post-LASIK Eye Research Articles

Computational simulation of the optical performance of an EDOF intraocular lens in post-LASIK eyes.

To evaluate computationally the optical performance of AcrySof IQ Vivity extended depth-of-focus (EDOF) intraocular lenses (IOLs) in post-laser in situ keratomileusis (LASIK) eyes. Visual Optics and Biophotonics Laboratory, Madrid, Spain. Experimental study. Computer pseudophakic eye models were implemented using reported post-LASIK corneal aberrations (refractive corrections from -7.5 to +4.5 diopters [D]) and virtually implanted with monofocal (AcrySof IQ) or EDOF (AcrySof IQ Vivity) IOLs. Retinal image quality was quantified through visual Strehl (VS). The depth of focus (DOF) was calculated from the through-focus VS curves. Halos were estimated from the light spread in the image of a pinhole. Those quantitative parameters were obtained for 5.0 and 3.0 mm pupil diameters. Simulated virgin eyes showed VS of 0.89/0.99 with monofocal IOLs and 0.74/0.52 with EDOF IOLs for 5.0/3.0 mm pupils at best focus. VS decreased with induced spherical aberration (SA) by 25% and with induced SA + coma by 61% on average (3.0 mm pupils). The DOF was 2.50 D in virgin eyes with EDOF IOLs, 1.66 ± 0.30 and 2.54 ± 0.31 D ( P < .05) on average in post-LASIK eyes for 3.0 mm pupils, monofocal and EDOF IOLs, respectively. Halos were more sensitive to SA induction for 5.0 mm pupils, and induction of positive SA (myopic LASIK) resulted in reduced halos with the EDOF when compared with the monofocal IOLs, by 1.62 (SA) and 1.86 arc min (SA + coma), on average. Computer post-LASIK pseudophakic eye models showed that the DOF was less dependent on the presence of SA and coma with EDOF IOLs and that halos were reduced with EDOF IOLs compared with the monofocal IOL for a range of SA.

Post-LASIK dry eye disease: A comprehensive review of management and current treatment options.

Laser-assisted in situ keratomileusis (LASIK) is a unique corneal stromal laser ablation method that uses an excimer laser to reach beneath corneal dome-shaped tissues. In contrast, surface ablation methods, such as photorefractive keratectomy, include removing epithelium and cutting off the Bowman's layer and the stromal tissue of the anterior corneal surface. Dry eye disease (DED) is the most common complication after LASIK. DED is a typical multi-factor disorder of the tear function and ocular surface that occurs when the eyes fail to produce efficient or adequate volumes of tears to moisturize the eyes. DED influences quality of life and visual perception, as symptoms often interfere with daily activities such as reading, writing, or using video display monitors. Generally, DED brings about discomfort, symptoms of visual disturbance, focal or global tear film instability with possible harm to the ocular surface, the increased osmolarity of the tear film, and subacute inflammation of the ocular surface. Almost all patients develop a degree of dryness in the postoperative period. Detection of preoperative DED and committed examination and treatment in the preoperative period, and continuing treatments postoperatively lead to rapid healing, fewer complications, and improved visual outcomes. To improve patient comfort and surgical outcomes, early treatment is required. Therefore, in this study, we aim to comprehensively review studies on the management and current treatment options for post-LASIK DED.

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.

