bluuebunny/crossref_metadata_2025 huggingface dataset:
Attitudes of Successful Contact Lens Wearers Toward Refractive Surgery
Authors: Migneco Mary K , Pepose Jay S
Published: April 2021

ABSTRACT

BACKGROUND: Traditionally, spectacle wearers and contact lens failures have been the patient population targeted for refractive surgery. We surveyed successful contact lens wearers to determine their attitudes toward refractive surgery.

METHODS: One hundred thirty-three consecutive successful myopic contact lens wearers older than 21 years were requested to read information regarding both radial keratotomy and excimer photorefractive keratectomy and complete a questionnaire. We report on the relationship between interest in undergoing radial keratotomy or photorefractive keratectomy and various patient parameters.

RESULTS: More than 75% of those surveyed indicated that they would consider either procedure at any time in the future. The only statistically significant correlation found was that patients younger than 40 more frequently expressed an interest in undergoing radial keratotomy than patients older than 40. Nearly 70% of those surveyed would not spend more than $500 per eye for either procedure, and most patients grossly underestimated the costs associated with contact lens wear.

CONCLUSIONS: In addition to spectacle wearers and contact lens failures, successful contact lens wearers can also be considered potential candidates for refractive surgery, provided it can be offered at a cost acceptable to them and if concerns regarding surgical side effects are addressed to satisfaction. This group does not appear to represent "early adapters" to new refractive technologies. The greatest interest was expressed by those younger than 40 years. [J Refract Surg. 1996;12:128-133.]
Penetrating Keratoplasty and Transsclerally Suture-Fixated Intraocular Lenses
Authors: Kandarakis Artemios S , Doulas Konstatinos G , Amariotakis Apostolos G
Published: April 2021

ABSTRACT

BACKGROUND: One of the options the surgeon has, in the absence of lens capsule in an eye to be rendered pseudophakic, is a transsclerally sutured posterior chamber intraocular lens. This procedure can be combined with penetrating keratoplasty, in aphakic or pseudophakic covered edema.

METHODS: We studied retrospectively the results of the first 10 cases of bullous keratopathy in which we performed penetrating keratoplasty combined with transsclerally suture fixated intraocular lenses.

RESULTS: Nine grans remained transparent and 1 became opaque due to graft rejection with a mean follow up of 26.4 months. Postoperative visual acuity was improved in 7 eyes, remained the same in 2 and became worse in 1 (graft rejection) The poor postoperative visual acuity in 2 eyes was attributed to cystoid macular edema. All sutured intraocular lenses remained in situ; there was no apparent degradation of the Prolene suture. Two eyes developed postoperative medically controlled glaucoma.

CONCLUSIONS: Intraocular lens scleral fixation with sutures, combined with penetrating keratoplasty, seems to be a good procedure for visual rehabilitation for aphakic or pseudophakic bullous keratopathy. [J Refract Surg. 1996;12:S304-S306.]
Inflammatory Cells, Refractive Regression, and Haze After Excimer Laser PRK
Authors: Ramirez-Florez Susana , Maurice David M
Published: April 2021

ABSTRACT

OBJECTIVE: To examine the role of inflammatory cell invasion and aspects of tissue reaction on refractive regression and corneal haze after myopic PRK in rabbits.

METHODS: Measurements were made for 12 weeks postoperatively of haze intensity, corneal topography, tear cytology, inflammatory cell invasion, subepithelial fibroblast density, and the thickness of the newly laid down connective tissue and of the regrown epithelium.

RESULTS: Inflammatory cell invasion could be prevented by fitting a soft contact lens, but this had no effect on the haze or the regression. Haze intensity correlated with subepithelial fibroblast proliferation but not with new connective tissue formation or epithelial hyperplasia. Neither connective tissue nor epithelium regrew in the form of a lens and thus they could not account for regression. Intensive treatment with corticosteroids resulted in a marked reduction in postoperative haze and a slight lessening of long-term regression. Correspondingly, it reduced fibroblast proliferation.

CONCLUSIONS: Haze appears, at least in part, to be a result of fibroblast proliferation. Regression is possibly caused by slow distortion of existing tissue rather than the growth of new. [J Refract Surg. 1996;12:370-381.1
Mechanical Stability of the Cornea After Radial Keratotomy and Photorefractive Keratectomy
Authors: Hjortdal Jesper Ø , Böhm Andreas , Kohlhaas Markus , Olsen Hanne , Lerche Ralph , Ehlers Niels , Draeger Jörg
Published: April 2021

ABSTRACT

BACKGROUND: Corneal refractive surgical procedures alter the shape and structure of the tissue, possibly compromising its mechanical stability.

METHODS: One or both eyes of 87 subjects were studied: 26 of these 87 had been treated for myopia by excimer laser ablation and 36 by radial keratotomy; 25 without previous corneal surgery functioned as controls. Corneal topography was evaluated by TMS-I videophotokeratography before and after 180° tilting of the patient, and the pressureinduced ring-wise changes in spherical equivalent power (axial power) were calculated. Changes in corneal shape also were evaluated by computing the instantaneous radius of curvature. The intraocular pressure was measured before and after tilting by a hand-held applanation tonometer.

RESULTS: The mean intraocular pressure increased from 13.9 + 2.3 nun Hg before tilting to 30.0 ± 3.8 mm Hg during tilting. In the control eyes, the mean power of the central cornea during tilting decreased 0.187 + 0.045 diopters (D) (p<.05); in the excimer-laser-ablated eyes, 0.038 ± 0.056 D (not statistically significant); and in those treated with radial keratotomy, 0.523 ± 0.054 D (p<.01). After radial keratotomy, the cornea steepened outside the clear zone in response to pressure loading, whereas it did not change significantly in the laserablated or control eyes.

