板层角膜移植治疗角膜缘皮样瘤临床分析

目的 评价板层角膜移植(lamellar keratoplasty,LKP)治疗角膜皮样瘤(limbal dermoids)的临床疗效.方法 对22例(22只眼,23处病变)行板层角膜移植治疗的角膜缘皮样瘤患者进行回顾性分析.随访3～48 个月(平均19个月).观察肿瘤治愈率,外观,植片透明度,视力变化及并发症.结果 肿瘤治愈率为100%.19/22例患者(20/23处病变)术后外观明显改善,植片透明.2/22例患者(2/23处病变)外观改善一般,植片轻度浑浊.1/22例患者(1/23处病变)术后发生排斥反应,外观改善差,植片灰白色混浊并见明显新生血管长入.术后最佳矫正视力等于或好于术前.结论 板层角膜移植术是治疗角膜皮样瘤的一种有效方法.早期手术,创伤小,术后反应轻.     

Outcome of lamellar keratoplasty for limbal dermoids in children.

PURPOSE: We report on the surgical management, complications, postoperative visual acuity, and astigmatism of limbal dermoids in children. METHODS: This was a retrospective study of 49 children (51 eyes) treated between 1990 and 2000. Demographic data, age at surgery, details of the surgical procedure, the preoperative and postoperative visual acuity and astigmatism, the complications of surgery, and the ocular and systemic associations were recorded. Age at surgery was regressed against the size of the corneal graft, the visual outcome, and astigmatism. The size of the corneal graft was regressed against the visual outcome and astigmatism. A test for a difference in proportions of the preoperative and postoperative astigmatism was conducted. Postoperatively children were followed up until suture removal if necessary at 4 weeks. Children living locally continued follow-up at The Hospital for Sick Children, Toronto, Ontario, Canada; the rest were referred to their referring ophthalmologist. RESULTS: The mean age of the patients at surgery was 4.4 +/- 3.8 years (range, 1 month to 15 years). Excision of the dermoid and lamellar keratoplasty was performed in 48 eyes, simple excision was performed in 2 eyes, and a penetrating graft was performed in 1 eye. The mean graft size (6.6 +/- 1.2 mm; range, 3.5-10 mm) was inversely related to the age of the patient (P =.04). Three eyes had microperforations during excision of the dermoid. Opacification of part of the graft was seen in 10.2% of eyes (5/49) with a mild haze in 3 eyes. Postoperatively 96.7% of eyes (29/30) had a visual acuity greater than or equal to 6/24, with 86.7% (26/30) greater than or equal to 6/12; one eye had a visual acuity of 6/120. The size of the graft correlated inversely with the visual acuity (P =.03). Preoperative and postoperative refraction was recorded in 23 patients. Astigmatism greater than 1 D was present in 43.4% preoperatively and in 60% postoperatively (P =.6). There was no association between age at surgery (P =.6) and the size of the graft (P =.2) and the presence of postoperative astigmatism. CONCLUSION: Excellent visual results were achieved in the majority of patients. Younger children were operated on for visual reasons with larger grafts and a tendency for a lower visual acuity. Although astigmatism was noted to decrease in a few children after excision, a significant number had an increase in astigmatism postoperatively, which warrants a close follow-up in children operated during the amblyogenic age.     

Epibulbar dermoids--clinical features and therapeutic methods

BACKGROUND: In a strict sense epibulbar dermoids are defined as congenital changes of mesodermal and ectodermal origin. Usually they are located at the limbus of the cornea in the inferotemporal quadrant, they can only rarely be observed in more central regions of the cornea. Intraocular structures are rarely involved. Connections to Goldenhar's oculo-auriculo-syndrome exist. Because of cosmetic reasons or a considerable astigmatism holding the danger of amblyopia a resection might be necessary. PATIENTS AND METHODS: Six patients (three girls and three boys) aged from 9 months to 6 years with limbal dermoids were included in the present study. All patients had been referred to the University Eye Hospital of Dresden for a possible therapy. RESULTS: All children showed a unilateral dermoid in the inferotemporal quadrant. In five cases the left eye was affected. In two patients a Goldenhar syndrome was present. In two patients a local resection of the dermoid was indicated. In three patients a keratoplasty (two lamellar, one penetrating) was additionally carried out. In the case of a two-year-old girl only prophylactic treatment of amblyopia was considered. The postoperative results reached from uncomplicated healing (visual acuity 1.0) to full cloudiness of the transplant and re-keratoplasty (visual acuity lux). CONCLUSION: Controls of the dermoid in half-year intervals and surgical intervention in early childhood are recommended. Simple local resection or a combination with lamellar or penetrating (sclero)-keratoplasty are used. A penetrating keratoplasty is seldom necessary due to deep and central dermoids. The prognosis can be described as favourable.     

