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1.
J Refract Surg ; 37(9): 582-589, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506240

RESUMO

PURPOSE: To compare the efficacy of oral codeine plus acetaminophen versus oxycodone plus acetaminophen for severe pain control following photorefractive keratectomy (PRK). METHODS: This single-center trial randomized 200 patients to receive codeine 30 mg/acetaminophen 325 mg (codeine group) or oxycodone 5 mg/acetaminophen 325 mg (oxycodone group)every 4 hours as needed for severe pain for 4 days following PRK. Patients recorded postoperative pain, tablet consumption, and tetracaine use. Patients were monitored at postoperative 1 day, 1 week, and 1, 3, and 6 months for visual acuity and follow-up. Study outcomes were mean postoperative pain, treatment and tetracaine use, and visual acuity. RESULTS: Analysis of 197 patients who completed the trial (97 codeine group and 100 oxycodone group) showed mean pain scores were lower in the codeine group throughout the intervention period. Mean pain scores were higher in the oxycodone group than the codeine group on postoperative days 2 and 4 (P = .017 and P = .034, respectively). The oxycodone group consumed more tablets than the codeine group, with a difference on postoperative day 2 (P = .019), and used a greater number of tetracaine drops (P = .015). Repeated measures analysis of variance showed significant improvement in visual acuity in both groups with no difference in visual outcomes (P = .81). CONCLUSIONS: Codeine/acetaminophen is as effective and safe as oxycodone/acetaminophen for pain control following PRK, with no clinical difference in overall pain control and long-term visual outcomes. This implies that treating postoperative pain after PRK with a Schedule III opioid (codeine) is effective and potentially decreases the risk of misuse by a higher regulated Schedule II opioid (oxycodone), lowering the potential for abuse and dependence. [J Refract Surg. 2021;37(9):582-589.].


Assuntos
Oxicodona , Ceratectomia Fotorrefrativa , Codeína , Método Duplo-Cego , Humanos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
2.
J Refract Surg ; 37(9): 590-594, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506241

RESUMO

PURPOSE: To determine patient preference and treatment outcomes with an intracanalicular dexamethasone 0.4 mg insert compared to a standard steroid drop regimen in the contralateral eye following bilateral photorefractive keratectomy (PRK). METHODS: In this randomized, prospective, self-controlled, open-label interventional study, one eye received the dexamethasone insert and the second eye received prednisolone acetate 1% taper following bilateral PRK surgery. Postoperative evaluations were performed on day 3, day 4, month 1, and month 3. Phone call surveys were performed on week 2. The Comparison of Ophthalmic Medications for Tolerability questionnaire was used to determine patient preference between postoperative regimens and postoperative pain. Corneal endpoints included time to epithelialization, presence of corneal haze, sodium fluorescein staining, and modified Standardized Patient Evaluation of Eye Dryness (SPEED) scores. Both corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) were assessed. RESULTS: Twenty patients participated in the study. At month 3, 70% of patients preferred the dexamethasone insert, 20% preferred prednisolone acetate, and 10% expressed no preference. Patient surveys did not show a difference in postoperative pain between the study group and control group. No statistical difference was shown in time to epithelialization, 90-day CDVA or UDVA, postoperative corneal haze, corneal staining, or modified SPEED scores. CONCLUSIONS: In patients undergoing PRK, there was preference toward a dexamethasone insert in place of topical prednisolone acetate for the postoperative steroid treatment. There were no statistically or clinically significant differences between the two cohorts in regard to healing time or visual outcomes. [J Refract Surg. 2021;37(9):590-594.].


Assuntos
Miopia , Ceratectomia Fotorrefrativa , Humanos , Inflamação , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento
3.
Zhonghua Yan Ke Za Zhi ; 57(8): 614-617, 2021 Aug 11.
Artigo em Chinês | MEDLINE | ID: mdl-34344123

RESUMO

Nowadays, myopia morbidity keeps increasing in China. As the improvements of technique and safety in corneal refractive surgeries, an increasing number of patients with refractive error tend to choose these treatments. The 26-year-old woman with myopia in this case, whose UCVA was 0.1 in OD and 0.2 in OS, had corneal macula in the nasal side of the left eye owing to a corneal trauma occurred more than 10 years ago. After sufficient preoperative examinations, FS-LASIK was performed on the right eye and PTK combined with PRK was performed on the left eye. The UCVA was 1.2 in both eyes 3 months postoperatively, and the corneal macula was mostly cleared in the left eye. It is demonstrated that PTK combined with PRK is an effective and safe way to correct the diopter as well as remove the lesions for the lowly or moderately myopic patients accompanied with superficial corneal opacity. (Chin J Ophthalmol, 2021, 57: 614-617).


