bluuebunny/crossref_metadata_2025 huggingface dataset:
Music: A Milieu Factor with Implications for the Nurse-Therapist
Authors: Hinds Pamela S
Published: April 2021

ABSTRACT

The effects of one type of music upon the social interactions observed in a group play therapy with ten male children, ages 8 to 10, were studied. A behavioral check list was developed to measure five target behaviors: the children's verbalizations, proximity with group members, proximity with the group co-therapists, involvement in toy exchanges and involvement in acts of physical aggression. The resulting statistical analysis of tabulated data suggests music to be a factor in an increased number of social interactions. Consideration of such a milieu factor as music may prove valuable in many varying situations.
A Conceptual Framework for Psychiatric-Mental Health Nursing
Authors: Mansfield Elaine
Published: April 2021

ABSTRACT

A conceptual framework for a psychiatric-mental health nursing program gives direction for course content and becomes a rich source of hypotheses leading to development of theory. For this described framework tenets of humanistic theorists provide the philosophical base: Belief in the individual's responsibility, capacity and potential for growth; meaning of life; respect and dignity of the individual; and freedom of the individual for self-determination. Four major components comprise the framework: social systems and developmental theories, communication concepts, and self-esteem. Set in the nursing process schema, concepts from social systems and developmental theories are used in the assessment, concepts from communication theories are the basis for intervention, and changes in self-esteem become a measure of evaluation. The framework is applicable for individual clients, families, and/or groups. The nurse therapist is viewed in the same framework which may evolve into an intersystem model. Numerous research questions are suggested which may validate the relationships between the components of the framework.
Temporal Lobe Epilepsy: A New Entity in Psychiatry
Authors: Lopez Kay A , Seastrunk Jay W
Published: April 2021

ABSTRACT

There has been a scarcity of information in the nursing literature in regard to the psychiatric syndrome of temporal lobe epilepsy. This paper attempts to describe the basic features of this disorder as well as its diagnosis and medical treatment. Guidelines for patient assessment and strategies for intervention are presented.
IAPCP APPLICATIONS
Authors: Anonymous
Published: April 2021

DIPLOMATE STATUS
PRODUCT OF ILLNESS
Authors: Anonymous
Published: April 2021

DEPRESSION
NEW PBS SERIES
Authors: Anonymous
Published: April 2021

THE BRAIN
MASTER'S PROGRAM AT VANDERBILT
Authors: Anonymous
Published: April 2021

FAMILY ABUSE
BEHAVIOR THERAPY
Authors: Anonymous
Published: April 2021

AGRESSION
QUIT FOR A DAY
Authors: Anonymous
Published: April 2021

SMOKEOUT
MENTAL HEALTH FIELD
Authors: Anonymous
Published: April 2021

MINORITY FELLOWSHIP
Coping with AIDS and HIV
Authors: Korniewicz Denise M , O'Brien Mary Elizabeth , Larson Elaine
Published: April 2021

Psychosocial Adaptation
Disclosing Incest: The Relationships That Make it Possible
Authors: Greenfeld Mark
Published: April 2021

When working with incest survivors, clinicians must be aware of symptoms that suggest sexual abuse and encourage the client to get in touch with repressed emotions.
Professionally Speaking
Authors: Lapierre Ernest D , Padgett Jean
Published: April 2021

How will cutbacks in hospital funding affect the relationship between psychiatric/mental health services and other disciplines? What can we do to maintain and strengthen these relationships?
An Ethical Dilemma: RISK VERSUS RESPONSIBILITY
Authors: McDonald Sally
Published: April 2021

What happens when a hospital adopts a position that jeopardizes patient health and safety?
Out of Control! The Most Effective Way to Help the Binge-Eating Patient
Authors: McGowan Anne , Whitbread Joanne
Published: April 2021

This article assessed the effectiveness of different treatments for bulimia nervosa by screening 400 studies published from 1987 through July 1993. Nineteen independent studies with a total of 1,015 subjects with 11 treatment types, and 316 subjects in 11 control groups fulfilled these criteria. Therapy outcome across studies was assessed meta-analyticaUy, producing effect sizes that represent pretreatment to posttreatment changes in bulimic symptoms.
A Nurse Battling With Her Own Depression
Authors: Masching Judith A
Published: April 2021

In this first-person account, Judith A. Masching, RN, MS, NCC1 LPC, details her long bout with depression, anxiety, and obsessive-compulsive disorder. She believes she serves as a symbol of hope for her patients suffering from mental illness.
"Mad" or "Bad"? Evaluating the Decision to Hospitalize SED Youth Using Qualitative Data
Authors: Smoyak Shirley A , Pressler Catherine M , Oppenheim Jen , Bruno Victoria
Published: April 2021

This study examines variables associated with positive and negative hospitalization outcomes of seriously emotionally disturbed (SED) youth, and proposes that the context of the decision-making process that takes place before hospitalization plays a role in determining outcomes.

Qualitative data from 13 case histories were analyzed to determine the effects of hospitalization after a 2-year follow-up period. Several indicators that have predicted negative outcomes in earlier studies are supported here, including bizarre symptom patterns, educational impairment, and additional hospitalization during the follow-up period. There was agreement in fewer than half of the cases among research clinicians, the subject, or the subject's family regarding the outcome.

