AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients w...AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography(AS-OCT).METHODS:Four patients with monocular corneal opacity(3 due to mechanical injury,1 due to a firecracker wound)were recruited and treated with refractive surgery(3 for SMILE,1 for FS-LASIK combined with limbal relaxing incision(LRI).Preoperative ocular manifestations,surgical details,postoperative visual outcomes,corneal opacity parameters,and corneal topography were analyzed.RESULTS:Preoperatively,spherical diopter ranged from-3.0 D to-4.75 D with cylinder ranging from-0.75 to-5.0 D,and corrected distance visual acuity(CDVA)ranging from 20/25 to 20/20.One eye’s corneal opacity was located in the central zone and three were in the mid-peripheral optical zone.Three patients underwent uneventful SMILE in both eyes,whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye.CDVA of the eye with corneal opacity ranged from 20/22to 20/20 one to six weeks postoperatively.Two patients achieved better CDVA and no patients lost Snellen lines.The postoperative diopter was within±0.75 D for all eyes.Significant edema existed above the corneal opacity in one eye and dissipated soon.No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.CONCLUSION:The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection.FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.展开更多
AIM:To determine the clinical outcomes of laser insitu keratomileusis(LASIK)treatments using LaserSight AstraPro Planner 2.2 Z software for myopia with asymmetric corneal shape.METHODS:Four hundred and eighty-five eye...AIM:To determine the clinical outcomes of laser insitu keratomileusis(LASIK)treatments using LaserSight AstraPro Planner 2.2 Z software for myopia with asymmetric corneal shape.METHODS:Four hundred and eighty-five eyes[243patients;spherical equivalent(SE),-5.93±1.88 diopters(D)]were treated with asymmetric ablations using LaserSight SLX laser(version 5.3,300Hz)were retrospectively analyzed and LaserSight AstraPro Planner2.2 Z software.Preoperative and postoperative uncorrected visual acuities(UCVA),spherical equivalent(SE)refraction,pachymetry,and corneal asphericity(Q value)and decentration were evaluated.RESULTS:At 12mo postoperatively,the decimal UCVA was 1.0 or better in 449(92.6%)eyes.Two eyes(0.4%)lost 1 line of the decimal best spectacle-corrected visual acuity(BCVA),316(65.2%)did not change,149(30.7%)gained 1 line,and 18(3.7%)gained 2 lines or more after surgery.Three hundred and thirty-two eyes(68.5%)were within 0.5 D in SE.The mean tissue saving ablation depth was 4.28±2.86(0-16)μm(median,4μm).The mean attempted remaining central corneal thickness was435.79±29.56μm,the mean postoperative pachymetry was 444.94±28.93μm.The mean preoperative Q value was-0.19±0.18,the postoperative was 0.30±0.48(P=0.000).The mean postoperative decentration was 0.39±0.19 mm.CONCLUSION:Topography-guidedLASIKwithAstraPro Planner 2.2 Z custom ablation planning software in an asymmetric ablation mode was an effective,safe,predictable,and stable refractive procedure for the myopia with asymmetric corneal topography.展开更多
AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optica...AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optical Quality Analysis System(OQAS)was used to evaluate clinical outcomes objectively after operation for high myopia correction.We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),safety index,efficacy index,spherical equivalent,modulation transfer function(MTF)cutoff frequency,strehl ratio(SR)and objective scatter index(OSI).RESULTS:At 1 y postoperatively,the safety indices were 1.33±0.27 in ICL group,and 1.17±0.24 in FS-LASIK group.39.58%in the ICL group and 27.59%in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA.The efficacy indices were 1.28±0.22 in ICL group,and 1.13±0.26 in FS-LASIK group.The changes of spherical equivalent from 1 wk to 1 y postoperatively was-0.12±0.37 D in ICL group,and-0.79±0.58 D in FS-LASIK group(P<0.05).Spherical equivalent within±0.50 D was achieved in 97.92%in ICL group and 68.97%in FS-LASIK group.MTF cutoff frequency were higher with ICL as compared to FSLASIK(P<0.05)at each postoperative follow-up stage;for postoperative 1 mo later,SR was statistically significant difference between two groups(P<0.05);with no statistically significant difference in OSI between two groups(P>0.05)in postoperative 3 mo later.CONCLUSION:ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction.ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.展开更多
Dear Editor,I am Dr.Xiu Wang,from Tianjin Medical University Eye Hospital,Tianjin,China.I write to present one case report of Posner-Schlossman syndrome(PSS)induced laser in situ keratomileusis(LASIK)keratectasia.PSS ...Dear Editor,I am Dr.Xiu Wang,from Tianjin Medical University Eye Hospital,Tianjin,China.I write to present one case report of Posner-Schlossman syndrome(PSS)induced laser in situ keratomileusis(LASIK)keratectasia.PSS is a condition characterized by recurrent,acute attacks of mild,unilateral,non-granulomatous,anterior展开更多
