1/23. Visual field defect associated with laser in situ keratomileusis.PURPOSE: To report a case of visual field defect associated with laser in situ keratomileusis. methods: Case report. A 28-year-old woman with high myopia (-10D) and a family history of normal tension glaucoma underwent bilateral laser in situ keratomileusis keratorefractive surgery. Preoperatively, both eyes had normal intraocular pressure and visual field. RESULTS: At the first postoperative visit 1 day after apparently uncomplicated laser in situ keratomileusis, the patient reported a scotoma in the right eye. At 3-month follow-up, visual fields revealed the patient had developed a near-superior altitudinal visual field defect in the right eye. The defect did not progress over 1 year of follow-up examinations. CONCLUSION: Increased intraocular pressure associated with the microkeratome vacuum ring used during laser in situ keratomileusis may have precipitated optic nerve head ischemia and visual field defect.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/23. A complication of scleral expansion surgery for treatment of presbyopia.PURPOSE: To report a patient who developed complications from an experimental technique using scleral expansion to treat presbyopia. methods: Case report of a 46-year-old woman who underwent scleral expansion surgery on her right eye. Postoperatively, the patient developed chronic pain and swelling that necessitated removal of the scleral expanders. RESULTS: After removal of the scleral expanders, the patient demonstrated a -1.4 diopter myopic shift in the right eye relative to her preoperative refraction. Axial length of the right eye was 1.15 mm longer than of the left, whereas preoperative axial lengths were equal. CONCLUSION: This patient developed scleral thinning with resultant axial lengthening and myopic shift, akin to the phenomenon observed with scleral buckles used to treat retinal detachments. We believe this was responsible for improved near vision in her right eye, rather than any increased accommodative potential purported to result from this operation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/23. Unusual presentations of accommodative esotropia.PURPOSE: Most patients with accommodative esotropia are first examined between the ages of 6 months and 2 years. This paper discusses unusual presentations of accommodative esotropia that occur outside of this age-group and/or have a precipitating event that triggered the esotropia. In a series of patients who were from 5 to 11 years of age, trauma was the precipitating event. In some of the patients under 6 months of age, high myopia, as well as a moderate to large amount of hyperopia, was the cause. In 1 teenager, diabetic ketoacidosis precipitated accommodative esotropia. methods: We reviewed all of our records for the past 25 years involving patients with a diagnosis of esotropia, and we found 17 patients who had unusual presentations of accommodative esotropia. Of 8 who were under the age of 6 months, 2 had high myopia and 6 had moderate to large amounts of hyperopia. Nine patients were older than age 5. Eight of the 9 had suffered trauma associated with the presentation of accommodative esotropia, and 1 patient's accommodative esotropia was associated with diabetes. The patients with myopia received their full myopic correction. The children under 6 months of age with hyperopia received their full cycloplegic refraction, and the children over age 5 received the most plus that they were able to accept in a noncycloplegic state consistent with good visual acuity (at least 20/30 in each eye). RESULTS: In 17 patients, accommodative esotropia was initially controlled with glasses. In a few of the trauma cases, bifocals were required for control of near deviation. Only 2 of the patients, in whom onset was under 6 months of age, came to surgery. One had hyperopia controlled for 2 years with glasses, and the other had myopia controlled for 3 years with glasses. CONCLUSIONS: Accommodative esotropia can occur prior to 6 months of age. It can also occur in older children (5 to 14 years of age) and can be precipitated by trauma or diabetic ketoacidosis.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/23. Suprachoroidal hemorrhage as a complication of vitrectomy.OBJECTIVE: To study the risk factors, management, and end results of suprachoroidal hemorrhage that occur during or after vitrectomy. MATERIALS AND methods: This retrospective study involves patients suffering from this complication either during the curing process or immediately after vitrectomy. Preoperative risk factors, operative management, postoperative picture, and end results are reported. RESULTS: During the study period, surgery was performed on 3342 patients with primary vitrectomy. Complications were experienced by 4 patients: 2 occurred near the end of vitrectomy, and 2 in the first postoperative day. The 4 patients were myopic more than 7 diopters, 2 were pseudophakic and 2 were aphakic. Cryopexy was used to treat the retinal breaks in the operative cases. Perfluorophenanthrene was used as a postoperative tamponade in one operative case. reoperation was done in the 4 patients 3 to 8 weeks after surgery. Silicone oil was used as a prolonged tamponade in all cases. Hypotony persisted in operative cases. All the patients had vision more than 20/400 at the end of follow-up (6 to 24 months). CONCLUSION: The risk factors for suprachoroidal hemorrhage were old age, high myopia, aphakia or pseudophakia, retinal detachment, and scleral buckle. Postoperative suprachoroidal hemorrhage has a better prognosis than the operative type. Perfluorophenanthrene "vitreon" as an operative and postoperative tamponade has a beneficial effect in keeping the retina attached and in preventing pooling of blood under the macula.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/23. Effect of high-altitude exposure on myopic laser in situ keratomileusis.PURPOSE: To study the effect of high-altitude exposure on visual acuity after myopic laser in situ keratomileusis (LASIK). SETTING: Aconcagua, Mendoza, argentina. methods: In the early postoperative period after uneventful myopic LASIK, 2 physicians prospectively assessed their visual acuity during an ascent of Aconcagua (22841 feet). The distance uncorrected visual acuity (UCVA) and peripheral oxygenation were measured at approximately every 2000 feet of altitude. RESULTS: Both climbers developed a moderate loss of distance UCVA but described normal near and pinhole acuity consistent with a myopic shift. The distance UCVA diminished to 20/100 in the right eye and 20/125 in the left eye of Climber A and to 20/160 and 20/30, respectively, of Climber B. The vision loss worsened with increased altitude, duration of exposure, and decreased peripheral oxygenation. One week after the climb, the manifest refraction demonstrated a small myopic shift in both eyes of Climber A; these subsequently resolved. CONCLUSIONS: Two climbers, 8 and 14 weeks after myopic LASIK, experienced vision loss consistent with a temporary myopic shift in the refractive error with ascent to high altitude. Climbers who have LASIK, particularly those in the early postoperative period, should be prepared for visual acuity fluctuations with high-altitude exposure.