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ABSTRACT: AIM: To compare postoperative visual acuity, higher-order aberrations (HOAs) and corneal asphericity after femtosecond lenticule extraction (FLEx) and after wavefront-guided laser-assisted in situ keratomileusis (wfg-LASIK) in myopic eyes. METHODS: We examined 43 eyes of 23 patients undergoing FLEx and 34 eyes of 19 patients undergoing wfg-LASIK to correct myopia. Ocular HOAs were measured by Hartmann-Shack aberrometry and corneal asphericity was measured by a rotating Scheimpflug imaging system before and 3 months after surgery. RESULTS: There was no statistically significant difference in uncorrected (p=0.66 Mann-Whitney U-test) or corrected distance visual acuity (p=0.14) after two surgical procedures. For a 6-mm pupil, the changes in fourth-order aberrations after FLEx were statistically significantly less than those after wfg-LASIK (p<0.001). On the other hand, there were no statistically significant differences in the changes in third-order aberrations (p=0.24) and total HOAs (p=0.13). Similar results were obtained for a 4-mm pupil. The positive changes in the Q value after FLEx were statistically significantly less than those after wfg-LASIK (p=0.001). CONCLUSIONS: In myopic eyes, FLEx induces significantly fewer ocular fourth-order aberrations than wfg-LASIK, possibly because it causes less oblation in the corneal shape, but there was no statistically significant difference in visual acuity or in the induction of third-order aberrations and total HOAs. It is suggested that FLEx is essentially equivalent to wfg-LASIK in terms of visual acuity and total HOA induction, although the characteristics of HOA induction are different.
The British journal of ophthalmology 12/2012; · 2.92 Impact Factor
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ABSTRACT: To assess the time course of refractive and corneal astigmatism after laser in situ keratomileusis (LASIK) in eyes with moderate to high astigmatism.
Department of Ophthalmology, Kitasato University, Kanagawa, Japan.
Retrospective case series.
Keratometric readings and corneal astigmatism were determined with an autokeratometer in consecutive patients who had LASIK for moderate to high astigmatism (≥2.00 diopters [D]).
The study enrolled 48 eyes of 35 patients with a mean age of 34.0 years ± 8.1 (SD), a mean spherical error of -5.10 ± 2.11 D, and a mean cylindrical error of -2.74 ± 0.99 D. Postoperatively, the mean spherical refraction changed significantly from 0.38 ± 0.80 D at 1 week to -0.13 ± 0.90 D at 1 year (P<.001, Wilcoxon signed-rank test). The mean cylindrical refraction showed no significant change (-0.67 ± 0.54 D at 1 week to -0.63 ± 0.63 D at 1 year) (P=.54). There were significant increases in the flattest and steepest keratometry readings at 1 week and at 1 year. However, no significant change in corneal astigmatism was found at either time point (P=.10).
After LASIK, there was significant refractive regression in the spherical component but not in the cylindrical component. This suggests that refractive regression occurs by corneal steepening in the spherical component and that astigmatic regression does not occur, even in moderately to highly astigmatic eyes.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of cataract and refractive surgery 08/2012; 38(8):1408-13. · 2.75 Impact Factor
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ABSTRACT: To compare postoperative visual function after implantable collamer lens (ICL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) in eyes with low to moderate myopia.
Retrospective observational case study.
We investigated 30 eyes of 20 patients undergoing ICL implantation and 64 eyes of 38 patients undergoing wavefront-guided LASIK for the correction of low to moderate myopia (manifest spherical equivalent: -3.00 to -5.88 diopters [D]). Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log contrast sensitivity function was calculated.
For 4-mm and 6-mm pupils, the changes in ocular third-order aberrations, fourth-order aberrations, and total HOAs after ICL implantation were significantly less than those after wavefront-guided LASIK (P < .05, Mann-Whitney U test). The postoperative area under the log contrast sensitivity function was significantly increased after ICL implantation (P < .001), whereas, after wavefront-guided LASIK, it was not significantly changed (P = .11).
ICL implantation induces significantly fewer ocular HOAs than wavefront-guided LASIK. Moreover, CS was significantly improved after ICL implantation but unchanged after wavefront-guided LASIK in eyes with low to moderate myopia. Thus, even in the correction of low to moderate myopia, ICL implantation appears to be superior in visual performance to wavefront-guided LASIK, suggesting that it may be a viable surgical option for the treatment of such eyes.
