bluuebunny/crossref_metadata_2025 huggingface dataset:
Optic Disc Topography Before and After Trabeculectomy in Advanced Glaucoma
Authors: Raitta Christina , Tomita Goji , Vesti Eija , Harju Mika , Nakao Hiroko
Published: April 2021

* BACKGROUND AND OBJECTIVE: To analyze changes in the optic disc topography after filtration surgery.

* PATIENTS AND METHODS. Laser scanning tomography was performed in 10 eyes of 9 patients (mean age 65-6 ± 8.1 years; age range 55 to 75 years) after a mean follow-up of 3.7 months, and in 8 eyes of 7 patients (mean age 63.1 ± 7.6 years; age range 55 to 75 years) after a mean follow-up of 13.1 months.

* RESULTS: Preoperatively, the mean intraocular pressure (IOP) was 24.4 ± 6.9 mm Hg with maximal medication. Postoperatively at 3.7 months it was 11.0± 2.2 mm Hg, and at 12.1 months it was 13.6 ±2.8 mm Hg. An initial reduction in IOP of more than 30% at 3.7 months was achieved without medication in all but 1 eye. After 12.1 months, an IOP reduction of more than 30% was achieved in 6 of 8 eyes (1 with medication), while 2 eyes had IOP reductions of less than 15% (≤ 3 mm Hg) despite medication. In the 6 eyes, the optic disc cup volume showed a decrease of more than 30%, while the 2 eyes without marked IOP reductions had slight increases in cup volume. Of the 2 eyes without marked decreases in cup size, 1 had normal-tension glaucoma and 1 experienced an increase in IOP of more than 25 mm Hg during the first postoperative week.

* CONCLUSION: The postoperative IOP should be kept low enough to permit reversal of optic disc changes.

[Ophthalmic Surg Lasers 1996;27:349-354.]
Removal of a Corneal Foreign Body Through a Lamellar Corneal Pocket
Authors: Au Yue-Kong , Libby Curtis , Patel Jayesh S
Published: April 2021

Abstract. A piece of glass was found in the posterior central cornea of a 43-year-old victim of a motor vehicle accident. The original entry of the foreign body had healed and epithelíalized. This foreign body was removed through a peripheral corneal incision and corneal stromal pocket extended to the glass particle. This technique avoids creation of a corneal incision near the optical axis and prevents unwanted distortion of the corneal topography. The authors report this case to emphasize the importance of preserving corneal topography in corneal surgery. [Ophthalmic Surg Lasers 1996;27:471-472.]
Circular Surgical Cyclopexy After Extensive Traumatic Cyclodialysis
Authors: Wiechens Burkhard , Rochels Rainer
Published: April 2021

Abstract. The authors operated on a patient who had bilateral ocular hypotony after severe blunt ocular trauma with subsequent circular cyclodialysis and luxation of the lenses. Because of the specific situation, none of the previously reported procedures could be applied. A new surgical technique was used to circularly refixate the ciliary body ab interno. The method described here is simple and can be recommended as an alternative technique to refixate the ciliary body in all aphakic or pseudophakic eyes with persistent ocular hypotony caused by traumatic or surgically induced cyclodialysis. [Ophthalmic Surg Lasers 1996;27:479-483.]
The Results of Ab Interno Laser Thermal Sclerostomy Combined With Cataract Surgery Versus Trabeculectomy Combined With Cataract Surgery 6 to 12 Months Postoperatively
Authors: Kendrick Ronald , Kollarits Carol R , Khan Nasreen
Published: April 2021

* BACKGROUND AND OBJECTIVE: When cataract surgery and glaucoma surgery are combined, the theoretical advantages of pressure control, removal of the visual impairment, and protection against an increase in intraocular pressure (IOP) in the immediate postoperative period are gained. The authors' objective was to determine whether ab interno laser thermal sclerostomy (LTS) combined with cataract surgery would be as effective as trabeculectomy combined with cataract surgery.

* PATIENTS AND METHODS: Ab interno LTS was compared with trabeculectomy, retrospectively, for patients who had undergone combined cataract and glaucoma surgery.

* RESULTS: There was no significant difference in the numbers of patients using no medications or fewer medications at 6 and 12 months. There was a greater reduction in IOP in the LTS group.

* CONCLUSIONS: LTS may be better than trabeculectomy in combined cataract and glaucoma surgery because it reduces the IOP more. Compared with trabeculectomy, LTS is simpler to perform and adds less operating time to cataract surgery. Continued follow-up is recommended.

[Ophthalmic Surg Lasers 1996;27:583-586.]
Cataract Surgery After Trabeculectomy
Authors: Seah Steve K L , Jap Aliza , Prata Joao A , Baerveldt George , Lee Paul P , Heuer Dale K , Minckler Don S
Published: April 2021

* BACKGROUND AND OBJECTIVE: To determine the effect of cataract surgery on glaucomatous eyes with good intraocular pressure (IOP) control after trabeculectomy.

* PATIENTS AND METHODS: Twenty-two eyes with functional blebs that underwent cataract extraction were retrospectively analyzed.

* RESULTS: The mean (± SD) preoperative IOP was 11.0 ± 4.3 mm Hg. The mean (± SD) postoperative IOPs at 1, 2, 6, and 9 months were 15.5 ± 4.9, 12.6 ± 4.7, 14.6 ± 5.6, and 19.0 ± 7.9 mm Hg, respectively. At each interval except for the second month, the mean IOP was statistically significantly higher than the preoperative value (P = .0003, .24, .02, and .0009, respectively). The total number of medications was also higher (3 preoperatively versus 27 postoperatively). The interval between the two surgeries had no influence on IOP control. Intraoperative complications during cataract surgery, particularly vitreous loss, were associated with poor IOP control. Phacoemulsification had less of an effect on the postoperative IOP control than did extracapsular cataract extraction.

