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Biomedical subjects

Brian S Boxer Wachler

Publications and source records attributed to Brian S Boxer Wachler.

At least 19 recordsLinked to original sources
PubMed2007

Effect of inferior-segment Intacs with and without C3-R on keratoconus.

PURPOSE: To determine whether corneal collagen cross-linking with riboflavin (C3-R) augments the effect of inferior-segment Intacs (Addition Technology) in the treatment of keratoconus. SETTING: Private practice, Beverly Hills, California, USA. METHODS: A retrospective nonrandomized comparative case series comprised 12 eyes of 9 patients who had inferior-segment Intacs placement without C3-R (Intacs-only group) and 13 eyes of 12 patients who had inferior-segment Intacs placement combined with C3-R (Intacs with C3-R group). The 2 groups were matched preoperatively. All patients had inferior-segment Intacs placed with the incision in the steep axis of manifest refraction. Corneal collagen cross-linking with riboflavin was performed after the Intacs segments were inserted. Outcome measures were topographic keratometry values and the lower-upper (L-U) ratio, which is a topographic measure of the degree of keratoconus. Preoperative data were compared to results 1 day postoperatively and measurements at the last postoperative visit. RESULTS: The Intacs with C3-R group had a significantly greater reduction in cylinder than the Intacs-only group (P<.05). Steep and average keratometry were reduced significantly more in the Intacs with C3-R group (P<.05). There was a greater reduction in L-U ratio in the Intacs with C3-R group (P<.05). CONCLUSION: The addition of C3-R to the Intacs procedure resulted in greater keratoconus improvements than Intacs insertion alone.

Adult↗
PubMed2006

Comparison of the effects of LASIK retreatment techniques on epithelial ingrowth rates.

PURPOSE: To compare the incidence of postoperative epithelial ingrowth using 3 different surgical LASIK retreatment techniques. DESIGN: Retrospective consecutive case series. PARTICIPANTS AND CONTROLS: Thirty consecutive eyes that underwent LASIK retreatments by a single surgeon. METHODS: The first 10 eyes underwent LASIK retreatment using the surgeon's routine surgical technique (forceps lift group), the next 10 retreated eyes had a bandage contact lens placed after surgery and removed the following day (contact lens group), and the next 10 patients had retreatment performed using a Pinelli spatula to cleave the circumference of the flap edge before lifting the flap and no contact lens placed after surgery (spatula cleaving group). The retreatment technique did not vary apart from these modifications. MAIN OUTCOME MEASURES: Incidence of postoperative epithelial ingrowth. RESULTS: The incidence of epithelial ingrowth was 40% in the contact lens group, 20% in the forceps lift group, and 10% in the spatula cleaving group. There was a trend toward a significant difference between the contact lens and spatula cleaving groups (P = 0.12). The patients with epithelial ingrowth showed a trend toward being older, with a mean age of 53+/-8.5 years compared with a mean age of 44+/-13 years for the patients without epithelial ingrowth (P = 0.07). Incidence of ingrowth was not related to the preoperative spherical equivalent. CONCLUSIONS: There was an increased incidence of epithelial ingrowth with use of an overnight bandage contact lens in our series. The Pinelli spatula may reduce trauma to the epithelium at the flap edge. The incidence of epithelial ingrowth was not related to the preoperative spherical equivalent. Increasing age may be a risk factor for epithelial ingrowth, but further study is warranted.

Adult↗
PubMed2006

Comparison of single-segment and double-segment Intacs for keratoconus and post-LASIK ectasia.

PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment Intacs in subjects with post-LASIK ectasia and keratoconus. DESIGN: Retrospective comparative analysis. METHODS: setting: Boxer Wachler Vision Institute, Beverly Hills, California, USA. study population: Thirty-seven eyes of 28 patients with keratoconus and post-LASIK ectasia classified into two groups: single-segment group (17 eyes, 11 patients) and double-segment group (20 eyes, 17 patients). Both groups were matched for age, visual acuity (uncorrected, UCVA; best spectacle-corrected, BSCVA), refractive error (sphere, cylinder, spherical equivalent), and keratometry (K) value (flat, steep, average) by t test for equality of means. intervention: Single- or double-segment Intacs procedure with axis of incision for insertion in the steep axis of manifest refraction. main outcome measure: Improvement of acuity, refractive error, K values, and inferior-superior (I-S) ratio. RESULTS: There was more improvement in UCVA in the single-segment group (nine lines) than the double-segment group (2.5 lines), P < .01; in BSCVA in the single-segment group (2.5 lines) than the double-segment group (<1 line), P < .01; in steep K values in the single-segment group (2.76 diopters +/- 2.68) than the double-segment group (0.93 diopters +/- 2.01), P = .02; and in I-S ratio in the single-segment group (9.51 +/- 7.49) than the double-segment group (4.22 +/- 4.82), P = .01; and greater cylinder decrease after Holladay vector analysis in the single-segment group (5.69 diopters +/- 3.10) than the double-segment group (1.58 diopters +/- 3.09), P < .01. CONCLUSIONS: Single-segment Intacs improved both UCVA and BSCVA by differential flattening of inferior meridian and steepening of superior meridian as reflected by change in I-S ratio.

