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Purpose: To evaluate and compare the outcome of initial resident surgical experience with photorefractive keratectomy (PRK) and LASIK. Methods: Retrospective review of all cases performed with the VISX Star S4 platform (Abbott Medical Optics) between July 1, 2003 and June 30, 2007. Inclusion criteria were spherical equivalent of −0.50 to −10.00 diopters (D), refractive astigmatic error of ≤3.00 D, intention to provide full distance correction, and minimum 3-month postoperative follow-up after initial ablation or retreatment (if performed). Results: A total of 153 cases performed by 20 different residents met the inclusion criteria; 38 eyes underwent PRK and 115 eyes had LASIK. After initial treatment, mean Snellen uncorrected distance visual acuity (UDVA) after PRK was 20/17.3 and after LASIK was 20/19.5. Photorefractive keratectomy was associated with a significantly better approximation between preoperative corrected distance visual acuity (CDVA) and postoperative UDVA (ΔlogMAR 0.009 vs 0.091; P =.004) and a greater percentage of eyes that achieved UDVA of 20/20 or better (94.7% vs 78.3%; P =.02) or 20/30 or better (100% vs 87.8%; P =.02). There was a higher prevalence of retreatment in eyes that underwent LASIK (7.0% vs 0%; P =.20). One (0.9%) eye lost 2 lines of CDVA after LASIK. Conclusions: Supervised refractive surgery residents can achieve excellent visual outcomes in patients operated during their initial refractive experience. Photorefractive keratectomy was associated with better visual outcome than LASIK.

PURPOSE: Penetrating keratoplasty and epikeratoplasty have been utilized in the surgical treatment of keratoconus. Comparison of the relative efficacy of each procedure in achieving visual outcomes has not been achieved due to limited numbers of cases and follow-up in previous series. METHODS: All patients who underwent either penetrating keratoplasty or epikeratoplasty for keratoconus between January 1987 and December 1997, and for whom at least 24 months of postoperative follow-up data for visual acuity was documented in the medical record, were included in this retrospective, nonrandomized, sequential comparative trial. The sole criteria for outcome in each group, as well as for comparison of the two groups, was Snellen visual acuity measured at the time of each follow-up with the presenting optical aid. RESULTS: Inclusion criteria were met for 443 eyes treated with penetrating keratoplasty and 161 eyes treated with epikeratoplasty. Mean follow-up was 4.3 years for penetrating keratoplasty and 4.5 years for epikeratoplasty. In each group, approximately 50% of the patients chose rehabilitation with optical correction with either spectacles or contact lenses and 50% chose no optical correction. Final median logMAR visual acuity for all patients, irrespective of means of visual rehabilitation, was 0.30 (20/40) for penetrating keratoplasty and 0.40 (20/50) for epikeratoplasty (P < .00005). In 209 penetrating keratoplasty and 77 epikeratoplasty eyes with optical correction, the final median logMAR visual acuity was 0.18 (20/30) for penetrating keratoplasty and 0.40 (20/50) for epikeratoplasty (P < .00005). The final median logMAR visual acuity in 234 penetrating keratoplasty and 84 epikeratoplasty eyes without optical correction was 0.48 (20/60) in both groups (P-value was not statistically significant). CONCLUSIONS: Although penetrating keratoplasty was statistically superior to epikeratoplasty with respect to visual outcome, results with epikeratoplasty were adequate to recommend its use as a surgical alternative in cases when it is not desirable to perform penetrating keratoplasty. [J Refract Surg 2001;17:138-146]

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.]

PURPOSE: To summarize the initial results of excimer laser photorefractive keratectomy (PRK) on 89 eyes of 80 patients with moderate myopia (myopia of -6.00 to -8.00 diopters [D]; mean -6.98 ± 0.90 D) at nine investigational sites. METHODS: All treatments used an argon fluoride excimer laser (VISX, Inc, Santa Clara, Calif) using standard settings. Sixty eyes received single-zone 6.0-millimeter ablations and 29 eyes received twozone ablations. Follow up ranged from 1 month (n = 89) to 6 months (n = 46). RESULTS: At 3 months, uncorrected visual acuity measured 20/40 or better in 75% and 20/20 or better in 18%; 78% were within ± 1.00 D of intended correction, 38% were within ±0.50 D, and 9% lost two or more lines of spectacle-corrected visual acuity. At 6 months, uncorrected visual acuity measured 20/40 or better in 74% and 20/20 or better in 17%; 67% were within 1.00 D of intended correction, 38% within 0.50 D, and 2% (1/46) lost two lines of spectacle-corrected visual acuity. CONCLUSIONS: PRK for moderate myopia with large diameter ablation zones appears safe and more predictable than that done using smaller ablation zone diameters. Longer follow up is needed to better define stability, the effects of postoperative corticosteroids, and the use of single- versus doublezone ablations. [J Refract Surg. 1995;11:238-247.]