Photorefractive keratectomy for the correction of residual refractive error with Intacs intrastromal corneal ring segments in place.

PURPOSE: To evaluate the efficacy and safety of photorefractive keratectomy (PRK) for residual refractive errors in patients who had previous insertion of intrastromal corneal ring segments (Intacs, Addition Technology, Inc.) for treatment of low myopia. SETTING: Shiley Eye Center, University of California San Diego, La Jolla, California, USA. METHODS: This retrospective case series comprised patients who had Intacs segment implantation and subsequently developed myopic regression. Eight eyes of 5 patients had PRK over the Intacs in situ for the correction of the residual refractive error. RESULTS: Six (75%) of the 8 eyes had plano refraction with 20/20 or better uncorrected visual acuity (UCVA) 1 month after PRK enhancement. Three months postoperatively, all eyes had plano refraction with 20/20 or better acuity. At the last follow-up examination (up to 2 years), all eyes had near plano vision (20/10 to 20/25). The corneal surface epithelium in all eyes healed in 3 to 5 days. One patient had subepithelial haze in both eyes, which resolved with epithelial scraping with mitomycin-C (MMC) application and a phototherapeutic keratectomy enhancement. CONCLUSIONS: This small series showed that PRK can be used to treat residual refractive error after Intacs insertion. The UCVA was 20/25 or better in all cases after PRK enhancement. The incidence of post-PRK haze in this series of patients was high; topical MMC might be used in future cases to mitigate the problem.

Eye banking error: report of a donor cornea with a soft contact lens left in place.

PURPOSE: To report the first known case of a donor cornea being examined and shipped with a soft contact lens in place. METHODS: Case Report. RESULTS: Surgery was cancelled, the two involved eye-banks were notified, and the patient underwent successful keratoplasty 2 days later. CONCLUSION: Eye banking is essential to the practice of Ophthalmology. Rarely, errors occur despite the strict protocols and procedures that have been instituted over the years. These errors force us to reevaluate and update those policies as technology rapidly advances. We present here the first reported case of donor ocular tissue being examined and then shipped with a contact lens on the cornea. It is possible that there are other errors that are not published. It behooves us to disclose these and to discuss any of these errors openly to allow us to maintain confidence in our local eye banks, and to help us practice the safest medicine possible for our patients.