Combined laser in situ keratomileusis and prophylactic high-fluence corneal collagen crosslinking for high myopia: two-year safety and efficacy.

Purpose: To evaluate the safety, efficacy, and refractive and keratometric stability of myopic femtosecond laser in situ keratomileusis (LASIK) with concurrent prophylactic high-fluence corneal collagen crosslinking (CXL) compared with the outcomes of standard femtosecond LASIK.

Setting: Private clinical practice, Athens, Greece.

Design: Consecutive randomized prospective comparative study.

Reshaping procedures for the surgical management of corneal ectasia.

Unlabelled: Corneal ectasia is a progressive, degenerative, and noninflammatory thinning disorder of the cornea. Recently developed corneal reshaping techniques have expanded the treatment armamentarium available to the corneal specialist by offering effective nontransplant options. This review summarizes the current evidence base for corneal collagen crosslinking, topography-guided photorefractive keratectomy, and intrastromal corneal ring segment implantation for the treatment of corneal ectasia by analyzing the data published between the years 2000 and 2014.

High-irradiance CXL combined with myopic LASIK: flap and residual stroma biomechanical properties studied ex-vivo.

Background/aims: To evaluate ex vivo biomechanical and enzymatic digestion resistance differences between standard myopic laser in-situ keratomileusis (LASIK) compared with LASIK+CXL, in which high-irradiance cross-linking (CXL) is added.

Methods: Eight human donor corneas were subjected to femtosecond-assisted myopic LASIK. Group A (n=4) served as a control group (no CXL).

OCT corneal epithelial topographic asymmetry as a sensitive diagnostic tool for early and advancing keratoconus.

Purpose: To investigate epithelial thickness-distribution characteristics in a large group of keratoconic patients and their correlation to normal eyes employing anterior-segment optical coherence tomography (AS-OCT).

Materials And Methods: The study group (n=160 eyes) consisted of clinically diagnosed keratoconus eyes; the control group (n=160) consisted of nonkeratoconic eyes. Three separate, three-dimensional epithelial thickness maps were obtained employing AS-OCT, enabling investigation of the pupil center, average, mid-peripheral, superior, inferior, maximum, minimum, and topographic epithelial thickness variability.

Clinical Correlation between Placido, Scheimpflug and LED Color Reflection Topographies in Imaging of a Scarred Cornea.

This case report aims to evaluate safety, efficacy and feasibility of anterior surface imaging by a novel point-source reflection topographer, in comparison to four other corneal imaging modalities. A 17-year-old female patient, clinically diagnosed with chronic herpetic keratitis in her left eye was imaged by a novel multicolored-spot reflection topography system. We comparatively investigated elevation and curvature maps between the novel topographer and established Placido disk topography and Scheimpflug tomography systems.

Clear-cornea cataract surgery: pupil size and shape changes, along with anterior chamber volume and depth changes. A Scheimpflug imaging study.

Purpose: To investigate, by high-precision digital analysis of data provided by Scheimpflug imaging, changes in pupil size and shape and anterior chamber (AC) parameters following cataract surgery.

Patients And Methods: The study group (86 eyes, patient age 70.58±10.

OCT-derived comparison of corneal thickness distribution and asymmetry differences between normal and keratoconic eyes.

Purpose: The aim of this study was to investigate the corneal thickness asymmetry indices in a large pool of patients with keratoconus derived using anterior segment optical coherence tomography (AS-OCT) in comparison with established Scheimpflug imaging-derived keratoconus classification indices.

Methods: Six specific indices were comparatively investigated in this study encompassing 2 groups: keratoconic group A (175 eyes) and age- and gender-matched control group B (175 eyes). AS-OCT was used for corneal focal thinning and irregularity indices, namely the superior nasal minus inferior temporal (SN-IT), superior minus inferior (S-I), minimum minus median (Min-Med) focal thinning, and thickness range, defined as the minimum minus maximum (Min-Max).

Epithelial remodeling after partial topography-guided normalization and high-fluence short-duration crosslinking (Athens protocol): results up to 1 year.

Purpose: To compare epithelial remodeling in keratoconic eyes that had photorefractive keratectomy and corneal collagen crosslinking (Athens protocol) with that in untreated keratoconic eyes and healthy eyes.

Setting: Private clinical practice, Athens, Greece.

Design: Comparative case series.

Toric topographically customized transepithelial, pulsed, very high-fluence, higher energy and higher riboflavin concentration collagen cross-linking in keratoconus.

Purpose: To report a novel application of toric topographically customized transepithelial collagen cross-linking (CXL) aiming to achieve refractive astigmatic changes in a keratoconic cornea.

Methods: Specially formulated riboflavin transepithelial administration and delivery of high-fluence UVA in a topographically customized pattern was applied in an eye with progressive keratoconus. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated for >6 months.

Long-term safety and efficacy of high-fluence collagen crosslinking of the vehicle cornea in Boston keratoprosthesis type 1.

Purpose: The aim of this study was to evaluate the safety and efficacy of very high-fluence collagen crosslinking (CXL) as a means of achieving increased corneal rigidity and reduced enzymatic digestion in the vehicle cornea of Boston keratoprosthesis (KPro) type 1.