* CONCLUSIONS: Eyes with previous successful trabeculectomies had higher IOPs and required more medications after subsequent cataract surgeries.

[Ophthalmic Surg Lasers 1996;27:587-594.]
Enlarged Extraocular Muscles From Metastatic Signet Ring Carcinoma
Authors: Loes Lee , Wesley Ralph E , Lavin Patrick
Published: April 2021

Abstract. Enlarged extraocular muscles usually occur from inflammatory conditions, but in rare instances metastatic tumors that invade the muscles will require a biopsy and specific treatment. The authors report what they believe to be the third case of metastases to the extraocular muscles from signet ring cell adenocarcinoma of an unknown primary site. [Ophthalmic Surg Lasers 1996;27:632-635.]
An Unusual Complication of a Postcataract Filtering Bleb
Authors: Rao Srinivas K , Padmanaban Prema
Published: April 2021

Abstract. Inadvertent blebs are sometimes encountered after cataract surgery using sutured limbal incisions. A number of surgical techniques have been described in the planned management of such blebs. Occasionally, an intraoperative bleb rupture may occur. The authors describe a rotational scleral autograft technique that can help in the management of this complication. [Ophthalmic Surg Lasers 1997;28:601-602.]
A New Water Bath for Ultrasonic Biomicroscopy
Authors: Kapetansky Frederick M
Published: April 2021

Abstract. Ultrasonic biomicroscopy (UBM) has added greatly to our understanding of the development of certain forms of glaucoma. Methylcellulose is usually recommended as the appropriate coupling medium between the transducer and the eye because of its increased viscosity, which makes it more easily retained on the eye. A new water bath has been developed that fits the eye so well that saline, a superior coupling agent, can be substituted for methylcellulose. This new water bath is a flexible polysiloxane cup with a beveled inner edge, providing a watertight seal and thus permitting the use of saline as the coupling medium for UBM. Saline, because of its lack of impurities, generates images that are superior in quality to those produced with methylcellulose as the coupling medium. [Ophthalmic Surg Lasers 1997;28:605-606.]
A Disposable Needle for Frontalis Suspension Surgery in Congenital Ptosis
Authors: Davi Giuseppe , Modorati Giulio , Brancato Rosario
Published: April 2021

Abstract. In six patients affected by congenital ptosis, a disposable epidural anesthesia needle was used instead of a Wright needle for frontalis suspension surgery. For each of the patients in this study, the use of a disposable needle permitted smaller supra-brow area incisions with a minimal scar. The needle also created a smaller breach in the plane of levator aponeurosis and preaponeurotic fat, causing less tissue edema and bleeding than with a Wright needle. [Ophthalmic Surg Lasers 1997;28:607-608.]
Comparative Results of Combined Procedures for Glaucoma and Cataract: II. Limbus-Based Versus Fornix-Based Conjunctival Flaps
Authors: Tezel Gülgün , Kolker Allan E , Kass Michael A , Wax Martin B
Published: April 2021

* BACKGROUND AND OBJECTIVE: One of the variables to be considered in a combined procedure for glaucoma and cataract is the type of conjunctival flap to be used. The objective of this study was to compare the effects of limbus-based and fornix-based conjunctival flaps on postoperative long-term intraocular pressure (IOP) control and visual acuity after combined trabeculectomy with phacoemulsification.

* PATIENTS AND METHODS: The authors retrospectively reviewed the charts of 189 patients (215 eyes) who underwent combined trabeculectomy with phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and intraoperative mitomycin-C administration and who had a minimum follow-up of 12 months. The results of the limbus-based (151 eyes) versus fornix-based (64 eyes) conjunctival incisions used in these combined procedures were compared.

* RESULTS: In the limbus-based conjunctival flap group, 146 eyes (97%) achieved an IOP of less than 20 mm Hg, with or without medication; 62 eyes (97%) of the fornix-based conjunctival flap group (P > .05) achieved this result. A visual acuity of 20/40 or better was noted in 106 eyes (70%) in the limbusbased conjunctival flap group and in 45 eyes (70%) in the fornix-based conjunctival flap group (P > .05) at the last examination. Early wound leakage was observed more frequently in the fornix-based conjunctival flap group (8% vs 1%) (P= .014); however, it was not a serious clinical problem, as only 1 eye required surgical repair. Posterior capsular opacification was found more often in the limbus-based conjunctival flap group (25% vs 14%) (P = .072) and required more frequent laser capsulotomy (22% vs 9%) (P= 0.03).

* CONCLUSION: Limbus-based and fornix-based conjunctival flaps appear to be comparable with respect to postoperative IOP control and visual acuity after a combined trabeculectomy with phacoemulsification and posterior chamber IOL implantation in cases supplemented by intraoperative mitomycin-C.

[Ophthalmic Surg Lasers 1997;28:551-557.]
Anticardiolipin Antibodies and Retinal Vascular Complications in Behçet's Disease
Authors: Özdemir Yildiz , Önder Feyza , Yarangümeli Alper , Küçükkuyumcu Cumhur , Kural Gülcan
Published: April 2021

* BACKGROUND AND OBJECTIVE: Intravascular thrombosis is a well-recognized feature of Behcet's disease (BD). In this study, the existence of a connection between serum anticardiolipin (aCL) antibodies and retinal vascular complications in BD is investigated.

