bluuebunny/crossref_metadata_2025 huggingface dataset:
Good Visual Outcome After Endophthalmitis in an Eye Previously Treated Successfully for Amblyopia
Authors: Kushner Burton J , Meyers Franklin L
Published: April 2021

ABSTRACT

A child with an extensive periorbital hemangioma developed an endophthalmitis caused by Staphylococcus aureus after her second strabismus surgical procedure. Treatment with vitrectomy and intraocular antibiotics and steroid resulted in preservation of her eye. Despite previous successful treatment for amblyopia in that eye, her visual acuity improved from hand motion during the acute episode of endophthalmitis to 20/40 -2.
Unilateral Pseudo-Synophthalmos
Authors: O'Rourke Melinda , Forstot S Lance , Ellis Philip P
Published: April 2021

ABSTRACT

A 4 ½-year-old girl had an unusual congenital defect of her left eye which we have elected to call a unilateral pseudo-synophthalmos. We have found no other such case reported. We review the case history and findings, discuss the embryology, and explore the possible embryologic explanations for such an anomaly.
Sclerodermiform Linear Atrophy After the Use of Intralesional Steroids for Periorbital Hemangiomas: A Review of Complications
Authors: Vazquez-Botet Rene , Reyes Blas A , Vazquez-Botet Miguel
Published: April 2021

ABSTRACT

A 1-year-old girl developed a linear atrophy 3 months after a second injection of intralesional steroids for a periorbital hemangioma, followed by spontaneous resolution of the atrophy within 13 months. Reported and potential complications of intralesional steroids for periorbital hemangiomas are reviewed.
Binocular Function in Human Infants: Correlation of Stereoptic and Fusion-Rivalry Discriminations
Authors: Gwiazda Jane , Bauer Joseph , Held Richard
Published: April 2021

ABSTRACT

Studies of stereopsis in infants have shown that the average age of onset is 3.5 months. This is the same age at which infants first show evidence of another binocular function, namely, preference for binocularly fusible patterns over rivalrous ones. We tracked the development, using two-alternative forced-choice preferential looking, of the two forms of binocular function in 17 infants, 11 male and six female. They were tested at regular intervals until they showed preferences for 1) a fusible pattern (vertical stripes presented to each eye) over a rivalrous one (vertical stripes presented to one eye, horizontal stripes to the other), and 2) a line stereogram of 32 min crossed disparity over a comparable stereogram with zero disparity. The correlation between the age of onset of the fusion preference (mean 12.4 weeks) and the age of onset of stereopsis (mean 11.0 weeks) was r = 0.79. Female infants showed a preference for the fusible stimulus at a mean age of 9.9 weeks, significantly earlier than the males at a mean age of 13.8 weeks. Similarly, females also showed evidence of stereopsis at an earlier age (9.1 weeks compared with 12.1 weeks for males).
Gonioscopic Findings in Trabeculectomies in Young Children
Authors: Hauviller Verónica
Published: April 2021

ABSTRACT

To discover why trabeculectomy often fails In children, we studied a series of 27 procedures, focusing on intraocular and scleral factors that prevent humoral drainage. Gonioscopy was performed under anesthesia with Fluothan M (ICI, UK), and trabeculectomy was considered successful when values were equal to or lower than 20 mm Hg. Only ten procedures proved successful, and all had large basal iridectomies plus visible anterior scleral openings at gonioscopy. Possible causes for the 17 failures are listed, together with indications for revision surgery.
Pediatric Intermediate Uveitis
Authors: Giles Conrad L
Published: April 2021

ABSTRACT

Clinical findings, course, treatment, and complications of intermediate uveitis in children is analyzed in a series of 60 patients. While generally a chronic indolent disease, in the pediatric age group acute anterior uveitis is the presenting symptom rather than the milder symptomatology characterized in the adult with a similar syndrome. The etiologic evaluation of these patients was unrewarding. The great majority of patients improved following the use of periocular corticosteroid injections and retinal cryopexy, and immunosuppressive agents were infrequently employed in the management of the disorder. Cataract formation, secondary glaucoma, band keratopathy, vitreous hemorrhage, and papillitis were seen as complications. A treatment algorithm is presented.
Further Observations of Ocular Pathology in Trisomy 9
Authors: Ginsberg Joseph , Soukup Shirley , Bendon Robert W
Published: April 2021

ABSTRACT

The ocular pathology in a new patient with mosaic trisomy 9 comprised major anomalies and contrasted sharply with the findings in a previous case reported by us. The ocular changes in this case were, in essence, indistinguishable from those encountered in the most severe form of trisomy 13. Similarities to trisomy 18 and 21 were further evidence of the overlap of ocular findings in autosomal trisomies. There is increasing evidence that most, if not all, chromosomes have some role in regulating ocular embryogenesis.
Diffuse Infiltrating Retinoblastoma
Authors: Mansour Ahmad M , Greenwald Mark J , O'Grady Richard
Published: April 2021

ABSTRACT

A young child was examined for unilateral hyphema of 1 month duration with a questionable history of blunt trauma. Ultrasonography was negative for tumefaction. Two months later the media cleared, revealing a diffusely abnormal retina. Computed tomography demonstrated a diffusely thickened posterior pole containing calcium. Histopathology of the enucleated globe was consistent with a diffuse infiltrating retinoblastoma. This is the first report of computed tomographic findings In diffuse infiltrating retinoblastoma.
Ophthalmic Findings in Classical Galactosemia-A Screened Population
Authors: Burke John P , O'Keefe Michael , Bowell Roger , Naughten Eileen R
Published: April 2021

