Screening for multifocal intraocular lens implantation in cataract patients in a public hospital.

PURPOSE: To identify the rate and characteristics of cataract surgery candidates suitable for multifocal intraocular lens implantation among patients undergoing preoperative evaluation in a public hospital. MATERIALS AND METHODS: Screening was performed based on the patient's medical records, comprehensive ophthalmic examination, optical biometry (Zeiss, IOL Master 700) and optical coherence tomography (OCT) (Heidelberg, OCT Spectralis) in accordance with the relevant indications and contraindications mentioned in the pertinent literature. Patients were included in the present study if they were eligible for bilateral cataract surgery. The exclusion criteria were the presence of central nervous system or motility issues, prior refractive surgery, the presence of astigmatism greater than 1 dioptre and/or the presence of important ocular comorbidities in either eye. RESULTS: The study evaluated 1200 consecutive patients. Four hundred thirty-two patients (36%) were not eligible for bilateral surgery and were excluded from the study. Of the 768 patients included in the present study, 346 (45.1%) were considered suitable candidates. Four hundred twenty-two patients (54.9%) were excluded for one or both eyes. Among them, 121 (28.7%) were excluded because of retinal disease, 120 (28.4%) because of regular astigmatism (> 1.0 D of corneal astigmatism), 32 (7.5%) because of pseudoexfoliation or zonular instability, and 30 (7.1%) because of glaucoma or ocular hypertension; in addition, 90 (21.3%) patients were excluded for multiple reasons. Suitable candidates were significantly younger (70 and 75 years, respectively) (p < 0.001). After being informed about the potential risks and benefits of MOIL implantation, 212 of 346 (83.8%) eligible patients provided consent. CONCLUSION: Close to half of cataract patients in a public hospital were eligible for MOIL implantation, and the majority of patients would proceed to surgery. The most prevalent contraindication was macular disease.

Update on Diagnosis and Treatment of Uveitic Glaucoma.

Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG.

UGH Syndrome Resolution after IOL Explantation and Concomitant Carlevale IOL Implantation.

OBJECTIVE: To examine the use of Carlevale IOL placement in patients with UGH, and to evaluate surgical outcomes. DESIGN: In this retrospective study, 28 patients with UGH syndrome that were subjected to IOL explantation and concomitant Carlevale IOL implantation were included in the study. METHODS: Information about VA, IOP, number of glaucoma medication, need for glaucoma surgery, presence of hemorrhage and inflammation were recorded up to 6 months after the procedure. RESULTS: We found a statistically significant increase in mean visual acuity and complete resolution of uveitis in all patients. Mean IOP and the mean number of glaucoma medications were significantly decreased postoperatively, while 14% of patients required additional glaucoma surgery. CONCLUSIONS: IOL explantation and concomitant Carlevale IOL implantation may provide a viable solution for UGH syndrome resolution, increases visual acuity, and decreases the need for glaucoma medication.

Association of lysyl oxidase-like 1 gene common sequence variants in Greek patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

PURPOSE: Three common sequence variants in the lysyl oxidase-like 1 (LOXL1) gene were recently associated with pseudoexfoliation (PEX) and pseudoexfoliation glaucoma (PEXG) in populations from various parts of the world. In this study, the genetic association of these variants was investigated in Greek patients with PEX and PEXG. METHODS: The three LOXL1 single nucleotide polymorphisms (SNPs), one intronic (rs2165241) and two nonsynonymous coding SNPs (rs1048661: R141L and rs3825942: G153D), were genotyped in a total of 48 unrelated patients with PEX, 35 patients with PEXG, and 52 healthy subjects who had normal findings in repeated ophthalmic examinations. A genetic association study was performed. RESULTS: Between the two coding SNPs, R141L did not show an association with PEX (p=0.297 for allele G, p=0.339 for genotype GG), whereas allele G of G153D showed a significant association (odds ratio [OR]=3.52, 95% confidence interval [CI]=1.735-7.166, p=3.24×10(-4) for allele G, p=0.004 for genotype GG). Likewise, for the intronic SNP of rs2165241, genotype TT (p=0.005) and its corresponding allele T (OR=2.99, 95% CI=1.625-5.527, p=3.53×10(-4)) showed a significant association with PEX. The allele G of G153D showed a significant association with PEXG (OR=3.74, 95% CI=1.670-8.387, p=0.001). The combined haplotype GGT, consisting of all three risk alleles, was associated with PEX (p=0.037), conferring a 1.8-fold of increased risk to the disease (OR=1.799, 95% CI=1.04-3.13). Furthermore, the haplotype GGT presented in 39.8% of the patients with PEX and 26.9% of the controls. CONCLUSIONS: Certain genetic variants in LOXL1 confer risk for PEX in Greek populations, confirming in part findings in patients from Northern Europe.

