bluuebunny/crossref_metadata_2025 huggingface dataset:
Modifications of the Glaucoma Drainage Implant To Prevent Early Postoperative Hypertension and Hypotony: A Laboratory Study
Authors: Brooks Steven E , Dacey Mark P , Lee Martha B , Baerveldt George
Published: April 2021

ABSTRACT

Hypotony or hypertension in the early postoperative period following implantation of a nonvalved seton such as the Molteno tube is a common problem. We conducted a laboratory investigation evaluating two modifications of the silicone drainage tube. One involved a longitudinally-oriented, pressure-sensitive slit-valve combined with an absorbable occluding ligature interposed between the valve and the episcleral plate. Experiments examining the relationship between slit length, opening pressure, and flow rate were performed. The second modification involves focally constricting the lumen of the tube with an external ligature in order to reduce flow rates. Our results indicate that a slit-valve length of 2.0 mm appears to provide a reliable opening pressure of around 10 mm Hg, with relatively high flow when pressures exceed opening pressure. Focally constricting the lumen of the tube, however, was shown to be both unpredictable and unsatisfactory for reducing the flow of fluid to a range consistent with steady state aqueous production.
The Efficacy of Cyclosporin-A in the Treatment of Behçet's Disease
Authors: Atmaca Leyla S , Batioglu Figen
Published: April 2021

ABSTRACT

We used cyclosporin A (CA) to treat 14 patients (25 eyes) with Behçet's disease characterized by severe retinal vasculitis and active intraocular inflammation. All of the patients had been treated previously with corticosteroids, colchicine, and immunosuppressives, without satisfactory results. The patients were given an initial oral dose of 5 mg/kg/day. All medication was tapered and eventually completely stopped after 12 months. The number and severity of ocular attacks (anterior and/or posterior uveitis with vitreous haze) were significantly reduced below pretreatment levels during therapy (Kolmogorov Smirnov two-pair test: P < .05). Visual acuity improved in 32% and remained unchanged in 44%. No ocular attacks recurred in 11 eyes; they recurred 1 time in 8 eyes; 2 times in 3 eyes; and 3 times in 3 eyes during CA therapy. There were no significant changes in the level of retinal vasculitis. In two cases with vasoobstructive changes, treatment with CA was not effective and laser photocoagulation was performed.

Based on our study, we recommend that an initial dose of 5 mg/kg/day CA be used in the systemic medical treatment of ocular Behçet's disease. The CA can be continued at this low dosage for an unspecified time. If intraocular inflammation does not totally resolve at this dosage or the inflammatory process recurs, combining the CA with low doses of a steroid should be considered.
En Bloc Capsulectomy in the Diagnosis and Treatment of Refractory, Chronic, Recurrent Pseudophakic Endophthalmitis
Authors: Thach Allen B , Das Arup , Lopez Pedro F
Published: April 2021

ABSTRACT

Anterior chamber and vitreous aspiration may fail to isolate a microorganism in chronic pseudophakic endophthalmitis. In some eyes, obtaining a portion of the central posterior lens capsule may assist in determining the infectious etiology of the endophthalmitis. We describe a technique by which the entire lens capsule and its internal contents are removed and cultured. This surgical method facilitated the isolation and eradication of the causative pathogen in a patient with chronic recurrent pseudophakic endophthalmitis that was diagnostically and therapeutical Iy refractory to previous vitrectomy, posterior capsutectomy, and intra vitrea! antibiotic injection.
Bubbles in the Bleb-Troubles in the Bleb? Molteno Implant and Intraocular Tamponade With Silicone Oil in an Aphakic Patient
Authors: Senn Peter , Büchi Ernst R , Daicker Basil , Schipper Isaak
Published: April 2021

ABSTRACT

A 14-year-old aphakic girl who had had previous bilateral glaucoma surgery with a Molteno implant underwent pars plana vrtrectomy and silicone-oil tamponade for proliferati ve- vitreoretinopathy retinal detachment in both eyes. The filtering bleb of the left eye was functional for 5 months before becoming available for histologie examination. We found numerous foreign-body granulomas coating the inner surface of the bleb, as well as intracellular and extracellular deposits of emulsified silicone oil in the wall of the bleb. In the fellow eye, the filtering bleb remained functional despite repeated vitreous surgery with silicone oil. Filtration in aphakic eyes with previous Molteno surgery and silicone-oil tamponade after vrtrectomy may continue normally for a prolonged period of time, although emulsified oil droplets likely will have accumulated in the bleb and become incorporated in its fibrous capsule.
Hypotonus Cyclodialysis Cleft Following Anterior Chamber Intraocular Lens Removal
Authors: Parnes Robert E , Dailey John R , Aminlari Ali
Published: April 2021

ABSTRACT

Inadvertent cyclodialysis cleft formation is a rare complication of intraocular surgery. We report a patient in whom a hypotonus cyclodialysis cleft developed following the removal of an anterior chamber intraocular lens. The cleft closed and the hypotony resolved after 1 month of topical atropine therapy.
Lamellar Keratoplasty Performed With a Corneal Scleral Button
Authors: Vrabec Michael P , Jordan Jeffrey J , Lawlor Peter P
Published: April 2021

ABSTRACT

Tissue for lamellar corneal surgical procedures is usually harvested from whole eyes. We describe a surgical technique for the rehabilitation of corneoscleral defects with lamellar keratoplasty in which the donor tissue is obtained from a preserved corneoscleral button instead of a whole globe. This technique is illustrated with a case involving the treatment of a limbal der mo id in a 26-month-old boy.
Transscleral Repair of Recalcitrant, Inadvertent, Postoperative Cyclodialysis Cleft
Authors: Metrikin David C , Allinson Richard W , Snyder Robert W
Published: April 2021