* PATIENTS AND METHODS: Serum aCL antibody levels were quantified in 31 patients with BD, all of whom fulfilled the major criteria of the disease. Patients were evaluated in terms of retinal vascular complications. Serum aCL antibody levels were determined through the ELISA method. Statistical analysis was performed with the chi-squared test and the Fisher exact test.

* RESULTS: Of 12 patients with high aCL antibody levels, retinal vascular thrombosis was detected in 5 and retinal vasculitis was present in 8. However, there was no statistically significant relation between these complications and serum aCL antibody elevation (P > .05).

* CONCLUSION: Based on this series of 31 patients with BD, there does not seem to be a significant correlation between retinal vascular complications and serum aCL antibody levels.

[Ophthalmic Surg Lasers 1997;28:653-656.]
Chalazion-Induced Hyperopia as a Cause of Decreased Vision
Authors: Cruz Cristian Santa , Culotta Tina , Cohen Elisabeth J , Rapuano Christopher J
Published: April 2021

Abstract. This article presents three cases of decreased vision due to acquired hyperopia, which were caused by a chalazion of the upper eyelid. Through manifest refraction and computerized corneal topographic analysis, acquired hyperopia associated with central corneal flattening was revealed. These findings were responsible for the blurred vision that was reversed by chalazion resolution or removal. Although not usually considered a risk factor for refractive disorders other than astigmatism, chalazia of the upper eyelid can present as a decrease in vision associated with reversible central corneal flattening and acquired hyperopia. [Ophthalmic Surg Lasers 1997;28: 683-684.]
Combined Pars Plana Vitrectomy and Scleral Buckling for Pseudophakic and Aphakic Retinal Detachments in Which a Break Is Not Seen Preoperatively
Authors: Desai Uday R , Strassman Israel B
Published: April 2021

* BACKGROUND AND OBJECTIVE: This study presents a group of patients with a Pseudophakic or aphakic retinal detachment (RD) and an unseen retinal break who were treated with a pars plana vitrectomy (PPV), fluid-air exchange, internal drainage, and endolaser in addition to a scleral buckle (SB) procedure.

* PATIENTS AND METHODS: The charts of 10 consecutive patients with a Pseudophakic or aphakic RD and an unseen retinal break who were treated with a PPV, fluid-air exchange, internal drainage, endolaser, and an SB were reviewed for preoperative and postoperative visual acuity, postoperative status of the retina, and surgical complications.

* RESULTS: All of the patients with a postoperative follow-up of at least 6 months continue to maintain an attached retina after one operation. Visual acuity has improved by at least 2 lines on the Snellen chart in 7 patients, remained the same in 2 patients, and decreased in 1 patient.

* CONCLUSIONS: This pilot study shows good anatomic results when performing a PPV, fluid-air exchange, internal drainage, and endolaser together with an SB for Pseudophakic or aphakic patients with an RD and an unseen break.

[Ophthalmic Surg Lasers 1997;28:718-722.]
Sub-Tenon's Anesthesia and Orbicularis Oculi Function
Authors: Rauz Saaeha , Subramaniam Srinivasan
Published: April 2021

* BACKGROUND AND OBJECTIVE: To assess the necessary volume of local anesthetic with added hyaluronidase that must be infiltrated to the subTenon's space to achieve complete eyelid akinesia.

* PATIENTS AND METHODS: Eighty-five consecutive patients were randomly assigned to two groups, receiving either 5 ml or 7 ml of local anesthetic to the sub-Tenon's space. Each patient was assessed clinically at 5 and 10 minutes for orbicularis oculi function. The anesthetic solution consisted of 5 ml of 2% lidocaine, 5 ml of 0.75% bupivacaine hydrochloride, and 1500 IU of hyaluronidase. A top-up of anesthetic infiltration was given in doses of 2 ml if excessive orbicularis muscle function persisted at 10 ml. Routine phacoemulsification surgery was performed, and, if necessary, a topup of anesthetic was given on the table.

* RESULTS: Complete eyelid akinesia was achieved in 7.5% (3 of 40) of the patients in the 5-ml group and in 93.3% (42 of 45) of the patients in the 7-ml group (P < .005). There was no effect for 57.5% (23 of 40) of the patients in the 5-ml group and for 2.2% (1 of 45) of die patients in the 7-ml group. A top-up of anesthetic was given in die anesthetic room to 40 patients, 37 of whom were in the 5-ml group, and a Van Lint block of the facial nerves was necessary for 1 patient from the 5-ml group. An on-the-table top-up of anesthesia was necessary for 3 patients (2 from the 5-ml group, 1 from the 7-ml group).

* CONCLUSIONS: The addition of hyaluronidase promotes diffusion of sub-Tenon's anesthetic, resulting in effective akinesia of the orbicularis oculi. The infiltration of 7 ml of the anesthetic solution significantly improves the rate of eyelid akinesia.

[Ophthalmic Surg Lasers 1997;28:727-730.]
Combined Phacoemulsification and Trabeculectomy With Mitomycin-C
Authors: Zacharia Peter T , Schuman Joel S
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the effectiveness of combined phacoemulsification and trabeculectomy with mitomycin-C with respect to visual rehabilitation and control of intraocular pressure in patients with coexisting cataract and glaucoma.

* PATIENTS AND METHODS: The authors retrospectively studied 20 consecutive cases of phacoemulsification with posterior chamber intraocular lens implantation combined with trabeculectomy using mitomycin-C. They included in their study 20 eyes of 19 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, inflammatory glaucoma, chronic angle-closure glaucoma, and normal tension glaucoma.