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Ceratectomia Fotorrefrativa , Adulto , China , Córnea , Feminino , Humanos , Lasers de Excimer , Miopia/cirurgia , Refração Ocular , Tomografia de Coerência Óptica , Acuidade Visual
4.
J Refract Surg ; 37(8): 562-569, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34388071

RESUMO

PURPOSE: To compare 1-year visual and tomographic outcomes of topography-guided photorefractive keratectomy (TGPRK) and topography-assisted phototherapeutic keratectomy (TPTK) with corneal cross-linking (CXL). METHODS: TGPRK and TPTK were performed in 72 eyes (68 patients) and 74 eyes (71 patients), respectively. Based on the TGPRK ablation plan, the eyes underwent TPTK where the theoretical minimum corneal thickness (MCT) after surgery was less than 400 µm. In the TGPRK group, the theoretical maximum ablation depth was 50 µm after epithelium removal. In TPTK, a decentered single-step PTK was performed only in the steepest anterior curvature zone and the stromal ablation depth was limited to 25 µm. After ablation, accelerated CXL was performed in the central 8-mm zone (9 mW/cm2 for 10 minutes in "epithelium-off" mode) in both TGPRK and TPTK. The visual acuity and tomography were assessed. RESULTS: Improvement in uncorrected (P = .73) and corrected (P = .66) distance visual acuity was similar between the two groups. However, TGPRK eyes had a greater decrease in keratometry, anterior defocus, and spherical aberration (P < .001) at the cost of greater ablation of tissue (P < .001). The median MCT decreased by 27 and 52.5 µm in the TPTK and TGPRK eyes, respectively. Both groups had similar decreases in anterior root mean square of lower (P = .10) and higher (P = .12) order aberrations. CONCLUSIONS: Both TGPRK and TPTK improved visual acuity in the keratoconic eyes at 1 year of follow-up. However, TPTK removed less volume of tissue. Further, it could be an alternative to TGPRK if the theoretical stromal ablation exceeds 50 µm in thin keratoconic corneas. [J Refract Surg. 2021;37(8):562-569.].


Assuntos
Ceratocone , Fotoquimioterapia , Ceratectomia Fotorrefrativa , Substância Própria/cirurgia , Topografia da Córnea , Reagentes para Ligações Cruzadas/uso terapêutico , Humanos , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Riboflavina/uso terapêutico , Raios Ultravioleta
5.
J Cataract Refract Surg ; 47(8): 1081-1087, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34292893

RESUMO

This systematic review reported the outcomes of laser corneal refractive surgery in pregnant or breastfeeding patients. This study was performed by searching in PubMed, Web of Science, and Scopus databases, on June 15, 2020. Included were 128 eyes from a total of 64 patients, with the mean maximum follow-up was 39.2 ± 36.14 months. Time from surgery to complication ranged from 1 to 67 months, with a mean value of 23.42 ± 22.23 months. Photorefractive keratectomy and laser in situ keratomileusis surgery seem to be stable procedures that are not modified during pregnancy and safe to complete during breastfeeding. Nevertheless, the lack of weight prospective research avoids having a greater certainty on this matter, and because of transitory nature of pregnancy and breastfeeding, it could still be contemplated that surgery risk outweigh the benefits. Additional investigation will be necessary to clarify these issues.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Ceratectomia Fotorrefrativa , Aleitamento Materno , Córnea , Feminino , Humanos , Lasers de Excimer , Miopia/cirurgia , Gravidez , Estudos Prospectivos , Acuidade Visual
6.
BMC Ophthalmol ; 21(1): 286, 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34301233

