Purpose: The aim of this paper was to describe 2 cases of ocular surface squamous neoplasia (OSSN) of the conjunctiva with intracorneal and intraocular extension following intraocular surgery. Methods: We conducted a clinical pathological retrospective case series. Results: Case 1 underwent cataract surgery in the setting of an unnoticed adjacent OSSN. An excisional biopsy with cryotherapy and intraoperative mitomycin C was subsequently performed, confirming OSSN. The patient had two recurrences treated topically with resolution. While the conjunctiva remained clear, a corneal haze emanating from the cataract incision site was noted. Penetrating keratoplasty (PK) for this haze revealed midstromal infiltrative carcinoma. Case 2 had a history of herpes simplex keratitis that ultimately required corneal grafts. Fifteen years later, he developed an OSSN treated with excisional biopsy and had clear margins. Eight months later, he presented with a recurrence of his OSSN and was treated briefly with topical interferon for 4 weeks; however, he developed an infectious keratitis with a corneal perforation requiring another PK. Four months after PK, low-grade inflammation was noted. Cytology of the anterior chamber aspirate revealed neoplastic squamous cells. Another PK was then performed. Pathology confirmed extensive intraocular neoplasia. Limited exenteration was performed. Conclusion: Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery.

The past 25 years have witnessed great changes in refractive surgery. As a result of advancements in technology, instrumentation, and technique, we have seen improvements in the treatment of all types of ametropias. In this article, we review some of the successes and failures of the past quarter-century.

PURPOSE: To determine whether the use of 70% isopropyl alcohol is useful as an adjunct to simple mechanical removal of epithelial ingrowth following laser in situ keratomileusis (LASIK). METHODS: A retrospective comparison of two techniques of epithelial ingrowth removal following LASIK was performed. A total of 38 procedures on 31 patients were included. In one group, the epithelium was removed using a simple mechanical scraping technique and in the other, a similar technique combined with the application of 70% isopropyl alcohol was used. The rates of recurrence in the two groups were compared using a chi-square analysis. RESULTS: The total incidence of epithelial ingrowth recurrence in both groups was 57.9% (22/38). The incidence of clinically significant ingrowth recurrence in both groups was 34.2% (13/38). In the scrape group, the recurrence of any ingrowth was 43.8% (7/16) and the recurrence of clinically significant ingrowth was 31.3% (5/16). In the alcohol group, these rates were 68.2% (15/22) and 36.4% (8/22), respectively. The difference between the two groups did not show statistical significance in either comparison (P=.14 and P=.75, respectively). CONCLUSIONS: The use of 70% isopropyl alcohol showed no additional benefit over simple mechanical scraping in the removal and prevention of epithelial ingrowth recurrence following LASIK. [J Refract Surg. 2005;21:148-151.]

PURPOSE: To report two different cases of sterile, peripheral keratitis following laser in situ keratomileusis (LASIK). METHODS: A report of two cases (two eyes of two patients). RESULTS: In two patients, peripheral infiltrates appeared 1 day after LASIK. One patient had a history of rheumatoid arthritis and both had peripheral corneal changes that may have represented prior inflammatory events. The presentations were quite different, with one occurring in association with an epithelial defect at the edge of the flap and the other occurring without an epithelial defect peripheral to the microkeratome cut. In the second case a similar infiltrate showed up in the unoperated fellow eye. Both patients were treated with aggressive antibiotic and corticosteroid therapy. Both patients recovered well with no loss of best spectacle-corrected visual acuity. CONCLUSION: Peripheral keratitis can occur in patients following LASBK; preoperative evidence of previous inflammation may be a marker for patients at higher risk. Rheumatoid arthritis patients may be at increased risk for this complication. With careful and aggressive management excellent visual outcomes are still possible. [J Refract Surg 2003;19:671-675]

PURPOSE: We report a case of keratolysis following phototherapeutic keratectomy (PTK) for a subepithelial nodule in a patient with keratoconus. METHODS: A 29-year-old male with keratoconus who became contact lens intolerant because of a raised subepithelial nodule was treated with excimer laser phototherapeutic keratectomy (PTK). RESULTS: The epithelium failed to heal postoperatively, and progressive keratolysis led to a central descemetocele by the eighth postoperative day. The patient was managed with a penetrating keratoplasty. CONCLUSIONS: Excimer laser phototherapeutic keratectomy has been shown to be an effective treatment for subepithelial nodules in patients with keratoconus. Rapidly progressive keratolysis is a potential complication of this procedure. [J Refract Surg 2001;17:555-558]