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To compare the postoperative refractive outcomes and visual quality between topography-guided laser in situ keratomileusis (TG-LASIK) and small incision lenticule extraction (SMILE) over a 6-month follow-up. This study included 100 eyes of 50 patients, 50 eyes received TG-LASIK and 50 underwent SMILE. The outcomes measured included uncorrected distance visual acuity (UDVA), spherical equivalent (SEQ), cylinder, contrast sensitivity, and objective visual quality including objective scattering index (OSI), modulation transfer function (MTF) cutoff and Strehl Ratio (SR). Baseline characteristics differed between groups, with the SMILE group being younger and demonstrating better preoperative UDVA and lower cylinder. At 6 months, 98% of TG-LASIK eyes and 100% of SMILE eyes achieved UDVA of 0.0 logMAR or better, with no significant difference between groups (P = 0.315). A significantly higher percentage of eyes in the TG-LASIK group achieved SEQ within ±0.25 D (58% vs 36%, P = 0.028) and ±0.50 D (88% vs 64%, P = 0.01). Despite treating significantly higher preoperative astigmatism, TG-LASIK achieved comparable correction accuracy to SMILE. Objective visual quality was similar between groups at 3 and 6 months; SMILE showed higher MTF cutoff at 1 month (P = 0.027). TG-LASIK demonstrated significantly higher contrast sensitivity at 6.0 c/d (P < 0.001) and 18.0 c/d (P < 0.001) at 6 months. Both TG-LASIK and SMILE are effective and safe for myopia and astigmatism correction. TG-LASIK demonstrated higher refractive precision and better contrast sensitivity at higher spatial frequencies compared to SMILE. Conventional FS-LASIK and SMILE have been widely compared in previous studies. However, TG-LASIK differs from both procedures by using individualized corneal topography to guide customized ablation and is often applied in eyes with higher astigmatism or greater refractive complexity in routine practice. Whether this customized approach provides meaningful clinical advantages over SMILE under real-world conditions remains unclear. Both TG-LASIK and SMILE provided comparable visual acuity outcomes at 6 months after surgery. TG-LASIK achieved higher refractive precision, with a greater proportion of eyes reaching the intended spherical equivalent target. Although objective visual quality parameters were largely similar between the two groups, TG-LASIK was associated with better contrast sensitivity at higher spatial frequencies.
To compare corneal nerve architecture and sensory function, and the distribution and morphodynamic (morphologic and dynamic) features of epithelial and stromal immune cells, between healthy (control) and post-LASIK corneas. Participants, comprising healthy (control) adults (n = 19) and age-similar individuals who had undergone myopic LASIK six to 24 months prior (n = 13), underwent ocular surface evaluations. Corneal sensitivity to mechanical (air) and hyper-osmotic (saline) stimuli were quantified. Corneal functional in vivo confocal microscopy (Fun-IVCM) imaging was performed; time-lapsed videos at ∼6.0 ± 2.0 min intervals, were used to quantify the density and morphodynamics of intraepithelial putative T cells and dendritic cells (DCs), and intrastromal macrophages. Corneal features, ocular surface findings and tear cytokines (analyzed using multiplex bead-based immunoassay) were compared between groups. Relative to controls, post-LASIK participants had lower central corneal epithelial nerve parameters, and attenuated sensitivity to mechanical, but not hyper-osmotic, stimuli. In the inferior cornea, putative DC density was lower and DC area was higher in post-LASIK corneas than controls (p < 0.05 for both comparisons). Putative T cell speed was higher in post-LASIK corneas at the whorl (p = 0.012), but similar in the inferior cornea. Clinical ocular surface findings, and corneal stromal macrophage features, were similar between groups. Post-LASIK participants had higher levels of tear interleukin-16 than controls (p = 0.0004). In post-LASIK corneas, sub-clinical differences in in vivo corneal nerve architecture and mechanosensitivity, and immune cell morphodynamics, were observed compared to healthy corneas. The long-term functional significance of these differences in corneal nerve and immune cell features after LASIK warrants further study.
