Ten-year prevalence of rhegmatogenous retinal detachment in myopic eyes after posterior chamber phakic implantable collamer lens.

PURPOSE: To determine and compare the prevalence of rhegmatogenous retinal detachment (RRD) in myopic eyes operated of posterior chamber phakic implantable collamer lens (ICL) with a control group of nonoperated myopic eyes over 10 years of follow-up. SETTING: Clinica Baviera, Madrid, Spain. DESIGN: Retrospective cohort study. METHODS: There were 2 study cohorts: one with patients operated with ICL and a control group of nonoperated patients. The primary outcome of RRD was measured retrospectively, first through chart review of ICL-operated patients with at least 10 years of follow-up, then secondarily through telephone questionnaires and specialist verification for those with incomplete follow-up. Prevalence and incidence were calculated and compared, as well as their possible association with other risk factors. RESULTS: 58 operated patients completed follow-up in our clinic. A survey of 3849 more patients was conducted for a total of 252 operated with a mean spherical equivalent (SEQ) of -12.6 diopters (D) and 221 nonoperated with a mean SEQ of -10.5 D. 7 eyes developed an RRD in the operated vs 5 eyes among the nonoperated (prevalence 1.71% vs 1.25%, respectively, P = .773). The equivalence tests, the two one-sided test and the null hypothesis test between groups, were within the 0.02 limits, confirming the null hypothesis, and compared survival curves did not show significant differences ( P = .59). CONCLUSIONS: ICL implantation surgery for high myopia did not affect the prevalence of RRD in operated eyes compared with similar nonoperated eyes, in this long-term study.

Trifocal IOL Implantation in Eyes With Previous Laser Corneal Refractive Surgery: The Impact of Corneal Spherical Aberration on Postoperative Visual Outcomes.

PURPOSE: To analyze corneal aberrations and factors affecting visual outcomes after implantation of a trifocal intraocular lens (IOL) in eyes previously treated with laser corneal refractive surgery. METHODS: This retrospective case series included 222 consecutive eyes implanted with the trifocal FineVision Micro-F IOL (PhysIOL) after laser corneal refractive surgery. The series was divided into two groups according to safety outcomes after lensectomy: eyes with loss of one or more lines of corrected distance visual acuity (CDVA) [n = 59, 26.5%]) (failed eyes group) and eyes with no loss or gain in CDVA lines (n = 163, 73.4%]) (successful eyes group). Distribution of tomographic corneal aberrations (spherical aberration [Z40], comatic and root mean square of higher order aberrations [RMS-HOA]), laser corneal refractive surgery error, kappa angle, and CDVA after laser corneal refractive surgery were compared among both groups. RESULTS: Mean CDVA after lensectomy was 0.15 ± 0.07 logMAR (range: 0.05 to 0.30 logMAR) versus 0.03 ± 0.04 logMAR (range: 0.00 to 0.15 logMAR) in the failed and successful eyes groups, respectively (P < .001). Comparison of both groups showed that failed eyes had a statistically significantly higher grade of hyperopic laser corneal refractive surgery than successful eyes measured as mean sphere (+0.71 ± 3.10 diopters [D] [range: -7.75 to +6.00 D] vs -0.46 ± 3.70 D [range: -10.75 to +6.00 D], P < .01), spherical equivalent (+0.27 ± 3.10 D [range: -8.00 to +5.50 D] vs -0.97 ± 3.60 D [range: -12.50 to +4.90 D], P < .05), and percentage of hyperopic laser corneal refractive surgery (64% vs 43.5%, P < .05). Corneal aberration analysis showed that mean Z40 values were significantly more negative in the failed eyes group than in the successful eyes group (+0.07 ± 0.40 mm [range: -0.82 to +0.65 mm] vs +0.18 ± 0.37 mm [range: -0.79 to +0.87 mm], P < .05). Laser corneal refractive surgery cylinder was distributed homogeneously between both groups, as well as coma and RMS-HOA, kappa angle, and CDVA after laser corneal refractive surgery that were not statistically significant. CONCLUSIONS: Surgeons should consider tomographic corneal spherical aberration after implantation of a trifocal IOL in eyes after keratorefractive surgery, particularly in eyes previously treated with hyperopic laser corneal refractive surgery, to prevent loss of lines of visual acuity after lensectomy. [J Refract Surg. 2022:38(4):222-228.].

