Management of Anterior Stromal Necrosis After Polymethylmethacrylate ICRS: Explantation Versus Exchange With Corneal Allogenic Intrastromal Ring Segments.

PURPOSE: To evaluate management of keratoconic eyes with anterior stromal necrosis overlying the intracorneal ring segment (ICRS), by either ICRS explantation alone or exchange with corneal allogenic intrastromal ring segments (CAIRS). METHODS: Among 643 Intacs SK (Additional Technology, Inc) inserted at one institutional center, 16 eyes (15 patients) with overlying spontaneous anterior stromal necrosis were identified. Data included size of stromal defect and refractive and topographical findings before ICRS insertion, before anterior stromal necrosis, and 6 months after intervention. RESULTS: The 10-year incidence of anterior stromal necrosis after femtosecond laser-assisted ICRS insertion was 5.5%. Eight eyes underwent ICRS removal only and 8 eyes had ICRS exchanged with CAIRS. In the first group, CDVA worsened from 0.14 before melt to 0.28 logMAR after removal (P = .10), simulated keratometry (SimK) and maximum axial keratometry (Kmax) increased from 44.73 to 46.34 diopters (D) (P = .14) and from 49.23 to 52.26 D (P = .14), respectively, and coma worsened from 0.87 to 1.52 D (P = .02). In the CAIRS group, CDVA of 0.16 before melt improved to 0.11 logMAR postoperatively (P > .99), and topographic indices stabilized with SimK, Kmax, and coma mildly altering from 45.31 to 45.44 D (P > .99), from 49.25 to 49.64 D (P > .99) and from 0.87 to 0.81 D (P > .99), respectively. Whether the ICRS were explanted or exchanged, the visual and topographic mean values were better than those reported before ICRS implantation, whereas higher order aberrations in eyes without CAIRS regressed to levels before ICRS insertion. At the site of melt, thinnest residual stromal thickness averaged 327 µm with ICRS removal and 490 µm with CAIRS. Eyes with larger melt areas resulted in less optimal results with CAIRS implantation. CONCLUSIONS: Early experience in the management of anterior stromal necrosis by exchange of polymethylmethacrylate ICRS with CAIRS seems to avoid stromal thinning and confer better visual and topographic results, which were more pronounced with thicker segments. The benefit of CAIRS in large stromal melts needs to be investigated. [J Refract Surg. 2022;38(4):256-263.].

Ophthalmic Injuries After the Port of Beirut Blast-One of Largest Nonnuclear Explosions in History.

IMPORTANCE: A review of the injury patterns, treatment strategies, and responding physicians' experience during the Port of Beirut blast may help guide future ophthalmic disaster response plans. OBJECTIVE: To present the ophthalmic injuries and difficulties encountered as a result of the Port of Beirut blast on August 4, 2020. DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical record review of all patients who presented to the emergency department and 13 ophthalmology outpatient clinics at the American University of Beirut Medical Center for treatment of ophthalmic injuries sustained from the explosion in Port of Beirut, Beirut, Lebanon, from August 4 to the end of November 2020. Patients were identified from emergency records, outpatient records, and operative reports. MAIN OUTCOMES AND MEASURES: Types of ocular injuries, final best-corrected visual acuity, and need for surgical intervention were evaluated. Visual acuity was measured with correction based on noncycloplegic refraction using the Snellen medical record. EXPOSURES: Ocular or ocular adnexal injuries sustained from the Port of Beirut explosion. RESULTS: A total of 39 blast survivors with ocular injuries were included in this study. Twenty-two patients presented with ocular injuries on the day of the blast, and 17 patients presented within the following 3 months to the ophthalmology clinics for a total of 48 eyes of 39 patients were treated secondary to the blast. Thirty-five patients (89.6%) were adults, and 24 (61.5%) were female. A total of 21 patients (53.8%) required surgical intervention, more than half of which were urgently requested on the same day of presentation (14 [35.9%]). Most eye injuries were caused by debris and shrapnel from shattered glass leading to surface injury (26 [54.2%]), eyelid lacerations (20 [41.6%]), orbital fractures (14 [29.2%]), brow lacerations (10 [20.8%]), hyphema (9 [18.8%]), open globe injuries (10 [20.8%]), and other global injuries. Only 7 injured eyes (14.5%) had a final best-corrected visual acuity of less than 20/200, including all 4 open globe injuries with primary no light perception (8.3%) requiring enucleation or evisceration. CONCLUSIONS AND RELEVANCE: In the aftermath of the Port of Beirut explosion, a review of the ophthalmic injuries showed a predominance of shrapnel-based injuries, many of which had a delayed presentation owing to the strain placed on health care services. Reverting to basic approaches was necessary in the context of a malfunctioning electronic medical record system.

