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Kirschenbaum MD, Hu KS, Ip CS, Lin A, Pierce J, Holubkov R, Jensen H, Mifflin MD. One-Year Results of a Phase I/II Randomized, Double-Masked, Placebo-Controlled Study of Processed Amniotic Fluid Drops After PRK. Cornea 2024:00003226-990000000-00463. [PMID: 38277050 DOI: 10.1097/ico.0000000000003474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE The aim of this study was to evaluate the 1-year outcomes of using processed amniotic fluid (pAF) postoperatively after photorefractive keratectomy (PRK). METHODS Sixty-one participants were randomized to receive either placebo or pAF drops. The drops were instilled 4 times daily for 1 week after PRK along with routine postoperative medications. The primary outcome measures included uncorrected visual acuity, topographic corneal irregularity measurement, and surface staining over 1 year. RESULTS A statistically significant difference in uncorrected distance visual acuity between the placebo and treatment groups was seen at 1 month post-PRK, with a visual advantage evident in the pAF group. A suggestive difference in corneal irregularity measurement was also seen between the placebo and treatment groups at 1 month postsurgery, with less irregularity noted in the pAF group. No differences in uncorrected distance visual acuity or corneal irregularity measurement were found at 3, 6, and 12 months. There was also no significant difference in corneal staining scores between the 2 groups at any of the measured time points. CONCLUSIONS This 1-year study evaluating the safety and efficacy of pAF as an additional postoperative topical medication after PRK demonstrated that pAF offered a mild visual advantage at 1 month post-PRK. There were no late adverse events, and the intervention proved safe at 1 year.
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Affiliation(s)
- Malka Davina Kirschenbaum
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Katherine S Hu
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Colin S Ip
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Amy Lin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Jan Pierce
- Cell Therapy and Regenerative Medicine, University of Utah, Salt Lake City, UT; and
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Hailey Jensen
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT
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Ip CS, Jones DK, Weinlander E, Gudgel B, Lin A, Yazdani H, Pierce J, Holubkov R, Jensen H, Church M, Mifflin MD. Phase I/II randomized, double-masked, placebo-controlled study of processed amniotic fluid drops after PRK. J Cataract Refract Surg 2023; 49:299-304. [PMID: 36730463 DOI: 10.1097/j.jcrs.0000000000001100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/14/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of processed amniotic fluid (pAF) used postoperatively after photorefractive keratectomy (PRK). SETTING University of Utah, Moran Eye Center, Salt Lake City, Utah. DESIGN Randomized, double-masked, placebo-controlled prospective study. METHODS 61 participants were randomized to receive either placebo or pAF drops, which were instilled 4 times per day for 1 week after PRK along with routine postoperative medications. The primary outcome measure was time to full re-epithelialization in days. Secondary measures included visual acuity at 30 days and postoperative pain scores during the first week. RESULTS There was no significant difference in time to re-epithelialization, with a median of 5 days for both groups. There were no difference in pain indicator scores during the first week and no difference in corneal staining scores at day 30 between the 2 groups. There were no adverse events. CONCLUSIONS This pilot study evaluating the safety and efficacy of pAF as an additional postoperative topical medication for PRK demonstrated that pAF did not improve the rate of epithelial healing after PRK. pAF may be safely studied in other ocular conditions to determine its effect on epithelial healing.
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Affiliation(s)
- Colin S Ip
- From the Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Ip, Jones, Weinlander, Gudgel, Lin, Yazdani, Church, Mifflin); Cell Therapy and Regenerative Medicine, University of Utah, Salt Lake City, Utah (Pierce); Department of Pediatrics, University of Utah, Salt Lake City, Utah (Holubkov, Jensen)
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Abstract
A 54-year-old man with noncontributory medical history presented to an ophthalmologist in January 2022 after 10 days of irritation in his right eye. The patient recounts having felt something get into his eye and under his contact lens (CL) while he was climbing into his car, but he was unsure what the foreign body may have been. Initial examination by the clinician found uncorrected distance visual acuity of 20/100-2 with a corneal abrasion, 4+ corneal edema, and 3+ conjunctival injection, for which he was placed on topical antibiotics (ocuflox and tobradex) with a bandage CL. 1 week later, visual acuity was 20/80, corneal edema had improved, and he was noted to have corneal scarring and an epithelial defect. Tobradex was continued while prednisolone drops and preservative-free artificial tears were started. 1 week later, the patient had worsening visual acuity to 20/250 and was referred to our tertiary center. On initial consultation, the patient had an uncorrected distance visual acuity of 20/500 and an uncorrected near visual acuity of >J10 in the right eye. Slitlamp examination of the right eye was significant for vortex keratopathy and mild corneal pannus with 360-degree subtle conjunctivalization of the limbus ( Figure 1JOURNAL/jcrs/04.03/02158034-202210000-00022/figure1/v/2022-10-03T121249Z/r/image-tiff ). The corneal topograph was obtained showing significant surface irregularity on the Placido image ( Figure 2JOURNAL/jcrs/04.03/02158034-202210000-00022/figure2/v/2022-10-03T121249Z/r/image-tiff ). Examination of the left eye was unremarkable. The ocular history is significant for myopia of -4.0 diopters and CL use for 20 years. The patient admits to regularly wearing soft CLs for several days straight and only removing them for a few hours. Antibiotics were discontinued, corticosteroid drops were reduced in frequency, and the patient was continued on preservative-free artificial tears. What imaging might you consider? What is your differential diagnosis at this point? What would be the most appropriate surgical and/or medical interventions? What would you counsel in prognosis for this patient?
