Bio

Clinical Focus


  • Ophthalmology

Academic Appointments


Professional Education


  • Residency:New Jersey Medical School UMDNJ (1994) NJ
  • Board Certification: Ophthalmology, American Board of Ophthalmology (1996)
  • Fellowship:UCLA - School of Medicine (1996) CA
  • Internship:Staten Island University Hosp (1991) NY
  • Medical Education:Albert Einstein College of Medicine (1990) NY

Research & Scholarship

Clinical Trials


  • Wavefront-guided Versus Wavefront-optimized LASIK for Nearsightedness Recruiting

    The purpose of the study is to compare the results of LASIK surgery when using wavefront-guided excimer laser treatment compared to wavefront optimized excimer laser treatment in patients with nearsightedness with and without astigmatism

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  • An Outcomes Study Comparing the Intralase FS 60 to the Intralase iFS When Performing LASIK Surgery for Nearsightedness Not Recruiting

    The purpose of the study is to compare the results of LASIK surgery when using two versions of a femtosecond laser in patients with nearsightedness with and without astigmatism.

    Stanford is currently not accepting patients for this trial. For more information, please contact Edward Manche, (650) 498 - 7020.

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  • A Comparison of Fellow Eyes Undergoing LASIK or PRK With a Wavefront-guided Excimer Laser Versus a Wavefront-optimized Excimer Laser Recruiting

    Subjects with myopia, hyperopia and astigmatism are being randomized to be treated in one eye with a wavefront-guided excimer laser and their fellow eye treated with a wavefront-optimized excimer laser.

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  • Effect of Preoperative Pupil Size on Quality of Vision After Wavefront-Guided LASIK Not Recruiting

    The purpose of this study is to evaluate whether the size of the pupil has an effect on quality of vision in patients undergoing LASIK surgery.

    Stanford is currently not accepting patients for this trial. For more information, please contact Edward Manche, 650498702.

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  • Wavefront-guided Photorefractive Keratectomy (PRK) Versus Wavefront-guided Lasik for Myopia Not Recruiting

    A prospective comparison of eyes undergoing wavefront-guided LASIK in one eye and wavefront-guided PRK in their fellow eye for myopia.

    Stanford is currently not accepting patients for this trial. For more information, please contact Edward Manche, (650) 498 - 7020.

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  • IntraLase vs Hansatome Flaps in LASIK Not Recruiting

    This study compared the clinical outcomes between fellow eyes randomized to either IntraLase femtosecond laser-created flaps or Hansatome mechanical keratome-created flaps during wavefront-guided laser in situ keratomileusis.

    Stanford is currently not accepting patients for this trial.

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Teaching

2013-14 Courses


Publications

Journal Articles


  • 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

  • One-Year Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes. Ophthalmology Sáles, C. S., Manche, E. E. 2013

    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??0.05). 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 PubMedID 23778091

  • 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 Web of Science ID 000310579500005

    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 Web of Science ID 000309736500024

    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 Web of Science ID 000308731200025

    View details for PubMedID 22906450

  • Pupil Size and LASIK reply OPHTHALMOLOGY Manche, E. E., Chan, A. 2012; 119 (8): 1716-1717
  • Pupil Size and LASIK Reply OPHTHALMOLOGY Manche, E. E., Chan, A. 2012; 119 (4): 884-885
  • 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
  • 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 ?m; 95% CI, -0.05 to -0.01; P=.002) and spherical aberrations (mean difference -0.02 ?m; 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 ?m (range 3 to 11 ?m) with the femtosecond laser and 14.2 ?m (range 17 to 52 ?m) 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 Web of Science ID 000295660000022

    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 Web of Science ID 000293602700028

    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 Web of Science ID 000293602700015

    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 Web of Science ID 000294259200011

    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 Web of Science ID 000289075200020

    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 Web of Science ID 000288969600005

    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 Web of Science ID 000281746200024

    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 Web of Science ID 000278652600026

    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 Web of Science ID 000278028000024

    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 PubMedID 20429496

  • Regression of effect over long-term follow-up of conductive keratoplasty to correct mild to moderate hyperopia JOURNAL OF CATARACT AND REFRACTIVE SURGERY Ehrlich, J. S., Manche, E. E. 2009; 35 (9): 1591-1596