Five-Year Results of Combined Small-Aperture Corneal Inlay Implantation and LASIK for the Treatment of Hyperopic Presbyopic Eyes.

PURPOSE: To evaluate the efficacy of simultaneous laser in situ keratomileusis (LASIK) and small-aperture corneal inlay (KAMRA; AcuFocus, Inc) implantation in hyperopic presbyopic eyes at 5 years postoperatively. METHODS: This was a retrospective single-center study of patients with hyperopia and presbyopia who underwent simultaneous LASIK and corneal inlay implantation by two experienced refractive surgeons. These patients were regularly observed for 5 years and evaluated with serial corneal tomographies and refractive assessments for uncorrected near visual acuity (UNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), and manifest refraction spherical equivalent (MRSE). RESULTS: Twenty-four eyes of 24 patients were included. Mean age was 53.63 ± 4.11 years (range: 47 to 63 years) and mean preoperative MRSE was +1.52 ± 0.64 diopters (D) (range: +0.50 to +3.00 D). UNVA was 0.04 ± 0.06 logMAR at 1 month and 0.02 ± 0.05 logMAR (J1+ equivalent) at 5 years postoperatively. In comparison, preoperative DCNVA was 0.44 ± 0.20 (J5/J6 equivalent) (P < .001). At 5 years postoperatively, UDVA was 0.16 ± 0.18 logMAR (20/30 Snellen equivalent), and 23 of 24 eyes (95.8%) had UNVA of J3 or better. Two eyes (8.3%) lost one line of CDVA. One corneal inlay needed readjustment but none were explanted. Eight eyes (25%) developed regression in UNVA with hyperopic shift, which responded to a 3- to 4-month course of topical steroids, with 3 eyes showing patchy haze on the undersurface of the corneal inlay. CONCLUSIONS: Simultaneous LASIK and KAMRA inlay implantation, evaluated for 5 years postoperatively, shows some efficacy and predictability in improving UDVA and UNVA in hyperopic presbyopic eyes. However, late-onset regression with hyperopic shift, possible loss of CDVA, and occasional haze remain challenges. [J Refract Surg. 2020;36(8):498-505.].

Refractory interface haze developing after epithelial ingrowth following laser in situ keratomileusis and small aperture corneal inlay implantation.

PURPOSE: To report the occurrence and the management of refractory interface haze that developed after epithelial ingrowth following small aperture inlay implantation. OBSERVATIONS: A 52 year-old man with sub-clinical anterior basement membrane dystrophy (ABMD) underwent combined hyperopic laser in situ keratomileusis and KAMRA corneal inlay implantation to correct presbyopia. Post-operatively, epithelial ingrowth developed requiring debridement and KAMRA removal. Significant diffuse interface haze, ground-glass in texture, involving the central 6 mm of the cornea developed the next day, and was refractory to topical and systemic steroids, necessitating flap irrigation, gentle scraping, and MMC application to the residual stromal bed after 12 days. The interface haze gradually improved to near complete resolution over 12-months. CONCLUSIONS AND IMPORTANCE: Epithelial ingrowth can lead to flap interface haze refractory to medical therapy. Early surgical intervention is key to haze resolution.

