Laser Refractive Surgery Research Articles

Surface Refractive Surgery Outcomes in Israeli Combat Pilots

Photorefractive keratectomy (PRK) has long been the method of choice for refractive surgery in pilots, and was FDA approved for U.S. Air Force aviators in 2000. We retrospectively reviewed the medical records of 16 male combat pilots (mean age 25.0 ± 5.5 years) who had undergone bilateral laser refractive surgery with surface ablation (alcohol-assisted PRK: 81.25%, transepithelial-PRK: 18.75%), and who had a mean baseline spherical equivalent (SE) of −2.1 ± 0.7 D in the right eye, and −2.0 ± 0.7 D in the left. The mean follow-up was 8.4 ± 6.6 months. On the last visit, the uncorrected visual acuity (UCVA) had improved from 0.75 ± 0.33 logMar to −0.02 ± 0.03 logMar (p < 0.001), and from 0.72 ± 0.36 logMar to −0.02 ± 0.05 logMar (p < 0.001), for the right and left eyes, respectively. The percentages of participants with a right eye UCVA of at least 0.0, −0.08, and −0.18 logMAR (6/6, 6/5, and 6/4 Snellen in meters) were 100%, 37.5%, and 6.2%, respectively, and for the left eye, 93.7%, 43.75%, and 6.2%, respectively. No complications occurred. This is the first study to assess refractive surgery outcomes in a cohort of Israeli combat pilots. Surface refractive surgery effectively improved UCVA and reduced spectacle reliance for the members of this visually demanding profession.

Laser vision correction in glaucoma; myths and reality

AbstractLaser vision correction has been a well‐established, rapidly developing, safe and widely used technique for refractive error correction. Nevertheless, there are several drawbacks for its use in specific groups of patients. A classic contraindication has been patients with glaucoma. These include those with diagnosed glaucoma and even glaucoma suspects. The main concern remains the evaluation of the intraocular pressure (IOP) after refractive surgery. Newer technology has been helpful in achieving accurate IOP measurements bypassing to an extend the biomechanical changes and thinning of the cornea induced by laser correction. Use of conversion factors may well be applied. Perioperative care of these patients has also been an issue as corticosteroids drops are used, sometimes for a prolonged period of time potentially causing a rise in IOP. Choosing between superficial techniques and LASIK, the former inducing high intraocular pressure during flap dissection is also a question to be answered. In addition, following up those patients to assess possible glaucoma progression can be challenging. Thorough preoperative assessment is mandatory with functional and anatomical testing of the optic nerve. This is especially important so new glaucoma disease is not missed especially in high myopes. Last but not least patients on glaucoma treatment usually have a compromised ocular surface due to the long‐term effects of topical drops. This fact has to be taken into consideration when deciding to proceed or not with laser refractive surgery. In conclusion the glaucoma patient and the glaucoma suspect are challenging patients regarding the potential laser vision correction. Several factors need to be considered in order to make the correct decision. So, myths andreality are analysed that either defeat or support the argument that under the laser vision correction can be safely performed in carefully selected glaucoma eyes.

Comparison of the optical quality vision between real post-LASIK myopic laser surgery and the simulated implantation of a phakic IOL in low myopia

A phakic intraocular lens (PIOL) of − 4.5 D was characterized from its wavefront aberration profile. A preclinical study was conducted using pre- and post-surgery data from four patients that had undergone myopic laser refractive surgery. All these patients would have needed a PIOL of − 4.5 D. Pre-surgery data were used to simulate the effect of a PIOL implantation. Post myopic refractive surgery data were used to calculate the post-LASIK eye model. Modulation transfer function (MTF), point spread function (PSF) and simulation of optotypes vision were obtained and compared. The PIOL did not worsen the optical quality of the eyes evaluated. High order Aberrations were always higher in the post-LASIK eye model. Optics quality trended to be better in PIOL implantation than post-LASIK surgery as pupil size increased.