ABSTRACT

We present a patient with a cyclodialysis deft in whom, after established medical, laser, and initial surgical interventions had failed to close the cleft, we successfully used ab externo suture placement to appose and close it. Although we present only one case, we believe this procedure, which may be useful in pseudophakic and aphakic eyes, is easier to perform than previously described techniques.
Management of Retinal Detachment
Authors: Schepens Charles L
Published: April 2021

ABSTRACT

I present what, in my opinion, is the optimal technique of managing primary simple retinal breaks and retinal detachment. For the preoperative examination, I recommend indirect stereoscopic ophthalmoscopy with scierai depression. The macula and suspected small peripheral breaks are studied with the biomicroscope and a three-mirror contact lens. Retinal breaks without retinal detachment are treated with cryotherapy if they are located anteriorly; with laser photocoagulation if they are posterior. Breaks with frank detachment can be treated with Lincoff's balloon, a procedure I prefer over pneumatic retinopexy. Multiple retinal breaks and those associated with fairly extensive chorioretinal degeneration are best treated with a permanent scierai buckling, the various modalities of which, along with their indications, I discuss in some detail.
Mitomycin C as Adjunctive Therapy With Glaucoma Implant Surgery
Authors: Susanna Remo , Nicolela Marcelo Teixeira , Takahashi Walter Y
Published: April 2021

ABSTRACT

Twenty-one eyes of 21 patients with refractory glaucoma underwent glaucoma surgery involving placement of a modified Molteno implant and intraoperative application of mitomycin C. Sixteen eyes (76.2%) had an intraocular pressure (IOP) of 21 mm Hg or less after a mean follow up of 9.4 ± 6.4 months; additional medication was needed in six eyes. Major complications included early flat anterior chamber (42.9%), implant plate erosion (9.5%), tube erosion (4.8%), late hypotony (4.8%), tube-corneal touch (4.8%), and phthisis bulbi after choroidal hemorrhage (4.8%). Only one patient had a high IOP due to decreased filtration through the implant. These results suggest that glaucoma implant surgery with the adjunctive use of mitomycin C may be useful in eyes with refractory glaucoma.
Breaks in the Pars Plicata Following Surgery for Atopic Cataract
Authors: Katsura Hiroshi , Oda Hitoshi , Utsumi Yoshikazu
Published: April 2021

ABSTRACT

Two cases involving retinal detachment caused by breaks in the pars plicata of the ciliary body are presented. In both, retinal detachment developed following surgery for atopic cataract. The residual lens capsules contracted with evidence of fibrotic change. Nonpigmented ciliary epithelium appeared to have become detached and torn by traction through the zonules of Zinn.
Suprachoroidal Hemorrhage in Penetrating Keratoplasty
Authors: Price Francis W , Whitson William E , Ahad Khandaker A , Tavakkoli Hassan
Published: April 2021

ABSTRACT

Nine cases of intraoperative expulsive Suprachoroidal hemorrhage occurred in a series of 2011 consecutive penetrating keratoplasties (an incidence of 0.45%). In four cases, the complication was directly related to the anesthesia technique. The incidence of hemorrhage was 1.0% in the eyes with preoperative anterior chamber intraocular lenses (IOLs), an incidence significantly higher than for any other associated condition (P < .02). Four of the nine patients recovered a postoperative visual acuity of 20/70 or better We discuss reasons for the relatively high incidence of hemorrhage during penetrating keratoplasty; its occurrence in relation to the type of anesthesia used, prior intraocular surgery, types of surgery performed together with the penetrating keratoplasty,, and the presence of an anterior chamber IOL; and the risks introduced by hemorrhage in a fellow eye and by a previous hemorrhage in the same eye.
Calcein Fluorophotometry in Streptozocin-Induced Diabetic Rats
Authors: Golshani M Reza , Khoobehi Bahram , Peyman Gholam A , Aras Cengiz
Published: April 2021

ABSTRACT

Calcein was used in vitreous flu oro photometry (VF) to study the blood-retinal barrier (BRB) in rats with streptozocin-induced diabetes. Calcein was injected intravenously in 18 diabetic rats and sodium fluorescein (NaF) in 12 diabetic rats. VF was performed at 1, 2, 4, 6, 9, and 21 hours following the single injection in these diabetic rats; it was also performed at these times in 24 normal (control) rats. On another day, the same experiment was performed using NaF. There was no significant difference between the two dyes in the diabetic and nondìabetic rats at 1 hour. However, at 4 hours and at later measurement points, there was dye leakage into the vitreous, peaking at 9 hours; the leakage was significantly greater in the diabetic rats. Also, the leakage was significantly greater with calcein than it was with NaF. The data demonstrate that calcein circulates longer and at higher levels than NaF and thus is probably more useful for BRB integrity studies.
Postoperative Intraocular Pressure Changes With Use of Different Viscoelastics
Authors: Dada Vijay K , Sindhu Narottama , Sachdev Mahipal S
Published: April 2021

ABSTRACT

Sixty eyes with age-related cataract underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC-IOL) implantation under similar conditions using hydroxypropyl methylcellulose (HPMC) (Oculose) (n = 20), sodium hyaluronate (Healon) (n = 20), or hyaluronic acid (IAL) In = 20) as the viscoelastic (VE). Postoperative evaluation was performed for intraocular pressure OOP), corneal thickness, and anterior chamber reaction at 6, 24, 48, 72 hours, and 10 days. Statistically-significant rises in IOP with IAL and Healon were observed at 6 and 24 hours; no such rises were observed with Oculose (P < .05). Seven eyes in the IAL group and six in the Healon group had IOPs greater than 22 mm Hg at 6 hours (range: 22 to 38 mm Hg and 22 to 28 mm Hg, respectively). A significant increase in average corneal thickness was observed in all of the 60 patients at 6 hours (18.5%). The average thickness decreased to 6.8% by day 10, with no intergroup variations. There were significantly fewer anterior chamber cells at 6 hours in the Healon group. We conclude that all three viscoelastics are equally useful for routine ECCE with PC-IOL implantation. However, IAL and Healon do cause an early postoperative IOP increase, which, though transient, should be treated.
The Conjunctival Wart: Report of a Case and Review of Treatment Options
Authors: Miller Daniel M , Brodell Robert T , Levine Mark R
Published: April 2021