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/23. Retinal hemorrhages in posterior vitreous detachment.Detachment of the posterior vitreous can cause clinically significant retinal hemorrhage. Two patients with acute posterior vitreous detachment had massive retinal hemorrhages overlying the optic disks. These absorbed in time without sequealae. A third patient had numerous small blot hemorrhages scattered near the optic disk and macula. A fourth patient presented with a small macular hemorrhage causing temporary visual loss. All patients had moderately severe myopia and were in good health without hypertension or diabetes. There was no history of trauma or valsalva maneuver. Hematologic and coagulation studies were normal. These cases indicate that retinal hemorrhages due to posterior vitreous detachment may be strikingly large, multiple, and, when involving the macula, cause temporary visual loss.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/23. Exodeviation following monocular myopic regression after laser in situ keratomileusis.We report a 44-year-old woman with intermittent left exotropia of 35 prism diopters at distance who initially exhibited alignment of both eyes after bilateral laser in situ keratomileusis (LASIK). The exophoria was not preserved due to myopic regression in the dominant eye. An uneventful LASIK treatment was performed to correct -11.00 -0.50 x 130 in the right eye and -13.50 -1.50 x 145 in the left eye. The aim was to achieve emmetropia in both eyes. Although an examination revealed exophoria at near and distance during the 6 months following refractive surgery, the tropic aspect of the divergent deviation appeared in the right eye following the myopic regression. Laser in situ keratomileusis is an effective option to achieve binocular visual quality in myopic anisometropic patients. However, myopic regression after LASIK may disrupt the binocular visual quality.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/23. Treatment of previous decentered excimer laser ablation with combined myopic and hyperopic ablations.PURPOSE: Decentration of the ablation zone is an occasional complication of excimer laser refractive surgery. We describe a technique to recenter the ablation zone without changing the refractive status obtained by the first surgery. methods: Sixteen eyes of 14 patients had moderate or marked ablation decentration after previous excimer laser surgery for myopia, but with only minor residual refractive error. Five eyes had spectacle-corrected visual acuity loss and all these patients reported various symptoms such as halos, ghost images, or night driving difficulties. To recenter the ablation zone without changing the refraction, a combination myopic and hyperopic treatment was used. The hyperopic treatment was decentered toward the initial decentered myopic ablation. A myopia ablation of near equal dioptric value was then added, but decentered in the opposite direction. The Bausch & Lomb Technolas Keracor 217 laser was used. RESULTS: After the first retreatment, the centration of the ablation zone was improved in 15 of the 16 eyes. All eyes with initial spectacle-corrected visual acuity loss recovered lines of visual acuity. Subjective decrease of symptoms was described as follows: nil in one eye, mild in one eye, moderate in four eyes, and marked in ten eyes. A second retreatment was needed in five eyes: in two to improve centration and in three to correct residual ametropia. The only complication (one eye) was induced decentration 180 degrees away from the initial decentration with a 1-line spectacle-corrected visual acuity loss, and additional retreatment was required. CONCLUSION: A combination of decentered myopic and hyperopic ablation of an equivalent dioptric magnitude, each decentered 180 degrees apart, was a useful method to correct previous excimer laser treatment decentration, with minimal alteration of refractive status that was obtained by the initial surgery.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/23. White lesion in the corneal pigmented ring associated with orthokeratology.The development of the pigmented corneal arc and a white lesion near the inner margin of the arc in a girl wearing overnight orthokeratology (ortho-k) lenses for myopic control is reported. The girl was examined before and followed up every 6 months after the treatment over a 3-year period. The initial spherical equivalent refractive error and keratometric readings (flattest/steepest meridians) were -2.37 D and 45.00 D/46.75 D respectively in the right eye and -3.12 D and 45.25 D/46.00 D respectively in the left eye. She was wearing ortho-k lenses of a four-zone design made of boston XO material on a nightly basis. The same lens design was used throughout the monitoring period. corneal topography showed a rather well-centred treatment zone but vision varied between visits because of fluctuations in residual refractive error. The corneal condition of each eye was unremarkable except for the presence of the pigmented corneal arc first observed 6 months after the commencement of the treatment. The intensity of the arc did not change over the years in the right eye but increased in the left eye. A faint white lesion within the inner border of the left pigmented arc was first observed at the end of the second year and it became more obvious at the end of the third year. This lesion appears to be similar to those reported in intense Fleischer's rings associated with keratoconus. Although the presence of the arc may have no clinical ramification, the change in the intensity and the development of the white lesion may reflect an increased stress exerted on the cornea with continued ortho-k lens wear.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/23. Amniotic membrane as a biologic pressure patch for treating epithelial ingrowth under a damaged laser in situ keratomileusis flap.We present 2 patients who had epithelial ingrowth after intraoperative laser in situ keratomileusis (LASIK) complications that created defects in the flap near the visual axis. As an adjuvant to removing the epithelium, an amniotic membrane patch was sutured tightly to the episclera so that it covered the entire cornea. The amniotic membrane overlay was left in place for about 1 week. There was no evidence of recurrent epithelial ingrowth after a minimum of 4 months. Use of an amniotic membrane overlay can be an effective adjuvant therapy to secure a LASIK flap when direct suturing would threaten the visual axis.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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