Retreatment after Laser In Situ Keratomileusis

Size: px
Start display at page:

Download "Retreatment after Laser In Situ Keratomileusis"

Transcription

1 Retreatment after Laser In Situ Keratomileusis Juan J. Pérez Santonja, MD, María J. Ayala, MD, Hani F. Sakla, MD, José M. Ruíz Moreno, MD, Jorge L. Alió, MD Objective: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) retreatment for correcting residual myopia. Design: Retrospective noncomparative case series. Participants and Intervention: Fifty-nine consecutive eyes (43 patients) underwent LASIK retreatment at 3 or 6 months after the primary LASIK procedure. Lifting the corneal flap and reablating the stromal bed with a VISX 20/20 excimer laser was the procedure used for LASIK enhancement. Main Outcome Measures: The following parameters were studied before and after retreatment: visual acuity, refraction, videokeratography, applanation tonometry, and corneal thickness. Complications after LASIK enhancement also were evaluated. Follow-up was 12 months. Results: Before retreatment, only 3.38% of eyes (2 of 59) had an uncorrected visual acuity of 0.5 (20/40) or better, and after retreatment, this percentage increased to 60% (30 of 50) at 6 months and 61.8% (34 of 55) at 12 months. After reoperation, mean best-corrected visual acuity improved by half a line over the values before retreatment. The preretreatment refraction of diopters (D) (mean standard deviation) decreased significantly to D at 6 months and to D at 12 months (P 0.001). In 82% of eyes (41 of 50) at 6 months and 81.8% (45 of 55) at 12 months, the spherical equivalent was within 1.00 D of emmetropia. There was a significant regression of effect (0.38 D) between 3 and 12 months (P 0.01). Postretreatment refraction was related to the original refraction before the primary LASIK, the preretreatment refraction, and the ablation diameter used. Although no vision-threatening complications were found, epithelial ingrowth and flap melting were more common after than before LASIK retreatment, with 31% of eyes at 12 months with epithelial ingrowth and 10.9% with flap melting. However, LASIK enhancement improved decentration and night-vision problems. Conclusions: LASIK retreatment was an effective and predictable procedure for correcting residual myopia. Epithelial ingrowth and flap melting were more frequent after than before LASIK retreatment, whereas decentration and night-vision symptoms improved. Ophthalmology 1999;106:21 28 Laser in situ keratomileusis (LASIK) is a new technique for the correction of moderate-to-high myopia. 1 4 This procedure combines lifting a corneal flap with a microkeratome and refractive photoablation on the stromal bed by means of a193-nm argon fluoride excimer laser. 1,2 Recent clinical studies found that LASIK offers good results in cases of moderate and high myopia, although clinical data on this procedure are still limited. 1,3 6 Scant information is also available concerning complications after LASIK. Although several complications have been reported, 1 7 undercorrection is the most common one after this procedure. Undercorrections greater than 1.00 Originally received: September 8, Revision accepted: July 8, Manuscript no From the Refractive Surgery and Cornea Unit, Alicante Institute of Ophthalmology, University of Alicante School of Medicine, Alicante, Spain. Presented in part at the American Academy of Ophthalmology annual meeting, San Francisco, October The authors have no proprietary interest in any of the materials described in this article. Reprint requests to Juan J. Pérez Santonja, MD, Alicante Institute of Ophthalmology, Avd de Denia 111, Alicante, Spain. diopter (D) have been reported in 11.3% to 59% of cases, depending on preoperative myopia. 1 6,8 Radial keratotomy and lifting the corneal flap with another laser ablation have been suggested as procedures for the management of LASIK undercorrections 9,10 ; however, limited data are available on these techniques. 10 The purpose of the current study was to evaluate the effectiveness, predictability, and safety of LASIK retreatment for correcting residual myopia in a series of 59 eyes, with a follow-up of 12 months. Materials and Methods From September 1994 through December 1995, 393 LASIK procedures for correcting myopia from 8.00 to D were performed by the same surgeon (JJP-S) at Alicante Institute of Ophthalmology, Alicante, Spain. The results of the first 143 consecutiveeyesfromthisserieswerereportedelsewhere. 6 Sixty-nine eyes (17.5%) of 393 were undercorrected by 1.00 D or more, and 59 eyes (15%) underwent LASIK retreatment for correcting this residual myopia. In ten undercorrected eyes (2.5%), the patients were satisfied with the results and decided not to undergo further treatment. 21

2 Ophthalmology Volume 106, Number 1, January 1999 The LASIK retreatment group comprised 59 consecutive eyes (43 patients) that underwent LASIK enhancement by the same surgeon (JJP-S) at 3 (n 16) or 6 (n 43) months after the primary LASIK procedure. Twenty-four eyes (40.6%) were in men and 35 eyes (59.3%) were in women. Mean patient age was years (mean standard deviation [SD]; range, years). Mean preoperative refraction before the primary LASIK was D (range, 8.00 to D), with 19 eyes between 8.00 and D (group A), 28 eyes between and D (group B), and 12 eyes between and D (group C). Mean preoperative refraction before LASIK retreatment was D (range, 1.00 to 6.75 D). Patient selection criteria for LASIK retreatment were residual myopia equal or greater than 1.00 D at 3 or 6 months after primary LASIK procedure, normal anterior segment, and normal peripheral retina or treatment with photocoagulation when necessary. In addition, the cornea had to be thick enough so that the remaining total corneal thickness after retreatment was greater than 370 m ( 200 m of stroma remaining under the flap). 6 Informed consent was obtained from all patients after they received a detailed description of LASIK retreatment and a thorough review of LASIK-known risks. The primary LASIK procedure criteria were reported elsewhere. 6 Before and after retreatment, patients underwent a complete ophthalmic examination. This examination included visual acuity, manifest and cyclopegic refractions, videokeratography (EyeSys Corneal Analysis System, Houston, TX), slit-lamp microscopy, Goldmann applanation tonometry, indirect ophthalmoscopy, and corneal thickness (DGH-500 pachymeter; DGH Technology, Inc, Exton, PA). Postoperative examinations were conducted at 3, 6, and 12 months. Five of the 59 eyes in the study were unavailable for the 3-month follow-up; 9 eyes, for the 6-month follow-up; and 4 eyes, for the 12-month follow-up. All primary LASIK procedures were performed with the patient under topical anesthesia using the Automated Corneal Shaper microkeratome (Chiron Vision, Irvine, CA) and the VISX 20/ nm, argon fluoride excimer laser (VISX Inc, Santa Clara, CA). 6 A nasally based corneal flap, 130- (n 23) or 160- m(n 36) thick and 8.5 mm in diameter, was performed using the automated microkeratome. The exposed stromal bed was then ablated by using the VISX 20/20 laser, with an energy fluence of 160 mj/cm 2 and a frequency of 6 Hz. A multizone approach was used, with 50% of correction done at the first zone, 30% at the second, and 20% at the third. The triple ablation profile was 4 mm (first zone)/4.5 mm (second)/5 mm (third) (n 7), 4.5/5.0/5.5 mm (n 13), or 5.0/5.5/6.0 mm (n 39), depending on the intended correction and the preoperative corneal thickness, so that the resulting central corneal thickness after surgery was greater than 370 m. The mean calculated central ablation depth was m (range, m). After ablation, the flap was replaced without sutures. Eyes were not occluded after the procedure. Antibiotic (tobramycin 0.3%, Tobrex; Alcon S.A., Madrid, Spain) and corticosteroid (fluorometholone 0.1%, FML; Allergan S.A., Madrid, Spain) eyedrops were instilled four times a day for the first 10 days. LASIK retreatments were performed by lifting the flap and reablating the stromal bed. Before surgery, the patient was taken to the slit lamp and the edge of the flap was marked with gentian violet on the temporal side. The procedure was performed with the patient under topical anesthesia with 0.4% oxibuprocaine. The cornea was marked with two additional pararadial gentian violet lines, and a small area of epithelium on the temporal side was debrided using a blunt spatula. A flat spatula was then inserted beneath the corneal flap edge. Once the flap interface was identified, the spatula was passed along the flap edge circumferentially, and the interface was dissected. The hinged flap was lifted using a nontoothed forceps and placed against the nasal sclera. The stromal bed was then ablated using the VISX 20/20 excimer laser. There was no specific retreatment nomogram. A single-zone ablation was used, which was 5.0 mm (n 12), 5.5 mm (n 12), or 6.0 mm (n 35) in diameter, depending on the intended correction and the preoperative corneal thickness. The mean calculated central ablation depth was m (range, m). After ablation, the flap was replaced to its original position, and the interface was irrigated copiously with balanced salt solution using a 23G cannula for removing debris and residual epithelial cells. The flap was then centered for proper alignment according to the pararadial marks, and the keratectomy incision was dried with absorptive sponges (Surgical Spears; Merocel Corp., Mystic, CT). After 3 minutes, the flap was checked for adhesion by depressing the peripheral host cornea and watching to ensure that the resulting indentation went into the flap. When adhesion was confirmed, the procedure was finished. Eyes were not occluded after retreatment, and the postoperative regimen was identical to that after the primary LASIK procedure. Both parametric and nonparametric statistical analyses were done based on the distribution of the data under consideration. Group differences for continuous variables were tested using the unpaired Student s t test, one-way analysis of variance (one-way ANOVA), or two-way analysis of variance (two-way ANOVA) for normally distributed data, and the Wilcoxon signed rank, Mann Whitney, and Kruskall Wallis tests for non-normally distributed data. Differences for categoric variables were tested using the chi-square or Fisher exact test for independence. Differences for ordered categoric variables were tested using the Wilcoxon and Mann Whitney tests. Paired proportions were compared using the McNemar test. Correlations between continuous variables were obtained using Pearson s correlation coefficient. Differences were considered statistically significant when P values were less than Results Visual Acuity To evaluate visual acuity, we must take into account the reduced levels of uncorrected- and best-corrected visual acuity (BCVA) in patients with high myopia due to myopic chorioretinal degeneration. Mean uncorrected visual acuity (UCVA) before the initial treatment was (mean standard deviation), and at the time of retreatment, it was After retreatment, mean UCVA increased to at 3 months, at 6months, and at 12 months (Fig 1). UCVA after retreatment was significantly better than the values before retreatment at all follow-ups (two-way ANOVA, P 0.001). There were no significant differences between mean visual acuities at the three follow-up times (two-way ANOVA, P 0.297). At the time of retreatment, 3.38% of eyes (2 of 59) had a UCVA of 0.5 (20/40) or better, and after retreatment, 59.2% of eyes (32 of 54) at 3 months, 60% (30 of 50) at 6 months, and 61.8% (34 of 55) at 12 months had a UCVA of 0.5 or better. Mean BCVA before the primary LASIK procedure was , and at the time of retreatment, it was After retreatment, mean BCVA increased to at 3 months, at 6months, and at 12 months (Fig 1). It improved by 0.06 at 3 and 6 months and by at 12 months (0.1 one line) over the values before retreatment. BCVA after retreatment was significantly better than the values before retreatment at all follow-ups (two-way ANOVA, P 0.001). There were 22

