Revisiting Classical 3ß-hydroxysteroid Dehydrogenase 2 Deficiency: Lessons from 31 Pediatric Cases.

CONTEXT: The clinical effects of classical 3ß-hydroxysteroid dehydrogenase 2 (3ßHSD2) deficiency are insufficiently defined due to a limited number of published cases. OBJECTIVE: To evaluate an integrated steroid metabolome and the short- and long-term clinical features of 3ßHSD2 deficiency. DESIGN: Multicenter, cross-sectional study. SETTING: Nine tertiary pediatric endocrinology clinics across Turkey. PATIENTS: Children with clinical diagnosis of 3ßHSD2 deficiency. MAIN OUTCOME MEASURES: Clinical manifestations, genotype-phenotype-metabolomic relations. A structured questionnaire was used to evaluate the data of patients with clinical 3ßHSD2 deficiency. Genetic analysis of HSD3B2 was performed using Sanger sequencing. Novel HSD3B2 mutations were studied in vitro. Nineteen plasma adrenal steroids were measured using LC-MS/MS. RESULTS: Eleven homozygous HSD3B2 mutations (6 novel) were identified in 31 children (19 male/12 female; mean age: 6.6 ±â€…5.1 yrs). The patients with homozygous pathogenic HSD3B2 missense variants of > 5% of wild type 3ßHSD2 activity in vitro had a non-salt-losing clinical phenotype. Ambiguous genitalia was an invariable feature of all genetic males, whereas only 1 of 12 female patients presented with virilized genitalia. Premature pubarche was observed in 78% of patients. In adolescence, menstrual irregularities and polycystic ovaries in females and adrenal rest tumors and gonadal failure in males were observed. CONCLUSIONS: Genetically-documented 3ßHSD2 deficiency includes salt-losing and non-salt-losing clinical phenotypes. Spared mineralocorticoid function and unvirilized genitalia in females may lead to misdiagnosis and underestimation of the frequency of 3ßHSD2 deficiency. High baseline 17OHPreg to cortisol ratio and low 11-oxyandrogen concentrations by LC-MS/MS unequivocally identifies patients with 3ßHSD2 deficiency.

Antihypertensive Drugs and Diabetic Retinopathy in Patients with Type 2 Diabetes.

OBJECTIVE: To evaluate the association between the development of sight-threatening diabetic retinopathy (STDR) and antihypertensive drugs (AHDs) use among type 2 diabetic patients with concomitant hypertension. METHODS: Type 2 diabetic patients aged 20-100 years who had at least one prescription for AHDs between 2000 and 2011 were identified from the Longitudinal Health Insurance Database (LHID) 2005. The incidence rates of STDR were followed and Cox proportional hazard models were used to analyze the risk associated with AHDs. RESULTS: Users of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were associated with a significantly higher risk than users of calcium channel blockers (CCBs), independent of baseline characteristics. After adjusting for time-varying use of concomitant medications for propensity score-matched or -unmatched cohorts, the results showed that patients receiving ACEIs/ARBs and CCBs were associated with a significantly greater risk compared with ß-blocker users. CONCLUSIONS: Our study did not support a superiority of ACEIs/ARBs and CCBs over ß-blockers for lowering the progression of diabetic retinopathy.

Association of refractive error with vision-related quality of life in junior high school students.

BACKGROUND/PURPOSE: To evaluate the relationship between refractive error and vision-related quality of life in 16-year-old students in Taiwan. METHODS: A cross-sectional study was designed for 16-year junior-high-school students in Taiwan. Myopia was defined as a spherical refractive error (SRE) < -0.50 D, hyperopia as SRE > +1.0 D, and emmetropia as SRE -0.5-+1.0 D in the better eye. Vision-related quality of life was assessed using the Taiwan Chinese version of the 25-Item National Eye Institute Visual Functioning Questionnaire. RESULTS: Of the 688 participants, 466 (68%) had myopia and 22 (3%) had hyperopia. In logistic-regression models adjusted for gender, parents' education, family income, and parental refractive error, myopia was an independent risk factor of poorer vision-related quality of life for both near vision (odds ratio 1.73, 95% confidence interval 1.22-2.45) and distance vision (odds ratio 3.11, 95% confidence interval 2.23-4.35). Hyperopia was not associated with near- or distance-vision difficulty. CONCLUSION: In this study population, myopia was associated with difficulties in near and distance vision compared to emmetropia. Further studies are needed to confirm our findings in other populations.

