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Purpose: to conduct a prospective study of the results of surgical treatment of patients with pigment dispersion syndrome and complex myopic astigmatism. Materials and methods. As a result of a comprehensive examination of 10453 adult primary patients with complex myopic astigmatism, the diagnosis of pigment dispersion syndrome was made in 99 patients (0.94 %). The study group consisted of 22 people, 9 men and 13 women, with an average age of 29.4 ± 9.8. In the case of iridosonular contact, according to ultrasound biomicroscopy, laser basal iridectomy was performed at the first stage. In the case of normal intraocular pressure indicators, laser correction of myopia was made in patients of the study group within 6 months after laser basal iridectomy. Results. During biomicroscopy, a Krukenberg spindle was observed in 34 eyes (77.2 %), exogenous pigment was detected in 20 eyes (45.4 %) on the iris and lens, and sectoral illumination of the iris was detected in 5 (11.4 %). After laser basal iridectomy on 24 eyes (54.5 %) in all the studied meridians, we noted a tendency to deepen the posterior chamber, but the increase was statistically significant only at 12 hours (P < 0.05). The achieved decrease in the angle of the anterior chamber was statistically significant (P < 0.05) in the meridians of 3, 9 and 12 hours and ranged from 3.56 to 8.53 degrees in different meridians. Laser correction of complex myopic astigmatism was performed in 11 patients (22 eyes) using ReLEx® SMILE technology and 10 (20 eyes) patients using FemtoLASIK technology. At the end of the observation period after correction, refraction within ±0.5 dptr of the planned one was achieved in 88.1 % of cases (37 eyes), ±1.0 dptr — in 100 % of cases. The efficiency coefficient was 88.46 %, the safety coefficient was 92.8 %. Postoperative values of corneal-compensated IOP were comparable with preoperative indicators (P > 0.05). Conclusions. The analysis of the of surgical treatment results in the patients with pigment dispersion syndrome and myopia showed the absence of negative dynamics in the course, as well as high efficiency, safety and stability of the results achieved after laser correction. The applied algorithm for the management of patients with combined pathology with pigment dispersion syndrome and myopia is pathogenetically justified, safe, promotes the preservation of visual functions of patients and improves their quality of life.

Purpose: to develop a clinical and functional rehabilitation system for patients with mild and moderate hyperopia and accommodation disorders before and after FemtoLASIK surgery and to assess its effectiveness.Material and methods. 234 patients (234 eyes) with the above conditions, aged 25 to 30 (mean age 27.9 ± 1.2 years) were divided into 2 groups. The control group included 114 patients (114 eyes) who received no prevention measures or accommodation disorders treatment, while the main group (120 patients, 120 eyes) received clinical and functional rehabilitation before and after FemtoLASIK.Results. The “false myopization” syndrome observed in the main group was 14.2% lower than in the control group. A week after FemtoLASIK, the normalization of accommodation parameters was achieved in 57.5% of the main group cases, and combined accommodation disorders occurred 2.37 less frequently than in the control group. Weak accommodation in patients of this group was 30% less than in the control group. Habitually excessive accommodation in the control group was 2.45 times more frequent than in the main group. According to the CISS test questionnaire, the mean values of indices for the main group patients reached the normal level one month after FemtoLASIK whilst the control group required 6 months.Conclusion. The clinical and functional rehabilitation system in patients with mild and moderate hyperopia and accommodation disorders applied before and after FemtoLASIK helps achieve maximum clinical and functional results 1 month after the operation and yields the best results in accommodation disorders treatment.

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. [ABSTRACT FROM AUTHOR]

Abstract Background Wavefront-optimized laser-assisted in situ keratomileusis (LASIK) ablation is the most commonly performed procedure in refractive surgery, but new technologies have become available. Our goal was to compare topography-guided (Contoura) and asphericity-guided (Custom-Q) customized ablation treatments for the correction of myopia with or without astigmatism. Methods This prospective, randomized, double-blind, contralateral eye study included 60 eyes of 30 patients with myopia or myopic astigmatism requiring femtosecond LASIK (FemtoLASIK) treatment. For each patient, one eye was randomized to undergo Contoura treatment, and the other underwent Custom-Q abaltion. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent (MRSE), sphere (SPH), cylinder (CYL), 6.0-mm total corneal aberration root mean square (RMS), coma (COMA), trefoil (TREF), and spherical aberration (SA) were measured and analysed after a 1-year follow-up. Results The UDVA was − 0.08 ± 0.06 logMAR in Contoura eyes and − 0.08 ± 0.05 logMAR in Custom-Q eyes (p = 0.309) after 12 months. Twenty-five eyes (83%) in the Contoura group and twenty-six eyes (87%) in the Custom-Q group had a UDVA of 20/16 at the end of 12 months, and 100% of eyes in both groups reached a UDVA of 20/25 or better. Ninety and 100% of eyes in the Contoura and Custom-Q groups, respectively, achieved a residual CYL ≤0.50 D (p = 0.237). No statistically significant difference was observed between the surgical techniques in the preoperative to 1-year postoperative changes for any of the parameters evaluated (MRSE, CYL, RMS, DEF, COMA, TREF, and SA). Conclusions The Contoura and Custom-Q techniques yielded excellent visual and refractive results, but the evidence did not reveal any clear differences between these two methods after 1 year of follow-up. Trial registration ReBEC - Registro Brasileiro de Ensaios Clínicos [Internet]: Rio de Janeiro (RJ): Instituto de Informação Científica e Tecnológica em Saúde (Brazil); 2010 -. Identifier RBR-8rs5kt Myopia and Astigmatism Topography-guided Refractive Surgery by Contoura Method Versus Customized by Asphericity in Contralateral Eyes: A prospective Double blind Randomized Study. Available from https://ensaiosclinicos.gov.br/rg/RBR-8rs5kt Date of registration: 02/03/2020 (dd/mm/yyyy). CAAE:96778718.9.0000.5192. Issuing authority: Plataforma Brasil. CEP:2.979.279. Issuing authority: HUOC.

