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Ye Y, Hou X, Yu N, Chen P, Zhuang J, Yu K. Corneal Epithelial Remodeling Induced by Photorefractive Keratectomy Enhancement After Small-Incision Lenticule Extraction. Transl Vis Sci Technol 2024; 13:14. [PMID: 38231497 PMCID: PMC10795581 DOI: 10.1167/tvst.13.1.14] [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] [Received: 08/03/2023] [Accepted: 11/25/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose To assess changes in corneal epithelial thickness (ET) within 9-mm diameter cornea after photorefractive keratectomy (PRK) retreatment after small-incision lenticule extraction (SMILE). Methods A total of 28 eyes of 19 patients with mean spherical equivalent of -1.30 ± 0.60 D who underwent retreatment after SMILE were included in this retrospective study. ET mapped across a 9-mm diameter area was obtained using wide-field optical coherence tomography (OCT) before and at one, three, and six months after surgery. The ET changes were compared between the different time points and analyzed zones. Results Before enhancement, the ET were 63.64 ± 6.01 µm and 61.25 ± 4.32 µm in central and paracentral zones, respectively. The ET of central and paracentral zones significantly decreased at one month and subsequently increased until six months. Six months after surgery, significant epithelial thickening occurred in 2- to 9-mm diameter cornea (all P < 0.05), whereas no significant change was observed in central 2-mm diameter cornea (P = 0.460). There was no significant difference in the ET between the central and paracentral zones (P = 1.00). The degree of myopic correction significantly correlated with the average ET in the central (P = 0.046) and paracentral (P = 0.033) zones at six months after PRK enhancement. No significant correlation was detected between the average ET of all zones and the postoperative spherical equivalent at six months after surgery (all P > 0.05). Conclusions PRK enhancement did not alter the overall trend of corneal epithelial remodeling induced by SMILE. An asymmetric and flatter lenticule-like pattern of epithelial remodeling was observed six months after surgery, which did not affect the refractive outcomes. Translational Relevance An asymmetric and centrally flattened lenticule-like pattern of epithelial remodeling was observed after PRK enhancement. Surgeons should consider expanding the intended optical zones for enhancement surgery after SMILE.
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Affiliation(s)
- Yiming Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiangtao Hou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Na Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Pei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Keming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Lin F, Liu S, Fu D, Zhang L, Wei R, Li M, Zhou X. Comparison of Visual Outcomes and Higher-order Aberrations Between FS-LASIK and SMI-LIKE for Moderate to High Hyperopia: A 2-Year Result. Cornea 2023; 42:1506-1512. [PMID: 37099670 PMCID: PMC10627543 DOI: 10.1097/ico.0000000000003283] [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] [Received: 09/01/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE The aim of the study was to evaluate and compare the long-term visual outcomes and higher-order aberrations (HOAs) between femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule intrastromal keratoplasty (SMI-LIKE) in the correction of moderate to high hyperopia. METHODS In this study, 16 subjects (20 eyes) underwent FS-LASIK and 7 subjects (10 eyes) underwent SMI-LIKE. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, mean keratometry (Km), anterior asphericity (Q), and HOAs preoperatively and 2 years postoperatively were obtained in both procedures. RESULTS The efficacy indices of the FS-LASIK group and the SMI-LIKE group were 0.85 ± 0.14 and 0.87 ± 0.17, respectively. The safety indices of the FS-LASIK and SMI-LIKE groups were 0.99 ± 0.15 and 1.08 ± 0.24, respectively. No significant difference in safety index or efficacy index was found between the FS-LASIK and SMI-LIKE groups (all P > 0.05). The correlation coefficient of the attempted versus achieved spherical equivalent postoperatively was 0.69 ( P < 0.01) and 0.89 ( P < 0.01) in the FS-LASIK group and SMI-LIKE groups, respectively. The front Km, negative Q value, negative spherical aberrations (SAs), coma, and total HOAs significantly increased postoperatively in the 2 groups ( P < 0.05). The FS-LASIK group had greater changes in Q value and SA postoperatively than the SMI-LIKE group ( P < 0.01). CONCLUSIONS SMI-LIKE had similar safety and efficacy to FS-LASIK in the correction of moderate to high hyperopia. However, SMI-LIKE may equip better visual quality postoperatively for its lower Q value and SA changes than FS-LASIK.
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Affiliation(s)
- Feng Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Shengtao Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Luoli Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
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Igras E, Czarnota-Nowakowska B, O’Caoimh R. Comparison of the Clinical Effectiveness of Correcting Different Types of Astigmatism with Small Incision Lenticule Extraction. J Clin Med 2023; 12:6941. [PMID: 37959406 PMCID: PMC10648579 DOI: 10.3390/jcm12216941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Few studies have reported the differential outcomes of Small Incision Lenticule Extraction (SMILE) on myopic astigmatism. Given this, we examined the effectiveness of SMILE for up to one year, comparing with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism, conducting a retrospective review of patients who underwent correction of myopic astigmatism using the 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec) at two refractive clinics in Poland between 2016-2017. Patients were aged ≥21 with stable refractive errors between -0.5 and -10.0 diopter (D) with astigmatism up to 5D. The mean age of the 209 patients (355 eyes) available was 32 years; 58.4% were female. Of these, 247 had WTR, 62 oblique, and 46 ATR astigmatism. The mean pre-operative spherical equivalent (SE) was -5.4 ± 2.57D and the cylinder -1.7 ± 1.0D. The mean SE for WTR reduced from -5.60 ± 2.37D to -0.31 ± 0.67D at 2 months and -0.38 ± 0.70D at 12 months; the mean cylinder improved from -1.90 ± 1.10D to -0.31 ± 0.39D and -0.36 ± 0.43D, respectively. Eyes with oblique astigmatism also improved from a mean SE of -5.8 ± 3.4 D to -0.82 ± 1.50D and -0.69 ± 1.15D and a cylinder of -1.4 ± 0.73D to -0.17 ± 0.33D at 2 months and -0.1 ± 0.32D at 12. For ATR, the mean SE improved from -4.0 ± 1.8D to -0.08 ± 0.22D and -0.04 ± 0.12D; and the mean cylinder from -1.25 ± 0.53 to -0.02 ± 0.09D -0.08 ± 0.21D at 2 and 12 months, respectively. There were statistically significant improvements in SE, manifest sphere and cylinder refraction, and UDVA and CDVA scores for each cylinder type at 2 months with ATR cylinders having better outcomes. Although missing data limited interpretation at one year, differences were maintained. The magnitude of error calculations suggests that WTR was more prone to under-correction, particularly for high astigmatism (>1.5D). SMILE for myopic astigmatism reliably corrects SE, irrespective of the subtype of astigmatism.
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Affiliation(s)
- Estera Igras
- Estera Igras, Optegra Eye Health Care Laser Clinic, Mickiewicza Street 140, 71-153 Szczecin, Poland
| | | | - Rónán O’Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland;
- Clinical Research Facility Cork, University College Cork, Mercy University Hospital, T12 WE28 Cork, Ireland
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Soundarya B, Sachdev GS, Ramamurthy S, Kumar SK, Dandapani R. Visual outcomes of early enhancement following small incision lenticule extraction versus laser in situ keratomileusis. Indian J Ophthalmol 2023; 71:1845-1848. [PMID: 37203042 PMCID: PMC10391394 DOI: 10.4103/ijo.ijo_3209_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.
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Affiliation(s)
- B Soundarya
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | | | - Shreyas Ramamurthy
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Shreesha K Kumar
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Ramamurthy Dandapani
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
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Wallerstein A, Gauvin M, Watt H, Trang N, Trottier P, Adiguzel E, Cohen M. Does Adjunctive Under-flap CXL Reduce Regression for Hyperopic LASIK? J Refract Surg 2022; 38:770-779. [PMID: 36476303 DOI: 10.3928/1081597x-20221026-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate whether adding accelerated under-flap corneal cross-linking to hyperopic laser in situ keratomileusis (LASIK-ufCXL) affects postoperative stability and regression, visual and refractive outcomes, and subjective quality of vision. METHODS This prospective comparative contralateral eye study included 51 patients with hyperopia (102 eyes) who received LASIK-ufCXL in the eye with highest defocus equivalent (DEQ) or randomized when DEQ equal, with the contralateral control eye receiving LASIK alone. After excimer ablation, 0.25% riboflavin was instilled on the stromal bed for 3 minutes. The flap was repositioned, followed by a total irradiation dose of 3.24 J ultraviolet A (UV-A) light administered to the corneal surface, using 18 mW/cm2 UV-A for 3 minutes. Postoperative hyperopic regression (stability) was the primary outcome measure, defined by the difference in spherical equivalent (SEQ) at 1 week and 24 months postoperatively. Secondary measures reported uncorrected distance visual acuity, corrected distance visual acuity, cylinder vector analysis, subjective quality of vision, subjective night vision disturbances, and corneal haze. RESULTS At 24 months, the SEQ stability (P = .4273) and the magnitude of hyperopic regression (P = .5613) did not significantly differ between groups, with a small trend showing hyper-opic regression of 0.50 diopters or greater being less frequent in LASIK-ufCXL eyes. There were no significant differences in accuracy, efficacy, and safety (P > .05), with a small trend of more residual refractive astigmatism in the LASIK-ufCXL group (P = .3216, Cohen's d: -0.29). Subjective quality of vision trended inferior in LASIK-ufCXL eyes (P = .2237, Cohen's d: -0.25), with a greater haze grading (P = .0466, Cohen's d: 0.41). CONCLUSIONS Postoperative regression and stability were statistically equivalent between hyperopic LASIK vs LASIK-ufCXL, with identical safety. There were small clinical trends of lower efficacy, accuracy, and subjective quality of vision in LASIK-ufCXL eyes. [J Refract Surg. 2022;38(12):770-779.].
