Severe epithelial ingrowth after pars plana vitrectomy ten years after LASIK relifting.

Epithelial ingrowth is one of the most significant complications of Laser in Situ Keratomileusis (LASIK) refractive surgery. We present the case of a 72-year-old male with a history of myopic LASIK (1999), who underwent cataract surgery and a second thin LASIK sub-Bowman flap to correct refractive error. Then, three months after pars plana vitrectomy for an epiretinal membrane, the patient complained of progressive vision loss. A diffuse haze of the corneal stroma that did not exist before surgery was observed. As the main suspicion was epithelial ingrowth, the flap was lifted and meticulous de-epithelialization of the stromal bed was performed. Mitomycin C 0.02% was applied, the flap was sutured with 10-0 Nylon, and a bandage contact lens was placed. The epithelialization of the interface after vitrectomy in a patient with LASIK could occur even when it is a rare complication and without obvious flap traumatism.

Evaluación de las modificaciones biométricas del ojo durante la succión del LASIK / Assessment of the biometric modifications of the eye in LASIK during suction

Objetivo Estudiar las modificaciones biométricas del globo ocular durante la succión en la cirugía de queratomileusis in situ asistida por láser (LASIK). Métodos Estudio observacional transversal. Se estudiaron 43 pacientes intervenidos de miopía y astigmatismo miópico. La edad media fue de 38,3 ± 11,5 años, 19 eran mujeres (44,2%). Se realizó una cirugía LASIK convencional con microqueratomo manual. Antes y durante la maniobra de succión se midieron los siguientes parámetros mediante una sonda biométrica de 11 Mhz: profundidad acuosa (AQD), espesor del cristalino (EC), longitud de la cavidad vítrea (LCV) y longitud axial (LA). Se utilizó la prueba t pareada para comparar las medidas biométricas antes y durante la succión. Resultados El equivalente esférico medio fue de -4,5 ± 2,3 dioptrías. Durante la succión, la AQD no aumentó significativamente (p = 0,231). Sin embargo, la LA y LCV aumentaron en 0,12 mm y 0,2 mm, respectivamente (p = 0,039 y < 0,01) y EC disminuyó en 0,20 mm (p < 0,01). La LA aumentó en 42% de los ojos y disminuyó en 16%, mientras que la LCV aumentó en 70% de los ojos y disminuyó en 9%, y el EC se redujo en 67% de los ojos. Conclusiones Las maniobras de succión durante la cirugía LASIK producen cambios de poca magnitud en el globo ocular, principalmente disminución de EC y aumento de LCV y LA. Por lo tanto, es esperable que estas modificaciones produzcan alteraciones anatómicas mínimas (AU)

Purpose To study the biometric modifications of the eyeball during suction in laser assisted in situ keratomileusis (LASIK). Methods Observational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3±11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 MHz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction. Results The mean spherical equivalent refractive error was −4.5±2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p<0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes. Conclusions Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations (AU)

Assessment of the biometric modifications of the eye in LASIK during suction.

PURPOSE: To study the biometric modifications of the eyeball during suction in Laser assisted in Situ Keratomileusis (LASIK). METHODS: Observational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3 ±â€¯11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 Mhz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction. RESULTS: The mean spherical equivalent refractive error was -4.5 ±â€¯2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p < 0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes. CONCLUSIONS: Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations.

Aberraciones corneales en pacientes con indicación de cirugía refractiva con láser de excímeros

Objetivo: Determinar las aberraciones corneales en pacientes con indicación de cirugía refractiva con láser de excímeros. Métodos: Se realizó un estudio retrospectivo, transversal, descriptivo, con 161 ojos de 81 pacientes adultos, de ambos sexos con indicación de cirugía con láser de excímeros para la corrección de su defecto refractivo. Se definieron como variables edad, sexo, desenfoque, astigmatismo, coma, trefoil y aberración esférica, las que se determinaron por el estudio topográfico de rutina con el topógrafo KeratronTM Scout, Optikon. Resultados: Se obtuvieron los siguientes valores promedios: desenfoque -4,17 ± 0,29 D (-16,15 a 8,5 D) y absoluto 4,94 ± 0,199 (10 a 16,5 D), astigmatismo -1,56 ± 0,09 D (-9,44 a -0,09 D), coma 0,25 ± 0,016 (0,01 a 1,5 D), trefoil 0,204 ± 0,016 (0,01 a 1,18 D) y aberración esférica 0,316 ± 0,018 D (0,0 a 1,27D). En el 75 % de los casos los valores absolutos de desenfoque fueron inferiores a 6,56, de astigmatismo inferior a 0,33 D, de coma menor que 0,33, trefoil inferior a 0,25 y aberraciones esféricas menores que 0,32 D. Conclusiones: Los valores promedio de las aberraciones corneales desenfoque, astigmatismo, coma, trefoil y aberración esférica se encuentran en el rango de los valores reportados en la literatura científica y la distribución de los valores de las aberraciones corneales presentan desplazamiento de la mayoría de los casos hacia los valores más bajo del rango de determinación.

