Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk

Chang, Jinn-Ming; Liu, Sylvia C T; Nadine, T C; Katsev, Blake; Ng, J. C.

doi:10.1097/j.jcrs.0000000000000817

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…Prior studies evaluating LASIK enhancements after primary LASIK have been published ( Table 3 ) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. At 12 months, 86% and 99% of our eyes had a UDVA of 20/20 or better and 20/40 or better, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…At 12 months, 86% and 99% of our eyes had a UDVA of 20/20 or better and 20/40 or better, respectively. In comparison, 21.1–93.3% of eyes in previous studies had a UDVA of 20/20 or better while 88.2–100% of eyes had a UDVA of 20/40 or better [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Our results showed 4% of eyes that lost one line of CDVA and 0.6% of eyes that lost two or more lines at 12 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…At 12 months, there were 93% of eyes within ±0.50 D of the intended target and 99% within ±1.00 D in our study. Other studies show 46.4–100% of eyes within ±0.50 D of the target and 63.4–100% within ±1.00 D [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our results showed 4% of eyes that lost one line of CDVA and 0.6% of eyes that lost two or more lines at 12 months postoperatively. Existing literature shows 0–28% of eyes that lost one line and 0–31.8% that lost two or more lines of CDVA [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. At 12 months, there were 93% of eyes within ±0.50 D of the intended target and 99% within ±1.00 D in our study.…”

Section: Discussionmentioning

confidence: 99%

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Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK

Moshirfar

Basharat

Bundogji

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK

Moshirfar

Basharat

Bundogji

et al. 2022

JCM

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“…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.…”

mentioning

confidence: 99%

Comment on: Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk

Moshirfar

Basharat

2022

J Cataract Refract Surg

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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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Sub-Bowman LASIK retreatment by second flap complicated by deep folds: Repositioning and suturing

Fernández-Vigo,

Burgos-Blasco,

Almorín-Fernández-Vigo

et al. 2024

Journal Français d'Ophtalmologie

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Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk

Abstract: To assess the association of time since primary laserassisted in situ keratomileusis (LASIK) with flap relift success and risk for epithelial ingrowth (EI) in eyes undergoing flap relift after primary LASIK.

Cited by 6 publications

References 27 publications

Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK

Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK

Comment on: Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk

Sub-Bowman LASIK retreatment by second flap complicated by deep folds: Repositioning and suturing

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