Edward Manche, MD

All Publications

• 12-Month Visual and Refractive Outcomes of Topography-guided Femtosecond Laser- Assisted LASIK for Myopia and Myopic Astigmatism JOURNAL OF REFRACTIVE SURGERY Saleh, S., Epp, L. J., Tran, E., Manche, E. E. 2024; 40 (9): e595-e603

  Abstract

  To report 12-month visual and refractive outcomes following topography-guided femtosecond laser-assisted laser in situ keratomileusis (LASIK) for myopia and compound myopic astigmatism correction.This prospective, single-center observational study was conducted in an outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, 5% and 25% contrast sensitivity CDVA, and manifest refraction following topography-guided femtosecond laser-assisted LASIK were assessed. Refractive measurements were used to perform a vector analysis.Sixty eyes of 30 patients (mean age: 32.8 ± 7.0 years; range: 23 to 52 years) undergoing topography-guided LASIK for the correction of myopia and compound myopic astigmatism were analyzed. Mean postoperative UDVA was -0.09 ± 0.10 logarithm of the minimum angle of resolution (logMAR) at 12 months. Mean preoperative CDVA was -0.09 ± 0.09 and -0.13 ± 0.08 logMAR at postoperative 12 months. At 12 months, 26.9% of eyes had gained one or more lines of postoperative UDVA compared to baseline CDVA. Mean pre-operative 5% contrast sensitivity CDVA was 0.68 ± 0.07 and 0.64 ± 0.12 logMAR at 12 months (P = .014) following LASIK.Topography-guided LASIK for myopia and myopic astigmatism correction provided excellent visual and refractive outcomes that were predictable, precise, and stable up to 12 months postoperatively. [J Refract Surg. 2024;40(9):e595-e603.].

  View details for DOI 10.3928/1081597X-20240717-01

  View details for Web of Science ID 001319488800018

  View details for PubMedID 39254246

• Refractive Surgery Patient Characteristics Associated With Satisfaction Scores JOURNAL OF REFRACTIVE SURGERY Tran, E. M., Manche, E. E. 2024; 40 (8): e539-e543

  Abstract

  To determine factors influencing patient satisfaction scores in recipients of refractive surgery.In this prospective survey-based study, patients who had refractive surgery at an outpatient refractive clinic completed a survey of selected questions from the Press Ganey survey and the National Eye Institute Visual Function Questionnaire-25. Correlation between patient-specific variables and survey questions were assessed using Student's t-tests.Fifty-three patients were recruited over a 3-year period. Most were male (55%) and middle aged (mean age: 34 years). Eleven percent underwent photorefractive keratectomy surgery and the rest had laser in situ keratomileusis, with no complications. Twenty-four percent of surveyed patients reported mild to moderate eye pain postoperatively, with the rest reporting no pain. All patients reported a full score for overall satisfaction.This study found persistent high patient satisfaction score across a variation of characteristics, suggesting that optimal scores are mainstay after refractive surgery procedures with excellent visual outcomes, independent of patient clinical and sociodemographic characteristics. [J Refract Surg. 2024;40(8):e539-e543.].

  View details for DOI 10.3928/1081597X-20240611-02

  View details for Web of Science ID 001294362600006

  View details for PubMedID 39120021

• Patient-Reported Outcomes and Higher Order Aberrations Following Topography-Guided Femtosecond Laser-Assisted In Situ Keratomileusis. Cornea Ahluwalia, A., Ma, K. K., Manche, E. E. 2024

  Abstract

  To examine patient-reported outcomes and higher order aberrations following topography-guided laser-assisted in situ keratomileusis (LASIK).This was a prospective, nonrandomized observational study at a single academic center. Sixty eyes from 30 patients underwent bilateral topography-guided femtosecond LASIK for correction of myopia using the VisuMax 500 femtosecond laser (Zeiss; Oberkochen, Germany) and Allegretto Wave Eye-Q 400 Hz Excimer Laser (Alcon/Wavelight; Erlangen, Germany) with the Contoura topography system (Alcon; Geneva, Switzerland) for topography-modified refraction. The main outcomes of this study were higher order aberrations (HOAs) and results from the Patient-Reported Outcomes with LASIK questionnaire.There was a small, significant increase in HOA root mean square, spherical aberration, and coma at 1, 3, 6, and 12 months following topography-guided LASIK (all P < 0.05), but no change in trefoil. In addition, self-reported worry related to vision (P < 0.001) and ability to perform activities (P < 0.001) significantly improved after surgery. The prevalence of double images, glare, halos, or starbursts decreased from 73% preoperatively to 56%, and no participants reported "very" or "extremely" bothersome visual symptoms after 12 months. Dry eye symptoms per Ocular Surface Disease Index score decreased significantly at 6 (P = 0.01) and 12 (P = 0.002) months after surgery. There was a 100% satisfaction rate with visual outcomes and duration of time to improvement in vision following the procedure.Although there was an increase in HOAs following topography-guided LASIK, there were significant improvements in the presence of double images, glare, halos, and starbursts and vision-related quality-of-life metrics. Overall satisfaction rates in this study were high.

  View details for DOI 10.1097/ICO.0000000000003581

  View details for PubMedID 38830188

• A comprehensive review on corneal crosslinking. Taiwan journal of ophthalmology Naranjo, A., Manche, E. E. 2024; 14 (1): 44-49

  Abstract

  Corneal crosslinking (CXL) represents a paradigm shift in the management of corneal ectatic disorders. Before CXL was introduced, patients would need specialty contact lenses and possible corneal transplantation. CXL involves a biochemical reaction in which ultraviolet A light is used in conjunction with Riboflavin to form crosslinks in between corneal stromal collagen. This leads to strengthening and stabilizing of the collagen lamellae, resulting in mechanical stiffening of the cornea. Multiple protocols have been proposed including epithelium on versus off and varying light intensity and duration of treatment. All protocols appear to be safe and effective with few reported complications including infection, stromal haze, scarring, and endothelial toxicity. Overall, CXL has demonstrated to halt the progression of the disease clinically and in keratometry readings and improve the quality of life for patients. It is a minimally invasive, cost-effective procedure that can be performed in an outpatient setting with a fast recovery time and long-lasting results.

  View details for DOI 10.4103/tjo.TJO-D-23-00055

  View details for PubMedID 38654993

  View details for PubMedCentralID PMC11034691

• Refractive Surgery Patient Characteristics Associated with Satisfaction Scores Tran, E., Manche, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053795605332

• Refractive Results and Perceived Quality of Vision in Physicians Undergoing LASIK and PRK Arboleda, A., Manche, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053795605338

• Subjective visual experience and ocular symptoms after wavefront-guided and wavefront-optimized LASIK in a prospective fellow eye study. American journal of ophthalmology Chiang, B., Manche, E. E. 2023

  Abstract

  The purpose of this study was to compare the subjective visual experience and ocular symptoms of fellow eyes treated with wavefront-optimized (WFO-) laser-assisted in situ keratomileusis (LASIK) and wavefront-guided (WFG-) LASIK.Prospective randomized fellow eye, controlled study.Two hundred eyes of 100 subjects from a single academic center were enrolled and randomly assigned to treatment with WFO-LASIK in one eye and WFG-LASIK in the fellow eye. Subjects filled out a validated 14-part questionnaire for each eye at the preoperative visit and at postoperative months 1,3,6,12.In comparing the number of subjects who reported symptoms in the WFG- vs WFO- LASIK eyes, there was no difference in number reporting any visual experience (glare, halos, starbursts, hazy vision, blurred vision, distortion, double or multiple images, fluctuations in vision, focusing difficulties, and depth perception; all p>0.05) or ocular symptoms (photosensitivity, dry eye, foreign body sensation, ocular pain; all p>0.05). There was no preference for WFG-LASIK (28%) or the WFO-LASIK treated eye (29%) with most subjects reporting no preference (43%; Chi-squared p=0.972). Of the subjects who preferred one eye or the other, the preferred eye saw statistically better than the fellow eye (0.8 ± 1.4 Snellen line, p=0.0002). There was no other difference in subjective visual experience, ocular symptoms, refractive characteristics when taking into account eye preference.Most subjects had no eye preference; and for subjects who did have eye preference, the only detectable difference was better visual acuity in the preferred eye.

  View details for DOI 10.1016/j.ajo.2023.02.018

  View details for PubMedID 36870589

• Patient-Reported Outcomes With Wavefront-Guided Laser in Situ Keratomileusis (PROWL) Study Outcomes From a Single Institution JOURNAL OF REFRACTIVE SURGERY Lee, M. D., Leibold, C., Manche, E. E. 2023: 198-204

  Abstract

  To determine patient-reported outcomes after laser in situ keratomileusis (LASIK) using wavefront-guided technology at a single institution.In this prospective observational study, 62 participants underwent examination and questionnaire at baseline, 1 month, and 3 months after surgery. The questionnaire included questions from validated questionnaires and new items to assess patient satisfaction with current vision and LASIK surgery, and existence/degree of visual symptoms.At month 1, patients reported an improvement in far vision (P = .01), activity limitations (P ≤ .001), and less worry about vision (P ≤ .001), as well as new visual symptoms, including halos (P ≤ .001) and double images (P = .03). At month 3, patients still noted an improvement in near vision (P = .05), far vision (P ≤ .001), activity limitation (P ≤ .001), and worry (P ≤ .001) along with halos (P = .05), double images (P = .01), and dry eye (P = .01). A total of 3.3% of patients at month 1 and 0% at month 3 had difficulty performing any activity due to symptoms, and 34.6% and 25.0% of patients reported decreased quality of life at months 1 and 3, respectively.After LASIK, patients experience new visual symptoms. Patients have high rates of satisfaction overall but with some patients reporting a decrease in quality of life 1 month after surgery; quality of life improves by postoperative month 3, with 25% patients reporting a decrease in visual well-being after surgery. [J Refract Surg. 2023;39(3):198-204.].

  View details for DOI 10.3928/1081597X-20230103-01

  View details for Web of Science ID 000966791000001

  View details for PubMedID 36892244

• Patient-Reported Quality of Vision in a Prospective Randomized Contralateral-Eye Trial Comparing LASIK and SMILE. Journal of cataract and refractive surgery Ma, K. K., Manche, E. E. 2022

  Abstract

  To compare patient-reported quality of vision and visual symptoms in participants undergoing laser in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE).Byers Eye Institute at Stanford University.Prospective randomized contralateral-eye clinical trial.Subjects with myopia were randomized to receive wavefront-guided femtosecond LASIK in one eye and SMILE in the fellow eye. Participants reported the presence and severity of adverse visual symptoms via the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) questionnaire and reported which eye had better vision at the preoperative and the postoperative 1-, 3-, 6-, and 12-month visits.80 eyes of 40 participants were treated. There was no difference in the presence or severity of double vision, glare, halo, or starbursts between eyes that underwent LASIK or SMILE at each visit (P ≥ 0.85 for each comparison). Scaled scores for the presence of visual symptoms improved from the preoperative visit to the postoperative month 12 visit for double vision (88 vs 97, P=0.03), glare (77 vs 92, P=0.02), halos (68 vs 87, P<0.01), and starbursts (60 vs 86, P<0.01). At the postoperative month 12 visit, 17/37 (46%) of participants preferred the vision from the eye that underwent LASIK compared to 7/37 (19%) that underwent SMILE. The preferred eye was correlated with uncorrected visual acuity (r=0.52, P<0.01).Rates of visual symptoms were similar for LASIK and SMILE, and visual symptoms improved with time. More patients preferred vision from the eye that underwent LASIK compared to SMILE.

  View details for DOI 10.1097/j.jcrs.0000000000001127

  View details for PubMedID 36539217

• Factors affecting eye preference in a prospective randomized controlled fellow eye study comparing WFG-LASIK and WFO-LASIK treatment Chiang, B., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437006126

• Corneal Sensitivity and Patient-Reported Dry Eye Symptoms in a Prospective Randomized Contralateral-Eye Trial Comparing LASIK and SMILE. American journal of ophthalmology Ma, K. K., Manche, E. E. 2022

  Abstract

  To prospectively compare corneal sensation and patient-reported symptoms of dry eye in individuals undergoing laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE).Prospective randomized contralateral-eye clinical trial.80 eyes of 40 patients with myopia at Byers Eye Institute at Stanford University were randomized to receive wavefront-guided femtosecond LASIK in one eye and SMILE in the fellow eye. Cochet-Bonnet esthesiometry was performed to assess corneal sensitivity preoperatively and at the 1-month, 3-month, 6-month, and 12-month postoperative visits. Participants also completed questionnaires at each visit to determine the Ocular Surface Disease Index (OSDI).Eyes that underwent LASIK compared to SMILE demonstrated more cornea denervation at the postoperative 1-month (mean 2.1 vs 3.6 cm, p < 0.001), 3-month (3.5 vs 5.4 cm, p < 0.001) and 6-month (4.7 vs 5.7 cm, p < 0.001) visits. At the 12-month visit, both groups had returned to baseline corneal sensitivity (5.9 vs 5.9 cm, p = 0.908). There was no difference in OSDI between the two groups at any visit. Mean OSDI improved from the preoperative to the postoperative 12-month visit in both LASIK (15.3 to 8.6, p = 0.020) and SMILE (15.1 to 9.5, p = 0.029) groups.LASIK resulted in greater corneal denervation compared to SMILE in the early postoperative period, though this difference was no longer apparent after 12 months. Despite this, there was no difference in self-reported dry eye symptoms between the two groups. Patient-reported dry eye symptoms improved after both LASIK and SMILE procedures.

  View details for DOI 10.1016/j.ajo.2022.05.010

  View details for PubMedID 35594919

• Effect of corneal epithelial remodeling on visual outcomes of topography-guided femtosecond LASIK. Journal of cataract and refractive surgery Saleh, S., Epp, L. J., Manche, E. E. 2022

  Abstract

  PURPOSE: To assess the effect of epithelial remodeling on visual outcomes over a 9 mm diameter corneal surface following topography-guided laser in-situ keratomileusis (LASIK) for myopia correction using spectral-domain anterior segment optical coherence tomography (AS-OCT).SETTING: Outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California, USA.DESIGN: Prospective non-randomized observational study.METHODS: Visual acuity, including uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), 5% and 25% contrast sensitivity CDVA, manifest refraction and corneal epithelial thickness following topography-guided femtosecond LASIK were analyzed. Corneal epithelial thickness was mapped across 13 sections and 3 concentric zones using AS-OCT preoperatively and at 1, 3, 6 and 12 months postoperatively.RESULTS: Sixty eyes of 30 patients with a mean age of 32.8 years (range 23-52 ± 7.03 years) undergoing myopic LASIK correction were assessed. In eyes with complete follow-up data (n=30), mean preoperative UDVA was logMAR 1.48 ± 0.45 and logMAR -0.11 ± 0.08 at postoperative 12 months. Mean preoperative CDVA was logMAR -0.08 ± 0.11 and logMAR -0.13 ± 0.07 at 12 months. Linear mixed modeling demonstrated a significant correlation between improvement in UDVA and decreased superior and nasal corneal epithelial thickness as well as between improvement in CDVA and increased central epithelial thickness 12 months postoperatively.CONCLUSIONS: Improvement in UDVA and CDVA at 12 months following topography-guided femtosecond LASIK was correlated with non-uniform epithelial remodelling, including epithelial thickening in the central zone and thinning in the superior and nasal sections as measured by AS-OCT.

  View details for DOI 10.1097/j.jcrs.0000000000000940

  View details for PubMedID 35333817

• Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided Laser in Situ Keratomileusis (WFG-LASIK) and Small Incision Lenticule Extraction (SMILE) refractive surgeries. American journal of ophthalmology Chiang, B., Valerio, G. S., Manche, E. E. 2021

  Abstract

  PURPOSE: Wave-front guided laser in situ keratomileusis (WFG-LASIK) and small incision lenticule extraction (SMILE) are keratorefractive surgeries that can improve uncorrected visual acuity in myopic patients. Comparison of visual outcomes in myopic patients treated with LASIK and SMILE are needed.DESIGN: Prospective, randomized contralateral eye-controlled trial METHODS: We performed a single-center prospective, randomized, contralateral eye comparison of WFG-LASIK and SMILE (NCT03067077). Myopic patients with low levels of astigmatism were treated with WFG-LASIK in one eye and SMILE in the fellow eye from March 2017 to March 2021. Treatments were randomized by ocular dominance. WFG-LASIK and SMILE were performed. Postoperative evaluation at 1 day consisted of UDVA, wavefront aberrometry, and a slit lamp examination. On subsequent postoperative visits at 1-mo, 3-mo, 6-mo, and 12-mo, UDVA, manifest refraction, 5% and 25% low-contrast visual acuity, wavefront aberrometry, and slit lamp examination were performed.MAIN OUTCOME MEASURE: The primary outcome measure was uncorrected distance visual acuity at twelve months RESULTS: Eighty-eight (88) eyes of 44 patients with myopia were enrolled in the study. Seventy-four eyes of 37 patients had successful treatments and ccompleted 12 months of follow-up. At postoperative month 12, there was significantly higher proportion of WFG-LASIK eyes who had >= 20/20 uncorrected distance visual acuity compared with SMILE eyes (94% vs 83%, p<0.05). There was no difference between spherical equivalent between WFG-LASIK eyes and SMILE eyes (-0.17±0.25 vs -0.29±0.38, p>0.05); there was no difference in higher order aberrations, including coma, trefoil, and spherical aberrations (p>0.05); and there was significantly higher proportion of WFG-LASIK eyes who had improved 5% and 25% low contrast visual acuity compared with SMILE eyes (p<0.05) CONCLUSIONS: WFG-LASIK and SMILE both offered significant improvements in corrected distance visual acuity and excellent predictability in both eyes. Compared with SMILE, WFG-LASIK resulted in faster visual recovery, better low contrast visual acuity, and greater gains in uncorrected visual acuity.

  View details for DOI 10.1016/j.ajo.2021.11.013

  View details for PubMedID 34788593

• Drug delivery to the anterior segment of the eye: a review of current and future treatment strategies. International journal of pharmaceutics Mofidfar, M., Abdi, B., Ahadian, S., Mostafavi, E., Desai, T. A., Abbasi, F., Sun, Y., Manche, E. E., Ta, C. N., Flowers, C. W. 2021: 120924

  Abstract

  Research in the development of ophthalmic drug formulations and innovative technologies over the past few decades has been directed at improving the penetration of medications delivered to the eye. Currently, approximately 90% of all ophthalmic drug formulations (e.g. liposomes, micelles) are applied as eye drops. The major challenge of topical eye drops is low bioavailability, need for frequent instillation due to the short half-life, poor drug solubility, and potential side effects. Recent research has been focused on improving topical drug delivery devices by increasing ocular residence time, overcoming physiological and anatomical barriers, and developing medical devices and drug formulations to increase the duration of action of the active drugs. Researchers have developed innovative technologies and formulations ranging from sub-micron to macroscopic size such as prodrugs, enhancers, mucus-penetrating particles (MPPs), therapeutic contact lenses, and collagen corneal shields. Another approach towards the development of effective topical drug delivery is embedding therapeutic formulations in microdevices designed for sustained release of the active drugs. The goal is to optimize the delivery of ophthalmic medications by achieving high drug concentration with prolonged duration of action that is convenient for patients to administer.

  View details for DOI 10.1016/j.ijpharm.2021.120924

  View details for PubMedID 34324989

• Outcomes of corneal crosslinking for keratoconus in children and young adults Saleh, S., Koo, E., Lambert, S., Manche, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500775

• Outcomes After Corneal Crosslinking for Keratoconus in Children and Young Adults. Cornea Saleh, S., Koo, E. B., Lambert, S. R., Manche, E. E. 2021

  Abstract

  PURPOSE: The aim of this study was to assess the effect of corneal crosslinking on vision and keratometry in children and young adults with progressive keratoconus.METHODS: A retrospective medical records review of patients aged 22 years or younger with keratoconus who underwent corneal crosslinking between January 2013 and November 2019 at Byers Eye Institute at Stanford University was conducted. Outcome measures included logarithm of the Minimum Angle of Resolution corrected distance visual acuity (CDVA); keratometry, including maximum keratometry (Kmax); pachymetry; and total wavefront aberration. Measurements were taken at baseline and at 12 and 24 months postoperatively.RESULTS: Fifty-seven eyes of 49 patients aged 12 to 22 years were assessed. The mean preoperative CDVA was logarithm of the Minimum Angle of Resolution 0.38 ± 0.32 (20/48), with a mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively, respectively. Compared with preoperative mean Kmax, there was an improvement of -0.8 diopters (D) to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and -1.3 D to 59.7 ± 8.8 D at 24 months. Subanalysis excluding the second eye of patients who underwent bilateral crosslinking showed similar results. Linear mixed modeling showed significant improvement in Kmax at both 12 and 24 months postoperatively. Minimum central corneal thickness initially decreased but stabilized at 24 months after crosslinking. Total wavefront aberration remained stable.CONCLUSIONS: Corneal crosslinking stabilizes, and in some cases improves, visual and corneal parameters in pediatric and young adult patients with keratoconus. The procedure is safe and well-tolerated and may prevent keratoconus progression in young patients.

  View details for DOI 10.1097/ICO.0000000000002730

  View details for PubMedID 33859086

• Quality of Vision Analysis in Wavefront-guided LASIK Compared to SMILE Surgery: Preliminary Results of a Prospective Study Valerio, G., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528301285

• One-Year Outcomes From a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized PRK in Myopia JOURNAL OF REFRACTIVE SURGERY Smith, R. G., Manche, E. E. 2020; 36 (3): 160-+

  Abstract

  To compare wavefront-guided (WFG) and wavefront-optimized (WFO) photorefractive keratectomy (PRK) in patients with myopia using objective and self-reported quality of vision outcomes.A total of 40 eyes from 20 participants were prospectively randomized to receive WFG or WFO PRK with the WaveLight Allegretto Eye-Q 400-Hz excimer laser (Alcon Laboratories, Inc., Fort Worth, TX). The primary outcome measured was uncorrected distance visual acuity (UDVA) at 12 months postoperatively. Secondary outcome measures included corrected distance visual acuity (CDVA), less than 5% and less than 25% contrast visual acuity, changes in higher order aberrations (HOAs), and self-reported quality of vision. Patients completed a validated, Rasch-tested, linear-scaled 30-item questionnaire assessing the quality of vision and visual symptoms preoperatively and at each visit.There was no statistically significant difference (P > .05) between the WFG and WFO groups in the frequency of attaining a refractive error within ±0.25 diopters of emmetropia, achieving postoperative UDVA of 20/16 or better or 20/20 or better, losing one or two or more lines or maintaining their preoperative CDVA, or differences in UDVA, CDVA, low contrast acuity, or HOAs. None of the measured quality of vision parameters exhibited statistically significant differences between the groups preoperatively or at 12 months postoperatively (all P > .05). The WFG and WFO groups each showed significant improvement in multiple subjective measures compared to pretreatment values in the same eye. A total of 12.5% of patients preferred their WFG PRK eye, 31.25% preferred their WFO PRK eye, and 56.25% had no preference at 12 months postoperatively.WFG and WFO PRK using the Alcon Wave-Light Allegretto Eye-Q 400-Hz excimer laser platform provide similar results and self-reported visual symptoms in myopic eyes at 12 months postoperatively. [J Refract Surg. 2020;36(3):160-168.].

  View details for DOI 10.3928/1081597X-20200129-01

  View details for Web of Science ID 000519984200003

  View details for PubMedID 32159820

• A Prospective Comparison of Wavefront-Guided LASIK versus Wavefront-Guided PRK After Previous Keratorefractive Surgery. Clinical ophthalmology (Auckland, N.Z.) Lee, M. D., Chen, L. Y., Tran, E. M., Manche, E. E. 2020; 14: 3411–19

  Abstract

  Purpose: To compare the results of retreatment with wavefront-guided LASIK versus wavefront-guided PRK for residual refractive error following previous myopic keratorefractive surgery.Methods: In this prospective study, 32 eyes of 28 patients after prior myopic keratorefractive surgery underwent retreatment with flap-lift wavefront-guided LASIK (n = 12) or wavefront-guided PRK (n = 20) for residual refractive error. Safety, efficacy, predictability, and wavefront outcomes were evaluated.Results: At last follow-up, both LASIK and PRK retreatment resulted in similar improvement in visual acuity with respective mean ± standard deviation (SD) uncorrected distance visual acuity of -0.07 ± 0.11 logMAR and -0.06 ± 0.13 logMAR (p = 0.87). In the study, 16.7% of LASIK and 33.3% of PRK eyes gained one or more lines of best-corrected distance visual acuity (CDVA), while 16.7% and 9.5% of eyes lost one or more lines of CDVA with LASIK and PRK, respectively. One hundred % of LASIK eyes and 89.5% of PRK eyes were within ± 0.50 diopters of emmetropia. Wavefront analysis demonstrated similar reductions in total RMS error higher-order aberrations (p = 0.84) with no difference in coma, trefoil, or spherical aberration between eyes undergoing LASIK or PRK retreatment.Conclusion: Wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery demonstrate similar safety, efficacy, and predictability with comparable wavefront outcomes.

  View details for DOI 10.2147/OPTH.S276381

  View details for PubMedID 33116393

• Quality of Vision Outcomes of Fellow-Performed LASIK and PRK Hirabayashi, K., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800704029

• Twelve-Month Astigmatic Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized PRK in Myopes Smith, R., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800707159

• Visual and keratometric outcomes after epithelium-off corneal collagen crosslinking for progressive keratoconus Ortiz, A., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800704034

• Patient-reported vision-related quality of life after bilateral wavefront-guided laser in situ keratomileusis JOURNAL OF CATARACT AND REFRACTIVE SURGERY Chen, S. P., Manche, E. E. 2019; 45 (6): 752–59

  View details for DOI 10.1016/j.jcrs.2018.12.013

  View details for Web of Science ID 000470947900008

• Patient-reported vision-related quality of life after bilateral wavefront-guided laser insitu keratomileusis. Journal of cataract and refractive surgery Chen, S. P., Manche, E. E. 2019

  Abstract

  PURPOSE: To evaluate functional vision and quality-of-life outcomes after bilateral wavefront-guided laser insitu keratomileusis (LASIK).SETTING: Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA.DESIGN: Prospective case series.METHODS: Visual acuity, refractive error, and aberrometric measurements were obtained preoperatively and 1, 6, and 12months after bilateral wavefront-guided LASIK. The Refractive Status and Vision Profile questionnaire scores were completed at each timepoint and compared with baseline scores.RESULTS: The study comprised 84 eyes of 42 patients (aged 24 to 47years). At 1year, 76 eyes (90.5%) had an uncorrected distance visual acuity of 20/20 or better and 88.1% of patients were satisfied with their vision without correction. Total refractive status and vision profile scores improved significantly from a mean of 30.9 points at baseline to 20.7 points 1year postoperatively (P<.001). The visual function, perceptions, and problems with corrective lenses subscales statistically significantly improved from preoperatively to postoperatively (all P<.001). In contrast, the driving (P=.286) and visual symptoms subscales (P=.199) did not show significant changes from baseline to 1year.CONCLUSION: Wavefront-guided LASIK not only afforded clinically measurable improvements in vision but also significant improvements in subjective functional vision and vision-related quality of life 1year after surgery.

