Ocular Injuries and Cultural Influences in Afghanistan During 5 Months of Operation Enduring Freedom.

In support of Operation Enduring Freedom, American, North American Treaty Organization (NATO) Coalition, and Afghan forces worked together in training exercises and counterinsurgency operations. While serving at the NATO Role 3 Multinational Medical Unit, Kandahar, Afghanistan, numerous patients with explosive blast injuries (Coalition and Afghan security forces, and insurgents) were treated. A disparity was noted between the ocular injury patterns of US and Coalition forces in comparison with their Afghan counterparts, which were overwhelmingly influenced by the use, or lack thereof, of eye protection. Computed tomography imaging coupled, with a correlative clinical examination, demonstrated the spectrum of ocular injuries that can result from an explosive blast. Patient examination was performed by Navy radiologists and an ophthalmologist. A cultural analysis by was performed to understand why eye protection was not used, even if available to Afghan forces, by the injured patients in hope of bridging the gap between Afghan cultural differences and proper operational risk management of combat forces.

Intraocular lens calculation adjustment after laser refractive surgery using Scheimpflug imaging.

PURPOSE: To test a new method of intraocular lens (IOL) calculation after corneal refractive surgery using Scheimpflug imaging (Pentacam HR) and partial coherence interferometry (PCI) (IOLMaster) that does not require historical data; that is, the Schuster/Schanzlin-Thomas-Purcell (SToP) IOL calculator. SETTING: Shiley Eye Center, San Diego, California, and Walter Reed National Military Medical Center, Bethesda, Maryland, USA. DESIGN: Retrospective data analysis and validation study. METHODS: Data were retrospectively collected from patient charts including data from Scheimpflug imaging and refractive history. Target refraction was calculated using PCI and the Holladay 1 and SRK/T formulas. Regression analysis was performed to explain the deviation of the target refraction, taking into account the following influencing factors: ratio of posterior-to-anterior corneal radius, axial length (AL), and anterior corneal radius. RESULTS: The regression analysis study included 61 eyes (39 patients) that had laser in situ keratomileusis (57 eyes) or photorefractive keratectomy (4 eyes) and subsequent cataract. Two factors were found that explained the deviation of the target refraction using the Holladay 1 formula; that is, the ratio of the corneal radii and the AL and the ratio of corneal radii for the SRK/T formula. A new IOL adjustment calculator was derived and validated at a second center using 14 eyes (10 patients). CONCLUSIONS: The error in IOL calculation for normal eyes after laser refractive treatment was related to the ratio of posterior-to-anterior corneal radius. A formula requiring Scheimpflug data and suggested IOL power only yielded an improved postoperative result for patients with previous corneal laser refractive surgery having cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Delayed diagnosis of microsporidial stromal keratitis: unusual Wessely ring presentation and partial treatment with medications against Acanthamoeba.

The authors report a case of an immunocompetent 38-year-old male who presented with an indolent keratitis that eluded diagnosis after multiple cultures taken over 9 months. He was started initially on medications against Acanthamoeba, after presenting with a nearly complete corneal ring 2 months after trauma. These medications likely partially treated his condition, thereby making laboratory diagnosis more difficult. He was identified as having Encephalitozoon hellum by PCR. The patient subsequently underwent cornea transplant after a full course of medical treatment and recovered best-corrected visual acuity of 20/20.

Visual acuity recovery after late traumatic femtosecond laser in situ keratomileusis flap loss.

We report a case of traumatic flap loss from a fingernail 2 months after femtosecond laser-assisted laser in situ keratomileusis. On presentation, the patient's uncorrected visual acuity (UCVA) was 20/400 and complete flap avulsion was noted. Irrigation and treatment with mitomycin-C were done immediately, and a bandage contact lens was inserted. The epithelium healed completely over 1 week. One month after the injury, the UCVA was 20/15(-2). This case illustrates an excellent outcome from a potentially devastating event following refractive surgery in a military member.

Astigmatism: risk factor for postoperative corneal haze in conventional myopic photorefractive keratectomy.

PURPOSE: To retrospectively assess risk factors other than high myopia for corneal haze in patients who had conventional photorefractive keratectomy (PRK) without mitomycin-C (MMC). SETTING: Department of Ophthalmology, Naval Hospital Camp Pendleton, California, USA. METHODS: This retrospective study comprised 362 eyes of 193 military members who had conventional PRK with the Star excimer laser system from 2004 to 2006. Study inclusion criteria were myopia less than -6.0 diopters (D) spherical equivalent with or without astigmatism, no MMC applied, and at least 3 months of postoperative data available. RESULTS: Nine eyes had grade 2 corneal haze or greater. Of these eyes, 5 had greater than 2.0 D of astigmatism and 4 had no identifiable risk factors. Clinically significant postoperative corneal haze was associated with the level of preoperative astigmatism (P<.001). CONCLUSIONS: Preoperative astigmatism was significantly associated with the development of corneal haze after conventional PRK without MMC. Based on these data, surgeons should consider prophylactic MMC use during conventional PRK procedures for patients with moderate to high levels of astigmatism (approximately >or=1.25 D).

Medical considerations before refractive surgery retreatment.

We report a case of a significant hyperopic shift 2 years after myopic photorefractive keratectomy with an interim of stability. The patient was an otherwise healthy man who reported a sudden change in vision when climbing to altitude. Medical considerations for refractive shifts should be looked at before retreatment is proposed. Diabetes was diagnosed in our patient; after initiation of insulin, the patient's uncorrected visual acuity returned to 20/20 in both eyes.