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Alghamdi A, Alghamdi EA, Alghamdi A, Abusayf MM, Ahad MA. Successful Collagen Crosslinking in a Patient With Keratoconus and Systemic Scleroderma. Cureus 2024; 16:e59431. [PMID: 38826919 PMCID: PMC11140440 DOI: 10.7759/cureus.59431] [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: 04/17/2024] [Indexed: 06/04/2024] Open
Abstract
Scleroderma is an autoimmune disease that affects connective tissue. Keratoconus (KC) is a rare ocular condition that may appear alongside scleroderma. Contact lenses are an essential visual aid for KC patients, especially in advanced cases. However, scleroderma patients may face difficulties using them due to finger-related disabilities. Corneal collagen cross-linking (CXL) is a crucial treatment used to prevent corneal thinning and visual deterioration in progressive KC. However, the potential trigger of corneal melt and delayed healing following CXL in KC patients with scleroderma is a matter of concern. We present a case of a patient with KC and scleroderma who underwent CXL without any complications.
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Affiliation(s)
- Ayman Alghamdi
- Oculoplastic Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | | | - Abdullah Alghamdi
- Community Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | - Muhammad A Ahad
- Cornea and External Disease Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
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Saad A, Narr J, Frings A, Steinberg J, Katz T, Linke SJ. Surgical outcomes of laser in situ keratomileusis (LASIK) in patients with stable systemic disease. Int Ophthalmol 2024; 44:119. [PMID: 38418603 PMCID: PMC10902021 DOI: 10.1007/s10792-024-02956-7] [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: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 03/01/2024]
Abstract
PURPOSE To evaluate the surgical outcome in terms of safety, efficacy, predictability, and retreatment rate of LASIK surgery in patients with controlled systemic diseases in comparison with healthy individuals. METHODS The retrospective study included data from 1936 eyes of 976 patients with stable systemic diseases who underwent LASIK surgery between January 2016 and June 2019. The safety, efficacy, predictability of the surgery, and retreatment rate were evaluated in comparison with a control group comprising 1951 patients. The study was approved by the local ethics committee and adhered to the principles of the Declaration of Helsinki. Statistical analysis was performed using R team and the level of statistical significance was set at p < 0.05. RESULTS All treatment groups demonstrated high safety and efficacy indices after LASIK surgery. Furthermore, the study arms demonstrated comparable predictability and retreatment rates to the control group in nearly all cases. Retreatment rates were significantly higher in the rheumatoid arthritis group (p = 0.03), while safety indices were significantly lower in the hay fever group compared to the control group (p = 0.004). No intra- or postoperative sight-threatening complications were documented. CONCLUSION Our findings suggest that selected patients with stable systemic conditions can safely undergo LASIK surgery and achieve comparable outcomes to healthy individuals. Further research is needed to better understand the treatment outcomes in this challenging patient population.
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Affiliation(s)
- Amr Saad
- Department of Ophthalmology, Heinrich-Heine University, Duesseldorf, Germany
| | - Jenny Narr
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
| | - Andreas Frings
- Department of Ophthalmology, Heinrich-Heine University, Duesseldorf, Germany.
- Augenheilkunde & Augenlaser Zentrum PD Dr. med. A. Frings, Nuremberg, Germany.
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Care-Vision, Hamburg, Germany
| | - Stephan Johannes Linke
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
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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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Upaphong P, Tananuvat N, Ausayakhun S, Chaidaroon W, Tangmonkongvoragul C, Niparugs M. Comorbidities in Corneal Refractive Surgery Candidates: A Cross-Sectional Study. Open Ophthalmol J 2022. [DOI: 10.2174/18743641-v16-e2204051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Individuals with refractive errors sometimes have other associated ocular and systemic abnormalities.
Objectives:
To explore ocular and systemic comorbidities in Corneal Refractive Surgery (CRS) candidates and to examine any contraindications for CRS.