Findings demonstrate the advantages of qualitative methods in determining the manner in which definitions of mental health influence hospitalization outcomes, suggesting that mental health categories are not a priori categories in the subjects' or families' minds. The social context of the decision to hospitalize is found to be a contributing factor in hospitalization outcomes.
People with Developmental Disabilities
Authors: Bush Carol T
Published: April 2021

A Target Population for Psychiatric Nurses
Effectiveness of a Training Program for ECT Nurses
Authors: Munday Jo , Deans Cecil , Little John
Published: April 2021

ABSTRACT

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient.

A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator.

If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.
Physical Symptoms Comorbid With Depression and the New Antidepressant Duloxetine
Authors: Bailey Katharine P
Published: April 2021

ABSTRACT

Most general descriptions of depression that date back to Hippocrates, including the DSM-IV, have listed gastrointestinal problems, sleep disturbances, headaches, appetite changes, and aches and pains of a diffuse nature as common features of the disorder. In addition, physical symptoms have a strong association with psychiatric disorders, and the presence of any physical symptom may increase the likelihood of a mood or anxiety disorder by two-fold or three-fold. A growing body of evidence suggests that serotonin and norepinephrine may share neurochemical mechanisms that tie depression and physical symptoms together. Both selective serotonin reuptake inhibitors alone and antidepressant agents that incorporate both serotonin and norepinephrine reuptake inhibition have shown evidence of relieving physical symptoms. Given the additional disease burden caused by physical symptoms in depression, it is vital that antidepressant agents that effectively treat the physical symptoms and chronic pain associated with depression be used.
Statement on Epikeratoplasty
Authors: Anonymous
Published: April 2021

THE BOARD OF DIRECTORS OF THE INTERNATIONAL SOCIETY OF REFRACTIVE KERATOPLASTY

This paper is intended to provide a general summary of the current status of epikeratoplasty. It is not intended to resolve lingering controversies about the procedure, to provide standards of care of the community, or to serve as an informed consent document in patient care.
Human Cadaver Corneal Thinning for Experimental Refractive Surgery
Authors: Duffey Richard J , Tchah Hungwon , Lindstrom Richard L
Published: April 2021

ABSTRACT: Human cadaver eyes can be dehydrated by prolonged elevation of intraocular pressure (three to five hours) or by hyperosmotic Dextran over a 20- to 30-minute period. We divided four pairs of donor eyes into 1wo groups (A and B) and dehydrated four corneas by each method. After corneal thinning to 500 to 600 µm, central corneal pachymetry was measured every ten minutes during the rehydration period for one hour, with each cornea pair being moistened at a different rate (every 30 seconds, 1 minute, 2.5 minutes or 5 minutes). The resultant increase in central corneal thickness noted by change in pachymetry (??) ranged from 12.4% to 14.7% over one hour between the two groups. ?? did not differ significantly between groups A and B, regardless of the varying rate of balanced salt solution irrigation of the corneas. Thus, it appears that either method of corneal dehydration provides comparable stability of corneal thinning for at least one hour to allow consistent corneal dynamics for experimental refractive surgery. [Refractive and Corneal Surgery 1989; 5:41-42.]
Symmetry of Refractive and Visual Acuity Outcome in the Prospective Evaluation of Radial Keratotomy (PERK) Study
Authors: Lynn Michael J , Waring George O , Nizam Azhar , Kutner Michael H , Culbertson William , McDonald Marguerite B , Meyers William D , Naidoff Michael A , Nelson J Daniel , Obstbaum Stephen A , Rowsey J James , Salz James J
Published: April 2021

ABSTRACT: In the Prospective Evaluation of Radial Keratotomy (PERK) study, the symmetry of refractive and visual acuity outcome was analyzed in 269 patients with bilateral radial keratotomy with a single operation in each eye. Patients were required to wait 1 year after surgery on the first eye before having surgery on the second eye. At 1 year after surgery on the second eye, 98% of patients had 3.00 diopters or less difference between their two eyes in the spherical equivalent of the cycloplegic refraction (100% before surgery), and 96% of patients had 3.00 D or less difference between their two eyes In the amount of refractive power in the vertical meridian (100% before surgery). Thus, surgically induced refractive anisometropia was not a major complication in the PERK study. However, 14% of patients had four to eight Snellen lines difference in the uncorrected visual acuity between their two eyes (1% before surgery), emphasizing that induced asymmetry of refraction is a potential clinical problem for some patients. [Refractive & Corneal Surgery 1989; 5:75-81.]
A Mechanical Model of the Cornea: The Effects of Physiological and Surgical Factors on Radial Keratotomy Surgery
Authors: Vito Raymond P , Shin Thomas J , McCarey Bernard E
Published: April 2021

ABSTRACT: A finite element-based computer simulation of radial keratotomy surgery was conducted to study, in particular, curvature changes of the central clear zone in human cornea under various physiological and surgical conditions. Corneal tissue was assumed to behave as a nearly incompressible, linear elastic, homogeneous, isotropic material undergoing small deformation. The Young's modulus was determined by using the model to predict the surgical outcome of a representative patient. The results of the simulation are in qualitative agreement with clinical experience indicating the potential of finite element modeling as an aid to the surgeon in evaluating variables. [Refractive & Corneal Surgery 1989; 5:82-88.]
Persistence of Diurnal Fluctuation After Radial Keratotomy
Authors: McDonnell Peter J , Fish Larry A , Garbus Jenny
Published: April 2021

