bluuebunny/crossref_metadata_2025 huggingface dataset:
Final Surgical Results With a Suction Trephine
Authors: Insler Michael S , Cooper H Douglas , Caldwell Delmar R
Published: April 2021

ABSTRACT

The suction trephine was studied in 31 aphakic and Pseudophakic penetrating keratoplasty patients (31 eyes). The postoperative corneal astigmatism averaged 3.9 ± 2.8 diopters overall. The 15 Pseudophakic cases in nonscarred corneas showed a marked reduction in postoperative corneal astigmatism (3.59 diopters) when compared to previous reports. Our results have encouraged us to continue use of the suction trephine in all aphakic or combined keratoplasty procedures.
Free Autogenous Grafts in Eyelid Tarsoconjunctival Reconstruction
Authors: Hawes Michael J
Published: April 2021

ABSTRACT

Classical techniques of reconstruction of large eyelid defects require temporary occlusion of the eye. Use of a free autogenous tarsoconjunctival graft with a skin-muscle flap is described. Twelve patients were operated with ten good, two fair, and no poor results. This method can be used to repair medial, lateral, and central defects of the upper and lower eyelids.
Treatment of Iris Melanoma by Photocoagulation: A Case Report
Authors: Cleasby Gilbert W , Van Westenbrugge J A
Published: April 2021

ABSTRACT

A 13-year-old white male was found to have a melanoma of the iris. Three treatments with xenon arc photocoagulation resulted in regression of the lesion with development of an iris coloboma. There were no complications, and corrected visual acuity has remained at 20/15 after a 19-year follow-up.
Effect of Peripheral Cryocoagulation on Ocular Blood Flow
Authors: Chandra Suresh R , Ernest J Terry , Goldstick Thomas K
Published: April 2021

ABSTRACT

Using the labeled microsphere impaction technique, we studied the effect of peripheral panretinal transscleral cryocoagulation in pigmented rabbits. One eye of each animal received peripheral cryocoagulation, and the fellow eye of the same animal was used as the control. Thirty-two animals received 40 exposures of peripheral cryocoagulation; twenty-six rabbits received 20 exposures. After 40 exposures of cryocoagulation, choroidal-retinal blood flow was significantly decreased when measured at one to two hours, 24 hours, and two weeks; normal flow recovered by four weeks. After 20 exposures of cryocoagulation, there was a significant reduction in choroidal-retinal blood flow at the earliest measurement time (one to two hours) only. The iris-ciliary body blood flow also was substantially decreased only at the earliest measurement time (one to two hours) and only after 40 exposures.
A Comparison of Retrobulbar Block Produced by Etidocaine 1% and by a Mixture of Lidocaine 2% and Bupivacaine 0.75%
Authors: Smith Porter H , Kemp Paul , Smith Emil R
Published: April 2021

ABSTRACT

In this double-blind study, retrobulbar block for cataract surgery was produced in 43 patients with etidocaine 1% and in 37 patients with a mixture of equal volume of lidocaine 2% and bupivacaine 0.75% (final concentrations of 1% and 0.375%, respectively). While a greater proportion of etidocaine-treated patients needed supplemental drug for block, the times of onset of sensory and motor block were not different for the two groups. Compared to treatment with etidocaine, patients treated with the mixture had a slower recovery of motor function. While the proportion of patients reporting postoperative pain was about the same in each group, both the onset of pain and the use of analgesic agents occurred earlier in the group treated with etidocaine. Thus retrobulbar blocks produced by the combination of lidocaine and bupivacaine occurred as rapidly as those produced by etidocaine but had a longer duration.
Central Retinal Artery Occlusion
Authors: Wesley Ralph E , Johnston Dan T , Gutow Gary S
Published: April 2021

ABSTRACT

Injecting steroid crystals into orbital inflammatory lesions produces a prolonged, high level of drug activity at the target tissue. This technique appears helpful in controlling orbital inflammations in problem cases while reducing the chance of steroid related systemic side effects. We report a patient who experienced central retinal artery occlusion from steroid particles injected into an orbit inflammatory mass. The mechanism of this complication and methods to reduce the chance of central retinal artery embolization are discussed.
An Instrument to Aid Intracapsular Cataract Extraction of Dislocated Lenses
Authors: Ryan Edwin H , Rosenberg Michael A
Published: April 2021

ABSTRACT

Techniques for surgical removal of a dislocated lens have evolved considerably in the past 30 years. There has been a change in preference from open-sky techniques to the use of automated vitrectomy instruments. We introduce an instrument which may be useful in selected patients with dislocated lenses. This instrument is placed through the pars plana to entrap the lens anteriorly without trauma to the retina or ciliary body. Cryoextraction of the lens through a limbal incision is then performed. We feel this instrument will be most useful in the management of a dislocated nucleosclerotic lens.
Pseudophakic Choroidal Detachment With Cyclodialysis Cyst
Authors: Slusher M Madison
Published: April 2021

ABSTRACT

Two cases of spontaneous pseudophakic ciliochoroidal detachment, associated with extracapsular cataract extraction, posterior chamber intraocular lens implantation with intact posterior capsules, and small cyclodialysis clefts are documented. In both patients, the choroidal detachments occurred in a delayed fashion following uncomplicated cataract surgery and both presented with characteristic ocular hypotony. Although one patient required surgical management, both patients regained excellent vision after closure of the clefts and resolution of the ciliochoroidal detachments.
A Clinical Review of the IOLAB Azar Model 91Z Flexible Anterior Chamber Intraocular Lens
Authors: Hagan John C
Published: April 2021

