Charles Reilly

Refractive surgery in the United States Air Force.

Purpose of review Laser refractive surgery in the United States Air Force has developed into a robust program since its inception in 2001. The goal of this study is to summarize recent developments in the program. Presentations at national meetings, recently published articles, and unpublished data from ongoing studies in the area of photorefractive keratectomy and laser-assisted in-situ keratomileusis are discussed. Recent findings Photorefractive keratectomy continues to be the most commonly performed corneal refractive surgery procedure in the United States Air Force. However, as the overall superiority of femtosecond laser-assisted in-situ keratomileusis flaps compared with microkeratome-assisted flaps continues to be established, there is an increasing trend towards this procedure. With a recent change in Air Force policy, photorefractive keratectomy and laser-assisted in-situ keratomileusis are now both approved for nonaviators and aviators, with the aviators undergoing contrast sensitivity and other additional testing to ensure readiness. Summary As members of the United States Air Force have stringent visual demands in carrying out their duties, the quality and safety of any refractive procedure are of the utmost importance. Thorough evaluation of ongoing advances in refractive surgery will help ensure that our airmen continue to meet the visual demands placed on them.

Novel approach for the treatment of corneal ectasia in a graft.

Purpose: The aim of this study was to report the use of novel masking agents during an anterior lamellar keratoplasty performed using a femtosecond laser in a patient with corneal ectasia that was consistent with recurrent keratoconus. Methods: This is a case report. Results: A 55-year-old man, with a 23-year status after penetrating keratoplasty for keratoconus, presented with a chief complaint of ocular discomfort in the right eye. On slit-lamp examination, the physician estimated 70% to 80% inferior thinning at the graft–host interface with inferior corneal neovascularization. Because of the high risk of developing corneal perforation and the patients desire to minimize visual recovery time, anterior lamellar keratoplasty was chosen. To minimize the risk of perforation during femtosecond dissection of the anterior lamellar bed, gentian violet and cyanoacrylate glue were used in the area of thinning as masking agents. Conclusions: This represents the first documented use of gentian violet and cyanoacrylate glue as double masking agents to defocus the femtosecond laser raster pass during keratoplasty.

Effect of Topical Immunomodulatory Interleukin 1 Receptor Antagonist Therapy on Corneal Healing in New Zealand White Rabbits (Oryctolagus cunniculus) After Photorefractive Keratectomy

OBJECTIVES To compare topical interleukin 1 receptor antagonist (IL-1ra) to steroid treatment following photorefractive keratectomy (PRK) in rabbit eyes. METHODS Our study is a randomized, investigator-masked study that was approved by the Institutional Animal Care and Use Committee. Following standard PRK, 48 eyes of 24 rabbits were divided into 5 arms: 4 treatment arms and 1 control arm. The right eye of each rabbit served as the treatment eye, and the left eye served as a control. Eyes in treatment arms were randomized to receive either fluorometholone, 0.1%, 4 times a day (Falcon, Fort Worth, Texas), or 2.5, 1.25, or 0.25 mg of IL-1ra 4 times a day. Control eyes received only moxifloxacin hydrochloride, 0.5% (Vigamox; Alcon, Fort Worth, Texas), and a solution of polyethylene glycol 400, 0.4%, and propylene glycol, 0.3% (Systane; Alcon), 4 times a day. Primary outcome measures included weekly evaluation of subjective haze formation and time to corneal reepithelization with clinic examinations, objective haze formation using Pentacam technology (Oculus, Lynnwood, Washington), as well as histological examination for haze thickness 7 weeks after PRK. RESULTS There was no difference among treatment groups in time to reepithelization. The IL-1ra treatment groups showed a statistically significant reduction in haze formation (P < .001, determined by repeated-measures analysis of variance) on corneal evaluation using the Pentacam 3 weeks after PRK compared with the control group. This effect was comparable to that in the steroid treatment group. There was also a statistically significant effect of the treatment on subjective haze evaluation at weeks 4 and 5 (P < .05, determined by repeated-measures analysis of variance), but this effect lost statistical significance when the steroid group was excluded from the evaluation. In addition, there was no statistically significant difference in histologic evaluation of haze thickness among treatment groups (P = .997). CONCLUSION Further studies are needed to determine the efficacy and adverse effect profile of topical IL-1ra in human eyes. CLINICAL RELEVANCE IL-1ra therapy may be an alternative to steroid treatment following PRK.