ABSTRACT: Three patients were examined before 8:00 AM and after 7:00 PM to determine diurnal changes in uncorrected visual acuity, refractive error, and average central keratometric power at 3 months, 4 years, and 6 years after radial keratotomy. The average absolute diurnal change in the spherical equivalent refraction increased over time: 0.26 diopters at 3 months, 0.75 D at 4 years, and 1.29 D at 6 years. Diurnal change in the absolute average keratometric values were not progressive: 0.35 D at 3 months, 0.27 D at 4 months, and 0.40 D at 6 years. Computer-assisted corneal topographic analysis demonstrated diurnal changes in the topography that may be subtle and not necessarily reflected in the average keratometry values. These limited data suggest that wound healing over several years may not restore stability to the cornea. [Refractive fit Corneal Surgery 1989; 5:89-93.]
Delayed Regression of Effect in Myopic Epikeratophakia vs Myopic Keratomileusis for High Myopia
Authors: Neumann Albert C , McCarty George , Sanders Donald R
Published: April 2021

ABSTRACT: We compared the effectiveness and stability of our first six consecutive myopic epikeratophakia procedures (mean foliow-up 18 months, range 14 to 26) with our first tour consecutive cryolathe myopic keratomileusis procedures (mean follow-up 28 months, range 14 to 35). Myopic keratomileusis reduced preoperative myopia (range - 8.9 to -12.1 diopters) by 77% to 94% in four patients. Refraction and visual acuity remained stable for over 1 to 3 years. In contrast, only three of the six myopic epikeratophakia procedures had stable results. The remaining three eyes which were within 0.38 D of emmetropia at the time of suture removal showed a loss of effect, resulting in myopia worse than their preoperative values in two eyes and a small correction in one eye. Only one of the six eyes achieved an uncorrected visual acuity better than 20/200. We conclude that myopic keratomileusis may be the procedure of choice for treating individuals with myopia of -8 to -15 D, because the incidence of late regression of effect after myopic epikeratophakia using the techniques in this study is unacceptable. [Refractive & Corneal Surgery 1989; 5:161-166.]
Air Lamellar Keratoplasty
Authors: Price Francis W
Published: April 2021

ABSTRACT: Lamellar keratoplasties often result in decreased postoperative visual acuity from irregularities and opacities in the interface, sometimes have difficulty in matching the thickness of the resected recipient bed and the donor tissue, and may develop vascularization of the host-donor interface. I describe my experience with a new technique of injecting air into the corneal stroma to form a plane of dissection for deep lamellar keratectomy just anterior to Descemet's membrane. A full thickness donor button with the endothelium removed was used. Results are reported on ten eyes of ten patients. Follow-up ranged from 6 to 15 months (mean, tl months) Three cases were converted to penetrating keratoplasty at the time of surgery and one five months after surgery. Of the remaining six, only one had a dissection completely to Descemet's membrane. All six recovered spectacle-corrected visual acuity of 20/40 or better. The technical limitations of this procedure are described. [Refractive and Corneal Surgery 1989; 5:240-243.]
The Castroviejo Square Graft: A Retrospective Study
Authors: Aquavella James V , Smith Richard S , Ruffini John J , Locascio Joseph A , Binder Perry S , Shaw Edward L , Perry Henry D
Published: April 2021

ABSTRACT: We examined 19 eyes of 12 patients who had undergone penetrating keratoplasty utilizing the Castroviejo square graft technique. The visual acuities at the time of examination for inclusion in the study ranged from 20/30 to counting fingers. Of the 19 original square grafts, eight were judged clear centrally with varying degrees of peripheral stromal haze, and one was hazy. The remaining eight failed with varying degrees of "irreversible corneal edema. The eight corneas obtained following repeat penetrating keratoplasty were studied with light and electron microscopy. The donor/recipient corneal stromal lamellae were continuous at the graft-host junction, particularly in the mid-stromal area. Disruptions in Descemet's membrane were present at the wound; transmission electron microscopy revealed differences in the composition of Descemet's membrane between the graft and the host. Two additional square grafts had failed, and the patients were awaiting keratoplasty. Nine of the 19 grafts were judged functionally clear, with six of the nine requiring contact lens correction. [Refractive and Corneal Surgery 1989; 5:262-267.]
Regression of Effect Following Radial Thermokeratoplasty in Humans
Authors: Feldman Sandy T , Ellis William , Frucht-Pery Joseph , Chayet Arturo , Brown Stuart I
Published: April 2021

ABSTRACT: Radial thermokeratoplasty is a new refractive surgical technique designed to reduce hyperopia and/or astigmatism. Four patients underwent this surgery between February and March 1988 and were monitored postoperatively for the refractive effect and evidence of endothelial cell damage. Immediately following surgery, all eyes were overcorrected, but with time regression of the effect occurred. By 10 to 12 months postoperatively, only 18% of the desired effect remained. No decrease in the central endothelial cell density occurred during this time. Further investigation into the predictability and stability of results is needed to evaluate the longterm effectiveness of this technique. [Refractive and Corneal Surgery. 1989; 5:288-291].
Comparison of a Computer-Assisted Laser Pachometer with Two Ultrasonic Pachometers in Normal Corneas
Authors: Gritz David C , McDonnell Peter J
Published: April 2021

