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Niknam S, Niknam J, Salouti R, Nowroozzadeh MH. Epithelial thickness map-adjusted transepithelial photorefractive keratectomy for treatment of myopic astigmatism: 12-month results. Int Ophthalmol 2024; 44:252. [PMID: 38907885 DOI: 10.1007/s10792-024-03184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE To evaluate the refractive results of Transepithelial Photorefractive Keratectomy (t-PRK) with the Technolas Teneo2 Excimer laser platform. METHODS In this retrospective comparative interventional case series, a total of 199 patients with myopia ranging from - 1 to - 7 diopters were enrolled and separated into three groups based on their target refraction of zero (group 1), - 0.25 (group 2), and - 0.5 diopters (group 3), respectively. The main outcome measure was post-operative cycloplegic refraction. Trans-PRK was performed using the Technolas Teneo2 Excimer laser. To prevent any remaining epithelium during stromal ablation, we adopted the thickest epithelial point in the 7 mm central map as the reference for Phototherapeutic keratectomy (PTK) depth. Patients were examined three and twelve months after the procedure, and the results were analyzed. RESULTS At the 12-month follow-up, uncorrected distance visual acuity was 20/20 in all patients. However, there was a significant difference in cycloplegic spherical equivalent refraction between the three groups. The 12-month post-operative spherical equivalent refraction was 0.90 ± 0.33 D, 0.79 ± 0.26 D, and 0.60 ± 0.19 D in groups 1, 2, and 3, respectively (P < 0.001; Kruskal-Wallis test). The rates of spherical equivalent refraction of more than 0.75 D were 58.3%, 39.1%, and 9.1% in the 0 D, - 0.25 D, and -0.50 D groups, respectively (P < 0.001; Chi-squared test). CONCLUSIONS The t-PRK with Technolas Teneo2 Excimer laser and epithelial thickness map adjustment of PTK induce a significant amount of residual hyperopia (> 0.75 D) in a large proportion of eyes with a target refraction of 0 or - 0.25, which is significantly reduced by using a target refraction of - 0.5.
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Affiliation(s)
| | - Janan Niknam
- William Carey University of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Ramin Salouti
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz University of Medical Sciences, Poostchi Clinic, Zand Street, Shiraz, 7134997446, Iran
- Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - M Hossein Nowroozzadeh
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz University of Medical Sciences, Poostchi Clinic, Zand Street, Shiraz, 7134997446, Iran.
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Sorkin N, Kaiserman I, Kayal M, Levinger E, Mashour RS, Sela T, Munzer G, Mimouni M. Factors Predicting the Need for Re-treatment After Laser Refractive Surgery in Patients With Mixed Astigmatism. J Refract Surg 2024; 40:e73-e78. [PMID: 38346124 DOI: 10.3928/1081597x-20231212-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE To identify risk factors that increase the likelihood of re-treatment following refractive surgery in patients with mixed astigmatism. METHODS This was a retrospective study including patients who underwent either laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between 2000 and 2019 and had mixed astigmatism (spherical error of +0.50 D or greater and spherical equivalent of less than 0.00 diopters [D]). Patients were divided into two groups according to whether they underwent re-treatments during the study period. RESULTS Overall, 785 eyes (785 patients) were included. In total, 5.2% of the eyes (n = 41) underwent re-treatment. The re-treatment group was more likely to have preoperative high astigmatism (80.5% vs 48.3%, P < .001), moderate to high hyperopia (36.6% vs 22.3%, P = .035), and to have undergone surgery earlier during the study period (P < .001). They were also more likely to have undergone surgery using the Wave-Light EX200 rather than the EX500 laser platform (Alcon Laboratories, Inc) (P < .001), have a treated optical zone of 6 mm rather than 6.5 mm (P < .001 for both), and their maximum ablation depth was greater (P < .001). There was no difference between the re-treatment and control groups regarding procedure type (PRK vs LASIK). Binary logistic regression found preoperative high astigmatism (odds ratio = 3.97, P < .001) and the type of laser platform used (EX200, odds ratio = 7.78, P < .001) as the only independent factors associated with re-treatment. CONCLUSIONS Re-treatment rates following correction of mixed astigmatism were 5.2% over 20 years. Use of a sixth-generation laser platform significantly reduced the risk of re-treatment. Presence of high astigmatism is a significant risk factor for re-treatment. There was no difference in retreatment risk between PRK and LASIK. [J Refract Surg. 2024;40(2):e73-e78.].
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Abdel-Radi M, Shehata M, Mostafa MM, Aly MOM. Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques. Eye (Lond) 2023; 37:1545-1552. [PMID: 35864163 PMCID: PMC10219954 DOI: 10.1038/s41433-022-02174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. METHODS A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. RESULTS Preoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. CONCLUSION The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. CLINICAL TRIALS REGISTRY (Clinical Trials.gov Identifier): NCT04710082.
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Affiliation(s)
| | - Mohamed Shehata
- Department of Ophthalmology, Assiut University, Assiut, Egypt
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Abdel-Radi M, Rateb M, Saleh MGA, Aly MOM. Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism. EYE AND VISION (LONDON, ENGLAND) 2023; 10:7. [PMID: 36855211 PMCID: PMC9976533 DOI: 10.1186/s40662-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/08/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Conventional mechanical or alcohol-assisted photorefractive keratectomy (PRK) techniques for correction of hyperopia and hyperopic astigmatism were associated with inconsistent results. The aim of this study is to evaluate the 12-month visual and refractive outcomes of the relatively new single-step transepithelial photorefractive keratectomy (TE-PRK) for moderate hyperopia and hyperopic astigmatism. METHODS This is a prospective interventional study. Forty-eight eyes of 30 patients with moderate hyperopia or hyperopic astigmatism with a cycloplegic spherical equivalent refraction (SEQ) between 2.0 and 4.5 diopters (D) underwent single-step StreamLight® TE-PRK using EX500 excimer laser (Alcon Laboratories, USA). The main outcome measures were recorded at 6 and 12 months postoperatively including assessment of logarithm of the minimum angle resolution (logMAR) uncorrected and corrected distance visual acuity (UDVA, CDVA), cycloplegic refraction, corneal topographic changes as well as post-PRK peripheral haze grading. RESULTS The mean preoperative cycloplegic SEQ was significantly reduced from 3.21 ± 0.61 D to 0.35 ± 0.04 D and 0.41 ± 0.04 D at 6 and 12 months, respectively (P < 0.001). The mean preoperative UDVA significantly improved from 0.53 ± 0.02 logMAR to 0.07 ± 0.01 logMAR and 0.08 ± 0.01 logMAR at 6 and 12 months, respectively (P < 0.001) while the mean preoperative logMAR CDVA showed non-significant change over time throughout the study (P = 0.135). At the end of the study, 41 eyes (85.4%) achieved UDVA of 20/25 or better and no eye lost any lines of CDVA. Thirty-eight eyes (79.1%) had a postoperative cycloplegic cylinder of 0.5 D or less at 12 months. The mean preoperative mean keratometry showed significant increase at 6 and 12 months postoperatively (P < 0.001) while there was no significant change between the two postoperative visits denoting topographic stability (P = 0.058). The mean postoperative Q value at 6 and 12 months showed a significant prolate shift (P < 0.001). No haze was observed in 62.5% and 85.4% of the enrolled eyes at 6 and 12 months, respectively. CONCLUSIONS Single-step StreamLight® TE-PRK for moderate hyperopia and hyperopic astigmatism achieved acceptable visual and refractive outcomes. TRIAL REGISTRATION (Clinicaltrials.gov): NCT05261685, 2 March 2022, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05261685.