This study compares the readability and thoroughness of patient education materials for LASIK and cataract surgery. Online patient education materials for LASIK and cataract surgery were collected from the top 30 U.S. ophthalmology programs, the American Academy of Ophthalmology (AAO), and generated using Doximity GPT. Materials were assessed using eight readability metrics that produced an average reading level score. Materials were also assessed for inclusion of information pertaining to description of the procedure, patient eligibility and contraindications, procedural risks, and post-operative care. Average readability and thoroughness were then compared between materials for each procedure. Of 30 ophthalmology programs, 27 had online patient education materials for LASIK and 19 for cataract surgery. There was no significant difference between the readability of LASIK and cataract surgery materials (grade level of 10.11 vs. 10.77, p = 0.100). A greater proportion of LASIK materials discussed patient eligibility (81.5% vs. 10.5%, p < 0.001), though there was no difference in the frequency of information pertaining to procedural risks and post-operative care. The AAO's materials were more readable than those from top ophthalmology programs (LASIK: 8.06 vs. 10.10, p < 0.001; cataract surgery: 8.73 vs. 10.77, p < 0.001), as were the Doximity GPT-generated materials (LASIK: 5.82 vs. 10.10, p < 0.001; cataract surgery: 7.32 vs. 10.77, p < 0.001). Online patient education materials for both LASIK and cataract surgery exceed a tenth-grade level, making them inaccessible to many patients. Ophthalmologists may consider using Doximity GPT to generate more readable materials.
To compare refractive predictability, long-term stability, visual quality, ocular surface outcomes, and safety of small incision lenticule extraction (SMILE), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy (Trans-PRK) for myopia correction in an Iraqi population. This retrospective multicenter comparative cohort study included 919 eyes of 919 patients who underwent SMILE (388 eyes), FS-LASIK (344 eyes), or Trans-PRK (187 eyes) between January 2023 and December 2025. Postoperative outcomes were evaluated at 6 months, 1 year, and 1.5 years. Primary outcome measures included refractive predictability and stability of spherical equivalent (SE). Secondary outcomes included uncorrected and corrected distance visual acuity (UDVA and CDVA), absolute refractive error, induced corneal higher-order aberrations (HOAs) at 6 months, Ocular Surface Disease Index (OSDI) scores, and safety outcomes. Multivariable linear regression analysis was performed to identify factors associated with residual SE at 1.5 years. SMILE demonstrated the highest refractive predictability and long-term stability, with postoperative SE values closest to emmetropia and the narrowest distribution of residual refractive error at all follow-up intervals. FS-LASIK showed intermediate outcomes, whereas Trans-PRK was associated with greater residual myopia and increased refractive regression over time. Induced corneal HOAs were lowest following SMILE and highest following Trans-PRK. OSDI scores were consistently lower after SMILE, intermediate after FS-LASIK, and highest after Trans-PRK throughout follow-up. Multivariable analysis identified surgical technique as the primary independent predictor of residual SE at 1.5 years, with FS-LASIK and Trans-PRK associated with significantly greater myopic residual error than SMILE. All three procedures demonstrated a high safety profile, with low rates of CDVA loss and infrequent enhancement procedures. In this large multicenter Iraqi cohort, SMILE provided superior refractive predictability, long-term stability, visual quality, and ocular surface outcomes compared with FS-LASIK and Trans-PRK. FS-LASIK remained an effective and safe alternative, while Trans-PRK was associated with greater refractive regression and higher enhancement rates, particularly in eyes with higher degrees of myopia. These findings support procedure-specific patient selection to optimize refractive outcomes and postoperative comfort.
FS-LASIK, small-incision lenticule extraction (SMILE), and phakic intraocular lens (ICL) implantation are widely used for correcting moderate to high myopia, yet their effects on peripheral optical quality remain incompletely understood. This study compared central and peripheral optical outcomes after these three procedures using on-axis and off-axis wavefront measurements. This retrospective comparative study included 598 eyes (18-35 years) that underwent FS-LASIK, SMILE, or phakic ICL implantation. Wavefront aberrations were measured preoperatively and at 6 months postoperatively, both centrally and at ± 30° eccentric fixation, using a modified Shack-Hartmann aberrometer. The measurements were reconstructed over a 4.5-mm pupil, ensuring consistency across subjects.Second-, third-, and fourth-order RMS aberrations, peripheral relative defocus, astigmatic vector J0, and horizontal coma were analyzed pre- and postoperatively, with inter-group comparisons and correlations with preoperative spherical equivalent (SE). All procedures achieved high refractive accuracy with minimal surgically induced astigmatism. Second-order aberrations were substantially reduced in all groups. Third-order aberrations increased postoperatively, most prominently after FS-LASIK, followed by SMILE and then ICL implantation, while fourth-order changes were small and similar among groups. Peripheral relative defocus shifted toward hyperopia after all procedures, greatest after FS-LASIK. Induced higher-order aberrations and peripheral defocus were significantly correlated with preoperative SE, particularly in the FS-LASIK group. Although FS-LASIK, SMILE, and phakic ICL implantation all provided effective correction of moderate to high myopia, they were associated with different patterns of postoperative central and peripheral optical change. In this cohort, phakic ICL implantation showed relatively smaller changes in peripheral optical quality measures, whereas FS-LASIK was associated with greater spherical equivalent-dependent increases in higher-order aberrations and peripheral hyperopic defocus. Peripheral wavefront assessment may provide clinically relevant information beyond central aberrometry.