3 Pérez Santonja et al Retreatment after LASIK Figure 1. Time course of uncorrected visual acuity and best-corrected visual acuity (mean standard deviation). Numbers in parentheses indicate number of eyes studied at each period. no significant differences between mean BCVAs at the three follow-up times (two-way ANOVA, P 0.401). No patient lost two or more lines of BCVA. Our data show an improvement in both UCVA and BCVA after LASIK retreatment and stability in both visual acuities after the third month. Refraction Mean spherical equivalent refraction before the initial treatment was D (range, 8.00 to D), and before retreatment, it was D (range, 1.00 to 6.75 D). After retreatment, mean refraction was D (range, 2.50 to 2.25 D) at 3 months, D (range, 1.25 to 3.00 D) at 6 months, and D (range, 1.00 to 3.50 D) at 12 months (Fig 2). The differences between values before and after retreatment were statistically significant at all follow-ups (two-way ANOVA, P 0.001). There was a significant regression of effect (0.21 D) between 3 and 6 months after retreatment (two-way ANOVA, P 0.01) and also between 6 and 12 months (0.17 D) (P 0.01). The whole regression between 3 and 12 months was 0.38 D(P 0.01) (Fig 3). In 92.6% of eyes (50 of 54) at 3 months, 82% (41 of 50) at 6 months, and 81.8% (45 Figure 2. Scattergram of attempted correction vs. refractive outcome (spherical equivalent) 12 months after retreatment. Figure 3. Time course of refractive outcome (spherical equivalent) (mean standard deviation). of 55) at 12 months, the spherical equivalent after retreatment was within 1.00 D of emmetropia. Mean keratometry and pachymetry at the time of retreatment were not correlated with postoperative refraction (keratometry: r 0.05, P at 6 months; r 0.01, P at 12 months. Pachymetry: r 0.14, P at 6 months; r 0.19, P at 12 months). Moreover, no differences were found in postoperative spherical equivalent between eyes operated on at 3 months after the primary LASIK procedure and those operated on at 6 months (Student s t test for unpaired data, P at 3 months; P at 6 months; P at 12 months). However, at 12 months, those eyes from the initial treatment group C (mean refraction, D) were undercorrected in 0.70 D compared to those from groups A ( D) and B ( D) (one-way ANOVA, P 0.020). Moreover, significant correlations were found between refraction at 6 and 12 months after retreatment and the spherical equivalent before retreatment (r 0.29, P at 6 months; r 0.28, P at 12 months) in such a way that the higher the myopia before retreatment, the higher the myopia after retreatment (Fig 2). Ablation diameters at the time of retreatment were also related to 12-month postretreatment refraction, since those eyes with 5.0-mm ablation diameter were more undercorrected ( D) than those with 5.5 ( D) or 6mm( D) (one-way ANOVA, P 0.021). No significant differences in regression of effect were observed between eyes operated on at 3 months after the primary LASIK and those operated on at 6 months (Mann Whitney test, P regression between 3 6 months; P between 6 12 months; P between 3 12 months). Moreover, no differences in regression of effect were found among the myopic groups before the initial treatment (groups A, B, and C) (Kruskall Wallis test, P for the regression between 3 6 months; P between 6 12 months; P between 3 12 months). A relationship between regression and preretreatment refraction was not present either (r 0.096, P for the regression between 3 6 months; r 0.008, P between 6 12 months; r 0.205, P between 3 12 months). Astigmatism Forty-nine percent of eyes (29 of 59) underwent a spherical laser ablation and 51% of eyes (30 of 59) an astigmatic ablation. In the spherical ablation group, mean astigmatism was D 23

4 Ophthalmology Volume 106, Number 1, January 1999 Figure 4. Time course of mean central keratometric values (mean standard deviation). The numbers in parentheses indicate number of eyes studied at each period. (range, D) at the time of retreatment and D (range, D) at 3 months, D (range, D) at 6 months, and D (range, D) at 12 months after retreatment. The differences between values before and after retreatment were not significant at any follow-up (two-way ANOVA, P 0.476) nor were the differences between values after retreatment (two-way ANOVA, P 0.237). No eye had an astigmatism greater than 1.00 D before retreatment and only one eye (3.5%) at 12 months after retreatment. In the astigmatic ablation group, mean astigmatism was D (range, D) at the time of retreatment and D (range, D) at 3 months, D (range, D) at 6 months, and D (range, D) at 12 months after retreatment. The differences between values before and after retreatment were significant for all follow-ups (two-way ANOVA, P 0.001); however, no significant differences were found between values after retreatment (two-way ANOVA, P 0.536). Thirty-three percent of eyes (10 of 30) had an astigmatism greater than 1.00 D before retreatment, whereas only one eye (3.7%) had an astigmatism greater than 1.00 D 12 months after retreatment. Figure 6. Time course of corneal pachymetry (mean standard deviation). Numbers in parentheses indicate number of eyes studied at each period. Videokeratography Mean central corneal keratometric values are shown in Figure 4. These values showed marked flattening after retreatment at all follow-ups (two-way ANOVA, P 0.001), with steepening documented (0.15 D) from the 3-month to the 6-month reading (twoway ANOVA, P 0.040) and also (0.21 D) from the 6-month examination to the 12-month reading (P 0.001). The corneal steepening between 3 and 12 months was 0.37 D (P 0.001). There was a highly significant correlation between achieved correction (difference between refractions before and after retreatment) and achieved corneal flattening (difference between mean keratometric readings before and after retreatment) at 3 months (r 0.65, P 0.001), 6 months (r 0.65, P 0.001), and 12 months (r 0.65, P 0.001) (Fig 5). The correlation between corneal steepening and regression of refraction after retreatment was significant between 3 and 6 months (r 0.52, P 0.003); the greater the corneal steepening, the higher the regression of refraction. However, no correlation was found between 6 and 12 months (P 0.138). Pachymetry Ultrasonic pachymetric readings after retreatment were significantly lower than before retreatment (two-way ANOVA, P 0.001) (Fig 6). Corneal thickness increased ( m) significantly between 3 and 6 months (P 0.001), whereas no change occurred between 6 and 12 months (P 0.237). Intraocular Pressure Mean intraocular pressure was mmhg before retreatment, and after retreatment, it was mmhg at 3 months, mmhg at 6 months, and mmhg at 12 months. No significant change was found between values before and after retreatment (Wilcoxon test, P 0.052). Figure 5. Relationship between achieved correction and corneal flattening 12 months after retreatment. Complications An undercorrection greater than 1.00 D was present in 3.7% of eyes (2 of 54) at 3 months after retreatment, 14% (7 of 50) at 6 months, and 18.1% (10 of 55) at 12 months. An overcorrection greater than 1.00 D occurred in 3.7% (2 of 54), 4% (2 of 50), and 24

