RESUMO
PURPOSE: To determine whether there is an increased risk to the corneal endothelium when mitomycin C (MMC) is administered after photorefractive keratectomy (PRK). DESIGN: Prospective, randomized, double-blind, placebo-controlled crossover trial. METHODS: Corneal endothelium was analyzed preoperatively and postoperatively in 18 eyes of nine patients who were administered either MMC- or balanced salt solution (BSS)-supplemented PRK at Codet Aris Vision, Tijuana, Mexico. After laser ablation, one eye was randomly assigned to intraoperative topical MMC 0.02% treatment for 30 seconds, and the fellow eye (the control eye) was treated in a standard fashion with topical BSS. Preoperative pachymetry and endothelial cell count were performed and compared with postoperative measurements after one month and three months. Main outcome measure studied was endothelial cell loss. RESULTS: There was no significant difference in the preoperative endothelial cell count between the 2 groups: MMC group 2835 +/- 395, control group 2779 +/- 492, P = .62. In the control group, at one month and three months the difference in the endothelial cell count was not statistically significant (P = .27, P = .14, respectively). However, in the MMC group the endothelial cell loss was statistically significant: at one month 14.7 +/- 5.1%, and at three months 18.2 +/- 9.0% (P = .0006, P = .002, respectively). CONCLUSIONS: The use of intraoperative topical MMC 0.02% for 30 seconds after PRK may affect the endothelial cell count.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Endotélio Corneano/efeitos dos fármacos , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Administração Tópica , Contagem de Células , Topografia da Córnea , Estudos Cross-Over , Método Duplo-Cego , Endotélio Corneano/patologia , Humanos , Cuidados Intraoperatórios/métodos , Lasers de Excimer , Estudos Prospectivos , Acuidade VisualRESUMO
PURPOSE: To assess the outcome of simultaneous implantable contact lens (ICL) removal and cataract extraction with pseudophakic intraocular lens (IOL) implantation. SETTING: CODET Aris Vision Institute, Tijuana, Mexico. METHODS: This retrospective noncomparative interventional case series evaluated 14 eyes of 12 patients with ICL implantations who developed a cataract and simultaneously had ICL removal and cataract extraction with IOL implantation. The follow-up time was at least 6 months (range 6 to 24 months). Visual acuity (logMAR), manifest refraction, intraocular pressure, and adverse events were recorded. RESULTS: Of the 12 patients (14 eyes), 10 patients (12 eyes) had ICL surgery to correct high myopia and 2 patients (2 eyes), to correct hyperopia. The mean uncorrected visual acuity after ICL implantation (before cataract development), before cataract surgery, and after cataract surgery were 0.48 +/- 0.32, 0.83 +/- 0.34, and 0.40 +/- 0.27, respectively. The mean best corrected visual acuity (BCVA) before ICL implantation, after ICL implantation, and after cataract surgery were 0.31 +/- 0.21, 0.28 +/- 0.19, and 0.27 +/- 0.21, respectively. The mean final manifest spherical equivalent was 0.30 diopters (D) +/- 1.07 (SD) (range +2.38 to 2.0 D). Ten eyes (71.4%) were within +/-1.0 D of the calculated target. One eye had a tear in the posterior capsule with vitreous loss during cataract surgery. No other intraoperative, perioperative, or postoperative complications were observed. No loss of BCVA was recorded at the last postoperative visit. CONCLUSIONS: Lens opacities and cataract formation are a potential complication of ICL surgery. The removal of the ICL and the cataract with IOL implantation was found to be safe, with predictable refractive results.
Assuntos
Catarata/etiologia , Lentes de Contato/efeitos adversos , Remoção de Dispositivo , Implante de Lente Intraocular , Facoemulsificação , Implantação de Prótese/efeitos adversos , Adulto , Humanos , Hiperopia/cirurgia , Pressão Intraocular , Pessoa de Meia-Idade , Miopia/cirurgia , Pseudofacia/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To evaluate the changes in ocular aberrations induced by corneal flap creation. DESIGN: Prospective interventional nonrandomized clinical trial. METHODS: This study included 15 patients who were scheduled for laser in situ keratomileusis. A nasal hinge flap was created, using the Nidek MK-2000 microkeratome and then replaced without performing laser ablation. The ocular aberrations were measured before and after flap creation using the Nidek Optical Path Difference Scanning System ARK-10000. RESULTS: The root mean square wavefront errors of the higher-order optical aberrations (third-, fourth-, fifth-, and sixth-order aberrations) were not significantly altered at 1 week postsurgery compared with the preoperative values (P >.35). CONCLUSIONS: Creating a corneal flap with the Nidek MK-2000 microkeratome did not induce changes in higher-order optical aberrations as measured with the Nidek Optical Path Difference Scanning System ARK-10000 during the early postoperative period.
Assuntos
Substância Própria/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Miopia/cirurgia , Complicações Pós-Operatórias , Retalhos Cirúrgicos , Adulto , Topografia da Córnea , Humanos , Estudos Prospectivos , Refração Ocular , Erros de Refração/etiologia , Retalhos Cirúrgicos/efeitos adversos , Transtornos da Visão/etiologiaRESUMO
PURPOSE: To compare the early postoperative visual rehabilitation after laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for the correction of myopia. SETTING: CODET Aris Vision Institute, Tijuana, Mexico. METHODS: This prospective study included 50 eyes of 25 patients with myopia who received LASEK in 1 eye and PRK in the contralateral eye. Excimer laser corneal ablation was done using the Nidek EC-5000 excimer laser. Patients were seen at 1 and 3 days, 1 week, and 1 month. Discomfort, subjective uncorrected visual acuity (UCVA), objective UCVA, best corrected visual acuity (BCVA), corneal clarity (haze), and time for corneal reepithelialization were analyzed. RESULTS: Seventy-two percent and 80% of the LASEK eyes had more discomfort at 1 day and 3 days, respectively. Eighty percent and 96% of the PRK eyes had better subjective UCVA at 1 day and 3 days, respectively. Corneas were fully reepithelialized at a mean of 3.3 days +/- 0.5 (SD) and 3.6 +/- 0.5 days in the PRK and LASEK groups, respectively. At 1 month, the UCVA was similar in both groups; no eye had lost lines of BCVA or developed haze. CONCLUSIONS: Both LASEK and PRK were effective and safe procedures in the surgical correction of myopia at the 1-month postoperative visit. Patients reported less discomfort and better visual acuity in their PRK eye during the early postoperative period. Patients should be informed that LASEK, whose acronym is similar to that of laser in situ keratomileusis, has a recovery speed that is similar to that of surface laser refractive procedures such as PRK.
Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia/cirurgia , Ceratectomia Fotorrefrativa , Adulto , Epitélio Corneano/fisiopatologia , Feminino , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Lasers de Excimer , Masculino , Ceratectomia Fotorrefrativa/efeitos adversos , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo , Acuidade Visual , CicatrizaçãoRESUMO
PURPOSE: To describe a complication resulting from the implantation of a posterior chamber intraocular lens in a phakic eye. DESIGN: Interventional case report. METHODS: We examined a 37-year-old woman with severe myopia who had implantation of a phakic posterior chamber intraocular lens. RESULTS: The patient developed pigmentary glaucoma with refractory increase in intraocular pressure, despitemedical therapy and intraocular lens removal. Trabeculectomy was required to reduce the pressure. CONCLUSION: This case demonstrates that pigmentary glaucoma secondary to implantation of a phakic posterior chamber intraocular lens can lead to filtering surgery to decrease intraocular pressure.