Decreased incidence of epithelial defects during laser in situ keratomileusis using intraoperative nonpreserved carboxymethylcellulose sodium 0.5% solution.

PURPOSE: To evaluate the incidence of epithelial defects that occur with laser in situ keratomileusis (LASIK) using nonpreserved carboxymethylcellulose sodium 0.5% solution (Refresh Plus(R)) intraoperatively. SETTING: Community-based refractive center. METHODS: This retrospective study comprised 105 patients (210 eyes) who had primary bilateral LASIK by 1 of 2 surgeons between October 1 and December 1, 2000. The 114 eyes treated subsequent to November 1, 2000, received Refresh Plus intraoperatively, and the 96 eyes treated before this date did not. The incidence of epithelial defects and diffuse lamellar keratitis (DLK) in both groups was recorded. The preoperative keratometry measurements of all cases were also recorded. RESULTS: There was a statistically significant decrease in the incidence of epithelial defects in the group that received Refresh Plus intraoperatively (P =.02). No statistically significant between-group difference in the incidence of DLK was detected. Analysis of the keratometry measurements revealed no statistically significant association between the amount or axis of astigmatism and the incidence of epithelial defects or DLK. CONCLUSION: The intraoperative use of nonpreserved Refresh Plus significantly decreased the rate of epithelial defects that occurred during LASIK.

Long-term filtration and visual field outcomes after primary glaucoma triple procedure with and without mitomycin-C.

OBJECTIVE: To evaluate the long-term effectiveness of glaucoma management in patients undergoing primary glaucoma triple procedure (PGTP) with and without adjunctive subconjunctival mitomycin-C (MMC). DESIGN: Case-controlled study. PARTICIPANTS: Of the 203 eyes of 203 primary open-angle glaucoma (POAG) patients who had undergone PGTP and in whom reliable Humphrey visual fields had been obtained both before and after surgery at 13.5 +/- 8.9 and 27.9 +/- 8.9 months, 124 of the 144 eyes that received MMC during surgery were matched to the other 59 eyes that did not with respect to cup-to-disc ratio and risk factors for filtration failure in addition to other variables. MAIN OUTCOME MEASURES: Both preoperative and postoperative intraocular pressure (IOP), Humphrey visual fields and their global indices, number of glaucoma medications, and best-corrected visual acuity (BCVA). RESULTS: There were no significant differences in demographics between the two groups (P > 0.05 for each). Whereas both the control and the MMC groups attained significant decreases of mean IOP (18.5 +/- 5.7 mmHg-;15.6 +/- 4.6 mmHg, P = 0.0014; 19.3 +/- 7.0 mmHg-13.7 +/- 4.9 mmHg, P = 0.0001) and mean number of medications (2.1 +/- 1.3-1.3 +/- 1.3, P = 0.0001; 2.3 +/- 1.2-1.0 +/- 1.3, P = 0.0001) at 36 months after surgery, the MMC group had significantly lower mean IOP than the control group at all postoperative visits (P < 0.05 for each). The MMC group also tended to have less medical dependency after surgery than the control group. There was no significant difference in postoperative BCVA between the two groups. Patients in both groups had mean visual acuity of 20/30 or better. There was a significant worsening of corrected pattern standard deviation (CPSD) in the control group (3.97 +/- 3.18-5.17 +/- 3.36, P = 0.001) compared with no significant change in the MMC group (5.07 +/- 4.11-5.23 +/- 3.36, P = 0.93). The mean deviation did not change significantly in either group. CONCLUSIONS: The long-term glaucoma management in POAG patients with cataract undergoing PGTP indicates a successful outcome in final IOP, medical dependency, and BCVA. Furthermore, the MMC group had better IOP control and stable visual fields (CPSD), whereas the control group had a significant worsening of CPSD.

Diffuse lamellar keratitis associated with carboxymethylcellulose sodium 1% after laser in situ keratomileusis.

PURPOSE: To investigate the association between the use of carboxymethylcellulose sodium 1% (Celluvisc) (Allergan, Inc.) during laser in situ keratomileusis (LASIK) and the development of diffuse lamellar keratitis (DLK). SETTING: Outpatient surgery center, Detroit, Michigan, USA. METHODS: In this retrospective case series, the postoperative clinical course and surgical outcomes in 30 eyes of 15 consecutive patients who had LASIK with the use of Celluvisc were reviewed. All patients had primary LASIK, and the incidence and severity of DLK were analyzed. RESULTS: Diffuse lamellar keratitis developed in 24 of the 30 eyes (80.0%) in which Celluvisc was used before the keratectomy (P = <.0001, Fischer exact test). Sixteen eyes (66.7%) had stage 1, and 8 (33.3%) had stage 2. Diffuse lamellar keratitis was diagnosed in most cases (91.6%) on postoperative day 1. All inflammation resolved after treatment with intense topical corticosteroids. CONCLUSIONS: Celluvisc used immediately before the keratectomy in LASIK was highly associated with the development of DLK.