Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
<b><i>Background:</i></b> Psoriasis is a chronic inflammatory skin disease with potential systemic involvement. Some evidence suggests an increased risk of dry eye in patients with psoriasis. However, the relationship between these two conditions remains unclear. The aim of our study is to investigate the association between psoriasis and dry eye disease. <b><i>Methods:</i></b> This meta-analysis was registered in PROSPERO (CRD42020199445) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between psoriasis and dry eye disease from inception to December 13, 2020. The primary outcome was the prevalence of dry eye disease in patients with psoriasis relative to controls. The secondary outcomes were the Schirmer I test score, tear film breakup time (TBUT), and ocular surface disease index (OSDI). The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale. <b><i>Results:</i></b> The meta-analysis showed a significant association between dry eye disease and psoriasis (OR, 8.49; 95% CI, 3.34–21.58). Moreover, patients with psoriasis had a significantly lower Schirmer I test score (MD, −2.80; 95% CI, −4.07 to −1.52), shorter TBUT (MD, −4.12; 95% CI, −5.22 to −3.02), and higher OSDI (MD, 20.15; 95% CI, 6.24–34.05; <i>p</i> < 0.01), compared to controls. <b><i>Conclusions:</i></b> The current evidence supports an association between dry eye disease and psoriasis. These results suggest ophthalmologic assessment for the early recognition and management of dry eye in patients with psoriasis.
<b><i>Background:</i></b> Vitiligo is a skin depigmentation disorder that results from the autoimmune destruction of cutaneous melanocytes. Several ocular abnormalities, including uveitis, dry eye, glaucoma, and retinal diseases, have been reported in patients with vitiligo. The aim of our study was to investigate the association of ocular abnormalities with vitiligo. <b><i>Methods:</i></b> This meta-analysis was registered in PROSPERO (CRD42021224167) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between ocular abnormalities and vitiligo from inception to December 10, 2020. Studies recruiting patients with Sjogren’s syndrome or Vogt-Koyanagi-Harada syndrome were excluded. The primary outcomes were the Schirmer test, tear film break-up time (TBUT), and ocular surface disease index (OSDI) of vitiligo patients compared to the controls. The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) of case-control studies. <b><i>Results:</i></b> This meta-analysis of 16 case-control studies showed that patients with vitiligo had significantly lower Schirmer test values (mean difference [MD], −1.65; 95% CI, −2.81 to −0.49), shorter TBUTs (MD, −4.66; 95% CI, −7.05 to −2.26), higher ocular surface disease indices (MD, 18.02; 95% CI, 5.7–30.35), and thinner subfoveal choroidal thicknesses (MD, −53.10; 95% CI, −69.84 to −36.36). No significant differences were found in the prevalence of glaucoma and the level of intraocular pressure. <b><i>Conclusions:</i></b> Our study supports an association between dry eye and thinner subfoveal choroidal thickness in patients with vitiligo. Dermatologists should be aware of these possible comorbidities and refer vitiligo patients with ocular symptoms to ophthalmologists for further management.
Background: To determine the correlation between the severity of chronic kidney disease (CKD) and treatment of diabetic macular edema (DME). Methods: The retrospective 2-year cohort study included eyes with DME confirmed using spectral-domain optical coherence tomography in Taipei Veterans General Hospital, Taiwan, between 2010 and 2020. All the eyes were treated with an intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) during regular follow-up over 2 years. They were categorized into 3 different groups: an estimated glomerular filtration rate ≥ 60 (mL/min per 1.73 m2 ) (group A), <60 (group B), and patients undergoing hemodialysis (group C). The main outcome measures were (1) visual improvement, (2) structural improvement, and (3) the injection frequency of anti-VEGF in the different groups. Results: In this study, 167 eyes from 120 patients were enrolled. Compared with groups B and C, the eyes in group A experienced the only significant visual improvement at month 3, month 6, and month 12 (P=.0001, .0002, .0013, respectively). The presence of subretinal fluid and intraretinal cysts was significantly decreased in groups A and B. In the treatment frequency analysis, the number of injections was the highest in group A and lowest in group C during the 2-year study period (P = .04). Conclusions: The severity of CKD had an impact on the DME treatment. The less severe CKD was, the greater the visual improvement that could be achieved. In addition, relatively poor renal function required a lower anti-VEGF injection frequency. The active prevention of the progression of CKD may play a key role in DME treatment.
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