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@#AIM:To compare the clinical effects of removing or reserving the epithelial flap in high myopia correction by laser subepithelial keratomileusis(LASEK). <p>METHODS: Retrospective analysis of 58 patients(115 eyes)with high myopia received LASEK were selected and divided into reserving the epithelial flap group(30 patients, 59 eyes)and removing epithelial flap group(28 patients, 56 eyes)according to the order of the alternating vists. The changes of corneal irritation, epithelial healing time,uncorrected visual acuity and the occurrence of haze after surgery were observed.<p>RESULTS:Postoperative 1d, 2d, 3d, respectively, the pain score of the two groups were 1.64±0.64, 1.57±0.57; 0.83±0.49, 0.84±0.56; 0.36±0.48, 0.34±0.47, respectively, the differences were not significant(<i>P</i>>0.05). Postoperative 1wk, 1mo, 3mo, respectively, the uncorrected visual acuity of two group was 0.15±0.06, 0.12±0.05; 0.032±0.004, 0.041±0.003; 0.018±0.004, 0.022±0.005, and the differences were not significant(<i>P</i>>0.05). After 1mo, 3mo of surgery, the differences of the haze less than grade one of the two group, respectively, and were not significant(<i>P</i>>0.05), the differences of the haze of grade two of the two groups, respectively, and the differences were significant(<i>P</i><0.05). The epithelial healing time of the two groups were 4.22±0.30d, 3.89±0.32d(<i>P</i><0.05). The number of epithelial delayed healing of two groups was 0 eye and 10 eyes(<i>P</i><0.05).<p>CONCLUSION:It was similar both the changes of corneal irritation and uncorrected visual acuity of two groups,the rate of level two haze was higher in removing epithelial flap group. The time of healing of epithelium was quick than reserving the epithelial flap group,but the rate of delayed healing and poor healing of epithelium was higher than reserving the epithelial flap group. Therefore, for high myopia, it is worthy of clinical application of reserving the epithelial flap by LASEK.
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@#Objective To compare the therapeutic effect of epithelial flap removed laser subepithelial keratomileusis (LASEK) and femtosecond laser assisted LASIK (FS-LASIK) in the treatment of moderate and low myopia. Methods A total of 103 patients (103 eyes) of low and moderate myopia were selected, 51 patients (51 eyes) were treated with LASEK and 52 patients (52 eyes) were treated with FS-LASIK. Data of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual equivalent spherical degree (SE), total high-order aberrations (HOAs), spherical aberration, coma and trefoil were examined before operation and 1month and 3 months after operation, and compared between two groups of patients. Results There were no significant differences in UCVA and BCVA 1 month and 3 months postoperatively between the two groups. SE shifted to myopia direction in LASEK group compared with that of FS-LASIK group 1 month postoperatively (P＜0.05), but reached a similar level 3 months after surgery. The HOAs and spherical aberration were significantly increased 1 month and 3 months postoperatively compared with those before operation in LASEK and FSLASIK groups (P＜0.05). Coma was significantly increased 1 month postoperatively in FS- LASIK group and returned to the preoperative level 3 months postoperatively, while it remained at baseline 1 month and 3 months postoperatively in the LASEK group. The HOAs and coma were significantly higher 1 month postoperatively in FS-LASIK group compared to those of LASEK group (P＜0.05), while they reached a similar level 3 months postoperatively. Conclusion The therapeutic effect of epithelial flap removed LASEK can reach a level equal to FS-LASIK at the early stage after surgery. It is a good selectable choice for patients with low to moderate myopia.
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Objective To detect and analyze of residual ethanol in abandoned flaps after laser subepithelial keratomileusis (LASEK) with ethanol infiltration methods.Methods Together 20 patients (40 eyes) undergoing LASEK were recruited in the study.After infiltrated with 20％ ethanol and rinsed in equilibration solution,the corneal epithelial free flap was isolated and removed in time for sealing,and then procedures were continuously completed.Finally,observation of the skin flap production,postoperative irritation symptoms,epithelial healing,visual recovery and postoperative haze situation was performed,and then the amount of ethanol in the epithelial flap was measured.Results There was no failure in making the intact corneal flaps.The sensory score of postoperative irritation was 2.52 ± 1.46.Neonatal epithelial with 1 grade was observed in 32 eyes,2 grade in 8 eyes 5 days after surgery,while corneal haze with 0.5 grade was occurred in 3 eyes,1 grade in 2 eyes 12 weeks after surgery.There were ethanol residues in corneal epithelium in the abandoned flaps,with the amount of ethanol residues of (0.205 2 ± 0.041 0) μL in each flap.Conclusion It is found that a certain amount of ethanol residue in the corneal epithelium after LASEK with ethanol infiltration equilibration solution rinse,which may be one reason of the corneal irritation symptoms and corneal haze.
