bluuebunny/crossref_metadata_2025 huggingface dataset:
Designing Clinical Examples to Promote Pattern Recognition: Nursing EducationBased Research and Practical Applications
Authors: Welk Dorette Sugg
Published: April 2021

ABSTRACT

Despite carefully planned classroom sessions and richly designed clinical experiences, nurse educators know that, realistically, students will not encounter all of the life-threatening patient situations that require recognition and intervention during these sessions and experiences. However, on graduation, these students will be legally accountable for recognition of these situations and the immediate interventions associated with them. Therefore, the challenge for nurse educators is how to structure didactic interactions that promote pattern recognition in anticipation of such yet-to-be-experienced events.
Clinical Evaluation in Advanced Practice Nursing Education: Using Standardized Patients in Health Assessment
Authors: Gibbons Susanne W , Adamo Graceanne , Padden Diane , Ricciardi Richard , Graziano Marjorie , Levine Eugene , Hawkins Richard
Published: April 2021

ABSTRACT

Clinical education is critically important because competency in practice ultimately will determine the future of advanced practice nursing. Skills taught in Health Assessment, the first in a series of clinical courses, exposed students to tools that form the basis on which other competencies are built. The availability of standardized patients, people who participate in enacting a simulated but seemingly "real life" clinical encounter in a realistic clinical setting for the benefit of student learning and/or evaluation, made this instructional development project possible. The underlying assumption of this project was that clinical advanced practice nursing student education is enhanced by using an authentic clinical environment, known as a simulation center, with standardized patients and by using one or more evaluation techniques with multiple evaluators (i.e., peer, self, faculty, standardized patient). The student clinical experience was expected to improve and overall learning to increase by this method. This improvement was reflected at the end-of-course evaluations and in the quality of the final videotaped physical examination, which was superior to previous years. Student and faculty satisfaction with this teaching-learning process exceeded all expectations.
Merging Reflective Inquiry and Self-Study as a Framework for Enhancing the Scholarship of Teaching
Authors: Drevdahl Denise J , Stackman Richard W , Purdy Jill M , Louie Belinda Y
Published: April 2021

ABSTRACT

This article provides a model for improving teaching practice and developing new knowledge about teaching. The reflective self-study approach to pedagogical inquiry is rooted in reflective inquiry and self-study as found in nursing and education literature, respectively. The model offers nurse educators a mechanism by which they can better understand themselves as teachers and how their teaching affects students. Essential features of the model include interdisciplinarity and collaboration. Using the framework outlined Ln this article will help establish reflective self-study research as an accepted model of inquiry and further the dialogue on teaching in higher education.
Stereopsis in Young Infants and Stereopsis in an Infant with Congenital Esotropia
Authors: Bechtoldt Harold P , Hutz Claudio S
Published: April 2021

Stereopsis in Young Infants
Orbital Aspergillosis: Report of a Case in a Child
Authors: Whitehurst Fred O , Liston Thomas E
Published: April 2021

Summary

A child developed eyelid swelling that was diagnosed in succession as an abscess, eosinophilic granuloma, malignancy, and inflammatory pseudotumor. Treatment modalities included antibiotics, radiation and corticosteroids. Repeated histologic examination finally provided the diagnosis of orbital mycosis, most consistent with aspergillosis. Despite six weeks of therapy with Amphotericin B, an exenteration was required. Amphotericin B was continued for another six weeks, and there has been no evidence of recurrent disease after two years of follow-up. The problems encountered in the diagnosis and management of this unusual infectious disease of the orbit in children are discussed in detail.
Congenital Toxoplasmosis Associated with Acquired Oculomotor Nerve (CN III) Palsy
Authors: Perry Dwight D , Merritt John C , Greenwood Robert S , Collier Albert M , Tennison Michael B
Published: April 2021

Abstract

A nine-week-old Caucasian male presented with right ptosis and right exotropia due to a third cranial nerve palsy. Symmetrical macular lesions and a paramacular hyperpigmented lesion with overlying vitreous cells in the left eye were compatible with congenital toxoplasmosis. Computer tomography demonstrated calcifications in the periventricular and midbrain regions where the oculomotor nerve exits the brainstem. The diagnosis was confirmed by the toxoplasma indirect fluorescent antibody titer greater than 1:2048 for the infant and greater than 1:512 for the mother. Treatment was instituted with pyrimethamine, sulfadiazine and folinic acid.

Neurologic sequelae included a right hemiparesis, infantile seizures, and generalized developmental delay. A Mueller's muscle resection (RUL) combined with 9mm recession of the right lateral rectus and 7-mm resection of the right medial rectus muscles produced minimal ptosis and right exotropia one year later. The child now prefers to fix with the right eye and a vertical nystagmus is evident in the left eye.

To our knowledge this is the first reported case of an infant with noncomitant strabismus due to congenital toxoplasma cranial nerve involvement. The finding of an acquired third cranial nerve palsy accompanied by progressive neurologic sequelae warrants consideration of congenital toxoplasmosis.
Evaluation of the Posterior Fixation Plus Recession Operation with Saccadic Velocities
Authors: Kushner Burton J
Published: April 2021

ABSTRACT

I performed a posterior fixation of the medial rectus in seven patients with convergence excess esotropia and successfully reduced their esotropia at near. Postoperative saccadic velocity testing did not reveal the expected decrease in saccadic velocity as the eye moved increasingly into the field of action of the operated muscle. Posterior fixation of a rectus muscle may enhance the effect of the standard recession operation by increasing the amount of slack created in the functional part of the muscle after recession. Also, it may make a large percentage of the muscle fibers ineffective.
Epibulbar Osseous Choristoma
Authors: Dreizen Neil G , Schachat Andrew P , Shields Jerry A , Augsburger James S
Published: April 2021

