1/35. Overcorrected radial keratotomy treated with posterior chamber phakic intraocular lens and laser thermal keratoplasty.PURPOSE: Modern refractive surgery is effective in a large majority of cases in achieving a good first time result. Some attempts at correction, however, are less successful and require subsequent revision. methods: A case of secondary hyperopic astigmatism ( 0.75 1.50 x 45 degrees) is reported in a patient who had undergone radial keratotomy for myopia of -6.00 0.75 x 90 degrees, 8 years previously. Preoperative uncorrected visual acuity was 20/120 improving to 20/20 with correction. Further refractive procedures were performed including arcuate keratotomy, posterior chamber phakic intraocular lens implantation and laser thermal keratoplasty to improve the uncorrected visual result. RESULTS: Final uncorrected visual acuity was 20/40, spectacle-corrected visual acuity was 20/20 with a manifest refraction of 0.50 1.00 x 40 degrees. CONCLUSIONS: This case demonstrates how the consecutive application of several procedures can successfully refine an initially unsatisfactory refractive result. The potential for reduced predictability and additional complications with each procedure should not be forgotten.- - - - - - - - - - ranking = 1keywords = myopia (Clic here for more details about this article) |
2/35. Piggyback silicone intraocular lenses of opposite power.A patient with high myopia and astigmatism had cataract extraction with implantation of 2 silicone intraocular lenses (IOLs) of opposite power (ie, 1 plus and 1 minus). A Staar AA4203TL toric IOL ( 9.50 diopters [D]/3.50 D) and a Staar AQ5010V additive lens (-3.00 D) were used to correct both the astigmatism and the high myopia. The use of the 2 lenses was necessary because the toric IOL was not available in low dioptric powers. A crystalline interpseudophakos deposit developed after 1 week and resolved after 4 weeks. Three months postoperatively, the patient had an uncorrected visual acuity of 20/25.- - - - - - - - - - ranking = 2keywords = myopia (Clic here for more details about this article) |
3/35. Interface fluid and diffuse corneal edema after laser in situ keratomileusis.PURPOSE: To report a new complication of interface fluid accumulation and corneal edema in an uneventful laser in situ keratomileusis (LASIK) procedure. methods: Uncomplicated bilateral LASIK for myopia using the Hansatome microkeratome was performed. One day postoperatively, the patient noted decreased visual acuity. The topical corticosteroid was changed from dexamethasone to prednisolone acetate 1% every 2 hours. Two weeks later the patient reported worsening visual acuity in both eyes. Uncorrected visual acuity was 20/200 in the right eye and 20/100 in the left. Slit-lamp biomicroscopy indicated significant fluid build-up in the interface. intraocular pressure (IOP) by Goldmann applanation tonometry was 15 mmHg in the right eye and 14 mmHg in the left. RESULTS: After 4 weeks, intraocular pressure by bidigital pressure was increased and high. The corticosteroid was discontinued and antiglaucoma medication lowered the intraocular pressure, which resulted in corneal clearing and disappearence of interface fluid in both eyes. CONCLUSIONS: Early recognition of this new complication of LASIK is necessary. The falsely low reading of IOP in the setting of interface fluid was the result of easy compressibility of the fluid-filled space and reflects the pressure of the interface fluid. This apparently low IOP reading can be an additional sign of the existence of interface fluid. The corticosteroid should be discontinued and antiglaucoma medication instituted. This should lead to a lowering of intraocular pressure and result in corneal clearing and disappearence of the interface fluid with improvement in visual acuity.- - - - - - - - - - ranking = 1keywords = myopia (Clic here for more details about this article) |
4/35. Presumed reactivation of herpes zoster ophthalmicus following laser in situ keratomileusis.PURPOSE: To report a case of herpes zoster ophthalmicus reactivation following laser in situ keratomileusis (LASIK) for myopia. methods: A 54-year-old healthy male underwent uneventful bilateral LASIK for the correction of myopia and astigmatism (-5.75 -3.00 x 20 degrees right eye, -5.50 -3.00 x 170 degrees left eye). Two months following LASIK, an epithelial dendritic lesion appeared in the lower third of the corneal flap of the left eye with vesiculoulcerative lesions of the lateral side of the tip of the nose. RESULTS: The patient was treated with topical and oral antiviral agents and had complete recovery of the lesions in 10 days. CONCLUSIONS: Herpes zoster reactivation may occur following LASIK. Reactivation of herpes zoster in this case could have been coincidental, or secondary to LASIK and the subsequent use of topical corticosteroids following LASIK.- - - - - - - - - - ranking = 2keywords = myopia (Clic here for more details about this article) |
5/35. Iatrogenic ring scotoma after laser in situ keratomileusis.A 37-year-old ophthalmologist had bilateral simultaneous laser in situ keratomileusis (LASIK) for moderate myopia with astigmatism using the Alcon Summit LADARVision laser; an ablation zone of 5.5 mm was used. Five months after surgery, the uncorrected visual acuity was 20/20 and 20/25 but despite regular corneal topographies, the patient experienced prominent ghost images under photopic and scotopic conditions. To elucidate the nature of the problem, automated static perimetry was performed, which revealed a significant depression between 10 degrees and 30 degrees compared with a baseline study obtained 3 years earlier. The patient started brimonidine 0.2% 1 drop in both eyes every morning, which caused 1.5 to 2.0 mm of pupillary miosis (tonic pupil size 3.0 to 4.0 mm in dim light) and eradicated the ghost images. Repeat perimetry showed significant improvement in all indices. The mechanism of improvement is unclear but may be due to elimination of light scatter from the transition zone between the ablated and unablated cornea. The issue of perimetric changes after refractive surgery deserves more attention; postoperative testing may be indicated for patients in whom the ablation zone diameter is close to the mesopic or scotopic pupil size to provide an accurate lifetime baseline visual field.- - - - - - - - - - ranking = 1keywords = myopia (Clic here for more details about this article) |
