Acute Corneal Endothelial Changes After Laser In Situ Keratomileusis

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative mitomycin-C on healthy corneal endothelium after laser-assisted subepithelial keratectomy

Zhao

Wei

et al. 2008

“…Although there are fewer studies of endothelial cell health conducted after LASIK than after PRK, most refractive surgeons have concluded that there are no significant lasting corneal endothelial changes. 10,11 Despite these reassuring reports, a substantial body of evidence indicates otherwise. Pallikaris and Siganos 12,13 report significant endothelial cell loss 6, 12, and 24 months after LASIK.…”

Section: Discussionmentioning

confidence: 99%

Myopic laser in situ keratomileusis in eyes with thick corneas

Wykoff¹,

Pineda²

2006

Laser in situ keratomileusis (LASIK) for the correction of refractive errors is effective, predictable, stable, and safe. 1 Contraindications to LASIK have been proposed including pregnancy, lactation, corneal edema, dry eyes, and systemic immune disorders such as rheumatoid arthritis and systemic lupus erythematosus. One of the most widely accepted contraindications is a thin cornea because of the risk for triggering iatrogenic keratectasia. 2 Outcomes after LASIK performed in eyes with thick corneas, however, are not well defined, and literature regarding this topic is lacking. Therefore, the safety and effectiveness of LASIK performed for correction of myopia and astigmatism on eyes with thick corneas was evaluated compared with published data.A thick cornea was defined as one having a central corneal thickness (CCT) R 599 mm, based on a recent review by Doughty and Zaman, 3 which determined the mean CCT in normal human eyes as 536 mm with a standard deviation (SD) of 31 mm. Thus, a CCT of R599 mm represents a cutoff greater than 2 SD above the mean and identifies approximately 2.5% of the population. METHODS AND RESULTSIn this retrospective chart-review analysis, all medical records for patients who had LASIK by the same surgeon (R.P.) at the Massachusetts Eye and Ear Infirmary in Boston, Massachusetts, between 1999 and 2004 were reviewed (approximately 2500 patients), and 70 eyes of 47 patients were identified with a preoperative CCT R599 mm, 43 (61.4%) in women and 27 (39.6%) in men. Mean CCT by ultrasonic pachymetry (DGH) was 614 mm (range 599 to 650 mm) ( Figure 1). Mean patient age was 41.8 years (range 23 to 60 years). Mean preoperative manifest spherical equivalent was ÿ4.57 diopters (D) (range ÿ1.63 to ÿ10.38 D; mean sphere ÿ3.97 D, mean cylinder ÿ1.20 D). No patient had clinically evident corneal edema or guttae.For LASIK treatments, a corneal flap was created using a Hansatome microkeratome (Bausch & Lomb) (64 eyes) with a 160 mm or 180 mm microplate head or an IntraLase laser (6 eyes) with a 115 mm flap thickness. The stromal bed was then treated with 1 of 3 excimer lasers: Visx Star S2 (49 eyes), Visx Star S4 (11 eyes), or Technolas 217A (Bausch & Lomb) (10 eyes), and the flap was then repositioned. Intraoperatively, 1 patient experienced a mild corneal abrasion. No other intraoperative complications were encountered. Treatment targets were between plano and ÿ0.5 D.Postoperatively, patients were followed for a mean of 8.3 months. Two eyes experienced displaced flaps on day 1 requiring repositioning (2.4%). No other complications were encountered. Ninety percent of eyes (63 of 70) were followed up for at least 1 month, at which point 67% had an uncorrected visual acuity (UCVA) of 20/25 or better and 87.3% had an UCVA of 20/40 or better.Enhancement was performed in 13 eyes (18.6%) in response to patient request for additional visual correction. Eleven of the enhancements were performed by additional excimer laser treatment, and 2 enhancements were performed by arcuate keratotomy. Eyes that necessita...

“…24,25 While the period of increased IOP during LASIK on application of the suction ring is minimal, in cases of marginal endothelial function, this transient spike may have the potential to induce stromal edema and cellular damage. Kim et al 19 reported morphological changes in a patient who had application of the suction ring only, suggesting that even transient increases in pressure may have an effect on the endothelium.…”

Section: Discussionmentioning

confidence: 99%

Laser in situ keratomileusis in patients with corneal guttata and family history of Fuchs' endothelial dystrophy

Moshirfar

Feiz²,

Feilmeier³

et al. 2005