Sequential pars plana vitrectomy and cataract extraction with intraocular lens implantation in patient with corneal inlay who developed retinal detachment followed by cataract.

Twenty-one months after successful small-aperture corneal inlay (Kamra) implantation simultaneous with myopic laser in situ keratomileusis, a patient presented with a superior rhegmatogenous macula-involving retinal detachment. Successful pars plana vitrectomy, transscleral cryotherapy, and gas tamponade were performed with the inlay in situ. Three months later, uneventful phacoemulsification and posterior chamber intraocular lens implantation were performed, also with the inlay in situ, for a visually significant cataract. Visualization of the central and peripheral retina and the anterior segment was possible in both procedures through the central aperture and around the periphery of the inlay. An indirect noncontact visualization system was helpful in the retinal surgery, and rotating the eye was helpful in both surgeries if the inlay blocked visualization.

Intrastromal corneal ring segment SK for moderate to severe keratoconus: a case series.

PURPOSE: To report clinical results and safety profiles of symmetrical intrastromal corneal ring segment (ICRS; Intacs SK, Addition Technology Inc) implantation in eyes with moderate to severe keratoconus. METHODS: Interventional case series of 24 eyes from 22 patients implanted with Intacs SK using the femtosecond laser. Evaluation included uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, and Placido-based Scheimpflug imaging. Postoperative follow-up was 1 day, 1 week, and 1, 3, and 6 months. RESULTS: Mean patient age was 28±7 years (range: 16 to 41 years). All eyes had keratoconus. Twenty-one of 24 eyes had 2, 450-µm symmetrical segments inserted. Mean UDVA and CDVA were significantly better at 1, 3, and 6 months postoperatively (UDVA: 20/340 preoperatively vs 20/70 at 6 months [P<.001]; CDVA: 20/70 preoperatively vs 20/40 at 6 months [P<.001]; UDVA analysis of variance [ANOVA]: F=6.46, P=.0057; CDVA ANOVA: F=5.24, P=.0138). Pre- and 6-months postoperative clinical results were: mean spherical equivalent refractive error -9.60±4.86 diopters (D) and -3.05±2.05 D (P<.001), respectively; mean refractive cylinder, -3.20±1.50 D and -1.55±1.10 D, respectively (P<.001); and mean average total corneal power 52.03±4.49 D and 46.95±4.61 D, respectively (P<.001). No complications occurred, and no patients were lost to follow-up. Eyes with steeper preoperative corneal keratometry readings had the greatest flattening in corneal curvature and thus the greatest decrease in myopic refraction (r=-0.4, P<.001). No correlation was found between preoperative thinnest corneal pachymetry and postoperative curvature flattening. CONCLUSIONS: Implantation of Intacs SK for moderate to severe keratoconus is safe and effective, leading to significant decrease in myopia and appreciable decrease in astigmatism with improvement in CDVA.

Photorefractive keratectomy for refractory laser in situ keratomileusis flap striae.

Photorefractive keratectomy (PRK) with mitomycin-C (MMC) was performed in 2 patients with visually significant, complicated laser in situ keratomileusis flap striae. These striae had been resistant to multiple treatments, including stretching, suturing, and PRK. The visual symptoms in both patients resolved after PRK with MMC, and both patients were stable 1 year later. Wavefront-guided PRK with MMC may be a viable treatment for patients who have complicated flap striae resistant to standard measures.

Complications of sequential keratorefractive and vitreoretinal surgery.

We describe 2 complications of sequential keratorefractive and vitreoretinal surgery not previously reported. Epithelial ingrowth occurred in 1 patient who experienced laser in situ keratomileusis flap dehiscence and replacement during vitreoretinal surgery. In the second patient, a flap could not be created with a microkeratome or a femtosecond laser because of anatomical changes from previous vitreoretinal surgery. Anatomic repair of the vitreoretinal pathology and completion of keratorefractive surgery with good visual outcomes were achieved in both patients. Flap stability should be an important operative consideration for vitreoretinal surgeons; patients may have to be informed of the risk for and possible subsequent complications of iatrogenic flap dehiscence. Refractive surgeons operating on patients after vitreoretinal surgery may encounter difficulty creating a LASIK flap even with a femtosecond laser and may need to consider other keratorefractive options.

