1/140. Voluntary nystagmus associated with accommodation spasms. BACKGROUND: Voluntary nystagmus has been recognized as a pendular, rapid, conjugate, primarily horizontal, benign eye movement initiated and maintained by voluntary effort. CASE: A 10-year-old Japanese girl presented with voluntary nystagmus associated with accommodation spasms. Her chief complaints, intermittent blurred vision, headache, and soreness of the eyes, were thought to be related to the voluntary nystagmus and accommodation spasms. FINDINGS: The waveform of the nystagmus appeared pendular, the frequency was 13-15 Hz, and the amplitude was 3-5 degrees. Scanning laser ophthalmoscopic video images clearly demonstrated vertical and torsional components in addition to the horizontal eye movements. Her refraction was unstable, varying between -0.5 diopters (D) and -5.5 D, and the recording of the accommodometer increased to -12.0 D when nystagmus was initiated. CONCLUSIONS: This may be a unique form of voluntary nystagmus that consists of horizontal, vertical, and rotational components associated with accommodation spasms. observation of this patient continues, without any further treatment or examination. ( info) |
2/140. Irreversible corneal decompensation in patients treated with topical dorzolamide. PURPOSE: To describe irreversible corneal decompensation after topical dorzolamide hydrochloride (Trusopt; Merck and Co, Inc, West Point, pennsylvania) therapy in nine patients who had histories consistent with corneal endothelial compromise. METHOD: Multicenter review of patients' charts. RESULTS: Nine eyes of nine patients developed overt corneal decompensation after starting topical dorzolamide, a condition that did not resolve with drug cessation. This occurred after 3 to 20 weeks (mean, 7.8) of therapy. All nine patients had undergone intraocular surgery. Eight patients had undergone cataract surgery; three were aphakic and three had posterior chamber intraocular lenses. Two patients had anterior chamber intraocular lenses and also had undergone trabeculectomies. Four patients had undergone penetrating keratoplasties, each case complicated by episodes of corneal allograft rejection that were successfully treated. Two patients had asymptomatic Fuchs endothelial dystrophy. Seven patients have since undergone successful penetrating keratoplasties. CONCLUSION: The reports suggest that dorzolamide can cause irreversible corneal edema in a subset of glaucoma patients with endothelial compromise. The findings suggest a rationale for research into the long-term effects of dorzolamide on the corneal endothelium. ( info) |
3/140. Bilateral microcornea and unilateral macrophthalmia resulting in incorrect intraocular lens selection. A 79-year-old man with symmetrical microcornea and a dense unilateral nuclear sclerotic cataract had cataract extraction by phacoemulsification. The SRK/T formula suggested a 10.0 diopter (D) intraocular lens (IOL) for emmetropia (axial length 26.58 mm). The non-cataract eye required a 25.0 D IOL for emmetropia (axial length 21.51 mm). Biometric measurements were rechecked, and an 18.0 D IOL was implanted (axial length 24.02 mm). The 6 week postoperative refraction of -13.0 2.0 x 25 necessitated IOL exchange (10.0 D). Six weeks postexchange, the refraction was -3.75 2.5 x 30. This illustrates that symmetrical anterior microphthalmos does not always coexist with symmetrical posterior microphthalmos. awareness of the association of symmetrical microcornea and unilateral colobomatous macrophthalmia may aid appropriate IOL selection in future cases. ( info) |
4/140. adie syndrome: evidence for refractive error and accomodative asymmetry as the cause of amblyopia. PURPOSE: To report objective changes in accommodation in a child with adie syndrome. methods: A child aged 2 years 10 months when initially examined was found to have good visual acuity in both eyes, a low degree of hypermetropia (isometropic), and Adie pupil presumed to be caused by chicken pox that had occurred 2 months earlier. amblyopia developed but responded well to treatment, which involved correction of the refractive error and occlusion therapy. Objective changes in the refraction of the eye were measured on the Canon R1 autorefractor at 3.8 m and 33 cm. RESULT: The degree of accommodation in the affected eye when both eyes were open was markedly reduced. CONCLUSION: The presence of isometropic hypermetropia, which remains uncorrected when adie syndrome is present, can lead to the development of amblyopia in a child. ( info) |
5/140. 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. ( info) |
6/140. incidence of vitreoretinal pathologic conditions within 24 months after laser in situ keratomileusis. OBJECTIVE: To report for the first time a case series of vitreoretinal pathologic conditions after laser in situ keratomileusis (LASIK) and to determine its incidence. DESIGN: Case series. PARTICIPANTS: Five refractive surgeons and 29,916 eyes that underwent surgical correction of ametropia (83.2% were myopic) ranging from -0.75 to -29.00 diopters (D; mean: -6.19 D) and from 1.00 to 6.00 D (mean: 3.23 D) participated in this retrospective study. MAIN OUTCOME MEASURES: Vitreoretinal complications after LASIK. RESULTS: The clinical findings of 20 eyes (17 patients) with LASIK-related vitreoretinal pathologic conditions are presented. Fourteen eyes experienced rhegmatogenous retinal detachments (RDs). Two eyes experienced corneoscleral perforations with the surgical microkeratome when a corneal flap was being performed (one experienced a vitreous hemorrhage and the other later experienced an RD). In four eyes, retinal tears without RDs were found. In one eye, a juxtafoveal choroidal neovascular membrane (CNVM) developed. Retinal tears were treated with argon laser retinopexy or cryotherapy. Corneoscleral perforations were sutured, and the RD was managed with vitrectomy. The remaining RDs were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The CNVM was surgically removed. The incidence of vitreoretinal pathologic conditions determined in our study was 0.06%. CONCLUSIONS: Serious complications after LASIK are infrequent. Vitreoretinal pathologic conditions, if managed promptly, will still result in good vision. It is very important to inform patients that LASIK only corrects the refractive aspect of myopia. Complications of the myopic eye will persist. ( info) |
