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AIM:To evaluate corrective effect and stability of corneal morphology in patients with moderate to high myopia after 2a treatment of femtosecond laser assisted laser in situ keratomileusis(FS-LASIK)Xtra.METHODS:Retrospective case-control study. A total of 30 cases(58 eyes)Patients with moderate to high myopia combined with astigmatism who planned to undergo refractive surgery in our hospital from August 2019 to August 2020 were included, and different types of surgery were performed respectively based on the relevant index of keratoconus screening in the preoperative corneal topography. They were divided into FS-LASIK group and Xtra group, with 15 cases(29 eyes)in each group. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), spherical equivalent(SE)and the corneal curvature of the anterior and posterior surfaces of different diameters(3, 5 and 7 mm)measured by Sirius three-dimensional corneal topography were observed preoperatively and 3 mo, 1 and 2 a postoperatively.RESULTS: The UCVA of the two groups of patients at different time points after surgery was significantly increased compared with preoperatively(both P<0.01), and there was no difference in UCVA and SE between the two groups(P>0.05). After 2 a postoperatively, residual astigmatism was -0.25-0 D in 25 eyes(86%)of the FS-LASIK Xtra group and 24 eyes(83%)of the FS-LASIK group. The actual corrected SE and expected corrected SE of both groups were positively correlated(both P<0.05). There were differences in corneal curvature on the surface of different diameter areas(3, 5, and 7 mm)between the two groups at 3 mo, 1, and 2 a postoperatively compared with preoperatively. After 1 and 2 a postoperatively, the corneal posterior surface curvature of the FS-LASIK Xtra group with corneal diameter of 3 and 5 mm was higher than that of the FS-LASIK group(P<0.05).CONCLUSIONS:FS-LASIK Xtra has good safety, efficacy and predictability in correcting patients with moderate to high myopia.
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Purpose: To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods: Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results: In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion: PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.
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Purpose: The goal of this study was to compare the difference in binocular visual function for high and low?moderate myopes before and after femtosecond laser?assisted in situ keratomileusis (FS?LASIK). Methods: Thirty?three subjects (17 males and 16 females) were divided into two groups according to their preoperative refractive errors in spherical equivalent (SE): low?moderate myopia group (SE ??6.00 D) and high myopia group (SE <?6.00 D). The binocular visual function including accommodative amplitude (AA), accommodative facility (AF), positive and negative relative accommodation (PRA and NRA, respectively), horizontal phoria measurement, positive and negative fusion vergence, accommodative–convergence over accommodation (AC/A) ratio, and stereopsis were assessed with the best?corrected vision before patients received FS?LASIK and 7 and 30 days after the surgery. Repeated measures analysis of variance (ANOVA) was applied to study the change in binocular visual function. Results: The AF values in both groups were significantly reduced after 7 days of FS?LASIK (baseline vs. day 7 (mean): high myopia group: 7.85 vs. 5.62 cpm, repeated ANOVA, P = 0.01; low?moderate myopia group: 5.95 vs. 4.40 cpm, repeated ANOVA, P = 0.04). This change returned to the baseline level 30 days after the operation. In addition, the horizontal phoria values in both groups were significantly reduced for both distant (P = 0.019 and P = 0.001, respectively) and near (P = 0.003 and P = 0.049, respectively) 7 days after the operation, but they rebound to preoperative state after 30 days. Conclusion: A transient change in binocular visual function was noticed after 7 days of FS?LASIK operation, which could cause symptoms of asthenopia. Our data showed all the binocular visual functions returned to baseline level after 30 days of operation.
