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PURPOSE: To report a 10-year follow-up for bilateral implantation of a Chiron Adatomed silicone posterior chamber phakic intraocular lens (PIOL). METHODS: A 32-year-old man presented with bilateral blurred vision and monocular diplopia in the left eye of 2 years' duration. RESULTS: Slit-lamp microscopy showed bilateral anterior subcapsular cataract and temporal PIOL decentration, and no visible space between the PIOL and crystalline lens in the right eye. After explantation of the posterior chamber PIOL, lens aspiration, and IOL implantation, uncorrected visual acuity improved to 20/15 in the right eye. Scanning electron microscopy examination showed denser deposits on the central portion of the back surface when compared with the edges. CONCLUSIONS: Long-term follow up of certain designs of posterior chamber PIOLs may reveal late occurrence of complications. Cataract formation may be related to direct contact between the implanted and crystalline lenses. [J Refract Surg. 2006;22:513-515.]

BACKGROUND: Twenty-three eyes of 22 patients remained undercorrected 5 to 49 months after radial keratotomy, either alone or in combination with transverse keratotomy. METHOD: We attempted to correct the residual myopia ranging from -1.25 to -5.75 diopters (D) (with astigmatism of 0 to 1.25 D) with photorefractive keratectomy. The mean age of patients was 26 years (range 22 to 40 years). RESULTS: After photorefractive keratectomy (follow-up 6 to 17 months) uncorrected visual acuity was equal to or better than 20/20 in 39% (9 eyes), better than 20/25 in 65% (15 eyes), and better than 20/40 in 74% (17 eyes). Spectacle-corrected visual acuity was equal or better than 20/40 in all eyes; one eye (4%) lost two lines of spectacle-corrected visual acuity. Refractive error was within ±0.50 D in 48% (11 eyes) and within ±1.00 D in 65% (15 eyes). Undercorrections of more than 1.00 D occurred in 22% (5 eyes) and overcorrections of more than 1.00 D occurred in 13% (3 eyes). No or minimal haze was present in 57% (13 eyes), mild haze in 39% (9 eyes) and moderate haze in 4% (1 eye). Final uncorrected visual acuity was better (p=0.0002) and haze was less (p=0.003) in the group with less than -3.00 D than in the group with greater than or equal to -3.00 D. CONCLUSION: Photorefractive keratectomy after radial keratotomy is safe but less effective and less predictable in eyes with greater than or equal to -3.00 D compared to those with less than -3.00 D. [J Refract Surg 1996;12:801-805]

BACKGROUND: Epikeratoplasty for keratoglobus performed to tectonically support the thin globular cornea may have complications such as interface opacities. METHODS: We report the case of a patient with persistent interface opacities and epithelial cysts following epikeratoplasty for keratoglobus that were treated primarily by washouts and repeated argon laser photocoagulation. RESULTS: Interface opacities led to massive epithelial inclusion cysts. Direct removal of these cysts and placement of a new lamellar graft resulted in a favorable outcome. CONCLUSION: Massive epithelial inclusion cysts may develop in the lamellar interface after epikeratoplasty. Direct surgical removal was successful. [J Refract Surg. 1996;12:517-520.]

BACKGROUND: Phototherapeutic keratectomy (PTK) is an effective treatment for many superficial corneal disorders. The efficacy of PTK for the treatment of climatic droplet keratopathy (CDK) has not been reported. METHODS: We report the results of excimer laser (Summit Technology, Inc, Waltham, Mass) PTK on 75 eyes (67 patients) with "smooth" climatic droplet keratopathy (55 eyes) and "irregular" climatic droplet keratopathy (20 eyes) in whom more than 6 months of follow up are available. RESULTS: PTK was successful in reducing corneal opacification in both smooth (98%) climatic droplet keratopathy and irregular (80%) climatic droplet keratopathy. Achievement of a clear or mildly hazy cornea following PTK was more likely to occur with smooth (80%) climatic droplet keratopathy than irregular (25%) climatic droplet keratopathy (P=0.01). Eyes with smooth climatic droplet keratopathy were more likely to obtain more than one line of improved uncorrected (56% vs. 25%) or spectacle-corrected visual acuity (61.8% vs. 21.2%) than those with irregular climatic droplet keratopathy (P=0.03 and 0.005, respectively). Delayed re-epithelialization (longer than 14 days) was more common in irregular CDK (21%) than in smooth CDK (9%), as was the incidence of secondary microbial keratitis (10.0% vs. 1.8%). CONCLUSIONS: PTK is effective in reducing superficial corneal opacification in CDK, although serious complications may occur, especially in advanced irregular CDK. [J Refract Surg. 1996;12:114-122.]

BACKGROUND: Phototherapeutic keratectomy (PTK) is effective in the treatment of many superficial corneal disorders. The incidence of bacterial keratitis following PTK has not been assessed in a large, prospective clinical trial. METHODS: We report three cases of bacterial keratitis that occurred in a prospective study of 258 consecutive PTK procedures at King Khaled Eye Specialist Hospital. RESULTS: Three (1.2%) of 258 eyes developed bacterial keratitis during a period of follow up ranging from 1 to 24 months. All three cases were in 183 eyes (1.6%) with a diagnosis of climatic droplet keratopathy, while no cases were observed in 75 eyes with other anterior corneal disorders. Gram-positive species (Streptococcus pneumonia in two, coagulase-negative Staphylococcus in one) were the predominant species isolated from all three cases. Two of the cases were polybacterial. The final visual outcomes ranged from 20/125 to 20/400. CONCLUSIONS: The risk of bacterial keratitis following treatment of superficial corneal disorders with PTK is low but its occurrence may adversely affect the final visual outcome. [J Refract Surg. 1996;12:123-127.]