José L. Güell

Laser in situ keratomileusis (LASIK) for myopia from -7 to -18 diopters

BACKGROUND Laser in situ keratomileusis (LASIK) combines a lamellar corneal flap with an excimer laser ablation in the stromal bed to correct a wide range of myopia. We reviewed 43 eyes treated with LASIK to correct -7.00 to -18.50 diopters (D). METHOD The data from 43 consecutive eyes of 30 patients aged 24 to 46 years were analyzed. Surgery was performed under topical anesthesia using the Chiron Automated Corneal Shaper and Keracor 116 Excimer laser with the multizone mode and our modified nomogram. Manifest and cycloplegic refraction, uncorrected visual acuity, spectacle corrected visual acuity, videokeratography, endothelial cell count, slit-lamp microscopy, fundus examination, and applanation tonometry were recorded preoperatively and at 1 week and 1, 3, and 6 months, postoperatively. RESULTS We divided the eyes into two groups. The lower myopia group had a mean preoperative spherical equivalent refraction of -9.30 +/- 1.31 D (range: -7.00 D to -12.00 D) and mean postoperative refraction of -0.80 +/- 0.79 (range: -0.25 D to -3.50 D). The mean spectacle corrected visual acuity preoperatively was 0.74 +/- 0.20 and postoperatively was 0.74 +/- 0.18. The higher myopia group had a mean preoperative spherical equivalent refraction of -14.86 +/- 1.87 D (range: -12.25 D to -18.50 D) and a mean postoperative refraction of -1.80 +/- 1.29 D (range -1.00 D to -5.25 D). The mean spectacle corrected visual acuity preoperatively was 0.50 +/- 0.19 and postoperatively was 0.51 +/- 0.18. No overcorrections occurred in either group. One eye of the higher group lost one line of spectacle corrected visual acuity. No eye had visually significant corneal haze. The mean change in spherical equivalent refraction between preoperatively and 6 months postoperatively was 8.50 D for the lower myopia group and 13.06 D for the higher myopia group, in the myopic direction. Visual rehabilitation was rapid after surgery. CONCLUSIONS In this study, LASIK resulted in insignificant corneal scarring, stable refractive correction over six months, no irregular astigmatism, and excellent visual acuity. Predictability was more accurate up to -12.00 D of intended correction.

Toric phakic intraocular lens: European multicenter study.

OBJECTIVE To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. DESIGN Prospective, nonrandomized, comparative (self-controlled) multicenter trial. PARTICIPANTS Seventy eyes of 53 patients (mean, 35 years; range, 22-59 years) with preoperative spherical equivalent between +6.50 and -21.25 diopters (D) and cylinder between 1.50 and 7.25 D. METHODS Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up was 6 months in all cases. Lenses were available in powers ranging from +12.0 D to -23.5 D (spherical equivalent) in 0.5-D increments, with additional cylinder from 1.0 D to 7.0 D, also in 0.5-D increments. MAIN OUTCOME MEASURES The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell count (ECC), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, subjective complaints, and patient satisfaction. RESULTS Eyes were divided into group A, myopia (n = 48), with an average preoperative spherical equivalent of -8.90 +/- 4.52 D, and group B, hyperopia (n = 22), with an average preoperative spherical equivalent of +3.25 +/- 1.98 D. No eyes in either group experienced a loss in BSCVA, and 46 eyes gained 1 or more lines of their preoperative BSCVA. In 62 eyes (88.6%), UCVA was 20/40 or better. There was a significant reduction in spherical errors and astigmatism in all cases after surgery. All eyes of both groups were within +/-1.00 D of target refraction, and 51 eyes (72.9%) were within +/-0.50 D of target refraction. There was a 4.5% mean total loss of ECC during the first 6 months. No serious complications were observed. Overall patient satisfaction was very high. CONCLUSIONS Six-month clinical trial results demonstrate that implantation of the Artisan TPIOL safely, predictably, and effectively reduced or eliminated high ametropia and astigmatism with one procedure. The refractive effect was stable at 6 months after surgery.

A randomized paired eye comparison of two techniques for treating moderately high myopia: LASIK and artisan phakic lens.

