Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity:case series

AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography(AS-OCT).METHODS:Four patients with monocular corneal opacity(3 due to mechanical injury,1 due to a firecracker wound)were recruited and treated with refractive surgery(3 for SMILE,1 for FS-LASIK combined with limbal relaxing incision(LRI).Preoperative ocular manifestations,surgical details,postoperative visual outcomes,corneal opacity parameters,and corneal topography were analyzed.RESULTS:Preoperatively,spherical diopter ranged from-3.0 D to-4.75 D with cylinder ranging from-0.75 to-5.0 D,and corrected distance visual acuity(CDVA)ranging from 20/25 to 20/20.One eye’s corneal opacity was located in the central zone and three were in the mid-peripheral optical zone.Three patients underwent uneventful SMILE in both eyes,whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye.CDVA of the eye with corneal opacity ranged from 20/22to 20/20 one to six weeks postoperatively.Two patients achieved better CDVA and no patients lost Snellen lines.The postoperative diopter was within±0.75 D for all eyes.Significant edema existed above the corneal opacity in one eye and dissipated soon.No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.CONCLUSION:The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection.FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.

Comparison of visual acuity of the patients on the first day after sub-Bowman keratomileusis or laser in situ keratomileusis

AIM：To compare recovery of the visual acuity in patients one day after sub-Bowman keratomileusis（SBK）or laser in situ keratomileusis（LASIK）.· METHODS：Data from 5923 eyes in 2968 patients that received LASIK（2755 eyes） or SBK（3168 eyes） were retrospectively analyzed.The eyes were divided into 4groups according to preoperative spherical equivalent：between-12.00 to-9.00 D,extremely high myopia（n =396,including 192 and 204 in SBK and LASIK groups,respectively）;-9.00 to-6.00 D,high myopia（n=1822,including 991 and 831 in SBK and LASIK groups,respectively）,-6.00 to-3.00 D,moderate myopia（n=3071,including 1658 and 1413 in SBK and LASIK groups,respectively）,and-3.00 to 0.00 D,low myopia（n =634,including 327 and 307 in SBK and LASIK groups,respectively）.Uncorrected logMAR visual acuity values of patients were assessed under standard natural light.Analysis of variance was used for comparisons among different groups.· RESULTS：Uncorrected visual acuity values were0.0115±0.1051 and 0.0466±0.1477 at day 1 after operation for patients receiving SBK and LASIK,respectively（P〈0.01）;visual acuity values of 0.1854±0.1842,0.0615±0.1326,-0.0033±0.0978,and-0.0164±0.0972 were obtained for patients in the extremely high,high,moderate,and low myopia groups,respectively（P〈0.01）.In addition,significant differences in visual acuity at day 1 after operation were found between patients receiving SBK and LASIK in each myopia subgroup.· CONCLUSION：Compared with LASIK,SBK is safer and more effective,with faster recovery.Therefore,SBK is more likely to be accepted by patients than LASIK for better uncorrected visual acuity the day following operation.

Three-year results of small incision lenticule extraction and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis for correction of high myopia and myopic astigmatism

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.

Corneal flap morphological analysis using anterior segment optical coherence tomography in laser in situ keratomileusis with femtosecond lasers versus mechanical microkeratome

