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PURPOSE: To describe interface corneal edema secondary to steroid-induced elevation of intraocular pressure (IOP) following LASIK. METHODS: Retrospective observational case series. Diffuse interface edema secondary to steroid-induced elevation of IOP was observed after LASIK simulating diffuse lamellar keratitis (DLK) in 13 eyes. Mean patient age was 31.4±5.3 years. Patients were divided into two groups according to provisional misdiagnosis: DLK group (group 1) comprised 11 eyes and infection group (group 2) comprised 2 eyes (microbial keratitis). Mean follow-up was 8.1±0.5 weeks. RESULTS: In the DLK group, typical diffuse haze was confined to the interface and extended to the visual axis, impairing vision in all eyes. Provisional diagnosis was late-onset DLK and topical steroids were started. Repeat examination showed elevated IOP as measured at the corneal center and periphery using applanation tonometry (mean 19.1 mmHg and 39.5 mmHg, respectively), causing interface edema with evident interface fluid pockets. Steroids were stopped and topical anti-glaucoma therapy was started. The interface edema decreased and at the end of follow-up the corneal transparency was restored and IOP dropped to normal values. The infection group demonstrated a microbial keratitis-like reaction and underwent flap lifting and interface wound debridement and biopsy with administration of fortified antibiotics and steroids. After elevated IOP was detected, steroids and antibiotics were stopped and topical anti-glaucoma therapy was started, resulting in the resolution of the interface edema. CONCLUSIONS: Interface fluid syndrome secondary to steroid-induced elevation of IOP might develop in steroid responders after LASIK with a misleading clinical picture simulating DLK or infectious keratitis. Management includes stopping topical steroids and starting topical antiglaucoma therapy. [J Refract Surg. 2006;22:441-447.]

PURPOSE: To evaluate the results of laser in situ keratomileusis after photorefractive keratectomy. METHODS: Eighty eyes of 80 patients with residual myopia after photorefractive keratectomy were reoperated with laser in situ keratomileusis. The study was retrospective. Laser in situ keratomileusis was performed using the automated corneal shaper microkeratome and Chiron Technolas 217-C d1 excimer laser. Data measured after laser in situ keratomileusis included uncorrected visual acuity, best-corrected visual acuity, refraction, haze, pachymetry, and keratometry. The follow-up was at least 12 ± 1.6 months (range, 12 to 15 months). RESULTS: After laser in situ keratomileusis the mean spherical equivalent was −0.24 diopters ± 0.78. (range, −3 to +1.5) at 12 months, and the mean uncorrected visual acuity was 0.76 diopters ± 0.24 (range, 0.1 to 1). Sixty-five eyes (81.3%) had various degrees of haze after laser in situ keratomileusis. One eye (1.2%) lost 2 lines of best-corrected visual acuity. CONCLUSIONS: Laser in situ keratomileusis enhancement may be a good alternative to correct residual myopia and astigmatism after primary photorefractive keratectomy. Corneal haze is a common problem in these eyes, and the treatment after laser in situ keratomileusis enhancement should be the same as the treatment after primary photorefractive keratectomy.

Purpose To evaluate the incidence, characteristics, and results of treatment of choroidal neovascularization (CNV) in myopic eyes corrected by photorefractive keratectomy (PRK). Setting University Miguel Hernandez, Instituto Oftalmologico de Alicante, Alicante, Spain. Methods This study was of the incidence of CNV in 5936 consecutive eyes that had PRK for the correction of myopia. Mean follow-up was 38.5 months ± 17.4 (SD). Results Extrafoveal CNV developed in the right eye of a 44-year-old woman 26 months after PRK for the correction of −12.00 diopters (D) of myopia. The follow-up after PRK was 38 months. Best corrected visual acuity (BCVA) before PRK was 20/40 (spherical equivalent [SE] −12.00 D). After PRK, BCVA was 20/32 SE −1.75 D). The CNV was treated by direct argon-green laser photocoagulation and did not recur in the subsequent 12 months). After CNV treatment, BCVA was 20/32 (SE −2.25 D). Conclusions The incidence of CNV after PRK for myopia was low. Choroidal neovascularization is a possible complication in myopic eyes, and the risk exists before PRK. After PRK, the risk of CNV in myopic patients did not increase.