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Mifflin MD, Mortensen XM. Intraoperative optical pachymetry in photorefractive keratectomy. J Cataract Refract Surg 2019; 45:495-500. [PMID: 30819562 DOI: 10.1016/j.jcrs.2018.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/24/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effect of variables on the accuracy and reliability of the optical pachymeter built into the WaveLight EX500 excimer laser during photorefractive keratectomy (PRK). SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Retrospective case series. METHODS A chart review of 352 eyes (181 patients) that had excimer laser PRK was performed. Programmed excimer laser residual stromal bed (RSB) measurements, optical pachymeter measurements after ablation, and Scheimpflug pachymetry measurements (Pentacam) at the 1-year follow-up were compared. Variables included ablation time, preoperative spherical equivalent (SE), 1-year SE, mitomycin-C use, operating room temperature and humidity, and programmed monovision. RESULTS The mean programmed RSB was 27 μm greater than the optical pachymetry post-ablation measurement (P < .001). Of patients with a 1-year follow-up, the 1-year Scheimpflug pachymetry RSB was 24 μm greater than the optical pachymetry post-ablation RSB (P < .001). Comparison of the programmed RSB with the optical pachymetry post-ablation RSB showed that the preoperative SE and ablation time had a Pearson correlation coefficient of -0.36 and 0.30, respectively (P < .001). There was no correlation between operating room temperature, humidity, or programmed monovision with these differences. CONCLUSIONS The RSB post-ablation values measured by optical pachymetry during PRK were significantly lower than the programmed excimer laser RSB value and 1-year Scheimpflug pachymetry RSB value. Intraoperative pachymetry during PRK underpredicted the actual long-term RSB thickness. The greater temporary drying effect associated with increased ablation time in higher myopic corrections might have caused this error.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
| | - Xavier M Mortensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
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Lass JH, Benetz BA, Patel SV, Szczotka-Flynn LB, O’Brien R, Ayala AR, Maguire MG, Daoud YJ, Greiner MA, Hannush SB, Lee WB, Mauger TF, Menegay HJ, Mifflin MD, Raizman MB, Rose-Nussbaumer J, Schultze RL, Schmidt GA, Sugar A, Terry MA, Verdier DD. Donor, Recipient, and Operative Factors Associated With Increased Endothelial Cell Loss in the Cornea Preservation Time Study. JAMA Ophthalmol 2019; 137:185-193. [PMID: 30422157 PMCID: PMC6439830 DOI: 10.1001/jamaophthalmol.2018.5669] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/26/2018] [Indexed: 12/19/2022]
Abstract
Importance Determining factors associated with endothelial cell loss after Descemet stripping automated endothelial keratoplasty (DSAEK) could improve long-term graft survival. Objective To evaluate the associations of donor, recipient, and operative factors with endothelial cell density (ECD) 3 years after DSAEK in the Cornea Preservation Time Study. Design, Setting, and Participants This cohort study was a secondary analysis of data collected in a multicenter, double-masked, randomized clinical trial. Forty US clinical sites with 70 surgeons participated, with donor corneas provided by 23 US eye banks. Individuals undergoing DSAEK for Fuchs dystrophy or pseudophakic/aphakic corneal edema were included. Interventions The DSAEK procedure, with random assignment of a donor cornea with a preservation time of 0 to 7 days or 8 to 14 days. Main Outcomes and Measures Endothelial cell density at 3 years as determined by a reading center from eye bank and clinical specular or confocal central endothelial images. Results The study included 1090 participants (median age, 70 years) with 1330 affected eyes (240 bilateral cases [22.0%]), who underwent DSAEK for Fuchs dystrophy (1255 eyes [94.4%]) or pseudophakic/aphakic corneal edema (PACE) (75 eyes [5.6%]). Of these, 801 eyes (60.2%) belonged to women and 1207 (90.8%) to white individuals. A total of 749 participants (913 eyes; 164 [21.9%] bilateral cases) had functioning grafts with acceptable endothelial images preoperatively and at 3 years postoperatively and were included in this analysis. Factors associated with a lower ECD at 3 years (estimated effect with 99% CI) in the final multivariable model included donors with diabetes (-103 [-196 to -9] cells/mm2), lower screening ECD (-234 [-331 to -137] per 500 cells/mm2), recipient diagnosis of PACE (-257 [-483 to -31] in cells/mm2), and operative complications (-324 [-516 to -133] in cells/mm2). Endothelial cell loss (ECL) from a preoperative measurement to a 3-year postoperative measurement was 47% (99% CI, 42%-52%) for participants receiving tissue from donors with diabetes vs 43% (99% CI, 39%-48%) without diabetes; it was 53% (99% CI, 44%-62%) for participants diagnosed with PACE vs 44% (99% CI, 39%-49%) for those diagnosed with Fuchs dystrophy, and 55% (99% CI, 48%-63%) in participants who experienced operative complications vs 44% (99% CI, 39%-48%) in those who did not. No other donor, recipient, or operative factors were significantly associated with 3-year ECD. Conclusions and Relevance Donor diabetes, lower screening ECD, a PACE diagnosis in the recipient, and operative complications were associated with lower ECD at 3 years after DSAEK surgery and may be associated with long-term graft success. While causation cannot be inferred, further studies on the association of donor diabetes and PACE in recipients with lower 3-year ECD warrant further study.
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Affiliation(s)
- Jonathan H. Lass
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | - Beth Ann Benetz
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | - Sanjay V. Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Loretta B. Szczotka-Flynn
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Maureen G. Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yassine J. Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Thomas F. Mauger
- The Ohio State University Wexner Medical Center-Havener Eye Institute, Columbus
| | - Harry J. Menegay
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | - Alan Sugar
- Kellogg Eye Center, University of Michigan, Ann Arbor
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Abstract
Purpose To present refractive outcomes from consecutive cases with the Alcon Wavelight® EX500 excimer laser using photorefractive keratectomy (PRK) in patients with high myopia. Methods A retrospective chart review of consecutive cases of high myopic eyes (≥6.0 Diopters [D]) undergoing PRK with the Alcon Wavelight EX500 excimer laser (Alcon Laboratories, Fort Worth, TX, USA) was done. Moderately high myopic eyes (6.0 to <8.0 D [6 D]) were compared with high myopic eyes (8.0 D or greater [8 D]). Outcomes measured included pre- and postoperative refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity, spherical equivalent correction (SEQ), haze incidence, and intraocular pressure (IOP). Results One hundred eighteen eyes of 63 patients were evaluated, with 59 eyes having 12 months of follow-up. Thirty-one eyes of 19 patients had 8.0 D or more of myopia. Twelvemonth average LogMAR UDVA was -0.06 (20/17) for the 6 D group and -0.08 (20/16) for the 8 D group. Average 12-month SEQ was -0.18 D and preoperatively was -7.52 D for the 6 D group and -0.09 and -9.02 in the 8 D group. Sixty-five eyes (86%) and 24 eyes (96%) had an SEQ within 0.50 D of emmetropia at 3 months in the 6 and 8 D groups, respectively. One eye had visually significant haze developed at 8 months. Three eyes had IOP elevation that resolved with addition of short-term topical IOP-lowering medication. Conclusion High myopic PRK with the Alcon Wavelight EX500 excimer laser yields excellent refractive outcomes with a low incidence of complications.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | | | - Jason Nguyen
- Department of Ophthalmology, West Virginia University School of Medicine, Morgantown, WV, USA
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Hwang ES, Stagg BC, Swan R, Fenzl CR, McFadden M, Muthappan V, Santiago-Caban L, Mifflin MD, Moshirfar M. Corneal biomechanical properties after laser-assisted in situ keratomileusis and photorefractive keratectomy. Clin Ophthalmol 2017; 11:1785-1789. [PMID: 29042748 PMCID: PMC5633312 DOI: 10.2147/opth.s142821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effects of laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) on corneal biomechanical properties. METHODS We used the ocular response analyzer to measure corneal hysteresis (CH) and corneal resistance factor (CRF) before and after refractive surgery. RESULTS In all, 230 eyes underwent LASIK and 115 eyes underwent PRK without mitomycin C (MMC). Both procedures decreased CH and CRF from baseline. When MMC was used after PRK in 20 eyes, it resulted in lower corneal biomechanical properties at 3 months when compared to the other procedures, but all three procedures had similar values at 12 months. CONCLUSION Significant but similar decreases in corneal biomechanical properties after LASIK, PRK without MMC, and PRK with MMC were noted.
