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PURPOSE: To assess subjective symptoms and objective clinical signs of dry eye and investigate corneal sensitivity after high myopic LASIK. METHODS: Twenty eyes of 20 patients with a mean age of 34±7.5 years who had undergone high myopic LASIK 2 to 5 years previously and 10 eyes of 10 controls with a mean age of 39.8±10.4 years were enrolled in the study. Clinical signs of dry eye and subjective dry eye symptoms were determined. The corneal sensitivity was assessed using non-contact esthesiometer. RESULTS: The preoperative spherical equivalent refraction was -11.40±1.40 diopters (D) (range: -9.10 to -14.00 D) and the intended spherical equivalent refraction correction was -10.40±1.10 D (range: -8.30 to -12.50 D). Schirmer'stest score was 14.4+8.9 mm in patients and 9.0±4.2 mm in controls (P= .066). The break-up time was 15.9 ±11.2 seconds in patients and 14.0±10.0 seconds in controls (P=. 505). The mean corneal sensitivity was 73.5±29.6 mL/min in patients and 78.0±18.7 mL/min in controls (P=. 666). The majority (55%) of patients still reported dry eye symptoms. Ocular surface disease index indicating degree of dry eye symptoms was significantly higher in LASIK patients (18.6+13.4%) compared to controls (7.5±5.7%; P=.022). CONCLUSIONS: The majority of patients who received LASIK for high myopia reported ongoing dry eye symptoms, although objective clinical signs of tear insufficiency and hypoesthesia were not demonstrable. We assume that symptoms represent a form of corneal neuropathy rather than dry eye syndrome. [J Refract Surg. 2007;23:338-342.]

ABSTRACT.Purpose: To quantitate the effect of intravenous hypertonic saline (IVHTS) injection on elevated intraocular pressure (IOP). Methods: Nineteen patients (median age, 65 years; range, 41-84 years) with glaucoma and an IOP 30 mmHg or higher were recruited. A bolus of IVHTS (sodium chloride concentration 23.4%) was injected in an antecubital vein over 10-20 seconds. The IOP and systolic and diastolic blood pressure (BP) were measured frequently for 2 hr. The dosage was 0.5 mmol ⁄ kg sodium in 11 patients (Group 1) and 1.0 mmol ⁄ kg in eight patients (Group 2). Results: In both groups, a median absolute IOP reduction of 7 mmHg was achieved in 5 min. The maximum median reduction was 7 mmHg (range, 4-16) and 9 mmHg (range, 3-14) at 5 and 16 min after IVHTS in Group 1 and 2, respectively, at which point the median IOP had reduced from 38 and 35 mmHg to 31 and 27 mmHg (p < 0.001), respectively. In both groups, the IOP remained 7 mmHg reduced 2 hr after IVHTS. Systolic BP increased a median of 14.5 mmHg at 3 min and was comparable with baseline after 6 min. Conclusion: Intravenous hypertonic saline solution reduces IOP moderately within minutes for up to 2 hr.

PURPOSE: To report a method of treatment for through-the-flap multibacterial ulcerative keratitis after laser in situ keratomileusis (LASIK). METHODS: Bacterial ulcerative keratitis after LASIK was treated with topical and systemic antibiotics followed by flap lifting, cleaning, and phototherapeutic keratectomy (PTK). Follow-up examinations included in vivo confocal microscopy, corneal topography, and wavefront analysis. RESULTS: Rapid recovery of the ulcerative keratitis was observed after flap lifting and cleaning of the interface and PTK combined with topical and systemic antibiotics. Two years postoperatively, corneal topography showed a slight depression of the ulcer area and decentration of the photoablation. Wavefront analysis revealed an irregular scan with a pronounced coma-like aberration, which with a wavefront-guided custom test lens correction provided 20/16 visual acuity. CONCLUSIONS: Ulcerative bacterial keratitis is a possible sight-threatening complication of LASIK refractive surgery. Lifting and rinsing the flap combined with cleaning of the flap interface with PTK may be helpful in these conditions when regression of the ulcer does not occur with topical and oral antibiotic treatment. [J Refract Surg. 2005;21:404-406.]

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