bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Cataract Extraction and Thermal Sclerostomy versus Combined Cataract Extraction and Trabeculectomy
Authors: Stewart Robert Hampton , Loftis M Dean
Published: April 2021

SUMMARY

We performed either a combined cataract extraction and trabeculectomy or a combined cataract extraction and thermal sclerostomy on 43 eyes. All eyes had chronic open angle glaucoma or chronic angle closure glaucoma, or a combination of the two. In our cataract/ trabeculectomy group, 74% had improvement in visual acuity, 91% had normalized intraocular pressure without antiglaucoma medications, 31% had transient postoperative hyphemas. In our cataract/thermal sclerostomy group, 61% had improvement in visual acuity, 61% had normalization of intraocular pressures without antiglaucoma medications, 17% had transient postoperative hyphemas. We could not correlate any of the complications of surgery with poor intraocular pressure results in either groups.

The mechanism for the higher success rate with a combined cataract extraction and trabeculectomy as compared with a combined cataract extraction and thermal sclerostomy was not obvious after analyzing these patients.
Repair of Marginal Furrow Perforation
Authors: Anderson Frank G
Published: April 2021

SUMMARY

Limbus base lamellar scleral flap and fornix base conjunctival flap have been combined for repair of perforation secondary to Terrien's marginal furrow degeneration of the cornea Postoperative thinning of the flaps, Pseudopterygium extension, and other complications have not occurred.
Basal Cell Carcinoma Recurrence: Early Diagnosis and Surgical Treatment
Authors: Dizon Rutheva V , Shannon Gerard M , Siliquini John J
Published: April 2021

SUMMARY

Twelve patients with twenty recurrent basal cell carcinomas of the lids and adnexa were studied. Observations on the behavior and treatment were discussed. Suggested management was also given. The radical aggressive approach towards these recurrent lesions is suggested, although initial excision of some basal cells need not be as radical.

As in all malignancies the prompt recognition of lesion, combined with appropriate treatment and regular follow-up are emphasized to effect a cure with good functional and cosmetic results.
Intraocular Lens Fixation with Dacron Mesh: Part I
Authors: Peyman Gholam , Koziol Jeffrey
Published: April 2021

SUMMARY

Rabbits were used to demonstrate the feasibility of using Dacron fibers to fix intraocular lenses. Adhesion occurred five days after insertion and was confirmed by histologic examination to consist of fibroblastic ingrowth into the Dacron fibers. This cellular response was consistent and remained localized. Anterior and posterior placement of the acrylic portion of the lens was compared. It is our clinical impression that the risk of pupillary block is increased with posterior placement of the lens.
Delayed Hypotony, Shallow Anterior Chamber, and Choroidal Detachment in the Postoperative Cataract Eye
Authors: O'Gawa Gilbert M
Published: April 2021

A Comparative Study of Closure with 7-0 Silk, 9-0 Silk, and 9-0 Nylon
Corneal Edema: Iris-Clip Lens Implantation and Simple Intracapsular Extraction Compared
Authors: Cheng H , James A , Rubinstein B
Published: April 2021

SUMMARY

Corneal edema following intracapsular lens extraction and iris-clip lens implantation was compared by assessing corneal thickness and epithelial edema. In a retrospective study the corneal thickness of twenty patients who had intracapsular lens extraction in one eye only was compared with twenty-six patients with iris-clip lens implants in one eye. There was no significant increase in corneal thickness in the operated eye in either group. In a prospective randomized controlled study, a smaller number of patients, had serial measurements of corneal thickness pre- and postoperatively. There was an increase in thickness in the immediate postoperative period for both groups. However, there was no significant difference between eyes which had simple extraction and those which had implants. The implanted eyes however had greater mean increase in corneal thickness and more widespread epithelial edema, suggesting greater endothelial trauma in the initial period, compared to eyes with cataract extraction alone.
Correction of Induced Astigmatism After Cataract Surgery With Introduction of an Intraocular Lens
Authors: Barron G J , Villaseñor R A , Weber Murry
Published: April 2021

SUMMARY

1. The induced astigmatism is most frequently due to corneal scleral suturing and not tilting of the pseudophakos. 2. A simple method of reducing postoperatively induced corneal astigmatism after implantation of intraocular lens has been presented.
Ultrasonic Fragmentation for Retroimplant Membranes and Pupillary Block
Authors: Girard Louis J , Hawkins Rowland S , Borodofsky Ted
Published: April 2021

SUMMARY

Retroimplant membranes may produce a reduction in vision and/or pupillary block glaucoma. Ultrasonic fragmentation through the pars plana is a quick and easy method for relieving the condition. The technique is described in six cases in which it has been used.
Complications Associated with the Orbital Bead Implant Operation
Authors: Walter William L
Published: April 2021

SUMMARY

The primary objective of this paper is to suggest various precautionary measures in order to decrease the occurrence of possible complications associated with the orbital bead implant operation for anophthalmic "enophthalmos."

