Claudio P. Juarez

Bilateral macular hemorrhage after laser in situ keratomileusis.

Abstract · Background: This is the first report of a bilateral submacular hemorrhage after LASIK surgery in an extreme myo pic patient. A 31-year-old man underwent bilateral surgery for correction of –16.75+0.75×70° and –16.50+0.50×55°. · Methods: Case report. · Results: One day after surgery the patient’s uncorrected visual acuity was in the 20/50 range OU and by 17 days after surgery his visual acuity had declined to 20/200 range. Fundus examination showed multifocal subretinal macular and posterior pole hemorrhages. Fluorescein angiography showed some macular lesions compatible with lacquer cracks. · Conclusions: Preoperative and postoperative fundus examination is important to detect this phenomenon. Patients should be informed of this rare complication.

Choroidal occlusive disease in sickle cell hemoglobinopathies

Two distinct episodes of posterior ciliary artery occlusion were studied in a 32-year-old man with hemoglobin SS disease and multiple episodes of amaurosis fugax. Although posterior ciliary artery occlusions have been observed following photocoagulation of sickle cell retinopathy, their spontaneous evolution in patients with sickling hemoglobinopathies has received little attention. The manifestations of posterior ciliar artery occlusion seen in this case and in other clinical and experimental situations are reviewed. Histopathologic examination of three additional eyes of patients with sickle hemoglobinopathies revealed changes which may have been the result of previous small posterior ciliary artery occlusions or small vessel occlusive disease related to the sickling hemoglobinopathies; these cases are also reported.

Resection of uveal melanocytoma: clinicopathological correlation.

Four patients had pigmented lesions in the anterior uveal tract and choroid which presented clinically as malignant melanomas. All the lesions were successfully removed by local excision. Histopathological studies showed the tumours to be melanocytomas, indicating that enucleation or irradiation would have been contraindicated. The 3 patients with iris and ciliary body melanocytomas continue to maintain corrected visual acuities of 20/30 or better. In the patient with choroidal melanocytoma central visual acuity was compromised owing to cystoid macular oedema. All 3 melanocytomas involving the anterior segment were located inferiorly. Biomicroscopically, they were chocolate coloured (not black) and resembled malignant melanomas of the same location. The choroidal melanocytoma also resembled a malignant melanoma by ophthalmoscopic and angiographic criteria, and did not have the jet black or homogeneous pigmentation that characterises most melanocytomas of the disc.

Full-thickness eye-wall biopsy: long-term results in 9 patients.

Nine patients who had an eye-wall biopsy were evaluated for long-term results. The follow-up time ranged from 2 1/2 months to 7 years. Six patients were followed up for more than 2 years. Few operative and postoperative complications were observed. Except for 1 patient with reticulum cell sarcoma, all eyes retained preoperative visual acuity. Tractional retinal detachment occurred only in 1 patient, who had vitreous bands around the biopsy site and did not undergo a simultaneous vitrectomy during the biopsy operation.

Laser in Situ Keratomileusis for Myopia and Hyperopia Using the Lasersight 200 Laser in 300 Consecutive Eyes

