Purpose: To investigate the refractive outcomes of multifocal LASIK to create a center far, peripheral near zone in presbyopes. Methods: This prospective study using LASIK with a center far, peripheral near ablation algorithm comprised 68 eyes of 34 hyperopes and 78 eyes of 39 myopes. Mean patient age was 49±5.60 years for hyperopes and 46.0±3.80 years for myopes. Mean baseline manifest refraction spherical equivalent was +1.76±0.96 diopters (D) in hyperopes and −3.06±1.73 D in myopes. The mean baseline addition was +1.94±0.40 D in hyper-opes and +1.67±0.44 D in myopes. One-year postoperative outcomes are reported. Results: The mean postoperative spherical equivalent refraction was −0.10±0.55 D in hyperopes and −0.48±0.51 D in myopes. Two percent of eyes in each group lost two lines of best spectacle-corrected visual acuity. With the distance correction in place, 20/40 or better near uncorrected visual acuity (UCVA) (Sloan acuity) was achieved in 33% of hyperopes and 36% of myopes. A statistically significant difference was noted in postoperative near visual acuity measured by the Sloan and Rosenbaum charts ( P <.05). Fifty-four percent of hyperopes and 48% of myopes were satisfied or very satisfied with their postoperative near UCVA. Conclusions: Multifocal LASIK to create a center far and peripheral near zone is safe and allows half of the patients to achieve spectacle independence. A peripheral near zone was only created in myopic treatments. [ J Refract Surg . 2009;25:296–305.]
Purpose:To examine the safety and efficacy of Intacs SK for moderate to severe keratoconus (KC) using femtosecond technology.Materials and Methods:This prospective, non-comparative study included 37 contact lens intolerant keratoconic eyes (stage II-III) of 24 patients who underwent femtosecond-assisted Intacs SK implantation. Inclusion criteria were mean K readings <56.00 D, corneal thickness >400 μm at the incision site, mesopic pupil <6.50 mm. Evaluation included manifest refraction, slitlamp examination, corneal topography, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). P < 0.05 was statistically significant.Results:Thirty-one (83.8%) eyes were classified as Amsler-Krumeich′s stage II and 6 (16.2%) were stage III. Mean central pachymetry was 490.3 ± 37.4 μm. UDVA at 6 months post-operatively was significantly better than pre-operatively (0.90 log MAR ± 0.52 standard deviation [SD] versus 0.32 ± 0.27 logMAR; respectively, P < 0.0001), as was the spherical equivalent (SEq) (−3.64 ± 2.52 D vs. −1.84 ± 2.2 D; P < 0.0001). The mean CDVA and manifest cylinder improved compared with pre-operatively (P = 0.319 and P = 0.078, respectively). Average keratometry decreased significantly from 48.50 ± 3.08 D to 44.40 ± 3.03 D (P < 0.0001).Conclusion:Implantation of Intacs SK using femtosecond laser in moderate to severe KC is safe and effective.
Purpose:To evaluate the visual outcomes, complications and retention of threadless type I Boston keratoprosthesis (KPro) in Saudi Arabia.Materials and Methods:Retrospective analysis of four eyes of four patients (one female and three males; age range: 48 to 72 years) who underwent Boston type I threadless KPro implantation between January and December 2009.Results:In the median follow-up of 11 months (range 6 to 14 months), visual outcomes were satisfactory. Preoperative diagnosis included two patients of post-trachoma dense vascularized corneal scarring, one patient of corneal alkali burn and one patient of repeated failed corneal grafts. All patients demonstrated significant improvement in vision; with pre-operative visual acuity of hand movements (HM), counting fingers and HM improved to best corrected visual acuity (BCVA) of 20/200, 20/60, 20/50 and 20/30 on their last follow-up visits respectively. None of the patients developed glaucoma as a result of the procedure. No retro-prosthetic membrane developed till the last follow-up visit. One of the four patients had a corneal melt (due to severe dryness associated with trachoma) 6 months after the KPro implantation and underwent a successful KPro revision. Despite the relatively poor prognosis expected in alkali burn eye, the patient attained the maximum BCVA (20/30) of the four eye series on the last follow-up visit at six months.Conclusion:In consistent with the earlier reports from other parts of the world, all the 4 eyes had a significant increase in vision after Boston type I KPro implantation. However, patients require close lifelong follow-up to manage any complications.
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