Интраокулярная коррекция пресбиопии после лазерной кераторефракционной хирургии

Purpose. To present the results of research on modern aspects of intraocular correction of presbyopia after laser keratorefractive surgery. Material and methods. A literature search was performed to identify studies on databases eLibrary, PubMed and Scopus, using the keywords «calculation of multifocal lenses», «multifocal IOLs after refractive surgery», «correction of presbyopia after refractive surgery» (in the eLibrary database), «multifocal IOL» and «multifocal lenses calculation» (in the PubMed and Scopus databases). Thirty related articles were identified. In addition, seven clinical studies in which different groups of patients with a history of refractive surgery underwent correction of presbyopia with multifocal intraocular lenses (IOL) were identified. Results. In this article, there are examples of recent research of information about the intricacies of calculating refractive power of multifocal lenses after refractive surgery. Every year the number of people with a history of laser vision correction is growing, which means that for surgeons arises question about correct calculation of keratometric parameters. To date, the calculation of the value of the optical power of an implantable multifocal IOL after laser refractive surgery is complex and individual for each patient. Most people in this category are still not ready to wear glasses. Recent studies confirm the success of calculating implantable multifocal IOL, and ways to minimize inaccuracies in hitting the refraction of the target lie both in the approach to calculating the optical power of an implanted multifocal lens, and in choosing the optimal method for assessing artificially modified cornea keratometry. Conclusion. The results of clinical studies presented in the review allow us to conclude that the results of calculating the optical power of implanted multifocal IOLs are quite successful and, in turn, clinical and functional results in patients with a history of laser refractive surgery. However, further research is required. Key words: presbyopia correction, multifocal IOL, IOL calculation formulas, laser correction, LASIK, FemtoLASIK, SMILE.

Рибофлавин в профилактике фиброплазии в лазерной рефракционной хирургии роговицы

Purpose: To substantiate the use of riboflavin for the prevention of subepithelial and intrastromal fibroplasia in laser refractive corneal surgery. Material and methods: The work is based on 9-year clinical observations of the results of photorefractive and phototherapeutic corneal surgery with stroma saturation with riboflavin (more than 700 operations). Keratoablation was performed after drip, aerosol or combined saturation of the stroma with 0.1 % or 0.25 % chilled isotonic riboflavin solution. Corneal OCT was performed on RTVue 100 and RTVue XR100 devices. Keratotopographic and densitometric studies were performed on a TMS-5 instrument. These devices were used with two-wavelength optical scanning in the visible green and infrared ranges to assess prophylactic crosslinking by the change in the refractive index of the cornea. Results: During photokeratoablation, corneal stroma layers saturated with riboflavin acted as spectral filters, protecting keratocytes from secondary radiation induced by ablation. This reduced the response of aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome. According to OCT and corneal densitometry data, the formation of a Bowman-like structure on the ablation surface was noted with an increase in optical density in the underlying layers of the stroma. Two-wavelength optical scanning revealed a significant increase in the refractive index. The effect of laser-induced crosslinking and the increase in optical density had a damped character and did not exceed 1/2 of the stroma thickness. These changes in the cornea were a barrier between pro-inflammatory epithelial and stromal cytokines that stimulate the development of subepithelial and intrastromal fibroplasia after photokeratoablation. Conclusion. During photokeratoablation, riboflavin-saturated layers of the corneal stroma protect deeper-lying keratocytes from secondary radiation induced by ablation, and the formation of a Bowman-like structure on the ablation surface with a damping effect of crosslinking in the superficial layers of the stroma prevents the development of fibroplasia. Keywords: Riboflavin, Mitomycin-C, fibroplasia, photoablation, excimer laser corneal surgery, laser-induced crosslinking.

Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19

To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction. The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2). A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication. Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.

