Cases reported "Hyperopia"

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1/106. Corneal iron ring after hyperopic laser-assisted in situ keratomileusis.

    PURPOSE: To report a new corneal iron ring after hyperopic laser-assisted in situ keratomileusis (LASIK). methods: Three patients underwent hyperopic LASIK for the correction of hyperopia in both eyes. Spherical equivalent refraction of the patients ranged from 3.37 to 6.50 diopters. LASIK procedure was performed using automated corneal shaper and 193-nm argon fluoride excimer laser. RESULTS: Both eyes of the patients were noted to have a corneal iron ring located at the paracentral area at 6-7 months after surgery. The localization of iron ring corresponded with outside border of central steep zone. Twelve-month examination showed there was no change in color, shape, and density of corneal iron ring. CONCLUSIONS: Corneal topographic changes induced by hyperopic LASIK may cause corneal iron ring to develop.
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2/106. Bacterial keratitis following laser in situ keratomileusis for hyperopia.

    A 42-year-old Bahraini man had uneventful laser in situ keratomileusis for hyperopia (OD: 3.00 0.75 x 155 degrees; OS: 2.00 0.50 x 155 degrees). Three weeks later, he presented with localized keratitis in his right eye, with localized keratitis at the flap margin with stromal edema. Uncorrected visual acuity was 20/80 OD with no improvement with pinhole, and was 20/20 OS. Corneal smear culture showed a positive growth of staphylococcus aureus. The patient was immediately treated with subconjunctival gentamicin and intensive topical ofloxacin 0.3% with systemic cephalosporin. The patient recovered from keratitis within 2 weeks and his uncorrected visual acuity OD improved to 20/20. keratitis following LASIK should be treated promptly so that it does not lead to permanent reduction in visual acuity.
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3/106. Clear lens extraction with intraocular lens implantation for hyperopia.

    PURPOSE: Current surgical options for the correction of moderate to severe hyperopia include hyperopic laser in situ keratomileusis (LASIK), phakic intraocular lens implantation and clear lens extraction with intraocular lens (IOL) implantation. We investigate the safety and efficacy of clear lens extraction with IOL implantation to correct hyperopia. methods: phacoemulsification and IOL implantation was performed on 18 eyes of 10 patients. In 16 eyes, the Hoffer-Q formula was used for IOL power calculation and a single IOL was inserted; in the remaining 2 nanophthalmic eyes, the Holladay-II formula was used and two piggy-back IOLs were inserted. RESULTS: Mean preoperative spherical equivalent for distance was 6.17 D (range, 4.25 to 9.62 D). patients were followed postoperatively for a mean of 10.5 months (range, 4 to 27 mo). Uncorrected visual acuity in all eyes was 20/50 or better with a median uncorrected visual acuity of 20/40 (range, 20/30 to 20/50). Two patients lost 2 lines of spectacle-corrected visual acuity; both of these patients achieved spectacle-corrected visual acuity of 20/30. CONCLUSIONS: Clear lens extraction with IOL implantation is a safe and effective procedure for the correction of moderate to severe hyperopia in the presbyopic age range.
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4/106. Abnormal head posture associated with high hyperopia.

    BACKGROUND: An abnormal head posture may be adopted for ocular or nonocular reasons. The most common ocular reasons are to maintain binocularity and to obtain the best possible visual acuity. patients with undercorrected or overcorrected refractive errors have been reported to adopt a variety of head positions, thought to be an attempt to obtain the best possible visual acuity. methods: Five patients with symmetric high hyperopia (at least 5.00 D) and an abnormal head posture are presented. RESULTS: All five patients demonstrated an abnormal head posture of chin down for fixation without the spectacle correction in place. This abnormal head posture was eliminated by occlusion of either eye and also by wearing of the refractive correction. No patient demonstrated significant strabismus. CONCLUSION: An abnormal head posture when not wearing spectacle correction can occur in children who have high hyperopia and insignificant strabismus. This may be a mechanism by which the best visual acuity is obtained (indicated by the disappearance of the abnormal head posture on wearing of the glasses) and also to maintain binocularity (indicated by the disappearance of the abnormal head posture under monocular testing conditions). The presence of a chin-down abnormal head posture should alert the examiner to the possible presence of high hyperopia and therefore the necessity for a cycloplegic refraction.
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5/106. Central bump-like opacity as a complication of high hyperopic photorefractive keratectomy.