The use of ocular hypotensive drugs for glaucoma treatment: changing trend in Taiwan from 1997 to 2007.

PURPOSE: Treatment of glaucoma has increasingly favored better intraocular pressure (IOP) lowering efficacy and safety of topical medications. The introduction of newer ocular hypotensive drugs (OHDs) has led changes in the prescribing patterns and treatment approaches. This study aimed to investigate the prescribing patterns, trends, and corresponding expenditures of OHDs in Taiwan over an 11-year period from 1997 to 2007. PATIENTS AND METHODS: A nationally representative sample of 1 million ambulatory visits from the National Health Research Institute data sets was used. Patients with glaucoma who aged ≥18 years were identified with ICD-9-CM and A230 codes. Six categories of OHDs were used to describe the rates, patterns, expenditures, and changes of annual prescriptions for glaucoma patients. RESULTS: The number of OHD prescriptions has tripled during the 11 years. Although the prescribing trend was being away from monotherapy with ß-blockers, this class remained the most commonly used OHD up to 2007. Prostaglandin analogs were the second most frequently prescribed OHDs since 2000. Changing prescribing patterns and increased patients were the main contributors to the rise in OHD expenditures. Part of increased expenditure was likely offset by reduced needs for laser and surgical interventions. CONCLUSIONS: The prescriptions of OHDs are shifting to newer categories and combination therapy. These findings provided insights into recent trends in management of glaucoma patients in Taiwan and implied a similar trend toward recent clinical reports and practices recommendations in the guidelines.

Two Zebrafish hsd3b Genes Are Distinct in Function, Expression, and Evolution.

HSD3B catalyzes the synthesis of δ4 steroids such as progesterone in the adrenals and gonads. Individuals lacking HSD3B2 activity experience congenital adrenal hyperplasia with imbalanced steroid synthesis. To develop a zebrafish model of HSD3B deficiency, we characterized 2 zebrafish hsd3b genes. Our phylogenetic and conserved synteny analyses showed that the tandemly duplicated human HSD3B1 and HSD3B2 genes are coorthologs of zebrafish hsd3b1 on chromosome 9 (Dre9), whereas the gene called hsd3b2 resides on Dre20 in an ancestral chromosome segment, from which its ortholog was lost in the tetrapod lineage. Zebrafish hsd3b1(Dre 9) was expressed in adult gonads and headkidney, which contains interrenal glands, the zebrafish counterpart of the tetrapod adrenal. Knockdown of hsd3b1(Dre 9) caused the interrenal and anterior pituitary to expand and pigmentation to increase, resembling human HSD3B2 deficiency. The zebrafish hsd3b2(Dre 20) gene was expressed in zebrafish early embryos as maternal transcripts that disappeared 1 day after fertilization. Morpholino inactivation of hsd3b2(Dre 20) led to embryo elongation, which was rescued by the injection of hsd3b2 mRNA. Thus, zebrafish hsd3b2(Dre 20) evolved independently of hsd3b1(Dre 9) with a morphogenetic function during early embryogenesis. Zebrafish hsd3b1(Dre 9), on the contrary, functions like mammalian HSD3B2, whose deficiency leads to congenital adrenal hyperplasia.

Long-acting insulin analogues and diabetic retinopathy: a retrospective cohort study.

PURPOSE: Long-acting insulin analogues were developed to facilitate consistent glycemic control without excessive hypoglycemia. However, structural modifications of the insulin molecule can alter biological responses and binding characteristics with specific receptors. The aim of this study was to estimate the risk of sight-threatening diabetic retinopathy (STDR) associated with treatment using long-acting insulin analogues compared with intermediate-acting insulin in patients with type 2 diabetes mellitus (T2DM). METHODS: A retrospective cohort consisting of patients with T2DM aged 20 years of age and older with newly initiated treatment with long-acting insulin analogues (glargine and detemir) and intermediate-acting human insulin was identified from the National Health Insurance database between January 2004 and December 2006 and was subdivided into different cohorts. The risk of the development of STDR was determined by Cox regression models and compared between different cohorts. FINDINGS: Of the 46,739 eligible patients, initiators of insulin glargine, insulin detemir, and neutral protamine Hagedorn (NPH) insulin were identified for comparison using propensity-score matching methods. Long-acting insulin analogues were not associated with changed risk for STDR by intention-to-treat and time-varying use approaches between either matched or unmatched cohorts. IMPLICATIONS: The strategies that aim at preventing diabetic retinopathy by treating T2DM patients with long-acting insulin analogues remain further prospective studies with longer follow-up period to validate our observations within an appropriate dosage range and to further evaluate the safety of long-acting insulin analogues on reducing the progression of diabetic retinopathy.

