One year follow-up of epikeratoplasty for myopia

Eighteen surgeons performed 166 consecutive epikeratoplasty procedures to correct myopia in 103 patients. Of this total, 147 (89%) were first surgeries and 19 (11%) were repeat surgeries. First surgery patients were divided into three subpopulations based on preoperative spherical equivalents (low -5.00 diopters [D] to -9.49 D, medium -9.50 D to -14.00 D, and high greater than -14.00 D). The percentage of eyes with 20/40 or better best corrected visual acuity before surgery was 93% for the low group, 89% for the medium group, and 57% for the high group. The percentage of eyes with 20/40 or better uncorrected visual acuity at 12 months after surgery was 58% for the low group, 42% for the medium group, and 17% for the high group. The average and median spherical equivalent after one year was -1.40 D (2.45 SD) and -1.00 D, respectively; 41% of the eyes were within one diopter of emmetropia, 65% within two diopters, and 76% within three diopters. Clinically significant regression was only noted in low and medium myope groups under 25 years of age. Repeat surgery outcomes were equivalent to those in first surgery patients who had a single procedure.     

A comparison of penetrating keratoplasty to epikeratoplasty in the surgical management of keratoconus

Of 40 patients intolerant to contact lenses, 47 eyes with keratoconus were surgically corrected with either epikeratoplasty (N = 31) or penetrating keratoplasty (N = 16). The percentage of eyes in both groups that had visual acuity of 20/40 or better with contact lenses at one year were equal (14 of 15 eyes [93.3%] in the penetrating keratoplasty group; 27 of 29 eyes [93.1%] in the epikeratoplasty group); however, the penetrating keratoplasty procedure resulted in a higher percentage of eyes that had visual acuity of 20/20 than the epikeratoplasty group (11 of 15 eyes [73%] compared with seven of 29 eyes [24.1%], respectively). Both procedures resulted in significant corneal flattening, with the penetrating keratoplasty group producing an average of 3 diopters more keratometric reduction than the epikeratoplasty group one year postoperatively. Although no irreversible graft failures occurred, five of 16 eyes (31%) in the penetrating keratoplasty group had graft reactions. No serious complications were noted in the eyes of the epikeratoplasty group. Both procedures were effective in the surgical management of keratoconus.     

Flap lift for LASIK retreatment in eyes with myopia

PURPOSE: To analyze the results achieved with LASIK retreatment after lifting the original flap in a large series of patients. DESIGN: Retrospective, noncomparative, interventional consecutive case series. PARTICIPANTS: Two thousand four hundred twenty-two consecutive eyes undergoing LASIK surgery for myopia, including 334 eyes submitted to flap lift for LASIK retreatment. MAIN OUTCOME MEASURES: Uncorrected visual acuity, best-corrected visual acuity, refractive error, and complications. RESULTS: LASIK retreatment was performed in 334 eyes (14%), and the mean time between initial procedure and retreatment was 8.2+/-6.2 months. The mean spherical equivalent (SE) improved from -1.2+/-0.6 diopters (D) (range, -4.2 to +1.2 D) before retreatment to +0.2+/-0.4 D (range, -3.1 to +1.1 D) after the retreatment. The uncorrected visual acuity (UCVA) after retreatment was 20/20 or better in 58% and 20/40 or better in 92% of eyes. The mean SE was within +/-1.0 D in 96% of the patients and within +/-0.5 D in 80.5% after retreatment. Eighteen eyes (5%) lost 1 line of best-corrected visual acuity, and 4 eyes (1%) lost 2 lines. CONCLUSIONS: LASIK retreatment surgery performed by relifting the flap was a useful procedure for correcting residual refractive errors after the primary LASIK procedure. It provided good uncorrected visual acuity, predictable results, good refractive stability, and few complications.     

