bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Microkeratome Suction Duration on Corneal Flap Thickness and Incision Angle
Authors: Seo Kyoung Yul , Wan Xiu H , Jang Jae W , Lee Jae Bum , Kim Moon J , Kim Eung Kweon
Published: April 2021

ABSTRACT

PURPOSE: To determine the effect of suction duration on corneal flap thickness and incision angle of the cut margin created by a microkeratome in a porcine eye.

METHODS: Thirty porcine eyes were randomly assigned to three groups according to different suction duration: group 1 (10 sec), group 2 (35 sec), and group 3 (60 sec). The Hansatome microkeratome with a #160 plate and 8.5-mm-diameter suction ring was used to create a corneal flap with a diameter of 8.5 millimeters. Corneal flap thickness was measured by automated ultrasonic pachymetry, and the incision angle was assessed by measuring the angle of a sagittal section of the cornea using image analysis software.

RESULTS: Mean corneal flap thickness in groups 1 (10 sec), 2 (35 sec), and 3 (60 sec) was 87.8 ± 22.0 µm, 116.0 ± 7.0 µm, and 127.2 ± 16.8 µm, respectively. There was a statistically significant difference between groups 1 (10 sec) and 2 (35 sec) (P=.005) and groups 1 and 3 (P=.004). The mean incision angle in groups 1, 2, and 3 was 34.8 ± 9.0°, 44.4 ± 16.1°, and 48.24 ± 15.3°, respectively. A statistically significant difference was found between groups 1 (10 sec) and 2 (35 sec) (P=.044) and groups 1 (10 sec) and 3 (60 sec) (P<.001).

CONCLUSION: In laser in situ keratomileusis in porcine eyes, an increase in suction duration resulted in a thicker flap and greater incision angle. [J Refract Surg 2002;18:715-719]
Intraoperative Arcuate Transverse Keratotomy With Phacoemulsification
Authors: Titiyal Jeewan S , Baidya Krishna P , Sinha Rajesh , Ray Manotosh , Sharma Namrata , Vajpayee Rasik B , Dada Vijay K
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the efficacy of paired intraoperative arcuate transverse keratotomy at a 7- mm- diameter zone along with a 3.5-mm clear corneal phaco tunnel in the steeper axis to correct pre-existing astigmatism.

METHODS: A prospective randomized case-control study was conducted on 34 eyes of 28 patients with immature senile cataract. They were divided into two groups; in one group (17 eyes) intraoperative arcuate keratotomy was coupled with phacoemulsification in the steeper meridian (arcuate keratotomy group; mean preoperative astigmatism 2.28 ± 0.89 D) and the other group (17 eyes) phacoemulsification was performed in the steeper meridian without arcuate keratotomy (control group; mean preoperative astigmatism 2.04 ± 0.50 D). The patients were examined at 1 day, and 1, 4, and 8 weeks postoperatively. Correction of keratometric astigmatism, surgically induced refractive changes, magnitude and axis of cylinder, spherical equivalent refraction, with and against the wound change, and coupling ratio were evaluated.

RESULTS: Mean reduction in keratometric astigmatism in the keratotomy group was 1.26 ± 0.54 D (P = .0067) and in the control group was 0.48 ± 0.60 D (P = .0423). The difference in reduction of keratometric astigmatism between the two groups was statistically significant (P = .0296). Surgically induced refractive change at 8 weeks follow-up was 2.15 ± 1.13 D in the keratotomy group and 1.50 ± 1.32 D in the control group (P = .046). Coupling ratio was -1.10 ± 0.43 in the keratotomy group at 8 weeks after surgery while the control group was -0.82 ± 0.38.

CONCLUSION: A combination of intraoperative arcuate keratotomy with steep axis phacoemulsification incision is more effective than steep axis phacoemulsification incision alone in reducing pre-existing astigmatism. IJ Refract Surg 2002; 18: 725-730]
Femtosecond Laser Flap Creation for Laser in situ Keratomileusis: Six-month Follow-up of Initial U.S. Clinical Series
Authors: Nordan Lee T , Slade Stephen G , Baker Richard N , Suarez Carlos , Juhasz Tibor , Kurtz Ron
Published: April 2021

ABSTRACT

PURPOSE: To evaluate clinical performance of a femtosecond laser for flap creation in laser in situ keratomileusis (LASIK).

METHODS: A prospective, consecutive series of 208 eyes (122 patients) undergoing LASIK between June 2000 and November 2000 using a femtosecond laser for creation of the corneal flap were evaluated for the incidence of complications. A subset of 114 patients who underwent myopic procedures and who were followed for 6 months was analyzed using standard outcome measures.

RESULTS: In 4 of 208 eyes (1.9%), suction was lost during the procedure, causing the flap resection to be interrupted. However, in all four of these eyes the procedure was successfully performed 5 to 45 minutes after re-applanation of the eye. No postoperative complications or adverse events were observed in any treated eye. In the subgroup of 96 eyes undergoing piano correction and followed for 6 months (preoperative spherical equivalent refraction range -0.63 to -12.40 D), 98% (94 eyes) achieved uncorrected visual acuity of 20/40 or better; 94% (90 eyes) achieved 20/30 or better, 79% (76 eyes) achieved 20/25; and 55% (53 eyes) achieved 20/20 or better- all without benefit of retreatment.

CONCLUSION: Femtosecond laser corneal flap creation is a safe and effective alternative to traditional mechanical mi crokera tomes. Standard LASK nomograms appeared to apply equally well to the all-laser LASLK procedures. The potential for improved flap safety, reproducibility, flexibility, as well as for additional corneal applications are now being explored. [J Refract Surg 2003;19:8-14]
Effect of Beam Size on the Expected Benefit of Customized Laser Refractive Surgery
Authors: Guirao Antonio , Williams David R , MacRae Scott M
Published: April 2021

ABSTRACT

PURPOSE: Customized laser surgery attempts to correct higher order aberrations, as well as defocus and astigmatism. The success of such a procedure depends on using a laser beam that is small enough to produce fine ablation profiles needed to correct higher order aberrations.

