scholarly journals Flap Sliding Technique for Managing Flap Striae following Laser In Situ Keratomileusis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Khaled Abdelazeem ◽  
Mohamed A. Nassr ◽  
Hazem Abdelmotaal ◽  
Ehab Wasfi ◽  
Dalia Mohamed El-Sebaity
Keyword(s):  
Visual Acuity ◽  
Laser In Situ Keratomileusis ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Corrected Distance Visual Acuity ◽  
Safe Technique ◽  
Optical Zone ◽  
Sliding Technique ◽  
Flap Elevation

Purpose. To assess the efficacy and safety of a simple, noninvasive, “flap-sliding” technique for managing flap striae following laser in situ keratomileusis (LASIK). Methods. This prospective, interventional study included eyes with post-LASIK flap striae. All eyes underwent flap sliding 1-2 days after surgery. Following flap edge epithelialisation, a cellulose sponge was used to gently slide the flap perpendicular to the striae direction. This technique allows for flap striae treatment without flap lifting, avoiding any associated lifting complications. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refractive error were monitored one day after the flap-sliding procedure. Results. Fifteen eyes (15 patients) with post-LASIK flap striae were managed using the flap-sliding technique. The procedure did not successfully relocate the flap striae in 1 eye, and flap elevation and floating (using a balanced salt solution) were required. Therefore, 14 eyes were included in post-flap-sliding analyses. The UDVA improved in all patients the first day after the flap-sliding procedure was performed, with 11 of 14 eyes (78.57%) reaching an UDVA of 20/25 or better. Complications following flap sliding occurred in 2 eyes (14.29%). One eye had intraoperative epithelial abrasion, and 1 eye had residual postoperative striae outside of the optical zone. Conclusion. The flap-sliding technique is a simple, noninvasive, efficient, and safe technique for managing post-LASIK flap striae that develop after epithelial healing in the early post-LASIK period. This trial is registered with NCT04055337.

scholarly journals Comparison of outcomes after topography-modified refraction versus wavefront-optimized versus manifest topography-guided LASIK

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jaeryung Kim ◽  
Sung-Ho Choi ◽  
Dong Hui Lim ◽  
Gil-Joong Yoon ◽  
Tae-Young Chung
Keyword(s):  
Visual Acuity ◽  
Vector Analysis ◽  
Laser In Situ Keratomileusis ◽  
Distance Visual Acuity ◽  
Postoperative Astigmatism ◽  
Uncorrected Distance Visual Acuity ◽  
Manifest Refraction ◽  
Corrected Distance Visual Acuity ◽  
Myopic Astigmatism

Abstract Background To compare the outcomes of myopia and myopic astigmatism corrected with topography-modified refraction laser in situ keratomileusis (TMR-LASIK), wavefront-optimized (WFO) LASIK, and topography-guided (TG) LASIK with a correction target based on the manifest refraction (manifest TG-LASIK). Methods This observational, retrospective cohort study included patients who underwent LASIK using the WaveLight® EX500 excimer laser to correct myopia and myopic astigmatism between August 2016 and July 2017. Patients who underwent TMR-LASIK (85 patients), WFO-LASIK (70 patients), or manifest TG-LASIK (40 patients) were enrolled, and only one eye from each patient was analyzed. All participants underwent measurement of the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), manifest refraction, vector analysis of astigmatic change, corneal topography, and corneal wavefront analysis at baseline and at every posttreatment visit. Results Three months postoperatively, a UDVA of 0.0 logMAR or better and manifest refraction spherical equivalent (MRSE) within ±0.5 diopters (D) did not differ across the TMR-, WFO-, and manifest TG-LASIK groups. However, the residual cylinder in the TMR group was significantly larger than that in the WFO and manifest TG groups. The magnitude of error in the TMR group measured using astigmatism vector analysis was significantly higher than that in the WFO and manifest TG groups. Conclusions Although these three LASIK platforms achieved the predicted surgical outcomes, TMR-LASIK overcorrected astigmatism and showed a higher residual postoperative astigmatism compared with WFO- and manifest TG-LASIK.

scholarly journals Comparison of 6.0 mm versus 6.5 mm Optical Zone on Visual Outcomes after LASIK

