bluuebunny/crossref_metadata_2025 huggingface dataset:
An Experience of Peer Mentoring with Student Nurses: Enhancement of Personal and Professional Growth
Authors: Glass Nel , Walter Ruth
Published: April 2021

ABSTRACT

This article discusses the importance of peer mentoring in nursing education. The current literature is reviewed and areas for further research are identified. Most specifically, the article explores the results of a recent research study conducted at Southern Cross University in Australia. The research investigated the relationship between personal and professional growth and peer mentoring with a group of women nurses. Seven nurses participated in this qualitative research project. Six of the participants were student nurses enrolled in an undergraduate nursing degree and the seventh participant was the degree program coordinator. The research was conducted over a 12-week period and was located in critical paradigm. The research methods used were reflective journaling and interviewing.

The results indicated that the process of peer mentoring in nursing education demonstrated a strong relationship to personal and professional growth for all of the participants. Characteristics of the peer mentoring process such as shared learning, shared caring, reciprocity, commitment to each other's personal and professional growth, and friendship, are discussed.
An Evidence-Based Project for Evaluating Strategies to Improve Knowledge Acquisition and Critical-Thinking Performance in Nursing Students
Authors: Angel Bonnie F , Duffey Margery , Belyea Michael
Published: April 2021

ABSTRACT

This longitudinal, quasi-experimental study with 142 junior nursing students focused on measurement of learning outcomes in two areas: acquisition of knowledge and development of critical thinking skills. The variation in clinical teaching strategy (structured versus unstructured health pattern assessment) was the independent variable. Results indicated significant gains in both knowledge and critical thinking performance from the beginning to the end of the semester. The significant gains in critical thinking performance provides support to the assertion that domain-specific measures of critical thinking are needed in nursing education. Additionally, our results suggested that it was the interaction between learning strategy and the characteristics of the learner that was more significant in determining knowledge improvement than the particular strategy. As a result of this sudy, it is recommended that faculty develop and use an evidence-based model to support their decision making regarding teaching methodologies. This seems especially relevant for large, introductory clinical courses that use team teaching to achieve educational goals related to improvement in critical thinking or knowledge.
The Meaning of the Clinical Learning Experience of Korean Nursing Students
Authors: Shin Kyung Rim
Published: April 2021

ABSTRACT

Clinical learning is the major component of nursing education. Since nursing is a practice discipline, experiential learning in clinical practice is vital in a nursing student's education. Moreover, it is within the structure of clinical practice that nursing students are inducted into the profession of nursing. The purpose of this phenomenological study was to understand the meanings embedded in the clinical learning experience of Korean nursing students. Informants were 25 junior baccalaureate nursing students in their first clinical rotation who volunteered to participate in extended, unstructured audiorecorded interviews, and to submit clinical diaries for six months. The patterns of the lived experience of clinical learning that emerged from this research are illustrated with descriptive data and provide useful insights for nursing faculty and students involved in nursing education.
Health Habits of Nursing versus Non-nursing Students: A Longitudinal Study
Authors: Shriver Cathy B , Scott-Stiles Anne
Published: April 2021

ABSTRACT

As our culture shifts from a sickness repair system to a health promotion and disease prevention system, nurses need to take more responsibility for practicing positive health behaviors. The problem addressed in this study was "Does exposure to nursing theory content and client interactions make any difference in the regular practice of positive health behaviors in nursing students when compared to non- nursing students?" The purpose of this study was to determine if nursing students practice healthy Ufe styles that would help prepare them to be effective advocates for health promotion and disease prevention. The Health Habits Inventory (HHI) was used in this two-year longitudinal study to compare health habits between 71 nursing and 83 non-nursing students. There was a statistically significant difference between nursing and nonnursing students in time 1 (t = 4.91, p < .001) and time 2 (t = 3.59, p < .001) with nursing students scoring higher in health habits. Nursing students improved significantly from time 1 to time 2 (t = 2.05, p = .021) whereas nonnursing students did not improve (t = .94, p = .175). In specific behaviors, nursing students improved in eating breakfast regularly, performing monthly self breast and testicular exams, reading food labels, wearing seatbelts, and exercising at least three times a week. Implications include the importance of emphasizing self health care in nursing curricula to promote healthy Ufe styles of nursing students who can subsequently become role models in their professional practice.
Applying the Theory of Planned Behavior: Nursing Students' Intention to Seek Clinical Experiences Using the Essential Clinical Behavior Database
Authors: Meyer Linda
Published: April 2021

ABSTRACT

This study examined the antecedents and determinants predictive of whether nursing students (N = 92) intend to ask for assignments to perform nursing behaviors after using a database to record essential clinical behaviors. The results of applying the theory of planned behavior (TPB) to behavioral intention using multivariant path analysis suggested that the endogenous variables, attitude and subjective norms, had a significant effect on the intention to ask for assignments to perform nursing behaviors. In addition, it was primarily through attitudes and subjective norms that the respective antecedents or exogenous variables, behavioral beliefs and normative beliefs, affected the intention to ask for assignments to perform nursing behaviors. The lack of direct influence of perceived behavioral control on intention and the direct negative impact of control belief on intention were contrary to expectations, given the tenets of the TPB.
Hemispheric Visually-Evoked Responses in Congenital Esotropia
Authors: Hoyt Creig S , Caltrider Nieca
Published: April 2021

