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Flap double twist technique for prevention of LASIK flap striae
摘要： A novel flap double twist technique was applied to reduce the incidence of post-laser-assisted in situ keratomileusis (LASIK) flap striae. The flap is floated and stroked in the same way as is done for management of first postoperative day striae, where the method is to float and irrigate the flap into position, followed by applying gentle pressure on the flap with a wet Merocel microsponge and moving the flap away from the hinge position. The sponge is then manually squeezed to become drier, and the flap is continuously stroked in a direction opposite to the hinge. Next, the flap is carefully twisted obliquely and sequentially in two opposite directions while applying gentle pressure on the flap in order to completely dehydrate the flap and stromal bed. Finally, the flap is repositioned while applying gentle horizontal pressure in two opposite directions. This novel flap double twist technique shows great success in post-LASIK striae prevention.
关键词： laser-assisted in situ keratomileusis,microsponge,pressure,wrinkles
更新于2025-09-23 15:22:29
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Early post-LASIK flap amputation in the treatment of aggressive, branching keratitis: a case report
摘要： Infectious keratitis is rare following laser vision correction. We present a case of aggressive fungal keratitis caused by Aspergillus flavus, following laser in situ keratomileusis (LASIK) in the setting of a unique environmental risk factor. We describe the key features of the acute case presentation, which guided empirical medical and surgical treatment, resulting in the most favorable outcome found in the literature, to date.
关键词： Keratomileusis,laser in situ/adverse effects,Keratitis/etiology
更新于2025-09-23 15:22:29
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Comparison of the posterior corneal elevation and biomechanics after SMILE and LASEK for myopia: a short- and long-term observation
摘要： Purpose This study compares the posterior corneal elevation and corneal biomechanics after small incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK) for myopia correction in a short- and long-term observation. Methods This prospective study included 32 patients in the SMILE group and 32 patients in the LASEK group. Corneal posterior central elevation (PCE), posterior mean elevation (PME), corneal back power (Kb), and anterior chamber depth (ACD) were evaluated with Pentacam, and intraocular pressure (IOP), corneal hysteresis (CH), and corneal resistance factor (CRF) were evaluated with the ORA at pre-operation and 3 months and 3 years post-operation. Results Three months post-operatively, CH, CRF, and IOP decreased significantly and central posterior surface shifted backward in both groups (p < 0.05). CH was lower in the LASEK group (p = 0.03) and change of CH and CRF per unit corneal tissue removed (ΔCH/ablation depth (AD) and ΔCRF/AD) was lower in SMILE than in LASEK (p = 0.01, 0.03). Three years post-operatively, the PME shifted more posteriorly in LASEK (p = 0.04), but was stable in SMILE (p = 0.06). Kb flattened and ACD was shallower in both groups (compared to preoperative data, p < 0.001). CH in the LASEK group increased and is comparable to that in the SMILE group at 3 years post-operative. Conclusion Both SMILE and LASEK can change the posterior surface and corneal biomechanics. SMILE may have less influence on corneal biomechanics than LASEK at an early stage post-operative in terms of per unit corneal tissue removed, but the effect became comparable in a long-term observation.
关键词： Corneal biomechanics,Corneal posterior elevation,Small incision lenticule extraction,Laser-assisted subepithelial keratomileusis
更新于2025-09-23 15:22:29
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Five-year outcomes of small-incision lenticule extraction vs femtosecond lasera??assisted laser in situ keratomileusis
摘要： To compare the long-term refractive and visual outcomes and the corneal higher-order aberrations of contralateral eyes of patients who received small-incision lenticule extraction (SMILE) in one eye and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) in the other eye.
