bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual Prognosis in Aphakic Bullous Keratopathy Treated by Penetrating Keratoplasty: A Retrospective Study of 73 Cases
Authors: Muenzler W Stanley , Harms Willard K
Published: April 2021

SUMMARY

Seventy-three eyes with limbus to limbus bullous keratopathy following cataract extraction were followed 24 months to determine the long-term visual prognosis following penetrating keratoplasty. All but one eye required anterior vitrectomy. A manual vitrectomy technique was utilized in all cases. Results obtained were equal to or better than other contemporary literature reports utilizing mechanical vitrectomy techniques.
Scleral Relaxing Incision Used for Wound Closure
Authors: Keates Richard H , Letson Alan D
Published: April 2021

SUMMARY

Attempts at closing gaping wounds may result in inadequate closure and/or excessive astigmatism. This report describes a scleral relaxing incision that will allow closure of an irregular wound and minimize postoperative astigmatism.
Current Techniques for Improved Visual Results After Penetrating Keratoplasty
Authors: Bourne William M
Published: April 2021

SUMMARY

Although 90% of corneal transplants today are clear one year after transplantation, many are not truly successful due to factors such as high astigmatism, poor vision until sutures are removed one year postoperatively, or gradual corneal decompensation (late endothelial failure). This paper describes results using both a double running suture technique to provide early visual rehabilitation and serial specular microscopic examinations to maintain the greatest possible number of viable donor endothelial cells. These techniques can be easily used today by any corneal surgeon to improve the overall visual results after penetrating keratoplasty.
Changes in Corneal Thickness During Radial Keratotomy
Authors: Villasenor Richard A , Salz James , Steel Douglas , Krasnow Michael A
Published: April 2021

SUMMARY

Ultrasonic pachometry readings were recorded at selected intervals during radial keratotomy. Findings indicate that during surgery on the dry cornea, there is significant reduction in corneal thickness. The range in corneal changes reported indicates the need to monitor corneal changes during surgery.
Particle-Free Environment for Refractive Keratoplasty
Authors: Stern Alan L , Taylor Daniel M
Published: April 2021

SUMMARY

The refractive keratoplasty techniques of keratomileusis and keratophakia require meticulous care to avoid intralamellar foreign particles. A portable High Efficiency Particular Air Filter Unit has been designed to meet the needs of those surgeons clinically performing this surgery. The unit, combined with a morphic techniques has minimized the clinical problem of particulate matter for the general hospital.
A New Donor Cutting Block for Penetrating Keratoplasty
Authors: Tanne Emanuel
Published: April 2021

SUMMARY

A new corneal cutting block of polycarbonate material is designed to provide a more perfectly shaped donor button. It differs from conventional cutting blocks which have only one radius and one diameter. The cutting block comprises an arrangement of curvatures and diameters which serve to approximate the shape of the anterior surface of the cornea and para-sclera.
Visual Prognosis in Pseudophakic Corneal Transplants
Authors: Charlton Kevin H , Binder Perry S , Perl Theodore
Published: April 2021

SUMMARY

Although the prognosis for obtaining a clear corneal transplant after aphakic bullous keratopathy is good, many patients do not achieve good vision primarily because of macular disease. To evaluate the visual benefit of an intraocular lens on corneal transplantation, we performed a retrospective study comparing the best attained and latest visual acuities, corneal thinning patterns, endothelial cell densities, and post-keratoplasty complications in 31 patients with aphakic bullous keratopathy, 19 patients with pseudophakic bullous keratopathy, 44 combined transplants with cataract extraction and 5 secondary lens implants at the time of keratoplasty. We found the presence of a lens provided patients with early functional visual rehabilitation. Subsequent visual acuity was equivalent in similar corneal disease categories. The presence of a lens did not produce additional endothelial cell loss, abnormal corneal thinning patterns, or increase the incidence of complications. The removal of an intraocular lens at transplant did not affect ultimate visual prognosis. We conclude that the implantation of an intraocular lens does not increase complications after keratoplasty in selected cases.
Flieringa Ring - The Poor Man's Operating Keratometer
Authors: Baum Norman
Published: April 2021

SUMMARY

The Flieringa ring, held close above the eye, produces a reflection on the cornea which gives a qualitative estimate of the corneal astigmatism.
Fundus Photocoagulation with the Argon and Krypton Lasers: A Comparative Study
Authors: Peyman Gholam A , Li Mark , Yoneya Shin , Goldberg Morton F , Raichand Motilal
Published: April 2021

SUMMARY

Photocoagulation of the monkey fundus with an argon-krypton laser photocoagulator was performed. Lesions produced by argon and krypton wavelengths were compared at various power settings, spot sizes, and exposure durations. At low energy levels argon laser lesions appeared clinically stronger than those produced by the krypton mode. Lesions in the foveal area produced with the argon laser demonstrated more extensive microscopic damage to the inner retinal layers than did those produced with the krypton laser. Histologically, both modalities affected the outer layers of the retina. However, the krypton wavelength affected more of the choriocapillaries and the larger choroidal vessels than the argon wavelengths. Conversely, argon laser coagulation of the retinal vessels damaged the perivascular tissue in the nerve fiber layer more than the krypton laser did.

