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Query: UMLS:C0022568 (keratitis)
 5,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laser-in-situ-keratomileusis (LASIK) has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased postoperative haze. Compared to photorefractive keratectomy (PRK), LASIK involves an additional procedure of creating a corneal flap. This may result in complications related to the flap, interface and underlying stromal bed. The common flap-related complications include thin flap, button holing, free caps, flap dislocation and flap striae. The interface complications of diffuse lamellar keratitis, epithelial ingrowth and microbial keratitis are potentially sight threatening. Compared to PRK, there is less inflammation and faster healing after LASIK, but there is a longer period of sensory denervation leading to the complication of dry eyes. The refractive complications include undercorrection, regression, irregular astigmatism, decentration and visual aberrations. Honest and unbiased reporting is important to understand the aetiology and redefine the management.
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PMID:Complications of laser-in-situ-keratomileusis. 1253 89

We report 2 cases of severe corneal infections caused by Serratia marcescens after laser in situ keratomileusis (LASIK). Twenty-four hours after LASIK, 2 patients developed infectious keratitis, 1 bilaterally. In each eye, the corneal flap was edematous, ulcerated, and detached from the stromal bed. Treatment included removal of the necrotic flap and aggressive antibiotic therapy. Cultures from corneal exudates were positive for S marcescens. After 1 year, both patients had a loss of best corrected visual acuity (BCVA) ranging from 20/40 to 20/22 because of irregular astigmatism. Overrefraction with a hard contact lens resulted in a BCVA of 20/20 in the 3 affected eyes. Slitlamp examination showed trace subepithelial haze without severe corneal scarring. Videokeratography disclosed areas of paracentral inferior steepening resembling keratoconus. Refraction and videokeratography remained stable after 6 months of follow-up. Ulcerative keratitis caused by S marcescens is a potential complication of LASIK. Bilateral involvement may occur if bilateral simultaneous surgery is performed.
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PMID:Ulcerative keratitis caused by Serratia marcescens after laser in situ keratomileusis. 1503 Aug 51

A 47-year-old woman with a history of laser in situ keratomileusis (LASIK) 2 years previously for myopia and astigmatism, presented with bilateral loss of vision due to diffuse lamellar keratitis (DLK) with corneal edema in the context of a pseudomembranous viral keratoconjunctivitis. After intense and early treatment with topical corticosteroids, the corneal edema and DLK resolved and corneal transparency was achieved with complete restoration of visual acuity. This case shows that DLK may occur associated with a viral pseudomembranous keratoconjunctivitis in patients who have had LASIK. Diffuse lamellar keratitis may present up to 2 years after lamellar surgery, which would indicate that the plane created by the microkeratome at the interface may remain unhealed for at least this period of time. Early diagnosis and treatment with topical corticosteroids can achieve complete resolution without visual loss.
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PMID:Diffuse lamellar keratitis and corneal edema associated with viral keratoconjunctivitis 2 years after laser in situ keratomileusis. 1517 19

Laser in situ keratomileusis (LASIK) is an effective option and currently one of the most commonly applied surgical techniques in the correction of refractive errors such as myopia, hyperopia, and astigmatism. In contrast to photorefractive keratectomy, it maintains the integrity of Bowman's membrane and the epithelium leading to faster visual rehabilitation as well as less pain and discomfort. Nevertheless, following LASIK the stroma is exposed to infectious organisms. Sight-threatening complications after LASIK are reported to be as rare as 1 in 1000 procedures. However, any infectious keratitis remains potentially devastating. Reports about infectious keratitis following LASIK have increasingly surfaced in recent years. We present a review of the literature on microbial keratitis and present our own cases and recommendations for possible prophylaxis and therapy.
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PMID:[Microbial keratitis following laser in situ keratomileusis. Prevention, differential diagnosis, and therapy]. 1550 51