ABSTRACT

Human papillomavirus, a papovavirus, is the causative agent of all warts. There are at least 63 subtypes of this virus, certain ones of which are more likely to cause warts in particular locations or to be associated with malignancies. Over the last 6 years, HPV-6, HPV-1 1, and HPV-16 have been detected in both benign and malignant lesions of the conjunctiva. We report a patient with a large viral papilloma of the palpebrai conjunctiva of the right lower eyelid. This case demonstrates that even very large viral papillomas can be treated successfully.
Pars Plana Fixation of Posterior Chamber Intraocular Lenses
Authors: Teichmann Klaus D
Published: April 2021

ABSTRACT

Given the problems associated with iris-sutured and scleral-fixated intraocular lenses (IOLs), pars plana fixation might be a safer and more effective approach. Significant improvements in lens design and materials, and changes in surgical approach and technique may now make pars plana fixation an attractive alternative. As contrasted with Girard's technique (1981), the implant loops would not be incorporated (buried) into the scierai wall, nor would the IOL be inserted through the pars plana. Advantages of a pars plana fixation include the low risk of intraoperative and postoperative hemorrhage, and the chance of avoiding contact between the IOL, iris, and pars plicata, depending on the lens design. Only the nonpigmented inner layer of the pars plana would be in direct contact with the haptic of the IOL. Thus, pigment dispersion should not occur unless there is contact with the iris.
Air Pump for Retinal Detachment With Macular Hole
Authors: Takenaka Chiaki , Nakatake Junji , Ideta Hidenao , Shinagawa Kouichi , Watanabe Ken , Demizu Seiji
Published: April 2021

ABSTRACT

From 1984 to 1992, 128 eyes with substantial retinal detachment due to macular hole underwent vitrectomy at the ldeta Eye Hospital. In the first 76 eyes treated, air was injected by syringe after removal of the vitreous (group A); in the subsequent 52 eyes, air was injected by a pump while subretinal fluid was aspirated through the macular hole (group B). The rates of retinal reattachment after the first surgery were 63.2% in group A and 82.7% in group B (P<.05). Thus, using the air pump was more effective than air injection.
Chemosis Following Blepharoplasty: An Unusual Complication
Authors: Levine Mark R , Davies Rodger , Ross Joseph
Published: April 2021

ABSTRACT

We observed four cases of chemosis associated with otherwise uneventful four-lid blepharoplasty. These patients experienced postoperative conjunctiva! chemosis (without associated globe injection), varied types of congestion, subconjunctival hemorrhage, retrobulbar hematoma, or corneal involvement. Postoperatively, the patients were treated with some combination of patching, topical and/or systemic steroids, decongestant eye drops, and observation. Regardless of the treatment, the chemosis resolved by 5 months, without permanent complication. Probable causes were blockage of orbital or eyelid lymphatics and excessive cautery during surgery.
Respiratory Arrest After 0.75% Bupivacaine Retrobulbar Block
Authors: Castillo Alfredo , Lopez-Abad Consuelo , Macias Juana M , Diaz David
Published: April 2021

ABSTRACT

Respiratory arrest is an uncommon complication of retrobulbar anesthesia. We present a case in which it occurred following a 0.75% bupivacaine and 2% lidocaine retrobulbar block and analyze the possible causes. We conclude that the most important of these were the relatively high concentration and volume of the anesthetic and a faulty technique.
Trabecular Aspiration: Clinical Results of a New Surgical Approach to Improve Trabecular Facility in Glaucoma Capsulare
Authors: Jacobi Philipp C , Krieglstein Günter K
Published: April 2021

ABSTRACT

The main reason for elevated intraocular pressure (IOP) in glaucoma capsulare is secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The goal of this study was to evaluate the clinical results of "trabecular aspiration," a new surgical technique designed to improve trabecular facility in pseudoexfoliative glaucoma (PEG).

Trabecular aspiration was performed under the operating microscope prior to extracapsular cataract extraction (ECCE) over half of the chamber-angle circumference using a specially designed irrigationaspiration device in 12 eyes diagnosed with PEG and cataract. Trabecular debris and pigment were cleared with a suction force of 100 to 200 mm Hg.

The mean preoperative IOP (with and without antiglaucoma medications) was 33.0 ± 6.27 mm Hg; on postoperative day 5, 16.25 ± 4.5 mm Hg; at 1 month, 18.1 ± 2.68 mm Hg; at 3 months, 18.33 ± 2.69 mm Hg; and at 6 months, 19.0 ± 6.26 mm Hg. The mean number of antiglaucoma medications per day decreased from 3.77 preoperatively to 0.67 at 6 months postoperatively.