Rupture of Bruch's membrane and choroidal hemorrhage occurred frequently with the krypton laser at low energy levels when a small spot size and a short coagulation time were used. Both complications were less likely to occur with argon burns at similar dosage parameters. By choosing larger spot sizes and longer coagulation times for the krypton laser, these complications were prevented.
Infant Donor Corneas for Penetrating Keratoplasty
Authors: Wood Thomas O , Nissenkorn Ilana
Published: April 2021

SUMMARY

A series of 13 patients who have undergone corneal transplantation with infant corneas have been reviewed. The average donor is eleven months. All grafts with infant donor material were crystal clear from the first postoperative day with no folds in Descemet's membrane. The corneas take on a normal convex shape earlier postoperatively than corneas of elderly donors, allowing the patients early visual rehabilitation. The final median postoperative refractive error in nine patients is +7.8 -2.91 axis. Control of the flexible infant donor cornea can be improved by using a 0.5 mm larger button at the time of surgery.
A Lifeline Suture for Posterior Chamber Lens Implants
Authors: Schulze Richard R
Published: April 2021

SUMMARY

A safety suture for retaining control of posterior lens implants in difficult cases is described.
The Use of Sodium Hyaluronate (Healon) in Intracapsular Cataract Extraction with Insertion of Anterior Chamber Intraocular Lenses
Authors: Lazenby G William , Broocker Geoffrey
Published: April 2021

SUMMARY

Intracapsular cataract extraction with insertion of anterior chamber intraocular lens was carried out on 40 subjects. In 21 procedures, balanced salt solution or air was used to deepen the anterior chamber. In 19 procedures, Hyaluremic Acid (Healon) was used to deepen the anterior chamber. In the two groups, no significant difference was noted in the endothelial cell count or in the corneal thickness. The surgeon felt that Healon made the surgery much easier, gave better control and greatly decreased the possibility of serious complications.
Combined Keratoplasty, Cataract Extraction, and Intraocular Lens Implantation: Experience at the Wilmer Institute
Authors: Bruner William E , Stark Walter J , Maumenee A Edward
Published: April 2021

SUMMARY

A review of 12 cases of combined keratoplasty, cataract extraction and IOL implantation performed during the past five years at the Wilmer Institute Js presented. The results show 80% of cases with 6/1 2 (20/40) vision or better with a follow-up of at least six months. All but one of the grafts remained clear. Our current technique for keratoplasty, extracapsular cataract extraction and posterior-chamber IOL implantation is described. This technique has several advantages, including the following: an intact posterior capsule, no anterior vitrectomy, protection of the cornea from the IOL by the iris, and potential for full pupil dilation after surgery. Conservative and highly selective use of the procedure is recommended.
A New Effective, Efficient and Economical System of Cryoextraction
Authors: Christy Norval E
Published: April 2021

SUMMARY

In a village hospital in Pakistan, where the work load demands very efficient surgical technique, a new system of cryoextraction featuring a very efficient method of freon delivery into a very effective cryoextractor was introduced. The system reduced complications without reducing the efficiency of the operation. It is recommended for use in situations where a large surgical load calls for efficiency and as a back-up system in other situations.
Cystoid Macular Edema in Vitreo-Retinal Traction
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

Advanced cystoid macular edema is demonstrated histologically in association with traction on the foveal retina by a preretinal membrane attached to diabetic neovascularization and a shrinking vitreous. A causative relationship between the traction and the cystoid changes is suspected.
An Ectropion-Producing Suture for Lower Lid Retraction During Cataract Surgery
Authors: Norris John W , Chirls I Allen
Published: April 2021

SUMMARY

A method of producing a mild ectropion of the lower lid is presented. The exposure produced remains constant and is independent of surgical drapes. Minimal practice is required for the surgeon to master the technique.
Toxicity of Antineoplastic Drugs in Vitrectomy Infusion Fluids
Authors: Barrada Ahmed , Peyman Gholam A , Greenberg David , Stelmack Thomas , Fiscella Richard
Published: April 2021

SUMMARY

Twelve antineoplastic drugs were evaluated for their toxicity when used in vitrectomy infusion fluid. These drugs may have implications in the prevention of cellular proliferation inside the eye.
Radial Keratotomy: Prospective Evaluation of Safety and Efficacy
Authors: Kremer Frederic B , Marks Ronald G
Published: April 2021

SUMMARY

One hundred five consecutive radial keratotomy procedures were followed for one year postoperatively. There was greatest correction of myopia with less than 8 diopters of preoperative correction, and correction to a lesser degree with more than 8 diopters of preoperative correction. There were no severe complications. Size of central optical zone, number of incisions, graduation of incisional depth, central corneal thickness, patient age, intraocular pressure, and sex are of value in predicting the success of the procedure.
Peripheral Corneal Grafts in Terrien's Marginal Degeneration
Authors: Brown Alan C , Rao Gullapalli N , Aquavella James V
Published: April 2021

SUMMARY

Surgical treatment of two cases of Terrien's marginal degeneration is discussed. Because of the peripheral location of the corneal thinning, free-hand grafting is required. The procedure and its complications, both intraoperative and postoperative, are described in detail.
Argon Laser Treatment of an Eyelid Margin Capillary Hemangioma
Authors: Gladstone Geoffrey J , Beckman Hugh
Published: April 2021

SUMMARY

When capillary hemangiomas do not resolve spontaneously, treatment may be indicated. Various forms of therapy have been employed. These include excisional surgery, cryotherapy, sclerosing solutions, embolization, external beam irradiation, steroids, and the argon laser.

We report the use of a standard ophthalmic argon laser combined with curettage on a noninvoluting eyelid margin hemangioma found on a 29-year-old man. Details of the surgical technique are provided and postoperative results documented. We believe this to be the first case of a lid margin hemangioma successfully treated in this manner.