6/35. Scheimpflug imaging of bilateral foldable in-the-bag intraocular lens implantation assisted by a scleral-sutured capsular tension ring in Marfan's syndrome.A 35-year-old white man with bilateral high myopia, astigmatism, subluxated crystalline lenses, and incipient cataract had phacoemulsification and implantation of a hydrophobic acrylic intraocular lens (IOL) (Alcon MA60BM) in both eyes. The subluxated capsular bag was stabilized and recentered using a scleral-fixated capsular tension ring (CTR) (type 1L, Morcher). Measured with Scheimpflug photography, the capsular bag and IOL were in a stable intraocular position during the 18-month follow-up. There were no major changes in refraction. Despite the sharp-edged IOL design, both eyes had posterior capsule opacification (PCO) 18 months after surgery that in 1 eye caused a decrease in visual acuity of more than 2 lines. High myopia and subluxated lenses may be treatable long-term with a scleral-fixated CTR and foldable IOL implantation; further evaluation of PCO is necessary.- - - - - - - - - - ranking = 2keywords = myopia (Clic here for more details about this article) |
7/35. Laser in situ keratomileusis combined with topography-supported customized ablation after repeated penetrating keratoplasty.I report the case of a 32-year-old woman who had penetrating keratoplasty (PKP) in both eyes because of keratoconus. After PKP, a high degree of spherical myopia and irregular astigmatism prevented optical correction. The patient then had laser in situ keratomileusis (LASIK) combined with topography-supported customized ablation (TOSCA) in both eyes. The procedure resulted in a significant reduction in spherical myopia and astigmatism. A tissue-sparing algorithm was used to plan the refractive treatment. There were no intraoperative or postoperative complications, and the treated corneas maintained transparency. TOSCA-supported LASIK is a useful method for dealing with specific refractive problems after PKP.- - - - - - - - - - ranking = 2keywords = myopia (Clic here for more details about this article) |
8/35. RK4 lens fitting for a flap striae in a LASIK patient.PURPOSE: To present a case in which an RK4 lens was fitted for a patient who developed flap striae resulting from laser-assisted in situ keratomileusis (LASIK). methods: Case report. RESULTS: A 44-year-old man underwent uncomplicated LASIK procedure for bilateral myopia and astigmatism. Visually significant flap striae (OS>OD) were noted postoperatively. The flaps were relifted, refloated, and stretched twice in each eye. In addition, OD enhancement laser treatment was performed. Nevertheless, decreased best-corrected visual acuity (OS>OD) persisted. One month after LASIK, the patient was referred to our office for a second opinion and further evaluation. To avoid additional manipulation of the flaps, we used an RK4 lens fitting to achieve a final corrected visual acuity of 20/20 OU. CONCLUSIONS: Persistent, visually significant flap striae following flap, refloating, stretching, and smoothing techniques can make LASIK patients unhappy. An RK4 lens fitting is an alternative method for correcting postoperative irregular astigmatism and to achieve the best-corrected visual acuity.- - - - - - - - - - ranking = 1keywords = myopia (Clic here for more details about this article) |
9/35. Corneal ectasia detected 32 months after LASIK for correction of myopia and asymmetric astigmatism.We report a case of corneal ectasia detected 32 months after laser in situ keratomileusis (LASIK) for correction of -4.25 diopters (D) of myopia associated with -2.00 D of regular but slight asymmetric astigmatism. The patient retained stable visual acuity for 15 months postoperatively. The preoperative corneal thickness was 540 microm, and the postablation untouched stroma was assumed to be 290 microm. Although a rare complication of LASIK, corneal ectasia can occur, and there is no consensus regarding how much stroma should be left intact to avoid it. Until we have a better understanding of corneal strength, we think surface photorefractive keratectomy or laser-assisted subepithelial keratectomy ablations should be considered instead of LASIK in borderline cases.- - - - - - - - - - ranking = 5keywords = myopia (Clic here for more details about this article) |
10/35. Topical thiotepa treatment for recurrent corneal haze after photorefractive keratectomy.PURPOSE: To describe the use of topical thiotepa in the treatment of recurrent haze after photorefractive keratectomy (PRK). SETTING: Gimbel eye Centre, Calgary, alberta, canada. methods: Five patients with recurrent haze after myopic PRK were retreated with phototherapeutic keratectomy and topical thiotepa. Before retreatment, the best corrected visual acuity (BCVA) ranged from 20/40 to 20/200. Follow-up ranged from 3 to to15 months. RESULTS:Haze, uncorrected visual acuity (UCVA), and BCVA improved in all patients. Three eyes had a UCVA of 20/20(-2) or better and a BCVA of 20/20(-1) or better. The other 2 eyes experienced regression of the myopia and astigmatism and had a BCVA of 20/25(-1) or better. CONCLUSION: Topical thiotepa appeared to be an effective treatment for recurrent corneal haze following myopic PRK.- - - - - - - - - - ranking = 1keywords = myopia (Clic here for more details about this article) |
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