To compare the distribution of relative peripheral refraction (RPR) and higher-order aberrations (HOAs) following ray-tracing-guided (RG) and topography-guided (TG) femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and to investigate their associations with postoperative visual symptoms. This study compared the clinical outcomes of RG FS-LASIK and TG FS-LASIK, with 50 eyes from 50 patients prospectively enrolled in each group. Evaluations preoperatively and 3 months postoperatively included visual acuity, manifest refraction, HOAs, RPR, and the quality of vision questionnaire. RPR was assessed via wide-field peripheral refraction and analyzed across eccentricities (5°, 12.5°, 25°, and >25°) within the superior, inferior, nasal, and temporal quadrants. The RG and TG groups showed comparable visual outcomes, with no significant differences in efficacy index (1.16 ± 0.22 vs. 1.14 ± 0.21, p = 0.755) and safety index (1.21 ± 0.22 vs. 1.24 ± 0.21, p = 0.816). Both platforms induced changes in HOAs and coma, whereas reduced spherical aberration was found in the RG group. Both procedures led to a reduction in RPR, a trend that became increasingly prominent in the peripheral region. However, the TG group showed relatively uniform RPR changes across the visual field, whereas the RG group exhibited a significant increase in superior-inferior RPR asymmetry after FS-LASIK. RPR was regionally associated with HOAs, with >25° RPR mainly correlated with spherical aberration (r = -0.458, p < 0.001) and HOAs (r = -0.265, p = 0.008), and superior-inferior asymmetry was negatively correlated with spherical aberration (r = -0.357, p = 0.001). Regression analysis indicated that superior RPR (coef = -0.601, p = 0.001) and superior-inferior (S - I) symmetry (coef = 0.652, p = 0.004) were significantly associated with glare, and a negative shift in spherical aberration (coef = 0.917, p = 0.007) was associated with fewer starburst symptoms. Both RG and TG FS-LASIK provide comparable central visual correction, but they exert distinct effects on RPR profiles and HOAs. Postoperative glare was associated with RPR asymmetry, whereas the negative spherical aberration appeared to alleviate starburst symptoms. Chinese Clinical Trial Registry (ChiCTR2500106477), retrospectively registered on July 24, 2025.
To evaluate within-group corneal biomechanical changes induced by LASIK, photorefractive keratectomy (PRK), and corneal cross-linking (CXL) using Corvis ST, while accounting for differences in baseline corneal status between refractive surgery candidates and keratoconic eyes. This prospective comparative study included 150 eyes of 150 patients undergoing LASIK (n = 50), PRK (n = 50), or epithelium-off CXL for keratoconus (n = 50). Corneal biomechanical parameters were assessed preoperatively and at 6 months postoperatively using Corvis ST, including deformation amplitude (DA), stiffness parameter at first applanation (SP-A1), DA ratio at 2 mm, Ambrósio relational thickness horizontal (ARTh), corneal biomechanical index (CBI), and tomographic biomechanical index (TBI), the latter derived from combined Pentacam tomography and Corvis ST measurements. Within-group changes were analyzed using paired parametric or non-parametric tests as appropriate. Between-group comparisons were performed using ANCOVA or linear mixed-effects models adjusted for baseline values, age, central corneal thickness, and biomechanically corrected intraocular pressure. LASIK and PRK eyes demonstrated significant postoperative increases in DA, DA ratio at 2 mm, CBI, and TBI, along with significant reductions in SP-A1 and ARTh (all p < 0.001), indicating biomechanical weakening relative to their preoperative state. The magnitude of weakening was greater following LASIK than PRK after baseline adjustment. In contrast, keratoconic eyes treated with CXL showed significant reductions in DA, DA ratio, CBI, and TBI, and a significant increase in SP-A1 (p < 0.001), consistent with biomechanical stiffening. These changes occurred despite differing baseline biomechanical profiles between groups. LASIK and PRK are associated with measurable corneal biomechanical weakening, whereas CXL induces biomechanical stiffening in keratoconic corneas. These findings should be interpreted within the context of distinct baseline corneal conditions rather than as direct comparisons of procedural efficacy. Corvis ST provides a robust framework for quantifying procedure-specific biomechanical directionality within different clinical settings.
