bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Photorefractive Keratectomy for Hyperopia Using the VISX Star Excimer Laser System
Authors: Stevens Julian D , Ficker Linda A
Published: April 2021

ARSTRACT

PURPOSE: To evaluate safety, efficacy, and predictability of photorefractive keratectomy (PRK) for hyperopic astigmatism of +1.75 to +5.00 D manifest refractive sphere and up to -2.50 D manifest refractive astigmatism using the VISX Star excimer laser system, version 2.5 software.

METHODS: Treatment was performed on 32 eyes of 21 patients. Eighteen of 21 patients were 45 years of age or older. Manifest and cycloplegic refraction together with Pelli-Robson contrast sensitivity assessment was performed prior to surgery and I1 3, 6, 12, and 24 months after treatment.

RESULTS: Twenty-seven of 32 surgical procedures were reviewed 1 year after treatment (84%). Corneal epithelial healing was complete between day 4 and 10. Twelve months after treatment, 25 of 27 eyes (93%) achieved 20/40 or better uncorrected visual acuity and 19 eyes (70%) achieved 20/20. No patient lost two or more lines of Snellen visual acuity assessed 6 months and later after treatment. The mean spherical equivalent refraction was reduced from +2.90 at baseline to +0.10 D at 1 year and +0.40 D at 2 years; 65% of eyes had a refraction within ±0.50 D. Four patients had further treatment by laser in situ keratomileusis for undercorrection in three eyes and overcorrection in one eye. PelliRobson contrast acuity was significantly reduced 12 months after treatment from a mean 1.72 before to 1.66 after PRK (P=.02, t-test).

CONCLUSIONS: PRK for hyperopia using the VISX Star excimer laser system was effective in the treatment of hyperopic astigmatism. Although no patient lost two or more lines of high contrast best spectacle-corrected Snellen visual acuity 1 year after treatment, there was a significant decrease in Pelli-Robson contrast acuity. [J Refract Surg 2002;18:30-36]
Risk Factors for Insufficient Fixation of Microkeratome During Laser in situ Keratomileusis
Authors: Asano-Kato Naoko , Toda Ikuko , Hori-Komai Yoshiko , Takano Yoji , Tsubota Kazuo
Published: April 2021

ABSTRACT

PURPOSE: To investigate the potential risk factors leading to insufficient fixation of a microkeratome during laser in situ keratomileusis (LASIK), especially in Asian eyes.

METHODS: We performed a retrospective analysis of 1809 eyes of 972 patients that underwent LASlK. Profiles of patients (age, sex, past medical history, width of palpebral fissure, corneal power, and postoperative clinical course) whose operations were discontinued due to insufficient fixation were compared to all LASIK patients.

RESULTS: Insufficient fixation was observed in 18 eyes of 16 patients. Those patients were significantly younger (26.1 ± 5.5 yr) compared to all patients (32.3 ± 8.6 yr). Mean keratometric power was 42.40 ± 1.37 D in patients with insufficient fixation and 43.60 ± 1.40 D in all patients (P<.001). Maximum width of palpebral fissure with eyes wide open was 0.96 ± 0.20 mm in patients with insufficient fixation, and 1.10 ± 0.19 mm in all patients (P=.0015). These patients subsequently underwent LASlK utilizing combinations of cooling, frequent corticosteroid instillation for several hours, and lateral canthotomy.

CONCLUSION: Narrow palpebral fissures commonly found in Asian populations might be a risk factor for insufficient fixation of a microkeratome in LASIK, especially in young patients with flat corneas. [J Refract Surg 2002;18:47-50]
Diurnal Variation of Human Corneal Curvature in Young Adults
Authors: Handa Tomoya , Mukuno Kazuo , Niida Takahiro , Uozato Hiroshi , Tanaka Shunichi , Shimizu Kimiya
Published: April 2021

ABSTRACT

PURPOSE: To elucidate the diurnal variation of human corneal curvature with regard to gender and menstrual cycle.

METHODS: Changes in corneal curvature and intraocular pressure (IOP) were measured over 24 hours in 14 young adults using corneal topography and a non-contact tonometer. In study 1, seven males and seven females (after menses) were measured. In study 2, four females out of the seven volunteers who participated in study 1 were measured again during menses.

RESULTS: The females after menses showed a remarkable diurnal variation throughout 24 hours. A significant difference between the light-wake periods and dark-sleep periods of 0.83 ± 0.15 D was found (P<.01). Corneal curvature was significantly flatter during menses than after menses in the light-wake period (P<05). In the males, no significant diurnal change (0.21 ± 0.12 D) was measured in corneal curvature.

CONCLUSIONS: Diurnal variation of corneal curvature was significant, approximately 0.83 D in young females after menses, and corneal curvature became flatter during menses in young females. Diurnal variation of corneal curvature is an important parameter for planning refractive surgery and contact lens wear. [J Refract Surg 2002;18:58-62]
Evaluation of Tear Film Following Intacs for Myopia
Authors: Kessler Daniel , El-Shiaty Ayman F , Wachler Brian S Boxer
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the effect of intrastromal corneal ring segments (lntacs, Keravision) placement on the tear film quality as a measure of dry eye status.

METHODS: Seventeen eyes of ten patients underwent lntacs placement for the correction of myopia with spherical equivalent refractions ranging from -1.75 to -3.25 D (mean, -2.43 ± 0.56 D). Dry eye grade values were measured preoperatively and at 1 day, 1 week, and 1 month postoperatively using the Ko wa -DR-I interferometer.

