Photopic pupillometry-guided laser in situ keratomileusis for hyperopic presbyopia.

PURPOSE: To evaluate a method of surgically treating presbyopia in hyperopic patients having laser in situ keratomileusis (LASIK) by selecting excimer ablation optical zone diameters based on the photopic pupil. SETTING: Private practice, Beverly Hills, California, USA. METHODS: This prospective analysis comprised 46 patients having hyperopic LASIK for presbyopia. The distance-dominant eye was treated with a standard 6.0 mm optical and 9.0 mm outer zone for full distance correction with no nomogram adjustment from the final preoperative manifest refraction. In the nondominant eye, an algorithm was used to select the optical and blend zone diameters and the optical zone size-dependent programmed amount of correction augmentation. Variables evaluated at the 6-month postoperative visit included preoperative and postoperative manifest refractive spherical equivalent (MRSE), refractive cylinder, and monocular and binocular near and distance uncorrected visual acuities. Patient satisfaction and spectacle dependence were also evaluated. RESULTS: In the near-corrected eye, the mean preoperative and postoperative MRSE was +1.10 diopters (D) +/- 1.20 (SD) and -1.30 +/- 0.56 D, respectively, and the mean refractive cylinder, -0.76 +/- 0.91 D and -0.36 +/- 0.33 D, respectively (P<.05). The mean uncorrected near acuity in the near-corrected eye was J10 preoperatively and J1 postoperatively (P<.0001) and the binocular mean uncorrected near acuity, J10 and J1, respectively (P<.0001). The mean uncorrected logMAR distance acuity in the near-corrected eye was +0.38 +/- 0.31 (20/50) preoperatively and +0.36 +/- 0.25 (20/50) postoperatively (P>.05). The mean binocular uncorrected logMAR distance acuity was +0.30 +/- 0.30 (20/40) and +0.01 +/- 0.08 (20/20) (P<.0001), respectively. The mean overall patient satisfaction score was 8.8 (scale 1 to 10). After LASIK, no patient reported using spectacles full time for near or distance and 15% reported part-time use. CONCLUSION: Photopic pupillometry-guided LASIK may be an effective option when considering surgical treatment of presbyopia in hyperopic patients.

Verisyse intraocular lens implantation in a child with anisometropic amblyopia: four-year follow-up.

A Verisyse phakic intraocular lens (pIOL) (AMO) was implanted in the eye of a 3-year-old child with unilateral high myopia and suspected dense amblyopia. Four years postoperatively, the Snellen visual acuity was 20/30 with a refraction of -1.00 -1.00 x 77 and the endothelial cell density was 3262 cells/mm(2) compared with 3092 cells/mm(2) in the right eye. The Verisyse pIOL may be a treatment option to prevent dense amblyopia in children with highly myopic anisometropia.

Herpetic lesion mimicking lower eyelid malignancy.

This photo-essay illustrates a case of a rapidly enlarging and ulcerated lower eyelid lesion in an HIV-positive man that was thought to be a malignant lesion. The biopsy revealed inclusions consistent with herpesvirus. This clinical entity should be considered in the clinician's differential diagnosis of eyelid lesions.