Corneal Remodeling After Myopic SMILE: An Optical Coherence Tomography and In Vivo Confocal Microscopy Study.

PURPOSE: To study corneal remodeling during the first 6 months after myopic small incision lenticule extraction (SMILE) with a 10% overcorrection nomogram, by spectral-domain optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM). METHODS: This prospective non-randomized observational study included 60 eyes from 30 patients treated by SMILE for low to moderate myopia. A 10% overcorrection nomogram was applied for all eyes. Epithelial and corneal thickness maps were obtained within the central 6 mm, by SD-OCT, at each visit. Lenticule thickness was calculated by subtracting the postoperative central stromal thickness from the preoperative central stromal thickness. IVCM was performed at each visit. RESULTS: The mean surgical refractive correction was -3.99 ± 1.50 diopters (D) before and -0.09 ± 0.37 D after surgery. Central epithelial thickness increased from 53.7 ± 4.0 to 57.1 ± 4.1 µm at 6 months after SMILE (P < .001). The measured lenticule thickness was 16 ± 6.1 µm less than the programmed lenticule thickness (P < .001). Both central epithelial hyperplasia and the mismatch between measured and programmed lenticule thickness were positively correlated to the degree of myopia (r2 = 0.60, P < .001 and r2 = 0.47, P < .001, respectively). Fibrosis at the interface was not correlated with epithelial thickening (r2 = 0.06, P = .29) or lenticule thickness error (r2 = 0.07, P = .22). CONCLUSIONS: Both epithelial thickening and the mismatch between the targeted and achieved lenticule thickness resulted in a slight undercorrection with a 10% overcorrection nomogram in low and moderate myopia. Fibrosis at the interface was not responsible for lenticule thickness error. Additional overcorrection is required to increase accuracy. [J Refract Surg. 2020;36(9):597-605.].

Argon Laser Iridoplasty For Plateau Iris Syndrome: Long-Term Outcomes of 48 Eyes.

PRECIS: Argon laser peripheral iridoplasty (ALPI) was performed on 48 eyes with plateau iris syndrome (PIS). Indentation gonioscopy was used to monitor the opening of the iridocorneal angle. Mean intraocular pressure (IOP) at 5 years decreased from 15.9 to 14.4 mm Hg. None of the eyes required trabeculectomy. PURPOSE: The purpose of this article was to report the long-term outcomes of ALPI for PIS. MATERIALS AND METHODS: A retrospective chart review was performed on all patients with PIS treated with ALPI from 2001 to 2012. The study included 48 eyes from 28 patients with PIS after peripheral iridotomy, with a follow-up of at least 5 years. Patients with advanced glaucoma requiring initial surgical treatment (pathologic discs and IOP above the target IOP despite medical treatment) were excluded. The primary outcomes were the effect on the number of IOP medications, and the need for complementary selective laser trabeculoplasty (SLT) or surgery (trabeculectomy and/or phacoemulsification). Secondary outcomes were optic nerve head changes and adverse events. RESULTS: The mean IOP statistically decreased after ALPI (15.91±2.62 vs. 14.35±2.18 mm Hg, P>0.001). The mean number of IOP-lowering medications statistically increased after ALPI (0.81±0.94 vs. 1.2±1.04, P>0.001). Mean follow-up was 92.4±26.5 months. At the end of the follow-up, 12 (25%) eyes had no medications, 20 (42%) had 1 medication, 11 (23%) had 2 medications, 3 (6%) had 3 medications, and 2 (4%) had 4. Ten (21%) eyes underwent SLT, 6 (10%) underwent phacoemulsification, and no trabeculectomy was necessary during follow-up. The change in cup to disc ratio from pre-ALPI to latest follow-up was not statistically significant, and no adverse events were reported. CONCLUSIONS: ALPI is relatively effective and safe to prevent angle-closure glaucoma and avoid trabeculectomy in patients with PIS. This procedure often helps to control IOP, although SLT and additional medical treatments are frequently necessary to maintain the target IOP.

Persistent corneal fibrosis after explantation of a small-aperture corneal inlay.

The KAMRA small-aperture corneal inlay can compensate for presbyopia. A small number of complications have been reported, including glare, halos, decentration, iron deposition, compromised distance and night vision, infectious keratitis and reversal corneal haze. We describe a case of corneal fibrosis after small-aperture corneal inlay implantation and its persistence after late explantation. The postoperative period was uneventful, with good uncorrected near and distance visual acuities. Six years after implantation, the patient reported vision loss in the left eye. A slitlamp evaluation and optical coherence tomography showed stromal opacity and a stromal hyperreflective signal at the level of the small-aperture corneal inlay. The corneal inlay was removed, but persistent decreased visual acuity and fibrosis were observed even 8 months after explantation and did not respond to steroids. Long-term monitoring with multimodal imaging methods is important to detect late adverse events after small-aperture corneal inlay implantation.