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Koosha N, Riazi MS, Janfaza P, Mohammadbeigy I, Rahimi A, Khoshali M, Pourazizi M, Peyman A. Laser vision correction after radial keratotomy: systematic review and meta-analysis. J Cataract Refract Surg 2024; 50:767-776. [PMID: 38353281 DOI: 10.1097/j.jcrs.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/09/2024] [Indexed: 06/25/2024]
Abstract
Laser vision correction for residual refractive errors in patients with previous radial keratotomy (RK) presents a challenging task. Different techniques have been used with varying outcomes. This study aimed to systematically review published articles on refractive surgeries in post-RK patients by conducting a search on PubMed, Scopus, and Web of Science. The final analysis included 35 studies that described a total of 888 eyes. Our systematic review and meta-analysis demonstrated a significant improvement in uncorrected distance visual acuity (UDVA) for photorefractive keratectomy (PRK), topography-guided PRK, wavefront-guided PRK, and femtosecond laser-assisted in situ keratomileusis (LASIK) while mechanical microkeratome LASIK did not yield such significant improvements. Moreover, our results suggest that post-RK patients with hyperopia had a significant improvement in UDVA, whereas no such improvement was observed in patients with myopia.
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Affiliation(s)
- Nima Koosha
- From the Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran (Koosha, Riazi, Janfaza, Mohammadbeigy, Pourazizi, Peyman); Health Information Technology Research Center, Isfahan University Medical Sciences, Isfahan, Iran (Rahimi); Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (Khoshali)
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Vinciguerra R, Catania F, Rosetta P, Archer TJ, Reinstein DZ, Vinciguerra P. Sequential Customized Therapeutic Keratectomy in Patients With a History of Radial Keratotomy. J Refract Surg 2023; 39:808-816. [PMID: 38063831 DOI: 10.3928/1081597x-20231018-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE To evaluate the outcome of sequential customized therapeutic keratectomy (SCTK) in reducing higher order aberrations (HOAs) and improving quality of vision in highly aberrated corneas consequent to previous radial keratotomy (RK). METHODS A retrospective review of patients undergoing SCTK treatment from January 2012 to October 2020 was conducted in the Eye Center, Humanitas Clinical and Research Center (Rozzano, Italy). Indications for treatment in patients who had RK were significantly and/or progressively reduced corrected distance visual acuity (CDVA) combined with visual symptoms critically affecting quality of life. Preoperative and postoperative CDVA, corneal topography and aberrometry, Scheimpflug tomography, and anterior segment optical coherence tomography were registered. RESULTS Thirty-four patients who underwent RK a mean of 26.62 ± 7.10 years before SCTK treatment were included. SCTK induced a significant improvement of CDVA from 0.44 ± 0.82 logMAR preoperatively to 0.15 ± 0.64 logMAR postoperatively (P < .001). No patient experienced worsening of CDVA, whereas 8 patients (23,50%) gained one line and 23 patients (67.65%) gained two lines or more. A significant decrease in corneal coma, trefoil, and spherical aberrations was also noted (P = .003, .003, and .004, respectively). CONCLUSIONS SCTK proved to be a safe and effective option to treat highly aberrated eyes following RK. The authors suggest the use of SCTK as a first-line approach for the treatment of HOAs after RK and avoiding more invasive procedures such as corneal transplantation or intraocular lens implantation. [J Refract Surg. 2023;39(12):808-816.].
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Santhiago MR, Dutra BAL, Morgado CR, Seiler TG, Wendelstein J, Awwad ST, Assaf JF, Ghanem RC, Ghanem VC, Talley Rostov AR, Wiley WF. Therapeutic visual rehabilitation in a patient with high hyperopia and flat cornea years after radial keratotomy. J Cataract Refract Surg 2023; 49:649-653. [PMID: 37257174 DOI: 10.1097/j.jcrs.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why?
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Colombo-Barboza GN, Colombo-Barboza MN, Colombo-Barboza LR, Colombo-Barboza MM, Colombo-Barboza FDP, Lui-Netto A, Dolci JEL, Moscovici BK, de Freitas D. Vision Quality Questionnaire Assessment in Patients After Topography-Guided Photorefractive Keratectomy for Irregular Astigmatism Secondary to Radial Keratotomy. Clin Ophthalmol 2022; 16:3491-3501. [PMID: 36274677 PMCID: PMC9581467 DOI: 10.2147/opth.s386009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the vision-related quality of life with the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire in patients with astigmatism secondary to radial keratotomy surgery who underwent topography-guided photorefractive keratectomy. Methods Prospective non-randomized clinical trial. This study included 15 patients (30 eyes) aged > 21 years, mean age 55.1 (SD, 3.5) years, 53.3% female, with astigmatism ≤ - 6.00 D resulting from radial keratotomy, which could have been associated with hyperopia ≤ + 6.00 D. Photorefractive keratectomy with topography-guided custom ablation treatment was used in all cases. The patients answered the NEI-RQL questionnaire preoperatively and at 4 and 48 months after topography-guided photorefractive keratectomy. The following data were collected: age, sex and education level, pre-operative refraction data, visual acuity with or without correction, pachymetry, and keratometry. Results There was a significant difference between pre-and postoperative NEI-RQL scores for the domains clarity of vision, near vision, far vision, diurnal fluctuation, activity limitations, glare, symptoms, correction dependence, appearance, and satisfaction with correction (p < 0.001). Conclusion Topography-guided photorefractive keratectomy improved vision-related quality of life in patients with a history of irregular astigmatism secondary to radial keratotomy.