Efficacy Of Using Cationorm and Systane Eye Drops on Post-Lasik Dry Eye

LASIK is famous procedure for correcting refractive errors. The post-LASIK dry eye is very common. Systane and cationorm eye drops are good for post-LASIK dry eye. Objectives: To evaluate and compare the efficacy of Cationorm and Systane eye drops and assess the effect on asthenopic symptoms post-LASIK dry eye. Methods: A Qusai experimental study design was used. This study included 80 patients with the age of 20 to 35 years. Data were collected at Al Qasim Eye Care. 40 patients were treated with cationorm; and other were treated with Systane on post-LASIK dry eye. After using cationorm and systane eye drops assessment of dry eye was measured by TBUT. Patients came for follow ups at 2nd day, 15th day and 1 month after the LASIK procedure was done. Statistical analysis was done by applying Mann Whitney U test, Friedman’s two-way test, Cochran’s test and chi square test. Results: The mean value and standard deviation of Systane and cationorm eye drop recorded at the baseline were 10.00, ± 0.00, 10.00 ± 0.00, after 2nd day it was 8.08 ± 1.163, 8.48 ± 0.987, after 15 days 8.93 ± 2.485, 12.30 ± 1.713, and 1 month 9.05 ± 2.417, 12.93 ± 1.745 respectively. There was a significant effect on post-LASIK dry eye after using Systane and Cationorm eye drop with p&lt;0. 001.Comparison of systane and Cationorm eye drops with asthenopic symptoms on post-LASIK dry eye showed cationorm is better than the systane eye drops. Conclusions: Cationorm showed more significant results as compared to systane eye drops and cationorm gave faster relief from asthenopic symptoms on post-LASIK dry eye

Dry Eyes Post Laser Assisted in Situ Keratomileusis

Dry eye is one of the most common complications following laser-assisted in situ keratomileusis (LASIK), with nearly all patients experiencing some degree of postoperative dry eye symptoms. Postoperative dry eye affects approximately 50% of patients at 1 week postoperatively, 40% at 1 month, and 20%-40% at 6 months postoperatively. LASIK can cause intracorneal nerve damage, goblet cell damage caused by suction, and can cause changes in the shape of the central cornea. Dry eye diagnosis can be made using a questionnaire to determine the patient's history, examination of tear break up time, staining of the eye surface using fluorescein or lissamine green, and Schirmer's test. This reserech use Literatur Review Method. Post-LASIK dry eye complaints such as irritation, red eyes, foreign body sensation, pain, gritty, and photophobia. Management of post-LASIK dry eyes can be done by giving tear supplements, anti-inflammatory agents, ointments and eye patches, and treatment of meibomian gland dysfunction. Post-LASIK dry eye usually peaks within a few months after surgery, and then improves in most patients 6-12 months after surgery. Although dry eye signs and symptoms are most common in the immediate postoperative period and are usually only temporary, a minority of individuals experience chronic and severe dry eye

Management of Post-LASIK Dry Eye with Intense Pulsed Light in Combination with 0.1% Sodium Hyaluronate and Heated Eye Mask.

IntroductionLaser in situ keratomelieusis (LASIK) is one of the most frequently performed refractive treatments. Dry eye (DE) is common in patients after LASIK and can be bothersome postoperatively. Therapies such as intense pulsed light (IPL), sodium hyaluronate (SH) and heated eye mask (HEM) have been reported to improve signs and symptoms of DE .AimThe purpose of this prospective study was to evaluate and compare the effects of IPL and 0.1% SH (IPL group, 50 eyes) and IPL in combination with 0.1% SH and HEM (IPL + group, 50 eyes) in participants with persistent post-LASIK DE.MethodsThe final analysis included 100 patients (100 eyes) who had LASIK for myopic correction and had been experiencing moderate to severe DE following LASIK for over a year. Participants were randomly assigned to either the IPL group (2 IPL sessions) or IPL + group (2 IPL sessions and daily HEM for 4 weeks), and both groups continued the use of daily 0.1% SH (HYLO-COMOD®) preservative-free eye drops. Non-invasive tear break-up time (NITBUT), tear film lipid layer (TFLL), lower tear meniscus height (LTMH), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and artificial tear usage (ATU) survey were assessed at baseline (BL) and follow-up at 2 (F1) and 4 weeks (F2).ResultsFollowing the treatment protocol, all dry eye (DE) parameters assessed in this study improved significantly (P < 0.05) in both groups at F2 compared with their respective BL measurements. Inter-group comparison at F2 found significant differences in their NITBUT (IPL: 6.06 ± 0.59 vs. IPL +: 6.67 ± 0.86, P < 0.001), TFLL (IPL: 1.90 ± 0.65 vs. IPL +: 1.60 ± 0.64, P = 0.021), LTMH (IPL: 0.186 ± 0.053 vs. 0.204 ± 0.034, P = 0.003), MGQ (IPL: 1.48 ± 0.54 vs. IPL +: 1.26 ± 0.56, P = 0.026), MGEx (IPL: 1.62 ± 0.53 vs. IPL +: 1.44 ± 0.50, P = 0.038) and OSDI (IPL: 32.54 ± 6.85 vs. IPL +: 29.76 ± 4.74, P = 0.001), while CFS score (IPL: 4.02 ± 0.65 vs. IPL +: 3.96 ± 0.73, P = 0.652) and ATU (IPL: 1.88 ± 0.63 vs. IPL +: 1.72 ± 0.50, P = 0.159) showed no significant difference.ConclusionPost-LASIK DE signs and symptoms can be improved by combining therapies such as IPL, HEM and 0.1% SH. Increased TFLL due to a combination of IPL, 0.1% SH and HEM had a greater positive impact on the subjective and objective DE measurements in participants with persistent post-LASIK DE.

