Intraoperative flap complications in laser in situ keratomileusis with two types of microkeratomes

To determine the incidence and types of intraoperative flap complications in laser in situ keratomileusis [LASIK] encountered with the Hansatome microkeratome and the Moria microkeratome. In this retrospective case series, all patients with intraoperative flap complications who were treated between June 1999 and July 2008 at the Eye Consultants Center in Riyadh, Saudi Arabia, were identified and reviewed. Of the 4352 subjects who underwent bilateral primary LASIK procedure, intraoperative microkeratome complications were detected in 89 eyes of 83 patients. The overall incidence of flap complications was 89/8704 [1.00%]: incomplete flaps occurred in 53 eyes [0.60%], followed by buttonhole flaps in 17 eyes [0.19%], free complete flaps in 10 eyes [0.11%], free partial flaps in 6 eyes [0.07%], sluffed epithelium in 2 eyes [0.023%], and a splitted flap [vertical flap cut] in 1 eye [0.01%]. The incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were 1.21% [41/3378] and 0.90% [48/5326], respectively [P = 0.19]. There was a statistically significant difference between the two microkeratomes with regard to the incidence of buttonhole flaps: 0.33% [11/3378] for the Hansatome microkeratome versus 0.11% [6/5326] for the Moria microkeratome [P = 0.04]. Generally, the incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were similar. However, buttonhole flaps occurred more often with the Hansatome microkeratome [a type of microkeratome that produces larger flaps]. The commonest complication encountered was the incomplete flap, followed by the buttonhole flap and free flap

Outcomes of retreatment after aborted laser In Situ keratomileusis due to flap complications

To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis [LASIK] due to flap complications. This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment. Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes [66.7%], buttonhole flaps in 7 eyes [21.2%], free partial flaps in 3 eyes [9.1%], and a free complete flap in 1 eye [3.0%]. Twenty-two eyes [66.7%] were retreated with LASIK, and 11 eyes [33.3%] were retreated with surface ablation. The mean spherical equivalent [SE] was ?0.23 +/- 0.72 D, the mean astigmatism was ?0.65 +/- 0.89 D, and the mean loss of the best corrected visual acuity [BCVA] was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation [P=0.610]. There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation [P=0.756]. There were no intraoperative complications and no eyes required a second retreatment. Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable

role of vascular endothelial growth factor and its inhibitors in diabetic macular edema: a review

Experimental and clinical evidence have shown the pivotal role of vascular endothelial growth factor [VEGF] in the etiology of diabetic macular edema [DME] as well as proliferative diabetic retinopathy as a permeability and angiogenesis factor. In the absence of an effective treatment to improve vision in most cases of DME, which is a very common cause of central vision impairment in adults, it is logical to investigate the efficacy of anti-VEGF therapy in DME. Short-term results showed that anti-VEGF drugs are effective and safe in the treatment of DME, especially the diffuse types. A major concern is the short duration of action of available ones and the lack of long-term, randomized clinical trails. These agents are a very good add to our armamentarium in the management of DME and should be used with care in selected cases for the time being. The future is promising for longer acting and more specific anti-VEGF agents that would increase efficacy and decrease possible side effects

Management of posteriorly dislocated intraocular lens in vitrectomized eyes: a new surgical technique

Management of posterior chamber intraocular lenses [PCIOL] dislocated into the vitreous cavity classically involves pars plana surgical approach. The aim of this communication is to describe a new surgical technique to manage posteriorly dislocated PCIOL in a vitrectomized eye. A simple technique, requiring the performance of neither pars plana surgery nor a conjunctival incision, is described for managing a posteriorly dislocated PCIOL in vitrectomized eyes. This technique utilizes the prone [face-down] position intra-operatively to bring the PCIOL into the anterior chamber, which can then be managed accordingly. Success of PCIOL explanation by intra-operative positioning and best-corrected visual acuity. Delivering PCIOL into the anterior segment of this vitrectomized eye was achieved successfully by assuming prone position. Once in the anterior chamber [AC], PCIOL was explanted and replaced by ACIOL with improvement in vision. This technique is simple, safe, and can be performed by anterior segment surgeons to manage posteriorly dislocated PCIOL in vitrectomized eyes

Mobile Pigmented Posterior Vitreous Cyst

Purpose: To describe a 30-year-old man who presented with a mobile pigmented vitreous cyst in the left eye without any other ocular abnormalities. Clinical evaluation along with photography and video recording to document the appearance and mobility of the cyst. The patient was observed and followed up over a 10-year period. The patient was able to tolerate the trivial symptoms produced by the cyst, which did not increase in size. Observation with regular follow up is advised as the initial plan for this condition if the cyst is benign

Retinopathy of prematurity at a University Hospital in Riyadh, Saudi Arabia

To prospectively study the incidence and nature of retinopathy of prematurity [ROP] at a University Hospital in Riyadh, Kingdom of Saudi Arabia. This study was carried out the Neonatal Intensive Care Unit of King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia. One hundred and ninety-five consecutive preterm infants with a birth weight of 2000 g or less were screened for ROP. The first examination was performed at 4-7 weeks of postnatal age. Mean gestational age of all premature infants was 28.4 +/- 2.4 weeks [range 22-34], mean birth weight was 1103 +/- 302 g [range 520-1960], and mean duration of oxygen therapy was 24.0 +/- 32.2 days [range 0-210]. Seventy-three children developed acute ROP, giving an overall incidence of 37.4%. The incidence in preterms with birth weight of <1500 g and <1250 g was 41% and 50.7%. No infants with a birth weight of >1500 g developed ROP. Nineteen of the 73 children with ROP [26% or 9.7% of all infants studied] reached threshold ROP, and needed laser treatment or cryotherapy which induced regression in all of patients. Incidence of ROP in our patients in comparable to other reports. Screening for ROP should be carried out for all preterms of <1500 g birth weight. Such screening programs will identify those requiring retinal ablative surgery in order to induce regression of the acute ROP and prevent cicatrizing sequelae with subsequent traction retinal detachment and blindness

Peripheral retinal changes: a survey of high school boys from Hail, Saudi Arabi

Purpose: A clinical study was carried out to document the prevalence of developmental degenerative changes in the peripheral retina which are sometimes precursors of retinal detachment. We examined the eyes of 330 normal, asymptomatic High School boys of Saudi Arabian origin at three schools in hail, Saudi Arabia. Peripheral cystoid degeneration was a very common finding. Lattice degeneration was found in 30[9.1%] subjects, 13 of whom had bilateral lattice degeneration. In seven eyes lattice degeneration was associated with atrophic holes. Retinal breaks were found in 21[6.4%] subjects; the majority [78.3%] were atrophic holes with 38.9% found within areas of lattice degeneration. Other retinal changes discovered were: white without pressure, retinal tufts, paving stone degeneration, meridional folds, and meridional complexes. Knowledge of these peripheral retinal changes is important in understanding the mechanism, management and, more importantly, the prevention of rhegmatogenous retinal detachment. Prophylactic treatment of the asymptomatic precursor tesions of retinal detachment is rarely indicated in the absence of high risk factors such as myopia, aphakia, retinal detachment in the other eye, or a family history of retinal detachment