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Hira S, Klein Heffel K, Mehmood F, Sehgal K, Felix De Farias Santos AC, Steuernagel Del Valle G. Comparison of refractive surgeries (SMILE, LASIK, and PRK) with and without corneal crosslinking: systematic review and meta-analysis. J Cataract Refract Surg 2024; 50:523-533. [PMID: 38288954 DOI: 10.1097/j.jcrs.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 04/24/2024]
Abstract
Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with vs without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with vs without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform statistical analysis. We included 2820 eyes from 28 studies. Compared with refractive surgery alone, surgery with prophylactic CXL resulted in decreased central corneal thickness, corrected distance visual acuity logMAR, and safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity of 20/20 or better at ≥12 months and other visual outcomes among both groups. More randomized controlled trials with standard crosslinking protocols are needed to analyze the prophylactic use of crosslinking with refractive surgeries.
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Affiliation(s)
- Sara Hira
- From the FMH College of Medicine & Dentistry, Lahore, Pakistan (Hira); Federal University of Pelotas, Pelotas, Brazil (Klein Heffel); Department of Ophthalmology, Fatima Memorial Hospital, Lahore, Pakistan (Mehmood); Teerthanker Mahaveer University, Moradabad, UP, India (Sehgal); City University of São Paulo, São Paulo, Brazil (Felix De Farias Santos); University of Iowa, Iowa City, Iowa (Steuernagel Del Valle)
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Masarwa D, Blockstein K, Sela T, Munzer G, Kaiserman I. Tel-Aviv Protocol for Postrefractive Surgery Corneal Ectasia: A Case Series. Cornea 2024; 43:578-584. [PMID: 37983313 DOI: 10.1097/ico.0000000000003428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this study was to describe the safety and efficacy of the Tel-Aviv Protocol (epithelial photorefractive keratectomy and corneal cross-linking) as a treatment for postrefractive surgery corneal ectasia. METHODS This study includes 8 eyes from 7 patients, each diagnosed with postrefractive surgery ectasia years after refractive surgery and treated with the Tel-Aviv Protocol. The procedure included transepithelial PRK using the EX500 excimer laser, a 50-μm laser ablation of the epithelium and anterior stroma, delivered on the visual axis with cyclotorsion correction, treating up to 50% of refractive astigmatism. After the epithelial photorefractive keratectomy, all patients underwent corneal cross-linking. RESULTS The mean keratometry (K) and maximal K both decreased [from 43.37 ± 2.23 to 41.84 ± 2.01 ( P = 0.03) and from 44.95 ± 3.08 to 42.78 ± 2.19 ( P = 0.03), respectively]. Astigmatism was significantly reduced (from 3.53 ± 2.36 to 0.88 ± 0.89 diopter; P = 0.02). Uncorrected visual acuity improved significantly in all patients from a mean of 0.56 ± 0.32 to 0.15 ± 0.14 logMAR ( P = 0.01). Best-corrected visual acuity improved from 0.22 ± 0.24 to 0.06 ± 0.06 logMAR ( P = 0.07; 1-tail P = 0.04). All patients maintained visual acuity during the follow-up period, up to 25 months, mean = 329 days. The Tel-Aviv Protocol was found to be safe [mean safety index: 1.63 ± 1.03 (range: 1.00-4)] and effective [mean efficacy index: 1.29 ± 0.66 (range: 0.71-2.1)]. CONCLUSIONS The Tel-Aviv Protocol, developed initially for keratoconus treatment, is a safe and promising procedure to stop postrefractive surgery ectasia progression while significantly improving vision, thereby avoiding keratoplasty.
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Affiliation(s)
- Dua Masarwa
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Keren Blockstein
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Tzahi Sela
- Care-Vision Laser Center, Tel Aviv, Israel; and
| | - Gur Munzer
- Care-Vision Laser Center, Tel Aviv, Israel; and
| | - Igor Kaiserman
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
- Care-Vision Laser Center, Tel Aviv, Israel; and
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Zhang Z, Xiang LX, Wu Y, Li Q, Ke SH, Liu LQ. Factors affecting long-term myopic regression after corneal refractive surgery for civilian pilots in southwest China. BMC Ophthalmol 2024; 24:145. [PMID: 38561680 PMCID: PMC10985992 DOI: 10.1186/s12886-024-03399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The purpose of this study was to analyze myopic regression after corneal refractive surgery (CRS) in civilian pilots and to explore the factors that may cause long-term myopic regression. METHODS We included civilian pilots who had undergone CRS to correct their myopia and who had at least 5 years of follow-up. We collected retrospective data and completed eye examinations and a questionnaire to assess their eye habits. RESULTS A total of 236 eyes were evaluated in this study. 211 eyes had Intrastromal ablations (167 eyes had laser in situ keratomileusis, LASIK, 44 eyes had small incision lenticule extraction, SMILE) and 25 eyes had subepithelial ablations (15 eyes had laser epithelial keratomileusis, LASEK and 10 eyes had photorefractive keratectomy, PRK). The mean preoperative spherical equivalent (SE) was - 2.92 ± 1.11 D (range from - 1.00 to -5.00 D). A total of 56 eyes (23.6%) suffered from myopic regression after CRS. Comparisons of individual and eye characteristics between the regression and non-regression groups revealed statistically significant differences in age, cumulative flight time, postoperative SE (at 6 months and current), uncorrected visual acuity (UCVA), accommodative amplitude (AA), positive relative accommodation (PRA), postoperative period, types of CRS and eye habits. Generalized propensity score weighting (GPSW) was used to balance the distribution of covariates among different age levels, types of CRS, cumulative flying time, postoperative period and continuous near-work time. The results of GPS weighted logistic regression demonstrated that the associations between age and myopic regression, types of CRS and myopic regression, continuous near-work time and myopic regression were significant. Cumulative flying time and myopic regression, postoperative period and myopic regression were no significant. Specifically, the odds ratio (OR) for age was 1.151 (P = 0.022), and the OR for type of CRS was 2.769 (P < 0.001). The OR for continuous near-work time was 0.635 with a P value of 0.038. CONCLUSIONS This is the first report to analyze myopic regression after CRS in civilian pilots. Our study found that for each year increase in age, the risk of civilian pilots experiencing myopic regression was increased. Intrastromal ablations had a lower risk of long-term myopia regression than subepithelial ablations. There is a higher risk of myopic progression with continuous near-work time > 45 min and poor accommodative function may be related factors in this specific population.
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Affiliation(s)
- Zhen Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, PR China
- Department of Ophthalmology, Chengdu Civil Aviation Medical Center, Chengdu, Sichuan Province, PR China
| | - Lan Xi Xiang
- Department of Ophthalmology, Chengdu Civil Aviation Medical Center, Chengdu, Sichuan Province, PR China
| | - Ye Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, PR China
| | - Qi Li
- Department of Internal, Chengdu Civil Aviation Medical Center, Chengdu, Sichuan Province, PR China
| | - Shan Hua Ke
- Department of Ophthalmology, Chengdu Civil Aviation Medical Center, Chengdu, Sichuan Province, PR China
| | - Long Qian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guoxue Xiang, Chengdu, Sichuan Province, 610041, PR China.
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Gupta A, Huang S, Sun MT, Zamora-Alejo K. Intrastromal Corneal Ring Segment Implantation Followed by Simultaneous Topography-Guided Photorefractive Keratectomy and Corneal Cross-Linking for Contact Lens-Intolerant Keratoconus. Cornea 2024; 43:307-314. [PMID: 37543736 DOI: 10.1097/ico.0000000000003354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/29/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE This study aimed to evaluate the efficacy and safety of Keraring implantation followed by simultaneous topography-guided photorefractive keratectomy (TGPRK) and corneal cross-linking (CXL) in the management of keratoconus. METHODS This is a single-center, private practice, retrospective review. Patients with keratoconus who were intolerant to contact lens wear underwent implantation of the Keraring, followed by TGPRK with CXL from 2 to 36 months after implantation. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction (cylinder and spherical equivalent), keratometry (steep, maximum, and central), and central corneal thickness (CCT). Patients were followed up for 3 to 60 months postoperatively. RESULTS Fifty-seven eyes from 45 patients were included. The mean time between Keraring and TGPRK/CXL was 6.0 ± 6.0 months. Patients were followed up for a mean of 28.6 ± 20.1 months after Keraring insertion. At 12-month follow-up, there was a statistically significant improvement in mean UDVA (0.94 ± 0.49-0.35 ± 0.23, P < 0.01), CDVA (0.39 ± 0.26-0.17 ± 0.15, P < 0.01), cylinder (-4.97 ± 2.68 to -1.74 ± 1.25, P < 0.01), steep keratometry (51.25 ± 3.37-45.03 ± 2.27, P < 0.01), central keratometry (52.59 ± 4.98-46.99 ± 3.53, P < 0.01), and maximum keratometry (58.78 ± 4.22-50.76 ± 3.42, P < 0.01). These results were sustained at 48-month follow-up. CCT decreased at 12 months after TGPRK (461.84 ± 27.46-418.94 ± 45.62, P < 0.01) and remained stable at 60 months. Postoperatively, 2 eyes (3.51%) had corneal haze, resulting in decrease in CDVA; 1 was treated successfully with repeat PRK; and 1 patient (1.75%) had wound melt due to partial Keraring extrusion, which settled with repositioning. CONCLUSIONS Keraring implantation followed by simultaneous TGPRK and CXL appears to be effective in the long term in improving UDVA, CDVA, cylinder, CCT, and keratometry in patients with keratoconus who are intolerant to contact lenses.
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Affiliation(s)
- Aanchal Gupta
- South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- IVISION Laser Eye Surgery, Adelaide, South Australia, Australia; and
| | - Sonia Huang
- South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michelle T Sun
- South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Katherine Zamora-Alejo
- IVISION Laser Eye Surgery, Adelaide, South Australia, Australia; and
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
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Ning J, Zhang L. Fourier analysis of corneal irregular astigmatism after small-incision lenticule extraction and transepithelial photorefractive keratectomy: A comparative study. Medicine (Baltimore) 2024; 103:e37340. [PMID: 38428861 PMCID: PMC10906594 DOI: 10.1097/md.0000000000037340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
To compare changes in the spherical component, regular astigmatism, and irregular astigmatism of the anterior surface of the cornea after small-incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (TransPRK). Fifty-six patients underwent SMILE in 56 eyes, and 68 patients underwet TransPRK in 68 eyes. The right eye was chosen to enter the group. Six months after the procedure, Scheimpflug images were acquired, and Fourier analysis of the anterior surface of patients' corneas was performed using the Pentacam built-in software. Fourier parameters encompass various measurements such as the steepest radius of the curvature and average eccentricity of the spherical components (SphRmin and SphEcc), maximum decentration (MaxDec), central and peripheral regular astigmatism (regular astigmatism at the center [AstC] and regular astigmatism at the periphery [AstP]), and irregularity (Irr). At 6 months postoperatively, SphEcc decreased significantly (P < .001), MaxDec increased significantly (P < .001), and Irr increased insignificantly (P = .254) in the SMILE group. SphEcc decreased significantly (P < .001) and MaxDec and Irr increased significantly (P < .001) in the TransPRK group. TransPRK caused greater changes in SphEcc, MaxDec, and Irr on the anterior corneal surface than SMILE (P < .05). The amount of MaxDec-induced changes in SMILE and TransPRK was significantly correlated with the amount of higher-order aberrations and spherical aberration changes (P < .05). SMILE and TransPRK increase overall irregular astigmatism on the anterior surface of the cornea, more so with TransPRK, where changes in decentration are associated with with increased higher-order aberrations.
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Affiliation(s)
- Jiliang Ning
- Department of Ophthalmology, The Third People’s Hospital of Dalian, Dalian, China
- Department of Ophthalmology, Dalian Municipal Eye Hospital, Dalian, China
- Liaoning Provincial Key Laboratory of Cornea and Ocular Surface Diseases, Dalian, China
- Liaoning Provincial Optometry Technology Engineering Research Center, Dalian, China
| | - Lijun Zhang
- Department of Ophthalmology, The Third People’s Hospital of Dalian, Dalian, China
- Department of Ophthalmology, Dalian Municipal Eye Hospital, Dalian, China
- Liaoning Provincial Key Laboratory of Cornea and Ocular Surface Diseases, Dalian, China
- Liaoning Provincial Optometry Technology Engineering Research Center, Dalian, China
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Mazzotta C, Stojanovic A, Romano V, Addabbo G, Borroni D, Balamoun AA, Ferrise M. Ray-Tracing Transepithelial Excimer Laser Central Corneal Remodeling Plus Pachymetry-Guided Accelerated Corneal Crosslinking for Keratoconus. Cornea 2024; 43:285-294. [PMID: 37699556 PMCID: PMC10836791 DOI: 10.1097/ico.0000000000003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The aim of this study was to report the 12 to 96 months results of a tissue-preservation algorithm based on ray-tracing-guided transepithelial excimer laser central corneal ablation (RT t-PRK) combined with individualized pachymetry-guided accelerated crosslinking (M nomogram ACXL) in young adult patients with stable keratoconus (KC). METHODS This was a prospective interventional study including 38 eyes of 38 young adult patients (stage II KC) with a mean age of 35 years (range 26-46 years) who underwent simultaneous RT with t-PRK plus pachymetry-based ACXL in the worst eye. The treatments were performed using the iViS Suite iRES Excimer Laser (Ligi, Taranto, Italy). Ray-tracing-guided treatments were planned using the customized interactive programmed transepithelial ablation (CIPTA) 2 web software and diagnostic data were assessed by the Precisio 2 tomographer (Ligi, Taranto, Italy) and Sirius tomographer (C.S.O., Florence, Italy). The main outcome measures included uncorrected distance visual acuity, best spectacle-corrected visual acuity, Kmax, high-order aberrations, minimum corneal thickness, and posterior elevation, with a mean follow-up of 52 months (range 12-96 m). RESULTS The mean UDVA improved + 3.5 ±1.28 Snellen lines (SL); 38% gained ≥ 4 ±1.34 SLs, 35% ≥ 3 ±1.21 SLs, 22% ≥ 2 ±1.12 SLs, and 5% ≥ 1 ±0.75 SLs. The mean best spectacle-corrected visual acuity increased by + 4.3 ±1.3 SL. Sixty-eight percent gained ≥ 4 ±0.88 SLs and 30% ≥ 3 ±0.78 SL. No SLs were lost. CONCLUSIONS RT t-PRK plus ACXL significantly improved the quality of vision in patients with KC, preventing overcorrection and minimizing tissue consumption.