Objective: To evaluate the effectiveness, predictability and city of laser in situ keratomileusis (LASIK) for correction of hyperopia. Methods 54 eyes of 35 patients with hyperopia ranging from+1.00 to + 6. 00 diopter...Objective: To evaluate the effectiveness, predictability and city of laser in situ keratomileusis (LASIK) for correction of hyperopia. Methods 54 eyes of 35 patients with hyperopia ranging from+1.00 to + 6. 00 diopter(D) received a one-pass, multizone scanning excimer laser ablations using the Chiron Technolas Keracor 11 7C excimer laser and System ALK automated corneal shaper H-230.Data on uncorrected and hot corrected visual acuity, predictability, stability of refraction, and complications were analyzed. The average follow-up was 12 months. Results At 12 months, the average residual refraction was(+ 0. 29 ±0. 78)D. 45 eyes (83.3% ) were in the range of ±1. OD and 33 eyes(61. 1% ) were within the range of ± 0. 5D. 50 eyes (92. 6% ) had uncorrected visual acuity of 20/40 or better and 34 eyes (63. 0% ) had 20/20 or better. 1 eyes (1. 9% ) lost 2 line of the best-corrected visual acuity and 2 eyes (3. 7% ) gained 2 lines or more. 2 eyes (3. 7%) had complaint of halos and 1 eyes (1. 9% ) had glare at 12 months. Conclusion LASIK can he used to treat hyperopia from + 1. 0D to + 6. 0D with good predictability and city. Primary and second hyperopia should he treated with different nomogram. some modification of the surgical algorithms and laser nomogram will help to improve predictability and stability of outcome.展开更多
A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemi...A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemic antibiotics were promptly administered.Bacterial culture was performed following corneal flap lift and scraping of the lesions.Afterwards,the therapeutic regimen was readjusted according to the culture results.Streptococcus pneumoniae was identified from the culture.Three months after the surgery,corrected distance visual acuity achieved 20/20 in both eyes.Streptococcus pneumoniae can affect the cornea following LASIK.As prompt treatment is crucial,we recommend,for acute and subacute cases,systemic and topical application of vancomycin or moxifloxacin before the culture results come out.展开更多
Dear Editor,I am Dr.David P Pi?ero from the Department of Optics,Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar(Oftalmar)and Vithas Virgen del Carmen(...Dear Editor,I am Dr.David P Pi?ero from the Department of Optics,Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar(Oftalmar)and Vithas Virgen del Carmen(Qvision)hospitals in Spain.I write to describe a case in which the visual acuity defocus curves(VADC)and contrast sensitivity展开更多
AIM: To evaluate the possible differences in visual quality between small incision lenticule extraction(SMILE) and femtosecond laser in situ keratomileusis(FS-LASIK) for myopia.METHODS: A Meta-analysis was performed. ...AIM: To evaluate the possible differences in visual quality between small incision lenticule extraction(SMILE) and femtosecond laser in situ keratomileusis(FS-LASIK) for myopia.METHODS: A Meta-analysis was performed. Patients were from previously reported comparative studies treated with SMILE versus FS-LASIK. The Pub Med, EMBASE, Cochrane, Web of Science and Chinese databases(i.e. WANFANG and CNKI) were searched in Nov. of 2016 using Rev Man 5.1 version software. The differences in visual acuity, aberration and biomechanical effects within six months postoperatively were showed. Twenty-seven studies including 4223 eyes were included. RESULTS: No significant differences were observed between SMILE and FS-LASIK in terms of the proportion of eyes that lost one or more lines of corrected distance visual acuity after surgery(P=0.14), the proportion of eyes achieving an uncorrected distance visual acuity of 20/20 or better(P=0.43), the final refractive spherical equivalent(P=0.89), the refractive spherical equivalent within ±1.00 diopter of the target values(P=0.80), vertical coma(P=0.45) and horizontal coma(P=0.06). Compared with the FSLASIK group, total higher-order aberration(P<0.001) and spherical aberration(P<0.001) were higher and the decrease in corneal hysteresis(P=0.0005) and corneal resistance factor(P=0.02) were lower in the SMILE group. CONCLUSION: SMILE and FS-LASIK are comparable in efficacy, safety and predictability for correcting myopia.However, the aberration in the SMILE group is superior to that in the FS-LASIK group, and the loss of biomechanical effects may occur less frequently after SMILE than after FS-LASIK.展开更多
Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising al...Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive Keratectomy.Following laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and neurotransmitters.Notably,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve regeneration.Alterations in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult induced.In this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.展开更多
AIM:To assess and compare the morphology of corneal flaps created by the Wavelight FS200 and Intralase FS60 femtosecond lasers in laser in situ keratomileusis(LASIK).METHODS:Four hundred eyes of 200 patients were enro...AIM:To assess and compare the morphology of corneal flaps created by the Wavelight FS200 and Intralase FS60 femtosecond lasers in laser in situ keratomileusis(LASIK).METHODS:Four hundred eyes of 200 patients were enrolled in this study and divided into Wavelight FS200 groups(200 eyes) and Intralase FS60 groups(200 eyes).Fourier-domain optical coherence tomography(RTVue OCT) was used to measure the corneal flap thickness of 36 specified measurements on each flap one week after surgery.Results were used to analyze the regularity,uniformity and accuracy of the two types of LASIK flaps.RESULTS:The mean thickness of corneal flap and central flap was 105.71±4.72 μm and 105.39±4.50 μm in Wavelight FS200 group and 109.78±11.42 μm and 109.15±11.59 μm in Intralase FS60 group,respectively.The flaps made with the Wavelight FS200 femtosecond laser were thinner than those created by the Intralase FS60 femtosecond laser(P=0.000).Corneal flaps in the 2 groups were uniform and regular,showing an almost planar configuration.But the Wavelight FS200 group has more predictability and uniformity of flap creation.The mean deviation between achieved and attempted flap thickness was smaller in the Wavelight FS200 group than that in the Intralase FS60 group,which were 5.18±3.71 μm and 8.68±7.42 μm respectively.The deviation of more than 20 μm was 0.2% measurements in Wavelight FS200 group and 8.29% measurements in Intralase FS60 group.CONCLUSION:The morphologies of flaps created by Wavelight FS200 are more uniform and thinner than those created by Intralase FS60.展开更多
AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in si...AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ^(2)=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ^(2)=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ^(2)=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ^(2)=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.展开更多
AIM:To investigate the changes in choroidal thickness(CT)in high myopic eyes after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery or central hole implantable collamer lens(ICL V4c)implantation usin...AIM:To investigate the changes in choroidal thickness(CT)in high myopic eyes after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery or central hole implantable collamer lens(ICL V4c)implantation using swept-source optical coherence tomography(SS-OCT).METHODS:We examined the right eyes of 116 patients with high myopia who were candidates for FS-LASIK surgery and ICL implantation.Sixty eyes underwent ICL V4c implantation and 56 eyes were subjected to FS-LASIK surgery.The CT was measured with SS-OCT.All data were recorded preoperatively and 2 h,1 wk,1 and 3 mo postoperatively.Other demographic information was collected,including age,sex,uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical equivalent(SE),intraocular pressure(IOP)and axial length(AL).RESULTS:The UCVA improved in both groups and showed no significant differences between groups.There also were no significant differences between the two groups in postoperative BCVA and SE(P=0.581 and 0.203,respectively).The foveal CTs,inner nasal and outer nasal CTs were significantly thicker at 2 h postoperatively in both groups(P<0.05)but returned to baseline levels in 1 wk;after 1 mo,no significant differences were found relative to the preoperative values.At 3 mo in each group,nine regions showed variations in the CT as compared with preoperative thickening,but only the foveal and nasal area CTs preoperative differences were statistically significant(P<0.05).In addition,there was no significant difference in 9 regions of CT between the two groups at all follow-up times(P>0.05).CONCLUSION:The CTs after ICL implantation and FSLASIK surgery are significantly thicker than those before operation,especially in the foveal and nasal areas,but there is no significant difference between the two methods.展开更多
AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A c...AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A case-controlled clinical study was performed.Twenty right eyes of 20 moderate and high hyperopia patients underwent s LIKE(s LIKE group)and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK(FS-LASIK group)were enrolled in this study from October 2015 to October 2017.Visual acuity,refractive error,corneal thickness,and keratometry were compared between the groups before and 1 y postoperatively.RESULTS:The postoperative uncorrected near visual acuity(UNVA)and uncorrected distance visual acuity(UDVA)were improved in the two groups.The UNVA reached J1 in 15 eyes(75.0%)in the s LIKE group and 5 eyes(22.7%)in the FS-LASIK group 1 y after surgery(χ2=11.476,P=0.001).The UDVA was equal or better than the preoperative CDVA in 16 eyes(80.0%)in the s LIKE group and 8 eyes(36.4%)in the FS-LASIK group,respectively(X2=8.145,P=0.004).No eyes lost any line of best-corrected visual acuity(BCVA)in either group.The amount of postoperative residual hyperopia in the s LIKE group was significantly less than in the FS-LASIK group(Z=-2.841,P=0.004).The postoperative keratometry and corneal thickness were significantly higher in the s LIKE group than in the FS-LASIK group(t=4.411,10.279,P<0.001).The SRI and SAI of the s LIKE group were significantly higher than that in the FS-LASIK group.There was no statistically significant difference in mean decentration between the two groups.CONCLUSION:s LIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.展开更多
AIM:To compare intraocular pressure(IOP)measurements before and after laser in situ keratomileusis(LASIK)with a femtosecond laser for flap creation using ocular response analyzer(ORA)and Goldmann applanation tonometry...AIM:To compare intraocular pressure(IOP)measurements before and after laser in situ keratomileusis(LASIK)with a femtosecond laser for flap creation using ocular response analyzer(ORA)and Goldmann applanation tonometry,and to identify factors that may influence the preoperative and postoperative IOP.METHODS:A prospective study conducted on myopic patients who underwent LASIK using a femtosecond laser for flap fashioning.Enrolled patients were evaluated preoperatively,6 wk and 3 mo postoperatively for manifest refraction(MR),keratometric(K)readings and central corneal thickness(CCT)using a scheimpflug-based topography.Corneal resistance factor(CRF),corneal hysteresis(CH),Goldmann correlated IOP(IOPg)and corneal compensated IOP(IOPcc)were measured using ORA besides IOP assessment by Goldman applanation tonometry(GAT).RESULTS:There was a statistically significant decrease in measures of IOPg by 3.35±0.83 mm Hg,followed by GAT which decreased by 2.2±0.44 mm Hg,and the least affected by operation was