Background: Proper calculation of ablation depth associated with LASIK and FEMTOLASIK surgeries is mandatory to estimate the post-refractive surgery remaining stroma to avoid the possibility of post-operative ectasia and to correct the maximum error to meet the patient’s needs and safety.Purpose: The current work aimed to assess the actual depths of ablation after the LASIK versus the FEMTO-LASIK surgeries.Patients and Methods: Forty eyes of 20 patients were included in this prospective non-randomized interventional study. They had myopia or myopic astigmatism, and scheduled for LASIK or FEMTOLASIK surgery. Pentacam was used to check the thickness of the thinnest corneal location and to exclude the possibility of keratoconus. They were divided into two groups according to the technique used to correct the error. Group I for LASIK and Group II for FEMTOLASIK surgery. Ablation was performed in all cases using the Allegretto excimer laser machine. After surgery, all patients received a combination of topical tobramycin 0.3% and dexamethasone 0.1% eye drops four times daily for 10 days, and topical Sodium Hyaluronate eye drops [2 mg/ml] four times daily for one month. All patients were examined at one day and one week postoperatively for evidence of flap malposition, striae, epithelial defects, or diffuse lamellar keratitis. Pentacam was used for follow up at 3 months after surgery to re-evaluate the thinnest central location.Results: In group I, the mean actual tissue ablation per one diopter was 13.3 microns for 6.5 mm treatment zone, and 11.9 microns for 6.0 mm treatment zone, while in group II, it was 13.4 microns for 6.5 treatment zone, and 11.8 microns for 6.0 treatment zone. There was insignificant difference between actual tissue ablation following the LASIK versus the FEMTOLASIK surgeries.Conclusion: The actual ablation depth should be considered to calculate the remaining stromal depth after LASIK or FEMTOLASIK surgeries for treatment of myopia or myopic astigmatism to avoid the possibility of post- LASIK or FEMTOLASIK ectasia and to correct the maximum error that meets the patient’s needs.

Purpose: a covariance analysis of the planned and actually obtained refraction after excimer laser myopia correction surgery in middle-aged patients. Material and methods. 85 patients (170 eyes) aged 35 to 50 underwent excimer laser myopia correction surgery by FemtoLASIK. The patients were divided into 3 groups according to the degree of myopia: group 1 included 13 patients (26 eyes) with myopia from -1.25 to -3.0 D, group 2 had 42 patients (84 myopic eyes) from -3.25 to -6.0 D and group 3 had 30 patients (60 eyes) with myopia of -6.25 D or higher. Results. The patients with low myopia, independently of the age, revealed a postoperative refraction effect closer to that planned than the patients with moderate and high myopia. The difference (delta) between the planned and the obtained results was -0.35 ± 0.08 D (41%) in group 1, -0.58 ± 0.04 D (51.3%) in group 2 and -0.64 ± 0.05 D (46%) in group 3. The divergence between the respective indicators for figures for low and high myopic groups is statistically significant. Conclusion.Patients with low myopia over 35 years old can be recommended a symmetric hypocorrection in binocular format irrespective of the objective data regarding the initial corneal hydration, which affects the ablation volume. To achieve a better agreement between the planned and the actual hypoeffect (and, accordingly, a more precise dosage of the surgery) in patients with moderate and high myopia, it is important to introduce into clinical practice the technology of contactless measurement of corneal hydration.

Purpose: to evaluate the clinical and functional results of the operation the FemtoLASIK by excimer lasers with frequency more 1000 Hz in patients with low to moderate myopia.Patients and methods. The 84 eyes of 84 patients with low to moderate myopia who had undergone FemtoLASIK procedure using with excimer lasers: Schwind Amaris 1050 Hz (Germany) and Microscan Visum 1100 Hz (Russia) were included in the study. The “Schwind Amaris 1050 Hz” and “Microscan Visum 1100 Hz” groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central thickness of the cornea, sphere, cylinder, SE) (p > 0.05). All patients underwent complete ophthalmological examination before refractive laser surgery, and also patients were examined on the 1st day and 1 month after FemtoLASIK.Results. One month postoperatively, in the “Schwind Amaris 1050 Hz” group the UDVA 1.0 or better (20/20 or better by Snellen) was achieved in 100 %, in the “Microscan Visum 1100 Hz” group — in 100 % (p > 0.05). There wasn’t observed a loss of the CDVA lines in both groups. In the “Schwind Amaris 1050 Hz” group gain of one or more lines of the CDVA was 14 %, in the “Microscan Visum 1100 Hz” group — in 12.2 % (p > 0.05). In the “Schwind Amaris 1050 Hz” group the predictability of targeted refraction within ±0.5 D was in 90.7, within ± 1.0 D — in 100 %, in the “Microscan Visum 1100 Hz” group — in 90.2 % and 100 %, respectively (p > 0.05).Conclusions. The FemtoLASIK procedure using with different high-frequency excimer lasers is an effective, safe and predictable method for correcting low to moderate myopia.