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Affiliation(s)
- Cosimo Mazzotta
- Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, Italy
- Departmental Ophthalmology Unit, AUSL Toscana Sud Est, Campostaggia, Siena, Italy
- Siena Crosslinking Center, Siena, Italy
| | | | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- ASST Civil Hospital of Brescia, Brescia, Italy
| | - Giuseppe Addabbo
- Eye Clinic, Hospital “SS. Annunziata”, ASL Taranto, Taranto, Italy
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Ashraf Armia Balamoun
- Watany Eye Hospital (WEH), Research and Development Centre, Cairo, Egypt
- Ashraf Armia Eye Clinic, Giza, Egypt; and
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Saad A, Saad A, Frings A. Refractive results of photorefractive keratectomy comparing trans-PRK and PTK-PRK for correction of myopia and myopic astigmatism. Int Ophthalmol 2024; 44:111. [PMID: 38403780 PMCID: PMC10894757 DOI: 10.1007/s10792-024-02999-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/19/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE To compare refractive outcomes after transepithelial photorefractive keratectomy (tPRK) and combined phototherapeutic keratectomy (PTK-PRK) procedure using two different excimer laser platforms for correction of myopia and myopic astigmatism. METHODS In this retrospective multicenter study, we compared the results of two different PRK methods. The first group received a tPRK treatment with the Amaris750 excimer laser (Schwind eye-tech solutions). The second group received a combined PTK-PRK treatment with the MEL90 excimer laser (Carl Zeiss). Only healthy eyes with no previous surgery and a spherical equivalent (SE) of -1 to -8 diopters (D) were included. Preoperative spherical equivalent (SE), age, and sex were matched among the two groups. All treatments were performed by the same surgeon in different clinics. This study was approved by the local Ethics Committee (No. 2022-1980). RESULTS We included 154 eyes of 86 patients in our study. There was no difference in predictability of SE between the two groups. Efficacy and safety indices were equally high in both groups. Similarly, no significant differences were seen in change of higher order aberrations (HOA) between the two groups (p > 0.05). No complications occurred. CONCLUSION Both investigated methods provide safe and effective refractive results. The combination of PTK with PRK may be a suitable option to the already used one-step tPRK for the correction of myopia.
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Affiliation(s)
- Ahmed Saad
- Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany
| | - Amr Saad
- Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany
| | - Andreas Frings
- Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany.
- Augenlaser-Zentrum Kärnten, Klagenfurt am Wörthersee, Klagenfurt, Austria.
- Augenheilkunde and Augenlaser Zentrum PD Dr. med. A. Frings, Nuremberg, Germany.
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Chorny A, Gershoni A, Mahler O, Sorkin N, Nahum Y, Sella R, Bahar I, Livny E. Corneal pseudoectasia: a case series. Int Ophthalmol 2024; 44:17. [PMID: 38321320 DOI: 10.1007/s10792-024-02992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 10/19/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To raise awareness of conditions that can tomographically mimic corneal ectasia and describe the actions required to avoid misdiagnosis. METHODS We report a retrospective case series of seven patients presenting at two tertiary care centers in Israel with a presumed diagnosis of keratoconus or post-refractive ectasia. Upon further examination, the ectasia diagnosis was reconsidered and eventually ruled out. RESULTS Included were ten eyes of seven patients. Cases included bilateral diffuse Salzmann's nodular degeneration, ophthalmoplegia with strabismus which precluded proper fixation during the acquisition of tomography images, two cases of incorrect Pentacam parameter settings, a patient with a history of hyperopic laser-assisted in situ keratomileusis (LASIK) treatment in one eye and myopic LASIK in the fellow eye, a case of old post-photorefractive keratectomy (PRK) stromal haze, and a patient with posterior polymorphous corneal dystrophy. CONCLUSIONS Tomography patterns mimicking corneal ectasia can appear in patients without ectatic pathology. The comprehensive ophthalmologist should be aware of such cases as they may substantially alter the treatment course and prognosis of these patients.
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Affiliation(s)
- Alexander Chorny
- Department of Ophthalmology, Soroka University Medical Center, Be'er Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
- Sydney Eye Hospital, 8 Macquarie St, Syndey, 2000, Australia.
| | - Assaf Gershoni
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Mahler
- Department of Ophthalmology, Shamir Medical Center, Be'er Yaakov, Israel
- Enaim Medical Center, Tel Aviv, Israel
| | - Nir Sorkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruti Sella
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wilson SE, Goshe JM. Prevention and Treatment of Persistent Epithelial Defects After Common Refractive Surgery Procedures. J Refract Surg 2024; 40:e117-e124. [PMID: 38346121 DOI: 10.3928/1081597x-20240102-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE To discuss the prevention and treatment of persistent epithelial defects after the most common refractive surgeries-photorefractive keratectomy, laser in situ keratomileusis, or small incision lenticule extraction. METHODS PubMed was used to search the medical literature. RESULTS Persistent epithelial defects are infrequent after photorefractive keratectomy, laser in situ keratomileusis, or small incision lenticule extraction. In the authors' opinion, any persistent epithelial defect present at 1 week or beyond after surgery should be treated aggressively with a properly fit bandage contact lens, lubrication with non-preserved artificial tears, and treatment of any eyelid abnormalities, including nocturnal lagophthalmos. Consideration should be given for presumptive treatment for herpes simplex virus or varicella zoster virus infection. If the persistent epithelial defect does not close within 2 weeks, then other measures should be considered, such as autologous serum drops, topical losartan, amniotic membranes, and topical human recombinant nerve growth factor to limit corneal scarring fibrosis and microbial infection. CONCLUSIONS Persistent epithelial defects are among the most feared complications of refractive surgery. Timely and aggressive treatment should be instituted to close the epithelium prior to the development of scarring fibrosis and/or microbial corneal infection. [J Refract Surg. 2024;40(2):e117-e124.].
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Sorkin N, Kaiserman I, Kayal M, Levinger E, Mashour RS, Sela T, Munzer G, Mimouni M. Factors Predicting the Need for Re-treatment After Laser Refractive Surgery in Patients With Mixed Astigmatism. J Refract Surg 2024; 40:e73-e78. [PMID: 38346124 DOI: 10.3928/1081597x-20231212-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE To identify risk factors that increase the likelihood of re-treatment following refractive surgery in patients with mixed astigmatism. METHODS This was a retrospective study including patients who underwent either laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between 2000 and 2019 and had mixed astigmatism (spherical error of +0.50 D or greater and spherical equivalent of less than 0.00 diopters [D]). Patients were divided into two groups according to whether they underwent re-treatments during the study period. RESULTS Overall, 785 eyes (785 patients) were included. In total, 5.2% of the eyes (n = 41) underwent re-treatment. The re-treatment group was more likely to have preoperative high astigmatism (80.5% vs 48.3%, P < .001), moderate to high hyperopia (36.6% vs 22.3%, P = .035), and to have undergone surgery earlier during the study period (P < .001). They were also more likely to have undergone surgery using the Wave-Light EX200 rather than the EX500 laser platform (Alcon Laboratories, Inc) (P < .001), have a treated optical zone of 6 mm rather than 6.5 mm (P < .001 for both), and their maximum ablation depth was greater (P < .001). There was no difference between the re-treatment and control groups regarding procedure type (PRK vs LASIK). Binary logistic regression found preoperative high astigmatism (odds ratio = 3.97, P < .001) and the type of laser platform used (EX200, odds ratio = 7.78, P < .001) as the only independent factors associated with re-treatment. CONCLUSIONS Re-treatment rates following correction of mixed astigmatism were 5.2% over 20 years. Use of a sixth-generation laser platform significantly reduced the risk of re-treatment. Presence of high astigmatism is a significant risk factor for re-treatment. There was no difference in retreatment risk between PRK and LASIK. [J Refract Surg. 2024;40(2):e73-e78.].
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Vakalopoulos DG, Chatzea MS, Chronopoulou K, Katsimpras M, Tsopouridou RD, Kymionis GD. Corneal Irregularity Induced by Transepithelial Photorefractive Keratectomy in a Patient With Partial Limbal Stem Cell Deficiency. Cornea 2024; 43:249-252. [PMID: 37906019 DOI: 10.1097/ico.0000000000003408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/15/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The aim of this study was to present a case of transepithelial photorefractive keratectomy (trans-PRK) laser ablation in a patient with partial limbal stem cell deficiency (LSCD) that resulted in corneal irregularity. METHODS A 23-year-old man with bilateral partial LSCD underwent trans-PRK for myopia correction 2 months before presentation to our department. Trans-PRK ablation was performed with a phototherapeutic keratectomy ablation profile set at 60 μm in the OD and 57 μm in the OS and 8 mm zone. At the time of presentation, the patient complained of decreased visual acuity. Corrected distant visual acuity was 20/20 (-3.25, -0.75 × 180 degrees) and 20/50 (-3.00, -3.00 × 180 degrees) in the OD and the OS, respectively. No further ocular history was reported other than prolonged soft contact lens use for myopia. Pre-trans-PRK tomography (WaveLight Oculyzer II diagnostic system, WaveLight GmbH, Germany) revealed bilateral superior steepening with corresponding epithelial thinning as obtained by the epithelial map using Optovue optical coherence tomography (Visionix Luneau technology). Slit-lamp examination showed bilateral superficial neovascularization, suggestive of early-stage LSCD. RESULTS A nonuniform laser stromal ablation resulting in corneal irregularity and decreased visual acuity was observed 2 months postoperatively. During the 6-month follow-up, corneal tomography was stable with only minimal improvement. At that time, corrected distant visual acuity remained 20/20 (-2.75, -0.75 × 160 degrees) in the OD and 20/50 (-3.00, -3.00 × 180 degrees) in the OS. CONCLUSIONS Trans-PRK seems to be a contraindication in cases with corneal epithelial irregularities and could lead to abnormal and nonuniform stromal ablation .
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Affiliation(s)
- Dionysios G Vakalopoulos
- National and Kapodistrian University of Athens, First Department of Ophthalmology, "G. Gennimatas" Hospital, Athens, Greece; and
| | - Marina S Chatzea
- National and Kapodistrian University of Athens, First Department of Ophthalmology, "G. Gennimatas" Hospital, Athens, Greece; and
| | | | - Marios Katsimpras
- National and Kapodistrian University of Athens, First Department of Ophthalmology, "G. Gennimatas" Hospital, Athens, Greece; and
| | | | - George D Kymionis
- National and Kapodistrian University of Athens, First Department of Ophthalmology, "G. Gennimatas" Hospital, Athens, Greece; and
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Khodaparast M, Ambrósio R, Ahmadzadeh H, Khorrami-Nejad M, Mohammadzadeh M, Azizi S, Mohammadi SF, Hashemian H. Evaluation of the effect of artificial tears on corneal epithelial thickness changes after photorefractive keratectomy. Indian J Ophthalmol 2024; 72:66-72. [PMID: 38131572 PMCID: PMC10841771 DOI: 10.4103/ijo.ijo_1354_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/30/2023] [Accepted: 08/12/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE This study aimed to evaluate the corneal epithelial thickness changes after photorefractive keratectomy (PRK) and the impact of long-term artificial tear usage on epithelial thickness changes in these patients. METHODS This study was performed on 71 patients (142 eyes) without dry eye disease who received PRK for myopic refractive correction. The corneal epithelial thickness profile was obtained before, one, three, and six months after surgery using anterior segment optical coherence tomography. Patients were randomly divided into two groups: group A, who received preservative-free artificial tears post-surgery, and group B, who did not receive artificial tears. RESULTS The epithelial thickness decreased universally in the first month and then increased in the 3- and 6-month follow-ups. Group A had a significantly thicker epithelium in central, paracentral, and midperipheral zones compared with group B in the 3-month follow-up. In the 6-month follow-up, no significant differences were detected between groups. At the last follow-up, the central, paracentral, and midperipheral zone epithelial thicknesses in all patients were significantly higher than preoperative values, but peripheral zone thickness only increased to preoperative values. CONCLUSIONS Patients using artificial tears showed a faster thickening, especially in the central and paracentral zones, but there were no significant differences between the two groups in the final follow-up. Artificial tear usage may increase the rate of the epithelial remodeling process in post-PRK patients without significantly altering the final epithelial thickness profile. Further studies are warranted to evaluate the influence of different factors on epithelial remodeling.
