SMILE is as safe and predictable as FS-LASIK. According to the ORA system, SMILE is not better than FS-LASIK in terms of biomechanical changes. However, SMILE causes less effect on dry eye parameters during the first 3 postoperative months.
PurposeTo compare complete versus incomplete ring implantation for keratoconus correction.MethodsWe investigated 25 eyes of keratoconic patients, of which 15 had femtosecond-assisted MyoRing corneal implantation (Group 1) and 10 had femtosecond-assisted Keraring segments (Group 2). Uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), mean K (Km), sphere, topographic cylinder, and corneal asphericity value (Q-value) were measured in all eyes preoperatively and at 4 weeks postoperatively (1 month).ResultsIn Group 1, the Km change was −6.15±2.16 D, with a mean change in sphere of 4.45±2.18 D and a mean change in refractive cylinder of 2.32±3 D. UCVA change was −0.57±0.273 logarithm of the minimum angle of resolution (LogMAR), BCVA change was −0.2±0.27 (LogMAR), and the Q-value change was 0.43±2.6. In Group 2, the Km change was −3.15±1.68 D, UCVA change was −0.48±0.37 (LogMAR), BCVA change was −0.09±0.15 (LogMAR), and the Q-value change was 0.5±0.21. Changes in the means did not significantly differ between groups, except for the Km change, which was significantly greater in Group 1 than in Group 2 (P=0.05).ConclusionBoth complete ring and ring segment implantation are effective for improving corneal and visual parameters in keratoconus. Complete ring implantation may have a greater flattening effect on the anterior corneal surface.
Purpose: To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. Patients and methods: A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. Results: The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group ( p = 0.017), Ranibizumab and Control groups ( p = 0.009) with no significant difference between Nepafenac and Ranibizumab group ( p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control ( p = 0.001) and intravitreal Ranibizumab/control ( p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. Conclusion: Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.
Introduction: This is a prospective nonrandomized interventional clinical trial conducted to measure and verify the intended versus the achieved LASIK flap side-cut angle in two groups of patients, Femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) using Wavelight FS200 (Alcon Laboratories Inc. Fort Worth, TX, USA) and the conventional mechanical microkeratme (Moria M 2 90). Methods: This prospective clinical trial was conducted on 40 eyes of 20 patients (20 eyes in each group) in the interval between December 2017 and August 2018. Heidelberg anterior segment OCT was done for the patients 2 weeks postoperatively to measure the corneal flap side cut angle. Results: The achieved side-cut angles of all the patients in the first group (the femtosecond laser-assisted in-situ keratomileusis group) were equal to or more inverted than the intended angle (110–115°) in all the study candidates with a minimum angle (110°) and maximum angle (155°). Unlike the achieved side-cut angle in the second group (the mechanical microkeratome group) in which all the achieved side-cut angle were acute with a minimum angle (30°) and maximum angle (65°) which is more acute than the intended side-cut angle (70°). Conclusion: In our study we found that the femtoLASIK technology was capable of making the flap side-cut angle more obtuse than the intended angle, unlike the achieved flap side-cut angle done using the mechanical microkeratome which was more acute than the intended angle in 100% of cases.
Purpose: To determine the percentage of contribution of the magnitude of posterior corneal astigmatism to total corneal astigmatism using Scheimpflug imaging. Methods: This prospective cross-sectional study was conducted on 356 eyes of 356 patients, where the total corneal astigmatism was calculated by addition of anterior and posterior corneal astigmatism using vector analysis and then the percentage of posterior to total corneal astigmatism was calculated. Results: The percentage of contribution of posterior to total corneal astigmatism was about 30% in patients with With The Rule astigmatism and about 8% in patients with Against The Rule astigmatism. Conclusion: Posterior corneal astigmatism should not be neglected during calculation of total corneal astigmatism as neglecting posterior corneal astigmatism can result in errors during calculation and correction of astigmatism.
Purpose: To investigate if topography-guided laser in situ keratomileusis (LASIK) depending on the topographic astigmatism which is measured using the Topolyzer leads to a better refractive outcome when compared to treatment of the manifest refractive astigmatism in cases of myopic astigmatism. Methods: This was a prospective non-masked, randomized study (block randomization) of postoperative vision and refraction of patients with myopic astigmatism that had LASIK using Contoura vision software. They were divided into three groups according to the treatment strategy, treating the manifest astigmatism in one group, the topographic astigmatism with compensation for the spherical power in the second group and treating the topographic astigmatism without changing the spherical power in the third group. It was conducted at Kasr Alainy Hospital and Dar Eloyon Hospital. Results: The postoperative uncorrected distant visual acuity (UDVA) in each group separately was better than the preoperative corrected distant visual acuity (CDVA) (58% (n=35) had UDVA better than 20/20 and gained 1 line or more); however, eyes treated with the topographic astigmatism without changing the spherical power showed the statistically best results (75% (n=15) had UDVA better than 20/20). The residual anterior corneal astigmatism was lower in this group (the mean 0.47 vs 0.95 and 0.59). No significant difference was noted in the residual refractive astigmatism, but it was also the least in that group. Conclusion: Topography-guided LASIK is a safe and effective ablation profile for treatment of myopic astigmatism. Treating according to the topographic astigmatism shows the best outcome as regards the vision and residual astigmatism.
Purpose: To evaluate the clinical efficacy of the coronally advanced lingual flap (CALF) technique in terms of the extent of lingual and buccal flap advancement, the maintenance of primary wound closure, and safety in comparison to buccal flap advancement alone during horizontal ridge augmentation in the posterior mandible. Materials and Methods: A total of 14 patients were randomly allocated to two different groups: buccal flap advancement without the CALF technique (control), referred to as the NO-CALF group, and buccal flap advancement with the CALF technique (test), referred to as the CALF group. Wound healing was monitored weekly for the first 4 weeks, then at 2, 4, 6, and 9 months postoperatively for any soft tissue dehiscence (titanium mesh [TM] exposure) along the incision line. The extent of lingual and buccal flap advancement was measured, and any intraoperative and postoperative CALF-related complications were reported. Results: The difference between groups was statistically significant (P < .0001) in terms of (1) TM exposure: 83.3% of cases in the NO-CALF group showed early Class П exposures, whereas the CALF group showed no exposure; (2) mean lingual flap advancement: 3.9 ± 1.1 mm and 14.4 ± 3.8 mm for the NO-CALF and CALF groups, respectively; and (3) mean buccal flap advancement: 15.8 ± 2.1 mm and 10.5 ± 1.4 mm for the NO-CALF and CALF groups, respectively. There were no reported complications related to the CALF technique. Conclusion: Tension-free primary wound closure was facilitated and maintained during the healing period by applying the CALF technique, which is a reliable technique to safely advance the lingual flap coronally.
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