Purpose: To compare laser in situ keratomileusis flaps created at the programmed target thickness of 120 μm using the LenSx multifunctional and the FS200 single-functional femtosecond lasers as evaluated by anterior segment optical coherence tomography (AS-OCT). Methods: This was a prospective, comparative, consecutive, blinded, nonrandomized study. Patients with stable refraction for over a year were consecutively allocated to the LenSx group or the FS200 group (n = 66; 33 patients in each group). All the patients underwent refractive surgery in both eyes. Previous eye surgery, ocular pathology associated with refractive errors, pregnancy, breastfeeding, and use of medication that causes ocular adverse effects constituted the exclusion criteria. Corneal topography, corneal tomography, dilated fundoscopy, applanation tonometry, ultrasonic pachymetry, dynamic and static refraction, visual acuity, and AS-OCT were evaluated before and after surgery. AS-OCT flap thickness was measured at 20 points on each cornea. Results: In the LenSx group, AS-OCT flap thickness differed significantly from the target thickness at 2 of 20 points (mean differences of 2.106 and 1.803 μm). In the FS200 group, 6 of 20 measurements differed significantly (mean differences ranging from 1.121 to 2.121 μm). The 2 lasers were similarly successful in creating regular and uniform flaps. The agreement between the 2 blinded examiners regarding the AS-OCT flap thickness measurements was excellent (intraclass correlation coefficient >0.75) in both groups. Conclusions: Both femtosecond lasers were safe and capable of creating highly reproducible, uniform, and regular flaps at the target preoperative thickness of 120 μm. The LenSx multifunctional femtosecond laser offers the advantage of allowing both cataract and corneal surgeries.
Purpose This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. Methods A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. Results After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81–592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62–1803.23). Conclusions Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. Trial registration It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.
Aim To evaluate the vision-related quality of life with the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire in patients with astigmatism secondary to radial keratotomy surgery who underwent topography-guided photorefractive keratectomy. Methods Prospective non-randomized clinical trial. This study included 15 patients (30 eyes) aged > 21 years, mean age 55.1 (SD, 3.5) years, 53.3% female, with astigmatism ≤ - 6.00 D resulting from radial keratotomy, which could have been associated with hyperopia ≤ + 6.00 D. Photorefractive keratectomy with topography-guided custom ablation treatment was used in all cases. The patients answered the NEI-RQL questionnaire preoperatively and at 4 and 48 months after topography-guided photorefractive keratectomy. The following data were collected: age, sex and education level, pre-operative refraction data, visual acuity with or without correction, pachymetry, and keratometry. Results There was a significant difference between pre-and postoperative NEI-RQL scores for the domains clarity of vision, near vision, far vision, diurnal fluctuation, activity limitations, glare, symptoms, correction dependence, appearance, and satisfaction with correction (p < 0.001). Conclusion Topography-guided photorefractive keratectomy improved vision-related quality of life in patients with a history of irregular astigmatism secondary to radial keratotomy.
Reproducibility of the multifunctional femtosecond laser was good for LASIK flap creation and no predictive correlation was found with preoperative clinical factors.
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