CONCLUSIONS: Pressure-induced deformation of normal and excimer laser-ablated human cornea is small, whereas radially incised corneas have significantly decreased mechanical stability. [J Refract Surg. 1996;12:459-466.]
Central Focal Interface Opacity After Laser in situ Keratomileusis
Authors: Fraenkel Graham E , Cohen Peter R , Sutton Gerard L , Lawless Michael A , Rogers Christopher M
Published: April 2021

ABSTRACT

BACKGROUND: The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded.

METHODS: We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASDX). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids.

RESULTS: Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slitlamp biomicroscopy, corneal topography, and vision. Etiology was uncertain.

CONCLUSION: Central interface opacification is a rare but visually important inflammatory complication of LASLK. [J Refract Surg 1998;14:571-576]
Prospective Study of Photorefractive Keratectomy for Hyperopia Using an Axicon Lens and Erodible Mask
Authors: Haw Weldon W , Manche Edward E
Published: April 2021

ABSTRACT

PURPOSE: To evaluate prospectively the longterm safety, efficacy, and visual performance following photorefractive keratectomy (PRK) for hyperopia using an erodible mask and axicon lens system.

METHODS: Eighteen eyes of 9 patients with a mean preoperative spherical equivalent refraction of +2.26 ± 0.82 D (range, +1.13 to +4.00 D) underwent PRK with the Summit Apex Plus excimer laser following manual scraping of the epithelium. Eyes were prospectively evaluated 1, 3, 6, 9, 12, 18, and 24 months following the procedure. Primary outcome variables included cycloplegic refraction and uncorrected visual acuity (UCVA). Visual performance was determined by contrast sensitivity measurements under scotopic (21 lux) and photopic (324 lux) conditions and best spectacle-corrected visual acuity (BSCVA) under scotopic, photopic, and glare conditions.

RESULTS: For 18 eyes, 98.2% of the mean preoperative spherical equivalent refraction was corrected to +0.04 ± 0.87 D (range, -1.38 to +2.00 D) at 24 months after PRK Twelve eyes (67%) were within ±0.50 D of attempted correction and 15 eyes (83%) were within ±1.00 D. Stability within ±0.50 D was achieved after 6 months. Two eyes (11%) experienced almost complete regression of the refractive effect. There was no statistically significant decrease in contrast sensitivity under scotopic or photopic conditions. (P > .05). Best spectaclecorrected visual acuity showed progressive improvement in the early postoperative period. By 24 months, 0 eyes (0%) lost 2 or more lines of BSCVA under scotopic and photopic conditions and 1 eye (5.5%) lost 2 or more lines under glare conditions. Fourteen eyes (78%) had grade 1 to 3 anterior stromal haze at 24 months which was characteristically mid-peripheral and did not adversely affect visual performance.

CONCLUSION: Photorefractive keratectomy with the the Summit Apex Plus excimer laser for low to moderate hyperopia resulted in an effective reduction of hyperopia without compromising long-term visual performance. Stability and recovery of distance uncorrected and best spectaclecorrected visual acuity took approximately 6 months. [J Refract Surg 2000;16:724-730]
Late Onset Diffuse Lamellar Keratitis Associated With an Epithelial Defect in Six Eyes
Authors: Haw Weldon W , Manche Edward E
Published: April 2021

ABSTRACT

PURPOSE: To report six cases of late onset diffuse lamellar keratitis associated with epithelial defects 2 to 12 months following uncomplicated laser in situ keratomileusis (LASIK).

METHODS: Retrospective case series.

RESULTS: The interface inflammation and epithelial defects were treated aggressively with topical corticosteroids and topical antibiotics with complete resolution over 1 to 2 weeks. There were no complications or loss of best spectacle-corrected visual acuity. These cases illustrate new understanding in the etiology of diffuse lamellar keratitis following lamellar surgery.

CONCLUSION: Late onset diffuse lamellar keratitis in association with epithelial defects may occur following LASIK. Treatment with topical antibiotics and topical corticosteroids may result in uncomplicated, complete resolution. [J Refract Surg 2000;16:744-748]
Penetrating Keratoplasty vs. Epikeratoplasty for the Surgical Treatment of Keratoconus
Authors: Wagoner Michael D , Smith Scott D , Rademaker Wilfried J , Mahmood Muneera A
Published: April 2021

ABSTRACT

PURPOSE: Penetrating keratoplasty and epikeratoplasty have been utilized in the surgical treatment of keratoconus. Comparison of the relative efficacy of each procedure in achieving visual outcomes has not been achieved due to limited numbers of cases and follow-up in previous series.

METHODS: All patients who underwent either penetrating keratoplasty or epikeratoplasty for keratoconus between January 1987 and December 1997, and for whom at least 24 months of postoperative follow-up data for visual acuity was documented in the medical record, were included in this retrospective, nonrandomized, sequential comparative trial. The sole criteria for outcome in each group, as well as for comparison of the two groups, was Snellen visual acuity measured at the time of each follow-up with the presenting optical aid.

