Management and Outcomes of Retained Lenticules and Lenticule Fragments Removal After Failed Primary SMILE: A Case Series
Small incision lenticule extraction (SMILE) is a corneal refractive procedure characterized by predictability, long-term stability of the attempted correction and corneal biomechanics, reduced incidence of intraoperative and postoperative complications, and excellent quality of the visual outcomes.1 –8 Despite the advantages of SMILE over femtosecond laser–assisted LASIK (FS-LASIK) and photorefractive keratectomy (PRK), the procedure is characterized by a steeper learning curve.7,9 A common intraoperative problem for the inexperienced surgeon is the incomplete separation of the lenticule due to (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Sri Ganesh, MS, DNB Source Type: research
Postoperative Corneal Asphericity in Low, Moderate, and High Myopic Eyes After Transepithelial PRK Using a New Pulse Allocation
Precise lasers with small laser spots and high repetition rates are now widely used to manipulate the shape of the cornea to correct refractive errors including myopia, hyperopia, astigmatism, and higher order wavefront aberrations and presbyopia.1 SmartSurfACE treatment (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) is a combination of transepithelial photorefractive keratectomy (PRK) implemented using the Smart Pulse Technology (SCHWIND eye-tech-solutions GmbH), which is a three-dimensional model based on a fullerene structure to improve the smoothness of the ablation beam profile (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: David T. C. Lin, MD, FRCSC Source Type: research
Laboratory Evaluation of the Influence of Decentration and Pupil Size on the Optical Performance of a Monofocal, Bifocal, and Trifocal Intraocular Lens
Various intraocular lens (IOL) designs have been developed to achieve better unaided vision for patients undergoing cataract surgery. Today's standard monofocal IOLs provide excellent distance visual acuity,1 whereas toric and aspheric IOLs optimize the refractive outcome.2,3 Bifocal IOLs provide uncorrected far and near visual acuity, whereas recently introduced trifocal designs flatten out defocus curves and thus additionally grant uncorrected intermediate visual acuity.4,5 To fully exploit the optical capabilities of these IOLs, especially bifocal and trifocal lenses, some requirements need (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Tamer Tandogan, MD Source Type: research
A Novel Corneal Remodeling Technique for the Management of Keratoconus
Surgical procedures for keratoconus can be additive, such as intracorneal ring segment implantation,1 or subtractive, such as excimer laser photoablation.2 For achieving larger refractive corrections, intracorneal ring segment implants with a smaller diameter may be needed, which, being closer to the visual axis, induces more higher order aberrations and associated photic phenomenon.3 Although photorefractive keratectomy has been attempted for improving visual outcomes in keratoconus, as a subtractive procedure, it is inherently associated with weakening of the keratoconic cornea. There is (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Cesar Carriazo, MD Source Type: research
In Vivo Early Corneal Biomechanical Changes After Corneal Cross-linking in Patients With Progressive Keratoconus
Increased biomechanical stability after CXL has been confirmed by several in vitro studies.1 –5 However, these findings have not yet been consistently supported by in vivo studies, which are often based on parameters such as corneal hysteresis and corneal resistance factor, obtained from the Ocular Response Analyzer (ORA) (Reichert Technologies, Inc., Buffalo, NY).6–11 It has been sugge sted that the biomechanical changes induced by CXL may be too subtle to be measured by the ORA parameters such as corneal hysteresis or corneal resistance factor or have characteristics not measured well by this (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Riccardo Vinciguerra, MD Source Type: research
Efficacy and Safety Comparison Between Suberoylanilide Hydroxamic Acid and Mitomycin C in Reducing the Risk of Corneal Haze After PRK Treatment In Vivo
Corneal haze formation involves changes in extracellular matrix deposition and keratocyte proliferation, migration, apoptosis, and differentiation of fibroblasts and myofibroblasts.1 –4 Transforming growth factor beta-1 (TGF-β1) has been shown to play a central role in myofibroblast generation and corneal haze formation.5 Myofibroblasts are opaque cells with high contractibility, show de novo expression of alpha-smooth muscle actin (α-SMA), and synthesize extracellular matri x protein. Accumulating literature reveals that myofibroblasts are responsible for corneal haze/fibrosis, but the exact (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Govindaraj Anumanthan, PhD Source Type: research
Long-term Follow-up of LASEK With Mitomycin C Performed to Correct Myopia in Thin Corneas
Excimer laser surface ablation procedures, such as photorefractive keratectomy (PRK) and laser-assisted subepithelial keratomileusis (LASEK), have become the technique of choice in corneas with inferior steepening on corneal topography without keratoconus, patients with thin central corneal thickness (CCT), those at risk for trauma, and those in whom epithelial problems are anticipated, such as patients with recurrent erosion syndrome or basement membrane disease.1 Although some studies have shown that LASIK performed in thin corneas with normal preoperative topography is a safe procedure when (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Montserrat Garcia-Gonzalez, MD, PhD Source Type: research
The Use of Capsular Tension Rings to Reduce Refractive Shift in Patients With Implantation of Trifocal Intraocular Lenses
