Outcome of second surgery in LASIK cases aborted due to flap complications

PURPOSE: To describe the technique and timing of second refractive surgery after aborted laser in situ keratomileusis (LASIK) due to intraoperative flap complication and determine the final visual outcome. SETTING: Outpatient ambulatory laser vision correction centers. METHODS: This retrospective noncomparative case series included 16 patients (16 eyes) who had a second refractive surgery after initial LASIK surgery was aborted because of a flap complication. Charts were reviewed with attention to initial preoperative data, intraoperative details of the aborted LASIK, postoperative examination, possible causes of the flap complication, timing and technique of second refractive surgery, and final visual outcome. RESULTS: Causes of the aborted LASIK were identified in 13 of 16 eyes (81.2%) and included eye squeezing (5 eyes), loss of suction or machine failure (5 eyes), steep corneas (2 eyes), and learning curve of the surgeon (1 eye). The mean time until the second surgery was 135 days (range 49 to 372 days). Repeat flaps were created deeper and larger than the initially attempted flaps when possible. No patient had a final uncorrected visual acuity (UCVA) worse than 20/30 after the second surgery. Two eyes (12.5%) lost 1 line of best spectacle-corrected visual acuity. CONCLUSION: A planned delayed reoperation after sufficient corneal healing following an intraoperative flap complication can result in satisfactory recovery of UCVA.     

Microkeratome complications of laser in situ keratomileusis

PURPOSE: To evaluate the incidence, types, and outcome of microkeratome complications that occur during laser in situ keratomileusis (LASIK). DESIGN: Retrospective, noncomparative, case series. PARTICIPANTS: Three thousand nine hundred ninety-eight eyes that underwent primary LASIK by four surgeons between November 1996 and August 1998 at a university-based refractive center. METHODS: All cases with significant microkeratome complications leading to abandonment of the LASIK procedure were identified and reviewed. MAIN OUTCOME MEASURES: Incidence of complications, change in best corrected visual acuity (BCVA), change in refractive error, and types of complication. RESULTS: There were 27 complications leading to abandonment of the LASIK procedure of 3998 eyes. The overall rate of microkeratome complication was 1 in 150 (0.68%), but it was 1 in 77 (1.3%) in the surgeons' first 1000 eyes, decreasing to 1 in 250 (0.4%) in the last 1000 eyes. Of the 24 planned bilateral cases, 15 complications (63%) happened on the first operated eye. Twenty-six of 27 eyes (96%) recovered to within one line of preoperative BCVA, and one eye lost two lines. At last examination before any repeat refractive procedures, spherical equivalent manifest refraction returned to within 1 diopter (D) of its preoperative value in 18 of 19 eyes (95%), and astigmatism in 16 of 19 eyes (84%) returned to within 1 D of its preoperative value. Sixteen of 27 eyes (59%) had repeat LASIK. Two eyes had complications at repeat LASIK, one of which led to abandonment of the LASIK procedure for a second time. CONCLUSIONS: There is a significant learning curve in the use of the microkeratome. If ablation is not performed, flap complications rarely lead to significant visual loss and generally do not result in a change in refractive error.     

Incidence and outcomes of lasik with diffuse lamellar keratitis treated with topical and oral corticosteroids

PURPOSE: To analyze the incidence and clinical outcomes of patients developing diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) treated with topical and oral corticosteroids. SETTING: Oregon Eye Institute, Eugene, Oregon, USA. METHODS: A retrospective analysis of the last consecutive 1000 LASIK cases was performed. Eyes developing stage 3 DLK or at risk for progressing to stage 3 were treated with a combination of high-dose prednisolone acetate 1% and oral prednisone and evaluated for corneal scarring, loss of best spectacle-corrected visual acuity (BSCVA), and deviation from the intended refractive outcome. RESULTS: Diffuse lamellar keratitis developed in 40 eyes (4%). It progressed to stage 3 in 7 eyes (17%). Oral and topical steroids were used in 22 eyes (55%). The mean variation from the desired refractive outcome was 0.14 diopter +/- 0.53 (SD). There were no instances of corneal scarring or permanent loss of BSCVA. No eye had interface irrigation. CONCLUSIONS: Treatment of severe DLK with high-dose topical and oral corticosteroids produced excellent results without flap lifting and interface irrigation.     