Wavefront-guided laser in situ keratomileusis using the WaveScan system for correction of low to moderate myopia with astigmatism: 6-month results in 277 eyes.

PURPOSE: To assess the safety and effectiveness of wavefront guided LASIK surgery using the Visx WaveScan system for correction of low to moderate myopia with astigmatism. SETTING: Multicenter study at 6 sites in the United States. METHODS: In this prospective nonrandomized clinical trial, treatments were performed at 6 sites in the United States using the WaveScan (CustomVue) guided excimer laser. A total of 351 eyes were enrolled, and 277 eyes were analyzed at 6 months. RESULTS: At 6 months, 94% of eyes achieved an uncorrected visual acuity (UCVA) of 20/20 or better and 74% achieved a UCVA of 20/16 or better. Sixty-nine percent of eyes had the same or better postoperative UCVA than their preoperative best spectacle-corrected visual acuity (BSCVA). Ninety percent of eyes were within +/-0.5 diopter of intended correction. No eye lost more than 1 line of BSCVA. Total higher-order root-mean square (RMS), coma, and spherical aberration values were stable (P<.05). CONCLUSION: The data support the safety and effectiveness of the WaveScan-guided customized laser ablation using the Visx Star S4 system for correction of low to moderate myopia with astigmatism.

Subluxation of iris-sutured intraocular lenses and results of a closed chamber technique for repositioning after penetrating keratoplasty.

PURPOSE: To describe subluxation of iris-fixated intraocular lenses (IOLs) after penetrating keratoplasty (PK) as a postoperative complication and report the long-term outcomes of a closed-chamber refixation technique used in the management. METHODS: This was a retrospective, noncomparative interventional case series in which 19 consecutive patient charts with a subluxated iris-fixated IOL after PK were retrospectively reviewed. Fourteen of the patients underwent surgery using a closed-chamber refixation technique. These patients were evaluated for visual outcome and surgical complications associated with the procedure. RESULTS: In 13 patients, postoperative follow-up was available. In all 13 cases, the fixated IOL appeared stable and remained well positioned during a follow-up period of 56 months (range, 6-122). All patients (100%) achieved improved uncorrected visual acuity. The postoperative visual acuity ranged from 20/20 to 20/100 with a mean of 20/40. Vitreous hemorrhage occurred in 1 patient, and an additional patient required a second surgery using the same technique. Both of these patients did well with a final visual acuity of 20/40 and 20/50, respectively. CONCLUSIONS: Subluxation of iris-fixated IOL after PK can occur as a postoperative complication. The technique that we herein describe enables secure refixation of subluxated IOLs and yields favorable long-term results.

Excimer laser surgery for correction of ametropia after cataract surgery.

