bluuebunny/crossref_metadata_2025 huggingface dataset:
Flap Measurements With the Hansatome Microkeratome
Authors: Spadea Leopoldo , Cerrone Loredana , Necozione Stefano , Balestrazzi Emilio
Published: April 2021

ABSTRACT

PURPOSE: To evaluate flap thickness, flap diameter, and hinge length during laser in situ keratomileusis (LASIK) and to correlate these measurements with preoperative keratometric power, central corneal thickness, and patient refraction, gender, and age.

METHODS: In this prospective study of 50 eyes of 28 patients (mean age 31 ? 6.6 yr; range, 24 to 43 yr) results of LASEK for myopia were analyzed (mean spherical equivalent refraction of -7.16 ? 1.69 D; range, -2.75 to -13.50 D). Corneal flaps were created using the Hansatome microkeratome (Baush & Lomb Surgical) with a 160-jtm plate and a 9.5-mm suction ring. Corneal thickness was evaluated using an ultrasonic 50-MHz pachymeter (Sonogage Corneo Gage Plus) and the mean keratometric power was measured with a Corneal Analysis System videokeratographic unit (EyeSys). Data were analyzed using /-test, Pearson product moment correlation coefficient, and Spearman's rho non-parametric correlation coefficients.

RESULTS: Mean corneal flap thickness was 142.6 ± 20.8 µm (range, 107 to 177 /tm), mean flap diameter was 9.9 ± 0.3 mm (range, 9.2 to 10.5 mm), and mean hinge length was 6.2 ± 0.4 mm (range, 5.2 to 7 mm). Statistically significant correlations (P<05) were found between mean keratometric power and flap hinge length, mean keratometric power and flap diameter, preoperative spherical equivalent refraction and flap diameter, corneal thickness and flap hinge length, as well as patient age and corneal thickness.

CONCLUSIONS: The Hansatome microkeratome was an effective and safe instrument in the creation of corneal flaps for LASIK. Consideration of preoperative keratometric power and corneal thickness may help to reduce or avoid complications. [J Refract Surg 2002;18:149-154]
Iatrogenic Keratectasia Following Laser in situ Keratomileusis
Authors: Spadea Leopoldo , Palmieri Giampiero , Mosca Luigi , Fasciani Romina , Balestrazzi Emilio
Published: April 2021

ABSTRACT

PURPOSE: To evaluate keratectasia after laser in situ keratomileusis (LASIK) for high myopia.

METHODS: A 49-year-old male patient with myopia of -23.50 D in both eyes underwent LASIK with a Summit Technology Apex Plus excimer laser. A Moria manually-guided MDSC microkeratome was used. Preoperative corneal topography in both eyes did not reveal underlying or fruste form of keratoconus. Four months after LASDX, a progressive keratectasia occurred in right eye and after 12 months, in left eye. Corneal transplantation was performed in both eyes.

RESULTS: Histological and ultrastructural examinations were performed on one corneal button. The analysis showed regular stromal morphology and cellularity, with no sign of inflammation. The morphometric analysis showed an overall thickness of 334 /cm, with a flap of 262 /on and a stromal residual bed of 72 ?a\, in the center of the button.

CONCLUSION: A LASIK corneal flap made with a planned 120-/tm plate turned out histologically to be approximately 260 ??\ thick, in an eye with a refractive correction of -23.50 D. The excessive flap thickness and excessive ablation produced progressive keratectasia requiring a penetrating keratoplasty. [J Refract Surg 2002;18:475-480]
The Ascent of Mount Everest Following Laser in situ Keratomileusis
Authors: Dimmig Jason W , Tabin Geoff
Published: April 2021

ABSTRACT

PURPOSE: To report the visual experiences of climbers with prior laser in situ keratomileusis (IuASIK) for myopia at extreme altitudes, including the summit of Mount Everest.