METHODS: Wave aberrations were obtained from a population of 109 normal eyes and 4 keratoconic eyes using a Shack-Hartmann wavefront sensor. We considered a theoretical customized ablation in each eye, performed with beams of 0.5, 1.0, 1.5, and 2.0 mm in diameter. We then calculated the residual aberrations remaining in the eye for the different beam sizes. Retinal image quality was estimated by means of the modulation transfer function (MTF), computed from the residual aberrations. Fourier analysis was used to study spatial filtering of each beam size.

RESULTS: The laser beam acts like a spatial filter, smoothing the finest features in the ablation profile. The quality of the correction declines steadily when the beam size increases. A beam of 2 mm is capable of correcting defocus and astigmatism. Beam diameters of 1 mm or less may effectively correct aberrations up to fifth order.

CONCLUSION: Large diameter laser beams decrease the ability to correct higher order aberrations. A top-hat laser beam of 1 mm (Gaussian with FWHM of 0.76 mm) is small enough to produce a customized ablation for typical human eyes. [J Refract Surg 2003;19:15-23]
Effect of Hyperopic Photorefractive Keratectomy on Corneal Sensitivity: A Longitudinal Study
Authors: Murphy Paul J , O'Brart David P S , Stephenson Christopher G , Oliver Katherine M , Patel Sudi , Marshall John
Published: April 2021

ABSTRACT

PURPOSE: To investigate corneal sensitivity after photorefractive keratectomy (PRK) for low hyperopia, as measured with a non-invasive stimulus.

METHODS: Two experimental groups were recruited: a control group of 17 patients (mean age 61.65 years) who underwent no treatment, and a PRK group of 11 patients (mean age 58.64 years) who underwent one of three attempted hyperopic corrections: +2.00 D (two patients), +3.00 D (four patients), +4.00 D (five patients). Corneal sensitivity was assessed centrally and peripherally, at temporal, medial, and inferior locations, approximately 1 mm from the limbus, using the Non-Contact Corneal Aesthesiometer (NCCA). Measurements were taken at each location for the control group and at preoperative, and postoperative weeks 1 and 2, 1, 3, and 6 months for the PRK group.

RESULTS: Comparison of control and PRK groups (preoperative sensation threshold) (t-test): central P=.715, temporal P=.719, medial P=.943, inferior P= .920. Comparison of longitudinal changes in PRK group (one-way ANOVA): central P=.612, temporal P=.997, medial P=.981, inferior P=993.

CONCLUSIONS: Using the Non-Contact Corneal Aesthesiometer, no significant difference was found between the control and PRK groups for preoperative sensation thresholds, and no significant change in corneal sensitivity was found between any of the test time periods at any of the four corneal test locations for the PRK group. [J Refract Surg 2003;19:34-39]
Photorefractive Keratectomy With and Without Smoothing: A Bilateral Study
Authors: Serrao Sebastiano , Lombardo Marco , Mondini Fabio
Published: April 2021

ABSTRACT

PURPOSE: To assess whether a smoother stromal surface and a faster epithelium regeneration after excimer laser photorefractive keratectomy (PRK) may lead to better visual results.

METHODS: Ten patients had unilateral PRK and contralateral PRK plus smoothing. The operative outcome was checked by means of digital standardized photographs taken at 0, 20, 40, and 60 hours after surgery. Complete clinical examinations were performed before and 1 and 3 months after surgery.

RESULTS: Between 20 and 40 hours after surgery, the average velocity of radial epithelial migration in eyes in which smoothing was performed was 0.083 ± 0.008 mm/h. This was faster than that (0.064 ± 0.007 mm/h [P<.01]) observed in the eyes without smoothing. The corneal regularity index at 1 and 3 months was worse in the PRK alone group compared to the PRK plus smoothing group (P=.l). At 3 months, better visual outcome and less haze were observed in the PRK plus smoothing group.

CONCLUSION: When using a flying spot laser, PRK plus smoothing improved the visual results and diminished regression and haze at 3 months, but gave rise to a slight hyperopic shift. [J Refract Surg 2003;19:58-64]
First Clinical Results With the Femtosecond Neodynium-glass Laser in Refractive Surgery
Authors: Ratkay-Traub Imola , Ferincz Istvan E , Juhasz Tibor , Kurtz Ron M , Krueger Ronald R
Published: April 2021

ABSTRACT

PURPOSE: We evaluated four femtosecond laser intrastromal cutting procedures: creation of a corneal flap for laser in situ keratomileusis (LASIK), tunnel and entry cut for intracorneal ring, corneal flap and removable lens for keratomileusis, and intrastromal ablation for myopia and hyperopia.

METHODS: A clinical trial using a femtosecond surgical laser (IntraLase Corporation) was performed in partially sighted eyes. Femto-LASIK treatment was performed on 46 eyes up to -14.00 D; 16 patients received intracorneal ring segments (Femto-ICRS); 5 patients each with one highly myopic eye had femtosecond laser keratomileusis (FLK), and 13 patients each with one myopic or hyperopic eye had intrastromal ablation (ISPRK). In Femto-LASIK, excimer laser ablation was done under the flap. In Femto-ICRS, ring segments were introduced into the laser-created channels. In femtosecond laser keratomileusis, a lens-shaped block of stroma was removed manually from under the flap.

RESULTS: No difference was found between the results obtained with Femto-LASIK and a standard microkeratome. No refractive effects occurred when the created flap was not elevated. In cases of Femto-ICRS and conventional ICRS produced the same refractive results. With Femto-ICRS, no intraoperative complications occurred and visual acuity improved immediately after surgery. In femtosecond laser keratomileusis, high myopia was corrected without using excimer laser ablation; centralization of the treatment area was excellent. In intrastromal ablation, 1 to 2 hours after surgery the corneas were highly transparent; refractive results were stable.