5 Pérez Santonja et al Retreatment after LASIK Figure 7. Corneal flap melting on an epithelial ingrowth area 12 months after laser in situ keratomileusis retreatment. 0% (0 of 55) of eyes at 3, 6, and 12 months after retreatment, respectively. In 1.7% of eyes (1 of 59) at the time of retreatment, fine wrinkles (striations) resembling fingerprint lines were observed in the flap under broad illumination. After retreatment, 5.5% (3 of 54), 6% (3 of 50), and 5.4% (3 of 55) of eyes at 3, 6, and 12 months, respectively, had fine wrinkles. The wrinkles were confined to the flap, did not affect visual acuity, and remained unchanged during follow-up. No flap displacement was found after retreatment. Haze or scarring in the stromal bed was minimal both before and after retreatment. On a subjective scale (0 none, 4 severe), the mean haze rating was before retreatment and at 3 months, at 6 months, and at 12 months after reoperation. Haze was never worse than mild throughout the follow-up. Dot remnants, related to epithelial or tear film debris or to foreign particles, were minimally observed after retreatment. One month after LASIK or after LASIK enhancement, it is usual to observe an incomplete gray line at the edge of the flap due to the interaction between the epithelium and the stroma; however, in a few eyes, some epithelial ingrowth at the edge of the flap was observed. In our study, this ingrowth was recorded when it was greater than 0.5 mm in depth. Mean epithelial ingrowth at the time of retreatment was , and after retreatment, it was at 6 months and at 12 months. There was a significant increase in epithelial ingrowth after surgery at all follow-ups (two-way ANOVA, P 0.01). At the time of retreatment, only 8.5% of eyes (5 of 59) had epithelial ingrowth, but after retreatment, 32% of eyes (16 of 50) at 6 months and 31% (17 of 55) at 12 months had epithelial ingrowth. The most common sites for epithelial ingrowth were temporal and inferior. Epithelial ingrowth was always a peripheral disorder, was never deeper than 1.5 mm, and did not affect visual acuity or corneal astigmatism. Corneal flap melt or necrosis of the flap edge was observed in one eye (1 of 59, 1.7%) before retreatment. However, flap melting was present in 8% of eyes (4 of 50) at 6 months and 10.9% (6 of 55) at 12 months after retreatment. In these eyes, the flap melting developed on an epithelial ingrowth area, and a significant relationship was found between flap melting and epithelial ingrowth (Fisher test, P 0.001). Flap meltings were usually very small and progressed very slowly, although one eye (1.8%) showed a more rapid progression with greater flap melt (approximately 1 mm) at 12 months (Fig 7). Because the flap melting appeared on the peripheral flap edge, visual acuity and corneal astigmatism were not affected. Thirty-nine percent of patients (23 of 58) reported night halos before retreatment. However, after retreatment, night halos decreased significantly to 26% (14 of 54) at 3 months (McNemar test, P 0.038), 16.3% (8 of 49) at 6 months (P 0.003), and 22% (12 of 55) at 12 months (P 0.038). Fifty-seven percent of patients (34 of 59) reported starbursts at night at the time of retreatment. After retreatment, starbursts were reported by 53.7% of patients (29 of 54) at 3 months, 42% (21 of 50) at 6 months, and 32.7% (18 of 55) at 12 months. There was a significant decrease in starbursts at 12 months after retreatment (McNemar test, P 0.010). At 12 months after retreatment, those eyes with 5.5- or 6-mm ablation diameters had lower incidence of halos (8.4% and 16%, respectively) than those with 5 mm (50%) (chi-square test 7.45, P 0.024). No relationship was found between starbursts and ablation diameters (chi-square test 3.03, P at 12 months). Decentration of ablation was calculated as the distance between the center of the laser ablation and that of the visual axis using videokeratography. 11 The decentration values before and 12 months after LASIK retreatment are shown in Figure 8. There was a significant improvement in decentration after retreatment (Wilcoxon test, P 0.01). The relationship between decentration and halos was not significant (Mann Whitney test, P 0.107). No patient had central islands develop before or after retreatment. Subjective Data Sixty percent of patients said that they were satisfied with the result after the primary LASIK procedure, and 60% said that they would have LASIK again. One year after retreatment, 100% of patients were satisfied with the final result, and all patients would have surgery again. Discussion Refractive correction of high myopia is controversial, and at this time, there is not acompletely satisfactory surgical procedure for its correction Recently, excimer laserassisted keratomileusis has generated high expectations among refractive surgeons. 3 6 Excimer lasers have been used to remove tissue, both from the cap, as in traditional keratomileusis (Buratto technique), 23 and from the stromal bed, as in the in situ technique (LASIK). 24 Figure 8. Percentage of eyes according to decentration before and 12 months after laser in situ keratomileusis retreatment. The numbers in parentheses indicate number of eyes. 25

6 Ophthalmology Volume 106, Number 1, January 1999 LASIK involves lifting a corneal flap with a microkeratome and then ablating the stromal bed with an excimer laser. 1,2 Preliminary studies found that LASIK offers good results for moderate and high myopia, although clinical data are still limited. 1 6,8 Concerning complications after LASIK, limited information is also available. Undercorrections, overcorrections, flap displacement, interface debris, epithelial ingrowth, flap melting, keratitis, and irregular astigmatism are complicationsreportedafterthisprocedure. 1 8 Undercorrectionisthe most common complication, and undercorrections greater than 1.00 Dhave been reported in 11.3% to 59% of cases. 1 6,8 Undercorrections may be managed either by performing radial keratotomy or by lifting the flap and performing another laser ablation 3to 6months after surgery, 9,10 although limited information is available on these techniques. 10 The aim of this study was to evaluate the effectiveness, predictability, and safety of LASIK retreatment for correcting residual myopia by lifting the flap and reablating the stromal bed. Uncorrected visual acuity is the main criterion used to assess the effectiveness of arefractive procedure. 25 Our study shows an improvement in UCVA after LASIK retreatment. Twelve months after retreatment, 61.8% of eyes had aucva of 0.5 (20/40) or better. This result is clearly betterthaninourownseries 6 ofsingle-lasikpatientswith high myopia ( 8.00 D), in which 46.4% of the eyes had a visual acuity greater than or equal to months after surgery. After reoperation, BCVA improved by half a line (0.054 at 12 months) over the values before retreatment. In addition, BCVA also improved after the primary LASIK procedure (0.03) in such a way that the global improvement in BCVA is nearly one line over the values before the primary LASIK procedure. These results are similar to those reported after single-lasik for high myopia. 1,5,6 Improved visual acuity is common with other refractive surgery methods, 21,22 and it is the result of an enlarged retinal image. 26 Concerning predictability, the mean refraction after retreatment was not as good as that obtained in eyes with only one LASIK procedure for high myopia (mean refraction 6 months after retreatment D, and 6 months after single-lasik D 6 ). At 6 months after retreatment, 82% of eyes were within 1.00 D of emmetropia and 81.8% at 12 months. This is a better result than in eyes that underwent only one LASIK for correcting myopia greater than 8.00 D 6 (in which from 46% 72% were within 1.00 D 6 months after surgery), but it is a poorer result than in eyes with only one LASIK procedure for correcting myopia lower than 6.00 D 8,27 (from 93% 94.4% of eyes were within 1.00 D 6 months after surgery). Both the original refraction before the primary LASIK procedure and the preretreatment refraction served as indicators of potential successful refractive outcome after reoperation. Those eyes with an original refraction from to D were more undercorrected after retreatment than those with an original refraction from 8.00 to D. In addition, the higher the myopia preretreatment, the higher the myopia after reoperation. Those eyes with 5.0-mm ablation diameter during LASIK enhancement were also more undercorrected than those with wider ablations. Conversely, no significant differences were found in postretreatment refraction between eyes operated on at 3 months after the primary LASIK and those operated on at 6 months. Therefore, the LASIK algorithms used in this study should be modified, taking into account, at least, the influence of the original and the preretreatment refractions and also the ablation diameter used. In terms of stability, our study shows a regression of effect (0.21 D) between 3 and 6 months after retreatment and also between 6 and 12 months (0.17 D). For single- LASIK patients, 6 amean regression of 0.15 Dwas found between 3 and 6 months after surgery for preoperative myopia from 8 to 12 D and 0.38 D for preoperative myopia from 12 to 16 D, these results being similar to ours. The regression after retreatment was neither related to the myopic groups before the initial treatment nor to the preretreatment refraction. Pallikaris and Siganos 1 reported that postoperative refractive astigmatism is minimally influenced by the surgical creation of a corneal flap in LASIK. In this study, no differences were found between refractive astigmatism before and after retreatment in the spherical ablation group, proving that lifting the corneal flap does not affect refractive astigmatism. In the astigmatic ablation group, refractive astigmatism decreased after retreatment, suggesting that LASIK retreatment may also be useful for correcting residual astigmatism. Somestudies 6,28 reportedconsiderableearlycornealflattening after LASIK followed by corneal steepening that decreases with time. This corneal steepening was related to preoperative myopia and to postoperative regression. Our keratographic results also showed a marked early flattening after retreatment followed by a significant corneal steepening of minor magnitude. The corneal steepening after LASIK retreatment (0.15 D from 3 6 months) was lower than that reported after single-lasik (0.23 D from 3 6 months). 6 Our keratographic study also found astrong relationship between achieved correction and achieved corneal flattening. This allows us to predict achieved correction based on the induced corneal flattening. Moreover, a significant relationship was found between regression of refractive effect and postretreatment corneal steepening between the third and sixth month. This finding suggests that regression of effect is caused by the postoperative corneal steepening, at least partially, because it was previously reported after single-lasik. 6 In our main series concerning single-lasik, 6 asignificant increase in corneal thickness was observed between 1 and 3 months after surgery; thereafter, corneal thickness remained stable. In this study, a significant increase in corneal thickness was also present from 3 to 6 months with no change thereafter. These findings suggest that some changes are present in the corneal epithelium, interface, or stroma. Recently, Arbelaez and coauthors 27 reported arelationship between regression after LASIK and epithelial hyperplasia. Several complications have been reported after LASIK. Undercorrectionisthemostcommoncomplication, 1 6,8 and in our whole group of 393 LASIK procedures, 17.5% of 26

