PURPOSE: Several authors have assessed the effect of prophylactic briomonidine on bleeding complications and flap adherence after laser in situ keratomileusis (LASIK). This study further evaluates these potential associations. METHODS: We performed a prospective, doublemasked, single-surgeon study of 31 patients (61 eyes) who underwent LASIK with or without prophylactic brimonidine for primary myopia/ myopic astigmatism (59 eyes) or hyperopic astigmatism (2 eyes). Among myopes, mean preoperative sphere was -4.44 ± 2.21 D and mean cylinder was -1.04 ± 1.01 D. Thirty-three eyes (54%) had nasal hinges; 28 eyes (46%) had superior hinges. RESULTS: Subconjunctival hemorrhage was observed in 22 of 61 eyes (36.1%). Three of these 22 eyes (13.6%) received prophylactic brimonidine; the remaining 19 eyes with subconjunctival hemorrhage (86.3%) did not receive brimonidine (P<0001). All but three eyes had some hyperemia; however, the amount of hyperemia was lower in the brimonidine group (P<.0001). Bleeding from the superior micropannus occurred in four of 61 eyes (6.6%). One of these four eyes received brimonidine. There was one case of flap slippage in a nonbrimonidine eye with a nasal hinge; no flap striae were observed after repositioning. CONCLUSION: This study suggests that brimonidine administered before LASIK may significantly reduce subconjunctival hemorrhage and reduce the amount of hyperemia. [J Refract Surg 2002;18:468-471]

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BACKGROUND: Posterior polymorphous dystrophy has been described in the scientific literature as having more than a casual association with keratoconus in adults. We studied four consecutive children with posterior polymorphous dystrophy who had coexisting astigmatism. In our patients, the posterior changes appeared to be associated with the corneal astigmatism, as evidenced by videokeratography. METHODS: Four consecutive cases of posterior polymorphous dystrophy in children were found over a 3-year period by one of the authors (PD). They presented with varying degrees of amblyopia in the eyes with the greater amount of posterior polymorphous dystrophy. Cycloplegic refractions and keratometry readings were performed . The more affected eyes had greater degrees of astigmatism, presumably causing the amblyopia. Whenever possible, the results were supplemented by confirmation by a corneal specialist, specular microscopy, slit-lamp photographs and videokeratography. RESULTS: Greater asymmetry of posterior polymorphous dystrophy was associated with greater astigmatism in the more affected eye. When more astigmatic anisometropia was present there was a greater amblyopia. Videokeratography of one of the patients showed that an area of confluent blebs forming a crescent shape compared exactly with a steep cylinder along the same axis. With-the-rule astigmatism was associated with a more diffuse pattern of blebs. CONCLUSION: Decreases in visual acuity in children with posterior polymorphous dystrophy may sometimes be due to an amblyopia caused by the astigmatism of asymmetric disease. [J Refract Surg. 1996;12:709-714.]

No author has a financial or proprietary interest in any material or method mentioned.