关键词： small-incision lenticule extraction,femtosecond laser–assisted laser in situ keratomileusis,myopic astigmatism,corneal higher-order aberrations,SMILE,FS-LASIK,myopia
更新于2025-09-19 17:13:59
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Patient-reported vision-related quality of life after laser in situ keratomileusis, surface ablation, and phakic intraocular lens
摘要： To evaluate the long-term efficacy of refractive surgery of all cases in a single center via the use of a patient-reported outcome (PRO) refractive status questionnaire using descriptive statistics. This study was prospective, single-center, cohort study that involved 1422 patients who underwent refractive surgery (laser in situ keratomileusis, surface ablation, and phakic intraocular lens) at Baptist Eye Institute, Kyoto, Japan. The patients were asked to answer the Refractive Status and Vision Profile (RSVP) questionnaire before the surgery after 6 months (n = 1133 patients) and after 5.5 years (n = 232 patients). During the same period, examination by slit-lamp biomicroscopy and visual acuity tests were performed. Moreover, the patients were asked to rate their satisfaction with the surgery 6 months and 5.5 years after it. We examined overall RSVP scale (S), 8 RSVP subscales, rate of satisfaction with surgical outcome, slit-lamp biomicroscopy findings, and refractive error. The mean preoperative S was 36, yet that score significantly improved to 19 at 6 postoperative months postoperatively (P < .01), and basically remained the same (i.e., 20) throughout the 5.5-year postoperative period. During the 5-year follow-up period, mean refractive error became slightly myopic (0.3 D). No change in the rate of satisfaction was observed at both 6 months and 5.5 years postoperative period. The findings of this study help to clarify long-term PRO quality of vision (QOV) postrefractive surgery in a single center, and show that minor change in refractive error during 5 years postoperative period had no influence on the mean RSVP scores among outpatients. Nearly all patients reported short-term improvement of QOV, which continued throughout the long-term follow-up period.
关键词： patient-reported outcome,phakic intraocular lens,refractive surgery,laser in situ keratomileusis,surface ablation
更新于2025-09-19 17:13:59
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Predictors affecting myopic regression in ??6.0D to ??10.0D myopia after laser-assisted subepithelial keratomileusis and laser in situ keratomileusis flap creation with femtosecond laser-assisted or mechanical microkeratome-assisted
摘要： Purpose To investigate the predictive factors of postoperative myopic regression among subjects who have undergone laser-assisted subepithelial keratomileusis (LASEK), laser-assisted in situ keratomileusis (LASIK) flap created with a mechanical microkeratome (MM), and LASIK flap created with a femtosecond laser (FS). All recruited patients had a manifest spherical equivalence (SE) from - 6.0D to - 10.0D myopia. Methods This retrospective, observational case series study analyzed outcomes of refraction at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Predictors affecting myopic regression and other covariates were estimated with the Cox proportional hazards model for the three types of surgeries. Results The study enrolled 496 eyes in the LASEK group, 1054 eyes in the FS-LASIK group, and 910 eyes in the MM-LASIK group. At 12 months, from - 6.0D to - 10.0D myopia showed that the survival rates (no myopic regression) were 52.19%, 59.12%, and 58.79% in the MM-LASIK, FS-LASIK, and LASEK groups, respectively. Risk factors for myopic regression included thicker postoperative central corneal thickness (P ^ 0.01), older age (P ^ 0.01), aspherical ablation (P = 0.02), and larger transitional zone (TZ) (P = 0.03). Steeper corneal curvature (Kmax) (P = 0.01), thicker preoperative central corneal thickness (P < 0.01), smaller preoperative myopia (P < 0.01), longer duration of myopia (P = 0.02), with contact lens (P < 0.01), and larger optical zone (OZ) (P = 0.02) were protective factors. Among the three groups, the MM-LASIK had the highest risk of postoperative myopic regression (P < 0.01). Conclusions The MM-LASIK group experienced the highest myopic regression, followed by the FS-LASIK and LASEK groups. Older age, aspheric ablation used, thicker postoperative central corneal thickness, and enlarging TZ contribute to myopic regression; steeper preoperative corneal curvature (Kmax), longer duration of myopia, with contact lens, thicker preoperative central corneal thickness, lower manifest refraction SE, and enlarging OZ prevent postoperative myopic regression in myopia from - 6.0D to - 10.0D.
