bluuebunny/crossref_metadata_2025 huggingface dataset:
Laser in situ Keratomileusis and Diode Thermal Keratoplasty for Correction of Hyperopia From +5.00 to +10.00 Diopters
Authors: Rad Ahmad Salamat , Jabbarvand Mahmood , Farahvash Mohammad Mehdi , Kheradvar Arash
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the effects and safety of laser in situ keratomileusis (LASIK) and diode thermal keratoplasty (DTK) for correction of moderate to high hyperopia (+5.00 to +10.00 D).

METHODS: This prospective study included 30 eyes of 15 patients who had LASEK-DTK bioptics. The median age of the patients was 50.5 years. LASES was performed using a Nidek EC-5000 excimer laser system and DTK by a Prolaser DTK laser, 2 months after LASES. Follow-up ranged from 9 to 12 months (mean, 10.5 mo).

RESULTS: The mean preoperative spherical equivalent refraction was +8.25 ± 0.25 D and mean postoperative was +1.00 * 0.50 D. The preoperative best spectacle-corrected visual acuity (BSCVA) was «20/40 in 10 eyes and 2*20/25 in 20 eyes. Postoperatively, BSCVA was «20/40 in 8 eyes and 2*20/25 in 22 eyes. No significant intra- or postoperative complications occurred.

CONCLUSION: LASDX-DTK bioptics for correction of moderate to high hyperopia (+5.00 to +10.00 D) was safe and effective. In this method, two different ablative and non-ablative laser systems were used to compensate for regression, which is the most important concern in the correction of hyperopia. [J Refract Surg 2002;18(suppl): S318-S320]
Reduction of Spherical Aberration: Experimental Model of Photoablation
Authors: Vinciguerra Paolo , MD Maria Ingrid Torres , Camesasca Fabrizio I
Published: April 2021

ABSTRACT

PURPOSE: Several authors have suggested that a compound ablation for myopia may reduce postoperative spherical aberration. This technique consists of treating myopic ablation by increasing the preoperative sphere 25% and applying a hyperopic ablation of 25% of preoperative sphere. Theoretically, this technique allows optical zone increase, and elimination of the peripheral red ring.

METHODS: Eight eyes of four patients with bilateral moderate myopia received laser epithelial keratomileusus (LASEK) with the Nidek EC-5000 excimer laser. In each patient, one eye was treated with the compound ablation (Group 1), and the fellow eye with the standard cross-cylinder technique (Group 2). Mean preoperative refraction and BSCVA were comparable within the two groups.

RESULTS: At 1 month postoperatively, UCVA was significantly better in Group 2 than in Group 1 eyes. In neither group was clinically important haze seen. Subjectively, all patients rated more satisfactorily the eye that received the standard ablation (Group 2) than the one treated with compound ablation (Group 1). Evaluation of keratorefractive indices derived from corneal topography revealed significantly better eccentricity in Group 2 eyes. Corneal topography showed the presence of a central island in all Group 1 eyes.

CONCLUSION: The compound ablation hypothesis was not confirmed. Presence of central island in compound-treated eyes induced significant optical aberrations. [J Refract Surg 2002;18(suppl): S366-S370]
Are Changes in Ocular Aberrations With Age a Significant Problem for Refractive Surgery?
Authors: Marcos Susana
Published: April 2021

ABSTRACT

We discuss current knowledge about the change of aberrations with aging, cataract surgery, and laser in situ keratomileusis (LASER) for myopia. Based on this evidence, we speculate about the long-term expectations for postoperative LAStK eyes in terms of aberrations. Standard myopic LASIK surgery produces a significant increase in aberrations, particularly corneal spherical aberration, which changes to positive values. Aberrations increase with age, and in particular, the spherical aberration of the crystalline lens shifts toward positive values. Therefore, no compensatory effect is expected to occur with age after standard myopic LASLK, but rather the unusually high amount of aberrations in postoperative LASLK patients is expected to worsen with age. The amount of aberrations in patients after cataract surgery with implantation of standard intraocular lenses (IOLs) is higher than in normal young subjects. If an ideal customized ablation (not inducing aberrations and reducing naturally existing aberrations) is ever possible, the perfect correction will not last (due to the change of aberrations with age), and aberrations of the crystalline lens corrected on the cornea are likely to reappear after conventional cataract surgery. Potential benefits of customized IOLs for cataract surgery and improved optics in older patients are discussed. [J Refract Surg 2002; 18:S572-S578]
Biomechanics of the Cornea and Wavefront-guided Laser Refractive Surgery
Authors: Roberts Cynthia
Published: April 2021

ABSTRACT

PURPOSE: Wavefront-guided laser refractive surgery induces postoperative optical aberrations that are not explained by the ablation profile.

METHODS: A conceptual model is presented for a potential mechanism of surgically-induced corneal shape change that is dependent on structural modification, rather than ablation profile.

RESULTS: Examples are provided from clinical and basic studies that are consistent with the proposed model.

CONCLUSION: Corneal biomechanical response to ablative surgery may significantly affect outcomes, and should be taken into account when planning customized procedures. [J Refract Surg 2002;18:S589-S592]
Effect of Aging on Ocular Light Scatter and Higher Order Aberrations
Authors: Kuroda Teruhito , Fujikado Takashi , Ninomiya Sayuri , Maeda Naoyuki , Hirohara Yoko , Mihashi Toshifumi
Published: April 2021

ABSTRACT

PURPOSE: To study the effect of aging on ocular light scatter and higher order aberrations in humane.