Methods:
This was a cross-sectional study. Medical records of individuals who underwent a refractive surgery screening at Chiang Mai University LASIK Center, Chiang Mai, Thailand, were reviewed. All clinical data of the initial visit were evaluated. Eyes with a history of CRS and phototherapeutic keratectomy were excluded.
Results:
A total of 1,167 cases (2,334 eyes) were recruited, out of which 643 cases were females (55.09%). Myopia was the most common type of refractive error (2,120 eyes, 90.83%), and 868 (40.94%) eyes had high myopia. Approximately 45% (n=526) of the cases had worn contact lenses. The five most common ocular comorbidities (eyes, proportion) included keratoconus suspect (297, 12.72%), cataract (246, 10.53%), dry eye/probable dry eye (208, 8.91%), glaucoma suspect (184, 7.88%), and amblyopia (149, 6.38%). The most common systemic conditions that affected choices or outcomes of CRS were hypertrophic scar/keloid (169 cases, 14.48%) followed by allergy/asthma (127 cases, 10.88%). A total of 1,028 eyes (44.04%) were excluded from CRS, mainly due to abnormal corneal topography (470/1,028 eyes, 45.72%).
Conclusion:
Most refractive candidates were myopic and contact lens wearers. Serious ocular sequelae from myopia and contact lens use were not uncommon. Additionally, systemic diseases regularly affected the CRS options. The most common contraindication for CRS was abnormal corneal topography. Our study, thus, emphasizes the need for thorough ocular and systemic screenings of refractive candidates.
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Moshirfar M, Seitz T, Ply B, Ronquillo YC, Hoopes PC. Corneal Refractive Surgery Considerations in Patients on Dupilumab. J Clin Med 2022; 11:jcm11123273. [PMID: 35743344 PMCID: PMC9225227 DOI: 10.3390/jcm11123273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022] Open
Abstract
Dupilumab is a biologic approved by the United States Food and Drug Administration (US FDA) for the treatment of atopic dermatitis. While it is an effective medication for eczema, ocular side effects are common in patients receiving dupilumab therapy. Greater consideration is needed when evaluating these individuals for corneal refractive surgery. Dupilumab patients may suffer from atopy, a condition that also merits consideration in those desiring refractive surgery. Additional testing and careful consideration are needed, as these patients have an increased risk of dry eye syndrome, keratoconus, cataracts, diffuse lamellar keratitis, viral keratitis, and perioperative infection. This commentary discusses the current understanding of dupilumab ocular side effects and investigates factors to consider when evaluating these patients for corneal refractive surgery.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (B.P.); (P.C.H.)
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
- Correspondence: (M.M.); (Y.C.R.)
| | | | - Brianna Ply
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (B.P.); (P.C.H.)
| | - Yasmyne C. Ronquillo
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (B.P.); (P.C.H.)
- Correspondence: (M.M.); (Y.C.R.)
| | - Phillip C. Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (B.P.); (P.C.H.)
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Sharma B, Soni D, Saxena H, Stevenson LJ, Karkhur S, Takkar B, Vajpayee RB. Impact of corneal refractive surgery on the precorneal tear film. Indian J Ophthalmol 2020; 68:2804-2812. [PMID: 33229655 PMCID: PMC7856956 DOI: 10.4103/ijo.ijo_2296_19] [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: 12/16/2019] [Revised: 03/28/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Corneal refractive surgeries are one of the commonly performed procedures for correction of refractive errors. Tear film abnormality is the most common postoperative complication of corneal refractive surgeries. Consequently, these procedures represent a clinically significant cause of dry eye disease. The mechanisms which lead to dry eye disease include corneal sensory nerve dysfunction, ocular surface desiccation, glandular apoptosis and ocular surface inflammation. Although transient tear film abnormalities occur in almost all patients following surgery, patients with pre-existing dry eye symptoms or dry eye disease are at significant risk of developing more severe or long-term ocular surface disease. As such, careful patient selection and preoperative evaluation is essential to ensuring successful surgical outcomes. This is particularly important with LASIK which has the strongest association with dry eye disease. Appropriate surface lubrication and anti-inflammatory therapy remains the cornerstone treatment. Timely and effective management is important to facilitate visual rehabilitation and reduce the risk of secondary complications. In this review we describe the causes, pathophysiology, risk factors, manifestations, and management of tear film dysfunction and dry eye disease following corneal refractive surgery.