RESULTS: Preoperatively, the 17 eyes had a mean dry eye grade of 2.18 ? 0.39 (range, 2 to 3). One day postoperatively, the 14 eyes measured had a mean dry eye grade of 2.64 ± 0.63 (range, 2 to 4; P = .03). At 1 week the 17 eyes had a mean dry eye grade of 2.41 ± 0.71 (range, 2 to 4; P = .25) and at 1 month, 2.18 ± 0.39 (range, 2 to 3; P = .75).

CONCLUSIONS: There was transient dry eye following lntacs placement, but the tear film quality was restored within 1 week of surgery. [J Refract Surg 2002;18:127-129]
Effect of Topical Diclofenac and Ketorolac on Patient Discomfort and Corneal Sensitivity
Authors: Narváez Julio , Kroll Peter , Guzek James P
Published: April 2021

ABSTRACT

PURPOSE: To determine if at clinical dosages, the topical nonsteroidal anti-inflammatory drugs diclofenac and ketorolac decrease corneal sensitivity, and if there is a difference in discomfort on instillation.

METHODS: In a double-masked study, 30 patients were randomized to receive two of three topical drops, Endosol, diclofenac sodium, and ketorolac tromethamine. A microaesthesiometer was used to evaluate corneal sensation. Baseline corneal sensitivity was obtained on each patient. Corneal sensory thresholds were remeasured at 7 and 15 minutes following eyedrop application. Patients also completed a questionnaire that graded the burning caused by the medications.

RESULTS: No significant decrease in corneal sensory thresholds was found with diclofenac or ketorolac compared with control at baseline (P = .50), 7 minutes (P = .41), or 15 minutes (P = .82). There was significantly more burning with diclofenac and ketorolac compared to control. There was a small but not statistically significant (P = .28) trend of more burning with ketorolac than diclofenac.

CONCLUSION: Neither diclofenac nor ketorolac were found to decrease corneal sensation compared to controL There was no significant difference in burning upon instillation reported by patients. [J Refract Surg 2002;18:145-148]
U.S. Trends in Refractive Surgery: 2001 International Society of Refractive Surgery Survey
Authors: Duffey Richard J , Leaming David
Published: April 2021

ABSTRACT

PURPOSE: To determine the trends in refractive surgery in the United States in 2001.

METHODS: The 980 U.S. members of the International Society of Refractive Surgery were mailed the 2001 refractive surgery survey dealing with volumes, types, and preferences of refractive surgery performed. Questions regarding radial keratotomy, astigmatic keratotomy, photorefractive keratectomy, laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis, intracorneal rings (lntacs), laser thermal keratoplasty, conductive keratoplasty, clear lens extraction, phakic intraocular lenses, and scleral expansion procedures for presbyopia were examined in the survey. Procedure preferences for low, moderate, and high myopia and hyperopia were compared with the results from the surveys of the previous 4 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of comanagement of refractive surgery patients were compared with 2000 data.

RESULTS and CONCLUSION: LASIK remains the dominant refractive surgery for refractive errors from -12.00 to +3.00 D; the VISX excimer laser and the Hansatome microkeratome are the most frequently used instruments for LASIK [J Refract Surg 2002;18:185-188]
Traumatic Dislocation of an Ophtec Artisan Phakic Intraocular Lens
Authors: Yoon Hawke , Macaluso Damien C , Moshirfar Majid , Lundergan Maureen
Published: April 2021

ABSTRACT

PURPOSE: Tb report a case of a traumatic dislocation of an Ophtec Artisan phakic anterior chamber intraocular lens.

METHODS: Retrospective case review.

RESULTS: A 38-year-old female underwent successful implantation of an Ophtec Artisan lens in her left eye as part of the phase ?? U.S. clinical trials. Approximately 5 months postoperatively, the patient was struck with a roll of packing tape in her left eye and noted immediate decreased vision. Following the blunt trauma, the patient had an uncorrected visual acuity (UCVA) of 20/60 and a best spectacle-corrected visual acuity (BSCVA) of 20/20. The wound was intact, however, the superior claw was no longer enclaved to the iris and the lens had dislocated nasally with the optic of the lens resting in the angle. The patient was taken back to the operating room, the lens was repositioned, and the superior claw was re-enclaved to the iris. One week after repositioning, UCVA was 20/30 and BSCVA was 20/20.

CONCLUSION: Despite adequate positioning, significant trauma may result in the iris claw tearing free from the iris with dislocation of the Artisan lens. The lens may be repositioned with good visual outcome, however, the long-term effects on endothelial cell density in this patient remain to be seen. [J Refract Surg 2002;18:481-483]
Corneal Sensitivity 10 Years After Epikeratoplasty
Authors: Kaminski Stephan L , Biowski Robert , Lukas Julius R , Koyuncu Didem , Grabner Günther
Published: April 2021

ABSTRACT

PURPOSE: To assess corneal sensitivity in patients 10 or more years after epikeratoplasty for myopia, aphakia, hyperopia, and keratoconus.

METHODS: A total of 45 eyes of 33 patients (age range at examination 33 to 55 yr) were included in the study. Corneal sensitivity thresholds using an electromagnetic aesthesiometer (Draeger) were measured at various locations on the lenticule and the recipient cornea. Measurements were evaluated regarding the corrective purpose, surgical technique, age, and gender of the patients and the area of measurements.

RESULTS: The mean corneal sensitivity threshold in the center of the epikeratoplasty lenticule was significantly lower than on the peripheral recipient cornea (320.0 ± 365.1 ? IO"6 N versus 0.1 ± 0.5 ? 10"5 N). Corneal sensitivity at the 3 and 9 o'clock positions was significantly higher compared to the values at the 6 and 12 o'clock positions on the lenticule. No correlations of these values with age, gender, type, and primary indications for the surgery were observed.