ABSTRACT

We studied 42 infants with congenital esotropia with and without abducting nystagmus. Hemispheric visuallyevoked potentials did not document any asymmetry of the retinogeniculostriate projections similar to those documented in albinotic animals and humans. This study does not substantiate the thesis that some forms of esotropia may be due to genetically determined anomalies of the anterior visual pathways.
Ocular Features of Multiple Sulfatase Deficiency and a New Variant of Metachromatic Leukodystrophy
Authors: Bateman J Bronwyn , Philippart Michel , Isenberg Sherwin J
Published: April 2021

ABSTRACT

Multiple sulfatase deficiency, a newly recognized autosomal recessive disorder caused by a deficiency of several sulfatase enzymes, is characterized by psychomotor retardation, ichthyosis, and mild organomegaly. Patients with metachromatic leukodystrophy, also an autosomal recessive disorder, have a deficiency of a single sulfatase enzyme, arysulfatase A. The ocular features of a patient with multiple sulfatase deficiency and a patient with a new biochemical variant of metachromatic leukodystrophy are described. The patient with multiple sulfatase deficiency had a unique, peripheral lens opacity and a panretinal degeneration. The patient with a new variant of metachromatic leukodystrophy exhibited a cherry- red spot.
Limbal Xanthogranuloma
Authors: Collum L M T , Power W J , Mullaney J , Farrell M
Published: April 2021

ABSTRACT

Three cases of histologically proven limbal xanthogranuloma are presented. All three cases presented with a yellow raised swelling at the limbus and no other ocular or systemic abnormality. A simple excision of the lesion was carried out in all cases and histological examination revealed features typical of xanthogranuloma. Two patients had a recurrence at the original site, necessitating keratectomy, with insertion of a lamellar graft. We suggest that a primary keratectomy with insertion of a lamellar graft should be performed in cases of limbal xanthogranuloma in order to lessen the risk of recurrence and to provide a better cosmetic result.
Bilateral Retinal Embolization Associated With Intralesional Corticosteroid Injection for Capillary Hemangioma of Infancy
Authors: Ruttum Mark S , Abrams Gary W , Harris Gerald J , Ellis Mary K
Published: April 2021

ABSTRACT

A 2-month-old female infant underwent intralesional corticosteroid injection for a capillary hemangioma that was causing amblyopia of the right eye from ptosis, globe displacement, and astigmatism. Forty-eight hours after the injection, the infant's parents noted that she was visually inattentive. On examination, she could not fixate or follow with either eye, and an afferent pupillary defect was present in the left eye. Ophthalmoscopy showed scattered areas of intraretinal hemorrhage in the right eye and extensive preretinal and intraretinal hemorrhages in the left eye. Ten months after injection, the hemangioma had greatly regressed, and visual acuity in the right eye was felt to be normal. The left eye had unsteady fixation with a persistent afferent pupillary defect and macular scarring. Retrograde flow of the corticosteroid suspension through the hemangioma's feeder vessels, probably originating from both ophthalmic arteries, is the most likely explanation for this complication.
The Importance of Controlled Illumination in Color Vision Testing in a Pediatric Ophthalmology Clinical Practice
Authors: Stager David R , Everett Mary , Swanson William H
Published: April 2021

ABSTRACT

The AO-HRR pseudoisochromatic plates are commonly used for color vision testing in pediatric ophthalmology; however, the recommended procedure for obtaining proper illumination (a completely darkened room and standard illuminant) is typically not followed. To evaluate the role of the illuminant in clinical testing with the AO-HRR1 132 children, ages 3 to 16 years, were tested with and without the recommended illuminant (MacBeth Easel Lamp) and with the self-illuminated APT-5 Color Vision Tester.

Twenty-two failed the AO-HRR with the recommended illuminant; 28 failed the AO-HRR without the illuminant. Only 13 failed the APT-5. The Cochran Q test for three related samples showed that the differences among the three groups were significant (Q = 17.1, P< .001). Diagnostic evaluation following clinical screening indicated that the differences among the tests were primarily due to false alarms, which were greatest without the recommended illuminant and least with the APT-5.

These results demonstrate the importance of controlled illumination in color vision testing, either by using the recommended illumination with the AO-HRR or a self-illuminated test such as the APT-5.
Ocular Manifestations of Deformational Frontal Plagiocephaly
Authors: Fredrick Douglas R , Mulliken John B , Robb Richard M
Published: April 2021

ABSTRACT

Frontal plagiocephaly can be caused by two mechanisms: craniosynostosis and external deformational pressure. Synostotic plagiocephaly is known to be associated with vertical strabismus and contralateral head tilt. Thirteen patients with deformational frontal plagiocephaly were examined to evaluate head position, ocular motility, and alignment. Nine of the patients (70%) were found to have ipsilateral torticollis, but only one patient had strabismus and this was a horizontal deviation not obviously associated with head position. The clinical features of synostotic and deformational plagiocephaly are discussed to distinguish the two conditions, which have a different treatment and outcome.
Cytomegalovirus Retinitis in Pediatric Acquired Immunodeficiency Syndrome: Report of Two Cases
Authors: Salvador Francisco , Blanco Román , Colín Alicia , Galán Alicia , Gil-Gibernau J José
Published: April 2021