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Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516, Assiut, Egypt.
| | - Mahmoud Rateb
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
| | - Mohamed G. A. Saleh
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
| | - Mohamed Omar M. Aly
- grid.411437.40000 0004 0621 6144Department of Ophthalmology, Assiut University, Assiut University Hospital, 6th Floor, 71516 Assiut, Egypt
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Chang JY, Lin PY, Hsu CC, Liu CJL. Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia. J Chin Med Assoc 2022; 85:145-151. [PMID: 34861667 DOI: 10.1097/jcma.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
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Affiliation(s)
- Jin-Yu Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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December consultation #5. J Cataract Refract Surg 2021; 47:1601-1602. [PMID: 34846341 DOI: 10.1097/01.j.jcrs.0000805124.76974.4b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tangmonkongvoragul C, Supalaset S, Tananuvat N, Ausayakhun S. Two-Step Transepithelial Photorefractive Keratectomy with WaveLight EX500 Platform for Adolescents and Adults with Low to Moderate Myopia: A 12-Month Comparative Evaluation. Clin Ophthalmol 2021; 15:4109-4119. [PMID: 34675478 PMCID: PMC8520963 DOI: 10.2147/opth.s336727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the visual and refractive results obtained after two-step TransPRK using an EX500 excimer laser for low to moderate myopic correction in adolescents and adults. Patients and Methods Retrospectively, 91 eyes of 52 patients were categorized into four groups based on age and level of myopia. The demographics, data of efficacy, safety, predictability, stability, and post-operative complications were evaluated at 1, 3, 6, and 12 months post-operatively. Results At 1-month, adolescents with low myopia achieved the highest mean efficacy index (P =0.034). The efficacy indices continuously increased during the 1-year follow-up in all groups, except in adolescents with moderate myopia. The highest safety and efficacy indices were recorded in adolescents with low myopia at 1-year. Post-operative spherical equivalent within ±0.50 D at 1 year was 48.75% of all treated eyes; however, the final mean refractive spherical equivalent (MRSE) was under-corrected in all groups. By month 3, the percentage of eyes that had grade 0.5 haze was most prevalent in adolescents with moderate myopia (P <0.001). Conclusion two-step TransPRK using an EX500 proved to be an effective, predictable, stable and safe procedure for the correction of low to moderate myopia with or without astigmatism at 1 year. Adolescents with low myopia achieved the best-post-operative UDVA, efficacy and safety indices. Adolescents tolerated night visual problems and dry eye symptoms better than adults.
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Affiliation(s)
- Chulaluck Tangmonkongvoragul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,CMU LASIK Center, Center of Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sumet Supalaset
- Department of Ophthalmology, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Napaporn Tananuvat
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,CMU LASIK Center, Center of Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,CMU LASIK Center, Center of Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Wasser LM, Koppel JH, Zadok D, Berkowitz L, Abulafia A, Heiman E, Aryan A, Roditi E, Weill Y. Pediatric Ocular Injury Due to Hand Sanitizer Exposure: An Emerging Hazard. Pediatr Emerg Care 2021; 37:462-465. [PMID: 34116551 DOI: 10.1097/pec.0000000000002468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The objective of this study was to describe the incidence and severity of ocular exposure to alcohol-based hand rub (ABHR) in children presenting to a tertiary medical center during the severe acute respiratory syndrome coronavirus 2 pandemic. METHODS A retrospective single-center observational study conducted from February 21, 2020, to October 11, 2020. Subjects 10 years or younger who presented with ABHR-induced ocular injury were included. The same period from 2019 was studied and a comparison was performed between the 2 years. Outcome measures included the number of subjects with ocular injury due to ABHR, extent of ocular epithelial defects, length of hospitalization and time to resolution. RESULTS A total of 9 patients presented to the Pediatric Emergency Department after sustaining ocular chemical injuries from ABHR during this period. Treatment included immediate irrigation followed by topical antibiotics, steroids, and lubrication. Six children were discharged and followed as outpatients with no reported adverse ocular sequelae. Three patients exhibited epithelial defects involving 85% to 100% of the cornea, 30% to 75% of the conjunctiva and required inpatient treatment ranging from 4 to 11 days. All patients experienced a complete resolution of the ocular epithelial defects after 12 to 19 days. No long-term irreversible damage was observed and visual acuity returned to normal in all patients. CONCLUSIONS The utilization of ABHR during the severe acute respiratory syndrome coronavirus 2 pandemic resulted in childhood ocular injury. Prompt treatment led to good visual outcomes. These products should be regarded as potentially toxic and stored out of the reach of young children.
