Gerard Sutton

LASIK for post penetrating keratoplasty astigmatism and myopia

AIMS To report the results of a series of patients who were treated with LASIK to correct post penetrating keratoplasty ametropia. METHODS 26 eyes of 24 patients underwent LASIK to correct astigmatism and myopia after corneal transplantation; 14 eyes also received arcuate cuts in the stromal bed at the time of surgery. The mean preoperative spherical equivalent was −5.20D and the mean preoperative astigmatism was 8.67D. RESULTS The results of 25 eyes are reported. The mean 1 month values for spherical equivalent and astigmatism were −0.24D and 2.48D respectively. 18 eyes have been followed up for 6 months or more. The final follow up results for these eyes are −1.91D and 2.92D for spherical equivalent and astigmatism. The patients undergoing arcuate cuts were less myopic but had greater astigmatism than those not. The patients receiving arcuate cuts had a greater target induced astigmatism, surgically induced astigmatism, and astigmatism correction index than those eyes that did not. One eye suffered a surgical complication. No eyes lost more than one line of BSCVA and all eyes gained between 0 and 6 lines UCVA. CONCLUSIONS LASIK after penetrating keratoplasty is a relatively safe and effective procedure. It reduces both the spherical error and the cylindrical component of the ametropia. Correction of high astigmatism may be augmented by performing arcuate cuts in the stromal bed.

Capsular block syndrome associated with femtosecond laser-assisted cataract surgery.

UNLABELLED We report intraoperative capsular block syndrome occuring during the first 50 femtosecond laser-assisted cataract surgeries performed in our facility. Two patients had uneventful combined laser fragmentation, capsulotomy, and corneal incision procedures. In both cases, following transfer to the operating room and manual removal of the laser-cut capsulotomy, posterior capsule rupture was noted during hydrodissection, resulting in posterior dislocation of the lens. Pars plana vitrectomy, removal of the crystalline lens, and sulcus implantation of an intraocular lens were performed in both patients with good visual outcomes. Femtosecond laser-assisted cataract surgery changes the intraoperative environment with the generation of intracapsular gas and laser-induced changes in the cortex. With awareness of the changed intraocular environment following laser lens fragmentation and capsulotomy and a modification of the surgical technique, no additional cases of intraoperative CBS have been seen in more than 600 laser-assisted cataract surgery procedures performed to date at our facility. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Applications of the femtosecond laser in corneal refractive surgery.

Purpose of review The femtosecond laser has become a rapidly and widely adopted technology for surgeons performing refractive surgery. With the advances in femtosecond lasers, clinical outcomes and safety with their use have improved. The purpose of this review is to outline the current surgical applications of the femtosecond laser in corneal refractive surgery. Recent findings Many surgeons have adopted femtosecond technology for the creation of the laser in-situ keratomileusis flap secondary to its improved safety, precision and reproducibility. Other applications include astigmatic keratotomy, channel creation for the insertion of intrastromal corneal ring segments, femtosecond lenticule extraction, facilitating the insertion of corneal inlays as well as in intrastromal presbyopia correction (IntraCOR). Further novel applications continue to be developed. Summary This review outlines the recent advances and applications of the femtosecond laser in corneal refractive surgery.

Six‐year review of Acanthamoeba keratitis in New South Wales, Australia: 1997–2002

Aim: To assess the incidence and risk factors for Acanthamoeba keratitis (AK), the diagnostic interval, and the efficacy and outcome of current treatment among the population of New South Wales, Australia.

Laser in situ keratomileusis in 2010 - a review.

Laser in situ keratomileusis has become a widely accepted and commonly performed surgical refractive procedure. With the rapid advances in laser technology and surgical techniques, the visual outcomes and safety of this procedure has significantly improved. This review outlines the historical background, recent technological advances, indications, patient assessment and selection, the surgical technique, as well as complications of the procedure and their management.Laser in situ keratomileusis has become a widely accepted and commonly performed surgical refractive procedure. With the rapid advances in laser technology and surgical techniques, the visual outcomes and safety of this procedure has significantly improved. This review outlines the historical background, recent technological advances, indications, patient assessment and selection, the surgical technique, as well as complications of the procedure and their management.

Staphylococcal infection under a LASIK flap

PURPOSE To report a staphylococcal infection under a laser in situ keratomileusis (LASIK) flap and to discuss the management of this rare and potentially devastating complication. METHODS A patient was referred to our practice having had bilateral LASIK. She was found to have abscesses under the left corneal flap. Staphylococcus aureus was identified as the infecting organism by corneal scrape and treated with appropriate antibiotics. The cornea improved, and then the abscess recurred. The abscess was again scraped and intensive treatment reinstituted. RESULTS After successful treatment, the patient recovered excellent visual acuity with only a minimal astigmatic error. CONCLUSION The possible reasons for the apparent improvement and then recurrence of the abscess are discussed. The management of this case including the need for corneal scrape and antibiotic prophylaxis is discussed in relation to previously reported cases.

Femtosecond laser cataract surgery: technology and clinical practice

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high‐resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side‐port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer‐guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience.The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience.

