) with a mean cylinder power of -1.90 ± 0.63 D, group 2 included 20 eyes of 17 patients (13 males and 4 females) with a mean cylinder power of -4.28 ± 0.76 D. All eyes were targeted for emmetropia. The results were evaluated using Calossi's vector analysis method. Six-month postoperative outcomes are presented. RESULTS Six months after PARK the mean sphere for the entire cohort was +0.28 ± 0.75 D (range +2.5 to -2 D), the mean cylindrical power was +0.33 ± 0.51 D (range +2.5 to -1.25 D) and the mean spherical equivalent refraction was +0.73 ± 0.81 D (range +1.75 to -2 D). CONCLUSIONS The cross-cylinder technique may be safely used with predictable results for the correction of astigmatism.
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Affiliation(s)
- Nicola Rosa
- Eye Department, and Centro Grandi Apparecchiature, 2nd University of Naples, Via De Crecchio 16, Naples, Italy
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Vasaiwala R, Jackson WB, Azar DT, Al-Muammar A. Excimer Laser Surface Treatment. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yuen LH, Chan WK, Koh J, Mehta JS, Tan DT. A 10-year prospective audit of LASIK outcomes for myopia in 37,932 eyes at a single institution in Asia. Ophthalmology 2010; 117:1236-1244.e1. [PMID: 20153899 DOI: 10.1016/j.ophtha.2009.10.042] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 10/25/2009] [Accepted: 10/26/2009] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study evaluates the efficacy, predictability and safety of LASIK surgery as a treatment for myopia performed as part of a large-scale, prospective clinical audit spanning 10 years in an Asian study population and to evaluate the outcomes and trends. DESIGN Prospective, nonrandomized, single-center, multisurgeon study. PARTICIPANTS We included 37,932 eyes of 19,753 patients that underwent myopic LASIK at the Singapore National Eye Centre between 1998 and 2007. METHODS All eyes underwent LASIK as a treatment for myopia. Pre- and postoperative refractions, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were documented. MAIN OUTCOMES MEASURES Safety, efficacy, refractive predictability, treatment trends, retreatment rates, and complications for mild, moderate, and high myopia according to spherical equivalence (SE) of less than -5.00 diopters (D), -5.00 D or more to less than -10.0 D, and -10.00 D or more, respectively. RESULTS Patients' median age was 32 years (mean, 33.0+/-7.9 years); there were 6832 males (34.6%) and 12,921 females included. Patients were predominantly ethnic Chinese (90.5%). Mean follow-up time was 68.8 days. The mean spherical error corrected was -5.90+/-2.57 D (median, -5.625 D), and outcomes were categorized into low, moderate, or high myopia. The UCVA achieving > or =20/40 has been consistently above 90% since 2000, with 72.8% achieving > or =20/20. More than 93.0% of eyes achieved within +/-1.00 D target in the last 4 years. An improvement in safety was observed since the start of the study, with the best outcomes observed in 2007; loss of 1 and 2 Snellen line BCVA postoperatively was 2.4% and 0.1%, respectively. The overall retreatment rate was 3.8%; 91% of retreated eyes achieved UCVA of > or =20/30. Between 1998 and 2007, there was a significant improvement in postoperative UCVA and BCVA (P<0.001). CONCLUSIONS Myopic LASIK performed in Asian eyes within a comprehensive LASIK clinical program with appropriate clinical audit governance can be safe and effective, with high refractive predictability. Improvements in the nomograms to prevent undercorrection and to compensate for myopic regression have led to better efficacy after LASIK, with an increasing percentage of patients achieving 20/15 visual acuity postoperatively.