CONCLUSIONS: These results indicate a relative hypesthesia of the epikeratoplasty lenticule as compared to the peripheral host cornea, even 10 years after surgery. In our patients no clinically significant changes were observed that could be attributed to the reduced sensitivity over this follow-up period. [J Refract Surg 2002;18:731-736]
Phototherapeutic Keratectomy With Mitomycin C for Corneal Haze Following Photorefractive Keratectomy for Myopia
Authors: Porges Yair , Ben-Haim Oded , Hirsh Ami , Levinger Samuel
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the safety and efficacy of phototherapeutic keratectomy (PTK) with single application of mitomycin C for patients with severe corneal haze following photorefractive keratectomy (PRK) for high myopia.

METHODS: Eight eyes of seven patients were treated with PTK and intraoperative topical application of mitomycin C (0.02%) for severe corneal haze (grade 3) following PRK for myopia.

RESULTS: AU patients' visual performance improved significantly. Mean preoperative visual acuity (20/200 for both UCVA and BSCVA) improved significantly to 20/33 (0.6) and 20/30 (0.7) for UCVA and BSCVA, respectively. Six eyes (85.7%) had improved UCVA to 20/40 or better and gained five or more lines of UCVA. The corneal haze score decreased from grade 3 initially (for all eyes prior to PTK and mitomycin C) to a final mean haze score of 0.3 (range 0 to 0.5). Mean final spherical equivalent refraction achieved was -1.30 ± 1.60 D (range -3.75 to +1.25 D). One eye gained only three lines of visual acuity due to regression and residual haze. No adverse effects related to the use of mitomycin C were recorded.

CONCLUSION: PTK with a single intraoperative application of mitomycin C was safe and effective in reducing corneal haze and improving visual acuity in patients with severe corneal haze following PRK. [J Refract Surg 2003;19:40-43]
Endothelial Cell Studies in Patients After Photorefractive Keratectomy for Hyperopia
Authors: Jabbur Nada S
Published: April 2021

ABSTRACT

PURPOSE: To report central and peripheral corneal endothelial cell studies performed as part of the VISX hyperopic photorefractive keratectomy (PRK) clinical trial.

METHODS: During this prospective, multicenter clinical trial, which was part of an FDA investigation, endothelial cell specular microscopy was done at five centers. Non-contact central and peripheral cell density, percent hexagonality, and coefficient of variability of cell size were obtained using the Konan Noncon Robo SP-8000FA with BAMBI analysis software. Data were gathered at baseline and at 1, 6, and 12 months after hyperopic PRK.

RESULTS: Analysis of results of 171 eyes demonstrated no statistically significant detrimental changes in the corneal endothelium at any postoperative time point. The statistically significant changes noted were interpreted as an improvement in cell morphology and were attributed to the cessation of contact lens wear following treatment.

CONCLUSION: Hyperopic PRK with the VISX STAR S2 Excimer Laser System produced no statistically significant adverse effect on the corneal endothelium. [J Refract Surg 2003;19:142-148]
Changes in Central Corneal Thickness After Laser in situ Keratomileusis and Photorefractive Keratectomy
Authors: Kozak Igor , Hornak Marek , Juhas Tomas , Shah Arvind , Rawlings E Franklin
Published: April 2021

ABSTRACT

PURPOSE: To evaluate changes in corneal thickness after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in eyes with the same preoperative refraction, correlate these changes to postoperative refractive outcomes, and compare corneal healing process in a standardized subset of patients.

METHODS: Central corneal thickness was measured by contact ultrasound pachymetry in 14 eyes of 8 patients with preoperative myopia of -6.00 D who had LASIK, and in 14 eyes of 8 patients with the same preoperative refractive error who had PRK. Measurements were taken preoperatively, and 1 week, 3, and 6 months after surgery. Data were evaluated and compared using the paired Student i-test and Pearson correlation coefficient.

RESULTS: Mean preoperative central corneal thickness in the LASIK group was 549.14 ± 37.4 µ?\, and in the PRK group, 552.64 ± 34.9 µp?. At 1-week postoperatively, mean central corneal thickness in the LASIK eyes was 467.28 ± 29 /tra and in the PRK eyes, 473.85 ± 39.2 µ??; at 6 months, central corneal thickness had increased in both groups compared to the 1-week values; LASIK eyes had a mean central corneal thickness of 481.42 ± 23.0 µ?a and PRK, 481.50 ± 35.3 µta. Mean postoperative refraction after 6 months was -0.48 ± 0.30 D in the LASIK group and -0.67 ± 0.35 D in the PRK group.

CONCLUSION: Increase in central corneal thickness between 1 week and 6 months postoperatively occurred in both LASLK and PRK eyes, but differences were not statistically significant. No statistically significant differences were found in myopic regression between the two patient groups. [J Refract Surg 2003;19:149-153]
Wavefront-guided Multipoint (Segmental) Custom Ablation Enhancement Using the Nidek NAVEX Platform
Authors: Gimbel Howard V , Sofinski Sandra J , Mahler Oron S , van Westenbrugge John A , Ferensowicz Maria I , Triebwasser Rick W
Published: April 2021

ABSTRACT

PURPOSE: To present our clinical experience regarding enhancement (retreatment) of previously performed non-wavefront-guided refractive surgery by wavefront-guided multipoint (segmental) custom ablation utilizing the Nidek NAVEX platform.

METHODS: Retrospective clinical analysis was conducted of 20 eyes (19 patients) with mixed myopic or hyperopic astigmatism who had undergone primary laser in situ keratomileusis (LASEK) or photorefractive keratectomy (PRK) and reported postoperative reductions in quality of vision. These vision disturbances correlated with clinically significant elevations in the root mean square of higher order aberrations (RMS of HOA) values. Before wavefront-guided multipoint (segmental) custom ablation enhancement with the NAVEX platform, all patients underwent testing with the Nidek Optical Path Difference Scan (OPD-Scan) and analysis with Final Fit Software.

