bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability of Astigmatism Over 3 Years After Corneal Stretch Incision
Authors: Müller-Jensen Kei , Buchholz Andreas , BarIinn Björn
Published: April 2021

ABSTRACT

PURPOSE: To assess long-term corneal stability of self-sealing clear corneal stretch incisions with implantation of 5 mm polymethylmethacrylate (PMMA) intraocular lenses.

METHODS: Two hundred consecutive eyes of 3500 cataract patients who had capsulorhexis, phacoemulsification, and preparation of a 1.5 to 2.0 mm corneal tunnel that had an external width of 4.0 to 4.1 mm and an internal width of 6.5 to 7.0 nun (stretch incision), and implantation of a 5 mm PMMA intraocular lens were evaluated clinically and statistically. Slit-lamp microscopy, keratometry, and corneal topography were performed preoperatively and postoperatively after 1 week, 1, 2, and 3 years.

RESULTS: The mean surgically induced astigmatism following superior corneal incision amounted to 1.59 ± 1.06 D after 3 years; following lateral corneal incision, mean surgically induced astigmatism was 0.84 ± 0.68 D. There were no corneal complications in the long-term follow-up study.

CONCLUSION: Our 5-year experience shows that the self-sealing clear corneal stretch incision in connection with implantation of a 5 mm polymethylmethacrylate intraocular lens induces approximately 1.00 D of astigmatism. We prefer the lateral incision and recommend the superior incision only for high preoperative with-the-rule astigmatism. [J Refract Surg 1998;14:455-458]
The Picosecond Laser for Nonmechanical Laser in situ Keratomileusis
Authors: Krueger Ronald R , Juhasz Tibor , Gualano Antonio , Marchi Vincenzo
Published: April 2021

ABSTRACT

PURPOSE: To introduce the clinical use of the Nd:YLF picosecond laser as a nonmechanical microkeratome.

METHODS: A commercially available Nd:YLF picosecond laser (25 µJ/pulse, 30 psec, 1053 nm) was used to deliver intrastromal pulses of focused high power laser light to generate a flap for laser in situ keratomileusis (LASIK) and perform picosecond laser keratomileusis (PLK) in two partially sighted patients with high myopia.

RESULTS: Case #1: A 6 mm, 150 µp? flap for LASIK was successfully created and the underlying stroma treated with an excimer laser for a target correction of -15.00 D of myopia. Good corneal clarity and a refractive change of -14.00 D was recorded 2 months postoperatively. Case #2: Both eyes of a high myope (-22.00 D right eye, -21.50 D left eye) underwent picosecond laser keratomileusis, removing a 3.2 mm diameter lenticule of 120 urn thickness under a 200 µp? flap. Postoperative refraction was -2.00 D at 7 months in the right eye and -0.75 D at 2 months in the left eye with improvement of spectacle-corrected visual acuity from 20/200 to 20/70 in each eye.

CONCLUSION: The Nd:YLF picosecond laser can be safely used in creating a corneal flap for LASIK and in performing picosecond laser keratomileusis for high myopia. Future refinements in the laser will include a larger flap diameter and femtosecond pulsing capability. [J Refract Surg 1998;14:467-469]
Ultrasound Biomicroscopic Imaging of Posterior Chamber Phakic Intraocular Lens
Authors: Trindade Fernando , Pereira Frederico , Cronemberger Sebastião
Published: April 2021

ABSTRACT

BACKGROUND: Phakic intraocular lens (IOL) implantation represents a major technique for the correction of high myopia. The STAAR collamer posterior chamber phakic IOL- trade named Implantable Contact Lens- is an emerging technology in refractive surgery. We studied the relative position of the posterior chamber phakic IOL using ultrasound biomicroscopy.

METHODS: The posterior chamber phakic intraocular lens was inserted in 9 eyes of 8 patients with high myopia. Ultrasound biomicroscopy was performed before and after implantation of the phakic IOL to assess its relative position in the anterior segment of the eye. The parameters measured and compared were anterior chamber depth, angle opening distance 500 urn from the scleral spur, iris-crystalline lens contact distance, iris-IOL contact distance, and K)L- crystal Ii ne lens distance.

RESULTS: Ultrasound biomicroscopy showed contact between the iris and the IOL in all eyes and between the IOL and the crystalline lens in 8 eyes. Reduction in the anterior chamber depth and localized narrowing of the angle opening were observed in all eyes.

CONCLUSION: IOL-iris touch, IOL-crystalline lens touch, and anterior chamber shallowing raise concerns of pigmentary dispersion, cataractogenesis, and narrow angle glaucoma following posterior chamber phakic intraocular lens implantation. Clinical data are needed to determine if these problems occur. [J Refract Surg 1998;14:497-503]
Astigmatism Outcomes Following Spherical Photorefractive Keratectomy for Myopia
Authors: Al-Abdulla Nael A , Jabbur Nada S , O'Brien Terrence P
Published: April 2021

ABSTRACT

BACKGROUND: Our aim was to examine the change in astigmatism after spherical photorefractive keratectomy (PRK). These effects are essential to optimizing photoastigmatic refractive keratectomy (PARK) to correct astigmatism to within fractions of a diopter.

METHODS: We retrospectively reviewed 98 eyes of 178 patients with mild to moderate myopia and cylinder «1.00 diopter (D) treated with spherical PRK (VISX 20/20 STAR excimer laser system); 31 eyes had epithelium removed mechanically with a blade and 67 eyes by a laser-scrape technique.

RESULTS: Refractive astigmatism was reduced by greater than 0.25 D in 27 eyes (28%); refractive astigmatism was induced by greater than 0.25 D in 31 eyes (32%); the average vector-corrected difference between an eye's astigmatism before and after surgery was 0.01 ± 0.52 D (P=.85). Eyes with high topographic astigmatism but low refractive cylinder before PRK showed an average of 0.07 ± -0.60 D change in refractive cylinder after PRK. Refractive astigmatism of more than 0.25 D was induced in 16 eyes (44%) that received manual removal of epithelium versus 15 eyes (24%) that received laser removal of epithelium (odds ratio 2.51, P<01).