METHODS: Seventy-six eyes of 76 normal subjects who had refractive errors but no ocular disease were studied« Their age ranged from 4 to 69 years (mean 34.8 ± 5.8 yr). Both light scatter and total higher order aberrations were simultaneously and quantitatively measured by a Hartmann-Shack sensor for the central 4-mm-diameter pupil. Higher order aberrations were calculated from the Zernike polynomials up to the 4th order. The amount of light scatter was estimated by using the diameter of the point spread functions (PSFs) of the Hartmann images. A correction was made for the effect of the aberrations on the width of the images. Linear regression analysis was performed to investigate the effect of aging on light scatter and total higher order aberrations.

RESULTS: A significant correlation was found between scatter and age (Spearman rank correlation coefficient, r = 0.501, P - .001). Also, the total higher order aberrations increased significantly with age (r = 0.323, P = .005). The total higher order aberration and scatter index were not statistically significantly correlated (r s 0.184, P = .112).

CONCLUSIONS: These results indicate that scatter was better correlated with age than higher order aberrations. [J Refract Surg 2002; 18: S598-S602]
Basal Cell Carcinoma of the Eyelids: A Review of Patients Treated by Surgical Excision
Authors: Perlman Gilbert S , Hornblass Albert
Published: April 2021

SUMMARY

A study of 107 cases of basal cell carcinoma involving the eyelids in 106 patients all treated by surgical excision was undertaken. The lesions were found predominantly in Caucasians, showed no sex predilection (except for the fact that all five cases under age 40 occurred in females), and were most prevalent in the 7th decade of life. The most common presenting symptom was a mass or growth, while the duration of symptoms of any kind referable to the tumor was 20 months. The lower lid was the most common site of involvement, followed in order of frequency by the upper lid, medial canthus, and lateral canthus. Excised lesions that show marginal involvement histopathologically will not necessarily clinically recur, although this study did show that incomplete excision will more likely show a clinical recurrence in previously treated rather than primary lesions. If basal cell carcinomas of the eyelid are fully surgically excised as a first procedure, the patient will have about a 99% cure rate. Lesions requiring orbital exenteration are rare.
Pathophysiology and Treatment of Corneal Hydrops
Authors: Shaw Edward L
Published: April 2021

SUMMARY

The new application of thermokeratoplasty as a treatment of both acute and chronic hydrops is presented as a possible alternative to present treatment regimens The histopathology of keratoconus and hydrops is reviewed relating to thermokeratoplasty effect Clinical success was achieved in the elimination of pain from advanced chronic hydrops. With the closure of the breaks in Descemefs membrane central corneal clearing occurred. In cases of total hydrops although complete resolution of the edema was not always found sufficient, clearing of the corneal periphery allowed for successful penetrating keratoplasty.
Vitrectomy in Sickling Retinopathy: Report of Five Cases
Authors: Goldbaum Michael H , Peyman Gholam A , Nagpal Krishan C , Goldberg Morton F , Asdourian George K
Published: April 2021

SUMMARY

The unique problems encountered in sickle patients include the need to remove peripheral vitreous if perfusing sea fans - which can bleed after vitrectomy - are present at the time of surgery. However, peripheral vitrectomy is riskier than central vitrectomy alone. If visualization of the sea fans is sufficient, it is safer to close the sea fans prior to vitrectomy in order to obviate the need for peripheral vitrectomy, then, only central vitrectomy is performed. When sea fans cannot be closed prior to vitrectomy, peripheral vitreous is removed to allow early photocoagulation of the sea fans before they bleed again. Four case presentations illustrate these principles. Vitrectomy relieved severe vitreous traction that complicated retinal detachment in the fifth patient, thereby eliminating the need for a tight encircling structure, which can be poorly tolerated in patients with SC hemoglobin.
Argon Laser Iridotomy: An Experimental and Clinical Study
Authors: Pollack Irvin P , Patz Arnall
Published: April 2021

SUMMARY

Iridotomies were made in rabbit and human eyes using a continuous wave argon laser. Several of these have been studied histologically to determine the short- and long-term effects on the iris, cornea, lens and retina.

Thirty-three eyes of patients with angle-closure glaucoma were treated by argon laser iridotomy and followed for periods of up to twelve months. In two eyes, planned cataract surgery was performed shortly after the laser iridotomy and histologic specimens of the iris were examined.

From the experimental and clinical studies, an evaluation was made of the complications and clinical usefulness of the continuous wave argon laser as a means to produce iridotomies for the treatment of angle-closure glaucoma. Further long-term controlled studies are recommended to document the role of laser iridotomy.
Surgical Repair of a Traumatized Shrunken Eye
Authors: Swartz Mano , Goldberg Morton F , Peyman Gholam
Published: April 2021

ABSTRACT

A 50-year-old Japanese man underwent removal of a traumatic cataract with an intralenticular foreign body. Surgery was complicated by an unplanned extracapsular delivery of the lens and vitreous loss. Two years later, with a visual acuity of hand motions and signs of phthisis bulbi, he had a vitrectomy that cleared the media to reveal a rhegmatogenous retinal detachment. The detachment was treated by cryopexy, scleral buckling, and intraocular gas injection. One year after this combined procedure, his best corrected visual acuity was 20/400 with clear media and attached retina.
Clinical and Ultrastructural Correlation in Congenital and Acquired Ptosis
Authors: Hornblass Albert , Adachi Masazumi , Wolintz Arthur , Smith Byron
Published: April 2021