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Affiliation(s)
- Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Harsha Saxena
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Louis J Stevenson
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rasik B Vajpayee
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
- Cornea Unit, Vision Eye Institute, Melbourne, Victoria, Australia
- Cornea and Cataract Surgery Unit, University of Melbourne, Melbourne, Victoria, Australia
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Rosen DB, Moshirfar M, Heiland MB, Ronquillo YC, Hoopes PC. Should Patients with Hidradenitis Suppurativa Undergo LASIK? Ophthalmol Ther 2019; 8:353-359. [PMID: 31313219 PMCID: PMC6692419 DOI: 10.1007/s40123-019-0201-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Indexed: 12/28/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a relatively common chronic inflammatory disease with immune dysregulation. While eye manifestations of HS are rare, a dilemma arises when these patients seek treatment for refractive errors. Although excimer laser surgery can be safely performed in patients with autoimmune and immune-mediated inflammatory disease, there are caveats. Aside from the routine laser-assisted in situ keratomileusis (LASIK) screening tests, in some instances, we recommend additional screening tests in patients with HS, such as dry eye tests, consultation with specialists regarding HS diagnosis and treatment, careful assessment of the eyelids and periorbital structures, and thorough history of past and current lesions and treatments. After these patients undergo LASIK, careful, frequent, and long-term follow-up is necessary. Any adverse event or complication should be managed immediately. FUNDING: Research to Prevent Blindness funded the study. Hoopes Vision funded the Rapid Service Fees.
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Affiliation(s)
- David B Rosen
- The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA.
| | | | | | - Phillip C Hoopes
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
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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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Mahendradas P, Francis M, Vala R, Gowda PB, Kawali A, Shetty R, Sinha Roy A. Quantification of Ocular Biomechanics In Ocular Manifestations of Systemic Autoimmune Diseases. Ocul Immunol Inflamm 2018; 27:1127-1137. [DOI: 10.1080/09273948.2018.1501491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Mathew Francis
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
| | - Ruchi Vala
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | | | - Ankush Kawali
- Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bangalore, India
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Suraida AR, Ibrahim M, Zunaina E. Correlation of the anterior ocular segment biometry with HbA1c level in type 2 diabetes mellitus patients. PLoS One 2018; 13:e0191134. [PMID: 29324896 PMCID: PMC5764367 DOI: 10.1371/journal.pone.0191134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives To compare the anterior ocular segment biometry among Type 2 diabetes mellitus (DM) with no diabetic retinopathy (DR) and non-proliferative diabetic retinopathy (NPDR), and to evaluate the correlation of anterior ocular segment biometry with HbA1c level. Methods A cross-sectional study was conducted in Hospital Universiti Sains Malaysia, Kelantan from November 2013 till May 2016 among Type 2 DM patients (DM with no DR and DM with NPDR). The patients were evaluated for anterior ocular segment biometry [central corneal thickness (CCT), anterior chamber width (ACW), angle opening distance (AOD) and anterior chamber angle (ACA)] by using Anterior Segment Optical Coherence Tomography (AS-OCT). Three ml venous blood was taken for the measurement of HbA1c. Results A total of 150 patients were included in this study (DM with no DR: 50 patients, DM with NPDR: 50 patients, non DM: 50 patients as a control group). The mean CCT and ACW showed significant difference among the three groups (p < 0.001 and p = 0.015 respectively). Based on post hoc result, there were significant mean difference of CCT between non DM and DM with NPDR (mean difference 36.14 μm, p < 0.001) and also between non DM and DM with no DR (mean difference 31.48 μm, p = 0.003). The ACW was significantly narrower in DM with NPDR (11.39 mm SD 0.62) compared to DM with no DR (11.76 mm SD 0.53) (p = 0.012). There were no significant correlation between HbA1c and all the anterior ocular segment biometry. Conclusion Diabetic patients have significantly thicker CCT regardless of retinopathy status whereas ACW was significantly narrower in DM with NPDR group compared to DM with no DR. There was no significant correlations between HbA1c and all anterior ocular segment biometry in diabetic patients regardless of DR status.