Adult↗
PubMed2006

Centration analysis of ablation over the coaxial corneal light reflex for hyperopic LASIK.

PURPOSE: To analyze postoperative topographic centration when the coaxially sighted corneal light reflex was used for laser centration in hyperopic LASIK. METHODS: Centration photographs of 21 eyes (12 patients) that underwent hyperopic LASIK with centration over the coaxially sighted corneal light reflex were reviewed to determine the distance from the entrance pupil center to the coaxially sighted corneal light reflex. Postoperative ablation centration was determined topographically at day 1 and 3 months by four different methods. The difference between the actual decentration and the decentration that would have occurred had the ablation been centered over the entrance pupil center was calculated. RESULTS: The mean deviation of the coaxially sighted corneal light reflex from the entrance pupil center preoperatively was 0.34 +/- 0.24 mm nasal or 4.5 +/- 3.0 degrees. At 1 day, the average decentration was 0.10 mm or 1.3 degrees temporal. The mean decentration that would have occurred if the ablation had been centered over the entrance pupil center was 0.44 mm or 5.5 degrees temporal. At 3 months, the average decentration was 0.07 mm or 0.25 degrees temporal. The mean decentration that would have occurred if the ablation had been centered over the entrance pupil center was 0.45 mm or 5.6 degrees temporal. Mean uncorrected visual acuity (logMAR) improved 3 lines from 0.54 +/- 0.14 (20/70) to 0.22 +/- 0.17 (20/32). No eye lost >2 lines of best spectacle-corrected visual acuity (BSCVA); 2 (10%) eyes lost 1 line of BSCVA at 3-month follow-up. CONCLUSIONS: Excellent centration in hyperopic ablation is possible even in eyes with positive angle kappa when the ablation is centered over the corneal light reflex.

Cornea↗
PubMed2005

Functional optical zone after myopic LASIK as a function of ablation diameter.

PURPOSE: To analyze spherical aberrations in patients who had myopic laser in situ keratomileusis (LASIK) with different optical zones and varying degrees of attempted corrections. SETTING: Laser Refractive Center, University of California, Los Angeles, USA. METHODS: This retrospective analysis comprised 78 eyes of 56 consecutive patients who had LASIK for myopia with the Alcon LADARVision excimer laser. The preoperative and 3-month postoperative functional optical zones (FOZs), a measure of spherical aberrations, were assessed in each eye. The change in FOZs was analyzed by size of the primary optical zone and degree of attempted correction. RESULTS: The mean preoperative FOZ was 6.1 mm +/- 0.6 (SD) and the mean 3-month FOZ, 5.2 +/- 1.0 mm. The mean decrease was 0.9 +/- 1.0 mm (P < .0001). The mean decreases were 0.005 +/- 0.7 mm, 0.7 +/- 0.9 mm, and 1.6 +/- 0.9 mm in the low, moderate, and high attempted correction groups, respectively (P < .05), and 1.3 +/- 0.9 mm, 1.2 +/- 1.0 mm, 0.5 +/- 1.3 mm, and 0.3 +/- 0.7 mm in optical zone groups of 6.0 to 6.5 mm, 6.6 to 7.0 mm, 7.1 to 7.5 mm, and 7.6 to 8.0 mm, respectively (P < .05). CONCLUSIONS: Larger optical zones had fewer postoperative spherical aberrations. Higher attempted corrections had larger increases in spherical aberrations. Larger treatment diameters minimized postoperative spherical aberrations.

Adolescent↗
PubMed2005

Reversal of laser in situ keratomileusis-induced ectasia with intraocular pressure reduction.

