bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Histologic Findings in Wound Healing of Rabbit Scleral Homografts With Fibrin Glue (Tisseel®) and Suture Material
Authors: Lee Kyeong Hee , Kim Man Soo , Hahn Tae Won , Kim Jae Ho
Published: April 2021

ABSTRACT

BACKGROUND: This study was performed to observe the histological differences of scleral homografts with fibrin glue and with suture material and to evaluate the effect of fibrin glue on wound healing as a fixation method in rabbits. Rabbits were divided into two groups: a suture group, using 10-0 nylon sutures, and a fibrin glue group, using Tisseel®.

METHODS: At 1, 7, 14, 30, and 90 days after scleral graft, the tissues of grafted rabbit scleras were examined under light microscope after staining with hematoxylin-eosin.

RESULTS: In the scleral homograft, fibrin glue induced hemostasis and inhibited the inflammatory process. At 7 days, aggregation of fibroblasts was more prominent at the fibrin glue site than at the suture site. At 14 days, a larger number of fibroblasts and more collagen fibril bundles were seen at the interspace between donor and recipient scleras in the fibrin glue group than in the suture group. At 1 month, more condensed collagen was seen in the fibrin glue group. At 3 months, the interspace between graft and recipient tissues showed complete wound healing with well-arranged, condensed collagen fibril bundles in the fibrin glue group.

CONCLUSION: These findings suggest that fibrin glue may promote hemostasis as well as collagen formation by fibroblasts and inhibit the inflammatory process in scleral homografts. [J Refract Surg. 1995;11:397-401.]
Laser Epithelial Keratomileusis for Myopia With the Autonomous Laser
Authors: Rouweyha Rajy M , Chuang Alice Z , Mitra Shrabanee , Phillips Chris B , Yee Richard W
Published: April 2021

ABSTRACT

PURPOSE: To describe the refractive outcome, objective clinical data, and subjective patient experiences after laser epithelial keratomileusis (LASEK) at 1, 3, and 6 months after surgery.

METHODS: This was a retrospective, nonrandomized, comparative study of 58 LASEK-treated eyes (36 patients) with myopia (with and without astigmatism) between -1.50 and -14.75 D (mean -7.80 ± 2.90 D, median -7.90 D). Refractive surgery was performed using the Alcon Summit Autonomous LADAR Vision excimer laser. Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, stability of refraction, and corneal haze were evaluated before surgery and up to 6 months after surgery. A group of randomly selected LASIK-treated eyes were compared at each time point.

RESULTS: Patients who opted for monovision (n=12) were excluded. In the emmetropia targeted eyes (n=46), 45%, 83%, 85%, and 89% achieved 20/40 or better uncorrected Snellen visual acuity (UCVA) at 1 day, 1 week, 2 weeks, and 1 month respectively. At 6 months, 73% (n=28) of eyes treated achieved UCVA 20/20 with 97% achieving 20/40 or better (mean, -0.51 D). At 3 and 6 months, 71% (n=46) and 68% (n=28) were within ±0.50 D of emmetropia. The percentage of eyes that achieved UCVA 20/40 or better at 6 months was 97% (n=28). Visually significant corneal haze was evident in two LASEK-treated patients (four eyes) at 6 months. No eyes lost two or more lines of best spectacle-corrected Snellen visual acuity.

CONCLUSIONS: Preliminary data suggest that LASEK appears to be a safe, effective, and comparable alternative to LASIK, even for higher amounts of myopia. A prospective, randomized clinical trial is needed to better define the role of LASEK as it compares to other refractive procedures, specifically LASIK and PRK. [J Refract Surg 2002;18:217-224]
Changes in Mesopic Vision After Photorefractive Keratectomy for Myopia
Authors: Nagy Zoltán Z , Munkácsy Györgyi , Krueger Ronald R
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the mesopic functions of excimer laser treated eyes with different treatment diameters and different laser beam delivery systems.

METHODS: In Group 1, 38 eyes were treated with the Aesculap Meditec MEL 60 ArF scanning laser beam excimer laser. The treatment diameter was 5.0 mm. In Group 2, 38 eyes were treated with the Aesculap Meditec MEL 70^sub G-Scap^ flying spot excimer laser; the chosen treatment diameter was 6.5 mm. In Group 3, there were 38 eyes with no treatment; vision was corrected only with spectacles (control group). All eyes had 20/20 best spectacle-corrected visual acuity before surgery, as did the control group. Measurements were carried out preoperatively and at 12 months following surgery. All eyes exhibited normal corneal wound healing, and subepithelial haze was <0.5 according to Hanna's scale. Mesopic functions (mesopic vision and glare sensitivity) were tested with the Mesoptometer II.

RESULTS: The average preoperative refractive error in Group 1 was -3.40 D; in Group 2, -3.38 D; in Group 3, -3.44 D. In Group 1, 34% of the treated eyes met the night driving requirements (recognition at 1:5 contrast level), whereas in Group 2, 85%, and in Group 3, 95% of the eyes fulfilled this criteria. When contrast vision was tested under glare conditions in Group 1, 31.6%; in Group 2, 80%; and in Group 3, 94.7% of the eyes identified the target orientation (Landolt ring) at contrast level 1:5.

CONCLUSIONS: The unoperated spectacle wearers had better results in all tested functions. The larger 6.5-mm treatment diameter with the use of the flying spot laser beam delivery system resulted in better mesopic function and contrast vision under mesopic conditions than the smaller 5.0-mm diameter. [J Refract Surg 2002;18:249-252]
Pseudo-accommodation With Intraocular Lenses Implanted in the Bag
Authors: Altan-Yaycioglu Rana , Gözüm Nilüfer , Gücükoglu Ahmet
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the accommodation potential in eyes after intraocular lens in-the-bag implantation.

