7,065 results on '"Keratomileusis, Laser In Situ"'
Search Results
2. 'Infolded' LASIK flap: an unusual variant of early postoperative flap dislocation
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Raghav Preetam Peraka, Somasheila I Murthy, Vidhyadhar Akkulugari, and Varsha M Rathi
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Male ,Postoperative Complications ,Keratomileusis, Laser In Situ ,Joint Dislocations ,Visual Acuity ,Humans ,General Medicine ,Postoperative Period ,Surgical Flaps ,Tomography, Optical Coherence - Abstract
Flap displacement is a rare but vision-threatening complication of laser-assisted in situ keratomileusis (LASIK). A young male patient underwent uneventful microkeratome-assisted LASIK. One-week postoperatively, flap displacement was noted in his right eye with its lower edge folded inwards, macrostria at the superior edge and the epithelium covering the bare stroma and into the interface. Anterior segment optical coherence tomography (AS-OCT) delineated the morphology of the displaced flap and the extent of epithelial ingrowth. The flap was repositioned by unrolling the fold and all the exposed surfaces were debrided to remove the epithelial ingrowth. Two months later, his corrected distance visual acuity improved to 20/30, and a smooth surface could be achieved. Infolded LASIK flap is a rare complication, which requires timely surgical intervention to achieve successful anatomical and functional outcomes. AS-OCT can be pivotal in determining the extent of infolding as well to delineate the extent of epithelial ingrowth within the interface.
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- 2024
3. The Role of Psychosocial and Other Quality of Life Parameters in Evaluating Functional Changes Prior to and Following Laser In-situ Keratomileusis (LASIK)Changes Laser In-situ Keratomileusis (LASIK)
- Author
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James P. McCulley
- Published
- 2018
4. Mechanical vs. Alcohol Separation of the Corneal Epithelium During Surface Ablation Refractive Procedures
- Published
- 2018
5. LASIK flap dislocation following direct face mask-induced mechanical trauma
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Sridevi Nair, Manpreet Kaur, and Jeewan S Titiyal
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Corneal Stroma ,Keratomileusis, Laser In Situ ,Masks ,Humans ,General Medicine ,Surgical Flaps - Published
- 2024
6. Salzmann's Nodular Degeneration in Refractive Surgery: The Earlier Hit Hypothesis of EBM Injury-Related Fibrosis of the Subepithelial Space and Deeper Corneal Extension.
- Author
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Wilson SE and Dupps WJ
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- Humans, Male, Bowman Membrane pathology, Adult, Myopia surgery, Myopia physiopathology, Female, Corneal Diseases etiology, Corneal Diseases surgery, Lasers, Excimer therapeutic use, Myofibroblasts pathology, Middle Aged, Fibrosis, Keratomileusis, Laser In Situ, Photorefractive Keratectomy, Epithelium, Corneal pathology
- Abstract
Purpose: To review the atypical development of Salzmann's nodular degeneration (SND) after two cases of laser in situ keratomileusis (LASIK) and one case of photorefractive keratomileusis (PRK), and to highlight the pathophysiology of SND and its treatment., Methods: Three cases of SND (two following LASIK performed with microkeratomes and one following PRK) were reviewed and Pubmed.gov and internet searches were performed., Results: SND is myofibroblast-generated fibrosis in the subepithelial space between the epithelium and Bowman's layer that develops years or decades after traumatic, surgical, infectious, or inflammatory injuries to the cornea in which the epithelial basement membrane is damaged in one or more locations and does not fully regenerate. It is hypothesized based on these cases, and the previous immunohistochemistry of other investigators, that myofibroblast precursors, such as fibrocytes or corneal fibroblasts, that enter the subepithelial space are driven to develop into myofibroblasts, which slowly proliferate and extend the fibrosis, by transforming growth factor-beta from epithelium and tears that passes through the defective epithelial basement membrane. These myofibroblasts and the disordered collagens, and other extracellular matrix components they produce, make up the subepithelial opacity characteristic of SND. Nodules are larger accumulations of myofibroblasts and disordered extracellular matrix. If the injury is associated with damage to the underlying Bowman's layer and stroma, as in LASIK flap generation, then the myofibroblasts and fibrosis can extend into Bowman's layer and the underlying anterior stroma., Conclusions: SND fibrosis often extends into Bowman's layer and the anterior stroma if there are associated Bowman's defects, such as incisions or lacerations. In the latter cases, SND frequently cannot be removed by simple scrape and peel, as typically performed for most common SND cases, but can be trimmed to remove the offending tissue. This condition is more accurately termed Salzmann's subepithelial fibrosis. [ J Refract Surg . 2024;40(5):e279-e290.] .
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- 2024
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7. Effects of Topical 0.05% Cyclosporine A on Dry Eye Symptoms and Parameters Following Small Incision Lenticule Extraction.
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Zhu X, Li S, Wang M, Yao W, Huang X, and Zhao L
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- Humans, Cyclosporine therapeutic use, Tears, Keratomileusis, Laser In Situ, Myopia surgery, Dry Eye Syndromes diagnosis, Dry Eye Syndromes drug therapy, Dry Eye Syndromes etiology
- Abstract
Purpose: To evaluate the effects of topical 0.05% cyclosporine A on Ocular Surface Disease Index (OSDI) score and ocular surface parameters after small incision lenticule extraction (SMILE) for myopia., Methods: In this study, 151 patients who underwent SMILE were randomized into the control group (71 eyes) and the 0.05% cyclosporine A group (80 eyes). Both groups received standard treatment during the 1 month after SMILE. Over the next 3 months, The control group continued standard therapy (0.3% sodium hyaluronate) and the 0.05% cyclosporine A group received additional 0.05% cyclosporine A. OSDI total and subscale scores, non-invasive tear break-up time (NIBUT), tear lipid layer thickness (LLT), and tear meniscus height (TMH) were assessed preoperatively and postoperatively., Results: Compared to baseline, the OSDI scores significantly increased in both groups ( P < .001). The 0.05% cyclosporine A group exhibited lower OSDI total scores after administering 0.05% cyclosporine A versus the control group ( P = .026). At 1 month of follow-up, NIBUT, LLT, and TMH values significantly decreased in both groups compared to baseline ( P < .05). The 0.05% cyclosporine A group exhibited higher NIBUT, LLT, and TMH versus the control group, returning to preoperative values after 2 months. Overall, the OSDI total score and NIBUT values during follow-up were not significantly different between the two groups; however, the LLT and TMH values were significantly different between the two groups ( P < .001 and .041, respectively) by repeated measures analysis of variance., Conclusions: Topical 0.05% cyclosporine A was effective in relieving subjective dry eye symptoms and maintaining ocular surface stability in the early postoperative period of SMILE. [ J Refract Surg . 2024;40(4):e229-e238.] .
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- 2024
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8. Factors associated with changes in posterior corneal surface following laser-assisted in situ keratomileusis.
- Author
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Nemet A, Ben Ephraim Noyman D, Nasser W, Sela T, Munzer G, Sapir S, Mimouni M, and Kaiserman I
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- Humans, Young Adult, Adult, Middle Aged, Retrospective Studies, Corneal Topography, Cornea surgery, Refraction, Ocular, Keratomileusis, Laser In Situ
- Abstract
Purpose: To identify factors associated with changes in the posterior corneal curvature following laser-assisted in situ keratomileusis (LASIK)., Methods: This retrospective study included myopic astigmatic eyes that underwent LASIK between January and December 2013 at Care-Vision Laser Center, Tel-Aviv, Israel. The average posterior keratometry was measured with the Sirius device at a radius of 3 mm from the center. The correlations between the surgically induced change in average posterior keratometry and preoperative parameters such as preoperative sphere, cylinder, spherical equivalent, central corneal thickness (CCT), refraction, Baiocchi Calossi Versaci (BCV) index, ablation depth, percent of tissue altered (PTA), and residual stromal bed (RSB) are reported., Results: A total of 115 eyes with a mean age of 32.5 ± 8.3 years (range 22-56 years) were included. Central corneal thickness (p < 0.005), preoperative sphere (p < 0.001), spherical equivalent (p < 0.005), and preoperative posterior inferior/superior ratio (p < 0.05) were all significantly correlated with the percentage of change in the mean posterior K. According to ranked stepwise multiple regression analysis, 22% of the variance of change in posterior K could be explained by the examined factors. The factors that remained significant were the percentage of change in posterior inferior/superior ratio, preoperative subjective sphere, and preoperative mean posterior K (for all, p < 0.001)., Conclusions: The percentage of change in posterior inferior/superior ratio, subjective sphere, and preoperative mean posterior K are all correlated with change in the mean posterior K after LASIK. Understanding of the variables that can influence posterior corneal changes following refractive surgery may play a role in the prevention of iatrogenic keratectasia., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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9. Novel Manifestation of Corneal Dystrophy After Keratorefractive Surgery.
- Author
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Yeh TC, Hsu CC, Lu YH, Chen YR, Niu DM, and Lin PY
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- Humans, Female, Adult, Middle Aged, Male, Cornea surgery, Keratoplasty, Penetrating, Corneal Dystrophies, Hereditary diagnosis, Corneal Dystrophies, Hereditary genetics, Corneal Dystrophies, Hereditary surgery, Corneal Opacity surgery, Keratomileusis, Laser In Situ
- Abstract
Purpose: This study aimed to report cases of bilateral corneal Bowman layer deposits in 4 patients with a history of keratorefractive surgery. To our knowledge, this condition has not previously been reported and should be distinguished from granular corneal dystrophy type 2 and other corneal dystrophies., Methods: We reviewed all available medical records that were collected between January 2010 and December 2021 at a tertiary referral center and performed whole-exome sequencing to provide diagnostic information., Results: Four patients exhibited similar bilateral corneal deposits that were observed more than 10 years after keratorefractive surgery. The patients' ages ranged from 36 to 53 years; 3 of the 4 patients were female. Three patients received laser in situ keratomileusis surgery, and 1 received radial keratotomy. All 4 patients denied having a family history of ocular diseases and reported an uneventful postoperative course. On examination, the best-corrected visual acuity ranged from 6/10 to 6/6 in all 4 patients. Slit-lamp examination revealed bilateral superficial corneal deposits involving the central cornea, and anterior segment optical coherence tomography revealed hyperreflective deposits located in the Bowman layer. Such unique manifestations suggested corneal dystrophy; thus, whole-exome sequencing was performed on all 4 patients. Only 1 patient exhibited a missense mutation in TGFBI . We further analyzed common de novo mutations to explore possible candidate genes associated with this presentation., Conclusions: We report a rare entity of presumed corneal dystrophy with deposits located in the Bowman layer in 4 patients who had received keratorefractive surgery. Clarifying the underlying pathophysiology and genetic predisposition of this disease may aid in diagnosing and preventing potential complications after keratorefractive surgery., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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10. Biomechanical properties of cornea and ocular aberrations in myopic eyes.
