Pressure-Induced Stromal Keratopathy after Surface Ablation Surgery.

Introduction: The purpose of this clinical report was to describe an unprecedented case of bilateral pressure-induced stromal keratopathy (PISK) following corneal photorefractive keratectomy, associated with presumed herpetic keratitis, and to present tomographic and biomechanical findings before and after appropriate treatment. Case Presentation: A 33-year-old male patient was referred to our clinic with suspected delayed corneal epithelial healing 3 weeks after an uncomplicated PRK. A central layer of corneal opacity with a presumed fluid-filled interface area was observed upon slit lamp biomicroscopy. Scheimpflug images from the Pentacam® revealed a hyperreflective area beneath the central cornea. Scheimpflug-based corneal tomography, biomechanical assessment using the Pentacam® AXL Wave, and the Corvis ST® were conducted. Goldmann applanation tonometry measured 23/13 mm Hg, while noncontact tonometry intraocular pressure measured with the Corvis ST® (Corvis ST IOPnct) was 40.5/43.5 mm Hg. Treatment with oral valacyclovir, combined with ocular hypotensive therapy, led to a significant reduction in IOP and improved corneal deformation parameters after 1 month. Conclusion: Surgeons should be aware of the inaccuracy of Goldmann applanation tonometry in PISK, which can occur after LASIK or surface ablation.

LASIK is associated with early cataract surgery in healthy patients.

PURPOSE: To evaluate the association between LASIK and early cataract phacoemulsification surgery (PE). METHODS: A matched case-control study was conducted. Cases were otherwise healthy adults with a history of LASIK. Groups were paired according to corrected-distance visual acuity (CDVA), axial length, and cataract grade. RESULTS: A total of 213 patients were included. 85 patients were classified as post-LASIK group and 128 as controls. The mean age at the time of LASIK was 42.32 ± 9.24 years. The mean CDVA before PE was 0.29 ± 0.19 Log MAR in post-LASIK group and 0.34 ± 0.22 Log MAR in controls (p = 0.07). The mean axial length was 23.99 ± 1.78 mm in post-LASIK group and 23.62 ± 0.98 mm in controls (p = 0.085). The mean nuclear cataract grading was 1.36 in post-LASIK group and 1.47 in controls (p = 0.34). The mean age at the time of PE was 60.18 ± 7.46 years in post-LASIK group and 67.35 ± 9.28 in controls (p < 0.0005). The difference between the mean age of LASIK and the mean age of PE was 17.85 ± 5.72 years. There was a positive association between the post-LASIK group and the age of PE ≤ 55 years (OR: 4.917, 95% CI: 2.21-10.90, p < 0.001). CONCLUSION: LASIK may be associated with early PE. Patients with LASIK had a 7-year earlier PE compared to a matched control group.

Hyperopic LASIK Enhanced by Pharmacological Treatment of Presbyopia.

Purpose: Regression of the refractive outcome is a major concern of LASIK procedures mainly in presbyopic patients. The purpose of this study was to evaluate the long-term efficacy of the pharmacological treatment of presbyopia performed with Benozzi's method, in combination with hyperopic LASIK surgery in presbyopic population. Methods: A nonrandomized case series was developed, including presbyopic patients who underwent bilateral "Hyperopic LASIK surgery" and were pharmacologically treated with Benozzi's Method from January 2011 to August 2018, with at least 2 years of follow-up, at two private ophthalmological clinics of Argentina. Main outcomes were spherical equivalent (SE), uncorrected distance visual acuity (UDVA), and uncorrected near visual acuity (UNVA). Measurements were evaluated at baseline and postoperative at 1 month (without Benozzi's treatment), 2 months (starting with Benozzi's treatment), and 2 years. The SE stability across the time was statistically compared. Results: A total of 84 eyes of 42 patients, with a mean age at the time of the surgery of 51.07 ± 4.5 (42-59), were found following 2 years of follow-up. Patients have improved and maintained UDVA, achieving Jaeger 1 in the second postoperative month, which was maintained up to the last year of follow-up. Refractive stability across the time is observed comparing first month after surgery with the last year of follow-up, without statistical significant difference (p: 0.11). Conclusion: Hyperopic presbyopic patients that underwent LASIK surgery and 1 month after surgery started with the pharmacological treatment of presbyopia (Benozzi's method) results in excellent UNVA and UDVA that is stable over time without refractive regression.

