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Biomedical subjects

E E Manche

Publications and source records attributed to E E Manche.

At least 19 recordsLinked to original sources
PubMed2001

Management of the corneal flap in laser in situ keratomileusis after previous radial keratotomy.

PURPOSE: To report a method of managing the corneal flap in patients having laser in situ keratomileusis for the treatment of residual refractive errors after radial keratotomy. DESIGN: Retrospective case series. METHODS: Intraoperative dehiscence of radial keratotomy wounds occurred in 7 eyes of 6 patients treated with laser in situ keratomileusis for residual myopia or astigmatism or hyperopia 5 to 15 years after radial keratotomy. To minimize extension of these tears, the flap was initially rolled like a carpet toward the hinge before the ablation and then rolled away from the hinge to its original position after the ablation. RESULTS: Using this method of managing the laser in situ keratomileusis flap in patients with previous radial keratotomy, all eyes had successful laser in situ keratomileusis, with 1-year postoperative uncorrected visual acuity ranging between 20/16 and 20/25. No eye had loss of spectacle-corrected vision or interface epithelial ingrowth. CONCLUSIONS: Laser in situ keratomileusis has proved to be an effective treatment for correction of residual refractive errors after radial keratotomy. The surgical technique used in these cases was targeted at minimizing shearing forces in lifting the corneal flap to avoid extension of radial keratotomy wound dehiscence, which could lead to epithelial ingrowth and loss of best-corrected vision.

Adult↗
PubMed2001

Iatrogenic keratectasia after a deep primary keratotomy during laser in situ keratomileusis.

PURPOSE: To describe a case of keratectasia after a deep primary keratotomy during an aborted laser in situ keratomileusis procedure. METHODS: Retrospective, observational case report. RESULTS: In a 47-year-old woman, progressive keratectasia developed after a 90% depth keratotomy during an aborted laser in situ keratomileusis procedure. This case was managed with a rigid gas permeable contact lens and consideration for penetrating keratoplasty. CONCLUSION: Keratectasia is a reported microkeratome-related complication after laser in situ keratomileusis. Appropriate microkeratome assembly and surgeon awareness are necessary to avoid this complication.

Astigmatism↗
PubMed2001

Effect of preoperative pupil measurements on glare, halos, and visual function after photoastigmatic refractive keratectomy.

PURPOSE: To prospectively assess the effect of preoperative variables such as pupil size on glare, halos, and visual function after photoastigmatic refractive keratectomy (PARK). SETTING: Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA. METHODS: Ninety-three eyes had PARK for primary compound myopic astigmatism. Preoperative pupil diameters were measured under scotopic and photopic illuminance conditions. Postoperatively, patients were evaluated at 1, 3, 6, 9, 12, 18, and 24 months. A regression model was performed to evaluate the predictive value of assessing preoperative variables such as pupil diameter on the development of glare and halos, contrast sensitivity, and best spectacle-corrected visual acuity (BSCVA) under scotopic, photopic, and glare conditions. RESULTS: The greater magnitude loss of BSCVA under scotopic conditions in the early postoperative period as well as the slower recovery to preoperative levels in eyes with larger scotopic pupil diameters were not statistically significant (P >.05). An increase in symptoms of glare was related more to the attempted level of spherical equivalent (SE) correction than to the pupil size during the first 12 postoperative months (P <.01). The photoablation dimensions as determined by the attempted level of astigmatic correction may result in decreases in the glare BSCVA up to 12 months after PARK (P =.03). At the 2 year follow-up, pupil diameter under both scotopic and photopic illuminance conditions was not predictive of any of the measured outcomes variables. CONCLUSIONS: An assessment of preoperative pupil size and the attempted level of both SE and astigmatic correction may be useful in identifying patients at risk of developing symptoms or declines in visual performance after PARK. However, follow-up studies are indicated to identify variables predictive of poor visual outcomes following excimer laser refractive surgery.

Adaptation, Ocular↗
PubMed2000

Photorefractive keratectomy for compound myopic astigmatism.

