Diffuse Lamellar Keratitis Research Articles

On the issue of complications following excimer laser correction of ametropia

Background. Diffuse lamellar keratitis is a rare yet severe postoperative complication that may arise following excimer laser correction of myopia. Research indicate that the incidence of this condition after LASIK ranges from 4.3 to 18.9 %, and after FemtoLASIK, it varies from 0.5 % to more than 37.5 %. Given the increasing popularity of LASIK and FemtoLASIK technologies, studying the frequency and clinical characteristics of this complication is crucial for enhancing treatment outcomes and patient safety. This study purposed to explore the clinical course and frequency of diffuse lamellar keratitis following different excimer laser technologies used for myopia correction. Materials and methods. We conducted a prospective, cohort, non-interventional study. It involved 180 patients (360 eyes) who underwent myopia correction using either LASIK (182 eyes) or FemtoLASIK (178 eyes). Postoperative monitoring included visual acuity, refraction, and biomicroscopy to identify potential complications, particularly diffuse lamellar keratitis. We examined the frequency and clinical course of the condition after each type of excimer laser correction. The observation period is 1 year. Results. Upon examination one week after excimer laser correction, the incidence of diffuse lamellar keratitis in the first group was 4.95 %, while in the second group it was 6.74 %. One month after surgery, there was a reduction in the frequency of diffuse lamellar keratitis: in the first group, it decreased to 3.30 %, and in the second group, to 2.81 %. By the three-month follow-up, the first group showed no manifestations of diffuse lamellar keratitis, whereas the second group had an incidence of 0.56 %. At the six-month follow-up, the incidence in the first group was 0.55 %, and there were no clinical manifestations of diffuse lamellar keratitis in the second group. At the one-year follow-up, neither group exhi­bited clinical signs of this disease. The clinical course and manifestations of diffuse lamellar keratitis did not differ between LASIK and FemtoLASIK throughout the study period. Additionally, it was found that 38.46 % of the patients had a history of SARS-CoV-2 infection. Conclusions. Our research revealed that the frequency of diffuse lamellar keratitis was 6.3 % after LASIK and 6.6 % after FemtoLASIK over a 1-year period. The clinical course and manifestations of the condition were similar for both LASIK and FemtoLASIK at all observation points. In was found that 38.46 % of patients who developed diffuse lamellar keratitis after excimer laser correction had a history of SARS-CoV-2 infection (from 2 weeks to 2 months). Future research should focus on investigating new local (ocular) and systemic (whole body) pathogenetic factors of diffuse lamellar keratitis following modern excimer laser methods for ametropia correction.

Clinical outcomes of epithelial basement membrane dystrophy after keratorefractive lenticule extraction.

To determine the clinical outcomes of keratorefractive lenticule extraction (KLEx) in eyes with epithelial basement membrane dystrophy (EBMD) that developed after surgery. Onnuri Smile Eye Clinic, Seoul, South Korea. Retrospective single-center study. This study reviewed the medical records of 26 eyes of 16 patients who exhibited signs of EBMD after KLEx. Postoperatively, corneal findings and visual outcomes were evaluated. Statistical analyses were also performed on eyes without corneal complications after KLEx. Signs of EBMD were first observed within 1 week postoperatively in 22 eyes (84.6%): 6 eyes (23.1%) showed epithelial defects, 10 eyes (38.5%) showed subepithelial corneal opacity, 5 eyes (19.2%) showed diffuse lamellar keratitis, and 1 eye (3.9%) showed epithelial ingrowth. Symptoms such as pain, while corneal lesions were present, occurred in 21 eyes (80.8%). At 3 months postoperatively, 21 eyes (80.8%) showed no specific findings on slitlamp microscopy after medical treatment, 2 eyes (7.7%) showed subepithelial corneal opacity, 2 eyes (7.7%) showed corneal scar, and 1 eye (3.9%) showed epithelial ingrowth. Uncorrected distance visual acuity was 20/25 or better in 24 eyes (92.3%), and spherical equivalent was within ±1.0 D in 20 eyes (76.9%). The efficacy index of the EBMD group did not significantly differ from the control group, while the safety index was significantly lower. Manifestations of EBMD can occur after KLEx and can affect clinical outcomes. Most cases showed favorable results with appropriate nonsurgical treatment; however, some cases had long-term complications such as corneal scarring.