OBJECTIVE To compare refractive performance and safety of laser in situ keratomileusis (LASIK) and Artisan phakic intraocular lens (PIOL) for moderately high myopia. DESIGN A prospective, randomized trial with paired eye control. PARTICIPANTS Twenty-five patients with myopia ranging from -8.00 to -12.00 diopters (D). INTERVENTION For each patient, one eye received LASIK and the other one was implanted with an Artisan phakic intraocular lens. The treated eye and the surgical technique were randomized. MAIN OUTCOME MEASURES Primary outcome measure was spherical equivalent refraction. Main secondary outcome measures were the change of two or more lines and safety index (ratio postoperative to preoperative best-corrected visual acuity). RESULTS One year after surgery, the mean spherical equivalent refraction was -0.74 +/- 0.67 D for LASIK-treated eyes and -0.95 +/- 0.45 D for Artisan-treated eyes, and the majority of LASIK-treated eyes (64%) and Artisan-treated eyes (60%) were within +/-1.00 D of the intended result. At 1 month, the mean spherical equivalent refraction was -0.28 +/- 0.71 D for LASIK and -1.07 +/- 0.59 D for Artisan (P < 0.01). The changes of two or more lines were in favor of Artisan (P < 0.05). The safety index was significantly better for Artisan (1.12 +/- 0.21) than for LASIK (0.99 +/- 0.17) at 1 year (P < 0.02). CONCLUSIONS In cases of moderately high myopia, LASIK and Artisan phakic intraocular lenses seemed to produce a similar predictability. The best-corrected visual acuity and subjective evaluation of quality of vision were better for Artisan.

Phakic intraocular lenses Part 2: Results and complications

&NA; The second part of a review of phakic intraocular lenses (pIOLs) addresses results and complications with current pIOL models. Phakic IOLs demonstrate reversibility, high optical quality, potential gain in visual acuity in myopic patients due to retinal magnification; correction is not limited by corneal thickness or topography. With proper anatomical conditions, pIOLs also show good results in hyperopic patients. Toric pIOL designs enable spherocylindrical correction. Complications are rare and primarily related to pIOL position and type. The main complications of angle‐supported anterior chamber pIOLs are glare and halos, pupil ovalization, and corneal endothelial cell loss; of iris‐fixated anterior chamber pIOLs, chronic subclinical inflammation, corneal endothelial cell loss, and dislocation or pupillary block glaucoma; and of posterior chamber pIOLs, anterior subcapsular cataract formation, pigment dispersion, and luxation or pupillary block glaucoma. No causative relationship between pIOL implantation (of any pIOL type) and retinal detachment has been established. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Limbal-conjunctival autograft transplantation for the treatment of recurrent pterygium

OBJECTIVE Different investigators have recently emphasized the importance of the limbus and its stem cells in the pathogenesis of the pterygium. In this article we examine the usefulness of limbal-conjunctival autograft transplantation for the treatment of advanced recurrent pterygium. DESIGN Prospective noncomparative case series. PARTICIPANTS Seven patients with advanced recurrent pterygium. All had previously been treated a minimum of two times by simple excision (two of them with intraoperative mitomycin C). INTERVENTION Limbal-conjunctival autograft transplantation after pterygium excision was performed in all cases. MAIN OUTCOME MEASURES Pterygium recurrences and complications with a minimal follow-up period of 14 months. RESULTS There were no recurrences of pterygial growth beyond the limbal edge. In addition, no significant complications were noted. Only one case of limited pseudopterygium in the donor site and one case of graft retraction were recorded. No further surgical interventions were needed in any case. CONCLUSIONS Limbal-conjunctival autograft transplantation is a promising technique for the treatment of advanced recurrent pterygium.

Phakic intraocular lenses

&NA; In this 2‐part overview, the current status of phakic intraocular lens (pIOL) surgery to correct refractive errors is reviewed. Three types of pIOLs, categorized by their intraocular position, are included: angle‐supported anterior chamber, iris‐fixated anterior chamber, and posterior chamber (usually fixated in the ciliary sulcus). Part 1 reviews the main models of each pIOL type, the selection criteria, and the surgical techniques, with emphasis on currently available pIOLs. Bioptics, adjustable refractive surgery, and enhancements are addressed, and applications of the new anterior segment imaging techniques are reviewed. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Artisan toric phakic intraocular lens for the correction of high astigmatism