Thin-Flap Laser In Situ Keratomileusis-Associated Dry Eye: A Comparative Study Between Femtosecond Laser and Mechanical Microkeratome-Assisted Laser In Situ Keratomileusis.

To assess and compare postlaser in situ keratomileusis (LASIK) dry eye after LASIK with planned thin flaps created by a femtosecond laser (FS) and mechanical microkeratome (MK). Patients were stratified according to the flap creation technique into FS and MK groups with planned 100 μm flap thickness in all eyes. Dry eye parameters including tear film break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and lower tear meniscus height and area (tear meniscus height [TMH] and tear meniscus area [TMA]) were assessed before surgery and at 3 and 6 months after surgery. The study included 102 eyes of 55 patients (52 eyes underwent FS-LASIK/50 eyes underwent MK-LASIK). The preoperative characteristics including age, gender, and spherical equivalents were similar in both groups (P>0.05). The difference in postoperative flap thickness was statistically significant (P<0.05). In each group, dry eye parameters showed a statistically significant worsening (P value<0.001) at 3 months with later significant improvement at 6 months but did not return to baseline. The mean TBUT, Schirmer I, and lower TMH and TMA were statistically higher, and the mean OSDI was statistically lower in FS-LASIK than the MK-LASIK group at both 3 and 6 months (P value<0.001). The depth of ablation had a statistically significant correlation with Schirmer I at 6 months and OSDI at both 3 and 6 months post-LASIK (P<0.05). The use of femtosecond laser technology in performing thin-Flap LASIK eye surgeries has improved the outcome of post-LASIK dry eye when compared with the mechanical microkeratome.

Intense Pulse Light for Treating Post-LASIK Refractory Dry Eye.

Objective: Optimal pulse technology-intense pulse light (OPT-IPL) treatment on patients with post-LASIK refractory dry eye (DE). Background: The prevalence of dry eye disease is common and can lead to ocular discomfort, reduced visual acuity, lowered quality of vision and life. Materials and methods: A prospective study was conducted on 72 eyes of 36 patients (treatment group, n = 42 eyes; control group, n = 30 eyes) who had previously undergone myopic LASIK correction with subsequent refractory DE. All eyes fulfilled the Japanese DE criteria and had not responded to conventional DE treatment. The treatment group underwent two OPT-IPL treatment sessions at 2-week intervals, while the control group received no treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), noninvasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, corneal fluorescein staining, meibum gland (MG), endothelial cell count (ECC), and intraocular pressure (IOP) were assessed at baseline (D0), day-14 (D14) and day-28 (D28) after OPT-IPL treatment. Results: The mean age of treatment group and control group was 30.48 ± 5.16 years (12 females, 57%) and 31.00 ± 4.33 years (8 females, 53%), respectively. Treatment group had clinically and statistically significant improvement in NITBUT and was observed at D14 (p < 0.001) and D28 (p < 0.001). OSDI, TFLL score, and MG quality and expressibility improved significantly (p < 0.05) at D28, whereas BCVA, ECC, and IOP showed no significant changes at D14 and D28 between the groups. Conclusions: Our results suggest that post-LASIK refractory DE is safely treated with OPT-IPL treatment. OPT-IPL treatment reduced the severity of symptoms and improved the overall tear film stability in patients with severe refractory DE post-LASIK surgery. In addition, the frequency of artificial tears usage was significantly less and can be attributed to the reduction in OSDI scores due to improved TFLL and tear film stability.

