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Purpose: To assess outcomes of corneal crosslinking (CXL) and intracorneal ring segments (ICRS) (Intacs) used adjunctively, and then compare the safety and efficacy of concurrent versus sequential surgery., Setting: Cornea and refractive surgery subspecialty practice., Design: Prospective randomized clinical trial., Methods: Patients were randomized to one of two groups: ICRS first, immediately followed by CXL during the same session (n = 104), or ICRS followed by CXL 3 months later (n = 94). Outcomes included changes in maximum keratometry (K) and topographic inferior-superior (I-S) difference, maximum flattening of topographic K, and changes in uncorrected (UDVA) and corrected (CDVA) distance visual acuities. These were analyzed in the entire cohort, in the two randomized groups, and in subgroups stratified to ICRS size and placement. Patients were followed for 6 months., Results: The study comprised 198 eyes of 198 patients. Overall, maximum K decreased by an average of 2.5 D, I-S difference improved by 3.9 D, and there was an average maximum flattening of -7.5 D. The UDVA improved by 2.0 logarithm of the minimum angle of resolution lines, on average, and the CDVA improved by 1.1 lines. There was no significant difference between the sequential and concurrent groups in any of the outcomes analyzed. There were 6 clinically significant adverse events., Conclusions: CXL and ICRS can be used adjunctively with substantial improvement in corneal topography, and with no increase in safety concerns over each procedure alone. Sequential and concurrent treatment with ICRS and CXL show equivalent outcomes. Both thicker segment size and single segment placement seem to result in greater topographic improvement., (Copyright © 2019 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the incidence and motivating determinants of explantation of intracorneal ring segments (ICRS) (Intacs) used for the treatment of keratoconus and corneal ectasia., Setting: Cornea and refractive surgery subspecialty practice., Design: Retrospective case series., Methods: Consecutive cases of ICRS implantation performed to treat keratoconus or corneal ectasia were reviewed to determine the number that were eventually explanted and the motivating factors for explantation. Cases were assigned to 1 of 2 groups: (1) medical complications requiring removal and (2) refractive/topographic problem, with the explantation being elective. The corrected distance visual acuity, uncorrected distance visual acuity, maximum keratometry, and inferior-superior topography power difference before and after ICRS removal were also evaluated., Results: The ICRS were explanted from 35 eyes of 31 patients from a total cohort of 572 eyes (6.1%). Of these, 15 ICRS (2.6%) were removed for medical complications and 20 (3.5%) for refractive/topographic considerations., Conclusions: A large proportion of ICRS were generally well tolerated on a long-term basis. The incidence of explantation secondary to medical complications was low, with the most frequent complication being infiltration around the segment. Explantation was effective in ameliorating medical complications and can be effective in improving corneal topography and clinical outcomes in some cases., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate outcomes of corneal crosslinking (CXL) using a transepithelial technique for the treatment of keratoconus., Setting: Cornea and refractive surgery subspecialty practice., Design: Prospective case series., Methods: Transepithelial CXL was performed in keratoconic eyes using riboflavin 0.1% and topical anesthetic containing benzalkonium chloride to facilitate riboflavin diffusion through the epithelium. Eyes were randomized to receive riboflavin administration either every 1 minute or every 2 minutes during ultraviolet-A exposure at 3mW/cm 2 . The principal outcome was change in maximum keratometry (K) and secondary outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, mean K, and comparison of randomized groups., Results: Eighty-two eyes of 56 patients were treated. At 1 year, maximum K decreased significantly by 0.45 diopters (D) ± 1.94 (SD); it improved by 2.0 D or more in 11 eyes (13%) and worsened by 2.0 D or more in 4 eyes (5%). The mean UDVA significantly improved by 0.7 lines, whereas the CDVA improved by 0.2 lines. Two eyes showed both continued progression with loss of CDVA. Only the 1-minute subgroup showed significant improvements in maximum K (-0.73 D) and UDVA. Transient corneal erosion and epitheliopathy were reported in 21% of eyes., Conclusions: Transepithelial CXL resulted in significant improvements in maximum K and UDVA over 1 year. There was a suggestion that increased riboflavin dosing might improve procedure outcomes. Further study is required to determine the relative advantages and disadvantages of different transepithelial approaches to the standard CXL protocol with epithelial removal., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of