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2.
Medicine (Baltimore) ; 99(6): e19030, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028415

RESUMO

BACKGROUND: This study aimed to assess the efficacy of rigid versus foldable iris-fixed phakic intraocular lens (PIOL) implantation in the treatment of high myopia. METHODS: A systematic search based on electronic databases such as Pubmed, Embase, and Cochrane Library was conducted to identify relevant studies published up to January 11, 2019. The pooled odds ratios and weighted mean differences (WMDs) with corresponding 95% confidence intervals were calculated. RESULTS: Eight comparative studies with 835 participants were included in this meta-analysis. The overall WMD showed statistical significance in terms of postoperative uncorrected distance visual acuity (UDVA), mean postoperative spherical equivalence (SE), and mean postoperative intraocular higher-order aberrations (HOA) (µm) for a 6-mm pupil, suggesting that foldable PIOL group showed significant improvement of high myopia, compared to rigid PIOL group. Besides, compared with rigid PIOL group, foldable PIOL group had beneficial effect on the proportion of eyes with central endothelial cell density (ECD) loss in patients with high myopia. CONCLUSION: This meta-analysis provided the up-to-date evidence and found that foldable PIOL group had significant beneficial effect on UDVA, SE, HOA, contrast sensitivity, and ECD, except best spectacle-corrected visual acuity, and safety in the treatment of high myopia over rigid PIOL group.


Assuntos
Implante de Lente Intraocular , Miopia/cirurgia , Lentes Intraoculares Fácicas , Humanos , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Resultado do Tratamento
3.
Zhonghua Yan Ke Za Zhi ; 56(2): 81-85, 2020 Feb 11.
Artigo em Chinês | MEDLINE | ID: mdl-32074816

RESUMO

Corneal refractive surgery in China, represented by laser corneal surgery, has undergone great changes in recent 30 years. Almost one million corneal refractive surgeries are performed each year. With the rapid technological innovation, the corrective effect is constantly higher, and complications are continuously controlled and reduced. The team of practitioners keeps expanding, and the academic strength is approaching the international level. With the application and promotion of various new technologies, the formulation of relevant norms and the increase of academic researches, corneal refractive surgery in China has stepped into the stage of diversification, intelligence and standardization. However, we should recognize the shortcomings while facing the great achievements. More efforts are still needed to provide the best visual quality and natural vision correction effect for patients. We would like to send congratulations on the 70th anniversary of Chinese Journal of Ophthalmology with this article. (Chin J Ophthalmol, 2020, 56: 81-85).


Assuntos
Miopia , Oftalmologia , Procedimentos Cirúrgicos Refrativos , China , Humanos , Miopia/cirurgia , Oftalmologia/tendências , Procedimentos Cirúrgicos Refrativos/tendências , Acuidade Visual
4.
Zhonghua Yan Ke Za Zhi ; 56(2): 86-88, 2020 Feb 11.
Artigo em Chinês | MEDLINE | ID: mdl-32074817

RESUMO

Small incision lenticule extraction (SMILE) has been widely used in the treatment of myopia and astigmatism due to its small incision (2 mm), without open corneal flap, rapid recovery of the ocular surface function and good comfort. However, it is the microincision and the potential cavity under the corneal cap that provide a suitable environment for microbial nourishment. In this article, the characteristics of SMILE and the particularity of postoperative infection are stated, and the key points of risk management and control during the period of operation as well as the principles of identification and treatment of infection after SMILE surgery are put forward, so as to enhance the perioperative preparation in SMILE and make sure of the safety and high quality for myopic eyes. (Chin J Ophthalmol, 2020, 56: 86-88).


