bluuebunny/crossref_metadata_2025 huggingface dataset:
Cyclocryotherapy in Selected Cases of Congenital Glaucoma
Authors: Al Faran Mubarak F , Tomey Karim F , Al Mutlaq Fatma A
Published: April 2021

ABSTRACT

We investigated the efficacy of cyclocryotherapy, a procedure which destroys the ciliary epithelium, thereby decreasing the production of aqueous humor, by retrospectively studying 109 eyes with advanced primary congenital glaucoma that had undergone the procedure. The eyes were divided into two groups: group I comprised 75 eyes (69%) that had undergone conventional surgical procedures for congenital glaucoma prior to cyclocryotherapy; group II, 34 eyes (31%) that had not undergone any such previous procedures. All eyes were followed for at least 12 months after the last cyclocryotherapy. With "success" defined as "having an IOP 5= 8 mmHg, ss 19 mmHg with or without medication," the success rate in all eyes was 30%, with no significant difference between the success rates in groups I and Il (P > .05). Chronic hypotony (IOP < 8 mmHg) was found in seven eyes (6%). Six eyes (6%) developed cataract during the course of treatment with cyclocryotherapy. Cyclocryotherapy appears to be a reasonable addition to the treatment of eyes with advanced, uncontrolled, primary congenital glaucoma.
Pressure-Curve Variations After Trabeculectomy for Chronic Primary Open-Angle Glaucoma
Authors: Saiz Angel , Alcuaz Alejandro , Maquet Jose A , de la Fuente Francisco
Published: April 2021

ABSTRACT

We report the results of a 5-year study of the influence of trabeculectomy on the maximum intraocular pressure (IOP) and the amplitude of its diurnal oscillation in 26 eyes (14 patients) with open-angle glaucoma. Pressure-curves were recorded before surgery and at 1 year and 5 years after surgery. The latter two pressure-curves demonstrated that trabeculectomy significantly reduced both the maximum IOP and the amplitude of the oscillations below preoperative values.
Aminocaproic Acid Prophylaxis in Traumatic Hyphema
Authors: Wilson Thomas W , Jeffers John B , Nelson Leonard B
Published: April 2021

ABSTRACT

Oral aminocaproic acid has been shown to be effective in clot stabilization and in the reduction of secondary bleeding rates in cases of traumatic hyphema. In a retrospective study of 105 patients treated during a 1-year period, we found the incidence of rebleeding in patients with traumatic hyphema who received aminocaproic acid prophylaxis was 2%; the incidence in those who did not was 25%.
Adjunctive Use of Transconjunctival Mitomycin-C in Ab Externo Diode Laser Sclerostomy Surgery in Rabbits
Authors: Karp Carol L , Higginbotham Eve J , Griffin Eric O
Published: April 2021

ABSTRACT

This study evaluates the role of transconjunctival mitomycin-C (MMC) in laser sclerostomy surgery. Sixteen albino rabbits underwent ab externo diode laser sclerostomy surgery in one eye (with the fellow eye as a control), with a single, intraoperative, 7-minute transconjunctival application of MMC (MMC group). Ten rabbits had the same sclerostomy surgery without MMC (NOMMC group). Successful filtration, defined as a difference in intraocular pressure less than 4 mm Hg between the operative and control eyes, lasted significantly longer in the MMC group (16.4 ± 11.0 days) than in the NOMMC group (8.5 ± 4.5 days) (P = .02). These data suggest that transconjunctival MMC can enhance the success of diode laser sclerostomy surgery in rabbits.
Subconjunctival THC:YAG Laser Sclerostomy Under a Partial-Thickness Corneal Flap
Authors: Fliegler Robert J , Mastrobattista John , Luntz Maurice H
Published: April 2021

ABSTRACT

To evaluate the safety and effectiveness of THC:YAG laser sclerostomy in reducing intraocular pressure (IOP), we performed 16 subconjunctival sclerostomies under a partial-thickness corneal flap. We report the 3- and 6-month follow-up results in these patients, all of whom had intractable glaucoma resistant to previous surgical treatment. The mean IOP decreased from a pretreatment value of 30 mm Hg to a posttreatment value of 14 mm Hg at 3 months. Fifty-seven percent of the treated eyes achieved an IOP below 20 mm Hg at 6 months. A significant reduction in glaucoma medications is also reported among the successes. Complications were minimal.
Evaluation and Implantation of a Teledioptric Lens System for Cataract and Age-Related Macular Degeneration
Authors: Koziol Jeffrey E , Peyman Gholam A , Cionni Robert , Chou Jim-Son , Portney Valdemar , Sun Rong , Trentacost Debbie
Published: April 2021

ABSTRACT

The teledioptric lens implant, with a high-minus central zone, was evaluated on an optical bench and implanted in the eyes of 50 patients with both cataract and age-related macular degeneration. In vitro testing demonstrated slightly reduced contrast and modulation-transfer-function as compared with a standard intraocular lens. The lens implant functions ideally with a 1. 9-millimeter diameter on the highminus portion. Lens implantation was proven safe in the clinical study. When used with spectacles as a part of a teledioptric system, the resulting visual field was 2.6 times larger than that achieved with an external telescope. Postoperative visual acuity initially improved in more than 65% of patients. After 1 year, due to disease progression, only 20% had improved acuity.
Microbiologic Evaluation of a Hydrogen Peroxide Sterilization System
Authors: Wilkins David L , Chung Paul Y , Tsuchiya Pam Y , Wessels Izak F , Zuccarelli Anthony J
Published: April 2021