METHODS: Fifty-one consecutive patiente were included in the study. Group 1 included 26 eyes that had phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag implanted foldable IOL. Twenty-five eyes in Group 2 had capsulotomy with extracapsular cataract extraction and were implanted with polymethylmethacrylate IOL. Time elapsed from surgery was at least 6 months. There was no significant difference for age or gender between groups (P>.05). We measured accommodation amplitude and depth of the anterior chamber at distance and near fixation with an ultrasonic biometry device. The results were compared using the unpaired Student t-test.

RESULTS: The anterior chamber depths while fixating at a distant object were not significantly different between groups (P>.05), however, at near the difference was statistically significant (P=.008). The change in depths between far and near fixation was significantly different (P=.002) and was more pronounced in the the capsulorhexis group (P<.001). The accommodation amplitudes in this group were significantly greater than in the capsulotomy group (P=.025).

CONCLUSION: Patients who had uncomplicated small incision phacoemulsification surgery with continuous curvilinear capsulorhexis and in-the-bag implanted lens seemed to preserve some pseudo-accommodation after surgery. [J Refract Surg 2002;18:271-275]
Antioxidant Activity of Tear Fluid and Antioxidant Therapy in Myopic Patients After Laser in situ Keratomileusis
Authors: Smirennaia Elena , Kourenkov Vyacheslav , Chesnokova Natalya B , Kuznetsova Tatyana P
Published: April 2021

ABSTRACT

PURPOSE: To study the antioxidant activity of the tear fluid after laser in situ keratomileusis (LASIK).

METHODS: Antioxidant activity of the tear fluid was investigated in 12 eyes of seven patients with myopia who underwent LASIK. All patients were treated with the Nidek EC-5000 excimer laser using the Chiron Vision Hansatome HT-230 microkeratome. The hemoluminescence method for assessment of antioxidant activity of tear fluid was used.

RESULTS: Increase in antioxidant activity of tear fluid was found in 50% of eyes and decrease was found in 25% of eyes on day 4 after surgery. In 25% of eyes, antioxidant activity did not change. Parameters of antioxidant activity returned approximately to preoperative levels in 75% of eyes on the 7th day. In eyes with increased antioxidant activity on the 7th day, signs of epitheliopathy and light dystrophic corneal flap changes were found. Topical use of antioxidants led to clinical improvement.

CONCLUSIONS: In eyes with epithelial or corneal flap problems after LASIK, we recommend 2-week antioxidant therapy for cornea protection from oxygen-derived free radicals. [J Refract Surg 2002;18(suppl):S364-S365]
Refractive Lens Exchange With an Array Multifocal Intraocular Lens
Authors: Dick H Burkhard , Gross Susanne , Tehrani Mana , Eisenmann Dieter , Pfeiffer Norbert
Published: April 2021

ABSTRACT

PURPOSE: To prospectively evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after refractive lens exchange (clear lens extraction) followed by posterior chamber implantation of a multifocal intraocular lens (IOL).

METHODS: Fifty eyes of 25 patients (mean age 51 years, range 44 to 62 years) with preoperative spherical equivalent refraction between -15.50 and +5.75 D and cylinder between 0 and 1.50 D underwent bilateral implantation of a zonal progressive multifocal IOL (Array, AMO).

RESULTS: Eyes were divided into group A (n=24; myopia, average preoperative spherical equivalent refraction -7.11 ± 3.25 D (-1.75 to -15.50 D), and group B (n=26; hyperopia, average preoperative spherical equivalent refraction +3.04 ± 1.04 D). Follow-up was 6 months in ail eyes. Postoperatively, all eyes of both groups were within ±1.00 D of target refraction. No eye in group A and three eyes in group B sustained a loss of one line of BSCVA, Forty-seven eyes (94%) remained unchanged or gained one or more lines of their preoperative BSCVA In all eyes, postoperative UCVA was 20/40 or better. When compared to preoperative, uncorrected near visual acuity improved (statistically significant). All patients achieved uncorrected binocular visual acuity of 20/30 and J4 or better. Patient satisfaction was extremely high; no intraor postoperative complications were reported.

CONCLUSION: Six-month results of implantation of the AMO Array multifocal IOL for refractive lens exchange demonstrated safety, efficacy, and predictability in correcting high ametropia and significant improvement of uncorrected near and distance visual acuity. [J Refract Surg 2002;18:509-518]
Photorefractive Keratectomy Using the Meditec MEL 70 G-scan Laser for Hyperopia and Hyperopic Astigmatism
Authors: Nagy Zoltán Z , Munkácsy Györgyi , Popper Mónika
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) using Gaussian flying spot technology in the treatment of hyperopia and hyperopic astigmatism.

METHODS: Two hundred eyes were evaluated with 12-month follow-up. An Asclepion-Meditec MEL 70 G-scan flying spot ArF excimer laser with a Gaussian scanner was used (6.0-mm treatment zone and 9.0-mm transition zone). Eyes were divided into four groups: Group 1 (spherical hyperopia up to +3.50 D and astigmatism lees than 1.00 D, n=62); Group 2 (hyperopia up to 4-3.50 D and astigmatism of 1.00 D or more, n=44); Group 3 (hyperopia greater than +3.50 D and astigmatism less than 1.00 D, n=56); and Group 4 (hyperopia greater than +3.50 D and astigmatism of 1.00 D or more, n=38).