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Affiliation(s)
- Lauren M Wasser
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
| | - Jordanna H Koppel
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer
| | - David Zadok
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
| | - Liron Berkowitz
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
| | - Adi Abulafia
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
| | - Eyal Heiman
- Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ahmad Aryan
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
| | - Eduardo Roditi
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
| | - Yishay Weill
- From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem
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Surface ablation outcomes in high myopia with different epithelium removal techniques. J Cataract Refract Surg 2021; 47:1175-1182. [PMID: 34468455 DOI: 10.1097/j.jcrs.0000000000000611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the outcomes of alcohol-assisted photorefractive keratectomy (PRK) when compared with transepithelial PRK (TransPRK) using 2 software programs, with or without SmartPulse Technology (SmartSurfACE), in high myopia. SETTING Vissum Miranza, University Miguel Hernandez, Alicante, Spain. DESIGN Retrospective, consecutive, case series. METHODS High myopic eyes undergoing surface ablation were included. The main inclusion criteria were preoperative spherical equivalent (SE) above -5.50 diopters (D) and no other ocular surgeries. Mitomycin-C was used in all the surgeries. The outcomes were analyzed using the 6-month follow-up visit data. RESULTS 135 eyes were included. Alcohol-assisted PRK was performed in 65 eyes, transepithelial PRK (TransPRK1) in 32 eyes, and TransPRK2 in 38 eyes. The mean all groups preoperative sphere, cylinder, and SE were -6.00 ± 0.87 D, -1.13 ± 1.03 D, and -6.57 ± 0.69 D, respectively. The mean efficacy index in the alcohol-assisted PRK group was 0.91 ± 0.18 compared with 0.98 ± 0.1 and 0.98 ± 0.12 in the TransPRK1 and TransPRK2, respectively (P = .027). The mean safety index in alcohol-assisted PRK was 0.99 ± 0.05, whereas it was 1 ± 0.06 in the TransPRK1 and 0.99 ± 0.08 in the TransPRK2 (P = .780). A final SE of ± 0.50 D was achieved in 96.9% of eyes in the TransPRK1 group and in 100% eyes in the TransPRK2 group compared with 73.8% in the alcohol-assisted PRK group (P < .001). CONCLUSIONS Surface ablation with the Amaris 500 excimer laser with flying spot pattern and mitomycin C use showed adequate refractive outcomes in high myopia correction in the 3 groups. TransPRK with or without SmartPulse Technology achieved statistically significant better outcomes than alcohol-assisted PRK in refractive predictability and efficacy.
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Abdelwahab SM, Salem MH, Elfayoumi MA. Single-Step Transepithelial Photorefractive Keratectomy in Low to Moderate Myopia: A One-Year Follow-Up Study. Clin Ophthalmol 2021; 15:3305-3313. [PMID: 34408389 PMCID: PMC8363478 DOI: 10.2147/opth.s326048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate predictability, safety, efficacy, and visual outcome of StreamLight. ™ (SL.), the newly released single-step transepithelial photorefractive keratectomy platform by Alcon WaveLight™ (WL). Methods In this prospective cohort study, photorefractive keratectomy (PRK) was conducted on 500 eyes of 250 patients seeking myopic refractive vision correction. The new single-step transepithelial PRK method was applied, using the SL. platform installed in the WL. Ex 500 excimer laser machine. Patients were followed up to monitor intensity and duration of postoperative pain, as well as speed of epithelial healing in the early post-operative period and visual acuity, postoperative refraction and development of postoperative haze for one year post-operatively. Results Average pain duration was 1.5 days, and the mean pain intensity score on a scale of 0–10 was 3.74 + 1.51. Mean postoperative spherical equivalence was 0.01 ± 0.38 D, and the final postoperative uncorrected distance visual acuity (UCDVA) was 20/20 in 98% of eyes included in this study. None of the eyes lost more than one Snellen chart line or developed visually significant postoperative haze during the follow-up period. Conclusion The new SL. platform for transepithelial PRK is a safe, accurate platform, offering an easier early post-operative recovery, with no compromise in final visual outcome. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/_lJS9rzTWDk
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Reitblat O, Gershoni A, Mimouni M, Livny E, Nahum Y, Bahar I. Transepithelial photorefractive keratectomy on the same day of the initial consultation for the correction of myopia. Eur J Ophthalmol 2021; 32:1448-1456. [PMID: 34269097 DOI: 10.1177/11206721211033484] [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: 11/17/2022]
Abstract
PURPOSE To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the first screening visit in comparison with operations scheduled at a following appointment. METHODS Data of consecutive patients with myopia of various degrees, who underwent Trans-PRK, were retrospectively analyzed. Findings were compared between patients who underwent Trans-PRK on the same day of first consultation to patients that underwent surgery at subsequent visits, following initial consultation on a different day. RESULTS The study included 599 eyes treated on the initial visit day and 1936 eyes treated on a subsequent visit. Mean final spherical equivalent was close to emmetropia in both groups (p = 0.183). Efficacy indices were 0.928 ± 0.192 in the initial-visit group and 0.945 ± 0.163 in the second-visit group (p = 0.152). Safety indices were 0.954 ± 0.156 and 0.955 ± 0.151 (p = 0.707), respectively. No differences between the groups were seen in uncorrected visual acuity (UDVA) of ⩾20/20, ⩾20/25, and ⩾20/32. Only the sub-analysis of patients reaching UDVA of 20/40 or better was slightly lower in the first-visit (95.5%) compared with the second-visit group (97.9%, p = 0.001). Results of attempted correction within ±0.50 D were: 63.3% and 69.0%, respectively (p = 0.009). Complications profiles in the two groups were comparable. CONCLUSIONS Trans-PRK completed on the day of the first screening appointment demonstrated a similar safety outcome compared with subsequent-visits procedures, and slightly lower, yet comparable, results regarding efficacy and predictability.
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Affiliation(s)
- Olga Reitblat
- Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
| | - Assaf Gershoni
- Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Eitan Livny
- Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
| | - Yoav Nahum
- Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
| | - Irit Bahar
- Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
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Mimouni M, Kaiserman I, Spierer R, Spierer O, Rabina G, Varssano D, Sorkin N. Factors Predicting the Need for Re-treatment After Laser Refractive Surgery in Patients With High Astigmatism: A Large Database Analysis. J Refract Surg 2021; 37:366-371. [PMID: 34170776 DOI: 10.3928/1081597x-20210226-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify the potential risk factors that increase the likelihood of requiring re-treatment following refractive surgery in patients with high astigmatism (3.00 diopters or greater). METHODS This retrospective study included patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2005 and December 2019 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients with high astigmatism (3.00 diopters or greater) were included and divided into two groups according to whether or not they underwent additional refractive surgery (re-treatment) during the study period. RESULTS Overall, 2,024 eyes (2,024 patients) were included in the final analysis of this study. In total, 3.1% of the eyes (n = 63) underwent re-treatment. Throughout the study period, there was a significant reduction in the 2-year annual re-treatment rates, with a decline from 7.0% for primary surgeries performed in 2005 to 0.0% for primary surgeries performed in 2017 (r =-0.65, P = .015). The re-treatment group had significantly older preoperative age. They were also more likely to be male and have preoperative against-the-rule astigmatism and preoperative mixed astigmatism. Binary logistic regression analysis demonstrated that preoperative age, male gender, mixed astigmatism, and earlier year of surgery were all associated with higher re-treatment rates. CONCLUSIONS The following factors are associated with higher rates of re-treatment in patients with high astigmatism: older preoperative age, male gender, and mixed astigmatism. These factors may be incorporated into nomograms to reduce future re-treatment rates in this population. [J Refract Surg. 2021;37(6):366-371.].