Assuntos
Astigmatismo , Cirurgia da Córnea a Laser , Miopia , Córnea , Substância Própria , Cirurgia da Córnea a Laser/efeitos adversos , Humanos , Lasers de Excimer , Miopia/cirurgia , Refração Ocular , Acuidade Visual
5.
Medicine (Baltimore) ; 98(44): e17677, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689784

RESUMO

The purpose of this retrospective study was to evaluate the visual quality, objective scattering index, aberration, etc after Implantable Collamer Lens with center hole (EVO-ICL) implantation to treat patients with hypermyopia (diopter > -10 D).A total of 30 eyes underwent EVO-ICL implantation. The uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), equivalent spherical degree, aberration, visual quality parameters, and corneal endothelial cell density were compared preoperative and postoperative. Fill in the National Eye Institute Refractive Error Quality of Life Instrument-42 before and after surgery.The modulation transfer function (MTF), Optical Quality Analysis System (OQAS) II values (OV 100%, 20%, 9%), and Stahl ratio 1 and 3 months after surgery were higher than the respective preoperative values. The objective scatter index value increased 1 week after surgery, but decreased 1 and 3 months after surgery compared with the preoperative values. Total aberration (TA), total low-order aberration (tLOAs), and defocus decreased at 1 week and 3 months after EVO-ICL implantation. Total high-order aberration (tHOAs) and spherical aberration were significantly increased 1 week after surgery and decreased 3 months after surgery, and the difference was statistically significant. Astigmatism, coma, and clover were not significantly different in each time period. TA, tLOAs, tHOAs, defocus, and spherical aberration were higher at 1 week than 3 months after surgery. At 3 months after surgery, the scores of the patients' NEI-RQL-42 scale were all improved except that the glare was lower than that before surgery. There was no significant difference in the density of corneal endothelial cells before and 3 months after surgery.For patients with hypermyopia, the postoperative subjective and objective visual quality of EVO-ICL implantation was better than preoperative.


Assuntos
Implante de Lente Intraocular/métodos , Miopia/cirurgia , Lentes Intraoculares Fácicas , Adulto , Feminino , Humanos , Pressão Intraocular , Implante de Lente Intraocular/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Acuidade Visual , Adulto Jovem
6.
Medicine (Baltimore) ; 98(47): e17906, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764789

RESUMO

BACKGROUND: Femtosecond laser (FL) is an effective method to treat patients with myopia, but its relative efficacy and safety is still unclear. Thus, this study will be conducted to assess the efficacy and safety of FL for myopia systematically. METHODS: This study will systematically retrieve the following electronic databases up to the present: Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, Wanfang, VIP, and China National Knowledge Infrastructure. All electronic databases will be searched without any limitations of language and publication status. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: We will summarize the targeted results evaluating the efficacy and safety of FL for patients with myopia. CONCLUSIONS: This study will provide a comprehensive evidence summary on FL for patients with myopia.PROSPERO registration number: PROSPERO CRD42019148659.


Assuntos
Terapia a Laser/métodos , Miopia/cirurgia , Projetos de Pesquisa , Revisão Sistemática como Assunto , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
7.
Vestn Oftalmol ; 135(5): 99-106, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714520

RESUMO

Small incision lenticule extraction (SMILE) keratorefractive surgery technique is a laser surgery alternative to common methods that doesn't require laser ablation of the cornea. Despite its novelty, SMILE technique has already demonstrated positive clinical results comparable to Photorefractive Keratectomy (PRK) and Laser-Assisted in Situ Keratomileusis (LASIK), which led to its widespread application in clinical practice. Compared with other keratorefractive techniques, SMILE has a number of distinct advantage including high biomechanical stability of the cornea, low risk of dry eye syndrome, absence of a corneal flap and associated complications, preservation of corneal epithelium. The article describes the most common SMILE modifications, its weak points and possible complications, as well as methods of additional correction of remaining ametropy.


Assuntos
Ceratoplastia Penetrante , Ceratectomia Fotorrefrativa , Córnea , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ , Lasers de Excimer , Miopia/cirurgia
8.
Korean J Ophthalmol ; 33(5): 458-466, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612657

RESUMO

PURPOSE: To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform. METHODS: This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees). RESULTS: The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was -0.32 ± 0.3 diopters (D, -1.25 to 0.00 D) in group 1, -0.47 ± 0.2 D (-2.00 to 0.00 D) in group 2, -0.62 ± 0.2 D (-1.00 to -0.25 D) in group 3, and -0.91 ± 0.2 D (-1.50 to -0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001). CONCLUSIONS: Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism.