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AIM:To observe the efficacy and safety of 1g/L bromfenac sodium hydrate ophthalmic solution in the partial substitution of glucocorticoid after laser subepithelial keratomileusis (LASEK).METHODS: Totally 104 cases (208 eyes) were received LASEK, which were selected and divided into study group and control group.The study group were adopted 1g/L bromfenac sodium hydrate ophthalmic solution combined with tobramycin dexamethasone eye drops and fluorometholone eye drops, the control group were adopted tobramycin dexamethasone eye drops and fluorometholone eye drops.The changes of visual acuity and intraocular pressure of two groups were recorded before and after surgery, and the score of painness and the occurrence of haze were observed after surgery.RESULTS: At postoperative 1, 2, 3d, respectively, the pain score of the study group were 1.70±0.35, 1.25±0.34, 0.82±0.32, the pain score of the control group were 2.30±0.43, 1.68±0.44, 1.12±0.33, the differences were significant (P0.05), and the differences were not significant(P>0.05).At preoperative and postoperative 1, 2wk, 1 and 3mo of surgery, respectively, the intraocular pressure of study group were 17.33±1.58, 7.54±1.28, 7.23±1.58, 7.26±1.47, and 7.30±1.36 mmHg;the intraocular pressure of control group were 17.53±1.43,7.57±1.32,7.73±1.55,7.80±1.38,7.86±1.43 mmHg,the differences were not significant between before and at 2wk after surgery(P>0.05), the differences were significant between the two groups at 2wk, 1mo and 3mo (P0.05).CONCLUSION: It is safe and effective that 1g/L bromfenac sodium hydrate ophthalmic solution in the partial substitution of glucocorticoid after laser subepithelial keratomileusis.The patient has a lower intraocular pressure, has similar therapeutic effect as glucocorticoid in vision and antiinflammatory.
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AIM: To observe the effect and safety of applying mitomycin C ( MMC ) in laser - assisted subepithelial keratomileusis ( LASEK) for extreme high myopia. ●METHODS:LASEK with 0. 02% MMC was performed in 364 eyes of 182 patients with extreme high myopia and spherical equivalent was-9. 0 to-10. 25 D. All the patients were divided into four groups according to the applying time of MMC. The time in Group l was 10s, in GroupⅡwas 25s, in Group Ⅲ was 40s and 55s in Group lV. Uncorrected visual acuity ( UCVA ) , residual refraction, Haze, healing time of corneal epithelium, density and variant index of corneal endothelium was examined in these patients and follow-up 6mo. ●RESULTS:At 6mo after surgery, 76. 3%, 94. 0%, 92. 3%and 93. 8% of the patients in Group l, GroupⅡ, GroupⅢ and Group lV respectively achieved the UCVA better than 15/20. There was significant difference of UCVA between Group l and the other three groups (χ2=19. 610, P=0. 000). Proportion of the residual refraction between ± 0. 5D in Group l (78. 8%) was lower than other groups (95. 2% in Group Ⅱ, 93. 3% in Group Ⅲ, and 92. 7% in GroupⅣ) at 6mo and there was significant difference (χ2=16. 329, P=0. 001). Group l had more Haze statistically than the other three groups at 6mo postoperatively ( Hc=50. 110, P=0. 000). The healing time of cornea epithelium seem to be no statistically difference between each group at 6mo (χ2=11. 611, P>0. 05). MMC had no influence on the density of corneal endothelium in each group postoperatively (P>0. 05), there were 3071. 3±284. 4 cells/mm2 in Group l, 3 105. 6 ± 337. 8 cells/mm2 in Group Ⅱ, 2 986. 3 ± 304. 1cells/mm2 in Group Ⅲ and 3 088. 7 ± 372. 5 cells/mm2 in Group lV respectively. The variant index of corneal endothelium calculated in each group at 6mo after surgery was 24. 72 ± 6. 52, 22. 93 ± 6. 74, 24. 38 ± 6. 63 and 23. 14±7. 22 repectively, compare with that preoperatively there were no statistically differences (P>0. 05). ●CONCLUSION: For extreme high myopia LASEK with 0. 02% MMC is effective and safe. The MMC applying time of 25s in LASEK can effectively reduce Haze after surgery and decrease potential complications.
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AlM:To observe clinical effects between the laser in situ keratomileusis ( LASlK ) surgery and the laser subepithelial keratomileusis ( LASEK ) surgery as the second operation after an unsuccessful LASlK surgery.METHODS:Forty-nine patients (98 eyes) with refractive regression after LASlK operation received the second surgery. All patients were divided into two groups:group A and B. Group A (48 eyes of 24 patients) received LASlK surgery and group B ( 50 eyes of 25 patients ) received LASEK surgery. lnspect the main parameters included visual acuity, refraction, corneal curvature, and the total value of high-aberration after 1wk, 1mo and 1a, t-test of groups was used as statistical analysis method.RESULTS: There was statistically significant (P0. 05). There developed one case of epithelium in growth after LASlK surgery, and one case of haze Ⅱ after LASEK surgery.CONCLUSlON: Both LASlK and LASEK surgery can obtain satisfactory therapeutic results after an unsuccessful LASlK surgery.