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Fogla R, Luthra G, Chhabra A, Gupta K, Dalal R, Khamar P. Preferred practice patterns for photorefractive keratectomy surgery. Indian J Ophthalmol 2021; 68:2847-2855. [PMID: 33229660 PMCID: PMC7856967 DOI: 10.4103/ijo.ijo_2178_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Over the past two decades, excimer laser-based refractive surgery procedures have been successfully established for their safety and satisfactory visual outcomes. Surface ablation procedures or photorefractive keratectomy (PRK) are practised commonly for the correction of refractive errors including myopia, astigmatism and hyperopia. Satisfactory visual outcomes are achieved in majority of cases, although a very small percentage have issues related to corneal haze, regression, and its associated visual disturbances. To ensure optimal outcomes and to minimize complications, certain keys to success have been designed on the basis of the current review of literature on surface ablation procedures.
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Affiliation(s)
- Rajesh Fogla
- Senior Consultant, Cataract, Cornea and Laser Refractive Surgeon, Director Cornea Clinic, Apollo Hospitals, Hyderabad, Telangana, India
| | - Gaurav Luthra
- Cataract and Refractive Surgeon, Director, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Aishwarya Chhabra
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Krati Gupta
- Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ritika Dalal
- Refractive Surgeon and Dry Eye Specialist, Dr Dalal's Clinic, Mumbai, Maharashtra, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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Sánchez-González JM, Alonso-Aliste F, Borroni D, Amián-Cordero J, De-Hita-Cantalejo C, Capote-Puente R, Bautista-Llamas MJ, Sánchez-González MC, Rodríguez-Calvo-de-Mora M, Rocha-de-Lossada C. Plasma Rich in Growth Factors (PRGF) in Transepithelial Photorefractive Keratectomy (TPRK). J Clin Med 2021; 10:jcm10091939. [PMID: 33946455 PMCID: PMC8124326 DOI: 10.3390/jcm10091939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/13/2023] Open
Abstract
To evaluate the usage of plasma rich in growth factor (PRGF) in transepithelial photorefractive keratectomy (TPRK) in low and moderate myopia, patients who underwent myopic and astigmatism TPRK with PRGF were involved in this retrospective, observational study. Subjects underwent a surgical procedure between February 2019 and June 2019. A three-month follow-up was recorded. Pain score was assessed with a visual analogue scale (0–10) and re-epithelialization time recorded. A total of 48 eyes from 24 patients were recruited. Mean uncorrected distance visual acuity (UDVA) was 20/20.31 (0.00 ± 0.02 LogMAR). A total of 98% of eyes did not change corrected distance visual acuity (CDVA) lines. Two percent of eyes lost one line of CDVA. Preoperative spherical equivalent was −2.67 ± 1.37 D and after three months changed to −0.21 ± 0.34 D, and 2% of eyes changed 0.50 D or more between one and three months. Pain score was 3.29 ± 0.61 (3 to 6) score points at day one and 0.08 ± 0.27 score points at day seven. Finally, re-epithelialization time was 2.50 ± 1.20 days. PRGF addition to conventional refractive treatment such as TPRK seems to alleviate immediate postoperative pain and positively contribute to corneal re-epithelization time.
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Affiliation(s)
- José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
- Department of Ophthalmology, Tecnolaser Clinic Vision, 41018 Seville, Spain; (F.A.-A.); (J.A.-C.)
- Correspondence:
| | - Federico Alonso-Aliste
- Department of Ophthalmology, Tecnolaser Clinic Vision, 41018 Seville, Spain; (F.A.-A.); (J.A.-C.)
| | - Davide Borroni
- The Veneto Eye Bank Foundation, 30174 Venice, Italy;
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
| | - Jonatan Amián-Cordero
- Department of Ophthalmology, Tecnolaser Clinic Vision, 41018 Seville, Spain; (F.A.-A.); (J.A.-C.)
| | - Concepción De-Hita-Cantalejo
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | - María-José Bautista-Llamas
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; (C.D.-H.-C.); (R.C.-P.); (M.-J.B.-L.); (M.C.S.-G.)
| | | | - Carlos Rocha-de-Lossada
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, 04120 Almería, Spain;
- Department of Ophthalmology, University Hospital Virgen de las Nieves, 18014 Granada, Spain
- Department of Ophthalmology, Ceuta Medical Center, 51001 Ceuta, Spain
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Alasmari M, M Alfawaz A. Transepithelial photorefractive keratectomy to treat mild myopia. Int Ophthalmol 2021; 41:2575-2583. [PMID: 33761045 DOI: 10.1007/s10792-021-01816-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the safety and effectiveness of transepithelial photorefractive keratectomy (T-PRK) in patients with mild myopia using the Schwind Amaris 750 s Excimer laser system which take corneal epithelium variability in consideration during ablation. METHODS A prospective case series study of patients with mild myopia with or without astigmatism (spherical equivalent ≤ -3 diopters), who underwent T-PRK as a single-step treatment, was carried out at King Abdulaziz University Hospital, Riyadh between May 2017 and January 2018. The main outcomes included postoperative uncorrected distance visual acuity (UDVA), residual refraction (manifest refraction) and complications. RESULTS A total of 42 patients (84 eyes) underwent bilateral T-PRK with a preoperative spherical equivalent ranging from - 0.75 to - 3.00 D. Median spherical equivalent before Trans-PRK was - 1.75 (- 1.25to - 1.75). The spherical equivalent six months after Trans-PRK was 0.0 (- 0.25 to 0.5). All patients had a postoperative UDVA of 20/20 or better in the last follow-up. Transient postoperative corneal haze was observed in five eyes (6%). CONCLUSION T-PRK appears to be safe and effective in patients who have mild myopia, with or without astigmatism. The normal variation in corneal epithelial thickness seems not to affect the outcomes.
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Affiliation(s)
- Mohammed Alasmari
- Department of Ophthalmology, College of Medicine, King Saud University, Airport Road, P.O. Box 245, Riyadh, 11411, Saudi Arabia
| | - Abdullah M Alfawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Airport Road, P.O. Box 245, Riyadh, 11411, Saudi Arabia.