Interest in trifocal lenses, a new generation of multifocal lenses that have demonstrated good visual outcomes at near, intermediate, and distance, has recently grown.1 –5 Since 2013, Memira has gradually switched from using traditional bifocal IOLs to trifocal IOLs (FineVision MicroF and FineVision POD F/POD FT; PhysIOL, Liege, Belgium) at our refractive surgery clinics across Scandinavia—a move driven by high patient satisfaction and spectacle independence. H owever, in early 2015, the quality department at Memira received several case reports from its clinicians describing refractive (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Kristin Nistad, Optometrist BSc Source Type: research
Comparison of Methodologies Using Estimated or Measured Values of Total Corneal Astigmatism for Toric Intraocular Lens Power Calculation
Koch et al.1 reported that posterior corneal astigmatism has a mean magnitude of 0.30 diopters (D) with a steeper axis in the vertical meridian in more than 80% of eyes, and is relatively stable over the years. It is recognized that ignoring its power results in overcorrection in eyes with with-the-rule (WTR) astigmatism and undercorrection in eyes with against-the-rule (ATR) astigmatism.1,2 Traditionally, keratometers and topographers have evaluated only the anterior corneal surface. In most cases, a standard keratometric index of 1.3375 is used for converting anterior surface measures in (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Tiago B. Ferreira, MD, FEBOS-CR Source Type: research
Predictive Formula for Refraction of Autologous Lenticule Implantation for Hyperopia Correction
Small incision lenticule extraction (SMILE) has been widely accepted for its safety, efficacy, predictability, and stability in correction of myopia throughout the world.1,2 In this procedure, a femtosecond laser is used to create an intrastromal lenticule, along with one corneal incision that extends to the anterior surface of the intrastromal lenticule. As with femtosecond laser –assisted LASIK (FS-LASIK), correction is achieved by removing corneal tissue and reducing corneal thickness.3,4 Because the corneal stroma lenticule is extracted in one complete piece in the SMILE procedure, there is (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - December 12, 2017 Category: Opthalmology Authors: Meng Li, MD Source Type: research
Accuracy of Visual Estimation of LASIK Flap Thickness
The use of the femtosecond laser for the creation of LASIK flaps has gained popularity due to its safety and reproducibility. Several studies have compared the femtosecond laser to the microkeratome and demonstrated more accurate and reproducible flap thickness.1 –5 This has led some surgeons to abandon the practice of routinely calculating the flap thickness prior to performing ablation on the stromal bed. One of the most feared complications of refractive surgery is corneal ectasia. Numerous risk factors have been implicated in the development of post-refractive ectasia, including (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - November 8, 2017 Category: Opthalmology Authors: Jason E. Brenner, MD Source Type: research
Erratum for “Intracorneal Ring Segments Implantation for Corneal Ectasia”
The article “Intracorneal Ring Segments Implantation for Corneal Ectasia” by Giacomin et al., which was published in the December 2016 issue of the Journal of Refractive Surgery (volume 32, number 12, pp. 829–839), has been amended to include a factual correction. An error was identified subsequent to its original printing. On page 829, the author name “Cristine C. Serpe” should be “Crislaine C. Serpe.” This error was acknowledged on page 788, volume 33, issue 11. The online article and its erratum are considered the version of record. (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - November 8, 2017 Category: Opthalmology Authors: TBD Source Type: research
Intraoperative Optical Coherence Tomography –Guided Management of Cap–Lenticule Adhesion During SMILE
Small incision lenticule extraction (SMILE) is a new keratomileusis technique for laser vision correction. In this technique, an intrastromal refractive lenticule is extracted through a small peripheral incision (2 to 4 mm), obviating the need for creation of a flap.1 The most crucial step in the SMILE procedure is dissecting the intrastromal lenticule from the anterior stromal cap. Inadvertent entry of the dissector posterior to the lenticule can result in cap –lenticule adhesion and difficult lenticule extraction.2 An inability to recognize cap–lenticule adhesion and repeated efforts to find (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - November 8, 2017 Category: Opthalmology Authors: Jayanand Urkude, MD Source Type: research
Keratoconus Screening With Dynamic Biomechanical In Vivo Scheimpflug Analyses: A Proof-of-Concept Study
Identifying patients with ectatic predispositions is crucial in corneal refractive surgery.1,2 Further, a reliable and easy to handle screening device could enable screening programs for keratoconus in adolescents to facilitate early treatment of the otherwise sight-threatening disease.3,4 Despite noticeable improvements of topography and tomography analysis, keratoconus screening remains challenging in borderline cases.5 Most devices are expensive, large, and prone to interference and require a calm positioning of the patients for several seconds to enable good quality results, which can be (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - November 8, 2017 Category: Opthalmology Authors: Johannes Steinberg, MD Source Type: research
Secondary Lenticule Remnant Removal After SMILE
Small incision lenticule extraction (SMILE) was first described by Sekundo et al.1 more than 5 years ago, and numerous studies have demonstrated its safety, efficacy, and stability in correcting myopia and myopic astigmatism.2 –7 However, both intraoperative and postoperative complications have been reported.8,9 In cases of difficult lenticule dissection, there could be incomplete lenticule removal, leaving a lenticule remnant in the eye. This could result in irregular astigmatism and reduced visual acuity.10,11 We have encountered several cases of incomplete lenticule removal that were (Source: Journal of Refractive Surgery)
Source: Journal of Refractive Surgery - November 8, 2017 Category: Opthalmology Authors: Alex L.K. Ng, FRCSEd (Ophth) Source Type: research