PURPOSE To evaluate effectiveness, safety, predictability, and short-term stability of laser in situ keratomileusis (LASIK) using the LaserSight Compac-200 Mini excimer laser with software version 9.0, for all refractive errors. METHODS One hundred fifty consecutive patients (300 eyes) that received bilateral LASIK for myopia, hyperopia, and astigmatism were studied prospectively. A new 9.0 software version applying a modified nomogram that takes advantage of bilateral surgery was used. Follow-up at 6 months was available for 267 eyes (89%). RESULTS Six months postoperatively, 131 eyes (96.32%) in the low to moderate myopia group (-1.00 to -5.99 D; n=136) had a spherical equivalent refraction within +/-1.00 D, and 123 eyes (90.44%) were within +/-0.50 D of emmetropia. In the high to extreme myopia group (-6.00 to -25.00 D; n=114), 97 eyes (87.08%) had a spherical equivalent refraction within +/-1.00 D and 78 eyes (68.42%) were within +/-0.50 D of emmetropia. In the hyperopia group (+1.00 to +6.00 D; n=50), 44 eyes (88%) had a postoperative spherical equivalent refraction within +/-1.00 D, and 31 eyes (62%) were within +/-0.50 D of emmetropia. Mean change in spherical equivalent refraction at 6 months was less than -0.50 D in the low to high myopia groups and -1.16 +/- 0.55 D in the extreme myopia group. At 6 months follow-up, uncorrected visual acuity was 20/20 or better in 73 eyes (54%) in the low to moderate myopia groups and 21 eyes (18%) in the high to extreme myopia groups. In the hyperopia group at 6 months follow-up, uncorrected visual acuity was 20/20 or better in 31 eyes (62%) and 20/40 or better in 41 eyes (82%). Only two eyes had a temporary loss of two or more lines of spectacle-corrected visual acuity due to corneal folds that were surgically treated. Six months after LASIK, no eye had lost any lines of best spectacle-corrected visual acuity in this series. CONCLUSIONS Our modified LASIK nomogram with the 9.0 software of the LaserSight 200 excimer laser (with a larger and smoother ablation pattern) resulted in safe and effective outcomes for the treatment of low to high myopia, astigmatism, and hyperopia.

Intravitreal triamcinolone acetonide injection in blind painful eyes. Intraocular steroids as a treatment for blind painful red eyes.

Purpose Phthisis bulbi results from different ocular conditions. We evaluated intravitreal triamcinolone acetonide as a treatment option in blind painful eyes. Methods Thirty-one patients with unilateral phthisis were randomly divided into two groups. Group A received 0.3 ml (12.5 mg) triamcinolone acetonide intravitreally and Group B 0.3 ml balanced salt solution after retrobulbar anesthesia. Treatment success was assessed by subjective response to pain and clinically by biomicroscopic evaluation of conjunctival congestion. Tonometry was done before and after treatment. Follow-ups were at 24 hours, 3 weeks, 3 and 6 months, and 1 and 2 years. Results Throughout the two-year follow-up, only two patients in Group A reported pain after the procedure and were retreated, one at week 4 and the other at week 7. Conjunctival congestion was significantly lower in Group A. Two patients with hypotony before treatment had normal tension after triamcinolone. All Group B patients were reinjected with triamcinolone because pain continued after balanced salt solution injection. No severe complications were found. Conclusions Intravitreal triamcinolone acetonide may be effective and safe for treating blind painful eyes.

Laser in situ keratomileus using the LaserSight 200 laser: Results of 950 consecutive cases

PURPOSE To examine the refractive outcome in 950 consecutive eyes having laser in situ keratomileusis (LASIK) by 1 surgeon with experience in keratomileusis. SETTING Outpatient excimer laser surgical facility. METHODS This study comprised 950 consecutive eyes of 475 patients having LASIK as a primary procedure with a LaserSight 200 excimer laser (8.51 software). A nasal hinged flap and a Chiron microkeratome were used. Preoperative cycloplegic refraction was done only in patients younger than 25 years and in all hyperopic cases. Subjective preoperative and postoperative manifest refractions were done after autorefractometry in all cases. In cases of hyperopia, the software was modified by adding 30% to the refractive error. Enhancement results are not included. RESULTS Of the 950 eyes, 893 (94.00%) were myopic and 57 (6.00%), hyperopic. In the low myopia group (1.00 to 3.99 D) of 223 eyes (24.97%), mean spherical equivalents (SEs) were -2.90 D +/- 0.56 (SD) preoperatively, -0.46 +/- 0.6 D 3 months postoperatively, and -0.41 +/- 0.5 D 6 months postoperatively. In the moderate myopia group (4.00 to 5.99 D) of 205 eyes (22.96%), respective mean SEs were -4.90 +/- 0.7 D, -0.90 D +/- 0.9 D, and -0.67 +/- 0.7 D. In the high myopia group (6.00 to 9.99) of 266 eyes (25.30%), the respective means were -7.70 +/- 1.3 D, -0.76 +/- 0.99 D, and -0.60 +/- 0.8 D. In the extreme myopia group (10.21 to 30.00) of 199 eyes (22.28%), the respective means were -13.30 +/- 2.9 D, -1.30 +/- 1.4 D, and -1.13 +/- 1.3 D. For the entire myopic group, the mean astigmatism was +1.55 +/- 1.38 D, +1.09 +/- 0.92 D, and +0.87 +/- 0.77 D, respectively. The low hyperopia group (1.00 to 2.99 D) of 39 eyes (68.42%) had a mean preoperative SE of +1.80 +/- 0.59 D and mean postoperative SEs of +1.00 +/- 0.76 D at 3 months and +1.16 +/- 0.52 D at 6 months. The respective means in the moderate hyperopia group (3.00 to 6.00) of 18 eyes (31.57%) were +4.62 +/- 1.19 D, +3.71 +/- 1.12 D, and +4.00 +/- 1.07 D. CONCLUSIONS Laser in situ keratomileus for myopia using the LaserSight 200 excimer laser was stable with time and safe for the correction of different degrees of myopia. In the hyperopic group, marked regression occurred in a large percentage of patients. Thus, we will not perform LASIK for hyperopia until the software improves.