RESUMO

BACKGROUND: to study the outcomes of topography-guided customized excimer laser subepithelial ablation combined with accelerated CXL for progressive keratoconus. METHODS: Thirty-one eyes of 30 patients with progressive keratoconus were included in this prospective study. Topography-guided excimer laser ablation without refractive correction was performed. Simultaneous accelerated collagen cross-linking with ultraviolet light of 30 mW/cm2 for 4 min was followed. Uncorrected distance visual acuity (UCVA), manifest refraction, corrected distance visual acuity (CDVA), tomograghy were examined at postoperative 1, 6, and 12 months. RESULTS: UDVA improved slightly after surgery (P > 0.05). BSCDVA improved significantly from 0.32 ± 0.20 logMAR to 0.15 ± 0.14 logMAR at postoperative 12 months (P < 0.05). During 12-month follow-ups, there were no significant differences in manifest refraction and corneal keratometry except for maximal keratometry value of the anterior surface (Kapex), which decreased significantly from 57.23 ± 5.09D to 53.13 ± 4.47D (P < 0.05). Even though the thinnest corneal thickness decreased from 465 ± 24 µm to 414 ± 35 µm (P < 0.05), curvature asymmetry index front (SIf), keratoconus vertex front (KVf) and Baiocchi Calossi Versaci index front (BCVf) decreased significantly till postoperative 12 months (P < 0.05). Corneal higher-order aberrations and coma also decreased significantly till 12 months after surgery (P < 0.05). CONCLUSIONS: Topography-guided surface ablation without refractive correction combined with simultaneous accelerated collagen cross-linking provided good stability in refraction and corneal curvature, and also showed significant improvement in BSCDVA, corneal regularity and corneal optical quality.


Assuntos
Ceratocone , Fotoquimioterapia , Ceratectomia Fotorrefrativa , Colágeno/uso terapêutico , Substância Própria/cirurgia , Topografia da Córnea , Reagentes para Ligações Cruzadas/uso terapêutico , Humanos , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Riboflavina/uso terapêutico
7.
J Refract Surg ; 37(6): 366-371, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34170776

RESUMO

PURPOSE: To identify the potential risk factors that increase the likelihood of requiring re-treatment following refractive surgery in patients with high astigmatism (3.00 diopters or greater). METHODS: This retrospective study included patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2005 and December 2019 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients with high astigmatism (3.00 diopters or greater) were included and divided into two groups according to whether or not they underwent additional refractive surgery (re-treatment) during the study period. RESULTS: Overall, 2,024 eyes (2,024 patients) were included in the final analysis of this study. In total, 3.1% of the eyes (n = 63) underwent re-treatment. Throughout the study period, there was a significant reduction in the 2-year annual re-treatment rates, with a decline from 7.0% for primary surgeries performed in 2005 to 0.0% for primary surgeries performed in 2017 (r =-0.65, P = .015). The re-treatment group had significantly older preoperative age. They were also more likely to be male and have preoperative against-the-rule astigmatism and preoperative mixed astigmatism. Binary logistic regression analysis demonstrated that preoperative age, male gender, mixed astigmatism, and earlier year of surgery were all associated with higher re-treatment rates. CONCLUSIONS: The following factors are associated with higher rates of re-treatment in patients with high astigmatism: older preoperative age, male gender, and mixed astigmatism. These factors may be incorporated into nomograms to reduce future re-treatment rates in this population. [J Refract Surg. 2021;37(6):366-371.].


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Ceratectomia Fotorrefrativa , Astigmatismo/cirurgia , Córnea , Feminino , Humanos , Lasers de Excimer/uso terapêutico , Masculino , Miopia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
8.
J Fr Ophtalmol ; 44(7): 1059-1075, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34148702

RESUMO

Regression after corneal refractive surgery is a complex phenomenon which seems inevitable. The choice of surgical technique has very little influence on regression for low myopia or myopic astigmatism. However, LASIK and SMILE are the two techniques of choice in the correction of high myopia. LASIK is also better for the correction of hyperopia, hyperopic astigmatism and mixed astigmatism. Intraoperatively, the choice of a wide optical zone and adherence to a thick residual stromal bed provide stability. Regression may also be reduced by modulating anti-inflammatory therapy, treating dry eye, and using mitomycin C in PKR. In all cases, obtaining keratometry during patient follow-up helps to identify the cause of the regression. The objective of this review is to synthesize recent data from the literature on regression in refractive surgery as a function of the ablation profiles used.


