Topograhy guided photo ablation for the correction of irregular astigmatism following laser in situ keratomileusis

To study the safety, efficacy and predictability of topography guided laser in situ keratomileusis [LASIK] to correct irregular astigmatism following previous LASIK surgery resulting from flap melting or decentered ablation. A series of case reports including three eyes of three patients were enrolled in this study. Significant reduction of the irregular astigmatism associated with improvement of the visual acuity was significantly observed following topography guided ablation in these eyes. Topography assisted photo ablation safely and effectively corrected post LASIK astigmatism resulting from melted or decentered flaps

Flap complications after redo in laser in situ keratomilusis

To evaluate the incidence and type of complications of flap elevation and reposition in cases where enhancements were done after LASIK. A retrospective interventional case series comprised 27 eyes of 25 female patients were done over a period of 9 years. Redoes were done 3 to 10 months after the initial LASIK procedure. Flap elevation was performed manually in all cases using the same technique. In 18 eyes [66%], the procedure was completed without complications, in 6 [22%] eye epithelial in growth occurred but was limited to be periphery of the corneal flap without any effect on the vision or flap integrity, in 1 [3.7%] eye epithelial in growth was more aggressive reaching the visual center causing marked effect on the vision, stromal and flap integrity and 2 eyes [7.4%] experienced diffuse lamellar keratitis

Intraocular foreign bodies: Visual outcome and prognostic factors

Purpose: to evaluate and highlight the prognostic factors that might predict the final visual outcome in trauma cases presenting with penetrating metallic IOFBs

Patients and Methods: 26 eyes were included in our study. The IOFB was successfully removed from 24 eyes and could not be located in 2 eyes in spite of presence in the CT scan images. In all cases a complete pars plana vitrectomy was performed with removal of the IOFB either with the FB forceps or with the intraocular magnet. Cataract extraction was performed in opaque or injured lenses with or without IOL implantation as needed

Results: the follow-up period ranged from 6 to 38 months. The final BCVA ranged from LP to 6/12. Sixteen patients [61%] had a final BCVA of 6/24 or better, 6 patients [23%] had a BCVA of 1/60 or better, 2 patients [7.6%] had a final BCVA of HM and 2 patients [7.6%] ended by LP due to a severe PVR in one eye and macular impact by the FB in the other eye. Good visual results were usually obtained in eyes with absent central corneal entry wounds, no associated iris or choroidal tissue prolapse, small size of FB, no retinal detachment and no macular injury. Traumatic cataract was not an important prognostic issue as a lens implantation was usually possible either primarily or at a later stage

Conclusion: in conclusion, penetrating eye trauma is a devastating condition in which prevention can save many eyes. Timely intervention by modern microsurgical techniques including pars plana vitrectomy and removal of the IOFB gives good results, and visual outcome is even better when there is no associated retinal detachment and no uveal tissue prolapse

Nd: YAG laser for drainage of subinternal limiting membrane hemorrhage [Sub ILM]

To highlight the efficacy and drawbacks of drainage of premacular hemorrhage into the vitreous with an Nd:YAG laser. Eight eyes were included in our study. A pulsed Nd:YAG laser was used to drain the entrapped, circumscribed, premacular blood into the vitreous cavity using a standard Goldmann 3-mirror lens. The follow-up period ranged from 8 to 28 months. The follow up period ranged from 8 to 28 months [mean= 18 months]. In 7 eyes, visual acuity improved within 3 weeks a least two lines or more according to standard Snellen chart. In one eye there was a persistent, dense, non-clearing vitreous opacity for 4 months that finally required pars plana vitrectomy to remove this epiretinal membrane. In conclusion, drainage of sub ILM hemorrhage into the vitreous cavity using Nd:YAG laser is an excellent treatment alternative for eyes with recent bleeding compared to pars plana vitrectomy with favorable visual outcome

