Comparison of the Levels of Transforming Growth Factor-ß1 in Tear Fluid in Patients with High Myopia after Transepithelial Photorefractive Keratectomy and Laser Subepithelial Keratomileusis (LASEK).

We compared the level of transforming growth factor-ß1 (TGF-ß1) in the tear fluid of 20 patients with high myopia who underwent transepithelial photorefractive keratectomy (T-PRK) in one eye and laser subepithelial keratomileusis (LASEK) in the contralateral eye. Tear fluid samples were collected with scaled microcapillary tubes before (day 0) and on days 1, 3, and 5 after surgery. The release of TGF-ß1 was determined by multiplying the concentration of TGF-ß1 by capillary tear fluid flow. Corneal haze was also evaluated in 1, 3, and 6 months after surgeries. The median TGF-ß1 release after T-PRK and LASEK differed significantly on days 1 and 3 (p<0.005) and on day 5 (p<0.05). The mean corneal haze score after T-PRK and LASEK also significantly differed in 1 month (p<0.005), but no significant differences in this parameter were revealed at later terms. Thus, the level of TGF-ß1 in the tear fluid after T-PRK was lower than after LASEK, which can be the cause of less pronounced corneal haze in 1 month after surgery.

[Microkeratome and excimer laser-assisted endothelial keratoplasty (MELEK)]. / Mikrokeratom- und Excimer-Laser-gestützte endotheliale Keratoplastik (MELEK).

INTRODUCTION: Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) have become well established procedures for the treatment of endothelial pathologies. In the last years the field of lamellar corneal surgery has further developed in terms of preparation of the lamellae as well as of implantation. PATIENTS AND METHODS: A modified form of the "ultrathin DSAEK" (UT-DSAEK) is the "microkeratome and excimer laser-assisted endothelial keratoplasty" (MELEK). In this new technique a corneal graft is prepared by a single cut of a microkeratome followed by a stromal excimer-laser thinning and smoothing. The purpose of the present report is to describe this new technique and present first clinical results. RESULTS: In this prospective clinical study 18 patients (76 ± 11 years) underwent a MELEK. The BCVA increased from 0.25 ± 0.1 preoperatively to one month postoperatively was 0.33 ± 0.21 (decimal, n = 12), after three months 0.51 ± 0.23 (n = 8) and after six months 0.80 ± 0.16 (n = 4). The average thickness of the residual stromal lamella before laser ablation was 173 ± 42 µm, after ablation 111 ± 15 µm. The central corneal thickness decreased from 704 µm to 639 µm, the thickness of the transplant decreased from 114 µm to 106 µm six months postoperatively. CONCLUSION: The ultrathin "microkeratome and excimer laser-assisted endothelial keratoplasty" (MELEK) is a new and safe technique in the field of lamellar keratoplasty. In the future it could have the potential to combine the advantages of DSAEK and DMEK for the treatment of endothelial pathologies.

Hyperopic LASEK treatments with mitomycin C using the SCHWIND AMARIS.

PURPOSE: To investigate the outcomes of hyperopic laser epithelial keratomileusis (LASEK) with mitomycin C (MMC) using the SCHWIND AMARIS platform. METHODS: Prospective study of 28 eyes of 14 patients. Mean preoperative manifest spherical equivalent refraction was +2.71±0.72 diopters (D) (range: +1.50 to +4.50 D). All eyes underwent LASEK with an Aberration-Free™ algorithm with the SCHWIND AMARIS followed by a 35-second application of MMC with a 6.7-mm optical zone size. RESULTS: At 1 year, mean manifest spherical equivalent refraction was 0.03±0.30 D (range: -0.53 to +0.50 D), with 13 eyes within -0.13 to +0.13 D and all 28 eyes within ±0.50 D. Mean uncorrected distance visual acuity was -0.03±0.09 logMAR, and the efficacy and safety indices were 1, respectively, at 1 year. The postoperative manifest spherical equivalent refraction was stable between 1 and 3 months and 1 year. CONCLUSIONS: Hyperopic LASEK with MMC using the SCHWIND AMARIS provided good outcomes in terms of accuracy, efficacy, safety, and stability.