年幼女童非综合征性眼球表面迷芽瘤:无休止的战争

迷芽瘤是儿童最常见的眼球上损伤,通常位于眼球表面,不涉及角膜或巩膜深层。由于高度散光和瘤的存在,眼球表层皮样囊肿常常引起弱视和美观问题,唯一治疗方法是手术。以前鼓励根据皮样囊肿的位置和深度行板层角膜移植术或穿透角膜移植术,但由于移植伴有弱视和血管生成高发率,治疗结果并不理想。本文报道了1例5岁女童右眼非综合征性眼球表面迷芽瘤,该女童接受了右眼皮样瘤切除联合板层角膜移植,术后美观问题得以改进,但散光和视力未见提高,因此术后应重视弱视治疗。     

Two-stage laser in situ keratomileusis to correct refractive errors after penetrating keratoplasty

PURPOSE: To evaluate the effect of a two-stage laser in situ keratomileusis (LASIK) procedure on eyes with high astigmatism and/or anisometropia after penetrating keratoplasty. METHODS: Eleven postoperative penetrating keratoplasty eyes were included in a prospective, non-controlled study. All patients had at least 4.00 D of astigmatism and/or at least 3.00 D of anisometropia and were spectacle and contact lens intolerant. Two-stage LASIK was performed; in the first stage a hinged corneal flap 160 microm in thickness and 9 mm in diameter was created. After stabilization of corneal shape (1 to 3 months after keratotomy), the corneal flap was lifted and laser refractive treatment (second stage) was performed. RESULTS: After the first stage, a statistically significant reduction in refractive astigmatism (P<.01) was recorded. In all eyes but one, best spectacle-corrected visual acuity was maintained or improved after the procedure. Three months after the second stage, refractive astigmatism in 8 of 11 eyes (73%) was within +/- 1.00 D, and spherical equivalent refraction in 9 of 11 eyes (82%) was within +/- 1.00 D of intended correction. Preoperative irregular astigmatism persisted in three patients (3 eyes) who could not be corrected within +/- 1.00 D of refractive astigmatism and/or +/- 1.00 D of intended spherical equivalent refraction. In one eye, an interface infiltrate developed shortly after creation of the flap, and resulted in limited melting. CONCLUSIONS: A two-stage LASIK procedure improved visual acuity and refraction in postoperative penetrating keratoplasty eyes with high astigmatism and/or anisometropia. Complications were uncommon but can lead to loss of vision.     

Long-term refractive and topographic changes after penetrating keratoplasty

PURPOSE: To analyze long-term refractive and videokeratoscopic changes after penetrating keratoplasty. PATIENTS AND METHODS: Forty eyes of 40 patients (26 keratoconus) with a clear corneal graft and no other ocular disease were examined after all sutures were removed, respectively at 22.0+/-7.3 months and 50.5+/-13.6 months after keratoplasty. All of the eyes were examined using videokeratography (EyeSys 2000) and ultrasonic pachymetry. Changes in subjective refraction, best spectacle-corrected visual acuity (LogMAR units), topography, and central corneal thickness between both exams were recorded. RESULTS: Visual acuity increased by an average of 0.41 lines +/-0.24 (p<0.001) between both exams, whereas no significant change in refractive astigmatism and videokeratoscopy (i.e., power, pattern, and indices) was observed. Central corneal thickness significantly increased from 545+/-36 micro m to 574+/-40 micro m (p<0.001). Change in best spectacle-corrected visual acuity significantly correlated with delay between the exams (r(s)=+0.34, p=0.03), whereas change in refractive astigmatism, topographic indices, and topographic patterns did not significantly correlate with delay. CONCLUSION: After penetrating keratoplasty, visual acuity improves long after surgery, whereas refraction and corneal surface regularity show no significant modification. This improvement in visual acuity, not explained by current techniques, may be due to an increase in graft transparency.     