  View details for PubMedID 30846350

• Prospective evaluation of a novel silicone corneal shield after PRK: 6-month efficacy, safety, and predictability outcomes. Clinical ophthalmology (Auckland, N.Z.) Sáles, C. S., Manche, E. E. 2019; 13: 115-121

  Abstract

  The aim of this study was to report the 1-week and 6-month refractive outcomes of eyes treated with a novel silicone corneal shield designed to improve visual recovery after photorefractive keratectomy (PRK).This prospective, observational clinical trial recruited 45 myopic eyes with or without astigmatism at a university eye clinic to undergo wavefront-guided PRK followed by application of an investigational silicone corneal shield that was removed on postoperative day 4. The primary outcome measures were efficacy, predictability, and safety at the 6-month visit. The secondary end points included short-term uncorrected distance visual acuity (UDVA) and pain.No adverse outcomes occurred using the device. At 6 months, 79.5% of eyes achieved UDVA >20/20, 94.9% achieved ≥20/25, and 97.4% achieved ≥20/40. Also, 2.6% lost one line of corrected distance visual acuity and none lost two lines; 71.8% and 97.4% measured within ±0.25 and ±0.50 D of emmetropia, respectively. During the first week, preoperative UDVA improved from 1.34 logarithm of the minimum angle of resolution (logMAR; <20/400 Snellen) to 0.14 logMAR (>20/30) on postoperative day 1 (P<0.0001) and remained stable on days 2-3 (all P>0.05). After removal of the shield on day 4, UDVA declined by two lines before rebounding to 0.16 logMAR (>20/30) on day 7 (both P<0.001). Subjective metrics of pain all peaked between days 2 and 3 before declining.The investigational silicone corneal shield is safe and effective when used after PRK and may aid early visual recovery and patient comfort, but comparative studies are needed to validate these preliminary findings.One-week and 6-month refractive outcomes of a novel silicone corneal shield used after PRK show that the device is not only safe and effective but may also speed visual recovery.

  View details for DOI 10.2147/OPTH.S183120

  View details for PubMedID 30662255

  View details for PubMedCentralID PMC6327892

• Hydrogel sealant to prevent recurrent epithelial ingrowth in the setting of a LASIK flap buttonhole. American journal of ophthalmology case reports Hirabayashi, K. E., Manche, E. E. 2019; 15: 100518

  Abstract

  To report the first case of hydrogel sealant to prevent the recurrence of epithelial ingrowth in a LASIK flap buttonhole.A 67-year-old female presented ten years after undergoing bilateral LASIK with diffuse lamellar keratitis and flap dislodgement after blunt trauma to the right eye. She was found to have epithelial ingrowth with diffuse debris and striae, so her flap was lifted and the epithelial ingrowth was removed. However, a central buttonhole was noted intraoperatively. Once all the epithelium was removed, the flap was repositioned and hydrogel sealant (ReSure, Ocular Therapeutix, Bedford, MA) was used to fill the buttonhole as well as seal down the edges of the flap. Sixteen months postoperatively, the patient's uncorrected visual acuity was 20/50-2 and there was no recurrence of the epithelial ingrowth at the edges of the buttonhole.Preventing the recurrence of epithelial ingrowth is a challenging situation, especially in the setting of a LASIK flap buttonhole. The use of hydrogel sealant in the buttonhole and around the edges of the flap may offer an elegant and effective solution.

  View details for DOI 10.1016/j.ajoc.2019.100518

  View details for PubMedID 31372580

  View details for PubMedCentralID PMC6656928

• Pros and cons of wavefront-guided photorefractive keratectomy EXPERT REVIEW OF OPHTHALMOLOGY Roe, J., Manche, E. E. 2019; 14 (4-5): 187–89

  View details for DOI 10.1080/17469899.2019.1662298

  View details for Web of Science ID 000498054700001

• Prospective evaluation of a novel silicone corneal shield after PRK: 6-month efficacy, safety, and predictability outcomes CLINICAL OPHTHALMOLOGY Sales, C. S., Manche, E. E. 2019; 13: 115–21

  View details for DOI 10.2147/OPTH.SI183120

  View details for Web of Science ID 000454982500002

• Prospective, randomized, eye-to-eye comparison of a new silicone corneal shield versus conventional bandage contact lens after photorefractive keratectomy. Journal of cataract and refractive surgery Hirabayashi, K. E., Sáles, C. n., Slade, S. G., Manche, E. E. 2019; 45 (12): 1782–88

  Abstract

  To compare uncorrected distance visual acuity (UDVA) and patient-reported outcomes with a new silicone corneal shield and a conventional bandage contact lens (BCL) after photorefractive keratectomy (PRK).Stanford Eye Laser Center (Palo Alto, California) and Slade & Baker Vision (Houston, Texas).Prospective randomized cohort study.Standardized bilateral wavefront-guided or wavefront-optimized PRK was performed in 25 patients with myopia. Each patient's dominant eye was randomized to either a silicone corneal shield or a conventional BCL, which was placed at the conclusion of surgery. The contralateral eye was assigned the other intervention. The UDVA and patient-reported outcomes were measured preoperatively, 1 hour after surgery, and at 1, 2, 3, 4, and 7 days postoperatively.At 1 day postoperatively, the mean logarithm of the minimum angle of resolution (logMAR) UDVA was 0.04 ± 0.16 (SD) in the silicone corneal shield group and 0.29 ± 0.22 in the BCL group (P < 0.01). At 7 days postoperatively, the mean logMAR UDVA was 0.09 ± 0.17 in the silicone corneal shield group and 0.23 ± 0.24 in the BCL group (P = .01). At 1 day through 3 days postoperatively, the patients reported greater pain, discomfort, foreign body sensation, and heavy eyelid in the eye with the silicone corneal shield. There was no statistically significant difference in the survey outcomes between the two groups at 4 days and 7 days postoperatively.The new silicone corneal shield was safe and effective, with faster visual recovery and a trend toward quicker epithelialization; however, it might be less comfortable than a conventional BCL.

  View details for DOI 10.1016/j.jcrs.2019.08.008

  View details for PubMedID 31856990

• Prospective, randomized, contralateral eye comparison of high-resolution wavefront-guided and wavefront-optimized LASIK. American journal of ophthalmology Roe, J. R., Manche, E. E. 2019

  Abstract

  To compare outcomes in wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) to high resolution wavefront-guided (WFG) LASIK.Randomized, fellow eye controlled, clinical trial METHODS: 200 eyes of 100 patients with myopia or compound myopic astigmatism undergoing bilateral LASIK between October 2015 and February 2017 underwent wavefront-optimized (WFO) in one eye and wavefront-guided (WFG) LASIK in fellow eye. Each eye was evaluated for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, refractive error and wavefront aberrometry.Primary outcome was UDVA at 12 months. Secondary outcomes were safety, predictability, stability, refractive error, CDVA, contrast sensitivity and higher order aberrations at 12 months.WFG LASIK had higher levels of supervision and better contrast sensitivity when compared to WFO. Both had excellent postoperative UDVA results, without a significant difference in either mean UDVA or frequency of achieving a specified UDVA, for example 20/16 or better (all P > 0.05). The mean gain in lines of CDVA was significantly higher in the WFG compared to WFO group (0.80 ± 0.75 vs 0.62 ± 0.72; P = 0.04). The WFG cohort had significantly better contrast sensitivity for mean and frequency of achieving > 20/40 for <5% low contrast sensitivity (37.1%, 95% CI, 27.5 - 46.7 vs 24.7%, 95% CI, 16.2 - 33.3; P = 0.01) and >20/32 for <25% low contrast sensitivity (10.3%, 95% CI, 4.3 - 16.4 vs 4%, 95% CI, 0.0 - 8.1; P = 0.04). The WFO group had a significantly higher frequency of <0.25 diopters (D) of refractive astigmatism at 12 months (82.5%, CI 95%, 75.0 - 90.0 vs 72.1%, CI 95%, 63.2 - 81.2; P = 0.02), but not <0.50 D (95.6%, CI 95%, 91.9 - 99.8 vs 96.9, CI 95%, 93.5 - 100; P = 0.61). The WFG group was significantly closer to emmetropia for both sphere and spherical equivalent at all timepoints. Trefoil was significantly lower in the WFG group and was also significantly lower than preoperative measurements.Wavefront-optimized and high-resolution wavefront-guided LASIK achieve excellent visual outcomes. Nonetheless, treatments based on a high-resolution aberrometer appear to offer superior results in some regards.

  View details for DOI 10.1016/j.ajo.2019.05.026

  View details for PubMedID 31173739

• Management of Complex Epithelial Ingrowth After Laser In Situ Keratomileusis Using Fibrin Tissue Glue EYE & CONTACT LENS-SCIENCE AND CLINICAL PRACTICE Chen, L. Y., Kung, J. S., Manche, E. E. 2018; 44: S210–S214

  View details for DOI 10.1097/ICL.0000000000000447

  View details for Web of Science ID 000457840400036

• Astigmatic outcomes in myopic wavefront-guided laser in situ keratomileusis versus wavefront-guided photorefractive keratectomy using vector analysis JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lee, M. D., Toy, B. C., Manche, E. E. 2018; 44 (11): 1350–54

  View details for DOI 10.1016/j.jcrs.2018.07.022

  View details for Web of Science ID 000449308900011

• Management of Complex Epithelial Ingrowth After Laser In Situ Keratomileusis Using Fibrin Tissue Glue. Eye & contact lens Chen, L. Y., Kung, J. S., Manche, E. E. 2018; 44 Suppl 2: S210–S214

  Abstract

  OBJECTIVES: To evaluate the efficacy and safety of adjunctive fibrin tissue glue in the treatment of complex epithelial ingrowth after laser in situ keratomileusis (LASIK).METHODS: A retrospective review was performed of 12 eyes in 12 patients treated for clinically significant epithelial ingrowth after LASIK with mechanical debridement of the ingrowth and placement of fibrin tissue glue. Primary outcome measurements including recurrence of ingrowth, visual acuity, and manifest refraction were evaluated at each postoperative examination. Changes in higher-order aberrometry were also evaluated.RESULTS: After epithelial ingrowth removal with adjunctive fibrin tissue glue, 11 eyes (91.7%) had no recurrence of ingrowth at the final follow-up examination. Uncorrected distance visual acuity changed from 20/20 or better in 3 eyes (25%) and 20/40 or better in 6 eyes (50%) preoperatively to 20/20 or better in 5 eyes (41.7%) and 20/40 or better in 10 eyes (83.3%) postoperatively. Nine eyes (75%) gained one or more lines of best-corrected distance visual acuity (CDVA). No eyes lost any lines of CDVA. There was no significant change in mean spherical equivalent (P=0.22) or mean cylinder (P=0.26) before and after surgery. Higher-order aberrations also remained stable with no significant change in root-mean-square error, coma, trefoil, and spherical aberration. There were no complications associated with the treatment.CONCLUSIONS: Adjunctive fibrin tissue glue seems to be a safe and effective treatment for epithelial ingrowth after LASIK. This therapy may be particularly useful in managing challenging cases of complex or recalcitrant ingrowth.

  View details for PubMedID 29219897

• Astigmatic outcomes in myopic wavefront-guided laser insitu keratomileusis versus wavefront-guided photorefractive keratectomy using vector analysis. Journal of cataract and refractive surgery Lee, M. D., Toy, B. C., Manche, E. E. 2018

  Abstract

  PURPOSE: To compare astigmatic outcomes between eyes having wavefront-guided laser insitu keratomileusis (LASIK) and eyes having wavefront-guided photorefractive keratectomy (PRK).SETTING: Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA.DESIGN: Prospective randomized case series.METHODS: Patients had refractive surgery, with one eye treated with LASIK and the other treated with PRK. Eyes were randomized according to ocular dominance. Astigmatism vectors were evaluated using the Alpins vector analysis of astigmatism.RESULTS: Thirty-four patients (68 eyes) had vector analysis; the LASIK and PRK groups had similar target-induced astigmatism vectors (P=0.75), surgically induced astigmatism vectors (P=0.86), difference vectors (P=1.0), indices of success (P=0.4), correction indices (P=0.28), and flattening indices (P=0.5).CONCLUSION: Based on Alpins vector analysis of astigmatism, there were no statistically significant differences between eyes that had LASIK and eyes that had PRK.

  View details for PubMedID 30201128

• Vector Analysis of 1-Year Astigmatic Outcomes From a Randomized Fellow Eye Comparison of Photorefractive Keratectomy Using 2 Excimer Laser Platforms Toy, B. C., Manche, E. E. LIPPINCOTT WILLIAMS & WILKINS. 2018: S71–S76

  View details for DOI 10.1097/ICL.0000000000000332

  View details for Web of Science ID 000457837000013

• Quality of Vision After Wavefront-Guided or Wavefront-Optimized Photorefractive Keratectomy: A Prospective Randomized Contralateral Eye Study Smith, R., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442932807111

• Recent advances in wavefront-guided LASIK CURRENT OPINION IN OPHTHALMOLOGY Manche, E., Roe, J. 2018; 29 (4): 287–92

  View details for DOI 10.1097/ICU.000000000000488

  View details for Web of Science ID 000446143500003

• Recent advances in wavefront-guided LASIK. Current opinion in ophthalmology Manche, E., Roe, J. 2018

  Abstract

  PURPOSE OF REVIEW: Laser vision correction remains an active area of research, and there have been many recent advances in the field. The purpose of this review is to provide an update on the recent advances for one of the most common methods of laser vision correction, wavefront-guided laser in-situ keratomileusis (LASIK).RECENT FINDINGS: Recent technological advancements in wavefront aberrometry are largely responsible for the improved visual outcomes that have been recently reported. In addition, improvements in femtosecond and excimer laser technology, used in flap creation and corneal ablation, have been shown to provide superior results when compared to microkeratomes and earlier lasers. Wavefront-guided LASIK appears to have advantages over some other keratorefractive modalities in terms of visual acuity, predictability, astigmatism correction, and subjective visual symptoms. Nonetheless, there may be some limitations in highly aberrated corneas, and also in biomechanical stability relative to other available platforms.SUMMARY: Improvements in wavefront aberrometry, and also femtosecond and excimer lasers, have continued to improve our ability to correct refractive errors. Wavefront-guided LASIK remains a well tolerated and effective keratorefractive procedure, with a trend toward superiority. Nonetheless, further studies comparing this modality to others are needed to define the role each can serve.

  View details for PubMedID 29708931

• Comparison of simulated keratometric changes following wavefront-guided and wavefront-optimized myopic laser-assisted in situ keratomileusis CLINICAL OPHTHALMOLOGY Lee, W., Manche, E. E. 2018; 12: 613–19

  Abstract

  The aim of the study was to determine and compare the relationship between change in simulated keratometry (K) and degree of refractive correction in wavefront-guided (WFG) and wavefront-optimized (WFO) myopic laser-assisted in situ keratomileusis (LASIK).A total of 51 patients were prospectively randomized to WFG LASIK in one eye and WFO LASIK in the contralateral eye at the Byers Eye Institute, Stanford University. Changes in simulated K and refractive error were determined at 1 year post-operatively. Linear regression was employed to calculate the slope of change in simulated K (ΔK) for change in refractive error (ΔSE). The mean ratio (ΔK/ΔSE) was also calculated.The ratio of ΔK to ΔSE was larger for WFG LASIK compared to WFO LASIK when comparing the slope (ΔK/ΔSE) as determined by linear regression (0.85 vs 0.83, p = 0.04). Upon comparing the mean ratio (ΔK/ΔSE), subgroup analysis revealed that ΔK/ΔSE was larger for WFG LASIK for refractive corrections of >3.00 D and >4.00 D (0.89 vs 0.83; p = 0.0323 and 0.88 vs 0.83; p = 0.0466, respectively). Both linear regression and direct comparison of the mean ratio (ΔK/ΔSE) for refractive corrections <4.00 D and >4.00 D revealed no difference in ΔK/ΔSE between smaller and larger refractive corrections.WFO LASIK requires a smaller amount of corneal flattening compared to WFG LASIK for a given degree of refractive correction. For both, there was no significant difference in change in corneal curvature for a given degree of refractive error between smaller and larger corrections.

  View details for PubMedID 29636597

• Quality of Vision After Femtosecond Laser or Mechanical Keratome for Laser In Situ Keratomileusis: A Prospective Randomized Contralateral Eye Study Muminovic, I., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432176305140

• Three-Month Outcomes from a Prospective, Randomized, Contralateral, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized PRK in Myopes Smith, R., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432176305157

• Real time, non invasive, assessment of transepithelial delivery of riboflavin in the human cornea Lombardo, G., Brownell, M., Villari, V., Micali, N., Manche, E. E., Abbate, A., Lombardo, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432176301097

• Phototherapeutic keratectomy for epithelial basement membrane dystrophy. Clinical ophthalmology (Auckland, N.Z.) Lee, W., Lam, C. K., Manche, E. E. 2017; 11: 15-22

  Abstract

  The purpose of this study was to evaluate the long-term efficacy of phototherapeutic keratectomy (PTK) in treating epithelial basement membrane dystrophy (EBMD).Preoperative and postoperative records were reviewed for 58 eyes of 51 patients with >3 months follow-up (range 3-170 months) treated for EBMD with PTK after failure of conservative medical treatment at Byers Eye Institute of Stanford University. Symptoms, clinical findings, and corrected distance visual acuity (CDVA) were assessed. The primary outcome measure was symptomatic recurrence as measured by erosions or visual complaints >3 months after successful PTK.For eyes with visual disturbances (n=30), preoperative CDVA waŝ20/32 (0.24 Log-MAR, SD 0.21) and postoperative CDVA was ~20/25 (0.07 LogMAR, SD 0.12; P<0.0001). Twenty-six eyes (86.7%) responded to treatment, with symptomatic recurrence in 6 eyes (23.1%) at an average of 37.7 months (SD 42.8). For eyes with painful erosions (n=29), preoperative CDVA was ~20/25 (0.12, SD 0.19) and postoperative CDVA was ~20/20 (0.05. SD 0.16; P=0.0785). Twenty-three eyes (79.3%) responded to treatment, with symptomatic recurrence in 3 eyes (13.0%) at an average of 9.7 months (SD 1.5). The probability of being recurrence free after a successful treatment for visual disturbances and erosions at 5 years postoperatively was estimated at 83.0% (95% confidence interval 68.7%-97.0%) and 88.0% (95% confidence interval 65.3%-96.6%), respectively.The majority of visual disturbances and painful erosions associated with EBMD respond to PTK. For those with a treatment response, symptomatic relief is maintained over long-term follow-up.

  View details for DOI 10.2147/OPTH.S122870

  View details for PubMedID 28031698

• Quality of vision after wavefront-guided laser in situ keratomileusis or photorefractive keratectomy: Contralateral eye evaluation JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lee, M. D., Manche, E. E. 2017; 43 (1): 54-59

  Abstract

  To compare quality of vision between laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA.Prospective randomized case series.Patients had refractive surgery, with 1 eye treated with LASIK and the other with PRK. Eyes were randomized for dominance. The patients completed a questionnaire assessing quality of vision in each eye at the initial visit and 1, 3, 6, and 12 months postoperatively.The study comprised 34 patients (68 eyes). There were no initial differences in quality of vision. The PRK eyes had worse clarity during the day (P = .001) and at night (P = .001), worse overall vision (P = .024), more vision fluctuation (P = .006), and more double vision (P = .022) at 1 month. Eyes with higher preoperative higher-order aberrations (HOAs) having PRK had worse clarity during the day and at night (P = .006 and P = .012, respectively) and more vision fluctuation (P = .041); PRK eyes with lower preoperative HOAs had worse daytime clarity (P = .036) at 1 month. After 1 month, there were no differences.The quality of vision was better in LASIK eyes after 1 month. At subsequent visits, there was no significant difference in quality of vision.

  View details for DOI 10.1016/j.jcrs.2016.10.021

  View details for PubMedID 28317678

• Vector Analysis of 1-Year Astigmatic Outcomes From a Randomized Fellow Eye Comparison of Photorefractive Keratectomy Using 2 Excimer Laser Platforms. Eye & contact lens Toy, B. C., Manche, E. E. 2016

  Abstract

  To compare the astigmatic outcomes of photorefractive keratectomy (PRK) with a wavefront-guided (WFG) and a wavefront-optimized (WFO) excimer laser performed on two different platforms.Setting: institutional.Prospective, randomized, fellow eye comparison clinical trial.A total of 142 eyes of 71 patients with myopia of 12 diopters (D) or less and astigmatism of 3D or less were enrolled at the Byers Eye Institute at Stanford between April 2009 and March 2011.One eye of each patient underwent WFG-PRK with the VISX CustomVue Star S4 IR (Abbott Medical Optics, Abbott Park, IL) and the contralateral eye underwent WFO-PRK with the Wavelight Allegretto Eye-Q 400-Hz laser platform (Alcon, Inc., Hüenberg, Switzerland). Alpins vector analysis of astigmatism was performed using manifest refraction measured preoperatively and 12 months postoperatively and vertexed to the corneal plane. Eyes were stratified for subgroup analysis based on preoperative manifest astigmatism.WFG-PRK and WFO-PRK were similar regarding surgically induced astigmatism, difference vector, magnitude of error, correction index, flattening index, and index of success. The angle of error was 60% less in the WFG group compared with the WFO group (4.9±1.1° vs. 11.8±2.4°, P=0.01).WFG-PRK with the VISX CustomVue Star S4 IR and WFO-PRK with the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform produce similar astigmatic results in myopic patients; however, the WFG mode may produce slightly more predictable astigmatic corrections.

  View details for DOI 10.1097/ICL.0000000000000332

  View details for PubMedID 28002091

• Quality of Vision After Wavefront-Guided Laser-Assisted In Situ Keratomileusis (LASIK) or Wavefront-Guided Photorefractive Keratectomy (PRK): A Prospective Randomized Contralateral Eye Evaluation Lee, M., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394210205119

• Phototherapeutic Keratectomy for Epithelial Basement Membrane Dystrophy Lee, W., Lam, C. K., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394174003171

• A prospective comparison of wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery. Chen, L., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394210205129

• Comparison of Simulated Keratometric Changes Following Wavefront-Guided and Wavefront-Optimized Myopic Photorefractive Keratectomy JOURNAL OF REFRACTIVE SURGERY Lee, W., Manche, E. E. 2016; 32 (8): 542-548

  Abstract

  To determine the relationship between change in simulated keratometry and corrected refractive error in both wavefront-guided and wavefront-optimized myopic photorefractive keratectomy (PRK), and to determine whether there is a difference in this relationship between these two ablation profiles.Sixty-eight patients received wavefront-guided PRK in one eye and wavefront-optimized PRK in the contralateral eye. The changes in simulated keratometry and corresponding refractive changes for both were determined at 1 year postoperatively. Linear regression was employed to calculate the slope of change in simulated keratometry (ΔK) for change in refractive error (ΔSE) for both wavefront-guided and wavefront-optimized PRK and compared. The mean ratio ΔK/ΔSE was also calculated for both wavefront-guided and wavefront-optimized PRK and compared.There was no significant difference in the ratio of ΔK to ΔSE between wavefront-optimized and wavefront-guided PRK by both linear regression modeling and comparison of the mean ratio ΔK/ΔSE. Linear regression modeling revealed that the ratio of ΔK/ΔSE was greater for small amounts of change in refractive error and smaller for large amounts of change in refractive error. This trend was only statistically significant for the wavefront-optimized group when comparing the means of the ratio ΔK/ΔSE (P = .0287).The change in corneal curvature induced for a given degree of refractive correction was similar for both wavefront-optimized and wavefront-guided PRK. For both, a proportionally smaller amount of corneal flattening was required for larger degrees of refractive correction compared to smaller degrees. [J Refract Surg. 2016;32(8):542-548.].

  View details for DOI 10.3928/1081597X-20160525-01

  View details for Web of Science ID 000384899900005

  View details for PubMedID 27505315

• Comparison of femtosecond and excimer laser platforms available for corneal refractive surgery CURRENT OPINION IN OPHTHALMOLOGY Chen, L. Y., Manche, E. E. 2016; 27 (4): 316-322

  Abstract

  The evolution of laser technology has left today's refractive surgeon with a choice between multiple laser platforms. The purpose of this review is to compare currently available femtosecond and excimer laser platforms, providing a summary of current evidence.Femtosecond lasers create LASIK flaps with better accuracy, uniformity, and predictability than mechanical microkeratomes. Newer higher-frequency femtosecond platforms elicit less inflammation, producing better visual outcomes. SMILE achieved similar safety, efficacy, and predictability as LASIK with greater preservation of corneal nerves and biomechanical strength. The emergence of wavefront technology has resulted in improved excimer laser treatments. Comparisons of wavefront-guided and wavefront-optimized treatments suggest that there is an advantage to using wavefront-guided platforms in terms of visual acuity and quality of vision. Topography-guided ablations are another well tolerated and effective option, especially in eyes with highly irregular corneas.Advances in femtosecond and excimer laser technology have not only improved the safety and efficacy of refractive procedures, but have also led to the development of promising new treatment modalities, such as SMILE and the use of wavefront-guided and topography-guided ablation. Future studies and continued technological progress will help to better define the optimal use of these treatment platforms.