Topical Cyclosporine in Treatment of Post-LASIK Symptomatic Dry Eye

Purpose: To determine the role of 0.05% topical cyclosporine A (CsA) in treatment of symptomatic dry eye after LASIK (Laser-Assisted in Situ Keratomileusis).&#x0D; Study Design: Interventional Case Series.&#x0D; Place and Duration of Study: Ophthalmology Department, Sir Syed Hospital, Karachi, from July 2018 to Dec. 2019.&#x0D; Methods: Seventy-five patients who underwent LASIK for myopic refractive error and presented with symptomatic dry eye and showed no response to artificial tears therapy after 1 month of LASIK were selected. The patient had ablation zone diameter of 6mm and flap diameter was 8.5mm to 9mm. Cyclisporine A 0.05% ophthalmic preparation was added to treatment regimen and response was observed at 1, 3 and 6 months. OSDI (Ocular Surface Disease Index) scores, Tear film break up time (TBUT), Schirmer's test (ST) values and Best Corrected Visual Acuity (BCVA) were recorded to analyze the treatment response at each visit. The statistical interpretation was done by using SPSS version 21. To interpret the correlation between pre-treatment and 6 month post treatment, Paired sample T test was applied with 95% Confidence Interval; CI and p-value of ≤ 0.05.&#x0D; Results: The mean post-LASIK OSDI score of enrolled patients was 54.25 ± 10.81. After 6 months of treatment mean OSDI score was improved to 21.05 ± 5.13 (p &lt; 0.001). Post-LASIK mean ST value was 5.2 ± 1.2 mm and mean TBUT value was 5.6 ± 1.3 seconds, which changed to 9.8 ± 1.0 mm and 8.9 ± 1.1 seconds respectively. BCVA improved from Log MAR 0.14 ± 0.09 to 0.01 ± 0.03 (p &lt; 0.001).&#x0D; Conclusion: Topical CsA 0.05% was effective in alleviating the symptoms of post-LASIK dry eye.&#x0D; Key Words: LASIK, Dry eye, Ocular Surface Disease Index Score, Cyclosporine A.

Dry Eye After LASIK

Post-LASIK dry eye is the most common postoperative dry eye after ophthalmic surgeries. The clinical signs of post-LASIK dry eye include positive vital staining of the ocular surface, decreased tear breakup time and Schirmer test values, reduced corneal sensitivity, and decreased functional visual acuity. The symptoms and signs usually last for about 1 month after LASIK. A small number of patients continue to experience symptoms more than 1 year postoperatively. It has been suggested that the loss of corneal innervation caused by flap-making is the major cause, affecting the corneal-lacrimal gland, corneal-blinking, and blinking-meibomian gland reflexes, resulting in decreased aqueous and lipid tear secretion and mucin expression. A new type of corneal refractive surgery, SMILE, which has less impact on corneal nerves, induces less postoperative dry eye, supporting the association between corneal denervation and postoperative dry eye. As LASIK enhancement by flap-lifting induces fewer dry eye symptoms and signs than initial surgery, factors other than neurotrophic effects may be involved in the mechanisms of post-LASIK dry eye. Post-LASIK ocular surface pain is a type of postoperative chronic pain and discomfort, and is thought to be a different clinical entity from dry eye, possibly induced by abnormal reinnervation or neural sensitization of peripheral nerves and the central nervous system after LASIK. Treatments include tear supplements, anti-inflammatory agents, meibomian gland dysfunction management, ointment and eye patches, punctal plugs, and autologous serum eye drops. For patients with preoperative dry eye, careful patient selection, and preoperative ocular surface management are mandatory.

Management of post-LASIK dry eye: a multicenter randomized comparison of a new multi-ingredient artificial tear to carboxymethylcellulose.

