Clinical Outcomes of Combined Procedure of Astigmatic Keratotomy and Laser in situ Keratomileusis

PURPOSE: To evaluate the clinical outcomes of a combined procedure of astigmatic keratotomy (AK) and laser in situ keratomileusis (LASIK) for the correction of high astigmatism. METHODS: Thirty-five eyes of 19 patients who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity, refractive error, efficacy, safety, and predictability. We compared preoperative and post-AK expected corneal ablation depth using an Amaris Ablation depth table. RESULTS: After astigmatic keratotomy, astigmatism was reduced by 61.43 ± 14.62%, and after LASIK, astigmatism was reduced by 91.65 ± 8.68%. Expected corneal ablation depth was reduced by 18.72 ± 11.77% after astigmatic keratotomy. The proportion of eyes with spherical equivalent 0.5 D or less was 85.71% at 6 months after the combined procedure of astigmatic keratotomy and LASIK. No intraoperative or postoperative complications were observed. CONCLUSIONS: This study showed the combined procedure of astigmatic keratotomy and LASIK is effective for visual acuity, refraction, and reduction in corneal ablation depth.

A Case of Suction Loss During SMILE and a Switch to LASIK

PURPOSE: To report a case of suction loss during small incision lenticule extraction (SMILE) and a good visual outcome after switching to femtosecond laser-assisted in-situ keratomileusis (LASIK). CASE SUMMARY: A 20-year-old female was admitted to receive refractive surgery. During SMILE in the left eye, suction loss occurred at 65% of posterior cut completion. We switched to LASIK and SMILE was performed in the right eye as planned. The uncorrected distance visual acuity was 1.2 with a manifest refraction of +0.25 Dsph with 0 Dcyl. The patient had no complications at 3 months postoperatively. CONCLUSIONS: Suction loss during SMILE is a rare complication. Good visual outcome was achieved by switching to LASIK.

Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

PURPOSE: To evaluate the beveled, full thickness astigmatic keratotomy. METHODS: This study included 185 eyes of 112 patients treated with beveled, full thickness astigmatic keratotomy. Treated eyes were divided into 3 groups: beveled, full thickness astigmatic keratotomy after implantable collamer lens (ICL) implantation (group A), beveled, full thickness astigmatic keratotomy after cataract surgery (group B) and beveled, full thickness astigmatic keratotomy alone (group C). Follow-up visits were at 1 week, 1 month, 3 months and 6 months. The outcome measures included uncorrected distance visual acuity, astigmatism, efficacy, safety and predictability. RESULTS: At 6 months postoperatively, astigmatism was significantly reduced: 68.9 +/- 18.24% in total, 69.24 +/- 20.76%, in the group A, 67.84 +/- 17.56% in the group B and 67.82 +/- 13.97% in the group C. The proportion of eyes with astigmatism 1.0 or less was 88.65% in total, 91.49% in the group A, 87.5% in the group B and 70.0% in the group C. Mean improvement in corrected distance visual acuity (CDVA) was 0.56 lines; no eyes lost 2 lines of CDVA after 6 months postoperatively. Postoperative complications were not observed. CONCLUSIONS: This study showed the beveled, full thickness astigmatic keratotomy is effective and safe for correcting astigmatism alone as well as correcting astigmatism after ICL implantation or cataract surgery.

Outcomes of Small Incision Lenticule Extraction: Mild to Moderate Myopia versus High Myopia

