Posterior vitreous detachment and retinal detachment after implantation of the Visian phakic implantable collamer lens.

INTRODUCTION: To evaluate the vitreoretinal complications in myopes after Visian implantable collamer lenses (ICL) implantation. MATERIALS AND METHODS: This is a retrospective, observational, non-comparative clinical study that evaluated 617 consecutive myopes who underwent ICL implantation at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen between July 2006 and May 2010. Follow up ranged from 6 months to 40 months. Preoperative and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), slit-lamp biomicroscopy, intraocular pressure and dilated retinal examination. Investigations included corneal topography, central corneal thickness, anterior chamber depth and white to white diameter. Retinal diseases and complications were recorded and analyzed preoperatively and postoperatively. RESULTS: Preoperatively, 61 (9.9%) eyes had posterior segment pathology requiring prophylactic laser photocoagulation. One eye developed spontaneous rhegmatogenous retinal detachment (RRD), one eye developed traumatic retinal detachment and two eyes required laser treatment postoperatively. The overall retinal detachment rate post-ICL was 0.32%. CONCLUSIONS: Posterior segment complications are rare after ICL implantation but dilated vitreoretinal assessment is important before and after the procedure. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist. If a patient develops floaters or blurry vision he/she requires further assessment by a vitreoretinal specialist.

Phacoviscocanalostomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma.

OBJECTIVE: To compare the outcome of phacoviscocanalostomy in pseudoexfoliation glaucoma (PEXG) versus that in primary open-angle glaucoma (POAG). DESIGN: Prospective comparative study. PARTICIPANTS: Sixty eyes of 60 patients who underwent phacoviscocanalostomy for cataract and medically uncontrolled PEXG (30 eyes) or POAG (30 eyes). METHODS: Success rate was based on intraocular pressure (IOP) reduction and need for antiglaucoma medication. Visual acuity (VA) and complication rates were secondary outcomes. RESULTS: The mean follow-up was 19.7 months (range, 12-36 months). The mean IOP values in both groups were significantly less than the preoperative values at all postoperative intervals (p < 0.001). From 1 month onward, the decrease in IOP was more dramatic in PEXG eyes than in POAG eyes (p < 0.05). At last visit, the mean percentage of IOP reduction was 49.7% in the PEXG group and 30.9% in the POAG group. All study eyes required decreased antiglaucoma medications and showed improved VA postoperatively. Transient complications included Descemet's membrane microperforations, macroperforation, zonular dehiscence, and postoperative IOP spike. No eyes developed trabeculectomy-type bleb, hyphema, fibrin exudation, or bleb-related complications. CONCLUSIONS: Phacoviscocanalostomy achieved excellent IOP control and VA improvement in both PEXG and POAG groups. PEXG demonstrated greater IOP reduction and fewer postoperative medications than POAG. The complication rate was low and did not affect surgical outcome. Phacoviscocanalostomy can be an effective and safe surgical alternative to phacotrabeculectomy in both groups of patients.

Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospital-based cohort in "yemen".

BACKGROUND: To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) were not performed in patients who presented for refractive surgery consultation. MATERIALS AND METHODS: A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. RESULTS: In this cohort, 1,660 (79.4%) patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 (21%) patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters (19%), keratoconus (18%), suboptimal central corneal thickness (15%), cataract (12%) and keratoconus suspect (forme fruste keratoconus) (10%). CONCLUSION: Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study.

Intraoperative and early postoperative complications of laser in situ keratomileusis in Yemen.

OBJECTIVE: To determine the intraoperative and early postoperative complications and visual outcome of laser in situ keratomileusis (LASIK) surgery for the correction of myopia. METHODS: The first 2000 consecutive myopic LASIK eyes operated at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen from June 2005 to October 2006 were the study group. This is a retrospective observational noncomparative clinical study. The preoperative and postoperative spherical equivalent, best-corrected visual acuity, and corneal status was recorded. The intraoperative and early postoperative complications were reviewed. RESULTS: There were 15 (0.8%) intraoperative microkeratome-related flap complications recorded namely, buttonhole (5), incomplete cut (3), thin flap (3), epithelial defect (3) and eccentric flap (1). There were 4 (0.2%) non-keratome related surgical events of inability to obtain sufficient suction. There were 46 (2.3%) first-day postoperative complications. Nine eyes required repositioning of the flap for macro-striae (5), or displaced flap (4). Four needed washing under the flap for severe deep lamellar keratitis (2), and gauze debris under the flap (2). Laser enhancement was carried out in 28 eyes (1.4%), and uncorrected visual acuity of 20/40 or better was attained in 96.9% of treated eyes. Twenty-four eyes (1.3%) lost more than 2 lines of best-corrected vision. CONCLUSION: The LASIK is a safe and effective procedure for the correction of myopia. A small number of patients may suffer complications, most of which are not serious, and rarely lead to visual loss of more than 2 Snellen lines.

Vitreoretinal complications in Yemeni patients with keratorefractive surgery.

OBJECTIVE: To evaluate vitreoretinal complications in patients undergoing laser keratorefractive surgery. METHODS: This retrospective observational non-comparative clinical study was carried out between June 2005 and March 2008, and included 4691 consecutive laser keratorefractive surgery procedures for 2480 patients performed in the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen. Patients were followed up for 12-36 months. The preoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best spectacle-corrected visual acuity, slit-lamp biomicroscopy, and dilated vitreoretinal assessment. Retinal diseases were recorded and analyzed during the preoperative and postoperative care. RESULTS: Sixty-five (1.4%) of the 4691 eyes had posterior segment pathology requiring intervention. In the preoperative assessment, 57 eyes had prophylactic laser photocoagulation for retinal lesions. Seven eyes developed posterior vitreous detachment postoperatively, and 4 of these required prophylactic laser therapy for lattice degeneration and retinal breaks. Two eyes (0.04%) developed rhegmatogenous retinal detachment, which occurred spontaneously. One patient developed cystoid macular edema in both eyes. CONCLUSION: Most complications are related to the refractive outcome or to corneal and anterior segment injury. Posterior segment complications are rare, but dilated vitreoretinal assessment is important before and after laser keratorefractive procedures. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist.

Changes in keratoconic corneas after intracorneal ring segment explantation and reimplantation.

PURPOSE: To evaluate the outcome and potential reversibility of the changes induced in keratoconic eyes after intracorneal ring segment explantation. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Five eyes of 4 patients who underwent uneventful implantation of one or two intracorneal ring segment segments for the correction of clear corneal keratoconus and who required explantation of one segment due to complications. MAIN OUTCOME MEASURES: Visual acuity, refraction, keratometric readings, and corneal topography. The follow-up was up to 1 year from the primary implantation procedure in all cases. RESULTS: Explantation was performed easily in all cases without intraoperative or postoperative complications. The segments were extracted due to migration and local melting. The visual, refractive, and topographic map findings regressed to approximate the original clinical situation before segment implantation. CONCLUSIONS: Intracorneal ring segments are safely and easily explanted from keratoconic eyes. Most of the visual, refractive, and topographic findings return to near the preimplantation levels.