PurposeTo compare the efficacy and safety of a preservative-free, multi-ingredient formulation of carboxymethylcellulose 0.5%, hyaluronic acid 0.1%, and organic osmolytes (CMC-HA), to preservative-free carboxymethylcellulose 0.5% (CMC) in the management of postoperative signs and symptoms of dry eye following laser-assisted in situ keratomileusis (LASIK).MethodsThis was a double-masked, randomized, parallel-group study conducted in 14 clinical centers in Canada and Australia. Subjects with no more than mild dry eye instilled CMC-HA or CMC for 90 days post-LASIK. Ocular Surface Disease Index© (OSDI; primary efficacy measure), corneal staining, tear break-up time (TBUT), Schirmer’s test, acceptability/tolerability surveys, and visual acuity were assessed at screening and days 2, 10, 30, 60, and 90 post-surgery. Safety analyses included all enrolled.ResultsA total of 148 subjects (CMC-HA, n=75; CMC, n=73) were enrolled and assigned to receive treatment, and 126 subjects completed the study without any protocol violations. Post-LASIK, dry eye signs/symptoms peaked at 10 days. OSDI scores for both groups returned to normal with no differences between treatment groups at day 90 (P=0.775). Corneal staining, Schirmer’s test, TBUT, and survey results were comparable. Higher mean improvements in uncorrected visual acuity were observed in the CMC-HA group at all study visits, reaching statistical significance at day 30 (P=0.013). Both treatments were well tolerated.ConclusionCMC-HA-containing artificial tears relieved post-LASIK ocular dryness as well as CMC alone, and demonstrated incremental benefit in uncorrected vision, with a favorable safety profile. Results support use of CMC-HA eye drops to reduce signs and symptoms of ocular dryness post-LASIK.

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study.

IntroductionLaser in situ keratomelieusis (LASIK) is one of the commonest refractive procedures performed nowadays. The dry eye problem is nearly universal in all patients after LASIK and it can be so annoying that the post-operative patient satisfaction is sometimes precluded. Conventional treatment includes the use of artificial tears. Alternative methods such as punctal plugs and botulinum toxin injection can be used for the management of post-LASIK dry eye. The aim of this study is to compare botulinum toxin injection in the orbicularis muscle to lacrimal punctal plugs for the control of post-LASIK dry eye manifestations.MethodsThis is a prospective study that included 60 patients who had LASIK eye surgery for correction of refractive errors. Patients were randomly assigned to one of three methods of dry eye management; the first method was conventional medical treatment with preservative-free tear substitutes only (group A: 20 patients = 40 eyes); the second method was intraoperative injection of botulinum toxin A (BTA) in the orbicularis muscle below the lower punctum of both eyes (group B: 20 patients = 40 eyes) and the third method was intraoperative insertion of temporary extended duration silicone punctal plugs in the lower punctum of both eyes (group C: 20 patients = 40 eyes).ResultsIn the first follow-up visit after 2 weeks, the two test groups (B, C) showed a statistically significant increase in both tear film break up time (TBUT) and Schirmer test score with a decrease in the OSDI score and daily frequency of lubricants used in comparison to the control group A. These differences were maintained in the next follow-up visit but they became statistically insignificant at the 3rd and 6th post-operative months. Complications were encountered more in the punctal plug patients (60%) than in BTA patients (25%) and this difference was statistically significant.ConclusionThe use of BTA injection to control dry eye symptoms by inducing temporary punctal ectropion is an effective method to improve patient satisfaction after LASIK eye surgery. It has higher level of patient satisfaction and fewer complications in comparison to punctal plugs or topical standard dry eye treatment.

Structural and functional changes in corneal innervation after laser in situ keratomileusis and their relationship with dry eye.

