Optic nerve sheath fenestration: A second lease at sight.

Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was -1.9789 ± 1.46270, which improved to -0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from -1.3378 ± 1.50107 to -1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.

Topography-based customized trans-epithelial phototherapeutic keratectomy for anterior corneal scar removal.

PURPOSE: To report a case of management of a post-LASIK superficial corneal scar using a novel single-step topography-based customized phototherapeutic keratectomy (PTK). METHODS: Surgical technique description. RESULTS: Ablation was planned using Schwind Amaris® 1050RS excimer laser as decentered trans-epithelial PTK of 5 mm × 3.5 mm of 75 µm depth exactly over the area of the scar. UDVA, CDVA improved from 20/60 and 20/40 pre-operatively to 20/30 and 20/20p post-operatively. Refractive error improved from -2.5 DC @135 to +0.25 DS/-0.25 DC @75. Regularization of topography and stromal surface on ASOCT was noted with minimal hyperopic shift. Another step of ablation to address induced hyperopia was not required. CONCLUSION: Topography-based customized PTK appears to be an effective novel technique for the management of superficial corneal scars with minimal induced refractive change. This technique holds promise as an alternative in the targeted management of superficial corneal scars, traditionally treated by conventional PTK, without significant ablation of normal tissue.

Preferred practice patterns for photorefractive keratectomy surgery.

Over the past two decades, excimer laser-based refractive surgery procedures have been successfully established for their safety and satisfactory visual outcomes. Surface ablation procedures or photorefractive keratectomy (PRK) are practised commonly for the correction of refractive errors including myopia, astigmatism and hyperopia. Satisfactory visual outcomes are achieved in majority of cases, although a very small percentage have issues related to corneal haze, regression, and its associated visual disturbances. To ensure optimal outcomes and to minimize complications, certain keys to success have been designed on the basis of the current review of literature on surface ablation procedures.

Photorefractive keratectomy (PRK) Prediction, Examination, tReatment, Follow-up, Evaluation, Chronic Treatment (PERFECT) protocol - A new algorithmic approach for managing post PRK haze.

PURPOSE: The aim of this study was to discuss the possible risk factors predisposing to post photorefractive keratectomy (PRK) haze formation and develop and validate a risk scoring system, so that this could be applied to our clinical practice as an algorithmic approach. METHODS: Study was divided into 2 arms, in the retrospective arm we looked at 238 eyes of patients undergoing PRK where certain presumed risk factors from literature and clinical experience were identified and statistical significance of association was studied in the development of corneal haze. The risk scoring system was applied to the 450 eyes in the prospective arm for validation. This was then used to formulate an algorithmic approach to manage post-PRK haze. RESULTS: 22 out of 238 eyes in the retrospective arm developed haze where risk factors such as contact lens intolerance, altered tear film break up time, meibomian gland drop out and vitamin d levels were significantly associated with post-PRK haze (p < 0.05) and these factors were identified in the prospective arm. Treatment of these modifiable factors led to a significant reduction in post-PRK haze. CONCLUSION: Thus identifying and treating risk factors of haze in patients undergoing PRK could improve surgical outcomes and patient satisfaction.