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study.

BACKGROUND: Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS: This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS: Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 µm with the ERM to 313.70 ± 36.98 µm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION: PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

Aberrometric, Keratometric, and Visual Outcomes After Trans-Epithelial Topography-Guided Phototherapeutic Keratectomy for the Treatment of Irregular Corneas.

PURPOSE: To assess the safety, aberrometric and keratometric changes, and stability of trans-epithelial topography-guided phototherapeutic keratectomy (TE-TG-PTK) with mitomycin C (MMC) using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. METHODS: This is a retrospective case series including 57 eyes that underwent TE-TG-PTK + MMC using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. CDVA, manifest refraction (MR), keratometry readings, and aberrometry readings were analyzed at 1, 3, 6, and 12 months. RESULTS: Causes of corneal irregularity included non-infectious leucoma (n=23), infectious leucoma (n=7), adenoviral keratitis (n=20), corneal haze (n=2), post-penetrant keratoplasty (PKP) (n=1), and others (n=4). Overall, 76% of the eyes (n=40) gained lines of vision; patients gained 1, and 2 or more lines of vision in 76%, and 38% of cases, respectively. Only 1 patient (2%) lost 5 lines of vision. Mean preoperative CDVA (LogMAR) was 0.37 ±0.31 and improved to 0.14 ±0.18 (p<0.001) at final follow-up (12 months). CDVA remained unchanged in 10 eyes (21%). No significant changes were observed in mean keratometry (Kmean) and keratometric astigmatism readings. Regarding aberrometry, only changes in coma proved to be significant 6 months after surgery (P<0.01). No intraoperative/postoperative complications were reported. CONCLUSION: At final follow-up, significant improvements were observed in CDVA and coma. TE-TG-PTK + MMC proved to be an effective and safe procedure for the treatment of corneal irregular astigmatism due to several causes.

Bilateral Refractive Lens Exchange With Trifocal Intraocular Lens for Hyperopia in Patients Younger Than 40 Years: A Case-Control Study.

PURPOSE: To evaluate visual outcomes, satisfaction, and spectacle independence in non-presbyopic hyperopic patients who underwent bilateral refractive lens exchange with a trifocal intraocular lens (IOL) and to compare them with presbyopic hyperopic patients. METHODS: In this retrospective study, patients younger than 40 years underwent bilateral refractive lens exchange with a diffractive trifocal IOL (FineVision Micro F; PhysIOL SA) for hyperopia with at least 3 months of follow-up. A control group of patients older than 50 years was matched by axial length, sex, and follow-up. Safety, efficacy, predictability, patient satisfaction, and spectacle independence were evaluated. RESULTS: One hundred thirty-three patients (average age = 36.94 ± 2.91 years; range = 21.50 to 40 years) were included in this study. After a mean follow-up of 8.83 ± 5.69 months (range = 2.75 to 77.63 months), the safety and efficacy indexes and predictability within ±1.00 diopters (D) were 1.02%, 0.98%, and 99.62%, respectively, which was not different from the control group (P > .05). No intraoperative complications were recorded. The only postoperative complication was posterior capsule opacification in 21 eyes (7.89%), which was similar to the control group (P > .05). Ninety-seven percent of patients in each group expressed that they were satisfied and all of them in each group reported that they did not use spectacles for distance, intermediate, or near vision. CONCLUSIONS: Refractive lens exchange and trifocal IOL implantation for hyperopia in patients without presbyopia provided the same good visual outcomes as in presbyopic patients with a high rate of patient satisfaction and spectacle independence. [J Refract Surg. 2021;37(8):524-531.].

