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Purpose: To determine the factors associated with clinically significant dry eye after keratorefractive surgery. Methods: This is a large database retrospective study that included consecutive cases of myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy performed between 2008 and 2016 at Care-Vision Laser Center, Israel. Patients were divided into 2 groups according to whether they developed clinically significant dry eye. Results: A total of 25,317 right eyes of 25,317 patients, with a mean age of 27.0 ± 8.3 years, were included. Postoperative dry eye developed in 1518 eyes (6.0%). The dry eye group was older (29.2 ± 9.0 vs. 27.6 ± 8.3 yrs, P < 0.001) and had a higher proportion of women (48.5% vs. 44.8%, P = 0.005), lower preoperative spherical equivalent (3.7 ± 2.0 vs. 4.0 ± 2.3D, P < 0.001), lower preoperative best-corrected visual acuity (0.019 ± 0.057 vs. 0.016 ± 0.064 Logarithm of the Minimum Angle of Resolution (LogMAR), P = 0.04), and lower proportion of preoperative soft contact lens wearers (40.6% vs. 45.5%, P < 0.001). In the postoperative dry eye group, a high proportion underwent LASIK (52.4% vs. 38.7%, P < 0.001) and were treated with a 7.0-mm (as opposed to 6.0 mm) optic zone (18.9% vs. 16.3%, P < 0.001). In multivariable analysis, older age [odds ratio (OR) 1.013, P < 0.001], female gender (OR 0.87, P = 0.009), lower preoperative refractive error (OR 1.05, P < 0.001), and LASIK (OR 0.67, P < 0.001) were associated with postoperative dry eye. Conclusions: Patients who are of older age, are of female gender, and have a lower preoperative refractive error and those undergoing LASIK are more likely to develop dry eye disease after keratorefractive surgery.

The use of the FSL to perform corneal cuts in a mushroom configuration for DALK is reliable and reproducible. Earlier visual rehabilitation may be possible because of the mechanical stability and wound healing advantages of stepped corneal wounds.

FSL or trephine DALK are viable options for keratoconus, ectasia and corneal scars. Earlier visual recovery occurs with FSL mushroom configuration compared with MT straight-edge DALK.

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Purpose: To compare refractive surgery outcomes in patients with different periods without contact lenses prior laser surgery. Materials and methods: Patients included in this study underwent myopic keratorefractive laser surgery between January 2005 and December 2014. Patients were divided into three groups based on the duration of time passed free of soft contact lens wearing prior to final preoperative evaluation and surgery (<24 h, 1–3 days or >3 days). Spectacle wearers served as a control group. Postoperative safety index, efficacy index and % of eyes within 0.5 D of the four groups were compared. A general linear model was used to compare main outcomes while adjusting for age, gender, preoperative measurements, and procedure type (LASIK vs PRK). Results: Overall, 19,747 eyes were included. Soft contact lenses were worn by 42.3% (<24 h: 4.8%, 1–3 days: 18.5% and >3 days: 19.0%) and spectacles by 57.7% prior to surgery. In the PRK group, after adjusting for differences in baseline variables, the <24-h group had a significantly lower efficacy index than all the other groups. There were no significant differences between groups in terms of % eyes within ±0.5 D of intended correction ( p = 0.55) or safety index (0.20). In the LASIK group, after adjusting for differences in baseline variables, there were no significant differences between groups in all primary outcomes. Conclusion: Soft contact lenses should be removed at least 24 h prior to final preoperative evaluation and refractive surgery, especially for patients undergoing PRK.

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