The technique offers these advantages: (1) Selective absorption of the laser energy by the blood-filled tissue allows microablation of the lesion under ideal hemostatic conditions with minimal loss of normal lid tissue. (2) Oculoplastic lid repair is obviated since minimal normal tissue is removed. (3) The procedure can be performed under local anesthesia on an outpatient basis.
Vitrectomy in Children
Authors: Brown Gary C , Tasman William S , Benson William E
Published: April 2021

SUMMARY

A series of 24 consecutive pars plana posterior vìtrectomìes in children is reported. The postoperative visual acuities improved in 59%, were unchanged in 23%, and worsened in 28%. Trauma was the most common predisposing etiologic factor to vitrectomy and accounted for 59% of cases. Boys in the series outnumbered girls by a ratio of nearly 3:1, a factor most likely attributable to the high incidence of trauma. In no case did visual loss occur as a direct result of vitrectomy.
Modification of the Bent Needle Technique for Anterior Capsulotomy
Authors: Feibel Robert M
Published: April 2021

ABSTRACT

A simple modification of the bent needle cystltome allows a more precise and regular anterior capsulotomy in extracapsular cataract surgery.
Computerized Tomography in the Management of Acute Orbital Cellulitis
Authors: Gold Samuel C , Arrigg Paul G , Hedges Thomas R
Published: April 2021

ABSTRACT

The usefulness of computerized tomography (CT scanning) in managing orbital cellulitis is analyzed in six cases. What appears as orbital abscess on CT scan may not be confirmed at surgery. Careful clinical evaluation and responsiveness to antibiotic therapy are most important in determining the need for surgical intervention.
Wound Necrosis Following Dacryocystorhinostomy in Patients With Wegener's Granulomatosis
Authors: Jordan David R , Miller Douglas , Anderson Richard L
Published: April 2021

ABSTRACT

Two patients with Wegener's granulomatosis underwent dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction and epiphora. Wound necrosis occurred in each individual with the formation of a nasal-cutaneous fistula. A pedicle flap was the treatment of choice in one case, while direct closure of the necrotic incision site and high-dose steroid therapy was used in the other. Both did well with complete wound healing. The tearing persisted in one and resolved in the other. Dacryocystorhinostomy should be avoided whenever possible in patients with Wegener's granulomatosis, and steroid dosage should be increased if surgery is necessary in the presence of active inflammation.
Surgical Approach to Lamellar Sclerouvectomy for Posterior Uveal Melanomas: The 1986 Schoenberg Lecture
Authors: Shields Jerry A , Shields Carol L
Published: April 2021

ABSTRACT

We describe a technique of surgically removing melanomas that involve the ciliary body and/or the choroid, while leaving intact the outer portion of the sclera and the overlying sensory retina. This procedure, called a partial lamellar sclerouvectomy, can be subclassified as a partial lamellar sclerocyclochoroidectomy in the case of ciliochoroidal melanomas, and as a partial lamellar sclerochoroidectomy in the case of pure choroidal melanomas.
Successful Treatment of Advanced Retinopathy of Prematurity
Authors: Topilow Harvey W , Ackerman Albert L , Wang Frederick M , Strome Robert R
Published: April 2021

ABSTRACT

Thirty-nine eyes of 20 premature infants, mean birthweight 922 g, mean gestational age 27 weeks, with active retinopathy of prematurity (ROP), were treated. Thirty-one eyes with stage 3+ ROP and 180° to 360° of preretinal neovascularization received cryotherapy to ablate the zone of peripheral avascular retina. All underwent complete regression of active disease. Eight of these eyes subsequently developed retinal detachments due to ongoing vitreous traction. One detachment was inoperable. Six eyes were successfully reattached following scleral buckling surgery. One of these six redetached and became inoperable after 20 months. Pars plicata vitrectomy was not successful in reattaching the eighth case. Twentyeight of these 31 eyes retain useful visual acuity with follow-up of 15 to 70 months (mean 41 months). There have been no complications resulting from cryotherapy.

Eight other eyes with stage 4 ROP (traction retinal detachment) were treated with cryotherapy and scleral buckling surgery. All were initially reattached, but ongoing vitreoretinal traction caused redetachment in five. One was inoperable. "Open sky" vitrectomy was successful in reattaching three of the other four. Of the six cases that remained reattached with follow-up of 6 to 51 months, only two retain useful vision.
Grid Laser Photocoagulation for Atypical Central Serous Chorioretinopathy
Authors: Roseman Robert L , Olk R Joseph
Published: April 2021

ABSTRACT

A 30-year-old man had symptoms and signs consistent with bilateral classic central serous chorioretinopathy. Conventional single-session laser treatments to both eyes stabilized the condition for 9 years. The patient then developed atypical central serous chorioretinopathy consisting of tracts of fluid emanating from the posterior pole and bilateral inferior exudative retinal detachments. Diffuse retinal pigment epithelial disease with recurrent leakage in both maculas was treated with grid laser photocoagulation, which was effective in stabilizing the patient's condition.
Mattress Bridge Sutures for Graft Fixation in Pediatric Keratoplasty: New Use of an Old Technique
Authors: Parish Carolyn M , Faris David A , O'Day Denis M
Published: April 2021

ABSTRACT

Because of decreased scleral rigidity of tissue, penetrating keratoplasty in the pediatric age group is difficult. We have applied an early keratoplasty technique of graft fixation with indirect "bridge" or "overlay" sutures to temporarily stabilize the graft and facilitate wound closure.
Surface Reaction on Glass Anterior Chamber Foreign-body Removed 24 Hours After Injury
Authors: Wolter J Reimer , Lindenmuth Kim A
Published: April 2021

ABSTRACT

An early stage in the formation of a reactive membrane on the exposed surface of a glass foreign body in the anterior chamber is demonstrated. It is emphasized that the formation of reactive membranes on the surface of foreign bodies in the anterior segment of the eye give the cytologic impression of different stages of successful adaptation.
An Improved Approach to Aqueous Paracentesis
Authors: May Donald R , Noll Francis G
Published: April 2021

