Surgical correction of nearsightedness.
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Biomedical subjects
Publications and source records attributed to S J Bechara.
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A 29-year-old man with a -22.00-diopter myopia in the right eye underwent a planar, nonfreeze myopic epikeratoplasty and postoperatively developed a central subepithelial opacity. The opacity recurred after two superficial keratectomies; finally, another epikeratoplasty was performed. Light microscopic examination of the original button showed that the epithelium was thickened, collagenous subepithelial fibrocellular tissue was present, and Bowman's layer was focally disrupted. The stroma was edematous and peripherally scarred with scattered keratocytes. Examination by transmission electron microscopy revealed keratocytes lying anterior and posterior to Bowman's layer. The subepithelial fibrocellular tissue corresponded to an area of a break in Bowman's layer and probably originated from the donor stroma. The break in Bowman's layer may have been caused by the microkeratome cuts, but its origin is not certain.
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Rabbit eyes submitted to alkali burns (in 1 N NaOH, 7 mm, for 2 min) were evaluated as to the effect of contact lenses on the corneal reepithelialization. Forty eyes were used, divided into two groups: 3 weeks and those observed for 5 weeks. In each group, 10 eyes received a contact lens while 10 served as controls. From the daily evaluation of the corneal surface as well as the microscopic examinations at the end of the two periods of observation, we concluded that hydrophilic contact lenses provide a beneficial effect on alkali burns of the cornea, reducing the incidence of epithelial defects to statistically significant levels.
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BACKGROUND: Microkeratome designs for lamellar refractive surgery have changed significantly in recent years. Three microkeratome systems (Automatic Corneal Shaper (Steinway Instrument Company, Inc, San Diego, Calif), Draeger Lamellar Keratome (Storz Instrument GmbH, Heidelberg, Germany), and Microprecision test model (Microprecision Instrument Company, Inc, Phoenix, Ariz) were subjected to a concurrent and independent evaluation. METHODS: Three types of keratectomies (primary superficial stromal, secondary intrastromal, and primary deep stromal) were performed under identical conditions in human cadaver eyes. The resected discs and the beds were observed for uniformity, accuracy, centering, and smoothness. Scanning electron microscopy of the corneal beds and cutting blades was done. RESULTS: The three systems produced irregular surfaces with chatter lines that appeared least rough with the Draeger rotating machine. The average primary and secondary section diameters were undersized by 10% in all three systems. The average primary keratectomy thickness was more accurate with Steinway, but the variability was over 20 microns in all three systems. Regarding the average secondary keratectomy thickness, Steinway tended to cut thicker, whereas Draeger and Microprecision tended to cut thinner than attempted. The Draeger blade presented the smoothest edge. CONCLUSIONS: All three systems need substantial improvements to produce more accurate, reproducible, and smooth resections. More reliable methods to accurately measure the thickness of the resected cornea should be developed.