ABSTRACT

Two cases of cytomegalovirus retinitis in pediatric acquired immunodeficiency syndrome (AIDS) are described. The first case was a 7-month-old infant who received an HIV-infected blood transfusion in 1983. The infant was treated with specific anti-cytomegalovirus immunoglobulin. The second case was an 8-year-old hemophiliac child who received HIV-infected factor VIII concentrates. Intravenous ganciclovir therapy resulted in marked improvement of ocular lesions. This is, to our best knowledge, the first report of pediatric AIDS-induced retinopathy resulting from postnatal intravenous causes.
Compliance With Safety Glasses Wear in Monocular Children
Authors: Drack Arlene , Kutschke Pamela J , Stair Sarah , Scott William E
Published: April 2021

ABSTRACT

Many ophthalmologists prescribe polycarbonate "safety glasses" to protect the remaining eye of monocular patients. Others do not routinely do so when the remaining eye is emmetropic since they feel compliance is poor. To evaluate compliance with safety glasses wear In these children, we reviewed the charts of all children (<21 years old) treated with enucleation and followed at the University of Iowa by the Pediatric Ophthalmology Service between 1962 and 1991. Safety glasses were defined as polycarbonate lenses in a frame suitable for protective wear with spherical equivalent =s - 0.7Sor =s + 2.00 diopters. Fifty-six patients were followed after enucleation. Forty-six of these patients met the inclusion criteria and 33 patients were available for follow up. Eighty-five percent of patients wear safety glasses s=50% of their waking hours; 61% wear them 2=80% of the time; 33% wear them 100% of their waking hours. Twenty-one of the 33 patients participate in sports. One hundred percent of the female participants and 80% to 93% of the male participants wear safety glasses, goggles, or face shields during sports. Fifteen of the 33 respondents reported at least one potentially serious accident in which the safety glasses had protected the good eye.

Compliance with safety glasses wear appears to be good in this population and may prevent injury to the remaining eye.
Strabismus Surgery in Patients With Myasthenia
Authors: Davidson John L , Rosenbaum Arthur L , McCall Laurie C
Published: April 2021

ABSTRACT

The efficacy of eye muscle surgery for strabismus in patients with myasthenia is not well-documented in the literature. We reviewed the results of strabismus surgery in six patients with the confirmed diagnosis of myasthenia. Patients selected for surgery had angles of deviation that were stable for at least 5 months preoperatively. Patient age ranged from 4 to 62 years. AK patients were exotropic. The four adults had moderate limitation of adduction. Surgery included horizontal rectus muscle recession and/or resection in all cases. Three cases involved additional surgery of the vertical rectus or superior oblique muscles. The mean postoperative follow up was 44 months with a minimum of 7 months. Three adults and one child achieved stable satisfactory alignment after one procedure. One child required three procedures to achieve satisfactory alignment. The results suggest that surgery is a viable option in the management of strabismus in selected patients with myasthenia.
Inferior Oblique Overaction in Infantile Esotropia: Fundus Extorsion as a Predictive Sign
Authors: Eustis H Sprague , Nussdorf Jonathan D
Published: April 2021

ABSTRACT

Background: Inferior oblique overaction develops in 72% of patients with infantile esotropia but generally is not recognized until the patient is between 2 and 4 years of age.

Methods: While undergoing bilateral medial rectus recessions, photographs were taken of the posterior pole of 27 eyes in 14 patients with infantile esotropia and graded for the presence or absence of torsion by a masked observer. Follow up ranged from 10 months to 6 years.

Results: Oblique muscle overaction developed in 15 of the 27 eyes. Of these 15, six demonstrated fundus torsion in infancy, before the oblique dysfunction was recognized clinically.

Conclusion: The presence of abnormal fundus torsion can serve as a marker for patients with infantile esotropia who ultimately will develop overt oblique muscle dysfunction.
Tensile Strength of Insertional Suture Techniques in Strabismus Surgery
Authors: Christiansen Stephen P , Rettele Garrick A , Soulsby Michael E , Walls Robert C
Published: April 2021

ABSTRACT

Background: The "lost" extraocular muscle is a serious adverse outcome of seemingly uncomplicated strabismus surgery. One potential cause of this complication is suture slippage in the operated muscle or tendon. The purpose of this study was to determine the relative tensile strengths of three suture techniques commonly used in strabismus surgery and to compare the incidence of suture slippage in the tendon or muscle among these techniques.

Methods: The horizontal rectus muscles of 18 adult pigs were assigned to undergo either recession or resection and were randomized to one of three suture techniques studied. Tension applied to the free ends of the suture was incrementally increased until failure occurred. The two techniques were compared in terms of the mean applied tensions at the time of failure and the incidence of slippage.

Results: No statistically significant difference in mean tension at failure between the three techniques used in recessed or resected muscles was found. Suture slippage in the tendon or muscle occurred in 25% of the trials and was almost evenly distributed among the techniques. Mean tension at slippage did not differ significantly between the techniques. No failure of any kind occurred at less than 100 g applied tension.

Conclusion: Each suture technique appeared to adequately secure the tendon or muscle for recession and resection procedures. Changing techniques is unlikely to alter the incidence of lost muscles in strabismus surgery.
Latent Fixation Nystagmus and Nasotemporal Asymmetries of Motion Visually Evoked Potentials in Naturally Strabismic Primate
Authors: Tychsen Lawrence , Boothe Ronald G
Published: April 2021

ABSTRACT

Purpose: To determine whether macaque monkeys who had onset of natural, alternating esotropia in early infancy have the eye movement abnormalities and motion visually evoked potential (VEP) abnormalities observed in human infantile esotropes.

