Visual field progression in open-angle glaucoma after refractive corneal ablation surgery.

This study aimed to investigate visual field (VF) progression in open-angle glaucoma (OAG) subjects who had a history of refractive corneal ablation surgery (RCAS). Retrospective study. The medical records of 21 subjects who had a history of refractive corneal ablation surgery (RCAS group) and 36 patients who had myopia without a history of RCAS (non-RCAS group) were reviewed. VF progression was determined by the non-parametric progression analysis (NPA) method. VF progression and clinical characteristics were compared between the two groups. For the RCAS group, refractive regressions were analysed. The mean follow-up periods were 4.5 years and 5.5 years for the RCAS and non-RCAS groups, respectively. More glaucoma subjects in the RCAS group (57.1%) had likely VF progression than in the non-RCAS group (25.0%) (p = 0.01). The RCAS group had a significantly lower percentage of IOP reduction with anti-glaucoma medication than the non-RCAS group (p = 0.037). Eyes with likely VF progression had a higher incidence of refractive regression (91.7%, 11/12) than eyes without it (33.3%, 3/9). Among subjects whose eyes had refractive regression, 78.6% (11/14) had likely VF progression, and 21.4% (3/14) did not (p = 0.016). The VF progression in OAG after RCAS was faster than that of myopic OAG without RCAS. Anti-glaucoma treatment should be actively enhanced in clinical practice.

Research progress on mechanism and medical prevention of refractive regression after laser myopia corneal refractive surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Laser corneal refractive surgery is an effective way for the correction of myopia, and its long-term stability is a common concern of surgeons and patients. However, refractive regression is still one of the most common postoperative long-term complications, which has a great impact on postoperative refractive state and visual quality. Refractive regression may be related to many factors, such as the remodeling of corneal epithelium and stroma, and the imbalance between corneal biomechanics and intraocular pressure. Although enhancement surgery could be a useful way to correct refractive regression, there is a risk of corneal ectasia and other complications. Some intraocular pressure lowering medications can be used to rebuild the balance of intraocular pressure and corneal biomechanics, and to prevent postoperative refractive regression by affecting the thickness of corneal epithelium. To a certain extent, the type, the timing and the way of intraocular pressure lowering medications application may have an impact on the prevention and treatment effect of refractive regression.

Analysis on the Correlation Between Long-term Refractive Regression and Visual Quality after FS-LASIK.

PURPOSE: To record the long-term visual quality after FS-LASIK and analyze the effect of long-term refractive regression after corneal laser surgery on visual quality. METHODS: Seventy-eight patients (153 eyes) who had undergone FS-LASIK more than 5 years before and had undergone follow-ups between November 2020 and March 2021. We collected data on the patients' age of surgery, postoperative period, and preoperative diopters (corrected to LogMAR 0.0 by mydriatic optometry). We obtained the measurements of ARC, PRC, THP by Pentacam, and extracted values for UCVA(LogMAR), CTRmsTotal, CTRmsHO, RmsTotal, RmsHO, MTFTotal, MTFHO, PSFTotal, PSFHO, Coma-T, Coma-CT, SA-T, SA-CT, Trefoil-T, and Trefoil-CT measured with OPD Scan III. We allocated the patients into emmetropia group (SE≤ -0.5 D) 40 patients (78 eyes) and regression group (SE > -0.5D) 38 patients (75 eyes) based on their postoperative diopters. RESULTS: The values for postoperative periods, preoperative diopters, CTRmsTotal, CTRmsHO, and RmsTotal, Coma-CT, CTSA-CT in the emmetropia group were significantly lower than those in the regression group. The age of surgery, UCVA, MTFTotaL, MTFHO, PSFTotal, and CTPSF values in the emmetropia group were significantly higher than those in the regression group. The ARC, PRC, THP, RmsHO, Coma-T, SA-T, Trefoil-T, and Trefoil-CT values were similar in both groups. There was no significant difference in preoperative sphere, spherical equivalent and BCVA between the two groups. There were significant differences in postoperative parameters at 1 year, 3 years, and 5 years. The postoperative diopter value was significantly correlated with age of surgery, postoperative period, THP, MTFTotal, PSFTotal, Coma-T, and SA-CT. CONCLUSION: After FS-LASIK, young patients with relatively thin cornea are susceptible to refractive regression. With the extension of postoperative period, refractive regression may aggravate. There was no significant correlation between postoperative refractive regression and higher order aberrations.

