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PURPOSE: To assess pupil diameter before and after femtosecond laser-assisted cataract surgery (FLACS) pretreatment and compare the outcomes of three laser platforms. METHODS: This prospective observational case series included consecutive patients scheduled to undergo cataract extraction using FLACS between August 2013 and February 2015. All eyes received FLACS pretreatment using three laser platforms: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics Inc., Santa Ana, CA), and Victus (Bausch & Lomb, Inc., Rochester, NY). The same protocol for preoperative medical mydriasis was used for all patients, and pupil diameter was assessed immediately before and 3 minutes after FLACS using a surgical ruler. RESULTS: A total of 198 eyes of 161 patients were included in the study. Mean pupillary miosis was 1.42 ± 1.26 mm for the LenSx, 0.66 ± 0.89 mm for the Catalys, and 0.14 ± 0.34 mm for the Victus groups. Furthermore, 8 of the 198 eyes (4.0%) demonstrated a pupil diameter of less than 5 mm after FLACS and 48 eyes (24.24%) demonstrated a pupil diameter of 6 mm or less. There was a statistically significant decrease in pupil diameter for all groups individually (P < .05). There was also a statistically significant difference among the three groups (P < .05), with LenSx inducing the highest degree of miosis, followed by Catalys, and finally Victus. A correlation between the pupil diameter before FLACS and degree of FLACS-induced miosis was demonstrated (P < .05), with larger pupil diameter before FLACS associated with greater miosis. CONCLUSIONS: FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (= 6 mm) after FLACS pretreatment. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe complications associated with femtosecond laser-assisted fl ap creation in LASIK surgery. The management and visual outcomes of femtosecond laser complications related to fl ap creation in LASIK patients are also described. METHODS: All eyes that underwent LASIK with the IntraLase femtosecond laser from September 2003 to June 2006 at a university-based refractive center were included in this retrospective, noncomparative, interventional case series and IntraLase-related LASIK complications are described. All fl aps were made with the 15- and 30-kHz IntraLase femtosecond laser. RESULTS: Included in the study were 4772 eyes, of which 44 (0.92%) eyes had direct or indirect complications due to fl ap creation. Thirty-two eyes had indirect complications (diffuse lamellar keratitis [DLK] and transient light sensitivity)--20 (0.42%) eyes developed DLK (stage 1 to 2) and 12 (0.25%) eyes had transient light sensitivity syndrome. Twelve (0.25%) eyes had direct femtosecond laser fl ap-related complications-- 8 (0.17%) eyes had premature breakthrough of gas through the epithelium within the fl ap margins, 3 (0.06%) eyes had incomplete fl aps due to suction loss, and 1 (0.02%) eye had irregular fl ap due to previous corneal scar. CONCLUSIONS: Less than 1% of eyes had direct or indirect complications due to femtosecond laser fl ap creation. Laser in situ keratomileusis complications specifi-cally related to the IntraLase femtosecond laser did not cause loss of best spectacle-corrected visual acuity in any eyes. [ABSTRACT FROM AUTHOR]

PURPOSE: To identify risk factors associated with primary and recurrent epithelial ingrowth after laser in situ keratomileusis (LASIK) requiring surgical debridement. METHODS: Charts of patients who required single or multiple surgical debridements of epithelial ingrowth were reviewed retrospectively and analyzed to identify preoperative, intraoperative, and postoperative risk factors. RESULTS: Fourteen of 22 patients had epithelial ingrowth that required a single surgical removal. These were mostly associated with the surgeon's learning curve, epithelial injury, and enhancement by lifting the flap. Multiple surgical debridements were required in eight patients and some of these were associated with epithelial basement membrane degeneration and a history of type I diabetes. CONCLUSIONS: Refractive surgeons should be aware of surgical and non-surgical ocular and systemic risk factors associated with both primary and recurrent epithelial ingrowth after LASIK to appropriately consent patients seeking refractive surgery. Type I diabetes may increase the risk of epithelial downgrowth in LASIK. [ABSTRACT FROM AUTHOR]

PURPOSE: To report central and peripheral corneal endothelial cell studies performed as part of the VISX hyperopic photorefractive keratectomy (PRK) clinical trial. METHODS: During this prospective, multicenter clinical trial, which was part of an FDA investigation, endothelial cell specular microscopy was done at five centers. Non-contact central and peripheral cell density, percent hexagonality, and coefficient of variability of cell size were obtained using the Konan Noncon Robo SP-8000FA with BAMBI analysis software. Data were gathered at baseline and at 1, 6, and 12 months after hyperopic PRK. RESULTS: Analysis of results of 171 eyes demonstrated no statistically significant detrimental changes in the corneal endothelium at any postoperative time point. The statistically significant changes noted were interpreted as an improvement in cell morphology and were attributed to the cessation of contact lens wear following treatment. CONCLUSION: Hyperopic PRK with the VISX STAR S2 Excimer Laser System produced no statistically significant adverse effect on the corneal endothelium. [ABSTRACT FROM AUTHOR]

Purpose: To report a patient who developed subconjunctival gas bubble formation during creation of a LASIK corneal flap with the IntraLase femtosecond laser. Methods: Case report of a 19-year-old-man with compound myopic astigmatism and a normal preoperative evaluation who underwent bilateral simultaneous LASIK. Results: The IntraLase FS15 was used to create an 8.8-mm diameter superior flap. Laser settings were 110-µm depth, 1.70-mJ bed and side-cut energy, 12-µm spot separation, 10-µm line separation, 70° side-cut angle, 240-µm pocket start width, and 200-µm pocket start depth. The procedure was uneventful in the right eye whereas subconjunctival air bubbles were observed along the corneal limbus in the left eye (no bubbles were seen in the peripheral cornea). The patient was examined 30 minutes later, and the subconjunctival bubbles could still be observed. By the next day, the bubbles had disappeared completely. Postoperative uncorrected visual acuity was 20/20 in both eyes. Conclusions: Subconjuctival bubbles can be found after LASIK flap creation with a femtosecond laser. [J Refract Surg. 2008;24:850–851.] [ABSTRACT FROM AUTHOR]