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Objective:To analyze and compare the corneal higher order aberration (HOA) after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE).Methods:A non-randomized controlled study was conducted.Sixty myopic patients (60 eyes) who underwent FS-LASIK or SMILE correction at Shandong Eye Hospital from April 2018 to January 2020 were enrolled and the data from the right eye were collected for analysis.Thirty cases (30 eyes) who received FS-LASIK in FS-LASIK group and 30 cases (30 eyes) who received SMILE in SMILE group had a preoperative equivalent spherical diopter of (-5.36±1.11)D and (-4.93±1.03)D, respectively.The HOA of the 6-mm anterior surface, posterior surface, and whole cornea were measured before surgery and at 1, 3, 6, and 12 months after surgery using Pentacam.The root mean square values (μm) of total corneal HOA, spherical aberration, coma and trefoil were obtained.Differences in the above root mean square values at different time points were compared between the two groups.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shandong Eye Hospital (No.SDSYKYY20180306). Written informed consent was obtained from each subject.Results:The preoperative and 1-, 3-, 6-, 12-month postoperative total HOA of the anterior corneal surface were (0.428±0.126), (0.775±0.169), (0.811±0.194), (0.759±0.214), (0.704±0.199)μm in the FS-LASIK group and (0.409±0.094), (0.656±0.148), (0.681±0.161), (0.668±0.175), (0.648±0.160)μm in the SMILE group, with a significant overall difference ( Fgroup=5.652, P=0.024; Ftime=107.169, P<0.01). Compared with SMILE group, the postoperative total HOA of anterior corneal surface and spherical aberration at different time points were increased in FS-LASIK group, showing statistically significant differences (all at P<0.05). Compared with before surgery, the postoperative total HOA of the anterior corneal surface and spherical aberration at different time points were increased in both groups, showing statistically significant differences (all at P<0.05). In the two groups, the 6- and 12-month postoperative total HOA of the anterior corneal surface were reduced in comparison with the 3-month postoperative ones of the anterior corneal surface, and the 12-month postoperative spherical aberrations of the anterior corneal surface were significantly reduced in comparison with the 1- and 3-month postoperative ones of the anterior corneal surface, showing statistically significant differences (all at P<0.05). There were significant differences in the coma and trefoil of the anterior corneal surface between before and after the operation (coma: Ftime=47.848, P<0.01; trefoil: Ftime=2.497, P=0.046). Compared with before surgery, the postoperative coma was significantly increased in the two groups (all at P<0.05). There were significant differences in total corneal HOA and spherical aberration at different postoperative time points between the two groups (total HOA: Fgroup=8.093, P=0.008; Ftime=125.019, P<0.01.spherical aberration: Fgroup=4.771, P=0.037; Ftime=34.033, P<0.01). Compared with SMILE group, the total corneal HOA and spherical aberration were significantly increased in FS-LASIK group at different postoperative time points (all at P<0.05). Compared with before surgery, postoperative total HOA of the anterior corneal surface and spherical aberration at different postoperative time points were significantly increased in both groups (all at P<0.05). In both groups, the 12-month postoperative corneal spherical aberration was significantly reduced in comparison with the 1- and 3-month postoperative ones (all at P<0.05). There was a significant difference in coma between before and after surgery ( Ftime=30.829, P<0.01). Compared with before surgery, the postoperative coma was significantly increased at different time points in both groups (all at P<0.05). Conclusions:Both FS-LASIK and SMILE increase the HOA of the anterior corneal surface and the whole cornea.Compared with FS-LASIK, SMILE introduces less HOA of the anterior corneal surface and the whole cornea as well as spherical aberrations.
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AIM: To investigate the characteristics of changes in corneal epithelial thickness at the early postoperative stage of femtosecond assisted laser in situ keratomileusis(FS-LASIK)and its related influencing factors.METHOD: Retrospective study. A total of 120 patients(240 eyes)of myopia undergoing FS-LASIK from May 2021 to June 2022 were selected. The corneal epithelium thickness in the central area, inner ring area, and outer ring area of patients before and at 1d, 1wk, 1 and 3mo after operation was recorded. The relationship between the variation of corneal epithelium thickness and spherical equivalent, optical zone diameter, depth of cut and cutting ratio was analyzed by Pearson correlation.RESULTS: There was no statistical significance in corneal epithelial thickness in the central area, inner ring area and outer ring area at 1d after FS-LASIK compared with that before operation(P>0.05). At 1wk, 1 and 3mo after surgery, the corneal epithelial thickness in the central area, inner ring area and outer ring area increased compared with that before surgery, and the corneal epithelial thickness in the central area and inner ring area at 1 and 3mo after surgery was greater than that in the outer ring area(all P<0.05). The corneal epithelial thickness in the central, inner and outer ring areas of high myopia patients was thicker than that of low and moderate myopia patients before operation. The corneal epithelial thickness in the central, inner and outer ring areas of high myopia patients was thinner than that of low and moderate myopia patients at 1wk after operation(P<0.05). At 1 and 3mo after operation, the corneal epithelial thickness in the central, inner and outer ring areas of patients with high myopia was greater than that of patients with low and moderate myopia, and the changes of corneal epithelial thickness in the central, inner and outer ring areas were greater than those of patients with low and moderate myopia(P<0.05). The results of Pearson correlation showed that the changes in corneal epithelial thickness in the central and inner ring area were positively correlated with the corneal curvature, depth of cut and cutting ratio at 3mo after surgery, and they were in negative correlation with the age, spherical equivalent and optical zone diameter(P<0.05).CONCLUSION: The corneal epithelial thickness of patients thickened after the FS-LASIK operation, and it was correlated with age, corneal curvature, preoperative depth of cut, cutting ratio, spherical equivalent and the optic zone diameter.