RESULTS: Inclusion criteria were met for 443 eyes treated with penetrating keratoplasty and 161 eyes treated with epikeratoplasty. Mean follow-up was 4.3 years for penetrating keratoplasty and 4.5 years for epikeratoplasty. In each group, approximately 50% of the patients chose rehabilitation with optical correction with either spectacles or contact lenses and 50% chose no optical correction. Final median logMAR visual acuity for all patients, irrespective of means of visual rehabilitation, was 0.30 (20/40) for penetrating keratoplasty and 0.40 (20/50) for epikeratoplasty (P < .00005). In 209 penetrating keratoplasty and 77 epikeratoplasty eyes with optical correction, the final median logMAR visual acuity was 0.18 (20/30) for penetrating keratoplasty and 0.40 (20/50) for epikeratoplasty (P < .00005). The final median logMAR visual acuity in 234 penetrating keratoplasty and 84 epikeratoplasty eyes without optical correction was 0.48 (20/60) in both groups (P-value was not statistically significant).

CONCLUSIONS: Although penetrating keratoplasty was statistically superior to epikeratoplasty with respect to visual outcome, results with epikeratoplasty were adequate to recommend its use as a surgical alternative in cases when it is not desirable to perform penetrating keratoplasty. [J Refract Surg 2001;17:138-146]
Comparative Results Between Standard and Bitoric Nomograms for Astigmatism Correction
Authors: Sheludchenko Viacheslav M , Fadeykina Tatiana
Published: April 2021

ABSTRACT

PURPOSE: To investigate results of excimer laser correction for mixed astigmatism, using two kinds of corneal photoablation; bitoric nomograms for cylinder and standard monotoric procedures.

METHODS: Intrastromal photoablation was performed with the Nidek EC-5000 excimer laser and a lamellar keratotomy was created with the Hansatome microkeratome. We selected 46 cases with mixed astigmatism. The first group included 28 eyes (average cylinder 4.15 ± 0.86 D, sphere 1.37 ± 0.18 D). In this group, procedures were performed using bitoric nomograms. The second group included 18 eyes (average cylinder 4.05 ± 0.64 D, sphere 1.67 ± 0.23 D). In this group ablation was performed with monotoric nomograms.

RESULTS: After 6 months in the bitoric group, average residual cylinder was 1.49 ± 0.24 D, and sphere was -0.57 ± 0.31 D. In seven cases (25%), re-ablations for astigmatism correction were needed. In the monotoric group, average postoperative cylinder was 1.89 ± 0,39 D, and sphere was 0.77 ± 0.28 D. In eight cases (44%), retreatments were planned.

CONCLUSION: Bitoric ablations for astigmatic corrections resulted in a decreased frequency of reablation as compared to standard monotoric procedures. [J Refract Surg 2001;17(suppl):S238-S241]
Schematic Eye Models for Simulation of Patient Visual Performance
Authors: Doshi James B , Sarver Edwin J , Applegate Raymond A
Published: April 2021

ABSTRACT

PURPOSE: To determine if model eyes can simulate the visual performance of normal human eyes under conditions of varying low myopic blur, pupil size, and contrast.

METHODS: High and low contrast Bailey-Lovie logMAR visual acuity (VA) of three normal eyes of three subjects were measured for four artificial pupil sizes and ten levels of myopic defocus. Simulated visual acuities were then determined for three model eyes? the Indiana Eye with no spherical aberration, the Indiana Eye with average spherical aberration, and the Kooijman Eye? by generating optically aberrated VA charts for each testing condition using Visual Optics Lab software by Sarver and Associates, Ine, and having the subjects read high resolution printouts of these charts using a 3-mm pupil and optimal spectacle correction. The correlation between real VA and simulated VA was then plotted and a regression line calculated.

RESULTS: Slopes for the Indiana Eye, Indiana Eye with spherical aberration, and Kooijman Eye were 0.98, 0.98, and 1.01 for high contrast, and 0.92, 0.67, and 0.75 for low contrast, respectively. The r2 values were 0.73, 0.74, and 0.77, for high contrast, and 0.69, 0.40, and 0.50 for low contrast, respectively. Under low contrast conditions the Indiana Eye VA was significantly closer to the real VA than that of the other two models (P<.0003).

CONCLUSION: Visual performance can be simulated by eye models. The simple single surface Indiana Eye with no spherical aberration best modeled both high and low contrast visual acuity. [J Refract Surg 2001;17:414-419]
Recutting the Cornea Versus Lifting the Flap: Comparison of Two Enhancement Techniques Following Laser in situ Keratomileusis
Authors: Domniz Yuval , Comaish Ian F , Lawless Michael A , Rogers Christopher M , Sutton Gerard L
Published: April 2021

ABSTRACT

PURPOSE: To evaluate enhancement techniques following laser in situ keratomileusis (LASIK).

METHODS: Recutting was performed on 263 eyes and the flap was lifted in 55 eyes that had LASIK for simple myopia or myopic astigmatism. The time interval between LASIK and retreatment was 340 ± 46 days (range, 270 to 892 days) in the recutting group and 215 ± 36 days (range, 53 to 617 days) in the flap lifting group. Mean spherical equivalent refraction, refractive cylinder, uncorrected and best spectacle-corrected visual acuity were examined prior to, and 1, 3, and 6 months after retreatment.

RESULTS: Seventeen eyes were lost to follow-up in the lifting group and 53 eyes in the recutting group. In the recutting group, mean spherical equivalent refraction improved from -1.48 ± 1.25 D to -0.49 ± 0.88 D at 6 months. In the flap lifting group, mean spherical equivalent refraction improved from -1.05 ± 1.49 D to -0.45 ± 0.39 D at 6 months. Refractive cylinder did not change significantly in either group (P = .2). There was a significant increase in uncorrected visual acuity (UCVA) of 6/6 in each group. In the recutting group, UCVA of 6/6 increased from 3.8% to 65.2% at 6 months, and in the lifting group from 3.6% to 71.1% at 6 months. In the recutting group, seven free flaps and three macerated flaps that required removal occurred. One eye in the recutting group and two in the lifting group developed significant epithelial ingrowth. No patient lost more than one line of best spectacle-corrected visual acuity (BSCVA).