CONCLUSIONS: When using PRK for astigmatism correction, refractive cylinder before surgery rather than topographic astigmatism may be the most appropriate method for targeting the astigmatism correction, especially when the two values are discordant. An unpredictable mild increase or decrease in astigmatism may be expected. [J Refract Surg 1998;14:610-614]
Radial Keratotomy Clear Zone Diameter Errors
Authors: Grimmett Michael R , Ogawa Gregory S H
Published: April 2021

ABSTRACT

PURPOSE: To examine the variability of achieved clear zone diameters following radial keratotomy and to determine if refractive outcomes are correlated to clear zone diameter errors.

METHODS: Twenty-six patients with radial keratotomy (51 eyes) were studied retrospectively. The central clear zone diameter for each radial incision meridian was measured using a slit-lamp and a photograph. The achieved clear zone diameters were statistically compared to the intended clear zone sizes and to the refractive outcomes.

RESULTS: Twenty-nine of the 51 eyes met various exclusion criteria. Ninety individual slit-lamp clear zone measurements were obtained for the remaining 22 eyes. Sixty-two of 90 (69%) achieved clear zone diameters were more than 0.25 mm different than the intended clear zone size. A maximum difference of ±0.80 mm from the intended clear zone marker size was observed. The average clear zone diameter error did not statistically differ between the three refractive outcome groups (undercorrection, emmetropia, and overcorrection).

CONCLUSIONS: In selected cases of centripetal radial keratotomy, the achieved clear zone diameter can vary widely from the intended clear zone size despite extensive surgeon experience. [J Refract Surg 1998;14:623-630]
Microbiological Examination of Bandage Soft Contact Lenses Used in Laser Refractive Surgery
Authors: Detorakis Efstathios T , Siganos Dimitrios S , Houlakis Vasilios M , Kozobolis Vasilios P , Pallikaris Ioannis G
Published: April 2021

ABSTRACT

BACKGROUND: Disposable soft contact lenses are known to be colonized by bacteria and play a key role in bacterial keratitis pathogenesis. Such lenses, commonly used after laser refractive surgery procedures in which postoperative corneal infiltrations are sometimes observed, are potentially a substrate for bacterial inoculation. This study evaluates the extent of such a contamination.

METHODS: Sixty disposable lenses collected from 60 eyes of patients who underwent photorefractive keratectomy (PRK), photoastigmatic refractive keratectomy (PARK), or laser in situ keratomileusis (LASK) for the treatment of myopia or hyperopia were collected under sterile conditions over 4 months and cultured in various media. Results were statistically analyzed and the correlation with clinical and epidemiological data was examined.

RESULTS: Eleven (18.3%) of the examined lenses were contaminated with Staphylococcus epidermidis. No other bacteria or fungi were found. Contamination was significantly more common among female patients (P=.036). Correlation with the other clinical or operative parameters examined was statistically insignificant.

CONCLUSIONS: Contamination was independent of the surgical procedure and females who were frequent users of eyelid cosmetics displayed higher contamination frequencies, suggesting that bacteria possibly originate from eyelid flora. The isolation of Staphylococcus epidermidis requires close postoperative surveillance, since it is a known cause of keratitis. Prophylactic postoperative treatment with tobramycin, gentamycin, or sulphonamides could be indicated. [J Refract Surg 1998;14:631-635]
Refractive Results of Radial Keratotomy After 10 Years
Authors: Charpentier Dominique Y , Garcia Philippe , Grunewald Franck , Brousse Dominique , Duplessix Michel , David Thierry
Published: April 2021

ABSTRACT

BACKGROUND: We analyzed retrospectively the refractive and visual resulte of a cohort of patients who underwent radial keratotomy for myopia 10 years ago.

METHODS: Radial keratotomies using centripetal incisions were performed by the same surgeon in 1986 and 1987 to correct myopia of -0.75 to -10.00 diopters (D). Refractive and visual results were evaluated at 1 month and on average 10 years after surgery.

RESULTS: Thirty-nine patients (71 eyes) underwent radial keratotomy. Mean spherical equivalent refraction before surgery was -3.90 D and after surgery was -0.50 D at 1 month and +0.13 D at 10 years after surgery. At last examination, 41 eyes (43.7%) had a spherical equivalent refractive error within ±1.00 D of emmetropia (24 eyes [34%] ±0.50 D) and 32.4% of eyes were overcorrected by more than 1.00 D. Between 1 month and 10 years after surgery, a hyperopic shift greater than 1.00 D occurred in 34.1% of eyes with a single procedure. Ten years after surgery, 59 eyes (83%) had uncorrected distance visual acuity of 20/40 or better (22 eyes [31%] with uncorrected visual acuity of 20/20 or better).

CONCLUSION: This retrospective evaluation confirms that radial keratotomy is an effective procedure to correct myopic error, but the hyperopic shift produces an unstable, less predictable refraction in one-third of eyes at 10 years. [J Refract Surg 1998;14:646-648]
Intrastromal Corneal Ring Segments: Reversibility of Refractive Effect
Authors: Asbell Penny A , U¸akhan Ömür Ö , Abbott Richard L , Assil Kerry A , Burris Terry E , Durrie Daniel S , Lindstrom Richard L , Schanzlin David J , Verity Steven M , Waring George O
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the reversibility of refractive effect following removal of the ICRS (intrastromal corneal ring segments; Intacs).