Objective: To determine corneal aberrations in patients indicated for excimer laser refractive surgery. Methods: A retrospective, cross-sectional and descriptive study was carried out with 161 eyes of 81 adult patients of both sexes with indication of excimer laser surgery for the correction of their refractive defect. Age, sex, defocus, astigmatism, coma, trefoil and spherical aberration were defined as variables, determined by routine topographic study with the KeratronTM Scout topographer, Optikon. Results: The following average values were obtained: defocus of -4.17 ± 0.29 D (-16.15 to 8.5 D) and absolute of 4.94 ± 0.199 (10 to 16.5 D), astigmatism of -1.56 ± 0.09 D (-9.44 to -0.09 D), coma of 0.25 ± 0.016 (0.01 to 1.5 D), trefoil of 0.204 ± 0.016 (0.01 to 1.18 D) and spherical aberration of 0.316 ± 0.018 D (0.0 to 1.27D). In 75 % of the cases, the absolute values for defocus were lower than 6.56; for astigmatism, lower than 0.33 D; for coma, lower than 0.33; for trefoil, lower than 0.25; and for spherical aberrations, lower than 0.32 D. Conclusions: The average values of corneal aberrations for defocus, astigmatism, coma, trefoil and spherical aberration are in the range of values reported in the scientific literature, while the distribution of corneal aberrations values present displacement of most of the cases towards the lower values of the determination range.

Estado de la cirugía refractiva con lente intraocular fáquica de cámara posterior Visian ICL en España / State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain

Objetivos Analizar la situación actual de la cirugía refractiva con implante de lente fáquica Visian ICL en España, señalando los rangos medios de potencias implantadas, los resultados visuales y refractivos obtenidos y los índices de seguridad y eficacia. Método Se trata de un estudio de población, transversal, descriptivo, analítico, retrospectivo, multicéntrico, en el que cada coautor recopiló los datos de, al menos, los 10 últimos pacientes (hasta un máximo de 30) con implante de lente fáquica Visian ICL. Se eligió aleatoriamente un ojo de cada sujeto para incluirlo en el estudio, y se analizaron las variables: edad, género, agudezas visuales sin corrección y con corrección pre y posquirúrgica, refracción preoperatoria y residual, queratometrías, recuento endotelial, profundidad de cámara anterior desde endotelio, paquimetría corneal central, presión intraocular, distancia blanco-blanco, lente implantada (potencia y talla) y equivalente esférico (SEQ) esperado y obtenido posquirúrgico al mes de la cirugía. Resultados Se obtuvo una muestra de 140 ojos de 140 pacientes con una edad media de 31,35±7,28 años. El SEQ preoperatorio medio fue de −6,33±3,69, la agudeza visual con corrección media de 0,96±0,16, la profundidad de cámara anterior desde endotelio de 3,30±0,29mm, distancia blanco-blanco 12,02±0,40mm, paquimetría corneal central 535,03±37,68μm, recuento endotelial 2.684,37±313,74céls/mm2 y presión intraocular 14,84±2,59mmHg. El 66,4% de las lentes implantadas fueron ICL esféricas y el 33,6% tóricas, con una potencia media de −7,81±4,09D y un cilindro medio de 2,27±1,23D. El 5,7% fueron hipermetrópicas. El 45,69% de las lentes implantadas eran de la talla 13,2mm, siendo el 37,93, 12,93 y 3,45% restante de las tallas 12,6, 12,1 y 13,7mm, respectivamente. Al mes de la cirugía se obtuvo un SEQ residual de −0,01±0,31D. Los índices de eficacia y seguridad fueron de 1,06±0,18 y 1,10±0,19, respectivamente... (AU)

Objectives To analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. Method This is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residual refraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. Results A sample of 140 eyes was obtained from 140 patients with a mean age of 31.35±7.28 years. Mean preoperative SEQ was −6.33±3.69D, mean visual acuities with correction was 0.96±0.16, anterior chamber depth was 3.30±0.29mm, white-white 12.02±0.40mm, central corneal pachymetry 535.03±37.68μm, endothelial cellular density 2684.37±313.74cels/mm2 and intraocular pressure 14.84±2.59mmHg. A percentage of 66.4 of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of −7.81±4.09D and a mean cylinder of 2.27±1.23D. A percentage of 5.7 of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04±0.27D. A percentage of 45.69 of the implanted lenses were of size 13.2mm, with the remaining 37.93, 12.93 and 3.45% being of sizes 12.6, 12.1 and 13.7mm, respectively. At one month after surgery a residual SEQ of −0.01±0.31D was obtained. The efficacy and safety indices were 1.06±0.18 and 1.10±0.19...(AU)

Actualización sobre las contraindicaciones en cirugía refractiva láser corneal / Update on contraindications in laser corneal refractive surgery

Los más de 25 años de experiencia con las técnicas de cirugía refractiva (desde que se aprobara por la Food and Drug Administration [FDA] de EE. UU. el uso del láser excímer en el remodelamiento de la córnea en 1995), sumado a los avances tecnológicos en oftalmología (láser de femtosegundo, ablación guida por topografía, sistemas de imagen de segmento anterior) y el mayor entendimiento de los errores refractivos, las aberraciones de alto orden y la biomecánica corneal, hacen que la cirugía refractiva corneal con láser sea un método seguro y eficaz para la corrección de estos defectos. Sin embargo, a día de hoy, siguen existiendo ciertas circunstancias que suponen una contraindicación para su aplicación, además de otras que podrían asociarse a complicaciones, y que deben ser analizadas con detenimiento.Esta revisión repasa las contraindicaciones actuales para la cirugía refractiva corneal con láser recogidas en los Protocolos de Práctica Preferente (PPP) de la Academia Estadounidense de Oftalmología y de la Sociedad Española de Oftalmología. Estos protocolos están basados en la mayor evidencia científica disponible en la actualidad y permiten extraer recomendaciones claras, mejorando el perfil de seguridad de estas técnicas.Las contraindicaciones pueden diferenciarse en relativas o absolutas; entre estas últimas están: la edad inferior a 18 años, la ausencia de estabilidad refractiva y la existencia de ciertas afecciones oculares (entre las que destacan determinadas distrofias corneales, queratocono, ojo seco mal controlado) o sistémicas (procesos autoinmunes activos o diabetes mellitus mal controlada)...(AU)