关键词： Myopic regression,Laser-assisted subepithelial keratomileusis,Mechanical microkeratome,Laser in situ keratomileusis,Femtosecond laser
更新于2025-09-16 10:30:52
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Analysis of Macular and Retinal Nerve Fiber Layer Thickness in Children with Refractory Amblyopia after Femtosecond Laser-assisted Laser In situ Keratomileusis
摘要： Background: Localized macular edema and retinal nerve fiber layer (RNFL) thinning have been reported shortly after laser in situ keratomileusis (LASIK) in adults. However, it is still unclear how LASIK affects the retina of children. This study aimed to investigate the macular retina and RNFL thickness in children with refractive amblyopia who underwent femtosecond laser?assisted LASIK (FS?LASIK). Methods: In this study, we included 56 eyes of 32 patients with refractive amblyopia who underwent FS?LASIK in our hospital from January 2012 to December 2016. Foveal (foveal center retinal, parafoveal retinal, and perifoveal), macular inner retinal (superior and inferior), and peripapillary RNFL thicknesses (superior, inferior, temporal, and nasal) were measured using Fourier?domain optical coherence tomography before surgery and 1 day, 3 days, and 1 week after surgery. We divided these patients into three groups based on their refractive error: High myopic group with 22 eyes (equivalent sphere, >6.00 D), mild myopic group with 19 eyes (equivalent sphere, 0–6.00 D), and hyperopic group with 15 eyes (equivalent sphere, >+0.50 D). We compared the macular retina and RNFL thickness before and after LASIK. A paired simple t?test was used for data analysis. Results: One week after surgery, the visual acuity for all 56 eyes of the 32 patients reached their preoperative best?corrected vision. Visual acuity improved two lines or better for 31% of the patients. The residual refractive errors in 89% of the patients were within ±0.5 D. In the high myopic group, the foveal center retinal and parafoveal retinal thicknesses were thicker 1 day and 3 days after surgery than before surgery (t = 2.689, P = 0.012; t = 2.383, P = 0.018, respectively); no significant difference was found 1 week after surgery (P > 0.05). The foveal center retinal and parafoveal retinal thicknesses were greater 1 day after surgery than they were before surgery (P = 0.000 and P = 0.005, respectively) in the mild myopic and hyperopic groups. No significant difference was found 3 days or 1 week after surgery (P > 0.05). In all three groups, no significant difference was found in the macular inner retinal or peripapillary RNFL thickness 1 day, 3 days, or 1 week after surgery (P > 0.05). Conclusions: The foveal center retinal edema after FS?LASIK is mild and reversible in children, that mostly occurred in the high myopic group with no effect on the visual acuity, and is always relieved within 1 week.
关键词： Child,Retinal,Laser In situ Keratomileusis,Optical Coherence Tomography
更新于2025-09-16 10:30:52
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Differences in Simulated Refractive Outcomes of Photorefractive Keratectomy (PRK) and Laser In-Situ Keratomileusis (LASIK) for Myopia in Same-Eye Virtual Trials
摘要： The use of computational mechanics for assessing the structural and optical consequences of corneal refractive procedures is increasing. In practice, surgeons who elect to perform PRK rather than LASIK must often reduce the programmed refractive treatment magnitude to avoid overcorrection of myopia. Building on a recent clinical validation study of finite element analysis (FEA)-based predictions of LASIK outcomes, this study compares predicted responses in the validated LASIK cases to theoretical PRK treatments for the same refractive error. Simulations in 20 eyes demonstrated that PRK resulted in a mean overcorrection of 0.17 ± 0.10 D relative to LASIK and that the magnitude of overcorrection increased as a function of attempted correction. This difference in correction closely matched (within 0.06 ± 0.03 D) observed differences in PRK and LASIK from a historical nomogram incorporating thousands of cases. The surgically induced corneal strain was higher in LASIK than PRK and resulted in more forward displacement of the central stroma and, consequently, less relative flattening in LASIK. This FE model provides structural confirmation of a mechanism of action for the difference in refractive outcomes of these two keratorefractive techniques, and the results were in agreement with empirical clinical data.