A 40 year-old woman had laser in situ keratomileusis for --7.75 --0.75 x 20 in the right eye. Preoperative examinations, including topography, pachymetry, and intraocular pressures (IOPs), were normal, and best spectacle-corrected visual acuity (BSCVA) was 20/20 in each eye. By 4 months postoperatively, the uncorrected visual acuity and BSCVA in the right eye had decreased to 20/40. Corneal topography of that eye was consistent with ectasia. One drop per day of timolol 0.5% (Timoptic XE) was prescribed. Five months postoperatively, the IOP had decreased and BSCVA and topography had improved. At 11 months, BSCVA returned to 20/20 and corneal topography normalized. Topographic difference maps were used to monitor corneal shape changes. In this case, early reduction in IOP completely reversed the ectasia.

Adult↗
PubMed2005

Establishing analysis parameters for spherical aberration after wavefront LASIK.

PURPOSE: To compare preoperative and postoperative spherical aberration, coma, and other higher order aberrations from wavefront LASIK at varying pupil analysis diameters and different myopic corrections, and to determine acceptable parameters for wavefront measurements. DESIGN: Nonrandomized retrospective chart review. PARTICIPANTS: Twenty-one eyes of 12 patients who had CustomCornea LASIK with the LADARVision 4000 (Alcon, Fort Worth, TX). METHODS: Wavefront analyses were performed before and 3 months after CustomCornea LASIK using a 6.5-mm central optical zone and blend zone to 9.0 mm. Wavefront measurements were made with pupil analysis diameters of 5.5, 6.0, 6.5, and 7.0 mm. Myopic corrections were divided into 3 spherical equivalent subgroups: low (<3 diopters [D]), medium (3-6 D), and high (>6 D). Main outcome measures were compared based on myopic subgroup within each analysis diameter. Results were analyzed with analysis of variance and paired t tests. MAIN OUTCOMES MEASURES: Spherical aberration, coma, and other higher order aberrations. RESULTS: There were no significant increases in coma or other higher order aberrations postoperatively or with larger analysis diameters. There was a significant increase in postoperative differences in spherical aberration between 6.5 and 7.0 mm for the >6-D myopic correction subgroup (P = 0.03). Differences between other 0.5-mm intervals and other subgroups were not significant. CONCLUSIONS: The largest difference between preoperative and postoperative spherical aberration occurred at the analysis diameter 0.5 mm greater than the laser optical zone for the subgroup with high myopic correction. To detect larger degrees of induced spherical aberrations, analysis diameters 0.5 mm larger than the central laser optical zone should be considered.

Adult↗
PubMed2004

Reasons patients recommend laser in situ keratomileusis.

PURPOSE: To evaluate the reasons patients who have had laser in situ keratomileusis (LASIK) recommend it to others and examine the disparity between high levels of satisfaction and patient reports of night-vision symptoms and/or dry eye after LASIK. SETTING: Northeastern Eye Institute, Scranton, and the University of Pittsburgh, Pittsburgh, Pennsylvania, and the University of California at Los Angeles, Los Angeles, California, USA. METHODS: Questionnaires assessing symptoms and satisfaction after LASIK were mailed to 2,100 patients. The questionnaires included items about night-vision symptoms and satisfaction and an open-ended question for patients to give their reasons for recommending LASIK to others. The open-ended responses were categorized and tabulated. RESULTS: Four hundred thirty-four patients provided reasons for recommending LASIK to others. Sixteen categories of reasons were identified. "No more spectacles/contact lenses" was listed by 180 patients (42%), followed by "better vision" (21%) and "convenience" (15%). Women were significantly more likely to cite "better comfort" (27 women versus 3 men; chi square = 8.99, P =.003) and "better quality of life" (41 women versus 9 men; chi square = 7.36, P =.007) as a reason for recommending LASIK. Of the 35 patients who reported dissatisfaction with post-LASIK vision, 20 (57%) would recommend LASIK to a friend because "LASIK helps others." CONCLUSIONS: Categories of reasons for recommending LASIK to others were similar to reasons given by patients for seeking LASIK. Some patients who reported dissatisfaction with their vision said they would recommend LASIK, suggesting that recommendation of LASIK to others is not necessarily a measurement of the quality of a patient's vision after LASIK.

Adult↗
PubMed2004

LASIK for hyperopia, hyperopic astigmatism, and mixed astigmatism: a report by the American Academy of Ophthalmology.

