Comparison of Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser In-Situ Keratomileusis (F-LASIK) for the correction of myopia and astigmatism: 1-year clinical outcome

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the efficacy, refractive predictability, stability and safety of Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser In-Situ Keratomileusis (F-LASIK) for the correction of myopia and astigmatism.</p> <p style="text-align: justify;"><strong>METHOD:</strong> This study was approved by the Institutional Review Committee of the St. Luke's Medical Center. A retrospective chart review was conducted at the Vision Laser Center of the St. Luke's Medical Center-Global City. All patients that underwent SMILE from January 2014 to July 2014, with adequate follow-up at 1 day, 1 week, 1 month, 3 months and 1 year, were included in the study. Age-matched and refraction-matched patients, who underwent F-LASIK from January 2012 to April 2014, were chosen as comparators. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), attempted refraction versus achieved refraction and adverse events at 1 day, 1 week, 1 month, 3 months and 1 year were compared postoperatively in both groups. Primary outcome measures were efficacy expressed as the percentage of eyes achieving UCVA of 20/25 or better during the postoperative follow-up, refractive predictability, safety and stability. </p> <p style="text-align: justify;"><strong>RESULTS:</strong> Thirty-five eyes of 18 patients who underwent SMILE and 38 eyes of 19 patients who underwent FLASIK were included in the study. The mean preoperative spherical equivalent of both groups had no statistical difference, with -3.84 ± 1.31 D and -4.07 ± 1.39 D for SMILE and F-LASIK, respectively (p=0.801). At 1 week postoperatively, 51% and 97% achieved UCVA of 20/25 or better in the SMILE and F-LASIK groups. At 3 months, 97% had 20/25 vision or better for the SMILE group, while 100% had 20/25 vision or better for the F-LASIK group. At 1 year, both groups achieved 100% 20/25 or better vision. Three percent lost one line of BCVA in both groups at 1 year. Mean spherical equivalent (SE) between groups at 1 year showed no statistically significant difference (p=0.21), with 0.05 ± 0.18 D in the SMILE group and -0.1 ± 0.15 D in the F-LASIK group. No significant change in mean SE was observed within groups from 1 day to 1 year post op, p=0.166 for SMILE and p=0.226 for F-LASIK. At 1 year, 100% of the SMILE and F-LASIK groups were within ± 0.5 D of target refraction. No adverse events were noted in either group. </p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> SMILE was comparable to F-LASIK in terms of visual outcomes (efficacy, refractive predictability, stability) and safety for the treatment of myopia and astigmatism. However, a slight delay in visual improvement during the first week was observed in the SMILE group.</p>

Carbomer versus carbomer with triglyceride in the treatment of dysfunctional-tear syndrome

Purpose: To compare the efficacy of carbomer alone and carbomer with triglyceride in relieving ocular discomfort and improving ocular-surface condition and tear-film stability in patients with dysfunctional-tear syndrome. Methods: We conducted an institution-based, double masked, randomized, controlled trial involving 45 patients (90 eyes) diagnosed with dysfunctional-tear syndrome who were randomly assigned to receive either carbomer alone (Vidisic) or carbomer with triglyceride (Lipolin) eye gels. Corneal and conjunctival staining with fluorescein and lissamine green, tear-breakup time (TBUT), Schirmer test with anesthesia, and subjective gradings of ocular discomfort were measured at baseline and at 1, 2,4, and 8 weeks after treatment. Outcome measures from both groups were subjected to statistical analyses. Results: Fifteen patients in the Vidisic group and 20 patients in the Lipolin group completed the study. The mean age was 53 +/- 12 years (range, 21 to 71). Both groups exhibited significant improvement from baseline in conjunctival lissamine green staining (p=0.001), TBUT (p=0.001), and subjective improvement of symptoms (/> = 0.001) after 8 weeks of treatment. The decrease in conjunctival staining by lissamine green and improvement in Schirmer test were significantly greater for Vidisic (p=0.03 for both). Conjunctival fluorescein staining worsened in the Lipolin group (p=0.02). Corneal fluorescein (p=0.25) and lissamine green (p=0.08) staining, and Schirmer test (p=0.28) were not significantly different for both groups. Conclusion: Vidisic and Lipolin are both well tolerated and effective in reducing dry-eye symptoms, improving ocular-surface integrity, and stabilizing the tear film. There is a trend toward better treatment response with Vidisic.

A mysterious case of bilateral stromal keratitis

OBJECTIVES: To describe a rare case of bilateral stromal keratitis and demonstrate the effectiveness of penetrating keratoplasty in the management of toxocara keratitis. METHOD: This is a case report. RESULTS: A 53-year-old male farmer had a 10-month history of bilateral corneal opacity, photophobia, redness, foreign body sensation, and eye pain. The diagnosis was central microbial keratitis with the following etiologies considered: Epstein-Barr virus, herpes simplex, fungal, syphilis, tuberculosis (TB), myobacteria other than TB, and acanthamoeba. Despite treatment with topical steroids and antibiotics, both eyes worsened. Penetrating keratoplasty markedly improved the patient's visual acuity. Histopathology of the left corneal button revealed toxocara keratitis. CONCLUSION: Good history taking, complete systemic and ocular examinations, and a histopathology of the corneal tissues are vital to the diagnosis of toxocara keratitis. Penetrating keratoplasty was shown to be effective in its management. Emphasis is given on prevention to decrease the incidence of the disease.

