Laser Subepithelial Keratomileusis for Myopia of -6 to -10 Diopters With Astigmatism With the MEL60 Laser

Comparison of postoperative visual quality after SMILE and LASEK for high myopia: A 1-year outcome

PURPOSE

To compare the 1-year outcome of visual quality after laser-assisted subepithelial keratomileusis (LASEK) and femtosecond laser-assisted small incision lenticule extraction (SMILE) for high myopia correction.

MATERIALS AND METHODS

This prospective, comparative study included 24 eyes of 24 patients in the LASEK group, with a mean spherical equivalent (SE) of -7.59 ± 1.32 diopters, and 26 eyes of 26 patients in the SMILE group, with a mean SE of -7.91 ± 1.08 diopters. Visual acuity, corneal topography, contrast sensitivity (CS), and wavefront aberrations were recorded preoperatively and compared with postoperative measurements. Objective scatter index (OSI) and modulation transfer function (MTF) cut-off frequency were measured 1 year postoperatively.

RESULTS

One year postoperatively, the two groups demonstrated no significant difference in the CS at all spatial frequencies. The increments of higher-order aberrations (HOAs) (HOA = 0.583 ± 0.210 μm), including spherical aberration (SA) (SA = 0.546 ± 0.249 μm), were higher (P < 0.05) in the LASEK group than those in the SMILE group (HOA = 0.451 ± 0.143 μm; SA = 0.450 ± 0.340 μm) after surgery. There were no significant differences in the increments of coma and trefoil aberrations between the two groups. The OSI and MTF cut-off frequency exhibited no significant differences between the two groups postoperatively. No vision-threatening complications were noted at any stage in either group.

CONCLUSIONS

Both LASEK and SMILE are safe and effective surgical options for the correction of high myopia. SMILE has a lower HOAs and SA induction rate 1 year postoperatively.

Five-Year Outcome of LASIK for Myopia

PURPOSE

To investigate the efficacy and safety of LASIK over a 5-year postoperative period.

DESIGN

Observational case series.

PARTICIPANTS

We examined 779 eyes in 402 patients with myopia or myopic astigmatism who underwent LASIK to correct their refractive errors and received regular postoperative assessments for 5 years.

METHODS

Postoperative examinations were performed 1 day; 1 week; 1, 3, and 6 months; and 1, 2, 3, 4, and 5 years after LASIK surgery.

MAIN OUTCOME MEASURES

We evaluated changes in uncorrected visual acuity (UCVA) (logarithm of the minimum angle of resolution [logMAR]), manifest refraction, best-corrected visual acuity (BCVA) (logMAR), intraocular pressure, corneal thickness, corneal endothelial cell counts, and complications.

RESULTS

Preoperative UCVA of 1.27 improved to -0.03 at 1 day after surgery and -0.08 at 1 month and revealed minimal but significant decreases thereafter. Postoperative manifest refraction was also improved by surgery, showing minimal but significant regression after 1 year. Final BCVA loss was seen in 10 eyes of 7 patients; in 7 cases, there were obvious reasons such as the progression of cataracts in 3 eyes, epithelial disintegrity due to dry eye in 2 eyes, irregular astigmatism due to flap striae in 1 eye, and age-related macular dystrophy in 1 eye. Intraocular pressure and corneal thickness decreased by 4.0 mmHg and 76.9 microm, respectively, due to surgery, but remained stable throughout the follow-up period. Corneal endothelial cell counts (2689.0+/-232.9 cells/mm(2) before surgery) showed a statistically significant decrease at 5 years after surgery (2658.0+/-183.1 cells/mm(2); 1.2% loss for 5 years), likely within the range due to physiological age-related loss. No serious, vision-threatening, irreversible complication such as keratectasia or progressive endothelial cell loss was observed.

CONCLUSION

LASIK surgery is an effective and safe procedure for correcting myopia/myopic astigmatism as long as inclusion and exclusion criteria are strictly respected. However, minimal regression occurred during the 5-year investigative period.

