1/27. Decompensated strabismus after laser in situ keratomileusis.We present a case of decompensated nerve IV palsy with vertical diplopia afer bilateral laser in situ keratomileusis. As the patient was given monovision, we believe diplopia occurred with a decrease in vision in 1 eye and interruption of fusion. Although corrective spectacles to restore equal vision at distance were prescribes, the patient needed a prism to eliminate her double vision. We suggest a careful cover/uncover test and versions assessment in all candidates for refractive surgery who want monovision correction and a full ocular motility evaluation if there is any doubt about binocular issues.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/27. Confocal microscopy of a patient with irregular astigmatism after LASIK reoperations and relaxation incisions.PURPOSE: Laser-assisted in situ keratomileusis (LASIK) is widely used for correcting refractive errors. If the predicted refractive result is not achieved after the first operation, a re-operation can be performed by ablating more stromal tissue after reopening the flap. The goal of this study was to analyze, by using in vivo confocal microscopy, the morphologic changes associated with repeated LASIKs. methods: Clinical examination, computed corneal topography, and real-time in vivo confocal microscopy were performed on both eyes of a 50-year-old patient with induced irregular astigmatism leading to decreased best-corrected vision in the left eye after LASIK. The left cornea had been operated on 5 times (LASIK with two reoperations followed by two relaxing incisions), and the right cornea twice (LASIK with one reoperation). RESULTS: Microfolds at the level of the Bowman's layer and highly reflective particles at the flap interface were observed in both corneas. The subbasal nerve plexus was severed in the left eye. In addition, we identified epithelial material in the flap margin and inside one of the two relaxing incisions placed inferotemporally. CONCLUSION: Repeated LASIKs may stretch the flap and result in microfolding at the Bowman's layer. This and deposition of particles in the flap interface may increase with the number of reoperations, challenging the healing response. Microfolding and occurrence of foreign material in the interface may add to the irregular astigmatism and poor visual outcome after LASIK. Clinical in vivo confocal microscopy offers new possibilities for the assessment of ultrastructural changes after corneal refractive surgery.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/27. Visual field defect associated with laser in situ keratomileusis.PURPOSE: To report a case of visual field defect associated with laser in situ keratomileusis. methods: Case report. A 28-year-old woman with high myopia (-10D) and a family history of normal tension glaucoma underwent bilateral laser in situ keratomileusis keratorefractive surgery. Preoperatively, both eyes had normal intraocular pressure and visual field. RESULTS: At the first postoperative visit 1 day after apparently uncomplicated laser in situ keratomileusis, the patient reported a scotoma in the right eye. At 3-month follow-up, visual fields revealed the patient had developed a near-superior altitudinal visual field defect in the right eye. The defect did not progress over 1 year of follow-up examinations. CONCLUSION: Increased intraocular pressure associated with the microkeratome vacuum ring used during laser in situ keratomileusis may have precipitated optic nerve head ischemia and visual field defect.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/27. Laser in situ keratomileusis-induced optic neuropathy.OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery. DESIGN: Observational case report. methods: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits. MAIN OUTCOME MEASURES: optic nerve status, visual field status, and visual acuity. RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified. CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
5/27. In vivo confocal microscopy of corneal epithelial ingrowth through a laser in situ keratomileusis flap buttonhole.We report a case of epithelial ingrowth through a buttonhole 6 months after laser in situ keratomileusis. Elevation topography showed irregular astigmatism and an unreliable pachymetric map. In vivo confocal microscopy showed an epithelial basal cell mosaic with prominent borders and distinct nuclei. No corneal nerves were identified in any image. Cells in the anterior stroma possessed bright, reflective nuclei and appeared to form clusters. The interface between the stromal bed and the flap had formation of nests of fibrotic tissue and epithelial cells.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/27. Histologic and ultrastructural findings in human corneas after successful laser in situ keratomileusis.OBJECTIVE: To examine the histologic and ultrastructural features of human corneas after successful laser in situ keratomileusis (LASIK) in 2 patients post mortem. methods: Portions of 4 corneas were processed for histology, transmission electron microscopy, and scanning electron microscopy. RESULTS: Case 1 had undergone LASIK 3 months prior to death and case 2 had undergone LASIK 20 months prior to death. A Hansatome (Bausch & Lomb Surgical Inc, Clarement, Calif) microkeratome with a 180-microm plate had been used for case 1 and an Automated Corneal Shaper (Chiron Corporation, Munich, germany) with a 160-microm plate had been used for case 2. Histologically, the LASIK flap measured 160 microm and 150 microm in thickness in case 1 and case 2, respectively. Corneas from both cases exhibited minor epithelial ingrowth into the wound, reactive keratocytes at the wound margin, irregular collagen fibrils in the wound bed, and severed collagen bundles at the flap hinge. These findings were more pronounced in case 1 than in case 2, and the wound interface was virtually imperceptible in case 2. Additionally, the corneas from case 1 contained periodic acid-Schiff--positive electron dense material and wide-spaced collagen at the wound interface, and there was an absence of corneal nerves. CONCLUSIONS: These findings show that changes caused by wound repair that are present at 3 months are minor 20 months after LASIK.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/27. Unilateral acquired upper eyelid ptosis and decreasing nystagmus.PURPOSE: To describe a patient with congenital nystagmus that decreased in one eye after the development of a cavernous sinus meningioma. DESIGN: Interventional case report. methods: A 45-year-old man with congenital nystagmus, albinism, and high myopia presented with right upper eyelid ptosis that was corrected surgically on three occasions during a 3-year period. An episode of syncope was followed by diagnostic evaluation that disclosed a cavernous sinus meningioma. He commented that his right eye nystagmus progressively decreased. He was found to have ophthalmoplegia on the right eye due to nerve compression by the meningioma. RESULTS: A magnetic resonance imaging scan disclosed a cavernous sinus meningioma extending into the parachiasmal and clival areas. A biopsy specimen of the lesion demonstrated a meningioma. CONCLUSIONS: Any patient with acquired ptosis should have a complete ophthalmic examination, including evaluation of extraocular motility.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/27. Aberrant regeneration of corneal nerves after laser in situ keratomileusis.We report a case of aberrant regeneration of corneal nerves along the corneal flap interface after myopic laser in situ keratomileusis (LASIK) using confocal microscopy in vivo. The aberrant stromal nerves persisted at the last follow-up, 2 years post LASIK. The short-term clinical outcome was excellent. The long-term clinical effects are unknown.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
9/27. Myelinated nerve fibers and severe myopia.Two 4-year-old boys, one white and one black, had unilateral extensive myelinization of retinal nerve fibers associated with severe myopia, esotropia, and amblyopia. The finding of unilateral extensive myelinization of the nerve head and retinal fibers in a child may indicate a potentially remediable anisometropic amblyopia.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
10/27. 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.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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