It is important that the subperiosteal insertion of glass beads be used primarily in an anophthalmic orbit. A preoperative x-ray of the patient's orbit will help the surgeon decide the ideal location in making entry into the subperiosteal space. Cautiousdissection of the subperiosteal pocket is important in order to avoid damage to the levator muscle, blood vessels and nerves of the orbit. An accurate and careful positioning of the bead inserter is necessary in order to deposit the beads properly into the posterior portion of the subperiosteal space.
The Results of Extracapsular Cataract Extraction with a Shearing Posterior Chamber Lens Implant 34 to 40 Months After Surgery
Authors: Jaffe Norman S , Clayman Henry M , Jaffe Mark S , Light David S
Published: April 2021

SUMMARY

A series of 300 consecutive extracapsular cataract extractions with a Shearing posterior chamber lens implant (plus 13 with a surgical complication necessitating another kind of lens implant or no implant) was evaluated 34 to 40 months after surgery, except for those who died before this time (21 patients) and those lost to follow-up (1 5 patients). Ninety-one percent of the 264 patients who were examined achieved 20/40 or better visual acuity. Ninety-one percent of the 300 patients (those examined plus those who died and those lost to follow-up according to their last recorded examination) achieved 20/40 or better visual acuity. This series was compared to a previously reported series of 300 consecutive intracapsular cataract extractions with a Binkhorst iris clip lens implant examined 34 to 40 months after surgery.
An Anatomical Reevaluation of Rectus Muscle Insertions
Authors: Apt Leonard , Call N Branson
Published: April 2021

SUMMARY

Certain strabismus operations require a thorough knowledge of the anatomy of rectus muscle insertions. Earlier anatomical studies were based on a small sample size and did not use precise microscopic techniques for measurements. To obtain accurate measurements of rectus muscle insertion relationships, 100 consecutive normal adult autopsy eyes were examined with a Vernier caliper and a dissecting microscope for high magnification.

Statistical analysis of these data provided a set of normal values for (1) distances from anterior and posterior limbus to rectus muscle insertions, (2) distances between anterior and posterior limbus, (3) length of line ("width") of rectus muscle insertions, and (4) distances between rectus muscle insertions. Although most of the determinations were somewhat similar to older previous studies, statistically they were significantly different.

The ophthalmologist can make use of the revised set of figures for rectus muscle insertion relationships in operations such as transposition procedures for A-V patterns and cranial nerve palsies, large recessions, and advancements in reoperations after recessions.
Muscle Surgery Without Scleral Sutures
Authors: von Noorden Gunter K
Published: April 2021

SUMMARY

Resection of the lateral rectus muscle with end-to-end suturing of the sectioned muscle segments in combination with marginal myotomies of the medial rectus muscles corrected a large angle esotropia in a patient with severe myopia and retinal damage. This approach may be considered as an alternative to conventional muscle surgery in patients in whom scleral suturing must be avoided.
Operating Microscope Anti-Fogging Lens Heaters
Authors: Schulze Richard R , Copeland James R
Published: April 2021

SUMMARY

The design and use of an operating microscope ocular heating device to prevent fogging of the lenses are described.
The Cornered Incision - A Precision Cataract Wound
Authors: Torchia Richard T , McCarthy Rodney W
Published: April 2021

SUMMARY

One hundred fifty-four patients underwent cataract extraction by using a new cornered incision. Closure with 10-0 nylon under keratometric control with the Terry surgical keratometer allowed 79% of patients to have 1.50 or less diopters of residual corneal astigmatism at two months without suture cutting. The cornered incision allowed for precision suture placement and wound closure, allowing for rapid patient visual rehabilitation.
Laboratory Analysis of the Lieberman Corneal Punch
Authors: Duffin R Michael , Olson Randall J
Published: April 2021

SUMMARY

The Lieberman Corneal Punch, an instrument for the trephination of corneal donor tissue, was tested in the laboratory on human corneas preserved in McCarey-Kaufman (M-K) medium. Excellent corneal buttons were produced using 7.5-and 8.0-mm trephine blades, but trephination quality was variable using 8.5 and 9.0 mm blades. Modification of the curvature of the punching well may improve the trephination quality with the larger trephine blades.
Endogenous Endophthalmitis With Lenticular Abscess Caused by Enterobacter Agglomerans (Erwinia Species)
Authors: Zeiter John H , Koch Douglas D , Parke David W , Font Ramon L
Published: April 2021

ABSTRACT

We report for the first time a case of metastatic endophthalmitis caused by the gram-negative organism Enterobacter agglomerane (Erwinia species). One day following internal hemorrhoidal ligation, the patient developed anterior uveitis that progressed to panophthalmitis with a lenticular abscess and a necrotic retina. Despite aggressive surgery and appropriate antibiotic therapy, the affected eye lost useful vision.
Use of a Scalp Vein Infusion Set in Oculoplastic Surgery
Authors: Custer Philip L
Published: April 2021

ABSTRACT

The scalp vein infusion set is a sterile, readily available device which has been used in a variety of oculoplastic procedures. Segments of the infusion tubing have been employed as bolsters for eyelid traction, tarsorrhaphy, and skin sutures. The tubing may also be placed in wounds for improved drainage. The material has enhanced postoperative wound care and has not been associated with significant complications.
A New Instrument for Surface Suction and Removal of Irrigation Fluid During Surgery
Authors: Hagan John C
Published: April 2021

ABSTRACT

A new instrument for removal of intraocular/extraocular irrigating solutions during eye surgery, based on modification of a miniature otologie suction device, is now commercially available.
Childhood Blindness: Dateline Africa
Authors: Kagame Kenneth , Schwab Larry
Published: April 2021

ABSTRACT

Prevalence rates of childhood blindness and infant and childhood mortality in Africa are the highest in the world. Major factors contributing to these high rates are similar for both blindness and mortality: malnutrition, measles and other acute febrile infections, malnutrition with xerophthalmia, and limited or poor access to preventive and curative health services. Because of high national growth rates, stagnant economies, and the failure of national health care systems to expand with rapidly growing populations, childhood blindness in Africa likely will remain a significant international public health problem for the foreseeable future.
Locating Cut Medial Canaliculi by Direct Injection of Sodium Hyaluronate into the Lacrimal Sac
Authors: Seiff Stuart R , Ahn James C
Published: April 2021