RESULTS: Twenty eyes showed improvement or resolution of visual symptoms following wavefrontguided multipoint (segmental) custom ablation enhancement. The postoperative root mean square of higher order aberration values were variable and not always related to improvement in visual function. No patient lost two or more lines of best spectacle-corrected visual acuity.

CONCLUSION: Topography and wavefrontguided multipoint (segmental) custom ablation enhancements were safe and effective in improving visual symptoms following primary refractive surgery. In some eyes, improved visual function without correspondingly lower RMS of HOA values may be an effect of neutralizing some chromatic aberrations across the visible light spectrum, thereby improving the modulation transfer function. [J Refract Surg 2003;19(suppl):S209-S216]
Refractive Outcome of Nidek OPD-Scan Customized Ablations
Authors: Nakano Kozo , Portellinha Waldir , Oliveira Marivaldo , Alvarenga Lenio , Nakano Celso , Nakano Eliane
Published: April 2021

ABSTRACT

PURPOSE: Custom ablation is an improved refractive laser treatment that aims to optimize the optical system of the eye. We report preliminary results of laser in situ keratomileusis (LASIK) using customized ablation and the Nidek OPD-Scan.

METHODS: We report a prospective, noncomparative interventional case series. After OPDScan analysis, patients underwent LASEK. Eightyfour eyes were included: 44 eyes were treated with Flex Scan, 22 eyes with customized ablation based on Nidek OPD-Scan analysis, and 18 eyes were treated with conventional (scanning slit) ablation.

RESULTS: Visual outcome did not differ among groups. No patient experienced a significant decrease (more than 1 Snellen line) in best spectacle-corrected visual acuity.

CONCLUSIONS: LASLK with the Nidek OPDScan system was safe and effective in this small group of patients. [J Refract Surg 2003; 19( suppl): S221-S222]
Laser in situ Keratomileusis for Astigmatism Greater than -3.50 D With the Nidek EC-5000 Excimer Laser
Authors: Handzel Alice , Kenikstul Ninel , Handzel Tim
Published: April 2021

ABSTRACT

PURPOSE: LASIK with the Nidek EC-5000 excimer laser was used to treat high astigmatism.

METHODS: The Nidek EC-5000 excimer laser and ACS microkeratome were used in regular LASIK procedures. Results of 74 eyes with astigmatism of more than 3.50 D and up to 10.00 D were evaluated.

RESULTS: With Nidek algorithms, it was possible to eliminate refractive error completely or reduce it to a satisfactory amount, especially in difficult cases of mixed astigmatism with high astigmatic components.

CONCLUSION: The Nidek software for mixed and high astigmatism was efficient, predictable, and produced good results in difficult cases of high astigmatism. [J Refract Surg 2003;19(suppl): S241-S242]
Comparison of Videokeratographic Functional Optical Zones in Conductive Keratoplasty and Laser in situ Keratomileusis for Hyperopia
Authors: Rojas Maria C , Manche Edward E
Published: April 2021

ABSTRACT

PURPOSE: To compare the videokeratographic functional optical zone of eyes treated with conductive keratoplasty to eyes treated with laser in situ keratomileusis (LASIK) for hyperopia.

METHODS: Sixteen eyes treated with conductive keratoplasty for hyperopia were retrospectively evaluated to determine the size of the videokeratographic functional optical zone. The functional optical zone of these eyes was compared to the functional optical zone of 16 eyes that underwent LASIK for hyperopia with the VISX S2 excimer laser, for comparable amounts of hyperopia. The functional optical zone was measured at the edge of central corneal steepening and paracentral flattening on videokeratography 3 to 6 months after surgery.

RESULTS: The functional optical zone after surgery measured an average of 5.6 mm horizontally and 5.6 mm vertically in the conductive keratoplasty eyes, and 4.7 mm horizontally and 5.1 mm vertically in the hyperopic LASIK eyes (P<.001 and P<.005). The mean functional optical zone area was 31.1 mm
p 2
in the conductive keratoplasty eyes and 24.6 mm
p 2
in the hyperopic LASEK eyes (P<.001). The functional optical zone created by conductive keratoplasty had more uniform central steepening and less peripheral blending than the functional optical zone created by hyperopic LASIK.

CONCLUSION: Conductive keratoplasty was effective at creating central steepening in the cornea. The functional optical zone resulting from conductive keratoplasty was significantly larger than that obtained with hyperopic LASIK using the VISX S2 excimer laser. [J Refract Surg 2003;19: 333-337]
Reliability of Corneal Thickness and Endothelial Cell Density Measures
Authors: Nichols Jason J , Kosunick Gregory M , Bullimore Mark A
Published: April 2021

ABSTRACT

PURPOSE: We evaluated the reliability and agreement between the Orbscan, an ultrasonic pachymeter (Humphrey 855), and the Konan SP 9000-LC in terms of central corneal thickness. The Konan was also used to study the reliability and agreement between endothelial cell density measures.

METHODS: Twenty-five normal subjects were examined on two occasions (mean separation = 9 ± 5 days) by a single examiner using all three instruments for central corneal pachymetry. The Konan Center Method and a manual counting method were performed by two examiners to determine endothelial cell density. Reliability and agreement were assessed by calculating the 95% limits of agreement (LoA) and intraclass correlation coefficients (ICC).