Outcomes of implantation of an artificial cornea, AlphaCor: effects of prior ocular herpes simplex infection.

Purpose. To review outcomes of AlphaCor artificial cornea implantation in patients with and without a history of ocular herpes simplex virus (HSV) and to determine whether herpetic eye disease is an indication for AlphaCor surgery. Methods. Outcomes of the initial 40 implantations were reviewed and stratified by the presence of a history of ocular disease caused by HSV. Outcomes measures (complications, visual acuity gained) were compared. Results. Eight of the 40 AlphaCor implantations (20%) were in patients with a history of ocular HSV. Six of these eight patients (75%) developed melt-related complications after AlphaCor insertion. Half of the affected patients required removal of the AlphaCor and replacement with a donor corneal graft to restore ocular integrity. In comparison, only six of the 32 (18.8%) patients without HSV developed a melt after AlphaCor insertion. Patients with HSV with devices in situ exhibited a mean loss of 0.3 line of best-corrected visual acuity compared with the preoperative visual acuity, whereas patients without HSV exhibited a mean gain of 1.4 lines of best-corrected visual acuity. Conclusions. The extensive lamellar corneal surgery involved in AlphaCor implantation may precipitate reactivation of latent HSV such that reactivation and resultant inflammation reduce device biointegration and facilitate melting of corneal stromal tissue anterior to the device. Although there may be some benefit from systemic antiviral medication, the current series is not large enough to demonstrate such a benefit, and melting can occur despite medication. The statistically significant difference in outcomes between recipients of AlphaCor with and without HSV is evidence that a history of HSV should be an exclusion factor for AlphaCor surgery.

Outcomes of Femtosecond Laser Cataract Surgery With a Diffractive Multifocal Intraocular Lens

PURPOSE To report the visual and refractive outcomes in an initial series of eyes undergoing femtosecond laser cataract surgery with implantation of a diffractive multi-focal intraocular lens (IOL). METHODS The first 61 consecutive eyes undergoing femtosecond laser cataract surgery and ReSTOR (Alcon Laboratories Inc) +3.00-diopter (D) add IOL implantation between May and July 2011 were enrolled in the study (LCS group). The control group consisted of a retrospective consecutive cohort of 29 eyes that underwent manual phacoemulsification cataract surgery and ReSTOR +3.00-D add IOL implantation (MCS group) between December 2010 and April 2011. Visual and refractive parameters were collected pre- and postoperatively at 1 and 3 months. RESULTS Mean postoperative spherical equivalent refraction was -0.01±0.35 D and -0.06±0.30 D in the LCS and MCS groups, respectively (P=.492). Mean absolute refractive prediction error (PE) was 0.26±0.25 D for the LCS group and 0.23±0.16 D for the MCS group (P=.489). Mean arithmetic refractive PE was 0.06±0.44 D and -0.02±0.30 D for the LCS and MCS groups, respectively (P=.388). No significant difference was noted in mean postoperative uncorrected distance visual acuity or uncorrected near visual acuity between groups. No eyes in either group had surgical complications or loss of corrected distance visual acuity in the follow-up period. CONCLUSIONS Mean spherical equivalent refraction and visual acuity of our initial group of patients undergoing laser cataract surgery are comparable to the manual phacoemulsification cohort for the AcrySof ReSTOR +3.00-D add IOL.

Recutting the Cornea Versus Lifting the Flap: Comparison of Two Enhancement Techniques Following Laser in situ Keratomileusis

PURPOSE To evaluate enhancement techniques following laser in situ keratomileusis (LASIK). METHODS Recutting was performed on 263 eyes and the flap was lifted in 55 eyes that had LASIK for simple myopia or myopic astigmatism. The time interval between LASIK and retreatment was 340+/-46 days (range, 270 to 892 days) in the recutting group and 215+/-36 days (range, 53 to 617 days) in the flap lifting group. Mean spherical equivalent refraction, refractive cylinder, uncorrected and best spectacle-corrected visual acuity were examined prior to, and 1, 3, and 6 months after retreatment. RESULTS Seventeen eyes were lost to follow-up in the lifting group and 53 eyes in the recutting group. In the recutting group, mean spherical equivalent refraction improved from -1.48+/-1.25 D to -0.49+/-0.88 D at 6 months. In the flap lifting group, mean spherical equivalent refraction improved from -1.05+/-1.49 D to -0.45+/-0.39 D at 6 months. Refractive cylinder did not change significantly in either group (P = .2). There was a significant increase in uncorrected visual acuity (UCVA) of 6/6 in each group. In the recutting group, UCVA of 6/6 increased from 3.8% to 65.2% at 6 months, and in the lifting group from 3.6% to 71.1% at 6 months. In the recutting group, seven free flaps and three macerated flaps that required removal occurred. One eye in the recutting group and two in the lifting group developed significant epithelial ingrowth. No patient lost more than one line of best spectacle-corrected visual acuity (BSCVA). CONCLUSION Both procedures were safe, effective, and highly predictable for enhancements, but flap complications may be more likely with recutting.