    PURPOSE: A new complication is reported in association with high hyperopic excimer laser photorefractive keratectomy. methods: One thousand consecutive eyes were treated with a Meditec MEL-60 excimer laser (Meditec Inc, Heroldsberg, germany) for hyperopic refractive error between 1 diopters and 7 diopters. RESULTS: Three eyes with high hyperopic corrections between 5 and 6 diopters had a central, round bump-like subepithelial scar develop 1 month after hyperopic photorefractive keratectomy, which reduced the uncorrected and spectacle-corrected visual acuity. CONCLUSION: Central bump-like opacity is a new, visually significant complication of unknown origin associated with high hyperopic photorefractive keratectomy. Possible causes of this complication include drying and edema of the cornea as a result of prolonged exposure, interruption of the peripheral superficial nerve plexus affecting the central anterior stroma, and abnormal epithelial or tear film function resulting from excessive central steeping.
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6/106. Piggyback posterior chamber multifocal intraocular lenses in anisometropia.

    A 63-year-old white man with anisometropic hyperopia presented with cataract in both eyes. He had uneventful temporal limbal phacoemulsification with intracapsular placement of a multifocal 3-piece silicone intraocular lens (IOL) in his right eye (model SA-40N, Allergan, Inc.). One week later, 2 intracapsular 3-piece silicone IOLs (1 monofocal backward, Allergan model SI-40NB; 1 multifocal in front, Allergan model SA-40N) were implanted in his left eye. At 8 days postoperatively, uncorrected visual acuity was 20/20 for distance and J1 for near vision in the right eye and 20/30 and J2, respectively, in the left. These values remained constant until the patient was seen 7 months postoperatively. Power calculation and insertion order of the piggyback IOLs were considered.
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7/106. Refractive error in cataract surgery after previous refractive surgery.

    Bilateral cataract extraction with posterior chamber intraocular lens (IOL) implantation was performed in a patient after previous photorefractive keratectomy, radial keratotomy (RK) combined with astigmatic keratotomy, and retreatment of RK. Significant hyperopic error was observed after cataract surgery, and the IOLs were eventually exchanged in both eyes. A review of this case found that the refractive error was smaller when a refraction-derived keratometric value was selected for IOL power calculation. Nevertheless, hyperopic error still occurred.
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8/106. Topography-controlled excimer laser photorefractive keratectomy.

    PURPOSE: To assess whether photorefractive keratectomy (PRK) controlled by videokeratography can successfully treat refractive errors in eyes with corneal irregularities and improve spectacle-corrected visual acuity. methods: In a prospective clinical study, PRK was performed in 10 eyes of 10 patients. Reason for surgery was irregular astigmatism after penetrating keratoplasty, corneal irregularity after corneal scarring, corneal astigmatism in keratoconus, and decentration after myopic and hyperopic PRK. Excimer ablation was controlled by preoperative videokeratography (Orbscan II, Orbtek) using the MEL-70 system from Aesculap Meditec. Follow-up was 6 months. RESULTS: Concerning manifest refraction, the sphere was reduced on average from 1.92 to 0.57 D, 6 months postoperatively. Cylinder changed from -1.95 D on average to -0.30 D at 6 months postoperatively. There was improvement of uncorrected visual acuity of 2 or more lines in 5 eyes and no change in 5 eyes 6 months postoperatively. Spectacle-corrected visual acuity improved in 2 eyes by 2 to 3 lines, in 9 eyes by 1 to 3 lines, and showed no change in 1 eye. CONCLUSION: Videokeratography-controlled PRK improved refractive errors in irregular corneas with improvement of spectacle-corrected visual acuity.
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9/106. Traumatic acremonium atrogriseum keratitis following laser-assisted in situ keratomileusis.

    A 52-year-old man underwent bilateral laser-assisted in situ keratomileusis. Eight months later, he sustained a penetrating corneal injury to the left eye. A dense white infiltrate, unresponsive to antimicrobial therapy, developed in the corneal stroma. Corneal biopsy and eventual penetrating keratoplasty were performed, and both specimens demonstrated fungal elements with branching, septate hyphae. culture identified the organism as acremonium atrogriseum. Histopathologic features of this organism and its differentiation from other, more common fungal organisms are discussed herein.
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10/106. Acute angle-closure glaucoma after hyperopic laser in situ keratomileusis.

    We report a case of acute angle-closure glaucoma 1 year after hyperopic laser in situ keratomileusis (LASIK). The glaucoma was resolved with laser iridotomy, and a prophylactic iridotomy was performed in the fellow eye. corneal topography was performed 2, 5, and 18 weeks after the acute episode. A myopic shift occurred after the episode and resolved within 3 months. Hyperopic patients with narrow angles are at risk for angle closure and should be carefully monitored.
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