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Chung HS, Lee H, Park SY, Min CH, Kim M, Kim JY, Tchah H. Intraocular pressure changes before and after a femtosecond laser procedure for cataract surgery. Sci Rep 2024; 14:9020. [PMID: 38641638 PMCID: PMC11031567 DOI: 10.1038/s41598-024-55961-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 02/29/2024] [Indexed: 04/21/2024] Open
Abstract
This study aimed to evaluate the changes in intraocular pressure (IOP) before and after femtosecond laser capsulorhexis and lens fragmentation for cataract surgery. We measured the IOP before, immediately, 30 min, and 1 h after the laser procedure in 47 eyes of 47 patients who underwent the femtosecond laser procedure. The mean IOP was 17.51 ± 3.28 mmHg, 30.23 ± 6.70 mmHg, 17.96 ± 3.75 mmHg, and 21.77 ± 5.88 mmHg before, immediately after, 30 min after, and 1 h after the laser procedure, respectively. The mean IOP significantly increased immediately (adjusted P < 0.001) and 1 h (adjusted P = 0.001) after the laser procedure compared with the pre-laser IOP. The mean IOP at 30 min after the laser procedure was significantly lower than that immediately after the procedure (adjusted P < 0.001). However, the IOP 1 h after the laser procedure became higher than that 30 min after the laser procedure. Additionally, the IOP 1 h after the laser procedure was positively correlated with the baseline IOP and negatively correlated with the axial length. In conclusion, this study demonstrated that cataract surgery should be commenced within 30 min after the femtosecond laser procedure to ensure a safe cataract surgery that reduces the risk of increased intraocular pressure.
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Affiliation(s)
- Ho Seok Chung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Young Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Hong Min
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mose Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, 136, Yeongsin-ro, Yeongdeungpo-gu, Seoul, 07031, South Korea.
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Saad A, Klabe K, Kirca M, Kretz FAT, Auffarth G, Breyer DRH. Refractive outcomes of small lenticule extraction (SMILE) Pro® with a 2 MHz femtosecond laser. Int Ophthalmol 2024; 44:52. [PMID: 38340212 PMCID: PMC10858925 DOI: 10.1007/s10792-024-02915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate the initial visual outcomes of Small Incision Lenticule Extraction (SMILE) Pro® using a 2 MHz femtosecond laser (VisuMax 800, Carl Zeiss Meditec) and to assess the efficacy, safety, predictability, accuracy, and complication rate. METHODS This retrospective analysis included eyes which underwent the SMILE Pro® procedure using VisuMax 800 femtosecond laser to correct myopia. All surgeries were performed by one surgeon (DB). Follow-up was conducted 3 months postoperatively to evaluate visual outcomes after neuroadaptation, corrected visual acuity (CDVA) and intra- and postoperative complications. RESULTS One hundred and fifty-two eyes of 82 patients (mean age 31 ± 6 years) results at 3 months are presented. The mean spherical equivalent (SE) was - 4.44 ± 1.86 D preoperatively while -0.24 ± 0.32 D postoperatively. 99% of eyes achieved SE within ± 1.0 D of attempted correction and 91% were within ± 0.5 D. Efficacy index was 0.93 while the safety index was 1. No complications occurred intra- or postoperatively. No eyes lost more than 1 line of their preoperative CDVA. All highly myopic eyes (- 6.25 to - 10.00 D; n = 18) achieved 20/20 at 3 months postoperatively and were within 0.5 D from the attempted SE and no eyes lost more than 1 line of CDVA. CONCLUSION The SMILE Pro® is a safe, efficient, and predictable procedure for the treatment of myopia and myopic astigmatism, with comparable results of conventional SMILE surgery. High myopic eyes achieve better results than low and moderate myopia. No complications were recorded in our patients.
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Affiliation(s)
- Amr Saad
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany.
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany.
| | - Karsten Klabe
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
| | - Mücella Kirca
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
| | - Florian A T Kretz
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
- Precise Vision, Kretz & Colleagues, Rheine, Germany
| | - Gerd Auffarth
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Detlev R H Breyer
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
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Vinod K, Salim S. Addressing Glaucoma in Myopic Eyes: Diagnostic and Surgical Challenges. Bioengineering (Basel) 2023; 10:1260. [PMID: 38002384 PMCID: PMC10669452 DOI: 10.3390/bioengineering10111260] [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: 10/16/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Epidemiological and genetic studies provide strong evidence supporting an association between myopia and glaucoma. The accurate detection of glaucoma in myopic eyes, especially those with high myopia, remains clinically challenging due to characteristic morphologic features of the myopic optic nerve in addition to limitations of current optic nerve imaging modalities. Distinguishing glaucoma from myopia is further complicated by overlapping perimetric findings. Therefore, longitudinal follow-up is essential to differentiate progressive structural and functional abnormalities indicative of glaucoma from defects that may result from myopia alone. Highly myopic eyes are at increased risk of complications from traditional incisional glaucoma surgery and may benefit from newer microinvasive glaucoma surgeries in select cases.
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Affiliation(s)
- Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Sarwat Salim
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02116, USA
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Muacevic A, Adler JR, DeNaro BB, Shelby C, Coleman WT. Activation of Ocular Syphilis After Small-Incision Lenticule Extraction. Cureus 2022; 14:e32299. [PMID: 36628014 PMCID: PMC9822783 DOI: 10.7759/cureus.32299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
A 41-year-old female presented to the Willis-Knighton Eye Institute to undergo evaluation for refractive surgery. The patient had a best-corrected visual acuity for a distance of 20/15-1 of the right eye (OD) and 20/15-1 of the left eye (OS) with a manifest refraction of -2.75 OD and -1.75 OS. Near visual acuity was J1+ in both eyes (OU). A trial of a monovision contact lens was successful with the dominant eye selected for distance. The patient was then planned for small-incision lenticule extraction (SMILE) OD only with a plano target. SMILE was performed and was uncomplicated with uncorrected visual acuity of 20/15- on postoperative day one. Two weeks after the initial SMILE procedure, the anterior segment was notable for 1-2+ cells OD. Topical prednisone was changed to difluprednate 0.05% TID OD with improvement in symptoms. However, the anterior chamber cell was never fully resolved by month three. A systemic workup revealed a positive rapid plasma reagin with 1:64 titer and a positive fluorescent treponemal antibody absorption in a patient never treated for syphilis. The patient was diagnosed with ocular syphilis and received a two-week course of intravenous penicillin G. A slow topical prednisone tapper was performed with the resolution of inflammation by one year. Anterior uveitis after refractive surgery is uncommon. The incidence of anterior uveitis after SMILE is even rarer with no previously documented incidence in the literature. As a result, persistent cell seen in refractive procedures, especially SMILE, is a concerning finding, warranting further workup to rule out underlying systemic diseases including syphilis.
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Liu YC, Morales-Wong F, Patil M, Han SB, Lwin NC, Teo EPW, Ang HP, Yussof NZM, Mehta JS. Femtosecond laser-assisted corneal transplantation with a low-energy, liquid-interface system. Sci Rep 2022; 12:6959. [PMID: 35484198 PMCID: PMC9050694 DOI: 10.1038/s41598-022-11461-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Femtosecond laser-assisted keratoplasty has been proposed as a treatment option for corneal transplantation. In this study, we investigated and compared the outcomes of Ziemer Z8 femtosecond laser (FSL)-assisted penetrating keratoplasty (PK) using a liquid interface versus flat interface. Thirty fresh porcine eyes underwent FSL-assisted PK with the Z8 using different levels of energies (30%, 90% or 150%) and different interfaces (liquid or flat). The real-time intraocular pressure (IOP) changes, incision geometry, corneal endothelial damage, as well as the accuracy of laser cutting and tissue reaction, were performed and compared. We found that the overall average IOP at all laser trephination stages was significantly higher with the flat interface, regardless of the energy used (68.9 ± 15.0 mmHg versus 46.1 ± 16.6 mmHg; P < 0.001). The overall mean laser-cut angle was 86.2º ± 6.5º and 88.2º ± 1.0º, for the liquid and flat platform respectively, indicating minimal deviation from the programmed angle of 90º. When high energy (150%) was used, the endothelial denuded area was significantly greater with the flat interface than with liquid interface (386.1 ± 53.6 mm2 versus 139.0 ± 10.4 mm2P = 0.02). The FSL cutting did not cause obvious tissue reaction alongside the laser cut on histological evaluation. The results indicated a liquid interface is the preferable choice in FSL-assisted corneal transplantation.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore. .,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore. .,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Ophthalmology Academic Clinical Program, Singapore, Singapore.
| | - Fernando Morales-Wong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore.,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore.,Faculty of Medicine, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo Leon, San Nicolás de los Garza, Mexico
| | - Moushmi Patil
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon-si, Republic of Korea
| | - Nyein C Lwin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Ericia Pei Wen Teo
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Heng Pei Ang
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Nur Zah M Yussof
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology Academic Clinical Program, Singapore, Singapore
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Gros-Otero J, Rodríguez-Pérez I, Teus MA, Katsanos A, Mikropoulos DG, García-González M. Myopic LASIK Outcomes: Comparison of Three Different Femtosecond Lasers and a Mechanical Microkeratome Using the Same Excimer Laser. Ophthalmol Ther 2022; 11:1047-1066. [PMID: 35262896 PMCID: PMC9114235 DOI: 10.1007/s40123-022-00486-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/11/2022] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION To compare the influence of one microkeratome and three femtosecond lasers on myopic laser in situ keratomileusis (LASIK) outcomes. METHODS Retrospective, observational cohort study. We compared 134 eyes treated with the IntraLase 60 kHz, 112 eyes treated with the Femto LDV Z6, 206 eyes treated with the FS200, and 98 eyes treated with the Hansatome zero compression microkeratome. All eyes were operated on using the same surgical protocol with the same excimer laser (Wavelight Allegretto) and were allocated to refraction-matched groups. RESULTS One day and one week postoperatively, uncorrected distance visual acuity was significantly lower in the FS200 group compared to others (P = 0.0001). This difference disappeared at the 1- and 3-month postoperative visits. Significant differences were found among groups in terms of safety index (P = 0.0001), residual sphere (P = 0.0001), and residual cylinder (P = 0.02) at the 3-month postoperative visit. No significant differences were found in corrected distance visual acuity or efficacy index. CONCLUSION According to our results, a slight delay in visual restoration after FS200 LASIK surgery might be expected. This delay was statistically significant at 1 day and 1 week postoperatively, but there were no differences from the 1-month visit onwards. Additionally, significant differences were found among devices in terms of safety index and the refractive results, which were found not to be clinically relevant.