Late-onset Diffuse Lamellar Keratitis in the Context of Conjunctivitis Related to COVID-19: Case Report

Purpose: To report a case of diffuse lamellar keratitis (DLK) occurring 23 years after laser in situ keratomileusis (LASIK), coinciding with a recent diagnosis of conjunctivitis related to coronavirus disease 2019 (COVID-19) . Methods: A 47-year-old woman had LASIK in 2000 and developed conjunctivitis related to COVID-19 in March 2022. In February 2023, she presented with 5 days of decreased vision (corrected distance visual acuity 20/25), photophobia, and glare in her right eye. She was diagnosed as having stage I DLK in the right eye based on corneal inflammatory infiltrates in the peripheral flap interface. Results: Topical steroids improved the patient's symptoms and resolved the inflammatory infiltrates within 2 months with a final corrected distance visual acuity of 20/20. Conclusions: This report describes a rare case of DLK occurring more than 20 years after LASIK. It is important to consider DLK even outside of the early postoperative period after LASIK or another lamellar interface–based procedure. In this case, conjunctivitis related to COVID-19 may have played a role in immune dysregulation and the development of DLK. [ Journal of Refractive Surgery Case Reports. 2024;4(1):e11–e14.]

Complications of laser in situ keratomileusis (LASIK)

Laser-in-situ-keratomileusis (LASIK) is one of the most commonly done refractive surgeries round the globe. It has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased post-operative haze. This review journal aims to give a brief outline about intra and postoperative complications of LASIK, clinical presentation and management guidelines for these complications. Intraoperative complications include free cap, buttonhole flap, flap tear, decentered ablation, interface debris and femtosecond laser related complications like vertical gas breakthrough and opaque bubble layer. Postoperative complications include flap striae, epithelial ingrowth, diffuse lamellar keratitis, residual refractive error, refractive regression and many more. The knowledge about these complications help the surgeon in early identification and timely intervention for achieving optimal visual outcome.

Surgical and visual outcomes of flap repositioning for various flap-related pathologies post laser in-situ keratomileusis (LASIK).

To evaluate the surgical and visual outcomes of flap repositioning for various post-laser-assisted in-situ keratomileusis (LASIK) flap pathologies. Retrospective review of consecutive cases between April 1, 2017 and February 28, 2022, where surgical flap repositioning was performed following LASIK for various flap-related complications. Of the 6018 eyes, 31 needed flap repositioning (0.51%). Indications were flap displacement and folds in 20 eyes (64%), flap subluxation in five eyes (16%), epithelial ingrowth and interface debris in two each, and one eye each of diffuse lamellar keratitis and incomplete flap. Final best spectacle-corrected visual acuity of ≥ 20/25 was obtained in 25/31 (80%) eyes. The efficacy index pre to post repositioning showed significant improvement (0.86 ± 0.39 vs. 0.63 ± 0.29 preop, P = 0.011). Flap repositioning incidence was significantly higher (7/602 (1.16%)) during the COVID lockdown phases compared to the non-COVID lockdown phase (24/5416 (0.44%, P = 0.019)). The COVID group had lower efficacy (0.72 ± 0.36 vs. 0.90 ± 0.39, P = 0.300) and safety indices (0.85 ± 0.24 vs. 1.06 ± 0.35, P = 0.144) compared to the non-COVID group; however, the results were not statistically significant. The flap displacement rate was statistically higher in nasal hinged (microkeratome) flaps (18/2013, 0.89%) compared to superior hinged (Femto) flaps (13/4005, 0.32%) (0.32%, P = 0.003). Our study shows that flap repositioning has a low incidence in LASIK, with the most common indication being flap displacement/folds. The outcome post flap repositioning was poorer during the lockdown period, perhaps due to the inability to follow up early. Early identification and surgical repositioning are successful in both anatomical and visual restoration.

Outcomes of Flap Amputation After Laser In Situ Keratomileusis.