ABSTRACT

The reliability of chemical sterilizers (acetone and/or 30-percent hydrogen peroxide at 25° C and at 60° C) was tested against Bacillus subtilis inoculated onto glass slides, commercial biological indicator discs (Bacillus stearothermophilus and B. subtilis], and B. subtilis spore survival. Acetone alone was not sporicidal. Hydrogen-peroxide-sterilized glass slides were sterile after 5 minutes. The indicator discs required 25 minutes at 25" C, and less than 3 minutes at 60° C (P < .0001). The D value of B. subtilis in 27-percent hydrogen peroxide at 25° C is 2 minutes, with z values of 22° C and 26° C at 25° C and 40° C, respectively. For delicate instruments, a 30-percent peroxide solution followed by an acetone rinse provides an effective alternative to classic heat sterilization.
Subretinal Hemorrhage Removal With Multiple Retinotomy Sites in Age-Related Macular Degeneration
Authors: Milisap C Mark , Peyman Gholam A , Greve Mark D J
Published: April 2021

ABSTRACT

We report a case of subretinal hemorrhage associated with age-related macular degeneration, in which tissue plasminogen activating factor was used to help remove the subretinal blood. The surgical technique involved using multiple small retinotomy sites and alternating suction and backflushing to produce fluid flow from the subretinal space to the vitreous cavity.
Management of a Partial-Thickness Scleral-Flap Buttonhole During Trabeculectomy
Authors: Brown Steven V L
Published: April 2021

ABSTRACT

I report the use of partial-thickness Tenon'sconjunctival tissue in the repair of an intraoperative scleral-flap buttonhole that developed during trabeculectomy using adjunctive mitomycin C.
Comparison of the Prevalence of Posterior Vitreous Detachment in Whites and Japanese
Authors: Hikichi Taiichi , Hirokawa Hiroyuki , Kado Masanori , Akiba Jun , Kakehashi Akihiro , Voshida Akitoshi , Trempe Clement L
Published: April 2021

ABSTRACT

The vitreous condition of healthy white (n = 551) and Japanese (n = 528) eyes were reviewed and compared with respect to the prevalence of posterior vitreous detachment (PVD) in the two groups. No white or Japanese patient 39 years of age or younger had PVD; the prevalence among those older than 39 increased with age in the fifth through the ninth decades, ie, respectively, to 4%, 24%, 37%, 59%, and 87% in the whites, and to 5%, 21%, 43%, 72%, and 82% in the Japanese. In none of these decades was there any significant difference between the prevalence of complete or partial PVD in the whites and the Japanese. This finding is significant because the vitreoretinal relationship influences the development and prognoses of the various vitreoretinal disorders.
Tenon's Cyst Formation After Trabeculectomy With Mitomycin C
Authors: Campagna John A , Munden Paul M , Alward Wallace L M
Published: April 2021

ABSTRACT

One hundred eyes of 100 patients in whom Tenon's cysts (TCs) developed in the early postoperative period following trabeculectomy with mitomycin C were retrospectively studied to determine their incidence, possible risk factors associated with their development, and the clinical course of the patients in whom they occurred. The incidence of TC formation was 29/100 (29%). Significantly more cysts developed in the men than in the women. There were no significant differences between those patients in whom TCs developed and those in whom they did not in terms of age, race, type of preoperative medications, mean preoperative intraocular pressure (IOP), prior argon laser trabeculoplasty, prior trabeculectomy, prior Tenon's cyst formation, or prior cataract surgery.

The 29 patients in whom a Tenon's cyst developed had a mean follow up of 22.0 ± 12.9 weeks, with a mean IOP at the last examination of 14.2 ± 6.3 mm Hg (as compared with 20.7 ± 8.3 mm Hg at the time of diagnosis). One patient required a repeat trabeculectomy with mitomycin C. Two patients required bleb needling, subsequent TC excision, and eventual seton placement. Of the remaining 26, 14 (54%) required no glaucoma medication for IOP control, 11 (42%) required one, and 1 (4%) required two.
Management of Orbital and Periorbital Arteriovenous Malformations
Authors: Hayes Bartlett H , Shore John W , Westfall Christopher T , Harris Gerald J
Published: April 2021

ABSTRACT

Arteriovenous malformations (AVMs) of the orbit are progressively enlarging communications between arteries and veins that bypass normal capillary beds. In contrast to arteriovenous fistulas (AVFs), AVMs are congenital lesions with multiple large feeding arteries, a central nidus, and numerous dilated draining veins. Management of AVMs of the orbit may be difficult due to the threat of hemorrhage, vascular occlusion during treatment, and collateral damage to surrounding organs.

We managed AVM of the orbit and periorbital tissues in four patients. Neuroimaging studies, clinical decision making, operative experience, and long-term postoperative results were retrospectively reviewed. Four cases of AVM of the orbit and periorbital tissues were successfully treated with preoperative embolization and subsequent excision of the central nidus of the AVM. There was no evidence of recurrence in any of the cases over follow up ranging from 2 to 5 years.

We conclude that identification of all arterial from both internal and external carotid systems, is critical in developing a therapeutic plan. AVMs may be treated by surgical excision alone, or embolization alone. However, in the hands of an experienced interventional neuroradiologist and an appropriately chosen surgical team, most AVMs can and should be treated by a combined approach of preoperative embolization followed by surgical excision of the vascular mass. The goal of therapy is closure of the low-resistance shunt.
Simple Approach to Secondary Posterior Chamber Intraocular Lens Implantation in Patients Without a Complete Posterior Lens Capsule Support
Authors: Tomikawa Setsuko , Hara Akira
Published: April 2021

ABSTRACT

We describe a simple new method of implanting secondary posterior chamber intraocular lenses (PC-IOLs) with ciliary sulcus fixation in patients with complete posterior lens capsule support. Two pairs of PC-9 needles (Alcon Surgical, Fort Worth, Tex) are involved, each pair connected by the Girth Hitch method, with a guiding needle on one end and a tying needle on the other. This ab externo technique overcomes many of the disadvantages noted in previous reports on secondary PC-IOL implantation.
Combined Topical and Subconjunctival Anesthesia in Cataract Surgery
Authors: Anderson Charles Joseph
Published: April 2021