ABSTRACT

Classical galactosemia due to a deficiency of galactoses -phosphate-uridyl transferase, is an autosomal recessive disorder of galactose metabolism with an incidence in Ireland of one in 30,000 births. It can result in cataract formation through the accumulation of galactitol within the lens. Seventeen children with transferase deficient galactosemia were studied. Early diagnosis followed by a galactose-free diet and tight biochemical control prevented cataract formation in 13 cases after a mean follow-up of 6.3 years. Cataracts did not regress in all patients commenced on diet by 6 weeks but early treatment prevented progression. The ophthalmologist may play an important role in the monitoring of patients with this disease as the recognition of new lens opacities by slit-lamp biomicroscopy may be the most sensitive initial index of inadequate biochemical control.
Long-Term Stability of Alignment in the Monofixation Syndrome
Authors: Arthur Brian W , Smith J Terry , Scott William E
Published: April 2021

ABSTRACT

From a collection of 328 patients with congenital esotropia, 80 patients were identified who had a minimum 4-year follow-up after surgical alignment within 8 prism diopters (pd) of orthophoria. These patients were subdivided into two groups: the M.S. group (38 patients) demonstrated the monofixation syndrome; the NO M.S. group (42 patients) did not have monofixation. The alignment of patients in each group was followed over time. After 17.5 years, 74% of patients in the M.S. group maintained alignment within 8 pd of orthophoria. In the NO M.S. group, only 45% were well aligned after 14 years. The mean time to loss of stability was significantly shorter for the NO M.S. group (P<0.005). Our findings suggest achievement of the monofixation syndrome improves but does not guarantee stability of ocular alignment.
Results of External Beam Radiation for Children With Retinoblastoma: A Comparison of Two Techniques
Authors: McCormick Beryl , Ellsworth Robert , Abramson David , LoSasso Thomas , Grabowski Eric
Published: April 2021

ABSTRACT

From 1979 through 1987, 82 children with retinoblastoma were treated with primary external beam therapy, to one or both eyes. A total of 120 eyes were irradiated, with doses from 3850-5000 cGy. We used a lens-sparing electron beam technique from 1 979 to 1984 and a modified lateral beam technique from 1984 to 1987. Comparison of outcome for eyes with Group l-lll (Reese-Ellsworth) disease revealed a significant advantage for freedom from relapse favoring the lateral technique (p - 0.0009). A similar trend was noted for final eye outcome (need for enucleation). No differences were noted for eyes with Group IV-V disease. Patient survival was 90% at 4 years, with a mean follow-up time of 36 months.
The Neonatal Fundus in Maternal Toxemia
Authors: Sihota Ramanjit , Bose Swaraj , Paul A Hemanth
Published: April 2021

ABSTRACT

Toxemic changes in the maternal fundus and their relationship to fetal prognosis have been studied. A study of the neonatal fundus in maternal toxemia revealed a 76.67% incidence of vascular changes similar to those seen in the maternal fundus. Arteriolar spasm, focal or generalized, was present in 23 of the 30 neonates seen. A pallor of the disc was present in six cases. Four infants, 13.33%, had either extensive dot and blot retinal hemorrhages with soft exudates, or a serous retinal detachment. The last four neonates died within the first postnatal week. This work highlights the fact that retinal vascular decompensation mirrors similar changes in the cardiopulmonary or cerebral circulation and should be considered as a determinant of the fetal prognosis in maternal toxemia.
Color Vision Screening of Young Children
Authors: Swanson William H , Everett Mary
Published: April 2021

ABSTRACT

Early detection of congenital color vision defects is desirable, but school screening studies have been stymied by lack of a suitable test. We evaluated a new color vision test, the APT-5™, for use by volunteer screeners In schools and preschools. The screeners tested 1794 children, ages 3 to 1 3 years, and found the APT-5 easy to use with young children ages 5 years and up.

Children who failed the screening were recruited for diagnostic color vision testing; for the children ages 5 to 13 years, 56% of those who failed the screening were successfully recruited. Data analysis indicated that the false-positive rate in this age group was 1% to 2%, and that for boys in this age group the positive predictive value was 71% to 81%. Retest data indicated that most false-positives were not due to the test itself, but to other factors In the school screening situation. Two thirds of all children scored as abnormal by anomaloscopy were simple deuteranomalous, indicating that the APT-5 effectively identified even mild color defects.

The results of this trial indicate that the APT-5 is suitable for school color vision screening of children ages 5 years and up.
Orbital Pseudotumor in the Differential Diagnosis of Pediatric Uveitis
Authors: Bloom Jeffrey N , Graviss E Richard , Byrne Bryan J
Published: April 2021

ABSTRACT

Pediatric orbital pseudotumor may be associated with iritis, unlike the adult form of this disorder. However, orbital pseudotumor is seldom considered in the differential diagnosis of childhood uveitis. We report two cases of children with uvettis who were ultimately diagnosed as having orbital pseudotumor. No proptosis was noted in either child. For those pediatric patients with a persistent or recurrent uveitis and a previous negative diagnostic workup, the possibility of an orbital pseudotumor should be considered and ultrasonography, magnetic resonance imaging, and/or computed tomography performed.
A Case of Developmental Glaucoma Presenting With Abdominal Colic and Subnormal Intraocular Pressure
Authors: Talbot Ernest Mark , Pitts John Francis , Dudgeon John , Lee William Robert
Published: April 2021

ABSTRACT

A healthy baby boy presented with abdominal colic. He was subsequently noted to have enlarged, edematous corneas. A clinical diagnosis of developmental glaucoma was made despite ocular hypotony. Trabeculectomies were designed to include peripheral cornea. This served as a biopsy to confirm the diagnosis and as a surgical treatment for the condition.