METHODS: Data from 34 eyes from which ICRS were removed during United States FDA Phase II and III clinical trials were evaluated with regard to segment size, loss or change of best spectacle-corrected visual acuity (BSCVA), any change of uncorrected visual acuity (UCVA), manifest spherical equivalent refraction, manifest cylinder refraction, stability of manifest cylinder refraction, and subjective visual symptoms.

RESULTS: Out of 725 initial or contralateral eyes placed with the ICRS during Phase II and III clinical trials, segments were removed from 34 eyes (4.7%). Other than one (1/725, 0.1%) safety related ICRS removal, 30/725 (4.1%) were due to visual symptoms. ICRS removal was accomplished under topical anesthesia without complications in all eyes. The mean length of time the segments remained in the cornea after initial surgery was 10.3 ± 5.4 months. At 3 months after ICRS removal, 21 eyes had monitored data available and were within ±1 line or 10 letters of their preoperative BSCVA. Twenty eyes (20/21, 95%) returned to within ±1.00 D of their preoperative manifest spherical equivalent refraction. All eyes had a stable refraction at the 3-month examination after removal, and a manifest spherical equivalent refraction within ±1.00 D of their 1-month examination after removal. Nineteen eyes (19/21, 90%) returned to within ±2 lines and 16 eyes (16/21, 76%) returned to within ±1 line of preoperative UCVA.

CONCLUSION: The ICRS (Intacs) was easily and safely removed, and eyes returned to preoperative refractive status within 3 months. [J Refract Surg 2001;17:25-31]
Posterior Chamber Phakic Intraocular Lenses to Correct High Myopia: A Comparative Study Between Staar and Adatomed Models
Authors: Menezo José L , Peris-Martínez Cristina , Cisneros Angel , Martínez-Costa Rafael
Published: April 2021

ABSTRACT

PURPOSE: To determine the feasibility of using posterior chamber phakic intraocular lenses (PIOLs) to treat high myopia, comparing two different models, Staar and Adatomed.

METHODS: Twenty-four eyes from 12 patients were studied prospectively. A phakic Staar IOL was implanted in one eye of each patient, and the other eye received a phakic Adatomed IOL. Patients with uveitis or ocular trauma prior to ocular surgery, diabetic retinopathy, or capsular pseudoexfoliation were excluded. The mean preoperative spherical equivalent refraction was -16.00 ± 5.05 D for the Staar group and -15.39 ± 2.83 D for the Adatomed group. Average follow-up was 32.4 months (range, 19 to 46 mo) for the Adatomed group and 18.3 months (range, 11 to 21 mo) for the Staar group and included evaluation of intraocular pressure, intraocular lens pigment deposits, lens decentration, anterior subcapsular cataract, and visual acuity.

RESULTS: Spectacle-corrected and uncorrected visual acuity improved in all eyes in both groups. No statistically significant differences in visual acuity gain were observed with the two materials (Student t-test, P = .08 for the Staar group and P = .6 for the Adatomed group), although the gain in visual acuity was somewhat greater with the Staar PIOLs. The difference in mean intraocular pressure before surgery and at last follow-up was 1.5 mmHg for the Staar group and 2.3 mmHg for the Adatomed group (P = .36). The incidence of lens pigment deposits was the same in both groups (41.66%), with deposits in 5 of the 12 eyes in both groups. The incidence of lens decentration was higher in the Adatomed group (5/12; 41.66%) than in the Staar group (2/12; 16.7%). Anterior subcapsular cataract was higher in the Adatomed group (4/12; 33.3%) than in the Staar group (3/12; 25%).

CONCLUSIONS: There was a higher incidence of lens decentration and anterior subcapsular cataract in the Adatomed group than in the Staar group. [J Refract Surg 2001;17:32-42]
Correlation Between Refractive and Corneal Topographic Changes After Photorefractive Keratectomy for Myopia
Authors: Rosa Nicola , Cennamo Giovanni , Rinaldi Michele
Published: April 2021

ABSTRACT

PURPOSE: To compare videokeratographic and refractive data obtained before and after photorefractive keratectomy (PRK) for myopia.

METHODS: Seventy-four eyes underwent PRK for myopia ranging from -2.50 to -17.00 D (mean, -7.76 ± 3.17 D). All patients had videokeratography with the EyeSys instrument before, and 1 and 6 months after PRK, and the changes in three corneal power measurements (center of the ablation, apex, and effective refractive power) were compared with refractive changes.

RESULTS: Changes obtained in the three corneal power measurements at 1 and 6 months were well correlated with manifest refraction (Pearson's coefficient ranged from 0.71 to 0.84).

CONCLUSION: Power measurements obtained with corneal topography, as described above, are a reliable and objective method for the evaluation and follow-up of PRK, provided addition of an approximate 25% correcting factor. [J Refract Surg 2001;17:129-133]
Laser in situ Keratomileusis Results of DOS and Windows Software Versions for the Nidek EC-5000 Excimer Laser Using the Same Nomogram
Authors: Vongthongsri Anun , Hanutsaha Prut , Naripthapan Pichit , Lerdvitayasakul MD Rungroj
Published: April 2021

ABSTRACT

PURPOSE: To compare the results of laser in situ keratomileusis (LASDK) correction for myopia and myopic astigmatism between the previous DOS software version and the Windows software version for the Nidek EC-5000 excimer laser, using the same nomogram.

METHODS: This retrospective review included 2021 eyes (980 patients) after LASIK using the Nidek EC-5000 excimer laser. Of these, 1632 eyes were corrected with the DOS software version and the other 389 eyes were corrected with the Windows software version of the laser. Both groups were treated with the same surgical nomogram. Minimum follow-up time was 6 months. Patients were classified into range of myopia: low, moderate, and high.

RESULTS: Postoperative uncorrected visual acuity was not statistically significantly different between the two groups in any range of refractive error. There was no loss of best spectacle-corrected visual acuity for any patient. Uncorrected visual acuity equal to or better than 20/40 was achieved in 96.3% of eyes in the Windows version group and 94.9% in the DOS version.

