Laser in situ keratomileusis for myopia and astigmatism: 6 month results.

PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) for mild to moderate myopia with or without astigmatism. SETTING: Barnet-Dulaney Eye Center, Phoenix, Arizona, USA. METHODS: Data were prospectively collected on 124 consecutive eyes having LASIK over 12 weeks. Eyes with a preoperative spherical equivalent (SE) from -1.35 to -10.00 diopters (D) (mean -4.81 D +/- 2.21 [SD]) and cylinder from 0 to 5.00 D (mean 1.12 +/- 1.12 D) were entered in the study. Thirty-one eyes had spherical corrections. Ninety-three eyes had spherocylinder corrections; preoperative astigmatism in these eyes ranged from 0.50 to 5.00 D (mean 1.47 +/- 1.09 D). Surgery included creation of a corneal flap using an automated microkeratome with a 160 microns plate followed by photoablation on the exposed stromal bed. Photoablation was performed using five zones varying from 5.0 to 6.6 mm in eyes with 6.25 D of myopia or less and with five passes at a 5.0 mm zone in eyes with 6.50 D of myopia or more. Astigmatism was corrected using a single-pass ablation through a 6.0 mm slit of varying diameter. RESULTS: Six month follow-up was obtained in 89 eyes (72%). All eyes were completely re-epithelialized by the first postoperative day. Uncorrected visual acuity was 20/40 or better in 81% of eyes at 1 day and in 91% at 6 months. At 6 months, the mean SE was -0.35 +/- 0.77 D; 83% were within +/- 1.00 D of plano. Postoperative astigmatism in the 93 eyes having cylinder correction ranged from 0 to 1.22 D (mean 0.38 +/- 0.42 D). No eye lost more than two lines of best spectacle-corrected visual acuity. Three eyes (2%) required surgical intervention for cap problems. Visually significant corneal haze was not observed. CONCLUSION: In eyes with myopia with or without astigmatism, LASIK provided rapid visual recovery with satisfactory visual and refractive outcomes. The effect of LASIK on visual function (night glare, contrast sensitivity) awaits further study.

Intraocular pressure following ECCE and IOL implantation in patients with glaucoma.

Patients with glaucoma may suffer optic nerve head damage due to elevated intraocular pressure (IOP) after any intraocular procedure. We retrospectively reviewed the IOP data in 82 consecutive patients (103 eyes) with glaucoma after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation. Nine eyes had previous trabeculectomy and three eyes required combined trabeculectomy with ECCE and PC-IOL. The average follow-up period is 1.5 years (range 0.5 to 6 years). The postoperative IOP rise of 8 mm Hg over baseline or above 23 mm Hg was observed in 45 eyes (49.5%). Two eyes needed argon laser trabeculoplasty and one required trabeculectomy to control postoperative IOP elevation. Most of the patients required the same or lesser number of medications for IOP control after surgery. Results suggest that ECCE with PC-IOL may be a relatively safe procedure in cataract patients with preexisting glaucoma.

Intraocular pressure following extracapsular cataract extraction and posterior chamber intraocular lens implantation.

Knowledge of the incidence of both short- and long-term elevation of intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) insertion is essential for the practicing ophthalmologist. We reviewed retrospectively the IOP data in 384 consecutive patients (506 eyes) that underwent the above procedure. A postoperative rise of 8 mm Hg above baseline or above 23 mm Hg was observed in 149 eyes (29%). Secondary glaucoma well controlled medically developed in 21 eyes (4%). Three eyes developed glaucoma after the first year postoperatively. Therefore, over the total follow-up period of 6 years, 24 eyes (4.7%) developed pseudophakic glaucoma. None, however, required laser or other surgical intervention. These results further support the prevailing view that ECCE with PC-IOL is the procedure of choice.

Intraocular pressure following secondary anterior chamber lens implantation.

Secondary anterior chamber implantation has become relatively simple since the advent of viscoelastic materials. Still, glaucoma, cystoid macular edema, endophthalmitis, and astigmatism remain vision-threatening complications. We studied intraocular pressures (IOPs) following this surgery in 102 patients (124 eyes) over 6 years. Elevated IOP was noted in 32 eyes (25.8%), but only 14 (11.3%) needed long-term medical treatment. None, however, required laser iridectomy, trabeculoplasty, or trabeculectomy. Patients should be selected for secondary anterior chamber implantation only after more conservative measures have been exhausted.