Complications of laser in situ keratomileusis (LASIK)

PURPOSE

To report major complications associated with laser in situ keratomileusis (LASIK).

METHODS

Twenty-four eyes of 23 patients who underwent LASIK in different centers in Saudi Arabia were included. There were 9 women and 14 men. The age range was from 20 to 65 years. Nineteen of the 23 patients had been referred to the Eye Center for management. All patients had a complete ophthalmologic examination, refraction, corneal topography and pachymetry.

RESULTS

The 24 eyes of 23 patients had complications consequent to LASIK. Thirteen were intraoperative complications, and 11 postoperative. Ten (44%) of the 23 cases were related to the corneal flap, two (9%) with intraocular perforation with the microkeratome. Three (13%) had photoablation-related complications. Postoperative complications included three (13%) cases of infections, four (17%) stromal-interface related problems, one (5%) who developed interface vascularization, and one (5%) with non-ischemic central retinal vein occlusion.

CONCLUSIONS

Although LASIK is a safe and effective procedure, a small number of patients may suffer serious complications that can even lead to visual loss. The procedure must be carefully performed by qualified surgeons.

Indolent corneal ulcers in a patient with congenital insensitivity to pain with anhidrosis: a case report and literature review

PURPOSE

To report a case of bilateral corneal neurotrophic ulcer in patient with congenital insensitivity to pain with anhidrosis (CIPA) and review the literature.

CASE REPORT

A 6 year-old boy presented with bilateral central corneal sterile ulcer, decreased corneal sensitivity, moderately altered corneal reflex and normal tearing response. History taken, systemic evaluation and medical chart review were undertaken.

DISCUSSION

Fifty-two cases of CIPA have been reported worldwide. Fourteen cases had corneal involvement. The clinical picture of our patient is characteristic of CIPA.

CONCLUSIONS

Congenital insensitivity to pain with anhidrosis may present as neurotrophic corneal ulcer. We report herewith, this vision threatening corneal congenital abnormality. Early diagnosis and prompt treatment are mandatory to prevent corneal complications such as scarring and perforation.

Laser in situ Keratomileusis for the Correction of Hyperopia From +0.50 to +11.50 Diopters With the Keracor 117C Laser

PURPOSE

To evaluate excimer laser in situ keratomileusis (LASIK) for the correction of hyperopia.

METHODS

We reviewed retrospectively the medical records of 46 patients treated with LASIK for hyperopia. All patients had a complete ophthalmologic evaluation. The corneal bed was ablated using the Bausch & Lomb Chiron Keracor 117C excimer laser to create a paracentral annular ablation under a nasally hinged 160-microm corneal flap with the Chiron Automatic Corneal Shaper microkeratome. Follow-up was a minimum of 6 months.

RESULTS

Eighty eyes of 46 patients (23 males and 23 females) were included. Age ranged from 18 to 65 years (mean, 42 yr). The range of preoperative spherical equivalent refraction was +0.50 to +11.50 D (mean, +3.40 D). Mean postoperative spherical equivalent refraction at 6 months was +0.26 D. Six months after surgery, 35 eyes (44%) achieved uncorrected visual acuity of 20/20 or better and 78 eyes (97.5%) achieved 20/40 or better. Forty-six eyes (58%) had a postoperative spherical equivalent refraction within +/-0.50 D of attempted correction, and 67 eyes (84%) were within +/-1.00 D of attempted correction. When using the Bausch & Lomb Chiron Keracor 117C excimer laser to correct hyperopia, eyes with a spherical equivalent refraction less +2.00 D should be overcorrected by 25%, +2.00 to +4.00 D by 30%, and over +4.00 by 40%. The positive cylinder should be overcorrected by 10%.

CONCLUSIONS

LASIK was safe and effective in the treatment of hyperopia from +0.50 to +11.50 D. Regression following LASIK for hyperopia remains a problem. A special nomogram was required to achieve results comparable with those for myopia.

Anterior uveitis following combined vaccination for measles, mumps and rubella (MMR): a report of two cases

PURPOSE

To describe two children who developed anterior uveitis after vaccination for common childhood diseases.

METHODS

A retrospective study of two Saudi patients who were seen at The Eye Center, Riyadh, Saudi Arabia.

RESULTS

Aged 12 and 14, respectively, the two patients developed anterior non-granulomatous uveitis 6 and 4 weeks after having the combined vaccination for measles, mumps and rubella (MMR). No other definite cause of uveitis was detected from history or from laboratory work up. Both patients responded to traditional regimens of uveitis therapy. However, they required a treatment period of several months.

CONCLUSION

Anterior uveitis may occur following MMR vaccination. Cases of vaccination thus require ophthalmic awareness if visual symptoms or a painful red eye develop.

The long term effects of unilateral corneal scars

The main purpose of this study was to evaluate the long term effects of unilateral dense central corneal scars on the axial length and development of lens opacities. We included 12 patients with unilateral dense central corneal scars of early onset before the age of seven years. This study served as naturally-controlled experiment and demonstrated a statistically significant increase in ocular axial length and decrease in the incidence of cataract in the eye with central corneal scar. Visual deprivation induced by unilateral central corneal scars occurring in early childhood leads to increase in the ocular axial length, and decrease in the incidence of cataract.

Extended wear contact lens related bacterial keratitis

AIMS

To report the clinical findings and visual outcome of patients with extended wear contact lens (EWCL) related bacterial keratitis.