More than 25 years of experience with refractive surgery techniques (since the FDA [Food and Drug Administration] of the United States approved the use of the excimer laser in the remodeling of the cornea in 1995), added to the technological advances in ophthalmology (femtosecond laser, topography-guided ablation, anterior segment imaging systems) and increased understanding of refractive errors, higher order aberrations, and corneal biomechanics make corneal laser refractive surgery a safe method and effective for the correction of these defects. However, to date, there are still certain circumstances that represent a contraindication for its application, in addition to others that could be associated with complications, and that must be carefully analyzed.This review analyzes the current contraindications for laser corneal refractive surgery listed in the Preferred Practice Protocols (PPPs) of the American Academy of Ophthalmology and the Spanish Ophthalmology Society. These protocols are based on the best scientific evidence currently available and allow clear recommendations to be drawn, improving the safety profile of these techniques.Contraindications can be differentiated into relative or absolute; among the latter are: age less than 18 years, the absence of refractive stability and the existence of certain ocular pathologies (including certain corneal dystrophies, keratoconus, poorly controlled dry eye) or systemic pathologies (active autoimmune processes or poorly controlled diabetes mellitus). Other circumstances such as the use of certain drugs (amiodarone, isotretinoin), extreme values of mean central keratometry and pachymetry, history of previous uveitis or glaucoma, pregnancy and lactation, are considered relative contraindications according to the PPPs. However, there are studies that demonstrate the safety of refractive surgery in some of these cases. (AU)

Update on contraindications in laser corneal refractive surgery.

More than 25 years of experience with refractive surgery techniques (since the FDA [Food and Drug Administration] of the United States approved the use of the excimer laser in the remodeling of the cornea in 1995), added to the technological advances in ophthalmology (femtosecond laser, topography-guided ablation, anterior segment imaging systems) and increased understanding of refractive errors, higher order aberrations, and corneal biomechanics make corneal laser refractive surgery a safe method and effective for the correction of these defects. However, to date, there are still certain circumstances that represent a contraindication for its application, in addition to others that could be associated with complications, and that must be carefully analyzed. This review analyzes the current contraindications for laser corneal refractive surgery listed in the Preferred Practice Protocols (PPPs) of the American Academy of Ophthalmology and the Spanish Ophthalmology Society. These protocols are based on the best scientific evidence currently available and allow clear recommendations to be drawn, improving the safety profile of these techniques. Contraindications can be differentiated into relative or absolute; among the latter are: age less than 18 years, the absence of refractive stability and the existence of certain ocular pathologies (including certain corneal dystrophies, keratoconus, poorly controlled dry eye) or systemic pathologies (active autoimmune processes or poorly controlled diabetes mellitus). Other circumstances such as the use of certain drugs (amiodarone, isotretinoin), extreme values of mean central keratometry and pachymetry, history of previous uveitis or glaucoma, pregnancy and lactation, are considered relative contraindications according to the PPPs. However, there are studies that demonstrate the safety of refractive surgery in some of these cases.

State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain.

OBJECTIVES: To analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. METHOD: This is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residualrefraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. RESULTS: A sample of 140 eyes was obtained from 140 patients with a mean age of 31.35 ± 7.28 years. Mean preoperative SEQ was -6.33 ± 3.69D, mean CDVA was 0.96 ± 0.16, ACD was 3.30 ± 0.29 mm, WTW 12.02 ± 0.40 mm, CCT 535.03 ± 37.68 µm, ECD 2684.37 ± 313.74 cels/mm2 and IOP 14.84 ± 2.59 mmHg. 66.4% of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of -7.81 ± 4.09D and a mean cylinder of 2.27 ± 1.23D. 5.7% of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04 ± 0.27D. 48.92% of the implanted lenses were of size 13.2 mm, with the remaining 36.69, 10.79 and 3.60% being of sizes 12.6, 12.1 and 13.7 mm, respectively. At one month after surgery a residual SEQ of -0.01 ± 0.31D was obtained. The efficacy and safety indices were 1.06 ± 0.18 and 1.10 ± 0.19, respectively. The mean central vault was 508.80 ± 201.04 µm. The accuracy between the calculated SEQ and the obtained SEQ was 99.3% for spherical lenses and 88.2% for Cyl correction. The mean ECD at 1 month after surgery was 2805.53±273.30céls/mm2, which was a difference from preoperative of 0.11% (p = 0.922), similarly, the mean IOP was 13.98 ± 2.57 mmHg, which was a difference of -0.92 ± 2.80 mmHg. CONCLUSIONS: ICL phakic lens surgery is an effective, safe and predictable procedure. There were no significant changes in endothelial cell count or intraocular pressure measurement one month after surgery.