SUMMARY

The levator superioris muscle has been studied with the light microscope and the electron microscope in congenital and acquired ptosis. Ultrastructural findings correlated closely with the clinical entities. Congenital ptosis appears to be on a myogenic basis. Acquired ptosis ultrastructural Iy indicates a regenerative process.
Intraocular Microsurgery: I. New Instrumentation (SITE)
Authors: Federman Jay L , Cook Kenneth , Bross Robert , Sarin Lov K , Tasman William S , Annesley William H , McDonald P Robb
Published: April 2021

SUMMARY

The SITE instrument appears to combine advantages of other instruments previously described. It meets the proposed objectives of an efficient cutter where tissue is removed at the front end of the tip. It allows the surgeon complete control of the suction and reflux systems. The instrument is of a simple modular design. A fiber optic attachment is available. It is dependable and safe.
A New Method to Achieve Complete Akinesia of the Facial Muscles of the Eyelids
Authors: Spaeth George L
Published: April 2021

ABSTRACT

Blocking the facial nerve by injecting anesthetic agent over the most posterior, most superior palpable aspect of the ramus of the mandible produces more reliably complete facial nerve akinesia than obtained by the standard techniques used to obtain facial akinesia. The position is posterior and inferior to the point chosen for the classical O'Brien block. This new technique is safe and no complications have been noted in over 10 years of use. It is highly recommended as a method of achieving total hemifacial akinesia for ophthalmic procedures.
Ultrasonography in Foreign Body Detection and Localization
Authors: Skalka Harold W
Published: April 2021

SUMMARY

The relative advantages and disadvantages of radiographic and ultrasonic studies in foreign body detection and localization are discussed. The value of ultrasonography in finding radiolucent orbital foreign bodies and its clear superiority in the localization of foreign bodies with respect to the walls of the eye is demonstrated by several examples.

The information concerning the state of the lens, vitreous, and retina in such traumatized eyes which is obtained by ultrasonography represents a very important additional benefit of such study.
Computerized Axial Tomography of the Orbit
Authors: Leone Charles R , Wilson Frank C
Published: April 2021

SUMMARY

Computerized Axial Tomography is a noninvasive radiologic technique that gives definition to orbital structures that aids the ophthalmologist in his diagnosis and treatment. This outpatient study is painless, takes approximately thirty minutes, but does demand a very still patient. The globe, horizontal extraocular muscles, and optic nerve are well delineated which allows detection of retrobulbar abnormalities. Eleven examples of the sixty patients studied are presented demonstrating its value as the most informative test now available in orbital diagnosis.
The Use of the Cryoprobe in the Removal of Posterior Orbital Tumors
Authors: Henderson John W , Neault Roger W
Published: April 2021

SUMMARY

Experience with a cryoprobe for the surgical removal of encapsulated and circumscribed tumors, cysts, and neoplasms in the posterior orbit indicates that the instrument is a useful and efficient adjunct to the surgical management of orbital tumors.
Fifty Consecutive Eyes with Anterior Segment Disease Treated by the Pars Plana Approach
Authors: Peyman Gholam A , Huamonte Felipe , Nagpal Krishan , Sanders Donald R
Published: April 2021

SUMMARY

Results of a pars plana approach using the Peyman vitrophage to treat various anterior segment diseases are presented in 48 patients (50 eyes). These included cases of ocular trauma, congenital cataracts, complications following unplanned and planned extracapsular cataract extractions and phacoemulsification, and dense secondary membranes. Visual acuity improved in 86%, remained unchanged in 10% and worsened in 4% of all eyes.
Brass Intraocular Foreign Body: Early Intervention and Combined Surgical Approach
Authors: McLean Edward B , Chandler John W
Published: April 2021

SUMMARY

The rapid development of suppurative reaction in response to a copper-containing intraocular foreign body disposes the eye to a poor prognosis. An intraocular brass foreign body case involving cornea, iris, lens, vitreous and retina was satisfactorily managed by early foreign body removal and corneal transplantation followed by scleral buckling for retinal detachment Early intervention is advocated as alternative management with expectation of improvement in the prognosis for recovery of useful visual function.
Pitfalls in the Determination of Intraocular Lens Power Without Ultrasound
Authors: Binkhorst Richard D
Published: April 2021

SUMMARY

The rule is simple: An 18 diopter intraocular lens tends to restore the basic refraction. For each diopter of basic refraction to be corrected add or subtract 1.25 diopters. To determine the basic refraction a careful history and an examination of old glasses and past refraction records is necessary. When the basic refraction cannot be ascertained, capital errors may occur. Given the basic refraction, errors of several diopters are still apt to occur. Calculation of intraocular lens power based on K-readings and ultrasonic measurements is therefore always advisable and a must when there is doubt about the basic refraction.
The Use of Solid Soft Silicone Rubber Exoplants in Retinal Detachment Surgery
Authors: Aaberg Thomas M , Wiznia Robert A
Published: April 2021

ABSTRACT

A method of retinal detachment surgery utilizing soft solid silicone rubber exoplants is described along with its use in typical cases. Solid silicone rubber, long used as a scleral implant, is a well-tolerated exoplant scleral buckling material which has been found to provide excellent long-term results. Thé surgical procedure described is relatively short in duration and has a minimum of operative and postoperative complications.
Trabeculectomy with Cautery
Authors: Schimek Robert A , Williamson William A
Published: April 2021