    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 Web of Science ID 000269961400019

    View details for PubMedID 19683158

  • Comparison of the Femtosecond Laser and Mechanical Keratome for Laser In Situ Keratomileusis ARCHIVES OF OPHTHALMOLOGY Chan, A., Ou, J., Manche, E. E. 2008; 126 (11): 1484-1490

    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 Web of Science ID 000260797300001

    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 Web of Science ID 000258427200013

    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 Web of Science ID 000256548900002

    View details for PubMedID 18541839

  • Long-term follow-up of hyperopic laser in situ keratomileusis correction using the Star S2 excimer laser JOURNAL OF CATARACT AND REFRACTIVE SURGERY Desai, R. U., Jain, A., Manche, E. E. 2008; 34 (2): 232-237

    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 Web of Science ID 000252909200017

    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 JOURNAL OF CATARACT AND REFRACTIVE SURGERY Bababeygy, S. R., Zoumalan, C. I., Manche, E. E. 2008; 34 (1): 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 Web of Science ID 000252291100016

    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 Web of Science ID 000248590600022

    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 Web of Science ID 000245540200022

    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 Web of Science ID 000244502500013

    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 Web of Science ID 000238413000027

    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 Web of Science ID 000236979800028

    View details for PubMedID 16631061

  • Analysis of the efficacy, predictability, and safety of LASEK for myopia and myopic astigmatism using the Technolas 217 excimer laser JOURNAL OF CATARACT AND REFRACTIVE SURGERY Partal, A. E., Rojas, M. C., Manche, E. E. 2004; 30 (10): 2138-2144

    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 Web of Science ID 000224719200032

    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 Web of Science ID 000223646900016

    View details for PubMedID 15313290

  • Treatment of epithelial ingrowth after laser in situ keratomileusis with mechanical debridement and flap suturing ARCHIVES OF OPHTHALMOLOGY Rojas, M. C., Lumba, J. D., Manche, E. E. 2004; 122 (7): 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 Web of Science ID 000222703400007

    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 Web of Science ID 000187839600022

    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 Web of Science ID 000186666100002

    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 Web of Science ID 000185565000005

    View details for PubMedID 14518741

  • Ablation centration in myopic laser in situ keratomileusis - Comparing the visx S3 ActiveTrak and the visx S2 JOURNAL OF CATARACT AND REFRACTIVE SURGERY Giaconi, J. A., Manche, E. E. 2003; 29 (8): 1522-1529

    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 Web of Science ID 000185091900020

    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 Web of Science ID 000183128700007

    View details for PubMedID 12777029

  • Conductive keratoplasty for the correction of low to moderate hyperopia: US clinical trial 1-year results on 355 eyes OPHTHALMOLOGY McDonald, M. B., Hersh, P. S., Manche, E. E., Maloney, R. K., Davidorf, J., Sabry, M. 2002; 109 (11): 1978-1989

    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

  • 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 Web of Science ID 000176145500003

    View details for PubMedID 12049576

  • 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 Web of Science ID 000174264300044

    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 Web of Science ID 000174264300030

    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 Web of Science ID 000173662600033

    View details for PubMedID 11821221

  • 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

  • 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

  • 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

Conference Proceedings


  • Conductive keratoplasty for the correction of low to moderate hyperopia - 1-year results on the first 54 eyes McDonald, M. B., Davidorf, J., Maloney, R. K., Manche, E. E., Hersh, P. ELSEVIER SCIENCE INC. 2002: 637-649

    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 Hamilton, D. R., Manche, E. E., Rich, L. F., Maloney, R. K. ELSEVIER SCIENCE INC. 2002: 659-665

    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

  • Laser in situ keratomileusis enhancement for consecutive hyperopia after myopic overcorrection 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 Web of Science ID 000173161600021

    View details for PubMedID 11777708

  • One-year evaluation of myopic laser photoastigmatic refractive keratectomy using the Summit Apex Plus - Phase III of a Food and Drug Administration clinical trial Haw, W. W., Manche, E. E. ELSEVIER SCIENCE INC. 2000: 1572-1577

    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

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