Resultados sensoriales y motores en pacientes miopes tratados con técnicas de superficies / Sensory and Motor Outcomes in Myopic Patients Treated with Surface Techniques

Objetivo: Evaluar los resultados sensoriales y motores poscirugía refractiva con técnicas de superficie (LASEK-MMC o PRK-MMC) en pacientes miopes con o sin astigmatismo asociado. Método: Se realizó estudio experimental controlado aleatorizado abierto, en el cual fueron incluidos 160 pacientes (320 ojos), de ellos tratados con LASEK-MMC (80 pacientes) y con PRK-MMC (80 pacientes), seguidos por 3 meses. Las principales variables evaluadas fueron: edad, tipo de error refractivo, equivalente esférico, ángulo Kappa, anisometropía, estereopsis, punto próximo de convergencia y su anomalía, amplitud de convergencia y de divergencia (cerca y lejos) y magnitud de la desviación del alineamiento ocular. Resultados: El grupo tratado con PRK-MMC tenía edad media de 26,48 años ± 4,47 y equivalente esférico preoperatorio de -3,27 ±1,54 que disminuyó significativamente (p <0,05) a -0,04 ± 0,23 dioptrías (D) a los tres meses de la cirugía. El grupo tratado con LASEK-MMC tenía edad media de 26,31 años ± 4,86 y equivalente esférico preoperatorio de -3,34 ± 1,66 dioptrías (D) que disminuyó significativamente (p <0,05) a -0,06 ± 0,26 D a los tres meses de la cirugía. Además, disminuyó la anisometropía, mejoró la estereopsis y disminuyó la amplitud la amplitud de convergencia y divergencia para lejos. El alineamiento ocular también mejoró. Conclusiones: Las técnicas de superficies para tratar pacientes con miopía o astigmatismo miópico compuesto disminuyen la anisometropía, mejoran la estereopsis y disminuyen la amplitud de convergencia y divergencia para lejos, con mayor proporción de pacientes con ortoforia después de la operación(AU)

Purpose : To evaluate sensory and motor outcomes after refractive surgery with surface techniques (LASEK-MMC or PRK-MMC) in myopic patients with or without associated astigmatism. Methods : An open randomized controlled experimental study was performed, in which 160 patients (320 eyes) were included, treated with LASEK-MMC (80 patients) and with PRK-MMC (80 patients), followed up during 3 months. The main variables evaluated were: age, type of refractive error, spherical equivalent, Kappa angle, anisometropia, stereopsis, near convergence point and its anomaly, convergence and divergence amplitude (near and far) and magnitude of ocular alignment deviation. Results : The group treated with PRK-MMC had an average age of 26.48 years ± 4.47 and preoperative spherical equivalent of -3.27 ± 1.54 which decreased significantly (p < 0.05) to -0.04 ± 0.23 diopters (D) three months after surgery. The LASEK-MMC treated group had an average age of 26.31 years ± 4.86 and preoperative spherical equivalent of -3.34 ± 1.66 diopters (D) which decreased significantly (p < 0.05) to -0.06 ± 0.26 D three months after surgery. In addition, anisometropia decreased, stereopsis improved, Kappa angle increased, and convergence and divergence amplitude (for far) decreased; ocular alignment also improved. Conclusions : Surface techniques to treat patients with myopia or compound myopic astigmatism decrease anisometropia, improve stereopsis, increase Kappa angle, and decrease near point anomaly and convergence and divergence amplitude (for far), with higher proportion of patients with orthophoria postoperatively(AU)

Estudio bibliométrico de cirugía refractiva y ojo seco en la literatura científica / Bibliometric study of refractive surgery and dry eye scientific literature

Antecedentes y objetivo La cirugía refractiva es actualmente un procedimiento seguro y eficaz, y es reconocida como factor de riesgo para el desarrollo del ojo seco. El objetivo del estudio es analizar la producción e identificar el estado de conocimiento sobre el ojo seco secundario a cirugía refractiva, sus inicios y su evolución, así como cuales son los autores e instituciones más notorios. Material y métodos Se realizó una búsqueda de referencias a través de la base de datos Scopus, utilizando «cirugía refractiva» como descriptor principal y «ojo seco» como secundario; unidos ambos por el operador booleano AND, y limitándose el campo a la disponibilidad de título, resumen y palabras clave. A las publicaciones seleccionadas se le aplicaron los indicadores y los mapas bibliométricos habituales. Resultados Se recopilaron 78 artículos del periodo 2001-2019. Según la ley de Price, el crecimiento de la producción de la literatura fue lineal. La tasa de crecimiento anual fue del 8,6% con un tiempo de duplicación de 8,4 años. El núcleo de Bradford ofreció 4 revistas, todas con factor de impacto>2. Estas fueron: Journal of Ophthalmology, Investigative Ophthalmology and Visual Science, Journal of Glaucoma y The British Journal of Ophthalmology. El país con mayor producción fue EE. UU. Conclusiones La producción científica sobre el ojo seco secundaria a cirugía refractiva sigue un crecimiento lineal, no cumpliéndose los postulados de Price. Existe una alta transitoriedad de autores. Esto puede indicar una baja productividad por autor, o bien la presencia alta de investigadores que hayan publicado publican ocasionalmente sobre este tema (AU)