Trabecular aspiration substantially lowered the IOP in all 12 patients. Removal of intertrabecular and pretrabecular debris prior to ECCE reduced IOP 42% from baseline at 6 months postoperatively, a clinically significant decrease. Additionally, routine preoperative and postoperative gonioscopy in most cases revealed a significant reduction of pigmentation in the area of treatment. More patients and longer follow up are required to substantiate these results.
Diode and Nd:YAG Laser Contact Transscleral Cyclophotocoagulation in a Human Eye: A Comparative Histopathologic Study of the Lesions Produced Using a New Fiber Optic Probe
Authors: Brancato Rosario , Trabucchi Giuseppe , Verdi Mariangela , Carassa Roberto Giuseppe , Gobbi Pier Giorgio
Published: April 2021

ABSTRACT

We compared the contact cyclodestructive effects (both gross and histologic) achieved with diode and Nd:YAG laser wavelengths (810 and 1064 nm, respectively), using equivalent energy doses, released by means of a new optical delivery system in a human eye that was soon to be enucleated because of a choroidal melanoma. For both lasers, a fiber optic system (400 µm) with a focusing microlens placed at the end of the fiber was used. The center of the beam was placed 1.5 mm from the corneoscleral limbus.

At medium (5.2 to 6.6 J) and higher (7.8 J) energy levels, the cyclodestructive thermal damage produced by the diode laser appeared more widespread than that created by the Nd:YAG laser. At lower levels (3.6 to 3.9 J), both laser treatments produced similar lesions. The new delivery system proved to be safe and effective in achieving the desired cyclodestructive effects at both wavelengths.
Results of Trabeculectomy Combined With Phacoemulsification Versus Trabeculectomy Combined With Extracapsular Cataract Extraction in Patients With Advanced Glaucoma
Authors: Stewart William C , Crinkley Crystal M C , Carlson Alan N
Published: April 2021

ABSTRACT

We compared the results of trabeculectomy combined with phacoemulsffication (n = 16) with those of trabeculectomy combined with extracapsular cataract extraction (n = 18). There was no significant difference between the two groups in terms of early or chronic postoperative intraocular pressure (IOP) control or in terms of the number of glaucoma medications prescribed postoperatively. However, by 12 weeks postoperatively, bleb height and extent were significantly greater in the phacoemulsification group. There was no significant difference between the groups in terms of postoperative spheroequivalent, astigmatism, or cylindrical axis. The mean final visual acuity, however, was less in the extracapsular group. We conclude that phacoemulsification combined with trabeculectomy offers a safe and effective technique to control postoperative IOP in patients with glaucoma.
The Blepharoplasty Rotational Flap
Authors: Weinstein Gary S
Published: April 2021

ABSTRACT

Patients with large benign upper eyelid lesions and dermatochalasis are optimally treated with excision of their lesions and a blepharoplasty. I have devised a myocutaneous flap to reconstruct defects created by excising upper eyelid lesions peripheral to the blepharoplasty incision lines. The flap is created from skin and muscle that would normally be excised during the blepharoplasty. This technique results in a welldefined upper eyelid crease, without eyelid retraction or epicanthal fold formation.
Retinal Detachment in Patients With Retained Lens Fragments or Dislocated Posterior Chamber Intraocular Lenses
Authors: Smiddy William E , Flynn Harry W , Kim Judy E
Published: April 2021

* BACKGROUND AND OBJECTIVE: Retinal detachment is a complication of dislocated crystalline and intraocular lenses. The purpose of this study was to compare the frequency and management of coexisting or subsequent retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses (PC IOLs).

* PATIENTS AND METHODS: A retrospective, consecutive series of patients undergoing vitrectomy for dislocated PC IOLs (99 eyes) or removal of retained lens material (80 eyes) were studied.

* RESULTS: Eyes with retinal detachment and retained lens fragments (2 cases) or dislocated PC IOLs (2 cases), or retinal detachment following vitrectomy for removal of retained lens fragments (2 cases) or repair of dislocated IOL (1 case) were identified. The prevalence of coexisting or postoperative retinal detachment and retained lens fragments (5% total) was slightly higher than the prevalence of coexisting or postoperative retinal detachment and dislocated PC IOLs (3% total). The retina was reattached in all cases using the standard scierai buckling and vitrectomy techniques.

* CONCLUSION: The rate of retinal detachment associated with retained lens material is decreased compared with previous reports. This may possibly be a result of increasing attention to minimizing surgical trauma by the cataract surgeon at the time of lens fragment loss and by the vitrectomy surgeon during primary repair.

[Ophthalmic Surg Lasers 1996;27:856-861.]
Neovascular Glaucoma After Carotid Endarterectomy
Authors: Nguyen Quang H , Hamed Latif M , Sherwood Mark B , Roseman Robert L
Published: April 2021

Abstract. The authors examined a patient who had neovascular glaucoma (NVG) shortly after ipsilateral carotid endarterectomy and followed the patient's clinical course. The authors speculate that the sudden reperfusion after endarterectomy that occurs in patients with combined central retinal artery occlusion and carotid occlusive disease may enhance the circulation of preformed angiogenesis factors, leading to the development of neovascularization. The authors recommend frequent and careful surveillance of patients with central retinal artery occlusion associated with carotid occlusive disease if ipsilateral carotid endarterectomy is performed. [Ophthalmic Surg Lasers 1996;27:881-884.]
A Retained Intraretinal Foreign Body
Authors: Arora Ritu , Gupta Aloke , Mazumdar Shahana , Gupta Ashok K
Published: April 2021

Abstract. A patient with an 11-mm retained intraretinal foreign body is described. Absence of any history of trauma or foreign body entry with no obvious wound of entry and little damage to the ocular structures makes this case unusual. [Ophthalmic Surg Lasers 1996;27:885-887.]
Repair of a Giant Scleral Ulcer With Preserved Sclera and Tissue Adhesive
Authors: Lin Chang Ping , Tsai Ming Chi , Wu Yuh Hsin , Shih Min Hsiu
Published: April 2021

BACKGROUND AND OBJECTIVE: Infectious scleral ulcer is a rare but severe late complication of pterygium surgery. Scleral grafts may be required in scleral ectasia with uveal exposure, corneal distortion, and severe anterior chamber reaction that are induced by scleral ulcer. The authors report a method for scleral grafting with preserved sclera and tissue adhesive.