CONCLUSION: Both procedures were safe, effective, and highly predictable for enhancements, but flap complications may be more likely with recutting. [J Refract Surg 2001;17:505-510]
Aberrations and Visual Performance Following Standard Laser Vision Correction
Authors: Marcos Susana
Published: April 2021

ABSTRACT

PURPOSE: To relate the change of ocular aberrations with the change of visual performance produced by standard laser in situ keratomileusis (LASIK) for myopia.

METHODS: Aberrations and visual performance were measured before and after surgery in 22 eyes. Total aberrations were measured using a laser ray tracing technique. Corneal aberrations were obtained using a commercial videokeratoscope and custom software. Visual performance was evaluated in terms of best spectacle-corrected contrast sensitivity and high-contrast visual acuity.

RESULTS: The amount of total and corneal aberrations increased with LASIK in all except two eyes. In general, the total and corneal aberration patterns were well-correlated after LASIK. However, the anterior corneal surface alone did not capture all the information (ie, possible changes induced on the posterior corneal surface or interactions between the different ocular components), which suggests that total aberrations are better predictors of visual performance. The decrease of the modulation transfer function (both in terms of area under the curve or as a function of spatial frequency) with LASIK accounted for most of the decrease in contrast sensitivity. High-resolution visual acuity was not very sensitive to the LASIKinduced changes in image quality.

CONCLUSION: Wavefront and total aberration measurements, and in particular a combination of the two techniques, provide useful information for understanding the optical changes induced by standard refractive surgery. Predictions of the change in modulation transfer function derived from wave aberrations matched measurements of change in contrast sensitivity. [J Refract Surg 2001 ;17: S596-S601]
Prophylactic Laser Photocoagulation for Retinal Breaks Before Laser in situ Keratomileusis
Authors: Lin Shih-Chin , Tseng Sung-Huei
Published: April 2021

ABSTRACT

PURPOSE: To determine the efficacy and safety of prophylactic laser photocoagulation for retinal breaks in myopic patients undergoing laser in situ keratomileusis (LASIK).

METHODS: Between August 1998 and August 2002, a total of 1931 eyes in 1006 patients requesting LASIK received a fundus examination with indirect ophthalmoscopy before surgery. For analysis, patients were divided into two groups according to the presence or absence of retinal breaks. All patients with retinal breaks underwent prophylactic laser photocoagulation to seal the breaks, even though they were asymptomatic.

RESULTS: Patient age ranged from 18 to 68 years (30.8 ± 7.4 yr). Mean preoperative spherical equivalent refraction was -7.55 ± 3.72 D (range -1.87 to -34.50 D). Retinal breaks were identified and treated in 39 eyes (2.029Í) of 32 patients (3.2%); 1892 eyes of 974 patients had no retinal breaks. No statistically significant difference was found in age (P=.87) or gender (P=. 91) between the two groups. However, a significantly higher preoperative spherical equivalent refraction was noted in patients with retinal breaks (-9.41 ± 4.15 D) compared with those without (-7.52 ± 3.71 D) (P=.017). During a mean 19-month follow-up, none of the patients developed retinal detachment except for one in a patient without retinal breaks who sustained ocular trauma 19 months after LASIK. This patient was treated with scleral buckle and the retina was attached after surgery.

CONCLUSIONS: Retinal breaks were identified and treated by photocoagulation in 2% of 1931 eyes before LASIK for myopia. [J Refract Surg 2003; 19:661-665]
Laser Epithelial Keratomileusis for Myopia
Authors: Camellin Massimo
Published: April 2021

ABSTRACT

PURPOSE: To describe a new technique for excimer laser corneal surgery: laser epithelial keratomileusis (LASEK).

METHODS: We report 76 eyes with spherical equivalent refractive myopia ranging from -8.00 to -22.00 D (mean -11.00 ± 3.00 D). Using ethanol applied over an 8.5-mm-diameter area for 20 seconds, the epithelium was detached and photorefractive keratectomy (PRK) was performed. The epithelium was reapplied to the ocular surface and covered with a therapeutic soft contact lens. Treatments were carried out with the Nidek EC-5000 excimer laser.

RESULTS: At a mean of 803 days after LASEK, mean spherical equivalent refraction was -1.80 ± 2.40 D (range -9.27 to +2.00 D). Stability was reached in approximately 60 days. Fifty-nine percent of the epithelial flaps were easy to detach intact during surgery and 62.7% of patients reported no postoperative pain. Eighty-four percent of eyes had the therapeutic bandage lens removed by the fourth postoperative day. Twelve percent of eyes had incomplete epithelial flap removal. Epithelium can fall off the cornea during the healing phase. No significant subepithelial haze was seen in 95% of eyes.

CONCLUSION: With LASEK, it may be possible to treat a larger diameter ablation zone in thinner corneas without the problems of a LASDX stromal flap and with less postoperative pain than PRK, with minimal subepithelial haze. [J Refract Surg 2003;19:666-670]
Peripheral Keratitis Following Laser in situ Keratomileusis
Authors: Lahners William J , Hardten David R , Lindstrom Richard L
Published: April 2021

ABSTRACT

PURPOSE: To report two different cases of sterile, peripheral keratitis following laser in situ keratomileusis (LASIK).

METHODS: A report of two cases (two eyes of two patients).