ABSTRACT

The IOLAB AZAR 91Z flexible anterior chamber intraocular lens may have the highest complication rate of any contemporary intraocular implant. Over 40,000 of these implants were inserted in human eyes. The complications of this lens includes a much higher than normal rate of chronic inflammation, cystoid macular edema, glaucoma, hyphema, vitreous hemorrhage, and pseudophakic bullous keratopathy. These complications together constitute the multiple manifestations of the UGH Plus syndrome. These complications tend to increase with time. The failure of the 91Z can be ascribed to problems of design and manufacturing causing excess movement, vaulting, and irritation of ocular tissue. Patients with this implant need to be notified of the high complication rate and the need for frequent follow-up. Most 91Z complications are recurrent or persistent and respond best to removal of the implant. Removal of the 91Z requires special technique to avoid traumatizing the eye. The design, materials, testing, manufacture, and recall of the 91Z needs close study to prevent another such problem prone lens from reaching widespread use.
Electrical Cataracts: A Case Report and Review of the Literature
Authors: Van Johnson E , Kline Lanning B , Skalka Harold W
Published: April 2021

ABSTRACT

A case report of electrically-Induced cataracts and a review of the literature is presented. Awareness of the possibility of this complication and screening of high-risk patients is stressed. The majority of cases respond well to surgery, but final visual acuity may be decreased secondary to retinal or optic nerve injury caused by the electrical current.
Transscleral Iridotomy Using a Neodymium: YAG Laser Operated Both With Standard Equipment and an Optical Fiber System - A Preliminary Report: Part II - Light and Electron Microscopic Findings
Authors: van der Zypen Eugen , Fankhauser Franz , Kwasniewska Sylwia
Published: April 2021

ABSTRACT

We report the morphology of transscleral iridotomies applied to human cadaver eyes using a free-running Nd:YAG laser (pulse duration: 20 ms, pulse energy: 1.5-6 J) with and without a fiber optic system. The pigment epithelium, which represents the barrier to the aqueous humor for passing through the iris, is damaged and blasted away over great areas. The mesothelial layer at the anterior surface of the iris is also broken up by the laser beam. Using low pulse energies, the iris stroma is only partially damaged.

The destruction of the iris is caused by generation of heat due to absorption of radiated energy.
Why Are Refractive Surgeons Still Wearing Glasses?
Authors: Wyzinski Peter
Published: April 2021

ABSTRACT

A 38-year-old ophthalmologist describes his thoughts and perceptions before, during, and for 12 months after bilateral radial keratotomy. Three kinds of visual fluctuations were experienced. Adaptation to monovision was good.
Herpetic Canalicular Obstruction
Authors: Harley Robison D , Stefanyszyn Mary A , Apt Leonard , Nelson Leonard B
Published: April 2021

ABSTRACT

The viruses of primary herpes simplex, herpes zoster, chicken pox, and vaccinia may produce Inflammatory changes in the epithelial lining of the lacrimal canalicult, resulting in varying degrees of obstruction. Five cases are described and compared with previously reported cases. A review of the literature suggests that the association of ocular viral infections and canalicular complications may be more prevalent than previously suspected. The possible important role of antiviral agents is considered. Early recognition and intubation can often prevent permanent canalicular obstruction, but late cases may require the Jones tube procedure, conjunctivodacryocystorbinostomy.
An Intraoperative Intraocular Pressure Monitor
Authors: Parel Jean-Marie , Parrish Richard K , Nose Izuru
Published: April 2021

ABSTRACT

An au tocia va ble instrument based on piezoelectric principles for intraoperative monitoring of the intraocular pressure is presented. Accurate and rapid recordings of intraocular pressure during various surgical techniques are discussed.
Subconjunctival 5-Fluorouracil Mechanisms of Ocular Penetration
Authors: Fantes Francisco E , Parrish Richard K , Heuer Dale K , Sossi Nunzio
Published: April 2021

ABSTRACT

Aqueous, corneal, and tear film
p 14
C 5-fluorouracil (5FU) levels were measured in rabbit eyes to better understand the mechanisms of intraocular penetration after subconjunctival injection. Significantly higher aqueous and tear 5-FU levels were achieved one hour after administration when the subconjunctival injection was given transconjunctivally rather than percutaneously through the upper lid [aqueous = 65.7 ± 9.1 µg/ml vs 21.3 ± 5.1 µg/ml(mean ± SE; p = 0.02,2tailed t-test); and tears = 5408.8 ± 357.3 µg/ml vs 228.0 ± 46.4 µg/ml (mean ± SE; p = 0.004, 2-tailed t-test)]. The aqueous 5-FU levels four hours after transconjunctival injection were significantly greater in anesthetized rabbits without blink reflexes than in those with intact reflexes [32.0 ± 3.2 µg/ml vs 13.4 ± 0.5 µg/ ml (mean ± SE; p = 0.026, 2-tailed t-test)]. The corneal 5-FU levels four hours after transconjunctival injection were greatest nearest the injection site. Direct corneal penetration appears to account for the majority of the aqueous 5-FU concentration after subconjunctival injection; however, there may also be diffusion through the limbus.
Cataract Blindness in Africa
Authors: Foster Allen
Published: April 2021

ABSTRACT

Of the estimated 17 million blind from cataract in the world, two to three million live in Africa, where manpower and material resources are inadequate to meet the increasing backlog of treatable blindness.

The training of primary health care workers to screen rural Africans for cataract, and of eye auxiliaries and general doctors to select patients and perform surgery, is essential.

Motivation for surgery will increase if eye services are made more accessible and reliable. This requires more motivated trained staff and appropriately equipped static eye facilities.
Subperiosteal Orbital Hematoma: Visual Recovery Following Delayed Drainage
Authors: Kersten Robert C , Rice Charles D
Published: April 2021

ABSTRACT

Subperiosteal orbital hematomas are rare sequelae of blunt periorbital trauma. Visual loss in such cases is very infrequent, but reportedly irreversible, unless treated with early decompression. A 17-year-old boy developed marked visual loss secondary to an acutely developing traumatic subperiosteal orbital hematoma. Despite delayed referral surgical evacuation of the hematoma remarkably restored his vision. Postoperative clinical examination, fluorescein angiography, and electrophysiologic testing confirmed that a compressive optic neuropathy had caused the visual dysfunction.