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PURPOSE: To evaluate the changes of higher order aberrations (HOAs) before and after laser subepithelial keratomileusis (LASEK) and to analyze the influence of tear film instability on HOAs of the corneal surface after LASEK. METHODS: In this cross-sectional study, 31 patients who underwent LASEK were divided into dry eye (16 patients, 32 eyes) and non-dry eye groups (15 patients, 30 eyes). Uncorrected distance visual acuity, spherical equivalent refraction, ablation depth, tear film parameters and Ocular Surface Disease Index (OSDI) questionnaire scores were evaluated in both groups. Total HOA root mean square (RMS), third-order coma, third-order trefoil and fourth-order spherical aberration (SA) of the corneal surface immediately and at 10 seconds after blinking were measured before and after surgery. RESULTS: The total HOA RMS, coma, trefoil and SA significantly increased after LASEK compared with preoperative values in both groups. In the dry eye group, total HOA RMS, coma and trefoil significantly increased except for SA at 10 seconds after blinking compared with those measured immediately after blinking. In addition, the changes of total HOA RMS, coma and trefoil were negatively correlated with tear film break-up time (R = -0.420, -0.473 and -0.439, respectively), but positively correlated with OSDI score (R = 0.433, 0.499 and 0.532, respectively). In the non-dry eye group, there were no significant differences between HOAs measured at 10 seconds after blinking and those measured immediately after blinking. CONCLUSIONS: The HOAs including coma, trefoil and SA significantly increased after LASEK. The tear film instability in the dry eye can be associated with more deterioration of the optical quality after LASEK, due to more significant increase of total HOA RMS, coma and trefoil.
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Adult , Female , Humans , Male , Young Adult , Cornea/physiopathology , Corneal Wavefront Aberration/etiology , Cross-Sectional Studies , Dry Eye Syndromes/physiopathology , Keratectomy, Subepithelial, Laser-Assisted/adverse effects , Lasers, Excimer/therapeutic use , Surveys and Questionnaires , Tears/physiology , Visual Acuity/physiologyABSTRACT
Objective To evaluate the clinical efficacy of laser-assited subepithelial keratomileusis(LASEK) for treatment of myopia and astigmatism.Methods LASEK was performed for 30 cases(60 eyes) with myopia and astigmatism.The preoperative myopia diopter ranged from -1.50DS to -11.00DS,the astigmatism ranged from -1.50DC to -2.50DC.To make corneal subepithelial valve,eyes were soaked in 20% alcohol for 30 to 35 seconds.It was applied with quasi-molecule laser system.Results The visions with 73.17% were between 0.8 and 1.0 one month post-operatively,26.55% between 0.5 and 0.7,and 0.27% less than 0.5;The average visions with 76.69% were between 0.8 and 1.0 three months post-operatively,and 23.30% between 0.5 and 0.7;The visions with 77.78% were between 0.8 and 1.0 in six months after operation,and 21.68% between 0.5 and 0.7.There were no significant difference between in three months post-operatively and preoperative in corrected visions.Conclusion LASEK induces less pain and HAZE than PRK and LASEK has wider surgery field.Moreover,the risk of LASEK has less risk and less hidden danger than LASIK.In summary,LASEK is one of the safe choices in the treatment of myopia with laser relatively.
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Objective:To evaluate the efficacy of laser subepithelial keratomileusis(LASEK) for the treatment of myopia and astigmatism with a thinner cornea.Methods:Eyes(128) from 67 patients were divided into 2 groups,preoperatively,according to the refractive degree.Group I contained 28 eyes with spherical and cylindrical refraction at-2.5 ~-6.0 DS and 0 ~ 2.0 DC,respectively.Group II contained 100 eyes with spherical and cylindrical refraction at-6.25 ~-14.0 DS and 0 ~-2.0 DC,respectively.Following-up was lasted over half a year and the results were compared.Results:The rates of eyes that achieved vision of 0.5 or better after operation in group Ⅰ and Ⅱ were respectively 76 % and 39 % at one week,89 % and 67 % at 1 month,93 % and 56 % at 6 months.The rates of eyes after operation in group Ⅰ and Ⅱ were respectively 93 % and 56 % for spherical refraction within?1.0 DS,and 96.43% and 76% for cylindrical refraction within?1.0 DC.Conclusion:LASEK was safer and more effective in treating low to moderate myopia with astigmatism than in treating high myopia with astigmatism.