Peripapillary Retinoschisis as a Manifestation of Ocular Hypotony.

The aim of this case report was to present an unusual case of peripapillary retinoschisis (PPRS) associated with ocular hypotony after glaucoma surgery. It refers to a 78-year-old man with primary open-angle glaucoma who developed PPRS while hypotonous. Optical coherence tomography of the peripapillary and the macular area of the right eye revealed PPRS temporally and nasally to the optic disc, more prominent at the level of the outer nuclear layer and less so at the inner nuclear layer. The PPRS completely regressed after 1 month of treatment and restoration of intraocular pressure to normal levels. This case report highlights the fact that PPRS in glaucoma patients may present in the setting of ocular hypotony and appears to resolve when the hypotony is successfully managed. Hydrostatic pressure gradient across retinal vasculature that allows movement of fluid into the extracellular spaces is a potential mechanism for the development of PPRS in ocular hypotony.

Comparison of Clinical Characteristics between Rubella Virus and Cytomegalovirus Associated Chronic Unilateral Anterior Uveitis.

PURPOSE: To identify the clinical characteristics that may predict the diagnosis of Rubella virus (RV) or Cytomegalovirus (CMV) among cases of chronic treatment resistant or steroid dependent unilateral anterior uveitis (AU). METHODS: Thirty-three consecutive patients with a diagnosis of CMV and 32 patients with RV chronic AU were enrolled. The respective frequency of certain demographic and clinical characteristics was compared between the two groups. RESULTS: The presence of abnormal vessels in the anterior chamber angle (75% and 6.1%, respectively, p < .001), vitritis (68.8%-12.1%, p < .001), iris heterochromia (40.6%-15.2%, p = .022) and iris nodules (21.9%-3%, p = .027) were more common among RV AU. Conversely, intraocular pressure greater than 26 mmHg was more commonly encountered in CMV associated AU (63.6%-15.6%, respectively, p < .001) and large keratic precipitates were detected only in CMV-associated AU. CONCLUSIONS: RV- and CMV-induced chronic AU differ significantly in the prevalence of specific clinical characteristics.

Combining Perfluorobutylpentane (F4H5) with Glaucoma Drainage Device Implantation for Silicone Oil-Induced Glaucoma: A Pilot Study.

Objectives: Our aim was to perform a perfluorobutylpentane (F4H5) washout in conjunction with glaucoma drainage device (GDD) placement in patients with silicone oil (SO)-induced glaucoma. In this report we present our preliminary results concerning the effectiveness in clearing the SO and the safety of the procedure. Materials and Methods: Eight patients who previously underwent pars plana vitrectomy with SO tamponade due to retinal detachment were selected. Removal of SO was performed on average 10 months after initial surgery. All patients developed glaucoma with evidence of SO remnants in the anterior chamber (AC) and angle. Removal of the remaining SO with F4H5 washout was performed in all cases with concomitant insertion of a GDD to treat the refractory glaucoma. Intraocular pressure (IOP), SO remnants, endothelial cell count, and need for glaucoma medications were evaluated up to 12 months after the surgical procedure. Results: All patients had uneventful surgery with no major complications 12 months postoperatively. A marked reduction of SO remnants in the AC and angle was observed in all cases after surgery. There was a 60.9% decrease in mean IOP 12 months postoperatively (p<0.05) and the need for glaucoma medication was lower in all patients (mean topical medicines: 4 preoperatively vs. 0.75±0.89 postoperatively; p<0.05). Endothelial cell density showed no significant change (mean 2012±129 cells/mm2 preoperatively vs. 1985±134 cells/mm2 postoperatively; p>0.05), and there were no signs of corneal edema. Conclusion: F4H5 is an effective emulsifier for removing SO remnants and may be safely used in conjunction with GDD placement in order to control IOP in eyes with silicone oil-induced glaucoma.

Late-onset Relapse of Aqueous Misdirection after Pars Plana Vitrectomy: Case Report and Literature Review.