ABSTRACT

We describe a quick and effective technique for performing safe anterior chamber paracenteses. The technique consists simply of inserting a small gauge disposable hypodermic needle without an attached syringe into the anterior chamber. The intraocular pressure and capillary action of the needle readily cause the rapid drainage of aqueous humor. This technique eliminates the cumbersome manipulations and potential complications associated with using an attached syringe for aspiration.
Sympathetic Ophthalmia Following Neodymium:YAG Cyclotherapy
Authors: Edward Deepak P , Brown Steven V L , Higginbotham Eve , Jennings Tom , Tessler Howard H , Tso Mark O M
Published: April 2021

ABSTRACT

Neodymium:YAG cyclotherapy has been demonstrated to lower intraocular pressure dramatically in patients with uncontrolled glaucoma, with potentially fewer side-effects than cyclocryotherapy. We report the clinical course and histopathological features of a case of sympathetic ophthalmia occurring soon after YAG cyclotherapy.
Contact Transscleral Cyclophotocoagulation With Nd:YAG Laser in Uncontrolled Glaucoma
Authors: Brancato Rosario , Giovanni Leoni , Trabucchi Giuseppe , Pietroni Cristiana
Published: April 2021

ABSTRACT

To evaluate the effectiveness of contact delivery systems, we treated 23 eyes with uncontrolled intraocular pressure using a continuous wave Nd:YAG laser delivered by a fiber optic. With the fiber's tip perpendicular to the surface of the conjunctiva, 1.5 mm from the corneal limbus, we applied 16 laser spots of 2 J/second energy. Patients were followed for at least 6 months (mean, 8.6 ± 2.4 months). The mean pressure decreased from a pretreatment value of 43.7 mm Hg to a posttreatment value of 24.7 mm Hg (P=0.000). A total of 66.6% of the treated eyes achieved a pressure on last follow-up visit of 25 mm Hg or less. Pain decreased in all the patients treated (P <.005). Complications were minimal.
Trabeculectomy as an Introduction to Intraocular Surgery in an Ophthalmic Training Program
Authors: Morrell Andrew J , Searle Anne E T , O'Neill Eamon C
Published: April 2021

ABSTRACT

Ninety seven trabeculectomies for open-angle glaucoma performed by either consultants (senior surgeons) or surgeons in training (resident junior staff) were retrospectively analyzed with reference to the outcome of surgery and the complication rate. The results obtained by the trainees were comparable with those obtained by experienced surgeons, suggesting that trabeculectomy is a suitable operation to be performed by surgeons in training.
The Effects of Exercise on Intraocular Pressure in Pigmentary Glaucoma Patients
Authors: Smith David L , Kao Sue F , Rabbani Roya , Musch David C
Published: April 2021

ABSTRACT

Previous studies of normal volunteers and openangle glaucoma patients have shown that exercise temporarily lowers intraocular pressure. However, two case reports have described pigmentary dispersion syndrome patients who developed symptomatic increased intraocular pressure after exercise. We evaluated the intraocular pressure response to exercise in ten pigmentary glaucoma patients. An exercise protocol was designed to increase the likelihood of lens zonule-iris pigment epithelium contact. Intraocular pressure measurements during the first two hours after exercise showed no statistically significant elevation of mean intraocular pressure. The pressure rose 6 mm Hg and 7 mm Hg respectively at 15 minutes in two eyes, but returned to baseline by 30 minutes. Our results suggest that exercise may not significantly increase the clinical intraocular pressure in pigmentary glaucoma patients.
Tangential-Radial Traction Suturing Technique for Intrascleral Foreign Material Implantation
Authors: Bar S , Savir H , Gasner S , Levy M
Published: April 2021

ABSTRACT

We used an infredderai implantation technique to anchor a kerato prosthesis in the li m bai sclera of 22 rabbits' eyes. The tangential-radial traction used in this procedure enabled multi vectorial traction forces to be applied while maintaining a tight junction between the biological tissue and the foreign material. During 23 weeks ol follow-up there was no postoperative leakage, no cataracts developed, and the anterior chamber was maintained in all the eyes at all times. No ocular infection developed in any eye during the first postoperative month. The compound-force traction used in this procedure may prove useful in other areas of ocular surgery.
In Vitro Release of Hydrophobic Drugs From Polyanhydride Disks
Authors: Jampel Henry D , Koya Paroo , Leong Kam , Quigley Harry A
Published: April 2021

ABSTRACT

We have evaluated the feasibility of using polyanhydride disks containing hydrophobic antiproliferative agents for controlled drug release after glaucoma filtration surgery. Taxol and VP-16 were the most potent inhibitors of fibroblast proliferation tested, with ID
50
S of 3 ng/mL and 200 ng/mL, respectively. In vitro release of taxol occurred at concentrations exceeding its ID
50
for at least 100 days; VP-16 was released for 31 days. The media into which the drugs were released were able to inhibit fibroblast proliferation in vitro, indicating that the bioactivity of the drugs withstood incorporation into, and release from, the polyanhydride. Polyanhydride disks containing taxol and VP-16 merit testing in animal models of glaucoma filtration surgery.
Refinements of the Tarsal Strip Procedure
Authors: Weber Paul J , Popp Jeffrey C , Wulc Allan E
Published: April 2021

ABSTRACT

We present several refinements in technique that simplify the tarsal strip procedure and enhance its results. Among these refinements are: electrosurgical deepithelialization of conjunctiva and lid margin, use of a V-shaped needle, direct needle passage about the lateral orbital tubercle, and the parallel placement of a buried absorbable suture to unite the upper and lower lid margins and to maintain a long-lasting sharp canthal angle. We have used these maneuvers in 45 patients with few complications; patient acceptance has been high. Also, we have found that using these maneuvers is helpful in teaching the procedure to residents.
Delayed Filtering Bleb Encapsulation
Authors: Ophir Avinoam , Ticho Uriel
Published: April 2021