Surgical treatment of corneal dermoid by using intrastromal lenticule obtained from small-incision lenticule extraction

To report a novel technique to treat superficial limbal dermoid by using the corneal intrastromal lenticules obtained from SMILE and to evaluate the initial clinical outcomes of lenticule patch graft for treatment of limbal dermoid. In this single-center case series, lenticules were obtained from patients undergoing SMILE for the correction of myopia and the lenticule patch graft was performed in three patients with limbal dermoid. Patients were postoperatively followed at first, second weeks and first, third months after surgery. The main measured outcome parameters were included the best-corrected visual acuity, transparency of graft, tectonic integrity and restoration of optical transparency. All surgeries were successful, and all patients recovered well. Obviously, improving tendency in visual acuity and astigmatism was seen at the final follow-up in all eyes. No statistically significant difference has found in the thickness of the cornea between the surgical field and the corresponding normal field. Globe integrity was achieved in all cases, and no immune rejection or perforation was detected until the last follow-up visit in all eyes treated. Lenticule keratoplasty may be a safe, feasible and inexpensive surgical option for the treatment of corneal dermoid. It retains globe integrity and decreases the risk of complications such as postoperative limbal ectasia and visible corneal scarring and should be widely promoted in the areas with shortage of donor corneas.     

Conductive keratoplasty to correct hyperopic astigmatism

PURPOSE: To evaluate the efficacy of conductive keratoplasty in the treatment of pre-existing and surgically induced hyperopic astigmatism. METHODS: In this prospective, noncomparative case series, four eyes of four subjects, two female and two male (age 25 to 47 yr) were treated for hyperopia (up to +5.50 D) and hyperopic astigmatism (up to +5.75 D) with the Refractec ViewPoint conductive keratoplasty system. The follow-up period was 6 months. Uncorrected and spectacle-corrected visual acuity, manifest and cycloplegic refraction, and videokeratographs were obtained before and after surgery. We treated two patients who had already had LASIK, one of them with a decentered ablation and the other with flap striae, one patient after PRK, and one patient with keratoconus. RESULTS: No complications were observed. No eye lost lines of spectacle-corrected visual acuity. All eyes showed improvement of uncorrected visual acuity of 3 or more lines. Videokeratographs demonstrated improved centration and reduction in keratometric power readings. Each eye was analyzed separately, including a comparative analysis of the proposed nomograms and quality of vision after surgery. CONCLUSIONS: Conductive keratoplasty may be a minimally invasive solution for patients with irregular hyperopic astigmatism, offering improved quality of vision in instances of flap striae by tightening the central cornea.     

Penetrating keratoplasty for corneal ectasia after laser in situ keratomileusis

PURPOSE: To improve the visual acuity of patients with progressive keratectasia following laser in situ keratomileusis (LASIK). METHODS: Five eyes of four patients underwent penetrating keratoplasty for ectasia after LASIK: In one patient the second eye was operated on 10 months after the first keratoplasty. The pre- and postoperative refraction, best spectacle-corrected visual acuity, and topographic data were evaluated. RESULTS: The preoperative refraction was -20.0 diopters (D) with high cylindrical values in all eyes at the time of surgery. After penetrating keratoplasty, mean spherical equivalent was -13.08+/-3.62 (SD) and mean refractive cylinder was -3.87+/-1.12 (SD). In one eye Urrets-Zavalia syndrome was noted as an early postoperative complication. In the second operated eye of another patient, there had been graft rejection several times. In this patient, frequent steroid use led to secondary glaucoma and he required filtering surgery. CONCLUSIONS: Penetrating keratoplasty is effective and successful in treating iatrogenic keratectasia after LASIK, but these patients need a close and lifelong follow-up to treat lateterm complications such as graft rejection and secondary glaucoma.     