ABSTRACT

Locating the cut medial ends of canaliculi after trauma or surgery can be difficult. In cases of double canalicular or common canalicular lacerations, injection of sodium hyaluronate (Healon®) directly into the lacrimal sac may help pinpoint the medial openings.
Surgical Removal of Cyanoacrylate Adhesive After Accidental Instillation in the Anterior Chamber
Authors: Siegal Jeffrey E , Zaidman Gerald W
Published: April 2021

ABSTRACT

Cyanoacrylate adhesivas are frequently used to seal small corneal perforations. Their use has been limited, however, because of concern over their toxic effect on ocular structures. We describe a post-keratoplasty patient with a wound dehiscence that a surgeon had attempted to seal with cyanoacrylate glue. The glue was accidentally injected into the anterior chamber. After surgical reconstruction of the eye, however, no permanent ocular damage was observed.
Management of Pseudophakic Bullous Keratopathy
Authors: Morrison Linda K , Waltman Stephen R
Published: April 2021

ABSTRACT

The incidence of pseudophakic bullous keratopathy, now the most common indication for penetrating keratoplasty, is increasing. Since over one million intraocular lenses were implanted in 1986, a large number of eyes are at risk. The etiology of pseudophakic bullous keratopathy is varied and depends in great part on the surgical technique used for cataract extraction. Given the magnitude and changing patterns of intraocular lens usage, a review of pseudophakic bullous keratopathy is appropriate.
Proliferative Vitreoretinopathy: Does Oral Low-Dose Colchicine Have an Inhibitory Effect? A Controlled Study in Humans
Authors: Berman David H , Gombos George M
Published: April 2021

ABSTRACT

We investigated by means of a controlled prospective study, the effect of low dose oral colchicine (1.2 mg/day) on proliferative vitreoretinopathy (PVR) in humans. The PVR cases studied included ones associated with proliferative diabetic retinopathy, sickle retinopathy, trauma, and by venous occlusive disease. Applying Sandler's A statistic for correlated samples, we found no statistically significant difference between the results achieved in the colchicine group and those in the control group (vitamin C, 250 mg/day orally). We conclude that safe dosages of this drug do not significantly inhibit PVR.
The Use of Cyanoacrylate Adhesive With a Collagen Shield in Leaking Filtering Blebs
Authors: Weber Paul A , Baker N Douglas
Published: April 2021

ABSTRACT

We describe our technique for sealing leaking filtering blebs with cyanoacrylate adhesive, using a collagen shield to cover the adhesive. We believe the shield makes the patient more comfortable and decreases the likelihood of dislodgement of the adhesive.
Axial Length and the Average Ophthalmologist-Is Biometry Worthwhile?
Authors: Story Paul G , Wiesner Paul D
Published: April 2021

ABSTRACT

The refractive predictability of 477 lens implants with powers calculated using biometric data and lens power formulas was reviewed and compared with postoperative refractions that would have been expected had standard power lenses been implanted. Eighty-nine percent of the calculated lenses were within 1.25 diopters and 98% were within 2.00 D of the desired refractions. Fifty-two percent and 73% of the standard lenses would have yielded these respective degrees of accuracy. Eyes grouped according to preoperative refractive error and those for which emmetropia or emetropia was predicted were similarly compared with similar results for all groups. The calculated lenses consistently provided better post-operative refractive predictability than could have been achieved with standard lenses.
An Evaluation of Three Surgical Approaches for Coexisting Cataract and Glaucoma
Authors: Murchison J Franklin , Shields M Bruce
Published: April 2021

ABSTRACT

Seventy-eight eyes of 69 patients with coexisting cataract and glaucoma underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation by one surgeon. A combined guarded filtering procedure was performed in 22 of these cases, and a two-stage procedure filtering surgery followed by cataract extraction was performed in 22 more. Cataract surgery alone was performed in the remaining 34. Since different criteria were used for selecting one of these three surgical approaches, and since baseline values in the three groups were not comparable, the significance of the results is limited. Observations of possible clinical significance, however, include the following: there were fewer early postoperative intraocular pressure rises associated with the combined procedures than were associated with cataract surgery alone, but there was an otherwise relatively lower complication rate in the latter group. AH three groups had similar final intraocular pressures, although eyes undergoing the two-stage procedure, having had higher baseline pressures than those in the other two groups, had a higher percentage pressure reduction.
Blindness Following Retrobulbar Anesthesia for Astigmatic Keratotomy
Authors: Jindra Lawrence F
Published: April 2021

ABSTRACT

Retrobulbar anesthesia has become the most common form of anesthesia used in ophthalmic surgery. Acute blindness is a rare but known complication of retrobulbar anesthesia given for intraocular surgery. I report a case of acute, permanent blindness caused by direct trauma to the optic nerve when retrobulbar anesthesia was used for an astigmatism correction procedure. Complications, sometimes probably too incidental or insignificant to be noticed, probably occur far more frequently than a review of the literature would indicate. Using dull shorter needles, proper eye positioning, and injection technique will minimize risk of injury to the optic nerve. Another alternative under review is the use of peribulbar anesthesia. Perhaps the best way to prevent a complication from a retrobulbar injection, however, is to carefully and judiciously consider whether any injection at all is needed.
A Modification of the Use of the Glaucoma Tamponade Shell
Authors: Joiner D Wade , Liebmann Jeffrey M , Ritch Robert
Published: April 2021