OBJECTIVE: To describe LASIK for hyperopia, hyperopia with astigmatism, and mixed astigmatism and to examine the evidence to answer questions about the safety and efficacy of the procedure. METHODS: A literature search conducted for the years 1968 to 2002 retrieved 118 citations. During review and preparation of this article, an additional 2 articles were included. The panel members selected 36 articles for the panel methodologist to review and rate according to the strength of evidence. A level I rating is assigned to properly conducted, well-designed, randomized clinical trials; a level II rating to well-designed cohort and case-control studies; and a level III rating to case series, case reports, and poorly designed prospective and retrospective studies. RESULTS: This assessment describes 5 nonrandomized interventional trials (level II), 3 nonrandomized comparative trials (level III), and 20 noncomparative case series (level III). Additionally, 6 single-case reports (level III) were included because they reported relevant complications, and 2 theoretical analyses (level III) were also considered. This assessment does not compare studies because many variables such as range of hyperopia, follow-up periods, lasers, microkeratomes, techniques, and surgeon experience have not been controlled. CONCLUSIONS: For low (<3 diopters [D]) to moderate (3-5 D) hyperopia, results from published studies (levels II and III evidence) have shown that LASIK is effective and predictable in achieving very good to excellent uncorrected visual acuity, achieving postoperative refractions within 1 D of emmetropia, and is safe in terms of minimal loss of best-corrected spectacle vision. Although there are fewer data for hyperopic astigmatism, the results available seem to mirror the data for low to moderate hyperopia (levels II and III evidence). The postoperative results for both uncorrected vision and safety are less compelling, as greater amounts of hyperopia are treated (>4 to 5 D). Utilizing hyperopic LASIK for the treatment of consecutive hyperopia and astigmatism is also effective, although the ability to reduce hyperopic astigmatism after radial keratotomy is limited. Although a variety of ablation profiles can be used to treat mixed astigmatism, very good visual results have been reported (levels II and III evidence). Serious adverse complications leading to permanent visual loss are possible but, fortunately, very rare. There are insufficient data to compare one laser system with another or one ablation profile with another.

Academies and Institutes↗
PubMed2003

Intacs for keratoconus.

PURPOSE: To evaluate the efficacy and safety of placement of Intacs in subjects with keratoconus. DESIGN: Retrospective, nonrandomized comparative trial. INTERVENTION: Intrastromal corneal ring segment implantation. PARTICIPANTS: Seventy-four eyes of 50 subjects (41 male and 9 female) were evaluated. The mean age of subjects in the study was 35 years, ranging from 20 to 73 years. Twenty-six subjects underwent single-eye treatment, and 24 subjects had both eyes treated. METHODS: A modified Intacs procedure was performed on subjects with keratoconus. Pachymetry was measured at the incision site, and the incision was made at 66% of the corneal thickness. A thicker ring segment was typically placed inferiorly, and a thinner segment was placed superiorly on the basis of a refractive nomogram. MAIN OUTCOME MEASURES: Differences between preoperative and postoperative uncorrected visual acuity, best spectacle-corrected acuity, and spherical equivalent. Changes in irregular astigmatism were evaluated with the inferior-superior value from comeotopographic maps, and differences in refractive cylinder groups were studied. RESULTS: Preoperative mean best-corrected logarithm of the minimum angle of resolution (LogMAR) visual acuity was 0.41 (20/50 - 1) (standard deviation [SD], +/-0.48), which improved to a postoperative mean of 0.24 (20/32 - 2) (SD, +/-0.31) (two lines of improvement). Preoperative mean uncorrected LogMAR visual acuity was 1.05 (20/200 - 2 1) (SD, +/-0.48), which improved to a mean of 0.61 (20/80-) (SD, +/-0.52) (four lines of improvement) at postoperative follow-up. Preoperative mean best-corrected LogMAR acuity in the corneal scarring group was 0.96 (20/200 + 2) (SD, +/-0.72), which improved to a mean of 0.54 (SD, +/-0.43) (20/63 - 2) (five lines of improvement). Uncorrected mean LogMAR acuity in the eyes with corneal scarring was 1.42 (20/400 - 4) (SD, +/-0.27), which improved to a mean of 1.03 (20/200 - 1) (SD, +/-73) (three lines of improvement). The mean spherical equivalent before surgery was -3.89 diopters (D) (SD, +/-5.16), which was reduced to a mean of -1.46 D (+/-4.11) at the postoperative follow-up. CONCLUSIONS: Asymmetric Intacs implantation can improve both uncorrected and best spectacle-corrected visual acuity and can reduce irregular astigmatism in corneas with and without corneal scarring.

Adult↗
PubMed2003

Use of large optical zones with the LADARVision laser for myopia and myopic astigmatism.