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Brar S, Ganesh S, Sriganesh SS, Dorennavar L. Long-term Outcomes of Bowman's Membrane Relaxation for Enhancement of Femtosecond Intrastromal Lenticule Implantation Performed for the Management of High Hyperopia. J Refract Surg 2022; 38:134-141. [DOI: 10.3928/1081597x-20211215-01] [Citation(s) in RCA: 1] [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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Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis. Diagnostics (Basel) 2021; 11:diagnostics11091588. [PMID: 34573930 PMCID: PMC8468565 DOI: 10.3390/diagnostics11091588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (LASIK) and LASIK using mechanical microkeratomes (MMKs). This study compares the flap thickness and risk of complications related to flap creation using femtosecond lasers and MMKs. METHODS PubMed and the Web of Science are used to search the medical literature. An extensive search is performed to identify the flap thickness and complications of LASIK as reported up to 15 July 2021. The following keywords are used in various combinations: Corneal flap, femtosecond laser, laser in situ keratomileusis, laser-assisted in situ keratomileusis, LASIK, mechanical microkeratome. RESULTS After removing duplicates and irrelevant studies, 122 articles were included for review. Pooled differences for intended vs. postoperative flap thickness using MMKs and femtosecond laser were -4.07 μm (95% CI: -19.55, 3.24 μm) in studies on the MMK and 5.43 μm (95% CI: 2.30, 7.84 μm; p < 0.001), respectively. After removing the studies evaluating outcomes of the old generation Hansatome MMKs (which had a significantly greater variation of flap thickness), the pooled difference for newer MMKs was 4.97 μm (95% CI: 0.35, 9.58 μm; p < 0.001), but the results still favored the femtosecond laser. Uncommon and mild complications unique for the femtosecond LASIK are epithelial gas breakthrough, opaque bubble layer, transient light sensitivity syndrome, and rainbow glare. A single study reported a very low, but stastically different risk of postoperative flap slippage (0.033% for MMK LASIK, and 0.003% for femtosecond LASIK, respectively). CONCLUSION In both manual microkeratome and femtosecond LASIK, intra- and postoperative complications were uncommon. The evidence of the superiority of one technique in terms of complications over another cannot be indisputably stated.
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Mimouni M, Kaiserman I, Spierer R, Spierer O, Rabina G, Varssano D, Sorkin N. Factors Predicting the Need for Re-treatment After Laser Refractive Surgery in Patients With High Astigmatism: A Large Database Analysis. J Refract Surg 2021; 37:366-371. [PMID: 34170776 DOI: 10.3928/1081597x-20210226-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify the potential risk factors that increase the likelihood of requiring re-treatment following refractive surgery in patients with high astigmatism (3.00 diopters or greater). METHODS This retrospective study included patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2005 and December 2019 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients with high astigmatism (3.00 diopters or greater) were included and divided into two groups according to whether or not they underwent additional refractive surgery (re-treatment) during the study period. RESULTS Overall, 2,024 eyes (2,024 patients) were included in the final analysis of this study. In total, 3.1% of the eyes (n = 63) underwent re-treatment. Throughout the study period, there was a significant reduction in the 2-year annual re-treatment rates, with a decline from 7.0% for primary surgeries performed in 2005 to 0.0% for primary surgeries performed in 2017 (r =-0.65, P = .015). The re-treatment group had significantly older preoperative age. They were also more likely to be male and have preoperative against-the-rule astigmatism and preoperative mixed astigmatism. Binary logistic regression analysis demonstrated that preoperative age, male gender, mixed astigmatism, and earlier year of surgery were all associated with higher re-treatment rates. CONCLUSIONS The following factors are associated with higher rates of re-treatment in patients with high astigmatism: older preoperative age, male gender, and mixed astigmatism. These factors may be incorporated into nomograms to reduce future re-treatment rates in this population. [J Refract Surg. 2021;37(6):366-371.].
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Pertiwi ANS, Mahayana IT, Supartoto A, Goenawan W, Suhardjo. Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values. Int J Ophthalmol 2021; 14:744-749. [PMID: 34012891 DOI: 10.18240/ijo.2021.05.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate demographic and preoperative factors increasing the risk of ametropia following transepithelial photorefractive keratectomy (transPRK) in myopia and myopic astigmatism. METHODS This retrospective cohort study included myopic eyes (-0.50 to -8.75 D) with or without astigmatism (up to 3.50 D) enrolled at Dr. Yap Eye Hospital Yogyakarta. TransPRK was performed using Technolaz 217z100 excimer laser. Subjects were clustered into ametropia and emmetropia group based on uncorrected distance visual acuities (UDVA) 3mo post-operatively. Multiple preoperative and intraoperative parameters were analyzed using Logistic regression to obtain their effect on ametropia risk following transPRK. RESULTS A total of 140 eyes of 87 consecutive subjects were studied. Prevalence of ametropia following transPRK was 20 (14.29%) eyes. Subjects in ametropia group were significantly older than the emmetropia group (31.80±14.23 vs 18.88±2.41, respectively; P<0.001). Bivariate Logistic regression analysis showed that older age (OR=1.23), higher preoperative spherical equivalent (>-6 D; OR=12.78), steeper anterior keratometric readings (Kmax>45 D and mean K>44 D; OR=4.28 and 4.35, respectively) increased the risk of ametropia following transPRK. Adjusted multivariate Logistic regression analysis showed that age was the strongest predictor for the incidence of ametropia following transPRK. Complications of transPRK were overcorrection, suspected posterior keratoectasia and accommodation insuffiency. CONCLUSION Older age can be the strongest factor for increasing ametropia risk following transPRK. Cut-off points of Kmax and mean K at 45 and 44 D respectively are proposed as the predictors for ametropia following transPRK.
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Affiliation(s)
- Amanda Nur Shinta Pertiwi
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia
| | - Indra Tri Mahayana
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia
| | - Agus Supartoto
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| | - Wasisdi Goenawan
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| | - Suhardjo
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
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Rush SW, Rush RB. Femtosecond-Assisted Laser in situ Keratomileusis with de novo Flap Creation Following Previous Microkeratome Laser in situ Keratomileusis. Clin Ophthalmol 2021; 15:1813-1818. [PMID: 33958854 PMCID: PMC8096443 DOI: 10.2147/opth.s301450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the outcomes of laser in situ keratomileusis (LASIK) in patients with previous microkeratome LASIK using a femtosecond laser platform to create a de novo flap. Methods The charts of 17 patients that underwent femtosecond-assisted LASIK with de novo flap creation for consecutive refractive error following previous microkeratome LASIK were retrospectively reviewed at a single private practice institution. The baseline characteristics, intraoperative findings and postoperative outcomes were analyzed. Results All 17 eyes underwent femtosecond-assisted LASIK with de novo flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity improved postoperatively (p<0.0001) and remained stable at 6 months follow-up. None of the subjects lost any lines of best spectacle corrected visual acuity or developed epithelial ingrowth during the postoperative period. Conclusion The femtosecond laser technique described in this report can provide a safe and effective method to deliver LASIK following previous microkeratome LASIK. Future investigations are required to further validate the findings in this study.
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Affiliation(s)
- Sloan W Rush
- Panhandle Eye Group, Amarillo, TX, 79106, USA.,Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
| | - Ryan B Rush
- Panhandle Eye Group, Amarillo, TX, 79106, USA.,Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, 79106, USA.,Southwest Retina Specialists, Amarillo, TX, 79106, USA
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Brar S, Gautam M, Sute SS, Ganesh S. Refractive surgery with simultaneous collagen cross-linking for borderline corneas - A review of different techniques, their protocols and clinical outcomes. Indian J Ophthalmol 2020; 68:2744-2756. [PMID: 33229650 PMCID: PMC7856924 DOI: 10.4103/ijo.ijo_1709_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Simultaneous corneal cross-linking (CXL) has been proposed as an adjunct therapy to corneal refractive procedures to prevent future ectasia, especially when performed in borderline corneas. This review analyses the currently available literature (minimum follow-up 6 months) on corneal refractive surgery and simultaneous CXL (PRK Xtra, LASIK Xtra, and SMILE Xtra) to evaluate the overall results including the safety, efficacy, and potential complications associated with these procedures. A comprehensive literature search of various electronic databases (PubMed, PubMed Central, Cochrane database, and MEDLINE) was performed up to 20th May 2020. Four relevant studies were found for PRK Xtra, 12 for LASIK Xtra, and 3 for SMILE Xtra. The total number of eyes included in this review was 1,512: 294 for PRK Xtra, 221 for PRK-only, 446 eyes for LASIK Xtra, 398 eyes for LASIK-only, 91 for SMILE Xtra and 62 for SMILE-only. Current literature suggests that refractive surgery and simultaneous CXL is generally safe and delivers comparable results in terms of visual and refractive outcomes than refractive surgery alone. However, there is no consensus on a standard cross-linking protocol, and complications such as diffuse lamellar keratitis, central toxic keratopathy, and corneal ectasia following Xtra procedures have been reported. It is therefore suggested that surgeons exercise caution in case-selection and counsel their patients regarding the potential risks and benefits with Xtra procedures. Also, further studies are required to standardize the UV-A irradiation protocols and to evaluate the long-term effect on safety, refractive predictability, and stability of these procedures.
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Affiliation(s)
- Sheetal Brar
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Megha Gautam
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Smith Snehal Sute
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sri Ganesh
- Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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12
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Gab-Alla AA. Is the axial length a risk factor for post-LASIK myopic regression? Graefes Arch Clin Exp Ophthalmol 2020; 259:777-786. [PMID: 33128672 PMCID: PMC7904712 DOI: 10.1007/s00417-020-04990-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the relationship between the axial length and post-LASIK regression in myopic patients. METHODS This is a retrospective case series study conducted at a private eye centre, Ismailia, Egypt. The clinical records of the patients, who experienced LASIK to correct myopia from January 2016 to January 2018, were analysed for myopic regression. The patients were operated on, examined, and followed-up 1 year by one surgeon (AAG). RESULTS This study included 1219 patients (2316 eyes) with myopia. Mean ± SD of pre-operative spherical equivalent (SE) was - 4.3 ± 2.1D, range (- 0.50 to - 10.0D). Mean ± SD age of the patients was 26.4 ± 6.8 years, range (21 to 50 years). Male to female ratio was 30.5 to 69.5%. The cumulative incidence rate of myopic regression according to the medical records of the patients was 25.12% (582 eyes out of total 2316 eyes) along the 2 years of this study (12.6% per year). Of the total patients, 14.94% had pre-operative high myopia, 35.84% had pre-operative moderate myopia, and 49.2% had pre-operative low myopia. Of the patients with myopic regression, 52.6% had pre-operative high myopia, 34% had pre-operative moderate myopia, and 13.4% had pre-operative low myopia. The mean ± SD of the axial length of the patients with myopic regression was 26.6 ± 0.44 mm, range (26.0 to 27.86 mm), while the mean ± SD of the axial length of other patients with stable refraction was 24.38 ± 0.73 mm, range (22.9 to 25.9 mm) (t test statistic = 69.3; P value < 0.001). CONCLUSIONS Pre-operative high axial length increases the risk of myopic regression after LASIK.