Lower intraoperative flap complication rate with the Hansatome microkeratome compared to the Automated Corneal Shaper

PURPOSE: The purpose of this study was to retrospectively compare the incidence of intraoperative flap complications, such as partial flaps, donut-shaped flaps, central corneal cuts, and complete caps with the Hansatome and Automated Corneal Shaper (ACS) microkeratomes. METHODS: All laser in situ keratomileusis (LASIK) procedures performed by a single surgeon with the Hansatome or Automated Corneal Shaper in which intraocular pressure was verified with a pneumotonometer were reviewed. RESULTS: A total of 90 eyes had LASIK with the ACS microkeratome. Six of the ACS eyes (6.7%) had intraoperative flap complications (4 partial flaps, 1 donut-shaped flap, 0 central corneal cuts, 1 complete cap). Partial flaps and donut-shaped flaps were replaced without laser application and the procedure repeated 2 to 3 months later. Two of these eyes lost 2 lines and one lost 1 line of spectacle-corrected visual acuity at 6 months after repeat LASIK. The eye with the donut-shaped flap was treated with transepithelial photorefractive keratectomy (PRK) and had no change in spectacle-corrected visual acuity at 6 months after PRK. The eye with the complete cap had no change in spectacle-corrected visual acuity after laser ablation. Five hundred ninety-eight (598) eyes had LASIK with the Hansatome microkeratome. Two of the Hansatome eyes (0.3%) had a flap complication (1 partial flap and 1 donut-shaped flap). The first eye retained spectacle-corrected visual acuity at 6 months after repeat LASIK. The second eye had transepithelial PRK to eliminate the donut shaped flap with no loss of spectacle-corrected visual acuity at 6 months after surgery. The difference in flap complications between the two procedures was statistically significant (P < .01). There were no flap displacements following surgery in either group. CONCLUSION: Intraoperative flap complications are less likely to occur with the Hansatome microkeratome than with the ACS microkeratome.     

Long-term refractive results of myopic LASIK complicated with intraoperative epithelial defects

PURPOSE: To evaluate the long-term refractive results of LASIK for myopia complicated with intraoperative epithelial defects. METHODS: Twenty-six eyes with epithelial defects on the LASIK flap were compared with the contralateral eye that had no intraoperative complications. Pre- and postoperative data were compared between the two groups including 3-, 6- and 12-month postoperative spherical equivalent refraction, amount of undercorrection, and complications. RESULTS: Eyes with intraoperative epithelial defects showed more undercorrection at 3 and 6 months postoperatively (P < .05). No statistically significant difference was noted at 12 months. Twenty (76%) eyes in the epithelial defect group lost best spectacle-corrected visual acuity (BSCVA) at 3 months postoperatively compared with 2 (7%) eyes in the control group. By 1 year, however, only 2 (7%) eyes in the epithelial defect group and no eyes in the control group lost > 1 line of BSCVA. Diffuse lamellar keratitis was observed in 15 (58%) of 26 eyes with epithelial defects and these eyes had more undercorrections at 6 and 12 months (P < .05) and higher corneal irregularity index at 6 and 12 months compared with controls (P < .05). Eyes with small epithelial defects (> 1 mm2 to < 3 mm2) had more undercorrections at 6 months (-1.08 +/- 0.76 diopters [D]) compared with the control group (-0.46 +/- 0.87 D). Eyes with centrally located epithelial defects had more undercorrections and increased corneal irregularity index compared with controls (P < .05). CONCLUSIONS: Intraoperative epithelial defects after LASIK should be considered a severe complication that may result in diffuse lamellar keratitis, induce loss of BSCVA, prolong recovery of visual acuity, and induce undercorrection.     

Management of corneal ectasia after laser in situ keratomileusis with INTACS

PURPOSE: To evaluate the safety and efficacy of intrastromal corneal ring segments (ICRS, INTACS, Keravision) for the correction of corneal ectasia after laser in situ keratomileusis (LASIK). METHODS: In this prospective, noncomparative case series, INTACS were implanted in three eyes (two patients) that were ectatic after LASIK. Mean follow-up was 8.7 months (range, 8 to 10 mo). RESULTS: No intraoperative complications occurred. After INTACS implantation, uncorrected visual acuity ranged from 20/20 to 20/25 at 6 months and remained stable until 9 months. Mean postoperative spherical equivalent refraction was 0.50 D at 1 month and no significant changes appeared up to 9 months after INTACS implantation. After INTACS implantation, no eye lost any lines of Snellen spectacle-corrected visual acuity and two eyes gained from one to two lines. There was an increase in topographical regularity in all three eyes. CONCLUSION: Implantation of INTACS in eyes with corneal ectasia after LASIK resulted in good refractive outcome, absence of complications, and improvement in visual acuity.     