PURPOSE: To evaluate the safety and efficacy of photorefractive keratectomy for the treatment of primary compound myopic astigmatism. METHODS: In a prospective study, 93 eyes from 56 patients with a mean spherical equivalent of -4.98 +/- 1.80 diopters (range, -1.75 to -8.5) underwent photoastigmatic refractive keratectomy with the Summit Apex Plus excimer laser using erodible mask technology and were followed for 2 years. Primary outcome measures included an assessment of astigmatic correction through vector analysis, manifest refraction, uncorrected visual acuity, corneal clarity, and the presence of adverse symptoms. RESULTS: Eighty-five eyes (91.4%) were available for analysis at 6 months. Mean spherical equivalent refraction was reduced 85% (mean, -0.75 +/- 0.85 diopter) and the target-induced astigmatism was reduced 70% (mean, 0.98 +/- 1.88 diopters). Forty-eight eyes (56%) had an uncorrected visual acuity of 20/20 or greater, whereas 70 eyes (82%) had an uncorrected visual acuity of 20/40 or greater. Twenty-four eyes (26% ) required re-treatment because of undercorrection of the spherical equivalent and astigmatic components after the 6-month follow-up. Fifty-nine of the remaining eyes were available at the 24-month visit. Mean spherical equivalent refraction was reduced to -0.39 +/- 0.72 diopter (91.8%). The target-induced astigmatism was reduced 64% from 1.74 diopters. Forty-one eyes (81.3%) were within +/-1.0 diopter of attempted spherical equivalent correction. Stability within a spherical equivalent of +/-0.5 diopter occurred after the first postoperative month. Fifty-six eyes (94.9%) had an uncorrected visual acuity of 20/40 or greater, whereas 34 eyes (57.6 %) demonstrated an uncorrected visual acuity of 20/20 or greater. One eye (1.7%) lost 2 or more lines of best spectacle-corrected visual acuity. CONCLUSION: Photoastigmatic refractive keratectomy with the Summit Apex Plus excimer laser is a safe and effective method of reducing compound myopic astigmatism. However, higher re-treatment rates may result from significant undercorrections because of current laser algorithms and variability in the mean angle of error.

Adult↗
PubMed2000

Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy.

PURPOSE: To report sloughing of corneal epithelium during laser in situ keratomileusis and subsequent wound healing complications in patients with epithelial basement membrane dystrophy. METHODS: In a retrospective study, the surgical procedures, postoperative course, and visual acuities of 16 eyes of nine patients with epithelial basement membrane dystrophy who underwent laser in situ keratomileusis complicated with epithelial sloughing at three centers were reviewed. The mean follow-up period was 23 weeks (range, 4 to 52 weeks). RESULTS: In 13 (81%) of 16 eyes with epithelial basement membrane dystrophy, epithelial sloughing occurred during laser in situ keratomileusis. In eight of the 13 eyes, epithelial growth beneath the flap was observed. The flap was lifted and the interface epithelium scraped in six eyes. Flap melt or keratolysis occurred in four eyes. At the last follow-up visit, 13 of 16 eyes had an uncorrected visual acuity of 20/30 or better, and all eyes had a best-corrected visual acuity of 20/30 or better. CONCLUSIONS: Patients with epithelial basement membrane dystrophy have poorly adherent corneal epithelium and are predisposed to epithelial sloughing during the microkeratome pass of laser in situ keratomileusis. This may lead to flap distortion, interface epithelial growth, flap keratolysis, and corneal scarring. It is not recommended that laser in situ keratomileusis be performed in patients with classic, symptomatic epithelial basement membrane dystrophy. In patients who present with mild and asymptomatic epithelial basement membrane dystrophy, laser in situ keratomileusis should be performed with caution, or photorefractive keratectomy may be the preferred refractive procedure.

Adult↗
PubMed2000

One-year evaluation of myopic laser photoastigmatic refractive keratectomy using the summit apex plus: phase III of a Food and Drug Administration clinical trial.