CONCLUSION: Results for the correction of myopia or myopic astigmatism were similar using the Nidek EC-5000 excimer laser with either the DOS software version or Windows software version, with the same surgical nomogram. [J Refract Surg 2001;17(suppl):S242-S245]
Changes in Intraocular Pressure After Laser in situ Keratomileusis
Authors: Rashad Khaled M , Bahnassy Ahmed A
Published: April 2021

ABSTRACT

PURPOSE: To evaluate changes in intraocular pressure (IOP) measurements by Goldmann applanation tonometry after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism, and to assess the accuracy of Goldmann applanation tonometry measurements after LASIK in these eyes.

METHODS: LASIK was performed on 166 eyes of 93 patients for correction of myopia and myopic astigmatism. Intraocular pressure was measured by Goldmann applanation tonometry at the central and temporal parts of the cornea before and at 1, 3, 6, and 12 months after LASIK. The amount of change in IOP was computed and its relation to different variables was evaluated by regression analysis.

RESULTS: Intraocular pressure measured at the center of the cornea was reduced by a mean of 3.69 ± 1.63 mmHg after LASIK Multiple regression analysis showed that the decrease in IOP was related to the preoperative IOP and the change in central corneal thickness after LASHC Measurements of IOP at the temporal part of the cornea were also reduced by a mean of 2.39 ± 1.71 mmHg. There was wide variability in the amount of difference between the temporal and central measurements after LASHi (temporal measurements were higher than central by 0 to +4 mmHg).

CONCLUSION: LASIK for myopia produced underestimation of IOP measured by Goldmann applanation tonometry at the central part of the cornea by a mean of 3.69 ?1.63 mmHg. The decrease of IOP was related to preoperative IOP and the change in central corneal thickness after LASHi. Temporal Goldmann applanation tonometry measurements, although decreased after LASHi, were less reliable. [J Refract Surg 2001;17:420-427]
Photorefractive Keratectomy for Astigmatism With the Meditec MEL 60 Laser
Authors: Nagy Zoltán Z , Krueger Ronald R , Süveges Ildikó
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) in eyes treated with astigmatic refractive errors.

METHODS: Nine hundred forty eyes were treated with the Aesculap M?dit?e MEL 60 ArF excimer laser. Treatment groups were: Group 1 (n=746) eyes with compound myopic astigmatism, Group 2 (n=104) eyes with compound hyperopic astigmatism, Group 3 (n=75) eyes treated for mixed astigmatism, and Group 4 (n=15) eyes with simple myopic astigmatism (negative cylinder).

RESULTS: In Group 1, the preoperative spherical equivalent refraction of -6.10 D with an average of -1.50 D cylinder decreased to -0.95 D with -0.13 D cylinder; uncorrected visual acuity (UCVA) of 20/40 or better was achieved in 86% (642/746 eyes); 20/20 or better in 58% (433/746 eyes); 0.8% (6/746 eyes) lost two lines of spectacle-corrected visual acuity (SCVA); 74% (552/746 eyes) were within ?0.50 D and 93% (694/746 eyes) were within ?1.00 D of target refraction. In Group 2, preoperative mean +4.57 D spherical equivalent refraction with an average of +1.57 D cylinder decreased to +1.13 D with +0.38 D cylinder; UCVA of 20/40 or better was achieved in 84% (87/104 eyes); 20/20 or better in 46% (48/104 eyes); 14,4% (15/104 eyes) lost two or more lines of SCVA; 52% (54/104 eyes) were within ?0.50 D and 82% (85/104 eyes) were within ?1.00 D of target refraction. In Group 3, mean preoperative -4.20 D cylinder and +3.00 D spherical equivalent refraction decreased to -0.50 D cylinder and -0.50 D spherical equivalent refraction; UCVA of 20/40 or better was achieved in 83% (62/75 eyes); 20/20 or better in 32% (24/75 eyes); 13.3% (10/75 eyes) lost two or more lines of SCVA. In Group 4, mean preoperative -3.98 D cylinder decreased to -0.62 D cylinder; UCVA of 20/40 or better was achieved in 60% (9/15 eyes); none of the eyes achieved 20/20 or better; SCVA remained stable in 6.6% (1/15 eyes) and decreased two or more lines in 20.0% (3/15 eyes); 20% (3/15 eyes) were within ?0.50 D and 53.3% (8/15 eyes) were within ?1.00 D of target refraction.

CONCLUSION: PRK with the M?dit?e MEL 60 laser produced the best results in eyes with compound myopic astigmatism (Group 1). In all other groups, results were less predictable. [J Refract Surg 2001;17:441-453]
Contrast Sensitivity After Posterior Chamber Phakic Intraocular Lens Implantation for High Myopia
Authors: Jiménez-Alfaro Ignacio , Gómez-Tellería Germán , Bueno José Luis , Puy Pilar
Published: April 2021

ABSTRACT

PURPOSE: To evaluate contrast sensitivity after posterior chamber phakic intraocular lens (PIOL) implantation for the correction of high myopia.

METHODS: Twenty eyes of ten patients had a posterior chamber phakic intraocular lens (Staar ICL) implanted to correct high myopia. Mean preoperative myopia was -14.10 ? 2.70 D. Follow-up was 24 months for all patients. Contrast sensitivity was tested with best spectacle-corrected visual acuity preoperatively and 3, 6, 12, 18, and 24 months postoperatively.

RESULTS: Contrast sensitivity increased after surgery in all spatial frequencies. Normal values were achieved for low and intermediate spatial frequencies (3 and 6 c/deg). However, in spite of the improvement, values were still below normal for high spatial frequencies (12 and 18 c/deg). When the first postoperative examination was not considered, there were no statistically significant differences in contrast sensitivity values at different postoperative periods.

