European Journal of Implant and Refractive Surgery最新文献

OBJECTIVE: To assess the efficacy of the VISX 20:20 excimer laser for phototherapeutic keratectomy (PTK) for band keratopathy. DESIGN: A prospective assessment of subjective and objective parameters associated with both the treatment and the disease. SETTING: This study was undertaken in a specialist clinic receiving many tertiary referrals at a specialist teaching hospital in a capital city. PATIENTS: Twenty-one eyes of 21 patients attending the corneal clinic with band keratopathy elected to undergo PTK. RESULTS: Although restricted to a single diagnosis, the patients proved to be heterogeneous with regards to visual potential and pain. All patients with visual potential had a subjective improvement in vision after treatment, and objective improvement was documented in over half. A shift to hypermetropia, by a mean of 2.4 D was seen. Where pain was the indication for treatment, all patients had markedly reduced or no symptoms after therapy. CONCLUSIONS: Excimer laser PTK with the VISX 20:20 laser is a highly effective, minimally invasive, out-patient treatment for band shaped keratopathy, which is likely to be the most common of the superficial corneal opacities and corneal surface disorders with pain which can be considered for PTK.

OBJECTIVE: Accuracy comparison of computerized videokeratopraphy and keratometry for use in the SRK II formula for lens calculations. STUDY DESIGN: Preoperative biometry on 46 eyes undergoing phacoemulsification using either the keratometric equivalent derived from the Eyesys Corneal Analysis System™ (ECAS) or standard keratometry. The SRK II formula was used for the lens calculations. The patients were refracted 3 months postoperatively and the difference between the predicted refraction and the actual refraction was determined. RESULTS: Use of the ECAS resulted in smaller mean errors, but not to a significant degree. The ECAS however, produced a significantly greater proportion of actual refractions within 0.5 D of the predicted refraction.

OBJECTIVES: To evaluate prospectively the effect of a modified capsulorhexis technique on the degree of intraocular lens (IOL) centration in patients undergoing extracapsular cataract extraction (ECCE). Patients were randomized to have envelope capsulotomy (EC) in group 1 or a continuous circular capsulorhexis (CCC) with 1 relieving anterior capsule incision at 11 o'clock in group 2. STUDY DESIGN: Prospective study. SETTING: Liverpool, District general hospital. MAIN OUTCOME MEASURES: Observed mean optic decentration and maintenance of capsular fixation in both groups after a mean of 12.7 months follow-up. RESULTS: Mean optic decentration was 0.51 mm in group 1(26 eyes) as compared to 0.19 mm in group 2 (28 eyes). This was statistically significant (2-sample t-test, t = 3.045, 38 d.f., P = 0.0042). Loss of capsular fixation was observed in 5 eyes (20%) in group 1 where a haptic migrated superiorly out of the capsular bag. CONCLUSIONS: Excellent IOL centration is achieved by using this modified CCC technique. A relieving incision prevents inadvertent intracapsular delivery of the lens and the superior location of the incision facilitates ‘in-the-bag’ placement of the IOL with the haptics orientated to the 3 and 9 o'clock positions. This safe modified CCC technique is well suited for routine ECCE.

OBJECTIVE: The objective of the study was to evaluate the effect of heparin surface modification of intraocular lenses (HSM IOLs) on postoperative inflammatory reactions in cataract patients with exfoliation syndrome. The primary efficacy variables were the presence on the lens surface of giant cells determined from specular microscopy photographs and the presence of cell deposits determined by slit-lamp. STUDY DESIGN: Prospective, randomized, double-blind clinical study with a follow-up period of 6 months. PATIENTS: The study comprised 58 patients who were randomized into 2 groups: 31 patients received polymethylmethacrylate (PMMA) lenses and 27 patients received HSM lenses. The mean age in the HSM group was 78.1 years and the mean age in the PMMA group was 78.3 years. RESULTS: Giant cells on the lens surface were found in more patients in the PMMA group at all postoperative visits. At 6 months the difference between the groups was statistically significant (P = 0.023). The maximal density of giant cells patient was significantly greater in the PMMA group compared to the HSM group at 1, 3 and 6 months postoperatively (P ≤ 0.05). Cell deposits, assessed by slit lamp, were observed in fewer patients in the HSM group (vs. PMMA) at 1 and 3 months. At 6 months 69% (11/16) of the patients in the HSM group and 84% (21/25), in the PMMA group had a best corrected visual acuity of 0.5 or better. This difference was not statistically significant (P = 0.25). Overall, the number of postoperative complications was lout. At 6 months no complications were reported. CONCLUSION: The postoperative inflammatory reaction as determined by the presence of giant cells and cell deposits on the lens surface is significantly reduced by heparin surface modification of the IOL in patients with exfoliation syndrome.

OBJECTIVE: To find an acceptable surgical procedure to relieve the pain of bullous keratopathy in the interim of waiting for corneal transplantation. STUDY DESIGN: Prospective study of the operative results in 13 eyes with bullous keratopathy were followed up from 7 months to 2 years. SETTING: Naval Eye Clinic, Manila, Philippines. PATIENTS: Thirteen patients with bullous keratopathy following anterior chamber IOLs, phacoemulsification, postPKP and glaucoma. MAIN OUTCOME MEASURES: Relief of pain, visual acuity improvement, cosmetic acceptability, and stability of the procedure. RESULTS: All patients were relieved of pain, appreciated transformation of conjunctiva into semi-transparent membrane with argon laser treatment and reported visual acuity improvement upon creation of an optical window on the graft. CONCLUSION: A horizontal bridge of conjunctival graft is effective in relieving the pain of bullous keratopathy better than any medical treatment or bandage lens. With argon laser treatment, the conjunctiva becomes semi-transparent and cosmetically acceptable. An optical window can be created on the graft to improve vision.