Infectious keratitis after laser refractive surgery.

PURPOSE: To report two cases of infectious keratitis, one fungal after photorefractive keratectomy (PRK) and the other bacterial after laser in situ keratomileusis (LASIK). DESIGN: Two interventional case reports. PARTICIPANTS: Case 1 is a male who was seen 3 weeks after PRK with a corneal ulceration. Case 2 involves a female who was seen 7 weeks after LASIK with interface granularity. RESULTS: Cultures in case 1 were identified as Scopulariopsis species, and despite intensive treatment, a therapeutic penetrating keratoplasty (PK) was eventually performed. Case 2 had cultures identified as Mycobacterium chelonae and also ultimately required a therapeutic PK. CONCLUSIONS: Two unusual infectious keratitides are reported after different laser refractive surgery techniques.

Topical mitomycin-C for subepithelial fibrosis after refractive corneal surgery.

OBJECTIVE: To determine the effectiveness of mitomycin-C (MMC), 0.02%, in preventing recurrence of corneal subepithelial fibrosis after debridement and/or keratectomy in patients who have undergone refractive corneal surgery. DESIGN: Noncomparative case series. PARTICIPANTS: Eight eyes of five patients with corneal subepithelial fibrosis who had previously undergone radial keratotomy (n = 4) or photorefractive keratectomy (n = 4). INTERVENTION: All eyes underwent epithelial debridement followed by a single intraoperative application of MMC (0.02%) for 2 minutes followed by saline irrigation. The eyes were then patched, or a bandage contact lens placed until epithelial healing was complete. MAIN OUTCOME MEASURES: Corneal clarity and best-corrected visual acuity (BCVA). RESULTS: In all cases, the cornea remained clear with no recurrence throughout the follow-up period (6-25 mos., mean, 13.8 mos). No adverse reactions were reported. BCVA improved in all cases. CONCLUSIONS: Subepithelial fibrosis can be a visually disabling condition after refractive corneal surgery. Topical application of MMC (0.02%) may be a successful method of preventing recurrence of subepithelial fibrosis after debridement.

Purse-string sutures for hyperopia following radial keratotomy.

BACKGROUND: Five years ago, we presented 19 procedures employing two intrastromal purse-string sutures to treat hyperopic shift following radial keratotomy. Thirty-four additional procedures and longer follow-up are now presented detailing the task of rehabilitating these eyes. METHODS: Fifty-three eyes of 53 radial keratotomy patients who were unhappy with their uncorrected vision and who were dissatisfied with contact lens or spectacle correction underwent double corneal intrastromal purse-string suturing and were subsequently followed for at least 1 year. There were seven eyes with primary overcorrection and 46 eyes with progressive hyperopic shift. Spherical equivalent refraction before purse-string sutures ranged from +0.50 to +6.25 D (mean, +2.60 D, SD +/- 1.26 D). Prior to purse-string suturing, uncorrected visual acuity ranged from 20/30 to 20/400 with 21 eyes (45.3%) 20/100 or worse. RESULTS: The follow-up after suturing averaged 3.6 years (range, 1 to 10 yr). All patients had follow-up of at least 1 year. The steepening in average keratometric power was 2.94 +/- 1.72 D (range, 1.06 to 6.68 D). The sherical equivalent refraction after suturing averaged -0.15 +/- 1.17 D (range, +3.75 to -2.50 D). Uncorrected visual acuity after suturing was 20/40 or better in 38 eyes (72%) and 20/50 to 20/100 in 15 eyes (28%). The number of eyes with a spherical equivalent refraction of +/- 0.50 D with 0.50 D or less refractive astigmatism was 15 (26% of eyes). There were 34 eyes (66%) with +/- 1.00 D with 1.00 D or less of refractive astigmatism, and 42 eyes (78%) with +/- 2.00 D with 2.00 D or less refractive astigmatism. Most of the spread was on the myopic side, as intended. There were no significant intraoperative or postoperative complications. Fifteen eyes gained two or more lines of best spectacle-corrected visual acuity and no eyes lost one line. CONCLUSION: Double intrastromal purse-string suturing produces steepening of the central cornea and reduces hyperopia after radial keratotomy.

Optical iridectomy for corneal opacities in Peter's anomaly.

Three children were born with partial corneal opacity and anterior segment anomalies but no cataract (Peter's anomaly type 1). In each affected eye, the corneal scar was off center and encroached on the visual axis. Glaucoma (if present) was controlled medically or surgically, after which an optical iridectomy was performed in each eye (in lieu of a penetrating keratoplasty). After surgery, in all patients the pupil extended beyond the corneal opacity and the corneal opacity decreased slightly. All could fixate and follow around the opacity. Optical iridectomy should be considered in selected cases of congenital corneal opacities.

Calcific band keratopathy associated with the use of topical steroid-phosphate preparations.

OBJECTIVE: To report a possible adverse effect of topical steroid-phosphate preparations and to identify factors that may contribute to the development of this effect. DESIGN: The medical records of five patients who developed calcium deposition in the cornea were reviewed and analyzed for possible contributing factors. PATIENTS: Five cases of calcium deposition in the cornea associated with the use of topical steroid-phosphate preparations are described. Scrapings from the cornea and/or specimens obtained at keratoplasty were available in all cases. These cases had the following characteristics in common: use of steroid-phosphate preparations (n = 5); multiple topical drops (n = 5); penetrating keratoplasty (n = 3); presence of epithelial defects (n = 4); history of herpetic stromal keratitis (n = 3) [corrected]; and history of iritis (n = 3). A hypothesis explaining calcium deposition in association with steroid-phosphate preparations is presented. CONCLUSIONS: We recommend withdrawal of steroid-phosphate preparations in patients who develop band keratopathy.