The purpose of our study was to evaluate the safety, effectiveness, predictability, and stability of myopic and astigmatic laser-assisted in situ keratomileusis (LASIK) with simultaneous prophylactic corneal cross-linking (CXL) in thin corneas. In total, 100 eyes from 50 patients who were subjected to myopic and astigmatism femtosecond LASIK with simultaneous prophylactic CXL were included. The design of the study was retrospective, longitudinal, and observational. All patients had a 48-month follow-up. The MEL 80 excimer laser was utilized with the Aberration Smart Ablation platform. CXL treatment was applied when the predicted stromal thickness was less than 330 µm. Patients’ mean age was 30.22 ± 5.97 years. Previous mean spherical equivalent was −5.50 ± 1.65 (−9.50 to −1.13) diopters (D). Postoperative mean spherical equivalent was −0.24 ± 0.29 (−0.85 to +0.50) D. Visual acuity (VA) of 20/20 or better was observed in 87% of the eyes and no eyes experienced VA loss. Spherical equivalent within ±0.50 D was observed in 93% of eyes, and 4% of eyes varied by 0.50 D or more between 3 and 48 months. Prophylactic corneal cross-linking with simultaneous femtosecond laser-assisted in situ keratomileusis in thin corneas proved to be effective, safe, and predictable. The results remained stable after 48 months of follow-up.

Background: Wavefront-optimized laser-assisted in situ keratomileusis (LASIK) ablation is the most commonly performed procedure in refractive surgery, but new technologies have become available. Our goal was to compare topography-guided (Contoura) and asphericity-guided (Custom-Q) customized ablation treatments for the correction of myopia with or without astigmatism.Methods: This prospective, randomized, double-blind, contralateral eye study included 60 eyes of 30 patients with myopia or myopic astigmatism requiring femtosecond LASIK (FemtoLASIK) treatment. For each patient, one eye was randomized to undergo Contoura treatment, and the other underwent Custom-Q abaltion. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent (MRSE), sphere (SPH), cylinder (CYL), 6.0-mm total corneal aberration root mean square (RMS), coma (COMA), trefoil (TREF), and spherical aberration (SA) were measured and analysed after a 1-year follow-up.Results: The UDVA was - 0.08 ± 0.06 logMAR in Contoura eyes and - 0.08 ± 0.05 logMAR in Custom-Q eyes (p = 0.309) after 12 months. Twenty-five eyes (83%) in the Contoura group and twenty-six eyes (87%) in the Custom-Q group had a UDVA of 20/16 at the end of 12 months, and 100% of eyes in both groups reached a UDVA of 20/25 or better. Ninety and 100% of eyes in the Contoura and Custom-Q groups, respectively, achieved a residual CYL ≤0.50 D (p = 0.237). No statistically significant difference was observed between the surgical techniques in the preoperative to 1-year postoperative changes for any of the parameters evaluated (MRSE, CYL, RMS, DEF, COMA, TREF, and SA).Conclusions: The Contoura and Custom-Q techniques yielded excellent visual and refractive results, but the evidence did not reveal any clear differences between these two methods after 1 year of follow-up.Trial Registration: ReBEC - Registro Brasileiro de Ensaios Clínicos [Internet]: Rio de Janeiro (RJ): Instituto de Informação Científica e Tecnológica em Saúde (Brazil); 2010 -. Identifier RBR-8rs5kt Myopia and Astigmatism Topography-guided Refractive Surgery by Contoura Method Versus Customized by Asphericity in Contralateral Eyes: A prospective Double blind Randomized Study. Available from https://ensaiosclinicos.gov.br/rg/RBR-8rs5kt Date of registration: 02/03/2020 (dd/mm/yyyy). CAAE:96778718.9.0000.5192. Issuing authority: Plataforma Brasil. CEP:2.979.279. Issuing authority: HUOC. [ABSTRACT FROM AUTHOR]

Purpose. To develop a step-by-step algorithm for managing patients with myopia and the risk of developing asthenopia after keratorefractive surgery (KRS) to optimize the work of the ophthalmologist and increase patient satisfaction with the results of the operation.Materials and methods. 66 patients (132 eyes) with moderate to high myopia were examined. The special research methods needed to create an algorithm for managing patients with myopia and the risk of developing asthenopia after corneal surgery were the study of binocular vision, fusional reserves, and a cover/uncover test to identify heterophoria and heterotropy. Results. Based on the identified of PA predictors development and the developed course of functional treatment of accommodation and binocular function disorders in patients with moderate and high myopia, after CLRS, a step-by-step algorithm was developed for managing patients with myopia and the risk of developing PA. Conclusion. Optimization of the ophthalmologist’s work and an increase the patient’s satisfaction with theresults of excimer laser corneal surgery.

The purpose of this study was a comparative assessment of the refraction and the axial length (AL) changes occurring in the operated and unoperated eyes of patients with anisometropic myopia who underwent unilateral excimer laser correction.Material and methods. We observed 13 patients (8 women and 5 men) aged 21 to 53 years (34.2 ± 8.6) with anisometropic myopia (averagely, with spherical equivalent of refraction -3.87 ± 1.77 D in one eye and 0.71 ± 0.71 D in the other), who underwent unilateral LASIK. The observation period was 3-5 years (averagely 3.5 ± 1.1 years). The observation included autorefractometry on a Nidek ARK-530A apparatus, ultrasound biometry on a Nidek US-1800 Echosсan (Japan), and pachymetry on a GALILEI G6 (Ziemer, Switzerland).Results. No significant changes in refraction or axial length were observed either in operated or fellow eyes. Changes in the axial length were controversial: 7 operated and 7 fellow eyes showed an increasing tendency while another 6 operated and 6 fellow eyes showed a decreasing tendency (p > 0.05).Conclusion. The data obtained fail to support the assumption that excimer laser reshaping of the cornea produces an inhibitory effect on the development of myopia.