Assuntos
Astigmatismo , Hiperopia , Ceratomileuse Assistida por Excimer Laser In Situ , Ceratectomia Fotorrefrativa , Astigmatismo/cirurgia , Córnea , Humanos , Hiperopia/cirurgia , Lasers de Excimer , Refração Ocular , Acuidade Visual
9.
Vestn Oftalmol ; 137(3): 68-75, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34156780

RESUMO

Water content in the cornea may affect the outcome of its excimer laser ablation, especially in presbyopic patients with myopic refraction. This hypothesis can be tested by scanning the cornea in the terahertz (THz) range to determine its hydration level. PURPOSE: To study the effect of hydration of the cornea determined by non-contact THz scanning and its biomechanical parameters on the results of photorefractive keratectomy (PRK) in an experiment. MATERIAL AND METHODS: PRK was performed using the Nidek EC-5000 QUEST excimer laser on 8 rabbit eyes. Corneal hydration was evaluated by determining the reflection coefficient (RC) in the THz electromagnetic radiation range before PRK, after 3-5 days, and after 1, 2, 3, and 4 months. Clinical examination included autorefractometry, assessment of corneal thickness and other anatomical and optical parameters of the anterior eye segment (Galilei G6, Ziemer Ophthalmic Systems AG 6.0.2, Switzerland), measurement of corneal hysteresis (CH) and corneal resistance factor (CRF) using the Ocular Response Analyzer (ORA; Reichert, USA), as well as tear production (Schirmer test). RESULTS: The initial water content in the cornea has a significant effect on the thickness of the removed layer, i.e. on the PRK effect, with correlation coefficient of Rs= -0.976 (p<0.01). The correlation between CH and the ablation depth is less pronounced (Rs=0.643), and CRF had no correlation with it (Rs= -0.089). Biomechanical indicators of the cornea depend on its hydration: changes in CH and CRF after excimer laser ablation qualitatively coincide with changes in RC, the correlation coefficient between RC and the initial value of CH is R= -0.619 (moderate negative correlation). CONCLUSION: THz scanning is an effective non-contact technology for monitoring corneal hydration level. The mismatch of the hypoeffect of keratorefractive excimer laser intervention planned for patients with presbyopia with the actual outcome can be caused by individual decrease in the initial water content in the cornea.


Assuntos
Miopia , Ceratectomia Fotorrefrativa , Animais , Segmento Anterior do Olho , Córnea/diagnóstico por imagem , Córnea/cirurgia , Humanos , Lasers de Excimer , Miopia/diagnóstico , Miopia/cirurgia , Coelhos
10.
Curr Opin Ophthalmol ; 32(4): 315-318, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989233

RESUMO

PURPOSE OF REVIEW: Corneal nerve function is an important consideration for the refractive surgeon. In patients without a history of neuropathy, refractive surgery can lead to destruction of corneal nerves and may predispose to keratopathy. The purpose of this review is to provide an update on the effect of refractive surgery on corneal nerve function and the potential for an increased risk of neurotrophic keratopathy development. RECENT FINDINGS: Recent studies have reinforced that refractive surgery can cause anatomical and functional changes in corneal nerve function. Among the most commonly performed refractive surgery procedures are Laser Assisted In-situ Keratomileusis, Photorefractive Keratectomy, and Small Incision Lenticule Extraction. Due to differences in technique, these procedures can have varying effects on corneal nerve structure. Using in vivo confocal microscopy, postrefractive patients were found to have decreased total nerve density when compared with controls in the immediate postoperative period. In some studies, patients have been shown to undergo re-innervation and regain significant amounts of nerve function. The majority of studies have found that despite decreased nerve cell density, long-term outcomes of refractive surgery patients are generally favorable. However, loss of corneal nerve function can lead to a variety of serious effects ranging from dry eye disease, corneal hypoesthesia/anesthesia, neuropathic pain, to neurotrophic keratopathy and ulceration in the rare cases. SUMMARY: Neurotrophic keratopathy is a rare occurrence after keratorefractive surgery and is largely due to damage to corneal nerves. Proper patient selection and counseling are essential to decrease the risk of development of this devastating complication.