corneal ectasia after laser refractive surgery., Design: Prospective, randomized, multicenter, controlled clinical trial., Participants: One hundred seventy-nine subjects with corneal ectasia after previous refractive surgery., Methods: The treatment group underwent standard CXL, and the sham control group received riboflavin alone without removal of the epithelium., Main Outcome Measures: The primary efficacy criterion was the change over 1 year of topography-derived maximum keratometry (K), comparing treatment with control groups. Secondary outcomes evaluated were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent, endothelial cell count, and adverse events., Results: In the crosslinking treatment group, the maximum K value decreased by 0.7 diopters (D) from baseline to 1 year, whereas there was continued progression in the control group (1.3 D difference between treatment and control, P < 0.0001). In the treatment group, the maximum K value decreased by 2.0 D or more in 14 eyes (18%) and increased by 2.0 D or more in 3 eyes (4%). The CDVA improved by an average of 5.0 logarithm of the minimum angle of resolution (logMAR) letters. Twenty-three eyes (32%) gained and 3 eyes (4%) lost 10 or more logMAR letters. The UDVA improved 4.5 logMAR letters. Corneal haze was the most frequently reported crosslinking-related adverse finding., Conclusions: Corneal collagen crosslinking was effective in improving the maximum K value, CDVA, and UDVA in eyes with corneal ectasia 1 year after treatment, with an excellent safety profile. CXL is the first approved procedure to diminish progression of this ectatic corneal process., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of progressive keratoconus., Design: Prospective, randomized, multicenter, controlled clinical trial., Participants: Patients with progressive keratoconus (n = 205)., Methods: The treatment group underwent standard CXL and the sham control group received riboflavin alone without removal of the epithelium., Main Outcome Measures: The primary efficacy criterion was the change over 1 year of topography-derived maximum keratometry value, comparing treatment with control group. Secondary outcomes evaluated were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent, endothelial cell count, and adverse events., Results: In the CXL treatment group, the maximum keratometry value decreased by 1.6 diopters (D) from baseline to 1 year, whereas keratoconus continued to progress in the control group. In the treatment group, the maximum keratometry value decreased by 2.0 D or more in 28 eyes (31.5%) and increased by 2.0 D or more in 5 eyes (5.6%). The CDVA improved by an average of 5.7 logarithm of the minimum angle of resolution (logMAR) units. Twenty-three eyes (27.7%) gained and 5 eyes lost (6.0%) 10 logMAR or more. The UDVA improved 4.4 logMAR. Corneal haze was the most frequently reported CXL-related adverse finding. There were no significant changes in endothelial cell count 1 year after treatment., Conclusions: Corneal collagen crosslinking was effective in improving the maximum keratometry value, CDVA, and UCVA in eyes with progressive keratoconus 1 year after treatment, with an excellent safety profile. Corneal collagen crosslinking affords the keratoconic patient an important new option to decrease progression of this ectatic corneal process., (Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the efficacy of removal and relocation of intracorneal ring segments for improving outcomes in treatment of keratoconus and corneal ectasia., Methods: This is a retrospective case series conducted at a cornea and refractive surgery subspecialty practice setting. Patients with previous insertion of 2 intracorneal ring segments underwent surgical removal and repositioning of segments because of unsatisfactory visual and topographic outcomes. The principal outcomes included uncorrected and corrected visual acuities, manifest refraction, topography-derived maximum keratometry (Kmax), inferior-superior topography power difference (I - S), and higher-order aberration profile derived from wavefront analysis., Results: Three patients are presented in this case series. Uncorrected visual acuity improved in all eyes by an average of 2.75 lines. Corrected visual acuity improved in 2 eyes and remained unchanged in 1 eye. Refractive astigmatism decreased in all patients by an average of 2.50 D. Kmax decreased by an average of 1.43 D. All patients had improvement in the I - S value with a mean decrease of 5.13 D., Conclusions: Topography-guided repositioning and/or replacement of corneal ring segments can result in improved topographic, optical, and visual outcomes in patients in whom the initial result is suboptimal. In these cases, a single segment repositioned beneath the cone resulted in an improved outcome. Analysis of corneal topography can guide the surgeon in treatment planning and can suggest patients in whom such an effort will be rewarded with better results.

