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Unlabelled: We present the case of a patient who had refractive corneal inlay implantation for near vision improvement after bilateral cataract surgery. The patient had a history of bilateral cataract, and a 2-step procedure was suggested to improve her near and distance visual acuities. The first step was bilateral cataract extraction with a power target of plano intraocular lens implantation. Six months later, a refractive corneal inlay, Presbia Microlens, was implanted in the nondominant eye in the intracorneal pocket made with the femtosecond laser. No intraoperative or postoperative complications occurred. The bilateral uncorrected near visual acuity improved from less than Jaeger (J)6 to J1 and remained stable during the 2-year follow-up. The refractive corneal inlay is a safe, simple, and efficient method for improving near visual acuity in patients after cataract surgery., Financial Disclosure: Dr. Pallikaris is the chair of the medical advisory board of Presbia Coöperatief U.A. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the visual and refractive outcomes and the corneal structural changes in myopic patients after surface refractive treatments (ie, photorefractive keratectomy [PRK] with adjuvant mitomycin-C [MMC] and epithelial laser in situ keratomileusis [epi-LASIK])., Setting: University of Crete, Heraklion, Crete, Greece., Design: Prospective comparative case series., Methods: One eye of consecutive myopic patients was randomly assigned to PRK-MMC, and the fellow eye was treated with epi-LASIK. Visual and refractive outcomes and corneal confocal microscopy findings were evaluated. All patients were examined preoperatively and 1, 3, 6, 12, and 24 months postoperatively., Results: Twenty-six eyes (13 patients) were included. The mean follow-up was 2.47 years ± 0.35 (SD) (range 1.64 to 2.93 years). In the PRK-MMC group, the mean preoperative spherical equivalent refraction was -3.84 ± 1.59 diopters (D) (range -1.5 to -8.7 D) and -0.21 ± 0.44 D (range -0.5 to 1.0 D) at the last follow-up and in the epi-LASIK group, -3.91 ± 1.48 D (range -1.5 to -8.5 D) and -0.18 ± 0.36 (range +0.5 to -0.5 D), respectively. Qualitative analysis of the subepithelial nerve plexus, haze development, and keratocyte distribution were similar in the 2 groups. There was no statistically significant difference in endothelial cell density between the groups throughout the follow-up (P>.05)., Conclusion: Epithelial LASIK and PRK-MMC gave similar visual, refractive, and corneal structural outcomes in patients with myopia for up to 2 years postoperatively., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the results of thin-flap laser in situ keratomileusis (LASIK) using a femtosecond-laser platform for flap creation., Setting: Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Greece., Design: Prospective interventional case series., Methods: Patients had LASIK with the FS200 femtosecond laser for flap creation and the Allegretto Wave Eye-Q excimer laser. Flap thickness was set at 105 μm. All eyes were examined 1 month postoperatively. Flap thickness was assessed with anterior segment optical coherence tomography using the manual flap tool at 5 locations on a horizontal B scan., Results: This study comprised 50 eyes of 25 patients (mean age 28 years ±5.72 [SD]); 42 eyes completed 6 months of follow-up. Preoperatively, the mean sphere was -3.61 ± 1.87 diopters (D) and the mean cylinder, -1.08 ± 1.23 D. Six months postoperatively, no eye lost lines of corrected distance visual acuity (CDVA), 29% gained 1 line, and 7% gained 2 lines. The mean spherical equivalent was -0.03 ± 0.42 D (range -0.88 to +0.88 D); 86% had an uncorrected distance visual acuity of 20/20 or better. The mean central flap thickness at 1 month was 102.98 ± 6.33 μm (range 91 to 114 μm). There were no intraoperative or postoperative complications., Conclusions: No significant complications occurred after treatment with this new femtosecond-laser platform in thin-flap LASIK. Clinical (visual and refractive) results were satisfactory in terms of safety, predictability, and stability., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the effects of defocus induced blur and blur adaptation on visual acuity and to evaluate any differences between emmetropes and myopes using letter and Landolt C logMAR charts., Methods: The sample consisted of 26 volunteers, with a mean age of 27 ± 3 years, comprising 13 emmetropes (spherical equivalent range: -0.63 to +0.50 D) and 13 myopes (spherical equivalent range: -0.75 to -5.00 D). Monocular visual acuity (VA) was measured in each eye using letter and Landolt C logMAR charts under the following conditions: (1) with the distance refractive correction, (2) immediately after exposure to +2.00 D defocus and (3) following 60 min of binocular adaptation to +2.00 D blur. Objective refraction at the beginning and at the end of the experimental procedure was evaluated. Averaged VA data between the two eyes were used for analysis., Results: Deterioration in VA with +2.00 D defocus was greater in the emmetropes compared to myopes for both charts. The mean difference between the two refractive groups was more pronounced for the Landolt-C (0.17 logMAR) compared to the letter chart (0.10 logMAR). The reduction in VA with blur was related to the amount of the refractive error. Following 60 min of adaptation, a significant improvement in VA was observed in both groups that did not differ between the two charts. The improvement in VA following adaptation using the letter chart was linearly correlated with spherical equivalent refractive correction., Conclusions: Myopes show higher tolerance to retinal defocus compared to emmetropes, which could be attributed to previous blur experience. The effect of blur on VA is more pronounced using Landolt C optotypes than with letters. Prolonged exposure to blur results in equally improved performance for both refractive groups., (Ophthalmic & Physiological Optics © 2013 The College of Optometrists.)