7 Pérez Santonja et al Retreatment after LASIK eyes were undercorrected by 1.00 D or more at 3 or 6 months after surgery. After retreatment, an undercorrection greater than 1.00 D was found in 14% of eyes at 6 months and 18.1% at 12 months. Therefore, undercorrections were more common after single-lasik than after LASIK retreatment if we compare the first 6 months. Salah and coauthors 8 reported that 5.6% of eyes were overcorrected more than 2.10 D after single-lasik, and Pé rez Santonja and coauthors 6 found an overcorrection greater than 2.50 D in 8.6% of eyes. After LASIK retreatment, only 4% of eyes at 6 months and 0% at 12 months were overcorrected more than 1.00 D. Haze or scarring in the interface is minimal or absent both after LASIK 1,5,6,8 and after LASIK retreatment. Dot remnants in the interface are rare after LASIK 5,6 and also after LASIK enhancement. Dot remnants have no clinical significance and are avoided with careful cleaning during flap replacement. Fine wrinkles in the flap have been reported in 3.4% of eyesaftersingle-lasik, 6 andtheywererelatedtoflapfolds during surgery. 6,29 Inthis study, fine wrinkles were present in 5.4% of eyes at 12 months after retreatment. The wrinkles did not affect visual acuity and remained unchanged during follow-up. Epithelium in the interface is not a rare condition after LASIK (2% 5 8.8% 6 ), although it is usually limited to the edge of the flap, does not usually progress, and does not affect visual acuity. However, epithelial ingrowth may lead to amore serious complication, flap melting or necrosis of the flap. 6 Our results show that epithelial ingrowth worsens after LASIK retreatment. We believe that this increase in epithelial ingrowth is related to surgical technique. The epithelium debridement and the interface dissection with a flat spatula create an irregular epithelial border with epithelial defects, which facilitates epithelial ingrowth beneath the flap edge after surgery. Although the proper management of epithelial ingrowth is still poorly understood, we believe that some measures might decrease its incidence after LASIK enhancement, such as a more meticulous surgical technique with a linear epithelial dissection without epithelial defects, a copious irrigation of the interface for removing all implanted epithelial cells, and a strong adhesion with a minimal gap between the flap edge and the stromal bed to block epithelial ingrowth. Flap melting has been reported in 5.7% of eyes after single-lasik. 6 Flap melting usually develops over an area of epithelial ingrowth and usually shows no progression. As epithelial ingrowth, it is a peripheral disorder and does not affect visual acuity. In our study, flap melting was only observed in one eye (1.7%) before retreatment; however, it was present in 10.9% of eyes at 12 months after retreatment. These meltings were usually very small and did not progress, although one eye showed a more rapid progression. Visual acuity was not affected in any case. A relationship was also found between flap melting and epithelial ingrowth as reported for single-lasik. Therefore, the same strategies described to decrease epithelial ingrowth would be useful to prevent flap melting. Decentration greater than 0.75 mm was reported in 6.5% of eyes after single-lasik. 6 Inthe current study, 12.2% of eyes had a decentration greater than 0.75 mm at the time of retreatment. However, after retreatment, only 1.8% of eyes were decentered by more than 0.75 mm. Therefore, a remarkable improvement in decentration is observed after LASIK enhancement. Night halos and starbursts improved significantly after retreatment. At 12 months, 22% and 32.7% of patients reportednighthalosandstarbursts,respectively,andsimilar results were found 6months after single-lasik. 5,6 These night-vision symptoms improved with time, and the night halos were related to small ablation diameters. In conclusion, LASIK retreatment by lifting the flap and reablating the stromal bed is an effective and predictable procedure for correcting residual myopia after LASIK. By taking into account both the original refraction before the primary LASIK and the preretreatment refraction, we could improve the predictability of LASIK retreatment. Refraction was stable after 3 months with only minor changes. Although vision-threatening complications are rare after LASIK enhancement, epithelial ingrowth and flap melting were more common than before retreatment. On the contrary, LASIK retreatment improved decentration and night-vision problems. Although LASIK retreatment is a safe procedure, a more meticulous surgical technique with less epithelial damage would improve its safety. References 1. Pallikaris IG, Siganos DS. Excimer laser in situ keratomileusis and photorefractive keratectomy for correction of high myopia. J Refract Corneal Surg 1994;10: Bas AM, Onnis R. Excimer laser in situ keratomileusis for myopia. J Refract Surg 1995;11(3 Suppl):S229 S Fiander DC, Tayfour F. Excimer laser in situ keratomileusis in 124 myopic eyes. J Refract Surg 1995;11(3 Suppl):S234 S Kremer FB, Dufek M. Excimer laser in situ keratomileusis. J Refract Surg 1995;11(3 Suppl):S244 S Güell JL, Muller A. Laser in situ keratomileusis (LASIK) for myopia from 7 to 18 diopters. J Refract Surg 1996;12: Pérez Santonja JJ, Bellot J, Claramonte P, et al. Laser in situ keratomileusis to correct high myopia. J Cataract Refract Surg 1997;23: Pérez Santonja JJ, Sakla HF, Abad JL, et al. Nocardial keratitis after laser in situ keratomileusis. J Refract Surg 1997;13: Salah T, Waring GO 3rd, el Maghraby A, et al. Excimer laser in situ keratomileusis under a corneal flap for myopia of 2 to 20 diopters. Am J Ophthalmol 1996;121: Hollis S, Rozakis GW. Complications, special cases and management. In: Rozakis GW, ed. Refractive Lamellar Keratoplasty. Thorofare, NJ: SLACK Inc., 1994; Machat JJ, ed. Excimer laser refractive surgery: practice and principles. Thorofare, NJ: SLACK, 1996; Cavanaugh TB, Durrie DS, Riedel SM, et al. Topographical analysis of the centration of excimer laser photorefractive keratectomy. J Cataract Refract Surg 1993;19(Suppl): Bas AM, Nano HD Jr. In situ myopic keratomileusis, results in 30 eyes at 15 months. Refract Corneal Surg 1991;7:

8 Ophthalmology Volume 106, Number 1, January Kim WJ, Lee JH. Long-term results of myopic epikeratoplasty. J Cataract Refract Surg 1993;19: Goosey JD, Prager TC, Goosey CB, Martin DI. One year follow-up of epikeratoplasty for myopia. J Cataract Refract Surg 1990;16: Werblin TP, Patel AS, Barraquer JI. Initial human experience with Permalens myopic hydrogel intracorneal lens implants. Refract Corneal Surg 1992;8: Barraquer C, Cavelier C, Mejía LF. Incidence of retinal detachment following clear-lens extraction in myopic patients. Retrospective analysis. Arch Ophthalmol 1994;112: Colin J, Robinet A. Clear lensectomy and implantation of low-power posterior chamber intraocular lens for the correction of high myopia. Ophthalmology 1994;101: Maxwell WA. Myopic keratomileusis: initial results and myopic keratomileusis combined with other procedures. J Cataract Refract Surg 1987;13: Keratophakia and keratomileusis: safety and effectiveness. American Academy of Ophthalmology. Ophthalmology 1992; 99: Heitzmann J, Binder PS, Kassar BS, Nordan LT. The correction of high myopia using the excimer laser. Arch Ophthalmol 1993;111: Fechner PU, Strobel J, Wicchmann W. Correction of myopia by implantation of a concave Worst-iris claw lens into phakic eyes. Refract Corneal Surg 1991;7: Pérez Santonja JJ, Bueno JL, Zato MA. Surgical correction of high myopia in phakic eyes with Worst Fechner myopia intraocular lenses. J Refract Surg 1997;13: Buratto L, Ferrari M, Rama P. Excimer laser intrastromal keratomileusis. Am J Ophthalmol 1992;113: Pallikaris IG, Papatzanaki ME, Stathi EZ, et al. Laser in situ keratomileusis. Lasers Surg Med 1990;10: Lynn MJ, Waring GO III, Carter JT. Combining refractive error and uncorrected visual acuity to assess the effectiveness of refractive corneal surgery. Refract Corneal Surg 1990;6: Applegate RA, Howland HC. Magnification and visual acuity in refractive surgery. Arch Ophthalmol 1993;111: Arbelaez MC, Pérez-Santonja JJ, Ismail MM, et al. Automated lamellar keratoplasty (ALK) and laser in situ keratomileusis (LASIK). In: Serdarevic ON, ed. Refractive Surgery: Current Techniques and Management. New York: Igaku-Shoin, 1997; chap Pallikaris IG, Siganos DS. Laser in situ keratomileusis to treat myopia: early experience. J Cataract Refract Surg 1997;23: Gimbel HV, Basti S, Kaye GB, Ferensowicz M. Experience during the learning curve of laser in situ keratomileusis. J Cataract Refract Surg 1996;22: Discussion by Mark E. Whitten, MD The excimer laser has been found to be a safe and effective tool for the correction of myopia. Haze and/or scarring of the cornea occurred as correction of high myopia was attempted with surface ablation. Laser in situ keratomileusis (LASIK) has been offered as an alternative to surface photorefractive keratectomy (PRK) for the correction of high myopia. 1,2 The current study examines the effectiveness, predictability, and complications of retreatment of LASIK patients. It is interesting to note in the study that only 15% of 393 eyes with high myopia greater than 8.00 diopters (D) required retreatment. This low retreatment rate is particularly encouraging in this highly myopic group. The retreatment was shown to be effective and predictable with significant improvement in uncorrected visual acuity and best-corrected visual acuity. They found that the higher the preretreatment myopia, the greater the myopia after retreatment. A correlation is established between regression and increased corneal steepening and thickening. They also found retreating astigmatism was very effective while there was no effect on astigmatism if the flap was lifted to only retreat residual myopia. Reviewing their complications, it is gratifying to note that lasting overcorrection did not occur. Haze or scarring was not an issue. Visually significant folds in the flap were not present after lifting. Night halos and starbursts actually improved with retreatment and enlargement of optical zones. The incidence of epithelial ingrowth (31%) in the retreatment group is disturbing. The rate of flap melting was 10.9%. The authors note that visual acuity was not affected by these occurrences. They believe this increase in epithelial ingrowth From the Department of Keratorefractive Service, Washington National Eye Center, Washington Hospital Center, 8218 Wisconsin Avenue, Suite #104, Bethesda, MD over that found in primary LASIK was related to their surgical technique. A procedure should be performed only if the benefits outweigh the risks. The authors have clearly shown that the benefits of retreatment are significant with greatly improved visual acuity and lessening of irritating night halos and starbursts. A flap melting rate of 10.9% with an associated epithelial ingrowth rate of 31% is concerning. Epithelial ingrowth should only be treated when vision is threatened or when flap melting occurs. Vision was not threatened in these cases. Flap melting does represent a real risk to the patient for vision loss. Patients with epithelial ingrowth need to be watched carefully to prove that flap melting will not occur. If the authors find that this rate of ingrowth cannot be modified by a change in technique, they may wish to substitute recutting the flaps 4 months after the primary LASIK so that the incidence of epithelial ingrowth then would approach that of the primary procedure. This excellent retrospective study allows us to hope that a prospective study will show improved predictability based on preretreatment myopia, pachymetry, and topography. Videotape recording of retreatment cases may help establish better techniques to avoid epithelial ingrowth. As the development of new procedures moves from the traditional academic setting to private practitioners, it becomes incumbent on us all to study our patients to improve our outcomes. With thousands of patients undergoing PRK, LASIK, and retreatment, it would be disappointing to lose the opportunity to analyze these patients in a meaningful way. References 1. Machat JJ. Excimer laser refractive surgery. Practice and Principles. Thorofare: Slack Inc, Kremer FB, Dufek M. Excimer laser in situ keratomileusis. J Refract Surg 1995;11:S244 S