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Affiliation(s)
- Amr A Gab-Alla
- Faculty of Medicine, Ophthalmology Department, Suez Canal University, Ring Road, Ismailia, Egypt.
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13
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Lee MD, Chen LY, Tran EM, Manche EE. A Prospective Comparison of Wavefront-Guided LASIK versus Wavefront-Guided PRK After Previous Keratorefractive Surgery. Clin Ophthalmol 2020; 14:3411-3419. [PMID: 33116393 PMCID: PMC7585789 DOI: 10.2147/opth.s276381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/18/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the results of retreatment with wavefront-guided LASIK versus wavefront-guided PRK for residual refractive error following previous myopic keratorefractive surgery. Methods In this prospective study, 32 eyes of 28 patients after prior myopic keratorefractive surgery underwent retreatment with flap-lift wavefront-guided LASIK (n = 12) or wavefront-guided PRK (n = 20) for residual refractive error. Safety, efficacy, predictability, and wavefront outcomes were evaluated. Results At last follow-up, both LASIK and PRK retreatment resulted in similar improvement in visual acuity with respective mean ± standard deviation (SD) uncorrected distance visual acuity of −0.07 ± 0.11 logMAR and −0.06 ± 0.13 logMAR (p = 0.87). In the study, 16.7% of LASIK and 33.3% of PRK eyes gained one or more lines of best-corrected distance visual acuity (CDVA), while 16.7% and 9.5% of eyes lost one or more lines of CDVA with LASIK and PRK, respectively. One hundred % of LASIK eyes and 89.5% of PRK eyes were within ± 0.50 diopters of emmetropia. Wavefront analysis demonstrated similar reductions in total RMS error higher-order aberrations (p = 0.84) with no difference in coma, trefoil, or spherical aberration between eyes undergoing LASIK or PRK retreatment. Conclusion Wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery demonstrate similar safety, efficacy, and predictability with comparable wavefront outcomes.
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Affiliation(s)
- Michele D Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Lisa Y Chen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elaine M Tran
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Edward E Manche
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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14
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Lim L, Lim EWL, Rosman M, Koh JCW, Htoon HM. Three-Year Outcomes of Simultaneous Accelerated Corneal Crosslinking and Femto-LASIK for the Treatment of High Myopia in Asian Eyes. Clin Ophthalmol 2020; 14:2865-2872. [PMID: 33061271 PMCID: PMC7526743 DOI: 10.2147/opth.s260088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the long-term visual outcomes of simultaneous femtosecond laser-assisted laser in situ keratomileusis (femto-LASIK) and accelerated cross-linking (CXL) [LASIK Xtra] for the treatment of high myopia. Patients and Methods All 163 consecutive eyes of 85 patients who underwent LASIK Xtra for the treatment of high myopia and/or myopic astigmatism (spherical equivalent ≥ −6.00 D) in Singapore National Eye Centre from the years 2013 to 2017 were included in this retrospective case series. Post-operative follow-up was up to 3 years. Results Of the 163 eyes, 67 were followed up for 1 year (mean 12.9 months), 69 for 2 years (mean 24.0 months) and 43 for 3 years (mean 36.4 months). Overall mean follow-up was 22.8 months (9–46 months). The mean pre-operative spherical equivalent (SE) was −8.60 ± 1.47 D [range: −11.75 to −4.75] (n = 163) and mean attempted correction SE was −8.84 ± 1.41 D [range: −11.88 to −5.25]. Most eyes (>95%) maintained an uncorrected distance visual acuity of 6/12 or better over 3 years. Visual outcomes were predictable with ≥95% of eyes achieving a SE correction within ± 1D of attempted correction over 3 years. There was a mild regression in SE refraction over 3 years with a mean of −0.10 ± 0.45 D three years post-operatively (p = 0.03). The safety index was >1.05 at 3 years follow-up. There were no significant post-operative complications though 24 eyes had mild haze and 2 eyes had grade 1 diffuse lamellar keratitis that resolved within 1 month. Conclusion Our 3-year LASIK Xtra results show favorable safety, efficacy, predictability and stability outcomes in Asian patients with high myopia.
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Affiliation(s)
- Li Lim
- Singapore National Eye Centre, Singapore 168751, Singapore.,Singapore Eye Research Institute, Singapore 169856, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
| | - Elizabeth Wen Ling Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Mohamad Rosman
- Singapore National Eye Centre, Singapore 168751, Singapore.,Singapore Eye Research Institute, Singapore 169856, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
| | | | - Hla Myint Htoon
- Singapore National Eye Centre, Singapore 168751, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
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15
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Correlation and regression analysis between residual gradation and uncorrected visual acuity one year after refractive surgery with LASIK, FS-LASIK, PRK, PRK Xtra techniques and the implantation of ICL® posterior chamber phakic lens in myopic correction. PLoS One 2020; 15:e0238399. [PMID: 32915816 PMCID: PMC7485817 DOI: 10.1371/journal.pone.0238399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyze the influence of the final spherical equivalent (SE) in LogMAR uncorrected distance visual acuity (UDVA) one year after refractive surgery. We analysed refractive results, their predictability and efficacy, and the safety results of the different methods as secondary outcomes. Setting Refractive Surgery Unit of the Institut Català de Retina (ICR) in Barcelona, Spain. Design Retrospective, analytical observational study. Methods Retrospective and observational study of 654 eyes of 327 patients who underwent refractive surgery to treat their myopia or myopic astigmatism using LASIK, FS-LASIK, PRK, PRK Xtra or ICL-type lens implantation surgery were included. Results The correlation between the SE in absolute value was statistically significant in all techniques utilized, reaching higher values in the FS-LASIK and LASIK techniques, 0.774 and 0.706 respectively, and lesser values in PRK (0.480) and PRK Xtra (0.482). A significant adjustment via a univariate linear regression model could be implemented in all techniques, albeit the R2 coefficient of determination values were higher than those for the FS-LASIK (0.599) and LASIK (0.494) techniques. Conclusions There is a positive correlation between post-surgical SE value and post-operative LogMAR UDVA. These regression models can be adjusted to predict the final UDVA according to the final SE. The techniques that are most influenced by the final SE in terms of their visual results are FS-LASIK and LASIK.
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16
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Aghaei H, Es'haghi A. Contributing Factors in Final Refractive Outcomes After Re-treatment Procedures. J Refract Surg 2020; 36:419. [PMID: 32521031 DOI: 10.3928/1081597x-20200522-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Wu YTY, Ho A, Naduvilath T, Lim C, Carnt N, Keay LJ, Edwards KP, Stapleton F. The risk of vision loss in contact lens wear and following LASIK. Ophthalmic Physiol Opt 2020; 40:241-248. [PMID: 31916275 DOI: 10.1111/opo.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the risk of vision loss following contemporary laser-assisted in situ keratomileusis (LASIK) with different types and modality of use of contact lenses. METHODS Data from a previously published study were used to derive the incidence of vision loss (≥ 2 line loss of best corrected spectacle acuity) following microbial keratitis for different contact lens types and wearing modality, stratified by duration of lens wear. A literature search on vision loss following LASIK was performed between 2003 and 2019. The prevalence of vision loss at six months post-surgery was captured from clinical trials published after 2003. A proportion meta-analysis was applied to derive the prevalence of vision loss following LASIK. A least-squares fitting of cumulative vision loss (P, /10 000 wearers) over time (t, years) using an exponential model estimated the years of contact lens wear to which the risk of vision loss with LASIK was equivalent. RESULTS Vision loss following LASIK occurred in 66 (95% confidence interval [CI] 34-108) per 10 000 wearers. As a conservative estimate based on the lower confidence interval of the estimated equivalent years of contact lens wear, daily wear contact lenses and extended overnight silicone wear hydrogel contact lens need to be worn for 103 (95% [CI] 103-391) and 25 (95% [CI] 25-79) years respectively, to equal the rate of vision loss equivalent to a one-off LASIK procedure. CONCLUSIONS The risk of vision loss to the individual is low with either contact lens wear or refractive surgery. Contact lens wear does not pose a higher risk of vision loss than LASIK surgery for the most common wear modalities.
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Affiliation(s)
- Yvonne Tzu-Ying Wu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Arthur Ho
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Thomas Naduvilath
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Chris Lim
- National University Hospital, Singapore, Sydney, New South Wales, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Lisa J Keay
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Katie P Edwards
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia
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18
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Pokroy R, Mimouni M, Sela T, Munzer G, Kaiserman I. Predictors of myopic photorefractive keratectomy retreatment. J Cataract Refract Surg 2019; 43:825-832. [PMID: 28732618 DOI: 10.1016/j.jcrs.2017.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/02/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the factors associated with retreatment after photorefractive keratectomy (PRK) in myopic eyes. SETTING Care-Vision Laser Centers, Tel-Aviv, Israel. DESIGN Retrospective cohort study. METHODS A large database on myopic PRK with mitomycin-C (MMC) performed from 2005 to 2012 was studied. Patients were divided into 2 groups according to whether they had retreatment. Multiple preoperative and intraoperative parameters were analyzed for association with retreatment. RESULTS A total of 9699 eyes of 9699 consecutive patients were studied. The mean age was 25.9 years ± 7.3 (SD); 54.1% were men. The mean preoperative subjective spherical equivalent and astigmatism were -4.30 ± 2.18 diopters (D) (range -0.5 to -13.0 D) and 0.77 ± 0.83 D (range 0 to 6.0 D), respectively. Two hundred twenty-three eyes (2.30%) were retreated. The 2-year retreatment rate decreased from 42 (6.17%) for primary PRK treatments done in 2005 to 2 (0.10%) for primary PRK done in 2012 (R2 = 0.79, P < .001). Multiple binary logistic regression analysis showed that transepithelial PRK, astigmatism equal to or higher than 3.5 D, and surgeon factor significantly increased the odds of retreatment. Additional parameters significant on univariate analysis alone included age older than 40 years, low preoperative sphere, maximum ablation depth less than 45 μm, preoperative corrected distance visual acuity better than 20/20, MMC application longer than 40 seconds, and optical ablation zone smaller than 7.0 mm. CONCLUSION The retreatment incidence of PRK has continued to decrease. High astigmatism and transepithelial PRK were associated with increased myopic PRK retreatment rates.
