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L A S I K

Fundamentals, Surgical Techniques,

and Complications

edited by

Dimitri T. Azar

Massachusetts Eye and Ear Infirmary

Schepens Eye Research Institute

and Harvard Medical School

Boston, Massachusetts, U.S.A.

Douglas D. Koch

Cullen Eye Institute

Baylor College of Medicine

Houston, Texas, U.S.A.

 

MARCEL DEKKER, INC.

NEW YORK BASEL

 

 

 

Copyright © 2002 by Marcel Dekker, Inc. All Rights Reserved.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress.

ISBN: 0-8247-0797-4

This book is printed on acid-free paper.

Headquarters

Marcel Dekker, Inc.

270 Madison Avenue, New York, NY 10016 tel: 212-696-9000; fax: 212-685-4540

Eastern Hemisphere Distribution

Marcel Dekker AG

Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland tel: 41-61-260-6300; fax: 41-61-260-6333

World Wide Web

http://www.dekker.com

The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the headquarters address above.

Copyright © 2003 by Marcel Dekker, Inc. All Rights Reserved.

Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.

Current printing (last digit): 10 9 8 7 6 5 4 3 2 1

PRINTED IN THE UNITED STATES OF AMERICA

To Nathalie, Alexander, Nicholas, and Lara—for all the joyful moments that we share.

DTA

To my wife, Marcia, who makes it all so much more meaningful—and fun.

DDK

Preface

Dov’é mio figlio? . . . più non lo vedo:

In te più Alfredo–trovar non so

For decades, the majority of ophthalmologists have been embarrassed by and highly suspicious of refractive surgery, at times with good justification. They have been repelled by its tactics in patient recruitment, uneasy about its seemingly cavalier use without longterm data, eager to defend its unsuspecting victims, and deeply concerned that its shortterm benefits are outweighed by its burdensome long-term consequences. And so the words of Germont, uttered pursuant to the most dramatic moment in Verdi’s La Traviata, echo the extreme and oftentimes passionate contempt expressed by so many colleagues and close friends towards academically oriented ophthalmologists who marched among the vanguards of laser refractive surgeons. Their repudiation was not unlike Germont’s scorn of his son Alfredo for offending Violetta and for making himself worthy of disdain:

Where is my son? . . . no more do I see him.

I am unable to see Alfredo in you.

The ophthalmological peer-reviewed publications and textbooks prior to the late 1980s reflected this disinterest in or hostility toward refractive surgery. Unfortunately, in the pre-LASIK era, there were relatively few high-quality peer-reviewed reports on refractive surgery. Criticisms of the scientific rigor with which clinical studies were conducted were often justified, which, in turn, discouraged academically bound graduates of ophthalmology training programs from dedicating their careers to this subspecialty. Comprehensive textbooks of ophthalmology in the pre-LASIK era also kept refractive surgery at arm’s length, relegating it to a minor chapter on the topic. Refractive surgery was viewed as an outlier of great potential but little practical merit in mainstream ophthalmology. But this has all changed with the advent of LASIK!

v

vi

Preface

This book is the first in a series dedicated to Refractive Surgery by Marcel Dekker, Inc. It will most certainly be judged by many as just another LASIK book. While there is abundant coverage of the topic in other books, this volume has several unique features. Its coverage of LASIK is relatively comprehensive, in that it is not limited to LASIK history, surgical techniques, complications, and their management. New aspects of lasers, optics, refraction, diagnostics, and instrumentation are combined with the science and general principles of LASIK, and indications for its use. Although not meant to be encyclopedic, key references abound. They are intended to serve as a guide to the literature on the topic. Thus, this book is not so much a chronicle of LASIK, as an attempt to serve as a source of information relevant to clinical practice.

We are indebted to the students, residents, and colleagues who have made valuable contributions to this book. Several have included original work and analysis in their chapters. It is evident that the authors have attended diligently to their assignments. We are grateful for their effort in integrating the sometimes limited information in peer-reviewed literature with the knowledge derived from their clinical experiences and interactions with colleagues. We hope that this has resulted in a text that is both clinically relevant and as ev- idence-based as possible.

We thank Dr. Geoffrey Greenwood and Elizabeth Curione of Marcel Dekker, Inc., for their commitment to this project and Drs. Tsubota, Boxer Wachler, Hoang-Xuan, Ang, and Gatinel for their assistance in future books in this series. Special thanks go to Leona Greenhill, for her editorial assistance, and to Rhonda Harris, who managed this project with care and precision. Her attention to detail and her dedication have enabled us to work coherently in the face of adversity.

We take the opportunity to acknowledge the pioneering surgeons and researchers in the field of refractive surgery. Their work and vision have provided the basis not only for current refractive developments that we can offer to our patients, but also for future advances to be made by the next generation of thoughtful contributors to this important field.

Dimitri T. Azar

Douglas D. Koch

Contents

Preface

v

Contributors

xi

1.

Refractive Errors and Their Treatment

1

 

Liane Clamen Glazer and Dimitri T. Azar

 

2.