PURPOSE: To review the cases of patients who had excimer laser refractive surgery to correct unintentional or undesired ametropia after cataract extraction with intraocular lens (IOL) implantation. SETTING: Wilmer Laser Vision Correction Center, Wilmer Eye Institute, Baltimore, Maryland, USA. METHODS: In this retrospective noncomparative review of consecutive cases, the Wilmer Laser Vision Correction Center's database was searched for patients who had laser in situ keratomileusis or photorefractive keratectomy to correct ametropia after cataract extraction with IOL implantation. RESULTS: Using the Visx Star excimer laser system (Visx, Inc.), 11 procedures were performed in 11 eyes of 10 patients a mean of 47 months (range 2 to 216 months) after cataract extraction with IOL implantation. Except for 1 patient with a silicone plate lens, all patients received 3-piece poly(methyl methacrylate) lenses. The mean age at time of excimer treatment was 75 years (range 70 to 81 years). Before laser surgery, the mean spherical equivalent of patient eyes was -3.76 diopters (D) +/- 2.50 (SD) (range -6.50 to +0.75 D), spherical refraction ranged from -9.00 D to plano, and the highest cylindrical refraction was +5.50 D. At last follow-up (mean 12.2 months; range 1 to 38 months), the mean manifest spherical equivalent was -0.88 +/- 1.43 D (range -2.75 to +2.13 D). Changes in mean manifest spherical equivalent were highly significant (P = .03, Wilcoxon signed rank test for paired values). There was no difference between targeted and achieved postoperative refraction (P = .34, Wilcoxon test). Increasing age was correlated with a hyperopic shift (r = 0.525, P = .05). All patients were satisfied with their final uncorrected visual acuity (UCVA), which improved in every case. Except for 1 patient in whom an epiretinal membrane developed, best spectacle-corrected visual acuity remained unchanged or improved. CONCLUSIONS: In this series of patients, who were a few decades older than the typical excimer laser candidate, laser refractive surgery was a safe, effective, and predictable method to correct ametropia after cataract extraction with IOL implantation. It may be a viable, noninvasive alternative to intraocular surgery, which has potential complications. Although satisfactory for all patients, final UCVA was not as high as that reported in laser refractive surgery patients in general, and this result may be because of prior cataract extraction with IOL implantation or increased age.

Improvement in best corrected visual acuity in amblyopic adult eyes after laser in situ keratomileusis.

PURPOSE: To evaluate improvement in best spectacle-corrected visual acuity (BSCVA) after laser in situ keratomileusis (LASIK) in adult patients with amblyopia. SETTING: Refractive Eye Surgery Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. METHODS: The charts of consecutive patients with a diagnosis of amblyopia at the time of refractive evaluation who had LASIK were reviewed retrospectively. The preoperative and postoperative uncorrected visual acuity (UCVA) and BSCVA were analyzed. RESULTS: Twenty-one eyes of 19 patients were identified as having amblyopia and LASIK surgery. Eight patients (42.1%) were diagnosed with amblyopia only, 6 patients (31.6%) had anisometropic amblyopia, 4 patients (21.1%) had strabismic amblyopia, and 1 patient (5.2%) had anisometropic and strabismic amblyopia. Eleven eyes (52.4%) had myopic astigmatism, 7 eyes (33.3%) were hyperopic, and 3 eyes (14.3%) had mixed astigmatism. Seven eyes (33.3 %) experienced more than a 1-line improvement in postoperative UCVA compared with the preoperative BSCVA. Nine eyes (42.8%) experienced more than a 1-line improvement in postoperative BSCVA compared with the preoperative BSCVA. The BSCVA was unchanged in 11 eyes (52.4%) and was worse by 2 lines in 1 eye (4.8%). CONCLUSION: After LASIK, the postoperative BSCVA was better than preoperatively in 42.8% of eyes with a history of amblyopia and the postoperative UCVA was better than the preoperative BSCVA in 33.3%.

Survey of complications and recommendations for management in dissatisfied patients seeking a consultation after refractive surgery.