Epikeratoplasty using lyophilized lenticles for the correction if aphakia in adults

Fifty adult aphakic patients were treated surgically by epikeratoplasty. Forty-one eyes had posttraumatic aphakia including 26 eyes with corneal scars. Results are presented with a mean follow-up of 31 months. 64% of eyes achieved an uncorrected visual acuity of 0.2 or better. Best visual acuity was 0.2 or better in 92% of eyes (this percentage is similar to the preoperative figure) and 0.5 or better in 62%. 78% of eyes had a refraction within 3 diopters of emmetropia. 10% of eyes lost 2 or more lines of best visual acuity. Mean keratometric results and spheric equivalent of the refraction show stability of the procedure during a 2 year follow up period. These results confirm, that in selected patients, epikeratoplasty is a valid surgical alternative for adult aphakia.     

Long-term reduction of intraocular pressure after repeat argon laser trabeculoplasty

Thirty-eight eyes (in 31 patients with glaucoma) that had shown a favorable response to an initial argon laser trabeculoplasty had a repeat laser trabeculoplasty four to 81 months (mean +/- S.E.M., 23 +/- 3 months) later because of inadequately controlled intraocular pressures. A mean (+/- S.E.M.) of 65 +/- 3 burns (range, 50 to 115) were given during the initial laser trabeculoplasty, and 58 +/- 2 burns (range, 36 to 100) were given during the first repeat treatment. Three months after the first repeat laser trabeculoplasty, one eye (3%) had undergone filtering surgery and 30 eyes (78%) were considered successes. Of the 30 eyes that were followed up for 12 months after the first repeat laser trabeculoplasty, two (7%) had undergone filtering surgery, three (10%) had received a second repeat laser trabeculoplasty, and 22 (73%) were successes. Fifteen eyes underwent a second repeat laser trabeculoplasty at six to 47 months (mean +/- S.E.M., 21 +/- 3 months) after the first repeat laser trabeculoplasty. Seven (47%) of these eyes required filtering surgery within three to 12 months after the second repeat laser trabeculoplasty. Four of 38 (11%) of the initial, two of 38 (5%) of the first repeat, and zero of 15 of the second repeat laser trabeculoplasty treatments resulted in a one- to two-hour rise in intraocular pressure of at least 10 mm Hg.     

Risk factors for complications following pediatric epikeratoplasty.

We studied the prevalence and types of complications that occurred in children treated with epikeratoplasty to identify risk factors. A review of the clinical records of 88 consecutive patients (106 eyes; 114 procedures) revealed that no complications occurred in 58 grafts (54%). Refractive complications (refractive error greater than 3.00 diopters spherical equivalent from emmetropia or astigmatism greater than 3.00 diopters) occurred in 30 eyes (28%). Medical complications occurred in 22 eyes (19%); these included epithelial defects (14 grafts), interface opacities (six grafts), graft vascularization (eight grafts), graft infection (two grafts), graft necrosis (five grafts), graft haziness (four grafts) or opacification (11 grafts), and graft dehiscence (three grafts). Eleven grafts (10%) were removed and five eyes received new grafts. Epikeratoplasty in children will be more successful if risk factors such as patient age less than one year, microcornea, corneal endothelial cell dysfunction, mental retardation, and combining the procedure with cataract surgery are avoided.     

Results of the prospective evaluation of radial keratotomy (PERK) study one year after surgery

The Prospective Evaluation of Radial Keratotomy (PERK) study is a nine-center, self-controlled clinical trial of a standardized technique of radial keratotomy in 435 patients who had physiologic myopia with a preoperative refraction between -2.00 and -8.00 diopters. The surgical technique consisted of eight incisions using a diamond micrometer knife with blade length determined by intraoperative ultrasonic pachymetry and the diameter of central clear zone determined by preoperative refraction. At one year after surgery, myopia was reduced in all eyes; 60% were within +/- 1.00 diopter of emmetropia; 30% were undercorrected and 10% were overcorrected by more than 1.00 diopter (range of refraction, -4.25 to +3.38 D). Uncorrected visual acuity was 20/40 or better in 78% of eyes. The operation was most effective in eyes with a refraction between -2.00 and -4.25 diopters. Thirteen percent of patients lost one or two Snellen lines of best corrected visual acuity. However, all but three eyes could be corrected to 20/20. Ten percent of patients increased astigmatism more than 1.00 diopter. Disabling glare was not detected with a clinical glare tester, but three patients reduced their driving at night because of glare. Between six months and one year, the refraction changed by greater than 0.50 diopters in 19% of eyes.     