Toxicidad por marcador corneal en Femto-LASIK. Reporte de caso / Toxicity by corneal marker in Femto-LASIK. Case report

La violeta de genciana es un colorante orgánico sintético, descrito por primera vez por Charles Lauth en 1861. Tiene propiedades antibacterianas, antifúngicas, antihelmínticas, antitripanosómicas, antiantiogénicas y antitumorales. Tiene diversos mecanismos de acción, entre los que principalmente se encuentra bloquear la actividad de las nicotinamida adenina dinucleótido fosfato oxidasas, evitando la generación de radicales superoxidativos y la posterior inflamación. En los últimos años se ha utilizado en marcadores para procedimientos en diferentes especialidades médicas, incluidos los de oftalmología. La tinta de violeta de genciana se describe por el fabricante como no tóxica, sin embargo existe evidencia clínica y experimental que sugiere que puede ser tóxica para el endotelio corneal y puede llegar a generar queratitis lamelar difusa posterior a LASIK y Femto-LASIK. Se describe el caso de una paciente de 23 años de edad, que presentó diversas patologías en la córnea después del uso de marcador quirúrgico durante procedimiento refractivo Femto-LASIK.

Gentian violet is a synthetic and organic dye. First described by Charles Lauth in 1861. It has antibacterial, antifungal, anthelmintic, antitrypanosomal, antiangiogenic, and antitumoral properties. It has various mechanisms of action, among which is mainly blocking the activity of nicotinamide adenine dinucleotide phosphate oxidases, preventing the generation of superoxidative radicals and subsequent inflammation. In recent years, it has been used as markers for procedures in different medical specialties, including ophthalmology. Gentian violet ink is described by the manufacturer as non-toxic, however, there is clinical and experimental evidence suggesting that it may be toxic to the corneal endothelium and may cause diffuse lamellar keratitis after LASIK and Femto-LASIK. The case about a 23-year-old female patient who presented various pathologies in the cornea after the use of a surgical marker during the Femto-LASIK refractive procedure is described.

Femtosecond laser-assisted in situ keratomileusis with topography-guided or asphericity-adjusted derived data: a comparative contralateral eye study.

BACKGROUND: Wavefront-optimized laser-assisted in situ keratomileusis (LASIK) ablation is the most commonly performed procedure in refractive surgery, but new technologies have become available. Our goal was to compare topography-guided (Contoura) and asphericity-guided (Custom-Q) customized ablation treatments for the correction of myopia with or without astigmatism. METHODS: This prospective, randomized, double-blind, contralateral eye study included 60 eyes of 30 patients with myopia or myopic astigmatism requiring femtosecond LASIK (FemtoLASIK) treatment. For each patient, one eye was randomized to undergo Contoura treatment, and the other underwent Custom-Q abaltion. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent (MRSE), sphere (SPH), cylinder (CYL), 6.0-mm total corneal aberration root mean square (RMS), coma (COMA), trefoil (TREF), and spherical aberration (SA) were measured and analysed after a 1-year follow-up. RESULTS: The UDVA was - 0.08 ± 0.06 logMAR in Contoura eyes and - 0.08 ± 0.05 logMAR in Custom-Q eyes (p = 0.309) after 12 months. Twenty-five eyes (83%) in the Contoura group and twenty-six eyes (87%) in the Custom-Q group had a UDVA of 20/16 at the end of 12 months, and 100% of eyes in both groups reached a UDVA of 20/25 or better. Ninety and 100% of eyes in the Contoura and Custom-Q groups, respectively, achieved a residual CYL ≤0.50 D (p = 0.237). No statistically significant difference was observed between the surgical techniques in the preoperative to 1-year postoperative changes for any of the parameters evaluated (MRSE, CYL, RMS, DEF, COMA, TREF, and SA). CONCLUSIONS: The Contoura and Custom-Q techniques yielded excellent visual and refractive results, but the evidence did not reveal any clear differences between these two methods after 1 year of follow-up. TRIAL REGISTRATION: ReBEC - Registro Brasileiro de Ensaios Clínicos [Internet]: Rio de Janeiro (RJ): Instituto de Informação Científica e Tecnológica em Saúde (Brazil); 2010 -. Identifier RBR-8rs5kt Myopia and Astigmatism Topography-guided Refractive Surgery by Contoura Method Versus Customized by Asphericity in Contralateral Eyes: A prospective Double blind Randomized Study. Available from https://ensaiosclinicos.gov.br/rg/RBR-8rs5kt Date of registration: 02/03/2020 (dd/mm/yyyy). CAAE:96778718.9.0000.5192. Issuing authority: Plataforma Brasil. CEP:2.979.279. Issuing authority: HUOC.

