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Einollahi B, Rezaei J, Sadoughi MM, Feizi S, Einollahi N, Veisi AR, Hassanpour K. Femtosecond thin-flap laser assisted in situ keratomileusis for correction of post-penetrating keratoplasty ametropia: long-term outcome. BMC Ophthalmol 2024; 24:174. [PMID: 38627647 PMCID: PMC11020473 DOI: 10.1186/s12886-024-03428-3] [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: 01/25/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To evaluate the long-term clinical outcomes of femtosecond thin-flap LASIK (femto-LASIK) for correction of refractive error after penetrating keratoplasty in keratoconus-affected eyes. SETTING a private ophthalmology clinic. DESIGN Prospective interventional case series. METHODS This prospective interventional case series enrolled 22 eyes of 22 patients who underwent femto-LASIK for the management of post-penetrating keratoplasty ametropia. The refractive error, uncorrected (UDVA), and corrected (CDVA) distance visual acuities and vector analysis were reported in short-term and long-term period after surgery. RESULTS The mean age was 32.7 ± 7.5 years (range, 23 to 47 years) at the surgery time. The average time between PK and femto-LASIK was 42.5 ± 31.7 months. The average follow-up duration after femto-LASIK was 81.2 ± 18.6 months. The mean preoperative UDVA significantly improved from 0.47 ± 0.15 logMAR to 0.35 ± 0.14 logMAR at 12 months (P = 0.048) and 0.4 ± 0.17 at final follow-up exam (P = 0.007). CDVA was 0.22 ± 0.1 at baseline which improved to 0.18 ± 0.15 and 0.15 ± 0.1 logMAR at 12 and 81 months, respectively. (Ps = 0.027, 0.014). The mean cylinder before surgery was - 5.04 ± 1.4D which significantly decreased to -1.5 ± 0.8 D at 12 months postoperatively. (P < 0.001). There was a significant increase in refractive astigmatism from 12 months to 81 months postoperatively (-3.1 ± 2.0, P = 0.002). At the final visit, the efficacy index was 0.83, and the safety index was 1.16. CONCLUSIONS Despite the short-term outcome indicated that femo-LASIK was effective for correction of post-keratoplasty ametropia during short-term period, a notable regression in its effect was observed in the long-term follow-up. Therefore, the predictability of this technique might decrease in the long-term.
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Affiliation(s)
- Bahram Einollahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Javad Rezaei
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran.
| | - Mohammad-Mehdi Sadoughi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Neda Einollahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Amir Reza Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, 23rd PaidarFard St., Boostan 9, Pasdaran Ave, Tehran, 16666, Iran
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Alfonso-Bartolozzi B, Lisa C, Fernández-Vega-Cueto L, Madrid-Costa D, Alfonso JF. Femto-LASIK after Deep Anterior Lamellar Keratoplasty to Correct Residual Astigmatism: A Long-Term Case Series Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081036. [PMID: 36013505 PMCID: PMC9412627 DOI: 10.3390/medicina58081036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
Purpose: To evaluate the long-term outcomes of femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) to correct residual astigmatism after deep anterior lamellar keratoplasty (DALK). Methods: This retrospective case series study included 10 eyes that underwent Femto-LASIK after a DALK. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, thinnest corneal thickness (TCT), and central corneal thickness (CCT) were registered. The postoperative follow-up ranged between 36 and 60 months. Results: All surgeries were uneventful, with no intra- or postoperative complications. The mean UDVA (Snellen scale) rose from 0.13 ± 0.05 to 0.47 ± 0.15 six months after Femto-LASIK (p < 0.001). All cases experienced a significant improvement in UDVA. None of the eyes lost lines of CDVA, and seven eyes (70%) improved the CDVA compared to preoperative values. The refractive cylinder changed from a preoperative value of −3.88 ± 1.00 D to −0.93 ± 0.39 six months after Femto-LASIK (p < 0.0001). In eight eyes (80%), the UDVA and refractive outcomes remained stable at postoperative follow-up visits. In contrast, one eye experienced a refractive regression over the follow-up. TCT and CCT were stable at the different postoperative follow-up visits. Conclusions: Our findings suggest that Femto-LASIK might safely and effectively corrects residual astigmatism after DALK. Despite these encouraging results, further long-term studies, including a larger number of cases, are required to confirm the safety of the procedure. The refractive stability in eyes with prior RK might be lower than for other DALK indications.