AIM: To assess and compare the flap morphology using anterior segment optical coherence tomography (AS-OCT) in laser in situ keratomileusis (LASIK) with Femto LDV femtosecond lasers versus Hansatome mechanical Microkeratome. METHODS: AS-OCT (Visante) was used to compare 1 month postoperatively the morphology of the flaps created with Femto LDV femtosecond lasers or Hansatome Microkeratome. The intendedfiap thickness was 110 mu m and 160 mu m respectively. The thickness of twenty-five points across each flap, which were 0mm, 1.5mm, 2.5mm, and 3.5mm to the corneal vertex on the horizontal, vertical, 45 degrees and 135 degrees meridian respectively, was evaluated. RESULTS: One month postoperative, the central flap thickness in the Femto LDV group was 107.43 +/- 4.70 mu m, while 125.90 +/- 17.50 mu m in the Hansatome group. The difference between the actual and the expectedfiap thickness was 5.61 +/- 3.84 mu m and 31.52 +/- 12.27 mu m, respectively. The Hansatome group had presented a statistically significant result (P<0.001). Flap morphology showed a more regular planar shape in the Femto LDV group and a meniscus shape in the Hansatome group. CONCLUSION: AS-OCT is a direct and fast procedure to assess the flap morphology. The morphology by AS-OCT showed that the flaps created with Femto LDV femtosecond laser were more accurate and regular than the flaps created with Hansatome microkeratome.

Using LaserSight Astrapro Planner 2.2 Z software in corneal topography-guided laser in situ keratomileusis for myopia with asymmetric corneal shape

AIM:To determine the clinical outcomes of laser insitu keratomileusis(LASIK)treatments using LaserSight AstraPro Planner 2.2 Z software for myopia with asymmetric corneal shape.METHODS:Four hundred and eighty-five eyes[243patients;spherical equivalent(SE),-5.93±1.88 diopters(D)]were treated with asymmetric ablations using LaserSight SLX laser(version 5.3,300Hz)were retrospectively analyzed and LaserSight AstraPro Planner2.2 Z software.Preoperative and postoperative uncorrected visual acuities(UCVA),spherical equivalent(SE)refraction,pachymetry,and corneal asphericity(Q value)and decentration were evaluated.RESULTS:At 12mo postoperatively,the decimal UCVA was 1.0 or better in 449(92.6%)eyes.Two eyes(0.4%)lost 1 line of the decimal best spectacle-corrected visual acuity(BCVA),316(65.2%)did not change,149(30.7%)gained 1 line,and 18(3.7%)gained 2 lines or more after surgery.Three hundred and thirty-two eyes(68.5%)were within 0.5 D in SE.The mean tissue saving ablation depth was 4.28±2.86(0-16)μm(median,4μm).The mean attempted remaining central corneal thickness was435.79±29.56μm,the mean postoperative pachymetry was 444.94±28.93μm.The mean preoperative Q value was-0.19±0.18,the postoperative was 0.30±0.48(P=0.000).The mean postoperative decentration was 0.39±0.19 mm.CONCLUSION:Topography-guidedLASIKwithAstraPro Planner 2.2 Z custom ablation planning software in an asymmetric ablation mode was an effective,safe,predictable,and stable refractive procedure for the myopia with asymmetric corneal topography.

Influence of transient intraocular pressure elevation during laser in situ keratomileusis on rabbit retina thickness

AIMTo utilize tissue micro measurement to study the effect of transient high intraocular pressure (IOP) induced by different durations of suction during laser in situ keratomileusis (LASIK) on rabbit retina thickness.METHODSSixty healthy New Zealand white rabbits were randomly divided into a control group, and 3 negative-pressure suction groups (20s group, 45s group, and 3min group) and each group was comprised of 15 rabbits (30 eyes); the latter 3 groups were the transient high IOP models. The retinal tissue around the papilledema was separated. Hematoxylin and eosin (HE) staining was carried out to generate slices for light microscopy. The changes in the retina thickness values of each layer were measured for all animals in each group at different postoperative recovery periods and compared with the values recorded for the animals in the control group. The thickness of the retinal tissue showed a normal distribution. The ANOVA was performed by using SPSS13.0 statistic software.RESULTSIn the comparison between the 20s and 45s negative-pressure suction groups and the control group, no significant differences were observed, except at 14d. Significant difference was observed between the 3min negative-pressure suction group and the control group, and the retina thickness value of each layer reached a peak at 14d after repair.CONCLUSIONConventional negative suction during LASIK may not lead to significant changes in retinal tissue thickness; however, if the suction duration is increased to 3min, it will cause significant changes in retinal tissue thickness.