CONCLUSION: Contrast sensitivity increased after posterior chamber phakic intraocular lens implantation (Staar ICL) in all spatial frequencies when compared to preoperative contrast sensitivity (best spectacle-corrected). [J Refract Surg 2001;17:641-645]
Monocular Diplopia Related to Asymmetric Corneal Topography After Laser in situ Keratomileusis
Authors: Takei Kazuo , Sano Yuta , Achiron Leonard R , Carr Jonathan D , Stulting R Doyle , Thompson Keith P , Waring George O
Published: April 2021

ABSTRACT

PURPOSE: To show a specific relationship between monocular diplopia and corneal refractive asymmetry after laser in situ keratomileusis (LASIK).

METHODS: One hundred thirty-eight eyes of 98 patients who underwent IASIK for myopia between -2.12 and -17.75 D were examined under room-lighted conditions. We examined 51 eyes at 2 weeks, 46 eyes at 3 months, 32 eyes at ? months, and 9 eyes at 1 year after LASD!. We attempted to correlate the presence of monocular diplopia with their corneal topographical features.

RESULTS: Eight eyes of five patients (five eyes at 2 weeks, three eyes at 3 months after LASIK) produced symptoms of monocular diplopia. These symptomatic patients had a common corneal topographical feature caused by decentralized or inhomogeneous ablation. Every pupillary area in the patients' topographies contained steeper and flatter areas. The range of refractive power variation in these asymmetric areas was at least 1.50 D. The location of the secondary image correlated with the direction of the steeper area in all eight eyes. Pinhole viewing eliminated or reduced the prominence of secondary images in every case.

CONCLUSION: Monocular diplopia following LASDI appears to correlate with postoperative corneal refractive power variation inside th? pupillary area, caused by decentralized or inhomogeneous ablation. [J Refract Surg 2001;17:652-?57]
Confocal Microscopic Imaging of Reticular Folds in a Laser in situ Keratomileusis Flap
Authors: Kohnen Thomas , Bühren Jens , Baumeister Martin
Published: April 2021

ABSTRACT

PURPOSE: To report the clinical and confocal microscopic characteristics of reticular folds (mudcracks) in a cornea after laser in situ keratomileusis (LASIK).

METHODS: A 30-year-old male showed reticular flap folds on slit-lamp examination 1 week after LASlK. In addition to slit-lamp biomicroscopy, confocal in vivo microscopy was performed.

RESULTS: Examination with a confocal whitelight slit-scanning microscope revealed distinct folds of Bowman's layer and underlying microfolds throughout the flap stroma. After flap re-lifting, no changes could be determined, either clinically or by confocal microscopy. At 12 months following the procedure, best spectacle-corrected visual acuity was slightly improved, but the folds, as imaged by confocal microscopy, still persisted.

CONCLUSIONS: In the present case, reticular folds after LASIK involved the entire thickness of the flap. Simple flap lifting was not sufficient for smoothing out the folds. [J Refract Surg 2001; 17:689-691]
Laser Epithelial Keratomileusis: Outcome of Initial Cases Performed by an Experienced Surgeon
Authors: Chalita Maria Regina , Tekwani Navin H , Krueger Ronald R
Published: April 2021

ABSTRACT

PUBPOSE: To evaluate refractive outcome and objective clinical data, and determine efficacy, predictability, and safety of laser epithelial keratomileusis (LASEK) for myopic treatments.

METHODS: We performed a retrospective noncomparative single-surgeon case series on the first 20 LASER procedures (Alcon LADARVision 4000 laser). Mean patient age was 41.2 years (range 21 to 60 yr): 13 men and 7 women. Mean preoperative spherical equivalent refraction was -6.47±2.78 D. Corneal haze, uncorrected and spectacle-corrected visual acuity and manifest refraction were evaluated.

RESULTS: Of 20 eyes studied, 3 were corrected for monovision. In the non-monovision group, 20/40 or better visual acuity was achieved in 94% (16 eyes) at 1 month, 100% (13 eyes) at 3 months, and 91% (10 eyes) at 6 months after LASEK; 20/20 or better was achieved in 12% (2 eyes) at 1 month, 46% (6 eyes) at 3 months, and 45% (5 eyes) at 6 months. Corneal haze at 1 month was grade 0.5 in 35% (7 eyes), 1 in 20% (4 eyes) and 2 in 10% (2 eyes). At 3 months, 62% (12 eyes) had grade 0.5 and 31% (6 eyes) had grade 1. At 6 months, 58% (12 eyes) had grade 0.5, 25% (5 eyes) had grade 1, and 8% (2 eyes) had grade 2.

CONCLUSIONS: LASEK is a challenging procedure. Creating the epithelial flap is not simple and may have contributed to the high haze incidence in our study. [J Refract Surg 2003;19:412-415]
Rupture of Radial Keratotomy Incisions by Blunt Trauma 6 Years After Combined Photorefractive Keratectomy/Radial Keratotomy
Authors: Artola Alberto , Ayala María J , Ruiz-Moreno José M , De La Hoz Fernando , Alió Jorge L
Published: April 2021

ABSTRACT

PURPOSE: To report a case of traumatic corneal rupture that occurred 6 years previous, following combined radial keratotomy (RK) and photorefractive keratectomy (PRK).

METHODS: A 28-year-old man experienced a severe direct trauma to the right eye. Upon initial examination, a ruptured globe was diagnosed. Four of the eight radial incisions were ruptured with extrusion of intraocular tissues. The patient was also diagnosed with a fracture of the medial wall of the right orbit. The patient received immediate surgery during which the radial incisions that had been torn were stitched with a suture.

RESULTS: Following the postoperative period, the patient had visual acuity of light perception.