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Pokroy R, Mimouni M, Sela T, Munzer G, Kaiserman I. Predictors of myopic photorefractive keratectomy retreatment. J Cataract Refract Surg 2019; 43:825-832. [PMID: 28732618 DOI: 10.1016/j.jcrs.2017.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/02/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the factors associated with retreatment after photorefractive keratectomy (PRK) in myopic eyes. SETTING Care-Vision Laser Centers, Tel-Aviv, Israel. DESIGN Retrospective cohort study. METHODS A large database on myopic PRK with mitomycin-C (MMC) performed from 2005 to 2012 was studied. Patients were divided into 2 groups according to whether they had retreatment. Multiple preoperative and intraoperative parameters were analyzed for association with retreatment. RESULTS A total of 9699 eyes of 9699 consecutive patients were studied. The mean age was 25.9 years ± 7.3 (SD); 54.1% were men. The mean preoperative subjective spherical equivalent and astigmatism were -4.30 ± 2.18 diopters (D) (range -0.5 to -13.0 D) and 0.77 ± 0.83 D (range 0 to 6.0 D), respectively. Two hundred twenty-three eyes (2.30%) were retreated. The 2-year retreatment rate decreased from 42 (6.17%) for primary PRK treatments done in 2005 to 2 (0.10%) for primary PRK done in 2012 (R2 = 0.79, P < .001). Multiple binary logistic regression analysis showed that transepithelial PRK, astigmatism equal to or higher than 3.5 D, and surgeon factor significantly increased the odds of retreatment. Additional parameters significant on univariate analysis alone included age older than 40 years, low preoperative sphere, maximum ablation depth less than 45 μm, preoperative corrected distance visual acuity better than 20/20, MMC application longer than 40 seconds, and optical ablation zone smaller than 7.0 mm. CONCLUSION The retreatment incidence of PRK has continued to decrease. High astigmatism and transepithelial PRK were associated with increased myopic PRK retreatment rates.
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Affiliation(s)
- Russell Pokroy
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
| | - Michael Mimouni
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Tzahi Sela
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Gur Munzer
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Igor Kaiserman
- From the Department of Ophthalmology (Pokroy), Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Care-Vision Laser Centers (Sela, Munzer, Kaiserman), Tel-Aviv, the Department of Ophthalmology (Mimouni), Rambam Health Care Campus, Haifa, and the Department of Ophthalmology (Kaiserman), Barzilai Medical Center, Ashkelon, and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Jun I, Kang DSY, Tan J, Choi JY, Heo W, Kim JY, Lee MG, Kim EK, Seo KY, Kim TI. Comparison of clinical outcomes between wavefront-optimized versus corneal wavefront-guided transepithelial photorefractive keratectomy for myopic astigmatism. J Cataract Refract Surg 2019; 43:174-182. [PMID: 28366363 DOI: 10.1016/j.jcrs.2016.11.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate and compare the clinical outcomes, including visual acuity, refractive errors, and aberrations, between aberration-free transepithelial photorefractive keratectomy (PRK) and corneal wavefront-guided transepithelial PRK in eyes with myopic astigmatism. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN Retrospective comparative case series. METHODS Patients with myopic astigmatism were treated with aberration-free transepithelial PRK or corneal wavefront-guided transepithelial PRK using a 1050 Hz high-repetition excimer laser. The safety, efficacy, predictability, and corneal aberrations were compared preoperatively and 1, 2, 3, and 6 months postoperatively. RESULTS The study comprised 188 patients (188 eyes); 91 eyes had aberration-free transepithelial PRK and 97 eyes corneal wavefront-guided transepithelial PRK. Six month after surgery, the mean uncorrected distance visual acuity was comparable (-0.06 logMAR ± 0.07 [SD] aberration-free group; -0.06 ± 0.06 logMAR wavefront-guided group). The safety, efficacy, and predictability of refractive and visual outcomes were also comparable between groups. Corneal total root-mean-square (RMS) higher-order aberrations (HOAs) increased after treatment in both groups, although fewer RMS HOAs were induced in the corneal wavefront-guided group than in the aberration-free group. Spherical aberration increased similarly after treatment in both groups. However, coma and trefoil increased only in the aberration-free group. CONCLUSIONS Aberration-free transepithelial PRK and corneal wavefront-guided transepithelial PRK were safe and effective for correction of myopic astigmatism without difference in visual acuity and refractive outcomes. However, the corneal wavefront-guided profile induced fewer corneal aberrations than the aberration-free profile.
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Affiliation(s)
- Ikhyun Jun
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - David Sung Yong Kang
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Jerry Tan
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Jin Young Choi
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Woon Heo
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Joo Young Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Min Goo Lee
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Eung Kweon Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Kyoung Yul Seo
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Tae-Im Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore.
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Goggin M, Stewart P, Andersons V, Criscenti G. Fine tuning of the default depth and rate of ablation of the epithelium in customized trans-epithelial one-step superficial refractive excimer laser ablation. EYE AND VISION 2019; 6:39. [PMID: 31828176 PMCID: PMC6889590 DOI: 10.1186/s40662-019-0159-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Abstract
Purpose To fine tune the default depth and rate of ablation of the epithelium in cTen™ customized trans-epithelial one-step superficial refractive surgery by the comparison between the attempted post-operative ideal corneal shape and the achieved corneal shape. Methods 88 consecutive eyes in 64 patients undergoing trans-epithelial superficial excimer ablation using the iVis laser Suite for either myopic/astigmatic or hyperopic/astigmatic refractive error. Each patient had at least 3 months of post-operative follow-up. Topographic examination of all eyes was carried out pre-operatively and at least 3 months post-operatively using the Precisio™ surgical topographer. The comparison of these two measurements yielded values for depth, volumes and rates of ablated corneal tissue. By determining the different ablation rates of stroma and epithelium, a refinement of the depth of epithelium to be removed and a refinement of the stromal ablation were calculated. The mathematical model was applied on each one of the 88 clinical cases and the parameters for the fine tuning of the default depth and rate of ablation of the epithelium were determined using the least squares method. Results The calculated pure stromal ablation rate was less than the average epithelium/stroma ablation rate used in planning the treatments by a factor of 0.96. The epithelial thickness predefined ablation assumption used to plan removal of the epithelium was adjusted considering the measured ablation and a radial adjustment function established for the fine tuning of the laser radial efficiency and allowing for the normal thickening of the epithelium in the peripheral cornea. From a clinical point of view, this methodology produces an improvement of the efficacy and a reduction of the variance of the clinical results. Conclusion Comparison of accurately measured pre and postoperative topographies yields accurately established ablation rates of stroma and epithelium in trans-epithelial one step superficial ablation.