ABSTRACT

Filtering surgery may be complicated by excessive filtration or bleb leak in the postoperative period, resulting in a shallow or flat anterior chamber and choroidal detachment. A glaucoma tamponade shell with a raised inner platform increases the resistance to flow through the fistula, deepening the anterior chamber. Some surgeons apply a pressure patch over the shell to increase the tamponading effect and to prevent rotation of the shell. Nevertheless, the shell may still rotate, resulting in less than adequate tamponade. We describe a technique that prevents rotation of the shell.
Punctal and Vertical Canaliculus Lacerations
Authors: Hurwitz Jeffrey J , Corin Scott M , Tucker Susan M
Published: April 2021

ABSTRACT

We report a patient with a rare form of laceration through the lower punctum, vertical canaliculus, ampulla, and lower eyelid. A modification of a standard canalicular laceration repair involving the use of silk stent in the canalicular system is described.
Cyanoacrylate Temporary Tarsorrhaphy in the Management of Corneal Epithelial Defects
Authors: Donnenfeld Eric D , Perry Henry D , Nelson David B
Published: April 2021

ABSTRACT

Cyanoacrylate tarsorrhaphy is an easily administered, painless technique for the temporary management of corneal epithelial defects. We have used the technique in 17 patients to treat persistent epithelial defects and exposure keratitis, as well as following epikeratophakia, allowing the tarsorrhaphy to remain in place for 1 to 15 days (mean, 5.7 days). Eleven of the 17 patients required only one application of Cyanoacrylate; five had additional Cyanoacrylate applied at the time of the original tarsorrhaphy to produce more extensive lid closure; and one required additional Cyanoacrylate on day 3 to produce more extensive lid apposition.
Optical Principles Related to Optimizing Sclerostomy Procedures
Authors: Fankhauser Franz , Dürr Ulrich , England Ceri , England Ceri , Kwasniewska Sylwia , Van der Zypen Eugen , Henchoz Pierre-David
Published: April 2021

ABSTRACT

A simple probe, consisting of a 200-micrometer uncladded silica optical fiber, advanced from a protecting 22-gauge hypodermic needle, was used to create sclerostomy fistulas both ab interno and ab externo by means of a combined radiation/ mechanical effect. Perforation was achieved by exerting gentle forward pressure on the fiber in synchrony with the delivery of radiation pulses. An irradiation protocol suitable for producing such canals in cadaver porcine eyes was delineated using Ho:YAG, Nd:YAG, and diode laser energy sources. Despite significant differences in the pulse energy required for perforation (0.25, 7, and 8 J for the Ho:YAG, diode, and Nd: YAG lasers, respectively), the extent of collateral damage was comparable for each type of laser. The physical mechanisms underlying these findings are discussed.
Histologic Differences in the Conjunctiva of Black and White Glaucoma Patients
Authors: McMillan Tod A , Stewart William C , Hennis Hugh L , Hunt Hurshell H , Apple David J
Published: April 2021

ABSTRACT

We compared perioperative conjunctival biopsy specimens from 31 consecutive trabeculectomy patients to determine If there were any histologic differences between black and white glaucoma patients. We found a statistically significantly greater mean and distribution of mast cells and neutrophils in the white patients. No significant difference was found in the mean number of goblet cells, eosinophiles, macrophages, fibroblasts, plasma cells, or lymphocytes; or in thickness of the epithelium, vascular density, or collagen or mucopolysaccharide staining. We conclude that histological conjunctival factors that could be evaluated preoperative^ probably are not related to the poor results in black patients of filtration surgery noted by some investigators.
Limiting Applications of Cryotherapy for Severe Retinopathy of Prematurity
Authors: Spencer Rand , Hutton William L , Snyder William B , Fuller Dwain G , Fish Gary E , Vaiser Albert , Jost Bradley F
Published: April 2021

ABSTRACT

In an effort to minimize surgical and visual morbidity of cryotherapy for retinopathy of prematurity (ROP), 18 eyes of 13 patients with 3 to 7 clock hours of stage 3 ROP with "plus" disease were treated by cryotherapy applications limited to the avascular retina adjacent to the areas of stage 3 disease. In 17 of 18 eyes, this limited use of cryotherapy was sufficient to cause regression of ROP without further treatments. After at least 3 months follow-up, ROP outcome showed a normal macular appearance in 16 eyes; two eyes developed macular dragging; no retinal detachments occurred.
Using High-Frequency Ultrasound to Characterize Intraocular Foreign Bodies
Authors: Nouby-Mahmoud Gamal , Silverman Ronald H , Coleman D Jackson
Published: April 2021

ABSTRACT

We scanned uniformly-sized particles of brass, aluminum, glass, and plastic at ultrasonic frequencies of 10 and 50 MHz to determine the effects of material type and transducer frequency on the ultrasonographic appearance of these particles. The particles were scanned in vitro against both anechoic and echoic backgrounds and in vivo, implanted in the angle of rabbit eyes. Both the metals and glass produced reverberations against an anechoic background; the plastic particles appeared as discrete objects, with no reverberations. Against an echoic background, the plastic particles created prominent shadows, while the metal ones did not. When placed in the angle of a rabbit eye, with the exception of the plastic at 10 MHz, all the materials could be differentiated from surrounding tissues at both frequencies. However, the appearance of the foreign body and the surrounding tissues, as well as their exact location and size, were most obvious with the 50-MHz system. In general, the particles produced more reverberations at 10 than at 50 MHz, and more prominent shadowing at 50 than at 10 MHz. In summary, high-frequency imaging enabled superior characterization of all the particles.
Wound Healing Modulation in Glaucoma Filtration Surgery
Authors: Costa Vital P , Spaeth George L , Eiferman Richard A , Orengo-Nania Silvia
Published: April 2021

ABSTRACT

In some cases, modulation of wound healing, in association with glaucoma filtration surgery, results in lower postoperative intraocular pressures than would occur without such therapy. Treatments affecting wound healing increase the likelihood of achieving long-term filtration, especially in eyes with a poor surgical prognosis.