Intacs after laser in situ keratomileusis and photorefractive keratectomy

PURPOSE: To evaluate the efficacy of intrastromal corneal ring segments (Intacs, Addition Technology) for the correction of residual myopia after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). METHODS: In this prospective noncomparative case series, Intacs were implanted in 5 eyes (4 patients) that developed myopic regression after LASIK or PRK. Intacs were implanted a minimum of 11 months after the laser procedure. The technique was identical to the standard procedure for myopic unoperated eyes. The Intacs thickness was based on the amount of residual myopia. RESULTS: Postoperative results revealed a reduction in the residual myopia and the mean K-reading. No eye lost best corrected Snellen visual acuity. No intraoperative or postoperative complications occurred. CONCLUSIONS: Implantation of Intacs in eyes with myopic regression after LASIK and PRK resulted in a good refractive outcome and an improvement in uncorrected visual acuity.     

LASIK术后即刻对角膜瓣的观察

目的：LASIK术后即刻检测角膜瓣并发症。

方法：回顾性病例研究。收集2010-01/2012-10就诊于我院行LASIK手术的2 040例4 080眼患者, LASIK术后30min之内,在裂隙灯下对角膜瓣进行常规检查,记录患者术后角膜瓣对位不良、角膜瓣皱褶、角膜瓣层间异物残留情况,针对上述并发症采取有效的治疗和控制措施。

结果：最常见的并发症为角膜瓣对位不良102眼(2.5%),角膜瓣皱褶95眼(2.33%),角膜瓣层间异物残留105眼(2.57%)等。无失败病例,无严重影响术后视觉质量的角膜瓣相关并发症。

结论：仔细的术后即刻检查对这些并发症的处理是一种有效的方法,从而促进LASIK术后并发症的诊治。     

LASIK complications: etiology, management, and prevention

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By examining the etiology, management, and prevention of these complications, the refractive surgeon may be able to improve visual outcomes and prevent vision-threatening problems. Reporting outcomes and mishaps of LASIK surgery will help refine our approach to the management of emerging complications.     

Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy

PURPOSE: To evaluate the results of the prophylactic use of mitomycin-C to inhibit haze formation after excimer laser photorefractive keratectomy (PRK) for medium and high myopia in eyes that were not good candidates for laser in situ keratomileusis (LASIK). SETTING: Carones Ophthalmology Center, Milan, Italy. METHODS: This prospective randomized masked study comprised 60 consecutive eyes (60 patients). The inclusion criteria were a spherical equivalent correction between -6.00 and -10.00 diopters (D) and inadequate corneal thickness to allow a LASIK procedure with a residual stromal thickness of more than 250 microm. The eyes were divided into 2 groups according to the randomization protocol. After PRK, the study group eyes were treated with a single intraoperative dose of mitomycin-C (0.2 mg/mL), applied topically with a soaked microsponge placed over the ablated area and maintained for 2 minutes. The control eyes did not receive this treatment. Refraction, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and slitlamp evidence of corneal opacity (haze) or other visible complications were evaluated. RESULTS: No toxic or side effects were encountered postoperatively. No study group eye had a haze rate higher than 1 during the 6-month follow-up; 19 eyes (63%) in the control group did (P =.01). At 6 months, the between-group difference in the refractive outcome was statistically significant (P =.05), with 26 study group eyes (87%) and 14 control eyes (47%) within +/-0.50 D of the attempted correction. No study group eye had a BCVA loss during the follow-up; 7 control eyes had lost 1 to 3 lines at 6 months (P =.0006). CONCLUSIONS: The prophylactic use of a diluted mitomycin-C 0.02% solution applied intraoperatively in a single dose after PRK produced lower haze rates, better UCVA and BCVA results, and more accurate refractive outcomes than those achieved in the control group.     