ABSTRACT

A 14-year-old girl presented with a firm, movable, epibulbar mass of the right eye. The clinical appearance was characteristic of an epibulbar osseous choristoma. and the diagnosis was substantiated radiographically and confirmed histopathologically. The clinical features, management, and histopathology of epibulbar osseous choristomas are reviewed.
Accommodation in School Children With Music or Sports Activities
Authors: Mäntyjärvi Maija I
Published: April 2021

ABSTRACT

The accommodation of 324 school children aged 10 to 16 years was studied before and after a 12-minute reading session. One hundred and twenty children (81 girls and 39 boys) were wind instrument players in school bands, 93 children (48 girls and 45 boys) trained in an individual sport, and 111 children (65 girls and 46 boys) having no such activities were studied as a control group. At the end of the reading session, decreased accommodation (7 diopters or less) was found in 19 (15.8%) of the musicians, in six (6.5%) of the athletes, and in six (5.4%) of the control group. The difference was significant between the musicians and the control group, but not significant between the athletes and the control group. The majority of the children with low accommodation were girls; there was only one boy with decreased accommodation in each of the three groups.
Goniotomy With Sodium Hyaluronate
Authors: Arnoult Jeffery B , Vila-Coro Antonio Aguirre , Mazow Malcolm L
Published: April 2021

ABSTRACT

A modification of the classical goniotomy technique is described. After complete evacuation of the anterior and posterior chambers, sodium hyaluronate is placed in the anterior chamber and on the cornea. Putting hyaluronate in both locations prevents the formation of air bubbles under the goniotomy lens, provides the same index of refraction on both sides of the cornea, prevents accidental loss of the anterior chamber, and allows maximal depth of the anterior chamber. Diminished intraocular bleeding and lower risk of injury to the corneal endothelium, iris, and lens may be additional advantages of the procedure.

Two cases are presented in which five goniotomies were performed on four eyes using this technique. Both patients had one eye controlled with a single goniotomy. The fellow eye of each patient required multiple procedures. Glaucoma was controlled successfully with no medication in all four eyes. No significant complications occurred.
Ten Years Without Orbital Optic Nerve: Late Clinical Results After Removal of Retrobulbar Gliomas With Preservation of Blind Eyes
Authors: Wolter J Reimer
Published: April 2021

ABSTRACT

Surgical removal of gliomas of the orbital optic nerve by the transconjunctival approach with preservation of the associated eyes was successful and has been reported in several cases. The central retinal arteries in the anterior optic nerves were proven histologically to have been excised along with the gliomas in all cases. Due to suspected variations of blood supply, however, the retinal blood vessels postoperatively remained bloodfilled in these blind eyes, and the eyes could be maintained. Follow-up of about 10 years in two cases with surviving blind eyes after surgical excision of large optic nerve gliomas revealed normal development of lids and orbit, good muscle function, and relatively good cosmetic appearance as well as satisfied patients.
Egocentric Localization Changes Following Unilateral Strabismus Surgery
Authors: Steinbach Martin J , Smith David R , Crawford John S
Published: April 2021

ABSTRACT

We measured spatial localization (using an open-loop pointing task) monocularly in each eye of eight patients undergoing unilateral strabismus surgery. Most of these patients had some degree of binocular vision. We found that, in most cases, changes In spatial localization produced by surgery on the operated eye paralleled those found In the other eye, both in magnitude and duration. Unilateral surgery can have central effects on egocentric localization.
Development of Normal Ocular Alignment
Authors: Soudhi Naval , Archer Steven M , Helveston Eugene M
Published: April 2021

ABSTRACT

Ocular alignment was examined in a large population of normal infants to determine the prevalence of various motillty findings at ages ranging from birth to 10 months. Exodeviations were frequently seen up to the age of 6 months. Esodeviations were occasionally seen in infants who did not go on to develop congenital esotropía, but not after 2 months of age. It is unclear whether precursors of pathologic strabismus, such as congenital esotropia, can be distinguished from these transient ocular deviations seen in normal Infants. However, any strabismus persisting after the ages listed above should be considered abnormal and receive ophtnalmologic evaluation.
Measurement of Vertical Deviations in Different Gaze Positions in Patients With a Superior Oblique Palsy
Authors: Catalano Robert A , Manley Donelson R , Calhoun Joseph H
Published: April 2021

ABSTRACT

Objective measurements in eight consecutive patients with an isolated congenital superior oblique palsy using a head tilt technique, with gaze directed toward a fixed distance target, and a second technique with gaze directed at a movable near object in different fields of gaze each identified the same oblique position of maximal vertical deviation. We call the latter technique "fielddirected." In distinction to the controversy that exists as to which method correctly diagnoses an isolated superior oblique palsy, either technique can be used to direct the surgical correction of this palsy. Superimposing a head tilt on the field-directed technique affected measurements in 16 of the 20 instances where tested. Despite the necessity of avoiding an inadvertent head tilt the fielddirected technique is considerably easier to perform and more comfortable for the patient to endure in determining the position of maximal vertical deviation.
True Charity and Professional Life: A Patient Advocacy Program
Authors: Hiatt Roger L , Mosley Rhonda J
Published: April 2021