Laser in situ keratomileusis in adult patients with anisometropic amblyopia

AIM: To evaluate the increase in corrected distance visual acuity (CDVA) after laser in situ keratomileusis (LASIK) in adults with anisometropic amblyopia. · METHODS: The medical records of consecutive patients diagnosed with anisometropic amblyopia at the time of refractive evaluation who underwent LASIK were retrospectively reviewed. Patients with at least a two-line difference of visual acuity (VA) between the eyes with a spherical refractive error difference of at least 3.00 diopters (D) or an astigmatic difference of at least 2.00D were included. Patients with any other possible reason for amblyopia other than anisometropia or those who had undergone previous amblyopia treatment were excluded. Amblyopic eyes with myopia or myopic astigmatism were considered as group 1, hypermetropia or hypermetropic astigmatism constituted group 2, and mixed astigmatism patients comprised group 3. Uncorrected distance visual acuity (UDVA), subjective manifest refraction, and CDVA were analyzed at 1 week and 1 month, 3, and 6 months. ·RESULTS: The study included 57 eyes of 57 patients. There were 33 eyes in group 1, 12 eyes in group 2, and 12 eyes in group 3. The preoperative mean values for spherical equivalent of subjective manifest refraction (SE) in groups 1, 2, and 3 were (-4.66±1.97)D, (4.40±1.00)D, and (0.15±1.05)D, respectively. Mean CDVA improved 0.1 log units (1 line LogMAR) at 6 months (P 【0.05). Sixteen eyes (28%) exhibited an improvement in CDVA in week 1. Fourteen eyes (25% ) experienced two or more lines of CDVA improvement at month 6. There were no statistically significant differences among the groups in terms of CDVA (P 】0.05). Moreover, age, the amount ofpreoperative refractive error, and the levels of preoperative corrected and UDVA had no effect on postoperative CDVA improvement (P 】0.05). · CONCLUSION: Correction of refractive errors with LASIK produced significant CDVA improvement in adult patients with anisometropic amblyopia and no previous amblyopia treatment.

Comparison of optical quality after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis

AIM： To compare the optical quality after implantation of implantable collamer lens（ICL） and wavefront-guided laser in situ keratomileusis（WG-LASIK）.METHODS： The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index（OSI）, the values of modulation transfer function（MTF） cutoff frequency, Strehl ratio, and the Optical Quality Analysis System（OQAS） values（OVs） were accessed. The higher order aberrations（HOAs） data including coma, trefoil, spherical, 2^（nd） astigmatism and tetrafoil were also obtained. For patients with pupil size 〈6 mm, HOAs data were analyzed for 4 mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6 mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS： In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent（P〈 0.001）. After the ICL implantation, the OSI decreasedslightly from 2.34±1.92 to 2.24±1.18 with no statistical significance（P=0.62）. While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively（Wilcoxon signed ranks test, P=0.000）. None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4 mmpupil or 6 mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2^（nd） astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05,-0.04±0.04, 0.03±0.01 respectively（Wilcoxon signed ranks test, all P〈0.05）. At 6 mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION： ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.

Effect of Laser in situ Keratomileusis on Accommodation

The accommodative function before and after laser in situ keratomileusis （LASIK） was observed, and the effect of LASIK on accommodation was investigated. In a prospective clinical trial, 48 myopic patients （96 eyes） subject to bilateral LASIK in Refractive Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology （China） from March 2006 to June 2006 were selected and studied. Refractions, accommodative range, amplitude of accommodative response and high frequency component （HFC） of accommodative microfluctuations were measured with NEDIK-730A before and one week and 30 days after operation. Dominant and non-dominant eyes were determined by hole-in-card method. It was found that all of the operative eyes showed an uncorrected visual acuity of 0.8 or better one week postoperatively, and 1.0 or better 30 days postoperatively. Compared with those preoperatively, accommodative range and HFC had no significant difference at first week and 30th day after operation in both dominant eyes and non-dominant eyes （P〉0.05）, but there was a significant difference in the amplitude of accommodative response/accommodative stimulus ratio （A/S） after operation （P〈0.01）, and no significant difference was found in accommodation between one week and 30 days postoperation. No ocular dominance＇s change was noted. There was no significant difference in accommodative function between dominant eyes and non-dominant eyes. It was suggested that LASIK produced no significant effect on accommodation.

Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction

AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optical Quality Analysis System(OQAS)was used to evaluate clinical outcomes objectively after operation for high myopia correction.We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),safety index,efficacy index,spherical equivalent,modulation transfer function(MTF)cutoff frequency,strehl ratio(SR)and objective scatter index(OSI).RESULTS:At 1 y postoperatively,the safety indices were 1.33±0.27 in ICL group,and 1.17±0.24 in FS-LASIK group.39.58%in the ICL group and 27.59%in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA.The efficacy indices were 1.28±0.22 in ICL group,and 1.13±0.26 in FS-LASIK group.The changes of spherical equivalent from 1 wk to 1 y postoperatively was-0.12±0.37 D in ICL group,and-0.79±0.58 D in FS-LASIK group(P<0.05).Spherical equivalent within±0.50 D was achieved in 97.92%in ICL group and 68.97%in FS-LASIK group.MTF cutoff frequency were higher with ICL as compared to FSLASIK(P<0.05)at each postoperative follow-up stage;for postoperative 1 mo later,SR was statistically significant difference between two groups(P<0.05);with no statistically significant difference in OSI between two groups(P>0.05)in postoperative 3 mo later.CONCLUSION:ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction.ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

Comparison of Intraocular Pressures at Different Points in Human's Cornea before and after Laser in situ Keratomileusis with Tono-Pen Tonometer

In order to explore the difference of intraocular pressure（IOP） at different points of cornea before and after laser in situ keratomileusis（LASIK）,IOP was measured by Tono-Pen Tonometer at central cornea,pericentral cornea and limbus respectively and analyzed statistically.After LASIK,IOP was dropped significantly at central cornea and pericentral cornea（P〈0.05）,while no statistically significant change occurred at limbus（P〉0.05）.There was no statistically significant difference in IOP at different points before LASIK（F=0.110,P=0.896）,but statistically significant difference was found after LASIK（F=7.375,P=0.001）.It was suggested that reliable IOP after LASIK could be obtained from the limbus by Tono-Pen tonometer.

Posner-Schlossman syndrome induced laser in situ keratomileusis keratectasia–a case report

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.

Evaluation of laser in situ keratomileusis for myopic correction performed under thin flaps

AIM： To evaluate the efficacy and safety of laser-assisted subepithelial keratectomy （LASIK） for myopic correction done under thin flaps（120μm） and compare with results obtained under thick flaps（150μm）.METHODS： The study included 150 myopic eyes of 75 patients without previous refractive surgery who underwent LASIK prospectively. Two microkeratome heads （90 and 130） were used to created a flap with thickness of 120μm and 150μm,respectively. Thin flap group（120μm） included 75 eyes while thick flap group included 75 eyes. Follow-up period was 12 mo. Efficacy,l safety, and stability were evaluated and compared between the two groups.RESULTS： In 150 eyes,the mean preoperative spherical equivalent refraction was -8.65±2.6D,mean sphere was -4.4±3.5D, and mean cylinder was -1.0±1.3D. THe amount of ablation was significantly larger in the thin flap （88.5±32.21μm） group than in the thick flap group （64±28.13μm）.Percentage of safety was higher in the thin flap group（94.8%） than in the thick flap group（91.7%）. There were no intraoperative complications, especially flap-related problems. Subjective symptoms of dry eye occurred in 20.7% and 33.3% of eyes in the thin and thick flap groups, respectively. CONCLUSION： Thin-flap LASIK is effective and safe in correcting myopic defects. It achivevs better visual results, rapid visual recovery, and stable postoperative refraction than LASIK with thick flaps.

