Eighty-micron flap femtosecond-assisted LASIK for the correction of myopia and myopic astigmatism.

PURPOSE: To evaluate the safety and efficacy of 80-µm flap femtosecond laser-assisted LASIK and the early clinical and refractive outcomes in the correction of myopia and myopic astigmatism. SETTING: Private practice, outpatient. DESIGN: Prospective study. METHODS: Patients who underwent femtosecond-assisted LASIK between February and April 2018 were included. Inclusion criteria were myopia from -1.00 to -8.00 diopters (D) and astigmatism up to -3.00 D and no previous surgeries. All patients were tested preoperatively and on day 1 and month 3 for uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), slitlamp and dilated fundus examination, Schirmer I test with anesthesia, and ocular surface disease index questionnaire. The FEMTO LDV Z8 was used for flap construction and the Wavelight Allegretto 400 excimer for refractive treatment. Flap thickness was measured at week 1 with anterior segment optical coherence tomography (AS-OCT). RESULTS: Eighty-two eyes were included. Logarithm of the minimum angle of resolution UDVA was 1.28 ± 0.53 preoperatively, 0.02 ± 0.05 at day 1, and 0.14 ± 0.127 at month 3. There was no loss of CDVA lines. The mean flap thickness measured at 1 week with AS-OCT was 73 ± 6.7 µm. CONCLUSIONS: The use of ultrathin flaps, just below Bowman's layer, with the Ziemer LDV Z8 femtosecond laser was possible, safe, reliable, and reproducible. Eighty-micron flaps allowed for excellent vision on 1 day post-LASIK and might be a good alternative to maintain an appropriate percentage of tissue altered, especially when attempting greater corrections or larger treatment zones.

Implantation of Presbyopia-Correcting Intraocular Lenses Staged After Descemet Membrane Endothelial Keratoplasty in Patients With Fuchs Dystrophy.

PURPOSE: To assess outcomes of presbyopia-correcting intraocular lens (IOL) implantation after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy. METHODS: This retrospective single-center study evaluated a consecutive series of patients with Fuchs endothelial corneal dystrophy who received presbyopia-correcting IOLs after DMEK. The main outcomes were corrected distance visual acuity, uncorrected distance visual acuity, uncorrected near visual acuity, and refractive error. RESULTS: Fourteen extended depth of focus and 2 bifocal IOLs were implanted in 16 eyes of 8 patients (5 women and 3 men; age, 47-68 years). Fourteen IOLs were spherical and 2 were toric. Postoperatively, the median corrected distance visual acuity was 20/20 (range, 20/15-20/25), the median binocular uncorrected distance visual acuity was 20/25 (range, 20/15-20/25), the median binocular uncorrected near visual acuity was 20/20 (range, 20/20-20/50), and the median manifest spherical equivalent refraction was 0.05 diopters (D) (range, -0.75 to +0.75 D). Implantation of toric extended depth of focus lenses reduced refractive cylinder from 1 and 2.25 D preoperatively to 0 D in both eyes of 1 patient postoperatively. A comparison of biometry measurements taken before and after DMEK showed the median change in average keratometry was 0.26 D with a substantial range of -1.74 to +1.18 D. The median endothelial cell loss was 63 cells/mm (3%) after staged phacoemulsification. CONCLUSIONS: Favorable visual and refractive outcomes were obtained with presbyopia-correcting IOLs in patients with Fuchs dystrophy when the biometry measurements and IOL implantation were staged after DMEK had cleared the guttae and corneal edema.