To assess patient subjective responses regarding satisfaction of vision, visual disturbances, and dry eye symptoms following WaveLight LASIK surgery for myopia or myopic astigmatism. This was an ambispective, multicenter, multi-surgeon, single arm, observational study. Subjects were included who had Wavefront Optimized or Phorcidies Planned Contoura LASIK (using the Wavelight EX500 laser) for myopia or myopic astigmatism (targeting bilateral emmetropia) within the last 12 to 15 months. Eligible subjects were identified by retrospective chart review and administered a modified Patient-Reported Outcomes with LASIK (PROWL), Ocular Surface Disease Index (OSDI), and dry eye questionnaires. A total of 300 subjects completed the study. Postoperatively, all patients were satisfied with their vision, with 95% (285/300) reported being "Completely Satisfied" or "Very Satisfied". In addition, 95% (285/300), 79% (237/300), 78% (234/300), and 70% (210/300) of subjects reported "Never" or "Rarely" experiencing double images, glare, halos, and starbursts, respectively, while 0% (0/300), 2% (6/300), 1% (3/300), and 3% (9/300) of subjects reported that these same visual disturbances were "Extremely" or "Very" bothersome, respectively. Furthermore, 98% (294/300) of patients said they would choose to have the procedure again and 98% (294/300) would recommend it. Mean score on the OSDI questionnaire was 8.7 ± 8.2, with the majority (71%, 213/300) of the subjects being asymptomatic (score < 12). The mean OSDI score was within the range indicative of a normal ocular surface. The results suggest high patient satisfaction of vision after approximately 12 months following Wavelight LASIK. Visual disturbances were rated low in frequency and in bothersomeness.
We present a case of epithelial ingrowth after late onset interface fluid syndrome, a rare complication after laser in situ keratomileusis (LASIK). This patient presented herself to the emergency department with corneal oedema due to endothelial failure after multiple intraocular surgeries. Anterior segment optical coherence tomography (OCT) showed a fluid filled pocket in the LASIK interface, 20 years after LASIK surgery. As a result, she was diagnosed with late onset interface fluid syndrome which resolved after endothelial transplantation (DMEK). However, 3 months after surgery, epithelial ingrowth in the LASIK interface was noticed. We adopted a conservative approach as there was no progression after 3 weeks. Epithelial ingrowth is a rare complication after DMEK, which might be caused by interface fluid induced flap lifting and further facilitated by intraoperative flap manipulation during graft unfolding.
Dry eye disease (DED) is among the most common complications experienced after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK), often affecting visual recovery, as well as patient satisfaction. Low-level light therapy (LLLT) has shown benefits in various ocular surface diseases, but its role in refractive surgery remains underexplored. This study aimed at evaluating the efficacy of perioperative LLLT in preserving tear film parameters and reducing ocular discomfort symptoms after Femto-LASIK. In this prospective multicentric, randomized, double-masked, sham-controlled clinical study, adult patients undergoing Femto-LASIK were randomized (1:1) to receive periocular LLLT (633 ± 10 nm, 15 min/session) or sham treatment 7 ± 2 days before and after surgery. Ocular surface evaluation was performed at baseline (T0), and 1 week (T1), 1 month (T2), and 3 months (T3) postoperatively. Outcomes were tear meniscus height (TMH), Schirmer test values, and Dry Eye Questionnaire-5 (DEQ-5) scores, noninvasive tear break-up time (NIBUT), and interferometry. Forty eyes of 40 patients (mean age: 34.58 ± 5.67 years) were analyzed. In the LLLT group, tear film parameters and subjective symptoms remained stable throughout follow-up, with no statistically significant changes over time. Conversely, the control group showed a significant decline in TMH (0.27 ± 0.05 mm to 0.20 ± 0.05 mm; p < 0.001), Schirmer test (20.39 ± 10.84 mm/5' to 15.65 ± 9.02 mm/5'; p = 0.022), and a significant worsening in DEQ-5 scores (3.53 ± 4.10 to 5.94 ± 2.79; p = 0.005). Between-group comparisons demonstrated in the LLLT group significantly higher TMH at T2 (p = 0.034) and T3 (p = 0.016), higher Schirmer values at T2 (p = 0.048) and T3 (p = 0.018), and lower DEQ-5 scores at T1 (p = 0.041), T2 (p = 0.029), and T3 (p = 0.018). NIBUT and interferometry showed no significant between-group differences at any time point. No treatment-related adverse events were observed. Perioperative LLLT appears to be a safe and well-tolerated adjunctive treatment that may help preserve tear volume and support postoperative comfort after Femto-LASIK. These findings suggest a potential role for LLLT in perioperative refractive surgery care, although further studies are warranted to confirm its clinical benefit.