Mid- and long-term results after trabeculectomy in patients with juvenile and late-juvenile open-angle glaucoma

BACKGROUND: To determine success rate of trabeculotomy in patients with juvenile and late-juvenile glaucoma in a retrospective study. PATIENTS AND METHODS: 46 eyes of 41 juvenile glaucoma-patients (24 female, 17 male) were submitted to trabeculotomy during the period of 1980-1997. Patients age at the time of surgery was 30.2 +/- 10.5 years (11-49 years, median 21 years). Follow-up time was 35 +/- 46 months (1-155 months). RESULTS: Median preoperative visual acuity was 1.0 (range 0.002 to 1.25), postoperative visual acuity at the end of the follow up period was 0.8 (median) with a range from 0.002 to 1.2. In all patients preoperative intraocular pressure was elevated and a glaucomatous configuration of the optic disc was noticed. Preoperative intraocular pressure (IOP) ranged from 30.5 +/- 13.2 mm Hg, after surgery IOP was 16.2 +/- 5 mm Hg. Mean decrease of the IOP postoperatively was 54.4%. In 37% of the eyes IOP was lower than 23 mm Hg without additional medication, in 47% of the eyes IOP was lower than 23 mm Hg with additional medication. In 8 eyes additional antiglaucoma-surgery was necessary. After a follow-up time of 60 months 81% of the patients (n = 37 eyes) had an IOP below 23 mm Hg, after 120 months in 80% of the patients (n = 29 eyes) IOP was below 23 mm Hg. CONCLUSION: The success rate of trabeculotomy (defined as the ability to lower intraocular pressure lower than 23 mm Hg with or without antiglaucoma medication) in our patients is 84%. After second operation, success rate is 89%. Trabeculotomy for patients with juvenile open angle glaucoma is a safe procedure and avoids problems and complications of filtering procedures.     

Laser epithelial keratomileusis for the correction of hyperopia using a 7.0-mm optical zone with the Schwind ESIRIS laser

PURPOSE: To investigate the efficacy of laser epithelial keratomileusis (LASEK) for the correction of hyperopia using a 7.0-mm optical zone and a 9.0-mm total ablation zone diameter with the Schwind ESIRIS flying-spot laser. METHODS: Forty-seven patients (70 eyes) were treated with a mean preoperative spherical equivalent refraction of +2.32 diopters (D) (range: 0 to +5.00 D). All eyes underwent LASEK using 15% alcohol with a 20-second application. RESULTS: An intact epithelial flap was obtained in 66 (94%) eyes. In 70 eyes at 12 months, the mean spherical equivalent refraction was +0.09 D (range: -0.75 to +1.00 D) with all (100%) eyes within +/- 1.00 D of the intended correction and 60 (86%) eyes within +/- 0.50 D. In 40 eyes with 24-month follow-up, the refractive correction remained stable after 6 months. Hyperopic cylindrical corrections were attempted in 49 eyes (range: +0.25 to +5.00 D) with vector analysis demonstrating a mean 102% correction at 12 to 24 months. In 60 non-amblyopic eyes, uncorrected visual acuity was > or = 20/20 in 47 (78%) eyes. Thirty-three (47%) eyes gained 1 to 2 lines of Snellen decimal equivalent best spectacle-corrected visual acuity, 30 (43%) eyes showed no change, and 7 (10%) eyes lost 1 line. Eight (11%) eyes at 12 to 24 months had grade +/- 1 of paracentral corneal haze and 57 (81%) had no haze. At 12 months (n = 70), the safety index was 1.06 with an efficacy index of 0.95. Analysis of higher order wavefront aberrations showed no significant changes in root-mean-square values post-operatively, except for a significant reduction of fourth order spherical aberration (P < .05). CONCLUSIONS: Laser epithelial keratomileusis for hyperopia up to +5.00 D using a 7.0-mm optical zone with the Schwind ESIRIS laser provides excellent refractive and visual outcomes with minimal complications. In eyes followed for 24 months, the refractive correction remained stable after 6 months.     

