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Refractive Surgery: Current Practice and Future Trends
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Refractive Surgery: Current Practice and Future Trends

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (1 July 2021) | Viewed by 22148

Special Issue Editor

Prof. Dr. Majid Moshirfar

E-Mail Website
Guest Editor
1. Hoopes Vision Research Center, Draper, UT 84020 USA
2. John Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
3. Utah Lions Eye Bank, Murray, UT 84107, USA
Interests: cornea and external disease; refractive surgery; cataract; new IOLs; keratoconus; new corneal transplant procedures and instruments
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Refractive surgery is an ever-advancing field for the correction of myopia, hyperopia, and astigmatism. PRK, LASIK, and SMILE are three of the present-day refractive procedures that have excellent outcomes. Continuous improvement in laser platforms will yield even higher levels of safety, efficacy, accuracy, predictability, and stability.

This Special Issue aims to update clinicians, surgeons, and referring providers regarding the indications for primary and enhancement laser procedures, choice of procedure, nomograms, complications, and future trends in the use of lasers for refractive errors. Parallel to the advances in refractive surgery are the advances in phakic intraocular lenses to address refractive errors independently or in combination with refractive surgery. Thus, clinical studies, such as case series, retrospective, and prospective studies are welcome. Manuscripts on evolving practice patterns for refractive surgery, new laser platforms, or improved surgical procedures are also welcome. Manuscripts on refractive surgery combined with other ocular surgeries, such as cataract surgery, ICL implantation, and corneal cross-linking for concomitant or evolving pathologies may also be submitted.

Thank you for seriously considering your contribution to this issue.

Prof. Dr. Majid Moshirfar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • laser in situ keratomileusis (LASIK)
  • photorefractive keratectomy (PRK)
  • small incision lenticule extraction (SMILE)
  • hyperopia
  • myopia
  • astigmatism
  • higher order aberrations

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Published Papers (7 papers)

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Editorial

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3 pages, 174 KiB  
Editorial
Special Issue on Refractive Surgery
by Majid Moshirfar and Yasmyne C. Ronquillo
J. Clin. Med. 2022, 11(3), 684; https://doi.org/10.3390/jcm11030684 - 28 Jan 2022
Cited by 2 | Viewed by 1414
Abstract
Laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), for the treatment of refractive errors, continues to evolve [...] Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)