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Affiliation(s)
- Michael Goggin
- 1South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, Australia
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Abstract
PURPOSE To compare clinical outcomes of patients undergoing first re-treatment by flap relift with those re-treated by surface ablation on the flap after an initial myopic laser-assisted in situ keratomileusis (LASIK) procedure. METHODS This is a retrospective cohort analysis of consecutive patients who underwent myopic LASIK and required re-treatment between January 2007 and December 2016. Cases re-treated by flap relift were propensity score matched with cases re-treated by surface ablation, and clinical outcomes were compared. One eye from each patient was included. RESULTS A total of 1,234 out of 21,191 cases required re-treatment after myopic LASIK during the follow-up period. Surface ablation was performed in 75% of cases and relift in 25%. Patients re-treated by surface ablation were more commonly male (61.8% vs. 48.1%, P < 0.001), were younger (33.2 ± 7.8 vs. 35.2 ± 10 years, P = 0.005), and had thinner corneas (483 ± 46 vs. 502 ± 43 μm, P < 0.001). Propensity score matching was performed for 416 eyes (208 from each group). After matching, differences in baseline characteristics became nonsignificant (P > 0.05). Cases re-treated by surface ablation had a worse safety index (0.98 ± 0.12 vs. 1.02 ± 0.17, P = 0.049), yet better predictability (0.14 ± 0.6 vs. 0.35 ± 0.5 diopters of deviation, P = 0.009), a similar efficacy index (0.92 ± 0.2 vs. 0.93 ± 0.3, P = 0.814), higher rates of haze (5.8% vs. 0.5%, P = 0.002), and a lower risk for epithelial ingrowth (0.5% vs. 8.2%, P < 0.001). CONCLUSIONS Re-treatment after myopic LASIK with surface ablation resulted in worse safety and higher rates of haze, yet more predictable outcomes and reduced ingrowth rates, compared with re-treatment with flap relift.
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20
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Hecht I, Achiron A, Ben Haim L, Sorin V, Mimouni M, Kaiserman I. Refractive surgery in the late adulthood and adolescent age groups. Graefes Arch Clin Exp Ophthalmol 2019; 257:2057-2063. [PMID: 31218400 DOI: 10.1007/s00417-019-04396-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/17/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Most refractive surgeries are performed in the young-adult age group, and less is known about the clinical outcomes of patients in late adulthood and of adolescents. The purpose of this study was to describe the outcomes of refractive surgery in patients over the age of 60 years and under the age of 18 years compared with a control group of patients aged 20-40 years. METHODS This retrospective cohort analysis consisted of 64,970 consecutive cases of 32,074 patients who underwent laser-assisted in situ keratomileusis and photorefractive keratectomy during a 10-year period in a single center. The populations were characterized, and a comparison of safety, efficacy, and retreatment rates was performed following propensity score matching, separately for hyperopic and myopic treatments. RESULTS Included in the analysis after matching were 143 patients above the age of 60, 608 patients aged < 18, and 2313 patients aged 20-40. Older patients undergoing hyperopic treatments had worse safety (0.95 ± 0.1 versus 0.99 ± 0.2, P = 0.023) and efficacy indices (0.89 ± 0.2 versus 0.97 ± 0.2, P = 0.004) compared with young adults. Lower efficacy was also seen in myopic treatments (0.88 ± 0.3 versus 0.97 ± 0.2, P = 0.001). Higher retreatment rates were also seen among older adults (6.2% versus 2.5%, P = 0.044 in hyperopic treatments, 11% versus 1.1%, P < 0.001 in myopic treatments). In adolescents, the safety and efficacy outcomes were slightly better compared with patients aged 20-40, with lower retreatment rates (1% versus 2.7%, P = 0.001). CONCLUSIONS Refractive surgery in the late adulthood population of our cohort was a relatively safe procedure, yet manifesting lower efficacy and requiring more retreatments. In adolescents, results were comparable to those achieved in young adults.
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Affiliation(s)
- Idan Hecht
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel
| | - Liron Ben Haim
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Vera Sorin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Igor Kaiserman
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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21
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Clinical outcomes of mechanical and transepithelial photorefractive keratectomy in low myopia with a large ablation zone. J Cataract Refract Surg 2019; 45:977-984. [PMID: 31029476 DOI: 10.1016/j.jcrs.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/22/2019] [Accepted: 02/09/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the clinical outcomes, vector parameters, and aberrations between mechanical photorefractive keratectomy (PRK) and transepithelial PRK in eyes with low myopia. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, Korea. DESIGN Retrospective, comparative case series. METHODS Eighty-four eyes of 84 patients with low myopia (≤2.00 diopters) were treated with mechanical or transepithelial PRK (41 eyes and 43 eyes, respectively), with the application of a large optical zone (OZ). Visual acuity, manifest refraction, slitlamp evaluation, autokeratometry, corneal topography, and the evaluation of corneal wavefront aberrations were measured preoperatively and at 1, 3, and 6 months after surgery. The efficacy, predictability, vector parameters, corneal aberrations, and safety at 6 months after surgery were compared between the two treatment groups. RESULTS The mean uncorrected distance visual acuity was comparable, at -0.13 ± 0.05 (SD) and -0.15 ± 0.05, in the mechanical and transepithelial PRK groups, respectively, at 6 months after surgery. The safety and efficacy indices, vector parameters, and aberrometric values were also comparable between the two groups. The OZ was large in both groups (7.09 ± 0.20 mm and 7.12 ± 0.27 mm in the mechanical PRK and transepithelial PRK groups, respectively), and showed no significant difference between groups. The corneal total root-mean-square higher-order aberrations and coma significantly reduced after treatment in both groups, and spherical aberrations significantly decreased after transepithelial PRK. CONCLUSIONS Mechanical and transepithelial PRK with a large OZ provided effective and safe outcomes for the correction of low myopia without differences in visual acuity and refractive outcomes between procedures.
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Zarei-Ghanavati S, Shandiz JH, Abrishami M, Karimpour M. Comparison of mechanical debridement and trans-epithelial myopic photorefractive keratectomy: A contralateral eye study. J Curr Ophthalmol 2019; 31:135-141. [PMID: 31317090 PMCID: PMC6611919 DOI: 10.1016/j.joco.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare clinical outcomes between mechanical debridement photorefractive keratectomy (m-PRK) and trans-epithelial photorefractive keratectomy (t-PRK) in myopic patients. Methods Eighty eyes of 40 myopic patients with age between 18 and 55 years were included in this study. In each patient, one eye was randomly assigned for t-PRK, using the Amaris laser's ORK-CAM software and the other eye for m-PRK, using a spatula. Stromal ablation was done by Schwind Amaris 750S. Uncorrected and best corrected visual acuity (BCVA), refractive outcomes, epithelial healing, pain, and discomfort were compared between the groups on day 1, 3, 7 and month 1, 3, and 6. Results Preoperative spherical equivalent (SE) were −3.97 ± 2.08 diopter (D) and −3.98 ± 2.06 D in m-PRK and t-PRK eyes, respectively (P = 0.981). Operation time was significantly shorter in the t-PRK group than m-PRK (P < 0.001). Postoperative pain was experienced significantly higher in the t-PRK group measured by 11-point numeric scale of pain questionnaire on the first postoperative day (P < 0.001). Photophobia, tearing, and vision fluctuation were also significantly higher in the t-PRK group postoperatively. However epithelial defect size and re-epithelialization time were lower in the t-PRK group (P = 0.012 and P < 0.001, respectively). Postoperative parameters including SE, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and contrast acuity did not show any significant difference between the two groups during all intervals. Conclusions Although epithelial defect size and epithelial healing time were lower in t-PRK, postoperative pain, photophobia, and vision fluctuation were significantly less in the m-PRK group in the first postoperative days. There was no statistically significant difference between the groups after one week, and both mechanical and trans-epithelial techniques were shown to be safe and effective.
