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Improved Binocularity After Laser in Situ Keratomileusis

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Improved Binocularity After Laser in Situ Keratomileusis shown effective intraocular concen- trations after oral dosing.7 The in- Improved Binocularity seconds of arc). At 7 months, she fection was successfully eradicated After Laser In Situ maintained Titmus stereoacuity (40 seconds of arc) and stated that the with preservation of ambulatory Keratomileusis vision. dots had become even easier to see. This first case of postoperative Refractive surgery can improve un- VRE endophthalmitis is an unfor- corrected vision over a wide range Comment. Refractive surgery effec- tunate milestone in ophthalmic sur- of refractive errors. However, im- tively improves visual acuity and re- gery. Future cases are probably in- paired binocularity has been re- duces refractive error. However, it evitable given the trends in the ported after refractive surgery.1 De- can adversely affect binocular func- epidemiology of VRE infection and compensated strabismus and loss of tion. Reports describe decompensa- colonization, especially in patients stereopsis can be disturbing, even tion of strabismus following refrac- tive surgery, with resultant esotropia, with compromised immunity. Colo- when visual acuity outcome is ex- 1 nized donor corneal tissue is a po- cellent. Improved stereopsis after re- exotropia, or hypertropia. The stra- bismus can lead to asthenopia or tential source. While optimal treat- fractive surgery is rarely reported and 3 ment of this infection is unknown, is usually found in the pediatric even diplopia. In cases of monovi- the favorable outcome in our pa- population.2 We present a case of im- sion refractive surgery, some pa- tients will lose subjective depth per- tient may have been the result of proved stereopsis after laser in situ 4 early intervention and the use of keratomileusis (LASIK) treatment of ception. Stereoacuity may be linezolid. anisometropia in an adult. difficult to recover, even when mo- novision is reversed with correction. Harshivinderjit S. Bains, MD, PhD Report of a Case. A 32-year-old This case presents improved ste- David V. Weinberg, MD woman was first seen for LASIK reopsis in an adult with long- Robert S. Feder, MD evaluation, complaining that her eyes standing anisometropia. Despite Gary A. Noskin, MD did not “work well together.” She had minimal amblyopia in the right eye (best-corrected visual acuity, 20/ Correspondence: Dr Weinberg, been prescribed glasses at age 6 years, but she did not wear them. She de- 25), her subjective and objective bin- Department of Ophthalmology, ocularity improved within 1 week af- Medical College of Wisconsin, 925 nied therapy for amblyopia or stra- bismus. She had no significant medi- ter LASIK. She further improved to N 87th St, Milwaukee, WI 53226 40 seconds of arc at 1 month after ([email protected]). cal history and her medication included only birth control. the operation, which was main- Financial Disclosure: None re- tained at 7 months. She did have ported. Uncorrected visual acuity was 20/ 150 OD and 20/30 OS. Preopera- some optical correction as a child, Funding/Support: This study was which may have yielded her some in- supported in part by an unre- tive best-corrected visual acuity was 20/25 OD and 20/20 OS. Cyclople- creased stereoacuity potential. Her stricted grant from Research to Pre- ϩ ϫ preoperative decreased stereoacu- vent Blindness Inc. gic refraction was 2.75 –4.50 116 OD and –0.75 –0.25 ϫ 80 OS. ity may have been related to her not Titmus stereoacuity testing with- wearing corrective devices and may out correction yielded 5 of 9 dots have improved with contact lens 1. Tenover FC, McDonald LC. Vancomycin- trial. However, she had a subjective resistant staphylococci and enterococci: epide- (100 seconds of arc). Pupil, extra- miology and control. Curr Opin Infect Dis. 2005; ocular motility, slitlamp, intraocu- and objective improvement with time 18(4):300-305. lar pressure, and dilated retinal ex- after LASIK resolved her anisome- 2. Esmaeli B, Holtz ER, Ahmadi MA, Krathen RA, tropia. In a MEDLINE search, we Raad II. Endogenous endophthalmitis second- amination results were all normal. ary to vancomycin-resistant enterococci No contact lens trial was performed. were unable to find cases in which an infection. Retina. 