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Affiliation(s)
- Abd-Rashid Suraida
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
| | - Mohtar Ibrahim
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
- * E-mail:
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Tabibian D, de Tejada BM, Gatzioufas Z, Kling S, Meiss VS, Boldi MO, Othenin-Girard V, Chilin A, Lambiel J, Hoogewoud F, Hafezi F. Pregnancy-induced Changes in Corneal Biomechanics and Topography Are Thyroid Hormone Related. Am J Ophthalmol 2017; 184:129-136. [PMID: 29032108 DOI: 10.1016/j.ajo.2017.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify biomechanical and topographic changes of the cornea during pregnancy and the postpartum period and its association to hormonal changes. DESIGN Prospective single-center observational cohort study. METHODS Participants were 24 pregnant women (48 eyes), monitored throughout pregnancy and after delivery. Biomechanical and topographic corneal properties were measured using the Ocular Response Analyzer (ORA) and a Scheimpflug imaging system (Pentacam HR) each trimester and 1 month after delivery. At the same consultations blood plasma levels of estradiol (E2) and thyroid hormones (TSH, T3t, T4t) were also determined. A factorial MANCOVA was used to detect interactions between hormonal plasma levels and ocular parameters. RESULTS Significant differences in corneal biomechanical and topographic parameters were found during pregnancy in relation to T3t (p = .01), T4t (p < .001), T3t/T4t (P = .001), and TSH (p = .001) plasma levels. E2 plasma levels (p = .092) and time period of measurement (p = .975) did not significantly affect corneal parameters. TSH levels significantly affected the maximal keratometry reading (p = .036), the vertical keratometry reading (p = .04), and the index of height asymmetry (p = .014). Those results persist after excluding hypothyroidism patients from the statistical analysis. CONCLUSIONS Hormonal changes affecting corneal biomechanics and topography during pregnancy could be thyroid related. Dysthyroidism may directly influence corneal biomechanics and represents a clinically relevant factor that needs further investigation.
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Abstract
PURPOSE The field of refractive surgery is changing quickly in the areas of screening, treatment, and postoperative management. The objective of this study was to review advances in the field of refractive surgery as reported in the peer-reviewed literature during the previous year. DESIGN This was a literature review. METHODS In this article, we highlight the progression in the field from May 2013 to the end of June 2014. This article is organized as preoperative, intraoperative, and postoperative considerations. RESULTS The growing use of newer modalities of treatment, such as small-incision lenticule extraction (SmILE) and phakic intraocular lenses, and their safety and efficacy add to the armamentarium in treating refractive error. This past year has seen many studies, which show these procedures to be safe and effective. Also, structurally, SmILE may result in a more biomechanically stable cornea, so that we may be able to safely treat higher refractive errors. CONCLUSIONS While laser-assisted in situ keratomileusis is the predominant surgical procedure, photorefractive keratectomy is still an appropriate choice in certain scenarios (higher risk for ectasia postrefractive surgery and patient choice) with safe, predictable results, and patient satisfaction. Many of the new developments in laser-assisted in situ keratomileusis have focused on flap creation with femtosecond lasers. Histopathology and in vivo optical coherence tomography studies have shown that the stromal bed is smoother, the side cuts are vertical, and the flap has predictable thickness. New surgical modalities, such as femtosecond lenticule extraction and SmILE, are increasingly being used.
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Affiliation(s)
- Naveen Mysore
- From the Department of Refractive Surgery, Cleveland Clinic, OH
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