Intrastromal corneal ring segment implantation for ectasia after refractive surgery.

Posted Posted in cornea, Uncategorized
Arq Bras Oftalmol. 2015 Jul-Aug;78(4):212-5. doi: 10.5935/0004-2749.20150055.

Intrastromal corneal ring segment implantation for ectasia after refractive surgery.

Abstract

PURPOSE:

To evaluate the clinical outcomes of intrastromal corneal ring segment (ICRS) implantation to correct ectasia in eyes with prior refractive surgery.

METHODS:

Forty-one eyes of 25 patients (13 men, 12 women; mean age, 28.66 years) with ectasia after refractive surgery [photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK)] were included in a nonrandomized, retrospective, observational case series. Corneal tunnels were created by mechanical dissection in all eyes. Main outcome measures included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), refraction, keratometry, and computerized analysis of corneal topography. Patients were divided into two groups by the type of refractive surgery (Group A: PRK, Group B: LASIK).

RESULTS:

The mean preoperative manifest astigmatism decreased from -1.88 to -0.84 D in Group A (p=0.096) and -3.18 to -1.77 D in Group B (p=0.000). The mean keratometric astigmatism decreased from -2.58 to -1.66 D in Group A (p=0.010) and -4.80 to -2.78 D in Group B (p=0.000). The mean spherical equivalent decreased from -2.97 to -2.05 D in Group A (p=0.065) and -3.31 to -2.42 D in Group B (p=0.014). No significant between-group differences were noted on the comparison of preoperative and postoperative results. No intraoperative or postoperative complications were observed.

CONCLUSION:

ICRS implantation is a useful treatment option for ectasia following refractive surgery, and it has significantly reduced the refractive cylinder and increased best spectacle-corrected visual acuity.

RESULTS:

The mean preoperative manifest astigmatism decreased from -1.88 to -0.84 D in Group A (p=0.096) and -3.18 to -1.77 D in Group B (p=0.000). The mean keratometric astigmatism decreased from -2.58 to -1.66 D in Group A (p=0.010) and -4.80 to -2.78 D in Group B (p=0.000). The mean spherical equivalent decreased from -2.97 to -2.05 D in Group A (p=0.065) and -3.31 to -2.42 D in Group B (p=0.014). No significant between-group differences were noted on the comparison of preoperative and postoperative results. No intraoperative or postoperative complications were observed.

CONCLUSION:

ICRS implantation is a useful treatment option for ectasia following refractive surgery, and it has significantly reduced the refractive cylinder and increased best spectacle-corrected visual acuity.

Vector analysis of astigmatism before and after LASIK: a comparison of two different platforms for treatment of high astigmatism.

Posted Posted in cornea

Astigmatism, Excimer laser, LASIK, Vector analysis

Graefes Arch Clin Exp Ophthalmol. 2015 Dec;253(12):2325-33. doi: 10.1007/s00417-015-3177-x. Epub 2015 Sep 24.

Vector analysis of astigmatism before and after LASIK: a comparison of two different platforms for treatment of high astigmatism.

Abstract

PURPOSE:

To compare the outcomes of astigmatic laser in-situ keratomileusis (LASIK) procedures between two different platforms using J0 and J45 vector analysis.

METHODS:

Patients were divided into four groups, depending on the type of astigmatism and laser platform on which they were treated. Astigmatism was between 2 and 7 diopters (D). One hundred and thirty-five patients with myopic astigmatism (246 eyes) and 102 patients with mixed astigmatism (172 eyes) underwent unremarkable LASIK correction on Wavelight Allegretto Eye-Q 400Hz and Schwind Amaris 750S laserplatform. The preoperative and postoperative sphere, negative cylinder [C] and axis (ø) of manifest refractions were subjected to vector analysis by calculations of the standard J0 (cos [4π(ø-90)/360]xC/2) and J45 (sin[4π(ø-90)/360]xC/2).