  View details for DOI 10.1097/ICU.0000000000000268

  View details for PubMedID 27031540

• Subjective Quality of Vision After Myopic LASIK: Prospective 1-Year Comparison of Two Wavefront-Guided Excimer Lasers. Journal of refractive surgery Yu, C. Q., Manche, E. E. 2016; 32 (4): 224-229

  Abstract

  To compare subjective quality of vision between two wavefront-guided lasers in the treatment of myopia up to 1 year postoperatively.In this prospective randomized study, 100 eyes of 50 patients were treated with wavefront-guided LASIK. One eye was treated with the WaveLight Allegretto Wave Eye-Q 400-Hz excimer laser (Alcon Laboratories, Inc., Hünenberg, Switzerland) and the other was treated with the VISX Star S4 IR CustomVue excimer laser (Abbott Medical Optics, Santa Ana, CA). Patients completed a questionnaire assessing quality of vision and visual symptoms preoperatively and at postoperative months 1, 3, 6, and 12.The Allegretto system demonstrated non-statistically significant superiority in several subjective parameters as early as 1 month after surgery. At 12 months, there was better clarity during the day (P = .001) in the Allegretto group. Subgroup analyses were performed on eyes with preoperative higher order aberrations of 0.3 µm or less and in patients with preoperative higher order aberrations greater than 0.3 µm. In subgroup analysis, there were no differences between the two systems in eyes with low higher order aberrations or high higher order aberrations. Patients did not express any preference for one system over the other when surveyed at 1 year postoperatively.One year after surgery, there were no differences in self-reported quality of vision outcomes with the exception of better clarity of vision during the day in the eyes treated with the Allegretto system. Patients did not express any preference for one treatment modality over the other. [J Refract Surg. 2016;32(4):224-229.].

  View details for DOI 10.3928/1081597X-20151222-03

  View details for PubMedID 27070228

• Quality of Vision After Wavefront-Guided or Wavefront-Optimized LASIK: A Prospective Randomized Contralateral Eye Study. Journal of refractive surgery Kung, J. S., Manche, E. E. 2016; 32 (4): 230-236

  Abstract

  To compare the effect of wavefront-guided and wavefront-optimized LASIK using different laser platforms on subjective quality of vision.The dominant eyes of 55 participants with myopia were randomized to receive either wavefront-guided LASIK treatment by the VISX Star S4 IR Custom-Vue excimer laser system (Abbott Medical Optics, Inc., Santa Clara, CA) or wavefront-optimized treatment by the WaveLight Allegretto Wave Eye-Q 400-Hz excimer laser system (Alcon Laboratories, Inc., Fort Worth, TX), whereas the fellow eye had the alternate laser treatment. Patients completed a questionnaire assessing quality of vision and visual symptoms (daytime and nighttime glare, daytime and nighttime clarity, halos, haze, fluctuating vision, and double vision) preoperatively and at postoperative months 1, 3, 6, and 12.At 3, 6, and 12 months postoperatively, there was no significant difference in any individual symptom between the wavefront-guided and wavefront-optimized groups, although at 12 months wavefront-guided eyes trended toward having more excellent vision (wavefront-guided vs wavefront-optimized; 2.26 vs 2.43; P = .039). In the subgroup of patients with preoperative root mean square (RMS) higher order aberrations (HOAs) less than 0.3 µm in both eyes, the wavefront-optimized group demonstrated a trend toward worsened nighttime clarity (P = .009), daytime clarity (P = .015), and fluctuating vision (P = .046), and less excellent vision (P = .009) at 12 months.Twelve months after surgery, most patients' self-reported visual symptoms were similar in eyes receiving wavefront-guided or wavefront-optimized LASIK. In general, 36% of patients preferred wavefront-guided LASIK, 19% preferred wavefront-optimized LASIK, and 45% had no preference at 12 months. The wavefront-guided preference was more pronounced in patients with lower baseline HOAs (RMS < 0.3 µm). [J Refract Surg. 2016;32(4):230-236.].

  View details for DOI 10.3928/1081597X-20151230-01

  View details for PubMedID 27070229

• Comparison of self-reported quality of vision outcomes after myopic LASIK with two femtosecond lasers: a prospective, eye-to-eye study. Clinical ophthalmology (Auckland, N.Z.) Sáles, C. S., Manche, E. E. 2016; 10: 1691-1699

  Abstract

  To compare self-reported quality of vision (QoV) outcomes after myopic LASIK (laser-assisted in situ keratomileusis) with two femtosecond lasers.Prospective, randomized, eye-to-eye study.Consecutive myopic patients were treated with wavefront-guided LASIK bilaterally. Eyes were randomized according to ocular dominance. The flap of one eye was made with the IntraLase FS 60 kHz femtosecond laser with a conventional 70° side-cut, and the flap of the fellow eye was made with the IntraLase iFS 150 kHz femtosecond laser with an inverted 130° side-cut. Patients completed the validated, Rasch-tested, linear-scaled 30-item QoV questionnaire preoperatively and at Months 1, 3, 6, and 12.The study enrolled 120 fellow eyes in 60 patients. None of the measured QoV parameters exhibited statistically significant differences between the groups preoperatively or at any postoperative time point.Creating LASIK flaps with an inverted side-cut using a 150 kHz femtosecond laser and with a conventional 70° side-cut using a 60 kHz femtosecond laser resulted in no significant differences in self-reported QoV assessed by the QoV questionnaire.

  View details for DOI 10.2147/OPTH.S111328

  View details for PubMedID 27621589

• Trends and Associations in Hospitalizations Due to Corneal Ulcers in the United States, 2002-2012 OPHTHALMIC EPIDEMIOLOGY Lee, R., Manche, E. E. 2016; 23 (4): 257-263

  Abstract

  To estimate incidence, temporal trends, and factors associated with inpatient hospitalization due to corneal ulcers in the United States.Data on inpatient hospitalizations due to corneal ulcers between 2002 and 2012 were reviewed using the National Inpatient Sample. A literature review was conducted to identify the most common causes of corneal ulcers, and use of contact lenses.An estimated 19,878 patients were seen in US emergency departments for evaluation of corneal ulcers in 2012. Rates of inpatient hospitalization due to corneal ulcers remained comparable over the decade (2003: 4.9, 95% confidence interval, CI, 3.0-6.7; 2012: 2.7, 95% CI 2.2-3.3 patients per million US population). Among those hospitalized for ophthalmic disease, patients holding public or no insurance (odds ratio, OR, 1.8 and 2.5, respectively, p<0.001), from low-income neighborhoods (OR 1.6, p < 0.001), and of older age (OR 3.4, p < 0.001) were more likely to be hospitalized for corneal ulceration. Medical conditions associated with hospitalization for corneal ulcer included history of keratitis (7.7%, p < 0.001), HIV infection (2.6%, p = 0.003), history of contact lens-related complications (2.5%, p < 0.001), and history of eye injury (2.5%, p = 0.001). Patients with a history of keratitis (p = 0.006) or rheumatoid arthritis (p = 0.001) were each twice as likely to receive a corneal transplant.Factors associated with hospitalization for corneal ulcer include insurance status in addition to history of contact lens-related disease and keratitis. Efforts should be made to address these factors prior to development of severe ulcers.

  View details for DOI 10.3109/09286586.2016.1172648

  View details for PubMedID 27348134

• Comparison of ocular aberrations measured by a Fourier-based Hartmann-Shack and Zernike-based Tscherning aberrometer before and after laser in situ keratomileusis. Journal of cataract and refractive surgery Sáles, C. S., Manche, E. E. 2015; 41 (9): 1820-1825

  Abstract

  To assess agreement between a Hartmann-Shack aberrometer (Wavescan) and a Tscherning aberrometer (Wavelight Allegro Analyzer) and their respective agreement with manifest refraction before and after laser in situ keratomileusis (LASIK).Stanford Eye Laser Center, California, USA.Prospective comparative observational study.Multiple readings were obtained both aberrometers preoperatively and 12 months after wavefront-guided LASIK. Sphere, cylinder, spherical equivalent (SE), defocus Z(2,0), astigmatism Z(2,2), spherical aberration Z(4,0), coma Z(3,1), trefoil Z(3,3), and total higher-order aberrations (HOAs) were compared using intraclass correlation coefficients (ICCs) (perfect agreement = 1; disagreement = 0).In the 100 study eyes, preoperative agreement was good to excellent between the aberrometers for the parameters of defocus, astigmatism, and spherical aberration (ICC: 0.8, 0.9, and 0.7, respectively) but was poor for coma, trefoil, and total HOAs (ICC: 0.6, -0.2, and 0.4, respectively). At 12 months, ICCs worsened for all parameters (ICC: defocus = 0.6; astigmatism = 0.2; spherical aberration = 0.6; coma = 0.4; trefoil = -0.3; total HOAs = 0.4). Preoperative agreement of sphere, cylinder, and SE was good to excellent between the manifest refraction and both aberrometers (ICC Hartmann-Shack: 0.98, 0.95, and 0.97, respectively; ICC Tscherning: 0.97, 0.92, and 0.98, respectively). However, agreement was poor to fair between the manifest refraction and both aberrometers at 12 months (ICC Hartmann-Shack: 0.4, 0.1, and 0.4, respectively; ICC Tscherning: 0.03, 0.02, and 0.2, respectively).Although some HOAs measured with both aberrometers agreed preoperatively, such agreement might not persist after LASIK. Spherocylinder measurements with both aberrometers seemed to agree closely with the manifest refraction before LASIK, but not at 12 months.Dr. Manche has equity in Calhoun Vision, Inc., Krypton Vision, Seros Medical, LLC, and Veralas and is a consultant to Best Doctors, Gerson Lehrman Group.

  View details for DOI 10.1016/j.jcrs.2015.09.014

  View details for PubMedID 26603389

• Managing residual refractive error after cataract surgery. Journal of cataract and refractive surgery Sáles, C. S., Manche, E. E. 2015; 41 (6): 1289-1299

  Abstract

  We present a review of keratorefractive and intraocular approaches to managing residual astigmatic and spherical refractive error after cataract surgery, including laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), arcuate keratotomy, intraocular lens (IOL) exchange, piggyback IOLs, and light-adjustable IOLs. Currently available literature suggests that laser vision correction, whether LASIK or PRK, yields more effective and predictable outcomes than intraocular surgery. Piggyback IOLs with a rounded-edge profile implanted in the sulcus may be superior to IOL exchange, but both options present potential risks that likely outweigh the refractive benefits except in cases with large residual spherical errors. The light-adjustable IOL may provide an ideal treatment to pseudophakic ametropia by obviating the need for secondary invasive procedures after cataract surgery, but it is not widely available nor has it been sufficiently studied.Dr. Manche has equity in Calhoun Vision, Inc., Krypton Vision, Refresh Innovations, Inc., Seros Medical, LLC, and Veralas, Inc. He is a consultant to Oculeve, Inc., Best Doctors, and Gerson Lehrman. Dr. Sáles has no financial or proprietary interest in any material or method mentioned.

  View details for DOI 10.1016/j.jcrs.2015.05.001

  View details for PubMedID 26096522

• Vacuum-mediated transepithelial delivery of riboflavin to the cornea Myung, D., Zaler, G., Abbate, A., DiGiore, D., Eaton, D., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882207178

• Wavefront-Optimized LASIK and PRK in Patients with High Astigmatism Wang, K., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362891102128

• Astigmatism Vector Analysis Comparing Laser In Situ Keratomileusis Flap Creation Using 150kHz and 60kHz Femtosecond Laser Platforms Toy, B. C., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362891102130

• Photorefractive keratectomy for residual refractive error in pseudophakic patients Chen, L., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362891102142

• Vector analysis of 1-year astigmatic outcomes from a prospective, randomized, fellow eye comparison of wavefront-guided and wavefront-optimized LASIK in myopes. Journal of refractive surgery Toy, B. C., Yu, C., Manche, E. E. 2015; 31 (5): 322-327

  Abstract

  To compare the astigmatic outcomes of LASIK with a single excimer laser platform using either wavefront-guided (WFG) or wavefront-optimized (WFO) modes.Sixty-eight eyes of 34 patients underwent LASIK for myopia with the Wavelight Allegretto Eye-Q 400-Hz laser platform (Alcon Laboratories, Inc., Hüenberg, Switzerland). One eye underwent WFG-LASIK and the contralateral eye underwent WFO-LASIK. Alpins vector analysis of astigmatism was performed using manifest refraction measured preoperatively and 12 months postoperatively and vertexed to the corneal plane. Eyes were stratified for subgroup analysis based on preoperative manifest astigmatism.WFG-LASIK and WFO-LASIK were similar with regard to surgically induced astigmatism, difference vector, magnitude of error, correction index, flattening index, and index of success. The angle of error was 80% less in the WFG group compared to the WFO group (1.92° ± 0.67º vs 9.66° ± 3.7º, P = .04).WFG-LASIK and WFO-LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform produce similar astigmatic results in myopic patients; however, the WFG mode may produce slightly more predictable astigmatic corrections.

  View details for DOI 10.3928/1081597X-20150424-08

  View details for PubMedID 25974971

• Vector Analysis of 1-Year Astigmatic Outcomes From a Prospective, Randomized, Fellow Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes JOURNAL OF REFRACTIVE SURGERY Toy, B. C., Yu, C., Manche, E. E. 2015; 31 (5): 322-?

  Abstract

  To compare the astigmatic outcomes of LASIK with a single excimer laser platform using either wavefront-guided (WFG) or wavefront-optimized (WFO) modes.Sixty-eight eyes of 34 patients underwent LASIK for myopia with the Wavelight Allegretto Eye-Q 400-Hz laser platform (Alcon Laboratories, Inc., Hüenberg, Switzerland). One eye underwent WFG-LASIK and the contralateral eye underwent WFO-LASIK. Alpins vector analysis of astigmatism was performed using manifest refraction measured preoperatively and 12 months postoperatively and vertexed to the corneal plane. Eyes were stratified for subgroup analysis based on preoperative manifest astigmatism.WFG-LASIK and WFO-LASIK were similar with regard to surgically induced astigmatism, difference vector, magnitude of error, correction index, flattening index, and index of success. The angle of error was 80% less in the WFG group compared to the WFO group (1.92° ± 0.67º vs 9.66° ± 3.7º, P = .04).WFG-LASIK and WFO-LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform produce similar astigmatic results in myopic patients; however, the WFG mode may produce slightly more predictable astigmatic corrections.

  View details for DOI 10.3928/1081597X-20150424-08

  View details for Web of Science ID 000356147500006

  View details for PubMedID 25974971

• Comparison of 2 femtosecond lasers for flap creation in myopic laser in situ keratomileusis: One-year results. Journal of cataract and refractive surgery Yu, C. Q., Manche, E. E. 2015; 41 (4): 740-748

  Abstract

  To compare laser in situ keratomileusis (LASIK) outcomes between 2 femtosecond lasers for flap creation in the treatment of myopia up to 1 year.University eye clinic.Prospective randomized eye-to-eye study.Consecutive myopic patients were treated with wavefront-guided LASIK. One eye had a flap created by the Intralase FS 60 kHz femtosecond laser, and the fellow eye was treated with the Intralase iFS 150 kHz femtosecond laser. Eyes were randomized according to ocular dominance. Evaluations included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity, contrast sensitivity and wavefront aberrometry.The study enrolled 122 eyes of 61 patients. The mean preoperative spherical equivalent refraction was -4.62 diopters (D) ± 2.32 (SD) and -4.66 ± 2.30 D in the 150 kHz group and 60 kHz group, respectively. Patients preferred the 150 kHz laser to the 60 kHz laser intraoperatively (52.5% versus 26.2%) (P = .005). One week postoperatively, UDVA was 20/16 or better in 85.2% in the 150 kHz group and 70.5% in the 60 kHz group; the difference was statistically significant (P < .05). At 12 months, there were no significant differences in refractive outcomes or higher-order aberrations between the 2 groups.Flap creation with the 150 kHz system and the 60 kHz system resulted in excellent LASIK outcomes. Intraoperatively, patients preferred the 150 kHz system, which yielded better UDVA in the early postoperative period. There were no significant differences at 1 year between the 2 laser systems.Proprietary or commercial disclosures are listed after the references.

  View details for DOI 10.1016/j.jcrs.2014.06.038

  View details for PubMedID 25840298

• Day 1 Wavefront Aberrometry for Prediction of Refractive Outcomes at Year 1 in Myopic LASIK JOURNAL OF REFRACTIVE SURGERY Yu, C. Q., Manche, E. E. 2015; 31 (3): 170-174

  Abstract

  To determine amount of change in wavefront aberrometric measurements from 1 day to 1 year after myopic LASIK.One hundred five eyes of 105 patients underwent wavefront-guided LASIK. Objective wavefront aberrometric refractions were recorded preoperatively, at postoperative day 1, and at postoperative year 1. Subjective manifest refractions were also collected at postoperative year 1.When comparing objective wavefront aberrometric refractions at postoperative year 1 to postoperative day 1, there was a mean 0.33 diopter spherical equivalent myopic shift. There was no significant difference in the number of eyes within 1.00 diopter of emmetropia spherical equivalent measured by wavefront aberrometric refraction at postoperative day 1 or year 1. There was a correlation of R(2) = 0.14 between degree of preoperative myopia and myopic shift. Higher-order aberrations were overall not increased at day 1 but increased significantly by year 1. Objective aberrometric refractions at postoperative day 1 can be useful in prediction of long-term refractive outcomes.There is a small myopic shift and an increase in higher-order aberrations when comparing wavefront aberrometry results at postoperative day 1 with those at postoperative 1 year.

  View details for DOI 10.3928/1081597X-20150220-04

  View details for Web of Science ID 000352490700005

  View details for PubMedID 25751833

• Contralateral Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized Photorefractive Keratectomy A Randomized Clinical Trial JAMA OPHTHALMOLOGY He, L., Manche, E. E. 2015; 133 (1): 51-59

  Abstract

  Wavefront-guided (WFG) and wavefront-optimized (WFO) platforms for refractive surgery are designed for improved visual outcomes. It is unclear which treatment profile is superior for patients undergoing photorefractive keratectomy (PRK).To compare the safety, efficacy, predictability, stability, and higher-order aberrations in eyes undergoing WFG and WFO PRK.A prospective, randomized, fellow-eye-controlled clinical trial was conducted at the Byers Eye Institute at Stanford with enrollment between April 2009 and March 2011; 1 year of follow-up was included. Of 90 patients screened, 71 patients (142 eyes) with less than 12.00 diopters (D) of spherical myopia and less than 3.00 D of astigmatism were enrolled consecutively.One eye was randomized to undergo WFG PRK treatment (Visx CustomVue Star S4 IR excimer laser system; Abbott Medical Optics), and the fellow eye received WFO PRK treatment (WaveLight Allegretto Wave Eye-Q 400 Hz excimer laser system; Alcon Surgical).Data on the manifest refraction, uncorrected visual acuity, best-corrected visual acuity, 5% and 25% contrast best-corrected visual acuity, and higher-order aberrations were collected preoperatively and at the 1-, 3-, 6-, and 12-month follow-up visits.Eyes undergoing both treatments had improved best-corrected visual acuity (WFG: mean, 0.05 [95% CI, 0.03-0.07]; WFO: mean, 0.04 [95% CI, 0.02-0.06]) and less sphere (WFG: mean, -4.79 [95% CI, -5.31 to -4.26]; WFO: mean, -4.61 [95% CI, -5.18 to -4.03]), cylinder (WFG: mean, 0.66 [95% CI, 0.49-0.82]; WFO: mean, 0.52 [95% CI, 0.35-0.69]), and spherical equivalents (WFG: mean, -4.45 [95% CI, -4.99 to -3.91]; WFO: mean, -4.34 [95% CI, -4.92 to -3.76]) (P < .001) but higher levels of spherical aberration (WFG: mean, -0.11 [95% CI, -0.15 to -0.06]; WFO: mean, -0.11 [95% CI, -0.14 to -0.07]) (P < .001) and higher-order root-mean-square aberrations (WFO: mean, -0.07 [95% CI, -0.12 to -0.02]; WFO: mean, -0.12 [95% CI, -0.17 to -0.70]) (P = .005 in WFG eyes and P < .001 in WFO eyes) at 12 months compared with preoperative measurements. A total of 93.0% of the eyes in the WFG group and 94.4% in the WFO had an uncorrected visual acuity of 20/20 or better at 12 months, with 56.3% in the WFG group and 43.7% in the WFO group gaining 1 or more lines of best-corrected visual acuity. The stability of the refractive correction was excellent for both groups.A difference in uncorrected visual acuity or contrast acuity between eyes undergoing WFG or WFO treatment at 3 months and beyond could not be identified. This lack of difference suggests that both systems can be used to provide excellent improvement in vision for persons with myopia.clinicaltrials.gov Identifier: NCT01135719.

  View details for DOI 10.1001/jamaophthalmol.2014.3876

  View details for Web of Science ID 000347972500008

  View details for PubMedID 25321951

• HOW DO I MANAGE A BUTTONHOLE OR FREE CAP DURING LASIK? CURBSIDE CONSULTATION IN REFRACTIVE AND LENS-BASED SURGERY He, L., Manche, E. E., Henderson, B. A., Yoo, S. H. 2015: 43–45

  View details for Web of Science ID 000343683200012

• Reply: To PMID 24560995. American journal of ophthalmology He, L., Liu, A., Manche, E. E. 2014; 158 (6): 1357-1358

  View details for DOI 10.1016/j.ajo.2014.09.007

  View details for PubMedID 25457709

• Corneal Sensation and Dry Eye Symptoms after Conventional versus Inverted Side-Cut Femtosecond LASIK A Prospective Randomized Study OPHTHALMOLOGY Kung, J. S., Sales, C. S., Manche, E. E. 2014; 121 (12): 2311-2316

  Abstract

  To compare corneal sensation and self-reported dry eye symptoms after femtosecond-assisted LASIK with conventional versus inverted side cuts.Prospective, randomized, eye-to-eye study.A total of 120 eyes in 60 participants with myopia.Fellow eyes were randomized to receive femtosecond-assisted LASIK with a conventional 70-degree side cut made with the 60 kHz IntraLase FS (Abbott Medical Optics, Santa Ana, CA) or an inverted 130-degree side cut made with the 150 kHz IntraLase iFS (Abbott Medical Optics). Cochet-Bonnet aesthesiometry (Luneau Ophthalmologia, Chartes, France) measured corneal sensation (60 mm = normal sensation; <60 mm = depressed sensation) preoperatively and at postoperative months 1, 3, 6, and 12. Participants also completed serial dry eye surveys using the same subscales (frequency, severity, bothersome) as the validated, Rasch-tested, linear-scaled Quality of Vision questionnaire.Objective corneal sensation and self-reported light sensitivity, dryness, foreign body sensation, and pain/discomfort.Preoperative corneal sensation as measured by mean Cochet-Bonnet aethesiometry was equal between the inverted and conventional side cut groups but was better in eyes with an inverted side cut compared with a conventional side cut at all postoperative months (inverted vs. conventional: 1 month, 14.5 vs. 13.2 mm; 3 months, 24.9 vs. 18.4 mm; 6 months, 51.2 vs. 42.6 mm; 12 months, 59.8 vs. 58.3 mm; all P ≤ 0.02). None of the subjective dry eye parameters demonstrated statistically significant differences between the groups at any time point.The LASIK flaps with an inverted side cut are associated with superior recovery of corneal sensation compared with flaps with a conventional side cut during the first postoperative year; however, this may not translate to significant improvements in subjective dry eye symptoms.

  View details for DOI 10.1016/j.ophtha.2014.07.015

  View details for Web of Science ID 000345509500012

• Corneal sensation and dry eye symptoms after conventional versus inverted side-cut femtosecond LASIK: a prospective randomized study. Ophthalmology Kung, J. S., Sáles, C. S., Manche, E. E. 2014; 121 (12): 2311-2316

  Abstract

  To compare corneal sensation and self-reported dry eye symptoms after femtosecond-assisted LASIK with conventional versus inverted side cuts.Prospective, randomized, eye-to-eye study.A total of 120 eyes in 60 participants with myopia.Fellow eyes were randomized to receive femtosecond-assisted LASIK with a conventional 70-degree side cut made with the 60 kHz IntraLase FS (Abbott Medical Optics, Santa Ana, CA) or an inverted 130-degree side cut made with the 150 kHz IntraLase iFS (Abbott Medical Optics). Cochet-Bonnet aesthesiometry (Luneau Ophthalmologia, Chartes, France) measured corneal sensation (60 mm = normal sensation; <60 mm = depressed sensation) preoperatively and at postoperative months 1, 3, 6, and 12. Participants also completed serial dry eye surveys using the same subscales (frequency, severity, bothersome) as the validated, Rasch-tested, linear-scaled Quality of Vision questionnaire.Objective corneal sensation and self-reported light sensitivity, dryness, foreign body sensation, and pain/discomfort.Preoperative corneal sensation as measured by mean Cochet-Bonnet aethesiometry was equal between the inverted and conventional side cut groups but was better in eyes with an inverted side cut compared with a conventional side cut at all postoperative months (inverted vs. conventional: 1 month, 14.5 vs. 13.2 mm; 3 months, 24.9 vs. 18.4 mm; 6 months, 51.2 vs. 42.6 mm; 12 months, 59.8 vs. 58.3 mm; all P ≤ 0.02). None of the subjective dry eye parameters demonstrated statistically significant differences between the groups at any time point.The LASIK flaps with an inverted side cut are associated with superior recovery of corneal sensation compared with flaps with a conventional side cut during the first postoperative year; however, this may not translate to significant improvements in subjective dry eye symptoms.

  View details for DOI 10.1016/j.ophtha.2014.07.015

  View details for PubMedID 25178805

• A Comparison of LASIK Flap Thickness and Morphology Between the Intralase 60-and 150-kHz Femtosecond Lasers JOURNAL OF REFRACTIVE SURGERY Yu, C. Q., Manche, E. E. 2014; 30 (12): 827-830

  Abstract

  To prospectively compare the achieved thickness and consistency of LASIK flaps created with a 60- and 150-kHz femtosecond laser.One hundred twenty eyes of 60 patients with myopia were treated with LASIK. One eye had flap created by the Intralase FS 60-kHz femtosecond laser (Abbott Medical Optics, Abbott Park, IL) and the fellow eye was treated with the IntraLase iFS 150-kHz femtosecond laser (Abbott Medical Optics). Eyes were randomized according to ocular dominance. Flap morphology and measurements were taken with anterior segment optical coherence tomography (AS-OCT) at the 1-month postoperative visit.AS-OCT showed similar regular planar morphologies in both groups. The mean thickness of the flaps in the FS 60 group was significantly higher than that of the iFS 150 group (105.4 ± 3.9 μm vs 103.9 ± 4.8 μm, P = .009). The mean deviation from targeted flap thickness was not significantly different between the two groups.The Intralase iFS 150-kHz femtosecond laser creates flaps of similar thickness and uniformity to the Intralase FS 60-kHz femtosecond laser.