Although immediate surgical decompression remains the treatment of choice for subperiosteal hematomas producing visual loss, this case demonstrates that the optic nerve may recover dramatically even after a prolonged period of dysfunction from compression.
A New Instrument for Nucleus Prolapse: Results and Surgical Technique
Authors: Newell Steven W , Parsley Teresa L
Published: April 2021

ABSTRACT

A new instrument for use in prolapsing a cataract nucleus into the anterior chamber during extracapsular cataract extraction is described. This instrument is a modification of the Kelman Blunt Irrigating Cystatome and the Youens Lens Manipulating Cannula. The tip is elongated, rounded, broadened, and set at an angle from the instrument shaft to enhance broad surface contact of the instrument tip with the nucleus equator. In a recent series of 100 consecutive cataract procedures it was possible to completely prolapse the nucleus into the anterior chamber in all but six cases. The surgical technique is described.
Ptosis and Dermatochalasis as Presenting Signs in a Case of Occult Primary Systemic Amyloidosis (AL)
Authors: Gonnering Russell S , Sonneland Paula R
Published: April 2021

ABSTRACT

Amyloidosis (AL) is a disease characterized by the extracellular deposition of a complex glycoprotein, part of which is derived from light chains of immunoglobulins. The ocular adnexa can be involved in both systemic primary amyloidosis (AL), usually associated with multiple myeloma or other immunologic disorders, or in a localized form without such systemic implications. We present the case report of a 65-yearold man in whom occult primary systemic amyloidosis (AL), associated with a monoclonal IgG-kappa gammopathy, occurred with presenting signs of ptosis and dermatochalasis secondary to infiltration of the extraocular and orbicularis oculi muscles with amyloid.
Total Facial Nerve Palsy Following Modified O'Brien Facial Nerve Block
Authors: Spaeth George L
Published: April 2021

ABSTRACT

A 78-year-old white male developed a total facial palsy immediately following a modified O'Brien facial nerve block utilizing mepivacaine 2%, 10 cc. There was no apparent complication at the time of the nerve block. The facial palsy persisted unchanged for three months, at which time recovery of function was first detectable. Recovery was clinically complete nine months after the palsy occurred. The presumed cause was direct trauma by the needle at the time of the injection.
The Effect of a Collagen Bandage Lens on Corneal Wound Healing: A Preliminary Report
Authors: Aquavella James V , del Cerro Manuel , Musco Paul S , Ueda Shunsuke , DePaolis Michael D
Published: April 2021

ABSTRACT

Collagen bandage lenses were inserted in 24 eyes of white New Zealand rabbits following 8-inclsion radial keratotomy. Specimens were examined at eight and 24 hours by light and electron microscopy. Treated eyes demonstrated more complete epithelial healing, as evidenced by surface microvilli and differentiation into multi-layers. In the treated eyes there was reduced stromal edema at the wound site, and reactive keratocytes were limited to the wound margins. Collagen bandage lenses therefore may be useful in the treatment of a variety of ocular surface problems.
Perforation of the Globe During the Injection of Local Anesthesia
Authors: Zaturansky Boris , Hyams Stanley
Published: April 2021

ABSTRACT

Perforation of the globe occurred during injection of local anesthetic into the eyelids. No such occurrence has been reported, although there have been reports of perforation of the globe during retrobulbar injection (five cases), while injecting anesthetic around the superior rectus muscle (one case), and when placing the superior rectus bridle suture (four cases). The prognosis is good if the perforation is recognized and treated immediately. New methods of local anesthesia should greatly reduce the incidence of this complication.
A Case of Prostatic Carcinoma Metastatic to the Orbit Diagnosed by Fine Needle Aspiration and Immunoperoxidase Staining for Prostatic Specific Antigen
Authors: Kopelman Joel E , Shorr Norman
Published: April 2021

ABSTRACT

A fine needle aspiration biopsy of the mass guided by computerized tomography was performed on a 65-year-old male with unilateral proptosis, inflammation, and diplopia in downgaze. Using an immunoperoxidase technique for prostatic specific antigen, the cytologic specimen stained positively. Subsequently, a needle biopsy of the prostate gland confirmed the presence of a moderately well-differentiated infiltrating carcinoma.
Oncocytic Carcinoma of the Plica Semilunaris With Orbital Extension
Authors: Gonnering Russell S , Sonneland Paul R
Published: April 2021

ABSTRACT

A 76-year-old male had orbital extension and regional lymph node involvement from an oncocytic carcinoma thought to have arisen in the plica semilunaris of the left eye. Declining early orbital exenteration and radical neck dissection, the patient received radiation therapy. Although initial palliation was achieved, the lesion recurred 1 year later, with massive orbital involvement. Despite exenteration and chemotherapy, the patient expired within 6 months.

