The laparotomy incision: a technique to facilitate capsulorhexis in microincision cataract surgery.

Microincision cataract surgery is a new technique in the development of cataract surgery and is not without difficulties. Creation of the continuous curvilinear capsulorhexis as performed in conventional coaxial phacoemulsification surgery does not apply as readily. The authors describe a method for initiating the continuous curvilinear capsulorhexis (the laparotomy incision) using only an inexpensive 25-gauge bent needle cystototome. The technique involves a long linear incision in the anterior capsule down the belly of the lens as a means of initiating the capsulorhexis. Advantages of the technique include the creation of a large capsular flap, which allows easier completion of the continuous curvilinear capsulorhexis through a smaller range of movement, avoiding "oar locking" in the small incision and creation of striae in the cornea. It also allows better maintenance of anterior chamber depth, minimizing risk of radial tears.

Reproducibility of LASIK flap thickness using the Hansatome microkeratome.

PURPOSE: To evaluate the actual versus the expected thickness of laser in situ keratomileusis (LASIK) flaps and to determine the factors that affect flap thickness. SETTING: Centre For Sight, Queen Victoria Hospital, East Grinstead, United Kingdom. METHODS: A retrospective analysis of LASIK procedures in 757 consecutive eyes was done. The surgery was performed by a single surgeon using 2 Hansatome microkeratomes (Bausch & Lomb) with 160 microm and 180 microm heads. Patient age, preoperative manifest refraction, automated keratometry, preoperative central pachymetry, and intraoperative stromal pachymetry were evaluated to determine whether they influenced the actual flap thickness. RESULTS: Bilateral LASIK was performed in 343 patients (686 eyes). The 160 microm head was used in 641 eyes (84.6%) (Group 1) and the 180 microm head, in 116 eyes (15.4%) (Group 2). The mean preoperative manifest refraction spherical equivalent (SE) was -3.9 diopters (D) +/- 4.5 (SD) (range +7.4 to -25.0 D) in Group 1 and -4.4 +/- 3.7 D (range +7.1 to -12.9 D) in Group 2. The mean preoperative keratometry reading was 43.6 +/- 1.8 D (range 36.0 to 48.6 D) and 43.6 +/- 1.8 D (range 35.9 to 47.0 D), respectively; the mean preoperative central pachymetry was 543 +/- 35 microm (range 447 to 643 microm) and 548 +/- 31 microm (range 453 to 613 microm), respectively; and the mean flap thickness was 116.4 +/- 19.8 microm and 117.3 +/- 18.0 microm, respectively. The difference between the actual and the expected flap thickness in each group was statistically significant (P<.001). There was no significant difference in the actual flap thickness between the 2 Hansatomes. The preoperative SE and central pachymetry were the only factors that influenced the actual flap thickness (P<.05); thin flaps were more common with increasing myopia and increasing corneal thickness. CONCLUSIONS: Spherical equivalent and preoperative pachymetry were the principal factors that influenced flap thickness. Preoperative keratometry values and patient age did not influence the actual flap thickness.

The stamler lid splint: a new short-term technique for achieving therapeutic ptosis.

PURPOSE: To provide an introduction to a new device, the Stamler lid splint (SLS), a disposable appliance designed to create a temporary total therapeutic ptosis. We also describe the indications for its use and analyze its limitations. METHODS: The utility of the SLS in effecting complete ptosis was examined in 33 patients. Outcome parameters examined were mean duration of (induced) ptosis, success (and failure) rate, and the incidence of side effects. RESULTS: The most common indications for using the SLS were lid closure abnormalities (n = 6) and epithelial defects after keratoplasty (n = 5). The induced ptosis lasted for a mean of 3.3 days (range, 1.5-6). The success rate of the SLS in achieving a total ptosis was 90.9%. Failure was attributed to the presence of atypical lid or orbital anatomy. No patient developed a complication specifically related to the SLS itself. CONCLUSIONS: The SLS is an inexpensive, quick, and technically straightforward means of treating a variety of ocular surface disorders in compliant patients with normal lid and orbital anatomy. The SLS is best suited to patients who require short-term therapy only.

The role of epithelial defects in intralamellar inflammation after laser in situ keratomileusis.

BACKGROUND: A single factor responsible for diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) has not yet been identified. Various theories have been proposed to explain what may trigger this condition. We evaluated the role of epithelial defects in interface inflammation and assessed the outcome of eyes with DLK with and without epithelial defects. METHODS: We reviewed the records of all patients with DLK after LASIK performed at the Toronto Gimbel Eye Centre between September 1999 and May 2000. Patients with other epithelial problems, such as punctate epithelial erosions, were excluded. Patients with an epithelial defect and interface keratitis (group 1) were treated with a bandage contact lens and topical steroid therapy; those with interface keratitis alone (group 2) were treated with topical steroid therapy. Variables examined included the onset and duration of DLK, uncorrected visual acuity, best corrected visual acuity, refractive outcome and retreatment rate. RESULTS: A total of 1,436 LASIK procedures were performed during the study period. Thirteen patients (20 eyes) had DLK after LASIK, in all cases of the sporadic type (i.e., nonepidemic). Of the 20 eyes, 8 had an epithelial disturbance. All the patients were followed for at least 3 months. Three eyes (37.5%) in group 1 had uncorrected visual acuity before retreatment of less than 20/25, compared with 2 eyes (16.7%) in group 2. The mean postoperative spherical equivalent was significantly higher in group 1 than in group 2 (-0.60 vs. -0.02 dioptres) (p = 0.01). The retreatment rate was 37.5% (3/8) in group 1 and 16.7% (3/12) in group 2, a nonsignificant difference. After retreatment the uncorrected visual acuity was 20/20 or better in all cases. There were no cases of recurrence of DLK after retreatment. INTERPRETATION: Eyes with interface keratitis and an epithelial defect have a larger deviation from emmetropia before retreatment than eyes with interface keratitis alone. Patients with epithelial defects intraoperatively or who are at risk for such defects postoperatively must be monitored carefully, as they may be at increased risk for DLK.