Impact of tamsulosin exposure on late complications following cataract surgery: retrospective cohort study.

The purpose of this study is to measure the impact of tamsulosin intake on five postoperative cataract surgery complications (toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema, and postoperative endophthalmitis). This retrospective cohort study was conducted at University Hospital of Henares. The study included 660-eyes of 660 patients submitted to cataract surgery at the ophthalmology unit of Hospital del Henares (Madrid) between 2 March 2009 and 28 February 2010. Extracapsular cataract extraction, combined glaucoma and cataract surgery phacovitrectomy, posterior capsule rupture and zonular damage were considered exclusion criteria. Clinical charts were reviewed during July 2012. Patients were divided in two groups (exposed and non-exposed to tamsulosin). Cumulative incidence of toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema and postoperative endophthalmitis were compared in both groups. Rebound uveitis (relative risk [RR] 3.39; confidence interval [CI] 1.63-7.08) and macular edema (RR 4.15; CI 1.06-16.22) were more common in the tamsulosin-exposed group. Retinal detachment had a similar incidence in both groups. We observed no cases of endophthalmitis or toxic anterior segment syndrome in either of the two groups. Tamsulosin exposure in this cohort was associated with a higher risk of rebound uveitis and macular edema but the other three studied postoperative complications had a similar incidence in both groups.

Trifocal versus monofocal intraocular lens implantation in eyes previously treated with laser in situ keratomileusis (LASIK) for myopia.

PURPOSE: To assess visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes that had previously undergone laser in situ keratomileusis (LASIK) for myopia and to compare them with those recorded after implantation of a monofocal IOL. DESIGN: Retrospective comparative cases series. METHODS: This study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), safety, and efficacy after the implantation of two comparable trifocal IOL models and one monofocal IOL model in patients who had previously undergone myopic LASIK. Patients were classified according to the implanted IOL (monofocal or trifocal). RESULTS: A total of 211 eyes from 170 patients received a monofocal IOL, and 211 eyes from 161 patients received a trifocal IOL. At the end of the study, after lensectomy, there was a higher myopic residual spherical equivalent in the monofocal group because some eyes had been targeted for slight myopia to achieve monovision; therefore, UDVA was better in the trifocal group. CDVA was comparable in both groups. As expected, both monocular and binocular UNVA were significantly better in the trifocal group. Although the percentage of eyes that lost ≥1 line of CDVA did not differ between the groups, the safety index was slightly better in the monofocal group. CONCLUSION: Although implantation of monofocal and trifocal IOLs after myopic LASIK yielded excellent distance visual outcomes, UNVA was significantly better for the trifocal IOL, with a minimally worse safety profile. Trifocal IOLs can be considered after previous LASIK for myopia, with an appropriate patient selection.

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia.

BACKGROUND: To assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation. METHODS: This is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction. RESULTS: 198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items). CONCLUSION: In eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment.

PURPOSE: To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). METHODS: This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. RESULTS: One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. CONCLUSIONS: Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.

Trifocal IOL Implantation in Eyes With Previous Laser Corneal Refractive Surgery: The Impact of Corneal Spherical Aberration on Postoperative Visual Outcomes.