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Affiliation(s)
- Mehdi Khodaparast
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro and Maceió, Brazil
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Hooman Ahmadzadeh
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadzadeh
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Azizi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesam Hashemian
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Levinger E, Arnon R, Pikkel J, Yahalomi T, Sela T, Munzer G, Mimouni M. Photorefractive keratectomy in flat, normal, and steep corneas. J Cataract Refract Surg 2024; 50:51-56. [PMID: 38048136 DOI: 10.1097/j.jcrs.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To compare photorefractive keratectomy (PRK) outcomes in patients with different corneal steepness. SETTING Care-Vision Laser Center, Tel-Aviv, Israel. DESIGN Retrospective comparative chart review. METHODS Patients included in this study underwent wavefront optimized myopic PRK between January 2013 and December 2019. Patients were divided into 3 groups based on the steepness of the cornea (steep keratometry) (flat: <42 diopters [D], normal: 42 to 46 D and steep: >46 D). One to one matching was performed to verify that baseline parameters (age, preoperative visual acuity and refractive error) were similar between groups. Primary outcome measures were: postoperative corrected/uncorrected distance visual acuity (CDVA/UDVA), efficacy index (postoperative UDVA/preoperative CDVA), safety index (postoperative CDVA/preoperative CDVA), spherical equivalence (SEQ) and cylinder. RESULTS After matching, 650 eyes were included in each group, which were similar in baseline parameters. There were no significant postoperative differences between flat, normal, and steep corneas in terms of safety index (1.02 vs 1.03 vs 1.03, P = .28), efficacy index (1.01 vs 1.01 vs 1.02, P = .57), logMAR CDVA (0.01 vs 0.02 vs 0.01, P = .76), logMAR UDVA (0.02 vs 0.03 vs 0.02, P = .68), %SEQ within 0.50 D (73.9% vs 74.2% vs 74.6%, P = .95) or 1.00 D of target (91.9% vs 92.5% vs 92.2%, P = .92), %cylinder within 0.50 D (82.8% vs 82.2% vs 81.4%, P = .81) or 1.00 D of target (96.9% vs 97.1% vs 97.2%, P = .95). CONCLUSIONS No significant differences were found between flat, normal and steep corneas following wavefront-optimized myopic PRK. Thus, this procedure may be safely and effectively performed in both flat and steep corneas.
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Affiliation(s)
- Eliya Levinger
- From the Department of Ophthalmology, Tel Aviv Medical Center affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Levinger); Department of Ophthalmology, Assuta-Samson Ashdod Hospital affiliated with the Faculty of Medicine, Ben Gurion University, Beer-Sheva, Israel (Arnon, Pikkel, Yahalomi); Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel (Mimouni); Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Mimouni); Care-Vision Laser Centers, Tel-Aviv, Israel (Sela, Munzer, Mimouni)
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Weng TH, Chang YM, Lin FH, Weng ZX, Wang TW, Chen YH, Tai MC, Chen JT, Liang CM, Lin TY. Investigation of corneal epithelial thickness and irregularity by optical coherence tomography after transepithelial photorefractive keratectomy. Clin Exp Optom 2024; 107:23-31. [PMID: 37078178 DOI: 10.1080/08164622.2023.2197107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
CLINICAL RELEVANCE Corneal epithelial healing after refractive surgery is a clinically significant issue, especially for surface ablation procedures, and this can be monitored using optical coherence tomography (OCT). BACKGROUND The aim of this work is to investigate the corneal epithelial thickness and irregularity by OCT after transepithelial photorefractive keratectomy (t-PRK) and analyse its correlation with visual and refractive outcomes. METHODS Patients aged ≥18 years with myopia, with or without astigmatism, who underwent t-PRK between May 2020 and August 2021 were included. All participants were subjected to complete ophthalmic examinations and OCT pachymetry at every follow-up visit. Patients were followed up at 1 week and 1, 3, and 6 months postoperatively. RESULTS A total of 67 patients (126 eyes) were enrolled in this study. One month postoperatively, spherical equivalent refraction and visual acuity achieved preliminary stability. However, central corneal epithelial thickness (CCET) and standard deviation of the corneal epithelial thickness (SDcet) took 3-6 months to progressive recovery. Patients with higher baseline spherical equivalent refraction were associated with slower epithelial recovery. At every follow-up time point, a significant superior-inferior difference in the minimum corneal epithelial thickness area was observed. Higher stromal haze was correlated with higher spherical equivalent refraction (both baseline and residual) but had no relation with visual outcomes. There was a significant correlation between higher CCET with a better uncorrected distance visual acuity and lower corneal epithelial thickness irregularity. CONCLUSIONS CCET and SDcet measured by OCT seem to be a good auxiliary indicator for reflecting the status of corneal wound recovery after t-PRK surgery. However, a well-designed randomised control study is needed to confirm the study results.
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Affiliation(s)
- Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Zi-Xuan Weng
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Tai-Wen Wang
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
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Jomar DE, Alshaikh L, Al-Swailem SA. Late-Onset Chronic Corneal Fistula Following Phototherapeutic Keratectomy: A Case Report and Importance of Early Detection. Am J Case Rep 2023; 24:e942279. [PMID: 38051696 PMCID: PMC10715623 DOI: 10.12659/ajcr.942279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND We report a case of late-onset chronic fistula in a decompensated cornea after multiple ocular surgeries and a recent phototherapeutic keratectomy (PTK). CASE REPORT A 73-year-old woman presented to our service with a past ocular history of bilateral chronic angle closure glaucoma and pseudophakic bullous keratopathy in the left eye. Given a history of long-term uncontrolled glaucoma with advanced disc cupping and poor visual potential, the patient underwent multiple palliative procedures, including, most recently, a PTK. Few years later she presented with a spontaneous late onset of slowly appearing corneal leak on fluorescein staining upon routine clinical examination. Corrected distance visual acuity was hand motion and intraocular pressure (IOP) was 40 mmHg in the affected eye. Serial anterior segment optical coherence tomography (AS-OCT) sections were obtained, which aided in understanding the current presentation and revealed distinctive multilayer corneal changes during the healing process. The patient was successfully managed with cyanoacrylate corneal gluing and ocular hypotensive medications, which halted the corneal leak. CONCLUSIONS We report a case of a rare finding of corneal fistula in an eye with multiple previous ocular surgeries, and provide an explanation of the possible etiopathogenesis. We also highlight the pivotal role of AS-OCT for evaluating such cases and stress the importance of early detection of similar subtle leaks in the setting of a formed anterior chamber, which can often be missed, carrying a risk of infection.
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Affiliation(s)
- Deema E. Jomar
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Lamees Alshaikh
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar A. Al-Swailem
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Vinciguerra R, Catania F, Rosetta P, Archer TJ, Reinstein DZ, Vinciguerra P. Sequential Customized Therapeutic Keratectomy in Patients With a History of Radial Keratotomy. J Refract Surg 2023; 39:808-816. [PMID: 38063831 DOI: 10.3928/1081597x-20231018-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE To evaluate the outcome of sequential customized therapeutic keratectomy (SCTK) in reducing higher order aberrations (HOAs) and improving quality of vision in highly aberrated corneas consequent to previous radial keratotomy (RK). METHODS A retrospective review of patients undergoing SCTK treatment from January 2012 to October 2020 was conducted in the Eye Center, Humanitas Clinical and Research Center (Rozzano, Italy). Indications for treatment in patients who had RK were significantly and/or progressively reduced corrected distance visual acuity (CDVA) combined with visual symptoms critically affecting quality of life. Preoperative and postoperative CDVA, corneal topography and aberrometry, Scheimpflug tomography, and anterior segment optical coherence tomography were registered. RESULTS Thirty-four patients who underwent RK a mean of 26.62 ± 7.10 years before SCTK treatment were included. SCTK induced a significant improvement of CDVA from 0.44 ± 0.82 logMAR preoperatively to 0.15 ± 0.64 logMAR postoperatively (P < .001). No patient experienced worsening of CDVA, whereas 8 patients (23,50%) gained one line and 23 patients (67.65%) gained two lines or more. A significant decrease in corneal coma, trefoil, and spherical aberrations was also noted (P = .003, .003, and .004, respectively). CONCLUSIONS SCTK proved to be a safe and effective option to treat highly aberrated eyes following RK. The authors suggest the use of SCTK as a first-line approach for the treatment of HOAs after RK and avoiding more invasive procedures such as corneal transplantation or intraocular lens implantation. [J Refract Surg. 2023;39(12):808-816.].
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Nabil KM, Elmassry AAK, Ntakarusho S, Said AA. Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus. Int Ophthalmol 2023; 43:4837-4849. [PMID: 37861937 PMCID: PMC10724307 DOI: 10.1007/s10792-023-02886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE The purpose of this prospective study was to evaluate the effect of combined photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) on intraocular pressure (IOP) in patients with keratoconus (KC). METHODS We included 64 eyes of 34 patients (19 males and 15 females; age: 19-40y) with stages 1-2 keratoconus which had undergone combined wavefront-optimized photorefractive keratectomy and corneal collagen cross linking. Two other groups of patients were added as controls: the PRK group including 110 eyes of 57 patients (23 males and 34 females; age: 18-44y) which had undergone wavefront-optimized photorefractive keratectomy for myopic refractive errors, and the CXL group including 36 eyes of 23 patients (14 males and 9 females; age: 12-38y) with keratoconus, not filling the inclusion criteria for combined PRK and CXL, which had undergone corneal collagen cross-linking. IOP was recorded preoperatively and postoperatively at 3, 6 and 12 months follow-up visits. RESULTS Preoperative IOP in both CXL (12.1 ± 2.53 mmHg) and PRK + CXL (13.2 ± 2.50 mmHg) groups was significantly lower than PRK group (15.8 ± 3.10 mmHg) (F = 30.505, p < 0.001). At 3 months postoperatively, IOP showed no statistically significant difference between the three studied groups (F = 1.821, p = 0.164). At 6 months postoperatively, IOP in the CXL group (14.6 ± 2.64 mmHg) was significantly higher than both PRK (13.4 ± 2.27 mmHg) and PRK + CXL (13.3 ± 2.62 mmHg) groups (F = 3.721, p = 0.026). At 12 months postoperatively, IOP in the CXL group (14.3 ± 2.69 mmHg) was significantly higher than the PRK group (13.2 ± 2.23 mmHg) and was higher than PRK + CXL group (13.3 ± 2.59 mmHg) although not statistically significant (F = 3.393, p = 0.035). Regarding the percent of change from preoperative IOP, a statistically significant difference between the three studied groups was detected at 3, 6 and 12 months postoperatively (H = 117.459, 109.303, 122.694 respectively, p < 0.001). The median percent of change from preoperative IOP in the PRK group was -16.7%, -15%, and -16.7%, in the CXL group was + 14.3%, + 19.4%, and + 19.1%, while in PRK + CXL group was 0% at 3, 6 and 12 months postoperatively. (Post-hoc power analysis 75%). CONCLUSIONS Combined PRK and CXL in patients with KC shows no significant effect on IOP, in contrast to either procedure performed separately.
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Affiliation(s)
- Karim Mahmoud Nabil
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Postal Code 21523, 19 Amin Fekry Street, Raml Station, Alexandria, Egypt.
| | - Ahmed Abdel Karim Elmassry
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Postal Code 21523, 19 Amin Fekry Street, Raml Station, Alexandria, Egypt
| | - Silas Ntakarusho
- Department of Ophthalmology, University of Ngozi, Ngozi, Burundi
| | - Amr Ahmed Said
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Postal Code 21523, 19 Amin Fekry Street, Raml Station, Alexandria, Egypt
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Morgado CR, Santhiago MR, Steigleman WA, Hofmeister EM, Henriquez MA, Zarei-Ghanavati S, Yoo SH, Jacob S, Schallhorn J. Late approach for LASIK flap striae. J Cataract Refract Surg 2023; 49:1285-1289. [PMID: 37982777 DOI: 10.1097/j.jcrs.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
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?
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Mahler SBC, Adams C, Daas L, Langenbucher A, Seitz B. Phototherapeutic Keratectomy for Salzmann's Nodular Degeneration. What Effect Does the Choice of Excimer Laser Have on Treatment Success? Klin Monbl Augenheilkd 2023; 240:1262-1268. [PMID: 35584772 DOI: 10.1055/a-1788-3819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the difference in treatment success after phototherapeutic keratectomy (PTK) for Salzmann's nodular degeneration (SND) using two excimer lasers with different specifications. PATIENTS AND METHODS 272 PTK procedures, which had been performed on 246 eyes with SND from 181 patients, were retrospectively examined in the period from 2007 to 2017. Until 2014 the excimer laser MEL70 (Carl Zeiss Meditec Vertriebsgesellschaft mbH, Oberkochen, Germany) was used for PTK following manual pannectomy, and after 2014 the excimer laser Amaris 750S (Schwind eye-tech-solutions GmbH, Kleinostheim, Germany) was used. Treatment success was assessed on basis of visual acuity, refraction, and astigmatism, as well as pachymetry and endothelial cell count, recorded at the following time points: T1 = preoperative, T2 = 6-week follow-up, T3 = 6-month follow-up. The Wilcoxon-Mann-Whitney U test and the chi-square test with a significance level of 5% were used to compare the data. RESULTS A significantly higher improvement of 0.17 ± 0.33 logMAR could be shown for visual acuity in the Schwind group (p < 0.013) after 6 months. In the Zeiss group, visual acuity improved by only 0.11 ± 0.36 (logMAR p < 0.057). Regarding refraction, a significant reduction of the spherical equivalent (SEQ) (p < 0.001) by 3.35 ± 2.76 diopters (D) after 6 months could only be shown for the Schwind group. SEQ did not change significantly in the Zeiss group (p < 0.676). The topographic astigmatism was significantly improved after 6 months in both study groups, by 1.73 ± 1.99 D in the Schwind group (p < 0.001) and by 1.99 ± 2.21 D in the Zeiss group (p < 0.0001). Haze had to be treated in 12.7% of the cases in the Schwind group and in 16.2% of the cases in the Zeiss group. No endothelial cell damage was found in either group. CONCLUSIONS In both study groups, the patients with SND clearly benefited from PTK. However, a significantly higher advantage for visual acuity and refraction was shown for the Schwind group compared with the Zeiss group. In contrast to the usual hyperopic effect of PTK in other diagnoses, PTK in SND showed a "myopic shift", which can be explained by the often midperipheral SND nodes and the associated asymmetric tear film pooling prior to surgery.
