Laser In Situ Keratomileusis Research Articles

Influence of the patient’s age on the safety, efficacy, and prediction accuracy of the microkeratome in laser-assisted in situ keratomileusis

The purpose of this retrospective pseudonymised data analysis was to determine whether the patient’s age has an influence on the safety, efficacy, and prediction accuracy of laser in situ keratomileusis (LASIK) treatment of myopic and hyperopic eyes. This study was performed at CARE Vision GmbH (Düsseldorf, Germany) and included two patient cohorts: an older group with patients > 55 years old and a younger group with patients 30–40 years old. Each patient had a single LASIK treatment. The safety, efficacy, and prediction accuracy of the refractive results were analysed. In total, 682 patients were analysed, with 341 patients in each patient group (one eye per patient). There were 570 myopic eyes and 112 hyperopic eyes. In myopic eyes, the efficacy was significantly influenced by the patient’s age but only in myopic eyes (myopic: p ≤ 0.05; hyperopic: p = 0.085), while safety was not significantly influenced by the patient’s age in hyperopic or myopic eyes (p = 0.204). We found that LASIK treatment at an older age (> 55 years) resulted in almost the same safety outcomes as a LASIK treatment at a younger age (30–40 years) but with a lower efficacy; the efficacy correlated with the patient’s age. If the patient was hyperopic, their age did not influence safety or efficacy.

Optical coherence elastography measures the biomechanical properties of the ex vivo porcine cornea after LASIK.

The biomechanical impact of refractive surgery has long been an area of investigation. Changes to the cornea structure cause alterations to its mechanical integrity, but few studies have examined its specific mechanical impact. To quantify how the biomechanical properties of the cornea are altered by laser assisted in situ keratomileusis (LASIK) using optical coherence elastography (OCE) in ex vivo porcine corneas. Three OCE techniques, wave-based air-coupled ultrasound (ACUS) OCE, heartbeat (Hb) OCE, and compression OCE were used to measure the mechanical properties of paired porcine corneas, where one eye of the pair was left untreated, and the fellow eye underwent LASIK. Changes in stiffness as a function of intraocular pressure (IOP) before and after LASIK were measured using each technique. ACUS-OCE showed that corneal stiffness changed as a function of IOP for both the untreated and the treated groups. The elastic wave speed after LASIK was lower than before LASIK. Hb-OCE and compression OCE showed regional changes in corneal strain after LASIK, where the absolute strain difference between the cornea anterior and posterior increased after LASIK. The results of this study suggest that LASIK may soften the cornea and that these changes are largely localized to the region where the surgery was performed.

Advancements in Laser Eye Surgery Through Sectional Study

Background: Laser in situ corneal surgery (LASIK) This technique has been considered as the most widespread and most widely performed refractive intervention in eye surgery in the world, which may show a high satisfaction index among patients after surgery. Objective: This study aimed to evaluate the results of vision quality for patients suffering from myopia and astigmatism after LASIK surgery. Patients and methods: We conducted a cross-sectional study of 74 patients ages 28-54 who suffered from myopia and astigmatism who underwent LASIK surgery. This study extended from February 16, 2022, to September 9, 2023. This study determined the importance of LASIK surgery in improving the visual function of patients in the long term in terms of satisfaction and happiness after surgery, functional improvement, and achieving the expected quality of vision. Results: Our results found that the percentage of males, which included 47 patients, was greater than that of females, which included 27 patients. The data for both surgery time were (22.46 ± 0.8) minutes, and corneal thickness was (498 ± 4.0 microns, recovery time was (3.6 ± 2.4) days. Our outcomes found that the surgery to be a good option, and it was 98%. The main goal was achieved. It was 96%. They were satisfied with the result. It was 95.40%. Happiness after LASIK was 99%. Conclusion: LASIK surgery has shown that the surgical procedure is the most healing, the quickest to perform, and the safest, which increases functional improvement and which contributes significantly.
 Great quality optical resolution. Our results confirm that there is great patient satisfaction with LASIK surgery, which is attributed to the quality of this surgery, which improves visual ability in a safer and more accurate way.