Management of late traumatic LASIK flap dislocation related to dog scratch 16 Years postoperatively.

PURPOSE: This report details a case of an unusual late dislocation of a laser in situ keratomileusis (LASIK) flap due to animal-related trauma 16 years after the initial surgery. OBSERVATIONS: A 59-year-old woman with history of LASIK surgery on both eyes 16 years prior, and uncomplicated cataract surgery on the left eye (oculus sinister; OS) 3 years prior, arrived at our institution with sudden painful visual loss 3 hours after receiving a scratch on OS from her dog. Corneal examination revealed a completely displaced nasally hinged LASIK flap folded irregularly over the hinge, with multiple creases over its entire thickness. The flap was intact but edematous and opaque, with detritus present both on the flap surface and stromal face. Treatment was initiated with topical moxifloxacin and oral clindamycin. The next morning, the flap was refloated, and debris was removed from both sides of the flap while irrigating with preservative-free moxifloxacin. The flap was repositioned and a bandage contact lens placed. Postoperative topical medication included moxifloxacin, prednisolone acetate, and sodium hyaluronate. At the final follow-up visit, the patient was asymptomatic, with a measured uncorrected distance visual acuity (UDVA) of 20/25 OS. CONCLUSION AND IMPORTANCE: This uncommon case highlights the longest reported interval-16 years- between initial surgery and traumatic LASIK flap displacement, caused by animal-related trauma. Patients experiencing LASIK surgery complications, including contaminated trauma many years after the original ablation, can still recover excellent visual acuity when managed appropriately and in a timely fashion.

Satisfação de pacientes submetidos à cirurgia refrativa de PresbiLASIK / Satisfaction of patients submitted to PresbyLASIK refractive surgery

Resumo Objetivos: Avaliar a satisfação dos pacientes submetidos à cirurgia de Presbilasik central e determinar a prevalência de sintomas relatados após a cirurgia. Métodos: Este é um estudo descritivo, observacional, transversal, com dados obtidos de pacientes submetidos previamente ao PresbiLASIK. Resultados: A amostra consistiu de 45 pacientes, com média de idade de 57,7 (±7,19) anos. A nota média atribuída para a satisfação visual com o procedimento foi 8.9 (±1.0). A qualidade visual após a cirurgia foi classificada como igual ou melhor que a esperada por 84,5% dos pacientes e 31% apresentaram sintomas noturnos, como halos e raios de cometa. Conclusão: A qualidade de visão após o procedimento de PresbiLASIK foi altamente satisfatória para os pacientes. Fator determinante dessa satisfação é o processo de manejo das expectativas pré-operatórias dos pacientes, informando das possibilidades terapêuticas disponíveis, e, no caso da escolha cirúrgica, acerca das vantagens e limitações.

Abstract Objectives: Toassess the satisfaction of patients undergoing central Presbilasik surgery and to determine the age of patients who undergo PresbiLASIK and the prevalence of symptoms reported after surgery. Methods: This is a descriptive, observational, cross-sectional study with data collected from patients previously submitted to PresbiLASIK. Results: The sample consisted of 45 patients, with a mean age of 57.7 (±7,19) years. The average score attributed to visual satisfaction with the procedure was 8.9 (±1.0). Visual quality after surgery was classified as equal to or better than expected by 84.5% of the patients and 31% complained of nocturnal symptoms such as halos and comet rays. Conclusion: The quality of vision after the PresbiLASIK procedure was highly satisfactory for the patients. A determining factor for this satisfaction is the process of managing patients' preoperative expectations, informing them about the therapeutic possibilities available, and, in the case of surgical choice, about its advantages and limitations.

Interface Fluid Syndrome (IFS) following Toxic Anterior Segment Syndrome (TASS): not related to high intraocular pressure but to endothelial failure.

