Secondary glaucoma and visual axis opacification in aphakic and pseudophakic patients following congenital cataract surgery: A 28-year longitudinal case series.

PURPOSE: To determine the incidence, timing and risk factors for glaucoma and visual axis opacification development following surgery for congenital cataract in the first year of life. METHODS: A prospective case series of all cataract surgery performed in Temple Street Children's University Hospital over a 28-year period was conducted. A total of 93 subjects (135 eyes) were analysed. Sixty-two eyes had a primary intraocular lens inserted at the time of surgery; 73 eyes were aphakic. We recorded patient demographics, age at surgery, length of follow-up, rates and time to diagnosis of glaucoma and rates of visual axis opacification. Relative risk analysis was performed to identify potential risk factors for secondary glaucoma and visual axis opacification. RESULTS: Mean length of follow-up was 160.02 ± 64.42 months (13.3 years), range 40-336 months. Final mean LogMAR across all groups was 0.85 ± 0.51 (0.90). Overall 45 (33.33%) eyes developed secondary glaucoma, 12 (19.4%) in pseudophakic eyes and 33 (45.21%) in aphakic eyes. The incidence of glaucoma was highest in bilateral aphakia (relative risk 1.96, p = 0.0240) and in eyes with corneal diameter <9.5 mm (relative risk 1.93, p = 0.0364). There was no significant difference in glaucoma rates between pseudophakia and aphakia in those operated on less than 2.5 months of age. Secondary glaucoma occurred between 3 months to 16.5 years post surgery. Rates of visual axis opacification were lower in aphakia compared to pseudophakia (relative risk 0.59, p = 0.0098). CONCLUSION: Overall glaucoma rates of one-third are similar to those recorded in the infantile aphakic treatment study. It can occur up to 17 years post cataract surgery, evidence that long-term follow-up is imperative.

Avoiding big bubble complications: outcomes of layer-by-layer deep anterior lamellar keratoplasty in children.

BACKGROUND/AIMS: To describe the visual and clinical outcomes of manual layer-by-layer deep anterior lamellar keratoplasty (DALK) in a paediatric population. METHODS: The charts of all children who underwent DALK surgery between January 2007 and January 2015 were reviewed retrospectively. Data collected included preoperative and postoperative spectacle-corrected distance visual acuity (CDVA), intraoperative and postoperative complications including graft rejection and failure. Residual posterior lamellar thickness (RPLT) and endothelial cell density (ECD) were measured in eyes with follow-up longer than 6 months. RESULTS: Fifty-one eyes of 42 patients were included in the study. The mean patient age at surgery was 11.2±5.2 years and the mean follow-up time was 36.5±23.7 months. The most common indications for surgery were mucopolysaccharidosis (29.4%) and keratoconus (23.5%). Nine eyes (17.6%) had intraoperative microperforation, none of which were converted to penetrating keratoplasty (PKP). Only one eye (2.0%) was converted to PKP. Five eyes (9.8%) had a stromal rejection episode of which one eye failed. Another four eyes (7.8%) experienced graft failure among which three eyes (75%) had infectious keratitis. Three of the five failed grafts had a successful repeat DALK. The average RPLT was 81.9±36.5µm. ECD was significantly lower in the operated eye compared with the normal eye (3096±333 cells/mm2 vs 3376±342 cells/mm2, n=11, P=0.003). The mean postoperative CDVA was 0.5±0.4 logarithm of the minimum angle of resolution (logMAR) reflecting a gain of 0.3 logMAR (P<0.001). CONCLUSION: Manual dissection DALK is a safe procedure in children with stromal opacities. Despite successful structural rehabilitation, functional recovery is still suboptimal mostly due to amblyopia.

Forceps Delivery-Related Ophthalmic Injuries: A Case Series.