CONCLUSION: PRK, carried out on a cornea already treated with RK, may increase the likelihood of rupture in blunt trauma. [J Refract Surg 2003;19:460-462]
Correlation of Pupil Sizes Measured With a Mesopic Infrared Pupillometer and a Photopic Topographer
Authors: Periman Laura M , Ambrosio Renato , Harrison Devin A , Wilson Steven E
Published: April 2021

ABSTRACT

PURPOSE: To determine if videokeratography-based pupil measurements are an accurate method of estimating pupil size under mesopic conditions.

METHODS: Sixty patients who had a preoperative work-up for refractive surgery participated in the study. A single observer obtained detailed pupil measurements with the Colvard pupillometer under standardized lighting conditions. The same observer recorded pupil size measurements obtained automatically when corneal topographic analysis was performed with Humphrey videokeratography.

RESULTS: The Colvard pupillometry low light group was statistically different (P<.0001) from the Humphrey videokeratography automatic pupil measurement group. We calculated the value at which the Humphrey pupil measurements can accurately predict which patients would have pupil diameters ≥6.5 mm under low mesopic conditions. By adding a constant of 2.6 mm to the Humphrey videokeratography pupil measurement, 100% of patients with a pupil diameter 5=6.5 mm under low mesopic conditions were detected (sensitivity 100%). However, the ability to correctly reject those patients who do not have pupil diameters >6.5 mm under low mesopic conditions was lower at 55% (specificity).

CONCLUSION: Videokeratography units can be used as a rapid, simple, and accurate method of predicting pupil size under mesopic conditions for potential refractive surgery patients and can provide a permanent record of pupil size. Care should be taken when relying on topography pupil sizes and more accurate measurements of mesopic and scotopic pupil sizes should be obtained. [J Refract Surg 2003;19:555-5591
Ocular Surface Management of Photorefractive Keratectomy and Laser in situ Keratomileusis
Authors: Albietz Julie M , McLennan Suzanne G , Lenton Lee M
Published: April 2021

ABSTRACT

PURPOSE: To examine the effects of keratorefractive surgery and ocular surface management on goblet cell density, dry eye symptom incidence, and spherical equivalent refraction.

METHODS: We performed a retrospective analysis of four myopia groups: Untreated controls (n = 53); PRK (n = 51); LASIK without ocular surface management (n = 56); LASIK with ocular surface management (n = 140). Ocular surface management involved the routine use of non-preserved artificial tears and other lubricants before, during, and after surgery. Lid hygiene procedures, topical antiinflammatory agents, and punctal plugs were used on indication. Assessments were conducted before and up to 12 months after surgery (right eyes only in patients with both eyes operated, and in the left or right eye in patients with one eye operated).

RESULTS: Surgery caused a significant reduction in goblet cell density, with the greatest reduction in the LASIK without ocular surface management group. No significant differences were detected in dry eye symptoms or spherical equivalent refraction between PRK and LASIK without ocular surface management. Ocular surface management significantly minimized LASIK-induced decreases in goblet cell density and was associated with significantly less myopic outcomes at months 1 to 3 and 6 to 9 after LASIK. After surgery (1 to 3 mo), dry eye symptoms were significantly lower in the LASIK with ocular surface management group. In all groups, significant inverse correlations existed between goblet cell density and dry eye symptoms.

CONCLUSIONS: Ocular surface management minimized the negative impact of LASIK on goblet cell density and reduced dry eye symptoms. Without ocular surface management, goblet cell density and dry eye symptoms after LASIK were similar to or worse than after PRK. [J Refract Surg 2003;19:636-644]
Relationship Between Cycloplegic and Wavefront-derived Refraction
Authors: de Castro Luis E Fernández , Sandoval Helga P , Al Sarraf Oday , Vroman David T , Solomon Kerry D
Published: April 2021

ABSTRACT

PURPOSE: To compare cycloplegic refractions to preoperative wavefront-derived refractions from three Hartmann-Shack-based wavefront devices.

METHODS: Ninety-nine eyes of 55 subjects were evaluated preoperatively using the LADARWave, WaveScan, and Zywave aberrometers. With cycloplegic refraction as the standard, the spherical equivalent refraction, sphere, and cylinder were compared to the wavefront-derived refractions using the three wavefront devices.

RESULTS: The LADARWave unit showed the highest correlation between wavefront-derived sphere and mean spherical equivalent refraction values relative to cycloplegic refraction, followed by Zywave and WaveScan. The WaveScan unit exhibited higher variability than the LADARWave or Zywave. Although Alcon Laboratories (LADARWave) and Bausch & Lomb Surgical (Zywave) recommend dilation, VISX specifically recommends against dilation in their WaveScan unit. All devices showed high cylinder error vectors when the cycloplegic cylinder was greater than 1.00 D.

CONCLUSION: Although wavefront-derived refractions appeared to correlate well to cycloplegic refractions, further research is required to reduce variability and improve the calculation of cylinder terms. [J Refract Surg 2003;19:S677-S681]
Neodymium:YAG Laser Posterior Capsulotomy: The First 100 Cases at UCLA
Authors: Gardner Kathryn M , Straatsma Bradley R , Pettit Thomas H
Published: April 2021

ABSTRACT

Initial anatomic success was reported in 97 of the first 100 neodymium:YAG laser posterior capsulotomies performed at the Jules Stein Eye Institute. Visual acuity improved in 90 patients, was unchanged in five, and decreased in five. In the five patients with decreased visual acuity after posterior capsulotomy, the decrease was unrelated to capsulotomy and caused by progression of preexisting retinal disease. Our experience suggests that attention to patient evaluation and surgical technique can help minimize complications and assure best results.
Transscleral Cyclocoagulation Using a Neodymium:YAG Laser
Authors: Wilensky Jacob T , Welch David , Mirolovich Milan
Published: April 2021