Oncocytomas arise from transformed, epithelial cells, generally in the medial canthal region. Oncocytic carcinoma of the ocular adnexa is extremely rare and no such lesion of the plica semilunaris has been reported.
Implantation Growth of an Iris Melanocyte Lesion Simulating a Ciliary Body Melanoma
Authors: Kremer I , Weinberger D , Cohen S , Lusky M , Ben-Sira I
Published: April 2021

ABSTRACT

A 59-year-old woman had a sectorial pigmented iris tumor in her right eye and was found to have secondary glaucoma unresponsive to medical therapy. Gonioscopy revealed a satellite tumor in the inferior chamber angle, which we suspected to be a ciliary body melanoma. Subsequently, both lesions were removed completely by superior total and inferior partial iridocyclectomy. Histologic examination disclosed a spindle cell nevus with surface plaque associated with a borderline epithelioid cell nevus. This case is an example of unexpected clinical findings that may be encountered in any iris melanocytic lesion, benign or malignant, and the consequent problems of diagnosis and management.
A New Infusion-Aspiration System for Extracapsular Cataract Surgery
Authors: Drews Robert C
Published: April 2021

ABSTRACT

This new unit has the advantages of motorized aspiration with greater control and far less cost than a console unit. The instrument is small and light enough to fit comfortably in the surgeon's hand. For those who prefer a small light handpiece, the unit is available in two parts. It is simply designed like a manual aspiration system without the disadvantage of two-handed operation.
Plus Meridian Incision for Secondary Implantation
Authors: Karickhoff John R
Published: April 2021

ABSTRACT

We studied 25 consecutive secondary implantations with a minimum of 4 months follow-up to learn the effect on astigmatism of passing or not passing the incision through the most plus corneal meridian. Eighteen of the 19 cases having a most plus meridian incision had postoperative astigmatism of 1 diopter or less, and their average astigmatism was reduced by surgery. All six of the cases with the incision not passed through the most plus meridian had postoperative astigmatism greater than 1 diopter, and their average astigmatism was doubled by surgery. The astigmatic difference between the two patient groups was highly significant. A most plus meridian incision is recommended.
An Anterior Limbal Approach to Vitrectomy for the Surgical Management of Infectious Endophthalmitis
Authors: Davis Richard M , Rowsey J James , Jensen Harold G
Published: April 2021

ABSTRACT

We present two cases illustrating a surgical approach to the diagnosis and treatment of infectious endophthalmitis following extracapsular cataract extraction with insertion of a posterior chamber lens. In both cases, a vitrectomy was initiated through a limbal approach after clearing the anterior chamber, thus allowing improved visualization of the vitreous cavity. The vitrectomy probe was then passed through a peripheral iridotomy, the peripheral posterior capsule and/or zonules, and into the anterior vitreous. The peripheral iridotomy allowed access to the vitreous cavity for an anterior vitrectomy. The entire anterior chamber and vitreous aspirate was then analyzed for culture and sensitivity. This technique minimizes the risks of pars plana vitrectomy for endophthalmitis by improving visualization and possibly decreasing the risk of retinal detachment.
Congenital Retraction of the Upper Lid
Authors: Ballen Peter H , Rochkopf Lavi
Published: April 2021

ABSTRACT

A 6-year-old boy with congenital retraction of the left upper lid was treated with guanethidine without result. Recession of the levator with release of the lateral expansion of the levator resulted in the normal position of the left upper lid.
Astigmatism After Cataract Surgery: Nylon Versus Mersilene
Authors: Drews Robert C
Published: April 2021

ABSTRACT

To find out if postoperative astigmatism decays less if Mersilene rather than nylon sutures are used, 25 patients had a standard wound closure with 10-0 nylon in one eye and 11-0 Mersilene in the other. There was no difference in the astigmatism decay over a 6-month period.
Preclinical Evaluation of a New Donor Corneal Trephination System
Authors: Allarakhia Liaquat , Skelnik Debra L , Aysta James E , Lindstrom Richard L
Published: April 2021

ABSTRACT

A new corneal trephination system developed by the University of Minnesota, Department of Ophthalmology and Vision Care/3M features a corneal holder that orients and stabilizes the donor cornea during storage, transportation, and trephination. A gravity corneal punch, and disposable trephine and cutting block minimize corneal button irregularities that in other devices may contribute to postoperative astigmatism. This new system was compared with the Iowa Press by evaluating trephinated corneas on the basis of profile projectors. Buttons trephined from 10 pairs of human corneas stored in (CSM) preservation solution at 4° C were evaluated by measuring diameters and edge angles and correlating them with the trephine size used. In contrast with the Iowa Press, this new system produces corneal buttons that are consistently circular, parallel-edged, and identical in size to the trephine used.
Experimental Evaluation of Low-Viscosity Fluorosilicone Oil as a Temporary Vitreous Substitute
Authors: Liu Kwan-Rong , Peyman Gholam A , Miceli Michael V
Published: April 2021

ABSTRACT

Fluorosilicone oil, a high specific gravity fluorinated siticene oil, has been recently reevaluated for temporary use in surgery to repair complicated retinal detachments. We evaluated the toxicfty of a low-viscosity 300 centistokes) fluorosilicone oil as a vitreous substitute in vitrectomized eyes of albino rabbits. No toxicrties could be demonstrated by histopathologic and electroretinographic examinations 6 weeks following surgery. In vitro experiments also showed no toxic effects on cultured retinoblastoma cells. When fluorosilicone oil was injected into the anterior chamber, endothelial cell damage could be seen 2 weeks following injection. Low-viscosity fluorosilicone oil appears to be a safe vitreous substitute for temporary use; it is easily injected and removed, and it maintains adequate surface tension for intraocular tamponade. Because of its relative low viscosity, 300-cst fluorosilicone oil (FS) may be a better vitreous substitute than perfluorocarbon liquids for both intraoperative manipulation of the retina and short-term intraocular tamponade for complicated retinal detachments.
Intraocular Pressure After Peripheral Retinal Cryopexy in Normotensive Human Eyes
Authors: Schubert Hermann D
Published: April 2021

ABSTRACT

Intraocular pressure (IOP) was measured before and after peripheral retinal cryopexy given for lattice degeneration and small retinal breaks. During the period of observation the IOP of treated eyes decreased, suggesting that freezing of areas remote from the ciliary body may tower IOP through mediation and/or transscleral outflow.
A Comparative Evaluation of Three Methods of Analyzing Optic Disc Topography
Authors: Varma Rohit , Douglas Gordon R , Steinmann William C , Wijsman Kees , Mawson Dan , Spaeth George L
Published: April 2021