American journal of ophthalmology 02/2012; 153(6):1178-86.e1. · 3.83 Impact Factor
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ABSTRACT: To assess the 1-year clinical outcomes of toric Visian Implantable Collamer Lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation for moderate to high myopic astigmatism.
Prospective, observational case series.
Fifty-six eyes of 32 consecutive patients, with spherical equivalent errors of -4.00 to -17.25 diopters (D) and cylindrical errors of -0.75 to -4.00 D, who underwent toric ICL implantation.
Before and 1 week and 1, 3, 6, and 12 months after surgery, the safety, efficacy, predictability, stability, and adverse events of the surgery were assessed in eyes undergoing toric ICL implantation. Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function also were evaluated before and 1 year after surgery.
Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), safety index, efficacy index, predictability, stability, adverse events, HOAs, and CS function.
The logarithm of the minimum angle of resolution (logMAR) UCVA and logMAR BSCVA were -0.11 (corresponding to Snellen equivalent 20/16) ± 0.12 and -0.19 (corresponding to 20/12.5) ± 0.08 1 year after surgery, respectively. The safety and efficacy indices were 1.17 ± 0.21 and 1.00 ± 0.29. At 1 year, 91% and 100% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of -0.07 ± 0.27 D occurred from 1 week to 1 year. For a 4-mm pupil, fourth-order aberrations were changed, not significantly, from 0.05 ± 0.02 μm before surgery to 0.06 ± 0.03 μm after surgery (P = 0.38, Wilcoxon signed-rank test). Similarly, for a 6-mm pupil, fourth-order aberrations were not significantly changed, merely from 0.20 ± 0.08 μm before surgery to 0.23 ± 0.11 μm after surgery (P = 0.15). The area under the log CS function was significantly increased from 1.41 ± 0.15 before surgery to 1.50 ± 0.13 after surgery (P < 0.001). No vision-threatening complications occurred during the observation period.
In the authors' experience, the toric ICL performed well in correcting moderate to high myopic astigmatism during a 1-year observation period, suggesting its viability as a surgical option for the treatment of such eyes.
Ophthalmology 12/2010; 117(12):2287-94. · 5.45 Impact Factor
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ABSTRACT: To assess the early clinical outcomes of toric implantable collamer lenses (toric ICL™, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus.
This study evaluated 27 eyes of 14 patients with spherical equivalents of -10.11 ± 2.46 D (mean ± standard deviation) and astigmatism of -3.03 ± 1.58 D who underwent toric ICL implantation for mild keratoconus. Before, and 1, 3 and 6 months after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery.
LogMAR uncorrected visual acuity (UCVA) and LogMAR best spectacle-corrected visual acuity (BSCVA) were -0.09 ± 0.16 and -0.15 ± 0.09 respectively, 6 months after surgery. The safety and efficacy indices were 1.12 ± 0.18 and 1.01 ± 0.25. At 6 months, 85% and 96% of the eyes were within ±0.5 and ±1.0 D respectively of the targeted correction. Manifest refraction changes of 0.00 ± 0.35 D occurred from 1 week to 6 months. No vision-threatening complications occurred during the observation period.
Toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of spherical and cylindrical errors in eyes with early keratoconus throughout the 6-month follow-up period, suggesting its viability as a surgical option for the treatment of such eyes.
Albrecht von Graæes Archiv für Ophthalmologie 10/2010; 249(7):1073-80. · 2.17 Impact Factor
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ABSTRACT: We report a case in which toric intraocular Collamer lenses (ICLs) effectively corrected the refractive errors of pellucid marginal degeneration (PMD). Preoperatively, in the patient's right eye, the manifest refraction was -10.5 -3.5 x 55, the uncorrected distance visual acuity (UDVA) was 20/1000, and the corrected distance visual acuity (CDVA) was 20/16; in the left eye, the manifest refraction was -11.0 - 6.5 x 130 and the UDVA and CDVA were 20/1000 and 20/20, respectively. After bilateral implantation of a toric ICL, in the right eye, the manifest refraction was +1.50 - 0.75 x 10, the UDVA was 20/16, and the CDVA was 20/12.5; in the left eye, the manifest refraction was +2.5 -3.25 x 125 and the UDVA and CDVA were 20/40 and 20/16, respectively. No sign of progressive disease and no vision-threatening complication were observed during the 6-month follow-up. Toric ICL implantation may be a viable surgical option for the correction of high myopic astigmatism in eyes with PMD. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
Journal of cataract and refractive surgery 01/2010; 36(1):164-6. · 2.75 Impact Factor
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ABSTRACT: To report on a patient in whom hyperopic Implantable Collamer Lenses (ICL, STAAR Surgical, Nidau, Switzerland) and limbal relaxing incisions have been beneficial for the correction of hyperopic astigmatism after laser in situ keratomileusis (LASIK).