CONCLUSIONS: Femtosecond lasers can produce precise intrastromal cutting, offering significant safety and other advantages (no razor blades, corneal trauma, partial resections, or sterilization issues) over current techniques. [J Refract Surg 2003;19:94-103]
Comparison of Subjective Visual Acuity With Visual Acuity Predicted From C-scan Topography
Authors: Tsai Show-Chuan , Wang I-Jong , Liou Shiow-Wen , Chen Wei-Li , Lee Yuan-Chieh , Tseng Gow-Lieng , Hu Fung-Rong
Published: April 2021

ABSTRACT

PURPOSE: To compare the capability of objective measures of visual acuity (potential visual acuity from C-scan) to predict subjective visual acuity (best spectacle-corrected visual acuity [BSCVA]).

METHODS: Patients with BSCVA ≥20/20 were enrolled in four groups (Group 1: normal [33 eyes]; Group 2: <-7.00 D myopia [43 eyes]; Group 3: ≥-7.00 D myopia [28 eyes]; Group 4: At least 1 month after LASIK [93 eyes I). Videokeratography was performed with the ray tracing Technomed C-scan. The potential visual acuity from C-scan was obtained with pupils undilated and intact precorneal tear films. All visual acuity was recorded in logMAR, and the significance of differences between acuities was assessed with a one-way ANOVA test.

RESULTS: The potential visual acuity from C-scan ray tracing of normal and myopic eyes in response to both photopic and mesopic stimuli did not differ. In a given eye, the potential visual acuity from C-scan ray tracing was better than BSCVA, and the difference was statistically significant. Although the potential visual acuity from C-scan of postoperative LASIK eyes in response to photopic stimuli was the same, it decreased under mesopic conditions.

CONCLUSIONS: Potential visual acuity from C-scan overestimates subjective visual acuity due to the inadequate assumptions in ray tracing or individual retinal resolution ability. In addition, the potential visual acuity from C-scan ray tracing varies with pupil diameter in different illumination. [J Refract Surg 2003;19:137-141]
Primary Multipoint (Segmental) Custom Ablation
Authors: Gimbel Howard V , Sofinski Sandra J , Mahler Oron S , van Westenbrugge John A , Triebwasser Rick W
Published: April 2021

ABSTRACT

PURPOSE: We present our experience in resolving visual symptoms in refractive patients undergoing primary multipoint (segmental) custom ablation.

METHODS: Twelve eyes with mixed myopic astigmatism underwent evaluation and primary treatment by multipoint (segmental) custom ablation for the correction of refractive errors and visual symptoms using the Nidek NAVEX platform.

RESULTS: Twelve eyes showed resolution of visual symptoms following diagnosis and treatment with MCA using the NAVEX platform. No patient lost two or more lines of best spectacle-corrected visual acuity. The postoperative root mean square of higher order aberrations did not change in a predictable or reproducible fashion.

CONCLUSION: Multipoint (segmental) custom ablation with the Nidek NAVEX system was safe and effective for correcting mixed myopic astigmatism and for resolving visual symptoms in selected refractive surgery candidates. Small changes in the root mean square of higher order aberration values were not always reflected in a patient's subjective assessment of vision quality. [J Refract Surg 2003;19(suppl):S202-S208]
One-year Results of Butterfly Laser Epithelial Keratomileusis
Authors: Vinciguerra Paolo , Camesasca Fabrizio I , Randazzo Alessandro
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the risks, complications, and refractive results at 1 year after modified laser epithelial keratomileusis (Butterfly LASEK).

METHODS: In a non-randomized prospective study of 773 eyes (452 patients; mean age 34.3 ± 16.5 years, mean preoperative spherical equivalent refraction -5.30 ± 3.70 D; mean sphere -4.80 ± 3.60 D; mean cylinder -1.00 ± 1.40 D; range -22.50 to +5.50 D), we used a modified LASEK technique and evaluated complications and refractive results at 1 year. The technique is based on the formation of the epithelial flap utilizing alcohol (20% diluted solution applied on the epithelium for 5 to 30 seconds), paracentral abrasion, blunt dissection of the epithelium from the underlying plane; the epithelium is then separated by means of a specially designed retractor. Ablation was performed with a Nidek EC-5000 excimer laser, followed by smoothing and repositioning of the epithelial flap.

RESULTS: After 1 year, we analyzed the results of 542 (70.1%) treated eyes with the following outcome: mean postoperative spherical equivalent refraction -0.20 ± 1.40 D; mean sphere -0.10 ± 1.30 D; mean cylinder -0.10 ± 0.60 D; range -2.50 to +0.75 D. In 83.0% of treated eyes, achieved refraction was within ±0.50 D of planned correction, with uncorrected visual acuity greater than or equal to 1.2 in 19.0% of treated eyes, greater than or equal to 1.0 in 56.0%, and greater than or equal to 0.8 in 19%. Concerning visual acuity, 0.3% of eyes lost 1 line, 49.8% of eyes had no change; 41.8% gained 1 line, 9.8% gained 2 lines, and 1.6% gained more than 2 lines.

CONCLUSION: One-year results of this preliminary study showed that Butterfly LASEK was easy to perform, safe, and led to excellent long-term refractive results. [J Refract Surg 2003; 19: S223-S226]
Effect of Laser in situ Keratomileusis on the Corneal Endothelium
Authors: Simaroj Pornchai , Kosalprapai Kessara , Chuckpaiwong Varintorn
Published: April 2021

ABSTRACT

PURPOSE: To assess the effects of laser in situ keratomileusis (LASIK) on the corneal endothelium.