Incidence of vitreoretinal pathologic conditions within 24 months after laser in situ keratomileusis

OBJECTIVE: To report for the first time a case series of vitreoretinal pathologic conditions after laser in situ keratomileusis (LASIK) and to determine its incidence. DESIGN: Case series. PARTICIPANTS: Five refractive surgeons and 29,916 eyes that underwent surgical correction of ametropia (83.2% were myopic) ranging from -0.75 to -29.00 diopters (D; mean: -6.19 D) and from +1.00 to +6.00 D (mean: +3.23 D) participated in this retrospective study. MAIN OUTCOME MEASURES: Vitreoretinal complications after LASIK. RESULTS: The clinical findings of 20 eyes (17 patients) with LASIK-related vitreoretinal pathologic conditions are presented. Fourteen eyes experienced rhegmatogenous retinal detachments (RDs). Two eyes experienced corneoscleral perforations with the surgical microkeratome when a corneal flap was being performed (one experienced a vitreous hemorrhage and the other later experienced an RD). In four eyes, retinal tears without RDs were found. In one eye, a juxtafoveal choroidal neovascular membrane (CNVM) developed. Retinal tears were treated with argon laser retinopexy or cryotherapy. Corneoscleral perforations were sutured, and the RD was managed with vitrectomy. The remaining RDs were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The CNVM was surgically removed. The incidence of vitreoretinal pathologic conditions determined in our study was 0.06%. CONCLUSIONS: Serious complications after LASIK are infrequent. Vitreoretinal pathologic conditions, if managed promptly, will still result in good vision. It is very important to inform patients that LASIK only corrects the refractive aspect of myopia. Complications of the myopic eye will persist.     

Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy for the correction of high myopia

PURPOSE: To compare the visual and refractive outcomes of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) in the treatment of high myopia. SETTING: Institute of Vision Research, Department of Ophthalmology, College of Medicine, Yonsei University, and Balgeunsesang Ophthalmology Clinic, Seoul, South Korea. METHODS: Four hundred seventy eyes of 240 patients with manifest refraction spherical components greater than -6.00 diopters (D) were assigned to 2 groups: 324 eyes (167 patients) were treated with LASIK and 146 eyes (73 patients), with LASEK. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), remaining refractive error, corneal haze, and complications were followed in both groups for 12 months. RESULTS: At 12 months, the mean spherical equivalent (SE) was within +/-0.50 D of emmetropia in 205 eyes (63.3%) in the LASIK group and 81 eyes (55.5%) in the LASEK group and within +/-1.00 D in 261 eyes (80.6%) and 104 eyes (71.2%), respectively. The UCVA was 20/25 or better in 269 LASIK eyes (83.0%) and 111 LASEK eyes (76.0%). There was more than a 1-line loss of BSCVA in 4 LASIK eyes (1.2%) and 21 LASEK eyes (14.3%). The between-group differences in SE, magnitude of cylinder, UCVA, and haze were statistically significant (P<.05). CONCLUSIONS: Both LASIK and LASEK were safe and effectively treated eyes with high myopia. Laser in situ keratomileusis provided superior results in visual predictability and corneal opacity.     

