Article

Persistent subepithelial haze in thin-flap LASIK.

Institute for Refractive and Opthalmic Surgery, Zurich, Switzerland.
Journal of refractive surgery (Thorofare, N.J.: 1995) (Impact Factor: 2.47). 10/2009; 26(3):222-5. DOI: 10.3928/1081597X-20090930-02
Source: PubMed

ABSTRACT To report persistent subepithelial haze in two patients following femtosecond LASIK associated with creation of a thin flap.
Subepithelial haze was assessed by slit-lamp photography, high-resolution Scheimpflug imaging, and corneal confocal microscopy.
Two patients showed distinct subepithelial haze and reduced corrected distance visual acuity at 3 months after LASIK with a think-flap generated by a femtosecond laser. The extent of haze was documented, and the haze was treated topically with steroids up to 12 weeks. The haze was localized approximately 20 to 40 microm below Bowman's layer and dissolved slowly during the 2 months of treatment. At 6 months after surgery, uncorrected visual acuity was 20/20.
Subepithelial haze formation represents a new potential complication in the thin-flap LASIK.

2 Bookmarks
 · 
79 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The corneal flap laser in-situ keratomileusis (LASIK) is among the most important determinants in the successful outcome of the surgery. Femtosecond lasers have evolved over the last decade to all but replace the mechanical microkeratome as the preferred method to create these flaps. With improvements in femtosecond laser technology, there has been a reduction in the time taken for the cut and the quality of the stromal bed has improved. Improved predictability has led surgeons to explore the possibility of thin flap LASIK. Corneal flaps created with the femtosecond laser have been shown to be more predictable in depth and have a more desirable planar morphology. Corneal flaps created by the femtosecond laser can be customized according to depth, profile, morphology, and side-cut configuration. Changes in the angulation of the side cut, to reduce the incidence of epithelial ingrowth, have not been corroborated by clinical evidence as yet. Thin flap LASIK, also referred to as sub-Bowman's keratomileusis, has the advantage of preserving more stroma and potentially reducing the incidence of corneal ectasia but seems to be associated with an increased incidence of interface haze. This review examines the advantages of creating a flap with the femtosecond laser and the various configurations of these flaps. It also explores the advantages of varying the thickness and profile of femtosecond flaps.
    Current opinion in ophthalmology 07/2011; 22(4):245-50. · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To review the published literature to assess the safety, efficacy, and predictability of femtosecond lasers for the creation of corneal flaps for LASIK; to assess the reported outcomes of LASIK when femtosecond lasers are used to create corneal flaps; and to compare the differences in outcomes between femtosecond lasers and mechanical microkeratomes. METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted on October 12, 2011, without language or date limitations. The searches retrieved a total of 636 references. Of these, panel members selected 58 articles that they considered to be of high or medium clinical relevance, and the panel methodologist rated each article according to the strength of evidence. Four studies were rated as level I evidence, 14 studies were rated as level II evidence, and the remaining studies were rated as level III evidence. RESULTS: The majority of published studies evaluated a single laser platform. Flap reproducibility varied by device and the generation of the device. Standard deviations in flap thicknesses ranged from 4 to 18.4 μm. Visual acuities and complications reported with LASIK flaps created using femtosecond lasers are within Food and Drug Administration safety and efficacy limits. Of all complications, diffuse lamellar keratitis is the most common after surgery but is generally mild and self-limited. Corneal sensation was reported to normalize by 1 year after surgery. Unique complications of femtosecond lasers included transient light-sensitivity syndrome, rainbow glare, opaque bubble layer, epithelial breakthrough of gas bubbles, and gas bubbles within the anterior chamber. CONCLUSIONS: Available evidence (levels I and II) indicates that femtosecond lasers are efficacious devices for creating LASIK flaps, with accompanying good visual results. Overall, femtosecond lasers were found to be as good as or better than mechanical microkeratomes for creating LASIK flaps. There are unique complications that can occur with femtosecond lasers, and long-term follow-up is needed to evaluate the technology fully. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
    Ophthalmology 11/2012; · 5.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the long-term outcomes of thin-flap laser in situ keratomileusis (LASIK) in eyes with thin corneas (central corneal thickness [CCT] <500 μm) but normal topography. Private center, Tokyo, Japan. Retrospective randomized comparative study. The efficacy, safety, predictability, and topography of LASIK were evaluated in eyes with a CCT of less than 500 μm but with normal topography (thin-cornea group) to 6 years postoperatively. The LASIK outcomes in the thin-cornea group were compared with those in eyes with a CCT of 500 μm or greater (control group). Analysis was performed to determine whether there were differences between the groups at the last checkup 3 to 4 years postoperatively. In the thin-cornea group (291 eyes; 146 patients), no significant differences were observed in LASIK outcomes when eyes were subdivided by the time of final checkup (3, 4, and ≥5 years). There was a significant difference in visual and refractive outcomes between 3 months postoperatively and the last checkup in the thin-cornea group and the control group (371 eyes; 193 patients). No significant difference in visual, refractive, or topography outcomes was observed between the 2 groups at the last checkup. Laser in situ keratomileusis in eyes with thin corneas was as safe and effective as and showed similar long-term stability in eyes with a CCT of 500 μm or greater. No eye in either group had a postoperative complication. No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 02/2014; 40(2):239-50. · 2.75 Impact Factor

Full-text

View
10 Downloads
Available from
May 21, 2014