PURPOSE: To review complications associated with and management options for dissatisfied patients seeking a consultation after refractive surgery performed elsewhere. SETTING: Refractive Eye Surgery Center, The Wilmer Institute, Lutherville, Maryland, USA. METHODS: In this retrospective review, charts of consecutive dissatisfied patients who sought a refractive consultation between June 1999 and January 2003 after refractive surgery performed elsewhere were reviewed and the following parameters were analyzed: visual acuity (uncorrected and best spectacle corrected), prior manifest refraction, complications, and recommendations. The subjective complaints, complications, and visual acuity were reviewed, and the associated historical or visual risk factors as well as treatment options were analyzed. RESULTS: One hundred sixty-one eyes in 101 patients with ocular complaints were identified. One hundred thirty-four eyes (83.2%) had had laser in situ keratomileusis; 22 eyes, photorefractive keratectomy; 4 eyes, radial keratotomy; and 1 eye, laser thermokeratoplasty. The most common subjective complaints were blurred distance vision (59.0%), glare and night-vision disturbances (43.5%), and dry eyes (21.1%). The most common complications were overcorrection (30.4%), irregular astigmatism (29.8%), dry eyes (29.8%), glare (26.1%), difficulty with night driving (16.7%), and corneal haze (16.7%). The most common cause identified in eyes with best spectacle-corrected visual acuity worse than 20/40 was irregular astigmatism (10 of 18 eyes [55.5%]). The most common recommendation for management was medical treatment or observation (68.3%). Medical therapies recommended included lubrication, punctal plugs, topical and systemic pharmaceutical agents to modulate ocular surface, spectacles, and contact lenses. Keratoplasty (lamellar or penetrating) was recommended in 4 patients (4 eyes [2.5%]). The diagnoses included corneal ectasia in 3 eyes and severe flap complication with irregular astigmatism in 1 eye. Nine patients (5.6% eyes) required nonkeratoplasty surgery. In other patients, waiting for advances in technology, including wavefront-guided customized retreatment, was recommended. CONCLUSIONS: A spectrum of complications associated with refractive surgery may result in patient dissatisfaction. Proper patient selection, prevention strategies, and prompt diagnosis and medical or surgical intervention may be beneficial in managing complications and improving patient satisfaction.

Risk factors in interface epithelialization after laser in situ keratomileusis.

PURPOSE: To identify risk factors associated with primary and recurrent epithelial ingrowth after laser in situ keratomileusis (LASIK) requiring surgical debridement. METHODS: Charts of patients who required single or multiple surgical debridements of epithelial ingrowth were reviewed retrospectively and analyzed to identify preoperative, intraoperative, and postoperative risk factors. RESULTS: Fourteen of 22 patients had epithelial ingrowth that required a single surgical removal. These were mostly associated with the surgeon's learning curve, epithelial injury, and enhancement by lifting the flap. Multiple surgical debridements were required in eight patients and some of these were associated with epithelial basement membrane degeneration and a history of type I diabetes. CONCLUSIONS: Refractive surgeons should be aware of surgical and non-surgical ocular and systemic risk factors associated with both primary and recurrent epithelial ingrowth after LASIK to appropriately consent patients seeking refractive surgery. Type I diabetes may increase the risk of epithelial downgrowth in LASIK.

Outcome of second surgery in LASIK cases aborted due to flap complications.

PURPOSE: To describe the technique and timing of second refractive surgery after aborted laser in situ keratomileusis (LASIK) due to intraoperative flap complication and determine the final visual outcome. SETTING: Outpatient ambulatory laser vision correction centers. METHODS: This retrospective noncomparative case series included 16 patients (16 eyes) who had a second refractive surgery after initial LASIK surgery was aborted because of a flap complication. Charts were reviewed with attention to initial preoperative data, intraoperative details of the aborted LASIK, postoperative examination, possible causes of the flap complication, timing and technique of second refractive surgery, and final visual outcome. RESULTS: Causes of the aborted LASIK were identified in 13 of 16 eyes (81.2%) and included eye squeezing (5 eyes), loss of suction or machine failure (5 eyes), steep corneas (2 eyes), and learning curve of the surgeon (1 eye). The mean time until the second surgery was 135 days (range 49 to 372 days). Repeat flaps were created deeper and larger than the initially attempted flaps when possible. No patient had a final uncorrected visual acuity (UCVA) worse than 20/30 after the second surgery. Two eyes (12.5%) lost 1 line of best spectacle-corrected visual acuity. CONCLUSION: A planned delayed reoperation after sufficient corneal healing following an intraoperative flap complication can result in satisfactory recovery of UCVA.

Outcomes of laser in situ keratomileusis in patients with pigment dispersion syndrome.

