Laser in situ keratomileusis using the Nidek EC-5000 or the Alcon LADARVision 4000 systems.

PURPOSE: To compare the refractive results of eyes with low to moderate myopia that underwent laser in situ keratomileusis with either the Nidek EC-5000 or the Alcon LADARVision 4000 excimer laser systems. METHODS: We performed a retrospective review of 114 LASIK procedures with either the Nidek EC-5000 (54 eyes) or the Alcon LADARVision 4000 (60 eyes) excimer laser systems. Preoperative refractive errors were similar and both populations were treated during the same time period. Data analyzed included uncorrected visual acuity (UCVA), spherical magnitude, spherical equivalent refraction, astigmatism power, astigmatism axis, and vector astigmatism change. RESULTS: Results at 6 months were analyzed. Spherical correction change was a mean -3.95 D for Nidek treated eyes and a mean -4.53 D for LADARVision treated eyes (P = .20). Mean spherical equivalent refraction change was -3.70 D for Nidek eyes and -4.20 D for LADARVision eyes (P = .23). Mean change in UCVA (LogMAR) was 1.05 for Nidek eyes and 0.99 for LADARVision eyes (P = .40). Mean astigmatism magnitude change was 0.71 D for Nidek eyes and 0.77 D for LADARVision eyes (P = .63). Mean vector-corrected astigmatism change was 0.93 D for Nidek eyes and 1.00 D for LADARVision eyes (P = .63). Mean vector-corrected astigmatism axis for Nidek eyes was 3.08 D and for LADARVision eyes 6.58 D (P = .70). CONCLUSION: There was no significant difference in refractive results in eyes treated with the Alcon LADARVision 4000 or the Nidek EC-5000 excimer laser systems. Inherent differences between the two laser systems are highlighted.

Possible adverse effects of drugs used in refractive surgery.

Adverse drug reaction reports were compiled from the National Registry of Drug-Induced Ocular Side Effects, Casey Eye Institute, Portland, Oregon, USA; the United States Food and Drug Administration, Rockville, Maryland; the World Health Organization, Uppsala, Sweden; and a Medline literature review of the past 50 years. The reported side effects of mydriatics, cycloplegics, benzodiazepines, tetracyclines, iodine, topical anesthetics, medications used for hemostasis, nonsteroidal antiinflammatory drugs, steroids, antibiotics, and artificial tears are described. Physicians should be aware of the side-effect profile and current industry standards for medications used in corneal refractive surgery, including off-label uses. Guidelines are provided for some classes of medications.

Treatment of interface keratitis with oral corticosteroids.

PURPOSE: To describe the results of treating interface keratitis using a combination of intensive topical and oral corticosteroids. SETTING: Casey Eye Institute, Portland, Oregon, USA. METHODS: Thirteen eyes treated for grade 2 to 3 interface keratitis using an oral corticosteroid (prednisone 60 to 80 mg) as well as an hourly topical corticosteroid were retrospectively reviewed. The best corrected visual acuity (BCVA) was used as an objective guide of whether to treat with intense topical and oral corticosteroids, flap irrigation, or both. Predisposing factors such as intraoperative epithelial defects or a history of severe allergies or atopy were also looked for. RESULTS: All 13 eyes responded favorably to the combination of intensive topical and oral corticosteroids and had a BCVA of 20/20 after the keratitis resolved. In 6 eyes (46%), the patients had a history of severe seasonal allergies. One day postoperatively, 3 eyes (23%) had an epithelial defect and 2 eyes (15%), lint particles or debris embedded in the interface. With oral corticosteroid use, 3 patients (23%) noted mild stomach irritation and 2 (15%) noted nervousness. All 5 side effects resolved without sequelae. No patient developed a serious side effect. CONCLUSIONS: A short, intense course of an oral corticosteroid was an effective treatment in patients with grade 2 or higher interface keratitis when combined with a topical corticosteroid administered hourly. The BCVA is a helpful objective measure of the severity of interface keratitis and can be used to guide the clinician in the therapeutic strategy.

Steroid-induced glaucoma after laser in situ keratomileusis associated with interface fluid.

PURPOSE: To report the ocular manifestations and clinical course of eyes developing interface fluid after laser in situ keratomileusis (LASIK) surgery from a steroid-induced rise in intraocular pressure. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS/INTERVENTION: We examined six eyes of four patients who had diffuse lamellar keratitis develop after uneventful myopic LASIK surgery and were treated with topical corticosteroids. PRINCIPAL OUTCOME MEASURE: Slit-lamp findings, intraocular pressure measurements, and visual field loss. RESULTS: All eyes had a pocket of fluid develop in the lamellar interface between the flap and the stromal bed associated with a corticosteroid-induced rise in intraocular pressure. However, because of the interface fluid, intraocular pressure was normal or low by central corneal Goldmann applanation tonometry in all eyes. The elevated intraocular pressure was diagnosed by peripheral measurement in several cases after months of elevated pressure. All six eyes had visual field defects develop. Three eyes of two patients had severe glaucomatous optic neuropathy and decreased visual acuity develop as a result of undiagnosed steroid-induced elevated intraocular pressure. CONCLUSIONS: A steroid-induced rise in intraocular pressure after LASIK can cause transudation of aqueous fluid across the endothelium that collects in the flap interface. The interface fluid leads to inaccurately low central applanation tonometry measurements that obscure the diagnosis of steroid-induced glaucoma. Serious visual loss may result.

Laser-assisted in situ keratomileusis complications in diabetes mellitus.

PURPOSE: To report the incidence of complications and the refractive results in patients with diabetes mellitus treated with laser-assisted in situ keratomileusis (LASIK). METHODS: A retrospective review of the charts, focusing on 6-month postoperative data, was performed on 30 eyes from patients with diabetes and 150 age- and gender-matched control eyes operated on during the same period. The incidence of complications and postoperative refractive results were compared. The data analyzed include UCVA, spherical equivalent, astigmatism power, astigmatism axis, and vector astigmatism change. RESULTS: Diabetic eyes treated with LASIK had an overall complication rate of 47% compared with the control population complication incidence of 6.9% (p< 0.01). The most frequent complications occurring in the diabetic population are punctate epithelial erosions and persistent epithelial defects. Spherical correction change was -4.64 diopters (D) for diabetic eyes and -4.98 D for control eyes (p= 0.49). Mean spherical equivalent change was -4.69 D for diabetic eyes and -4.75 D for control eyes (p= 0.9). Mean change in uncorrected visual acuity (LogMAR) was 1.5 for diabetic eyes and 1.65 for control eyes (p= 0.18). Mean astigmatism magnitude change was 0.31 in diabetic eyes and 0.57 in control eyes (p= 0.12). Mean vector corrected astigmatism change was 0.97 for diabetic eyes and 1.12 for control eyes (p= 0.31). Mean vector-corrected astigmatism axis for patients with diabetes was 18.17 for diabetic eyes and 6.20 for control eyes (p= 0.30). CONCLUSION: Patients with diabetes who undergo LASIK are at a significantly higher risk of developing postoperative epithelial complications. In addition, this study revealed poorer refractive results in the eyes of patients with diabetes treated with LASIK.