Effectiveness of Laser Refractive Surgery to Address Anisometropic Amblyogenic Refractive Error in Children: A Report by the American Academy of Ophthalmology

To review the published literature assessing the safety and effectiveness of laser refractive surgery to treat anisometropic amblyogenic refractive error in children aged ≤ 18 years. A literature search of the PubMed database was conducted in October 2021 with no date limitations and restricted to publications in English. The search yielded 137 articles, 69 of which were reviewed in full text. Eleven articles met the criteria for inclusion and were assigned a level of evidence rating. The 11 included articles were all level III evidence and consisted of 1 case-control study and 10 case series. Six studies used laser-assisted in situ keratomileusis (LASIK), 1 used photorefractive keratectomy (PRK), 1 used refractive lenticule extraction/small incision lenticule extraction, and the rest used a combination of LASIK, PRK, laser epithelial keratomileusis (LASEK), or refractive lenticule extraction/small incision lenticule extraction. Five studies enrolled patients with anisometropic myopia, 2 studies enrolled patients with anisometropic hyperopia, and the remainder were mixed. Although all studies demonstrated an improvement in best-corrected visual acuity (BCVA), the magnitude of improvement varied widely. As study parameters varied, a successful outcome was defined as residual refractive error of 1 diopter (D) or less of the target refraction because this was the most commonly used metric. Successful outcomes ranged between 38% and 87%, with a mean follow-up ranging from 4 months to 7 years. Despite this wide range, all studies demonstrated an improvement in the magnitude of anisometropia. Regression in refractive error occurred more frequently and to a greater degree in myopic eyes and eyes with longer follow-up, and in younger patients. Although one study reported 2 free flaps, most studies reported no serious adverse events. The most common complications were corneal haze and striae. Findings from included studies suggest that laser refractive surgery may address amblyogenic refractive error in children and that it appears to decrease anisometropia. However, the evidence for improvement in amblyopia is unclear and long-term safety data are lacking. Long-term data and well-designed clinical studies that use newer refractive technologies in standardized patient populations would help address the role of refractive surgery in children and its potential impact on amblyopia.

Outcomes and eye care knowledge in rhegmatogenous retinal detachment patients with a history of laser refractive surgery for myopia.

PurposeTo investigate the surgical outcomes and eye care knowledge of patients with rhegmatogenous retinal detachment (RRD) who had previously undergone laser refractive surgery (LRS) for myopia in a myopia epidemic area.MethodsThis retrospective study included patients with primary RRD who underwent surgery and had a history of LRS for myopia at a tertiary medical center. Data were reviewed from medical charts to analyse the surgical outcomes. Questions about eye care knowledge and attitude toward myopia and LRS were obtained.ResultsA total of 774 patients underwent RRD surgery, among whom 341 (44%) had myopia > −3 dioptres, 66% of whom had high myopia. Thirty eyes of 26 patients had a history of LRS for myopia. The mean age of patients with a history of LRS was significantly lower than that of those without a history of LRS (45.7 ± 2.9 years vs. 53.8 ± 1.0, p < 0.001). The mean pre-LRS spherical equivalent was −8.66 ± 0.92 (range: −3.00–−12.00) dioptres. In more than half the patients (n = 15, 57.7%), the interval between LRS and RRD was more than 10 years. The primary retinal reattachment rate was only 60%, whereas the final retinal reattachment rate was 93%. The mean final visual acuity (VA) improved from a 20/286 to 20/105 (p = 0.006). Linear mixed model analysis showed factors of male sex and macular detachment were significant with poor visual outcome (p = 0.046 and 0.008) Eye care knowledge obtained from the 19 RRD patients with history of LRS, 47% of patients (9/19) mistakenly thought that LRS could cure myopia and its complications, and 63% of patients were less willing to visit an ophthalmologist because uncorrected VA improvement after LRS. Eighty-four percent thought that proper knowledge and more education about LRS and myopia for the public are important.ConclusionIn the RRD patients with a history of LRS for myopia, their age was relative younger. Male sex and macular detachment were associated with poor visual outcome. More education with proper knowledge of LRS, myopia and RRD is recommended for the patients to prevent or early detect the occurrence of RRD.

