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Vastardis I, Gatzioufas Z, Pajic BE, Müller J, Pajic B. Multifocal Corneal Excimer Femtosecond Laser in situ Keratomileusis following Radial Keratotomy: A Case Report with Six Months of Follow-Up. Case Rep Ophthalmol 2015; 5:423-8. [PMID: 25566065 PMCID: PMC4280468 DOI: 10.1159/000369920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 46-year-old female patient who was referred to our clinic (Orasis Eye Clinic, Reinach, Switzerland) seeking improvement of her distance and near visual acuity. Radial keratotomy (RK) was performed at a younger age on both eyes to correct -5 D myopia. The patient underwent a bilateral same-session multifocal corneal excimer femtosecond laser (Supracor) keratomileusis correction. We introduce a new correction approach, possibly suitable for presbyopic patients previously treated with RK, and we present several potential novel advantages such as enhanced near, intermediate vision, and improvement in quality of life. This is the first report of a bilateral excimer laser treatment attempt of presbyopia following RK.
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Affiliation(s)
- Iraklis Vastardis
- Swiss Eye Research Foundation, ORASIS Eye Clinic, Reinach, Switzerland
| | - Zisis Gatzioufas
- Swiss Eye Research Foundation, ORASIS Eye Clinic, Reinach, Switzerland
| | | | - Jörg Müller
- Swiss Eye Research Foundation, ORASIS Eye Clinic, Reinach, Switzerland ; University of Novi Sad, Faculty of Physics, Novi Sad, Serbia
| | - Bojan Pajic
- Swiss Eye Research Foundation, ORASIS Eye Clinic, Reinach, Switzerland ; University of Novi Sad, Faculty of Physics, Novi Sad, Serbia ; Medical Faculty, Military Medical Academy, University of Defense, Belgrade, Serbia
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Sinha R, Sharma N, Ahuja R, Kumar C, Vajpayee RB. Laser in-situ keratomileusis for refractive error following radial keratotomy. Indian J Ophthalmol 2011; 59:283-6. [PMID: 21666312 PMCID: PMC3129752 DOI: 10.4103/0301-4738.81995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK). DESIGN Retrospective study. MATERIALS AND METHODS A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively. STATISTICAL SOFTWARE: STATA-9.0. RESULTS The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 ( P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen's acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was -5.37 ± 4.83 diopters (D) and -0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK. CONCLUSION LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.
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Affiliation(s)
- Rajesh Sinha
- Department of Ophthalmology, Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Rastegar A. LASIK surgery in patients with residual refractive errors after radial keratotomy. Int J Ophthalmol 2010; 3:172-4. [PMID: 22553546 DOI: 10.3980/j.issn.2222-3959.2010.02.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 05/03/2010] [Indexed: 11/02/2022] Open
Abstract
AIM To study the results and complications of LASIK surgery after radial keratotomy. METHODS This descriptive study was carried out in Yazd LASIK Center, Yazd, Iran. Cases included all patients who had been operated between April 2003 and September 2006. Data were collected via a special questionnaire and analyzed by SPSS software and paired t-test. RESULTS Samples included 33 eyes of 23 patients of whom 11 (47.8%) were women and 12 (52.2%) were men. Their age ranged from 28 to 49 years old and the mean age was 31.6 years old. Two cases (6.1%) had openings of the previous radial keratotomy incisions during flap lifting and one case (3%) had moderate non-infectious keratitis. The mean preoperative spherical equivalent (SE) was -2.17D±0.94SD, while the postoperative SE was -0.17D±0.19SD, the difference of which was significant (P=0.0001). Mean preoperative uncorrected visual acuity (UCVA) was 0.07±0.02SD (logMAR) and the postoperative was 0.880.16SD (log MAR), the difference of which was also significant (P=0.0001). The mean best spectacle corrected visual acuity prior to the operation was 0.930.08SD (log MAR) and 0.920.08SD (logMAR) after the operation, the difference of which was not significant (P=0.268). CONCLUSION LASIK surgery could improve residual myopia after the radial keratotomy without major complications during or post operation, but necessity of the second procedure must be pondering and require careful case selection and assessment.