Objective Currently, refractive surgery is a safe and effective procedure, and considered as a risk for development of dry eye. The aim of study is to analyze the scientific publications in the field of ocular dryness secondary to refractive surgery through a bibliometric approach. The temporal period goes since 2001 to 2019, years in which first references appeared and search limited selection is done, respectively. The set of publications ranges from the first publication appeared in 2001, to the last one selected in 2019. Methods A search of references was made through Scopus, using «refractive surgery» as main descriptor, and «dry eye» as secondary one; both descriptors were limited to those available in the chosen field for the title, abstract, and keywords. The most common indicators and bibliometric maps were applied for to the selected publications. Results A total of 78 original articles were collected from the timeframe 2001-2019. According to the Price's law, the growth of literature production was linear turned out in a linear growth of literature production. The annual growth rate was 8.6% with a literature doubling time of 8.4 years. The Bradford core, preferred journals chosen by authors were 4 with offered four preferred journals by the authors, all of them with an impact factor >2. These were Ophthalmology, Investigative Ophthalmology & Visual Science, Journal of Glaucoma and British Journal of Ophthalmology. Regarding geographical distribution, the United States had the highest production. Conclusions The scientific production of dry eye after refractive surgery follows a linear growth. In this instance, postulates of the Price's growth law of science are not fulfilled. In addition, there is a high rate of transience. That may indicate low productivity or presence of researchers from other related subjects disciplines, who have published occasionally in this topic (AU)

Bibliometric study of refractive surgery and dry eye scientific literature.

OBJECTIVE: Currently, refractive surgery is a safe and effective procedure, and considered as a risk for development of dry eye. The aim of study is to analyze the scientific publications in the field of ocular dryness secondary to refractive surgery through a bibliometric approach. The temporal period goes since 2001-2019, years in which first references appeared and search limited selection is done, respectively. The set of publications ranges from the first publication appeared in 2001, to the last one selected in 2019. METHODS: A search of references was made through Scopus, using "refractive surgery" as main descriptor, and «dry eye¼ as secondary one; both descriptors were limited to those available in the chosen field for the title, abstract, and keywords. The most common indicators and bibliometric maps were applied for to the selected publications. RESULTS: A total of 78 original articles were collected from the timeframe 2001-2019. According to the Price's law, the growth of literature production was linear turned out in a linear growth of literature production. The annual growth rate was 8.6% with a literature doubling time of 8.4 years. The Bradford core, preferred journals chosen by authors were 4 with offered four preferred journals by the authors, all of them with an impact factor >2. These were Ophthalmology, Investigative Ophthalmology & Visual Science, Journal of Glaucoma and British Journal of Ophthalmology. Regarding geographical distribution, the United States had the highest production. CONCLUSIONS: The scientific production of dry eye after refractive surgery follows a linear growth. In this instance, postulates of the Price's growth law of science are not fulfilled. In addition, there is a high rate of transience. That may indicate low productivity or presence of researchers from other related subjects disciplines, who have published occasionally in this topic.

Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery.

OBJECTIVE: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO. METHODS: An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019. RESULTS: There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis. CONCLUSIONS: Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Evidencia en la prevención de la recurrencia de queratitis por herpes simple y herpes zóster tras cirugía ocular / Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery

Propósito: La queratitis herpética, ya sea por herpes simple (HSK) o por herpes zóster oftálmico (HZO) puede presentar recaídas tras la cirugía ocular. Se postula como necesaria una profilaxis para evitarla. El objetivo de este estudio es revisar la evidencia científica sobre los métodos preventivos empleados en el período perioperatorio en pacientes previamente afectados de HSK/HZO.MétodosSe ha realizado una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre profilaxis y riesgo de recurrencia de HSK/HZO en pacientes sometidos a cirugía ocular hasta el 31 de diciembre de 2019.ResultadosHay pruebas sólidas de que la profilaxis oral debe recomendarse tras una queratoplastia penetrante en pacientes que hayan sufrido previamente HSK/HZO. Para otros tipos de cirugías, la evidencia es menos convincente; sin embargo, debe considerarse un período latente de inactividad entre la enfermedad y la profilaxis oral.ConclusionesLa queratoplastia penetrante y lamelar, crosslinking corneal, cirugía de catarata y cirugía fotorrefractiva y fototerapéutica provocan una alteración del plexo nervioso sub-basal de la cornea. Debido al traumatismo quirúrgico, así como a la modulación de la respuesta inmunológica ocular causada por los esteroides aplicados en el postoperatorio, es posible inducir la reactivación de HSK/HZO, siendo en algunos casos común. Dentro del presente artículo discutimos la evidencia disponible para la profilaxis de HSK/HZO en cirugía ocular. Son necesarios estudios adicionales para definir el riesgo real de recurrencia de HSK/HZO después de cirugías oculares, particularmente en cirugía de catarata y para confirmar la eficacia de la profilaxis perioperatoria con antivíricos anti HSK/HZO (AU)

Objective: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.° Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO.MethodsAn exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019.ResultsThere is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis.ConclusionsPenetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals (AU)

Resultados refractivos y visuales en pacientes operados de miopía con técnicas de superficies / Refractive and visual results in patients operated on for myopia with surface techniques

Objetivo: Comparar los resultados visuales y refractivos pre- y posoperatorios en pacientes miopes operados con técnicas de superficie y perfil de ablación asférico. Métodos: Se realizó un estudio experimental controlado aleatorizado abierto, tipo de equivalencia y no inferioridad, en 160 pacientes (320 ojos). En el estudio se formaron dos grupos: el primero quedó constituido por 80 pacientes (160 ojos), a quienes se les realizó queratectomía fotorrefractiva más mitomicina C, y el segundo fue conformado por 80 pacientes (160 ojos), a quienes se les realizó LASEK más mitomicina C. Resultados: Predominaron en ambos grupos las mujeres con miopía leve y edades entre 21 y 29 años. A los tres meses el grupo queratectomía fotorrefractiva más mitomicina C tenía agudeza visual sin corrección de 0,97 ± 0,09; esfera 0,003 ± 0,21; cilindro -0,09 ± 0,30 y equivalente esférico -0,04 ± 0,23. En el grupo LASEK más mitomicina C, la agudeza visual sin corrección fue de 0,96 ± 0,11; la esfera -0,007 ± 0,24; el cilindro -0,08 ± 0,25 y el equivalente esférico -0,06 ± 0,26. Conclusión: Ambas técnicas quirúrgicas mejoraron significativamente los resultados refractivos y visuales, pero no hubo diferencia entre ellas(AU)