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Affiliation(s)
| | - Christian Adams
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
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Humayun S, Tahir A, Ishaq M, Arzoo S, Shah AA. Mechanical Epithelial Debridement <em>versus</em> Transepithelial Phototherapeutic Keratectomy Followed by Accelerated Corneal Collagen Crosslinking for Progressive Keratoconus. J Coll Physicians Surg Pak 2023; 33:1264-1270. [PMID: 37926879 DOI: 10.29271/jcpsp.2023.11.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To compare the visual and topographic outcomes between mechanical epithelial debridement followed by accelerated corneal collagen cross linking (CXL) vs. transepithelial phototherapeutic keratectomy followed by accelerated CXL for treatment of progressive keratoconus. STUDY DESIGN Quasi experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), National University of Medical Sciences, Rawalpindi, Pakistan, from December 2020 to December 2021. METHODOLOGY On the basis of surgical technique used, patients were divided into two groups, Group A comprising of twenty eyes that underwent mechanical epithelial removal followed by accelerated CXL, and Group B comprising of twenty-two eyes that underwent transepithelial phototherapeutic keratectomy (t-PTK) followed by accelerated CXL. All variables were recorded preoperatively and 6 and 12 months postoperatively and included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), MRSE (manifest refraction spherical equivalent), and keratometric indices (flat K, steep K, Kmax , mean K, thinnest pachymetry, KPI, K prob, CLMIaa, and I-S). RESULTS Forty-two eyes of twenty-nine patients were included in the study and were divided into two groups; Group A (mechanical epithelial removal followed by accelerated CXL) and Group B (t-PTK followed by accelerated CXL). The visual acuity improved in both the groups at 6 and 12 months, with more significant improvement in Group B in both UCVA (p=0.005) and CDVA (p=0.004) parameters. Keratometric outcomes showed significant differences in median values for flat K (p=0.048) and thinnest pachymetry (p=<0.001) in Group A, while significant difference in Kmax (p=0.024) and thinnest pachymetry (p=<0.001) in Group B. At 6 and 12 months, the CLMIaa, PPK, and I-S values were significantly lower in Group B (p=0.002 for all three indices). CONCLUSION Transepithelial PTK followed by accelerated CXL yielded better outcomes regarding visual acuity and keratomertic indices as compared to mechanical epithelial removal followed by accelerated CXL and did not show any significant decrease in corneal pachymetry. KEY WORDS Mechanical, Corneal Collagen Crosslinking (CXL), Transepithelial, Phototherapeutic keratectomy, Keratoconus.
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Affiliation(s)
- Sadia Humayun
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Aaiza Tahir
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mazhar Ishaq
- Refractive Surgical Department, Mazhar Ishaq Centre of Ophthalmology, Rawalpindi, Pakistan
| | - Sabahat Arzoo
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Aizaz Ali Shah
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan
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Hashemi H, Asgari S, Khabazkhoob M, Heidari Z. Vector analysis of astigmatism correction after PRK, FS-LASIK, and SMILE for myopic astigmatism. Int Ophthalmol 2023; 43:3999-4009. [PMID: 37405568 DOI: 10.1007/s10792-023-02804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To compare astigmatic correction among photorefractive keratectomy (PRK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and small-incision lenticule extraction (SMILE). METHODS This prospective study enrolled 157 eyes that underwent three procedures (59 PRK, 47 FS-LASIK, and 51 SMILE) for the treatment of myopia with low to high astigmatism (- 0.25 to - 4.50 D). Ocular residual astigmatism (ORA) was calculated by vector analysis using refractive (RA) and corneal astigmatism. Vector analysis results were compared in different procedures in the two RA groups (low ≤ 1.00 D and high > 1.00 D) at 3 and 12 months postoperatively. RESULTS There were no significant between-group differences in postoperative safety and efficacy outcomes (all P > 0.05). No significant differences were found in postoperative cylinders between all surgical groups (all p > 0.05), except for 3 months postoperative ORA in FS-LASIK (P = 0.004). At 12 months, 77%, 59.2%, and 50% of eyes attain emmetropia in the FS-LASIK, SMILE, and PRK groups, respectively. Vector analysis showed comparable values for surgical induced astigmatism, target induced astigmatism, mean error, and angle of error between groups at 12 months. Significant differences were observed only in the correction index and difference vector parameters in the astigmatic > 1.00 D group at 3 months (P < 0.001), and FS-LASIK was preferable. CONCLUSIONS One-year outcomes revealed that PRK, FS-LASIK, and SMILE were all equally effective in correcting myopic astigmatism. However, FS-LASIK demonstrated more favorable astigmatism correction in eyes with astigmatism > 1.00D in early postoperatively.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Ophthalmology, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran; Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Koosha N, Fathian A, Peyman A, Nourbakhsh SA, Noorshargh P, Pourazizi M. Combined simultaneous photorefractive keratectomy and collagen cross-linking in keratoconus suspect patients. J Fr Ophtalmol 2023; 46:921-928. [PMID: 37085363 DOI: 10.1016/j.jfo.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 11/05/2022] [Accepted: 11/21/2022] [Indexed: 04/23/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of combined simultaneous photorefractive keratectomy (PRK) with collagen cross-linking (CXL) in keratoconus suspects (KCS). METHODS This was a retrospective, non-randomized study of KCS patients who underwent combined simultaneous PRK with CXL. The efficacy, safety, refractive outcomes, and corneal wavefront aberration changes were assessed after the surgery and compared with existing preoperative data. RESULTS Fifty-six eyes of 28 patients, including 20 females (71.4%), with a mean age of 30.92±4.09 years, were enrolled. The mean follow-up was 19.46±8.48 months (range: 7-35). At the conclusion of the study, mean uncorrected distance visual acuity LogMAR improved from 0.89±0.44 preoperatively to 0.04±0.09 postoperatively (P<0.001). In addition, a statistically significant corneal flattening was observed postoperatively, with a decrease in manifest refraction. A statistically significant increase was found in higher-order aberrations (P<0.001), horizontal coma (P<0.001), and spherical aberration (P<0.001) compared with preoperatively. Postoperatively, 41% exhibited refractive astigmatism of 0.50 diopter (D) or less; 83.8% showed 1.00 D or less. CONCLUSION The results of our study indicate that combined simultaneous PRK with CXL can be a safe and effective method for treating refractive instability in KCS patients.
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Affiliation(s)
- N Koosha
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Fathian
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - P Noorshargh
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Chang MS, Jun I, Kim EK. Mini-Review: Clinical Features and Management of Granular Corneal Dystrophy Type 2. Korean J Ophthalmol 2023; 37:340-347. [PMID: 37336511 PMCID: PMC10427907 DOI: 10.3341/kjo.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
Granular corneal dystrophy type 2 (GCD2) is an autosomal dominant corneal stromal dystrophy that is caused by p.Arg124His mutation of transforming growth factor β induced (TGFBI) gene. It is characterized by well demarcated granular shaped opacities in central anterior stroma and as the disease progresses, extrusion of the deposits results in ocular pain due to corneal epithelial erosion. Also, diffuse corneal haze which appears late, causes decrease in visual acuity. The prevalence of GCD2 is high in East Asia including Korea. Homozygous patients show a severe phenotype from an early age, and the heterozygote phenotype varies among patients, depending on several types of compound heterozygous TGFBI mutations. In the initial stage, conservative treatments such as artificial tears, antibiotic eye drops, and bandage contact lenses are used to treat corneal erosion. Different surgical methods are used depending on the depth and extent of the stromal deposits. Phototherapeutic keratectomy removes anterior opacities and is advantageous in terms of its applicability and repeatability. For deeper lesions, deep anterior lamellar keratoplasty can be used as the endothelial layer is not always affected. Recurrence following these treatments are reported within a wide range of rates in different studies due to varying definition of recurrence and follow-up period. In patients who have undergone corneal laser vision-correction surgeries such as photorefractive keratectomy, LASEK, or LASIK including SMILE surgery, corneal opacity exacerbates rapidly with severe deterioration of visual acuity. Further investigations on new treatments of GCD2 are necessary.
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Affiliation(s)
- Myung Soo Chang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul,
Korea
| | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul,
Korea
- Saevit Eye Hospital, Goyang,
Korea
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Humayun S, Tahir A, Ishaq M, Arzoo S. Comparison of Higher Order Aberrations between Wavefront Optimized Photorefractive Keratectomy and Laser <em>in situ</em> Keratomileusis in Myopic Patients. J Coll Physicians Surg Pak 2023; 33:884-889. [PMID: 37553927 DOI: 10.29271/jcpsp.2023.08.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To compare the higher order aberrations (HOA) between wavefront optimized (WFO) laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in myopic patients. STUDY DESIGN Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from December 2021 to December 2022. METHODOLOGY Forty-four patients underwent wavefront optimized PRK and fifty-seven patients underwent wavefront optimized LASIK. All variables were recorded before the procedure and at 1, 3, 6, and 12 months postoperatively and included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), root mean square (RMS) of HOAs, spherical aberration (SA), and coma aberration (CA). RESULTS A total of 101 eyes of 51 patients were considered in the final analysis. Patients were divided into two groups. Group A comprised of 44 (43.6%) eyes of 22 patients who underwent PRK while group B comprised of 57 (56.4%) eyes of 29 patients who underwent LASIK. UCVA significantly improved postoperatively at 3 and 6 months in both PRK and LASIK groups (p<0.001 for both groups). In this study, the increase in root mean square (RMS) of higher order aberrations from baseline value was 77% after PRK and 28% after LASIK, similar ratio was observed in spherical aberration (SA). The trend of rise in Coma aberrations was more in LASIK group 66.49% as compared to 46.2% in PRK group. CONCLUSION Both Wavefront Optimized PRK and LASIK are safe and have elicited comparable results of post-procedure visual recovery. There was a marked increase in RMS of HOAs in PRK group as compared to WFO LASIK group while coma aberration increased more in LASIK as compared to PRK postoperatively. KEY WORDS LASIK, PRK, RMSh, HOAs, Spherical aberration, Coma, Myopia.
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Affiliation(s)
- Sadia Humayun
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
- Refractive Surgical Department, Mazhar Ishaq Centre of Ophthalmology, Rawalpindi, Pakistan
| | - Aaiza Tahir
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
- Refractive Surgical Department, Mazhar Ishaq Centre of Ophthalmology, Rawalpindi, Pakistan
| | | | - Sabahat Arzoo
- Refractive Surgical Department, Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
- Refractive Surgical Department, Mazhar Ishaq Centre of Ophthalmology, Rawalpindi, Pakistan
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Moore BA, Jalilian I, Kim S, Mizutani M, Mukai M, Chang C, Entringer AM, Dhamodaran K, Raghunathan VK, Teixeira LBC, Murphy CJ, Thomasy SM. Collagen crosslinking impacts stromal wound healing and haze formation in a rabbit phototherapeutic keratectomy model. Mol Vis 2023; 29:102-116. [PMID: 37859806 PMCID: PMC10584030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 07/14/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the elastic modulus, keratocyte-fibroblast-myocyte transformation, and haze formation of the corneal stroma following combined phototherapeutic keratectomy (PTK) and epithelium-off UV-A/riboflavin corneal collagen crosslinking (CXL) using an in vivo rabbit model. Methods Rabbits underwent PTK and CXL, PTK only, or CXL 35 days before PTK. Rebound tonometry, Fourier-domain optical coherence tomography, and ultrasound pachymetry were performed on days 7, 14, 21, 42, 70, and 90 post-operatively. Atomic force microscopy, histologic inflammation, and immunohistochemistry for α-smooth muscle actin (α-SMA) were assessed post-mortem. Results Stromal haze formation following simultaneous PTK and CXL was significantly greater than in corneas that received PTK only and persisted for more than 90 days. No significant difference in stromal haze was noted between groups receiving simultaneous CXL and PTK and those receiving CXL before PTK. Stromal inflammation did not differ between groups at any time point, although the intensity of α-SMA over the number of nuclei was significantly greater at day 21 between groups receiving simultaneous CXL and PTK and those receiving CXL before PTK. The elastic modulus was significantly greater in corneas receiving simultaneous CXL and PTK compared with those receiving PTK alone. Conclusions We showed that stromal haze formation and stromal stiffness is significantly increased following CXL, regardless of whether it is performed at or before the time of PTK. Further knowledge of the biophysical cues involved in determining corneal wound healing duration and outcomes will be important for understanding scarring following CXL and for the development of improved therapeutic options.