Investigating Post-Operative Refractive Outcomes in Patients Undergoing Cataract Surgery to Assess the Potential Impact of a Concurrent Diagnosis of Dry Eye Disease (DED)

Cataract surgery is one of the most performed surgical procedures in the world. A cataract is defined as opaqueness in the interior of the ocular lens2. The exact etiology of cataracts is multifactorial ranging from environmental conditions to biochemical changes induced by aging3. The Intraocular lens (IOL) power calculation is an essential part of the pre-operative planning for cataract surgery as it determines the specific IOL that should be utilized for a patient. Keratometry measurements are required for this IOL power calculation, however, DED has been shown to cause inaccurate keratometry measurements4,5. We hypothesize that patients with DED undergoing cataract surgery will have a larger deviation from the predicted spherical equivalent (SE) post-operatively.
 Patients who were over the age of 18 and underwent cataract surgery were included. Patients who had a diagnosis of glaucoma, Herpes Simplex Keratitis, punctual plugs, undergone Laser-Assisted in Situ Keratomileusis (LASIK) surgery, Radial Keratometry, or any form of corneal scarring were excluded from this study as they can negatively impact keratometry measurements.
 The DED sample had a statistically significant larger SE deviation from the predicted SE compared to the healthy sample (p=0.037). The DED sample also had a statistically significant larger percentage of patients with an SE deviation of 0.50 D or greater (p=0.002). Finally, the DED had a statistically significant older age than the healthy group (p=0.028).
 The significant difference in age between the healthy sample and the DED sample confirms the significant correlation between age and prevalence of DED the literature has described6. The statistically significant increased post-operative SE deviation from predicted SE within the DED sample can be the result of the increased variability in the tear film associated with DED. This can lead to inaccurate keratometry measurements, thus leading to incorrect IOL power calculations.

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.]

Perceptions of Risk, Benefit and Trust - A Comparative Assessment Between Healthcare Workers and the General Public Towards 3 Medical Technologies.

While there is a substantial amount of research on risk perception, there has been less focus on the way medical technologies are perceived by experts as opposed to lay individuals. We investigated the factors that may influence the risk perception of healthcare workers (HCWs) and the general public regarding 3 distinct medical technologies: magnetic resonance imaging (MRI), laser-assisted in situ keratomileusis (LASIK) and the Covid-19 vaccine. A cross-sectional study conducted in 2021 among 2 populations: HCWs employed at a general public hospital and a sample of outpatients and individuals who are not medical professionals. The participants completed an electronic questionnaire. In total, 739 respondents were included: 197 HCWs (26.7%) and 542 members of the public (73.3%). Most of the respondents (89.4%) reported being vaccinated against Covid-19, 43.8% had previously undergone an MRI but 90% had not undergone LASIK. Overall, all 3 technologies assessed in the study were rated by the respondents as having a high benefit and low risk. HCWs and the public showed statistically significant differences in perceived risk towards MRI and LASIK, as well as in some of the risk perception characteristics of each technology. In contrast, no differences in risk perception towards the Covid-19 vaccine were found between HCWs and the public. Both study populations showed a significant negative correlation between trust in the MoH and the perceived risk towards MRI and the Covid-19 vaccine. Both study populations regarded information provided by medical sources as the most reliable for decision-making. The perceptions and concerns towards medical technologies influence individuals' behavior and acceptance of technologies. They are also essential for risk communication. The study contributes to the understanding of attitudes towards various medical technologies, including risk perception, risk characteristics, trust and sources of information pertaining to each of the technologies, by examining the differences between HCWs and the general public.

Optimization of Ray-Tracing-Guided LASIK Outcomes: A Prospective Comparative Study of ZZ InnovEyes Strategy versus Automated Strategy.

To evaluate the effectiveness of Zhang and Zheng's InnovEyes (ZZ InnovEyes) strategy for optimizing outcomes of ray-tracing-guided laser in situ keratomileusis (LASIK) compared to the standard automated strategy. A total of 38 patients (71 eyes) undergoing therapeutic refractive surgery at Hangzhou MSK Eye Hospital were randomly assigned to the ZZ InnovEyes and automated groups using double-masked randomization. The study assessed visual acuity, refractive outcomes, and higher-order aberrations preoperatively and at 1-day, 2-week, 1-month, and 3-month follow-ups. Statistical analysis was done with Microsoft Excel and SPSS 19.0. The exposure and control groups comprised 36 and 35 eyes, respectively. The ZZ InnovEyes group demonstrated significant advantages in manifest refraction spherical equivalent (MRSE) correction compared to the automated approach group (0.13 ± 0.30 D vs 0.62 ± 0.40 D, p < 0.001), achieving 97.22% uncorrected distance visual acuity (UDVA) of 20/16 or better compared to 85.71% in the automated group at the 3-month follow-up (p = 0.08), and achieving 50.00% UDVA of 20/12.5 or better compared to 28.57% in the automated group at the 3-month follow-up (p = 0.06). Loss lines from preoperative corrected distance visual acuity to postoperative UDVA were lower in the ZZ InnovEyes group (0.00%) than the automated group (8.57%; p = 0.07). Both groups exhibited similar astigmatism corrections and higher-order aberrations. The ZZ InnovEyes strategy, which incorporates manifest and wavefront refraction for ray-tracing-guided LASIK, demonstrated superior MRSE correction and potential advantages in visual acuity outcomes compared to the standard automated strategy. This study highlights the need for ongoing optimization and research in refractive surgery. ChiCTR2300078709.