Aim: We report on an 88-year-old female patient who presented with a relapse in aqueous misdirection 15 years after being treated with pars plana vitrectomy (PPV) with hyaloidotomy-zonulectomy-iridotomy (HZI) for the same cause. Case description: A 73-year-old pseudophakic woman with a history of pseudoexfoliation underwent a trabeculectomy in the left eye in our institution because of uncontrolled intraocular pressure. Days after trabeculectomy, the patient developed aqueous misdirection and was treated with PPV combined with HZI. In the following years, the patient had regular follow-up appointments in our instruction, and she had normal intraocular pressures in the left eye without any treatment. A total of 15 years after the vitrectomy, the patient developed gradual swallowing in the anterior chamber and increased intraocular pressure. Neodymium (Nd): yttrium aluminum garnet (YAG) laser hyaloidotomy through the iridectomy opening was performed, the anterior chamber was immediately deepened, and the intraocular pressure was reduced to normal limits. The anterior chamber remained deep, and the intraocular pressure remained normal through the 36 months of follow-up. Conclusion: Relapse of aqueous misdirection may occur many years after vitrectomy, even when HZI is performed. An Nd: YAG- laser hyaloidotomy should be attempted before a second HZI is considered. Clinical relevance: A close and long-lasting follow-up of patients with aqueous misdirection is warranted, especially if the patients are treated not with complete PPV but by a limited disruption of the anterior hyaloid face along with HIZ. How to cite this article: Halkiadakis I, Tzimis V, Markopoulos I, et al. Late-onset Relapse of Aqueous Misdirection after Pars Plana Vitrectomy: Case Report and Literature Review. J Curr Glaucoma Pract 2023;17(1):49-51.

Evaluation of the Icare-ONE rebound tonometer as a self-measuring intraocular pressure device in normal subjects.

PURPOSE: To compare Icare ONE rebound self-tonometer (ICRBT) measurements with Goldman applanation tonometry (GAT). METHODS: A trained examiner instructed each of 60 normal subjects on use of the ICRBT. Each subject then took two measurements of his/her own pressure using the ICRBT. Finally, a different examiner, who was masked to the earlier readings, measured IOP by GAT. Bland­Altman limits of agreement (LOA), intraclass correlation coefficients (ICCs), Kappa values, and paired t-test were used to assess the agreement between the two methods. Pearson's correlation coefficient was used for correlation analysis. RESULTS: All of the subjects were able to obtain correct measurements with ICRBT after three attempts. The mean intraocular pressure with ICRBT and GAT measurements were 16.0 ± 3.3 mmHg and 13.7 ± 2.5 mmHg respectively. The mean difference between patient's ICRBT and technician's GAT measurements was 2.3 mmHg (p < 0.001). In 63% (38/60) of the cases the IOP difference (ICRBT − GAT) was within ± 3 mmHg. The weighted Kappa for the IOP measurements of the two methods was 0.49 (95% CI: 0.30­0.68, p < 0.001), indicating acceptable agreement. A significantly positive correlation was found between ICRBT IOP measurements and central corneal thickness (CCT) (r = 0.48, p < 0.001). In addition, the difference in IOP measurements (ICRBT − GAT) between the two methods was positively correlated with CCT (r = 0.31, p = 0.015), indicating that greater thickness is associated with greater differences between the two methods. CONCLUSION: The ICRBT was reliable in the hands of normal subjects, and may be used for self-monitoring of IOP. ICRBT measurements generally overestimated GAT measurements.

Evaluation of Corvis ST tonometer with the updated software in glaucoma practice.

