Confocal assessment of the corneal response to intracorneal lens insertion and laser in situ keratomileusis with flap creation using IntraLase

Petroll, Walter M; Goldberg, Damien F.; Lindsey, Sara S.; Kelley, Patrick; Cavanagh, Harrison D; Bowman, Robert W; Parmar, Dipak N.; Verity, Steven M.; McCulley, James P.

doi:10.1016/j.jcrs.2006.01.093

Cited by 21 publications

(13 citation statements)

References 30 publications

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“…Deeper stromal implantation allows better movement of water and nutrients across the corneal stroma and around the edges of Confocal imaging has been used to evaluate shortterm effects of hydrogel intracorneal lens implantation in animals and humans. 10,11 Twenty-two years after implantation, both patients showed a similar backscatter profile, with increased backscatter at the anterior and posterior interfaces. This can be explained by a small difference in refractive index between the hydrogel lens and the surrounding stroma.…”

Section: Discussionmentioning

confidence: 89%

Long-term follow-up of hydrogel intracorneal lenses in 2 aphakic eyes

Saelens

Bleyen

Hillenaar

et al. 2010

Journal of Cataract and Refractive Surgery

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We report the outcome of hydrogel intracorneal lens implantation in 2 patients. The lenses were implanted at approximately 50% depth in the cornea to correct high hyperopic refractive errors of 10.5 diopters (D) and 14.0 D, respectively. Both patients were contact lens intolerant and not suitable for intraocular lens implantation. Surgery was performed in 1988, and the patients were followed until early 2010. The patients showed good tolerance for the intracorneal lenses, but both developed opacities around the implant, leading to reduced visual acuity in 1 patient. Long-term patient monitoring is essential since corneal opacities can develop after many years. Removing the implant is not necessary as the lens can easily be rinsed by lifting the corneal cap.

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Section: Discussionmentioning

confidence: 89%

Long-term follow-up of hydrogel intracorneal lenses in 2 aphakic eyes

Saelens

Bleyen

Hillenaar

et al. 2010

Journal of Cataract and Refractive Surgery

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“…15 Interface particles were also counted from each CMTF scan and converted to a density measure of particles/mm 2 . 12 Individual images from the CMTF scans were evaluated for qualitative assessment of changes in keratocyte morphology and/or reflectivity. The area under the CMTF peak corresponding to the flap interface on the intensity curve was calculated as previously described [16][17][18] ; this measurement incorporates all factors that might contribute to interface backscatter such as keratocyte activation, edema, interface particles, and debris.…”

Section: Confocal Microscopy Through Focusingmentioning

confidence: 99%

“…However, a small subset of patients develop significant corneal haze after intra-LASIK, which may be associated with transient light sensitivity; the underlying cause of this haze has been attributed to keratocyte activation and appears to be linked to use of higher raster energies. 11,12 Intra-LASIK entered its second generation with the introduction of the IntraLase FS30 femtosecond laser (IntraLase Corp.), which replaced the IntraLase FS15 femtosecond laser. The FS30 laser generates 30000 pulses/second, allowing a faster procedure time, tighter spot placement, and lower overall energy exposure than to the FS15 laser (15000 pulses/second).…”

mentioning

confidence: 99%

Comparison of the corneal response to laser in situ keratomileusis with flap creation using the FS15 and FS30 femtosecond lasers

McCulley

Cavanagh

et al. 2007

Journal of Cataract and Refractive Surgery

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Both the FS15 and FS30 lasers provided more reproducible flap thickness and fewer interface particles than previously observed using microkeratomes. The response of corneal keratocytes to intra-LASIK was reduced compared with previous results in which higher raster energies were used. Compared with the FS15, there was an apparent reduction in overall interface reflectivity and fewer interface particles with the FS30 laser.

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“…1 Numerous reports have been published describing central epithelial thickening following central tissue removal by myopic excimer laser ablations, which has been related to myopic regression. 2-12 Epithelial thickness changes have also been described after radial keratotomy, 13 intracorneal ring segments, 14,15 and orthokeratology contact lens wear. 16-20 The epithelium has also been reported to compensate for stromal irregularities in cases of asymmetric resection in automated lamellar keratoplasty, 4 asymmetric LASIK flaps, 4,21,22 microfolds, 21,22 flap malposition and short flap, 21-23 free cap malrotation, 24 and irregular stromal surface following multiple refractive procedures.…”

mentioning

confidence: 99%

Epithelial Thickness After Hyperopic LASIK: Three-Dimensional Display with Artemis Very High-Frequency Digital Ultrasound

Reinstein

Archer²,

Gobbé³

et al. 2010

J Refract Surg

121

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PURPOSE To characterize the epithelial thickness profile in a population of eyes after LASIK for hyperopia or hyperopic astigmatism. METHODS The epithelial thickness profile was measured in vivo by Artemis very high-frequency (VHF) digital ultrasound scanning (ArcScan Inc) across the central 10-mm diameter of the cornea on 65 eyes at least 3 months after hyperopic LASIK using a 7-mm ablation zone with the MEL 80 excimer laser (Carl Zeiss Meditec). Maps of the average, standard deviation, minimum, maximum, and range of epithelial thickness were plotted. The cross-sectional hemi-meridional epithelial thickness profile was calculated using annular averaging. Linear regression analysis was performed to evaluate correlations between epithelial thickness, spherical equivalent refraction treated, and maximum simulated keratometry. RESULTS The mean thinnest epithelial thickness was 39.7±5.6 μm and the mean thickest epithelial thickness was 89.3±14.6 μm. The average epithelial thickness profile showed an epithelial doughnut pattern characterized by localized central thinning within the 4-mm diameter zone surrounded by an annulus of thick epithelium, with the thickest epithelium at the 3.4-mm radius. The epithelium was on average 10-μm thicker temporally than nasally at the 3.4-mm radius. Central epithelium was thinner and paracentral epithelium was thicker for higher hyperopic corrections and steeper maximum simulated keratometry. CONCLUSIONS Three-dimensional high-resolution ultrasound mapping of epithelial thickness profile after LASIK for hyperopia demonstrated thinner epithelium centrally and thicker epithelium paracentrally. Presumably, the paracentral epithelial thickening compensated in part for the stromal tissue removed by the hyperopic ablation, whereas the central epithelial thinning compensated for the localized increase in corneal curvature.

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Confocal assessment of the corneal response to intracorneal lens insertion and laser in situ keratomileusis with flap creation using IntraLase

Abstract: Both LASIK with IntraLase and ICL insertion following IntraLase induced keratocyte activation, which may underlie clinical observations of haze in some patients. Intracorneal lens implant also induced thinning of the overlying corneal epithelium.

Cited by 21 publications

References 30 publications

Long-term follow-up of hydrogel intracorneal lenses in 2 aphakic eyes

Long-term follow-up of hydrogel intracorneal lenses in 2 aphakic eyes

Comparison of the corneal response to laser in situ keratomileusis with flap creation using the FS15 and FS30 femtosecond lasers

Epithelial Thickness After Hyperopic LASIK: Three-Dimensional Display with Artemis Very High-Frequency Digital Ultrasound

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