Discussing Questions of Laser Refractive Surgery in Hyperopia: Literature Review and Clinical Experience

Relevance. Modern keratorefractive surgery is a high-tech field of ophthalmology aimed at solving various problems of correcting a wide range of ametropias.Objective: to formulate recommendations for refractive surgeons when planning the correction of hypermetropic refraction using modern keratorefractive surgery.Materials and methods. An analysis of 20 literature sources and a retrospective analysis of outpatient records of 188 patients with hypermetropia who underwent surgery were carried out.Results. The analysis of the literature and our own clinical study allows us to recommend focusing on the final keratometry after keratorefractive surgery, which should not exceed 48 diopters. Among the analyzed charts of patients in compliance with these criteria, the accuracy of hitting the target refraction in the range of ± 1 D was 98.9 %, the regression did not exceed 0.5 D from that obtained 1 month after surgery in 96.8 %, and the loss of 1 line of BCVA was 3.7 % of cases. Among patients with achieved keratometry above 48 diopters, the loss of line 1 BCVA was 13.8 %, line 2 — 2.7 %.Conclusion. Thus, the tactics of correction of hypermetropia by CRC methods require an integrated approach to the assessment of visual functions, drug preparation for surgery, careful implementation of the surgical stages of the intervention, and rational postoperative pharmacological support.

A New Corneal Remodeling Technique with Laser Asymmetric Keratectomy Using Semi-Cylindrical Ablation Pattern Reducing Regional Asymmetry of Corneal Thickness, Case Series

Laser asymmetric keratectomy using semi-cylindrical ablation pattern (LAK-SCAP) is a new customized corneal remodeling method reducing regional asymmetry of corneal thickness, so could be to avoid and treat conventional laser refractive surgery adverse effects. Three eyes (3 patients) had laser epithelial keratomileusis (LASEK) linked LAK-SCAP (L-LAK-SCAP) to reduce regional asymmetry of corneal thickness and correct refractive errors. On Orbscan map, the cones of the corneas were located in the peripheral side, the corneal thickness imbalance was severe due to the sum of 4 direction differences in corneal thickness &gt;80µm.

Refractive Outcomes Following Trifocal Intraocular Lens Implantation in Post-Myopic LASIK and PRK Eyes.

PurposeTo assess refractive outcomes of a trifocal intraocular lens (IOL) in post-myopic laser refractive surgery eyes.MethodsThis was a retrospective chart review of 35 eyes (21 patients), with history of laser refractive surgery, who were implanted with a trifocal IOL. Surgeon’s standard procedure included femtosecond laser (FLACS), digital registration, and intraoperative aberrometry (IA). The primary outcome measure was absolute prediction error. Secondary measures were refractive outcomes, postoperative residual astigmatism (PRA), monocular uncorrected visual acuity at distance (UDVA; 4m), intermediate (UIVA; 60cm), and near (UNVA; 40cm), and monocular best-corrected visual acuity at distance (BCVA; 4m).ResultsAt 3 months postoperatively, 71% and 68% of eyes had absolute prediction error 0.5 D or less with IA and preoperative planning respectively, which was not statistically significant (p > 0.05). The PRA was 0.5 D or less in 91% of eyes with IA and 56% of eyes with preoperative planning. The PRA differences between IA and preoperative planning were statistically significant (p < 0.002). The percentage of eyes 20/20 or better for monocular UCVA, BCVA, UIVA, and UNVA was 29%, 77%, 78%, and 66%, respectively. Absolute prediction error 0.5 D or less was significantly higher in post-LASIK eyes versus post-PRK eyes (p < 0.003), at 85% and 56% of eyes, respectively.ConclusionImplantation with a trifocal IOL can provide acceptable refractive and visual outcomes with minimal residual astigmatism in post-myopic LASIK and PRK eyes.