PURPOSE: To report a case series of neonatal ophthalmic trauma induced by forceps-assisted vaginal delivery. METHODS: Retrospective, non-comparative case series focusing on presentation and long-term outcomes. RESULTS: Eleven cases of ophthalmic injury secondary to forceps delivery (7 male, 4 female) from October 1997 to July 2014 are presented. Eight cases were born at a single center from January 2006 to July 2014, a rate of 1 case per 413 forceps-assisted deliveries. Follow-up ranged from 2 months to 17 years. Three cases had self-limiting eyelid bruising only. There was one case each of vitreous hemorrhage and hyphema, which resolved spontaneously. There were two cases of oculomotor nerve palsy associated with intracranial hemorrhage, both requiring surgical ptosis repair at 3 and 5 weeks old, respectively. There was one case of facial nerve palsy. Four cases sustained corneal trauma, manifesting as corneal edema in three cases at birth. The fourth of these cases presented at age 4.5 years with corneal scarring and amblyopia. Resulting astigmatism in these four cases ranged from 3.5 to 7.5 diopters and best-corrected visual acuity ranged from 6/12 to 6/36 Snellen at last follow-up. CONCLUSIONS: Although rare, ophthalmic trauma secondary to forceps-assisted delivery can result in a wide spectrum of anatomical injuries, which may be self-limiting or cause significant long-term visual impairment. The authors recommend awareness among obstetricians and pediatricians of these injuries, and referral to the ophthalmologist of any newborn delivered by forceps with evidence of compressive trauma such as scalp or eyelid bruising to rule out the presence of more serious ophthalmic trauma.

Incidence of dislocated and subluxed iris-fixated phakic intraocular lens and outcomes following re-enclavation.

BACKGROUND: The purpose of this study was to establish the incidence of re-enclavation of iris-fixated phakic intraocular lenses in our centre and evaluate outcomes following re-enclavation. DESIGN: Retrospective observational case series. Single surgeon, hospital setting. PARTICIPANTS: Six hundred and nine patients (1218 eyes) implanted with iris-fixated phakic intraocular lenses between 2000 and 2011. METHODS: Eyes requiring re-enclavation were identified, and outcome measures were evaluated 12 months following re-enclavation. MAIN OUTCOME MEASURES: Rate of re-enclavation, uncorrected distance visual acuity and manifest refractive spherical equivalent were measured 12 months following re-enclavation. RESULTS: Twenty-five eyes (2% of eyes overall) of 20 patients required re-enclavation of a dislocated or subluxed phakic intraocular lens. Eight cases (32%) dislocated secondary to trauma and 17 (68%) subluxed spontaneously. No significant difference was detected (P = 0.59) in uncorrected distance visual acuity (logMAR equivalent) 12 months post-re-enclavation (0.18 ± 0.04) compared with that recorded 6 months post-initial uneventful phakic intraocular lens implantation (0.10 ± 0.06). No significant difference was detected (P = 0.95) in mean manifest refractive spherical equivalent 12 months post-re-enclavation (-0.59D ± 0.29D) compared with that recorded 6 months post-initial phakic intraocular lens implantation (-0.57D ± 0.17D). Following re-enclavation, mean endothelial cell count was 2627 ± 101 cells/mm(2) 12 months postoperatively in 16 eyes. This did not differ significantly from that recorded 6 months post-initial phakic intraocular lens implantation in these eyes (P = 1). CONCLUSION: Dislocation and subluxation of iris-fixated phakic intraocular lenses may occur secondary to trauma or spontaneously because of inadequate iris enclavation. Re-enclavation can be carried out successfully with no significant adverse effect on clinical outcomes.

Primary conjunctival anaplastic large cell lymphoma in a child.

Conjunctival tumors in children are uncommon and behave differently from those in adults. The vast majority of tumors are benign. Of the malignant lesions in this age group, lymphoma and melanoma are most commonly reported. Most lymphoid tumors in children represent lymphoid hyperplasia, not lymphoma. Clinical differentiation of these two entities is not possible and biopsy is required to establish the diagnosis. We present an unusual case of primary anaplastic large cell lymphoma of the conjunctiva in a young boy.

Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery.

BACKGROUND: The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy. DESIGN: Prospective hospital-based study. PARTICIPANTS: Eighty-five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at The Mater Misericordiae University and The Mater Private Hospital, Dublin, Ireland. METHODS: Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1-year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications. MAIN OUTCOME MEASURES: The intraoperative and postoperative bleeding rates. RESULTS: One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus. CONCLUSIONS: There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period.

Vision-related quality of life assessment using the NEI-VFQ-25 in adolescents and young adults with a history of congenital cataract.

