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Purpose: To analyze the occurrence of epithelial defects during primary laser in situ keratomileusis (LASIK) and identify predictive preoperative risk factors., Setting: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA., Methods: The records of primary LASIK cases performed between January 2001 and May 2002 were retrospectively evaluated. Information abstracted included patient sex, age, and preoperative refraction (spherical equivalent) and the excimer laser used (Nidek EC-5000 or Alcon LADARVision). The primary outcome measure was the rate of intraoperative epithelial defect formation., Results: A total of 6984 primary LASIK cases were analyzed; these included 6067 cases with myopia and 917 cases with hyperopia. In all cases, the flaps were created with a Hansatome microkeratome (Bausch & Lomb). Most cases (75.6%) were performed with the Nidek EC-5000 excimer laser; all hyperopia cases were performed with the LADARVision laser. Overall, 647 cases (9.3%) had epithelial defects. There were 323 cases (9.5%) of epithelial defect in men and 319 (9.0%) in women (P = .4). The rate of epithelial defect increased with age; 124 (4.1%) occurred in patients younger than 40 years, and 523 (13.2%) occurred in patients older than 40 years (P<.0001). One hundred sixty cases (17.3%) were in hyperopic eyes and 487 cases (8.0%), in myopic eyes (P<.0001). Multivariate analysis of LADARVision cases showed that age older than 40 years and hyperopia were risk factors for epithelial defect (odds ratio 2.7 and 1.7, respectively; P<.0001 and P = .00002, respectively), while sex was not., Conclusion: Risk factors for epithelial defect formation during LASIK included increasing patient age, especially older than 40 years, and preoperative hyperopia.

Purpose: To compare early visual outcomes after wavefront-optimized advanced surface ablation (ASA) with those after wavefront-optimized LASIK., Design: Retrospective comparative series., Participants: One hundred thirty-six eyes undergoing ASA and 136 preoperative refraction-matched eyes undergoing LASIK from June 2004 through October 2005., Methods: Database review of preoperative characteristics, including patient age, gender, refraction, and central corneal pachymetry; perioperative information, including type of surgery, flap thickness (for LASIK cases), ablation depth, and residual stromal bed thickness; and postoperative information, including uncorrected visual acuity (UCVA) at 1 day, 1 week, 2 weeks, and 3 months, refraction at 3 months, and complications. All ASA patients had topical mitomycin C applied intraoperatively., Main Outcomes Measures: Postoperative UCVA, best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) refraction, speed of visual recovery, and postoperative complications., Results: Surface ablation patients were younger (35.4 years vs. 39.8 years, P = 0.0002) and had thinner corneas (514 microm vs. 549 microm, P<0.0001) preoperatively. Average UCVA was significantly better after LASIK at 1 day (20/26.8 vs. 20/50.4, P<0.0001) and 2 weeks (20/24.4 vs. 20/33.3, P = 0.0002) postoperatively. However, by 3 months postoperatively, UCVA was better after ASA (20/20.8 vs. 20/22.7, P = 0.05), and 81.5% of patients achieved 20/20 or better UCVA after ASA, compared with 70.5% after LASIK (P = 0.05). More ASA eyes had postoperative UCVA that achieved or surpassed preoperative BSCVA than LASIK eyes (66% vs. 41.6%, P<0.0001). There were 53 patients who underwent bilateral simultaneous ASA. By 1 week, 87.5% had 20/40 or better UCVA in at least one eye and 62.5% had 20/40 or better UCVA in both eyes. By 2 weeks, 86.8% had 20/40 or better UCVA in one eye and 82.6% had 20/40 or better UCVA in both eyes., Conclusion: Initial visual recovery is more rapid after LASIK; however, by 3 months postoperatively UCVA and SE refractions were better after ASA. Advanced surface ablation is an effective alternative to LASIK, and based on early visual recovery, bilateral simultaneous surface ablation is a reasonable alternative to sequential surgery for the majority of patients.

Purpose: To report two cases of corneal ectasia, which developed after hyperopic LASIK., Methods: Preoperative pellucid marginal corneal degeneration was observed in patient 1. Patient 2 had no preoperative risk factors., Results: Patient 1, a 47-year-old man, developed corneal ectasia in his right eye 6 months after unilateral hyperopic LASIK. Preoperative manifest refraction was +2.00 +1.50 x 178 in the right eye and +1.00 sphere in the left eye. Corneal thickness was 585 microm and 575 microm (right and left eye, respectively). Preoperative topography of the right eye demonstrated inferior steepening in the far periphery, suggestive of early pellucid marginal corneal degeneration. Patient 2, a 35-year-old man, developed corneal ectasia in his right eye > 3 years after bilateral LASIK. Preoperative manifest refraction was +2.50 sphere and +3.25 sphere (right and left eye, respectively), and corneal thickness was 556 microm in both eyes. Preoperative topography was normal in both eyes with no evidence of asymmetry, steepening, or irregularity., Conclusions: Corneal ectasia can occur after hyperopic LASIK in patients with or without recognized preoperative risk factors. Although uncommon, patients with pellucid marginal corneal degeneration can have hyperopic refractions and are at high risk for developing corneal ectasia after LASIK.