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Affiliation(s)
- Russell Pokroy
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
| | - Michael Mimouni
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Tzahi Sela
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Gur Munzer
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Igor Kaiserman
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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19
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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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20
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Spadea L, Giovannetti F. Main Complications of Photorefractive Keratectomy and their Management. Clin Ophthalmol 2019; 13:2305-2315. [PMID: 31819355 PMCID: PMC6885542 DOI: 10.2147/opth.s233125] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 11/23/2022] Open
Abstract
Photorefractive keratectomy (PRK) was the first surface ablation procedure introduced for the treatment of refractive errors and has been proven to be effective and safe. In some cases, however, the patient may not be totally satisfied with the final result and retreatment may be necessary. We performed a literature review to describe the main conditions that may arise following PRK that may require retreatment and new promising techniques to allow customized and effective treatments for patients. There is currently no gold standard for retreatment of residual refractive error after PRK. The surgeon must take into account the patient's history and type of problem when choosing the most appropriate technique. LASIK and PRK are the main options. Haze can be treated with good results with phototherapeutic keratectomy and mytomicin C. High order aberrations and decentration may be addressed with topographically-guided excimer photoablation or with wavefront-guided PRK.
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Affiliation(s)
- Leopoldo Spadea
- Eye Clinic, Policlinico Umberto 1, Department of Sensory Organs, "La Sapienza" University of Rome, Rome, Italy
| | - Francesca Giovannetti
- Eye Clinic, Policlinico Umberto 1, Department of Sensory Organs, "La Sapienza" University of Rome, Rome, Italy
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21
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Bamashmus MA, Al-Akhlee HA, Al-Azani YA, Al-Kershy NA. Results of laser enhancement for residual myopia after primary laser in situ keratomileusis. Taiwan J Ophthalmol 2019; 10:264-268. [PMID: 33437599 PMCID: PMC7787091 DOI: 10.4103/tjo.tjo_32_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/14/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE: The purpose of the study is to evaluate and analyze the results and outcomes after laser enhancement for residual myopia after primary laser in situ keratomileusis (LASIK). MATERIALS AND METHODS: This retrospective interventional consecutive case series clinical study was performed on 112 consecutive eyes (82 patients) that had undergone primary LASIK before the enhancement procedure. The study was done in the Refractive Surgery Unit in Yemen Magrabi Hospital between 2006 and 2014. The retreatment was for residual myopia with or without astigmatism. Either the original flap was lifted or surface ablation was performed. Parameters evaluated were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (VA), spherical equivalent (SE) refraction, corneal topography, and pachymetry. Complications after laser enhancement were also evaluated. RESULTS: Mean age of the study group was 26.72 ± 6.89 years (range from 18 to 44 years). Males accounted for 37/82 (45.1%) and females for 45/82 (54.9%). The right eye was treated in 67/112 (59.8%) and the left eye in 45/112 (40.2%). Before primary LASIK, the mean SE (MSE) was −5.78 ± 1.89 D. Before enhancement, the MSE was −1.32 ± 0.61 D (range −3.25 D to −0.50 D), and none of the eyes had an UCVA of 20/40 or better. Twelve months after retreatment, the percentage of eyes having UCVA of 20/40 or better increased to 67.9% (76 of 112). There were no vision-threatening complications seen. CONCLUSION: Retreatment or enhancement after LASIK surgery by lifting the original flap or surface ablation is a safe and effective method for the treatment of regressed or undercorrected myopia. The risk of postoperative complications is very minimal.
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Affiliation(s)
- Mahfouth A Bamashmus
- Eye Department, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Refractive Surgery Unit, Magrabi Eye Hospital, Sana'a, Yemen
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22
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Abstract
PURPOSE To compare clinical outcomes of patients undergoing first re-treatment by flap relift with those re-treated by surface ablation on the flap after an initial myopic laser-assisted in situ keratomileusis (LASIK) procedure. METHODS This is a retrospective cohort analysis of consecutive patients who underwent myopic LASIK and required re-treatment between January 2007 and December 2016. Cases re-treated by flap relift were propensity score matched with cases re-treated by surface ablation, and clinical outcomes were compared. One eye from each patient was included. RESULTS A total of 1,234 out of 21,191 cases required re-treatment after myopic LASIK during the follow-up period. Surface ablation was performed in 75% of cases and relift in 25%. Patients re-treated by surface ablation were more commonly male (61.8% vs. 48.1%, P < 0.001), were younger (33.2 ± 7.8 vs. 35.2 ± 10 years, P = 0.005), and had thinner corneas (483 ± 46 vs. 502 ± 43 μm, P < 0.001). Propensity score matching was performed for 416 eyes (208 from each group). After matching, differences in baseline characteristics became nonsignificant (P > 0.05). Cases re-treated by surface ablation had a worse safety index (0.98 ± 0.12 vs. 1.02 ± 0.17, P = 0.049), yet better predictability (0.14 ± 0.6 vs. 0.35 ± 0.5 diopters of deviation, P = 0.009), a similar efficacy index (0.92 ± 0.2 vs. 0.93 ± 0.3, P = 0.814), higher rates of haze (5.8% vs. 0.5%, P = 0.002), and a lower risk for epithelial ingrowth (0.5% vs. 8.2%, P < 0.001). CONCLUSIONS Re-treatment after myopic LASIK with surface ablation resulted in worse safety and higher rates of haze, yet more predictable outcomes and reduced ingrowth rates, compared with re-treatment with flap relift.
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Lim EWL, Lim L. Review of Laser Vision Correction (LASIK, PRK and SMILE) with Simultaneous Accelerated Corneal Crosslinking - Long-term Results. Curr Eye Res 2019; 44:1171-1180. [PMID: 31411927 DOI: 10.1080/02713683.2019.1656749] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Laser in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE) are safe and effective refractive surgical procedures. However, complications include regression of treatment and iatrogenic keratectasia which can be severe and sight-threatening. In order to reduce these complications, simultaneous corneal cross-linking (CXL) is currently being added to these refractive procedures. This review analyses current long-term literature (≥ 1 year follow-up) on refractive surgery and simultaneous CXL (LASIK Xtra, PRK Xtra and SMILE Xtra) to determine its overall safety and efficacy.Methods: A comprehensive literature search of various electronic databases (PubMed, PubMed Central and MEDLINE) was performed up to 9th February 2019. Efficacy and safety indices are calculated where possible.Results: Ten relevant studies were found for LASIK Xtra, 4 for PRK Xtra and 1 for SMILE Xtra. The total number of eyes included in this review was 1,189: 347 eyes for LASIK Xtra, 300 eyes for LASIK-only, 298 for PRK Xtra, 204 for PRK-only, 40 for SMILE Xtra and none for SMILE-only. Current studies show that refractive surgery and simultaneous CXL produces comparable or better results in terms of refractive and keratometric stability than refractive surgery alone. However, case reports of complications such as corneal ectasia, diffuse lamellar keratitis and central toxic keratopathy have also recently been published.Conclusions: Simultaneous accelerated CXL and refractive surgery is effective for the treatment of myopia. However, it is as yet unclear if the additional CXL step reduces the incidence of iatrogenic keratectasia. Further long-term comparative studies would be useful in evaluating safety and efficacy of this procedure. More research should also be performed to titrate the UV-A irradiation settings for an optimal outcome.
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Affiliation(s)
| | - Li Lim
- Department of Corneal and External Eye Disease, Singapore National Eye Centre, Singapore.,Adjunct Clinical Investigator, Singapore Eye Research Institute, Singapore.,Adjunct Associate Professor, Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Masters J, Kocak M, Waite A. Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomileusis patients. J Cataract Refract Surg 2019; 43:67-73. [PMID: 28317680 DOI: 10.1016/j.jcrs.2016.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/07/2016] [Accepted: 10/25/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the risk for microbial keratitis in contact lens wearers stratified by wear schedule with the risk after laser in situ keratomileusis (LASIK). SETTING Hamilton Eye Institute and Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. DESIGN Comparative metaanalysis and literature review. METHODS An extensive literature search was performed in the PubMed database between December 2014 and July 2015. This was followed by a metaanalysis using a mixed-effects modeling approach. RESULTS After 1 year of daily soft contact lens wear, there were fewer microbial keratitis cases than after LASIK, or approximately 2 cases fewer cases per 10 000 (P = .0609). If LASIK were assumed to have essentially a 1-time risk for microbial keratitis, 5 years of extrapolation would yield 11 more cases per 10 000 with daily soft contact lens wear than with LASIK, or approximately 3 times as many cases (P < .0001). The extended use of soft contact lenses led to 12 more cases at 1 year than LASIK, or approximately 3 times as many cases (P < .0001), and 81 more cases at 5 years (P < .0001). When incorporating an estimated 10% retreatment rate for LASIK, these results changed very little. CONCLUSIONS Microbial keratitis is a relatively rare complication associated with contact lens use and LASIK postoperatively. The risk for microbial keratitis was similar between patients using contact lenses for 1 year compared with LASIK. Over time, the risk for microbial keratitis was higher for contact lens use than for LASIK, specifically with extended-wear lenses.
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Affiliation(s)
- Jordan Masters
- From the Department of Ophthalmology (Masters, Waite), Hamilton Eye Institute, and the Department of Preventive Medicine (Kocak), University of Tennessee Health Science Center, Memphis, Tennessee, USA.
| | - Mehmet Kocak
- From the Department of Ophthalmology (Masters, Waite), Hamilton Eye Institute, and the Department of Preventive Medicine (Kocak), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aaron Waite
- From the Department of Ophthalmology (Masters, Waite), Hamilton Eye Institute, and the Department of Preventive Medicine (Kocak), University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Siedlecki J, Siedlecki M, Luft N, Kook D, Meyer B, Bechmann M, Wiltfang R, Sekundo W, Priglinger SG, Dirisamer M. Surface Ablation Versus CIRCLE for Myopic Enhancement After SMILE: A Matched Comparative Study. J Refract Surg 2019; 35:294-300. [PMID: 31059578 DOI: 10.3928/1081597x-20190416-02] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the outcomes of enhancement after small incision lenticule extraction (SMILE) using surface ablation versus the VisuMax CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), which converts the SMILE cap into a femtosecond laser-assisted laser in situ keratomileusis flap. METHODS The databases of the SMILE Eyes centers in Munich, Marburg, and Cologne, Germany, and Linz, Austria, were screened for eyes that had undergone enhancement using surface ablation with mitomycin C or CIRCLE. Eyes from both enhancement methods suitable for a retrospective matched analysis were identified based on pre-SMILE and pre-enhancement mean refractive spherical equivalent (MRSE), astigmatism, age, and corrected and uncorrected distance visual acuity (CDVA/UDVA). Refractive and functional outcomes were compared after a follow-up of 3 months. RESULTS After the application of the matching criteria on 2,803 SMILE procedures, 24 eyes (12 in each group) with a follow-up of 3 months or longer were available for analysis. Enhancement was performed after a mean 9.7 ± 7.2 (surface ablation) and 11.0 ± 4.4 (CIRCLE) months for a residual MRSE of -0.91 ± 0.55 (surface ablation) and -0.90 ± 0.61 (CIRCLE) diopters. At 3 months, residual MRSE showed comparable accuracy with -0.07 ± 0.19 (surface ablation) and 0.04 ± 0.22 (CIRCLE) diopters (P = .18). UDVA improvement was similar to a final value of 0.02 ± 0.10 (surface ablation) versus 0.03 ± 0.07 (CIRCLE) logMAR (P = .78). Only one eye in the surface ablation group and no eye in the CIRCLE group lost one line of CDVA. At 3 months, the safety (surface ablation: 1.00, CIRCLE: 1.06; P = .36) and efficacy (surface ablation: 0.95, CIRCLE: 1.03; P = .36) indices were equivalent. In terms of speed of visual recovery, at week 1 UDVA and CDVA were significantly better after CIRCLE than surface ablation (P = .008 and .002, respectively). CONCLUSIONS In this first study directly comparing surface ablation versus CIRCLE enhancement after SMILE, both methods yielded comparable results at 3 months. However, CIRCLE re-treated eyes showed a markedly increased speed of recovery concerning UDVA and CDVA compared to surface ablation. [J Refract Surg. 2019;35(5):294-300.].