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Affiliation(s)
| | | | - Miguel A Teus
- Clínica Novovisión, Paseo de la Castellana 54, 28046, Madrid, Spain.,Hospital Universitario "Príncipe de Asturias", University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Dimitrios G Mikropoulos
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Moshirfar M, Barke MR, Huynh R, Waite AJ, Ply B, Ronquillo YC, Hoopes PC. Controversy and Consideration of Refractive Surgery in Patients with Heritable Disorders of Connective Tissue. J Clin Med 2021; 10:3769. [PMID: 34501218 PMCID: PMC8432249 DOI: 10.3390/jcm10173769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023] Open
Abstract
Heritable Disorders of Connective Tissue (HDCTs) are syndromes that disrupt connective tissue integrity. They include Osteogenesis Imperfecta (OI), Ehlers Danlos Syndrome (EDS), Marfan Syndrome (MFS), Loeys-Dietz Syndrome (LDS), Epidermolysis Bullosa (EB), Stickler Syndrome (STL), Wagner Syndrome, and Pseudoxanthoma Elasticum (PXE). Because many patients with HDCTs have ocular symptoms, commonly myopia, they will often present to the clinic seeking refractive surgery. Currently, corrective measures are limited, as the FDA contraindicates laser-assisted in-situ keratomileusis (LASIK) in EDS and discourages the procedure in OI and MFS due to a theoretically increased risk of post-LASIK ectasia, poor wound healing, poor refractive predictability, underlying keratoconus, and globe rupture. While these disorders present with a wide range of ocular manifestations that are associated with an increased risk of post-LASIK complications (e.g., thinned corneas, ocular fragility, keratoconus, glaucoma, ectopia lentis, retinal detachment, angioid streaks, and ocular surface disease), their occurrence and severity are highly variable among patients. Therefore, an HDCT diagnosis should not warrant an immediate disqualification for refractive surgery. Patients with minimal ocular manifestations can consider LASIK. In contrast, those with preoperative signs of corneal thinning and ocular fragility may find the combination of collagen cross-linking (CXL) with either photorefractive keratotomy (PRK), small incision lenticule extraction (SMILE) or a phakic intraocular lens (pIOL) implant to be more suitable options. However, evidence of refractive surgery performed on patients with HDCTs is limited, and surgeons must fully inform patients of the unknown risks and complications before proceeding. This paper serves as a guideline for future studies to evaluate refractive surgery outcomes in patients with HDCTs.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA; (B.P.); (Y.C.R.); (P.C.H.)
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
| | - Matthew R. Barke
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Rachel Huynh
- University of Utah School of Medicine, Salt Lake City, UT 84132, USA;
| | - Austin J. Waite
- A.T. Still University College of Osteopathic Medicine in Arizona, Mesa, AZ 85206, USA;
| | - Briana Ply
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA; (B.P.); (Y.C.R.); (P.C.H.)
| | - Yasmyne C. Ronquillo
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA; (B.P.); (Y.C.R.); (P.C.H.)
| | - Phillip C. Hoopes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA; (B.P.); (Y.C.R.); (P.C.H.)
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Ozsaygili C, Altunel O, Duru N. Evaluation of the change in retinal thickness after femtosecond laser-assisted laser in situ keratomileusis and photorefractive keratectomy. Curr Eye Res 2021; 47:18-24. [PMID: 34231433 DOI: 10.1080/02713683.2021.1951297] [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: 10/20/2022]
Abstract
PURPOSE OF THE STUDY To investigate the change in individual retinal layer thickness by spectral-domain optical coherence tomography (SD-OCT) in eyes underwent femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and photorefractive keratectomy (PRK). METHODS In patients who underwent PRK and FS-LASIK, changes in the thickness of all retinal layers in the foveal, parafoveal, and perifoveal regions were evaluated by SD-OCT automated segmentation analysis at pre-operatively and different time points post-operatively. RESULTS Seventy-one eyes of 71 patients (38 patients in PRK, 33 patients in LASIK) were included. In the pre-operative period, mean spherical equivalent (SE), mean keratometry, axial length, and segmentation values of the retinal layers were similar (P> .05). In the PRK group, the pre-operative measurements of individual retinal layers did not show a statistically significant difference compared to the post-operative measurements on the 1st day, 1st week, and 1st month. In the FS-LASIK group, the mean inner nuclear layer (INL) thickness one day after the surgery was significantly higher than that before surgery in the foveal (21.22 ± 4.66 µm vs 19.03 ± 4.50 µm, P= .013) and parafoveal regions (41.98 ± 3.70 µm vs 40.56 ± 3.49 µm, P= .044). CONCLUSIONS The findings of our study suggest that the increase of INL thickness may be due to temporary structural and circulatory changes of the retina that may occur in the suction phase in the FS-LASIK procedure.
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Affiliation(s)
- Cemal Ozsaygili
- Kayserı City Training and Research Hospital, Kocasinan, Turkey
| | - Orhan Altunel
- Kayserı City Training and Research Hospital, Kocasinan, Turkey.,Kutahya Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Necati Duru
- Kayserı City Training and Research Hospital, Kocasinan, Turkey
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Fuest M, Mehta JS. Advances in refractive corneal lenticule extraction. Taiwan J Ophthalmol 2021; 11:113-121. [PMID: 34295616 PMCID: PMC8259523 DOI: 10.4103/tjo.tjo_12_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 01/31/2023] Open
Abstract
Refractive errors are the leading cause of reversible visual impairment worldwide. In addition to the desired spectacle independence, refractive procedures can improve quality of life, working ability, and daily working performance. Refractive corneal lenticule extraction (RCLE) is a relatively new technique, dependent only on a femtosecond laser (FS). This leads to potential benefits over laser-assisted in situ keratomileusis (LASIK) including a quicker recovery of dry eye disease, a larger functional optical zone, and no flap-related complications. SMILE, available with the VisuMax FS (Carl Zeiss Meditec AG, Jena, Germany), is the most established RCLE application, offering visual and refractive outcomes comparable to LASIK. SmartSight (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) and CLEAR (Ziemer Ophthalmic Systems AG, Port, Switzerland) are two new RCLE applications that received Conformité Européenne (CE) approval in 2020. In this article, we review refractive and visual outcomes, advantages, and disadvantages of RCLE and also report on the latest advances in RCLE systems.
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Affiliation(s)
- Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Eye-Academic Clinical Program, Duke-National University of Singapore Graduate Medical School, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
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10
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Lauzirika G, Garcia-Gonzalez M, Bolivar G, Hernández-Verdejo JL, Blázquez Sánchez V, Gros-Otero J, Teus MA. Measurement of the Intraocular Pressure Elevation During Laser-Assisted In Situ Keratomileusis Flap Creation Using a Femtosecond Laser Platform. Transl Vis Sci Technol 2021; 10:9. [PMID: 34003943 PMCID: PMC7961108 DOI: 10.1167/tvst.10.3.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to measure the intraocular pressure (IOP) elevation during laser assisted in situ keratomileusis (LASIK) flap creation using the WaveLight FS200 femtosecond (FS) laser platform. Methods We conducted an ex vivo experimental study in an animal model. The WaveLight FS200 FS laser platform was used to perform the corneal LASIK flap in freshly enucleated porcine eyes. We measured the changes in IOP from the application of the suction ring (suctioning phase) through the creation of the lamellar corneal flap (cutting phase). The IOP was recorded using a manometric technique with direct cannulation to the anterior chamber. Results Nine freshly enucleated porcine eyes were included in the study. The mean baseline IOP before the procedure was 20.33 ± 5.9 mm Hg. The mean IOP increase over baseline IOP was 32.33 ± 11.3 mm Hg at the suctioning phase, and 38.22 ± 11.3 mm Hg at the cutting phase. The total surgical time needed to complete the procedure was 29.5 ± 4.4 seconds. Conclusions The WaveLight FS200 FS laser platform produces a low to moderate increase in IOP during LASIK flap creation. Translational Relevance The WaveLight FS200 is a safe FS laser platform because it induces a low to moderate IOP increase during LASIK flap creation.
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Affiliation(s)
- Gorka Lauzirika
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
- Clínica Novovisión, Madrid, Spain
| | | | - Gema Bolivar
- Hospital Universitario Príncipe Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | | | - Miguel A. Teus
- Clínica Novovisión, Madrid, Spain
- Hospital Universitario Príncipe Asturias, Alcalá de Henares, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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First Experience in Small Incision Lenticule Extraction with the Femto LDV Z8 and Lenticule Evaluation Using Scanning Electron Microscopy. J Ophthalmol 2020; 2020:6751826. [PMID: 33062315 PMCID: PMC7533789 DOI: 10.1155/2020/6751826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the specifications and technique properties of the new Femto LDV Z8 in creating intrastromal refractive lenticules during small incision lenticule extraction (SMILE). Methods Six enucleated porcine eyeballs were equally divided into two groups (Femto LDV Z8 or VisuMax) and were randomly assigned to three experienced refractive surgeons who performed SMILE on each group. Five intraoperative time parameters and surgeons' satisfaction on the surgical procedure were compared between two groups. Postoperatively, the roughness of the lenticule surfaces and the irregularity of edges were observed by scanning electron microscopy (SEM) and were also compared between the two groups. Results Longer time on suction peak pressure, total laser application, and total surgery were spent in the Femto LDV Z8 group as compared with the VisuMax group. The Femto LDV Z8 group applied OCT scanning and offsetting before performing the laser procedure, which expended more time for these crucial steps. The widest range of surgeons' satisfaction scores was found in the step of lenticule interface identification of the Femto LDV Z8 group. The roughness scores of the anterior and posterior lenticule surfaces were statistically less in the Femto LDV Z8 group than in the VisuMax group (anterior, ×180, p=0.039; anterior, ×250, p=0.337; posterior, ×180, p=0.006; and posterior, ×250, p=0.007). Conclusions Femto LDV Z8 showed promising performances as a novel SMILE equipment for the correction of myopia. It has special and unique features for SMILE procedures, which need more learning and researching processes. With its low-energy high-frequency nJ-level laser system, the Femto LDV Z8 provided smoother lenticule surface than VisuMax.
