bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative Posterior Chamber Lens Haptic Fixation in the Human Cadaver Eye
Authors: Miyake Kensaku , Miyake Chikako
Published: April 2021

ABSTRACT

The authors observed the intraoperative behavior of several posterior chamber lens (PCL) loops inserted in the human cadaver eye in a manner similar to an actual operation. The procedure was viewed under an operating microscope, and was filmed by a 16-mm movie camera. In PCLs with a length of 13-mm or more, which were originally designed for ciliary sulcus fixation, the first loop (usually the inferior loop) was easily inserted into the ciliary sulcus, but the second loop (usually the superior loop) was often misinserted into the posterior capsule. Neighboring tissues sometimes were accidentally traumatized during maneuvers to correct lens decentration. In PCLs with shorter loops, which were designed for capsular bag fixation, both loops could always be placed securely in the bag. When we compared the C-loop and the J-loop, the former was found to be excellent in its flexible nature of the loop.
Pathology of an Orbital Dermis-Fat Graft
Authors: Wojno Ted , Tenzel Richard R
Published: April 2021

ABSTRACT

A patient had an orbital dermis-fat graft implanted for a secondary socket reconstruction. The graft shrank only minimally and a portion had to be excised to permit better prosthesis fitting. The pathologic findings are presented. Although a generalization cannot be made on the basis of one case, prudence should be exercised with regard to the degree that such grafts are oversized in socket reconstruction.
Clearance of Intravitreal
p 3
H-Fluorouracil
Authors: Case James L , Peyman Gholam A , Barrada Ahmad , Hendricks Robert , Fiscella Richard , Hindi Musa
Published: April 2021

ABSTRACT

The clearance of intravitreally administered 5-fluorouracil (5-FU) was studied under five experimental conditions. The same nontoxic dose resulted in similar initial intravitreal concentrations and cleared rapidly from all eyes (approximately 90% clearance within eight hours). Half-life values ranged from 46 to 168 minutes. The longest half-life occurred in aphakicvitrectomized eyes in which hyaluronic acid (Healon *) was substituted for vitreous (168 minutes). A similar half-life was found in normal eyes (150 minutes). The shortest half-life occurred in aphakic-vitrectomized eyes postoperatively (46 minutes). Intermediate halflife values occurred in vitrectomized but phakic eyes postoperatively (67 minutes) and in aphakic-vitrectomized "quiet" eyes (at least two weeks postoperatively) (82 minutes).
The Anterior Capsular Nibbler
Authors: Schulze Richard R
Published: April 2021

ABSTRACT

A spatula designed to cut anterior capsular tags in conjunction with an aspiration tip is described.
Argon Laser Therapy of Occult Recurrent Hyphema From Anterior Segment Wound Neovascularization
Authors: Sharpe Elizabeth D , Simmons Richard J
Published: April 2021

ABSTRACT

Recurrent hyphema is a complication of anterior segment surgery that may present with a variety of signs and symptoms. The appropriate diagnosis of this syndrome may be overlooked because its presentation is frequently delayed, and its symptoms and signs are varied and frequently evanescent. Major forms of surgical intervention have been recommended for this syndrome, but we believe that many such cases can be treated relatively simply and effectively with argon laser goniophotocoagulation using topical anesthesia. We present five cases of recurrent hyphema from neovascularization of a surgical incision.
Cataract Surgery After Expulsive Choroidal Hemorrhage in the Fellow Eye
Authors: Straatsma Bradley R , Khwarg Steven G , Rajacich George M , Meyer Kenneth T , Pettit Thomas H
Published: April 2021

ABSTRACT

Expulsive choroidal hemorrhage (ECH) is a dramatic and serious complication of cataract surgery that occurred in four of 8,285 consecutive cataract operations performed at the Jules Stein Eye Institute from 1970 to 1983, an incidence of 0.05%. This report reviews six patients who had uncomplicated cataract surgery after an expulsive choroidal hemorrhage occurred during cataract operation in the fellow eye. Factors predisposing to ECH are considered, and recommendations to minimize the risk of this complication during preoperative, operative, and postoperative periods are presented.
Laser Photocoagulation of Feeder Vessels in Lipid Keratopathy
Authors: Mendelsohn Alan D , Stock E Lee , Lo Garland G , Schneck Gideon L
Published: April 2021

ABSTRACT

Argon laser photocoagulation was performed on rabbit eyes with lipid keratopathy. The lipid keratopathy was induced by rendering 30 rabbits hypercholesterolemic and inciting neovasculatization by insertion of cornea] sutures. The number of laser shots required to occlude corneal vessels increased with the suture residence time, whereas the number of llmbal shots remained essentially constant. Corneal opacification and cholesterol content increased as a result of greater suture residence time and unexpectedly from the laser applications which were administered in a single treatment session.
Cyanoacrylate Tissue Adhesive in Securing Orbital Implants
Authors: Tse David T
Published: April 2021

ABSTRACT

Butyl-2-cyanoacrylate (Histoacryl blue) tissue adhesive was used to secure orbital floor implants in the correction of superior sulcus deformities and blowout fracture repairs and in one case of autogenous orbital roof bone plate. We have found this tissue adhesive to be a valuable substitute for wiring of orbital implants and have not seen general or local toxicity to the material.
The Scleral Yoke Suture for Anterior Segment Surgery
Authors: McKenzie Keith S , Adams William L
Published: April 2021

ABSTRACT

A safe effective method of global control during anterior segment surgery is presented. The method used in 1184 consecutive cases was the scierai yoke traction suture adapted from a method often used in strabismus surgery. The incidence of postoperative ptosis severe enough to require surgical correction is presented in that group as well as in a group of 591 consecutive cataract extractions utilizing the classic superior reclus traction surgery. The principle advantages of this method as compared to the classic superior reclus traction suture are pointed out, with emphasis on the reduction of postoperative ptosis.
Clinical and Immunological Results of Corneal Allograft Rejection
Authors: Smiddy William E , Stark Walter J , Young Elaine , Klein Pamela E , Bias Wilma , Maumenee A Edward
Published: April 2021