ABSTRACT: A computer-assisted laser pachometer was compared with two ultrasonic pachometers for intra- and interobserver error. Two observers each performed two examinations at 11 predetermined locations on the corneas of six subjects. The laser pachometer was found to have intra- and interobserver errors comparable to both of the ultrasonic pachometers. By performing multiple examinations on three subjects, the laser pachometer was found to have an average standard deviation of ±0.012 mm. Unlike ultrasonic pachometers, the laser pachometer has the advantage of being a noncontact method of evaluating corneal thickness, and does not require topical anesthesia; the trauma and anesthesia might alter corneal thickness by inducing epithelial edema. The nasal cornea was found to be slightly thicker than the temporal cornea in most patients. Lid closure for three hours caused a consistent thickening (about 6.3%) of central and peripheral cornea. [Refractive and Corneal Surgery 1990;6:9-14]
Terrien's Marginal Degeneration: Corneal Topography
Authors: Wilson Steven E , Lin David T C , Klyce Stephen D , Insler Michael S
Published: April 2021

ABSTRACT: Computer-assisted corneal topographic analysis was used to evaluate the corneal contour of four patients with Terrien's marginal degeneration. The corneal topography in these patients was characterized by flattening over the areas of peripheral thinning produced by the disorder. When thinning was restricted to the superior and/or inferior areas of the peripheral cornea, there was a relative steepening of the corneal surface approximately 90° away from the midpoint of the thinned area. This resulted in high against-the-rule or oblique astigmatism characteristic of the disorder. This common pattern is attributable to the frequency with which the superior and/or inferior peripheral cornea is preferentially involved in Terrien's marginal degeneration. In some patients, the central corneal topography may remain relatively spherical if the area of thinning is small or if the disorder extends around the entire circumference of the cornea. [Refractive and Corneal Surgery 1990;6:15-20]
Excimer Laser (193 nm) Myopic Keratomileusis in Sighted and Blind Human Eyes
Authors: Seiler Theo , Kahle Gunter , Kriegerowski Martin
Published: April 2021

ABSTRACT: Ten blind and 13 sighted human eyes underwent excimer laser (193 nm) keratomileusis. The radiant exposure was 180 mJ/cm
p 2
with an ablation zone diameter of 3.5 mm. The follow-up of the blind eyes ranged from 9 to 11 months, whereas that of the sighted eyes was at least 6 months. The intended refraction change was - 3.0 and - 5.0 D in the blind eyes and ranged from -1.5 to -7.0 D in the sighted eyes. After 3 months, 12 of 13 sighted eyes (92%) achieved a refraction between ±1.0 D, whereas after 6 months 77% of the refractions were in this range. Temporary subepithelial haze occurred in all eyes except some of the -3.0 D blind eyes. After 6 months, the subepithelial haze had resolved to a clinical non-significant level (trace to grade 0.5 haze), except in one eye that showed a focal scar [Refractive and Corneal Surgery 1990;6:165-173.]
The Surgical Treatment of High Myopia: Comparison of Epikeratoplasty, Keratomileusis and Minus Power Anterior Chamber Lenses
Authors: Colin Joseph , Mimouni Fernand , Robinet Anne , Conrad Hervé , Mader Phlippe
Published: April 2021

ABSTRACT: Seventy high myopic eyes (-8.00 to -28.00 diopters) with epikeratoplasty (n = 29), myopic non-freeze keratomileusis (n = 26) or minus power anterior chamber intraocular lenses in phakic eyes (n = 15) were operated by two surgeons and were evaluated retrospectively. Results are reported at the 6-month postoperative interval.

Eyes treated with epikeratoplasty had an average preoperative spherical equivalent of the cycloplegic refraction of -17.80 D (range -12.00 to -28.00 D). At 6 months, 66.6% of eyes were within 3 D of emmetropia and 7.4% of eyes had an uncorrected visual acuity of 20/40 or more. Average preoperative spectacle visual acuity was 20/50 (0.39); it was 20/50 (0.37) at both 6 and 24 months. Between 6 and 24 months, 32.2% of eyes had a change in refraction of 1.00 D or more. Two lenticules were removed.

Eyes treated with non-freeze keratomileusis had an average preoperative refraction of -10.0 D (range - 8 to - 15 D). At 6 months, 61.5% of eyes were within 3.00 D of emmetropia and 30.7% of eyes had an uncorrected visual acuity of 20/40 or better. Average preoperative spectacle visual acuity was 20/30 (0.67), and 6 and 12 months afterward it was 20/30 - 20/40 (0.57) and 20/30 (0.66) respectively. Between 6 and 12 months, 8.3% of eyes, had a change in refraction of 1.00 D or more.

Eyes treated with minus power anterior chamber lenses had an average preoperative refraction of - 17.30 D (range - 12.50 to - 20.00 D). At 6 months, 100% of eyes were within 2 D of emmetropia and 46.6% of eyes had an uncorrected visual acuity of 20/40 (0.5) or better. Average preoperative best spectacle visual acuity was 20/50 (0.40), and 6 months afterward it was 20/40 (0.49).