Purpose. Evaluation of the visual and refractive results of additional correction using LASIK and PRK methods in patients with residual refractive error after previous cataract surgery. Patients and methods. The prospective open study included 57 patients (79 eyes) who previously underwent cataract phacoemulsification (n = 37) or refractive lensectomy (n = 42) with various IOL models implantation (2012–2017). The average age of patients was 50.8 ± 13.9 (19–79) years. Operations LASIK (91.1 %) and PRK (8.9 %) were carried out according to standard methods. In 6 cases, femtosecond laser supported by laser correction. The target refraction ranged from –0.25 to 0.25 D in most (97.5 %) cases. The follow-up period ranged from 6 to 9 months. Results. The patients were divided into groups according to the type of residual refractive error (Group 1 — myopia, group II — emmetropia and group III — hyperopia). Statistically significant differences were determined for the species of previously implanted IOLs — in group II, the frequency of monofocal IOLs was significantly higher (p < 0.05). In group II, the values of the cylindrical component of refraction were significantly higher compared with groups I and III (p < 0.05). In group I, a significant (p < 0.05) decrease in the spherical component of refraction from –1.36 ± 0.92 to –0.2 ± 0.8 D was observed. In patients of group II, there was a slight increase in the spherical component of refraction from 0 ± 0.20 to 0.25 ± 0.29 D (p > 0.05). In group III, a significant (p < 0.05) decrease was observed in the spherical component of refraction from 1.27 ± 0.69 to 0.43 ± 0.49 D. When analyzing the cylindrical component of refraction in group I, its decline was noted from –0.69 ± 0.5 to –0.38 ± 0.46 D (p > 0.05). In group II, the largest decrease in the cylindrical component was observed from –1.6 ± 1.0 to 0.03 ± 1.10 Dptr (p < 0.01). In all the studied groups, a statistically significant (p < 0.05) increase in UCFVA was revealed in the postoperative period. Indicators K1 and K2 did not significantly change. Conclusion. The high efficiency of the correction using the LASIK, PRK and femtoLASIK methods on pseudophakic eyes with the achievement of the target refraction in most of the studied cases was shown. This method can be used as an alternative to spectacle and contact correction in patients with residual refractive error after cataract phacoemulsification and refractive lensectomy with IOL implantation.

Purpose. To evaluate visual and refractive results of FemtoLASIK using the WaveLight EX 500 and Microscan Visum excimer laser systems in patients with low to moderate myopia.Material and methods. This study was performed in 62 eyes of 62 patients with low to moderate myopia operated according to the FemtoLASIK technique using the different excimer lasers WaveLight EX 500 (USA) and Microscan Visum (Russia). All patients underwent a complete ophthalmological examination before the laser refractive surgery, on the 1st day and 1 month after the FemtoLASIK. The results are presented as Me (Q25; Q75).Results. Postoperatively the uncorrected distance visual acuity (UDVA) increased from 0.05 (0.04; 0.10) to 1.00 (1.00; 1.00) (p0.05), the safety index was 1.00 (1.00; 1.00) and 1.00 (1.00; 1.00), respectively (p>0.05). Visual and refractive results showed no statistically significant difference between the two groups (p>0.05). The ablation depth was higher in the ≪Microscan Visum≫ group compared with the ≪WaveLight EX 500≫ group.Conclusions. 1. The conventional FemtoLASIK procedure using the WaveLight EX 500 and Microscan Visum excimer lasers, is an effective and safe method for low to moderate myopia correction. There is no statistically significant difference between two algorithms (p>0.05). 2. It is necessary to improve the standard ablation algorithm on the Microscan Visum excimer laser platform to reduce the ablation depth.

A clinical case of excimer laser correction performed by sub-Bowman femtosecond keratomileusis at the peak of botulinum toxin A effect in a patient with high congenital anisometropic myopia and horizontal nystagmus is presented. Keratorefractive surgery improved functional visual performance and the parameters of nystagmus.

Laser technologies of corneal surgery perfection was one of the important events in ophthalmology in the past decades. Despite to the significant success in refractive surgery and the achieved high result in visual acuity, the ideal healing of the cornea, the absence of dry eye syndrome, some patients in the postoperative period present asthenopic complaints. Patients may notice a decrease in visual acuity when working near, difficulty in refocusing from far to near distance, fuzzy, blurred images, red eyes, tearing, periodic or permanent diplopia at different distances in the postoperative period. Adaptation to emmetropic refraction in these patients can cause discomfort, headache and visual fatigue even with insignificant visual loads, which leads to the development of asthenopia and worsening of their subjective status. Corneal refractive surgery leads to changes in the anatomical and optic parameters of the eye, which contributes to the formation of new accommodation-convergence interactions. If the accommodative and binocular functions were disrupted preoperatively, there is a risk of decompensation and development of postoperative asthenopic syndrome (AS). Refractive surgery, saving patients from glasses and contact lenses, can not completely eliminate their existing imbalances between accommodation and convergence. This can be explained with the fact that the existence of a formed pathological system does not cease with the elimination of the etiologic factor. In order to correct the disturbed parameters, additional research methods and effective methods of functional treatment of patients in the postoperative period were suggested. However, most of them are aimed at pathogenetic effects on accommodative muscles, often without taking into account disturbances in the oculomotor apparatus and binocular function. Thus, existing algorithms for investigating and managing patients with refractive disorders do not allow us to identify predictors for the development of asthenopia before refractive surgery, there is no set of preventive restoration measures aimed at restoring accommodative capacity and binocular interaction in the preoperative period to increase satisfaction with the results of surgery in patients at risk of postoperative AS.