ABSTRACT

A combined technique of topical anesthesia (TA) and subconjunctival anesthesia (SCA) was used in 73 consecutive patients undergoing scierai tunnel phacoemulsffication cataract surgery. Medical records were evaluated preoperatively, intraoperative, and postoperatively. A patient questionnaire was used to obtain subjective intraoperative and postoperative information. Preoperative and intraoperative sedation of varying degrees was necessary. Ninety-five percent of the patients reported no pain. No patients required additional retrobulbar or peribulbar anesthesia. The most frequent postoperative problems were pain, a need for patching, and headache. The combined TA and SCA technique appeared safe, medically acceptable, and cost-effective.
Optimum Timing of Postoperative Adjustment in a Rabbit Model of Adjustable Suture Strabismus Surgery
Authors: Holmes Jonathan M , Townshend Alice M
Published: April 2021

ABSTRACT

Strabismus surgeons disagree on the optimum timing of the postoperative adjustment in adjustable suture surgery. We compared the peak force necessary for adjustment at various postoperative times using a rabbit model. Twenty-four eyes of 12 rabbits underwent a superior rectus recession of 5 mm using a standard adjustable suture technique. The eyes were randomized to adjustment at 15 minutes, and at 6, 24, and 48 hours postoperatively. The peak force required to advance the muscle 3 mm was measured using a strain gauge. During each adjustment, the peak force was noted to be that required for initial disinsertion of muscle from sclera. The mean peak force required was 14 ± 5 g at 15 minutes, 37 ± 10 g at 6 hours, 60 ± 40 g at 24 hours, and 103 ± 52 g at 48 hours. There was a significant relationship between the time of adjustment and the peak force required for adjustment (F=7.8, P=0.001). Post-hoc analysis showed that the peak force required at 48 hours was greater than that required at 24 hours (P=0.04), 6 hours (P=0.003), and at 15 minutes (P=0.0002). The force required for adjustment at 24 hours and beyond was greater than the maximal force generated by an extraocular muscle. We therefore suggest that the postoperative adjustment should be performed within the first 24 hours.
Transection of the Superior Rectus Muscle During Intended Superior Oblique Tenotomy: A Report of Three Cases
Authors: Raymond William R , Parks Marshall M
Published: April 2021

ABSTRACT

Reported complications of superior oblique surgery include postoperative vertical or torsional deviation. Brown's syndrome, head tilt, blepharoptosis, and conversion of an A-pattern to a V-pattern. McNeer reported three cases of postoperative vertical deviation, one of which was attributed to severing of the superior rectus tendon. We report three additional cases of inadvertent unrecognized transection of the superior rectus during intended superior oblique tenotomy to emphasize the importance of direct visualization of these tendons during surgery.
An Ultrasound Biomicroscopic Dark-Room Provocative Test
Authors: Pavlin Charles J , Harasiewicz Kasia , Foster F Stuart
Published: April 2021

ABSTRACT

Ultrasound biomicroscopy can image the relationship of angle structures under any lighting conditions. Eight patients with narrow angles were examined in the light and in the dark. All of the eyes showed iris thickening and shortening, increased anterior convexity of the iris, and varying degrees of angle narrowing in the dark. In one eye, the angle was completely closed. Iridotomy in this patient flattened the iris profile and opened the angle. The degree of angle opening observed after the iridotomy did not change depending on the lighting conditions. Ultrasound biomicroscopy allows imaging of dynamic changes in anterior ocular structures as they occur and provides information regarding angle occludability in the dark.
Corneal Endothelial Polymerization of Histoacryl Adhesive: A Report of a New Intraocular Complication
Authors: Markowitz Gary D , Orlin Stephen E , Frayer William C , Andrews Anthony P , Prince Richard B
Published: April 2021

ABSTRACT

Tissue adhesives are commonly used in ophthalmology to seal small corneal perforations. We report a case of inadvertent instillation of cyanoacrylate adhesive (Histoacryl) in the anterior chamber resulting in polymerization of the glue on the corneal endothelial surface, with iridocorneal and iridolenticular adhesion.
Ptosis Repair and Blepharoplasty in the Adult
Authors: Older J Justin
Published: April 2021

ABSTRACT

When contemplating upper lid ptosis and blepharoplasty surgery, preoperative evaluation is essential so that the patient and the surgeon have similar expectations as to the final result of the surgery. Blepharoplasty and ptosis repair can be performed as a combined procedure in the adult. The procedure involves excising excess skin and underlying orbicularis muscle, and in some cases, orbital fat. The levator aponeurosis is advanced onto the tarsus and the excess levator excised. An eyelid crease is formed during closure by passing a suture through the advanced aponeurosis.
Long-Term Surgical Results of Combined Trabeculotomy Ab Externo and Cataract Extraction
Authors: Tanihara Hidenobu , Negi Akira , Akimoto Masayuki , Nagata Makoto
Published: April 2021

ABSTRACT

Trabeculotomy ab externo has been demonstrated to be effective in controlling intraocular pressure (IOP) in adult patients with either primary open-angle glaucoma or pseudoexfoliation syndrome. We evaluated the surgical outcome of 60 eyes with either primary open-angle glaucoma or pseudoexfoliation syndrome that underwent combined trabeculotomy ab externo and cataract extraction. All patients were at least 40 years old, and were followed for at least 1 year. At the final examination, IOP was well controlled (21 mm Hg or less) in 54 (90%) of the 60 eyes, with or without medication. Also, "overall success" (ie, stabilization of IOP, visual field, and optic nerve status) was achieved in 49 (81.7%). Complications included fibrin exudation (22%), transient IOP elevation (17%), early perforation of the probe into the anterior chamber (10%), and detachment of Descemet's membrane (5%).