ABSTRACT

Of Hl episodes of graft rejection in 66 patients, 62 responded to therapy with graft clearing (responders); 49 did not (non-responders). Both groups were of similar age, sex, and etiology; both had a similar rate of glaucoma and a similar rate of previous grafting. In responders the graft reaction was shorter in duration (2.2 vs. 5.6 wks. p < 0.005), and it was necessary to increase the number of glaucoma medications more often in non-responders compared to responders (41% vs. 19%, p <0.02). The interval from surgery to reaction was similar in responders and non-responders (18.2 vs. 13.3 mos., p >0.1). An epithelial rejection Une was present in 11% of responders, but was not present in nonresponders (p <0.05). Lymphocytotoxic antibody development correlated with rejection in 16 of 64 episodes.

Patients who responded to treatment were more frequently asymptomatic (p <0.05) or were treated earlier following the onset of symptoms compared to nonresponders (p 0.0001).

These results suggest that, although graft rejection appears to be a more severe form of immunologie reactivity than graft reaction, there is no reproducible laboratory measure of any different basic immunologie mechanism. Clinically, however, reaction is more likely when an epithelial rejection line is present and when the duration of inflammatory activity is short.
The Value of Cryoprobe-Assisted Removal of Orbital Tumors
Authors: Hurwitz J J , Mishkin S K
Published: April 2021

ABSTRACT

Freezing a tumor and using a cryoprobe for removing a noninfiltrative space-occupying orbital lesion helps greatly in removal of a tumor. The cryoprobe minimizes the potential problem of tearing the capsule of the tumor, decreases bleeding at the time of removal of an hemangioma, and plays a role in removing tumors, either benign or malignant, after they have been biopsied. It is possible that freezing a tumor decreases the potential spilling of tumor cells into the orbit through the biopsy site and upon the delivery of the tumor itself.
Digoxin Cannot Account For the Reported Association of EKG Abnormalities and Rhegmatogenous Retinal Detachment
Authors: Frambach Donald A , Roy Chandra E , Valentine John L , Boles Samuel F , Weiter John J , Schepens Charles L
Published: April 2021

ABSTRACT

The prevalence of cardiovascular disease (by EKG criteria) in patients with rhegmatogenous retinal detachments has been reported to be more than four times that found in age-matched controls. Adhesion between the retinal pigment epithelium (RPE) and the photoreceptors is facilitated by RPE transport. Because RPE transport is driven by a Na-K ATPase, it has been suggested that the correlation of EKG abnormalities and retinal detachment may be due to clinical use of digoxin, a Na-K ATPase inhibitor frequently given to patients with cardiovascular disease. The prevalence of EKG abnormalities in 299 consecutive patients with primary retinal detachment is about the same as that reported previously. However, 92% of these patients with EKG abnormalities did not take digoxin. Therefore, clinical use of digoxin cannot account for the reported association of EKG abnormalities and rhegmatogenous retinal detachment.
The PAR IS 2000: A New System for Retinal Digital Image Analysis
Authors: Varma Rohit , Spaeth George L
Published: April 2021

ABSTRACT

We describe the PAR IS 2000, a new system of digital image analysis of the optic disc. The system uses a simultaneous stereoscopic camera and a video camera to acquire images directly from the optic disc and from optic disc photographs, respectively. The image data are stored on an optical laser disk capable of handling large amounts of data (4000 monochrome images/ disk). These images can be analyzed using a modified digital interactive mapping program to generate stereometric parameters, contour maps, section profiles, pallor maps, depth maps, and three-dimensional topographic plots of the retina. A skeletonizing program permits determination and measurement of shifts in the position of retinal vessels. The systems wide range of capabilities may be helpful in improving patient care and ophthalmic research.
Evaluation of Rebreathing in Patients Undergoing Cataract Surgery
Authors: Sabo Betsy , Smith R Brian , Gilbert T James
Published: April 2021

ABSTRACT

Ten patients undergoing elective cataract surgery with local anesthesia were evaluated for rebreathing using mass spectrometry and arterial blood gas analysis. Results showed a 10 or 5 1 oxygen-air mixture with an inspired oxygen concentration of 50% (FIO2) administered via a face tent maintained normal blood gases and a satisfactorily low inspired carbon dioxide (FICO2) in conscious patients who were free of lung disease.
Intraocular Pressure Following Secondary Anterior Chamber Lens Implantation
Authors: Kooner Karanjit S , Dulaney David D , Zimmerman Thom J
Published: April 2021

ABSTRACT

Secondary anterior chamber implantation has become relatively simple since the advent of viscoelastic materials. Still, glaucoma, cystoid macular edema, endophthalmitis, and astigmatism remain visionthreatening complications. We studied intraocular pressures (I OPs) following this surgery in 102 patients (124 eyes) over 6 years. Elevated IOP was noted in 32 eyes (25.8%), but only 14 (11.3%) needed long-term medical treatment. None, however, required laser Iridectomy, trabeculoplasty, or trabeculectomy. Patients should be selected for secondary anterior chamber implantation only after more conservative measures have been exhausted.
The Pressure-Controlled Infusion System: A New Instrument for Closed-System Surgery
Authors: Moorhead Louise C , Armeniades C D
Published: April 2021