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Affiliation(s)
- Leonard H Yuen
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore
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Rosman M, Alió JL, Ortiz D, Perez-Santonja JJ. Comparison of LASIK and Photorefractive Keratectomy for Myopia From −10.00 to −18.00 Diopters 10 Years After Surgery. J Refract Surg 2010; 26:168-76. [DOI: 10.3928/1081597x-20100224-02] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 02/18/2009] [Indexed: 11/20/2022]
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Ang EK, Couper T, Dirani M, Vajpayee RB, Baird PN. Outcomes of laser refractive surgery for myopia. J Cataract Refract Surg 2009; 35:921-33. [DOI: 10.1016/j.jcrs.2009.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 02/19/2009] [Accepted: 02/19/2009] [Indexed: 11/30/2022]
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Kramarevsky N, Hardten DR. Excimer Laser Photorefractive Keratectomy. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Several laser and non-laser refractive surgical procedures have been used to modify the shape of the cornea and correct myopia, hyperopia, astigmatism, and presbyopia. Introduction of the excimer laser to reshape the cornea has resulted in remarkable developments in the correction of these refractive errors. Combined with other advanced ophthalmological instruments, laser refractive eye surgery has resulted in a substantial rise in the safety, efficacy, and predictability of surgical outcomes. Despite these advances, certain limitations and complications persist. In this review, we describe the history, preoperative assessment, surgical techniques, outcomes, and complications of laser refractive surgery.
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Affiliation(s)
- Tohru Sakimoto
- Massachusetts Eye and Ear Infirmary, the Schepens Eye Research Institute, Harvard Medical School, Boston, MA 02114, USA
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Shortt AJ, Allan BDS. Photorefractive keratectomy (PRK) versus laser-assisted in-situ keratomileusis (LASIK) for myopia. Cochrane Database Syst Rev 2006:CD005135. [PMID: 16625626 DOI: 10.1002/14651858.cd005135.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Myopia (also known as short-sightedness or near-sightedness) is an ocular condition in which the refractive power of the eye is greater than is required, resulting in light from distant objects being focused in front of the retina instead of directly on it. The two most commonly used surgical techniques to permanently correct myopia are photorefractive keratectomy (PRK) and laser-assisted in-situ keratomileusis (LASIK). OBJECTIVES The aim of this review was to compare the effectiveness and safety of PRK and LASIK for correction of myopia. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2005, Issue 3), MEDLINE (1966 to September 2005), EMBASE (1980 to September 2005) and LILACs (1982 to 3 November 2005). We also searched the reference lists of the studies and the Science Citation Index. SELECTION CRITERIA We included randomised controlled trials comparing PRK and LASIK for correction of any degree of myopia. We also included data on adverse events from prospective multicentre consecutive case series in the Food and Drugs Administration (FDA) trials database (http//www.fda.gov/cdrh/LASIK/lasers.htm). DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Data were summarised using odds ratio and mean difference. Odds ratios were combined using a random-effects model after testing for heterogeneity. MAIN RESULTS This review included six randomised controlled trials involving a total of 417 eyes, of which 201 were treated with PRK and 216 with LASIK. We found that although LASIK gives a faster visual recovery than PRK, the effectiveness of these two procedures is comparable. We found some evidence that LASIK may be less likely than PRK to result in loss of best spectacle-corrected visual acuity. AUTHORS' CONCLUSIONS LASIK gives a faster visual recovery than PRK but the effectiveness of these two procedures is comparable. Further trials using contemporary techniques are required to determine whether LASIK and PRK are equally safe.
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Affiliation(s)
- A J Shortt
- Moorfields Eye Hospital, 162 City Road, London, UK, EC1V 2PD.