SUMMARY

Trabeculectomy with cautery was performed on 31 eyes of 25 glaucoma patients uncontrolled on maximal medical therapy. The procedure was designed to combine the effectiveness of Scheie's thermal sclerostomy with the low incidence of complications associated with trabeculectomy. There was an 81 percent success rate overall and an 83 percent success rate in blacks. Average followup was 25 months. The average preoperative pressure was 29 mm Hg and the average postoperative pressure was 11 mm Hg. Immediate postoperative complications were minimal. The most serious long-term problem was the acceleration of lenticular changes. The procedure is technically simple with a majority of cases being performed by house staff at a relatively early stage of training. It is believed that trabeculectomy with cautery is indicated in blacks, in far-advanced glaucoma cases, and in patients in whom a conventional trabeculectomy has failed.
Detection of Orbital and Intraocular Foreign Bodies by Computerized Tomography
Authors: Kollarits Carol R , Di Chiro Giovanni , Christiansen John , Herdt Jean B , Whitmore Paul , Vermess Michael , Michels Ronald G
Published: April 2021

SUMMARY

Localization of intraocular and orbital foreign bodies with computerized tomography (CT) was evaluated in eight patiente and an experimental model. CT examination was particularly helpful in cases with multiple similar foreign bodies and in identifying foreign bodies too radiolucent to be seen by standard skull xrays. Limitations of CT technique included insufficient resolution to localize a foreign body immediately adjacent to the sclera as either intraocular or extraocular, and obscuration of a small foreign body by artifacts from an adjacent, larger foreign body.
Plugs and Stiletto: Entry Incisions for A 20-Gauge Instrument System
Authors: O'Malley Conor , Tripp R Maurice
Published: April 2021

ABSTRACT

A specialized stiletto shaped knife (Stiletto) and self-retaining incision plugs (Sclera Plugs) have been made. They are very useful for creating and temporarily occluding entry incisions for 2f>gauge instruments suitable for closed eye intraocular surgery such as vitrectomy, lensectomy, removal of retina and vitreous membranes.

The choice of material, configuration and dimensions of these new devices enable one to create incisions in the pars plana which do not leak liquid, gas, or tissue at IOP up to 80 mm Hg , when occupied by20-gauge cylindrical instruments or Sclera Plugs.

The plugs free one or both of the surgeon's hands for use outside the eye for indirect ophthalmoscopy, external surgery, and reduce considerably the time and skill formerly required for proper incision management
Dacryocystectomy for Tumors of the Lacrimal Sac
Authors: Stokes D Parker , Flanagan Joseph C
Published: April 2021

SUMMARY

A high index of suspicion is very important in the early diagnosis and treatment of potentially lethal tumors of the lacrimal sac. The triad of a mass above the medial canthal tendon, chronic dacryocystitis which irrigates freely and bloody reflux on irrigation should alert the ophthalmologist of this potentially fatal situation. Complete surgical excision and postoperative irradiation are important in the treatment of malignant tumors.
Results of Primary and Secondary Implants Using Choyce Mark VIII Lenses
Authors: Tennant Jerald L
Published: April 2021

SUMMARY

The author's experiences with the Choyce Mark VIII implant have been statistically reviewed. The results reveal no significant increase in complications over standard cataract extraction without implantation. Secondary implantation is compared with primary implantation. The results seem to support the author's position that secondary implantation with the Choyce lens carries a 3-5% incidence of complications which must be weighed against the patient's need for further rehabilitation. The importanc- of fixation in implantation has been reviewed from an historical standpoint to support the conclusion that the Choyce lens owes much of its superior results to its ideal fixation and lack of pseudophakodonesis.
Secondary Intraocular Lens Implantation
Authors: Hardenbergh Firmon E
Published: April 2021

SUMMARY

Mere aphakia is not an indication for secondary intraocular lens implantation. However, many patients with positive indications may be benefited most strikingly by this procedure. These indications are illustrated and results of the author's first 65 secondary implantations are analyzed.
Iridocapsular Lenses Versus Iris-Clip Lenses: Comparison of the Results and Complications of 100 of Each
Authors: Kern Rudolf
Published: April 2021

SUMMARY

The results and complications of implantation of 100 iridocapsular and 100 iris-clip lenses are evaluated. The follow-up period for the first group varied from one to 25 months (mean 12 months) and from one to 43 months (mean 27 months) for the second group. I performed all of the operations and most of the follow-up examinations. Of the patients with iridocapsular lenses, 86 percent and of those with iris-clip lenses, 87 percent obtained a visual acuity of 0.5 (6/12) or better. Binocular vision, positive depth perception, and a small degree of aniseikonia (3% or less) are evident optical benefits.

The complications most frequently necessitating a second operation were retained lens material (17%) and repositioning the pseudophakos (6%) in the iridocapsular group. The four-loop lenses caused fewer problems; in one case, posterior luxation necessitated its removal.
Experience With The Large Circular Loop Medallion Lens And A Critical Comparison With The Suture Medallion Lens: A Report of 300 Cases
Authors: Kraff Manus C , Lieberman Howard L
Published: April 2021

SUMMARY

An iris-supported intraocular lens must have stable fixation to minimize postoperative complications. A series of 46 large circular loop Medallion lenses were implanted after intracapsular cataract extraction and compared with a series of 254 suture Medallion lenses. An unexpectedly high incidence of lens dislocation and iris damage occurred with the large circular loop Medallion lens implants. Based on our results, we believe that the large circular loop Medallion lens should not be used for implantation after intracapsular cataract extraction at this time. The suture Medallion lens provides a standard to which other pseudophakai may be compared.
Corneal Thickness Measurements Following Intraocular Lens Implantation
Authors: Praeger Donald L , Schneider Harold A
Published: April 2021