ABSTRACT

We present the new Pressure-Controlled Infusion System (PCIS), designed to automatically regulate intraocular pressure (IOP) during surgery. Studies were performed with rabbits in which we compared the true IOP during closed-system surgery using gravity-fed infusion with the automatic control provided by the PCIS. The results from irrigation/aspiration of the lens cortex, wound closure, and vitrectomy show that the PCIS performs two functions during closed surgery: it automatically maintains the baseline IOP at the pre-set level, and it dramatically decreases the pressure fluctuations that occur with gravity infusion.
Tarsoconjunctival Grafts for Upper Eyelid Cicatricial Entropion
Authors: Shorr Norman , Christenbury Jonathan D , Goldberg Robert A
Published: April 2021

ABSTRACT

Many surgical procedures have been described for correction of cicatricial entropion of the upper eyelid. However, many of them fail to address the altered anatomy responsible for cicatricial entropion, which may lead to excessive scarring, eyelid margin malposition, or blepharoptosis. Tarsoconjunctival grafts provide a strong and permanent buttress to correct the scarring of the posterior eyelid margin that characterizes cicatricial entropion. They provide a smooth mucosal surface to interface with the corneal tear film. Depending on the circumstances, we use free ipsilateral, free contralateral, or sliding "bucket handle" tarsoconjunctival grafting. Mucosal grafts are rarely needed. Blepharoptosis is avoided by conservative dissection in the supratarsal space, sparing most of the attachments of the levator aponeurosis.
A Syndrome of Multiple Fundal Anomalies in Siblings With Microcephaly Without Mental Retardation
Authors: Sheriff Sayed M M , Hegab Samiha
Published: April 2021

ABSTRACT

Chorioretinal and retinal anomalies, among others, have been described in association with true autosomal recessive microcephaly. Accompanying hypertrophy of retinal pigment epithelium has been described in association with Gardners syndrome.

We present the cases of three siblings (two boys and one girl) with true autosomal recessive microcephaly without mental retardation and without associated systemic anomalies who showed hypertrophy of the retinal pigment epithelium similar to that described in Gardners syndrome. In the boys, these spots were located on a background of fine variations in pigment, with scattered depigmented atrophic areas revealing the sclera in the peripheral and mid peripheral fundus. Superadded white spots were located in front of the retinal vessels. The younger boy also had discrete patches of chorioretinal atrophy of 0.5 to 1 disc diameter. The girl, in addition to the hyperpigmented spots, had a diffuse area of chorioretinal atrophy.

The anomalies described above suggest that congenital hypertrophy of the retinal pigment epithelium is not unique to Gardners syndrome.
Penlight Test for Glare Disability of Cataracts
Authors: Maltzman Barry A , Horan Catherine , Rengel Alison
Published: April 2021

ABSTRACT

We describe an alternative glare test using a simple penlight. When the glare and decrease in vision created by the penlight were compared on Snellen chart recordings, 92% of eyes within 20/50 or less visual acuity were no longer able to see even the 20/200 Snellen figure. This penlight test is suggested as an adjunct to standard Snellen testing in the evaluation of the cataract surgery patient.
Implantation of a Posterior Chamber Lens Without Capsular Support During Penetrating Keratoplasty or as a Secondary Lens Implant
Authors: Spigelman Alan V , Lindstrom Richard L , Nichols Bruce D , Lindquist Thomas D , Lane Stephen S
Published: April 2021

ABSTRACT

We have devised a technique to fixate a posterior chamber lens in the ciliary sulcus when no posterior capsular support exists. Our short-term follow-up of 22 eyes with lenses thus fixated has shown these eyes to be quiet and to have good pupillary motility after at least 3 months. We believe this new technique is a significant advancement in corneal and anterior segment surgery.
Laser Chalazion Removal
Authors: Korn Elliot L
Published: April 2021

ABSTRACT

CO2 laser excision of chalazion can be done successfully in the office with minimal to no bleeding and with complete extirpation of the granulomous tissue. The technique involves using only the CO2 laser and the curette. This method does not require patching of the eye, and contact lens wearing can be resumed within an hour.
Elimination of Monocular Diplopia by Corneal Tattooing
Authors: Reed John W , Beran Robin F
Published: April 2021

ABSTRACT

Corneal tattooing to eliminate monocular diplopia secondary to surgical peripheral iris defects was performed successfully in two patients who were unable to tolerate contact lenses. The technique is simple, safe, cosmetically satisfactory, and eliminates the need for patient compliance with contact lens care. Although corneal tattooing is usually considered to have only cosmetic value, these patients demonstrate that it can be therapeutic as well.
Intraocular Pressure Following ECCE and IOL Implantation in Patients With Glaucoma
Authors: Kooner Karanjit S , Dulaney David D , Zimmerman Thom J
Published: April 2021

ABSTRACT

Patients with glaucoma may suffer optic nerve head damage due to elevated intraocular pressure (IOP) after any intraocular procedure. We retrospectively reviewed the IOP data in 82 consecutive patients (103 eyes) with glaucoma after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation. Nine eyes had previous trabeculectomy and three eyes required combined trabeculectomy with ECCE and PC-IOL. The average follow-up period is 1.5 years (range 0.5 to 6 years). The postoperative IOP rise of 8 mm Hg over baseline or above 23 mm Hg was observed in 45 eyes (49.5%). Two eyes needed argon laser trabeculoplasty and one required trabeculectomy to control postoperative IOP elevation. Most of the patients required the same or lesser number of medications for IOP control after surgery. Results suggest that ECCE with PC-IOL may be a relatively safe procedure in cataract patients with preexisting glaucoma.
Two Eyes or One? The Data Analyst's Dilemma
Authors: Katz Joanne
Published: April 2021