2003;23(1):118-119. adult patient had improved stereoa- 3. Han DP, Wisniewski SR, Wilson LA, et al. Spec- The patient underwent LASIK trum and susceptibilities of microbiologic iso- surgery with the Moria CB manual cuity after refractive surgery. lates in the Endophthalmitis Vitrectomy Study microkeratome (Moria USA, Patients with a history of strabis- [published correction appears in Am J Ophthal- mus or undergoing monovision re- mol. 1996;122(6):920]. Am J Ophthalmol. 1996; Doylestown, Pennsylvania) and the 122(1):1-17. VISX STAR S4 Laser (VISX USA Inc, fractive surgery should be warned of 4. Recchia FM, Busbee BG, Pearlman RB, Carvalho- Santa Clara, California). At postop- decreased binocularity. However, Recchia CA, Ho AC. Changing trends in micro- some patients with anisometropia biologic aspects of postcataract endophthalmitis. erative week 1, the patient stated that Arch Ophthalmol. 2005;123(3):341-346. her eyes were working better to- may experience an improvement in 5. Scott IU, Loo RH, Flynn HW, Miller D. Endoph- binocularity after refractive surgery. thalmitis caused by Enterococcus faecalis: anti- gether. Uncorrected visual acuity was biotic selection and treatment outcomes. 20/25 OD and 20/20 OS. Stereoacu- Barry N. Wasserman, MD Ophthalmology. 2003;110(8):1573-1577. ity testing results were now 8 of 9 dots 6. Noskin GA, Siddiqui F, Stosor F, Hacek D, Chrishonda C. McCoy, MD Peterson LR. In vitro activities of linezolid against (50 seconds of arc). At 1 month af- important gram-positive bacterial pathogens in- ter the operation, the patient felt her Correspondence: Dr Wasserman, cluding vancomycin resistant enterococci. An- timicrob Agents Chemother. 1999;43(8):2059- depth perception was “perfect.” Her Department of Pediatric Ophthal- 2062. vision was unchanged and manifest mology, Wills Eye Hospital, 840 7. Fiscella RG, Lai WW, Burek B, et al. Aqueous refraction was plano –0.50 ϫ 146 OD Walnut St, Philadelphia, PA 19107 and vitreous penetration of linezolid (Zyvox) af- ϫ ter oral administration. Ophthalmology. 2004; and plano –0.25 13 OS. Stereoa- (bwasserman@americansurgisite 111(6):1191-1195. cuity had improved to 9 of 9 dots (40 .com). (REPRINTED) ARCH OPHTHALMOL / VOL 125 (NO. 9), SEP 2007 WWW.ARCHOPHTHALMOL.COM 1293 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 Financial Disclosure: None reported. Hittner HA. Laser in situ keratomileusis for surgery: occurrence and prevention. Arch treated anisometropic amblyopia in awake, Ophthalmol. 2003;121(3):315-321. 1. Godts D, Tassignon MJ, Gobin L. Binocular vi- autofixating pediatric and adolescent patients. 4. Fawcett SL, Herman WK, Alfieri CD, et al. Ste- sual impairment after refractive surgery. J Cata- J Cataract Refract Surg. 2004;30(12):2522- reoacuity and foveal fusion in adults with long- ract Refract Surg. 2004;30(1):101-109. 2528. standing surgical monovision. J AAPOS. 2001; 2. Phillips CB, Prager TC, McClellan G, Mintz- 3. Kushner BJ, Kowal L. Diplopia after refractive 5(6):342-347. From the Archives of the Archives Quantitative determinations of the absorption of UV ra- diations by different structures of the eye are of impor- tance, since various pathologic conditions, such as cata- ract, retinal damage, and functional visual disturbances, have been variously ascribed to these radiations. The UV absorption spectrums of various compo- nents of the rabbit eye have been measured. The limit of transmission for the whole eye is approximately 330 millimicrons; that for the lens, 310 millimicrons, and that for the aqueous and vitreous humors and cornea, sepa- rately, approximately 280 millimicrons. Measurements of the absorption of ultraviolet radia- tions by the corneal epithelium indicate that the chief absorbing element is nucleoprotein, its limit of trans- mission being less than 230 millimicrons. The minimal amount of radiant energy from the sun to which the eye would have to be exposed before mini- mal damage would occur to the lens was calculated to be about 3 times the dose necessary to produce mini- mal damage to the cornea. The results suggest that so little ultraviolet radiation in the abiotic region reaches the retina that damage from these rays would be extremely unlikely. Reference: Kinsey VE. Spectral transmission of the eye to ultraviolet radiations. Arch Ophthalmol. 1948;39: 508, 513. (REPRINTED) ARCH OPHTHALMOL / VOL 125 (NO. 9), SEP 2007 WWW.ARCHOPHTHALMOL.COM 1294 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021.
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