PURPOSE: To assess vision-specific health-related quality of life in adolescents and young adults with a history of congenital cataract using the National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25). METHODS: A retrospective chart review was performed for patients who underwent surgery aged younger than 24 months. Those 13 years or older at follow-up were selected for inclusion. Educational attainment was determined. A control group of healthy individuals of similar age with no visual complaints also completed the questionnaire. RESULTS: Sixteen patients with a history of unilateral cataract (mean age: 17.8 ± 2.8 years), 22 with bilateral cataract (19.5 ± 4.6 years), and 15 controls (17.9 ± 2.5 years) were included in the study. The bilateral cataract group had greater difficulty with near and distance activities compared with the unilateral group, and had significantly lower vision-specific social functioning, role difficulties, mental health, and composite scores. Comparing the unilateral cataract and control groups, there was no significant difference in ocular pain, vision-specific social functioning, role difficulties, and dependency scores between both groups. CONCLUSION: Patients with unilateral cataract had fewer difficulties performing near and distance activities and certain vision-specific tasks than the bilateral group, but both groups were comparable in terms of general vision scores. The control group had better scores than the unilateral group in some, but not all, categories and better than the bilateral group in most. Educational achievements were high in both cataract groups. All attended main stream school and many attended university.

One year follow-up of contrast sensitivity following conventional laser in situ keratomileusis and laser epithelial keratomileusis.

PURPOSE: To determine the effect of conventional laser in situ keratomileusis (LASIK) and laser epithelial keratomileusis (LASEK) for myopia on contrast sensitivity (CS) using the Pelli-Robson and Vector Vision CSV-1000E CS tests. METHODS: A prospective, comparative study was conducted on 36 eyes of 36 patients with myopia undergoing LASIK (18 eyes) and LASEK (18 eyes). Surgery was performed using the Technolas 217z laser (Bausch & Lomb). CS was recorded preoperatively and at 3, 6 and 12 months postoperatively. RESULTS: No statistically significant difference was found in LogMAR uncorrected visual acuity post-LASIK (-0.02 ± 0.16) and LASEK (-0.04 ± 0.14). Using the Pelli-Robson, CS was significantly lower in the LASIK group 3 and 6 months postoperatively. No significant postoperative reduction in CS was observed in either treatment group. Using the CSV-1000E test, CS was significantly reduced post-LASIK at 3 (p = 0.05) and 6 (p = 0.05) cycles/degree under photopic conditions. No significant postoperative change occurred in the LASEK group under photopic or scotopic conditions. There was no significant difference in postoperative CS between the LASIK and LASEK groups at 3, 6, 12 or 18 cycles/degree using the CSV-1000E test. CONCLUSION: One year postoperatively, there was no difference in CS between both treatment groups using the Pelli-Robson and CSV-1000E tests. CS was reduced postoperatively in the LASIK group at the lower spatial frequencies under photopic conditions. No postoperative change was detected in CS following LASIK or LASEK using the Pelli-Robson test.

Prospective contralateral eye study to compare conventional and wavefront-guided laser in situ keratomileusis.

PURPOSE: To compare outcomes of customized/wavefront guided with conventional ablation in myopic patients with or without astigmatism undergoing laser in situ keratomileusis. METHODS: A prospective, comparative, contralateral eye study was performed. Sixty-eight eyes of 34 myopic patients with similar refractive error in both eyes were included. One eye was randomly selected to undergo conventional and the fellow eye customized ablation. Surgery was performed using the Technolas 217z laser (Bausch & Lomb, Surrey, UK). Uncorrected visual acuity, manifest refractive spherical equivalent (MRSE), astigmatism, aberrometry and contrast sensitivity were recorded pre and 3 months postoperatively. RESULTS: Mean MRSE treated in the conventional and customized groups were 3.77 ± 1.61 dioptres and -3.83 ± 1.59 dioptres respectively. Three months postoperatively there was no significant difference between the groups in mean MRSE (p = 0.99) or cylinder (p = 0.56). The factor increase in postoperative total higher order aberrations (HOAs) was less in the customized (1.32) compared with the conventional (1.54) treatment group but did not reach statistical significance (p = 0.08). Scotopic contrast sensitivity decreased significantly postoperatively in the conventional but not in the customized treatment group. CONCLUSION: Visual acuity and refractive error outcomes were similar in both treatment group and no patient preference was observed. Customized ablation was associated with a smaller but not statistically significant postoperative increase in HOAs, better preservation of scotopic contrast sensitivity, quicker treatment time and removal of less corneal tissue.