Purpose: To evaluate the outcomes of refractive surgery in patients with topographic superior corneal steepening., Methods: This retrospective, noncomparative, interventional, clinical study included 16 patients (29 eyes) with persistent superior corneal steepening as a variation of corneal curvature (inferior to superior topographic corneal difference of at least 1.00 diopter [D] at a 3-mm zone) not related to any underlying disease or condition who underwent corneal refractive surgery. Refractive, keratometric, and visual outcomes were evaluated preoperatively and at 1, 3, 6, 12, and 24 months postoperatively., Results: Twenty-two eyes underwent photorefractive keratectomy and 7 eyes underwent LASIK. Mean follow-up was 27.38±2.37 months (range: 25 to 32 months). Mean preoperative inferior to superior keratometric difference was 1.61±0.36 D (range: 1.20 to 2.63 D). Mean preoperative spherical equivalent refraction was -4.45±1.66 D (range: -2.25 to -8.00 D), which decreased to -0.09±0.61 D (range: +0.75 to -1.38 D) (P<.05) at last follow-up. Mean preoperative topographic corneal astigmatism was 1.44±0.79 D (range: 0.52 to 3.83 D), which decreased to 0.66±0.39 D (P<.05) 3 months postoperatively and remained stable during follow-up (P<.54). Mean preoperative uncorrected distance visual acuity and corrected distance visual acuity in logMAR units were 1.57±0.62 and 0.02±0.06, respectively, which improved at last follow-up to 0.00±0.05 and -0.02±0.04, respectively. No intra- or postoperative complications were noted; specifically, no patients developed postoperative ectasia., Conclusions: Corneal refractive surgery in patients with isolated topographic superior corneal steepening provided acceptable refractive and visual outcomes without any intra- or postoperative complications. Diligence is required to screen for the potential of ectatic corneal disorders in this population. Photorefractive keratectomy may be a safer option for these patients than LASIK., (Copyright 2012, SLACK Incorporated.)

Purpose: To compare the efficacy of 2 types of silicone hydrogel bandage contact lenses with high oxygen transmissibility after photorefractive keratectomy (PRK)., Setting: Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece., Methods: In this prospective study, 1 eye of patients having bilateral PRK was randomly fitted with a bandage contact lens of lotrafilcon A (Night & Day) and the fellow eye, with a bandage contact lens of lotrafilcon B (O(2)Optix). The patients and the examiner were masked to which bandage contact lens type was in which eye. Patients were examined on the day of surgery and 1, 3, and 5 days postoperatively. Postoperative examinations included uncorrected distance visual acuity and slitlamp biomicroscopy to assess epithelial defect size. Subjective evaluation of pain and vision was recorded 1, 2, 3, and 4 days postoperatively., Results: The study enrolled 44 patients (88 eyes). The mean epithelial defect size immediately after surgery was 47.0 mm(2) with both types of bandage contact lenses. There was no statistically significant difference in epithelial defect size between the 2 lenses at any postoperative visit. Three days postoperatively, reepithelialization was complete in 75.0% of eyes in the lotrafilcon A group and 72.7% of the eyes in the lotrafilcon B group., Conclusion: There were no differences in corneal reepithelialization or subjective measurements after PRK between the 2 types of silicone hydrogel bandage contact lenses.

Purpose: To report a patient fifteen years after anterior chamber phakic intraocular lens (AC-PIOL) implantation in one and laser in situ keratomileusis (LASIK) in the fellow eye., Methods: Case report., Results: A 56-year-old male underwent AC-PIOL implantation in one eye and LASIK in the fellow eye fifteen years ago. Preoperative uncorrected visual acuity (UCVA) was finger count in both eyes. Preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 (-16.75 -0.50 x 40) in the LASIK eye and 20/32 (-24.50 -0.50 x 90) in the AC-PIOL eye. Fifteen years postoperatively, UCVA was finger count in the LASIK eye and 20/200 in the AC-PIOL eye, while BSCVA was 20/32 and 20/25, respectively. Endothelial cell density (ECD) was 2020+/-47 in the LASIK eye and 945+/-22 in the AC-PIOL eye., Conclusion: Both procedures had similar visual outcomes. Furthermore, lower ECD was found in the AC-PIOL eye in comparison to the LASIK eye.