ABSTRACT

Ophthalmic data usually include measures of disease status, visual function, or ocular physiology for both eyes of each patient. Many ocular characteristics, while differing among individuals, are quite similar for the eyes of the same individual. In studies, eyes, not patients, are often treated as the primary unit of analysis. If an ocular measure is similar for both eyes of an individual, many standard statistical techniques may give misleading results if both eyes of each person are included in analyses. This article discusses the correlation between pairs of eyes for a variety of ocular measures and its impact on common statistical procedures.
Sling Markers in Scleral Reinforcement Surgery
Authors: Brian G R , Hollows F C
Published: April 2021

ABSTRACT

Scleral reinforcement surgery requires a long-term controlled study to establish its efficacy in arresting the blinding complications of pathologic myopia. Only those cases with proven scleral sling reinforcement of the posterior pole should be included in such a study. Tantalum graft markers allow postoperative verification of sling position, and the exclusion of those cases with inappropriately placed reinforcement grafts.
Intraocular Lenses With Posterior Convex Optics: A Clinical Review
Authors: Story Paul G
Published: April 2021

ABSTRACT

Surgidev Style 20 lenses with posterior convex optics and angulated haptics were placed in 294 consecutive eyes. Follow-up was from 2 months to 4% years, with an average of 32 months. Final acuity was 20/40 or better in 96.3%. There was no incident of persistent cystoid macular edema, and the capsular opacity rate was 5.4% No retinal detachment has occurred to date in this series, and only one eye has required reoperation.
Simultaneous Bilateral Conjunctival and Orbital Lymphoma Presenting as a Conjunctival Lesion
Authors: Mamalis Nick , Mackman Gary , Holds John B , Anderson Richard L , Apple David J , Scholes Gary
Published: April 2021

ABSTRACT

A 44-year-old man with the dignosis of a conjunctival lymphoma in the left eye was also found on further evaluation to have a lymphoma in the opposite orbit. The patient had no systemic signs of the disease, and was treated with localized radiation therapy. Although simultaneous presentation of lymphoma affecting the conjunctiva in one eye and the orbit on the opposite side is rare, any patient with an isolated conjunctival lymphoma should have a careful evaluation of the opposite eye and orbit, including an orbital computed tomographic scan to rule out simultaneous involvement.
Reproducibility of the Early Cataract Detector (Kowa ECD 2000)
Authors: Datiles Manuel , Podgor Marvin , Edwards Paul
Published: April 2021

ABSTRACT

We conducted a reproducibility study on the Kowa Early Cataract Detector, a laser light scattering spectroscope that determines the diameter of particles within the lens and designed to quantify changes in particle size in early cataracts. We found good reproducibility in the nuclear region (where changes are homogeneous), but found poor reproducibility in the cortical region (where changes are heterogeneous). We advise careful evaluation of other similar devices before extensive use.
The Effect of Selective Suture Removal on Astigmatism Following Penetrating Keratoplasty
Authors: Burk Linda L , Waring George O , Radjee Bahram , Stulting R Doyle
Published: April 2021

ABSTRACT

We retrospectively evaluated selective removal of interrupted nylon sutures to reduce astigmatism following penetrating keratoplasty in 68 eyes with eight or 12 interrupted sutures and one running suture. Following removal of one to four interrupted sutures at one visit (N =234 visits), corneal astigmatism had changed 2 to 3 diopters (range 0 to 12 D) by the next visit. The astigmatism decreased ≥1 D in 54%, changed 0 to .87 D in 28%, and increased 1≥ D in 18%. When a total of five or six sutures were removed during the 5 months following surgery, less than 3 D of residual astigmatism was present in 50 eyes (74%). The axis of astigmatism changed less than or equal to 40° in 74% (n = 65). In a second group of 20 eyes with double running sutures, removal of the 10-0 running suture in all 20 eyes produced an average change of 1.8 D (range = 0 to 3.75 D), with an equal number of increases and decreases. Vector analysis showed the total induced change in astigmatism was approximately twice the absolute keratometric change.
Pharmacological Modulation of Human Subconjunctival Fibroblast Behavior In Vitro
Authors: Damji Karim F , Rootman Jack , Palcic Branko , Thurston Gavin
Published: April 2021

ABSTRACT

The response of human Subconjunctival fibrobfasts to a variety of pharmacological agents was evaluated utilizing a novel in vitro wound assay and a separate proliferation assay. Both colchicine and cytochalasin B dramatically arrested wound closure at concentrations greater than or equal to 0.01 µ?/G?? and 2 µ9/p??, respectively (p<0.05). At lower doses these drugs altered fibroblast morphology and inhibited directed cell migration. Dexamethasone and 6-MP delayed wound closure at concentrations greater than or equal to 100 jig/ml and 1000 µ9/???, respectively (p<0.05). Effective antiproliferative agents, in order of decreasing potency (based on unit weight), were Cytarabine (cytosine arabinoside), doxorubicin (Adriamycin), colchicine, 5-fluorouracil, cytochalasin B, cyclosporin (Sandimmunel, 6-mercaptopurine, and dexamethasone. The antiprotease agents and methotrexate were ineffective as determined by both assays.

