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Purpose To report outcomes in Descemet stripping automated endothelial keratoplasty (DSAEK) using donor tissue from eyes that have had previous refractive surgery and to report histopathology of the donor free cap. Methods Retrospective case series. Preoperative and postoperative data were collected on each patient, and donor information was collected. Histopathologic evaluation was carried out on donor caps to determine the stability of the laser in situ keratomileusis (LASIK) flap and smoothness of the microkeratome cut during preparation of the donor. Results DSAEK was performed on 7 eyes using donors that had undergone photorefractive keratectomy (PRK) or LASIK. One patient received PRK donor tissue, had no interface haze, and had improvement in vision. All but one patient who received LASIK donor tissue had improvement in vision, and that patient had severe graft folds noted intraoperatively that persisted. Histopathologic examination of 3 donor caps showed mild to moderate dehiscence of the LASIK flap, but the cut interface was consistent with normal donor tissue preparation histopathology. Conclusions We report the first case of DSAEK using PRK donor tissue, which was successful. Our experience with LASIK donor tissue was comparable to nonrefractive donor tissue with the exception of the persistent donor macrofolds in one patient.

Purpose To compare the incidence of flap complications after creation of laser in situ keratomileusis (LASIK) flaps using a zero-compression microkeratome or a femtosecond laser. Setting John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. Design Evidence-based manuscript. Methods The flap complication rate was evaluated during the initial 18 months of experience using a zero-compression microkeratome (Hansatome) or a femtosecond laser (IntraLase FS60) for flap creation. Results The flap complication rate was 14.2% in the microkeratome group and 15.2% in the femtosecond laser group (P = .5437). The intraoperative flap complication rate was 5.3% and 2.9%, respectively (P = .0111), and the postoperative flap complication rate, 8.9% and 12.3%, respectively (P = .0201). The most common intraoperative complication in the microkeratome group was major epithelial defect/sloughing; the rate (2.6%) was statistically significantly higher than in the femtosecond laser group (P = .0006). The most common postoperative complication in both groups was diffuse lamellar keratitis (DLK) (6.0%, microkeratome; 10.6%, femtosecond laser) (P = .0002). Conclusion Although the total complication rates between the 2 groups were similar, the microkeratome group had significantly more epithelial defects intraoperatively and the femtosecond laser group had significantly more DLK cases postoperatively. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

To compare visual outcomes between wavefront-guided photorefractive keratectomy (PRK) and wavefront-guided laser in situ keratomileusis (LASIK).Academic center, Salt Lake City, Utah, USA.In this randomized prospective study, myopic eyes were treated with wavefront-guided PRK and or wavefront-guided LASIK using a Visx Star S4 CustomVue platform with iris registration. Primary outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities and manifest refraction. Secondary outcome measures were higher-order aberrations (HOAs) and contrast sensitivity.The PRK group comprised 101 eyes and the LASIK group, 102 eyes. At 6 months, the mean UDVA was -0.03 logMAR +/- 0.10 [SD] (20/19) and 0.07 +/- 0.09 logMAR (20/24), respectively (P = .544). In both groups, 75% eyes achieved a UDVA of 20/20 or better (P = .923); 77% of eyes in the PRK group and 88% in the LASIK group were within +/-0.50 diopter of emmetropia (P = .760). There was no statistically significant difference between groups in contrast sensitivity at 3, 6, 12, or 18 cycles per degree. The mean postoperative HOA root mean square was 0.45 +/- 0.13 mum in the PRK group and 0.59 +/- 0.22 mum in the LASIK group (P = .012), representing an increase factor of 1.22 and 1.74, respectively.Wavefront-guided PRK and wavefront-guided LASIK had similar efficacy, predictability, safety, and contrast sensitivity; however, wavefront-guided PRK induced statistically fewer HOAs than wavefront-guided LASIK at 6 months.No author has a financial or proprietary interest in any material or method mentioned.

We report the refractive correction of high myopia in a 23-year-old patient with idiopathic microspherophakia using iris-fixated phakic intraocular lenses (pIOLs) (Verisyse/Artisan). Four years after bilateral implantation, the uncorrected distance visual acuity was 20/25 with a correction of 20/20 −1 in both eyes. No intraoperative or postoperative complications occurred. Iris-fixated pIOLs are not recommended for every patient with microspherophakia. However, this procedure may be an option in microspherophakic patients with appropriate anterior chamber depth and no history of lens dislocation who are likely to comply with annual eye examinations. Follow-up should include monitoring the endothelial cell count and biomicroscopy for adequate space between the pIOL, the natural crystalline lens, and the corneal endothelium. Scheimpflug photography can be a valuable tool in such cases. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose of review To review the most recent literature regarding the incidence and pathophysiology of phakic intraocular lens (pIOL) associated cataracts, surgical issues and outcomes of combined pIOL explantation/cataract surgery, and the prevention of cataract formation secondary to pIOLs. Recent findings The overall rate of cataracts secondary to pIOLs is low, but a disproportionate number is associated with posterior chamber pIOLs. All combination pIOL explantation/cataract surgeries resulted in the successful implantation of a posterior chamber intraocular lens in the capsular bag. We present several theories regarding the pathophysiology of anterior subcapsular cataracts secondary to posterior chamber pIOLs. In addition, we present general strategies in performing combination pIOL explantation/cataract surgery. Several methods of preoperative assessment show promise in helping prevent cataracts secondary to pIOLs, including new ultrasound methods for sulcus imaging and preoperative simulations. Summary Although the incidence of cataracts secondary to pIOLs is low, more studies regarding the pathophysiology of this phenomenon and improvement of preoperative assessment are needed, especially for posterior chamber pIOLs.