  View details for DOI 10.3928/1081597X-20141113-04

  View details for Web of Science ID 000347475200008

  View details for PubMedID 25437481

• Wavefront-Guided Versus Wavefront-Optimized Laser in situ Keratomileusis for Patients With Myopia: A Prospective Randomized Contra lateral Eye Study AMERICAN JOURNAL OF OPHTHALMOLOGY He, L., Liu, A., Manche, E. E. 2014; 157 (6): 1170-1178

  Abstract

  To compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in situ keratomileusis (LASIK).Prospective, randomized, fellow-eye-controlled study.The setting was a single academic institution. The study population included 110 eyes of 55 patients with myopia with and without astigmatism. One eye of each patient was randomized to undergo wavefront-guided LASIK by the AMO Visx CustomVue S4 IR excimer laser system; the fellow eye received wavefront-optimized LASIK by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system. Corneal flaps were constructed using the Intralase FS 60 Hz femtosecond laser. Patients were followed at postoperative months 1, 3, 6, and 12. The study's main outcome measures were uncorrected visual acuity, stability of refractive correction, contrast sensitivity, and wavefront aberrometry.After 12 months, LASIK eyes had achieved visual acuity of 20/12.5 or better (30 eyes, 56%) in the wavefront-guided group compared to those receiving wavefront-optimized treatment (22 eyes, 41%) (P = 0.016). Average spherical equivalent refractions were -0.13 ± 0.46 diopters in wavefront-guided eyes whereas in wavefront-optimized eyes the refractions were -0.41 ± 0.38 diopters at 12 months. Wavefront-guided eyes also achieved better best-corrected visual acuity at both the 5% and 25% contrast levels (P = 0.022 and P = 0.004, respectively). There were no differences in levels of residual astigmatism (P = 0.798) or in higher order aberrations (P = 0.869).Both wavefront-guided and wavefront-optimized treatments are able to correct myopia safely and effectively in eyes with and without astigmatism. However, wavefront-guided treatment platforms appear to offer significant advantages in terms of residual refractive error, uncorrected distance acuity and contrast sensitivity.

  View details for DOI 10.1016/j.ajo.2014.02.037

  View details for Web of Science ID 000337644400009

  View details for PubMedID 24560995

• Clinical Outcomes of Phototherapeutic Keratectomy after treatment of Epithelial Basement Membrane Dystrophy and Salzmann's nodular corneal dystrophy Lam, C., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433203502264

• A prospective study of corneal sensation following myopic LASIK with two femtosecond lasers Kung, J., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433199703241

• Vector analysis of compound myopic astigmatism comparing wavefront- guided and wavefront-optimized excimer platforms Toy, B. C., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433199703247

• Comparison of 2 wavefront-guided excimer lasers for myopic laser in situ keratomileusis: One-year results JOURNAL OF CATARACT AND REFRACTIVE SURGERY Yu, C. Q., Manche, E. E. 2014; 40 (3): 412-422

  Abstract

  To compare laser in situ keratomileusis (LASIK) outcomes between 2 wavefront-guided excimer laser systems in the treatment of myopia.University eye clinic, Palo Alto, California, USA.Prospective comparative case series.One eye of patients was treated with the Allegretto Wave Eye-Q system (small-spot scanning laser) and the fellow eye with the Visx Star Customvue S4 IR system (variable-spot scanning laser). Evaluations included measurement of uncorrected visual acuity, corrected visual acuity, and wavefront aberrometry.One hundred eyes (50 patients) were treated. The mean preoperative spherical equivalent (SE) refraction was -3.89 diopters (D) ± 1.67 (SD) and -4.18 ± 1.73 D in the small-spot scanning laser group and variable-spot scanning laser group, respectively. There were no significant differences in preoperative higher-order aberrations (HOAs) between the groups. Twelve months postoperatively, all eyes in the small-spot scanning laser group and 92% in the variable-spot scanning laser group were within ±0.50 D of the intended correction (P = .04). At that time, the small-spot scanning laser group had significantly less spherical aberration (0.12 versus 0.15) (P = .04) and significantly less mean total higher-order root mean square (0.33 μm versus 0.40 μm) (P = .01). Subjectively, patients reported that the clarity of night and day vision was significantly better in the eye treated with the small-spot scanning laser.The predictability and self-reported clarity of vision of wavefront-guided LASIK were better with the small-spot scanning laser. Eyes treated with the small-spot scanning laser had significantly fewer HOAs.

  View details for DOI 10.1016/j.jcrs.2013.08.050

  View details for PubMedID 24581773

• Prospective Randomized Contralateral Eye Evaluation of Subjective Quality of Vision After Wavefront-Guided or Wavefront-Optimized Photorefractive Keratectomy JOURNAL OF REFRACTIVE SURGERY He, L., Manche, E. E. 2014; 30 (1): 6-12

  Abstract

  To compare the effect of wavefront-guided (WFG) and wavefront-optimized (WFO) photorefractive keratectomy (PRK) on patient perceived quality of vision.Seventy-one patients (142 eyes) were enrolled in this prospective, randomized, fellow eye controlled study. One eye was randomized to undergo WFG PRK treatment by the AMO Visx CustomVue S4 IR excimer laser system (Abbott Medical Optics, Inc., Santa Clara, CA) and the fellow eye received WFO PRK treatment by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system (Alcon Laboratories, Inc., Fort Worth, TX). Patients answered questionnaires on their visual symptoms and quality of vision preoperatively and at 1, 3, 6, and 12 months after surgery.Patients in both groups reported better vision compared to baseline from 3 months onward (mean change in score of 1.56 to 2.51 in the WFO group and 1.54 to 2.28 in the WFG group, P ⩽ .003). Both groups experienced less nighttime glare from 6 months onward (P ⩽ .030). Halos, double vision, and visual clarity were initially worse (P ⩽ .025) but not significantly different after 1 month. Haze and fluctuating vision resolved after 3 months. Visual symptoms were similar between the two groups at all times (P ⩾ .059) except at 6 months, when patients felt their WFG eyes had more excellent vision (P = .029). A composite of all symptoms was also similar between the groups until 12 months when patients had fewer symptoms in their WFO eye (P = .044).One year after surgery, patient self-reported visual symptoms were not significantly different in eyes receiving WFG or WFO PRK. However, the average of all symptoms was lower in eyes receiving wavefront-optimized treatment. [J Refract Surg. 2014;30(1):6-12.].

  View details for DOI 10.3928/1081597X-20131217-01

  View details for Web of Science ID 000329833200001

  View details for PubMedID 24763144

• One-year eye-to-eye comparison of wavefront-guided versus wavefront-optimized laser in situ keratomileusis in hyperopes. Clinical ophthalmology (Auckland, N.Z.) Sáles, C. S., Manche, E. E. 2014; 8: 2229-2238

  Abstract

  To compare wavefront (WF)-guided and WF-optimized laser in situ keratomileusis (LASIK) in hyperopes with respect to the parameters of safety, efficacy, predictability, refractive error, uncorrected distance visual acuity, corrected distance visual acuity, contrast sensitivity, and higher order aberrations.Twenty-two eyes of eleven participants with hyperopia with or without astigmatism were prospectively randomized to receive WF-guided LASIK with the VISX CustomVue S4 IR or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400 Hz. LASIK flaps were created using the 150-kHz IntraLase iFS. Evaluations included measurement of uncorrected distance visual acuity, corrected distance visual acuity, <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a questionnaire detailing symptoms on a quantitative grading scale.There were no statistically significant differences between the groups for any of the variables studied after 12 months of follow-up (all P>0.05).This comparative case series of 11 subjects with hyperopia showed that WF-guided and WF-optimized LASIK had similar clinical outcomes at 12 months.

  View details for DOI 10.2147/OPTH.S70145

  View details for PubMedID 25419115

• One-year eye-to-eye comparison of wavefront-guided and wavefront-optimized laser in-situ keratomileusis in hype ropes Clin Ophthalmol Sales, C. S. 2014; 12 (8): 2229-2238

  View details for DOI 10.2147/OPTH.S70145

• Prospective randomized contralateral eye evaluation of subjective quality of vision after wavefront-guided or wavefront- optimized photorefractive keratectomy. Journal of refractive surgery He, L., Manche, E. E. 2014; 30 (1): 6-12

  Abstract

  To compare the effect of wavefront-guided (WFG) and wavefront-optimized (WFO) photorefractive keratectomy (PRK) on patient perceived quality of vision.Seventy-one patients (142 eyes) were enrolled in this prospective, randomized, fellow eye controlled study. One eye was randomized to undergo WFG PRK treatment by the AMO Visx CustomVue S4 IR excimer laser system (Abbott Medical Optics, Inc., Santa Clara, CA) and the fellow eye received WFO PRK treatment by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system (Alcon Laboratories, Inc., Fort Worth, TX). Patients answered questionnaires on their visual symptoms and quality of vision preoperatively and at 1, 3, 6, and 12 months after surgery.Patients in both groups reported better vision compared to baseline from 3 months onward (mean change in score of 1.56 to 2.51 in the WFO group and 1.54 to 2.28 in the WFG group, P ⩽ .003). Both groups experienced less nighttime glare from 6 months onward (P ⩽ .030). Halos, double vision, and visual clarity were initially worse (P ⩽ .025) but not significantly different after 1 month. Haze and fluctuating vision resolved after 3 months. Visual symptoms were similar between the two groups at all times (P ⩾ .059) except at 6 months, when patients felt their WFG eyes had more excellent vision (P = .029). A composite of all symptoms was also similar between the groups until 12 months when patients had fewer symptoms in their WFO eye (P = .044).One year after surgery, patient self-reported visual symptoms were not significantly different in eyes receiving WFG or WFO PRK. However, the average of all symptoms was lower in eyes receiving wavefront-optimized treatment.

  View details for PubMedID 24868564

• One-Year Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes OPHTHALMOLOGY Sales, C. S., Manche, E. E. 2013; 120 (12): 2396-2402

  Abstract

  OBJECTIVE: To compare wavefront (WF)-guided and WF-optimized LASIK in myopes. DESIGN: Prospective, randomized, eye-to-eye study. PARTICIPANTS: A total of 72 eyes of 36 participants with myopia with or without astigmatism. METHODS: Participants were randomized to receive WF-guided or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400-Hz excimer laser platform (Alcon, Inc., Hüenberg, Switzerland). LASIK flaps were created using the 150-kHz IntraLase iFS (Abbott Medical Optics, Santa Ana, CA). Evaluations included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a validated questionnaire detailing symptoms on a quantitative scale. MAIN OUTCOME MEASURES: Safety, efficacy, predictability, refractive error, UDVA, CDVA, contrast sensitivity, and higher-order aberrations (HOAs). RESULTS: The frequency with which the WF-guided and WF-optimized groups achieved postoperative UDVA of ≥20/16 or ≥20/20 and the frequency with which the groups lost 1 or 2 or more lines or maintained their preoperative CDVA were not statistically different from each other (all P > 0.05). The frequency with which the WF-guided group attained a refractive error within ±0.25 diopters of emmetropia was higher than in the WF-optimized group (67.6%, 95% confidence interval [CI], 50.4-84.8 vs. 41.2%, 95% CI, 23.2-59.2; P = 0.03). The WF-guided group's mean UDVA was better than the WF-optimized group's UDVA by approximately 1 Early Treatment Diabetic Retinopathy Study line (-0.17±0.11 logarithm of the minimum angle of resolution [logMAR], slightly <20/12 Snellen vs. -0.13±0.12, slightly >20/16; P = 0.05). There were no statistically significant differences in contrast sensitivity, astigmatism, coma, or higher-order root mean square error between the groups (all P > 0.05), but the WF-guided group had less trefoil compared with the WF-optimized group (0.14±0.07 vs. 0.20±0.09; P < 0.01). There were no statistically significant differences in subjective parameters between the groups (all P > 0.05). CONCLUSIONS: Wavefront-guided and WF-optimized LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform provide similar results in myopic patients; however, the WF-guided approach may yield small gains in visual acuity, predictability, and HOAs. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.ophtha.2013.05.010

  View details for PubMedID 23778091

• Pupil Size and LASIK: A Review JOURNAL OF REFRACTIVE SURGERY Myung, D., Schallhorn, S., Manche, E. E. 2013; 29 (11): 734-?

  Abstract

  To provide a literature review on the evidence both for and against pupil size as an independent predictor of adverse visual outcomes after LASIK.Peer-reviewed publications on the effect of pupil size on LASIK outcomes since 2002 are reviewed. Particular attention was paid to the following attributes of each publication: type of study, number of patients or eyes, mean age, mean level of myopia, mean pupil size, testing conditions, ablation zone diameter, presence or absence of blend zones, and mean follow-up period.Among the 19 studies examined, none correlates a persistent relationship between pupil size and night vision complaints (NVCs) beyond 3 months when LASIK was performed with a 6.0-mm optical zone or larger ablation. The studies that did explicitly determine a correlation either included some or all patients with ablation zones smaller than 6.0 mm or did not specify ablation diameter at all. Among the studies that had drawn more mixed conclusions, the studies either covered short follow-up intervals (1 to 3 months) or showed a progressive improvement in NVCs over time in a relatively small patient cohort.As keratorefractive technology continues to evolve, the role of pupil size warrants further investigation; however, based on the literature reviewed herein, modern LASIK has negated the role of the low light pupil in predicting adverse visual outcomes after LASIK outside of the early postoperative period.

  View details for DOI 10.3928/1081597X-20131021-02

  View details for Web of Science ID 000329186600002

  View details for PubMedID 24203804

• One Year Quality of Vision Outcomes from a Prospective, Randomized Eye-to-Eye Comparison of Wavefront guided and Wavefront optimized Laser in Situ Keratomileusis (LASIK) using the WaveLight (R) Allegretto Eye-Q 400 Hz Sales, C., Manche, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013

  View details for Web of Science ID 000436232707150

• Refractive surgical problem: April consultation. Journal of cataract and refractive surgery Masket, S., Fram, N. R., Shen, T. T., Talamo, J. H., Manche, E. E. 2013; 39 (4): 652-655

  View details for DOI 10.1016/j.jcrs.2013.02.015

  View details for PubMedID 23522590

• Prospective, Randomized Comparison of Self-reported Postoperative Dry Eye and Visual Fluctuation in LASIK and Photorefractive Keratectomy OPHTHALMOLOGY Murakami, Y., Manche, E. E. 2012; 119 (11): 2220-2224

  Abstract

  We sought to prospectively compare postoperative symptoms of dry eye, visual fluctuations, and foreign body sensation in patients undergoing LASIK and photorefractive keratectomy (PRK).Randomized clinical trial.Sixty-eight eyes of 34 patients were treated with wavefront-guided LASIK and PRK.One eye was treated with LASIK and the fellow eye was treated with PRK. Eyes were randomized by ocular dominance. Patients completed a questionnaire preoperatively and at each postoperative visit evaluating symptoms of dry eye, dry eye severity, vision fluctuations, and foreign body sensation.Change in self-reported dry eye with secondary outcome measure of visual fluctuations and foreign body sensation scores after LASIK and PRK.Both groups of eyes experienced significant increases in symptoms of dry eye, vision fluctuation, and foreign body sensation after LASIK and PRK at postoperative months 1, 3, and 6. However, by the 12-month postoperative visit, there was no increase in dry eye symptoms over the preoperative baseline levels in either group. Patients undergoing PRK experienced significantly higher levels of vision fluctuation at postoperative month 1 than those undergoing LASIK.Both LASIK and PRK caused an increase in dry eye symptoms and severity, vision fluctuations, and foreign body sensation over baseline in the early postoperative period. At postoperative month 1, PRK caused greater vision fluctuations than LASIK. By 1 year postoperatively, all symptoms of dry eye, vision fluctuations, and foreign body sensation returned to their baseline, preoperative levels.

  View details for DOI 10.1016/j.ophtha.2012.06.013

  View details for PubMedID 22892151

• Fibrin glue for prevention of recurrent epithelial ingrowth under a LASIK flap with a central buttonhole defect JOURNAL OF CATARACT AND REFRACTIVE SURGERY He, L., Manche, E. E. 2012; 38 (10): 1857-1860

  Abstract

  A 61-year-old woman presented with a paracentral buttonhole flap defect associated with a linear tear, extensive epithelial ingrowth, and macrostriae in the right eye. A laser in situ keratomileusis enhancement had been performed 3 weeks earlier. The epithelial ingrowth was removed after careful lifting of the flap, and tissue adhesive was used postoperatively as a barrier to further ingrowth. Six months postoperatively, the patient's corrected distance visual acuity had improved to 20/20 and the slitlamp examination showed no evidence of recurrent epithelial ingrowth. This case presents a novel approach to the management of a buttonhole defect.

  View details for DOI 10.1016/j.jcrs.2012.08.031

  View details for PubMedID 22999605

• Toxic peripheral keratopathy: A syndrome in laser refractive surgery JOURNAL OF CATARACT AND REFRACTIVE SURGERY Liu, A., Maloney, R. K., Manche, E. E. 2012; 38 (9): 1684-1689

  Abstract

  This retrospective observational case series describes a clinical syndrome in laser refractive surgery. Five eyes of 4 patients with noninflammatory peripheral corneal opacification in the period immediately after photorefractive keratectomy or laser in situ keratomileusis were identified and the charts abstracted. Peripheral stromal opacification, localized corneal thinning, irregular astigmatism leading to a decrease in corrected visual acuity, and gradual clearing were characteristic findings. Gradual clearing occurred without treatment in all eyes over a period of 2 weeks to 12 months. This syndrome has similarities to central toxic keratopathy but occurs in the peripheral cornea. We refer to the syndrome as toxic peripheral keratopathy, the cause of which is unknown.

  View details for DOI 10.1016/j.jcrs.2012.07.008

  View details for PubMedID 22906450

• Pupil Size and LASIK reply OPHTHALMOLOGY Manche, E. E., Chan, A. 2012; 119 (8): 1716-1717

  View details for Web of Science ID 000307080100038

• Pupil Size and LASIK Reply OPHTHALMOLOGY Manche, E. E., Chan, A. 2012; 119 (4): 884-885

  View details for Web of Science ID 000302355400039

• Wavefront-guided laser in situ keratomileusis (Lasik) versus wavefront-guided photorefractive keratectomy (Prk): a prospective randomized eye-to-eye comparison (an American Ophthalmological Society thesis). Transactions of the American Ophthalmological Society Manche, E. E., Haw, W. W. 2011; 109: 201-220

  Abstract

  To compare the safety and efficacy of wavefront-guided laser in situ keratomileusis (LASIK) vs photorefractive keratectomy (PRK) in a prospective randomized clinical trial.A cohort of 68 eyes of 34 patients with -0.75 to -8.13 diopters (D) of myopia (spherical equivalent) were randomized to receive either wavefront-guided PRK or LASIK in the fellow eye using the VISX CustomVue laser. Patients were evaluated at 1 day, 1 week, and months 1, 3, 6, and 12.At 1 month, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), 5% and 25% contrast sensitivity, induction of higher-order aberrations (HOAs), and subjective symptoms of vision clarity, vision fluctuation, ghosting, and overall self-assessment of vision were worse (P<0.05) in the PRK group. By 3 months, these differences had resolved (P>0.05). At 1 year, mean spherical equivalent was reduced 94% to -0.27 ± 0.31 D in the LASIK group and reduced 96% to -0.17 ± 0.41 D in the PRK group. At 1 year, 91% of eyes were within ±0.50 D and 97 % were within ±1.0 D in the PRK group. At 1 year, 88% of eyes were within ±0.50 D and 97% were within ±1.0 D in the LASIK group. At 1 year, 97% of eyes in the PRK group and 94% of eyes in the LASIK group achieved an UCVA of 20/20 or better (P=0.72). Refractive stability was achieved in both PRK and LASIK groups after 1 month. There were no intraoperative or postoperative flap complications in the LASIK group. There were no instances of corneal haze in the PRK group.Wavefront-guided LASIK and PRK are safe and effective at reducing myopia. At 1 month postoperatively, LASIK demonstrates an advantage over PRK in UCVA, BSCVA, low-contrast acuity, induction of total HOAs, and several subjective symptoms. At postoperative month 3, these differences between PRK and LASIK results had resolved.

  View details for PubMedID 22253488

• Preoperative Pupil Size and LASIK reply OPHTHALMOLOGY Manche, E., Chan, A. 2011; 118 (12): 2526-2527

  View details for Web of Science ID 000298138000042

• Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia: Metaanalysis of randomized controlled trials JOURNAL OF CATARACT AND REFRACTIVE SURGERY Zhang, Z., Jin, H., Suo, Y., Patel, S. V., Montes-Mico, R., Manche, E. E., Xu, X. 2011; 37 (12): 2151-2159

  Abstract

  To examine differences in efficacy, accuracy, safety, and changes in aberrations between femtosecond and mechanical microkeratome laser in situ keratomileusis (LASIK) for myopia.Department of Ophthalmology, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.Evidence-based manuscript.Data sources, including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register, were searched to identify potentially relevant prospective randomized controlled trials. Primary outcome measures were efficacy (uncorrected distance visual acuity ≥20/20), accuracy (±0.50 diopter mean spherical equivalent), and safety (loss of ≥2 lines of corrected distance visual acuity). Aberrations and postoperative complications were secondary outcomes.Seven prospective randomized controlled trials describing a total of 577 eyes with myopia were included in this metaanalysis. At 6 months or more follow-up, no significant differences were found in the efficacy (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.40 to 3.42; P=.78), accuracy (OR, 1.69; 95% CI, 0.68 to 4.20; P=.26), or safety (OR, 7.37; 95% CI, 0.37 to 147.61; P=.19). In eyes that had femtosecond LASIK, the postoperative total aberrations (mean difference -0.03 μm; 95% CI, -0.05 to -0.01; P=.002) and spherical aberrations (mean difference -0.02 μm; 95% CI, -0.03 to -0.01; P<.00001) were significantly lower.According to the metaanalysis, femtosecond LASIK did not have an advantage in efficacy, accuracy, and safety measures over mechanical microkeratome LASIK in the early and midterm follow-up, although it might induce fewer aberrations.

  View details for DOI 10.1016/j.jcrs.2011.05.043

  View details for Web of Science ID 000298026000011

  View details for PubMedID 22108110

• Comparison of intraoperative subtraction pachymetry and postoperative anterior segment optical coherence tomography of laser in situ keratomileusis flaps JOURNAL OF CATARACT AND REFRACTIVE SURGERY Murakami, Y., Manche, E. E. 2011; 37 (10): 1879-1883

  Abstract

  To prospectively compare intraoperative subtraction pachymetry flap thickness measurements and postoperative anterior segment optical coherence tomography (AS-OCT) flap thickness measurements in eyes that had laser in situ keratomileusis (LASIK) flap creation with a femtosecond laser or a mechanical microkeratome.Stanford Eye Laser Center, Stanford University School of Medicine, Stanford, California, USA.Comparative case series.Each patient received wavefront-guided LASIK using an Intralase femtosecond laser in 1 eye and a Hansatome mechanical microkeratome in the fellow eye. Flap morphology was assessed with an ultrasound pachymeter intraoperatively and an AS-OCT system postoperatively at 1 year.Thirty-six eyes (18 patients) were enrolled. Intraoperative subtraction pachymetry consistently underestimated mechanical microkeratome flap thickness compared with postoperative AS-OCT (P<.001). There was no significant difference between intraoperative subtraction pachymetry and postoperative AS-OCT measurements for femtosecond flaps (P=.38). The overall mean variation in flap thickness (ie, mean deviation from targeted flap thickness) was 2.6 μm (range 3 to 11 μm) with the femtosecond laser and 14.2 μm (range 17 to 52 μm) with the mechanical microkeratome (P<.001). Postoperative AS-OCT measurements showed femtosecond flaps had a planar configuration and mechanical microkeratome flaps had a meniscus-shaped configuration.The femtosecond laser created more uniformly planar flaps than the mechanical microkeratome as measured by intraoperative subtraction pachymetry and postoperative AS-OCT. Postoperative AS-OCT measurements varied less than intraoperative subtraction pachymetry measurements for mechanical microkeratome flaps.Neither author has a financial or proprietary interest in any material or method mentioned.

  View details for DOI 10.1016/j.jcrs.2011.05.024

  View details for PubMedID 21840682

• Bilateral posterior subcapsular cataracts associated with long-term intranasal steroid use JOURNAL OF CATARACT AND REFRACTIVE SURGERY Liu, A., Manche, E. E. 2011; 37 (8): 1555-1558

  Abstract

  The use of systemic steroids has been established as a risk factor for the development of posterior subcapsular cataracts. In recent decades, the use of nasal topical steroids has increased in an effort to decrease systemic side effects. Current evidence of an association between nasal steroid use and cataract formation is contradictory. We present a case of rapid-onset bilateral posterior subcapsular cataracts in a young healthy patient with a history of long-term nasal steroid use.

  View details for DOI 10.1016/j.jcrs.2011.05.020

  View details for PubMedID 21782102

• Dry eye after laser in situ keratomileusis with femtosecond laser and mechanical keratome JOURNAL OF CATARACT AND REFRACTIVE SURGERY Golas, L., Manche, E. E. 2011; 37 (8): 1476-1480

  Abstract

  To prospectively compare dry-eye symptoms after laser in situ keratomileusis (LASIK) with mechanical keratome-created flaps and femtosecond laser keratome-created flaps.Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.Randomized clinical trial.Fellow eyes were prospectively randomized to the mechanical keratome group and femtosecond laser keratome group. Patients had wavefront-guided LASIK using a mechanical keratome in 1 eye and a femtosecond laser keratome in the fellow eye. They completed dry-eye questionnaires preoperatively and 1, 3, 6, and 12 months postoperatively. The effect of laser ablation depth, sex, age, and flap thickness on dry-eye symptoms was also analyzed.The study enrolled 51 patients. There was no statistically significant change in dry-eye symptoms except in the femtosecond group 1 month postoperatively (mean increase 1.08) (P=.03). There were no significant differences in symptoms between the 2 groups (P=.7). The dry-eye score was 1.3 points lower in women than in men (P=.01). Central ablation depth, flap thickness, and age did not significantly affect the reported dryness.There appeared to be no statistically significant difference in self-reported dry-eye symptoms between the mechanical keratome group and the femtosecond laser keratome group.

