Purpose: . To evaluate the results of LASER in SITU KERATOMILEUSIS (LASIK) for hyperopia. Methods: 23 eyes of, 14 patients underwent hyperopic LASIK using , the hansatome corneal shaper and Keracor 217-c Chiron (Bausch -& Lamb) excimer LASER. patients were divided into two groups based on Preoperative spherical equivalent; group I, spherical equivalent ≤5D and group II >5D, The ,following factors were measured post-operatively:. Uncorrected Visual Acuity (UCVA), Best spectacle Corrected Visual Acuity (BCVA); refraction (dry, cycloplegic); lines of ,visual acuity ,gained and lost. Results:, six months after LASIK, Group I had a mean ±SD spherical Equivalent of +0.22±91D (range -1.19 to +1.63) and, group 2, 2.08:±2.52 (range -0.06 to +8.43). After six months 66.6% in group I and 45.4% in group II were ,within ±ID emmetropia. UCVA was 20/40 or better in 100% in group I and 71.4% in group II. UCVA remained unchanged or increased in 66.6% in group I and 28.4% in group II. Thirty three and three tenth percent in group I and 21.4% in group two lost 1 or 2 lines of BCVA. Conclusions: LASIK was predictable and safe for low and moderate hyperopia (MSE≤5D); but for high hyperopia (>5D) is not a good

BACKGROUND: This study was conducted to evaluate variations in heart rate and to determine the occurrence of oculocardiac reflex (OCR) during LASER in SITU KERATOMILEUSIS (LASIK). METHODS: This descriptive, prospective study was designed to observe the effect of suction ring and ablation stages during LASIK procedure on the heart rate. The ECG was taken before and during LASIK operation on the first eye in 61 patients. These patients were selected randomly among cases that presented to Al-Zahra Hospital, Isfahan, Iran for LASIK surgery in summer 2001. All patients were healthy without history of cardiovascular disease and no systemic medication. The ECG prior to the procedure was considered as baseline. Decrease in the heart rate of 10% or more of baseline was considered as oculocardiac reflex. RESULTS: In 12 patients (20%) the heart rate decreased more than 10% during the suction ring stage. In 19 patients (31%) the heart rate increased more than 20% of baseline. In 15 patients (25%) the heart rate increased 10%-20% more than baseline during the preparation and ablation stages. In the remaining 15 patients (25%) the heart rate did not change during the procedure. CONCLUSIONS: Results of this study confirm that oculocardiac reflex may occur during the LASIK procedure especially in the suction ring stage. Because the oculocardiac reflex may cause heart rate changes during LASIK, the patients should be closely monitored during the procedure.

Purpose: To report a case of unilateral Aspergillus fumigatus interface keratitis after LASER in SITU KERATOMILEUSIS (LASIK).Case Report: A 22-year-old woman developed corneal infiltrates located at the flap- stroma interface in her left eye 48 hours after myopic LASIK. The infiltration progressed despite administration of topical fortified antibiotics therefore, the flap was lifted and irrigated with antibiotic solution. Six days after LASIK, visual acuity was counting fingers at 30 cm and a large full-thickness corneat infiltrate was located at the flap-stroma interface. On scanning confocal microscopy, fungal hyphae were observed as high-contrast filaments. The LASIK flap was amputated. Corneal scraping revealed fungal filaments in smears and culture. The fungus was identified as Aspergillus fumigatus. Fortified antibiotic drops were discontinued and intensive topical natamycin and systemic ketoconazole were initiated which controlled the keratitis. Two months after surgery the eye was quiet and vision improved to 20/200.Conclusion: Interface fungal infection after LASIK is a potentially vision-threatening complication Early lifting of the flap, fungal culture and aggressive antifungal treatment are required to treat this complication. Confocal microscopy may be a fast and safe diagnostic tool in determining the presence of fungal hyphae in vivo within the human cornea.