We recommend combined trabeculotomy ab externo and cataract extraction in selected cases of glaucoma with coexisting cataract. For cases in which the target IOP level is in the low teens, or for patients who may not tolerate postoperative fluctuations in IOP, we do not recommend trabeculotomy ab externo. Also, in eyes that have normal-tension glaucoma, or that have already sustained severe damage to the optic nerve, visual dysfunction caused by glaucomatous changes may progress even after successful combined trabeculotomy ab externo and cataract extraction.
Direction and Location of Retinotomy for Removal of Subretinal Neovascular Membranes
Authors: Greve Mark D J , Peyman Gholam A , Millsap C Mark
Published: April 2021

ABSTRACT

We describe two cases in which a new retinotomy technique is used to remove subretinal neovascular membranes. The direction and location of the retinotomy are of ultimate importance in prevention of damage to retinal nerve fibers and the corresponding visual field loss. The retinotomy is made with an angled 20-gauge needle in nondiathermized retina. The direction of the retinotomy is parallel to the nerve fiber layer and located over the subretinal neovascular membrane. No laser retinopexy was necessary after removal of the subretinal neovascular membrane.
Follow-up of Argon Laser Trabeculoplasty: Is a Day-One Postoperative IOP Check Necessary?
Authors: Mittra Robert A , Allingham R Rand , Shields M Bruce
Published: April 2021

* BACKGROUND AND OBJECTIVES: To evaluate the benefit of measuring the intraocular pressure (IOP) on the first postoperative day after argon laser trabeculoplasty (ALT).

* PATIENTS AND METHODS: We retrospectively reviewed 407 ALT procedures with perioperative apraclonidine performed on 226 patients between January 1991 and December 1993. Data analyzed included type of glaucoma, extent of treatment, whether the procedure was initial or repeat, laser parameters, and IOP preoperatively and at 1 hour, 1 day, and 1 month postoperatively.

* RESULTS: The percentage of patients with an IOP rise of greater than 3 mm Hg at 1 hour, 1 day, and 1 month following ALT was 11.3%, 4.2%, and 5.2% respectively. The incidence of IOP elevations greater than 10 mm Hg was 2.2%, 1.0%, and 1.5% at 1 hour, 1 day and 1 month, respectively. Of 17 cases with an IOP elevation greater than 3 mm Hg at 1 day, four eventually required a trabeculectomy. However, there were no consistent factors that distinguished which cases with elevated IOP at 1 day ultimately needed further therapy, nor did the 1-day postoperative examination predict which patients would have IOP elevation at 1 month.

* CONCLUSION: IOP 1 day after ALT is rarely elevated and does not correlate with IOP elevation at 1 month. Therefore, an IOP check at 1 day is not felt to be necessary for most patients.

[Ophthalmic Surg Lasers 1995;26:410-413.]
Comparison of Combined Cataract and Glaucoma Surgery Using Planned Extracapsular and Phacoemulsification Techniques
Authors: Shingleton Bradford J , Jacobson Lawrence M , Kuperwaser Mark C
Published: April 2021

* BACKGROUND AND OBJECTIVE: The surgical management of coexisting cataract and glaucoma is a common problem for the ophthalmologist.

* PATIENTS AND METHODS: We evaluated intraocular pressure (IOP) reduction and bleb formation in combined cataract and filtration surgery, comparing planned extracapsular cataract extraction (ECCE) and phacoemulsification approaches coupled with similar trabeculectomy techniques. Seventy-two eyes with primary open-angle or pseudoexfoliation glaucoma underwent combined cataract and filtration surgery. Thirty-five eyes underwent planned ECCE, intraocular lens (IOL) implantation, and trabeculectomy, and 37 eyes underwent phacoemulsification, IOL implantation and trabeculectomy. Minimum follow-up for both groups was 1 year with a mean of 16 months.

* RESULTS: The mean IOP reduction for phacoemulsification/trabeculectomy eyes (5.0 ± 4,3 mm Hg) was significantly lower than the mean IOP reduction for ECCE/trabeculectomy eyes (2.9 ±4.1 mm Hg; P< 0.03). There was no significant difference between the groups in terms of visual acuity improvement or glaucoma medication reduction.

* CONCLUSION: Combined cataract and filtration surgery using phacoemulsification is associated with greater IOP reduction than combined surgery using ECCE.

[Ophthalmic Surg Lasers 1995;26:4l4-419.]
Combined Pars Plana Vitrectomy, Phacoemulsification, and Intraocular Lens Implantation in the Capsular Bag: A Comparison to Vitrectomy and Subsequent Cataract Surgery as a Two-Step Procedure
Authors: Senn Peter , Schipper Isaak , Perren Barbara
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the effectiveness and safety of combined surgery.

* PATIENTS AND METHODS: Combined surgery (CS) consisting of pars plana vitrectomy (PPV), phacoemulsification, and implantation of a posterior chamber intraocular lens (PC IOL) in the capsular bag was performed on 26 patients. Another 26 had phacoemulsification with PC IOL insertion one to 84 months (mean 17.3) after PPV (sequential surgery, SS). Mean follow-up was 21.9 months after CS and 19.5 months after the cataract surgery in the SS group. The data were analyzed in a prospective, nonrandomized fashion.

* RESULTS: Visual acuity and refraction, astigmatism, accuracy of biometry, intraocular pressure, intraoperative, postoperative and long-term complications, and medical treatment were comparable in the two groups. Among the four uveitis patients in each group, transient fibrin formation was more frequent with CS (100%) than with SS (25%). The advantages of CS are that only one operation is needed, intraoperative working conditions are good, macular recovery is not masked by postvitrectomy cataract formation, and ideal lens centration is achievable. Potential disadvantages of CS include a longer operative time and increased technical demand, shrinkage of the anterior capsular opening, which may interfere with fundus view, and increased inflammation may be seen in patients with preexisting uveitis.

* CONCLUSION: Combined surgery in selected patients is a safe and effective approach, and outcomes are comparable to sequential surgery.