Methods: Recordings were obtained of horizontal pursuit eye movements and fixation nystagmus under conditions of monocular viewing. Motion VEPs in response to horizontal motion were recorded with the animals sedated to reduce the possibility of eye movement artifact.

Results: The strabismic monkeys had a naso-temporal asymmetry of horizontal pursuit favoring nasally directed motion when viewing with either eye. When fixating stationary targets, latent nystagmus was apparent; the eyes drifted conjugately and the slow phase of the nystagmus was always nasally directed with respect to the fixating eye. Motion VEPs were characterized by a strong horizontal asymmetry with the directional bias inverted approximately 180 deg in the two eyes. These eye movement and motion VEP asymmetries were not observed in a normal macaque.

Conclusions: Macaque monkeys who have infantile esotropia possess asymmetries of horizontal pursuit and motion VEPs like those documented in strabismic humans. Macaques with infantile esotropia appear to be an appropriate animal model for study of neural mechanisms in strabismus.
The Adjustable Globe: A Technique for Adjustable Strabismus Surgery
Authors: Connor Thomas B , Guyton David L , Repka Michael X , Jain Rajni
Published: April 2021

ABSTRACT

Background: Conventional adjustable strabismus surgery involves postoperative repositioning of individual muscles anchored to the sclera via adjustable sutures.

Greaves has described anchoring opposing rectus muscles to one another, via sutures passing on either side of the limbus. With the muscles dismserted, the "freed" globe can be adjusted to the desired position within the resulting suture cradle. Friction of the sutures against the sclera holds the muscles in place until healing occurs.

Methods: Using a cul-de-sac approach, we performed 23 horizontal and three vertical adjustable globe procedures, with median follow-up of 7 weeks.

Four procedures were performed on nonhuman primates, monitored with iris fluorescein angiography.

Results: Esodeviations were well corrected, but exodeviations were often grossly undercorrected. Prolonged postoperative discomfort and photophobia were experienced. Possible evidence for mild anterior segment ischemia was noted.

Conclusion: Concern about poor results with exodeviations, discomfort, and possible anterior segment ischemia led us to abandon this procedure.
Posterior Superior Oblique Tenectomy at the Scleral Insertion for Collapse of A-Pattern Strabismus
Authors: Shin Grace S , Elliott Richard L , Rosenbaum Arthur L
Published: April 2021

ABSTRACT

Purpose: To evaluate the efficacy of teneetomy of the posterior fibers of the superior oblique tendon at the scleral insertion to reduce ?-pattern deviations with mild-to-moderate superior oblique overaction.

Methods: We retrospectively reviewed 22 consecutive patients with A-pattern strabismus and mild-to-moderate superior oblique overaction on whom posterior teneetomy of the superior oblique at the scleral insertion was performed between January 1988 and August 1994. Nine females and 13 males were included, with an age range of 3 to 36 years (mean 13.0 years).

Results: The average preoperative A-pattern for all patients was 18.0 prism diopters (Δ) (10 to 33 Δ), and a collapse of 16.1 Δ was achieved (F<.000001).The average preoperative A-pattern for esotropie patients was 21 .0 Δ with an average correction of 18.6 A.The average preoperative A-pattern for exotropic patients was 16.2 Δ with a mean improvement of 14.5 Δ. Twenty patients (91%) were postoperatively measured to have 6 Δ or less difference between up and downgaze. Follow up ranged from 5.0 to 41.0 months (average, 14.0 months).

Conclusions: This technique provides the surgeon with a predictable partial superior oblique weakening operation that carries a low risk of induced superior oblique palsy, unwanted cyclotorsion, or head tilt.
Congenital Aphakia: A Clinicopathologic Report of Three Cases
Authors: Johnson Bruce L , Cheng Kenneth P
Published: April 2021

ABSTRACT

Background: Congenital aphakia is a rare condition that has been classified as primary when no lens induction of the surface ectoderm occurs and secondary when lens development takes place but later is resorbed or expelled in utero.

Methods: The authors report the clinical and pathologic findings in three infants with congenital aphakia whose eyes were enucleated either at surgery at 11 months or at autopsy after 1 and 3 days of life.

Results: Two cases classified as primary congenital aphakia had severe microphthalmos, anterior segment aplasia, or anomalous development and posterior choroidal and optic disc colobomas. One was in a case believed to be Waardenburg's recessive anophthalmia syndrome and the other had 18 trisomy. A case of secondary congenital aphakia had findings of Peter's syndrome and features suggesting rubella, which had been observed in some previous reports.

Conclusions: Primary congenital aphakia can result from a variety of teratogenic events in the first 4 weeks of embryogenesis and results in microphthalmos and severe anterior segment aplasia/dysplasia. Secondary congenital aphakia is associated with less severe ocular anomalies. The possible role of deletion or mutation involving the PAX6 gene in anterior segment anomalies and induction of lens development is discussed. In addition to chromosomal influences, in utero viral infection, particularly rubella, may play a role in some cases.
Visual Outcome of Craniopharyngioma in Children
Authors: Abrams Lisa S , Repka Michael X
Published: April 2021

ABSTRACT

Purpose: To assess the visual outcome of children with craniopharyngioma and identify predictors of visual loss.

Methods: A retrospective analysis of all patients younger than 18 at presentation who were evaluated between 1984 and 1995 was performed. Visual outcome was assessed as a function of age, systemic symptoms, visual acuity at presentation, and need for postoperative radiotherapy.