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Chua D, Htoon HM, Lim L, Chan CM, Mehta JS, Tan DTH, Rosman M. Eighteen-year prospective audit of LASIK outcomes for myopia in 53 731 eyes. Br J Ophthalmol 2018; 103:1228-1234. [PMID: 30355717 DOI: 10.1136/bjophthalmol-2018-312587] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/28/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND To assess the outcomes of laser-assisted in situ keratomileusis (LASIK) performed for the treatment of myopia in terms of safety, efficacy and predictability in an 18-year clinical audit. METHOD In this single-centre, prospective, non-randomised study, preoperative and postoperative refractions, uncorrected (UCVA), best-corrected Snellen visual acuity (BCVA) and complications of all eyes undergoing myopic LASIK were recorded. Safety, efficacy, refractive predictability, treatment trends, retreatment rates and complication rates were evaluated. RESULTS Between 1998 and 2015, 53 731 eyes of 27312 patients underwent myopic LASIK. Patients' median age was 31.6 years (mean, 32.6±7.3 years); there were 9703 males (35.5%). Patients were predominantly ethnic Chinese (87.4%). Mean follow-up time was 78±75.6 days (median, 86 days). Overall efficacy index was 0.91 with >99% of eyes achieving UCVA of ≥20/40 and >70% achieving 20/20 since 2010. 95.43% of eyes had no loss of vision postoperatively and 4.2% and 0.37% lost 1 and ≥2 lines BCVA, respectively. From 2010 the safety index has been >1.05. More than 94.0% of eyes achieved within ±1.0 D of target refraction and at least 70% achieved within ±0.50 D of target from 2010 onwards. Retreatment rate was 2.55% and after retreatment 98.4% of eyes achieved ≥20/40 UCVA and 63.5% achieved ≥20/20 UCVA. The overall complication rate is 0.98%, and since 2010, the annual complication rate has been <0.8%. CONCLUSIONS Myopic LASIK performed in Asian eyes is safe and effective with high refractive predictability in a comprehensive LASIK programme with appropriate clinical audit.
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Affiliation(s)
- Daniel Chua
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Hla Myint Htoon
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Li Lim
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Cordelia Ml Chan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore
| | - Mohamad Rosman
- Singapore National Eye Centre, Singapore, Singapore .,Singapore Eye Research Institute, Singapore, Singapore
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Myopic laser in situ keratomileusis retreatment: Incidence and associations. J Cataract Refract Surg 2018; 42:1408-1414. [PMID: 27839594 DOI: 10.1016/j.jcrs.2016.07.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the factors associated with retreatment after laser in situ keratomileusis (LASIK) for myopic eyes in the modern LASIK era. SETTING Care-Vision Laser Centers, Tel-Aviv, Israel. DESIGN Retrospective cohort study. METHODS All cases of myopic LASIK performed between January 2005 and December 2012 were analyzed according to whether they had retreatment refractive surgery. RESULT The study evaluated 9177 right eyes in 9177 consecutive LASIK cases. The mean preoperative subjective spherical equivalent and astigmatism were -3.30 diopters (D) ± 1.53 (SD) (range -0.50 to -12.00 D) and 0.69 ± 0.94 D (range 0.00 to 6.00 D), respectively. Of the eyes, 165 (1.80%) had at least 1 retreatment. Over the course of the study, the 2-year retreatment rate decreased from 2.58% to 0.38% (P < .001). Multiple binary logistic regression analysis showed that older age (odds ratio [OR], 1.03; P = .007), higher astigmatism (OR, 1.23; P = .008), sphere (OR, 1.15; P = .026), and mean keratometric power (OR, 1.13; P = .036) significantly increased the odds for retreatment. A larger optical zone ablation (7.0 mm) significantly decreased the odds for retreatment (OR, 0.10; P = .022). Significant cutoffs associated with retreatments were age greater than 50 years, astigmatism more than 1.5 D, and sphere more than 2.0 D. CONCLUSIONS Older age and higher preoperative astigmatism, sphere, and corneal steepness were associated with myopic LASIK retreatment. Larger optical ablation zones might decrease retreatment rates. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Naderi M, Sabour S, Khodakarim S, Daneshgar F. Studying the factors related to refractive error regression after PRK surgery. BMC Ophthalmol 2018; 18:198. [PMID: 30107828 PMCID: PMC6092795 DOI: 10.1186/s12886-018-0879-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/07/2018] [Indexed: 12/02/2022] Open
Abstract
Backgtound Photorefractive keratectomy (PRK) is used for a wide range of refractive errors such as low to moderate myopia, hyperopia and astigmatism. While many improvements have been made in laser application and accuracy as well as the modes of corneal flap removal, and although the results are somewhat predictable, regression of refractive errors is still a common complaint among the patients undergoing refractive surgery with Excimer Laser. We aimed to determine related factors of regression following photorefractive keratectomy (PRK) in different types of refractive errors. Methods This cross-sectional study included patients who had undergone PRK more than 6 months previously and investigated refractive error regression and related factors. The participants were those who had PRK eye surgery for the first time from 2013 to 2016 using Technolas 217z100. A refraction value of spherical equivalent > 0.75 D after cycloplegic refraction was defined as refractive error regression. Results A total of 293 eyes on 150 subjects were studied. The preoperative refractive error of the eyes were as follows: 5.5% were myopic, 1% were hyperopic, 4.8% had astigmatism, 76% had myopic astigmatism and 12.6% had hyperopic astigmatism. Regressed and non-regressed eyes were assessed using the generalized estimating equations for the probabilistic variables of demographic characteristics, topography and eye refraction. The variables of simulated keratometry astigmatism (simK) (OR = 2.8; p = 0.04), 5 mm irregularity (OR = 3.56; p = 0.01) and sphere value (OR = 1.98; p = 0.01) were significantly related to refractive error regression. There was no significant relationship between the regressed and non-regressed eyes of the same person (p ≥ 0.05). Conclusion There was a positive relationship between the increase of 5 mm irregularity, simK, sphere value before surgery and refractive error regression. Age, sex and type of refraction error of the patient and the expertise of the PRK surgeon could change the general results; therefore, not all cases should be dealt with identically.
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Affiliation(s)
- Mehdi Naderi
- Department of Clinical Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, I.R, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, I.R, Iran.
| | - Soheila Khodakarim
- Department of Clinical Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran, I.R, Iran
| | - Farid Daneshgar
- Department of Ophthalmology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mimouni M, Flores V, Sela T, Munzer G, Kaiserman I. Risk Factors for Re-treatment Following Hyperopic LASIK. J Refract Surg 2018; 34:316-320. [PMID: 29738587 DOI: 10.3928/1081597x-20180228-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/02/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the risk factors for re-treatment following LASIK in hyperopic eyes. METHODS In this retrospective study, consecutive hyperopic eyes underwent LASIK at the Care Vision Laser Centers, Tel-Aviv, Israel, between January 2000 and October 2014. Patients were divided into two groups according to whether or not they underwent additional refractive surgery (re-treatment). Logistic regression was performed to determine predictors of re-treatment. RESULTS Overall, 1,776 eyes of 888 patients were included, of which 82 (4.6%) needed re-treatment. Eyes that underwent re-treatment were of older age (49.1 ± 7.5 vs 46.9 ± 10.3 years, P = .01), had better preoperative CDVA (1.0 ± 0.14 vs 0.95 ± 0.15 decimal, P = .001), were treated more often with the Allegretto EX200 (Alcon Laboratories, Inc., Fort Worth, TX) as opposed to the EX-500 (90.2% vs 63.7%, P < .001), and were treated with a Moria M2-90 microkeratome (Moria S.A., Antony, France) as opposed to Moria SBK-90 (66.7% vs 36.4%, P < .001). Multiple logistic regresison analysis demonstrated that treatment with Allegretto EX200 (odds ratio: 2.67, P = .04), and Moria M2-90 microkeratome (odds ratio: 2.23, P = .04) and older age (odds ratio: 1.03, P = .03) were significant risk factors for re-treatment. CONCLUSIONS Factors associated with a higher risk of re-treatment following hyperopic LASIK include type of laser, type of microkeratome used, and older age. Identifying such factors may aid in reducing future retreatment rates in hyperopic LASIK. [J Refract Surg. 2018;34(5):316-320.].