RESULTS: For corneal pachymetry test-retest reliability, the 95% limits of agreement were -20 to +17 µm for the ultrasound, -27 to +22 µm for the Konan, and -13 to +13 µm for the Orbscan. There was fair-to-good agreement between the pachymeters (intraclass correlation coefficients range = 0.85 to 0.92). For endothelial cell density test-retest reliability, the 95% limits of agreement for the Konan Center Method was -498 to +530, and -482 to +333 cells/mm
p 2
for examiners 1 and 2, respectively. The test-retest 95% limits of agreement for the manual overlaid grid method was -355 to +355, and -535 to +670 cells/mm
p 2
for examiners 1 and 2, respectively.

CONCLUSIONS: The reliability and agreement of the Orbscan and Konan corneal pachymeters was good, although the reliability of the Konan for estimating endothelial cell density was fair, at best. [J Refract Surg 2003;19:344-352]
Intraoperative Optical Coherence Pachymetry During Laser in situ Keratomileusis-First Clinical Experience
Authors: Wirbelauer Christopher , Pham Duy Thoai
Published: April 2021

ABSTRACT

PURPOSE: To investigate intraoperative optical coherence pachymetry during laser in situ keratomileusis (LASIK).

METHODS: In an initial clinical evaluation, three patients with myopia and myopic astigmatism were studied. Corneal thickness was assessed with optical pachymetry based on low-coherence interferometry during LASIK.

RESULTS: The attempted mean spherical equivalent refraction was -5.70 ± 2.00 D with a mean calculated stromal ablation depth of 95 ± 18 µm. Intraoperative optical coherence pachymetry was reproducible in all patients during the different stages of LASIK, demonstrating a mean flap thickness of 141 ± 30 µm with a residual corneal stroma of 274 ± 24 µm at the end of the laser ablation. The immediate postoperative corneal thickness revealed marked swelling.

CONCLUSIONS: This initial clinical evaluation proved that intraoperative optical coherence pachymetry may be an important safety feature for monitoring flap and residual stromal thickness during LASIK. It may be particularly helpful in the effort to avoid iatrogenic corneal ectasia in patients with thin corneas, higher refractive corrections, and LASIK enhancements. [J Refract Surg 2003;19:372-377]
Pars Plana Phacoprosthesis (Aphakic Intraocular Implant): A Preliminary Report
Authors: Girard Louis J
Published: April 2021

SUMMARY

A preliminary report is presented on a new intraocular implant which is inserted through the pars plana and is anchored to the sclera in that area. The optic is positioned in the posterior chamber allowing free movement of the iris and best optical correction. Twenty implants are reported without serious complications after a minimum follow-up of one year; however, two retinal detachments have occurred in more recent operations.

ABSTRACT

A phacoprosthesis inserted through the pars plana and fixated to the sclera in the region of the pars plana can prevent damage to cornea during insertion, should give permanent fixation and should be well tolerated. A preliminary report of the technique and results are presented.
The Effect of Scleral Fixation Ring Placement and Trephine Tilting on Keratoplasty Wound Size and Donor Shape
Authors: Olson Randall J
Published: April 2021

SUMMARY

To examine the effect of trephine tilting and scleral ring placement on wound size, five corneas from McCarey-Kaufman medium and ten whole eyes were trephined centrally under controlled conditions and the major and minor axes measured. It was found that, even with great care taken to hold the trephine perpendicular to the cornea, a fair amount of disparity between the major and minor axes of the donor tissue was seen. The scleral fixation ring produced much distortion, although removal allowed the peripheral cornea to return to a more normal configuration. The relationship between amount of trephine tilting and increase in the major axis of the cornea is examined, and all of these concepts are discussed in terms of current keratoplasty technique.
Extracapsular Cataract Extraction and Pseudophakos Implantation in Primates: A Clinico-Pathologic Study
Authors: Irvine A Rodman
Published: April 2021

SUMMARY

Eighteen rhesus monkeys underwent lens implantation with Choyce Mark VIII, Binkhorst iridocapsular, or Shearing posterior chamber lenses. They were sacrificed 4-28 months postoperative. The eyes were compared clinically and histologically. Controls included unoperated eyes and eyes with lens extraction without implantation.

Several histologic findings pertained equally to cataract extraction with or without lens implantation. Late opacification of the posterior capsule was caused by migration and fibrous metaplasia of the lens epithelial cells. These cells appeared to undergo such metaplasia only when exposed directly to aqueous, never when they were in firm apposition to another tissue such as another layer of capsular epithelium, lens cortex, or iris.

All plants were well tolerated clinically. Histologically the eyes with Binkhorst lenses showed a tendency to focal loss of iris pigment epithelium and some pigmented macrophages in the iris stroma and trabecular mesh. The Choyce lenses frequently displayed marked displacement and thinning of the iris root, and occasionally showed a few chronic inflammatory cells and thin fibrous encapsulation around the implant feet. The Shearing lenses had no effect on the adjacent ciliary body when the loops were well seated in the lens capsule, but when a loop was anterior to the capsule, it eroded into the ciliary body. The loops developed a thin fibrous capsule within the ciliary body with very little chronic inflammatory reaction. The long-term effect of such loops lying in the ciliary body is undetermined, however. At present it is recommended that, if such a lens is implanted, every effort be made to ensure both loops lie in the capsular envelope. On the basis of this study, it is also recommended that in removing such a lens, one must assume that a loop might lie embedded in the ciliary body and cut the lens free from the loops before removing it.
Hypnosis in High Risk Ophthalmic Surgery
Authors: Lewenstein Leonard N , Iwamoto Kumiko , Schwartz Herman
Published: April 2021

SUMMARY

Hypnosis is an effective tool in many areas of medicine and surgery. The exacting demands of ophthalmic surgery require good patient cooperation and strict adherence to treatment regimens. Multisystemic diseases compounded by the physiological stress of surgery make it essential that already strained homeostatic mechanisms are interfered with minimally.

