Purpose: To determine the ten-year visual results and outcomes of excimer laser pho totherapeutic keratectomy (PTK) for recurrent corneal erosions. Methods: Twenty-six eyes of 23 patients with recurrent corneal erosions were treated by PTK from 1996 to 2000 at the Goiania Eye Institute, Brazil. All eyes had failed to respond to conventional therapy. Data regarding preoperative and postopera ti ve best-spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE), sympto matic relief, incidence of recurrence, and complications arising from the laser treatment were analyzed. The mean duration of symptoms prior to PTK was 18 months (range, 8 to 36 months). The corneal epithelium was debrided, and laser ablation was performed to a depth of 5 micron with an ablation zone of 7 to 9 mm, using the Technolas 217C Plano Scan excimer laser. Mean postoperative follow-up was 12 years (range, 10 to 14 years). Results: At the last follow-up visit, 15 eyes (57.69%) were symptomsfree. Five eyes (19.2%) had occasional mild symptoms of irritation and photophobia upon awakening. Recurrence of painful corneal erosions occurred in six eyes (23.07%), which required a PTK retreatment. Twenty-four eyes had a preserved or improved BCVA, while 2 eyes showed deterioration of 1 line on Snellen test. Eleven eyes (42.3%) had no change in SE, and the others (57.69%) had a change of less than +/-0.75 diopters (D). There were no major complications during the follow-up period. Conclusion: Ten-year data show that PTK is a safe, fast, effective and minimal invasive choice of treatment for recurrent corneal erosions in patients who do not respond to conventional treatments.
Purpose: To evaluate the clinical outcomes of intrastromal corneal ring segment (ICRS) implantation to correct ectasia in eyes with prior refractive surgery. Methods: Forty-one eyes of 25 patients (13 men, 12 women; mean age, 28.66 years) with ectasia after refractive surgery [photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK)] were included in a nonrandomized, retrospective, observational case series. Corneal tunnels were created by mechanical dissection in all eyes. Main outcome measures included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), refraction, keratometry, and computerized analysis of corneal topography. Patients were divided into two groups by the type of refractive surgery (Group A: PRK, Group B: LASIK). Results:The mean preoperative manifest astigmatism decreased from -1.88 to -0.84 D in Group A (p=0.096) and -3.18 to -1.77 D in Group B (p=0.000). The mean keratometric astigmatism decreased from -2.58 to -1.66 D in Group A (p=0.010) and -4.80 to -2.78 D in Group B (p=0.000). The mean spherical equivalent decreased from -2.97 to -2.05 D in Group A (p=0.065) and -3.31 to -2.42 D in Group B (p=0.014). No significant between-group differences were noted on the comparison of preoperative and postoperative results. No intraoperative or postoperative com plications were observed. Conclusion: ICRS implantation is a useful treatment option for ectasia following refractive surgery, and it has significantly reduced the refractive cylinder and increased best spectacle-corrected visual acuity.
P urpose: To determ ine the safety and efficacy of corneal collagen cross-linking (C X L ) for progressive keratoconus in patients aged betw een 9 and 14 years old. M ethods: Sixteen eyes of 11 patients (8 m ale and 3 fem ale) w ith progressive keratoconus underw ent epithelium -off C X L according to the standard D resden protocol. M ean follow -up w as 26 m onths (range, 12 to 60 m onths). P re-and postoperative exam inations included: uncorrected visual acuity (U C V A ), best spectacle-corrected visual acuity (B SC V
Objetivo: Comparar os resultados obtidos pelas técnicas de "laser in situ keratomileusis" (LASIK) e "photorefractive keratectomy" (PRK) na correção de miopia e astigmatismo em olhos previamente submetidos à cirurgia de descolamento de retina (DR) com "buckle" escleral. Métodos: Vinte e cinco olhos de 22 pacientes com alterações refracionais significativas após a cirurgia de DR foram submetidos à cirurgia refrativa. Em 14 olhos de 13 pacientes foi realizado LASIK e em 11 olhos de 9 pacientes, PRK. O intervalo mínimo entre a cirurgia de DR e a cirurgia refrativa foi de 12 meses. O tempo de seguimento foi de, pelo menos, 12 meses. Resultados: Doze meses após a cirurgia, a média do equivalente esférico (EE) no grupo submetido ao LASIK diminuiu de -6,49 D antes da cirurgia para -0,17 D e a média do cilindro de -1,10 D para -0,23 D. A média do EE no grupo submetido ao PRK foi reduzida de -5,35 D para +0,02 D e a média do cilindro, de -1,38 D para -0,54D. Em ambos os grupos, 11 olhos apresentaram melhora da acuidade visual sem correção de pelo menos 4 linhas. Conclusão: Tanto o LASIK quanto o PRK foram seguros e eficazes para a correção do erro refracional induzido após a cirurgia de DR. Nossos resultados não apresentaram diferenças significativas entre os procedimentos. Estudos posteriores envolvendo maior amostragem e seguimento mais prolongado contribuirão para melhor avaliação da cirurgia refrativa em pacientes submetidos à cirurgia com "buckle" escleral. A indentação escleral por meio da colocação de faixa e explante escleral é um dos procedimentos utilizados rotineiramente para retinopexia em pacientes com descolamento de retina simples. Consiste na aproximação mecânica do epitélio pigmentado da retina sensorial selando a rasgadura que permite a entrada de líquido sub-retiniano (1) . Esse procedimento leva a uma compressão do equador do bulbo ocular com mudança em seu comprimento axial. De acordo com a literatura há aumento do diâmetro ântero-posterior do olho de cerca de 0,99 mm com indução de miopia em torno de 2,75 D, podendo também, ocorrer astigmatismo regular ou irregular (2)(3) . LASIK e PRK constituem atualmente os principais procedimentos para tratamento de ametropias (4)(5) . As indicações para realização de cirurgia refrativa com o "excimer laser" não se limitam apenas à correção do erro refracional bilateral, sendo também utilizado para o tratamento de anisometropias em que o paciente não tolera a correção com óculos ou lentes de contato. Em pacientes submetidos à cirurgia com "buckle" escleral, o erro refracional induzido pode comprometer o resultado cirúrgico, principalmente quando Descritores: Ceratectomia fotorrefrativa por excimer laser; Ceratomileuse assistida por excimer laser in situ; Deslocamento retiniano/cirurgia; Miopia/cirurgia; Astigmatismo/ cirurgia; Adulto LASIK x PRK after retinal detachment surgery
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