Unlabelled: We describe 2 cases in which clinically significant epithelial ingrowth was removed by debridement and followed by the use of a hydrogel sealant (Resure) to seal the flap edge. In both cases, the epithelial ingrowth was seen after otherwise uneventful laser in situ keratomileusis retreatment. The visual outcomes were good with no recrudescence of interface epithelium., Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Unlabelled: A minimally invasive keratorefractive procedure using high-intensity, low-energy femtosecond laser pulses to perform intrastromal ablation is described. Because of the low pulse energy and the ultrashort duration, tissue in the corneal stroma can be ablated with almost no heat or shockwave generation. This technique obviates the need for the laser in situ keratomileusis (LASIK) flap but retains the advantages of the LASIK procedure. In the technique, a series of femtosecond laser pulses create temporary microchannels in the stroma, oriented perpendicular to the eye's optical axis. After the microchannels are created, a second series of femtosecond pulses directly ablate the desired amount of stromal tissue in a controlled fashion. The ablated material is ejected from the microchannels so the surface layer above the ablated regions collapses, with a consequent change in the refractive power of the cornea., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) using a transepithelial technique to treat keratoconus., Setting: Cornea and refractive surgery subspecialty practice., Design: Prospective clinical trial., Methods: Transepithelial CXL was performed in eyes with keratoconus using proparacaine with benzalkonium chloride (BAK) 0.01% to facilitate riboflavin absorption and riboflavin 0.10% without dextran. Eyes were randomized to receive ultraviolet-A treatment (365 nm, 3 mW/cm(2)) with concurrent administration of riboflavin randomized to every 1 minute or every 2 minutes for 30 minutes. The principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities and topography-derived maximum keratometry (K) values. Patients were followed for 6 months., Results: Thirty eyes of 25 patients were treated. The mean maximum K value flattened by 0.9 diopter (D) (baseline 58.7 D; 6 months 57.8 D) (P=.01). The maximum K worsened by 2.0 D or more in 1 patient. The mean CDVA improved by 0.83 Snellen lines (P=.03). One patient lost 2 lines of CDVA. There were no differences in the UDVA, CDVA, or keratometry outcomes between the 1-minute instillation subgroup and the 2-minute instillation subgroup., Conclusions: Transepithelial CXL resulted in a statistically significant improvement in maximum K values and CDVA at the 6-month follow-up. Further follow-up is necessary to ascertain the ability of transepithelial CXL to achieve long-term stabilization of the cornea in eyes with keratoconus., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine preoperative patient characteristics that may predict topography and visual acuity outcomes of corneal collagen crosslinking (CXL)., Setting: Cornea and refractive surgery practice., Design: Cohort study., Methods: Crosslinking was performed in eyes with keratoconus or corneal ectasia. Multiple regression and odds ratio analyses were performed to determine independent predictors of changes in topography-derived maximum keratometry (K) and corrected distance visual acuity (CDVA) 1 year postoperatively. Preoperative characteristics included sex, age, uncorrected distance visual acuity (UDVA), CDVA, maximum keratometry (K), corneal thickness, corneal haze, disease group, and cone location. Postoperative improvement in maximum K was defined as flattening of 2.0 diopters (D) or more and worsening as steepening of 1.0 D or more. Improvement in CDVA was defined as a gain of 2 lines or more and worsening as a loss of 1 line