We conclude that the wound assay is well suited for rapid screening of drugs for their effect on fibroblast morphology, motility, and proliferation, and that colchicine and cytochalasin B, in doses well below those documented to produce ocular toxicity, are effective in inhibiting directed migration and proliferation of Subconjunctival fibroblasts in vitro. Differences in mechanism, onset of action, therapeutic range, and cytotoxicity of drugs could be exploited in controlling ocular fibroblast behavior in vivo.
Electric Microtrephine for New Anterior Capsular Openings (Barbell-like Tear-Free Slit Openings)
Authors: Hara Tsutomu , Hara Takako
Published: April 2021

ABSTRACT

We developed a microtrephine that can be used to create 0.9-mm or 0.5-mm, round, tear-free, anterior lens capsular openings. The 0.9-mm tip can be used to greatly facilitate experimental endocapsular cataract surgery followed by lens refilling. The 0.5-mm tip is useful for obtaining new anterior capsular openings.
Long-Term Results with the White Glaucoma Pump-Shunt
Authors: Davidovski Florence , Stewart Robert H , Kimbrough Richard L
Published: April 2021

ABSTRACT

A White glaucoma pump-shunt was inserted in 16 eyes in 15 patients, 2 to 76 years of age (10 female and 5 male patients; 6 were white, 6 were black, and 3 were Hispanic). Six had primary open-angle glaucoma, 2 glaucoma in aphakia, 1 congenital glaucoma, 4 secondary glaucoma, 2 neovascular glaucoma, and 1 glaucoma in pseudophakia. There were no complete successes. There were five (31.3%} "qualified successes" (ie, an intraocular pressure less than or equal to 21 mm Hg on medical treatment, without pain, and without visual acuity loss of more than two Snellen lines). This qualified success rate is far below rates reported for other setons.
Reversible Corneal Keratinization Following Trabeculectomy and Treatment with 5-Fluorouracil
Authors: Phelan Mark J , Skuta Gregory L
Published: April 2021

ABSTRACT

A 66-year-old pseudophakic man with primary openangle glaucoma and ocular cicatricial pemphigoid underwent trabeculectomy and was given postoperative subconjunctival 5-fluorouracil. He developed an inferior corneal epithelial defect and, later, a welldemarcated area of inferior cornea! keratinization. Since the corneal keratinization clinically improved with conservative management, surgical intervention was not required.
High Dose Corticosteroids for Treatment of Vision Loss Due to Indirect Injury to the Optic Nerve
Authors: Seiff Stuart R
Published: April 2021

ABSTRACT

Thirty-six patients with vision loss due to indirect injury to the optic nerve were retrospectively studied. Twenty-one had been acutely treated with high-dose intravenous dexamethasone and 15 had not. The visual acuity of 62% of the treated patients and of 33% of the untreated patients improved. This difference was not statistically significant. However, of those patients whose vision did improve, the vision of those on steroids began to improve earlier (P<.05).
Lacrimal Tube Repositioning: Technique and Ultrasonic Assessment
Authors: Vila-Coro A Aguirre , Prager Thomas C
Published: April 2021

ABSTRACT

A section of migrated lacrimal silicone tubing was repositioned in a 7-year-old patient by dilating the lacrimal passage with hyaluronate solution and pushing the tube back into the nasal fossa with a probe. The position of the tube was postoperatively confirmed by ultrasonographic studies.
The Shouting Surgeon as a Possible Source of Endophthalmitis
Authors: Schiff Frank S
Published: April 2021

ABSTRACT

An ophthalmic surgeon's speaking to a patient during surgery, especially if the patient is hard of hearing and the surgeon must shout to be understood, may increase the patient's risk of developing postoperative endophthalmitis.

We performed an experiment demonstrating that the number of bacterial colonies on blood agar plates placed 30 cm from a person's mouth increased in relationship to the volume at which the person spoke. Wearing a surgical mask with an overlapping hood considerably reduced the levels of bacterial growth.
Treatment of Dysthyroid Myopathy With Adjustable Suture Recession
Authors: Gardner Thomas A , Kennerdell John S
Published: April 2021

ABSTRACT

Extraocular muscle recessions with adjustable sutures were performed on 32 muscles for diplopia secondary to dysthyroid myopathy. Orthophoria in the primary position was achieved in 30 of the 32 (94%) 1 day after surgery. All remained Orthophorie for at least 6 weeks. Of 20 patients followed for 6 months or more, 12 (60%) remained Orthophorie for the full extent of their follow-up (6 months to 8 years), and another three (15%) were asymptomatic with prisms (3, 4, and 8 prism diopters). Thus, a total of 15 of 20 (75%) patients remained asymptomatic at least 6 months after surgery.
Pupillary Dilatation During Cataract Surgery-Relative Efficacy of Indomethacin and Flurbiprofen
Authors: Sachdev Mahipal S , Mehta Manoj R , Dada Vijay K , Jain Arun K , Garg S P , Gupta S K
Published: April 2021

ABSTRACT

In a prospective, randomized, double-blind trial, we evaluated the relative efficacy of indomethacin and flurbiprofen when used as adjuvants to routinely used mydriatics for maintenance of pupillary dilatation in patients with heavily pigmented ins undergoing extracapsular cataract extraction. The drugs were administered orally as well as topically according to a fixed regimen. The pupillary diameters, measured with calipers at various surgical steps, were significantly larger at every step in the study groups in which either of the adjuvants had been used than they were in the control group [P < .001 ). Flurbiprofen tended to help maintain a larger pupillary diameter in the later stages of surgery than indomethacin, but this difference was not statistically significant. We conclude that it is important to use prostaglandin synthetase inhibitors as adjuvants to routine mydriatics, and that flurbiprofen may be somewhat more effective than indomethacin in this capacity.
Severe Anterior Segment Inflammation Following Corneal Surgery for Keratoconus
Authors: Shands Phillip R , Lass Jonathan H
Published: April 2021

ABSTRACT

We present three keratoconus patients who experienced severe anterior segment inflammation, two following penetrating keratoplasty, and one following epikeratoplasty. A favorable response to indomethacin therapy in the second eyes of these patients suggests that the inflammation in the first ones was prostaglandin mediated.
Hemihang-Back Recession: Description of the Technique and Review of the Literature
Authors: Potter William S , Nelson Leonard B , Handa James T
Published: April 2021