ABSTRACT

The Patient Advocacy Program, built on an already existing, sympathetic hospital staff, has placed added emphasis on the physician-patient relationship which recently has been obscured by increasing technology, mechanization, and third party process. Furthermore, the Patient Advocacy Program stresses that the patient is the most important reason for the focus of the physician and staff. We have tried to exhibit not only true professionalism, but also true charity, by giving more than is expected and in return receiving an appreciative and satisfying response from patients, parents, and responsible parties.
Beyond Outcomes: Evaluating Staff Functioning On An Inpatient Psychiatric Ward
Authors: DeGiovanni Ina Sue , Gordon Myra E , Schlesinger Stephen E
Published: April 2021

ABSTRACT

Both theoretical issues and a methodology for evaluating staff functioning are presented in the context of an evaluation carried out on a 30-bed inpatient psychiatric ward.
Psychiatric Day Programs: A Descriptive Analysis
Authors: Edwards Martha Shatley
Published: April 2021

ABSTRACT

Partial hospitalization programs evolved as a result of a variety of financial, social and therapeutic circumstances. At present, these programs can take one of several different forms. Of these, the most common ones are the three day programs - day hospital, day treatment, and day care. In theory, each of the three would serve a distinct population, have a clearly defined structure, and be administered in a predictable manner. This article contrasts theory with practice and makes an analysis of the actual and potential effectiveness of each. External factors that bear on effectiveness such as demographics and economics are presented. Recommendations for the present and future follow from projected long range shifts and trends.
DIAGNOSTIC LABELING: The ROTTEN APPLE STIGMA
Authors: Wilson Holly Skodol , Plumly Sally
Published: April 2021

The moral justification for classifying people into psychiatric diagnostic categories lies in its potential utility as a means to relieve human suffering. Yet, some claim that not only does the diagnostic process fail, it may perpetuate, or even create, the suffering it was intended to relieve.
FACT & FICTION
Authors: Anonymous
Published: April 2021

HOLIDAY BLUES
NEW CLINIC
Authors: Anonymous
Published: April 2021

PAIN RELIEF
BOOKLET
Authors: Anonymous
Published: April 2021

SCHIZOPHRENIA
DETECTION AND PREVENTION
Authors: Anonymous
Published: April 2021

EATING DISORDERS
BOOKLET AVAILABLE
Authors: Anonymous
Published: April 2021

HEALTH FOR THE AGED
USING LAKOVIC'S: Countertransference Classifications
Authors: Witherspoon Valerie
Published: April 2021

FOCUS BORDERLINE PERSONALLY
Why a Psychogeriatric Unit?
Authors: Whall Ann L , Conklin Colleen
Published: April 2021

Although the elderly are present in large number in the U.S. population and their numbers continue to increase, mental health services for the elderly are not commensurate with their proportion of the total population. Ann L. Whall, RN, PhD, CS, and Colleen Conklin, RN, MS, CS review the unique needs of elderly psychiatric patients and answer the question
COMMUNICATION SKILLS
Authors: Anonymous
Published: April 2021

AUDIO CASSETTE
BEHAVIORAL MANAGEMENT OF INSOMNIA
Authors: Pawlicki Robert E , Heitkemper Thomas
Published: April 2021

A behavioral sleep program can provide a safe, useful alternative to the use of medication for patients battling problems of sleep onset, sleep interruptions, and/or early morning awakenings.
TALKING WITH TEENS
Authors: Anonymous
Published: April 2021

AQUAINTANCE RAPE
Boundary Marking
Authors: Boettcher Elaine Grace
Published: April 2021

A Social Ecological Study of Human Need Satisfaction Among Institutionalized Elderly Persons
LIFE THREATENING ILLNESS
Authors: Wright Lore K
Published: April 2021

When patients and family members are confronted with a life threatening illness, staff members often feel helpless to intervene approprìately. One sensitive approach is to understand the person's life trajectory once knowledge of critical illness has occurred. At each of the three clinically recognized phases, the acute crisis, the chronic living dying, and the terminal phase, patients and families have different needs. Interventions must be individualized to meet expressed needs according to circumstances and coping styles.
POLICEMEN AND NURSING STUDENTS: Crisis Intervention Team
Authors: Sullivan-Taylor Lois
Published: April 2021

Teaching crisis intervention skills to undergraduate nursing students presents a creative challenge to nursing faculty. Teaming nursing students with well-trained police patrolmen is one way to provide students with invaluable first-hand experience in crisis intervention.
NURSING DIAGNOSIS OF DEPRESSION
Authors: Thomas Mary Durand , Sanger Eldine , Whitney JoAnne Davis
Published: April 2021

Clinical Identification on an Inpatient Unit
Successful Treatment of Psychiatric Complications Cited
Authors: Anonymous
Published: April 2021

AIDS Update
Disability Claims for Mental Disorders on the Rise
Authors: Anonymous
Published: April 2021

Mental Health Law Project

Claimants with Psychoses or Mental Retardation Highest
HOW FAMILIES COPE
Authors: Baker Ann F
Published: April 2021

living with a chronically ill schizophrenic can place great stress on individual family members and the family unit
COPS & COUNSELORS
Authors: Rynerson Barbara C
Published: April 2021

counseling issues with prison inmate substance abusers
Ethical Guidelines for Competence
Authors: Anonymous
Published: April 2021

Colorado Society of Clinical Specialists in Psychiatric Nursing
Basic Principles of Psychopharmacologic Treatment for Advanced Practice Psychiatric Nurses With Prescriptive Authority
Authors: Bailey Katharine P
Published: April 2021

