Visual outcomes after femtosecond laser in situ keratomileusis flap complications.

PURPOSE: To compare visual outcomes in normal and complicated laser in situ keratomileusis (LASIK) flaps constructed with a femtosecond laser. SETTING: Wilford Hall Ambulatory Surgical Center, San Antonio, Texas. DESIGN: Retrospective chart review. METHODS: The main outcome measures were uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (CDVA) at 1 month post-surgery, which were compared in patients with and without complications during flap creation. RESULTS: This retrospective chart review identified 586 eyes of 293 consecutive patients who had bilateral simultaneous femtosecond LASIK for myopia. A normal flap was attained in 539 (91.8%) of patients. At 1 month postoperatively, the mean UDVA was 20/19.1, and the CDVA was 20/16.8. 3 (0.51%) of patients experienced an incomplete side cut or intraoperative flap tear (the mean 1-month uncorrected distance visual acuity [UDVA] was 20/17.5 and the corrected distance visual acuity [CDVA] was 20/16.9 in both groups). Microstriae were seen in 28 (4.8%) of patients (mean 1-month UDVA, 20/21.7; CDVA, 20/17.4). Diffuse lamellar keratitis appeared in 4 (0.68%) of patients (mean 1-month UDVA, 20/21.7; CDVA, 20/15.6). Epithelial ingrowth developed in 9 (1.5%) of patients (mean 1-month UDVA, 20/18.7; CDVA, 20/16.9). There was no statistically significant difference in UDVA or CDVA at 1 month postoperatively between complicated and uncomplicated flaps (P > .05), and complicated flaps did not lose a statistically significant amount of CDVA or low-contrast acuity (CDVA 5%) compared to preoperative values. CONCLUSIONS: Intraoperative and postoperative complications of LASIK flaps created with the femtosecond laser were rare, and their visual outcomes were equivalent to those of normal flaps. FINANCIAL DISCLOSURE: Charles D. Reilly is a consultant to Alcon Labs and Abbott Medical Optics at present, but was not at the time of the study. For the remaining authors none are declared.

Endoscopic photocoagulation in the management of epithelial downgrowth.

PURPOSE: Epithelial downgrowth, a rare but devastating complication of intraocular surgery and penetrating ocular trauma, remains a therapeutic dilemma in ophthalmology. We present an interventional case report of an instance successfully treated with diode laser photocoagulation by using a purely endoscopic approach. METHODS: Case report and literature review. RESULTS: An 81-year-old woman initially presented with worsening visual acuity, diffuse corneal edema, band keratopathy, peripheral anterior synechiae, and an atypical iris cyst with angle involvement. Histopathologic examination of the iris cyst revealed nonkeratinized stratified squamous epithelium consistent with epithelial downgrowth. After thorough treatment of the epithelial downgrowth by an endoscopic technique, penetrating keratoplasty and cryoablation of the remaining corneal tissue were performed for visual rehabilitation. One year after treatment, no signs of recurrence were present. CONCLUSIONS: Diode photocoagulation by using an endoscopic approach potentially offers an effective, safe, and minimally invasive surgical approach for the management of epithelial downgrowth in patients with corneal opacity.