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We report a case of evolutive high hyperopia in a child aged 10 years. It is associated with organic amblyopia due to a large papillomacular retinal fold. Ultrasonography and CT scan helped to establish the diagnosis. This is probably a hereditary disease affecting the development of the posterior sclera.
BACKGROUND: A new experimental surgical technique to correct hyperopia by steepening the central corneal curvature was performed on the eyes of rabbits. METHODS: After X-shaped incisions at four quadrants of the paracentral cornea, four deep, transverse interrupted sutures were placed across the incisions and the knots were tightened to compress the corneal tissue in the direction of the suture. Twenty-three eyes of 12 albino rabbits were divided into group A (7 eyes) with a 4-millimeter diameter clear zone, group B (9 eyes) with a 6-millimeter diameter clear zone, and control group C, consisting of 7 contralateral eyes of group A without any incision or suture. RESULTS: There was significant (p < .01) steepening of the central cornea as measured by the keratometer at postoperative 8 weeks in group A (+1.88 diopters) and group B (+1.68 D) compared with that of the control group C (-3.44 D). The difference in effect of hyperopic correction between groups of A and B was not statistically significant. CONCLUSIONS: This procedure serves only as an experimental model of corneal response to incisions and sutures and is not for use in human corneas.
We present a patient who underwent bilateral radial keratotomy (RK) followed by a bilateral revisional RK for undercorrection. After the second procedure, the patient had a severely flattened left cornea, with marked hyperopia and irregular astigmatism. The right eye, however, remained myopic, causing extreme anisometropia. We hypothesize that the different results in these two eyes may have been due to a critical number of damaged left corneal stromal fibers. Patients undergoing revisional RK or requiring additional incisions may be at increased risk for such a complication.
Epikeratophakia for the correction of aphakia, myopia, hyperopia and keratoconus has overcome many of the objections to earlier lamellar refractive procedures (keratophakia and keratomileusis), such as the lamellar dissection of the recipients' healthy cornea over the visual axis and the need for expensive surgical equipment. It is reasonably reversible and repeatable. The complications observed in a series of 119 operations performed at the 2nd Department of Ophthalmology, University of Vienna, are discussed and compared with those reported in the literature. Serious complications, both intraoperatively and in the early and late postoperative period, that permanently threaten the patients vision are rare. Predictability and loss of effect in a significant percentage of myopic cases, caused by lack of precision during manufacturing of the lenticules and individual wound healing, makes careful patient selection mandatory.
Cervical myelopathy due to developmental cervical canal stenosis occurred in a 13-year-old boy. The patient's father and aunt also had an abnormally small cervical canal, although both were asymptomatic. The patient and his family had many congenital anomalies including hereditary brachydactyly, syndactyly, and hyperopia. The association of these anomalies seems not to have been previously reported in the literature.
Overcorrection is a significant complication following radial keratotomy (RK). This study using human cadaver eyes demonstrates that the use of interrupted sutures placed across radial incisions coincident with a 7-mm optical zone mark can induce a wide range of central corneal steepening and can therefore correct varying amounts of hyperopia following RK. A case presentation confirms the effectiveness of using interrupted sutures to steepen the cornea following RK, but it also shows that significant regression of the effect must be considered at the time of suture placement. Since placement of interrupted corneal sutures is a routine procedure, it is a very convenient technique for treating overcorrection following RK.
In an earlier report, the authors demonstrated a trend toward progressive hyperopia in radial keratotomy (RK) patients examined between one and three to four years postoperatively. In those 109 cases, the surgeries were performed using a metal-blade instrument. In the following study, the metal-blade series was updated to a total of 225 procedures, and a more recent series of 300 procedures performed on 228 patients was examined in which a diamond-knife cutting instrument was used. Patients had uncorrected visual acuity determination, cycloplegic refractions with best corrected visual acuity measurements and keratometry measurements. The authors demonstrated a hyperopic shift in the distribution of postoperative spherical equivalent (SE) values across time such that higher proportions of cases in both metal-blade and diamond-knife series were at least 1.0 diopter (D) away from emmetropia at 24 and 48 months than was the case at 12 months after surgery. Regression analysis determined that none of the preoperative or surgical variables known to affect refractive outcome of RK (alone or in combination) could account for the changes in refraction seen during the course of postoperative time. In general, changes in keratometry paralleled refractive changes, but were somewhat smaller in magnitude.
Many practitioners have long been frustrated with traditional treatments of symptomatic latent hyperopia (fogging techniques, bifocals, etc.). A technique employing short-acting cycloplegia has been developed which provides rapid relief of symptoms by promoting full correction of latent refractive error. Fifteen symptomatic subjects ages 3-40 were diagnosed as latent hyperopes with the aid of 1% cyclopentolate, and subsequently recyclopleged utilizing full correction in constant wear spectacles. Acuity was maintained via slow diminution of cycloplegia. Short-term and long-term follow-up, with continued use of spectacles or contact lenses, revealed rapid and complete resolution of symptoms and restoration of visual efficiency in each case. Cyclotherapy offers both practitioners and patients an efficient, rapid-acting, and satisfying alternative treatment for this vexing accommodative anomaly.
Two-hundred and ninety eight high astigmatic refractive errors are reviewed in order to establish the clinical and theoretical relationship of high astigmatism to hyperopia. All methods of analysis demonstrated that high astigmatism and greater plus power are related.
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A number of studies have documented the reasonable efficacy and safety of radial keratotomy, but most were based upon results obtained one year or less after surgery. This study reviewed 109 consecutive radial keratotomy procedures performed on 79 patients between Nov 10, 1979, and Jan 31, 1981. In addition to a number of earlier postoperative visits, 81 eyes in 55 patients (74.3%) were examined between eight and 18 months postoperatively (a "one-year visit") and again between 31 and 57 months postoperatively (a "four-year visit"). Patients had uncorrected visual acuity determination, cycloplegic refractions with best-corrected visual acuity measurements, and keratometry. Of the 81 eyes, 17 (21.0%) became more myopic between one and four years postoperatively; five (6.2%) remained the same; and 59 (72.8%) became more hyperopic. With a significant change defined as 1.0 diopter or more, two eyes (2.5%) became significantly more myopic at four years; 54 eyes (66.7%) remained within 1.0 D of their one-year spherical equivalent; and 25 (30.9%) became significantly more hyperopic. Changes in keratometry generally paralleled refraction changes.
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Seven healthy adults with acquired hyperopic change in refractive error had choroidal folds in affected eyes. High resolution computerized tomographic scanning techniques used to obtain coronal, oblique coronal, and parasagittal reformations revealed flattening of the posterior globes and mild to moderate optic nerve enlargement. In 5 of 11 eyes, a space was noted between the optic nerve and its sheath, implying expansion of the sub-arachnoid perineural compartment. The clinical findings and natural history of this syndrome, based on an average follow-up of 4.5 years, are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.