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Affiliation(s)
- Bret A. Moore
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Iman Jalilian
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Soohyun Kim
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Makiko Mizutani
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Madison Mukai
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Connor Chang
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Alec M. Entringer
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX
| | - Kamesh Dhamodaran
- Department of Basic Sciences, College of Optometry, University of Houston, Houston, TX
| | - Vijay Krishna Raghunathan
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX
- Department of Basic Sciences, College of Optometry, University of Houston, Houston, TX
| | - Leandro B. C. Teixeira
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Christopher J. Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
- Department of Ophthalmology & Vision Science, School of Medicine, University of California-Davis, Sacramento, CA
| | - Sara M. Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
- Department of Ophthalmology & Vision Science, School of Medicine, University of California-Davis, Sacramento, CA
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Asroui L, Arba-Mosquera S, Torbey J, Ahmed MA, Fattah MA, Koaik M, Awwad ST. Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study. J Cataract Refract Surg 2023; 49:716-723. [PMID: 36913543 DOI: 10.1097/j.jcrs.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE To evaluate the long-term visual and refractive outcomes of hyperopic excimer ablation using alcohol-assisted photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). SETTING American University of Beirut Medical Center, Beirut, Lebanon. DESIGN Retrospective, matched comparative study. METHODS Eyes that underwent alcohol-assisted PRK were compared to matched eyes that underwent FS-LASIK. All patients were followed up for at least 3 years after surgery. The refractive and visual outcomes of each group were compared at different postoperative time points. The main outcome measures were spherical equivalent deviation from target (SEDT), manifest refraction, and visual acuity. RESULTS 83 eyes underwent alcohol-assisted PRK and 83 matched eyes underwent FS-LASIK. Preoperative manifest refraction spherical equivalent was 2.44 ± 1.18 diopters (D) and 2.20 ± 0.87 D ( P = .133) in the PRK and FS-LASIK groups, respectively. Preoperative manifest cylinder was -0.77 ± 0.89 D and -0.61 ± 0.59 D ( P = .175) for the PRK and LASIK groups, respectively. 3 years postoperatively, SEDT was 0.28 ± 0.66 D and 0.40 ± 0.56 D for the PRK and LASIK groups, respectively ( P = .222), whereas manifest cylinder was -0.55 ± 0.49 D and -0.30 ± 0.34 D for PRK and LASIK, respectively ( P < .001). The mean difference vector was 0.59 ± 0.46 for PRK and 0.38 ± 0.32 for LASIK ( P < .001). 13.3% of PRK eyes and 0% of LASIK eyes had >1 D of manifest cylinder ( P = .003). CONCLUSIONS Both alcohol-assisted PRK and FS-LASIK are safe and effective for the treatment of hyperopia. PRK induces slightly more postoperative astigmatism than LASIK. Larger optical zones and recently introduced ablation profiles that lead to a smoother ablation surface might improve the clinical results of hyperopic PRK.
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Affiliation(s)
- Lara Asroui
- From the Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon (Asroui, Torbey, Ahmed, Fattah, Koaik, Awwad); Department of Research and Development, SCHWIND eye-tech-solutions GmbH & Co. KG, Kleinostheim, Germany (Arba-Mosquera)
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Sima G, Tătaru CI, Munteanu M. Evaluation of the efficiency and safety of TransPRK and FS-LASIK refractive procedures on patients with astigmatism and amblyopia. Rom J Ophthalmol 2023; 67:267-274. [PMID: 37876510 PMCID: PMC10591439 DOI: 10.22336/rjo.2023.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 10/26/2023] Open
Abstract
Purpose: To compare the outcomes of transepithelial photorefractive keratectomy (transPRK) with femtosecond laser assisted in situ keratomileusis (FS-LASIK) for the correction of astigmatism on amblyopic eyes. Methods: The design was a retrospective interventional study on 37 eyes with hyperopic or mixed astigmatism and refractive amblyopia, which underwent transPRK or FS-LASIK. The patients were distributed into 2 groups according to the technique used. Data was collected from patient files and comparison between groups was performed. The main outcomes measured were corrected distance visual acuity (CDVA), sphere, cylinder, spherical equivalent (SEQ), efficiency and safety indexes. Results: In the transPRK group, SEQ improved significantly after 1 month, from 2.08 ± 2.02D (p<0.01) to 0.125 ± 0.86D and at the 12 month visit to -0.04 ± 0.62D (p>0.05), sphere improved from 4.03 ± 1.44D preoperatively to 0.67 ± 0.9D at 1 month (p<0.05) and further to 0.44 ± 0.71 at 12 months (p<0.05). CDVA improved from 0.194 ± 0.11 logMAR to 0.115 ± 0.1 logMAR at the 1-year visit. Safety index after 1 month was 1.09 ± 0.2 and 1.12 ± 0.35 at the 1-year visit. Efficiency index was 0.95 ± 0.22 at 1 month and 1.03 ± 0.34 after 1 year. In FS-LASIK group, SEQ improved after 1 month, from 2.28 ± 3.04 to -0.79 ± 0.73D (p<0.01), and further to -0.49 ± 0.79 (p>0.05) at the 12 month visit, sphere improved from 4.11 ± 2.35D preoperatively to -0.42 ± 0.66D at 1 month (p<0.05) and further to -0.08 ± 0.75D at 12 months (p<0.05). CDVA also improved from 0.191 ± 0.1 logMAR to 0.140 ± 0.1 logMAR at 1 year. Safety index after 1 month was 1.1 ± 0.2 and 1.16 ± 0.21 at the 1-year visit. Efficiency index was 0.98 ± 0.27 at 1 month and 1.06 ± 0.23 after 1 year. Conclusion: Both procedures were safe and efficient in improving visual acuity for patients with mixed and hyperopic astigmatism and refractive amblyopia. Abbreviations: transPRK = transepithelial photorefractive keratectomy, FS-LASIK = femtosecond laser in situ keratomileusis, logMAR = logarithm of the Minimum Angle of Resolution, BCVA = best corrected distance visual acuity, CDVA = corrected distance visual acuity.
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Affiliation(s)
- George Sima
- Department of Ophthalmology, “Victor Babeş” University of Medicine and Pharmacy Timișoara, Faculty of Medicine, Timişoara, Romania
| | - Cătălina-Ioana Tătaru
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; Alcor Ophthalmology Clinic, Bucharest, Romani
| | - Mihnea Munteanu
- Department of Ophthalmology, “Victor Babeş” University of Medicine and Pharmacy Timișoara, Faculty of Medicine, Timişoara, Romania
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Paryani M, Israni N, Kochar S, Aggarwal K. Microkera to mechronicles : Management of a free flap. Indian J Ophthalmol 2023; 71:2926-2927. [PMID: 37417158 PMCID: PMC10491053 DOI: 10.4103/ijo.ijo_756_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Background In LASIK (laser in situ keratomileusis), a hinged corneal flap is made, which enables the flap to be lifted and the excimer laser to be applied to the stromal bed. If the hinge of the corneal flap detaches from the cornea, the flap is called a free cap. A free cap is a rare intra-operative complication of LASIK most commonly associated with the use of a microkeratome on corneas with flat keratometry, which predisposes to a small flap diameter. Free caps are preventable and treatable. Rarely does the complication lead to a severe or permanent decrease in visual acuity. Purpose As free caps are avoidable, prevention is critical. Our video gives some tips and tricks on how to avoid a free flap and also focuses on how to manage a cut through a free flap. Synopsis If a free cap is created, the surgeon must decide whether to continue with excimer laser ablation or to abort the procedure. When to abort: If the stromal bed is irregular, the flap is replaced without applying laser ablation. Without ablation, generally, there is no change in refractive error or significant loss of visual acuity. When to continue: If the stromal bed is regular and the cap is of normal thickness, the surgeon may proceed with ablation. To prevent desiccation, the free cap should be handled with caution and should be placed on a drop of balanced salt solution. The free cap should be placed epithelial facing up, along with a bandage contact lens. The endothelial cell pump mechanism typically allows the cap to re-adhere tightly. Highlights Risk factors for a free cap are generally anatomic or mechanical. Especially in flat corneas, an appropriate ring and stop size should be chosen looking at the nomogram on the basis of the keratometry values. Deep orbits and deep-seated eyes should be looked for as PRK is a better option in such cases. Inadequate suction should be dealt with a lot of care, and once this is done, the vacuum should be stopped. Re-docking of the microkeratome with suction can be done again. Prior testing of the microkeratome and a good verbal anesthesia are a few more such important points to be pondered upon. This video gives us such tips and is a comprehensive video for a novice surgeon performing microkeratome LASIK. Video link https://youtu.be/piU9nK6rbm4.
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Affiliation(s)
- Mukesh Paryani
- Department of Ophthalmology, Neovision Eye Care, Pune, Maharashtra, India
| | - Neeraj Israni
- Department of Ophthalmology, Innovision Eye Hospital and Laser Centre, Mumbai, Maharashtra, India
| | - Shruti Kochar
- Department of ophthalmology, Care- CHL Hospital, Indore, Madhya Pradesh, India
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Abdel-Radi M, Shehata M, Mostafa MM, Aly MOM. Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques. Eye (Lond) 2023; 37:1545-1552. [PMID: 35864163 PMCID: PMC10219954 DOI: 10.1038/s41433-022-02174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. METHODS A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. RESULTS Preoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. CONCLUSION The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. CLINICAL TRIALS REGISTRY (Clinical Trials.gov Identifier): NCT04710082.
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Affiliation(s)
| | - Mohamed Shehata
- Department of Ophthalmology, Assiut University, Assiut, Egypt
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Grentzelos MA, Liakopoulos DA, Kankariya VP, Siganos CS, Tsilimbaris MK, Pallikaris IG, Kymionis GD. Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus. Cornea 2023; 42:680-686. [PMID: 36730364 DOI: 10.1097/ico.0000000000003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus. METHODS In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively. RESULTS Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 ( P < 0.001) and 0.06 ± 0.12 ( P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from -5.39 ± 3.89 diopters (D) preoperatively to -2.29 ± 2.65 D ( P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from -4.70 ± 2.86 D preoperatively to -3.55 ± 2.45 D ( P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up ( P > 0.05). CONCLUSIONS Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up.
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Affiliation(s)
- Michael A Grentzelos
- Laboratory of Vision and Optics (LVO)-Vardinoyiannion Eye Institute of Crete (VEIC), School of Medicine, University of Crete, Heraklion, Crete, Greece
- Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Dimitrios A Liakopoulos
- Laboratory of Vision and Optics (LVO)-Vardinoyiannion Eye Institute of Crete (VEIC), School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Charalambos S Siganos
- Laboratory of Vision and Optics (LVO)-Vardinoyiannion Eye Institute of Crete (VEIC), School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Miltiadis K Tsilimbaris
- Laboratory of Vision and Optics (LVO)-Vardinoyiannion Eye Institute of Crete (VEIC), School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioannis G Pallikaris
- Laboratory of Vision and Optics (LVO)-Vardinoyiannion Eye Institute of Crete (VEIC), School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - George D Kymionis
- Department of Ophthalmology, Faculty of Medicine, University of Athens, Athens, Greece
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Yousif MO, Elkitkat RS, Edrees ES, Alaarag NA. Introducing a Revised Tissue Saving Protocol for Combined Topography-Guided Photorefractive Keratectomy and Cross-Linking in Keratoconic Corneas. Cornea 2023; 42:755-765. [PMID: 36728310 DOI: 10.1097/ico.0000000000003225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/26/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to introduce a revised tissue-saving technique for combined topography-guided photorefractive keratectomy (PRK) and cross-linking for keratoconus (KC) treatment and to evaluate its efficacy, safety, and stability. METHODS This retrospective, noncontrolled study was performed at Maadi Eye Subspecialty Center and Eye Care Center, Cairo, Egypt. The technique was performed on virgin keratoconic corneas with 3 different morphological patterns of ectasia. It involves performing topography-guided PRK before epithelial removal, followed by customized phototherapeutic keratectomy (PTK) that is tailored to each cornea after studying the treatment profile on the laser treatment screen. The electronic medical records were explored for preoperative and postoperative data, including subjective refraction and topographic data (using Sirius topographer). RESULTS The study was conducted on 123 eyes of 93 patients with a mean age of 27.98 years ±6.06. The follow-up ranged from 6 to 36 months (mean ± SD of 16.2 months ±10.4). The results showed statistically nonsignificant differences among the 3 ectasia subgroups in treatment spherical equivalent, treatment maximum depth, thickness of removed epithelium, and thinnest residual stromal bed. There were statistically significant differences in almost all values between the preoperative and postoperative data, with significant postoperative patients' improvement ( P value <0.001). The subgroups' results were almost the same as the whole cohort's results. The safety and efficacy indices of the performed procedure showed remarkably high values (1.48 ± 0.21 and 0.87 ± 0.40, respectively). CONCLUSIONS This revised protocol for KC management maximally preserves stromal tissue with proven efficacy, safety, and stability.
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Affiliation(s)
- Mohamed Omar Yousif
- Assistant Professor of Ophthalmology, Faculty of Medicine, Ain Shams University
- Cornea and Refractive Surgery Consultant, Maadi Eye Subspecialty Center
| | - Rania Serag Elkitkat
- Assistant Professor of Ophthalmology, Faculty of Medicine, Ain Shams University
- Watany Eye Hospital
- Watany Research and Development Center
- Head of Ophthalmology Department, Faculty of Medicine, MTI University
| | - Eman Samir Edrees
- Lecturer of Ophthalmology, Faculty of Medicine, Ain Shams University; and
- Maadi Eye Subspecialty Center, Cairo, Egypt
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Jorge FA, Taguchi F, Campos M. The 18-Month Outcomes of a Contralateral, Randomized, Prospective Clinical Trial Comparing Photorefractive Keratectomy and SMILE for Myopia. J Refract Surg 2023; 39:180-186. [PMID: 36892242 DOI: 10.3928/1081597x-20230113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To compare clinical outcomes and patient satisfaction of photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE) for myopia. METHODS This contralateral, randomized, prospective clinical trial included 86 eyes of 43 patients diagnosed as having spherical equivalent (SE) from -1.00 to -8.00 diopters (D). One eye of each patient was randomly allocated to receive either PRK with 0.02% mitomycin C or SMILE. Visual acuity measurement, slit-lamp microscopy, manifest and cycloplegic refraction, Scheimpflug corneal tomography, contrast sensitivity assessment, ocular wavefront aberrometry, and a satisfaction questionnaire were performed preoperatively and during an 18-month follow-up. RESULTS Forty-three eyes of each group completed the study. After 18 months of follow-up, eyes treated with PRK and SMILE showed comparable results regarding uncorrected distance visual acuity (-0.12 ± 0.07 and -0.25 ± 0.09, respectively), safety, efficacy, contrast sensitivity, and ocular wavefront aberrometry. For predictability, eyes treated with PRK had a statistically lower residual spherical equivalent when compared with eyes treated with SMILE. Residual astigmatism of 0.50 D or less was achieved in 95% of the PRK group and 81% of the SMILE group. At the 1-month follow-up visit, the PRK group presented worse evaluation in relation to vision and foreign body sensation when compared to the SMILE group. CONCLUSIONS Both PRK and SMILE presented as safe and effective strategies for treating myopia with comparative clinical results. Eyes treated with PRK showed lower spherical equivalent and residual astigmatism. In the first month, eyes treated with SMILE showed less foreign body sensation and faster visual recovery. [J Refract Surg. 2023;39(3):180-186.].