We describe the case of a 52-year-old female with past history of LASIK, 21 years earlier, without Fuchs' endothelial dystrophy, who underwent phacoemulsification and intraocular lens (IOL) implantation. During the early postoperative period severe corneal edema, anterior chamber cellularity and iris inflammation presented, accompanied by a clear space along the LASIK interface. Those findings were interpreted as part of a Toxic Anterior Segment Syndrome (TASS) and secondary interface fluid syndrome (IFS). When interface fluid was present, intraocular pressure (IOP) measured in the center of the cornea yielded very low values. In addition, applanation tonometry performed in the corneal periphery, as well as Schiotz tonometry and digital tonometry also indicated that the IOP was not high. Fluid in the interface persisted until a DMEK was carried out 11 months after the phacoemulsification surgery. Five days postoperatively the IFS resolved, confirmed by OCT imaging. The origin of IFS in this case was corneal edema secondary to endothelial cell dysfunction and it was not related to high IOP. This is the first reported case of IFS following TASS, the third case published of DMEK procedure used to solve endothelial failure-related IFS, and the case with the longest time of presentation after LASIK.

Post-LASIK Ectasia: Twenty Years of a Conundrum.

Corneal ectasia has emerged as a serious complication of laser vision correction (LVC) procedures since the first report by Seiler in 1998. Thereby, its prevention has become a major concern for refractive surgeons. Ectasia occurs due to biomechanical decompensation of the stroma, which may be related to a severe impact on corneal structure (i.e., attempted treatment for high myopia) or the altered biomechanical properties preoperatively. The current understanding is that a combination from those factors determines stability or ectasia progression after LVC. Abnormal corneal topography has been the most important surrogate for lower biomechanical properties, but novel imaging technologies such as tomography and biomechanical assessment have proven to enhance the ability for detecting mild ectatic disease, such as in the eyes with normal topography from patients with clinical ectasia in the fellow eye. Bohac and associates in a retrospective case series analyzed data from 30,167 eyes from 16,732 documented ten eyes (0.033%) of seven patients that developed post-LASIK ectasia. This data supports the concept that the actual incidence of ectasia has decreased from 0.66% reported by Pallikaris in 2001. This has been the result of major development related to the advanced screening strategies. Nevertheless, mysterious cases of ectasia still challenge the field and stimulated research in this field. Ocular allergy and eye rubbing may be a factor that triggered ectasia in such series. Artificial intelligence (AI) and machine-learning algorithms may play a definitive role for further enhancing ectasia risk assessment. Reporting ectasia after LVC is needed.

Epitelización de la interfase después de la técnica de LASIK / Interface epithelialization after surgery LASIK technique

La epitelización de la interfase es una de las complicaciones secundarias a la cirugía refractiva corneal mediante la técnica de LASIK y de SMILE, que pueden influir de forma negativa sobre la calidad visual de los pacientes operados. Se presenta una paciente femenina de 51 años de edad operada de astigmatismo hipermetrópico compuesto de ambos ojos, hace aproximadamente dos años, mediante la técnica de LASIK con microquerátomo pendular. Desde hace 5 meses aproximadamente comenzó con disminución de la visión del ojo derecho, agudeza visual sin corrección del ojo derecho de 0,1 y con corrección de 0,3. Al examen oftalmológico se observaron depósitos blanquecinos en la entrecara del flap corneal, correspondientes a la epitelización de la interfase. Se decidió levantar el flap corneal para eliminar el tejido epitelial de la entrecara; se realizó queratectomía fototerapéutica y se colocó mitomicina C al 0,02 por ciento. La evolución de la paciente fue satisfactoria. La agudeza visual posterior al mes sin corrección del ojo derecho mejoró a 0,5 y con corrección a 0,9, sin mostrar signos de recurrencia(AU)

Interface epithelialization is one of the secondary complications of LASIK and SMILE refractive corneal surgery which may negatively affect the visual quality of operated patients. A female 51-year-old patient presents who underwent surgery about two years ago for compound hyperopic astigmatism of both eyes by LASIK technique with a pendular microkeratome. Approximately five months ago the patient began experiencing gradual visual loss in her right eye. Visual acuity of the right eye was 0.1 without correction and 0.3 with correction. Ophthalmological examination found whitish deposits in the corneal flap interface revealing interface epithelialization. It was decided to lift the corneal flap to remove the epithelial tissue from the interface. Phototherapeutic keratectomy was performed and 0.02 percent mitomycin C applied on the area. The patient's evolution was satisfactory. At one month, visual acuity of the right eye had risen to 0.5 without correction and 0.9 with correction, and no signs of recurrence were observed(AU)

