Purpose: To compare the safety, efficacy, predictability, stability and complications of wavefront-guided laser-assisted subepithelial keratectomy (LASEK) in low myopia, myopic astigmatism and high myopia correction.Methods: In his retrospective study, 416 eyes were divided to 3 groups: 159 eyes with low myopia (LM) and mean refractive spherical equivalent (MRSE) of -3.68±1.33 (SD) diopter (D); 161 eyes with myopic astigmatism (MA) and MRSE of -5.99±2.24 D and mean cylinder of 2.41±1.07 D; and 96 eyes with high myopia (HM) and MRSE of -7.41±0.80 D. After an epithelial flap creation, a Wavefront-based excimer laser ablation was performed. Safety, efficacy, predictability, and stability were evaluated at day 10, months 2, 6 and 12 postoperatively.Results: The MRSE were -0.36±0.31 D in LM group, 0.15±0.41 D in MA group and 0.58±0.68 D in HM group. The uncorrected visual acuity (UCVA) were 20.20 in 90.60% of patients in LM group, 78.90% in MA group and 67% in HM group. Efficacy indices were 0.98, 1.04 and 0.92 in LM, MA and HM groups, respectively. Safety indices were 1.00, 1.07 and 1.05 in LM, MA and HM respectively. Five eyes (3.1%) in the LM group improved 1 line. Forty-four eyes (27.3%) in MA gained 1-3 lines and 19.2 % of HM group gained 1-2 lines of BSCVA. Only 2 eyes in LM group developed corneal haze. There were not significant statistically differences in efficacy and safety indices between three groups.Conclusion: Wavefront-guided LASEK is an effective and safe procedure for the treatment of LM, MA, and HM. Although predictability, efficacy and safety indices improved in myopic astigmatism.

Purpose: To assess the effectiveness, safety and stability of Laser epithelial keratomileusis (LASEK) for moderate to high myopia.Methods: Fifty-one eyes of 28 myopic patients were enrolled in this prospective, uncontrolled clinical study. All eyes operated by one surgeon. Slit-lamp examination, manifest refraction, uncorrected and spectacle-corrected visual acuity, and videokeratography were done before surgery. Patients assessed at first 7 days, 1 and 3 months after surgery. A questionnaire assessed glare and halo in the scale of 0 to 5 (5 for very severe) 1 and 3 month after surgery. Pain was assessed in the scale of 0 to 3 (3 for severe) subjectively. A grading score (in the scale of 0 to 4+) was used for assessment of corneal haze.Results: All patients were examined at 1 month, and 37 eyes (74%) were examined at 3 month. One month after surgery, 49 eyes (98%) achieved an uncorrected visual acuity of 20/40 or better. The mean epithelial healing time was 3.26 days ±1.14, the mean subjective pain score was 1.11±0.83. The mean spherical equivalent refraction was - 6.54 diopters (D) ±1.17 before surgery, and it was 0.32 D±0.55 at 1 month, and 0.16 D ± 0.77 at 3 months after surgery. At 1 month and 3 months after surgery, 46.0% and 45.9% of eyes had up to grade 1 of haze. One eye had grade 2 of haze at 1 and 3 months postoperatively. At 3 months after surgery, the mean glare score was 1.83:t0.99 and the mean halo score was 2.43:t1.44.Conclusion: In this study, LASEK showed its efficacy, safety, and predictability for treatment of moderate to high myopia.

Purpose: To report a case of delayed corneal perforation secondary to topical diclofenac usage after myopic LASEK and review of literature.Patients and Findings: A 25-year-oldfemale with history of myopic LASEK 2 months before referred to her surgeon with epithelial defect, stromal thinning and infiltration. She was treated with antimicrobial medications for infectious keratitis for one week. She was then referred to Labbafi nejad Medical Center because of lack of response and progressive stromal thinning. Two days after admission, corneal perforation was occurred. Smear and culture of the cornea were negative. She had used topical diclofenac for 6 weeks. After discontinuing the topical medications and conservative measures (oral acetazolamide, patching, simple eye ointment) the perforation started healing.Conclusions: Prolonged use of topical non-steroidal anti-inflammatory drugs after surface ablation may lead to stromal melting and corneal perforation; therefore, such medications should be used cautiously in these patients especially in high risk groups such as rheumatoid arthritis, dry eye syndrome, ocular surface disorders and neurotrophic keratopathy.

Background-We aimed to evaluate the effectiveness, safety, and patient satisfaction of laser epithelial keratomileusis (LASEK) for myopia in patients with thin cornea. Methods - Seventy-one eyes of 56 patients with myopia of -1.50 to -8.75 diopters (D) and corneal thickness of 451 - 499 microns were enrolled in this prospective clinical study. Slit-lamp examination, manifest refraction, uncorrected and spectacle-corrected visual acuity, and video keratography were done before surgery. Patients were visited in the first 7 days, and also at 1^st and 3^rd months after the surgery. Results - All patients were examined in the first 7 days and at 1^st month, while 48 eyes (71%) were examined 3 months after the surgery. At 3^rd month, 46 eyes (95.8%) had an uncorrected visual acuity of 20140 or better, 37 eyes (77.1%) had an uncorrected visual acuity of 20120 or better, 36 eyes (75%) had a spherical equivalent (SE) within ± 0.50 D, and 46 eyes (96%) had a SE within ± 1.00 D. The mean corneal thickness was 409 ± 23 microns (SD) with a minimum of 372 microns. The epithelial healing time was 3.37 ± 1.05 days (SD). The mean subjective pain score in the scale of 0 to 3 (3 for severe) was 1.14 ± 0.75 (SD). One eye lost 2 lines of spectacle-corrected visual acuity, and no eye lost more than 2 lines. Thirty-four patients (82.9%) were very satisfied or satisfied with their operated eyes. Conclusion - LASEK was shown to be effective and safe in correction of myopia in patients with thin cornea in a short period of time. LASEK can be considered as an alternative for treatment of myopic patients whose corneal thickness is inadequate for laser in situ keratomileusis (LASIK).

