History Of Laser In Situ Keratomileusis Research Articles

Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty in Patients With History of LASIK.

The aim of this study was to evaluate the visual, pachymetric, tomographic, and biomicroscopic findings in a series of cases with laser in situ keratomileusis (LASIK) flap interface fluid syndrome (IFS) after Descemet membrane endothelial keratoplasty (DMEK). Six cases were included in this study; all patients had a history of LASIK and underwent DMEK for the treatment of bullous keratopathy. After uneventful surgery, all patients presented with corneal edema and IFS under the LASIK flap, which was demonstrated with anterior segment optical coherence tomography (AS-OCT). Visual acuity, clinical findings, pachymetry, endothelial cell count, and AS-OCT were documented during the management of these cases. IFS appears 2.33 days (±1.03) after DMEK. One case improved with conservative treatment. In 5 cases, the LASIK flap was lifted, the fluid was drained, and the flap was replaced. The mean best-corrected visual acuity after fluid drainage was 0.44 logMAR (range 0.18-1.0) and mean central corneal thickness was 538 μm ± 160. Total resolution of the IFS was achieved at 14.5 days (range 4-30) after DMEK. AS-OCT showed resolution of the flap interface in 5 of 6 cases, while 1 patient required second DMEK due to reaccumulation of the interface fluid. IFS can occur after DMEK in patients with previous LASIK. AS-OCT is a valuable tool for monitoring these cases preoperatively and postoperatively. Early surgical management is often needed to achieve resolution.

Delayed Laser In Situ Keratomileusis Interface Haze 6 Months After Corneal Cross-linking for Ectasia

PURPOSE: To report a case of delayed subepithelial haze at the laser in situ keratomileusis (LASIK) flap interface after corneal cross-linking (CXL) for LASIK-induced ectasia. METHODS: A 39-year-old woman with ectasia after LASIK underwent accelerated CXL with riboflavin and hydroxypropyl methylcellulose every 2 minutes for 20 minutes, then ultraviolet light at a fluence of 10 mW/cm 2 for 9 minutes. Outcomes measured included stromal haze assessment and visual refractive parameters. Follow-up was conducted using slit-lamp imaging, optical coherence tomography (OCT), corneal topography, and a dedicated OCT image analysis software. RESULTS: Six months after CXL, OCT of the right eye showed a sharply demarcated hyperreflective linear lesion inferotemporal to the corneal center, at the LASIK flap interface. The haze was 1.5-mm wide with 12.49 grayscale units (GSU) intensity and involved the anterior stroma at 0.9 mm away from the center extending from 225° to 255°. This haze peaked at 9 months after CXL, reaching 3 mm in size and 29.01 GSU in intensity. Corneal topography showed steepening on the haze area and flattening on the diametrically opposite side. Topical steroid therapy was initiated. At final evaluation (19 months), there was a significant decrease in haze reflectivity and size, accompanied by marked improvement of the topography. CONCLUSIONS: Delayed corneal haze after CXL with a history of LASIK can develop at the level of the LASIK interface right under the cone area. Although it was responsive to topical steroid therapy, the reasons for this clinical presentation are still unknown. [ Journal of Refractive Surgery Case Reports. 2022;2(2):e46–e50.]

Protective efficacy of bandage lens on corneal flap of patients with retinal detachment after LASIK surgery

Objective To evaluate the protective efficacy of bandage contact lens on corneal flap for retinal detachment patients with LASIK history. Methods A prospective, self-controlled clinical study. Nine eyes of 9 patients with retinal detachment who had history of LASIK were enrolled. All cases underwent vitreoretinal surgery with non-contact wide-angle lens. Corneal bandage lenses were used to completely cover the surface of the corneal flap during surgery. The visual acuity, IOP, corneal fluorescein sodium staining, tear function, corneal thickness and corneal endothelial cell density at 1 d, 1 week and 1 month postoperatively were recorded. Results No corneal flap displacement or loss occurred in 9 cases. Before surgery corneal fluorescein staining showed scattered cornea around the next spot color in 7 cases. The score of corneal fluorescein staining was (2.00±0.87) 1 d after surgery, it was higher than that before surgery (t=-5.547, P=0.001). The score returned to preoperative level at 1 week after surgery. BUT was agreement with results of corneal fluorescein sodium staining. The corneal thickness at 1 week after surgery was (531.78±24.17)μm, it was thicker than that before surgery(t=-4.918, P=0.001). The difference of corneal thickness was not statistically significant between before and 1 month after surgery. The difference of Schirmer Ⅰtest and corneal endothelial cell density were not statistically significant between before and after surgery. Conclusion Application of corneal bandage lens for retinal detachment patients with history of LASIK can protect corneal flap, recovery early of tear film stability, effectively protect the corneal function. Key words: Retinal detachment, after surgery, laser in situ keratomileusis(LASIK); Vitreoretinal surgery; Bandage contact lens; Corneal flap