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Ambati BK, Higgins E, Gupta N, Hu G, Kim T, Carlson AN, Ambati J. Eyelid disease. Ophthalmology 2005; 112:2052-3. [PMID: 16271321 DOI: 10.1016/j.ophtha.2005.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 08/11/2005] [Indexed: 11/24/2022] Open
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Pérez-Santonja JJ, Galal A, Cardona C, Artola A, Ruíz-Moreno JM, Alió JL. Severe corneal epithelial sloughing during laser in situ keratomileusis as a presenting sign for silent epithelial basement membrane dystrophy. J Cataract Refract Surg 2005; 31:1932-7. [PMID: 16338563 DOI: 10.1016/j.jcrs.2005.06.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 01/20/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the occurrence of large intraoperative epithelial sloughing during laser in situ keratomileusis (LASIK) as a first diagnostic sign for silent epithelial basement membrane dystrophy (EBMD). SETTING Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, Alicante, Spain. METHODS In this retrospective case series, the medical records of all patients with large corneal epithelial sloughing/defects during LASIK from January 1995 to December 2004 were reviewed. All patients who presented normal corneas before LASIK and EBMD changes after LASIK were included in this study. The surgical procedures and postoperative course were recorded. The follow-up period was 12 months for all patients. RESULTS Eleven eyes of 6 patients were included. The mean age was 35 years +/- 6.1 (SD). Mean preoperative uncorrected visual acuity (UCVA) was 20/500 (0.04 +/- 0.02); 12 months after surgery, mean UCVA increased to 20/27 (0.74 +/- 0.21). There was a significant decrease in best spectacle-corrected visual acuity 1 month after surgery. One year postoperatively, 10 of 11 eyes (91%) were within +/-1.00 diopter of emmetropia. Postoperatively, clinical manifestations of EBMD were observed in all eyes and complications were common. In the early postoperative period, diffuse lamellar keratitis was observed in 6 of 11 eyes (54.5%) and flap microfolds were noted in 2 of 11 (18.2%). One year after surgery, epithelial ingrowth was present in 8 of 11 eyes (72.7%) and flap melting was noted in 4 of 11 (36.4%). CONCLUSION Occurrence of large intraoperative epithelium sloughing/defects during LASIK might be a diagnostic sign for subclinical EBMD. These patients are predisposed to multiple postoperative complications. Because of the high risk for epithelial sloughing in the second eye, LASIK should not be performed.
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Affiliation(s)
- Juan J Pérez-Santonja
- Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain
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Saeed M, Poon W, Goyal S, McHugh D, Lee N. Choroidal neovascularization after laser in situ keratomileusis in a patient with low myopia. J Cataract Refract Surg 2004; 30:2632-5. [PMID: 15617938 DOI: 10.1016/j.jcrs.2004.04.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2004] [Indexed: 11/22/2022]
Abstract
We report a case of choroidal neovascularization after laser in situ keratomileusis in a 37-year-old man with low myopia.
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Affiliation(s)
- Manzar Saeed
- King's College Hospital, London, United Kingdom.
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Neeracher B, Senn P, Schipper I. Glare sensitivity and optical side effects 1 year after photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg 2004; 30:1696-701. [PMID: 15313292 DOI: 10.1016/j.jcrs.2003.12.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the outcome of low-contrast visual acuity and glare sensitivity after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). SETTING Department of Ophthalmology, Cantonal Hospital of Lucerne, Lucerne, Switzerland. METHODS In this prospective study, patients selected PRK or LASIK after the advantages and disadvantages of both had been described. Snellen visual acuity and disability glare were measured with the Berkeley glare test preoperatively and 1 year postoperatively. At the 1-year follow-up, haze was graded and patients had to assess their quality of vision subjectively. RESULTS One-year follow-up of 58 patients in the PRK group and 64 patients in the LASIK group was achieved. In both groups, the mean uncorrected visual acuity was 20/32 (P =.63) and the mean best corrected visual acuity, 20/20 with no statistically significant difference (P =.20). There were no preoperative or postoperative differences between the 2 groups in low-contrast visual acuity under 4 glare conditions. At 1 year, LASIK eyes had significantly lower postoperative haze scores than PRK eyes (P =.0013). The number of eyes with visually moderate and disturbing halos or disturbances in night vision did not differ considerably between the groups (P =.88). CONCLUSIONS Efficacy outcomes were generally similar in the PRK and LASIK groups. Both achieved good objective and subjective results after treatment with a second-generation excimer laser.