PATIENTS AND METHODS: Six cases of infectious scleral ulcers were repaired with this method. Preserved sclera was attached to the thinning sclera with tissue adhesive without sutures. The free or rotation conjunctival flap was placed over the graft area and sutured with 10-0 nylon.

RESULTS: The six cases repaired by this method showed good results during the follow-up, except for one loss. The only complication was protrusion of the adhesive postoperatively. This protrusion can be easily removed with forceps on an outpatient basis.

CONCLUSION: Tissue adhesive with preserved sclera is a useful method for repair of scleral thinning.

[Ophthalmic Surg Lasers 1996;27:995-999.]
In Vivo Evaluation of Corneal Endothelial Function Following Cataract Surgery
Authors: Saini Jagjit S , Mittal Sangeet
Published: April 2021

BACKGROUND AND OBJECTIVE: To quantify corneal endothelial function measured in vivo following extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC IOL) implantation.

PATIENTS AND METHODS: Endothelial function was assessed in 18 patients using recovery of the corneal hydration rate following induced cornea swelling before and after ECCE and PC IOL implantation.

RESULTS: The mean percentage recovery per hour (PRPH) showed a significant decrease at 12 and 24 weeks after surgery compared with before surgery (P < .01). A decrease in PRPH of more than 5% was observed in 55.6% and 66.7% of the eyes at 12 and 24 weeks after surgery, respectively.

CONCLUSIONS: PRPH measured in vivo demonstrates decreased endothelial function following ECCE and PC IOL implantation. The PRPH measures even slight changes in endothelial function and could be useful in evaluating endothelial damage.

[Ophthalmic Surg Lasers 1996;27:1000-1004.]
Atropine Versus Cyclopentolate Plus Tropicamide in Esodeviations
Authors: Goldstein Joseph H , Schneekloth Barbara B
Published: April 2021

BACKGROUND AND OBJECTIVE: The correction of the total hypermetropic refractive error in the management of esodeviations is well accepted. The choice of the appropriate cycloplegic agent is still not settled. Despite evidence that atropine will more effectively uncover the total refractive error, cyclopentolate in combination with other cycloplegic agents continues to be recommended. This study evaluates the use of atropine compared with a combination of cyclopentolate and tropicamide and analyzes age, size of the refractive error, and size of the esodeviation as possible contributing variables in the response.

PATIENTS AND METHODS: The records of 74 patients who underwent refraction with atropine 1% on one occasion and a combination of 1% cyclopentolate and 1% tropicamide on another occasion were reviewed. The mean and range of refractive errors for each eye for each group were determined. Comparisons were made for groups depending on age, size of the refractive error, and size of the esodeviâtion.

RESULTS: The amount of hypermetropia determined with atropine was significantly higher than the amount determined with the combination of cyclopentolate and tropicamide. This difference was significant for three age groups of three groups with increasing amounts of hypermetropia, and two groups with differing amounts of esodeviations. In addition, 1 1% of right eyes and 19% of left eyes showed 1.25 D or more of hypermetropia wich atropine.

CONCLUSION: Refraction with 1% atropine ointment yields a significantly larger amount of hypermetropia than does refraction with a combination of cyclopentolate and tropicamide. This difference is statistically significant regardless of age, amount of hypermetropia, or size of the esotropia.

[Ophthalmic Surg Lasers 1996;27:1030-1034.]
A Simple Surgical Treatment for Upper Lid Trichiasis
Authors: Yeung Yat-ming , Hon Ching-yu , Ho Chi-kin
Published: April 2021

Abstract. The authors report the results of a simple surgical treatment in 24 lids of 19 patients. The most common cause of the trichiasis was trachoma (83.3%). The operation involved splitting the lid margin, fracturing the tarsal plate, and everting sutures. The anatomic success rate was 62.5% and the functional success rate was 75%. Recurrent cilia were mostly isolated and symptomatic improvement was achieved in all but one patient. The authors conclude that this is a cost-effective procedure. [Ophthalmic Surg Lasers 1997;28:74-76.]
Treatment Outcomes in a 10-Year Study of Endogenous Fungal Endophthalmitis
Authors: Essman Thomas F , Flynn Harry W , Smiddy William E , Brod Roy D , Murray Timothy G , Davis Janet L , Rubsamen Patrick E
Published: April 2021

* BACKGROUND AND OBJECTIVE: To review prevalence of organisms, associated factors, and treatment outcomes from one medical center's 10-year experience managing culture-proven endogenous fungal endophthalmitis (EFE).

* PATIENTS AND METHODS: The authors retrospectively reviewed the microbiology and corresponding clinical records of patients diagnosed as having culture-proven EFE at the Bascom Palmer Eye Institute during a 10-year period.

* RESULTS: Culture-proven EFE occurred in 20 eyes of 1 8 patients. Candida species occurred in 1 7 of 20 eyes (85%), and Aspergillus species occurred in 3 of 20 eyes (15%). The most common association was long-term intravenous line placement, which was present in 12 patients (67%). Whereas 12 patients (67%) had a history of recent hospitalization, only 2 (11%) had a documented history of systemic fungal infection. After initial examination, only 2 patients had a systemic culture positive for a fungal organism (none had a positive blood culture). Treatment after initial examination included pars plana vitrectomy in 17 of the 20 eyes (85%), intravitreal amphotericin B in 19 eyes (95%), and systemic antifungal medication in 16 eyes of 15 patients. Thirteen of the 17 eyes (76%) with Candida endophthalmitis and O of 3 eyes with Aspergillus endophthalmitis achieved visual acuity of 20/400 or better.

