Hyperopic laser in situ keratomileusis to treat overcorrected myopic LASIK.

PURPOSE: To evaluate the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) in treating hyperopia caused by overcorrected myopic LASIK and to evaluate a new technique to place the hyperopic treatment after lifting the initial myopic flap. SETTING: Open-access outpatient excimer laser surgical facility. METHODS: A retrospective analysis was performed of 54 eyes in 47 patients who had spherical hyperopic LASIK by 21 surgeons for the treatment of significant hyperopia after overcorrected LASIK for myopia. In 42 eyes, the initial LASIK flaps were lifted and in 12 eyes, new flaps were cut. The mean age of the 25 men (53%) and 22 women (47%) was 48.2 years +/- 8.4 (SD). Outcome measures included refractive error, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications. The mean follow-up was 2.97 months. RESULTS: In eyes in which postoperative emmetropia was attempted (n = 45), the mean spherical equivalent improved from +1.21 +/- 0.49 diopters (D) preoperatively to -0.38 +/- 0.50 D postoperatively (P <.001). The mean UCVA improved from 20/38.6 +/- 16.3 to 20/27.4 +/- 9.4 (P <.001). At the last follow-up, 69% of eyes were within +/-0.5 D and 96% were within +/-1.0 D of emmetropia; 42% had a UCVA of 20/20 and 96% had a UCVA of 20/40 or better. No eyes lost 2 or more lines of BSCVA. No vision-threatening complications occurred. Results in patients who had initial flaps lifted and those who had new flaps cut were statistically indistinguishable. On average, achieved hyperopic corrections were 18% greater than intended. CONCLUSION: Hyperopic LASIK was safe, predictable, and effective in the treatment of hyperopia caused by overcorrected myopic LASIK. Results were similar whether the original flap was lifted or a new one was cut.

Nurse manager exemplar: a journey out of the glass house.

Our interdisciplinary patient care planning process began with team members convening in a closed room "talking" about the patient. The patient, family, physician, and even the staff nurse at times were unable to attend. No medical record was available for use. This article discusses the vital role of the nurse manager in the evolution of Health Care Team Rounds and the impact of the behaviorally based competencies on the process. When all is said and done, this is why we are here. This is our work!

The predictability of corneal flap thickness and tissue laser ablation in laser in situ keratomileusis.

OBJECTIVE: To evaluate the relationship between predicted flap thickness and actual flap thickness and between predicted tissue ablation and actual tissue ablation. DESIGN: Prospective, nonrandomized comparative (self-controlled) trial. PARTICIPANTS: A total of 60 patients (102 eyes) who underwent laser in situ keratomileusis (LASIK). MAIN OUTCOME MEASURES: Subtraction pachymetry was used to determine actual corneal flap thickness and corneal tissue ablation depth. Other measurements included flap diameter and keratometry readings. RESULTS: Actual flap thickness was significantly different (P < 0.0001) from predicted flap thickness. Fifteen eyes had a predicted flap thickness of 160 micrometer and a mean actual flap of 105 micrometer (standard deviation [SD], +/-24. 3 micrometer range, 48-141 micrometer). Sixty-four had a predicted flap of 180 micrometer with an actual flap mean of 125 micrometer (SD, +/-18.5 micrometer range, 82-155 micrometer). Seventeen eyes had a predicted flap of 200 micrometer, with an actual flap mean of 144 micrometer (SD, +/-19.3 micrometer range, 108-187 micrometer). In addition, we found that significantly more tissue (P < 0.0001) was ablated than predicted. Linear regression of the observed ablation on predicted ablation yielded the following relationship: actual ablation = 14.5 + 1.5 (predicted ablation). Neither flap diameter nor flap thickness were found to increase with respect to steeper corneal curvatures. CONCLUSIONS: Actual corneal flap thickness was consistently less than predicted regardless of the depth plate used; actual tissue ablation was consistently greater than predicted tissue ablation for the laser used in this study.

Nurse leaders: roles driving organizational transition.

Transition leaders have developed in our organizations. These roles allow nurse leaders to combine the knowledge of the customer, the art of nursing, and the chaos of health care in order to pioneer new strategies. These roles are flexible, either focused or broad, and change in scope and direction. The teams we lead are diverse in team experience, seen as disconnected from operations, and struggle with exceedingly defined or hardly evident boundaries. Methodologies add structure and foster active participation; they are fast, decisive, compressed, creating results. "Change-magic" assists in making decisions and influencing the organization to "get the job done."