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Purpose: To compare the induced corneal stromal bed roughness measured with atomic force microscopy (AFM) after LASIK flap creation with the IntraLase 60 kHz and the VisuMax femtosecond laser platforms. Methods: Three freshly enucleated porcine eyes were operated with each femtosecond laser in this experimental study. Standard LASIK treatment parameters were used for the experiment. After LASIK flap creation, the corneal stromal roughness was assessed using a JPK NanoWizard II® AFM in contact mode immersed in liquid. Olympus OMCL-RC800PSA commercial silicon nitride cantilever tips were used. Surface measurements were made in 10 regions of the central cornea of each sample measuring 20 x 20 microns, at 512 x 512 point resolution. Roughness was measured using the root-mean-square (RMS) value within the given regions. Results: Measurements from 30 regions of the 3 eyes (10 measurements per eye) in the Intralase (FS1) group, and 30 regions of the 3 eyes (10 measurements per eye) in the VisuMax (FS2) group were analyzed. There was a statistically significant difference in mean ± standard deviation RMS values between the FS1 and the FS2 groups (360 ± 120 versus 230 ± 100 nm respectively; P< 0.00001). Conclusion: This AFM study indicates that the surface of the stromal bed after LASIK flap creation is smoother in the FS2 group than the FS1 group. [ABSTRACT FROM AUTHOR]

Purpose: To describe the postoperative evolution of visual acuity, flap morphology, and stromal optical density femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Setting: Clinica Rementeria, Madrid, Spain. Design: Prospective case series. Methods: The study comprised 44 consecutive eyes that had FS-LASIK performed with the WaveLight FS200 and the Allegretto excimer laser to correct myopia. Visual outcomes, flap thickness, and stromal optical density were assessed 1 day, 1 week, 1 month, and 3 months postoperatively. Results: A statistically significant improvement in the mean uncorrected distance visual acuity at 1 day (0.94 +/- 0.2) and 1 week (0.93 +/- 0.2) to 1 month (1.04 +/- 0.2) and 3 months (1.11 +/- 0.1) postoperatively (P <.05). At 3 months postoperatively, the femtosecond laser had good outcomes in efficacy (0.98 +/- 0.1), safety (0.98 +/- 0.1), and predictability (100% of eyes were within +/- 0.5 D of emmetropia). The femtosecond-created flaps were slightly thicker than intended, the mean SD intraflap was 7.1 [mu]m, the range between the thickest and thinnest points in each flap was 25.4 [mu]m, and the mean flap thickness homogeneity was 7.6 [mu]m at 3 months postoperatively. A progressive decrease in the optical density of the flap stroma and the residual stromal bed was detected during follow-up. Conclusions: The femtosecond laser study appears to be a safe, effective, and predictable platform to obtain LASIK flaps. The flaps were planar and homogeneous but slightly thicker than intended. The optical density of the flap stroma was slightly higher at early follow-up and decreased over time. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare the visual and refractive results of femtosecond laser–assisted LASIK (FS-LASIK) with and without the adjuvant use of mitomycin C (MMC) to correct hyperopia. METHODS: A total of 152 consecutive hyperopic eyes were included in this retrospective, observational cohort study, comparing 76 eyes treated with FS-LASIK + MMC with 76 age- and refraction-matched eyes treated with FS-LASIK without MMC. Visual and refractive results were evaluated 1 day, 1 week, and 1, 3, 6, and 15 months postoperatively. RESULTS: Preoperative mean spherical equivalent was +3.27 diopters (D) versus +3.50 D in the MMC and no MMC groups, respectively (P > .05). Three months postoperatively, uncorrected distance visual acuity was significantly better in the MMC group (0.93 ± 0.2) than in the no MMC group (0.87 ± 0.2) (P = .01). The residual spherical equivalent was significantly lower in the MMC group (+0.18 ± 0.40 D) than in the no MMC group (+0.42 ± 0.50 D) (P = .01). Fifteen months postoperatively, including re-treated eyes, no significant differences were found in uncorrected distance visual acuity, corrected distance visual acuity, and residual refraction. Slightly better outcomes were found in the MMC group in terms of efficacy, safety, and predictability; however, these small differences were not statistically significant. The incidence of re-treatments during the 15-month follow-up was significantly lower in the MMC group than in the no MMC group (6.6% vs 10.5%, respectively) (P = .01).CONCLUSIONS: FS-LASIK with or without the intraoperative use of MMC is safe and effective to correct hyperopia. However, slightly better refractive outcomes and a lower incidence of re-treatments were observed when intraoperative MMC was used, at least in a 15-month follow-up. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the long-term outcomes of laserassisted subepithelial keratomileusis (LASEK) with intraoperative use of mitomycin C (MMC) performed on thin corneas for the correction of myopia. METHODS: This retrospective cohort study included 100 eyes with a preoperative central corneal thickness (CCT) thinner than 500 µm that underwent LASEK + MMC with at least 6 years of follow-up. Stability of visual acuity and refraction and the efficacy, safety, and predictability at the examinations 3 months and the last annual postoperative visit were analyzed. RESULTS: Preoperative CCT was 482.9 ± 14.7 µm (range: 433 to 499 µm). Mean preoperative spherical equivalent was -4.09 ± 2.3 diopters (D). At the 3-month postoperative visit, mean CCT was 419.79 ± 32.6 µm. The residual spherical equivalent showed a statistically significant regression (P = .001) in the comparison between the 3-month and the last annual postoperative visit. The efficacy index showed a significant decrease (P = .01) and the safety index remained stable around 0.96. Six or more years after the surgery, 85 eyes (85%) were within ±0.50 D and 94 eyes (94%) eyes were within ±1.00 D of emmetropia. The topography did not show signs of secondary corneal ectasia in any eye. CONCLUSIONS: LASEK with intraoperative use of MMC seems to be safe, effective, and predictable to correct myopia in corneas thinner than 500 µm and with normal preoperative topography, providing good visual and refractive outcomes with no topographic signs of corneal ectasia in a mean 6.5-year follow-up. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe a method of LASIK enhancement in which a new femtosecond laser-assisted miniflap is created over the original LASIK flap. METHODS: The 60-kHz IntraLase femtosecond laser (IntraLase Corp., Irvine, CA) was used to create a new miniflap over an original LASIK flap for the re-treatment of late regression after LASIK. The diameter of the mini-flap was 7 mm and the attempted flap depth was 100 μm. RESULTS: The procedure was performed on 10 eyes of 7 patients. No intraoperative or postoperative complications developed in any case during the follow-up. At the 6-month follow-up visit, all eyes were within ±0.5 diopters of the targeted refraction. CONCLUSIONS: The preliminary results suggest that creation of a femtosecond laser-assisted mini-flap over a previous LASIK flap seems to be a safe and effective procedure for the enhancement of late regression after LASIK. By creating a femtosecond laser-assisted miniflap that is smaller in diameter than the original flap, the adhesion of the primary flap edges and peripheral interface remain intact, thus decreasing the risk of dislocation of the original LASIK flap and of losing a sliver of tissue. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to measure the intraocular pressure (IOP) elevation during laser assisted in situ keratomileusis (LASIK) flap creation using the WaveLight FS200 femtosecond (FS) laser platform., Methods: We conducted an ex vivo experimental study in an animal model. The WaveLight FS200 FS laser platform was used to perform the corneal LASIK flap in freshly enucleated porcine eyes. We measured the changes in IOP from the application of the suction ring (suctioning phase) through the creation of the lamellar corneal flap (cutting phase). The IOP was recorded using a manometric technique with direct cannulation to the anterior chamber., Results: Nine freshly enucleated porcine eyes were included in the study. The mean baseline IOP before the procedure was 20.33 ± 5.9 mm Hg. The mean IOP increase over baseline IOP was 32.33 ± 11.3 mm Hg at the suctioning phase, and 38.22 ± 11.3 mm Hg at the cutting phase. The total surgical time needed to complete the procedure was 29.5 ± 4.4 seconds., Conclusions: The WaveLight FS200 FS laser platform produces a low to moderate increase in IOP during LASIK flap creation., Translational Relevance: The WaveLight FS200 is a safe FS laser platform because it induces a low to moderate IOP increase during LASIK flap creation.

Aim: To evaluate the effect of age on visual and refractive results after laser in situ keratomileusis (LASIK) obtained with a mechanical microkeratome or a femtosecond laser., Methods: Retrospective, nonrandomized, cohort study. A total of 3826 eyes were included in the study (1725 eyes treated with mechanical LASIK and 2101 eyes treated with femtosecond LASIK). The relationship between patient age and the 3-month postoperative visual and refractive results of both procedures were analyzed by linear regression analysis., Results: Three months postoperatively, we found a significant correlation between age and the postoperative spherical equivalent (SE; r 2 =0.004, P =0.006), efficacy ( r 2 =0.006, P =0.001), and safety indexes ( r 2 =0.05, P =0.0001) in the mechanical LASIK group. On the other hand, we found a significant correlation between age and the postoperative SE ( r 2 =0.02, P =0.0001) and the efficacy index ( r 2 =0.01, P =0.0001) but not the safety index in the femtosecond laser group. Mechanical LASIK provided slightly but significantly better efficacy and predictability in patients 18 to 40 years of age and femtosecond LASIK did so in patients older than 40 years of age. The femtosecond laser provided better safety results than the mechanical microkeratome in both age groups., Conclusion: A tendency toward undercorrection and less predictability is found with aging after myopic LASIK regardless of whether the flap was created with a mechanical microkeratome or a femtosecond laser. However, femtosecond laser provides significantly better outcomes in terms of efficacy, safety and predictability compared to mechanical microkeratome for the correction of myopia in patients over 40y.