or more., Results: The study comprised 104 eyes (66 keratoconus; 38 corneal ectasia). Eyes with a preoperative CDVA of 20/40 or worse were 5.9 times (95% confidence interval [CI], 2.2-6.4) more likely to improve 2 Snellen lines or more. Eyes with a maximum K of 55.0 D or more were 5.4 times (95% CI, 2.1-14.0) more likely to have topographic flattening of 2.0 D or more. No preoperative characteristics significantly predicted worsening of visual acuity or corneal topography., Conclusions: Patients with worse preoperative CDVA and higher K values, particularly with a CDVA of 20/40 or worse or a maximum K of 55.0 D or more, were most likely to have improvement after CXL. No preoperative characteristics were predictive of CXL failure., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the effect of preoperative topographic cone location on 1-year outcomes of corneal collagen cross-linking (CXL)., Methods: In this prospective, randomized, controlled clinical trial, 99 eyes (66 keratoconus, 33 ectasia) from 76 patients underwent CXL. Cone location was defined by the coordinates of preoperative maximum keratometry (maximum K) using the anterior sagittal curvature topography map (Pentacam, Oculus Optikgeräte GmbH). Patients were divided into three groups: those with a maximum K located within the central 3-mm (central cone group), 3- to 5-mm (paracentral cone group), and outside the 5-mm (peripheral cone group) optical zones. Topography and visual acuity data were obtained preoperatively and at 1 year., Results: In the combined cohort, maximum K and uncorrected and corrected distance visual acuity significantly improved by -1.60±3.40 diopters (D) (P<.001), -0.08±0.25 logMAR (P=.001), and -0.10±0.18 log-MAR (P<.001), respectively. Comparing cone groups, maximum K decreased by 2.60±4.50 D (P<.001) in the central cone group, 1.10±2.50 D (P=.02) in the paracentral cone group, and 0.40±1.20 D (P=.08) in the peripheral cone group. Differences among groups were statistically significant (P<.001). Uncorrected distance visual acuity improved by -0.07±0.3 logMAR (P=.1) (central cone group), -0.1±0.17 logMAR (P=.004) (paracentral cone group), and -0.1±0.25 logMAR (P=.04) (peripheral cone group). Corrected distance visual acuity improved by -0.14±0.21 logMAR (P<.001) (central cone group), -0.08±0.17 logMAR (P=.01) (paracentral cone group), and -0.08±0.12 logMAR (P=.002) (peripheral cone group). For both UDVA and CDVA outcomes, these differences among groups were not statistically significant., Conclusions: After CXL, more topographic flattening occurs in eyes with centrally located cones and the least flattening effect occurs when the cone is located peripherally. This cone-location effect is found in eyes with both keratoconus and ectasia., (Copyright 2012, SLACK Incorporated.)

Purpose: To assess subjective visual function after corneal collagen crosslinking (CXL)., Setting: Cornea and refractive surgery subspecialty practice., Design: Prospective randomized controlled clinical trial., Methods: Patients completed a subjective questionnaire regarding visual symptoms administered preoperatively and 1 year after CXL. Patients ranked self-reported symptoms of photophobia, difficulty night driving, difficulty reading, diplopia, fluctuations in vision, glare, halo, starburst, dryness, pain, and foreign-body sensation on a scale from 1 to 5. Possible associations of symptoms with changes in corrected distance visual acuity (CDVA) and maximum keratometry were also analyzed., Results: One hundred seven eyes of 76 patients had CXL for keratoconus (n = 71) or ectasia (n = 36). The mean preoperative to 1-year postoperative changes in night driving (3.2 ± 1.5 [SD] to 2.8 ± 1.5), difficulty reading (3.1 ± 1.5 to 2.9 ± 1.3), diplopia (2.5 ± 1.3 to 2.1 ± 1.2), glare (3.1 ± 1.4 to 2.7 ± 1.2), halo (2.9 ± 1.4 to 2.5 ± 1.3), starbursts (2.6 ± 1.5 to 2.4 ± 1.4), and foreign-body sensation (1.8 ± 1.1 to 1.6 ± 0.9) were statistically significant. There were no associations between the change in any symptom and changes in CDVA. There was a weak association between the change in night driving, pain, and foreign-body sensations and the change in maximum keratometry., Conclusions: After CXL, patients noted subjective improvement in visual symptoms, specifically night driving, difficulty reading, diplopia, glare, halo, starbursts, and foreign-body sensation. These subjective outcomes corroborate quantitative clinical improvements seen after CXL., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine changes in higher-order aberrations (HOAs) after corneal collagen crosslinking (CXL)., Setting: Cornea and refractive surgery practice., Design: Prospective randomized controlled clinical trial., Methods: Corneal and ocular HOAs were measured and analyzed using the Pentacam device and Ladarwave aberrometer, respectively, at baseline and 12 months after CXL., Results: Ninety-six eyes (64 keratoconus, 32 ectasia) of 73 patients had CXL. A fellow-eye control group comprised 42 eyes. The mean preoperative total anterior corneal HOAs, total coma, 3rd-order coma, and vertical coma were 4.68 μm ± 2.33 (SD), 4.40 ± 2.32 μm, 4.36 ± 2.30 μm, and 4.04 ± 2.27 μm, respectively. At 1 year, the mean values decreased significantly to 4.27 ± 2.25 μm, 4.01 ± 2.29 μm, 3.96 ± 2.27 μm, and 3.66 ± 2.22 μm, respectively (all P<.001). There were no significant changes in posterior corneal HOAs. The mean preoperative total ocular HOAs, total coma, 3rd-order coma, trefoil, and spherical aberration were 2.80 ± 1.0 μm, 2.60 ± 1.03 μm, 2.57 ± 1.03 μm, 0.98 ± 0.46 μm, and 0.90 ± 0.42 μm, respectively. At 1 year, the mean values decreased significantly to 2.59 ± 1.06 μm, 2.42 ± 1.07 μm, 2.39 ± 1.07 μm, 0.88 ± 0.49 μm, and 0.83 ± 0.38 μm, respectively (all P=.01). After CXL, HOAs were significantly improved compared with the control group. Changes in HOAs were not statistically associated with an improvement in visual acuity or most subjective visual symptoms, however., Conclusion: Corneal and ocular HOAs decreased after CXL, suggesting an improvement in corneal shape., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate changes in corneal topography indices after corneal collagen crosslinking (CXL) in patients with keratoconus and corneal ectasia and analyze associations of these changes with visual acuity., Setting: Cornea and refractive surgery subspecialty practice., Design: Prospective randomized controlled clinical trial., Methods: Corneal collagen crosslinking was performed in eyes with keratoconus or ectasia. Quantitative descriptors of corneal topography were measured with the Pentacam topographer and included 7 indices: index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, minimum radius of curvature, index of height asymmetry, and index of height decentration. Follow-up was 1 year., Results: The study comprised 71 eyes, 49 with keratoconus and 22 with post-LASIK ectasia. In the entire patient cohort, there were significant improvements in the index of surface variance, index of vertical asymmetry, keratoconus index, and minimum radius of curvature at 1 year compared with baseline (all P < .001). There were no significant differences between the keratoconus and ectasia subgroups. Improvements in postoperative indices were not correlated with changes in corrected or uncorrected distance visual acuity., Conclusions: There were improvements in 4 of 7 topography indices 1 year after CXL, suggesting an overall improvement in corneal shape. However, no significant correlation was found between the changes in individual topography indices and changes in visual acuity after CXL., (Copyright © 2011. Published by Elsevier Inc.)