PURPOSE: To evaluate the refractive outcomes of small incision lenticule extraction (SMILE) in high myopia patients compared with mild to moderate myopia patients. METHODS: This study included 332 eyes of 166 myopic patients treated with SMILE using Visumax 500 kHz femtosecond laser. Treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE): mild to moderate myopia (A group, or =-6.0 D). Follow-up visits were at 1 day, 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index and predictability. RESULTS: Preoperative SE was -4.85 +/- 0.86 D in the A group and -7.70 +/- 1.0 D in the B group. No differences were observed between -0.04 +/- 0.29 D in the A group and -0.30 +/- 0.37 D in the B group at 6 months postoperatively (p = 0.062). At 6 months postoperatively, 98.3% and 97.3% had UDVA of 20/25 or better in the A group and B group, respectively. In the A group, 97.3% and 100% were within +/-0.5 D and +/-1.0 D of intended correction and in the B group, 91.7% and 96.9% were within +/-0.5 D and +/-1.0 D, respectively. Efficacy indices were 1.02 +/- 0.19 in the A group and 0.99 +/- 0.18 in the B group. Safety indices were 1.16 +/- 0.16 in the A group and 1.14 +/- 0.16 in the B group. The efficacy and safety indices were not significantly different between the A and B groups at 6 months postoperatively (p = 0.09, p = 0.695, respectively). CONCLUSIONS: This study showed that SMILE is effective and safe for correcting high myopia as well as mild to moderate myopia.

A Case of White-centered Retinal Hemorrhage in Infective Endocarditis

PURPOSE: To report a case of white-centered retinal hemorrhage in infective endocarditis. CASE SUMMARY: A 45-year-old patient complained of acute visual loss. The patient had a history of epidural anesthesia for the relief of back pain. On the day of admission the patient showed no light perception and had a white-centered retinal hemorrhage and cotton wool spot in the left eye upon fundus examination. Other ocular manifestations were not specific and there were no specific findings on a brain MRI and visual evoked potential. The patient was diagnosed with pyogenic spondylitis and was treated by abscess drainage and systemic antibiotics therapy. The patient's near vision improved up to 0.4/0.5. He was diagnosed with infective endocarditis based on the echocardiogram with epidural and subarachnoid hemorrhage. CONCLUSIONS: Roth spot can occur in many diseases such as diabetes, leukemia, anemia, and trauma, but most commonly in sepsis due to infective endocarditis. Therefore, medical evaluation and an echocardiogram for patients with white-centered retinal hemorrhage should be considered.

The Morphological Study of Muller Cells with Enzyme Histochemical Staining in Retina of Induced Diabetic Rats

PURPOSE: To evaluate the morphological changes in Muller cells of an induced diabetic rat model with carbonic anhydrase histochemical staining. METHODS: Retinae of three normal rats and four streptozotocin-induced diabetic rats were used. The morphological changes in the Muller cells of these retinae were observed using enzyme histochemical staining. RESULTS: The numbers of positive staining Muller cells in diabetic rats retinae were significantly lower than those of the normal rats. In addition, the shape of the Muller cell bodies in the streptozotocin-induced diabetic rat model's retina changed from polygonal to abnormally flat. Furthermore, the staining of the Muller cells' segment in the outer nuclear layer of the diabetic rat's retinae were weaker, and some Muller cell segments were not stained at all. CONCLUSIONS: The numbers of Muller cells in diabetic rats' retinae were significantly lower than those of the normal rats. In addition, the features of Muller cell bodies of the diabetic rats were changed morphologically.

Clinical Features of Ophthalmic Artery Hypoperfusion

PURPOSE: The purpose of the study is to investigate the clinical features and relation of systemic disease of ophthalmic artery hypoperfusion (OAH). METHODS: We reviewed the records of 20 eyes of 19 ophthalmic artery hypoperfusionpatients who were followed up for 1month or more. The clinical outcome were reviewed, retrospectively. RESULTS: The patients' chief complain was sudden visual loss (14 eyes, 70.0%) and at initial visit, eyes with OAH had mean visual acuity more than or equal 0.5 in 55.0%. The most common ocular sign is the retinal hemorrhage and choroidal infarction and the most associated systemic disease in these patients is the hypertension in 63.2%. Normal patency or mild changes of the internal carotid artery was seen in 75.0% on the side of OAH. CONCLUSIONS: Ophthalmic artery hypoperfusion has a comparatively good visual prognosis. However, the ophthalmologist's diagnosis may be crucial to the health of these patients, because OAH includes ocular ischemic syndrome that may be the presenting sign of serious cerebrovascular and ischemic heart disease.