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Affiliation(s)
| | - Javad Heravian Shandiz
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Karimpour
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
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23
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Zernii EY, Gancharova OS, Tiulina VV, Zamyatnin AA, Philippov PP, Baksheeva VE, Senin II. Mitochondria-targeted antioxidant SKQ1 protects cornea from oxidative damage induced by ultraviolet irradiation and mechanical injury. BMC Ophthalmol 2018; 18:336. [PMID: 30587174 PMCID: PMC6307206 DOI: 10.1186/s12886-018-0996-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background Cornea protects the eye against natural and anthropogenic ultraviolet (UV) damage and mechanical injury. Corneal incisions produced by UV lasers in ophthalmic surgeries are often complicated by oxidative stress and inflammation, which delay wound healing and result in vision deterioration. This study trialed a novel approach to prevention and treatment of iatrogenic corneal injuries using SkQ1, a mitochondria-targeted antioxidant approved for therapy of polyethiological dry eye disease. Methods Rabbit models of UV-induced and mechanical corneal damage were employed. The animals were premedicated or treated with conjunctival instillations of 7.5 μM SkQ1. Corneal damage was assessed by fluorescein staining and histological analysis. Oxidative stress in cornea was monitored by measuring malondialdehyde (MDA) using thiobarbituric acid assay. Total antioxidant activity (AOA) was determined using hemoglobin/H2O2/luminol assay. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were measured using colorimetric assays. Results In both models corneas exhibited fluorescein-stained lesions, histologically manifesting as basal membrane denudation, apoptosis of keratocytes, and stromal edema, which were accompanied by oxidative stress as indicated by increase in lipid peroxidation and decline in AOA. The UV-induced lesions were more severe and long healing as corneal endothelium was involved and GPx and SOD were downregulated. The treatment inhibited loss of keratocytes and other cells, facilitated re-epithelialization and stromal remodeling, and reduced inflammatory infiltrations and edema thereby accelerating corneal healing approximately 2-fold. Meanwhile the premedication almost completely prevented development of UV-induced lesions. Both therapies reduced oxidative stress, but only premedication inhibited downregulation of the innate antioxidant activity of the cornea. Conclusions SkQ1 efficiently prevents UV-induced corneal damage and enhances corneal wound healing after UV and mechanical impacts common to ocular surgery. Its therapeutic action can be attributed to suppression of mitochondrial oxidative stress, which in the first case embraces all corneal cells including epitheliocytes, while in the second case affects residual endothelial cells and stromal keratocytes actively working in wound healing. We suggest SkQ1 premedication to be used in ocular surgery for preventing iatrogenic complications in the cornea.
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Affiliation(s)
- Evgeni Yu Zernii
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia. .,Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia.
| | - Olga S Gancharova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia.,Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Veronika V Tiulina
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - Andrey A Zamyatnin
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia.,Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Pavel P Philippov
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - Viktoriia E Baksheeva
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - Ivan I Senin
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia.
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Adib-Moghaddam S, Soleyman-Jahi S, Salmanian B, Omidvari AH, Adili-Aghdam F, Noorizadeh F, Eslani M. Single-step transepithelial photorefractive keratectomy in myopia and astigmatism: 18-month follow-up. J Cataract Refract Surg 2018; 42:1570-1578. [PMID: 27956283 DOI: 10.1016/j.jcrs.2016.08.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/01/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the long-term quantitative and qualitative optical outcomes of 1-step transepithelial photorefractive keratectomy (PRK) to correct myopia and astigmatism. SETTING Bina Eye Hospital, Tehran, Iran. DESIGN Prospective interventional case series. METHODS Eyes with myopia with or without astigmatism were evaluated. One-step transepithelial PRK was performed with an aberration-free aspheric optimized profile and the Amaris 500 laser. Eighteen-month follow-up results for refraction, visual acuities, vector analysis, higher-order aberrations, contrast sensitivity, postoperative pain, and haze grade were assessed. RESULTS The study enrolled 146 eyes (74 patients). At the end of follow-up, 93.84% of eyes had an uncorrected distance visual acuity of 20/20 or better and 97.94% of eyes were within ±0.5 diopter of the targeted spherical refraction. On vector analysis, the mean correction index value was close to 1 and the mean index of success and magnitude of error values were close to 0. The achieved correction vector was on an axis counterclockwise to the axis of the intended correction. Photopic and mesopic contrast sensitivities and ocular and corneal spherical, cylindrical, and corneal coma aberrations significantly improved (all P < .001). A slight amount of trefoil aberration was induced (P < .001, ocular aberration; P < .01, corneal aberration). No eye lost more than 1 line of corrected distance visual acuity. No eye had a haze grade of 2+ degrees or higher throughout the follow-up. CONCLUSIONS Eighteen-month results indicate the efficacy and safety of transepithelial PRK to correct myopia and astigmatism. It improved refraction and quality of vision. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Soheil Adib-Moghaddam
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Saeed Soleyman-Jahi
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bahram Salmanian
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amir-Houshang Omidvari
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fatemeh Adili-Aghdam
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Farsad Noorizadeh
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
| | - Medi Eslani
- From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA
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Efficacy and safety of transepithelial photorefractive keratectomy. J Cataract Refract Surg 2018; 44:1267-1279. [PMID: 30172569 DOI: 10.1016/j.jcrs.2018.07.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022]
Abstract
Transepithelial photorefractive keratectomy (PRK) was introduced to prevent complications from conventional PRK and femtosecond laser-assisted laser in situ keratomileusis (LASIK). In the 2-step platform, phototherapeutic keratectomy is followed by PRK. It did not show notable safety or efficacy superiorities over conventional PRK. In the conventional single-step transepithelial PRK, ablation of epithelium and stroma occurs in a single continuous session by an Amaris laser. It showed better comparative safety results. Reverse single-step transepithelial PRK and the platform using smart-pulse technology were recent improvements in the single-step Amaris laser. They provide a smoother postablative stromal bed counter. In the refined single-step platform, a modified nomogram is used for determination of ablation parameters, along with modifications in postablative measures. It yielded better comparative results in hyperopia. Controlled trials comparing reverse, smart-pulse technology-equipped, or refined platforms of single-step transepithelial PRK with other modern laser-assisted methods could provide more robust evidence on the topic. Some key elements with significant roles in post-transepithelial PRK outcomes are discussed.