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Affiliation(s)
| | - Carlos Lisa
- Fernández-Vega Ophthalmological Institute, 33012 Oviedo, Spain; (B.A.-B.); (C.L.); (L.F.-V.-C.)
| | | | - David Madrid-Costa
- Clinical and Experimental Eye Research Group (CEER), Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain;
| | - José F. Alfonso
- Fernández-Vega Ophthalmological Institute, 33012 Oviedo, Spain; (B.A.-B.); (C.L.); (L.F.-V.-C.)
- Correspondence:
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Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes. J Clin Med 2022; 11:jcm11144221. [PMID: 35887985 PMCID: PMC9316233 DOI: 10.3390/jcm11144221] [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: 05/16/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was −9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to −5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty.
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Donoso R, Díaz C, Villavicencio P. [Long-term results of lasik refractive error correction after penetrating keratoplasty in patients with keratoconus]. ACTA ACUST UNITED AC 2015; 90:308-11. [PMID: 25817948 DOI: 10.1016/j.oftal.2014.11.009] [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: 12/17/2012] [Revised: 10/10/2014] [Accepted: 11/03/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the long term results of Lasik for residual refractive errors (RE) after penetrating keratoplasty (PKP) for keratoconus (KC). DESIGN Retrospective cohort. METHOD Records of 14 consecutive patients (19 eyes) who had Lasik after PKP for KC were retrospectively reviewed. In all eyes with refractive stability and suture removed before Lasik, far distance Visual Acuity with (AVCC) and without correction (AVSC), spherical equivalent (EE), refractive (Ast) and keratometric (dK) astigmatism were analyzed pre- and post-operatively before and after one year of follow up. Data were analyzed using Shapiro-Wilk normality test, Student t test and Mann-Whitney test. A P-value of <0,05 was considered statistically significant. RESULTS The mean follow-up time was 3.16 months for the follow-up before one year postoperative and 5.8 years for the follow-up after one year postoperative. The best spectacle corrected visual acuity of 0,11 LogMAR (DE 0,07) before Lasik remained stable throughout the study. The SE decreased from -2.6 (DE 3.53) to -0,36 D (DE 1.33) (P<.05) for the follow-up before one year postoperative and -1.28 D (DE 1.63) (P=.07) for the follow-up after one year postop. The refractive cylinder was reduced from -3.43 (DE 1.35) preoperative to -1.37 D (DE 1.24) (P<.05) and -3.21 D (DE 2.29) (P=.36) in the long term after one year of follow-up. CONCLUSIONS Lasik refractive results regress one year after the operation; therefore it is not an effective long-term surgical refractive procedure for residual refractive errors after PKP for KC.
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Affiliation(s)
- R Donoso
- Clínica Oftalmológica Pasteur, Servicio de Oftalmología, Hospital del Salvador, Universidad de Chile, Santiago, Chile.
| | - C Díaz
- Clínica Oftalmológica Pasteur, Servicio de Oftalmología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - P Villavicencio
- Clínica Oftalmológica Pasteur, Servicio de Oftalmología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
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New combined technique of deep intrastromal arcuate keratotomy overlayed by LASIK flap for treatment of high astigmatism. Cornea 2014; 33:1123-8. [PMID: 25127189 DOI: 10.1097/ico.0000000000000236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to describe a novel technique combining deep intrastromal arcuate keratotomy and superficial lamellar keratotomy followed by excimer photoablation for the management of high naturally occurring or postkeratoplasty astigmatism. METHODS In this retrospective case series, the first step was deep intrastromal arcuate keratotomy and superficial lamellar keratotomy performed at 100-μm depth by femtosecond laser. Manual incisions were made for flap elevation. The second step, after 1 month, consisted of reopening the flap and using an excimer laser to correct residual ametropia. RESULTS Nine eyes series were studied. The mean preoperative refractive cylinder correction was 6.11 ± 2.54 diopters (D). The mean postoperative refractive cylinder correction was 2.85 ± 1.31 D. The mean correction index was 1.07 ± 0.28 D. The mean best-corrected visual acuity improved from 20/40 to 20/22 after the 2 steps. The median follow-up was 11 (range, 9-17) months. No complications were observed and postoperative outcome was satisfactory. CONCLUSIONS Permitting correction of a broader range of high astigmatism with good accuracy, this combined approach minimizes excision of corneal stromal tissue and postoperative complications.