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Dhiman R, Singh D, Vanathi M, Tandon R, and Mahalingam K
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- Humans, Young Adult, Adult, Cornea, Intraocular Pressure, Biomechanical Phenomena, Myopia diagnosis, Myopia surgery, Refractive Errors, Keratomileusis, Laser In Situ
- Abstract
Purpose: To study the correlation of corneal topography, corneal biomechanical properties, and ocular aberrations with the magnitude of refractive error in myopic eyes., Methods: All myopic patients attending the clinic for refractive surgery were recruited. Data recorded included visual acuity, axial length (AL), central corneal thickness (CCT), manifest refraction spherical equivalent (MRSE), topography (Pentacam - Oculus), corneal biomechanical factors [ocular response analyzer (ORA)], and optical aberrations (iTrace). They were further categorized into group 1 (suitable for femto-LASIK) and group 2 (unsuitable for femto-LASIK)., Results: Sixty eyes (30 myopes) of mean age 22.78 ± 2.71 years were enrolled. A negative correlation of refractive error was noted with AL (ρ = -0.9; P < 0.001), total aberrations (ρ = 0.53; P < 0.001), and lower-order aberrations (LOA) (ρ = 0.54; P < 0.001). A strongly positive correlation was noted between CCT and corneal hysteresis (CH) (ρ = 0.63; P < 0.001), CCT and CRF (ρ = 0.56; P < 0.001), CH and corneal resistance factor (CRF) (ρ = 0.83; P < 0.001), and Goldmann equivalent intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) (ρ = 0.78; P < 0.001). An increase in higher-order aberrations (HOAs) as well as lower-order aberrations (LOAs) was noted with increasing sim-K [HOA (r = 0.73, P = 0.001); LOA (r = 0.601, P = 0.014)] and increasing CRF [HOA (r = 0.5, P = 0.006); LOA (r = 0.732, P = 0.001)] in group 2. The amount of refractive error, axial length, central corneal thickness, and sim-K were significantly different in the two groups., Conclusion: Increasing degree of myopia is associated with an increase in axial length, total aberrations, and lower-order aberrations. Corneal biomechanical parameters have a strong correlation with each other. Lower corneal biomechanics are noted in high myopes as they have weaker and thinner corneas. Corneal biomechanics and ocular aberrations do not differ significantly between cases suitable for femto-LASIK and cases unsuitable for femto-LASIK., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)
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- 2024
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11. Visual Quality Assessment After FS-LASIK Using Customized Aspheric Ablation Profile for Age-Related Accommodation Deficiency Compensation.
- Author
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Zhang R, Yuan Y, Zhang Y, and Chen Y
- Subjects
- Humans, Adult, Retrospective Studies, Visual Acuity, Cornea, Lasers, Excimer therapeutic use, Refraction, Ocular, Treatment Outcome, Keratomileusis, Laser In Situ, Myopia surgery, Astigmatism surgery, Corneal Wavefront Aberration
- Abstract
Purpose: To evaluate clinical outcomes and visual quality 12 months after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) performed with the Custom-Q algorithm for correction of myopia with or without astigmatism and compensate for age-related accommodation deficiency., Methods: Patients who had Custom-Q FS-LASIK for myopia and myopic astigmatism with age-related accommodation deficiency were included in this retrospective study. Distance, intermediate, and near visual acuities, objective and subjective refractions, Q-factor, corneal higher order aberrations (HOAs), accommodation function, defocus curve, contrast sensitivity, and a subjective questionnaire assessing visual quality were evaluated 12 months postoperatively., Results: Clinical data of 43 cases were analyzed. The mean age was 42.02 ± 1.85 years (range: 40 to 48 years). At the 12-month follow-up visit, there were 43 (100%), 42 (97%), and 33 (77%) patients who achieved a binocular uncorrected distance, intermediate, and near visual acuity, respectively, better than 20/20 separately. Defocus curves revealed better distance vision in the dominant eyes, and the nondominant eyes performed better at intermediate and near vergence ( P < .001). The Q-value and corneal spherical aberration coefficient were more positive in the dominant eyes than those in the nondominant eyes ( P < .001). The accommodative amplitude and relative accommodation improved binocularly ( P < .001). The questionnaire demonstrated high patient satisfaction with near vision, and no one reported having severe visual disturbance., Conclusions: For myopic patients with age-related accommodation deficiency, the Custom-Q algorithm proved to be an effective way to achieve acceptable near vision without compromising distance vision. [ J Refract Surg . 2024;40(4):e245-e252.] .
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- 2024
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12. LASIK is associated with early cataract surgery in healthy patients.
- Author
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Ortiz-Morales G, Ramos-Davila EM, Elizondo-Fernández B, Arreola-Martinez J, Garcia JN, and Valdez-Garcia JE
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- Adult, Humans, Child, Adolescent, Young Adult, Middle Aged, Case-Control Studies, Keratomileusis, Laser In Situ, Cataract Extraction, Phacoemulsification, Cataract complications
- Abstract
Purpose: To evaluate the association between LASIK and early cataract phacoemulsification surgery (PE)., Methods: A matched case-control study was conducted. Cases were otherwise healthy adults with a history of LASIK. Groups were paired according to corrected-distance visual acuity (CDVA), axial length, and cataract grade., Results: A total of 213 patients were included. 85 patients were classified as post-LASIK group and 128 as controls. The mean age at the time of LASIK was 42.32 ± 9.24 years. The mean CDVA before PE was 0.29 ± 0.19 Log MAR in post-LASIK group and 0.34 ± 0.22 Log MAR in controls (p = 0.07). The mean axial length was 23.99 ± 1.78 mm in post-LASIK group and 23.62 ± 0.98 mm in controls (p = 0.085). The mean nuclear cataract grading was 1.36 in post-LASIK group and 1.47 in controls (p = 0.34). The mean age at the time of PE was 60.18 ± 7.46 years in post-LASIK group and 67.35 ± 9.28 in controls (p < 0.0005). The difference between the mean age of LASIK and the mean age of PE was 17.85 ± 5.72 years. There was a positive association between the post-LASIK group and the age of PE ≤ 55 years (OR: 4.917, 95% CI: 2.21-10.90, p < 0.001)., Conclusion: LASIK may be associated with early PE. Patients with LASIK had a 7-year earlier PE compared to a matched control group., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
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- 2024
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13. Laser in Situ Keratomileusis Flap Free-Floating on Interface Edema in Acute Corneal Hydrops.
- Author
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Warner EJ
- Subjects
- Humans, Edema diagnosis, Edema etiology, Cornea surgery, Keratomileusis, Laser In Situ, Corneal Edema diagnosis, Corneal Edema etiology
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- 2024
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14. Camellin-Calossi Formula for Intraocular Lens Power Calculation in Patients With Previous Myopic Laser Vision Correction.
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Zollet P, Romeo MA, Tripepi D, Vinciguerra P, and Vinciguerra R
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- Humans, Lens Implantation, Intraocular, Retrospective Studies, Refraction, Ocular, Biometry, Lasers, Optics and Photonics, Lenses, Intraocular, Phacoemulsification, Keratomileusis, Laser In Situ, Myopia surgery
- Abstract
Purpose: To assess the performance of the Camellin-Calossi formula in eyes with prior myopic laser vision correction., Methods: This was a retrospective case series. Patients included had a history of uncomplicated myopic laser vision correction and cataract surgery. The primary outcome measures were cumulative distribution of absolute refractive prediction error, absolute refractive prediction error, and refractive prediction error. These parameters were estimated post-hoc using the Camellin-Calossi, Shammas, Haigis-L, Barrett True-K with or without history, Masket, and Modified Masket formulas and their averages starting from biometric data, clinical records, postoperative refraction, and intraocular lens power implanted., Results: Seventy-seven eyes from 77 patients were included. The Camellin-Calossi, Shammas, Haigis-L, Barrett True-K No History, Masket, Modified Masket, and Barrett True-K formulas showed a median absolute refractive error (interquartile range) of 0.25 (0.53), 0.51 (0.56), 0.44 (0.65), 0.45 (0.59), 0.40 (0.61), 0.60 (0.70), and 0.55 (0.76), respectively. The proportion of eyes with an absolute refractive error of ±0.25, 0.50, 0.75, 1.00, 1.50, and 2.00 diopters (D) for the Camellin-Calossi formula was 54.5%, 72.7%, 85.7%, 92.2%, 98.7%, and 100%, respectively. The cumulative distribution of the Camellin-Calossi formula showed the best qualitative performances when compared to the others. A statistically significant difference was identified with all of the others except the Haigis-L using a threshold of 0.25, with the Shammas, Modified Masket, and Barrett True-K at a threshold of 0.50 D and the Barrett True-K and Modified Masket at a threshold of 1.00 D., Conclusions: The Camellin-Calossi formula is a valid option for intraocular lens power calculation in eyes with prior myopic laser vision correction. [ J Refract Surg . 2024;40(3):e156-e163.] .
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- 2024
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15. Something to SMILE about. Is small incision lenticule extraction ready to become the gold standard in laser refractive surgery? Yes.
- Author
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Tsatsos M, Giachos I, Tsinopoulos I, Ziakas N, and Jacob S
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- Humans, Corneal Stroma surgery, Lasers, Lasers, Excimer therapeutic use, Refractive Surgical Procedures, Corneal Surgery, Laser, Keratomileusis, Laser In Situ
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- 2024
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16. Something to SMILE about. Is small incision lenticule extraction (SMILE) ready to become the gold standard in laser refractive surgery? no.