  View details for DOI 10.1016/j.jcrs.2011.03.035

  View details for PubMedID 21684109

• Late Onset Secondary Cataract Following Implantation of an Iris-fixated Phakic Intraocular Lens JOURNAL OF REFRACTIVE SURGERY Liu, A., Manche, E. E. 2011; 27 (4): 305-308

  Abstract

  To report a case of bilateral late onset anterior cortical cataract following implantation of an iris-fixated phakic intraocular lens (pIOL).Single observational case report.Three and a half years following uncomplicated consecutive implantation of iris-fixated pIOL in both eyes, anterior cortical cataract changes inferiorly emanating from the site of enclavation of the lens in the right eye were noted. By 7 years after implantation, anterior cortical cataract changes were seen emanating from the enclavation sites superiorly and inferiorly in both eyes. These cataracts did not cause any loss of corrected distance visual acuity.This case demonstrates that a potential complication of an iris-fixated pIOL is late onset secondary cataract formation.

  View details for DOI 10.3928/1081597X-20100812-01

  View details for PubMedID 20795584

• Effect of Preoperative Pupil Size on Quality of Vision after Wavefront-Guided LASIK OPHTHALMOLOGY Chan, A., Manche, E. E. 2011; 118 (4): 736-741

  Abstract

  To evaluate the effect of preoperative pupil size on quality of vision after wavefront-guided LASIK.Prospective study.One hundred two eyes.LASIK for mild to moderate myopia or astigmatism (preoperative manifest spherical equivalent, -3.99±1.42 diopters).Questionnaires evaluating specific visual symptoms before and after surgery. Each eye was evaluated before surgery, and 1 week and 1, 3, 6, and 12 months postoperatively. Pupils were stratified according to size: small (≤5.5 mm), medium (5.6-6.4 mm), or large (≥6.5 mm). Mesopic pupil size and preoperative and postoperative variables were evaluated using an analysis of variance. A regression model was also performed to determine the correlation between mean spherical equivalent and cylinder and visual symptoms.In the early postoperative period, there was no difference between the 3 groups with regard to any of the symptoms. At the final 12-month postoperative visit, patients with medium pupils experienced less glare at night than small pupils (P = 0.02), medium pupils had less halos than small or large pupils (P = 0.001 and P = 0.02, respectively), and medium pupils experienced greater satisfaction in visual improvement than small pupils (P = 0.014).Twelve months after wavefront-guided LASIK surgery, large pupil size does not positively correlate with any postoperative visual symptoms.

  View details for DOI 10.1016/j.ophtha.2010.07.030

  View details for PubMedID 21093922

• Wavefront-guided Photorefractive Keratectomy With the VISX Platform for Myopia JOURNAL OF REFRACTIVE SURGERY Bababeygy, S. R., Manche, E. E. 2011; 27 (3): 173-180

  Abstract

  To evaluate the safety, efficacy, and clinical outcome of wavefront-guided photorefractive keratectomy (PRK) for the treatment of low to moderate and high myopia and compound myopic astigmatism.This retrospective study included 174 eyes of 102 patients with low to moderate (-0.125 to <-6.50 diopters [D]) and high (≥-6.50 D) myopia treated with wavefront-guided PRK using the VISX CustomVue S4 IR (Abbott Medical Optics) excimer laser. Eyes were analyzed preoperatively and at 1, 3, 6, and 12 months postoperatively. At 3 months, 174 eyes of 102 patients were evaluated, and at 12 months, 146 eyes of 75 patients were evaluated. No eyes were retreated in the study.Mean patient age was 38.3±8.76 years (range: 20 to 66 years), and mean preoperative manifest refraction spherical equivalent (MRSE) was -5.60±2.58 D (range: -0.13 to -10.50 D). At 12 months postoperative, MRSE was -0.16±0.45 D (range: -1.50 to 1.38 D); 96.6% of eyes were within ±1.00 D of intended correction, whereas 81.5% were within ±0.50 D of intended correction. For all eyes, the safety and efficacy indexes were 1.01 and 1.02, respectively.These data support the safety and efficacy for the correction of low to moderate and high myopia and compound myopic astigmatism using wavefront-guided PRK.

  View details for DOI 10.3928/1081597X-20100527-01

  View details for PubMedID 20873706

• Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia: Metaanalysis of randomized controlled tirals Journal of Cataract and Refractive Surgery Zhang, Z. H., Jin, H. Y., Suo, Y., Patel, S. V., Manche, E. E. 2011; 37 (12): 2151-2159
• Visually significant haze after retreatment with photorefractive keratectomy with mitomycin-C following laser in situ keratomileusis JOURNAL OF CATARACT AND REFRACTIVE SURGERY Liu, A., Manche, E. E. 2010; 36 (9): 1599-1601

  Abstract

  Photorefractive keratectomy (PRK) with the adjunctive use of mitomycin-C (MMC) for the treatment of residual refractive error after laser in situ keratomileusis (LASIK) has been shown to be safe and effective, with no occurrences of visually significant postoperative haze reported. We report a case of visually significant haze after PRK with MMC for residual myopia following LASIK.

  View details for DOI 10.1016/j.jcrs.2010.06.004

  View details for PubMedID 20692575

• Traumatic shattering of intrastromal corneal ring segments JOURNAL OF CATARACT AND REFRACTIVE SURGERY Liu, A., Manche, E. E. 2010; 36 (6): 1042-1044

  Abstract

  Long-term stability of intrastromal corneal ring segments is important in maintaining patients' corrected distance visual acuity and avoiding injury to the local tissues. We report a case of traumatic shattering of intrastromal segments due to blunt trauma, with successful removal of the fragments.

  View details for DOI 10.1016/j.jcrs.2010.03.022

  View details for PubMedID 20494780

• Late-onset nontraumatic dislocation of anterior chamber phakic intraocular lens JOURNAL OF CATARACT AND REFRACTIVE SURGERY Liu, A., Manche, E. E. 2010; 36 (5): 854-856

  Abstract

  Long-term stability of the position of phakic intraocular lenses (pIOLs) is important in maintaining visual acuity as well as avoiding injury to the local tissues. We report a case of late nontraumatic dislocation of an iris-fixated pIOL, with subsequent successful repositioning.

  View details for DOI 10.1016/j.jcrs.2010.03.001

  View details for PubMedID 20457382

• Anterior Segment Optical Coherence Tomography Imaging of Central Toxic Keratopathy. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Liu, A., Manche, E. E. 2010: 1-3

  Abstract

  The authors report anterior segment optical coherence tomography (OCT) imaging findings in a case of central toxic keratopathy following laser in situ keratomileusis (LASIK) surgery for low hyperopia. OCT imaging 1 month after surgery demonstrates that the flap thickness is maintained and the location of stromal tissue loss is just posterior to the flap in the stromal bed in the affected area. This corresponds to the clinical observation of interface opacity extending posteriorly into the stroma as first described by Sonmez and Maloney1 in their initial description of the syndrome. Follow-up OCT imaging 3 months later revealed interval decrease in stromal thinning. The etiology of this syndrome is unknown.

  View details for DOI 10.3928/15428877-20100325-10

  View details for PubMedID 20429496

• Regression of effect over long-term follow-up of conductive keratoplasty to correct mild to moderate hyperopia 110th Annual Meeting of the American-Academy-of-Ophthalmology Ehrlich, J. S., Manche, E. E. ELSEVIER SCIENCE INC. 2009: 1591–96

  Abstract

  To evaluate the long-term efficacy and stability of conductive keratoplasty (CK) for low to moderate hyperopia.Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.In this prospective nonrandomized noncontrolled clinical trial, performed as part of a U.S. Food and Drug Administration pivotal trial, patients with +0.75 to +3.00 diopters (D) of hyperopia and 0.75 D or less cylinder were initially treated with CK. The postoperative uncorrected and corrected Snellen visual acuities and refractions over time were evaluated. The main outcome measures were differences in refraction and uncorrected visual acuity postoperatively.Nine patients (16 eyes) of a subset of 14 consecutive patients (25 eyes) originally enrolled between 1999 and 2000 were available for long-term follow-up. Preoperatively, the mean manifest refraction spherical equivalent (MRSE) in the subset with long-term follow-up was +1.45 D. Postoperatively, the mean MRSE was +0.295 D. at 23 months, regressing to +1.00 D at 48 months and +1.394 D at the final follow-up (mean 73 months), indicating significant regression of effect. No eye lost more than 1 line of corrected Snellen visual acuity as a result of CK. The rate of regression was linear and calculated at +0.0184 D per month after 6 months postoperatively. Keratometric regression appeared to be similar to MRSE regression.Conductive keratoplasty led to significant regression of refractive and keratometric effects over extended follow-up. Patients should be counseled that this refractive procedure is not permanent.

  View details for DOI 10.1016/j.jcrs.2009.05.010

  View details for PubMedID 19683158

• Comparison of the Femtosecond Laser and Mechanical Keratome for Laser In Situ Keratomileusis 24th Congress of the European-Society-of-Cataract-and-Refractive-Surgeons Chan, A., Ou, J., Manche, E. E. AMER MEDICAL ASSOC. 2008: 1484–90

  Abstract

  To compare clinical outcomes between fellow eyes randomized to femtosecond laser-created flaps (femtosecond group) or mechanical keratome-created flaps (mechanical group) during wavefront-guided laser in situ keratomileusis.Prospective, randomized, comparative clinical study.Efficacy, safety, predictability, stability, changes in corneal optical aberrations, and low-contrast visual acuity before and 1 week and 1, 3, 6, and 12 months after surgery.Forty-three patients underwent evaluation in this study. One month after surgery, the mean (SD) spherical equivalent was -0.15 (0.30) diopters (D) for the femtosecond group and -0.12 (0.29) D for the mechanical group (differences were not statistically significant). Twelve months after surgery, 39 eyes (98%) in the femtosecond group had uncorrected visual acuity of 20/20 or better compared with 37 (95%) in the mechanical group. The femtosecond group had fewer high-order, spherical, and coma aberrations and more trefoil aberrations than the mechanical group at 1 month (P = .55), 3 months (P = .05), 6 months (P = .33), and 12 months (P = .48) after surgery. At 25% contrast, the femtosecond group had gains at 1 month (P = .01) and 6 months (P = .008) after surgery.Twelve months after keratomileusis, clinical outcomes were similar for both groups.

  View details for PubMedID 19001213

• Wavefront-guided laser in situ keratomileusis retreatment for consecutive hyperopia and compound hyperopic astigmatism JOURNAL OF CATARACT AND REFRACTIVE SURGERY Bababeygy, S. R., Zoumalan, C. I., Chien, F. Y., Manche, E. E. 2008; 34 (8): 1260-1266

  Abstract

  To evaluate the efficacy, predictability, and safety of wavefront-guided laser in situ keratomileusis (LASIK) using the Visx CustomVue excimer laser (Advanced Medical Optics) in eyes with consecutive hyperopia and compound hyperopic astigmatism after LASIK.Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA.This retrospective analysis included 19 eyes of 16 patients who had wavefront-guided LASIK for consecutive hyperopia and compound hyperopic astigmatism after initial LASIK surgery. Primary outcome variables, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), higher-order aberration (HOA) analysis, and spherical equivalence, were evaluated at 1 and 3 months. Nine eyes of 7 patients were available for all visits.The mean patient age was 51.7 years +/- 3.77 (SD) (range 44 to 55 years). The mean preoperative manifest refractive spherical equivalent (MRSE) was 0.99 +/- 0.32 diopters (D) (range 0.50 to 1.50 D) and the mean 3-month postoperative MRSE, -0.04 +/- 0.66 D (range -1.50 to 0.75 D). At 1 month, 57.9% of eyes had a UCVA of 20/20 or better and 78.9% of 20/25 or better; 84.2% were within +/-1.00 D of emmetropia. At 3 months, 66.7% of eyes had a UCVA of 20/20 or better and 88.9% of 20/25 or better; 88.9% were within +/-1.00 D of emmetropia. No eye lost 2 or more lines of BSCVA at 1 or 3 months.Wavefront-guided LASIK was an effective, predictable, and safe procedure for consecutive hyperopia and compound hyperopic astigmatism after LASIK.

  View details for DOI 10.1016/j.jcrs.2008.04.026

  View details for PubMedID 18655974

• Prospective long-term evaluation of the efficacy, safety, and stability of the phakic intraocular lens for high myopia ARCHIVES OF OPHTHALMOLOGY Silva, R. A., Jain, A., Manche, E. E. 2008; 126 (6): 775-781

  Abstract

  To evaluate the safety, efficacy, predictability, and long-term stability of the Artisan Phakic Intraocular Lens (Ophtec BV, Groningen, the Netherlands) for the correction of high myopia.Prospective analysis of 26 eyes from 15 patients who underwent placement of the Artisan lens for the correction of high and extreme myopia. The mean (SD) preoperative spherical equivalent was - 12.30 (2.69) diopters (D) (range, - 17.25 to - 8.25 D).At 5 years, the mean (SD) manifest refraction was - 0.37 (0.69) D, with 95% of eyes within 1 D of attempted correction and 74% of eyes within 0.5 D of the attempted correction. Ninety-five percent of eyes achieved an uncorrected visual acuity of 20/40 or better and 74% achieved an uncorrected visual acuity of 20/20 or better. No eyes experienced a loss of 1 or more lines of best-corrected visual acuity. Sixteen percent of eyes gained 2 or more lines of best-corrected visual acuity. From preoperative measurements, the mean endothelial cell density decreased by 14.05% at 5 years postoperatively.Placement of the Artisan lens is predictable, stable, and effective at reducing high and extreme myopia 5 years after implantation. The rate of endothelial cell loss was significantly higher than has been reported in previous studies.

  View details for PubMedID 18541839

• Three-year results of Artisan/Verisyse phakic intraocular lens impolantation 107th Annual Meeting of the American-Academy-of-Ophthalmology/Annual Meeting of the ISRS Stulting, R. D., John, M. E., Maloney, R. K., Assil, K. K., Arrowsmith, P. N., Thompson, V. M. ELSEVIER SCIENCE INC. 2008: 464–72

  Abstract

  To assess the safety and efficacy of the Artisan/Verisyse phakic intraocular lens (IOL) for the correction of high myopia.Prospective, open-label, noncomparative, multicenter clinical trial.A total of 684 adults with axial myopia from -4.5 diopters (D) to -22 D were enrolled: 662 in the primary analysis group and 22 under compassionate use protocol expansion. Efficacy data are based on the 662 first eyes implanted.Implantation of the Artisan/Verisyse phakic intraocular lens.Efficacy measures included uncorrected distance visual acuity (UCVA), refractive predictability and stability, patient satisfaction, and contrast sensitivity. Safety measures were best spectacle-corrected visual acuity (BSCVA), intraocular pressure, slit-lamp observations, endothelial cell density (ECD), complications, and adverse events.At 3 years, UCVAs for first eyes were 20/40 or better in 84.0% (194/231) and 20/25 or better in 51.9% (120/231). Of first eyes, 71.7% to 76.7% were within 0.50 D of target refraction and 93.1% to 95.0% were within 1.0 D at 6 months and later. Best spectacle-corrected visual acuity was 20/40 or better for 99% to 100% of first eyes from the 1-month visit through 3 years. At 3 years, 54% of first eyes gained >/=1 lines of BSCVA, and 7.5% lost >/=1 lines of BSCVA. The mean change in ECD from baseline to 3 years was -4.8%+/-7.8%, with a 2.4% loss between 2 and 3 years. One site had a mean cell loss of -5.0% (P = 0.023), and the others combined had a mean cell loss of 1.7%+/-5.4%. For a cohort of 57 eyes with ECD data for all visits, the mean change from baseline was -3.8%+/-9.8% over 3 years. Approximately half (31/59) of the adverse events and preventative repositionings were among the first 10 cases performed by each investigator.The Artisan/Verisyse phakic IOL provides excellent refractive outcomes; endothelial cell loss within a mean of 5.0% over 3 years, or 1.8% per year; and few complications.

  View details for DOI 10.1016/j.ophtha.2007.08.039

  View details for Web of Science ID 000253798600008

  View details for PubMedID 18031820

• Long-term follow-up of hyperopic laser in situ keratomileusis correction using the Star S2 excimer laser Symposium on Cataract, IOL and Refractive Surgery Desai, R. U., Jain, A., Manche, E. E. ELSEVIER SCIENCE INC. 2008: 232–37

  Abstract

  To prospectively evaluate the safety, efficacy, predictability, and long-term stability of hyperopic laser in situ keratomileusis (LASIK) using the Star S2 excimer laser (Visx).Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.This study evaluated 41 eyes of 27 patients who had LASIK for the correction of spherical hyperopia. Patients were divided into 3 groups based on preoperative cycloplegic refraction: low hyperopia (less than +2.00 diopters [D]), medium hyperopia (+2.00 to +4.00 D), and high hyperopia (more than +4.00 D).In all eyes, the mean preoperative spherical equivalent (SE) was +2.53 D (range +0.75 to +5.25 D) and the mean attempted SE was +2.58 D (range +0.75 to +5.25 D). At the last visit (mean 5.29 years), the mean SE was +0.44 D +/- 0.69 (SD) in the low hyperopia group, +0.58 +/- 0.56 D in the medium hyperopia group, and +0.59 +/- 1.18 D in the high hyperopia group. The percentage of eyes within +/-1.00 D of emmetropia was 82.4%, 75.0%, and 66.7%, respectively (68.9% overall). The uncorrected visual acuity was 20/40 or better in 100% of eyes in the low hyperopia group, 91.7% in the medium hyperopia group, and 66.7% in the high hyperopia group (87.8% overall). The hyperopic shift between 1 year and the last visit was +0.18 D, +0.30 D, and +0.55 D, respectively (+0.40 D overall; range -1.25 to +2.63 D).Hyperopic LASIK using the Star S2 excimer laser was safe, effective, and predictable for hyperopia up to +4.10 D (mean of high group). A mild regression of the refractive effect was seen over the 5-year follow-up.

  View details for DOI 10.1016/j.jcrs.2007.09.019

  View details for PubMedID 18242445

• Visual outcomes of wavefront-guided laser in situ keratomileusis in eyes with moderate or high myopia and compound myopic astigmatism Symposium on Cataract, IOL and Refractive Surgery Bababeygy, S. R., Zoumalan, C. I., Manche, E. E. ELSEVIER SCIENCE INC. 2008: 21–27

  Abstract

  To evaluate the safety, efficacy, and clinical outcomes of wavefront-guided laser in situ keratomileusis (LASIK) surgery for the treatment of moderate to high myopia and compound myopic astigmatism.Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA.This retrospective study included patients with moderate (-6.0 to -8.0 diopters [D]) and high (greater than -8.00) myopia treated with wavefront-guided LASIK using the WaveScan linked to the CustomVue system (AMO USA, Inc.). Eyes were analyzed preoperatively and 1, 3, and 12 months postoperatively.The mean patient age was 38.4 years +/- 7.14 (SD). Eighty-nine eyes of 45 patients were evaluated at 3 months and 50 eyes of 25 patients at 12 months. No eye was retreated during the study. The mean manifest refraction spherical equivalent was -8.10 +/- 0.98 D (range -6.00 to -10.63 D) preoperatively and -0.33 +/- 0.55 D (range -1.625 to 1.375 D) 12 months postoperatively. Ninety percent of the eyes were within +/-1.00 D of the intended correction and 64.0%, within +/-0.50 D. For all eyes, the safety index was 1.00 and the efficacy index, 1.18.The data support the safety and efficacy of correcting moderate to high myopia and compound myopic astigmatism using wavefront-guided LASIK.

  View details for DOI 10.1016/j.jcrs.2007.08.032

  View details for PubMedID 18165076

• Corneal perforation after conductive keratoplasty in a patient with previously undiagnosed Sjogren syndrome ARCHIVES OF OPHTHALMOLOGY Ou, J. I. 2007; 125 (8): 1131-1132

  View details for PubMedID 17698765

• Methicillin-resistant Staphylococcus aureus infectious keratitis following refractive surgery AMERICAN JOURNAL OF OPHTHALMOLOGY Solomon, R., Donnenfeld, E. D., Perry, H. D., Rubinfeld, R. S., Ehrenhaus, M., Wittpenn, J. R., Solomon, K. D., Manche, E. E., Moshirfar, M., Matzkin, D. C., Mozayeni, R. M., Maloney, R. K. 2007; 143 (4): 629-634

  Abstract

  To elucidate risk factors, clinical course, visual outcomes, and treatment of culture-proven methicillin-resistant Staphylococcus aureus (MRSA) infectious keratitis following refractive surgery.Interventional case series.Multicenter chart review of 13 cases of MRSA keratitis following refractive surgery and literature review.Thirteen eyes of 12 patients, nine of whom were either healthcare workers or exposed to a hospital surgical setting, developed MRSA keratitis following refractive surgery. All patients presented with a decrease in visual acuity and complaints of pain or irritation in the affected eye. Common signs on slit-lamp biomicroscopy were corneal epithelial defects, focal infiltrates with surrounding edema, conjunctival injection, purulent discharge, and hypopyon. All patients were diagnosed with infectious keratitis on presentation and treated with two antibiotics. All eyes were culture-positive for MRSA.According to a computerized MEDLINE literature search, this is the first case series of MRSA infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a healthcare facility, the first report of MRSA keratitis after a laser in situ keratomileusis (LASIK) enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones. MRSA keratitis is a serious and increasing complication following refractive surgery. Patients with exposure to a healthcare environment should be considered at additional risk for developing MRSA keratitis. However, in addition, surgeons should now be vigilant for community-acquired MRSA. Prompt identification with culturing and appropriate treatment of MRSA keratitis after refractive surgery is important to improve visual rehabilitation.

  View details for DOI 10.1016/j.ajo.2006.12.029

  View details for Web of Science ID 000245537800010

  View details for PubMedID 17320811

• Zernike versus Fourier treatment tables for myopic patients having CustomVue wavefront laser in situ keratomileusis with the S4 excimer laser JOURNAL OF CATARACT AND REFRACTIVE SURGERY Ou, J. I., Manche, E. E. 2007; 33 (4): 654-657

  Abstract

  To compare the efficacy, predictability, and safety of Zernike-based versus Fourier-based treatment tables in myopic eyes 1 year after CustomVue wavefront laser in situ keratomileusis (LASIK) using the S4 excimer laser (Visx).Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.A prospective analysis of 32 eyes of 16 patients with myopia who had CustomVue LASIK with the S4 excimer laser was conducted using Zernike or Fourier treatment tables. Mean spherical equivalent (SE), uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and higher wavefront analyses were determined.The mean postoperative SE was -0.27 diopter (D) +/- 0.41 (SD) in Zernike-treated eyes and -0.20 +/- 0.29 D in Fourier-treated eyes. Twenty-eight of 32 eyes were available for analysis. Ninety-two percent of eyes in the Zernike group and all eyes in the Fourier group had 20/20 or better acuity (P = .85). Seventy-nine percent and 92%, respectively, were within +/-0.50 D of emmetropia (P = .68). All eyes in the Zernike group and 93% of eyes in the Fourier group had no change or gained at least 1 Snellen line of BSCVA (P = .85). Mean higher-order aberration values (mum) in the Zernike group and Fourier group were as follows: total root mean square, 0.91 and 0.99, (P = 0.95); defocus, 0.71 and 0.74, (P = 0.98); astigmatism, 0.15 and 0.31, (P = 0.81); coma, 0.21 and 0.20, (P = 0.99); trefoil, 0.11 and 0.11, (P = 1); and spherical aberration, 0.17 and 0.30, (P = 0.85), respectively.Myopic eyes that had CustomVue LASIK had better visual outcomes in the Fourier group than in the Zernike group. Higher-order wavefront aberration results were similar between the 2 groups.

  View details for DOI 10.1016/j.jcrs.2006.12.013

  View details for PubMedID 17397739

• Topographic centration of ablation after LASIK for myopia using the CustomVue VISX S4 excimer laser JOURNAL OF REFRACTIVE SURGERY Ou, J. I., Manche, E. E. 2007; 23 (2): 193-197

  Abstract

  To determine the ablation centration, efficacy, predictability, and safety of CustomVue LASIK using the VISX S4 excimer laser for the treatment of myopia and myopic astigmatism.A retrospective review of 20 myopic eyes of 12 patients treated with LASIK CustomVue VISX S4 was conducted. Corneal topography was used to determine ablation centration. Primary outcome variables including manifest refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and complications were evaluated at 3 months postoperatively.Mean decentration (from ablation zone to entrance pupil) was 0.23 +/- 0.08 mm at 3 months postoperatively. No eyes were decentered > 0.5 mm. Preoperatively, the mean spherical equivalent refraction was -4.81 +/- 11.39 diopters (D) (range: -6.75 to -2.25 D). At 3 months postoperatively, mean spherical equivalent refraction was -0.63 +/- 0.25 D (range: -2.00 to 0.25 D). Nineteen (95%) of 20 eyes had UCVA of 20/40 and 16 (80%) of 20 eyes had UCVA of 20/20 at 3 months postoperatively. Fourteen (70%) eyes were within +/- 0.50 D and 18 (90%) eyes were within +/- 1.00 D of emmetropia. No eye lost > 1 line of BSCVA.Wavefront-guided LASIK using the CustomVue VISX S4 for myopic eyes results in minimal decentration ablation and effective, predictable, and safe visual outcomes.

  View details for PubMedID 17326359

• Superficial keratectomy after epi-LASIK JOURNAL OF CATARACT AND REFRACTIVE SURGERY Ou, J. I., Manche, E. E. 2006; 32 (12): 2153-2154

  View details for DOI 10.1016/j.jcrs.2006.06.037

  View details for Web of Science ID 000242819900043

  View details for PubMedID 17138002

• CustomVue laser in situ keratomileusis treatment after previous keratorefractive surgery JOURNAL OF CATARACT AND REFRACTIVE SURGERY Montague, A. A., Manche, E. E. 2006; 32 (5): 795-798

  Abstract

  To evaluate the efficacy, predictability, and safety of Visx CustomVue wavefront-guided enhancement after previous keratorefractive surgery.Stanford University Eye Laser Center, Stanford, California, USA.A retrospective analysis was used to evaluate wavefront-guided enhancement in a preliminary set of 120 eyes of 102 patients. All eyes had previous keratorefractive surgery (photorefractive keratoplasty [PRK] in 1 eye, laser in situ keratomileusis [LASIK] in 119 eyes); the prekeratorefractive surgery spherical equivalent (SE) refraction ranged from -1.25 diopters (D) to -7.00 D. Primary outcome variables including uncorrected visual acuity (UCVA), manifest refraction, and complications were evaluated at 1 and 3 months.At 1 month, the mean pre-enhancement SE was reduced from -0.91 D +/- 0.40 (SD) (range -2.375 to -0.125 D) to -0.13 +/- 0.33 D (range -1.25 to 0.75 D) with 91% of eyes within +/-0.5 D of emmetropia and 100% within +/-1.0 D. All eyes showed equal or improved UCVA (range 20/15 to 20/30) with 20/20 or better in 84 of 91 eyes. At 3 months, the mean was -0.20 +/- 0.32 D (range -0.75 to 0.75 D) with 100% of eyes within +/-0.75 D of emmetropia. All eyes showed equal or improved UCVA (range 20/15 to 20/30) with 20/20 or better in 74 of 84 eyes. Higher-order wavefront aberration analysis showed that the mean root-mean-square error was reduced from 0.39 +/- 0.14 microm (range 0.16 to 0.86 microm) to 0.34 +/- 0.12 microm (range 0.12 to 0.78 microm). Coma was reduced from 0.22 +/- 0.13 microm (range 0.02 to 0.71 microm) to 0.16 +/- 0.11 microm (range 0.01 to 0.62 microm), and trefoil was reduced from 0.16 +/- 0.09 microm (range 0.01 to 0.62 microm) to 0.11 +/- 0.07 microm (range 0.01 to 0.27 microm). Spherical aberration was unchanged from 0.14 +/- 0.14 microm (range -0.18 to 0.59 microm) to 0.14 +/- 0.14 microm (range -0.16 to 0.5 microm).Preliminary data show that Visx CustomVue wavefront-guided enhancement after keratorefractive surgery is an effective, predictable, and safe procedure.