Methods: Eleven consecutive patients fitted with a KPro (5 with a previous repeat cornea graft failure, 4 with ocular cicatricial pemphigoid, and 2 with chemical burn) underwent donor vehicle cornea pretreatment with very high-fluence prophylactic CXL in a 2-step procedure. First, the donor cornea was crosslinked with an intrastromal riboflavin instillation through a femtosecond laser-created pocket.

Epithelial remodeling after femtosecond laser-assisted high myopic LASIK: comparison of stand-alone with LASIK combined with prophylactic high-fluence cross-linking.

Purpose: The aim of this study was to evaluate the possible topographic epithelial profile thickness changes (remodeling) after high myopic femtosecond laser in situ keratomileusis (LASIK) with concurrent prophylactic high-fluence cross-linking (CXL) in comparison with standard femtosecond LASIK.

Methods: Preoperative and 6-month postoperative 3-dimensional epithelial thickness distribution maps were investigated through clinical spectral domain anterior-segment optical coherence tomography in 2 groups of femtosecond laser-assisted myopic LASIK cases. Group A represented 67 eyes treated additionally with concurrent prophylactic CXL (LASIK-Xtra); group B represented 72 eyes subjected to stand-alone femtosecond LASIK.

Anterior-segment optical coherence tomography investigation of corneal deturgescence and epithelial remodeling after DSAEK.

Purpose: The aim of this study was to evaluate via Fourier-domain anterior-segment optical coherence tomography 3-dimensional corneal, epithelial, and graft thickness changes after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods: Sixteen eyes were investigated preoperatively and up to 6 months postoperatively for preoperative and postoperative central corneal thickness (CCT), minimum corneal thickness, central graft thickness (CGT), and for epithelial topographic thickness variability. An age-matched and gender-matched control group of 32 healthy eyes was used for comparison.

Forme Fruste Keratoconus Imaging and Validation via Novel Multi-Spot Reflection Topography.

Background/aims: This case report aims to evaluate safety, efficacy and applicability of anterior surface imaging in a patient with forme fruste keratoconus (FFKC) based on a novel multi-spot, multicolor light-emitting-diode (LED) tear film-reflection imaging technology.

Case Description: A 45-year-old male patient, clinically diagnosed with FFKC, with highly asymmetric manifestation between his eyes, was subjected to the multicolor-spot reflection topography. We investigated elevation and sagittal curvature maps comparatively with the multicolor-spot reflection topographer, a Placido topographer and a Scheimpflug imaging system.

Comparison of high-resolution Scheimpflug and high-frequency ultrasound biomicroscopy to anterior-segment OCT corneal thickness measurements.

Background: The purpose of this study was to compare and correlate central corneal thickness in healthy, nonoperated eyes with three advanced anterior-segment imaging systems: a high-resolution Scheimpflug tomography camera (Oculyzer II), a spectral-domain anterior-segment optical coherence tomography (AS-OCT) system, and a high-frequency ultrasound biomicroscopy (HF-UBM) system.

Methods: Fifty eyes randomly selected from 50 patients were included in the study. Inclusion criteria were healthy, nonoperated eyes examined consecutively by the same examiner.

In vivo 3-dimensional corneal epithelial thickness mapping as an indicator of dry eye: preliminary clinical assessment.

Purpose: To evaluate in vivo epithelial thickness in dry eye by anterior segment optical coherence tomography.

Design: Observational, retrospective case-control study.

Methods: Two age-matched groups of female subjects, 70 eyes each, age ≈ 55 years, were studied in clinical practice setting: a control (unoperated, no ocular pathology) and a dry eye group (clinically confirmed dry eye, unoperated and no other ocular pathology).

In vivo three-dimensional corneal epithelium imaging in normal eyes by anterior-segment optical coherence tomography: a clinical reference study.

Purpose: To evaluate the safety and efficacy of real-time measurement of corneal epithelial thickness and investigate the distribution characteristics in a large normal-eye population using a clinically available spectral-domain anterior-segment optical coherence tomography (AS OCT) system.

Methods: Corneal epithelial thickness distribution and topographic thickness variability were clinically investigated using AS OCT imaging in 373 patients with normal, healthy eyes. Descriptive statistics investigated 3 sets of subgroups, male (n = 171) and female (n = 202), younger (n = 194) and older (n = 179), right eyes (n = 195) and left eyes (n = 197).

Revisiting keratoconus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases.

Purpose: To survey the standard keratoconus grading scale (Pentacam®-derived Amsler-Krumeich stages) compared to corneal irregularity indices and best spectacle-corrected distance visual acuity (CDVA).

Patients And Methods: Two-hundred and twelve keratoconus cases were evaluated for keratoconus grading, anterior surface irregularity indices (measured by Pentacam imaging), and subjective refraction (measured by CDVA). The correlations between CDVA, keratometry, and the Scheimpflug keratoconus grading and the seven anterior surface Pentacam-derived topometric indices - index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, index of height asymmetry, index of height decentration, and index of minimum radius of curvature - were analyzed using paired two-tailed t-tests, coefficient of determination (r(2)), and trendline linearity.