Over the past decade, a major trend in psychiatric care has been a greater emphasis on the biological aspects of psychiatric disorders, a rapidly expanding pharmacopoeia of efficacious psychotropic agents, and an increase in the use of psychopharmacotherapy in the treatment of mental illness. As mental health care delivery systems strive to address goals of cost containment, access to care, quality of care, and patient satisfaction, the expanded use of advanced practice psychiatric nurse prescribers is a logical conclusion, and prescriptive authority allows for the independence and the full scope of advanced nursing practice. This article outlines 11 basic principles of sound psychopharmacotherapy that can serve as guidelines for the achievement of optimal patient care and favorable patient outcomes.
Psychiatric Nursing for the 21st Century The PACED Model
Authors: McGihon Norma N
Published: April 2021

Abstract

Health care reform has had a profound effect on the way psychiatric treatment occurs in this country. Decreasing length of stay, increasing acuity, and reducing staff levels are making traditional approaches to mental health care infeasible. Resources already in place may still be focusing on long-term treatment issues and do not facilitate rapid stabilization and discharge planning that includes continued care within an integrated system.

Research supports the feasibility of quality mental health care, which can be accomplished in shortened lengths of stay, as long as clinical managers plan inpatient programs focused on shortterm goals followed by appropriate aftercare. In addition to recommendations for clinical managers, this article provides a proposal for executives redesigning a mental health care delivery system, which includes the goals of rapid assessment and stabilization, as well as discharge planning and appropriate follow up within an integrated system.
COMPUTER Addiction: When Monitor Becomes Control Center
Authors: Christensen Margaret H , Orzack Maressa Hecht , Babington Lynn M , Patsdaughter Carol A
Published: April 2021

ABSTRACT

Computer addiction is a newly recognized problem. While controversy exists about whether computer addiction should be considered a primary psychiatric disorder, clinicians are treating increasing numbers of clients experiencing problems caused by excessive computer use. Case studies are provided that include typical histories and symptoms. Behavioral cognitive therapy is discussed as a treatment approach. The stages of change theory is recommended as a strategy to help clients plan and implement change.
Selective Serotonin Reuptake Inhibitor Discontinuation Syndrome
Authors: Finfgeld Deborah L
Published: April 2021

VIGNETTE

Robert had been taking paroxetine for depression and anxiety, and his symptoms appeared well controlled after 10 weeks of treatment. Despite his improvement, Robert developed some concerns related to his sexual performance. Based on information gleaned from a magazine article, Robert suspected his antidepressant medication may be causing the problem. Without consulting his nurse practitioner, he stopped taking his medication. By the end of the second day of discontinuation, Robert was experiencing dizziness and anxiety. Fearing that his original symptoms were reoccurring, he resumed taking his paroxetine as prescribed, and the symptoms abated. When he told his nurse practitioner what had happened, she suspected Robert experienced selective serotonin reuptake inhibitor discontinuation syndrome.
Lans Distinguished Refractive Surgery Lecture
Authors: Anonymous
Published: April 2021

International Society of Refractive Keratoplasty
Continuous Tear Capsulotomy and Phacoemulsification Cataract Extraction Combined With Penetrating Keratoplasty
Authors: Groden Lewis R
Published: April 2021

ABSTRACT: Continuous tear capsulotomy, or capsuiorhexis, permits secure and precise placement of a posterior chamber intraocular lens. This techniaue can be used open sky during triple procedures combining penetrating keratoplasty with cataract extraction and intraocular lens insertion. Expression of the nucleus through a continuous tear capsulotomy can be difficult. Incisions in the anterior capsule facilitate nucleus expression but can extend, obviating the advantages of continuous tear capsulotomy. With phacoemulsification using low irrigation and adequate ultrasound power, the nucleus can be completely emulsified or fragmented into easily removable pieces. This permits continuous tear capsulotomy to be part of triple procedure surgery. [Refractive and Corneal Surgery 1990;6:456459.)
Photorefractive Keratectomy in 202 Myopic Eyes: One Year Results
Authors: Kim Jae Ho , Hahn Tae Won , Lee Young Chun , Joo Cheon Ki , Sah Woo Jin
Published: April 2021

ABSTRACT

We performed one-step procedures of photorefractive keratectomy (PRK) with the use of the excimer laser (193 nm) on 1519 myopic eyes during 1 year. From this group, we prospectively evaluated visual and refractive results of 202 (13%) consecutive myopic eyes that were followed for more than 1 year. Myopic eyes were divided into two groups according to the amount of myopia: group I, 135 eyes, 87 patients, less than -7.00 D, and group II, 67 eyes, 48 patients (-7.25 D to - 13.50 D). The excimer laser system used was the ExciMed 200UV (Summit Technology, Ine, Waltham, Mass), the one-step computer program was fixed at a maximum ablation up to -6.00 D correction.

Uncorrected visual acuity of 20/25 or better was achieved In 89.6% of eyes in group 1 and 47.8% in group II at 1 year. Best spectacle corrected visual acuity was equal to, or better than, the preoperative level in 93.8% of eyes.