2021 ◽  
Vol 10 (17) ◽  
pp. 3776
Author(s):  
Majid Moshirfar ◽  
Rachel Huynh ◽  
Nour Bundogji ◽  
Alyson N. Tukan ◽  
Thomas M. Sant ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Laser System ◽  
Spherical Equivalent ◽  
Distance Visual Acuity ◽  
Visual Outcomes ◽  
Refractive Outcomes ◽  
Uncorrected Distance Visual Acuity ◽  
Corrected Distance Visual Acuity ◽  
Optical Zone ◽  
The Difference

Previous studies have demonstrated safety and efficacy using 6.0 and 6.5 mm optical zones in the WaveLight EX500 Excimer Laser System but have not evaluated if differing optical zone sizes influence refractive outcomes. This study examines visual outcomes between two study populations undergoing LASIK with either a 6.0 mm (1332 patients) or 6.5 mm (1332 patients) optical zone. Outcomes were further stratified by severity of myopia (low, moderate, and high) and astigmatism (low and high). Patients were matched by age and preoperative manifest sphere and cylinder. Postoperative measurements were then compared. The 6.5 mm group demonstrated better postoperative manifest refractive spherical equivalent (MRSE), manifest sphere, and absolute value of the difference in actual and target spherical equivalent refraction (|∆ SEQ|), within the total population, moderate myopia, and low astigmatism groups, but this did not lead to improved postoperative uncorrected distance visual acuity (UDVA) or best corrected distance visual acuity (CDVA). Though astigmatic correction and postoperative angle of error were similar between optical zone sizes, they were significantly worse with high myopia. Overall, this study demonstrates differences in visual outcomes between the 6.0 and 6.5 mm optical zone sizes that may warrant consideration; however, essentially, the results are comparable between them.

scholarly journals Effect of Transepithelial Photorefractive Keratectomy without Mitomycin C in the Treatment of Femtosecond Laser In Situ Keratomileusis Corneal Flap Complications

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jing Wang ◽  
Weiqian Cao ◽  
Liming Tao
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Mitomycin C ◽  
Laser In Situ Keratomileusis ◽  
Photorefractive Keratectomy ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Haze Formation

Purpose. To assess the efficacy and safety of transepithelial photorefractive keratectomy (TPRK) without mitomycin C as treatment for femtosecond laser in situ keratomileusis (FS-LASIK) corneal flap complications. Methods. Eight patients with corneal flap complications that occurred after FS-LASIK (five with eccentric flaps, two with buttonhole flaps, and one with a thick flap) were included in the study. Patients were treated with TPRK without mitomycin C between two weeks and twelve months after surgery. The postoperative manifest refraction, uncorrected distance visual acuity, and haze formation were assessed during six months of follow-up. Results. The mean manifest refractive spherical and cylinder refraction was 0.16 ± 0.26 and −0.44 ± 0.33 diopters, respectively, at six months postoperatively. The uncorrected distance visual acuity was above 20/25 in all patients after six months of follow-up. No haze formation was detected. Conclusions. TPRK without mitomycin C appears to be a safe and effective treatment for FS-LASIK corneal flap complications.

scholarly journals Femtosecond-Assisted Elliptical LASIK Flap for the Correction of Post-Arcuate Keratotomy Residual Astigmatism

2019 ◽  
Vol 10 (3) ◽  
pp. 379-383
Author(s):  
Nafsika Voulgari ◽  
Michael A. Grentzelos ◽  
George A. Kontadakis ◽  
Erwin Samutelela ◽  
George D. Kymionis
Keyword(s):  
Visual Acuity ◽  
Arc Length ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Manifest Refraction ◽  
Corrected Distance Visual Acuity ◽  
Ablation Pattern

We report the application of an elliptical femtosecond laser-assisted in situ keratomileusis (LASIK) flap for the management of post-arcuate keratotomy (AK) residual astigmatism. An 82-year-old male was referred to our institute for evaluation of his right eye due to residual regular astigmatism 1 year after AK. On examination, uncorrected distance visual acuity (UDVA) was 20/50 and corrected distance visual acuity was 20/25 (+3.25 –5.50 × 125). Slit-lamp examination revealed two 70-arc length peripheral corneal incisions at the 7.50-mm zone. The patient underwent femtosecond-assisted LASIK for the correction of residual astigmatism. An elliptical LASIK flap was adjusted intraoperatively with a 2-dimension diameter of 7.98 × 6.69 mm in order to avoid intersection of the flap with the AK incisions. The short flap diameter was placed along the meridian of the incisions and the long diameter in the perpendicular meridian, corresponding to the excimer laser astigmatic ablation pattern. No intraoperative or postoperative complications were encountered. Six months postoperatively, UDVA improved to 20/25 with a manifest refraction of pl –0.75 × 5. No AK incision flap-related complications were observed.