Assuntos
Córnea/cirurgia , Doenças da Córnea/etiologia , Ceratectomia Fotorrefrativa/efeitos adversos , Complicações Pós-Operatórias , Córnea/diagnóstico por imagem , Doenças da Córnea/diagnóstico , Humanos , Microscopia Confocal
11.
BMC Ophthalmol ; 21(1): 216, 2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-33992084

RESUMO

BACKGROUND: The refractive surgeries induce corneal higher order aberrations (C-HOAs). In this study, change of C-HOAs after small-incision lenticule extraction (SMILE) compared to femtosecond assisted laser in situ keratomileusis (femto-LASIK), and to photorefractive keratectomy with mitomycin-C (PRK) under photopic and mesopic conditions. METHODS: In this prospective study, age, gender, and apical corneal thickness (ACT) matched cases with moderate myopia [spherical equivalent (SE) 3.00 to 6.00D) to high myopia (SE > 6.00D)] were enrolled. In addition to visual acuity and refraction, total C-HOA, coma, spherical aberration (SA), and trefoil in the 3- and 6-mm zones were measured before and 3 and 6 months after surgery. RESULTS: Overall, 372 moderate myopia cases (124 eyes of 124 individuals in each surgical group) and 171 high myopia cases (57 eyes of 57 individuals in each surgical group) were enrolled. At baseline, the differences in age, gender, ACT, uncorrected and corrected visual acuity, and SE were not statistically significant between subgroups of surgical methods within each myopia group (all P > 0.05). At 12 months, in the moderate myopia group, there was less increase in 6-mm zone total C-HOA, coma, and SA with SMILE compared to the other groups (all P < 0.05). In the high myopia group, there was greater increase in photopic total C-HOA and trefoil and less increase in mesopic SA with SMILE (all P < 0.05). CONCLUSIONS: In correction of moderate myopia, SMILE has better results in mesopic condition. In high myopia correction, femto-LASIK and PRK have better results in photopic and SMILE in mesopic condition.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Ceratectomia Fotorrefrativa , Humanos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Estudos Prospectivos , Refração Ocular
12.
J Fr Ophtalmol ; 44(6): 835-841, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33858699

RESUMO

OBJECTIVES: To study corneal haze following myopic photorefractive keratectomy (PRK) in a high-risk population and to assess methods for minimizing the risk. METHODS: The medical records of 150 patients who underwent PRK were reviewed. A total of 300 eyes were included. All patients underwent myopic PRK using the Allegretto Wave Concerto 500Hz (Wavelight AG, Erlangen, Germany)excimer laser platform with intraoperative mitomycin-C (MMC) application. Demographic data including age, gender and ethnicity in addition to preoperative and postoperative subjective manifest refraction, spherical equivalent, best-corrected distance visual acuity, uncorrected distance visual acuity (UDVA), postoperative corneal haze grade and other possible postoperative complications were retrieved. Hanna grading (0-4+) was used to evaluate corneal haze. RESULTS: The patients were comprised of 74 men (49.3%) and 76 women (50.7%). The mean age at the time of surgery was 26.5±6.0 (range, 17-46) years. All patients were Saudis with brown irides. UDVA improved to 20/25 in 93.8% at 3 months. The mean and standard deviation of preoperative spherical equivalent was -3.02±1.63 (range, -7.63 - -0.13). At 3 months, postoperative spherical equivalent improved to 0.05±0.50 (-1.00 - +1.00). At 6 months, 13.6% exhibited corneal haze of grade 1, and none exhibited grades 2 or 3. CONCLUSIONS: The results of this study confirmed that patients with brown irides can achieve favorable outcomes after PRK. MMC, postoperative topical steroids and ultraviolet protection evidently play a major role in preventing corneal haze in high-risk populations.


Assuntos
Miopia , Ceratectomia Fotorrefrativa , Córnea , Cor de Olho , Feminino , Alemanha , Humanos , Lasers de Excimer , Masculino , Miopia/cirurgia , Refração Ocular , Resultado do Tratamento
13.
J AAPOS ; 25(3): 187-190, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33895344

RESUMO

Refractive surgery has been performed under general anesthesia on pediatric and neurobehaviorally challenged adults without reported loss of vision or serious complications. Persistent epithelial defect (PED) is a rare complication of photorefractive keratectomy (PRK) in the general refractive surgery population. We report a case of PED following PRK under general anesthesia for high myopia in a man with autism and ocular history of juvenile open-angle glaucoma and dry eye syndrome.