The aim of this study was to describe the indications and outcomes of flap amputation after laser in situ keratomileusis (LASIK) at a referral-based institution. In this retrospective consecutive case series, medical records of patients who underwent LASIK flap amputation at Mayo Clinic, Rochester, MN, between January 1, 1998, and January 31, 2023, were reviewed. Fifteen eyes (15 patients) underwent flap amputation during the study period. The median age was 45 years (range, 25-71 years), and 8 patients (53%) were men. The median uncorrected visual acuity before flap amputation was 20/200 (range 20/40-hand motions). Indications for flap amputation included epithelial ingrowth (n = 6, 40%), infectious keratitis (n = 6, 40%), diffuse lamellar keratitis (n = 1, 7%), vegetative foreign body (n = 1, 7%), and astigmatism from fixed flap striae (n = 1, 7%). The median duration of follow-up was 8 months (range 1-234 months). Subsequent corneal interventions included chelation of calcific band keratopathy (n = 1, 7%), lamellar keratoplasty (n = 1, 7%), penetrating keratoplasty (n = 2, 18%), keratoprosthesis (n = 1, 7%), and rigid contact lens wear (n = 4, 27%). The final median best visual acuity was 20/25 (range 20/20-20/200). Compared with noninfectious indications for flap amputation, eyes with infectious indications had worse baseline median uncorrected visual acuity (hand motions vs. 20/63, P < 0.001), were more likely to undergo major corneal surgical intervention (50% vs. 11%), and had worse final median best visual acuity (20/50 vs. 20/20, P = 0.018). LASIK flap amputation is sometimes necessary to control threatening corneal diseases. Excellent visual outcomes were achieved in most cases, albeit with additional intervention or rigid contact lens wear.

Adverse Events of Femtosecond-Assisted Laser-Assisted In situ Keratomileusis: A Manufacturer and User Facility Device Experience Database Study.

To analyze the United States Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database, which contains reports of adverse events involving medical devices, and characterize the most common adverse events of femtosecond (FS) laser-assisted in situ keratomileusis (LASIK). The MAUDE database was queried on May 19, 2022, for adverse events involving the ophthalmic FS laser reported from January 2012 to April 2022. Reports unrelated to LASIK procedures were excluded. Data extraction was performed on these reports, including the type of adverse event and whether surgery was successfully completed. Frequency analysis was performed using the Statistical Package for the Social Sciences. From the 3491 reported adverse events involving the FS laser system, 1136 met the inclusion criteria. Of the 672 cases where outcomes were reported, 476 were successfully completed and 196 were aborted. The most common intraoperative complications were incomplete cut (42.8%), thinner than intended flap (17.6%), and difficulty lifting the flap (12.0%). FS-related complications included opaque bubble layer (2.3%), air bubbles in the anterior chamber (2.4%), and vertical gas breakthrough (4.1%). Other device-related intraoperative complications included suction loss (10.2%), difficulty docking (2.4%), and laser malfunction (2.0%). The most common postoperative complications were diffuse lamellar keratitis (DLK) (7.8%) and rainbow glare (4.6%). The most common intraoperative FS-assisted LASIK complication in the MAUDE database was an incomplete flap. The most common postoperative complication was DLK. This study is the first to investigate FS-assisted LASIK adverse events in the MAUDE database. It can raise awareness of real-world surgical complications and help ophthalmologists better counsel and treat patients.

Incidence and Management of Epithelial-Related Complications After SMILE.

To investigate the incidence and management of only epithelial-related complications following small incision lenticule extraction (SMILE). A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups. Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye). There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001). Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001). However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively). There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively). In our study, epithelial-related complications were more prevalent in older patients and predisposed patients to require PRK enhancements after recovery from SMILE. Despite the incidence of epithelial-related complications, visual prognoses were favorable and achieved through various management strategies.

Effects of Chilled Saline Irrigation on SMILE Surgery.

To investigate the effect of ultra-early visual correction and prognosis of myopic astigmatism after irrigation with the chilled balanced salt solution (BSS) during small incision lenticule extraction (SMILE) surgery. A prospective case-control study was enrolled from 202 patients (404 eyes) who had SMILE, and randomly divided into an intervention group and a control group (each group was 101 cases [202 eyes]). After lenticule extraction on SMILE, the corneal cap and the corneal incision were flushed with chilled saline in the intervention group, whereas the control group was flushed with room temperature saline. All patients in the two groups were examined for early complications before and 2 hours, 24 hours, and 7 days after surgery and the results were compared, and statistically analyzed, including the recovery degree of naked eye vision, ocular irritation symptoms, opaque bubble layer, diffuse lamellar keratitis (DLK), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity. The ocular irritation symptoms in the intervention group were milder than those in the control group at 2 hours after surgery, and the recovery of visual acuity at 2 and 24 hours after surgery was significantly faster than that in the control group, but there was no statistical difference in UDVA between the two groups at 7 days after surgery (P > .05). The incidence of DLK in the intervention group was lower than that in the control group, and the difference was significant (P = .041). Chilled BSS irrigation can reduce the emergency response of corneal tissue after SMILE, relieve ocular irritation, promote vision recovery, and relatively reduce incidence of early complications. [J Refract Surg. 2023;39(4):282-287.].

