PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.
Aged ; Aged, 80 and over ; Corneal Edema/*surgery ; Corneal Surgery, Laser/*methods ; Corneal Topography ; Corneal Transplantation/*methods ; Endothelium, Corneal/*transplantation ; Female ; Fuchs' Endothelial Dystrophy/*surgery ; Humans ; Male ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.
Aged ; Aged, 80 and over ; Corneal Edema/*surgery ; Corneal Surgery, Laser/*methods ; Corneal Topography ; Corneal Transplantation/*methods ; Endothelium, Corneal/*transplantation ; Female ; Fuchs' Endothelial Dystrophy/*surgery ; Humans ; Male ; Tomography, Optical Coherence ; Visual Acuity

The purpose of this study is to assess the efficacy of the multi-zone cross-cylinder method as compared with the single method for astigmatism correction using LASIK. This prospective study enrolled 40 patients (52 eyes) who underwent the cross-cylinder method using LASIK, and 52 patients (60 eyes) who underwent the single method using LASIK: all patients were given a diagnosis of complex myopic astigmatism from the department of ophthalmology of this hospital between January 2002 and July 2003. Preoperatively, the mean spherical equivalent refraction was .3.85 +/- 1.13 D in the cross-cylinder group and .4.05 +/-1.20 D in the single method group (p = 0.23). The mean cylinder was .2.05 +/-1.58 D in the cross-cylinder group and .1.95 +/-1.12 D in the single method group (p = 0.31). 6 months after treatment the results were a mean spherical equivalent refraction of .0.26 +/-0.30 D in the crosscylinder group and -0.34 +/-0.35 D in the single method group (p = 0.13). The mean cylinder was .0.38 +/-0.29 D in the cross-cylinder group and .0.45 +/-0.30 D in the single method group (p = 0.096). There were no statistically significant differences between the two groups. The mean BCVA was not different from mean preoperative BCVA in both groups (i.e., 0.98 +/-0.10, 0.96 +/-0.25, p = 0.86). Postoperatively, patient complications that included night halo, glare and corneal haze were not noted in either group. In conclusion, the results of cross-cylinder method are no different from the single method for the correction of a complex astigmatism. In the future, studies will have to be conducted to assess the efficacy of the cross-cylinder method in consideration of those factors that can affect the postoperative outcome.
Adult ; Astigmatism/*surgery ; Corneal Stroma/surgery ; Humans ; Keratomileusis, Laser In Situ/*methods ; Myopia/*surgery ; Postoperative Complications ; Prospective Studies

To evaluate the relationship between ablation zone demm in PRK and 88.7% were decentered less than 0.75 mm in LASIK. The most meridional displacement was toward the superonasal quadrant; 46% in PRK and 51% in LASIK. There was less decentration in males, in the 2nd-operated eye, in older age, PRK, in larger ablation diameter, and in shallower ablation depth, but these differences were not statistically significant.
Adult ; Corneal Transplantation/methods* ; Factor Analysis, Statistical ; Female ; Human ; Keratectomy, Photorefractive, Excimer Laser* ; Laser Surgery* ; Male ; Middle Age ; Myopia/surgery* ; Pupil*

The purpose of this study is to demonstrate a method of how to remove epithelium grown beneath the hinge area after laser in situ keratomileusis (LASIK) without affecting the refractive part of the lenticule. In three cases, an incision was made at the base of the hinge by RK diamond knife to free the lenticule from the stroma. The lenticule was lifted from the nasal edge. The epithelium grown along the interface beneath the hinge area was removed with a Bard-Parker No. 15 knife. The lenticular flap was repositioned with interrupted sutures using 10-0 nylon. No further epithelial ingrowth was observed. The central cornea remained clear leaving a peripheral ring-shaped opacity without affecting the preoperative naked visual acuity. In conclusion, epithelial ingrowth along the interface after LASIK can be removed safely without affecting the refractive part by the incision of the hinge area with a RK diamond knife, removal of the epithelium, and suturing of the lenticule to the stromal bed.
Adult ; Epithelium, Corneal/surgery* ; Epithelium, Corneal/pathology* ; Female ; Human ; Keratectomy, Photorefractive, Excimer Laser/adverse effects* ; Male ; Reoperation ; Suture Techniques ; Treatment Outcome ; Visual Acuity/physiology

PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.
Anti-Bacterial Agents ; Chlorhexidine ; Cornea ; Corneal Injuries ; Corneal Surgery, Laser ; Disinfection ; Edema ; Endothelial Cells ; Ethanol ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Orbit ; Punctures ; Skin ; Steroids