Microbiologic study of soft contact lenses after laser subepithelial keratectomy for myopia

PURPOSE

To evaluate the extent and agents of bacterial contamination of bandage disposable soft contact lenses after laser subepithelial keratectomy (LASEK) and to correlate the findings with clinical data.

METHODS

Disposable soft contact lenses were collected from 52 eyes of 26 consecutive patients treated with LASEK for myopia. The patients were treated with a fixed combination of tobramycin and diclofenac until epithelial closure. The lenses were removed on the fourth or fifth postoperative day with sterile forceps and immediately placed in sterile tubes containing culture media brain-heart infusion broth. The lenses were evaluated for microbial colonization.

RESULTS

Of the 52 contact lenses analyzed, six (11.5%) had positive cultures. However, no clinical finding of infection was noted. Isolated microorganisms were coagulase-negative staphylococci (two lenses), Stenotrophomonas maltophilia (two lenses), Acinetobacter species (one lens), and Aeromonas hydrophila (one lens). Except for one case, the microorganisms were sensitive to the administered antibiotic.

CONCLUSIONS

The risk of infectious keratitis after LASEK seems to be low. Except for staphylococci, the isolated microorganisms have not been previously reported to colonize the ocular surface or cause keratitis after refractive surgery. These findings may suggest a changing trend of potentially infectious agents after surface ablation.

LASEK and Photorefractive Keratectomy for Myopia: Clinical and Confocal Microscopy Comparison

PURPOSE

To compare postoperative visual acuity and corneal morphology after laser epithelial keratomileusis (LASEK) versus photorefractive keratectomy (PRK) in the correction of low to moderate myopia.

METHODS

In a double-blind, randomized clinical trial, 50 myopic patients (mean: -4.5 +/- 1.35 diopters) were randomized to receive LASEK in one eye and PRK in the fellow eye. No mitomycin C eye drops were used in this study. Patients were observed daily for 4 days, then at 1 month and every 3 months up to 1 year. Uncorrected and best-corrected visual acuity (UCVA and BSCVA), manifest refraction, corneal epithelium healing time, postoperative pain, and corneal haze were evaluated. Corneal wound healing was quantified with corneal confocal microscopy.

RESULTS

Refractive error, UCVA, and BSCVA were not statistically different between eyes treated with LASEK and PRK. Corneal epithelium healing time was 2.52 +/- 0.99 days in the eyes treated with PRK and 2.29 +/- 0.52 days in the eyes treated with LASEK (P=.22). The postoperative pain score was 2.17 +/- 0.87 in the eyes treated with PRK and 2.62 +/- 0.60 (P=.02) in the eyes treated with LASEK. Corneal confocal microscopy showed fewer stromal activated keratocytes and less extracellular matrix deposition in the eyes treated with LASEK than in the eyes treated with PRK at 1 month postoperatively (P=.003).

CONCLUSIONS

LASEK is an effective and safe procedure for low to moderate myopia, but it seems more painful until full corneal reepithelization. In the early postoperative period, the corneal wound healing process is significantly less intense in eyes treated with LASEK than in eyes treated with PRK. The role of LASEK in corneal wound healing modulation remains controversial.

Effectiveness of laser-assisted subepithelial keratectomy to treat residual refractive errors after laser in situ keratomileusis

PURPOSE

To evaluate the effectiveness of laser-assisted subepithelial keratectomy (LASEK) to treat residual refractive errors after laser in situ keratomileusis (LASIK).

SETTINGS

Isik Eye Clinic, Ankara, Turkey.

METHODS

This retrospective study included 24 eyes of 15 patients who had retreatment by LASEK for residual refractive errors after myopic LASIK. All patients had examinations that included slitlamp biomicroscopy, subjective and cycloplegic refractions, uncorrected visual acuity (UCVA), best corrected visual acuity, corneal topography, and pachymetry preoperatively and postoperatively. Postoperative examinations were performed at 1 week and 1, 3, and 6 months.