METHODS: In a prospective study, preoperative and 12-month postoperative specular microscopy of the central corneal endothelium and corneal thickness assessment was done in L80 eyes of 105 patients (mean age 31.96 ± 8.88 years; range 16 to 55 yr) who had LASIK to correct myopia. The central endothelium was analyzed for several parameters including cell density, coefficient of variation, and corneal thickness. Preoperative and postoperative data were compared.

RESULTS: The mean preoperative endothelial cell density was 2547.37 ± 282.00 cells/mm2, mean coefficient of variation of cell size was 58.33 ± 11.50%, and mean central corneal thickness was 558.90 ± 28.42 /*m. There was not a statistically significant change in mean endothelial cell density (2508.24 ± 289.57 cells/mm2) or mean coefficient of variation (58.61 ± 9.89%) at 1 year after surgery (P>.05 ). Average endothelial cell loss was 1.54% at 1 year after surgery. Mean central corneal thickness at 12 months postoperatively was 493.24 ± 52.55 µt? (P<.01).

CONCLUSION: LASIK did not appear to alter corneal endothelial cell density at 12 months postoperatively. [J Refract Surg 2003;19(suppl): S237-S240]
Complications of Photorefractive Keratectomy and Laser in situ Keratomileusis
Authors: Lui Marcelo Mastromonico , Silas Marcia Ap Grandini , Fugishima Helio
Published: April 2021

ABSTRACT

PURPOSE: To analyze the safety of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) with the Nidek EC-5000 excimer laser for surgery performed from Jan 1999 to Dec 2001.

METHODS: Retrospective study of excimer laser in 683 eyes: PRK was performed in 103 eyes and LASDX was performed in 580 eyes using the Nidek EC-5000 excimer laser and Moria Carriazo Barraquer microkeratome. We classified complications as intraoperative, early postoperative (30 days) and late postoperative complications. All patients were followed for at least 6 months.

RESULTS: There were 15 (2.19%) intraoperative microkeratome -related flap complications, 5 thin flaps (0.73%), 4 free caps (0.58%), 3 buttonholes (0.43%), and 3 small flaps (0.43%). The most frequent early postoperative complication was dry eye with pain in 42 eyes. There were 30 cases of microwrinkled flaps (4.39%), 14 cases of dislocated flaps or flap striae that necessitated lifting and irrigating the flap (2.04%), 8 interface epithelial ingrowth (1.17%), 4 interface debris (0.58%), 3 haze (0.43%), 3 glare (0.43%), 2 decentered ablations (0.29%), and 2 cases of toxic keratitis (0.29%). Late postoperative complications were 98 cases of spherical equivalent refraction more than or equal to 1.00 D (14.3%) with 6 months follow-up. Reoperation was necessary in 33 eyes (4.83%). Five eyes lost 1 or more lines of preoperative best spectacle-corrected visual acuity (0.73%), and 2 eyes had keratoconus (0.29%).

CONCLUSION: Refractive surgery with the Nidek EC-5000 excimer laser was safe, with few complications. [J Refract Surg 2003;19(suppl): S247-S249]
Experimental Imaging of Intracorneal Ring Segments With Optical Coherence Tomography
Authors: Wirbelauer Christopher , Winkler Jörg , Scholz Christian , Häberle Heike , Pham Duy Thoai
Published: April 2021

ABSTRACT

PURPOSE: To investigate the imaging of corneal structures with optical coherence tomography (OCT) after implantation of intracorneal ring segments (ICRS).

METHODS: In an experimental study with six porcine eyes, qualitative and quantitative imaging with corneal OCT using a wavelength of 1310 nm after implantation of ICRS was performed. The optical results were compared with light microscopy of the histological sections.

RESULTS: In corneal OCT, the ICRS revealed marked hyporeflective intrastromal areas, which correlated well with macroscopic and microscopic findings. Corneal OCT enabled precise images of the incision depth for the implantation of ICRS, and the exact intrastromal segment position.

CONCLUSIONS: Noncontact slit lamp-adapted corneal optical coherence tomography could be employed to clinically monitor corneal changes after implantation of ICRS, evaluate the depth of the segments to correlate refractive changes, and quantify the stromal wound healing response. [J Refract Surg 2003;19:367-371]
Intermittent Exotropia: Is Surgery Necessary?
Authors: Newman Judith , Mazow Malcolm L
Published: April 2021

SUMMARY

Sixty cases of intermittent exotropia were studied to compare the outcome of those patients treated medically with the outcome of those patients treated surgically. Below 30 prism diopters of intermittent exotropia, there is a high functional cure rate in both groups. Preoperative orthoptics did not lead to a surgical overcorrection. And finally, central fusion is not essential for a clinical cure.
Magnetized Instrument Removal of Foreign Body Through the Pars Plana
Authors: Bennett Thomas O , Diddie Kenneth R , Trolinger Kenneth
Published: April 2021

SUMMARY

We describe a new, safe technique for removing posteriorly located magnetic intraocular foreign bodies. The technique consists of magnetizing an intraocular instrument by placing an electromagnet against the extraocular portion. After a vitrectomy, the magnetized instrument lifts the foreign body anteriorly in a controlled fashion, and removes the object through the pars plana. Its use is illustrated in two case reports.
Short Exposure Times in Argon Laser Iridotomy
Authors: Mandelkorn Robert M , Mendelsohn Alan D , Olander Kenneth W , Zimmerman Thom J
Published: April 2021

SUMMARY

Currently employed techniques utilizing a continuous wave argon laser for the production of peripheral iridotomies in the treatment of angle-closure glaucoma are successful in producing patent iridotomies; however, complications such as corneal, lenticular, and retinal burns have been experienced.