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Affiliation(s)
- Abolghasem Rastegar
- Department of Ophthalmology, Sadoughi Hospital, Yazd Medical Sciences University, Yazd, Iran
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Perente I, Utine CA, Cakir H, Yilmaz OF. Complicated Flap Creation With Femtosecond Laser After Radial Keratotomy. Cornea 2007; 26:1138-40. [PMID: 17893553 DOI: 10.1097/ico.0b013e318123f2b1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of laser in situ keratomileusis (LASIK) that used the Intralase femtosecond laser 14 years after radial keratotomy (RK) for residual myopic astigmatism. METHODS A 39 year-old male patient had undergone a bilateral RK operation for myopic correction. The manifest refraction was -1.25 -3.00 x 175 D, with uncorrected visual acuity (UCVA) of 20/50 and best-corrected visual acuity (BCVA) of 20/20. The central and thinnest pachymetry measurements were 582 and 576 mum, respectively, by Orbscan II. RESULTS Intralase was used for LASIK, and initially, a loss of suction was seen during flap formation. The flap could be created again at the same intracorneal plane. During flap lifting, the RK incisions were separated, and one of the RK incisions progressed to the corneal center with the force applied by the blunt spatula. No piece was separated completely from the flap. Excimer laser treatment and flap repositioning could be done without any problems. At the fifth postoperative month, his UCVA was 20/20. All RK incisions seemed well aligned. There was no haze or epithelial ingrowth. CONCLUSIONS This case showed that the Intralase femtosecond laser not only has no unique benefit as opposed to the mechanical keratome for post-RK eyes but also can lead to serious complications. We recommend that femtosecond laser flap formation not be used in post-RK eyes.
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Affiliation(s)
- Irfan Perente
- Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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Tahzib NG, Eggink FAGJ, Odenthal MTP, Nuijts RMMA. Artisan iris-fixated toric phakic and aphakic intraocular lens implantation for the correction of astigmatic refractive error after radial keratotomy. J Cataract Refract Surg 2007; 33:531-5. [PMID: 17321407 DOI: 10.1016/j.jcrs.2006.10.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
We report 2 patients who had radial keratotomy (RK) to correct myopia. The first patient developed a postoperative hyperopic shift and cataract. Nine years post RK, she had intracapsular cataract extraction and implantation of an Artisan aphakic intraocular lens (IOL). Twenty years post RK, hyperopia and astigmatism progressed to +7.0 -5.75 x 100 with a best corrected visual acuity (BCVA) of 20/20. Due to contact lens intolerance, the Artisan aphakic IOL was exchanged for an Artisan toric aphakic IOL. Three months later, the BCVA was 20/20 with +1.0 -0.50 x 130. The second patient demonstrated residual myopic astigmatism 6 years after bilateral RK and had become contact-lens intolerant. An Artisan toric phakic IOL was implanted in both eyes. Four months later, the BCVA was 20/25 with a refraction of +0.25 -1.0 x 135 and 20/20 with a refraction of -1.0 x 40. Both patients were satisfied with the visual outcomes.
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Affiliation(s)
- Nayyirih G Tahzib
- Department of Ophthalmology, the Diaconessenhuis, Leiden, The Netherlands.
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Muñoz G, Albarrán-Diego C, Sakla HF, Pérez-Santonja JJ, Alió JL. Femtosecond laser in situ keratomileusis after radial keratotomy. J Cataract Refract Surg 2006; 32:1270-5. [PMID: 16863960 DOI: 10.1016/j.jcrs.2006.02.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 02/22/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the safety, efficacy, and predictability of femtosecond laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK). SETTING Hospital Virgen del Consuelo de Valencia, Valencia, and Vissum Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS This prospective study comprised 11 eyes of 7 patients with residual low myopia after previous RK who had surgery with the IntraLase femtosecond laser (IntraLase Corp.) and the Star 2 excimer laser (Visx, Inc.). Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), defocus equivalent, refraction, flap thickness, flap diameter, and intraoperative complications were evaluated over a minimum 6-month follow-up. RESULTS Although the RK incisions opened in all eyes when the flap was lifted, LASIK was successfully completed in all cases. Mean flap thickness was 119 microm +/- 13 (SD). There were no cases of slipped flaps, microstriae, or epithelial ingrowth. Defocus equivalent was reduced from a mean of 2.51 +/- 0.62 diopters (D) to 0.52 +/- 0.28 D; 7 eyes (63.6%) were within +/-0.50 D, and 11 eyes (100%) were within +/-1.00 D. All eyes had 20/40 or better UCVA, although 2 eyes (18.1%) lost 1 line of BSCVA. CONCLUSIONS The femtosecond laser was safely used to create thin LASIK flaps in eyes with previous RK. An increased postoperative inflammatory response may explain the loss of BSCVA in some cases. Efficacy and predictability of the procedure were comparable to those of LASIK after RK with mechanical microkeratomes.