SUMMARY

Corneal thickness measurements were carried out on patients who had undergone combined phacoemulsification cataract extraction with simultaneous intraocular lens implantation in one eye at least six months prior to the date of measurement. The unoperated eye served as control. Another group of patients who had undergone simultaneous phacoemulsification cataract extraction combined with intraocular lens implantation were followed over a two-month period of time, serial corneal thickness measurements being performed. The results indicate that, in surgery performed by experienced surgeons on carefully selected patients, phacoemulsification cataract extraction using the Kelman technique combined with intraocular lens implantation had no significant effect on corneal endothelial function as reflected in corneal thickness changes.
Restoration of Binocular Vision
Authors: Choyce D P
Published: April 2021

SUMMARY

Numerous studies have shown that Pseudophakic surgery is a better (because it is a more natural) method of restoring binocularity than contact lenses or aphakic spectacles provided that the potential for binocular vision was present before the onset of the cataracts). However, this restoration is achieved more easily in some groups of patients than others.

Unilateral: Excellent prognosis for binocularity is retained for many years -even 50-60 years - in adult unilateral traumatic cataract/aphakia. At the other extreme are patients born with one normal eye and the other containing a well-marked cataract. In unilateral traumatic cataractfaphakia in children the potential for restoration of binocularity is related to age - the older the child, the better the chances.

To achieve binocularity central vision must not fall below 20/70 in each eye.

Bilateral: There is not much to choose between pseudophakia and contact lenses; both are effective in restoring binocularity, and both are superior in this respect to cataract spectacles of keratophakia.1
Intraocular Lens Implantation Combined With Penetrating Keratoplasty
Authors: Aquavella James V , Shaw Edward L , Rao Gullapalli N
Published: April 2021

SUMMARY

A restrospective analysis was conducted of 27 cases of penetrating keratoplasty associated with intraocular lens implantation. Although not statistically significant the results indicated an 80% success rate when penetrating keratoplasty, cataract extraction and intraocular lens implantation were combined in a single operation. Secondary implantation of intraocular lenses in cases of previous keratoplasty were unsuccessful in all three cases.
Cystoid Macular Edema Following Intraocular Lens Implantation
Authors: Harris William S , Taylor Bruce C , Winslow Richard L
Published: April 2021

SUMMARY

This presentation recounts the original description of CME and the more recent developments associated with intravenous fluorescein angiography in its study and diagnosis. The work of previous authors to show the incidence of CME and its possible prognosis are reviewed. Our findings in a retrospective study agree with the other authors and show that there is no particular increase in CME following intraocular lens implantation regardless of the type of surgical procedure used. It is established that vitreous loss does increase the incidence of CME. A prospective study with routine intravenous fluorescein at six weeks is presented and shows an incidence that is below that found by other authors when it was performed following routine intracapsular cataract extraction.
Results After Intracapsular Extraction: The Atonic Pupil
Authors: Percival S P B
Published: April 2021

SUMMARY

Satisfactory visual results are reported in a series of 80 consecutive patients who underwent intracapsular cataract extraction with a four- or three-loop Binkhorst lens replacement. Nearly 50% of patients could see 20/30 or better unaided. However, results in the under 70 age group tend to be marred by macular edema, and in the over 80 age group by corneal edema, the latter occasionally being the result of lens instability because of an atonic pupil.
Intraocular Lens Surgery on a Resident's Service
Authors: Reinhart W J , Annable W L
Published: April 2021

SUMMARY

Twenty-three patients had intraocular lens surgery performed by eight separate ophthalmology residents over an eighteen month period of time. Adequate technical results were achieved in 19 of the 23 cases. Three patients had visual complications directly related to the intraocular lens surgery: two with bullous keratopathy and one with cystoid macular edema. By restricting surgical indications to older patients with good vision in the fellow eye and using general anesthesia in conjunction with the operating microscope, osmotic agents, intracapsular surgery, and close operative supervision, it is hoped that results will justify continued use of intraocular lenses on our resident's service.
Unilateral Congenital Cataracts and their Management
Authors: Ryan Stephen J , Maumenee A Edward
Published: April 2021

SUMMARY

Eight cases of unilateral congenital cataract were operated in the first two years of life. They were treated with contact lenses fitted within the first three weeks postoperatively and with patching of the good eye. None of these eyes achieved better than 3/100 vision. This dense amblyopia would seem based on the marked refractive difference. In addition to the ocular aspects, the psychological aspects of this evaluation would indicate that such surgery and postoperative management is probably not indicated for unilateral congenital cataracts.
In Vitro Evaluation of Intraocular Infusion Fluids: Effects on the Lens and Cornea
Authors: Sanders Donald R , Peyman Gholam A , McEnerney James K , Janevicius Raymond V
Published: April 2021

SUMMARY

Glutathione-bicarbonate-Ringer solution (GBR), GBR deficient in adenosine and glutathione, and a newly proposed glucose-phosphate-Ringer solution (GPR) have been found to maintain lens fu notion and corneal endothelial viability with approximately equal efficacy during prolonged periods of incubation. Currently used intraocular irrigating solutions do not perform as well in maintaining the function of borderline decompensated lenses and in sustaining endothelial viability.
A Tarsal Resection Procedure for Senile Entropion with Lid Retraction
Authors: Bodian Martin
Published: April 2021

SUMMARY

1. A method of tarso-conjunctival resection for correction of spastic entropion associated with lid retraction has been presented which prevents a) the presence of suture knots against the cornea, b) localized trichiasis, and c) tissue reaction to absorbable sutures.

