Background: To evaluate the safety, efficacy, and predictability of laser-assisted in situ keratomileusis (LASIK) enhancement after primary LASIK and compare to Food and Drug Administration (FDA) criteria. Methods: Patients who underwent LASIK enhancement after primary LASIK between 2002 and 2019 were compared to those who underwent LASIK without retreatment. Patient demographics, preoperative characteristics, visual outcomes, and postoperative complications were compared between groups. Epithelial ingrowth (EI) development was stratified based on duration between primary and secondary procedures. Results: We compared 901 eyes with LASIK enhancement to 1127 eyes without retreatment. Age, sex, surgical eye, sphere, cylinder, and spherical equivalent (SE) were significantly different between groups (p < 0.05). At 12 months post-enhancement, 86% of the eyes had an uncorrected distance visual acuity of 20/20 or better and 93% of eyes were within ±0.50 D of the target. Development of EI (6.1%) demonstrated an odds ratio of 16.3 in the long-term compared to the short-term (95% CI: 5.9 to 45.18; p < 0.0001). Conclusions: Older age at primary LASIK, female sex, right eye, and larger sphere, cylinder and SE were risk factors for enhancement. Risk of EI significantly increased when duration between primary and enhancement procedures exceeded five years. LASIK enhancements produce favorable outcomes and meet FDA benchmarks for safety, efficacy, and predictability.
Immune checkpoint inhibitors (ICIs) are antibodies that target and block immune checkpoints. These biologics were initially approved by the United States Food and Drug Administration (US FDA) in 2011 for the management of melanoma. Since then, the use of ICI therapy has increased, with many new medications on the market that treat approximately 50 types of cancers. Patients receiving this therapy are at an increased risk for transplant rejection, including corneal rejection. Ophthalmologists must be aware of individuals receiving ICI therapy as it may be a relative contraindication for patients with a history of corneal transplantation. Patients on ICIs may also experience ocular side effects, including uveitis, dry eye, and inflammation, while on checkpoint inhibitor therapy. This commentary discusses the current understanding of immune checkpoint inhibitors, their mechanism of action, their ocular side effects, and their role in corneal transplant rejection.
PURPOSE: To evaluate the safety, efficacy, and predictability of photorefractive keratectomy (PRK) at least 4 years after primary laser in situ keratomileusis (LASIK) and compare it to the United States Food and Drug Administration (FDA) criteria. METHODS: This retrospective, single-site study compared patients who underwent PRK enhancement from 2014 to 2019 after primary LASIK to those who only underwent primary LASIK without re-treatment from the same time period. Patient demographics and clinical information were compared between the two groups. Visual outcomes and postoperative complications were evaluated in the enhancement group. RESULTS: A total of 374 eyes with PRK enhancement were compared to 472 without re-treatment. Age, sex, surgical eye, and preoperative sphere, and spherical equivalent (SE) were significantly different between the enhancement and control groups ( P < .05). At 12 months post-enhancement, 67% had uncorrected distance visual acuity (UDVA) of 20/20 or better, 98% had UDVA of 20/40 or better, and 0.4% of eyes lost at least two lines of corrected distance visual acuity (CDVA). A total of 83% and 98% of eyes were within ±0.50 and ±1.00 diopters of the target, respectively. Post-enhancement complications (n = 66) included dryness (6.1%), epithelial ingrowth (2.7%), and haze (2.7%). CONCLUSIONS: Older age at the time of the primary LASIK, female sex, right surgical eye, and more myopic sphere and SE were risk factors for enhancement. Although PRK enhancements are considered off-label procedures, they produce favorable outcomes at 3 and 12 months postoperatively while meeting FDA benchmarks for safety, efficacy, and predictability. [ J Refract Surg . 2022;38(11):733–740.]
Purpose To analyze refractive changes after neodymium: yttrium-aluminum-garnet (Nd:YAG) posterior capsulotomy in pseudophakic eyes. Patients and Methods Patients who underwent Nd:YAG capsulotomy after cataract surgery from January 2013 to April 2022 were included in this retrospective study. Sphere, cylinder, spherical equivalent (SE), axis, and corrected distance visual acuity (CDVA) were compared pre- and postoperatively in 683 eyes of 548 patients at one month (n = 605 eyes) and one year (n = 211 eyes). Patients with both one-month and one-year follow-ups (n = 133) were also compared. Eyes were stratified into single-piece (n = 330), three-piece (n = 30), and light adjustable lenses (LALs) (n = 16). Pre- and postoperative measurements were analyzed within each group. Results Cylinder was significantly decreased at one-month (difference: 0.042±0.448 D, p = 0.006) and one-year (difference: 0.101±0.455 D, p = 0.003) compared to preoperative measurements. No significant change in sphere or axis was observed at follow-up visits (p > 0.05). CDVA significantly improved at both time points (p < 0.05). No significant change in any parameters between the one-month and one-year groups was observed (p > 0.05). There was significant improvement in CDVA in the single and three-piece lens groups (p < 0.0001 and p = 0.026, respectively), with no change in the LAL group (p > 0.05). Conclusion There were no changes in sphere, axis, or spherical equivalent after Nd:YAG capsulotomy. However, cylindrical error and CDVA were significantly better after the procedure. Lens type did not impact refractive parameters postoperatively.
Comment on: Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk We congratulate Chang et al. for their clinically relevant and timely study regarding the effect of time after primary laser-assisted in situ keratomileusis (LASIK) on flap relift success and epithelial ingrowth (EI) risk. 1 They concluded that flaps can be successfully relifted up to 22 years after the primary LASIK with low rates of EI. This topic is extremely important to clinicians who perform these surgeries, so we appreciate their dedication to the advancement of this subject.Because EI with LASIK enhancements after primary LASIK has been well-researched, we were surprised by the authors' results and conclusions. [2][3][4] We acknowledge that the authors reported limitations within their study, but we raise additional limitations that may have affected their results. They included 73 eyes, but 2 (2.7%) were unsuccessfully relifted. They did not elaborate on the causes for this failure, and to be more accurate, only 71 eyes were relifted. Because they conclude that flaps can be successfully relifted up to 22 years after the primary procedure, it is imperative to report the circumstances behind those unsuccessful relifts. In addition, they reported 12 cases of EIG (16.9%), but only 3 (4.2%) were clinically significant. We understand only these 3 eyes required intervention, but the authors admit they used a higher threshold for defining clinically significant EI. Of note, more than 10% of eyes are being deemed clinically insignificant due to the authors' stringent definitions. We suggest a larger sample size to support the conclusion based on their EI definition.The authors acknowledge that the follow-up interval may have been inadequate for EI in some eyes. These patients may potentially develop progressive EI with further deterioration of their vision to a level of clinical significance after the observation period. We suggest a reasonable but minimum postoperative interval for each eye to ensure there were sufficient follow-ups.We compliment the authors for their elegant surgical technique in the linked video. However, we do not think it is accurate for them to imply that their technique is unique with reduced rates of EI; many clinicians perform flap relifts quite similarly to what was described by the authors and still encounter postoperative EI.In summary, the authors may display their results with more transparency to make the flap relift outcomes more apparent to the readers. They note a large time range between the primary and enhancement procedures and varying postenhancement timeframes. However, they do not explicitly state the circumstances of each case. We believe readers should be aware of the duration between procedures and the observation period for each of these 14 eyes. We recommend an appendix be added to reflect the clinically relevant details for all 14 eyes.Once again, we sincerely thank the authors for their important contribution to the literature. Our inten...
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