Clinical aspects and prognosis of corneal burns mainly depend on the agent responsible for the trauma. The most severe burns are caustic burns, which should be classified as burns caused by basic agents, associated with deep and prolonged injuries, and burns caused by acidic agents, associated with more superficial injuries. At the acute stage, caustic burns induce epithelial defects, corneal edema, and ischemic necrosis of the limbus, conjunctiva, iris and ciliary body. At the early stage, reepithelialization occurs and is often associated with corneal vascularization and stromal infiltrates, followed by corneal scar formation. At the chronic stage, the following complications are possible: corneal scars, limbal stem cell insufficiency, lachrymal insufficiency, irregular astigmatism, ocular surface fibrosis, cataract, glaucoma, decreased intraocular pressure, and ocular atrophy. The Ropper-Hall classification is based on the extent of limbal ischemia. Thermal burns induce epithelial defects at the acute stage, with the more severe forms giving the same complications as caustic burns. Radiation-related burns can be caused by ultraviolet radiations (acute epithelial keratitis, pterygium, droplet-like keratitis), microwaves, infrared radiations, ionizing radiations or, laser radiations. Electrical burns are often a result of torture and give corneal stroma opacification.
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PMID:[Clinical aspects of corneal burns]. 1568 32

Orthokeratology (OK) is a clinical technique that uses specially designed rigid contact lenses to reshape the cornea to temporarily reduce or eliminate refractive error. This article reviews the history of traditional daily-wear OK (1960s to 1980s) and discusses the reasons for the recent resurgence in interest in the new modality of overnight OK, using reverse-geometry lens designs (1990s to the present). The clinical efficacy of the current procedure is examined and outcomes from clinical studies in terms of refractive error change and unaided visual acuity are summarised. Onset of the effects of overnight OK lens wear is rapid, with most change after the first night of lens wear and stability of refractive change after seven to 10 days. Mean reductions in myopic refractive error of between 1.75 and 3.33 D and individual reductions of up to 5.00 D have been reported. There appear to be slight reductions or minimal changes in astigmatism with the use of reverse-geometry lenses and most patients are reported to achieve 6/6 unaided vision or better. The induction of higher order aberrations, in particular, spherical aberration, has been reported and this may affect subjective vision under conditions of low contrast and pupil dilation. Patient satisfaction with overnight OK has been reported as similar to or better than with other popular modalities of contact lens wear. Available evidence suggests that the corneal changes induced by overnight OK are fully reversible. The refractive effect in OK is achieved by central epithelial thinning and this has raised concerns about compromise of the epithelial barrier to microbial infection. Recent reports of microbial keratitis in the modality are reviewed and the overall safety of the procedure is examined critically. Recent research on stromal contributions to the OK effect, particularly relating to overnight oedema, is summarised. Emerging issues in OK, including myopic control, correction of other refractive errors and permanency of the OK effect, are discussed.
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PMID:Orthokeratology review and update. 1663 67

A 24-year-old man with myopic astigmatism had uncomplicated laser-assisted subepithelial keratectomy (LASEK) in October 2004. Approximately 4 weeks later, a foreign-body sensation and redness developed in the left eye. A paracentral anterior stromal infiltrate was observed, and Gram stain on the day of presentation showed branching filamentous gram-positive rods. Cultures subsequently grew Mycobacterium chelonae. Topical tobramycin 15 mg/mL, azithromycin 2 mg/mL, amikacin 25 mg/mL, and cefazolin 50 mg/mL were initiated based on Gram stain results. We believe this is the first documented case of M chelonae keratitis after LASEK.
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PMID:Mycobacterium chelonae keratitis after laser-assisted subepithelial keratectomy. 1681 72