RESULTS:

Reporting the key results, we found J0 significantly reduced after LASIK in both groups (p < 0.001) but not J45. There was no significant association between individual pairs of pre and postoperative J0 & J45 values. There was no significant difference between the outcomes of the two platforms.

CONCLUSIONS:

Wavelight Allegretto 400Hz and Schwind Amaris 750S showed excellent results for treating patients with astigmatism, regardless whether it is mixed or myopic astigmatism. The J45 did not reduce significantly possibly because of the low number of eyes with oblique astigmatism. There was no genuine difference post-operatively between groups treated on two different laser platforms according to the vector analyses.

KEYWORDS:

Astigmatism; Excimer laser; LASIK; Vector analysis

CONCLUSIONS:

Wavelight Allegretto 400Hz and Schwind Amaris 750S showed excellent results for treating patients with astigmatism, regardless whether it is mixed or myopic astigmatism. The J45 did not reduce significantly possibly because of the low number of eyes with oblique astigmatism. There was no genuine difference post-operatively between groups treated on two different laser platforms according to the vector analyses.

KEYWORDS:

Astigmatism; Excimer laser; LASIK; Vector analysis

Femtosecond Laser Flap Creation for Laser In Situ Keratomileusis in the Setting of Previous Radial Keratotomy.

Posted Posted in cornea, lasik
Asia Pac J Ophthalmol (Phila). 2015 Sep-Oct;4(5):283-5. doi: 10.1097/APO.0000000000000131.

Femtosecond Laser Flap Creation for Laser In Situ Keratomileusis in the Setting of Previous Radial Keratotomy.

Abstract

PURPOSE:

The aim of the study was to report the outcomes of laser in situ keratomileusis (LASIK) in subjects with previous radial keratotomy (RK) using a novel femtosecond laser setting on a proprietary femtosecond laser platform.

DESIGN:

This was a retrospective, consecutive chart review of patients at a single private practice institution.

METHODS:

The medical records of 16 eyes of 8 subjects who underwent femtosecond-assisted LASIK for consecutive hyperopia after RK were retrospectively reviewed. The preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed.

RESULTS:

All 16 eyes had successful femtosecond laser flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity significantly improved postoperatively (P = 0.0142) and remained stable through the final follow-up interval at 9 to 12 months postoperatively. None of the subjects lost any lines of best spectacle-corrected visual acuity in the postoperative period.

CONCLUSIONS:

The novel femtosecond laser technique described in this study can provide a safe and effective method for patients undergoingLASIK after previous RK. Future investigations are required to further validate the findings reported in this study.

DESIGN:

This was a retrospective, consecutive chart review of patients at a single private practice institution.

METHODS:

The medical records of 16 eyes of 8 subjects who underwent femtosecond-assisted LASIK for consecutive hyperopia after RK were retrospectively reviewed. The preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed.

RESULTS:

All 16 eyes had successful femtosecond laser flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity significantly improved postoperatively (P = 0.0142) and remained stable through the final follow-up interval at 9 to 12 months postoperatively. None of the subjects lost any lines of best spectacle-corrected visual acuity in the postoperative period.

CONCLUSIONS:

The novel femtosecond laser technique described in this study can provide a safe and effective method for patients undergoingLASIK after previous RK. Future investigations are required to further validate the findings reported in this study.

Soft Contact Lens Optimizes Visual Goals for a Patient with Keratoectasia.

Posted Posted in cornea, lasik
Optom Vis Sci. 2015 Nov;92(11):e409-13. doi: 10.1097/OPX.0000000000000703.

Soft Contact Lens Optimizes Visual Goals for a Patient with Keratoectasia.

Abstract

PURPOSE:

To determine the usefulness of the KeraSoft IC lens with a patient with high visual and comfort demands with keratoectasia.