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Ahmed AA, Hatch KM. Advantages of Small Incision Lenticule Extraction (SMILE) for Mass Eye and Ear Special Issue. Semin Ophthalmol 2020; 35:224-231. [PMID: 32892680 DOI: 10.1080/08820538.2020.1807028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review summarizes the advantages of Small-incision lenticule extraction (SMILE), including improved patient intraoperative experience, improved postoperative ocular surface, low incidence of regression, low re-treatment rates, and advantageous biomechanical corneal stability. Visual and refractive outcomes are similar to those achieved with LASIK, notably in large population studies. Since the inception of SMILE almost 10 years ago, the procedure has been rapidly growing in popularity. With the implementation of the novel SMILE technology in their practice, refractive surgeons generate excitement and potential for expanding the refractive market. Other parts of the world, including Asia, Europe, and Russia, SMILE has become the most popular refractive procedure performed. It is speculated that as SMILE continues to grow in popularity in the US since FDA approval in 2016 and more refractive surgeons implement this technology into their practice, it will drive an increase in the refractive market similar to what is seen in other countries.
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Affiliation(s)
- Amani A Ahmed
- Anterior Segment - Cornea and Refractive Surgery, Mass Eye and Ear Main Campus , Boston, MA, USA.,Anterior Segment - Cornea and Refractive Surgery, Harvard University , Boston, MA, USA
| | - Kathryn M Hatch
- Anterior Segment - Cornea and Refractive Surgery, Mass Eye and Ear Main Campus , Boston, MA, USA.,Anterior Segment - Cornea and Refractive Surgery, Harvard University , Boston, MA, USA
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Reinstein DZ, Archer TJ, Vida RS, Carp GI. Suction stability management in small incision lenticule extraction: incidence and outcomes of suction loss in 4000 consecutive procedures. Acta Ophthalmol 2020; 98:e72-e80. [PMID: 31448878 DOI: 10.1111/aos.14215] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To report the incidence and outcomes of suction loss during small incision lenticule extraction (SMILE). METHODS The incidence of suction loss was measured over 4000 consecutive SMILE procedures and categorized by cause, the interface in which suction was lost and management (restart/continue SMILE, re-SMILE thinner cap, convert to laser in-situ keratomileusis [LASIK]). One-year outcomes were compared to the fellow eye where no suction loss occurred. RESULTS There were 20 cases of suction loss (0.50%): during the lenticule interface in seven eyes, lenticule side cut in one eye, cap interface in nine eyes and small incision for three eyes. Small incision lenticule extraction (SMILE) was continued in seven eyes, thinner cap SMILE in four eyes, LASIK in eight eyes, and the small incision was manually completed in one eye. Suction loss was caused by a Bell's reflex in 10 eyes, fixation light tracking in six eyes, patient anxiety in two eyes, a nociceptive reflex in one eye and false suction in one eye. There was no difference in results for suction loss and fellow eyes, respectively: uncorrected distance visual acuity was 20/20 or better in 100% in both groups, spherical equivalent was within ±0.50 D in 85% and 79%, one line loss of corrected distance visual acuity in 5% and 0%, and no eyes lost two lines. CONCLUSION Suction loss can be managed depending on the interface during which suction is lost. Treatment was completed on the same day in all instances. Visual and refractive outcomes were unaffected compared to the fellow eye in this series.
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Affiliation(s)
- Dan Z. Reinstein
- London Vision Clinic London UK
- Department of Ophthalmology Columbia University Medical Center New York NY USA
- Sorbonne Université Paris France
- Biomedical Science Research Institute Ulster University Coleraine UK
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Impact of baseline IOP, vacuum, and different docking mechanisms, and their interaction on IOP rise in femtosecond laser-assisted refractive and cataract surgery. J Cataract Refract Surg 2019; 45:1818-1825. [PMID: 31856995 DOI: 10.1016/j.jcrs.2019.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/04/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To study the intraocular pressure (IOP) variation during vacuum and docking of femtosecond laser application. SETTING Department for Ophthalmology, Kepler University Hospital, Johannes Kepler University Linz, Austria. DESIGN Experimental study. METHODS Intracameral intraocular pressure (IOP) was monitored in 30 porcine ex vivo models using a dual femtosecond laser platform (VICTUS). Five different baseline IOP levels (10 to 30 mm Hg) were assessed during fluid-filled (liquid) docking, full-contact (applanating) docking, and vacuum application without docking. RESULTS Raising the baseline intracameral IOP from 10 to 30 mm Hg increased the IOP from 27.55 mm Hg ± 5.93 (SD) to 56.85 ± 6.10 mm Hg in the fluid-filled docking group, and from 60.91 ± 8.41 mm Hg to 90.11 ± 6.64 mm Hg in the full-contact docking group. The full-contact docking procedure per se (excluding vacuum effect) increased the IOP by 61.7% (+36.58 ± 5.84 mm Hg). In contrast, fluid-filled docking (excluding vacuum effect) raised the IOP by only 3.1% (+0.72 ± 2.71 mm Hg). Each 5 mm Hg reduction of baseline IOP resulted in a mean IOP reduction of 7.33 ± 3.05 mm Hg in the fluid-filled group, and 7.30 ± 6.88 mm Hg in the full-contact docking group (P < .001). Decreasing baseline intracameral IOP from 15 to 10 mm Hg resulted in the highest IOP reduction between all subgroups (P < .01). CONCLUSIONS Baseline IOP, docking procedures, and vacuum influenced IOP during femtosecond laser application in a synergistic manner. Lowering the baseline intracameral IOP resulted in a significantly lower IOP during fluid-filled docking for cataract surgery and full-contact docking for refractive surgery. Full-contact (applanating) docking resulted in a significantly higher IOP elevation compared with similar IOP values found during fluid-filled (liquid) docking and the application of the suction ring alone without docking.
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Intraocular Pressure Changes during Femtosecond Laser-Assisted Cataract Surgery: A Comparison between Two Different Patient Interfaces. J Ophthalmol 2019; 2019:5986895. [PMID: 31662896 PMCID: PMC6778884 DOI: 10.1155/2019/5986895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/23/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this retrospective cohort study was to evaluate intraocular pressure (IOP) changes during femtosecond laser-assisted cataract surgery (FLACS) using two different patient interface systems. Methods 116 eyes of 116 patients scheduled for cataract surgery were divided into 2 groups: group 1 (61 eyes) and group 2 (55 eyes) underwent FLACS using Catalys Laser with fluid interface (liquid optics interface, LOI) and LenSx Laser with curved interface and soft contact lens (SoftFit), respectively. IOP was assessed using a portable rebound tonometer (Icare®) preoperatively, after docking, immediately after surgery, at one and seven days postoperatively. Results In group 1, the mean IOP (±SD) was 14.1 ± 0.4 mmHg before surgery, 33.2 ± 1.1 mmHg after docking, and 21.4 ± 0.9 mmHg immediately after surgery. In group 2, the mean IOP was 13.8 ± 0.4 mmHg before surgery, 24.2 ± 1.4 mmHg after docking, and 20.2 ± 1.2 mmHg immediately after surgery. After the docking procedure, a statistically significant increase in IOP from the baseline was found in both groups (p < 0.001). Moreover, no statistically significant difference in IOP measured at 1 and 7 days postoperatively was observed compared with the preoperative values (p > 0.05) using both laser platforms. No intraoperative and postoperative complications were observed. Conclusions FLACS suction phase resulted in a transient increase of IOP in both groups, especially with the LOI system, and it is probably related to the greater pressure of a suction ring and suction generated through the vacuum, independently from the effect of femtosecond laser itself.
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Bolivar G, Garcia-Gonzalez M, Laucirika G, Villa-Collar C, Teus MA. Intraocular pressure rises during laser in situ keratomileusis: Comparison of 3 femtosecond laser platforms. J Cataract Refract Surg 2019; 45:1172-1176. [DOI: 10.1016/j.jcrs.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022]
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Changes in Retinal Vasculature and Thickness after Small Incision Lenticule Extraction with Optical Coherence Tomography Angiography. J Ophthalmol 2019; 2019:3693140. [PMID: 31236290 PMCID: PMC6545814 DOI: 10.1155/2019/3693140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the changes in retinal vessel density and thickness after small incision lenticule extraction (SMILE) with optical coherence tomography angiography (OCTA) in myopic patients. Methods In this prospective study, SMILE surgeries were done in 46 eyes of 24 patients with spherical equivalent (SE) more than −6.0 diopters (D). Retinal vessel density and thickness at the macula and optic nerve were recorded with OCTA before and 1 day, 2 weeks, and 1 month after surgery. Intraocular pressure (IOP), uncorrected distance visual acuity (UDVA), and refraction were taken at the same time. Results The superficial retinal vessel density and deep foveal retinal vessel density 1 day after surgery were less than those before surgery; however, the changes at any timepoints were not statistically significant (p=0.2736 and p=0.1590, respectively). Both the superficial vessel density and deep vessel density at the parafoveal and perifoveal regions decreased significantly 1 day postoperatively (all p < 0.05) and then returned to the preoperative level at 2 weeks and stabilized thereafter. There were no significant changes in any of the 4 vessel densities in the area of peripapillary before and 1 day, 2 weeks, and 1 month after surgery (p=0.3345). No statistically significant differences between preoperative and postoperative retinal thickness were detected for the area of macula and optic nerve (all p > 0.5). Conclusions The vessel density at the parafoveal and perifoveal regions decreased at 1 day after SMILE with no effect on the visual acuity and relieved within 2 weeks. Decreased ocular blood flow in response to the spike in IOP may account for such changes.