All three surgical procedures reduce high myopia. At 6 months postoperatively, minus power anterior chamber intraocular lenses had a better accuracy and a faster and better visual recovery than epikeratoplasty and non-freeze keratomileusis. Longer term studies are necessary to evaluate the safety of this procedure. [Refractive and Corneal Surgery 1990,245-251.]
Proposed Formula for the Dioptric Power Evaluation of the Posterior Corneal Surface
Authors: Camellin Massimo
Published: April 2021

ABSTRACT: The author performed mathematical calculations to determine the radius of the corneal posterior surface. Knowledge of this value can be used to accurately compute the intraocular lens power, especially in corneas modified by refractive surgery, such as keratomileusis or epikeratophakia. [Refractive and Corneal Surgery 1990;261-264.]
Myopic Excimer Laser Keratectomy: A Preliminary Report
Authors: Zabel Ralph W , Sher Neal A , Ostrov Charles S , Parker Paula , Lindstrom Richard L
Published: April 2021

ABSTRACT: Six patients underwent excimer laser refractive keratectomy for the correction of myopia. All eyes, with the exception of patient 6, who underwent a previous failed epikeratophakia procedure and subsequent removal of the lenticule, had normal baseline ophthalmologic evaluations and best corrected visual acuities of 20/25 or better. Spherical equivalents ranged between -5.50 and -12.00 diopters. Under topical and peribulbar anesthesia, the central corneal epithelium was removed. The delivery system of the laser was programmed to ablate corrections onto the central 5.0 mm of the cornea that would result in approximate emetropia. Moderate fluctuation of refractive and topographic parameters was noted during the period of epithelial healing and remodeling. At the 12th postoperative week, five of the corneas were clear on biomicroscopic evaluation with best corrected acuities of 20/20. The final patient, who was noncompliant in the use of topical corticosteroid therapy, developed a central, 2-mm opacity and resulting best corrected acuity of 20/40. Overall, the group demonstrated that myopic excimer laser photorefractive keratectomy is consistent with good wound healing, insignificant corneal scarring, a stable refractive correction, and excellent visual acuity. [Refractive and Corneal Surgery 1990;6:329-334.]
Laser Thermokeratoplasty by Means of a Pulsed Holmium:YAG Laser for Hyperopic Correction
Authors: Seiler Theo , Matallana Michael , Bende Thomas
Published: April 2021

ABSTRACT: A new technique of hyperopic correction similar to radial thermokeratoplasty is presented. A pulsed Holmium:YAG laser was used, emitting a wavelength of 2.06 µm. The laser light was guided by a quartz fiber and focused by means of a handpiece. Eight of 16 coagulations located on rings concentric to the pupil resulted in central corneal steepening. The refractive change increased with the applied pulse energy above a threshold of about 10 mJ per pulse and was constant between 15 and 35 mJ per pulse. The effect decreased linearly with greater distance from the center. Four blind human eyes demonstrated that the parameters evaluated in the human cadaver eyes can be transferred to the living eye. Immediately after surgery, folds in Descemet's membrane parallel to the limbus appeared. With time, they gradually diminished but were still persistent after 4 months. Hyperopic changes of up to 5.00 diopters were obtained, remaining stable for 4 months. [Refractive and Corneal Surgery 1990;6:335-339.]
Corneal Wound Healing in Monkeys 18 Months After Excimer Laser Photorefractive Keratectomy
Authors: Hanna Khalil D , Pouliquen Yves M , Savoldelli Michele , Fantes Francisco , Thompson Keith P , Waring George O , Samson Jean
Published: April 2021

ABSTRACT: Excimer laser keratomileusis (photorefractive keratectomy, direct corneal ablation) for myopic corrections of 2.00 diopters (n = 1), 4.00 D (n = 4), and 8.00 D (n = 3) was performed on eight corneas of four Rhesus monkeys. All animals were followed for 18 months. The ablations healed normally and no epithelial erosions occurred. Serial slit-lamp microscope examinations revealed that a variable amount of corneal haze developed in all animals; this haze progressively faded during the follow-up period. Histopathology revealed an epithelium of normal thickness, basement membrane abnormalities, increased number and activity of stromal keratocytes, and a variable amount of newly secreted extracellular matrix in the anterior stroma. These findings suggest that excimer laser keratomileusis induces a mild wound healing response in the anterior cornea which displays considerable individual variability and persists up to 18 months. [Refractive and Corneal Surgery 1990;6:340-345.]
Corneal Topography and Optical Zone Location in Photorefractive Keratectomy
Authors: Maloney Robert K
Published: April 2021