METHODS

11 cases with EWCL related bacterial keratitis were included. Corneal scrapings were obtained for cytology and cultures.

RESULTS

Nine patients had unilateral bacterial keratitis and two patients showed bilateral involvement. Corneal scrapings revealed Pseudomonas aeruginosa in seven patients, Staphylococcus aureus coagulase positive in one patient, and Staphylococcus epidermidis in three patients.

CONCLUSION

EWCLs may be associated with bacterial keratitis and may result in visual loss. Dispensing contact lenses by optometrists should be performed in consultation with ophthalmologists.

Corneal haze among blue eyes and brown eyes after photorefractive keratectomy

BACKGROUND

To compare the incidence and severity of corneal haze after photorefractive keratectomy (PRK) among white patients with blue eyes and Saudi patients with brown eyes.

DESIGN

Retrospective, nonrandomized, comparative trial.

PARTICIPANTS

A total of 150 patients (71 females and 79 males) were included in this study. Two hundred sixty-six eyes of 150 patients were subjected to PRK. One hundred blue eyes of 50 white patients and 166 brown eyes of 100 Saudi patients were included in this study.

METHODS

Two hundred sixty-six eyes of 150 patients were subjected to PRK with the Chiron Technolas Keracor 117C for the correction of myopia and astigmatism.

MAIN OUTCOME MEASURES

All patients had complete ophthalmologic examinations, visual acuity testing, intraocular pressure, pachymetry, corneal haze assessment (0-4+), and computerized corneal topography.

RESULTS

There were 266 eyes of 150 patients with 100 blue irides and 166 brown irides. The spherical equivalent was -0.50 diopter (D) to -8.75 D. The mean postoperative spherical equivalent at 6 months was -0.063 D (standard deviation [SD], +/-0.595) in blue eyes compared to -0.28 D (SD, +/-0.683) in brown eyes (P = 0.006). Ninety-five (95%) of 100 of the blue eyes achieved +/- 1 D of attempted correction compared to 148 (89.2%) of the 166 brown eyes. All patients with blue eyes had a visual acuity of 20/30 or better compared to 153 (92.2%) of the 166 brown eyes (P = 0.009). Forty-eight (18.04%) eyes had minimal to mild haze, 3 (1.12%) eyes had moderate haze, and 2 (0.75%) eyes had severe haze. The incidence of corneal haze among brown eyes was 48 (28.9%) of 166 eyes compared to 5 (5%) of 100 in blue eyes (P < 0.001). The difference remained significant after adjustment for age and gender with a P value of 0.0283. The relative risk for developing haze in brown eyes was found to be 7.72.

CONCLUSION

The incidence of corneal haze after PRK was significantly higher among Saudi patients with brown irides than among white patients with blue irides. This suggests that racial factors may play a role in the development of corneal haze.

Treatment of acute bacterial conjunctivitis with topical lomefloxacin 0.3% compared to topical ofloxacin 0.3%

PURPOSE

The main purpose of this prospective study was to compare the efficacy, local tolerance, and safety of topical lomefloxacin 0.3% and topical ofloxacin 0.3% in the treatment of acute bacterial conjunctivitis.

PATIENTS AND METHODS

Forty patients with acute bacterial conjunctivitis were included in a randomized, prospective, parallel-group study. Twenty patients were assigned to the lomefloxacin group (Okacin, CIBA Vision Ophthalmics) and 20 patients to ofloxacin (Oflox, Allergan). Lomefloxacin 0.3% was given 1 drop every 2 hours during waking hours on the first day then twice daily for one week. Ofloxacin 0.3% eyedrops were given four times daily. All patients underwent eye examination and clinical findings were graded and recorded according to severity of lid hyperemia, lid edema, lid crusting, conjunctival edema and discharge, bulbar conjunctival hyperemia, palpebral conjunctival hyperemia, corneal edema, and ocular discomfort. The score for each clinical sign was recorded before and after treatment. The mean cumulative sum score (CSS) was obtained by adding the scores for signs and symptoms. All conjunctival swabs were cultured and tested for sensitivity. Patients with confirmed bacterial conjunctivitis were included.

RESULTS

There were 10 male and 10 female patients in each group. The age range was from 1 to 78 years, and the mean age was 35 years in the lomefloxacin group. In the ofloxacin group the age range was from 1 to 70 years, and the mean age was 26 years. There was no significant difference between the two groups in relation to age or sex. The causative organisms were Staphylococcus epidermidis in 16 cases (36%), alpha-hemolytic Streptococci in 9 (20%), Haemophilus spp. 6 (13%), Staphylococcus aureus 5 (11%), Streptococcus pneumoniae 4 (9%), Pseudomonas aeruginosa 3 (7%), and other 2 (4%). The mean CSS for conjunctivitis was 12.1 before therapy in the lomefloxacin group and 12.7 in the ofloxacin group. On the 7th day of therapy, the mean CSS was 0.7 in the lomefloxacin group, and 1.6 for ofloxacin. All patients showed improvement, but a total of 18 out of 20 (88%) in the lomefloxacin group showed complete resolution compared to 15 (75%) in the ofloxacin group. The difference was not statistically significant (p = 0.08). Tolerance was excellent in both groups, and no side effects were reported. A burning sensation was noted by two patients, one in each group.

CONCLUSIONS

Lomefloxacin and ofloxacin were equally effective and safe in the treatment of acute bacterial conjunctivitis.