Retinal detachment after phacoemulsification in refractive surgery clinics: a large series analysis with variable follow-up during 16 years.

PURPOSE: To determine the long-term incidence of pseudophakic retinal detachment (PRD) after phacoemulsification and the weight of the main risk factors in the appearance of such complication in a large sample. To implement a customized formula and a software calculation program able to quantify the risk of suffering PRD applicable to all lens extraction patients. METHODS: Retrospective cumulative risk analysis conducted on 178,515 eyes operated under similar conditions in a group of refractive surgery clinics (Clínica Baviera SL) located in a relatively limited geographical area (Spain). A survival analysis was performed and the data were modelled using the Weibull regression to determine the risk over a period of 16 years and to estimate the association of different risk factors: sex, age, axial length (AXL) of the eye, intraoperative posterior capsule rents (PCR), and YAG laser capsulotomies. The resulting estimates were translated into a predictive equation for hazard rates and survival probabilities. Later, an application was developed to make prediction available for the clinical community in order to estimate the potential risk of any hypothetical case before lens surgery. RESULTS: Globally, 1521 (0.85%) cases of PRD were diagnosed during the period. The risk for PRD was significantly greater in males (5.48 [2.94-10.2]; p < 0.001), in long eyes (1.24 [1.21-1.26]; p < 0.001), and also after posterior capsule rents (13.97 [11.61-16.82]; p < 0.001). Posterior capsule rupture increased the risk of PRD up to fourteen times. CONCLUSIONS: From weaker to stronger impact, age, axial length, sex, and intraoperative posterior capsule rent were significant risk factors for the appearance of PRD after lens extraction.

Diffractive trifocal pseudophakic intraocular lenses in high myopic eyes: 2-year assessment after implantation.

PURPOSE: To assess the visual outcomes and ocular safety when implanting diffractive trifocal intraocular lenses in a population of high myopic eyes. METHODS: This is a retrospective cumulative clinical study. Two hundred five myopic eyes consecutively operated in the hospitals of Clínica Baviera, Spain, were included. All eyes presented an axial length equal or greater than 26 mm and were treated and examined following the same methodology for at least 2 years. Refractive and visual outcomes and also intraoperative or postoperative complications were tabulated for later analysis. Furthermore, a subjective questionnaire was completed by all patients at the end of the follow-up period. RESULTS: The percentage of eyes that lost two or more lines of corrected distance visual acuity (CDVA) was 5.9%, 11.5% and 10.7% 3, 12 and 48 months after surgeries respectively. However, 33% of eyes gained two or more lines of CDVA 2 years after implantation. Excimer laser correction of residual refractive error was performed after implants in 29.75% of eyes. Uncorrected distance visual acuities (UDVAs) were significantly better 1 year (0.10 ± 0.3 logMAR) and 2 years after the surgeries (0.10 ± 0.14 logMAR) compared with those estimated 3 months postoperatively (0.14 ± 0.15 logMAR; Kruskal-Wallis; p < 0.001). Mean near and intermediate uncorrected visual acuities remained stable from the first to the last postoperative visit (Kruskal-Wallis; p > 0.05 for all comparisons). Of the eyes, 27.31% were diagnosed and treated with yttrium aluminum garnet (YAG) laser after being diagnosed as having posterior capsular opacification. Retinal detachment (RD) was diagnosed in six eyes (2.92%). CONCLUSIONS: Diffractive trifocal IOLs have good efficacy and predictability in high myopic eyes. Retinal concerns should lead the surgeons to explore other alternatives for refractive surgery in young patients without cataracts.

Dynamic Assessment of Light-Induced Vaulting Changes of Implantable Collamer Lens With Central Port by Swept-Source OCT: Pilot Study.