RESULTS: In two patients, peripheral infiltrates appeared 1 day after LASIK. One patient had a history of rheumatoid arthritis and both had peripheral corneal changes that may have represented prior inflammatory events. The presentations were quite different, with one occurring in association with an epithelial defect at the edge of the flap and the other occurring without an epithelial defect peripheral to the microkeratome cut. In the second case a similar infiltrate showed up in the unoperated fellow eye. Both patients were treated with aggressive antibiotic and corticosteroid therapy. Both patients recovered well with no loss of best spectacle-corrected visual acuity.

CONCLUSION: Peripheral keratitis can occur in patients following LASBK; preoperative evidence of previous inflammation may be a marker for patients at higher risk. Rheumatoid arthritis patients may be at increased risk for this complication. With careful and aggressive management excellent visual outcomes are still possible. [J Refract Surg 2003;19:671-675]
Comparison of Clinical Outcomes and Visual Quality Using a Medium Versus Small Contact Glass in Patients Undergoing SMILE With Large Corneal Diameters
Authors: Brar Sheetal , Ganesh Sri , Gautam Megha , Devi Roxy Chirom
Published: April 2021

PURPOSE:

To compare the clinical outcomes and visual quality using a small (S) versus medium (M) size contact glass in eyes with large white-to-white (WTW) distance undergoing bilateral small incision lenticule extraction (SMILE) for myopia correction.

METHODS:

This contralateral eye study involved 60 eyes of 30 patients (mean age: 27.20 years) undergoing bilateral SMILE for myopia/myopic astigmatism with a WTW distance of 12 mm or greater in both eyes, which were randomized to receive treatment with an S-contact glass in one eye and an M-contact glass in the fellow eye. Opaque bubble layer (OBL) was graded using a new grading system. On postoperative 1 day, 2 weeks, and 3 months, UDVA, CDVA, contrast sensitivity, Objective Scatter Index, and modulation transfer function cut-off values were compared between the two groups.

RESULTS:

The mean OBL score was significantly lower in the S-contact glass group (28.18%) compared to the M-contact glass group (67.13%) (
P
< .01). At 1 day postoperatively, the UDVA, Objective Scatter Index score, and contrast sensitivity values for all spatial frequencies were significantly better in eyes treated with the S-contact glass compared to the M-contact glass (
P
⩽ .05). At 3 months postoperatively, however, the UDVA, Objective Scatter Index score, modulation transfer function cut-off, and contrast sensitivity values were comparable for both groups. No eye in either group had intraoperative complications such as suction loss, incision/lenticule tears, or lenticule retention.

CONCLUSIONS:

In corneas with a WTW distance of 12 mm or greater, docking with the S-contact glass resulted in significantly better immediate visual results due to less OBL formation and smoother tissue dissection compared to the M-contact glass.

[
J Refract Surg
. 2021;37(3):150–157.]
Re-Examining the Tarsal Kink Syndrome: Considerations of its Etiology and Treatment
Authors: Bosniak Stephen , Hornblass Albert , Smith Byron
Published: April 2021

ABSTRACT

A severe corneal ulceration that is evident shortly after birth and persists in spite of adequate medical therapy, may be secondary to a congenital entropion. A vertically kinked tarsus is an unusual and frequently overlooked form of congenital entropion. Prompt recognition of this entity is essential to avoid severe corneal injury and amblyopia.

We present a technique of tarsal stabilization which corrected this upper lid deformity in one case.
Pseudophakic Phacoanaphylactic Endophthalmitis
Authors: Wohl Lisa G , Kline Oram R , Lucier Alfred C , Galman Barry D
Published: April 2021

ABSTRACT

Two cases of pseudophakic phacoanaphylactic endophthalmitis are reported. Both responded favorably to a total posterior capsulectomy performed in addition to removal of the intraocular lens and remaining cortical material. Current theories on phacoanaphylactic endophthalmitis are discussed. Excision of the entire posterior capsule with anterior capsular flaps and entrapped cortex is emphasized as an integral part of the treatment of this condition.
Persistent Elevation in Intraocular Pressure After Nd: YAG Laser Treatment
Authors: Demer Joseph L , Koch Douglas D , Smith Jess A , Knolle Guy E
Published: April 2021

ABSTRACT

A bilaterally pseudophaldc patient, who had no previous evidence of glaucoma, underwent Nd: YAG laser posterior capsulotomy and dispersal of vitreous syneresis opacities of his left eye. The eye developed persistent Intraocular pressure elevation and visual field loss, requiring medical therapy and argon laser trabeculoplasty. His fellow eye remained normotehsive after Nd: YAG laser posterior capsulotomy. Nd: YAG laser treatment can result in chronic intraocular pressure elevation and glaucomatous visual field loss.
Rhegmatogenous Retinal Detachment With a Pit of the Optic Nerve Head
Authors: Traboulsi Elias I , Pilkerton A Raymond
Published: April 2021

ABSTRACT

A 56-year-old myope developed a retinal detachment of the macular area and the temporal quadrants in his left eye that harbored a temporally-located pit of the optic nerve head. Under anesthesia a small peripheral retinal break was identified, and the retina was reattached successfully using cryotherapy and a limited scleral buckling procedure. Peripheral retinal breaks should be searched for in myopic eyes with optic pits and retinal detachments involving peripheral retinal quadrants.
Enhancing Surgery for Acquired Esotropia
Authors: Jotterand Veronique H , Isenberg Sherwin J
Published: April 2021

ABSTRACT

In acquired esotropia, operating only on the nonaccommodative angle often results in under-correction. To decrease the frequency of this outcome, we enhanced surgery in a preliminary study by operating for a target angle equal to half the sum of the distant non-accommodative angle (minimum 12 prism diopters) plus the distant angle measured without correction. The mean augmentation in 12 patients undergoing bimedial rectus recession was 0.8 ± OJZ mm, and in eight patients who had a previous bimedial rectus recession and were undergoing a bilateral rectus resection it was 1.7 ± 0.8 mm.