- Author
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Tsatsos M, Giachos I, Prousali E, Jacob S, and Ziakas N
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- Humans, Cornea surgery, Lasers, Corneal Stroma surgery, Lasers, Excimer therapeutic use, Refractive Surgical Procedures, Corneal Surgery, Laser, Keratomileusis, Laser In Situ
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- 2024
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17. Investigation into the interest in LASIK in Canada during the COVID-19 pandemic: predicting interest and demand in periods of uncertainty.
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Kowal S, Mezey N, and Johnson D
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- Humans, Uncertainty, Pandemics, Canada epidemiology, COVID-19 epidemiology, Keratomileusis, Laser In Situ
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- 2024
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18. Trifocal versus monofocal intraocular lens implantation in eyes previously treated with laser in situ keratomileusis (LASIK) for myopia.
- Author
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Bilbao-Calabuig R, Ortega-Usobiaga J, Mayordomo-Cerdá F, Beltrán-Sanz J, Fernández-García J, and Cobo-Soriano R
- Subjects
- Humans, Lens Implantation, Intraocular, Retrospective Studies, Refraction, Ocular, Prosthesis Design, Patient Satisfaction, Keratomileusis, Laser In Situ, Myopia surgery, Lenses, Intraocular, Phacoemulsification
- Abstract
Purpose: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL., Design: Retrospective comparative cases series., Methods: This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal)., Results: A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost ≥1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group., Conclusion: Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)
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- 2024
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19. Influence of the patient's age on the safety, efficacy, and prediction accuracy of the microkeratome in laser-assisted in situ keratomileusis.
- Author
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Benabidi S, Frings A, Druchkiv V, and Katz T
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- Humans, Adult, Middle Aged, Retrospective Studies, Eye, Lasers, Keratomileusis, Laser In Situ, Myopia, Hyperopia
- Abstract
The purpose of this retrospective pseudonymised data analysis was to determine whether the patient's age has an influence on the safety, efficacy, and prediction accuracy of laser in situ keratomileusis (LASIK) treatment of myopic and hyperopic eyes. This study was performed at CARE Vision GmbH (Düsseldorf, Germany) and included two patient cohorts: an older group with patients > 55 years old and a younger group with patients 30-40 years old. Each patient had a single LASIK treatment. The safety, efficacy, and prediction accuracy of the refractive results were analysed. In total, 682 patients were analysed, with 341 patients in each patient group (one eye per patient). There were 570 myopic eyes and 112 hyperopic eyes. In myopic eyes, the efficacy was significantly influenced by the patient's age but only in myopic eyes (myopic: p ≤ 0.05; hyperopic: p = 0.085), while safety was not significantly influenced by the patient's age in hyperopic or myopic eyes (p = 0.204). We found that LASIK treatment at an older age (> 55 years) resulted in almost the same safety outcomes as a LASIK treatment at a younger age (30-40 years) but with a lower efficacy; the efficacy correlated with the patient's age. If the patient was hyperopic, their age did not influence safety or efficacy., (© 2024. The Author(s).)
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- 2024
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20. Refractive Outcome of Femtosecond Assisted Laser<em> in situ</em> Keratomileusis in 1564 cases of Myopia and Compound Myopic Astigmatism.
- Author
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Humayun S, Ishaq M, Fawad A, and Arzoo S
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- Humans, Refraction, Ocular, Vision Tests, Keratomileusis, Laser In Situ, Astigmatism surgery, Myopia surgery
- Abstract
Objective: To determine the outcomes of Femtosecond Assisted Laser in situ Keratomileusis (Femto LASIK) on eyes with myopia and compound myopic astigmatism in terms of efficacy, safety, accuracy, predictability, and stability of the procedure., Study Design: Quasi-experimental study. Place and Duration of the Study: Refractive Surgical Department, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan, from January 2014 to August 2019., Methodology: Participants aged 18 years and above with upto -12D (dioptre of myopia, underwent preoperative detailed work-up with history, ocular examination, subjective refraction and assessment on topography, tomography, and aberrometry. Suitable candidates underwent Femto LASIK and were re-evaluated at 1st postoperative day, end of 1st week, 1 month, 3 months, 6 months and 1 year. Results were analysed and represented in form of standard graphs for refractive surgery. Results: Postoperative UDVA (uncorrected distance visual acuity) of 20/40 was achieved in 99% of patients. Efficacy index was 1.02 + 0.15. Safety index was 1.04 + 0.199. None of the patients lost more than one line in postoperative CDVA (corrected distance visual acuity) when compared to preoperative CDVA. All the eyes (100%) were accurately treated within +1.0 DS of intended spherical equivalent (SEQ) range. Mean SEQ showed stability with 1% eyes recorded to have more than 0.5D change or more over 12 months., Conclusion: Femto LASIK is an effective, safe, accurate, predictable, and stable procedure for correction of myopia and compound myopic astigmatism., Key Words: Femtosecond, Laser in situ Keratomileusis, Refractive surgery, Myopia, Compound myopic astigmatism, Uncorrected distance visual acuity.
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- 2024
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21. Factors Predicting Slow Visual Recovery Following Hyperopic LASIK.
- Author
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Safir M, Sorkin N, Kaiserman I, Sela T, Munzer G, Spierer O, and Mimouni M
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- Humans, Female, Adult, Middle Aged, Male, Refraction, Ocular, Visual Acuity, Postoperative Period, Keratomileusis, Laser In Situ, Hyperopia surgery
- Abstract
Purpose: To identify factors predicting slow visual recovery following hyperopic laser in situ keratomileusis (LASIK)., Methods: The study included consecutive patients who underwent hyperopic LASIK between January 2005 and December 2019 at a single medical center. Patients were divided into two groups according to whether they experienced normal recovery of visual acuity (1-week visit) or slow visual recovery (1-month visit). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected distance visual acuity / preoperative corrected distance visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery., Results: Overall, 861 eyes of 861 patients were included. Mean age was 48.0 ± 9.5 years and 55.9% were women. Two hundred forty-nine patients (28.9%) experienced slow visual recovery. Younger age ( P = .01), a larger preoperative spherical equivalence ( P = .002), and greater maximum ablation depth ( P = .002) were predictors of slow visual recovery. In binary logistic regression, female gender ( P = .036) and greater spherical equivalence ( P = .007) remained significant predictors of slow visual recovery., Conclusions: Female gender and greater preoperative spherical equivalence were associated with slow visual recovery. Patients may be advised accordingly. [ J Refract Surg . 2024;40(1):e42-e47.] .
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- 2024
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22. Associations of Near Work, Time Outdoors, and Sleep Duration With Myopic Regression 5 Years After SMILE and FS-LASIK: A Cross-sectional Study.
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Xu Y, Han Y, Lv X, Li J, Zhai C, and Zhang F
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- Adult, Humans, Female, Cross-Sectional Studies, Sleep Duration, Keratomileusis, Laser In Situ, Myopia surgery, Surgical Wound
- Abstract
Purpose: To investigate the association of near work, time outdoors, and sleep duration with myopic regression 5 years after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) ., Methods: This cross-sectional study included patients who received SMILE or FS-LASIK at Beijing Tongren Hospital 5 years ago. The patients underwent ophthalmic examinations including visual acuity, intraocular pressure, subjective refraction, slit-lamp examination, keratometry, corneal topography, optical coherence tomography, and fundus examination from January 2020 to March 2023. Fluorescein break-up time was measured and the Ocular Surface Disease Index questionnaire was completed to exclude dry eye. A self-administered questionnaire was used to collect data on near work exposure, physical activities, and sleep duration., Results: A total of 323 eyes were included in the analysis, with a 5-year incidence rate of myopic regression after SMILE or FSLASIK of 16.1%. After adjusted for all confounders, total near work more than 8 hours/day revealed a significant association with myopic regression (odds ratio: 2.461; 95% CI: 1.143 to 5.298, P = .021), particularly in younger adults, women, and patients with high myopia and FS-LASIK treatment. The significant association between sleep duration 8 hours/day or more and myopic regression was restricted to women and patients with FS-LASIK (near significant). However, no significant associations were observed between continuous near work or time outdoors and myopic regression., Conclusions: Excessive near work exposure was associated with greater myopic regression 5 years after SMILE or FS-LASIK. It is crucial to maintain good visual behavior and care for preventing regression after SMILE or FS-LASIK, especially for younger patients and eyes with high myopia. [ J Refract Surg . 2024;40(1):e10-e19.] .
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- 2024
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23. [Uncommon treatment options for epithelial ingrowth after laser lenticule extraction].
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Früh T, Linke SJ, and Steinberg J
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- Lasers, Corneal Stroma, Keratomileusis, Laser In Situ
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- 2024
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24. Cataract surgery after corneal refractive surgery: preoperative considerations and management.
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Ting DSJ, Gatinel D, and Ang M
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- Humans, Lens Implantation, Intraocular methods, Refraction, Ocular, Biometry methods, Optics and Photonics, Retrospective Studies, Lenses, Intraocular, Presbyopia surgery, Myopia surgery, Keratomileusis, Laser In Situ, Cataract
- Abstract
Purpose of Review: Corneal refractive surgery (CRS) is one of the most popular eye procedures, with more than 40 million cases performed globally. As CRS-treated patients age and develop cataract, the number of cases that require additional preoperative considerations and management will increase around the world. Thus, we provide an up-to-date, concise overview of the considerations and outcomes of cataract surgery in eyes with previous CRS, including surface ablation, laser in-situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE)., Recent Findings: Challenges associated with accurate biometry in eyes with CRS have been mitigated recently through total keratometry, ray tracing, intraoperative aberrometry, and machine learning assisted intraocular lens (IOL) power calculation formulas to improve prediction. Emerging studies have highlighted the superior performance of ray tracing and/or total keratometry-based formulas for IOL power calculation in eyes with previous SMILE. Dry eye remains a common side effect after cataract surgery, especially in eyes with CRS, though the risk appears to be lower after SMILE than LASIK (in the short-term). Recent presbyopia-correcting IOL designs such as extended depth of focus (EDOF) IOLs may be suitable in carefully selected eyes with previous CRS., Summary: Ophthalmologists will increasingly face challenges associated with the surgical management of cataract in patients with prior CRS. Careful preoperative assessment of the ocular surface, appropriate use of IOL power calculation formulas, and strategies for presbyopia correction are key to achieve good clinical and refractive outcomes and patient satisfaction. Recent advances in CRS techniques, such as SMILE, may pose new challenges for such eyes in the future., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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25. Pilocarpine HCl 1.25% for treatment of presbyopia after laser vision correction: pooled analysis of two phase 3 randomized trials (GEMINI 1 and 2).