Objective: To compare rabbits corneal wound healing by two methods of Keratomileusis.Design: A comparative experimental study.Animals: 61 eyes of 35 laboratory white rabbits.Procedures: A few drops of 20% ethyl alcohol solution were placed on to the corneal epithelial ring and apedanculated corneal flap (9 mm in diameter and 50/l in thickness) from the cornea was separated and then, replaced back to original position (LASEK). In PRK group a corneal flap was completely removed. In both groups a bandage of soft contact lens placed and the eyelids were sutured Five parameters including: Corneal Wound, vascular injection from limbus toward cornea, corneal edema, light transmissibility and routine histopathological examination were used to evaluate and compare the two procedures. Six normal intact corneas were collected as normal group.Statistical analysis: Kruskal- wallis test.Results: There were no significant differences between the all studied parameters among three groups after 14th day of surgical intervention. There were no significant differences in 6th post surgical' day between LASEK and normal groups for corneal wound healing while there was significant difference between PRK and normal groups (P< 0.05). There were significant differences for transmissible light in 3rd day after surgery between LASEK and PRK groups (P<0.05).Clinical implications: Objective data and statistical results showed that the LASEK method of corneal splitting may prove superior to the PRK method.

Purpose: To compare the effectiveness, safety and patient satisfaction following laser epithelial keratomileusis (LASEK) and photo refractive keratectomy (PRK) for low to moderate myopia.Methods: Eighty-four eyes of 42 myopic patients were enrolled in this prospective, randomized, paired clinical study. Each patient received LASEK on one eye and PRK on the other eye; procedure assignment to each eye, and the sequence of operations for each patient was randomized. Before surgery, mean spherical equivalent of refractive error (SE) was-3.57 diopters (D) ±1.25 (SD)(range,-1.50 to -6.50 D) in the LASEK eyes and -3.44 D ±1.13 (SD) (range, -1.60 to -6.00 D) in the PRK eyes. Patients were visited on the first 7 days, and 1 and 3 months after surgery. Patient satisfaction and quality of vision were assessed using a subjective questionnaire.Results: In the first 7 days and at 1 month after surgery, all patients (100%) and at 3 months, 32 patients (76%) came for follow-up. At 3 months, 32 (100%) of LASEK eyes and 31 (97%) of PRK eyes had an uncorrected visual acuity of 20/40 or better; 25 (79%) of LASEK eyes and 26 (82%) of PRK eyes had uncorrected visual acuity of 20/20 or better (P=0.959), mean spherical equivalent refraction was 0.08 D ±0.53 (SD) in LASEK eyes and 0.12 D± 0.50 (SD) in PRK eyes (P=0.652), 26 (81%) of LASEK eyes and 23 (72%) of PRK eyes had a SE within± 0.50 D and 29 (91%) of LASEK eyes and 30 (94%) of PRK eyes had a SE within± 1.00 D. The epithelial healing time was 3.97 days± 1.27 (SD) in LASEK group and 3 69 days ± 1.03 (SD) in PRK group (P=0.078). Mean subjective pain score in the scale of 0 to 3 (3 for severe) was 1.07±0.75 (SD) in LASEK eyes and 0.85±0.73 (SD)in PRK eyes on the first day after operation (P=0.183). At 1 month and 3 months after surgery, the grade of haze was not statistically different in the two groups. Patients were similarly satisfied with both techniques.Conclusions: In this study, LASEK and PRK were found to have similar effectiveness, safety, and predictability for treatment of low to moderate myopia. LASEK, as a modified PRK, was not found to have any advantage to PRK considering postoperative pain, epithelial healing and corneal haze.

Objective: Vaginal agenesis or atresia in females suffering from MRKH syndrome is more common and management involves both surgical and non-surgical approaches. Use of prefabricated stents to maintain the patency of the canal may not fit appropriately during the initial surgical phase and are not economical. This case report discusses a series of modifications in a custom-made vaginal dilator to improve the retention for expansion after surgical management of MRKH syndrome. Case report: A 28-year-old female diagnosed with MRKH syndrome with characteristic Mullerian agenesis was referred for CUSTOMISED vaginal stent. CUSTOMISED surgical stent was fabricated with loops for orientation and retention, which was later modified into interim expansion and passive stent. Conclusion: The customisation of the vaginal stent, provision of a retentive loop that positioned the stent in the proper orientation, and gradual increase in the size of the stent, ensured dilatation in a patient with vaginal agenesis.