We found that a combination of low energy, much shorter exposures and an overlapping stretch pattern also gave a high success ratio in terms of formation of a patent iridotomy while reducing the number of complications for both black and white patients. Highly encouraging was the absence of corneal edema of a severity sufficient to cause an interruption in the treatment.
Combined Trabeculotomy-Trabeculectomy for the Management of Glaucoma Associated with Sturge-Weber Syndrome
Authors: Board R Jeffrey , Shields M Bruce
Published: April 2021

SUMMARY

Experience in managing five eyes with glaucoma associated with the Sturge-Weber syndrome is presented. All cases were treated with a combined trabeculotomy-trabeculectomy as the primary surgical procedure. A review of the proposed mechanisms involved in the glaucoma of this syndrome is given to provide the reasoning behind the selection of this operation. Although the results of this small series do not prove superiority of this surgical approach over techniques reported by others, we feel that a combined operation of this type offers the most reasonable hope for success, untila more precise understanding of the glaucoma mechanism in this condition is established.
The Effect of Anterior Orbital Decompression on Motility in Thyroid Exophthalmos
Authors: Dixon Ray , Lesser George R
Published: April 2021

SUMMARY

Nineteen orbits from 13 patients with endocrine exophthalmos were effectively decompressed into the maxillary and ethmoid antra through an anterior orbitotomy. Six patients with preoperative diplopia had improved ocular ductions and return of binocular single vision in functional positions. Diplopia was not induced in five patients with normal pre-op motility. In one patient with active orbitopathy, a large postoperative esotropia was caused by worsening of medial rectus inflammation. This approach appears to lessen the incidence of postoperative diplopia and may make subsequent extraocular muscle procedures unnecessary.
Full-Thickness Eyelid Biopsy for Presumed Carcinoma In Situ of the Palpebral Conjunctiva
Authors: Leibsohn Joel , Bullock John , Waller Robert
Published: April 2021

SUMMARY

A biopsy-proven diagnosis of carcinoma in situ of the palpebrai conjunctiva should always evoke doubt. This change may represent pagetoid spread of an occult sebaceous gland carcinoma. The conjunctiva! changes may be subtle, preceding the formation of any obvious mass in the eyelid. In this situation, full-thickness eyelid biopsy should be considered as a possible alternative to diagnosis accurately the disease process.

The authors present two cases where biopsy of chronically inflamed palpebrai conjunctiva was at first diagnosed as carcinoma in situ. Fufl-thickness eyelid biopsy was performed at varying times following the conjunctival biopsy. Sebaceous gland carcinoma was then diagnosed in each case. The pathogenicity of carcinoma in situ differs markedly from sebaceous gland carcinoma. A palpebrai conjunctival biopsy diagnosed as carcinoma in situ should arouse suspicion that a more serious pathologic process may be present. Full-thickness eyelid biopsy may be appropriate under such circumstances.
Psychiatric Reactions Complicating Cataract Surgery: A Prospective Study
Authors: Karhunen Ulla , Orko Riitta
Published: April 2021

SUMMARY

In a prospective study, 50 of 1 505 (3.3%) patients undergoing cataract extraction during a three-year period developed postoperative psychiatric reactions. Old age and markedly deteriorated vision seemed to contribute to this complication, which in all cases was reversible.
Preparation of Split Thickness Auricular Cartilage for Use in Ophthalmic Plastic Surgery
Authors: Smith Byron , Lisman Richard D
Published: April 2021

SUMMARY

Auricular cartilage can be used extensively in a number of procedures by the ophthalmic plastic surgeon. It is ideal for the lengthening of eyelids, and also has a place in eyelid reconstruction, surgery for trichiasis, a nd the anophthalmic socket. It is vita I that the cartilage be prepared in a precise and meticulous manner in order to insure optimum results.
Controlled Retrobulbar Anesthesia for ECCE and IOL Implantation
Authors: Zauberman Hanan
Published: April 2021

ABSTRACT

A method of controlled retrobulbar anesthesia was used in 20 patients undergoing extracapsular cataract extraction with intraocular lens implantation. The method includes:

1. leaving the pupil undilated before anesthesia;

2. applying topical anesthetic to the conjunctiva;

3. injecting about 0.25 ml of anesthesia through the non-sensitive conjunctiva into the muscle cone, then waiting until the pupil becomes dilated before injecting an additional 1.5 ml;

4. injecting 0.25 ml anesthesia under the conjunctiva and into the tendon of the superior rectus muscle; and

5. applying short-acting mydriatics after the injection.

This method is almost painless and does not result in increased intraocular pressure after injection. Massage or compression to soften the eye is not required, and there is excellent anesthesia and akinesia.
The Role of Lacrimal Sac Palpation in Evaluation of Lacrimal Drainage Problems
Authors: Frueh Bartley R
Published: April 2021

ABSTRACT

Lacrimal sac palpation in the evaluation of the lacrimal excretory system, both before and during irrigation, is proposed to minimize the necessity for lacrimal excretory function tests.
Sodium Hyaluronate (Healon®) in Glaucoma Filtering Procedures
Authors: Alpar John J
Published: April 2021

ABSTRACT

Healon® (sodium hyaluronate) has been used in a prospective study designed to investigate its possible usefulness in promoting effective bleb formation and preventing cleft closure in trabeculectomy for glaucoma. One hundred fourteen patients with open-angle glaucoma were randomly assigned to one of two groups. In one group (55 patients), filtering surgery was performed without the use of Healon. In the remaining 59 patients, Healon was used to separate the iris from the cleft, the sclera from the sclera and the conjunctiva from the sclera. The surgical procedure used was the Stallard-Worst triangular modification of Cairns' method, combined with removal of the Tenon's capsule. The patients whose operations were performed with the aid of Healon had a higher success rate, as manifested by better and more permanent bleb formation and maintenance, more open clefts, less scarring, less peripheral anterior synechiae formation, and significantly lower long-term intraocular pressure. Moreover, the number of patients requiring supplemental postoperative timolol therapy was significantly smaller in the Healon group (5/59 patients: 8.5%) than in the control group (33/55 patients: 60%). There was a transient delay in the reduction of intraocular pressure following trabeculectomy in the Healon patients which was not observed in control patients. Apart from this, no adverse effects were associated with the use of Healon.
Elimination of Sodium Hyaluronate-Induced Decrease in Outflow Facility With Hyaluronidase
Authors: Hein Stephen R , Keates Richard H , Weber Paul A
Published: April 2021