Surgical revision of failed filtration surgery with mitomycin C augmentation

AIM: The aim of the study was to assess the outcomes of surgical revision with reopening of the scleral flap in eyes with failed glaucoma surgery and adjunctive mitomycin C (MMC). METHODS: Retrospective, noncomparative, interventional case series. Fifty-four eyes of 54 consecutive patients with previously failed trabeculectomy or deep sclerectomy who underwent formal surgical revision (23 with concurrent phacoemulsification) were included. MMC, 0.2 mg/mL for 2 to 3 minutes, was applied under a fornix-based conjunctival flap. The preexisting scleral flap was dissected open to reestablish filtration. RESULTS: Mean follow-up was 39.5+/-10 months. Kaplan-Meier survival analysis showed that the probability (with 95% confidence intervals) of maintaining an intraocular pressure (IOP) between 5 and 18 mm Hg and 20% decrease from preoperative IOP was 64% (47% to 76%) with medications and/or needle revision and 38% (26% to 53%) without, 3 years after surgery. Mean IOP before surgery was 23.6+/-7.2 mm Hg and 14.4+/-6.0 three years after surgery (last IOP before further glaucoma procedure carried forward). Needle revision for bleb failure or high IOP was carried out in 23 eyes (42.5%) and further glaucoma surgery in 5 eyes (9.3%). Patients were on an average of 2+/-1.1 glaucoma medications before surgery. At last follow-up, the number of medications had decreased to 0.8+/-1.2 (P<0.000), with 23 eyes (42.5%) requiring medications to control IOP. Significant complications included delayed suprachoroidal hemorrhage (3 eyes, 5.6%), delayed bleb leaks (5 eyes, 9.3%), hypotony (2 eyes, 3.7%), and blebitis (2 eyes, 3.7%). CONCLUSIONS: There is a progressive increase in IOP with time after surgical revision of failed glaucoma surgery with adjunctive MMC. A significant proportion of eyes will eventually require a needle revision procedure and/or glaucoma medications to further lower IOP. Also, there is a significant incidence of complications associated with this procedure.     

Angle-supported phakic intraocular lenses followed by laser-assisted in situ keratomileusis for the correction of high myopia

To evaluate the safety, effectiveness, predictability, and stability of the combination of angle-supported phakic intraocular lens (PIOL) implantation and laser-assisted in situ keratomileusis (LASIK) for the correction of high myopia.Noncomparative interventional case series.At the Instituto Oftalmológico de Alicante, Spain, 24 consecutive eyes of 12 patients with a preoperative spherical equivalent between -9 and -26 diopters were studied. Implantation of an angle-supported PIOL was done as the first surgery. Laser-assisted in situ keratomileusis was performed at least 6 months after PIOL surgery, once stability of topography and refraction were proved. Main outcome measures were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, applanation tonometry, and corneal endothelial study (cell density, hexagonality, and coefficient of variation), with a minimum follow-up of 12 months after LASIK.The mean spherical equivalent refraction decreased from -15.17 +/- 5.15 diopters before PIOL implantation to -1.33 +/- 1.18 diopters after PIOL surgery and to 0.01 +/- 0.53 12 months after LASIK. Uncorrected visual acuity was 0.39 +/- 0.12 after PIOL surgery, increasing to 0.65 +/- 0.23 12 months after LASIK. There was an increase in 20/40 or better UCVA from 16.6% after PIOL surgery alone to 83.3% after addition of LASIK. At final follow-up, spherical equivalent was within +/- 1 diopter of emmetropia in 22 eyes (91.7%) and in 18 eyes (75%) within +/- 0.50 diopters. Vector analysis demonstrated that astigmatic components of refractive error after PIOL surgery were well corrected by LASIK. At final follow-up the mean endothelial cell loss was 4.88% (P <.001). There were no statistically significant differences between mean endothelial cell count, percentage of hexagonality, or coefficient of variation before LASIK and 12 months after LASIK, suggesting that no corneal endothelial damage was produced by LASIK itself. No sight-threatening complications occurred through the follow-up period.The combination of angle-supported PIOL implantation and LASIK appears to be a safe, effective, predictable, and stable procedure for the correction of high myopia. This paper emphasizes the benefits of adding LASIK to the use of PIOL alone.     

