Photorefractive keratectomy for -1.25 to -25.00 diopters of myopia.

BACKGROUND: We evaluated prospectively the efficacy, predictability, stability, and safety of photorefractive keratectomy (PRK) for myopia. METHODS: Three hundred sixty-nine eyes of 257 patients were treated with an Aesculap-Meditec MEL 60 excimer laser. Treated eyes were divided into 3 groups: low myopes (-1.25 to -6.00 D), 226 eyes; medium myopes (-6.10 to -10.00 D), 104 eyes; high myopes (-10.10 to -25.00 D), 39 eyes. Follow-up at 12 months was available for 348 eyes (94%). RESULTS: One year after surgery the number of eyes within +/- 1.00 D of emmetropia was 182 (86.7%) for low myopes, 43 (40.5%) for medium myopes, and 12 (30.8%) for high myopes. Values for +/- 0.50 D were low: 142 (67.6%), medium: 29 (29.3%), and high: 9 (23.1%). Three eyes with low myopia (1.4%) and 5 eyes with medium myopia (5.1%) lost 2 or more lines of spectacle-corrected visual acuity. None of the high myopes lost 2 or more lines. Uncorrected visual acuity of 20/20 or better was achieved in 82 eyes (39%) with low myopia; 20/40 or better was achieved in 183 eyes (87.1%). Five eyes (5.1%) of medium myopes achieved 20/20 or better; 52 eyes (52.5%) with medium myopia achieved 20/40 or better. Zero eyes with high myopia achieved 20/20 or better; 11 eyes (28.8%) achieved 20/40 or better. CONCLUSION: Photorefractive keratectomy proved to be an effective method to correct myopia up to -6.00 D. For myopia greater than -6.00 D, good results were achieved in most eyes when myopia was less than -10.00 D, but efficacy and predictability decrease. To avoid systematic undercorrection, slight overcorrection must be attempted with the Aesculap-Meditec MEL 60 excimer laser for the treatment of myopia.

Excimer laser photorefractive keratectomy for hyperopia.

OBJECTIVE: Excimer laser photorefractive keratectomy (PRK) has been shown to be an effective method in the treatment of refractive errors, especially myopia. We evaluated prospectively the efficacy, predictability, stability, and safety of excimer laser PRK in the treatment of hyperopia. METHODS: Thirty-four hyperopic eyes were treated with an Aesculap-Meditec (MEL 60) excimer laser. The patients were divided into two groups. In the low-moderate hyperopia group, baseline spherical equivalent refraction was between +1.50 and +6.00 diopters (D) (mean, +4.20 +/- 1.30 D) and in the high hyperopia group between +6.25 and +9.75 D (mean, +7.70 +/- 1.30 D). Follow-up visits occurred 1, 3, 6, and 12 months after surgery. RESULTS: One-year results were available for a total 27 eyes (79%): 15 eyes with low to moderate hyperopia and 12 eyes with high hyperopia. One year after PRK in the low-moderate group, six eyes (40%) had a refractive error within +/- 1.00 D of emmetropia, but in the high hyperopia group only two eyes (17%) were within +/- 1.00 D of emmetropia; three eyes (20%) and one eye (8%) were within +/- 0.50 D, respectively. The stability of the refractive change was better in the low to moderate hyperopia group; in the high hyperopia group there was still some regression after 6 months. At 12 months, 10 eyes (67%) in the low-moderate and one eye (8%) in the high hyperopia group had postoperative uncorrected visual acuity of 20/40 or better. One eye in the low-moderate hyperopia group saw 20/20 without correction. Only one eye lost two lines of spectacle-corrected visual acuity. Haze was more intense in the high hyperopia group, but it did not reduce visual acuity. No vision-threatening complications were observed. CONCLUSIONS: When low to moderate hyperopia up to +6.00 D is treated, excimer laser PRK with the Aesculap Meditec MEL60 laser is safe and moderately effective, and refraction stabilizes after 3 months in most eyes. However, PRK is not sufficient to treat high hyperopia in an effective and predictable way.

Comparison of etidocaine and bupivacaine + lidocaine in retrobulbar anaesthesia.

Etidocaine (15 mg/ml) was compared with bupivacaine (5 mg/ml) combined with lidocaine (10 mg/ml) in retrobulbar anaesthesia. One hundred and twelve patients were randomised into two groups. Supplemental anaesthesia was needed in 41% of cases of the etidocaine group and 32% of the bupivacaine-lidocaine group. Akinesia was evaluated by the surgeon both pre- and postoperatively and was found to be good or complete in more than 95% of both groups. Recovery from the motor and sensory block was investigated three times during the first 24 postoperative hours. The motor block of the orbicular muscle disappeared earlier than that of the globe. Akinesia lasted significantly longer in the etidocaine group than in the bupivacaine-lidocaine group: after 14 h 69% vs 100%, respectively, of the eyes showed normal movements. Sensation in the cornea was also regained more rapidly in patients treated with the mixture.

Effect of sodium hyaluronate on immediate postoperative intraocular pressure after extracapsular cataract extraction and IOL implantation.

We studied 129 eyes which were undergoing extracapsular cataract extraction with IOL-implantation. The amount of residual Healon had a clearcut effect on the IOP elevations postoperatively. In eyes operated on with the intercapsular techniques, pressure elevations and the mean values during the first 6 postoperative hours were significantly higher than in eyes operated on with the planned ECCE (can opener-technique) (P less than 0.01). The pressure elevation reached the maximal values 8-12 h postoperatively and had normalized already at 24 h in most cases, except in glaucomatous eyes which at that time had significantly higher mean IOP values than the non-glaucomatous eyes (P less than 0.01). When operations were done with an air bubble no clearcut postoperative pressure increases could be observed. Our study indicates that a comparatively small amount of Healon may cause a pressure elevation and the amount left in the eye has a greater effect upon the level of the pressure than the duration of the pressure elevation. The less we inject Healon into the eye and the more we avoid leaving it there, the less risk we have of the possibility of vision deteriorating high postoperative intraocular pressure.

Posterior chamber lens implantation. A clinicopathological report of a successful case.

This report describes the clinical and histopathological studies of an eye 13 months after successful extracapsular cataract surgery and J-loop-type posterior chamber lens implantation. The lens was of PMMA while the loops were made of polypropylene. The corrected visual acuity of the patient was 1.0 and clinically the eye showed no evidence of anterior uveitis. The lower loop was in the capsular bag while the upper loop was embedded in the ciliary body surrounded by chronic foreign body giant-cell inflammatory reaction.