With a mean follow-up of 26 ± 20 months, 13 patients were within 10 prism diopters of orthotropia and four were undercorrected. Three overcorrected patients were Orthophorie after reducing the hyperopic correction. All 17 patients old enough to cooperate had stereopsis or a positive Worth four-dot test at some point postoperatively.
Ciliochoroidal Effusion as Precursor of Suprachoroidal Hemorrhage: A Pathologic Study
Authors: Wolter J Reimer , Garfinkel Richard A
Published: April 2021

ABSTRACT

Ciliochoroidal effusion and suprachoroidal (expulsive) hemorrhage both occur in hypotonic eyes and may be serious complications of intraocular surgery or other ocular perforations. Clinical observations have given rise to the suspicion that ciliochoroidal effusion may be a precursor of suprachoroidal hemorrhage, which has resulted in a change of recommended surgical management of the complications. In the present pathologic study, typical ciliochoroidal effusion is demonstrated at the stage at which rupture of stretched posterior ciliary arteries makes suprachoroidal hemorrhage imminent. Our observations morphologically support the clinical conclusions of Maumenee and Schwartz.
Dacryocystorhinostomy Without Flaps
Authors: Becker Bruce B
Published: April 2021

ABSTRACT

In a series of 50 consecutive cases, a modification of the Kasper technique of dacryocystorhinostomy without flaps resulted in a success rate of 90%. The success rate was 92.5% in patients with nasolacrimal duct obstruction alone, but only 80% in those with both nasolacrimal duct obstruction and canalicular disease. The results of this study indicate that equivalent results are achieved with or without the use of flaps. The elimination of flaps shortens and simplifies the procedure.
Prolonged Aqueous Humor Levels of Subconjunctival Antibiotics After Treatment With Acetazolamide and/or Timolol
Authors: Ellis Philip P , Riegel Maris
Published: April 2021

ABSTRACT

Many ophthalmologists routinely administer subcon junctival antibiotics at the end of cataract surgery for prophylaxis against bacterial endophthalmitis. Additionally they use acetazolamide and/or timolol to control intraocular pressure in the first 24-hour postoperative period. An animal study was undertaken to learn whether treatment with the aqueous humor suppressants, acetazolamide, and timolol prolongs the concentrations of antibiotics in the aqueous humor after subconjunctival administration of the antibiotic. Treatment with acetazolamide significantly increased concentrations of piperacillin; it had less consistent effects on tobramycin levels. Timolol treatment did not produce increased piperacillin concentrations at six hours; however, concentrations at 12 and 24 hours were significantly higher than in the controls. Timolol treatment increased tobramycin concentrations only at six hours. The combined use of timolol and acetazolamide produced significantly higher concentrations of piperacillin, but not of tobramycin.
Management of the Blepharoplasty Patient With Ptosis
Authors: Leone Charles R
Published: April 2021

ABSTRACT

Patients who request correction of both dermatochalasts and acquired blepharoptosis require separate evaluation of each condition. The blepharoplasty is done in the standard way, depending on the amount of skin redundancy and fat herniation. The method of ptosis repair is dependent on whether Müllers muscle or levator aponeurosis is weak, the degree of ptosis and levator function, and the position of the upper eyelid crease. A tarsal Müllers muscle resection Is employed in cases where the ptosis is minimal, the upper eyelid crease is normal, or the phenylephrine test is positive. A levator advancement Is done If the ptosis is due to a levator aponeurosis dehiscence or attenuation with a higher than normal upper eyelid crease and thinning of the eyelid. Both procedures are easily combined with an upper eyelid blepharoplasty.
Subretinal Neovascularization Complicating Laser Photocoagulation of Diabetic Maculopathy
Authors: Lewen Robert M
Published: April 2021

ABSTRACT

A subretinal neovascular membrane was diagnosed in a 60-year-old black woman 1 year following uneventful laser treatment for diabetic maculopathy. The membrane originated from the edge of a photocoagulation scar, ft is believed that this neovascular membrane represents a complication of laser photocoagulation of diabetic maculopathy.
Excision of Limbal Dermoids
Authors: Panton Robert W , Sugar Joel
Published: April 2021

ABSTRACT

We reviewed the clinical files of 10 patients who had undergone excision of unilateral epibulbar limbal dermoids. Preoperatively, all of the affected eyes had worse visual acuity (P < .02) and more astigmatism (P < .01) than the contralateral eyes. Postoperatively, every patient was cosmetically improved. Of the eight patients for whom both preoperative and postoperative visual acuity measurements had been obtained, in six it had changed minimally (≤ 1 line), and in two it had improved (≤ 2 lines). Surgical complications included persistent epithelial defects (40%) and peripheral corneal vascularization and opacity (70%). These complications do not outweigh the cosmetic and visual benefits of dermoid excision in selected patients.
Bilateral Retinal Venous Caliber Decrease Following Unilateral Optic Nerve Sheath Decompression
Authors: Lee Sang V , Shin Dong H , Spoor Thomas C , Kim Chaesik , McCarty Beverly , Kim David
Published: April 2021