RESULTS: In Group 1, 82.2% (51/62 eyes) were within ±0.50 D of target refraction; 88.7% (55/62 eyes) had 20/20 or better uncorrected visual acuity; 1.6% (1/62 eye) lost two or more lines, 3.2% (2/62 eyes) gained two or more lines of spectacle-corrected visual acuity. In Group 2, 68.1% (30/44 eyes) were within ±0.50 D; 77.2% (34/44 eyes) had 20/20 or better uncorrected visual acuity; 9.1% (4/44 eyes) lost two or more lines of spectacle-corrected visual acuity. In Group 3, 76.8% (43/56 eyes) were within ±0.50 D; 78.6% (44/56 eyes) had 20/20 or better uncorrected visual acuity; 5.4% (3/56 eyes) lost two or more lines of spectacle-corrected visual acuity. In Group 4, 42% (16/38 eyes) were within ±0.50 D; 60.5% (23/38 eyes) had 20/20 or better uncorrected visual acuity; 15.8% (6/38 eyes) lost two or more Snellen lines.

CONCLUSION: PRK with the flying spot Méditée MEL 70 G-scan was most safe and effective for low hyperopia. [J Refract Surg 2002;18:542-550]
Are All Aberrations Equal?
Authors: Applegate Raymond A , Sarver Edwin J , Khemsara Vic
Published: April 2021

ABSTRACT

PURPOSE: To determine for a fixed RMS error (25 µm, over a 6-mm pupil) how each mode of the normalized Zernike polynomial (second through the fourth radial order) affects high and low contrast logMAR visual acuity.

METHODS: Three healthy volunteers served as subjects. CTView was used to generate optically aberrated logMAR charts. Accommodation was paralyzed and pupils dilated. The foveal achromatic axis of the eye was aligned to a 3-mm pupil and the eye was optimally refracted. Aberrated acuity charts were read until five letters were missed. Data were normalized for each subject to the acuity obtained by reading unaberrated charts and plotted as letters lost as a function of Zernike mode.

RESULTS: Defocus (Z
p 0
2
) decreased letter acuity more than astigmatism (Z
p 2
2
, Z^sup -2^
2
). Coma (Z
p 1
3
, Z^sup -1^
3
) decreased acuity more than trefoil (Z
p 3
3
, Z^sup -3^
3
). Spherical aberration (Z
p 0
4
) and secondary astigmatism (Z
p 2
42
, Z^sup -2^
4
) decreased acuity much more than quadrafoil (Z
p 4
4
, Z^sup -4^
4
).

CONCLUSIONS: 1. For an equal amount of RMS error not all coefficients of the Zernike polynomial induce equivalent losses in high and low contrast logMAR acuity. 2. Wavefront error concentrated near the center of the pyramid adversely affects visual acuity more than modes near the edge of the pyramid. 3. Large changes in chart appearance are not reflected in equally large decreases in visual performance (ie, subjects could correctly identify highly aberrated letters). 4. Interactions between modes complicate weighting each Zernike mode for visual impact. [J Refract Surg 2002;18:S556-S562]
Are Optical Aberrations During Accommodation a Significant Problem for Refractive Surgery?
Authors: Artal Pablo , Fernández Enrique J , Manzanera Silvestre
Published: April 2021

ABSTRACT

PURPOSE: To study the limits to a perfect ideal customized wavefront correction due to the change of aberrations during accommodation.

METHODS. We measured the dynamic changes of ocular aberrations during accommodation in normal eyes with a real-time Hartmann-Shack wavefront sensor. Those results were used in computer simulations to predict the benefit of a perfect customized correction.

RESULTS: Due to the continuous changes of the aberrations over time, an ideal perfect static correction will not provide stable aberration-free optics. For example, when the eye accommodates to near objects, due to the changing aberrations, the eye will become aberrated again. An alternative correction using the aberration pattern for a slightly accommodated condition could provide a bettercorrection in a larger accommodative range, although at the cost of non-perfect correction for far vision.

CONCLUSIONS: Due to the dynamic nature of ocular optics, a static perfect correction, for instance performed in customized refractive surgery, would not remain perfect for every condition occurring during normal accommodation. [J Refract Surg 2002;18:S563-S566]
Wavefront and Topography: Keratome-induced Corneal Changes Demonstrate That Both Are Needed for Custom Ablation
Authors: Schwiegerling Jim , Snyder Robert W , Lee James H
Published: April 2021

ABSTRACT

PURPOSE: To examine the effects of laser in situ keratomileusis (LeASIK) flap incision and healing on the shape of the cornea and the wavefront error of the eye.

METHODS: Four weeks prior to bilateral LASLK, study subjects had a flap cut using a keratome in one eye. The fellow eye remained untouched as a control. Corneal topography and wavefront errors were measured at 1 day, 1, and 4 weeks after the flap was created. After 4 weeks, the flap was lifted and LASLK was performed. The control eye also had LASLK at this time.

RESULTS: Differences in corneal shape and wavefront error consistent with a mild hyperopic shift were seen as a result of the keratome incision.

CONCLUSION: Cutting the flap in LASLK causes subtle changes to corneal shape and the optics of the eye that may affect customized treatments. Additional work is needed to quantify these changes so that their effect can be incorporated into future treatments. [J Refract Surg 2002; 18:S584-S588]
Wavefront-guided Photorefractive Keratectomy for Myopia and Myopic Astigmatism
Authors: Nagy Zoltán Z , Palágyi-Deák Ilona , Kelemen Edit , Kovács Andrea
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the results of wavefrontsupported customized ablation (WASCA) in eyes treated with photorefractive keratectomy (PRK) to correct spherical myopia and myopic astigmatism.

METHODS: One-hundred fifty eyes of 104 patients (mean age 33.4 ± 4.4 years) were included in the study. An Asclepion Shack-Hartmann wavefront aberrometer was used to assess lower and higher order refractive aberrations of eyes, and customized PRK treatments were carried out using the Asclepion-Meditec MEL 70 G-Scan excimer laser. Follow-up time was 6 months.