PURPOSE: To prospectively evaluate the safety and efficacy of the Summit Apex Plus excimer laser in the treatment of primary compound myopic astigmatism. DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: Patients with primary compound myopic astigmatism: sphere of -1.0 to -7.0 diopters (D) and cylinder -1.0 to -5.0 D. METHODS: Ninety-three eyes of 56 patients with a mean spherical equivalent of -4.98 +/- 1.80 D (-1.75 to -8.5) underwent photoastigmatic refractive keratectomy (PARK) with the Summit Apex Plus excimer laser using erodible mask technology. Prospective follow-up is analyzed at 1-year postoperatively. MAIN OUTCOME MEASURES: Postoperative reduction in myopic sphere, myopic astigmatism, spherical equivalent, angle of error, magnitude of error, difference vector, uncorrected visual acuity, and corneal haze. RESULTS: Seventy-one eyes were available at 1-year follow-up. Mean spherical equivalent was reduced 86.5% to a mean residual of -0. 65 D +/-0.70 D (-2.88-+1.13 D). Astigmatism was reduced 66.2% to a mean residual of -0.76 +/- 0.52 D (-2.25-0.00 D); 77.5% were within 1.0 D of attempted correction; 1.4% of eyes experienced an overcorrection >1.0 D of spherical equivalent; 0.27 D of mean myopic regression was demonstrated between 1 and 12 months; 93.0% of eyes achieved an uncorrected visual acuity of 20/40 or better; and 49.3% of eyes achieved an uncorrected visual acuity of 20/20 or better. CONCLUSIONS: PARK with the Summit Apex Plus excimer laser is effective at reducing compound myopic astigmatism. However, current laser algorithms result in consistent undercorrection of both the compound myopia and the astigmatic component.

Adult↗
PubMed2000

Visual performance following photoastigmatic refractive keratectomy: a prospective long-term study.

PURPOSE: To prospectively determine the long-term effect of excimer laser photoastigmatic refractive keratectomy (PARK) on visual performance using psychophysical assessments and to identify predictors of poor performance on the psychophysical assessments. SETTING: University-based hospital, Stanford University, Stanford, California, USA. METHODS: Ninety-three eyes of 56 patients with a mean of -4.98 diopters +/- 1. 80 (SD) of primary compound myopic astigmatism had PARK using the Summit Apex Plus excimer laser and an erodible mask system. Patients were prospectively evaluated 1, 3, 6, 9, 12, 18, and 24 months following the procedure. Primary outcome variables included changes in the contrast sensitivity function curve (3.0, 6.0, 12.0, 18.0 cycles per degree) under 2 standard illuminance conditions (scotopic and photopic) and changes in the best spectacle-corrected visual performance under scotopic, photopic, and glare conditions. RESULTS: A relative decline in the contrast sensitivity function curve occurred in the early postoperative period under both scotopic and photopic conditions. This was most pronounced under photopic illuminance and at the low spatial frequencies at the 6 month visit. By 1 year, however, the mean contrast sensitivity at all spatial frequencies and all illuminance conditions had returned to the preoperative level. Further improvements beyond the preoperative level may be related to the independent analysis of retreatment eyes beyond 6 months. A higher level of attempted correction of the spherical equivalent was predictive of an elevated scotopic contrast threshold at the extreme spatial frequencies 6 months after PARK (P <.05). The attempted level of astigmatic correction was predictive of a poor best corrected visual performance under scotopic conditions at 1 month (P <.05). This effect was only temporary and by postoperative month 3, there was no predictive effect of preoperative astigmatism (P >.05). CONCLUSIONS: Psychophysical assessments may be a more sensitive indicator of decreases in visual performance following excimer laser refractive surgery. The attempted level of correction of spherical equivalent and astigmatism may adversely affect early scotopic visual performance. Decreases in visual performance are temporary, return to normal by 12 months, and remain stable 24 months following PARK.

Adult↗
PubMed2000

Large optical ablation zone using the VISX S2 smoothscan excimer laser.

PURPOSE: To prospectively evaluate the safety and efficacy of the new large-zone (6.5 mm) photoablation technology using the VISX S2 Smoothscan excimer laser. SETTING: University-based hospital, Stanford, California, USA. METHODS: Forty-two eyes of 21 patients with a mean preoperative spherical equivalent (SE) of-5.55 diopters (D)+/- 2.24 (SD) (range-2.13 to-10.75 D) had laser in situ keratomileusis (LASIK) using the VISX Smoothscan S2 excimer laser for simple myopia or compound myopic astigmatism. A 6.5 mm optical zone was used in all eyes. Patients were prospectively followed 1 day and 1 and 3 months postoperatively. RESULTS: At 3 months, the mean SE was reduced 94% to-0. 31+/- 0.55 D. Ninety-one percent of eyes had an uncorrected visual acuity of 20/40 or better. Eighty-eight percent were within+/-1.00 D of attempted correction and 84%, within +/-0.50 D. Stability within+/-0.50 D occurred after the first postoperative month. Vector analysis of eyes that had toric ablations demonstrated a difference vector within+/-1.00 D in 100% of eyes. The mean angle of error was-0.04+/- 6.37 degrees. Visually significant steep central islands associated with loss of best spectacle-corrected visual acuity was observed in 7.5% of eyes at 1 month. No eyes experienced significant glare or halos. CONCLUSIONS: The new large-zone (6.5 mm) photoablation technology with the VISX S2 Smoothscan resulted in effective reduction of simple myopia and compound myopic astigmatism. However, with the 6.5 mm zone, there may be an increased risk of developing symptomatic steep central islands in the early post-LASIK period compared with the standard 6.0 mm treatment zone.