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Lievens CW, Hom MM, McLaurin EB, Yuan J, Safyan E, and Liu H
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- Adult, Humans, Pilocarpine therapeutic use, Refraction, Ocular, Lasers, Excimer therapeutic use, Prospective Studies, Treatment Outcome, Randomized Controlled Trials as Topic, Presbyopia surgery, Myopia surgery, Photorefractive Keratectomy, Keratomileusis, Laser In Situ
- Abstract
Purpose: To evaluate the efficacy of topical pilocarpine HCl 1.25% (Pilo) in treating presbyopia in individuals with or without a history of laser vision correction (laser-assisted in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK])., Setting: Multiple clinical sites., Design: Pooled analysis of 2 identically designed prospective, randomized, vehicle-controlled studies (GEMINI 1 and 2)., Methods: Adults aged 40 to 55 years with presbyopia received once-daily Pilo or vehicle bilaterally for 30 days. Responder rates for ≥3-line improvement in mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) were determined on day 30., Results: Among participants with a history of LASIK/PRK (n = 39 in the Pilo group, n = 41 in the vehicle group), responder rates for ≥3-line improvement in DCNVA on day 30 at hours 0.25, 0.5, 1, 3, 6, 8, and 10, respectively, were 16.7%, 38.9%, 41.7%, 37.8%, 16.2%, 13.9%, and 8.3% with Pilo and 0.0%, 2.6%, 10.5%, 5.1%, 7.7%, 2.6%, and 0.0% with vehicle. Responder rates in the LASIK/PRK subgroup were significantly higher with Pilo than vehicle at hours 0.25 ( P = .0087), 0.5 ( P = .0001), 1 ( P = .0022), and 3 ( P = .0005). In contrast, there were no significant differences in responder rates between Pilo-treated participants with and without LASIK/PRK. Among non-LASIK/PRK participants in the Pilo group (n = 336), responder rates for ≥3-line improvement in DCNVA on day 30 at hours 0.25, 0.5, 1, 3, 6, 8, and 10, respectively, were 16.8%, 32.7%, 39.0%, 28.0%, 17.4%, 12.6%, and 10.5%., Conclusions: Pilo treatment effectively and similarly improved DCNVA in presbyopes with or without a history of laser vision correction., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS.)
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- 2024
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26. Corneal suture for acute corneal hydrops secondary to post-LASIK ectasia: a case report.
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Diniz, Daniel, Xavier Andrade, Fábio Mendonça, Chamon, Wallace, and Allemann, Norma
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EDEMA ,LASIK ,HYDROPS fetalis ,SUTURES ,HYPEROPIA - Abstract
Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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27. LASIK excimer misfire on fluence test mode: induced refractive error quantification and corneal ablation profile
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Priyanka Prasad, Avilasha Mohapatra, Sudarshan Khokhar, and Amber Amar Bhayana
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Refractive error ,Excimer laser ,business.industry ,medicine.medical_treatment ,Keratomileusis, Laser In Situ ,LASIK ,Corneal Topography ,Keratomileusis ,General Medicine ,medicine.disease ,Excimer ,Refractive Errors ,Fluence ,Corneal ablation ,Cornea ,Optics ,Refractive surgery ,medicine ,Myopia ,Humans ,Lasers, Excimer ,business - Abstract
A 23-year-old man with refractive error as in [figure 1A][1] was planned for LASIK (Laser assisted in-situ keratomileusis) refractive surgery (ZEISS MEL 90). After flap preparation, the subject was accidentally fired on by excimer laser at fluence test settings[1][2] instead of that for the
- Published
- 2023
28. Regional Changes in Posterior Corneal Surface During a 6-Month Follow-up Period After tPRK, FS-LASIK, and SMILE
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Jie, Wu, JinFang, Wu, SongAn, Wu, DaTian, Zhu, YuanYuan, Miao, ChengYi, Huang, Stephen, Akiti, Riccardo, Vinciguerra, XinYu, Zhang, PeiPei, Zhang, XiaoBo, Zheng, JunJie, Wang, QinMei, Wang, ShiHao, Chen, YiYu, Li, YuFeng, Ye, FangJun, Bao, and Ahmed, Elsheikh
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Ophthalmology ,Corneal Wavefront Aberration ,Corneal Stroma ,Keratomileusis, Laser In Situ ,Surgical Wound ,Myopia ,Visual Acuity ,Humans ,Lasers, Excimer ,Surgery ,Photorefractive Keratectomy ,Follow-Up Studies - Abstract
PURPOSE: To investigate changes in corneal curvature in different zones of the posterior corneal surface during a 6-month follow-up period after transepithelial photorefractive keratectomy (tPRK), femtosecond laser–assisted excimer laser in situ keratomileusis (FS-LASIK), and small incision lenticule extraction (SMILE). METHODS: The study included a total of 202 eyes, including 65, 77, and 60 that underwent tPRK, FS-LASIK, and SMILE, respectively. Elevation data for the posterior surface were obtained preoperatively (pre), as well as 1 week (pos1w), 1 month (pos1m), 3 months (pos3m), and 6 months (pos6m) postoperatively. Changes in posterior corneal curvature (M) were analyzed in the central (diameter: 0 to 3 mm), paracentral (diameter: 3 to 6 mm), and peripheral (diameter: 6 to 9 mm) regions. RESULTS: Over all follow-up periods, the central region of the posterior surface in all patients became flatter ( P < .05), with FS-LASIK showing the largest change, whereas the paracentral and peripheral regions became steeper. The posterior curvature changes between pre and pos6m, determined before and after correction for ablated stromal depth, tended to follow similar trends in the three regions and after the three surgeries. There was also no significant correlation ( P > .05) between the changes in the mean curvature (M, recorded between pre and pos6m) and each of the refractive error corrections, the changes in spherical aberration postoperatively, the optical zone diameter, ablated stromal depth, and residual stromal bed thickness in the central and peripheral regions, but the correlation was significant in the paracentral region. CONCLUSIONS: The postoperative changes in posterior corneal shape followed different trends in the central, paracentral, and peripheral regions. The FS-LASIK group exhibited the most notable changes in posterior corneal curvature, especially in the central region. These changes were statistically correlated with variations in spherical aberration, and ablated and residential stromal thickness in the paracentral region. [ J Refract Surg . 2022;38(11):708–715.]
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- 2022
29. Comparison Between the Wavefront-Optimized and Custom-Q Aspheric Ablation Profiles in Myopic Eyes With Two Different Q-targets: A Contralateral Eye Study
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Timoteo González-Cruces, Alberto Villarrubia, Álvaro Sánchez Ventosa, Elisa Palacín Miranda, Rosa Castillo Eslava, Aurora Gomera Martinez, José Alberto García Párrizas, Pablo Torres Huelva, Jose María Sánchez-González, and Antonio Cano-Ortiz
- Subjects
Ophthalmology ,Treatment Outcome ,Keratomileusis, Laser In Situ ,Visual Acuity ,Myopia ,Humans ,Lasers, Excimer ,Surgery ,Refraction, Ocular - Abstract
PURPOSE: To compare two aspheric ablation profiles in myopic refractive surgery using different asphericity targets. METHODS: Patients underwent laser in situ keratomileusis (LASIK) with the WaveLight EX500 laser platform (Alcon, WaveLight Laser Technologie). Asymmetric surgery was performed, programming the wavefront-optimized (WFO) ablation profile in one eye and the custom-Q (CQ) profile in the contralateral eye. The patients were divided into two groups following a systematic randomization method. The Q-target programmed for the preoperative Q group was equal to the preoperative asphericity of the CQ profile, and for the −0.6 Q-target group, the Q-target was set to −0.6. RESULTS: The study included 100 patients (200 eyes). Both groups had comparable safety and efficacy indexes greater than 1. A similar oblate shift in postoperative asphericity was seen in both groups regardless of the ablation profile and programmed Q-target. Asphericity was 0.33 ± 0.34 and 0.35 ± 0.29 ( P = .18) in the preoperative Q group and 0.26 ± 0.28 and 0.26 ± 0.27 ( P = .89) in the −0.6 Q-target group for WFO and CQ, respectively. A lower spherical aberration was found with CQ compared to WFO when the Q-target was set to −0.6: 0.211 ± 0.121 versus 0.144 ± 0.114 ( P < .01). However, no statistically significant differences were found when the preoperative Q-target was used. CONCLUSIONS: WFO and CQ treatments are similar in terms of refractive and visual outcomes. CQ offers greater control over the increase in positive spherical aberration after myopic refractive surgery, but it does not represent an advantage over WFO in the oblate shift in postoperative asphericity regardless of the Q-target programmed. [ J Refract Surg . 2022;38(11):698–707.]
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- 2022
30. Ectasia Risk Model: A Novel Method Without Cut-off Point Based on Artificial Intelligence Improves Detection of Higher-Risk Eyes
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Marcony R, Santhiago, Daniella C, Araujo, Larissa R, Stival, David, Smadja, and Adriano A, Veloso
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Cornea ,Ophthalmology ,Postoperative Complications ,Artificial Intelligence ,Case-Control Studies ,Keratomileusis, Laser In Situ ,Humans ,Corneal Topography ,Surgery ,Dilatation, Pathologic ,Retrospective Studies - Abstract
PURPOSE: To develop a new ectasia risk model through artificial intelligence (AI) and machine learning, enabling the creation of an integrated method without a cut-off point per risk factor, and subsequently better at differentiating patients at higher risk of ectasia with normal topography. METHODS: This comparative case-control study included 339 eyes with normal preoperative topography, with 65 eyes that developed ectasia after laser in situ keratomileusis (ectasia group) and 274 eyes that did not develop ectasia (control group). The AI model used known risk factors to engineer 14 additional ones, totaling 20 features. In this methodology, no variable is used in isolation because its cut-off point is never considered. All separation between cases and controls is made through the interaction detected by the machine learning model that gathers the variables considered relevant. The ability to correctly separate ectatic cases identified as high risk, ectatic cases wrongly classified as low risk, and controls were illustrated by the diagram t-distributed stochastic neighbor embedding (t-SNE). RESULTS: Only two original variables (percent tissue altered and corneal thickness) and two derived from the feature engineering process (derivative percent tissue altered and age weighted value) were selected by the final AI model (ie, best performing AI-based model to separate patients at higher risk). The t-SNE visualization demonstrated the greater ability to differentiate between patients considered at risk by the AI-based model, without a cut-off point, compared to all other methods used alone ( P < .0001). CONCLUSIONS: This study describes a new AI-based model that integrates different risk factors without a cut-off point, increasing the number of cases correctly identified as at higher risk. [ J Refract Surg . 2022;38(11):716–724.]