Cost-effectiveness comparison between monofocal and multifocal intraocular lens implantation for cataract patients in Taiwan.

PURPOSE: Our aim was to conduct a cost-effectiveness analysis (CEA) of monofocal and multifocal intraocular lenses (IOLs) for cataract patients in Taiwan. METHODS: This prospective nonrandomized study was designed to evaluate the effectiveness of monofocal and multifocal IOLs by means of visual performance, visual quality, vision-related quality of life, and spectacle-independence rates. The direct costs were calculated using the payment points of the fee schedule for medical services multiplied by the treatment items. The concept of incremental cost effectiveness ratios was used to evaluate the costs of different types of IOLs in cataract surgery and postoperative outcomes in patients. FINDINGS: A total of 61 patients from the monofocal IOL group (n = 21), multifocal IOL group 1 (n = 22), and multifocal IOL group 2 (n = 18) who completed the study were included in the analysis. No significant differences were observed in mean ages or patient to eye ratio. Significant differences in effectiveness after the implantations of monofocal and multifocal IOLs were observed for spectacle-free rate and monocular contrast sensitivity under glare conditions only. The incremental cost-effectiveness ratios of monofocal versus multifocal IOLs indicated that it cost an additional $57 to $58 (US dollars) to increase each 1% of the spectacle-independence rate. IMPLICATIONS: This study's results indicated that multifocal IOLs provided better effectiveness on vision-related indicators like the incremental cost effectiveness ratios of postoperative spectacle-independence rate and binocular best-corrected visual acuity measurements at near vision. Our findings suggest that multifocal IOLs can be highly cost effective for patients who prefer to be spectacle free, so it is important to ensure that patients have realistic expectations when making choices between monofocal and multifocal IOLs.

Refractive error change and its association with ocular and general parameters in junior high school students in Taiwan.

PURPOSE: To assess the relationships between refractive error and ocular and general parameters in Taiwanese junior high school students and to identify the predictive factors associated with the changes in refractive error. METHODS: This was a prospective, school-based study. A total of 687 students (357 boys and 330 girls) from a municipal junior high school in Taipei were enrolled. The students' refractive status, intraocular pressure, and ocular parameters were measured first in 2010 and again 1 year later. Data were analyzed using multiple linear regression models and generalized estimating equations (GEEs). RESULTS: Significant differences were found between the baseline (2010) and 1-year follow-up (2011) mean anterior chamber depths, mean axial lengths, and mean horizontal and vertical corneal refractive powers. GEE models revealed that vertical and horizontal corneal refractive powers, axial length, and anterior chamber depth were significantly associated with refractive error change. CONCLUSIONS: Students with a longer axial length, steeper corneal radius, and shallower anterior chamber depth had an increased risk of myopic refractive errors.

Sex- and age-specific prevalence and incidence rates of sight-threatening diabetic retinopathy in Taiwan.