IOPcc which decreased only by 0.87±0.1 mm Hg after 6 wk.After 3 mo follow up there was a statistically significant decrease in IOPcc which decreased only by 0.76±0.4 mm Hg,followed by IOP GAT by 1.6±0.5 mm Hg,and the most affected by operation was IOPg which decreased by 2.3±0.3 mm Hg.Correspondingly,there was a statistically significant decrease in CH and CRF after 6 wk and 3 mo.At 3 mo,the preoperative MR and preoperative GAT were prominent significant predictors of the postoperative GAT changes.The prediction equation was subsumed.CONCLUSION:IOP measurements and corneal biomechanical factors reduce significantly after LASIK with a femtosecond laser for flap creation.The IOPcc values are less influenced by changes in corneal properties than IOPg and GAT,indicating that IOPcc may provide the most reliable measurement of IOP after this procedure.展开更多
AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was perf...AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases(i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA(version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed.RESULTS: Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity(UCVA) of 20/20 or better(P=0.377), gaining one line or more(P=0.05), postoperative cylinder(P=0.40), vertical coma(P=0.593) and horizontal coma(P=0.957). After TG ablation, the proportion of the patients’ eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO(P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent(MRSE;P=0.000) was lower, and UCVA(P=0.005) was better in the TG group. The higher-order aberrations(HOAs;P=0.000), spherical aberration(P=0.000) and coma(P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups.CONCLUSION: Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.展开更多
AIM:To compare the short-term impacts of femtosecond lenticule extraction(FLEx)and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)on ocular surface measures and tear inflammatory mediators.METHODS:Th...AIM:To compare the short-term impacts of femtosecond lenticule extraction(FLEx)and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)on ocular surface measures and tear inflammatory mediators.METHODS:This prospective comparative nonrandomized clinical study comprised 75 eyes(75 patients).Totally 20 male and 15 female patients(age 21.62±3.25 y)with 35 eyes underwent FLEx,and 26 male and 14 female patients(age 20.18±3.59 y)with 40 eyes underwent FS-LASIK.Central corneal sensitivity,noninvasive tear breakup time,corneal fluorescein staining,Schirmer I test,tear meniscus height,and ocular surface disease index were evaluated in all patients.Tear concentrations of nerve growth factor(NGF),interleukin-1α(IL-1α),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),and matrix metalloproteinase-9(MMP-9)were assessed by multiplex antibody microarray.All measurements were performed preoperatively,and 1 d,1 wk,and 1 mo postoperatively.RESULTS:Patients who underwent FLEx exhibited a more moderate reduction in central corneal sensation and less corneal fluorescein staining than those in the FS-LASIK group 1 wk after the procedure(P<0.01).NGF was significantly higher 1 d and 1 wk after surgery in the FS-LASIK group than in the FLEx group(P<0.01).By contrast,compared to those in the FLEx group,higher postoperative values and slower recovery of tear TGF-β1,IL-1α,and TNF-αconcentrations were observed in the FS-LASIK group(P<0.01).Tear concentrations of NGF,TGF-β1,TNF-α,and IL-1αwere correlated with ocular surface changes after FLEx or FS-LASIK surgery.CONCLUSION:There is less early ocular surface disruption and a reduced inflammatory response after FLEx than after FS-LASIK.NGF,TGF-β1,TNF-α,and IL-1αmay contribute to the process of ocular surface recovery.展开更多
The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery.With accuracy,safety,and repeatability,eye surgeons can utilize the femtosecond laser in almost all anterior refractive p...The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery.With accuracy,safety,and repeatability,eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures;laser in situ keratomileusis(LASIK),small incision lenticule extraction(SMILE),penetrating keratoplasty(PKP),insertion of intracorneal ring segments,anterior and posterior lamellar keratoplasty(Deep anterior lamellar keratoplasty(DALK)and Descemet's stripping endothelial keratoplasty(DSEK)),insertion of corneal inlays and cataract surgery.As the technology matures,it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored.As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay.This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.展开更多
This review summarizes the current status of the small incision lenticule extraction(SMILE)procedure.Following the early work by Sekundo et al.and Shah et al.,SMILE has become increasingly popular.The accuracy of the ...This review summarizes the current status of the small incision lenticule extraction(SMILE)procedure.Following the early work by Sekundo et al.and Shah et al.,SMILE has become increasingly popular.The accuracy of the creation of the lenticule with the VisuMax femtosecond laser(Carl Zeiss Meditec)has been verified using very high-frequency(VHF)digital ultrasound and optical coherence tomography(OCT).Visual and refractive outcomes have been shown to be similar to those achieved with laser in situ keratomileusis(LASIK),notably in a large population reported by Hjortdal,Vestergaard et al.Safety in terms of the change in corrected distance visual acuity(CDVA)has also been shown to be similar to LASIK.It was expected that there would be less postoperative dry eye after SMILE compared to LASIK because the anterior stroma is