EFFECTS OF PREOPERATIVE SOFT CONTACT LENS WEAR ON HIGHER-ORDER ABERRATIONS AFTER LASER IN SITU KERATOMILEUSIS

Objective To evaluate the effects of preoperative soft contact lens (SCL) wear on higher-order aberrations(HOAs)correction after wavefront-guided and conventional laser in situ keratomileusis (LASIK). Methods A prospective randomized double-masked comparative study was conducted in 180 eyes of 90 patients scheduled for LASIK, including 92 eyes of 46 patients with previous SCL wear. The patients were divided into four groups: no SCL-conventional group, SCL-conventional group, no SCL-wavefront group and SCL-wavefront group. Preoperative and postoperative examinations included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity and HOAs. Results The UCVA and BSCVA were 20/20 in all patients at 6 months postoperatively. And 36.3%, 22.7%, 18.1% and 35.4% gained one line or more of BSCVA in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Both the safety index and efficacy index surpassed one in 4 groups and were highest in no SCL-wavefront group. The increase in root-mean-square (RMS) values of HOAs was significantly lower in no SCL-wavefront group and higher in SCL-wavefront group. At 6 months postoperatively, the increase in RMS of HOAs (RMSh) were 0.67, 1.58, 1.17 and 1.28 in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Conclusion Preoperative contact lens wear has significant influence on the efficacy of HOAs correction in wavefront-guided LASIK. Patients with contact lens wear preoperatively should be cautious when scheduled for wavefront-guided LASIK.

ONE YEAR RESULTS OF LASER IN SITU KERATOMILEUSIS FOR CORRECTION OF HYPEROPIA

Objective: To evaluate the effectiveness, predictability and city of laser in situ keratomileusis (LASIK) for correction of hyperopia. Methods 54 eyes of 35 patients with hyperopia ranging from+1.00 to + 6. 00 diopter(D) received a one-pass, multizone scanning excimer laser ablations using the Chiron Technolas Keracor 11 7C excimer laser and System ALK automated corneal shaper H-230.Data on uncorrected and hot corrected visual acuity, predictability, stability of refraction, and complications were analyzed. The average follow-up was 12 months. Results At 12 months, the average residual refraction was(+ 0. 29 ±0. 78)D. 45 eyes (83.3% ) were in the range of ±1. OD and 33 eyes(61. 1% ) were within the range of ± 0. 5D. 50 eyes (92. 6% ) had uncorrected visual acuity of 20/40 or better and 34 eyes (63. 0% ) had 20/20 or better. 1 eyes (1. 9% ) lost 2 line of the best-corrected visual acuity and 2 eyes (3. 7% ) gained 2 lines or more. 2 eyes (3. 7%) had complaint of halos and 1 eyes (1. 9% ) had glare at 12 months. Conclusion LASIK can he used to treat hyperopia from + 1. 0D to + 6. 0D with good predictability and city. Primary and second hyperopia should he treated with different nomogram. some modification of the surgical algorithms and laser nomogram will help to improve predictability and stability of outcome.

DIOPTER REGRESSION ANALYSIS OF LASER IN SITU KERATOMILEUSIS IN THE TREATMENT OF MYOPIA

Objective To evaluate the relevant factors of regression phenomenon of laser in situ kerato-mileusis (LASIK) for treatment of myopia. Methods We studied 408 eyes of 250 myopic patients who received LASIK. Patients were divided into 2 groups according to preoperative diopters (- 6 .00D- -10 .00D, 194 eyes;-10.10D- -15 .00D, 214 eyes). Mean period of follow-up were 12 months and the results were statistically analyzed. Results 12 months after surgery, in the first group (- 6.00--10.00D) the regressionequal to or beyond -1 .0D were 21 eyes (10.8%), range from -1 .0D to - 3 .0D. The average regression was -1.33D. In the second group (- 10 .10D - - 15 .00D) regression equal to or beyond -1.0D were 78 eyes (36.5%), range from -1 .0D to -5.50D. The average regression was -1 .99D. Conclusion The results indicate that excimer LASIK can be used to treat myopia between -6 .00D-- 15 .00D effectively with minimal regression within 12 months. Preoperative thin corneas with intraoperative small ablation zone could induce regression . Some modification of the surgical algorithms and laser nomogram will help to improve predictability and reduce regression.

