Anthony Liu

Visually significant haze after retreatment with photorefractive keratectomy with mitomycin-C following laser in situ keratomileusis

Photorefractive keratectomy (PRK) with the adjunctive use of mitomycin-C (MMC) for the treatment of residual refractive error after laser in situ keratomileusis (LASIK) has been shown to be safe and effective, with no occurrences of visually significant postoperative haze reported. We report a case of visually significant haze after PRK with MMC for residual myopia following LASIK.

Wavefront-Guided Versus Wavefront-Optimized Laser in situ Keratomileusis for Patients With Myopia: A Prospective Randomized Contralateral Eye Study

PURPOSE To compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in situ keratomileusis (LASIK). DESIGN Prospective, randomized, fellow-eye-controlled study. METHODS The setting was a single academic institution. The study population included 110 eyes of 55 patients with myopia with and without astigmatism. One eye of each patient was randomized to undergo wavefront-guided LASIK by the AMO Visx CustomVue S4 IR excimer laser system; the fellow eye received wavefront-optimized LASIK by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system. Corneal flaps were constructed using the Intralase FS 60 Hz femtosecond laser. Patients were followed at postoperative months 1, 3, 6, and 12. The studys main outcome measures were uncorrected visual acuity, stability of refractive correction, contrast sensitivity, and wavefront aberrometry. RESULTS After 12 months, LASIK eyes had achieved visual acuity of 20/12.5 or better (30 eyes, 56%) in the wavefront-guided group compared to those receiving wavefront-optimized treatment (22 eyes, 41%) (P = 0.016). Average spherical equivalent refractions were -0.13 ± 0.46 diopters in wavefront-guided eyes whereas in wavefront-optimized eyes the refractions were -0.41 ± 0.38 diopters at 12 months. Wavefront-guided eyes also achieved better best-corrected visual acuity at both the 5% and 25% contrast levels (P = 0.022 and P = 0.004, respectively). There were no differences in levels of residual astigmatism (P = 0.798) or in higher order aberrations (P = 0.869). CONCLUSIONS Both wavefront-guided and wavefront-optimized treatments are able to correct myopia safely and effectively in eyes with and without astigmatism. However, wavefront-guided treatment platforms appear to offer significant advantages in terms of residual refractive error, uncorrected distance acuity and contrast sensitivity.

Long-term effect of phacoemulsification on intraocular pressure using phakic fellow eye as control

PURPOSE: To investigate the long‐term effect of phacoemulsification on intraocular pressure (IOP) in patients with ocular hypertension and open‐angle glaucoma. SETTING: Three multispecialty ophthalmology practices and one glaucoma specialty group. DESIGN: Retrospective comparative case series. METHODS: Review of medical records of patients with open‐angle glaucoma or ocular hypertension who had had unilateral phacoemulsification (without other prior or concurrent ophthalmic procedure) with the fellow eye remaining phakic at least 3 years postoperatively. RESULTS: Preoperatively, the IOP in the surgical and fellow eyes in the 29 patients was 15.66 mm Hg ± 3.33 (SD) and 15.64 ± 4.23 mm Hg (P=.98), respectively. Postoperatively, it was 13.56 ± 2.04 mm Hg and 14.92 ± 2.85 mm Hg, respectively, at 4.5 months (P=.06); 14.88 ± 3.20 mm Hg and 15.27 ± 3.19 mm Hg, respectively, at 1 year (P=.67); 14.16 ± 2.61 mm Hg and 14.95 ± 2.79 mm Hg, respectively, at 2 years (P=.37); and 14.68 ± 3.44 mm Hg and 14.68 ± 2.68 mm Hg at 3 years (P=1.00), respectively. There was no significant difference in the mean number of IOP‐lowering medications used in the surgical eyes (1.96 ± 1.40) and fellow eyes (2.08 ± 1.44) postoperatively (P=.77). CONCLUSIONS: In a cohort of ocular hypertensive and glaucoma patients, uncomplicated phacoemulsification had no significant IOP‐lowering effect compared with the phakic fellow eye for up to 3 years postoperatively. There was also no difference between the mean number of postoperative IOP‐lowering medications used in the surgical and fellow eyes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Bilateral posterior subcapsular cataracts associated with long-term intranasal steroid use