2. These advantages are achieved through the use of several figure-of-8 silk sutures which are tied on the skin surface.

3. By keeping the apex of the excised triangle of tarsus 2 mm below the lid margin trichiasis may be avoided.

4. Twelve operations have been followed for 1 to 6 years. The retraction and entropion were markedly improved in eleven lids. One under-correction resulted. There were no other complications.
Iris Tissue Reaction to Intraocular Materials: Feasibility for Intraocular Lens Fixation
Authors: Janevicius Ray , Peyman Gholam A
Published: April 2021

SUMMARY

We evaluated six commercially available materials for possible use in intraocular lens fixation. Dacron, Teflon, Marlex, nylon, silk, and catgut samples were placed adjacent to rabbit iris tissue and judged for tissue ingrowth and adhesion. Dacron produced maximal adhesion with minimal postoperative inflammation.
A New Operating Microscope With Increased Illumination Efficiency And A Stereoscopic Assistant Viewer
Authors: Peyman Gholam A , Sanders Donald R , Koziol Jeffrey , Fried Walter
Published: April 2021

SUMMARY

We have developed a simple operating microscope that provides stereopsis, undiminished and equal illumination, and the same operative view for both the surgeon and assistant.
Assessment of the Efficacy of Chemiluminescent Evaluation of the Human Lacrimal Drainage System
Authors: Raflo Gary T , Hurwitz Jeffrey J
Published: April 2021

SUMMARY

A chemiluminescent material, Cyalume, was used to demonstrate the anatomy and patency of the human lacrimal drainage system. Cadaver models were used to simulate blockages at various levels of the lacrimal drainage system and the Cyalume technique compared favorably with the corresponding dacryocystograms. Cyalume also shows promise for use in locating the lacrimal sac at surgery, the proximal end of a lacerated canaliculus, and the free ends of canalicular intubation tubes high in the nose. The authors feel that Cyalume shows promise as both a convenient method of clinical investigation of the lacrimal system and an aid in lacrimal surgery.
Use of the Honan Intraocular Pressure Reducer at The Wilmer Institute
Authors: Martin Neil F , Stark Walter J , Maumenee A Edward , Bruner William E , Rosenblum Paul
Published: April 2021

SUMMARY

Our technique for the preparation of the patient for cataract surgery is discussed, with description of our use of the Honan intraocular pressure reducer (HIPR). Results of preoperative use of the HIPR in a prospective study of 21 patients and our retrospective experience with over 1,000 patients undergoing cataract surgery (with or without lens implantation) are discussed. The HIPR appears to be a safe and effective means of reducing intraocular pressure preoperatively when used with due care.
Expansile Loops for Anterior Chamber Lens Implants
Authors: Girard Louis J , Hofmann Robert F , Pearlman Peter M
Published: April 2021

SUMMARY

Twenty eyes undergoing pars plana lensectomy with insertion of expansile loop anterior chamber lens implants were followed for 4-11 months. Sixteen eyes received a Simcoe lens, and all achieved a visual acuity of 20/20-20/40 without complications.

Two of three eyes with Shearing implants developed uveitis and cystoid maculopathy. The one Sinsky implant tilted and required replacement. Highly flexible expansile implants (i.e., Simcoe lens) appear to be well tolerated in the anterior chamber and achieved excellent stability.

The observation period was too short to draw definite conclusions. This study will be continued.
Three-Years' Experience in a Regional Burn Center With Burns of the Eyes and Eyelids
Authors: Guy Roxanne J , Baldwin Jack , Kwedar Stephen , Law Edward J
Published: April 2021

SUMMARY

A retrospective three-year study of lid and ocular burn injuries in a regional burn center revealed no major complications. The management program was based on cooperation between the burn unit and ophthalmological staff and included: 1. A high index of suspicion for eye injuries of the burned patient; 2. Early ophthalmologic consultation and examination; 3. Aggressive early treatment; 4. Rigorous follow-up and re-examination; and 5. Multiple and frequent grafting of lids, as needed.
One-Stage Lower Eyelid Reconstruction
Authors: Beyer Charles K , Bathrick Marie E
Published: April 2021

SUMMARY

A technique for reconstruction of 75% to 90% of the lower eyelid is presented. This procedure utilizes a large tarsoconjunctival graft in conjunction with an advancement skin graft from the cheek. This one-stage approach is valuable in lower eyelid reconstruction in monocular patients.
Complications Associated with Running 11 -0 Nylon Suture in Penetrating Keratoplasty
Authors: Olson Randall J
Published: April 2021

SUMMARY

In a series of 100 penetrating keratoplasties, an 11 -0 nyton suture was placed after first running a 10-0 suture. Three suture-related complications presented. One complication resulted from inadvertently cutting the 1 1 -O nylon as the 1 0-0 nylon was removed. The second complication was that of a traumatic rupture of the 1 1 -O nylon, which occurred ten months after surgery. The third complication arose from exposure of the 1 1 -O nylon through the epithelium due to wound contracture. The management of each suturerelated complication is discussed.
Tarso-Septal Z-Plasty Combined with Skin Grafting for the Late Correction of Traumatic Upper Lid Contractures
Authors: Zolli Christine L
Published: April 2021