Repeat Radial Keratotomy in Monkeys

Six adult rhesus monkey eyes underwent a repeat radial keratotomy consisting of eight additional incisions one year following the initial procedure. An additional 1.07 diopters (63%) flattening of the corneal curvature and +0.82 diopters (33%) of refractive error change was produced when compared with the control eyes.     

Primary piggyback implantation using the ReSTOR intraocular lens: case series

PURPOSE: To assess the postoperative outcomes of piggyback implantation using the AcrySof ReSTOR intraocular lens (IOL) (model SA60D3, Alcon Surgical Laboratories). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Thirteen eyes of 7 patients who had phacoemulsification with piggyback IOL implantation were analyzed prospectively. In all cases, a ReSTOR IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included uncorrected visual acuity (UCVA) at near and distance, best corrected visual acuity (BCVA), and spherical equivalent (SE) before and after surgery. RESULTS: The patients were followed for 12 months. The mean distance UCVA was 0.25 (20/80) preoperatively and 0.88 (20/23) at the last follow-up (1 year), which was significantly better than before surgery (P<.05). The mean SE was +4.25 diopters (D) +/- 1.5 (SD) preoperatively and +0.15 +/- 0.44 D (range -0.50 to +0.75 D) at 1 year, which was significantly better than preoperatively (P<.05). No patient lost lines of BCVA after surgery. At the last follow-up, all eyes had a near UCVA of J1 and none required spectacles for near or distance vision. CONCLUSION: Piggyback implantation using the ReSTOR IOL appeared to be a safe and efficient procedure providing high-quality visual acuity for near and distance vision in selected patients.     

Iris-supported phakic lenses (rigid vs foldable version) for treating moderately high myopia: randomized paired eye comparison

PURPOSE: To compare refractive performance of Artisan (Ophtec, Groningen, The Netherlands) or Verisyse phakic intraocular lens and its foldable version, Artiflex (Ophtec), for the correction of moderately high myopia. DESIGN: Randomized pilot study. METHODS: setting: Institutional practice. patient population: Thirty-one patients with myopia that ranged from -6 to -14 diopters (D). interventional procedure: One eye was implanted with an Artisan phakic intraocular lens (PIOL) and the other with an Artiflex PIOLs. main outcome measures: Primary outcome measure was the percentage of eyes with uncorrected visual acuity (UCVA) of >20/40 at one year after the operation. Main secondary outcome measures were the safety index, the change of two lines or more of best spectacle-corrected visual acuity (BSCVA) and the endothelial cell count. RESULTS: No intraoperative complications were noticed. One year after surgery, the percentage of eyes with UCVA of >20/40 was 51.6% (16/31 patients) for Artisan-treated eyes and 77.4% (24/31 patients) for Artiflex-treated eyes (P = .033). One month after surgery, this same percentage was 42.9% (13/31 patients) and 77.4% (24/31 patients), respectively (P = .004). The safety index at one year was 1.13 +/- 0.24 for Artisan-treated eyes and 1.12 +/- 0.21 for Artiflex-treated eyes, which is a difference that was not statistically significant (P = 0.742). At one year after surgery, the changes of two lines or more of BSCVA and the endothelial cell loss were similar for both groups. CONCLUSION: To correct moderately high myopia, the Artiflex lens provides a faster visual recovery and a better UCVA than does the Artisan lens. The safety of the lens should be supported by an enlarged sample size and a longer follow-up period.     