To compare early postoperative dry eye outcomes in contralateral eyes of the same patients undergoing Keratorefractive Lenticule Extraction (KLEx) versus Femtosecond Laser-Assisted Laser In Situ Keratomileusis (FS-LASIK), with tear film osmolarity defined as the primary outcome measure. This study was conducted at Dunyagoz Izmır Hospital and involved patients who underwent corneal refractive surgery between June 2021 and December 2024. Patients with pre-existing dry eye disease were excluded from the study. Patients underwent KLEx in one eye and FS-LASIK in the fellow eye. Tear film osmolarity (primary outcome) was measured preoperatively and postoperatively using the TearLab® system. Secondary outcome measures included tear break-up time (tBUT) and subjective symptoms assessed via the Ocular Symptom Questionnaire Scores (OSDI). A total of 34 eyes of 17 patients (7 females and 10 males) were evaluated. Group 1 (KLEx) included 17 eyes and group 2 (FS-LASIK) included contralateral 17 eyes. The mean postoperative follow-up period was 34.2 days. Mean tear osmolarity was 297.7 ± 8.3 mOsm/L in the group 1 and 315.3 ± 10.2 mOsm/L in the group 2 (p < 0.001). Mean tBUT was 10.3 ± 3.1 s for group 1 and 7 ± 2.32 s for group 2 (p < 0.001). The mean postoperative OSDI scores were 32.5 for group 1 and 42 for group 2, with a preoperative baseline of 10.2 (both groups; p < 0.001). KLEx demonstrated superior early postoperative ocular surface stability compared to FS-LASIK in contralateral eyes. The procedure resulted in significantly less tear hyperosmolarity and better subjective comfort, suggesting it may be a preferable surgical option for minimizing dry eye induced by corneal refractive surgery.
Background/Objectives: Femtosecond laser-assisted LASIK (FS-LASIK) is currently the most commonly performed procedure for the correction of myopia and myopic astigmatism. However, it inherently weakens the biomechanical integrity of the cornea due to flap creation and stromal ablation. This prospective study aimed to compare refractive and corneal biomechanical parameters after myopic FS-LASIK with different flap thicknesses and to identify parameters that may influence the change in corneal biomechanics after surgery. Methods: A total of 246 eyes were enrolled and divided into two groups based on flap thickness: 110 µm (n = 129) and 140 µm (n = 117). All procedures were performed using a femtosecond LDV Ziemer laser and standardized ablation profiles with similar ablation depths. Visual acuity, refractive outcomes, and corneal biomechanical parameters-corneal hysteresis (CH) and corneal resistance factor (CRF)-were assessed preoperatively and during a 6-month follow-up using the Ocular Response Analyzer (ORA). Multivariate regression analysis was used to identify predictors of biomechanical change. Results: The groups did not differ in preoperative values of the mean refractive spherical equivalent, keratometry, central corneal thickness, CH and CRF. At 6 months, both groups achieved comparable refractive outcomes, with no significant differences in uncorrected or corrected distance visual acuity, efficacy index and safety index. However, the thicker flap group exhibited significantly greater reductions in CH (-2.89 vs. -2.04 mmHg, p < 0.05) and CRF (-3.61 vs. -2.77 mmHg, p < 0.05), as well as greater biomechanical weakening per micron of ablation. Multivariate regression identified anterior weighted biomechanical index (AWBI) and flap thickness as the strongest predictors of CH reduction, while flap thickness, residual stromal bed thickness, ablation depth, and central corneal thickness contributed to CRF changes. Conclusions: While FS-LASIK with both flap thicknesses achieved equally effective visual outcomes, thicker flaps were associated with significantly greater biomechanical weakening. Flap thickness had a stronger influence on corneal biomechanics than ablation depth. These findings support consideration of flap thickness in surgical planning to optimize corneal biomechanical stability.
PurposeTo evaluate the differences in hyperopic laser assisted in situ keratomileusis (LASIK) results between small, medium, and large cyclorotational angle degrees.MethodsThis retrospective study included consecutive patients who underwent hyperopic LASIK between 2012 and 2023 at Care-Vision Laser Centers, Israel. Patients were divided into three groups according to their cyclorotation angle magnitude. A comparison of baseline and intraoperative parameters was performed. Refractive and visual outcomes were assessed, including Efficacy and safety indexes, and an Alpins vector analysis was performed. Multiple linear regression was performed to identify the effect of potential confounders.ResultsOverall, 621 eyes of 428 patients were included. Mean age was 44.5 ± 12.6 years and 52.7% were female. Analysis indicated no significant differences in any of the visual and refractive outcomes including the calculated indexes. Alpins vector analysis showed no significant differences between the groups in any of the vectors either in size or magnitude, nor were there significant differences in the Alpins calculated indicators. Multi-linear regression for potential confounders suggested the preoperative axis had significant confounding association only with a null effect (β < 0.01, p = 0.03) on the Alpins index of success.ConclusionsCyclorotational angle magnitude did not significantly impact visual or refractive outcomes in hyperopic LASIK performed using modern excimer laser systems with cyclorotation correction abilities. These findings suggest limited clinical relevance of cyclorotation degree in LASIK outcomes in this context, with other factors potentially playing a more significant role in surgical planning.