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Affiliation(s)
- Eileen S Hwang
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center
| | - Russell Swan
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center
| | - Carlton R Fenzl
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center
| | - Molly McFadden
- Department of Internal Medicine, University of Utah, Salt Lake City
| | | | | | - Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center
| | - Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center.,HDR Research Center, Hoopes Vision, Draper, UT, USA
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Abstract
Purpose To study the accuracy and reliability of optical pachymetry using the Alcon WaveLight EX500 during laser-assisted in situ keratomileusis (LASIK). Materials and methods This was a retrospective chart review of 90 eyes from 45 patients who had undergone LASIK (mean age 35.2±8.2 years; 19 males, 26 females). The WaveLight FS200 femtosecond laser was programmed to cut LASIK flaps at a desired depth of 120 μm. Optical low-coherence reflectometry (WaveLight EX500) was used to measure central corneal thickness prior to lifting the flap, and the residual stromal bed immediately after excimer ablation. Flap thickness (FT) was calculated using simple subtraction. Optical coherence tomography (OCT) was used to measure central corneal thickness, flap thickness, and residual stromal bed in the postoperative period and the results compared to intraoperative measurements. Results Mean programmed FS200 FT was 119 μm. Mean FT using EX500 optical pachymetry was 109 μm. The difference between FS200- programmed and EX500-measured FT was 9 μm (P<0.001). There was also a significant difference between the EX500 and OCT FT (109 μm vs 119 μm, respectively; P<0.001). Conclusion FT values calculated using intraoperative EX500 optical pachymetry were significantly lower than programmed FS200 values or OCT measurements.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Xavier M Mortensen
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brent S Betts
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Cole Gross
- University of Nevada School of Medicine, Reno, NV, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
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Mifflin MD, Betts BS, Frederick PA, Feuerman JM, Fenzl CR, Moshirfar M, Zaugg B. Efficacy and safety of a 3-month loteprednol etabonate 0.5% gel taper for routine prophylaxis after photorefractive keratectomy compared to a 3-month prednisolone acetate 1% and fluorometholone 0.1% taper. Clin Ophthalmol 2017; 11:1113-1118. [PMID: 28652697 PMCID: PMC5476723 DOI: 10.2147/opth.s138272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the outcome of photorefractive keratectomy (PRK) and complications in patients treated with either loteprednol etabonate 0.5% gel or prednisolone acetate 1% suspension and fluorometholone (fml) 0.1% suspension. Setting John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA. Design Prospective, randomized, partially masked trial. Methods PRK was performed on 261 eyes of 132 participants. Patients were randomized to a postoperative corticosteroid regimen of either loteprednol etabonate 0.5% gel (loteprednol) or prednisolone 1% acetate suspension followed by fluorometholone 0.1% suspension (prednisolone/fml). Primary outcome measures included incidence and grade of postoperative corneal haze and incidence of increased intraocular pressure of 10 mmHg above baseline, or any intraocular pressure over 21 mmHg. Secondary outcome measures included uncorrected distance visual acuity, best corrected distance visual acuity, and manifest refraction spherical equivalent. Results The incidence of haze in the first 3 months was 2.6% (3/114 eyes) in the loteprednol group and 4.8% (7/147 eyes) in the prednisolone/fml group and was not statistically significant between groups (P=0.37). The incidence of elevated intraocular pressure was 1.8% (2/114 eyes) in the loteprednol group and 4.1% (6/147 eyes) in the prednisolone/fml group, and was not statistically significant between the groups (P=0.12). The mean 3-month postoperative logMAR uncorrected visual acuity was −0.078±0.10 and −0.075±0.09 in the loteprednol and prednisolone/fml groups, respectively (P=0.83). Conclusion Postoperative corneal haze and elevated intraocular pressure were uncommon in both treatment arms. There was no statistically significant difference between each postoperative regimen. Refractive results were similar and excellent in both treatment arms. A tapered prophylactic regimen of loteprednol 0.5% gel is equally effective to prednisolone 1%/fml 0.1% after PRK.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | - Brent S Betts
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
| | | | | | | | - Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT.,Hoopes Vision, Draper, UT, USA
| | - Brian Zaugg
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah, Salt Lake City, UT
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Eftekhari K, Mifflin MD, Anderson RL. Prostaglandin-Associated Periorbital Lipodystrophy in Cosmetic Eyelid Surgery: A Novel Cause of Facial Asymmetry. Aesthet Surg J 2016; 36:NP119-21. [PMID: 26374814 DOI: 10.1093/asj/sjv184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/13/2022] Open
Abstract
A 70-year-old woman presented to our practice with profound ptosis of the left upper eyelid and notable asymmetry of the periocular area. On examination, she was noted to have significant atrophy of the periocular tissues on the left side, with lower eyelid retraction. These features were present but less severe on the right side. Upon further questioning, she stated that she had cataract surgery on the left side that was complicated by a high intraocular pressure and required subsequent secondary surgery. She had taken a prostaglandin eyedrop for many months after her cataract surgery to keep the eye pressure low. Recently, a newly recognized adverse effect of prostaglandin eyedrops has been described in the ophthalmic literature in which patients develop periorbital lipodystrophy. This case emphasizes that this may occur unilaterally in patients taking the eyedrop in only one eye, and should be recognized prior to considering functional and aesthetic surgery of the periocular area.
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Affiliation(s)
- Kian Eftekhari
- Dr Eftekhari is a fellow and Dr Anderson is an oculoplastic surgeon in private practice in Salt Lake City, UT, USA. Dr. Mifflin is a Clinical Professor of Ophthalmology and Fellowship Director in Corneal Surgery, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Mark D Mifflin
- Dr Eftekhari is a fellow and Dr Anderson is an oculoplastic surgeon in private practice in Salt Lake City, UT, USA. Dr. Mifflin is a Clinical Professor of Ophthalmology and Fellowship Director in Corneal Surgery, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Richard L Anderson
- Dr Eftekhari is a fellow and Dr Anderson is an oculoplastic surgeon in private practice in Salt Lake City, UT, USA. Dr. Mifflin is a Clinical Professor of Ophthalmology and Fellowship Director in Corneal Surgery, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Abstract
PURPOSE The purpose of this laboratory study was to assess the effect of povidone-iodine (PI) use topically on the conjunctiva in regard to needle bore contamination and to compare these results with our previous findings from an evaluation of bacterial contamination following gatifloxacin and moxifloxacin administration. METHODS We performed 100 conjunctival 27-gauge needle penetrations of both eyes of 13 fresh cadavers. Eyes were then soaked in 10% PI, after which conjunctiva was again penetrated 100 times. After conjunctival penetration, the needles were irrigated, and the irrigant was assessed for bacterial growth. Results were compared with previous work assessing fluoroquinolone effectiveness through the same model. RESULTS We observed a 28% (P = 0.003) decrease in bacterial growth and 40% (P < 0.0001) decrease in colony counts after PI placement. Differences between the effect of PI versus moxifloxacin and gatifloxacin were not statistically significant. CONCLUSIONS There is a greater decrease in bacterial load after treatment with PI for surface cultures than for cultures obtained through a needle bore passed through the conjunctiva. PI is a superior approach to topical antibiotics to decrease conjunctival bacterial load.