Purpose: To compare the proportions of school children with myopia and impaired visual acuity in Greece and Bulgaria., Methods: A sample of 898 children, aged 10-15 years, was selected from two primary and two secondary schools in a Greek city (Heraklion), and one primary and secondary school in a Bulgarian city (Stara Zagora). Five hundred and eighty eight children were Greek (65.5%, mean age 12.5 +/- 0.08 years) and 310 Bulgarian (34.5%, age 12.4 +/- 0.07 years). VA was assessed with the habitual refractive correction. Refractive error was measured in the absence of cycloplegia using an auto-refractor., Results: The percentage of children, tested with their habitual refractive correction, with decimal VA <0.5 in at least one eye was 11.7% (95% CI 9.1-14.3%) for Greek and 5.2% (95% CI 2.7-7.6%) for Bulgarian pupils. The percentage of myopic children also differed between the two countries with the proportion with myopic refractive error

Purpose: To study the outcomes of LASIK after intended thin flap creation using the SCHWIND Carriazo-Pendular microkeratome with the 90-microm head., Methods: Forty-seven eyes of 26 patients (mean age 28.78+/-6.98 years) underwent LASIK with a superior hinge flap using the 90-microm head of the SCHWIND Carriazo-Pendular microkeratome. Evaluation included flap parameters (thickness, diameter, hinge size), complications, and visual outcome., Results: No intraoperative or early postoperative complications were observed. The mean flap thickness was 79.88+/-6.94 microm (range: 70 to 93 microm). Mean flap diameter was 9.25+/-0.45 mm (range: 8.5 to 11 mm) whereas mean hinge size was 4.63+/-0.66 mm (range: 3 to 6.5 mm). No eye lost lines of best spectacle-corrected visual acuity, and all eyes were emmetropic within one diopter postoperatively., Conclusions: The SCHWIND Carriazo-Pendular microkeratome with the 90-microm head seems to have increased accuracy in intended creation of thin flaps.

Purpose: To compare the early postoperative course and the 1-year clinical results of off-flap Epi-LASIK and Epi-LASIK for the treatment of low and moderate myopia., Design: Pilot double-masked, randomized, comparative study., Participants: Fifty-six patients (112 myopic eyes)., Methods: Epithelium was separated in all eyes with the use of Centurion SES epikeratome (Norwood Abbey EyeCare, Vic, Australia). The first eye treated and surgical method in the first eye were randomized. One eye of each patient underwent standard Epi-LASIK, whereas in the contralateral eye, the epithelial sheet was not retained on the photoablated stroma (off-flap Epi-LASIK eyes). Mean preoperative spherical equivalent was -3.50+/-1.22 diopters (D; range, -1.75 to -6.37 D) in Epi-LASIK eyes and -3.61+/-1.22 D (range, -1.50 to -6.50 D) in off-flap Epi-LASIK eyes (P>0.05, paired Student t test). Excimer laser corneal ablation was performed using the Allegretto 200Hz (Wavelight Laser Technologie AG, Erlangen, Germany). Patients were followed up daily until the epithelial healing was complete and at 1, 3, 6, and 12 months., Main Outcome Measures: Epithelial healing time, subjective pain score, and uncorrected visual acuity (UCVA) were evaluated during the first postoperative days. Uncorrected visual acuity, spherical equivalent refraction, best spectacle-corrected visual acuity, haze scores, and wavefront aberrations were recorded at all subsequent intervals., Results: Time of epithelial healing did not differ significantly in Epi-LASIK and off-flap Epi-LASIK eyes (4.76+/-0.84 days in Epi-LASIK eyes vs. 4.54+/-0.93 days in off-flap Epi-LASIK eyes). No significant difference in UCVA was found after the 2 techniques during the first postoperative days. Subjective pain score was lower in off-flap Epi-LASIK eyes at 2 postoperative hours, whereas no significant difference in pain scores was noted between the 2 techniques at the other intervals. There was no significant difference in spherical equivalent, line gain or loss, haze scores, and higher-order aberrations between Epi-LASIK and off-flap Epi-LASIK eyes at any interval. Uncorrected visual acuity was significantly better in Epi-LASIK eyes only at 6 months (-0.05+/-0.08 in Epi-LASIK eyes vs. 0.00+/-0.07 in off-flap Epi-LASIK eyes). Preoperative wavefront aberrations did not change significantly 1 year after either procedure., Conclusions: Epi-LASIK and off-flap Epi-LASIK had equal visual and refractive results for the treatment of low and moderate myopia in this study., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Purpose: To compare the refractive outcomes after photorefractive keratectomy (PRK) for low to moderate myopic corrections using 2 excimer lasers with different repetition rates (200 Hz and 400 Hz)., Setting: University refractive surgery center., Methods: This retrospective study included all consecutive patients who underwent PRK using the 200 Hz or the 400 Hz Allegretto laser platform (WaveLight Laser Technologie AG). Thirty-five patients (70 eyes) and 29 patients (58 eyes) had PRK with the 200 Hz platform and the 400 Hz platform, respectively, using the same surgical technique., Results: The mean follow-up was 13.22 months +/- 1.16 (SD) (range 11 to 15 months). No intraoperative or early postoperative (eg, late reepithelialization) complications were found in either group. At 1 year, 66 eyes (94.2%) in the 200 Hz group and 56 eyes (96.6%) in the 400 Hz group were within +/-1.00 diopter of the attempted correction. At 3 months, 20 eyes (29%) in the 200 Hz group and 27 eyes (46%) in the 400 Hz group had mild or moderate corneal haze (P = .03). These corneas showed progressive clearing over subsequent months without statistically significant differences in haze formation between the 2 groups. Twelve months after PRK, all corneas in both groups were clear., Conclusion: Photorefractive keratectomy for the treatment of low to moderate refractive errors using a 200 Hz or 400 Hz excimer laser gave comparable results.