Laser epithelial keratomileusis in 2010 - a review.

Photorefractive keratectomy, laser epithelial keratomileusis (LASEK) and Epi-LASIK are all variants of a similar type refractive surgery involving laser on the surface of the cornea and differ mainly in management of the epithelium. Although laser in situ keratomileusis (LASIK) is currently the most popular form of refractive surgery, LASEK is the procedure of choice in some patients. We highlight potential complications of LASEK and how these may be managed. Following laser refractive surgery, corneal thickness is reduced, which has implications for intraocular pressure measurement and glaucoma screening and management. This is particularly important following surface laser procedures where no evidence of previous surgery may be visible. In the event that cataract surgery is required at a later date, correct calculation of the appropriate intraocular lens power can be difficult and it thus important that patients are given their preoperative keratometry readings and refraction. Compared with LASIK patients, those who undergo LASEK are considered to be at lower risk of corneal ectasia. Improved understanding of wound healing post LASEK and better postoperative pain management are ongoing challenges.

5-year prospective follow-up of Artisan phakic intraocular lenses for the correction of myopia, hyperopia and astigmatism.

AIM: To determine the efficacy and safety of Artisan phakic intraocular lenses (IOLs) for refractive error correction. METHODS: A prospective study was conducted on patients undergoing Artisan phakic IOL implantation for myopia, hyperopia or astigmatism from 2002 to 2008. Visual acuity, manifest refractive spherical equivalent (MRSE), endothelial cell counts and higher order aberrations were recorded pre- and postoperatively. RESULTS: One hundred and fifty-one (84 patients) myopic (mean MRSE -11.2 +/- 4.1 D) and 14 (7 patients) hyperopic eyes (mean MRSE 7.1 +/- 1.3 D) were treated. Twenty eyes (11 patients) had toric IOLs to correct astigmatism (mean MRSE -9.05 +/- 6.13 D, mean astigmatism 4.06 +/- 1.26 D). Three months postoperatively, mean MRSE in 37.6% of eyes was within +/-0.5 D, 61.8% within +/-1.0 D and 91.4% within +/-2.0 D. 18.5% underwent keratorefractive surgery to correct residual refractive error. A 1.56-fold increase occurred in 4th order spherical aberration. Endothelial cell loss was 1.45% at 1 year and negligible at 5 years. Fifty-four eyes (29.2%) gained one or more lines of best corrected visual acuity and no eye lost a line. CONCLUSION: Artisan phakic IOLs are safe and effective for refractive error correction.

Refractive surgery in patients with accommodative and non-accommodative strabismus: 1-year prospective follow-up.

AIM: To determine the efficacy and safety of keratorefractive surgery in patients with accommodative and non-accommodative strabismus in a prospective study. METHODS: Preoperative assessment included uncorrected (UCVA) and best-corrected visual acuity (BCVA), manifest and cycloplegic refraction and orthoptic examination. Laser in situ keratomileusis, laser epithelial keratomileusis and Artisan phakic intraocular lens implantation were performed. All treated eyes had a BCVA of at least 6/18 preoperatively. One year postoperatively, visual acuity, refractive error and ocular alignment were reassessed. RESULTS: 28 patients (nine male, 19 female) of mean age 33.0+/-10.0 years (range 20-59) were included in the study. Esotropia was present in 16 patients; nine fully accommodative, three partially accommodative and four non-accommodative. Twelve patients had exodeviations; 10 exotropia and two exophoria and a history of strabismus surgery. Excellent visual and refractive outcomes were obtained postoperatively. There was no loss, and one eye gained a line of BCVA. Fully accommodative esotropes attained orthophoria or microtropia. Improved ocular alignment occurred in partially accommodative esotropes and myopic exotropes. No patient experienced decompensation of strabismus or diplopia. CONCLUSIONS: Refractive surgery may be performed successfully in patients with accommodative and non-accommodative strabismus. However, great care must be taken when determining patient suitability. This is of particular importance in young hyperopic patients to prevent decompensation of ocular alignment over time.

Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of life.

PURPOSE: To determine the incidence and risk factors for glaucoma in pseudophakic and aphakic eyes following surgery for congenital cataract within the first year of life. METHODS: We conducted a review of all cataract surgery performed at our unit over a 23-year period. Age at surgery, corneal diameter, intraocular lens implantation, presence of persistent foetal vasculature and visual axis opacification (VAO) were documented. Time to development of glaucoma, management and outcome were determined. One eye was selected randomly for analysis in cases of bilateral cataract. RESULTS: Duration of follow-up was significantly longer (p < 0.001) in the aphakic (113 +/- 69 months) compared to the pseudophakic group (56 +/- 44 months). Age at surgery was significantly less (p = 0.01) in the aphakic group. The incidence of glaucoma was significantly greater (p = 0.02) in the aphakic (15 eyes, 33%) compared to the pseudophakic (seven eyes, 13%) group. Each eye that developed glaucoma underwent cataract extraction aged < or = 2.5 months. Analysis of all eyes that underwent surgery aged < or = 2.5 months revealed no statistical difference (p = 0.08) in the incidence of glaucoma. Smaller corneal diameter and VAO were not associated with increased risk of glaucoma development. Ahmed valves proved effective in controlling intraocular pressure but visual outcome was poor in the majority of cases. CONCLUSION: Surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic. Intraocular pressure control with Ahmed valves is frequently required. Glaucomatous damage and dense amblyopia contribute to poor visual outcome in these eyes.

Results of a 1-year comparative study of Zyoptix Tissue-Sparing and conventional Planoscan LASIK treatments.

AIM: To determine the efficacy, stability and higher order aberrations (HOAs) following Zyoptix Tissue-Sparing (TS) and conventional Planoscan LASIK. METHODS: A prospective study was conducted on myopic patients. The Technolas 217z laser and XP microkeratome (Bausch & Lomb) were used. Patients were matched for age, pupil size, optical zone, ablation depth and preoperative HOAs. UCVA, MRSE and HOAs were analysed preoperatively and 3 and 12 months postoperatively. RESULTS: 35 eyes underwent conventional and 31 eyes TS LASIK. 3 months postoperatively, all eyes in the both groups had UCVA < or =20/30 with good stability at 1 year. The mean RMS of total HOA increased significantly 3 months postoperatively in the conventional (1.49 factor increase) and TS LASIK groups (1.84 factor increase) and remained stable at 12 months. CONCLUSION: TS LASIK induced a greater increase in HOA than conventional Planoscan LASIK. This may be attributable to the smaller blend zone in TS treatments.

Comparative study of higher-order aberrations after conventional laser in situ keratomileusis and laser epithelial keratomileusis for myopia using the technolas 217z laser platform.

PURPOSE: To examine changes in higher-order aberrations (HOAs) after PlanoScan laser in situ keratomileusis and (LASIK) and laser epithelial keratomileusis (LASEK). DESIGN: Prospective, comparative study. METHODS: Myopic patients undergoing LASIK (65 eyes of 36 patients) and LASEK (50 eyes of 28 patients) at a private practice were selected randomly. Surgery was performed using the Technolas 217z laser (Bausch & Lomb, Surrey, United Kingdom). Main outcome measures included uncorrected visual acuity (UCVA), manifest refractive spherical equivalent (MRSE), and aberrometry (Zywave; Bausch & Lomb, Rochester, New York, USA) and were recorded before surgery and at three and 12 months after surgery. RESULTS: There was no statistical difference between both groups in terms of MRSE (P = .91), ablation depth (P = .47), scotopic pupil size (P = .38), or optical zone (P = .07). Before surgery, there was no statistical difference in root mean square (RMS) of total (P = .70), third- (P = .79), fourth- (P = .23), and fifth- (P = .33) order aberrations and individual terms. Three months after surgery, RMS of total HOA was raised significantly more (P = .03) after LASIK (1.46-factor increase) than LASEK (1.25-factor increase). One year after surgery, a reduction in total HOAs was observed in 13.8% of LASIK- and 48.5% of LASEK-treated eyes compared with preoperative levels. CONCLUSIONS: Postoperative increases in total HOA and vertical coma were significantly greater in LASIK- than in LASEK-treated eyes. Postoperative reduction in total HOAs was observed in a number of eyes with high preoperative levels and occurred more frequently in LASEK-treated eyes.

