Early Corneal Wound Healing and Inflammatory Responses after Refractive Lenticule Extraction (ReLEx)

Riau, Andri K.; Angunawela, Romesh; Chaurasia, Shyam S.; Lee, Wing S.; Tan, Donald; Mehta, Jodhbir S.

doi:10.1167/iovs.11-7439

Cited by 113 publications

(97 citation statements)

References 26 publications

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“…The clinical symptoms and signs were scored at the initiation of treatment and after the 1st, 2th, 4th, and 8th weeks, and then graded (Table 1, modified from previously published studies [10,18]). The images of dendritic cells obtained by confocal microscopy were analyzed with ImageJ software (http://rsbweb.nih.gov/ij/index.html) [19,20]. The scores and data were expressed as the mean ± standard deviation.…”

Section: Methodsmentioning

confidence: 99%

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

Wan¹,

Tang²,

Han³

et al. 2017

Ophthalmic Res

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Objective: The purpose of this study was to evaluate the efficacy and safety of 0.1% tacrolimus eye drops in the tarsal form of vernal keratoconjunctivitis (VKC) and to survey the changes of dendritic cells at the palpebral conjunctiva in patients with VKC by in vivo confocal microscopy. Methods: A total of 17 patients (34 eyes) with the tarsal form of VKC were enrolled in this prospective, nonrandomized case series. They were treated with 0.1% tacrolimus eye drops twice daily after discontinuation of all other topical medications. Subjective ocular symptoms and objective ocular signs were scored on a 4-point scale by one ophthalmologist and the characteristics of the dendritic cells in each right eye at the palpebral conjunctiva were evaluated by in vivo confocal microscopy before treatment and at the 1st, 2th, 4th, and 8th weeks after treatment. Results: After 1 week of treatment with 0.1% tacrolimus eye drops, the score for each symptom in all patients showed a significant (p < 0.001) improvement, and 13 patients (76%) experienced dramatic relief of symptoms. In addition, there was a significantly (p < 0.001) decreased clinical sign score (except for giant papillae) after 4 weeks, and a significant (p < 0.001) improvement in the score of giant papillae after 8 weeks of treatment. The characteristics of dendritic cells (including cell count, total area, average size, perimeter, and diameter) showed a significant (p < 0.05) decrease after 2 weeks of treatment. During the follow-up, no other topical medications were required and no significant changes in visual acuity were documented. No cataracts or elevation of intraocular pressures were detected. Only 5 patients (29%) had a tingling or burning sensation or discomfort. Conclusions: Tacrolimus 0.1% eye drops are an effective and safe treatment for the tarsal form of VKC, and can rapidly inhibit the activity of dendritic cells, improve symptoms, reduce papillary hyperplasia, and reverse damage at the palpebral conjunctiva. The side effects could affect the compliance of some patients.

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Section: Methodsmentioning

confidence: 99%

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

Wan¹,

Tang²,

Han³

et al. 2017

Ophthalmic Res

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“…In accordance, a study in rabbits has demonstrated FLEx to induce less wound healing and inflammation than FS-LASIK, particularly after high myopic corrections. 47 In another recent study in rabbits, SMILE also induced less keratocyte apoptosis, proliferation and inflammation compared with FS laser LASIK. 46 Whether these observations have any clinical relevance remains to be determined; wound repair after LASIK and, in particular, PRK has been extensively investigated and is known to influence the postoperative outcome.…”

Section: Wound Healingmentioning

confidence: 93%

New Developments in the Lenticule Extraction Procedure

Hjortdal¹,

Ivarsen²

2014

European Ophthalmic Review

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31Over the last few years, surgical extraction of a refractive lenticule, or ReLEx ® , has evolved as a new treatment in the field of keratorefractive surgery. Currently, the VisuMax ® femtosecond (FS) laser (Carl Zeiss Meditec, Jena, Germany) is the only platform to offer this treatment.The 500 kHz VisuMax laser generates very fast pulses (10 -15 s range) in the near-infrared spectrum. Depending on the specific laser settings, each pulse conveys approximately 150 nJ, which causes localised photodisruption at the focal point. The generated plasma expands, creating a cavitation bubble, and, as individual cavitation bubbles fuse, the stroma is cut with a minimum of collateral damage. The VisuMax FS laser uses a high numerical aperture and a concave contact glass to focus the laser pulses with very high precision. Thus, laser spots of approximately 1 μm diameter are placed with a defined distance of 2-5 μm in a spiral pattern. To ensure centration on the visual axis, the patient fixates on a blinking light and suction is applied at the limbus to maintain stability of the eye. Initially, the posterior refractive surface of the lenticule is cut, followed by creation of the plano anterior surface, which is slightly enlarged in diameter to facilitate surgical manipulation.This review article reviews the current state of the technique, updated clinical results, 1 experimental studies and, finally, presents some of the challenges that need to be addressed by new technologies.Depending on the method used to access the lenticule, ReLEx can be split into FLEx, in which a laser-assisted in situ keratomileusis ( In contrast to LASIK, ReLEx is a one-laser approach, where the critical laser treatment is performed on the intact cornea rather than on exposed corneal stroma. Consequently, the potential variability associated with the excimer laser photoablation is avoided.In addition, the minimally invasive SMILE treatment has several theoretical advantages over flap-based treatments, including little trauma to the corneal surface, less corneal denervation and better biomechanical strength due to an almost intact anterior stroma. Since AbstractFor the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism.Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualise...

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Section: Experimental Studiesmentioning

confidence: 99%

“…In contrast to the excimer laser, femtosecond lasers deliver only minimal amounts of energy to surrounding tissue [49], suggesting that the femtosecond laser may induce less postoperative wound repair. In accordance, a recent study in rabbits has demonstrated ReLEx flex to induce less wound healing and inflammation than FS-LASIK, particularly after high myopic corrections [49]. Whether this observation has any clinical consequence remains to be determined; however, wound repair after LASIK and, in particular, PRK has been extensively investigated and is known to influence the postoperative outcome [48,50,51].…”

Section: Experimental Studiesmentioning

confidence: 99%

All-Femtosecond Laser Keratorefractive Surgery

Ivarsen

Hjortdal

2013

Curr Ophthalmol Rep

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During the last few years, refractive lenticule extraction (ReLEx) has been introduced as a new approach in the field of keratorefractive surgery. In contrast to previous treatments, ReLEx is an all-femtosecond laser treatment where a refractive lenticule is created within the intact cornea. The lenticule can be removed using a flapbased approach (ReLEx flex), but in its latest evolution (ReLEx smile), the lenticule is extracted through a small peripheral incision, leaving most of the anterior stroma untouched. In theory, this approach should spare most of the corneal nerves and minimize the biomechanical impact of the procedure. Clinical studies have shown the safety and the visual and refractive outcomes after ReLEx to be as good as after FS-LASIK. The current article aims to provide an up-to-date overview of all-femtosecond laser keratorefractive surgery with particular emphasis on the most current of approach, ReLEx smile.

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Early Corneal Wound Healing and Inflammatory Responses after Refractive Lenticule Extraction (ReLEx)

Abstract: This study has shown that the ReLEx procedure may result in less topographic changes, inflammation, and early extracellular matrix deposition than LASIK, especially at high refractive correction.

Cited by 113 publications

References 26 publications

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

New Developments in the Lenticule Extraction Procedure

All-Femtosecond Laser Keratorefractive Surgery

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