Purpose: To evaluate 1-year outcomes of corneal collagen crosslinking (CXL) for treatment of keratoconus and corneal ectasia., Setting: Cornea and refractive surgery subspecialty practice., Design: Prospective randomized controlled clinical trial., Methods: Collagen crosslinking was performed in eyes with keratoconus or ectasia. The treatment group received standard CXL and the sham control group received riboflavin alone. Principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, astigmatism, and topography-derived outcomes of maximum and average keratometry (K) value., Results: The UDVA improved significantly from 0.84 logMAR ± 0.34 (SD) (20/137) to 0.77 ± 0.37 logMAR (20/117) (P = .04) and the CDVA, from 0.35 ± 0.24 logMAR (20/45) to 0.23 ± 0.21 logMAR (20/34) (P<.001). Fifteen patients (21.1%) gained and 1 patient lost (1.4%) 2 or more Snellen lines of CDVA. The maximum K value decreased from baseline by 1.7 ± 3.9 diopters (D) (P<.001), 2.0 ± 4.4 D (P = .002), and 1.0 ± 2.5 D (P = .08) in the entire cohort, keratoconus subgroup, and ectasia subgroup, respectively. The maximum K value decreased by 2.0 D or more in 22 patients (31.0%) and increased by 2.0 D or more in 3 patients (4.2%)., Conclusions: Collagen crosslinking was effective in improving UDVA, CDVA, the maximum K value, and the average K value. Keratoconus patients had more improvement in topographic measurements than patients with ectasia. Both CDVA and maximum K value worsened between baseline and 1 month, followed by improvement between 1, 3, and 6 months and stabilization thereafter., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the natural history of collagen crosslinking (CXL)-associated corneal haze measured by Scheimpflug imagery and slitlamp biomicroscopy in patients with keratoconus or ectasia after laser in situ keratomileusis., Setting: Cornea and refractive surgery subpecialty practice, United States., Design: Prospective randomized controlled clinical trial., Methods: The treatment group received ultraviolet-A/riboflavin CXL therapy. The control group received riboflavin alone without epithelial debridement. To objectively measure CXL-associated corneal haze, corneal densitometry using Scheimpflug imagery was measured and the changes in haze were analyzed over time. A similar analysis was performed using clinician-determined slitlamp haze. Correlation of CXL-associated corneal haze with postoperative outcomes was analyzed., Results: The mean preoperative corneal densitometry was 14.9 ± 1.93 (SD) (Pentacam Scheimpflug densitometry units). Densitometry peaked at 1 month (mean 23.4 ± 4.40; P<.001), with little change at 3 months (mean 22.4 ± 4.79; P = .06) and decreased between 3 months and 6 months (19.4 ± 4.48; P<.001) and between 6 months and 12 months. By 12 months, densitometry had not completely returned to baseline in the entire cohort (mean 17.0 ± 3.82; P<.001) and the keratoconus subgroup; however, it returned to baseline in the ectasia group (16.1 ± 2.41; P = .15). The postoperative course of slitlamp haze was similar to objective densitometry measurements. Increased haze, measured by densitometry, did not correlate with postoperative clinical outcomes., Conclusions: The time course of corneal haze after CXL was objectively quantified; it was greatest at 1 month, plateaued at 3 months, and was significantly decreased between 3 months and 12 months. Changes in haze did not correlate with postoperative clinical outcomes., (Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy of phototherapeutic keratectomy (PTK) in reducing or resolving visually significant surface irregularities resulting from flap striae after LASIK., Design: Retrospective, noncomparative case series., Participants: Twenty-three eyes of 22 patients with flap striae after LASIK and reduced best-corrected visual acuity or visual symptoms that resolved with diagnostic contact lens fitting treated between January 2001 and April 2002 with at least 1 month of follow-up. The mean follow-up interval was 134 days (range, 30-354 days)., Intervention: Transepithelial PTK., Main Outcome Measures: Uncorrected visual acuity (UCVA), resolution or reduction of preoperative symptoms, corneal haze, and best spectacle-corrected visual acuity (BSCVA)., Results: Mean BSCVA and UCVA improved significantly from 20/32 and 20/48 to 20/22 and 20/33 (P<0.0001 and P = 0.027), respectively, after PTK. There was a significant mean hyperopic shift of 0.88 diopters (D; P = 0.002, range, -1.38 to +3.88 D). Fourteen eyes (61%) were clinically clear, 6 eyes (23%) had trace haze, and 3 eyes (16%) had 1+ haze at the last follow-up visit. Mean spherical equivalent refractive error before LASIK was -7.23 D (range, -2.88 to -13.55 D). Twenty-two of 23 eyes had significant qualitative resolution or reduction of preoperative visual symptoms., Conclusions: In cases of visually significant LASIK flap striae, PTK is effective in improving best-corrected visual acuity and reducing visual symptoms. High myopia may be a risk factor for development of visually significant microstriae. Development of anterior stromal haze did not exceed 1+ density and was not correlated to either the number of laser pulses or the length of the follow-up period.