Purpose To evaluate the effectiveness, predictability, and safety of photorefractive keratectomy (PRK) for correcting residual myopia and myopic astigmatism after cataract surgery with intraocular lens implantation. Setting Refractive Surgery and Cornea Unit, Instituto Oftalmologico de Alicante, Alicante, Spain. Methods Thirty consecutive eyes (30 patients) had PRK for residual myopia after cataract surgery. Surface PRK with a VISX Twenty-Twenty excimer laser was used in all patients. Follow-up was 1 year. Results Before PRK, no eye had an uncorrected visual acuity (UCVA) of 20/40 or better. Twelve months after PRK, 16 eyes (53.33%) had a UCVA of 20/40 or better. After PRK, best corrected visual acuity (BCVA) improved 1 line or more in 14 eyes (46.66%) over the preoperative values, and 15 eyes (50.00%) had the same BCVA as before PRK. Mean pre-PRK refraction of –5.00 diopters (D) ± 2.50 (SD) decreased significantly to –0.25 ± 0.50 D at 12 months (P < .001). At 12 months, the spherical equivalent was within ±1.00 D of emmetropia in 27 eyes (90.00%). No vision-threatening complications occurred. Conclusion Photorefractive keratectomy was an effective, predictable, and safe procedure for correcting residual myopia and myopic astigmatism after cataract surgery.

PURPOSE To report a patient who presented an infectious keratitis 4 years after laser in situ keratomileusis (LASIK) without any other predisposing risk factor than the LASIK procedure itself. CASE REPORT We report a 32-year-old man operated by LASIK in January 2006 who presented with infectious keratitis in the OD in April 2010. Clinical examination showed a corneal abscess at 10-o'clock position in the interface and fibrin and Tyndall 4+ in the anterior chamber. Microbiological analysis identified Pseudomonas aeruginosa as the cause of infection. The patient was given ofloxacin, sulfate neomycin, polymyxin B, and prednisolone acetate to be used every 2 h. Treatment led to clinical improvement with resolution of corneal infiltrate. Keratitis with intact epithelium by Pseudomonas can occur up to 4 years after LASIK. CONCLUSIONS LASIK treatment is a predisposing factor for bacterial keratitis even years after surgery. This report demonstrates the importance of continued postoperative vigilance by patient and his/her clinician.

Purpose To evaluate the efficacy, predictability, safety, and stability of conductive keratoplasty (CK) for correcting residual hyperopia after cataract surgery with intraocular lens implantation. Setting Vissum-Instituto Oftalmologico de Alicante, Alicante, and Vissum-Instituto de Albacete, Albacete, Spain. Methods Sixteen eyes of 16 patients had CK for the correction of residual hyperopia after cataract surgery. The CK was performed with the CK View Point Refractec (RCS-200, Refractec, Inc.). The follow-up was 12 months. Results One year after CK, 10 eyes (62.5%) achieved an uncorrected visual acuity (UCVA) of 0.50 or better. The mean UCVA was 0.50 ± 0.21 (SD), and the mean best spectacle-corrected visual acuity (BSCVA) was 0.68 ± 0.24. One eye lost 1 line of BSCVA, and none lost 2 or more lines. The mean spherical equivalent refraction was +0.39 ± 0.84 D 1 year after CK. No vision-threatening complications occurred. Conclusions One-year data show that CK for the correction of low to moderate hyperopia after cataract surgery was safe, stable, relatively predictable, and efficient. No complications occurred when CK was performed after phacoemulsification.

Purpose To evaluate near visual performance after implantation of a pseudoaccommodating intraocular lens (IOL) (Crystalens® AT-45, eyeonics) or a multifocal IOL (refractive model, AMO Array®; diffractive model, AcriTec TwinSet) after lens surgery. Settings Instituto Oftalmologico de Alicante, Miguel Hernandez University, Alicante, Spain. Methods Forty patients were included in this prospective clinical comparative study. The patients were divided into 3 groups according to the type of IOL implanted. Group 1 included 24 eyes (12 patients) implanted with the Crystalens IOL; Group 2, 32 eyes (16 patients) with the Array IOL, and Group 3, 24 eyes (12 patients) with the TwinSet IOL. Bilateral phacoemulsification and IOL implantation were performed in all patients, and the follow-up was 1 year. The postoperative main visual outcome evaluations were uncorrected and best corrected distance and near visual acuities, mean add for near, and best distance-corrected near acuity. Results In Group 1, the mean uncorrected near acuity was 20/40 preoperatively and 20/25 after 1 year. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 2, the mean uncorrected near acuity was 20/40 and 20/25, respectively. The mean preoperative best distance-corrected near acuity was 20/32 and 20/25 after 1 year. In Group 3, the mean uncorrected near acuity was 20/63 preoperatively; after 1 year, it was approximately 20/25. The mean best distance-corrected near acuity was 20/50 and 20/25, respectively. A neodymium:YAG laser capsulotomy was performed for posterior capsule opacification when required, with no change in the refractive outcome. Conclusions Implantation of multifocal and pseudoaccommodating IOLs provides adequate near vision restoration. The TwinSet IOL provided faster recovery of near vision than the other 2 IOLs. The Crystalens IOL provided less postoperative visual phenomena with favorable near vision. The Array IOL achieved the most comfortable distance and near vision.