Objective: Compare the pre- and postoperative visual and refractive results in myopic patients operated with surface techniques and aspheric ablation profile. Methods: An open randomized controlled experimental study, equivalence and non-inferiority type was carried out in 160 patients (320 eyes). In the study, two groups were formed: the first group was made up of 80 patients (160 eyes), who underwent Photorefractive keratectomy - mitomycin C, and the second group made up of 80 patients (160 eyes), underwent LASEK - mitomycin C. Results: Women with mild myopia and ages between 21 and 29 years old predominated in both groups. At three months, the Photorefractive keratectomy - mitomycin C group had AVSC 0.97 ± 0.09; sphere 0.003 ± 0.21; cylinder -0.09 ± 0.30 and spherical equivalent -0.04 ± 0, 2. 3. In the Photorefractive keratectomy - mitomycin C group, AVSC 0.96 ± 0.11; sphere -0.007 ± 0.24; cylinder -0.08 ± 0.25 and spherical equivalent -0.06 ± 0.26. Conclusion: Both surgical techniques improved significantly refractive and visual results, but there was no difference between them(AU)

In vivo confocal microscopy findings after SMILE refractive surgery technique.

OBJECTIVE: To evaluate confocal microscopy finding after SMILE surgery by in vivo confocal microscopy and stromal lenticule and stromal interface accuracy planed vs measured. METHOD: Thirty eyes of 15 patients were evaluated before and 1 month after SMILE surgery by using confocal microscopy. Cellular morphology was studied. Planed stromal lenticule thickness was compared vs measured stromal lenticule thickness after surgery by comparing the total stromal corneal thickness before vs after surgery. Stromal corneal interface was evaluated and depth of this planed interface was compared vs measured post-surgery interface depth. RESULTS: Sub-epithelial nerve plexus was absent at 1 month after surgery. Activated keratocytes were found before and after stromal corneal interface depth. There was not statistical significant difference between mean planed stromal lenticule vs. post-surgery measured (102.3 ± 25.7 vs. 104.2 ± 29.9 mm; p = 0.73). There was not statistical significant difference between mean planed stromal interface depth vs. post-surgical measured (113.7 ± 8.2 vs. 120.5 ± 17.3 mm; p = 0.058). CONCLUSIONS: Confocal microscopy is useful to evaluate changes after SMILE surgery; lenticule thickness and stromal interface depth are exact.

OBJETIVO: Evaluar los hallazgos mediante microscopía confocal in vivo de pacientes operados de cirugía SMILE, la exactitud del lentículo estromal y la profundidad de la interfaz estromal planeados versus medidos. MÉTODO: Treinta ojos de 15 pacientes operados de SMILE se estudiaron mediante microscopía confocal antes y al mes de la cirugía. Se evaluaron la morfología celular, el espesor del lentículo estromal planeado versus el medido en el posoperatorio mediante la diferencia entre el espesor estromal preoperatorio y el postoperatorio, así como la interfaz estromal, y se comparó la profundidad de esta interfaz estromal planeada con la medida en el posoperatorio. RESULTADOS: Se observó la ausencia del plexo nervioso subepitelial al mes del posoperatorio y una activación de queratocitos anterior y posterior a la profundidad de la interfaz estromal. No hubo diferencia en el lentículo estromal planeado versus el medido en el posoperatorio (102.3 ± 25.7 vs. 104.2 ± 29.9 mm; p = 0.73). No hubo diferencia entre la profundidad de la interfaz estromal planeada y medida (113.7 ± 8.2 vs. 120.5 ± 17.3 mm; p = 0.058). CONCLUSIONES: Tras la cirugía SMILE se pueden evaluar los cambios mediante microscopía confocal; el espesor del lentículo y la profundidad de la interfaz son exactos.

Femto-LASIK outcomes obtained by a fellowship trainee during a refractive surgery training program.

PURPOSE: To report, for the first time, the clinical outcomes and patient satisfaction of laser refractive surgery performed by a trainee during a corneal and refractive surgery fellowship program in Latin America. METHODS: This prospective and interventionist study reviewed the clinical charts of the first 100 consecutive refractive surgery cases performed by a single Cornea Fellowship trainee between March 2018 and June 2018 in the Blindness Prevention Association of Mexico (Asociación para Evitar la Ceguera en Mexico). Femtosecond LASIK was performed in all eyes. Visual and refractive outcomes were evaluated during the first year of follow-up. Patient satisfaction was measured using 5 author-created questions 6 months after surgery. RESULTS: Data of 100 eyes of 50 consecutive patients were evaluated. One year after the surgery, mean uncorrected distance visual acuity (UDVA) was 0.01 logMAR. Spherical equivalent error passed from -3.91 ± 2.28 D preoperatively to -0.22 ± 0.28 D. No eyes lost lines in corrected distance visual acuity (CDVA). Manifest refraction maintained stable during the first year after surgery. The five author-created questions revealed a high level of confidence and patient satisfaction. CONCLUSIONS: Femto-LASIK performed by a corneal and refractive surgery fellowship trainee showed good refractive and visual outcomes, as well as high patient satisfaction and confidence in a refractive surgery centre in Latin America.