Assuntos
Astigmatismo/cirurgia , Córnea/cirurgia , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Refração Ocular/fisiologia , Acuidade Visual , Adolescente , Adulto , Astigmatismo/complicações , Astigmatismo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/complicações , Miopia/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Asia Pac J Ophthalmol (Phila) ; 8(5): 371-376, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567264

RESUMO

Small incision lenticule extraction (SMILE) is a new paradigm for refractive surgery, and was first performed by Sekundo and Blum in 2008. It uses only a femtosecond laser to carve out a lenticule within the corneal stroma, and then achieves refractive correction by extracting the lenticule through a small incision. A number of studies have shown that SMILE leads to stable and efficacious outcomes, combined with high safety. Long-term studies also indicate that SMILE has excellent outcomes combined with high safety. Although relatively safe, SMILE can have some intraoperative and postoperative complications, including suction loss during the procedure, lenticule tears, incision tears, epithelial ingrowth, diffuse lamellar keratitis, and residual refractive error. Studies indicate that SMILE leads to less postoperative dry eyes. It is thus preferred over laser-assisted in-situ keratomileusis (LASIK) in cases wherein there is mild dry eye preoperatively. It is also preferred over LASIK in cases wherein the patient is likely to engage in contact sports. LASIK may be preferred over SMILE for the treatment of hyperopia, and in cases of significant higher order wavefront aberrations or topographic irregularities.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Humanos , Miopia/fisiopatologia
10.
Asia Pac J Ophthalmol (Phila) ; 8(5): 385-390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567265

RESUMO

The advent of "flapless" small-incision lenticule extraction (SMILE), employing all-in-one technology, has resulted in a revolutionary breakthrough in refractive surgeries. SMILE has been gaining popularity due to fewer potential complications, such as postoperative dry eyes and greater biomechanical stability, etc. However, attention must be given to 1) the centration on the corneal vertex, 2) the proper alignment of the astigmatic axis, and 3) the relationship between pupil size and treatment diameter, to achieve good SMILE results. There is no pupil-tracking system to ascertain the accuracy of centration during the SMILE surgery. To improve the centration accuracy, our center uses two corneal topographers (Pentacam and Sirius) to measure and determine corneal vertex. Proper predicted optical zone diameter is not clearly defined yet in SMILE. Some scholars insist that mesopic pupil size should be taken into consideration when setting the predicted optical zone. Meanwhile, the issue of "functional optical zone" still has many unresolved issues and warrants further studies.


Assuntos
Substância Própria/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Substância Própria/diagnóstico por imagem , Topografia da Córnea , Humanos , Miopia/diagnóstico , Miopia/fisiopatologia
12.
Vestn Oftalmol ; 135(4): 3-9, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31573551

RESUMO

INTRODUCTION: One important question for patients with both myopia and glaucoma is comparability of optical coherence tomography (OCT) data obtained before and after a significant change in eye refraction following cataract extraction surgery with implantation of intraocular lens (IOL). PURPOSE: To assess the impact of correcting moderate and high myopia during cataract phacoemulsification with IOL implantation (Phaco/IOL) on the parameters measured by OCT. MATERIAL AND METHODS: OCT was performed in 31 patients (31 eyes) with axial eye length of more than 25.5 mm before and the day after Phaco/IOL. Changes in 17 parameters of the retina, retinal ganglion cells-inner plexiform layer (GCIPL), peripapillary retinal nerve fiber layer (RNFL) and optic nerve head (ONH) were analyzed. RESULTS: Axial eye length was 26.94±1.09 mm in average (25.57-29.39 mm). The average refractive effect of the intervention was 8.44±4.16 D (3.75-19.0 Diopters). Signal strength in all OCT protocols was no lower than 5. Changes in the average values of OCT parameters after surgery were insignificant. They exceeded 1% of the pre-operation values only in 7 cases, including all 5 parameters of the ONH, and were significant only in 5 out of 17 parameters. For GCIPL and RNFL thickness, the changes on average did not exceed 0.9 µm, for retinal thickness in the macular area - 2.1 µm. In relative terms, the largest decrease (an average of -0.03 mm2; -2.5%) was in the optic disc area. CONCLUSION: In patients with high and moderate myopia, the parameters of the retina, RNFL, GCIPL, and ONH, as measured by OCT, changed insignificantly on the first day after Phaco/IOL (considering the signal strength of Cirrus HD-OCT device was not lower than 5).