PURPOSE: To analyze corneal aberrations and factors affecting visual outcomes after implantation of a trifocal intraocular lens (IOL) in eyes previously treated with laser corneal refractive surgery. METHODS: This retrospective case series included 222 consecutive eyes implanted with the trifocal FineVision Micro-F IOL (PhysIOL) after laser corneal refractive surgery. The series was divided into two groups according to safety outcomes after lensectomy: eyes with loss of one or more lines of corrected distance visual acuity (CDVA) [n = 59, 26.5%]) (failed eyes group) and eyes with no loss or gain in CDVA lines (n = 163, 73.4%]) (successful eyes group). Distribution of tomographic corneal aberrations (spherical aberration [Z40], comatic and root mean square of higher order aberrations [RMS-HOA]), laser corneal refractive surgery error, kappa angle, and CDVA after laser corneal refractive surgery were compared among both groups. RESULTS: Mean CDVA after lensectomy was 0.15 ± 0.07 logMAR (range: 0.05 to 0.30 logMAR) versus 0.03 ± 0.04 logMAR (range: 0.00 to 0.15 logMAR) in the failed and successful eyes groups, respectively (P < .001). Comparison of both groups showed that failed eyes had a statistically significantly higher grade of hyperopic laser corneal refractive surgery than successful eyes measured as mean sphere (+0.71 ± 3.10 diopters [D] [range: -7.75 to +6.00 D] vs -0.46 ± 3.70 D [range: -10.75 to +6.00 D], P < .01), spherical equivalent (+0.27 ± 3.10 D [range: -8.00 to +5.50 D] vs -0.97 ± 3.60 D [range: -12.50 to +4.90 D], P < .05), and percentage of hyperopic laser corneal refractive surgery (64% vs 43.5%, P < .05). Corneal aberration analysis showed that mean Z40 values were significantly more negative in the failed eyes group than in the successful eyes group (+0.07 ± 0.40 mm [range: -0.82 to +0.65 mm] vs +0.18 ± 0.37 mm [range: -0.79 to +0.87 mm], P < .05). Laser corneal refractive surgery cylinder was distributed homogeneously between both groups, as well as coma and RMS-HOA, kappa angle, and CDVA after laser corneal refractive surgery that were not statistically significant. CONCLUSIONS: Surgeons should consider tomographic corneal spherical aberration after implantation of a trifocal IOL in eyes after keratorefractive surgery, particularly in eyes previously treated with hyperopic laser corneal refractive surgery, to prevent loss of lines of visual acuity after lensectomy. [J Refract Surg. 2022:38(4):222-228.].

Laser corneal enhancement after trifocal intraocular lens implantation in eyes that previously had photoablative corneal refractive surgery.

PURPOSE: To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS). SETTING: Clinica Baviera-AIER-Eye Group, Spain. DESIGN: Retrospective comparative case series. METHODS: Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement. RESULTS: 186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P < .001), cylinder ( P < .001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P > .05 all items). CONCLUSIONS: Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.

Expert Panel Consensus for Addressing Anti-VEGF Treatment Challenges of Diabetic Macular Edema in Spain.

Purpose: The treatment of diabetic macular edema (DME) has evolved rapidly in the past decade, highlighting the need to address the challenges of routine clinical practice decision-making through expert consensus agreements. Methods: After a literature review and discussion of real-world experience on DME management, a group of ten retina specialists agreed on a consensus of recommendations for the most appropriate management of DME patients using vascular endothelial growth factor inhibitors (anti-VEGF) in Spain. Results: The panel recommended early treatment initiation in DME patients with worse baseline visual acuity (VA) to maintain or improve outcome. For patients with good VA, an observation strategy was recommended, considering the presence of diabetic retinopathy, optical coherence tomography biomarkers, and impact on patient's quality of life. Based on the available evidence and clinical experience, the panel recommended the use of anti-VEGF intensive loading doses with the objective of achieving anatomic and visual responses as soon as possible, followed by a Treat & Extend (T&E) strategy to maintain VA improvement. Aflibercept was recommended for patients with a baseline decimal VA <0.5, followed by a T&E strategy, including the possibility to extend frequency of injections up to 16 weeks. Conclusion: An expert panel proposes a consensus for the management of DME in Spain. Early treatment initiation with anti-VEGF in DME patients is recommended to maintain or improve VA; aflibercept is recommended for patients with a poor baseline VA.

Trifocal intraocular lens implantation in eyes with previous corneal refractive surgery for myopia and hyperopia.