After summarizing the wound-healing process following filtration procedures, we review the mechanism of action, the effectiveness, and the complications associated with some of the most commonly used wound healing inhibitors and then discuss new alternatives currently under investigation. Although much progress has been made, the challenge remains to develop new drugs or combinations of drugs that are less toxic and can yield more predictable results.
Subconjunctival THC:YAG Laser Sclerostomy for the Treatment of Glaucoma: Preliminary Data
Authors: Bonomi Luciano , Perfetti Sergio , Marraffa Michele , Bellucci Roberto , Baravelli Stefano , Casata Annamaria
Published: April 2021

ABSTRACT

A subconjunctival thermal sclerostomy was performed using the recently developed THC:YAG laser in 33 eyes with a variety of glaucomas in which, in most cases, neither medical therapy nor previous procedures had been successful in controlling intraocular pressure (IOP). The mean preoperative IOP was 27.5 ± 7,5 mm Hg with maximum medication. The laser procedure was quick and easy, with minimal manipulation of tissues; complications were clinically insignificant. The day after the operation, 23 eyes had an IOP less than 18 mm Hg; in the other 10, it was unchanged. In most of the eyes, an obvious filtering bleb developed at the site of the sclerostomy. The internal opening of the sclerostomy was visible on gonioscopy, except in five cases, in which it was plugged by a fold of the iris root. One year after the operation, IOP was controlled in three eyes without medication and in 18 with medication. IOP remained uncontrolled in the remaining 12 eyes.
The Efficacy of cw Nd:YAG Laser Trabeculoplasty
Authors: Kwasniewska Sylwia , Fankhauser Franz , Larsen Søren E , Cruz-Orive Luis M
Published: April 2021

ABSTRACT

The long-term (mean follow up, 51 weeks) efficacy of cw Nd:YAG laser trabeculoplasty in reducing intraocular pressure (IOP) was studied in 106 eyes of 75 patients. Fifty patients (73 eyes) of this group had primary open-angle glaucoma; 11 (17), mixed glaucoma; 10 (12), pseudoexfoliation syndrome; and 4 (4), secondary glaucoma of varied etiology. Fifty laser impacts were delivered over 180° of the circumference of the chamber angle with an Nd: YAG laser working in the cw mode (spot diameter, 100 µ,p?; exposure duration, from 200 to 300 milliseconds; constant power level, 9 W, resulting in 1.8 to 2.7 J/pulse and a total energy dose/session of 90 to 135 J). In a few cases, an exposure duration of 400 milliseconds was used, corresponding to a pulse energy of 3.6 J/pulse and a total energy dose/session of 180 J.

Success was defined as a reduction in IOP to 22 mm Hg or less without any further laser or surgical intervention. The cumulative success rate was 97.2% at 1 month, 93.3% at 3 months, 83.3% at 6 months, 78.7% at 12 months, and 71.5% at 24 months. Thus, the efficacy of cw Nd: YAG laser trabeculoplasty is comparable to that reported for trabeculoplasty performed using the argon laser (ALT), the Nd:YAG laser working in the free-running mode, and the diode laser. Biomicroscopy failed to reveal any serious inflammatory reactions persisting longer than 1 week. We conclude that cw Nd: YAG laser trabeculoplasty is a safe and effective alternative to ALT.
Pasteurella multocida Keratitis and Corneal Laceration from a Cat Scratch
Authors: Ho Allen C , Rapuano Christopher J
Published: April 2021

ABSTRACT

A 24-year-old woman was evaluated 12 hours after she sustained a cat scratch to her left eye. Slit-lamp examination revealed a Seidel-positive corneal laceration with a surrounding dense full-thickness corneal ulcer and severe inflammatory reaction. Since the anterior chamber was well formed, it was decided not to repair the laceration on an emergency basis. She was initially treated with intensive topical fortified tobramycin and vancomycin, and intravenous gentamicin and clindamycin. Cultures of the corneal ulcer revealed Pasteurella multocida and the antibiotic regimen was adjusted appropriately. The laceration healed without surgery, and the infection resolved well, with excellent visual acuity.
Heterologous Cartilage in Sandwich Lower Lid Reconstruction
Authors: Steinkogler F J
Published: April 2021

ABSTRACT

Postoperative healing in 15 patients in which Chondroplast®, a heterologous irradiated bovine cartilage preparation, was used in conjunction with the "sandwich technique" to replace form-defining and supporting intrapalpebral lamella in connection with treatment of palpebrai tumors, was uncomplicated, with no rejection to date.
Size of the Lens Nucleus Separated by Hydrodissection
Authors: Ayaki Masahiko , Ohde Hisao , Yokoyama Noriko
Published: April 2021

ABSTRACT

We measured the extracted central nucleus (diameter and thickness) of 88 eyes (average patient age, 72 years) undergoing extracapsular cataract extraction (ECCE). The average diameter was 6.51 ± 0.75 mm; the average thickness, 2.96 ± 0.33 mm. Since the average lens diameter is approximately 10 mm, a corneoscleral incision of 7 to 8 mm in chord length should be sufficient for its removal in most ECCE cases. Accumulation of these data and further analysis correlating them with age and degree and type of cataract in larger series will be useful in determining the smallest possible incision size required for individual patients.
The Lower-Lid Retractors in Congenital Entropion and Epiblepharon
Authors: Jordan R
Published: April 2021