ABSTRACT

Encapsulated filtering blebs concomitant with increased intraocular pressure (IOP) developed 47 and 6 months, respectively, after surgery in two women, 46 and 60 years old, respectively, who had undergone trabeculectomy operations in one eye. Both blebs were associated with mild anterior uveitis. Following treatment with topical steroids, cyclopentolate, hypotensive medications, and digital massage, the uveitis resolved and the IOP fell. The likely cause of these late-appearing encapsulated blebs was anterior uveitis.
Intraocular Suture Ligature to Reduce Hypotony Following Molteno Seton Implantation
Authors: Liebmann Jeffrey , Ritch Robert
Published: April 2021

ABSTRACT

We describe a technique of internal suture ligation of the tube of the Molteno seton to prevent hypotony in the immediate postoperative period, without risking infection or inflammation.
Mucoepidermoid Carcinoma Presenting as an Orbital Apex Syndrome
Authors: Gore Holly L , Corin Scott M , Klussmann Kurt G , Doshi Himanshu M
Published: April 2021

ABSTRACT

We report a mucoepidermoid carcinoma of the maxillary sinus acutely presenting as an orbital apex syndrome.
A "Development Aid" Approach to Third World Surgical Blindness
Authors: Brian Garry , Hollows Fred
Published: April 2021

ABSTRACT

Establishing local production of intraocular lenses (IOLs) and sutures should be as much a part of surgical blindness prevention assistance to Third World countries as teaching extracapsular cataract extraction with IOL implantation, because it would increase financial independence and encourage economic growth.
Surgical and Medical Management of Patients With Narrow Anterior Chamber Angles: Comparative Results
Authors: Schwartz Gail F , Steinmann William C , Spaeth George L , Wilson Richard P
Published: April 2021

ABSTRACT

We retrospectively reviewed case records of 70 patients (114 eyes) to assess long-term outcome of surgical and medical treatment of narrow anterior chamber angles. Fifty eyes had undergone a peripheral iridectomy, incisional or laser; 64 had been treated medically, without surgery. The two groups were not strictly comparable. (It is assumed but not proven that, since iridectomy was considered necessary in one group and not in the other, the surgicallytreated patients were more seriously diseased.)

Comparing clinical data obtained at the first visit with data obtained at the last visit, the eyes receiving iridectomies, as compared with those receiving medical treatment alone, showed a greater number of improved anterior chamber configurations (74% vs 28%), had a lower incidence of peripheral anterior synechiae (2% vs 10%), and required fewer glaucoma medications (30% fewer vs 10% fewer). The percentage of eyes with increased intraocular pressure was similar in both groups (36% vs 28%), as was the percentage of those with decreased visual field (17% vs 21%) and decreased visual acuity (66% vs 60%). No significant complications occurred in the eyes receiving laser iridectomies; however, one of the incisionally-treated eyes lost nine Snellen lines of vision.
Bifocal Versus Monofocal Intraocular Lenses in Bilateral Pseudophakia
Authors: Scialdone A , Merighi M , Bertuzzi A , Brancato R
Published: April 2021

ABSTRACT

After a mean follow up of 19 months, the visual characteristics of eyes with bifocal diffractive intraocular lenses (IOLs) ("bifocals") in one eye were compared with those of fellow eyes with monofocal IOLs ("monofocals") in 29 bilateral Pseudophakic patients. All of the eyes had a distance-corrected acuity of 0.6 or more, but 24.1% of the bifocals and 48.3% of the monofocals had an acuity of 1.00. Near acuity with distance correction was J2 or more in 93.1% of the bifocals and in 17.4% of the monofocals (without correction: 79.3% and 41.4%, respectively). In 55.2% of the bifocals and 20.7% of the monofocals, the combined uncorrected acuity was 0.5 or more for distance and J2 or more for near. Fogging revealed a similar depth of focus in the monofocals and a similar distance focus in the bifocals. The bifocals had two peaks of acuity but no "plateau" between them. The eye with the monofocal IOL was preferred by 37.9% and the eye with the bifocal IOL by 10.3%. Vision in no eye was rated "poor." Visual disturbances were more frequent in the bifocals. No glasses were prescribed for 20.7% of all of these patients; 65.5% required bifocal glasses; 44.8% managed most of daytime without glasses.
Peripheral Iridotomy Using Nd:YLF Laser
Authors: Frangie John P , Park Steve B , Aquavella James V
Published: April 2021

ABSTRACT

We used the Nd:YLF Oscillator/Regenerative Amplifier Laser (ISL, San Diego, Calif) at 1053 nm to perform peripheral iridotomies in three eyes. The total amount of energy required was greater than the usual amount needed in Nd:YAG peripheral iridotomies. However, each laser pulse uses a much smaller quantity of laser energy and produces a smaller and more refined optical breakdown. The postoperative courses for these patients were uneventful, without postoperative intraocular-pressure spike or increasing anterior-chamber reactions.
Clinical Experience With the Molteno Dual-Chamber Single-Plate Implant
Authors: Freedman Jeffrey
Published: April 2021