PURPOSE: To evaluate the visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic and hyperopic corneal refractive laser surgery. SETTING: Clinica Baviera-AIER-Eye group, Spain. DESIGN: Retrospective comparative case series. METHODS: The series was divided into 2 groups according to the type of corneal laser refraction (myopic and hyperopic). The main visual and refractive outcome measures included corrected distance visual acuity (CDVA) and uncorrected distance and near visual acuity, safety, efficacy, and predictability. The secondary outcome measures were percentage of enhancement and Nd:YAG capsulotomy and influence of prelaser magnitude of myopia and hyperopia on the outcome of trifocal IOL implantation. RESULTS: The sample comprised 868 eyes (543 patients): myopic, n = 319 eyes (36.7%); and hyperopic, n = 549 eyes (63.2%). Three months postoperatively, visual outcomes were poorer in the hyperopic group than those in the myopic group for mean CDVA (0.06 ± 0.05 vs 0.04 ± 0.04, P < .01) and safety (21% vs 12% of CDVA line loss, P < .05) outcomes. However, precision outcomes were worse in the myopic group than those in the hyperopic group, with a mean spherical equivalent of -0.38 ± 0.3 vs -0.17 ± 0.3 (P < .01). Stratification by magnitude of primary laser treatment revealed poorer visual and safety results in the high hyperopia subgroup (>+3.0 diopters [D]) and poorer precision in the high myopia subgroup (<-5.0 D). CONCLUSIONS: Trifocal IOL implantation after photorefractive surgery in eyes previously treated with myopic ablation achieved good visual outcomes but less predictability in the high myopia subgroup. However, eyes with a previous hyperopic corneal ablation achieved excellent precision but worse visual and safety outcomes in the high hyperopia subgroup.

Infectious keratitis in 204 586 LASIK procedures.

PURPOSE: To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies. DESIGN: Retrospective study. PARTICIPANTS: We included 107 613 patients who underwent LASIK at Clínica Baviera (Instituto Oftalmológico Europeo, Spain) from September 2002 to May 2008. METHODS: The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual outcomes were recorded. MAIN OUTCOME MEASURES: Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome. RESULTS: Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently required in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >or=20/20 in 38 cases (52.7%) and >or=20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%). CONCLUSIONS: The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Spontaneous malignant glaucoma: Case report and review of the literature.

Malignant glaucoma usually occurs after anterior segment surgery (typically after glaucoma surgery). The aim of this article is to report a case of spontaneous malignant glaucoma (SpMG), which required phacovitrectomy for resolution and to review the cases of SpMG reported in modern literature. Only nine cases were identified. SpMG has no gender predilection and age at onset seems to be lower (mean age 47 years) than in secondary malignant glaucoma (SeMG). Nearly in half of the reported patients (4 out of 9) the condition had a bilateral presentation. The risk factors that have been identified for SeMG (nanophthalmos, shallow anterior chamber, iris plateau, zonular laxity) are underrepresented in SpMG.

Retreatment of hyperopia after primary hyperopic LASIK.

PURPOSE: To evaluate factors that influence retreatment results after primary hyperopic LASIK. METHODS: Restrospective study of 86 eyes of 61 patients that underwent LASIK to correct primary hyperopic spherical equivalent refraction and a second hyperopic retreatment due to undercorrection. All procedures were performed with the Technolas Keracor 217C excimer laser, lifting the preexisting flap for the retreatment. Preoperatively, under cycloplegia, mean spherical equivalent refraction of the series was +3.05 +/- 0.99 diopters (D). RESULTS: At last follow-up, mean spherical equivalent refraction was -0.07 +/- 0.50 D. Efficacy of the retreatment procedure was better when the primary LASIK attempted spherical equivalent refraction correction was < +3.00 D (P < .05). Safety of retreatment was lower when attempted spherical equivalent refraction correction was > +1.00 D (P < .05) and when attempted spherical equivalent refraction correction of both procedures combined was >+4.00 D (P < .05). CONCLUSIONS: Efficacy, safety, and predictability of retreatments secondary to undercorrection after primary hyperopic LASIK may be affected depending on the amount of diopters corrected in the primary procedure, in the retreatment procedure, and in both primary and retreatment procedures combined.

