Correlation of subepithelial haze and refractive regression 1 month after photorefractive keratectomy for myopia.

PURPOSE: To relate myopic regression after photorefractive keratectomy (PRK) to subepithelial haze at the first postoperative month. METHODS: One hundred nineteen eyes of 119 patients underwent excimer laser PRK for treatment of myopia up to -8.00 D. Eyes were examined at 1, 3, 6, 9, and 12 months after surgery. All eyes received fluorometholone 0.1% for the first 5 postoperative months in a tapered dose. Dexamethasone 0.1% qid for 1 month was prescribed to all eyes with a spherical equivalent refraction less than plano, followed by an augmented dose of fluorometholone 0.1%. Eyes with myopia greater than -0.75 D at 12 months, as well as those that had received dexamethasone at any postoperative interval--regardless of refractive outcome--were considered to be regressed. Eyes that regressed and those that did not regress were compared statistically (Chi-squared statistical criterion with Yate's correction) regarding haze grade. RESULTS: Forty-seven percent (56 of 119) of eyes regressed. In 89.28% (50 of 56) of eyes, subepithelial haze grade was 1 to 2, and in 10.71% (6 of 56), subepithelial haze was graded 0 to 0.5 at 1 month. Fifty-three percent of eyes (63 of 119) did not regress and in all, subepithelial haze was graded 0 to 0.5 at the first month. The correlation between regression and haze grade 1 or more at the first postoperative month was statistically significant (P<.001). CONCLUSION: Mild to marked subepithelial haze (grade 1 to 2) at the first postoperative month after PRK for myopia is strongly related to regression of initial refractive effect and increasing myopia.     

Oxygen-derived free radicals and postischemic myocardial reperfusion: therapeutic implications

Oxygen-derived free radicals have been implicated in the pathogenesis of various disease states, including myocardial ischemia and reperfusion. In this article, we review 1) the evidence linking free radical production and myocardial injury during myocardial ischemia and reperfusion and 2) results of studies of the effects of the pharmacological therapies available potentially to prevent free radical-mediated injury. Free radicals can be produced during ischemia and reperfusion by several different biochemical pathways. Of these, the xanthine oxidase reaction and the output of free radicals by neutrophils that have accumulated in damaged tissue have been studied extensively. When produced, free radicals can potentially damage myocytes or endothelial cells through peroxidation of membrane lipids or damage to proteins or nucleic acids. Using electron spin resonance spectroscopy, several studies have shown a 'burst' of oxygen free radicals immediately after reperfusion. Moreover, exogenous generation of intravascular free radicals has been shown to produce marked vascular and myocyte damage, as well as contractile dysfunction. 'Anti-free radical' interventions, such as xanthine oxidase inhibitors and free radical scavengers have been reported to prevent contractile dysfunction and reperfusion-induced arrhythmias after an episode of reversible ischemic injury. However, after more severe episodes of ischemia, such interventions have had conflicting effects on myocardial infarct size. 'Anti-free radical' interventions could be of potential use in situations where reversible ischemic injury occurs. In situations where reperfusion is achieved after irreversible ischemic injury has occurred, the potential beneficial effect of these treatments on infarct size is more doubtful.     

Intravascular signal in MR imaging: use of phase display for differentiation of blood-flow signal from intraluminal disease

Intravascular signal from flowing blood is frequently observed on magnetic resonance (MR) images and may be indistinguishable from partial or complete vascular occlusion caused by thrombus or tumor. With a phase-display reconstruction method, qualitative assessment of large-vessel patency within the abdomen was undertaken in 15 healthy subjects and 12 patients with angiographically or surgically documented intravascular thrombus or tumor. Computed tomographic (CT) scans were available in all patients for correlation. MR studies were performed with a multisection spin-echo pulse sequence and two-dimensional Fourier transform spatial encoding. Data acquired from a single sequence was reconstituted in two ways to provide both routine anatomic images and a pictorial representation of large-vessel flow on a phase-sensitive image. With this method, reliable and easy differentiation of intraluminal thrombus and tumor from blood flow signal within large vessels was achieved. Information from these phase-display images compared favorably with findings from angiography and contrast-enhanced CT in the determination of luminal patency and obstruction.     

Epipolis laser in-situ keratomileusis: an evolving surface ablation procedure for refractive corrections

PURPOSE OF REVIEW: The aim of this article is to provide an update on epipolis laser in-situ keratomileusis--an alternative surface photorefractive surgical technique for the correction of myopia. RECENT FINDINGS: In-vivo studies on animal models provide evidence that the replacement of the epithelial sheet on an ablated cornea can control corneal wound healing. Preliminary clinical data confirm that epipolis laser in-situ keratomileusis can provide excellent long-term visual and refractive results. The problems of late visual rehabilitation and postoperative pain, however, have not yet been fully addressed. SUMMARY: Being a recently introduced surgical photorefractive technique for ametropias correction, epipolis laser in-situ keratomileusis is a fast evolving area of interest for refractive surgeons.