Visual outcomes after femtosecond laser in situ keratomileusis flap complications.

Purpose To compare visual outcomes in normal and complicated laser in situ keratomileusis (LASIK) flaps constructed with a femtosecond laser. Setting Wilford Hall Ambulatory Surgical Center, San Antonio, Texas. Design Retrospective chart review. Methods The main outcome measures were uncorrected distance visual acuity (UDVA) and best‐corrected distance visual acuity (CDVA) at 1 month post‐surgery, which were compared in patients with and without complications during flap creation. Results This retrospective chart review identified 586 eyes of 293 consecutive patients who had bilateral simultaneous femtosecond LASIK for myopia. A normal flap was attained in 539 (91.8%) of patients. At 1 month postoperatively, the mean UDVA was 20/19.1, and the CDVA was 20/16.8. 3 (0.51%) of patients experienced an incomplete side cut or intraoperative flap tear (the mean 1‐month uncorrected distance visual acuity [UDVA] was 20/17.5 and the corrected distance visual acuity [CDVA] was 20/16.9 in both groups). Microstriae were seen in 28 (4.8%) of patients (mean 1‐month UDVA, 20/21.7; CDVA, 20/17.4). Diffuse lamellar keratitis appeared in 4 (0.68%) of patients (mean 1‐month UDVA, 20/21.7; CDVA, 20/15.6). Epithelial ingrowth developed in 9 (1.5%) of patients (mean 1‐month UDVA, 20/18.7; CDVA, 20/16.9). There was no statistically significant difference in UDVA or CDVA at 1 month postoperatively between complicated and uncomplicated flaps (P > .05), and complicated flaps did not lose a statistically significant amount of CDVA or low‐contrast acuity (CDVA 5%) compared to preoperative values. Conclusions Intraoperative and postoperative complications of LASIK flaps created with the femtosecond laser were rare, and their visual outcomes were equivalent to those of normal flaps. Financial Disclosure Charles D. Reilly is a consultant to Alcon Labs and Abbott Medical Optics at present, but was not at the time of the study. For the remaining authors none are declared.

Retrospective Analysis Comparing the Preoperative and Postoperative "Q" Values for 2 Different Lasers in Refractive Surgery.

Purpose: To compare the presurgical and postsurgical corneal asphericity, or “Q value,” between VISX Wavefront-guided treatment and Allegretto Wave Wavefront-optimized treatment in photorefractive keratectomy for the correction of myopia. Methods: This is a retrospective database analysis performed at the Joint Warfighter Refractive Surgery Center, Lackland Air Force Base, TX. All data were accessed through the Institutional Review Board-approved Joint Warfighter Refractive Surgery Center database. Fifty-one patient records (102 eyes) were reviewed to determine the change in the Q value after photorefractive keratectomy for the correction of myopia. Results: The average change in the Q value per diopter of treatment sphere over the entire study population was 0.12 (±0.04) for Allegretto and 0.14 (±0.04) for VISX (P = 0.004). There was no statistical difference among the preoperative and postoperative best-corrected visual acuities (BCVAs), low-contrast BCVA (BCVA 5%), or quality of vision complaints between both platforms. Conclusions: Low to moderate myopic correction with the Allegretto laser was associated with a smaller change in the Q value per diopter of treatment and therefore more closely maintained the original prolate shape of the cornea when compared with VISX. No difference in the postoperative visual outcome between both groups was detected.

Isolation of kingella denitrificans from a corneal ulcer

Purpose: To report a case of a corneal ulcer caused by an unusual pathogen. Design: Case report. Methods: Clinical review describing initial presentation, course, and outcome of 1 patient with a corneal ulcer caused by Kingella denitrificans. Results: A 77-year-old man with a prior history of 4 penetrating keratoplasties in the right eye for herpes simplex virus keratitis presented with a 3-day history of a red painful right eye. On examination, he was found to have a corneal ulcer identified by culture as K. denitrificans. Conclusions: Although Kingella spp. is not a common ocular pathogen, it can infect the cornea, especially when the host immune defense is altered.