ABSTRACT

We describe a modification of the hang-back and loop techniques that we call the hemi hang-back recession, in which the muscle is reattached to the sclera posterior to the original insertion with a single, absorbable suture. We recommend it for difficult strabismus cases, specifically when recessions of 7 mm or more are required.
Scleral Buckle Revision to Treat Recurrent Rhegmatogenous Retinal Detachment
Authors: Smiddy William E , Glaser Bert M , Michels Ronald G , de Bustros Serge
Published: April 2021

ABSTRACT

Recurrent rhegmatogenous retinal detachment sometimes occurs following scleral buckling surgery in the absence of advanced proliferative vitreoretinopathy (grade C-2 or greater). Such detachments can occur because: 1) the scleral buckle is not properly positioned beneath the original break; 2) the buckle is not high enough; 3) the break is elevated off the buckle due to progressive vitreous traction; 4) there are new breaks; and 5) chorioretinal adhesion is insufficient. Techniques that may be useful for reattaching the retina in these cases include: 1) adding scleral buckling material to augment the original buckle; 2) modifying the existing buckle without adding new material; 3) replacing the original buckle with other material; 4) re-treating inadequately closed breaks; and 5) combinations of these four techniques. Vitrectomy may be avoided in many cases.
Subcapsular Fluid Entrapment in Extracapsular Cataract Surgery
Authors: Olson Randall J , Younger Kenneth M , Crandall Alan S , Mamalis Nick
Published: April 2021

ABSTRACT

We report five cases of sudden shallowing of the anterior chamber associated with irrigation under the iris. We suspect that irrigation in this context forces fluids through the zonules into the posterior chamber, where it becomes trapped, causing anterior chamber shallowing. In our cases, this phenomenon was most commonly associated with irrigation during cortex removal in cases in which the cornea was open (associated with cornea) transplantation) and with zonular dehiscence.
Retinal Breaks in Diabetic Retinopathy: Vitreoretinal Relationships
Authors: Kakehashi Akihiro , Trempe Clement L , Fujio Naoki , McMeel Wallace , Schepens Charles L
Published: April 2021

ABSTRACT

We retrospectively reviewed the eyes of 143 patients with fractional retinal detachment caused by diabetes that had been studied biomicroscopically, and, after some exclusions, divided them into two groups: those with retinal breaks (group 1) (16 patients, 16 eyes), and those without retinal breaks (group 2) (127 patients, 161 eyes). The group 1 eyes were further divided into three subgroups: those with retinal tears from limited anteroposterior vitreous traction (subgroup A), those with macular holes in an area without posterior vitreous detachment (subgroup B), and those with oval retinal holes anterior to the anteroposterior vitreous traction (subgroup C). Subgroup C comprised most of the eyes in group 1 (10 eyes) and was the only subgroup that we compared with group 2. Significant differences between subgroup C and group 2 were found in terms of the extent of fractional retinal detachment (P = .002) and the degree of preretinal fibrosis (P = .009). These data suggest that large fractional retinal detachments and extensive preretinal fibrosis are significant risk factors for the development of retinal breaks in proliferative diabetic retinopathy.
Cataract Surgery Using Heparin Surface-Modified Intraocular Lenses in Fuchs' Heterochromic Uveitis
Authors: Jones Nicholas P
Published: April 2021

ABSTRACT

I prospectively studied cataract extraction with implantation of heparin surface-modified intraocular lenses (IOLs) in 20 patients with Fuchs' heterochromic uveitis. The mean follow up was 14.5 months. Seven episodes of postoperative uveitis occurred, including two with fibrin deposition, but substantial giant-cell adhesion to the IOL was seen in only four cases. A visual acuity of 20/40 or better was achieved in 95% of the eyes despite other causes of visual loss such as vitreous opacities. The use of heparin surfacemodified (OLs is suggested for patients with heterochromic uveitis.
Preparation of pH-Adjusted Local Anesthetics
Authors: Hinshaw Kevin D , Fiscella Richard , Sugar Joel
Published: April 2021

ABSTRACT

Characteristics of alkalinized local anesthetics are poorly described with regard to stability and precipitation. Current fixed-volume methods of alkalinization often result in unstable, precipitated solutions of unpredictable pH. We determined a stable, nonprecipitating, anesthetic mixture and used it in a randomized double-blind crossover study of 21 patients to evaluate alkalinized anesthetic solutions in reducing pain on injection. Our solution significantly reduced pain associated with retrobulbar injection (analysis of variance, P= .0362) but not that associated with Nadbath injection. Fixed-volume alkalinization is not recommended because complications can result with the use of precipitated anesthetics.
Intralenticular Foreign Bodies: Case Reports and Surgical Review
Authors: Macken Peter L , Boyd Shelley R , Feldman Fredrick , Heathcote J Godfrey , Steiner Michael , Billson Frank A
Published: April 2021

ABSTRACT

Management of intralenticular foreign bodies (ILFBs) is controversial. Correlation between visual outcome, foreign body characteristics, the need for surgical intervertion, and the choice of surgical technique are not well established. We report five cases of traumatic ILFBs all managed surgically. Three ILFBs were metal, one was presumably also metal, and one was wood. We chose to proceed with foreign body removal and simultaneous cataract extraction with intraocular lens implantation as a single-staged procedure in four cases. In one case of planned extrecapsular cataract extraction, a foreign body was identified only after the expressed nucleus was sent for pathological examination. Visual outcomes were 20/30 or greater in all cases at 5 to 18 month follow up.
Anterior Synechiolysis After Keratoplasty
Authors: Vajpayee Rasik B , Taherian Kasra , Honavar Santosh G , Negi Anil
Published: April 2021