disturbed only by the small incision,meaning that the anterior corneal nerves should be less affected.A number of studies have demonstrated a lower reduction and faster recovery of corneal sensation after SMILE than LASIK.Some studies have also used confocal microscopy to demonstrate a lower decrease in subbasal nerve fiber density after SMILE than LASIK.The potential biomechanical advantages of SMILE have been modeled by Reinstein et al.based on the non-linearity of tensile strength through the stroma.Studies have reported a similar change in Ocular Response Analyzer(Reichert)parameters after SMILE and LASIK,however,these have previously been shown to be unreliable as a representation of corneal biomechanics.Retreatment options after SMILE are discussed.Tissue addition applications of the SMILE procedure are also discussed including the potential for cryo-preservation of the lenticule for later reimplantation(Mohamed-Noriega,Angunawela,Lim et al.),and a new procedure referred to as endokeratophakia in which a myopic SMILE lenticule is implanted into a hyperopic patient(Pradhan et al.).Finally,studies reporting microdistortions in Bowman’s layer and corneal wound healing responses are also described.展开更多
基金Supported by the Science and Technology Program of Zhejiang Province(No.2019C03046)the Natural Science Foundation of Zhejiang Province under Grant(No.LQ20H120007)。
文摘AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography(AS-OCT).METHODS:Four patients with monocular corneal opacity(3 due to mechanical injury,1 due to a firecracker wound)were recruited and treated with refractive surgery(3 for SMILE,1 for FS-LASIK combined with limbal relaxing incision(LRI).Preoperative ocular manifestations,surgical details,postoperative visual outcomes,corneal opacity parameters,and corneal topography were analyzed.RESULTS:Preoperatively,spherical diopter ranged from-3.0 D to-4.75 D with cylinder ranging from-0.75 to-5.0 D,and corrected distance visual acuity(CDVA)ranging from 20/25 to 20/20.One eye’s corneal opacity was located in the central zone and three were in the mid-peripheral optical zone.Three patients underwent uneventful SMILE in both eyes,whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye.CDVA of the eye with corneal opacity ranged from 20/22to 20/20 one to six weeks postoperatively.Two patients achieved better CDVA and no patients lost Snellen lines.The postoperative diopter was within±0.75 D for all eyes.Significant edema existed above the corneal opacity in one eye and dissipated soon.No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.CONCLUSION:The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection.FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.
文摘AIM:To determine the clinical outcomes of laser insitu keratomileusis(LASIK)treatments using LaserSight AstraPro Planner 2.2 Z software for myopia with asymmetric corneal shape.METHODS:Four hundred and eighty-five eyes[243patients;spherical equivalent(SE),-5.93±1.88 diopters(D)]were treated with asymmetric ablations using LaserSight SLX laser(version 5.3,300Hz)were retrospectively analyzed and LaserSight AstraPro Planner2.2 Z software.Preoperative and postoperative uncorrected visual acuities(UCVA),spherical equivalent(SE)refraction,pachymetry,and corneal asphericity(Q value)and decentration were evaluated.RESULTS:At 12mo postoperatively,the decimal UCVA was 1.0 or better in 449(92.6%)eyes.Two eyes(0.4%)lost 1 line of the decimal best spectacle-corrected visual acuity(BCVA),316(65.2%)did not change,149(30.7%)gained 1 line,and 18(3.7%)gained 2 lines or more after surgery.Three hundred and thirty-two eyes(68.5%)were within 0.5 D in SE.The mean tissue saving ablation depth was 4.28±2.86(0-16)μm(median,4μm).The mean attempted remaining central corneal thickness was435.79±29.56μm,the mean postoperative pachymetry was 444.94±28.93μm.The mean preoperative Q value was-0.19±0.18,the postoperative was 0.30±0.48(P=0.000).The mean postoperative decentration was 0.39±0.19 mm.CONCLUSION:Topography-guidedLASIKwithAstraPro Planner 2.2 Z custom ablation planning software in an asymmetric ablation mode was an effective,safe,predictable,and stable refractive procedure for the myopia with asymmetric corneal topography.
基金Supported by the Research Grant of Hunan Provincial Health Commission Project(No.C2017037)。
文摘AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optical Quality Analysis System(OQAS)was used to evaluate clinical outcomes objectively after operation for high myopia correction.We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),safety index,efficacy index,spherical equivalent,modulation transfer function(MTF)cutoff frequency,strehl ratio(SR)and objective scatter index(OSI).RESULTS:At 1 y postoperatively,the safety indices were 1.33±0.27 in ICL group,and 1.17±0.24 in FS-LASIK group.39.58%in the ICL group and 27.59%in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA.The efficacy indices were 1.28±0.22 in ICL group,and 1.13±0.26 in FS-LASIK group.The changes of spherical equivalent from 1 wk to 1 y postoperatively was-0.12±0.37 D in ICL group,and-0.79±0.58 D in FS-LASIK group(P<0.05).Spherical equivalent within±0.50 D was achieved in 97.92%in ICL group and 68.97%in FS-LASIK group.MTF cutoff frequency were higher with ICL as compared to FSLASIK(P<0.05)at each postoperative follow-up stage;for postoperative 1 mo later,SR was statistically significant difference between two groups(P<0.05);with no statistically significant difference in OSI between two groups(P>0.05)in postoperative 3 mo later.CONCLUSION:ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction.ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.