Laser in situ keratomileusis in patients with a history of ocular herpes.

PURPOSE: To report the outcomes of laser in situ keratomileusis (LASIK) in patients with a history of ocular herpes simplex virus (HSV) or herpes zoster ophthalmicus (HZO). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. METHODS: In this retrospective case series, the records of eyes with a history of ocular herpes that had LASIK from 2003 through 2005 were reviewed. The main outcome measure was postoperative recurrence of ocular herpes. RESULTS: Forty-nine eyes (48 patients) with a history of ocular herpes (HSV keratitis, 28 eyes; HSV eyelid lesions, 17 eyes; HZO, 4 eyes) were identified. All LASIK procedures were uneventful. Herpetic disease was inactive at the time of surgery in all eyes and for more than 1 year in 31 eyes. Perioperative antiviral systemic prophylaxis was used in 13 patients with a history of HSV keratitis. No eye developed reactivation of herpetic keratitis during the follow-up (range 1 to 28 months). CONCLUSIONS: Laser in situ keratomileusis was safe in patients with a history of ocular herpes; no recurrences occurred during the follow-up period. However, candidates should be selected with caution and surgery performed only in eyes in which the herpes has been inactive for 1 year before surgery, without stromal disease, and with regular topography and pachymetry maps and normal corneal sensitivity. The most reasonable clinical strategy is perioperative systemic antiviral prophylaxis.

LASIK outcomes in patients with underlying systemic contraindications: a preliminary study.

OBJECTIVES: To determine the anatomic and functional outcomes of photorefractive surgery in patients with underlying systemic diseases that are traditionally listed as relative or absolute contraindications. DESIGN: Observational retrospective case-control study. PARTICIPANTS: The case groups were composed of 275 eyes of 141 consecutive patients who underwent a LASIK procedure with any of the following underlying conditions: autoimmune connective-tissue disorders (n = 62), psoriasis (n = 91), intestinal inflammatory diseases (n = 67), diabetes mellitus (n = 44), and history of keloid formation (n = 18). Twenty-nine patients (56 eyes) were receiving systemic immunosuppressive therapy. The control group comprised 358 eyes of 181 patients without the above-mentioned conditions who underwent LASIK. METHODS: The study had 2 parts, relating to the anatomic and functional (visual and refractive) outcomes. For anatomic outcome, we compared the entire sample of both groups. For functional outcome, only myopic eyes of each group were compared. Independent comparisons were performed between each disease group and the control group. MAIN OUTCOME MEASURES: Anatomic outcomes included perioperative and postoperative epithelial, flap, and interface complications. Functional outcomes were evaluated using visual and refractive indicators, percentage of eyes undergoing enhancement, and number of postoperative visits. RESULTS: Mild anatomic complications were observed in the case and control groups with similar percentages, and there were no statistical differences between groups. Regarding functional outcome, the only significant finding was a worse refractive outcome in the collagen vascular diseases group compared with controls. There were no other statistical differences detected in the other systemic disease groups. CONCLUSIONS: In our experience, LASIK can be performed effectively and safely in selected patients with stable and controlled systemic diseases with favorable postoperative anatomic and visual outcomes. The absolute exclusion of certain systemic contraindications should be reconsidered.

Thin flap laser in situ keratomileusis: analysis of contrast sensitivity, visual, and refractive outcomes.