Retinal detachment in phakic eyes with anterior chamber intraocular lenses to correct severe myopia

PURPOSE: To analyze the incidence and characteristics of retinal detachment in patients with severe myopia corrected by implantation of phakic anterior chamber intraocular lenses. METHODS: We studied retinal detachments in 166 consecutive eyes (98 patients) that underwent implantation of angle-supported phakic anterior chamber intraocular lenses (models ZB5M and ZB5MF; Domilens; Lyon, France) for the correction of severe myopia (follow-up +/- SD, 45.26 +/- 14.65 months; range, 20 to 84 months). RESULTS: Retinal detachment occurred in eight eyes (4.8%); four eyes belonged to men and four to women. The time between implanting surgery and retinal detachment was 17.43 +/- 16.4 months (range, 1 to 44 months). In all cases, retinal detachment was spontaneous. In seven eyes, the retina was reattached successfully during the first retinal detachment surgery. Mean best-corrected visual acuity after phakic anterior chamber intraocular lens implantation and before retinal detachment development was 20/50 (range, 20/100 to 20/25). After retinal detachment repair, best-corrected visual acuity was 20/73 (range, 20/2000 to 20/33). In these seven eyes, differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .898, paired Student t test). In one eye, a proliferative vitreoretinopathy was observed, which required additional treatment by vitrectomy and explantation of the phakic anterior chamber intraocular lens. A refractive change was observed after retinal detachment repair, from -1.1 +/- 0.7 diopters (range, 0.00 to -2.50 diopters) before retinal detachment and -2.8 +/- 1.1 diopters (range, -1.00 to -4.50 diopters) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: The implantation of a phakic anterior chamber intraocular lens as a correcting procedure for severe myopia was followed by a 4.8% incidence of retinal detachment. Conventional scleral surgery was successful in most cases, without causing significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after retinal detachment repair in these patients.     

Comparison of visual results in initial and re-treatment laser in situ keratomileusis procedures for myopia and astigmatism

PURPOSE: To report the results of initial and re-treatment laser in situ keratomileusis procedures for myopia and astigmatism. METHODS: A total of 1161 consecutive inital and retreatment laser in situ keratomileusis procedures in 697 patients performed between September 19, 1996, and June 20, 1998, were retrospectively analyzed. Baseline and postoperative best spectacle-corrected visual acuity, uncorrected visual acuity, spherical and cylindrical refractions, computerized video keratography, and biomicroscopy were measured or performed on each eye. RESULTS: Of 1,071 eyes, 900 (84%) underwent a single-laser in situ keratomileusis procedure, and 171 of 1,071 eyes (16%) underwent one or two re-treatment procedures. The preoperative mean +/- SD spherical equivalent was -5.09 +/- 3.15 diopters (range, -0.75 to -14.38 diopters) and the cylinder was 0.97 +/- 1.09 diopters (range, 0.00 to 3.25 diopters) in the group that underwent a single laser in situ keratomileusis treatment. The preoperative mean +/- SD spherical equivalent was -6.26 +/- 3.04 diopters (range, -1.75 to -12.88 diopters) and the cylinder was 1.53 +/- 1.11 diopters (range, 0.00 to 3.50 diopters) in the group that underwent re-treatment. Before re-treatment, 110 eyes (64.3%) in the group that underwent re-treatment achieved 20/40 or better uncorrected visual acuity and 23 eyes (13.5%) achieved 20/25 or better. Three months after re-treatment, 155 eyes (90.6%) achieved 20/40 or better, and 80 eyes (46.8%) achieved 20/25 or better. In the single-procedure group, uncorrected visual acuity at 3 months revealed 20/40 vision or better in 856 eyes (95.1%) and 20/25 vision or better in 572 eyes (63.6%). In this study group, 23.6% of eyes with a preoperative spherical equivalent greater than -6.0 diopters underwent re-treatment compared with 11.8% of eyes with a preoperative spherical equivalent of -6.0 diopters or less. CONCLUSIONS: Laser in situ keratomileusis appears to be an effective procedure for mild, moderate, and severe myopia. In eyes with residual refractive error, re-treatment laser in situ keratomileusis procedures can result in good visual outcomes.     