scholarly journals Femtosecond Laser-Assisted In Situ Keratomileusis Treatment of Residual Refractive Error following Femtosecond Laser-Enabled Keratoplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Elizabeth Shen ◽  
Lester Tsai ◽  
Hannah Muniz Castro ◽  
Matthew Wade ◽  
Marjan Farid
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Spherical Equivalent ◽  
Case Review ◽  
Retrospective Case ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Corrected Distance Visual Acuity ◽  
The University

Purpose. To evaluate the safety and effectiveness of femtosecond laser-assisted in situ keratomileusis (LASIK) in the treatment of residual myopia and astigmatism following femtosecond laser-enabled keratoplasty (FLEK). Design. Retrospective case review. Methods. Chart review of all patients with prior FLEK who subsequently underwent femto-LASIK surgery after full suture removal was performed at the Gavin Herbert Eye Institute at the University of California, Irvine. A total of 14 eyes in 13 patients met this criterion, and their comprehensive examinations performed at standard intervals were reviewed. Main outcome measures include uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), manifest refractive astigmatism, and spherical equivalent. Results. From the preoperative visit to the 3 month visit, all 14 eyes significantly improved in UDVA (logMAR, 0.93 ± 0.23 to 0.44 ± 0.32, P=0.002) with no loss of CDVA (logMAR, 0.26 ± 0.19 to 0.18 ± 0.23, P=0.50). All 14 eyes showed significant improvement in manifest refractive astigmatism (4.71 ± 1.77 to 2.18 ± 1.45 diopters (D), P=0.003) and spherical equivalent (−2.57 ± 2.45 to −0.48 ± 0.83 D, P=0.0007). There were no flap or graft complications as a result of femto-LASIK. Conclusions. Our findings suggest that femto-LASIK on eyes with prior FLEK is safe and effective in improving visual acuity and reducing residual astigmatism.

Laser in Situ Keratomileusis for High Hyperopia with Corneal Vertex Centration and Asymmetric Offset

2016 ◽  
Vol 27 (2) ◽  
pp. 141-152 ◽  
Author(s):  
Diego de Ortueta ◽  
Sam Arba-Mosquera
Keyword(s):  
Visual Acuity ◽  
Spherical Aberration ◽  
Higher Order ◽  
Laser In Situ Keratomileusis ◽  
Higher Order Aberrations ◽  
Distance Visual Acuity ◽  
Refractive Outcomes ◽  
Uncorrected Distance Visual Acuity ◽  
High Hyperopia

Purpose To investigate refractive outcomes and induction of corneal higher order aberrations (HOA) in eyes that underwent laser-assisted in situ keratomileusis (LASIK) for high hyperopia correction using an aberration neutral profile with corneal vertex centration and asymmetric offset. Methods A total of 24 consecutive patients (38 eyes) who underwent LASIK by one surgeon using AMARIS 750S excimer laser and a Carriazo-Pendular microkeratome for flap creation were retrospectively analyzed. Eyes targeted for plano and with correction in the maximum hyperopic meridian strictly higher than +4D were included in the retrospective analysis. Patients were reviewed at 1, 3, and 6 months postoperatively. Postoperative monocular corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, and corneal wavefront aberrations were compared with respective preoperative metrics. Results Mean preoperative spherical equivalent and refractive astigmatism was +4.07 ± 0.90 D and 1.37 ± 1.26 D, respectively, reducing to +0.28 ± 0.58D (p<0.0001) and 0.49 ± 0.47 D (p = 0.0001) at the last postoperative visit. Six months postoperatively, 78% of eyes achieved a UDVA of 20/25 or better. No eye lost more than 2 Snellen lines of CDVA at any follow-up. There was a statistically significant induction of vertical trefoil (+0.104 ± 0.299 µm, p<0.05), vertical coma (-0.181 ± 0.463 µm, p<0.01), horizontal coma (+0.198 ± 0.663 µm, p<0.05), spherical aberration (-0.324 ± 0.281 µm, p<0.0001), secondary vertical trefoil (+0.018 ± 0.044 µm, p<0.01), and secondary horizontal coma (+0.026 ± 0.083 µm, p<0.05) Conclusions Laser-assisted in situ keratomileusis for high hyperopia using corneal vertex centration with asymmetric offset results in significant improvement in refraction and visual acuity although affected by significant induction of some higher order aberrations.