To assess the refractive outcomes, visual quality, and patient satisfaction after ray-tracing-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the correction of moderate-to-high myopia and myopic astigmatism. In this consecutive case series retrospective study, 51 patients (101 eyes) with moderate-to-high myopia and myopic astigmatism underwent ray-tracing-guided FS-LASIK. Visual acuity, manifest refraction, objective and subjective visual quality, patient satisfaction were assessed over 3 months. For objective visual quality, InnovEyes Sightmap was used to measure the higher-order aberrations (HOAs) over 5-mm optical zone, and Optical Quality Analysis System II was used to evaluate the modulation transfer function cut off (MTFcut off) frequency, Strehl ratio (SR), and ocular scattering index (OSI). Subjective visual quality was evaluated utilizing the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire. Regarding visual and refractive outcomes, at 3 months, uncorrected distance visual acuity reached ≥ 20/20 in all eyes, ≥20/16 in 69% of eyes, and ≥20/12.5 in 18% of eyes. Best-corrected distance visual acuity was better in 61% of eyes. All eyes achieved manifest refractive spherical equivalent within ± 1.00 D and 86% of eyes achieved cylinder within ± 0.25 D. As for objective visual quality, total HOA increased significantly (P < 0.001), whereas spherical aberration showed no significant change (P = 0.225); no changes were found in MTFcut off, SR, and OSI (all P > 0.05). In terms of subjective visual quality, 100% of patients reported clear distance vision, and 96.10% had no near-reading difficulty. Investigation of patient satisfaction showed that 98.04% of patients were satisfied with the surgery, 98.04% would recommend it to others. Ray-tracing-guided FS-LASIK may be an effective, safe and predictable procedure for moderate-to-high myopia and myopic astigmatism. It yielded favorable refractive outcomes, maintained objective visual quality, and achieved high patient satisfaction.
PurposeTo investigate the long-term efficacy, safety, and predictability of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the treatment of mixed astigmatism.MethodsThis retrospective study included 72 eyes of 43 patients who underwent FS-LASIK for mixed astigmatism and completed at least 3 years of follow-up. Uncorrected and corrected distance visual acuity (UDVA, CDVA), manifest refraction, corneal topography, and higher-order aberrations (HOAs) were evaluated preoperatively and at the 1st, 3rd, and 5th years postoperatively.ResultsThe study included 16 females and 27 males with a mean age of 29.44 ± 5.82 years and a mean follow-up of 4.41 ± 0.91 years. The mean preoperative UDVA and CDVA were 0.67 ± 0.34 and 0.07 ± 0.09 logMAR, respectively, and both improved significantly at all postoperative visits (each p < 0.001). The mean preoperative manifest spherical (1.66 ± 1.32 D) and cylindrical (-3.77 ± 1.05 D) values showed significant reductions at all postoperative follow-ups (each p < 0.001). At final follow-up, all HOAs decreased at a 4 mm, while at 6 mm, spherical aberration decreased and total HOAs increased (each p < 0.001).ConclusionLong-term outcomes indicate that FS-LASIK is an effective, safe, and predictable procedure for the correction of mixed astigmatism.
To assess the efficacy and safety of intense pulsed light (IPL) therapy in managing dry eye syndrome (DES) following laser-assisted in situ keratomileusis (LASIK) surgery through a systematic review and meta-analysis. A comprehensive literature search was conducted across PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov for studies reporting outcomes of IPL treatment in post-LASIK DES. Eligible studies included randomized controlled trials, observational studies with control groups, and retrospective or prospective chart reviews. Outcomes analyzed included tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, artificial tear use (ATU), corneal staining, lipid layer thickness, and meibomian gland function. Analyses were restricted to pre-post single-arm comparisons. Random-effects meta-analyses were conducted using inverse-variance weighting with DerSimonian-Laird estimation and Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity was assessed using I2 and τ2 statistics, and design-effect corrections were applied for eye-level clustering. Four studies met inclusion criteria, comprising 146 treated eyes. IPL was associated with a significant improvement in patient-reported symptoms measured by OSDI (P = 0.005). Improvements in TBUT, ATU, corneal staining, lipid layer thickness, and meibomian gland function were directionally favorable but did not reach statistical significance after conservative correction. Between-study heterogeneity was substantial, and follow-up duration was limited (0-24 weeks). IPL therapy may improve subjective dry eye symptoms following LASIK, while objective clinical outcomes remain uncertain. Current evidence remains limited, underscoring the need for larger, controlled studies with standardized protocols and longer follow-up to further define IPL's role in managing post-surgical dry eye.