The cases presented in this report illustrate the beneficial use of hypnosis in the treatment of several high risk patients in unusual situations.
Persistent Urinary Retention After Ophthalmic Surgery
Authors: Odell Peter M , Pitts W Reid
Published: April 2021

SUMMARY

A two-year prospective study showed that the only serious urological complication after ophthalmic surgery was persistent urinary retention in older men with prior symptoms of bladder outlet obstruction. Osmotic therapy did not seem to be a factor in this rare complication. General anesthesia increased the risk of persistent urinary retention, while local anesthesia without osmotics avoided this complication.
Cyclodialysis With Air Injection in Black Patients
Authors: Miller Ronald D , Nisbet A Michael
Published: April 2021

SUMMARY

Thirty-two cases are presented in which cyclodialysis with air injection was used to treat glaucoma in black patients. Nineteen of the 32 cases were of aphakic glaucoma and most represented failures of other glaucoma surgery. The success rate was found at 12 months postoperative follow-up to be 75%. Three of 13 eyes with phakic glaucoma developed cataracts. Cyclodialysis may be superior to trabeculectomy for surgical treatment of glaucoma in black patients.
The Use of Anterior Chamber Na-Hyaluronate in a Pseudophakic Patient Requiring Intravitreal Air During Retinal Reattachment Surgery
Authors: Swartz Mano , Olson Randall J , Pingree George C , Sakauye Carolyn
Published: April 2021

SUMMARY

Na-hyaluronate, a viscoelastic substance without evidence of intraocular toxicity, appears to have potential as a means of maintaining the anterior chamber in the presence of an intravitreal air bubble and an intraocular lens.
New Cataract Removal Instrumentation and Techniques: I. The NASA-McGannon Cataract Fragmentor
Authors: Baehr Edward F , McGannon William J , Liu Luke H S , Tolentino Felipe I , Schepens Charles L
Published: April 2021

SUMMARY

The instrument consists of a high-speed air turbine driven cutter combined with a pressure-regulated infusion system and a peristaltic pump evacuation system. The tool has an exposure control to vary the axial position of the cutter relative to its housing. The entire unit is controlled and powered by compressed air. A foot pedal starts and stops all suction and cutting functions. The intraocular pressure is controlled by a flow-compensating pressure regulator that balances out the inflow system pressure drop and thereby provides essentially constant intraocular pressure.
The Single Point Cam Guided Trephine: An Interim Report
Authors: Lieberman David M
Published: April 2021

SUMMARY

The development of the single point cam guided cornea trephine frees the cornea surgeon from always cutting a round recipient window perpendicular to the visual axis of the eye. This new trephine allows for any angle of cut relative to the visual axis of the eye and any shaped window, be that window round, ellipse, oval or "other than round." Full development of the technique lies in the future with the development of more complete topographical measuring techniques and the integration of that measurement into a computer program wherein the computer controls the indexing of the blade cutting the recepient window and the angle of the blade while the blade is making the incision.
Vertical Folds of Central Retina and Choroid in Sudden Ocular Decompression
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

Sudden and limited decompression of an eye due to corneal rupture has four days later allowed for the histopathological demonstration of an interesting combination of a vertical retinal fold, cystoid macular edema, degeneration of foveal cones, a vertical choroidal fold with loss of pigment epithelium and papilledema. The rather bizarre changes in this case may be helpful for the understanding of the much more subtle histopathological findings in typical cystoid macular edema.
Reversible Visual Loss in Subperiosteal Hematoma of the Orbit
Authors: Gillum William N , Anderson Richard L
Published: April 2021

SUMMARY

A 19-year-old white male developed blindness in the left eye following a motor vehicle accident. Orbital echography and computerized axial tomography established the diagnosis of subperiosteal hematoma of the orbit. Emergency medical therapy and lateral canthotomy resulted in slight visual improvement but rebleeding occurred 12 hours after injury with visual loss. An emergency surgical decompression of the orbit was performed. Vision returned to 6/7.5 following decompression. This is the first report illustrating that orbital decompression can reverse complete visual loss from a subperiosteal hematoma of the orbit.
Management of Epithelial Cysts of the Anterior Chamber
Authors: Bruner William E , Michels Ronald G , Stark Walter J , Maumenee A Edward
Published: April 2021

SUMMARY

Epithelial cysts in the anterior chamber are treated only if they obstruct the pupil or cause other serious complications. A closed-eye method is used in aphakic eyes to collapse the cyst and devitalize the epithelial cells using cryotherapy without incising the cyst wall. In phakic eyes, the cyst is dissected away from the cornea and then partially excised through an open-sky approach followed by transscleral cryotherapy to devitalize epithelial remnants. Four of seven eyes operated on with these methods were successfully treated without complications. Persistent cystoid macular edema occurred in two of the other three eyes, and one eye developed a postoperative sheet-like epithelial ingrowth requiring further surgery and resulting in corneal edema. The cyst did not recur in any of these seven eyes.
Use of Stereo Headphones for Patient Relaxation During Cataract Surgery Under Local Anesthesia
Authors: Gulledge Sid L , Kline Oram R
Published: April 2021

SUMMARY

The use of stereo headphones to provide relaxing background music to patients undergoing cataract surgery under local anesthesia is described. This technique helps to relieve patient anxiety, reduces the amount of sedative medication required, obscures disturbing operating room noise, and facilitates teaching as the surgeon's comments are not allowed to disturb the patient.
Utilization of a Curved Aspiration-Irrigation Handpiece
Authors: Maida Jerry W
Published: April 2021