Morphological examination of the outflow system revealed findings compatible with a diagnosis of developmental glaucoma; a hypoplastic trabecular meshwork which contained an abundance of abnormal collagenous tissue in the extracellular spaces and the presence of endothelial cells overlying a continuous collagenous membrane. In the iris stroma there were numerous abnormal blood vessels, with a paucity of mural contractile cells.
Sclerocornea and Interstitial Deletion of the Short Arm of Chromosome 6-(46XY del[6] [p22 p24])
Authors: Moriarty A P , Kerr-Muir M G
Published: April 2021

ABSTRACT

The interstitial deletion of the short arm of chromosome (6)- 46 XY del (6) (p22.3 p24) is unrecorded. The ophthalmic findings in a dysmorphic infant included peripheral sclerocornea and epicanthal folds with upsianting palpebral fissures. We present a short review of sclerocornea and the ophthalmic findings of infants with anomalies of chromosome 6. Our findings provide further evidence that genes influencing the development of the anterior segment are located on the distal portion of the short arm of chromosome 6.
The Surgical Treatment of Traumatic Brown Syndrome
Authors: Aylward George W , Lawson Joanna , McCarry B , Lee John P , Fells Peter
Published: April 2021

ABSTRACT

We present the results of surgical treatment in 13 patients who attended Moorfields Eye Hospital with traumatic Brown syndrome between 1975 and 1990. The average age was 34 years (range, 18 to 46 years), and in 12 cases the cause was a road traffic accident. Diplopia was the indication for surgery in all cases. Most patients had two surgical procedures; but in two patients, three were required. The outcome was assessed both subjectively and objectively. Objective assessment was by analysis of the preoperative and postoperative fields of binocular single vision and Hess charts which were available for 11 patients. The Hess charts were analyzed using a new scoring system. At final follow up, subjective improvement had occurred in 7 patients, 3 patients reported no improvement, and 3 patients thought their symptoms were worse. The field of binocular single vision improved in 8 patients and was worse in 3 patients. The Hess chart improved in 8 patients and was worse in 3 patients. The management of this difficult condition is discussed.
Superior Oblique Tuck Surgery in the Management of Superior Oblique Palsies/Superior Oblique Tuck Surgery in the Management of Superior Oblique Palsies: Discussion
Authors: Morris Robert J , Scott William E , Keech Ronald V
Published: April 2021

ABSTRACT

Three hundred and twenty-four patients with superior oblique muscle palsies required surgery over a 15-year period. Forty-four patients underwent superior oblique tuck surgery. Fifteen patients had unilateral and six bilateral tucks alone. Seventeen had unilateral tucks and three bilateral tucks in conjunction with other extraocular muscle surgery. Three had unilateral tucks with a contralateral Harada-lto procedure. The best results were obtained with isolated superior oblique tucks and tucks in conjunction with a contralateral inferior rectus muscle recession or an ipsilateral inferior oblique muscle weakening procedure. The mean vertical correction following isolated, unilateral surgery was 3.6 prism diopters (range, 0 to 11 Δ) in primary gaze and 15.3 Δ (range, 0 to 40 Δ) in the field of maximum deviation. The mean eso correction in downgaze with bilateral superior oblique tucks was 1 5.2 Δ (range, 10 to 21 Δ). There was no statistically significant correlation between the size of the tuck and the amount of deviation corrected. Some degree of postoperative Brown syndrome was seen in all patients, but became less marked with time and in no patient was it severe enough to require reversal of the tuck. In only four patients was there a significant lessening of the effect of the procedure with time. The results show that the superior oblique tuck procedure is an effective operation. In patients with unilateral muscle palsies, 64.3% with an abnormal head posture, 37.5% with diplopia, and 100% with both an abnormal head posture and diplopia achieved an excellent result. In patients with bilateral muscle palsies, 50% with an abnormal head posture and 66% with both an abnormal head posture and diplopia achieved an excellent result. The incidence of complications is lower than previously reported: only two patients had symptomatic Brown syndrome and four had a reduction of the effect of the tuck with time.
An Alternative Approach to the Surgical Management of Exotropia-The Unilateral Lateral Rectus Recession
Authors: Nelson Leonard B , Bacal Darron A , Burke Miles J
Published: April 2021

ABSTRACT

Fifty-five patients with moderate angle exotropia of 15 to 20 prism diopters were surgically treated with a unilateral lateral rectus recession of 7.0, 7.5, or 8.0 mm. The mean age at surgery was 14.5 years. The mean preoperative deviation was 18.0 Δ. The mean lateral rectus recession was 7.6 mm. At the initial postoperative follow up, all patients were either a small-angle exotropia or esotropia, or orthophoric. Twenty-eight of the 55 patients (51%) were orthophoric at their most recent follow up. Twenty-four patients (44%) were undercorrected, with 22 of these having residual exodeviations less than 8 Δ. Three patients (5%) were overcorrected.
Results of a Prospective Randomized Trial of Botulinum Toxin Therapy in Acute Unilateral Sixth Nerve Palsy
Authors: Lee John , Harris Sharon , Cohen Janine , Cooper Karen , MacEwen Caroline , Jones Stephen
Published: April 2021

ABSTRACT

Forty-seven patients entered a prospective randomized trial to assess the effect of early botulinum neurotoxin A treatment to the ipsi lateral antagonist medial rectus on the ultimate recovery rate of acute unilateral sixth nerve palsy. Twenty-two patients received injections and 25 acted as controls.