IMPORTANCE: The prevalence of diabetic retinopathy (DR) is high in individuals with diabetes mellitus. Published estimates for sight-threatening DR (STDR) prevalence range widely. There is a need for precise contemporary estimates of the prevalence and incidence of STDR for providing optimal strategies of clinical management in Taiwan. OBJECTIVE: To determine the precise contemporary estimates of the prevalence and incidence of STDR in patients with type 2 diabetes mellitus in Taiwan. DESIGN, SETTING, AND PARTICIPANTS: Data were collected from a representative database, the Longitudinal Health Insurance Database 2005, from 2005 to 2011, on a total of 2926 incident cases of patients with STDR among 63,582 patients with type 2 diabetes. Sight-threatening DR was defined as clinically significant macular edema, severe nonproliferative DR, or proliferative DR according to the classification of the Early Treatment Diabetic Retinopathy Study research group. Sex-specific and age-adjusted incidence and prevalence rates of STDR were analyzed for patients with type 2 diabetes and STDR identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and procedure codes. MAIN OUTCOMES AND MEASURES: Procedure codes were used to determine the diagnosis of STDR. RESULTS: The number of incident cases of STDR increased in line with the increasing diabetic population during 2005-2011. Sex differences in the age-adjusted incidence rates were observed, showing a declining trend from 10.84 (95% CI, 10.69%-10.99%) to 6.00 (95% CI, 5.86%-6.14%) per 1000 person-years for women (P < .001) contrasting with an increasing trend in men, from 14.86 (95% CI, 14.71%-15.01%) to 21.89 (95% CI, 21.76%-22.02%) per 1000 person-years (P < .001). The age-adjusted prevalence rates of STDR were in decreasing trends for both sexes, with a mean of 2.75% for women and 2.87% for men. Apart from apparent sex differences in prevalence rates of STDR, increasing trends were observed among younger patients (aged <60 years). CONCLUSIONS AND RELEVANCE: We found considerable variation in the incidence trends between sexes. Our findings provide evidence that the incident cases of STDR have increased among patients with type 2 diabetes, but the overall prevalence of STDR is in a declining trend in Taiwan, suggesting that decreased mortality rate, better diabetes management, and early detection of treatable DR might contribute to the prevalence patterns.

A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses.

BACKGROUND: The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients' decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. METHODS: This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one's own expense, overall patient satisfaction and postoperative visual clarity. RESULTS: The results showed that the patient's gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. CONCLUSIONS: Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.

Assessment of quality of life among Taiwanese patients with visual impairment.

BACKGROUND/PURPOSE: This study aims at evaluating the relationship between visual impairment and health-related quality of life (QoL) by identifying factors that affect the EQ-5D index score and Visual Functioning Questionnaire (VFQ) global score, and determining whether the VFQ-25 scores and the European Quality of Life-5 Dimensions (EQ-5D) scores are correlated. METHODS: This cross-sectional study comprised 318 patients aged 40 years or more presenting with best corrected visual acuity (BCVA) of 20/40 or worse in the better eye.Patients received comprehensive ophthalmologic examinations, and were administered the National Eye Institute VFQ-25 and the EQ-5D instruments. A higher VFQ-25 score indicates a better QoL and, after conversion of the EQ-5D scores to an index score, a higher EQ-5D index score indicates a better QoL. RESULTS: On multivariate analysis of the EQ-5D index scores, women and those with arthritis were found to have significantly worse QoL, and the EQ-5D index score was increased by every unit increase in BCVA or mean deviation. Multivariate analysis of the VFQ-25 scores revealed that a history of heart disease, arthritis, and eye diseases, such as age-related macular degeneration or diabetic retinopathy, had significant negative effects on patients' QoL, and VFQ-25 global score was decreased by every unit increase in logMAR. According to this analysis, patients' QoL was improved by each unit increase in BCVA or mean deviation. The correlation between the two questionnaires was only weak to moderate. CONCLUSION: Visual impairment was associated with lower QoL, as assessed by either questionnaire in Taiwanese patients.

Synthesis of hexagonal ZnO clubs with opposite faces of unequal dimensions for the photoanode of dye-sensitized solar cells.

Novel sub-micro sized hexagonal clubs of ZnO (HC-ZnO), which are coated as a scattering layer (SL) for the photoanode of a DSSC, are synthesized. X-ray diffraction (XRD) patterns of the ZnO clubs show clear peaks corresponding to wurtzite crystal phase of ZnO. Scanning electron microscopic (SEM) images show that each club has two opposite hexagonal faces (parts) of unequal dimensions. High resolution transmission electron microscopic (HR-TEM) image of a single ZnO club reveals that the ZnO is single crystalline and has wurtzite crystal structure; the image indicates a lattice spacing (d) of 0.26 nm; this is ascribed to the (002) planar spacing of the hexagonal ZnO. A solar-to-electricity conversion efficiency (η) of 3.36% is achieved for the cell with the double layer (DL) film, which is 16% higher than that of the cell with only transparent layer (TL) of commercial ZnO (2.89%) and far higher than that of the cell with SL (0.05%). The η of the cell with the DL (3.36%) could further be improved to 4.28% through the modification of the DL surface with TiO(x). Incident photo-to-current conversion efficiency (IPCE) curves, UV-vis absorption spectra, energy dispersive X-ray (EDX) spectra, and electrochemical impedance spectra (EIS) are also used to substantiate the results.