Adolescent↗
PubMed2000

Excimer laser retreatment of residual myopia following photoastigmatic refractive keratectomy for compound myopic astigmatism.

PURPOSE: To prospectively evaluate the safety, efficacy, and visual performance of excimer laser enhancement following photoastigmatic refractive keratectomy (PARK) with the Summit Apex Plus. SETTING: Stanford University School of Medicine Eye Laser Clinic, Stanford, California, USA. METHODS: As part of a Food and Drug Administration clinical trial, 93 eyes of 56 patients with a mean spherical equivalent (SE) of -4.98 diopters (D) +/- 1.80 (SD) (range -1.75 to -8.50 D) had PARK for compound myopic astigmatism using the Summit Apex Plus excimer laser and a poly(methyl methacrylate) erodible mask. Seventeen eyes with a mean SE of -2.08 +/- 0.76 D required excimer laser refractive keratectomy for residual spherical myopia or compound myopic astigmatism. Patients were prospectively followed 1, 3, 6, 9, and 12+ months after the enhancement procedure. Primary outcome variables included uncorrected visual acuity (UCVA), refraction, vector analysis, best spectacle-corrected visual acuity (BSCVA) under standard ambient conditions (photopic, scotopic, and glare), corneal clarity, and contrast sensitivity function curve under photopic and scotopic conditions. RESULTS: At the last postoperative visit, the mean sphere had been corrected 82% to a residual of -0.29 +/- 1.23 D and mean SE had been corrected 65% to a residual of -0.74 +/- 1.27 D. Eighty-two percent of eyes were within +/-1.0 D of attempted correction. Eighty-eight percent had a UCVA of 20/40 or better. Vector analysis demonstrated a difference vector of within +/-1.0 D in 75% of eyes that had PARK retreatment. There was no significant loss in the contrast sensitivity curve. Late regression associated with corneal haze and loss of BSCVA occurred in 2 eyes (11.7%). CONCLUSIONS: Retreatment following PARK for compound myopic astigmatism results in effective reduction in residual spherical myopia and compound myopic astigmatism. An improvement in UCVA without loss of contrast sensitivity can be expected in most eyes. However, regression, corneal haze, and loss of BSCVA may occur. Further studies are indicated to predict risk factors for these complications.

Astigmatism↗
PubMed1999

Deep lamellar keratoplasty using viscoelastic dissection.

We describe a technique for performing deep lamellar keratoplasty using viscoelastic dissection. Deep lamellar dissections of the cornea using viscoelastic substances (sodium hyaluronate) were performed on 4 eyes of 4 patients. One patient with keratoconus and another with corneal scarring underwent lamellar keratoplasty using the technique as the sole procedure for visual rehabilitation. Two patients (2 eyes) with opaque corneas underwent deep lamellar dissection with removal of stromal tissue to allow visualization of the anterior segment structures prior to penetrating keratoplasty, thereby facilitating separation of iridocorneal adhesions as the Descemet membrane was incised. Deep lamellar dissection was performed without complications related to the procedure in all 4 eyes. The 2 lamellar grafts cleared completely, and both eyes achieved excellent visual acuity with spectacle correction. In the other 2 eyes, deep lamellar dissection provided clear visualization of anterior segment structures during incision of the Descemet membrane. Deep lamellar dissection using viscoelastic substances is a useful technique during lamellar keratoplasty.

Aged↗
PubMed1998

Factors influencing the outcome of hyperopic lamellar keratoplasty.