Severe sterile inflammatory keratitis associated with recurrent epithelial erosion after small incision lenticule extraction

A 32-year-old man had undergone small incision lenticule extraction (SMILE) that was complicated by intraoperative epithelial detachment in the right eye. Corneal epithelial erosion reoccurred at two and four months after surgery. At the third time of epithelial erosion, slit-lamp examination revealed dense white infiltrates throughout the corneal cap-stromal interface. The patient was initially managed with high-dose topical antibiotics. After the negative culture and Gram staining results from the interface washout, diffuse lamellar keratitis was confirmed and topical steroids were administered. The inflammation resolved, and corneal transparency was achieved after treatment. Timely diagnosis and appropriate treatment are highly critical for prognosis.

Diffuse lamellar keratitis as a rare complication of diamond burr superficial keratectomy for recurrent corneal erosion: a case report

BackgroundTo present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE).Case presentationA 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20.ConclusionsDiffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions.

Corneal Refractive Surgery Considerations in Patients on Dupilumab

Dupilumab is a biologic approved by the United States Food and Drug Administration (US FDA) for the treatment of atopic dermatitis. While it is an effective medication for eczema, ocular side effects are common in patients receiving dupilumab therapy. Greater consideration is needed when evaluating these individuals for corneal refractive surgery. Dupilumab patients may suffer from atopy, a condition that also merits consideration in those desiring refractive surgery. Additional testing and careful consideration are needed, as these patients have an increased risk of dry eye syndrome, keratoconus, cataracts, diffuse lamellar keratitis, viral keratitis, and perioperative infection. This commentary discusses the current understanding of dupilumab ocular side effects and investigates factors to consider when evaluating these patients for corneal refractive surgery.

A rare case of post-laser-assisted in situ keratomileusis Scedosporium prolificans keratitis

A 21-year-old female presented with a stick injury in her right eye 6 months after an uneventful laser in situ keratomileusis (LASIK). Diffuse lamellar keratitis which responded well to the initial treatment with topical steroids, progressed rapidly within the next 3 weeks to develop corneal perforation. A microbiological examination revealed a rare fungus Scedosporium prolificans. The patient was successfully managed with topical voriconazole 1% and cyanoacrylate glue for corneal perforation. At the end of 7 weeks, keratitis healed with a best-corrected visual acuity of hand movements. Hence, a strong suspicion of infectious interface keratitis is warranted while treating post-LASIK keratitis.

Surgical management of a calzone-like posttraumatic infolding of a 10-year-old LASIK flap

Introduction: The popularity of femtosecond laser–assisted in situ keratomileusis (LASIK) has increased, but flap-related complications such as trauma and possibility of displacement, even years after surgery with complications such as striae, diffuse lamellar keratitis, and epithelial ingrowth, may still be challenging. Patient and Clinical Findings: A 45-year-old woman was referred a week after trauma and flap displacement on a 10-year-long myopic LASIK correction. Corrected distance visual acuity was 20/30 (0, −2.25 at 35 degrees) due to epithelial ingrowth involving the visual axis. The external third of the flap was rolled inward (calzone-like), exposing the underlying edematous stroma associated with dense fibrosis at the level of the roll. Diagnosis, Intervention and Outcomes: Emergency flap surgical revision was performed using a technique of mechanical debridement and a 20% alcohol-dipped sponge application to help with epithelial cells lysis, and fibrin glue was applied on the flap. Uncorrected distance visual acuity was restored and examination revealed a stable, well-apposed flap, without epithelial cell ingrowth, and an otherwise unremarkable examination. Conclusions: This study showed the 10-month-efficacy of a combined approach of mechanical debridement, ethanol-based cell lysis, and fibrin glue in traumatic 10-year-old-flap management with infolding or invagination and extensive epithelial ingrowth.