Correlation of visual function with health-related quality of life in glaucoma patients.

OBJECTIVES: The purpose of this study was to assess visual impairment and quality of life (QOL), the relationship between visual function and health-related and vision-related QOL, and to identify factors significantly impacting QOL for glaucoma patients. METHODS: One-on-one interviews of 280 glaucoma patients at a regional hospital in Taiwan from 1 April 2005 to 30 September 2005. Data collected included demographics, clinical examinations and treatment status. QOL data collected utilized the Chinese (Taiwanese) version of the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) and the National Eye Institute Visual Function-25 (NEIVFQ-25). RESULTS: The majority of study participants had open-angle glaucoma (54.3%) and were classified as moderate stage (33.6%). The higher the health-related QOL scores for both questionnaires, the fewer difficulties experienced by the patients. Moderate correlation was found between the SF-36 and NEIVFQ-25 subscales and visual function. Significant predicting factors for the SF-36 were gender, age, employment status, presence of systemic disease, better-eye visual acuity and better-eye mean defect. For the NEIVFQ-25, these were general vision, near and distance activities, colour vision and peripheral vision scores. CONCLUSIONS: A combination of demographic data, clinical examination and QOL questionnaires may help clinicians better ascertain the impact of disease severity on glaucoma patients' QOL. This information may help in patient education, treatment compliance and selection of treatment options.

Psychometric validation of the Taiwan Chinese version of the 25-Item National Eye Institute Visual Functioning Questionnaire.

OBJECTIVES: To evaluate the reliability and construct validity of a Taiwan Chinese version of the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25) in patients with visual impairment. METHODS: The NEI-VFQ 25 was translated and adapted into the Taiwan Chinese version. In total, 222 patients responded to the questionnaire. To examine reliability, Cronbach's alpha for each subscale was used as an index of internal consistency. Test-retest reliability was evaluated with intraclass correlation coefficients. Regarding construct validity, both convergent and discriminant validities were calculated by means of multi-trait analysis. Clinical validity was examined by correlation of clinical measurements and subscale scores and known-groups comparison. Finally, correlation between different subscales was examined to evaluate hypothetical relationship between subscales. RESULTS: Five patient groups were studied, each including participants with a single cause of visual impairment. Group 1 consisted of 53 cataract patients; group 2 included 51 subjects with glaucoma; group 3 included 36 subjects with age-related macular degeneration (ARMD); and group 4 included 48 subjects with diabetic retinopathy. Thirty-four individuals with uncorrected refractive error comprised the control group. NEI-VFQ scores (mean +/- SD) for the cataract, glaucoma, ARMD, diabetic retinopathy and control groups were: 73.5 +/- 17.1, 69.2 +/- 20.4, 62.3 +/- 23.7, 63.7 +/- 20.8 and 80.7 +/- 12.0, respectively. Item analysis revealed moderate data skewing. Cronbach's alpha coefficients of subscales ranged from 0.956 (mental health) to 0.964 (near activities). Intraclass correlation coefficients ranged from 0.41 (driving) to 0.846 (distance activities). All items passed the convergent and discriminant validity tests. Moderate correlations were detected between visual acuity and the 'general vision', 'distance activities' and 'near activities' subscales. Significant correlations were detected between visual field deficits and the vision associated subscales. CONCLUSION: This study revealed that the Taiwan Chinese version of the NEI-VFQ 25 is a valid and reliable instrument to measure vision-related quality of life in patients with visual impairment.

Zebrafish cyp11a1 and hsd3b genes: structure, expression and steroidogenic development during embryogenesis.

