Implantation of angle-supported phakic IOLs to correct myopia in patients with keratoconus stage I to II was an effective procedure. Although astigmatism did not improve by the creation of the incision, it was well tolerated by most patients. Long-term endothelial safety must be assessed.
Angle-supported IOLs can effectively correct high myopia, although residual refractive errors may require secondary procedures. The main intraoperative and postoperative complications were halos, steroid response, and incorrect IOL sizing. The role of surgery in inducing macular hemorrhages should be assessed further.
Neither author has a financial or proprietary interest in any material or method mentioned.
Purpose: To evaluate the incidence, evolution, and prognosis of diffuse lamellar keratitis (DLK) in a large series of laser in situ keratomileusis (LASIK) with low-energy femtosecond laser. Setting: Private practice, Siena, Italy. Design: Retrospective, consecutive, noncomparative case series study. Methods: Single-use instruments, powder-free gloves, and no corneal marking were used. Flap was created by a low-energy femtosecond laser (Ziemer Z2 and Z4). Results: A total of 37 315 eyes of 19 602 patients were reviewed. DLK was observed in 236 eyes (0.63%) of 149 patients (0.76%). Grade 1 DLK was observed in 231 eyes of 142 patients, grade 2 in 1 eye: when treated with topical steroids, they had no visual consequences. Three patients had bilateral grade 3 to 4 DLK: one of them, with bilateral grade 3, despite flap lifting and irrigation worsened to stage 4 (central stroma thinning and flattening), partially recovered in 2 years, and underwent repeat femtosecond laser–assisted LASIK for hyperopic shift in 1 eye. In all the 5 eyes that developed grade 4 DLK, corneal thickness decreased until the first month and then partially recovered; mean final tissue loss at 1 to 2 years was 35 µm. Compensatory epithelial thickening was observed. Conclusions: DLK after low-energy femtosecond laser–assisted LASIK is rare; severe DLK (stages 3 and 4) was found in only 6 eyes (0.016%). Flap lifting and irrigation might not prevent progression. Spontaneous reformation of stromal tissue and epithelial thickening improve visual acuity in the long term; residual hyperopic shift can be corrected by repeat femtosecond laser–assisted LASIK.
The purpose of the study was to evaluate the results and complications of laser-assisted in situ keratomileusis (LASIK) using a femtosecond laser as a retreatment modality of myopia and myopic astigmatism after previous myopic photorefractive keratectomy (PRK).Methods: In this retrospective, consecutive, noncomparative case series study, 69 eyes of 41 patients receiving femtosecond LASIK after previous myopic PRK were evaluated. The mean age was 43.0 6 8.9 years. The preoperative mean SE was 21.82 6 1.01 diopter (D), range 20.62 to 26.25. The mean central epithelial thickness was 65 6 5 mm. A flap was created using a low-energy femtosecond laser (Ziemer LDV Z8), with a programmed thickness calculated by adding 40 mm to the epithelial thickness. Refractive ablation was performed using a Technolas Teneo 317 laser (Bausch and Lomb).Results: Twelve months after LASIK, the mean SE was 20.03 6 0.17 D, with all eyes #0.50 D of SE. The mean DE was 0.30 6 0.25, with 62 eyes (89.9%) #0.50 D and all eyes #1 D. The mean corrected distance visual acuity (CDVA) was 0.04 6 0.10 logMAR; no eye lost more than 1 line of CDVA. The mean uncorrected distance visual acuity was 0.07 6 0.13 logMAR, being 20/25 or better in all eyes. The safety index (postoperative CDVA/preoperative CDVA) was 1.05. The efficacy index (postoperative uncorrected distance visual acuity/ preoperative CDVA) was 0.98. No significant complications occurred.Conclusions: Myopic retreatments by femtosecond LASIK after primary PRK yielded excellent refractive results without relevant complications. The flap thickness must be tailored to the epithelial thickening after PRK.
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