Ten-year follow-up of laser in situ keratomileusis for myopia of up to -10 diopters

PURPOSE: To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for myopia of up to -10 diopters (D). DESIGN: A long-term (10-year) follow-up retrospective, interventional case series. METHODS: The study included 97 eyes of 70 patients with a preoperative spherical equivalent (SE) of up to -10 D treated with myopic LASIK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA) and the Automated Corneal Shaper microkeratome (Chiron Vision, Irvine, California, USA). All patients were evaluated three months, one year, two years, five years, and 10 years after surgery. The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS: At 10 years, 71 (73%) of 97 eyes were within +/- 1.00 D and 89 (92%) were within +/- 2.00 D. Twenty eyes (20.8%) underwent retreatments because of overcorrection, undercorrection, regression, or both. The mean SE slightly decreased (myopic regression) over 10 years, with a mean myopic regression of -0.12 +/- 0.16 D per year. Fifty-four (54.6%) of 97 eyes demonstrated an increase in best spectacle-corrected visual acuity (BSCVA) after 10 years. No eye developed corneal ectasia in the long-term, and only three eyes lost more than two lines of BSCVA because of complications that were not attributable to the LASIK procedure. CONCLUSIONS: LASIK for myopia of up to -10 D is a safe and effective procedure with slight myopic regression that slows down with time and a high rate of BSCVA increase in the long-term.     

Femtosecond laser for residual refractive error correction after refractive lens exchange with multifocal intraocular lens implantation

PURPOSE: To assess visual and refractive outcomes of femtosecond laser for residual refractive error correction after refractive lens exchange (RLE) with multifocal intraocular lens (IOL) implantation. DESIGN: Prospective, nonrandomized, masked observational case series (self-controlled). METHODS: Fifty-three eyes of 31 consecutive patients were submitted to femtosecond laser surgery after RLE with multifocal IOL implantation. Patients showed an average manifest refractive error (D) of M, 0.200 +/- 0.490; J(0), -0.051 +/- 0.532; and J45, -0.007 +/- 0.371. Visual acuity (VA) was measured at distance and near vision before and six months after the surgery. RESULTS: At six months after surgery, mean uncorrected VA was 0.83 +/- 0.20 and improved in 100% of the eyes. No eye lost two or more lines of best-corrected distance VA; five eyes lost one line, 31 eyes did not change after the surgery, 13 eyes gained one line, and four eyes gained two lines. All eyes were within +/- 1.00 diopters (D) and 96.2% were within +/- 0.50 D of the desired refraction. The average manifest refractive error (D) after surgery was M, 0.014 +/- 0.170; J0, 0.029 +/- 0.118; and J45, 0.007 +/- 0.061. No eye lost two or more line of best distance-corrected near VA; two eyes lost one line, 40 eyes did not change, and 11 eyes gained one line. Mean uncorrected distance near VA was 0.88 +/- 0.12 at six months. Best distance-corrected near VA changed from 0.89 +/- 0.14 before surgery to 0.90 +/- 0.13 at six months. CONCLUSIONS: Femtosecond laser after RLE with multifocal IOL implantation is an effective procedure for correcting residual ametropia and resulted in better distance visual outcomes.     

Comparison of iris-fixed Artisan lens implantation with excimer laser in situ keratomileusis in correcting myopia between -9.00 and -19.50 diopters: a randomized study