Purpose: To report the outcome of laser in situ keratomileusis (LASIK) in a patient with Fleck corneal dystrophy., Methods: Case report and literature review., Results: A 48-year-old Taiwanese man presented in November 2005, 6 years after bilateral myopic LASIK. He complained of loss of uncorrected distance visual acuity that was worse in the left eye. The patient did not report glare, halos, or other visual aberrations. Preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 OU, with a manifest refraction of -14 D OU. In November 2005, uncorrected visual acuity (UCVA) was 20/40 OD and 20/50 OS, and BSCVA was 20/25 in each eye with a manifest refraction of -1.00 sphere OD and -1.75 -1.25 x 115 OS. Slit-lamp examination was remarkable for several subtle, small, gray corneal opacities present throughout the corneal stroma. Confocal microscopy revealed refractile bodies within swollen keratocytes and normal surrounding stromal mileu. The clinical and confocal appearance was consistent with Fleck corneal dystrophy., Conclusion: In this patient with Fleck corneal dystrophy, corneal clarity and BSCVA were maintained 6 years after bilateral myopic LASIK, suggesting that LASIK does not stimulate visually significant exacerbation of Fleck corneal dystrophy.

Two patients developed corneal ectasia after photorefractive keratectomy (PRK). Case 1 had evidence of early keratoconus preoperatively, with manifest refractions of -4.00 +2.50 x 160 (20/20) in the right eye and -7.00 +3.00 x 180 (20/30) in the left eye; thin corneas (472 microm and 441 microm, respectively); and inferior paracentral steepening in the right eye and central steepening in the left eye on topography. Case 2 had manifest refractions of -8.50 +3.75 x 123 (20/20(-2)) in the right eye and -9.25 +4.00 x 077 (20/20(-1)) in the left eye; corneal thickness of 509 microm and 508 microm, respectively; and symmetric bow-tie patterns in both eyes on topography. Case 2 had a family history suspicious for keratoconus, with a sibling who had bilateral corneal transplantation at a young age. Both patients developed bilateral corneal ectasia after PRK.

Purpose: To report the first case of Avellino corneal dystrophy exacerbation after LASIK in a white or North American patient., Methods: Case report and literature review., Results: A 25-year-old white female developed progressive corneal opacities after LASIK. Preoperative examination had revealed only subtle white corneal opacities in each eye. The patient's mother had similar corneal opacities. DNA analysis of the patient revealed a heterozygous mutation at the R124H location in the BIGH3 gene., Conclusions: LASIK can exacerbate Avellino corneal dystrophy and should be avoided in patients with this condition. A careful history and genetic analysis can identify affected patients and those at risk.

Uneventful small-incision cataract surgery was performed in a 70-year-old man and a 62-year-old woman with implantation of a Tecnis Z9000 intraocular lens (IOL) (Pharmacia). No ocular pathology was present in the patients preoperatively. Unsolicited complaints of negative dysphotopsia were made postoperatively, and the symptoms have persisted for more than 1 year in both patients. Symptomatic negative dysphotopsia may be seen in association with the Z9000 IOL.

Purpose: To describe two cases of secondary congenital aphakia in association with Peters anomaly., Methods: Two infants were noted to have corneal opacification at birth. Each child was found to have Peters anomaly requiring corneal transplantation in 1 or both eyes., Results: Each child underwent penetrating keratoplasty, revealing absence of the crystalline lens in 1 eye. Histopathologic evaluation of the corneal buttons was performed. Each specimen showed full-thickness corneal defects with lens remnants., Conclusions: Secondary congenital aphakia from corneal perforation should be considered in the presentation of severe Peters anomaly.

Study Design: Retrospective review of patients who underwent lumbar juxtafacet cyst resection with questionnaire follow-up., Objectives: Determine the long-term outcome after resection of lumbar juxtafacet cysts., Summary of Background Data: Juxtafacet cysts are uncommon causes of radicular pain and are often associated with significant spinal degenerative disease. Previous studies have not focused on the outcome of patients who have undergone resection., Methods: Charts of 29 patients who underwent lumbar juxtafacet resection were reviewed and an outcomes questionnaire was sent to each., Results: Thirty-three lumbar juxtafacet cysts were resected from 29 patients. Cysts, 31 (94%) from facets and 2 (6%) from the ligamentum flavum, most commonly arose at the L4-L5 level (51%). Twelve patients (41%) were found to have some degree of spondylolisthesis before surgery, while 26 patients (90%) had facet arthropathy. Two patients (7%) underwent concurrent resection and fusion. Recurrence occurred in 3%. Three patients (9%) had subsequent lumbar spine operations, including 2 fusions (6%). Incidental durotomy was the most common surgical complication occurring in 3 cases (9%). Twenty-four patients (83%) responded to follow-up questionnaire or phone interview. Mean length of follow-up was 24 months (4-64 months). Twenty patients (83%) reported improvement in pain, and 16 (67%) reported an improved level of function. All respondents reported some degree of improvement in their condition after surgery., Conclusions: Juxtafacet cysts are an uncommon cause of radiculopathy. Surgical resection is the treatment of choice with low rates of complications, recurrences, and residual complaints.