Phakic anterior chamber lenses for the correction of high myopia

This study aimed to evaluate the clinical and refractive outcome of angle supported phakic intraocular lenses [PIOLs] in the correction of high myopia. Thirty-one eyes of 17 highly myopic patients with a mean age of 27.9 [ +/- 5.1 SD] years were implanted with PIOLs [phakic 6 IOL, OII]. Mean preoperative spherical equivalent [SE] was -16.9 diopters [ +/- 3.84 SD]. Preoperative evaluation included subjective refraction, slit lamp biomicroscopy, tonometry and dilated fundus examination for all patients. PIOL power calculation was based on subjective refraction, AC depth and keratometry using the nomogram supplied by the PIOL manufacturer. Mean follow up period was 11.8 months [range 6-18 months]. The results revealed that mean preoperative best-corrected visual acuity [BCVA] was 0.8 [ +/- 13 SD]. Mean postoperative SE was -0.86 [ +/- 0.75 SD]. Mean postoperative uncorrected visual acuity [UCVA] was 0.67 [ +/- 0.27]. Mean postoperative BCVA was 0.97 [ +/- 0.04 SD]. Specular microscopy was performed on 15 patients preoperatively and at 12 months postoperative. It showed a mean reduction of endothelial cell density of 5.6% one year after surgery. Postoperative anterior uveitis occurred in 2 patients [6.4%]. Pupil ovalization occurred in 2 patients [6.4%] at 12 months postoperative. Steroid induced ocular hypertension occurred in 3 patients [9.6%] at one week postoperative and resolved on adding a topical beta blocker until topical steroids were tapered then discontinued. The study concluded that PIOL implantation is a relatively simple, potentially reversible and a precise procedure for correction of high myopia. It has a predictable and stable refractive outcome. Longer follow up, however, is necessary to evaluate long-term complications such as endothelial cell loss, cataract formation, iris retraction and retinal changes

Small incision secondary implantation of a posterior chamber foldable intraocular lens with scleral fixated suture technique

This new technique was done to evaluate the safety and efficacy of secondary implantation of a scleral fixation injectable silicone IOL. A 70-year-old man underwent uncomplicated intracapsular cataract extraction OS in 1978. He complained of contact lens intolerance and a scleral fixation IOL was implanted, safety and efficacy regarding UCVA, BCVA and induced astigmatism was observed. The results revealed that the patient had UCVA of 20/100 at one month and 20/50 at six months and there was a mild insignificant change in astigmatism. The study concluded that scleral fixation injectable IOL is a safe and effective measure in treating aphakia

Radial keratotomy after photorefractive keratectomy

This study aimed to evaluate the results of radial keratotomy [RK] after photorefractive keratectomy [PRK] for myopic refractive errors. This included efficacy, predictability, safety, validity of available nomograms and complications of the procedure. This prospective study comprised nine eyes of nine patients treated with RK for residual myopic errors following PRK. Patients were followed for at least 12 months. The results revealed that there was a statistically significant reduction in the mean spherical equivalent following the procedure. All eyes had a significant improvement of uncorrected visual acuity [UCVA] postoperatively. No eyes lost two or more lines of best spectacle-corrected visual acuity [BSC-VA]. The results were stable for the minimum follow-up period of 12 months. No complications were encountered. Patient satisfaction was high due to both the good refractive outcome and the relatively low economical value. The study concluded that radial keratotomy is still a valid procedure for addressing the under corrected myopia following PRK. In addition of being an effective, predictable and safe method, it has the great advantage of being an economical and easy procedure

Effect of metabolic control on ocular complications of type 1 [insulin- dependent] diabetes mellitus

In a study of 152 insulin dependent diabetic patients in whom the degree of metabolic control was judged by the level of glycosylated hemoglobin [HbAIc], we found ocular complications in 28 cases [18%]. These ocular complications were: diabetic retinopathy [17.1%], glaucoma [3.3%], rubeosis irides [2%], cataract [1.3%], and ocular palsy [0.6%]. We found that cases who were more liable to develop ocular complications were male patients, those with a positive family history, long postpubertal duration, retarded growth, hyperlipemia, nephropathy, and poor metabolic control as monitored by the level of HbAlc