ABSTRACT

A case of congenital entropion is presented in which the lower-lid crease was lost during entropion surgery, yielding a postoperative condition resembling an epiblepharon. The case suggests that deficiencies in the lower-lid retractor fibers are a key factor in the pathogenesis of both congenital entropion and epiblepharon.
Lamellar Flap Corneal Biopsy
Authors: Hwang David G
Published: April 2021

ABSTRACT

A modified technique of corneal biopsy is described that allows a lesion in the deep corneal strema to be accessed for scraping or biopsy while sparing the stromal tissue anterior to the lesion. This technique may be especially valuable in cases of deep corneal pathology in which traditional methods of corneal biopsy risk excessive removal of tissue, which, in turn, can lead to complications such as thinning or perforation.
Wedge Resection for Postkeratoplasty Astigmatism
Authors: Frucht-Pery Joseph
Published: April 2021

ABSTRACT

Twelve patients underwent a modified wedge resection after keratoplasty; 11 of them were followed for 6 to 24 months. The average preoperative astigmatism was 15.40 diopters (range, 12.50 to 22.00 D). The wedge was resected from the donor side and the wound dosed with 10-0 or 11-0 Mersilene sutures. Postoperatively, the average astigmatism was 4.36 D (range, 1.50 to 9.00 D), and the visual acuity, corrected with spectacles, was 20/40 or better in five cases (45%). Complications included high residual astigmatism or irregular astigmatism and extensive scarring due to the use of Mersilene sutures. Overall, modified resection of the wedge is an effective technique for managing postkeratoplasty high astigmatism.
Suture Use in Pediatric Cataract Surgery: A Survey
Authors: Lavrich Judith B , Goldberg David S , Nelson Leonard B
Published: April 2021

ABSTRACT

Many different sutures have been advocated for use in closing the corneoscleral incision during cataract surgery· We surveyed 354 North American pediatrie ophthalmologists to find out the type of suture they use for pediatrie cataract surgery and any associated complications. Of the sutures indicated in the 244 (69%) surveys returned, 10-0 nylon sutures were the most popular choice despite a relatively large number of related complications and the occasional need for general anesthesia to remove them.
Histopathology of Argon Laser Peripheral Iridoplasty
Authors: Sassani Joseph W , Ritch Robert , McCormick Steven , Liebmann Jeffrey M , Eagle Ralph C , Lavery Kevin , Koster Harry R
Published: April 2021

ABSTRACT

We report the light and electron microscopic findings from two eyes treated with argon laser peripheral iridoplasty (ALPI) for bilateral angle-closure glaucoma. The patient, a 45-year-old man, died from complications of acquired immunodeficiency syndrome 16 days following ALPI. Ocular pathologic findings included contraction furrow formation and proliferation of fibroblast-like cells, accompanied by collagen deposition on the iris surface, denaturation of stromal collagen, and coagulative necrosis of blood vessels within the anterior two thirds of the iris stroma. These findings suggest that heat shrinkage of collagen may be responsible for the short-term response to ALPI, and that contraction of the fibroblastic membrane may be responsible for its long-term effects. Additionally, the presence of coagulative necrosis of iris blood vessels suggests that overttreatment may result in iris necrosis. To our knowledge this is the first report of the histopathology of ALPI.
Surface Morphology Following Photorefractive Keratectomy
Authors: Campos Mauro , Trokel Stephen L , McDonnell Peter J
Published: April 2021

ABSTRACT

To examine the effects of surface dehydration on corneal surface morphology before and after photorefractive keratectomy, corneas of fresh porcine eyes were deeprthelialized and then immediately fixed or treated according to one of six protocols (four eyes per protocol): dehydrated under the illumination of an operating microscope; dehydrated and then rehydrated with topically applied balanced salt solution; photorefractive keratectomy; photorefractive keratectomy followed by surface dehydration; or photorefractive keratectomy followed by dehydration and subsequent rehydration.

Surface smoothness (S) was measured with an image analysis system. The surfaces of the unablated corneas were smooth (S = 0.992 ± 0.002), and dehydration did not significantly (P = .7) influence the morphology. After ablation, dehydration resulted in apparent fragmentation of the superficial lamellae, with consequent roughening of the surface (P = .0001). Rehydration was only partially successful in reducing surface irregularity. We conclude that corneal dehydration during and following photorefractive keratectomy roughens the corneal surface and should be carefully avoided.
Simplifying Scleral Fixation of Posterior Chamber Intraocular Lenses
Authors: Guimarães Fernando Cenci , Stabile Sebãstiao R , e Cruz Antonio Augusto Velasco
Published: April 2021

ABSTRACT

We describe a surgical modification for primary scleral fixation of posterior chamber intraocular lenses. The technique keeps intraocular surgical manipulation at a minimum and allows fixation of the lens during accidental rupture of the posterior lens capsule.
Tenonplasty: A New Surgical Approach for the Treatment of Severe Eye Burns
Authors: Kuckelkorn Ralf , Redbrake Claudia , Reim Martin
Published: April 2021

* BACKGROUND AND OBJECTIVE: In the acute stage of most severe eye burns, the primary goal is survival of the globe. Initial tissue destruction may lead to extensive necrosis of the conjunctiva and underlying tissue down to the fornices, with resulting ischemia. These circumstances may cause a polymorphonuclear cell response, with resulting corneo-scleral ulceration and early melting of the globe. To reestablish the ocular surface, Tenonplasty was performed as a plastic procedure to reconstruct the conjunctival matrix of the globe up to the limbus.

* PATIENTS AND METHODS: Vital Tenon's sheets from the orbital region were prepared and advanced up to the limbus to cover the ischemic or ulcerating sclera with healthy, vascularized tissue. Fifty-nine patients with 75 severely burned eyes were treated with this procedure between 1987 and 1994. A total of 243 Tenon's flaps were prepared.