Assuntos
Miopia , Disco Óptico , Catarata , Extração de Catarata , Humanos , Implante de Lente Intraocular , Miopia/cirurgia , Células Ganglionares da Retina , Tomografia de Coerência Óptica
13.
BMC Ophthalmol ; 19(1): 205, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615462

RESUMO

BACKGROUND: To compare the visual and refractive outcomes after myopic LASEK using three different excimer lasers and standardized surgical and mitomycin C (MMC) application protocols. METHODS: In this retrospective, observational cohort study, we examined 122 eyes treated with Allegretto, 135 eyes treated with Esiris and 137 eyes treated with Technolas excimer lasers. All eyes were treated under the same surgical protocol, and a standardized MMC dosage was used. The three groups were refraction-matched, and both visual and refractive outcomes were evaluated at 1 and 7 days and 1 and 3 months after surgery. RESULTS: At 3 months postsurgery, Allegretto provided significantly better outcomes than Esiris and Technolas in terms of postoperative uncorrected distance visual acuity (UDVA) (1.11 ± 0.2 vs 1.01 ± 0.2 vs 0.98 ± 0.2) (P = 0.0001), corrected distance visual acuity (CDVA) (1.13 ± 0.2 vs 1.10 ± 0.1 vs 1.04 ± 0.2) (P = 0.0001), residual sphere (- 0.01 ± 0.2 vs + 0.29 ± 0.7 vs + 0.27 ± 0.6) (P = 0.0001), and efficacy index (0.99 ± 0.2 vs 0.90 ± 0.2 vs 0.91 ± 0.2) (P = 0.0004). CONCLUSIONS: We found slightly better visual and refractive outcomes in the Allegretto group at 3 months post-op after LASEK with MMC to correct myopia.


Assuntos
Ceratectomia Subepitelial Assistida por Laser/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Adulto , Feminino , Seguimentos , Humanos , Masculino , Miopia/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
14.
Invest Ophthalmol Vis Sci ; 60(13): 4408-4415, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31639827

RESUMO

Purpose: We study the density and excitatory response of neurites, and Schwann cells (SCs) in fresh and cryopreserved stromal lenticules derived from small incision lenticule extraction (SMILE). Methods: Human stromal lenticules (n = 23) were immunostained for ß III-tubulin and imaged using spinning disk confocal laser microscopy, followed by three-dimensional reconstruction, to reveal neurite distribution. The lenticule neurite density (LND) was assessed using a validated neurite tracing and length measurement method with NeuronJ. LND was compared among groups of different lenticule thickness (71-165 µm) obtained from -3 to >-6 diopters (D) corrections. SCs were identified by marker expression and the laser effect on SC-neurite interaction was examined under transmission electron microscopy (TEM). Fresh porcine SMILE-lenticules (n = 18) were used for LND comparison among storage conditions and functional excitatory calcium response assay. Results: Using a validated neurite length measurement method, we found an inverse correlation of LND with lenticule thickness. Higher LND was found in thinner lenticules obtained from lower power of correction (r = -0.8925, P < 0.0001), whereas total lenticule neurite lengths did not alter significantly with regards to lenticule thickness. SCs were identified by GAP43 and p75NTR expression and were closely associated with lenticule neurites under TEM. In porcine lenticules, LND and excitatory calcium response were reduced after cold and cryogenic storage, when compared to fresh lenticules. Conclusions: The stromal neurites showed variations in density related to SMILE lenticule thickness and cryopreservation. With the presence of SC support and excitatory response, these neurite residues could retain minimal functionality that might serve as a potential advantage in the event of lenticule implantation.