Background and Aim: Post-LASIK infection is a life threatening condition. The present study was conducted to measure the rate of corneal interface contamination during LASER in SITU KERATOMILEUSIS (LASIK), determine probable sources of the contamination, and evaluate how the cornea reacts to the contamination. Material and Methods: In this case series, 200 eyes were evaluated for the corneal interface contamination at the end of LASIK. Cultures were obtained from the upper and lower eyelid margins and the inferior fornices before surgery and from the corneal interface and the instrument at the end of surgery. Media were cultured at 37°C for 14 days under aerobic and anaerobic conditions. Bacteria from positive cultures were isolated and identified by biochemical procedures to determine the species of the organisms. Results: The rate of contamination was 24.5%. The most common retrieved organism was Staphylococcus epidermidis (43 cases, 87.7%). None of the contaminated or non-contaminated cases developed corneal ulcers; however, 2 eyes developed diffuse lamellar keratitis. Conclusion: The corneal stroma has the ability to clear introduced microorganisms during LASIK.

Purpose: To report the characteristics and incidence of rhegmatogenous retinal detachment (RRD) in myopic eyes after LASER in SITU KERATOMILEUSIS (LASIK). Design: Retrospective, interventional case series. Methods: Medical records of 49 patients with RRD after 59,424 LASIK procedures were reviewed. The incidence of post-LASIK RRD was determined and potential risk factors were evaluated. Results: LASIK was performed on eyes with spherical equivalents (SE) ranging from -0.75 to -26.50 Diopters (D) (mean -6.10±3.5 D). Forty-nine eyes developed RRD between 1.5 and 76 months (mean 27.3±21.7 mo.) after LASIK. The mean pre-operative refractive error in these eyes was -8.6±3.9 D. These patients were on average 38.2±11.2 years old. Thirty five patients (71.4%) were male. The cumulative incidence of RRD was 0.082% (95% Cl: 0.061-0.109), and the yearly incidence was 0.032% (95% Cl: 0.023-0.042) after LASIK. The most frequent location of the breaks was superior temporal quadrant (22.7%). The male sex, higher age and higher pre-operative myopia were significantly related with the incidence of RRD after LASIK (p<0.001). Conclusion: Based on the results of this study, following the treatment of high risk peripheral retinal lesions, LASIK did not appear to be an additional risk factor for the development of RRD after LASIK in our patients, but the patients should be informed of the possibility of RRD as a consequence of myopia. Male patients and those with higher age and pre-operative myopia may be at increased risk.        

Purpose: To evaluate the visual and refractive results of LASER in SITU KERATOMILEUSIS (LASIK) for mild to severe hyperopia with or without astigmatism.Setting: Private Aban Clinic, ISFAHAN; IRAN.Material & Methods: This quasi-experimental study comprised 51 eyes of 26 patients. All patients were operated by one surgen (M.G) using technolas 217 excimer LASER.Hansatome microkeratome was used to create a corneal Flap with diameter of 9.50 mm and thickness of 160-180 mm.Results: 51 eyes of 26 patients (61.5% Male and 38.5% Female) ranging in age from 19 to 54 years were operared. Of these; 13 eyes had simple hyperopia and other 38 eyes had hyperopic astigmatism.Mean preoperative refractive error was +4.40±1.70 D. which reduced to +0.99 :1:0.640 postoperativly (P<0.001).Pre-operative mean astigmatism was 1.07+1.14 D. which regressed to 0.58 diopter following operation.Pre-op. BSCVA of 20/20 was found in 25. 47% of eyes whilst it was found in 27.45% of eyes postoperatively.Pre-op UCVA 20/20 and 20/40 or greater were seen in 00.00% & 05.88% eyes respectively whilst were seen in 15.68 and 82.35% eyes post-op.Symptoms of blured vsion in 73.10% ; glare in 69.20%, forgin body sensation in 34.60% and eye strain in 19.30% were detected postoperatively.Pseudo-fleischer ring and SPK were visible in ophathalmologic examination of 56.80% and 09.80% of patients in postoperative examination respectively.Conclusion: LASIK was an effective procedure for correction of mild to moderate degrees of simple and astigmatic hyperopia in our experience although some minor complications has been occured.