* RESULTS: In all cases, scierai ulcerations were prevented or healed. Epithelialization of the advanced Tenon's sheets was complete within 21 days in 80% of the cases and in all eyes within 54 days. Primary epithelialization of the burned cornea was achieved in approximately 31% of the cases. Fornices were sufficiently deep in about 74%, but severe symblepharon formation occurred in 26% of the cases.

* CONCLUSION: Tenonplasty may be an alternative surgical procedure to transplantation of autologous conjunctival or mucous grafts in restoring the conjunctival surface of the globe in severely burned eyes.

[Ophthalmic Surg Lasers 1997;28:105-110.]
Endoscopic Diode Laser Cyclophotocoagulation With a Limbal Approach
Authors: Mora J S , Iwach A G , Gaffney M M , Wong P C , Ngungen N , Ma S A , Dickens C J
Published: April 2021

* BACKGROUND AND OBJECTIVE: Endoscopie diode laser Cyclophotocoagulation with a limbal approach was reviewed retrospectively. The delivery system and procedure used as well as the role of this procedure in the management of glaucoma are discussed.

* PATIENTS AND METHODS: An 810-nm pulsed continuous-wave diode laser capable of 1 .2-W output was used. The maximum treatment area is 7 to 8 clock hours with a single limbal incision. Generally, 800 mW were used for less than 1 second, for a total of 0.8 J per treatment.

* RESULTS: Eight eyes of 6 patients were treated. The mean follow-up time for each procedure was 3.2 months (range 1 to 8 months) and for each eye was 5.1 months (range 2 to 8 months). Pre- and postoperative intraocular pressures were determined. Postoperative inflammation was the most common complication.

* CONCLUSION: One reason for the failure of transscleral Cyclophotocoagulation, particularly in congenital glaucoma, may be displacement of the ciliary processes. This displacement does not permit the indirect treatment to reach the appropriate area. Because endoscopie laser Cyclophotocoagulation allows direct visualization, treatment can be accurately applied to individual ciliary processes.

[Ophthalmic Surg Lasers 1997;28:1 18-123.]
Fibrin Sealant in the Management of Complicated Hypotony After Trabeculectomy
Authors: Grewing Ralf , Mester Ulrich
Published: April 2021

* BACKGROUND AND OBJECTIVE: In the postoperative course of trabeculectomy, hypotony may cause choroidal detachment with shallowing of the anterior chamber. If conservative medical treatment fails, a surgical revision may become necessary. To achieve only a temporary seal of the scierai flap, a subconjunctiva! tamponade with fibrin glue was performed.

* PATIENTS AND METHODS: Two patients with corneal decompensation as a result of cornea-lens contact complicating hypotony with massive choroidal detachment are described. Hypotony occurred after trabeculectomy in one case and after combined cataract and glaucoma surgery in another case, and was not correlated to a leaking bleb. Temporary tamponade of the scierai flap was achieved by subconjunctival injection of fibrin sealant.

* RESULTS: After the fibrin sealant was applied, the choroidal detachment resolved and intraocular pressure increased to normal. During the follow-up period of 6 months, a functioning bleb developed.

* CONCLUSION: Subconjunctival application of fibrin sealant is effective for temporary closure of the scierai flap after trabeculectomy in eyes with massive hypotony syndrome.

[Ophthalmic Surg Lasers 1997;28:124-127.]
Vitrectomy for Endogenous Klebsiella pneumoniae Endophthalmitis With Massive Subretinal Abscess
Authors: Yarng Shahng-Shiarng , Hsieh MD Chia-Ling , Chen Tun-Lu
Published: April 2021

Abstract. A 39-year-old man with pyogenic liver abscess had bilateral endogenous Klebsiella pneumoniae endophthalmitis. At presentation, the left eye had a localized subretinal abscess. Despite repeated intravitreal amikacin and dexamethasone injections, a subretinal abscess spread and detached all of the retina. Pars plana vitrectomy with drainage of the subretinal abscess was performed. The retina was reattached, and the patient had 5/200 vision 5 months postoperatively. Early vitrectomy with drainage of the subretinal abscess may save some eyes with endogenous Klebsiella pneumoniae endophthalmitis. [Ophthalmic Surg Lasers 1997;28:147-150.]
Clinicopathologic Features and Surgical Management of Dissecting Glaucoma Filtering Blebs
Authors: Ulrich George G , Proia Alan D , Shields M Bruce
Published: April 2021

Abstract. Three patients are described in whom fullthickness glaucoma filtering procedures were complicated by marked extension of the bleb over the cornea, with subsequent symptoms that required surgical intervention. The surgical management in each case involved blunt dissection of the bleb from the cornea, with revision of the remaining portion of the bleb differing in each case according to the intraoperative findings. Light microscopic examination of one surgical specimen revealed a markedly attenuated epithelium covering hydropic corneal stroma. The authors postulate that the mechanism of formation involves aqueous humor dissection between corneal epithelium and stroma, leading to abnormal hydration of the superficial lamellae. [Ophthalmic Surg Lasers 1997; 28:151-155.]
Peter's Anomaly: Diagnosis by Ultrasound Biomicroscopy
Authors: Haddad Andre M , Greenfield David S , Stegman Zeev , Liebmann Jeffrey M , Ritch Robert
Published: April 2021