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Myopia and myopic astigmatism photorefractive keratectomy: applying an advanced multiple regression-derived nomogram. Graefes Arch Clin Exp Ophthalmol 2018; 257:225-232. [DOI: 10.1007/s00417-018-4101-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022] Open
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Comparison of visual and refractive results after transepithelial and mechanical photorefractive keratectomy in myopia. Int Ophthalmol 2017; 38:627-633. [DOI: 10.1007/s10792-017-0501-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/13/2017] [Indexed: 12/14/2022]
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Adib-Moghaddam S, Soleyman-Jahi S, Adili-Aghdam F, Arba Mosquera S, Hoorshad N, Tofighi S. Single-step transepithelial photorefractive keratectomy in high myopia: qualitative and quantitative visual functions. Int J Ophthalmol 2017; 10:445-452. [PMID: 28393038 DOI: 10.18240/ijo.2017.03.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/08/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) in high myopia. METHODS In a prospective interventional case-series, 30 eyes with high myopia (-6.00 to -8.75 D) with (up to -3.00 D) or without astigmatism were enrolled from Bina Eye Hospital, Tehran, Iran. One-step TransPRK was performed with aberration-free aspherical optimized profile and SCHWIND AMARIS 500 laser. One-year follow-up results for refraction, visual acuities, vector analysis, ocular wave-front (OWF) and corneal wave-front (CWF) higher order aberrations (HOA), contrast sensitivity (CS), and post-operative haze were assessed. RESULTS After the surgery, both photopic and mesopic CSs significantly improved (both P<0.001). We detected significant induction of OWF coma and trefoil (P<0.001 for both) HOAs; CWF coma (P=0.002), spherical (P<0.001), and tetrafoil (P=0.003) HOAs in 6 mm analysis diameter; and CWF trefoil (P=0.04) HOA in 4 mm analysis diameter. The range of mean induction observed for various HOAs was 0.005-0.11 µm. The 86.7% of eyes reached an uncorrected distance visual acuity of 20/20 or better; 96.7% of eyes were within ±0.5 D of targeted spherical refraction. In vector analysis, mean correction index value was 1.03 and mean index of success was 0.22. By 12mo after the operation, no eye lost any number of corrected distance visual acuity lines. We detected no corneal haze greater than 1+ throughout the follow-up. CONCLUSION Our findings show promising effects of single-step TransPRK on quality of vision in high myopic eyes. It also improves refraction and visual acuity.
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Affiliation(s)
- Soheil Adib-Moghaddam
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Saeed Soleyman-Jahi
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Fatemeh Adili-Aghdam
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Samuel Arba Mosquera
- Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran; SCHWIND Eye-Tech-Solutions, Kleinostheim D-63797, Germany; Instituto de Oftalmobiología Aplicada, University of Valladolid, Valladolid 8-47002, Spain
| | - Niloofar Hoorshad
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
| | - Salar Tofighi
- Bina Eye Hospital, Tehran 1634764651, Iran; TransPRK Research Group, Tehran 1586863813, Iran; Universal Council of Ophthalmology (UCO), Universal Scientific Education and Research Network (USERN), Tehran 1417613151, Iran
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Antonios R, Abdul Fattah M, Arba Mosquera S, Abiad BH, Sleiman K, Awwad ST. Single-step transepithelial versus alcohol-assisted photorefractive keratectomy in the treatment of high myopia: a comparative evaluation over 12 months. Br J Ophthalmol 2016; 101:1106-1112. [PMID: 27941045 DOI: 10.1136/bjophthalmol-2016-309409] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/16/2016] [Accepted: 11/19/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate refractive outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) versus alcohol-assisted PRK (EtOH-PRK) for the correction of high myopia. METHODS This was a retrospective non-randomised comparative study conducted at the American University of Beirut Medical Center, Beirut, Lebanon. Eyes with myopia (spherical equivalent (SE) larger than -6.00 D) that had undergone EtOH-PRK treatment combined with mitomycin C and TransPRK (SE: -7.53±0.90 D and -7.24±0.77 D, p=0.062), using the Schwind Amaris excimer laser, were included. 59 eyes (37 patients) that had single-step TransPRK were compared with 59 eyes (36 patients) that had EtOH-PRK. Visual and refractive outcomes, including analysis of astigmatism, and corneal higher order aberrations (HOAs) at 6.0 mm optical zone, were compared for 12 months postoperatively. RESULTS Baseline characteristics were similar between the two groups (p>0.05). The SE deviation from target (SEDT) at 1 week, 1, 3, 6 and 12 months follow-up visits were similar between groups (p=0.428). At 12 months, 81.3% and 73.3% of eyes that had undergone TransPRK and EtOH-PRK, respectively, were between ±0.50 D SEDT (p=0.381). Mean cylinder power was 0.33±0.26 D versus 0.41±0.30 D at 12 months follow-up (p=0.140). The mean success index was 0.50±0.50 for the TransPRK group and 0.49±0.52 for the EtOH-PRK group (p=0.939), while the absolute mean angle of error was 7.81°±61.98° vs 13.12°±71.86° (p=0.667), respectively. The change in total, spherical and comatic corneal HOAs were similar in both groups at 12 months (p>0.05). Haze was similar between both groups; two eyes had +1 haze at 12 months in the TransPRK group versus zero eyes among the EtOH-PRK group (p=0.154). CONCLUSIONS Single-step TransPRK for high myopia with or without astigmatism appears to yield similar visual, refractive and safety results as EtOH-PRK.
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Affiliation(s)
- Rafic Antonios
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Samuel Arba Mosquera
- Department of Research and Development, Schwind Eye-Tech-Solutions, Kleinostheim, Germany.,Recognized Research Group in Optical Diagnostic Techniques, University of Valladolid, Valladolid, Spain.,Department of Ophthalmology and Sciences of Vision, University of Oviedo, Oviedo, Spain
| | - Bachir H Abiad
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Karim Sleiman
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Shady T Awwad
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
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