Purpose: To compare histopathologic changes after photorefractive keratectomy (PRK) for myopia using either a solid state laser (SSL) at 213 nm or an excimer laser (EL) at 193 nm in an experimental model., Methods: Forty pigmented rabbits (80 eyes) underwent myopic PRK for the correction of 6 D. Photoablation was randomly assigned, with a solid state laser used in one eye and an EL in the fellow eye. Rabbits were killed immediately after ablation (n = 10) or at 7 days (n = 10), 1 month (n = 8), 3 months (n = 6), or 12 months (n = 6) after surgery. Corneal tissue was preserved for light microscopy and transmission electron microscopy at all postoperative intervals., Results: All eyes reepithelialized in 1 week with no early or late postoperative complication. Immediately after ablation, light, scanning, and transmission electron microscopy revealed relatively smooth ablation surfaces in both groups. Seven days after surgery, epithelium in the SSL specimens appeared thinner than in the EL specimens. Activated keratocytes were observed adjacent to the epithelium in both groups, whereas endothelial cells demonstrated normal morphology. At 1, 3, and 12 months after surgery, tissue appearance of all corneal layers was similar in both groups., Conclusions: PRK in rabbits using ultraviolet SSL and EL revealed similar histopathologic findings up to 1 year after surgery.

Purpose: To present 15-year follow-up of one of the first LASIK-treated patients., Methods: A 40-year-old woman underwent LASIK in the left eye for myopia in July 1991., Results: Fifteen years after LASIK, spherical equivalent error was statistically significantly reduced from preoperative -8.75 -3.75 x 025 degrees to postoperative -4.25 -2.75 x 010 degrees. Six months postoperatively, refractive and topographic stability was obtained and remained stable during follow-up with no significant changes between interval mean time (-3.75 -3.00 x 020 degrees 6 months postoperatively to -4.25 -2.75 x 010 degrees 15 years postoperatively). No early or late postoperative complications were observed, and confocal microscopy revealed a regenerated nerve plexus and normal cornea. However, increased scattering and presence of debris were observed at the flap interface even after 15 years. Despite moderate predictability (residual refractive error) and small optical zone, the patient was satisfied with final outcome., Conclusions: One of the first LASIK-treated patients was presented 15 years after surgery. LASIK in this patient had low predictability, although refractive and topographic stability occurred after the sixth postoperative month. No long-term, sight-threatening complications were identified during follow-up.

Purpose: To evaluate whether photorefractive keratectomy (PRK) for moderate myopia using a solid-state laser with a wavelength of 213 nm alters the corneal endothelial cell density., Setting: University refractive surgery center., Methods: The corneal endothelium was analyzed preoperatively and 1, 6, and 12 months postoperatively using corneal confocal microscopy (modified HRT II with a Rostock Cornea Module, Heidelberg Engineering) in 60 eyes (30 patients). Patients were randomized to have myopic PRK using a 213 nm wavelength solid-state laser (study group) or a conventional 193 nm wavelength excimer laser (control group). Three endothelial images were acquired in each of 30 preoperative normal eyes to evaluate the repeatability of endothelial cell density measurements. Repeated-measures analysis of variance was used to compare the variations in endothelial cell density between the 2 lasers and the changes in endothelial cell density over time., Results: There were no statistically significant differences in sex, age, corneal pachymetry, attempted correction, preoperative endothelial cell density, or postoperative refractive outcomes (uncorrected visual acuity, best spectacle-corrected visual acuity, and spherical equivalent refraction) between the 2 groups (P>.05). The coefficient of repeatability of endothelial cell density was 131 cells/mm(2). The measured endothelial cell count per 1.0 mm(2) did not significantly change up to 1 year postoperatively in either group (both P>.05). No statistically significant difference was found between the 2 groups in any postoperative interval (P>.05)., Conclusion: Photorefractive keratectomy for moderate myopia using a 213 nm wavelength solid-state laser or a conventional 193 nm wavelength excimer laser did not significantly affect corneal endothelial density during the 1-year postoperative period.

Purpose: To study the long-term results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in low to moderate myopic corrections using the Pulzar Z1 system (CustomVis), a 213 nm wavelength solid-state laser., Setting: University refractive surgery center., Methods: This prospective noncomparative case series comprised 20 patients (40 eyes) who had refractive surgery using the Pulzar Z1 laser system. Manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), safety, predictability, stability, and confocal microscopy images were evaluated., Results: Ten patients (20 eyes) had PRK and 10 patients (20 eyes) had LASIK. The mean follow-up was 13.9 months +/- 1.1 (SD) (range 12 to 17 months) and 14.6 +/- 1.2 months (range 12 to 18 months) in the PRK group and LASIK group, respectively. No eye lost a line of Snellen BSCVA during the follow-up period; 2 eyes (10%) gained 2 Snellen lines. There was a statistically significant decrease in spherical equivalent manifest refraction postoperatively in both groups (P<.05). Refractive stability was obtained during the first postoperative month and remained stable during the follow-up period, with no significant changes between any interval in both groups (P>.05). At the last follow-up, 95% of all eyes were within +/-1.00 diopter of emmetropia. No late postoperative complications were observed., Conclusion: Refractive surgery using the Pulzar Z1 213 nm wavelength solid-state laser was a safe, effective procedure in the treatment of low to moderate myopia.

