Laser in situ keratomileusis and surface ablation in pregnancy.

PURPOSE: Although corneal refractive surgery is contraindicated during pregnancy, some patients are unaware that they are pregnant when they undergo surgery. Our objectives were to determine the functional outcomes of corneal refractive surgery during pregnancy and to compare the results with those of nonpregnant women. METHODS: We performed a multicenter, retrospective, interventional case series review of patients who were pregnant and who underwent laser in situ keratomileusis (LASIK) or surface ablation (photorefractive keratectomy, PRK) from September 11, 2002 to December 12, 2020 (group 1, n=82 eyes). Patients were included consecutively. Findings were compared with those of nonpregnant women (group 2, n=164 eyes). Functional (visual and refractive) outcomes are described. Follow-up was at least 550 days (control group, median [IQR], 990 days [715-1496]; study group, 895 days [709-1310]). The setting was Clínica Baviera, Spain, (AIER Eye Hospital Group). RESULTS: A statistically significant difference was found between the groups in terms of efficacy index (EI). No complications of pregnancy or labor were reported. Similarly, a search of medical records revealed no adverse effects in the infants. CONCLUSIONS: To the best of our knowledge, this is the first case series on pregnancy and refractive surgery. We do not recommend performing LASIK or surface ablation on pregnant women. Our objective in the present study was to present relevant scientific data obtained from women who underwent refractive surgery while unaware that they were pregnant.

The use of HCT and/or ACE inhibitors significantly increases the risk of non-melanotic skin cancer in the periocular region.

BACKGROUND/AIMS: To investigate a possible association between the use of hydrochlorothiazide (HCT) and/or angiotensin-converting enzyme inhibitors (ACE inhibitors) and the occurrence of periocular non-melanoma skin cancer. METHODS: The files of 929 patients from the University Medical Center Hamburg-Eppendorf who were surgically treated for suspected periocular malignancy were evaluated retrospectively regarding the occurrence of non-melanoma skin cancer and concomitant medication. To be able to put the data in an overall context, we also analyzed age-matched routine data of the DAK-Gesundheit (DAK-G), a nationwide operating German health insurance company. RESULTS: Of the 929 patient records examined, who underwent surgical excision for suspected non-melanotic malignancy, non-melanocytic skin cancer could actually be determined by histology in 199 patients. In total, 176 patients (103 women, 72 men) had a basal cell carcinoma and 23 patients (16 women, 7 men) suffered from squamous cell carcinoma. The rate of intake of HCT or ACE inhibitors in our patient collective with non-melanotic skin cancer is significantly higher than in the general age-matched population (ORACE: 2.51, p < 0.001; ORHCT: 7.24, p < 0.001, ORBOTH: 4.61, p < 0.001). CONCLUSION: The rate of intake of HCT or ACE inhibitors is significantly higher in our patient collective with non-melanotic skin cancer compared to the group from the age-matched general population (DAK insured (p < 0.001)) compared to the routine data of the DAK-G. This leads us to the conclusion that taking the medication is associated with an increased risk for non-melanotic skin cancer. We recommend regular skin cancer screening, moderate ordination of photosensitizing medication, but above all comprehensive clarification of possible risks.

[Comparative analysis of refractive and topographic changes after eye muscle surgery]. / Vergleichende Analyse der Refraktions- und Topographieveränderungen nach Augenmuskeloperationen.

BACKGROUND: The question of whether refractive or topographic changes are to be expected after eye muscle surgery is largely unanswered. MATERIALS AND METHODS: Results of pre- and postoperative objective refraction, Pentacam (Oculus, Menlo Park, CA, USA), and visual acuity tests of 229 eyes are included in the present analysis. The examinations took place preoperatively, on the first postoperative day, and after 3 months. RESULTS: After surgery on one or two extraocular recti muscle, there are significant changes in the cylinder (p < 0.001) on the first postoperative day, although values returned to normal after 3 months. Similar changes also appeared in combined operations of extraocular and oblique muscles. CONCLUSION: The authors postulate that extensive patient education with regard to temporary changes in the cylinder is necessary, particularly when the extraocular muscles are involved, and that additional refraction and topography control can be useful postoperatively if visual rehabilitation is inadequate.

