Joao J Nassaralla

Prophylactic mitomycin C to inhibit corneal haze after photorefractive keratectomy for residual myopia following radial keratotomy.

PURPOSE To evaluate the efficacy and safety of mitomycin C (MMC) 0.02% in inhibiting haze formation after excimer laser photorefractive keratectomy (PRK) for residual myopia following radial keratotomy (RK). METHODS A prospective, nonrandomized, noncomparative interventional case series was conducted of 22 eyes (14 patients) with residual myopia after RK performed at a single institution. All eyes were treated with PRK and a single intraoperative topical application of MMC 0.02% solution for 2 minutes using a soaked cellulose sponge placed over the ablated area. Refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and slit-lamp evidence of cotneal opacity (haze) were evaluated over 12 months. RESULTS Twelve months postoperatively, 3 eyes showed grade 1 haze, and 2 eyes showed grade 0.5 haze. Twelve months postoperatively, 2 (9%) eyes had UCVA > or = 20/20. No eye before and 17 (77%) eyes after treatment had UCVA > or = 20/40, and no eye before and 9 eyes (40.9%) after treatment had UCVA > or = 20/25. Best spectacle-corrected visual acuity was > or = 20/40 in all (100%) eyes and 21 (95%) eyes before and after treatment, respectively, and > or = 20/25 in 12 (54.5%) eyes before and after treatment. One (4.5%) eye lost 1 line of BSCVA. Mean spherical equivalent refraction achieved was -0.18 diopters (D) (range: -0.75 to +0.50 D) compared to -2.72 D (range: -1.50 to -4.00 D) before treatment. Twelve months after treatment, 19 (85.5%) eyes had a refractive outcome within +/- 0.50 D. CONCLUSIONS A single intraoperative application of MMC 0.02% for 2 minutes appears to be effective in preventing subepithelial haze after PRK for residual myopia in patients with undercorrection or regression following RK.

Laser in situ Keratomileusis After Penetrating Keratoplasty

PURPOSE To determine the safety, efficacy, predictability, and stability of laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism in eyes with prior penetrating keratoplasty. METHODS Eight eyes of 8 patients with penetrating keratoplasty had significant postoperative refractive error. Each eye received LASIK 1 year or more after penetrating keratoplasty. All were followed for 6 months or more. All patients were treated with the Chiron Technolas 217 excimer laser and the Automated Corneal Shaper microkeratome. RESULTS Mean spherical equivalent refraction decreased from -4.50 D (range, -3.00 to -7.25 D) to -0.75 D (range, -1.50 to +0.50 D) and the mean preoperative astigmatism decreased from 3.50 D (range, 1.50 to 5.00 D) to 1.25 D (range, 0.75 to 2.00 D). Uncorrected visual acuity improved by at least two Snellen lines in all eyes. Best spectacle-corrected visual acuity did not change in four eyes (50%) and improved in three eyes (37.5%). CONCLUSION LASIK effectively reduced low and moderate myopia and myopic astigmatism following penetrating keratoplasty.

Laser in situ keratomileusis in children 8 to 15 years old.

PURPOSE To determine the safety, efficacy, predictability, and stability of laser in situ keratomileusis (LASIK) to correct high myopia or high myopic astigmatism in patients with high anisometropia in whom conventional treatments have failed. METHODS Nine eyes of nine patients, three boys and six girls with high anisometropia (>3.50 D), were included in this study. Patient age was 8 to 15 years. Minimum follow-up was 12 months. All patients were treated with the Chiron Technolas 217 excimer laser. RESULTS Three months after LASIK, uncorrected visual acuity improved by at least five Snellen lines in all eyes. Three eyes (33.3%) were 20/40 or better without correction. Due to dense amblyopia, no eye had uncorrected visual acuity of 20/20 or better. The mean spherical equivalent refraction decreased from -7.66 to -0.22 D, and mean preoperative astigmatism decreased from -3.11 to -0.69 D. Eight eyes (88.8%) were within +/-1.00 D of emmetropia. Two eyes (22.2%) were within +/-0.50 D of the desired outcome. All patients were able to function binocularly. CONCLUSION In this study of selected older children, LASIK was a safe and effective option for the correction of high anisometropia and for improved binocularity, when conventional therapies had failed. Further study is necessary to determine the long-term refractive stability in these young patients.

Tres anos pos-LASIK em criancas anisometropes de 8 a 15 anos de idade

PURPOSE: To determine the safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK), three years after surgery, to correct high myopia or high myopic astigmatism in children with high anisometropia in whom conventional treatments had failed. METHODS: Nine eyes of 9 patients, 3 boys and 6 girls with a mean age of 11.5 years (range, 8 to 15 years) underwent LASIK using the Chiron Technolas 217 excimer laser. Minimum follow-up was 36 months. RESULTS: Three years after LASIK, uncorrected visual acuity improved by at least five Snellen lines in all eyes; five eyes (55.5%) were 20/50 or better without correction. Six eyes (66.6%), were 20/50 or better with correction and five eyes (55.5%) improved at least 1 line in the best spectacle corrected visual acuity (BSCVA). Due to amblyopia, no eye had uncorrected visual acuity of 20/20 or better. The mean spherical refraction equivalent decreased from -7.66 (± 3.75) D to -1.02 (± 1.26) D, and mean preoperative astigmatism decreased from -3.11 (± 2.09) D to -0.75 (± 0.25) D. Highest anisometropia was 1.5 D. CONCLUSION: Three years after surgery, LASIK seems to be a safe and effective option for the correction of high anisometropia in children from 8 to 15 years old, in whom conventional therapy had failed. The natural change in refraction related to maturation did not affect the use of appropriate spectacle correction.

Estudo experimental da eficácia clínica e microbiológica da associação do diclofenaco sódico e sulfato de gentamicina no tratamento da ceratite por Pseudomonas aeruginosa

Objetivo comparar o efeito da associacao de diclofenaco sodico 0,1 ppor cento, mais sulfato de gentamicina 0,3 por cento em olhos de coelhos infectados por meio de injecao intra-estromal de Pseudomonas aeruginosa, apos remocao do epitelio da regiao central da cornea. Metodos: os animais foram tratados com solucoes topicas contendo diferentes drogas. Grupo I: associacao de diclofenaco sodico 0,1 por cento, mais sulfato de gentamicina 0,3 por cento. Grupo II: veiculo da associacao de diclofenaco sodico 0,1 por cento, mais sulfato de gentamicina 0,3 por cento. Grupo III: apenas diclofenaco sodico 0,1 por cento. Grupo IV: sulfato de gentamicina 0,3 poe cento isoladamente. Grupo V: BSS. Grupo VI: nao recebeu nenhuma medicacao. Os animais do grupo VI foram sacrificados no primeiro dia ..