ABSTRACT

Topographical evaluations of the optic discs of 17 eyes obtained using a clinical planimeter, the Rodenstock video-ophthalmograph, and the IS 2000 image analyzer were compared. The parameters studied were vertical and horizontal cup-to-disc ratios, cup volumes, rim areas, disc areas, and rim area-to-disc area ratios. There was good correlation between the measurements obtained by the three methods (correlation coefficients ranged from 0.46 to 0.88). For various parameters, the correlations between clinical planimetry and image analysis were higher than either those between image analysis and video-ophthalmography, or those between clinical planimetry and video-ophthalmography. The mean horizontal cup-todisc ratios and rim areas as measured by clinical planimetry were significantly higher than those measured by image analysis. Image analysis measured signiflcantly higher disc area and rim areas and lower cup volumes than video-ophthalmography.
Intraocular Lens Explantation With and Without Penetrating Keratoplasty
Authors: Noecker Robert J , Branner William A , Cohen Kenneth L
Published: April 2021

ABSTRACT

We reviewed the records of 33 consecutive patients who had undergone intraocular lens (IOL) explantations for IOL-related complications. Results from 19 eyes that underwent penetrating keratoplasty at the time of explantation (pk eyes) were compared with the results from 14 eyes that underwent only IOL explantation (nk eyes). Uvettis was the most common indication for explantation in the npk eyes; frank bullous keratopathy was the most common in the pk eyes. Fifteen of the IOLs explanted from the pk eyes were anterior chamber IOLs, 13 of which were the semiflexible, closed-loop type. Ten of the npk eyes had anterior chamber IOLs explanted, six of which also were the semiflexible, closed-loop type. Visual acuities in the pk group were significantly worse than they were in the npk group, both before and after explantation. Based on this review, we conclude that if anterior chamber and iris-supported IOL complications occur and medical therapy fails, IOL explantation prior to the need for penetrating keratoplasty may improve visual acuity.
Peribulbar Anesthesia for Primary Vitreoretinal Surgery
Authors: Nicholson Anjali D , Singh Preetam , Badrinath Sengamedu S , Murugesan Radha , Sundararaj Ian , Vardarajan Srinivasan , Krishnan Madhusudan , Nagarajan Krishnaswamy , Gopal Lingam , Sharma Tarun , Challa Jagannadh K
Published: April 2021

ABSTRACT

We prospectively studied the efficacy of peribulbar anesthesia in 76 consecutive patients who underwent vitreoretinal surgery. The mean duration of anesthesia was 124.74 ± 50.17 minutes, and the mean duration of akinesia, 151.5 ± 54.45 minutes. Adequate anesthesia and akinesia, independent of the duration of surgery, was obtained in 26 of 33 (78.8%) patients who underwent vitrectomy; 9 of 32 (28.1%) who underwent scleral buckling; and 2 of 11 (18.2%) who underwent vitrectomy combined with scleral buckling. In all, topical and systemic supplementation of drugs for inadequate anesthesia or akinesia allowed 32 of the 33 (97%) vitrectomies, 30 of the 32 (94%) scleral buckling procedures, and all 11 of the combined surgeries to be completed as planned. Three (4%) patients vomited, moved, or were restless, resulting in an operative complication or postponement of surgery. Fifty-eight (76%) said they would desire similar anesthesia if subsequent surgery was needed in the same or fellow eye. We conclude that peribulbar anesthesia should be considered primarily for patients requiring vitreous surgery alone, and as an alternative for patients requiring scleral buckling or combined surgery for whom general anesthesia is contraindicated.
Combined Cataract-Glaucoma Surgery Using the THC:YAG (Holmium) Laser Ab Interno Without Gonioscopy
Authors: Kendrick Ronald M , Kollarits Carol R
Published: April 2021

ABSTRACT

We describe a simple method of combined cataract-glaucoma surgery, involving use of the THC:YAG (holmium) laser ab interno, without gonioscopy, in which the initial cataract incision remains small and the glaucoma filtering procedure can be completed relatively quickly, with minimal surgical manipulation of the conjunctiva. In a series of 15 eyes (13 patients) with visually significant cataracts and medically uncontrolled glaucoma, followed for an average of 14 weeks (range, 1 to 26 weeks), 13 of the 15 eyes had decreased IOR Visual acuity was improved in 9 eyes, remained the same in 4 eyes (with age-related macular degeneration), and was worse in 2 eyes (with opacification of the posterior capsule sufficient to account for the decrease in acuity).
Intraocular Lens Insertion During Vitrectomy
Authors: Smiddy William E
Published: April 2021

ABSTRACT

Vitrectomy was performed in 10 patients in combination with posterior chamber intraocular lens (IOL) insertion. Indications for vitrectomy included traumatically dislocated cataract, choroidal hemorrhage, epiretinal membrane, lens involving intraocular foreign body, vitreous hemorrhage, and extruded anterior chamber IOL. Postoperative visual acuity improved in each case. The main advantages of simultaneous IOL insertion, in selected cases, are reduced cost and inconvenience, and more rapid visual rehabilitation.
Pupillary Capture of a Posterior Chamber Lens Following Convulsive Seizures
Authors: Forstot S Lance , Ellis Philip P
Published: April 2021

ABSTRACT

Total pupillary capture of the optic of a posterior chamber intraocular lens (PC-IOL) occurred over 1 year after implantation, following severe, convulsive seizures. We suggest that the generalized seizures and associated extraocular muscle contractures created significantly elevated vitreous pressure, which caused anterior displacement of the IOL. To our knowledge, this is the first reported case of late pupillary capture of a PC-IOL following severe, convulsive seizures.
Topical Fluorometholone Reduces Stremal Inflammation After Photorefractive Keratectomy
Authors: Campos Mauro , Abed Hamid Moghareh , McDonnell Peter J
Published: April 2021