Purpose: to evaluate the results of symmetric binocular hypocorrection of myopia with FemtoLasik surgery in patients with presbyopia of various age groups.Material and methods. 33 patients (66 eyes) with myopic refraction, aged 36 to 50, were operated by FemtoLasik. The intended Femto Flap thickness was 100 μm. The patients were divided into three groups depending on age; group 1 included 16 patients (32 eyes) aged 39–44, group 2 had 12 patients (24 eyes) aged 45–50, and group 3 (controls) was composed of 5 patients (10 eyes) of pre-presbyopic age (36–38 years).Results. The symmetric binocular hypocorrection proved efficient in 35 % of cases in the group 1 and 50 % of cases in group 2. In the control group the intended and obtained values coincided in all 100 % of cases.Conclusion. A possible cause of the discrepancy between the intended and the obtained hypocorrection effect may be a reduced corneal hydration of patients older than 39 years.

Purpose. A comparative analysis of the results of two-stage optico-functional rehabilitation of patients with a high risk of postoperative asthenopic syndrome (AS).Materials and methods. 36 patients (72 eyes) who had no binocular vision at a distance of 5 m and had a symmetrical position of the eyes, or a position close to symmetry, were randomly divided into 2 equal groups of comparison. Patients in both groups underwent functional treatment followed by the correction of refractive errors with FemtoLASIK technology. To eliminate accommodation dysfunctions, a medical device OXYS was used. Diploptic treatment was carried out using a Speckle-M laser apparatus and Bagolini raster glasses. To expand fusional reserves, a prism compensator (OKP-20, Russia) and a Speckle-M laser apparatus were used. The patients of the first group underwent a fast course of medical and functional rehabilitation for 5 working days (2 times a day with a break of 2–3 hours). As an additional pharmacological support, daily instillations of phenylephrine hydrochloride 2.5 % without preservatives were prescribed. The other group received the same functional treatment for 10 working days.Results. After the fast and the standard rehabilitation courses, the patients revealed an increase in absolute accommodation and a decrease in the coefficient of micro fluctuations, an expansion of fusional reserves, an increase in stereovision acuity, and an increased number of cases of binocular vision. No statistically significant difference of clinical and functional parameters obtained as a result of the fast and the standard rehabilitation courses was revealed.Conclusions. Functional and medicament treatment of patients with refractive disorders and the absence of binocular vision prior to FemtoLASIK is shown to be effective. This treatment reduces the risk of postoperative AS and increases the patient’s satisfaction with the results of the surgery.

Background and Aims: Refractive eye surgery is a rapidly expanding field of ophthalmology and corneal surgery is undergoing constant development leading to less invasive technologies. The goal of this study was to compare the most common femtoLASIK surgery with the newer ReLEx SMILE surgery which is gentler to the cornea. The comparison was made in terms of dioptric error reduction. Methods: The studied cohort of patients consisted of two major groups: 30 patients who underwent femtoLASIK surgery and 30 who underwent ReLEx SMILE surgery. -30 patients, 60 eyes. All patients were aged 18-45 years with moderate myopia or astigmatism ranging from -3.25 to -6.0 spherical diopters and from 0 to -1.0 cylindrical diopters. In all, the best corrected visual acuity measured prior to surgery was 1.0. Pachymetry was not comparable because each surgical method was performed at a different time point and the introduction of an innovative method into practice led to a change in selection criteria. Results: During postsurgical check-ups, the ReLEx SMILE method (0.74) led to lower values of non-corrected visual acuity compared to the femtoLASIK method (0.88), (P

Purpose: to compare in vivo histomorphologic structure of cornea after the FemtoLASIK procedure using femtolaser systems Femto Visum (Russia) and Femto LDV Z6 (Switzerland). Patients and methods: The study was carried for 70 eyes from 70 patients with low to moderate myopia after FemtoLASIK procedure. Group 1 (Femto Visum) included 36 eyes (n = 36) there the flap were formed using femtolaser Femto Visum («Optosystems», Russia), group 2 (Femto LDV Z6) included 34 eyes (n = 34) and Femto LDV Z6 was used («Ziemer Ophthalmic Systems AG», Switzerland). The excimer laser ablation was performed with Microscan Visum system («Optosystems», Russia) in both groups. The Femto Visum and Femto LDV Z6 groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central corneal thickness, sphere, cylinder, spherical equivalent) (p > 0.05). In vivo histomorphological structure of the cornea was examined using confocal microscope Confoscan 4 (Nidek, Japan) 1 week, 1, 3, 6, and 12 months after FemtoLASIK. The endothelial cell density (ECD) was measured with endothelial microscope (EM-3000, Tomey, Japan) before surgery and 12 months after FemtoLASIK. Results: The main in vivo histomorphological cornea changes occurred in the anterior and middle layers of the corneal stroma during post-operative period in both groups (Femto Visum and Femto LDV Z6). The underlying corneal structures remained intact. There was no statistically significant difference between the two groups (p > 0.05). Twelve months postoperatively, the loss of ECD was 0.31 % in the Femto Visum group and 0.33 % in the Femto LDV Z6 group (p > 0,05). Conclusions: FemtoLASIK procedures using Femto Visum (Russia) and Femto LDV Z6 (Switzerland) lead to similar histomorphological cornea changes in post-operative period (p > 0.05) and they are safe for corneal structure in the treatment of myopia.

