Purpose The safety and effectiveness of complex myopic astigmatism correction using ReLEx SMILE or Femto-LASIK techniques have been well established. The purpose of the current study is to compare quality of life (QoL) outcomes following ReLEx SMILE or Femto-LASIK procedures in parallel with functional vision and anatomic outcomes of treated eyes. Patients and methods This prospective, consecutive series included 118 patients, 18–43 years of age, out of which 56 underwent ReLEx SMILE and 62 underwent Femto-LASIK surgery for correction of myopic astigmatism. All patients underwent standard comprehensive ophthalmic examinations, and additionally, completed The Quality of Life Impact of Refractive Correction Questionnaire to determine the impact the vision-correction treatment had on their QoL. Results In both treatment groups, the postoperative refractive outcomes were comparable, with visual acuity improvements for both groups noted the day following surgery. After laser correction of complex myopic astigmatism using Femto-LASIK and ReLEx SMILE methods, the overall QoL indicators are statistically significant ( P <0.01) exceeding preoperative values 1 month after the operation and reaching the maximum values by the end of the observation period ( P <0.0001). Conclusion The results of the study suggest that patients require some time to adapt to their new visual function and its impact on their daily living, delaying detectable improvements in QoL. Moreover, these results may suggest a higher satisfaction trend and long-term QoL in patients undergoing ReLEx SMILE in comparison to Femto-LASIK. Long-term results from the study demonstrated high patient satisfaction with both methods.
Purpose. To evaluate the effectiveness of dry eye syndrome (DES) treatment in patients with meibomian gland dysfunction (MGD) before refractive surgery.Materials and methods. We examined 48 women (aged 29.6 ± 3.9 years) with myopia, DES, and MGD of noninfectious etiology before performing LASIK. Group 1 of these patients received presurgical correction of DES for 2 months, including instillation of 3 % trehalose as a bioprotector (Thealoz®; 3–4 times a day); application of 5 % dexpanthenol in the conjunctival cavity (before going to bed); eyelid hygiene (2 times per day), which included cleaning (Theagel®), warm compresses on eyelid area, massage of eyelid margin (Blephaclean wipes). Group 2 only received bioprotective and reparative therapy for 2 months. Testing included a standard ophthalmological examination; assessment of DES symptoms (OSDI scale, points); BUT test (sec) and Schirmer-1 test (Sh-1, mm); measuring the height of the lower tear meniscus (optical coherence tomography, μm); lissamine green staining with calculation of xerosis index by Bijsterveld (points); assessment of MGD severity (points). Processing of the results included calculation of M ± s; Wilcoxon t-test, Mann Whitney U-test.Results. A positive change of OSDI (decrease from 31.9 ± 2.9 to 8.71 ± 1.1 points), xerosis index (decrease from 4.71 ± 0.5 to 2.1 ± 0.3 points) and BUT test (increase from 4.14 ± 0.53 to 8.66 ± 0.93 sec) was significantly stronger in patients of group 1 (p < 0.05) in comparison with patients of group 2 (decrease in OSDI from 33.2 ± 3.1 to 15.6 ± 2.4 points; decrease of xerosis index from 4.75 ± 0.50 to 3.7 ± 0.5 points; BUT increase from 4.21 ± 0.47 to 6.05 ± 0.73 sec). Apparently, this was caused by a significant decrease in the severity of MGD (from 2.1 ± 0.3 to 0.9 ± 0.2 points) and a decrease in the severity of lipid deficiency due to eyelid hygiene in patients of group 1. In group 2, MGD severity change proved unreliable. Change of Sh-1 and the height of the lower tear meniscus was unreliable in all cases. Conclusion. The inclusion of eyelid hygiene (Theagel and Blephaclean) in the pre-surgery preparation of patients with DES and MGD leads to a more significant correction of eye surface condition compared to isolated bioprotective and reparative therapy, thus providing an opportunity of more favorable conditions for carrying out surgical correction of ametropia.
Purpose. To evaluate the prevalence, clinical and pathogenetic variants and statistically significant risk factors of dry eye (DE) in patients before cataract surgery. Patients and Methods. 600 age-related and complicated cataract patients (70.6 ± 7.8 years old; 269 men, 331 women) were examined. Visometry and biomicroscopy with photographic recording of the lens state and assessment of its opacities according to the LOCS III classification were used to cataract revealing. OSDI testing, lipid interferential test, TBUT, Shirmer-1, -2 tests, visual and OCT meniscometry, evaluation of epitheliopaty and microerosion (with vital staining), compression Norn test in Korb modification, visual and OCT LIPCOF assessment, lid viper epitheliopathy evaluation, anterior segment of the eye photoregistration with computer morphometry were performed to assess the ocular surface condition. The structure of the DE risk factors, was studied both in DE patients and non-DE subjects with calculation of the Pearson xi-square test. To estimate the strength of the connection between the etiological condition and the DE, the normalized value of the Pearson coefficient (C´) was used. Results. The dry eye prevalence was 53.2 % (of them, 25.5 % was mild, 27.7 % — moderate, by Brzhesky). Subclinical DE prevalence was 27 %. Clinical and pathogenetic variants of mild DE included: isolated lipid deficiency (71.9 %), lipid-mucin deficiency (28.1 %). In patients with moderate DE were identified: aqueous-lipid-mucin deficiency (54.8 %), aqueous-lipid deficiency (37.95 %), isolated aqueous deficiency (7.2 %). The most significant systemic-organ DE risk factors were: diabetes mellitus (C´ = 0.302; in 18.8 % DE patients), female sex (C´ = 0.240; in 62.1 % de patients), allergy (С´ = 0.233; in 23.2 % DE patients). Local risk factors most significantly associated with DE were: meibomian glands dysfunction (С´ = 0.58; in 77.7 % DE patients), chronic blepharitis (С´ = 0.233; in 23.2 % DE patients), pterygium (С´ = 0.276; in 13.2 % DE patients), allergic conjunctivitis (С´ = 0.21; in 21.3 % DE patients). Among the exogenous risk factors, the most significant were: the use of medication affecting tear production or tear film stability (С´ = 0.485; in 89.03 % DE patients), preservative eye drops instillation (С´ = 0.2975; in 56.1 % DE patients). Conclusion. In our opinion, data on the high DE prevalence in cataract patients (53.2 %) should be taken into account when planning cataract surgery, since perioperative correction of the ocular surface condition can increase the surgical treatment efficiency, predictability and safety. The data on the structure of significant risk factors and clinical and pathogenetic DE variants in cataract patients can be the basis for the development of measures to ensure timely DE detection and implementation of reasonable therapy. The risk factor most significantly associated with DE in cataract patients was the meibomian gland dysfunction (MGD) (Pearson xi-square test = 88.542, p < 0.001, С´ = 0.58; “relatively strong” strength). Considering the modifiability of this risk factor (MGD), as well as its high prevalence (77.7 %), it can be considered that eye lids hygiene may be a reasonable therapy in most DE and cataract patients before phacoemulsification.
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