ABSTRACT

To examine the effectiveness of topical steroids in decreasing corneal stremai inflammation induced by photorefractive keratectomy, four rabbits underwent uniocular corneal deepithelialization, or deepithelialization followed by photorefractive keratectomy. Topical fluorometholone acetate 0.5% was applied topically to half of the eyes after photorefractive keratectomy. Polymorphonuclear leukocytes (PMNs) were counted 24 hours after surgery· The number of PMNs in the corneal stroma was significantly higher after photorefractive keratectomy than after deepithelialization alone (P = .001) and than in normal unoperated corneas; fluorometholone treatment significantly reduced PMN accumulation (P = .001). Photorefractive keratectomy in rabbits induces an intense inflammation of the superficial stroma that can be effectively treated with topical fluorometholone. A short course of topical corticosteroide may, therefore, be appropriate after excimer laser surgery in humans.
A Technique for Knotting a Suture Around the Loops of a Dislocated Intraocular Lens, Within the Eye, for Fixation in the Ciliary Sulcus
Authors: Navia-Aray Emigdio A
Published: April 2021

ABSTRACT

I describe a new, simpler, technique for attaching a suture to the haptic of a dislocated posterior chamber lens implant. A 10-0 polypropylene suture is used, doubly armed with straight needles. This technique has been used successfully in five cases.
Trabeculotomy Combined With Phacoemulsification and Implantation of an Intraocular Lens for the Treatment of Primary Open-Angle Glaucoma and Coexisting Cataract
Authors: Tanihara Hidenobu , Honjo Megumi , Inatani Masaru , Honda Yoshihito , Ogino Nobuchika , Ueno Satoki , Negi Akira , Ichioka Hiroshi , Mizoguchi Takanori , Matsumura Miyo , Nagata Makoto
Published: April 2021

* BACKGROUND AND OBJECTIVE: The authors previously reported the usefulness of trabeculotomy ab externo for the treatment of primary openangle glaucoma in adult patients. In an attempt to elucidate the long-term risk-to-benefit ratio of this surgical modality in combination with cataract surgery, the authors conducted a retrospective study of the surgical effects and complications of a triple procedure: phacoemulsification, implantation (of an intraocular lens), and trabeculotomy (PIT).

* PATIENTS AND METHODS: The authors conducted a retrospective study of patients treated with PIT at multiple hospitals. Intraocular pressure (IOP) and visual function data were obtained from patients after PIT as an initial surgical treatment in cases where antiglaucoma medications failed to resolve uncontrolled IOP (higher than 21 mm Hg). Included in this study were 96 eyes of 64 patients with primary openangle glaucoma and coexisting cataract. The mean follow-up period was 22.6 ± 14.7 months (range 3-56 months).

* RESULTS: In 94 (98%) of the 96 eyes, the IOP was well controlled, having achieved a level of 21 mm Hg or lower at the final examinations. The mean preoperative IOP of the 33 eyes that underwent the triple procedure using a single flap method (PIT-I) was 24.3 ± 3.9 mm Hg, with an average of 2.1 ± 1.1 medications. At the final examinations, the mean IOP had dropped to 16.0 ±1.2 mm Hg, with an average of 1.2 ± 1.2 medications. The mean preoperative IOP of the 63 eyes that underwent the triple procedure using a double flap method (PIT-II) was 26.2 ± 6.2 mm Hg, with an average of 1.9 ± 1.2 medications. At the final examination, the mean IOP for this group was 15.6 ± 2.9 mm Hg, with an average of 1.0 ± 0.9 medications.

* CONCLUSION: The long-term results from this multicenter study showed that the triple procedure, PIT, can be useful and effective as an initial surgical treatment for open-angle glaucoma in glaucoma patients with coexisting cataract.

[Ophthalmic Surg Lasers 1997;28:810-817.]
Intraoperative Miotics and Posterior Capsular Opacification Following Phacoemulsification With Intraocular Lens Insertion
Authors: Phillips Barratt , Crandall Alan S , Mamalis Nick , Olson Randall J
Published: April 2021

* BACKGROUND AND OBJECTIVES: Posterior capsular opacification (PCO) is a frequent complication following phacoemulsification with intraocular lens (IOL) implantation. A series of consecutive patients receiving capsular bag- fixated, silicone IOL implants were assessed for both incidence of PCO and the administration of intraoperative miotics.

* PATIENTS AND METHODS: During a 5-year period, 477 consecutive eyes were retrospectively evaluated. Surgeries were grouped according to intraoperative miotic agent: 0.01% carbachol or 1.0% acetylcholine. Patients receiving no miotic drug served as a control group. Yttrium-aluminum-garnet (YAG) laser posterior capsulotomy was performed on patients with clinically significant PCO.
Rotational Autokeratoplasty in Advanced Lipid Keratopathy
Authors: Sah Woo J , Myoung Yoon W , Hahn Tae W , Kim Jae H
Published: April 2021

Abstract. The authors performed autokeratoplasty (AKP) on four eyes of four patients with advanced lipid keratopathy to improve their visual acuity and the subjective symptoms. The patient group consisted of four females (mean age 28.8 years), each having an advanced lipid keratopathy that obscured the pupillary zone with large feeding vessels. The average best-corrected visual acuity, which was 20/286 preoperatively, was 20/35 after AKR The central cornea had remained clear for each patient as of the final follow-up (mean 18.5 months), and there were no instances of vascular ingrowth or lipid infiltration into the autograft. The most common complaint was a poor cosmetic appearance of the cornea. AKP may be a useful surgical technique for recovering visual acuity and preventing further progression, not only in nonprogressive, localized corneal opacity, but also in some progressive corneal diseases, such as an advanced lipid keratopathy. [Ophthalmic Surg Lasers 1997;28:1020-1024.]
Clinical Application of Er:YAG Laser for the Treatment of Pterygium
Authors: Nakammura Kunihiko , Bissen-Meyajima Hiroko , Shimmura Shigeto , Tsubota Kazuo
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the clinical application of Er: YAG laser for the treatment of pterygium.