Original Articles. Laser in situ Keratomileusis to Correct Residual Myopia After Cataract Surgery

Original Articles. Laser in situ Keratomileusis to Correct Residual Myopia After Cataract Surgery Original Articles Laser in situ Keratomileusis to Correct Residual Myopia After Cataract Surgery Maria J. Ayala, MD, PhD; Juan J. Pérez-Santonja, MD; Alberto Artola, MD, PhD; Pascual Claramonte, MD; Jorge

More information

All surgical procedures have the potential for

All surgical procedures have the potential for Laser in situ Keratomileusis Retreatment for Residual Myopia and Astigmatism Khaled M. Rashad, MD ABSTRACT PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK)

More information

Retreatment by Lifting the Original Laser in Situ Keratomileusis Flap after Eleven Years

Retreatment by Lifting the Original Laser in Situ Keratomileusis Flap after Eleven Years Retreatment by Lifting the Original Laser in Situ Keratomileusis Flap after Eleven Years Hassan Hashemi, MD 1,2 Mehrdad Mohammadpour, MD 3 Abstract Purpose: To describe a case of successful laser in situ

More information

TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM

TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM 1 BoydVision TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM Risks and Side Effects... 2 Risks Specific to PRK... 3 Risks Specific to LASIK... 4 Patient Statement of Consent... 5 Consent for Laser Eye

More information

Overview of Refractive Surgery

Overview of Refractive Surgery Overview of Refractive Surgery Michael N. Wiggins, MD Assistant Professor, College of Health Related Professions and College of Medicine, Department of Ophthalmology Jones Eye Institute University of Arkansas

More information

Central Islands After LASIK Detected by Corneal Topography

Central Islands After LASIK Detected by Corneal Topography Korean J Ophthalmol Vol. 15:8-14, 2001 Central Islands After LASIK Detected by Corneal Topography Jin Seok Lee, MD, Choun-Ki Joo, MD Department of Ophthalmology, Kangnam St. Mary s Hospital, College of

More information

Comparison of Two Procedures: Photorefractive Keratectomy Versus Laser In Situ Keratomileusis for Low to Moderate Myopia

Comparison of Two Procedures: Photorefractive Keratectomy Versus Laser In Situ Keratomileusis for Low to Moderate Myopia Comparison of Two Procedures: Photorefractive Keratectomy Versus Laser In Situ Keratomileusis for Low to Moderate Myopia Jae Bum Lee, Jae Sung Kim, Chul-Myong Choe, Gong Je Seong and Eung Kweon Kim Institute

More information

Consent for LASIK (Laser In Situ Keratomileusis) Retreatment

Consent for LASIK (Laser In Situ Keratomileusis) Retreatment Consent for LASIK (Laser In Situ Keratomileusis) Retreatment Please read the following consent form very carefully. Please initial at the bottom of each page where indicated. Do not sign this form unless

More information

ALTERNATIVES TO LASIK

ALTERNATIVES TO LASIK EYE PHYSICIANS OF NORTH HOUSTON 845 FM 1960 WEST, SUITE 101, Houston, TX 77090 Office: 281 893 1760 Fax: 281 893 4037 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION This information

More information

Keratorefractive Surgery for Post-Cataract Refractive Surprise. Moataz El Sawy

Keratorefractive Surgery for Post-Cataract Refractive Surprise. Moataz El Sawy Keratorefractive Surgery for Post-Cataract Refractive Surprise Moataz El Sawy Departmentof Ophthalmology, Faculty of Medicine,MenoufiyaUniversity, Egypt mfelsawy@yahoo.co.uk Abstract: Purpose: To evaluate

More information

Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery

Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery Farhad Hafezi, MD; Michael Mrochen, PhD; Franz Fankhauser II, MD; Theo Seiler, MD, PhD

More information

Topographically-guided Laser In Situ Keratomileusis to Treat Corneal Irregularities

Topographically-guided Laser In Situ Keratomileusis to Treat Corneal Irregularities Topographically-guided Laser In Situ Keratomileusis to Treat Corneal Irregularities Michael C. Knorz, MD, Bettina Jendritza, MD Objective: To evaluate the predictability and safety of topographically guided

More information

The Efficacy of Multi-Zone Cross-Cylinder Method for Astigmatism Correction

The Efficacy of Multi-Zone Cross-Cylinder Method for Astigmatism Correction Korean J Ophthalmol Vol. 18:29-34, 2004 The Efficacy of Multi-Zone Cross-Cylinder Method for Astigmatism Correction Seong Joo Shin, MD, Hae Young Lee, MD Department of Ophthalmology, Seoul Adventist Hospital,

More information

Case Reports Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking

Case Reports Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking Case Reports Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking Kay Lam, MD, Dan B. Rootman, MSc, Alejandro Lichtinger, and David S. Rootman, MD, FRCSC Author affiliations:

More information

Risks and Limitations of LASIK Procedure

Risks and Limitations of LASIK Procedure Drs. Fine, Hoffman & Packer, LLC 1550 Oak Street, Suite #5 Eugene, OR 97401 541-687-2110 From Drs. Fine, Hoffman, & Packer Risks and Limitations of LASIK Procedure Infection, serious injury, or even death,

More information

Comparison of Residual Stromal Bed Thickness and Flap Thickness at LASIK and Post-LASIK Enhancement in Femtosecond Laser-Created Flaps

Comparison of Residual Stromal Bed Thickness and Flap Thickness at LASIK and Post-LASIK Enhancement in Femtosecond Laser-Created Flaps Comparison of Residual Stromal Bed Thickness and Flap Thickness at LASIK and Post-LASIK Enhancement in Femtosecond Laser-Created Flaps Lingo Y. Lai, MD William G. Zeh, MD Clark L. Springs, MD The authors

More information

LASIK SURGERY IN AL- NASSIRYA CITY A CLINICOSTATISTICAL STUDY

LASIK SURGERY IN AL- NASSIRYA CITY A CLINICOSTATISTICAL STUDY Thi-Qar Medical Journal (TQMJ): Vol(4) No(4):1(14-21) SUMMARY: LASIK SURGERY IN AL- NASSIRYA CITY A CLINICOSTATISTICAL STUDY Dr. Ali Jawad AL- Gidis (M.B.Ch.B., D.O., F.I.C.O.)* Background: LASIK which

More information

Incidence and Associations of Retreatment After LASIK

Incidence and Associations of Retreatment After LASIK Incidence and Associations of Retreatment After LASIK Peter S. Hersh, MD, 1,2,3 Kristen L. Fry, OD,MS, 1,2,3 Douglas S. Bishop, BA 3 Purpose: To determine the incidence and risk factors for laser in situ

More information

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) Lasik Center 2445 Broadway Quincy, IL 62301 217-222-8800 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION This information is being provided to you so that you can make an informed

More information

INFORMED CONSENT TO HAVE LASIK

INFORMED CONSENT TO HAVE LASIK A Division of Scott & Christie and Associates INFORMED CONSENT TO HAVE LASIK This information is to help you make an informed decision about having Laser Assisted Intrastromal Keratomileusis (LASIK), an

More information

Treatment of Myopia and Myopic Astigmatism by Customized Laser In Situ Keratomileusis Based on Corneal Topography

Treatment of Myopia and Myopic Astigmatism by Customized Laser In Situ Keratomileusis Based on Corneal Topography Treatment of Myopia and Myopic Astigmatism by Customized Laser In Situ Keratomileusis Based on Corneal Topography Michael C. Knorz, MD, 1 Thomas Neuhann, MD 2 Objective: To evaluate the predictability,

More information

Enhancement outcomes after photorefractive keratectomy and laser in situ keratomileusis using topographically guided excimer laser photoablation

Enhancement outcomes after photorefractive keratectomy and laser in situ keratomileusis using topographically guided excimer laser photoablation J CATARACT REFRACT SURG - VOL 31, DECEMBER 2005 Enhancement outcomes after photorefractive keratectomy and laser in situ keratomileusis using topographically guided excimer laser photoablation Leopoldo

More information

LASIK EPILASIK FEMTOSECOND LASER. Advantages

LASIK EPILASIK FEMTOSECOND LASER. Advantages LASIK EPILASIK FEMTOSECOND LASER Advantages There are many advantages to having laser vision correction. Laser vision correction gives most patients the freedom to enjoy their normal daily activities without

More information

Long-Term Outcomes of Flap Amputation After LASIK

Long-Term Outcomes of Flap Amputation After LASIK Long-Term Outcomes of Flap Amputation After LASIK Priyanka Chhadva BS, Florence Cabot MD, Anat Galor MD, Sonia H. Yoo MD Bascom Palmer Eye Institute, University of Miami Miller School of Medicine Miami

More information

Adjustable Refractive Surgery: 6-mm Artisan Lens Plus Laser In Situ Keratomileusis for the Correction of High Myopia

Adjustable Refractive Surgery: 6-mm Artisan Lens Plus Laser In Situ Keratomileusis for the Correction of High Myopia Adjustable Refractive Surgery: 6-mm Artisan Lens Plus Laser In Situ Keratomileusis for the Correction of High Myopia José L.Güell, MD, Mercedes Vázquez, MD, O. Gris, MD Purpose: To evaluate efficacy, predictability,

More information

INFORMED CONSENT FOR LASIK SURGERY

INFORMED CONSENT FOR LASIK SURGERY IMPORTANT: READ EVERY WORD! This information is to help you make an informed decision about having laser assisted in-situ keratomileusis (LASIK) surgery to treat your nearsightedness, farsightedness and/or

More information

The pinnacle of refractive performance.