PURPOSE: To determine which factors affect the refractive outcome of hyperopic lamellar keratoplasty. SETTING: Jules Stein Eye Institute and Department of Ophthalmology, UCLA, Los Angeles, California, USA. METHODS: This retrospective study comprised 38 consecutive eyes of 25 patients with naturally occurring hyperopia who had automated lamellar keratoplasty by one surgeon. Mean attempted correction was 3.80 diopters (D) (range of 1.50 to 6.00 D); 34 eyes were followed for 3 months. The effect of applanation lens diameter, keratometry, age, corneal thickness, absolute flap thickness in microns, thickness of the posterior lamellae in microns, and flap thickness as a percentage of corneal thickness were determined using multivariate linear regression. RESULTS: With current nomograms, mean undercorrection 3 months after hyperopic lamellar keratoplasty was 1.26 D +/- 0.91 (SD); 14 of 34 eyes were within +/- 1.00 D of the attempted correction. The best predictive factors of achieved correction were applanation lens diameter and absolute flap thickness in microns, which accounted for 54% of the variability in outcome. Keratometry, corneal thickness, and flap thickness as a percentage of corneal thickness had no significant additional predictive value. CONCLUSION: The refractive outcome of hyperopic lamellar keratoplasty was primarily determined by applanation lens diameter and absolute flap thickness in microns. Current nomograms suggest that flap thickness as a percentage of corneal thickness is a major determinant of effect, but this factor appears unimportant to the refractive effect of hyperopic lamellar keratoplasty. We hypothesize that it is slight swelling of the anterior corneal stroma rather than the bulging of the posterior cornea that causes the hyperopic correction in hyperopic lamellar keratoplasty.

Adult↗
PubMed1998

Treatment of topographic central islands following refractive surgery.

PURPOSE: To evaluate the safety and efficacy of using central reablation to treat topographic central islands following photorefractive keratectomy (PRK), myopic keratomileusis in situ, and laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Stanford University School of Medicine, Stanford, and Jules Stein Eye Institute, Los Angeles, California, USA. METHODS: Central reablation was performed on eight eyes with clinically significant topographic central islands after refractive surgery. Two eyes developed central islands after PRK, five eyes after LASIK, and one eye after myopic keratomileusis in situ. A clinically significant topographic central island was defined as an area of steepening of at least 3.0 diopters by at least 1.5 mm in diameter documented by computerized videokeratography. Reablation was tailored to each eye based on the diameter and power of the topographic central island using the Munnerlyn formula. RESULTS: All eyes experienced a reduction or elimination of the topographic central islands following central reablation. Six eyes experienced an improvement in uncorrected visual acuity, and all eyes returned to within one line of their preoperative level of best spectacle-corrected visual acuity 1 month after the procedure. CONCLUSION: Topographic central islands following PRK, myopic keratomileusis in situ, and LASIK can be effectively treated using the excimer laser. Poor predictability of the refractive effect of central reablation may be the limitation of this treatment modality.

Adult↗
PubMed1998

Excimer laser refractive surgery.

Excimer laser photorefractive keratectomy and excimer laser in situ keratomileusis are relatively new treatment modalities that can be used to correct refractive errors of the eye. They are most commonly used to correct myopia (nearsightedness) but can also be used to correct hyperopia (farsightedness) and astigmatism. The excimer laser alters the refractive state of the eye by removing tissue from the anterior cornea through a process known as photoablative decomposition. This process uses ultraviolet energy from the excimer laser to disrupt chemical bonds in the cornea without causing any thermal damage to surrounding tissue. The modified anterior corneal surface enables light to be focused on the retina, thereby reducing or eliminating the dependence on glasses and contact lenses. We discuss in detail all aspects of excimer laser refractive surgery--techniques, indications and contraindications, clinical outcomes, and complications.

Humans↗
PubMed1998

Delayed corneal epitheliopathy after antimetabolite-augmented trabeculectomy.

PURPOSE: The authors describe the first case of delayed antimetabolite-related corneal epithelial toxicity after trabeculectomy and its successful treatment with limbal stem cell transplantation. METHODS: A 73-year-old woman underwent trabeculectomy with intraoperative mitomycin C. After surgery she received six 5-mg injections of subconjunctival 5-fluorouracil (5-FU) adjacent to the bleb. RESULTS: The patient had a functioning trabeculectomy and clear cornea until 30 months after surgery, at which time she developed a nonhealing superior corneal epithelial defect. After 4 months of conservative medical management, an autologous limbal stem cell transplantation was performed. The epithelial defect resolved completely within 1 week of limbal stem cell transplantation. CONCLUSIONS: Delayed corneal epithelial toxicity may be a late complication of antimetabolite-augmented trabeculectomy.

Aged↗
PubMed1997

Air bag-related ocular injuries.