Assuntos
Substância Própria/cirurgia , Cirurgia da Córnea a Laser/métodos , Neuritos/metabolismo , Adulto , Cálcio/metabolismo , Substância Própria/metabolismo , Criopreservação , Feminino , Proteína GAP-43/metabolismo , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional , Masculino , Microscopia Confocal , Microscopia Eletrônica de Transmissão , Microcirurgia , Miopia/cirurgia , Proteínas do Tecido Nervoso/metabolismo , Neuritos/patologia , Receptores de Fator de Crescimento Neural/metabolismo , Células de Schwann/metabolismo
15.
Asia Pac J Ophthalmol (Phila) ; 8(5): 406-411, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513041

RESUMO

PURPOSE: To provide an overview of the currently available retreatment methods after myopic small-incision lenticule extraction (SMILE). DESIGN: Systematic literature review. METHODS: The PubMed library was searched for articles containing the terms "small-incision lenticule extraction" and "enhancement" or "retreatment". The last search was performed on May 1, 2019. RESULTS: In contrast to laser in-situ keratomileusis (LASIK), which can be retreated by a flap relift, repeat SMILE retreatment is currently not approved and only seldomly performed. As substitutes, surface ablation, cap-to-flap conversion using the CIRCLE program in the VisuMax platform, and thin-flap LASIK have been recently established. While all options offer safety and efficacy comparable to LASIK retreatments, each has its patient-specific advantages and disadvantages. While surface ablation preserves the flap-free approach of the primary procedure, the aspect of pain and a slow visual recovery might render it less attractive as compared with CIRCLE and thin-flap LASIK which offer quick recovery, however at the price of flap creation. Besides, each retreatment method generates specific tissue responses and has a different impact on corneal biomechanics, which is strongly dependent on the previous SMILE parameters, especially the cap thickness. CONCLUSIONS: Refractive enhancement after SMILE is currently mostly performed by surface ablation, CIRCLE cap-to-flap conversion or thin-flap LASIK, which all offer safety and efficacy comparable to LASIK retreatments. In this review, a detailed overview over each method, its technical aspects, and specific advantages and disadvantages is given.


Assuntos
Substância Própria/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Substância Própria/patologia , Humanos , Miopia/fisiopatologia
16.
Middle East Afr J Ophthalmol ; 26(2): 65-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543662

RESUMO

PURPOSE: The aim of the study is to evaluate patients' satisfaction and subjective vision 12 months after monocular KAMRA corneal inlay implantation for the surgical compensation of presbyopia. SUBJECTS AND METHODS: Medical records of patients who underwent corneal inlay implantation in the nondominant eye between 2013 and 2014 were retrospectively reviewed. Data were collected from several centers in Lebanon. Patients with hyperopia or myopia with presbyopia between 45 and 70 years not suffering from any other ocular pathology were eligible for inclusion. Twelve-month postoperative satisfaction score was evaluated in all patients as well as the subjective vision score for near, intermediate, and distant tasks. RESULTS: This study included 73 patients. Almost 95% (69/73) of patients were satisfied or very satisfied with their vision and 93% (68/73) never or almost never used reading glasses while performing daily tasks. Subjective vision scores were found to be higher for distant and intermediate tasks performed during the day than for those performed during the night (P < 0.001). The average subjective vision score for reading a book or a newspaper in dim light was the lowest among all average subjective vision scores. No difference in satisfaction was found between patients with myopia or hyperopia or between males and females. CONCLUSION: The implant of a small-aperture corneal inlay resulted in a substantial improvement in patients' distant, intermediate, and near subjective vision, better in normal light than in dim light, and most patients became spectacles independent.


Assuntos
Substância Própria/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Presbiopia/cirurgia , Próteses e Implantes , Implantação de Prótese , Acuidade Visual/fisiologia , Idoso , Feminino , Humanos , Hiperopia/cirurgia , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Inquéritos e Questionários
17.
Asia Pac J Ophthalmol (Phila) ; 8(5): 377-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31478935