关键词： laser in situ keratomileusis (LASIK),refractive surgery,cornea,photorefractive keratectomy (PRK),finite element analysis
更新于2025-09-16 10:30:52
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<p>Intraocular Pressure Calculation in Myopic Patients After Laser-Assisted In Situ Keratomileusis</p>
摘要： Background: Corneal refractive surgery is widely used worldwide. Myopia is the most common reason for laser-assisted corneal refractive surgery (LASIK) and one of the risk factors for glaucoma. Intraocular pressure (IOP) measurement becomes variable postoperatively as the results are affected by the decrease in corneal thickness and biomechanics. This prospective clinical case study attempted to establish a simple correction formula for the calculation of IOP in post-LASIK myopic patients. Methods: This study included 300 eyes of 150 patients with myopia and myopic astigmatism as a refractive error who underwent LASIK. IOP was measured preoperatively and 6 months postoperatively. Preoperative and postoperative corneal thickness as well as ablation depth were measured. Statistical analysis was performed to detect the relationship between ablation depth and change in IOP. An attempt was made to construct a correction formula for the calculation of post-LASIK IOP. Results: The age of the patients ranged between 18 and 50 (mean ± SD 34.78±8.8) years. The spherical equivalent of refractive error ranged between ?1.5 and ?10 diopters. The mean IOP decreased signi?cantly from 15.72±2.37 mmHg preoperatively to 11.71±2.24 mmHg postoperatively, with a mean difference of 4±1.75 mmHg (p?0.001). A positive correlation was detected between corneal thickness and IOP difference among patients both preoperatively and postoperatively (p?0.001). A positive correlation was identi?ed between ablation depth and IOP change (p?0.001). The correction formula for IOP was established: Real IOP=4+0.7(preoperative IOP)?0.3(ablation depth). Conclusion: IOP measurements change after corneal refractive surgery with LASIK. A corrected formula may be a good option for the proper calculation of post-LASIK IOP.
关键词： intraocular pressure calculation,Goldmann applanation tonometry,laser in situ keratomileusis,glaucoma,post-LASIK glaucoma
更新于2025-09-16 10:30:52
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Risk factors for early flap misalignment following microkeratome-assisted laser in situ keratomileusis: A retrospective large database analysis
摘要： Purpose: To determine factors associated with early flap misalignment following microkeratome-assisted laser in situ keratomileusis. Materials and Methods: This retrospective study included the right eyes of consecutive patients who underwent laser in situ keratomileusis procedure between 2005 and 2016 at Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into two groups according to whether or not they subsequently developed early flap misalignment. Results: A total of 14,582 eyes (mean age of patients: 32.4 ± 10.3 years) were included. Post-laser in situ keratomileusis early flap misalignment developed in 158 eyes (1.1%). Misalignment was more frequent during the spring (32.3% vs 22.8%, p = 0.003) and in a higher operating room temperature (23.34 ± 1.06 vs 22.98 ± 1.26, p < 0.001). In addition, in the misalignment group, there was a higher rate with the of use of the a Moria M2 microkeratome (rather than sub-Bowman’s keratomileusis microkeratome) head (55.2% vs 40.5%, respectively, p < 0.001). In a multivariable analysis adjusted for surgeon and year of surgery, high operating room temperature (odds ratio = 1.22, p = 0.006), treatment zone of 9.0 mm (as opposed to smaller treatment zones, odds ratio = 1.54, p = 0.04), and springtime (odds ratio = 1.58, p = 0.02) were associated with flap misalignment. There was a significant difference in misalignment rates between surgeons (p = 0.02). Conclusion: This study found that larger treatment zones, higher operating room temperature, operating during the spring, and the use of Moria M2 microkeratome were associated with increased flap misalignment rates. The association with operating room temperature and seasonal variation is of interest and merits further research.
关键词： microstriae,macrostriae,laser in situ keratomileusis,Flap misalignment,flap risk factors
更新于2025-09-12 10:27:22