Resultados de Femto-LASIK obtenidos por un fellow durante un programa de formación en cirugía refractiva / Femto-LASIK outcomes obtained by a fellowship trainee during a refractive surgery training program

Objetivo Informar por primera vez sobre los resultados clínicos y la satisfacción de los pacientes operados de cirugía refractiva con láser por un fellow durante un programa de formación en cirugía corneal y refractiva en Latinoamérica. Métodos En este estudio prospectivo e intervencionista se revisaron las historias clínicas de los primeros 100 casos consecutivos de cirugía refractiva realizados por un solo fellow del departamento de córnea de la Asociación para Evitar la Ceguera en México entre marzo de 2018 y junio de 2018. La técnica LASIK asistida por femtosegundo se realizó en todos los ojos. Los resultados visuales y refractivos se evaluaron durante el primer año de seguimiento. La satisfacción del paciente se midió 6 meses después de la cirugía con 5 preguntas creadas por el autor. Resultados Se evaluaron datos de 100 ojos de 50 pacientes consecutivos. Después de 12 meses de la cirugía, la agudeza visual no corregida (AVNC) fue de 0,01logMAR. El equivalente esférico pasó de –3,91±2,28D preoperatoriamente a –0,22±0,28D. No se perdieron líneas en la agudeza visual mejor corregida (AVMC). La refracción manifiesta se mantuvo estable durante el primer año después de la cirugía. Las 5 preguntas creadas por el autor revelaron un alto grado de confianza y satisfacción del paciente. Conclusiones Los resultados refractivos y visuales obtenidos mediante Femto-LASIK por un fellow de cirugía corneal y refractiva fueron buenos. Del mismo modo se demostró una alta satisfacción y confianza del paciente en el cirujano en periodo de aprendizaje en un centro formativo de cirugía refractiva en Latinoamérica (AU)

Purpose To report, for the first time, the clinical outcomes and patient satisfaction of laser refractive surgery performed by a trainee during a corneal and refractive surgery fellowship program in Latin America. Methods This prospective and interventionist study reviewed the clinical charts of the first 100 consecutive refractive surgery cases performed by a single Cornea Fellowship trainee between March 2018 and June 2018 in the Blindness Prevention Association of Mexico (Asociación para Evitar la Ceguera en Mexico). Femtosecond LASIK was performed in all eyes. Visual and refractive outcomes were evaluated during the first year of follow-up. Patient satisfaction was measured using 5 author-created questions 6 months after surgery. Results Data of 100 eyes of 50 consecutive patients were evaluated. One year after the surgery, mean uncorrected distance visual acuity (UDVA) was 0.01logMAR. Spherical equivalent error passed from –3.91±2.28D preoperatively to –0.22±0.28D. No eyes lost lines in corrected distance visual acuity (CDVA). Manifest refraction maintained stable during the first year after surgery. The five author-created questions revealed a high level of confidence and patient satisfaction. Conclusions Femto-LASIK performed by a corneal and refractive surgery fellowship trainee showed good refractive and visual outcomes, as well as high patient satisfaction and confidence in a refractive surgery centre in Latin America (AU)

Fórmula Barrett True K en pacientes con catarata operados de cirugía refractiva corneal / The Barrett True-K formula in cataract patients undergoing corneal refractive surgery

Objetivo: Determinar los resultados refractivos en pacientes operados de catarata con cirugía refractiva corneal, según el cálculo del poder dióptrico de la lente intraocular con la fórmula Barrett True K. Métodos: Se realizó un estudio pre-experimental, del tipo antes y después, en el cual fueron incluidos 18 pacientes (31 ojos). En ellos se analizaron variables demográficas y clínicas. La principal variable de salida fue la predictibilidad del componente esférico ± 0,50 D, ± 1,0 D según la longitud axial. Resultados: Fueron estudiados pacientes con un promedio de edad de 59,4 años, predominantemente del sexo femenino (66,7 por ciento). El 77,4 por ciento fue operado con queratotomía radial. Con la cirugía de catarata se produjo una mejora ostensible de la agudeza visual no corregida (mediana preoperatoria: 0,12 y mediana posoperatoria: 0,60). Solo el 9,7 por ciento de los ojos analizados presentó una agudeza visual sin corregir de 20/20 y el 90,3 por ciento de 20/40 o más. La cantidad de ojos con un equivalente esférico de ± 0,50 disminuyó en la medida en que aumentó la longitud axial (corta: 100 por ciento; normal: 57,1 por ciento; larga: 22,7 por ciento), no así la predictibilidad del componente esférico de ± 0,50, que aumentó (corta: 50,0 por ciento; normal: 57,1 por ciento; larga: 63,6 por ciento). Conclusiones: La fórmula Barrett True K resulta útil para el cálculo de la lente intraocular en pacientes operados de catarata y cirugía refractiva corneal previa(AU)