The difference between attempted and achieved refractive correction was within ± 1 .00 D in 91 .4% in group I, and 51 .7% In group II. The mean reduction of manifest (spherical equivalent) refraction In group Il was 6.84 D at 1 year. Keratometric readings and central corneal thickness showed gradual changes until 6 months after surgery. Corneal haze disappeared in most of eyes at 1 year. The most common subjective complaint was glare and/or decreased vision at night or under dim light. We think that the excimer laser PRK is a very predictable and effective method to correct myopia under -7.00 D. But myopic eyes with more than -7.00 D, might require two-step (repeated) procedures of PRK. (Refract Corneal Surg (suppl) 1993;9:S11-S16.)
Effect of Centering Excimer Laser PRK on Refractive Results: A Corneal Topography Study
Authors: Spadea Leopoldo , Sabetti Lelio , Balestrazzi Emilio
Published: April 2021

ABSTRACT

Computer-assisted analysis of corneal topography, using an EyeSys Corneal Analysis System instrument, was performed on 20 normally sighted human eyes that underwent excimer laser photorefractive keratectomy (PRK) to correct high myopia from 6.00 to 17.00 D (mean 10.90 ±.SD 2.90 D). Ablations utilized one or two zones, at a single time, with an ExciMed UV200 193-nanometer excimer laser (Summit Technology, Ine, Waltham, Mass). Mean follow up was 28.9 weeks (±13). Decentered treatment caused an average error of 1.06 D in the attempted refractive result. (Refract Corneal Surg (suppl) 1993;9:S22-S25.)
Photorefractive Keratectomy for Myopia from 6.00 D to 10.00 D
Authors: Buratto Lucio , Ferrari Massimo
Published: April 2021

ABSTRACT

Surgical correction of mild and high myopia using excimer laser photorefractive keratectomy (PRK) remains controversial. We present a retrospective study of 40 consecutive PRK procedures performed to reduce myopia ranging from -6.00 D to - 10.00 D. Postoperative follow up was 24 months. The mean preoperative spheroequivalent refraction was -8.12 ±1.52 D; postoperatively it was -2.31 ±1.25 D. In 26 of 40 eyes (65%) we observed a regression of the refraction effect after 6 months. In 85% of eyes a persistent corneal haze ( + 1 grading) was observed at the end of follow up. Photorefractive keratectomy to correct or reduce mild or high myopia is simple ana safe but had poor predictability and significant refractive regression in this series. (Refract Corneal Surg (suppl) 1993;9:S34-S36.)
Cause of Subepithelial Corneal Haze Over 18 Months After Photorefractive Keratectomy for Myopia
Authors: Caubet Emmanuel
Published: April 2021

ABSTRACT

This study of 285 myopic eyes treated with photorefractive keratectomy (PRK), with a maximum follow up of 18 months, was designed to analyze the clinical subepithelial significance of corneal haze after excimer laser PRK. The treatment parameters included an ablation zone diameter from 3.6 to 5 mm, ablation rate from 0.22 to 0.25 µm pulse, fluence of 180 mJ/cm
p 2
, and frequency of 10 Hz. All patients used a standard topical corticosteroid regimen.

A statistical analysis of the subjective haze grading showed a maximum at 3 months (mean grading, 1.03) and a decrease to 0.38 at 18 months. Haze is statistically greater with higher amounts of treatment (p=.003 between 2.00 D and 3.00 D groups, p =.0002 between 2.00 D and 6.00 D groups). In males (p =.0004), and in ablations less than 4.5 mm diameter (p =.0002) but no difference was found related to age. The overall frequency of clinically significant haze was 11.5% with a mean age of 35.1 years and a mean attempted correction of -5.71 D. This frequency increased to 24% in the 6.20 D to 9.90 D group and 38.6% in the 4.4 mm and less group, and it decreased to 8.6% in the 1.00 D to 6.00 D group and 6.6% in the 4.5 and 5 mm group. All patients with significant haze gave a history of discontinued use of corticosteroids. We suggest there exists a significant haze risk group in which the absence of steroid or discontinuation of corticosteroids will lead to significant haze. (Refractive and Corneal Surgery (suppl) 1993;9:S65-S70.)
Contrast Sensitivity Under Photopic Conditions in Photorefractive Keratectomy: A Preliminary Study
Authors: Esente S , Passarelli N , Falco L , Passani F , Guidi D
Published: April 2021

ABSTRACT

In order to control and quantify the quality of vision after photorefractive keratectomy (PRK)1-4 we tested 21 treated eyes with contrast sensitivity.5-9 (Refract Corneal Surg (suppl) 1993;9:S70S72.)
Halos-A Problem for All Myopes? A Comparison Between Spectacles, Contact Lenses, and Photorefractive Keratectomy
Authors: Lohmann Chris P , Fitzke Fred W , O'Brart David , Muir Malcolm Kerr , Marshall John
Published: April 2021

ABSTRACT

After photorefractive keratectomy (PRK) using excimer lasers (193 nm) many patients report the presence of halos around light sources at night. However, halos are not unique to PRK patients, as they are a common observation in myopic contact lens wearers.

We present an objective measurement of the halos using a computerized technique. The patient fixated on a red cross within a white circle in the center of a video monitor which served as the halo source. The screen surrounding the circle was not illuminated. The operator controlled the movement of the white spot and moved the spot toward the halo source until the subject indicated when the cursor was at the outer parameter of the halo. Measurements were made at 30° intervals around the halo source and expressed as square degrees.
Phototherapeutic Keratectomy in Corneal Diseases
Authors: Förster Werner , Grewe Stephan , Atzler Ulrich , Lunecke Christian , Busse Holger
Published: April 2021

ABSTRACT

We present our clinical strategy to treat corneal diseases with the excimer laser. Nine eyes with recurrent erosion after trauma, three eyes with band keratopathy, and one eye with secondary crystalline deposits and a leukoma adherens after perforating injury underwent excimer laser phototherapeutic keratectomy (PTK). The patients with recurrent erosion had at least six episodes in the 12 months, the other patients suffered from severe pain. The recurrent erosions were treated with 15 pulses (193 nm, 180 mJ/cm2, 10 Hz) after removing the epithelium. There was only one new episode within 6 months after treatment in a patient who failed to follow the postoperative therapeutic regimen. In the patients with band keratopathy we removed the calcium deposits mechanically and then used masking fluids to obtain a smooth surface. The crystalline deposits in the patient with leukoma adherens could be removed but recurred after 4 months; the patient still suffered from glare. (Refractive and Corneal Surgery (suppl) 1993;9:S85-S90.)
Phototherapeutic Keratectomy: Strategies and Results in 12 Eyes
Authors: Hersh Peter S , Spinak Andrew , Garrana Randa , Mayers Martin
Published: April 2021

