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Corneal endothelial cell changes 5 years after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome.

ABSTRACT: To compare corneal endothelial cell density (ECD) and morphology between flap creation with a femtosecond laser and flap creation with a mechanical microkeratome 5 years after laser in situ keratomileusis (LASIK).Mayo Clinic, Rochester, Minnesota, USA.Prospective randomized masked paired-eye study.In this study of LASIK for myopia or myopic astigmatism, fellow eyes were randomized by ocular dominance to flap creation by a femtosecond laser or by a mechanical microkeratome. Central endothelial images were analyzed before and 3 years and 5 years after LASIK; endothelial cell variables were compared between treatments at each examination. Relationships between endothelial cell loss and contact lens wear, residual bed thickness, and preoperative refractive error were evaluated.There were no differences in the ECD, percentage of hexagonal cells, or coefficient of variation of cell area between treatments at any examination (all P = .99); the smallest detectable differences were 120 cells/mm(2), 5%, and 2%, respectively. The mean annual rate of corneal endothelial cell loss was -0.1% ± 1.2% (SD) and -0.1% ± 1.0% for the femtosecond laser and the mechanical microkeratome, respectively. Endothelial cell loss was not associated with contact lens wear, residual bed thickness, or preoperative refractive error.The energy delivered to the cornea during femtosecond laser flap creation did not affect the corneal endothelium 5 years after LASIK when compared with flap creation with a mechanical microkeratome. Corneas that have had either method of flap creation could be accepted as donor tissue for endothelial keratoplasty from the standpoint of endothelial health.No author has a financial or proprietary interest in any material or method mentioned.

SUBMITTER: Klingler KN

PROVIDER: S-EPMC3511658 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Corneal endothelial cell changes 5 years after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome.

Klingler Kyle N KN McLaren Jay W JW Bourne William M WM Patel Sanjay V SV

Journal of cataract and refractive surgery 20121013 12

<h4>Purpose</h4>To compare corneal endothelial cell density (ECD) and morphology between flap creation with a femtosecond laser and flap creation with a mechanical microkeratome 5 years after laser in situ keratomileusis (LASIK).<h4>Setting</h4>Mayo Clinic, Rochester, Minnesota, USA.<h4>Design</h4>Prospective randomized masked paired-eye study.<h4>Methods</h4>In this study of LASIK for myopia or myopic astigmatism, fellow eyes were randomized by ocular dominance to flap creation by a femtosecond ...[more]

PMID: 23073480

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Project description:PurposeThe goal of this study was to compare small incision lenticule extraction (SMILE) with femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for treating myopia.MethodsThe CENTRAL, EMBASE, PubMed databases and a Chinese database (SinoMed) were searched in May of 2016. Twelve studies with 1,076 eyes, which included three randomized controlled trials (RCTs) and nine cohorts, met our inclusion criteria. The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group framework. Data were extracted and analysed at three to six months postoperatively. Primary outcome measures included a loss of one or more lines of best spectacle corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA) of 20/20 or better, mean logMAR UCVA, postoperative mean spherical equivalent (SE) and postoperative refraction within ±1.0 D of the target refraction. Secondary outcome measures included ocular surface disease index (OSDI), tear breakup time (TBUT) and Schirmer's 1 test (S1T) as dry eye parameters, along with corneal sensitivity.ResultsThe overall quality of evidence was considered to be low to very low. Pooled results revealed no significant differences between the two groups with regard to a loss of one or more lines in the BSCVA (OR 1.71; 95% CI: 0.81, 3.63; P = 0.16), UCVA of 20/20 or better (OR 0.71; 95% CI: 0.44, 1.15; P = 0.16), logMAR UCVA (MD 0.00; 95% CI: -0.03, 0.04; P = 0.87), postoperative refractive SE (MD -0.00; 95% CI: -0.05, 0.05; P = 0.97) or postoperative refraction within ±1.0 D of the target refraction (OR 0.78; 95% CI: 0.22, 2.77; P = 0.70) within six months postoperatively. The pooled analysis also indicated that the FS-LASIK group suffered more severely from dry eye symptoms (OSDI; MD -6.68; 95% CI: -11.76, -2.00; P = 0.006) and lower corneal sensitivity (MD 12.40; 95% CI: 10.23, 14.56; P < 0.00001) at six months postoperatively.ConclusionsIn conclusion, both FS-LASIK and SMILE are safe, effective and predictable surgical options for treating myopia. However, dry eye symptoms and loss of corneal sensitivity may occur less frequently after SMILE than after FS-LASIK.

Dataset Information

Corneal endothelial cell changes 5 years after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome.

Publications

Corneal endothelial cell changes 5 years after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome.

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