PURPOSE: To assess dynamic variations in vault induced by changes in brightness in eyes implanted with phakic collamer intraocular lens (pIOL) with central port for correction of myopia, defining new parameters of vaulting measurement. METHODS: We used a noninvasive Fourier-domain swept-source anterior-segment optical coherence tomography (AS-OCT) system to dynamically evaluate the shifts between the pIOL and anterior chamber structures under changing light conditions. For each eye assessed, we measured vault interval (VI), which we define based on central vault values in maximum mydriasis and in maximum miosis after light-induced changes in pupil diameter, and vault range (VR), which we define as the absolute difference between the VI values. RESULTS: The pilot study sample comprised 39 eyes (23 patients) previously implanted (mean 107 ± 156 days) with a pIOL. A significant difference in vault value was found when maximum and minimum pupil size was assessed under changing external light conditions (P < 0.001). The mean VR from scotopic (0.5 lux) to photopic (18,500 lux) light conditions was 167 ± 70 µm. CONCLUSIONS: Vault is continuously affected during movements of the pupil induced by external luminance. TRANSLATIONAL RELEVANCE: Quantifiable dynamic parameters VR and VI obtained with this AS-OCT device describe the position of the pIOL in the posterior chamber of the eye in a more accurate and real way than static vault measurements, and may contribute to improved understanding of the behavior of the pIOL in terms of safety.

Genome Sequence of Bacillus halotolerans Strain MS50-18A with Antifungal Activity against Phytopathogens, Isolated from Saline Soil in San Luís Potosí, Mexico.

Bacillus halotolerans strain MS50-18A, isolated from saline soil, possesses antifungal activity toward root rot causal phytopathogens and has friendly interactions with the chili pepper plant. The draft genome sequence is 4.06 Mb in length and contains 4,215 genes. Genes related to glycine/betaine uptake and bacilysin biosynthesis are present, supporting its saline stress tolerance and antifungal activity.

Nd:YAG Capsulotomy Rates With Two Trifocal Intraocular Lenses.

PURPOSE: To compare Nd:YAG capsulotomy rates following implantation of two diffractive trifocal intraocular lenses (IOLs). METHODS: This multi-center retrospective analysis included patients who underwent uncomplicated lens phacoemulsification and were implanted with a diffractive trifocal IOL: FineVision MicroF (PhysIOL, Liège, Belgium) or AT Lisa tri 839MP (Carl Zeiss Meditec, Jena, Germany). All surgeries were performed during the same period. The postoperative follow-up period was at least 1 year. Chi-square and Kaplan-Meier tests analyzed non-parametric estimates for survival/failure functions. The Wilcoxon (Breslow) test compared Nd:YAG capsulotomy rates between the two groups. RESULTS: Of 5,130 eyes included, 3,387 were implanted with the FineVision MicroF IOL and 1,743 with the AT Lisa tri 839MP IOL. There were no statistical differences in age, axial length, or IOL power between groups. Nd:YAG capsulotomies were necessary in 330 eyes (9%) in the FineVision group and 408 eyes (23%) in the AT Lisa tri group (P < .001). The probability of having Nd:YAG capsulotomy up to 9 months postoperatively was equal for both lenses. Beyond 9 months, the Nd:YAG capsulotomy rate increased significantly more in the AT Lisa tri group, reaching a probability of 35% for eyes with a follow-up of 34 to 44 months, whereas in the FineVision group the probability was 14% after a follow-up of 37 to 47 months. The differences in survival (without Nd:YAG capsulotomy)/failure (with Nd:YAG capsulotomy) functions were significant (P < .001). CONCLUSIONS: Eyes implanted with the FineVision MicroF IOL required significantly fewer Nd:YAG laser capsulotomies than those with the AT Lisa tri 839MP IOL during the first years after implantation. The design of the IOL platforms could account for these differences. [J Refract Surg. 2016;32(11):748-752.].

Long-term evaluation of eyes with central corneal thickness <400 µm following laser in situ keratomileusis.