* CONCLUSION: The most common cause of culture-proven EFE at the authors' institution is Candida species. The overall visual outcomes were more favorable for Candida cases than they were for Aspergillus cases. In the treatment of patients with marked vitreous infiltrates from EFE, pars plana vitrectomy, intravitreal amphotericin B injection, and administration of appropriate systemic antifungal medication (fluconazole for Candida) are generally recommended.

[Ophthalmic Surg Lasers 1997;28:185-194.]
Air Bag-Related Ocular Injuries
Authors: Manche Edward E , Goldberg Robert A , Mondino Bartly J
Published: April 2021

Abstract. This study reviewed the nature and severity of ocular and orbital air bag-related injuries at a large tertiary care referral center. The records of all patients treated by the ophthalmology trauma service for air bag-related ocular injuries between 1993 and 1995 were reviewed. Five patients were identified who had air bag-related ocular trauma. All of the patients who were referred to the ophthalmology trauma service for air bag-related ocular injuries had significant ocular or orbital injury. The extent and severity of the injuries were variable, ranging from orbital contusion to ruptured globe and retinal detachment. Although air bags substantially reduce the overall rates of mortality and morbidity associated with motor vehicle accidents, they also cause a variety of ocular injuries. [Ophthalmic Surg Lasers 1997;28:246-250.]
Microbial Keratitis Resulting in Loss of the Eye
Authors: Cruz Cristian Santa , Cohen Elisabeth J , Rapuano Christopher J , Laibson Peter R
Published: April 2021

* BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the clinical characteristics of infected corneal ulcers resulting in loss of the eye.

* PATIENTS AND METHODS: The authors conducted a retrospective study of all cases requiring evisceration or enucleation due to microbial keratitis at Wills Eye Hospital between January 1, 1989, and December 31, 1995. Medical records were reviewed to determine the past medical and ophthalmic history, duration of symptoms and treatment prior to referral, and the size of the ulcer at time of presentation. Treatment, culture results, and clinical course were also analyzed.

* RESULTS: During the study period, 1.8% (17 of 965) of the patients with corneal ulcers admitted to Wills Eye Hospital underwent evisceration or enucleation for microbial keratitis. The median age of the patients was 67 years (± 20.1 years). A majority of the patients (82%, 14 of 17) had a history of preexisting ocular disease resulting in poor visual acuity. The median duration of symptoms prior to presentation to Wills Eye Hospital was 11.4 days (± 13.9 days). The average size of the corneal infiltrate was 40.8 mm
p 2
(± 38.7 mm2). The most common pathogens were Pseudomonas (7 cases) and Streptococcus (3 cases). Patients required evisceration (14 cases) or enucleation (3 cases) due to uncontrolled infection.

* CONCLUSIONS: Microbial keratitis resulting in loss of the eye occurred typically in patients who were elderly with preexisting poor visual acuity, who presented with severe infections due to virulent organisms or delayed treatment.

[Ophthalmic Surg Lasers 1998;29:803-807.]
Response of Intraocular Pressure to Retrobulbar and Peribulbar Anesthesia
Authors: Sanford D Keith , de Cal Oscar E Minoso , Belyea David A
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the response of intraocular pressure (IOP) to retrobulbar and peribulbar anesthesia.

* PATIENTS AND METHODS: Patients were prospectively masked and randomized to receive either 4 cc of retrobulbar anesthesia (X = 29) or 6 cc of peribulbar anesthesia (X = 30), each consisting of a 50:50 mixture of 2% Xylocaine and 0.75% bupivacaine with 150 units of hyaluronidase. IOPs were measured pre-anesthesia and 1, 2, and 5 minutes postanesthesia in nonglaucoma patients undergoing cataract extraction and intraocular lens implantation.

* RESULTS: Mean IOPs in the retrobulbar group as determined with a tonometer were 18.24, 18.66, 19.14, and 17.86 mm Hg pre-anesthesia and 1, 2, and 5 minutes post-anesthesia, respectively. In the peribulbar group, the mean IOPs were 18.53, 21.20, 20.40, and 19.20 mm Hg, respectively. The 1 -minute pressures in the two groups were statistically different (P= .023). Within the peribulbar group, the 1- and 2minute pressures were statistically different from the pre-anesthesia IOP (P = .001 and P = .018, respectively).

* CONCLUSION: Peribulbar anesthesia, with its higher volume of anesthetic (6 vs 4 cc), results in a higher initial IOP. This difference was slight and short lived, and occurred in the absence of any external ocular compression. This study may have application in avoiding elevation of IOP in select patients undergoing a local procedure.

[Ophthalmic Surg Lasers 1998;29:815-817.]
Photodynamic Therapy for Corneal Neovascularization
Authors: Primbs George B , Casey Richard , Wamser Kay , Snyder Wendy J , Crean David H
Published: April 2021

* BACKGROUND AND OBJECTIVE: Photodynamic therapy with tin ethyl etiopurpurin (SnET2) was evaluated as a treatment modality for rat corneal neovascularization .

* MATERIALS AND METHODS: Escalating light doses at 664 nm were applied focally to corneal neovascularization in rats 1 0 minutes following an intravenous injection of SnET2 using a low-power diode laser. Controls consisted of light-only and drug-only treatments. Clinical, angiographic, and histopathologic evaluations were performed on the animals up to 28 days after drug and/or light treatment.

* RESULTS: A drug and light dose- response was seen in producing neovessel closure. In animals treated with SnET2 and the highest light dose (25 J/cm2), all eyes showed occlusion at every follow-up evaluation up to 28 days. Control eyes demonstrated progressive disease at all time points.