ABSTRACT

A series of pigmented rabbit eyes were treated with pulsed 10 msec (free running mode) neodymium:YAG laser burns to achieve transscleral cyclocoagulation. Grossly evident burns were created in the ciliary body with laser pulses of 1.5 joules of energy. Sustained reduction in intraocular pressure was obtained when 30 such laser burns were made in an eye.
Pupillary Block Associated With Posterior Chamber Lenses
Authors: Willis Dan A , Stewart Robert H , Kimbrough Richard L
Published: April 2021

ABSTRACT

Two patients developed pupillary block glaucoma after extracapsular cataract extraction with implantation of a posterior chamber lens but without peripheral iridectomies. The intraocular pressure of each eye was successfully controlled with laser iridotomy No long-term medication was necessary to control their intraocular pressures.
Surgically Induced Corneal Astigmatism and its Spontaneous Regression
Authors: Gorn Robert A
Published: April 2021

ABSTRACT

Serial keratometry readings were obtained pre- and postoperative cataract extraction utilizing all silk closure. The induction of with-the-rule cylinder and its spontaneous regression was plotted over 24 weeks. The data are compared to others utilizing all nylon closure.
Design of New Contact Lens for YAG Laser Filtering Procedures
Authors: March Wayne F , Gherezghiher Tseggai , Koss Michael C , Nordquist Robert E
Published: April 2021

ABSTRACT

A contact goniolens has been developed specifically for YAG laser filtering procedures both for use in unblocking failed surgical filtering procedures and for performing two-stage or one-stage YAG filtering procedures. The design concentrates the YAG energy and maintains a constant small angle with the cornea.
Spontaneous Posterior Bulbar Perforation of Congenital Scieral Coloboma and its Surgical Treatment: A Case Report
Authors: Mori Shigeru , Komatsu Hitoshi , Watari Hironi
Published: April 2021

ABSTRACT

A 35-year-old male presented with abrupt hypotonic oculopathy caused by a spontaneous bulbar perforation, due to a scleral defect in the equatorial area of the nasal side of the left eye. The scleral defect was surgically repaired using lyophilized homologous dura mater encephali and fibrin glue (Tisseel™).* Highly satisfactory results were obtained.

The pathogenesis of this scleral defect was suspected to involve complex factors related to abnormal retinal development and abnormal ocular muscles. Such a case has not been reported previously.
Trabeculectomy With Implantation of the Mendez Glaucoma Seton: Early Results
Authors: Stewart Robert H , Kimbrough Richard L , Okereke Phyllis C
Published: April 2021

ABSTRACT

We present the early results in a small series of 12 eyes of 12 patients with uncontrolled glaucoma who underwent trabeculectomy with implantation of a Mendez Glaucoma Seton. All eyes, except one with neovascular glaucoma, had had multiple glaucoma surgery and all, without exception, were on maximal tolerated medical therapy prior to surgery.

The follow-up period ranged from one and one fourth to three and three fourths months. The surgical technique was the same in all cases.

Our success rate was 33.3% or 40%, if one eye with persistent hypotonia could be counted as a success. This result is inferior to those quoted in the literature with the use of other types of setons, and especially to the results of Dr. Antonio Mendez who used a similar Implant.
An Upper Eyelid Cyst from Migration of a Hard Corneal Contact Lens
Authors: Benger Ross S , Frueh Batley R
Published: April 2021

ABSTRACT

A migrated polymethylmethacrylate contact lens in the upper eyelid presented as a mass of unknown etiology. The lens had been unknowingly retained in the eyelid for seven years, after it had migrated through the conjunctiva of the superior fornix, and then moved in front of the levator aponeurosis and upper tarsal plate, where it lay encysted by conjunctiva. We believe that having sequestered conjunctival epithelium around the lens explains the minimal nature of the inflammatory and secretory responses necessary to allow such a protracted period of retention.
Proptosis With Mastication: An Unusual Presentation of an Orbital Dermoid Cyst
Authors: Whitney Clayton E , Leone Charles R , Kincaid Marilyn C
Published: April 2021

ABSTRACT

A 25-year-old woman presented in 1973 with the complaint of proptosis of the left eye with mastication. A firm retrobulbar orbital mass was detected, and diagnosis of possible dermoid cyst was made. She was subsequently lost to follow-up. Computed tomographic (CT) scanning and surgical excision done in 1984 confirmed the presence of an orbital dermoid cyst communicating with the temporal fossa through a bony defect in the lateral orbital wall. We suspect that pressure by the temporalis muscle on the dumbbellshaped cyst caused the proptosis with mastication.
Evaluating the Applications of the Spatially Adaptive Program (SAPRO) in Clinical Perimetry: Part I
Authors: Fankhauser F , Funkhouser A , Kwasniewska S
Published: April 2021

ABSTRACT

Some clinical application possibilities of a spatially adaptive program (SAPRO) are presented and analyzed. Due to the ability of the program to adapt operationally to the visual field situation that is encountered, useful clinical findings can be obtained, even in patients with complicated visual field disturbances. The spatially adaptive detection mechanism, as well as a simplified bracketing strategy, make it possible to keep the cost/benefit ratio down. Short- and long-term fluctuations, especially when these are large, may compromise the validity of the examination results or place them in doubt. Their effects can be diminished using data reduction methods (averaging). In cases where averaging cannot be applied, one can nevertheless achieve useful results by the appropriate selection of the perimetric visual fields (or portions thereof) that are measured.
A Case of Epithelial Ingrowth Primarily Involving the Lens Capsule
Authors: Bruner William E , Green W Richard , Stark Walter J
Published: April 2021

ABSTRACT

We describe an unusual case of epithelial ingrowth primarily involving the lens capsule. Four years following removal of the lens and epithelial tissue the eye was quiet with 20/20 acuity. Histopathology showed intraocular epithelium attached to the anterior surface of the lens capsule.
Tattooing of Eyelids: Magnetic Resonance Imaging Artifacts
Authors: Lund Gunnar , Wirtschafter Jonathan D , Nelson J Daniel , Williams Patricia A
Published: April 2021

ABSTRACT

We describe artifacts (linear densities and distortion of the shape of the globe) on Magnetic Resonance Imaging (MRI) of the brain and orbits that result from the tattooing of human eyelids with iron oxide particles.