* RESULTS: After a mean postoperative follow-up time of 14.4 ± 3.1 months, intraocular pressure was reduced from a preoperative mean of 19.2 ± 6.1 mm Hg to a postoperative mean of 13.4 ± 3.9 mm Hg (P = .0004). The number of required intraocular pressure-lowering medications dropped from a preoperative mean of 2.3 ± 0.7 medications to 0.2 ± 0.4 medications postoperatively (P < .0001), with only 4 eyes requiring the restarting of a single medication each. Mean log
10
(minimum angle of resolution) visual acuity improved from a preoperative 0.66 ± 0.53 (Snellen 20/91) to a postoperative 0.30 ± 0.40 (Snellen 20/40) (P < .0005). The most frequent complication was a bleb leak (8 of 20 eyes [40%]), usually occurring early and responding to conservative management. One eye with later-onset bleb leak incurred endophthalmitis. In another eye, hypotony with maculopathy developed.

* CONCLUSIONS: Phacoemulsification combined with trabeculectomy using mitomycin-C appears to be an effective approach to the management of cataract in patients with glaucoma. It offers potential for good improvement in visual acuity as well as long-term control of intraocular pressure with reduced or no dependence on medications. Potential vision-threatening complications of this procedure, specifically hypotony maculopathy and late-onset bleb leaks, should be considered in the decision to use mitomycin-C.

[Ophthalmic Surg Lasers 1997;28:739-744.]
Adjustable Temporal Suture in Trabeculectomy With Scleral Flap
Authors: Prevezas Dimitrios C , Melissurgos Ioannis D
Published: April 2021

* BACKGROUND AND OBJECTIVE: The long-term success of trabeculectomy depends primarily on the degree of scarring that occurs to the artificial filtration route that is created by the procedure. The most serious postoperative complication of trabeculectomy is a persistent shallow anterior chamber or a flat chamber. The objective of this study was to evaluate the effect of a suturing technique on the long-term success of trabeculectomy.

* PATIENTS AND METHODS: In this study, the authors analyzed a trabeculectomy technique that is based on the application of a suture of variable tightness on the scleral flap. The technique was performed on 11 patients subjected to trabeculectomy.

* RESULTS: The postoperative complication of shallow anterior chamber was successfully treated with further tightening of the suture for one patient. For each patient, the authors loosened the suture on the fourth postoperative day and removed it completely on the seventh or eighth postoperative day. The patients were observed postoperatively for a minimum of 1 year. During this period the intraocular pressure for each patient was within the normal limits.

* CONCLUSION: The authors contend that this trabeculectomy technique, in which a suture on the scleral flap can be adjusted for tightness and is later removed, contributes significantly to the treatment of a postoperative shallow anterior chamber or a flat chamber and to the long-term function of an effective filtration fistula.

[Ophthalmic Surg Lasers 1997;28:745-750.]
A Flexible Infusion Micro-Cannula for Subretinal Surgery
Authors: Loewenstein Anat , Rader R Scott , Shelley Terry H , de Juan Eugene
Published: April 2021

Abstract. Injection of fluids or drugs into the subretinal space is often necessary during subretinal surgery. The authors have developed a flexible micro-cannula for subretinal surgery that can be used for submacular injection of drugs or for atraumatic hydrodissection of the retina. The novel features of the soft tip include reduced diameter (200 µm), increased length, and material selection for resistance to tip buckling. The authors have used this cannula following pars plana vitrectomy for 14 patients with subfoveal choroidal neovascularkation secondary to age-related macular degeneration (13 patients) and angioid streaks (1 patient). The cannula creates a relatively atraumatic retinotomy and allows an efficient, controlled injection of subretinal fluid. This micro-cannula seems to be a valuable tool for the subretinal infusion of fluids or drugs. [Ophthalmic Surg Lasers 1997;28:774-775.]
The Regularity of Laser Keratectomy Depth in Nonmechanical Trephination for Penetrating Keratoplasty
Authors: Seitz Berthold , Langenbucher Achim , Fischer Susanne , Kus Murat M , Vilchis Ernesto , Naumann Gottfried O H
Published: April 2021

* BACKGROUND AND OBJECTIVES: To study the regularity of laser keratectomy depth in nonmechanical trephination for penetrating keratoplasty (PK) and to assess its implications on astigmatism and visual acuity (VA).

* PATIENTS AND METHODS: In this retrospective clinicopathologic study, the authors enrolled 26 women and 32 men (mean age 54 ± 20 years) with either keratoconus (n = 27) or Fuchs' dystrophy (n = 31), who underwent excimer laser (193 nm) trephination using a manually guided beam. Donor cornea trephination was performed using an artificial anterior chamber and either an automated rotation device (n = 27) or a manually guided beam (n = 31). The minimum residual corneal thickness (MRCT) and the random residual corneal thickness (RRCT), requiring division with scissors in excised patient buttons or corneoscleral donor rims, were assessed in a masked fashion using histologic sections. The postkeratoplasty keratometric net astigmatism, the subjective cylinder, and the VA were evaluated before and after suture removal.

* RESULTS: In patients with keratoconus, the mean MRCT (13% ± 14%) and RRCT (38% ± 20%) were significantly higher than in the patients with Fuchs' dystrophy (7% ± 11% and 26% ± 15%, respectively) (P < .01). When an automated rotation device for trephination of the donor cornea was used, the mean MRCT (2% ± 4%) and RRCT (14% ± 11%) were significantly smaller than when a manually guided laser beam was employed (15% ± 12% and 38% ± 15%, respectively) (P < .001). After suture removal, the VA increased significantly with automated trephination (P = .04), but not with manually guided trephination of the donor cornea (P = .24). However, after a mean follow-up of 30 ± 8 months, the differences in the mean keratometric astigmatism, refractive cylinder, and VA after automated trephination (3.0 D, 2.6 D, 20/29, respectively) compared with those after manually guided trephination of the donor cornea (4.3 D, 3.9 D, 20/33, respectively) did not reach statistical significance.