RESUMO

PURPOSE: Laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) are popular refractive surgeries. The objective refractive outcomes of LASIK and SMILE have been studied extensively; both procedures have comparable safety, efficacy, and predictability. However, owing to various psychosocial factors, refractive patients may report dissatisfaction despite good postoperative vision. Hence the importance of studies on subjective patient-reported outcomes. This review discusses the role of psychometric-technique-based validated questionnaires when evaluating subjective outcomes. It also summarizes the literature on patient-reported outcomes for LASIK and SMILE. DESIGN: A literature search was performed on PubMed database to identify studies that have assessed patient-reported outcomes for LASIK and SMILE. RESULTS: Several studies have looked into patient-reported outcome measures for LASIK, but the number of equivalent studies for SMILE is limited. Questionnaires (validated and non-validated) are used to evaluate patient-reported outcomes. Validated questionnaires are designed based on psychometric techniques, such as Classic Test Theory, Item Response Theory, and Rasch analysis. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire, a validated questionnaire administered to both LASIK and SMILE patients, suggests that both groups have comparable vision-related quality of life in the first few months postoperatively; but SMILE might confer a slight advantage in the later postoperative period (postoperative month 6). CONCLUSIONS: Future LASIK-SMILE comparative studies utilizing standardized validated questionnaires for patient-reported outcome measures with longer follow-up durations would be a welcome contribution to this important aspect of refractive surgery.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Microcirurgia/métodos , Miopia/cirurgia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Refração Ocular/fisiologia , Substância Própria/cirurgia , Humanos , Miopia/fisiopatologia , Acuidade Visual
18.
J Refract Surg ; 35(9): 575-582, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31498415

RESUMO

PURPOSE: To compare clinical outcomes between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) in fellow eyes of myopic patients. METHODS: This prospective randomized contralateral study included 432 eyes of 216 myopic patients who underwent LASIK. TCAT was randomly performed in one eye (TCAT group) and WFO LASIK in the fellow eye (WFO group). The WaveLight FS200 femtosecond laser (Alcon Laboratories, Inc., Fort Worth, TX) was used to create the flap and the EX500 excimer laser was used for photoablation. The Sirius combined corneal topographer and tomographer system (CSO, Florence, Italy) was used to measure the corneal aberrations. Refractive and visual outcomes and corneal aberrations were compared between the two groups. RESULTS: At 1 month postoperatively, the uncorrected distance visual acuity (UDVA) was 20/20 or better in 89.4% of eyes in the TCAT group and 93.5% of eyes in the WFO group (P < .05). The UDVA became similar at postoperative 6 months (P > .05). Postoperative corrected distance visual acuity and residual manifest refractive spherical equivalent were similar between the groups (P > .05). The postoperative residual refractive astigmatism in the TCAT group was greater than that in the WFO group (P < .05). The optical path difference and root mean square of higher order aberrations and coma were significantly lower in eyes in the TCAT group at postoperative 1 and 6 months (P < .05). CONCLUSIONS: TCAT in virgin eyes induced less corneal optical path difference, fewer higher order aberrations, and less coma than WFO LASIK. However, TCAT was not as accurate as WFO, especially in astigmatism correction. A better compensation method for TCAT is warranted. [J Refract Surg. 2019;35(9):575-582.].


Assuntos
Aberrometria , Astigmatismo/cirurgia , Topografia da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Cirurgia Assistida por Computador , Adolescente , Adulto , Astigmatismo/fisiopatologia , Sensibilidades de Contraste/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Estudos Prospectivos , Refração Ocular/fisiologia , Microscopia com Lâmpada de Fenda , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
19.
J Refract Surg ; 35(9): 600-605, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31498418

RESUMO

PURPOSE: To assess the repeatability of epithelial, stromal, and total corneal thickness measurements with spectral-domain optical coherence tomography (SD-OCT; RTVue-XR; Optovue, Inc., Fremont, CA) in patients with myopia, keratoconus, and corneas after transepithelial photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: A total of 352 eyes of 352 patients (75 myopic, 68 post-transepithelial PRK, 61 post-SMILE, 75 post-FS-LASIK, 20 mild keratoconus, and 53 advanced keratoconus eyes) were included. The epithelial, stromal, and total corneal thickness were recorded from the pachymetric map in the following four zones: (1) central 2-mm region, (2) eight paracentral regions within 2- to 5-mm diameter, (3) eight midperipheral regions within 5- to 7-mm diameter, and (4) eight peripheral regions within 7- to 9-mm diameter. Three successive scans were performed to evaluate the repeatability. RESULTS: For all zones up to 9-mm diameter, the coefficient of variation (CoV) for epithelial thickness measurements ranged from 1.7% to 3.5% for myopia, 2.6% to 6.2% for post-transepithelial PRK, 2.3% to 4.7% for post-SMILE, 4.0% to 6.3% for post-FS-LASIK, 2.5% to 6.2% for mild keratoconus, and 3.5% to 8.0% for advanced keratoconus. The CoV for stromal and total thickness measurements ranged from 0.2% to 2.0% for myopia, 0.7% to 4.2% for post-transepithelial PRK, 0.3% to 2.4% for post-SMILE, 0.3% to 1.9% for post-FS-LASIK, 0.6% to 3.0% for mild keratoconus, and 1.0% to 5.9% for advanced keratoconus. CONCLUSIONS: RTVue-XR SD-OCT showed excellent repeatability when generating the pachymetric map in myopic eyes. Measurements, especially for epithelial thickness, were relatively more variable for corneas with keratoconus and those having undergone keratorefractive surgery. [J Refract Surg. 2019;35(9):600-605.].