Research

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20 pages, 8369 KiB  
Article
Comparison of 6.0 mm versus 6.5 mm Optical Zone on Visual Outcomes after LASIK
by Majid Moshirfar, Rachel Huynh, Nour Bundogji, Alyson N. Tukan, Thomas M. Sant, Shannon E. McCabe, William B. West, Jr., Kirk Drennan, Yasmyne C. Ronquillo and Phillip C. Hoopes
J. Clin. Med. 2021, 10(17), 3776; https://doi.org/10.3390/jcm10173776 - 24 Aug 2021
Cited by 5 | Viewed by 3209
Abstract
Previous studies have demonstrated safety and efficacy using 6.0 and 6.5 mm optical zones in the WaveLight EX500 Excimer Laser System but have not evaluated if differing optical zone sizes influence refractive outcomes. This study examines visual outcomes between two study populations undergoing [...] Read more.
Previous studies have demonstrated safety and efficacy using 6.0 and 6.5 mm optical zones in the WaveLight EX500 Excimer Laser System but have not evaluated if differing optical zone sizes influence refractive outcomes. This study examines visual outcomes between two study populations undergoing LASIK with either a 6.0 mm (1332 patients) or 6.5 mm (1332 patients) optical zone. Outcomes were further stratified by severity of myopia (low, moderate, and high) and astigmatism (low and high). Patients were matched by age and preoperative manifest sphere and cylinder. Postoperative measurements were then compared. The 6.5 mm group demonstrated better postoperative manifest refractive spherical equivalent (MRSE), manifest sphere, and absolute value of the difference in actual and target spherical equivalent refraction (|∆ SEQ|), within the total population, moderate myopia, and low astigmatism groups, but this did not lead to improved postoperative uncorrected distance visual acuity (UDVA) or best corrected distance visual acuity (CDVA). Though astigmatic correction and postoperative angle of error were similar between optical zone sizes, they were significantly worse with high myopia. Overall, this study demonstrates differences in visual outcomes between the 6.0 and 6.5 mm optical zone sizes that may warrant consideration; however, essentially, the results are comparable between them. Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)
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12 pages, 1981 KiB  
Article
Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK
by Majid Moshirfar, Kathryn M Durnford, Adam L Lewis, Chase M Miller, David G West, R Alek Sperry, William B West, Jr., Kathryn M Shmunes, Shannon E McCabe, MacGregor N Hall, Yasmyne C Ronquillo and Phillip C Hoopes
J. Clin. Med. 2021, 10(14), 3067; https://doi.org/10.3390/jcm10143067 - 11 Jul 2021
Cited by 6 | Viewed by 3016
Abstract
Femtosecond (FS) lasers initially had a higher incidence of diffuse lamellar keratitis (DLK) compared with microkeratome flap creation. It has been theorized that higher-frequency lower-energy (HFLE) FS lasers would reduce the incidence of DLK. Our study sought to evaluate the incidence of newer [...] Read more.
Femtosecond (FS) lasers initially had a higher incidence of diffuse lamellar keratitis (DLK) compared with microkeratome flap creation. It has been theorized that higher-frequency lower-energy (HFLE) FS lasers would reduce the incidence of DLK. Our study sought to evaluate the incidence of newer HFLE FS lasers with pulse frequencies above 60 kHz. It was a retrospective case-control study evaluating the incidence of DLK following flap creation with one of three FS lasers (AMO iFs, WaveLight FS200, Zeiss VisuMax). Uncomplicated LASIK cases were included as the control group (14,348 eyes) and cases of DLK were recorded in the study group (637 eyes). Of the 637 cases of DLK, 76 developed stage II, 25 progressed to stage III, and only three developed stage IV DLK. The overall incidence rate of DLK was 4.3%; it has fallen with the invention of newer HFLE FS lasers and is approaching the DLK incidence rates of DLK with microkeratome. Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)
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10 pages, 540 KiB  
Article
Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK
by Majid Moshirfar, David G. West, Chase M Miller, William B. West, Jr., Shannon E. McCabe, Kathryn M. Shmunes, Preston A. Baker, Yasmyne C. Ronquillo and Phillip C. Hoopes
J. Clin. Med. 2021, 10(11), 2478; https://doi.org/10.3390/jcm10112478 - 3 Jun 2021
Cited by 8 | Viewed by 2989
Abstract
Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in [...] Read more.
Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes. Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)
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9 pages, 713 KiB  
Article
Plasma Rich in Growth Factors (PRGF) in Transepithelial Photorefractive Keratectomy (TPRK)
by José-María Sánchez-González, Federico Alonso-Aliste, Davide Borroni, Jonatan Amián-Cordero, Concepción De-Hita-Cantalejo, Raúl Capote-Puente, María-José Bautista-Llamas, María Carmen Sánchez-González, Marina Rodríguez-Calvo-de-Mora and Carlos Rocha-de-Lossada
J. Clin. Med. 2021, 10(9), 1939; https://doi.org/10.3390/jcm10091939 - 30 Apr 2021
Cited by 7 | Viewed by 1959
Abstract
To evaluate the usage of plasma rich in growth factor (PRGF) in transepithelial photorefractive keratectomy (TPRK) in low and moderate myopia, patients who underwent myopic and astigmatism TPRK with PRGF were involved in this retrospective, observational study. Subjects underwent a surgical procedure between [...] Read more.
To evaluate the usage of plasma rich in growth factor (PRGF) in transepithelial photorefractive keratectomy (TPRK) in low and moderate myopia, patients who underwent myopic and astigmatism TPRK with PRGF were involved in this retrospective, observational study. Subjects underwent a surgical procedure between February 2019 and June 2019. A three-month follow-up was recorded. Pain score was assessed with a visual analogue scale (0–10) and re-epithelialization time recorded. A total of 48 eyes from 24 patients were recruited. Mean uncorrected distance visual acuity (UDVA) was 20/20.31 (0.00 ± 0.02 LogMAR). A total of 98% of eyes did not change corrected distance visual acuity (CDVA) lines. Two percent of eyes lost one line of CDVA. Preoperative spherical equivalent was −2.67 ± 1.37 D and after three months changed to −0.21 ± 0.34 D, and 2% of eyes changed 0.50 D or more between one and three months. Pain score was 3.29 ± 0.61 (3 to 6) score points at day one and 0.08 ± 0.27 score points at day seven. Finally, re-epithelialization time was 2.50 ± 1.20 days. PRGF addition to conventional refractive treatment such as TPRK seems to alleviate immediate postoperative pain and positively contribute to corneal re-epithelization time. Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)
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8 pages, 588 KiB  
Article
Comparison of Phakic Intraocular Lens Vault Using Conventional Nomogram and Prediction Formulas
by Wakako Ando, Kazutaka Kamiya, Hideki Hayakawa, Masahide Takahashi and Nobuyuki Shoji
J. Clin. Med. 2020, 9(12), 4090; https://doi.org/10.3390/jcm9124090 - 18 Dec 2020
Cited by 26 | Viewed by 3061
Abstract
This study aimed to compare the achieved vault using a manufacturer’s nomogram and the predicted vault using the currently available prediction formulas after posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens; ICL, STAAR Surgical) implantation. We included 200 eyes of 100 consecutive [...] Read more.
This study aimed to compare the achieved vault using a manufacturer’s nomogram and the predicted vault using the currently available prediction formulas after posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens; ICL, STAAR Surgical) implantation. We included 200 eyes of 100 consecutive patients (mean age ± standard deviation, 34.3 ± 7.8 years) undergoing ICL implantation with a central hole. Three months postoperatively, we quantitatively measured the actual vault, and we compared it with the predicted vault using anterior segment optical coherence tomography (CASIA 2, Tomey). The agreement rate of the recommended ICL size using the manufacturer’s nomogram, the NK formula, and the KS formula was 50.0%. The achieved vault was 477.1 ± 263.7 µm, which was significantly smaller than the predicted vaults of 551.2 ± 335.1 and 606.4 ± 212.2 µm, using the NK and KS formulas, respectively (Dunnett test, p = 0.014, p < 0.001). The achieved vault was not significantly different from the predicted vault using the NK or KS formula (p = 0.386, p = 0.157) when selecting a 12.1 mm ICL size. It was not significantly different from the predicted vault using the NK formula (p = 0.962), but it was significantly smaller than that using the KS formula (p = 0.033) when selecting a 12.6 mm size. It was significantly smaller than the predicted vault using the NK and KS formulas (p < 0.001) when selecting 13.2 mm size. The total agreement rate of the recommended ICL size was approximately 50%. The predicted ICL vault tended to overestimate the actual ICL vault, especially when selecting a larger ICL size. Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)
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Review