Assuntos
Transtorno Autístico , Glaucoma de Ângulo Aberto , Ceratectomia Fotorrefrativa , Adulto , Transtorno Autístico/complicações , Criança , Humanos , Lasers de Excimer/uso terapêutico , Masculino , Refração Ocular , Resultado do Tratamento , Acuidade Visual
14.
BMJ Case Rep ; 14(4)2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910801

RESUMO

Several refractive techniques are available for the treatment of hyperopia. Conductive keratoplasty (CK) is a safe and non-ablative procedure suitable for the treatment of low hyperopia and presbyopia. Due to the high rate of regression, it is not a commonly used technique. There is minimal literature about the use of refractive procedures for the treatment of hyperopic regression after CK. We report a case of a 49-year-old man who had undergone bilateral CK 15 years before for the correction of his hyperopia. He experienced a regression, with sph +2.75 cyl -0.50(20) in the right eye and sph +2.50 cyl -0.75(170) in the left eye. Transepithelial photorefractive keratectomy (tPRK) was performed with Schwind Amaris 750 s. After 12 months, his best-corrected visual acuity was 20/20, with -0.25 sph in both eyes. To the best of our knowledge, this is the first reported case of tPRK performed after CK.


Assuntos
Transplante de Córnea , Hiperopia , Ceratectomia Fotorrefrativa , Córnea , Seguimentos , Humanos , Hiperopia/cirurgia , Lasers de Excimer , Masculino , Pessoa de Meia-Idade , Refração Ocular , Resultado do Tratamento , Acuidade Visual
15.
BMC Ophthalmol ; 21(1): 181, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863311

RESUMO

PURPOSE: To compare early clinical outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and photorefractive keratectomy (PRK) regarding refractive outcome, visual acuity, wound healing, pain intensity and visual recovery time.d. METHODS: In this prospective clinical observational study 200 eyes of 100 consecutive patients with mild to moderate myopia with or without mild astigmatism were included. One hundred eyes each were either treated with StreamLight™ tPRK or PRK with the WaveLight® EX500 excimer laser. Visual acuity (Decimal) was assessed preoperatively and at day 4, 7 and 6 weeks postoperatively. Wound healing (hours between surgery and complete epithelial closure) was monitored at the slit lamp. At day 4, patients subjectively rated the maximum pain intensity within the last 4 days using a numerical pain rating scale (0-15). RESULTS: Visual recovery was significantly faster in the tPRK group. At days 4 and 7, the mean monocular UCDVA was significantly better in the tPRK group than in the PRK group (p < 0.001). Four days after surgery 72 % of eyes in the tPRK group but no eye in the PRK had a UCDVA of 0.7 or better. At six weeks postoperatively, a UCDVA of 1.0 or better was achieved in both groups. Complete epithelial wound closure was achieved significantly faster in the tPRK group (p < 0.0001) and maximum pain level within the first 4 days after surgery was significantly lower in the tPRK group (p < 0.0001). No patient had lost a line of BCDVA and no complications or adverse effects were observed. CONCLUSIONS: According to our early clinical results, both treatments options appear to be safe and effective methods for the correction of low to moderate myopia with and without astigmatism. However, in our study, StreamLight™ tPRK offered faster visual recovery and epithelial healing and was associated with less pain compared to PRK. It can therefore be considered a good treatment option for patients who refuse or are not eligible for Femto-LASIK, but at the same time demand a faster and more comfortable recovery time than PRK can offer.


