Outcomes of custom laser in situ keratomileusis: dilated wavescans versus undilated wavescans.

PURPOSE: To evaluate refractive outcomes of custom laser in situ keratomileusis (LASIK) based on undilated and pharmacologically dilated wavefront aberrometry with the Visx laser system. SETTING: Clinical refractive practice, St. Louis, Missouri, USA. DESIGN: Comparative case series. METHODS: Eyes that had LASIK using dilated wavescans (study group) were evaluated for the reason for use of dilated scans; age; preoperative refractive error; preoperative root mean square (RMS), coma, trefoil, and spherical aberration values; postoperative uncorrected distance visual acuity (UDVA); postoperative refractive error; percentage of iris-registration capture; and enhancement rate. The study group was compared with a control group that had LASIK using undilated wavescans. RESULTS: The study group comprised 52 eyes (31 patients) and the control group, 104 eyes (55 patients). At 1 month, the mean postoperative UDVA was 20/21 in the study group and 20/22 in the control group and at 3 months, 20/22 and 20/20, respectively. At 1 month, the mean postoperative spherical equivalent (SE) was +0.07 diopter (D) ± 0.49 (SD) in the study group and +0.14 ± 0.30 D in the control group and at 3 months, -0.01 ± 0.44 D and +0.02 ± 0.23 D, respectively; there was no statistically significant difference between groups at either timepoint. There was no statistically significant difference in preoperative RMS or postoperative coma, trefoil, or spherical aberration between the groups. Although the study group had a slightly higher enhancement rate, the difference was not statistically significant. CONCLUSION: Compared with custom LASIK based on undilated wavescans, use of dilated wavescans for custom LASIK resulted in comparable postoperative outcomes. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Ultra-wide-field imaging for cytomegalovirus retinitis.

BACKGROUND AND OBJECTIVE: To compare the Optomap imaging system (Optos PLC, Dunfermline, Scotland) with conventional fundus photography in patients with cytomegalovirus (CMV) retinitis. PATIENTS AND METHODS: Patients treated at Rush University for acquired immune deficiency syndrome and CMV retinitis were studied prospectively. Conventional nine-field photography and Optomap ultra-wide-field photography were performed on the same day. A patient satisfaction questionnaire was completed. The main outcome measures were total retinal area imaged, area of CMV retinitis imaged, and patient satisfaction. RESULTS: Twelve eyes met the inclusion criteria. Ultra-wide-field imaging captured 48.3% greater retinal area and 40.0% greater CMV retinitis area compared with standard photography. Standard photography missed peripheral CMV lesions in two eyes. The patient satisfaction survey indicated a preference for ultra-wide-field imaging based on increased comfort and decreased imaging time. CONCLUSION: The ultra-wide-field Optomap imaging system tended to capture greater areas of total retina and peripheral CMV retinitis lesions. Patients tended to prefer ultra-wide-field imaging because of the perceived time requirements and comfort of use.

Reduced application time for prophylactic mitomycin C in photorefractive keratectomy.

OBJECTIVE: To determine whether the duration of mitomycin C (MMC) 0.02% application affects visual outcome or the incidence of subepithelial haze in patients undergoing photorefractive keratectomy (PRK) with prophylactic administration of MMC. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Two hundred sixty-nine eyes undergoing PRK. METHODS: This was a retrospective comparative case series that included 269 eyes that underwent PRK with prophylactic MMC application for 120 seconds (group 1, n = 74), 60 seconds (group 2, n = 36), or 12 seconds (group 3, n = 159). The mean preoperative spherical equivalent was -6.49 diopters (D) in group 1, -6.77 D in group 2, and -7.10 D in group 3. Photorefractive keratectomy was performed using a modified nomogram. All eyes received a single intraoperative application of MMC (0.02%) after laser ablation for the above specified durations. MAIN OUTCOME MEASURES: Best-corrected visual acuity and corneal haze score. RESULTS: Best-corrected visual acuity was 20/23 in group 1, 20/20 in group 2, and 20/21 in group 3. The mean haze score+/-standard deviation (scale, 0.00-4.00) was 0.11+/-0.31 in group 1, 0.14+/-0.28 in group 2, and 0.07+/-0.20 in group 3 throughout a mean follow-up of 31 months in group 1, 16 months in group 2, and 10 months in group 3. No eyes had a haze score of more than 1.00. CONCLUSIONS: There was no statistically significant difference in postoperative best-corrected visual acuity or haze scores among the 3 groups. Administration of prophylactic MMC 0.02% for 12 seconds after PRK seems to be equally efficacious for haze prophylaxis when compared with longer application times of 60 and 120 seconds.