Elevated intraocular pressure‐induced interlamellar keratitis in a patient with LASIK surgery 14 years ago

AbstractPurposeTo describe a case of interlamellar keratitis induced by elevated intraocular pressure (IOP) in a patient with a history of LASIK surgery and the importance of having a strong diagnostic suspicion for establishing adequate treatment.MethodsIntraocular pressure‐induced interlamellar keratitis is one of the potential complications of LASIK refractive surgery. The cases described generally occur a few months after surgery although there are some cases that have been described several years after surgery, usually in a context of uveitis and corticosteroid treatment or silent glaucoma. We present a case of 43‐year‐old woman who came to the emergency room with visual acuity (VA) impairment in the left eye in the setting of elevated intraocular pressure‐induced interlamellar keratitis secondary to the intravitreal corticosteroid implant in her left eye due to a diabetic retinopathy. She underwent LASIK surgery 14 years ago.ResultsThe treatment was based on lowering the intraocular pressure. Oral acetazolamide and topical timolol, bimatoprost and brinzolamide were used. The patient recovered her baseline VA and the IOP were properly controlled posteriorly.ConclusionsThis case shows the importance of considering this diagnosis in patients with corneal haze, elevated intraocular pressure and a history of LASIK surgery to establish an adequate treatment. A full recovery is expected.Bibliography1. Galal A, Artola A, Belda J, (2006) Interface corneal edema secondary to steroid‐induced elevation of intraocular pressure simulating diffuse lamellar keratitis. Journal of refractive surgery.2. Lee V, Sulewski M, Zaidi A (2010) Elevated Intraocular Pressure–Induced Interlamellar Stromal Keratitis Occurring 9 Years After Laser In Situ Keratomileusis. Corneal Journal.3. Lyle W, Jin G, Jin Y (2003) Interface fluid after laser in situ keratomileusis. Journal of refractive surgery.4. Tourtas T, Kopsachilis N, Meiller R, et al. (2010). Pressure‐Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis. Corneal Journal.

Evaluate the Prevalence, Natural Course, and Final Visual Acuity in Patients with Stages III or IV of Diffuse Lamellar Keratitis Following Laser in Situ Keratomileusis

Background: And aim: The prevalence of DLK has been reported differently in different centers based onits severity. Hence, the aim of present study was evaluate the prevalence, natural course, and final visualacuity in patients with stages III or IV of diffuse lamellar keratitis following laser in situ keratomileusis.Methods: In the present descriptive study, 3941 eyes files from 2125 patients underwent LASIK surgery;were examined. All patients had a complete ophthalmologic examination before LASIK and had suitableconditions for LASIK.Result: Among the studied cases, 39 eyes (0.98%), out of 16 patients (0.75). The mean time intervalbetween LASIK and DLK diagnosis was 3± 2.4 days. A history of allergy was negative in all patients. Themean post-operative spherical refractive error in all eyes was in the range of 1 diopters and the averagecylindrical refractive error in 33 eyes was -0.66±1.2 diopters. The mean of final spherical refraction in34 eyes was 0.5±1.2 diopter and the mean of final cylindrical refraction in 35 eyes was -0.75±1.3 diopter.Severe turbidity at the flap surface in the first week decreased over time in all patients with stage III and IVDLK. So that only in four eyes (10.25%)Conclusion: The prevalence of stages III and IV in DLK is negligible compared to the large number ofLASIK procedures and all patients respond well to topical and systemic corticosteroid therapy.

Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK

Femtosecond (FS) lasers initially had a higher incidence of diffuse lamellar keratitis (DLK) compared with microkeratome flap creation. It has been theorized that higher-frequency lower-energy (HFLE) FS lasers would reduce the incidence of DLK. Our study sought to evaluate the incidence of newer HFLE FS lasers with pulse frequencies above 60 kHz. It was a retrospective case-control study evaluating the incidence of DLK following flap creation with one of three FS lasers (AMO iFs, WaveLight FS200, Zeiss VisuMax). Uncomplicated LASIK cases were included as the control group (14,348 eyes) and cases of DLK were recorded in the study group (637 eyes). Of the 637 cases of DLK, 76 developed stage II, 25 progressed to stage III, and only three developed stage IV DLK. The overall incidence rate of DLK was 4.3%; it has fallen with the invention of newer HFLE FS lasers and is approaching the DLK incidence rates of DLK with microkeratome.