* CONCLUSIONS: The regularity of donor trephination depth can be significantly improved by using an automated rotation device instead of a manually guided beam. Although residual postkeratoplasty astigmatism was not directly related to trephination depth, the improvement of the functional results after suture removal seems to be promoted by automated trephination.

[Ophthalmic Surg Lasers 1998;29:33-42.]
Surgical Results of Pars Plana Vitrectomy Combined With Phacoemulsification and Intraocular Lens Implantation for Complications of Proliferative Diabetic Retinopathy
Authors: Honjo Megumi , Ogura Yuichiro
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of combining phacoemulsification (PEA), pars plana vitrectomy (PPV), and intraocular lens (IOL) implantation.

* PATIENTS AND METHODS: Combined operations of PEA and PPV were performed in 76 eyes of 54 patients with cataract complicated by proliferative diabetic retinopathy (PDR). The mean follow-up period was 24.4 months. Gas tamponade was employed in 15 eyes. IOLs were implanted during surgery.

* RESULTS: Visual acuity improved by 2 lines or more in 59 eyes (78%). Forty-seven eyes (77%) without tamponade and 12 eyes (80%) with tamponade had improved visual acuity. Postoperative complications included fibrin reaction in 8 eyes (10%), posterior synechia of the iris in 11 eyes (14%), and recurrence of retinal detachment in 8 eyes (10%). The incidence of these complications and of additional operations was higher in eyes that required tamponade, which corresponded with the severity of each case and the complexity of the surgical procedures.

* CONCLUSIONS: Although further studies are indicated, this study suggests that the combined operation of PPV, PEA, and IOL implantation is safe and effective for patients with PDR. The choice of IOL may be correlated with postoperative complications.

[Ophthalmic Surg Lasers 1998;29:99-105.]
The Paralimbal Approach With Deferred Conjunctival Closure for Adjustable Strabismus Surgery
Authors: Santiago Alvina Pauline , Isenberg Sherwin J , Neumann Doron , Spierer Abraham
Published: April 2021

Abstract. Interest in the adjustable suture technique was renewed in the mid-1970s. The authors report a new modification of the fornix and limbal conjunctival approaches that combines the advantages of both. A paralimbal conjunctival incision is placed halfway between the limbus and the muscle insertion and directed parallel to the muscle insertion. This approach permits easy access to the rectus muscle. After the adjustable suture is temporarily secured with a bow-tie knot, the conjunctiva is partially closed using a loop suture over the muscle suture. An optional modification is the use of a "sweep suture" to break early adhesions at the time of adjustment. The adjustment procedure is performed at least 6 hours after the surgery. The conjunctiva is retracted as necessary for access to the muscle suture. If a sweep suture is used, this is first withdrawn before attempting any adjustment. After adjustment, the conjunctival loop suture is closed, covering the muscle suture. The sweep suture serves as a safeguard for what may otherwise be a difficult adjustment. This approach increases patient comfort after the surgery. [Ophthalmic Surg Lasers 1998;29:151-156.]
Phacotrabeculectomy: Comparison of Results From 3.5- and 5.2-mm Incisions
Authors: Vyas Ashok V , Bacon Peter J , Percival S Piers B
Published: April 2021

* BACKGROUND AND OBJECTIVE: To compare the intraocular pressure control, visual results, and astigmatic results of 3.5-mm and 5.2-mm incisions following phacotrabeculectomy with 12 months of follow-up.

* PATIENTS AND METHODS: Fifty eyes underwent clear cornea punch trabeculectomy under a 5.0 × 2.5-mm scleral flap, closed with two 10-0 polyglactin sutures. The first 25 eyes underwent wound extension to 5.2 mm for insertion of a single-piece polymethylmethacrylate (PMMA) lens. The next 25 eyes underwent wound extension to 3.5 mm for insertion of a folded silicone lens.

* RESULTS: The mean intraocular pressure decrease from the preoperative level was 7.6 mm Hg in the 3.5-mm incision group and 7.8 mm Hg in the 5.2-mm incision group. One patient required continued medication. The best-corrected visual acuity was 20/40 or better in 86% of the patients, with no significant difference between the groups. The mean "with the wound" induced astigmatism showed no statistical difference between the two groups.

* CONCLUSIONS: The use of 10-0 polyglactin appears to aid filtration, yet minimizes hypotony or the need for antimetabolites. For surgeons who wish to reduce costs without compromising results during phacotrabeculectomy, there is merit in considering a 5.2-mm incision; moreover, the more rigid single-piece PMMA lens appears to be associated with fewer complications in the immediate postoperative period.

[Ophthalmic Surg Lasers 1998;29:227-233.]
Subretinal Semiconductor Microphotodiode Array
Authors: Peyman Gholam , Chow Alan Y , Liang Chanping , Chow Vincent Y , Perlman Jay I , Peachey Neal S
Published: April 2021

* BACKGROUND AND OBJECTIVE: To examine the function of a semiconductor microphotodiode array (SMA) surgically implanted in the subretinal space.

