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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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Direct and Indirect Flap Measurements in Femtosecond Laser–Assisted In Situ Keratomileusis
摘要： To compare direct and indirect LASIK flap thickness measurements using ultrasound and Scheimpflug technology. Eighty-two eyes treated with laser-assisted in situ keratomileusis refractive surgery using a femtosecond laser (IntraLase FS150) were prospectively included in the study. Flap thickness was set to 115 mm. Corneal flap thickness was measured using the direct method—ie, ultrasound pachymetry immediately after flap construction in the presence of cavitation bubbles—and indirect methods, with subtraction of intraoperative post-lift corneal thickness measured using ultrasound pachymetry (intrastroma) from preoperative central corneal thickness using ultrasound (Indirect-US) or Scheimpflug thinnest pachymetry (Indirect-Scheimpflug). Mean flap thickness was overestimated using the indirect methods, Indirect-US and Indirect-Scheimpflug (122.6 6 24.5 mm and 128.1 6 26.1 mm, respectively; P , 0.0060 and P , 0.0001, respectively). There were no significant correlations between the direct and indirect methods. Indirect-Scheimpflug was significantly higher (P = 0.0122) than Indirect-US. The closest average flap thickness compared with the set parameter of 115 mm was that of the direct method (115.6 6 8.6 mm; 95% confidence interval: 21.3 to 2.5; P = 0.5163). The direct method provided the lowest SD of all groups (SD: 8.64). The direct method of flap thickness measurement was the most comparable to the set parameter compared with the indirect subtraction methods. Additional studies are needed to determine which method allows for the most accurate measurement of flap thickness.
关键词： flap thickness,femtosecond laser,laser in situ keratomileusis,Scheimpflug,ultrasound
更新于2025-09-12 10:27:22
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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
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Outcomes of Flap Lift Laser In Situ Keratomileusis Enhancements in a Large Patient Population
摘要： Purpose: To compare the incidence of corneal epithelial ingrowth (EIG) and the visual outcomes of enhancement with laser in situ keratomileusis (LASIK) by ?ap lift when a bandage soft contact lens (CL) was ?tted after the procedure and when it was not. Methods: This is a multicenter, retrospective, interventional case series in which all patients who underwent LASIK enhancement from January 2005 to January 2015 were included consecutively. Patients were grouped depending on whether a bandage CL was ?tted after re-treatment by ?ap lift (group 1) or not (group 2). Results: A total of 16,702 eyes from 12,485 patients were included. There were statistically signi?cant differences between the groups regarding corrected distance visual acuity (better in group 1) and safety index (better in group 2) although these were not clinically relevant. The incidence of EIG was 0.58% in group 1 and 0.55% in group 2 although, again, the difference was not statistically different. Conclusions: We found no relevant differences in LASIK enhancement between patients who received a bandage CL and those who did not regarding the incidence of EIG and visual outcomes.
关键词： LASIK re-treatment,corneal epithelial ingrowth,bandage contact lens,laser in situ keratomileusis,LASIK
更新于2025-09-12 10:27:22
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Partial Scleral Rupture Presenting 4 Years After Laser in Situ Keratomileusis
摘要： To report a case of partial scleral rupture after laser in situ keratomileusis (LASIK) surgery. This is a retrospective case report describing a late complication of LASIK surgery. A 32-year-old white woman with a history of LASIK surgery performed with a mechanical microkeratome 4 years previously presented for evaluation of partial bilateral scleral ruptures. An arcuate ?ltering bleb along the contour of the cornea was found on the right eye with associated hypotony and corneal astigmatism. There were no signs or symptoms of prior in?ammation, and rheumatologic workup was negative. Imaging revealed scleral microbreaks in the absence of adjacent thinning. The pattern and location of thinning without ?ndings consistent with in?ammatory disease suggest that the partial bilateral scleral rupture was because of mechanical damage at the time of LASIK, possibly compounded by the hormonal changes of pregnancy.
关键词： scleral rupture,complications,complication,hypotony,scleral microbreaks,laser in situ keratomileusis (LASIK)
更新于2025-09-12 10:27:22