Results of late flap removal after complicated laser in situ keratomileusis.

PURPOSE: To evaluate the effect of flap removal on complications after laser in situ keratomileusis (LASIK). SETTING: Three university-based referral centers and 1 private practice. METHODS: This retrospective interventional case series comprised 6 eyes of 6 patients at 4 centers. Flap removal occurred 2 to 41 weeks after the LASIK procedure. The corneal flaps were excised by 2 methods: In 2 eyes, the flap was lifted and excised manually. In 4 eyes, the thin flap was removed by excimer ablation using phototherapeutic keratectomy and/or photorefractive keratectomy. Postoperative measurements included uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, slitlamp evaluation, and computerized videokeratography. All patients had an 8-month or longer convalescence to assess visual recovery. RESULTS: After the initial flap complication, the BSCVA decreased in all 6 eyes (mean loss 3.0 lines +/- 1.5 [SD]). After flap removal, it improved in all eyes (mean gain 2.2 +/- 1.2 lines). All patients reported a reduction in or elimination of visual symptoms. Despite the improvements, a minor loss of BSCVA (mean -0.8 lines [range 0 to 2 lines]) remained in 4 patients. CONCLUSION: In carefully selected patients, flap removal is a viable surgical option to improve visual function.

Dense pigmentation of the posterior lens capsule associated with the pigment dispersion syndrome.

PURPOSE: To report an unusual case of pigment dispersion syndrome associated with unilateral dense pigmentation of the posterior lens capsule. METHODS: Case report. RESULTS: A 59-year-old male with bilateral pigment dispersion syndrome presented with progressive decrease in visual acuity in the left eye over the past 10 to 20 years. Clinical examination revealed the typical findings of pigment dispersion syndrome including the presence of bilateral Krunkenberg spindles, iris transillumination defects, and heavy trabecular meshwork pigmentation. Of note, there was remarkably dense pigmentation of the posterior lens capsule in the eye with decreased visual acuity. CONCLUSION: Pigmentation of the posterior lens capsule may be a rare finding associated with pigment dispersion syndrome. Such a finding suggests that there may be aqueous flow into the retrolental space in some patients with this condition. The optimal treatment of this unusual condition remains undetermined.