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Siedlecki J, Luft N, Mayer WJ, Siedlecki M, Kook D, Meyer B, Bechmann M, Wiltfang R, Priglinger SG, Dirisamer M. CIRCLE Enhancement After Myopic SMILE. J Refract Surg 2018; 34:304-309. [PMID: 29738585 DOI: 10.3928/1081597x-20180308-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/21/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of enhancement after small incision lenticule extraction (SMILE) using the VisuMax CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), which converts the SMILE cap into a femtosecond LASIK flap for secondary excimer laser application. METHODS Of 2,065 SMILE procedures, 22 eyes (1.1%) re-treated with CIRCLE with a follow-up of 3 months were included in the analysis. SMILE was performed in the usual manner. For re-treatment, the CIRCLE procedure was performed with pattern D flap creation on the VisuMax system and subsequent excimer laser ablation with a Zeiss MEL 90 laser (Carl Zeiss Meditec) with plano target in all cases. RESULTS Spherical equivalent was -5.56 ± 2.22 diopters (D) before SMILE and -0.51 ± 1.08 D before CIRCLE. CIRCLE enhancement was performed after a mean of 10.0 ± 7.9 months, allowed for safe flap lifting in all eyes, and resulted in a final manifest refraction spherical equivalent of 0.18 ± 0.31 D at 3 months (P < .008). The number of eyes within 0.50 and 1.00 D from target refraction increased from 31.8% to 90.9% and from 77.3% to 100%, respectively. Mean uncorrected distance visual acuity (UDVA) had already improved from 0.37 ± 0.16 to 0.08 ± 0.16 logMAR at 1 week (P < .0001), resulting in 0.03 ± 0.07 logMAR at 3 months (P < .0001). All eyes gained at least one line of UDVA. Corrected distance visual acuity (CDVA) remained unchanged at all time points (before vs after CIRCLE, P = .40). Two eyes (9.1 %) lost one line of CDVA; no eye lost two or more lines. The safety and efficacy indices were 1.03 and 0.97 at 3 months. CONCLUSIONS The CIRCLE procedure represents an effective re-treatment option after SMILE. Compared to surface ablation re-treatment after SMILE, CIRCLE seems to offer advantages in respect to speed of visual recovery, safety, and predictability, but at the price of flap creation. [J Refract Surg. 2018;34(5):304-309.].
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Yan MK, Chang JS, Chan TC. Refractive regression after laser in situ keratomileusis. Clin Exp Ophthalmol 2018; 46:934-944. [PMID: 29700964 DOI: 10.1111/ceo.13315] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022]
Abstract
Uncorrected refractive errors are a leading cause of visual impairment across the world. In today's society, laser in situ keratomileusis (LASIK) has become the most commonly performed surgical procedure to correct refractive errors. However, regression of the initially achieved refractive correction has been a widely observed phenomenon following LASIK since its inception more than two decades ago. Despite technological advances in laser refractive surgery and various proposed management strategies, post-LASIK regression is still frequently observed and has significant implications for the long-term visual performance and quality of life of patients. This review explores the mechanism of refractive regression after both myopic and hyperopic LASIK, predisposing risk factors and its clinical course. In addition, current preventative strategies and therapies are also reviewed.
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Affiliation(s)
- Mabel K Yan
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - John Sm Chang
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Tommy Cy Chan
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Frings A, Intert E, Steinberg J, Druchkiv V, Linke SJ, Katz T. Outcomes of retreatment after hyperopic laser in situ keratomileusis. J Cataract Refract Surg 2017; 43:1436-1442. [PMID: 29223233 DOI: 10.1016/j.jcrs.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) retreatment in eyes with hyperopia. SETTING Multicenter refractive surgery centers and University Hospital, Germany. DESIGN Retrospective case series. METHODS This multicenter study included hyperopic patients with a preoperative difference between cycloplegic and manifest refraction of 1.00 diopter (D) or less who had LASIK retreatment based on manifest refraction. The refractive outcome was analyzed according to standard graphs for reporting the efficacy, predictability, and safety of refractive surgery. RESULTS One hundred thirteen eyes of 113 consecutive hyperopic patients were enrolled. Efficacy (P < .001) and safety (P = .004) were statistically significantly improved by retreatment without being negatively influenced by preoperative manifest spherical equivalent (SE), manifest cylinder, or keratometry. In cases still showing a trend toward undercorrection, retreatment resulted in 88 eyes (78.0%) being within ±0.50 D of the attempted correction. The optical zone (OZ) diameter of the retreatment did not correlate with efficacy, predictability, or safety. CONCLUSIONS Retreatment after hyperopic LASIK resulted in high efficacy, predictability, and safety outcomes. The efficacy and safety of the retreatment were not affected by preoperative manifest SE, manifest cylinder, keratometry, or OZ diameter.
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Affiliation(s)
- Andreas Frings
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany.
| | - Elisa Intert
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Johannes Steinberg
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Vasyl Druchkiv
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Stephan J Linke
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
| | - Toam Katz
- From the Department of Ophthalmology (Frings), Heinrich-Heine-University Düsseldorf, Düsseldorf, the Department of Ophthalmology (Intert, Steinberg, Druchkiv, Linke, Katz), University Medical Centre Hamburg-Eppendorf, zentrumsehstärke (Steinberg, Linke) Hamburg, and Care Vision (Steinberg, Druchkiv, Linke, Katz), Hamburg, Germany
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Alió Del Barrio JL, Vargas V, Al-Shymali O, Alió JL. Small incision lenticule extraction (SMILE) in the correction of myopic astigmatism: outcomes and limitations - an update. EYE AND VISION 2017; 4:26. [PMID: 29167808 PMCID: PMC5686829 DOI: 10.1186/s40662-017-0091-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/01/2017] [Indexed: 12/24/2022]
Abstract
Small Incision Lenticule Extraction (SMILE) is a flap-free intrastromal technique for the correction of myopia and myopic astigmatism. To date, this technique lacks automated centration and cyclotorsion control, so several concerns have been raised regarding its capability to correct moderate or high levels of astigmatism. The objective of this paper is to review the reported SMILE outcomes for the correction of myopic astigmatism associated with a cylinder over 0.75 D, and its comparison with the outcomes reported with the excimer laser-based corneal refractive surgery techniques. A total of five studies clearly reporting SMILE astigmatic outcomes were identified. SMILE shows acceptable outcomes for the correction of myopic astigmatism, although a general agreement exists about the superiority of the excimer laser-based techniques for low to moderate levels of astigmatism. Manual correction of the static cyclotorsion should be adopted for any SMILE astigmatic correction over 0.75 D.
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Affiliation(s)
- Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain.,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Verónica Vargas
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
| | - Olena Al-Shymali
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain.,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
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Siedlecki J, Luft N, Kook D, Wertheimer C, Mayer WJ, Bechmann M, Wiltfang R, Priglinger SG, Sekundo W, Dirisamer M. Enhancement After Myopic Small Incision Lenticule Extraction (SMILE) Using Surface Ablation. J Refract Surg 2017; 33:513-518. [DOI: 10.3928/1081597x-20170602-01] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
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Liu YC, Rosman M, Mehta JS. Enhancement after Small-Incision Lenticule Extraction: Incidence, Risk Factors, and Outcomes. Ophthalmology 2017; 124:813-821. [PMID: 28318639 DOI: 10.1016/j.ophtha.2017.01.053] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To report the incidence, risk factors, and outcomes of enhancement after small-incision lenticule extraction (SMILE). DESIGN Retrospective cohort study. PARTICIPANTS Five hundred twenty-four eyes of 307 patients who underwent SMILE at Singapore National Eye Center between February 2012 and March 2016. METHODS The data collected included patient age at primary SMILE, gender, race, preoperative and postoperative manifest refraction spherical equivalent (MRSE), preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity, the occurrence of suction loss during the procedure, and the need for enhancement. All enhancements were carried out by performing an alcohol-assisted photorefractive keratectomy (PRK) procedure with application of mitomycin C (MMC). MAIN OUTCOME MEASURES Incidence, prevalence, preoperative and intraoperative risk factors for enhancement, and outcomes after enhancement. RESULTS The prevalence of enhancement was 2.7%, and 71.4% eyes had enhancement within 1 year of primary SMILE. The incidence of enhancement was 2.1% and 2.9% at 1 and 2 years, respectively. Age older than 35 years, preoperative MRSE more than -6.00 diopters (D), preoperative myopia more than 6.00 D, preoperative astigmatism more than 3.00 D, and intraoperative suction loss were significant risk factors for enhancement after SMILE after adjusting for all other covariates (odds ratios, 5.58, 4.80, 1.41, 3.06, and 2.14, respectively; P = 0.004, 0.021, 0.022, 0.002, and 0.020, respectively). In the patients who underwent bilateral SMILE, the first-operated eye had a marginal trend toward significance for enhancement (P = 0.054). There was no gender or racial difference. In the 14 eyes requiring enhancement, the uncorrected distance visual acuity before enhancement ranged from 20/80 to 20/25, and the mean attempted enhancement spherical equivalent was -0.50±0.86 D. The uncorrected distance visual acuity improved in most patients (92.9%) after enhancement. CONCLUSIONS The 2-year incidence of enhancement after SMILE was 2.9%. Risk factors associated with enhancement included older age at SMILE procedure, greater preoperative MRSE, greater preoperative myopia, greater preoperative astigmatism, and the occurrence of intraoperative suction loss. Clinical outcomes of using PRK with application of MMC for enhancement were good.
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Affiliation(s)
- Yu-Chi Liu
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Singapore National Eye Center, Singapore, Republic of Singapore
| | - Mohamad Rosman
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Singapore National Eye Center, Singapore, Republic of Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Singapore National Eye Center, Singapore, Republic of Singapore; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Republic of Singapore; School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Republic of Singapore.
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Moshirfar M, Jehangir N, Fenzl CR, McCaughey M. LASIK Enhancement: Clinical and Surgical Management. J Refract Surg 2017; 33:116-127. [DOI: 10.3928/1081597x-20161202-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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Abstract
PURPOSE To determine the demographic and refractive characteristics of excimer laser refractive surgery candidates in Iran. METHODS This was a cross-sectional study between 2010 and 2014. All information was collected from 28 centers randomly selected from 12 provinces. Then, for each season of the year, one week was chosen through simple random selection, and within each week, 3 days were again chosen randomly. All excimer laser surgical procedures performed during these 3 days were identified by training staff, and data were extracted from patient charts. RESULTS A total of 14,569 charts were reviewed; 67.5% of the subjects were female and the rest were male. Of the total surgeries, 18.6% had been done in 2010 which reached to 19.1% in 2014. The mean age of people receiving refractive surgery showed an upward trend (P<0.001) and female patients were significantly younger than male patients (P<0.001). The 25 to 39 years age group received the highest number of surgeries (31.9% of the total) and there was a significant association with gender (P<0.001). The most common refractive error was compound myopic astigmatism with a prevalence of 79.3%. In 2010, 33.3% of the performed surgeries were covered by insurance policies, and this decreased to 30.2% in 2014 (P<0.001). CONCLUSION Women with compound myopic astigmatism in the age range of 25 and 35 years are the most frequent users of excimer laser refractive surgery. Less than one-third of laser refractive surgeries are covered by insurance policies. Therefore, proper planning for improving services to this group must be given priority.