* CONCLUSIONS: Photodynamic therapy appears to be safe and effective for eliciting prolonged (> 28 days) occlusion of corneal neovascularization in the rat model with minimal side effects and good clinical outcomes.

[Ophthalmic Surg Lasers 1998;29:832-838.]
The Effect of Vehicle on Corneal Penetration of Triturated Ketoconazole and Itraconazole
Authors: Guzek James P , Roosenberg Joann M , Gano David L , Wessels Izak F
Published: April 2021

* BACKGROUND AND OBJECTIVES: Triturated (crushed and suspended) ketoconazole has been recommended for the treatment of fungal keratitis when commercial antifungal eyedrops are unobtainable. The authors evaluated the in vivo corneal stromal concentration with different vehicles in the eyes of adult rabbits.

* MATERIALS AND METHODS: Ketoconazole and itraconazole tablets were triturated to 20 mg/ml in four vehicles: polyvinyl alcohol (PVA), boric acid, olive oil, and balanced salt solution (BSS). Six eyes (deepithelialized for better penetration) received one drop every 1 5 minutes for 2 hours. A yeast overlay bioassay of extracts determined the stromal concentration.

* RESULTS: Itraconazole in BSS, olive oil, PVA, and boric acid produced inhibition zones of 17.3, 15.6, 15.4, and 13.2 mm, respectively. Ketoconazole produced inhibition zones of 35-9, 39.4, 41.8, and 44.7 mm, respectively. From a standard curve, the concentrations of ketoconazole in tissue were 512, 773, 1221, and 1492 µg/g, respectively.

* CONCLUSION: The vehicle that is used to triturate antifungals affects the tissue concentration. This may have an impact on fungal keratitis therapy.

[Ophthalmic Surg Lasers 1998:29:926-929.]
Accidental Subretinal Injection of Triamcinolone Acetonide
Authors: Modarres Mehdi , Parvaresh Mohammad M , Peyman Gholam A
Published: April 2021

Abstract. Approximately one-third of the contents of a 1-ml, 40-mg ampule of triamcinolone acetonide was accidentally injected into the subretinal space of the left eye of a 30-year-old man with chronic uveitis. The manufacturer provided a list of the contents of the ampule. A large, white subretinal mass was seen in the superotemporal quadrant. In subsequent days, the medication was seen to migrate interiorly. Visual acuity in the left eye was 20/400. Sub retinal hemorrhage and mild atrophy of the retinal pigment epithelium and choroid were observed superotemporally. Visual acuity returned to 20/100 (preinjection level) in 1 week. Four months postinjection, the superotemporal atrophy was more severe; the inferotemporal medication was minimally visible without producing significant chorioretinal atrophy. The visual acuity remained at 20/100 until the patient underwent cataract extraction and intraocular lens implantation; his vision then improved to 20/40. Steroids, when not accompanied by harmful vehicle substances, may be well tolerated by ocular tissues. [Ophthalmic Surg Lasers 1998;29:935-938.]
Single Wound, In Situ Tying Technique for Iris Repair
Authors: Ogawa Gregory S H , O'Gawa Gilbert M
Published: April 2021

Abstract. The authors describe a technique for placing and tying interrupted iris sutures in virtually any area of the iris using only a single limbal paracentesis wound. The tying is performed with conventional knot-forming techniques outside the eye before the throws are pulled into the anterior chamber and tightened with the desired 180° tension on the suture ends. During suture tying, the iris stays in situ rather than being stretched and distorted. [Ophthalmic Surg Lasers 1998;29:943-948.]
Visual Field Results After Vitreous Surgery in a Case Series of Patients with Open-Angle Glaucoma
Authors: Moroi Sayoko E , Gottfredsdottir Maria S , Van Heck Terri , Musch David C , Johnson Mark W
Published: April 2021

* BACKGROUND AND OBJECTIVE: Visual field loss is a complication of vitrectomy and a concern for patients with glaucoma. Our objective was to determine whether vitrectomy is associated with new field defects in patients with glaucoma.

* PATIENTS AND METHODS: This retrospective case series involved 7 eyes of 7 patients, who had open-angle glaucoma and underwent vitrectomy for macular hole (2) or epiretinal membrane (5).

* RESULTS: Acuity improved by at least two lines in 5 eyes. Visual fields showed a change in mean deviation following vitrectomy (mean difference -1.50 dB, P=0.0006, paired Student's t-test). One eye had confirmed progression of a pre-existing visual field defect, but no new defects were apparent in the other eyes. Transient intraocular pressure rises requiring therapy occurred in 3 eyes. One eye developed macular edema, but no other operative complications occurred.

* CONCLUSIONS: The results of our small case series suggest that vitrectomy may be an acceptable intervention in eyes with glaucoma and co-existing macular problems.

[Opthalmic Surg Lasers 2000;31:380-386]
Retinal Toxicity of Triamcinolone Acetonide in Silicone-Filled Eyes
Authors: Kivilcim Muhamet , Peyman Gholam A , El-Dessouky El-Said , Kazi Abdul A , Cheema Rizwan , Hegazy Hassan
Published: April 2021

* OBJECTIVE: To determine the retinal toxicity of triamcinolone acetonide at different doses in vitrectomized, silicone-filled rabbit eyes.

* MATERIALS AND METHODS: Vitrectomy with silicone oil placement was performed in 32 rabbit eyes. A dosage of 1 mg/0.025 mL, 2 mg/0.05 mL, or 4 mg/0.1 mL of triamcinolone acetonide was injected intravitreally in the study group eyes; the control group received 0.1 mL of sterile saline. Electroretinography and retinal histology were performed to evaluate toxicity.