PURPOSE: To compare the changes in posterior corneal curvature using scanning slit topography (Orbscan II) and Scheimpflug imaging (Pentacam) before and after Epi-laser in situ keratomileusis (LASIK) for myopia. METHODS: In a prospective observational case-series study, 20 myopic patients having undergone Epi-LASIK were examined serially with two different devices, Orbscan II and Pentacam, preoperatively and one month postoperatively. Posterior central elevation (PCE) and posterior maximal elevation (PME) were compared between the two devices, and the changes in parameters after Epi-LASIK were analyzed using a difference map. RESULTS: All parameters (preoperative and postoperative PCE and preoperative and postoperative PME) that were measured using the Orbscan II were significantly greater compared to those of the Pentacam (for all p < 0.001). PCE and PME were significantly increased one month postoperatively in the Orbscan II measurements (p < 0.05) but were not significantly increased in the Pentacam measurements. Also, DeltaPCE and DeltaPME, in the difference map obtained by each serial scanning, were significantly greater in the Orbscan II measurements than with the Pentacam (p = 0.012, p = 0.016). CONCLUSIONS: The Pentacam measurements displayed significantly reduced values in all parameters related to posterior corneal elevation compared to those of the Orbscan II. The Pentacam showed no significant change in posterior corneal curvature after Epi-LASIK, based on the difference map.
Adult ; Corneal Topography/*methods ; Female ; Humans ; Keratomileusis, Laser In Situ/*methods ; Male ; Myopia/*surgery ; Prospective Studies ; Treatment Outcome

Epidermal growth factor (EGF) has been believed to promote the corneal epithelial wound healing by stimulating the proliferation of the epithelial cells located at the wound base and limbus. Thus we made transepithelial photokeratectomy by excimer laser to cornpare the rate of corneal wound healing and the histological findings between a group received only photokeratectomy (control) and a group with photokeratectorny and topical EGF treatment. The results showed that the corneal epithelial wounds treated with EGF after excimer laser photokeratectomy was closed significantly faster than those without. EGF, PCNA immunoreactive cells appeared at. the basal cell layer of limbus and wound area in EGF-treated groups but, not, in control group These resuite suggest that EGF accelerates the corneal epithelial wound healing after excimer laser photokeratectomy by stimulating the proliferation of the basal cells of limbus and wound area and results in 8 faster wound healing time.
Corneal Surgery, Laser* ; Epidermal Growth Factor* ; Epithelial Cells ; Lasers, Excimer* ; Proliferating Cell Nuclear Antigen ; Rabbits* ; Wound Healing* ; Wounds and Injuries*

Corneal neovascularization, which is associated with complications in corneal diseases, can cause lipid deposit, decreasing vision, and graft rejection after penetrating keratoplasty (PKP). Corneal laser photocoagulation using an argon laser or yellow dye laser for ablation of corneal neovascularization has been described. We performed corneal argon laser photocoagulation (CALP) in two male patients with corneal neovascularization after herpetic keratitis. One PKP was performed after CALP and restored good vision with no rejection of the graft during an 8 month follow-up period. In the other case we observed visual improvement and no recurrence of corneal neovascularization after CALP.
Adult ; Corneal Neovascularization/etiology/*surgery ; Follow-Up Studies ; Humans ; Keratitis, Herpetic/complications ; *Laser Coagulation ; Male ; Middle Aged ; Visual Acuity

PURPOSE: The corneal change induced by refractive procedures influence both the postoperative refractive status and the ocular spherical aberration (SA). We evaluated changes in corneal SA after three types of surface ablation: phototherapeutic keratectomy (PTK), myopic photorefractive keratectomy (PRK), and myopic wavefront-guided laser epithelial keratomileusis (LASEK). METHODS: Twenty-six eyes (25 patients) were subjected to PTK 26 eyes (14 patients) to PRK, and 34 eyes (17 patients) to wavefront-guided LASEK. Corneal SA was measured with the iTrace in all patients both preoperatively and 6 months postoperatively. RESULTS: Six months after surgery, mean corneal SA was -0.173 +/- 0.171 micrometer in the PTK group, 0.672 +/- 0.200 micrometer in the PRK group, and 0.143 +/- 0.136 micrometer in the wavefront-guided LASEK group. The mean difference between the preoperative and postoperative corneal SA (DeltaSA) was -0.475 micrometer in the PTK group, 0.402 micrometer in the PRK group, and -0.143 micrometer in the wavefront-guided LASEK group. CONCLUSIONS: Surgically induced changes in corneal SA vary with procedure. The prediction of the pattern of SA change induced by various surface ablation procedures may be helpful for developing future surgical procedures.
Adult ; Aged ; Corneal Dystrophies, Hereditary/*surgery ; Corneal Wavefront Aberration/*surgery ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ/*methods ; Male ; Middle Aged ; Myopia/*surgery ; Photorefractive Keratectomy/*methods ; Prospective Studies ; Treatment Outcome