The overall etiologies were microvascular (72.3%), unknown (17%), multiple sclerosis (6%), and one case each of central nervous system (CNS) sarcoidosis and basilar artery ectasia.

Eighty-three percent of the patients entered the trial within 2 weeks of the onset of symptoms and 95.7% within 3 weeks.

The controls had a final recovery rate of 20/25 (80%), and the injected group had a final recovery rate of 19/22 (86%). No serious side effects were encountered.

We conclude that there is no evidence for a prophylactic effect of botulinum toxin in the group that we have studied.
Traumatically Ruptured Globes in Children
Authors: Rudd Jay C , Jaeger Edward A , Freitag Suzanne K , Jeffers John B
Published: April 2021

ABSTRACT

This retrospective study was designed to document the etiology of tra u metical Iy ruptured globes in children and to determine the prognostic value of several clinical parameters with respect to visual outcome. Forty-six children 16 years of age and under seen in the emergency room over a 2-year period were found to have full thickness penetration of the globe.

Fifty-nine percent of injuries occurred during recreational activities, and 59% occurred outside of the home. Boys outnumbered girls by a 6:1 ratio. For children, initial visual acuity proved to be less valuable as a prognostic indicator with regard to final vision than has been reported in adults. Smaller corneal wounds offered better visual outcomes. Four eyes were enucleated. Ten ruptures (22%) were related to activity involving guns. Four of six BB gun injuries were the result of a ricocheted BB. Visual outcomes in gun-related injuries were particularly poor.
New Instruments for Muscle Surgery
Authors: El-Naggar Saad A
Published: April 2021

ABSTRACT

Several techniques have been described and utilized for recession and resection of the extraocular muscles with various technical difficulties and complications. Two new instruments have been designed which may minimize surgical difficulties and provide more accurate and consistent measurements in muscle surgery.
Teaching Interpersonal Skills: A Model for Facilitating Optimal Interpersonal Relations
Authors: Topf Margaret , Dambacher Betty
Published: April 2021

ABSTRACT

This article draws upon the results of a series of studies involving observations of interviews involving psychiatric patients and their friends, and between psychiatric patients and nurses. A twodimensional structure of interpersonal behavior is described. Three principles of effective interpersonal relations are detailed, including interpersonal complementarity, interpersonal versatility, and interpersonal influence. Research results that indicate how psychiatric patients have trouble exercising these principles are reported. A three-phased assessment, intervention, and reassessment approach to facilitating interpersonal skills in patients is detailed. A counselor-teacher approach to the treatment of psychiatric patients is recommended.
The 24-HOUR STAY
Authors: Hambrick-Butler Shirley A , Sarasin Karen
Published: April 2021

Senior nursing students experience psychiatric hospitalization from the patient's perspective
Androgyny, Sexual Satisfaction, and Women
Authors: Frank Deborah I , Downard Elizabeth , Lang Alan R
Published: April 2021

Sexual satisfaction is a complex result of both effective physical and psychological stimulation with positive evaluations of the experience. But what is the relationship among sex role personality factors, interpretations of sexual experience, and sexual satisfaction?
Somatopsychology and AIDS Victims
Authors: Menenberg Sonia R
Published: April 2021

Sensationalism accompanies a disease like acquired immune deficiency syndrome (AIDS) because many of the taboo behaviors of society are included: sex, drugs, and death. Nurses are confronted with understanding AIDS as a process in today's culture. Somatopsychology is a body of knowledge or a specialized field that examines the relationship between handicaps and the development of characteristic personality traits related to social and personal issues (Wright, 1960). Concepts of somatopsychology have been found useful in understanding behavioral patterns and psychological changes in individuals with disabilities and it may provide a useful way of understanding the AIDS victim.
Case Management with the Chronically Mentally Ill
Authors: Baier Marjorie
Published: April 2021

Case management is a brokerage of services for chronically mentally ill clients who would otherwise not be able to live successfully in the community.
Does the Family Make A Difference?
Authors: Hughes Linda , Joyce Beverley , Staley Douglas
Published: April 2021

An Examination of Family Involvement in Discharge Planning and Its Effect on Readmission Rates to a Psychiatric Unit
Lesbian Stress and Coping Methods
Authors: Gillow Kim Elaine , Davis Linda Lindsey
Published: April 2021

Lesbians may experience stress as a result of an incongruence between internal self-concept and external expression of self
TRANSITIONS
Authors: Anonymous
Published: April 2021

In Mental Health Nursing
A PSYCHOEDUCATIONAL APPROACH TO DEPRESSION IN WOMEN
Authors: Maynard Carolyn
Published: April 2021

Traditional approaches do not effectively treat the complex etiology and broad-based impact of women's depression.
'So . . . What Do You Do?'
Authors: Rotteveel Jacqueline
Published: April 2021

The kinds of things people with disabilities need to return to work are not much different from what we all need.
The Culture Police
Authors: Hardy Bryan
Published: April 2021

Armed with self-righteousness, these professionals may be dangerous
Dialectical Behavior Therapy for Patients With Borderline Personality Disorder
Authors: Alper Gretchen , Peterson Sandra J
Published: April 2021

ABSTRACT

This study examined the effectiveness of dialectical behavior therapy (DBT) in the treatment of people diagnosed with borderline personality disorder (BPD). The frequency of self-injurious behaviors of 15 women hospitalized on a DBT unit was traced over a 4-week period. Data on selfinjurious behaviors and the use of the DBT approach were collected from a review of incident reports and patients' charts. The self-injurious behaviors decreased by almost 50%.