The 48-year-old man had undergone LASIK to correct high myopia 5 years earlier. Preoperatively, the manifest refraction was +2.25, -1.00 x 160, with an uncorrected visual acuity of 0.15 and a best spectacle-corrected visual acuity of 1.5.
Postoperatively, the manifest refraction was +0.50, -0.5 x 165, with an uncorrected visual acuity of 1.0 and a best spectacle-corrected visual acuity of 1.2. No serious complications were observed during the 10-month observation period.
Hyperopic Implantable Collamer Lenses implantation combined with limbal relaxing incisions may be an alternative for the treatment of hyperopic astigmatism after overcorrected myopic LASIK.
Cornea 11/2009; 29(1):99-101. · 1.73 Impact Factor
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ABSTRACT: To compare postoperative outcomes of a new aspheric laser in situ keratomileusis (LASIK) system, which applies an index for corneal asphericity (Q-value), with outcomes of the conventional LASIK procedure.
Twenty-eight eyes of 15 consecutive patients (mean age, 36.4 +/- 5.8 years) underwent aspheric LASIK (As-LASIK group), and 33 eyes of 18 consecutive patients (mean age, 32.9 +/- 8.3 years) underwent conventional LASIK (Con-LASIK group) at Sanno Hospital (Tokyo, Japan). Both procedures were performed with a Moria LSK-One microkeratome and a Bausch and Lomb Technolas 217-z100 excimer laser. Preoperative mean spherical equivalent refraction values were -5.13 +/- 1.23 diopters (D) and -5.63 +/- 0.88 D in the As-LASIK and Con-LASIK groups, respectively. Higher order aberrations were measured and contrast sensitivity was assessed at 3 months after the procedure, and these, along with safety, efficacy, and predictability, were compared between the two procedures.
Conventional LASIK significantly increased higher order aberrations and reduced contrast sensitivity, whereas As-LASIK did not increase spherical-like aberrations or alter contrast sensitivity.
Aspheric LASIK may be a better laser technique than Con-LASIK, with less postoperative increase in spherical-like aberrations and better control over contrast sensitivity.
Japanese Journal of Ophthalmology 09/2009; 53(5):458-63. · 0.92 Impact Factor
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ABSTRACT: To assess the long-term clinical outcomes of implantation of a lens consisting of a biocompatible collagen copolymer (Visian implantable Collamer lens [ICL]; STAAR Surgical, Nidau, Switzerland) for moderate to high myopia.
We evaluated 56 eyes of 34 patients with myopic refractive errors of -4.00 to -15.25 diopters (D) who underwent ICL implantation and routine postoperative examinations. Before and 1, 3, and 6 months and 1, 2, and 4 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery.
Mean (SD) logMAR uncorrected and best spectacle-corrected visual acuities were -0.03 (0.23) and -0.21 (0.09), respectively, at 4 years after surgery. The mean (SD) safety and efficacy indexes were 1.19 (0.25) and 0.83 (0.29), respectively. At 4 years, 44 (79%) and 52 (93%) of the eyes were within +/-0.5 and +/-1.0 D, respectively, of the targeted correction. Mean (SD) manifest refraction changes of -0.24 (0.57) D occurred from 1 month to 4 years after surgery. No vision-threatening complications occurred during the observation period.
Implantation of ICLs is safe and effective and provides predictable and stable refractive results in the treatment of moderate to high myopia during a 4-year observation period, suggesting its viability as a surgical option for the treatment of such eyes.
Archives of ophthalmology 08/2009; 127(7):845-50. · 3.86 Impact Factor
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ABSTRACT: To assess astigmatism induced after phakic intraocular lens (Visian ICL, STAAR Surgical) implantation.
Seventy-three eyes of 47 patients undergoing ICL implantation through a horizontal 3.0 mm clear corneal incision were retrospectively examined. The amount of corneal astigmatism before and 3 months after surgery using an automated keratometer (ARK-700A, Nidek) and corneal topography (ATRAS995, Carl Zeiss Meditec) were quantitatively investigated. The surgically induced astigmatism was assessed by vector analysis using the Holladay-Cravy-Koch formula.