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Iovieno A, Teichman JC, Low S, Yeung SN, Eve Lègarè M, Lichtinger AD, Slomovic AR, Rootman DS. Outcomes of photorefractive keratectomy following laser in situ keratomileusis: a cohort study. Can J Ophthalmol 2016; 51:417-422. [PMID: 27938951 DOI: 10.1016/j.jcjo.2016.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/25/2016] [Accepted: 02/28/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the outcomes of photorefractive keratectomy (PRK) on residual myopia and hyperopia post-laser in situ keratomileusis (LASIK) and to compare these results with PRK on eyes without previous laser refractive surgery. DESIGN Retrospective comparative cohort study. PARTICIPANTS Patients undergoing PRK between 2006 and 2010 were reviewed. METHODS Patients were divided into 4 groups, myopic or hyperopic PRK post-LASIK (mPRK-PL and hPRK-PL, respectively) and myopic or hyperopic PRK on corneas without previous laser refractive surgery (mPRK and hPRK, respectively). Uncorrected and corrected distance visual acuity, mean refractive spherical equivalent (MRSE), and mean keratometry and aberrations (total, higher order [HOA], coma, trefoil, and spherical aberration) were recorded at months 3 and 6 postoperatively, as were complications and attempted versus achieved MRSE. RESULTS Thirty-three eyes of 25 patients who underwent PRK post-LASIK (21 eyes of 14 patients for hPRK-PL and 12 eyes of 11 patients for mPRK-PL) and 35 eyes of 21 patients who underwent PRK on virgin eyes (11 eyes of 8 patients for hPRK and 24 eyes of 13 patients for mPRK) were included in the study. The only significant differences in outcomes were found to be HOA at 3 months for hPRK-PL as compared with both hPRK and mPRK. Achieved MRSE was significantly different from expected MRSE for hPRK-PL at 3 months postoperatively. No haze- or flap-related complications were observed. CONCLUSION Outcomes of PRK were not different in myopic and hyperopic corrections post-LASIK by 6 months or when compared with PRK in virgin eyes. HOA may render hPRK-PL results less predictable early in the postoperative period.
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Affiliation(s)
- Alfonso Iovieno
- Department of Ophthalmology, University Health Network, Toronto, Ont; Department of Ophthalmology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
| | - Joshua C Teichman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont; Division of Ophthalmology, Department of Surgery, Credit Valley Hospital, Trillium Health Partners, Missisauga, ON
| | - Stephanie Low
- Department of Ophthalmology, University Health Network, Toronto, Ont
| | - Sonia N Yeung
- Department of Ophthalmology, University Health Network, Toronto, Ont; Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C
| | - Marie Eve Lègarè
- Department of Ophthalmology, University Health Network, Toronto, Ont; Centre Universitaire d'Ophtalmologie, Hôpital St-Sacrement, Quebec City, Que
| | - Alejandro D Lichtinger
- Department of Ophthalmology, University Health Network, Toronto, Ont; Instituto de Ciencias Oftalmologicas, Hospital Angeles Lomas, Mexico City, Mexico
| | - Allan R Slomovic
- Department of Ophthalmology, University Health Network, Toronto, Ont
| | - David S Rootman
- Department of Ophthalmology, University Health Network, Toronto, Ont
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Abstract
PURPOSE To identify the potential risk factors that increase the likelihood of requiring retreatment after refractive surgery. METHODS This retrospective study included patients who underwent laser in situ keratomileusis or photorefractive keratectomy between January 2005 and December 2012 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into 2 groups according to whether they underwent additional refractive surgery (retreatment) during the study period. RESULTS Overall, 41,504 eyes (n = 21,313) were included in the final analysis of this study. Throughout the study period, there was a significant reduction in the 2-year annual retreatment rates with a decline from 4.52% for primary surgeries done in 2005 to 0.18% for surgeries performed in 2012 (quadratic R = 0.96, P < 0.001). The retreatment group had significantly higher preoperative age, maximum keratometric power, sphere, cylinder, and better best-corrected visual acuity. They were more likely to have preoperative hyperopia, photorefractive keratectomy as opposed to laser in situ keratomileusis, intraoperative higher humidity conditions and lower temperature, and higher ablation depths. Significant differences in retreatment rates were found between the 5 high-volume surgeons (>1500 procedures performed) ranging from 0.48 to 3.14% (P < 0.0001). Multiple logistic regression analysis demonstrated that age, astigmatism, hyperopia, temperature, and surgeon's experience all significantly affected the need for retreatment. CONCLUSIONS The following factors significantly increase the need for refractive retreatment: older preoperative age, higher degrees of astigmatism, hyperopia, colder operating room temperature, and less surgeon experience. Some of these factors may be incorporated into nomograms to reduce future retreatment rates.
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Hood CT, Shtein RM, Veldheer D, Hussain M, Niziol LM, Musch DC, Mian SI. The effect of humidity and temperature on visual outcomes after myopic corneal laser refractive surgery. Clin Ophthalmol 2016; 10:2231-2236. [PMID: 27853351 PMCID: PMC5104295 DOI: 10.2147/opth.s118503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To determine whether procedure room environmental conditions are associated with outcomes after myopic laser in situ keratomileusis (LASIK) or laser-assisted keratomileusis (LASEK). Design Retrospective chart review. Participants Eight hundred sixty-three eyes of 458 consecutive patients at a university-based academic practice. Methods We reviewed the medical records of consecutive patients who underwent LASIK or LASEK over a 3-year period. Linear mixed regression models were used to investigate the association of laser room temperature and humidity with the outcomes of visual acuity and postoperative manifest spherical equivalent refraction. Repeated measures logistic regression models were used for the outcomes of diffuse lamellar keratitis (DLK) and need for enhancement surgery. Results Subjects were on an average 38.6 years old at the time of surgery (standard deviation [SD] =10.3) and the average spherical equivalent refraction of eyes was 3.8 diopters (SD =2.03). Regression models did not reveal a significant association between temperature and uncorrected distance visual acuity (UDVA) or corrected distance visual acuity (CDVA), or between humidity and UDVA (P>0.05 for all). However, increased humidity was associated with a small but statistically significant improvement in CDVA after LASIK at 1 day, 1 month, 3 months, and 1 year postoperatively (P<0.05 for all). There was no significant association between temperature and humidity and the need for enhancement, the incidence of DLK, or postoperative manifest refraction. Conclusion While increased laser room humidity was consistently associated with small improvements in CDVA after myopic LASIK over time, variations in room temperature and humidity were not associated with UDVA, the need for enhancement, the incidence of DLK, or refraction after myopic LASIK or LASEK.
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Affiliation(s)
- Christopher T Hood
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI
| | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI
| | - Daniel Veldheer
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Munira Hussain
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI; Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI
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Seven I, Vahdati A, De Stefano VS, Krueger RR, Dupps WJ. Comparison of Patient-Specific Computational Modeling Predictions and Clinical Outcomes of LASIK for Myopia. Invest Ophthalmol Vis Sci 2016; 57:6287-6297. [PMID: 27893094 PMCID: PMC5119490 DOI: 10.1167/iovs.16-19948] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/10/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the predictive accuracy of simulation-based LASIK outcomes. Methods Preoperative and 3-month post-LASIK tomographic data from 20 eyes of 12 patients who underwent wavefront-optimized LASIK for myopia were obtained retrospectively. Patient-specific finite element models were created and case-specific treatment settings were simulated. Simulated keratometry (SimK) values and the mean tangential curvature of the central 3 mm (Kmean) were obtained from the anterior surfaces of the clinical tomographies, and computational models were compared. Correlations between Kmean prediction error and patient age, preoperative corneal hysteresis (CH), and corneal resistance factor (CRF) were assessed. Results The mean difference for Kmean between simulated and actual post-LASIK cases was not statistically significant (-0.13 ± 0.36 diopters [D], P = 0.1). The mean difference between the surgically induced clinical change in Kmean and the model-predicted change was -0.11 ± 0.34 D (P = 0.2). Kmean prediction error was correlated to CH, CRF, and patient age (r = 0.63, 0.53, and 0.5, respectively, P < 0.02), and incorporation of CH values into predictions as a linear offset increased their accuracy. Simulated changes in Kmean accounted for 97% of the variance in actual spherical equivalent refractive change. Conclusions Clinically feasible computational simulations predicted corneal curvature and manifest refraction outcomes with a level of accuracy in myopic LASIK cases that approached the limits of measurement error. Readily available preoperative biomechanical measures enhanced simulation accuracy. Patient-specific simulation may be a useful tool for clinical guidance in de novo LASIK cases.
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Affiliation(s)
- Ibrahim Seven
- Ocular Biomechanics and Imaging Lab, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Ali Vahdati
- Ocular Biomechanics and Imaging Lab, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | | | - Ronald R. Krueger
- Refractive Surgery Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - William J. Dupps
- Ocular Biomechanics and Imaging Lab, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
- Refractive Surgery Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Schallhorn SC, Venter JA, Hannan SJ, Hettinger KA, Teenan D. Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes. J Cataract Refract Surg 2016; 41:2501-12. [PMID: 26703501 DOI: 10.1016/j.jcrs.2015.05.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/03/2015] [Accepted: 05/16/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze results of wavefront-guided laser vision correction retreatments performed either by lifting the original flap or by surface ablation over the flap. SETTING Optical Express, Glasgow, United Kingdom. DESIGN Retrospective case series. METHODS This retrospective study included patients grouped according to whether they had flap lift enhancement or photorefractive keratectomy (PRK) performed over the LASIK flap. All retreatment procedures were performed with the Visx Star S4 IR excimer laser with wavefront-guided ablation profile derived from the iDesign aberrometer. Visual acuities, refractive outcomes, vector analysis of refractive cylinder and complications were analyzed in this study. The results of the last available clinical visit are presented. RESULTS This retrospective study included 290 eyes of 202 patients divided into 2 groups: 119 eyes that had flap lift enhancement (Group A), and 171 eyes in which photorefractive keratectomy (PRK) was performed over the LASIK flap (Group B). The mean follow-up was 4.0 ± 1.9 months in Group A and 4.2 ± 1.6 in Group B. The mean postoperative manifest spherical equivalent was -0.01 ± 0.35 D and +0.06 ± 0.39 D in Groups A and B, respectively. The percentage of eyes with postenhancement UDVA 20/20 or better was 87.4% in Group A and 79.5 % in Group B (P = .09). In Group A, 22 eyes (18.5%) developed epithelial ingrowth, of which surgical intervention was required in 2 eyes (1.7%). Grade 1 or less haze was noted in 9 (5.3%) eyes in Group B, and resolved in all cases within the first 6 postoperative months. CONCLUSION Both retreatment techniques were considered to be effective, predictable, and safe. FINANCIAL DISCLOSURE Steven C Schallhorn MD is a consultant to Abbott Medical Optics and Zeiss, and Global Medical Director for Optical Express. None of the other authors have a financial or proprietary interest in the products and materials presented in this paper.