The pinnacle of refractive performance. Introducing! The pinnacle of refractive performance. REFRACTIVE SURGERY sets a new standard in LASIK outcomes More than 98% of patients would choose it again. 1 It even outperformed glasses and contacts

More information

Laser-assisted In Situ Keratomileusis for Correction of Astigmatism and Increasing Contact Lens Tolerance after Penetrating Keratoplasty

Laser-assisted In Situ Keratomileusis for Correction of Astigmatism and Increasing Contact Lens Tolerance after Penetrating Keratoplasty pissn: -9 eissn: 9-9 Korean J Ophthalmol ;(5):59- http://dx.doi.org/./kjo...5.59 Original Article Laser-assisted In Situ Keratomileusis for Correction of Astigmatism and Increasing Contact Lens Tolerance

More information

Management of Epithelial Ingrowth after LASIK. Helen K. Wu, MD New England Eye Center Tufts University School of Medicine Boston, MA

Management of Epithelial Ingrowth after LASIK. Helen K. Wu, MD New England Eye Center Tufts University School of Medicine Boston, MA Management of Epithelial Ingrowth after LASIK Helen K. Wu, MD New England Eye Center Tufts University School of Medicine Boston, MA Acknowledgements IOP Ophthalmics Staar Surgical Case Presentation 46

More information

Intraoperative Management of Partial Flap during LASIK

Intraoperative Management of Partial Flap during LASIK Intraoperative Management of Partial Flap during LASIK A Small Case Series Report Vikentia J. Katsanevaki, MD, PhD, Nikolaos S. Tsiklis, MD, Nikolaos I. Astyrakakis, OD, Ioannis G. Pallikaris, MD, PhD

More information

EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH www.ejpmr.com

EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH www.ejpmr.com ejpmr, 2015,2(3), 436-440 EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH www.ejpmr.com Tumram et al. SJIF Impact Factor 2.026 Research Article ISSN 3294-3211 EJPMR CLINICAL OUTCOME OF TORIC IOL

More information

LASIK. Complications. Customized Ablations. Photorefractive Keratectomy. Femtosecond Keratome for LASIK. Cornea Resculpted

LASIK. Complications. Customized Ablations. Photorefractive Keratectomy. Femtosecond Keratome for LASIK. Cornea Resculpted Refractive Surgery: Which Procedure for Which Patient? David R. Hardten, M.D. Minneapolis, Minnesota Have done research, consulting, or speaking for: Alcon, Allergan, AMO, Bausch & Lomb, Inspire, Medtronic,

More information

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE TECHNOLOGY

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE TECHNOLOGY EYE PHYSICIANS OF NORTH HOUSTON 845 FM 1960 WEST, SUITE 101, Houston, TX 77090 Office: 281 893 1760 Fax: 281 893 4037 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE

More information

IntraLase and LASIK: Risks and Complications

IntraLase and LASIK: Risks and Complications No surgery is without risks and possible complications and LASIK is no different in that respect. At Trusted LASIK Surgeons, we believe patients can minimize these risks by selecting a highly qualified

More information

KERATOCONUS IS A BILATERAL, ASYMMETRIC, CHRONIC,

KERATOCONUS IS A BILATERAL, ASYMMETRIC, CHRONIC, Comparison of and Intacs for Keratoconus and Post-LASIK Ectasia MUNISH SHARMA, MD, AND BRIAN S. BOXER WACHLER, MD PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment

More information

significantly different from that of sequential treatments. Methods: Data were obtained from 254 consecutive patients that were

significantly different from that of sequential treatments. Methods: Data were obtained from 254 consecutive patients that were PROSPECTIVE, RANDOMIZED COMPARISON OF SIMULTANEOUS AND SEQUENTIAL BILATERAL LASIK FOR THE CORRECTION OF MYOPIA* BY G. 0. Waring III, MD, FACS, FRCOPHTH, J. D. Carr, MD, MA, FRCOPHTH, R. D. Stulting, MD,

More information

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) Drs. Fine, Hoffman and Packer, LLC PHYSICIANS AND SURGEONS, EyeMDs OPHTHALMOLOGY I. Howard Fine, M.D. Richard S. Hoffman, M.D. Mark Packer, M.D. 1550 Oak Street, Suite 5 www.finemd.com Eugene, OR 97401-7701

More information

REFRACTIVE ERROR AND SURGERIES IN THE UNITED STATES

REFRACTIVE ERROR AND SURGERIES IN THE UNITED STATES Introduction REFRACTIVE ERROR AND SURGERIES IN THE UNITED STATES 150 million wear eyeglasses or contact lenses 2.3 million refractive surgeries performed between 1995 and 2001 Introduction REFRACTIVE SURGERY:

More information

Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology

Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology INDICATIONS AND PROCEDURE This information is being provided to

More information

Flap striae after LASIK can be treated successfully

Flap striae after LASIK can be treated successfully Flap striae after LASIK can be treated successfully Following a few key rules leads to positive outcomes, surgeons say. by Insun Lee, Miten Vasa, and Emil W. Chynn, MD Special to OCULAR SURGERY NEWS LASIK

More information

How To Implant A Keraring

How To Implant A Keraring Corneal Remodeling Using the Keraring A variety of thicknesses, arc lengths, and optical zone sizes allows tailoring of the procedure to the individual patient. BY DOMINIQUE PIETRINI, MD; AND TONY GUEDJ

More information

Life Science Journal 2014;11(9) http://www.lifesciencesite.com. Cross cylinder Challenging cases and their resultswith Nidek Quest (EC-5000)

Life Science Journal 2014;11(9) http://www.lifesciencesite.com. Cross cylinder Challenging cases and their resultswith Nidek Quest (EC-5000) Cross cylinder Challenging cases and their resultswith Nidek Quest (EC-5000) Gamal Mostafa Abo El Maaty, Mohamed Elmoddather, Mahmoud Ibrahem Ghazy, Mohamed Al-Taher Ophthalmology Department, Faculty of

More information

refractive surgery a closer look

refractive surgery a closer look 2011-2012 refractive surgery a closer look How the eye works Light rays enter the eye through the clear cornea, pupil and lens. These light rays are focused directly onto the retina, the light-sensitive

More information

WAKE FOREST BAPTIST HEALTH EYE CENTER. LASIK Consent Form

WAKE FOREST BAPTIST HEALTH EYE CENTER. LASIK Consent Form 1 WAKE FOREST BAPTIST HEALTH EYE CENTER LASIK Consent Form 1. GENERAL INFORMATION The following information is intended to help you make an informed decision about having Laser In-Situ Keratomileusis (LASIK).

More information

Laser in situ keratomileusis (LASIK) has been. Retreatment of Hyperopia After Primary Hyperopic LASIK REPORTS

Laser in situ keratomileusis (LASIK) has been. Retreatment of Hyperopia After Primary Hyperopic LASIK REPORTS REPORTS Retreatment of Hyperopia After Primary Hyperopic LASIK Julio Ortega-Usobiaga, MD, PhD; Rosario Cobo-Soriano, MD, PhD; Fernando Llovet, MD; Francisco Ramos, MD; Jaime Beltrán, MD; Julio Baviera-Sabater,

More information

Ectasia after laser in-situ keratomileusis (LASIK)

Ectasia after laser in-situ keratomileusis (LASIK) Ectasia after laser in-situ keratomileusis (LASIK) 長 庚 紀 念 醫 院 眼 科 蕭 靜 熹 Post-LASIK ectasia A rare complication of LASIK Manhattan jury awarded a former investment banker a record $7.25 million for post-lasik

More information

VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment)

VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment) CustomVue Advantage Patient Information Sheet VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment) Statements

More information

Corneal ectasia induced by laser in situ keratomileusis. Ioannis G. Pallikaris, MD, PhD, George D. Kymionis, MD, PhD, Nikolaos I.

Corneal ectasia induced by laser in situ keratomileusis. Ioannis G. Pallikaris, MD, PhD, George D. Kymionis, MD, PhD, Nikolaos I. Corneal ectasia induced by laser in situ keratomileusis Ioannis G. Pallikaris, D, PhD, George D. Kymionis, D, PhD, Nikolaos I. Astyrakakis, OD ABSTRACT Purpose: To identify factors that can lead to corneal

More information

Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State

Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State University Columbus, Ohio Refractive Errors Myopia (nearsightedness)

More information

Post LASIK Ectasia. Examination: Gina M. Rogers, MD and Kenneth M. Goins, MD

Post LASIK Ectasia. Examination: Gina M. Rogers, MD and Kenneth M. Goins, MD Post LASIK Ectasia Gina M. Rogers, MD and Kenneth M. Goins, MD October 6, 2012 Chief Complaint: Decreasing vision after laser- assisted in- situ keratomileusis (LASIK) History of Present Illness: This

More information

INFORMED CONSENT FOR PHAKIC IMPLANT SURGERY

INFORMED CONSENT FOR PHAKIC IMPLANT SURGERY INFORMED CONSENT FOR PHAKIC IMPLANT SURGERY INTRODUCTION This information is being provided to you so that you can make an informed decision about having eye surgery to reduce or eliminate your nearsightedness.