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Affiliation(s)
- Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah , Salt Lake City, Utah
| | - Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah , Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah , Salt Lake City, Utah
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Kinard KI, Smith AG, Singleton JR, Lessard MK, Katz BJ, Warner JEA, Crum AV, Mifflin MD, Brennan KC, Digre KB. Chronic migraine is associated with reduced corneal nerve fiber density and symptoms of dry eye. Headache 2015; 55:543-9. [PMID: 25828778 DOI: 10.1111/head.12547] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND We used in vivo corneal confocal microscopy to investigate structural differences in the sub-basal corneal nerve plexus in chronic migraine patients and a normal population. We used a validated questionnaire and tests of lacrimal function to determine the prevalence of dry eye in the same group of chronic migraine patients. Activation of the trigeminal system is involved in migraine. Corneal nociceptive sensation is mediated by trigeminal axons that synapse in the gasserian ganglion and the brainstem, and serve nociceptive, protective, and trophic functions. Noninvasive imaging of the corneal sub-basal nerve plexus is possible with in vivo corneal confocal microscopy. METHODS For this case-control study, we recruited chronic migraine patients and compared them with a sex- and age-similar group of control subjects. Patients with peripheral neuropathy, a disease known to be associated with a peripheral neuropathy, or prior corneal or intraocular surgery were excluded. Participants underwent in vivo corneal confocal microscopy using a Heidelberg Retinal Tomography III confocal microscope with a Rostock Cornea Module. Nerve fiber length, nerve branch density, nerve fiber density, and tortuosity coefficient were measured using established methodologies. Migraine participants underwent testing of basal tear production with proparacaine, corneal sensitivity assessment with a cotton-tip applicator, measurement of tear break-up time, and completion of a validated dry eye questionnaire. RESULTS A total of 19 chronic migraine patients and 30 control participants completed the study. There were no significant differences in age or sex. Nerve fiber density was significantly lower in migraine patients compared with controls (48.4 ± 23.5 vs. 71.0 ± 15.0 fibers/mm2 , P < .001). Nerve fiber length was decreased in the chronic migraine group compared with the control group, but this difference was not statistically significant (21.5 ± 11.8 vs. 26.8 ± 5.9 mm/mm2, P < .084). Nerve branch density was similar in the two groups (114.0 ± 92.4 vs. 118.1 ± 55.9 branches/mm2 , P < .864). Tortuosity coefficient and log tortuosity coefficient also were similar in the chronic migraine and control groups. All migraine subjects had symptoms consistent with a diagnosis of dry eye syndrome. CONCLUSIONS We found that in the sample used in this study, the presence of structural changes in nociceptive corneal axons lends further support to the hypothesis that the trigeminal system plays a critical role in the pathogenesis of migraine. In vivo corneal confocal microscopy holds promise as a biomarker for future migraine research as well as for studies examining alterations of corneal innervation. Dry eye symptoms appear to be extremely prevalent in this population. The interrelationships between migraine, corneal nerve architecture, and dry eye will be the subject of future investigations.
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Affiliation(s)
- Krista I Kinard
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Moshirfar M, Mifflin MD, McCaughey MV, Gess AJ. Prospective, randomized, contralateral eye comparison of tetracaine and proparacaine for pain control in laser in situ keratomileusis and photorefractive keratectomy. Clin Ophthalmol 2014; 8:1213-9. [PMID: 25061267 PMCID: PMC4079638 DOI: 10.2147/opth.s66701] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Tetracaine and proparacaine are two of the most commonly used medications for providing topical anesthesia in laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). These agents have not been previously compared in a prospective manner to determine their efficacy in these settings. Methods This prospective, single-masked, randomized study comprised 256 eyes from 128 consecutive patients being treated with LASIK or PRK who were randomized to receive tetracaine in one eye and proparacaine in the other. The patients were blinded as to which anesthetic agent was used in each eye. Pain levels were graded on a 0–10 scale, and were assessed upon instillation, during surgery, immediately postoperatively, 30 minutes postoperatively, overnight, and on postoperative day 1. Patients were asked 30 minutes after surgery which anesthetic agent they would choose. Results Both anesthetic agents resulted in diminished amounts of subjective pain in patients undergoing LASIK and PRK. Tetracaine caused significantly more pain upon instillation than proparacaine for both LASIK and PRK patients. LASIK patients noted significantly less pain 30 minutes after surgery when treated with tetracaine. Significantly more LASIK patients preferred the eye treated with tetracaine. These differences were not present in the PRK group. Conclusion Both tetracaine and proparacaine are effective methods of topical anesthesia in LASIK and PRK. Tetracaine caused significantly more pain upon instillation in all patients, but resulted in greater analgesia 30 minutes after surgery in the LASIK group. Patients in the LASIK group expressed a preference for tetracaine over proparacaine. There was no significant drop preference among PRK patients.
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Affiliation(s)
- Majid Moshirfar
- John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Mark D Mifflin
- John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | | | - Adam J Gess
- John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Kim G, Mifflin MD, Mamalis N, Moshirfar M. Conjunctival eyelashes: a rare presentation of dermoid. J Ophthalmic Vis Res 2014; 9:106-8. [PMID: 24982740 PMCID: PMC4074482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/27/2012] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe a previously unreported presentation of a conjunctival dermoid. CASE REPORT An 8-year-old girl presented with a progressively enlarging mass in the right conjunctival fornix composed of normal appearing eyelashes. The patient had a history of aberrant conjunctival eyelash growth that had caused recurrent conjunctivitis in her right eye over the past few years. The mass was surgically removed and the pathology report revealed it to be a conjunctival dermoid. The patient had an excellent surgical result with normal cosmetic appearance. CONCLUSION Mature hair follicle growth from the conjunctiva is another possible presentation of a conjunctival dermoid that can be cured by simple surgical excision.