RESULTS: The mean preoperative spherical equivalent refraction was -4.02 ±- 1.04 D, and mean uncorrected visual acuity (UCVA) was 0.06 ± 0.02. Postoperatively, mean UCVA was 1.04 (better than 20/20), mean best spectacle-corrected visual acuity was 1.22 (20/16), and average spherical equivalent refraction was -0.12 D; 98.6% (148 of 150 eyes) were within ±0.50 D of intended refraction, and 100% were within ±1.00 D. Concerning safety, in 71.1% of eyes (107 of 150) BSCVA was the same as preoperative^, and in 8.2% (11 of 150) it increased by two or more Snellen lines. None of the eyes lost two or more lines of BSCVA. The root mean square value for higher order aberrations increased 1.4 times following PRK.

CONCLUSIONS: WASCA-guided PRK was efficacious, safe and predictable; BSCVA may be improved by the WASCA method compared to results achievable with a traditional PRK technique, in spite of an increase in the root mean square value for higher-order aberrations. [J Refract Surg 2002;18:S615-S619]
Keratoplasty and Intraocular Lenses
Authors: Taylor Daniel M
Published: April 2021

SUMMARY

The art and science of intraocular lens implantation surgery is expanding. Highly successful results with elderly uncomplicated cataract patients have led to cautious implantation surgery in patients with co-existing eye disease. The results of implantation surgery achieved in sixteen patients with combined corneal disease and cataract formation are analyzed. In twelve patients penetrating keratoplasty was performed prior to cataract removal and implantation surgery, performed simultaneous with or in combination with secondary implantation in previously aphakic eyes. Vitrectomy was avoided in all primary lens insertion procedures but was necessary in two secondary implantations without untoward effect In this entire group of twelve patients all grafts have remained clear, there was minimal tissue reaction and visual return was excellent In those with pre-existing corneal disease not requiring keratoplasty including one instance of Fuch's Corneal Dystrophy, there was no change in corneal status as a result of implantation surgery.
Combined Cyclodialysis and Cataract Extraction
Authors: Shields M Bruce , Simmons Richard J
Published: April 2021

SUMMARY

Combined cyclodialysis and cataract extraction was performed on 78 eyes in a consecutive series of 26 years duration. This operation was performed on eyes with severe glaucoma, inadequately controlled on maximum medical therapy, and with a cataract needing extraction. Glaucoma types included open-angle, angleclosure with peripheral anterior synechias, combined open-angle and angleclosure, and secondary to uveitis. Seventy of the 78 eyes had follow-up of six months or more and the results in these 70 eyes were analyzed. In thirteen percent of the eyes in this study the postoperative intraocular pressure was the same or higher than the preoperative level, or reductions of intraocular pressure were not clinically significant Eighty-seven percent (61 eyes) had a clinically significant lowering of intraocular pressure following the combined procedure. Thirty-nine percent (27 eyes) of the 70 eyes in this study had a tension of 0-14 mm Hg, and 44% (31 eyes) had a tension of 15-20 mm Hg.

Intraocular pressure was improved significantly more often in patients over 60 years of age. Resulting intraocular pressures of 14 mm Hg or less were more likely when the cyclodialysis was performed in the lower quadrant The results of the combined procedure were not significantly influenced by the type of glaucoma involved or by a history of previous glaucoma surgery. Bleeding was a frequent complication, but was not related to resulting intraocular pressure. Other complications were rare.

We conclude that combining cyclodialysis with cataract extraction is safe and effective, and is a suitable procedure when there is need for surgery to relieve severe glaucoma, along with a need for cataract extraction.
Unusual Presentation of Phacoanaphylaxis Following Phacoemulsification
Authors: Smith Ronald E , Weiner Peter
Published: April 2021

SUMMARY

A case of phacoanaphylaxis following phacoemulsification is presented. The unusual features of the disease included the markedly delayed onset and the clinical appearance of the hypopyon. Emphasis is placed on the cytologic examination of anterior chamber aspirate in such cases.
Radial Keratotomy: Preliminary Report of Complications
Authors: Rowsey J James , Balyeat Hal D
Published: April 2021

SUMMARY

We have observed the following complications with radial keratotomy which require further evaluation: missing the visual axis while marking the central cornea, regression of myopic flattening, epithelial defects, recurrent erosions, stromal overgrowth, Cogan's map-dot fingerprint corneal dystrophy with Moncreiff iron lines, blood in the incisions, vascular ingrowth, perforation of the anterior chamber, induction of astigmatic errors, epithelial ingrowth, glare complaints and decreased night vision, pain, fluctuating vision from morning to evening, overcorrection and unpredictable results, contact lens refitting difficulties, endothelial cell loss, and corneal scarring.

We feel these complications require extensive further study before the relative safety and long-term efficacy of this experimental procedure may be determined.
An Operating Table Support Mattress For Ophthalmie Surgery
Authors: Torchia R T
Published: April 2021

SUMMARY

A new surgical support mattress has been designed which virtually eliminates patient movement and discomfort.
Total Keratoplasty in Peripheral Corneal Degeneration
Authors: Mohammadi Hosein , Morton Ronald L , Wetterholm Dennis
Published: April 2021

SUMMARY

A case of total penetrating homologous keratoplasty with excellent visual improvement is reported. The postoperative course was remarkably uneventful. Sodium Hyaluronate (Healon) was used at the time of surgery. We believe that the use of Healon facilitated the intraoperative procedure and eliminated peripheral anterior synechiae with associated secondary glaucoma. The graft remained entirety clear during the 13 months of postoperative observation. The tension was below 14 mm Hg. The visual acuity improved to 20/20.
The Slit Canaliculus
Authors: Hurwitz J J
Published: April 2021