[Ophthalmic Surg Lasers 1995;26:420-428.]
Ocular Perforation During Retrobulbar and Peribulbar Injections
Authors: Berglin Lennart , Stenkula Staffan , Algvere Peep V
Published: April 2021

* BACKGROUND AND OBJECTIVE: To determine the ocular perforations during retrobulbar and peribulbar injections.

* PATIENTS AND METHODS: Twenty-five ocular perforations between 1976 and 1993 occurred after 13 retrobulbar and 12 peribulbar injections. Eighteen patients (72%) were women. Eighteen eyes were myopic (72%). Risk factors included high myopia in 11 cases (44%), use of Atkinson gaze in 21 cases (84%) and a sharp injection needle.

* RESULTS: Deep position of the posterior pole was common. Perforation signs comprised vitreous hemorrhage in 25 eyes (100%), subretinal hemorrhage in 19 eyes (76%), retinal breaks along the inferior vascular arcade in 19 eyes (76%), and retinal detachment in 14 eyes (56%). Proliferative vitreoretinopathy developed in 11 eyes (44%).

* CONCLUSION: Retinal detachment strongly correlated to poor visual outcome.

[Ophthalmic Surg Lasers 1995;26:429-434.]
Contact Versus Noncontact Diode Laser Transscleral Cyclophotocoagulation in Cadaver Eyes
Authors: Stroman Gesa A , Stewart William C , Hamzavi Sirus , Powers Timothy P , Blessing Walter D
Published: April 2021

* BACKGROUND AND OBJECTIVE: The optimal placement and laser energy levels of a new contact probe with a variable focus used for transscleral diode cyclophotocoagulation were compared with the diode laser noncontact technique.

* MATERIALS AND METHODS: Fresh cadaver eyes were evaluated by a modified posterior Miyake view using videotape, light microscopy, and scanning electron microscopy.

* RESULTS: The noncontact diode technique at maximum energy (1.2 J) and contact diode applications at similar energy levels failed to produce obvious gross tissue ciliary body change and mild alterations by histology. Consistent gross, histologic, and scanning electron microscopic damage was noted at 3.0 J or more with the contact probe placed at the surgical limbus and defocused 0.5 to 1.5 mm posteriorly.

* CONCLUSIONS: This study indicates that the Multilase contact diode laser causes transscleral ciliary body destruction in a cadaver eye model and may have potential clinical usefulness.

[Ophthalmic Surg Lasers 1996;27:60-65.]
Accommodation and Iridotomy in the Pigment Dispersion Syndrome
Authors: Pavlin Charles J , Macken Peter , Trope Graham E , Harasiewicz Kasia , Foster F Stuart
Published: April 2021

* BACKGROUND AND OBJECTIVE: Iris concavity has been noted in pigment dispersion syndrome, and could have a role in producing iris-zonule contact. Iris concavity is most likely caused by a relative increase in anterior chamber pressure. The method by which this occurs remains speculative. The authors used ultrasound biomicroscopy to examine the role of accommodation in producing iris concavity and to document changes that occur following iridotomy.

* PATIENTS AND METHODS: Thirteen patients with clinically diagnosed pigmentary dispersion and pigmentary glaucoma underwent accommodation studies while being continuously imaged with ultrasound biomicroscopy. Anterior chamber depths were measured and iris configuration noted on distance and near fixation. These studies were repeated in 6 patients following laser iridotomy.

* RESULTS: All patients showed a decrease in anterior chamber depth with accommodation. Ten patients had a planar iris configuration on distance fixation and 3 concave. Eleven of 13 patients showed increased concavity of the iris on near fixation as compared with distance fixation. Following iridotomy in 6 patients, the iris showed a planar configuration that remained unchanged on near fixation.

* CONCLUSION: Accommodation increases iris concavity in some patients with pigment dispersion syndrome. The most likely explanation is an accommodation-induced relative increase in anterior chamber pressure secondary to anterior movement of the lens surface. Iridotomy prevents change in the iris profile with accommodation.

[Ophthalmic Surg Lasers 1996;27:113-120.]
Vitrectomy and Juvenile Epiretinal Membrane
Authors: Desai Uday R , Blinder Kevin J , Dennehy Patrick J
Published: April 2021

Abstract. The cases of two children who had idiopathic epiretinal membranes are reported. Causes for juvenile epiretinal membranes, including trauma, pars planitis, toxocariasis, Coats' disease, or combined hamartomas, were not present. Both patients previously had documented normal vision in the affected eye. Observation revealed deterioration of vision, and a pars plana vitrectomy and a membranectomy were performed. The 5-year-old girl's vision improved from counting fingers at 5 feet to 20/80. The 12-year-old boy's vision improved from 20/200 to 20/80. Selected cases of juvenile epiretinal membranes may benefit from surgical excision. [Ophthalmic Surg Lasers 1996;27:137-139.]
Benign Orbital Fibrous Histiocytoma Simulating a Lacrimal Gland Tumor
Authors: Al-Hazzaa Selwa A F , Specht Charles S , McLean Ian W , Holds John B , Anderson Richard L
Published: April 2021

Abstract. The case of a patient with a lacrimal fossa mass that was believed to be a primary lacrimal gland tumor is reported. However, at lateral orbitotomy, the tumor was found within the lacrimal fossa, but distinct from the lacrimal gland. Histopathology revealed a benign fibtous histiocytoma. The tumor was totally excised, and has not recurred over a 3-year follow-up period. This mesenchymal tumor should be included in the differential diagnosis of lacrimal fossa mass in adults. [Ophthalmic Surg Lasers 1996;27:140-142.]
Foveal Color and Luminance Sensitivity Losses in Glaucoma
Authors: Kelly John P , Fourman Stuart M , Jindra Lawrence F
Published: April 2021

* BACKGROUND AND OBJECTIVE: Losses in color vision sensitivity are noted in patients with glaucoma and these losses can occur before the onset of visual field defects in ocular hypertensive patients. The authors incorporate a technique that measures foveal luminance and isoluminant-color thresholds.