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Reinstein DZ, Stuart AJ, Vida RS, Archer TJ, Carp GI. Incidence and Outcomes of Sterile Multifocal Inflammatory Keratitis and Diffuse Lamellar Keratitis After SMILE. J Refract Surg 2019; 34:751-759. [PMID: 30428095 DOI: 10.3928/1081597x-20181001-02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To report the incidence outcomes of sterile multifocal inflammatory keratitis and diffuse lamellar keratitis (DLK) after small incision lenticule extraction (SMILE) in a large population. METHODS This was a retrospective review of a population of 4,000 consecutive eyes treated by SMILE at the London Vision Clinic using the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany). The inclusion criterion was to have presented with inflammatory keratitis after SMILE. In some cases after SMILE, the inflammatory keratitis presented as sterile multifocal interface keratitis uncharacteristic of classic DLK. The incidence was measured and categorized as primary or secondary by presenting appearance, grade, and time to presentation. Patients were observed for 1 year after surgery and standard outcomes analysis was performed. RESULTS Of the 4,000 eye population, there were 18 cases (0.45%) of DLK grade 1 or 2. All cases were managed and resolved with topical steroid therapy. Of these, 12 cases (67%) were of classic appearance and 6 cases (33%) presented as sterile multifocal inflammatory keratitis. DLK was primary in nature in 11 cases (61%) and secondary in 7 cases (39%). Postoperative uncorrected distance visual acuity was 20/20 or better in 93% of eyes. No patients lost any lines of corrected distance visual acuity and there was no change in contrast sensitivity. CONCLUSIONS DLK occurred after SMILE with an incidence of 0.45% in this population. Topical steroid therapy resolved the DLK in all cases with no sequelae and no adverse effect on refractive or visual outcome at 1 year postoperatively. A unique type of DLK presentation can occur after SMILE, characterized by multiple focal sterile inflammatory spots. Management is the same as for classic DLK, but with a lower threshold for performing an interface washout. [J Refract Surg. 2018;34(11):751-759.].
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Reinstein DZ, Carp GI, Archer TJ, Day AC, Vida RS. Outcomes for Mixed Cylinder LASIK With the MEL 90 ® Excimer Laser. J Refract Surg 2019; 34:672-680. [PMID: 30296328 DOI: 10.3928/1081597x-20180814-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of LASIK for mixed cylinder using the Triple-A ablation profile with the MEL 90 excimer laser (Carl Zeiss Meditec, Jena, Germany). METHODS This was a retrospective analysis of all eyes treated by LASIK for mixed cylinder using the Triple-A ablation profile with the MEL 90 laser between July 2013 and October 2016. Patients were observed for 1 year after surgery. Standard outcomes analysis and vector analysis by the Alpins method were performed. RESULTS The database review identified 105 eyes (82 patients) treated by LASIK for mixed cylinder using the MEL 90 laser. Mean age was 40 ± 11 years (range: 18 to 65 years). Mean attempted spherical equivalent was +0.30 ± 0.90 diopters (D) (range: -2.30 to +1.75 D). Mean cylinder was -2.93 ± 1.47 D (range: -0.75 to -7.00 D). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 81% of eyes. Postoperative uncorrected distance visual acuity was 20/20 or better in 69% and 20/25 or better in 86% of eyes. Mean postoperative spherical equivalent relative to the intended target was -0.21 ± 0.38 D (range: -1.25 to +1.13 D), with 83% within ±0.50 D. Mean postoperative cylinder was -0.57 ± 0.41 D (range: 0.00 to -1.75 D). Geometric mean was 1.12 for the correction index and 0.25 for the index of success. For angle of error, the arithmetic mean was -0.6° ± 4.2° (range: -13.5° to 9.5°) and the absolute mean was 2.9° ± 3.0° (range: 0.0° to 13.5°). There was loss of one line of CDVA in 3% of eyes and no eyes lost two or more lines CDVA. There was a small increase in contrast sensitivity after surgery at 3, 6, 12, and 18 cycles per degree (P < .05). CONCLUSIONS One-year outcomes of LASIK using the MEL 90 laser for mixed cylinder up to -7.00 D demonstrated excellent efficacy, safety, and predictability. Vector analysis found a 12% overcorrection in magnitude of refractive cylinder. Given the high accuracy for angle of error, a nomogram could be applied to reduce the over-correction and further improve the uncorrected distance visual acuity outcomes. [J Refract Surg. 2018;34(10):672-680.].
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Reinstein DZ, Carp GI, Archer TJ, Vida RS. Outcomes of Re-treatment by LASIK After SMILE. J Refract Surg 2018; 34:578-588. [PMID: 30199561 DOI: 10.3928/1081597x-20180717-02] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/03/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of LASIK re-treatments after small incision lenticule extraction (SMILE). METHODS Retrospective review of all eyes to have undergone a re-treatment by LASIK after primary SMILE between September 2013 and January 2016. Thin-flap LASIK was used in most cases as long as sufficient tissue was available for safe flap creation between the maximum epithelial thickness and minimum cap thickness. Otherwise, the SMILE interface was converted into a LASIK flap by the Circle technique or side cut only. The multivariate nomogram for LASIK re-treatments was used, including sphere, cylinder, age, and primary spherical equivalent (SEQ) as variables. Patients were observed for 1 year after surgery and standard outcomes analysis was performed. RESULTS A total of 116 LASIK re-treatments were performed in a population of 2,643 consecutive SMILE procedures, indicating a re-treatment rate of 4.39%. Mean attempted SEQ was -0.05 ± 0.99 diopters (D) (range: -1.88 to +1.50 D). Mean cylinder was -0.70 ± 0.55 D (range: 0.00 to -2.25 D). Postoperative uncorrected distance visual acuity was 20/20 or better in 81% of eyes, for a population with corrected distance visual acuity (CDVA) of 20/20 or better in 95% before re-treatment. Mean postoperative SEQ relative to the target was +0.19 ± 0.49 D (range: -0.88 to +2.13 D), with 74% within ±0.50 D. Mean postoperative cylinder was -0.29 ± 0.24 D (range: 0.00 to -1.25 D). There was one line loss of CDVA in 15% of eyes, but no eyes lost two or more lines. There was a small increase in contrast sensitivity (P < .05). Overcorrection was identified in myopic re-treatments (n = 20) of -1.00 D or more; mean postoperative SEQ was +0.59 ± 0.64 D (range: -0.63 to +2.13 D). CONCLUSIONS Re-treatment after SMILE by LASIK achieved excellent visual and refractive outcomes, although these results indicate that myopic LASIK retreatment after primary myopic SMILE requires a different nomogram than for myopic LASIK re-treatment after primary myopic LASIK. [J Refract Surg. 2018;34(9):578-588.].
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Reinstein DZ, Carp GI, Archer TJ, Vida RS. Inferior pseudo-hinge fulcrum technique and intraoperative complications of laser in situ keratomileusis retreatment after small-incision lenticule extraction. J Cataract Refract Surg 2018; 44:1355-1362. [PMID: 30287159 DOI: 10.1016/j.jcrs.2018.07.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/05/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the evolution of a flap-lift technique for laser in situ keratomileusis (LASIK) retreatment after small-incision lenticule extraction (SMILE) and report the incidence of complications. SETTING London Vision Clinic, London, United Kingdom. DESIGN Retrospective case series. METHODS All retreatments between September 2013 and January 2017 were included. A bimanual inferior pseudo-hinge fulcrum flap-lift technique was developed to minimize the chance of tearing or entering the small incision. A flap lifter and a McPherson forceps were inserted into the inferior one third of the flap, slightly angled up to avoid perforating the small-incision lenticule extraction interface. One instrument provided countertraction, and the second separated the interface superiorly, keeping the tip away from the incision. One instrument was held against the hinge for the second instrument to separate the inferior one third. The incidence of intraoperative complications was analyzed. RESULTS The study evaluated 162 retreatments (4.12%) for 3933 small-incision lenticule extraction treatments (1-year maturity). The retreatment was LASIK (n = 135), side-cut only (n = 1), cap-to-flap procedure (CIRCLE) (n = 3), or photorefractive keratectomy (n = 23). Two eyes (1.4%) had a tear to the small incision. The small-incision lenticule extraction interface was accessed in 8 eyes (5.8%), 1 (0.7%) centrally, and the interface was lifted in 1 eye (0.7%). There were no complications in the last 84 consecutive procedures (60%) using the finalized technique. CONCLUSION The bimanual inferior pseudo-hinge fulcrum decreased the risk for accessing the small-incision lenticule extraction interface or tearing the small incision.
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Affiliation(s)
- Dan Z Reinstein
- From the London Vision Clinic (Reinstein, Carp, Archer, Vida), London, and Biomedical Science Research Institute (Reinstein, Archer), University of Ulster, Coleraine, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Northern Ireland.
| | - Glenn I Carp
- From the London Vision Clinic (Reinstein, Carp, Archer, Vida), London, and Biomedical Science Research Institute (Reinstein, Archer), University of Ulster, Coleraine, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Northern Ireland
| | - Timothy J Archer
- From the London Vision Clinic (Reinstein, Carp, Archer, Vida), London, and Biomedical Science Research Institute (Reinstein, Archer), University of Ulster, Coleraine, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Northern Ireland
| | - Ryan S Vida
- From the London Vision Clinic (Reinstein, Carp, Archer, Vida), London, and Biomedical Science Research Institute (Reinstein, Archer), University of Ulster, Coleraine, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Northern Ireland
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Katsanos A, Arranz-Marquez E, Cañones R, Lauzirika G, Rodríguez-Perez I, Teus MA. Retinal nerve fiber layer thickness after laser-assisted subepithelial keratomileusis and femtosecond LASIK: a prospective observational cohort study. Clin Ophthalmol 2018; 12:1213-1218. [PMID: 30013314 PMCID: PMC6038866 DOI: 10.2147/opth.s168033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Based on the assumption that high levels of intraocular pressure (IOP) during femtosecond laser-assisted in situ keratomileusis (FS-LASIK) may compromise the retinal nerve fiber layer (RNFL), newer femtosecond platforms that operate without causing significant IOP elevation have been developed in recent years. However, this assumption has not been adequately tested. The aim of the current study was to evaluate possible changes in RFNL thickness in nonglaucomatous myopic patients undergoing FS-LASIK using the 60 KHz IntraLase® device that significantly elevates the IOP for an appreciable period of time vs an advanced surface ablation technique (laser-assisted subepithelial keratomileusis, LASEK) that does not induce any IOP elevation. Methods This was a prospective, observational, controlled cohort study. One randomly selected eye of 114 consecutive eligible patients was analyzed. Inclusion criteria were myopia up to -6.00 diopters and astigmatism up to -2.00 diopters. As clinically indicated, 50 patients underwent LASEK and 64 underwent FS-LASIK. The RNFL thickness was determined with a spectral-domain optical coherence tomography device preoperatively and 3 months postoperatively by the same masked observer. Results There was no significant difference in preoperative refractive error, age, or sex between the groups. Preoperatively, central corneal thickness was significantly lower in the LASEK group (529.1±36.1 vs 562.4±31.6 µm, P=0.001). For the LASEK group, there was no significant difference between preoperative and postoperative RNFL thickness in the studied sectors (superior-temporal, temporal, inferior-temporal, average). For the FS-LASIK group, compared to preoperative RNFL measures, statistically significant thicker postoperative values were found for the average RNFL (mean difference: 0.67 µm, 0.7% increase, P=0.008) and the inferior-temporal sector (mean difference: 0.92 µm, 0.6% increase, P=0.02). Conclusion LASIK with a femtosecond platform that induces high intraoperative IOP did not cause RNFL thinning. The observed differences between preoperative and postoperative values are below the axial resolution limit of optical coherence tomography devices.