Background: To evaluate the long-term predictability, stability, safety, efficacy, and patient satisfaction of LASER in SITU KERATOMILEUSIS (LASIK) in treating our first myopic patients after five years. Methods: Ninety-seven eyes (54 patients) that had LASIK for myopia with our first system were revisited. The mean follow-up time for these patients was 5.4 years (range, 4.4 to 6.3 years) on the last examination. The Chiron Automated Corneal Shaper (ACS) was used to create the flap and a summit OmniMed Technology excimer LASER was used to ablate all corneas. All patients had an ophthalmic examination that included refraction (manifest, subjective, and cycloplegic), visual acuity, biomicroscopy, applanation tonometry, funduscopy, keratometry, pachymetry, and corneal topography. Patients completed an 11 item questionnaire to evaluate their satisfaction with the surgery and its visual outcome. Results: The mean spherical equivalent was -8.5±3.4D (range, -16.8 to -2.9 D) preoperativelyand -1.7±1.8D (range, -8.3 to 0.8 D) on the final follow-up visit with 55 (56.7%) eyes within ±1.0 D and 86 (88.7%) within ±3.0 D of the intended correction. Uncorrected visual acuity was 20120 or better in 23 (23.7%) eyes, and 20/40 or better in 66 (68.0%). Four eyes (4.2%) gained >2 lines of BCVA, and 2 eyes lost >2 lines of BCVA. A 92.1% of patients were quite or very pleased with their vision and 82.4% would certainly have had the surgery again.Conclusion: In the long term, LASIK seems to be a safe and effective modality for treating myopia especially in low to moderate corrections. Considering the advances in its technology and the better comprehension of its effects and complications, more favorable outcomes can be expected.

Purpose: To evaluate the visual and refractive results of LASER in SITU KERATOMILEUSIS (LASIK) for mild to high myopia with or without astigmatism.Setting: Private clinic, Tehran, Iran. Methods: This retrospective study comprised 222 eyes of 115 patients. All the patients were operated by one surgeon (M.J.) using Nidek EC 5000 excimer LASER.Hansatome and Moria microkeratom was used to creat a corneal flap diameter of 8.5 mm and thickness 130 to 160 µ.Results: 222 eyes of 115 patients 79.1 % male and 20.0% female with a mean age of 20.9% female with a mean age of 29±7.5 years ranging in age from 18 to 48 were operated. Of these 96 were simple myopia and 126 myopic astigmatism. Mean preoperative refractive error was -5.00±1.00 which reduced to -0.18±0.57 D post operatively (P<0.001). Pre-operative mean astigmatism was 1.5±1.02 which regressed to 0.23±0.5 diopters.Pre op BCVA was 20/20 or greater in 67.4% whilst it was 68.3% post operatively. Postoperative UCVA of 20/20 was seen in 41.3% and 20/40 or greater in 92.3%. Complications occurred in 36 eyes (16.2%), DLK (7.7%) and flap wrinkling (6.3%) were the most common.Conclusion: Lasik is an effective procedure for correction of simple and astigmatic myopia with limited major complication.

Purpose: To compare long-term results of excimer LASER sub-epithelial keratectomy (LASEK) and LASER in SITU KERATOMILEUSIS (LASIK) for low to moderate myopia. Methods: In a comparative case series, visual outcomes in 415 LASIK -treated eyes (212 Patients) and 359 LASEK-treated eyes (194 patients) with myopia ranging from -1.5 to -5 diopters (D) and astigmatism up to -2.75 0 using a flying spot excimer LASER (Technolas 217) by a single surgeon were analyzed. Patients were divided into mild and moderate myopia. Uncorrected and corrected visual acuity, manifest refraction, and complications were evaluated.Results: Patients' age ranged from 19 to 47 years. Uncorrected visual acuity was 20/20 or better  in 89.3% of LASEK treated eyes and 90.7% of LASIK treated eyes at about 2 years follow-up (P>0.05). Spherical equivalent within ±0.5 D of emmetropia was achieved in 83.3% of eyes in the LASEK group and 84.7% of eyes in the LASIK group (P>0.05). None of the eyes lost 2 or more lines of BCYA.Conclusion: LASEK is a safe and effective procedure that provides excellent refractive and visual results with no serious complications. It can be considered as an alternative refractive surgery for correction of low to moderate myopia.