In addition, four RNs, who were involved on the DBT unit both before and after the institution of the treatment approach, were interviewed. Semi-structured interviews were conducted to determine the nurses' perceptions of the effectiveness of DBT. Their responses were uniformly positive. The most commonly occurring phrase was "it works."
Losing a Generation: The Impact of COVID-19 on Older Americans
Authors: Sorrell Jeanne M.
Published: April 2021

As COVID-19 is killing untold numbers of older adults around the world, it is important to reflect on the loss of this generation. Approximately eight in 10 deaths were in people aged ≥65 years. This is a devastating loss to our society—losses that will last long after the pandemic has run its course. Lock-downs and visitor restrictions that were meant to protect older adults created an isolation that often led to declining health. Ageist stereotypes, prejudice, and discrimination are internalized by older adults as they face being devalued and viewed as a burden. Reflecting on what has been lost with the deaths of so many from this older generation can spur us to think about how society failed to protect them and to find ways to move beyond the stigma attached to being old. We have much to learn from this generation. [
Journal of Psychosocial Nursing and Mental Health Services, 59
(4), 9–12.]
Use of Keratoscopy, Slit-Lamp Biomicroscopy, and Retinoscopy in the Management of Astigmatism After Penetrating Keratoplasty
Authors: Rowsey J James , Fowler W Craig , Terry Mark A , Scoper Stephen V
Published: April 2021

ABSTRACT: Selective suture removal following corneal transplant surgery can facilitate the reduction of astigmatism. We present concepts concerning astigmatism analysis after keratoplasty related to suture compression by reviewing keratoscopy, slit-lamp biomicroscopy, and retinoscopy findings. Keratoscopy observations indicating tight sutures include peripheral indentation of the keratoscope rings, individual keratoscope ring images between tight sutures, and decentration of the corneal apex away from a tight suture. The utilization of the Van Loenen keratoscope at the slit-lamp in "dynamic keratoscopy" allows the surgeon to readily recognize these findings and also proves useful intraoperatively. Slit-lamp biomicroscope observations indicative of tight sutures include a doughnut of tissue compression, Kaye's epithelial white dots, and epithelial or endothelial stress lines. Retinoscopy observations demonstrate that tight sutures induce astigmatism with the narrowest side of the retinoscopy beam pointing directly toward the tightest suture. Astigmatism management plays a major role in the future success of ophthalmology and needs to be increasingly integrated into the practice of the general ophthalmologist. [Refractive and Corneal Surgery 1990;7:33-41]
The Triple Procedure: Cataract Extraction in a Different Setting
Authors: Kramer Steven G
Published: April 2021

ABSTRACT: This article compares and contrasts ordinary cataract extraction, including lens implantation, with cataract extraction and lens implantation in eyes also undergoing penetrating keratoplasty. Variations in cataract extraction technique which are necessary when a keratoplasty is added are described, and differences in an important complication which occurs in both settings, cystoid macular edema, are evaluated.[Refractive and Corneal Surgery 1991;7:51-56.]
Corneal Allograft Rejection
Authors: Friedlander Mitchell H
Published: April 2021

ABSTRACT: Corneal allograft rejection remains the major impediment to the success of the most commonly performed solid tissue transplant. Immunologic mechanisms, particularly cellular immunity, appear to be responsible for the majority of cases of graft failure. While the prognosis for dystrophic and noninflammatory conditions is highly favorable, the failure rate in vascularized corneas can be as high as 60%. Considerable interest in the HLA system has led to a greater understanding of the distributions of these major histocompatability antigens in the cornea. It is generally believed that tissue typing and matching class I and class II HLA antigens will result in a higher success rate for corneal transplantation. Other strategies for reducing graft-host disparity, such as decreasing the antigen load, interfering with clonal expansion, and utilizing new forms of immunotherapy, will undoubtedly contribute to better survival of corneal transplants.[Refractive and Corneal Surgery 1991;7:70-72.]
Current Applications of the Corneal Modeling System
Authors: McDonnell Peter J
Published: April 2021

ABSTRACT: The ability of the Corneal Modeling System to incorporate curvature and thickness data into a single mathematical construct of the cornea is an important achievement. As experience with this and similar instruments is gained, a number of important issues in corneal topography can be addressed. Snellen visual acuity, refraction, and keratometric changes do not fully reveal the effects of refractive surgical procedures. Detailed analysis of corneal topography will prove necessary to understanding the quality of vision resulting from surgery, as it can explain the disparity between uncorrected visual acuity and residual refractive error after radial keratotomy. Computer-assisted topographic measurement devices will undoubtedly play a particularly important role in the design and evaluation of current and future refractive procedures. Similarly, mild topographic changes (eg, subclinical keratoconus) can be detected that are not apparent with refraction, biomicroscopy, or keratometry. The author reviews his personal experience with one instrument.[Refractive and Corneal Surgery 1991;7:87-91.]
Modification, Calibration, and Comparative Testing of an Automated Surgical Keratometer
Authors: Simon Gabriel , Parel Jean-Marie , Nose Izuru , Lee William
Published: April 2021

