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PURPOSE: We conducted a prospective study to determine the best treatment option for patients with low-to-moderate spherical myopia or myopic astigmatism who are considered equally eligible for LASEK with mitomycin-C (MMC) and LASIK with either mechanical microkeratome or femtosecond laser flap creation. METHODS: Forty-six adult patients (86 eyes) who underwent LASEK with MMC (16 patients, 31 eyes), and mechanical microkeratome LASIK (13 patients, 23 eyes) or Femtosecond LASIK (17 patients, 32 eyes) were assessed for clinical outcomes 1, 3 and 6 months post-operatively. RESULTS: Six months after surgery, all eyes in all three groups were within 1 D of the intended refractive change. UCVA 20/20 or better was achieved in 96% of eyes undergoing LASEK with MMC 88% of eyes in the mechanical microkeratome LASIK and 72% of eyes in the Femtosecond LASIK group at 6 months. Mean spherical equivalent was -0.12 ± 0.22 D, -0.09 ± 0.28 D and -0.25 ± 0.28 D in the three groups, respectively (p = 0.077). Patients in the LASEK with MMC group had less high order aberrations at 3 and 6 months compared to the two LASIK groups. None of the three procedures were associated with early- or late-onset complications or loss of 2 or more lines after surgery. CONCLUSIONS: After an initially slower visual improvement, LASEK with MMC, and to lesser extent, LASIK with mechanical microkeratome, produced better visual acuity and less corneal aberrations compared to Femtosecond LASIK at 3 and 6 months after surgery. These observations deserve further investigation in a randomized controlled trial.
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PURPOSE: To analyze the visual results of Descemet stripping automated endothelial keratoplasty (DSAEK) in the first consecutive 10 cases. MATERIALS AND METHODS: Retrospective, non-randomized, non-comparative interventional case series. Ten eyes of 10 patients with endothelial dysfunctions of different etiology, scheduled for DSEAK, were included in this study. Indications, operative problems, and postoperative complications were noted. Best-corrected visual acuity, refractive and keratometric astigmatism, and central corneal thickness were analyzed for each patient after a minimum follow-up of 10 months. RESULTS: In a median follow-up of 12 months (range 10-16 months), visual outcomes were satisfactory. Preoperative diagnosis included five eyes of psuedophakic bullous keratopathy and two eyes of repeated failed corneal grafts and one bullous keratopathy secondary to anterior chamber phakic IOL implantation. Two eyes with Fuchs dystrophy and cataract had combined DSAEK and phacoemulsification and IOL implantation. One patient had known glaucomatous optic nerve precluding vision better than 20/150. Of the remaining nine patients, four eyes had BSCVA of 20/40 or better by postoperative 6 months (3 by 3 months). The average pachymetry was 646.9 µm. One patient had total graft dislocation and one needed trabeculectomy. None of the patients developed graft rejection or graft failure. None of patients needed to convert to penetrating keratoplasty. CONCLUSION: DSAEK is safe and effective procedure in patients with endothelial dysfunctions with encouraging surgical and visual outcomes.
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PURPOSE: To evaluate the outcomes of implantation of an accommodating intraocular lens (IOL) in pseudophakic presbyopic eyes. SETTING: Ophthalmology Department, Benha Medical School, Benha, Egypt. METHODS: In this prospective controlled trial, near and distance visual acuities, the manifest refraction spherical equivalent, and patient satisfaction were evaluated in presbyopic eyes that had phacoemulsification cataract removal and implantation of a Crystalens AT-45 IOL accommodating IOL. The difference between preoperative and postoperative mean values was compared using the Student t and paired-sample t tests. Comparison between postoperative follow-up visits was by analysis of variance. RESULTS: The study comprised 25 eyes (23 patients; 13 men). The mean IOL power was 21.80 diopters (D) +/- 1.45 (SD) (range 19.00 to 24.00 D). At 6 months, 23 eyes (92%) had an uncorrected distance visual acuity (UDVA) of 6/12 or better; all eyes had a corrected distance visual acuity (CDVA) of 6/12 or better (P = .000). The difference in CDVA and UDVA between 1 month and 6 months postoperatively was not statistically significant. The mean distance-corrected near visual acuity (DCNVA) was J5 at 1 month and 6 months; from 1 month on, the DCNVA was J3 or better in more than 60% of eyes. There was a statistically significant difference in DCNVA between preoperatively and 6 months postoperatively (P = .021). CONCLUSIONS: Initial experience indicates that the accommodating IOL provides functional near and distance visual acuity for daily tasks. Surgeon experience and refinement of IOL calculations are required to improve outcomes. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.