241/763. X-linked pathologic myopia. We examined a patient with decreased visual acuity and macular changes attributable to pathologic myopia. Thirteen additional family members were examined, and historic information was obtained on their relatives. A pedigree spanning six generations was constructed that demonstrated an X-linked mode of inheritance. This finding has important genetic and therapeutic implications for similarly affected patients. ( info) |
242/763. Uncommon ocular changes in Down's syndrome (mongolism). A one-year-old White female mongoloid child was seen with typical palpebral fissures, esotropia, myopic astigmatism, and nystagmus. Additional uncommon ocular findings included ganglionic neuroretinal hypoplasia (hypoplasia of the optic nerve) and bilateral congenital impatency of the nasolacrimal duct. An active search for these ocular changes is recommended in cases of Down's syndrome. ( info) |
243/763. LASIK complication: loss of electricity to the microkeratome during the forward pass. CONTEXT: A 32-year-old woman was scheduled for myopic laser in situ keratomileusis (LASIK) because of myopia and anisometropia caused by retinal detachment surgery. CASE REPORT: During surgery, a sudden malfunction of the microkeratome during the forward pass was experienced. It was not possible to reverse the blade manually along the suction ring. Moreover, disconnecting the suction from the control unit did not help at first, because the suction ring was firmly attached to the ocular surface. However, detaching the suction line from the control unit aborted the vacuum and allowed the surgeon to turn the whole microkeratome backwards, mimicking the normal blade movement. Finally, an almost normal flap was observed, and the operation was successfully completed. Afterwards, the wire to the electromotor of the microkeratome was found to be broken and subsequently replaced. CONCLUSION: This type of unforeseen microkeratome malfunction may result in serious flap or other complications. ( info) |
244/763. Central corneal haze increased by radial keratotomy following photorefractive keratectomy. PURPOSE: To report a case of central corneal haze induced by minimally invasive radial keratotomy (mini-RK) after photorefractive keratectomy (PRK) and subsequent deep lamellar keratoplasty. methods: We report a case (one eye of one patient) of central corneal haze that worsened after mini-RK was performed 2 years following PRK. Four years later, a second PRK was done, myopic regression was subsequently observed, and corneal haze persisted. Deep lamellar keratoplasty was performed and a corneal graft was taken, which was examined by light and electron microscopy. RESULTS: In the ablated area, irregularity of the basal membrane and hypertrophy of the corneal epithelium were observed. In the stromal layer, collagen fibers showed disorder in their disposition. Aggregated activated keratocytes were observed. An epithelial plug filling the gap of the RK incision persisted for 6 years after the mini-RK. The RK incision was easily divided when deep lamellar keratoplasty was performed and the patient obtained a stable visual outcome. CONCLUSIONS: It is possible that mini-RK enhancement after PRK induces central corneal haze and reduces corneal integrity. Deep lamellar keratoplasty for refractory corneal haze after refractive surgery was useful in this eye. ( info) |
| BACKGROUND: To assess the natural history of juxtafoveal and subfoveal choroidal neovascularization in eyes with high myopia. methods: We retrospectively reviewed the charts of 31 patients (31 eyes) with myopia > or = 6 diopters, well-defined juxtafoveal (1-200 microm from the foveal center) or subfoveal choroidal neovascularization (CNV) on fluorescein angiography at baseline, no prior laser treatment, age < or = 55 years and presenting visual acuity (VA) > or = 20/200. Initial and final VA were compared with the Wilcoxon signed rank test. Multifactor analysis of variance was used to assess the association between baseline characteristics of the lesion and final VA. RESULTS: Twenty-two patients were females and 9 males with a median age of 44 years (range 14-55). Median diopters spherical equivalent was -11.5 (range -6, -25). Follow-up ranged from 1 to 20 years (median, 3 years). Nine eyes had juxtafoveal CNV and 22 subfoveal involvement. Median final VA (20/100) was significantly worse than median initial VA (20/50)(p = 0.02). A decrease in VA > or = 2 lines occurred in 18 eyes, whereas 8 eyes remained stable and 5 improved (4 juxtafoveal membranes and 1 subfoveal membrane). Of the 9 juxtafoveal CNV, 7 had a final VA > or = 20/40 after a median follow-up of 4 years. By contrast, only 2 of the 22 subfoveal CNV had a final VA > or = 20/40 (median, 20/100) with a median follow-up of 2.5 years. The only factor associated with better final VA was the initial location of CNV (p = 0.0000). CONCLUSION: This study confirms the poor functional outcome of subfoveal CNV in degenerative myopia with more than 70% of patients having a final VA of 20/100 or less. Juxtafoveal CNV shows a better functional prognosis. These differences should be considered when planning treatment strategies. ( info) |