ABSTRACT: A new digital surgical keratometer (SK1, Canon Ine) designed to fit existing operating microscopes and provide quantitative measurements at a nominal 2.0- and 3.6-mm diameter optical zone of the central cornea was modified for single foot-switch operation by the surgeon. The instrument was tested against three calibrated steel spheres, an astigmatic test-jig, and compared with a standard clinical keratometer (CLC, A.O. Co) in two studies involving six eye bank eyes and five healthy human corneas. Assessed with the steel spheres, the SK-I calibration error was -0.042 diopters at the 3.6-mm diameter and + 0.207 D at the 2.0-mm chord, while it was - 0. 1 20 D for the CLC. With cylindrical power greater than 0.50 D, the astigmatic angle was accurate to ±1°. After correction for calibration error, the CLC readings on eye bank eyes were 1.00 D higher in average (range + 0.45 to + 1 .90) than those obtained with the SK-I which gave lower keratometric values at the 2-mm chord diameter (-0.254 D, range: +0.05 to -0.7 ). The human subject corrected readings at the 3.6-mm chord were within 0.137 D (range -0.09 to +0.41) from the CLC values. A mean corrected difference of + 0.068 D (range -027 to +0.30) was found between the two chords. The SK-I instrument was easier to use than the CLC. A more accurate calibration and the addition of automated averaging and video display of readings as well as of a motorized Placido disc would further augment its clinical usefulness. (Refract Corneal Surg 1991;7:151-160.)
Blood Staining of the Cornea Following Radial Keratotomy
Authors: Rapizzi Albino , Prosdocimo Giovanni , Gorla Claudio , Martinuzzi Alberto
Published: April 2021

ABSTRACT: Although topical anesthesia is commonly used for radial keratotomy, a regional intraorbital block may offer better control of the eye in anxious or uncooperative patients.1 Some complications of retrobulbar injections can produce severe loss of vision. Besides perforation of the globe and optic atrophy due to nerve perineural or intraneural injection of the anesthetic, posterior orbital hemorrhages have been reported, with consequent proptosis, tightness of fhe eyelids, and even occlusion of the central retinal artery.2 We report an unusual complication: blood staining of the cornea. (Refract Corneal Surg 1991;7:188-189.)
Endothelial Reaction to Perforating and Non-Perforating Excimer Laser Excisions in Rabbits
Authors: Koch Juergen W , Lang Gerhard K , Naumann Gottfried O H
Published: April 2021

ABSTRACT: With an ArF excimer laser (193 nm, 750 mJ/cm
p 2
, 20 Hz) and a special slit-mask system, perforating and non-perforating linear keratectomies were performed in 55 rabbit corneas with a follow-up from 1 hour to 6 months. Varying the pulse number according io ablation rate (0.8 µ???/pulse) and corneal thickness, four linear radial excisions (3 mm length, 70 µp? width) of increasing depth (70%, 80%, 90%, 100% perforation) were produced. The corneas were processed for light microscopy, scanning and transmission electron microscopy, and vital staining of the endothelium. Except for mild cell contact alterations and discrete single cell damage in the 90% deep excisions, no endothelial damage could be detected after non-perforating keratectomies. Minute (< 20 µm and small (20 to 100 µmmaximal diameter) perforations induced cell enlargement, formation of pseudopodia, rosette-like figures, multi-nucleated giant cells, and ultimately uniform reformation of the cell pattern (1 hour to 7 days postoperatively). Larger excimer laser defects of Descemet's membrane (> 100 µt?) were overgrown by dedifferentiated endothelial cells producing a new PAS-positive basement membrane. Vital staining revealed the complete and stable reorganization of the endothelium over these lesions within 6 months. Our observations are similar to those reported on the endothelial repair process following other surgical manipulations (knife incisions, direct Nd:YAG-laser trauma) and support the applicability of excimer lasers for corneal trephination in patients. Refract Corneal Surg 1991;7:214-222.)
The Effect of Epidermal Growth Factor on Corneal Wound Healing: Practical Considerations for Therapeutic Use
Authors: Feldman Sandy T
Published: April 2021

ABSTRACT: Modulation of wound healing is particularly important for the corneal and refractive surgeon. At least some of the unpredictability in effect observed following radial keratotomy, penetrating keratoplasty, and photorefractive keratectomy, as well as the failure of epikeratoplasty may be explained by the variations in wound healing. Refract Corneal Surg 1991; 7:232-239.)
Retinal Detachment Following Radial and Astigmatic Keratotomy
Authors: Feldman Robert M , Crapotta Joseph A , Feldman Sandy T , Goldbaum Michael H
Published: April 2021

ABSTRACT: Serious complications of radial keratotomy are infrequent, but include: iridocyclitis, microbial keratitis, endophthalmitis, corneal perforation, and traumatic wound rupture. We report a case of retinal detachment following microperforation during radial keratotomy. Refract Corneal Surg 1991;7:252-253.)
Role of the Corneal Epithelium in Refractive Changes Following Laser in situ Keratomileusis for High Myopia
Authors: Spadea Leopoldo , Fasciani Romina , Necozione Stefano , Balestrazzi Emilio
Published: April 2021

ABSTRACT

PURPOSE: Epithelial hyperplasia is one of the factors that plays a role in myopic regression after photorefractive keratectomy (PRK). We evaluated the role of the epithelium following excimer laser in situ keratomileusis (LASIK) performed on highly myopic eyes.

METHODS: Fifty eyes of 32 patients (18 females and 14 males; mean age, 31.7 ± 6.5 years) were treated with LASIK for myopia with an attempted correction ranging between -8.50 and -12.25 D (mean, -10.48 ± 1.43 D). No sutures were placed. The thickness of the central epithelium was evaluated either with a 50-MHz ultrasonic pachymeter or an ultrasound biomicroscope. Postoperatively, topical corticosteroid drops were administered for at least 1 month.