The corneal astigmatism was significantly increased from 1.10 (0.51) dioptres (D) to 1.44 (0.57) D using the keratometer (Wilcoxon signed-rank test, p<0.001). It was also significantly increased from 1.16 (0.53) D to 1.45 (0.57) D using corneal topography (p<0.001). On the other hand, the manifest astigmatism was significantly decreased from 0.93 (0.60) D to 0.72 (0.58) D (p<0.001). The surgically induced astigmatism was 0.45 (0.26) D at an axis of 93.3 degrees using the keratometer and 0.49 (0.26) D at an axis of 98.0 degrees using corneal topography.
ICL implantation induces corneal astigmatism through a with-the-rule astigmatic shift of approximately 0.5 D, which was small but not negligible for candidates for refractive surgery.
The British journal of ophthalmology 08/2009; 93(12):1648-51. · 2.92 Impact Factor
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ABSTRACT: To compare postoperative visual function after implantable collamer lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation and after wavefront-guided laser in situ keratomileusis (WFG-LASIK) in eyes with high myopia.
Retrospective, observational case study.
We investigated 46 eyes of 33 patients undergoing ICL implantation and 47 eyes of 29 patients undergoing WFG-LASIK (Technolas217z; Bausch & Lomb, Rochester, New York, USA) for the correction of high myopia (manifest spherical equivalent < or = -6 diopters). Ocular higher-order aberrations (HOA) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan) and a CS unit (VCTS-6500; Vistech Consultants Inc, Dayton, Ohio, USA) before and 3 months after surgery, respectively. From the CS, the area under the log CS function (AULCSF) was calculated.
For a 4-mm pupil, the changes in ocular coma-like aberrations, spherical-like aberrations, and total HOAs after ICL implantation were significantly less than those after WFG-LASIK (P < .001, Mann-Whitney U test). The postoperative AULCSF was significantly increased after ICL implantation (P < .001), whereas after WFG-LASIK, it was significantly decreased (P < .001).
ICL implantation induces significantly fewer ocular HOAs than WFG-LASIK. Moreover, CS was improved significantly after ICL implantation, but deteriorated after WFG-LASIK in eyes with high myopia. Thus, in the correction of high myopia, ICL implantation seems to be superior in visual performance to WFG-LASIK, suggesting that it may be a better surgical option for the treatment of such eyes.
American journal of ophthalmology 04/2009; 148(1):164-70.e1. · 3.83 Impact Factor
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ABSTRACT: To evaluate the vaulting of the STAAR Implantable Collamer Lens (ICL) over the crystalline lens after implantation.
One hundred twenty-three eyes of 68 patients with myopic refractive errors of -3.25 to -22.75 diopters undergoing ICL implantation were examined retrospectively. The magnitude of the central vaulting of the ICL was assessed quantitatively using slit-lamp microscopy at 3 months after surgery. Multiple regression analysis was used to assess the factors affecting the amount of vaulting.
The mean central vaulting 3 months after surgery was 603.6 +/- 259.6 microm. Explanatory variables relevant to the vaulting were, in order of influence, the horizontal white-to-white distance (partial regression coefficient B = 0.268, P = .0002) and patient age (B = -0.007, P = .011).
Although the majority of the variance remains unexplained, younger patients' eyes and eyes with greater white-to-white distances are more predisposed to have higher ICL vaulting over the crystalline lens.
Journal of refractive surgery (Thorofare, N.J.: 1995) 04/2009; 25(3):259-64. · 2.54 Impact Factor
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ABSTRACT: To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism.
Department of Ophthalmology, Kitasato University, Kanagawa, Japan.
This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] <or=-6.0 diopters [D]; manifest refractive cylinder >or=1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively.
At 6 months, the mean safety index was 1.28+/-0.25 (SD) in the ICL group and 1.01+/-0.16 in the LASIK group and the mean efficacy index, 0.87+/-0.15 and 0.83+/-0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/-1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04+/-0.24 D in the ICL group and -0.60+/-0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations.
Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.
Journal of Cataract [?] Refractive Surgery 10/2008; 34(10):1687-93. · 2.26 Impact Factor
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ABSTRACT: To assess effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis (LASIK).
Prospective, nonrandomized clinical trial.
We examined 27 eyes with mean myopic regression +/- standard deviation of -1.26 +/- 0.48 diopters (D; range, -0.50 to -2.25 D) after LASIK. Nipradilol 2.5% was administered topically twice daily to these regressive eyes. We obtained the refraction (spherical equivalent, astigmatism), intraocular pressure (IOP) measurements, pachymetry, geometry, and refractive power of the cornea before and three months after treatment.