ABSTRACT

Anterior synechiae that develop following keratoplasty may induce immunological graft rejection or graft failure. Current surgical techniques designed to remove the synechiae early on are quite cumbersome. We describe a simple technique of anterior synechiolysis, performed 1 to 4 weeks postoperatively, using a bent 26-gauge needle, that proved safe and effective in seven cases. The only complication was a hyphema in one case. None of the synechiae had recurred at the final follow up at 3 months.
Posterior Segment Triple Surgery After Traumatic Eye Injuries
Authors: Soheilian Masoud , Ahmadieh Hamid , Afghan M H , Sajjadi S H , Azarmina M , Peyman Gholam A
Published: April 2021

ABSTRACT

Cataract extraction, posterior chamber intraocular lens (PC-IOL) implantation, and complete vitrectomy combined in a one-stage procedure were performed in 16 eyes (16 patients) with traumatic eye injuries undergoing anterior lensectomy (seven eyes), extracapsular cataract extraction (six eyes), or pars plana lensectomy (three eyes). Membrane peeling and intraocular foreign-body removal (13 eyes, 6 with intra ret i nal foreign bodies) were performed as needed. Surgery was performed from 1 week to 10 years after injury. After an average follow up of 8 months, 13 eyes (81%) had a visual acuity of at least 20/200; 50%, at least 20/40.
Dislocation of Cataractous Lens by Enzymatic Zonulolysis: A Suggested Solution to the Problem of the 18 Million Individuals Blind From Cataracts in Third-World Countries
Authors: Girard Louis J
Published: April 2021

ABSTRACT

There are 18 million persons blind from cataracts in Third-World countries and the number is doubling every 20 to 25 years. It is impossible to cure this many blind with present sophisticated surgical techniques. Enzymatic dislocation of the cataractous lens could be performed by nonmedicai personnel and the patients given inexpensive mass-produced spectacles, which could solve this tremendous problem.
Vertical Tripod Fixation (VTF) Simplifies Transscleral Approaches
Authors: Berger Roland R , Kenyers Agnes M , Van Coller Beulah , Pretorius Christine F
Published: April 2021

ABSTRACT

Transscleral fixation of intraocular lenses (IOL) is an accepted procedure today. Following Malbran's initial approach, new techniques have been developed in various ophthalmic centers; many, however, are time-consuming and difficult, as reflected by complications, most commonly hyphema and IOL tilt.

We present here a simple method of transscleral fixation, which was performed in 24 patients in our department. It involves fixating the IOL vertically, on a three-point configuration, using standard 10-0 prolene stitches. Performing it is easy and time-saving. VTF ensures a stable transscleral fixation of an IOL.
Tissue Plasminogen Activator in the Surgical Excision of Subfoveal Choroidal Neovascular Membranes
Authors: Thomas John W , Lopez Pedro F , Lambert H Michael
Published: April 2021

ABSTRACT

We investigated the use of tissue plasminogen activator (t-PA) as an adjunct to the surgical removal of subfoveal choroidal neovascular membranes. t-PA in a concentration of 6 µg/0.1 cc dissolved the fibrin rim surrounding recent subfoveal membranes but was less effective on more mature lesions. t-PA may be a useful intraoperative tool to limit the damage to surrounding structures during the surgical excision of recent subfoveal choroidal neovascular membranes with surrounding fibrin rims.
Mortality and Morbidity Associated With Ophthalmic Surgery
Authors: Badrinath Sengamedu S , Bhaskaran S , Sundararaj Ian , Rao B Sridhar , Mukesh B N
Published: April 2021

* BACKGROUND AND OBJECTIVES: To study the mortality and morbidity among the patients undergoing ophthalmic surgery under local or general anesthesia.

* MATERIALS AND METHODS: A retrospective analysis of all patients who underwent ophthalmic surgery at Sankara Nethralaya, Madras, India, between 1979 and 1988, was performed. Relevant details included the preoperative medical status of the patients (ASA status), type of surgical procedure, type of anesthesia, and intraoperative and postoperative complications.

* RESULTS: The overall mortality rate was 1.15 per 1000. There was a decrease in the mortality rate from 2.09 per 1000 in the first 5-year period to 0.37 per 1000 in the second 5-year period. The factors significantly associated with mortality were hypertension, presence of cardiac pacemaker, renal disease, duration of surgery, type of surgery, and physical status (American Society of Anaesthesiologists classification).

* CONCLUSION: Identifying the risk factors can help reduce the mortality in ophthalmic surgery.

[Ophthalmic Surg Lasers 1995;26:535-54l.]
The Effect of Trephination on Corneal Topography
Authors: Greenfield David S , Jivanjee Shafiq Q , Raizman Michael B
Published: April 2021

* BACKGROUND AND OBJECTIVE: A prospective study was performed to assess the effect of trephination on corneal curvature.

* MATERIALS AND METHODS: Thirty-seven fresh porcine globes with intact corneal epithelium were used. Radius of curvature, central dioptric power, and powers and axes of the steepest and flattest meridians were obtained using a vertically mounted computerized videokeratography unit. Following 8-mm vacuum trephination of the central donor corneas, the said parameters were reassessed on the resultant buttons. No globes with epithelial defects were included in the study.

* RESULTS: The mean corneal radius of curvature (mm) increased from 8.68 ± 0.79 to 10.46 ± 3.24 (P = .005), the central dioptric power (D) decreased from 39.36 ± 3.84 to 36.31 ± 10.15 (P = .08), and the total corneal asphericity (D) increased from 5.03 ± 2.99 to 7.47 ± 3.42 (P = .0001). No significant changes in the axes of the steepest and the flattest meridians were noted following trephination.

* CONCLUSION: Trephination leads to significant corneal flattening and increased asphericity. Cornea! topography can be used successfully as a research tool for whole globes and trephined buttons.