Flap complications associated with lamellar refractive surgery

PURPOSE: Corneal lamellar refractive surgery for myopia reduces the risk of corneal haze but adds to the risk of flap complications. We retrospectively determined the incidence of flap complications in the initial series of eyes undergoing lamellar refractive surgery by one surgeon. We assessed the incidence of flap complications overall, the trend in these complications during the surgeon's learning curve, and the impact of the complications on best spectacle-corrected visual acuity. METHODS: Charts of the first 1,019 eyes that underwent myopic keratomileusis in situ or laser in situ keratomileusis were reviewed for flap complications and visual outcome. RESULTS: Of the 1,019 eyes, 490 eyes underwent myopic keratomileusis in situ, and 529 eyes underwent laser in situ keratomileusis. Eighty-eight (8.6%) of 1,019 eyes had flap-related complications. Six eyes had two complications. Intraoperative complications included irregular keratectomy in nine eyes (0.9%), incomplete keratectomy in three eyes (0.3%), and a free cap in 10 eyes (1.0%). The incidence of intraoperative complications was six (6.0%) in the first 100 consecutive eyes, 14 (2.3%) in the next 600 consecutive eyes (P = .04, chi-square test), and one (0.3%) in the last 300 eyes (P = .03, chi-square test). Postoperative complications included displaced flaps that required repositioning in 20 eyes (2.0%), folds in the flap that required repositioning in 11 eyes (1.1%), diffuse lamellar keratitis in 18 eyes (1.8%), infectious keratitis in one eye (0.1%), and epithelial ingrowth that required removal in 22 eyes (2.2%). The incidence of flap displacement and folds in 200 eyes in which we irrigated under the flap and allowed it to settle without further manipulation averaged 8.5%, whereas the incidence in other groups of 100 consecutive eyes averaged 0.8% (P < .00001, chi-square test). The incidence of diffuse lamellar keratitis was 0.2% in eyes that had undergone myopic keratomileusis in situ and 3.2% in eyes treated by laser in situ keratomileusis (P = .0003, chi-square test). No eye lost 2 or more lines of best spectacle-corrected visual acuity because of flap complications. CONCLUSION: Flap complications after lamellar refractive surgery are relatively common but rarely lead to a permanent decrease in visual acuity. Physician experience with the microkeratome and with the handling of the corneal flap decreases the incidence of flap complications.     

飞秒激光制作角膜瓣的激光角膜原位磨镶术的临床观察

目的探讨应用飞秒激光制作角膜瓣的准分子激光角膜原位磨镶术（LASIK）的安全性、有效性和可预测性。方法应用VISX Stars 4准分子激光设备和Intralase飞秒激光仪,对屈光不正512例（1016眼）施行飞秒激光制作角膜瓣的LASIK手术。术后随访6～12个月,裂隙灯显微镜及角膜地形图仪检查角膜及角膜屈光改变情况。结果术后6个月的屈光状态,（等效球镜）为（1．00D～＋1．25D）,平均为（-0．25±0．75D）。923眼（90．85％）的裸眼视力大于或等于1．0,1002眼（98．62％）的裸眼视力等于或超过术前最佳矫正视力。术前与术后结果行t检验显示,二者差异有统计学意义（P〈0．01）。术中并发症有结膜下出血57眼（5．61％）,未见其他并发症。结论应用飞秒激光制作角膜瓣的LASIK手术是矫正屈光不正的安全和有效的方法,可预测性好。     

Laser in situ keratomileusis to correct myopia, hypermetropia and astigmatism after penetrating keratoplasty for keratoconus: a series of 27 cases.

BACKGROUND: Excimer laser treatment has been shown to be effective and safe in correcting anisometropia following penetrating keratoplasty (PKP). In this report we review our experience with excimer laser in situ keratomileusis (LASIK) to correct refractive myopia, hypermetropia and astigmatism in patients who had undergone PKP for keratoconus. METHODS: We reviewed the records of 22 patients (27 eyes) who had undergone LASIK to correct myopia, hypermetropia or astigmatism, in simple or combined forms, following corneal transplantation for keratoconus. LASIK was performed at a hospital in Curitiba, Brazil, between September 1998 and February 2000. The eyes were classified into two groups: those with a negative spherical equivalent and those with a positive spherical equivalent. LASIK was performed using the Moria LSK microkeratome and the Nidek EC-5000 excimer laser. RESULTS: The mean length of follow-up was 9.52 months for the 23 eyes with myopia and 5.75 months for the 4 eyes with hypermetropia. The mean refractive spherical equivalent in the myopic eyes was -5.27 (standard deviation [SD] 1.91) dioptres before LASIK and -0.45 D (SD 1.68 D) at the last follow-up visit. The corresponding values in the eyes with hypermetropia were +5.18 D (SD 1.46 D) and + 1.18 D (SD 0.94 D). The rate of regression of astigmatism in the myopic eyes was 76%. After surgery 18 (78%) of the myopic eyes and all the hypermetropic eyes had an uncorrected visual acuity of 20/40 or better. The best spectacle-corrected visual acuity was better than 20/25 in 22 (95.7%) of the myopic eyes and all the hypermetropic eyes. One eye lost 1 line of best spectacle-corrected Snellen visual acuity, and one eye lost 6 lines secondary to epithelial ingrowth. Wound dehiscence, intraoperative flap complications, graft rejection or other complications did not develop in this series. INTERPRETATION: In this series, LASIK proved to be relatively safe and effective in correcting refractive errors after PKP for keratoconus.     