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Affiliation(s)
- Andreas Katsanos
- Clínica Novovisión, Madrid, Spain, .,Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain, .,Department of Ophthalmology, University of Ioannina, Ioannina, Greece,
| | - Esther Arranz-Marquez
- Clínica Novovisión, Madrid, Spain, .,Ophthalmology Clinic, Rey Juan Carlos Universitary Hospital, Móstoles, Madrid, Spain
| | - Rafael Cañones
- Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain,
| | | | | | - Miguel A Teus
- Clínica Novovisión, Madrid, Spain, .,Department of Ophthalmology, University of Alcala, Alcala de Henares, Spain,
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Cheng W, Liu L, Yu S, Jing Y, Zuo T, Cui T, Zhang H, Ma J, Wei P, Hao W, Lap-Ki Ng A, Pak-Man Cheng G, Chi-Pang Woo V, Chiu K, Wang Y. Real-Time Intraocular Pressure Measurements in the Vitreous Chamber of Rabbit Eyes During Small Incision Lenticule Extraction (SMILE). Curr Eye Res 2018; 43:1260-1266. [PMID: 29874938 DOI: 10.1080/02713683.2018.1485949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate real-time intraocular pressure (IOP) during small incision lenticule extraction (SMILE) in rabbit eyes for myopia correction. METHODS During SMILE, real-time IOP was measured in the vitreous cavity of rabbit eyes with an optic fiber pressure sensor (OFPS). Two groups (n = 6 for each) underwent surgery, one group for a -2.00 diopter (D) refractive spherical correction and the other for a -6.00 D correction. RESULTS During surgery, the IOP increased once the glass contact attached to the cornea (Pre-suction), and peaked 83.94 mmHg (SD ± 23.87 mmHg) for the -2.00 D group and 89.17 mmHg (SD ± 22.66 mmHg) for the -6.00 D group, both average values were less than 110 mmHg when suction was initiated to fix the glass contact onto the cornea (Suction on). It then fell to 74.81 mmHg (SD ± 20.64 mmHg) and 76.94 mmHg (SD ± 27.43 mmHg), respectively, and remained stable during lenticule creation (Cutting). After suction stopped (Suction off), IOP fell steeply. During lenticule separation/extraction, the change in IOP was 32.26 mmHg (SD ± 2.91 mmHg). Notably, the average duration of elevated IOP during the surgery was 166.05 s (no longer than 3 min). CONCLUSIONS The IOP fluctuations in the vitreous cavity using an OFPS in a rabbit model during SMILE showed that real-time IOP significantly was increased during Pre-suction, Suction on, Cutting, Suction off, and lenticule separation/extraction compared to baseline IOP, although, peaked at Suction on. Neither the degree of myopic correction nor central corneal thickness significantly affected these changes in IOP.
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Affiliation(s)
- Wenbo Cheng
- a Clinical College of Ophthalmology , Tianjin Medical University , Tianjin , China
| | - Lingjia Liu
- b Medical College of Nankai University , Tianjin , China
| | - Shasha Yu
- a Clinical College of Ophthalmology , Tianjin Medical University , Tianjin , China.,c Department of Ophthalmology, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR , China
| | - Yin Jing
- d Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Clinical College of Ophthalmology , Tianjin , China
| | - Tong Zuo
- d Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Clinical College of Ophthalmology , Tianjin , China
| | - Tong Cui
- a Clinical College of Ophthalmology , Tianjin Medical University , Tianjin , China
| | - Hui Zhang
- d Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Clinical College of Ophthalmology , Tianjin , China
| | - Jiaonan Ma
- a Clinical College of Ophthalmology , Tianjin Medical University , Tianjin , China
| | - Pinghui Wei
- d Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Clinical College of Ophthalmology , Tianjin , China
| | - Weiting Hao
- a Clinical College of Ophthalmology , Tianjin Medical University , Tianjin , China
| | - Alex Lap-Ki Ng
- c Department of Ophthalmology, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR , China
| | | | | | - Kin Chiu
- c Department of Ophthalmology, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR , China.,f State Key Laboratory of Brain and Cognitive Sciences , The University of Hong Kong , Hong Kong SAR , China
| | - Yan Wang
- a Clinical College of Ophthalmology , Tianjin Medical University , Tianjin , China.,b Medical College of Nankai University , Tianjin , China.,d Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Clinical College of Ophthalmology , Tianjin , China
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Ganesh S, Brar S, Arra RR. Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm. Indian J Ophthalmol 2018; 66:10-19. [PMID: 29283117 PMCID: PMC5778540 DOI: 10.4103/ijo.ijo_761_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Small incision lenticule extraction (SMILE), a variant of refractive lenticule extraction technology is becoming increasingly popular, as a flapless and minimally invasive form of laser vision correction (LVC) for the treatment of myopia and myopic astigmatism. This review aims at summarizing the principles, surgical technique, and clinical outcomes in terms of visual and refractive results, safety, efficacy, postoperative dry eye, aberrations, and biomechanics of SMILE and its comparison with other conventional techniques of LVC, such as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Recent advancements in the laser frequency and energy delivery patterns, instrumentation, and surgical techniques have shown significant improvement in the visual recovery and outcomes after SMILE, compared to the initial results published by Sekundo and Shah et al. Most of the recently published literature on long-term outcomes of SMILE shows excellent stability of the procedure, especially for higher myopia. In terms of the postoperative dry eye, SMILE shows a clear advantage over LASIK as numerous studies have shown significant differences about the Schirmer's, Tear film break up time, corneal sensitivity, and corneal nerve regeneration to be better following SMILE compared to LASIK. There is some evidence that since the Bowman's membrane (BM) and the anterior lamellae remain intact after SMILE, this may be a potential advantage for corneal biomechanics over LASIK and PRK where the BM is either severed or ablated, respectively, however, the data on biomechanics are inconclusive at present. Overall, this procedure has proved to be promising, delivering equivalent, or better visual and refractive results to LASIK and providing clear advantage in terms of being a flapless, minimally invasive procedure with minimal pain and postoperative discomfort thus offering high patient satisfaction.
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Affiliation(s)
- Sri Ganesh
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Raghavender Reddy Arra
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Distinct macular thickness changes after femtosecond laser-assisted cataract surgery of age-related cataract and myopia with cataract. Sci Rep 2018; 8:3279. [PMID: 29459782 PMCID: PMC5818511 DOI: 10.1038/s41598-018-21698-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/08/2018] [Indexed: 12/02/2022] Open
Abstract
Cataract surgery can cause macular thickness change. We used optical coherence tomography (OCT) to assess the macular thickness of different regions after femtosecond laser–assisted cataract surgery of age-related cataracts (ARC) and myopia cases with cataract (myopia group). Fifty eyes of 50 patients in ARC group and fifty eyes of 50 patients in myopia with cataract group were included. All study underwent femtosecond laser–assisted cataract surgery and macular thickness of was measured at pre-operation and 1 week, 1 month after surgery. There are significant differences of foveal thickness (P = 0.02), foveal volume (P = 0.02) and average retinal thickness (P = 0.02) between two groups before operation. In the myopia group, statistically significant differences were not found in postoperative macular thickness as compared with ARC group. There are differences in macular thickness between pre-operation and 1 month after operation when compared with nasal outer macular ring thickness (P = 0.022), foveal volume (P = 0.005) and average retinal thickness (P = 0.012) in ARC group. The study suggest that femtosecond laser–assisted cataract extraction is safe in myopia group that did not cause significant increase of macular thickness. However, an increased post-operative local macular thickness was recoded while comparing macular thickness with the baseline in ARC group.
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[LenSx® femto-LASIK, FEMTO LDV Z4® femto-LASIK, and PRK : Comparison of refractive results and an analysis of complications]. Ophthalmologe 2017; 115:928-940. [PMID: 29085999 DOI: 10.1007/s00347-017-0598-4] [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: 10/18/2022]
Abstract
BACKGROUND The aim of this study is to evaluate three refractive procedures: LenSx® (Alcon, Fort Worth, TX, USA) femto-laser in situ keratomileusis (LASIK), FEMTO LDV Z4® (Ziemer, Port, Switzerland) femto-LASIK, and photorefractive keratectomy (PRK) in terms of refractive outcome, perioperative complications, pain, and patient satisfaction. MATERIALS AND METHODS Data of 168 eyes (myopic n = 84) were included in this retrospective study. Of these, 54 eyes (n = 27, 33.85 ± 7.64 years) were treated with LenSx® femto-LASIK, 60 eyes (n = 30, 35.03 ± 7.46 years) with FEMTO LDV Z4® femto-LASIK, and 54 eyes (n = 27, 33.24 ± 8.52 years) with PRK. Photoablation was induced by a MEL80 Excimerlaser (Zeiss, Oberkochen, Germany). The corrected (Vsc) and uncorrected (Vcc) distance subjective visual acuity, corneal topography (Pentacam® HR; Wetzlar, Germany), and objective astigmatism (ARK-760A Refractometer ; Nidek, Fremont, CA, USA) were measured preoperatively, and 1 day, 1 week, 1 month, and 3 months postoperatively. Subjective pain (verbal rating scale) and patient satisfaction were also recorded. RESULTS Subjective Vsc showed significantly better results in both femto-LASIK cohorts compared to PRK (p < 0.05) 1 day and 1 week postoperatively. There was no significant difference between the groups in terms of spherical equivalent and astigmatism 3 months postoperatively. The LenSx® femto-LASIK caused flap complications. The highest patient satisfaction results were shown in the LDV Z4® group, followed by the LenSx® and PRK cohorts (p = 0.072). LDV Z4® femto-LASIK showed the lowest pain score 1 day postoperatively (p < 0.001). There was no significant correlation between target refraction and preoperative corneal thickness and astigmatism. DISCUSSION Femtosecond laser-assisted LASIK is an effective procedure enabling rapid rehabilitation of visual acuity with low postoperative pain compared to PRK. There is no difference between the three techniques regarding refractive outcome after 3 months follow-up. LDV Z4® femto-LASIK can be recommended, if available, due to its low intraoperative complication rate and higher patient satisfaction compared to LenSx® femto-LASIK.