Factors Predicting Slow Visual Recovery Following Hyperopic LASIK.

To identify factors predicting slow visual recovery following hyperopic laser in situ keratomileusis (LASIK). The study included consecutive patients who underwent hyperopic LASIK between January 2005 and December 2019 at a single medical center. Patients were divided into two groups according to whether they experienced normal recovery of visual acuity (1-week visit) or slow visual recovery (1-month visit). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected distance visual acuity / preoperative corrected distance visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery. Overall, 861 eyes of 861 patients were included. Mean age was 48.0 ± 9.5 years and 55.9% were women. Two hundred forty-nine patients (28.9%) experienced slow visual recovery. Younger age (P = .01), a larger preoperative spherical equivalence (P = .002), and greater maximum ablation depth (P = .002) were predictors of slow visual recovery. In binary logistic regression, female gender (P = .036) and greater spherical equivalence (P = .007) remained significant predictors of slow visual recovery. Female gender and greater preoperative spherical equivalence were associated with slow visual recovery. Patients may be advised accordingly. [J Refract Surg. 2024;40(1):e42-e47.].

A Comprehensive Retrospective Analysis of EVO/EVO+ Implantable Collamer Lens: Evaluating Refractive Outcomes in the Largest Single Center Study of ICL Patients in the United States.

We evaluate visual outcomes in patients with EVO/EVO+™ (posterior chamber phakic intraocular lens with a central port) within approved United States (US) age and refractive range indications. This single-center retrospective study evaluated one-month, single-center postoperative data for 225 eyes meeting inclusion criteria and undergoing EVO/EVO+ implantation from April to October 2022. Data included lens size (mm), lens power (diopters of spherical and cylindrical power), preoperative best corrected visual acuity, preoperative spherical equivalent from manifest refraction, achieved postoperative uncorrected visual acuity, postoperative refraction, intraocular pressure (mmHg), and adverse events. A total of 225 eyes underwent EVO/EVO+ Implantable Collamer Lens (ICL) implantation from April to October 2022, with 51.5% receiving toric lenses. The most common ICL size was 12.6mm (56.4%), followed by 13.2mm (27.5%), 12.1mm (15.1%), and 13.7mm (0.9%). Among patients with preoperative BCVA of 20/20 or better (149 eyes), 95.2% achieved postoperative UCVA of 20/20 or better, and 99.3% achieved UCVA of 20/25 or better at postoperative month one. About 75% of eyes were within a spherical equivalent target of ±0.50 D and 94% within ±1.00 D. Toric ICLs were implanted in 116 eyes (51.8%). Of these, anticipated residual cylinder >1 diopter was seen in 21 eyes (18.1%) resulting in three rotations, three explants, and three laser vision correction (LVC) enhancements. The postoperative adjustment rate (including rotations, exchanges, and LVC enhancement) was minimal (4.8%). Incidence of major adverse events was 0%. Our study, the largest US single-center analysis of EVO/EVO+ ICL implantation, demonstrates strong early results and infrequent adverse events, supporting ICL safety and effectiveness. High predictability and favorable visual outcomes, including 20/20 or better, highlight the reliability of this technology. Despite study limitations, our findings underscore this technology's effectiveness. Future research should refine patient criteria and assess long-term outcomes in this evolving landscape.

Pilocarpine HCl 1.25% for treatment of presbyopia after laser vision correction: pooled analysis of two phase 3 randomized trials (GEMINI 1 and 2).