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AIM: To compare the changes in corneal densitometry after small incision lenticule extraction(SMILE)and femtosecond laser in situ keratomileusis(FS-LASIK)and investigate the effect of corneal interface haze on vision after SMILE.METHODS: Prospective cohort study. A total of 93 patients(186 eyes)who were scheduled to undergo refractive surgery at the Ophthalmic Refractive Surgery Center of the Affiliated Hospital of Nantong University from May 2020 to October 2021 were included in the study, and there were 48 patients(96 eyes)in the SMILE group and 45 patients(90 eyes)in the FS-LASIK group. The changes in corneal densitometry, spherical equivalent(SE), and uncorrected visual acuity(UCVA)were observed and compared between the two groups before and at 1d, 1wk, 1, 3 and 6mo after surgery.RESULTS: The 93 patients all successfully completed the surgery, and there were no related complications during and after the surgery, and there were no lost cases. The UCVA of FS-LASIK group was 0.044±0.064 and -0.001±0.065 respectively at 1d and 1wk after surgery, which was better than that of SMILE group(0.102±0.077 and 0.023±0.064; all P<0.05). There was no statistical difference in the SE between the two groups at the postoperative follow-ups(P>0.05). The corneal densitometry values at 0-2 and 2-6 mm from corneal vertex and total corneal densitometry at 1d postoperatively in the FS-LASIK group were 18.0(17.5, 18.6), 16.2(15.6, 16.7)and 16.7(16.1, 17.3), which were lower than those of SMILE group [18.6(18.1, 19.3), 16.8(16.4, 17.4), 17.2(16.6, 17.8)](all P<0.05); The corneal densitometry values at 0-2 and 2-6 mm from corneal vertex and total corneal densitometry at 1wk postoperatively in the FS-LASIK group were 17.2(16.7, 17.6), 15.5(15.0, 15.9)and 15.9(15.3, 16.7), which were lower than those of SMILE group [17.6(17.1, 18.3), 16.0(15.6, 16.5), 16.6(15.9, 17.1)](all P<0.05).CONCLUSIONS: The transient interface haze after SMILE is responsible for the early higher corneal densitometry than FS-LASIK. The presence of interface haze is probably a factor for the quality of vision.
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AIM: To observe and compare the changes in retinal peripheral refraction and aberrations after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)versus small incision lenticule extraction(SMILE)for myopia correction.METHODS: A total of 71 patients(71 eyes)with myopia who underwent FS-LASIK from October 2022 to April 2023 in our hospital were selected as the FS-LASIK group, and 80 patients(80 eyes)with myopia who underwent SMILE were selected as the SMILE group. All patients underwent corneal wavefront aberration measurement and multispectral refractive topography preoperatively and 3mo postoperatively, as well as refraction difference value(RDV)in the range of 0°～10°, 10°～20°, 20°～30°, 30°～40°, and 40°～53° in the annulus of the retina, which were recorded as RDV-(0°～10°), RDV-(10°～20°), RDV-(20°～30°), RDV-(30°～40°), and RDV-(40°～53°). The results of two groups of patients were compared.RESULTS: No significant differences were observed in RDV-(0°～10°), RDV-(10°～20°), RDV-(20°～30°), RDV-(30°～40°), RDV-(40°～53°)between the two groups at 3mo post-operation(all P>0.05). Furthermore, the RDV-(20°～30°), RDV-(30°～40°)and RDV-(40°～53°)of the two groups at 3mo postoperatively were all significantly lower than those preoperatively(all P<0.05). The changes in coma(horizontal)and spherical aberration(SA)at 3mo postoperatively were smaller in the SMILE group [0.106(0.056, 0.171)and 0.115(0.081, 0.182)μm] than in the FS-LASIK group [0.206(0.104, 0.355)and 0.197(0.128, 0.254)μm](Z=-4.170, -5.016, all P<0.05). A negative correlation was found between postoperative SA and postoperative RDV-(10°～53°)(rs=-0.205, -0.181, -0.226, -0.244, all P<0.05).CONCLUSION: Both FS-LASIK and SMILE reduced retinal hyperopic defocus in the peripapillary macular range of 20°～53° eccentricity, and the postoperative changes in coma(horizontal)and SA were smaller with SMILE than with FS-LASIK. There was a certain correlation between postoperative SA and postoperative retinal peripheral defocus.