* METHOD: Five patients (5 eyes) with pterygium, 2 primary cases and 3 retreatment cases, whose ages ranged from 44 to 68 years (mean 54.4 years), were treated with the Er: YAG laser. The optical system consisted of a fluorozirco-aluminate glass fiber and a handpiece tip made of quartz glass. The tip of the guiding probe was applied to the surface of the pterygium, where the laser beam was emitted. The radiant energy was set at 10 mj with water spray.

* RESULT: The removal of pterygium was accomplished under topical anesthesia with a laser output approximate range from 50 to 100 shots. Complications such as corneal erosion or thinning of the sclera were not observed. However, recurrence was seen in the 3 retreatment cases.

* CONCLUSION: The Er: YAG laser system may be a clinically useful tool as a laser surgical knife for ocular tissue.

[Ophthalmic Surg Lasers 2000;31:8-12.]
Photoablative Laser-Grid Trabeculectomy in Glaucoma Filtering Surgery: Histology and Outflow Facility Measurements in Porcine Cadaver Eyes
Authors: Jacobi Philipp C , Dietlein Thomas S , Colling Tom , Krieglstein Günter K
Published: April 2021

* BACKGROUND AND OBJECTIVE: Midinfrared laser technology opens new perspectives in experimental glaucoma surgery. The aim of the study was to determine the efficacy of grid-laser trabeculectomy to reduce aqueous outflow resistance sufficiently in perfused porcine cadaver eyes.

* MATERIALS AND METHODS: Twenty-five freshly enucleated porcine cadaver eyes were randomly assigned to either laser-grid trabeculectomy (LGT), conventional trabeculectomy (CT), or control. In all surgical cases a scierai flap was prepared in a standardized manner. In order to penetrate into the anterior chamber a 1 × 2 mm sclerectomy was performed in CT, and 10 transscleral ablation craters were created in LGT. An erbium:YAG laser (2.96 µm) was used for transscleral photoablation. Radiation was delivered in a single 6 mJ-pulse of 200 µs duration by means of an articulated zirconium fluoride optical fiber and a 200 µm quartz fiber-tip. Outflow facility was measured at a constant perfusion pressure.

* RESULTS: Laser-grid trabeculectomy (LGT) yielded reproducible ablation areas varying between 210-300 µm in diameter, with 90% being full-thickness penetrations. Collateral thermal damage was less than 30 µm. Outflow facility measurements revealed a statistically significant increase (mean ± SD) from 0.255 ± 0.096 µL/min/mm Hg in control eyes (n = 9) to 0.772 ± 0.157 µL/min/mm Hg in the LGT group (n = 9), and 2.957 ± 0.602 µL/min/mm in the CT group (n = 7). Flattening of the anterior chamber, folding of Descemets membrane, and iris prolapse were only observed in the CT eyes but not in the GLT group.

* CONCLUSION: Application of the laser-grid trabeculectomy produces patent transscleral perforation with minimal collateral tissue damage and effects a significant reduction (67%) in outflow resistance without any postoperative hypotony-related complications.

[Ophthalmic Surg Lasers 2000;31:49-54.]
Nocardia Endophthalmitis Following Uncomplicated Phacoemulsification and Implantation of a Posterior Chamber Intraocular Lens
Authors: Cacchillo Paul F , Ciulla Thomas A , Strayer Thomas , Fisher Michael , Massicotte Stephen
Published: April 2021

Abstract. A patient developed endophthalmitis 15 days after uncomplicated cataract extraction. Excised infectious material sequestered in the capsular bag revealed Nocardia on culture. She required multiple intravitreal injections of Amikacin and dexamethasone, pars plana vitrectomies with explantation of the lens, and chronic topical and oral sulfonamide antibiotics to control the infection. Clinicians should also consider Nocardia when the suspicion of fungal endophthalmitis is entertained, as Nocardia are resistant to antifungals, but respond to intravitreal amikacin and chronic topical and oral sulfonamides. [Ophthalmic Surg Lasers 2000;31:64-65.]
Clinical Results of Ahmed Glaucoma Valve Implantation in Refractory Glaucoma with Adjunctive Mitomycin C
Authors: Kook Michael S , Yoon Juntaek , Kim Jaeyong , Lee Moo-Song
Published: April 2021

* OBJECTIVE: To study the surgical outcome and complications of Ahmed glaucoma valve (AGV) implantation with mitomydn C (MMC) in refractory glaucoma.

* PATIENTS AND METHODS: The authors retro spectively reviewed the records of 40 eyes in 37 consecutive patients who underwent combined AGV with MMC (0.4 mg/mL; 5 minutes). All patients had a minimum of 6 months of follow-up. Outcome measures were best corrected visual acuity, intraocular pressure (IOP), the number of medications, success rates, and the incidence of complications.

* RESULTS: The Kaplan-Meier life table analysis revealed that the probabilities of surgical success based on our success criteria at 1 year and 2 years postoperatively were 80% and 77%, respectively. Postoperative IOP was significantly lower at all follow-up intervals. At the final visit fewer glaucoma medications were used (2.5 vs 0.7, preoperative vs postoperative). The most frequent complication was hypotony (17%).

