Retrospective comparison of simultaneous and non-simultaneous bilateral radial keratotomy.

PURPOSE: Many radial keratotomy surgeons advocate bilateral simultaneous surgery, in which there is an inherent, although rare, risk of bilateral sight-threatening complications such as microbial keratitis. This study was designed to evaluate the refractive outcomes of simultaneous and non-simultaneous radial keratotomy performed by a single surgeon. METHODS: We retrospectively compared the results of radial keratotomy performed simultaneously (both eyes operated on the same day, 20 patients) versus non-simultaneously (right and left eyes operated on different days, 71 patients) by a single surgeon. Both eyes had the same surgical procedure, including clear zone diameter and number of incisions. RESULTS: The refractive results of bilateral simultaneous and non-simultaneous surgery were largely equivalent for all parameters analyzed except one. The variability of the difference in postoperative refractive error between right and left eyes was less for those patients undergoing simultaneous surgery (p = .0008). CONCLUSION: Our data suggest that performing radial keratotomy as a bilateral simultaneous procedure increases the symmetry of the refractive effect. In view of recent reports of sight-threatening risks such as bilateral microbial keratitis following bilateral keratotomy, however, the potential risks and benefits of bilateral surgery should be carefully considered before operating on both eyes on the same day.

Corneal surface after deepithelialization using a sharp and a dull instrument.

Manual removal of the corneal epithelium currently precedes excimer laser photorefractive keratectomy. To assess the smoothness of the corneal surface following this procedure, six paired human eye-bank eyes (12 eyes) were manually deepithelialized using a blunt instrument (Paton spatula) on one eye and a sharp instrument (surgical blade) on the contralateral eye; all deepithelializations were done by the same surgeon. The 12 corneas were then resected and processed in an identical fashion for scanning electron microscopy. The microphotographs obtained showed that among the corneas deepithelialized with the blunt spatula, two had a smooth surface, and four had variable amounts of residual epithelial cells and basement membrane, confirmed by light microscopy. The surface of five corneas deepithelialized with the sharp instrument were slightly rougher than the former, with occasional linear scratches; one cornea retained a small amount of basement membrane. Removal of epithelium appears to be more complete when a sharp instrument is used. These findings may have clinical relevance, since residual epithelium and basement membrane after deepithelialization may influence the depth of ablation subsequently achieved with the excimer laser.

Corneal topographic changes over time after radial keratotomy.

Radial keratotomy flattens the cornea, but in a nonuniform fashion. We used computer-assisted topographic analysis to examine curvature changes in different regions of the cornea. Within 45 days after surgery in human eyes, the central and midperipheral cornea flattens and the periphery steepens. Shortly after surgery, the central cornea (within 1-1.5 mm of the corneal light reflex) is steeper than the adjacent midperipheral cornea (1.5-3 mm peripheral to the light reflex). With time, however, the central cornea flattens more than the midperiphery, such that it is no longer relatively steeper. This regional variability in corneal curvature after radial keratotomy helps explain phenomena such as multifocal lens effect after radial keratotomy, and the changes with time account for the conflicting results observed clinically in human corneas and experimentally in human eye bank eyes.

Excimer laser smoothing of a reproducible model of anterior corneal surface irregularity.

A reproducible model of an irregular corneal surface was developed to test the ability of the excimer laser to treat such surfaces. Using a 193-nm argon fluoride excimer laser set at a fluence of 160 mJ/cm2, repetition rate of 10 Hz, and 185 pulses, fresh de-epithelialized pig eyes underwent phototherapeutic ablations through a piece of stainless steel wire screen that masked the cornea. This yielded an uneven corneal surface in a grid-like pattern, with the peaks 50 microns higher than the troughs. The eyes then underwent further treatment in an attempt to smooth the center of the irregularity. Hydroxypropyl-methylcellulose 0.3% protected the valleys in 12 eyes; 2 eyes were ablated without a protecting fluid. The same laser, at the above noted settings, was used, except that both 2 Hz and 10 Hz frequencies were used. Immediately after treatment, the eyes were processed for scanning electron microscopy. The eyes treated at 2 Hz showed less surface irregularity than did those treated at 10 Hz. The eyes treated without a protecting fluid, regardless of repetition rate, had the greatest irregularities. This model is simple and reproducible, and the authors' results suggest that modifying the repetition rates of the excimer laser can influence its effectiveness in smoothing irregular corneas.

Treatment of experimental Pseudomonas keratitis with cyclo-oxygenase and lipoxygenase inhibitors.

The role of metabolites of arachidonic acid in experimental Pseudomonas keratitis was studied using inhibitors of arachidonic acid metabolism. Nordihydroguaiaretic acid 1%, which inhibits predominantly the lipoxygenase pathway, and flurbiprofen 0.03%, which inhibits predominantly the cyclo-oxygenase pathway were administered topically to rabbit eyes after intrastromal injection of Pseudomonas aeruginosa. Levels of the cyclo-oxygenase product prostaglandin E2 (PGE2) and the lipoxygenase product leukotriene B4 (LTB4) were measured, and the number of ulcers that had progressed to descemetocele formation by 24 hours was determined. Corneal ulceration was accelerated by flurbiprofen, but nordihydroguaiaretic acid limited the flurbiprofen-induced worsening. The use of flurbiprofen was associated with decreased levels of PGE2 and a relative increase in LTB4, a potent chemoattractant and activator of polymorphonuclear leukocytes. These results suggest that inhibition of the cyclo-oxygenase pathway may be contraindicated in Pseudomonas keratitis; inhibition of lipoxygenase can prevent this worsening of the keratitis.