Purpose To compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction.

PURPOSE: We evaluated the incidence and intraoperative microkeratome-related complications in laser in situ keratomileusis (LASIK). METHODS: We present non-randomized, retrospective, comparative, interventional case series. We reviewed the records of patients who underwent LASIK from August 2000 to March 2004 at Excimer Laser Santa Cruz, São Paulo, Brazil (47,094 eyes). We identified 369 eyes (0.0078%) with an intraoperative complication. Data were collected regarding microkeratome, average keratometric power, and type of complication. RESULTS: The Hansatome microkeratome was the most common microkeratome used (34,182 eyes; 73%), followed by the Automated Corneal Shaper-ACS (11,164 eyes, 24%) and the Nidek MK-2000 (1748 eyes, 3.7%). Intraoperative complications were more common with the ACS (1.26%) than with the Hansatome (0.63%) and MK-2000 (0.63%) (P<.001; P=.03; respectively). Complications included incomplete flaps (0.23%), buttonholes (0.13%), thin flaps (0.08%), and free flaps (0.08%). Buttonholes were more frequent with the ACS (0.34%) than with the Hansatome (0.06%) (P<.001) and free flaps were more common with the ACS (0.20%) and MK-2000 (0.29%) than with the Hansatome (0.04%) (P<.001). Keratometric power of eyes with intraoperative complications was significantly higher in the ACS group compared to the Hansatome group. CONCLUSIONS: Intraoperative complications were more common with the ACS than with the Hansatome or MK-2000. Buttonholes were most frequent with the ACS, and the Hansatome had the lowest incidence of free flaps. [J Refract Surg 2004;20(suppl):S723-S726]

PURPOSE: This study correlated confocal microscopic images obtained using the Nidek ConfoScan 2.0 System in corneas with clinical suspicion of Acanthamoeba keratitis, with diagnosis confirmed by either cytological and/or histological analysis. METHODS: Fifteen eyes of 14 patients with a clinical diagnosis of Acanthamoeba keratitis underwent confocal microscopy evaluation. RESULTS: Fifteen eyes of 14 patients (one bilateral case) showed Acanthamoeba keratitis alterations that ranged from massive infestation to cicatricial opacity in the stroma. Ten patients (71%) were females. Mean age was 26 years (range 19 to 37 yr). All patients were contact lens wearers. CONCLUSION: Confocal microscopy was a useful, noninvasive technique in the diagnosis and treatment of Acanthamoeba keratitis, especially in those cases in which corneal scraping, cytological analysis, and culture are negative. It also eliminated the necessity of tissue biopsy, considered an invasive procedure. [J Refract Surg 2004;20 (suppl): S737-S740]

PURPOSE: To compare the distribution of ocular higher order wavefront aberrations (third to sixth order) in the Brazilian population of Asian and non-Asian refractive surgery patients. METHODS: Preoperative refractive and wavefront data were reviewed for 648 eyes in 324 patients who underwent custom ablation at the Excimer Laser Santa Cruz refractive surgery center in São Paulo, Brazil, from March 2002 to July 2005. Patients were divided into two groups: Asian patients and non-Asian patients, based on family history. Statistical analysis was performed to assess the differences between the groups with respect to manifest refractive spherical equivalent, astigmatism, pachymetry, OPD-root-square-mean (RMS) for a 6.0-mm pupil, total wavefront aberrations, third- to sixth-order higher order aberrations, and individual aberrations. RESULTS: The mean spherical equivalent refraction in the Asian group of -4.38 diopters (D) was significantly higher than the spherical equivalent refraction of -3.46 D in the non-Asian group (t=-4.32; P=.00001). Comparison of the differences between groups with respect to higher order aberrations, coma, trefoil, quadrafoil, spherical aberration, higher order astigmatism, and pachymetry was not statistically significant. CONCLUSIONS: Asian patients have a higher prevalence of myopia than non-Asian patients. No differences were noted in higher order aberrations between Asian and non-Asian patients. [J Refract Surg. 2006;22:S1024-S1026.]

The Flexivue Microlens provided patients with improved near vision, as a result of a negative spherical aberration. A significant loss of corrected distance visual acuity in the operated eyes was observed. Overall, this intracorneal inlay was an effective alternative to other procedures for the correction of presbyopia.

PurposeHere, we report the results of a 3-year follow-up analysis of the outcomes of the Flexivue Microlens corneal inlay.PatientsNon-dominant eyes (n=31) of emmetropic presbyopic patients (spherical equivalent: −0.5 to 1.00 dioptre).MethodsA Flexivue Microlens corneal inlay was implanted after the creation of a 300 μm deep stromal pocket using a femtosecond laser. Patients were followed up according to a clinical protocol involving refraction, anterior segment imaging analysis (Oculyser), optical quality analysis (OPD-Scan), monocular binocular uncorrected and corrected visual acuity tests, contrast sensitivity measurements (photopic and mesopic), satisfaction questionnaire results and adverse event reporting.ResultsThirty patients were examined at the 3-year follow-up in this ongoing study. The mean uncorrected near visual acuity improved to Jaeger 1 in 76.9% of eyes treated with the inlays (vs 87.1% at the 1-year follow-up). All eyes improved four lines in all visits, except for four patients for whom the inlay was explanted. Patients reported that their near vision was good or excellent in 73.3% of cases (vs 90.3% in the first year). The UDVA remained stable over time. Three patients were explanted due to blurred vision for near-point and far-point distances. One patient developed a superficial corneal ulcer after 20 months. Two patients underwent cataract removal. Four patients underwent inlay exchange to increase near power correction.ConclusionsThe Presbia Flexivue Microlens provided presbyopia treatment by improving near vision. Manageable complications may occur over the long term.Clinical trial registration numberU1111-1185-5684 and 0310451200000550.

The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.

PURPOSE: To investigate the efficacy of mitomycin C (MMC) in preventing haze formation in surface wavefront customized ablations with successful refractive treatment (laser epithelial keratomileusis [LASEK]) and to evaluate the safety of this technique on corneal stroma and endothelium. METHODS: This study was a prospective, doublemasked, randomized clinical trial involving 52 eyes (30 placebo and 22 MMC) of 26 patients. The manifest refractive spherical equivalent (MRSE), best spectaclecorrected visual acuity, uncorrected visual acuity, corneal pachymetry, topography, aberrometry, endothelial specular microscopy, contrast sensitivity, corneal confocal microscopy, and complaints of pain via a subjective questionnaire were recorded preoperatively and 90 days postoperatively. RESULTS: The mean MRSE at 90 days postoperatively was -0.56 diopters (D) (-4.95±1.85 D, range: -8.00 to -1.62 D) for the MMC group and -0.49 D (-4.51±1.81 D, range: -7.75 to -2.25 D) for the placebo group. Higher order aberrations were similar between the placebo and MMC groups 90 days postoperatively (0.538±0.228µ?? and 0.478±0.134µ??, respectively). Analysis of the endothelial cell count indicated a statistically significant decrease in endothelial cell density (P=. 017) after LASEK, independent of MMC use. CONCLUSIONS: The predictability of the final target refraction, induction of high order aberrations, and improvement in contrast sensitivity proved that the use of MMC was equally safe when compared to procedures that did not use MMC. In addition, the procedure was efficient in the prevention of corneal haze. [J Refract Surg. 2007;23:S1021-S1028.]