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- 2022
31. Effect of corneal epithelial remodeling on visual outcomes of topography-guided femtosecond LASIK
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Solin, Saleh, Liam J, Epp, and Edward E, Manche
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Adult ,Adolescent ,Keratomileusis, Laser In Situ ,Refraction, Ocular ,Sensory Systems ,Cornea ,Young Adult ,Ophthalmology ,Treatment Outcome ,Myopia ,Humans ,Lasers, Excimer ,Surgery ,Prospective Studies - Abstract
To assess the effect of epithelial remodeling on visual outcomes over a 9 mm diameter corneal surface after topography-guided laser in situ keratomileusis (LASIK) for myopia correction using spectral-domain anterior segment optical coherence tomography (AS-OCT).Outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California.Prospective nonrandomized observational study.Visual acuity, including uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), 5% and 25% contrast sensitivity CDVA, manifest refraction, and corneal epithelial thickness after topography-guided femtosecond LASIK were analyzed. Corneal epithelial thickness was mapped across 13 sections and 3 concentric zones using AS-OCT preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively.60 eyes of 30 patients with a mean age of 32.8 years (range 23 to 52 ± 7.03 years) undergoing myopic LASIK correction were assessed. In eyes with complete follow-up data (n = 30), mean preoperative UDVA was logMAR 1.48 ± 0.45 and logMAR -0.11 ± 0.08 at postoperative 12 months. Mean preoperative CDVA was logMAR -0.08 ± 0.11 and logMAR -0.13 ± 0.07 at 12 months. Linear mixed modeling demonstrated a significant correlation between improvement in UDVA and decreased superior and nasal corneal epithelial thickness and between improvement in CDVA and increased central epithelial thickness 12 months postoperatively.Improvement in UDVA and CDVA at 12 months after topography-guided femtosecond LASIK was correlated with nonuniform epithelial remodeling, including epithelial thickening in the central zone and thinning in the superior and nasal sections as measured by AS-OCT.
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- 2022
32. Posterior chamber toric implantable collamer lenses vs LASIK for myopia and astigmatism: systematic review
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Stéphanie Goes and Heleen Delbeke
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Lenses, Intraocular ,Phakic Intraocular Lenses ,Ophthalmology ,Treatment Outcome ,Lens Implantation, Intraocular ,Keratomileusis, Laser In Situ ,Myopia ,Visual Acuity ,Astigmatism ,Humans ,Surgery ,Refraction, Ocular ,Sensory Systems - Abstract
This systematic review compares the visual and refractive outcome of laser in situ keratomileusis with (toric) implantable collamer lens (ICL) in the treatment of myopic astigmatism. An electronic literature search led to 19 comparative articles. Refractive outcome, efficacy, safety, predictability, and stability as well as differences in contrast sensitivity and higher-order aberrations (HOAs) were analyzed for moderate (-3 to -6 diopters [D]) and high (≥-6 D) myopia. Results were either significantly in favor of (toric)-ICL or equal. Fewer HOAs and better contrast sensitivity after (toric)-ICL seem to be the largest asset in its refractive and clinical superiority. However, longer follow-up studies are indicated, specifically for systematically comparing long-term adverse effects.
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- 2022
33. Corneal Sensitivity and Patient-Reported Dry Eye Symptoms in a Prospective Randomized Contralateral-Eye Trial Comparing Laser In Situ Keratomileusis and Small Incision Lenticule Extraction
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Kevin K. Ma and Edward E. Manche
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Cornea ,Ophthalmology ,Corneal Stroma ,Keratomileusis, Laser In Situ ,Humans ,Dry Eye Syndromes ,Lasers, Excimer ,Patient Reported Outcome Measures ,Prospective Studies - Abstract
To prospectively compare corneal sensation and patient-reported symptoms of dry eye in individuals undergoing laser in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE).Prospective randomized contralateral-eye clinical trial.80 eyes of 40 patients with myopia at Byers Eye Institute at Stanford University were randomized to receive wavefront-guided femtosecond LASIK in one eye and SMILE in the fellow eye. Cochet-Bonnet esthesiometry was performed to assess corneal sensitivity preoperatively and at the 1-, 3-, 6-, and 12-month postoperative visits. Participants also completed questionnaires at each visit to determine the Ocular Surface Disease Index (OSDI).Eyes that underwent LASIK compared to SMILE demonstrated more corneal denervation at the postoperative 1-month (mean 2.1 vs 3.6 cm, P.001), 3-month (3.5 vs 5.4 cm, P.001), and 6-month (4.7 vs 5.7 cm, P.001) visits. At the 12-month visit, both groups had returned to baseline corneal sensitivity (5.9 vs 5.9 cm, P = .908). There was no difference in OSDI between the 2 groups at any visit. Mean OSDI improved from the preoperative to the postoperative 12-month visit in both LASIK (15.3 to 8.6, P = .020) and SMILE (15.1 to 9.5, P = .029) groups.LASIK resulted in greater corneal denervation compared to SMILE in the early postoperative period, though this difference was no longer apparent after 12 months. Despite this, there was no difference in self-reported dry eye symptoms between the 2 groups. Patient-reported dry eye symptoms improved after both LASIK and SMILE procedures.
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- 2022
34. Determining the Utility of Epithelial Thickness Mapping in Refractive Surgery Evaluations
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Lara Asroui, William J. Dupps, and J. Bradley Randleman
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Cornea ,Ophthalmology ,Keratomileusis, Laser In Situ ,Myopia ,Visual Acuity ,Humans ,Lasers, Excimer ,Photorefractive Keratectomy - Abstract
To determine the impact of corneal epithelial thickness maps on screening for refractive surgery candidacy in a single refractive surgical practice.Comparison of screening methods.A total of 100 consecutive patients who presented for refractive surgery screening were evaluated. For each patient, screening based on Scheimpflug tomography, clinical data, and patient history was performed and a decision on eligibility for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE)was independently made by 2 masked examiners. Examiners were then shown patients' epithelial thickness maps derived from optical coherence tomography (OCT). The percentage of screenings that changed after evaluating the epithelial thickness maps, with regard to candidacy for surgery, and ranking of surgical procedures from most to least favorable was determined.Candidacy for corneal refractive surgery changed in 16% of patients after evaluation of the epithelial thickness maps, with 10% of patients screened in and 6% screened out. Surgery of choice changed for 16% of patients, and the ranking of surgical procedures from most to least favorable changed for 25% of patients. A total of 11% of patients gained eligibility for LASIK, whereas 8% lost eligibility for LASIK. No significant difference was found between the evaluations of the 2 examiners.Epithelial thickness mapping derived from optical coherence tomography imaging of the cornea altered candidacy for corneal refractive surgery, as well as choice of surgery, in a substantial percentage of patients in our practice, and was thus a valuable tool for screening evaluations. Overall, the use of epithelial thickness maps resulted in screening in a slightly larger percentage of patients for corneal refractive surgery.
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- 2022
35. IOL power calculations after LASIK or PRK: Barrett True-K biometer-only calculation strategy yields equivalent outcomes as a multiple formula approach
- Author
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Tanner J, Ferguson, Rachel A, Downes, and J Bradley, Randleman
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Lenses, Intraocular ,Optics and Photonics ,Ophthalmology ,Biometry ,Phacoemulsification ,Lens Implantation, Intraocular ,Keratomileusis, Laser In Situ ,Humans ,Surgery ,Refraction, Ocular ,Refractive Errors ,Sensory Systems ,Retrospective Studies - Abstract
To compare the accuracy of intraocular lens (IOL) power calculations performed using the biometer-embedded Barrett True-K formula vs a multiple formula approach using the ASCRS postrefractive calculator in eyes with previous myopic or hyperopic refractive surgery.Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.Retrospective, consecutive case series.Patients who underwent cataract surgery with a history of corneal refractive surgery were included. For each formula, the IOL prediction error and refractive prediction error was calculated. Main outcome measures included mean absolute error (MAE) and the percentage of eyes within ±0.25 diopters (D), ±0.50 D, and ±1.00 D.96 postmyopic eyes and 47 posthyperopic eyes were analyzed. In the postmyopic cohort, the Barrett True-K formula had the lowest MAE (0.36 D), followed by the Haigis-L formula (0.41 D). The Barrett True-K formula had a significantly higher percentage (44.8%) of eyes within ±0.25 D in comparison with the Haigis-L formula (34.4%), which had the second highest percentage ( P.01). In the posthyperopic cohort, the Barrett True-K formula had the lowest MAE (0.41 D), followed by the ASCRS-mean (0.46). The Barrett True-K and ASCRS-mean formulas had the highest percentage of eyes within ±0.25 D (42.6% vs 38.3%, P = .16).The Barrett True-K formula built into the biometer performed equivalently to a multiple formula approach on the ASCRS online calculator in both postmyopic and posthyperopic eyes. This approach reduces the potential for transcription error from data entry for lens power calculation approaches that require manual data entry.