OBJECTIVE: To compare Artisan lens implantation with laser in situ keratomileusis (LASIK) for the correction of myopia between -9.00 and -19.50 diopters. DESIGN: Prospective randomized clinical trial. PARTICIPANTS: Ninety eyes of 61 consecutive patients were enrolled in the study. INTERVENTION: Forty-five eyes (50%) received Artisan lens, and 45 eyes (50%) received LASIK; the procedure assigned to each eye was randomized. Eighteen patients (29.5%) received Artisan lens in one eye and LASIK in the other. MAIN OUTCOME MEASURES: Slit-lamp microscopy, manifest refraction, uncorrected and spectacle-corrected visual acuity, contrast sensitivity, and specular microscopy were performed before surgery, and 1, 3, 6, and 12 months after surgery. Patient satisfaction and preference were assessed by a subjective questionnaire. RESULTS: At 1 year, 43 eyes (95.6%) from the Artisan group and 41 eyes (91.1%) from the LASIK group were examined, the mean spherical equivalent refraction was -0.64 +/- 0.8 diopter in the Artisan eyes and -0.87 +/- 0.8 in the LASIK eyes. The uncorrected visual acuity was 20/20 or better in 9 Artisan eyes (20.9%) and 5 LASIK eyes (12.2%) and 20/40 or better in 38 Artisan eyes (88.4%) and 24 LASIK eyes (58.5%); no Artisan eyes and 5 LASIK eyes (12.2%) lost 2 or more Snellen lines of spectacle-corrected visual acuity. One Artisan eye (2.3%) and six LASIK eyes (14.6%) reported severe night glare; the Artisan lens was exchanged with a larger optic diameter lens. Mean endothelial cell loss at 1 year was 0.7 +/- 1.1 cells/mm(2) in the Artisan eyes and 0.3 +/- 0.9 cells/mm(2) in the LASIK eyes. Contrast sensitivity curve decreased by 2 or more lines in two Artisan (4.7%) and six LASIK eyes (14.6%). Of the 18 patients who received both surgeries, one in each eye, 13 patients (72.2%) preferred the Artisan procedure because of the better quality of vision. CONCLUSIONS: In this study, Artisan lens implantation and LASIK were found to be similarly effective, stable, and reasonably safe for the correction of myopia between -9.00 and -19.50 diopters. Better uncorrected and spectacle-corrected visual acuity and contrast sensitivity, a lower enhancement rate, and exchangeability are the main advantages of Artisan lens implantation. Thirteen (72.2%) of the 18 patients who received the Artisan lens in one eye and LASIK in the other preferred the Artisan lens to the LASIK, mainly because of the better quality of vision.     

Conventional and wavefront-guided myopic LASIK retreatment

PURPOSE: To assess the clinical outcomes of conventional and wavefront-guided myopic laser in situ keratomileusis (LASIK) retreatment. DESIGN: Retrospective, nonrandomized case series. METHODS: The study comprised a cohort of 97 eyes having LASIK retreatment for residual myopia after primary LASIK. The eyes were divided into two groups: conventional retreatment (CR) group (n = 74) and wavefront-guided retreatment (WR) group (n = 23). The retreatment LASIK was performed using LADARVison 4000 with/without CustomCornea (Alcon Surgical, Orlando, Florida, USA). The mean follow-up was 8.9 +/- 5.8 months after retreatment (range three to thirty-six months). RESULTS: The mean pre-retreatment spherical equivalent (SE) was -0.93 +/- 0.41 diopters in the CR group and -0.84 +/- 0.48 diopters in the WR group (P = .409). At the last visit, the mean SE was -0.19 +/- 0.28 diopters and +0.32 +/- 0.47 diopters, respectively (P < .001). An SE of +/- 0.50 diopters was achieved in 92% (68 of 74) of CR eyes and 65% (15 of 23) of WR eyes. In the CR group, 85% eyes had a uncorrected visual acuity (UCVA) > or = 20/20 and 99% > or = 20/40, and in the WR group, 35% and 100%, respectively. None of the CR eyes and 17% (4 of 23) of WR eyes lost two lines of best spectacle-corrected visual acuity (BSCVA). Nine percent (7 of 74) of CR eyes and 30% of WR eyes (7 of 23) had optical symptoms before retreatment, the number was reduced to 1% (1 of 74) and 4% (1 of 23), respectively. CONCLUSIONS: In the study period with the current equipment, our results showed that conventional LASIK retreatment was superior to wavefront-guided LASIK retreatment in both efficacy and safety.