文摘Dear Editor,I am Dr.Xiu Wang,from Tianjin Medical University Eye Hospital,Tianjin,China.I write to present one case report of Posner-Schlossman syndrome(PSS)induced laser in situ keratomileusis(LASIK)keratectasia.PSS is a condition characterized by recurrent,acute attacks of mild,unilateral,non-granulomatous,anterior
文摘Objective: To evaluate the effectiveness, predictability and city of laser in situ keratomileusis (LASIK) for correction of hyperopia. Methods 54 eyes of 35 patients with hyperopia ranging from+1.00 to + 6. 00 diopter(D) received a one-pass, multizone scanning excimer laser ablations using the Chiron Technolas Keracor 11 7C excimer laser and System ALK automated corneal shaper H-230.Data on uncorrected and hot corrected visual acuity, predictability, stability of refraction, and complications were analyzed. The average follow-up was 12 months. Results At 12 months, the average residual refraction was(+ 0. 29 ±0. 78)D. 45 eyes (83.3% ) were in the range of ±1. OD and 33 eyes(61. 1% ) were within the range of ± 0. 5D. 50 eyes (92. 6% ) had uncorrected visual acuity of 20/40 or better and 34 eyes (63. 0% ) had 20/20 or better. 1 eyes (1. 9% ) lost 2 line of the best-corrected visual acuity and 2 eyes (3. 7% ) gained 2 lines or more. 2 eyes (3. 7%) had complaint of halos and 1 eyes (1. 9% ) had glare at 12 months. Conclusion LASIK can he used to treat hyperopia from + 1. 0D to + 6. 0D with good predictability and city. Primary and second hyperopia should he treated with different nomogram. some modification of the surgical algorithms and laser nomogram will help to improve predictability and stability of outcome.
基金Supported by Shanghai Leading Academic Discipline Project (S30205)
文摘A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemic antibiotics were promptly administered.Bacterial culture was performed following corneal flap lift and scraping of the lesions.Afterwards,the therapeutic regimen was readjusted according to the culture results.Streptococcus pneumoniae was identified from the culture.Three months after the surgery,corrected distance visual acuity achieved 20/20 in both eyes.Streptococcus pneumoniae can affect the cornea following LASIK.As prompt treatment is crucial,we recommend,for acute and subacute cases,systemic and topical application of vancomycin or moxifloxacin before the culture results come out.
文摘Dear Editor,I am Dr.David P Pi?ero from the Department of Optics,Pharmacology and Anatomy of the University of Alicante and from the Department of Ophthalmology of Vithas Medimar(Oftalmar)and Vithas Virgen del Carmen(Qvision)hospitals in Spain.I write to describe a case in which the visual acuity defocus curves(VADC)and contrast sensitivity
文摘AIM: To evaluate the possible differences in visual quality between small incision lenticule extraction(SMILE) and femtosecond laser in situ keratomileusis(FS-LASIK) for myopia.METHODS: A Meta-analysis was performed. Patients were from previously reported comparative studies treated with SMILE versus FS-LASIK. The Pub Med, EMBASE, Cochrane, Web of Science and Chinese databases(i.e. WANFANG and CNKI) were searched in Nov. of 2016 using Rev Man 5.1 version software. The differences in visual acuity, aberration and biomechanical effects within six months postoperatively were showed. Twenty-seven studies including 4223 eyes were included. RESULTS: No significant differences were observed between SMILE and FS-LASIK in terms of the proportion of eyes that lost one or more lines of corrected distance visual acuity after surgery(P=0.14), the proportion of eyes achieving an uncorrected distance visual acuity of 20/20 or better(P=0.43), the final refractive spherical equivalent(P=0.89), the refractive spherical equivalent within ±1.00 diopter of the target values(P=0.80), vertical coma(P=0.45) and horizontal coma(P=0.06). Compared with the FSLASIK group, total higher-order aberration(P<0.001) and spherical aberration(P<0.001) were higher and the decrease in corneal hysteresis(P=0.0005) and corneal resistance factor(P=0.02) were lower in the SMILE group. CONCLUSION: SMILE and FS-LASIK are comparable in efficacy, safety and predictability for correcting myopia.However, the aberration in the SMILE group is superior to that in the FS-LASIK group, and the loss of biomechanical effects may occur less frequently after SMILE than after FS-LASIK.
文摘Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive Keratectomy.Following laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and neurotransmitters.Notably,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve regeneration.Alterations in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult induced.In this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.
文摘AIM:To assess and compare the morphology of corneal flaps created by the Wavelight FS200 and Intralase FS60 femtosecond lasers in laser in situ keratomileusis(LASIK).METHODS:Four hundred eyes of 200 patients were enrolled in this study and divided into Wavelight FS200 groups(200 eyes) and Intralase FS60 groups(200 eyes).Fourier-domain optical coherence tomography(RTVue OCT) was used to measure the corneal flap thickness of 36 specified measurements on each flap one week after surgery.Results were used to analyze the regularity,uniformity and accuracy of the two types of LASIK flaps.RESULTS:The mean thickness of corneal flap and central flap was 105.71±4.72 μm and 105.39±4.50 μm in Wavelight FS200 group and 109.78±11.42 μm and 109.15±11.59 μm in Intralase FS60 group,respectively.The flaps made with the Wavelight FS200 femtosecond laser were thinner than those created by the Intralase FS60 femtosecond laser(P=0.000).Corneal flaps in the 2 groups were uniform and regular,showing an almost planar configuration.But the Wavelight FS200 group has more predictability and uniformity of flap creation.The mean deviation between achieved and attempted flap thickness was smaller in the Wavelight FS200 group than that in the Intralase FS60 group,which were 5.18±3.71 μm and 8.68±7.42 μm respectively.The deviation of more than 20 μm was 0.2% measurements in Wavelight FS200 group and 8.29% measurements in Intralase FS60 group.CONCLUSION:The morphologies of flaps created by Wavelight FS200 are more uniform and thinner than those created by Intralase FS60.
