A group of California researchers finds that unintentional hyperopia can be significantly decreased but not eliminated as a complication of post-RK cataract surgery. They propose that the accuracy of the intraocular lens power determination can be im-proved if myopia is targeted as the post-cataract surgery refractive error and the flatter K is used in the IOL determination.
The physicians retrospectively studied 24 cases drawn from their practices or reported in the literature with previous RK surgery and with known IOL power, axial length and K-values.

They found that aiming for plano with the implantation of an IOL in the 24 post-RK eyes would have resulted in a hyperopic refraction in 83.4 percent of the cases, while aiming for myopia reduced the frequency of hyperopia to 42 percent. Selection of an IOL calculated with a flatter K and aiming for plano decreased hyperopia to 44.4 percent. Aiming for -1.50 D still resulted in hyperopia in 44.4 percent of eyes.
(J Cataract Refract Surg 2003;29:65-70)
Chen L, Mannis M, Salz J, Garcia-Ferrer F, Ge J

Atopy: A Risk Factor for DLK
A retrospective survey study conducted by a team of Midwestern researchers indicates that atopy is a patient-specific risk factor for the development of diffuse lamellar keratitis after primary bilateral LASIK for either myopia or myopic astigmatism. Researchers say that atopic individuals may benefit from preoperative treatment to minimize the incidence of DLK and the potential for visual loss.

Determine the presence of allergic conjunctivitis in your candidates for LASIK.
The physicians studied the data on 360 consecutive patients who underwent same-day bi-lateral primary LASIK procedures for myopia with astigmatism during a four-month period. On preop medical history questionnaires, patients indicated if they were atopic or if they were taking any antiallergy medications or were untreated for allergy. Atopy was self-identified by 94 patients (26.1 percent) in this study. Of these, 26 patients reported current preoperative use of a prescription nonsedating histamine receptor-1 antagonist. No patients who self-identified as atopic were taking antiasthma, ß-adrenergic blocking agents alone.

The chart review revealed that the risk of DLK in untreated atopic patients was 5.85 times greater than the risk of DLK among nonatopics. However, the risk of DLK among atopic patients taking an oral systemic nonsedating H1 antagonist and among nonatopic patients didn't differ significantly. Examination of other variables revealed that female gender and the increased frequency of postoperative topical steroids seemed to be protective against DLK.  
(Ophthalmology 2003;110:131-137)
Boorstein S, Henk H, Elner V