The effect of preoperative keratometry on visual outcomes after moderate myopic LASIK

Journal ArticleThe relationship between preoperative keratometry (K) and visual outcomes in laser-assisted in situ keratomileusis (LASIK) has been studied in high myopia and hyperopia, but not in moderate myopia. Rao et al report increased undercorrection in eyes with preoperative spherical equivalent (SE) of −10.0 to −11.9 diopters (D), and in eyes with flat corneas compared with steeper corneas.1 Williams et al, conversely, reported undercorrection and loss of best spectacle corrected visual acuity (BSCVA) following hyperopic LASIK in eyes with steep corneas, compared with flat corneas.2 To our knowledge, to date no study has analyzed visual prognosis based on preoperative keratometry in moderately myopic LASIK. In this retrospective analysis, we studied the relationship between preoperative keratometry and postoperative visual outcomes in flat and steep corneas treated with LASIK for the correction of moderate myopia (−2.00 to −5.99 D)

Surgical technique: coupling of intrastromal corneal ring segments for ectatic corneal disorders in eye bank corneas

The management of corneal ectasia is evolving, with intrastromal corneal ring segments playing an important role in delaying or eliminating the need for penetrating keratoplasty. This paper describes a modification in the implantation technique of intrastromal corneal ring segments that allows for coupling of the two segments with suture, affording more structural support

Epithelial growth over the optic surface of the type 1 Boston Keratoprosthesis: histopathology and implications for biointegration

We report the histopathology of epithelial overgrowth in the Boston type I keratoprosthesis. The epithelium shows an inconsistent number of layers and basement membrane and goblet cells are absent. Epithelialization of the keratoprosthesis optic would have multiple advantages, but the limitation of vision makes tolerating the overgrowth difficult

Trends in refractive surgery at an academic center: 2007-2009

<p>Abstract</p> <p>Background</p> <p>The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs) has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients.</p> <p>Methods</p> <p>Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK) vs. laser-assisted in-situ keratomileusis (LASIK), and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D) of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs.</p> <p>Results</p> <p>Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10). The proportion of high myopes, however, decreased (p = 0.05). The proportions of types of procedure changed, with an increase in the proportion of PRK between 2007 and 2009 (p = 0.02). The mean age of patients did not change [42.4 ± 14.4 (standard deviation) years in 2007 vs. 39.6 ± 14.5 years in 2009; p = 0.4]. Astigmatism-correcting IOL and presbyopia-correcting IOL volumes increased 15-fold and three-fold, respectively, between 2007 and 2009.</p> <p>Conclusions</p> <p>Volume of excimer laser refractive surgery decreased by at least 30% between 2007 and 2009. No significant change in mean age or in the distribution of refractive error was seen, although the proportion of high myopes decreased between summer quarters of 2007 and 2009. PRK gained as a proportion of total cases. Premium IOL volume increased, but still comprised a very small proportion of total IOL volume.</p

The Incidence of Central Serous Chorioretinopathy after Photorefractive Keratectomy and Laser In Situ Keratomileusis

Purpose. To assess the incidence of central serous chorioretinopathy (CSCR) following laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Methods. A chart review was performed to identify all patients with CSCR and a previous history of LASIK or PRK. Results. Over the 6-year study period, 1 of 4,876 eyes which had LASIK or PRK at the Moran Eye Center was diagnosed with CSCR. One other patient was referred from an outside center, developed CSCR symptoms one month after PRK. Both patients were managed conservatively with a final visual acuity of 20/20 or better. All other patients presented 4 or more years after refractive surgery. Conclusions. We report the first 2 CSCR cases developing within one month after PRK. The low incidence argues against a causal association. Topical corticosteroids or anxiety may elevate cortisol levels presenting therapeutic challenges for the management of CSCR after PRK or LASIK

The effect of preoperative keratometry on visual outcomes after moderate myopic LASIK

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Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Numerous designs of punctal and canalicular plugs are available on the market. This variety presents challenges to ophthalmologists when choosing punctal plugs for the management of various ocular conditions. The aim of this literature review is to provide a classification system for lacrimal occlusive devices based on their location and duration of action as well as to identify different characteristics of each one of them. We want to give a comprehensive overview on punctal and canalicular plugs including their manufacturing companies, indications, and complications that have been reported in various articles. PubMed and Google Scholar were used to identify articles written in English as well as few articles written in Japanese, Chinese, Slovak, and Spanish that had abstracts in English. Nine different companies that manufacture punctal and canalicular plugs were identified and their plugs were included in this review. Punctal and canalicular plugs are used in the management of various ocular conditions including dry eye disease and punctal stenosis as well as in ocular drug delivery. Although they are a relatively safe option, associated complications have been reported in the literature such as infection, allergic reaction, extrusion, and migration