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Femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE)are the mainstream corneal refractive surgeries at present. Despite efficacy, safety and predictability they have showed in refractive error correction, there are still complications relating to femtosecond laser, such as suction loss and opaque bubble layer(OBL), due to that the production of corneal flap or lenticule is dependent on the femtosecond laser. OBL is a complication that is unique to femtosecond laser surgery and the bubbles are generated from photo-disruptive effect towards corneal tissues which consisted of water vapor and carbon dioxide, and OBL gradually formed when the bubbles are trapped in the stroma. The bubbles can influence the intraoperative manipulation and postoperative visual quality. This review discusses the mechanism, grading, classification, and influencing factors of OBL and its effects on intraoperative manipulations and postoperative recovery, in the hope of providing reference and basis for further clinical studies.
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AIM:To evaluate the changes in corneal biomechanics of patients with moderate refractive error after receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)using the corneal visualization Scheimpflug technology(Corvis ST).METHODS:Prospective cohort study. A total of 65 moderate myopia patients(65 eyes)who were scheduled to undergo refractive surgery at the Ophthalmic Refractive Surgery Center of the Ningxia Eye Hospital from November 2020 to November 2021 were included in the study, and there were 30 eyes in the SMILE group and 35 eyes in the FS-LASIK group. The changes in corneal biomechanical parameters, including integrated radius(IR), inverse concave radius(ICR), deformation amplitude ratio 2mm(DAR2), stiffness parameter at first applanation(SP-A1), ambrosio relational thickness(ARTh)and the central curvature radius at highest concavity(HC-Radius)were observed by Corvis ST between both groups preoperatively and 1 and 3mo postoperatively.RESULTS: There were no statistical significance in biomechanical parameters between two groups of patients 1 and 3mo postoperatively(P&#x003E;0.05). IR, ICR and DAR2 of each groups of patients 1 and 3mo postoperatively were significantly increased than those preoperatively, and SP-A1, ARTh and HC-Radius were significantly decreased than those preoperatively(all P&#x003C;0.05). The biomechanical parameters at 1mo and 3mo postoperatively showed no statistical significance(P&#x003E;0.05). In addition, a positive correlation was found between central corneal thickness(CCT)and ARTh and SP-A1 of the two groups of patients at 3mo postoperatively(FS-LASIK group: r=0.727, 0.819, SMLIE group: r=0.683, 0.434, all P&#x003C;0.05), while a negative correlation was found between CCT and IR and ICR at 3mo postoperatively.(FS-LASIK group: r=-0.697, -0.622, SMLIE group: r=-0.447, -0.491, all P&#x003C;0.05).CONCLUSION:For patients with moderate myopia, both SMILE and FS-LASIK can reduce corneal biomechanical stability. Both surgeries showed no significant differences in the effect on biomechanical, and the biomechanical has been stabilized at 1mo postoperatively. A correlation was found between postoperative CCT and ARTh, SP-A1, IR and ICR.
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AIM: To investigate long-term efficacy and safety of patients after excimer laser in situ keratomileusis(LASIK)surgery in 20a.METHODS: A retrospective study.Patients who underwent LASIK in our hospital from January 1998 to December 2001 were recruited. The patients were notified by telephone to the outpatient for follow-up. The collected data included demographic characteristics(gender and age), preoperative uncorrected distance visual acuity(UCVA)and best corrected visual acuity(BCVA), preoperative diopter, intraoperative corneal flap thickness and corneal stromal residual thickness(RST). The main indicators were long-term efficacy index, safety index, UCVA, BCVA, corneal thickness and axial length. The slit lamp, fundus and optical coherence tomography(OCT)examination were performed at the same time.RESULTS: A total of 95 patients(190 eyes)were recruited. At the final postoperative visit, there were 71 patients(142 eyes, 74.7%)had UCVA≥1.0, and 82 patients(164 eyes, 86.3%)had BCVA≥1.0. There were 2 eyes among them had bad BCVA(≤0.6)due to macular retinoschisis and glaucoma, respectively, while other patients' BCVA was 0.8. There was no significant correlation between the UCVA and BCVA of patients after surgery in 20a and the factors such as age at surgery, preoperative diopter and corneal thickness(P>0.05), but there was a negative correlation with the increase of axis length(rs=-0.32, -0.31, all P<0.05). UCVA and BCVA were positively correlated with corneal stromal residual thickness at the last postoperative follow-up(P<0.05). The safety and efficacy indexes of LASIK after surgery in 20a were 1.00±0.10 and 0.83±0.27, respectively. During the follow-up, no patients were found to have corneal ectasia and complications related to corneal flap, and no patients underwent secondary surgery. No patients with corneal dryness were found after silt lamp examination.CONCLUSION: LASIK after surgery in 20a shows good safety and efficacy.