Mean manifest refraction was improved significantly from -1.02 +/- 0.52 D to -0.44 +/- 0.39 D (P < .001). However, mean manifest astigmatism was changed from -0.55 +/- 0.30 D to -0.49 +/- 0.22 D, but the difference was not significant (P = .23). The IOP was decreased significantly from 11.4 +/- 2.4 mm Hg to 9.4 +/- 1.3 mm Hg (P < .001). Central corneal thickness was not changed significantly from 505.2 +/- 39.3 microm to 503.6 +/- 38.7 microm (P = .61). The posterior corneal surface was shifted posteriorly by 9.1 +/- 8.2 microm, and the total refractive power of the cornea was decreased significantly, by 0.63 +/- 0.62 D (P < .001), at three months after application.
The preliminary data show that antiglaucoma drugs are effective for the reduction of the refractive regression, especially of the spherical errors, after LASIK. It is suggested that backward movement of the cornea may occur, possibly flattening the corneal curvature by lowering the IOP. Reduction of the IOP may contribute to improving regression after keratorefractive surgery.
American Journal of Ophthalmology 02/2008; 145(2):233-238. · 4.22 Impact Factor
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ABSTRACT: To evaluate the cases that were treated with laser in situ keratomileusis (LASIK) and who were follwed up for a full 2-year period without fail.
LASIK was performed in 62 eyes of 35 patients between June 1997 and March 1999. Mean age was 29.1 years and the preoperative mean spherical equivalent refraction was -6.90 +/- 2.49 (mean +/- standard deviation) diopter (D). Five aspects were studied as follows.
1. Safety: 26 eyes (41.9%) gained 1 line or more in best corrected visual acuity. Twenty eyes (32.3%) were unchanged. Sixteen eyes(25.8%) lost 1 line. No eye lost 2 lines or more. The safety index was 1.04. 2. Efficacy: The efficacy index was 0.85. 3. Predictability: Forty-eight eyes (77.4%) were predictable within +/- 0.5 D, and 55 eyes (88.7%) were within +/- 1.0 D. 4. Stability: Manifest refraction was relatively stable after 3 months. 5. Complication: No complications were experienced.
Our 2-year follow-up showed that postoperatively LASIK was safe and effective.
Nippon Ganka Gakkai zasshi 03/2005; 109(2):88-92.
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ABSTRACT: To evaluate the clinical outcomes 6 months after wavefront-guided laser in situ keratomileusis (LASIK) for myopia in Japan.
Department of Ophthalmology, Sanno Hospital, Tokyo, Japan.
This prospective study comprised 22 eyes of 12 patients treated with wavefront-guided LASIK who were available for evaluation at 6 months. The mean patient age was 31.2 years +/- 8.4 (SD) (range 23 to 50 years), and the mean preoperative spherical equivalent refraction was -7.30 +/- 2.72 diopters (D) (range -2.75 to -11.88 D). In all cases, preoperative wavefront analysis was performed with a Hartmann-Shack aberrometer and the Technolas 217z flying-spot excimer laser system (Bausch & Lomb) was used with 1.0 mm and 2.0 mm spot sizes and an active eye tracker with a 120 Hz tracking rate. The clinical outcomes of wavefront-guided LASIK were evaluated in terms of safety, efficacy, predictability, stability, complications, and preoperative and postoperative aberrations.
At 6 months, 10 eyes had no change in best spectacle-correct visual acuity and 10 gained 1 or more lines. The safety index was 1.11 and the efficacy index, 0.82. Slight undercorrections were observed in highly myopic eyes. In all eyes, the postoperative refraction tended slightly toward myopia for 3 months and stabilized after that. No complication such as epithelial ingrowth, diffuse lamellar keratitis, or infection was observed. Comparison of the preoperative and postoperative aberrations showed that 2nd-order aberrations decreased and higher-order aberrations increased. In the 3rd order, aberrations increased in the high-myopia group (-6.0 D or worse) and decreased in the low to moderate-myopia group (better than -6.0 D).
Wavefront-guided LASIK was a good option for refractive surgery, although a longer follow-up in a larger study is required.
Journal of Cataract [?] Refractive Surgery 08/2003; 29(8):1507-13. · 2.26 Impact Factor
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ABSTRACT: Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis (LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or 2 following surgery.
We described 2 cases of DLK that occurred 3 months after LASIK. These patients were treated with intensive topical corticosteroids.
Treatment with topical corticosteroid was instituted, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopic findings.
DLK may occur as late as 3 months after LASIK.
Japanese Journal of Ophthalmology 47(5):463-8. · 0.92 Impact Factor