The Modern Technologies of Refractive Lenticular Extraction: Comparative Analysis of Clinical and Functional Results

Relevance. Today, keratorefractive surgery is a high-tech branch of ophthalmology and provides a predictable, high-precision, stable and safe refractive result in patients with a wide range of refractive disorders.Purpose. To evaluate the clinical and functional results of myopia correction using the technology of fractional lenticular extraction performed using femtosecond VisuMax and LDV Z8 lasers.Materials and methods. Within the framework of this work, 160 patients (160 eyes) with inpatient myopia of medium and high degree were examined and operated, with average keratometry parameters (43.0–45.0 dptr), aged from 18 to 36 years. The follow-up period was 1 month after the operation. The SMILE group was formed: a group of patients who underwent surgery using refractive lenticular extraction technology using a femtosecond VisuMax 500 laser (80 eyes); and the CLEAR group: a group of patients who underwent surgery using refractive lenticular extraction technology using femtosecond laser Femto LDV Z8 (80 eyes).Results and discussion. Operations with SMILE and CLEAR technology were performed in the Department of refractive laser surgery of the FSAU NMIC MNTC “Eye Microsurgery” named after S.N. Fedorov of the Ministry of Health of Russia (Moscow) according to standard protocols. No intraoperative complications were recorded. The analysis of comparable clinical and functional results of myopia correction using the technology of fractional lenticular extraction performed using femtosecond VisuMax and LDV Z8 lasers was carried out.Conclusion. Thus, the analysis of the clinical and functional results of correction of myopia of medium and high degree by the technology of refractive extraction of the lenticle performed using femtosecond lasers VisuMax and LDV Z8 showed their high comparability in terms of efficiency, safety, predictability and stability. A new technology of fractional lenticular extraction using a comprehensive assessment of the condition of the ocular surface at the preoperative stage, which allows to identify and eliminate the changes that have occurred, can be recommended for widespread clinical implementation.

EE341 Hospital Costs Associated with Cataract, Glaucoma, Vitreoretinal, and Laser Refractive Surgeries: A Targeted Literature Review

To identify hospital costs associated with cataract, glaucoma, vitreoretinal, and laser refractive surgeries that can be used to inform economic analyses.

Excimer Laser Corneal Refractive Surgery in the Clinic: A Systematic Review and Meta-analysis.

Objective To systematically evaluate the efficacy, safety, recovery speed, and long-term visual quality of excimer laser corneal refractive surgery and to provide evidence-based medicine for the promotion and use of excimer laser corneal refractive surgery. Methods Randomized controls on excimer laser refractive surgery in Web of science, PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network (CNKI), China VIP Database, Wan Fang Database, and China Biomedical Literature Database (CBM) were searched by the computer. Randomized controlled trial (RCT) data were extracted independently by two researchers, and the risk of bias of each included RCT was assessed according to the Cochrane Handbook 5.1.0 criteria. Meta-analysis of the collected data was performed using RevMan5.4 statistical software. Results In the end, 9 high-quality literatures were included, with a total of 4366 samples, and meta-analysis was used. There was no significant difference in uncorrected visual acuity WMD after excimer laser keratorefractive surgery, but there was a statistically significant difference in WMD in the safety of excimer laser keratorefractive surgery. The results of uncorrected visual acuity (close) indicated the following: Chi2 = 13.56, DF = 5, P = 0.02, and I2 = 100%; the results of uncorrected visual acuity (distance) indicated the following: Chi2 = 34.44, DF =5 (P < 00000), and I2 = 85%; the results of best corrected visual acuity (myopia) indicated the following: Chi2 = 0.65, DF = 3, P = 088 > 0.05, and I2 = 0%; the results of best corrected visual acuity (hyperopia) indicated the following: Chi2 = 1.80, DF = 3, P = 0.61 > 0.05, and I2 = 0%. Conclusion Excimer laser corneal refractive surgery is safe and effective, with faster recovery and better long-term visual acuity treatment effect. However, more studies and follow-up with higher methodological quality and longer intervention time are needed for further validation.

Angle κ Measurement and Its Correlation with Other Ocular Parameters in Normal Population by a New Imaging Modality.