  View details for DOI 10.1016/j.jcrs.2006.01.081

  View details for PubMedID 16765797

• CustomVue laser in situ keratomileusis for myopia and myopic astigmatism using the Visx S4 excimer laser - Efficacy, predictability, and safety JOURNAL OF CATARACT AND REFRACTIVE SURGERY Partal, A. E., Manche, E. E. 2006; 32 (3): 475-479

  Abstract

  To evaluate the efficacy, predictability, and safety of custom laser in situ keratomileusis (LASIK) using the Visx wavefront platform CustomVue for the treatment of myopia and myopic astigmatism.Stanford University Eye Laser Center, Stanford, California, USA.This retrospective analysis was of the initial 140 eyes of 78 patients treated consecutively with LASIK for myopia using the Visx Star S4 excimer laser. Primary outcome variables, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and complications, were evaluated at 1 week and 1 and 3 months. Vector analysis was performed on eyes that received astigmatic correction.Mean preoperative spherical equivalent (SE) was reduced from -3.89 diopters +/- 1.48 (SD) to an SE of -0.21 +/- 0.36 D at 1 month and -0.28 +/- 0.36 D at 3 months (P < .001). At 1 and 3 months, UCVA was 20/20 or better in 84.3% and 87.9%, respectively. Eighty-six percent of eyes at 1 month and 81.4% of eyes at 3 months were within +/-0.5 D of emmetropia. No eyes lost more than 2 lines of BSCVA. Vector analysis yielded an index of success of 0.39, indicating a 61% success rate in achieving the astigmatic surgical correction at 3 months. The preoperative root-mean-square value of 0.28 +/- 0.08 microm increased slightly to 0.33 +/- 0.11 microm at 1 month and 0.34 +/- 0.11 microm at 3 months.Wavefront-guided LASIK using the Visx CustomVue system was effective, predictable, and safe for correction of low to moderate myopic refractive error.

  View details for DOI 10.1016/j.jcrs.2005.12.128

  View details for PubMedID 16631061

• The treatment of hyperopia or presbyopia with Light Touch conductive keratoplasty JOURNAL OF CLINICAL AND SURGICAL OPHTHALMOLOGY Haw, W. W., Lin, D. Y., Manche, E. E. 2006; 3: 475-479
• Analysis of the efficacy, predictability, and safety of LASEK for myopia and myopic astigmatism using the Technolas 217 excimer laser Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Partal, A. E., Rojas, M. C., Manche, E. E. ELSEVIER SCIENCE INC. 2004: 2138–44

  Abstract

  To evaluate the efficacy, predictability, and safety of laser-assisted subepithelial keratectomy (LASEK) for the treatment of myopia and myopic astigmatism.Stanford University Eye Laser Center, Stanford, California, USA.This retrospective analysis comprised 102 eyes that had LASEK for myopia using the Bausch & Lomb Technolas 217 excimer laser. Primary outcome variables including uncorrected visual acuity (UCVA), best spectacle- corrected visual acuity (BSCVA), manifest refraction, and complications were evaluated at 3, 6, and 12 months. Vector analysis was performed on eyes that received astigmatic correction.The mean spherical equivalent was -7.03 diopters (D) +/- 2.61 (SD) preoperatively, +0.19 +/- 0.64 D at 3 months, +0.23 +/- 0.82 D at 6 months, and +0.03 +/- 0.63 D at 12 months (P<.001). At 3, 6, and 12 months, the UCVA was 20/20 or better in 66%, 67%, and 83% of eyes, respectively, and 20/40 or better in 98%, 99%, and 100%; 74%, 70%, and 83%, respectively, were within +/-0.5 D of emmetropia, and 89%, 86%, and 97%, respectively, were within +/-1.0 D. No eye lost more than 2 lines of BSCVA. At 3, 6, and 12 months, 10.0%, 8.7%, and 0% of eyes, respectively, had trace corneal haze. Vector analysis found a success rate of approximately 78% to 80% in achieving the astigmatic surgical correction at the 3 postoperative visits.Laser-assisted subepithelial keratectomy was an effective, predictable, and safe procedure for the treatment of myopia and myopic astigmatism. Further studies are needed to determine the role of LASEK in the refractive surgery spectrum.

  View details for DOI 10.1016/j.jcrs.2004.02.083

  View details for PubMedID 15474827

• Custom-contoured ablation pattern method for the treatment of decentered laser ablations JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lin, D. Y., Manche, E. E. 2004; 30 (8): 1675-1684

  Abstract

  To evaluate the custom-contoured ablation pattern (C-CAP) method as a tool for providing customized laser ablations for decentered ablations based on corneal topography data.Department of Ophthalmology, Stanford University, Stanford, California, USA.In a prospective noncomparative interventional case series, 8 eyes from 7 post-laser in situ keratomileusis (LASIK) patients and 1 post-photorefractive keratectomy (PRK) patient with symptomatic laser decentration were treated with the C-CAP method. The Zeiss Humphrey topography system was used to identify and analyze decentered ablations. The computer software allowed the surgeon to preoperatively model the effect of various ablation schemes on the preoperative topography until a scheme that alleviated the decentration was identified. The planned ablation parameters, which included size, depth, and location of the ablation, were programmed into the Visx S4 excimer laser before treatment.The mean follow-up after C-CAP ablation was 4.2 months (range 1.8 to 6.3 months). At the last postoperative examination, no eye lost a line of best spectacle-corrected visual acuity (BSCVA). The uncorrected visual acuity (UCVA) improved by 3 lines in 1 eye (12.5%), by 2 lines in 1 eye (12.5%), and by 1 line in 3 eyes (37.5%); it remained unchanged in 2 eyes (25.0%) and decreased by 1 line in 1 eye (12.5%). The BSCVA improved by 3 lines in 1 eye (12.5%), by 2 lines in 2 eyes (25.0%), and by 1 line in 3 eyes (37.5%); it remained unchanged in 2 eyes (25.0%). In all eyes, including those without improvement in UCVA or BSCVA, a significant improvement in centration and subjective complaints was achieved. The pre-C-CAP and post-C-CAP root-mean-square (RMS) wavefront data were available in 5 of 8 eyes. The total and higher-order RMS aberrations decreased by 41.7% (P =.0027) and 45.5% (P =.039), respectively, after C-CAP treatment.Early U.S. results show the topography-driven C-CAP method is an effective tool to address untreatable postsurgical decentration. This method is presented as a technique to enhance the overall quality of vision, reduce patient-perceived visual aberrations, regularize the corneal surface, and maximize BSCVA.

  View details for DOI 10.1016/j.jcrs.2003.12.052

  View details for PubMedID 15313290

• Treatment of epithelial ingrowth after laser in situ keratomileusis with mechanical debridement and flap suturing Symposium on Cataract, IOL and Refractive Surgery Rojas, M. C., Lumba, J. D., Manche, E. E. AMER MEDICAL ASSOC. 2004: 997–1001

  Abstract

  To evaluate the efficacy and safety of mechanical debridement and suturing of the laser in situ keratomileusis (LASIK) flap in the treatment of clinically significant epithelial ingrowth after LASIK.In a retrospective study, 20 eyes (n = 19 patients) in which clinically significant epithelial ingrowth developed after LASIK were treated with lifting of the flap, scraping of the epithelial ingrowth, and flap suturing. Primary outcome measurements including recurrence of ingrowth, uncorrected visual acuity (VA), manifest refraction, best spectacle-corrected VA, and complications were evaluated at the last postoperative examination.At the last postoperative examination (mean +/- SD, 10.5 +/- 14.3 months; range, 1.5-64 months), 100% of eyes had no recurrence of clinically significant epithelial ingrowth. The uncorrected VA changed from 20/20 or better in 7 eyes (35%) and 20/40 or better in 15 eyes (75%) preoperatively to 20/20 or better in 9 eyes (45%) and 20/40 or better in 16 eyes (80%) at the last follow-up examination. There was no significant change in the mean logarithm of the minimum angle of resolution (logMAR) uncorrected VA before (mean +/- SD, 0.3 +/- 0.5; range, -0.1 to 1.7) and after surgery (mean +/- SD, 0.2 +/- 0.4; range, -0.1 to 1.7) (P =.40). Mean +/- SD spherical equivalent changed from -0.21 +/- 0.82 diopters (D) (range, -1.25 to 1.00 D) preoperatively to -0.53 +/- 0.89 D (range, -2.50 to 0.38 D) at last follow-up (P =.30). No eyes lost 2 or more lines of best spectacle-corrected VA, and there were no complications associated with the treatment.Suturing the LASIK flap in addition to mechanical debridement of epithelial ingrowth is a safe and effective treatment for clinically significant epithelial ingrowth after LASIK.

  View details for PubMedID 15249364

• Successful corneal flap replacement following complete traumatic flap amputation after laser-assisted in situ keratomileusis ARCHIVES OF OPHTHALMOLOGY Haw, W. W., Manche, E. E. 2004; 122 (2): 275-276

  View details for Web of Science ID 000188776900018

  View details for PubMedID 14769607

• Two-year results of conductive keratoplasty for the correction of low to moderate hyperopia JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lin, D. Y., Manche, E. E. 2003; 29 (12): 2339-2350

  Abstract

  To evaluate the 2-year postoperative safety, efficacy, predictability, and stability results of conductive keratoplasty (CK) to correct low to moderate hyperopia.Department of Ophthalmology, Stanford University Medical Center, Stanford, California, USA.In a prospective nonrandomized noncontrolled trial, 25 eyes of 14 patients with +0.75 to +3.00 diopters (D) of hyperopia and

  View details for DOI 10.1016/j.jcrs.2003.09.022

  View details for PubMedID 14709295

• Ablation centration in laser in situ Keratomileusis for hyperopia: Comparison of VISX S3 ActiveTrak and VISX S2 JOURNAL OF REFRACTIVE SURGERY Giaconi, J., Manche, E. E. 2003; 19 (6): 629-635

  Abstract

  To compare ablation centration and outcome measurements in laser in situ keratomileusis (LASIK) for hyperopia using the pupil-tracking VISX S3 ActiveTrak or the nontracking VISX S2 excimer laser.In a retrospective study, 49 consecutively treated hyperopic eyes (32 patients) that had LASIK by the VISX StarS3 ActiveTrak were compared to 49 control-matched eyes treated with the VISX StarS2 without pupil-tracking. Primary outcome variables including ablation centration, uncorrected visual acuity, best spectacle-corrected visual acuity, manifest refraction, complications, and induced cylinder analyzed by vector analysis were evaluated 3 months postoperatively.Hyperopic sphere ranged between plano and +5.50 D and cylinder between 0 and +2.75 D. Ninety-five of 98 eyes (96.9%) were available for analysis at 3 months. Of these 95, 52 eyes could be used for analysis of ablation centration. Mean decentration of the ablation zone from the entrance pupil was 0.30 +/- 0.20 mm in tracked eyes (n=31) and 0.41 +/- 0.39 mm in nontracked eyes (n=21), P=.17. Two eyes (6.5%) in the tracked group were significantly decentered between 0.5 and 1 mm from the pupil center. In the nontracked group, decentration was between 0.5 and 1 mm in one eye (4.8%) and greater than 1 mm in two eyes (9.5%).Comparable ablation centration in LASIK for hyperopia was achieved between actively-tracked and nontracked eyes. Decentrations (greater than 1 mm) were not seen with a tracking system in this study. Visual and refractive results were similar between the VISX StarS3 ActiveTrak and VISX StarS2 laser systems.

  View details for PubMedID 14640427

• Diameters of topographic optical zone and programmed ablation zone for laser in situ keratomileusis for myopia JOURNAL OF REFRACTIVE SURGERY Partal, A. E., Manche, E. E. 2003; 19 (5): 528-533

  Abstract

  To compare topographic optical zones with programmed ablation zone settings of eyes treated with laser in situ keratomileusis (LASIK) for myopia using the VISX S2 excimer laser.Two-hundred three eyes treated with LASIK using the VISX S2 excimer laser were retrospectively evaluated to determine the size of the topographic optical zone. Three to six months after LASIK, the topographic optical zone was measured at the zone of highest curvature on topography and subtraction topography. Eyes were divided into four groups (A, B, C, D) in order of increasing myopia.When the topographic optical zone was compared with the programmed ablation zone, an optical zone reduction of 0.5 +/- 0.1 mm and 0.4 +/- 0.1 mm was found for the longest and shortest diameters, respectively. For eyes with spherical ablation zones, this reduction was 0.6 +/- 0.1 mm and 0.4 +/- 0.1 mm shorter than the programmed horizontal and vertical dimensions. Groups A, B, C, and D, in order of increasing myopia, all showed reductions of approximately 0.5 +/- 0.1 mm for the longest and 0.3 to 0.4 +/- 0.1 mm for the shortest diameters of the optical zone.The topographic optical zone was reduced from the programmed ablation zone. This reduction was statistically significant for both elliptical and spherical ablations, and seemed to be independent of the amount of myopia.

  View details for PubMedID 14518741

• Ablation centration in myopic laser in situ keratomileusis - Comparing the visx S3 ActiveTrak and the visx S2 Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Giaconi, J. A., Manche, E. E. ELSEVIER SCIENCE INC. 2003: 1522–29

  Abstract

  To compare ablation centration and outcome measurements in myopic laser in situ keratomileusis (LASIK) using the eye-tracking Visx S3 ActiveTrak and the nontracking Visx S2 excimer lasers.University-based refractive surgery practice.In a retrospective study, 71 consecutively treated myopic eyes that had LASIK with the Visx Star S3 ActiveTrak were compared to 71 control-matched eyes treated with the Visx Star S2 without pupil tracking. Primary outcome variables including ablation centration, uncorrected visual acuity, best spectacle-corrected visual acuity, manifest refraction, complications, and induced cylinder analyzed by vector analysis were evaluated 3 months postoperatively.The myopia ranged from -1.50 to -11.25 diopters (D) and the cylinder, from +0.25 to +2.75 D. Ninety-four of 142 eyes (66%) were available for analysis at 3 months; 50 eyes could be used to analyze ablation centration. At 3 months, the mean decentration of the ablation zone from the entrance pupil was 0.22 mm +/- 0.20 (SD) in tracked eyes (n = 25) and 0.21 +/- 0.26 mm in nontracked eyes (n = 25) (P =.88). Three eyes (12%) in the tracked group were decentered 0.5 to 1.0 mm, and 1 eye (4%) in the nontracked group was decentered more than 1.0 mm. All other eyes were decentered less than 0.5 mm. There was an association in the tracked group between greater decentrations and higher levels of myopia (r = 0.67), but this association did not exist in the nontracked group (r = -0.03).Comparable ablation centration as well as visual and refractive outcomes can be achieved with and without active eye tracking during myopic and astigmatic myopic LASIK.

  View details for DOI 10.1016/S0886-3350(03)00222-0

  View details for PubMedID 12954299

• Comparison of videokeratographic functional optical zones in conductive keratoplasty and laser in situ keratomileusis for hyperopia JOURNAL OF REFRACTIVE SURGERY Rojas, M. C., Manche, E. E. 2003; 19 (3): 333-337

  Abstract

  To compare the videokeratographic functional optical zone of eyes treated with conductive keratoplasty to eyes treated with laser in situ keratomileusis (LASIK) for hyperopia.Sixteen eyes treated with conductive keratoplasty for hyperopia were retrospectively evaluated to determine the size of the videokeratographic functional optical zone. The functional optical zone of these eyes was compared to the functional optical zone of 16 eyes that underwent LASIK for hyperopia with the VISX S2 excimer laser, for comparable amounts of hyperopia. The functional optical zone was measured at the edge of central corneal steepening and paracentral flattening on videokeratography 3 to 6 months after surgery.The functional optical zone after surgery measured an average of 5.6 mm horizontally and 5.6 mm vertically in the conductive keratoplasty eyes, and 4.7 mm horizontally and 5.1 mm vertically in the hyperopic LASIK eyes (P<.001 and P<.005). The mean functional optical zone area was 31.1 mm2 in the conductive keratoplasty eyes and 24.6 mm2 in the hyperopic LASIK eyes (P<.001). The functional optical zone created by conductive keratoplasty had more uniform central steepening and less peripheral blending than the functional optical zone created by hyperopic LASIK.Conductive keratoplasty was effective at creating central steepening in the cornea. The functional optical zone resulting from conductive keratoplasty was significantly larger than that obtained with hyperopic LASIK using the VISX S2 excimer laser.

  View details for PubMedID 12777029

• Two-year results of conductive keratoplasty (CK) for the correction of low to moderate hyperopia Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Lin, D. Y., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2003: U27–U27

  View details for Web of Science ID 000184607000150

• Implantation of scleral expansion band segments for the treatment of presbyopia AMERICAN JOURNAL OF OPHTHALMOLOGY Qazi, M. A., Pepose, J. S., Shuster, J. J. 2002; 134 (6): 808-815

  Abstract

  To assess the effects of scleral expansion band (SEB) segments on accommodative amplitude (primary measure), along with near and distance vision, refraction, pupil size and function, keratometry, axial length, intraocular pressure, contrast sensitivity, stereopsis, and other parameters (secondary measures) in a cohort of 29 emmetropic, presbyopic patients.Multicenter, prospective, nonrandomized, unmasked clinical trial in which the nonoperated eye served as the control.Four polymethylmethacrylate segments were surgically implanted in quadrantic scleral pockets created in the dominant eye of 29 emmetropic patients who were between the ages of 51 and 60 (mean age 54). Patients were examined preoperatively and up to 6 months postoperatively. The aforementioned tests were performed on the operated and control eye of each patient. Data were analyzed using two-sided rank tests. Medians, means, and standard deviations are provided for all measurements.Accommodative amplitude was measured monocularly using a near-point "push" technique from both a 70-cm and 30-cm starting point. An increase in accommodative amplitude of surgical eyes by +1.7 +/- 1.5 diopters and +1.5 +/- 1.2 diopters, at these two testing distances, respectively, was noted at 6 months postoperatively (P <.0001). A smaller increase was also seen in control eyes (+1.2 +/- 1.1 diopters and +1.3 +/- 1.2 diopters, respectively). There was notable intercenter variation in gains in accommodation, with three of seven centers showing significant improvement in near-point accommodative amplitudes relative to the others (P =.0003). There was a median improvement of uncorrected near acuity in surgical eyes by 0.3 logarithm of the minimal angle of resolution (logMAR) at 30 and 40 cm and by 4 lines at 20 cm, with the difference in near acuity improvement at 6 months between SEB eyes and control eyes statistically significant at 20 cm (P <.030). Changes in spherical equivalence, axial length, and central keratometry readings were not statistically significant. There were no reports of anterior segment ischemia or malignant glaucoma. Adverse effects were limited to a transient elevation of intraocular pressure in one patient and misalignment of individual SEB segments, due to inadequate scleral pocket formation, in three patients. Only one SEB segment in one eye was replaced. It appears that the thickness and uniformity of the scleral belt loop is critical to the proper positioning and efficacy of the SEB segments.While the safety profile of SEB segments for the treatment of presbyopia was high, a modest improvement in near vision was noted in approximately half the patients using subjective methods of testing. The mechanisms that underlie improvement in near vision in the nonoperated eye await explanation. This may be due to a centrally controlled consensual response, potentiated convergence generating increased intravitreal pressure and hydraulic lift of the vitreo-zonular-lens diaphragm, or artifact from current testing techniques. Future studies of the SEB procedure should address the issue of intercenter variation by further standardizing and automating specific aspects of the surgical technique, as well as incorporating objective testing methods into the study design.

  View details for Web of Science ID 000179738600002

  View details for PubMedID 12470747

• Conductive keratoplasty for the correction of low to moderate hyperopia: US clinical trial 1-year results on 355 eyes 105th Annual Meeting of the American-Academy-of-Ophthalmology McDonald, M. B., Hersh, P. S., Manche, E. E., Maloney, R. K., Davidorf, J., Sabry, M. ELSEVIER SCIENCE INC. 2002: 1978–89

  Abstract

  To document the 1-year safety, efficacy, and stability results of 355 eyes treated in the multicenter study of conductive keratoplasty (CK) used to correct low to moderate hyperopia.Nonrandomized comparative (self-controlled) trial.Twenty surgeons at 13 centers performed CK on the eyes of all patients enrolled in a multicenter, 2-year, U.S. phase III clinical trial. Treated eyes had +0.75 to +3.00 diopters (D) of hyperopia and < or =0.75 D of cylinder. Patients were 40 years of age or older.Low-energy, high-frequency current was applied directly into the peripheral corneal stroma through a delivery tip inserted at 8 to 32 treatment spots. The number of treatment spots was increased for increasing levels of hyperopia, but the amount of radiofrequency energy remained constant. Emmetropia was intended. All eyes were treated once (there were no retreatments).Data from 355 eyes with 1 year of follow-up were analyzed for safety and stability, and data from 318 eyes were analyzed for efficacy and predictability, as well as stability and safety. All patients reported on satisfaction and quality of vision after surgery.At 1 year, uncorrected visual acuity was < or =20/20 in 56%, < or =20/25 in 75%, and < or =20/40 in 92% of eyes. The manifest refractive spherical equivalent refraction was within 0.50 D in 63%, within +/-1.00 D in 89%, and within +/-2.00 D in 99%. Seven of 355 eyes lost 2 lines of best spectacle-corrected visual acuity at 1 year, but no eye lost >2 lines. One eye of 355 had induced cylinder of >2.00 D. The cycloplegic refractive spherical equivalent changed a mean of 0.25 +/- 0.50 D between months 3 and 6, 0.11 +/- 0.41 D between months 6 and 9, and 0.11 +/- 0.35 D between months 9 and 12. Refractive stability seemed to be attained by 6 months and remained stable through 12 months. Histology and confocal microscopy showed deep penetration of the treatment into the stroma. Endothelial cell counts were not changed by the treatment.CK seems to be safe, effective, and stable for correcting low to moderate spherical hyperopia in patients 40 years old or older. Treatment penetration is deep and cylindrical in shape, and it does not damage the corneal endothelium. Uncorrected visual acuity, predictability, and stability are as good as or better than those obtained with other techniques used to correct hyperopia.

  View details for Web of Science ID 000178778600023

  View details for PubMedID 12414402

• Conductive keratoplasty and laser thermal keratoplasty. International ophthalmology clinics Haw, W. W., Manche, E. E. 2002; 42 (4): 99-106

  View details for PubMedID 12409925

• Artisan phakic intraocular lens for myopia - Short-term results of a prospective, multicenter study OPHTHALMOLOGY Maloney, R. K., Nguyen, L. H., John, M. E. 2002; 109 (9): 1631-1641

  Abstract

  To evaluate the safety and efficiency of the Artisan iris-supported phakic intraocular lens (Ophtec BV, Groningen, Netherlands) for the correction of high myopia.Nonrandomized, prospective, multicenter trial conducted under a United States Food and Drug Administration (FDA) Investigational Device Exemption.One hundred fifty-five eyes of 155 patients with myopia from -5.5 to -22.5 diopters (D) underwent implantation of an Artisan lens, as part of a phase I, II, or III FDA trial.Eyes were examined at 1 day (154 eyes), 2 weeks (142 eyes), 2 months (130 eyes), and 6 months (84 eyes). Intraocular pressure and presence of flare and cell on slit-lamp biomicroscopy were recorded at each visit.Achieved correction, stability of spherical equivalent refraction, change in astigmatism, postoperative uncorrected vision, change in best spectacle-corrected acuity, and change in endothelial cell count.Mean spherical equivalent manifest refraction stabilized on postoperative day 1. Mean difference between attempted and achieved correction at 2 months was -0.32 +/- 0.95 D (mean +/- standard deviation; range, -4.42 to +2.2 D). At 6 months, 85% of eyes saw 20/40 or better uncorrected, and 90% of eyes were within 1 D of the attempted correction. Refractive astigmatism increased in 4.8% of eyes and decreased in 17% of eyes at 6 months. At 2 months, six eyes (4.8%) lost two or more lines of best spectacle-corrected visual acuity; by 6 months, no eyes lost two or more lines of best-corrected visual acuity. Endothelial cell count was unchanged at 6 months compared with the preoperative count. Nonprogressive lens opacities developed in four eyes as a result of surgical trauma. Chronic inflammation was not detected in any eye by slit-lamp biomicroscopy, nor did any eye develop angle closure or glaucoma.Short-term results suggest that the Artisan lens is an accurate and safe method for the correction of high myopia. Surgical skill is important in avoiding lens opacities. Longer-term data are needed to assess the impact of the lens on the endothelium, the crystalline lens, and the iris.