Abstract. Peter s anomaly is a congenital corneal disorder characterized by a central leukoma and adhesions at the periphery of the corneal opacity. A 35-year-old man presented for clinical evaluation of suspected sclerocornea. High-resolution ultrasound biomicroscopy revealed iridocorneal adhesions throughout the anterior segment, a shallow anterior chamber, and abnormal hyper-reflectivity along the posterior corneal surface. Through ultrasound biomicroscopy, characteristics of Peter's anomaly were recognized, and a diagnosis was established. This case illustrates how ultrasound biomicroscopy aids in the clinical differentiation between Peter's anomaly and other causes of congenital corneal opacification. [Ophthalmic Surg Lasers 1997;28:311-312.]
New Ophthalmic Manifestations of Presumed Rifabutin-Related Uveitis
Authors: Arevalo J Fernando , Russack Valentina , Freeman William R
Published: April 2021

Abstract. Rifabutin-related uveitis has been reported in AIDS patients who take a daily dose of 300 to 1800 mg of this drug. Presumed rifabutin-related uveitis is characterized by unilateral or bilateral anterior chamber inflammation with hypopyon accompanied by hyperemia, pain, photophobia, and vitritis. However, retinal manifestations or vitreous cytology of this entity have never been reported. This report describes a patient who had retinal vascular changes associated with uveitis while being treated with oral rifabutin. Fundus photographs and fluorescein angiograms documented resolved retinal vasculitis. Vitreous cytology of this case showed acute inflammatory cells. To the authors' knowledge, this is the first report of retinal vasculopathy in a patient with rifabutin-related uveitis and the first analysis of the vitreous cytologic aspects of this disease. [Ophthalmic Surg Lasers 1997;28:321-324.]
Bimedial Rectus Recession Using the Anchored Hang-Back Technique
Authors: MacLeod J D Alexander , Rhatigan Maire C , Luff Andrew J , Morris Robert J
Published: April 2021

Abstract. Hang-back recession of a rectus muscle offers several advantages over conventional techniques: a reduced risk of scleral perforation, easy intraoperative adjustment, and a convenient site for suturing to the sclera. There are also disadvantages: the muscle tends to collapse, thereby increasing the effective recession and making the result less predictable. In addition, the insertion cannot accurately be displaced upward or downward, as may be required to correct A- and V-patterns, or vertical deviations. The authors describe a modified technique, an anchored hang-back recession, and discuss the results in 60 consecutive cases of bimedial rectus recession. [Ophthalmic Surg Lasers 1997;28:343-346.]
Capsule Excision After Failed Molteno Surgery
Authors: Välimäki Juha , Tuulonen Anja , Airaksinen P Juhani
Published: April 2021

* BACKGROUND AND OBJECTIVES: To determine the frequency of scar tissue formation requiring surgical intervention after single-plate Molteno implantation and the outcome of excision of the encapsulated bleb.

* PATIENTS AND METHODS: A retrospective study was performed on 95 eyes of 79 consecutive patients who underwent a single-stage Molteno implantation for refractory glaucoma. Fourteen eyes of 12 patients developed an encapsulated bleb. A successful outcome after bleb excision was defined as final intraocular pressure (IOP) between 6 and 22 mm Hg with the same amount of medication as preoperatively or less.

* RESULTS: At the end of the mean follow-up of 30 months (range 8 to 75), the mean IOP (19.7 ± 3.8 mm Hg) after bleb excision was significantly lower than the preoperative IOP (35.2 ± 10.1 mm Hg; P < .001). The overall conventional success rate was 75%.

* CONCLUSION: Excision of the encapsulated Molteno bleb offers an alternative in severely damaged eyes that have undergone several surgical procedures.

[Ophthalmic Surg Lasers 1997;28:382-386.]
Human Dura Mater as a Wrapping Material for Hydroxyapatite Implantation in the Anophthalmic Socket
Authors: Lee Sang Y , Kim Hye Y , Kim Sung J , Kang Shin J
Published: April 2021

Abstract. Homologous sclera and autologous fascia lata have been accepted as common wrapping materials for hydroxyapatite implantation; however, various problems have been observed, such as the risk of transmittable diseases such as AIDS or hepatitis. This report details the use of cadaver dura mater to wrap hydroxyapatite implants. For 73 eyes of 73 patients with hydroxyapatite implantation, cadaver dura mater was used to wrap the hydroxyapatite after enucleation or secondary implantation. Of the 73 patients, 20 had conjunctival erosion; however, all of the patients but 1 healed spontaneously within an average of 22 days. Only 1 of the 73 patients progressed to implant exposure requiring a dermis graft. The authors suggest that cadaver dura mater is a suitable wrapping material for hydroxyapatite implantation. [Ophthalmic Surg Lasers 1997;28:428-431.]
Surgical Revision of Glaucoma Shunt Implants
Authors: Tsai James C , Grajewski Alana L , Parrish Richard K
Published: April 2021

* BACKGROUND AND OBJECTIVE: To deter mine the efficacy of surgical revision of glaucoma shunt implants in patients with advanced glaucoma.

* PATIENTS AND METHODS: The records of 13 patients who underwent revision of their shunt implants were retrospectively reviewed.

* RESULTS: Surgical success was achieved in: 3 of 3 patients (100%) with drainage tube malposition or extrusion; 1 of 6 patients (17%) with occlusion of the intracameral portion of the drainage tube; and 1 of 4 patients (25%) with elevated intraocular pressure secondary to fibrous capsule formation over the implant.

* CONCLUSIONS: Surgical revision of glaucoma shunt implants is a useful procedure in patients who develop tube malposition or extrusion. Surgical revision is much less effective in patients with tube occlusion or fibrous capsule formation. Failure of the shunts due to recurrent fibrosis is commonly observed.

[Ophthalmic Surg Lasers 1999; 30: 41-46]