ABSTRACT

As part ot a multicenter study of excimer laser procedures, we performed phototherapeutic keratectomy (PTK) on 12 eyes In 11 patients. Three eyes had superficial corneal scarring, two Salzmann's degeneration, two Reis-Bückler's dystrophy; and one each with recurrent lattice dystrophy in a corneal graft, band keratopathy, recurrent erosion syndrome, after pterygium scarring, and contact-lens related keratopathy. Indications for treatment included poor visual acuity, severe glare symptoms, ocular surface discomfort, recurrent erosions, and monocular diplopia. Follow up ranged from 1 to 4 months. Best spectacle corrected visual acuity Improved in ten eyes with no eyes suffering loss of best spectacle corrected visual acuity. A hyperopic refractive shift was found in eight of 12 treated eyes. Corneal surface regularity improved in six of 12 eyes and worsened in one eye as measured by computerized corneal topographic analysis. Ten patients (11 eyes) noted improvement in their visual perception and subjective symptoms. We review various strategies of phototherapeutic keratectomy designed to treat particular corneal disorders: patient selection criteria to optimize clinical outcome are reviewed as well. (Refract Corneal Surg (suppl) 1993;9:$90-S95.)
Photorefractive Keratectomy in 472 Eyes
Authors: Lavery Frank L
Published: April 2021

ABSTRACT

Between July 1990 and July 1992, 472 eyes were treated with photorefractive keratectomy (PRK) using the ExciMed UV200 193-nanometer excimer laser (Summit Technology, Inc. Watham, Mass). The sphere equivalent refractions ranged between - 1.25 and - 9.60 D, with less than 1 .25 D of astigmatism. Eyes with refractive error up to -6.00 D were treated with a spherical ablation, as determined by the surgeon's decision and the algorithm built into the laser software. In this group, 92% had a refraction within 1.00 D of intended correction.
Photorefractive Keratectomy for Myopia: 6-Month Results in 95 Eyes
Authors: Tutton Miles K , Ramsell Terry G , Garston J Bernard , Tolia Jiten J , Banerjee Dipak K , Adhikary Hari P , Birch Michael , Cherry Paul M H , Neave Christopher G , Fichte Claus M
Published: April 2021

ABSTRACT

Ninety-five eyes of 91 patients with myopia from -1.00 to -6.00 D (mean -3.40 D, ±1.2) were treated with an ExciMed UV200LA 193-nanometer excimer laser (Summit Technology, Inc. Waltham, Mass) (with version 5.5 software) with a 5-millimeter ablation zone. At 6 months, 67 eyes (70%) were within ±0.50 D, 84 eyes (88%) were within ± 1.00 D, and 94 eyes (99%) were within ±2.00 D. There was an average overcorrection of + 0.25 D which had decreased to +0.18 D by 9 months. Best spectacle corrected visual acuity was 6/6 or better in 88 eyes (94%) and six eyes (6%) had a corrected visual acuity of 6/9. Fifty percent of eyes had slight astigmatism (mean 0.68 D, range 0.25 to 2.00 D) and this reduced to 0.33D (0.02>p>0.01) at 6 months. (Refract Corneal Surg (suppl) 1993;9:S103-S104.)
Holmium:YAG Laser Thermokeratoplasty for Hyperopia and Astigmatism: An Overview
Authors: Thompson Vance M , Seiler Theo , Durrie Daniel S , Cavanaugh Timothy B
Published: April 2021

ABSTRACT

The holmium:YAG laser can be used to perform corneal collagen shrinkage and treat refractive errors. Studies are underway for the treatment of hyperopia by shrinking collagen in the peripheral cornea, which produces central and paracentral steepening. There is initial overcorrection followed by a regression of effect postoperatively, which appears to stabilize 4 to 6 months postoperatively. Refinement of current nomograms and definition of the amount of expected regression will enhance its accuracy. The holmium:YAG laser may be superior to radial thermokeratoplasty with a hot needle.

Nearly 100 years ago, Lans was the first to report that heating of the cornea could induce collagen shrinkage with resultant corneal curvature changes.1 Various collagen shrinkage procedures have evolved since then. To date, the most wellknown form of collagen shrinkage involves the hot needle and a technique developed by Fyodorov to do radial thermokeratoplasty for hyperopia.2 This article will review the current state of holmium:YAG laser technology and the advantages it may provide over radial thermokeratoplasty. (Refract Corneal Surg (suppl) 1993;9:S134-S137.)
Long-term Follow-up of Pediatric Epikeratophakia
Authors: Uusitalo Risto J , Uusitalo Hannu M
Published: April 2021

ABSTRACT

BACKGROUND: Epikeratophakia is a potentially reversible corneal surgical procedure that can correct refractive errors in children who are aphakic and poor candidates for intraocular lens implantation. The correction of aphakia in the pediatric population poses specific problems because of associated amblyopia.

METHODS: The clinical records of 61 consecutive patients (82 eyes) treated for pediatric aphakia by epikeratophakia were reviewed retrospectively with a follow-up of 3 to 5 years. For the purpose of analysis, the patients were divided into seven groups.