* PATIENTS AND METHODS: This study included 31 patients with glaucoma, 1 0 patients suspected of having glaucoma, and 67 control subjects. The testing conditions measured thresholds under identical spatial and temporal conditions. Individual differences in luminosity between colors were controlled by presenting 16 different ratios of the three phosphors on a color monitor.

* RESULTS: Relative to the control subjects, the patients with glaucoma showed a nonselective defect in both color and luminance sensitivity for red-green stimuli (P < .05), but a selective color defect for yellow-blue stimuli (P < .01). There were no statistically significant differences between patients suspected of having glaucoma and control subjects (P > .3).

* CONCLUSION: If the isoluminant-color stimuli are detected by foveal P-ganglion cells, then these results suggest that glaucoma leads to a generalized decrease in P-ganglion cell sensitivity that is more pronounced for cells with an input from cones sensitive to short wavelengths.

[Ophthalmic Surg Lasers 1996;27:179-187.]
A Pneumovitrector for the Diagnostic Biopsy of the Vitreous
Authors: Peyman Gholam A
Published: April 2021

Abstract. A full-function vitrectomy instrument (pneumovitrector) developed by the author is described. This instrument is composed of an aspirating and cutting system combined with an infusion line for injecting air or gas into the vitreous cavity. Simultaneous injection of gas and removal of the vitreous pneumovitrectomy allows for a large vitreous biopsy specimen that has not been diluted with infusion fluid and does not reduce the intraocular pressure. [Ophthalmic Surg Lasers 1996;27:246-247.]
A Simple Modification of the Hoskins Lens for Patients With Dermatochalasis
Authors: Haynes William L
Published: April 2021

Abstract. This brief report describes the use of transparent tape to modify the Hoskins lens for use in patients with dermatochalasis. The modification of the lens allows it to be used in these patients without the aid of an assistant. [Ophthalmic Surg Lasers 1996;27:324-325.]
Vitreomacular Traction Syndrome Confused With Pseudophakic Cystoid Macular Edema
Authors: Falcone Philip M
Published: April 2021

Abstract. Vitreomacuiar traction syndrome causes visual loss as a consequence of persistent traction on the fovea from an attached posterior hyaloid. The diagnosis can be challenging because the attachment may be subtle. Cystoid macular edema secondary to cataract extraction is well known and can occur in the absence of any surgical complication. Herein, a patient is described who had vitreomacular traction syndrome diagnosed after uneventful cataract surgery. Pars plana vitrectomy with detachment of the posterior hyaloid restored vision to an acceptable level. Careful examination and clinical suspicion are important because recognition and surgical intervention will benefit the majority of these patients. [Ophthalmic Surg Lasers 1996;27:392-394.]
Pupillary Block Glaucoma Due to Residual Perfluoro-decalin
Authors: Alster Yair , Ben-Nun Yehoshuah , Loewenstein Anat , Lazar Moshe
Published: April 2021

Abstract. Perfluorocarbon liquids are used in vitreoretinal surgery and should be removed by the end of surgery. Removal is not always achieved and a few cases of complications resulting from perfluorocarbon liquid residues have been reported. The authors report a unique case of pupillary block glaucoma resulting from perfluoro-decalin residue in the anterior chamber that blocked a surgical coloboma of the iris at the 6-o'clock position. The perfluoro-decalin residue dissolved spontaneously with antiglaucoma treatment and no surgical intervention was needed. When perfluorocarbon liquids are used during pars plana vttrectomy, the possibility of silicone-induced pupillary block in the presence of an inferior iris coloboma should not be overlooked. [Ophthalmic Surg Lasers 1996;27:395-396.
Penetrating Keratoplasty With Donor and Recipient Corneas of the Same Diameter
Authors: Spadea Leopoldo , Bianco Guido , Mastrofini Maria Caterina , Balestrazzi Emilio
Published: April 2021

* BACKGROUND AND OBJECTIVE: A retrospective study was conducted to investigate the effect of penetrating keratoplasty (PK) with donor and recipient corneas of equal diameter on astigmatism, corneal curvature, and spherical equivalent.

* PATIENTS AND METHODS: A total of 89 eyes of 86 consecutive patients who underwent PK with donor and recipient corneas of equal diameter were studied. The surgical techniques were performed using the Hanna suction punch block (endothelial cut) with the trephine system, and a single running 16-bÍte 10-0 nylon suture. Sixteen eyes underwent a triple procedure (PK, extracapsular cataract extraction, and intraocular lens [IOL] insertion) and 14 eyes underwent PK with sulcus fixation of a posterior chamber IOL. Follow-up ranged from 12 to 30 months (mean ± SD 17.5 ± 4.7). The sutures were removed at approximately 1 2 months postoperatively.

* RESULTS: The postoperative astigmatism ranged from 0.4 to 10.8 D (mean ± SD 4.5 ± 2.8), as evaluated by a computer-assisted videokeratograph topography unit. Twenty-seven eyes (30.3%) achieved a refractive error (spherical equivalent) within ±1.5 D of emmetropia. The mean postoperative refractive error (spherical equivalent) was -0.1 ± 3.5 D (range -6.75 to +7.25). No wound dehiscences or glaucoma was noted during the follow-up.

* CONCLUSION: The Hanna suction system creates a sharp, deep, and perpendicular cut on both button cornea and host cornea, making it possible to use donor and recipient corneas of the same diameter in PK with good clinical and refractive results, particularly for myopic (keratoconus) patients.

[Ophthalmic Surg Lasers 1996;27:425-430.]
Topical Cyclosporine and Glaucoma Drainage Implant Surgery in Rabbits
Authors: Park Ki Ho , Kim Dong Myung , Youn Dong Ho
Published: April 2021

* BACKGROUND AND OBJECTIVE: To assess the effect of topical cyclosporine on the function of filtering blebs and fibroblast proliferation after glaucoma drainage implant surgery in rabbits.