SUMMARY

Canalicular stent tubes were inserted in patients at canaliculo-dacryocystorhinostomy, dacryocystorhinostomy with a common internal punctum membrane, or at dacryocystorhinostomy with small mucosal anastomosis. Canalicular slits occurred in 16% of cases, more often with polyethylene than with silicone, and more often with increased duration of implantation. With a large patent mucosal flap anastomosis, slitting did not significantly impair function. The need for adequate mucosal anastomosis is emphasized in the treatment of Canalicular disease.
A Simple Method To Tie An Adjustable Slipknot Suture To Control Astigmatism During Cataract Incision Closure
Authors: Jolson Alfred S
Published: April 2021

SUMMARY

A simple and rapid technique for tying a slipknot suture in conjunction with a surgical keratometer is presented for the control of astigmatism in cataract incision closure.
A Teaching Mirror for Patient's Observations During Indirect Ophthalmoscopy
Authors: Peyman Gholam A , Rednam Krishna Rao V
Published: April 2021

SUMMARY

We developed a technique by which patients can observe the central fundus of their own contralateral eye during indirect ophthalmoscopy. This is achieved by adding an angulated mirror to the side of the presently available teaching mirror of the indirect ophthalmoscope. Self-indirect ophthalmoscopy is also feasible when the light source is kept stable.
Alloplastic Epikeratophakia for the Correction of Aphakia
Authors: McDonald Marguerite B , Koenig Steven B , Friedlander Miles H , Hamano Takashi , Kaufman Herbert E
Published: April 2021

SUMMARY

Plastic implants were combined with epikeratophakia grafts on the primate cornea. Implants in intrastromal pockets survived but did not substantially increase refractive powers. When implants were placed simultaneously with lyophilized epikeratophakia grafts, necrosis and loss of the graft ensued. Alloplastic implants survived on the cornea only if the overlying tissue contained living keratocytes, i.e., fresh donor tissue grafted over the implant or established lyophilized grafts in which the peripheral scar was opened slightly and the implant slipped between the graft and the cornea. Advantages of easily replaced implants include the ability to accommodate changing refractive needs, as for infants with monocular aphakia.
Relaxing Keratotomy for Post-Keratoplasty High Astigmatism
Authors: Sugar Joel , Kirk Ann K
Published: April 2021

SUMMARY

Seventeen patients underwent relaxing keratotomy for post-keratoplasty high astigmatism (range 8.5 to 18.0 diopters). The mean reduction in cylinder was 7.53 (±3.13 SD) diopters, with a range from 2.5 to 11.5 diopters. There was a trend toward a more myopic spherical equivalent of 1.69 (±2.29 SD) diopters with a range of 0.43 diopters of flattening to 5.5 diopters of steepening. Perforations occurred in two patients, but none had a permanent negative outcome.
Intraocular Lens Implantation in Developing Countries: An Ophthalmic Surgical Dilemma
Authors: Young Peter W , Schwab Larry
Published: April 2021

ABSTRACT

Rapid and remarkable development of intraocular lens technology during the past 10 years has made intraocular lens (IOL) implantation the standard of practice with cataract surgery in wealthy industrialized nations. However, although visual results of IOL implantation are vastly superior to aphakic spectacle correction after cataract surgery, several factors mitigate against the widespread implantation of IOLs in most developing nations: the high cost of surgical equipment, ancillary drugs, and intraocular lenses; difficulty in postoperative follow-up of cataract surgical patients; and a dearth of surgical personnel properly trained in IOL technology in developing nations.

While many of these problems could be addressed through national initiatives, a major area of concern remains that of manpower, since the number of unoperated cataract patients is immense. One strategy for alternative surgical manpower development is the training of medical assistants to perform cataract surgery, as is presently being carried out in several African nations. The question arises, however, as to whether medical assistants, as opposed to ophthalmologists, are qualified to select patients and implant IOLs.
Relationship Between Age at Time of Cataract Extraction and Time Interval Before Capsulotomy for Opacification
Authors: Maltzman Barry A , Haupt Ed , Notis Corey
Published: April 2021

ABSTRACT

This retrospective study reviews the time interval between extracapsular cataract extraction with posterior chamber intraocular lens placement and neodymium (Nd): YAG laser posterior capsulotomy relative to the age of the patient at the time of cataract surgery. Two hundred thirteen consecutive laser procedures involving eyes that had had extracapsular cataract extraction within 6 years were reviewed. We found that there was an upper limit on the time interval from extracapsular cataract extraction to Nd: YAG posterior capsulotomy for all patients eventually requiring a Nd: YAG capsulotomy. This time limit appeared to be directly proportional to the age of the patient at the time of his or her cataract surgery: the older the patient at the time of surgery, the longer the period the patient was at risk for requiring a capsulotomy. Beyond this time limit, the likelihood that an Nd: YAG capsulotomy would be required was less than 2.5%. The prolonged period of risk for elderly patients may be related to an age-related decline in lenticular hyperplasia.
The Use of Viscoelastic Substances in the Drainage of Postoperative Suprachoroidal Hemorrhage
Authors: Baldwin Larry B , Smith Thomas J , Hollins Jack L , Pearson P Andrew
Published: April 2021

ABSTRACT

Suprachoroidal hemorrhage is a serious surgical complication occurring in up to 10% of aphakic patients undergoing filtration surgery. Surgical treatment includes drainage of the hemorrhage through sclerotomies and reformation of the anterior chamber with balanced salt solution or air. Two patients are presented whose suprachoroidal hemorrhages were managed with the instillation of 10% sodium hyaluronate. The intraocular administration of a space-occupying fluid produces an even distribution of hydraulic force to facilitate drainage of the hemorrhage and avoids the optical problems associated with the use of intraocular air. While most cases of suprachoroidal hemorrhage can be effectively managed using balanced salt solution or air, we believe that viscoelastic agents may be of special benefit in selected situations.
Sutureless Skin Graft Reconstruction of the Exenterated Orbit
Authors: Conn Howard , Kolin Talia
Published: April 2021