PURPOSE: To analyze the visual acuity, contrast sensitivity, and target deviations of patients who underwent laser in situ keratomileusis (LASIK) for spherical and astigmatic myopia with up to 8.0-mm laser optical zones. DESIGN: A retrospective noncomparative interventional case series. PARTICIPANTS: Three hundred fifty-two eyes of 186 patients in a refractive surgery practice. METHODS: Chart review of consecutive patients who underwent LASIK for spherical and astigmatic myopia with the Autonomous LADARVision excimer laser. MAIN OUTCOME MEASURES: The preoperative and the 3-month postoperative visual acuity and contrast sensitivity, as well as the target deviation, were assessed for each eye. The change in best spectacle-corrected visual acuity (BSCVA), best spectacle-corrected contrast sensitivity (BSCCS), and target deviation were analyzed by size of optical zone. RESULTS: For spherical myopes, uncorrected visual acuity (UCVA) was 20/20 or better in 55.7% of eyes. The mean deviation from target was -0.19 +/- 0.64 diopters (D), with 75.3% within +/-0.50 D of the target. None of the eyes lost more than two lines of BSCVA. A loss of three or more patches (levels) of BSCCS was seen in 2.7% of eyes, whereas a loss of four or more patches of BSCCS was seen in 1.1%. For astigmatic myopes, UCVA was 20/20 or better in 61.9% of eyes. The mean deviation from target was -0.17 +/- 0.55 D, with 67.5% within +/-0.50 D of the target. No eye lost more than two lines of BSCVA. A loss of three or more patches of BSCCS was seen in 4.3% of eyes, whereas a loss of four or more patches of BSCCS was seen in 1.2%. CONCLUSIONS: Larger optical diameters did not adversely affect BSCVA and BSCCS. Postoperative target deviation with the nomogram used was accurate with larger optical zones.

Adolescent↗
PubMed2003

Patient satisfaction and visual symptoms after laser in situ keratomileusis.

PURPOSE: To examine preoperative risk factors for decreased satisfaction and symptoms of glare, halos, and/or starbursts after laser in situ keratomileusis (LASIK). DESIGN: Retrospective, case-control study. PARTICIPANTS: Participants were 604 previously myopic patients who underwent LASIK at least six months prior to completing the questionnaire. METHODS: Questionnaires about satisfaction and night vision symptoms were mailed to 2100 patients from the Northeastern Eye Institute, UCLA, and the University of Pittsburgh. Preoperative and postoperative ocular variables were collected from the medical charts of the 841 subjects who returned the questionnaire. MAIN OUTCOME MEASURES: Responses to various satisfaction and night vision symptom questions were compared to demographic and preoperative ocular variables using multivariate logistic regression. RESULTS: The questionnaire return rate was 42.9%. The mean age for all subjects was 43.0 +/- 10.6 years, and 63% of the subjects were women. Overall, 97% of the subjects would recommend LASIK to a friend. Among subjects who would not recommend LASIK to a friend, a significantly larger percentage reported that they experienced glare, halos, or starbursts (13 of 16 (81.3%) vs. 206 of 388 (53.1%), chi(2) = 4.9, p = 0.03). Also, subjects with flatter preoperative minimum corneal curvature values were more likely to report that they would not recommend LASIK to a friend (OR = 0.71, 95% confidence interval (CI) = (0.52, 0.96), p = 0.03). The median score for satisfaction with vision was 100%, or the maximum value of 127 mm on the visual analog scale. Increasing age was significantly associated with dissatisfaction with vision after LASIK (OR = 1.68, 95% CI = (1.10, 2.56), P = 0.02). Halos were reported by 30%, glare by 27%, and starbursts by 25% of all subjects. Subjects who reported starbursts had a significantly flatter preoperative minimum corneal curvature (43.54 +/- 1.60 D versus 43.92 +/- 1.69 D, t = 2.15, p = 0.03). Also, subjects who had surgical enhancement were more likely to experience glare, halos, and/or starbursts (OR = 2.14, 95% CI = (1.33, 3.46), p = 0.002). CONCLUSIONS: Most subjects are satisfied with their vision after LASIK. Our study suggests, however, that certain factors are associated with decreased satisfaction and night vision symptoms after LASIK. Some of these factors include: increasing age, flatter preoperative minimum corneal curvature, and surgical enhancement.

Adult↗
PubMed2003

Effect of pupil size on visual function under monocular and binocular conditions in LASIK and non-LASIK patients.