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Hashemi H, Roberts CJ, Elsheikh A, Mehravaran S, Panahi P, Asgari S. Corneal Biomechanics After SMILE, Femtosecond-Assisted LASIK, and Photorefractive Keratectomy: A Matched Comparison Study. Transl Vis Sci Technol 2023; 12:12. [PMID: 36928130 PMCID: PMC10029763 DOI: 10.1167/tvst.12.3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Purpose To evaluate the change in corneal stiffness after small incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and photorefractive keratectomy (PRK). Methods Age, gender, spherical equivalent, and central corneal thickness (CCT)-matched cases undergoing SMILE with a 120-µ cap, FS-LASIK with a 110-µ flap, and PRK were enrolled. One-year change in the stress-strain index, stiffness parameter at first applanation, integrated inverse radius, deformation amplitude ratio at 2 mm, and deformation amplitude ratio at 1 mm were compared between the surgical groups by linear mixed-effect models. Results Within each surgical group, 120 eyes completed 1 year of follow-up. The residual stromal bed (RSB) thickness and (RSB/CCTpostop) were 348.1 ± 35.0 (0.74), 375.4 ± 31.0 (0.77) and 426.7 ± 2 µm (0.88) after SMILE, FS-LASIK, and PRK, respectively. The 1-year change in all biomechanical indices was significant, except the stress-strain index with PRK (P = 0.884). The change in all indices with SMILE were significantly greater than with FS-LASIK and with PRK (all P < 0.01), except the deformation amplitude ratio at 1 mm change between SMILE and FS-LASIK (P = 0.075). The changes in all indices with FS-LASIK were significantly greater than with PRK (all P < 0.05). Conclusions Although SMILE preserves the greatest amount of anterior cornea with a cap thickness of 120 µ, this also produces the smallest RSB and the greatest decrease in stiffness. Thus, the RSB is shown to be the predominant determinant of stiffness decreases, rather than the preserved anterior cornea. We recommend using a thinner cap to achieve a thicker RSB and a lesser decrease in the corneal stiffness in the SMILE procedure. Translational Relevance After refractive surgery, RSB is predominant determinant of stiffness decreases, rather than the preserved anterior cornea.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Cynthia J Roberts
- Department of Ophthalmology & Visual Sciences, Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Shiva Mehravaran
- School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Parsa Panahi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
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Soleimani M, Keykhaei M, Tabatabaei SA, Shahriari M, Farrokhpour H, Ramezani B, Cheraqpour K. Post photorefractive keratectomy (PRK) infectious keratitis; six-year experience of a tertiary eye hospital. Eye (Lond) 2023; 37:631-637. [PMID: 35273348 PMCID: PMC9998852 DOI: 10.1038/s41433-022-02009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES As an essential development in the new century, surface ablation procedures have attracted increasing attention. There exists a concern regarding the risk of infectious keratitis. Hence, we aimed to investigate the rate and predisposing factors of infectious keratitis after photorefractive keratectomy (PRK). SUBJECTS/METHODS This retrospective study was designed in two phases. First, the rate of post-PRK keratitis of Farabi Eye Hospital was investigated. In other words, the targeted population was the patients who developed keratitis after performing procedure at Farabi Eye Hospital. In the second phase, all the patients with the diagnosis of post-PRK keratitis were studied regardless of the centre where surgery was performed. Patients with the diagnosis of infectious keratitis between 2014 and 2020 were enrolled and following information was analyzed: demographics, presentation time after surgery, perioperative medications, culture results, risk factors, medical treatment, complications, and final visual acuity. RESULTS The total number of PRK procedures in our centre was 24,986 (13,253 patients), in which 6 eyes of 5 patients developed keratitis. Beside these 5 patients, 24 referred patients (24 eyes) from the other centres were enrolled. Finally, a total number of 29 patients (30 eyes) were included. Our analysis revealed that manipulation of contact lens, dry eye, and blepharitis were the essential predisposing factors for keratitis development. CONCLUSION The overall post-PRK keratitis occurrence rate of our study was 0.02%. Our observation highlighted the importance of preoperative examination and treatment of the lids and dry eye disease.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Farrokhpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Ramezani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Hofmeister EM, Cason JB, Murdoch DM, Yau IW, Wang Y, Parizadeh DD, Janakiraman DP, Kasthurirangan S. Wavefront-guided PRK treatment of myopia using a refractive aberrometer. J Cataract Refract Surg 2023; 49:292-298. [PMID: 36730946 DOI: 10.1097/j.jcrs.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the safety, effectiveness, and patient-reported outcomes of wavefront-guided photorefractive keratectomy (PRK) for the correction of myopic refractive errors with and without astigmatism. SETTING U.S. multicenter study. DESIGN Prospective, nonrandomized clinical investigation. METHODS 334 eyes (167 patients) underwent wavefront-guided PRK with the STAR S4 IR Excimer Laser System. Patients had preoperative myopic refractive errors with sphere up to -8.00 diopters (D) and cylinder up to -4.00 D with a maximum spherical equivalent (SE) of -10.00 D. All eyes were targeted for emmetropia, and treatment plans were derived from the iDESIGN system wavefront measurements. RESULTS At 6 months, the point of refractive stability, 99.4% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), 92% of eyes achieved 20/16 or better UDVA, 85.5% of eyes achieved manifest refraction SE (MRSE) within 0.50 D of target, mean SE was -0.06, and less than 1% of eyes lost more than 2 lines of corrected distance visual acuity. Glare and halos occurred with similar or lower frequencies at 6 months vs preoperative. Results from the National Eye Institute Refractive Error Quality of life questionnaire showed statistically significant improvements at 6 months vs preoperative across most measures of vision-related functioning and well-being. Approximately 98% of patients reported high satisfaction with their overall vision at 6 months. CONCLUSIONS Wavefront-guided PRK with the iDESIGN aberrometer was safe, effective, and predictable for the correction of low to moderate myopia with and without astigmatism and led to high patient satisfaction.
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Affiliation(s)
- Elizabeth M Hofmeister
- From the Ophthalmology Department, Naval Medical Center San Diego, San Diego, California; (Hofmeister, Cason, Murdoch); Johnson & Johnson Vision, Irvine, California (Yau, Wang, Parizadeh, Janakiraman, Kasthurirangan)
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Rohlf D, La Nasa A, Terveen D, Shafer B, Thompson V, Berdahl J. Outcomes of LASIK vs PRK enhancement in eyes with prior cataract surgery. J Cataract Refract Surg 2023; 49:62-68. [PMID: 36026691 DOI: 10.1097/j.jcrs.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 07/20/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare postenhancement visual acuity between patients who underwent postcataract laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). SETTING A private, tertiary referral practice in Sioux Falls, South Dakota. DESIGN 3-year, retrospective chart review. METHODS Patients who underwent postcataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 diopter). Postenhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. RESULTS 822 postcataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least 6-month follow-up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRK-enhanced patients ( P < .001). Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK-enhanced and PRK-enhanced patients at or beyond 6 months, respectively ( P < .001). 330 (67%) LASIK-enhanced patients achieved 20/20 or better postenhancement UDVA, compared with 142 (43%) PRK-enhanced patients ( P < .001). Controlling for pre-enhancement UDVA, LASIK-enhanced patients showed significantly better postenhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean postenhancement of 0.05 ± 0.14 UDVA compared with 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients ( P < .001). CONCLUSIONS LASIK provides better and more predictable outcomes in UDVA than PRK in postcataract enhancement patients, even when controlling for pre-enhancement visual acuity and prior ocular procedures.
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Affiliation(s)
- Derek Rohlf
- From the University of South Dakota Sanford School of Medicine, Vermillion, South Dakota (Rohlf, La Nasa); Vance Thompson Vision, Sioux Falls, South Dakota (Terveen, Shafer, Thompson, Berdahl)
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Zhou W, Reinstein DZ, Archer TJ, Nitter T, Feng Y, Mule G, Stojanovic A. The Impact of Epithelial Remodeling on Surgical Techniques Used in Topography-guided Surface Ablation in Irregular Corneas. J Refract Surg 2022; 38:529-537. [PMID: 35947001 DOI: 10.3928/1081597x-20220711-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the optical consequences of epithelial remodeling in irregular corneas and their impact on the choice of different surface ablation techniques. METHODS Anterior corneal and stromal surface topographies and epithelial thickness maps were analyzed in 24 eyes with irregular corneal optics. On two of the eyes, four different surface ablation techniques were simulated: (1) conventional anterior topography-guided photorefractive keratectomy (PRK), (2) transepithelial phototherapeutic keratectomy (PTK), (3) transepithelial anterior topography-guided PRK, and (4) stromal topography-guided PRK. RESULTS Stromal surface topographies showed higher keratometric values, astigmatism, asphericity, and corneal higher order aberrations compared to topographies of anterior corneas covered by epithelium. Transepithelial anterior topography-guided PRK and stromal topography-guided PRK both resulted in regularized stromal surface, transepithelial PTK achieved partial regularization corresponding to the smoothing effect of the epithelial remodeling, and conventional anterior topography-guided PRK delivered after epithelial removal resulted in residual stromal surface irregularities. CONCLUSIONS The difference in optical landscapes between the stromal and anterior surfaces in irregular corneas will represent a source of error when anterior topography-guided treatments are delivered on the deepithelialized stroma, as in conventional PRK. In contrast, anterior topography-guided ablations performed as transepithelial PRK and stromal topography-guided PRK delivered after epithelial removal address the full stromal irregularity, whereas transepithelial PTK alone may be used when topography-guided treatments are not possible. The authors conclude topography-guided PRK of irregular corneas should lead to significantly improved regularization only if it includes the effect of epithelial remodeling. [J Refract Surg. 2022;38(8):529-537.].
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Zarei-Ghanavati S, Jafarpour S, Hassanzadeh S, Bakhtiari E, Daraee G, Monadi SD, Ziaei M. Changes in Corneal Biomechanical Properties After Small-Incision Lenticule Extraction and Photorefractive Keratectomy, Using a Noncontact Tonometer. Cornea 2022; 41:886-893. [PMID: 34690272 DOI: 10.1097/ico.0000000000002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate and compare early corneal biomechanical changes after small-incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK). METHODS The study comprised 74 patients eligible for refractive surgery, equally allocated to PRK (37 patients) and SMILE (37 patients). Corneal biomechanical properties were recorded and compared between the 2 groups at preoperatively and 3 months after surgery using a dynamic ultra-high-speed Scheimpflug camera equipped with a noncontact tonometer. RESULTS Both procedures significantly affected corneal biomechanical properties at 3 months after surgery. Patients in the PRK group showed significantly better results for deformation amplitude ratio (DA ratio) ( P = 0.03), maximum inverse radius (InvRadMax) ( P = 0.02), and A2 time ( P = 0.03). The mean changes in DA ratio, HC radius, InvRadMax, and Ambrosio relational thickness were significantly higher in the SMILE group in comparison with those of the PRK group (all, P < 0.05). In both groups, change in CCT was significantly correlated with changes in DA ratio and InvRadMax ( P < 0.05). CONCLUSIONSS Both SMILE and PRK refractive surgeries significantly altered corneal biomechanical properties but the changes were more prominent after SMILE.
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Affiliation(s)
- Siamak Zarei-Ghanavati
- Ophthalmology Department, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheyla Jafarpour
- Ophthalmology Department, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Department of Optometry, Refractive Error Research Center, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Department of ophthalmology, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghazaleh Daraee
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Sahar Darabi Monadi
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Mohammed Ziaei
- Faculty of Medical and Health Sciences, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Mukherjee H, Pipis S, Yang Y, Santos A. P-19 Transepithelial PTK/limited non topoigraphic PRK combined with corneal crosslinking for keratoconus. BMJ Open Ophthalmol 2022; 7:A6. [PMID: 36161813 DOI: 10.1136/bmjophth-2022-bcm.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
UNLABELLED *Correspondence - Hatch Mukherjee: hatch.mukherjee@gmail.com OBJECTIVE: To evaluate the outcomes of combined excimer laser PTK/limited PRK combined with corneal crosslinking in the management of keratoconus. METHODS AND ANALYSIS Data were analysed from a retrospective cohort of eyes undergoing PTK epithelial removal or limited PRK combined with corneal crosslinking. Patients undergoing PRK were either contact lens intolerant or were considering alternate surgical therapy including corneal transplantation. Data included uncorrected and best corrected vision, refraction and OCT topographic findings. Treatments were performed using a TECHNOLAS® TENEO™ 2 (Bausch & Lomb) and CXL with Avedro KXL (Glaukos) according to a modified protocol. RESULTS 24 eyes were treated using combined Excimer laser PTK or limited non-topographic transepithelial PRK depending on intervention protocol with >3 month follow-up. Postoperative best corrected visual acuity improved by a mean of 0.42 LOGMAR units (SD 0.37, range 0.1 to 1.4) (p<0.005). All eyes had improvement of BCVA. Mean absolute spherical refractive error decreased by 0.56 D (SD 1.26, range -2.5 to 2) (p<0.05). Postoperative spherical error increased in a few cases (3/24, 12%) Mean absolute refractive cylinder decreased by 1.46D (SD 2.3 range -4.75 to 7) (p<0.05). Limited increase of astigmatism occurred in 2 (8,3%) cases. There were no postoperative complications noted. CONCLUSION PTK/limited non topographic PRK combined with CXL may offer improvement to corrected visual acuity compared to CXL alone.