* MATERIALS AND METHODS: Intraocular pressure, flow resistance through the implant capsule, and fibroblast density in the capsule were compared between 12 eyes that received implant surgery only (group A) and 1 1 eyes treated with topical 2% cyclosporine twice a day for 2 weeks after implant surgery (group B).

* RESULTS: There were significantly larger decreases in intraocular pressure at 1, 2, 4, and 8 weeks postoperatively in group B than in group A (n = 12, P < .05). Flow resistance was significantly lower in group B than in group A (n = 5, P < .05) at 8 weeks postoperatively. Fibroblast density was not significantly different between the two groups (n = 3, P> .05).

* CONCLUSION: These results suggest that topical 2% cyclosporine may enhance the effectiveness of glaucoma drainage implant surgery.

[Ophthalmic Surg Lasers 1996;27:452-458.]
"Capsulocopsis": A New Surgical Instrument and Method for Capsulotomies
Authors: Michalos Peter , Avila Eli N
Published: April 2021

Abstract. Capsulotomy using a cystotome and continuous tear capsulorhexis has dramatically improved the quality of modern cataract surgery. The authors have devised a microscalpel that has a semicircular configuration and can turn 360° and score or cut the anterior capsule. The blade also has the ability to salvage a radial tear that may occur during capsulorhexis by cutting the extension from the opposite direction and continuing the "peeling off" of the capsule. [Ophthalmic Surg Lasers 1996;27:476-478.]
Photodynamic Therapy for Antifibrosis in a Rabbit Model of Filtration Surgery
Authors: Hill Richard A , Crean David H , Doiron Daniel R , McDonald Thomas J , Liaw Lih-Huei , Ghosheh Ferris , Hamilton Ann , Berns Michael W
Published: April 2021

* BACKGROUND AND OBJECTIVE: The purpose of this pilot study was to investigate the use of photodynamic therapy (PDT) using tin ethyl etiopurpurin (SnET2) as an adjunctive antifibrotic therapy for filtering surgery in a rabbit model.

* MATERIALS AND METHODS: The pharmacokinetics of SnET2 were established by intravenous (1 mg/kg) and subconjunctival (25, 50, or 75 ug) injections and compared with controls. Intravenous and subconjunctival SnET2 injections were given prior to posterior Hp sclerectomies followed by postoperative laser irradiation (664 ± 7 nm; 100 mW/cm
p 2
; 30 J/cm
p 2
). Antifibrotic efficacy was established by clinical response and histologic examination.

* RESULTS: After subconjunctival injections, large areas of avascular conjunctiva were produced and filtering bleb survival was prolonged. No effect was found for intravenously administered photosensitizer followed by light irradiation.

* CONCLUSIONS: PDT may be an alternative antifibrotic therapy for filtration surgery that does not use chemotherapeutic agents or ionizing radiation. Multiple parameters (light, drug dose, irradiation area) may be manipulated to improve predictability of the antifibrotic effect.

[Ophthalmic Surg Lasers 1997;28:574-581.]
Free Radical Production by Nd: YAG Laser Photodisruption
Authors: Timberlake George T , Gemperli Amy W , Larive Cynthia K , Warren Keith A , Mainster Martin A
Published: April 2021

* BACKGROUND AND OBJECTIVES: Plasma and cavitation bubble formation during optical breakdown in aqueous media may produce hydroxyl (*OH) radicals. The authors' objectives were to detect *OH produced by a neodymium:yttriumaluminum-garnet (Nd:YAG) laser photodisruptor and to determine *OH concentration in relation to laser energy.

* MATERIALS AND METHODS: *OH was assayed by measuring absorbance of triiodide (I
3
^sup -^) in a potassium iodide (KI) solution exposed to optical breakdown by an Nd:YAG laser. The concentration-dependent reduction of radical production in relation to cystamine concentration was evaluated.

* RESULTS: I
3
^sup -^ concentration increased linearly with total irradiation energy and decreased exponentially with increasing cystamine concentration. *OH concentration was calculated using extinction coefficients of I
3
^sup -^ and chemical equations relating I
3
^sup -^ formation to *OH.

* CONCLUSIONS: The authors calculated that -4X1 0^sup -12^ moles of *OH are produced in a typical posterior capsulotomy of 100 mJ of total energy. This *OH concentration could produce strand breaks in -0.4% of vitreous hyaluronic acid molecules, but is unlikely to produce clinical effects.

[Ophthalmic Surg Lasers 1997;28:582-589.]
An Applicator-Shaped Scleral Depressor for Vitreoretinal Surgery
Authors: Lewis John Michael , Ohji Masahito , Tano Yasuo
Published: April 2021

Abstract. This article describes an instrument that combines a standard T-shaped scleral depressor at one end with a cotton applicator-shaped depressor at the other end. The applicator-shaped depressor has a matted surface to prevent slippage. This simple instrument has several advantages over depressors now available for intraoperative use. [Ophthalmic Surg Lasers 1997;28:603-604.]
A Case-Control Study of Suprachoroidal Hemorrhage During Pars Plana Vitrectomy
Authors: Sharma Tarun , Virdi Devinder Singh , Parikh Sunil , Gopal Lingam , Badrinath Sengamedu S , Mukesh Bickol N
Published: April 2021

* BACKGROUND AND OBJECTIVE: To investigate the risk factors associated with suprachoroidal hemorrhage (SCH) during vitrectomy.

* PATIENTS AND METHODS: Of 6971 pars plana vitrectomies performed between May 1988 and December 1994, SCH occurred intraoperatively in 12 (0.17%) cases. Forty-two age- and sex-matched control subjects were selected by computer-generated random numbers. Preoperative and intraoperative variables were subjected to univariate and conditional logistic regression analysis.