SUMMARY

The safest way to completely remove the cortex from under the iris superiorly is with the angulated aspiration-irrigation handprece. It is recommended that a .3 or .5 handle be utilized in low aspiration. As the instrument is rotated around its axis the opening of the aspiration handpiece is up, the cortex is grasped, and the surgeon is able to stay away from the posterior capsule. The incidence of vitreous loss is markedly reduced.
Lid Lag and Lagophthalmos: A Clarification of Terminology
Authors: Harvey John T , Anderson Richard L
Published: April 2021

SUMMARY

Lid lag, lagophthalmos and von Grafe's sign are useful terms which refer to important clinical signs. Despite the fact that they have discrete meanings, they are often used interchangeably and incorrectly by many ophthalmologists and, therefore, their value has been degraded.

We provide definitions for these commonly used (but often confused) ophthalmic terms: Lagophthalmos is the inability to completely close the eyes; Lid lag is the static situation in which the eyelid is higher than normal with the globe in downgaze; and von Grafe's sign is a dynamic sign describing the retarded descent of the eyelid during movement of the globe from primary position to downgaze.

It is our hope that these terms will be adopted by the ophthalmic community so that precision in definition will lead to clarity of thought and communication.
Late Failure of a Dacryocystorhinostomy from Sarcoidosis
Authors: Weingarten Robert , Goodman Edward F
Published: April 2021

SUMMARY

A patient with acute bilateral dacryocystitis presumably secondary to nasolacrimal duct obstruction from sarcoid granulomas is presented. Two patent dacryocystorhinostomies failed after three years due to blockage from sarcoid granulomas. The causes of early and late failure of a dacryocystorhinostomy are discussed.
Iris Incarceration Associated With Digital Ocular Massage
Authors: Segrest David R , Ellis Philip P
Published: April 2021

SUMMARY

Iris incarceration into the trabeculectomy site occurred in three patients following the use of digital ocular massage to maintain satisfactory aqueous humor filtration. The iris incarceration occurred within the first six weeks after surgery and the institution of ocular massage. There had been no complications at the time of surgery, and immediately postoperatively the iris was in normal position. The success of the trabeculectomies was compromised by the iris incarceration.
Preparation of Intravitreal Drug Doses
Authors: Jeglum Edward L , Rosenberg Stewart B , Benson William E
Published: April 2021

SUMMARY

Due to the narrow therapeutic index of drugs injected into the vitreous cavity, this study was undertaken to determine the accuracy of preparation of an intravitreal drug dose (400 µg/0.1 ml from a stock solution of 40mg/ml) when prepared by pharmacists and physicians using the preparation method each would utilize in a clinical setting and to determine which of nine standard preparation methods is most accurate.
Stripping of Descemet's Membrane After Glaucoma Surgery
Authors: Kozart David M , Eagle Ralph C
Published: April 2021

SUMMARY

A case of delayed stromal edema following stripping of Descemet's membrane at the time of filtering surgery is presented. Stripping of Descemet's membrane must be considered in the differential diagnosis of stromal edema, even if the clinical signs occur years after surgery.
Pseudo Vitreous Hemorrhage: A New Intraoperative Complication of Sodium Hyaluronate
Authors: Nirankari Verinder S , Karesh James , Lakhanpal Vinod
Published: April 2021

SUMMARY

We describe a previously unreported complication associated with the use of sodium hyaluronate in anterior segment surgery. Intraoperative blood trapped between an intact vitreous face and anterior chamber sodium hyaluronate presented as a black pupil which clinically mimicked a vitreous hemorrhage.
Precision Standardization of Radial Keratotomy
Authors: Kramer Steven G , Yavitz Edward Q , Sulonen Jukka
Published: April 2021

SUMMARY

Radial keratotomy is an experimental surgical procedure being performed in increasingly large numbers, often without carefully designed protocols which meet accepted methodology for clinical research.

This paper presents an instrumentation system which makes it possible to have precise control of the length, depth, and spacing of radial keratotomy incisions.

This is not a paper in favor of radial keratotomy. It raises the need for rigid standardization of the technique with evaluation of the results according to carefully controlled and accepted clinical trial methodology.
Wound Closure in Cataract Surgery
Authors: Dowling Joseph L
Published: April 2021

SUMMARY

Review of a series of cataract incisions closed by synthetic absorbable sutures shows excellent final visual acuity and few complications. However, comparison with a similar series of cataract extractions closed with 10-0 nylon sutures, clearly demonstrates the superiority of the nylon in terms of the amount and axis of astigmatism, the incidence of wound related complications, and the integrity of the wound by gonioscopy.
Posterior Fixation Suture Operation (Fadenoperation)
Authors: Shuckett E Paul , Hiles David A , Biglan Albert W , Evans Donald E
Published: April 2021

SUMMARY

The posterior fixation operation affords the ophthalmologist an additional procedure for the correction of DVD, nystagmus blockage syndrome and abnormal distance/near relationships associated with esodeviations. The authors report that 95% of the patients had improved their control of manifest DVD. The results of surgery for the nystagmus blockage syndrome and abnormal distance/near relationship patients remain inconclusive. The posterior fixation procedure, while technically difficult, may be performed safely by the experienced surgeon. Refinements of the surgical technique are described.
Localization of Suspected Intraocular Foreign Bodies with a Modified Delta 2020 Scanner
Authors: Wilhelm Joseph Lee , Zakov Z Nicholas , Weinstein Meredith A , Berlin Louise A , Zegarra Hernando , Gutman Froncie A
Published: April 2021