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Affiliation(s)
| | | | | | - Majid Moshirfar
- Correspondence to: Majid Moshirfar, MD, Clinical Professor, Department of Ophthalmology, John A. Moran Eye Center, 65 Mario Capecchi Drive, Salt Lake City, UT84132, USA; Tel: +1 801 585 7689, Fax: +1 801 581 3357;
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Moshirfar M, Anderson E, Hsu M, Armenia JM, Mifflin MD. Comparing the rate of regression after conductive keratoplasty with or without prior laser-assisted in situ keratomileusis or photorefractive keratectomy. Middle East Afr J Ophthalmol 2013; 19:377-81. [PMID: 23248539 PMCID: PMC3519124 DOI: 10.4103/0974-9233.102743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To assess the regression rate of conductive keratoplasty (CK) in patients with or without previous laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Setting: University of Utah, Medical School, John A. Moran Eye Center, Salt Lake City, Utah. Materials and Methods: A retrospective, age-matched chart review identified records of 6 patients who underwent CK after refractive surgery and 12 patients who underwent CK without prior refractive surgery. The main outcome measures were postoperative uncorrected and corrected visual acuities and refraction changes over time. Results: Preoperatively, the mean manifest refraction spherical equivalent (MRSE) of the 15 eyes (12 patients) that underwent CK without refractive surgery was 0.83 diopters (D) and the 7 eyes (6 patients) that underwent CK after refractive surgery had an average MRSE of 0.27 D. Postoperatively, the mean MRSE of the refractive surgery patients was -0.86 D at 6 months, regressing to -0.67 D at 12 months. The postoperative MRSE in the eyes without refractive surgery was -0.58 D. at 6 months, regressing to -0.38 D at 12 months. The rate of regression was linear in both groups, calculated at 0.033 D per month in all patients. Conclusions: Patients with previous LASIK or PRK showed a greater treatment response to CK but regressed at a similar rate as those eyes without prior LASIK or PRK. Overall CK is a safe procedure that inevitably regresses.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, University of Utah, John A Moran Eye Center, Salt Lake City, UT, USA
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Hsu M, Jorgensen AJ, Moshirfar M, Mifflin MD. Management and Outcomes of Descemet Stripping Automated Endothelial Keratoplasty With Intraocular Lens Exchange, Aphakia, and Anterior Chamber Intraocular Lens. Cornea 2013; 32:e64-8. [DOI: 10.1097/ico.0b013e31826ef43b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pettey JH, Mifflin MD, Kamae K, McEntire MW, Pettey DH, Callegan MC, Brown H, Olson RJ. The impact of short-term topical gatifloxacin and moxifloxacin on bacterial injection after hypodermic needle passage through human conjunctiva. J Ocul Pharmacol Ther 2013; 29:450-5. [PMID: 23425429 DOI: 10.1089/jop.2012.0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the bacterial contamination rate of a 27-gauge needle bore during conjunctival penetration in donor eye bank eyes and the effect of short-term use of topical 0.3% gatifloxacin and 0.5% moxifloxacin. METHODS One hundred consecutive human donors had 10 conjunctival penetrations per 10 syringes per eye before antibiotic placement; this was repeated 15 min after antibiotic use. Samples were cultured by expressing 0.3 mL of saline through the needle. Positive cultures were speciated. RESULTS There were 1,033 positive cultures (25.8% of all cultures); 568 (28.4%) pre-antibiotics, 249 (24.9%) after gatifloxacin (P=0.04, compared to the pre-antibiotic rate), and 216 (21.6%) after moxifloxacin (P<0.001). The most common organism was Staphylococcus epidermidis [334 positive cultures (8.4%)]. No antibiotic effect was seen on this or other organisms except S. aureus [4.6% pre-antibiotic, 2.8% after gatifloxacin (P=0.02), and 1.8% after moxifloxacin (P<0.001)] and other Staphylococcus species [5.3% pre-antibiotic, 3.6% after gatifloxacin (P=0.04), and 3.2% after moxifloxacin (P=0.01)]. CONCLUSIONS Transconjunctival penetration often results in needle bore contamination; bacteria are included in an injected solution. Fifteen minutes of exposure to 2 topical antibiotics had a minimal effect on bacterial contamination and no significant effect on many common pathogens.
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Affiliation(s)
- Jeff H Pettey
- John A. Moran Eye Center, University of Utah , Salt Lake City, Utah 84132, USA
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Christiansen SM, Mifflin MD, Edmonds JN, Simpson RG, Moshirfar M. Astigmatism induced by conventional spherical ablation after PRK and LASIK in myopia with astigmatism < 1.00 D. Clin Ophthalmol 2012; 6:2109-17. [PMID: 23277735 PMCID: PMC3532022 DOI: 10.2147/opth.s37489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate surgically-induced astigmatism after spherical ablation in photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) for myopia with astigmatism < 1.00 D. METHODS The charts of patients undergoing spherical PRK or LASIK for the correction of myopia with minimal astigmatism of <1.00 D from 2002 to 2012 at the John A Moran Eye Center in Salt Lake City, UT, were retrospectively reviewed. Astigmatism was measured by manifest refraction. The final astigmatic refractive outcome at 6 months postoperatively was compared with the initial refraction by Alpins vector analysis. RESULTS For PRK, average cylinder increased from 0.39 ± 0.25 (0.00-0.75) preoperatively to 0.55 ± 0.48 (0.00-1.75) postoperatively (P = 0.014), compared with an increase in LASIK eyes from 0.40 ± 0.27 (0.00-0.75) preoperatively to 0.52 ± 0.45 (0.00-2.00) postoperatively (P = 0.041). PRK eyes experienced an absolute value change in cylinder of 0.41 ± 0.32 (0.00-1.50) and LASIK eyes experienced a change of 0.41 ± 0.31 (0.00-1.50, P = 0.955). Mean surgically-induced astigmatism was 0.59 ± 0.35 (0.00-1.70) in PRK eyes, with an increase in surgically-induced astigmatism of 0.44 D for each additional 1.00 D of preoperative cylinder; in LASIK eyes, mean surgically-induced astigmatism was 0.55 ± 0.32 (0.00-1.80, P = 0.482), with an increase in surgically-induced astigmatism of 0.29 D for each 1.00 D of preoperative cylinder. CONCLUSION Spherical ablation can induce substantial astigmatism even in eyes with less than one diopter of preoperative astigmatism in both PRK and LASIK. No significant difference in the magnitude of surgically-induced astigmatism was found between eyes treated with PRK and LASIK, although surgically-induced astigmatism was found to increase with greater levels of preoperative astigmatism in both PRK and LASIK.
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Mifflin MD, Kinard K, Neuffer MC. Comparison of stromal hydration techniques for clear corneal cataract incisions: conventional hydration versus anterior stromal pocket hydration. J Cataract Refract Surg 2012; 38:933-7. [PMID: 22624890 DOI: 10.1016/j.jcrs.2012.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 12/28/2011] [Accepted: 01/07/2012] [Indexed: 11/27/2022]
Abstract
Anterior stromal pocket hydration was compared with conventional hydration for preventing wound leak after 2.8 mm uniplanar clear corneal incisions (CCIs) in patients having routine cataract surgery. Conventional hydration involves hydration of the lateral walls of the main incision with visible whitening of the stroma. The anterior stromal pocket hydration technique involves creation of an additional supraincisional stromal pocket overlying the main incision, which is then hydrated instead of the main incision. Sixty-six eyes of 48 patients were included in the data analysis with 33 assigned to each study group. The anterior stromal pocket hydration technique was significantly better than conventional hydration in preventing wound leak due to direct pressure on the posterior lip of the incision.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center University of Utah, Salt Lake City, Utah 84132, USA.