文摘AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ^(2)=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ^(2)=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ^(2)=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ^(2)=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.
基金Supported by the Cross-disciplinary Research Fund of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.JYJC201907)。
文摘AIM:To investigate the changes in choroidal thickness(CT)in high myopic eyes after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery or central hole implantable collamer lens(ICL V4c)implantation using swept-source optical coherence tomography(SS-OCT).METHODS:We examined the right eyes of 116 patients with high myopia who were candidates for FS-LASIK surgery and ICL implantation.Sixty eyes underwent ICL V4c implantation and 56 eyes were subjected to FS-LASIK surgery.The CT was measured with SS-OCT.All data were recorded preoperatively and 2 h,1 wk,1 and 3 mo postoperatively.Other demographic information was collected,including age,sex,uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical equivalent(SE),intraocular pressure(IOP)and axial length(AL).RESULTS:The UCVA improved in both groups and showed no significant differences between groups.There also were no significant differences between the two groups in postoperative BCVA and SE(P=0.581 and 0.203,respectively).The foveal CTs,inner nasal and outer nasal CTs were significantly thicker at 2 h postoperatively in both groups(P<0.05)but returned to baseline levels in 1 wk;after 1 mo,no significant differences were found relative to the preoperative values.At 3 mo in each group,nine regions showed variations in the CT as compared with preoperative thickening,but only the foveal and nasal area CTs preoperative differences were statistically significant(P<0.05).In addition,there was no significant difference in 9 regions of CT between the two groups at all follow-up times(P>0.05).CONCLUSION:The CTs after ICL implantation and FSLASIK surgery are significantly thicker than those before operation,especially in the foveal and nasal areas,but there is no significant difference between the two methods.
基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding(No.XMLX201614)。
文摘AIM:To compare the clinical outcome of small-incision lenticule intrastromal keratoplasty(s LIKE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK)for correction of moderate and high hyperopia.METHODS:A case-controlled clinical study was performed.Twenty right eyes of 20 moderate and high hyperopia patients underwent s LIKE(s LIKE group)and 22 right eyes of 22 moderate and high hyperopia patients underwent FS-LASIK(FS-LASIK group)were enrolled in this study from October 2015 to October 2017.Visual acuity,refractive error,corneal thickness,and keratometry were compared between the groups before and 1 y postoperatively.RESULTS:The postoperative uncorrected near visual acuity(UNVA)and uncorrected distance visual acuity(UDVA)were improved in the two groups.The UNVA reached J1 in 15 eyes(75.0%)in the s LIKE group and 5 eyes(22.7%)in the FS-LASIK group 1 y after surgery(χ2=11.476,P=0.001).The UDVA was equal or better than the preoperative CDVA in 16 eyes(80.0%)in the s LIKE group and 8 eyes(36.4%)in the FS-LASIK group,respectively(X2=8.145,P=0.004).No eyes lost any line of best-corrected visual acuity(BCVA)in either group.The amount of postoperative residual hyperopia in the s LIKE group was significantly less than in the FS-LASIK group(Z=-2.841,P=0.004).The postoperative keratometry and corneal thickness were significantly higher in the s LIKE group than in the FS-LASIK group(t=4.411,10.279,P<0.001).The SRI and SAI of the s LIKE group were significantly higher than that in the FS-LASIK group.There was no statistically significant difference in mean decentration between the two groups.CONCLUSION:s LIKE has better visual and refractive outcome than FS-LASIK for correction of moderate and high hyperopia.
文摘AIM:To compare intraocular pressure(IOP)measurements before and after laser in situ keratomileusis(LASIK)with a femtosecond laser for flap creation using ocular response analyzer(ORA)and Goldmann applanation tonometry,and to identify factors that may influence the preoperative and postoperative IOP.METHODS:A prospective study conducted on myopic patients who underwent LASIK using a femtosecond laser for flap fashioning.Enrolled patients were evaluated preoperatively,6 wk and 3 mo postoperatively for manifest refraction(MR),keratometric(K)readings and central corneal thickness(CCT)using a scheimpflug-based topography.Corneal resistance factor(CRF),corneal hysteresis(CH),Goldmann correlated IOP(IOPg)and corneal compensated IOP(IOPcc)were measured using ORA besides IOP assessment by Goldman applanation tonometry(GAT).RESULTS:There was a statistically significant decrease in measures of IOPg by 3.35±0.83 mm Hg,followed by GAT which decreased by 2.2±0.44 mm Hg,and the least affected by operation was IOPcc which decreased only by 0.87±0.1 mm Hg after 6 wk.After 3 mo follow up there was a statistically significant decrease in IOPcc which decreased only by 0.76±0.4 mm Hg,followed by IOP GAT by 1.6±0.5 mm Hg,and the most affected by operation was IOPg which decreased by 2.3±0.3 mm Hg.Correspondingly,there was a statistically significant decrease in CH and CRF after 6 wk and 3 mo.At 3 mo,the preoperative MR and preoperative GAT were prominent significant predictors of the postoperative GAT changes.The prediction equation was subsumed.CONCLUSION:IOP measurements and corneal biomechanical factors reduce significantly after LASIK with a femtosecond laser for flap creation.The IOPcc values are less influenced by changes in corneal properties than IOPg and GAT,indicating that IOPcc may provide the most reliable measurement of IOP after this procedure.