| Refractive surgery has been used widely in some countries for the last 20 years for the correction of myopia. Radial keratotomy and keratomileusis, the most common procedures, may concur with retinal detachment. A total of 14 eyes in 12 patients, 7 after keratomileusis and 7 after radial keratotomy, which had either asymptomatic or symptomatic retinal breaks, subclinical and clinical rhegmatogenous retinal detachments, or both, are discussed here. Five eyes were treated with either laser photocoagulation or cryopexy alone, seven eyes with a scleral buckling procedure, one eye with vitrectomy, and one eye was not operated on. At the final follow-up examination, anatomic reattachment had been achieved in 12 of 14 eyes (85.7%). visual acuity improved in 3 eyes (21.4%), remained stable in 9 eyes (64.3%), and was worse in 2 eyes (14.3%). The scleral buckling procedures used in the repair of retinal detachment induced refractive changes by modifying axial length and corneal curvature, with recurrence of myopia and astigmatism. myopia increased a mean of -3.00 diopters in 6 of 7 eyes (86%). Myopic astigmatism power changed a mean of -1.00 diopter in 5 eyes (71%), and the astigmatic axes shifted in 3 eyes (43%). This situation could be prevented with an early peripheral search for and treatment of peripheral retinal degenerative pathologic changes, by avoiding encircling bucklings, or by using alternative methods of treatment. ( info) |
247/763. Interface keratitis due to mycobacterium fortuitum following laser in situ keratomileusis. A case of unilateral interface keratitis due to mycobacterium fortuitum following simultaneous bilateral LASIK procedure for low myopia is reported. Excimer phototherapeutic keratectomy was performed to the stromal bed to reduce the infective load. Intensive topical therapy with topical amikacin and ciprofloxacin resulted in resolution of the keratitis. ( info) |
248/763. Optical coherence tomography for retinal detachment with a macular hole in a highly myopic eye. Optical coherence tomography can facilitate observation of the macula in highly myopic eyes, which may be difficult using an ophthalmoscope because of myopic chorioretinal atrophy. The use of optical coherence tomography to record the process of retinal reattachment and closure of a macular hole in a highly myopic eye following macular buckling surgery is described. ( info) |
249/763. Drug-induced bilateral transient myopia with the sulphonamide sulphasalazine. Whereas there are numerous reported ocular side effects from systemic sulpha medication, most are rare and reversible, with myopia being the most common reaction observed. A case report is presented of sudden bilateral onset of -1.0 DS of myopia (from -3.0 to -4.0 DS) in a young adult female following the addition of a sulphonamide (sulphasalazine) to oral non-steroidal anti-inflammatory treatment (meloxicam) for rheumatoid arthritis. The myopia regressed to -3.50 DS after 2 weeks when all medication was withdrawn and stabilised at this level when subsequent treatment was resumed after 8 weeks with the non-steroidal anti-inflammatory drug celecoxib. The case indicates that account needs to be taken of the possibility that relatively modest myopic shifts encountered in young adult contact lens wearers may be associated with concomitant systemic medication. ( info) |
250/763. Peripheral keratitis following laser in situ keratomileusis. PURPOSE: To report two different cases of sterile, peripheral keratitis following laser in situ keratomileusis (LASIK). methods: A report of two cases (two eyes of two patients). RESULTS: In two patients, peripheral infiltrates appeared 1 day after LASIK. One patient had a history of rheumatoid arthritis and both had peripheral corneal changes that may have represented prior inflammatory events. The presentations were quite different, with one occurring in association with an epithelial defect at the edge of the flap and the other occurring without an epithelial defect peripheral to the microkeratome cut. In the second case a similar infiltrate showed up in the unoperated fellow eye. Both patients were treated with aggressive antibiotic and corticosteroid therapy. Both patients recovered well with no loss of best spectacle-corrected visual acuity. CONCLUSION: Peripheral keratitis can occur in patients following LASIK; preoperative evidence of previous inflammation may be a marker for patients at higher risk. Rheumatoid arthritis patients may be at increased risk for this complication. With careful and aggressive management excellent visual outcomes are still possible. ( info) |