Laser in situ keratomileusis after penetrating keratoplasty

PURPOSE: To determine the safety, efficacy, predictability, and stability of laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism in eyes with prior penetrating keratoplasty. METHODS: Eight eyes of 8 patients with penetrating keratoplasty had significant postoperative refractive error. Each eye received LASIK 1 year or more after penetrating keratoplasty. All were followed for 6 months or more. All patients were treated with the Chiron Technolas 217 excimer laser and the Automated Corneal Shaper microkeratome. RESULTS: Mean spherical equivalent refraction decreased from -4.50 D (range, -3.00 to -7.25 D) to -0.75 D (range, -1.50 to +0.50 D) and the mean preoperative astigmatism decreased from 3.50 D (range, 1.50 to 5.00 D) to 1.25 D (range, 0.75 to 2.00 D). Uncorrected visual acuity improved by at least two Snellen lines in all eyes. Best spectacle-corrected visual acuity did not change in four eyes (50%) and improved in three eyes (37.5%). CONCLUSION: LASIK effectively reduced low and moderate myopia and myopic astigmatism following penetrating keratoplasty.     

Late changes in refraction, pachymetry, visual acuity, and corneal topography after penetrating keratoplasty

PURPOSE: To analyze the late changes in refraction, corneal topography, and pachymetry after penetrating keratoplasty. METHODS: We have retrospectively analyzed data of 64 eyes of 56 patients with a clear corneal graft and no other ocular diseases. The eyes were examined soon and several years after all sutures were removed, at 19.5 +/- 3.1 months and 76.8 +/- 25.2 months, respectively, after keratoplasty. All eyes were examined using the EyeSys 2000 videokeratograph and the Tomey SP2000 ultrasonic pachymeter. Corneal surface regularity was studied using the indices provided by the Holladay Diagnostic Summary (ie, asphericity coefficient Q; corneal uniformity index CU; predicted corneal acuity PCA). Irregular astigmatism was quantified using semimeridian data from videokeratographs (refractive power symmetry index). RESULTS: Visual acuity increased by an average of 0.35 +/- 0.93 lines (P = 0.002) between the 2 examinations, whereas no significant changes in refraction and videokeratoscopy (ie, power, indices, and irregular astigmatism) were observed (P > or = 0.08). Central corneal thickness significantly increased from 542 +/- 31 microm to 572 +/- 38 microm (P < 0.001). Change in BSCVA did not significantly correlate with the change in refraction, in topographic indices, or in irregular astigmatism (rs < or = 0.13; P > or = 0.16). CONCLUSION: Late after penetrating keratoplasty, best corrected visual acuity shows a small but statistically significant improvement, whereas refraction and corneal surface regularity are stable. This late improvement in visual acuity is not explained by current techniques.     

Laser in situ keratomileusis for residual hyperopic astigmatism after conductive keratoplasty

PURPOSE: To report a case of laser in situ keratomileusis (LASIK) in a patient with previous conductive keratoplasty. METHODS: A 48-year-old man underwent conductive keratoplasty for low hyperopic astigmatism (manifest refraction OD: +2.25 -0.50 x 77 degrees; OS: +2.50 -0.50 x 105 degrees). Three months postoperatively, UCVA was 20/25 and BSCVA was 20/20 in both eyes; manifest refraction OD: -0.25 -0.75 x 110 degrees; OS: +0.75 -0.75 x 50 degrees. Sixteen months after the operation, regression of refractive outcome was (manifest) OD: +1.75 -1.25 x 90 degrees; OS: +2.50 -0.50 x 85 degrees; UCVA was 20/40 in the right eye and 20/63 in the left eye and BSCVA was 20/20 in both eyes. LASIK was performed for hyperopic regression in the left eye using an automated microkeratome (Alcon SKBM, 130-microm plate; Aesculap-Meditec MEL 70 excimer laser). RESULTS: LASIK was uneventful and no intraoperative or postoperative complications related to the previous conductive keratoplasty procedure or LASIK were observed. Three months after LASIK and 19 months after the initial conductive keratoplasty, the patient's left eye was emmetropic; UCVA was 20/20(-2), BSCVA was 20/20 and manifest refraction was +0.25 -0.25 x 35 degrees. There was a uniform increase in topographical steepening. Visual acuity, refraction and topographic findings remained unchanged at 6 months. CONCLUSIONS: Even though our experience is limited, treatment of hyperopia with LASIK in an eye with refractive regression following previous conductive keratoplasty resulted in a predicted refractive outcome, with no complications, and improvement in visual acuity at 6 months follow-up.     