SUMMARY

Metallic foreign bodies were localized in seven patients using a modified Delta 2020 scanner. In six of these seven, we compared the localization obtained by sector CT scan with ultrasound. The two methods were found to be complementary, with the sector CT scan giving more positive and more easily interpreted localizations, and ultrasonography giving more detailed soft tissue diagnosis. The new sector CT scanner greatly raised the level of confidence in the localization of metallic foreign bodies; however, we recommend the combined use of both techniques for a complete evaluation.
Incompletely Excised Basal Cell Carcinoma of the Ocular Adnexa
Authors: Wiggs Eugene O
Published: April 2021

SUMMARY

Incompletely excised basal cell carcinoma of the ocular adnexa is discussed by reviewing the role of surgery, cryosurgery, Mohs' chemosurgery, radiation, and observation in the management of this problem. The ultimate treatment depends upon tumor histology, operability of the lesion, location of the lesion, type of surgery performed, age and general condition of the patient, and extenuating socio-economic variables. What may be optimal treatment for a primary tumor is not necessarily optimal treatment for an incompletely excised tumor because of the risk of converting a minor surgical procedure into a major one and possibly impairing ultimate lid or ocular function via flap or graft compromise or corneal exposure. Th is paper explores the choices available to the surgeon in detail.
Surgical Management of Orbital Implant Extrusion by Implant Placement Posterior to Tenon's Fascia
Authors: Stewart William B , Gratiot James B , Soll David B
Published: April 2021

SUMMARY

Surgical management of extruded orbital implants by implant placement posterior to Tenon's fascia provides results which are cosmetically satisfactory and offers minimal likelihood of further extrusion, even in the poorest risk patient. A lateral, vertical, posterior Tenon's fascia incision, intraconal placement of a large eyebank sclera wrapped spherical implant, deep undermining of the conjunctiva, and forniceal sutures from implant through Tenon's fascia and conjunctiva may further minimize the risk of implant extrusion and improve cosmesis and motility.
Optic Nerve Retrieval After Enucleation
Authors: Friberg Thomas R
Published: April 2021

SUMMARY

Occasionally a surgeon does not obtain an adequate length of optic nerve during enucleation surgery for a suspected intraocular malignancy. Retrieval of an additional nerve segment can be accomplished rapidly utilizing a glass test tube containing a few milliliters of water as an orbital endoscope. Under direct visualization, the remainder of the optic nerve can be located, grasped with a curved clamp, and sectioned with scissors.
Effects of Argon and Krypton Laser on Experimentally Detached Retinas
Authors: Juarez Claudio P , Peyman Gholam A , Raichand Motilal
Published: April 2021

SUMMARY

Krypton and argon laser photocoagulation on the foveas and blood vessels of experimentally detached monkey retinas were studied clinicopathologically. In this manner heat transmission from the retinal pigment epithelium (RPE) to the overlying sensory retina was avoided,

Krypton lesions bypassed the sensory retina on every occasion to produce major photocoagulative effects at the level of the RPE and choroid. Argon laser wavelengths damaged the overlying retina in the foveal areas as well as in perivascular structures. Although the krypton laser appears preferable for treatment of macular diseases, proper parameters should be used to avoid serious complications.
Lens Implant Cytology
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

A simple cytological technique for the demonstration of cellular membranes or single cells on intraocular lens implants is presented. This allows for the study of the nature and the behavior of cells, which grow on the outer surface of the implants.
Aphakic Cystoid Macular Edema in Children After Vitrectomy for Anterior Segment Injuries
Authors: Schulman Joel , Peyman Gholam A , Raichand Motilal , Jednock Norbert
Published: April 2021

SUMMARY

Twenty-four children had surgery utilizing vitrectomy instrumentation for anterior segment trauma. Lensectomy was performed in 23 of 24 eyes. In each child a pars plicata approach was used. Fluorescein angiography or angioscopy performed two months to seven years after surgery failed to document aphakic cystoid macular edema.
Suture Technique for Implanting the Superior Notched Loop of a Posterior Chamber Intraocular Lens
Authors: Bailey John R
Published: April 2021

SUMMARY

A suture technique for compressing the superior notched loop of a posterior chamber intraocular lens is presented, which will provide controllability, less trauma, and no zonular pressure.
Major Early Complications of Laser Trabeculoplasty
Authors: Levene Ralph
Published: April 2021

SUMMARY

A complication frequency of 3.1% visual loss and 1.8% emergency glaucoma surgery occurred in 224 and 159 eyes respectively after laser trabeculoplasty. The latter was associated with blacks and advanced cases of glaucoma. Both were highly associated with a 24-hour rise in pressure after laser.
The Effect of Corneal Trephination on Neovascularization
Authors: Groden Lewis R , Cassel Gary H , Laibson Peter R
Published: April 2021

SUMMARY

In order to investigate a neural influence on corneal neovascularization, we attempted to induce new vessel growth within a denervated zone produced by trephination. The stimulus for vascularization was cauterization central to the trephined margin. We demonstrated that in corneas denervated and stimulated in this manner neovascularization did not occur. This finding supports our hypothesis of a neural influence on neovascularization.
Tape Lid Retraction
Authors: Saragas Savvas , Miller David
Published: April 2021

SUMMARY

A method of retracting the upper lid with sticky tape is described. Such a tape retraction eliminates the need for a third hand in office procedures such as limbal suture removal, corneal foreign body removal, and anterior segment photography.
Modified Lacrimal System Intubation
Authors: Neuhaus Russell W , Shorr Norman
Published: April 2021

SUMMARY

A modified technique for silicone intubation of the lacrimal system is presented to eliminate the two major postoperative problems of punctal erosion and loop retraction.