Outcomes of a 320-degree intrastromal corneal ring segment implantation for keratoconus: Results of a 6-month follow-up

2018 ◽  
Vol 30 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Guilherme Andrade do Nascimento Rocha ◽  
Paulo Ferrara de Almeida Cunha ◽  
Leonardo Torquetti Costa ◽  
Luciene Barbosa de Sousa
Keyword(s):  
Visual Acuity ◽  
Spherical Equivalent ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Intrastromal Corneal Ring ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment ◽  
The Mean ◽  
Corneal Tomography

Importance: This study shows that a newer long-arc length intrastromal corneal ring segment is efficient and safe for keratoconus treatment. Background: To evaluate visual, tomographic results and complications of a 320-degree intrastromal corneal ring segment implantation with the femtosecond laser for keratoconus treatment. Design: A prospective, nonrandomized, and interventional study. Participants: A total of 34 eyes of 31 patients diagnosed with keratoconus were enrolled. Methods: Patients were divided into two groups based on the strategy used for 320-degree intrastromal corneal ring segment thickness selection. In one group, this selection was based on spherical equivalent (SE group) and in the other on the mean asphericity (Q group). The uncorrected and corrected distance visual acuities, spherical equivalent, K1, K2, Km, Kmax, and mean asphericity ( Q) on corneal tomography were evaluated preoperatively and at 3 and 6 months postoperatively. For astigmatism improvement, we analyzed the corneal tomographic vectorial astigmatism change preoperatively and at 6 months postoperatively. The mean follow-up period was 6.63 ± 0.96 months. Results: The mean uncorrected distance visual acuity and corrected distance visual acuity improved with a significant spherical equivalent improvement ( p < 0.05), with no differences between the 320-degree intrastromal corneal ring segment groups. All corneal tomographic parameters improved significantly ( p < 0.05) between the preoperative and postoperative intervals, with a significant better performance when we used spherical equivalent for the 320-degree intrastromal corneal ring segment thickness selection. Finally, the mean vectorial corneal tomographic astigmatism significantly improved after 6 months, again with no differences between groups. Conclusion: This study suggests that implanting a 320-degree intrastromal corneal ring segment is a safe and effective procedure for treating patients with keratoconus. It also suggests that for thickness selection spherical equivalent is the better strategy.

scholarly journals Long-term Stability of Ectasia in a Young Patient with Asymmetric Keratoconus

2015 ◽  
Vol 4 (2) ◽  
pp. 66-68
Author(s):  
Rosane de Oliveira Corrêa ◽  
Ana Laura Caiado Canedo ◽  
Rozalia Beildeck ◽  
Marcella Quaresma Salomão ◽  
Penelope Burle de Politis
Keyword(s):  
Visual Acuity ◽  
Young Patient ◽  
Distance Visual Acuity ◽  
Long Term Stability ◽  
Uncorrected Distance Visual Acuity ◽  
Manifest Refraction ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment ◽  
Intracorneal Ring Segment ◽  
The Right

ABSTRACT Purpose To report the clinical course of a typical young patient presenting with asymmetric keratoconus (KC), that demonstrates that stabilization of the ectatic process is possible without cross-linking (CXL) procedure. Methods Case report and review of the literature. Results A 17-year-old male patient was referred due to the diagnosis of keratoconus. Patient complained of loss of vision in the left eye (OS). Uncorrected distance visual acuity (UDVA) was 20/25+ in the right eye (OD) and 20/80 in the left eye; wavefront-assisted manifest refraction gave best corrected distance visual acuity (CDVA) of 20/20 in OD and 20/40 in OS. The diagnosis of keratoconus was confirmed with Placido disk-based topography (Oculus Keratograph 4), and Pentacam HR corneal tomography (Oculus Optikgeräte GmbH, Wetzlar, Germany). Femtosecond laser-assisted intracorneal ring segment (ICRS) implantation was performed in the left eye and treatment for allergy was prescribed for both eyes, along with patient education and advice not to rub the eyes. After 3 months, significant improvement was observed on UDVA (20/30) and CDVA (20/20) in the left eye. Topometric and tomographic stability of ectasia was observed in the right eye in a 4-year follow-up. Conclusion Intracorneal ring segment caused significant regularization of the corneal shape and improvement on visual acuity. Ectasia stability was achieved with no need for CXL, despite the patient's young age. This case raises the point that the indication of CXL for every keratoconic patient should be reconsidered. How to cite this article de Oliveira Corrêa R, Canedo ALC, Beildeck R, Salomão MQ, de Politis PB, Ambrósio R Jr. Longterm Stability of Ectasia in a Young Patient with Asymmetric Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):66-68.