To evaluate the efficacy of topical pilocarpine HCl 1.25% (Pilo) in treating presbyopia in individuals with or without a history of laser vision correction (laser-assisted in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]). Multiple clinical sites. Pooled analysis of 2 identically designed prospective, randomized, vehicle-controlled studies (GEMINI 1 and 2). Adults aged 40 to 55 years with presbyopia received once-daily Pilo or vehicle bilaterally for 30 days. Responder rates for ≥3-line improvement in mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) were determined on day 30. Among participants with a history of LASIK/PRK (n = 39 in the Pilo group, n = 41 in the vehicle group), responder rates for ≥3-line improvement in DCNVA on day 30 at hours 0.25, 0.5, 1, 3, 6, 8, and 10, respectively, were 16.7%, 38.9%, 41.7%, 37.8%, 16.2%, 13.9%, and 8.3% with Pilo and 0.0%, 2.6%, 10.5%, 5.1%, 7.7%, 2.6%, and 0.0% with vehicle. Responder rates in the LASIK/PRK subgroup were significantly higher with Pilo than vehicle at hours 0.25 ( P = .0087), 0.5 ( P = .0001), 1 ( P = .0022), and 3 ( P = .0005). In contrast, there were no significant differences in responder rates between Pilo-treated participants with and without LASIK/PRK. Among non-LASIK/PRK participants in the Pilo group (n = 336), responder rates for ≥3-line improvement in DCNVA on day 30 at hours 0.25, 0.5, 1, 3, 6, 8, and 10, respectively, were 16.8%, 32.7%, 39.0%, 28.0%, 17.4%, 12.6%, and 10.5%. Pilo treatment effectively and similarly improved DCNVA in presbyopes with or without a history of laser vision correction.

Performance of IOL calculation formulas that use measured posterior corneal power in eyes following myopic laser vision correction.

To compare the predictive accuracy of the biometer-embedded Barrett True-K TK and new total corneal power methods of intraocular lens (IOL) power calculation in eyes with prior laser vision correction (LVC) for myopia. Academic clinical practice. Retrospective case series. IOL power formulas were assessed using measurements from a swept-source optical coherence biometer. Refractive prediction errors were calculated for the Barrett True-K TK, EVO 2.0, Pearl-DGS, and HofferQST, which use both anterior and posterior corneal curvature measurements. These were compared with the Shammas, Haigis-L, Barrett True-K No History (NH), optical coherence tomography, and 4-formula average (AVG-4) on the ASCRS postrefractive calculator, and to the Holladay 1 and 2 with non linear axial length regressions (H1- and H2-NLR). The study comprised 85 eyes from 85 patients. Only the Barrett True-K TK and EVO 2.0 had mean numerical errors that were not significantly different from 0. The EVO 2.0, Barrett True-K TK, Pearl-DGS, AVG-4, H2-NLR, and Barrett True-K NH were selected for further pairwise analysis. The Barrett True-K TK and EVO 2.0 demonstrated smaller root-mean-square absolute error compared with the Pearl-DGS, and the Barrett True-K TK also had a smaller mean absolute error than the Pearl-DGS. The Barrett True-K TK and EVO 2.0 formulas had comparable performance to existing formulas in eyes with prior myopic LVC.

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.

Assessing the level of satisfaction with anesthesia among patients who underwent ophthalmology surgery at ambulatory surgical centers; a cross-sectional observational survey-based study

Objective: This study aimed to assess the level of satisfaction towards anesthesia and its related factors among patients who underwent ophthalmology surgery at ambulatory surgical centers (ASCs). Methods: A cross-sectional observational study was conducted in Western Saudi Arabia in October 2023. A validated questionnaire comprised of socio-demographic characteristics and level of satisfaction with anesthesia was used. Results: The study included 686 participants who underwent ophthalmology surgery. Majority were aged 18-40 years (61.4%), Saudi (94.2%), married (47.4%), unemployed (52.9%), and with a university degree (70.1%). Of them, 31% underwent laser vision correction surgery, 14% underwent cataract surgery, 61.4% underwent surgery with local anesthesia, and 38.6% underwent total anesthesia. The total satisfaction score for all the study participants ranged from 15 to 39 out of 39, with a median (IQR) of 34 (24). Being married (p=0.005), not feeling pain during or after the surgery (p

Ocular surface disturbances after laser refractive surgery

Most patients undergoing laser refractive surgery demonstrate transient and mild symptoms of dry eye disease. The article presents the main mechanisms involved in dry eye disease after the most frequently performed laser vision correction methods. Differences in the occurrence of dry eye disease between flap, surface procedures and minimally invasive lenticule extraction were highlighted.