7/140. Effectiveness of LASIK to correct refractive error after penetrating keratoplasty. OBJECTIVE: refractive errors may invalidate the good results of penetrating keratoplasty (PK). The Authors evaluate the effectiveness of excimer laser in situ keratomileusis (LASIK) in the correction of refractive error after PK. MATERIALS AND methods: Four patients, a 26-year-old woman, a 54-year-old man, a 19-year-old man, and a 51-year-old woman, showed refractive errors: -11 = -4.5 x 85 ; -8, -4.5 = -11 x 95 ; and -4.5 = -4 x = 1200, with a clear graft at least 20 months after penetrating keratoplasty secondary to keratoconus. However, they underwent the LASIK procedure with a nasal-hinged flap of 160 um. No sutures were placed. RESULTS: At follow-up, 24, 18, 12, and 12 months, respectively, the graft remained clear and the endothelial cells were unchanged. The uncorrected visual acuities were 20/50, 20/25, 20/50, and 20/25, respectively with an unchanged best corrected visual acuity (20/20) for all patients. No significant complications were observed. CONCLUSIONS: LASIK procedure seems to be an effective technique to correct refractive error after successful penetrating keratoplasty. ( info) |
8/140. Contact lens fitting difficulties following refractive surgery for high myopia. PURPOSE: To describe the clinical and optical problems encountered in contact lens fitting following refractive surgery for high myopia. methods: Following refractive surgery for high myopia (greater than -10.00 D) we corrected residual refractive errors with contact lenses in the four eyes of two patients. The first patient had undergone bilateral laser in situ keratomileusis (LASIK),with two subsequent LASIK retreatments in the left eye. Ten months later she was fit with rigid gas permeable (RGP) lenses in both eyes. The second patient had undergone a clear lens extraction in the right eye and radial keratotomy followed by photorefractive keratectomy(PRK) in the left eye. She was fit with toric soft lenses six years postoperatively. RESULTS: Final visual acuity obtained with contact lenses was 20/25-20/20 in all eyes. The first patient required significant minus lens power compensation. Furthermore, the RGP lens in the left eye was slightly decentered due to corneal irregularity induced by LASIK. The second patient had regular corneal surfaces and was successfully fit with daily wear toric soft lenses despite the 2.75 D of residual astigmatism in the left eye. CONCLUSIONS: Following refractive surgery for high myopia a proportion of patients will remain undercorrected. In these patients the alterations in corneal architecture that ensue make contact lens fitting more challenging. patients with regular astigmatism may be fitted successfully with toric soft lenses. patients with corneal irregularities should be fit with RGP lenses. ( info) |
9/140. Postoperative refractive error resulting from incorrectly labeled intraocular lens power. Postoperative refractive errors after intraocular lens (IOL) implantation can be caused by different reasons. The most likely is incorrect IOL calculation resulting from incorrect measurements of the eye. However, other explanations must also be taken into account. The surgeon in the operating theater should make sure that the correct IOL was chosen. The IOL package should also contain the correct IOL cartridge. When unsealed IOL packages are used, an IOL cartridge from 1 package can be mistakenly placed in another package. Finally, incorrect IOL labeling by the manufacturer can occur. In this case, the optical power of an explanted IOL was not identical to the IOL power printed on the company's label. Even with the highest quality control throughout the IOL manufacturing process, the surgeon should keep in mind the possibility of a mislabeled IOL. ( info) |
10/140. Thickness of the peripapillary retina in healthy subjects with different degrees of ametropia. PURPOSE: To evaluate the thickness of the peripapillary retina in healthy subjects with different degrees of ametropia. DESIGN: Cross-sectional study. PARTICIPANTS: Forty-three healthy normal subjects, ages 15 to 64 years (38 /-15 years) were recruited. methods: The method of retinal thickness mapping was applied to generate serial optical section images in the temporal peripapillary retinal area. The digitized images were analyzed to detect the separation between the vitreoretinal and chorioretinal interfaces. The separation was converted to absolute thickness by taking into account the magnification of the optical system and the optical dimensions of the eyes. MAIN OUTCOME MEASURES: The refractive error of the eyes ranged from 8.25 to -12.75 diopters (spherical equivalent). The axial length of the eyes ranged from 19.3 to 27.35 mm. The retinal thickness in a 2- x 2-mm temporal peripapillary retinal area was determined. RESULTS: The separation between the retinal interfaces decreased with increasing axial length (P<0.001). The thickness in the temporal peripapillary retinal area was not significantly correlated with the axial length of the eye (P = 0.3). A lack of statistically significant difference between the average thickness in the hyperopic, emmetropic, and myopic eyes (P> or =0.06) was found. CONCLUSIONS: The average thickness in the temporal peripapillary retinal area was not influenced by the axial length of the eye, when the magnification of the optical system and the optical dimension of the eyes were taken into consideration. ( info) |