PURPOSE: To compare binocular and monocular vision in patients treated with laser in situ keratomileusis (LASIK) and in non-LASIK patients. SETTING: Jules Stein Eye Institute, Los Angeles, California, USA. METHODS: This comparative cross-sectional study comprised 20 postoperative LASIK patients and 20 non-LASIK ametropic patients. LogMAR visual acuity, contrast sensitivity, and infrared pupillometry were tested. Outcome measures were better-eye monocular acuity, binocular acuity, better-eye contrast sensitivity, binocular contrast sensitivity, and pupil diameter under monocular and binocular conditions. RESULTS: Binocular visual acuity and contrast sensitivity were statistically significantly better than the visual acuity in the better eye (P =.0047 to <.0001) in both patient groups. Pupil diameter was statistically significantly smaller under the binocular condition than the monocular condition (P <.0001) in both groups. CONCLUSIONS: Monocular testing induced larger pupil diameters, which was associated with reduced vision compared to binocular measurements in LASIK and non-LASIK patients.

Adult↗
PubMed2003

Feasibility of contact lens fitting on keratoconus patients with INTACS inserts.

PURPOSE: To demonstrate the feasibility of contact lens fitting in keratoconus patients with INTACS inserts. METHODS: A chart review was conducted of all patients with bilateral keratoconus who were treated with INTACS inserts on one eye and who were subsequently referred for contact lens fitting in a university based contact lens practice between April 2000 and April 2002. The study was a retrospective, non-comparative case series. The uncorrected and best spectacle corrected visual acuity (BSCVA) after INTACS implantation surgery, postoperative best contact lens-corrected visual acuity (BCLVA), number of diagnostic contact lenses used, number of contact lenses ordered within a 4-month follow-up period, contact lens complications encountered, final base curves, final lens powers, and final wearing times were determined. RESULTS: Three keratoconic patients meeting the selection criteria were found through the chart review. Prior to surgery, all patients had uncorrected visual acuity (UCVA) of 2.0 logMAR (counting fingers). This improved to a mean of 0.81+/-0.25 logMAR (20/125-1) after surgery. Mean BSCVA also improved from 0.51+/-0.30 logMAR (20/60-2) to 0.30+/-0.16 logMAR (20/40). The mean postoperative best contact lens-corrected visual acuity was 0.02+/-0.10 logMAR (20/20-1). The number of diagnostic lenses ranged from 1 to 7. The numbers of contact lenses ordered during the 4-month follow up period ranged from 1 to 3. Two eyes were fitted with larger than usual lens designs made of rigid gas-permeable material and one eye was fitted with a toric soft lens. The final lens power ranged from +1.25 to -21.0D with a mean spherical equivalent of -7.46+/-11.89 D. Final wearing times ranged from 2.5 to 12.0h. CONCLUSION: Fitting contact lenses on keratoconus patients who have INTACS inserts is feasible and has a role in augmenting their vision.

Journal Article↗
PubMed2002

Role of instrument cleaning and maintenance in the development of diffuse lamellar keratitis.

OBJECTIVE: To determine if instrument cleaning techniques affect the rate of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). DESIGN: Retrospective case series. PARTICIPANTS: Two hundred ten eyes of 109 patients. METHODS: A record review was performed of all patients who underwent LASIK at the Jules Stein Eye Institute from April 1 through June 24, 1999. During the first 6 weeks, the instruments used in LASIK surgery were cleaned according to our conventional protocol. At the end of this 6-week period, the cleaning protocol was modified and used for a subsequent 6-week period. For each eye during the two periods, the status of DLK on the first postoperative day was recorded. MAIN OUTCOME MEASURES: Presence of DLK. RESULTS: During the first 6-week period, 118 eyes of 60 patients underwent LASIK surgery. In the subsequent 6 weeks, 92 eyes of 49 patients underwent LASIK surgery. The two groups included patients with similar demographic background: gender, age, and target correction. Diffuse lamellar keratitis was present in 13 of 118 eyes (11%) using our conventional protocol. In only 2 of 92 eyes (2%) did DLK develop after the protocol was modified. Using the chi-square test, the difference between the two groups was statistically significant (P = 0.01). CONCLUSIONS: Diffuse lamellar keratitis is a fairly uncommon phenomenon after LASIK surgery. Although the cause remains to be elucidated, these results demonstrated a reduced incidence of DLK associated with alteration of cleaning procedures and a decrease in stagnant instrument cleaning fluids. The authors recommend that refractive centers avoid the use of stagnant fluids in their instrument cleaning and sterilizing protocols to minimize the occurrence of DLK outbreaks.

Adult↗