Results: Thirty-one patients were identified, with a mean age of 7.7 years (range, 1.2 to 16.8 years) at the time of surgical resection. The initial visual acuity (known in 20 patients at presentation) in the better-seeing eye was ≥20/40 in 14 (70%) patients and <20/200 in 2 (10%) patients. Twelve (39%) patients presented with visual symptoms and 15 (48%) with systemic symptoms. All patients underwent surgical resection; some patients required multiple surgeries (52%) or adjuvant radiotherapy (48%). The mean postsurgical follow up was 6.5 years (range, 4 days to 25 years). Postoperative visual acuity was ≥20/40 in the better eye in 22 (71%) patients; 8 (26%) patients had visual acuity <20/200 in their better-seeing eye. Optic atrophy developed In 51 eyes of 27 patients (81%).

Conclusions: Craniopharyngioma presents with visual symptoms in children and is associated with significant permanent visual dysfunction. Age younger than 6 years at presentation and visual symptoms at presentation were associated with a significantly poorer visual outcome. Craniopharyngioma should be considered in the differential diagnosis of every child with amblyopia, particularly when no amblyogenic factors such as anisometropia or strabismus are present.
Cyclofusion in Normal and Superior Oblique Palsy Subjects
Authors: Sharma Pradeep , Prasad Krishna , Khokhar Sudarshan
Published: April 2021

ABSTRACT

Purpose: To evaluate the cyclofusional status in normal and acquired superior oblique palsy subjects. To know the extent to which cyclodeviations can be tolerated asymptomatically.

Method: Incyclovergence and excyclovergence break points and recovery points were evaluated in 40 normal subjects and 17 cases of acquired superior oblique palsy. A Polaroid dissociation stereoprojector was used with special torsional slides at fixation distances of 1 meter and 6 meters. In addition, maximum intorsion tolerated (MIT) and maximum extorsion tolerated (MET), ie, the torsion that allowed baseline horizontal fusion, were studied. The evaluation was repeated in the palsy group 1 month after recovery, which was spontaneous in 8 cases, and after surgery in 9 cases.

Result: The normal values for incyclovergence and excyclovergence were in the range of 12° (break point) and 8° (recovery point). In the case of superior oblique palsy, only the incyclovergence recovery point was significantly diminished (p=. 004), which improved after recovery to near normal values. The intorsion tolerance (MIT) and extorsion tolerance (MET) also showed deterioration in the palsy group. After recovery, the MIT normalized but the MET did not recover at 1meter distance fixation. The maximum torsional tolerance values appear to be more critical.

Conclusion: The cyclofusional vergence under physiological conditions are better than reported earlier. But MIT and MET are better indicators of cyclofusional potential. These low values demand more precise alignment of the torsion in weakening or strengthening surgery of the oblique muscles.

Journal of Pediatrie Ophthalmology and Strabismus 1999;36:264-270.
Critical Age of Botulinum Toxin Treatment in Essential Infantile Esotropia
Authors: Campos Emilio C , Schiavi Costantino , Bellusci Costantino
Published: April 2021

Abstract

Purpose: To assess the results of botulinum toxin treatment in 60 consecutive children with essential infantile esotropia.

Methods: Bilateral simultaneous injection of botulinum toxin into the medial rectus muscle was performed in 60 patients under direct visualization with an "open sky" technique. Fluothane/sevoflurane insufflation anesthesia was used. Each patient underwent a single bilateral botulinum toxin injection. Patient age at the time of injection ranged from 5-8 months.

Results: Mean patient age at the time of treatment for the 88% of patients who gained a good alignment (within + 10 prism diopters [Δ] of residual esotropia) was 6.5 months, while mean patient age at time of injection for the 12% of patients who were undercorrected or the deviation relapsed was 7.8 months. Follow-up averaged 5.2 years (range: 2-9 years, SD 2).

No variation of the angle of strabismus was observed after 6 months from injection. In some patients with hyperopic refraction, plus lens corrections were prescribed during follow-up to stabilize the alignment.

Conclusion: Botulinum toxin can be effective in essential infantile esotropia when children are treated by age 7 months.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:328-332.
PSYCHIATRIC NURSING in a Psychosocial Setting
Authors: Thompson Joyce , Strand Karen
Published: April 2021

The revolutionary upheaval in chis nation's health care system may cause many psychiatric nurses in traditional settings to be concerned about their future role.

According to the United States Department of Health and Human Services (1990). there were 66,142 psychiatric registered nurses employed in inpatient hospital settings as of 1988. The advent of managed care, decrease in entitlements, and overburdening of the health care system has again led to less accessibility to inpatient psychiatric hospitalization, and briefer stays once hospitalized As freatment once again moves into the community, nurses may wonder what types of new programs will follow, and if they will employ psychiatric nurses.

