Purpose: To report the incidence of postoperative ectasia after laser in situ keratomileusis (LASIK). Methods: A retrospective case review of 30,167 eyes (16,732 patients) was conducted following LASIK between August 2007 and August 2015. The follow-up was between 2 and 8 years. Tomography was performed after 2 years postop. After identifying cases of ectasia, the charts of these patients were examined to identify any common factors that may have predisposed them to develop ectasia. Results: Ten eyes of seven patients developed post-LASIK ectasia. Eight eyes had been treated for myopia and myopic astigmatism, two eyes for mixed astigmatism. There were no cases of ectasia after LASIK for hyperopia. All 10 cases of ectasia had a flap that was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15 ± 12.88 µm) and refractive error corrected using the Wavelight Allegretto excimer laser. Retrospectively, most prevalent risk factors were thin cornea (≤ 500 µm, 50% of cases), anterior topographic map irregularities (e.g., asymmetric bow tie, 40% of cases), Ectasia Risk Score > 3 (40% of cases), percent tissue thickness alteration ≥ 40% (20% of cases) and low residual stromal bed (≤ 300 µm, 30% of cases). One eye had no identifiable risk factors. In the retrospective chart review 14.97% (4,506) of all the eyes had similar risk factors to the cases that went on to develop ectasia. Conclusion: The incidence of ectasia was 0.033% over 8 years. The incidence could be higher as some cases may destabilize beyond this period and some patients were lost to follow-up asymptomatic of any clinical signs. Other intrinsic factors may trigger the development of post LASIK ectasia. The current widely accepted risk factors are not sufficiently rigorous for screening out potential ectasia from developing after LASIK. There is a need to augment accuracy with higher sensitivity and specificity.

Purpose To compare functional outcomes of Wavelight Allegretto Eye-Q 400Hz and Schwind Amaris 750S excimer laser for astigmatism between 2 and 7 diopters(D). Methods Prospective comparative non-randomized case series of 480 eyes assigned in two laser groups and further divided into myopic and mixed astigmatism subgroups. All treatments were centered on corneal vertex. One-year results were compared between the groups. Statistical analysis was performed using z-test. Results Both Allegretto and Amaris postoperative uncorrected distance visual acuity (UDVA) improved in comparison to preoperative corrected distance visual acuity (CDVA). The difference was significant in the Allegretto group for myopic astigmatism (p = 0.017). There was no difference in postoperative UDVA between lasers. Average sphere decreased in all groups for both lasers (p < 0.001) without difference in effectiveness of spherical correction between lasers for both groups. In Allegretto, average cylinder decreased from −3.30D to −0.55D in myopic astigmatism (p < 0.001) and from −3.84D to −0.85D in mixed astigmatism (p < 0.001). In Amaris average cylinder decreased from −3.21D to −0.43D in myopic astigmatism (p < 0.001) and from −3.66D to −0.58D in mixed astigmatism (p < 0.001). Amaris group had less residual astigmatism (myopic astigmatism p = 0.023, mixed astigmatism p < 0.001). Mean spherical aberration shifted from positive to negative in mixed astigmatism for both lasers. Conclusion Both lasers are effective in terms of UDVA, CDVA, spherical correction, and preservation of high-order aberrations. However, Amaris was more effective in cylinder correction.

Background To evaluate vision 3 months after SmartSight lenticule extraction treatments. Design Case series. Methods This case series of patients were treated at Specialty Eye Hospital Svjetlost in Zagreb, Croatia. Sixty eyes of 31 patients consecutively treated with SmartSight lenticule extraction were assessed. The mean age of the patients was 33 ± 6 years (range 23–45 years) at the time of treatment with a mean spherical equivalent refraction of −5.10 ± 1.35 D and mean astigmatism of 0.46 ± 0.36 D. Monocular corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA) were assessed pre- and post-operatively. Ocular and corneal wavefront aberrations have been postoperatively compared to the preoperative baseline values. Changes in ocular wavefront refraction, as well as changes in keratometric readings are reported. Results At 3 months post-operatively, mean UDVA was 20/20 ± 2. Spherical equivalent showed a low myopic residual refraction of −0.37 ± 0.58 D with refractive astigmatism of 0.46 ± 0.26 D postoperatively. There was a slight improvement of 0.1 Snellen lines at 3-months follow-up. Compared to the preoperative status, ocular aberrations (at 6 mm diameter) did not change at 3 months follow-up; whereas corneal aberrations increased (+0.22 ± 0.21 µm for coma; +0.17 ± 0.19 µm for spherical aberration; and +0.32 ± 0.26 µm for HOA-RMS). The same correction was determined using changes in ocular wavefront refraction, as well as changes in keratometric readings. Conclusion Lenticule extraction after SmartSight is safe and efficacious in the first 3 months postoperatively. The post-operative outcomes indicate improvements in vision.

Purpose: To compare refractive stability, endothelial cell count (ECC), incidence of complications, and patients’ satisfaction between a rigid Verisyse (group I, n = 198) and foldable Veriflex (group II, n = 212) phakic intraocular lenses (pIOL) over 36 months postop. Materials and methods: This was a retrospective study. Patients’ satisfaction and incidence of photic phenomena were evaluated at one month and one year postop. Data were analyzed to determine difference between groups for astigmatism, mean spherical equivalent (MRSE), uncorrected (UDVA) and corrected (CDVA) monocular distance visual acuity, complication rate (acute and chronic), and ECC. Differences were considered statistically significant when p < 0.05. Results: Group II cases had significantly higher UDVA, CDVA, and lower astigmatism during the entire follow-up. There was no significant difference in mean MRSE or mean ECC postoperatively. In both groups, mean ECC reduced significantly at one month postop, followed by a gradual linear decline between 1 and 36 months of 22.4 cells/mm²/annum (group I) and 13.32 cells/mm²/annum (group II). Overall complication rates were ≤ 10% with no significant inter-group differences. Group I patients reported lower incidence of halos at one month but more problems with night vision at one year compared with group II. Overall satisfaction was high and total incidence of reported photic phenomena was low. Conclusion: Both Verisyse and Veriflex pIOLs are effective in correcting myopia. The Veriflex lens demonstrated better refractive outcome; however, subclinical inflammation observed in the Veriflex group and potential influence of inflammation on ECC loss require further investigation.