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Javaloy Estañ J, Vidal MT, Quinto A, De Rojas V, Alió JL. Quality assessment model of 3 different microkeratomes through confocal microscopy. J Cataract Refract Surg 2004; 30:1300-9. [PMID: 15177608 DOI: 10.1016/j.jcrs.2003.10.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To study the quality of the cut created by 3 microkeratomes from 2 different generations using corneal confocal microscopy. SETTING Department of Refractive Surgery, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS Two different studies were conducted: Study 1 and Study 2. Study 1 was a prospective analysis using confocal microscopy examination data from 2 reference groups: Group A (control) with 20 nonoperated eyes of 20 healthy volunteers, and Group B with 50 eyes of 30 patients operated on with the Bausch & Lomb Automated Corneal Shaper (ACS) microkeratome. Study 2 was a prospective randomized double-masked study in which 40 eyes of 20 patients underwent myopic laser in situ keratomileusis by 1 surgeon. The right and left eyes of each patient were randomly and alternatively assigned to Group C, flap made with the Hansatome microkeratome, or Group D, flap made with the Moria M2. Immediately after surgery, the microscopic appearance of the cut was subjectively evaluated by the surgeon. One month postoperatively, flap thickness, particle density, and the subclinical confocal wound healing opacity (WHO) index were evaluated with the corneal confocal microscope. RESULTS Surgeon handling comfort was nearly the same with the Hansatome as with the M2 (P =.540). However, the apparent quality of the resulting flap was better with the M2 microkeratome (P =.041). The depth of the cuts made by the 3 microkeratomes were significantly different (P<.001), with the ACS flaps being thinner than the flaps made with the Hansatome or the M2. Particle density at the interface was significantly poorer in the eyes operated on with the ACS, but in these cases the WHO index was significantly greater (P<.001 in both cases). CONCLUSIONS Confocal microscopy is a very useful tool to evaluate the quality of the cut made by different microkeratomes. Overall, the predictability in flap thickness and the apparent quality of the cut made by the Moria M2 microkeratome are better than those obtained with the Hansatome or the ACS. The thin flap made by the ACS microkeratome produced a significantly greater WHO index than the thicker flaps created with the other 2 microkeratomes.
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von Mohrenfels CW, Huber A, Gabler B, Herrmann W, Kempe A, Donitzky C, Lohmann CP. Wavefront-guided Laser Epithelial Keratomileusis With the WaveLight Concept System 500. J Refract Surg 2004. [DOI: 10.3928/1081-597x-20040901-29] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Scott D Barnes
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Cornea and Refractive Surgery Service, Boston 02114, USA
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Gabler B, Winkler von Mohrenfels C, Herrmann W, Gora F, Lohmann CP. Laser-assisted subepithelial keratectomy enhancement of residual myopia after primary myopic LASEK: six-month results in 10 eyes. J Cataract Refract Surg 2003; 29:1260-6. [PMID: 12900230 DOI: 10.1016/s0886-3350(03)00253-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether residual myopia after primary laser-assisted subepithelial keratectomy (LASEK) can be corrected by repeated LASEK and whether this procedure is safe and effective. SETTING University Eye Clinic, University of Regensburg, Regensburg, Germany. METHODS Laser-assisted subepithelial keratectomy was performed in 10 eyes that had had primary LASEK for myopia. The initial mean spherical equivalent (SE) was -6.2 diopters (D) (range -2.5 to -8.0 D), and the residual mean SE was -1.6 D (range -1.0 to -3.0 D). The retreatment ratio was 7.6%. The exposure time of the corneal epithelium to alcohol (20% ethanol) was 30 seconds plus an additional 10 to 15 seconds in cases of strong epithelial adherence. Laser ablation was performed with a Keracor 117 excimer laser (Chiron Technolas). The follow-up after the second LASEK treatment was 6 months. RESULTS The epithelial flap for repeated LASEK was successfully created in all 10 eyes. The postoperative course in the eyes was uneventful. Six months after LASEK enhancement, the SE refraction was within +/-0.5 D in all eyes. No eye lost more than 1 line of best corrected visual acuity, and the uncorrected visual acuity was 20/20 or better in 8 eyes. Significant haze was not observed after repeated LASEK (mean 0.35 before and 6 months after LASEK enhancement). CONCLUSIONS Laser-assisted subepithelial keratectomy enhancement appears to be safe and effective for the correction of residual myopia after primary LASEK. Repeated epithelial flap preparation is possible without technical modifications.