Assuntos
Ceratectomia Fotorrefrativa/métodos , Refração Ocular/fisiologia , Cicatrização , Adulto , Feminino , Humanos , Lasers de Excimer/uso terapêutico , Masculino , Dor , Resultado do Tratamento , Acuidade Visual/fisiologia
16.
Int Ophthalmol ; 41(7): 2575-2583, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33761045

RESUMO

PURPOSE: To assess the safety and effectiveness of transepithelial photorefractive keratectomy (T-PRK) in patients with mild myopia using the Schwind Amaris 750 s Excimer laser system which take corneal epithelium variability in consideration during ablation. METHODS: A prospective case series study of patients with mild myopia with or without astigmatism (spherical equivalent ≤ -3 diopters), who underwent T-PRK as a single-step treatment, was carried out at King Abdulaziz University Hospital, Riyadh between May 2017 and January 2018. The main outcomes included postoperative uncorrected distance visual acuity (UDVA), residual refraction (manifest refraction) and complications. RESULTS: A total of 42 patients (84 eyes) underwent bilateral T-PRK with a preoperative spherical equivalent ranging from - 0.75 to - 3.00 D. Median spherical equivalent before Trans-PRK was - 1.75 (- 1.25to - 1.75). The spherical equivalent six months after Trans-PRK was 0.0 (- 0.25 to 0.5). All patients had a postoperative UDVA of 20/20 or better in the last follow-up. Transient postoperative corneal haze was observed in five eyes (6%). CONCLUSION: T-PRK appears to be safe and effective in patients who have mild myopia, with or without astigmatism. The normal variation in corneal epithelial thickness seems not to affect the outcomes.


Assuntos
Astigmatismo , Miopia , Ceratectomia Fotorrefrativa , Astigmatismo/cirurgia , Humanos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento
17.
Exp Eye Res ; 206: 108537, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33716013

RESUMO

Excimer lasers induces significant changes to corneal structure and corneal biomechanics. The aim of this paper is to describe all laser-tissue interactions which are relevant for clinical practice, particularly, we will focus on laser ablations profiles, causes of regression and haze and prevention of those. At last the manuscript will describe the impact on corneal biomechanics of different Laser Vision Corrections techniques.


Assuntos
Córnea/fisiopatologia , Opacidade da Córnea/cirurgia , Lasers de Excimer/uso terapêutico , Ceratectomia Fotorrefrativa , Fenômenos Biomecânicos , Córnea/diagnóstico por imagem , Córnea/cirurgia , Opacidade da Córnea/diagnóstico , Opacidade da Córnea/fisiopatologia , Humanos , Cicatrização
18.
Clin Exp Optom ; 104(4): 505-509, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33689606

RESUMO

Silicone-hydrogel (SiH) contact lenses are frequently used as a bandage after anterior segment surgical procedures. Several types of lenses may exhibit clinical performances with different characteristics. This study aims to evaluate the efficacy of two SiH contact lenses following corneal crosslinking (CXL). Forty-nine keratoconus patients scheduled for consecutive CXL surgery in both eyes were included in this comparative, double-blind, prospective study. A Balafilcon A (Pure Vision 2 HD, Bausch+Lomb, Rochester, NY, USA) or Lotrafilcon B (Air Optix Aqua, Ciba Vision, Duluth, GA, USA) lens was fitted in a randomised fashion in the eyes at the end of the CXL. Remaining epithelial defect area measured by slitlamp biomicroscopy, subjective level of pain and discomfort with visual analogue scale (VAS) and total number of oral analgesics taken were evaluated and compared at post-operative days 0, 1, 2 and 3. The average epithelial defect size was significantly smaller in the eyes with Lotrafilcon B than the eyes with Balafilcon A at post-operative Day 1 (31.2 ± 4.3 mm2 and 33.8 ± 5.2 mm2, respectively, p < 0.001) and Day 2 (8.2 ± 3.6 mm2 and 10.5 ± 5.4 mm2, respectively, p = 0.039). There was no statistically significant in the average epithelial defect size between the groups at Day 3 (p = 0.859). Re-epithelialisation time was similar in both groups (p = 0.317) There was no statistically significant difference in VAS scores regarding the lens type in any post-operative follow-up. The mean oral analgesic numbers were similar in both groups (p = 0.217). SiH contact lenses can be used as an effective bandage for corneal re-epithelialisation after CXL. The material and features of bandage contact lens used after CXL may affect the corneal re-epithelialisation process. Lotrafilcon B lens showed faster re-epithelialisation at post-operative days 1 and 2 after CXL.