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Avetisov KS, Bol'shunov AV, Avetisov SE, Yusef YN, Ivanov MN, Sobol EN, Sakalova ED. [Hybrid (femtosecond laser-assisted) phaco surgery and the state of the macula]. Vestn Oftalmol 2017; 133:97-102. [PMID: 28980573 DOI: 10.17116/oftalma2017133497-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The review covers different aspects of the impact of femtosecond laser-assisted cataract surgery on the state of the macular zone of the retina. Literature search has revealed inconsistency of the published data and indicated the need for a more detailed study of this problem.
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Affiliation(s)
- K S Avetisov
- Research Institute of Eye Disease, 11 A,B, Rossolimo St., Moscow, Russia, 119021
| | - A V Bol'shunov
- Research Institute of Eye Disease, 11 A,B, Rossolimo St., Moscow, Russia, 119021
| | - S E Avetisov
- Research Institute of Eye Disease, 11 A,B, Rossolimo St., Moscow, Russia, 119021; First Moscow State Medical University, Ophthalmology Department, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russia, 119991
| | - Y N Yusef
- Research Institute of Eye Disease, 11 A,B, Rossolimo St., Moscow, Russia, 119021
| | - M N Ivanov
- Research Institute of Eye Disease, 11 A,B, Rossolimo St., Moscow, Russia, 119021
| | - E N Sobol
- Federal Scientific Research Centre 'Crystallography and Photonics' of the Russian Academy of Sciences, 59 Leninskiy prospekt, Moscow, Russia, 119333
| | - E D Sakalova
- Research Institute of Eye Disease, 11 A,B, Rossolimo St., Moscow, Russia, 119021
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Liu M, Wang J, Zhong W, Wang D, Zhou Y, Liu Q. Impact of Suction Loss During Small Incision Lenticule Extraction (SMILE). J Refract Surg 2016; 32:686-692. [DOI: 10.3928/1081597x-20160608-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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Correlation Between Corneal Button Size and Intraocular Pressure During Femtosecond Laser-Assisted Keratoplasty. Cornea 2016; 35:383-7. [PMID: 26751991 DOI: 10.1097/ico.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate changes in intraocular pressure (IOP) in recipient and donor eyes during femtosecond laser-assisted keratoplasty (FLAK) and to assess for differences in the diameter of trephinated corneal buttons according to changes in pressure. MATERIALS AND METHODS Twenty porcine whole eyes (recipient model) and 20 porcine-corneoscleral rims (donor model) were prepared, and anterior chamber pressures were measured using a fiberoptic sensing device (Opsens, Quebec, Canada) during the femtosecond laser corneal cutting process. To determine the diameter of corneal buttons, 10 porcine whole eyes (recipient model) and 12 corneoscleral rims (donor model) of each baseline IOP were cut with the femtosecond laser programmed to the following pattern: "vertical side cut"; 1200 μm (depth), 8 mm (diameter). Digital photographs were obtained using microscopy and subsequently analyzed. RESULTS The IOP (mean ± SD) for the recipient model was 10.2 (±0.9) mm Hg at baseline and ranged from 96.6 (±4.5) to ∼138.4 (±3.8) mm Hg during the corneal cutting process. This shows that the maximum IOP during FLAK increased 13.5 times compared with baseline. In the donor model, the mean pressure elevation from baseline artificial anterior chamber (AAC) pressure to corneal cutting was 15.8 (±5.4) mm Hg. This showed a positive correlation with baseline IOP [correlation coefficient (CC) = 0.827, P = 0.006]. As the baseline IOP in the recipient eye increased, trephinated corneal button size was reduced by up to 3.9% in diameter (CC = -0.945, P = 0.015). In addition, in donor eyes, the diameter was decreased by up to 11.7% as the baseline AAC pressure increased (CC = -0.934, P = 0.006). CONCLUSIONS During the FLAK procedure, the IOP increases in both recipient and donor eyes. The diameter of the trephinated donor and recipient corneal buttons was decreased as the initial baseline IOP increased. Ophthalmic surgeons can determine the AAC pressure based on the baseline IOP in the recipient patient.
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Williams GP, Ang HP, George BL, Liu YC, Peh G, Izquierdo L, Tan DT, Mehta JS. Comparison of intra-ocular pressure changes with liquid or flat applanation interfaces in a femtosecond laser platform. Sci Rep 2015; 5:14742. [PMID: 26439499 PMCID: PMC4593965 DOI: 10.1038/srep14742] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/05/2015] [Indexed: 02/06/2023] Open
Abstract
Cataract surgery is the most common surgical procedure and femtosecond laser assisted cataract surgery (FLACS) has gained increased popularity. FLACS requires the application of a suction device to stabilize the laser head and focus the laser beam accurately. This may cause a significant escalation in intra-ocular pressure (IOP), which poses potential risks for patients undergoing cataract surgery. In this study we aimed to assess the effect of the Ziemer LDV Z8 femtosecond cataract machine on IOP. We demonstrated through a porcine model that IOP was significantly higher with a flat interface but could be abrogated by reducing surgical compression and vacuum. Pressure was lower with a liquid interface, and further altering angulation of the laser arm could reduce the IOP to 36 mmHg. A pilot series in patients showed comparable pressure rises with the porcine model (30 mmHg). These strategies may improve the safety profile in patients vulnerable to high pressure when employing FLACS with the Ziemer LDV Z8.
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Affiliation(s)
- G P Williams
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore
| | - H P Ang
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - B L George
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Y C Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - G Peh
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | | | - D T Tan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - J S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
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31
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A Comparison of Different Operating Systems for Femtosecond Lasers in Cataract Surgery. J Ophthalmol 2015; 2015:616478. [PMID: 26483973 PMCID: PMC4592914 DOI: 10.1155/2015/616478] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/06/2015] [Accepted: 06/23/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of femtosecond lasers is potentially a major shift in the way we approach cataract surgery. The development of increasingly sophisticated intraocular lenses (IOLs), coupled with heightened patient expectation of high quality postsurgical visual outcomes, has generated the need for a more precise, highly reproducible and standardized method to carry out cataract operations. As femtosecond laser-assisted cataract surgery (FLACS) becomes more commonplace in surgical centers, further evaluation of the potential risks and benefits needs to be established, particularly in the medium/long term effects. Healthcare administrators will also have to weigh and balance out the financial costs of these lasers relative to the advantages they put forth. In this review, we provide an operational overview of three of five femtosecond laser platforms that are currently commercially available: the Catalys (USA), the Victus (USA), and the LDV Z8 (Switzerland).
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Wavefront-optimized laser in situ keratomileusis with the Allegretto Wave Eye-Q excimer laser and the FEMTO LDV Crystal Line femtosecond laser: 6 month visual and refractive results. Cont Lens Anterior Eye 2015; 38:245-9. [DOI: 10.1016/j.clae.2015.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 11/20/2022]
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Ibarz M, Hernández-Verdejo JL, Bolívar G, Tañá P, Rodríguez-Prats JL, Teus MA. Porcine Model to Evaluate Real-Time Intraocular Pressure During Femtosecond Laser Cataract Surgery. Curr Eye Res 2015; 41:507-12. [PMID: 26016665 DOI: 10.3109/02713683.2015.1023459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the changes in intraocular pressure (IOP) in porcine eyes during femtosecond laser-assisted cataract surgery using a liquid-optic interface system. MATERIALS AND METHODS Femtosecond laser cataract surgery with the Catalys™ was performed on freshly enucleated porcine eyes in Oftalvist Moncloa, Madrid, Spain. Capsulorhexis and lens fragmentation were completed in all the eyes without complications. IOP was measured with a reusable blood pressure transducer connected by direct cannulation to the anterior chamber, recording data before suction (basal), at the beginning of the suction phase, every five seconds during femtosecond procedure and after the removal of the suction ring from the eye. RESULTS Nine porcine eyes were used in this study. Basal IOP before suction was 5.67 ± 2.39 mmHg, rising to 20.33 ± 4.18 mmHg at the beginning of the suction phase (p < 0.001). During femtosecond procedure, pressure reached a value of 19.74 ± 4.31 mmHg, remaining stable during the entire process. The IOP recorded prior to removal of the suction ring was 21.00 ± 6.93 mmHg, returning to basal values in all the eyes after the suction ring was removed, with no statistical differences between basal and post-suction IOPs. Total femtosecond procedure time was 125.9 ± 15.9 s. CONCLUSIONS Real-time IOP can be measured during surgery using a transducer connected to the anterior chamber. The results showed a significant increase in IOP during the procedure due to the pressure exerted by the suction ring but not by the effect of the femtosecond laser.
