Endothelial decompensation after laser in situ keratomileusis

Vroman, David T; Solomon, Kerry D.; Holzer, MP; Peng, Qun; Apple, David J.; Bowie, Esther M

doi:10.1016/s0886-3350(01)01352-9

Cited by 28 publications

(30 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cuando se ha realizado la técnica LASIK para corregir la hipermetropía en córneas con distrofia de Fuchs (5), la evolución ha sido hacia la descompensación corneal y queratoplastia. En el LASIK hipermetrópico, la ablación es periférica por lo que debe tenerse en cuenta la celularidad endotelial a este nivel (5). En los dos casos descritos de LASIK para corregir miopía en córneas con DPP (3), la pér-dida endotelial al año ha sido del 2,3%.…”

Section: Discussionunclassified

Distrofia polimorfa posterior y LASIK

Huerva

Mateo

2008

Arch Soc Esp Oftalmol

View full text Add to dashboard Cite

RESUMENObjetivo/Método: Mujer hipermétrope de 50 años desea información sobre cirugía refractiva. En la córnea se aprecia vesículas y bandas en la membrana de Descement y endotelio catalogándose de distrofia polimorfa posterior (DPP). El recuento endotelial resulta bajo por lo que se le contraindica cualquier cirugía refractiva corneal. Resultados/Conclusiones: La presencia de vesícu-las y bandas a nivel de la membrana de Descement y endotelio es característico de una DPP. En estos casos resulta obligatorio realizar una microscopía especular previa a una cirugía refractiva con láser excimer. Un recuento de células endoteliales bajo puede constituir una contraindicación para el LASIK hipermetrópico en casos de DDP por el posible riesgo de descompensación endotelial.Palabras clave: Distrofia polimorfa posterior, PPD, distrofias corneales posteriores, distrofia endotelial de Fuchs, LASIK, hipermetropía. COMUNICACIÓN CORTA ABSTRACTObjective/Method: A 50-year-old hyperopic woman requested information about refractive surgery. Vesicle and band lesions at Descemet's membrane and endothelium were suggestive of posterior polymorphous dystrophy (PPD). Lower than normal endothelial cell densities were detected. A corneal refractive procedure was not recommended in this case. Results/Conclusions: The presence of vesicles and bands at Descemet's membrane and endothelium is suggestive of PPD. Specular microscopy is mandatory in such patients, although corneal decompensation is not evident. A low endothelial cell count may be a contraindication for a hyperopic LASIK procedure in cases of PPD because of the possible risk of corneal decompensation (Arch Soc Esp Oftalmol 2008; 83: 607-614).

show abstract

Section: Discussionunclassified

Distrofia polimorfa posterior y LASIK

Huerva

Mateo

2008

Arch Soc Esp Oftalmol

View full text Add to dashboard Cite

show abstract

“…Specifically, these reports observed corneal decompensation after LASIK in patients with preoperative corneal guttata with and without associated corneal edema, highlighting the importance of avoiding LASIK in patients with signs of endothelial dysfunction. 14,15 Given these data, it is imperative, especially in patients with relatively thick corneas, that signs of corneal endothelial dysfunction including guttata and corneal edema be actively sought and excluded before LASIK is performed. In the absence of such clinical findings, we have found that outcomes after LASIK in patients with relatively thick corneas are comparable to outcomes in patients with more routine corneal thicknesses.…”

Section: Discussionmentioning

confidence: 99%

Myopic laser in situ keratomileusis in eyes with thick corneas

Wykoff¹,

Pineda²

2006

Journal of Cataract and Refractive Surgery

View full text Add to dashboard Cite

Laser in situ keratomileusis (LASIK) for the correction of refractive errors is effective, predictable, stable, and safe. 1 Contraindications to LASIK have been proposed including pregnancy, lactation, corneal edema, dry eyes, and systemic immune disorders such as rheumatoid arthritis and systemic lupus erythematosus. One of the most widely accepted contraindications is a thin cornea because of the risk for triggering iatrogenic keratectasia. 2 Outcomes after LASIK performed in eyes with thick corneas, however, are not well defined, and literature regarding this topic is lacking. Therefore, the safety and effectiveness of LASIK performed for correction of myopia and astigmatism on eyes with thick corneas was evaluated compared with published data.A thick cornea was defined as one having a central corneal thickness (CCT) R 599 mm, based on a recent review by Doughty and Zaman, 3 which determined the mean CCT in normal human eyes as 536 mm with a standard deviation (SD) of 31 mm. Thus, a CCT of R599 mm represents a cutoff greater than 2 SD above the mean and identifies approximately 2.5% of the population. METHODS AND RESULTSIn this retrospective chart-review analysis, all medical records for patients who had LASIK by the same surgeon (R.P.) at the Massachusetts Eye and Ear Infirmary in Boston, Massachusetts, between 1999 and 2004 were reviewed (approximately 2500 patients), and 70 eyes of 47 patients were identified with a preoperative CCT R599 mm, 43 (61.4%) in women and 27 (39.6%) in men. Mean CCT by ultrasonic pachymetry (DGH) was 614 mm (range 599 to 650 mm) ( Figure 1). Mean patient age was 41.8 years (range 23 to 60 years). Mean preoperative manifest spherical equivalent was ÿ4.57 diopters (D) (range ÿ1.63 to ÿ10.38 D; mean sphere ÿ3.97 D, mean cylinder ÿ1.20 D). No patient had clinically evident corneal edema or guttae.For LASIK treatments, a corneal flap was created using a Hansatome microkeratome (Bausch & Lomb) (64 eyes) with a 160 mm or 180 mm microplate head or an IntraLase laser (6 eyes) with a 115 mm flap thickness. The stromal bed was then treated with 1 of 3 excimer lasers: Visx Star S2 (49 eyes), Visx Star S4 (11 eyes), or Technolas 217A (Bausch & Lomb) (10 eyes), and the flap was then repositioned. Intraoperatively, 1 patient experienced a mild corneal abrasion. No other intraoperative complications were encountered. Treatment targets were between plano and ÿ0.5 D.Postoperatively, patients were followed for a mean of 8.3 months. Two eyes experienced displaced flaps on day 1 requiring repositioning (2.4%). No other complications were encountered. Ninety percent of eyes (63 of 70) were followed up for at least 1 month, at which point 67% had an uncorrected visual acuity (UCVA) of 20/25 or better and 87.3% had an UCVA of 20/40 or better.Enhancement was performed in 13 eyes (18.6%) in response to patient request for additional visual correction. Eleven of the enhancements were performed by additional excimer laser treatment, and 2 enhancements were performed by arcuate keratotomy. Eyes that necessita...

show abstract

“…26 However, the lack of this capacity may lead to accelerated endothelial cell loss and a compromised barrier. 27,28 Both Vroman et al 11 and Dastjerdi and Sugar 12 have reported cases of endothelial cell loss after LASIK in patients with Fuchs' dystrophy. While these studies support our observations, it is difficult to separate the effect of the refractive surgery on endothelial cells from the natural course of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Although several studies have documented the safety of myopic LASIK in patients with a healthy endothelium, 6-10 experience with LASIK in corneas with abnormal endothelium is limited. 11,12 In this study, the outcomes of LASIK in 4 patients (7 eyes) who had preoperative trace to 1C guttata and a family history of Fuchs' dystrophy were reviewed.…”

mentioning

confidence: 99%