Comparación de 5.468 retratamientos tras láser in situ queratomileusis levantando el lentículo o mediante queratectomía fotorrefractiva sobre el lentículo / Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap

Objetivo: Describir los resultados visuales del retratamiento tras láser in situ queratomileusis (LASIK) levantando el lentículo previamente o realizando queratectomía fotorrefractiva (PRK) sobre él, establecer si el riesgo de crecimiento epitelial de la interfase (CEI) es mayor cuanto más tiempo ha pasado entre el LASIK inicial y el retratamiento por levantamiento y determinar la incidencia de la opacidad corneal (haze) tras PRK. Métodos: Estudio retrospectivo de 4.077 pacientes (5.468 ojos) tratados mediante LASIK y retratamiento para estudiar los resultados visuales e identificar los casos de CEI y haze corneal. Resultados: Se estudiaron 5.196 ojos de 3.876 pacientes retratados de miopía levantando el lentículo y 272 ojos de 201 pacientes retratados mediante PRK en el lentículo. No se encontraron diferencias estadísticamente significativas entre los retratamientos en predictibilidad, eficacia y seguridad. Se encontró un total de 704 casos de CEI tras levantar el lentículo; se necesitó limpieza quirúrgica en 70. La limpieza quirúrgica disminuyó el índice de eficacia al compararlo con el de los pacientes con CEI que no precisaron limpieza (p = 0,01). Las diferencias en términos de seguridad y predictibilidad no fueron estadísticamente significativas. La incidencia de haze corneal tras la ablación de superficie sobre el lentículo previo fue del 14,34%, aunque ninguno de estos casos fue clínicamente relevante. Conclusiones: Los resultados visuales son similares entre los pacientes retratados mediante levantamiento del lentículo o mediante PRK. La incidencia de CEI levantando lentículo fue del 13,55%. La incidencia de CEI aumenta a medida que aumenta el tiempo entre el procedimiento primario y el retratamiento (AU)

Purpose: To assess visual outcomes of retreatment after laser in situ keratomileusis (LASIK) by lifting the flap or performing photorefractive keratectomy (PRK) on the flap, as well as to establish whether there was an increased risk of epithelial ingrowth (EIG) when LASIK and lifting of the flap are separated by a long time interval and to determine the incidence of corneal haze after PRK. Methods: Retrospective study of 4077 patients (5468 eyes) who underwent LASIK and subsequent retreatment were reviewed in order to study their visual results and identify cases of EIG and corneal haze. Results: Enhancements included 5196 eyes from 3876 patients that were retreated by lifting the flap, and 272 eyes from 201 patients that were retreated by PRK on the flap. No statistically significant differences were found between the retreatments in terms of predictability, efficacy, and safety. A total of 704 cases of EIG were found after lifting the flap, for which surgical cleansing was necessary in 70. Surgical cleansing decreased the efficacy index when compared with patients with EIG who did not need cleansing (P = .01). Differences in terms of safety and predictability were not statistically significant. The incidence of corneal haze after ablation of the surface of the previous flap was 14.34%, although none of these cases were clinically relevant. Conclusions: Visual outcomes were similar between patients who were retreated by lifting the flap and those who underwent PRK. The incidence of EIG when the flap was lifted was 13.55%. The incidence of EIG increases with the time elapsed between the primary procedure and retreatment (AU)

Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap. / Comparación de 5.468 retratamientos tras láser in situ queratomileusis levantando el lentículo o mediante queratectomía fotorrefractiva sobre el lentículo.

PURPOSE: To assess visual outcomes of retreatment after laser in situ keratomileusis (LASIK) by lifting the flap or performing photorefractive keratectomy (PRK) on the flap, as well as to establish whether there was an increased risk of epithelial ingrowth (EIG) when LASIK and lifting of the flap are separated by a long time interval and to determine the incidence of corneal haze after PRK. METHODS: Retrospective study of 4077 patients (5468 eyes) who underwent LASIK and subsequent retreatment were reviewed in order to study their visual results and identify cases of EIG and corneal haze. RESULTS: Enhancements included 5196 eyes from 3876 patients that were retreated by lifting the flap, and 272 eyes from 201 patients that were retreated by PRK on the flap. No statistically significant differences were found between the retreatments in terms of predictability, efficacy, and safety. A total of 704 cases of EIG were found after lifting the flap, for which surgical cleansing was necessary in 70. Surgical cleansing decreased the efficacy index when compared with patients with EIG who did not need cleansing (P=.01). Differences in terms of safety and predictability were not statistically significant. The incidence of corneal haze after ablation of the surface of the previous flap was 14.34%, although none of these cases were clinically relevant. CONCLUSIONS: Visual outcomes were similar between patients who were retreated by lifting the flap and those who underwent PRK. The incidence of EIG when the flap was lifted was 13.55%. The incidence of EIG increases with the time elapsed between the primary procedure and retreatment.