Comparison of Placido disc and Scheimpflug image-derived topography-guided excimer laser surface normalization combined with higher fluence CXL: the Athens Protocol, in progressive keratoconus.

Background: The purpose of this study was to compare the safety and efficacy of two alternative corneal topography data sources used in topography-guided excimer laser normalization, combined with corneal collagen cross-linking in the management of keratoconus using the Athens protocol, ie, a Placido disc imaging device and a Scheimpflug imaging device.

Methods: A total of 181 consecutive patients with keratoconus who underwent the Athens protocol between 2008 and 2011 were studied preoperatively and at months 1, 3, 6, and 12 postoperatively for visual acuity, keratometry, and anterior surface corneal irregularity indices. Two groups were formed, depending on the primary source used for topoguided photoablation, ie, group A (Placido disc) and group B (Scheimpflug rotating camera).

FS200 femtosecond laser LASIK flap digital analysis parameter evaluation: comparing two different types of patient interface applanation cones.

Purpose: To evaluate the safety and efficacy of a novel LASIK flap patient interface (PI) cone with our reported digital analysis and compare for potential differences with the standard metal and glass PI in flap parameters when used with the Alcon/WaveLight FS200 femtosecond laser.

Patients And Methods: Thirty-six consecutive LASIK patients (72 eyes) subjected to a bilateral femtosecond assisted LASIK procedure with the novel clear cone PI FS200 1505 were examined for flap diameter and flap thickness over the entire flap area via digital analysis performed on intraoperation image (flap diameter) and anterior-segment optical coherence tomography image (flap thickness). This group was compared with an age- and procedure-matched group B from our practice, in which the standard metal and glass PI was employed.

Anterior segment optical coherence tomography: assisted topographic corneal epithelial thickness distribution imaging of a keratoconus patient.

Purpose: To evaluate safety, efficacy and ease of measurement of epithelial thickness in a keratoconic patient based on anterior segment optical coherence tomography (AS-OCT).

Methods: A 25-year-old male patient, previously diagnosed with keratoconus, with highly asymmetric manifestation among the two eyes, was subjected to AS-OCT corneal epithelial imaging. We investigated epithelial thickness and epithelial topographic thickness distribution.

Essential opaque bubble layer elimination with novel LASIK flap settings in the FS200 Femtosecond Laser.

Background: The purpose of this study is to evaluate the extent and incidence of opaque bubble layer (OBL) using laser-assisted in situ keratomileusis (LASIK) flaps created with the Alcon/WaveLight® FS200 femtosecond laser as a result of a recent change in flap programming parameters aiming to reduce further the incidence and extent of OBL.

Methods: Intraoperative digital images of flaps from 36 consecutive patients (72 eyes) subjected to bilateral femtosecond-assisted LASIK were analyzed using a proprietary computerized technique. The incidence and extent of OBL was measured and reported as a percentage of the entire flap area.

Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: long-term experience with the 400 Hz eye-Q excimer platform.

Background: The purpose of this study was to evaluate the safety and efficacy of topography-guided ablation using the WaveLight 400 Hz excimer laser in laser-assisted in situ keratomileusis (LASIK) for hyperopia and/or hyperopic astigmatism.

Methods: We prospectively evaluated 208 consecutive LASIK cases for hyperopia with or without astigmatism using the topography-guided platform of the 400 Hz Eye-Q excimer system. The mean preoperative sphere value was +3.

Wavefront-guided enhancements using the wavelight excimer laser in symptomatic eyes previously treated with LASIK.

Purpose: To describe our clinical experience in wavefront-guided LASIK enhancements using the WaveLight ALLEGRETTO system (WaveLight Technologie AG, Erlangen, Germany) for symptomatic eyes previously treated with standard LASIK.

Methods: Twenty-six eyes of 20 patients with residual myopia, hyperopia, or mixed astigmatism and/or night vision symptoms after primary standard LASIK were considered for wavefront-guided customized retreatment using the WaveLight ALLEGRETTO WAVE 200 Hz excimer laser system (model 106). Preoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, topography with the ALLEGRETTO Topolyzer, wavefront analysis using the ALLEGRETTO WAVE Tscherning Analyzer, and contrast sensitivity were compared to postoperative (enhancement) measurements.

An alternative surgical procedure for the management of keratoglobus.

Purpose: To describe an alternative surgical technique in stabilizing peripheral corneal thinning in keratoglobus corneas with severe ectasia.

Methods: A 27-year-old man with keratoglobus and severe corneal ectasia in his remaining functional eye was managed by surgically placing an allograft corneoscleral ring around the limbus to support the mid-peripheral thinned cornea. Nylon 10-0 interrupted sutures were used only at the limbus.

Topography-guided custom retreatments in 27 symptomatic eyes.

Purpose: To evaluate the use of topography-guided ablations for refractive irregularities induced by previous surgery.

Methods: This prospective, non-comparative trial comprised 27 symptomatic eyes with a history of LASIK for myopia that underwent topography-guided treatment with the ALLEGRETTO WAVE system. Pre- and postoperative refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal asphericity (Q value), low contrast sensitivity, and patient's subjective assessment of improvement were measured.