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- 2022
36. Laser corneal enhancement after trifocal intraocular lens implantation in eyes that previously had photoablative corneal refractive surgery
- Author
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Javier L. Fernández-García, Felix Gonzalez-Lopez, Fernando Mayordomo-Cerdá, Fernando Llovet-Osuna, Julio Ortega-Usobiaga, Rafael Bilbao-Calabuig, and Rosario Cobo-Soriano
- Subjects
medicine.medical_specialty ,Distance visual acuity ,genetic structures ,medicine.medical_treatment ,Keratomileusis, Laser In Situ ,Intraocular lens ,Prosthesis Design ,Refraction, Ocular ,Near visual acuity ,law.invention ,Lens Implantation, Intraocular ,law ,Ophthalmology ,Refractive surgery ,Myopia ,medicine ,Humans ,Retrospective Studies ,Lenses, Intraocular ,business.industry ,Lasers ,Laser ,eye diseases ,Sensory Systems ,Hyperopia ,Intermediate visual acuity ,Patient Satisfaction ,Surgery ,sense organs ,Previously treated ,business - Abstract
To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS).Clinica Baviera-AIER-Eye Group, Spain.Retrospective comparative case series.Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement.186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P.001), cylinder ( P.001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P.05 all items).Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.
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- 2022
37. Accuracy of the Preoperative Predicted Percentage of Tissue Altered Calculation in Refractive Surgery Planning for Myopic LASIK
- Author
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David, Smadja, Michael, Mimouni, Avi, Shoshani, Igor, Kaiserman, Itay, Lavy, and Marcony R, Santhiago
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Ophthalmology ,Keratomileusis, Laser In Situ ,Myopia ,Humans ,Reproducibility of Results ,Surgery ,Surgical Flaps ,Retrospective Studies - Abstract
PURPOSE: To determine the reliability of the percentage of tissue altered (PTA) calculation as part of the planning strategy for myopic laser in situ keratomileusis (LASIK) by comparing the estimated PTA provided by preoperative calculation to the postoperative PTA actually achieved in microkeratome-assisted myopic LASIK. METHODS: This retrospective study included 3,624 eyes of 3,624 patients who underwent mechanical microkeratome-assisted LASIK surgery for myopic correction. The calculated preoperative PTA values based on the planned flap thickness and ablation depth were compared with the actual achieved postoperative PTA using the difference of corneal central thickness postoperatively for assessing the achieved ablation depth and the intraoperative ultrasound-assisted flap thickness measurement. Regression analysis was performed to reveal preoperative parameters that might influence PTA calculation accuracy. RESULTS: The mean difference between the estimated and achieved PTA was 0.451 ± 3.45% ( P < .001) (95% CI: 0.3708 to 0.5322) with a preoperative and postoperative mean PTA of 31.07 ± 4.07% and 31.52 ± 5.78%, respectively. The differences between the achieved and planned maximum ablation depth and flap thickness were 4.32 ± 13.70 µm ( P < .001) and −1.61 ± 13.66 µm ( P < .001), respectively. CONCLUSIONS: Although a statistically significant difference was found between the preoperative calculated PTA and actually achieved PTA, the difference in PTA value (less than 1%) was clinically non-significant and indicated a highly reliable metric for preoperative refractive surgery planning. [ J Refract Surg . 2022;38(7):422–427.]
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- 2022
38. Personalized wavefront-guided ablation after complication in FemtoLasik lamella dissection
- Author
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Saito, Marina Siqueira, Soares, Paula Virginia Brom dos Santos, Barboza, Guilherme Novoa Colombo, Barboza, Marcello Novoa Colombo, Torricelli, André Augusto Miranda, and Moscovici, Bernardo Kaplan
- Subjects
Lasers, excimer ,Keratomileusis, laser in situ ,Cirurgia refrativa ,Ceratomileuse assistida por excimer laser in situ ,Refractive surgery ,Lasers de Excimer ,Femtolasik - Abstract
RESUMO O FemtoLasik é uma das técnicas mais empregadas em cirurgia refrativa, por seus bons resultados refracionais, sua previsibilidade, sua reprodutibilidade e sua segurança. Tem alto grau de satisfação, com rápida recuperação visual. Apesar de as taxas de complicações do FemtoLasik serem pequenas, intercorrências podem existir. O objetivo deste trabalho foi relatar um caso de uma complicação na dissecção da lamela por Lasik com laser de femtossegundo com consequente rasgadura da lamela, sendo aplicado Excimer Laser com mitomicina C 0,02%. O retratamento foi realizado com ablação de superfície (ceratectomia fotorrefrativa) guiada por frente de onda, evoluindo com boa qualidade visual final. ABSTRACT Femtolasik is one of the most used techniques in refractive surgery due to good refractive results, predictability, reproducibility, and safety, achieving excellent results and a high degree of satisfaction. Although the complication rates are small, it is worth noting that there may be intercurrences. The objective of this work is to report a case of complication in the dissection of the lamella of laser in situ keratomileusis (Lasik) with Femtosecond laser, and subsequent lamella tear. Excimer Laser was applied with mitomycin 0.02% and re-approached with wavefront guided surgery, evolving with good final visual quality.
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- 2023
39. Acute interface fluid syndrome after laser in situ keratomileusis in a case of cytomegalovirus (CMV) endotheliitis and secondary glaucoma
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Somasheila I Murthy, Kavya Chandran, Joveeta Joseph, and Sayali Tendolkar
- Subjects
Intraocular pressure ,medicine.medical_specialty ,genetic structures ,medicine.medical_treatment ,Keratomileusis, Laser In Situ ,Congenital cytomegalovirus infection ,Glaucoma ,Cytomegalovirus ,Eye Infections, Viral ,Keratomileusis ,Case Report ,Aqueous Humor ,03 medical and health sciences ,0302 clinical medicine ,Ophthalmology ,Medicine ,Trabeculectomy ,Humans ,Endotheliitis ,Intraocular Pressure ,business.industry ,Aqueous humour ,General Medicine ,medicine.disease ,Uveitis, Anterior ,eye diseases ,Cytomegalovirus Infections ,DNA, Viral ,030221 ophthalmology & optometry ,Etiology ,sense organs ,business ,030217 neurology & neurosurgery - Abstract
Cytomegalovirus (CMV) can cause recalcitrant recurrent keratouveitis and secondary glaucoma. We report a case of chronic recurrent anterior uveitis with secondary glaucoma presenting with acute visual loss and interface fluid 9 years after laser in situ keratomileusis. Based on clinical presentation, a viral aetiology was suspected. Aqueous tap was positive for CMV-DNA by real-time quantitative PCR of the aqueous humour. The patient was treated with systemic antivirals, topical corticosteroids and antiglaucoma medications. The interface fluid resorbed rapidly. The intraocular pressure (IOP) was controlled by trabeculectomy. There was no further corneal deterioration at 7-month follow-up and the IOP had also stabilised. We believe this is only the third reported case of CMV-related interface fluid syndrome. This case highlights the role of quantitative PCR analysis for establishing viral aetiology in recurrent unilateral hypertensive anterior uveitis and reports the unusual finding of interface fluid which resolved after starting systemic antiviral therapy.
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- 2023
40. Late Spontaneous Postradial Keratotomy Corneal Perforation After Scleral Contact Lens Use—Case Report
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Sarah La Porta, Weber, Bianca Carneiro de Melo, Jorge, Ana Beatriz Gurgel, Mourão, and Ana Luisa, Hofling-Lima
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Male ,Cornea ,Ophthalmology ,Corneal Perforation ,Contact Lenses ,Keratomileusis, Laser In Situ ,Surgical Wound ,Humans ,Middle Aged ,Keratotomy, Radial - Abstract
To describe a case of late spontaneous postradial keratotomy corneal perforation after scleral contact lens (SCL) wear for optic correction.Tertiary referral center for corneal pathology.Case report.A 64-year-old man presented the consequences of a late radial keratotomy (RK) surgery performed for myopia correction 26 years ago. His ophthalmologic history was a RK in both eyes (BE), previous Lasik surgery in BE and Lasik enhancement in the right eye (RE), and pterygium excision with conjunctival transplantation in RE. To improve visual acuity, SCL were fitted in both eyes. After 8 months of use, on a certain day, when removing the lens from the RE, the patient reported experiencing intense eye pain and reduced visual acuity. On ophthalmologic examination, the RE cornea was perforated in one of the previous RK incisions. An urgent corneal transplant was performed in the RE, followed by cataract surgery in the same eye.Corneal instability caused by RK scars and daily manipulation with the SCL use may have led to ocular perforation.
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- 2022
41. Visual and Refractive Outcomes Following Laser Blended Vision With Non-linear Aspheric Micro-anisometropia (PRESBYOND) in Myopic and Hyperopic Patients
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Andrea Russo, Dan Z. Reinstein, Ottavia Filini, Timothy J. Archer, Alessandro Boldini, Gloria Cardin, Giulia Festa, Francesco Morescalchi, Chiara Salvalai, and Francesco Semeraro
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Anisometropia ,Corneal Topography ,Humans ,Hyperopia ,Keratomileusis, Laser In Situ ,Lasers, Excimer ,Middle Aged ,Myopia ,Presbyopia ,Refraction, Ocular ,Retrospective Studies ,Treatment Outcome ,Lasers ,Refraction ,Ophthalmology ,Excimer ,Ocular ,Surgery ,Laser In Situ ,Keratomileusis - Abstract
PURPOSE: To report 6-month visual and refractive outcomes following PRESBYOND Laser Blended Vision (Carl Zeiss Meditec) treatment using non-linear aspheric micro-anisometropia laser in situ keratomileusis (LASIK) for the correction of myopic and hyperopic presbyopia. METHODS: A retrospective, non-comparative study of 139 consecutive patients with a mean age of 53.13 ± 5.84 years (range: 42 to 70 years) treated with LASIK-induced micro-anisometropia using the MEL 90 excimer laser and VisuMax femtosecond laser (both Carl Zeiss Meditec). The target refraction was plano for distance eyes (dominant eye) and between −0.50 and −1.50 diopters (D) for near eyes. Patients were observed for 6 months. RESULTS: A total of 278 eyes (78 myopic and 200 hyperopic) from 139 patients completed the study. Mean preoperative spherical equivalent (SE) was −3.40 ± 1.83 D (range: −0.50 to −8.25 D) for myopic eyes and +1.61 ± 0.98 D (range: −1.25 to +4.63 D) for hyperopic eyes. Mean postoperative SE refraction of distance eyes was +0.20 ± 0.35 D (range: −0.38 to +1.00 D) and −0.14 ± 0.42 D (range: −1.38 to +0.88 D) for myopic and hyperopic eyes, respectively. Mean postoperative SE refraction of near eyes was −0.90 ± 0.44 D (range: −0.13 to −2.25 D) and −1.21 ± 0.48 D (range: −0.13 to −2.25 D) for myopic and hyperopic eyes, respectively. Mean binocular uncorrected near visual acuity was 0.15 ± 0.16 logMAR (range: 0.00 to 0.50 logMAR) and 0.10 ± 0.15 logMAR (range: 0.00 to 0.60 logMAR) for myopic and hyperopic eyes, respectively. Mean binocular uncorrected distance visual acuity was -0.08 ± 0.09 logMAR (range: -0.10 to 0.20 logMAR) and -0.06 ± 0.12 logMAR (range: -0.10 to 0.40 logMAR) for myopic and hyperopic eyes, respectively. Stereoacuity was better than 100 seconds of arc in 79% of myopic eyes and 85% of hyperopic eyes and all vision quality scores were greater than 90 of 100. No eyes lost two or more lines. CONCLUSIONS: The non-linear aspheric micro-anisometropia protocol resulted in safe and effective visual outcomes in patients with both myopic and hyperopic presbyopia. [ J Refract Surg . 2022;38(5):288–297.]