CASE REPORT:

A 30-year-old white woman was diagnosed as having bilateral corneal ectasia after laser-assisted in situ keratomileusis. She underwent a penetrating keratoplasty for her left eye with subsequent photorefractive keratectomy to improve visual acuity. She was referred by her corneal specialist for a specialty contact lens evaluation to improve contact lens visual acuity and comfort during demanding physical activities.

CONCLUSIONS:

This case highlights the success of the KeraSoft IC soft contact lens for irregular corneas to address specific visual and comfort demands during physical fitness activities.

Optom Vis Sci. 2015 Nov;92(11):e409-13. doi: 10.1097/OPX.0000000000000703.

Soft Contact Lens Optimizes Visual Goals for a Patient with Keratoectasia.

Abstract

PURPOSE:

To determine the usefulness of the KeraSoft IC lens with a patient with high visual and comfort demands with keratoectasia.

CASE REPORT:

A 30-year-old white woman was diagnosed as having bilateral corneal ectasia after laser-assisted in situ keratomileusis. She underwent a penetrating keratoplasty for her left eye with subsequent photorefractive keratectomy to improve visual acuity. She was referred by her corneal specialist for a specialty contact lens evaluation to improve contact lens visual acuity and comfort during demanding physical activities.

CONCLUSIONS:

This case highlights the success of the KeraSoft IC soft contact lens for irregular corneas to address specific visual and comfort demands during physical fitness activities.

Optom Vis Sci. 2015 Nov;92(11):e409-13. doi: 10.1097/OPX.0000000000000703.

Soft Contact Lens Optimizes Visual Goals for a Patient with Keratoectasia.

Abstract

PURPOSE:

To determine the usefulness of the KeraSoft IC lens with a patient with high visual and comfort demands with keratoectasia.

CASE REPORT:

A 30-year-old white woman was diagnosed as having bilateral corneal ectasia after laser-assisted in situ keratomileusis. She underwent a penetrating keratoplasty for her left eye with subsequent photorefractive keratectomy to improve visual acuity. She was referred by her corneal specialist for a specialty contact lens evaluation to improve contact lens visual acuity and comfort during demanding physical activities.

CONCLUSIONS:

This case highlights the success of the KeraSoft IC soft contact lens for irregular corneas to address specific visual and comfort demands during physical fitness activities.

Femtosecond-assisted laser in situ keratomileusis for consecutive hyperopia after radial keratotomy.

Posted Posted in cornea, glaucoma, lasik, Retina
J Cataract Refract Surg. 2015 Aug;41(8):1594-601. doi: 10.1016/j.jcrs.2015.08.014.

Femtosecond-assisted laser in situ keratomileusis for consecutive hyperopia after radial keratotomy.

Abstract

PURPOSE:

To evaluate femtosecond-assisted laser in situ keratomileusis (LASIK) for the treatment of hyperopic shift after radial keratotomy (RK).

SETTING:

Private practice, Siena, Italy.

DESIGN:

Prospective case series.

METHODS:

Eyes with a spherical equivalent (SE) of +1.0 diopters (D) to +4.0 D after RK with 6 or 8 incisions had LASIK. The flap (nominal thickness 130 μm) was created with a femtosecond laser (LDV Z2); the refractive ablation was performed with an excimer laser (217P). The flap was dissected in a centrifugal fashion along previous RK cuts.

RESULTS:

Eighteen eyes of 10 patients were treated. Preoperatively, the mean defocus equivalent was 3.13 diopters (D) ± 0.71 (SD); the corrected distance visual acuity (CDVA) was 0.09 ± 0.06 logMAR. At 9 months, the mean defocus equivalent was 0.51 ± 0.47 D (P < .05), with 13 eyes (72%) having 0.50 D or less of defocus equivalent and 16 eyes (89%) having 1.0 D or less of defocus equivalent. The mean CDVA was 0.04 ± 0.06 logMAR (P < .05). No lines of logMAR CDVA were lost. The mean uncorrected distance visual acuity was 0.11 ± 0.10 logMAR. The safety index was 1.11; the efficacy index was 0.97. No retreatments were performed. Flap complications were limited to an RK incision opening larger than 2 mm in 3 eyes and 1 case of a small, self-limiting epithelial ingrowth.