[Ophthalmic Surg Lasers 1995;26:560-567.]
Complement-derived Anaphylatoxins in Human Donor Corneas Treated With Excimer Laser
Authors: Gardner Bradley P , Pleyer Uwe , Mondino Bartly J , Sumner Humphrey L , Frieberg Murray L , Imperia Paul S
Published: April 2021

* BACKGROUND AND OBJECTIVE: An inflammatory response produced by excimer laser photorefractive keratectomy (PRK) may be associated with the subsequent corneal haze and regressions in refractive error observed after treatment. Complement-derived anaphylatoxins, potent mediators of inflammation, may have a role in postoperative healing.

* MATERIALS AND METHODS: Twenty right human donor corneas underwent a 6-D excimer laser PRK treatment. The corresponding left donor corneas served as the controls. After incubation in tissue culture media for 6 hours and elution in phosphatebuffered saline with EDTA for 24 hours, complement-derived anaphylatoxins C3a, C4a, and C5a were measured in corneal eluates by radioimmunoassay.

* RESULTS: Compared with control corneas, the excimer PRK corneas failed to demonstrate a significant increase in C3a, C4a, or C5a levels (P > .05).

* CONCLUSIONS: These results suggest that the excimer laser at this dose does not activate significant complement in the cornea.

[Ophthalmic Surg Lasers 1995;26:568-571.]
The Castroviejo Square Graft
Authors: Haselwood David M , Lesko William S , Maumenee Irene H , Stark Walter J , Green W R
Published: April 2021

Abstract. The histopathologic features of three keratoplasty specimens from three cases involving square graft procedures performed by Dr. Castroviejo are reported. Light and electron microscopy were performed. In two of the cases, repeat keratoplasties were performed because of recurrent corneal dystrophies. In the third case, a repeat keratoplasty was performed because of graft failure. [Ophthalmic Surg Lasers 1996;27:127-132.]
Fluorescent Vesicle Angiography With Sodium Fluorescein and Indocyanine Green
Authors: Peyman Gholam A , Moshfeghi Darius M , Moshfeghi Andrew A , Khoobehi Bahram
Published: April 2021

* BACKGROUND AND OBJECTIVE: The authors evaluated the feasibility of merging free-dye angiography and the fluorescent vesicle technique to achieve the best characteristics of both.

* MATERIALS AND METHODS: Fluorescent vesicles encapsulated with either ìndocyanine green or carboxyfluorescein were mixed with free indocyanine green or free sodium fluorescein, respectively, and imaged with a scanning laser ophthalmoscope in both an in vitro model and primate and rabbit models.

* RESULTS: In the in vitro model of the sodium fluorescein combination, optimal viewing of vesicleencapsulated dye and free dye was at a ratio of 150:1; for indocyanine green, the ratio was 50:1. In vivo, high-quality fluorescent vesicle angiograms were obtained that demonstrated leakage of free dye from choroidal laser spots.

* CONCLUSIONS: Free dye and fluorescent vesicles can be combined to obtain an angiogram with all of the advantages of a traditional angiogram, while allowing the operator to assess the changes in retinal or choroidal circulation direcdy.

[Ophthalmic Surg Lasers 1996;27:279-284.]
In Vitro Evaluation of Polymeric Matrix and Porous Biodegradable Reservoir Devices for Slow-release Drug Delivery
Authors: Peyman Gholam A , Yang Dachuan , Khoobehi Bahram , Rahimy Mohamad H , Chin So Y
Published: April 2021

* BACKGROUND AND OBJECTIVE: Biodegradable polymeric devices were evaluated in vitro for intravitreal drug delivery.

* MATERIALS AND METHODS: The matrix (short-term drug delivery) and the porous (longerterm drug delivery) reservoir devices were made from polycaprolactone of two molecular weights (30,000 and 56,000). Matrix devices were loaded with 5-fluorouracil or ganciclovir. Porous reservoirs were loaded with 5-fluorouracil, ganciclovir, 5-carboxyfluorescein, or foscarnet. The release was monitored in phosphatebuffered solution using ultraviolet spectrophotometry.

* RESULTS: Release from the matrix devices was characterized by an initial burst, followed by a nonlinear release. The porous reservoirs demonstrated zeroorder linear release of drugs, sustained up to 250 days in this experiment.

* CONCLUSIONS: The matrix device is capable of sustained release over several months; the porous reservoir can deliver drugs for over 1 year. Further studies are needed to evaluate in vivo biodégradation behavior and toxicity of drugs used for sustained release.

[Ophthalmic Surg Lasers 1996;27:384-391.]
Bilateral Fascia Lata Patch Grafts in a Patient With Progressive Scleromalacia Perforans
Authors: Kachmaryk Martha , Bouchard Charles S , Duffner Lisa A
Published: April 2021

Abstract. This study was performed to evaluate the use of autogenous fascia lata patch grafts with systemic immunosuppression in the treatment of progressive bilateral scleromalacia perforans. Autogenous fascia lata was compared with donor bank sclera and was demonstrated to be more suitable for this condition. [Ophthalmic Surg Lasers 1996;27:397-400.]
Lidocaine-Prilocaine Cream for Local-Anesthesia Chalazion Incision in Children
Authors: Wessels Izak F , Wessels Gunter F
Published: April 2021

* BACKGROUND: Chalazia are not uncommon in children. If conservative therapy for them fails, incision and drainage are necessary and usually require a general anesthetic, which increases costs and risks.

* PATIENTS AND METHODS: Five children (3 to 8 years old) had a eutectic mixture of lidocame and prilocaine applied to the skin of the eyelid for 1 hour. Then local anesthetic was injected into the same site.

* RESULTS: The local anesthetic injection was painless, permitting successful incision and drainage in all cases.

* CONCLUSION: Lidocaine-prilocaine cream permits local anesthetic injection into the eyelids, facilitating office-based management of chaiazia in children.

[Ophthalmic Surg Lasers 1996;27:431-433.]