RESULTS: The overall success rate for epikeratophakia was 92%, but with repeated surgery, the patient success rate was 93%. The average refractive error at 1 year was +0.10 diopters (D). At 1 year, 68% of eyes had a refraction within 1 D of emmetropia. In these growing eyes, we documented an average myopic shift of -0.40 D during 4 years. A myopic shift occurred in 30.2% and a hyperopic shift in 9.4% of eyes. Spectacle-corrected visual acuity at 3 years showed 36% of eyes seeing 20/40 or better. Visual acuity results in different groups varied with the timing of epikeratophakia, density of amblyopia and parents' ability to maintain the patching schedule. The most encouraging results came from the treatment of monocular traumatic cataracts. In this group, 31% achieved visual acuities of 20/40 or better and 85% achieved 20/100 or better at final examination. Those with incomplete congenital cataracts also showed favorable results: 39% achieved 20/40 or better at final examination.

CONCLUSIONS: Follow-up of 3 to 5 years demonstrated that epikeratophakia can correct refractive errors safely and successfully in aphakic children, either as a primary procedure, or as a secondary procedure after cataract extraction. [J Refract Surg 1997;13:45-54]
Sutureless Homoplastic Lamellar Keratoplasty
Authors: Elkins Brad S , Casebeer J Charles , Kezirian Guy M
Published: April 2021

ABSTRACT

BACKGROUND: Previously, penetrating keratoplasty has been used to treat corneal cap complications related to keratomileusis. We sought to develop a technique to avoid the unnecessary use of penetrating procedures for lamellar problems, that would be technically easier than standard lamellar keratoplasty-sutureless homoplastic lamellar keratoplasty.

METHODS: Five eyes with complications from automated lamellar keratoplasty underwent sutureless homoplastic lamellar keratoplasty utilizing an automated microkeratome and topical anesthesia.

RESULTS: Three of the five eyes had improved vision; two eyes with final visual acuities of 20/20 and 20/30. The two remaining eyes had poor host stromal beds and required penetrating keratoplasty. The mean follow-up time was 13 months (range 3 to 36 months). All lamellar grafts were clear and well-seated at the last postoperative examination.

CONCLUSION: Sutureless homoplastic lamellar keratoplasty is an alternative to penetrating keratoplasty in some eyes that have cap-related problems. [J Refract Surg 1997;13:185-187]
FUKASAKU LASIK SPATULA
Authors: Anonymous
Published: April 2021

KATENA INTRODUCES NEW LASIK AND LASER SURGERY INSTRUMENTS
Posterior Chamber Silicone Phakic Intraocular Lens
Authors: Marinho António , Neves Manuel C , Pinto Maria C , Vaz Fernando
Published: April 2021

ABSTRACT

BACKGROUND: We investigated the efficacy, safety, and stability of correction achieved with a silicone posterior chamber intraocular lens used to correct high myopia in phakic eyes.

PATIENTS AND METHODS: A silicone posterior chamber plate-style intraocular lens (Chiron, Adatomed) was implanted in 38 consecutive phakic eyes with high myopia (-7.00 to -28.00 diopters (D) over a period of 21 months. Follow-up ranged from 3 to 24 months.

RESULTS: Three months after surgery, refractions in 27 eyes (71%) ranged from -1.00 to +1.00 D and remained stable thereafter. Spectaclecorrected visual acuity improved at least two lines in 24 eyes (63%), and none was lost in any eye. Patient satisfaction was high (92%). The few complications that occurred were mostly related to imperfections in the surgical technique rather than lack of biocompatibility of the lens. No cataract or other vision-threatening complication was present at the end of the study.

CONCLUSION: This silicone posterior chamber plate-style intraocular lens provides a reasonably predictable, safe, and stable means of correcting high myopia. [J Refract Surg 1997;13:219-222]
Prevalence of Myopia in Adults: Implications for Refractive Surgeons
Authors: McCarty Catherine A , Livingston Patricia M , Taylor Hugh R
Published: April 2021

ABSTRACT

BACKGROUND: We reviewed the research on the prevalence of myopia in the adult population to compare the refractive distribution of patients being treated with excimer laser photorefractive keratectomy to correct myopia, and assess the potential market for excimer laser surgery.

METHODS: All published reports of myopia prevalence in adults were reviewed, as well as the prevalence in the Melbourne "Visual Impairment Project and the distribution of refractive errors treated by the Melbourne Excimer Laser Group in 1994.

RESULTS: A large population-based study of people aged 4 to 74 years in the U.S. showed that 43% had low myopia (less than -5.00 diopters (D)), 3.2% had high myopia (-5.01 to -10.00 D), and 0.2% had extreme myopia (more than -10.00 D). In Asian populations these proportions may be much higher and in African and Pacific island groups, much lower. In the Melbourne Visual Impairment Project, we found the prevalence of low myopia was 21%, high myopia 2%, and extreme myopia 0.3%. A single excimer laser has operated for 3 years in Melbourne. Of those treated, 45% had low myopia, 42% high myopia, and 13% extreme myopia. Compared to low myopes, high myopes were ten times (OR: 9.8; Confidence interval: 6.69 to 12.91) more likely to have excimer laser treatment and extreme myopes were 16 times (OR: 16.40; Confidence interval: 12.53 to 20.27) more likely.

