AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-gui...AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） for correction of high myopia and myopic astigmatism. METHODS： In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent （SE） of -8.11±1.09 diopters （D） received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser （Carl Zeiss Meditec, Jena, Germany） for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index （OSDI） and tear break-up time （TBUT） were evaluated during a 3-year follow-up. RESULTS： The difference of uncorrected distance visual acuity （UDVA） postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant （t=-1.59, P=-0.13）. The postoperative change of SE was 0.89 D in the FS-LASIK group （t=5.76, P=0.00）, and 0.14 D in the SMILE group （t=-0.54, P=0.59） from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group （P=0.00）, but the coma root mean square （RMS） was higher in the SMILE group （0.59±0.26） than in the FS-LASIK group （0.29±0.14, P=0.00）. The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION： Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.展开更多
AIM：To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction（SMILE） and femtosecond laser-assisted in situ keratomileusis（FSLASIK）.METHODS：The Meta-analysis was p...AIM：To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction（SMILE） and femtosecond laser-assisted in situ keratomileusis（FSLASIK）.METHODS：The Meta-analysis was performed using Rev Man 5.3.We searched on Pub Med from inception to March 2016.Summary weighted mean difference（WMD） and 95% confidence intervals（CIs） were used to analyze the datum.Random-effects or fixed-effects models were chosen up to between-study heterogeneity.The main outcomes were composed of the Ocular Surface Disease Index（OSDI） scores,tear film break-up time（TBUT）,Schirmer Test and corneal sensitivity.RESULTS：Eight eligible studies including 772 eyes（386 in SMILE group and 386 in FS-LASIK group） were identified.The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively.There were significant differences between the two groups in OSDI scores at one and three months postoperatively,in TBUT at one and three months postoperatively,in corneal sensitivity at one week,about one month and three months postoperatively.However,there was no significant difference observed in Schirmer Test at the follow-up periods.CONCLUSION：Compare to FS-LASIK,dry eye and the corneal sensitivity recover better in the SMILE group,in first three months after the surgery.展开更多
Objective To assess the time course of Q value after myopic laser-assisted in situ keratomileusis(LASIK) and preliminarily evaluate the determinants of the difference of Q value between before and after LASIK.Methods ...Objective To assess the time course of Q value after myopic laser-assisted in situ keratomileusis(LASIK) and preliminarily evaluate the determinants of the difference of Q value between before and after LASIK.Methods We performed a retrospective,longitudinal investigation on patients undergoing wavefront optimized LASIK therapy for emmetropization.A total of 418 eyes from 222 cases were examined preoperatively,and partly followed up at one week(172 eyes),one month(134 eyes) and three months(51 eyes) after surgery.The horizontal,vertical and total Q values of cornea were calculated from eccentricity measured at the central 6-mm corneal zones respectively.Potential determinants of the change of Q value were analyzed using multiple linear regressions.Results The mean Q value was-0.17±0.13 preoperatively,and 0.99±0.70,0.97±0.66,and 0.86±0.41 one week,one and three months postoperatively,respectively.One way analysis of variance(ANOVA) demonstrated significant differences between measurements made before surgery and at all postoperative times(at one week,one and three months;all P<0.0001,Bonferroni post hoc),but no significant differences were found among postoperative groups.Significant differences of Q values between horizontal and vertical meridians were found before surgery and at all postoperative times(all P<0.0001).Multiple regression analysis revealed that change of Q value significantly correlated with manifest refraction spherical equivalent(r=0.116,P<0.0001) and axial length(r=0.264,P<0.0001).Conclusions Over the study period,the primary changes in Q value occur within 1 week after surgery,and then become slightly decreased and nearly stable.Manifest refraction spherical equivalent and axial length play a significant role in the change of postoperative Q value.展开更多
Iam Dr. Xiu Wang, from Tianjin Medical University Eye Hospital, Tianjin, China. I write to present one case report of Posner-Schlossman syndrome （PSS） induced laser in situ keratomileusis （LASIK） keratectasia.