Quantify clinical differences between standard and Correcting Applanation Tonometry Surface (CATS) Goldmann prism intraocular pressure (IOP) measurements in myopic laser in situ keratomileusis (LASIK) subjects and validate the CATS prism's accuracy using manometric comparisons in myopic LASIK cadaver eyes. Prospective cross-sectional cohort study and in vitro cohort comparison. One hundred ninety-eight eyes were enrolled from 100 subjects previously having undergone myopic LASIK. Separately, 18 enucleated globes that previously had undergone myopic LASIK were examined. LASIK subjects were enrolled from 3 investigative sites, obtaining IOP measurements by Goldmann with standard and CATS prisms per international standard organization (ISO) standardized procedures. Intraocular pressure measurements were taken using 18 enucleated LASIK globes at the manometric pressures between 5 and 50 mmHg. Statistically demonstrate the CATS prism IOP measurement is higher and more accurate compared to intracameral pressure in LASIK-treated cadaver eyes than the standard prism. Clinical validation of higher (CATS) IOP measurements compared to the standard prism in live LASIK subjects. In vivo, the mean IOP difference (CATS minus standard) was +1.50 ± 2.13 mmHg (p<0.0001), indicating standard prism underestimation post-LASIK. In cadaver eyes, the CATS prism consistently measured closer to true intracameral pressure (5-50 mmHg, p<0.0001), with mean differences ranging from +1.2 to +1.8 mmHg. No difference in prism measurement variability were noted (p>0.05). The CATS prism yields higher, more accurate IOP readings than the standard prism in myopic LASIK patients, aligning closely with intracameral pressure. Prior cadaver and clinical studies confirmed equivalence of the two prisms in healthy corneas (non-LASIK). Clinically, the CATS prism enhances ocular hypertension detection in LASIK patients, potentially reducing undiagnosed glaucoma risk. Findings may extend to other refractive surgeries or thin-cornea populations, warranting further study. Adoption of the CATS prism could refine postoperative IOP monitoring, impacting practice guidelines and patient outcomes. Standard Goldmann tonometry underestimates intraocular pressure (IOP) after myopic LASIK, while a CATS prism improves accuracy, validated by intracameral pressure in LASIK cadaver eyes. Measuring accurate eye pressure is critical to determining glaucoma risk. The LASIK procedure has been shown to falsely reduce pressure measurements. A CATS modification to the standard eye pressure measurement device yields a more accurate assessment of glaucoma in those who have had LASIK eye surgery.
To compare the clinical outcomes of the current V4c model of the myopic implantable Collamer lens (ICL) with those of laser in situ keratomileusis (LASIK) for the correction of myopia ranging from -2.0 to -18.0 diopters (D). This prospective, non-randomized study enrolled participants who underwent either LASIK or implantation of the ICL V4c at Bolor Melmii Eye Hospital. In the LASIK group, participants received Intralase LASIK (I-LASIK) using the Intralase FS-200 femtosecond laser and the MEL-80 excimer laser. Each group comprised the same number of participants and eyes (38 participants, 73 eyes). A total of 146 eyes from 76 participants were analyzed. Among the LASIK group, 76.3% were female, with a mean age at surgery of 29.76±5.95y (range, 20-43y). In the ICL group, 92.1% were female, with a mean age of 31.59±8.32y (range, 20-49y). Preoperative best-corrected visual acuity (BCVA) did not differ significantly between the LASIK and ICL groups (P=0.68). Postoperatively, the ICL group consistently demonstrated better BCVA (20/20 or better) at all follow-up points, with statistically significant differences observed at 1d (56.2% vs 30.1%, P=0.003) and 3mo (54.8% vs 32.9%, P=0.012). The mean BCVA improvement also favored the ICL group for up to 6mo postoperatively. A higher proportion of eyes in the ICL group achieved uncorrected distance visual acuity (UDVA) of 20/20 or better at 1mo (50.7% vs 41.1%, P=0.319) and 6mo (57.5% vs 43.8%, P=0.136), although these differences were not statistically significant. Predictability was comparable between the groups, except at 6mo, where fewer ICL-treated eyes were within ±0.5 D of the intended correction (49.3% vs 64.4%, P=0.094). Nevertheless, both groups achieved identical outcomes within ±1.0 D (90.4%, P=1.000). Between 1 and 6mo, 78.1% of eyes in the ICL group showed a change in spherical equivalent refraction of no more than 0.5 D, compared to 65.8% in the LASIK group. Refraction stability, defined as a change of less than 1.0 D, remained good in both groups throughout all follow-up periods. Both LASIK and ICL implantation leads to significant improvements in visual outcomes, with early postoperative gains observed in both groups. However, the ICL group demonstrates greater long-term improvement in BCVA compared to the LASIK group, particularly among participants with higher degrees of myopia. Visual outcomes in both groups stabilized by 6mo postoperatively.