Assuntos
Córnea/patologia , Paquimetria Corneana , Ceratocone/patologia , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia/patologia , Ceratectomia Fotorrefrativa , Adolescente , Adulto , Criança , Córnea/diagnóstico por imagem , Substância Própria/diagnóstico por imagem , Substância Própria/patologia , Epitélio Anterior/diagnóstico por imagem , Epitélio Anterior/patologia , Feminino , Humanos , Ceratocone/diagnóstico por imagem , Ceratocone/cirurgia , Masculino , Miopia/diagnóstico por imagem , Miopia/cirurgia , Tamanho do Órgão , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia de Coerência Óptica/métodos , Adulto Jovem
20.
Zhonghua Yan Ke Za Zhi ; 55(9): 670-676, 2019 Sep 11.
Artigo em Chinês | MEDLINE | ID: mdl-31495152

RESUMO

Objective: To analyze clinical effects of modified Yokoyama's surgery combined with medial rectus muscle recession for treatment of high myopic strabismus fixus. Methods: Retrospective analysis of records of 9 patients (14 eyes) with high myopic strabismus fixus treated from February 2013 to December 2016 in the Department of Ophthalmology, Xiangya Hospital, Central South University. All patients underwent modified Yokoyama's surgery. The temporal 1/2 of the superior rectus (SR) and the superior 1/2 of the lateral rectus (LR) were united 12 to 14 mm, combined with medial rectus muscle recession. The angle of deviation of primary position, the mobility of the affected eye, and the change of CT imaging were observed and analyzed before and 6 months after surgery. Statistical analysis was performed by Mann-Whitney U test. Results: The patients were 5 females and 4 males with an average age of (60±10) years. The duration of high myopia was (33.33±6.61) years. The refractive power was (-23.32±5.95) D, and the axial length was (33.04±2.63) mm. The recession mount of medial rectus was (7.2±2.1) mm (4.0-10.0 mm) intraoperatively. At 6 months, the median esotropia improved from 130 (80-140) prism diopter (PD) to 0 (0-10) PD, and the hypotropia from 20 (15-25) PD to 0 (0-5) PD. The median abduction limitation decreased from -3 (-4--1) to -1 (-2-0), and the median limitation of elevation decreased from -2 (-4--1) to 0 (-1-0). The angle of esotropia and hypotropia significantly improved (Z=-2.67, -2.70; P=0.008, 0.007), and the restriction of abduction and elevation decreased (Z=-3.35, -3.24; both P=0.001). Only 3 patients' CT images were enrolled in a comparative study. Preoperative orbital CT scans showed inferior LR displacement and medial SR displacement with the posterior portion of the eyeball to the superotemporal quadrant of the orbit. After surgery, the mean reduction ratio of dislocation degree of the 3 patients was 28.97%, the dislocation of LR and SR was reduced, and the posterior global part was correctly positioned within the orbit. Conclusions: The modified Yokoyama's surgery combined with medial rectus muscle recession can effectively correct high myopic strabismus fixus, recover the eyeball anatomical position, and evidently improve eye mobility. The clinical effects are satisfactory. (Chin J Ophthalmol, 2019, 55: 670-676).


Assuntos
Esotropia , Miopia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo , Idoso , Esotropia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Músculos Oculomotores , Órbita , Estudos Retrospectivos , Estrabismo/cirurgia
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