* RESULTS: Statistically significant risk factors for SCH after univariate analysis included myopia (P = .048), aphakia or pseudophakia (P = .024), rhegmatogenous retinal detachment (P = .044), scleral buckling and/or encirclage at vitrectomy (P = .029), and longer duration of surgery (P = .044). Multivariate analysis revealed independent risks associated with the absence of a lens and longer duration of the surgery.

* CONCLUSION: A knowledge of the risk factors involved with SCH helps the physician to identify patients who are at a greater risk for this complication.

[Ophthalmic Surg Lasers 1997;28:640-644.]
Aspirating Specula With Sponge Covers
Authors: Suzuki Yukihiko , Sakuraba Tomoki , Yamagami Kiyoshi
Published: April 2021

Abstract. Improved aspirating specula for the removal of irrigating fluid during ocular surgery are now commercially available. Thin sponge covers are used to prevent the conjunctiva from occluding the aspiration ports, thereby ensuring continuous effective suction. [Ophthalmic Surg Lasers 1997;28:685-686.]
Cataract Extraction in Eyes With Diabetic Iris Neovascularization
Authors: Küchle Michael , Händel Angelika , Naumann Gottfried O H
Published: April 2021

* BACKGROUND AND OBJECTIVE: Iris neovascularization used to be considered a strict contraindication to intraocular surgery, especially intraocular lens implantation. In this study, the authors analyzed whether cataract extraction and posterior chamber lens implantation is associated with unacceptable intraoperative and early postoperative complications in patients with proliferative diabetic retinopathy and rubeosis iridis.

* PATIENTS AND METHODS: Using a computerized data retrieval system, the authors identified all the patients with manifest iris neovascularization and proliferative diabetic retinopathy who underwent cataract extraction in their institution between 1989 and 1995. The preoperative, intraoperative, and early postoperative data were analyzed retrospectively with regard to complications and visual results.

* RESULTS: Thirty-nine eyes of 33 patients (mean age 64.6 ± 10.9 years) with manifest pupillary rubeosis iridis were analyzed. All but 3 of the eyes had undergone previous retinal laser treatment, with dense cataracts preventing additional photocoagulation. Additional chamber angle neovascularization was present in 11 eyes. Posterior chamber intraocular lenses were implanted in 35 eyes. Intraoperatively, iris hemorrhage was noted in 10 eyes and was significantly more frequent in eyes that underwent nuclear expression (50%) than in those that underwent phacoemulsification (12%; P = .019). Postoperatively, spontaneously resolving hyphema was observed in 7 eyes as well as reversible fibrin formation in 6 eyes. No severe sight-threatening complications occurred. Visual acuity improved in 33 (85%) of the eyes.

* CONCLUSION: Cataract extraction with posterior chamber lens implantation does not appear to be associated with unacceptable intraoperative or early postoperative complications. However, adequate treatment of underlying diabetic retinopathy prior to cataract extraction (and if necessary, postoperatively) is essential to prevent the progression of retinal and iris neovascularization.

[Ophthalmic Surg Lasers 1998;29:28-32.]
Graft Decentration in Penetrating Keratoplasty: Nonmechanical Trephination With the Excimer Laser (193 nm) Versus the Motor Trephine
Authors: Langenbucher Achim , Seitz Berthold , Kus Murat M , Vilchis Ernesto , Naumann Gottfried O H
Published: April 2021

* BACKGROUND AND OBJECTIVE: Graft decentration is an obvious cause of postkeratoplasty astigmatism. The purpose of this study was to compare graft decentration after nonmechanical trephination with the excimer laser (193 nm) with that after mechanical motor-trephination in 50 consecutive patients with Fuchs' dystrophy and 50 patients with keratoconus.

* PATIENTS AND METHODS: To determine decentration in absolute values and clock hours, a postoperative slide was projected with a fixed magnification onto a pattern with circles corresponding to the trephination margin. Using a second transparent and movable pattern with concentric circles and ellipses, the authors measured the amount and direction of decentration relative to the limbus and to the pupil. In addition, the keratometric astigmatism and the refractive cylinder were assessed. In this prospective study, the patients were assigned randomly to either method of trephination.

* RESULTS: The decentration was significantly lower (P < .002) with excimer laser trephination (0.23 ± 0.26 mm, relative to the limbus; 0.33 ± 0.26 mm, relative to the pupil) than with mechanical trephination (0.58 ± 0.23 mm, relative to the limbus [P < .01]; 0.64 ± 0.24 mm, relative to the pupil [P < .005]). There was no significant difference between the results obtained in patients with Fuchs' dystrophy and those of patients with keratoconus. The preferred direction of decentration relative to the pupil was the lower quadrants. There was a mild correlation between net astigmatism and the absolute value of decentration. However, with sutures in place, there were no significant differences in the keratometric net astigmatism between mechanical and nonmechanical trephination (P = .16) or between Fuchs' dystrophy and keratoconus (P= .18).

* CONCLUSIONS: The results indicate that the amount of decentration can be reduced by specific techniques associated with nonmechanical trephination. This might have a favorable impact on the residual astigmatism after suture removal.

[Ophthalmic Surg Lasers 1998;29:106-113.]
Late Hypotony After Cataract Extraction Due to a Scleral Fistula: A Technique for Surgical Correction
Authors: Laroche Daniel , McGowan Bernard , Greenfield David , Liebmann Jeffrey M , Ritch Robert
Published: April 2021

Abstract. The authors report the use of a surgical procedure for the correction of a scleral fistula in a patient with late hypotony after cataract surgery. Trephination of necrotic tissue lining the scleral fistula with a double scleral patch technique was performed. Four months later, the patients vision had improved to 20/40, with improvement of the macular folds and an intraocular pressure of 10 mm Hg. The authors conclude that the use of a double-patching technique is effective in the repair of scleral fistulas. The technique allows one to avoid more risky repair procedures that involve a greater area of tissue excision. [Ophthalmic Surg Lasers 1998;29:140-143.]