ABSTRACT

A Molteno dual-chamber single-plate implant was placed in 40 consecutive patients, who were followed for a minimum of 6 months. This implant is identical to the single-plate Molteno implant, except for the addition of a pressure ridge to the upper surface of the episcleral plate, which allows the episcleral tissues to function as a temporary, pressure-sensitive valve, limiting the escape of aqueous in the early postoperative period. Confirming earlier studies, we found that use of the modified implant reduced immediate postoperative hypotony, eliminated choroidal hemorrhage, and, by obviating ligature of the silicone tube, permitted immediate reduction of elevated intraocular pressure.
Simultaneous Lateral, Anterior, and Posterior (SLAP) Lower-Lid Blepharoplasty
Authors: Weber Paul J , Popp Jeffrey C , Wulc Allan E
Published: April 2021

ABSTRACT

We report a hybrid of procedures for correcting the aging lower eyelid - transconjunctival blepharoplasty, skin blepharoplasty, and skin-muscle blepharoplasty - that maximizes the strengths of these procedures while minimizing their shortcomings. Our procedure, a simultaneous lateral, anterior, and posterior blepharoplasty, simultaneously attacks the lateral canthal angle, the anterior lamella, and the posterior lamella of the eyelid.
5-Fluorouracil in Trabeculectomy for Patients Under the Age of 40 Years
Authors: Bansal R K , Gupta Amod
Published: April 2021

ABSTRACT

In an attempt to enhance the success of trabeculectomy in patients under 40 years old, beginning 48 hours after surgery, we injected 5 to 45 mg (mean, 35 mg) of 5-fluorouracil in 10 eyes of six patients. After a mean follow up of 14.9 months (range, 6 to 27 months), intraocular pressure was below 21 mm Hg in 9 of the 10 eyes, with no antiglaucoma medication.
The Pitfall of Dacryostenosis
Authors: Zehavi Chaya , Zadok Josefh , Sachs Dan
Published: April 2021

ABSTRACT

We examined a 65-year-old woman with complaints of epiphora, which was diagnosed as due to dacryostenosis. After she had undergone dacryocystorhinostomy for this presumed condition, we discovered a large mass protruding through the incision. A biopsy showed anaplastic carcinoma, and a CT scan revealed that the right-side sinuses were filled with tumor. We conclude that the possibility of paranasal sinus tumors should at least be considered before initiating treatment for complaints of epiphora in elderly patients.
A Surgical Method to Repair Leaking Filtering Blebs
Authors: O'Connor Daniel J , Tressler Charles S , Caprioli Joseph
Published: April 2021

ABSTRACT

Surgical revision of a chronically-thinned filtering bleb with a leak at the limbus is described. After surgical excision of the scarred cystic conjunctiva and Tenon's fascia surrounding the leaking bleb, relatively uninvolved conjunctiva and Tenon's fascia are mobilized with the help of a large relaxing incision in the superior fornix and sutured over the area of filtration. We have used this technique successfully in five cases to provide fresh tissue to repair the bleb leak and restore adequate filtration.
Encapsulated Filtering Bleb and Subconjunctival 5-Fluorouracil
Authors: Ophir Avinoam , Ticho Uriel
Published: April 2021

ABSTRACT

Filtering bleb encapsulation (BE) involves fibroblast proliferation and collagen synthesis. We analyzed the effect of 5-fluorouracil (5-FU) on the inhibition of BE. Forty-one patients with primary open-angle glaucoma underwent trabeculectomy in one eye as an initial surgery. Twenty-one of these eyes, randomly chosen, were treated postoperatively with four to six 5-FU subconjunctival injections over 10 days to inhibit bleb scarring; the remaining 20 eyes did not receive 5-FU. After 12 to 24 months, the surgical success rate was significantly higher in the treated eyes (P < .05). However, the incidence of BE was similar: two eyes (9.5% and 10%, respectively) in each group. The difference between the effect of 5-FU in the inhibition of BE and bleb scarring suggests that the characteristics of the two fibroblast populations are heterogeneous.
Prediction of Visual Acuity Recovery in Cystoid Macular Edema
Authors: McDonnell Peter J , Ryan Stephen J , Walonker A Frances , Miller-Scholte Andrea
Published: April 2021

ABSTRACT

Three consecutive patients participated in a prospective evaluation of Pseudophakie cystoid macular edema. The duration of the macular edema ranged from 6 to 8 months. On the initial visit, the best corrected acuity with spectacles was determined and a potential acuity meter reading was obtained; this test suggested potential for visual recovery in two of the three patients. Sub-tenon's injections of methylprednisolone acetate (20 mg) were administered along with topical 1% prednisolone acetate and 1% atropine. One month later, visual acuity was improved by more than 2 Snellen lines in all three of the patients. A visual acuity measurement with the potential acuity meter that is better than the best corrected acuity with spectacles may reflect the presence of intact, but dysfunctional photoreceptors that are capable of restoring visual acuity upon resolution of the edema.
Tissue Plasminogen Activator Irrigation to Facilitate Removal of Subretinal Hemorrhage During Vitrectomy
Authors: Vander James F
Published: April 2021

ABSTRACT

I report removing a large submacular hemorrhage by means of vitrectomy combined with use of tissue plasminogen activator (tPA) to facilitate clot removal.

