Laser Ablation in Eyes With Congenital Nystagmus

PURPOSE

To report photorefractive keratectomy and LASIK for the correction of myopia in eyes with congenital nystagmus.

METHODS

Photorefractive keratectomy was performed in one eye and LASIK performed in eight eyes of five adult patients (three men and two women) with congenital nystagmus. Mean patient age was 34 years.

RESULTS

Preoperative refraction ranged between -1.50 and -22.00 diopters (D) sphere, and -0.50 and -3.25 D of astigmatism; best spectacle-corrected visual acuity (BSCVA) ranged between 2 m finger counting and 20/30. In all nine eyes, postoperative uncorrected visual acuity (UCVA) equaled or exceeded preoperative BSCVA. Postoperative topography showed central ablations. Results were stable at follow-up 18 months after surgery, except in one eye with follow-up of 4 months. Enhancement was not required in any eye.

CONCLUSIONS

Positive results were achieved for ablation performed with a broad beam laser in eyes with nystagmus.

The Effects of Droperidol in Perforating Keratoplasty

PURPOSE

To evaluate the intraoperative and postoperative effects of droperidol administered with general anesthesia during perforating keratoplasty.

METHODS

A prospective, randomized, double-masked clinical trial. Twenty-seven patients undergoing penetrating keratoplasty under general anesthesia were included. Patients were assigned randomly to two groups. Fifteen subjects received droperidol during induction of general anesthesia. Twelve control patients received general anesthesia without droperidol.

RESULTS

Droperidol significantly reduced fellow eye intraocular pressure (p < 0.0001). Intraoperative anterior chamber depth was significantly deeper with droperidol (p = 0.0002). Iris bulging was observed in 25% of the control group and 0% with droperidol. There was significantly less postoperative nausea in the droperidol group (p = 0.038). There was less postoperative vomiting in the droperidol group, although the difference was not significant (p = 0.07). Postoperative wound gaping was observed in 2 patients; both of them did not receive droperidol.

CONCLUSIONS

Droperidol effectively reduces intraoperative and postoperative complications in keratoplasty surgery.

Reactivation of Ocular Toxoplasmosis After LASIK

PURPOSE

To report a reactivation of ocular toxoplasmosis after LASIK.

METHODS

Case report of a 34-year-old man who underwent bilateral LASIK. The posterior segment examination revealed an old toxoplasmosis scar in the retinal periphery of the right eye.

RESULTS

Uncorrected visual acuity improved postoperatively, and the patient was satisfied. However, 52 days after the procedure, he complained of loss of visual acuity in his right eye. Examination revealed signs of anterior uveitis, vitreitis, and active chorioretinal lesion satellite of the old toxoplasmosis scar. The patient was treated with a multidrug regiment with resolution of the vitreous and lesion activity.

CONCLUSIONS

Toxoplasmosis reactivation may develop after LASIK.

Management of Pellucid Marginal Degeneration With Intracorneal Ring Segments

PURPOSE

To present intracorneal ring segments for potential management of pellucid marginal degeneration.

METHODS

A 41-year-old man with pellucid marginal degeneration with poor visual acuity due to irregular astigmatism was treated with Intacs microthin insert (KeraVision, Fremont, Calif) in the left eye.

RESULTS

Uncorrected visual acuity improved from 2/60 to 6/60 following the procedure. The procedure completely eliminated myopia of -8.00 diopters and improved the irregularity of the astigmatism, although it did not change its magnitude.

CONCLUSIONS

Insertion of the intracorneal ring segment improves visual acuity in pellucid marginal degeneration by flattening the central corneal protrusion, thus reducing myopia and improving the astigmatism irregularity.

Intacs after laser in situ keratomileusis and photorefractive keratectomy

PURPOSE

To evaluate the efficacy of intrastromal corneal ring segments (Intacs, Addition Technology) for the correction of residual myopia after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).

METHODS

In this prospective noncomparative case series, Intacs were implanted in 5 eyes (4 patients) that developed myopic regression after LASIK or PRK. Intacs were implanted a minimum of 11 months after the laser procedure. The technique was identical to the standard procedure for myopic unoperated eyes. The Intacs thickness was based on the amount of residual myopia.

RESULTS

Postoperative results revealed a reduction in the residual myopia and the mean K-reading. No eye lost best corrected Snellen visual acuity. No intraoperative or postoperative complications occurred.

CONCLUSIONS

Implantation of Intacs in eyes with myopic regression after LASIK and PRK resulted in a good refractive outcome and an improvement in uncorrected visual acuity.

Keratitis after implantation of intrastromal corneal ring segments

A 53-year-old man had implantation of 2 intrastromal corneal ring segments (Intacs, Addition Technology Inc.) in the left eye. Several days after the lower segment was exchanged, an infiltrate was present at the corneal incision site. This progressed to a lower channel infection followed by diffuse keratitis. Culture from the conjunctiva was positive for Staphylococcus epidermidis, but cultures from the cornea were negative for microorganisms. Later, 2 gas bubbles appeared at the interface. The patient was treated with topical and subconjunctival antibiotics and channel irrigation. The keratitis resolved, leaving a neovascularized opacity at the nasal part of the lower channel.