Epitelización de la interfase después de la técnica de LASIK / Interface epithelialization after surgery LASIK technique

La epitelización de la interfase es una de las complicaciones secundarias a la cirugía refractiva corneal mediante la técnica de LASIK y de SMILE, que pueden influir de forma negativa sobre la calidad visual de los pacientes operados. Se presenta una paciente femenina de 51 años de edad operada de astigmatismo hipermetrópico compuesto de ambos ojos, hace aproximadamente dos años, mediante la técnica de LASIK con microquerátomo pendular. Desde hace 5 meses aproximadamente comenzó con disminución de la visión del ojo derecho, agudeza visual sin corrección del ojo derecho de 0,1 y con corrección de 0,3. Al examen oftalmológico se observaron depósitos blanquecinos en la entrecara del flap corneal, correspondientes a la epitelización de la interfase. Se decidió levantar el flap corneal para eliminar el tejido epitelial de la entrecara; se realizó queratectomía fototerapéutica y se colocó mitomicina C al 0,02 por ciento. La evolución de la paciente fue satisfactoria. La agudeza visual posterior al mes sin corrección del ojo derecho mejoró a 0,5 y con corrección a 0,9, sin mostrar signos de recurrencia(AU)

Interface epithelialization is one of the secondary complications of LASIK and SMILE refractive corneal surgery which may negatively affect the visual quality of operated patients. A female 51-year-old patient presents who underwent surgery about two years ago for compound hyperopic astigmatism of both eyes by LASIK technique with a pendular microkeratome. Approximately five months ago the patient began experiencing gradual visual loss in her right eye. Visual acuity of the right eye was 0.1 without correction and 0.3 with correction. Ophthalmological examination found whitish deposits in the corneal flap interface revealing interface epithelialization. It was decided to lift the corneal flap to remove the epithelial tissue from the interface. Phototherapeutic keratectomy was performed and 0.02 percent mitomycin C applied on the area. The patient's evolution was satisfactory. At one month, visual acuity of the right eye had risen to 0.5 without correction and 0.9 with correction, and no signs of recurrence were observed(AU)

Application of corneal tomography before keratorefractive procedure for laser vision correction.

Ectasia after refractive surgery represents a major concern among refractive surgeons. Corneal abnormalities and preexisting corneal ectasia are the most important risk factors. Corneal topography and central corneal thickness are the factors traditionally screening for in refractive surgery candidates. Study of the anterior surface by Placido topography allows for identification of keratoconus before biomicroscopy. However, this is insufficient for the evaluation of pre-operative refractive surgery. There are cases of ectasia after laser in situ keratomilusis (LASIK) without identifiable risk factors such that there is a need to go beyond the corneal surface. A key requirement is quantifying susceptibility to corneal biomechanical instability and progression to ectasia. Tomographic indices derived from elevation maps and pachymetry spatial variation produce a Belin Ambrosio display final D index (BAD-D index), which has shown better results compared to surface curvature indices for detecting very mild forms of ectasia. A logistic regression formula, integrating age, residual stromal bed, and BAD-D (Ectasia Susceptibility Score, ESS) resulted in a significant improvement in accuracy, leading to 100% sensitivity and 94% specificity for detecting susceptible cases. A comprehensive corneal structural analysis based on corneal segmental tomography can detect susceptible corneas, which increases safety for refractive surgery patients.

3-Year follow-up after Lasik: assessing the risk factors for retreatment.