Zebrafish has been used increasingly as a good animal model for a number of studies. To facilitate the use of this zebrafish model, the current report put emphasis on the study of two steroidogenic genes: cyp11a1 and hsd3b. These two genes encode enzymes that catalyze the first two steps of the steroidogenic pathway, and both enzymes are important for the synthesis of all steroids. Zebrafish cyp11a1 and hsd3b genes are expressed in the same cells in the gonads and interrenal gland. The interrenal gland is the counterpart of mammalian adrenal; it is located inside the head kidney and is developed parallel to the development of the pronephros. In addition, cyp11a1 and hsd3b are also expressed in the blastomeres of the early embryos before gastrulation, and in the extra-embryonic yolk syncytial layer during gastrulation. This early expression implies a novel role of steroids at gastrulation.

Atypical retinitis pigmentosa masquerading as primary open angle glaucoma.

PURPOSE: This study was conducted to describe a case of atypical retinitis pigmentosa initially diagnosed with primary open angle glaucoma. METHODS: Complete ophthalmologic examination, visual field examination, electroretinogram, and Heidelberg Retinal Tomograph were performed. RESULTS: Visual field examination showed arcuate defects extending to large temporal defects OU. Electroretinogram showed significant abnormalities with reduced b wave amplitudes and prolonged implicit times. Heidelberg Retinal Tomograph revealed a small central cup with no neuroretinal rim thinning or nerve fiber layer dropout OU. CONCLUSIONS: The present report suggests that visual field defects atypical for glaucoma should be carefully scrutinized for other etiologies.

An "exploding cataract" following Nd:YAG laser iridectomy.

A case of an "exploding" cataract (an iatrogenic posterior capsular rupture) following Nd:YAG laser iridectomy is described. Rapid cataract development was observed in the right eye of a 76-year-old woman following an iridectomy. B-scan ultrasonography documented cortical debris in the vitreous cavity. The patient underwent an extracapsular cataract extraction and intraocular lens implantation. During the cataract extraction, a posterior capsular tear extending from the 10-o'clock to the 4-o'clock position was noted, through which fluffy cortical material was floating in the vitreous.

RK4 (reverse-geometry) contact lens fitting after penetrating keratoplasty.

PURPOSE: We evaluated the performance of the RK4 (reverse-geometry) contact lens in patients with flat central and steep peripheral corneal topography after penetrating keratoplasty (PK). METHODS: A retrospective study was performed of post-PK patients fitted with RK4 lenses on the Cornea Service at Wills Eye Hospital, between March 2000 and February 2002. RESULTS: Fifteen eyes of 13 post-PK patients were fitted with RK4 lenses and monitored for more than two months (range, 2.1-23.5 months; mean, 8.1 +/- 7.0 months). The average number of lens refits per eye was 1.0 +/- 1.2 (range, 0-4). Ninety-three percent (14/15) of the eyes that were fitted achieved at least 20/30 visual acuity, and 53% (8/15) of eyes achieved 20/20 visual acuity. A comparison of prefitted and post-fitted corrected visual acuity demonstrated a statistically significant improvement (P < 0.01). RK4 lenses were successfully worn full time or part time in all cases. CONCLUSIONS: The RK4 lens can provide well-tolerated visual correction in cases with central flat, peripheral steep corneal contour following PK.

RK4 lens fitting for a flap striae in a LASIK patient.

PURPOSE: To present a case in which an RK4 lens was fitted for a patient who developed flap striae resulting from laser-assisted in situ keratomileusis (LASIK). METHODS: Case report. RESULTS: A 44-year-old man underwent uncomplicated LASIK procedure for bilateral myopia and astigmatism. Visually significant flap striae (OS>OD) were noted postoperatively. The flaps were relifted, refloated, and stretched twice in each eye. In addition, OD enhancement laser treatment was performed. Nevertheless, decreased best-corrected visual acuity (OS>OD) persisted. One month after LASIK, the patient was referred to our office for a second opinion and further evaluation. To avoid additional manipulation of the flaps, we used an RK4 lens fitting to achieve a final corrected visual acuity of 20/20 OU. CONCLUSIONS: Persistent, visually significant flap striae following flap, refloating, stretching, and smoothing techniques can make LASIK patients unhappy. An RK4 lens fitting is an alternative method for correcting postoperative irregular astigmatism and to achieve the best-corrected visual acuity.