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Affiliation(s)
- Bernhard Gabler
- University Eye Clinic, University of Regensburg, Regensburg, Germany.
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Abstract
The advent of the excimer laser as an instrument for use in reshaping the corneal stroma was a great step forward in refractive surgery. Laser energy can be delivered on the stromal surface in the photorefractive keratectomy (PRK) procedure or deeper on the corneal stroma by the means of a lamellar surgery in which a flap is created with the microkeratome in the laser in situ keratomileusis (LASIK) procedure. LASIK is currently the dominant procedure in refractive surgery. The main advantage of LASIK over PRK is related to maintaining the central corneal epithelium. This increases comfort during the early post-operative period, allows for rapid visual recovery, and reduces the wound healing response. Reduced wound healing correlates with less regression for high corrections and a lower rate of complications such as significant stromal opacity (haze). PRK, however, remains as an excellent option for mild to moderate corrections, particularly for cases associated with thin corneas, recurrent erosions, or a predisposition for trauma (Martial arts, military, etc.). Recently, a modification of PRK, laser subepithelial keratomileusis (LASEK), was introduced. In the LASEK procedure, an epithelial flap is created and replaced after the ablation. The benefits, if any, of the creation of an epithelial flap compared to traditional PRK are not fully appreciated. Advocates of LASEK suggest that there is less discomfort in the early postoperative period, faster visual recovery, and less haze compared to standard PRK for correction of similar levels of refractive error. Additional long-term clinical studies, along with laboratory research, will be crucial to validate these potential advantages of LASEK procedure.
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Affiliation(s)
- Renato Ambrósio
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98195, USA
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Russell GE, Stulting RD, Thompson KP. Postoperative LASIK visual aberrations and treatment with InterWave-guided multipass, multistage correction. Optom Vis Sci 2003; 80:93-6. [PMID: 12597323 DOI: 10.1097/00006324-200302000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Visual aberrations such as glare and halo have been well documented after laser in-situ keratomileusis (LASIK). These are more likely in patients with higher refractive errors and large pupil diameters. We present a patient with good Snellen acuity but functional impairment by visual aberrations after LASIK. These symptoms resolved after an InterWave-guided LASIK multipass, multistage enhancement treatment to correct spherical aberrations.