* MATERIALS AND METHODS: Positive-intrinsic layer-negative (PiN) or negative-intrinsic layer-positive (NiP) SMAs were surgically placed into the subretinal space of rabbits through a pars plana incision and a posterior retinotomy. The implants required no external connections for power and were sensitive to light over the visible and infrared (IR) spectrum; IR stimuli were used to isolate implant-mediated responses from the activity of native photoreceptors. A stimulator ophthalmoscope was used to superimpose IR stimuli on the implant and adjacent retinal areas, and responses were recorded during the postoperative recovery period. SMA responses were also evaluated in vitro. The animals were given lethal anesthetic overdoses, and the retinas were examined histologically.

* RESULTS: The in vitro implant response consisted of an electrical spike, followed by a small-amplitude DC offset that followed the time course of the IR stimulation, and an overshoot at the stimulus offset. The SMAs placed in the subretinal space retained a stable position and continued to function throughout the postoperative period. The SMA responses recorded in vivo included additional slow-wave components that were absent from the in vitro recordings. These responses reverted to the in vitro configuration following the death of the animal. There was a significant loss of retinal cells in areas overlying the implant, and the retina appeared normal away from the implant and surgical site.

* CONCLUSION: SMAs can be successfully implanted into the subretinal space and will generate current in response to light stimulation during an extended period of time.

[Ophthalmic Surg Lasers 1998;29:234-241.]
Delayed-Onset Expulsive Choroidal Hemorrhage Following Traumatic Globe Rupture
Authors: Meyer Marcus A , Bouchard Charles S
Published: April 2021

Abstract. The authors describe a 59-year-old woman who had a traumatic wound rupture 6 months following penetrating keratoplasty. While she was in the preoperative holding area awaiting surgical repair, hemorrhagic choroidal detachments developed. Digital pressure was initiated on diagnosis of imminent expulsion of intraocular contents and maintained until repair of the wound rupture could be performed. Four months postoperatively, the patients vision was 20/80 and her central pachymetry was 585 µm. This case demonstrates that a delayed-onset expulsive choroidal hemorrhage may be successfully managed with simple and rapid intervention based on knowledge of the disease process. [Ophthalmic Surg Lasers 1998;29:247-248.]
Using the Phacoemulsification Crescent Knife in Dacryocystorhinostomy
Authors: Fong K S , Koh Adrian H C , Choo C T
Published: April 2021

Abstract. Dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Most techniques employ a conventional blade or knife in making the incision of the nasal mucosa and lacrimal sac. The authors describe the use of a phacoemulsification crescent knife for this purpose. This technique can be effective and at the same time safer and easier to perform. [Ophthalmic Surg Lasers 1998;29: 343-344.]
Indocyanine Green Angiography Patterns of Zones of Relative Decreased Choroidal Blood Flow in Patients With Exudative Age-Related Macular Degeneration
Authors: Goldberg Marlyn F , Dhaliwal Ranjit S , Olk R Joseph
Published: April 2021

* BACKGROUND AND OBJECTIVE: To investigate the incidence and patterns of posterior zones of relative decreased choroidal blood flow in patients with exudative age-related macular degeneration.

* PATIENTS AND METHODS: Digital indocyanine green (ICG) angiograms from 100 patients with exudative age-related macular degeneration were reviewed for the presence of posterior zones of relative decreased choroidal blood flow. The patterns of these zones and their location relative to the choroidal neovascular process were noted.

* RESULTS: Ninety-five percent of the angiograms displayed the presence of either a complete or an incomplete zone of relative choroidal hypoperfusion. The zone was most apparent in the early frames of the angiogram. Five different patterns of relative decreased choroidal blood flow were identified: horizontal (32%), vertical (14%), bipartite (9%), tripartite (31%), and quadripartite (9%). The choroidal neovascular process was located within or at the edge of the zone of relative choroidal hypoperfusion in all cases.

* CONCLUSION: Most cases of choroidal neovascularization localize to areas of relative choroidal dye nonfilling on ICG angiography. These patterns of choroidal nonfilling may have implications in the pathogenesis and management of choroidal neovascular membranes in age-related macular degeneration.

[Ophthalmic Surg Lasers 1998;29:385-390.]
Combined Intraocular and Strabismus Surgery
Authors: Zwaan Johan , Al-Sadhan Yasir
Published: April 2021

* BACKGROUND AND OBJECTIVE: To study the results of combined intraocular and strabismus surgery.

* PATIENTS AND METHODS: Combined surgery was done in 14 patients. In 10 of these patients, cataract and strabismus surgery were combined. One had a penetrating keratoplasty, and another required placement of a glaucoma valve implant. In one patient trabeculectomy, pupilloplasty, and lensectomy were done, and one patient needed repair of a leaking bleb.

* RESULTS: The strabismus of most patients was significantly improved. Eleven patients (79%) were orthophoric ±10 prism diopters (PD). Visual outcome was good in patients with no structural abnormalities who were compliant with occlusion therapy, if applicable.

* CONCLUSIONS: Combined intraocular and strabismus surgery has a success rate comparable with that of standard strabismus surgery.

[Ophthalmic Surg Lasers 1998;29:456-461.]
The Effect of Mitomycin-C on Postoperative Corneal Astigmatism in Trabeculectomy and a Triple Procedure
Authors: Hong Young J , Choe Chul M , Lee Young G , Chung Hak S , Kim Ho K
Published: April 2021

* BACKGROUND AND OBJECTIVE: The authors attempted to determine the effect of mitomycin-C (MMC) on postoperative corneal astigmatism in patients who underwent trabeculectomy or a triple procedure (trabeculectomy, extracapsular cataract extraction, and intraocular lens implantation).