CONCLUSIONS: Although there are many more people with lower amounts of myopia in the population and the clinical results have been more predictable after one procedure in this group, the perceived benefits of excimer laser treatment may be greater for those with higher amounts of myopia, thus influencing their decision to undergo excimer laser surgery to correct their myopia. There is clearly a large market potential for excimer laser surgery in people with low myopia. [J Refract Surg 1997;13:229-234]
Comparison of Corneal Epithelial Wound Healing after Photorefractive Keratectomy in the Rabbit with Two Types of Excimer Lasers
Authors: Hamberg-Nyström Heléne , van Setten G-B , Fagerholm Per
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the differences in epithelial wound healing following photorefractive keratectomy when performed with the Summit UV 200 LA and the VISX 20/20 excimer lasers.

METHODS: Sixteen New Zealand rahhits were divided into two groups. One group was treated with the Summit laser and the other group treated with the VISX 20/20 laser. The treatment consisted of a -6.00 diopter photorefractive keratectomy with a 5-mm diameter treatment zone. Epithelial wound healing was followed by photography at 4 hour intervals for 64 hours. The length of the wound edge and the size, shape, and closure time of the wound were measured.

RESULTS: The median wound edge length at 4 hours was 18.3 mm for the Summit laser and 16.7 mm for the VISX laser. The median wound size at 4 hours was 22.0 mm2 for the Summit and 21.2 mm2 for the VISX The median wound closure time was 53.4 hours for the Summit laser and 54.0 hours for the VISX laser.

CONCLUSION: There was no statistically significant difference in the epithelial healing of rabbit corneal wounds created by photorefractive keratectomy when performed with two current ophthalmic excimer lasers, the Summit UV 200 LA and the VISX 20/20. [J Refract Surg 1997;13:263-267]
Increased Corneal Scarring after Phototherapeutic Keratectomy in Fuchs' Corneal Dystrophy
Authors: Alaa Mohammed , Waring George O , Malaty Amin , Grossniklaus Hans
Published: April 2021

ABSTRACT

PURPOSE: A 63-year-old female with Fuchs' endothelial corneal dystrophy, stromal edema and subepithelial scarring was inappropriately treated with phototherapeutic keratectomy, leading to a central focal circular corneal scar and decreased visual acuity that required penetrating keratoplasty.

METHOD: The host corneal button was bisected and fixed in 10% formaldehyde and in glutaraldehyde immediately after its removal.

RESULTS: Light microscopy demonstrated a central area of absent Bowman's layer with a thin layer of subepithelial fibrosis, stromal corneal edema, and thickened Descemet's membrane.

CONCLUSION: Correct estimation of differential ablation rates of tissue and shallow, repeated ablations followed by slit-lamp microscopy and/or videokeratography help prevent over-treatment.

[J Refract Surg 1997;13:308-310]
Excimer Laser In Situ Keratomileusis to Correct Compound Myopic Astigmatism
Authors: El Danasoury M Alaa , Waring George O , El Maghraby Akef , Mehrez Kamal
Published: April 2021

ABSTRACT

PURPOSE: We studied the efficacy, predicability, stability, and safety of excimer laser in situ keratomileusis (LASIK) to correct myopia and astigmatism.

METHODS: We prospectively studied 87 consecutive eyes of 56 patients who received LASIK, divided into two groups: the myopic group included eyes with myopia more than -2.00 diopters (D) and astigmatism less than 0.50 D and the astigmatism group included eyes with myopia of more than -2.00 D and astigmatism of 0.50 D or more. The Chiron automated corneal shaper and the Nidek EC-5000 excimer laser were used in all eyes. A modified personal nomogram was used in all eyes. The changes in refractive sphere and cylinder, and complications were studied at 2 and 6 weeks, 3, 6, and 12 months after surgery. Preoperatively, the mean spherical equivalent refraction was -4.41 D (range, -2.25 to -7.25; SD, 1.74) in the myopia group and -5.79 D (range, -2.25 to -15.50 D; SD, 2.45) in the astigmatism group. The mean spherical component of the refraction was -4.39 D (range, -2.25 to -7.25; SD, 1.74) in the myopia group and -5.19 D (range, -2.00 to -14.00; SD, 2.32) in the astigmatism group. The mean refractive cylinder was 1.19 D (range, 0.5 to 3.00 D; SD, 0.62) in the astigmatism group.

RESULTS: At 12 months, 81 eyes (93.6%) of 51 patients were examined; the mean spherical equivalent refraction was -0.43 D (range, +0.50 to -1.25 D; SD, 0.35) in the myopia group and -0.33 D (range, +1.25 to -2.13 D; SD, 0.52) in the astigmatism group. The mean spherical component of the refraction at 12 months was -0.33 D (range, +0.50 to -1.25 D; SD, 0.33) in the myopia group and -0.17 D (range, +1.50 to -1.50; SD, 0.48) in the astigmatism group. The mean refractive cylinder was 0.19 D (range, 0 to 0.75 D; SD, 0.25) in the myopia group and 0.32 D (range, 0 to 1.25 D; SD, 0.30) in the astigmatism group. The mean change in spherical equivalent refraction between 6 weeks and 12 months after surgery was -0.08 D toward myopia (range, -0.50 to -0.75 D; SD, 0.23) in both groups. No eyes lost two or more lines of spectacle-corrected visual acuity. Patient satisfaction was high in both groups. Complications included undercorrection that necessitated reoperation (three eyes), overcorrection (two eyes), and small disc diameter (one eye). No vision threatening complications were observed.

CONCLUSION: LASIK with the Nidek EC5000 laser is effective, reasonably predictable, stable, and safe for correction of compound myopic astigmatism with a spherical component between -2.00 and -14.00 D, and a cylindrical component between 0.50 and 3.00 D using the techniques in this study. Astigmatism is undercorrected with the current algorithm. Correction of higher amounts of astigmatism requires further study. [J Refract Surg 1997;13:511-520]