The purpose of this study was to evaluate the correlation of important risk factors for LASIK retreatment and the retreatment rate. A retrospective cohort study was conducted. Records of patients who underwent LASIK between January 2011 and January 2012 at the Zambrano-Hellion Medical Center, Tec de Monterrey (México), and posteriorly underwent LASIK retreatment were identified and risk factors to receive retreatment were assessed using relative risk. Main outcomes were retreatment rate, risk factors for retreatment, and uncorrected distance visual acuity (UDVA). 482 eyes from 241 patients were available for a 36-month follow-up analysis. 68.5 % had primary myopic LASIK; 37 % were ≤ 2 diopters (D), 52 % were > 2 and < 6 D, and 11 % were ≥ 6 D of myopia. 31.5 % of the eyes had hyperopic LASIK. Retreatment was performed in 6.85 % eyes. Myopia > 6 D (RR 4.13), hyperopic refraction (RR 3.18), and age > 40 (RR 3.07) were the most important risk factors for retreatment (P = 0.004, P = 0.007, P = 0.006, respectively). UDVA was ≥ 20/40 in 92.1 % and ≥ 20/20 in 81.6 % of the retreated eyes and 82 % of the eyes within ± 0.50 D of target refraction. Increasing degrees of myopia, followed by hyperopic refraction, and age were the most important associated factors to retreatment. LASIK retreatment was safe and effective.

Predictibilidad en la inducción de aberración esférica basada en la asfericidad corneal post LASIK en miopes / Predictability of spherical aberration based on corneal asphericity after myopic laser customized corneal ablation

Purpose: To determine the predictability of postoperative ocular spherical aberration (Z 4,0) based on postoperative corneal asphericity (Q value) in patients with myopic astigmatism. Design: Case series, retrospective. Methods: Wavefront-guided laser in situ keratomileusis (LASIK) was performed in 40 eyes of 23 patients using the Schwind Esiris Excimer Laser. Patients were evaluated preoperatively and 3 months postoperatively. Spherical aberration was measured with a COAS Shack-Hartmann wavefront sensor, and determined for a 6 mm analysis diameter zone. Corneal asphericity was measured with the Orbscan II topographer. Correlation and linear regression analysis was performed. A P value less than 0.05 was considered statistically significant. Results: Treated eyes had a mean manifest spherical error of ­2.98 + 1.36 Diopters (D), and a mean manifest astigmatic error of 0.52 + 0.46 D. The mean Q was -0.30 + 0.13 preoperatively and +0.03 + 0.22 postoperatively. The mean spherical aberration was 0.054 + 0.109 microns preoperatively and 0.262 + 0.135 microns postoperatively. We found a positive statistically signifi cant correlation between postoperative Q value and postoperative spherical aberration (r=0.367) (P=0.02). The postoperative Q value showed a low correlation with postoperative spherical aberration (R2=0.14). Conclusions: There was an increase in corneal asphericity and spherical aberration after surgery. Postoperative corneal asphericity is mildly associated with postoperative spherical aberration. Predictability of postoperative spherical aberration in terms of correlation with postoperative Q value was poor, suggesting that corneal asphericity is not a major predictor of spherical aberration induction.

Uso de adhesivo tisular de fibrina en el tratamiento de endocrecimiento epitelial severo posterior a Lasik. Reporte de caso / Use of fibrin tissue adhesive in the treatment of severe epithelial ingrowth after LASIK. Case Report

Objetivo: Describir el uso de adhesivo tisular de fibrina para el sellamiento del flap en el tratamiento de un paciente con endocrecimiento epitelial severo posterior a Laser In Situ Keratomileusis (LASIK). Diseño: Reporte de caso. Metodología: Reporte de Caso retrospectivo, mediante la recopilación de datos clínicos, imágenes, video y valoraciones postoperatorias. Resultado: Se reporta el uso de adhesivo tisular para el sellamiento del flap en el tratamiento de un paciente con endocrecimiento epitelial severo bilateral posterior a LASIK. Se documenta la recuperación de la agudeza visual en el ojo izquierdo (el ojo tratado) posterior a el uso de adhesivo tisular de fibrina para el sellamiento del flap en el tratamiento del endocrecimiento epitelial severo posterior a LASIK, llegando a una visión mejor corregida de 20/30. Conclusión: Se han descrito varias opciones de manejo: remoción mecánica junto con adhesión del flap mediante sutura, cianoacrilato, adhesivo tisular de fibrina o hidrogel. En la literatura mundial hay publicaciones de casos sobre el uso de adhesivo tisular de fibrina con buenos resultados, hasta la fecha este es el primer caso reportado en nuestro país, siendo demostrativo de buenos resultados, en cuanto a la tasa de recidiva y agudeza visual.