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Affiliation(s)
- Steven C Schallhorn
- From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom.
| | - Jan A Venter
- From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom
| | - Stephen J Hannan
- From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom
| | - Keith A Hettinger
- From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom
| | - David Teenan
- From the Department of Opthalmology, University of California, San Francisco (Schallhorn), San Francisco, California, USA; Optical Express (Schallhorn, Venter, Hannan, Hettinger, Teenan), Glasgow, United Kingdom
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Chen X, Stojanovic A, Simonsen D, Wang X, Liu Y, Utheim TP. Topography-Guided Transepithelial Surface Ablation in the Treatment of Moderate to High Astigmatism. J Refract Surg 2016; 32:418-25. [PMID: 27304606 DOI: 10.3928/1081597x-20160428-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the outcomes of treatment of astigmatism of 2.00 diopters (D) or greater with topography-guided transepithelial surface ablation. METHODS Retrospective analysis of a series of 206 eyes divided into two groups: myopic astigmatism (153 eyes) and mixed astigmatism (53 eyes). All cases were treated with topography-guided transepithelial surface ablation. Efficacy, safety, and predictability were evaluated, and vector analysis of cylindrical correction was performed. RESULTS The median preoperative spherical equivalent was -2.63 and -0.63 D for the myopic and mixed astigmatism groups, respectively, with median cylinder of -2.50 D. Postoperative uncorrected distance visual acuity was 20/20 or better in 92% and 83% of eyes in the myopic and mixed astigmatism groups, respectively; the corresponding efficacy indices were 1.00 and 0.96 and residual astigmatism of 0.50 D or less was present in 82.4% and 56.7% of eyes in the myopic and mixed astigmatism groups, respectively. The arithmetic mean magnitude of the difference vector was 0.38 (myopic) and 0.65 (mixed) D. Difference vector magnitude was positively correlated with the magnitude of target induced astigmatism in both groups. The geometric mean coefficient of adjustment index was 1.04 and 1.19, representing undercorrection of 4% and 19% in the myopic and mixed astigmatism groups, respectively. CONCLUSIONS Topography-guided transepithelial ablation is a safe, effective, and predictable treatment for moderate to high astigmatism. [J Refract Surg. 2016;32(6):418-425.].
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Kruh JN, Garrett KA, Huntington B, Robinson S, Melki SA. Risk Factors for Retreatment Following Myopic LASIK with Femtosecond Laser and Custom Ablation for the Treatment of Myopia. Semin Ophthalmol 2016; 32:316-320. [DOI: 10.3109/08820538.2015.1088552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jonathan N. Kruh
- Boston Eye Group, Boston, MA, USA
- Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Kenneth A. Garrett
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Brian Huntington
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Steve Robinson
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Samir A. Melki
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
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Broderick KM, Sia RK, Ryan DS, Stutzman RD, Mines MJ, Frazier TC, Torres MF, Bower KS. Wavefront-optimized surface retreatments of refractive error following previous laser refractive surgery: a retrospective study. EYE AND VISION 2016; 3:3. [PMID: 26870742 PMCID: PMC4750286 DOI: 10.1186/s40662-016-0034-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022]
Abstract
Background Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery. Many different combinations of primary treatment methods and retreatment techniques have been studied, however, few studies have investigated wavefront-optimized (WFO) technology for retreatment following primary refractive surgery. This study aimed to report the outcomes of WFO photorefractive keratectomy (PRK) retreatments of refractive error following previous laser refractive surgery with PRK, laser in situ keratomileusis (LASIK), or laser-assisted subepithelial keratectomy (LASEK). Methods We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System (Alcon Surgical) between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center. Outcomes were recorded in terms of uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), corrected distance visual acuity (CDVA), and complications at 1 month (M), 3 M, and 6 M post-op. Results Seventy-eight patients (120 eyes) underwent WFO PRK retreatment during the study period. Primary surgery was surface ablation in 87 eyes (78 PRK, 9 LASEK) and LASIK in 33 eyes. The mean spherical equivalent before retreatment was −0.79 ± 0.94 D (−3.00 to 1.88 D). UDVA was ≥ 20/20 in 69 eyes (60.0 %) at 1 M, 54 eyes (71.1 %) at 3 M, and 27 eyes (73.0 %) at 6 M follow-up. MRSE was within ±0.50 D of emmetropia in 78 eyes (67.8 %) at 1 M, 59 eyes (77.6 %) at 3 M, and 25 eyes (67.6 %) at 6 M follow-up. CDVA was maintained within ±1 line of pre-op in 113 of 115 eyes (98.3 %) at 1 M, 74 of 76 eyes (97.4 %) at 3 M, and 37 eyes (100 %) at 6 M follow-up. Conclusion Although follow-up was limited beyond 3 M, WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure. Further studies are necessary to determine the long-term safety and stability of outcomes.
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Affiliation(s)
- Kevin M Broderick
- Ophthalmology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center, Ft. Belvoir, VA USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Ft. Belvoir, VA USA
| | - Richard D Stutzman
- Ophthalmology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Michael J Mines
- Ophthalmology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Travis C Frazier
- Ophthalmology Service, Madigan Army Medical Center, Tacoma, WA USA
| | - Mark F Torres
- Ophthalmology Service, Madigan Army Medical Center, Tacoma, WA USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA
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Rajpal RK, Wisecarver CB, Williams D, Rajpal SD, Kerzner R, Nianiaris N, Lytle G, Hoang K. Lasik Xtra ® Provides Corneal Stability and Improved Outcomes. Ophthalmol Ther 2015; 4:10.1007/s40123-015-0039-x. [PMID: 26499330 PMCID: PMC4675731 DOI: 10.1007/s40123-015-0039-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 11/28/2022] Open
Abstract
A new procedure which combines LASIK and corneal cross-linking (Lasik Xtra®) has been proposed as an alternative to traditional LASIK. It is aimed at restoring strength to the cornea, increasing stability in visual outcomes, increasing the accuracy of the refractive correction, and potentially lowering enhancement rates. This article reviews the current clinical evidence which has been published on the topic and reviews both the safety and efficacy argument for the procedure.
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Affiliation(s)
- Rajesh K Rajpal
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA.
| | | | - Dawn Williams
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA
| | - Sachin D Rajpal
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA
| | | | | | | | - Khoa Hoang
- See Clearly Vision Group, 8138 Watson Street, Mclean, VA, USA
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Mohammadi SF, Nabovati P, Mirzajani A, Ashrafi E, Vakilian B. Risk factors of regression and undercorrection in photorefractive keratectomy: a case-control study. Int J Ophthalmol 2015; 8:933-7. [PMID: 26558204 DOI: 10.3980/j.issn.2222-3959.2015.05.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/30/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To determine risk factors of regression and undercorrection following photorefractive keratectomy (PRK) in myopia or myopic astigmatism. METHODS A case-control study was designed in which eyes with an indication for re-treatment (RT) were defined as cases; primary criteria for RT indication, as assessed at least 9mo postoperatively, included an uncorrected distance visual acuity (UDVA) of 20/30 or worse and a stable refraction for more than 3mo. Additional considerations included optical quality symptoms and significant higher order aberrations (HOAs). Controls were chosen from the same cohort of operated eyes which had complete post-operative follow up data beyond 9mo and did not need RT. The cohort included patients who had undergone PRK by the Tissue-Saving (TS) ablation profile of Technolas 217z100 excimer laser (Bausch & Lomb, Rochester, NY, USA). Mitomycin C had been used in all of the primary procedures. RESULTS We had 70 case eyes and 158 control eyes, and they were comparable in terms of age, sex and follow-up time (P values: 0.58, 1.00 and 0.89, respectively). Pre-operative spherical equivalent of more than -5.00 diopter (D), intended optical zone (OZ) diameter of less than 6.00 mm and ocular fixation instability during laser ablation were associated with RT indications (all P values <0.001). These factors maintained their significance in the multiple logistic regression model with odd ratios of 6.12, 6.71 and 7.89, respectively. CONCLUSION Higher refractive correction (>-5.00 D), smaller OZ (<6.00 mm) and unstable fixation during laser ablation of PRK for myopia and myopic astigmatism were found to be strong predictors of undercorrection and regression.
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Affiliation(s)
- Seyed-Farzad Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Payam Nabovati
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran ; Department of Optometry, School of Rehabilitation, Iran University of Medical Sciences, Tehran 1676666431, Iran
| | - Ali Mirzajani
- Department of Optometry, School of Rehabilitation, Iran University of Medical Sciences, Tehran 1676666431, Iran
| | - Elham Ashrafi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Banafsheh Vakilian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Schallhorn SC, Venter JA, Hannan SJ, Hettinger KA. Clinical outcomes of wavefront-guided laser in situ keratomileusis to treat moderate-to-high astigmatism. Clin Ophthalmol 2015. [PMID: 26203219 PMCID: PMC4508064 DOI: 10.2147/opth.s87887] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the refractive and visual outcomes of wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopic astigmatism and cylindrical component ≥2.0 diopter (D). METHODS In this retrospective study, 611 eyes that underwent LASIK for simple or compound myopic astigmatism were analyzed. Preoperative refractive cylinder ranged from -2.00 D to -6.00 D (mean -2.76±0.81 D), and the sphere was between 0.00 D and -9.75 D (mean -2.79±2.32 D). Predictability, visual outcomes, and vector analysis of changes in refractive astigmatism were evaluated. RESULTS At 3 months after LASIK, 83.8% of eyes had uncorrected distance visual acuity of 20/20 or better, 90.3% had manifest spherical equivalent within ±0.50 D, and 79.1% had residual refractive cylinder within ±0.50 D of intended correction. The mean correction ratio for refractive cylinder was 0.92±0.14, the mean error of angle was -0.45°±2.99°, and the mean error vector was 0.37±0.38 D. A statistically significant correlation was found between the error of magnitude (arithmetic difference in the magnitudes between surgically induced refractive correction and intended refractive correction) and the intended refractive correction (r=0.26, P<0.01). CONCLUSION Wavefront-guided LASIK for the correction of myopic astigmatism is safe, effective, and predictable.
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Affiliation(s)
- Steven C Schallhorn
- University of California, San Francisco, CA, USA ; Optical Express, Glasgow, UK
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