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Tomita M, Huseynova T. Evaluating the short-term results of KAMRA inlay implantation using real-time optical coherence tomography-guided femtosecond laser technology. J Refract Surg 2014; 30:326-9. [PMID: 24893357 DOI: 10.3928/1081597x-20140416-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the outcomes from using real-time optical coherence tomography (OCT)-guided femtosecond laser technology for pocket creation for KAMRA inlay (Acufocus, Inc., Irvine, CA) implantation surgery. METHODS One hundred fifty-one eyes underwent KAMRA inlay implantation using the real-time OCT-guided femtosecond laser for pocket creation. All patients had a history of prior LASIK. Uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, corrected near visual acuity, and manifest refraction spherical equivalent were evaluated preoperatively and postoperatively. The follow-up period was 3 months. RESULTS Mean manifest refraction spherical equivalent, uncorrected distance visual acuity, and uncorrected near visual acuity changed from -0.18 ± 0.33 to -0.95 ± 0.64, 20/16 to 20/20, and J8 to J2, respectively. Corrected distance visual acuity and corrected near visual acuity remained stable before and after KAMRA inlay implantation, 20/12 and J1, respectively. CONCLUSIONS Using real-time OCT-guided femtosecond laser technology increases the safety and accuracy of corneal KAMRA inlay implantation surgery with a history of prior LASIK with excellent visual and refractive outcomes.
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Ghoreishi M, Naderi Beni A, Naderi Beni Z. Visual outcomes of Femto-LASIK for correction of residual refractive error after corneal graft. Graefes Arch Clin Exp Ophthalmol 2013; 251:2601-8. [PMID: 24068438 DOI: 10.1007/s00417-013-2458-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/08/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the outcomes of the Femto-LASIK method in the treatment of refractive errors following penetrating keratoplasty (PK) at the Persian Eye Clinic, Isfahan, Iran METHODS In a prospective, non-comparative case series, 34 consecutive symptomatic eyes of 34 patients after corneal graft, were operated on. Tissue-saving (TS) Femto-LASIK (n = 16), and Zyoptix Personalized Treatment Advanced (PTA) Femto-LASIK (n = 18) were performed using the Bausch & Lomb Technolas 217z excimer laser and Zyoptic algorithm. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, contrast sensitivity, and HOAs were evaluated preoperatively and 12 months after enhancement treatment. RESULTS At 12 months, the mean preoperative myopic spherical equivalent refraction (SE) decreased from -6.50 ± 2.8 D to -1.6 ± 1.8 D, and mean hyperopic SE from +3.2 ± 2.20 D to 0.37 ± 1.2 D. The safety index was 1.42 (1.2 in the TS group and 1.5 in the PTA group). In the TS group, 100% of eyes achieved 20/80 or better UCVA and 50%, 20/40 or better and in the PTA group, 100% of eyes achieved 20/80 or better UCVA and 77.7%, 20/40 or better. The efficacy index was 1.08 (0.9 in TS group and 1.21 in the PTA group). Patients obtained statistically significant lower values of root mean square (RMS) of HOAs with spherical aberrations (p < 0.05). CONCLUSIONS Femto-LASIK method with Zyoptic programs after PK was safe, effective, and predictable for correction of spherical and cylindrical components of the refractive error.
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Femtosecond laser refractive surgery after descemet stripping-automated endothelial keratoplasty. Case Rep Ophthalmol Med 2012; 2012:190953. [PMID: 22606487 PMCID: PMC3350082 DOI: 10.1155/2012/190953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/19/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose. To report the use of femtosecond laser-assisted in situ keratomileusis (LASIK) in the treatment of hyperopia subsequent to Descemet stripping-automated endothelial keratoplasty (DSAEK). Methods. Interventional case report. Results. A 66-year-old woman with Fuchs endothelial dystrophy developed bullous keratopathy after cataract surgery in her right eye. She underwent DSAEK with a significant postoperative hyperopic shift in her refraction. Thirteen months after DSAEK, she underwent wavefront-guided, femtosecond laser-assisted LASIK (IntraLase, Inc., Irvine, CA/AMO, Inc., IL, USA). Pretreatment unaided visual acuity was 20/120, and best-corrected visual acuity was 20/20 with a refraction of +3.25/−0.50 × 170. One year after laser refractive correction, unaided visual acuity was 20/20 with a refraction of +0.25/−0.75 × 160. Conclusion. To our knowledge, this is the first paper on the successful treatment of hyperopic shift related to DSAEK with wavefront-guided, femtosecond laser-assisted LASIK.
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Menassa N, Fitting A, Auffarth GU, Holzer MP. Visual outcomes and corneal changes after intrastromal femtosecond laser correction of presbyopia. J Cataract Refract Surg 2012; 38:765-73. [PMID: 22520302 DOI: 10.1016/j.jcrs.2011.11.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 11/13/2011] [Accepted: 11/20/2011] [Indexed: 10/28/2022]
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Bibliography. Refractive surgery. Current world literature. Curr Opin Ophthalmol 2011; 22:304-5. [PMID: 21654397 DOI: 10.1097/icu.0b013e3283486839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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