AIM: To evaluate the agreement of biomechanically corrected intraocular pressure (b-IOP) and central corneal thickness (CCT) measurements obtained with the updated Corvis ST tonometer versus Goldmann applanation tonometry (GAT) and optical-based corneal pachymetry (OB-CCT) in controls, patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG). Additionally, we examined the differences in corneal deformation parameters provided by the updated Corvis ST among the three groups. METHODS: For each participant, GAT IOP, OB-CCT and measurements with a Corvis ST with updated software were obtained. Bland-Altman analysis was used to assess the agreement between the two measurement methods. RESULTS: A consecutive series of 80 eyes from 80 participants (30 with POAG, 25 with OHT and 25 normal controls) were included in this prospective study. The mean GAT IOP of all eyes was 17.2±3.6 mm Hg, and the mean b-IOP was 15.9±3.7 mm Hg (Spearman's rho=0.767, P<0.001). The 95% limits of agreement (LoAs) ranged from -3.1 mm Hg to 5.5 mm Hg for GAT IOP and b-IOP. b-IOP was not correlated with OB-CCT (Spearman's rho=-0.13 P=0.917). Meanwhile there was a weak positive corelation between OB-CCT and GAT IOP-b-IOP difference (Spearman's rho=0.378, P=0.001). The mean OB-CCT was 549.5±36.4 µm, and the Corvis-CCT was 556.1±41.5 µm (Spearman's rho=0.900, P<0.001). No statistically significant difference in the new indices provided by the updated Corvis ST was detected among the three groups. Compared with control eyes, POAG eyes had a significantly reduced applanation time 2 after adjusting for OB-CCT and GAT IOP (P=0.048). CONCLUSION: Corvis b-IOP and CCT correlate well with GAT IOP and OB-CCT. b-IOP is not affected by CCT, which might be an advantage, especially in thick or thin corneas. Corvis ST yields shorter applanation time 2 measurements in patients with POAG, which might reflect altered corneal viscoelasticity.

Assessment of Corneal Epithelium Thickness in Glaucomatous Patients Undergoing Medical Treatment.

PRECIS: Patients with glaucoma have reduced and irregular corneal epithelial thickness (CET) even if they do not report symptoms of dry eyes. The reduction of corneal epithelium affects equally the superior and inferior areas of the cornea. PURPOSE: To evaluate CET parameters by means of anterior segment optical coherence tomography in glaucomatous patients undergoing medical treatment and compare them with CET parameters of controls. METHODS: This was a cross-sectional study of 62 patients with primary open-angle or pseudoexfoliative glaucoma (study group) and 62 age-matched controls. Fourier-domain optical coherence tomography (RTVue) with a corneal adaptor module was used in the present study. Τhe pachymetry scan pattern was used to map the cornea and the software generated corneal thickness parameters were recorded. Simple comparisons between groups were performed and the correlations of CET parameters with parameters associated with medication use (treatment duration, number of medications and number of instillations) were assessed. RESULTS: Mean age of the patients was 68±11.9 years in the glaucoma group and 65.5±8.5, years in the control group (P=0.17). Median number of instillations of medication was 2 (range, 1 to 6) for the glaucoma group. Central corneal thickness was 537.6±33.3 in the glaucoma group and 550.8±33.7 in the control group, respectively (P=0.028). The central CET was 48.8.±3.7 µm in the glaucoma group and 53.5±3.7 µm in the control group (P<0.001). Similarly, the average superior (2 to 7 mm) CET and the average inferior (2 to 7 mm) CET were almost equally reduced in the glaucoma group (45±4 vs. 49.6±3.3 µm, P<0.001 and 49±3.9 vs 53.5±3.7, P<0.001, respectively). No CET parameter was correlated with any of the treatment parameters. CONCLUSIONS: Patients treated for glaucoma have uniformly reduced corneal epithelial thickness.

Efficacy and safety of latanoprost in eyes with uveitic glaucoma.

BACKGROUND: To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. METHODS: Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. RESULTS: Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 +/- 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 +/-0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 +/- 8.4 mmHg to 18.6 +/- 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 +/-8.1 mmHg to 22.6 +/-10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. CONCLUSION: Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma.

Comparison of optical coherence tomography and scanning laser polarimetry in glaucoma, ocular hypertension, and suspected glaucoma.

BACKGROUND AND OBJECTIVE: To compare the performance of the newest generation optical coherence topography (OCT) and scanning laser polarimetry with variable corneal compensation (SLP-VCC) in eyes with glaucoma, ocular hypertension, and suspected glaucoma. PATIENTS AND METHODS: One eye each of 84 patients (30 with glaucoma, 26 with suspected glaucoma, and 28 with ocular hypertension) was included in the study. Retinal nerve fiber layer (RNFL) thickness was measured with both technologies and thickness parameters were compared in the three groups of eyes. The correspondence of RNFL thickness measurements with visual field function was also studied. RESULTS: Average OCT-RNFL thickness was found to have a statistically significant difference between patients with glaucoma and either suspected glaucoma or ocular hypertension. A statistically significant correlation between the average RNFL thicknesses measured by the two different technologies was shown only in the glaucoma group. A significant correlation with visual field mean deviation was found for superior average RNFL thickness as measured by SLP and for nerve fiber indicator and average and inferior average RNFL thickness as measured by OCT in glaucomatous eyes. Regression analysis indicated nerve fiber indicator to be the most valuable factor in predicting mean deviation. CONCLUSION: RNFL thickness measurements obtained with OCT and SLP-VCC correlate well only in eyes with more advanced glaucomatous damage. The nerve fiber indicator parameter derived by SLP correlated best with mean deviation.