History of LASIK

21

 

Ioannis Pallikaris and Thekla Papadaki

 

3.

Lasers in LASIK: Basic Aspects

39

 

Rodrigo Torres, Robert T. Ang, and Dimitri T. Azar

 

4.

Microkeratomes

57

 

Sandeep Kakaria, Thanh Hoang-Xuan, and Dimitri T. Azar

 

5.

Adjunctive Instrumentation in LASIK

71

 

Robert T. Ang and Dimitri T. Azar

 

6.

LASIK Indications, Contraindications, and Preoperative Evaluation

91

 

Richard E. Braunstein, Marc Winnick, and Kenneth A. Greenberg

 

7.Preoperative Optical Considerations in LASIK: Refractive Errors,

Monovision, and Contrast Sensitivity

101

Balamurali K. Ambati, Leon Strauss, and Dimitri T. Azar

 

8. Corneal Topography and LASIK Applications

111

Li Wang, Douglas D. Koch, Dimitri T. Azar, Robert T. Ang,

 

and Rengin Yildirim

 

vii

viii

 

Contents

9. Wavefront Technology and LASIK Applications

139

 

Naoyuki Maeda

 

10.

Preoperative Considerations: Diagnosis, Classification,

 

 

and Avoidance of Keratoconus Complications

153

 

Paul Chung-Shien Lu and Dimitri T. Azar

 

11.

Corneal Stability and Biomechanics After LASIK

163

 

Esen Karamursel Akpek, Rana Altan-Yaycioglu, and Walter J. Stark

 

12.

LASIK Techniques

175

 

Dimitri T. Azar, Kathryn Colby, and Douglas D. Koch

 

13.

Microkeratomes and Laser Settings

189

 

William J. Lahners and David R. Hardten

 

14.

Centration of LASIK Procedures

199

 

Marsha C. Cheung, Chun Chen Chen, and Dimitri T. Azar

 

15.

Surgical Caveats for Managing Difficult Intraoperative

 

 

Situations

229

 

Samir G. Farah and Dimitri T. Azar

 

16.

Bilateral Simultaneous LASIK: Advantages, Disadvantages,

 

 

and Surgical Caveats

243

 

David R. Hardten, Elizabeth A. Davis, Richard L. Lindstrom,

 

 

and William J. Lahners

 

17.

Postoperative Management Protocols for Uncomplicated

 

 

LASIK Procedures

255

 

Melanie A. R. Graham and Dimitri T. Azar

 

18.

Visual Outcomes After Primary LASIK

265

 

Samir G. Farah and Dimitri T. Azar

 

19.

Quality of Vision After LASIK

277

 

Patrick C. Yeh and Dimitri T. Azar

 

20.

LASIK for Hyperopia, Hyperopic Astigmatism, and Presbyopia

285

 

Neal A. Sher

 

21.

LASIK Retreatments

297

 

Ayman F. El-Shiaty and Brian S. Boxer Wachler

 

22.

LASIK Following Radial Keratotomy and Photorefractive

 

 

Keratectomy

313

Natalie A. Afshari and Dimitri T. Azar

Contents

ix

23.

LASIK After Penetrating Keratoplasty

319

 

Glenn C. Cockerham and Natalie A. Afshari

 

24.

Bioptics: Combined LASIK and Phakic Intraocular Lens Surgery

329

 

José L. Güell, Mercedes Vázquez, Fortino Velasco, and Felicidad Manero

 

25.

LASIK and Intrastromal Corneal Ring Segments (ICRS)

335

 

Jonathan D. Primack, Samir G. Farah, and Dimitri T. Azar

 

26.

Intraoperative Complications

351

 

Li Wang, Manjula Misra, and Douglas D. Koch

 

27.

Postoperative Complications of LASIK

365

 

Samir G. Farah, Jae Bum Lee, and Dimitri T. Azar

 

28.

Optical Aberrations After LASIK

387

 

Samir A. Melki, Cinthia E. Proano, and Dimitri T. Azar

 

29.

Posterior Segment Complications of LASIK

397

 

Ron Afshari Adelman and Natalie A. Afshari

 

30.

Management of Topographical Irregularities Following LASIK

403

 

Jeffrey Johnson, Roselyn Jeun, and Dimitri T. Azar

 

31.

LASIK and TopoLink for Irregular Astigmatism

421

 

Michael C. Knorz

 

32.

Management of Flap Complications in LASIK

431

 

Manolette R. Roque, Samir A. Melki, Dimitri T. Azar, and Emily Yeung

 

33.

Management of Interlamellar Epithelium

463

 

Nan Wang and Douglas D. Koch

 

34.

Management of Infections, Inflammation, and Lamellar

 

 

Keratitis After LASIK

477

 

Bilal F. Khan, Margaret Chang, Sandeep Jain, Kathryn Colby,

 

 

and Dimitri T. Azar

 

35.

The Future of LASIK

491

 

Nan Wang and Douglas D. Koch

 

Index

495