One type of community based program uses the principles of psychosocial rehabilitation. The Village Integrated Services Agency is such an organization, allowing nurses to fully use their nursing skills, but without the focus on illness and the constraints on autonomy typically experienced in hospital settings.
What We Have Learned About Corneal Wound Healing From Refractive Surgery
Authors: Binder Perry S
Published: April 2021

ABSTRACT: The refractive corneal surgical procedures achieve their effects by modifying the corneal curvature of previously unoperated, healthy eyes, Combinations of corneal Incisions, excisions, or the introduction of optical interfaces are utilized to achieve the intended refractive effect(s). Each of the currently practiced refractive procedures modifies the wound healing response of the cornea in ways that are different from the standard corneal wound heating studies using sutured wounds as a model. The wound healing response of the cornea to each of the refractive procedures can be responsible for some of the visual complications that have been documented to occur after these procedures. An understanding of the factor(s) associated with the wound healing response and our subsequent ability to control those factors may establish refractive corneal surgery as a major field in ophthalmology. [Refractive & Corneal Surgery 1989; 5:98-120.]
Topographic Changes that Occur with 10-0 Running Suture Removal Following Penetrating Keratoplasty
Authors: Lin David T C , Wilson Steven E , Reidy James J , Klyce Stephen D , McDonald Marguerite B , Insler Michael S , Kaufman Herbert E
Published: April 2021

ABSTRACT: Twelve eyes undergoing penetrating keratoplasty with a double-running suture technique had corneal topographical analysis immediately before and one month after 10-0 suture removal. Substantial changes in astigmatism were evident following suture removal. Twenty five percent of eyes showed a decrease of 1 D, 33% of eyes showed a decrease of 3 D, 8.3% of eyes showed an increase of 1 D, 8.3% of eyes showed an increase of 2 D, 16.6% of eyes showed an increase of 3 D, and 8.3% of eyes showed an increase of 4 D of astigmatism following suture removal. The mean corneal astigmatism did not show a significant change from a mean of 5.3 D after suture removal. There was less individual variation of spherical corneal power following suture removal. Thirty three percent of eyes showed a decrease of 1 D, 33% of eyes showed a decrease of 2 D, 8.3% of eyes showed a decrease of 3 D, 18.3% of eyes showed an increase of 1 D, and 6.6% of eyes showed an increase of 2 D of spherical power following suture removal. The surface asymmetry index (SAI), a centrally weighted measure of corneal surface irregularity, decreased significantly (P<0.04) from a mean of 1.17 before suture removal to a mean of 0.93 after suture removal. These results suggest that surface irregularity may be decreased following the removal of a single running 10-0 nylon suture following penetrating keratoplasty. [Refractive and Corneal Surgery 1990;6:21-25]
Ablation Rate of Human Corneal Epithelium and Bowman's Layer With the Excimer Laser (193 nm)
Authors: Seiler Theo , Kriegerowski Martin , Schnoy Norbert , Bende Thomas
Published: April 2021

ABSTRACT: Laser keratomileusis is a laser-specific procedure whereby a layer of corneal tissue as thin as 10 µm or more is removed from the anterior surface. In most cases, the laser ablates not only Bowman's layer but also portions of the anterior stroma. The histologic evaluation presented shows that the ablation behavior of these two layers is not uniform: at a fluence of 205 mJ/cm
p 2
in Bowman's layer, the ablation rate was 0.38 ± 0.05 µm per pulse, whereas in stroma it amounted to 0.55 ± 0.1 µm per pulse. In epithelium, the ablation rate was 0.68 ± 0.15 µm per pulse, but decreased with deeper excisions. We discuss the consequences of these different ablation rates on the procedure of laser keratomileusis. [Refractive and Corneal Surgery 1990; 6:99-102.]
A New Technique for Transscleral Fixation of a Posterior Chamber Intraocular Lens in the Absence of Capsular Support During Penetrating Keratoplasty
Authors: Mannarino Anthony P , Hannush Sadeer B
Published: April 2021

ABSTRACT: In the setting of penetrating keratoplasty for the rehabilitation of aphakic or pseudophakic bullous keratopathy, a posterior chamber intraocular lens is frequently implanted in the absence of capsular support. Some surgeons have advocated transscleral fixation over iris fixation of the intraocular lens. Problems faced during such a procedure, however, include the obstructed approach of the suture needle behind the iris, and the exposed or eroded knot of the polypropylene suture. To circumvent both problems, we propose an ab externo technique that takes advantage of the work of Duffey et al and avoids the use of partial thickness scleral flaps. [Refractive and Corneal Surgery 1990;6:353-356.]
Finite Element Based Mechanical Models of the Cornea for Pressure and Indenter Loading
Authors: Vito Raymond P , Carnell Peter H
Published: April 2021

ABSTRACT

Background: In this article, we examine the finite element method and its use in mechanical modeling of the cornea.

Methods: Both linear elastic and geometrically nonlinear models are considered. The effects of corneal geometry, boundary conditions, thickness, and the number of layers in the model are determined.

Results: Results indicate that, for intraocular pressure loading, the thickness and the choice of boundary conditions at the limbus are significant.

Conclusions: A model of tonometry showed that simulating the layered nature of the cornea and including the increased flexibility of large deformation are critical. (Refract Corneal Surg 1992;8:146-151.)
Cat Keratoplasty Wound Healing and Corneal Astigmatism
Authors: Tripoli Nancy K , Cohen Kenneth L , Proia Alan D
Published: April 2021

ABSTRACT

BACKGROUND: A major contributor to postkeratoplasty astigmatism may be donor/recipient disparity. Deficient or excess comea at the wound is thought to influence the directions of the steep and flat meridians. Using an established model of penetrating keratoplasty in the cat, this study evaluated the morphometry of histopathologic wound features in the steep and flat meridians.

METHODS: Thirteen cats had successful penetrating keratoplasties after intentionally misshapen donor corneas were misaligned in misshapen recipient beds. At 9.50 ± 0.32 (mean ± 1 SEM) months after keratoplasty, photokeratography was performed and analyzed, corneas were sectioned along the steep and flat meridians, and four histologic sections were processed. Features of the wounds were measured using a Zeiss Videoplan®. The relationships between the morphometry of each feature and every other feature, between the morphometry of each feature and eccentricity, and between the steep and flat section morphometry of each feature were statistically evaluated.