丝裂霉素抑制PRK后haze形成及屈光回退的研究

目的评价在高度近视的PRK手术中预防性使用丝裂霉素（MMC）抑制术后角膜上皮下混浊（haze）和屈光回退的效果，以寻求更佳的屈光手术方式。方法将不宜接受LASIK手术的高度近视患者（－6．0～－10．0D）按协议随机分为研究组40例（80眼）和对照组38例（76眼），研究组患者在PRK手术中使用0．02％丝裂霉素，对照组患者采用常规的PRK手术，术后两组用药方案一样，评价术后角膜上皮下混浊（haze）、角膜上皮修复、屈光状态、裸眼视力，矫正视力、角膜内皮细胞改变等情况。结果研究组未出现一眼2级或2级以上haze，无一眼出现术后最佳矫正视力下降，术后达到最佳矫正视力所需屈光改变小于－0．5D有70眼；对照组有26眼出现2级或2级以上haze，有14眼出现术后矫正视力下降，术后达到最佳矫正视力所需屈光改变小于－0．5D有37眼。研究组与对照组的差异有显著性。使用丝裂霉素未见明显毒副作用。结论PRK手术中预防性使用0．02％丝裂霉素，对术后减少角膜雾状混浊，防止屈光回退，改善裸眼视力和最佳矫正视力，是安全有效的。     

Simultaneous bilateral laser in situ keratomileusis: Safety and efficacy

ObjectiveTo compare the safety and efficacy of simultaneous bilateral to sequential bilateral laser in situ keratomileusis (LASIK) surgery for the correction of myopia.DesignRetrospective, nonrandomized, comparative trial.ParticipantsA total of 2142 consecutive simultaneous and sequential bilateral myopic LASIK surgery eyes operated from March 1996 through June 1998 for the correction of myopia were reviewed.InterventionTwo surgeons (HVG and JAV) performed myopic LASIK using the Nidek EC-5000 excimer laser and either the Chiron Automated Corneal Shaper or the Bausch & Lomb Hansatome microkeratome.Main outcome measuresThe incidence of intra- or perioperative complications for sequential and simultaneous bilateral LASIK for myopia was recorded. Refractive and visual outcomes at 3 to 6 months postoperative were analyzed. Deviations from targeted spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and retreatment rates are reported.ResultsLaser in situ keratomileusis was performed on the first eye of 1853 patients scheduled for simultaneous bilateral myopic LASIK. Of these, 28 (1.5%) first eyes had intraoperative or perioperative complications. The second eye surgery was cancelled in 11 cases, and 1842 second eyes completed simultaneous surgery; 13 (0.7%) intraoperative or perioperative complications occurred. Of these 41 complications in simultaneous cases, 1 eye lost 1 line of BCVA at 6 months follow-up. Two hundred eighty-nine patients were scheduled for sequential bilateral myopic LASIK. Five (1.8%) first eyes of the sequential cases had intraoperative complications compared with four (1.4%) sequential second eyes. There was no loss of BCVA in any sequential bilateral case with complications at a minimum at 6 months follow-up. There was no statistically significant difference between intra- and perioperative complication rates comparing simultaneous to sequential bilateral LASIK. Three to 6 months postoperative visual and refractive data were reviewed; except when comparing simultaneous first eye postoperative SE to sequential first eye, there was no statistically significant difference in refractive or visual outcomes, including deviation from targeted SE, UCVA, BCVA, and retreatment rates.ConclusionSimultaneous bilateral LASIK is as safe and effective as sequential surgery. Simultaneous bilateral LASIK may offer several benefits to the patient.     