Purpose: To evaluate the clinical results of epi-LASIK for the treatment of low to moderate myopia and myopic astigmatism., Design: Retrospective, noncomparative, interventional case series., Participants: Two hundred thirty-four eyes of 138 patients underwent epi-LASIK for the correction of low to moderate myopia. Mean preoperative spherical equivalent ranged from -1.0 to -7.25 diopters (D) (-3.74+/-1.46, mean+/-standard deviation [SD]) and baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) from 0.10 to -0.18 (mean+/-SD, 0.00+/-0.06)., Methods: All enrolled eyes underwent epi-LASIK using the Centurion SES epikeratome (Norwood Abbey EyeCare, Victoria, Australia) and the Allegretto (Wavelight Laser Technologie AG, Erlangen, Germany) laser platform. The enrolled patients were followed up daily until the epithelial healing was complete as well as at the 1-, 3-, 6-, and 12-month postoperative intervals., Main Outcome Measures: The main parameters assessed were subjective evaluation of postoperative pain, uncorrected visual acuity (UCVA) and BSCVA, manifest refraction, haze grade, and contrast sensitivity of the operated eyes., Results: The mean epithelial healing time was 4.70+/-0.87 days (range, 3-7 days), with mean logMAR UCVA on the day of reepithelization of 0.26+/-0.14 (range, 0.7-0.0). One year after the treatment, the spherical equivalent of the treated eyes (n = 222) ranged from -1.25 to +0.625 D (mean+/-SD, -0.18+/-0.6 D), with 80.33% of the eyes within 0.5 D (96.72% within 1 D) of the attempted correction. At the same interval, 86% of the eyes had clear corneas and 14% clinically insignificant (trace) haze, whereas 60% of the eyes had a line gain of 1 or more lines of BSCVA. Mean logMAR contrast sensitivity of the treated eyes at 4 different spatial frequencies was improved or remained unchanged throughout the follow-up period., Conclusions: One-year visual and refractive results after epi-LASIK suggest that it is a safe and efficient method for the correction of low to moderate myopia and myopic astigmatism.

Purpose: To report the long-term (11-year) outcomes (stability and complications) of laser in situ keratomileusis (LASIK) in patients with high myopia., Setting: University refractive surgery center., Methods: Seven patients (4 with bilateral treatment and 3 with unilateral treatment) who had myopic LASIK and completed 11 years of follow-up were included in the study., Results: The mean age of the 2 men and 5 women was 41.7 years +/- 6.5 (SD) (range 34 to 50 years). The mean follow-up was 140.18 +/- 6.70 months (range 132 to 150 months). At 11 years, the spherical equivalent error was statistically significantly reduced, from a mean of -12.96 +/- 3.17 diopters (D) (range -19.00 to -10.00 D) before LASIK to a mean of -1.14 +/- 1.67 D (range -4.25 to 1.00 D) after (P<.001). Predictability of postoperative refraction 6 months and 11 years after LASIK showed that 6 eyes (55%) were within +/-1.00 D of intended correction. No late postoperative complications occurred. Five patients (8 eyes, 73%) were satisfied with the final outcome., Conclusions: Laser in situ keratomileusis was moderately predictable in the correction of high degrees of myopia. After the sixth postoperative month, refractive and topographic stability were obtained. No long-term sight-threatening complications occurred during the follow-up period.

Purpose: To evaluate the accuracy and consistency of corneal flap thickness, horizontal diameter, and hinge size with the Moria M2 90-microm single use head., Methods: Fifty-two myopic patients (104 eyes), mean age 32.6 years, underwent bilateral LASIK with a superior hinged flap using the Moria M2 microkeratome (90-microm single use head). Prospective evaluation included flap thickness (subtraction method), diameter, hinge size, interface particles, intraoperative complications, and visual recovery., Results: The mean preoperative spherical equivalent refraction was -5.72 +/- 2.59 diopters (D) (range: -2.88 to -10.75 D) and -5.84 +/- 2.73 D (range: -3.13 to -9.38 D) for right and left eyes, respectively. The mean preoperative central corneal thickness was 548 +/- 24 microm and 547 +/- 25 microm for right and left eyes, respectively. The mean preoperative steepest K was 44.12 +/- 1.28 D and 44.41 +/- 1.27 D for right and left eyes, respectively. Corneal diameter (white-to-white) was 12 +/- 0.4 mm and 11.9 +/- 0.4 mm for right and left eyes, respectively. The mean postoperative flap thickness was 109 +/- 18 microm (range: 67 to 152 microm) and 103 +/- 15 microm (range: 65 to 151 microm) for right and left eyes, respectively. The mean postoperative flap diameter was 9.4 +/- 0.3 mm (expected mean according to the nomogram given by the company was 9.5 mm). The mean postoperative hinge chord was 4.4 +/- 0.4 mm (expected mean 4.2 mm). No interface particles were detected on slit-lamp examination., Conclusions: The Moria M2 90-microm single use head is safe with reasonable predictability for LASIK flap creation.