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Affiliation(s)
- Hatch Mukherjee
- Colchester Eye Centre, East Suffolk and North East Essex Trust, Colchester, UK
| | - Spyros Pipis
- Colchester Eye Centre, East Suffolk and North East Essex Trust, Colchester, UK
| | - Yunfei Yang
- Colchester Eye Centre, East Suffolk and North East Essex Trust, Colchester, UK
| | - Adriana Santos
- Colchester Eye Centre, East Suffolk and North East Essex Trust, Colchester, UK
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Bizrah M, Yuan PH, Ching G, Holland SP. P-13 Trans-epithelial phototherapeutic keratectomy (PTK) for recurrent corneal erosion syndrome (RCES). BMJ Open Ophthalmol 2022; 7:A4. [PMID: 36161817 DOI: 10.1136/bmjophth-2022-bcm.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
UNLABELLED *Correspondence - Mukhtar Bizrah: m.bizrah@nhs.net OBJECTIVE: To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (PTK) as a treatment for recurrent cornea erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. METHODS AND ANALYSIS All patients who received PTK treatment for RCES had failed more than one conventional treatment, and were first vetted and approved by the British Columbia public health authority. A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre. Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy. RESULTS This study included 593 eyes of 555 patients (46.2% male; 50.9±14.2 years old) who underwent PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). 36 eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies, 20% required ongoing drops and 6 patients (1.1%) reported no symptom improvement. All 6 eyes were successfully retreated with PTK between 11.3±14.9 months from initial PTK. All study patients showed no significant differences in best corrected visual acuity pre vs. postoperatively. CONCLUSION When compared to other surgical options, PTK is potentially more costly but frequently more effective and has a high safety profile. The third-party public health vetted nature of this study, the high patient satisfaction, and the low recurrence rate of RCES suggest that PTK should be considered at an earlier stage in the management of RCES.
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Affiliation(s)
| | - Po Hsiang Yuan
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Geoffrey Ching
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Simon P Holland
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Ozdas D, Yesilirmak N, Sarac O, Cagil N. 36-Month Outcomes of Mechanical and Transepithelial PTK Epithelium Removal Techniques Prior to Accelerated CXL for Progressive Keratoconus. J Refract Surg 2022; 38:191-200. [PMID: 35275008 DOI: 10.3928/1081597x-20220114-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the 36-month visual, refractive, and topographic results and the optical quality of the cornea between mechanical and transepithelial phototherapeutic keratectomy (PTK) epithelium removal techniques prior to the accelerated corneal cross-linking (CXL) procedure in patients with progressive keratoconus. METHODS Keratoconic eyes that received either mechanical epithelium removal or transepithelial PTK epithelium removal prior to accelerated CXL with 36 months of follow-up were included. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), manifest astigmatism, flat keratometry (K1), steep keratometry (K2), maximum keratometry (Kmax) readings, thinnest corneal thickness (TCT), topographic astigmatism, point spread function (PSF), and aberrometric parameters including root mean square higher order aberrations (RMS HOAs), vertical coma, and spherical aberration (SA) were assessed preoperatively and 12, 24, and 36 months postoperatively. RESULTS One hundred ten eyes of 110 patients with keratoconus were included (mechanical epithelium removal group: 69 eyes, transepithelial PTK epithelium removal group: 41 eyes). After the CXL procedure, the mean UDVA, CDVA, manifest astigmatism, RMS HOAs, SA, vertical coma, and PSF improved significantly throughout the follow-up visits in both groups (P < .05 for all variables). The improvement in the mean UDVA, CDVA, manifest astigmatism, K1, K2, Kmax, RMS HOAs, SA, vertical coma, and PSF were significantly better in eyes that underwent transepithelial PTK epithelium removal when compared to eyes that underwent mechanical epithelium removal during the follow-up period (P < .05 for all variables). CONCLUSIONS Transepithelial PTK-assisted accelerated CXL seems to be more efficient in improving the visual acuity and the optical quality while stabilizing the cornea compared to the accelerated CXL with mechanical epithelium removal in patients with progressive keratoconus. [J Refract Surg. 2022;38(3):191-200.].
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Maharramov PM, Aghayeva FA. Evaluation of the effectiveness of combined staged surgical treatment in patients with keratoconus. PLoS One 2022; 17:e0264030. [PMID: 35255102 PMCID: PMC8901062 DOI: 10.1371/journal.pone.0264030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study performs comparative assessment of the results of different types of two-stage surgical treatment in patients with keratoconus, including combination of corneal collagen cross-linking with intrastromal corneal ring segments followed by topography-guided photorefractive keratectomy. Materials and methods Prospective review of 101 patients (101 eyes) with keratoconus was performed. Patients underwent corneal collagen cross-linking (32 patients), intrastromal corneal ring segments (48 patients), and a combination of these two procedures (21 patients). Transepithelial topography-guided photorefractive keratectomy was performed as the second stage of treatment in all patients with obtained stable refractive results at 8 months after first stage. Main outcome measures were visual acuity (uncorrected distance and corrected distance) and corneal topographic indices. Results Comparison of the studied parameters after first stage surgical treatment between non-combined CXL and combined groups demonstrated a statistically significant difference for uncorrected distance visual acuity, corrected distance visual acuity, and cylindrical refraction values (p<0.05). We observed significant improvement of visual acuity and key corneal topographic indices after topography-guided photorefractive keratectomy in all study groups (p<0.05). In 50 (49.5%) patients customized excimer laser ablation gave the possibility of full spherical and cylindrical corrections. Ten eyes (10%) had delayed epithelial healing, no corneal stromal opacities developed. Conclusions This study shows that combined two-stage surgical treatment of keratoconus, consisting of intrastromal corneal ring segment implantation with corneal collagen cross-linking followed by topography-guided photorefractive keratectomy, is clinically more effective to prevent keratectasia progression and increase visual acuity than the use of non-combined two-stage techniques.
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Affiliation(s)
- Polad M. Maharramov
- National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan
- * E-mail:
| | - Fidan A. Aghayeva
- National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan
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Asroui L, Dupps WJ, Randleman JB. Determining the Utility of Epithelial Thickness Mapping in Refractive Surgery Evaluations. Am J Ophthalmol 2022; 240:125-134. [PMID: 35247335 DOI: 10.1016/j.ajo.2022.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the impact of corneal epithelial thickness maps on screening for refractive surgery candidacy in a single refractive surgical practice. DESIGN Comparison of screening methods. 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- Lara Asroui
- From the Cole Eye Institute (L.A., W.J.D., J.B.R.), Department of Biomedical Engineering, Lerner Research Institute (W.J.D.), Cleveland Clinic, Department of Biomedical Engineering, Case Western Reserve University (W.J.D.), and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (W.J.D, J.B.R) Cleveland, Ohio, USA
| | - William J Dupps
- From the Cole Eye Institute (L.A., W.J.D., J.B.R.), Department of Biomedical Engineering, Lerner Research Institute (W.J.D.), Cleveland Clinic, Department of Biomedical Engineering, Case Western Reserve University (W.J.D.), and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (W.J.D, J.B.R) Cleveland, Ohio, USA
| | - J Bradley Randleman
- From the Cole Eye Institute (L.A., W.J.D., J.B.R.), Department of Biomedical Engineering, Lerner Research Institute (W.J.D.), Cleveland Clinic, Department of Biomedical Engineering, Case Western Reserve University (W.J.D.), and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (W.J.D, J.B.R) Cleveland, Ohio, USA.
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Sarkar S, Devi P, Vaddavalli PK, Reddy JC, Bharadwaj SR. Differences in Image Quality after Three Laser Keratorefractive Procedures for Myopia. Optom Vis Sci 2022; 99:137-149. [PMID: 34974458 DOI: 10.1097/opx.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Psychophysical estimates of spatial and depth vision have been shown to be better after bilateral ReLEx small-incision lenticule extraction (SMILE) refractive surgery for myopia, relative to photorefractive keratectomy (PRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). The present study provides the optical basis for these findings using computational image quality analysis. PURPOSE This study aimed to compare longitudinal changes in higher-order wavefront aberrations and image quality before and after bilateral PRK, FS-LASIK, and SMILE refractive procedures for correcting myopia. METHODS Wavefront aberrations and image quality of both the eyes of 106 subjects (n = 40 for FS-LASIK and SMILE and n = 26 for PRK) were determined pre-operatively and at 1-week, 1-month, 3-month, and 6-month post-operative intervals using computational through-focus analysis for a 6-mm pupil diameter. Image quality was quantified in terms of its peak value and its interocular difference, residual defocus that was needed to achieve peak image quality (best focus), and the depth of focus. RESULTS The increase in root mean squared deviations of higher-order aberrations post-operatively was lesser after SMILE (1-month visit median [25th to 75th interquartile range], 0.34 μm (0.28 to 0.39 μm]) than after PRK (0.80 μm [0.74 to 0.87 μm]) and FS-LASIK (0.74 μm [0.59 to 0.83 μm]; P ≤ .001), all relative to pre-operative values (0.20 μm [0.15 to 0.30 μm]). The peak image quality dropped and its interocular difference increased, best focus shifted myopically by 0.5 to 0.75 D, and depth of focus widened significantly after PRK and FS-LASIK surgeries, all relative to pre-operative values (P < .001). All these changes were negligible but statistically significant in a minority of instances after SMILE surgery (P ≥ .01). CONCLUSIONS Although all three refractive surgeries correct myopia, the image quality and its similarity between eyes are better and closer to pre-operative values after SMILE, compared with FS-LASIK and PRK. These results can be explained from the underlying increase in higher-order wavefront aberrations experienced by the eye post-operatively.
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Affiliation(s)
| | | | | | - Jagadesh C Reddy
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Hart CT, Cleary G, Chan E. Long-Term Outcomes of Phototherapeutic Keratectomy for Bullous Keratopathy. Cornea 2022; 41:155-158. [PMID: 33605629 DOI: 10.1097/ico.0000000000002695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the long-term outcomes after phototherapeutic keratectomy (PTK) for the treatment of bullous keratopathy. METHODS This is a retrospective medical record review of all patients with symptomatic bullous keratopathy who underwent PTK between June 2005 and March 2019 at the Royal Victorian Eye and Ear Hospital who were followed up for at least 12 months after the procedure. Medical records were used to extract demographic data, etiology of bullous keratopathy, complication rates, and subsequent procedures after PTK. The main outcomes recorded were pain and recurrence of bullae, which were assessed according to three time periods: 0 to 3 months, 4 to 12 months, and greater than 12 months after PTK. RESULTS During the study period, 64 eyes of 64 patients underwent PTK for bullous keratopathy. The mean follow-up duration was 51 months (range 12-140). The most common indication was pseudophakic bullous keratopathy (44% of cases). Pain had resolved in 88% of eyes within 0 to 3 months, 77% of eyes between 3 and 12 months (P = 0.031, compared with 0-3 months), and 70% of eyes with greater than 12-month follow-up (P = 0.131, compared with 3-12 months). Bullae recurred in 17% of eyes within 0 to 3 months, 22% of eyes between 3 and 12 months (P < 0.001 compared with 0-3 months), and 33% of eyes after the 12-month follow-up (P < 0.001 compared with 3-12 months). Eighty-six percent of patients undergoing PTK had no postoperative complications, and 73% of cases did not require subsequent procedures. CONCLUSIONS PTK is effective in providing long-term symptom relief from bullous keratopathy in most of the treated patients.