* PATIENTS AND METHODS: Using the vector analysis method, the authors measured the postoperative induced astigmatism of 76 eyes in 59 patients who underwent trabeculectomy or a triple procedure with or without the application of MMC. Postoperative induced astigmatism corresponding to the 180° axis was compared between the two groups.

* RESULTS: The patients who underwent trabeculectomy with or without MMC showed a mean induced astigmatism of -1.01 D and -2.63 D, respectively, after 1 month (P < .05), and 0.34 D and -1.42 D after 12 months (P < .05). Those who underwent a triple procedure with or without MMC showed a mean induced astigmatism of -1.81 D and -4.50 D, respectively, after 7 days (P < .05), and 1.73 D and -0.13 D, respectively, after 12 months (P < .05). The entire amount of postoperative against-the-rule astigmatic shift was similar between the with-MMC group and the without-MMC group. The against-the-rule astigmatic shift of the group without MMC reached a plateau after 3 months. However, the group with MMC showed continuous against-the-rule astigmatic shift until 12 months.

* CONCLUSION: This study suggests that MMC induces less with-the-rule astigmatism in early postoperative periods and continuous against-the-rule shift after 3 months following a trabeculectomy or a triple procedure.

[Ophthalmic Surg Lasers 1998;29:484-489.]
Blood Velocity in an Experimental Iris Tumor
Authors: Peyman Gholam A , Khoobehi Bahram , Moshfeghi Andrew , Sonmez Murat , Moshfeghi Darius , Shaibani Sanan , Alghadyan A
Published: April 2021

* BACKGROUND AND OBJECTIVE: Greene strain melanoma was implanted into the irides of eight nonpigmented rabbits to evaluate the blood flow in tumor vasculature.

* MATERIALS AND METHODS: Conventional scanning laser ophthalmoscopy was used in conjunction with fluorescent microsphere angiography (FMA). Changes were documented on SVHS videotape for later analysis. Individual microsphere movement was tracked through the tumor vessels. Subsequently, blood velocity measurements were taken.

* RESULTS: The tumor vessels were poorly organized and inefficient. Tumor blood velocity was up to 2.5 times slower compared with normal blood velocity in the unaffected iris of the same eye of the same rabbit (P = .05). Tumor blood flow could be qualitatively visualized in real time in the live rabbit model.

* CONCLUSION: The ability to visualize fluorescent microspheres within the poorly organized tumor vasculature coupled with the reduced blood velocity in the tumor helps to explain the success of hyperthermic tumoricidal therapy, and may allow for development of more efficient and selective drug delivery systems and tumoricidal agents.

[Ophthalmic Surg Lasers 1998;29:506-509.]
Phacomorphic Glaucoma Associated With Choroidal Melanoma
Authors: Al-Torbak Abdullah , Karcioglu Zeynel A , Abboud Emad , Netland Peter A
Published: April 2021

Abstract. Patients with phacomorphic glaucoma present with mature cataract, shallowing of the anterior chamber, and angle-closure glaucoma. The opaque ocular media due to cataract formation usually precludes visualization of the posterior segment of the affected eyes. The authors describe a 65-year-old man who presented with reduced vision and clinical findings typical of phacomorphic glaucoma. Preoperative ultrasonography revealed an intraocular tumor, and magnetic resonance imaging showed a high signal intensity in T
1
-weighted images and a low signal intensity in T
2
-weighted images consistent with choroidal melanoma. Histopathologic examination of the tumor after enucleation confirmed the diagnosis. The clinical findings characteristic of phacomorphic glaucoma may be associated with choroidal melanoma. Ultrasonography or other imaging studies should be performed on eyes with phacomorphic glaucoma and opaque ocular media to allow timely detection of any mass lesion and to guide appropriate surgical management. [Ophthalmic Surg Lasers 1998;29:510-513.]
The Efficacy and Safety of Diclofenac 0.1% Versus Prednisolone Acetate 1% Following Trabeculectomy With Adjunctive Mitomycin-C
Authors: Kent Alexander R , Dubiner Harvey B , Whitaker Roy , Mundorf Thomas K , Stewart Jeanette A , Cate Elin A , Stewart William C
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of diclofenac 0.1% versus prednisolone acetate 1% following trabeculectomy with adjunctive mitomycin-C.

* PATIENTS AND METHODS: The authors prospectively randomized chronic open-angle glaucoma patients who underwent trabeculectomy with adjunctive mitomycin-C to receive postoperatively either diclofenac 0.1% or prednisolone acetate 1% 4 times daily, to be tapered as inflammation resolved.

* RESULTS: In the diclofenac group (n = 14), the preoperative intraocular pressure of 30.4 ± 13.1 decreased to 12.4 ± 6.5 mm Hg at 6 months postoperatively. In the prednisolone acetate group (n = 12), the preoperative intraocular pressure decreased from 29.1 ± 10.4 to 12.8 ± 4.2 mm Hg at 6 months postoperatively (P = .85). The average number of medicines used 6 months postoperatively was 0.50 ± 0.8 in the diclofenac group and 0.24 ± 0.6 in the prednisolone acetate group (P = .36). Adverse events were similar between groups (P = .51). One patient in the diclofenac group underwent reoperation at 1 month due to uncontrolled intraocular pressure.

* CONCLUSIONS: This study shows that following trabeculectomy with adjunctive mitomycin-C, a similar intraocular pressure result may be expected when either diclofenac or prednisolone acetate is prescribed postoperatively for intraocular inflammation.