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- 2022
42. Combined accelerated collagen crosslinking and sub-Bowman’s keratomileusis in high myopic eyes: a comparison between total ultraviolet energy dose
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Kelvin H, Wan, Tommy Cy, Chan, Peter Sk, Kwok, and Alex Lk, Ng
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Ophthalmology ,Photosensitizing Agents ,Ultraviolet Rays ,Keratomileusis, Laser In Situ ,Myopia ,Humans ,Lasers, Excimer ,Collagen ,General Medicine ,Refraction, Ocular ,Retrospective Studies - Abstract
To compare the safety, efficacy, and predictability outcomes of combined sub-Bowman's keratomileusis (thin flap laser in situ keratomileusis [LASIK]) and accelerated crosslinking (CXL) using two different irradiation durations.A retrospective comparative study of patients with percent tissue altered ≥35%, undergoing simultaneous CXL during sub-Bowman's keratomileusis were recruited. Following riboflavin application, they underwent ultraviolet-A (UVA) irradiation (18 mW/cmThe baseline characteristics were similar between the 40 eyes/patients treated using the 2-min protocol and the 33 eyes/patients treated with the 3-min protocol (A comparable volume of crosslinked corneal tissue can be achieved by using a shorter UVA irradiation duration. Additional duration of UVA irradiation could lead to delay in visual rehabilitation after simultaneous sub-Bowman's keratomileusis and CXL.
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- 2022
43. Efficacy and Safety of Surgically Managed Late Traumatic LASIK Flap Displacements in a Study of 66 Cases
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Yolanda Fernández-Barrientos, Julio Ortega-Usobiaga, Jaime Beltran-Sanz, Vasyl Druchkiv, José Luis Ramos-Navarro, and José Luis González-de-Gor-Crooke
- Subjects
Ophthalmology ,Postoperative Complications ,Treatment Outcome ,Corneal Stroma ,Keratomileusis, Laser In Situ ,Humans ,Surgery ,Surgical Flaps ,Retrospective Studies - Abstract
PURPOSE: To evaluate safety and efficacy in the management of flap displacement after laser in situ keratomileusis (LASIK) and subsequent complications. METHODS: This was a retrospective study performed using data recorded at the center's database from October 2002 to August 2021. Efficacy and safety were both converted to binary outcomes (loss of one or more lines and no change or gain in lines of visual acuity). The effects of time from surgery to complication and from complication to repair were assessed and the odds ratios and probabilities were calculated. The same procedure was applied to investigate the effect of these temporal variables on complications. RESULTS: A total of 66 eyes with late traumatic LASIK flap displacements were studied. Efficacy remained unchanged in 48 patients (64 eyes, 75%), and safety remained unchanged in 53 patients (59 eyes, 90%). Sixty-six patients (64 eyes, 100%) achieved visual acuity values of 20/40 and 45 patients (64 eyes, 70.3%) achieved values of 20/20. The flap displacement was resolved in the first 24 hours (SD ± 0.1 days). Surgery was performed in 58 patients (65 eyes, 90%). Epithelial ingrowth was the most frequent complication. Patients who underwent surgery tended not to lose lines ( P = .05). The risk of developing epithelial ingrowth increases with time after LASIK surgery until traumatic flap displacement (odds ratio: 1.001; P < .001). The prevalence of dislocation during the study period was 0.012%. CONCLUSIONS: Visual safety values were favorable after resolution of the flap complication. Immediate surgical management leads to better visual efficacy, and the time between LASIK and trauma increases the risk of epithelial ingrowth after flap displacement. [ J Refract Surg . 2022;38(4):270–276.]
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- 2022
44. Prediction accuracy of no-history intraocular lens formulas for a diffractive extended depth-of-focus intraocular lens after myopic corneal refractive surgery
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Qian, Tan, Yong, Wang, Libei, Zhao, Manqiang, Peng, Hansong, Zheng, and Ding, Lin
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Lenses, Intraocular ,Optics and Photonics ,Ophthalmology ,Biometry ,Phacoemulsification ,Lens Implantation, Intraocular ,Keratomileusis, Laser In Situ ,Myopia ,Humans ,Surgery ,Refraction, Ocular ,Sensory Systems ,Retrospective Studies - Abstract
To compare the accuracy of intraocular lens (IOL) calculation methods for extended depth-of-focus (EDoF) IOLs in eyes with a history of myopic laser-assisted in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) surgery lacking historical data.Changsha Aier Eye Hospital, Changsha, and Wuhan Aier Eye Hospital, Wuhan, China.Retrospective case series.Patients with axial lengths (ALs) ≥25.0 mm and a history of myopic LASIK/PRK surgery who underwent cataract surgery with implantation of EDoF IOLs were enrolled. A comparison was performed of the accuracy of 10 IOL methods lacking historical data, including Barrett True-K no history (Barrett TKNH), Haigis-L, Shammas, and Potvin-Hill formulas and average, minimum, and maximum IOL power on the ASCRS online postrefractive IOL calculator; Seitz/Speicher/Savini (Triple-S) formula; and Schuster/Schanzlin-Thomas-Purcell (SToP) formulas based on Holladay 1 and SRK/T formulas. IOL power was calculated with the abovementioned methods in 2 groups according to AL (Group 1: 25.0 mm ≤ AL28.0 mm and Group 2: AL ≥ 28.0 mm).64 eyes were included. Excellent outcomes were achieved with the minimum, Barrett TKNH, SToP (SRK/T), and Triple-S formulas in the whole sample and subgroups, which led to similar median absolute error, mean absolute error, and the percentage of eyes with a prediction error within ±0.5 diopters (D). In the whole sample, the Haigis-L and maximum formulas had a significantly higher absolute error than minimum, SToP (SRK/T), and Barrett TKNH formulas. The maximum formula also had a significantly lower percentage of eyes within ±0.5 D than the Barrett TKNH, and SToP (SRK/T) formulas (15.6% vs 50% and 51.5%, all P.05 with Bonferroni adjustment).Predicting the EDoF IOL power in postmyopic refractive eyes by no-history IOL formulas remains challenging. The Barrett TKNH, Triple-S, minimum, and SToP (SRK/T) formulas achieved the best accuracy when AL ≥ 25.0 mm, while the Barrett TKNH and SToP (SRK/T) formulas were recommended when AL ≥ 28.0 mm.
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- 2022
45. Topography-Guided FS-LASIK With PAE Algorithm and Sirius Tomography Data for Correction of Myopia and Myopic Astigmatism
- Author
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Yifei, Yuan, Yu, Zhang, Tong, Sun, Xiaoxiao, Sun, Xiaorui, Zhao, and Yueguo, Chen
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Ophthalmology ,Treatment Outcome ,Keratomileusis, Laser In Situ ,Myopia ,Astigmatism ,Corneal Topography ,Humans ,Lasers, Excimer ,Surgery ,Refraction, Ocular ,Tomography ,Algorithms ,Retrospective Studies - Abstract
PURPOSE: To compare the clinical outcomes after topography-guided and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) planned with the Phorcides Analytic Engine (PAE) algorithm system and Sirius tomography data for correction of myopia and myopic astigmatism when the ocular residual astigmatism (ORA) was great or not. METHODS: In this retrospective study, a total of 163 eyes with myopia and myopic astigmatism (99 patients) were included. Eyes with myopic astigmatism and high ORA of 0.75 diopters (D) or greater were assigned to the high ORA group and the others to the low ORA group. All surgeries were performed by topography-guided FS-LASIK planned with a PAE algorithm system. PAE took anterior and posterior corneal negative cylinder of the 5-mm zone from the Sirius combined topography and tomography. Refractive and visual outcomes, vector analysis, and corneal aberrations were compared between the two groups. RESULTS: At 6 months postoperatively, the uncorrected distance visual acuity of 20/16 or better was measured in 59% of eyes in the high ORA group and 66% of eyes in the low ORA group ( P = .307). Postoperative corrected distance visual acuity, manifest refractive spherical equivalent, refractive astigmatism, target induced astigmatism, surgically induced astigmatism, and difference vector were similar between the two groups ( P > .05). The postoperative corneal astigmatism was significantly higher in the high ORA group ( P = .008), and the high ORA group over-corrected astigmatism with the rule and showed a higher correction index ( P = .003) compared with the low ORA group. CONCLUSIONS: Topography-guided FS-LASIK with PAE algorithm and Sirius combined topography and tomography data for correction of myopia and myopic astigmatism achieved the predicted surgical outcomes and there was a tendency to have a similar clinical outcome for PAE when the ORA was great or not. However, the PAE with high ORA overcorrected astigmatism with-the-rule and showed a higher correction index compared with the low ORA group. [ J Refract Surg . 2022;38(4):235–242.]