Objective: Determine refractive outcomes in patients undergoing cataract corneal refractive surgery based on intraocular lens dioptric power calculation with the Barrett True-K formula. Methods: A pre-experimental before/after study was conducted of 18 patients (31 eyes). Demographic and clinical variables were analyzed. The main output variable was spherical component predictability ± 0.50 D, ± 1.0 D according to axial length. Results: Mean age was 59.4 years; female sex prevailed (66.7 percent). Of the patients studied, 77.4 percent underwent radial keratotomy. Cataract surgery led to notable uncorrected visual acuity improvement (preoperative mean: 0.12; postoperative mean: 0.60). Only 9.7 percent of the eyes examined had an uncorrected visual acuity of 20/20, whereas 90.3 percent had 20/40 or more. The number of eyes with a spherical equivalent of ± 0.50 fell as axial length rose (near: 100 percent; normal: 57.1 percent; far: 22.7 percent), unlike ± 0.50 spherical component predictability, which rose from near: 50.0 percent; normal: 57.1 percent; far: 63.6 percent. Conclusions: The Barrett True-K formula is useful for intraocular lens calculation in patients undergoing previous cataract and corneal refractive surgery(AU)

Immediate and short term visual recovery after SmartSurfACE photorefractive keratectomy.

PURPOSE: To investigate immediate and short-term visual recovery in a large cohort of 2093 myopic eyes (with or without astigmatism) treated with SmartSurfACE procedure, a combination of Transepithelial Photo Refractive Keratectomy (PRK) and Smart Pulse Technology (SPT, SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany). METHODS: In this retrospective case series, post-operative outcomes were evaluated immediately after the surgery (Day 0), at day 1 and 3 months postoperatively, after myopic SmartSurfACE treatment with mean pre-operative spherical equivalent -4.65±2.53D and range from -16.13D to -0.13D. In all cases, pre and postoperative standard examinations were performed. The analysis evaluated preoperative Corrected and Uncorrected Distance Visual Acuity (CDVA and UDVA, respectively), and postoperative UDVA, monocularly and binocularly, immediately after the surgery, at day 1 and 3 month follow up. RESULTS: Sixty-two percent eyes achieved monocular UDVA 20/40 or better immediately after the surgery, while 82% patients achieved binocular UDVA 20/32 or better immediately after the surgery. At 3-month postoperatively, monocular UDVA 20/25 or better was achieved in 94% eyes. Treated eyes achieved immediately after the surgery or by the next day mean UDVA 20/41±8. UDVA improved significantly from Day 1 to 3-months follow up (p<0.0001 for both OS and OD) to mean UDVA 20/21±5 (equal to preoperative CDVA 20/21±8). CONCLUSION: Immediate and short-term visual recovery after SmartSurfACE PRK in our large cohort was rapid, providing functional binocular UDVA immediately after the surgery.

LASEK-mitomicina C versus PRK-mitomicina C en pacientes con miopía o astigmatismo miópico compuesto / LASEK-mitomycin C versus PRK-mitomycin C in patients with myopia or compound myopic astigmatism

RESUMEN Objetivo: Evaluar los resultados relacionados con la efectividad y la seguridad en el tratamiento con queratectomía subepitelial asistida por láser con mitomicina C versus queratectomía fotorreactiva con mitomicina C en ojos con miopía o astigmatismo miópico compuesto. Métodos: Se realizó un estudio experimental, longitudinal y prospectivo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer entre abril del año 2016 y abril de 2017. Se empleó un muestreo aleatorio simple por el cual se obtuvo la técnica quirúrgica a realizar. El primer ojo operado fue el derecho y a la semana se realizó la cirugía en el ojo izquierdo, en el cual se aplicó la otra técnica quirúrgica. Esto permitió realizar en cada paciente ambas técnicas quirúrgicas. La muestra quedó constituida por 146 ojos (73 pacientes) que cumplían con los criterios de selección. Resultados: El comportamiento preoperatorio entre los dos grupos fue muy similar. En ninguno de los casos existieron diferencias en las variables que se evaluaron (agudeza visual sin corrección, agudeza visual mejor corregida, esfera, cilindro y equivalente esférico). La diferencia entre los valores preoperatorios y los encontrados a los 6 meses del tratamiento quirúrgico en cada grupo fueron estadísticamente significativos (p= 0,000) para todas las variables analizadas, excepto para la agudeza visual mejor corregida en el grupo de ojos tratados con láser con mitomicina C (p= 0,083). El haze y el defecto de epitelización fueron los dos tipos de complicaciones observadas. Conclusiones: Se demostró que ambas técnicas quirúrgicas son efectivas y seguras(AU)

ABSTRACT Objective: Evaluate the effectiveness and safety of laser-assisted subepithelial keratectomy with mitomycin C vs. photoreactive keratectomy with mitomycin C in eyes with myopia or compound myopic astigmatism. Methods: An experimental prospective longitudinal study was conducted at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to April 2017. Simple random sampling was used to decide on the surgical technique to be applied. Surgery was first performed on the right eye using one of the techniques, and then one week later on the left eye with the other technique. That way each patient could undergo both surgical techniques. The sample was composed of 146 eyes (73 patients) meeting the inclusion criteria. Results: Preoperative behavior was very similar in the two groups. In neither case were differences found in the variables analyzed (uncorrected visual acuity, best corrected visual acuity, sphere, cylinder and spherical equivalent). The differences between preoperative values and those found six months after surgery in each group were statistically significant for all the variables analyzed (p= 0.000), except for best corrected visual acuity in the group of eyes treated with laser with mitomycin C (p= 0.083). Haze and epithelization defect were the two types of complications observed. Conclusions: It was demonstrated that both surgical techniques are effective and safe(AU)