RESULTS

The patient cohort comprised 9 men and 6 women. The median spherical equivalent (SE) of attempted correction for retreatment with LASEK was -1.25 diopters (D). The median follow-up after LASEK was 11.5 months (range 6 to 16 months). At the end of the follow-up, the median SE of the refractive error was -0.38 D. The median UCVA increased from 20/45 before LASEK to 20/25 at the last follow-up visit, which was statistically significant (P<.001). After LASEK, significant postoperative haze developed in 5 eyes. In all 5 eyes, the estimated ablation depth was more than 40 mum and the SE of attempted correction was -2.00 D or greater.

CONCLUSIONS

Laser-assisted subepithelial keratectomy retreatment in eyes with myopic regression after LASIK resulted in a significant improvement in UCVA that was comparable to the improvement after flap lifting. An SE of attempted correction greater than -2.00 D was associated with a significant rate of haze.

Development of late-onset subepithelial corneal haze after laser-assisted subepithelial keratectomy with prophylactic intraoperative mitomycin-C

We present a case of dense, visually significant reticular haze that developed approximately 17 months after uneventful laser-assisted subepithelial keratectomy with mitomycin-C (MMC). The patient was successfully treated with manual debridement coupled with phototherapeutic keratectomy and intraoperative MMC.

One-year Outcomes of a Bilateral Randomized Prospective Clinical Trial Comparing Laser Subepithelial Keratomileusis and Photorefractive Keratectomy

PURPOSE

To compare laser subepithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) in different eyes of the same patients in terms of visual acuity, refractive error, and complications over 1 year.

METHODS

This prospective, randomized, double-masked study comprised 30 active-duty military personnel with myopia who underwent LASEK in one eye and PRK in the other eye.

RESULTS

Twenty-eight patients' results were available for 1-year follow-up. The primary outcome measures were visual acuity and refractive error. The mean visual acuity for the LASEK group was 1.56 and 1.67 for the PRK group (z = -0.18, P = .15). The mean spherical equivalent refraction for the LASEK group was -0.007 D and +0.124 D for the PRK group (t = 0.982, P = .40). No significant differences were noted in visual acuity or refractive error in the eyes that had LASEK versus the eyes that had PRK.

CONCLUSIONS

After 1-year follow-up, LASEK and PRK show similar levels of visual acuity and refractive error.

Laser Subepithelial Keratomileusis for the Correction of High Myopia With the Schwind ESIRIS Scanning Spot Laser

PURPOSE

To investigate the efficacy of laser subepithelial keratomileusis (LASEK) for the correction of high myopia with the Schwind ESIRIS scanning spot laser (Schwind eye-tech-solutions Gmbh & Co, Kleinostheim, Germany).

METHODS

Fifty-one patients (76 eyes) were treated with a mean preoperative spherical equivalent refraction of -7.55 diopters (D) (range: -6.0 to -10.75 D). All eyes received a LASEK technique using 15% alcohol with a 20-second application.

RESULTS

An intact epithelial flap was obtained in 73 (96%) eyes. At 1 week, uncorrected visual acuity (UCVA) was > or =20/30 in 53 (70%) eyes and > or =20/60 in all eyes. At 6 months (n=76), the mean SE was +0.08 D (range: -1.00 to +1.875 D) with 73 (96%) eyes within +/-1.0 D of the intended correction and 60 (79%) eyes within +/-0.5 D. At 12 months (n=46), the mean SE was -0.07 D (range: -1.375 to +2.0 D) with 44 (96%) eyes within +/-1.0 D of the intended correction and 37 (80%) eyes within +/-0.5 D. Myopic cylindrical corrections were attempted in 68 eyes (range: -0.25 to -4.25 D) with vector analysis demonstrating a mean 85% correction. At last follow-up, UCVA was > or =20/20 in 47 (62%) eyes, > or =20/25 in 63 (83%) eyes, and > or =20/40 in 75 (99%) eyes. Three (4%) eyes gained two lines of Snellen decimal equivalent best spectacle-corrected visual acuity compared to preoperative levels, 68 (89%) eyes showed no change or gained one line, and 5 (7%) eyes lost one line. None lost more than one line. Only 2 (3%) eyes at 6 to 12 months had more than +1 axial corneal haze and 50 (66%) showed no evidence of haze on slit-lamp examination.