The use of systemic steroids has been established as a risk factor for the development of posterior subcapsular cataracts. In recent decades, the use of nasal topical steroids has increased in an effort to decrease systemic side effects. Current evidence of an association between nasal steroid use and cataract formation is contradictory. We present a case of rapid-onset bilateral posterior subcapsular cataracts in a young healthy patient with a history of long-term nasal steroid use.

Anterior Segment Optical Coherence Tomography Imaging of Central Toxic Keratopathy

The authors report anterior segment optical coherence tomography (OCT) imaging findings in a case of central toxic keratopathy following laser in situ keratomileusis (LASIK) surgery for low hyperopia. OCT imaging 1 month after surgery demonstrates that the flap thickness is maintained and the location of stromal tissue loss is just posterior to the flap in the stromal bed in the affected area. This corresponds to the clinical observation of interface opacity extending posteriorly into the stroma as first described by Sonmez and Maloney1 in their initial description of the syndrome. Follow-up OCT imaging 3 months later revealed interval decrease in stromal thinning. The etiology of this syndrome is unknown.

Transected Lamellar Cut Following Second Pass with a Femtosecond Laser after Incomplete Flap Construction during Laser In Situ Keratomileusis

Background: The majority of complications of Laser in Situ Keratomileusis leading to vision loss are related to the corneal flap. Uses of the femtosecond laser for flap construction has been shown have improved safety and predictability when compared to mechanical keratome use. We report a case of irregular astigmatism following second pass with a femtosecond laser performed due to incomplete flap construction. Methods: Single observational case report. Results: Examination revealed a horizontal linear opacified stromal scar likely representing a discontinuity of the deeper second flap plane with transection into the original flap plane. This complication caused a loss of six lines of best corrected visual acuity. Conclusion: This case demonstrates that complications resulting in persistent significant visual loss are possible with use of the femtosecond laser for a second pass following incomplete flap construction.

Toxic peripheral keratopathy: a syndrome in laser refractive surgery.

This retrospective observational case series describes a clinical syndrome in laser refractive surgery. Five eyes of 4 patients with noninflammatory peripheral corneal opacification in the period immediately after photorefractive keratectomy or laser in situ keratomileusis were identified and the charts abstracted. Peripheral stromal opacification, localized corneal thinning, irregular astigmatism leading to a decrease in corrected visual acuity, and gradual clearing were characteristic findings. Gradual clearing occurred without treatment in all eyes over a period of 2 weeks to 12 months. This syndrome has similarities to central toxic keratopathy but occurs in the peripheral cornea. We refer to the syndrome as toxic peripheral keratopathy, the cause of which is unknown.

Late Onset Secondary Cataract Following Implantation of an Iris-Fixated Phakic Intraocular Lens

PURPOSE To report a case of bilateral late onset anterior cortical cataract following implantation of an iris-fixated phakic intraocular lens (pIOL). METHODS Single observational case report. RESULTS Three and a half years following uncomplicated consecutive implantation of iris-fixated pIOL in both eyes, anterior cortical cataract changes inferiorly emanating from the site of enclavation of the lens in the right eye were noted. By 7 years after implantation, anterior cortical cataract changes were seen emanating from the enclavation sites superiorly and inferiorly in both eyes. These cataracts did not cause any loss of corrected distance visual acuity. CONCLUSIONS This case demonstrates that a potential complication of an iris-fixated pIOL is late onset secondary cataract formation.

Late-onset nontraumatic dislocation of anterior chamber phakic intraocular lens.

Long-term stability of the position of phakic intraocular lenses (pIOLs) is important in maintaining visual acuity as well as avoiding injury to the local tissues. We report a case of late nontraumatic dislocation of an iris-fixated pIOL, with subsequent successful repositioning.