ABSTRACT

The use of intraocular sodium hyaluronate is complicated by a postoperative rise in intraocular pressure (IOP). The rise in IOP is thought to stem from a "clogging" at the trabecular meshwork by the large molecules of hyaluronate. This study uses serial tonographic measurements in an animal model to document this change in outflow facility. Furthermore, we investigate the ability of the enzyme hyaluronidase to cleave the hyaluronate into smaller molecular weight fragments, in vivo, and thereby eliminate the change in outflow facility. This report demonstrates the potential usefulness of this enzyme and documents the lack of harmful side effects histopathologically.
Carbon Dioxide (CO2) Laser Therapy For Conjunctival Lymphangioma
Authors: Jordan David R , Anderson Richard L
Published: April 2021

ABSTRACT

Lymphangiomatous tissue involving the ocular adnexa may be difficult to manage because this highly vascular, unencapsulated tissue intermingles freely with normal adnexal structures. Hemostasis is difficult to obtain, and important ocular and periocular structures are damaged easily. We have successfully treated two individuals who had extensive conjunctival involvement of their lymphangioma with the carbon dioxide (CO2) laser. The CO2 laser permits a precise form of treatment with the ultimate form of hemostasis (tissue vaporization), resulting in minimal trauma, edema, and scarring, and thus offers a safe alternative to surgical excision of these lesions.
Ciliary Block (Malignant) Glaucoma Following Posterior Chamber Lens Implantation
Authors: Duy T Pham , Wollensak J
Published: April 2021

ABSTRACT

Ciliary block (malignant) glaucoma is a rare complication of cataract surgery. In eyes with narrow angles and acute glaucoma, ciliary block must be differentiated from pupillary block to provide appropriate therapy. We review two cases of ciliary block glaucoma following uncomplicated extracapsular cataract extraction with posterior chamber lens implantation.

Previous filtering procedures in these cases resulted in protracted shallowing of the anterior chamber, possibly contributing to the pathogenesis of ciliary block. In addition, the operative trauma of cataract surgery may have resulted in the separation of the vitreous base from the pars plana. Misdirected aqueous humor then could have entered the vitreous body, displacing the iris-pseudophakos diaphragm forward, and resulting in the acute glaucoma.

Vitrectomy, which resolved the acute glaucoma, is valuable in treating ciliary block glaucoma.
An Improved Radial Marker For Radial Keratotomy
Authors: Shahinian Lee
Published: April 2021

ABSTRACT

Radial marks on the peripheral cornea in radial keratotomy can lead to confusion during incision placement. I have designed and successfully used a small radial marker that indicates the starting position for each incision, but does not mark the peripheral cornea.
Failed Laser Trabeculoplasty Requiring Surgery in Open-Angle Glaucoma
Authors: Schoenleber Dana B , Bellows A Robert , Hutchinson B Thomas
Published: April 2021

ABSTRACT

Argon laser trabeculoplasty (ALT) has been successful in controlling open-angle glaucoma, but a significant number of patients still require filtration surgery. Concern that post-laser inflammatory changes or alterations of structural anatomy with damage to the trabecular meshwork may adversely affect the outcome of filtration surgery prompted a retrospective review of 87 consecutive eyes with open-angle glaucoma that required filtration surgery following failed ALT. The follow-up period was at least 6 months, with a mean of 18 months (6 to 38 months). Posterior lip sclerectomy was chosen for 69 eyes and trabeculectomy for 18 eyes. The overall success rate of filtration surgery during the follow-up period was 92%. There was no recognized difference in the response to filtration surgery following ALT.
Inflammatory Response to Viscoelastic Materials
Authors: McKnight Scott J , Giangiacomo Joseph , Adelstein Edward
Published: April 2021

ABSTRACT

Healon®, Amvisc®, or Viscoat® was injected into the corneal stroma of 36 normal rabbit eyes. Twelve additional rabbit eyes were used as controls by performing a sham procedure. Twelve rabbits were euthanized at one day and the remainder seven days after injection. The eyes were enucleated and examined by light microscopy. No control eyes had detectable inflammation. Only Viscoat produced mild inflammation at seven days, but this was statistically significant only at p = 0.182. There appears to be little difference in the inflammatory response of these three viscoelastic substances.
Laser Sclerostomy ab interno Using a Continuous Wave Nd:YAG Laser
Authors: Javitt Jonathan C , O'Connor Stefan S , Wilson Richard P , Federman Jay L
Published: April 2021

ABSTRACT

We report the use of a continuous wave Nd:YAG (CW-YAG) laser focused through a sapphire crystal to create a filtering bleb by ab-interno sclerostomy. A 2-mm clear corneal incision was made in each eye of five anesthetized Dutch Belted rabbits, and the 30-mm-long sapphire crystal with a 0.2-mm focal tip was passed across the anterior chamber until it came in contact with the opposite angle. Between two and three pulses of 0.8 J were required to produce a filtering bleb in each of the 10 eyes. The overlying conjunctiva was not damaged; the procedure time was under five minutes. Histological examination revealed a surrounding area of scleral melting that extended an average of 0.06 mm from the sclerostomy. These data suggest that the CW-YAG laser may be useful in performing glaucoma filtering surgery with minimal damage to surrounding ocular tissues.
Effects of Tissue Plasminogen Activator on Glaucoma Filter Blebs in Rabbits
Authors: Fourman Stuart , Vaid Kuldip
Published: April 2021