CONCLUSIONS

Laser subepithelial keratomileusis for myopia up to -11.00 D with the Schwind ESIRIS laser provides good refractive and visual outcomes, with acceptable visual recovery and minimal complications.

Phototherapeutic LASEK for a Persistent Epithelial Defect and a Recurrent Epithelial Erosion

PURPOSE

To present two patients, one with persistent epithelial defect and one with recurrent epithelial erosion, unresponsive to conventional therapy treated with phototherapeutic keratectomy (PTK) with the laser subepithelial keratomileusis (LASEK) technique (phototherapeutic LASEK).

METHODS

The epithelial flap was created following 18% ethanol application for 20 seconds. A 10-microm deep ablation was performed in the central 7.0-mm zone. A contact lens was placed and the patient examined daily until epithelial closure. Upon epithelial closure, the contact lens was removed. A mild topical steroid and artificial tears were applied for 2 weeks.

RESULTS

The epithelium healed in 4 days in both patients. Patients reported only mild pain until epithelial closure. The manifest refraction and uncorrected visual acuity remained unchanged in both eyes. No haze was noted. The first patient has remained asymptomatic without any recurrence for 12 months, and the second for 9 months.

CONCLUSIONS

Phototherapeutic LASEK provides a therapeutic option for refractory recurrent erosions and persistent epithelial defects, with the additional benefit of being less painful and less risky for haze development than conventional PTK.

Laser Epithelial Keratomileusis With Mitomycin C: Indications and Limits

PURPOSE

To assess the advantages and safety of using mitomycin C (MMC) with laser epithelial keratomileusis (LASEK) by measuring high order aberrations of the cornea.

METHODS

We analyzed the results of 86 eyes that had LASEK plus a brushstroke of MMC 0.01%. Another group of 100 eyes had LASEK only (control group). Mean follow-up was 312 days for the MMC group and 774 days for the control group. A Nidek EC-5000 laser was used in all eyes. We measured mean refractive error, best spectacle-corrected visual acuity (BSCVA), haze, and high order aberrations before and at 1 month and nearly 1 year after LASEK.

RESULTS

Mean baseline spherical equivalent refraction was -6.80 +/- 3.00 D for the MMC group and -6.00 +/- 3.10 D for the control group (P=.34). In eyes with low myopia (-1.20 to -10.80 D), a single ablation zone of 6 mm with a transition zone of 8 mm was used, and in the higher myopia group (-5.60 to -15.50 D), smoothing and a cross sphere procedure (+0.75 D) were used. Mean spherical equivalent refraction after LASEK for low myopia in the MMC group at last examination (mean follow-up 312 days) was +0.50 +/- 0.93, and 0 +/- 0.34 D for the control group. Mean spherical equivalent refraction after LASEK for high myopia in the MMC group at last examination (mean follow-up 312 days) was +0.50 +/- 1.03 D, and +0.40 +/- 0.78 D for the control group. Mean haze in the low myopia MMC group was 0.06 and in the control group, 0.11; in the high myopia MMC group it was 0.1, and in the control group, 0.27 (all differences P<.05). No differences between baseline and postoperative BSCVA were noted. Early and late overcorrection were noted in the MMC group. Increased high order aberrations were evident at 1 month and 1 year in the MMC groups.

CONCLUSIONS

The use of mitomycin C 0.01% with LASEK significantly decreased subepithelial haze. However, refractive outcome was less predictable. High order aberrations increased after LASEK with MMC. Additional studies with longer follow-up are necessary to evaluate long-term effects, and ideal MMC concentration and exposure time.