ABSTRACT: Optical zone diameters in photorefractive keratectomy are small in order to minimize the depth of stromal tissue excision and, possibly, the resultant stromal scarring. A small optical zone demands accurate placement on the corneal surface. This article reviews the principles that are important to location and measurement of the optical zone in photorefractive keratectomy. The ablated area should be centered on the cornea overlying the entrance pupil while the patient is fixating coaxially with the surgeon. An optical zone that is too small or decentered may decrease acuity, lessen contrast sensitivity, or produce glare, either on the fovea or on the perifoveal retina. The relationship between optical zone size and location and quality of vision is not yet known. Studies of this relationship will require videokeratography to locate the optical zone and its relationship to the entrance pupil, a capability that current videokeratoscopes do not possess. [Refractive and Corneal Surgery 1990;6:363-371.]
Photorefractive Keratectomy Researchers Call for Technical Improvements
Authors: Moretti Michael
Published: April 2021

REFRACTIVE LASER UPDATE
No-Suture Aphakic Epikeratoplasty
Authors: Cotter John B
Published: April 2021

ABSTRACT

Background: Use of sutures with aphakic epikeratoplasty is time-consuming during surgery and can create significant hazards for the patient. Thus, a surgical technique for aphakic epikeratoplasty without sutures was developed.

Methods: The conventional procedure was modified to use an oversized lenticule tucked evenly in an expanded lamellar pocket with no anchoring sutures. The technique was performed on one eye of 27 consecutive patients over a 9-month period.

Results: After a mean follow up of 14 months, results showed refractive and visual parameters comparable to a sutured technique. A 100% success rate at surgery was obtained using the oversized 9-millimeter lenticule. Five eyes (19.2%) developed a partial lenticule edge dislocation postoperatively. Three of the edge dislocations were reposited at the slit lamp without suturing. One lenticule, manufactured undersize, required primary suturing, leaving 24 of 26 (92.3%) patients healed without sutures. Postoperative spectacle-corrected acuity for the group either improved by one or more Snellen lines or remained unchanged. Two patients had reduced vision: one due to unrelated retinal changes and one due to vernal catarhh resulting in a persistent epithelial defect with subsequent epithelial haze.

Conclusions: A sutureless technique can accomplish visual rehabilitation comparable to the conventional procedure. While the technique is not without complication, significant benefits to the patient include reduced morbidity, eliminating hazards of postoperative suture management, and a simplified surgical procedure. (Refract Corneal Surg 1992;8:27-32.)
Surgical Procedures Performed After Refractive Surgery
Authors: Binder Perry S , Charlton Kevin H
Published: April 2021

ABSTRACT

Background: Refractive surgical procedures have been performed for over one decade. The complications that cause visual disability are abnormalities in wound healing, residual ametropia, and/or severe irregular astigmatism. Many of these complications can be manifested clinically in terms of visually disabling problems (loss of best-corrected vision, glare, monocular diplopia, etc). Some of these complications require additional standard ophthalmic or refractive surgical procedures to restore vision. However, since these secondary procedures have been performed in only a few cases, we know little about their outcome.

Methods: We report the histopathologic analysis of 132 cases that have undergone a secondary surgical procedure following a primary keratorefractive procedure. We attempt to correlate the problems encountered with such secondary intervention with histopathologic information obtained from specimens that have been submitted to our pathology laboratory and that had undergone secondary surgical procedures.

Results: Many specimens displayed abnormalities in wound healing associated with visual difficulties such as loss of best corrected acuity, glare, and under- and overcorrection. A short time from the initial procedure to the time of secondary intervention was common.

Conclustions: The combination of a secondary surgical or keratorefractive procedure can produce unpredictable retractive results. Judicious application of a refractive procedure and an appropriate time period before a second procedure is performed may reduce unexpected refractive complications. [Refract Corneal Surg 1992;8:61-74.)
Computer Modeling of Wound Gape Following Radial Keratotomy
Authors: Sawusch Mark R , McDonnell Peter J
Published: April 2021

ABSTRACT

Background: The edges of radial keratotomy incisions remain separated by epithelium or new collagen. To determine if the amount of gape of the incision edges agrees with the induced corneal flattening, two mathematical models of the cornea were studied.

Methods: A finite element model of the eye was constructed; radial incisions through Bowman's membrane and stroma were simulated, as well as incisions confined to the stroma but not involving Bowman's or Descemet's membranes. Geometrical calculations were also performed in a second morphologic model of a spherical shell.

Results: The finite element and geometrical models agree closely on the corneal curvature change for a given incision gape. Both models predict that linear intrastromal incisions that do not involve Bowman's layer would not produce significant corneal flattening.

Conclusions: Corneal flattening after radial keratotomy is closely related to incision gape, mediated through structural weakening of the cornea. Purely intrastromal radial incisions, as might be created with Nd:YAG lasers, prevent wound gape and would not appear to be a promising technique for flattening the cornea. [Refract Corneal Surg 1992;8:143-145.)
Intraoperative and Early Postoperative Complications in 466 Radial Keratotomies
Authors: les Jardins S Leroux , Bertrand I , Massin M
Published: April 2021

ABSTRACT

We have retrospectively studied the intraoperative and early postoperative complications of 466 radial keratotomies. These complications included: microperforations and macroperforations, incisions into the optical zone, and early bacterial corneal ulcers and endophthalmitis. [Refract Corneal Surg 1992;8:215-216.)
Quantitative Measurement of Wound Spreading in Radial Keratotomy*
Authors: Buzard Kurt A , Ronk James F , Friedlander Miles H , Tepper Dan J , Hoeltzel David A , Choe Kang-Il
Published: April 2021

ABSTRACT

BACKGROUND: Many studies of radial keratotomy have been performed, however quantitative laboratory evaluation of the biomechanics of this procedure is still incomplete. Furthermore, most measurements of strain in the past have utilized strip testing, thus destroying the normal physiological structure and water balance of the cornea.

