In their article reporting the results of a pilot study assessing the use of accelerated corneal crosslinking (CXL) concurrent with laser in situ keratomileusis (LASIK), Celik et al. 1 demonstrated that the addition of accelerated CXL to the LASIK procedure did not appear to affect LASIK algorithms. We have also incorporated accelerated CXL into LASIK procedures and have similarly demonstrated predictable visual and refractive outcomes with this combined method.We incorporate partial-strength accelerated CXL into the LASIK procedure for patients we consider LASIK candidates with higher than average risk for regression: those younger than 30 years, those who will have a deep ablation, and those with a family history of ectasia. It has been argued that the creation of a LASIK flap may weaken the integrity of the cornea by as much as 32%, 2 and our goal in adding crosslinking to the procedure is to offset this effect without significantly affecting visual recovery.We retrospectively compared 66 myopic eyes having LASIK and accelerated CXL and 42 myopic eyes having LASIK alone. Both treatment groups had a similar mean age (27.28 years in the LASIK group and 26.55 years in the LASIK-accelerated CXL group), and all were treated by the same experienced surgeon (G.E.T). The mean preoperative manifest refraction spherical equivalents (MRSE) were À2.97 diopters (D) (LASIK-accelerated CXL) and À2.25 D (LASIK). No adjustment was made to the excimer laser treatment nomogram to account for accelerated CXL, which was performed immediately following stromal ablation. The stromal bed was coated with 0.1% riboflavin in 20% dextran (VibeX), soaked for 60 seconds, and thoroughly irrigated with balanced salt solution. Following replacement of the LASIK flap, the central 9.0 mm zone was irradiated with 365 nm ultraviolet at 30 mW/cm 2 for 75 seconds using the KXL device (Avedro, Inc.).Both groups demonstrated excellent uncorrected distance visual acuity (UDVA) 1 day (20/21 LASIKaccelerated CXL, 20/20 LASIK) and 1 month (20/18 LASIK-accelerated CXL, 20/20 LASIK) postoperatively. Although most patients in both groups returned to their referring optometrists at this stage, we have had no retreatments to date in any myopic LASIK-accelerated CXL patients. The mean MRSE was 0.17 (LASIK-accelerated CXL) and À0.73 (LASIK) at 1 week and 0.49 and 0.17, respectively, at 1 month. We have treated a small group of presbyopic patients with laser-blended LASIK-accelerated CXL and have had 1 retreatment in this group, which is not surprising as our typical retreatment rate is between 8% and 10% in presbyopic patients. While it has been suggested that concurrent LASIK and CXL may increase LASIK flap adhesion, 3 the surgeon was able to successfully relift the flap and retreat this patient with LASIK 10 days after the initial treatment, with a resultant UDVA of 20/15 in the retreated eye at 1 month and 3 months after the second treatment.In conclusion, we agree that partial-strength accelerated CXL may be added to the LASIK procedure without affecting L...
We describe the neurological evaluation and MRI analysis of 30 patients, belonging to 16 families with Usher syndrome (US) type 1 and type I1 (US 1 and US2). In addition to the classic visual and audiological abnormalities seen in these patients, we observed abnormal gait in 88.9% of US1 and in 66.7% of US2 patients and abnormal coordination in 33.4% of US1, and in 58.3% of US2. Borderline mental retardation, depression or bipolar affective disorder were observed in 16.7% of US1 and 33.3% of US2 patients. MRI analysis showed cerebellar abnormalities in 50% of US 1 and 75% of US2 patients, but no clear correlation was observed between structural abnormalities and clinical findings. A pattern for the MRI classification of US patients is suggested.
PurposeA preliminary study to evaluate the outcomes of high-resolution wavefront-guided (HRWG) photorefractive keratectomy (PRK) with simultaneous corneal cross-linking (CXL) in ectasia eyes.MethodsSixteen eyes of 11 patients (mean age 31.9±9.8 years; range: 15–48 years) with keratoconus or post-laser-assisted in situ keratomileusis ectasia underwent HRWG PRK with simultaneous CXL. Manifest refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and keratometric and aberrometric outcomes are reported at 12 months.ResultsSignificant improvement was observed postoperatively in visual acuity, refraction, and keratectomy in all eyes. At postoperative 12 months, 87.5% eyes were within ±1.0 D of attempted correction and 81.25% of eyes had a postoperative UDVA of 20/32 or better. A gain of 2 or more lines of CDVA was observed in 12.5% (2/16) of eyes and there was no change in CDVA lines in 25% (4/16) eyes. A substantial reduction in higher-order aberrations was observed in all eyes postoperatively; however, the improvement was not statistically significant.ConclusionThe outcomes of HRWG PRK in ectasia eyes with estimated residual stromal bed thickness of at least 350 μm (without epithelium) are promising at postoperative 1 year and provide surgeons with a valuable tool to improve vision with a high degree of refractive predictability.
Otological, ophthalmological and genetic studies were performed in 46 patients with Usher syndrome, identified through a screening program in Colombia. Of them, 69.6% had Usher syndrome type I, 26.1% type II, and 4.3% type III. Thirty‐three patients showed profound deafness (71.7%), while 13 (28.3%) had moderate to severe hearing loss. The ophthalmologic manifestations showed marked variability. Although the majority of the patients had serious ocular impairment before age 20. 32.6% had good central visual acuity. The prevalence of Usher syndrome in Colombia, estimated at 3.2/100000, warrants the implementation of screening programs in schools for the deaf and for the blind. Our study confirms that Usher syndrome shows no geographic or racial variation and that the disorder has a wide variability of expression and genetic heterogeneity. The large size of the families we have detected may provide important opportunities for further genetic studies, particularly in terms of the assignment of the locus and gene mapping.
To identify causative factors we screened 1,715 deaf individuals from 16 schools for the deaf in Colombia. We found evidence of environmental causation in 579 (33.8%) cases, genetic in 608 (35.4%), and in 528 (30.8%) we were unable to identify the etiology. The degree of hearing loss was severe to profound in 1,238 (72.2%), although in 987 (57.5%) of the deaf population studied the hearing impairment was not noticed until 2 to 5 years of age. The frequent association of deafness with other anomalies underscores the importance of a careful clinical and ophthalmologic evaluation in individuals with hearing loss. Our observations also emphasize the need for programs directed towards the prevention of hearing loss, including primary prevention as well as early diagnosis, investigation of possible genetic causes, and rehabilitation of deaf individuals.
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