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- 2022
46. Anterior segment inflammation and its association with dry eye parameters following myopic SMILE and FS-LASIK.
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Zhao J, Li Y, Yu T, Wang W, Emmanuel MT, Gong Q, and Hu L
- Subjects
- Humans, Prospective Studies, Fluoresceins, Keratomileusis, Laser In Situ, Myopia surgery, Dry Eye Syndromes surgery
- Abstract
Purpose: To evaluate dry eye and anterior segment inflammation after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and investigate their association., Methods: This prospective and observational study included 96 eyes from 48 myopic patients. The evaluation was performed at baseline, postoperative day 1, week 1, month 1 and month 3. Outcome measures included anterior chamber flare, bulbar redness (BR), limbal redness (LR), ocular surface disease index (OSDI), tear meniscus height (TMH), the first and average noninvasive breakup time (NIBUT-1, NIBUT-a), fluorescein breakup time (FBUT), corneal fluorescein staining (CFS), and Schirmer I. Generalized estimating equations (GEEs) were applied to explore the correlation between flare and ocular surface parameters., Results: Flare increased significantly in both groups at day 1 and week 1 and then returned to baseline at month 1. In both groups, BR decreased on day 1 and then gradually increased towards the baseline. In FS-LASIK, LR was lower than baseline at day 1 and month 3. An increase in OSDI was found in the SMILE group on day 1, and in the FS-LASIK group at day 1 to month 1. NIBUT-1 and NIBUT-a decreased significantly on day 1 in both groups. At month 3, NIBUT-a did not return to baseline in FS-LASIK. CFS increased significantly at week 1 in both groups. All parameters were comparable between SMILE and FS-LASIK except for OSDI and NIBUT-a. Time and spherical equivalent showed a correlation with flare., Conclusions: Both SMILE and FS-LASIK induced elevated anterior chamber flare and dry eye. However, flare might not be considered a factor determining perioperative dry eye.Key MessagesDry eye disease is common after corneal refractive surgery. Signs and symptoms of dry eye disease persist longer after FS-LASIK compared with SMILE.Both FS-LASIK and SMILE transiently disrupted blood-aqueous barrier integrity, leading to anterior segment inflammation.Anterior chamber flare might not be considered a factor explaining perioperative dry eye, other biomarkers remain for future exploration.
- Published
- 2023
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47. Late approach for LASIK flap striae.
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Morgado CR, Santhiago MR, Steigleman WA, Hofmeister EM, Henriquez MA, Zarei-Ghanavati S, Yoo SH, Jacob S, and Schallhorn J
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- Male, Humans, Young Adult, Adult, Corneal Stroma surgery, Visual Acuity, Lasers, Excimer therapeutic use, Refraction, Ocular, Keratomileusis, Laser In Situ, Photorefractive Keratectomy methods
- Abstract
A 24-year-old man was referred for postrefractive surgery evaluation. The patient had a history of uneventful laser in situ keratomileusis (LASIK) in both eyes 3 months previously. According to the surgeon who originally performed the surgery, on slitlamp examination, only microstriae in the left eye was detected on postoperative day 1 and a more conservative follow-up approach was adopted without further immediate intervention. The patient returned only 3 months after surgery, complaining of low vision in the left eye that, according to the patient, had been present since postoperative week 2. The patient was then referred for examination and surgical procedure with a diagnosis of significant postoperative striae. The slitlamp examination revealed a LASIK flap with striae, epithelial filling, and a wrinkled appearance (Figure 1JOURNAL/jcrs/04.03/02158034-202312000-00017/figure1/v/2023-11-20T151558Z/r/image-tiff). There were no signs of infection or inflammation. Originally, the LASIK flap was programmed to be 110 μm. Preoperative manifest refraction in the right eye was -5.25 (20/20) and in the left eye was -5.25 (20/20). Assuming it is a case of late-approach LASIK flap striae, how would you proceed? Would you try to hydrate and lift the flap and just reposition it? Would you avoid lifting and associate phototherapeutic keratectomy (PTK) with excimer laser on top of the flap? Would you consider topo-guided surgery with regularization of the visual axis or even amputation of the flap?, (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)
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- 2023
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48. Comparison of myopic astigmatic correction after cross-assisted SMILE, FS-LASIK, and transPRK.
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Yang YZ, Li FF, Wu SQ, Dai Q, Bao FJ, Cheng D, Zhu J, and Ye YF
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- Humans, Eye, Photorefractive Keratectomy, Keratomileusis, Laser In Situ, Astigmatism surgery, Myopia surgery, Surgical Wound
- Abstract
Purpose: To compare astigmatic correction among cross-assisted small-incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy (transPRK)., Setting: The Eye Hospital of Wenzhou Medical University, Zhejiang, China., Design: Prospective comparison study., Methods: 154 right eyes of 154 patients with astigmatism of -1.00 to -2.75 diopters (D) were included in this study. 64 eyes, 42 eyes, and 48 eyes were receiving SMILE, FS-LASIK, and transPRK, respectively. The SMILE group used cross-axial alignment for head positioning for astigmatism correction. In the FS-LASIK and transPRK groups, static and dynamic cyclotorsion control were used. Changes in ocular parameters and vector analysis were assessed at 6 months postoperatively., Results: The safety and efficacy indices were comparable among the 3 groups at 6 months postoperatively. Residual astigmatism was smallest in the SMILE group (-0.23 ± 0.25 D) compared with that in FS-LASIK (-0.40 ± 0.28 D, P = .009) and transPRK groups (-0.42 ± 0.32 D, P = .001). 53 (82.8%), 36 (85.7%), and 37 (77.1%) eyes achieved an angle of error within ±5 degrees, respectively ( P = .55). Notably, vector analysis showed that the difference vector, the magnitude of the error, and its absolute value were significantly smaller in the SMILE group than those in the other groups ( P < .05). In addition, the higher-order aberrations, especially coma, were significantly induced postoperatively in each group ( P < .001)., Conclusions: Residual astigmatism magnitude was smallest by cross-assisted SMILE, followed by FS-LASIK and transPRK, and the astigmatism axial correction was comparable among groups., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS.)
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- 2023
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49. Comparison of errors in ablation depth calculation after myopic femtosecond laser in situ keratomileusis in patients with different degrees of myopia: a prospective study.
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Jiao YD, Yan Z, Zhao TQ, and Zhao HX
- Subjects
- Humans, Prospective Studies, Lasers, Excimer therapeutic use, Cornea surgery, Refraction, Ocular, Keratomileusis, Laser In Situ, Myopia surgery
- Abstract
Background: To investigate the difference between the predicted preoperative corneal ablation depth and the measured ablation depth for femtosecond laser in situ keratomileusis (FS-LASIK) in patients with different degrees of myopia, and to analyze the source of the difference., Methods: A total of 55 patients (109 eyes) were included in this study. Multiple logistics regression was applied to analyze the sources affecting postoperative refractive outcomes. The difference between the preoperative predicted corneal ablation depth and the 1-day postoperative ablation depth in patients with different degrees of myopia was explored using linear regression. Corneal biomechanical parameters influencing error in ablation depth calculation were examined using multiple linear regression., Results: One hundred and nine eyes were divided into low to moderate myopia (55 eyes, myopia of 6 D or less), high myopia (45 eyes, myopia ranging from 6 D to a maximum of 9 D), and very high myopia group (9 eyes, myopia greater than 9 D) based on preoperative refractive error (spherical equivalent). Postoperative visual outcomes were comparable among the three groups of patients, with no significant difference in uncorrected visual acuity (UCVA). We did find notable disparities in spherical equivalent (SE) and central corneal thickness (CCT) in patients with different degrees of myopia at 1 day postoperatively (all p < 0.001). Logistic regression analysis showed that error in ablation depth calculation was an independent risk factor for refractive outcomes one day after surgery (OR = 1.689, 95% CI: 1.366 - 2.089). There was a substantial discrepancy in error in ablation depth calculation at 1 day postoperatively between the three groups. The measured ablation depth of the laser platform was lower than the predicted ablation depth in the low to moderate myopia and very high myopia groups, but the opposite was true in the high myopia group. Pre-operative SE (p < 0.001) and corneal front minimum radius of curvature (Front Rmin) (p = 0.007) obviously influenced the error in ablation depth calculation., Conclusions: Error in ablation depth calculation values vary significantly between patients with different degrees of myopia and correlate highly with preoperative SE and Front Rmin. At the same time, the available evidence suggests that error in ablation depth calculation is an influential factor in postoperative refractive status, so it is imperative to control error in ablation depth calculation., (© 2023. The Author(s).)
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- 2023
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50. Effect of sodium fluorescein strip application on cornea parameters commonly used in laser-assisted in-situ keratomileusis.
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Han D, Xie W, Yuan M, Cui J, Wang Q, and Zhang Q
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- Humans, Fluorescein, Corneal Topography methods, Cornea surgery, Lasers, Keratomileusis, Laser In Situ
- Abstract
To assess the effect of sodium fluorescein (NaF) strip on corneal parameters commonly used in Laser-assisted in-situ keratomileusis (LASIK). Eighty-six subjects (172 eyes) scheduled for LASIK were recruited between January and March 2022. The study and statistical analysis test were conducted in April 2022. Topographic measurements of corneal parameters, including central corneal thickness (CCT), anterior keratometric (K) readings (K1, flat keratometry; K2, steep keratometry), horizontal corneal diameter (white to white, WTW), and corneal asphericity (Q value), were obtained using a Scheimpflug device (Pentacam) before and 10 min after NaF strip treatmentThe Pentacam recorded a small significant increase in CCT (mean 538.88 ± 28.78 μm to 547.90 ± 29.94 μm; p < .001), with no differences in K1 and K2 (mean 42.24 ± 1.35D to 42.24 ± 1.35D, and mean 43.34 ± 1.50D to 43.32 ± 1.51D; P > .05, for all) as well as WTW(mean 11.58 ± 0.32 mm to 11.58 ± 0.32 mm, P > .05) before and after NaF strip intervention. Furthermore, there was no significant difference was observed in Q value (mean - 0.30 ± 0.13 to - 0.30 ± 0.14, P > .05). These results indicate that clinicians should avoid NaF strip application before obtaining precise topographic measurements of cornea parameters using the Pentacam., (© 2023. The Author(s).)
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- 2023
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