METHODS: We report on a membrane inflation method of wound spreading in intact human corneas using the Baribeau Micronscope.™

RESULTS: We measured a secant elastic modulus of 7.58 × 10
p 6
N/m
p 2
between 25 and 100 mm Hg. The spreading of radial keratotomy incisions as a function of intraocular pressure showed a maximum spreading of approximately 50µ at 25 mm Hg at a radius of 3.50 mm from the optical center. A slight increase in spreading was observed in proceeding from a single to four radial incisions.

CONCLUSIONS: Quantitative measurement of wound spreading is an important parameter of radial keratotomy and can provide important information regarding opposing theories of the biomechanics of this operation. [Refract Corneal Surg 1992;8:217-223.)
An In-Vivo Technique for Monitoring Keratocyte Migration Following Lamellar Keratoplasty
Authors: Kratz-Owens Katherine L , Hageman Gregory S , Schanzlin David J
Published: April 2021

ABSTRACT

BACKGROUND: We have recently developed a method for labeling and following the migration of keratocytes using the fluorescent dye, 4\6diamidino-2-phenylindole (DAPI), which intercalates specifically into the adenine-thymine base pairs of deoxyribonucleic acid (DNA).

METHODS: DAPI was applied to a 2-millimeter area of the corneal stroma, at the edge of the microkeratome wound, prior to placement of the autograft.

RESULTS: DAPI-labeled keratocytes were identiby epifluorescence microscopy along the microkeratome wound and in the mid-periphery of the lamellar graft by day 7. In contrast, no DAPI-labeled keratocytes were observed in the graft immediately following surgery, indicating the DAPI-labeled keratocytes observed in the graft at day 7 resulted from keratocyte migration, and not from diffusion of DAPI from the host into the graft.

CONCLUSIONS: These investigations suggest that DAPI could be a useful probe for monitoring the migration of keratocytes into corneal grafts following lamellar keratoplasty and other corneal transplant surgical techniques. [Refract Corneal Surg 1992;8:230-234.)
On the Safety of 193-Nanometer Excimer Laser Refractive Corneal Surgery
Authors: Van Mellaert Catherine E , Missotten Luc
Published: April 2021

ABSTRACT

Current literature on the potential hazards of 193-nanometer excimer laser corneal surgery is reviewed. The healing process of the different layers involved in the procedure is examined. The epithelium regenerates without delay or abnormal adhesion. A certain loss of corneal transparency seems to be only a short-term complication. The phototoxic risk for the endothelium and the lens has not yet been fully investigated. This risk is presently thought to be minimal. Factors such as improper corneal centering could lead to degradation of best corrected visual acuity or to loss of contrast sensitivity. Results of the first clinical trials indicate that vision quality does not appear to be adversely affected. The last section reviews studies designed to investigate the mutagenicity and cytotoxicity of 193-nanometer UV radiation. In vivo experiments could find no evidence of cellular transformation. (Refract Corneal Surg 1992;235-239.)
Subepithelial Reticular Cicatrization Following Radial Keratotomy in a Patient With Inactive Trachoma
Authors: Polit Fernando , Anwar Mohamed , Tabbara Khalid , El-Maghraby Akef
Published: April 2021

ABSTRACT

BACKGROUND: Opacification of the clear optical zone following radial keratotomy has not been observed before.

METHODS AND RESULTS: The authors noted the appearance of subepithelial dense white reticular cicatrization in the central area following radial keratotomy in a patient with inactive trachoma and clear cornea. The corneal changes resulted in regression of the surgical effect and decrease in visual acuity. A good visual result was obtained by performing homoplastic myopic keratomileusis in situ. Clinical and histopathological findings are presented.

CONCLUSIONS: Patients undergoing radial keratotomy should be carefully screened for inactive trachoma which may contribute toward postoperative reticulate opacity of the central cornea. [Refract Corneal Surg 1992;8:240-241.)
Complications of Mersilene Sutures in Penetrating Keratoplasty
Authors: Bertram Bradley A , Drews-Botsch Carolyn , Gemmill Mary , Guell Jose , Murad Mervat , Waring George O
Published: April 2021

ABSTRACT

BACKGROUND: After penetrating keratoplasty, many corneal surgeons adjust sutures to reduce astigmatism and then leave the sutures in place indefinitely. Nylon sutures can hydrolyze and break years after surgery. In a series of human penetrating keratoplasties, we studied the use of polyester (Mersilene®) sutures that do not hydrolyze.

METHODS: We performed two prospective studies of polyester (Mersilene) sutures in human penetrating keratoplasty done by one surgeon. Study I was a randomized comparison of combined running and interrupted Mersilene and nylon sutures in 45 consecutive eyes. Study Il was a case series of single running Mersilene suture with postoperative adjustment of suture tension to manage astigmatism in 23 consecutive eyes. We evaluated the performance of the suture and the control of astigmatism.