ABSTRACT

We present a rapid method for fixation of split-thickness skin grafts to the exenterated orbit using Steri-Strips and tincture of benzoin.
Peribulbar Anesthesia for the Repair of Orbital Floor Fractures
Authors: Kezirian Guy M , Hill Fred D , Hill F Jerry
Published: April 2021

ABSTRACT

Four patients underwent successful repair of an isolated orbital floor fracture under local anesthesia. The surgical approach was by antero-inferior orbitotomy, with placement of a Nylamid plate (S Jackson Ine, Washington, DC). The anesthetic technique used was a peribulbar and infratrochlear nerve block with local supplementation. Digital control of the globe was maintained during the peribulbar injection to prevent ocular perforation. We conclude that local anesthetic for this procedure in carefully selected cases is safe and efficacious, avoiding the morbidity of a general anesthetic.
A Comparison of Visual Outcome in Open-Globe Repair: Succinylcholine With D-Tubocurarine vs Nondepolarizing Agents
Authors: Wang Michael L , Seiff Stuart R , Drasner Kenneth
Published: April 2021

ABSTRACT

We compared the visual outcome in patients with ocular perforations who received succinylcholine with d-tubocurarine during anesthesia induction, with the visual outcome of those who did not. No statistically significant differences in visual outcome were detected. No extrusion of intraocular contents occurred during induction in either group.
Hyperopia, Anisometropia, and Irregular Astigmatism in a Patient Following Revisional Radial Keratotomy
Authors: Olson Randal J , Biddulph Michael C
Published: April 2021

ABSTRACT

We present a patient who underwent bilateral radial keratotomy (RK) followed by a bilateral revisional RK for undercorrection. After the second procedure, the patient had a severely flattened left cornea, with marked hyperopia and irregular astigmatism. The right eye, however, remained myopic, causing extreme anisometropia. We hypothesize that the different results in these two eyes may have been due to a critical number of damaged left corneal stromal fibers. Patients undergoing revisionai RK or requiring additional incisions may be at increased risk for such a complication.
Laser Sclerostomy Ab Externo Using Mid Infrared Lasers
Authors: Wetzel Wolfgang , Scheu Manfred
Published: April 2021

ABSTRACT

An ab externo fistulizing procedure (sclerostomy) was performed in vivo in 48 rabbit eyes using a pulsed (20 µs and 200 µs) Holmium:YAG (Ho:YAG) laser (2120 nm) and a pulsed (200 µs) Erbium:YAG (ErYAG) laser (2940 nm). The laser energy was delivered via an infrared transmitting fiber in contact with the sclera, with the fiber inserted into a specially sharpened retractable cannula in order to guide it into the subconjunctival space. An additional optical fiberfiber coupling system was required for the Er-YAG laser. A patent fistula (200-micrometer diameter) with formation of a filtering bleb and marked intraocular pressure reduction was achieved in nearly all cases. Significant intraoperative or postoperative complications occurred only with the 20-microsecond Ho:YAG laser. Trauma to the conjunctiva was as minimal as in a subconjunctival injection. The Er.YAG laser created a smaller thermal damage zone at the fistula walls and required significantly less laser energy than the Ho-YAG laser.
Peters' Anomaly: A Review of 26 Penetrating Keratoplasties in Infants
Authors: Parmley Vernon C , Stonecipher Karl G , Rowsey J James
Published: April 2021

ABSTRACT

We reviewed the specimen records log of the McGee Eye Institute Histopathology Service from January 1979 to December 1990 for penetrating keratoplasty specimens submitted with a clinical diagnosis of Peters' anomaly. The records of the 19 cases thereby identified were reviewed for clinical outcome and visual rehabilitation, and the histopathology of all specimens was reviewed and correlated with the clinical diagnosis.

Two specimens from the same patient were eliminated as histopathologically inconsistent with Peters' anomaly; one patient's data were not used because the patient was an adult when first grafted. Six eyes were grafted two or more times, for a total of 26 grafts on 16 eyes in 10 patients. Mean age at the time of first transplant was 18 weeks (range, 3 weeks to 40 months). Mean follow up was 30 months (range, 7 months to 61/z years). Five eyes had preoperative glaucoma which persisted postoperatively. Ten eyes developed glaucoma postoperatively. Of the 15 eyes with glaucoma, 14 were uncontrolled medically and 12 underwent cyclodestructive or Molteno filtering procedures, or both, to control pressure. Graft rejection developed in 9 of the 10 eyes that required a cyclodestructive procedure, with partial or complete graft failure occurring shortly after the procedure. Glaucoma did not develop in one eye; in one other eye, it was medically controlled. These 2 eyes maintained clear grafts. Of the 6 eyes that were regrafted, only 1 obtained ambulatory vision.