To evaluate real-world visual and refractive outcomes in the Diabetes Mellitus (DM) population. DM may impair corneal healing and neurosensory function, often serving as a relative contraindication for laser vision correction (LVC). This study evaluated visual and refractive outcomes of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) in adults with controlled DM compared to healthy controls and compared the two techniques within the diabetic cohort. Care Vision Laser Center, Tel Aviv, Israel. Retrospective comparative study. This retrospective study (2013-2024) included consecutive primary PRK or LASIK procedures in adults with controlled DM (HbA1c <8.0%, no worse than mild NPDR, no diabetic macular edema) and healthy controls. Eyes were propensity-matched on baseline characteristics. Outcomes included refractive and visual measures and complications (retreatment, dry eye, glare, infectious keratitis, haze, epithelial ingrowth, DLK). After matching, 784 myopic PRK eyes (158 DM), 471 myopic LASIK eyes (96 DM), 123 myopic DM eyes (86 PRK; 37 LASIK), and 611 hyperopic LASIK eyes (31 DM) were analyzed. Mean follow-up was approximately 3-5 months. Generalized Estimating Equations (GEE)-adjusted analyses showed no significant differences in visual, refractive, or complication outcomes between DM and controls for myopic PRK or LASIK. Within the diabetic population, PRK and LASIK outcomes were comparable. Hyperopic LASIK outcomes were similar, though DM patients showed a higher retreatment rate. In carefully selected adults with controlled DM, both PRK and LASIK yielded comparable safety and visual outcomes to controls. These findings suggest LVC is viable for this population and that current guidelines may be overly conservative.
To compare the incidence and timing of postoperative complications between laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) within a national clinical registry. Retrospective registry-based clinical cohort study. A total of 48,892 eyes of 27,372 patients who underwent refractive surgery in the IRIS Registry (Intelligent Research in Sight). LASIK and PRK procedures were identified using Healthcare Common Procedure Coding System codes. Postoperative complications, including dry eye disease (DED), visual disturbances, and ocular pain, were identified using International Classification of Diseases codes and analyzed at the eye level. Incidence was evaluated across three postoperative intervals (1 day to 1 month, 1 to 3 months, and 3 to 12 months). Interval-specific incidence rates and incidence rate ratios (IRRs) comparing LASIK and PRK were estimated using multivariable-adjusted Poisson generalized estimating equations. Interval-specific incidence of postoperative complications and comparative IRRs between LASIK and PRK. DED was the most frequently documented postoperative complication, occurring in 16.1% of LASIK eyes and 15.6% of PRK eyes over the follow-up period. During the 1 to 3 months interval, LASIK was associated with a lower incidence of DED compared with PRK (IRR, 0.8 [95% confidence interval (CI), 0.7-0.9]). In the first postoperative month, visual disturbances occurred more frequently after PRK (IRR, 0.3 [95% CI, 0.3-0.4]), but differences between procedures were not significant at later intervals. Ocular pain was rare after both procedures, with no consistent differences in early intervals, but showed a lower incidence after LASIK in the 3 to 12 months interval (IRR, 0.5 [95% CI, 0.3-0.9]). Postoperative complication profiles following refractive surgery varied by procedure and postoperative interval. PRK was associated with a higher risk of visual disturbances in the early postoperative period and a higher incidence of DED during the 1 to 3 months interval compared with LASIK. Ocular pain was rare overall but showed a lower incidence after LASIK in the 3 to 12 months interval, whereas most other complication rates were comparable between procedures. Recognition of these temporal patterns may help inform patient counseling, optimize postoperative follow-up strategies, and guide postoperative management during different phases of corneal recovery after refractive surgery.