This study obtained normative database for angle κ using Orbscan 3. The average angle κ values were 2.3 ± 1.34° in the whole sample, 2.23 ± 1.36° in myopic eyes, and 3.3 ±1.5° in hyperopic eyes. This is very important to optimize refractive surgery outcomes. The aim of this cross-sectional study was to obtain the value of mean angle κ in normal eyes of patients seeking laser vision correction, by the Orbscan 3. The study was conducted on healthy eyes of people seeking laser refractive surgery. A total of 1815 eyes of 908 candidates were included. These were examined as a part of pre-operative assessment. Orbscan 3 was used to measure angle κ and its XY intercepts, keratometry readings, central corneal thickness, thinnest location, white-to-white diameter, and corneal asphericity of front surface (Qf) and back surface (Qb). The mean ± standard deviation angle κ in all eyes was 2.3 ± 1.34°. The values were 2.23 ± 1.36° in myopic eyes, 3.3 ±1.5° in hyperopic eyes, and 2.9 ±1.6° in emmetropic eyes. Positive correlation was found between angle κ and age, spherical equivalent, subjective sphere, and white-to-white diameter. On the other hand, axial length, average keratometry, central corneal thickness, pupil diameter, and asphericity Q front were negatively correlated with angle κ. The mean ± standard deviation angle κ value measured by the Orbscan 3 was 2.3 ± 1.34°. This could be attributed to different software used, in addition to the relatively high axial length in the studied eyes.

Russian scientific and practical conference with international participation «Laser intraocular and refractive surgery». section «Pediatric ophthalmology»

The article is devoted to reviewing the problems that were discussed in the section Pediatric ophthalmology, organized for the first time within the Russian scientific and practical conference with international participation in Laser intraocular and refractive surgery. The conference was held on December 1011, 2021 in St. Petersburg and organized by the St. Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution with the support of the Society of Ophthalmologists of Russia and North-Western State Medical University named after I.I. Mechnikov. In the pediatric section, 11 reports were made by leading Russian and foreign experts, and the topics were mainly related to the use of laser technologies in ophthalmopediatric practice. The discussion focused on the issues of diagnosis and laser treatment of premature retinopathy and other retinal diseases, modern approaches and results of surgical and contact correction of ametropias (keratoconus, hypermetropia, and progressive myopia) in childhood, and clinical cases of the effectiveness of complex treatment of bilateral retinoblastoma. In conclusion, an overview of new portable technologies for visualization of the state of anterior and posterior eye parts was presented, which is especially important for pediatric ophthalmologists.

Genetic prescreening of a candidate for laser refractive surgery identifies risk for inadequate tissue response: a case report

BackgroundInadequate response to corneal laser refractive surgery, e.g., ectatic corneal diseases, may not be identified by conventional examinations, hence creating therapeutic uncertainty. Herein we demonstrate the application of genetic prescreening to augment preassessment for corneal laser refractive surgery and highlight the ability to prevent the possibility of enrolling a subject at risk for developing ectatic corneal diseases.Case presentationPreoperative tests were performed alongside deoxyribonucleic acid (DNA) sequencing of 75 genes specific to the structure and health of the eye of a 44-year-old Caucasian male candidate for corneal laser refractive surgery. The patient had no medical, family, or psychosocial history, nor symptoms that could lead to suspect any corneal abnormalities, and conventional preoperative tests confirmed that no corneal abnormalities were present. The sequencing results uncovered rare DNA variants within the ADGRV1, PTK2, ZNF469, and KRT15 genes. These variants were considered potential risk factors for inadequate response in the patient post corneal laser refractive surgery. Subsequent reevaluation with three different last-generation corneal tomographers identified in the left eye a “warning” for a deformity of the posterior profile of the cornea.ConclusionsGenetic prescreening identifies potential risk of inadequate response to corneal laser refractive surgery where current technologies in use may lead to a hazardous predictive diagnostic uncertainty.