Topography-controlled excimer laser photorefractive keratectomy

PURPOSE: To assess whether photorefractive keratectomy (PRK) controlled by videokeratography can successfully treat refractive errors in eyes with corneal irregularities and improve spectacle-corrected visual acuity. METHODS: In a prospective clinical study, PRK was performed in 10 eyes of 10 patients. Reason for surgery was irregular astigmatism after penetrating keratoplasty, corneal irregularity after corneal scarring, corneal astigmatism in keratoconus, and decentration after myopic and hyperopic PRK. Excimer ablation was controlled by preoperative videokeratography (Orbscan II, Orbtek) using the MEL-70 system from Aesculap Meditec. Follow-up was 6 months. RESULTS: Concerning manifest refraction, the sphere was reduced on average from +1.92 to +0.57 D, 6 months postoperatively. Cylinder changed from -1.95 D on average to -0.30 D at 6 months postoperatively. There was improvement of uncorrected visual acuity of 2 or more lines in 5 eyes and no change in 5 eyes 6 months postoperatively. Spectacle-corrected visual acuity improved in 2 eyes by 2 to 3 lines, in 9 eyes by 1 to 3 lines, and showed no change in 1 eye. CONCLUSION: Videokeratography-controlled PRK improved refractive errors in irregular corneas with improvement of spectacle-corrected visual acuity.     

Solid limbal dermoid in an 80-year-old patient

BACKGROUND: Typically solid limbal dermoids are excised in pre-school age unless a high irregular astigmatism and its risk for amblyopia lead to an earlier intervention. CASE REPORT: An 80-year-old lady from a rural area complained about a burning, tearing and foreign body sensation of the left eye for two months. In the past two years she had recognized that an extraocular prominence which had been present since birth had shown a tendency to grow. Slit lamp examination showed a markedly prominent and vascularized limbal tumor from 3.30 to 7.00 o'clock. Paralleling the border of the mass there was a bow-shaped stromal lipoid deposit reaching from limbus to limbus. Gonioscopic examination revealed a deep penetration of the process almost into the anterior chamber. The tumor was excised and some fatty tissue adjacent to Descemet's membrane was left. Histological assessment brought us to the diagnosis of a chronically irritated, predescemetal limbal dermoid with marked secondary vascularization, epidermalization, elastoid degeneration and degenerative arcus lipoides. CONCLUSIONS: The excision of the limbal dermoid in the described case was performed in the later stage of life. When indicated cosmetically or medically, surgery should typically take place in pre-school age and be performed as a lamellar excision.     

Effects of lamellar keratotomy on postkeratoplasty astigmatism

AIM: To determine the changes in postkeratoplasty astigmatism induced by lamellar keratotomy. METHODS: A prospective, non-randomised comparative trial of patients undergoing a hinged lamellar corneal flap for treatment of significant astigmatism after penetrating keratoplasty. Uncorrected visual acuity, best corrected visual acuity, refraction, and corneal topography were assessed at 1 and 3 months after the lamellar keratotomy. RESULTS: 17 eyes in 16 patients (13 M, 3F) were included in the study (mean age 48.2 years; range 20-86 years). Six of 17 eyes (35.3%) changed more than 1 dioptre (D) in spherical equivalent by 3 months. Nine of 17 eyes (52.9%) changed more than 1 D in sphere by 3 months. 12 of 17 eyes (70.6%) changed more than 1 D in refractive cylinder. Seven patients of 15 (46.7%) changed more than 1 D in corneal power as measured topographically. Five of 17 eyes (29.4%) changed in refractive cylinder axis more than 15 degrees and this was similar to the change measured topographically of four of 15 eyes (26.7%). Vector analysis showed 60% of eyes had a surgically induced astigmatism (SIA) vector of more than 1 D, including a net corneal astigmatism decrease of more than 1 D in four eyes and increase of more than 1 D in two eyes at 3 months after surgery. Complications of the lamellar keratotomy included two partial buttonholes and one partial wound dehiscence. CONCLUSIONS: The creation of a lamellar flap alone can have significant effects on the astigmatism following penetrating keratoplasty. LASIK for correction of postkeratoplasty astigmatism may be more accurately performed as a two stage procedure rather than a single stage, after the corneal effects of the lamellar keratotomy have stabilised.     