PURPOSE: To study long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) in eyes with a postoperative thin central cornea. METHODS: In this retrospective observational case series, we studied 282 myopic eyes with a normal preoperative topographic pattern and postoperative thin corneas (<400 µm) that had at least 3 years of follow-up after LASIK in three private clinics. The main outcome measures were safety, efficacy, predictability, percent tissue altered, and complications. RESULTS: The mean postoperative central corneal thickness was 392.05 µm (range: 363.00-399.00 µm). After a mean follow-up of 6.89±2.35 years (standard deviation), the safety index was 1.17, the efficacy index was 0.94, and predictability (±1.00 diopter [D]) was 73.49. The mean residual stromal bed thickness was 317.34±13.75 µm (range: 275-356 µm), the mean flap thickness was 74.76±13.57 µm (range: 55-124 µm), and the mean percent tissue altered was 37.12%±3.62% (range: 27.25%-49.26%). No major complications were recorded. CONCLUSION: LASIK with a resultant central cornea thickness <400 µm seems to be effective, safe, and predictable provided that preoperative topography is normal and the residual stromal bed thickness is >275 µm.

Visual outcomes in adult amblyopic eyes with moderate myopia after corneal laser surgery versus copolymer phakic intraocular lens implant.

PURPOSE: To assess visual acuity and refractive correction in moderately myopic adult eyes with suboptimal preoperative corrected distance visual acuity (CDVA) after laser in situ keratomileusis (LASIK) or insertion of a posterior chamber Implantable Collamer Lens phakic intraocular lens (pIOL). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Torrevieja Hospital, Madrid, Spain. DESIGN: Retrospective study. METHODS: The study sample included 1310 eyes that had LASIK and 94 that had insertion of a pIOL from July 2002 to September 2013. Suboptimal preoperative CDVA was defined as equal to logMAR 0.15 or below and moderate myopia as a spherical equivalent of -5.0 to -10.0 diopters (D). RESULTS: The preoperative mean CDVA was 0.22 logMAR ± 0.09 (SD) in the LASIK group and 0.23 ± 0.09 logMAR in the pIOL group. Postoperative uncorrected distance visual acuity (UDVA) was 0.13 ± 0.12 logMAR in the laser group and 0.12 ± 0.09 logMAR in the pIOL group, with a postoperative CDVA of 0.11 ± 0.10 logMAR and 0.08 ± 0.07 logMAR, respectively. CONCLUSIONS: Compared with preoperative values, amblyopic eyes with moderate myopia having LASIK or implantation of a pIOL demonstrated a statistically significant improvement in UDVA and CDVA (P < .001). The pIOL group performed significantly better than the LASIK group in terms of safety and efficiency. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Implantable Collamer Lens for Myopia: Assessment 12 Years After Implantation.

PURPOSE: To evaluate the long-term refractive and visual stability and the risks related to the implantation of Implantable Collamer Lens (ICL; STAAR Surgical, Monrovia, CA) phakic intraocular lens (PIOL) for myopia. METHODS: This retrospective, consecutive, cumulative clinical study was performed in a group of 144 eyes implanted with ICL PIOL for myopia. Only the cases with clinical data available 12 years after the implantation were included in the series. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity, spherical equivalent, refractive astigmatism, endothelial cell density, ICL vaulting, and postoperative complications were analyzed. RESULTS: Mean spherical equivalent refraction was -16.90±4.26 diopters (D) preoperatively and -1.77±1.93 D 12 years postoperatively. Mean CDVA at the first and last visit were 0.31±0.19 logMAR and 0.22±0.22 logMAR, respectively (Mann-Whitney U test, P<.001). Twelve years postoperatively, 8.9% of eyes had lost more than two lines of CDVA. The incidence of clinically relevant cataracts (13.88%) was significantly linked to the use of the V3 model ICL (chi-square test, P=.007). During the follow-up period, a significant reduction in PIOL vaulting was observed (Kruskal-Wallis test, P<.05), and the mean endothelial cell density decreased by 19.75%. CONCLUSIONS: The ICL PIOL provided good refractive outcomes and stability in the long term. The incidence of cataracts is low when the latest models of this PIOL are used.