RESULTS: The interrupted running suture study demonstrated that interrupted Mersilene sutures were 5.5 times more likely to have handlingrelated complications than nylon Interrupted sutures (p = .01); in addition, they were three times as likely to have tissue-related complications as nylon (p = .16). The running suture study demonstrated an unacceptable complication rate of 69% when Mersilene was used as a single adjustable running suture. Af 6 months postoperatively, the median refractive astigmatism for the adjustable cases was 3.37 diopters (mean, 4.03 ± 2.37 D). Eyes with significant suture-related complications were 2.85 times more likely to have greater than 4.00 D of refractive astigmatism than were eyes without suture-related complications.

CONCLUSIONS: Mersilene is an undesirable suture for use in penetrating keratoplasty. [Refract Cornea! Surg 1992;8;296-305.)

RÉSUMÉ

INTRODUCTION. Après kératoplastie transfixiante nombreux sont les chirurgiens rompus à cette technique qui tente de réduire l'astigmatisme secondaire par l'ajustement des sutures. Il est reconnu que les sutures en Nylon s'hydrolysent progressivement avec le temps. Nous rapportons sur une série de keratoplasties transfixiantes l'utilisation de sutures en polyester (MersileneR) connues pour leur stabilité.

METHODES. Nous avons conduit deux études prospectives sur l'utilisation des sutures en polyester (Mersilene) dan les greffes de cornee. Des greffes ont éfé réalisées un seul chirurgion. Dans le première étude, nous avons comparé l'utilisation combinée de surjet de points séparés en Mersilène et en Nylon sur 40 yeux consécutifs. Dans l'étude numéro 2, nous avons réalisé un simple surjet en Mersilene avec un ajustement postopératoire de la tension de ces sutures pour améliorer l'astigmatisme sur 23 yeux consécutifs. Nous avons évalué l'efficacité de ces sutures et du contrôle de l'astigmatisme post-opératoire.
Sliding Flap of Conjunctival Limbus to Prevent Recurrence of Pterygium
Authors: Tomas Teofilo
Published: April 2021

ABSTRACT

BACKGROUND: Several techniques have been advocated for the excision of a pterygium: bare sclera, conjunctival flaps, free conjunctival graft, and labial mucous membrane graft.

METHODS: Twenty eyes were treated with a sliding flap of limbal conjunctiva into the scleral bed of the excised pterigium, using 7-0 and 8-0 Vicryl sutures. Corticosteroids and tear substitutes were administered postoperatively.

RESULTS: There was one recurrence in the 20 eyes performed with 1 year follow up.

CONCLUSIONS: Recurrence was limited to that of 5% (1 case out of 20). Postoperative inflammatory reaction was minimal. [Refract Corneal Surg 1992;8:394-395.)
Early Rehabilitation After Small Incision Cataract Surgery
Authors: Uusitalo Risto J , Ruusuvaara Pekka , Järvinen Esko , Raivio llkka , Krootila Kari
Published: April 2021

ABSTRACT

BACKGROUND: The use of smaller cataract incision is thought to induce less astigmatism, resulting in a more stable refraction and more stable wound.

METHODS: We have analyzed the early astigmatic changes and rehabilitation in 20 eyes of 16 patients operated with advanced phacoemulsification techniques. The patients operated with small-incision surgery (incision 4.0 mm) were compared to those with large-incision surgery (incision 7.5 mm). Keratometric values and visual acuity data were evaluated up to 6 months postoperatively.

RESULTS: Less initial induced astigmatism was demonstrated at day 7 postoperatively with a 4.0-millimeter incision (0.1 ± 0.53 D) compared with a 7.5-millimeter incision (1.90 ± 1.97). Similar but not statistically significant changes were seen at days I and 30 postoperatively. Visual rehabilitation was also faster in the small -incision group and 70% of the eyes gave uncorrected visual acuity of 20/40 or better in this group as early as the first postoperative day. Only 1 1% of the eyes showed that uncorrected visual acuity after largeincision surgery at first postoperative day.

CONCLUSION: The low amount of induced cylinder, rapid stabilization of the wound, and faster visual rehabilitation confirms the advantage of small-incision cataract surgery to large-incision surgery. (Refract Corneal Surg 1993;9:67-70.)
Isomorphic Corneal Topography: A Clinical Approach to 3-D Representation of the Corneal Surface
Authors: Young Joshua A , Siegel Irwin M
Published: April 2021

ABSTRACT

BACKGROUND: Newer methods of refractive surgery produce their effect by reshaping the corneal surface. It follows that topographic representations, used primarily to map refractive power, should now emphasize morphology and contour features.

METHODS: We introduce a procedure using commercially available instrumentation which provides isomorphic three-dimensional cornea) topography. The representations may be displayed either as refractive power, as is conventionally done, or as the more surgically relevant contour configuration. These images contain data points that are continuous rather than stepped as in the familiar color-coded displays.

RESULTS: The technique proved easy to execute requiring no special software or mainframe computing. The corneal displays generated were freely rotatable and rescalable.

CONCLUSIONS: In addition to producing clear and intuitive three-dimensional representations, the digital graphics environment allows manipulation unavailable in the conventional color-coded format; such representations should be particularly valuable for pre- and postoperative evaluation. Refract Corneal Surg 1993;9:74-78.)