Corneal hysteresis and corneal resistance factor in keratoectasia: findings using the Reichert ocular response analyzer.

AIM: To examine corneal hysteresis (CH) and corneal resistance factor (CRF) in normal and ectatic corneas. METHODS: CH and CRF were measured using the Reichert Ocular Response Analyzer in patients with clinically diagnosed keratoconus (KC), forme fruste KC (FFKC) and normal eyes. RESULTS: 21 eyes (13 patients) with clinically diagnosed KC and 30 eyes (18 patients) with FFKC were included in the study. Mean CH and CRF in FFKC did not differ from that in pachymetry-matched normal eyes. KC eyes had significantly lower CH and CRF than normal and FFKC eyes. CONCLUSION: A significant overlap in CH and CRF values among the 3 groups was evident. Our findings do not indicate a role for CH and CRF measurement as a single test to aid in the detection of early ectasia. It may be of use when used in conjunction with other parameters such as aberrometry. CH and CRF values may prove to be useful in monitoring ectasia progression.

Measurement of intraocular pressure in LASIK and LASEK patients using the Reichert Ocular Response Analyzer and Goldmann applanation tonometry.

PURPOSE: To determine the efficacy of the Reichert Ocular Response Analyzer (ORA) to measure intraocular pressure (IOP) following corneal laser refractive surgery. METHODS: Intraocular pressure was measured using Goldmann applanation tonometry preoperatively and 3 months following LASIK and LASEK for all levels of myopia and low levels of hyperopia. In LASIK eyes, 120-microm flaps were cut using the Hansatome XP. The ORA was used to measure Goldmann correlated IOP and corneal compensated IOP 3 months postoperatively. Postoperative central corneal thickness, hysteresis, and corneal curvature were assessed to determine their relationship with postoperative change in Goldmann applanation tonometry IOP. Efficacy of ORA IOP measurement was analyzed by comparing Goldmann applanation tonometry IOP with Goldmann correlated IOP. RESULTS: LASEK was performed on 35 eyes, and LASIK was performed on 90 eyes. In the LASIK group, mean Goldmann applanation tonometry IOP decreased 3.7+/-2.3 mmHg postoperatively (P=.00). Postoperative Goldmann applanation tonometry did not differ significantly (P=.06) from postoperative ORA Goldmann correlated IOP (10.2+/-2.1 mmHg). In the LASEK group, mean Goldmann applanation tonometry IOP decreased 3.9+/-2.3 mmHg (P=.00). Postoperative Goldmann applanation tonometry did not differ significantly (P=.6) from postoperative ORA Goldmann correlated IOP (10.7+/-2.5 mmHg). Postoperative decrease in Goldmann applanation tonometry IOP did not correlate with age, ablation depth, pre- and postoperative central corneal thickness or corneal hysteresis, or postoperative decrease in corneal curvature. CONCLUSIONS: Intraocular pressure measurements were similar using both the ORA Goldmann correlated IOP and Goldmann applanation tonometry following keratorefractive surgery.

A double-blind randomized control study to determine the effect of Visthesia viscoelastic substance on pain following LASEK.

AIM: To determine the efficacy of topical Visthesia drops and viscoelastic in reducing pain during the early postoperative period following laser-assisted subepithelial keratectomy (LASEK). METHODS: In a prospective randomized double-blind study, LASEK was performed on both eyes of patients using the Technolas 217Z Laser (Bausch & Lomb). Visthesia was placed in one eye and placebo (Healon) in the fellow eye, following insertion of a bandage contact lens on completion of surgery. Pain experienced on the evening of surgery and the following morning were scored using a visual analogue scale. RESULTS: 18 patients of mean age 27.3 years were examined. Mean refractive spherical equivalent was not statistically different between both groups (p = 0.6). No statistically significant difference (p = 0.87) in pain was detected between both groups on the evening of surgery or the following morning (p = 0.12). CONCLUSION: Visthesia, applied topically on completion of LASEK, did not have a significant effect on pain during the early postoperative period compared with placebo.