Clinical Case of Postoperative Infectious Crystalline Keratopathy

Infectious crystalline keratopathy (ICK) is a sluggish infectious inflammation of the cornea. Described for the first time in 1983, it is currently a rare pathology. Most often, the etiological factor is gram-positive bacterial flora, which causes the typical formation of “crystals” in the anterior layers of the corneal stroma. Less often, infiltrates are formed by gram-negative bacterial flora, which is characterized by its location mainly in the posterior parts of the stroma. Atypical etiological agents include Mycobacteria and fungal microflora. The main predisposing factors for the development of ICK are drug immunosuppression and previous corneal surgery (through keratoplasty, layered keratoplasty, laser keratomilesis in situ — LASIK). This article describes an atypical clinical case of monolateral postoperative infectious crystalline keratopathy. The patient’s medical history includes bilateral LASIK surgery followed by drug therapy for postoperative keratitis of the right eye for 1 month.

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.

Reasons for declining corneal refractive laser correction for refractive candidates in Southern India.

To analyze the reasons for declining corneal refractive laser correction procedures in patients presenting to tertiary eye care centers in Tamil Nadu, Southern India, and review the literature. Retrospective case records of subjects presenting from January 2019 to December 2021 for refractive surgery workup were analyzed. Demographic details and refractive parameters of patients rejected for corneal refractive laser corrections (CRLC) were documented and reviewed. A total of 2358 patients presented for refractive surgery evaluation during the study period, and out of them, 395 patients (16.8%) were not considered ideal candidates for undergoing CRLC. The common reasons for rejecting the patients were unfit topography (n = 110, 27.8%), unstable refraction over a one-year duration (n = 9, 2.27%), low corneal thickness (n = 85, 21.5%), keratoconus (n = 5, 12.9%), and other ocular and systemic disorders (n = 48, 12.1%). There was a marked change in magnitude and rationalization for not performing either laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy in our study. The reasons are unfit topography, keratoconus, and systemic disorders, which were diagnosed during pre-LASIK screening workup, being the most common cause for rejecting patients for corneal refractive corrections.

Accuracy of intraoperative aberrometry versus modern preoperative methods in post-myopic laser vision correction eyes undergoing cataract surgery with capsular tension ring placement

PurposeTo assess the accuracy of intraoperative wavefront aberrometry (IWA) versus modern intraocular lens formulas in post-myopic laser vision correction (LVC) patients undergoing cataract surgery with capsular tension ring placement.MethodsThis is a retrospective chart review conducted at an academic outpatient center. All post-myopic LVC eyes undergoing cataract surgery with IWA from a single surgeon from 05/2017 to 12/2019 were included. All patients received a capsular tension ring (CTR). Mean numerical error (MNE), median numerical error (MedNE), and percentages of prediction error within 0.50D, 0.75D, and 1.00D were calculated for the above formulas.ResultsTwenty-seven post-myopic LVC eyes from 18 patients were included. In post-myopic LVC, MNE with Optiwave Refractive Analysis (ORA), Barrett True K (BTK), Haigis, Haigis-L, Shammas, SRK/T, Hill-RBF v3.0, and W-K AL-adjusted Holladay 1 were + 0.224, − 0.094, + 0.193, − 0.231, − 0.372, + 1.013, + 0.860, and + 0.630 (F = 8.49, p < 0.001). MedNE were + 0.125, − 0.145, + 0.175, + 0.333, + 0.333, + 1.100, + 0.880, and + 0.765 (F = 7.89, p < 0.001), respectively. BTK provided improved accuracy in both MNE (p < 0.001) and MedNE (p = .033) when compared to ORA in pairwise analysis. If the ORA vs. BTK-suggested IOL power were routinely selected, 30% and 15% of eyes would have projected hyperopic outcomes, respectively (p = 0.09).ConclusionsOur study suggests that in post-myopic LVC eyes undergoing cataract surgery with CTRs, BTK performed more accurately than ORA with regard to accuracy and yielded a lower percentage of eyes with hyperopic outcomes. Haigis, Haigis-L, and Shammas yielded similar results to ORA with regard to accuracy and percentage of eyes with hyperopic outcomes. On average, Shammas and Haigis-L suggested IOLs that would yield outcomes more myopic than expected when compared to BTK.

The main aspects of the diagnosis of dry eye syndrome in refractive patients

A comprehensive assessment of the condition of the ocular surface was carried out in patients planning keratorefractive surgery using FemtoLASIK technology (30 eyes) and refractive lenticular extraction technology (30 eyes) with initially no subjective signs of dry eye syndrome. A comprehensive diagnostic approach to assessing the condition of the ocular surface, based on subjective and objective data, forms a holistic view of the homeostasis of the ocular surface in refractive profile patients, which will subsequently determine the choice of optimal laser vision correction technology, the tactics of patient administration and the featuress course of the postoperative period.

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.