Refractive regression after corneal refractive surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Corneal refractive surgery is a method of correcting refractive errors such as myopia, hyperopia and astigmatism through corneal surgery. Refractive regression can often be seen in clinical practice, that is, refractive errors occur again after surgery. Refractive regression and the consequent poor visual quality often trouble patients. So far, different types and methods of corneal refractive surgery have the problem of refractive regression. It is believed that refractive regression is mainly related with epithelium thickening and change of corneal biomechanics. Refractive regression could be predicted and avoided by preoperative risk factors such as preoperative conditions and operative parameters, and can also be prevented by selecting appropriate refractive surgery and using medicine. Non-operative and enhancement surgery can be used to treat refractive regression that has occurred.

Virtual Reality Assessment Reveals Myopic Regression After ICL Implantation in High Myopia.

PURPOSE: To investigate the correlative factors of vision regression after Implantable Collamer Lens (ICL) surgery from the perspective of binocular vision and to develop a predictive model for the refractive change over the long term. METHODS: This was a prospective study of 30 subjects (60 implants), who underwent ICL surgery at Guangdong General Hospital. Corrected distance visual acuity, uncorrected distance visual acuity, spherical equivalent (SE), axial length and binocular examination using virtual reality were analyzed before, 1 month and 1 year after the surgery. RESULTS: Mean SE was (-12.01 ± 0.86) D preoperatively, (-0.44 ± 0.13)D 1 month postoperatively and (-0.97 ± 0.15)D 1 year postoperatively. The average regression 1 year postoperatively (-0.53 ± 0.25D of SE) was significant (P = 0.01). Mean axial length at the base line and 1 year after the surgery was (28.35 ± 0.39) mm and (28.91 ± 0.57) mm. The regression was correlated with the binocular equilibrium difference (r = 0.553, P = 0.002), and the degree of perceptual eye position shift, especially the horizontal shift (r = -0.620, P = 0.000). The important variables relevant to myopic regression were preoperative horizontal perceptual eye position shift (B = -0.007, P = 0.001) and binocular equilibrium difference (B = 0.146, P = 0.012). CONCLUSION: Perceptual eye position deviation and the binocular equilibrium difference could cause binocular gazing instability, and the unstable retinal image created a 'micro retinal-defocus phenomena', leading to an elongation of the axial length and resulting in myopic regression after ICL surgery.

Permavision intracorneal inlay after sixteen years. Regression of initial refractive hyperopia.

According to the available scientific literature, 77 patients underwent Permavision inlay worldwide, between 2004 and 2007. This study reported about the use of Permavision intracorneal inlay to increase the central corneal curvature and to correct hyperopia. A 32-year-old male patient went to the Tecnolaser Clinic Vision ® facilities for a refractive study. Preoperative refraction without cycloplegia was +6.00 D in the right eye (RE) and +4.00 in the left eye (LE). The surgery was performed for both eyes on December 2, 2003. The Carriazo-Barraquer mechanical microkeratome (Moria) was used to create a 180 µm-thick corneal flap with a diameter of 8.5 mm. After lifting the flap, the corneal inlay was placed centrally above the pupil and the flap was re-positioned. In this case report, the patient reverted to the initial refractive situation. The first refractive regression appeared at twelve-month follow-up. After sixteen years, it was found a decrease in maximum corneal curvature, an increase in mean corneal densitometry percentage, and no important changes in the central corneal thickness. In the reported case, the cornea reverted to its original shape. In the scientific literature, this is the first case report of a non-explanted Permavision inlay after sixteen years.

Effect of timolol on refractive regression after high myopia surgery at different time points in LASIK operation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the effect of timolol on refractive regression after high myopia surgery at different time points in LASIK operation.<p>METHODS: Prospective study. Totally 180 eyes of 90 patients with high myopia who were admitted to our hospital from August 2015 to August 2016 were randomly divided into control group and observation group. Each group had 45 cases and 90 eyes. Both groups were treated with loxacin eye drops and tobramycin dexamethasone eye drops for 1wk. The control group was treated with timolol eye drops 7d after operation, and the observation group was treated with timolol eye drops 1d after operation. The uncorrected visual acuity, spherical equivalent, intraocular pressure, corneal surface curvature and corneal stroma thickness were measured and compared before and 7d, 1, 3 and 6mo after operation.<p>RESULTS: There were differences in naked vision and spherical equivalent between the two groups at different time points after operation(<i>P</i><0.05). At 6mo after operation, the naked vision and spherical equivalent of the observation group were better than those of the control group(0.03±0.01 <i>vs</i> 0.08±0.01; 0.15±0.33D <i>vs</i> -0.17±0.36D; all <i>P</i><0.05). There was no difference in corneal stroma thickness and corneal surface curvature between the two groups at different time points(<i>P</i>>0.05). The intraocular pressure of the observation group was significantly lower than that of the control group at 7d, 1 and 3mo after operation(all <i>P</i><0.05). The intraocular pressure of the two groups tended to be stable at 6mo after operation.<p>CONCLUSION: Early application of timolol after LASIK can effectively reduce intraocular pressure, maintain relatively long-term stability of intraocular pressure, prevent corneal swelling, and thus prevent refractive regression.