Visual acuity, refractive error, and endothelial cell density six months after Descemet stripping and automated endothelial keratoplasty (DSAEK)

PURPOSE: To evaluate visual acuity, refractive outcomes, and endothelial cell density 6 months after Descemet stripping and automated endothelial keratoplasty (DSAEK). METHODS: We performed an institutional review board-approved prospective study of a surgical case series of 34 patients at 2 institutions undergoing DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, or aphakic bullous keratopathy with or without simultaneous phacoemulsification and intraocular lens implantation. Clinical outcomes, including best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, and refractive astigmatism and topographic or keratometric astigmatism, were assessed at the 6-month postoperative examination and compared with preoperative values with paired Student t tests. The change in endothelial cell density from the eye bank examination to 6 months after transplantation was similarly evaluated. RESULTS: BSCVA averaged 20/99 preoperatively and 20/42 postoperatively (P < 0.0001). After DSAEK, 30 (88.2%) of 34 patients showed improved BSCVA, and 21 (61.8%) of the 34 patients achieved a BSCVA of 20/40 or better. For patients not undergoing simultaneous phacoemulsification and intraocular lens implantation, a hyperopic shift in refraction of 1.19 +/- 1.32 D was noted. Refractive astigmatism, topographic astigmatism, and keratometry showed no statistically significant change. Endothelial cell density of donor corneas averaged 2826 +/- 370 cells/mm, whereas the mean postoperative density was 1396 +/- 440 cells/mm. This finding corresponded to an average loss of 1426 cells/mm (50% loss; P = 0.0001). The first half of cases experienced an average cell loss of 1674 cells/mm (59% loss) compared with 1181 (41% loss) in the second half of cases (P = 0.005). Three (9%) of 34 grafts experienced iatrogenic graft failure and required reoperation with new donor tissue. Also, 9 (27%) of 34 grafts experienced dislocation in the early postoperative period and required repositioning. CONCLUSIONS: In this prospective study of DSAEK for bullous keratopathy and Fuchs endothelial corneal dystrophy, improvement of visual acuity was achieved with only a mild tendency toward hyperopic shift and without significant induced astigmatism. Endothelial cell loss was significant, however, and may be related to surgical experience.     

Laser in situ keratomileusis for correction of high astigmatism after penetrating keratoplasty

PURPOSE: To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) for correction of high astigmatism after penetrating keratoplasty, and to assess the refractive results and predictability of the procedure. METHODS: LASIK was performed on 19 patients (19 eyes) with high astigmatism after penetrating keratoplasty, using the Chiron Automated Corneal Shaper and the Chiron-Technolas Keracor 116 excimer laser. The amount of preoperative refractive astigmatism ranged from 6.50 to 14.50 D (mean, 9.21 +/- 1.95 D) and the spherical component of manifest refraction ranged from -7.00 to +1.25 D (mean, -2.14 +/- 2.11 D). All patients completed a minimum follow-up of 12 months. RESULTS: Refraction was stable after 3 months. At 1 year after LASIK, the amount of refractive astigmatism was reduced to a mean of 1.09 +/- 0.33 D (range, 0.50 to 1.75 D), with 57.9% of the eyes within +/- 1.00 D of refractive astigmatism. The mean percent reduction of astigmatism was 87.9 +/- 3.7%. The postoperative spherical component of manifest refraction ranged from -1.00 to +1.75 D with a mean of +0.43 +/- 0.82 D. Vector analysis showed that the mean amount of axis deviation was 1.1 +/- 1.3 degrees and the mean percent correction of preoperative astigmatism was 92.6 +/- 8.4%. There were no intraoperative complications. Spectacle-corrected visual acuity was not reduced in any eye, and improved by 2 or more lines in 42.1% of eyes after LASIK. CONCLUSION: LASIK with the Chiron-Technolas Keracor 116 excimer laser was effective for correction of both astigmatism and myopia after penetrating keratoplasty. The procedure proved to be safe and gave fairly predictable and stable refractive results.     