Purpose: To describe the use of fibrin adhesive for flap sealing in the treatment of a patient with severe epithelial ingrowth following Laser In Situ Keratomileusis (LASIK). Design: Case Report. Methods: Retrospective Case Report study, was performed by collecting clinical data, images, video and postoperative evaluations. Results: The use of tissue adhesive for flap sealing is reported in the treatment of a patient with severe bilateral epithelial ingrowth post-LASIK Subsequent recovery of the visual acuity in the left eye (treated eye) after the use of fibrin adhesive for fl ap sealing in the treatment of severe epithelial post-LASIK epithelial ingrowth, reaching a better-corrected vision of 20/30. Conclusion: Several management options have been described: mechanical removal along with flap adhesion by suture, cyanoacrylate, fibrin adhesive or hydrogel. In the world literature there are case reports on the use of fibrin adhesive with good results, to date this is the fi rst case reported in our country, demonstrating good results in terms of relapse rate and visual acuity.

Queratomileusis in situ asistida por Láser de Excímeros en la corrección del Astigmatismo Miópico / Excimer laser-assisted in situ keratomileusis for correction of myopic astigmatism

Introducción: la queratomielusis es un procedimiento quirúrgico de valor en el tratamiento de las ametropías.Objetivo: determinar los resultados de la queratomileusis "in situ" asistida por láser de excímeros (LASIK) en la corrección del astigmatismo miópico.Métodos: se realizó un estudio retrospectivo de 73 pacientes con astigmatismo miópico, operados con la técnica LASIK durante el año 2013 en el Hospital Militar Dr. Carlos J. Finlay. Las variables fueron: edad, sexo, agudeza visual con corrección pre y postoperatorias, equivalente esférico, complicaciones trans-operatorias, postoperatorias inmediatas y tardías. Para el procesamiento de la información se utilizó programa SPSS. Resultados: se mantuvo la agudeza visual previa corregida y no se detectaron complicaciones graves o irreversibles. Se observaron cambios significativos en las variables estudiadas con tendencia a la emetropía para un 92,3 por ciento.Conclusión: LASIK es una técnica segura y útil para la corrección del astigmatismo miópico, que permite mejorar la agudeza visual(AU)

Objetive: to determinate the results of ExcÝmer laser assisted ôin situõ keratomileusis (LASIK)in the correction of myopic astigmatism. Methods: a descriptive, retrospective study of the results was performed after surgery LASIK in 73 patients with myopic astigmatism. The variables were: age, sex, pre and postoperative visual acuity without correction, spherical equivalent, intraoperative complications, postoperative immediate and late complications. Significant changes were observed in all the variables studied tending to emmetropia and 92.3 percent. Results: with the use of this surgical technique the corrected previous visual acuity remained and not serious or irreversible complications were detected.Conclusions: Lasik is a safe and useful technique for the correction of myopic astigmatism that improves visual acuity(AU)

Queratomileusis in situ asistida por láser de excímeros en la corrección del astigmatismo miópico / Excimer laser-assisted in situ keratomileusis for correction of myopic astigmatism

INTRODUCCIÓN: la queratomielusis es un procedimiento quirúrgico de valor en el tratamiento de las ametropías. OBJETIVO: determinar los resultados de la queratomileusis "in situ" asistida por láser de excímeros (LASIK) en la corrección del astigmatismo miópico. MÉTODOS: se realizó un estudio retrospectivo de 73 pacientes con astigmatismo miópico, operados con la técnica LASIK durante el año 2013 en el Hospital Militar "Dr. Carlos J. Finlay". Las variables fueron: edad, sexo, agudeza visual con corrección pre y postoperatorias, equivalente esférico, complicaciones trans-operatorias, postoperatorias inmediatas y tardías. Para el procesamiento de la información se utilizó programa SPSS. RESULTADOS: se mantuvo la agudeza visual previa corregida y no se detectaron complicaciones graves o irreversibles. Se observaron cambios significativos en las variables estudiadas con tendencia a la emetropía para un 92,3 %. CONCLUSIÓN: LASIK es una técnica segura y útil para la corrección del astigmatismo miópico, que permite mejorar la agudeza visual.