Timolol versus latanoprost for primary open-angle glaucoma

CLINICAL SCENARIO: A 46-year-old male consulted for refraction. Best-corrected visual acuity was 20/20 for both eyes (OU), Jaeger 1 for near. Slit-lamp examination was normal. Intraocular pressure (IOP) was 25 mm Hg OU. Gonioscopy revealed iridocorneal angles that were open up to the ciliary body band OU. Funduscopy revealed clear media with no exudates or hemorrhages in the retina. Cup-disc ratio was 0.7 vertically and 0.6 horizontally with notching of the inferotemporal neuroretinal rim OU. Automated visual-field examination showed superior arcuate scotomas OU with no threat to fixation. The working diagnosis upon consultation was primary open-angle glaucoma. After all treatment options had been explained to the patient, a trial of medical therapy was chosen. Given the severity of the glaucoma, a target IOP range was initially set at 15 to 17 mm Hg. Nonselective beta-adrenergic blockers and prostaglandin analogues are two classes of medications that will most probably lower the IOP to the desired levels CLINICAL QUESTION: Among patients undergoing initial medical therapy for primary open-angle glaucoma, would latanoprost be more effective in lowering the IOP compared with timolol? SEARCH METHOD: An electronic literature search was performed using Medline (PubMed). The key words used were "latanoprost" and "timolol." The search was further limited to randomized clinical trials or metaanalysis published in the English language. Table 1 shows the search process performed The search was narrowed down to 5 articles. Abstracts of the articles were reviewed. One article employed ocular hypertensive subjects while another compared brimonidine and timolol. These studies were, therefore, excluded. Among all the metaanalyses obtained from the search, Zhang et al.s had the most number of subjects and outcome measures. It was for this reason that the article was chosen for appraisal in resolving the clinical scenario. (Author)

Laser in situ keratomileusis (LASIK) for high myopia

EXCIMER laser vision correction in the form of LASIK and PRK/LASEK has been proved to be highly effective and safe in the treatment of low-to moderate myopia (less than -6 diopters [D]) and astigmatism. It is the most common refractive-surgery procedure done worldwide. However, the outcome of laser vision correction among those with high myopia (greater than -6D) may not be the same as in those with low to moderate myopia CLINICAL SCENARIO: A 26-year-old, female, myopic patient unhappy with spectacle correction and contact lenses heard about LASIK and sought opinion regarding the probability of her achieving 20/20 vision. Her last refraction was -7.00 sphere -1.00 cylinder x 100 in the right eye (OD) and -9.00 sphere -0.50 cylinder x 90 in the left eye (OS). Best-corrected visual acuity (BCVA) was 20/20 OD and 20/20 OS. Her refraction has been stable for 5 years CLINICAL QUESTION: The patient has high myopia and is concerned about her chances of seeing 20/20 after undergoing laser vision correction. Among patients with high myopia, how effective is LASIK in achieving 20/20 vision? SEARCH METHOD: An electronic literature search was performed using MEDLINE (PubMed). The following search terms were used: "Myopia," "LASIK," "laser in situ keratomileusis," "technology assessment." The search was further limited to the English language and human studies published from 1968 to April 2005. The search yielded 5 articles but only one was relevant to the clinical question CITATION: Sugar A, Rapuano CJ, Culbertson WW, et al. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy. A Report by the American Academy of Ophthalmology. Ophthalmology 2002; 109:175-187. (Author)

The hidden eye: A case of cryptophthalmos

Methods: This is a report of a case of cryptophthalmos seen at the University of the Philippines-Philippine General Hospital (UP-PGH). Differential diagnosis and management options are discussed. Results: A 12-day old boy presented with no right palpebral fissure, eyelashes, or eyebrow. The skin overlying the right orbit was continuous from the forehead to the cheek. Under this skin was a 17 mm x 15 mm soft, round, movable mass anterior to the globe. The left upper lid was colobomatous with no eyebrow and fornix. The left cornea measured 9 mm x 6 mm with exposure keratitis and large ulcer. Ultrasound of the right orbit identified the presence of the right globe with normal posterior segment. Cranial computed tomography (CT) showed a cystic mass anterior to the right globe with absent lens. Visual-evoked response of the left eye established nonspecific severe optic-nerve damage, delayed visual-pathway maturation and visual-pathway affectation. Conclusion: Management of complete cryptophthalmos is difficult and requires separation of the lids and placement of mucous membrane grafts to allow for fitting of prosthesis. Reconstruction of the lid coloboma is necessary to prevent exposure keratitis. Genetic counseling is also important in the management of cryptophthalmos.