Similar artifacts are frequently seen with certain types of external eye cosmetics and dental fillings or braces that contain ferromagnetic materials.

The artifacts are most likely due to the distortion of the local magnetic field by the iron oxide.

The artifact was reproduced when a tattooed pig's ear was scanned. Plain x-ray films did not detect the iron oxide.

These small artifacts should be recognized and not confused with abnormalities due to foreign bodies of surgical material.
Long-Term Results of Keratoplasty in Eyes With Intraocular Lenses
Authors: Alpar John J
Published: April 2021

ABSTRACT

We present a retrospective study of our patients who had penetrating keratoplasty in eyes which had intraocular lenses in situ. Our results show that although the short-term result was good with any kind of intraocular lenses, the long-term (more than five years) graft survival was better if intraocular lenses with preiridial optics were removed and/or replaced at the time of the grafting with posterior chamber lenses.
Effect of Therapeutic Ultrasound on Intraocular Lenses
Authors: McDonnell Peter J , Quigley Harry A , Green W Richard
Published: April 2021

ABSTRACT

High intensity, focused ultrasound energy is currently being evaluated as a therapy for glaucoma. The energy is delivered through conjunctiva and sclera to the pars plica ta. The haptics of intraocular lenses may erode into the pars plicata, and we were therefore prompted to study the effects of ultrasound energy on intraocular lenses. The energy is highly absorbed by polymethylmethacrylate (PMMA), resulting in partial melting, vacuolization, and opacification of this material at intensities much lower than those used in the glaucoma treatment. Polypropylene absorbed much less of the energy, resulting in relatively minor morphologic changes with this material. We recommend caution in using this device in eyes with anterior chamber intraocular lenses and eyes with posterior chamber intraocular lenses having PMMA haptics.
Endophthalmitis After Strabismus Surgery With a Good Visual Result
Authors: Uniat Linda M , Olk R Joseph , Kenneally Cynthia Z , Windsor Charles E
Published: April 2021

ABSTRACT

A 78-year-old woman underwent recession-resection surgery for longstanding exotropia. A scleral perforation occurred at the time of surgery and was treated with transscleral retinocryopexy. Three days after surgery the patient experienced light perception vision, pain, and hypopyon. She underwent a trans pars plana vitrectomy with intravitreal and periocular antibiotics. Three months after vitrectomy, visual acuity returned to the preoperative level of 20/50. Six months after vitrectomy she underwent an uneventful cataract extraction with posterior chamber lens implant. Visual acuity 5 months after cataract surgery was 20/20.
The Use of Video to Monitor Continuous Gold Laser Photoradiation Treatment of an Ocular Melanoma
Authors: Khaw P T , Keightley S J , Absolon M J
Published: April 2021

ABSTRACT

A video system to monitor continuous Gold laser photoradiation treatment of an ocular melanoma is described. We believe this technique considerably improves the safety and accuracy of continuous laser treatment.
Technique for Slit Lamp Comparison of Anterior Chamber Depth
Authors: Cohen John S , Tilton Tom
Published: April 2021

ABSTRACT

A quick, clinically useful, and easily performed technique is described that permits comparison of anterior chamber depths of both eyes in the same patient.
A New Sling Material for Ptosis Patients
Authors: Sternberg Ido , Seelenfreund Morton H , Sternberg Natan
Published: April 2021

ABSTRACT

Patients with poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle, innervated by the seventh nerve, to mechanically raise the droopy eyelid. The most common materials used for the sling are autogenous or preserved fascia lata and synthetic products such as nylon or dacron sutures. We introduce a new material for the sling procedure - preserved placental umbilical vein modified for the use as a sling. Two cases are presented in which this material was used with excellent results.
Transpupillary Argon Laser Cyclophotocoagulation in the Treatment of Glaucoma
Authors: Shields Steven , Stewart William C , Shields M Bruce
Published: April 2021

ABSTRACT

Twenty-seven patients with glaucoma, which could not be controlled with maximum tolerable medication and standard laser techniques, underwent transpupillary argon laser cyclophotocoagulation. Only six patients (22.3%) had a successful outcome, and the postoperative course in many cases was complicated by an additional, sustained increase in intraocular pressure. Notwithstanding these results, the procedure may be useful occasionally to preclude the need for conventional glaucoma surgery.
A Surgical Technique for the Successful and Stable Reconstruction of the Totally Contracted Ocular Socket
Authors: Putterman Allen M , Karesh James W
Published: April 2021

ABSTRACT

We describe the successful and stable reconstruction of 47 severely contracted sockets over a 10- year period. The surgical technique employed in all these cases used a large custom-designed, C-shaped conformer wrapped with a full-thickness oral mucous membrane graft. After all cicatriciel tissue within the socket was excised, the wrapped conformer was sutured at its midperiphery to the inferior and superior orbital rims. In contrast to other procedures using flatter conformers, which direct their force in a vertical dimension, this uniquely designed conformer directs its force both vertically and deeply posteriorly within the socket. A somewhat modified but similar conformer also can be used for sockets compromised by total symblepharon formation. Excluding six patients with inadequate follow-up, we were able to successfully reform spacious and stable fomices in 40 of 41 severely contracted sockets. The average postoperative followup after reconstruction in these cases was 23.9 months. This technique represents an effective approach to successfully reconstruct and maintain stable ocular culde-sacs in cases of severe socket contracture or total symblepharon formation.