Assessment of Intra-operative and Early Post-operative Complications of Laser in–situ Keratomileusis
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Several Laser in-situ keratomileusis (LASIK) complications have been identified over the years.Reporting complications of LASIK surgery will help refine the approach to their management.LASIK was introduced in the late 1980s with the development of the ophthalmic excimer laser [1,2].To avoid the disadvantages of photorefractive keratectomy (PRK), LASIK was introduced [3].LASIK rapidly increased in popularity and became the predominant form of refractive surgery in the late 1990s and continues till today [4].Correcting different refractive errors, including myopia, hyperopia, and astigmatism, is the main aim of all laser refractive procedures.LASIK has been used to treat many degrees of myopia with promising results, and there are great expectations for treating farsightedness.Compared to PRK, LASIK is advantageous in causing minimal postoperative discomfort, rapid restoration of visual clarity and stability of refractive changes, less frequent opacification, and better ability to correct high levels of myopia.Intraoperative complications, although infrequent, include Microkeratome-related flap complications (flap buttonhole, free cap, and incomplete, short, or irregular flaps), corneal perforation, corneal epithelial defect, conjunctival bleeding, subconjunctival hemorrhage, and interface debris [6].Post-operative Complications include inaccurate correction, visual aberrations, flap striae (macrostriae -microstriae) [6], flap dislocation, dry eye, diffuse lamellar keratitis (DLK), pressure-induced stromal keratitis (PISK), infectious keratitis [7], and epithelial ingrowth [8].Aim of the Study: To assess incidences, possible aetiology of the intra-operative, and early post-operative complications of LASIK.Literature-based Methodology: The intra-operative complication rate, reported between 0.7% and 6.5% [6], is most commonly associated with flap-related issues, including mechanical or FS Laser complications.To evaluate the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) to correct residual astigmatism after cataract surgery.LASIK was performed on 20 eyes of 20 patients with refractive myopic or mixed astigmatism (3.00 to 6.00 D) at least 1 year after extracapsular cataract extraction with posterior chamber intraocular lens implantation without complication. Each eye received bitoric LASIK with the Nidek EC-5000 excimer laser and the Automated Corneal Shaper microkeratome.At 6 months after LASIK, mean refractive cylinder decreased from 4.64+/-0.63 D to 0.44+/-0.24 D (P<.001). Mean percent reduction of astigmatism was 90.4+/-5.0% (range 80% to 100%). Mean spherical equivalent refraction decreased from -2.19+/-0.88 D (range -1.00 to -3.88 D) to -0.32+/-0.34 D (range -1.25 to +0.38 D) (P<.001). Vector analysis showed that the mean amount of axis deviation was 0.7+/-1.2 degrees (range 0 degrees to 4.3 degrees) and the mean percent correction of preoperative astigmatism was 92.1+/-5.9% (range 85.6% to 108%). Eighty-five percent of all eyes had a mean spherical equivalent refraction and mean cylinder within +/-0.50 D of emmetropia. Change in spherical equivalent refraction and cylinder from 2 weeks to 6 months was < or = 0.50 D in 90% (18 eyes) and 95% (19 eyes), respectively. Spectacle-corrected visual acuity was not reduced in any eye. Diffuse lamellar keratitis occurred in three eyes (15%) after LASIK, and were treated successfully with eyedrops.LASIK was an effective, predictable, stable, and safe procedure for correction of residual myopic or mixed astigmatism ranging from 3.00 to 6.00 D with a low spherical component after cataract surgery.
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The most important factor in undertaking a refractive procedure is that we need to be within the stroma to make it comfortable to the patient. But, from a biomechanical standpoint, we need to be as superficial as we can. Also to decrease wound-healing complications, we must avoid any damage to the epithelium. That’s why, the switch over to thinner flaps. A new technique known as sub bowmans keratomileusis offers us more room for doing wider and deeper ablations and serves as a bridge between surface ablation and LASIK
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Objective: Evaluation of corneal reinnervation after cryo-keratomileusis and keratomileusis. Study Design: Retrospective evaluation of corneal sensitivity after cryo-keratomileusis and in situ keratomileusis. The measurements were performed with the Draeger electromechanical optical-controlled aesthesiometer, which is very precise and independent of external changes in temperature and humidity. Three measuring points were on the lenticle and 2 at approximately 1 mm distance from the limbus. Setting: Instituto Barraquer, Bogota, Columbia (South America). Patients: Twelve patients after cryo-keratomileusis and 38 patients after in situ keratomileusis. Results: It was shown that the recovery of corneal sensitivity after cryo-keratomileusis is delayed due to the depth of the keratectomy and freezing procedure compared to in situ keratomileusis.
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Objective To investigate the relation of the measured value of intraocular pressure(IOP)after laser in situ keratomileusis (LASIK) and central corneal thickness (CCT) and its significance. Methods Fifty patients (100eyes) with high myopia were performed LASIK. Before and 3months after operation ,IOP was measured by NIDEK NT-2000 tonometry individually,CCT was measured by ultrasound corneal pachymeter ,and the correlation between the two indexes was analyzed. Results The IOP before and after operation were (13.99±2.37),(11.89±2.73)mmHg,P0.01.The CCT were (529.63±27.82),(452.39±36.11)μm,P0.01. The CCT was positively associated with IOP before or after operation (r=0.46,P=0.01.r=0.43,P=0.02). The changing magnitude of IOP and CCT were(-2.68±1.78)mmHg and (77.45± 19.88)μm,which were negatively correlated with each other(r=-0.523,P0.01).Conclusions The measured value of IOP after LASIK decrease with the reduction of CCT,which does not represent the change of IOP intrinsically. Patients with questionable intraocular hypotension signs after LASIK should be given necessary examination.
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Ziel In einer retrospektiven Studie wurde die Hornhautreinnervation nach lamellärer refraktiver Keratoplastik zur Myopiekorrektur untersucht.
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Laser in situ & undersurface of flap keratomileusis for regression after laser in situ kertomileusis
Objective To study the efficacy and safety of laser in situ undersurface of flap keratomileusis(LASUK) for regression after laser in situ keratomileusis.Methods LASIK was performed in 10 cases(15 eyes) of regression after laser in situ keratomileusis with insufficient corneal stroma.Results Postoperative examination showed that the corneas were transparent and the flap did not displace.Mean uncorrected visual acuity increased to 0.95±0.26,0.98±0.25,1.02±0.26;1,7 days and 3 months after operation mean spherical equivalent refraction and mean cylinder refraction decreased from(-2.50±1.25)DS and(-1.05±0.65)DC before operation to(-0.37±0.50)DS and(-0.50±0.37)DC 3 months after operation(F=6.250,P=0.002;F=3.086,P=0.043).Fifteen eyes reached or exceeded their preoperative best corrected visual acuity 3 months after operation.Conclusion Laser in situ undersurface of flap keratomileusis for regression after laser in situ keratomileusis is effective and safe,no complication occurred,but further efficacy would be confirmed.
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