Recurrence of keratitis after excimer laser keratectomy

We report 3 patients who experienced a recurrence of nonherpetic keratitis after excimer laser photorefractive surgery. Two patients had a history of culture-positive adenoviral keratoconjunctivitis, and 1 had a clinical diagnosis of Thygeson’s superficial punctate keratitis (SPK) prior to excimer laser surgery. Patients should be informed that excimer laser surgery may contribute to a recurrence of keratitis and Thygeson’s SPK. Recognition and appropriate treatment can result in resolution and maintenance of a good refractive outcome

Incidence of intraoperative corneal abrasions and correlation with age using the Hansatome and Amadeus microkeratomes during laser in situ keratomileusis

To compare the incidence of intraoperative corneal abrasions using the Hansatome (Bausch & Lomb Surgical) and Amadeus (Advanced Medical Optics) microkeratomes and to determine whether there is a correlation between patient age and the occurrence of intraoperative corneal abrasions. Outpatient ambulatory laser vision correction center. The charts of 133 patients (263 eyes) having laser in situ keratomileusis (LASIK) were reviewed retrospectively. The patients were randomized to LASIK performed by 2 surgeons using the same technique with alternative microkeratome selection. The incidence of intraoperative corneal abrasions was significantly higher with the Hansatome microkeratome than with the Amadeus microkeratome (P =.014). There was a significant correlation between increasing patient age and the incidence of corneal abrasions with both microkeratomes (P<.05). Laser in situ keratomileusis surgeons should be aware that certain microkeratome designs pose a higher risk for intraoperative corneal abrasions and that older patients are more susceptible to intraoperative corneal epithelial injury. These patients should be informed accordingly for appropriate consent

Survey of complications and recommendations for management in dissatisfied patients seeking a consultation after refractive surgery

To review complications associated with and management options for dissatisfied patients seeking a consultation after refractive surgery performed elsewhere. Refractive Eye Surgery Center, The Wilmer Institute, Lutherville, Maryland, USA. In this retrospective review, charts of consecutive dissatisfied patients who sought a refractive consultation between June 1999 and January 2003 after refractive surgery performed elsewhere were reviewed and the following parameters were analyzed: visual acuity (uncorrected and best spectacle corrected), prior manifest refraction, complications, and recommendations. The subjective complaints, complications, and visual acuity were reviewed, and the associated historical or visual risk factors as well as treatment options were analyzed. One hundred sixty-one eyes in 101 patients with ocular complaints were identified. One hundred thirty-four eyes (83.2%) had had laser in situ keratomileusis; 22 eyes, photorefractive keratectomy; 4 eyes, radial keratotomy; and 1 eye, laser thermokeratoplasty. The most common subjective complaints were blurred distance vision (59.0%), glare and night-vision disturbances (43.5%), and dry eyes (21.1%). The most common complications were overcorrection (30.4%), irregular astigmatism (29.8%), dry eyes (29.8%), glare (26.1%), difficulty with night driving (16.7%), and corneal haze (16.7%). The most common cause identified in eyes with best spectacle-corrected visual acuity worse than 20/40 was irregular astigmatism (10 of 18 eyes [55.5%]). The most common recommendation for management was medical treatment or observation (68.3%). Medical therapies recommended included lubrication, punctal plugs, topical and systemic pharmaceutical agents to modulate ocular surface, spectacles, and contact lenses. Keratoplasty (lamellar or penetrating) was recommended in 4 patients (4 eyes [2.5%]). The diagnoses included corneal ectasia in 3 eyes and severe flap complication with irregular astigmatism in 1 eye. Nine patients (5.6% eyes) required nonkeratoplasty surgery. In other patients, waiting for advances in technology, including wavefront-guided customized retreatment, was recommended. A spectrum of complications associated with refractive surgery may result in patient dissatisfaction. Proper patient selection, prevention strategies, and prompt diagnosis and medical or surgical intervention may be beneficial in managing complications and improving patient satisfaction

Outcomes of laser in situ keratomileusis in patients with pigment dispersion syndrome

Purpose: To analyze the outcome of laser in situ keratomileusis (LASIK) in patients with pigment dispersion syndrome (PDS). Setting: Outpatient ambulatory laser vision correction centers. Methods: This noncomparative case series reviewed the medical records of 12 patients (22 eyes) who had clinical features consistent with PDS at the time of the initial preoperative refractive evaluation and had LASIK surgery. Results: Twenty eyes (90.9%) of 11 patients had an uneventful course after LASIK and a good final uncorrected visual acuity (mean follow-up 26 months). One patient (2 eyes) with PDS and suspicion of glaucoma on topical β-blocker therapy had delayed healing, fluctuations in vision, and a lengthy visual recovery. Conclusions: Corneal findings of PDS do not appear to affect the intraoperative or postoperative outcomes of LASIK. However, patients who have PDS in the context of glaucoma and therapy with an intraocular-pressure-lowering agent may experience delayed healing and a less predictable visual outcome

Refractory interface haze developing after epithelial ingrowth following laser in situ keratomileusis and small aperture corneal inlay implantation

Purpose: To report the occurrence and the management of refractory interface haze that developed after epithelial ingrowth following small aperture inlay implantation. Observations: A 52 year-old man with sub-clinical anterior basement membrane dystrophy (ABMD) underwent combined hyperopic laser in situ keratomileusis and KAMRA corneal inlay implantation to correct presbyopia. Post-operatively, epithelial ingrowth developed requiring debridement and KAMRA removal. Significant diffuse interface haze, ground-glass in texture, involving the central 6 mm of the cornea developed the next day, and was refractory to topical and systemic steroids, necessitating flap irrigation, gentle scraping, and MMC application to the residual stromal bed after 12 days. The interface haze gradually improved to near complete resolution over 12-months. Conclusions and importance: Epithelial ingrowth can lead to flap interface haze refractory to medical therapy. Early surgical intervention is key to haze resolution. Keywords: Refractory interface haze, KAMRA, Inlay implantation, Anterior basement membrane dystrophy, Epithelial ingrowth, Laser in situ keratomileusi

Outcome of second surgery in LASIK cases aborted due to flap complications

Purpose: To describe the technique and timing of second refractive surgery after aborted laser in situ keratomileusis (LASIK) due to intraoperative flap complication and determine the final visual outcome. Setting: Outpatient ambulatory laser vision correction centers. Methods: This retrospective noncomparative case series included 16 patients (16 eyes) who had a second refractive surgery after initial LASIK surgery was aborted because of a flap complication. Charts were reviewed with attention to initial preoperative data, intraoperative details of the aborted LASIK, postoperative examination, possible causes of the flap complication, timing and technique of second refractive surgery, and final visual outcome. Results: Causes of the aborted LASIK were identified in 13 of 16 eyes (81.2%) and included eye squeezing (5 eyes), loss of suction or machine failure (5 eyes), steep corneas (2 eyes), and learning curve of the surgeon (1 eye). The mean time until the second surgery was 135 days (range 49 to 372 days). Repeat flaps were created deeper and larger than the initially attempted flaps when possible. No patient had a final uncorrected visual acuity (UCVA) worse than 20/30 after the second surgery. Two eyes (12.5%) lost 1 line of best spectacle-corrected visual acuity. Conclusion: A planned delayed reoperation after sufficient corneal healing following an intraoperative flap complication can result in satisfactory recovery of UCVA