Terrance N. Clapham

Central Photorefractlve Keratectomy for Myopia: Partially Sighted and Normally Sighted Eyes

Ten partially sighted and 19 normally sighted eyes underwent excimer laser photorefractive keratectomy for the correction of myopia. Nine of the partially sighted and 17 of the normally sighted eyes had 12 months of follow-up. Epithelial healing was complete in all eyes by day 6. None of the eyes had recurrent erosions, infections, or other medical complications. An increase in corneal haze after surgery was followed by a slow trend toward clearing. Average uncorrected visual acuity in the 7 normally sighted eyes with attempted corrections of 5 diopters (D) or less was 20/40 from month 2 on; the eyes with greater than 5 D attempted corrections had an average of 20/80--at month 2, which declined to 20/200--by month 6. Best spectacle-corrected visual acuity was within +/- 1 Snellen line of preoperative values in 14 of the normally sighted eyes, improved 2 or more lines in 2 eyes, and worsened two or more lines in two eyes. Hard contact lens overcorrection restored all of the two-line loss in 1 eye and 1 line of the 3-line loss in the other. Refraction and keratometry indicated corneal flattening without induced astigmatism.

Quantitative Analysis of Wound Healing after Cylindrical and Spherical Excimer Laser Ablations

PURPOSE Superficial corneal ablation using the 193 nm excimer laser for the correction of myopia and astigmatism produces histologic changes in the corneal profile that can be quantitatively analyzed. METHODS Using the excimer laser, spherical and cylindrical corneal ablations were performed on rabbit eyes at depths of 2, 4, 6, and 8 diopters. After 12 weeks, the corneas were examined histologically using a dichlorotriazinyl aminofluorescein stain for collagen, and the results were quantified using a digital video image analysis system. RESULTS Epithelial thickness and thickness of new collagen were positively correlated with the depth of ablation after spherical ablations. With astigmatic ablations, epithelial thickness and new collagen production were correlated with ablation depth in one axis only. CONCLUSION These results suggest that during cylindrical corneal ablations with the excimer laser, radially asymmetrical stromal ablations produce quantitatively asymmetrical wound healing.

Axial and transverse displacement tolerances during excimer laser surgery for myopia

This paper presents an analysis of the effects of axial and transverse displacement on the optical quality and accuracy of lenses created during excimer laser photoablation. Tolerance levels for axial positioning of the cornea prior to and during surgery are presented. The axial tolerance levels are dependent upon a number of parameters which include the intended dioptric correction and laser system cone angle. A collimation lens is introduced as a means of desensitizing the laser system to axial displacement. Transverse displacement tolerances during laser treatment are shown to depend upon the treatment diameter, dioptric correction and acceptable distortion level in the lens ablated into the anterior corneal stroma. A video and computer analysis of transverse motion during seven randomly selected excimer laser refractive surgeries is presented. Although transverse displacement exceeded the tolerance levels presented, it did not appear to affect the quality of correction in the eight patients analyzed.

Refraction Measurements Of Excimer Area Ablated Animal Corneas Using A Modified Autorefractor

Developing refractive surgery techniques usually requires pre-clinical trials with animals before human clinicals are performed. In order to assess the results of the surgery, an accurate and repeatable measurement of the resultant refraction must be made. Normal techniques such as retinoscopy, subjective examinations, and conventional autorefractions all run into problems when animals are involved. The authors have modified a conventional autorefractor and have made measurements on rabbits and monkeys both before and after refractive surgery treatments with an excimer laser. The results showed refractive changes with degrees of myopic correction.