METHODS: We measured the visual acuity of 12 LASIK eyes of 6 Mount Everest climbers at base camp (17,600 ft). Results are reported on their subjective visual experiences, as all climbers ascended above 26,000 feet and four reached the 29,035-foot summit.

RESULTS: Five of the six climbers reported no visual changes up to 26,400 feet. Three climbers noted no problems and perfect vision with their LASDX eyes on the summit of Mount Everest. One reported mild blurring with ascent above altitudes of 16,000 feet that improved with descent, or a prolonged stay at altitude. Two climbers reported blurred vision at 27,000 and 28,500 feet, respectively, which improved with descent.

CONCLUSION: Laser in situ keratomileusis may be a good choice for patients involved in high altitude activities. Patients achieving extreme altitudes of 26,000 feet and above should be aware of possible fluctuation of vision. [J Refract Surg 2003; 19:48-51]
Intraocular Pressure in Myopic Patients After Worst-Fechner Anterior Chamber Phakic Intraocular Lens Implantation
Authors: Aguilar-Valenzuela Lucrecia , Lleó-Pérez Antonio , Alonso-Muñoz Luis , Casanova-Izquierdo Joaquin , Pérez-Moltó Francisco José , Rahhal Mohamed Saleh
Published: April 2021

ABSTRACT

PURPOSE: To assess intraocular pressure measured with a Goldmann tonometer over a period of 1 year after implantation of a Worst-Fechner anterior chamber phakic intraocular lens to correct myopia of -7.00 D or more.

METHODS: We performed a prospective, nonmasked study of 100 patients (100 myopic eyes) who had a Worst-Fechner phakic intraocular lens implanted to correct myopia of -7.00 D or greater. Central corneal Goldmann tonometry was performed before surgery and 1, 3, 6, and 12 months after surgery. The influence of different variables was assessed.

RESULTS: IOP showed a significant increase of of a mean 2.1 mmHg at 3 months after surgery (P=. 001). There was not a statistically significant difference between IOP before surgery and 6 months after PIOL implantation (P=.244) or 1 year after surgery (P=.845). In one eye, the lens was explanted 11 months after surgery because of the presence of ocular hypertension. No variables studied showed a statistically significant difference from before to after surgery.

CONCLUSIONS: Worst-Fechner anterior chamber phakic intraocular lens implantation led to a slight transitory increase of intraocular pressure during the first 3 months after surgery, but returned to preoperative levels by 6 months after implantation. [J Refract Surg 2003; 19:131-136]
Partial Flap During Laser in situ Keratomileusis: Role of Smaller Diameter Corneal Flap of Original Thickness
Authors: Fogla Rajesh , Sitalakshmi Guruswamy
Published: April 2021

ABSTRACT

PURPOSE: To report results of smaller diameter corneal flap of original thickness in the management of partial flap during laser in situ keratomileusis (LASIK).

METHODS: Retrospective review of the case records of three patients (3 eyes) who had a partial corneal flap during LASIK.

RESULTS: Retreatment was performed using an 8.5-mm-diameter corneal flap, which was smaller than the original partial flap of 9.5-mm diameter. The reçut depth was maintained as the original cut depth of 160 µm. No intraoperative or postoperative complications were noted. At follow-up 4 weeks later, two patients had an uncorrected visual acuity of 20/20. One patient had uncorrected visual acuity of 20/40 that improved to preoperative best spectacle-corrected visual acuity of 20/30 with a correction of +0.50 -1.2? ? 170°.

CONCLUSION: A smaller diameter corneal flap of original thickness can be used for retreatment of partial flap during LASIK. A thicker posterior stromal bed after laser ablation may be retained with this technique, compared to retreatment using a corneal flap of greater thickness. [J Refract Surg 2003;19:165-168]
Safety of Laser in situ Keratomileusis Performed Under Ultra-thin Corneal Flaps
Authors: Lin Robert T , Lu Stephanie , Wang Lan Lan , Kim Elli S , Bradley Jarrod
Published: April 2021

ABSTRACT

PURPOSE: To report on the safety of laser in situ keratomileusis (LASIK) performed under ultra-thin corneal flaps (Micro-LASIK).

