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Quality of life improves after refractive surgery with ReLEx SMILE procedure

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This issue’s Refractive Surgery Story is the first of the series to discuss the SMILE procedure, an acronym for small-incision lenticule extraction performed with the Zeiss VisuMax laser. This procedure is not yet approved by the FDA in the U.S., and in fact, submission of data for myopic correction has just begun.Dr. Dirisamer chose this procedure, performed in Europe, although he was a LASIK candidate, because he felt that the post-procedure structural integrity of the cornea would be better maintained than with LASIK. Other advantages may include higher predictability in higher myopes, less induction of spherical aberration and a more comfortable docking procedure. Visual recovery is sometimes a little slower than with LASIK.

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Middle-aged woman experiences refractory uveitis

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A 46-year-old Indian woman was referred by her optometrist for uveitis in the right eye. She initially presented to the optometrist’s office 1 month before the referral with a 1-day history of blurred vision, tearing and photophobia. The optometrist prescribed prednisolone acetate 1% four times per day.On review of systems, she reported dysphagia and odynophagia for the past several months. Ocular history was significant for three to four prior episodes of anterior uveitis beginning 3 to 4 years before presentation, always in the right eye, as well as a choroidal nevus in the right eye with no thickening or adjacent inflammation. No prior laboratory workup was performed to investigate the etiology of the uveitis. There was no significant medical or surgical history. She denied any history of cold sores. Family history was significant for her two children who were diagnosed and treated for latent tuberculosis upon starting grade school in the United States. She did not use any medications, tobacco or alcohol and did not have known drug allergies.

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Pars plana approach can be used for surgical injection technique

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Topical ocular medications are an integral part of the pre- and postsurgical therapeutic regimen for cataract and other anterior segment procedures. The use of these mostly multi-dose topical medications introduces issues such as patient compliance, cumulative added drug cost to the patient, preservative-related alterations to the ocular surface and secondary visual quality degradation.The introduction of the “dropless” approach to the surgical therapeutic regimen appears to be a welcome modality that negates many issues with drops. However, such a turn in the path of ocular drug delivery poses new challenges and has to meet the litmus test of therapeutic efficacy, safety and absence of any major drug-related complications. New therapeutic routes of drug delivery during cataract surgery include the anterior chamber, posterior chamber, pars plana region and vitreous. Such a route of drug administration has the added advantage of direct, timely treatment of potential pathogenic organisms that may contaminate the interior of the eye during cataract surgery.

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