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AIM: To explore the clinical efficacy of the myopic with moderate to high astigmatism correction between corneal topography-guided femtosecond laser in situ keratomileusis(FS-LAISK)and Toric implantable collamer lens(TICL).METHODS: A total of 60 patients(115 eyes)with moderate to high astigmatism in myopia(115 eyes)from June 2019 to June 2021 and treated in the refractive center of Heyuan Aier Eye Hospital were enrolled in the study, then were divided into Group A and Group B according to the operations they would accept. There were 32 patients(62 eyes)in the Group A treated with corneal topography-guided FS-LASIK and 28 patients(53 eyes)in the Group B treated with TICL implantation. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), spherical diopter and residual astigmatism were recorded preoperatively and postoperatively at 3mo, surgical safety and efficacy were evaluated, and the Alpins vector analysis was used to evaluate the astigmatism.RESULTS: The postoperative at 3mo, there were no differences in the safety index(1.163±0.167 vs 1.136±0.194)and the efficacy index(1.145±0.159 vs 1.123±0.196)between the patients of the two groups(P>0.05). However, the astigmatism vector analysis showed that there were statistically differences in the index of success index [0.125(0.091, 0.200)vs 0.200(0.167, 0.250)], the correction index [1.000(0.902, 1.066)vs 0.834(0.783, 0.869)] and the flattening index [1.000(0.922, 1.079)vs 0.835(0.795, 0.870)](P<0.01).CONCLUSION:Corneal topography-guided FS-LASIK and TICL implantation were effective and safe in correcting myopia with moderate to high astigmatism, and corneal topography-guided FS-LASIK perform better than TICL implantation for the astigmatism correction.
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@#AIM:To observe the therapeutic effects of standard laser in situ keratomileusis(LASIK), wavefront-guided LASIK(WF-LASIK)and small incision lenticule extraction(SMILE)on refractive errors. <p>METHODS: This study retrospectively analyzed 97 patients(194 eyes)with refractive errors admitted to the hospital between March 2020 and March 2021. They were divided into LASIK group(28 cases, 56 eyes), WF-LASIK group(32 cases, 64 eyes)and SMILE group(37 cases, 74 eyes)according to the surgical method. The uncorrected visual acuity(UCVA), diopter, high-order aberrations, tear film break-up time(BUT)and tear secretion function(SⅠt)were observed before and after operation, and related complications were recorded. <p>RESULTS: The UCVA, spherical diopter, cylindrical lens diopter and spherical equivalent were similar in the 3 groups at 1 and 3mo after operation(all P>0.05). The spherical aberrations of LASIK group, WF-LASIK group, and SMILE group at 1 and 3mo after operation decreased in order(all P<0.05). The horizontal coma and vertical coma of LASIK group and SMILE group at 1 and 3mo after operation were greater than those of WF-LASIK group(all P<0.05). The total high order aberrations of LASIK group at 1 and 3mo after operation were significantly greater than those of the other two groups(all P<0.05). BUT and SⅠt of SMILE group at 1 and 3mo after operation were significantly better than those of the other two groups(all P<0.05), without significant difference between WF-LASIK group and LASIK group(all P>0.05). The total incidence rates of complications in the 3 groups were close(P>0.05). <p>CONCLUSION: All of LASIK, WF-LASIK and SMILE can improve vision of patients with refractive errors. However, patients treated with WF-LASIK have the best visual quality after operation, and those treated with SMILE can obtained better tear film stability after operation.
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ABSTRACT A 27-year-old healthy man with a history of bilateral photorefractive keratectomy (PRK) enhancement after femtosecond laser in situ keratomileusis (LASIK) presented with decreased uncorrected distance visual acuity (UDVA) of 20/125 in the right eye (OD) and 20/300 in the left eye (OS) six months after PRK. Examination revealed bilateral dense subepithelial opacities. Both eyes (OU) were treated with superficial keratectomy combined with phototherapeutic keratectomy (PTK) and adjunctive application of mitomycin C 0.02%. At three months follow up UDVA was 20/30 OD and 20/25 OS. Superficial keratectomy combined with PTK seems to be a safe and efficient technique for treatment of dense subepithelial scar formation following PRK enhancement after LASIK.