Four months postoperatively, the vision was 20/100 and the retina was flat, with a very thin layer of residual hemorrhage and pigmentary alteration in the macula. Although the long-term prognosis is guarded, this case does suggest that tPA may be a useful adjunct in managing selected cases of subretinal hemorrhage associated with macular degeneration.
Concurrent Benign Teratoid Medulloepithelioma and Pineoblastoma
Authors: Mamalis Nick , Font Ramon L , Anderson Chad W , Monson M Chris , Williams A Thomas
Published: April 2021

ABSTRACT

Teratoid medulloepithelioma of the ciliary body is a rare tumor usually occurring in young children. Primary tumors of the pineal gland are also quite rare and have a similar age distribution. We report the case of a 2-year-old girl who had a leukocoria of the right eye. Cataract surgery was performed; however, the patient developed a total retinal detachment refractory to treatment. She eventually developed early changes of phthisis bulbi and underwent an evisceration. Histopathologic examination revealed a benign teratoid medulloepithelioma containing islands of hyaline cartilage and rhabdomyoblasts. During the course of her evaluation, a pineoblastoma was discovered and surgically excised. While the association of pineal tumors with retinoblastomas has been well established, no such association has been reported for medulloepitheliomas. To our knowledge, this is the first recorded case of a benign teratoid medulloepithelioma occurring concurrently with a pineoblastoma.
Racial Variation of Optic Disc Parameters in Children
Authors: Mansour A M
Published: April 2021

ABSTRACT

The optic disc parameters of 66 children without ocular disease were analyzed in a prospective study. The vertical disc diameter, the disc area, and the cup-to-disc ratio were significantly larger in blacks than in whites. The race-based variation of optic disc size demonstrated previously in adults appears to be inherited, as it is also present in children.
Extrusion of Enucleation Implants: Treatment With Secondary Implants and Autogenous Temporalis Fascia or Fascia Lata Patch Grafts
Authors: Wiggs Eugene O , Becker Bruce B
Published: April 2021

ABSTRACT

We performed one autogenous fascia lata graft and 11 autogenous temporalis fascia grafts in eight patients with extrusion of an orbital enucleation implant and in four patients with a bulging implant who could not wear a prosthesis. Excluding one patient with inadequate follow up, 10 of the 11 patients (91%) successfully retained their implant. One patient had severe conjunctivitis followed by anterior migration of his implant 21/2 years after patch grafting, necessitating replacement of the implant. We conclude that autogenous temporalis fascia patch grafting is an effective treatment for orbital enucleation implant extrusion or a bulging implant.
Monopolar Cautery for Graft Cartilage Sculpting in Reconstructive Eyelid Surgery
Authors: Markowitz Gary D , Wulc Allan E , Perman Kevin I , Popp Jeffrey C
Published: April 2021

ABSTRACT

We describe a technique for using the monopolar cautery to sculpt ear cartilage to prepare it for use as a graft to reconstruct or support the posterior lamella of the eyelid in oculoplastic procedures. We have used this simple, rapid, and predictable technique in 16 patients with excellent results.
A Modified Technique of Transscleral Suture Fixation of Posterior Chamber Lenses
Authors: Mittelviefhaus Hans
Published: April 2021

ABSTRACT

I describe a modified technique of sulcus fixation of posterior chamber intraocular lenses (PC-IOLs) in which the anterior vitrectomy is restricted to the vitreous base and anterior chamber and a single-armed sling suture is used. These modifications reduce operating time and the risk of intraoperative and postoperative infection. This technique has been used successfully in the last 20 of the 96 patients in our institution who have had transscleral suture fixation procedures.
Treatment of Iris Melanoma With Photodynamic Therapy
Authors: Davidorf Jonathan , Davidorf Frederick
Published: April 2021

ABSTRACT

Photodynamic therapy was used to treat four patients with iris melanoma. Hematoporphyrin derivative was used as a sensitizing agent. The tumors were exposed to a total dose of 1.72 x 10
p 6
J/cm
p 2
of 630-nanometer laser light. The eye of the first patient, enucleated after treatment, histopathologically showed significant tumor necrosis. The tumors in the three subsequent patients were almost completely ablated, with no evidence of regrowth.
Intraocular Lens Implantation in an Almost Completely Retained Capsular Bag With a 4.5- to 5.0Millimeter Linear Dumbbell Opening in the Human Eye
Authors: Hara Tsutomu , Hara Takako
Published: April 2021

ABSTRACT

As a preliminary step in developing a capsular opening that will permit the firm fixation of the full-size intraocular lenses (IOLs) of the future in a completely retained capsular bag, conventional 11-millimeter long posterior chamber IOLs with 6-millimeter polymethylmethacrylate optics were implanted in almost completely retained capsular bags with a 4.5- to 5.0-millimeter linear dumbbell opening. Undergoing the procedure were 23 cataractous eyes of 23 patients (average age, 72 ± 8 years). Average follow up was 15 ± 2 months. The dumbbell opening was made with an automated electric trephine or manually. The Cavitron 10 000 was used for phacoemulsification. Lens epithelial cell removal was performed by cryopexy. All IOLs were fixed in the capsule satisfactorily. Although complete transparency was not retained in any of the eyes, postoperative visual acuity was better than 10/20 in 16 eyes (70%). There were no apparent complications other than anterior capsular opacification.
Ciliary Sulcus Fixation of a Dislocated Posterior Chamber Intraocular Lens Using Liquid Perfluorophenanthrene
Authors: Fanous Maher M , Friedman Scott M
Published: April 2021

ABSTRACT

A posterior chamber intraocular lens was transsclerally sutured to the ciliary sulcus with the aid of liquid perfluorophenanthrene (Vitreon®). This vitreous substitute facilitates the procedure and reduces the possibility of damage to the retina.
Removal of Corneal Foreign Bodies: An Instructional Model
Authors: Collins D W , Coroneo M T
Published: April 2021

ABSTRACT

A simple method for inflicting corneal foreign body injuries on bovine eyes is described and illustrated. The subsequent use of these eyes for teaching corneal and rust-ring removal is demonstrated. This method is suitable for instruction of large numbers of students and could be included in an undergraduate curriculum.
Using Donor Sclera to Create a Flap in Glaucoma Filtering Procedures
Authors: Riley Shawn F , Lima Francisco L , Smith Thomas J , Simmons Richard J
Published: April 2021