* RESULTS: No retinal toxicity was seen in the groups given 1, 2, and 4 mg of triamcinolone acetonide or in the control group. ERG and histologic sections in all groups were normal. No drug was visible in the vitreous cavity at the end of the 140-day period (average) in eyes injected with 4 mg of triamcinolone acetonide.

* CONCLUSIONS: Up to 4 mg of triamcinolone acetonide can be safely injected in silicone-filled, vitrectomized eyes without any significant retinal toxicity.

[Ophthalmic Surg Lasers 2000;31:474-478]
Endophthalmitis After Cataract Surgery in Eyes With Small Pupils Managed by Sector Iridectomy and Polypropylene Suture Closure
Authors: Scott Ingrid U , Flynn Harry W
Published: April 2021

Abstract. Two patients with small pupils developed endophthalmitis following cataract surgery during which the small pupils were managed by sector iridectomy and closed with a polypropylene suture. Prior studies have reported that implantation of intraocular lenses (IOLs) with haptics made of polypropylene is associated with a higher risk of postoperative endophthalmitis than the use of IOLs with polymethylmethacrylate haptics. Endophthalmitis in the two patients reported herein was managed successfully without removal of the polypropylene suture; vision returned to 20/60 in one patient and 20/30 in the other patient. Iris retractors may represent a faster and safer alternative management option for small pupils than sector iridectomy closed with a polypropylene suture. [Ophthalmic Surg Lasers 2000;31:484-486]
Phacoemulsification and Foldable Intraocular Lens Implantation in Eyes Filled With Silicone Oil
Authors: Öner Hakan F , Durak Ismet , Saatci Osman A
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the visual outcome of phacoemulsification and foldable intraocular lens (IOL) implantation in eyes already filled with silicone oil.

* PATIENTS AND METHODS: Following vitrectomy and silicone oil injection, 16 eyes of 16 consecutive patients undergoing phacoemulsification and IOL implantation were included in the study.

* RESULTS: The mean age of patients was 58.3 ± 9.2 years (range, 38 to 71 years). The time interval between the cataract surgery and silicone oil injection was 5.8 ± 1.7 months (range, 4 to 9 months). The mean number of previous surgeries was 2.0 ± 0.8 (range, 1 to 4). Trypan blue (0.4%) was used for anterior capsule staining in 3 eyes with white cataract. Dispersive viscoelastic material was used during all steps of phacoemulsification. A capsular tension ring was inserted after capsulorhexis and hydrodissection in all cases. An IOL with a 6.0-mm optic was implanted in all eyes. The preoperative best-corrected visual acuity ranged from hand motions to 0.3. The mean postoperative best-corrected visual acuity was 0.3 ±0.1 (range, 0.1 to 0.6); best-corrected visual acuity increased in all eyes. A small amount of silicone oil moved into the anterior chamber during phacoemulsification in 1 eye and was evacuated. In all eyes, no silicone oil was present in the anterior chamber postoperatively.

* CONCLUSION: The use of dispersive viscoelastic and a capsular tension ring provides safer phacoemulsification and foldable IOL implantation in eyes already filled with silicone oil.

[Ophthalmic Surg Lasers Imaging 2003:34:358-362.]
Botulinum Toxin A in the Treatment of Adherence Syndrome
Authors: Özkan Seyhan B , Kir Erkin , Dayanir Volkan , Dündar Sema Oruç
Published: April 2021

Abstract. The effect of botulinum toxin A is investigated in the treatment of adherence syndrome related to strabismus surgery. An 18-year-old boy with decompensated right congenital fourth nerve palsy underwent ipsilateral superior rectus muscle recession and inferior oblique muscle disinsertion. During the early postoperative period, a right hypotropia with limitation of elevation developed and the result of the forced duction test was positive for passive elevation of the right eye. Botulinum toxin A was injected into the right inferior rectus muscle on the 15th postoperative day and orthophoria was achieved 1 week later. A repeat injection of botulinum toxin A was performed 6 months later. On follow-up 2 ½ years later, his eyes remained orthophoric with limitation of elevation in the right eye and the patient was satisfied with the result. This case demonstrated that adherence syndrome can be treated successfully by botulinum toxin A injection if it is administered during the acute phase, before the development of fibrous scar tissue. [Ophthalmic Surg Lasers Imaging 2003;34:391-395.]
Tuberculous Osteomyelitis and Optic Neuritis
Authors: Das J C , Singh Kirti , Sharma Pankaj , Singla Ritesh
Published: April 2021

Abstract. This case report describes a rare instance of bilateral optic papillitis associated with histologically and bacteriologically proven tubercular osteomyelitis of the right sphenoid and temporal bone of the orbit in a 30-year-old woman. This case also highlights the usefulness of computerized axial tomography of the orbits, skull, and paranasal sinuses to evaluate optic neuritis and its pathophysiology in the event of no obvious cause or contributing systemic disease. [Ophthalmic Surg Lasers Imaging 2003;34:409-412.]
Bilateral Ulnar Decubitus as a Complication of Macular Hole Surgery
Authors: Vincent Jared M , Peyman Gholam A , Ratnakaram Ramakrishna
Published: April 2021

Abstract. Bilateral ulnar decubitus is described in a 69year-old patient maintaining prone positioning after vitrectomy, membrane peeling, and perfluoropropane gas injection for the treatment of a macular hole. Patients should be warned to report any skin breakdown or ulnar paresthesias resulting from positioning and to change position frequently to allow weight bearing on other parts of the body. Patients with certain personality traits may be more iikely to maintain correct positioning despite pain or injury to ensure surgical success. [Ophthalmic Surg Lasers Imaging 2003;34:485-486.]