The most likely etiology of post-LASIK dry eye is corneal nerve damage; however, no direct relationship between post-LASIK dry eye symptoms and nerve damage has been established, and limited information is available about the relationship between dry eye signs and corneal reinnervation after LASIK. Tear neuropeptides (SP and CGRP) are important in the maintenance of corneal nerve health, but the impact of LASIK has not yet been studied. This study evaluated changes in nerve morphology, tear neuropeptide, and dry eye, so as to establish the relationship between reinnervation and dry eye and to assess the role of tear neuropeptides in reinnervation post-LASIK. Twenty non-dry eye volunteers who had undergone bilateral myopic-LASIK completed this study. Corneal nerve morphology (density, width, interconnections, and tortuosity), SP and CGRP concentration, and dry eye were monitored over time prior to, 1 day, 1 week, 1, 3, and 6 months post-LASIK. Dry eye symptoms and tear function, except for osmolarity (P = 0.003), remained unchanged post-LASIK. Corneal nerve morphology decreased immediately, and did not return to preoperative levels by 6 months post-LASIK (P < 0.001). Increased tear SP concentration was observed 3 months post-LASIK (P < 0.001). Associations between reinnervation as measured by increased density and lower tear SP (P = 0.03), and between increased density and decreased dry eye symptoms (P = 0.01) were found post-LASIK. An inverse relationship between reinnervation post-LASIK and dry eye symptoms was found, confirming that post-LASIK dry eye is a neuropathic disease. This study is the first to demonstrate an association between tear SP and post-LASIK reinnervation, suggesting that strategies for manipulating neuropeptide concentration to improve reinnervation may improve ocular comfort post-LASIK.

Management of post-LASIK keratectasia with a piggyback contact lens system

Purpose: This case report highlights the clinical challenges involved in the management of a patient with post-LASIK keratectasia and reviews the various treatment options for iatrogenic keratoconus. A single case is presented with a focus on contact lens fitting and management of concurrent ocular surface disease.Although the patient was successfully fitted with large diameter corneal gas permeable lenses, the interference of pre-existing atopic disease combined with post-LASIK dry eye induced a compromised ocular surface requiring a therapeutic bandage piggyback lens. A review of the literature indicates that current screening methods prior to refractive surgery have made improvements for detecting patients at higher risk of serious complications. However, as this case illustrates, previous guidelines were inadequate in identifying incipient keratoconus. Possible treatment options for iatrogenic keratoconus, one of the most severe refractive surgery complications, include contact lenses, intrastromal corneal ring segments, corneal cross linking, and keratoplasty. This case report demonstartes that post- LASIK keratectasia with concurrent ocular surface disease can be successfully managed with the use of a piggyback contact lens system.

Nonarteritic ischemic optic neuropathy secondary to severe ocular hypertension masked by interface fluid in a post-LASIK eye

We report a case of ischemic optic neuropathy arising from elevated intraocular pressure (IOP) masked by interface fluid in a post-laser in situ keratomileusis (LASIK) eye. A 51-year-old man, who had had LASIK 6 years prior to presentation, sustained blunt trauma to the left eye that resulted in a hyphema and ocular hypertension. Elevated IOP resulted in accumulation of fluid in the stromal bed-LASIK flap interface, leading to underestimation of IOP when measured centrally over the flap. After days of unrecognized ocular hypertension, ischemic optic neuropathy developed. To our knowledge, this is the first reported case of ischemic optic neuropathy resulting from underestimated IOP measurements in a post-LASIK patient. It highlights the inaccuracy of IOP measurements in post-LASIK eyes and a vision-threatening potential complication. No author has a financial or proprietary interest in any material or method mentioned.

Application of umbilical cord serum eyedrops after laser epithelial keratomileusis

To investigate the efficacy of umbilical cord serum eyedrops after laser epithelial keratomileusis (LASEK). Sixty patients (120 eyes) with myopia who underwent LASEK were studied. Thirty-two patients (64 eyes) were treated with 20% umbilical cord serum eyedrops in combination with conventional treatment (group A), and 28 patients (56 eyes) received conventional treatment only (group B). Epithelial healing time was analysed. Visual acuity, refraction, haze score (0-4) and tear film and ocular surface parameters were evaluated at 1, 2, 4 and 12 weeks after LASEK. The concentration of transforming growth factor (TGF)-β1 in tears was measured with ELISA at 1 week after LASEK. No significant differences in visual acuity and refraction were found between groups. The mean time to epithelial healing was 3.53 ± 1.19 days in group A and 3.91 ± 1.41 days in group B (p = 0.18). The mean haze scores at 2 and 4 weeks were 0.59 ± 0.80 and 0.31 ± 0.54 in group A and 1.06 ± 0.91 (p = 0.02) and 0.69 ± 0.78 (p = 0.03) in group B. Four and 12 weeks after LASEK, tear film break-up time was longer and keratoepitheliopathy score was lower in group A compared with group B. The mean concentration of TGF-β1 was lower in group A compared with group B (p = 0.01). Application of 20% umbilical cord serum eyedrops in addition to conventional treatment after LASEK can reduce early postoperative corneal haze and improve tear film and ocular surface parameters.

