Photorefractive corneal procedures in patients with systemic diseases

This retrospective, non-randomized, non-comparative clinical study included 14 eyes of 7 patients who underwent laser in situ keratomileusis [LASIK] and 4 eyes of 4 patients who underwent photorefractive keratectomy [PRK] as a primary procedure to correct their myopia and astigmatism. All patients had a history of controlled systemic autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, psoriasis and Behcet's disease. The visual acuity, refraction, keratometric readings, slit-lamp biomicroscopy and corneal topography were assessed in these eyes at regular follow-up periods of 1, 3 and 6 months postoperatively. The mean pre-LASIK/PRK spherical equivalent [SE] decreased from -4.01 D +/- 1.51 standard deviation [SD] preoperatively to - 0.31 D +/- 0.47 SD by the end of the sixth postoperative month which was statistically significant. The mean preoperative uncorrected visual acuity [UCVA] was less than 20/200. Six months after LASIK/PRK procedure, UCVA was 20/25 that was also statistically significant. Retreatment for regression was necessary in 5 [27.7%] eyes at variable periods of time following the primary procedure. The procedures were done easily without any unusual intraoperative complications. The postoperative symptom suggestive of dry eye were not more than usual with the exception of one eye which developed exaggerated symptoms

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