ABSTRACT

We investigated retinal vascular changes in nine patients undergoing optic nerve sheath decompression for vision-threatening papilledema associated with pseudotumor cerebri. Two major (one superior and one inferior) retinal venous and arterial calibers were measured before and 1.1 ± 0.1 months, 3.2 ± 0.2 months, 5.0 ± 0.2 months, 7.6 ± 0.2 months, and 13.0 ±1.9 months after surgery. The retinal venous caliber decreased significantly, and the decrease progressed until 3.2 months after surgery. The venous caliber in the contralateral unoperated eyes also decreased significantly. The decrease in the venous caliber in the contralateral unoperated eye as well as in the operated eye following the surgery supports the hypothesis that slow filtration is the mechanism of successful optic nerve sheath decompression. Retinal venous caliber measurement, in either the operated eye or the unoperated fellow eye, can be used to quantitatively monitor the status of papilledema associated with pseudotumor cerebri.
Initial Experience With an Eight-Month Sustained-Release Intravitreal Ganciclovir Implant for the Treatment of CMV Retinitis Associated With AIDS
Authors: Duker Jay S , Robinson Michael , Anand Rajiv , Ashton Paul
Published: April 2021

* BACKGROUND AND OBJECTIVE: An intravitreal device administering ganciclovir in a sustained-release fashion has been developed for site-specific therapy of cytomegalovirus (CMV) retinitis. The initially tested devices released ganciclovir at a rate of approximately 2 µg/hour Mark I device), yielding an estimated in vivo therapeutic life span of 4 months. This report describes the initial clinical results of a longer-lasting device that releases ganciclovir at a rate of 1 µg/hour (Mark II device), designed to be effective for up to 8 months.

* PATIENTS AND METHODS: Over a 15-month time period, a total of 39 Mark II intravitreal ganciclovir devices were placed in 35 eyes of 29 patients with a diagnosis of CMV retinitis. At the time of implantation, none of the patients were on systemic anti-CMV therapy.

* RESULTS: Of the first 29 eyes of the 29 enrolled patients implanted with their initial Mark II device, 28 (97%) had no progression of retinitis at the 4-week postoperative examination. Survival analysis of these initial 29 implants revealed the median time to disease progression was 29.3 weeks (205 days). Serious ocular complications included one case of acute bacterial endophthalmitis (2.9% of eyes or 2.5% of implantations), and four cases of rhegmatogenous retinal detachment (four of 35 or 11.4% of eyes). Of the 10 patients with initially unilateral retinitis, four (40%) eventually developed contralateral disease. Five clinically suspected cases of extraocular, systemic CMV disease occurred during the study (17.2 % of patients), necessitating reinstitution of systemic therapy.

* CONCLUSION: This small, uncontrolled pilot study indicates that the Mark II (1 mg/hour) sustained-release intravitreal ganciclovir device is effective for local control of CMV retinitis.

[Ophthalmic Surg Lasers 1995;26:442-448.]
Diagnosis of Traumatic Cyclodialysis by Ultrasound Biomicroscopy
Authors: Gentile Ronald C , Pavlin Charles J , Liebmann Jeffrey M , Easterbrook Michael , Tello Celso , Foster F Stuart , Ritch Robert
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the ability of high-frequency ultrasound biomicroscopy to diagnose traumatic cyclodialyses not evident on clinical examination.

* PATIENTS AND METHODS: Six eyes of six patients with posttraumatic hypotony and/or shallow anterior chamber and suspected cyclodialysis clefts were examined with slit-lamp biomicroscopy, gonioscopy, B-scan ultrasonography, and ultrasound biomicroscopy. Ultrasound biomicroscopy provided high resolution of cross-sectional images of the anterior chamber angle, posterior chamber, and anterior uveal tissue.

* RESULTS: Ultrasound biomicroscopy confirmed the disinsertion of the ciliary body from the scleral spur and associated ciliary body detachment in all eyes. Gonioscopy failed to demonstrate a cyclodialysis cleft in five eyes because of hyphema (two eyes) and abnormal iris architecture (related to trauma) precluding visualization of the angle recess (three eyes). Using information from ultrasound biomicroscopy imaging, one patient underwent a ciliary body reattachment procedure and repair of the cyclodialysis cleft.

* CONCLUSION: Ultrasound biomicroscopy is a noninvasive method that can accurately diagnose the presence of traumatic cyclodialyses and can aid in surgical management. It is particularly useful in the presence of hazy media, hypotony, and/or abnormal anterior segment anatomy.

[Ophthalmic Surg Lasers 1996;27:97-105.]
Effect of Surgical Technique on the Increase in Intraocular Pressure After Cataract Extraction
Authors: Lagrèze Wolf-Dietrich A , Bömer Thomas F , Funk Jens
Published: April 2021

* BACKGROUND AND OBJECTIVE: A prospective study was performed to determine the influence of surgical technique on the increase in intraocular pressure (IOP) after cataract surgery.

* PATIENTS AND METHODS: Three groups of 30 patients each underwent either extracapsular cataract extraction with scterocorneal suture (ECCE), phacoemulsification with sclerocorneal suture (PS), or phacoemulsification with a sutureless scleral tunnel (PT).

* RESULTS: Each group experienced a significant increase in IOP 5 to 7 hours after surgery: 20.2 ± 7.9 mm Hg for ECCE, 11.2 ± 8.3 mm Hg for PS, and 4.7 ± 8.7 mm Hg for PT. The differences in the increases among the three groups were significant.

* CONCLUSION: PS produces the lowest postoperative increase in IOP and should be considered for patients with glaucomatous damage.

[Ophthalmic Surg Lasers 1996;27:169-173.]
Endoscopic Fluorescein Angiography of the Ciliary Body in Glaucoma Management
Authors: Uram Martin
Published: April 2021

* BACKGROUND AND OBJECTIVE: The laser endoscopy system has been modified to permit highresolution intraoperative fluorescein angiograms. Because the ciliary processes can be directly viewed and photocoagulated from a limbal wound in the phakic, aphakic, or Pseudophakie eye in virtually any patient, the novel opportunity to angiographically study the ciliary processes before and after various forms of ablation was created.