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Affiliation(s)
| | - Georgia Cleary
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; and
- Department of Ophthalmology and Surgery, University of Melbourne, Centre for Eye Research Australia, Melbourne, Australia
| | - Elsie Chan
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; and
- Department of Ophthalmology and Surgery, University of Melbourne, Centre for Eye Research Australia, Melbourne, Australia
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Kanellopoulos AJ. Keratoconus Management With Customized Photorefractive Keratectomy by Artificial Intelligence Ray-Tracing Optimization Combined With Higher Fluence Corneal Crosslinking: The Ray-Tracing Athens Protocol. Cornea 2021; 40:1181-1187. [PMID: 34050067 PMCID: PMC8330827 DOI: 10.1097/ico.0000000000002739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 02/07/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to report novel ray-tracing customization of surface excimer laser ablation combined with higher fluence corneal crosslinking (CXL) in the stabilization and normalization of ectasia and visual rehabilitation of progressive keratoconus. METHODS A 28-year-old man with bilateral progressive keratoconus was treated with Athens protocol: CXL combined with photorefractive surface ablation customized by a novel artificial intelligence platform calculating lower- and higher-order aberrations based on wavefront, Scheimpflug tomography, and interferometry axial length data from a single diagnostic device. Visual acuity, refractive error, keratometry, optical coherence tomography and Scheimpflug tomography, and endothelial cell density were evaluated over 12 months. RESULTS Keratoconus stabilized in both eyes. Uncorrected distance visual acuity changed from 20/80 to 20/20 in the OD and from 20/40 to 20/25 in the OS at 12 months. Keratometry changes were as follows: from 40.7 and 42.7 at 165.1 degrees to 41.4 and 43.1 at 169.3 degrees in the OD and from 40.9 and 42.6 at 15.9 degrees to 44.1 and 44.7 at 9.8 degrees in the OS. Corneal surface normalization was as follows: index of height decentration from 0.115 to 0.099 and index of surface variance from 77 to 67 in the OD and index of height decentration from 0.066 to 0.014 and index of surface variance from 49 to 31 in the OS. CONCLUSIONS We introduced in this study the management of progressive keratoconus with CXL combined with novel excimer laser customization using several independent up-to-now diagnostics calculated by software, evaluating bidirectional theoretical ray tracing. It bears the potential advantage of addressing more accurately normalization of the distorted human eye optics associated with corneal ectasia, compared with using anterior corneal surface data or wavefront data alone.
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Affiliation(s)
- Anastasios John Kanellopoulos
- Department of Ophthalmology, the Laservision.gr Clinical and Research Institute, Athens, Greece; and
- Department of Ophthalmology, New York University, School of Medicine, New York City, NY
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Gaeckle HC. Early clinical outcomes and comparison between trans-PRK and PRK, regarding refractive outcome, wound healing, pain intensity and visual recovery time in a real-world setup. BMC Ophthalmol 2021; 21:181. [PMID: 33863311 PMCID: PMC8052644 DOI: 10.1186/s12886-021-01941-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To compare early clinical outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and photorefractive keratectomy (PRK) regarding refractive outcome, visual acuity, wound healing, pain intensity and visual recovery time.d. METHODS In this prospective clinical observational study 200 eyes of 100 consecutive patients with mild to moderate myopia with or without mild astigmatism were included. One hundred eyes each were either treated with StreamLight™ tPRK or PRK with the WaveLight® EX500 excimer laser. Visual acuity (Decimal) was assessed preoperatively and at day 4, 7 and 6 weeks postoperatively. Wound healing (hours between surgery and complete epithelial closure) was monitored at the slit lamp. At day 4, patients subjectively rated the maximum pain intensity within the last 4 days using a numerical pain rating scale (0-15). RESULTS Visual recovery was significantly faster in the tPRK group. At days 4 and 7, the mean monocular UCDVA was significantly better in the tPRK group than in the PRK group (p < 0.001). Four days after surgery 72 % of eyes in the tPRK group but no eye in the PRK had a UCDVA of 0.7 or better. At six weeks postoperatively, a UCDVA of 1.0 or better was achieved in both groups. Complete epithelial wound closure was achieved significantly faster in the tPRK group (p < 0.0001) and maximum pain level within the first 4 days after surgery was significantly lower in the tPRK group (p < 0.0001). No patient had lost a line of BCDVA and no complications or adverse effects were observed. CONCLUSIONS According to our early clinical results, both treatments options appear to be safe and effective methods for the correction of low to moderate myopia with and without astigmatism. However, in our study, StreamLight™ tPRK offered faster visual recovery and epithelial healing and was associated with less pain compared to PRK. It can therefore be considered a good treatment option for patients who refuse or are not eligible for Femto-LASIK, but at the same time demand a faster and more comfortable recovery time than PRK can offer.
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Affiliation(s)
- Harald C Gaeckle
- Augenlaserzentrum Neu-Ulm, Edisonallee 19, 89231, Neu-Ulm, Germany.
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Chacra LM, Arba-Mosquera S, Awwad ST. Customized Ablation Area PTK as a Technique for Salzmann's Degeneration and Other Focal Stromal Pathologies. J Refract Surg 2021; 36:340-344. [PMID: 32396646 DOI: 10.3928/1081597x-20200226-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To introduce a customized ablation area photo-therapeutic keratectomy (PTK) technique that uses a preoperatively generated laser ablation profile to accurately match and ablate the area of the pathology. METHODS A case of mid-peripheral Salzmann's nodular degeneration causing recurrent epithelial erosion is described. The white-to-white distance, on a slit-lamp image of the patient's eye, was measured by a Placido and dual-Scheimpflug analyzer and used as a scale on a Java-based image processing program to extrapolate the focal corneal pathology's vertical and horizontal dimensions on the corneal plane. The lesion's depth was measured by corneal optical coherence tomography (OCT). Customized ablation area transepithelial PTK, tailored to the exact dimensions of the pathology was then performed in one pass, regionally ablating the area of the pathology only. RESULTS Complete epithelial healing was observed by the next day with unaltered visual acuity of 20/20. Corneal OCT performed at 1 and 3 months postoperatively showed near-complete resolution of the lesion. The patient was followed up for a total of 6 months with no reported symptoms of corneal erosions. CONCLUSIONS The application of a customized laser ablation area in the treatment of Salzmann's nodular degeneration and other focal stromal pathologies avoids unnecessary epithelial and stromal ablation. This contributes to faster visual recovery and less refractive impact, especially for peripheral lesions. [J Refract Surg. 2020;36(5):340-344.].
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Li L, Zhang B, Hu Y, Xiong L, Wang Z. Comparison of safety and efficiency of corneal topography-guided photorefractive keratectomy and combined with crosslinking in myopic correction: An 18-month follow-up. Medicine (Baltimore) 2021; 100:e23769. [PMID: 33466126 PMCID: PMC7808543 DOI: 10.1097/md.0000000000023769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/17/2020] [Indexed: 01/05/2023] Open
Abstract
To compare the safety and efficiency of simple corneal topography-guided (T-CAT) photorefractive keratectomy (PRK) and T-CAT PRK combined with crosslinking (CXL) to correct myopia with borderline suspicious tomography.Eyes with suspicious tomography (not classified as forme fruste keratoconus) underwent PRK combined with CXL. The suspicious tomography showed irregular posterior corneal morphology or maximum elevation value of the central 6 mm zone of the posterior surface (MEL) >15 μm, or Belin/Ambrósio Enhanced Ectasia Index (BAD-D) was >1.6. The PRK group was generated and matched within 2 μm for MEL, 0.3 for BAD-D value, and 0.5 D for manifest refractive spherical equivalent (MRSE) compared with the PRK-CXL group.PRK-CXL exhibited a larger MRSE (0.09 ± 0.22 D vs -0.03 ± 0.24 D, P = .02) and a larger sphere (0.14 ± 0.22 D vs 0.01 ± 0.21 D, P = .002) compared with PRK alone at 18 months postoperatively. The magnitude change and relative change rate of stiffness parameter A1 in the PRK-CXL were smaller than in the PRK group (-15.72 ± 14.56 vs -19.95 ± 14.37, P = .04, for magnitude change and -0.16 ± 0.15 vs -0.20 ± 0.14, P = .02, for relative change rate). In the PRK-CXL and PRK groups, 4.8% and 6.9% of eyes suffered grade 0.5 haze at postoperative 18-month. No cases of ectasia were reported in either group.PRK in combination with prophylactic crosslinking showed comparable safety and efficacy, but higher biomechanical stability compared to PRK alone, thus, the additional CXL plays a measurable role in reducing the change in corneal biomechanical properties after PRK in suspicious eyes.
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Affiliation(s)
- Li Li
- Aier School of Ophthalmology, Central South University, Changsha
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou
| | - Bo Zhang
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou
- Aier Institute of Refractive Surgery, Aier Eye Hospital Group, Changsha, China
| | - Yijun Hu
- Aier School of Ophthalmology, Central South University, Changsha
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou
- Aier Institute of Refractive Surgery, Aier Eye Hospital Group, Changsha, China
| | - Lu Xiong
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou
| | - Zheng Wang
- Aier School of Ophthalmology, Central South University, Changsha
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou
- Aier Institute of Refractive Surgery, Aier Eye Hospital Group, Changsha, China
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Abstract
BACKGROUND Refractive errors (conditions in which the eye fails to focus objects accurately on the retina due to defects in the refractive system), are the most common cause of visual impairment. Myopia, hyperopia, and astigmatism are low-order aberrations, usually corrected with spectacles, contact lenses, or conventional refractive surgery. Higher-order aberrations (HOAs) can be quantified with wavefront aberration instruments and corrected using wavefront-guided or wavefront-optimized laser surgery. Wavefront-guided ablations are based on preoperative measurements of HOAs; wavefront-optimized ablations are designed to minimize induction of new HOAs while preserving naturally occurring aberrations. Two wavefront procedures are expected to produce better visual acuity than conventional procedures. OBJECTIVES The primary objective was to compare effectiveness and safety of wavefront procedures, laser-assisted in-situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) or laser epithelial keratomileusis (LASEK) versus corresponding conventional procedures, for correcting refractive errors in adults for postoperative uncorrected visual acuity, residual refractive errors, and residual HOAs. The secondary objective was to compare two wavefront procedures. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2019, Issue 8); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences (LILACS); the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 6 August 2019. We imposed no restrictions by language or year of publication. We used the Science Citation Index (September 2013) and searched the reference lists of included trials to identify additional relevant trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing either wavefront modified with conventional refractive surgery or wavefront-optimized with wavefront-guided refractive surgery in participants aged ⪰ 18 years with refractive errors. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We identified 33 RCTs conducted in Asia, Europe and United States, totaling 1499 participants (2797 eyes). Participants had refractive errors ranging from high myopia to low hyperopia. Studies reported at least one of the following review-specific outcomes based on proportions of eyes: with uncorrected visual acuity (UCVA) of 20/20 or better, without loss of one or more lines of best spectacle-corrected visual acuity (BSCVA), within ± 0.50 diopters (D) of target refraction, with HOAs and adverse events. Study characteristics and risk of bias Participants were mostly women, mean age 29 and 53 years, and without previous refractive surgery, ocular pathology or systemic comorbidity. We could not judge risks of bias for most domains of most studies. Most studies in which both eyes of a participant were analyzed failed to account for correlations between two eyes in the analysis and reporting of outcomes. Findings For the primary comparison between wavefront (PRK or LASIK or LASEK) and corresponding conventional procedures, 12-month outcome data were available from only one study of PRK with 70 participants. No evidence of more favorable outcomes of wavefront PRK on proportion of eyes: with UCVA of 20/20 or better (risk ratio [RR] 1.03, 95% confidence interval (CI) 0.86 to 1.24); without loss of one or more lines of BSCVA (RR 0.94, 95% CI 0.81 to 1.09); within ± 0.5 D of target refraction (RR 1.03, 95% CI 0.86 to 1.24); and mean spherical equivalent (mean difference [MD] 0.04, 95% CI -0.11 to 0.18). The evidence for each effect estimate was of low certainty. No study reported HOAs at 12 months. At six months, the findings of two to eight studies showed that overall effect estimates and estimates by subgroup of PRK or LASIK or LASEK were consistent with those for PRK at 12 month, and suggest no difference in all outcomes. The certainty of evidence for each outcome was low. For the comparison between wavefront-optimized and wavefront-guided procedures at 12 months, the overall effect estimates for proportion of eyes: with UCVA of 20/20 or better (RR 1.00, 95% CI 0.99 to 1.02; 5 studies, 618 participants); without loss of one or more lines of BSCVA (RR 0.99, 95% CI 0.96 to 1.02; I2 = 0%; 5 studies, 622 participants); within ± 0.5 diopters of target refraction (RR 1.02, 95% CI 0.95 to 1.09; I2 = 33%; 4 studies, 480 participants) and mean HOAs (MD 0.03, 95% CI -0.01 to 0.07; I2 = 41%; 5 studies, 622 participants) showed no evidence of a difference between the two groups. Owing to substantial heterogeneity, we did not calculate an overall effect estimate for mean spherical equivalent at 12 months, but point estimates consistently suggested no difference between wavefront-optimized PRK versus wavefront-guided PRK. However, wavefront-optimized LASIK compared with wavefront-guided LASIK may improve mean spherical equivalent (MD -0.14 D, 95% CI -0.19 to -0.09; 4 studies, 472 participants). All effect estimates were of low certainty of evidence. At six months, the results were consistent with those at 12 months based on two to six studies. The findings suggest no difference between two wavefront procedures for any of the outcomes assessed, except for the subgroup of wavefront-optimized LASIK which showed probable improvement in mean spherical equivalent (MD -0.12 D, 95% CI -0.19 to -0.05; I2 = 0%; 3 studies, 280 participants; low certainty of evidence) relative to wavefront-guided LASIK. We found a single study comparing wavefront-guided LASIK versus wavefront-guided PRK at six and 12 months. At both time points, effect estimates consistently supported no difference between two procedures. The certain of evidence was very low for all estimates. Adverse events Significant visual loss or optical side effects that were reported were similar between groups. AUTHORS' CONCLUSIONS This review suggests that at 12 months and six months postoperatively, there was no important difference between wavefront versus conventional refractive surgery or between wavefront-optimized versus wavefront-guided surgery in the clinical outcomes analyzed. The low certainty of the cumulative evidence reported to date suggests that further randomized comparisons of these surgical approaches would provide more precise estimates of effects but are unlikely to modify our conclusions. Future trials may elect to focus on participant-reported outcomes such as satisfaction with vision before and after surgery and effects of remaining visual aberrations, in addition to contrast sensitivity and clinical outcomes analyzed in this review.
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Affiliation(s)
- Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Samuel A Abariga
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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