RESULTS: Epithelial thickness, area of lamellar alteration, length of Descemets membrane produced postoperatively, and the depth that preoperative Descemet's membrane was embedded in the stroma were correlated with eccentricity (corneal astigmatism). Stromal thickness and the presence or absence of folded and fragmented Descemet's membrane were not correlated with eccentricity. Wound morphometry at the steep meridians was neither correlated with nor significantly different from wound morphometry at the flat meridians.

CONCLUSIONS: Differences between healing at the steep and flat meridians were not likely contributors to astigmatism. Disproportionate availability of tissue in wound regions may have affected healing throughout the entire wound over time. The absence of Bowman's layer in cats restricts application of our results to understanding the etiology of corneal astigmatism after penetrating keratoplasty in humans. [Refract Corneal Surg 1992;8:196-203.)
Circular Keratotomy for the Correction of Astigmatism
Authors: Krumeich Jorg H , Knuelle Alfred
Published: April 2021

ABSTRACT

BACKGROUND: Mathematical and physical considerations that are contained in Gauss' law lead to the concept of a circular cut for the correction of corneal astigmatism.

METHODS: The method applied is the coupling of the aspheric corneal surface to the spherical obturator of the Guided Trephine System® and cutting of 90% of the parenchyma. Nineteen human eyes were treated with this technique, using a double-running suture closure.

RESULTS: Results of reduction of astigmatism can regularly be obtained but are of different amounts depending on the origin of asiigmaiism. Mean preoperative refractive astigmatism was 5.41 diopters and mean postoperative refractive astigmatism was 1.34 D. Six eyes required additional tranverse arcuate keratotomy.

CONCLUSIONS: The procedure is effective, but the results are variable. It may be improved by the use of obturators that fit the radius of curvature of the cornea. [Refract Corneal Surg 1992;8:204-210.)
Photokeratitis From Subablative 193-Nanometer Excimer Laser Radiation
Authors: Krueger Ronald R , Sliney David H , Trokel Stephen L
Published: April 2021

ABSTRACT

BACKGROUND: Photokeratitis is a side effect of UV light exposure whereby the corneal epithelium is photochemically injured in a time delayed fashion. UV light exposure in the far ultraviolet wavelength range has not previously been observed. This study addresses the concern of photokeratitis from subablative 193-nanometer excimer laser light.

METHODS: Dutch belted rabbit corneas were irradiated with subablative 193-nanometer excimer laser light over a wide range of total energy exposures, and examined by slit lamp biomicrosope for signs of photokeratitis. Photokeratitis was identified by epithelial haze and stippling.and rose bengal and flourescein staining at varied time intervals between ½ to 26 hours post exposure.

RESULTS: At threshold energy exposures of 1.0 to 1.5 J/cm
p 2
, an immediate superficial epithelial haze was seen which disappeared within several hours. At higher energy exposures of 10 J/cm
p 2
, a delayed photokeratitis with deep rose bengal and even fluorescein staining was seen. This latter delayed photokeratitis resembles that of longer UV wavelengths and is due to excimer laser fluorescence, whereas the former is a direct response of the 193-nanometer light. The percentage of excimer laser light undergoing fluorescence is calculated as less than 1%.

CONCLUSIONS: The potential side effects and hazards of scattered 193-nanometer radiation during excimer laser surgery are extremely limited because of the shorter penetration depth of direct excimer radiation and the minimal fluorescent emission of longer UV wavelengths for energy exposures within the realm of clinical use. [Refract Corneal Surg 1992;8:274-279.)
Differences Between Objective and Subjective Refractions After Radial Keratotomy
Authors: Russell Gregg E , Bergmanson Jan P G , Barbeito Raphael , Cross Warren D
Published: April 2021

ABSTRACT

BACKGROUND: In patients who are free of pathology, automatic refractions have shown close agreement with the subjective refractions. Clinical experience indicated that the normally strong relationship between objective and subjective refraction is significantly weakened as a result of radial keratotomy.

METHODS: Seventy-two patients were refracted before and after surgery, objectively with a Humphrey Model #510 autorefractor and subjectively using a binocular refraction procedure without cycloplegia. All patients were free of ocular disease and had preoperative myopia ranging from -1.00 to -9.00 diopters as determined by the subjective spherical equivalent.

RESULTS: The results indicated that the preoperative difference between the mean spherical automatic and subjective refractions was a clinically acceptable 0.25 diopter. However, postoperatively, there was a statistically significant difference of 1.25 D with the automatic refractor determining more myopic refractions. Subsequent analysis revealed that the age of the patient had a direct bearing on this finding with patients less than 40 years of age showing more minus in the automatic refraction than patients 40 years and older.