Fibrin adhesive in conjunction with epithelial ingrowth removal after laser in situ keratomileusis: Long-term results

To describe the long-term results of fibrin adhesive use in the management of epithelial ingrowth after laser in situ keratomileusis (LASIK). Private practice, Minneapolis, Minnesota, and an academic medical center, Durham, North Carolina, USA. Retrospective case series. Patients with a history of LASIK had epithelial ingrowth removal with mechanical debridement and fibrin glue application. Visual outcomes and the presence or absence of epithelial ingrowth were evaluated again after 3 months and at the last follow-up. The main outcome measures were recurrence of epithelial ingrowth and visual acuity. Thirty-nine eyes of 38 patients were evaluated. After epithelial ingrowth removal and application of fibrin glue, 31 eyes (79.5%) had no recurrence of ingrowth at the final follow-up and 5 eyes (12.8%) had mild epithelial ingrowth not requiring removal. Three eyes (7.7%) had significant epithelial ingrowth at the 3-month follow-up that required subsequent removal and fibrin application. At the 3-month follow-up visit, 76.9% of eyes achieved 20/25 or better corrected distance visual acuity (CDVA) and 69.2% of eyes achieved 20/40 or better uncorrected distance visual acuity (UDVA). At the last follow-up visit (mean 26.6 ± 17.0 months [SD]), 84.6% of eyes had 20/25 or better CDVA and 74.4% of eyes had 20/40 or better UDVA. Fibrin adhesive in conjunction with manual epithelial removal prevented a clinically significant recurrence of epithelial ingrowth in the majority of eyes. Larger randomized studies are needed to compare the success of this technique with that of others. No author has a financial or proprietary interest in any material or method mentioned.

Elevated Intraocular Pressure–Induced Interlamellar Stromal Keratitis Occurring 9 Years After Laser In Situ Keratomileusis

Elevated intraocular pressure-induced interlamellar stromal keratitis (PISK) is an entity of interface haze usually occurring weeks to months after laser in situ keratomileusis (LASIK) that is associated with elevated intraocular pressures and worsening with steroid treatment. There is evidence that this interface haze is the result of abnormal fluid dynamics that occur in the cornea after LASIK. We present a case of pressure-induced interlamellar stromal keratitis occurring 9 years after LASIK in the setting of anterior uveitis. This case emphasizes the importance of considering such diagnoses as pressure-induced interlamellar stromal keratitis in the differential diagnosis when presented with a patient with corneal haze and a history of LASIK.

The Incidence of Central Serous Chorioretinopathy after Photorefractive Keratectomy and Laser In Situ Keratomileusis

Purpose. To assess the incidence of central serous chorioretinopathy (CSCR) following laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Methods. A chart review was performed to identify all patients with CSCR and a previous history of LASIK or PRK. Results. Over the 6-year study period, 1 of 4,876 eyes which had LASIK or PRK at the Moran Eye Center was diagnosed with CSCR. One other patient was referred from an outside center, developed CSCR symptoms one month after PRK. Both patients were managed conservatively with a final visual acuity of 20/20 or better. All other patients presented 4 or more years after refractive surgery. Conclusions. We report the first 2 CSCR cases developing within one month after PRK. The low incidence argues against a causal association. Topical corticosteroids or anxiety may elevate cortisol levels presenting therapeutic challenges for the management of CSCR after PRK or LASIK.