Implantable collamer lens for the correction of post-keratoplasty myopia and astigmatism

2020 ◽  
Vol 1 (2) ◽  
pp. 113-116
Author(s):  
Nasser A Alsabaani ◽  
◽  
Salem Almalki ◽  
Keyword(s):  
Visual Acuity ◽  
Contact Lenses ◽  
Posterior Chamber ◽  
Implantable Collamer Lens ◽  
Distance Visual Acuity ◽  
Refractive Outcomes ◽  
Uncorrected Distance Visual Acuity ◽  
Single Center Study ◽  
Corrected Distance Visual Acuity ◽  
Corneal Refractive Surgery

AIM: To evaluate the safety, refractive outcomes and vision after phakic posterior chamber implantable collamer lens (ICL) after keratoplasty (KP). METHODS: This retrospective single center study evaluated 32 (35 eyes) patients who received an ICL for myopia and/or astigmatism after keratoplasty. Patients underwent ICL surgery if they were unable to wear glasses or contact lenses and excimer laser surgery was contraindicated. Data were collected on uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and complications. Data were analyzed for the preoperative and last postoperative visits (16.7±13mo) (P<0.05). RESULTS: Preoperatively, spherical equivalent (SE) ranged from -4.00 to -20.00 D and cylinder from -2.00 to -9.00 D. The mean SE decreased statistically significantly from -11.41±3.62 D preoperatively to -1.95±1.78 D postoperatively (P<0.0001). Mean UDVA increased statistically significantly from 20/400 preoperatively to 20/25 postoperatively (P<0.0001). There was a mean improvement in postoperative CDVA of 1.5 lines compared to preoperatively, 37% of eyes had an increase of 2 or more lines. One eye (2.8%) lost ≥1 line of CDVA. There were no intraoperative or postoperative complications. CONCLUSION: Posterior chamber phakic intraocular lens implantation is a safe and effective treatment for post-keratoplasty myopia and astigmatism in patients unable to wear spectacles or contact lenses and where corneal refractive surgery is contraindicated.

Clinical outcomes of small incision lenticule extraction versus advanced surface ablation in low myopia

2019 ◽  
Vol 30 (6) ◽  
pp. 1278-1286 ◽  
Author(s):  
Suphi Taneri ◽  
Saskia Kießler ◽  
Anika Rost ◽  
Tim Schultz ◽  
H Burkhard Dick
Keyword(s):  
Visual Acuity ◽  
Spherical Equivalent ◽  
Small Incision Lenticule Extraction ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Surface Ablation ◽  
Uncorrected Distance Visual Acuity ◽  
Corrected Distance Visual Acuity ◽  
Spherical Equivalent Refraction ◽  
Lenticule Extraction

Purpose: To compare the visual and refractive outcomes of small incision lenticule extraction and advanced surface ablation for low myopia or myopic astigmatism. Methods: Retrospective, observational case series of our first 50 consecutive small incision lenticule extraction patients compared to refraction-matched 50 advanced surface ablation treatments with attempted spherical equivalent correction ⩽−3.5 D, astigmatism ⩽−1.5 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Only one eye per patient was included. Results: Small incision lenticule extraction: mean attempted spherical equivalent correction was −2.80 ± 0.63 D. Uncorrected distance visual acuity was 0.85 and 1.0 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.02 ± 0.32 D (range: −0.5 to +0.75 D), mean cylinder was −0.24 ± 0.21 D (range: 0 to −0.75 D), mean uncorrected distance visual acuity was 1.27, mean efficacy index was 0.96, and mean safety index was 1.05. Uncorrected distance visual acuity was same or better than corrected distance visual acuity in 96%, astigmatism ⩽0.5 D in 98% and ⩽1 D in 100% of eyes, respectively. Advanced surface ablation: mean attempted spherical equivalent correction was −2.75 ± 0.5 D. Uncorrected distance visual acuity was 0.72 and 0.61 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.22 ± 0.32 D, mean cylinder was −0.27 ± 0.27 D, mean uncorrected distance visual acuity was 1.21, mean efficacy index was 1.03, and mean safety index was 1.08. Conclusion: Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes at 3 months similar to those obtained with advanced surface ablation while offering a quicker visual recovery.

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