RESULTS: Follow-up was at least 12 months. Epithelium measurements were thicker compared to preoperative measurements from the first week postoperatively (mean, +1.9 µm, +2.77%; P<.05). Epithelial thickness peaked at the third month after LASIK (mean, +6.5 /im, +9.5%; P<05) and remained stable through 12 months. A negative correlation between epithelium thickness and manifest refraction from the first month postoperatively to the end of follow-up was present.

CONCLUSION: The epithelium seemed to have a role in the regression of refractive effect after LASDX to correct high myopia. [J Refract Surg 2000;16:133-139]
Laser in situ Keratomileusis for Recurrent Hyperopia Following Laser Thermal Keratoplasty
Authors: Attia Walid , Pérez-Santonja Juan J , Alió Jorge L
Published: April 2021

ABSTRACT

PURPOSE: Laser thermal keratoplasty (LTK) has its main indication in the correction of hyperopia. However, regression of refractive effect following LTK is a limitation. Laser in situ keratomileusis (LASDK) may provide a good alternative to correct residual refractive errors.

METHODS: Fifty hyperopic eyes with varying amounts of regression after LTK underwent LASIK. The Chiron Automated Corneal Shaper microkeratome was used to make a flap of 160 /im and laser ablation was performed with the Technolas 217 Pianoscan excimer laser. Postoperative follow-up was 6 months.

RESULTS: Mean spherical equivalent refraction improved from +2.92 ± 1.60 D to +0.36 ± 1.48 D. Mean best spectacle-corrected visual acuity changed from 0.78 ± 0.14 before LASHi to 0.76 ± 0.16 D 6 months after LASHi. Mean uncorrected visual acuity changed from 0.37 ± 0.16 to 0.66 ± 0.24. Fortytwo percent (21 eyes) were within ±0.50 D of intended correction, 60% (30 eyes) were within ±1.00 D, and 76% (38 eyes) were within ±2.00 D. After LASHi, confluent haze between previous LTK spots was observed in most eyes, as LASHi ablation took place at the sites of the LTK spots.

CONCLUSIONS: LASHi after LTK is a good alternative for hyperopic regression. Predictability and efficacy are less than with primary LASIK for hyperopia, but the procedure is equally safe. [J Refract Surg 2000;16:163-169]
Laser in situ Keratomileusis Flap Complications and Management
Authors: Gimbel Howard V , Peters N Timothy , Iskander Nader G , Penno Ellen Anderson
Published: April 2021

ABSTRACT

PURPOSE: To provide detailed descriptions of intraoperative and postoperative flap complications independent of the microkeratome. Management of these complications is discussed.

METHODS: Complications have been assimilated and categorized based on our past experiences and those of others. Methods for managing these complications are discussed.

RESULTS: Positive results were considered to be successful resolution of the flap complication, which typically occurs in the majority of cases.

CONCLUSION: LASDX is a technically difficult surgical procedure with unique complications. Excellent flap management both intraoperatively and postoperatively is essential to maximize visual outcome. Some flap complications are easily managed and others require immediate expert surgical intervention to preserve good visual outcomes. [J Refract Surg 2000;16(suppl):S223-S225]
Customized Corneal Ablation and Super Vision
Authors: MacRae Scott M , Schwiegerling James , Snyder Robert
Published: April 2021

ABSTRACT

PURPOSE: To review the early development of new technologies that are becoming available through customized corneal ablation techniques.

METHODS: The authors describe the early development of two diagnostic methods to perform customized corneal ablation as well as a variety of new treatment modalities in development.

RESULTS and CONCLUSION: Results using the wavefront sensors indicate that these techniques have the potential to be more sensitive than traditional refraction and keratometry. Subtle defects such as coma and spherical aberration can be detected and treated. A whole series of new technologies are being incorporated to treat patients with customized corneal ablation. [J Refract Surg 2000;16(suppl):S230-S235]
Intacs After Laser in situ Keratomileusis: A Preliminary Report
Authors: Durrie Daniel S , Vande Garde Trent L
Published: April 2021

ABSTRACT

PURPOSE: To assess the corneal topographic and refractive results and feasibility of placing Intacs in eyes with a history of previous laser in situ keratomileusis (LASIK) surgery.

METHODS: This was a prospective study on 25 eyes with residual myopia between -0.75 and -3.00 D. Residual myopia in these patients was secondary to regression or planned undercorrection due to preoperative thin corneas.

RESULTS: Main outcome measures included uncorrected visual acuity, preservation of best spectacle-corrected visual acuity, refractive predictability, corneal topographic changes, and evaluation of surgical complications.

CONCLUSIONS: Initial Intacs procedures after previous LASIK were performed uneventfully. In addition to correcting residual myopia, these procedures may improve night vision symptoms in some patients. These cases may improve our understanding of the ideal corneal shape. [J Refract Surg 2000;1 6(suppl):S236-S238]
Visual Outcome in High Myopia After Laser in situ Keratomileusis
Authors: Moniz Noel , Fernandes Tony , Narayanan Kutty K , Sreedhar Ani
Published: April 2021

ABSTRACT

PURPOSE: The aim of the study was to study the results of LaAIK for myopia over -12.00 D.

METHODS: Surgery was done using Hansatome microkeratome and Nidek EC-5000 excimer laser. One hundred forty-five eyes were followed for a minimum of 6 months to assess the extent of correction and the gain or loss of lines as compared of previous spectacle correction.