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Affiliation(s)
- Marta Ibarz
- a Hospital Moncloa, Oftalvist Madrid , Madrid , Spain
| | | | - Gema Bolívar
- c Hospital Príncipe de Asturias , Alcalá de Henares, Madrid , Spain
| | - Pedro Tañá
- d Clínica Vistahermosa, Oftalvist Alicante , Alicante , Spain , and
| | | | - Miguel A Teus
- e Hospital Príncipe de Asturias, Universidad de Alcalá de Henares , Madrid , Spain
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Reinstein DZ, Carp GI, Lewis TA, Archer TJ, Gobbe M. Outcomes for Myopic LASIK With the MEL 90 excimer laser. J Refract Surg 2015; 31:316-21. [PMID: 25974970 DOI: 10.3928/1081597x-20150423-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/16/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual outcomes of myopic LASIK performed with the MEL 90 excimer laser (Carl Zeiss Meditec AG, Jena, Germany) using the Triple-A profile with a 500-Hz pulse rate. METHODS Retrospective analysis of the first 286 myopic LASIK procedures (147 patients) by two experienced surgeons in which the VisuMax femtosecond laser and MEL 90 excimer laser (Carl Zeiss Meditec) were used following a standardized surgical technique. Inclusion criteria were preoperative spherical equivalent refraction (SEQ) up to -10.38 diopters (D), cylinder up to 5.00 D, and corrected distance visual acuity (CDVA) of 20/25 or better. No nomogram adjustments were made. Patients were observed for 3 months. Flap thickness was between 80 and 110 µm and optical zone was between 6 and 7 mm. Standard outcomes analysis was performed. RESULTS Preoperatively, mean SEQ was -3.83 ± 1.83 D (range: -0.13 to -10.38 D) and mean cylinder was -0.94 ± 0.86 D (range: 0.00 to -5.00 D). Mean age was 36.4 years (range: 18.2 to 74.1 years) with 50% female patients. Of this population, 138 eyes were treated by one surgeon and 148 eyes by another. The mean predictability of SEQ was -0.13 ± 0.34 D (range: -1.00 to +1.00 D). Postoperative SEQ was ± 0.50 D in 88% and ± 1.00 D in 100% of eyes. Preoperative CDVA was 20/20 or better in 97% of eyes. Postoperative uncorrected distance visual acuity was 20/20 or better in 92% and 20/25 or better in 99% of eyes. One line of CDVA was lost in 6% of eyes and no eyes lost two or more lines. There was statistically significant improvement in mesopic contrast sensitivity (CSV-1000) at 3 (P = .021), 6, 12, and 18 (all P ≤.001) cycles per degree. CONCLUSIONS The MEL 90 excimer laser using the Triple-A ablation profile with a 500-Hz pulse rate was found to achieve a small but real increase in contrast sensitivity and high efficacy for myopia up to -10.00 D and cylinder up to 5.00 D without the need for a nomogram adjustment.
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Liu HH, Hu Y, Cui HP. Femtosecond laser in refractive and cataract surgeries. Int J Ophthalmol 2015; 8:419-26. [PMID: 25938066 DOI: 10.3980/j.issn.2222-3959.2015.02.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/15/2014] [Indexed: 11/02/2022] Open
Abstract
In the past few years, 9 unique laser platforms have been brought to the market. As femtosecond (FS) laser-assisted ophthalmic surgery potentially improves patient safety and visual outcomes, this new technology indeed provides ophthalmologists a reliable new option. But this new technology also poses a range of new clinical and financial challenges for surgeons. We provide an overview of the evolution of FS laser technology for use in refractive and cataract surgeries. This review describes the available laser platforms and mainly focuses on discussing the development of ophthalmic surgery technologies.
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Affiliation(s)
- Han-Han Liu
- Department of Ophthalmology, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China
| | - Ying Hu
- Department of Ophthalmology, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China
| | - Hong-Ping Cui
- Department of Ophthalmology, Shanghai East Hospital Affiliated to Tongji University, Shanghai 200120, China
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Reinstein DZ, Carp GI, de Benedictis D, Archer TJ, Gobbe M, Khan R, von Borch M. Standardization of laser in situ keratomileusis surgical technique evaluated by comparison of procedure time between 2 experienced surgeons. J Cataract Refract Surg 2015; 41:1004-8. [DOI: 10.1016/j.jcrs.2014.08.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
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Zhang J, Zhou Y, Zheng Y, Liu Q, Zhai C, Wang Y. Effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis. J Cataract Refract Surg 2014; 40:1994-2001. [DOI: 10.1016/j.jcrs.2014.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 10/24/2022]
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Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. EYE AND VISION (LONDON, ENGLAND) 2014; 1:3. [PMID: 26605350 PMCID: PMC4604118 DOI: 10.1186/s40662-014-0003-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022]
Abstract
This review summarizes the current status of the small incision lenticule extraction (SMILE) procedure. Following the early work by Sekundo et al. and Shah et al., SMILE has become increasingly popular. The accuracy of the creation of the lenticule with the VisuMax femtosecond laser (Carl Zeiss Meditec) has been verified using very high-frequency (VHF) digital ultrasound and optical coherence tomography (OCT). Visual and refractive outcomes have been shown to be similar to those achieved with laser in situ keratomileusis (LASIK), notably in a large population reported by Hjortdal, Vestergaard et al. Safety in terms of the change in corrected distance visual acuity (CDVA) has also been shown to be similar to LASIK. It was expected that there would be less postoperative dry eye after SMILE compared to LASIK because the anterior stroma is disturbed only by the small incision, meaning that the anterior corneal nerves should be less affected. A number of studies have demonstrated a lower reduction and faster recovery of corneal sensation after SMILE than LASIK. Some studies have also used confocal microscopy to demonstrate a lower decrease in subbasal nerve fiber density after SMILE than LASIK. The potential biomechanical advantages of SMILE have been modeled by Reinstein et al. based on the non-linearity of tensile strength through the stroma. Studies have reported a similar change in Ocular Response Analyzer (Reichert) parameters after SMILE and LASIK, however, these have previously been shown to be unreliable as a representation of corneal biomechanics. Retreatment options after SMILE are discussed. Tissue addition applications of the SMILE procedure are also discussed including the potential for cryo-preservation of the lenticule for later reimplantation (Mohamed-Noriega, Angunawela, Lim et al.), and a new procedure referred to as endokeratophakia in which a myopic SMILE lenticule is implanted into a hyperopic patient (Pradhan et al.). Finally, studies reporting microdistortions in Bowman's layer and corneal wound healing responses are also described.
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Affiliation(s)
- Dan Z Reinstein
- />London Vision Clinic, 138 Harley Street, London, W1G 7LA UK
- />Department of Ophthalmology, Columbia University Medical Center, New York, NY USA
- />Centre Hospitalier National d’Ophtalmologie, Paris, France
| | | | - Marine Gobbe
- />London Vision Clinic, 138 Harley Street, London, W1G 7LA UK
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Intraocular pressure profiles during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg 2014; 40:1784-9. [PMID: 25261391 DOI: 10.1016/j.jcrs.2014.04.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To document the intraocular pressure (IOP) profiles during femtosecond laser-assisted cataract surgery. SETTING Refractive cataract surgery center. DESIGN Prospective case series. METHODS Intraocular pressure was measured using a handheld portable applanation tonometer (Tono-Pen Avia) during femtosecond laser-assisted cataract surgery using the Victus platform. RESULTS Forty-one eyes of 35 patients were recruited. The mean age of the patients was 70.5 years ± 8.2 (SD) (range 51 to 85 years). The mean IOP before, during, and after suction was 17.2 ± 3.2 mm Hg (range 10 to 23 mm Hg), 42.1 ± 10.8 mm Hg (range 20 to 55 mm Hg), and 13.8 ± 3.4 mm Hg (range 9 to 25 mm Hg), respectively. The mean difference between IOP before and during suction was 25.0 ± 11.3 mm Hg (range 5 to 43 mm Hg) (P<.01, Wilcoxon signed-rank test). The mean difference between IOP during and after suction was -28.7 ± 10.8 mm Hg (range -45 to -10 mm Hg) (P<.01, Wilcoxon signed-rank test). The mean suction duration was 216 ± 15 seconds (range 180 to 245 seconds). CONCLUSIONS The increase in IOP during the suction phase of femtosecond laser-assisted cataract surgery was statistically significant compared with the baseline IOP. Caution should be taken in patients with ocular conditions that are vulnerable to IOP fluctuation. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Abstract
PURPOSE OF REVIEW Emerging data in the peer-reviewed literature indicate that femtosecond laser-assisted cataract surgery (LCS) is a well tolerated and effective alternative to conventional phacoemulsification. Initial reports have largely been based on findings from an optimal patient selection. As confidence with the technology has grown, clinical indications have expanded and the benefit of LCS in high-risk patients with complex cataracts is increasingly being considered. RECENT FINDINGS We discuss challenging cataract surgery cases, citing the currently available literature alongside experience from over 3000 completed LCS cases at our centre. SUMMARY Current experience is limited. However, LCS platforms are continuously evolving and improving. The results collected to date would suggest that the precision and safety offered by LCS may improve outcomes in these challenging cases.
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Patient and surgeon experience during laser in situ keratomileusis using 2 femtosecond laser systems. J Cataract Refract Surg 2014; 40:423-9. [PMID: 24461333 DOI: 10.1016/j.jcrs.2013.08.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the subjective experience of patients and surgeons during laser in situ keratomileusis (LASIK) using the Intralase 60 kHz or the Visumax 500 kHz femtosecond laser. SETTING Singapore National Eye Centre, Singapore. DESIGN Prospective randomized clinical study. METHODS In myopic patients, LASIK was performed with the corneal flap created using the 60 kHz laser in 1 eye and the 500 kHz laser in the contralateral eye. Postoperatively, patients completed a standardized validated questionnaire about their subjective intraoperative experiences (eg, light perception, pain, fear). Surgeons reported their intraoperative experiences and preferences. RESULTS Loss of light perception occurred in 50.0% of 60 kHz laser cases and 0% of 500 kHz laser cases during docking and in 63.0% and 0% of cases, respectively, during laser flap creation (P < .0001). The mean pain score with the 60 kHz laser was significantly higher during docking (P < .0001) but not during laser flap cutting (P = .006). Subconjunctival hemorrhage occurred in 67.4% of eyes with the 60 kHz laser and in 2.2% of eyes with the 500 kHz laser (P < .0001). The 500 kHz laser was preferred by 78.3% of patients, while 21.7% preferred the 60 kHz laser (P < .0001). The surgeons preferred the 60 kHz laser in 50.0% of cases and the 500 kHz laser in 8.7% (P < .0001); 41.3% had no preference. CONCLUSIONS Patients preferred surgery with the 500 kHz laser with no loss of light perception, less pain, less fear, and less subconjunctival hemorrhage. Surgeons preferred the 60 kHz laser.