[Multifocal intraocular lens (MIOL) surgery in young non-presbyopic ametropes : Reasonable and safe?] / Multifokale Intraokularlinsen (MIOL) bei jungen, nicht-presbyopen Patienten : Sinnvoll und sicher?

BACKGROUND: Refractive lens exchange and implantation of a multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses. OBJECTIVES: This retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible. MATERIALS AND METHODS: This retrospective case series comprised consecutively treated 32 eyes of 16 patients (5 myopic, 11 hyperopic patients; mean age 31 ± 6 years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1­year follow-up examination were assessed. RESULTS: Related to distance corrected near visual acuity myopic eyes had a median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (P = 0.415). For intermediate vision, in both groups a lower EI (<0.5; P = 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up. CONCLUSIONS: When neither laser refractive surgery nor implantation of a phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.

[Corneal biomechanics: Corvis® ST parameters after LASIK]. / Korneale Biomechanik : Corvis® ST-Parameter nach Laser-in-situ-Keratomileusis.

BACKGROUND: Corneal refractive surgery alters the biomechanical properties of the cornea. OBJECTIVES: This study was initiated to evaluate corneal biomechanical parameters after LASIK using a Corvis® ST tonometer (CST). METHODS: This retrospective study included 51 eyes of 32 myopic patients. All CST measurements were performed 1 day before surgery and at the 1-month follow-up examination. The LASIK procedure included mechanical flap preparation using a Moria SBK microkeratome and an Allegretto excimer laser platform. RESULTS: Statistically significant differences were observed for mean second applanation length, mean first and second deflection lengths, mean first and second deflection amplitudes, peak distance and radius of curvature. Statistically significant positive correlations were found between the change (Δ) in radius of curvature and Δ in manifest refraction spherical equivalent (MRSE), between the ablation depth and the Δ in intraocular pressure. Applying multiple regression models also revealed statistically significant differences in parameters obtained by CST measurements. CONCLUSION: Several CST parameters were statistically significantly altered by LASIK thereby indicating that flap creation, ablation or both, significantly change the ability of the cornea to absorb or dissipate energy.

[Pachymetry and intraocular pressure measurement by corneal visualization Scheimpflug technology (Corvis ST): A clinical comparison to the gold standard]. / Pachymetrie und Augeninnendruckmessung mittels Corneal-Visualization-Scheimpflug-Technologie (Corvis ST) : Ein klinischer Vergleich zum Goldstandard.

BACKGROUND: Analyses regarding accuracy and reproducibility of intraocular pressure (IOP) measurements and pachymetry with corneal visualization Scheimpflug technology (Corvis ST®, CST). MATERIAL UND METHODS: Retrospective analysis of 72 eyes with primary open angle glaucoma (POAG) and ocular hypertension (OHT) with no prior surgery or other pathology. The results of Goldmann applanation tonometry (GAT), non-contact tonometry (NCT) and ultrasound pachymetry (USP) were compared with repeat measurements with CST. For statistical analyses the t-test and Bland-Altman plots were applied. RESULTS: The mean IOP was 15.5 ± 4.4 mmHg (CST), 14.8 ± 4.4 mmHg (GAT) and 15.6 ± 4.8 mmHg (NCT). The results of GAT and CST as well as GAT and NCT demonstrated statistically significant differences (p < 0.001) whereas NCT and CST displayed no significant differences in IOP (p = 0.72). The mean differences between the repeat measurements were 0.35 ± 1.7 mmHg (CST) and 0.04 ± 0.85 mmHg (GAT). The mean CST pachymetry results showed 551.3 ± 46.5 µm and the USP 526.5 ± 46.4 µm (p < 0.001). The mean difference between the repeated CST measurements was 24.8 ± 21 µm. No repeat measurement data were available for USP. CONCLUSION: The CST is a new device for simultaneously measuring the IOP, pachymetry and biomechanical properties of the cornea. Whether the deviations in the IOP measured by CST and CST pachymetry from the manually performed gold standard has to be evaluated as deficient, tolerable or maybe as an improvement, has to be evaluated in further studies. Because of the automated and contact-free measurement method as well as the potential for simultaneously analyzing biomechanical properties of the cornea, the CST is a device that might help the quest for measuring the 'true' IOP.