OBJECTIVEA systematic review of literature was performed to compare various visual function parameters including the final visual acuity outcome and/or adverse events between corneal refractive surgery (CLRS) and phakic intraocular lens implantation (p-IOLi) in the treatment of refractive amblyopic children.

DATA SOURCESTwo reviewers independently searched the PubMed, EMBASE, and Controlled Trials Register databases for publications from 1991 to 2013.

STUDY SELECTIONThere were 25 articles, including 597 patients and 682 eyes, was included in CLRS group. Among them, 21 articles reported the use of CLRS in the treatment of myopic anisometropia for 318 patients (13 photorefractive keratectomy or laser epithelial keratomileusis and eight laser in situ keratomileusis). And 11 articles had the results of CLRS in treating hyperopic anisometropic amblyopia children. Eleven articles reported the effect of p-IOLi for treating high myopia or anisometropic amblyopia, including 61 patients (75 eyes). Age, pre- and postoperation best-corrected vision acuity (BCVA), and spherical equivalent (SE) were compared in CLRS and p-IOLi groups.

RESULTSThe average age of CLRS group and p-IOLi group has no statistically significant difference. The SE in CLRS group for myopic anisometropia amblyopia patients was (-10.13 ± 2.73) diopters (D) and for hyperopic anisometropia amblyopia patients was (5.58 ± 1.28) D. In p-IOLi group the SE was (-14.01 ± 1.93) D. BCVA was improved significantly in both groups, and even better in p-IOLi group. Refractive errors were corrected in both groups, but there was no clinically significant difference in final SE between each group. More than one-half of the children had improved binocular fusion and stereopsis function in both groups.

CONCLUSIONSBoth CLRS group and p-IOLi group showed their advantage in treating refractive amblyopia in children. In comparing p-IOLi with CLRS for treatment of refractive amblyopia, no statistically significant difference in final BCVA was observed.

Amblyopia ; etiology ; surgery ; therapy ; Anisometropia ; complications ; Child ; Child, Preschool ; Humans ; Myopia ; complications

PURPOSE: To evaluate the optical quality after laser in situ keratomileusis (LASIK) or serial photorefractive keratectomy (PRK) using a double-pass system and to follow the recovery of optical quality after laser vision correction. METHODS: This study measured the visual acuity, manifest refraction and optical quality before and one day, one week, one month, and three months after laser vision correction. Optical quality parameters including the modulation transfer function, Strehl ratio and intraocular scattering were evaluated with a double-pass system. RESULTS: This study included 51 eyes that underwent LASIK and 57 that underwent PRK. The optical quality three months post-surgery did not differ significantly between these laser vision correction techniques. Furthermore, the preoperative and postoperative optical quality did not differ significantly in either group. Optical quality recovered within one week after LASIK but took between one and three months to recover after PRK. The optical quality of patients in the PRK group seemed to recover slightly more slowly than their uncorrected distance visual acuity. CONCLUSIONS: Optical quality recovers to the preoperative level after laser vision correction, so laser vision correction is efficacious for correcting myopia. The double-pass system is a useful tool for clinical assessment of optical quality.
Adult ; Female ; Humans ; *Keratomileusis, Laser In Situ ; Male ; Middle Aged ; Myopia/*surgery ; *Photorefractive Keratectomy ; Postoperative Complications ; Prospective Studies ; *Recovery of Function ; Treatment Outcome ; *Visual Acuity ; Young Adult

PURPOSE: To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS). METHODS: Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group. RESULTS: With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 micrometer, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003). CONCLUSIONS: Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.
Adult ; Female ; Glaucoma/*complications/drug therapy/pathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Myopia/*complications/pathology/*surgery ; *Refractive Surgical Procedures ; Retrospective Studies ; Severity of Illness Index ; Tomography, Optical Coherence

PURPOSE: To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS). METHODS: Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group. RESULTS: With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 micrometer, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003). CONCLUSIONS: Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.
Adult ; Female ; Glaucoma/*complications/drug therapy/pathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Myopia/*complications/pathology/*surgery ; *Refractive Surgical Procedures ; Retrospective Studies ; Severity of Illness Index ; Tomography, Optical Coherence

A 38-year-old woman developed diffusely distributed opacities with crystalline materials in the laser in situ keratomileusis (LASIK) interface of her eye after she was scratched by a sprig during mountain climbing. No sign of flap displacement was noted. Despite two days of topical and systemic antibiotics therapy, the corneal infiltration with interface opacities persisted. The following day, the distribution of the crystalline materials had rotated in a counterclockwise direction. Flap lifting and foreign body removal using sufficient irrigation were performed. One month after surgery, the patient's postoperative uncorrected visual acuity was 0.8 with cleared interface. No signs of epithelial ingrowth or flap striae were noted. Mild traumatic corneal scratching without flap displacement may threaten the integrity of the LASIK interface. If foreign bodies are suspected to be the cause of inflammation, early flap lifting with irrigation is imperative for successful treatment.
Adult ; Cornea/*injuries/pathology/surgery ; Eye Injuries/*complications/diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ/*methods ; Myopia/surgery ; *Surgical Flaps ; Surgical Wound Dehiscence/diagnosis/*etiology/surgery ; Wounds, Nonpenetrating/*complications/diagnosis/surgery

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

OBJECTIVE: To investigate the pathogenesis and treatment of high myopia in patients with angle-closure glaucoma. METHODS: Clinic data of 692 patients with angle closure glaucoma were analyzed retrospectively. Eleven patients with high myopia and angle closure underwent surgery. RESULTS: Eleven patients with high myopia in the 692 angle-closure glaucoma were identified: 3 Weill-Marchesani syndrome, 1 plateau iris configuration and syndrome, 5 primary pupillary block, and 2 iris cyst. Intraocular pressure in 19 eyes of the 11 patients was successfully controlled after receiving phaco or filtering surgery. CONCLUSION Angle closure can occur in eyes with high myopia, and pupillary block may be the main cause of angle closure.
Adult ; Aged ; Female ; Glaucoma, Angle-Closure ; diagnosis ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Myopia ; complications ; diagnosis ; Retrospective Studies ; Young Adult

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

PURPOSE: Cornelia de Lange syndrome is a rare disease showing characteristic facial appearance, developmental delay, growth retardation, low birth weight, skeletal formation anomaly, hirsutism and various ophthalmologic problems. METHODS: We experienced a case of an 18-year-old female with Cornelia de Lange syndrome showing superficial keratitis with entropion, ptosis, high myopia, lacrimal cutaneous fistula and characteristic facial appearance. She was born with low birth weight, operated for cleft palate and diagnosed with ventricular septal defect. In addition, she showed psychological lag and developmental impairment. RESULTS: We performed entropion correction surgery, administered medical therapy for superficial keratitis and prescribed glasses for her myopia. CONCLUSIONS: This is the first case report on the successful correction of entropion with Cornelia de Lange syndrome in Korea.
Adolescent ; *Asian Continental Ancestry Group ; Blepharoptosis/*complications ; De Lange Syndrome/*complications/*ethnology ; Entropion/*complications/surgery ; Eyeglasses ; Female ; Humans ; Keratitis/*complications/drug therapy ; Myopia/*complications/therapy

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