The preferences and practices regarding refractive surgeries among Saudi Ophthalmology Society members

Abstract Background: Refractive errors are the leading cause of visual impairments in the Kingdom of Saudi Arabia (KSA). Laser refractive eye surgeries are getting huge popularity for correcting these visual impairments in KSA and other gulf countries. Aims: The study assessed the preferences and practices regarding refractive surgeries The preferences and practices regarding refractive surgeries among Saudi ophthalmology society members. Setting and Design: A cross-sectional study was conducted using an online questionnaire among the Saudi Ophthalmology Society members. Methods and Materials: The questionnaire was pilot tested and had 28 items that included sociodemographic details and practices related to refractive eye surgery of participating ophthalmologists. Statistical Analysis: The collected data was analyzed using Pearson's Chi-square test to determine the relationship between categorical variables. Results: Excimer laser platform EX500 (Alcon) was the most commonly used refractive surgery system. There were region-wise differences observed in the type of refractive surgery system where surgeons from Central KSA used AMARIS 1050 RS (SCHWIND) (83.4%) and AMARIS 500 (SCHWIND) (68.4%) comparatively more than other regions (P &lt; 0.05). The majority of the eye surgeons (84.4%) used Pentacam comprehensive eye scanner preoperative screening, and corneal topography was the most commonly used preoperative examination method. Only 9.1% of the surgeons had refractive eye surgery on 75%–100% of their patients, and the most commonly preferred refractive eye surgery (RES) by the surgeons in our study was photorefractive keratectomy. Conclusion: The findings showed that refractive eye surgery trends are changing, and surgeons are shifting to more reliable techniques with fewer postsurgical complications.

CT Assessment of Vascular Density at Limbus Area after Excimer Laser Refractive Surgery in Myopic Patients

Purpose: to assess the indicators of vascular network density at limbus area in patients with myopia and myopic astigmatism before and after excimer laser refractive surgery.Material and methods. A total of 22 patients aged 18 to 37 years with myopia and myopic astigmatism of varying degrees, who previously underwent excimer laser refractive surgery, were examined. Additionally, the vascular network density at limbus area was assessed quantitatively in the preoperative and early postoperative periods using the Nidek RS-3000 AngioScan OCT device and utilizing a module for scanning the anterior segment of the eye.Results. One hour after excimer laser refraction surgery, there was a decrease in vascular network density at limbus area in all four analyzed sectors (upper, lower, temporal, nasal). One day after surgery, there was an increase in this indicator, tending to preoperative values. We were unable to identify the dependence of the degree of vascular network density on the method of corneal flap formation.Conclusion. OCT-angiography makes it possible to assess the indicators of vascular density at limbus area. The estimated indicators varied depending on the time passed after excimer laser refractive surgery.

Restoration of Ocular Surface and Correction of Irregular Corneas Caused by Radial Keratotomy Using EyePrintPRO&lt;sup&gt;TM&lt;/sup&gt; Technology (Case Report)

Background. The number of laser refractive surgeries to treat myopia is growing, and so does the number of complications. One of these complications, leading to progressive loss of vision, is iatrogenic corneal ectasia, which is difficult to correct and often causes work incapacity.Purpose. The purpose of this case report is to demonstrate the possibilities of correcting iatrogenic corneal ectasia with contact lenses utilizing EyePrintPROTM technology.Materials and methods. A clinical case describes the correction of iatrogenic progressive hyperopia with EyePrintPROTM contact lenses in a 52-year-old white male. The patient underwent several refractive surgeries, including Radial Keratotomy, Lasik and Cross-Linking, which resulted in peripheral corneal ectasia and progressive hyperopia. Previously fitted scleral lenses did not provide comfort and caused hyperemia and a foreign body sensation. The patient underwent a complete ophthalmological examination, including special examinations required for calculation of contact lens parameters. The EyePrintPROTM lenses were made by taking an impression of the anterior ocular surface. In addition, an analysis of literature on corneal ectasia available on PubMed, eLibrary, Cyberleninka, Crossref metadata search and other resources was carried out.Results and discussion. Thanks to EyePrintPROTM technology, it was possible to restore visual acuity and comfort: visual acuity increased from 0.16 to 1.0 in OD and from 0.4 to 1.0 in OS. Despite the presence of a pinguecula in the left eye, an adequate fit was achieved as demonstrated by optical coherence tomography (OCT) of the anterior segment of the eye. The discussion section provides a literature-based analysis of the causes leading to the occurrence of iatrogenic ectasia and expands on specifics of treatment of this pathology.Conclusion. Impressionbased contact lenses may be a preferred choice for patients with corneal and scleral irregularities.