METHODS: We performed a retrospective review of 1131 eyes that underwent LASIK for myopia with the Nidek MK-2000 microkeratome, and Nidek EC5000 excimer laser. The 130-/nn head and 8.5-mm ring were used in 1042 eyes and the 160-jim head and 9.5-mm ring were used in 89 eyes. For 175 eyes, intraoperative ultrasonic pachymetry was used to measure central corneal thickness and central bed thickness. Flap thickness was calculated by subtracting bed thickness prior to laser ablation from central corneal thickness. All 175 of these eyes had keratectomies using the 130-/¿m head and 8.5-mm ring.

RESULTS: At last follow-up, 455 eyes (40%) achieved 20/20 or better, 798 eyes (70%) achieved 20/25 or better, and 1077 eyes (95%) achieved 20/40 or better uncorrected visual acuity; 922 eyes (82%) achieved within 1 line of their best spectaclecorrected visual acuity. The following clinically significant complications were observed: four epithelial defects (3.5%), zero irregular flaps (0%), seven stria (0.6%), one diffuse lamellar keratitis (0.1%), one epithelial ingrowth (0.1%), and zero infections (0.0%). Two eyes (0.2%) with stria had 20/40 best spectacle-corrected visual acuity, but lost more than 2 lines of best spectacle-corrected visual acuity. The average measured flap thickness was 87.3 ± 15.4 /an.

CONCLUSION: LASIK can be performed safely under ultra-thin corneal flaps. [J Refract Surg 2003;19(suppl):S231-S236]
New Test Hemisphere for Evaluation and Development of Ablation Profiles
Authors: Vinciguerra Paolo , Camesasca Fabrizio I , Munoz Maria Ingrid Torres
Published: April 2021

ABSTRACT

PURPOSE: To develop and apply a new evaluation device for testing excimer laser ablation that allows a three-dimensional test of the characteristics of the imparted ablation.

METHODS: A specially designed PMMA hemisphere with a 43.00-D curvature was developed, and results obtained with different algorithms and profiles of curvature with the Nidek EC-5000 excimer laser were evaluated. Topography, OPD-scan, wavefront, and keratoscopy were performed before and after ablation.

RESULTS: The test hemisphere proved to be a reliable tool, allowing repeatable ablation results, precise calibration results, as well as experimental evaluation and comparison of new profiles.

CONCLUSION: This new PMMA hemisphere can be used to improve the understanding of commonly used ablation algorithms and profiles, as well as in the daily safety routine and the experimental development and evaluation of advanced treatment solutions in excimer laser refractive surgery. [J Refract Surg 2003;19(suppl)S2e0-S264]
Statistical Analysis of Physiological Aberrations of the Cornea
Authors: Vinciguerra Paolo , Camesasca Fabrizio I , Calossi Antonio
Published: April 2021

ABSTRACT

PURPOSE: To determine corneal aberrometric values in a normal population.

METHODS: Corneal topography from a group of 4340 patients was retrospectively evaluated. Exclusion criteria were applied in order to select a population with good visual acuity, no previous ocular surgery, no contact lens influence, and no corneal disease. Aberrometric analysis of the corneal wavefront derived from the topographical data of the selected population was performed. Topography from 500 patients (1000 eyes) was selected for Zernike analysis of the corneal surface, with coefficients derived up to the tenth order.

RESULTS: Corneal surface aberration values related to different pupil diameter were determined.