Purpose: To compare the effect of Epi-LASIK or Laser In Situ Keratomileusis (LASIK) on corneal sensitivity and tear function., Design: Prospective, non-randomized comparative clinical trial., Methods: Seventy-nine eyes (Group A) underwent Epi-LASIK and 61 eyes underwent LASIK (Group B) for the treatment of myopia. Matching parameters between the groups were age and attempted correction. Corneal sensitivity, tear break-up time (BUT), and Schirmer test II were evaluated before and at one, three, and six months after the procedure., Results: Corneal sensitivity and BUT were decreased at one month in Group A (P < .001) to be restored by the third month (P = .71 and P = .58, respectively). In Group B, corneal sensitivity and BUT were reduced postoperatively (P < .001). There was a significant difference in corneal sensitivity between the two groups at all postoperative intervals. Schirmer test II was not significantly decreased postoperatively in Group A. In Group B, it was decreased at one and three months and restored by the sixth month., Conclusion: Epi-LASIK-treated eyes had faster rehabilitation of corneal sensitivity and tear function than LASIK-treated eyes.

Purpose: To study the long-term efficacy, safety, and stability of laser in situ keratomileusis (LASIK) after unintentional ultrathin flap creation less than 80 mum., Setting: University refractive surgery center., Methods: This retrospective case series comprised 25 patients (33 eyes) who had LASIK after flap creation less than 80 mum with the Moria M2 disposable microkeratome (head 90 microm). Flap thickness was measured with intraoperative ultrasound pachymetry. Manifest refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity, predictability, stability, complications, patient satisfaction, and confocal microscopy images were studied., Results: The mean follow-up was 14.58 months +/- 3.73 (SD) (range 12 to 25 months). The mean flap thickness was 72.1 +/- 5.9 microm (range 58 to 80 microm), and the mean preoperative spherical equivalent (SE) refraction was -5.59 +/- 2.01 diopters (D) (range -10.25 to -3.25 D). On the first postoperative day, the UCVA was 20/25 or better. The SE manifest refraction was 1.00 D or less in all patients. The mean SE manifest refraction was -0.75 +/- 0.55 D (range -1.00 to +0.75 D) (P < .01). At the last follow-up, changes in visual acuity and manifest refraction were not statistically significant; no late postoperative complications were observed. All patients were satisfied with the final outcome. Qualitative analysis of confocal microscopy images revealed interface particles and activated keratocytes., Conclusions: Despite the small sample and retrospective nature of the study, superficial LASIK seemed to be a safe and predictable technique for myopic refractive corrections. Patients were satisfied with the results and had rapid visual recovery with no intraoperative or early or late postoperative complications. If the safety and efficacy of an ultrathin flap are confirmed by additional studies, superficial LASIK could represent a new approach that combines the advantages of surface and lamellar procedures.

Purpose of Review: The aim of this article is to provide an update on epipolis laser in-situ keratomileusis--an alternative surface photorefractive surgical technique for the correction of myopia., Recent Findings: In-vivo studies on animal models provide evidence that the replacement of the epithelial sheet on an ablated cornea can control corneal wound healing. Preliminary clinical data confirm that epipolis laser in-situ keratomileusis can provide excellent long-term visual and refractive results. The problems of late visual rehabilitation and postoperative pain, however, have not yet been fully addressed., Summary: Being a recently introduced surgical photorefractive technique for ametropias correction, epipolis laser in-situ keratomileusis is a fast evolving area of interest for refractive surgeons.

Purpose: To evaluate the clinical results of epi-LASIK, a new surface ablation surgical technique for the treatment of low myopia., Setting: Vardinoyannion Eye Institute of Crete, University of Crete, Greece., Methods: Forty-four eyes of 31 patients had epi-LASIK for the correction of low myopia. Mean preoperative spherical equivalent was 3.71 diopters (D) +/- 1.2 (SD) (range -1.75 to -7.00 D) and the mean baseline logMAR best spectacle-corrected visual acuity was -0.01 +/- 0.06 (range 0.10 to -0.10). All the epithelial separations were performed with the Centurion epikeratome (CIBA Surgical). The enrolled patients were followed daily until the epithelial healing was complete as well as at 1- and 3-month intervals. On the operative day, patients filled out a questionnaire grading visual performance and pain score of treated eyes every 2 hours for a total of 5 records., Results: The mean epithelial healing time was 4.86 +/- 0.56 days (range 3 to 5 days). The mean logMAR uncorrected visual acuity on the day of reepithelization was 0.19 +/- 0.09 (range 0.40 to 0.10). At 1 month, the mean was spherical equivalent of the treated eyes (N=44), -0.3 +/- 0.6 D (range -1.0 to 0.87 D), and at 3 months it was (N=37), -0.10 +/- 0.4 D (range -0.75 to 0.75 D); 97% of eyes had clear corneas or trace haze 3 months after treatment., Conclusions: Preliminary clinical results suggest that epi-LASIK is a safe and efficient method for the correction of low myopia. Further studies will establish this method as an alternative surface ablation procedure.