OBJETIVE: to determinate the results of Excímer laser assisted "in situ" keratomileusis (LASIK)in the correction of myopic astigmatism. METHODS: a descriptive, retrospective study of the results was performed after surgery LASIK in 73 patients with myopic astigmatism. The variables were: age, sex, pre and postoperative visual acuity without correction, spherical equivalent, intraoperative complications, postoperative immediate and late complications. Significant changes were observed in all the variables studied tending to emmetropia and 92.3 %. RESULTS: with the use of this surgical technique the corrected previous visual acuity remained and not serious or irreversible complications were detected. CONCLUSIONS: Lasik is a safe and useful technique for the correction of myopic astigmatism that improves visual acuity.

Selección del paciente para cirugía refractiva: actualización / Update on the selection of patients for refractive surgery

Se realiza una búsqueda de la literatura más actualizada de los últimos cinco años enfocada en publicaciones de expertos y basada principalmente en una revisión realizada recientemente en la revista Current Opinion in Ophthalmology por un grupo de investigadores de la Universidad de Baltimore, Maryland (EE.UU.) sobre las contraindicaciones actuales de la cirugía refractiva. La Academia Americana de Oftalmología publica periódicamente directrices de patrones de práctica para la cirugía refractiva láser. El propósito de esta revisión es proporcionar una actualización sobre las contraindicaciones actuales y los detalles específicos relacionados con la cirugía refractiva láser(AU)

The present paper made a search for the most updated literature in the last five years, focused on expert publications and based on a recent review appeared in Current Opinion in Ophthalmology Journal by a group of researchers from the University of Baltimore in Maryland, United States of America on the current counter indications of the refractive surgery. The American Academy of Ophthalmology systematically publishes the practical guidelines for laser refractive surgery. The objective of this review was to provide update on the current counter indications and the specific details of the laser refractive surgery(AU)

Selección del paciente para cirugía refractiva: actualización / Update on the selection of patients for refractive surgery

Se realiza una búsqueda de la literatura más actualizada de los últimos cinco años enfocada en publicaciones de expertos y basada principalmente en una revisión realizada recientemente en la revista Current Opinion in Ophthalmology por un grupo de investigadores de la Universidad de Baltimore, Maryland (EE.UU.) sobre las contraindicaciones actuales de la cirugía refractiva. La Academia Americana de Oftalmología publica periódicamente directrices de patrones de práctica para la cirugía refractiva láser. El propósito de esta revisión es proporcionar una actualización sobre las contraindicaciones actuales y los detalles específicos relacionados con la cirugía refractiva láser(AU)

The present paper made a search for the most updated literature in the last five years, focused on expert publications and based on a recent review appeared in Current Opinion in Ophthalmology Journal by a group of researchers from the University of Baltimore in Maryland, United States of America on the current counter indications of the refractive surgery. The American Academy of Ophthalmology systematically publishes the practical guidelines for laser refractive surgery. The objective of this review was to provide update on the current counter indications and the specific details of the laser refractive surgery(AU)

Corrección de la miopía mediante cirugía Lasik / Myopia correction by LASIK surgery

Objetivo: identificar resultados refractivos y las complicaciones tras la corrección de la miopía mediante Lasik.Métodos: se dividieron los 241 ojos que se operaron por Lasik en cuatro grupos según grado de miopía y astigmatismo. Tras un estudio oftalmológico preoperatorio completo y después de ser intervenidos quirúrgicamente, se evaluó la agudeza visual en los miopes y astigmatas, así como las complicaciones, intraoperatorias y posoperatorias durante el primer mes con seguimiento de tres meses. Resultados: se mantuvo la agudeza visual previa corregida y no se detectaron complicaciones graves o irreversibles. Conclusiones: Lasik es una técnica segura y útil para la corrección de la miopía, permite mejorar la agudeza visual espontánea y disminuir la corrección óptica(AU)

Objective: identify refractive results and complications following myopia correction by LASIK. Methods: 241 eyes which had been operated on by LASIK were divided into 4 groups based on the degree of myopia and astigmatism. Patients underwent a complete preoperative ophthalmological study before they were operated on. After surgery, myopic and astigmatic patients were evaluated for visual acuity, as well as intraoperative and postoperative complications during the first month and in a three-month follow-up period. Results: previous corrected visual acuity was preserved and no serious or irreversible complications were detected. Conclusions: LASIK is a safe myopia correction technique useful to improve spontaneous visual acuity and reduce optical correction(AU)