CONCLUSION: This preliminary study provided reference values for corneal aberrations in the normal population. [J Refract Surg 2003;19(suppl): S265-S269]
The Advantages of Interrupted Sutures and a Therapeutic Lens in Keratoplasty
Authors: Paglen Patrick G , Webster Robert G , Abbott Richard L
Published: April 2021

SUMMARY

Forty-one consecutive keratoplasties were performed using interrupted sutures with exposed knots in combination with therapeutic lenses applied at the time of surgery. We found that this technique offers the advantages of interrupted sutures and provides maximum comfort. The therapeutic lens prevents problems with faulty re-epithelialization, discourages vascularization, and allows easy and selective suture removal. Early final visual rehabilitation was possible because all sutures were safely removed by 15 weeks.
Sidewall-Holed Needle for Anterior Chamber Infusion
Authors: Kaufman Paul L , Friske Harlan H
Published: April 2021

SUMMARY

A solid-tipped, sidewall-holed needle for anterior chamber infusion during intraocular surgery is described. The needle is passed through the corneal limbus and entirely across the periphery of the anterior chamber, so that the point emerges 2 to 3 clock hours from the entry site, with the sidewall hole centered in the chamber 1 to 1.5 clock hours from both entry and exit sites. There is no edge or point in the anterior chamber, the needle is firmly anchored to the eye at the two fixation points, the globe may be freely rotated, and the surgical field is unobstructed.
Carbon Dioxide Laser Beam Control for Corneal Surgery
Authors: Keates Richard H , Pedrotti Leno S , Weichel Hugo , Possel William H
Published: April 2021

SUMMARY

Precise control of output power and beam divergence of a CO2 laser resulted in focused beam diameters down to 25 microns and essentially continuous control of energy deposition on target. Application of controlled laser beams on cow, hog, and human eye-bank reject corneal tissue gave evidence of well-defined, narrow cuts. The controllable penetration depth and width of the CO2 laser incisions seem to make the laser an ideal "knife" for such corneal modifications as radial keratotomy and epikeratophakia. Our results indicate that the CO2 laser, when successfully integrated with the standard slit lamp, may be a safe and useful tool in laser surgery of the cornea.
Closed Chamber Iridoplasty
Authors: Pallin Samuel L
Published: April 2021

SUMMARY

A patient with iatrogenic, ultrasound-induced hemi-iris atrophy complained of intraocular lens edge glare and intolerable monocular diplopia. A surgical reconstruction of the iris was undertaken utilizing a new suture manufactured by Ethicon for retention and stabilization of the pupillary lens implant during secondary procedures. A straight general surgical needle 15 mm in length swedged to a 10-0 prolene ophthalmic suture is used to cross the anterior chamber limbus to limbus. The resulting horizontal trans AC suture retains the pupillary lens in position. The McCannel suture technique is modified to produce intracameral iris repair with interrupted 10-0 prolene.
Midline Forehead Flap in Reconstructive Procedures of the Eyelids and Exenterated Socket
Authors: Dortzbach Richard K , Hawes Michael J
Published: April 2021

SUMMARY

The midline forehead flap is a good, versatile alternative when more standard techniques cannot be used to reconstruct the eyelids, medial canthus or exenterated socket. Indications are where: (1) the recipient site has a poor blood supply; (2) standard reconstructive procedures have failed; (3) deep, as well as superficial, tissue loss is present; and (4) extensive tissue loss is present. Four patients illustrate the value and versatility of the midline forehead flap. Disadvantages also are discussed.
Amputation Neuroma Mistaken for Recurrent Melanoma in the Orbit
Authors: Folberg Robert , Bernardino Vitaliano B , Aguilar Gary L , Shannon Gerard M
Published: April 2021

SUMMARY

A 69-year-old white male had an enucleation for a choroidal melanoma 18 years ago. He had an orbital recurrence 26 years later necessitating an exenteration. Four years later, the patient complained of severe pain and a mass lesion at the apex of the orbit. Biopsy of the lesion revealed amputation (traumatic) neuroma.
Role of the CO2 Laser in Chorioretino-iridocyclectomy
Authors: Peyman Gholam A , Salzano Thomas C , Green James L , Andrews Albert H
Published: April 2021

SUMMARY

Surgical extirpation of a uveal melanoma was performed by a sclerochorioretino iridocyclectomy using an externally focused CO2 laser. This was followed by a lens extraction and partial vitrectomy. The uveal melanoma proved to be of a mixed cell type.