CONCLUSION:

Laser in situ keratomileusis with a low-energy femtosecond laser was a safe and effective approach to treat post-RK hyperopia, causing no relevant inflammation.

RESULTS:

Eighteen eyes of 10 patients were treated. Preoperatively, the mean defocus equivalent was 3.13 diopters (D) ± 0.71 (SD); the corrected distance visual acuity (CDVA) was 0.09 ± 0.06 logMAR. At 9 months, the mean defocus equivalent was 0.51 ± 0.47 D (P < .05), with 13 eyes (72%) having 0.50 D or less of defocus equivalent and 16 eyes (89%) having 1.0 D or less of defocus equivalent. The mean CDVA was 0.04 ± 0.06 logMAR (P < .05). No lines of logMAR CDVA were lost. The mean uncorrected distance visual acuity was 0.11 ± 0.10 logMAR. The safety index was 1.11; the efficacy index was 0.97. No retreatments were performed. Flap complications were limited to an RK incision opening larger than 2 mm in 3 eyes and 1 case of a small, self-limiting epithelial ingrowth.

CONCLUSION:

Laser in situ keratomileusis with a low-energy femtosecond laser was a safe and effective approach to treat post-RK hyperopia, causing no relevant inflammation.

Evaluation of a short-term topical interferon α-2b treatment for histologically proven melanoma and primary acquired melanosis with atypia.

Posted Posted in eye health
Orbit. 2015 Dec 4:1-6. [Epub ahead of print]

Evaluation of a short-term topical interferon α-2b treatment for histologically proven melanoma and primary acquired melanosis with atypia.

Abstract

OBJECTIVE:

To evaluate the efficiency of series of 6-week treatments with brief intervals (6-week = 1 cycle) of topical Interferon α-2b (IFNα-2b) treatment in primary acquired melanosis (PAM) with atypia and melanoma of the conjunctiva.

PATIENTS AND METHODS:

Five patients with biopsy-proven PAM with atypia and seven patients with melanoma of the conjunctiva, treated with topical IFNα-2b (1 million units/ml, 5 times daily), were included in the study. All patients had colour photographs and the tumour area was measured manually for each patient before and after treatment.

RESULTS:

The median age of 12 patients at initiation of treatment was 61.5 years (range 39-75 years). The mean therapy duration was 2.4 cycles (range 1-6 cycle). Compared to pretreatment lesion dimension, the mean decrease in tumour size were after the first cycle 66% (range 18-98%; p = 0.004; n = 10 patients), after the second cycle 55% (range 10-100%; p = 0.016; n = 7 patients), and after the third cycle 74% (range 23-100%; n = 3 patients). In one patient 6 cycles of topical IFNα-2b were needed. The decrease in size was 22% after the 4th cycle, 34% after the 5th cycle, and 98% after the 6th cycle.

CONCLUSION:

Our clinical experience demonstrates promising results of topical IFNα-2b treatment for PAM with atypia and melanoma of the conjunctiva without any local or systemic side effects. However, future multicenter prospective studies are recommended to confirm the efficiency and safety of topical IFNα-2b treatment.

KEYWORDS:

Conjunctiva; Topical IFNα-2b; melanoma; primary acquired melanosis with atypia

CONCLUSION:

Our clinical experience demonstrates promising results of topical IFNα-2b treatment for PAM with atypia and melanoma of the conjunctiva without any local or systemic side effects. However, future multicenter prospective studies are recommended to confirm the efficiency and safety of topical IFNα-2b treatment.

KEYWORDS:

Conjunctiva; Topical IFNα-2b; melanoma; primary acquired melanosis with atypia