CONCLUSIONS: The postoperative discrepancy between the two refractions may be explained by induced optical aberrations and may contribute towards the visual fluctuations experienced by radial keratotomy patients. It is postulated that the inconsistency in refractive determination is due to optical distortion since the age dependence of this effect may be related to the reduction of pupil size that occurs with aging. In the radial keratotomy patient, the practitioner is faced with a more complex and uncertain refraction that may vary according to refractive procedures used and other factors such as pupil size. Refract Corneal Surg 1992;8:290-295.)
Four-Incision Radial Keratotomy for High Myopia After Penetrating Keratoplasty
Authors: Gothard Todd W , Agapitos Peter J , Bowers Richard A , Mma Stephen , Chen Varda , Lindstrom Richard L
Published: April 2021

ABSTRACT

BACKGROUND: High amounts of myopia can frequently produce anisometropia and limit visual rehabilitation by conventional means in eyes with clear corneal grafts. This condition is frequently coupled with large amounts of astigmatism. Fourincision radial keratotomy provides a way to reduce myopia in normal individuals. In our present study, we used the technique of four- Incision radial keratotomy to reduce myopia in a group of keratoplasty patients who failed conventional visual rehabilitation. Arcuate or transverse keratotomy was used in conjunction with radial keratotomy in eyes with high amounts of astigmatism.

METHODS: This study retrospectively examined a group of 1 1 eyes with penetrating keratoplasty which underwent four-incision radial keratotomy for the treatment of visually disabling myopia. The radial incisions were placed in the graft, inside the graft- host interface. Seven eyes underwent concomitant arcuate relaxing incisions at the grafthost interface for treatment of associated astigmatism. One additional eye had paired straight transverse incisions for the treatment of astigmatism. The mean postoperative follow up was 16 months (range, 3 months to 5 years).

RESULTS: There was a mean reduction of the spherical equivalent refraction of 3.48 diopters (D) (range, 0.25 to 7.75 D). The eight eyes undergoing astigmatic surgery showed a mean reduction in keratometric astigmatism of 2.25 D (range, -6.75 to +6.50 D) and refractive astigmatism of 4.63 D (range, - 1.50 to -9.50 D). Nine of the 1 1 eyes had stable or improved best spectacle corrected visual acuity. Two eyes had reduction of best spectacle corrected visual acuity- one due to development of irregular astigmatism and one due to worsening of preexisting macular edema.

CONCLUSIONS: Four-incision radial keratotomy can reduce myopia after penetrating keratoplasty when the patient is unable to tolerate spectacle or contact lens correction. It can be combined with relaxing Incisions or transverse keratotomy to reduce astigmatism. There is a high amount of variability, and predictability is currently limited by the complex topographical changes occurring in corneal transplants. Complex corneal biomechanical changes may predispose these eyes to the development of irregular astigmatism. Refract Corneal Surg 1993;9:51-57.)

RESUME

INTRODUCTION: La myopie forte donne fréquemment une anisométropie qui limite la guérison visuelle chez les patients post- keratoplasties, même si le greffon reste claire. Ces malades sont souvent fortes astigmates, aussi. Comme la kérafofomie radiare à quatre incisions réduit la myopie chez les yeux autrement normaux, nous en avons pratiqué chez les myopes fortes post-kératoplasties qui n'ont pas supportées la correction optique traditionelle. Les incisions arciformes ou transverses furent utilisées avec la kératotomie radiare chez les patients fortes astigmates.
Double Descemet's Membrane in Penetrating Keratoplasty
Authors: Archila Eduardo Arenas , Cabrera Marco F Ramirez , Alviar Alexandra Mieth
Published: April 2021

ABSTRACT

A rare complication of penetrating keratoplasty is incomplete removal of the host Descemet's membrane, which can progressively become opaque. Utilizing a Nd:YAG laser, we opened the opaque membrane, improving visual acuity from 20/400 to 20/100.(Refracf Corneal Surg 1993;9;6566.)
Effects of Ablation Diameter, Depth, and Edge Contour on the Outcome of Photorefractive Keratectomy
Authors: O'Brart David P S , Corbett Melanie C , Verma Seema , Heacock Greg , Oliver Katherine M , Lohmann Chris P , Muir Malcolm G Kerr , Marshall John
Published: April 2021

ABSTRACT

PURPOSE: To investigate the effects of the ablation diameter, depth, and edge contour on the outcome of excimer laser photorefractive keratectomy (PRK).

METHODS: A prospective study was conducted in which 60 patients (60 eyes) were randomly allocated to 5.00-mm, 6.00-mm, or 5.00 to 6.00-mm multizone treatment groups. All eyes underwent a -6.00 diopter (D) correction using a Summit Omnimed excimer laser.

RESULTS: In eyes treated with 6.00-mm diameter zones, the initial hyperopic shift was reduced, with significant differences at 1 and 4 weeks (p<0.01). At 6 and 12 months, the refractive changes were closer to the intended correction with 6.00-mm diameters. The predictability of PRK was improved with 6.00-mm zones, with a significant reduction in variance of the refractive changes, at all stages postoperatively (p<0.05 to p<0.001).

Objective measurements of haze were significantly less at 1, 3, and 6 months with 6.00-mm ablations (p<0.05). There were no differences between the 5.00-mm and the 5.00- to 6.00-mm multizone groups.

Computerized measurements of "night" halo were significantly smaller in the 6.00-mm treatment group at 1 week and 1 month (p<0.05). At 12 months, two patients treated with 5.00-mm zones and three with the 5.00- to 6.00-mm multizone complained of severe night vision disturbances. No 6.00-mm eyes were similarly affected.

CONCLUSIONS: Treatment with a 6.00-mm spherical ablation diameter produced less initial overcorrection, improved predictability, and was associated with a reduction in postoperative halos and night vision disturbances. Creating a superficial blend zone with a 5.00- to 6.00-mm multizone treatment had no beneficial effect on the outcome. [J Refract Surg. 1996;12:50-60.]