Of the 26 eyes receiving grafts, the grafts failed completely in 17 and partially in 5; 4 have remained clear. Five patients maintain ambulatory vision.
Visual Recovery Following Transethmoidal Optic Nerve Decompression in Traumatic Optic Neuropathy
Authors: Amrith Shantha , Pham Tuan , Chee Caroline , Chan Tat Keong
Published: April 2021

ABSTRACT

We report a case in which visual acuity improved after decompression of the optic canal by a transethmoidal approach performed 13 days after the initial trauma.
Temperature Distributions in Porcine Orbital Tissues Following the Use of CO2 and Nd:YAG Lasers
Authors: Chedid Mokbel K , Handy Francine F , Wilkinson D Allan , Kennerdell John S , Maroon Joseph C
Published: April 2021

ABSTRACT

Temperature distributions in the orbital tissues of a live porcine model were obtained during and immediately following the application of CO2 and Nd:YAG (both contact and noncontact) laser irradiation to muscle tissue adjacent to the optic nerve. Temperatures were measured with thermocouples and an infraredsensitive thermographie camera system. Significant thermal spread was observed only in the case of the contact Nd:YAG laser, along with histologie evidence of damage to the optic nerve. After the laser was switched off, the target cooled with a time constant on the order of 10 seconds.
Microwave-Induced Retinal Destruction With Sparing of Sclera and Choriocapillaris
Authors: Bhatt Nitul , Peyman Gholam A , Khoobehi Bahram , Golshani M Reza
Published: April 2021

ABSTRACT

We studied the effect of short-term hyperthermia on sclera, choroid, and retina by delivering microwave radiation (2.45 GHz) for 1 minute to 12 eyes of Dutch belted pigmented rabbits. Four eyes each were treated with 430C, 450C, and 470C and followed for 4 weeks. The 430C group showed minimal disruption of retinal pigment epithelium and outer retina, with pigment migration; the 450C and 470C groups showed complete retinal and RPE damage, pigment migration, and glial proliferation. At the same time, the sclera and choroid in all of the eyes remained essentially unchanged. We conclude that microwaveinduced hyperthermia can create retinal scarring without significant damage to sclera and choriocapillaris. The next experimental step will be to refine the microwave delivery system to ensure predictable and reproducible lesions.
Melanocytoma of the Ciliary Body With Scleral Extension
Authors: Stokes Douglas W , O'Day Denis M , Glick Alan D
Published: April 2021

ABSTRACT

A 35-year-old woman had a circumscribed pigmented scleral lesion overlying a pigmented mass in the ciliary body and trabecular meshwork. Sclerectomy and iridocyclectomy were performed. Histologically, the lesion proved to be a melanocytoma. This represents to our knowledge the fourth reported case of scleral extension of a ciliary body melanocytoma.
Filtering Blebs: Follow Up of Trabeculectomy
Authors: Vesti Eija
Published: April 2021

ABSTRACT

We retrospectively reviewed the results of 88 primary trabeculectomies with 1- to 5-year (mean, 3-year) follow up in an attempt to correlate the biomicroscopic appearance and function of the filtering bleb with intraocular pressure (IOP), and to detect possible risk factors for bleb failure. IOP in 74% of the eyes was « 21 mm Hg without medication. Three eyes needed retrabeculectomy. A diffuse filtering bleb was present in 36 (42%), a flap-sized bleb in 42 (50%), and no bleb in 7 (8%). Among these three groups, those with diffuse blebs had the lowest IOP, the highest proportion of eyes without medication, and the highest tonographic C value. Early postoperative hypotony tended to occur more often in the eyes with flap-sized blebs and in those in which the bleb failed. Blebs tended to fail more often in the younger patients.
Ocular Hypotony and Choroidal Effusion following Bleb Needling
Authors: Potash Seth D , Ritch Robert , Liebmann Jeffrey
Published: April 2021

ABSTRACT

A choroidal effusion, hypotony, and a shallow anterior chamber developed in a patient following a transconjunctival needling revision of an encapsulated filtering bleb. While choroidal effusions occur frequently following filtration surgery, to our knowledge, this complication has not been previously reported following a filtering bleb needle revision.
A Closed Chamber Technique for Repair of Iridodialysis
Authors: Zeiter John H , Shin Dong H , Shi Dian X
Published: April 2021

ABSTRACT

We have developed a surgical technique for repair of traumatic iridodialysis, in which a 25-gauge hypodermic needle is used to place a 10-0 polypropylene suture in sewing-machine fashion through a closed anterior chamber. The technique also can be modified to secure a posterior capsule with a partial zonular dialysis, such as may occur during phacoemulsffication or cortical clean-up.
Glaucoma Drainage Implants in Pediatric Patients
Authors: Netland Peter A , Walton David S
Published: April 2021

ABSTRACT

To assess the use of drainage implants in pediatric patients with glaucoma refractory to conventional medical and surgical therapy, we retrospectively reviewed 20 consecutive eyes in children 10 years of age or younger treated with 16 Molteno (three of which were removed and replaced with second Molteno shunts) and seven Baerveldt implants. The age of the patients ranged from 1 month to 10 years (mean, 3 years). The patients had undergone a mean of two previous failed glaucoma procedures (range, one to six). The mean intraocular pressure (IOP) prior to drainage tube implantation was 37 ± 4 mm Hg, compared with a mean of 18 ± 6 mm Hg following surgery, with average postoperative follow up of 25 months (range, 8 to 41 months). The overall success, defined as IOP ≤ 21 mm Hg without further surgical therapy, was 80%. Postoperative glaucoma medications were required in 75% of patients. There were 23 complications, one of which resulted in decreased visual acuity. These findings demonstrate that drainage tube implants can be effective in lowering IOP in uncontrolled pediatric glaucomas. Patients often require postoperative glaucoma medications and close monitoring for complications.
A Review of the Outcome of Trabeculectomy in Open-Angle Glaucoma
Authors: Vesti Eija , Raitta Christina
Published: April 2021

* BACKGROUND AND OBJECTIVE: The outcome of trabeculectomy in the treatment of primary open-angle glaucoma and exfoliative glaucoma was reviewed.

* PATIENTS AND METHODS: The study included 87 consecutive eyes of 87 patients with open-angle glaucoma. The outcome of trabeculectomy was correlated with a biomicroscopic appearance of the filtering bleb. Visual acuity, myopic shift in refraction, and lens opacity measurements were used as indicators for cataract progression. The effect of viscoelastics on complications and short-term outcome was studied in a randomized series of 107 eyes.