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Affiliation(s)
- Guilherme Novoa Colombo-Barboza
- Department of Ophthalmology, Hospital Visão Laser, Santos, Brazil,Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil,Department of Ophthalmology and Vision Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil,Department of Ophthalmology, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil,Correspondence: Guilherme Novoa Colombo-Barboza, Av. Conselheiro Nebias 355, Santos, SP, CEP 11015-001, Brazil, Tel +55 13 2104-5000, Email
| | - Marcello Novoa Colombo-Barboza
- Department of Ophthalmology, Hospital Visão Laser, Santos, Brazil,Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil,Department of Ophthalmology and Vision Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | - Adamo Lui-Netto
- Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Bernardo Kaplan Moscovici
- Department of Ophthalmology, Hospital Visão Laser, Santos, Brazil,Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil,Department of Ophthalmology and Vision Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Vision Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Zhou W, Reinstein DZ, Archer TJ, Nitter T, Feng Y, Mule G, Stojanovic A. The Impact of Epithelial Remodeling on Surgical Techniques Used in Topography-guided Surface Ablation in Irregular Corneas. J Refract Surg 2022; 38:529-537. [PMID: 35947001 DOI: 10.3928/1081597x-20220711-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the optical consequences of epithelial remodeling in irregular corneas and their impact on the choice of different surface ablation techniques. METHODS Anterior corneal and stromal surface topographies and epithelial thickness maps were analyzed in 24 eyes with irregular corneal optics. On two of the eyes, four different surface ablation techniques were simulated: (1) conventional anterior topography-guided photorefractive keratectomy (PRK), (2) transepithelial phototherapeutic keratectomy (PTK), (3) transepithelial anterior topography-guided PRK, and (4) stromal topography-guided PRK. RESULTS Stromal surface topographies showed higher keratometric values, astigmatism, asphericity, and corneal higher order aberrations compared to topographies of anterior corneas covered by epithelium. Transepithelial anterior topography-guided PRK and stromal topography-guided PRK both resulted in regularized stromal surface, transepithelial PTK achieved partial regularization corresponding to the smoothing effect of the epithelial remodeling, and conventional anterior topography-guided PRK delivered after epithelial removal resulted in residual stromal surface irregularities. CONCLUSIONS The difference in optical landscapes between the stromal and anterior surfaces in irregular corneas will represent a source of error when anterior topography-guided treatments are delivered on the deepithelialized stroma, as in conventional PRK. In contrast, anterior topography-guided ablations performed as transepithelial PRK and stromal topography-guided PRK delivered after epithelial removal address the full stromal irregularity, whereas transepithelial PTK alone may be used when topography-guided treatments are not possible. The authors conclude topography-guided PRK of irregular corneas should lead to significantly improved regularization only if it includes the effect of epithelial remodeling. [J Refract Surg. 2022;38(8):529-537.].
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Ghoreishi M, Abtahi MA, Seyedzadeh I, Fesharaki H, Mohammadnia M, Jahanbani-Ardakani H, Abtahi SH. Photorefractive keratectomy in the management of postradial keratotomy hyperopia and astigmatism. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:82. [PMID: 28919909 PMCID: PMC5553247 DOI: 10.4103/jrms.jrms_478_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/24/2016] [Accepted: 04/16/2017] [Indexed: 11/18/2022]
Abstract
Background: The aim of this study is to evaluate the results of photorefractive keratectomy (PRK) in the management of postoperative hyperopia and astigmatism in patients with history of radial keratotomy (RK). Materials and Methods: This prospective nonrandomized noncomparative interventional case series enrolled consecutive eyes treated with PRK after RK. In cases, in which (1) wavefront (WF) scan was undetectable during primary examinations; and/or, (2) WF data were not transferable to the excimer laser device, patients were treated with the tissue-saving (TS) mode. Patients with detectable/transferable WF were assigned to WF-guided advanced personalized treatment (APT). Results: Thirty-two and 47 eyes were managed by APT and TS modes, respectively. Pooled analysis of both APT and TS groups showed improvement in uncorrected distant visual acuity and corrected distant visual acuity. The amount of sphere, cylinder, corneal cylinder, spherical equivalent, defocus equivalent, and total aberration showed improvement as well. Conclusion: PRK seems to bring favorable outcome and safety profile in the management of post-RK hyperopia and astigmatism. It is crucial for practitioners to warn their patients about the fact that they may still have progressive refractive instability regardless of their choice on the laser method of vision correction.
