Superficial keratectomy, penetrating and lamellar keratoplasty have all been advocated when intervention in Reis Bucklers' corneal dystrophy is necessary because of diminished visual acuity. In this study, 11 eyes were treated by phototherapeutic keratectomy with an excimer laser. Two eyes had previously been treated by penetrating keratoplasty. The visual acuity improved in all eyes, from an average of 6/60 to 619 with complete cessation of recurrent erosions. The technique was modified, with experience, to minimise the hyperopic shift that occurs with this procedure. Phototherapeutic keratectomy has significant advantages over other procedures and is now the procedure of choice once surgery is required in Reis Bucklers' dystrophy.

BACKGROUND: The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded. METHODS: We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASDX). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids. RESULTS: Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slitlamp biomicroscopy, corneal topography, and vision. Etiology was uncertain. CONCLUSION: Central interface opacification is a rare but visually important inflammatory complication of LASLK. [J Refract Surg 1998;14:571-576]

Reis-Bückler's dystrophy has been a difficult management problem with generally poor longterm results from the conventional treatment techniques of penetrating and lamellar keratoplasty. Phototherapeutic keratectomy (PTK) is now the standard method of managing this anterior corneal disease when intervention is required. We have treated nine eyes with Reis-Bückler's dystrophy, including two in whom previous penetrating keratoplasty had been performed. All of our patients achieved substantial visual improvement from an average visual acuity of 6/60 to 6/9, and all had complete cessation of recurrent erosions. (Refract Corneal Surg (suppl) 1993;9:S96-S98.)

OBJECTIVE: To prospectively study excimer laser correction of hyperopia, with a 1-year followup. METHODS: Eleven consecutive hyperopic eyes (10 phakic and 1 aphakic) underwent correction of hyperopia using the Summit Technology SVS Apex Plus excimer laser. Data collection included cycloplegic refraction, spectacle-corrected visual acuity, contrast sensitivity, corneal haze, manual keratometry, and videokeratography. Prior to treatment the mean hyperopic spherical equivalent refraction (corneal plane) was +5.80 diopters (D)(SD 2.10). The mean attempted correction was +3.09 D at the corneal plane. RESULTS: Refractive data for the group showed a mean overcorrection at 1 month of +3.18 D. This regressed slightly before stabilizing at 3 months, with a mean overcorrection of +1.88 D. Thereafter there was no statistically significant fluctuation in refraction ip = 0.67). The amount of overcorrection and regression was greater in eyes that received higher corrections. Changes in manual keratometry and videokeratography mirrored the attempted correction more closely than refraction, although stabilization did not occur until 6 months. CONCLUSIONS: Because the hyperopic correction achieved when measured by refraction was greater than expected, algorithms should be adjusted. The hyperopic erodible disc and Axicon lens system is capable of treating low to moderate amounts of hyperopia. [J Refract Surg 1997; 13:349355]

Fourteen eyes treated by photorefractive keratectomy (PRK) for myopia required retreatment because of undercorrection. The mean preoperative refraction of these eyes had been -9.82 D (range 5.25 to 17.13). No eyes before photorefractive keratectomy had low myopia, three eyes had myopia between -3.10 and -6.00 D, four were between -6.10 and -10.00 D, and seven had more than -10.00 D of myopia. Retreatment was required for manifest scars in association with regression, unresponsive to topical corticosteroids. The retreatments were performed using a Summit ExciMed UV200LA excimer laser with a dual ablation technique utilizing a phototherapeutic keratectomy followed by a photorefractive keratectomy. Follow-up ranged from 1 to 9 months. Eight eyes followed more than 3 months had a mean spherical equivalent refraction of -0.58 D (range -7.35 to +1.25). [J Refract Corneal Surg. 1994;10:S174-S177.]