Long term changes of posterior corneal elevation after myopic laser in situ keratomileusis

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.

Comparison of Intraoperative Ultrasound Pachymetry and Postoperative Optical Coherence Tomography of Anterior Segment in the Measurement of Flap Thickness in Eyes Receiving Laser in situ Keratomileusis

Purpose:To compare the measurement of flap thickness using intraoperative ultrasound pachymetry and postoperative visante anterior segment optical coherence tomography (Visante-OCT) in eyes receiving laser in situ keratomileusis (LASIK). Methods: Seventeen patients (34 eyes) received LASIK using a Technolas-217Z100 laser and AMADEUSⅡ mechanical microkeratome(140 μm head). Flap thickness was assessed with an ultrasound pachymeter intraoperatively and a Visante-OCT postoperatively at 1 week and 1 month. Results: The intraoperative mean flap thickness by ultrasound pachymetry was (124±13.9) μm (range: 96.5 to 160 μm), and mean flap thickness by Visante-OCT was (145±7.13) μm (range: 130 to 158 μm) and (143±5.32) μm (range: 132 to 155 μm) postoperatively at 1 week and 1 month respectively (F=63.52,P<0.01). Intraoperative subtraction pachymetry underestimated flap thickness compared with postoperative Visante-OCT.(P<0.01)..There was no significant difference between postoperative Visante-OCT measurements at 1 week and 1 month after LASIK.(P=0.16). The 95% limit of agreement.(LoA).of flap thickness between ultrasound Visante-OCT and pachymetry was -5.40 to 42.10 μm. Conclusion: OCT overestimates flap thickness compared with intraoperative ultrasound pachymetry when using the AMADEUSⅡ mechanical microkeratome.

Comparative study of functional optical zone:small incision lenticule extraction versus femtosecond laser assisted excimer laser keratomileusis

AIM:To investigate the size of functional optical zone(FOZ)after small incision lenticule extraction(SMILE)versus femtosecond laser assisted excimer laser keratomileusis(FS-LASIK)for myopia correction and potential associated factors for FOZ.METHODS:A total of 133 patients who received corneal refractive surgery in our hospital between November 2018 and July 2021 were retrospectively enrolled.There were 63 patients(123 eyes)in SMILE group and 70patients(139 eyes)in FS-LASIK group.The size of FOZ was measured using Pentacam 3-dementional anterior segment analyzer before and 3mo after surgery,so as to analyze postoperative achieved functional optical zone(AFOZ)and its contributing parameters.RESULTS:When planned functional optical zone(PFOZ)was 6.5 mm for both groups,AFOZ was 1.45±0.27 and 1.67±0.25 mm smaller than preoperative FOZ in SMILE group and FS-LASIK group 3mo after surgery.AFOZ in SMILE group was significantly larger than that in FS-LASIK group(P<0.001).Variation of FOZ was negatively correlated with preoperative spherical equivalent(SE)and positively correlated with variation of mean keratometry value(△Km),variation of spherical aberration(△SA),and variation of Q-value(△Q,all P<0.001)in both groups.Multiple variable linear regression equations were△FOZ=1.354-0.1×pre-SE+0.336×△Q+1.462×△SA in SMILE group and△FOZ=1.512+0.137×△Q+0.468×△SA in FS-LASIK group.CONCLUSION:AFOZ is significantly smaller than preoperative FOZ in both SMILE and FS-LASIK groups.With the same PFOZ,larger AFOZ is achieved in SMILE group than in FS-LASIK group.

Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis:a Meta-analysis

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.