PURPOSE: To analyze refractive, visual, and contrast sensitivity outcomes of laser in situ keratomileusis (LASIK) performed under thin flaps (less than 100 microm), and compare them with those of conventional thicker flaps. SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. METHODS: This retrospective study comprised 280 consecutive eyes that had LASIK for myopia using the Moria LSK-One microkeratome and the Technolas 217C excimer laser. Efficacy, predictability, and contrast sensitivity indicators were compared between 3 groups of flap thickness: thin (<100 microm, n = 105), medium (100 to 129 microm, n = 122), and thick (>130 microm, n = 53). RESULTS: Refractive results were excellent and comparable between the 3 groups; however, visual outcomes-measured as efficacy, postoperative evolution of uncorrected visual acuity, and contrast sensitivity-test were significantly better in the thin flap group. Efficacy results were 92.9%, 91.0%, and 81.0% in the thin, medium, and thick flap groups, respectively (P < .05), and the rate of enhancements was 0%, 2.3%, and 5.6%, respectively. With regard to contrast sensitivity, changes between preoperative and postoperative values at month 3 of follow-up, the thin flap group achieved the preoperative levels at 3 spatial frequencies (3, 6, and 18 cycles per degree), while the thicker flap groups maintained lower than preoperative levels at more than 2 spatial frequencies. When comparing contrast sensitivity values between the 3 groups, the thin flap group also obtained the best results at lower spatial frequencies. CONCLUSIONS: Thin flap LASIK is a safe technique to correct myopic defects since it blends the advantages of surface and lamellar procedures (minimal debilitation of corneal biomechanical architecture with the rapid and comfortable visual recovery of lamellar approaches). Moreover, it achieves excellent refractive outcomes, a lower rate of enhancements, and a good visual performance with better contrast sensitivity test results.

Factors that influence outcomes of hyperopic laser in situ keratomileusis.

PURPOSE: To analyze the influence of preoperative corneal curvature, postoperative keratometric power, and the amount of correction on the outcomes of hyperopic laser in situ keratomileusis (LASIK). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. METHODS: In this retrospective study, the records of 376 eyes that had LASIK for hyperopia using the Moria LSK-One microkeratome and the Technolas-Keracor 217C excimer laser were reviewed. The results were analyzed by preoperative hyperopia (5 subgroups) and by preoperative (more than and less than 43.0 diopters [D]) and postoperative (more than and less than 48.0 D) mean keratometry. RESULTS: A statistically significant keratometry regression was found in the +3.00 to +3.90 D range (P <.01), a significant decrease in predictability in the +4.00 to +4.90 D range (P <.05), and a significant worsening in safety in the highest range (+6.00 to +7.90 D; P <.05). Comparative analysis of the > or = +4.00 D and <+4.00 D groups showed statistically significant differences in most measurement parameters. The preoperative keratometry did not influence postoperative results with the exception of poorer predictability in the group of preoperative flat corneas in which a high degree of hyperopia was corrected; ie, spherical equivalents within +/-0.50 D were found in 40.4% and 61.0% of cases with flat and steep corneas, respectively (P <.05). The efficacy and safety in eyes that achieved a postoperative keratometry >48.00 D did not differ significantly from the efficacy and safety in eyes that had a lower final keratometric power. CONCLUSIONS: The factor that negatively influenced the outcome of hyperopic LASIK was the degree of hyperopia corrected. Preoperative keratometry did not significantly influence the postoperative results, and postoperative keratometry >48 D did not result in significant worsening of visual results when the attempted correction was less than +4.00 D.

Indications for intrastromal corneal ring segments in ectasia after laser in situ keratomileusis.