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Mifflin MD, Leishman LL, Christiansen SM, Sikder S, Hsu M, Moshirfar M. Use of loteprednol for routine prophylaxis after photorefractive keratectomy. Clin Ophthalmol 2012; 6:653-9. [PMID: 22570546 PMCID: PMC3346185 DOI: 10.2147/opth.s30282] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this work is to report our experience using loteprednol 0.5% for routine prophylaxis after photorefractive keratectomy in an academic refractive surgery center. Materials and methods Photorefractive keratectomy was performed on 579 eyes from 316 patients in this retrospective chart review of patients treated postoperatively with either fluorometholone 0.1% (273 eyes) or loteprednol 0.5% (306 eyes). Primary outcome measures at 6 months included uncorrected distance visual acuity, corrected distance visual acuity, and manifest refraction spherical equivalent. Secondary outcome measures were incidence of corneal haze and increased intraocular pressure. Results There were no statistically significant differences in preoperative characteristics between the two groups when comparing age, sex, best-corrected visual acuity, spherical equivalent, or keratometry. Both groups achieved excellent visual outcomes, with a mean uncorrected distance visual acuity (logMAR) of 0.004 ± 1.4 in the fluorometholone group and −0.028 ± 1.1 in the loteprednol group (P = 0.013) at 6 months. Postoperative corneal haze and increased intraocular pressure were uncommon and not statistically different between the groups. Conclusion Loteprednol 0.5% performed similarly to fluorometholone 0.1% when used for prophylaxis following photorefractive keratectomy. The incidence of haze and increased intraocular pressure were similar between the two groups.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT
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Oberg TJ, Sikder S, Jorgensen AJ, Mifflin MD. Topical–intracameral anesthesia without preoperative mydriatic agents for Descemet-stripping automated endothelial keratoplasty and phacoemulsification cataract surgery with intraocular lens implantation. J Cataract Refract Surg 2012; 38:384-6. [DOI: 10.1016/j.jcrs.2011.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 10/15/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
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Mifflin MD, Hatch BB, Sikder S, Bell J, Kurz CJ, Moshirfar M. Custom vs conventional PRK: a prospective, randomized, contralateral eye comparison of postoperative visual function. J Refract Surg 2012; 28:127-32. [PMID: 22230057 DOI: 10.3928/1081597x-20120103-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 11/28/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether VISX S4 (VISX Inc) custom photorefractive keratectomy (PRK) results in better visual outcomes than VISX S4 conventional PRK. METHODS Photorefractive keratectomy was performed on 80 eyes from 40 patients in this randomized, prospective, contralateral eye study. Dominant eyes were randomized to one group with the fellow eye receiving the alternate treatment. Primary outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and root-mean-square (RMS) higher order aberrations. RESULTS Mean UDVA was -0.023±0.099 (20/19) in the custom group and -0.044±0.080 (20/18) in the conventional group 6 months after surgery (P=.293). Mean CDVA was -0.073±0.067 (20/17) in the custom group and -0.079±0.071 (20/17) in the conventional group 6 months after surgery (P=.659). Total higher order aberration RMS and spherical aberration increased in both groups compared to preoperative values (P<.05). Coma increased in the conventional group (P<.05) whereas it was similar to preoperative values in the custom group. No significant differences were noted in induction of trefoil. CONCLUSIONS Custom and conventional PRK were shown to be safe and effective with excellent visual acuity and contrast sensitivity performance at 6 and 12 months. Conventional PRK induced more coma than custom PRK; however, this did not seem to correlate with clinical outcomes.
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Affiliation(s)
- Mark D Mifflin
- University of Utah, Department of Ophthalmology and Visual Sciences, Salt Lake City, Utah, USA.
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Holt DG, Sikder S, Mifflin MD. Surgical management of traumatic LASIK flap dislocation with macrostriae and epithelial ingrowth 14 years postoperatively. J Cataract Refract Surg 2011; 38:357-61. [PMID: 22112789 DOI: 10.1016/j.jcrs.2011.10.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/31/2011] [Accepted: 09/02/2011] [Indexed: 11/24/2022]
Abstract
Fourteen years after uneventful laser in situ keratomileusis (LASIK), a 59-year-old woman presented after suffering blunt trauma to her left eye 5 weeks earlier. The injury resulted in traumatic flap dislocation, epithelial ingrowth, and significant macrostriae. Following epithelial removal, the flap was hydrated with sterile water, facilitating reduction of the macrostriae and reapproximation without the need for suture placement. The postoperative course was uneventful, and at 1 month, the epithelial ingrowth and macrostriae had resolved and the uncorrected distance visual acuity was 20/30. This case represents the longest documented interval from LASIK surgery to traumatic flap dislocation. We describe our surgical approach to the management of this type of injury and present a video illustrating the technique.
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Affiliation(s)
- Derick G Holt
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA
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Moshirfar M, Betts BS, Churgin DS, Hsu M, Neuffer M, Sikder S, Church D, Mifflin MD. A prospective, randomized, fellow eye comparison of WaveLight® Allegretto Wave ® Eye-Q versus VISX CustomVue™ STAR S4 IR™ in laser in situ keratomileusis (LASIK): analysis of visual outcomes and higher order aberrations. Clin Ophthalmol 2011; 5:1339-47. [PMID: 22034553 PMCID: PMC3198407 DOI: 10.2147/opth.s24316] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To compare outcomes in visual acuity, refractive error, higher-order aberrations (HOAs), contrast sensitivity, and dry eye in patients undergoing laser in situ keratomileusis (LASIK) using wavefront (WF) guided VISX CustomVue and WF optimized WaveLight Allegretto platforms. Methods In this randomized, prospective, single-masked, fellow eye study, LASIK was performed on 44 eyes (22 patients), with one eye randomized to WaveLight Allegretto, and the fellow eye receiving VISX CustomVue. Postoperative outcome measures at 3 months included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, root-mean-square (RMS) value of total and grouped HOAs, contrast sensitivity, and Schirmers testing. Results Mean values for UDVA (logMAR) were −0.067 ± 0.087 and −0.073 ± 0.092 in the WF optimized and WF guided groups, respectively (P = 0.909). UDVA of 20/20 or better was achieved in 91% of eyes undergoing LASIK with both lasers while UDVA of 20/15 or better was achieved in 64% of eyes using the Allegretto platform, and 59% of eyes using VISX CustomVue (P = 1.000). In the WF optimized group, total HOA increased 4% (P = 0.012), coma increased 11% (P = 0.065), and spherical aberration increased 19% (P = 0.214), while trefoil decreased 5% (P = 0.490). In the WF guided group, total HOA RMS decreased 9% (P = 0.126), coma decreased 18% (P = 0.144), spherical aberration decreased 27% (P = 0.713) and trefoil decreased 19% (P = 0.660). One patient lost one line of CDVA secondary to residual irregular astigmatism. Conclusion Both the WaveLight Allegretto and the VISX CustomVue platforms had equal visual and safety outcomes. Most wavefront optimized HOA values trended upward, with a statistically significant increase in total HOA RMS. Eyes treated with the WF guided platform showed a decreasing trend in HOA values.