Accuracy of Scheimpflug Holladay equivalent keratometry readings after corneal refractive surgery

To determine the accuracy of Pentacam Scheimpflug system Holladay equivalent keratometry (K) readings (EKRs) in calculating intraocular lens (IOL) power after corneal refractive surgery, including laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and radial keratotomy (RK). Jules Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA. In this combined retrospective and prospective clinical study, patients who had cataract surgery after corneal refractive surgery were recalled to have Scheimpflug imaging of the operated cornea and Holladay EKR determination. The Holladay EKR was compared with a gold-standard K value, which was the back-calculated value using the original Hoffer formula based on the actual surgical outcomes. Eyes without a history of refractive surgery served as controls. Twenty-seven patients (41 eyes) were evaluated; 26 eyes had previous LASIK or PRK and 15, previous RK. Forty-one eyes served as controls. The mean error of the Holladay EKR in eyes with previous LASIK or PRK was +1.84 diopters (D) (range +0.66 to +4.94 D). The mean error in eyes with previous RK was +2.17 D (range +0.48 to +3.09 D). In the control eyes, the mean EKR error was +1.38 D (range -0.17 to +2.54 D). The Holladay EKR calculated using version 1.16r04 of the Scheimpflug system software was inaccurate in virgin corneas and in those with a history of LASIK, PRK, or RK using current IOL power calculation formulas. The Scheimpflug power measurements were consistently steeper than the true corneal power.

Rapid Progression of Amebic Keratitis 1 Week After Corneal Trauma and 1 Year After LASIK

To report a case of amebic keratitis that showed unusually rapid clinical progression after corneal trauma in a patient 1 year after successful laser in situ keratomileusis (LASIK) surgery. A 42-year-old pilot with a previous history of 20/20 uncorrected vision 1 year after LASIK surgery developed a clinical picture suggestive of acute microbial keratitis 7 days after the eye was traumatized by an ice chip. The correct diagnosis of amebic keratitis was confirmed by tissue biopsy 17 days after initial trauma when rapid progression of the keratitis necessitated excision of the LASIK flap. Pathology from the excised LASIK flap showed a mean of 30 amebic cysts per high power field. Thirty-three days after beginning 0.02% polyhexamethylene biguanide every hour, the patient developed culture negative hypopyon and an endothelial inflammatory plaque. Six months after starting antiamebic treatment, he developed sterile iris nodules and focal hemorrhages in the anterior chamber. Penetrating keratoplasty revealed persistence of amebic cysts in the anterior corneal stroma. Fifteen months after his initial injury, his vision remains hand motion. Amebic keratitis presented atypically and progressed rapidly to a stage of severe ring infiltrate within 10 days of trauma in a patient whose only risk factor was a history of uncomplicated LASIK more than 1 year before the trauma. Amebic keratitis should be included in the differential diagnosis of rapidly progressive corneal ulcer after trauma in patients with a history of LASIK.

Upper Lid Blepharoplasty in Patients with LASIK

Purpose: To investigate the changes in tear secretion and tear film stability after upper lid blepharoplasty in patients that had previously undergone excimer laser in situ keratomileusis (LASIK). Methods: We performed carbon dioxide (CO2) laser upper lid blepharoplasty to 18 eyes of 9 patients that had undergone bilateral LASIK at least 18 months before the surgery. Six women and 3 men aged 35 to 52 were included in this group. An additional control group of 18 eyes of similar age patients with no history of LASIK, contact lens usage or dry eye symptoms were studied. We studied the Schirmer tear test values without anesthesia at 5 minutes in both groups before and after the upper lid blepharoplasty procedure. Tear break-up time values were also measured before and 4 weeks after (CO2) laser upper lid blepharoplasty. The Schirmer tear test and tear break-up time values were analyzed statistically using the independent t-test. Results: The mean Schirmer tear test value was 19.07 ± 4.03 mm in both eyes of the patients who had undergone LASIK and upper lid blepharoplasty, and it was 21.07 ± 7.03 mm in the eyes of the control group that only had (CO2) laser upper lid blepharoplasty. The mean tear break-up time value was 21.0 ± 3.55 seconds in the eyes that had LASİK treatment, and it was 21.27 ± 6.79 seconds in the eyes of the control group. There was no statistical difference between the two groups. Conclusion: Because LASIK and blepharoplasty both may cause dry eye symptoms, the possible cumulative effect of these surgeries is a serious consideration. However, dry eye symptoms after LASIK is usually temporary, and we may perform upper lid blepharoplasty to these patients after a certain time interval by closely monitoring their preoperative and postoperative tear function.