More information

Effect of Lasik on Endothelial Cell Count in Patients Treated for Myopia

Effect of Lasik on Endothelial Cell Count in Patients Treated for Myopia Original Article Effect of Lasik on Endothelial Cell Count in Patients Treated for Myopia Mirza Jamil Ud din Baig, Khalid Mahmood, Tariq Khan, Zaheer Uddin Aqil Qazi Pak J Ophthalmol 2010, Vol. 26 No.1.....................................................................................................

More information

INTRODUCTION. Trans Am Ophthalmol Soc 2006;104:402-413

INTRODUCTION. Trans Am Ophthalmol Soc 2006;104:402-413 ORBSCAN II ASSISTED INTRAOCULAR LENS POWER CALCULATION FOR CATARACT SURGERY FOLLOWING MYOPIC LASER IN SITU KERATOMILEUSIS (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS) BY Henry Gelender MD ABSTRACT Purpose:

More information

Refractive Surgery. Evolution of Refractive Error Correction

Refractive Surgery. Evolution of Refractive Error Correction Refractive Surgery Techniques that correct for refractive error in the eye have undergone dramatic evolution. The cornea is the easiest place to place a correction, so most techniques have focused on modifying

More information

How To See With An Cl

How To See With An Cl Deciding on the vision correction procedure that s right for you is an important one. The table below provides a general comparison of the major differences between Visian ICL, LASIK and PRK. It is NOT

More information

Comparison of higher-order aberrations after wavefront-guided laser in situ keratomileusis and laser-assisted subepithelial keratectomy

Comparison of higher-order aberrations after wavefront-guided laser in situ keratomileusis and laser-assisted subepithelial keratectomy J CATARACT REFRACT SURG - VOL 32, MAY 2006 Comparison of higher-order aberrations after wavefront-guided laser in situ keratomileusis and laser-assisted subepithelial keratectomy So-Hyang Chung, MD, In

More information

ABLATION-RELATED COMPLICATIONS FOLLOWING

ABLATION-RELATED COMPLICATIONS FOLLOWING Topographically Supported Customized Ablation for the Management of Decentered Laser In Situ Keratomileusis GEORGE D. KYMIONIS, MD, PHD, SOPHIA I. PANAGOPOULOU, BSC, IOANNIS M. ASLANIDES, MD, PHD, SOTIRIS

More information

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement)

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) Mark Packer, M.D. Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) This surgery involves the removal of the natural lens of my eye, even though it is not a cataract. The natural lens

More information

What is Refractive Error?

What is Refractive Error? Currently, about 55% of the civilian pilots in the United States must utilize some form of refractive correction to meet the vision requirements for medical certification. While spectacles are the most

More information

Surgical Advances in Keratoconus. Keratoconus. Innovations in Ophthalmology. New Surgical Advances. Diagnosis of Keratoconus. Scheimpflug imaging

Surgical Advances in Keratoconus. Keratoconus. Innovations in Ophthalmology. New Surgical Advances. Diagnosis of Keratoconus. Scheimpflug imaging Surgical Advances in Keratoconus Keratoconus Ectatic disorder 1 in 1,000 individuals Starts in adolescence & early adulthood Uncertain cause 20% require corneal transplant Innovations in Ophthalmology

More information

Daniel F. Goodman, M.D. 2211 Bush Street, 2nd Floor San Francisco, CA 94115 Phone: 415-474-3333 Fax: 415-474-3939

Daniel F. Goodman, M.D. 2211 Bush Street, 2nd Floor San Francisco, CA 94115 Phone: 415-474-3333 Fax: 415-474-3939 Daniel F. Goodman, M.D. 2211 Bush Street, 2nd Floor San Francisco, CA 94115 Phone: 415-474-3333 Fax: 415-474-3939 INFORMED CONSENT FOR LASIK (LASER IN SITU KERATOMILEUSIS) and PRK (PHOTOREFRACTIVE KERATECTOMY)

More information

INTRACOR. An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the

INTRACOR. An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the INTRACOR An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the 1 Dr Luis Ruiz Presbyopia treatment with INTRACOR Luis

More information

SUB-PROTOCOL Title: Healthcare Performance Measurement & Reporting for LASIK surgery services provided by OPTIMAX Malaysia

SUB-PROTOCOL Title: Healthcare Performance Measurement & Reporting for LASIK surgery services provided by OPTIMAX Malaysia Page 1 of 11 MAIN PROTOCOL Reporting System (HPMRS). Developing healthcare performance measurement and reporting system for purposes of accountability, quality improvement and population health Protocol

More information

Active Cyclotorsion Error Correction During LASIK for Myopia and Myopic Astigmatism With the NIDEK EC-5000 CX III Laser

Active Cyclotorsion Error Correction During LASIK for Myopia and Myopic Astigmatism With the NIDEK EC-5000 CX III Laser Active Cyclotorsion Error Correction During LASIK for Myopia and Myopic Astigmatism With the NIDEK EC-5000 CX III Laser Sudhank Bharti, MD; Harkaran S. Bains ABSTRACT PURPOSE: To investigate the predictability

More information

Dr. Booth received his medical degree from the University of California: San Diego and his bachelor of science from Stanford University.

Dr. Booth received his medical degree from the University of California: San Diego and his bachelor of science from Stanford University. We've developed this handbook to help our patients become better informed about the entire process of laser vision correction. We hope you find it helpful and informative. Dr. Booth received his medical

More information

Cornea and Refractive Surgery Update

Cornea and Refractive Surgery Update Cornea and Refractive Surgery Update Fall 2015 Optometric Education Dinner Sebastian Lesniak MD Matossian Eye Associates Disclosures: None Bio: Anterior Segment and Cornea Surgery Fellowship Wills Eye

More information

Avoiding Serious Corneal Complications of Laser Assisted In Situ Keratomileusis and Photorefractive Keratectomy

Avoiding Serious Corneal Complications of Laser Assisted In Situ Keratomileusis and Photorefractive Keratectomy Avoiding Serious Corneal Complications of Laser Assisted In Situ Keratomileusis and Photorefractive Keratectomy Simon P. Holland, MB, FRCSC, 1,2 Sabong Srivannaboon, MD, 1,3 Dan Z. Reinstein, MD, FRCSC

More information

Bitoric Laser In Situ Keratomileusis for the Correction of Simple Myopic and Mixed Astigmatism

Bitoric Laser In Situ Keratomileusis for the Correction of Simple Myopic and Mixed Astigmatism Bitoric Laser In Situ Keratomileusis for the Correction of Simple Myopic and Mixed Astigmatism Arturo S. Chayet, MD, 1 Miguel Montes, MD, 1 Laura Gómez, MD, 1 Xavier Rodríguez, MD, 1 Nora Robledo, OD,

More information

LASIK: Clinical Results and Their Relationship to Patient Satisfaction

LASIK: Clinical Results and Their Relationship to Patient Satisfaction LASIK: Clinical Results and Their Relationship to Patient Satisfaction Lien Thieu Tat A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Applied Vision

More information

Intended Benefits. Who Is Not Eligible For the Procedure? (Intralase Sub-Bowman s Keratomileusis)

Intended Benefits. Who Is Not Eligible For the Procedure? (Intralase Sub-Bowman s Keratomileusis) PATIENT CONSENT FORM Intralase SBK / WGA SBK (Intralase Sub-Bowman s Keratomileusis) Intralase Sub-Bowman s Keratomileusis (SBK) is a term used to describe a Laser Vision Correction procedure where a laser

More information

Shawn R. Klein, MD Klein & Scannapiego MD PA

Shawn R. Klein, MD Klein & Scannapiego MD PA Shawn R. Klein, MD Klein & Scannapiego MD PA Patient Authorization for Laser Vision Correction Surgery 1. General information The following information is intended to help you make an informed decision

More information

LASIK SURGERY OUTCOMES, VOLUME AND RESOURCES

LASIK SURGERY OUTCOMES, VOLUME AND RESOURCES MOH Information Paper: 2006/17 LASIK SURGERY OUTCOMES, VOLUME AND RESOURCES By Dr. Ganga Ganesan 1 I INTRODUCTION LASIK stands for Laser-Assisted In Situ Keratomileusis and is a surgical procedure that

More information

Effect of Preoperative Keratometric Power on Intraoperative Complications in LASIK in 34,099 Eyes

Effect of Preoperative Keratometric Power on Intraoperative Complications in LASIK in 34,099 Eyes Effect of Preoperative Keratometric Power on Intraoperative Complications in LASIK in 34,099 Eyes J. Carlos Albelda-Vallés, MD; Clara Martin-Reyes, MD; Francisco Ramos, MD; Jaime Beltran, MD; Fernando

More information

XXXII nd Congress of the ESCRS, London, September 13, 2014 Instructional Course # 7. LASIK: basic steps for safety and great results

XXXII nd Congress of the ESCRS, London, September 13, 2014 Instructional Course # 7. LASIK: basic steps for safety and great results XXXII nd Congress of the ESCRS, London, September 13, 2014 Instructional Course # 7 LASIK: basic steps for safety and great results Microkeratomes Jérôme C. VRYGHEM, M.D. Brussels Eye Doctors Brussels

More information

The subject of irregular astigmatism1-6 and the. Treatment of Irregular Astigmatism with a Broad Beam Excimer Laser

The subject of irregular astigmatism1-6 and the. Treatment of Irregular Astigmatism with a Broad Beam Excimer Laser Treatment of Irregular Astigmatism with a Broad Beam Excimer Laser Kurt A. Buzard, MD, FACS; Bradley R. Fundingsland, BS ABSTRACT BACKGROUND: Four basic types of irregular astigmatism are described: central

More information

Laser intrastromal keratomileusis for high myopia and myopic astigmatism

Laser intrastromal keratomileusis for high myopia and myopic astigmatism British Journal of Ophthalmology 1997;81:199 206 199 Laser intrastromal keratomileusis for high myopia and myopic astigmatism P I Condon, M Mulhern, T Fulcher, A Foley-Nolan, M O Keefe Waterford Regional

More information

Conductive keratoplasty (CK) utilizes radiofrequency energy. Original Article

Conductive keratoplasty (CK) utilizes radiofrequency energy. Original Article Original Article Comparing the Rate of Regression after Conductive Keratoplasty with or without Prior Laser-Assisted in situ Keratomileusis or Photorefractive Keratectomy Majid Moshirfar, Erik Anderson

More information

To date, several million patients have been treated worldwide. So why not discover the benefits The Eye Hospital can bring to your life.