Purpose: to make a comparison of the corneal flap parameters after the FemtoLASIK procedure using femtolaser systems Femto Visum (Russia) and Femto LDV Z6 (Switzerland).Patients and methods. The study was carried out in 192 eyes from 192 patients with mild and moderate myopia who had undergone FemtoLASIK prodecure. Group 1 (Femto Visum) included 98 eyes (n = 98) on which flap were formed using femtolaser Femto Visum (“Optosystems”, Russia), group 2 (Femto LDV Z6) included 94 eyes (n = 94) and Femto LDV Z6 was used (“Ziemer Ophthalmic Systems AG”, Switzerland). The Femto Visum and Femto LDV Z6 groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central corneal thickness, sphere, cylinder, spherical equivalent) (p > 0.05). The intended flap thickness was 100 μm and diameter was 9.0 mm in both groups. One month after surgery the achieved flap thickness in the horizontal and vertical meridians (14 measurement points) and the flap diameter in the horizontal meridian were measured using Visante OCT (Carl Zeiss, Germany), also we determined the shape of the flap and the mean deviation of the values from morphometric parameters of the corneal flap relative to the intended values.Results. In group 1 (Femto Visum), the total average thickness of the flap was 98.89 ± 3.96 μm with the mean deviation 2.91 ± 2.91 μm, the mean flap diameter was 8.96 ± 0.13 mm with the mean deviation 0.11 ± 0.07 mm, in group 2 (Femto LDV Z6) the same parameters were 99.11 ± 3.89 μm, 2.99 ± 2.64 μm and 8.91 ± 0.14 mm, 0.13 ± 0.10 mm, respectively. The configuration of the corneal flap was uniform in both groups. For all studied parameters it was no any statistically significant differences between studied groups (p > 0.05, Student’s t-test).Conclusions. The Femto Visum and Femto LDV Z6 femtolaser systems allow to shape the uniform and highly predictable corneal flap morphometric parameters, similar measurements were obtained from both systems.

Purpose: to evaluate the effectiveness, safety, and predictability of the wavefront-guided FemtoLASIK using the Platoscan computer program and data from the KR-1W aberrometer, in comparison with the conventional algorithm FemtoLASIK in patients with low to moderate myopia.Patients and methods. There were 62 eyes of 62 patients with low to moderate myopia who had undergone FemtoLASIK procedure using an excimer laser ‘Microscan Visum” (Russia) and a femtosecond laser Femto LDV Z6 (Switzerland) in the study. In the “Wavefront” group which included 31 eyes with a mean spherical equivalent (SE) -=3,32 ± 1,23 D (M ± SD) was performed a wavefront-guided Femtosecond LASIK using aberrometer KR-1W (Japan) and a program for calculating the operation’s parameters “Platoscan” (Russia). “Standard” group included 31 eyes with an average SE –3.51 ± 1.21 D (M ± SD), who received the conventional FemtoLASIK. The “Wavefront” and “Standard” groups were comparable in terms of pre-operative data (age, sex, corneal curvature, central thickness of the cornea, sphere, cylinder, SE) (p > 0.05). All patients underwent complete ophthalmological examination before refractive laser surgery, and also patients were examined on the 1st day and 1 month after FemtoLASIK.Results. One month postoperatively, in the “Wavefront” group the UDVA 1.0 or better (20/20 or better by Snellen) was achieved in 93.5%, in the “Standard” group — in 96,8% (p > 0.05). There wasn’t observed a loss of the CDVA lines in both groups. In the “Wavefront” group, gain of one or more lines of the CDVA was in 38.7%, in the “Standard” group — in 12.9% (p = 0.04, Fisher’s exact test). In the “Wavefront” group the predictability of targeted refraction within ±0.5 D was in 93.5%, within ±1.0 D — in 100%, in the “Standard” group — in 90,3 and 100%, respectively (p > 0.05). The efficiency index in the “Wavefront” group was 1.00 (1.00; 1.20) (Me (Q25; Q75)), in the “Standard” group — 1.00 (1.00; 1,00) (Me (Q25; Q75)) (p > 0.05). The safety index in the “Wavefront” group was 1.00 (1.00; 1.20) (Me (Q25; Q75)), in the “Standard” group — 1.00 (1.00; 1,00) (Me (Q25; Q75)) (p > 0.05).Conclusions. The FemtoLASIK procedure, performed according to the conventional and wavefront-guided algorithms using the “Platoscan” computer program and data from the KR-1W aberrometer, is an effective, safe and predictable method for correcting low to moderate myopia, there is no statistically significant difference between two algorithms (p > 0.05).

Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation. [ABSTRACT FROM AUTHOR]

Purpose. To perform a comparative 3D digital morphometric assessment of corneal flap formed using a femtosecond laser Femto Visum and Femto LDV Z6.Material and methods. Experiment was performed on 20 cadaver eyes, on which corneal flaps were formed using the femtosecond laser systems Femto Visum (Optosystems, Russia) (Group 1 – «Femto Visum» – 10 eyes) and Femto LDV Z6 (Ziemer, Switzerland) (Group 2 – «Femto LDV Z6» – 10 eyes). In both groups, the corneal flap was formed on the set parameters: side cut angle – 70°, the flap thickness – 100 µm, diameter of stromal bed – 9.0 mm. By using 3D digital microscope Hirox KH-8700 (Japan) the side cut angle of the flap, the flap thickness and diameter of the stromal bed were measured.Results. With 3D digital estimation we obtained following results in group 1 («Femto Visum»): side cut angle – 74.61±3.09°, the flap thickness – 87.91±6.93 µm, diameter of the stromal bed – 8.88±0.09 mm; in group 2 ( «Femto LDV Z6») – side cut angle – 74.06±3.08°, the flap thickness – 87.92±7.79 µm, diameter of the stromal bed – 8.83±0.06 mm. Those parameters are not statistically different between the two groups (p>0.05, Mann-Whitney U-test).Conclusions. 1. 3D digital microscope Hirox KH-8700 allows precise measurements of morphometric parameters of corneal flap in the coordinates X, Y, Z. 2. Femtosecond laser systems, Femto Visum and Femto LDV Z6, allow us to create the corneal flap such that the side cut angle and the diameter of the corneal stromal bed meet the set parameters, with no statistically significant difference between systems (p>0.05). The flap thickness was thinner than desired, («Femto Visum» and «Femto LDV Z6»), but there was no statistical difference between two groups (p>0.05).

Purpose: To investigate the outcomes of unilateral Supracor treatment to enhance near vision while maintaining good distance vision in hyperopic eyes., Methods: This prospective interventional study includes consecutive hyperopic patients with presbyopia. All eyes underwent femtosecond laser-assisted in situ keratomileusis treatment for hyperopia with an additional Supracor multifocal treatment algorithm in nondominant eyes. Monocular and binocular uncorrected and spectacle-corrected distance visual acuity (UCDVA and SCDVA), monocular and binocular uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity at 40 cm and high-order aberration changes and complications were evaluated for 6 months., Results: Sixty-four patients with a mean age of 51.91 ± 3.64 were enrolled. After 6-month follow-up, the mean binocular UCDVA and UNVA were 0.03 ± 0.05 and 0.04 ± 0.06 logMAR, respectively. UCDVA (logMAR) of nondominant and dominant eyes was 0.30 ± 0.18 and 0.03 ± 0.05, respectively. Preoperative and postoperative mean ± standard deviation manifest refraction spherical equivalent was +1.84 ± 0.75 and -0.48 ± 0.57, respectively, in nondominant eyes and +1.77 ± 0.69 and +0.12 ± 0.33, respectively, in dominant eyes. No complications were observed., Conclusion: Supracor procedure in nondominant eyes may improve functional near, intermediate, and distance vision without significant photic phenomena in presbyopic patients with low and moderate hyperopia., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Current Ophthalmology.)

Background and Aims. Refractive eye surgery is a rapidly expanding field of ophthalmology and corneal surgery is undergoing constant development leading to less invasive technologies. The goal of this study was to compare the most common femtoLASIK surgery with the newer ReLEx SMILE surgery which is gentler to the cornea. The comparison was made in terms of dioptric error reduction. Methods. The studied cohort of patients consisted of two major groups: 30 patients who underwent femtoLASIK surgery and 30 who underwent ReLEx SMILE surgery. -30 patients, 60 eyes. All patients were aged 18-45 years with moderate myopia or astigmatism ranging from -3.25 to -6.0 spherical diopters and from 0 to -1.0 cylindrical diopters. In all, the best corrected visual acuity measured prior to surgery was 1.0. Pachymetry was not comparable because each surgical method was performed at a different time point and the introduction of an innovative method into practice led to a change in selection criteria. Results. During postsurgical check-ups, the ReLEx SMILE method (0.74) led to lower values of non-corrected visual acuity compared to the femtoLASIK method (0.88), (P<0.001). However, the results changed at the one-year post-surgery check-up, when ReLEX SMILE patients achieved non-corrected visual acuity of 0.97 compared to femtoLASIK patients, who scored 0.83, (P=0.007). Based on data analysis from the automatic refractometer, the average spherical diopters of the femtoLASIK (-0.32 D) were higher than those of the ReLEx SMILE (-0.07 D), (P<0.001). The results for the cylindrical diopters were also significant, (P=0.021). When we compared the spherical equivalent one year after surgery, the difference between methods was significant. The FemtoLASIK method resulted in an average SE -0.55 D compared to -0.09 D for the ReLEx SMILE method, (P<0.001). Conclusion. This study showed that there was a significant difference in results between the two surgical methods of treatment of moderate myopia and astigmatism, in terms of regression of dioptric error, as well as in achievement and maintenance of visual acuity during the observed period. The ReLEx SMILE had better results. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual and refractive outcomes after FEMTOLASIK with and without iris registration.Methods: In this randomized, prospective, comparative, contralateral eye study, 118 eyes of 59 patients with myopia and myopic astigmatism underwent LASIK using the Femto LDV femtosecond laser (160 µm) and the MEL80 with or without iris registration. For each patient, iris registration FEMTOLASIK was performed on one eye and non-iris registration FEMTOLASIK was performed on the other eye, assigned at random. Patients were evaluated before and 12 months. Uncorrected visual acuity, best-corrected visual acuity, manifest refraction, contrast sensitivity, and higher-order aberrations (HOAs) were evaluated.Results: At 12 months, the mean UDVA was 0.002 ± 0.07 logMAR (20/19) in iris registration eyes and 0.00 ± 0.06 logMAR (20/24) in non-iris registration eyes (P = 0.9). 61% of iris registration eyes and 71.2% of non-iris registration eyes achieved a UDVA of 20/20 or better (P = 0.31); 98.3% of eyes with the iris registration FEMTOLASIK and 94.9% with the non-iris registration FEMTOLASIK were within ±0.50 D from emmetropia (P = 0.71). No statistically significant difference was found in postoperative contrast sensitivity between groups at 3, 6, 12, or 18 cycles/degree (P > 0.05). There was significant increase in total HOA root mean square in two groups. The mean error magnitude of surgically induced astigmatism 12 months postoperatively was −0.33 in iris registration eyes and −0.24 in the non-iris registration eyes (P = 0.36).Conclusions: FEMTOLASIK with and without iris registration provides similar results in myopic and myopic astigmatism patients. [ABSTRACT FROM AUTHOR]

Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax ® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax ® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation., (Copyright: © Tăbăcaru et al.)

