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      The evolution of corneal and refractive surgery with the femtosecond laser

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          Abstract

          The use of femtosecond lasers has created an evolution in modern corneal and refractive surgery. With accuracy, safety, and repeatability, eye surgeons can utilize the femtosecond laser in almost all anterior refractive procedures; laser in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), penetrating keratoplasty (PKP), insertion of intracorneal ring segments, anterior and posterior lamellar keratoplasty (Deep anterior lamellar keratoplasty (DALK) and Descemet's stripping endothelial keratoplasty (DSEK)), insertion of corneal inlays and cataract surgery. As the technology matures, it will push surgical limits and open new avenues for ophthalmic intervention in areas not yet explored. As we witness the transition from femto-LASIK to femto-cataract surgery it becomes obvious that this innovation is here to stay. This article presents some of the most relevant advances of femtosecond lasers to modern corneal and refractive surgery.

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          The development of an instrument to measure quality of vision: the Quality of Vision (QoV) questionnaire.

          Sophie E. Moore, Konrad Pesudovs, Colm McAlinden … (2010)
          To develop an instrument to measure subjective quality of vision: the Quality of Vision (QoV) questionnaire. A 30-item instrument was designed with 10 symptoms rated in each of three scales (frequency, severity, and bothersome). The QoV was completed by 900 subjects in groups of spectacle wearers, contact lens wearers, and those having had laser refractive surgery, intraocular refractive surgery, or eye disease and investigated with Rasch analysis and traditional statistics. Validity and reliability were assessed by Rasch fit statistics, principal components analysis (PCA), person separation, differential item functioning (DIF), item targeting, construct validity (correlation with visual acuity, contrast sensitivity, total root mean square [RMS] higher order aberrations [HOA]), and test-retest reliability (two-way random intraclass correlation coefficients [ICC] and 95% repeatability coefficients [R(c)]). Rasch analysis demonstrated good precision, reliability, and internal consistency for all three scales (mean square infit and outfit within 0.81-1.27; PCA >60% variance explained by the principal component; person separation 2.08, 2.10, and 2.01 respectively; and minimal DIF). Construct validity was indicated by strong correlations with visual acuity, contrast sensitivity and RMS HOA. Test-retest reliability was evidenced by a minimum ICC of 0.867 and a minimum 95% R(c) of 1.55 units. The QoV Questionnaire consists of a Rasch-tested, linear-scaled, 30-item instrument on three scales providing a QoV score in terms of symptom frequency, severity, and bothersome. It is suitable for measuring QoV in patients with all types of refractive correction, eye surgery, and eye disease that cause QoV problems.
          Article 0 comments Cited 101 times – based on 0 reviews     Review now
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            Dry eye disease after refractive surgery: comparative outcomes of small incision lenticule extraction versus LASIK.

            Alexandre Denoyer, Elise Landman, Liem Trinh … (2015)
            To compare small incision lenticule extraction (SMILE) versus LASIK for post-refractive dry eye disease.
            Article 0 comments Cited 86 times – based on 0 reviews     Review now
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              Femtosecond laser capsulotomy.

              J Talamo, N. Friedman, M S Blumenkranz … (2011)
              To evaluate a femtosecond laser system to create the capsulotomy. Porcine and cadaver eye studies were performed at OptiMedica Corp., Santa Clara, California, USA; the human trial was performed at the Centro Laser, Santo Domingo, Dominican Republic. Experimental and clinical study. Capsulotomies performed by an optical coherence tomography-guided femtosecond laser were evaluated in porcine and human cadaver eyes. Subsequently, the procedure was performed in 39 patients as part of a prospective randomized study of femtosecond laser-assisted cataract surgery. The accuracy of the capsulotomy size, shape, and centration were quantified and capsulotomy strength was assessed in the porcine eyes. Laser-created capsulotomies were significantly more precise in size and shape than manually created capsulorhexes. In the patient eyes, the deviation from the intended diameter of the resected capsule disk was 29 μm ± 26 (SD) for the laser technique and 337 ± 258 μm for the manual technique. The mean deviation from circularity was 6% and 20%, respectively. The center of the laser capsulotomies was within 77 ± 47 μm of the intended position. All capsulotomies were complete, with no radial nicks or tears. The strength of laser capsulotomies (porcine subgroup) decreased with increasing pulse energy: 152 ± 21 mN for 3 μJ, 121 ± 16 mN for 6 μJ, and 113 ± 23 mN for 10 μJ. The strength of the manual capsulorhexes was 65 ± 21 mN. The femtosecond laser produced capsulotomies that were more precise, accurate, reproducible, and stronger than those created with the conventional manual technique. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Eleftherios I. Paschalis: eleftherios_paschalis@meei.harvard.edu
                Journal
                Journal ID (nlm-ta): Eye Vis (Lond)
                Journal ID (iso-abbrev): Eye Vis (Lond)
                Title: Eye and Vision
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2326-0254
                Publication date (Electronic): 14 July 2015
                Publication date PMC-release: 14 July 2015
                Publication date Collection: 2015
                Volume: 2
                Electronic Location Identifier: 12
                Affiliations
                [ ]Laser Institute Thessaloniki, Thessaloniki, Greece
                [ ]Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
                [ ]Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, 02114 MA USA
                [ ]Southampton University Hospitals, Southampton, UK
                [ ]Flinders University, Adelaide, South Australia Australia
                [ ]Wenzhou Medical University, Wenzhou, Zhejiang China
                Article
                Publisher ID: 22
                DOI: 10.1186/s40662-015-0022-6
                PMC ID: 4655461
                PubMed ID: 26605365
                SO-VID: 1024ad67-2268-4ba9-ac62-4fca8cd04933
                Copyright © © Aristeidou et al. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 March 2015
                Date accepted : 20 June 2015
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                Keywords: femtosecond,laser,refractive,corneal surgery,cataract surgery,penetrating keratoplasty,deep anterior lamellar keratoplasty,descemet's stripping automated endothelial keratoplasty,laser in situ keratomileusis,small incision lenticule extraction
                Data availability:
                Keywords: femtosecond, laser, refractive, corneal surgery, cataract surgery, penetrating keratoplasty, deep anterior lamellar keratoplasty, descemet's stripping automated endothelial keratoplasty, laser in situ keratomileusis, small incision lenticule extraction

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