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18 pages, 535 KiB  
Review
Controversy and Consideration of Refractive Surgery in Patients with Heritable Disorders of Connective Tissue
by Majid Moshirfar, Matthew R. Barke, Rachel Huynh, Austin J. Waite, Briana Ply, Yasmyne C. Ronquillo and Phillip C. Hoopes
J. Clin. Med. 2021, 10(17), 3769; https://doi.org/10.3390/jcm10173769 - 24 Aug 2021
Cited by 10 | Viewed by 4657
Abstract
Heritable Disorders of Connective Tissue (HDCTs) are syndromes that disrupt connective tissue integrity. They include Osteogenesis Imperfecta (OI), Ehlers Danlos Syndrome (EDS), Marfan Syndrome (MFS), Loeys-Dietz Syndrome (LDS), Epidermolysis Bullosa (EB), Stickler Syndrome (STL), Wagner Syndrome, and Pseudoxanthoma Elasticum (PXE). Because many patients [...] Read more.
Heritable Disorders of Connective Tissue (HDCTs) are syndromes that disrupt connective tissue integrity. They include Osteogenesis Imperfecta (OI), Ehlers Danlos Syndrome (EDS), Marfan Syndrome (MFS), Loeys-Dietz Syndrome (LDS), Epidermolysis Bullosa (EB), Stickler Syndrome (STL), Wagner Syndrome, and Pseudoxanthoma Elasticum (PXE). Because many patients with HDCTs have ocular symptoms, commonly myopia, they will often present to the clinic seeking refractive surgery. Currently, corrective measures are limited, as the FDA contraindicates laser-assisted in-situ keratomileusis (LASIK) in EDS and discourages the procedure in OI and MFS due to a theoretically increased risk of post-LASIK ectasia, poor wound healing, poor refractive predictability, underlying keratoconus, and globe rupture. While these disorders present with a wide range of ocular manifestations that are associated with an increased risk of post-LASIK complications (e.g., thinned corneas, ocular fragility, keratoconus, glaucoma, ectopia lentis, retinal detachment, angioid streaks, and ocular surface disease), their occurrence and severity are highly variable among patients. Therefore, an HDCT diagnosis should not warrant an immediate disqualification for refractive surgery. Patients with minimal ocular manifestations can consider LASIK. In contrast, those with preoperative signs of corneal thinning and ocular fragility may find the combination of collagen cross-linking (CXL) with either photorefractive keratotomy (PRK), small incision lenticule extraction (SMILE) or a phakic intraocular lens (pIOL) implant to be more suitable options. However, evidence of refractive surgery performed on patients with HDCTs is limited, and surgeons must fully inform patients of the unknown risks and complications before proceeding. This paper serves as a guideline for future studies to evaluate refractive surgery outcomes in patients with HDCTs. Full article
(This article belongs to the Special Issue Refractive Surgery: Current Practice and Future Trends)
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