SUMMARY

A technique for the repair of upper eyelid contracture, which involves a full thickness "tarso-septal Z plasty," is described. The vertical arm goes through the scarred area, and the horizontal arms are approximately parallel to the brow and eyelid margin. Skin grafting is also commonly done in conjunction, and the operated lid is then kept in overextension for two to four weeks.
Air-Fluid Exchange in the Treatment of Vitreous Hemorrhage During Vitrectomy
Authors: Cohen Ben Zane , Fisher Yale Lloyd
Published: April 2021

SUMMARY

We describe the use of an air-fluid exchange to treat serious vitreous hemorrhages that occur during vitrectomy. This technique allows identification and treatment of bleeding sites, ensuring clear media during completion of surgery and postoperatively.
Traumatic Dislocation of a Shearing Lens 31 Months After Implantation
Authors: Murphy Gates E
Published: April 2021

SUMMARY

A case is reported of traumatic dislocation of a previously well-fixated Shearing posterior chamber implant occurring 31 months after surgery, and the surgical management is briefly discussed. This case is believed to be the first reported instance of a Shearing lens dislocation definitely unrelated to zonular rupture at the time of implantation.
Marsupialization of a Lacrimal Gland Cyst
Authors: Harris Gerald J
Published: April 2021

SUMMARY

A lacrimal gland cyst developed as a late complication of Stevens-Johnson syndrome. The mass produced mechanical ptosis and became secondarily infected. Obstruction of lacrimal secretions contributed to a quantitative tear deficiency and epithelial erosions of the cornea. The mass and the keratoconjunctivitis sicca were successfully managed by marsupialization of the cyst wall.
Combined Procedure: Sub-Scleral Trabeculectomy with Cataract Extraction
Authors: Praeger Donald L
Published: April 2021

SUMMARY

A sub-scleral trabeculectomy and cataract extraction were performed in 34 eyes of 28 patients. Postoperative visual acuity was 6/6 to 6/12 in 24 eyes. Nine of the remaining 10 eyes had pre-existing glaucomatous neuropathy or chorioretinal maculopathy. Duration of follow-up extended from a minimum of 12 months to a maximum of 68 months. Thirty eyes exhibited satisfactory glaucoma control (88.2%). Twenty-one eyes (61.7%) required no medication postoperatively. There were no significant postoperative complications from the combined procedure.
Double-Masked Trial of Fenoprofen Sodium: Treatment of Chronic Aphakic Cystoid Macular Edema
Authors: Burnett Jettie , Tessler Howard , Isenberg Sherwin , Tso Mark O M
Published: April 2021

SUMMARY

Aphakic cystoid macular edema is a serious eye disease. Its etiology is unknown, but a widely held theory attributes it to an inflammatory response to surgical trauma.

In a double-masked study, a 1% solution of fenoprofen sodium, a topically applied antiprostaglandin agent, was evaluated against placebo in determining the effectiveness of fenoprofen in the treatment of chronic aphakic cystoid macular edema.

Fourteen patients, five women and nine men, participated in the study. Fenoprofen sodium was found to have no effect on the course of chronic aphakic cystoid macular edema. We believe that the lack of effect may have been due to the duration of edema at the time of treatment or to the small sample size. Larger studies in the immediate postoperative period are suggested.

The importance of iris angiography as a possible predicting technique of macular leakage is emphasized.
A New Headrest and Drape Support for Ophthalmic Surgery
Authors: Garland Marvin A
Published: April 2021

SUMMARY

A new type of combination headrest, drape support, instrument tray, and oxygen delivery system has been designed for use with eye surgery. It can be used with local, stand-by, and general anesthesia. It eliminates the need for a separate wrist support. It can also be modified to be used with other facial procedures.
The Spectrum of Primary Open Angle Glaucoma I: Senile Sclerotic Glaucoma Versus High Tension Glaucoma
Authors: Geijssen H Caroline , Greve Erik L
Published: April 2021

ABSTRACT

This paper describes two subgroups of primary open angle glaucoma: senile sclerotic glaucoma in the elderly with relatively low intraocular pressures, normal chamber angles, senile excavation, perlpapillary atrophy and choroidal sclerosis; high tension glaucoma in the younger age-group with high intraocular pressures, signs of mesodermal dysgenesis in the chamber angle, deep and steep excavation, little perlpapillary atrophy and no choroidal sclerosis.

The description of senile sclerotic glaucoma is new as are the differences in the chamber angle and perlpapillary atrophy. The size of the visual field defects in the upper and lower half of the visual field is similar in high tension glaucoma. In senile sclerotic glaucoma the larger defect tends to be in the upper half of the visual field.

It is suggested that in senile sclerotic glaucoma the primary cause of damage is local vascular disease, and that in high tension glaucoma the intraocular pressure with a secondary role for an insufficient blood supply is the major cause of damage.