Purpose: To evaluate the results and complications of photorefractive keratectomy (PRK) for myopia. Setting: Alicante Institute of Ophthalmology, University of Alicante, Spain. Methods: This prospective study evaluated the results and complications of the first 3000 cases of PRK performed with a VISX Twenty-Twenty excimer laser. Myopia ranged from −1.0 to −14.0 diopters (D) and astigmatism, from −1.0 to −5.0 D. Follow-up was 2 years. Results: Ten eyes (0.7%) lost two or more lines of best corrected visual acuity 1 year after surgery. Retreatment for undercorrection or regression was done in 7.41% in the low myopia group and 38.69% in the high myopia group. Central islands, which could be detected only on videokeratoscopy, occurred frequently but influenced the refractive and visual outcomes in few cases. Severe haze was present in 17 eyes only after 1 year follow-up. There were no cases of progressive hyperopia. Other complications such as eccentric ablation producing astigmatism (n = 15), delayed re-epithelialization, or recurrent corneal erosion were rare. Conclusion: There were few complications after PRK in 3000 eyes. With proper patient selection, PRK can be considered relatively safe compared with other refractive orocedures.

Purpose: To evaluate the visual results of excimer laser photorefractive keratectomy (PRK) to treat pediatric patients with amblyopic myopic anisometropia in whom conventional amblyopia treatments have failed. Setting: Instituto Oftalmologico de Alicante, University of Alicante, Spain. Methods: Six patients aged 5 to 7 years with amblyopic myopic anisometropia were treated by PRK in the more myopic eye using a VISX Twenty-Twenty excimer laser. Minimum preoperative refraction in the amblyopic eyes ranged from −4.00 to −13.00 diopters and best corrected visual acuity (BCVA), from 20/40 to 20/400. All cases completed a minimum of 2 years follow-up of antiamblyopic treatment. Results: After PRK, preoperative BCVA was maintained without optical correction and complementary refraction resulted in increased BCVA in every case. One patient with high myopia developed severe haze. There were no other significant complications. Conclusion: Our results indicate' that PRK may be an alternative for the correction of pediatric myopic anisometropia and an important aid in treating amblyopia. When other therapies have failed, using PRK in children of the ages in this study must be carefully evaluated; however, our results suggest a beneficial effect.

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correcting residual myopia after cataract surgery with intraocular lens implantation. METHODS: Twenty-two eyes of 22 patients underwent LASIK for the correction of residual myopia after cataract surgery. LASIK was carried out using the Chiron Automated Corneal Shaper and the NIDEK EC-5000 excimer laser. In all eyes, the follow-up was 12 months. RESULTS: Before LASIK, 1 eye (4.5%) had an uncorrected visual acuity of 0.5 or better; 12 months after LASIK, 10 eyes (45.4%) achieved this level of visual acuity and 0 eyes achieved 1.00 or better. Before LASIK, mean refraction was -2.90 ± 1.80 D; 12 months after LASIK it decreased significantly to 0.40 ± 0.60 D (P < .01). In 18 eyes (81.8%) at 12 months after LASIK, spherical equivalent refraction was within ±1.00 D of emmetropia; 11 eyes (50%) were within 0.50 D. No vision-threatening complications occurred. CONCLUSION: LASIK with the Automated Corneal Shaper and Nidek EC-5000 excimer laser was an effective, predictable, stable, and safe procedure for correcting residual myopia after cataract surgery. No intraocular lens or cataract incision related complications occurred when LASIK was performed at least 3 months after phacoemulsification. [J Refract Surg 2001;17:12-16]

PURPOSE: Phakic intraocular lenses are being used increasingly to correct refractive errors. We studied the relationship between anterior chamber depth, refractive state of the eye, spherical equivalent refraction, axial length of the globe, corneal diameter, and keratometry. METHODS: Two hundred eleven eyes of 211 patients were enrolled. All eyes underwent the same protocol with a complete ocular examination that included slit-lamp microscopy, intraocular pressure, objective and subjective refraction, calculation of the spherical equivalent refraction, corneal pachymetry, anterior chamber depth, axial length of the globe, and keratometry. All results were analyzed statistically using SPSS statistics software. Correlations between different parameters were studied using the Pearson correlation test. RESULTS: The anterior chamber depth was found to correlate significantly with both the average corneal diameter and the axial length of the globe (0.744, 0.531, P < .01) and was also found to correlate through an inverse relation with both age and spherical equivalent refraction (-0.391, -0.623, P < .01). Corneal thickness and keratometric power did not correlate with the anterior chamber depth. CONCLUSION: Most parameters (axial length, corneal diameter, spherical equivalent refraction, patient age) affected anterior chamber depth and should be considered carefully when planning refractive procedures that employ phakic intraocular lenses. [J Refract Surg 2000;16:336-340]