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Sugar A, Rapuano CJ, Culbertson WW, Huang D, Varley GA, Agapitos PJ, de Luise VP, Koch DD. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology. Ophthalmology 2002; 109:175-87. [PMID: 11772601 DOI: 10.1016/s0161-6420(01)00966-6] [Citation(s) in RCA: 314] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE This document describes laser in situ keratomileusis (LASIK) for myopia and astigmatism and examines the evidence to answer key questions about the efficacy and safety of the procedure. METHODS A literature search conducted for the years 1968 to 2000 retrieved 486 citations and an update search conducted in June 2001 yielded an additional 243 articles. The panel members reviewed 160 of these articles and selected 47 for the panel methodologist to review and rate according to the strength of evidence. A Level I rating is assigned to properly conducted, well-designed, randomized clinical trials; a Level II rating is assigned to well-designed cohort and case-control studies; and a Level III rating is assigned to case series and poorly designed prospective and retrospective studies, including case-control studies. RESULTS The assessment describes randomized controlled trials published in 1997 or later (Level I evidence) and more recent comparative and noncomparative case series (Level II and Level III evidence), focusing on results for safety and effectiveness. It is difficult to extrapolate results from these studies that are comparable to current practices with the most recent generation lasers because of the rapid evolution of LASIK technology and techniques. It is also difficult to compare studies because of variations in the range of preoperative myopia, follow-up periods, lasers, nomograms, microkeratomes and techniques, the time frame of the study, and the investigators' experience. CONCLUSIONS For low to moderate myopia, results from studies in the literature have shown that LASIK is effective and predictable in terms of obtaining very good to excellent uncorrected visual acuity and that it is safe in terms of minimal loss of visual acuity. For moderate to high myopia (>6.0 D), the results are more variable, given the wide range of preoperative myopia. The results are similar for treated eyes with mild to moderate degrees of astigmatism (<2.0 D). Serious adverse complications leading to significant permanent visual loss such as infections and corneal ectasia probably occur rarely in LASIK procedures; however, side effects such as dry eyes, night time starbursts, and reduced contrast sensitivity occur relatively frequently. There were insufficient data in prospective, comparative trials to describe the relative advantages and disadvantages of different lasers or nomograms.
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Affiliation(s)
- Alan Sugar
- Ophthalmic Technology Assessment Committee 2000-2001 Refractive Surgery Panel
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Maguen E, Zorapapel NC, Zieske JD, Ninomiya Y, Sado Y, Kenney MC, Ljubimov AV. Extracellular matrix and matrix metalloproteinase changes in human corneas after complicated laser-assisted in situ keratomileusis (LASIK). Cornea 2002; 21:95-100. [PMID: 11805516 DOI: 10.1097/00003226-200201000-00020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize extracellular matrix (ECM) and nine matrix metalloproteinase (MMP) changes in two corneas that underwent a complicated laser-assisted in situ keratomileusis (LASIK) procedure. METHODS The first patient underwent bilateral LASIK. The flap on the left eye was transected in several locations and placed back. This cornea later developed edema, and the removed flap was analyzed after lamellar keratoplasty. The second patient had a LASIK flap lifted, replaced twice, and then completely removed. The epithelium grew over the stroma, but haze and severe ectasia occurred. After penetrating keratoplasty, the recipient cornea was analyzed. An autopsy cornea from a person who underwent uneventful LASIK and ten normal autopsy corneas served as controls. Corneas were analyzed by immunohistochemistry. RESULTS Both flap regions in the treated corneas had marked alterations of ECM components and MMPs. Stromal deposits of various ECM proteins, including those normally absent in the central cornea (tenascin-C, fibrillin-1, type XIV collagen), were found. Rare myofibroblasts and inflammatory cells were present. The epithelial basement membrane (BM) was altered in both cases. The most dramatic change was poor or no staining for alpha3-alpha6 type IV collagen chains and thrombospondin. The limbal alpha1-alpha2 type IV collagen and laminin-2 (alpha2beta1gamma1) appeared in the central epithelial BM. Other components were altered to a lesser extent. The anterior stroma was positive for MMP-1 and MMP-2, and some MMP-7 was seen in the epithelium. These ECM and MMP patterns were not seen in uneventful LASIK or normal corneas. CONCLUSIONS In the flaps of LASIK-treated corneas, fibrosed areas of anterior stroma had increased levels of MMP-1 and MMP-2 that may have caused loss of specific type IV collagen isoforms in the epithelial BM. These changes may reflect an ongoing wound healing process and contribute to the development of ectasia.
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Affiliation(s)
- Ezra Maguen
- Ophthalmology Research Laboratories, Burns & Allen Research Institute, Cedars-Sinai Medical Center, UCLA Medical School, Los Angeles, California 90048, USA.
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