ABSTRACT
PURPOSE: To evaluate the efficacy and safety of diclofenac sodium 0.1% ophthalmic solution in patients having myopic photorefractive keratectomy (PRK). SETTING: Corneal Laser Centre, Clatterbridge Hospital, Wirral, United Kingdom. METHODS: We performed a prospective, randomized, double-masked, parallel-group, placebo-controlled study of 50 patients (diclofenac 25, placebo 25) of both sexes who had myopic excimer laser PRK. Results were evaluated by several types of questionnaires and comprehensive clinical examination on the day of the procedure and 1 and 3 to 14 days postoperatively. RESULTS: Diclofenac-treated patients experienced significantly less photophobia, burning/stinging, and ocular pain and took significantly fewer oral narcotic analgesics over the first 24 hours postoperatively than placebo-treated patients. CONCLUSION: Topical diclofenac significantly reduced the ocular pain and discomfort immediately after excimer PRK without any clinically significant complications or adverse effects.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diclofenac/therapeutic use , Myopia/surgery , Pain, Postoperative/prevention & control , Photorefractive Keratectomy/adverse effects , Administration, Topical , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Diclofenac/administration & dosage , Double-Blind Method , Female , Humans , Lasers, Excimer , Male , Middle Aged , Ophthalmic Solutions , Pain, Postoperative/etiology , Pain, Postoperative/physiopathology , Prospective Studies , Safety , Treatment Outcome , Visual AcuityABSTRACT
BACKGROUND AND OBJECTIVE: Treatment of hyperopia is more of a challenge than PRK but the development of the holmium:YAG laser has provided a more controlled way of carrying out laser thermokeratoplasty (LTK). PATIENTS AND METHODS: Twenty two eyes with hyperopia were treated with a Summit Technology OmniMed holmium laser by placing two rings of eight laser spots at 6.5 and 9 mm (centred on the visual axis) to produce a 4.00 diopters (D) correction. RESULTS: An average +2.10 D refractive correction was achieved in the 17 eyes with no induced astigmatism with an accuracy of 25% within 1.00 D, 60% within 2.00 D and 100% within 3.00 D. However, significant astigmatism (+1.25 to +2.5 Dcyl) was produced in 23% of eyes from 6 months post-laser and these required astigmatic LTK correction. CONCLUSIONS: The overall results were disappointing in that there was an approximate 50% regression at two years post-LTK. However, the rate of regression was very slow at 24 months, and most patients remarked how well they could see in the first few months following the treatment.
Subject(s)
Cornea/surgery , Hyperopia/surgery , Laser Coagulation , Adult , Aged , Aluminum Silicates , Astigmatism/prevention & control , Astigmatism/surgery , Cornea/pathology , Eyeglasses , Female , Follow-Up Studies , Holmium , Humans , Hyperopia/pathology , Laser Coagulation/adverse effects , Male , Middle Aged , Patient Satisfaction , Recurrence , Refraction, Ocular , Visual Acuity , YttriumABSTRACT
We describe a method of endonasal laser dacryocystorhinostomy, using a neodynium-YAG laser, whose ease of performance should make it attractive to general ophthalmologists as an alternative to the routine external approach. A small series of 6 patients were investigated 6 months after surgery and a patent drainage system was revealed.
Subject(s)
Dacryocystorhinostomy/methods , Laser Therapy , Aged , Aged, 80 and over , Humans , Middle Aged , Nasolacrimal Duct/surgery , Treatment OutcomeABSTRACT
The Summit Technology erodible mask treatment of astigmatism does not alter the keratometric astigmatism significantly, even though the refractive astigmatism appears to improve by about 50%. Myopia is satisfactorily treated with the erodible mask, but there is slightly more undercorrection compared to photorefractive keratectomy (PRK) using an expanding diaphragm. Increasing the minus power in ordering the mask cylinder improves the myopia result, but not the keratometric astigmatism result. The following factors do not influence the keratometric astigmatism result: 1) The type of astigmatism (with-, against-the-rule, or oblique); 2) The initial keratometry readings; and 3) The time from the commencement of epithelial removal to laser treatment.
Subject(s)
Astigmatism/surgery , Cornea/surgery , Laser Therapy/instrumentation , Myopia/surgery , Astigmatism/physiopathology , Follow-Up Studies , Humans , Laser Therapy/methods , Myopia/physiopathology , Refraction, Ocular , Treatment Outcome , Visual AcuityABSTRACT
The most effective management of the pain that follows excimer laser photorefractive keratectomy (PRK) appears to be the use of topical nonsteroidal anti-inflammatory agents. A bandage contact lens for 2 days after photorefractive keratectomy is additive to pain relief. The helpfulness of patching was not confirmed. Surprisingly, drops of local anesthetic were not an efficacious means of managing the pain. This was possibly because they were not used frequently enough. The findings showed trends, but were not statistically significant.
