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.

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.

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.

Pseudotumor : Distribution, Clinical Features, Treatment Outcomes

PURPOSE: To evaluate the clinical characteristics and results of outcomes in different types of orbital pseudotumor. METHODS: This study included 62 patients diagnosed with orbital pseudotumor between 2002 and 2007, who were followed-up for more than 6 months. The pseudotumor was classified into anterior, diffuse, apical, myositic, or lacrimal types according to computed tomography (CT) findings. All patients were initially treated with corticosteroids and checked for symptom improvement and response to the corticosteroids. RESULTS: Lacrimal type pseudotumor (61%, 39/62) showed the highest incidence, and lid swelling (97%, 60/62) was the most common symptom. Response rate to corticosteroid treatment was 84%, and the recurrence rate was 29%. CONCLUSIONS: The orbital pseudotumors were localized by computed tomography and classified to compare the symptoms, treatment efficacy and recurrence rates between the different types. The orbital pseudotumor is most commonly diagnosed based on clinical symptomsand radiologic features without biopsy. The orbital pseudotumor showed a good treatment response but also a high recurrence rate. Therefore, when starting treatment, it is important to consider differential diagnosis. It is recommended to carefully examine patients who have lid swelling for a few weeks with computed tomography before using corticosteroid treatment.

Two Cases of Subconjunctival Bevacizumab Injection to Prevent Bleb Failure After Trabeculectomy

PURPOSE: Angiogenesis is an integral part of wound healing, which is an unwanted process in the postoperative period after trabeculectomy. It was the aim of this study to report on the subconjunctival use of bevacizumab (Avastin(R)) as an antiproliferative agent to augment trabeculectomy. CASE SUMMARY: This clinical interventional case study included 2 patients with secondary glaucoma associated with uveitis who underwent antiglaucomatous filtering surgery combined with a subconjunctival injection of bevacizumab. Limbal-based trabeculectomy was performed, and subconjunctival injections (1.25 mg/0.05 ml) were given at the end of the surgery adjacent to the bleb, which was raised using a single-use 26 gauge needle. At 1 and 2 weeks and 1, 3, and 6 months after surgery, intraocular pressure was reduced in both patients to 11 mmHg with functioning filtering blebs. No complications were observed. CONCLUSIONS: The results suggest that subconjunctival bevacizumab injection may be helpful in reducing the risk of postoperative scarring of the filtering bleb.

Combination of Laser Treatment and Intravitreal Triamcinolone Injection for Macular Edema with Branch Retinal Vein Occlusion

PURPOSE: To examine the clinical effect of combination method of laser treatment and intravitreal triamcinolone (TA) injection for patient of macular edema with branched retinal vein occlusion (BRVO). METHODS: fifteen patients, -(15 eyes), 7 malse and 8 females, with macular edema associated with BRVO were included in the study. The mean age was 59.47 years old. The response to treatment was monitored functionally by visual acuity assessment and anatomically by Optical Coherence Tomography(OCT) for macular thickness. Four milligrams of TA were injected into the vitreous cavity. The clinical outcome and complication were reviewed, retrospectively. RESULTS: After the combination method of laser treatment and intravitreal TA injection, 13 (87%), 12 (80%), 13 (87%) of the 15 eyes showed improved the mean visual acuity at 1-, 2-, and 6-month follow-ups retrospectively. Central macular thickness as measured by OCT decreased by 37% (312.5 +/- 9 micrometer), 42% (282.1 +/- 556 micrometer), and 56% (276.9 +/- 76 micrometer), at the same follow-ups from an initial pretreatment mean of 495.9 +/- 114 micrometer. The post-operative complications were intraocular pressure elevation (1 eye, 7%), and cataract (3 eyes, 20%). However, there were no serious postoperative complication such as retinal detachment, vitreous hemorrhage, and endophthalmitis. CONCLUSIONS: The combination method of laser treatment and intravitreal TA injection may be useful for treating patient of macular edema with BRVO.

Leakage of Intraocular Silicone Oil into the Subconjunctival Space and Orbit through an Ahmed Glaucoma Valve

PURPOSE: We report a patient with intraocular silicone oil leakage into the subconjunctival space and orbit through an Ahmed glaucoma valve implant. METHODS: A 47-year-old male with high myopia and traumatic retinal detachment underwent in the left eye, pars plana vitrectomy, lensectomy and ultimately intraocular silicone oil placement for traumatic retinal detachment. Subsequently, he developed intractable glaucoma and underwent a superotemporal Ahmed glaucoma tube implant, left eye. RESULTS: Intraocular silicone oil migrated through the Ahmed valve into the subconjunctivalspace and orbit. The Ahmed glaucoma valve was removed with excisional biopsy. CONCLUSIONS: Silicone oil migration through an Ahmed valve may be observed after retinal detachment repair with intraocular silicone oil. An Ahmed valve implantation should be done with great care.