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Rosman M, Hall RC, Chan C, Ang A, Koh J, Htoon HM, Tan DT, Mehta JS. Comparison of efficacy and safety of laser in situ keratomileusis using 2 femtosecond laser platforms in contralateral eyes. J Cataract Refract Surg 2013; 39:1066-73. [DOI: 10.1016/j.jcrs.2013.02.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 02/15/2013] [Accepted: 02/18/2013] [Indexed: 10/26/2022]
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Kanellopoulos AJ, Asimellis G. FS200 femtosecond laser LASIK flap digital analysis parameter evaluation: comparing two different types of patient interface applanation cones. Clin Ophthalmol 2013; 7:1103-8. [PMID: 23807830 PMCID: PMC3685444 DOI: 10.2147/opth.s43396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of a novel LASIK flap patient interface (PI) cone with our reported digital analysis and compare for potential differences with the standard metal and glass PI in flap parameters when used with the Alcon/WaveLight FS200 femtosecond laser. Patients and methods Thirty-six consecutive LASIK patients (72 eyes) subjected to a bilateral femtosecond assisted LASIK procedure with the novel clear cone PI FS200 1505 were examined for flap diameter and flap thickness over the entire flap area via digital analysis performed on intraoperation image (flap diameter) and anterior-segment optical coherence tomography image (flap thickness). This group was compared with an age- and procedure-matched group B from our practice, in which the standard metal and glass PI was employed. Results Horizontal flap diameter for group A (clear cone) was 7.87 mm ± 0.02 mm (range 7.89–7.84 mm) for 8.00 mm programmed, whereas for group B (metal and glass cone) was 7.85 mm ± 0.04 mm (range 7.93–7.80 mm). Likewise, along the vertical line, flap diameter for group A was 7.84 mm ± 0.02 mm (range 7.85–7.80 mm) and for group B was 7.83 mm ± 0.03 mm (range 7.87–7.80 mm). Central flap thickness for group A was 113.29 μm (±1.19 μm) for 110 μm planned, 122.1 μm (±2.10 μm) for 120 μm planned, and 133.50 μm (±0.71 μm) for 130 μm planned. Group B central flap thickness was, accordingly, 112.8 μm (±1.25 μm), 122.4 μm (±2.15 μm), and 132.50 μm (±0.90 μm). The data evaluated (paired group comparisons) between group A and group B did not show statistically significant differences. Conclusion This study indicates that two PIs in use with the FS200 femtosecond laser are safe and have highly reproducible and accurate flap parameter results, such as achieved diameter and flap thickness. The paired group comparisons between the two PIs’ respective data do not show statistically significant differences.
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Affiliation(s)
- A John Kanellopoulos
- LaserVision.gr Eye Institute, Athens, Greece ; New York University School of Medicine, NY, USA
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Abstract
PURPOSE OF REVIEW To review the literature for recent advancements in the femtosecond laser technology with regard to its applications in corneal transplantation and eye banking. RECENT FINDINGS Advancements in corneal surgery have encouraged the use of disease-specific corneal subcomponents, utilized in procedures such as anterior-lamellar keratoplasty and endothelial keratoplasty, instead of traditional transplant procedures to minimize adverse effects of penetrating keratoplasty. Femtosecond laser microkeratomes can precisely create flaps for such transplant procedures, achieve better wound stability, and promote healing by shaped wound configurations. Laser microkeratomes have been compared to traditional mechanical microkeratomes for keratoplasty procedures from various aspects and are superior in some aspects and offer unique capabilities. SUMMARY Femtosecond laser applications in eye banking include preparation of donor and recipient corneas for use in penetrating keratoplasty, anterior-lamellar keratoplasty, and endothelial keratoplasty. Advantages of femtosecond laser microkeratomes include higher precision of the cut, ability to achieve thinner flaps, and wound configurations that allow greater wound stability, shorter recovery time, and less postoperative pain. However, cost and availability at the eye-bank level may hinder widespread and immediate application.
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Vetter JM, Faust M, Gericke A, Pfeiffer N, Weingärtner WE, Sekundo W. Intraocular pressure measurements during flap preparation using 2 femtosecond lasers and 1 microkeratome in human donor eyes. J Cataract Refract Surg 2013; 38:2011-8. [PMID: 23079315 DOI: 10.1016/j.jcrs.2012.05.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/05/2012] [Accepted: 05/08/2012] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate and compare intraocular pressures (IOPs) during flap preparations performed using 2 femtosecond lasers and a mechanical microkeratome in human donor globes. SETTING University Medical Center Mainz, Mainz, and Euroeyes Clinic Stuttgart, Stuttgart, Germany. DESIGN Experimental study. METHODS A cannula was inserted through the optic nerve in human globes. The IOP was obtained continuously during flap preparation using the 60 kHz Intralase femtosecond laser, the 200 kHz Visumax femtosecond laser, or the Amadeus II microkeratome. For each experiment, a normal lamellar flap preparation (regular procedure) and a worst-case procedure (femtosecond laser interface was pressed against globe until docking maneuver was aborted) were performed. RESULTS During the regular procedure, the mean maximum IOP measured was 181.3 mm Hg (range 159.1 to 194.8 mm Hg) with the 60 kHz femtosecond laser, 77.6 mm Hg (range 58.1 to 100.3 mm Hg) with the 200 kHz femtosecond laser, and 198.1 mm Hg (range 162.8 to 299.6 mm Hg) with the microkeratome. During the worst-case procedure, the maximum measured IOP was 319.7 mm Hg (range 299.1 to 341.2 mm Hg) with the 60 kHz laser and 120.4 mm Hg (range 118.1 to 134.7 mm Hg) with the 200 kHz laser. CONCLUSION Maximum IOPs during corneal flap preparations in human enucleated eyes were lower during performance of a regular procedure and a worst-case procedure with the 200 kHz femtosecond laser than with the 60 kHz femtosecond laser and the mechanical microkeratome. FINANCIAL DISCLOSURE Dr. Sekundo is a member of the Scientific Advisory Board of Carl Zeiss Meditec AG, Jena, Germany. No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jan M Vetter
- Departments of Ophthalmology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
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Kerr NM, Abell RG, Vote BJ, Toh T'Y. Intraocular pressure during femtosecond laser pretreatment of cataract. J Cataract Refract Surg 2013; 39:339-42. [PMID: 23312148 DOI: 10.1016/j.jcrs.2012.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/08/2012] [Accepted: 12/03/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the course of intraocular pressure (IOP) during femtosecond laser pretreatment to cataract surgery. SETTING Launceston Eye Institute, Tasmania, Australia. DESIGN Interventional prospective study. METHODS Femtosecond laser pretreatment was performed using the Catalys Precision Laser System with Liquid Optics Interface. The IOP was measured using a rebound tonometer (iCare PRO) during different stages of surgery and analyzed by number of docking attempts, vacuum time, treatment time, and central corneal thickness (CCT). RESULTS The mean baseline IOP in the 25 eyes was 17.5 mm Hg ± 2.4 (SD). During vacuum application, the mean IOP rise was 11.4 ± 3.3 mm Hg. Peak IOPs were recorded immediately after laser capsulotomy and lens fragmentation (mean 36.0 ± 4.4 mm Hg; mean increase from baseline 18.5 ± 4.7 mm Hg) and remained above baseline 2 minutes after the procedure (26.6 ± 4.0 mm Hg) (P<.001). Multiple regression analysis found no association between IOP rise and number of docking attempts, vacuum time, treatment time, or CCT. CONCLUSION Femtosecond laser pretreatment was associated with a mean peak increase in IOP of 18.5 mm Hg from baseline and appeared to be safe and well tolerated.
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Affiliation(s)
- Nathan M Kerr
- Launceston Eye Institute, Launceston, Tasmania, Australia.
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Schultz T, Conrad-Hengerer I, Hengerer FH, Dick BH. Intraocular pressure variation during femtosecond laser–assisted cataract surgery using a fluid-filled interface. J Cataract Refract Surg 2013; 39:22-27. [DOI: 10.1016/j.jcrs.2012.10.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 10/05/2012] [Accepted: 10/11/2012] [Indexed: 02/03/2023]
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Farjo AA, Sugar A, Schallhorn SC, Majmudar PA, Tanzer DJ, Trattler WB, Cason JB, Donaldson KE, Kymionis GD. Femtosecond lasers for LASIK flap creation: a report by the American Academy of Ophthalmology. Ophthalmology 2012; 120:e5-e20. [PMID: 23174396 DOI: 10.1016/j.ophtha.2012.08.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/07/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To review the published literature to assess the safety, efficacy, and predictability of femtosecond lasers for the creation of corneal flaps for LASIK; to assess the reported outcomes of LASIK when femtosecond lasers are used to create corneal flaps; and to compare the differences in outcomes between femtosecond lasers and mechanical microkeratomes. METHODS Literature searches of the PubMed and Cochrane Library databases were last conducted on October 12, 2011, without language or date limitations. The searches retrieved a total of 636 references. Of these, panel members selected 58 articles that they considered to be of high or medium clinical relevance, and the panel methodologist rated each article according to the strength of evidence. Four studies were rated as level I evidence, 14 studies were rated as level II evidence, and the remaining studies were rated as level III evidence. RESULTS The majority of published studies evaluated a single laser platform. Flap reproducibility varied by device and the generation of the device. Standard deviations in flap thicknesses ranged from 4 to 18.4 μm. Visual acuities and complications reported with LASIK flaps created using femtosecond lasers are within Food and Drug Administration safety and efficacy limits. Of all complications, diffuse lamellar keratitis is the most common after surgery but is generally mild and self-limited. Corneal sensation was reported to normalize by 1 year after surgery. Unique complications of femtosecond lasers included transient light-sensitivity syndrome, rainbow glare, opaque bubble layer, epithelial breakthrough of gas bubbles, and gas bubbles within the anterior chamber. CONCLUSIONS Available evidence (levels I and II) indicates that femtosecond lasers are efficacious devices for creating LASIK flaps, with accompanying good visual results. Overall, femtosecond lasers were found to be as good as or better than mechanical microkeratomes for creating LASIK flaps. There are unique complications that can occur with femtosecond lasers, and long-term follow-up is needed to evaluate the technology fully.
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Affiliation(s)
| | - Alan Sugar
- Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Steven C Schallhorn
- University of California, San Francisco, California; Global Medical Director Optical Express; Gordon-Weiss-Schanzlin Vision Institute, San Diego, California
| | | | - David J Tanzer
- Gordon-Weiss-Schanzlin Vision Institute, San Diego, California
| | | | - John B Cason
- Ophthalmology Clinic, Naval Medical Center, San Diego, California
| | | | - George D Kymionis
- Institute of Vision and Optics (IVO), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
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