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PURPOSE: To compare surgically induced astigmatism (SIA) based on incision site and evaluate the clinical results and astigmatic stability of iris-claw phakic intraocular lens (Artisan lens; Ophtec BV, Groningen, Netherlands) implantation. METHODS: Eighty-five eyes of 53 patients with myopia who underwent Artisan lens implantation with a 6.2-mm incision and follow-up of 6 months were retrospectively observed. SIA was assessed using keratometric astigmatism at 6 months postoperatively for the incision sites of the sclera, limbus, and cornea, and the efficacy, safety, predictability, and astigmatic stability were also calculated. RESULTS: SIA obtained using Naeser’s polar method (KP[90] SIA ) was −0.48 ± 0.35 for scleral incisions, −0.99 ± 0.35 for limbal incisions, and −1.14 ± 0.54 for corneal incisions. Corresponding net astigmatism values, as calculated with KP(90) SIA and KP(135) SIA , were 0.70 ± 0.48 (177°), 1.04 ± 0.37 (175°), and 1.21 ± 0.57 (1°), respectively, with SIA increasing the nearer the incision was to the cornea center. Six months after surgery, the efficacy index was 1.03 and the safety index was 1.08. Ninety-eight percent of patients were within 1.50 diopters of attempted refraction. CONCLUSIONS: The values of SIA after Artisan lens insertion showed significant differences among three incision locations, despite the absence of significant differences in preoperative steep corneal axis astigmatism values at the incision locations. It would be applicable for refractive surgery in the aspect of minimizing astigmatism after surgery. [ J Refract Surg. 2014;30(5):330–335.]

PURPOSE: To assess the corneal architecture and reproducibility of LASIK flap thickness created by the Amadeus II mechanical microkeratome (Ziemer Ophthalmic Systems AG) using Fourier-domain optical coherence tomography (OCT; Optovue Inc). METHODS: Anterior segment Fourier-domain OCT was used to analyze the morphology of 58 LASIK flaps from 30 patients created with the Amadeus II microkeratome 140-μm head and ML7090CLB blades (Med-Logics Inc) at 2 weeks postoperatively. Flap thickness was assessed at 10 points across the central 6 mm of the cornea (horizontal and vertical meridians). Postoperative central corneal flap thickness measured by Fourier-domain OCT was compared with intraoperative ultrasound pachymetry measurements. RESULTS: No significant difference was noted between central flap thickness measured by intraoperative pachymetry (107.2±14 μm) and postoperative OCT (111.7±11 μm; P =.07, correlation coefficient=0.86). Fourier-domain OCT measurements demonstrated functionally planar flap architecture (standard deviation [SD] of thickness across the flap=4.9 μm, SD range across the flap=2 to 9 μm) for the microkeratome flaps. CONCLUSIONS: The Amadeus II microkeratome with Med-Logics blades created thin, reproducible, functionally planar flaps as measured by Fourier-domain OCT. Central flap thickness measured by intraoperative ultrasound pachymetry was equivalent to that measured 2 weeks postoperatively by OCT.

PURPOSETo report cases of granular corneal dystrophy type II (Avellino corneal dystrophy) that were exacerbated by uncomplicated laser epithelial keratomileusis (LASEK) for myopia. METHODSEight patients (15 eyes) with granular corneal dystrophy type II who underwent LASEK were examined by DNA sequencing, slit-lamp microscopy, and confocal microscopy. RESULTSThe number and density of the opacities increased after LASEK. Best spectacle-corrected visual acuity decreased after LASEK as the density of the opacities increased. In three patients, mitomycin C was used intraoperatively, but corneal deposits also worsened in these patients. CONCLUSIONSLASEK is contraindicated in patients with granular corneal dystrophy type II because vision may be reduced from an increase in the density of corneal opacities postoperatively. [J Refract Surg. 2008;24:39-45.] ABOUT THE AUTHORS From the Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea (J.H. Lee, C.S. Lee, E.K. Kim); the Department of Ophthalmology, Inha University College of Medicine, Incheon, Korea (J.H. Lee); the Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga (Stulting); Yonsei Eye Center, Seoul, Korea (D.H. Lee); Emory University, Atlanta, Ga (W.C. Kim); and BK21 Project Team of Nanobiomaterials for Cell-based Implants, Yonsei University, Seoul, Korea (E.K. Kim). This study was supported by a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (A050554). The authors have no proprietary interest in the materials presented herein. Correspondence: Eung Kweon Kim, MD, PhD, Dept of Ophthalmology, Yonsei University College of Medicine, Seodaemoongu Shinchondong 134, CPO Box 8044, Seoul, Korea. Tel: 822 2228 3570; Fax: 822 312 0541; E-mail: eungkkim@yumc.yonsei.ac.kr Received: May 10, 2006 Accepted: December 14, 2006 Posted online: May 30, 2007

From Gordon Binder Weiss Vision Institute, San Diego, Calif (Binder); Minnesota Eye Consultants, Minneapolis, Minn (Lindstrom); Emory University, Atlanta, Ga (Stulting); Ophthalmic Consultants of Long Island, Rockville Centre, NY (Donnenfeld); Tufts New England Medical Center, Boston, Mass (Wu); Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Md (McDonnell); and Cornea Genetic Eye Institute, Cedars Sinai Medical Center, Los Angeles, Calif (Rabinowitz).

PURPOSE: We report a case of keratolysis following phototherapeutic keratectomy (PTK) for a subepithelial nodule in a patient with keratoconus. METHODS: A 29-year-old male with keratoconus who became contact lens intolerant because of a raised subepithelial nodule was treated with excimer laser phototherapeutic keratectomy (PTK). RESULTS: The epithelium failed to heal postoperatively, and progressive keratolysis led to a central descemetocele by the eighth postoperative day. The patient was managed with a penetrating keratoplasty. CONCLUSIONS: Excimer laser phototherapeutic keratectomy has been shown to be an effective treatment for subepithelial nodules in patients with keratoconus. Rapidly progressive keratolysis is a potential complication of this procedure. [J Refract Surg 2001;17:555-558]