* CONCLUSION: In this retrospective case series with relatively short follow-ups, AGV implantation with mitomycin C in refractory glaucoma appears to be effective without increased complication rates.

[Ophthalmic Surg Lasers 2000;31: 100-106]
Human Lens Effect on In Vivo Scanning Laser Polarimetric Measurements of Retinal Nerve Fiber Layer Thickness
Authors: Collur Surekha , Carroll Alicia M , Cameron Bruce D
Published: April 2021

* OBJECTIVE: To determine the effect of the human lens on retinal nerve fiber layer measurements by scanning laser polarimetry. This technique uses the form birefringence of the retinal nerve fiber layer to estimate its thickness. The GDx Nerve Fiber Analyzer contains an optical retarder element to compensate for the birefringence of the human cornea.

* PATIENTS AND METHODS: Fourteen nonglaucomatous pseudophakic or aphakic eyes were matched by age and race to 14 nonglaucomatous phakic eyes. Intraocular pressure, optic nerve head evaluation by slit lamp biomicroscopy and visual fields were performed to establish the absence of glaucoma. The nerve fiber layer thickness measurements by the GDx Nerve Fiber Analyzer were compared between the two groups.

* RESULTS: The average nerve fiber layer thickness in the phakic group was 67.2±11.9 urn and in the nonphakic group was 66. 1 ± 1 1 .8 µ?? (?=0.80).

* CONCLUSION: The human lens has negligible influence on in vivo nerve fiber layer thickness measured by the GDx Nerve Fiber Analyzer.

[Ophthalmic Surg Lasers 2000;31:126-130]
Threshold Power Levels for NPe6 Photodynamic Therapy
Authors: Kazi Abdul A , Peyman Gholam A , Unal Melih , Khoobehi Bahram , Yoneya Shin , Mori Keisuke , Moshfeghi Darius , Moshfeghi Andrew A
Published: April 2021

* OBJECTIVE: To determine the threshold power levels for producing retinal and choroidal vascular occlusion using mono-L-aspartyl chlorin e6 (NPe6) photodynamic therapy; to evaluate its efficacy with longer intervals between photosensitìzer injection and laser application; to determine the elapsed time between light application and appearance of angiographie changes.

* METHODS: Pigmented and nonpigmented rabbits were injected intravenously with 2 mg/kg of NPe6 before laser irradiation of the retìna-choroid. Group 1 was treated at increasing power levels; fluorescein angiograms were obtained at each fluence. Group 2 animals were exposed to laser irradiation at 5 minutes, and 1 and 3 hours postinjection to determine (by fluorescein angiography 24 hours post-treatment) if increasing the interval affected outcome. Group 3 animals underwent fluorescein angiography at 30 minutes, 1 hour, 2 hours, and 24 hours posttreatment to document the time between laser application and subsequent vessel closure.

* RESULTS: Choroidal vessel occlusion was angiographically evident in all lesions at fluences of > 2.65 J/cm2 in pigmented rabbits and at > 0.88 J/cm2 in nonpigmented tabbits. Lesion diameter decreased as the time between injection and treatment increased. Vessel occlusion was documented at least 2 hours after treatment.

* CONCLUSION: Choroidal vessel occlusion can occur at very low fluence.

[Ophthalmic Surg Lasers 2000;31:136-142]
Silicone Oil Emulsification of the Retinal Surface
Authors: Rumelt Shimon , Haimovici Robert
Published: April 2021

Abstract. A 35-year-old patient with cytomegalovirus (CMV) retinitis secondary to acquired immunodeficiency syndrome (AIDS) underwent pars plana vitrectomy and fluid-gas-silicone exchange for tetinal detachment. Three weeks following surgery and additional laser photocoagulation, extensive retinal surrace emulsification was noted. It masked the retinal surface and demonstrated shirting in subsequent examinations. This case stresses the importance of careful and close follow-up after pars plana vitrectomy and silicone oil injection. Silicone oil emulsification may in some cases require removal of the emulsified fluid or silicone oil exchange, but in others such as our case, shifting of the emulsified silicone oil may allow evaluation of the nonobscured retina. [Ophthalmic Surg Lasers 2000;31:143-144]
Excision of Multiple Eyelid Apocrine Hidrocystomas via an En-Bloc Lower Eyelid Blepharoplasty Incision
Authors: Henderer Jeffrey D , Tanenbaum Myron
Published: April 2021

Abstract. A 39-year-old man presented with upper and lower eyelid apocrine hidrocystomas that had recurred after each of three prior attempts at excision. These multiple, cystic tumors were adherent to the epidermis, thus precluding complete dissection and excision of each individual lesion. We report a surgical technique using a lower eyelid blepharoplasty incision to remove the confluent tumors of the lower eyelids en-bloc. We paid careful attention to both removing the lesions without rupturing the cysts and to achieving adequate depth of excision. Histology revealed features typical of apocrine hidrocystomas. The patient has remained free of recurrence three years since the en-bloc excision of the lesions. [Ophthalmic Surg Lasers 2000;31:157-161]
Optical Coherence Tomography Images of Retinitis Pigmentosa
Authors: Ogata Nahoko , Ida Hisashi , Takahashi Kanji , Fukuchi Toshic , Uyama Masanobu
Published: April 2021

Abstract. The retinas of 3 patients with typical retinitis pigmentosa (RP) were evaluated by optical coherence tomography (OCT), fluorescein angiography (FA), and fundus photography (FP).

OCT showed that retinal thickness was decreased in the areas of the retina affected by RP, and nearly normal in the unaffected macular area. Reflectivity was partially decreased in the affected retinal areas and pigment masses were hyper- reflective. Reflectivity of the macular area was nearly normal except in the fovea, where it was decreased because of edema. Cystic spaces of the fovea were evident in Patient 1. [Ophthalmic Surg Lasers 2000:31:253-256]