Light-adjustable intraocular lens in post-LASIK and post-traumatic cataract patient

The case illustrates the use of a light-adjustable intraocular lens (IOL) in a patient who had had refractive surgery and developed blunt trauma with resultant flap damage and traumatic cataract. Consistent with early reports of the light adjustable IOL, which show positive results in non-LASIK eyes, this case suggests that the light-adjustable IOL may have similar benefits in the post-LASIK eye and other complex situations.

Punctal plugs for treatment of post-LASIK dry eye

To evaluate the efficacy of punctal plugs for patients with post-LASIK dry eye. A prospective study was conducted on 25 eyes of 18 patients who underwent LASIK. All eyes fulfilled the Japanese dry-eye criteria and had not responded to conventional treatment with artificial tears by 1 month postsurgery. They were randomly divided into a plug and a non-plug group. Punctal plugs were inserted into the superior and inferior puncta in the plug group after the 1-month examination. Uncorrected and best corrected visual acuity (UCVA, BCVA), refraction, functional visual acuity (FVA) after 10 s eye opening (FVA 10), surface regularity index (SRI) after 10 s eye opening (SRI 10), corneal sensitivity, Schirmer test, fluorescein staining (FS), tear break-up time (TBUT), and symptoms were compared between the groups 1 and 3 months postsurgery. Changes in these data from 1 to 3 months were also compared between the groups. The values in SRI 10, FS, and TBUT were significantly better in the plug group at 3 months. Changes in the values of UCVA, FVA 10, FS, TBUT, and symptoms between 1 and 3 months improved significantly in the plug group compared with the non-plug group. Our results suggest that punctal occlusion for both puncta is effective for patients with post-LASIK dry eye that cannot be controlled by artificial tears alone. Punctal plugs can improve not only the symptoms and tear function, but also the quality of vision, for example FVA.

Spontaneous, uncomplicated dissolution of a large cotton fiber in the laser in situ keratomileusis interface

In this article, we report the spontaneous dissolution of a long cotton thread in the laser in situ keratomileusis (LASIK) flap interface. In this observational case report, sequential follow-up of a post-LASIK eye with a long cotton fiber noticed in the LASIK interface was performed. The postoperative course was uneventful, with no evidence of infection, uveitis, or any other complications. The cotton thread underwent spontaneous dissolution. Conservative management of a cotton fiber, not causing any symptoms and noticed after the immediate postoperative follow-up period is over, seems to be a possible alternative to flap relift and intervention.

Allergic complications with laser-assisted in-situ keratomileusis

This article reviews the complications of laser-assisted in-situ keratomileusis (LASIK) associated with ocular allergy. This review will provide guidance and heighten the need for a more comprehensive allergic evaluation before recommending LASIK procedure to patients. The material provided allows enhanced awareness of the potential postsurgical effects on allergic responses of the ocular surface and management thereof. Ocular allergy is often underdiagnosed and has been previously reported only in a handful of peer-reviewed journals as the cause for ocular irritation and visual morbidity in post-LASIK dry eye disease. Diffuse lamellar keratitis is one complication of LASIK that has been linked to atopic individuals. LASIK causes significant inflammation in normal eyes, which is only exacerbated in atopic patients. Atopy may be a contributing factor in patients with patients with post-LASIK dry eye symptoms. Further investigation is required to better understand the complications of LASIK in allergic patients. LASIK surgery has been associated with increased anterior surface inflammatory processes that include dry eye syndromes and ocular allergy. In addition, poorer outcomes of LASIK procedures have been reported in patients with moderate to severe ocular allergies and chronic forms of allergic conjunctivitis, which is an absolute contraindication to the LASIK procedure. We propose preoperative and postoperative management algorithms for allergic LASIK candidates.