ABSTRACT

Tissue plasminogen activator ItPA), a zymogen associated with fibrinolysis, was used in an attempt to prevent scarring and the consequent loss of glaucoma filtration blebs. Bilateral trephine filter procedures were performed in 10 new Zealand white rabbits. In a randomized, masked fashion, one eye received intracameral tPA (25 µg), and the fellow placebo, immediately following surgery. One week after surgery, outflow facility in the tPA-treated eyes was significantly greater than that in the control {P<0.01}. Two weeks after surgery, the outflow facility returned to preoperative levels in all eyes. Eyes receiving tPA had larger blebs than the controls. No increase in postoperative complications, such as hemorrhage or wound leak, was attributable to tPA use. The results suggest that tPA interferes with the wound healing process after surgery and may promote glaucoma filter bleb formation.
Comparison of the Effects of Two Viscoelastic Agents, Healon and Viscoat, on Postoperative Intraocular Pressure After Penetrating Keratoplasty
Authors: Burke Sharon , Sugar Joel , Farber Marilyn D
Published: April 2021

ABSTRACT

Sixty-two patients undergoing penetrating keratoplasty were randomized to receive Healon (1% sodium hyaluronate) or Viscoat (3% sodium hyaluronate and 4% chondroitin sulfate) as a means of maintaining the anterior chamber during surgery. Neither viscoelastic agent was irrigated from the eye at the end of the procedure. Intraocular pressures (IOPs) were measured at 4, 10, 24, and 72 hours postoperatively. For the Healon group, IOPs were 16.52, 23.50, 28.31, 23.27, and 16.03 mm Hg at baseline and at the four follow-up periods, respectively. For the Viscoat group, they were 19.10, 28.33, 23.48, 18.62, and 16.17 mm Hg at those points, respectively. IOPs were significantly elevated over baseline in the Healon group at 4, 10, and 24 hours, and in the Viscoat group at 4 and 10 hours. There were no statistically significant differences between the Healon and Viscoat groups at 4, 10, and 72 hours. At 24 hours, the Healon group had a mean pressure rise over baseline of 6.5 mm Hg, while the Viscoat group had returned to baseline levels (P = .02). We conclude that both Healon and Viscoat raise postoperative IOPs, but that Healon appears to elevate IOPs for a longer period after surgery than Viscoat.
Clearance of Fluorescein Incorporated Into Microspheres From the Cornea and Aqueous After Subconjunctival Injection
Authors: Khoobehi Bahram , Stradtmann Manrique Ortiz , Peyman Gholam A , Aly Omar M
Published: April 2021

ABSTRACT

The clearance of sodium fluorescein from the cornea and aqueous humor of albino rabbits was quantitated after subconjunctival injection of fluorescein entrapped in lactide/glycolide (group 1) and lactide (group 2) microspheres. Seven hours after injection, approximately equal concentrations of fluorescein were measured in both groups in the cornea and aqueous. Fluorescein concentrations in the cornea were more than three times those found in the aqueous. Fluorescein concentrations in both groups decreased at 22 hours, and remained constant at 46 hours. Corneal fluorescein levels in group 2 were slightly higher than in group 1 at 22 and 46 hours. All eyes showed conjunctival inflammatory reaction at the injection sites after 6 days. One eye showed conjunctival necrosis at the injection site after 13 days.
Transscleral Cyclophotocoagulation of Human Autopsy and Monkey Eyes
Authors: Coleman Anne L , Jampel Henry D , Javitt Jonathan C , Brown Andy E , Quigley Harry A
Published: April 2021

ABSTRACT

We studied the effect of uveal pigmentation on contact Nd:YAG transscleral cyclophotocoagulation in 36 human autopsy and eight cynomolgus monkey eyes. Ten autopsy eyes from black individuals required less energy to croate a lesion than 23 eyes from whites. The mean lesion diameter at the posterior pars plicata was similar in all these eyes; however, the mean energy required was 4.4 J in the black and 6.4 J in the white eyes. Transscleral cyclophotocoagulation lowered intraocular pressure (IOP) in four monkey eyes with elevated IOP, but did not in four other eyes without elevated IOP. Treatment over conjunctival pigmentation burned the conjunctiva, even at the lowest energy tested (3.5 J). Contrary to other investigators' findings, transmission electron microscopy snowed at least short-term loss of scleral architecture in both the human autopsy and monkey eyes.
The Use of Tissue Plasminogen Activator in Experimental Filtration Surgery
Authors: Ozment Randall R , Laiw Zuei-Ching , Latina Mark A
Published: April 2021

ABSTRACT

Tissue plasminogen activator (tPA), a clot-specific fibrinolytic agent, was used as an adjunct to filtration surgery in Dutch belted rabbits to determine its effects on the outcome of filtration surgery. Thirty-eight animals that underwent a standardized posterior-lip sclerectomy in both eyes were divided into five postoperative protocol groups. In masked fashion, experimental eyes received 25 µg of tPA in 100 µL of diluent. Fellow eyes received 100 µL of diluent and served as controls. Group 1 received daily subconjunctival tPA. Group 2 received intracameral, followed by daily subconjunctival, tPA. Groups 3, 4, and 5 received intracameral tPA on postoperative days 1 and 2; 2 and 3; and 3, 4, and 5, respectively. Intraocular pressure (IOP), quality of bleb, number of days to bleb failure, and incidence of intraocular bleeding were determined in each group. No significant tPA effect was seen in groups 1 or 2. In groups 3, 4, and 5, the tPA-treated eyes demonstrated marked reduction of IOP and improvement in the quality of the blebs lasting between 6 to 24 hours.
Pars Plana Vitrectomy and Direct Diathermy for Complications of Multiple Retinal Angiomas
Authors: Johnson Mark W , Flynn Harry W , Gass J Donald M
Published: April 2021