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Affiliation(s)
- Majid Moshirfar
- John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA.
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Moshirfar M, Churgin DS, Betts BS, Hsu M, Sikder S, Neuffer M, Church D, Mifflin MD. Prospective, randomized, fellow eye comparison of WaveLight Allegretto Wave Eye-Q versus VISX CustomVueTM STAR S4 IRTM in photorefractive keratectomy: analysis of visual outcomes and higher-order aberrations. Clin Ophthalmol 2011; 5:1185-93. [PMID: 21966184 PMCID: PMC3180481 DOI: 10.2147/opth.s24319] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to compare differences in visual outcomes, higher-order aberrations, contrast sensitivity, and dry eye in patients undergoing photorefractive keratectomy using wavefront-guided VISX CustomVue™ and wavefront-optimized WaveLight® Allegretto platforms. Methods In this randomized, prospective, single-masked, fellow-eye study, photorefractive keratectomy was performed on 46 eyes from 23 patients, with one eye randomized to WaveLight Allegretto, and the fellow eye receiving VISX CustomVue. Three-month postoperative outcome measures included uncorrected distance visual acuity, corrected distance visual acuity, refractive error, root mean square of total and grouped higher-order aberrations, contrast sensitivity, and Schirmer’s testing. Results Mean values for uncorrected distance visual acuity (logMAR) were −0.03 ± 0.07 and −0.06 ± 0.09 in the wavefront-optimized and wavefront-guided groups, respectively (P = 0.121). Uncorrected distance visual acuity of 20/20 or better was achieved in 91% of eyes receiving wavefront-guided photorefractive keratectomy, and 87% of eyes receiving wavefront-optimized photorefractive keratectomy, whereas uncorrected distance visual acuity of 20/15 was achieved in 35% of the wavefront-optimized group and 64% of the wavefront-guided group (P ≥ 0.296). While root mean square of total higher-order aberration, coma, and trefoil tended to increase in the wavefront-optimized group (P = 0.091, P = 0.115, P = 0.459, respectively), only spherical aberration increased significantly (P = 0.014). Similar increases were found in wavefront- guided root mean square of total higher-order aberration (P = 0.113), coma (P = 0.403), trefoil (P = 0.603), and spherical aberration (P = 0.014). There was no significant difference in spherical aberration change when comparing the two platforms. The wavefront-guided group showed an increase in contrast sensitivity at 12 cycles per degree (P = 0.013). Conclusion Both VISX CustomVue and WaveLight Allegretto platforms performed equally in terms of visual acuity, safety, and predictability in photorefractive keratectomy. The wavefront-guided group showed slightly improved contrast sensitivity. Both lasers induced a comparable degree of statistically significant spherical aberration, and tended to increase other higher-order aberration measures as well.
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Affiliation(s)
- Majid Moshirfar
- University of Utah, John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, Salt Lake City, UT, USA
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Hatch BB, Moshirfar M, Ollerton AJ, Sikder S, Mifflin MD. A prospective, contralateral comparison of photorefractive keratectomy (PRK) versus thin-flap LASIK: assessment of visual function. Clin Ophthalmol 2011; 5:451-7. [PMID: 21573091 PMCID: PMC3090298 DOI: 10.2147/opth.s18967] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Indexed: 11/28/2022] Open
Abstract
Purpose: To compare differences in visual acuity, contrast sensitivity, complications, and higher-order ocular aberrations (HOAs) in eyes with stable myopia undergoing either photo-refractive keratectomy (PRK) or thin-flap laser in situ keratomileusis (LASIK) (intended flap thickness of 90 μm) using the VISX Star S4 CustomVue excimer laser and the IntraLase FS60 femtosecond laser at 1, 3, and 6 months postoperatively. Methods: In this prospective, masked, and randomized pilot study, refractive surgery was performed contralaterally on 52 eyes: 26 with PRK and 26 with thin-flap LASIK. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and complications. Results: At 6 months, mean values for UDVA (logMAR) were −0.043 ± 0.668 and −0.061 ± 0.099 in the PRK and thin-flap LASIK groups, respectively (n = 25, P = 0.466). UDVA of 20/20 or better was achieved in 96% of eyes undergoing PRK and 92% of eyes undergoing thin-flap LASIK, whereas 20/15 vision or better was achieved in 73% of eyes undergoing PRK and 72% of eyes undergoing thin-flap LASIK (P > 0.600). Significant differences were not found between treatment groups in contrast sensitivity (P ≥ 0.156) or CDVA (P = 0.800) at postoperative 6 months. Types of complications differed between groups, notably 35% of eyes in the thin-flap LASIK group experiencing complications, including microstriae and 2 flap tears. Conclusion: Under well-controlled surgical conditions, PRK and thin-flap LASIK refractive surgeries achieve similar results in visual acuity, contrast sensitivity, and induction of HOAs, with differences in experienced complications.
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Affiliation(s)
- Bryndon B Hatch
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Moshirfar M, Hatch BB, Chang JC, Kurz CJ, Eugarrios MF, Mifflin MD. Prospective, Contralateral Comparison of 120-μm and 90-μm LASIK Flaps Using the IntraLase FS60 Femtosecond Laser. J Refract Surg 2011; 27:251-259. [DOI: 10.3928/1081597x-20100624-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Purpose:
To compare differences in visual acuity, contrast sensitivity, higher order ocular aberrations, quality of life, and patient-reported outcomes at 3 and 6 months postoperatively in eyes with stable myopia undergoing thin-flap (intended flap thicknesses of 120 or 90 μm) LASIK using the VISX Star S4 CustomVue excimer laser (VISX Inc), with flaps created by the IntraLase FS60 femtosecond laser (Abbott Medical Optics).
Methods:
In this prospective study, thin-flap LASIK was performed contralaterally on 94 eyes: 47 eyes with 120-μm intended flap thickness and 47 eyes with 90-μm intended flap thickness. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and higher order aberrations.
Results:
At 6 months, mean values for UDVA (logMAR) were −0.064±0.077 and −0.051±0.070 in the 120-μm and 90-μm groups, respectively (n=40,
P
=.431). Visual acuity of 20/20 was achieved in 98% of eyes with 120-μm flaps and 95% of eyes with 90-μm flaps, whereas 20/15 vision was achieved in 50% of eyes with 120-μm flaps and 45% of eyes with 90-μm flaps (
P
≥.454). Both groups had significant increases in total higher order aberrations (
P
≤.003). Significant differences were not found between groups in contrast sensitivity (
P
≥.258), CDVA (
P
≥.726), total higher order aberrations (
P
≥.477), or patient-reported outcomes (
P
≥.132). Patients in both groups reported increased quality of life postoperatively (
P
≤.002).
Conclusions:
Under well-controlled surgical conditions, thin-flap LASIK achieved similar results in visual acuity, contrast sensitivity, and low induction of higher order aberrations in eyes with intended flap thicknesses of either 120 or 90 μm.