[Ophthalmic Surg Lasers 1998;29:562-569.]
Reversal of Blood Flow in Experimental Branch Retinal Vein Occlusion
Authors: Peyman Gholam A , Khoobehi Bahram , Moshfeghi Andrew , Moshfeghi Darius
Published: April 2021

* BACKGROUND AND OBJECTIVE: To demonstrate that the obstructed vascular lumen of the experimentally induced branch retinal vein occlusion (BRVO) induces retrograde blood flow, resulting in flow from the occluded vein to the feeder arterioles.

* MATERIALS AND METHODS: Photocoagulation was used to create occlusion of the branch retinal vein in a monkey model (n = 2; 1 cynomolgus, 1 rhesus). Twenty-four hours following photocoagulation, the eyes were examined for evidence of vascular occlusive disease. Vascular occlusion was proven by fluorescent vesicle angiography with scanning laser ophthalmoscopy; these results were recorded to SVHS videotape. The images were then serially analyzed frame by frame to track individual microsphere movement.

* RESULTS: The authors observed retrograde flow proximal to the point of vessel obstruction and extending backward into the arterial system.

* CONCLUSIONS: This demonstrates the existence of retrograde flow in an experimental model of BRVO and might explain vascular complications seen in this disease process.

[Ophthalmic Surg Lasers 1998;29:595-597.]
Needle Entrance Into the Maxillary Sinus During Retrobulbar Anesthesia
Authors: Tsilimbaris Miltiadis K , Karabekios Spyros , Kozobolis Vassilis P , Velegrakis George , Pallikaris Ioannis G
Published: April 2021

Abstract. Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose. [Ophthalmic Surg Lasers 1998;29: 602-605.]
The Baylor Survey of Ophthalmology Residency Graduates: Rationale for Reform in Residency Training
Authors: Lee Andrew G , Koch Douglas D
Published: April 2021

* BACKGROUND AND OBJECTIVE: To survey graduates of an ophthalmology residency training program regarding skills necessary for a well-trained ophthalmologist.

* METHODS: Two survey instruments were mailed to the graduates of the Baylor College of Medicine Department of Ophthalmology Residency Training Program.

* RESULTS: Specific skills were identified that were rated as clincally important and for which training was considered adequate, and, conversely, skills that were rated as less important but for which training was adequate.

* CONCLUSION: This survey instrument may allow ophthalmology residency training programs to identify perceived and real deficiencies in the resident education process, thereby assisting in the prioritization of changes in curriculum or the skills transfer process.

[Ophthalmic Surg Lasers 1998;29:649-657.]
Histologic Effect of Diode Laser Sclerostomy in Human Cadaver Eyes
Authors: Rodrigues Merlyn , Shelton Karen , Glaser Edmund , Higginbotham Eve
Published: April 2021

* BACKGROUND AND OBJECTIVES: To study tissue effects and thresholds of efficacy in producing a full-thickness scierai fistula in human eyes obtained from cadavers. The effect of laser sclerostomies created with indocyanine green (ICG) was also evaluated.

* MATERIALS AND METHODS: Ab externo laser sclerostomies were produced in 12 fresh human eyes obtained from cadavers using a 200-µm diameter fiber optic connected to a diode laser system. Power settings were 500, 750, 1000, 1250, 1500, and 2000 mW with a constant duration of 100 and 200 ms. The same diode laser settings were repeated in the tissues injected with ICG.

* RESULTS: The laser sclerostomies were associated with heat coagulation damage adjacent to the burn margins, with disruption of stromal collagen. Tissue damage was greater at higher power and longer duration. Scleral injection of ICG prior to laser sclerostomy did not enhance laser penetration.

* CONCLUSION: The diode laser can create a sclerostomy in human sclera with an optimum level of 1500 mW and 100 ms. ICG did not significantly enhance the ease of penetration or reduce the associated thermal damage to the sclera.

[Ophthalmic Surg Lasers 1998;29:758-761.]
The Effect of Tissue Plasminogen Activator on Premacular Hemorrhage
Authors: Chung Jin , Kim Min-Ho , Chung Sang-Moon , Chang Kwang-Yul
Published: April 2021

* BACKGROUND AND OBJECTIVE: Early vitrectomy is recommended for eyes with premacular hemorrhage, which causes fibrovascular proliferation and macular traction. The purpose of this study was to investigate the therapeutic effects of tissue plasminogen activator (tPA) on premacular hemorrhage, and the clearing of hemorrhage from the macula.

* PATIENTS AND METHODS: The authors injected tPA (25-37.5 µg) into the vitreous cavity of 13 eyes with premacular hemorrhage. The causes of premacular hemorrhage were diabetic retinopathy in 11 eyes and traumatic injuries in 2 eyes. Prior to tPA injection, 4 eyes had complete posterior vitreous detachment (PVD) and 9 eyes had no PVD.

* RESULTS: After tPA injection, the hemorrhages in 10 eyes were completely absorbed. They were absorbed partially in 2 eyes and were not absorbed at all in 1 eye. Absorption of hemorrhage in the 4 eyes with complete PVD took an average of 5.5 days, and in the 6 eyes with no PVD, it took an average of 12.7 days (P=0.002). After tPA injection, visual acuity improved in 9 eyes, remained stable in 3 eyes, and worsened in 1 eye. In 5 eyes, pars plana vitrectomy (PPV) was required after tPA injection because of recurrent vitreous hemorrhage, macular traction or nonabsorbed premacular hemorrhage.

* CONCLUSION: TPA seems to be a good alternative method of treatment for premacular hemorrhage, especially in eyes with complete PVD. It appears to improve vision and defer the need for PPV. [Ophthalmic Surg Lasers 2001:32:7-12]