文摘AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases(i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA(version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed.RESULTS: Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity(UCVA) of 20/20 or better(P=0.377), gaining one line or more(P=0.05), postoperative cylinder(P=0.40), vertical coma(P=0.593) and horizontal coma(P=0.957). After TG ablation, the proportion of the patients’ eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO(P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent(MRSE;P=0.000) was lower, and UCVA(P=0.005) was better in the TG group. The higher-order aberrations(HOAs;P=0.000), spherical aberration(P=0.000) and coma(P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups.CONCLUSION: Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.
基金Supported by the National Natural Science Foundation of China(No.81870681)Key Program of the Department of Science and Technology of Hainan Province(No.ZDYF2020151)+1 种基金Huaxia Translational Medicine Fund For Young Scholars(No.2017-D-001)Medical Science and Technology Research Foundation of Guangdong Province(No.A2020406)。
文摘AIM:To compare the short-term impacts of femtosecond lenticule extraction(FLEx)and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)on ocular surface measures and tear inflammatory mediators.METHODS:This prospective comparative nonrandomized clinical study comprised 75 eyes(75 patients).Totally 20 male and 15 female patients(age 21.62±3.25 y)with 35 eyes underwent FLEx,and 26 male and 14 female patients(age 20.18±3.59 y)with 40 eyes underwent FS-LASIK.Central corneal sensitivity,noninvasive tear breakup time,corneal fluorescein staining,Schirmer I test,tear meniscus height,and ocular surface disease index were evaluated in all patients.Tear concentrations of nerve growth factor(NGF),interleukin-1α(IL-1α),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),and matrix metalloproteinase-9(MMP-9)were assessed by multiplex antibody microarray.All measurements were performed preoperatively,and 1 d,1 wk,and 1 mo postoperatively.RESULTS:Patients who underwent FLEx exhibited a more moderate reduction in central corneal sensation and less corneal fluorescein staining than those in the FS-LASIK group 1 wk after the procedure(P<0.01).NGF was significantly higher 1 d and 1 wk after surgery in the FS-LASIK group than in the FLEx group(P<0.01).By contrast,compared to those in the FLEx group,higher postoperative values and slower recovery of tear TGF-β1,IL-1α,and TNF-αconcentrations were observed in the FS-LASIK group(P<0.01).Tear concentrations of NGF,TGF-β1,TNF-α,and IL-1αwere correlated with ocular surface changes after FLEx or FS-LASIK surgery.CONCLUSION:There is less early ocular surface disruption and a reduced inflammatory response after FLEx than after FS-LASIK.NGF,TGF-β1,TNF-α,and IL-1αmay contribute to the process of ocular surface recovery.
文摘The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery.With accuracy,safety,and repeatability,eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures;laser in situ keratomileusis(LASIK),small incision lenticule extraction(SMILE),penetrating keratoplasty(PKP),insertion of intracorneal ring segments,anterior and posterior lamellar keratoplasty(Deep anterior lamellar keratoplasty(DALK)and Descemet's stripping endothelial keratoplasty(DSEK)),insertion of corneal inlays and cataract surgery.As the technology matures,it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored.As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay.This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.
文摘This review summarizes the current status of the small incision lenticule extraction(SMILE)procedure.Following the early work by Sekundo et al.and Shah et al.,SMILE has become increasingly popular.The accuracy of the creation of the lenticule with the VisuMax femtosecond laser(Carl Zeiss Meditec)has been verified using very high-frequency(VHF)digital ultrasound and optical coherence tomography(OCT).Visual and refractive outcomes have been shown to be similar to those achieved with laser in situ keratomileusis(LASIK),notably in a large population reported by Hjortdal,Vestergaard et al.Safety in terms of the change in corrected distance visual acuity(CDVA)has also been shown to be similar to LASIK.It was expected that there would be less postoperative dry eye after SMILE compared to LASIK because the anterior stroma is disturbed only by the small incision,meaning that the anterior corneal nerves should be less affected.A number of studies have demonstrated a lower reduction and faster recovery of corneal sensation after SMILE than LASIK.Some studies have also used confocal microscopy to demonstrate a lower decrease in subbasal nerve fiber density after SMILE than LASIK.The potential biomechanical advantages of SMILE have been modeled by Reinstein et al.based on the non-linearity of tensile strength through the stroma.Studies have reported a similar change in Ocular Response Analyzer(Reichert)parameters after SMILE and LASIK,however,these have previously been shown to be unreliable as a representation of corneal biomechanics.Retreatment options after SMILE are discussed.Tissue addition applications of the SMILE procedure are also discussed including the potential for cryo-preservation of the lenticule for later reimplantation(Mohamed-Noriega,Angunawela,Lim et al.),and a new procedure referred to as endokeratophakia in which a myopic SMILE lenticule is implanted into a hyperopic patient(Pradhan et al.).Finally,studies reporting microdistortions in Bowman’s layer and corneal wound healing responses are also described.