  View details for Web of Science ID 000177919700020

  View details for PubMedID 12208709

• Phototherapeutic keratectomy for anterior basement membrane dystrophy after laser in situ keratomileusis ARCHIVES OF OPHTHALMOLOGY Rojas, M. C., Manche, E. E. 2002; 120 (6): 722-727

  Abstract

  To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK) in the treatment of symptomatic anterior basement membrane dystrophy following laser in situ keratomileusis (LASIK).In a retrospective study, 10 eyes of 10 patients that developed symptomatic anterior basement membrane dystrophy following LASIK for myopia were treated with PTK using the VISX S2 (VISX Inc, Santa Clara, Calif) excimer laser. Primary outcome measurements including corneal clarity, resolution of symptoms, uncorrected visual acuity (UCVA), manifest refraction, best spectacle-corrected visual acuity (BSCVA), and complications were evaluated preoperatively, 1 day postoperatively, and at the last postoperative follow-up visit.At the last follow-up visit (mean [SD], 8.8 [5.5] months; range, 4-22 months), 100% of the eyes had clear corneas with no evidence of anterior basement membrane dystrophy, and all eyes were asymptomatic. Mean spherical equivalent changed from -0.75 (0.99) diopters (D) (range, -2.75 to +0.25 D) preoperatively to -0.51 (0.80) D (range, -1.63 to +1.00 D) at the last follow-up visit (P =.64). Uncorrected visual acuity improved from 20/20 or better in 1 eye (10%) and 20/40 or better in 5 eyes (50%) preoperatively to 20/20 or better in 5 eyes (50%) and 20/40 or better in 7 eyes (70%) postoperatively. No eyes lost lines of BSCVA, 2 eyes gained 1 line, 2 eyes gained 2 lines, and 1 eye gained 4 lines. There was a statistically significant improvement in mean logMAR BSCVA postoperatively, improving from 0.06 (0.16) (range, -0.1 to +0.3) to -0.08 (0.07) (range, -0.1 to +0.1) (P =.04). Postoperative complications included diffuse lamellar keratitis that resolved after treatment without sequelae (20%) and induced myopia exceeding -1.50 D (10%).Phototherapeutic keratectomy for the treatment of symptomatic anterior basement membrane dystrophy following LASIK treatment is safe and effective.

  View details for PubMedID 12049576

• Conductive keratoplasty for the correction of low to moderate hyperopia - 1-year results on the first 54 eyes 104th Annual Meeting of the American-Academy-of-Ophthalmology McDonald, M. B., Davidorf, J., Maloney, R. K., Manche, E. E., Hersh, P. ELSEVIER SCIENCE INC. 2002: 637–49

  Abstract

  To document the 1-year postoperative clinical results of the safety, efficacy, and stability of conductive keratoplasty (CK) to correct low to moderate hyperopia.Prospective, nonrandomized, self-controlled trial.Five surgeons at four centers performed CK on the first 54 eyes of a multicenter, 2-year clinical trial. Treated eyes had +0.875 to +4.00 diopters (D) of hyperopia and < or =0.75 D of cylinder. The nature of this procedure was explained to all participating patients who signed informed consent forms prior to undergoing the procedure.Low energy, high-frequency current was applied directly into the peripheral corneal stroma through a delivery tip inserted at 16 or more treatment spots. An early nomogram was used for the first 54 eyes with an intended refraction of plano.Data from all 54 eyes were analyzed for safety and stability. A subset of 30 of the 54 eyes was found that had been treated with the appropriate number of spots with the early nomogram. These eyes were categorized as current nomogram eyes; the data for these eyes were analyzed for efficacy and predictability, as well as stability and safety. All patients reported on satisfaction and quality of vision after surgery.Preoperatively, the manifest refractive spherical equivalent refraction (MRSE) of the 30 current nomogram eyes was +1.57 D. At 1 year postoperatively, uncorrected visual acuity was 20/20 or better in 57% of the eyes and 20/40 or better in 93%. The MRSE was within 0.50 D in 46%, within +/-1.00 D in 93%, and within +/-2.00 D in 100%. No eye lost > or =2 lines of best spectacle-corrected visual acuity at 1 year postoperatively nor had an induced cylinder of > or =2.00 D. The MRSE changed a mean of 0.25 D +/- 0.43 between 3 and 6 postoperative months, 0.16 D +/- 0.38 between 6 and 9 postoperative months, and 0.07 D +/- 0.38 between 9 and 12 postoperative months. Refractive stability appeared to be attained by 6 months postoperatively.Conductive keratoplasty appears to be safe, effective, and stable for correcting low to moderate spherical hyperopia. Stability appeared by the 6-month follow-up visit. For the eyes treated with the current CK nomogram, uncorrected visual acuity, predictability, and stability are as good as or better than those obtained with hyperopic laser in situ keratomileusis or noncontact laser thermal keratoplasty.

  View details for Web of Science ID 000174636000020

  View details for PubMedID 11927418

• Steroid, induced glaucoma after laser in situ keratomileusis associated with interface fluid 105th Annual Meeting of the American-Academy-of-Ophthalmology Hamilton, D. R., Manche, E. E., Rich, L. F., Maloney, R. K. ELSEVIER SCIENCE INC. 2002: 659–65

  Abstract

  To report the ocular manifestations and clinical course of eyes developing interface fluid after laser in situ keratomileusis (LASIK) surgery from a steroid-induced rise in intraocular pressure.Retrospective, noncomparative interventional case series.We examined six eyes of four patients who had diffuse lamellar keratitis develop after uneventful myopic LASIK surgery and were treated with topical corticosteroids. PRINCIPAL OUTCOME MEASURE: Slit-lamp findings, intraocular pressure measurements, and visual field loss.All eyes had a pocket of fluid develop in the lamellar interface between the flap and the stromal bed associated with a corticosteroid-induced rise in intraocular pressure. However, because of the interface fluid, intraocular pressure was normal or low by central corneal Goldmann applanation tonometry in all eyes. The elevated intraocular pressure was diagnosed by peripheral measurement in several cases after months of elevated pressure. All six eyes had visual field defects develop. Three eyes of two patients had severe glaucomatous optic neuropathy and decreased visual acuity develop as a result of undiagnosed steroid-induced elevated intraocular pressure.A steroid-induced rise in intraocular pressure after LASIK can cause transudation of aqueous fluid across the endothelium that collects in the flap interface. The interface fluid leads to inaccurately low central applanation tonometry measurements that obscure the diagnosis of steroid-induced glaucoma. Serious visual loss may result.

  View details for Web of Science ID 000174636000023

  View details for PubMedID 11927421

• Latrogenic keratoconus as a complication of radial keratotomy JOURNAL OF CATARACT AND REFRACTIVE SURGERY Shaikh, S., Shaikh, N. M., Manche, E. 2002; 28 (3): 553-555

  Abstract

  A 47-year-old man with a family history of keratoconus had uneventful bilateral radial keratotomy (RK) with astigmatic keratotomy (AK) enhancements 12 years earlier. He noticed a gradual onset of blurry vision with progressively increasing myopic shift. Visual acuity remained poor even with spectacles or soft contact lenses. Slitlamp examination revealed 16 well-healed RK scars and 2 AK scars with marked corneal steepening inferiorly in an area of astigmatic enhancement in the left eye but an otherwise normal fellow eye with 16 well-healed RK scars. He subsequently had penetrating keratoplasty for decreased vision not correctable by rigid gas-permeable contact lenses. Microscopic examination of the corneal button showed findings consistent with keratoconus. This case represents the first documented incidence of corneal ectasia as a complication of primary RK.

  View details for PubMedID 11973109

• Laser in situ keratomileusis for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser JOURNAL OF CATARACT AND REFRACTIVE SURGERY Shaikh, N. M., Manche, E. E. 2002; 28 (3): 485-490

  Abstract

  To evaluate the safety, efficacy, predictability, and visual results of laser in situ keratomileusis (LASIK) using the Bausch & Lomb Technolas(R) 217 scanning-spot laser for the treatment of myopia and compound myopic astigmatism.Stanford Eye Laser Center, Stanford, California, USA.In a prospective study, 110 eyes of 58 patients with a mean spherical equivalent (SE) of -4.87 diopters (D) +/- 2.5 (SD) (range -1.0 to -11.4 D) had LASIK for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser. The primary outcome variables included preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), achieved versus attempted correction, vector analysis of astigmatism, and complications.One hundred ten eyes were available for analysis at 3 months. The mean SE refraction was reduced 95% (mean -0.23 +/- 0.4 D), and astigmatism was reduced 70% (mean 0.28 +/- 0.3 D). One day postoperatively, 100% of eyes had a UCVA of 20/40 or better, 96% had 20/25 or better, 77% had 20/20 or better, and 39% had 20/15 or better. At the 3-month examination, 100% of eyes had a UCVA of 20/40 or better, 95% had 20/25 or better, 83% had 20/20 or better, and 48% had 20/15 or better. Ninety percent of eyes were within +/-0.5 D of emmetropia. No eye lost 2 or more lines of BSCVA.The Technolas 217 scanning-spot laser produced excellent postoperative UCVA and BSCVA. It was predictable, safe, and effective for the treatment of myopia and compound myopic astigmatism. Long-term follow-up is needed to assess the stability of the procedure.

  View details for PubMedID 11973095

• Progression to end-stage glaucoma after laser in situ keratomileusis JOURNAL OF CATARACT AND REFRACTIVE SURGERY Shaikh, N. M., Shaikh, S., Singh, K., Manche, E. 2002; 28 (2): 356-359

  Abstract

  We describe 2 patients, one a glaucoma suspect because of family history and the other with juvenile glaucoma. Both patients developed complications after laser in situ keratomileusis that required frequent topical steroids, leading to steroid-induced glaucoma. In both cases, corneal edema from the acute rise in intraocular pressure (IOP) caused inaccurate IOP measurement by standard methods. The inability to recognize glaucoma early may have resulted in significant irreversible vision loss.

  View details for PubMedID 11821221

• Laser in situ keratomileusis enhancement for consecutive hyperopia after myopic overcorrection Fall World Refractive Surgery Symposium of the International-Society-of-Refractive-Surgery Rojas, M. C., Haw, W. W., Manche, E. E. ELSEVIER SCIENCE INC. 2002: 37–43

  Abstract

  To assess the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) for the treatment of consecutive hyperopia after myopic LASIK.Stanford University School of Medicine, Stanford, California, USA.In a retrospective study, 36 eyes of 30 patients with consecutive hyperopia after myopic LASIK had LASIK retreatment using the VISX S2 excimer laser. Primary outcome variables including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, complications, and vector analysis were evaluated preoperatively and 1 day and 3 months postoperatively.The mean spherical equivalent decreased from +1.52 diopters (D) +/- 0.55 (SD) (range +0.63 to +2.63 D) preoperatively to -0.10 +/- 0.52 D (range -1.25 to +1.50 D) 3 months after retreatment. The UCVA was 20/20 or better in 24 eyes (66.7%) and 20/40 or better in 34 eyes (94.4%). Twenty eyes (55.5%) were within +/-0.5 D of the intended correction and 34 eyes (94.4%), within +/-1.0 D. No eye lost 2 or more lines of BSCVA. One eye (2.8%) developed diffuse lamellar keratitis that resolved without sequelae, and 2 eyes (5.6%) developed nonprogressive epithelial ingrowth that did not require removal.Laser in situ keratomileusis retreatment for consecutive hyperopia following myopic LASIK was an effective, predictable, and safe procedure. Long-term follow-up is needed to assess stability.

  View details for PubMedID 11777708

• Topical corticosteroids after keratorefractive surgery: Reply JOURNAL OF CATARACT AND REFRACTIVE SURGERY Manche, E. E., Singh, K., Shaikh, N., Shaikh, S. 2002; 8: 1307
• Latrogenic keratectasia after a deep primary keratotomy during laser in situ keratomileusis AMERICAN JOURNAL OF OPHTHALMOLOGY Haw, W. W., Manche, E. E. 2001; 132 (6): 920-921

  Abstract

  To describe a case of keratectasia after a deep primary keratotomy during an aborted laser in situ keratomileusis procedure.Retrospective, observational case report.In a 47-year-old woman, progressive keratectasia developed after a 90% depth keratotomy during an aborted laser in situ keratomileusis procedure. This case was managed with a rigid gas permeable contact lens and consideration for penetrating keratoplasty.Keratectasia is a reported microkeratome-related complication after laser in situ keratomileusis. Appropriate microkeratome assembly and surgeon awareness are necessary to avoid this complication.

  View details for Web of Science ID 000172506900017

  View details for PubMedID 11730659

• Management of the corneal flap in laser in situ keratomileusis after previous radial keratotomy AMERICAN JOURNAL OF OPHTHALMOLOGY Chung, M. S., Pepose, J. S., Manche, E. E. 2001; 132 (2): 252-253

  Abstract

  To report a method of managing the corneal flap in patients having laser in situ keratomileusis for the treatment of residual refractive errors after radial keratotomy.Retrospective case series.Intraoperative dehiscence of radial keratotomy wounds occurred in 7 eyes of 6 patients treated with laser in situ keratomileusis for residual myopia or astigmatism or hyperopia 5 to 15 years after radial keratotomy. To minimize extension of these tears, the flap was initially rolled like a carpet toward the hinge before the ablation and then rolled away from the hinge to its original position after the ablation.Using this method of managing the laser in situ keratomileusis flap in patients with previous radial keratotomy, all eyes had successful laser in situ keratomileusis, with 1-year postoperative uncorrected visual acuity ranging between 20/16 and 20/25. No eye had loss of spectacle-corrected vision or interface epithelial ingrowth.Laser in situ keratomileusis has proved to be an effective treatment for correction of residual refractive errors after radial keratotomy. The surgical technique used in these cases was targeted at minimizing shearing forces in lifting the corneal flap to avoid extension of radial keratotomy wound dehiscence, which could lead to epithelial ingrowth and loss of best-corrected vision.

  View details for Web of Science ID 000170168800016

  View details for PubMedID 11476687

• Effect of preoperative pupil measurements on glare, halos, and visual function after photoastigmatic refractive keratectomy JOURNAL OF CATARACT AND REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2001; 27 (6): 907-916

  Abstract

  To prospectively assess the effect of preoperative variables such as pupil size on glare, halos, and visual function after photoastigmatic refractive keratectomy (PARK).Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.Ninety-three eyes had PARK for primary compound myopic astigmatism. Preoperative pupil diameters were measured under scotopic and photopic illuminance conditions. Postoperatively, patients were evaluated at 1, 3, 6, 9, 12, 18, and 24 months. A regression model was performed to evaluate the predictive value of assessing preoperative variables such as pupil diameter on the development of glare and halos, contrast sensitivity, and best spectacle-corrected visual acuity (BSCVA) under scotopic, photopic, and glare conditions.The greater magnitude loss of BSCVA under scotopic conditions in the early postoperative period as well as the slower recovery to preoperative levels in eyes with larger scotopic pupil diameters were not statistically significant (P >.05). An increase in symptoms of glare was related more to the attempted level of spherical equivalent (SE) correction than to the pupil size during the first 12 postoperative months (P <.01). The photoablation dimensions as determined by the attempted level of astigmatic correction may result in decreases in the glare BSCVA up to 12 months after PARK (P =.03). At the 2 year follow-up, pupil diameter under both scotopic and photopic illuminance conditions was not predictive of any of the measured outcomes variables.An assessment of preoperative pupil size and the attempted level of both SE and astigmatic correction may be useful in identifying patients at risk of developing symptoms or declines in visual performance after PARK. However, follow-up studies are indicated to identify variables predictive of poor visual outcomes following excimer laser refractive surgery.

  View details for Web of Science ID 000169396500026

  View details for PubMedID 11408140

• Conductive keratoplasty for the correction of hyperopia. Transactions of the American Ophthalmological Society Asbell, P. A., Maloney, R. K., Davidorf, J., Hersh, P., McDonald, M., Manche, E. 2001; 99: 79-84

  Abstract

  Conductive keratoplasty (CK) is a surgical technique that delivers radio frequency (350 kHz) current directly into the corneal stroma through a Keratoplasty tip inserted into the peripheral cornea at 8 to 32 treatment points. A full circle of CK spots produces a cinching effect that increases the curvature of the central cornea, thereby decreasing hyperopia. We report here the 12-month results of a 2-year, prospective, multicenter US clinical trial conducted to evaluate the efficacy, safety, and stability of CK.A total of 233 patients (401 eyes) with preoperative hyperopia of +0.75 to +3.00 D and < or = 0.75 D of astigmatism (mean preoperative manifest refractive spherical equivalent = +1.76 D +/- 0.60) were enrolled into the study at 13 centers and underwent CK treatment.Twelve-month postoperative data are available on 203 eyes for safety and stability and 171 eyes for safety, stability, and efficacy. A total of 91% had uncorrected visual acuity (UCVA) of 20/40 or better, and 51% had UCVA of 20/20 or better. Manifest refractive spherical equivalent was within +/- 0.50 D in 58%, within +/- 1.00 D in 91%, and within +/- 2.00 D in 99%. The mean change in residual refraction was 0.26 D +/- 0.49 between 3 and 6 months, 0.09 D +/- 0.37 between 6 and 9 months, and 0.13 D +/- 0.39 between 9 and 12 months.One-year data show safety and efficacy of CK in the treatment of hyperopia. Changes in residual refractive error after CK appeared to be small, suggesting that a stable refraction could be achieved by 6 months.

  View details for PubMedID 11797323

  View details for PubMedCentralID PMC1359026

• Refractive surgical problem - Consultation section JOURNAL OF CATARACT AND REFRACTIVE SURGERY Manche, E. E. 2001; 27: 1716-1717
• Multiple striae post-LASIK management OPHTHALMIC CASE CONSULTATIONS Manche, E. E. 2001; 2: 359-364
• Laser in-situ keratomileusis (LASIK) following previous refractive surgery: An update COMPREHENSIVE OPHTHALMOLOGY UPDATE Manche, E. E., Haw, W. W. 2001; 17: 63-68
• Treatment of progressive or recurrent epithelial ingrowth with ethanol following laser in situ keratomileusis JOURNAL OF REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2001; 17 (1): 63-68

  Abstract

  To evaluate the use of ethanol in the treatment of progressive or recurrent epithelial ingrowth following laser in situ keratomileusis (LASIK).Four eyes of four patients with aggressive epithelial ingrowth following LASIK underwent epithelial ingrowth removal with 50% ethanol. Aggressive epithelial ingrowth was defined as, 1) progressive enlargement on serial examination with an area of ingrowth involving at least 30% of the flap surface area, 2) epithelial ingrowth associated with stromal melting as evidence on clinical or topographic examination, or 3) recurrent epithelial ingrowth in the same area following previous removal.Epithelial ingrowth was removed successfully in all eyes. No eye lost best spectacle-corrected visual acuity. One eye with multiple risk factors for failure experienced nonprogressive recurrence. No eyes required reoperation for recurrent epithelial ingrowth. No eyes experienced progression of stromal melt. Regularization of corneal topography was observed in an eye with preoperative stromal melting. The only complication was a tendency for the development of diffuse lamellar keratitis. Two eyes (50%) experienced diffuse lamellar keratitis following epithelial ingrowth removal with ethanol, which resolved completely with topical corticosteroids.Ethanol may be a useful adjunct in the treatment of aggressive or recurrent epithelial ingrowth following LASIK. Cautious use with the lowest concentration of ethanol may prove useful in these difficult epithelial ingrowth cases. Randomized and prospective studies are recommended to evaluate our experience.

  View details for Web of Science ID 000166560100010

  View details for PubMedID 11201779

• Large optical ablation zone casing the VISX S2 Smoothscan excimer laser JOURNAL OF CATARACT AND REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2000; 26 (12): 1742-1747

  Abstract

  To prospectively evaluate the safety and efficacy of the new large-zone (6.5 mm) photoablation technology using the VISX S2 Smoothscan excimer laser.University-based hospital, Stanford, California, USA.Forty-two eyes of 21 patients with a mean preoperative spherical equivalent (SE) of-5.55 diopters (D)+/- 2.24 (SD) (range-2.13 to-10.75 D) had laser in situ keratomileusis (LASIK) using the VISX Smoothscan S2 excimer laser for simple myopia or compound myopic astigmatism. A 6.5 mm optical zone was used in all eyes. Patients were prospectively followed 1 day and 1 and 3 months postoperatively.At 3 months, the mean SE was reduced 94% to-0. 31+/- 0.55 D. Ninety-one percent of eyes had an uncorrected visual acuity of 20/40 or better. Eighty-eight percent were within+/-1.00 D of attempted correction and 84%, within +/-0.50 D. Stability within+/-0.50 D occurred after the first postoperative month. Vector analysis of eyes that had toric ablations demonstrated a difference vector within+/-1.00 D in 100% of eyes. The mean angle of error was-0.04+/- 6.37 degrees. Visually significant steep central islands associated with loss of best spectacle-corrected visual acuity was observed in 7.5% of eyes at 1 month. No eyes experienced significant glare or halos.The new large-zone (6.5 mm) photoablation technology with the VISX S2 Smoothscan resulted in effective reduction of simple myopia and compound myopic astigmatism. However, with the 6.5 mm zone, there may be an increased risk of developing symptomatic steep central islands in the early post-LASIK period compared with the standard 6.0 mm treatment zone.

  View details for Web of Science ID 000166015500015

  View details for PubMedID 11134873

• Late onset diffuse lamellar keratitis associated with an epithelial defect in six eyes JOURNAL OF REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2000; 16 (6): 744-748

  Abstract

  To report six cases of late onset diffuse lamellar keratitis associated with epithelial defects 2 to 12 months following uncomplicated laser in situ keratomileusis (LASIK).Retrospective case series.The interface inflammation and epithelial defects were treated aggressively with topical corticosteroids and topical antibiotics with complete resolution over 1 to 2 weeks. There were no complications or loss of best spectacle-corrected visual acuity. These cases illustrate new understanding in the etiology of diffuse lamellar keratitis following lamellar surgery.Late onset diffuse lamellar keratitis in association with epithelial defects may occur following LASIK. Treatment with topical antibiotics and topical corticosteroids may result in uncomplicated, complete resolution.

  View details for Web of Science ID 000165489800009

  View details for PubMedID 11110316

• Prospective study of photorefractive keratectomy for hyperopia using an axicon lens and erodible mask JOURNAL OF REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2000; 16 (6): 724-730

  Abstract

  To evaluate prospectively the long-term safety, efficacy, and visual performance following photorefractive keratectomy (PRK) for hyperopia using an erodible mask and axicon lens system.Eighteen eyes of 9 patients with a mean preoperative spherical equivalent refraction of +2.26 +/- 0.82 D (range, +1.13 to +4.00 D) underwent PRK with the Summit Apex Plus excimer laser following manual scraping of the epithelium. Eyes were prospectively evaluated 1, 3, 6, 9, 12, 18, and 24 months following the procedure. Primary outcome variables included cycloplegic refraction and uncorrected visual acuity (UCVA). Visual performance was determined by contrast sensitivity measurements under scotopic (21 lux) and photopic (324 lux) conditions and best spectacle-corrected visual acuity (BSCVA) under scotopic, photopic, and glare conditions.For 18 eyes, 98.2% of the mean preoperative spherical equivalent refraction was corrected to +0.04 +/- 0.87 D (range, -1.38 to +2.00 D) at 24 months after PRK. Twelve eyes (67%) were within +/-0.50 D of attempted correction and 15 eyes (83%) were within +/-1.00 D. Stability within +/-0.50 D was achieved after 6 months. Two eyes (11%) experienced almost complete regression of the refractive effect. There was no statistically significant decrease in contrast sensitivity under scotopic or photopic conditions. (P > .05). Best spectacle-corrected visual acuity showed progressive improvement in the early postoperative period. By 24 months, 0 eyes (0%) lost 2 or more lines of BSCVA under scotopic and photopic conditions and 1 eye (5.5%) lost 2 or more lines under glare conditions. Fourteen eyes (78%) had grade 1 to 3 anterior stromal haze at 24 months which was characteristically mid-peripheral and did not adversely affect visual performance.Photorefractive keratectomy with the the Summit Apex Plus excimer laser for low to moderate hyperopia resulted in an effective reduction of hyperopia without compromising long-term visual performance. Stability and recovery of distance uncorrected and best spectacle-corrected visual acuity took approximately 6 months.

  View details for Web of Science ID 000165489800006

  View details for PubMedID 11110313

• Visual performance following photoastigmatic refractive keratectomy - A prospective long-term study JOURNAL OF CATARACT AND REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2000; 26 (10): 1463-1472

  Abstract

  To prospectively determine the long-term effect of excimer laser photoastigmatic refractive keratectomy (PARK) on visual performance using psychophysical assessments and to identify predictors of poor performance on the psychophysical assessments.University-based hospital, Stanford University, Stanford, California, USA.Ninety-three eyes of 56 patients with a mean of -4.98 diopters +/- 1. 80 (SD) of primary compound myopic astigmatism had PARK using the Summit Apex Plus excimer laser and an erodible mask system. Patients were prospectively evaluated 1, 3, 6, 9, 12, 18, and 24 months following the procedure. Primary outcome variables included changes in the contrast sensitivity function curve (3.0, 6.0, 12.0, 18.0 cycles per degree) under 2 standard illuminance conditions (scotopic and photopic) and changes in the best spectacle-corrected visual performance under scotopic, photopic, and glare conditions.A relative decline in the contrast sensitivity function curve occurred in the early postoperative period under both scotopic and photopic conditions. This was most pronounced under photopic illuminance and at the low spatial frequencies at the 6 month visit. By 1 year, however, the mean contrast sensitivity at all spatial frequencies and all illuminance conditions had returned to the preoperative level. Further improvements beyond the preoperative level may be related to the independent analysis of retreatment eyes beyond 6 months. A higher level of attempted correction of the spherical equivalent was predictive of an elevated scotopic contrast threshold at the extreme spatial frequencies 6 months after PARK (P <.05). The attempted level of astigmatic correction was predictive of a poor best corrected visual performance under scotopic conditions at 1 month (P <.05). This effect was only temporary and by postoperative month 3, there was no predictive effect of preoperative astigmatism (P >.05).Psychophysical assessments may be a more sensitive indicator of decreases in visual performance following excimer laser refractive surgery. The attempted level of correction of spherical equivalent and astigmatism may adversely affect early scotopic visual performance. Decreases in visual performance are temporary, return to normal by 12 months, and remain stable 24 months following PARK.

  View details for Web of Science ID 000089913500014

  View details for PubMedID 11033392

• Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy AMERICAN JOURNAL OF OPHTHALMOLOGY Dastgheib, K. A., Clinch, T. E., Manche, E. E., Hersh, P., Ramsey, J. 2000; 130 (3): 297-303

  Abstract

  To report sloughing of corneal epithelium during laser in situ keratomileusis and subsequent wound healing complications in patients with epithelial basement membrane dystrophy.In a retrospective study, the surgical procedures, postoperative course, and visual acuities of 16 eyes of nine patients with epithelial basement membrane dystrophy who underwent laser in situ keratomileusis complicated with epithelial sloughing at three centers were reviewed. The mean follow-up period was 23 weeks (range, 4 to 52 weeks).In 13 (81%) of 16 eyes with epithelial basement membrane dystrophy, epithelial sloughing occurred during laser in situ keratomileusis. In eight of the 13 eyes, epithelial growth beneath the flap was observed. The flap was lifted and the interface epithelium scraped in six eyes. Flap melt or keratolysis occurred in four eyes. At the last follow-up visit, 13 of 16 eyes had an uncorrected visual acuity of 20/30 or better, and all eyes had a best-corrected visual acuity of 20/30 or better.Patients with epithelial basement membrane dystrophy have poorly adherent corneal epithelium and are predisposed to epithelial sloughing during the microkeratome pass of laser in situ keratomileusis. This may lead to flap distortion, interface epithelial growth, flap keratolysis, and corneal scarring. It is not recommended that laser in situ keratomileusis be performed in patients with classic, symptomatic epithelial basement membrane dystrophy. In patients who present with mild and asymptomatic epithelial basement membrane dystrophy, laser in situ keratomileusis should be performed with caution, or photorefractive keratectomy may be the preferred refractive procedure.