Incidence of corneal infections after laser in situ keratomileusis and surface ablation when moxifloxacin and tobramycin are used as postoperative treatment.

PURPOSE: To assess the incidence, culture results, and visual outcomes of infectious keratitis after laser in situ keratomileusis (LASIK) and surface ablation when topical moxifloxacin was added to postoperative prophylaxis with tobramycin. SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Bilbao, Spain. DESIGN: Retrospective case series review. METHODS: The medical records of 55 255 patients (108 014 eyes) who had LASIK and surface ablation were reviewed to identify cases of infectious keratitis. The incidence, risk factors, clinical course, days to diagnosis, treatment, and final visual outcomes were recorded. These data were compared with previously published data of 221 437 eyes that received postoperative tobramycin alone. RESULTS: Post-LASIK infectious keratitis was diagnosed in 10 eyes (9 patients) and post-surface ablation infectious keratitis in 11 eyes (10 patients). The onset of infection was early in 40.00% of cases after LASIK and in 36.36% after surface ablation. Cultures were positive in 2 cases after surface ablation. Immediate flap lifting and irrigation with antibiotics were performed in all eyes after LASIK. The final corrected distance visual acuity was 20/20 or better in 7 cases after LASIK (70.00%) and 7 cases after surface ablation (63.64%) and 20/40 or better in all cases after LASIK or surface ablation. CONCLUSIONS: The incidence of infectious keratitis decreased from 0.025% to 0.011% (P < .001) per procedure after LASIK and from 0.200% to 0.066% (P < .001) after surface ablation. Infectious keratitis was less frequent after LASIK than after surface ablation. The frequency of infection, mainly early-onset infection, was lower when the postoperative treatment was tobramycin and moxifloxacin rather than tobramycin alone. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular pressure during the early postoperative period after 100 consecutive implantations of posterior chamber phakic intraocular lenses with a central hole.

PURPOSE: To study changes in intraocular pressure (IOP) during the early postoperative period in eyes having implantation of a posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens V4c). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. DESIGN: Case series. METHODS: This retrospective review included the first consecutive eyes having implantation of a spherical or toric myopic pIOL with a central hole at Clínica Baviera from December 2011 to June 2012 by the same experienced surgeon. The IOP was evaluated preoperatively and 1 day, 1 week, and 1 month postoperatively. RESULTS: The study comprised 100 eyes. The mean IOP changed from 14.6 mm Hg ± 3.4 (SD) (range 8 to 26 mm Hg) preoperatively to 14.5 ± 4.6 mm Hg (range 6 to 30 mm Hg) 1 day postoperatively, 14.2 ± 4.2 mm Hg (range 6 to 29 mm Hg) at 1 week, and 12.3 ± 3.4 mm Hg (range 9 to 24 mm Hg) at 1 month. No statistically significant changes were detected over time postoperatively (P>.2). No perioperative complications associated with the implantation of the pIOL were recorded. No pIOLs were explanted, no toric pIOL rotation was detected, and no pupillary block or acute angle closure was observed. CONCLUSION: The short-term clinical data for the new pIOL model with the central hole (KS-Aquaport) suggest that it is a safe and effective means for controlling postoperative IOP.

Indications for intrastromal corneal ring segments in ectasia after laser in situ keratomileusis.