Course of macular edema in uveitis under medical treatment.

OBJECTIVE: To describe the response of uveitic macular edema to various treatment methods using optical coherence tomography (OCT). METHODS: This is a prospective study of consecutive uveitis patients with macular edema in at least one eye. The patients received medical treatment. Best corrected Snellen Visual Acuity (BCVA) and tomographic features of the macula, including macular thickness measurement, were obtained at one, three, six, and 12 months after commencing treatment. RESULTS: Eighty-one eyes of 58 patients were analyzed. Complete resolution of macular edema occurred in 38 eyes (47%). The average BCVA was 20/34 logarithm of minimum angle of resolution (-logMAR, 0.2 +/- 0.3) upon study entry and 20/27 (-logMAR, 0.13 +/- 0.29) upon study completion. The difference was statistically significant (p = 0.04). The corresponding mean retinal thickness at the central fovea was 319 +/- 150 microm at the beginning of the study compared to 241 +/- 125 microm at 12 months (p < 0.001). A weak but statistically significant correlation between the reduction of macular thickness and the improvement of BCVA (r = 0.3, p = 0.01) was found. Thirteen of the 43 eyes (30%) with persistent macular edema had a more than 15% reduction of macular thickness compared to baseline, whereas 10 eyes (23, 3%) had a more than 15% increase in macular thickness. Statistical analysis indicated that the presence of an epiretinal membrane and an OCT pattern of diffuse macular edema was a significant factor associated with medical treatment failure. CONCLUSION: This study demonstrates the overall favorable visual prognosis of uveitic macular edema under medical treatment. The presence of an epiretinal membrane is an important factor associated with medical treatment failure.

Occlusion therapy of unilateral amblyopia with botulinum toxin induced ptosis.

In order to evaluate the role of botulinum toxin induced ptosis as an occlusion method to treat unilateral deep strabismic amblyopia in two uncooperative children, we injected 0.2 ml of diluted botulinum toxin in the levator palpaebrae; low sedation was necessary in one of the two children. In both cases a marked ptosis was achieved, which lasted about four weeks and then gradually resolved completely. The visual acuity of the ablyopic eye increased in both children, making patching easy thereafter. One child developed amblyopia in the injected eye, which was handled successfully using part-time occlusion. No other side effects were noted. Whether this new method could be a simple, safe and effective alternative method of occlusion for the treatment of deep amblyopia in uncooperative children needs to be proven with a larger series of children.

Causes and management of small pupil in patients with cataract.

BACKGROUND: The purpose of the study was to present the causes and management of small pupil (<6 mm) in Greek patients with cataract. METHODS: About 1144 consecutive patients with cataract comprised the study group. The pupil size was measured after maximal dilation by means of Rosenbaum cards and Colvard pupillometer. Dilation regimen included phenylephrine 10%, tropicamide 1%, cyclopentolate 1%, and ketorolac trometamol 0.5% administered 3 times at 5 min intervals starting 1 h before surgery. The presence of possible risk factors for small pupil was recorded. The need of additional maneuvers and devices to dilate the pupil during cataract surgery was examined, and the complication rate in cases with small pupils was recorded. RESULTS: Small pupil was observed in 78 out of 1144 eyes (6.8%, 95% confidence interval = 5.2%-8.8%). Nine eyes had pupil size <4 mm (0.78%) preoperatively. Six cases (0.52%) developed intraoperative pupillary miosis. The major cause of small pupil was pseudoexfoliation (PEX) in 47.4% (37/78) of patients. No significant associations were observed regarding age, gender, history of diabetes mellitus, the maturity of cataract, and phacodonesis. Techniques for small pupil management included pupil stretching in 14 cases (17.9%), use of iris hooks in 6 cases (7.7%), iris sphincter cuts in 2 cases (2.6%), and placement of a Malyugin Ring in 4 cases (5.1%). Seven eyes (9%) with small pupil had capsular rupture versus 16 eyes (1.5%) with normal dilation (P < 0.001). CONCLUSIONS: Small pupil is not very common in Greek population, is mostly caused by PEX, and it is associated with increased complication rate.