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Affiliation(s)
- Gonzalo Muñoz
- Refractive Surgery Department, Hospital NISA Virgen del Consuelo, Valencia, Spain.
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Afshari NA, Schirra F, Rapoza PA, Talamo JH, Ludwig K, Adelman RA, Kenyon KR. Laser in situ keratomileusis outcomes following radial keratotomy, astigmatic keratotomy, photorefractive keratectomy, and penetrating keratoplasty. J Cataract Refract Surg 2006; 31:2093-100. [PMID: 16412921 DOI: 10.1016/j.jcrs.2005.08.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 03/11/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) to enhance refractive status following other corneal surgical procedures. SETTING Clinical office-based practice. METHODS Seventy-one eyes of 57 patients had LASIK for refractive errors following radial keratotomy (n = 22), astigmatic keratotomy (n = 13), photorefractive keratectomy (n = 18), and penetrating keratoplasty (n = 18). A Moria LSK-1 microkeratome was used with a Visx S2 or Wavelight Allegretto excimer laser. Data were acquired by retrospective chart review of all appropriately qualified patients. RESULTS The mean preoperative manifest refractive spherical equivalent (MRSE) was -3.93 diopters (D) +/- 2.83 (SD) in myopic eyes and +1.43 +/- 1.79 D in hyperopic eyes. The mean time from the initial corneal surgical procedure to LASIK was 65.0 months. The mean post-LASIK follow-up was 9.40 months (range 1 to 42 months). Postoperatively, the mean MRSE was -0.85 +/- 1.42 D in myopic eyes (P<.0001) and -0.16 +/- 1.09 D in hyperopic eyes (P<.0001). Enhancement by LASIK was required in 14% of eyes. CONCLUSION In eyes that have had a variety of previous corneal surgeries, LASIK offers a safe and predictable method for enhancing refractive results.
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Affiliation(s)
- Natalie A Afshari
- Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27705, USA.
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Oral D, Awwad ST, Seward MS, Bowman RW, McCulley JP, Cavanagh HD. Hyperopic laser in situ keratomileusis in eyes with previous radial keratotomy. J Cataract Refract Surg 2005; 31:1561-8. [PMID: 16129292 DOI: 10.1016/j.jcrs.2005.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK). SETTING Zale Lipshy University Hospital Laser Center for Vision, University of Texas Southwestern Medical Center, Dallas, Texas, USA. METHODS Thirty-eight eyes of 25 patients were treated with LASIK for secondary hyperopia after RK using a Visx Star S2, S3, S4, or LADARVision excimer laser. Retreatment was done in 7 eyes. The main outcome measures were manifest refraction spherical equivalent (MRSE), uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of treatment, and complications. RESULTS Preoperative mean MRSE was +2.39 diopters (D) +/- 1.28 (SD) (range +0.87 to +6.00 D). At the last visit (25 eyes with minimum follow-up of 12 months, including retreatments), the mean follow-up was 23.3 +/- 7.3 months (range 12 to 34 months), the mean MRSE was +0.11 +/- 0.71 D, and the UCVA was 20/40 or better in 24 eyes (96%). Although no significant change in the mean MRSE was observed, the postoperative mean refractive cylinder showed a gradual increase over the follow-up period. No eye lost more than 2 lines of BSCVA. CONCLUSIONS Laser in situ keratomileusis was a safe and effective treatment with good predictability for the correction of consecutive hyperopia after RK. Cylindrical errors were difficult to correct, and astigmatic correction tended to regress over time. Retreatments are safe when old flaps were relifted.