Subject(s)
Cornea/surgery , Laser Therapy/adverse effects , Myopia/surgery , Pain, Postoperative/therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Bandages , Combined Modality Therapy , Contact Lenses , Cornea/drug effects , Humans , Ophthalmic Solutions , Pain Measurement , Pain, Postoperative/etiology , Tetracaine/administration & dosageABSTRACT
Ninety-five eyes of 91 patients with myopia from -1.00 to -6.00 D (mean -3.40 D, +/- 1.2) were treated with an ExciMed UV2OOLA 193-nanometer excimer laser (Summit Technology, Inc, Waltham, Mass) (with version 5.5 software) with a 5-millimeter ablation zone. At 6 months, 67 eyes (70%) were within +/- 0.50 D, 84 eyes (88%) were within +/- 1.00 D, and 94 eyes (99%) were within +/- 2.00 D. There was an average overcorrection of +0.25 D which had decreased to +0.18 D by 9 months. Best spectacle corrected visual acuity was 6/6 or better in 88 eyes (94%) and six eyes (6%) had a corrected visual acuity of 6/9. Fifty percent of eyes had slight astigmatism (mean 0.68 D, range 0.25 to 2.00 D) and this reduced to 0.33D (0.02 > p > 0.01) at 6 months.
Subject(s)
Cornea/surgery , Laser Therapy , Myopia/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Laser Therapy/adverse effects , Male , Middle Aged , Myopia/physiopathology , Treatment Outcome , Visual AcuityABSTRACT
The SRK Regression formula for intraocular lens power calculation was used to predict postoperative emmetropia in two series of routine cataract operations using different posterior chamber lenses. More accurate results were obtained when the intraocular lenses were used in one dioptre steps. Some practical points about the routine use of ultrasound are made.
Subject(s)
Lenses, Intraocular , Humans , Methods , Optics and Photonics , UltrasonographyABSTRACT
Oral atenolol (25 mg twice daily and 50 mg and 100 mg once daily) and placebo were tested as additional therapy in a double-masked, randomised, cross-over study. Twenty-four patients (16 with chronic simple glaucoma and 6 with ocular hypertension) participated who had an intraocular pressure (IOP) higher than 21 mmHg. The mean fall of intraocular pressure varied between 28% and 36% and was observed 2 to 6 hours after administration. After 2 weeks of treatment there was still a small fall in intraocular pressure (13%) after 12 hours (for the 25 mg dose) and 24 hours (for the 50 mg and 100 mg dose), but this was not significant (p less than 0.5). There was a fall in blood pressure and reduced pulse rate which persisted for at least 30 hours. Some patients complained of tiredness during treatment periods. Oral atenolol may be useful additional therapy for glaucoma.
Subject(s)
Atenolol/therapeutic use , Glaucoma, Open-Angle/drug therapy , Ocular Hypertension/drug therapy , Administration, Oral , Aged , Atenolol/administration & dosage , Clinical Trials as Topic , Dose-Response Relationship, Drug , Double-Blind Method , Female , Humans , Intraocular Pressure/drug effects , Male , Middle AgedABSTRACT
Prophylactic metronidazole was compared with no treatment in a randomly allocated study of patients undergoing appendicectomy. A 1-g suppository of metronidazole was given with the premedication and 200 mg t.d.s. orally for 7 days thereafter. There were 4 hospital wound infections in the 87 patients receiving metronidazole and 11 out of 83 in the no-treatment group (P < 0.05). However, 60 per cent of wound infections occurred at home and the overall infection rates were not significantly different. The duration of postoperative hospital stay was longer in the control group (5.8 days +/- 3.0 s.d.) than in the treated group (4.8 +/- 2.3; P < 0.01). Only one anaerobic infection occurred in a patient receiving metronidazole but late infection was not prevented. Blood levels of metronidazole taken at the end of operation showed a wide variation but there was no correlation with subsequent infection. Culture of the appendix showed aerobic organisms in 88 per cent of cases and anaerobes in 72 per cent. It is suggested that an antibiotic which is effective against both aerobic and anaerobic organisms might have an advantage over metronidazole in appendicitis.