RESULTS: Forty percent of eyes gained at least one line, 56% remained the same, and 4% lost one line of visual acuity. Thirty-five eyes were undercorrected with the majority between 0 and -5.00 D. One hundred ten eyes achieved their preoperative best spectacle-corrected visual acuity with no correction. Complications were minimal.

CONCLUSION: LASIK with the Nidek EC-5000 excimer laser achieved good results in eyes with myopia over -12.00 D. [J Refract Surg 2000; 16(suppl):S247-S250]
Intrastromal Corneal Ring Segments In a Patient With Previous Laser in situ Keratomileusis
Authors: Fleming Joseph F , Lovisolo Carlo F
Published: April 2021

ABSTRACT

PURPOSE: Intrastromal corneal ring segments (ICRS; Intacs) were inserted in a patient with residual myopia of -3.375 D (spherical equivalent) 10 months after laser in situ keratomileusis (LASIK).

METHODS: A standard intrastromal corneal ring segment implantation technique was used with the addition of intraoperative ultrasonic pachymetry in 4 quadrants at the 7-mm zone to insure adequate stromal thickness for segment insertion.

RESULTS: Four months after ICRS surgery and 14 months after LASIK, the patient had uncorrected visual acuity of 20/20 and a cycloplegic refraction of piano -1.00 ? 23°.

CONCLUSION: Implantation of intrastromal corneal ring segments in an eye with previous LASIK resulted in additional corneal flattening with a decrease in residual myopia and improved uncorrected visual acuity. [J Refract Surg 2000;16:365-367]
Postoperative Inflammation, Microbial Complications, and Wound Healing Following Laser in situ Keratomileusis
Authors: Alió Jorge L , Pérez-Santonja Juan J , Tervo Timo , Tabbara Khalid F , Vesaluoma Minna , Smith Ronald J , Maddox Bobby , Maloney Robert K
Published: April 2021

ABSTRACT

Although the biology of corneal wound healing is only partly understood, healing after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) differs in many respects, and the mechanisms appear to be differently controlled. There is less of an inflammatory and healing response after LASIK, but a longer period of sensory denervation. The cellular, molecular, and neural regulatory phenomena associated with postoperative inflammation and wound healing are likely to be involved in the adverse effects after LASIK, such as flap melt, epithelial ingrowth, and regression. Interface opacities in the early postoperative period include diffuse lamellar keratitis (DLK), microbial keratitis, epithelial cells, and interface opacities. Diffuse lamellar keratitis (sands of the Sahara syndrome) describes an apparently noninfectious diffuse interface inflammation after lamellar corneal surgery probably caused by an allergic or a toxic inflammatory reaction. Noninfectious keratitis must be distinguished from microbial keratitis to avoid aggressive management and treatment with antimicrobial drugs. Microbial keratitis is a serious complication after LASIK, but a good visual outcome can be achieved following prompt and appropriate treatment. [J Refract Surg 2000; 16: 523-5381
Visual Benefit of Correcting Higher Order Aberrations of the Eye
Authors: Williams David , Yoon Geun-Young , Porter Jason , Guirao Antonio , Hofer Heidi , Cox Ian
Published: April 2021

ABSTRACT

There is currently considerable debate concerning the visual impact of correcting the higher order aberrations of the eye. We describe new measurements of a large population of human eyes and compute the visual benefit of correcting higher order aberrations. We also describe the increase in contrast sensitivity when higher order aberrations are corrected with an adaptive optics system. All these results suggest that many, though not all, observers with normal vision would receive worthwhile improvements in spatial vision from customized vision correction, at least over a range of viewing distances and particularly when the pupils are large. Keratoconic patients or patients suffering from spherical aberration as a result of laser refractive surgery as it is presently performed would especially benefit. These results encourage the development of methods to correct higher order aberrations. [J Refract Surg 2000;16:S554-S559]
A Quick Method for Analyzing Hartmann-Shack Patterns: Application to Refractive Surgery
Authors: Haman Habib
Published: April 2021

ABSTRACT

A quick method to analyze the Hartmann-Shack pattern was developed. This method allows us to study the limitations of the system and to determine how to improve its capacity to measure a large range of aberration. It can treat situations presenting difficulty when analyzing a detected pattern. An application to eyes with large amounts of aberration due to corneal surgery is considered. [J Refract Surg 2000;16:S636-S642]
Determining the Accuracy of an Eye Tracking System for Laser Refractive Surgery
Authors: Taylor Natalie M , Eikelboom Robert H , van Sarloos Paul P , Reid Philip G
Published: April 2021

ABSTRACT

PURPOSE: Patient eye and head movements during laser refractive surgery may result in errors between the surgical beam position and the desired location for optimum correction. This, in turn, may lead to reduced postoperative vision, including increased higher order aberrations of the eye. Active eye tracking systems are often incorporated into laser delivery systems, which aim to reduce the effect of patient eye movement.

METHODS: In this study, the accuracy of an eye tracking system designed for laser refractive surgery was determined. An enucleated porcine eye was attached to a scanning device and the movement measured using the eye tracking system. The recorded position is compared to the preprogrammed position of the scanning device.

RESULTS: The system demonstrated an accuracy of 0.06 m for an intact cornea and 0.1 mm for a cornea with a thin flap removed. This compares to an average decentration of ablation of 0.4 mm for patients relying on passive fixation, as measured by previous clinical trials.

CONCLUSION: implementation of this eye tracker would lead to improved alignment between the laser and eye during laser refractive surgery. [J Refract Surg 2000;16:S643-S6461