PURPOSE: To evaluate clinical results of intrastromal corneal ring segments (ICRS) in a large series of post-laser in situ keratomileusis (LASIK) ectasia and determine which clinical parameters were related to the success of this technique. SETTINGS: Vissum Corporation and Clínica Baviera Group, Alicante, Spain. DESIGN: Case series. METHODS: Intrastromal corneal ring segments were implanted to correct the spherocylindrical error and improve visual acuity. Based on a previously described grading system, the best indications for ICRS implantation to treat post-LASIK ectasia were evaluated. The variables related to favorable outcomes over a 12-month follow-up were determined. RESULTS: Patients who lost 2 or more lines due to post-LASIK ectasia had a mean gain of +2.89 lines of corrected distance visual acuity (CDVA) after ICRS implantation (P<.001) and a mean CDVA of 0.81 (95% confidence interval, 0.74-0.88). In contrast, patients who did not lose vision after ectasia had a mean loss of -2.00 lines of CDVA after the ICRS implantation (P<.001). The odds ratio of a gain of at least 1 line of CDVA was 18 times greater for those who had lost 2 or more lines of CDVA after ectasia. CONCLUSIONS: The best indications for ICRS were a loss of 2 or more lines of CDVA after ectasia and post-LASIK ectasia grade 4. Patients who do not have vision loss after ectasia and those classified as grade 1 should not be considered candidates for ICRS implantation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Clinical grading of post-LASIK ectasia related to visual limitation and predictive factors for vision loss.

PURPOSE: To evaluate and characterize the main clinical features of post-laser in situ keratomileusis (LASIK) ectasia, propose a grading system based on visual limitation, and identify predictive factors related to the degree of visual loss. SETTING: Vissum Corp., Alicante, Spain. DESIGN: Retrospective case series. METHODS: This study comprised consecutive eyes with corneal ectasia after LASIK from 1996 to 2010. Main outcomes were post-LASIK ectasia corrected distance visual acuity (CDVA), CDVA loss, spherical equivalent (SE), and the corneal bulge (delta K). These outcomes were correlated with the residual stromal bed, ablation depth, ablation ratio (ablation depth:pachymetry), corneal depth (flap + ablation depth), and corneal ratio (corneal depth:pachymetry) to characterize their role in the severity of the disease. RESULTS: The mean post-LASIK ectasia CDVA, CDVA loss, SE, and delta K were 0.20 logMAR ± 0.18 (SD), -0.13 ± 0.15 logMAR, -3.80 ± 3.86 diopters (D), and 4.77 ± 4.23 D, respectively. The ablation ratio had the strongest correlation with post-LASIK ectasia CDVA (ρ = 0.477 and P<.001), whereas the corneal ratio had the strongest correlation with the post-LASIK ectasia SE and delta K (ρ = -0.614 and ρ = 0.453, respectively: P<.001). The ablation ratio was the main predictive factor for post-LASIK ectasia CDVA loss (relative risk, 2.04; P=.049). CONCLUSIONS: The grading system based on visual limitation was consistently represented by differences in CDVA loss, SE, and delta K. A high amount of tissue removed by the refractive procedure was associated with greater corneal biomechanical destabilization, increased corneal steepening, and a worse prognosis.

Infectious keratitis in 18,651 laser surface ablation procedures.

PURPOSE: To evaluate the incidence, culture results, risk factors, treatment strategies, and visual outcomes of infectious keratitis after surface ablation. SETTING: Multicenter study in Spain. DESIGN: Case series. METHODS: The medical records of patients who had surface ablation between January 2003 and December 2009 were reviewed to identify cases of infectious keratitis. The incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and visual outcome were recorded. Main outcome measures were incidence of infectious keratitis after surface ablation, culture results, response to treatment, and visual outcomes. RESULTS: The study reviewed the records of 9794 patients (18,651 eyes). Infectious keratitis after surface ablation was diagnosed in 39 eyes of 38 patients. The onset of infection was early (within 7 days after surgery) in 28 cases (71.79%). Cultures were positive in 13 of 27 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus species (9 cases). The final corrected distance visual acuity (CDVA) was 20/20 or better in 23 cases (58.97%), 20/40 or better in 36 cases (92.30%), and worse than 20/40 in 3 cases (7.69%). CONCLUSIONS: The incidence of infectious keratitis after surface ablation was 0.20%. Infectious keratitis is a potentially vision-threatening complication. Prompt and aggressive management with an intensive regimen of fortified antibiotic agents is strongly recommended. Proper management can preserve useful vision in most cases. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.