Objective： To report the occurrence, management and outcome ot late-onset traumauc aemscence ana dislocation of laser assisted in situ keratomileusis （LASIK） flaps. Treatment and Results： One patient occurred late...Objective： To report the occurrence, management and outcome ot late-onset traumauc aemscence ana dislocation of laser assisted in situ keratomileusis （LASIK） flaps. Treatment and Results： One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery. The flap was lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flap was successfully repositioned in the case. The dislocated flap was repositioned 7 days after the trauma, and the patient recovered his uncorrected visual acuity （UCVA） of 10/20, 20/20 day 1 and day 20 after the procedure, of 20/20 20 days later and had a well-positioned flap with a clear interface. Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids. Conclusion： Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which should be pay more attention to it for us.展开更多
I am Dr. David P Pifiero from the Department of Optics, Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar （Oftalmar） and Vithas Virgen del Carmen （Qv...I am Dr. David P Pifiero from the Department of Optics, Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar （Oftalmar） and Vithas Virgen del Carmen （Qvision） hospitals in Spain.展开更多
Background: Corneal ectasia is a serious complication after laser in situ keratomileusis(LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, t...Background: Corneal ectasia is a serious complication after laser in situ keratomileusis(LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation(PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN~ IIz(Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN~ IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.Results: There was no statistical difference between the mean best-fit sphere(BFS) pre-LASIK and 6 years postop(P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm(range, 12 to-31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent(ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK.展开更多
AIM:To investigate the changes in corneal biomechanics and posterior corneal surface elevation after femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:Totally 197 eyes of 100 patients who underwent t...AIM:To investigate the changes in corneal biomechanics and posterior corneal surface elevation after femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:Totally 197 eyes of 100 patients who underwent the FS-LASIK from April 2022 to November 2022 were included.They were divided into three groups according to the ratio of residual corneal stroma thickness/corneal thickness(RCST/CT):Group I(50%≤RCST/CT<55%,63 eyes of 32 patients),Group II(55%≤RCST/CT<60%,67 eyes of 34 patients),and Group III(RCST/CT≥60%,67 eyes of 34 patients).The intraocular pressure(IOP),corneal compensated IOP(IOPcc),corneal hysteresis(CH)and corneal resistance factor(CRF)were measured immediately,1,and 3mo postoperatively by ocular response analyzer(ORA)and the posterior elevation difference(PED)was measured by Pentacam.RESULTS:After operation,IOP,CH,CRF,and PED were statistically different among the three groups(F=12.99,31.148,23.998,all P<0.0001).There was no statistically significant difference in IOPcc among the three groups(F=0.603,P>0.05).The IOP,IOPcc,CH,and CRF were statistical changed after surgery(F=699.635,104.125,308.474,640.145,all P<0.0001).The PED of Group I was significantly higher than that of Group II(P<0.05),and Group II was significantly higher than that of Group III(P<0.05).The PED value of 3mo after surgery decreased in each group compared with 1mo after surgery,but there was no statistical difference(Group I:t=0.82,P=0.41;Group II:t=0.17,P=0.87;Group III:t=1.35,P=0.18).The correlation analysis of corneal biomechanical parameter changes with PED at 1mo and 3mo after surgery showed thatΔIOP,ΔIOPcc,ΔCH,andΔCRF were not correlated with PED value in three groups(P>0.05).CONCLUSION:The smaller the RCST/CT,the greater effect on corneal biomechanics and posterior surface elevation.There is no correlation between changes in corneal biomechanics and posterior corneal surface elevation in the range of RCST/CT≥50%.展开更多
Objective To discuss the characteristics of degenerative retinoschisis in young adults with medium to high myopia prior to laser-assisted in situ keratomileusis(LASIX) surgery and the significance of preventive photoc...Objective To discuss the characteristics of degenerative retinoschisis in young adults with medium to high myopia prior to laser-assisted in situ keratomileusis(LASIX) surgery and the significance of preventive photocoagulation.Methods A total of 32 eyes in 19 patients suffering from myopia combined with degenerative retinoschisis were included.The mean best-corrected visual acuity was 0.82±0.13 and the mean spherical equivalent of the subjective refraction was -(6.50±3.98) Diopter. The patients underwent preventive photocoagulation 1 month before the laser surgery for myopia.Results All the eyes that received preventive photocoagulation for retinoschisis had no further progression or retinal detachment during 4-year period of follow-up.Conclusion The degenerative retinoschisis in young adults should be recognized and treated with preventive photocoagulation.This may prevent further damage of visual field and other complications of slowly progressive retinoschisis after LASIK surgery.展开更多
文摘AIM： To compare and calculate the 3-year refractive results, higher-order aberrations （HOAs）, contrast sensitivity （CS） and dry eye parameters after small incision lenticule extraction （SMILE） and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK） for correction of high myopia and myopic astigmatism. METHODS： In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent （SE） of -8.11±1.09 diopters （D） received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser （Carl Zeiss Meditec, Jena, Germany） for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index （OSDI） and tear break-up time （TBUT） were evaluated during a 3-year follow-up. RESULTS： The difference of uncorrected distance visual acuity （UDVA） postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant （t=-1.59, P=-0.13）. The postoperative change of SE was 0.89 D in the FS-LASIK group （t=5.76, P=0.00）, and 0.14 D in the SMILE group （t=-0.54, P=0.59） from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group （P=0.00）, but the coma root mean square （RMS） was higher in the SMILE group （0.59±0.26） than in the FS-LASIK group （0.29±0.14, P=0.00）. The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION： Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.