Modern tonometers (Ocular Response Analyzer) can only show the presence of biomechanical disorders of the fibrous membrane, while elastotonometry reacts not only to their presence, but also to their type., Purpose: To build a mathematical model that would use elastotonometry to assess biomechanical properties of the eye in treatment of hyperopia with LASIK and FemtoLASIK surgeries., Material and Methods: The study included 64 operations: 34 FemtoLASIK surgeries, and 31 LASIK surgeries. All patients before and after surgery underwent standard examination necessary for keratorefractive surgery, including elastotonometry. The next step was the analysis of elastotonometry curves and eye finite element model in the software package Ansys (Ansys, Inc.; U.S.A.). During the analysis, the fibrous membrane was modeled by two spherical segments, which before elastotonometry were influenced only by true intraocular pressure (IOP). There was a problem of determining tonometric IOP when the cornea is pressured with flat bottomed loads during elastotonometry. It was taken into account that at the first stage of loading, the IOP was applied, and then the force corresponding to the weight of the tonometer. After tonometry, IOP increased so that the volume inside the composite membrane corresponded to the value before loading., Results: Mathematical modeling has shown that after surgical treatment of hyperopia, flexural stiffness of the cornea decreases, elevation of the elastotonometry curve increases, and the higher the true IOP, the greater the elevation. The greatest increase in lift due to increased IOP is observed after LASIK operation, while after FemtoLASIK this change is not significant, in which case the dependence of tonometric IOP on the weight of the load is almost linear., Conclusion: The obtained results allow for elastotonometry to be recommend for further medical research as a promising method for assessing biomechanical characteristics of the fibrous membrane of the eye.

Purpose: To compare the effectiveness, safety, predictability and stability of FemtoLASIK procedure in low to moderate myopia using Femto Visum and Femto LDV Z6 femtosecond laser platforms and to evaluate the effect of these procedures on corneal higher-order aberrations., Material and Methods: Russian femtolaser platform (1 MHz) was used to form the corneal flap in the main group consisting of 98 patients (98 eyes) with mean spherical equivalent (SE) of -3.73±1.42 D. Swiss femtolaser platform (5 MHz) was used in the control group (94 patients, 94 eyes; mean SE -3.81±1.44 D). Excimer laser ablation was performed using the Russian platform (500 Hz) in both groups. All patients underwent complete ophthalmological examination. The follow-up period was 12 months., Results: Twelve month postoperatively, in the '1 MHz' group uncorrected visual acuity (UCVA) of 1.0 or better was achieved in 91.8% of patients, and in the '5 MHz' group - in 90.4% (p>0.05). There were no registered losses of 2 or more lines of best-corrected visual acuity (BCVA) in either group. In the '1 MHz' group, predictability of targeted refraction within ±0.5 D was achieved in 91.8% of patients, within ±1.0 D - in 99.0%; in the '5 MHz' group - in 91.5% and 98.9% of patients, respectively (p>0.05). Root-mean-square (RMS) deviation of corneal higher-order aberrations in the 6-mm optical zone was increased by 0.072 μm (by 1.21 times) and by 0.077 μm (by 1.22 times) in the '1 MHz' and '5 MHz' groups (p>0.05), respectively., Conclusion: The FemtoLASIK procedures performed using Russian (1 MHz) and Swiss (5 MHz) femtosecond laser platforms are effective, safe, predictable, have stable postoperative visual and refractive outcomes, and lead to increase in RMS of corneal higher-order aberrations using both platforms in patients with low to moderate myopia. There were no statistically significant differences between the two femtolaser platforms (p>0.05) for all examined parameters.

Purpose: To evaluate the safety, efficacy, predictability and stability for a cohort of myopic eyes treated by Femtosecond-LASIK procedure. Methods: 60 eyes (36 patients) with different degrees of myopia that underwent refractive surgery by using the Femtosecond-LASIK technique were prospectively evaluated for 12 months. The mean preoperative spherical equivalent value was -3.827 ± 1.410 diopters (D) (range: -8.125 to -1.375 D). VisuMax® femtosecond laser was used for cutting the corneal flap and then the Mel80® excimer laser for the stromal ablation. Results: Mean age was 30.80 ± 5.745 years (range: 21 to 46 years) with 75% female patients. Postoperative spherical equivalent at 12 months was within ±0.25 D of emmetropia in 90% of the eyes and within ±0.50 D of emmetropia in 100% of the eyes. All the eyes achieved an uncorrected distance visual acuity (UDVA) of 1.0 (decimal scale). No eye lost lines of preoperative corrected distance visual acuity (CDVA). No major intraoperative or postoperative complications were encountered. Conclusions : Femtosecond-LASIK seems to be a suitable option for the correction of mild, moderate, and high myopia, as the procedure showed to be safe, effective, and predictable for the treatment of myopic refractive errors.