Flap complications in our learning curve of laser in situ keratomileusis using the Hansatome microkeratome.

PURPOSE: To determine the incidence and the type of flap complications in our initial series of eyes undergoing laser in situ keratomileusis and the impact of microkeratome-related complications on best spectacle-corrected visual acuity. METHODS: We reviewed the charts of the 630 consecutive eyes operated in the Refractive Surgery Department of Cerrahpasa Medical School, University of Istanbul, Turkey using the Hansatome microkeratome and the Summit, SVS Apex Plus excimer laser between March 1998 and November 1999. The mean follow-up was 12.6 months. RESULTS: The incidence of total flap complications was 19.8%. Flap folds (5%) were the most common complication. The incidence of epithelial ingrowth was 3.3%. Diffuse lamellar keratitis was encountered in 20 cases (3.17%). Displaced flaps were seen shortly after the procedure in 8 eyes (1.26%) and repositioned immediately. Improper keratectomy occurred in 14 eyes (2.2%) and incomplete keratectomy in four procedures (0.63%). The presence of interface debris and hemorrhage was each 1.9%. We observed one interface abscess, which was culture-negative and cured with fortified antibiotics, and one free flap. CONCLUSIONS: Although the LASIK procedure with the Hansatome had an easy learning curve without any of the serious complications that frequently occur in this phase, we still observed flap related complications that affected visual outcome.

Associated ocular findings in pericentral pigmentary retinopathy.

Macular complications occurred in two isolated patients who had pericentral pigmentary retinopathy. One patient demonstrated bilateral bull's-eye maculopathy and a unilateral full-thickness macular hole. Later, she developed central retinal artery occlusion in the fellow eye. The second patient had a rhegmatogenous retinal detachment that was reattached by scleral buckling surgery, but a full-thickness macular hole was found 3 months postoperatively. In both patients, foveal ischemia may have played a role for the development of macular hole, resulting in poor visual prognosis in pericentral pigmentary retinopathy.

[Secondary hyperactivity of the contralateral oblique muscle after unilateral weakening of the inferior oblique muscle]. / Hyperaction consécutive de l'oblique controlatéral après affaiblissement unilatéral de l'oblique inférieur.

PURPOSE: This study was designed to analyze the consecutive overaction of the contralateral inferior oblique (IO) muscle after unilateral weake in procedure of the same muscle which is a well-known but not regularly studied phenomenon. MATERIAL AND METHODS: Unilateral weakening of overactive IO muscle was performed in a group of 27 patients with esotropia (14 recessions and 13 marginal myotomias). Eleven of these patients had unilateral overaction of the IO muscle. In the remaining 16 patients the overaction was highly asymmetric. RESULTS: Postoperatively we observed only one consecutive overaction of the contralateral IO in patients with unilateral overaction. However, this condition was observed in 11 of 16 patients with asymmetric IO overaction. CONCLUSION: The innervational pathogenesis of this phenomenon is a subject of discussion. The authors emphasize the necessity of the clinical examination in order to identify the bilateral asymmetric forms and to neutralize them by convenient surgical procedures.

Brain SPECT evaluation of the visual cortex in amblyopia.

UNLABELLED: In amblyopia, the number of visual cortical neurons are reduced and abnormal or absent sensitivity to retinal light stimulation of the amblyopic eye is demonstrated. Ten amblyopic patients were studied to evaluate the response of the visual cortex to visual stimulation. METHODS: All patients with unilateral amblyopia received 500-550 MBq 99mTc-HMPAO during visual stimulation. Strobe light flashing was used as the stimulus for five patients and a checkerboard pattern reversal was used in the other five patients, closing one eye. For both groups a 2-Hz frequency was used. One week later, the same procedure was repeated with the opposite eye closed. SPECT images were reconstructed with prefiltering techniques and sliced along the orbitomeatal line. RESULTS: For all patients, the amblyopic eye demonstrated less radioactivity in the visual cortex than in the normal eye. The mean cerebral-to-cerebellar ratios were 0.95 +/- 0.05 and 1.09 +/- 0.07 for amblyopic and normal eyes, respectively (p < 0.0001). CONCLUSION: Visual cortex response of the amblyopic eye to light stimulation was severely reduced when compared to the normal eye.

Effect of valproate and carbamazepine on visual evoked potentials in epileptic children.

The effects of carbamazepine (CBZ) and sodium valproate (SV) monotherapy on visual evoked potentials (VEP) were studied in 18 epileptic children receiving CBZ and nine epileptic children receiving SV. Pattern reversal VEP were determined before the administration of antiepileptic drugs (AED) and 1 year later during which time the patients had received AED. The VEP amplitude showed no consistent changes after 1 year of CBZ and SV therapy, but VEP P-100 latencies were significantly prolonged after 1 year of CBZ therapy. We conclude that CBZ causes a slowing down of central impulse conduction and that VEP is useful to evaluate the effects of AED within the central nervous system.