基金Supported by the National Natural Science Foundation of China(No.81470648)
文摘AIM：To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction（SMILE） and femtosecond laser-assisted in situ keratomileusis（FSLASIK）.METHODS：The Meta-analysis was performed using Rev Man 5.3.We searched on Pub Med from inception to March 2016.Summary weighted mean difference（WMD） and 95% confidence intervals（CIs） were used to analyze the datum.Random-effects or fixed-effects models were chosen up to between-study heterogeneity.The main outcomes were composed of the Ocular Surface Disease Index（OSDI） scores,tear film break-up time（TBUT）,Schirmer Test and corneal sensitivity.RESULTS：Eight eligible studies including 772 eyes（386 in SMILE group and 386 in FS-LASIK group） were identified.The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively.There were significant differences between the two groups in OSDI scores at one and three months postoperatively,in TBUT at one and three months postoperatively,in corneal sensitivity at one week,about one month and three months postoperatively.However,there was no significant difference observed in Schirmer Test at the follow-up periods.CONCLUSION：Compare to FS-LASIK,dry eye and the corneal sensitivity recover better in the SMILE group,in first three months after the surgery.
基金Supported by Natural Science Foundation of Shanghai,China (09ZR1425400)Foundation of Sight-restoring Centre of Shanghai,China (050802)
文摘Objective To assess the time course of Q value after myopic laser-assisted in situ keratomileusis(LASIK) and preliminarily evaluate the determinants of the difference of Q value between before and after LASIK.Methods We performed a retrospective,longitudinal investigation on patients undergoing wavefront optimized LASIK therapy for emmetropization.A total of 418 eyes from 222 cases were examined preoperatively,and partly followed up at one week(172 eyes),one month(134 eyes) and three months(51 eyes) after surgery.The horizontal,vertical and total Q values of cornea were calculated from eccentricity measured at the central 6-mm corneal zones respectively.Potential determinants of the change of Q value were analyzed using multiple linear regressions.Results The mean Q value was-0.17±0.13 preoperatively,and 0.99±0.70,0.97±0.66,and 0.86±0.41 one week,one and three months postoperatively,respectively.One way analysis of variance(ANOVA) demonstrated significant differences between measurements made before surgery and at all postoperative times(at one week,one and three months;all P<0.0001,Bonferroni post hoc),but no significant differences were found among postoperative groups.Significant differences of Q values between horizontal and vertical meridians were found before surgery and at all postoperative times(all P<0.0001).Multiple regression analysis revealed that change of Q value significantly correlated with manifest refraction spherical equivalent(r=0.116,P<0.0001) and axial length(r=0.264,P<0.0001).Conclusions Over the study period,the primary changes in Q value occur within 1 week after surgery,and then become slightly decreased and nearly stable.Manifest refraction spherical equivalent and axial length play a significant role in the change of postoperative Q value.
文摘Iam Dr. Xiu Wang, from Tianjin Medical University Eye Hospital, Tianjin, China. I write to present one case report of Posner-Schlossman syndrome （PSS） induced laser in situ keratomileusis （LASIK） keratectasia.
文摘Objective： To report the occurrence, management and outcome ot late-onset traumauc aemscence ana dislocation of laser assisted in situ keratomileusis （LASIK） flaps. Treatment and Results： One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery. The flap was lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flap was successfully repositioned in the case. The dislocated flap was repositioned 7 days after the trauma, and the patient recovered his uncorrected visual acuity （UCVA） of 10/20, 20/20 day 1 and day 20 after the procedure, of 20/20 20 days later and had a well-positioned flap with a clear interface. Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids. Conclusion： Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which should be pay more attention to it for us.
文摘I am Dr. David P Pifiero from the Department of Optics, Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar （Oftalmar） and Vithas Virgen del Carmen （Qvision） hospitals in Spain.