The problems of mild and high hyperopia surgical correction are complicated and an individual approach is needed. The aim of the study was to evaluate long-term efficiency and safety of two types of refractive procedures in mild and high hyperopia correction: LASIK and ICL (phakic intraocular posterior chamber contact lens) implantation. The authors evaluated a group of 37 eyes of 20 patients; the average age was 36.3 years +/- 11.8 (SD) and the follow-up period was 28.1 months +/- 10.2 (SD) after LASIK procedure, and a group of 21 eyes of 13 patients; the average age was 28.6 years +/- 6.1 (SD) and the follow-up period 30.4 months +/- 20.9 (SD) after the ICL implantation. They compared occurrence of preoperative, intraoperative and postoperative complications in both methods. They specified the efficiency and safety of the procedure by means of so called efficiency and safety index. With a questionnaire they evaluated the patient's subjective satisfaction with the refractive procedure. In the group of hyperopic LASIK, they proved statistically significant appearance of the refractive error regression, number of performed re-operations, appearance of the peroperative decentration of the photoablation zone and induced astigmatism (p < 0.05). In the ICL group, the repeated preoperative sessions for Nd-YAG laser iridotomies were necessary. Postoperatively, the appearance of keratitis striata, syndrome of the late pigment dispersion, and glare were statistically significant (p < 0.05). The authors also demonstrated higher efficiency and safety of the ICL implantation method comparing to LASIK during the whole follow up period (p < 0.05), and also higher subjective satisfaction after ICL implantation. Comparing the intraocular procedure (ICL) to the laser method (LASIK), in mild and high hyperopia correction, the higher efficiency and safety was achieved by ICL implantation.
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PMID:[Comparison of the efficiency and safety of the two methods, LASIK and ICL in mild and high hyperopia correction--part two]. 1762 30

This article reviews the literature on manual small incision cataract surgery (MSICS) and its complications. Various articles on MSICS published in indexed journals were reviewed, as well as the sections on complications of MSICS. The Pubmed search engine on the Internet was used to find out articles published since 1985 on MSICS in any language in indexed journals. Books published by Indian authors and the website of Indian Journal of Ophthalmology were also referred to. MSICS has become very popular technique of cataract surgery in India, and it is often used as an alternative to phacoemulsification. Studies on its efficacy and safety for cataract surgery show that, being a variant of extracapsular cataract surgery, MSICS also has similar intraoperative and postoperative complications. The considerable handling inside the anterior chamber during nucleus delivery increase the chances of iris injury, striate keratitis, and posterior capsular rupture. The surgeon has to be extra careful in the construction of the scleral tunnel and to achieve a good capsulorrhexis. Postoperative inflammation and corneal edema are rare if surgeons have the expertise and patience. The final astigmatism is less than that in the extracapsular cataract surgery and almost comparable to that in phacoemulsification. There is, however, a concern of posterior capsular opacification in the long term, which needs to be addressed. Although MSICS demands skill and patience from the cataract surgeon, it is a safe, effective, and economical alternative to competing techniques and can be the answer to tackle the large backlog of blindness due to cataract.
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PMID:Small incision cataract surgery: Complications and mini-review. 1907 10

A 52-year-old man had uneventful bilateral myopic laser in situ keratomileusis (LASIK) with planned monovision. Three months later, the left eye was retreated to improve the near vision. On postoperative day 1, the uncorrected distance visual acuity (UDVA) was 0.95 and the patient reported mild ocular pain. Stage 2 diffuse lamellar keratitis was observed. Despite hourly prednisolone instillation, the UDVA decreased to 0.1 and central flap necrosis syndrome was diagnosed. The flap was lifted and stromal bed irrigation performed. One month later, the UDVA was 0.05 with a hyperopic shift of +3.25 diopters and the flap, which had central haze and several striae, was amputated. Four months later, the UDVA was 0.05 with residual irregular astigmatism. Customized transepithelial photorefractive keratectomy (PRK) was performed; there were no postoperative complications. Three months after PRK, the UDVA was 0.8 with no refractive defect.
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PMID:Surgical flap amputation for central flap necrosis after laser in situ keratomileusis. 2414 Nov 43


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