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Mifflin MD, Neuffer MC, Mamalis N. Retained nuclear fragment found during Descemet-stripping automated endothelial keratoplasty. J Cataract Refract Surg 2011; 37:608-10. [DOI: 10.1016/j.jcrs.2010.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 11/09/2010] [Indexed: 11/29/2022]
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Moshirfar M, Gardiner JP, Schliesser JA, Espandar L, Feiz V, Mifflin MD, Chang JC. Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison. J Cataract Refract Surg 2010; 36:1925-33. [PMID: 21029902 DOI: 10.1016/j.jcrs.2010.05.027] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 04/07/2010] [Accepted: 05/13/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the incidence of flap complications after creation of laser in situ keratomileusis (LASIK) flaps using a zero-compression microkeratome or a femtosecond laser. SETTING John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. DESIGN Evidence-based manuscript. METHODS The flap complication rate was evaluated during the initial 18 months of experience using a zero-compression microkeratome (Hansatome) or a femtosecond laser (IntraLase FS60) for flap creation. RESULTS The flap complication rate was 14.2% in the microkeratome group and 15.2% in the femtosecond laser group (P = .5437). The intraoperative flap complication rate was 5.3% and 2.9%, respectively (P = .0111), and the postoperative flap complication rate, 8.9% and 12.3%, respectively (P = .0201). The most common intraoperative complication in the microkeratome group was major epithelial defect/sloughing; the rate (2.6%) was statistically significantly higher than in the femtosecond laser group (P = .0006). The most common postoperative complication in both groups was diffuse lamellar keratitis (DLK) (6.0%, microkeratome; 10.6%, femtosecond laser) (P = .0002). CONCLUSION Although the total complication rates between the 2 groups were similar, the microkeratome group had significantly more epithelial defects intraoperatively and the femtosecond laser group had significantly more DLK cases postoperatively.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.
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Khalifa YM, Moshirfar M, Mifflin MD, Kamae K, Mamalis N, Werner L. Cataract development associated with collagen copolymer posterior chamber phakic intraocular lenses: clinicopathological correlation. J Cataract Refract Surg 2010; 36:1768-74. [PMID: 20870124 DOI: 10.1016/j.jcrs.2010.04.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/06/2010] [Accepted: 04/16/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the histopathology of anterior subcapsular cataract associated with a collagen copolymer posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens) using light microscopy after pIOL explantation and cataract surgery. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Laboratory investigation. METHODS Pathology specimens related to explanted pIOLs were reviewed and preoperative and postoperative patient data collected. The anterior lens capsules and explanted pIOLs were examined. RESULTS Four eyes (3 patients) had pIOL explantation for low vault and anterior subcapsular cataract. The explanted pIOLs were the shorter length models (3, 12.1 mm; 1, 12.6 mm). Anterior segment optical coherence tomography (AS-OCT) confirmed the low pIOL vault before explantation in 2 eyes. Histopathology of the anterior subcapsular cataract showed fibrous metaplasia with a variable number of lens epithelial cell (LEC) layers attached to the inner surface of the anterior capsulorhexis specimens. Light microscopy of the explanted pIOLs showed no pigment on 1 lens, mild pigment deposition on 1 haptic, and pigment deposition throughout the anterior surface of 2 pIOLs. CONCLUSIONS Anterior subcapsular cataract associated with the pIOLs was caused by low vaulting (confirmed on AS-OCT) and consequent fibrous metaplasia of the anterior LECs. Surgeons should consider the possibility of anterior subcapsular cataract associated with shorter platforms when selecting a pIOL length for appropriate vault.
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Affiliation(s)
- Yousuf M Khalifa
- Flaum Eye Institute, University of Rochester, Rochester, New York, USA
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Moshirfar M, Schliesser JA, Chang JC, Oberg TJ, Mifflin MD, Townley R, Livingston MK, Kurz CJ. Visual outcomes after wavefront-guided photorefractive keratectomy and wavefront-guided laser in situ keratomileusis: Prospective comparison. J Cataract Refract Surg 2010; 36:1336-43. [DOI: 10.1016/j.jcrs.2010.02.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/17/2010] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
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Holz HA, Meyer JJ, Espandar L, Tabin GC, Mifflin MD, Moshirfar M. Corneal profile analysis after Descemet stripping endothelial keratoplasty and its relationship to postoperative hyperopic shift. J Cataract Refract Surg 2008; 34:211-4. [PMID: 18242442 DOI: 10.1016/j.jcrs.2007.09.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 09/27/2007] [Indexed: 10/22/2022]
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Abstract
PURPOSE To describe corneal intrastromal epithelial cysts and present a minimally invasive surgical technique successfully used to treat such a lesion. METHODS A 5-year-old girl with a progressive, vision-threatening, intrastromal corneal opacity in the left eye is described. The patient had a history of accommodative esotropia and bilateral medial rectus recession two years before presentation. A presumptive diagnosis of an epithelial cyst secondary to iatrogenic seeding of the limbal corneal stroma was made. Because of documented growth toward the visual axis and a decrease in best-corrected visual acuity, surgical treatment was initiated. The cyst was incised and debrided through a 2.0-mm, partial-thickness, limbus-parallel, clear corneal incision. RESULTS Cytologic analysis of the cyst contents showed intact and degenerated epithelial cells, thereby confirming the diagnosis. The cyst walls were scraped through the nonenlarged incision, and irrigation resulted in nearly complete clearing of the opacity. Stable vision and no recurrences were documented with 21 months of follow-up. CONCLUSION This minimally invasive surgical approach may be a good alternative to previously described treatments for intrastromal corneal cysts.
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Affiliation(s)
- M D Mifflin
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, USA.
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Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr 1990; 51:241-7. [PMID: 2305711 DOI: 10.1093/ajcn/51.2.241] [Citation(s) in RCA: 1467] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A predictive equation for resting energy expenditure (REE) was derived from data from 498 healthy subjects, including females (n = 247) and males (n = 251), aged 19-78 y (45 +/- 14 y, mean +/- SD). Normal-weight (n = 264) and obese (n = 234) individuals were studied and REE was measured by indirect calorimetry. Multiple-regression analyses were employed to drive relationships between REE and weight, height, and age for both men and women (R2 = 0.71): REE = 9.99 x weight + 6.25 x height - 4.92 x age + 166 x sex (males, 1; females, 0) - 161. Simplification of this formula and separation by sex did not affect its predictive value: REE (males) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) + 5; REE (females) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161. The inclusion of relative body weight and body-weight distribution did not significantly improve the predictive value of these equations. The Harris-Benedict Equations derived in 1919 overestimated measured REE by 5% (p less than 0.01). Fat-free mass (FFM) was the best single predictor of REE (R2 = 0.64): REE = 19.7 x FFM + 413. Weight also was closely correlated with REE (R2 = 0.56): REE = 15.1 x weight + 371.
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Affiliation(s)
- M D Mifflin
- Nutrition Education and Research Program, University of Nevada School of Medicine, Reno 89557
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