To date, several million patients have been treated worldwide. So why not discover the benefits The Eye Hospital can bring to your life. L a s e r E y e S u r g e r y I N F O R M A T I O N 1 Welcome Imagine the freedom of being able to do away with glasses and contact lenses. You too, may be suitable for laser eye surgery, freeing you from

More information

Consumer s Guide to LASIK

Consumer s Guide to LASIK Consumer s Guide to LASIK A Community Service Project brought to you by Price Vision Group Your Guide To A Successful LASIK Procedure The purpose of this educational guide is to help prospective patients

More information

Alain Saad, MD, Alice Grise-Dulac, MD, Damien Gatinel, MD, PhD

Alain Saad, MD, Alice Grise-Dulac, MD, Damien Gatinel, MD, PhD CASE REPORT Bilateral loss in the quality of vision associated with anterior corneal protrusion after hyperopic LASIK followed by intrastromal femtolaser-assisted incisions Alain Saad, MD, Alice Grise-Dulac,

More information

PATIENT CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)

PATIENT CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION: You have been diagnosed with myopia (nearsightedness) or hyperopia (farsightedness) with or without astigmatism, or astigmatism alone. Myopia is a result of light entering the eye and focusing

More information

Informed Consent for Refractive Lens Exchange (Clear Lens Extraction)

Informed Consent for Refractive Lens Exchange (Clear Lens Extraction) Informed Consent for Refractive Lens Exchange (Clear Lens Extraction) This form is designed to ensure that you have all the information you need to make a decision about whether or not you wish to undergo

More information

Comparison of Iris-fixed Artisan Lens Implantation with Excimer Laser In Situ Keratomileusis in Correcting Myopia between 9.00 and 19.

Comparison of Iris-fixed Artisan Lens Implantation with Excimer Laser In Situ Keratomileusis in Correcting Myopia between 9.00 and 19. Comparison of Iris-fixed Artisan Lens Implantation with Excimer Laser In Situ Keratomileusis in Correcting Myopia between 9.00 and 19.50 Diopters A Randomized Study M. Alaa El Danasoury, FRCS, 1 Akef El

More information

Early Flap Displacement after LASIK

Early Flap Displacement after LASIK Early Flap Displacement after LASIK Gerry Clare, FRCOphth, Tara C. B. Moore, PhD, Claire Grills, PhD, Antonio Leccisotti, MD, PhD, Johnny E. Moore, FRCOphth, PhD, Steve Schallhorn, MD Purpose: To evaluate

More information

Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy

Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy ARTICLE Femtosecond laser in situ keratomileusis for consecutive hyperopia after radial keratotomy Gonzalo Muñoz, MD, PhD, FEBO, César Albarrán-Diego, OD, Hani F. Sakla, MD, PhD, Jaime Javaloy, MD, PhD

More information

LASER VISION C ORRECTION REFRACTIVE SURGERY CENTER

LASER VISION C ORRECTION REFRACTIVE SURGERY CENTER LASER VISION C ORRECTION REFRACTIVE SURGERY CENTER W e l c o m e Throughout our history, physicians at Mass. Eye and Ear have led clinical advances and research that have resulted in the discovery of disease-causing

More information

INFORMED CONSENT FOR PHAKIC LENS IMPLANT SURGERY

INFORMED CONSENT FOR PHAKIC LENS IMPLANT SURGERY INTRODUCTION INFORMED CONSENT FOR PHAKIC LENS IMPLANT SURGERY This information is being provided to you so that you can make an informed decision about having eye surgery to reduce or eliminate your nearsightedness.

More information

Clinical Results of Topography-based Customized Ablations in Highly Aberrated Eyes and Keratoconus/Ectasia With Cross-linking

Clinical Results of Topography-based Customized Ablations in Highly Aberrated Eyes and Keratoconus/Ectasia With Cross-linking Clinical Results of Topography-based Customized Ablations in Highly Aberrated Eyes and Keratoconus/Ectasia With Cross-linking David T.C. Lin, MD, FRCSC; Simon Holland, MD, FRCSC; Johnson C.H. Tan, MBBS,

More information

Anterior Elevation Maps as the Screening Test for the Ablation Power of Previous Myopic Refractive Surgery

Anterior Elevation Maps as the Screening Test for the Ablation Power of Previous Myopic Refractive Surgery Anterior Elevation Maps as the Screening Test for the Ablation Power of Previous Myopic Refractive Surgery Soo Yong Jeong, MD, Hee-Seung Chin, MD, PhD, Jung Hyub Oh, MD, PhD Department of Ophthalmology,

More information

Initial Supervised Refractive Surgical Experience: Outcome of PRK and LASIK

Initial Supervised Refractive Surgical Experience: Outcome of PRK and LASIK Initial Supervised Refractive Surgical Experience: Outcome of PRK and LASIK Urmil Shah 1, Mahesh Shah 2, Bharati Shah 3 1 DO, DNB, FICO Resident, Aravind eye hospital, Tirunelveli 627001, Tamilnadu, India

More information

Walter Sekundo, MD, Katrin Bönicke, MD, Peter Mattausch, Wolfgang Wiegand, MD

Walter Sekundo, MD, Katrin Bönicke, MD, Peter Mattausch, Wolfgang Wiegand, MD Six-year follow-up of laser in situ keratomileusis for moderate and extreme myopia using a firstgeneration excimer laser and microkeratome Walter Sekundo, MD, Katrin Bönicke, MD, Peter Mattausch, Wolfgang

More information

LASIK for post penetrating keratoplasty astigmatism and myopia

LASIK for post penetrating keratoplasty astigmatism and myopia Br J Ophthalmol 1999;83:113 118 113 LASIK for post penetrating keratoplasty astigmatism and myopia Suzanne K Webber, Michael A Lawless, Gerard L Sutton, Christopher M Rogers The Eye Institute, Chatswood,

More information

Comparing Femtosecond Lenticule Extraction (FLEx) and Femtosecond Laser In-situ Keratomileusis (LASIK) for Myopia and Astigmatism

Comparing Femtosecond Lenticule Extraction (FLEx) and Femtosecond Laser In-situ Keratomileusis (LASIK) for Myopia and Astigmatism Original Article Philippine Journal of OPHTHALMOLOGY Comparing Femtosecond Lenticule Extraction (FLEx) and Femtosecond Laser In-situ Keratomileusis (LASIK) for Myopia and Astigmatism Tina Marie Saban-Roa,

More information

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement)

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) Drs. Fine, Hoffman and Packer, LLC PHYSICIANS AND SURGEONS, EyeMDs OPHTHALMOLOGY I. Howard Fine, M.D. Richard S. Hoffman, M.D. Mark Packer, M.D. 1550 Oak Street, Suite 5 www.finemd.com Eugene, OR 97401-7701

More information

The future of laser refractive surgery is exciting

The future of laser refractive surgery is exciting The Cornea is Not a Piece of Plastic Cynthia Roberts, PhD Editorial The future of laser refractive surgery is exciting with the potential for ever-improved postoperative visual performance. In the past,

More information

Surgical treatment for hyperopia currently

Surgical treatment for hyperopia currently Posterior Chamber Phakic Intraocular Lens for Hyperopia of +4 to +11 Diopters Jonathan M. Davidorf, MD; Roberto Zaldivar, MD; Susana Oscherow, MD ABSTRACT PURPOSE: To examine the efficacy, predictability,

More information

Wavefront-guided Custom Ablation for Myopia Using the NIDEK NAVEX Laser System

Wavefront-guided Custom Ablation for Myopia Using the NIDEK NAVEX Laser System Wavefront-guided Custom Ablation for Myopia Using the NIDEK NAVEX Laser System Jan Venter, MD ABSTRACT PURPOSE: To determine the predictability, effi cacy, safety, and stability of LASIK using custom ablation

More information

Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia

Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia Maria I. Kalyvianaki, MD, PhD, 1,2 George D. Kymionis, MD, PhD, 1,2 George A. Kounis, PhD, 1 Sophia I. Panagopoulou,

More information

Femto-LASIK. Pulsewidth: Ultrashort-pulse micro- machining can make sub- wavelength holes. micromachining

Femto-LASIK. Pulsewidth: Ultrashort-pulse micro- machining can make sub- wavelength holes. micromachining All-laser laser LASIK (Femto( Femto-LASIK) Femto-LASIK 台 大 眼 科 王 一 中 IntraLase 2/1 Perfect Vision Ziemer (DaVinci) Carl Zeiss Meditec Pulsewidth: Femtosecond laser (Nd:Glass)) 153 nm (near infrared) Each

More information

One of the exciting new research areas in laser

One of the exciting new research areas in laser Future Challenges to Aberration-free Ablative Procedures Cynthia Roberts, PhD One of the exciting new research areas in laser refractive surgery is the development of sophisticated devices to measure the

More information