Rhodococcus globerulus keratitis after laser in situ keratomileusis.

A healthy 20-year-old woman with myopia had uneventful bilateral laser in situ keratomileusis after which the uncorrected visual acuity was 20/20 in the right eye and 20/30 in the left eye. Fifteen days later, a stromal paraxial lesion was found in the right eye with a corresponding loss of visual acuity, pain, and photophobia. The flap was lifted and the infiltrate scraped for smears. Cultures showed that Rhodococcus globerulus was the infectious agent. Intensive topical antibiotic treatment was applied with good visual results.

Effects of Argon and Krypton Laser on Experimentally Detached Retinas

Krypton and argon laser photocoagulation on the foveas and blood vessels of experimentally detached monkey retinas were studied clinicopathologically. In this manner heat transmission from the retinal pigment epithelium (RPE) to the overlying sensory retina was avoided. Krypton lesions bypassed the sensory retina on every occasion to produce major photocoagulative effects at the level of the RPE and choroid. Argon laser wavelengths damaged the overlying retina in the foveal areas as well as in perivascular structures. Although the krypton laser appears preferable for treatment of macular diseases, proper parameters should be used to avoid serious complications.

Effects of topical diclofenac and prednisolone eyedrops in laser in situ keratomileusis patients

PURPOSE To compare the effects of a topical nonsteroidal anti-inflammatory agent, diclofenac, and prednisolone acetate on wound healing, postoperative inflammation, and other clinical parameters in laser in situ keratomileusis (LASIK) patients. SETTING Fundación VER, Córdoba, Argentina. METHODS Laser in situ keratomileusis for myopia was performed simultaneously in both eyes of 16 patients by 1 surgeon. Patients were prospectively randomized to receive diclofenac eyedrops in the right eyes and prednisolone acetate eyedrops in the left. Postoperatively, the drops were administered topically every 2 hours the first day, every 6 hours the first week, every 8 hours the second week, and once a day the fourth week. Preoperatively and at each postoperative visit, evaluation of visual acuity, slitlamp biomicroscopy, corneal topography, and clinical scoring (0-III) of pain and photophobia were done; epithelial interface opacities were objectively evaluated. Follow-up was at 24, 48, and 72 hours, 1, 2, and 3 weeks, and 1, 2, 3, and 6 months. A paired t test was used for statistical analysis. RESULTS Mean age of the 16 patients was 29.4 years +/- 6.5 (SD). Preoperatively, mean spherical equivalent was -5.83 +/- 3.61 diopters (D) in the right eyes and -6.96 +/- 4.66 D in the left eyes. At 6 months postoperatively, it was -1.83 +/- 1.87 D and -1.88 +/- 2.13 D, respectively. In the first 24 hours, there were significant clinical symptoms in the diclofenac group. CONCLUSIONS Wound healing was stable, with no regression, in the diclofenac and prednisolone groups. Both anti-inflammatory agents worked well in LASIK patients.