PURPOSE: To evaluate clinical results of intrastromal corneal ring segments (ICRS) in a large series of post-laser in situ keratomileusis (LASIK) ectasia and determine which clinical parameters were related to the success of this technique. SETTINGS: Vissum Corporation and Clínica Baviera Group, Alicante, Spain. DESIGN: Case series. METHODS: Intrastromal corneal ring segments were implanted to correct the spherocylindrical error and improve visual acuity. Based on a previously described grading system, the best indications for ICRS implantation to treat post-LASIK ectasia were evaluated. The variables related to favorable outcomes over a 12-month follow-up were determined. RESULTS: Patients who lost 2 or more lines due to post-LASIK ectasia had a mean gain of +2.89 lines of corrected distance visual acuity (CDVA) after ICRS implantation (P<.001) and a mean CDVA of 0.81 (95% confidence interval, 0.74-0.88). In contrast, patients who did not lose vision after ectasia had a mean loss of -2.00 lines of CDVA after the ICRS implantation (P<.001). The odds ratio of a gain of at least 1 line of CDVA was 18 times greater for those who had lost 2 or more lines of CDVA after ectasia. CONCLUSIONS: The best indications for ICRS were a loss of 2 or more lines of CDVA after ectasia and post-LASIK ectasia grade 4. Patients who do not have vision loss after ectasia and those classified as grade 1 should not be considered candidates for ICRS implantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Clinical grading of post-LASIK ectasia related to visual limitation and predictive factors for vision loss.

PURPOSE: To evaluate and characterize the main clinical features of post-laser in situ keratomileusis (LASIK) ectasia, propose a grading system based on visual limitation, and identify predictive factors related to the degree of visual loss. SETTING: Vissum Corp., Alicante, Spain. DESIGN: Retrospective case series. METHODS: This study comprised consecutive eyes with corneal ectasia after LASIK from 1996 to 2010. Main outcomes were post-LASIK ectasia corrected distance visual acuity (CDVA), CDVA loss, spherical equivalent (SE), and the corneal bulge (delta K). These outcomes were correlated with the residual stromal bed, ablation depth, ablation ratio (ablation depth:pachymetry), corneal depth (flap + ablation depth), and corneal ratio (corneal depth:pachymetry) to characterize their role in the severity of the disease. RESULTS: The mean post-LASIK ectasia CDVA, CDVA loss, SE, and delta K were 0.20 logMAR ± 0.18 (SD), -0.13 ± 0.15 logMAR, -3.80 ± 3.86 diopters (D), and 4.77 ± 4.23 D, respectively. The ablation ratio had the strongest correlation with post-LASIK ectasia CDVA (ρ = 0.477 and P<.001), whereas the corneal ratio had the strongest correlation with the post-LASIK ectasia SE and delta K (ρ = -0.614 and ρ = 0.453, respectively: P<.001). The ablation ratio was the main predictive factor for post-LASIK ectasia CDVA loss (relative risk, 2.04; P=.049). CONCLUSIONS: The grading system based on visual limitation was consistently represented by differences in CDVA loss, SE, and delta K. A high amount of tissue removed by the refractive procedure was associated with greater corneal biomechanical destabilization, increased corneal steepening, and a worse prognosis.

Long-term comparison of laser in situ keratomileusis versus laser surface ablation in corneas thinner than 470 µm.

PURPOSE: To compare long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) and laser surface ablation in eyes with corneas thinner than 470 µm. SETTING: Private clinics, Spain. DESIGN: Comparative case series. METHODS: The study comprised eyes with myopic error and corneas thinner than 470 µm that had at least 2.9 years of postoperative follow-up between September 2001 and June 2007. The main outcome measures were safety, efficacy, predictability, and complications. RESULTS: The mean central corneal thickness was 462.0 µm (range 440 to 469 µm) in the LASIK group (n = 40) and 458.1 µm (range 420 to 469 µm) in the laser surface ablation group (n = 88). All eyes had normal preoperative topography. In the LASIK group after a mean follow-up of 5.1 years ± 1.5 (SD), the safety index was 1.07, efficacy was 0.99, and predictability (± 1.00 diopter [D]) was 0.93. In the laser surface ablation group after a mean follow-up of 4.8 ± 1.3 years, the safety index was 1.01, efficacy was 0.93, and predictability (± 1.00 D) was 0.92. The mean residual corneal bed thickness in all eyes was 345 ± 25 µm (range 270 to 399 µm). No major complications occurred. The safety index was better in the LASIK group than in the laser surface ablation group. CONCLUSION: Both techniques were effective, safe, and predictable in eyes with corneas thinner than 470 µm, normal preoperative topography, and a residual corneal bed thickness greater than 250 µm.