  View details for Web of Science ID 000089650600006

  View details for PubMedID 11020408

• One-year evaluation of myopic laser photoastigmatic refractive keratectomy using the Summit Apex Plus - Phase III of a Food and Drug Administration clinical trial Annual Meeting of the American-Academy-of-Ophthalmology Haw, W. W., Manche, E. E. ELSEVIER SCIENCE INC. 2000: 1572–77

  Abstract

  To prospectively evaluate the safety and efficacy of the Summit Apex Plus excimer laser in the treatment of primary compound myopic astigmatism.Prospective noncomparative interventional case series.Patients with primary compound myopic astigmatism: sphere of -1.0 to -7.0 diopters (D) and cylinder -1.0 to -5.0 D.Ninety-three eyes of 56 patients with a mean spherical equivalent of -4.98 +/- 1.80 D (-1.75 to -8.5) underwent photoastigmatic refractive keratectomy (PARK) with the Summit Apex Plus excimer laser using erodible mask technology. Prospective follow-up is analyzed at 1-year postoperatively.Postoperative reduction in myopic sphere, myopic astigmatism, spherical equivalent, angle of error, magnitude of error, difference vector, uncorrected visual acuity, and corneal haze.Seventy-one eyes were available at 1-year follow-up. Mean spherical equivalent was reduced 86.5% to a mean residual of -0. 65 D +/-0.70 D (-2.88-+1.13 D). Astigmatism was reduced 66.2% to a mean residual of -0.76 +/- 0.52 D (-2.25-0.00 D); 77.5% were within 1.0 D of attempted correction; 1.4% of eyes experienced an overcorrection >1.0 D of spherical equivalent; 0.27 D of mean myopic regression was demonstrated between 1 and 12 months; 93.0% of eyes achieved an uncorrected visual acuity of 20/40 or better; and 49.3% of eyes achieved an uncorrected visual acuity of 20/20 or better.PARK with the Summit Apex Plus excimer laser is effective at reducing compound myopic astigmatism. However, current laser algorithms result in consistent undercorrection of both the compound myopia and the astigmatic component.

  View details for Web of Science ID 000088465500038

  View details for PubMedID 10919911

• Photorefractive keratectomy for compound myopic astigmatism AMERICAN JOURNAL OF OPHTHALMOLOGY Haw, W. W., Manche, E. E. 2000; 130 (1): 12-19

  Abstract

  To evaluate the safety and efficacy of photorefractive keratectomy for the treatment of primary compound myopic astigmatism.In a prospective study, 93 eyes from 56 patients with a mean spherical equivalent of -4.98 +/- 1.80 diopters (range, -1.75 to -8.5) underwent photoastigmatic refractive keratectomy with the Summit Apex Plus excimer laser using erodible mask technology and were followed for 2 years. Primary outcome measures included an assessment of astigmatic correction through vector analysis, manifest refraction, uncorrected visual acuity, corneal clarity, and the presence of adverse symptoms.Eighty-five eyes (91.4%) were available for analysis at 6 months. Mean spherical equivalent refraction was reduced 85% (mean, -0.75 +/- 0.85 diopter) and the target-induced astigmatism was reduced 70% (mean, 0.98 +/- 1.88 diopters). Forty-eight eyes (56%) had an uncorrected visual acuity of 20/20 or greater, whereas 70 eyes (82%) had an uncorrected visual acuity of 20/40 or greater. Twenty-four eyes (26% ) required re-treatment because of undercorrection of the spherical equivalent and astigmatic components after the 6-month follow-up. Fifty-nine of the remaining eyes were available at the 24-month visit. Mean spherical equivalent refraction was reduced to -0.39 +/- 0.72 diopter (91.8%). The target-induced astigmatism was reduced 64% from 1.74 diopters. Forty-one eyes (81.3%) were within +/-1.0 diopter of attempted spherical equivalent correction. Stability within a spherical equivalent of +/-0.5 diopter occurred after the first postoperative month. Fifty-six eyes (94.9%) had an uncorrected visual acuity of 20/40 or greater, whereas 34 eyes (57.6 %) demonstrated an uncorrected visual acuity of 20/20 or greater. One eye (1.7%) lost 2 or more lines of best spectacle-corrected visual acuity.Photoastigmatic refractive keratectomy with the Summit Apex Plus excimer laser is a safe and effective method of reducing compound myopic astigmatism. However, higher re-treatment rates may result from significant undercorrections because of current laser algorithms and variability in the mean angle of error.

  View details for Web of Science ID 000089407100002

  View details for PubMedID 11004254

• Excimer laser retreatment of residual myopia following photoastigmatic refractive keratectomy for compound myopic astigmatism JOURNAL OF CATARACT AND REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 2000; 26 (5): 660-667

  Abstract

  To prospectively evaluate the safety, efficacy, and visual performance of excimer laser enhancement following photoastigmatic refractive keratectomy (PARK) with the Summit Apex Plus.Stanford University School of Medicine Eye Laser Clinic, Stanford, California, USA.As part of a Food and Drug Administration clinical trial, 93 eyes of 56 patients with a mean spherical equivalent (SE) of -4.98 diopters (D) +/- 1.80 (SD) (range -1.75 to -8.50 D) had PARK for compound myopic astigmatism using the Summit Apex Plus excimer laser and a poly(methyl methacrylate) erodible mask. Seventeen eyes with a mean SE of -2.08 +/- 0.76 D required excimer laser refractive keratectomy for residual spherical myopia or compound myopic astigmatism. Patients were prospectively followed 1, 3, 6, 9, and 12+ months after the enhancement procedure. Primary outcome variables included uncorrected visual acuity (UCVA), refraction, vector analysis, best spectacle-corrected visual acuity (BSCVA) under standard ambient conditions (photopic, scotopic, and glare), corneal clarity, and contrast sensitivity function curve under photopic and scotopic conditions.At the last postoperative visit, the mean sphere had been corrected 82% to a residual of -0.29 +/- 1.23 D and mean SE had been corrected 65% to a residual of -0.74 +/- 1.27 D. Eighty-two percent of eyes were within +/-1.0 D of attempted correction. Eighty-eight percent had a UCVA of 20/40 or better. Vector analysis demonstrated a difference vector of within +/-1.0 D in 75% of eyes that had PARK retreatment. There was no significant loss in the contrast sensitivity curve. Late regression associated with corneal haze and loss of BSCVA occurred in 2 eyes (11.7%).Retreatment following PARK for compound myopic astigmatism results in effective reduction in residual spherical myopia and compound myopic astigmatism. An improvement in UCVA without loss of contrast sensitivity can be expected in most eyes. However, regression, corneal haze, and loss of BSCVA may occur. Further studies are indicated to predict risk factors for these complications.

  View details for Web of Science ID 000087092300018

  View details for PubMedID 10831894

• Deep lamellar keratoplasty using viscoelastic dissection ARCHIVES OF OPHTHALMOLOGY Manche, E. E., Holland, G. N., Maloney, R. K. 1999; 117 (11): 1561-1565

  Abstract

  We describe a technique for performing deep lamellar keratoplasty using viscoelastic dissection. Deep lamellar dissections of the cornea using viscoelastic substances (sodium hyaluronate) were performed on 4 eyes of 4 patients. One patient with keratoconus and another with corneal scarring underwent lamellar keratoplasty using the technique as the sole procedure for visual rehabilitation. Two patients (2 eyes) with opaque corneas underwent deep lamellar dissection with removal of stromal tissue to allow visualization of the anterior segment structures prior to penetrating keratoplasty, thereby facilitating separation of iridocorneal adhesions as the Descemet membrane was incised. Deep lamellar dissection was performed without complications related to the procedure in all 4 eyes. The 2 lamellar grafts cleared completely, and both eyes achieved excellent visual acuity with spectacle correction. In the other 2 eyes, deep lamellar dissection provided clear visualization of anterior segment structures during incision of the Descemet membrane. Deep lamellar dissection using viscoelastic substances is a useful technique during lamellar keratoplasty.

  View details for Web of Science ID 000083616000017

  View details for PubMedID 10565532

• Excimer laser refractive surgery in the pediatric population JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Haw, W. W., Alcorn, D. M., Manche, E. E. 1999; 36 (4): 173-177

  View details for Web of Science ID 000081538500002

  View details for PubMedID 10442722

• Sterile peripheral keratitis following laser in situ keratemileusis JOURNAL OF REFRACTIVE SURGERY Haw, W. W., Manche, E. E. 1999; 15 (1): 61-63

  Abstract

  Sterile infiltrates have been reported as a possible complication following photorefractive keratectomy (PRK). They have not been reported following laser in situ keratomileusis (LASIK). We review a case of fleeting, sterile peripheral corneal infiltrates following LASIK.A 53 year old patient developed peripheral, sterile corneal infiltrates along the edge of the primary flap following LASIK. This was successfully managed with topical antibiotics and corticosteroids without permanent sequelae.Sterile peripheral corneal infiltrates are now a known complication following LASIK. Pathogenesis is undetermined but may involve activation of marginal keratitis reminiscent of that following blepharitis or a mechanism similar to acute subepithelial infiltrative keratitis following PRK.Fleeting, sterile peripheral corneal infiltrates can occur following LASIK. This undesired complication is poorly characterized but can be successfully managed with culturing of the infiltrates, topical corticosteroids, and antibiotics.

  View details for Web of Science ID 000078357000008

  View details for PubMedID 9987726

• Delayed corneal epitheliopathy after antimetabolite-augmented trabeculectomy JOURNAL OF GLAUCOMA Manche, E. E., Afshari, M. A., Singh, K. 1998; 7 (4): 237-239

  Abstract

  The authors describe the first case of delayed antimetabolite-related corneal epithelial toxicity after trabeculectomy and its successful treatment with limbal stem cell transplantation.A 73-year-old woman underwent trabeculectomy with intraoperative mitomycin C. After surgery she received six 5-mg injections of subconjunctival 5-fluorouracil (5-FU) adjacent to the bleb.The patient had a functioning trabeculectomy and clear cornea until 30 months after surgery, at which time she developed a nonhealing superior corneal epithelial defect. After 4 months of conservative medical management, an autologous limbal stem cell transplantation was performed. The epithelial defect resolved completely within 1 week of limbal stem cell transplantation.Delayed corneal epithelial toxicity may be a late complication of antimetabolite-augmented trabeculectomy.

  View details for Web of Science ID 000075303500004

  View details for PubMedID 9713780

• Excimer laser refractive surgery WESTERN JOURNAL OF MEDICINE Manche, E. E., Carr, J. D., Haw, W. W., Hersh, P. S. 1998; 169 (1): 30-38

  Abstract

  Excimer laser photorefractive keratectomy and excimer laser in situ keratomileusis are relatively new treatment modalities that can be used to correct refractive errors of the eye. They are most commonly used to correct myopia (nearsightedness) but can also be used to correct hyperopia (farsightedness) and astigmatism. The excimer laser alters the refractive state of the eye by removing tissue from the anterior cornea through a process known as photoablative decomposition. This process uses ultraviolet energy from the excimer laser to disrupt chemical bonds in the cornea without causing any thermal damage to surrounding tissue. The modified anterior corneal surface enables light to be focused on the retina, thereby reducing or eliminating the dependence on glasses and contact lenses. We discuss in detail all aspects of excimer laser refractive surgery--techniques, indications and contraindications, clinical outcomes, and complications.

  View details for Web of Science ID 000074838100005

  View details for PubMedID 9682628

• Treatment of topographic central islands following refractive surgery JOURNAL OF CATARACT AND REFRACTIVE SURGERY Manche, E. E., Maloney, R. K., Smith, R. J. 1998; 24 (4): 464-470

  Abstract

  To evaluate the safety and efficacy of using central reablation to treat topographic central islands following photorefractive keratectomy (PRK), myopic keratomileusis in situ, and laser in situ keratomileusis (LASIK).Department of Ophthalmology, Stanford University School of Medicine, Stanford, and Jules Stein Eye Institute, Los Angeles, California, USA.Central reablation was performed on eight eyes with clinically significant topographic central islands after refractive surgery. Two eyes developed central islands after PRK, five eyes after LASIK, and one eye after myopic keratomileusis in situ. A clinically significant topographic central island was defined as an area of steepening of at least 3.0 diopters by at least 1.5 mm in diameter documented by computerized videokeratography. Reablation was tailored to each eye based on the diameter and power of the topographic central island using the Munnerlyn formula.All eyes experienced a reduction or elimination of the topographic central islands following central reablation. Six eyes experienced an improvement in uncorrected visual acuity, and all eyes returned to within one line of their preoperative level of best spectacle-corrected visual acuity 1 month after the procedure.Topographic central islands following PRK, myopic keratomileusis in situ, and LASIK can be effectively treated using the excimer laser. Poor predictability of the refractive effect of central reablation may be the limitation of this treatment modality.

  View details for Web of Science ID 000073272100016

  View details for PubMedID 9584239

• Factors influencing the outcome of hyperopic lamellar keratoplasty JOURNAL OF CATARACT AND REFRACTIVE SURGERY Ghiselli, G., Manche, E. E., Maloney, R. K. 1998; 24 (1): 35-41

  Abstract

  To determine which factors affect the refractive outcome of hyperopic lamellar keratoplasty.Jules Stein Eye Institute and Department of Ophthalmology, UCLA, Los Angeles, California, USA.This retrospective study comprised 38 consecutive eyes of 25 patients with naturally occurring hyperopia who had automated lamellar keratoplasty by one surgeon. Mean attempted correction was 3.80 diopters (D) (range of 1.50 to 6.00 D); 34 eyes were followed for 3 months. The effect of applanation lens diameter, keratometry, age, corneal thickness, absolute flap thickness in microns, thickness of the posterior lamellae in microns, and flap thickness as a percentage of corneal thickness were determined using multivariate linear regression.With current nomograms, mean undercorrection 3 months after hyperopic lamellar keratoplasty was 1.26 D +/- 0.91 (SD); 14 of 34 eyes were within +/- 1.00 D of the attempted correction. The best predictive factors of achieved correction were applanation lens diameter and absolute flap thickness in microns, which accounted for 54% of the variability in outcome. Keratometry, corneal thickness, and flap thickness as a percentage of corneal thickness had no significant additional predictive value.The refractive outcome of hyperopic lamellar keratoplasty was primarily determined by applanation lens diameter and absolute flap thickness in microns. Current nomograms suggest that flap thickness as a percentage of corneal thickness is a major determinant of effect, but this factor appears unimportant to the refractive effect of hyperopic lamellar keratoplasty. We hypothesize that it is slight swelling of the anterior corneal stroma rather than the bulging of the posterior cornea that causes the hyperopic correction in hyperopic lamellar keratoplasty.

  View details for Web of Science ID 000071823500012

  View details for PubMedID 9494897

• Ocular cicatricial pemphigoid and ocular manifestations of pemphigus vulgaris INTERNATIONAL OPHTHALMOLOGY CLINICS Smith, R. J., Manche, E. E., Mondino, B. J. 1997; 37 (2): 63-75

  View details for Web of Science ID A1997XP71600005

  View details for PubMedID 9269598

• Air bag-related ocular injuries OPHTHALMIC SURGERY AND LASERS Manche, E. E., Goldberg, R. A., Mondino, B. J. 1997; 28 (3): 246-250

  Abstract

  This study reviewed the nature and severity of ocular and orbital air bag-related injuries at a large tertiary care referral center. The records of all patients treated by the ophthalmology trauma service for air bag-related ocular injuries between 1993 and 1995 were reviewed. Five patients were identified who had air bag-related ocular trauma. All of the patients who were referred to the ophthalmology trauma service for air bag-related ocular injuries had significant ocular or orbital injury. The extent and severity of the injuries were variable, ranging from orbital contusion to ruptured globe and retinal detachment. Although air bags substantially reduce the overall rates of mortality and morbidity associated with motor vehicle accidents, they also cause a variety of ocular injuries.

  View details for Web of Science ID A1997WN44600013

  View details for PubMedID 9076803

• Keratomileusis in situ for high myopia JOURNAL OF CATARACT AND REFRACTIVE SURGERY Manche, E. E., Maloney, R. K. 1996; 22 (10): 1443-1450

  Abstract

  To examine the safety and efficacy of myopic keratomileusis in situ (automated lamellar keratoplasty) using an automated microkeratome.Jules Stein Eye Institute and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California.A retrospective study was done on 135 consecutive eyes of 91 patients who had keratomileusis in situ for myopia by one surgeon between October 4, 1993, and February 23, 1995. Mean preoperative myopia was 8.30 +/- 2.50 diopters (D) (range 4.50 to 20.50). Follow-up ranged from 1 (108 eyes) to 6 months (52 eyes). No eye had enhancement surgery before 3 months; eyes were dropped from the study at the time of enhancement.Three months after myopic keratomileusis in situ, the mean difference between attempted and achieved correction was an undercorrection of 0.90 +/- 1.50 D; 32 of 83 eyes were within 1.00 D of attempted correction. Forty eyes were undercorrected by more than 1.00 D, and 11 were overcorrected by more than 1.00 D. Uncorrected visual acuity improved to 20/40 or better in 42 of 83 eyes at 3 months. Best spectacle-corrected visual acuity (BSCVA) declined by two or more lines in 8 of 83 eyes at 3 months and 1 of 52 eyes at 6 months. In eyes with 6 months of follow-up, a mean myopic shift of 0.40 D occurred between 3 and 6 months. Two eyes had clinically significant ingrowth into the interface. The variability in outcome (standard deviation in achieved less attempted correction) at 3 months was 1.70 D in the first 45 cases, 1.20 D in the second 45 cases, and 1.10 D in the last 45 cases.Myopic keratomileusis in situ is relatively effective and safe for the correction of high myopia; however, a mild loss of BSCVA is not uncommon in the early postoperative period. Surgeon experience may be important for refractive accuracy.

  View details for Web of Science ID A1996WK40600014

  View details for PubMedID 9051500

• Astigmatic keratotomy combined with myopic keratomileusis in situ for compound myopic astigmatism AMERICAN JOURNAL OF OPHTHALMOLOGY Manche, E. E., Maloney, R. K. 1996; 122 (1): 18-28

  Abstract

  Myopic keratomileusis in situ by an automated microkeratome corrects myopia but not astigmatism, which is traditionally corrected by astigmatic keratotomy months after keratomileusis. We developed a technique for simultaneously correcting astigmatism and severe myopia, and examined its effectiveness in a retrospective case-control study.Thirty-four eyes (23 patients) underwent myopic keratomileusis in situ combined with one or two arcuate keratotomy incisions performed after the refractive cut, in the bed of the primary keratectomy flap. The myopic keratomileusis control group consisted of 34 matched eyes (30 patients) undergoing keratomileusis without astigmatic keratotomy. The astigmatic control group consisted of 117 unmatched eyes (85 patients) undergoing astigmatic keratotomy combined with radial keratotomy.Mean refractive astigmatism in the study group decreased from 2.4 diopters (range, 1.0 to 4.0 diopters) preoperatively to 1.7 diopters (range, 1.0 to 4.0 diopters) at three months postoperatively, and increased by 0.4 diopter in the myopic keratomileusis control group at three months postoperatively (P < .005). Eighteen of 27 eyes in the study group showed decreased refractive astigmatism compared with ten of 34 eyes in the myopic keratomileusis control group (P < .0001). Combining astigmatic keratotomy with myopic keratomileusis produced 0.2 +/- 0.9 diopter less astigmatic correction than that expected from the astigmatic control group. One of 27 eyes lost two or more lines of best spectacle-corrected visual acuity at the three-month postoperative visit. No eye lost two or more lines of best spectacle-corrected visual acuity at postoperative month 6.Eyes with substantial preoperative refractive astigmatism that undergo myopic keratomileusis in situ may benefit from simultaneous astigmatic keratotomy to reduce residual post-operative refractive astigmatism.

  View details for Web of Science ID A1996UX37400002

  View details for PubMedID 8659595

• Lamellar keratoplasty for hyperopia JOURNAL OF REFRACTIVE SURGERY Manche, E. E., Judge, A., Maloney, R. K. 1996; 12 (1): 42-49

  Abstract

  Lamellar keratoplasty for hyperopia (automated lamellar keratoplasty for hyperopia) can correct hyperopia by weakening the cornea with a deep lamellar resection. The safety and efficacy of the procedure is uncertain.Twenty-four eyes of 17 patients underwent hyperopic lamellar keratoplasty using the automated corneal shaper (Chiron Corp, Irvine, Calif) by one surgeon using a flap technique. The mean attempted correction was +3.90 +/- 0.90 D (range, +2.00 to +6.00). The eyes were followed for 1 month (23 eyes) to 6 months (17 eyes).Six months after hyperopic lamellar keratoplasty, the mean difference between attempted and achieved correction was an undercorrection of +1.40 +/- 0.80 diopters (D) with 7 of 17 eyes within 1.00 D of the attempted correction. No eyes were overcorrected, and 15 eyes were undercorrected. In eyes with a refractive goal of emmetropia, uncorrected visual acuity was 20/40 or better in 13 of 15 eyes and 20/20 or better in 8 of 15 eyes. No eye lost two or more lines of spectacle-corrected visual acuity at 3 or 6 months postoperatively. Between 1 and 6 months, there was a mean hyperopic shift of 0.20 D. There was clinically significant epithelial ingrowth into the interface in two eyes.Hyperopic lamellar keratoplasty is an effective method of reducing hyperopia and induces little irregular astigmatism. The nomogram we used produces a consistent undercorrection. Refraction appears to stabilize at 1 month, but longer follow up is necessary to assess stability.

  View details for Web of Science ID A1996TU35500010

  View details for PubMedID 8963817

• RUPTURE OF RADIAL AND ARCUATE KERATOTOMY SCARS BY BLUNT TRAUMA 91 MONTHS AFTER INCISIONAL KERATOTOMY AMERICAN JOURNAL OF OPHTHALMOLOGY Lee, B. L., Manche, E. E., Glasgow, B. J. 1995; 120 (1): 108-110

  Abstract

  We studied a case in which blunt trauma caused dehiscence of radial and arcuate corneal scars 91 months after incisional keratotomy. The ruptured incisions did not extend beyond the corneoscleral limbus.Incisional refractive surgery renders the cornea susceptible to blunt traumatic rupture. This vulnerability results from the intrinsic weakness of the keratotomy wounds. Our case documents that this weakness persists up to 91 months after the operation.

  View details for Web of Science ID A1995RH06600014

  View details for PubMedID 7611314

• MICROFIBRIL-MICROVESSEL CONNECTIONS IN THE UVEA AND OPTIC-NERVE OF THE MAMMALIAN EYE ACTA ANATOMICA KORTE, G. E., Manche, E. 1991; 142 (1): 49-56

  Abstract

  Light- and electron-microscopic examination of arterioles, venules and capillaries of the eyes of several mammalian species has shown that the microfibrils of ocular elastic tissue attach to microvascular basement membranes throughout the uvea (iris, ciliary body, choroid) and optic nerve. Although described sporadically in prior investigations, this report shows that the connections are a common feature of the mammalian eye. The connections appear most numerous at venules and capillaries and are sparse at arterioles. The connections may provide a mechanism by which perivascular elastic tissue influences microvascular function, e.g. the control of blood pressure in them or their response to changes in intraocular pressure.

  View details for Web of Science ID A1991GT95900008

  View details for PubMedID 1781239

• MICROFIBRIL-MICROVESSEL CONNECTIONS IN THE RABBIT EYE - CORRELATIVE CONFOCAL AND ELECTRON-MICROSCOPY JOURNAL OF ELECTRON MICROSCOPY TECHNIQUE KORTE, G. E., Manche, E. E. 1991; 18 (1): 74-81

  Abstract

  The connections between elastic tissue and microvessels (arterioles, capillaries, and venules) in the rabbit eye were examined by light and electron microscopy. In particular, confocal scanning laser microscopy of tissue stained with orcein and examined by fluorescence using a rhodamine filter was correlated with electron microscopic observations. The goal was an analysis of the way in which elastic tissue of the uvea (i.e., choroid, ciliary body, and iris) and the optic nerve of the eye connect to the microvessels in these structures. Confocal microscopy revealed these connections advantageously and showed how they link the elastic tissue meshwork in the perivascular tissue spaces with the wall of the blood vessels. Electron microscopy showed that the connections consist of bundles of 10-12 nm diameter microfilaments that insert into vascular basement membranes. These connections may contribute to the vascular response to changes in blood pressure or intraocular pressure in the eye.

  View details for Web of Science ID A1991FG80200009

  View details for PubMedID 2056353

• ULTRASTRUCTURAL EVIDENCE OF REMODELING IN THE MICROVASCULATURE OF THE NORMAL RABBIT AND HUMAN EYE ACTA ANATOMICA Manche, E. E., KORTE, G. E. 1990; 138 (2): 89-96

  Abstract

  Several investigators have recently presented ultrastructural evidence for remodelling in the mammalian, including human, choriocapillaris. This evidence consists of cytoplasmic processes off endothelium and pericytes that penetrate the basal lamina of the capillary and enter the pericapillary space and redundant layers of basal lamina interpreted as the result of secretory activity subsequent to cellular movement within the wall of the capillary. This report extends these observations to the remaining microvasculature of the choroid--its arterioles and venules--and to another part of the ocular microvasculature--the pars plana of the ciliary body--of the rabbit and human eye. Cytoplasmic processes and redundant basal laminae were observed in the microvasculature at both sites, most frequently associated with venules and capillaries. Cytoplasmic processes and redundant basal laminae are generally associated with cellular movement and vessel growth during ocular neovascularization. However, their presence in histologically normal eyes suggests that these phenomena occur in the absence of neovascularization, i.e. that the microvasculature is remodelled in the normal eye.

  View details for Web of Science ID A1990DJ92200001

  View details for PubMedID 2368611