Clinical Applications of In Vivo Confocal Microscopy in Keratorefractive Surgery.

To review the contribution of in vivo confocal microscopy (IVCM) to the understanding of corneal wound healing following refractive surgery, and its role in the diagnosis and management of complications arising from keratorefractive procedures. Review of the basic science and clinical literature relating to the study of keratorefractive surgical procedures using IVCM. Extensive research using IVCM has generated a comprehensive understanding of tissue responses after corneal refractive surgery. Epithelial thickness and stromal keratocyte density can be quantified postoperatively and studied longitudinally. Corneal nerve loss and subsequent reinnervation has been characterized and differs significantly between laser refractive techniques. IVCM has also been used to study complications arising from postoperative inflammation (diffuse lamellar keratitis, central toxic keratopathy, ring keratitis, and ectasia), infection (microbial keratitis), and neuropathy (dry eye and neuralgia). This imaging technique can have a critical role in the diagnosis of these complications and subsequent monitoring of treatment response. Manual processing of IVCM images is time-consuming and there may be significant interobserver and intraobserver variability with poor repeatability. However, increasing automation and the use of artificial intelligence is improving the speed and accuracy of image analysis. IVCM has historically been confined to a research setting because image capture and subsequent processing was extremely labor intensive. However, advances in both hardware and software capabilities promise to allow the use of IVCM in routine clinical practice. Real-time evaluation of the cornea at a cellular level will be particularly useful in patients with inflammatory, infectious, or neuropathic complications of keratorefractive surgery. [J Refract Surg. 2021;37(7):493-503.].

One-Year Visual and Refractive Outcomes following LASIK for Myopia and Myopic Astigmatism with MEL 90 versus Schwind Amaris 750S Excimer Laser: A Comparative Study.

Purpose To compare clinical outcomes following LASIK for myopia performed with MEL 90 vs. Schwind Amaris 750S excimer laser. Methods Data were collected retrospectively for patients who underwent Femto-LASIK, using the MEL 90 and Schwind Amaris 750S excimer laser for correction of myopia and myopic astigmatism within the range of −1.00 to −10.00 D SE from January 2013 till June 2018. Outcomes were analysed at 12 months for safety, efficacy, enhancement rate, and long-term complications. Results A total of 328 eyes of 328 patients were analysed. One hundred and sixty-three eyes were treated with Schwind Amaris and the remaining 165 eyes with the MEL 90 laser. Twelve months postoperatively, the mean UDVA, CDVA, residual SE, and cylinder in the Amaris group were −0.10 ± 0.09 logMAR, −0.14 ± 0.06 logMAR, −0.21 ± 0.22 D, −0.13 ± 0.18 D versus −0.05 ± 0.07 logMAR, −0.09 ± 0.08 logMAR, −0.23 ± 0.23 D, and −0.14 ± 0.21 D for the MEL 90 group (p values >0.05). For the Amaris group, safety and efficacy indices were 1.12 and 1.02, whereas for the MEL 90 group, these indices were 1.08 and 1.00, respectively. No eye in either group had any postop flap-related complications, infectious keratitis, diffuse lamellar keratitis, or keratectasia. Two eyes in the Amaris and 4 eyes in MEL 90 group required enhancement for the progression of myopia. Conclusion At 12 months, both Schwind Amaris 750S and MEL 90 lasers demonstrated comparable clinical outcomes for myopic LASIK in a single surgeon setting.

Complications of laser-assisted in situ keratomileusis.

Laser-assisted in situ keratomileusis (LASIK) is one of the most commonly performed kerato-refractive surgery globally. Since its introduction in 1990, there has been a constant evolution in its technology to improve the visual outcome. The safety, efficacy, and predictability of LASIK are well known, but complications with this procedure, although rare, are not unknown. Literature review suggests that intraoperative complications include suction loss, free cap, flap tear, buttonhole flap, decentered ablation, central island, interface debris, femtosecond laser-related complications, and others. The postoperative complications include flap striae, flap dislocation, residual refractive error, diffuse lamellar keratitis, microbial keratitis, epithelial ingrowth, refractive regression, corneal ectasia, and others. This review aims to provide a comprehensive knowledge of risk factors, clinical features, and management protocol of all the reported complications of LASIK. This knowledge will help in prevention as well as early identification and timely intervention with the appropriate strategy for achieving optimal visual outcome even in the face of complications.