We report the outcome of conventional epipolis laser in situ keratomileusis (Epi-LASIK, flap-on) and lamellar epithelial debridement (LED; Epi-LASIK, flap-off) in myopic patients with dermatologic keloids. Three patients, who were all noted to be susceptible to keloid scarring, received conventional Epi-LASIK in their right eyes and LED in their left eyes. The patients were followed-up for 6 to 21 months after their surgeries, and the outcomes were then evaluated. In case 1, the preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). At 21 months postoperatively, the uncorrected visual acuity (UCVA) was 20 / 12.5 in both eyes. In case 2, the preoperative SE was -5.25 (OD) / -6.00 (OS). After six months, the postoperative UCVA was 20 / 12.5 in both eyes. In case 3, the preoperative SE was -4.5 (OD) / -2.0 (OS). The UCVA at the six-month follow-up was 20 / 12.5 in both eyes. No adverse events, including corneal haze, occurred in any of the patients. All three of our patients reported excellent visual outcomes following both conventional Epi-LASIK and LED, despite their histories of keloid formation. The present cases suggest that both Epi-LASIK and LED may be safe and effective techniques for myopic patients with dermatologic keloids.
Adult ; *Debridement ; Eyeglasses ; Female ; Follow-Up Studies ; Humans ; Keloid/complications/physiopathology/*surgery ; Keratomileusis, Laser In Situ/*methods ; Myopia/complications/physiopathology/*surgery ; Postoperative Period ; Skin Diseases/complications/physiopathology/*surgery ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H(R)) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1~5) numeric scale. RESULTS: The mean age of patients was 37.3+/-9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10+/-5.41 diopters (D). The postoperative mean refraction (SE) was -1.75+/-0.76 D at six months. The postoperative BCVA improved an average 3.92+/-1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.
Visual Acuity/*physiology ; Treatment Outcome ; Severity of Illness Index ; Retrospective Studies ; Refraction, Ocular/*physiology ; Myopia/complications/physiopathology/*surgery ; Middle Aged ; Male ; Lens Implantation, Intraocular/*methods ; Humans ; Follow-Up Studies ; Female ; Anterior Chamber/*surgery ; Amblyopia/complications/physiopathology/*surgery ; Adult

INTRODUCTIONThis paper reports the 1-year results of the first 2 cases of macular translocation in Singapore.

CLINICAL PICTUREA 66-year-old female and a 45-year-old male Chinese presented with subfoveal choroidal neovascularisation (CNV) in their right eyes. The woman's condition was secondary to pathological myopia while the man's was idiopathic. Their preoperative best-corrected visual acuities were 6/15-2 and 6/30, respectively.

TREATMENTBoth patients underwent macular translocation with punctate retinotomies and chorioscleral infolding (limited macular translocation) in their affected eye.

OUTCOMEBoth patients achieved effective macular translocation postoperatively. Their CNVs became extrafoveal and were ablated with conventional laser photocoagulation in the early postoperative period. They did not recur and their visual acuities improved to 6/9-1 and 6/12 at 1 year postoperatively, respectively.

CONCLUSIONMacular translocation is a new treatment modality that offers patients with subfoveal CNV a chance of improving their vision, potentially to a level that may allow reading and driving.

Aged ; Choroidal Neovascularization ; diagnostic imaging ; etiology ; surgery ; Female ; Fluorescein Angiography ; Humans ; Laser Coagulation ; Macula Lutea ; transplantation ; Macular Degeneration ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Myopia, Degenerative ; complications ; Prognosis ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Visual Acuity