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Affiliation(s)
| | - Mohammad-Ali Abtahi
- Isfahan Eye Research Center, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Ophthalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Seyedzadeh
- Isfahan Eye Research Center, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Ophthalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Fesharaki
- Isfahan Eye Research Center, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Ophthalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohadeseh Mohammadnia
- Isfahan Eye Research Center, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Ophthalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Jahanbani-Ardakani
- Isfahan Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Student of Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Hossein Abtahi
- Isfahan Eye Research Center, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Ophthalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Ghanem RC. June consultation #7. J Cataract Refract Surg 2016; 42:942-943. [DOI: 10.1016/j.jcrs.2016.04.011] [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]
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Tomás-Juan J, Murueta-Goyena Larrañaga A, Hanneken L. Corneal Regeneration After Photorefractive Keratectomy: A Review. JOURNAL OF OPTOMETRY 2015; 8:149-69. [PMID: 25444646 PMCID: PMC4502084 DOI: 10.1016/j.optom.2014.09.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/01/2014] [Indexed: 05/20/2023]
Abstract
Photorefractive keratectomy (PRK) remodels corneal stroma to compensate refractive errors. The removal of epithelium and the ablation of stroma provoke the disruption of corneal nerves and a release of several peptides from tears, epithelium, stroma and nerves. A myriad of cytokines, growth factors, and matrix metalloproteases participate in the process of corneal wound healing. Their balance will determine if reepithelization and stromal remodeling are appropriate. The final aim is to achieve corneal transparency for restoring corneal function, and a proper visual quality. Therefore, wound-healing response is critical for a successful refractive surgery. Our goal is to provide an overview into how corneal wounding develops following PRK. We will also review the influence of intraoperative application of mitomycin C, bandage contact lenses, anti-inflammatory and other drugs in preventing corneal haze and post-PRK pain.
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Affiliation(s)
- Javier Tomás-Juan
- Department of Visual Science, VallmedicVision International Eye Clinic, Andorra.
| | | | - Ludger Hanneken
- Department of Visual Science, VallmedicVision International Eye Clinic, Andorra
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Abstract
PURPOSE The aim of this study was to report the outcomes of corneal collagen crosslinking (CXL) after previous radial keratotomy (RK) in patients with decreasing visual acuity and/or diurnal visual fluctuations. METHODS The charts of all patients who had undergone CXL because of a worsening corrected distance visual acuity (CDVA) and/or diurnal visual fluctuations after RK were reviewed retrospectively. Uncorrected distance visual acuity, CDVA, manifest refraction, and corneal topography were recorded preoperatively and at 1, 3, 6, and 12 months after the procedure. RESULTS Nine eyes of 6 patients that had undergone an RK 15 to 23 years before the CXL were included in the study. In 5 patients (8 out of 9 eyes), discontinuation of diurnal visual fluctuation was reported between 6 and 12 months after the CXL. The mean uncorrected distance visual acuities pre and 12 months after the CXL were 0.7 logarithm of the minimum angle of resolution (logMAR) and 0.6 logMAR, respectively (P = 0.3). The mean CDVAs pre and 12 months after the CXL were 0.2 logMAR and 0.1 logMAR (P = 0.5), respectively. The mean average keratometry pre and 12 months after the CXL were 40.1 and 39.1 diopters (P = 0.06), respectively. The mean corneal astigmatism values pre and 12 months after the CXL were 2.3 and 1.9 diopters (P = 0.06), respectively. The mean manifest refraction spherical equivalents (MRSEs) before and 12 months after the CXL were +1.4 and +2.5 (P = 0.1), respectively. CONCLUSIONS CXL is a safe and effective method to restore corneal stability in eyes with a history of RK. However, some of the effect that was achieved at the 6-month visit was blunted at the 12-month visit. Therefore, a longer follow-up is necessary to validate these findings.
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Corneal wavefront-guided photorefractive keratectomy with mitomycin-C for hyperopia after radial keratotomy: Two-year follow-up. J Cataract Refract Surg 2012; 38:595-606. [DOI: 10.1016/j.jcrs.2011.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/07/2011] [Accepted: 11/11/2011] [Indexed: 10/28/2022]
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