Purpose: To evaluate the efficacy and safety of implantation of a new posterior chamber phakic refractive lens (PRL, Ciba Vision Surgical) in highly myopic eyes., Setting: Department of Ophthalmology, Medical School, University of Crete, Vardinoyannion Eye Institute of Crete, Crete, Greece., Methods: Thirty-four myopic eyes of 19 patients were treated for high myopia with implantation of a silicone PRL in the posterior chamber. Mean patient age was 29.0 years +/- 7.9 (SD) (range 18 to 44 years). Manifest refraction in spherical equivalent (MR), uncorrected (UCVA) and best corrected (BCVA) visual acuity (decimal scale), intraocular pressure, higher-order aberrations (root-mean-square [RMS] wavefront error measured with a Shack-Hartmann wavefront sensor WASCA analyzer [Carl Zeiss, Meditec]), possible complications, and subjective symptoms were evaluated., Results: Phakic refractive lenses were successfully implanted in all eyes. Mean follow-up was 17.17 +/- 3.76 months (range 12 to 24 months). There was a statistically significant reduction in the MR (from -14.70 D +/- 2.65 D [range -20.75 D to -10.50 D] to -0.61 D +/- 0.89 D [range -2.25 D to 1.00 D]) (P<.001). Twenty-seven (79%) and 15 eyes (44%) were within +/-1.00 D and +/-0.50 D of target refraction, respectively. Mean UCVA significantly improved (from counting fingers to 0.62 +/- 0.28 (range 0.08 to 1.20) (P<.001). Mean BCVA also improved from 0.70 +/- 0.24 (range 0.10 to 1.00) to 0.85 +/- 0.24 (range 0.10 to 1.20) (P<0.001). Overall, there was a mean increase in BCVA of 1.5 +/- 1.5 lines (range loss of 2 lines to gain of 5 lines). There was no statistically significant difference in higher-order aberrations after PRL implantation (pre-PRL RMS: 0.18 microm +/- 0.08 microm [range 0.09 microm to 0.38 microm]; post-PRL RMS: 0.21 microm +/- 0.08 microm; [range 0.05 microm to 0.38 microm]) (P =.12)., Conclusion: The PRL showed encouraging results in treating high myopia. Additional patients and longer follow-up period are needed to detect the long-term efficacy and safety of this refractive lens.

Purpose: To determine how refractive error, visual acuity, and high-order aberrations (3rd- and 4th-order) are affected by the formation of a lamellar corneal flap during laser in situ keratomileusis (LASIK)., Setting: University refractive surgery center., Methods: The effect of lamellar corneal flap formation was analyzed in 15 myopic eyes (mean preoperative refraction -4.72 diopters [D] [range -1.25 to -7.25 D]). The flap was created using a 2-step procedure: (1). a nasally hinged lamellar corneal flap was created; (2). the flap was lifted and stromal ablation performed 2 months after the flap was made. A Hartmann-Shack aberrometer was used to measure the aberrations., Results: There was no significant change in the refractive error (spherical equivalent pre-flap -4.72 +/- 1.99 D and post-flap -4.62 +/- 1.99 D [P =.28]) or visual acuity (pre-flap uncorrected visual acuity [UCVA] 0.07 and best corrected visual acuity [BCVA] 0.96; post-flap UCVA 0.08 and BCVA 0.95 [P =.16 and P =.33, respectively]). A statistically significant increase in total higher-order wavefront aberrations was observed following flap formation (root mean square pre-flap 0.344 +/- 0.125 and post-flap 0.440 +/- 0.221 [P =.04])., Conclusion: Flap formation during LASIK can modify the eye's existing natural higher-order aberrations (especially spherical and coma-like aberrations along the axis of the flap's hinge), while visual acuity and refractive error remain unaffected.

Objective: To identify the incidence and refractive outcome of intraoperative laser in situ keratomileusis (LASIK) complications using one type of microkeratome., Design: Retrospective noncomparative case series., Participants: Three hundred thirty-four consecutive myopic LASIK patients (September 1997 to November 1998) operated on by one surgeon., Intervention: Myopic LASIK surgeries were performed with the Mediate Mel 60 Aesculap Meditec Laser system., Main Outcome Measures: Preoperative and 1-year postoperative spherical equivalent, best spectacle-corrected visual acuity (BSVA), and corneal anatomic features (as obtained from videokeratography) were recorded, as was the incidence of intraoperative complications., Results: Forty-eight (14%) eyes had keratome-related complications. Thirty-seven (77%) eyes were immediately treated; the remaining eyes were treated on a later date. One year after treatment, 13% of the immediately treated complicated eyes maintained the preoperative BSVA; 24% had a 1-line loss; 2.7% had a greater loss of BSVA., Conclusions: Microkeratome-related complications may result in loss of BSVA. The complication of an irregular flap had the poorest refractive outcome in this series of eyes. We did not find any statistically significant relationship between corneal anatomic factors and keratome-related complications in this series.