Primary open angle glaucoma can be characterized by the ratio of pressure risk factors and vascular risk factors.
Reactive Membrane on a Foldable Silicone Lens Implant in the Posterior Chamber of a Human Eye
Authors: Wolter J Reimer , Sugar Alan
Published: April 2021

ABSTRACT

A foldable silicone posterior chamber intraocular lens implant caused irritation and glaucoma postoperatively in the eye of a diabetic patient who subsequently was treated with steroids and a laser capsulotomy. Because the lens implant was loose in the capsular bag and caused considerable glare, it was removed about 4 months after placement. Pathologic study revealed the entire surface of the implant to be covered by a continuous and firmly adherent protein membrane with excrescences and of irregular thickness. Sessile macrophages found on the membrane were not firmly attached.
Effect of Collagen Shields on Corneal Epithelialization Following Penetrating Keratoplasty
Authors: Ruffini John J , Aquavella James V , LoCascio Joseph A
Published: April 2021

ABSTRACT

To evaluate the effects of collagen shields on corneal epithelial healing following keratoplasty, we conducted a prospective study of 89 consecutive penetrating keratoplasty patients over a 9-month period, applying collagen shields in alternate cases. Eyes were evaluated on the first and on the eighth postoperative day. The appearance of the epithelium was graded on a scale from 0 to 4. Independent variables, such as donor age, patient age, patient and donor sex, death to preservation time, and donor time in K-Sol media prior to surgery, were also evaluated. Donor corneas treated with collagen demonstrated less epithelial staining and smaller epithelial defects on the first day following surgery. The results were evaluated with a Student's t test and were found to be significant (P<0.001). We conclude that the application of porcine collagen shields following keratoplasty is an effective means of encouraging reepithelialization of the graft.
Surgical Dilation of the Pupil During Pars Plana Vitrectomy
Authors: Federman Jay L , Anand Rajiv
Published: April 2021

ABSTRACT

Adequate pupillary dilation is essential to dissect and excise peripheral fractional proliferative tissue during vitreous surgery. Most surgical dilating procedures involve an incision or excision of iris tissue, that is either inadequate or irreversible. We describe a modification of a previously devised technique for stretching the pupil that ensures an excellent view of the peripheral retina. The technique has been used in aphakic and pseudophakic eyes in over 50 cases with no postoperative morbidity or problems with glare or poor cosmesis.
Use of Apraclonidine to Reduce Acute Intraocular Pressure Rise Following Q-switched Nd:YAG Laser Iridotomy
Authors: Kitazawa Yoshiaki , Taniguchi Tohru , Sugiyama Kazuhisa
Published: April 2021

ABSTRACT

We evaluated the effectiveness of topical apraclonidine (ALO 2145, p-amino clonidine hydrochloride) in suppressing an acute postoperative intraocular pressure (IOP) rise following Nd:YAG laser iridotomy. Fifty-eight eyes (45 patients) with chronic primary angle-closure glaucoma underwent Q-switched Nd:YAG laser iridotomy. Twenty-nine eyes followed prospectively underwent Nd:YAG laser iridotomy following the topical administration of 0.5% apraclonidine prior to and immediately following the procedure. A retrospective control group of 29 eyes underwent Nd:YAG laser iridotomy without topical apraclonidine. Only one eye (3.4%) treated with apraclonidine experienced an IOP rise greater than 10 mm Hg over baseline, while five among 29 untreated eyes (17.2%) developed an IOP rise greater than 10 mm Hg.
Postoperative Refractive Changes in Children With Congenital Esotropia: A Preliminary Study
Authors: Snir M , Nissenkorn I , Buckman G , Cohen S , Ben-Sira I
Published: April 2021

ABSTRACT

A transient myopic inclination was found 2 months postoperatively in 23 children who had undergone surgery for congenital esotropia. Neither the age of the children at the time of surgery nor the length of muscle recession/resection influenced these refractive myopic changes. Early postoperative refractive correction with periodic follow-up is essential in preventing amblyopia. In 21 of the 23 children, visual acuity was 6/10 or better at last examination.
Endophthalmitis Due to Propionibacterium acnes Sequestered Between IOL Optic and Posterior Capsule
Authors: Sawusch Mark A , Michels Ronald G , Stark Walter J , Bruner William E , Annable William L , Green W Richard
Published: April 2021

ABSTRACT

A 68-year-old woman had delayed onset, persistent uveitis following routine extracapsular cataract extraction with posterior chamber intraocular lens implantation. The patient initially responded to topical steroids, but developed a whitish capsular plaque thought to represent possible Propionibacterium acnes endophthalmitis. A vitrectomy and capsular biopsy yielded cultures positive for P. acnes only after nine days. The intraocular lens was left in place. Light and electron microscopy revealed bacteria sequestered within the capsular bag.
Intermittent Intraocular Thrombin as an Adjunct to Vitrectomy
Authors: Maxwell Donald P , Orlick Martin E , Diamond G
Published: April 2021

ABSTRACT

The use of intraocular thrombin to control intraoperative hemorrhage is presented in two cases, one involving severe ocular trauma, the other severe proliferative diabetic retinopathy. The technique of intermittent boluses of 100 units/ml of thrombin in BSS Plus solution has certain advantages over the constant infusion mode of delivery. The ability to quickly manipulate the flow offers a distinct advantage in controlling the intraocular pressure and total amount of thrombin delivered. This is achieved by a simple and uncomplicated modification of the standard gravity infusion controlled by the surgical assistant.
Prognosis of Foveal Splitting Rhegmatogenous Retinal Detachments
Authors: Brenton Randall S , Blodi Christopher F
Published: April 2021

ABSTRACT

Retrospectively reviewing 4,966 patients with rhegmatogenous retinal detachments, we identified 21 patients with foveal split detachments who had no coexisting macular disease and who had been followed at least 6 months postoperatively. All detached retinas were anatomically reattached with one operation. The average preoperative and postoperative visual acuity was 20/50. Because eyes with foveal split detachments have a good visual prognosis when the retinas are anatomically reattached, we recommend that they be treated urgently, as if they had a maculaspared detachment.