ABSTRACT

We report a surgical technique in which donor sclera is used to create a flap in glaucoma filtering procedures. This simple technique is helpful when the sclera is too thin to safely and effectively form an adequate scieral flap. The use of donor sclera allows the procedure to continue as a guarded procedure and prevents early postoperative hypotony.
Proximity-Sensor Dimmer Device as an Aid in the Reduction of Operating Microscope-Induced Retinal Phototoxicity
Authors: Urinowski E , Cahane M , Ashkenazi I , Blumenthal M , Avni I
Published: April 2021

ABSTRACT

The length of exposure to the light source of the operating microscope is a major factor determining retinal phototoxicity. In our experience, for about 20% of the time during cataract surgery, the surgeon is not looking through the oculars. To take advantage of these times, we designed a device, a proximity switch consisting of an infrared sensor mounted between the oculars in the operating microscope. When the surgeon's forehead approaches the microscope to look through the oculars, the sensor increases the illumination; when the surgeon moves away, it is automatically reduced. The resulting decreased overall exposure to light may reduce retinal phototoxicity.
A New Lens for Argon Laser Suture Lysis
Authors: Ritch Robert , Potash Seth D , Liebmann Jeffrey M
Published: April 2021

ABSTRACT

Argon laser suture lysis is a valuable adjunct for regulating intraocular pressure and establishing a filtration bleb in the early postoperative period after trabeculectomy. We have developed a lens that provides excellent compression of the conjunctiva, an improved view of scleral flap sutures, and effortless retraction of the upper lid.
Lid Crease and Capsulopalpebral Fascia Repair in Congenital Entropion and Epiblepharon
Authors: Millman Arthur L , Mannor Geva E , Putterman Allen M
Published: April 2021

ABSTRACT

Forty-one eyelids of 21 patients with congenital entropion or epiblepharon underwent transcutaneous reconstruction of the eyelid crease and retractor (capsulopalpebral fascia). All of the patients demonstrated lack of cutaneous-capsulopalpebral fascia attachment. In contrast with the patients with epiblepharon, those with congenital entropion also had partial or complete absence of tarsal-capsulopalpebral fascia attachment. Surgical treatment included anastomosis of the capsulopalpebral fascia, tarsal border, and eyelid skin crease; no skin or muscle was removed. With a minimum follow up of 1 year, malposition recurred in 3 of the 33 (9%) eyelids with epiblepharon, and in none of the 8 eyelids with entropion.
Penetrating Ocular Trauma in Children by "Broomstick Bows and Arrows"
Authors: Sharma Tarun , Agarwal Premlata , Gopal Lingam , Badrinath Sengamedu Srinivasa , Murugesan Radha
Published: April 2021

ABSTRACT

Ocular trauma by "broomstick bows and arrows" is a unique penetrating injury among Indian children. Hitting the eye with a great velocity, these highly contaminated missiles may cause severe damage. The results of surgical treatment of 100 children who suffered such trauma are presented. Anatomic success, ie, successful reconstruction of the globe with attached retina, was attained in 85 (85%) of these eyes. Functional success, ie, improvement in visual acuity of two Snellen lines in eyes with measurable preoperative acuity, or improvement to at least 2/60 in the eyes with preoperative acuities of light perception or hand movements, was attained in 62 (62%) of the eyes. Of the functionally successful eyes, an acuity of 6/9 or better was achieved in 28 (45.2%). Factors predictive of poor anatomical success were:

* injuries involving both anterior and posterior segment (P<.02),

* endophthalmitis (P < .05), and

* presence of retinal detachment with or without proliferative vitreoretinopathy (P <.05).

Mean follow up was 4.5 ± 3.59 months (range, 2 to 24 months).
Hyperplastic Pupillary Membrane and Laser Therapy
Authors: Kumar Harsh , Sakhuja Navin , Sachdev Mahipal S
Published: April 2021

ABSTRACT

The eyes in two cases of extensive hyperplastic pupillary membranes with significant reduction of visual acuity and clarity were subjected to sectioning of the membranes in the superior 270° of the pupil using a Q-switched Nd:YAG laser. The complications of microhemorrhages, pigment dispersal, and elevation of intraocular pressure were insignificant, while the objective and subjective improvement in vision was remarkable.
Resident Phacoemulsification Experience Using the In Situ Nuclear Fracture Technique
Authors: Noecker Robert J , Allinson Richard W , Snyder Robert W
Published: April 2021

ABSTRACT

We retrospectively reviewed all of the 176 phacoemulsification procedures attempted by two thirdyear residents from July 1, 1991 to June 30, 1992. The in situ nuclear fracture technique was performed in 131 eyes; a nonf radure technique in 45. Overall, the rate of vitreous loss was 4.5% (8 of 176). The rate of vitreous loss associated with the in situ nuclear fracture technique was 3.1% (4 of 135); with the nonfracture technique, 8.9%. We conclude that phacoemulsification can be learned and performed by residents with vitreous loss rates comparable to those reported for extracapsular cataract extraction.
Releasable "U" Suture for Trabeculectomy Surgery
Authors: Maberley David , Apel Andrew , Rootman David S
Published: April 2021

ABSTRACT

Overfiltration after glaucoma surgery can lead to significant complications. Tight suturing of the trabeculectomy flap reduces this problem but can lead to higher pressure and poor drainage of aqueous. Releasable sutures often leave irritating exposed suture ends. We describe a simple two-arm releasable suture technique that leaves no exposed suture ends until one arm of the suture is removed. Good control of postoperative pressure with few complications was achieved in 28 cases using this technique, which allows manipulation at the slit lamp of the trabeculectomy flap, obviating laser lysis of the sutures.