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Purpose: To evaluate the long-term results of phakic refractive lens (PRL; Carl Zeiss Meditec) implantation in eyes with high myopia. Methods: In this retrospective, noncomparative, interventional case series, 143 myopic eyes of 82 patients were treated for high myopia with the implantation of the silicone PRL in the posterior chamber. Results: Mean follow-up was 3.8±1.7 years (range: 1 to 6 years). Six years postoperatively (n=34), a statistically significant reduction was noted in the cycloplegic spherical equivalent from −14.08±4.00 diopters (D) (range: −24.88 to −4.75 D) before PRL implantation to −0.45±0.62 D (range: −1.00 to 1.00 D) (P<.001). At 6 years, 67.6% (23 eyes) and 91.2% (31 eyes) were within ±0.50 and ±1.00 D of target refraction, respectively. Mean logMAR uncorrected and corrected distance visual acuity improved significantly (P<.001) (counting fingers preoperatively in all eyes to 0.17±0.15 [range: 0.54 to −0.06] and 0.19±0.19 [1.00 to −0.08] to 0.07±0.10 [range: 0.30 to −0.10], respectively). Complications included anterior capsule damage (3 eyes), temporary intraocular pressure increase (14 eyes), pigment dispersion (1 eye), and PRL decentration (1 eye). No eyes presented any signs of cataract up to 6 years postoperatively. Conclusions: Long-term results show that PRL implantation is an effective and safe method for treating high myopia. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the feasibility, safety, and predictability of correcting high irregular astigmatism in symptomatic eyes with the use of topography-guided photoablation. METHODS: In a prospective, non-comparative case series, 16 consecutive symptomatic eyes of 11 patients with small hyperopic and myopic excimer laser optical zones, decentered and irregular ablation after corneal graft, and corneal scars were operated. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest and cycloplegic refraction, and corneal topography, with asphericity and regularity, were analyzed. LASIK (n=10) and photorefractive keratectomy (n=6) were performed using the ALLEGRETTO WAVE excimer laser and T-CAT software (Topography-guided Customized Ablation Treatment; WaveLight Laser Technologie AG, Erlangen, Germany). RESULTS: In the LASIK group, UCVA improved from 0.81±0.68 logMAR (20/130) (range: 0.2 to 2.0) to 0.29±0.21 logMAR (20/39) (range: 0.1 to 0.7) at 6 months. In the PRK group, mean UCVA improved from 0.89±0.87 logMAR (20/157) (range: 0.1 to 2.0) to 0.42±0.35 logMAR (20/53) (range: 0.1 to 1.0) at 6 months. Best spectacle-corrected visual acuity did not change significantly in either group. One PRK patient lost one line of BSCVA. Refractive cylinder for the LASIK group improved from -2.53±1.71 diopters (D) (range: -0.75 to -5.75 D) to -1.28±0.99 D (range: 0 to -2.50 D) at 6 months. Refractive cylinder in the PRK group improved from -2.21±2.11 D (range: -0.25 to -5.50 D) to -1.10±0.42 D (range: -0.50 to -1.50 D). Index of surface irregularity showed a decrease from 60±12 (range: 46 to 89) to 50±9 (range: 32 to 63) at 6 months in the LASIK group whereas no significant change was noted in the PRK group. Subjective symptoms, such as glare, halos, ghost images, starbursts, and monocular diplopia, were not present postoperatively. CONCLUSIONS: Topography-guided LASIK and PRK resulted in a significant reduction of refractive cylinder and increase of UCVA, without a significant loss of BSCVA. [ABSTRACT FROM AUTHOR]

PURPOSE: To report the histological findings of four eyes of three patients who underwent epi-LASIK treatment for the correction of low myopia. METHODS: The epithelial sheets were harvested either immediately after separation (one eye) or were accidentally dislocated and harvested from the operative eyes 24 hours after treatment (three eyes). All sheets underwent optical and transmission electron microscopy. RESULTS: Histological evaluation showed that the majority of the epithelial cells were morphologically normal in all examined specimens. CONCLUSIONS: Histological examination of specimens in four eyes showed that 24 hours after mechanical separation the epithelial cells' morphology was close to normal. [ABSTRACT FROM AUTHOR]

A 42-year-old man had Intacs (Addition Technology Inc.) implantation for early pellucid marginal degeneration (PMD). Two Intacs segments (0.45 mm thickness) were inserted uneventfully in the fashion typically used for low myopia correction (nasal–temporal). Eleven months after the procedure, the uncorrected visual acuity was 20/200, compared with counting fingers preoperatively, while the best spectacle-corrected visual acuity improved to 20/25 from 20/50. Corneal topographic pattern also improved. Although the results are encouraging, concern still exists regarding the long-term effect of this approach for the management of patients with PMD. [Copyright &y& Elsevier]