Intravenous pulse methylprednisolone therapy for acute treatment of serpiginous choroiditis.

PURPOSE: To evaluate the safety and efficacy of high-dose intravenous steroid therapy (HDIST) for the acute treatment of vision-threatening serpiginous choroiditis. METHODS: Retrospective review of the records of five patients with serpiginous choroiditis who were treated with HDIST (1 g methylprednisolone for three days) in addition to their standard immunosuppressive treatment. The visual acuities and improvement of ocular signs after HDIST were evaluated. RESULTS: Twelve episodes of macula-threatening choroiditis in five patients with serpiginous choroiditis were treated during a seven-year period. All patients responded to HDIST with evidence of a decrease in intraocular inflammation immediately after and complete restoration of visual acuity within 10 days of commencing treatment. In one patient, medical intervention was required because of gastric distress. During the follow-up, three out of five patients experienced new attacks and two patients developed subretinal neovascularization. CONCLUSION: HDIST is effective in controlling severe vision-threatening serpiginous choroiditis and in improving visual function in a short period of time. However, the effect of this treatment in long-term disease control is uncertain.

Laser in situ keratomileusis in patients with diabetes.

PURPOSE: To study the outcomes of laser in situ keratomileusis (LASIK) in patients with well-controlled diabetes mellitus. SETTING: Gimbel Eye Centres, Calgary and Edmonton, Canada. METHODS: The charts of all patients with diabetes who had LASIK surgery at the Gimbel Eye Centres were reviewed retrospectively. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), final refraction, and complications were assessed. RESULTS: Twenty-four patients (16 men and 8 women) were identified. Mean patient age was 42 years (range 24 to 57 years). Seventeen patients had diabetes type II, and 7 had diabetes type I. Mean preoperative spherical equivalent (SE) was -4.88 +/- 2.13 diopters (D) (range +1.625 to -9.00 D). Median follow-up was 6 months (range 4 to 44 months). No eye lost BSCVA. Twenty-nine eyes (63%) achieved UCVA 20/25 or better, and 31 eyes (67%) were within +/-0.5 D of the intended refraction after the first LASIK surgery. Retreatment was required in 13 eyes (28.3%) because initial surgery was not adequate to correct the refractive error. At the last follow-up visit, 40 eyes (87%) achieved UCVA of 20/25 or better and 43 eyes (93.5%) were within +/-0.5 D of the intended refraction. Three eyes (6.5%) developed an epithelial defect after surgery, and secondary epithelial ingrowth developed in 2 of these eyes. No advancement of diabetic retinopathy was noticed in any eye at the end of the follow-up period. CONCLUSIONS: Laser in situ keratomileusis surgery was safely performed in patients with well-controlled diabetes. Enhancement may often be required for optimal correction.

Assessment of nerve fiber layer thickness before and after laser in situ keratomileusis using scanning laser polarimetry with variable corneal compensation.

PURPOSE: To determine the effect of laser in situ keratomileusis (LASIK) on retinal nerve fiber layer (RNFL) thickness measurements obtained by scanning laser polarimetry with variable corneal compensation (SLP-VCC). SETTING: Gimbel Eye Centre, Calgary, Alberta. METHODS: Retinal nerve fiber layer thickness measurements were performed in both eyes of 25 consecutive healthy patients the day of LASIK surgery and 1 month after by trained examiners using the GDx-VCC nerve fiber analyzer. Thickness measurements and all other parameters provided by the software of the machine before and after LASIK were analyzed using the paired Student t test. RESULTS: Mean age of the patients was 39 years +/- 9.6 (SD) (range 24 to 57 years). The mean preoperative spherical equivalent was -4.15 +/- 1.76 diopters (D) (range -1.0 to -7.50 D) and the mean postoperative spherical equivalent, 0.12 +/- 0.39 D (range -0.75 to +1.00 D). Mean ablation depth was 62 +/- 23 mum. No statistically significant difference was found in SLP parameters after LASIK (P<.05). No clinically significant difference in RNFL thickness measurements was noted in any eye. CONCLUSION: These data suggest that SLP-VCC mean thickness measurements are not influenced by LASIK-induced alterations in corneal architecture. Measurements obtained with SLP-VCC before surgery may be used for future comparisons.

Late in-the-bag intraocular lens dislocation: incidence, prevention, and management.

Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.