Pupillary capture of a posterior chamber lens following convulsive seizures.

Total pupillary capture of the optic of a posterior chamber intraocular lens (PC-IOL) occurred over 1 year after implantation, following severe, convulsive seizures. We suggest that the generalized seizures and associated extraocular muscle contractures created significantly elevated vitreous pressure, which caused anterior displacement of the IOL. To our knowledge, this is the first reported case of late pupillary capture of a PC-IOL following severe, convulsive seizures.

Surgical correction of hyperopia following radial keratotomy.

BACKGROUND: No effective treatment for hyperopia following radial keratotomy has been described. A new surgical technique of two purse-string intrastromal sutures was investigated for correction of this hyperopia. METHODS: Eighteen radial keratotomy patients who were unhappy with uncorrected vision and who were unsatisfied with contact lens or spectacle correction, after informed consent, underwent corneal suturing. The 19 hyperopic eyes included 5 original overcorrections, 5 overcorrections after reoperation, and 9 progressive hyperopes. The refractive error ranged from +1.25 to +5.75 diopters spherical equivalent (mean +3.47 D). Presuturing uncorrected visual acuity ranged from 20/50 to 20/400 with 11 eyes (58%) 20/100 or worse. RESULTS: The follow up after double purse-string suturing averaged 24 months (range, 12 to 47 months). All patients had follow up of at least 1 year; 14 patients (74%) had follow up of 2 years or more. The change in refractive spherical equivalent following surgery averaged -3.30 D (range, -1.00 to -7.50 D). The steepening in average keratometry was 4.10 D (range, 1.00 to 8.00 D). The refraction after suturing averaged -1.12 D (range, +2.50 to -3.50 D). Uncorrected visual acuity after suturing was 20/40 or better in 14 eyes (74%), and 20/50 to 20/80 in 5 eyes (36%). There were no significant intraoperative, early or late postoperative complications. Seventeen eyes were either the same or gained 1 line of acuity; 2 eyes gained 2 lines of acuity; no eyes lost any lines of refractive Snellen acuity. CONCLUSIONS: The placement of two purse-string intrastromal sutures appears to provide significant steepening of the central cornea following excessive flattening after radial keratotomy. The steepening effect appears to remain stable with greater than 1-year follow up. This surgical technique offers an alternative to symptomatic hyperopic postradial keratotomy patients who cannot be corrected with spectacles or contact lenses.

Radial keratotomy in high myopia: an evaluation of one technique.

Ninety-one consecutive eyes of 53 patients with refractive errors of -6.00 to -11.50 diopters (D) spherical equivalent (mean, -7.48 D) underwent radial keratotomy with redeepening and astigmatic incisions. All eyes were examined at six months, and 65.9% had one year of follow-up (mean follow-up, 11.65 months). In retrospective analysis of this group, 78% of patients had greater than or equal to 20/40 uncorrected visual acuity at six months with 76% at one year. In 59.3% of patients they were with 1.0D of emmetropia at six months with 56.7% at one year. Overcorrections (greater than +1.00D) with 11.1% at six months and 13.3% at one year. Undercorrections (greater than -1.00D) were 29.6% at six months and 30% at one year. Four patients lost two lines of Snellen visual acuity.

Unilateral pseudo-synophthalmos.

A 4 1/2-year-old girl had an unusual congenital defect of her left eye which we have elected to call a unilateral pseudo-synophthalmos. We have found no other such case reported. We review the case history and findings, discuss the embryology, and explore the possible embryologic explanations for such an anomaly.

Corneal edema related to accidental Hibiclens exposure.

Five patients developed corneal edema presumably caused by accidental preoperative ocular exposure to Hibiclens. In all cases, the patients complained of ocular pain after surgery. Conjunctival inflammation and corneal epithelial defects were found in all patients. Between two and ten weeks after exposure, stromal and epithelial edema, with a predilection for the inferior cornea initially, developed in all patients. The corneal edema resolved in three patients in approximately six months, leaving mild stromal scarring and reduced endothelial cell counts. The corneal edema in the other two patients progressed to diffuse bullous keratopathy, which eventually required penetrating keratoplasty. We recommend that Hibiclens be avoided in preoperative preparation of the facial skin to prevent accidental ocular exposure.

Trauma after radial keratotomy.

Eight cases of trauma are reported in seven patients after radial keratotomy. Trauma occurred 2 weeks to 53 months postoperatively. There was mild, moderate, and severe trauma to the orbit and globe region in five patients and severe, direct trauma to the globe in three patients. The incisions remained intact in six cases. Two patients with severe, direct, ocular trauma opened a radial incision, had flat chambers, and were treated successfully with bandage lenses. In all eight instances of trauma, there was no permanent change from pre-trauma acuity (with or without correction).

Modified relaxing incision technique for postkeratoplasty astigmatism.

A modified relaxing incision technique for postkeratoplasty astigmatism is described in this article. Following the initial, standard relaxing incision techniques, a planned spreading and recutting of the initial relaxing incision was performed at 1-3-week intervals following the initial surgery. The wound may be deepened and lengthened if more effect is needed. The number of spreading and recutting procedures is also dependent on the effect required. This additional procedure may be performed for late regression of the desired effect. The endpoint for the procedure is corneal astigmatism that will allow either spectacle or contact lens correction, depending on the patient's visual needs. Corrections of greater than 10 D of astigmatism are possible. The technique allows for evaluation of the corneal astigmatism with no sutures in place. No complications of the recutting and spreading procedure have been noted. There have been no microperforations or macroperforations requiring suturing, no infections, and no graft rejections following the procedures. Seven cases using the modified relaxing incision technique are described.