RESUMO Um homem saudável de 27 anos de idade com história de aprimoramento com ceratectomia fotorrefrativa (PRK) bilateral, após Ceratomileuse Assistida por Excimer Laser In Situ (LASIK) com laser de femtossegundos, apresentou diminuição da acuidade visual à distância não corrigida (AVNC) de 20/125 no olho direito (OD) e 20/300 no olho esquerdo (OE) seis meses após PRK. O exame revelou opacidades subepiteliais densas bilaterais. Ambos os olhos (AO) foram tratados com queratectomia superficial combinada com ceratectomia fototerapêutica (PTK) e aplicação adjuvante de mitomicina C a 0,02%. Aos três meses de acompanhamento, o AVNC foi de 20/30 OD e 20/25 OE. A ceratectomia superficial combinada com PTK parece ser uma técnica segura e eficiente para o tratamento da formação densa de cicatrizes subepiteliais após o aprimoramento com PRK pós-LASIK.
Subject(s)
Humans , Male , Adult , Fibrosis/therapy , Photorefractive Keratectomy/adverse effects , Wound Healing , Fibrosis/etiology , Visual Acuity , Mitomycin/administration & dosage , Photorefractive Keratectomy/methods , Corneal Opacity/diagnosis , Corneal Opacity/etiology , Corneal Topography , Keratomileusis, Laser In Situ , Debridement , Corneal Surgery, Laser , Slit Lamp Microscopy , Myopia/surgeryABSTRACT
RESUMO O Lasik é a técnica de cirurgia refrativa mais utilizada no mundo. Apesar de segura e efetiva, ela pode levar a algumas complicações. O crescimento epitelial pós-Lasik é uma complicação pós-operatória incomum, com prevalência maior em casos de retratamento. Geralmente, é um achado não progressivo e assintomático, que não requer tratamento, mas, em uma minoria de pacientes, os sintomas podem ser clinicamente significantes e variados. O tratamento é feito com debridamento mecânico do crescimento epitelial, mas alguns recursos adjuvantes também podem ser utilizados. O presente estudo consiste em um relato de caso de paciente com crescimento epitelial pós-Lasik que apresentou quatro recidivas após intervenções de debridamento epitelial, sutura de lamela corneana e ablação a laser. No quinto procedimento, o paciente foi finalmente tratado com combinação de debridamento epitelial, uso de álcool a 20% e cola de fibrina. Entretanto, a regressão do crescimento epitelial e a melhora da acuidade visual só ocorreram ao longo dos meses após a intervenção, o que mostra a importância de esperar um tempo para que ocorra a melhora da visão no pós-operatório, evitando-se reintervenções.
ABSTRACT Lasik is the most often performed laser refractive surgery worldwide. Despite its efficacy and safety, some complications may occur. Epithelial ingrowth is a rare postoperative complication of Lasik, with an increased prevalence in cases of retreatment. Epithelial ingrowth is usually a nonprogressive and asymptomatic finding, which requires no treatment; however, in a minority of cases, symptoms may be clinically significant and diverse. Treatment is done with mechanical debridement of the affected interface, and additional interventions may be required. This study reported a case of recalcitrant epithelial ingrowth after Lasik, whichrelapsed four times after mechanical debridement, flap lift and laser ablation. In the fifth intervention, the patient was finally treated with a combined scraping/use of 20% alcohol and fibrin glue. However, regression of epithelial ingrowth and better visual acuity were only observed some months after the intervention, which shows the importance of waiting for better vision in the postoperative period, thus avoiding new reinterventions.