LASIK after retinal detachment surgery

AIM: To assess the efficacy and safety of laser in situ keratomileusis (LASIK) for correction of myopic refractive errors in eyes which have previously undergone retinal detachment surgery. METHODS: In a prospective, non-comparative case series, 10 eyes of nine patients who had a myopic refractive error and had previously undergone retinal detachment surgery underwent LASIK surgery according to the standard surgical protocol. The surgery could be completed in eight eyes and in two eyes it was aborted intraoperatively. The parameters evaluated included the uncorrected visual acuity, best corrected visual acuity, refraction, detailed fundus evaluation with indirect ophthalmoscope, slit lamp biomicroscopy, and corneal pachymetry. Any intraoperative or postoperative complications were recorded. Follow up visits were scheduled at day 1, 1 week, 1 month, 3 months, and 6 months after LASIK. RESULTS: Eight eyes underwent successful LASIK surgery. The mean spherical equivalent before surgery was -5.436 (SD 1.6) dioptres (D), which was reduced to +0.42 (0.65) D, -0.07 (1.32) D, -0.06 (1.39) D, and -0.06 (0.65) at 1 week, 1 month, 3 months, and 6 months respectively after LASIK. The uncorrected visual acuity improved in all the eyes and the best corrected visual acuity improved or remained same in all the eyes. There was no retinal complication after LASIK. CONCLUSION: LASIK may be used to correct refractive errors in eyes that have undergone retinal detachment surgery. However, scarred conjunctiva in such cases may prevent generation of optimal suction for the microkeratome.     

Femtosecond laser flap creation for laser in situ keratomileusis: six-month follow-up of initial U.S. clinical series

PURPOSE: To evaluate clinical performance of a femtosecond laser for flap creation in laser in situ keratomileusis (LASIK). METHODS: A prospective, consecutive series of 208 eyes (122 patients) undergoing LASIK between June 2000 and November 2000 using a femtosecond laser for creation of the corneal flap were evaluated for the incidence of complications. A subset of 114 patients who underwent myopic procedures and who were followed for 6 months was analyzed using standard outcome measures. RESULTS: In 4 of 208 eyes (1.9%), suction was lost during the procedure, causing the flap resection to be interrupted. However, in all four of these eyes the procedure was successfully performed 5 to 45 minutes after re-applanation of the eye. No postoperative complications or adverse events were observed in any treated eye. In the subgroup of 96 eyes undergoing plano correction and followed for 6 months (preoperative spherical equivalent refraction range -0.63 to -12.40 D), 98% (94 eyes) achieved uncorrected visual acuity of 20/40 or better; 94% (90 eyes) achieved 20/30 or better, 79% (76 eyes) achieved 20/25; and 55% (53 eyes) achieved 20/20 or better--all without benefit of retreatment. CONCLUSION: Femtosecond laser corneal flap creation is a safe and effective alternative to traditional mechanical microkeratomes. Standard LASIK nomograms appeared to apply equally well to the all-laser LASIK procedures. The potential for improved flap safety, reproducibility, flexibility, as well as for additional corneal applications are now being explored.     

Measurement of corneal curvature change after mechanical laser in situ keratomileusis flap creation and femtosecond laser flap creation

PURPOSE: To compare the change in corneal curvature from the predicted surgical radius (sculpted in the corneal stroma) and the measured postoperative radius of the first surface of the cornea after laser in situ keratomileusis (LASIK) for myopia correction using 2 methods of flap creation: mechanical microkeratome and femtosecond laser. SETTING: Vissum-Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This retrospective consecutive nonrandomized comparative interventional case series included 85 eyes with myopia or myopic astigmatism treated using the Esiris excimer laser (Schwind). Patients were divided into 2 groups. One group had LASIK with an M2 microkeratome (Moria) (mechanical LASIK group) and the other, with a femtosecond laser (IntraLase FS, IntraLase Corp.) (femtosecond LASIK group). The relationship between the postsurgical corneal radius and the predicted sculpted radius as well as the mean value of the percentage change in the curvature radius were analyzed to obtain the effect on the refractive defect in each group. RESULTS: There were 44 eyes in the mechanical LASIK group and 41 eyes in the femtosecond LASIK group. A high correlation was found between the final corneal radius and the predicted sculpted radius in both groups (r(2) = 0.85). The mean percentage change in the curvature radius was -3.6% in the mechanical LASIK group and -1.6% in the femtosecond LASIK group (P<.001). The mean estimated refractive change was 1.2 diopters (D) and 0.8 D, respectively. CONCLUSIONS: The refractive change in corneal curvature, which related to the biomechanical response of the corneal surface after the flap cut and repositioning, was lower after femtosecond laser LASIK than after LASIK performed using a mechanical microkeratome. Estimations of refractive change induced by this response should be taken into account in surgery design.