Two-years results of small-incision lenticule extraction and wavefront-guided laser in situ keratomileusis for Myopia.

PURPOSE: To compare the 2-years visual and refractive outcomes between small-incision lenticule extraction (SMILE) and wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopia and myopic astigmatism. METHODS: Our retrospective case-control study examined 30 eyes of 30 patients with the manifest refraction spherical equivalent (MRSE) of -3.71 ± 1.83 dioptres (D) who underwent SMILE and 30 eyes of 30 patients with MRSE of -3.81 ± 1.40 D who underwent wavefront-guided LASIK. We assessed the 2-years clinical outcomes. RESULTS: Logarithm of the minimal angle of resolution (LogMAR)-corrected distance visual acuity (CDVA) was -0.23 ± 0.07 in the SMILE group and -0.24 ± 0.07 in the wavefront-guided LASIK group 2 years postoperatively (p = 0.82). Logarithm of the minimal angle of resolution-uncorrected distance visual acuity (UDVA) was -0.18 ± 0.09 and -0.15 ± 0.11 (p = 0.30, respectively). In the SMILE and wavefront-guided LASIK groups 2 years postoperatively, 100% and 73% of eyes, respectively, were within 0.5 D of the prompted MRSE correction (p = 0.005). Changes in the MRSE of -0.10 ± 0.30 D and -0.23 ± 0.51 D occurred from 3 months to 2 years (p = 0.40, respectively). We found a significant correlation between myopic regression and the changes in the keratometric readings from 3 months to 2 years after wavefront-guided LASIK (r = -0.48, p = 0.002), but not after SMILE (r = -0.004, p = 0.90). CONCLUSION: Small-incision lenticule extraction offers better refractive outcomes than wavefront-guided LASIK during a 2-years follow-up for the correction of myopia and myopic astigmatism.

Refractive Regression and Changes in Central Corneal Thickness Three Years after Laser-Assisted Subepithelial Keratectomy for High Myopia in Eyes with Thin Corneas: A Retrospective Study.

This retrospective study aimed to explore refractive regression and central corneal thickness (CCT) following laser-assisted subepithelial keratectomy (LASEK) performed for the correction of high myopia in eyes with thin corneas. Forty patients (19 male, 21 female; mean age, 28.5 years) representing 76 treated eyes were included. The mean optical zone was 6.10 ± 0.32 mm, and the mean ablation depth was 121.53 ± 15.48 µm. CCT was significantly greater three years after surgery than at three months after surgery (425.66 ± 15.44 vs. 385.20 ± 12.81, respectively; p<0.001). The mean change in CCT from three months to three years was 40.46 ± 14.02 µm. The SE at three years was greater than that at three months (p<0.001). Although there was refractive regression, these data suggest that LASEK may have utility in the correction of high myopia in eyes with thin corneas.

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia.

PURPOSE: High myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery. METHODS: We included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery. RESULTS: The study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: Moderately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia

PURPOSE: High myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery. METHODS: We included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery. RESULTS: The study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: Moderately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.

Correlation between dry eye and refractive regression after laser in situ keratomileusis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the correlation between chronic dry eye and refractive regression after laser in situ keratomileusis (LASIK)for myopia.METHODS:Two hundred and twenty-five eyes of 225 patients were enrolled in this study.Examinations including Schirmer test,tear break-up time(BUT),corneal sensation,and ocular surface staining were performed before and 6 months after LASIK.Dry eye symptoms were assessed using the McMonnies Dry Eye Symptom Survey.Data were analyzed on history and treatment response.RESULTS:Refractive regression after LASIK was related to chronic dry eye.It occurred in 8(25.0%)of 32 patients with chronic dry eye and in 18(9.3%)of 193 patients without dry eye(P＜0.01).CONCLUSION:The risk of refractive regression was increased in patients with chronic dry eye.