Laser in situ keratomileusis retreatment for residual myopia and astigmatism

PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) retreatment on eyes with residual myopia with or without astigmatism. METHODS: LASIK retreatment was performed on 35 eyes of 23 patients for correction of residual myopia, with or without astigmatism, with a mean manifest spherical equivalent refraction of -2.17+/-0.82 D (range, -1.00 to -3.87 D) and mean refractive astigmatism of -0.55+/-0.61 D (range, 0 to -1.75 D). Retreatment was performed 3 to 18 months after primary LASIK (mean, 5.1+/-2.6 mo). The corneal flap of the previous LASIK was lifted and laser ablation was performed using the Chiron-Technolas Keracor 116 excimer laser. Follow-up was 12 months for all eyes. RESULTS: At 1 year after retreatment, manifest spherical equivalent refraction was reduced to a mean -0.23+/-0.28 D (range, 0 to -0.87 D), and refractive astigmatism was reduced to a mean -0.16+/-0.25 D (range, 0 to -0.75 D). Thirty-two eyes (91.5%) had a manifest spherical equivalent refraction within +/-0.50 D of emmetropia, and 33 eyes (94.3%) had 0 to 0.50 D of refractive astigmatism. Uncorrected visual acuity was 20/20 or better in 11 eyes (31.4%). Spectacle-corrected visual acuity was not reduced in any eye after retreatment. There were no significant complications. CONCLUSION: LASIK retreatment was effective for correction of residual myopia or astigmatism after primary LASIK. Refractive results were predictable with good stability after 3 months. Lifting the flap during LASIK retreatment was relatively easy to perform and did not result in visual morbidity in eyes treated from 3 up to 18 months after primary LASIK.     

Laser in situ keratomileusis for ametropia after penetrating keratoplasty

PURPOSE: To evaluate the efficacy of excimer laser in situ keratomileusis (LASIK) in the treatment of refractive errors after penetrating keratoplasty. METHODS: Eight eyes underwent LASIK after a mean 71 months (SD 60) following the initial penetrating keratoplasty. A full ophthalmic assessment was performed before LASIK and at 1 week, 1, 3, 6, and 12 months after surgery. Mean follow-up was 8.6 months (SD 3.2). RESULTS: No eyes lost any Snellen lines of best spectacle-corrected visual acuity at the latest follow-up. Mean reduction in spherical equivalent refraction was 91% from -6.79 D (SD 4.17) to -0.64 D (SD 1.92) and mean reduction of cylinder was 72% from -6.79 D (SD 3.28) to -1.93 D (SD 1.17) at 6 months. Mean surgically induced astigmatism was 5.50 D (SD 2.42) and the index of surgically induced astigmatism divided by the initial cylinder expressed as a percentage was 81%. Mean outcome indices were: correction index 0.87, index of success 0.31, and angle of error 0.95 degrees. Three eyes (43%) achieved a spherical equivalent refraction of +/-0.50 D and 4 eyes (57%) achieved a spherical equivalent refraction of +/-1.00 D of emmetropia. CONCLUSIONS: The efficacy of LASIK after penetrating keratoplasty was good compared to incisional or surface based excimer laser methods and has the advantage of reducing the myopic spherical equivalent refraction in addition to astigmatism, thus improving the uncorrected visual acuities.     

多焦点人工晶状体植入术后的屈光状态

目的了解白内障摘出多焦点人工晶状体植入术后的属光状态。方法我院行白内障摘出多焦点人工晶状体植入的老年性白内障21例（30眼），在术后3月均采用相同的标准，存暗窄用点状检影镜50em距离进行小瞳孔检影验光，并详细记录屈光度及矫正视力。结果近视14眼，其中9眼为单纯近视，5眼为近视散光；远视7眼，均为远视散光；混合性散光2眼；无屈光异常7眼。裸眼视力：远视力达1．0以上者19眼；0．4—0．8者11眼，其矫正视力有10眼达1．0以上，1眼为0．9。结论白内障摘出多焦点人工晶状体植入明显优于只提高远视力的单焦点人工晶状体。