Subject(s)
Humans , Male , Middle Aged , Postoperative Complications/therapy , Epithelium, Corneal/surgery , Epithelium, Corneal/pathology , Corneal Diseases/etiology , Corneal Diseases/therapy , Keratomileusis, Laser In Situ/adverse effects , Recurrence , Reoperation , Fibrin Tissue Adhesive , Combined Modality Therapy , Debridement , Ethanol/administration & dosageABSTRACT
Objective:To investigate and compare the changes of modulation transfer function (MTF) after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK).Methods:A cohort study was conducted.One hundred and two myopic patients (102 eyes) who underwent SMILE and FS-LASIK in Tianjin Eye Hospital from December 2015 to June 2016 were enrolled and divided into SMILE group with 53 eyes and FS-LASIK group with 49 eyes according to different surgical methods.The ocular aberrations and corneal morphology of all patients were measured by the Hartman-Shack wave-front analyzer and Pentacam topography before surgery and 1, 3 and 6 months postoperatively.MTF of optic system was calculated and analyzed.The changes of MTF values were compared between the two groups at different time points under different spatial frequencies, after removal of low-order aberrations at postoperative 6 months, and after removal of vertical coma aberration, horizontal coma aberration and spherical aberration in the SMILE group at postoperative 6 months.The study protocol complied with the Declaration of Helsinki and was approved by an Ethics Committee of Tianjin Eye Hospital (No.TJYYLL-2014-17). Written informed consent was obtained from each patient before surgery.Results:Compared with the preoperative MTF, there were significant increases in postoperative 1-, 3- and 6-month MTF at all spatial frequencies in the SMILE group and FS-LASIK group (all at P<0.05). MTF values at all spatial frequencies in the SMILE group were significantly higher than those in the FS-LASIK group at 1, 3, and 6 months after surgery (all at P<0.05), except at 55 c/d and 60 c/d at 6 months postoperatively.The postoperative 6-month MTF values at all spatial frequencies without low-order aberration were higher in the SMILE group than those in the FS-LASIK group, showing significant differences between the two groups (all at P<0.05). In the SMILE group, the postoperative 6-month MTF values at 1 c/d spatial frequency without the horizontal coma aberration and spherical aberration were significantly higher than the preoperative MTF values (both at P<0.01); the postoperative 6-month MTF values at 1 c/d and 3 c/d spatial frequency without vertical coma aberration were significantly higher than the preoperative MTF values (both at P<0.05), and there were no statistically significant differences between the postoperative 6-month MTF values at the other spatial frequencies with and without single high-order aberrations (all at P>0.05). Conclusions:Optic quality has been obviously improved after SMILE and FS-LASIK, and the SMILE is superior to FS-LASIK in the MTF value.
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Objective:To evaluate the clinical features of interface fluid syndrome (IFS) after laser in situ keratomileusis (LASIK).Methods:We searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, and Chinese Science and Technology Periodical Database for literature reports on IFS published from 1999 to 2021.Article selection, data extraction, quality rating, and data analysis were performed with reference to the PRISMA statement for priority reporting entities of systematic reviews and Meta-analysis.Results:A total of 30 publications were included, including 46 cases (62 eyes). Among them, 34 cases (47 eyes) were male and 12 cases (15 eyes) were female.Age ranged from 19 to 69 years with a mean of (36.57±13.40) years.There were 16 cases of bilateral eyes and 30 cases of monocular eyes.The 85.48% (53/62) of IFS was due to increased intraocular pressure (IOP) after LASIK.All 62 eyes included had decreased visual acuity.The 24.19% (15/62) of the affected eyes had ocular pain, redness, and photophobia.All 46 patients showed different degrees of corneal edema and interface fluid.Keratic precipitates and anterior chamber cells were visible in 9.68% (6/62) of the affected eyes, and 16.13% (10/62) showed visual field damage.IOP-lowering eye drops were given to 77.42% (48/62) of eyes.Of the 31 patients (40 eyes) with prognostic descriptions, and 75.00% (30/40) recovered their vision with treatment and 25.00% (10/40) did not.Conclusions:IFS is a rare complication after LASIK.It should be considered in patients with corneal edema after LASIK.Proper measurement of IOP and reasonable application of glucocorticoids and IOP-lowering drops can prevent irreversible vision loss.
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@#AIM: To analyze the early visual quality differences of femtosecond laser small incision matrix lens extraction(SMILE)versus femtosecond laser excimer laser <i>in situ</i> keratomileusis(LASIK).<p>METHODS: From February 2017 to February 2018, 78 patients(including 156 eyes)with SMILE myopia were enrolled in our hospital. Eighty patients(160 eyes)who underwent LASIK myopia in the same period were selected. All patients were followed up for three times. Months were observed for surgical outcomes, high-order aberrations, and contrast sensitivity(CS)status.<p>RESULTS: At 1mo and 3mo postoperatively, the central corneal thickness change rate in the SMILE group was(-14.48±2.67)%,(-13.54±2.90)% lower than that of LASIK(-17.92±2.85)%,(-15.63±2.71)%, and intraocular pressure changes. The rates were(-27.08±3.64)% and(-24.41±3.28)% were lower than those in the LASIK group(-29.26±3.81)% and(-27.01±3.62)%(<i>P</i><0.05). The total high-order aberrations of the SMILE group were the sputum difference was lower than that of LASIK group(<i>P</i><0.05). The SMILE group values were(1.86±0.21),(1.52±0.23)and(0.91±0.14)when the spatial frequency of glare CS was 1.5, 12.0 and 18.0 at 1mo after operation was higher than the LASIK group(1.71±0.20),(1.41±0.25),(0.81±0.12)(<i>P</i><0.05).<p>CONCLUSION: SMILE has a lower effect on patients with higher-order aberrations than LASIK, and the early visual quality is better.