ABSTRACT

A 16-year-old female had multiple retinal capillary angiomas, complicated by marked retinal and optic disc neovascularization, preretinal membranes, and retinal detachment in her right eye. Pars plana lensectomy, vitrectomy, fluid/gas exchange, direct transvitreai diathermy of the angiomas, endolaser scatter photocoagulation, and scleral buckling resulted in retinal reattachment and regression of the neovascularization. Although additional surgery was necessary for recurrent tractional retinal detachment, long-term retinal reattachment and stable vision was achieved following obliteration of all angiomas.
Direct Intraoperative Continuous Monitoring of Intraocular Pressure
Authors: Blumenthal Michael , Cahane Michael , Ashkenazi Isaac
Published: April 2021

ABSTRACT

We present a system of intraoperative continuous monitoring of intraocular pressure (IOP) consisting of a sterilizable pressure sensor attached to a digital monitor and an analogic recording instrument. Used in conjunction with an anterior-chamber maintainor, IOP may be accurately maintained at a specific and desired level.
Endothelial Cell Loss Following "Modern" Phacoemulsification by a Senior Resident
Authors: Kreisler Kenneth R , Mortenson Steve W , Mamalis Nick
Published: April 2021

ABSTRACT

Historically, extracapsular cataract extraction (ECCE) has been shown to cause less endothelial cell loss than phacoemulsification. To further evaluate endothelial cell loss following phacoemulsification, we prospectively studied 60 patients who underwent cataract extraction with "in situ" phacoemulsification within the capsular bag following a continuoustear circular capsulotomy, with placement of a posterior chamber intraocular lens (PC-IOL) in the capsular bag. All procedures were performed by a single senior ophthalmology resident. The average preoperative endothelial count was 2318 ± 36 cells/ mm
p 2
; the average postoperative count (at 8.5 weeks) was 2167 ± 41 cells/mm
p 2
. The average endothelial cell loss, then, was 6.4 ± 1.2%. This level of cell loss with a capsular-bag-fixed PC-IOL is comparable to that reported for ECCE.
Ab-Interno Neodymium:YAG Versus Erbium:YAG Laser Sclerostomies in a Rabbit Model
Authors: Hill Richard A , Özler Serdar A , Baerveldt George , Viscardi Jeffrey J , Keates Richard H , Lee Martha , Harrington James A , Berns Michael W
Published: April 2021

ABSTRACT

This study was undertaken to determine whether thermally-induced tissue necrosis was a factor in ab-interno contact-laser sclerostomy failure. A rabbit model was used to compare the continuous-wave Neodymium (Nd):YAG with the pulsed Erbium (Er):YAG laser with respect to such failure. Laser energy was focused into a fused-silica fiber optic (400 µm) for the Nd:YAG laser (12 W; 3 to 5 seconds), and into a single-crystal, uncladded sapphire fiber optic (250 µm) for the Er:YAG laser (7 to 8 mJ; 250 microseconds; 6 to 8 pulses). The Nd:YAG and Er:YAG lasers required from 21 to 35 J and from 42 to 64 mJ, respectively, to create the sclerostomies. Filtering blebs and intraocular pressure reduction lasted longer (log-rank test; P < .03) and surgical complications were fewer in the Er:YAG group than in the Nd:YAG group. By creating sclerostomies with minimal thermal damage, the Er:YAG laser may offer significant clinical advantages over lasers producing larger thermal effects.
Design and Results of Trabeculectomy Operation for Use With 5-Fluorouracil
Authors: Brooks Anne M V , Gillies W E
Published: April 2021

ABSTRACT

We revised our trabeculectomy technique in an effort to minimize the complications associated with the use of 5-fluorouracil (5-FU) in these procedures and then compared the results obtained with this procedure both with (25 patients) and without (25 patients) the use of 5-FU. There was no significant difference between the two groups in terms of mean postoperative IOP at 1 year, number of patients that required needling of the bleb to control postoperative IOP, and number of patients requiring postoperative topical medications to control IOP. Since more (although not significantly more) patients who did not receive 5-FU required needling of the bleb to maintain filtration, and since we were able to achieve satisfactory results in the great majority of cases using only a small total dose of 5-FU, we suggest that it may be simpler to use low doses of 5-FU in all trabeculectomy procedures.
Transcanalicular THC:YAG Dacryocystorhinostomy
Authors: Silkiss Rona Z , Axelrod Robert N , Iwach Andrew G , Vassiliadis Art , Hennings David R
Published: April 2021

ABSTRACT

Chromium-sensitized and thulium- and holmiumdoped YAG lasers (THC:YAG laser) were used to create a nasal bony ostium in the area of the lacrimal sac fossa in four fresh frozen bisected human cadaver heads. The lasers - long pulsed (300 milliseconds), compact, self-contained, and solid state - operate in the near infrared (2.1 urn). The opening was created by passing the 320-micrometer laser fiber across the canalicular system. Pulse energies of 250 to 900 mJ were used with a repetition rate of 5 to 15 pulses per second. Energy levels ranging from 1.25 to 9 W produced a full-thickness bony ostium approximately 3 to 4 mm in diameter. Silicone tubing was then threaded through the superior and inferior canaliculus system in the standard fashion. This technique may simplify conventional dacryocystorhinostomy as well as endonasal laser dacryocystorhinostomy procedures.
Permanent Blindness Following Retrobulbar Hemorrhage After Peribulbar Anesthesia for Cataract Surgery
Authors: Puustjärvi Tuomo , Purhonen Sinikka
Published: April 2021

ABSTRACT

We present a case in which a modified peribulbar anesthesia, administered with a 24-gauge (0.55 × 25 mm) sharp, disposable needle, induced an orbital hemorrhage, resulting in complete and permanent loss of vision. To our knowledge, this is the first report of severe complications following a peribulbar block.