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Affiliation(s)
- Deniz Oral
- Department of Ophthalmology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9057, USA
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Muñoz G, Montés-Micó R, Albarrán-Diego C, Alió JL. Keratectasia after bilateral laser in situ keratomileusis in a patient with previous radial and astigmatic keratotomy. J Cataract Refract Surg 2005; 31:441-5. [PMID: 15767172 DOI: 10.1016/j.jcrs.2004.05.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2004] [Indexed: 11/26/2022]
Abstract
We describe a case of bilateral keratectasia after laser in situ keratomileusis (LASIK) in a patient with previous radial keratotomy and astigmatic keratotomy. The best spectacle-corrected visual acuity (BSCVA) was 20/25 in both eyes. After uneventful LASIK was performed in both eyes for low myopic astigmatism, the patient presented with progressive myopia and astigmatism and a BSCVA of 20/50 in both eyes. Videokeratography showed progressive deformation of the cornea, increasing K-values over 50.0 diopters, and irregular astigmatism. The best corrected visual acuity in both eyes improved to 20/25 with rigid poly(methyl methacrylate) contact lenses.
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Affiliation(s)
- Gonzalo Muñoz
- Refractive Surgery Department, Instituto Oftalmológico de Alicante, Hospital NISA Virgen del Consuelo, Valencia, Spain.
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Joyal H, Grégoire J, Faucher A. Photorefractive keratectomy to correct hyperopic shift after radial keratotomy. J Cataract Refract Surg 2003; 29:1502-6. [PMID: 12954296 DOI: 10.1016/s0886-3350(03)00482-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To evaluate the safety, efficacy, and predictability of photorefractive keratectomy (PRK) to correct post-radial-keratotomy (RK) hyperopic shift. University of Sherbrooke, Sherbrooke, Québec, Canada.This retrospective nonconsecutive case series comprised 53 eyes of 53 patients who had PRK to correct hyperopic shift after RK. Both RK and PRK were performed by the same surgeon at the same clinic from 1993 to 2001.The mean time after RK was 57 months (range 24 to 84 months). The mean follow-up after hyperopic PRK (HPRK) was 10 months (range 3 to 33 months). The mean hyperopic shift 1 month post-RK to HPRK was +1.6 diopters (D) +/- 1.0 (SD) (range +0.25 to +4.125 D). The mean pre-HPRK spherical equivalent (SE) was +2.15 +/- 0.80 D (range +1.00 to +4.125 D) and the mean post-HPRK SE, -0.10 +/- 0.80 D (range -2.00 to +2.125 D). At the last examination, 47 eyes (88.7%) had a refractive error within +/-1.0 D of emmetropia and 38 eyes (71.7%) had an uncorrected visual acuity of 20/25 or better. Two eyes lost 1 Snellen line of best corrected visual acuity. No significant haze or complications developed in any eye. Hyperopic PRK with a conservative technique (large optical zone and small ablation thickness) can be used successfully to correct RK-induced hyperopia in patients with small to moderate refractive errors. It appeared to be effective, predictable, and safe.
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Affiliation(s)
- Hélène Joyal
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Sforza PD, Saffra NA. Laser in situ keratomileusis as treatment for anisometropia after scleral buckling surgery. J Cataract Refract Surg 2003; 29:1042-4. [PMID: 12781299 DOI: 10.1016/s0886-3350(02)01606-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Scleral buckling is an excellent procedure for retinal reattachment but can induce disabling refractive errors. Laser in situ keratomileusis (LASIK) has been proven effective for the reduction of refractive errors induced by ophthalmic surgery. We describe the case of a 53-year-old man who developed symptomatic anisometropia after placement of a scleral buckle for repair of a rhegmatogenous retinal detachment (RD). After the scleral buckling procedure, he retained excellent best corrected visual acuity but could not tolerate spectacle or contact lens correction. Thirty-four months after the scleral buckling procedure, LASIK was performed to correct myopic astigmatism with excellent refractive and functional results. This case demonstrates that LASIK may be safe and effective for the correction of refractive errors induced by RD repair.
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Affiliation(s)
- Paul D Sforza
- Department of Ophthalmology, Maimonides Medical Center, 902 49th Street, Brooklyn, NY 11219, USA
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