文摘Background: Corneal ectasia is a serious complication after laser in situ keratomileusis(LASIK). Ideally, patients at risk of ectasia should be identified prior to laser as unsuitable for LASIK, however, at present, there is no absolute test, system, or marker that can unequivocally identify patients at risk of developing ectasia. It has been suggested that changes in the forward protrusion of the posterior cornea or posterior corneal elevation(PCE) may be a key to the early detection of ectasia after LASIK. The purpose of this study was to examine the long term changes of the PCE after myopic LASIK using the ORBSCAN~ IIz(Bausch & Lomb, Rochester, USA) and to evaluate the contributory preoperative factors to PCE changes.Methods: This was a retrospective longitudinal case series. Forty-two eyes of 23 consecutive myopic patients who underwent uneventful LASIK surgery 6 years ago were recalled for a postoperative follow-up examination using the ORBSCAN~ IIz to determine the elevation changes to the posterior corneal surface from the preoperative measurements. A forward shift of the posterior surface was given a negative value. Correlation analyses and forward stepwise regression analyses were performed to evaluate the effect of each of the preoperative parameters on the changes in PCE. Statistical and graphical analyses were performed.Results: There was no statistical difference between the mean best-fit sphere(BFS) pre-LASIK and 6 years postop(P=0.25). Forty-two post-LASIK eyes had a mean posterior displacement of -9.38±9.84 μm(range, 12 to-31 μm) 6 years after LASIK. Forward stepwise multiple linear regression analysis indicated that the ablation spherical equivalent(ASE) was the only indicator of the forward shift of the posterior cornea after LASIK.Conclusions: The present study identified a significant forward shift of the posterior cornea 6 years after LASIK. The ASE was the most significant prognostic determinant for forward protrusion of the posterior cornea after LASIK.
文摘AIM:To investigate the changes in corneal biomechanics and posterior corneal surface elevation after femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:Totally 197 eyes of 100 patients who underwent the FS-LASIK from April 2022 to November 2022 were included.They were divided into three groups according to the ratio of residual corneal stroma thickness/corneal thickness(RCST/CT):Group I(50%≤RCST/CT<55%,63 eyes of 32 patients),Group II(55%≤RCST/CT<60%,67 eyes of 34 patients),and Group III(RCST/CT≥60%,67 eyes of 34 patients).The intraocular pressure(IOP),corneal compensated IOP(IOPcc),corneal hysteresis(CH)and corneal resistance factor(CRF)were measured immediately,1,and 3mo postoperatively by ocular response analyzer(ORA)and the posterior elevation difference(PED)was measured by Pentacam.RESULTS:After operation,IOP,CH,CRF,and PED were statistically different among the three groups(F=12.99,31.148,23.998,all P<0.0001).There was no statistically significant difference in IOPcc among the three groups(F=0.603,P>0.05).The IOP,IOPcc,CH,and CRF were statistical changed after surgery(F=699.635,104.125,308.474,640.145,all P<0.0001).The PED of Group I was significantly higher than that of Group II(P<0.05),and Group II was significantly higher than that of Group III(P<0.05).The PED value of 3mo after surgery decreased in each group compared with 1mo after surgery,but there was no statistical difference(Group I:t=0.82,P=0.41;Group II:t=0.17,P=0.87;Group III:t=1.35,P=0.18).The correlation analysis of corneal biomechanical parameter changes with PED at 1mo and 3mo after surgery showed thatΔIOP,ΔIOPcc,ΔCH,andΔCRF were not correlated with PED value in three groups(P>0.05).CONCLUSION:The smaller the RCST/CT,the greater effect on corneal biomechanics and posterior surface elevation.There is no correlation between changes in corneal biomechanics and posterior corneal surface elevation in the range of RCST/CT≥50%.
文摘Objective To discuss the characteristics of degenerative retinoschisis in young adults with medium to high myopia prior to laser-assisted in situ keratomileusis(LASIX) surgery and the significance of preventive photocoagulation.Methods A total of 32 eyes in 19 patients suffering from myopia combined with degenerative retinoschisis were included.The mean best-corrected visual acuity was 0.82±0.13 and the mean spherical equivalent of the subjective refraction was -(6.50±3.98) Diopter. The patients underwent preventive photocoagulation 1 month before the laser surgery for myopia.Results All the eyes that received preventive photocoagulation for retinoschisis had no further progression or retinal detachment during 4-year period of follow-up.Conclusion The degenerative retinoschisis in young adults should be recognized and treated with preventive photocoagulation.This may prevent further damage of visual field and other complications of slowly progressive retinoschisis after LASIK surgery.