* RESULTS: In a series of 87 eyes, 61% had intraocular pressure (IOP) of less than 22 mm Hg without glaucoma medication 1 year after surgery. After 3 years, the corresponding success rate was 74% in a series of 85 eyes that had preoperative pupillary dilation of 4 mm or more.

* CONCLUSION: The difíuse filtering bleb type was associated with the greatest decrease in IOP. Unfavorable flap-sized blebs and bleb failures were associated with preoperative treatment with miotics, anterior fistulation, and postoperative hypotony. These patients also tended to be younger. In a randomized, prospective study of 107 eyes, the use of sodium hyaluronate had no significant effect on the incidence of complications or on the short-term outcome. Age 61 years or older, exfoliative glaucoma, postoperative hypotony, and IOP peaks were identified as risk factors for accelerated cataract progression after trabeculectomy.

[Ophthalmic Surg Lasers 1997;28:128-132.]
New Corneal Marker for Passing a 24-bite Anti-torque Corneal Transplant Single Continuous Suture
Authors: Geggel Harry S
Published: April 2021

Abstract. The use of a single continuous-suture closure technique allows the surgeon to minimize corneal transplant astigmatism within 1 month of surgery. Passage of this suture in a precise, anti-torque pattern is difficult. A new surgical instrument has been designed to place 24 equidistant dots on both the recipient and the donor tissues after the cardinal sutures have been placed. The surgeon simply must "connect the dots" to achieve a rapid, precise antitorque closure. The instrument is easy to use and should prove helpful to surgeons who perform the single, continuous-suture closure technique. [Ophthalmic Surg Lasers 1997;28:168-170.]
Excimer Laser Reablation
Authors: Loewenstein Ama , Lipshitz Isaac , Varssano David , Lazar Moshe
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the outcome of repeated excimer laser keratectomy after photorefractive keratectomy (PRK).

* PATIENTS AND METHODS: A retrospective study of 32 of 1000 consecutive patients who had a follow-up of at least 1 2 months and who underwent repeated PRK in the Assutah Laser Center.

* RESULTS: The mean spherical equivalent (SE) declined significantly as a result of the repeated treatment. As opposed to zero eyes before re-treatment, 19 of 29 eyes (66%) achieved SE of within ± 1 D 6 months after re-treatment. Before re-treatment, 20 of 32 eyes (62%) had medium or severe haze, whereas after re-treatment only 1 of 29 eyes (3%) had medium haze, and none of the eyes had severe haze. At 6 months after reoperation, visual acuity had improved to 20/36, a significant improvement to the mean log MAR equivalent of 20/40 before re-treatment, yet still significantly worse than the log MAR equivalent before initial ablation which was 20/30.

* CONCLUSION: Repeated excimer laser PRK has the potential for successful treatment of undercorrection, regression, and haze occurring after an initial PRK.

[Ophthalmic Surg Lasers 1997;28:282-287.]
Decreased Prevalence of Retinopathy of Prematurity in an Inner-City Hospital
Authors: Lim Johnson , Fong Donald S , Dang Yadavinder
Published: April 2021

* BACKGROUND AND OBJECTIVE: Improvements in care of low birth weight preterm infants has led to an increased survival of this population. It is not known whether the improved care has decreased the prevalence of retinopathy of prematurity (ROP), or whether the survival of even smaller infants has increased the prevalence. The purpose this study was to determine the prevalence of ROP in an inner-city hospital during two time periods to determine whether the prevalence is changing.

* PATIENTS AND METHODS: The frequency and characteristics of ROP were compared between a 10-month observation period in 1995-1996 and published data from a similar time period in 1988-1989.

RESULTS: There were fewer cases of ROP per live births less than 1500 g during 1995-1996 compared with 1988-1989 (P < .0001). This included both mild and severe ROP. When the two racial subgroups were examined separately, there was a statistically significant decline for the black (P < .001) but not the Hispanic population (P = .12). The Mantel-Haenszel χ
p 2
test confirmed that the decline was statistically significant when the two groups were combined (P < .001).

* CONCLUSIONS: In this population, the prevalence of ROP appears to have decreased between 1995-1996 and 1988-1989. The subgroup experiencing the biggest decline was black infants. Other studies should be performed to investigate whether the frequency of ROP has also declined in other settings.

[Ophthalmic Surg Lasers 1999; 30: 12-16.]
Total Internal Reflection of Laser Light in Eyes Filled With Silicone Oil
Authors: Bartov Elisha , Rock Tali , Treister Giora , Belkin Michael
Published: April 2021

* BACKGROUND AND OBJECTIVES: This is the first report of clinical settings in which total internal reflection of laser light in eyes filled with silicone oil was observed. The authors analyze this phenomenon and outline the potential hazards it may present to patient, surgeon, and operating room personnel.

* MATERIALS AND METHODS: The authors observed significant reflection of laser light off the silicone-water interface both intraoperatively and in the clinic. The critical angle according to Snell's law (i.e., the angle at which total internal reflection occurs at the interface between silicone oil and vitreous) was calculated. The critical angle was found to be 71.9691° ( 72°).

* RESULTS: An analysis of each of the clinical conditions where this phenomenon was observed is presented. Clinical and surgical implications are discussed.

* CONCLUSIONS: The hazard of total internal reflection of laser light in eyes filled with silicone oil should be recognized by ophthalmologists to avoid possible complications. Techniques for overcoming and circumventing the difficulties resulting from this phenomenon are proposed.

[Ophthalmic Surg Lasers 1999; 30: 17-23.]