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@#AIM: To observe the early clinical effects of smart pulse technology(SPT)-assisted transepithelial photorefractive keratectomy(TPRK).<p>METHODS: This was a retrospective non-randomized research. There were 260 patients(508 eyes)who were underwent SPT-assisted TPRK surgery. The best corrected visual acuity(BCVA)was recorded at 1 to 2wk before surgery. The uncorrected visual acuity(UCVA)was recorded at 1mo and 3mo after surgery. Corneal epithelial growth status and haze grade were recorded after surgery. Record the degree of pain within 3d after surgery and satisfaction surveys in all patients.<p>RESULTS: After 1mo and 3mo, UCVA(-0.080±0.0798, -0.108±0.089)achieved or even better than preoperative BCVA(-0.050±0.0561). Corneal epithelial wounds were completely repaired in all patients during 5d after operation. In the follow-up of 1mo and 3mo after operation, the corneas of most patients are clear except for 3 cases who had haze in 0-1 grade. Very satisfied patients accounted for 93.0%.<p>CONCLUSION: SPT-TPRK surgery is safe. The average postoperative UCVA can reach or even exceed the preoperative average BCVA.
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@#AIM: To compare the changes of dry eye symptoms and signs after femtosecond-assisted laser <i>in situ</i> keratomileusis(LASIK)and conventional LASIK by Keratograph 5M.<p>METHODS: Sixty patients(120 eyes)who underwent corneal refractive surgery from June 2017 to November 2017 were enrolled. Thirty patients(60 eyes)underwent femtosecond-assisted laser LASIK and 30 patients(60 eyes)underwent conventional LASIK. All patients took examinations of Keratograph 5M dry eye related examinations,routine ophthalmological examinations and ocular surface disease index(OSDI)questionnaire before and 1wk, 1mo, 3mo and 6mo after surgery.<p>RESULTS: One week after operation, the OSDI scores of two groups were significantly higher than pre-operation(<i>P</i><0.01), but 1mo after operation, the two groups recovered to the preoperative level(<i>P</i>>0.05). Noninvasive tear film break-up time(NI-BUT)in the conventional group was shorter 1wk, 1mo and 3mo after operation(<i>P</i><0.01), while it was shorter in 1wk and 1mo after operation in femtosecond laser group(<i>P</i><0.01). There was significant difference between conventional group and femtosecond laser group at 3mo after operation in NI-BUT(<i>P</i><0.01). Tear meniscus hight(TMH)and the thickness of lipid layers of the two groups all decreased in 1wk and 1mo after operation(<i>P</i><0.05).<p>CONCLUSION: Whether femtosecond-assisted or conventional LASIK will affect tear film stability and cause dry eye symptoms. The degree of influence decreases gradually with the time after operation, but femtosecond laser group can recover more quickly.
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Presbyopia is an age-related condition that progressively decreases the ability to focus on near objects. Minimally invasive surgical techniques have been developed to improve near vision, including laser in situ keratomileuses (LASIK) and corneal inlay. Most have similar approaches using monovision or increasing the depth of focus. Monovision laser refractive surgery is a combination of conventional LASIK, LASIK which creates a multifocal cornea (central near or peripheral near) and aspheric micro-monovision LASIK with a special ablation profile, which develops spherical aberration. Conductive keratoplasty is a method that uses radiofrequency energy to shrink the mid-peripheral corneal stromal tissue. However, it is not used because of regression. A corneal inlay is a small device that is implanted in the corneal flap or pocket made by a femtosecond laser. It is inserted into the non-dominant eye. There are various inlays such as the Flexivue Microlens (refractive), Raindrop (corneal shape-changing), and KAMRA (small-aperture) inlays. However, the safety and effectiveness of these inlays have not been proven over a long follow-up period, so care is required when performing inlay implantation. All presbyopia treatments can improve near vision but also have limitations and side effects such as reduced far vision, contrast sensitivity, or increased glare. Therefore, it is essential to select patients carefully. Mechanisms associated with presbyopia are not fully understood, and presbyopia remains challenging for ophthalmologists.