This study reviewed the nature and severity of ocular and orbital air bag-related injuries at a large tertiary care referral center. The records of all patients treated by the ophthalmology trauma service for air bag-related ocular injuries between 1993 and 1995 were reviewed. Five patients were identified who had air bag-related ocular trauma. All of the patients who were referred to the ophthalmology trauma service for air bag-related ocular injuries had significant ocular or orbital injury. The extent and severity of the injuries were variable, ranging from orbital contusion to ruptured globe and retinal detachment. Although air bags substantially reduce the overall rates of mortality and morbidity associated with motor vehicle accidents, they also cause a variety of ocular injuries.

Accidents, Traffic↗
PubMed1996

Astigmatic keratotomy combined with myopic keratomileusis in situ for compound myopic astigmatism.

PURPOSE: Myopic keratomileusis in situ by an automated microkeratome corrects myopia but not astigmatism, which is traditionally corrected by astigmatic keratotomy months after keratomileusis. We developed a technique for simultaneously correcting astigmatism and severe myopia, and examined its effectiveness in a retrospective case-control study. METHODS: Thirty-four eyes (23 patients) underwent myopic keratomileusis in situ combined with one or two arcuate keratotomy incisions performed after the refractive cut, in the bed of the primary keratectomy flap. The myopic keratomileusis control group consisted of 34 matched eyes (30 patients) undergoing keratomileusis without astigmatic keratotomy. The astigmatic control group consisted of 117 unmatched eyes (85 patients) undergoing astigmatic keratotomy combined with radial keratotomy. RESULTS: Mean refractive astigmatism in the study group decreased from 2.4 diopters (range, 1.0 to 4.0 diopters) preoperatively to 1.7 diopters (range, 1.0 to 4.0 diopters) at three months postoperatively, and increased by 0.4 diopter in the myopic keratomileusis control group at three months postoperatively (P < .005). Eighteen of 27 eyes in the study group showed decreased refractive astigmatism compared with ten of 34 eyes in the myopic keratomileusis control group (P < .0001). Combining astigmatic keratotomy with myopic keratomileusis produced 0.2 +/- 0.9 diopter less astigmatic correction than that expected from the astigmatic control group. One of 27 eyes lost two or more lines of best spectacle-corrected visual acuity at the three-month postoperative visit. No eye lost two or more lines of best spectacle-corrected visual acuity at postoperative month 6. CONCLUSION: Eyes with substantial preoperative refractive astigmatism that undergo myopic keratomileusis in situ may benefit from simultaneous astigmatic keratotomy to reduce residual post-operative refractive astigmatism.

Adult↗
PubMed1996

Keratomileusis in situ for high myopia.

PURPOSE: To examine the safety and efficacy of myopic keratomileusis in situ (automated lamellar keratoplasty) using an automated microkeratome. SETTING: Jules Stein Eye Institute and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California. METHODS: A retrospective study was done on 135 consecutive eyes of 91 patients who had keratomileusis in situ for myopia by one surgeon between October 4, 1993, and February 23, 1995. Mean preoperative myopia was 8.30 +/- 2.50 diopters (D) (range 4.50 to 20.50). Follow-up ranged from 1 (108 eyes) to 6 months (52 eyes). No eye had enhancement surgery before 3 months; eyes were dropped from the study at the time of enhancement. RESULTS: Three months after myopic keratomileusis in situ, the mean difference between attempted and achieved correction was an undercorrection of 0.90 +/- 1.50 D; 32 of 83 eyes were within 1.00 D of attempted correction. Forty eyes were undercorrected by more than 1.00 D, and 11 were overcorrected by more than 1.00 D. Uncorrected visual acuity improved to 20/40 or better in 42 of 83 eyes at 3 months. Best spectacle-corrected visual acuity (BSCVA) declined by two or more lines in 8 of 83 eyes at 3 months and 1 of 52 eyes at 6 months. In eyes with 6 months of follow-up, a mean myopic shift of 0.40 D occurred between 3 and 6 months. Two eyes had clinically significant ingrowth into the interface. The variability in outcome (standard deviation in achieved less attempted correction) at 3 months was 1.70 D in the first 45 cases, 1.20 D in the second 45 cases, and 1.10 D in the last 45 cases. CONCLUSION: Myopic keratomileusis in situ is relatively effective and safe for the correction of high myopia; however, a mild loss of BSCVA is not uncommon in the early postoperative period. Surgeon experience may be important for refractive accuracy.

Adult↗