Contrast sensitivity after LASIK, LASEK, and wavefront-guided LASEK with the VISX S4 laser.

PURPOSE: To evaluate the changes in contrast sensitivity and glare after corneal refractive surgery for moderate myopia. METHODS: The study comprised 267 eyes of 149 patients who underwent LASIK, laser epithelial keratomileusis (LASEK), or wavefront-guided LASEK with the VISX STAR S4. Contrast sensitivity was measured with VCTS 6500 before surgery and at 2 and 6 months postoperatively. Glare was evaluated using questionnaires and the ALC glare test at last follow-up. Contrast sensitivity at 2 and 6 months was compared with preoperative contrast sensitivity in each group. Glare sensitivity in each group was compared to normal controls. RESULTS: Contrast sensitivity did not change after LASIK (P > .05). Contrast sensitivity of 3 and 6 cycles per degree (cpd) at 2 months increased after LASEK (P < .05) and contrast sensitivity of 6, 12, and 18 cpd at 2 months and 3, 6, 12, and 18 cpd at 6 months improved in wavefront-guided LASEK (P < .05). Glare test and questionnaires did not show any significant difference between the groups. CONCLUSIONS: Wavefront-guided LASEK induced significant increases in contrast sensitivity of moderate myopes at high spatial frequencies under mesopic conditions by 6 months. Glare was not affected by the different refractive procedures.

Laser subepithelial keratomileusis for the correction of high myopia with the Schwind ESIRIS scanning spot laser.

PURPOSE: To investigate the efficacy of laser subepithelial keratomileusis (LASEK) for the correction of high myopia with the Schwind ESIRIS scanning spot laser (Schwind eye-tech-solutions Gmbh & Co, Kleinostheim, Germany). METHODS: Fifty-one patients (76 eyes) were treated with a mean preoperative spherical equivalent refraction of -7.55 diopters (D) (range: -6.0 to -10.75 D). All eyes received a LASEK technique using 15% alcohol with a 20-second application. RESULTS: An intact epithelial flap was obtained in 73 (96%) eyes. At 1 week, uncorrected visual acuity (UCVA) was > or =20/30 in 53 (70%) eyes and > or =20/60 in all eyes. At 6 months (n=76), the mean SE was +0.08 D (range: -1.00 to +1.875 D) with 73 (96%) eyes within +/-1.0 D of the intended correction and 60 (79%) eyes within +/-0.5 D. At 12 months (n=46), the mean SE was -0.07 D (range: -1.375 to +2.0 D) with 44 (96%) eyes within +/-1.0 D of the intended correction and 37 (80%) eyes within +/-0.5 D. Myopic cylindrical corrections were attempted in 68 eyes (range: -0.25 to -4.25 D) with vector analysis demonstrating a mean 85% correction. At last follow-up, UCVA was > or =20/20 in 47 (62%) eyes, > or =20/25 in 63 (83%) eyes, and > or =20/40 in 75 (99%) eyes. Three (4%) eyes gained two lines of Snellen decimal equivalent best spectacle-corrected visual acuity compared to preoperative levels, 68 (89%) eyes showed no change or gained one line, and 5 (7%) eyes lost one line. None lost more than one line. Only 2 (3%) eyes at 6 to 12 months had more than +1 axial corneal haze and 50 (66%) showed no evidence of haze on slit-lamp examination. CONCLUSIONS: Laser subepithelial keratomileusis for myopia up to -11.00 D with the Schwind ESIRIS laser provides good refractive and visual outcomes, with acceptable visual recovery and minimal complications.

[Recent development of refractive surgery in China].

Refractive surgery develops very quickly in recent years. Normalized the pre-surgery examination and gradual development of refractive surgery methods which are close to the over-sea are all current situations. Clinic experiences improve the quality of surgery. While the basic research perfects the effective of surgery. To pursuit high vision quality challenges the refractive surgery.