Assuntos
Lentes de Contato Hidrofílicas , Ceratectomia Fotorrefrativa , Curativos Hidrocoloides , Método Duplo-Cego , Humanos , Hidrogéis , Estudos Prospectivos , Silicones
19.
Int Ophthalmol ; 41(6): 2149-2156, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33730316

RESUMO

PURPOSE: To evaluate long-term visual and refractive outcomes of corneal wavefront-guided transepithelial photorefractive keratectomy (t-PRK) with mitomycin C for the treatment of corneal opacities secondary to adenoviral epidemic keratoconjunctivitis. METHODS: Records of patients who underwent corneal wavefront-guided t-PRK with excimer laser from January 2012 to December 2018 were retrospectively reviewed. Preoperative and postoperative uncorrected visual acuity, best-spectacle corrected visual acuity, slit-lamp biomicroscopic examination findings, manifest refraction, and corneal aberrations and fundus examination findings were evaluated. RESULTS: Twenty-two eyes of 22 patients comprising 12 male (55%) and 10 female (45%) were treated. The mean age was 34.5 ± 10.8 years (range 19-55). The mean follow-up time was 34.4 ± 17.50 months (range 13-61 months). There was a statistically significant improvement in UCVA and BSCVA (p < 0.001 and p = 0.02), and there was a significant decrease in total higher-order aberrations, spherical, coma and trefoil aberration at postoperative first year (p < 0.001 in each). In two eyes of two patients, minimal haze formation was observed after the procedure, and both eyes were treated with topical steroid. No recurrence was observed in subepithelial infiltrates in any patient during long-term follow-up. CONCLUSION: In long-term clinical follow-up, corneal wavefront-guided t-PRK treatment is an effective and reliable treatment method for rehabilitation of visual impairment due to corneal scars following adenoviral infections, in properly selected patients.


Assuntos
Opacidade da Córnea , Aberrações de Frente de Onda da Córnea , Epidemias , Ceratoconjuntivite , Miopia , Ceratectomia Fotorrefrativa , Adulto , Opacidade da Córnea/diagnóstico , Opacidade da Córnea/etiologia , Opacidade da Córnea/cirurgia , Topografia da Córnea , Feminino , Seguimentos , Humanos , Ceratoconjuntivite/diagnóstico , Ceratoconjuntivite/cirurgia , Lasers de Excimer/uso terapêutico , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Refração Ocular , Estudos Retrospectivos , Adulto Jovem
20.
Int Ophthalmol ; 41(6): 2091-2098, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33751303

RESUMO

PURPOSE: To compare the refractive outcomes of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for myopic astigmatism of 3 diopters (D) or more. STUDY DESIGN: Retrospective matched comparative study. METHODS: This study include consecutive myopic patients (SE 0 to -10 D) undergoing LASIK or PRK between 2007 and 2016 with astigmatism of 3 to 6 D, and postoperative follow-up of at least 30 days for LASIK and 60 days for PRK, compared outcomes of LASIK and PRK eyes. RESULTS: The LASIK and PRK groups comprised 175 eyes of 175 patients each, with median follow-up of 39 and 139 days, respectively (P < 0.001). Mean preoperative manifest astigmatism was -3.35 ± 0.46 and -3.42 ± 0.51 D (P = 0.92), postoperative SE was -0.43 ± 0.55 and -0.16 ± 0.64 D (P < 0.001), and arithmetic astigmatism was -0.59 ± 0.46 and -0.88 ± 0.60 D (P < 0.001), for the LASIK and PRK groups, respectively. Fifty-seven and 64.0% eyes had postoperative SE within ± 0.5 D of emmetropia (P = 0.19), and 57.7 and 38.8% eyes were within 0.5 D of attempted astigmatic correction (P < 0.001) for the LASIK and PRK groups, respectively. More PRK eyes were overtreated regarding both SE and astigmatism than LASIK eyes (P < 0.001). The efficacy and safety indices were close to 1.0 in both groups. The surgically induced astigmatism, magnitude of error, index of success, correction index and flattening index were all better in the LASIK group. CONCLUSION: Both LASIK and PRK achieve good outcomes in high astigmatism. LASIK achieved mild superiority over PRK.


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Ceratectomia Fotorrefrativa , Astigmatismo/cirurgia , Córnea/cirurgia , Humanos , Lasers de Excimer/uso terapêutico , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
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