PURPOSE: To analyze the outcome of laser in situ keratomileusis (LASIK) in patients with pigment dispersion syndrome (PDS). SETTING: Outpatient ambulatory laser vision correction centers. METHODS: This noncomparative case series reviewed the medical records of 12 patients (22 eyes) who had clinical features consistent with PDS at the time of the initial preoperative refractive evaluation and had LASIK surgery. RESULTS: Twenty eyes (90.9%) of 11 patients had an uneventful course after LASIK and a good final uncorrected visual acuity (mean follow-up 26 months). One patient (2 eyes) with PDS and suspicion of glaucoma on topical beta-blocker therapy had delayed healing, fluctuations in vision, and a lengthy visual recovery. CONCLUSIONS: Corneal findings of PDS do not appear to affect the intraoperative or postoperative outcomes of LASIK. However, patients who have PDS in the context of glaucoma and therapy with an intraocular-pressure-lowering agent may experience delayed healing and a less predictable visual outcome.

Excessive fibrin after cataract surgery associated with aminocaproic acid use.

A 78-year-old woman developed a severe fibrinous anterior chamber reaction 1 day after uneventful clear corneal incision cataract extraction with intraocular lens implantation. There was no history of uveitis or diabetes, and the fibrin responded immediately to topical steroids. The patient was followed closely to rule out endophthalmitis. The only risk factor identified was the use of systemic aminocaproic acid as prophylaxis for bleeding in chronic leukemia.

Incidence of intraoperative corneal abrasions and correlation with age using the Hansatome and Amadeus microkeratomes during laser in situ keratomileusis.

To compare the incidence of intraoperative corneal abrasions using the Hansatome (Bausch & Lomb Surgical) and Amadeus (Advanced Medical Optics) microkeratomes and to determine whether there is a correlation between patient age and the occurrence of intraoperative corneal abrasions. Outpatient ambulatory laser vision correction center. The charts of 133 patients (263 eyes) having laser in situ keratomileusis (LASIK) were reviewed retrospectively. The patients were randomized to LASIK performed by 2 surgeons using the same technique with alternative microkeratome selection. The incidence of intraoperative corneal abrasions was significantly higher with the Hansatome microkeratome than with the Amadeus microkeratome (P =.014). There was a significant correlation between increasing patient age and the incidence of corneal abrasions with both microkeratomes (P<.05). Laser in situ keratomileusis surgeons should be aware that certain microkeratome designs pose a higher risk for intraoperative corneal abrasions and that older patients are more susceptible to intraoperative corneal epithelial injury. These patients should be informed accordingly for appropriate consent.

Endothelial cell studies in patients after photorefractive keratectomy for hyperopia.

PURPOSE: To report central and peripheral corneal endothelial cell studies performed as part of the VISX hyperopic photorefractive keratectomy (PRK) clinical trial. METHODS: During this prospective, multicenter clinical trial, which was part of an FDA investigation, endothelial cell specular microscopy was done at five centers. Non-contact central and peripheral cell density, percent hexagonality, and coefficient of variability of cell size were obtained using the Konan Noncon Robo SP-8000FA with BAMBI analysis software. Data were gathered at baseline and at 1, 6, and 12 months after hyperopic PRK. RESULTS: Analysis of results of 171 eyes demonstrated no statistically significant detrimental changes in the corneal endothelium at any postoperative time point. The statistically significant changes noted were interpreted as an improvement in cell morphology and were attributed to the cessation of contact lens wear following treatment. CONCLUSION: Hyperopic PRK with the VISX STAR S2 Excimer Laser System produced no statistically significant adverse effect on the corneal endothelium.

Recurrence of keratitis after excimer laser keratectomy.

We report 3 patients who experienced a recurrence of nonherpetic keratitis after excimer laser photorefractive surgery. Two patients had a history of culture-positive adenoviral keratoconjunctivitis, and 1 had a clinical diagnosis of Thygeson's superficial punctate keratitis (SPK) prior to excimer laser surgery. Patients should be informed that excimer laser surgery may contribute to a recurrence of keratitis and Thygeson's SPK. Recognition and appropriate treatment can result in resolution and maintenance of a good refractive outcome.