* PATIENTS AND METHODS: Eighty patients were divided into four groups and were studied under various conditions.

* RESULTS: The ciliary processes normally fill with fluorescein early in the angiogram and maintain hyperfluorescence throughout. Functional ciliary processes (or portions of them) are hyperfluorescent; ablated processes are densely hypofluorescent. This technique can delineate inadequately treated zones, permitting appropriate correction at the time of initial surgery. Eyes with previous transscleral cyclodestruction did not experience the degree of ciliary process ablation that the surgeon reported.

* CONCLUSION: Intraoperative delineation of treated and untreated ciliary processes permits accurate correlation with observed intraocular pressure response.

[Ophthalmic Surg Lasers 1996;27:174-178.]
Magnetic Resonance Imaging Findings in a Case of Advanced Coats' Disease
Authors: Lai Wico W , Edward Deepak P , Weiss Robert A , Mafee Mahmood F , Tso Mark O M
Published: April 2021

Abstract. Coats' disease is an idiopathic, primary vascular anomaly of the retina often presenting with retinal detachment. In this report, the unusual radiologic findings of a 17-month-old patient with advanced Coats' disease are discussed. Computed tomography (CT) showed diffuse increased density of the right eye. Magnetic resonance imaging (MRI) demonstrated moderately hyperintense signal intensity on T1weighted images, mildly hypointense signal intensity on T2-weighted images, and linear enhancement of the leaves of the detached retina with intense enhancement in the retinal periphery following gadolinium- diethylenetriamine penta-acetic acid (DTPA) contrast administration. The hypointense T2-weighted images and the linear enhancement of the detached retina have not been reported previously in cases of Coats' disease. These observations correlated with the histopathologic features, which showed a totally detached retina containing large telangiectatic vessels and a subretinal space occupied by eosinophilic proteinaceous exudates containing abundant cholesterol crystals. It appears that the MRI characteristics observed in Coats' disease may vary depending on the nature of the subretinal exudate and the severity of the disease. [Ophthalmic Surg Lasers 1996;27:234-238.]
Ultrasound Biomicroscopic Features of Iris Retraction Syndrome
Authors: Morinelli Elisa N , Gentile Ronald , Stegman Zeev , Liebmann Jeffrey M , Shabto Uri , Ritch Robert
Published: April 2021

* BACKGROUND AND OBJECTIVES: To examine anatomic relationships of anterior and posterior chamber structures in iris retraction syndrome using ultrasound bìomìcroscopy.

* PATIENTS AND METHODS: Four eyes of four patients with iris retraction syndrome were imaged using high-frequency, high-resolution, anterior segment ultrasound biomicroscopy. In two patients, scans were obtained before and after medical therapy.

* RESULTS: Three patients presented wirh iris retraction configuration and one with iris bombe. In the latter case, iris bombe converted to iris retraction and back to Ìris bombe with the administration and later withdrawal of aqueous suppressants. Ciliochoroidal effusion was present in all eyes.

* CONCLUSIONS: Ciliochoroidal effusion is a constant feature of iris retraction syndrome. The hypotony associated with this disorder may result in part from aqueous hyposecretion related to ciliary body detachment. Ultrasound biomicroscopy is a useful aid in the diagnosis and follow-up of eyes with iris retraction syndrome.

[Ophthalmic Surg Lasers 1996;27:257-262.]
Indocyanine Green Angiography of Idiopathic Polypoidal Choroidal Vasculopathy
Authors: Phillips William B , Regillo Carl D , Maguire Joseph I
Published: April 2021

Abstract. The authors report a case of idiopathic polypoidal choroidal vasculopathy and sudden decrease in vision in which indocyaníne green (ICG) angiography aided in the diagnosis and treatment. ICG angiography identified choroidal-based vascular abnormalities in a patient with idiopathic polypoidal choroidal vasculopathy. One of these areas demonstrated apparent leakage and was treated with laser photocoagulation, resulting in resolution of subretinal fluid and improvement in visual acuity. ICG angiography provides a clearer visualization of the choroidal vasculature than fluorescein angiography and can aid in the diagnosis and treatment of idiopathic polypoidal choroidal vasculopathy. [Ophthalmic Surg Lasers 1996;27:467470.]
Do Standard Procedures in Squint Surgery Influence the Blood-Aqueous Barrier?
Authors: Neugebauer Antje , Kaszli Franz A , Diestelhorst Michael , Rürsmann Walter
Published: April 2021

* BACKGROUND AND OBJECTIVE: Surgery on the rectus muscles may interfere with anterior segment perfusion. This study investigates the influence of combined rectus muscle surgery on the blood-aqueous barrier in children. Namely, the influences of tucking and resection procedures were compared.

* PATIENTS AND METHODS: Laser flare measurements for tyndallometry were performed preoperatively and postoperatively in 25 children. Fifteen of the children had undergone a combination of a rectus recession and tucking; 10 had undergone a combined recession-resection procedure.

* RESULTS: The mean preoperative flare value was 4.1 photon counts/ms versus 3.7 photon counts/ms postoperatively in the eyes that had undergone surgery. Statistical evaluation showed that the postoperative changes were insignificant. No significant difference was found between the two surgical techniques (tucking vs resection) regarding the preoperative versus postoperative flare value change (level of statistical significance .05).

* CONCLUSION: Combined squint surgery, either recession- tucking or recession-resection, was not shown to influence the blood-aqueous barrier.

[Ophthalmic Surg Lasers 1997;28:570-573.]