PURPOSE To evaluate efficacy, predictability, and safety of Artisan toric phakic intraocular lens (Ophtec, Groningen, The Netherlands) implantation for the correction of astigmatism higher than 2 diopters. DESIGN Interventional case series. METHODS This prospective study included 27 eyes of 16 patients with a mean preoperative spherical equivalent of -11.78 +/- 6.24 diopters and a mean preoperative astigmatism of -3.43 +/- 0.81. The Artisan phakic intraocular lens was inserted in the anterior chamber through a posterior corneal incision; the technique is similar to the implantation of the classical Artisan lens, but in these cases it is particularly important to secure the lens accurately in the correct axis. The main parameters evaluated in this study were uncorrected visual acuity, best-corrected visual acuity, refraction, and endothelial cell count. RESULTS Twelve months after the implantation of the Artisan toric phakic intraocular lens, 62.90% of the eyes were within +/-0.50 diopters. of emmetropia and 96.20% within +/-1.0 diopters. Seventy percent of the eyes gained 1 or more Snellen lines from their preoperative best-corrected visual acuity, and 11.11% lost 1 Snellen line. Mean endothelial cell count increased 2.9%. Mean of the parallel and orthogonal components of cylinder correction were 1.97 diopters and 0.10 diopters, respectively, of the intended cylinder change. The mean of axis alignment error was 10.53 degrees. No serious complications were observed. CONCLUSION Artisan toric phakic intraocular lens implantation appears to be a safe and predictable method for the correction of high levels of astigmatism.

Endophthalmitis prophylaxis in cataract surgery: overview of current practice patterns in 9 European countries.

Data on practice patterns for prophylaxis against infectious postoperative endophthalmitis (IPOE) during cataract surgery in 9 European countries were searched in national registers and reviews of published surveys. Summary reports assessed each nations IPOE rates, nonantibiotic prophylactic routines, topical and intracameral antibiotic use, and coherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines. Although the reliability and completeness of available data vary between countries, the results show that IPOE rates differ significantly. Asepsis routines with povidone-iodine and postoperative topical antibiotics are generally adopted. Use of preoperative and perioperative topical antibiotics as well as intracameral cefuroxime varies widely between and within countries. Five years after publication of the ESCRS guidelines, there is no consensus on intracameral cefuroxime use. Major obstacles include legal barriers or persisting controversy about the scientific rationale for systematic intracameral cefuroxime use in some countries and, until recently, lack of a commercially available preparation.

Secondary Artisan-Verysise aphakic lens implantation

PURPOSE: To evaluate efficacy, predictability and safety of Artisan–Verysise intraocular lens (IOL) secondary implantation for aphakia correction. SETTING: Instituto de Microcirugía Ocular, and Autonoma University of Barcelona, Barcelona, Spain. METHODS: Uncorrected visual acuity, best spectacle‐corrected visual acuity (BSCVA), manifest refraction, endothelial cell count, and clinical complications were evaluated. Sixteen consecutive eyes of 14 patients with aphakia were submitted to surgery. Postoperative examinations were done at 6 weeks, 6 months, 1 year, and every year for at least 3 years. An iris‐supported Artisan–Verysise IOL was implanted for aphakia correction. RESULTS: Thirty‐six months after Artisan–Verysise lens implantation, BSCVA was 20/40 or better in 6 eyes (37.5%). Preoperatively, 5 eyes had the same BSCVA (31.25%). Mean postoperative spherical equivalent (SE) was 0.46 diopter (D). Mean endothelial cell loss was 10.9% 36 months postoperatively. The cell loss occurred predominantly during the first year (7.78%). Cystoid macular edema was observed in 2 cases, 1 of them associated with chronic unresponsive low intraocular pressure. No other serious complications were observed. CONCLUSION: Artisan–Verysise IOL implantation seems a safe, predictable, and effective option for aphakic eyes without capsule support.

Clear lens extraction to correct high myopia

Purpose: To assess the refractive outcome and postoperative complications in a single surgeon series of clear lens extraction for high myopia. Setting: Ophthalmology Department, Cornea and Refractive Surgery Unit, Vall d’Hebrón Hospital, Autónoma University of Barcelona, Spain. Methods: Forty‐six clear lens extraction procedures performed in 37 patients from November 1992 to January 1994 by one surgeon were retrospectively analyzed. Capsule tear and vitreous loss, endothelial cell loss, preoperative and postoperative best corrected visual acuity and cycloplegic refraction, and retinal detachment occurrence were looked at. Results: Capsule tear with vitreous loss occurred in one eye (2.17%). Mean endothelial cell loss was 2.6% during the first postoperative year. Best corrected visual acuity was 6/12 or better in 69.4% of eyes preoperatively and in 88.5% postoperatively. Mean cycloplegic refraction was −16.05 diopters (D) preoperatively; the residual cycloplegic refraction was within 1.00 D in 48.4% of eyes and within 2.00 D in 92.5% postoperatively. Conclusion: Because of its high predictability, stability, and low morbidity, we believe clear lens extraction is a reasonable refractive surgery option for middle‐aged patients with myopia.