The minimal operative and postoperative hemorrhaging was attributed in part to the cauterizing cutting characteristics of the CO2 laser. Extensive coagulation necrosis produced by the CO2 laser precluded precise histopathologic evaluation of the resected tissue margin.
Pars Plana Lensectomy for Subluxated and Dislocated Lenses
Authors: Girard Louis J
Published: April 2021

SUMMARY

Pars plana lensectomy by ultrasonic fragmentation appears to be the treatment of choice for extraction of subluxated and dislocated lenses. The closed system technique allowed extraction of 11/11 subluxated lenses without operative or postoperative complications with an average observation period of 4.5 years. The technique was employed in four traumatica I Iy dislocated lenses in eyes with accompanying traumatic pathology requiring additional surgical procedures, i.e., cryoretinopexy and sclera) buckling. There were no complications in 4/4 eyes with an average observation period of 1.5 years. Pars plana lensectomy avoids many of the complications of the open-sky limbal approach i.e. anterior synechiae, vitreous incarceration, wound dehiscence, aphakic or pupillary block glaucoma, bullous keratopathy, epithelial ingrowth, stremai ingrowth or outgrowth and surgically induced astigmatism.
Foveal Pathology Following Anterior Segment Injury
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

A case of traumatic ocular perforation and aphakia resulting in enucleation after six weeks is used to demonstrate histopathological details of an early stage of a typical foveal involvement with grossly visible petaloid swelling of the central retina, separation of the inner limiting membrane with some exudate, massive swelling and early cystoid degeneration of Henle's fiber layer and a vertical retinal fold of the outer retinal layers extending downward from the foveola. This demonstration is important in view of its possible relationship to the clinical entity of cystoid macular edema.
Silicone Rod Frontalis Sling For the Correction of Blepharoptosis
Authors: Leone Charles R , Shore John W , Van Gemert John V
Published: April 2021

SUMMARY

A frontalis sling procedure for blepharoptosis using a 1 mm solid silicone rod is described. This procedure is ideal for patients requiring frontalis suspension who are at risk for postoperative exposure keratopathy, or for patients likely to need postoperative eyelid position adjustment. These would include individuals with chronic progressive external ophthalmoplegia, third nerve paralysis, and myasthenia gravis. The advantages of this technique are the elasticity and the availability of the silicone rod, together with formation of an eyelid crease and ability postoperatively to adjust the position of the upper eyelid.
Iridoplasty for Prevention of Post-Keratoplasty Angle Closure and Glaucoma
Authors: Cohen Elisabeth J , Kenyon Kenneth R , Dohlman Claes H
Published: April 2021

SUMMARY

Twenty patients who had iridoplasties performed at the time of penetrating keratoplasty were followed for a minimum of nine months. Although 12 patients had peripheral anterior synechiae (PAS) preoperatively, only four developed progressive PAS and secondary angle closure glaucoma postoperatively. Our experience suggests that iris suturing, by producing a mechanically rigid iris diaphragm, may prevent postoperative anterior synechiae and appositional angle closure.
Progressive Endothelial Cell Loss Following Repeat Radial Keratotomy - A Case Report
Authors: Salz James J
Published: April 2021

SUMMARY

A 57-year-old female patient underwent 1 6-incision radial keratotomy followed by four additional re-operations in an attempt to eliminate her myopia (-5.75). Although she finally attained an excellent visual result uncorrected to 20/40), she sustained an endothelial cell loss of 24%, and her cornea showed excessive scarring and focal epithelial inclusion cysts indicative of poor wound healing. Re-operations for myopia should be approached with great caution because of these potential complications.
Foreign Body Giant Cells Selectively Covering Haptics of Intraocular Lens Implants: Indicators of Poor Toleration?
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

A Sputnik lens implant removed after five years because of bullous keratopathy exhibits a dense covering of its Supramid anterior staves with large foreign body giant cells, while its Prolene loops and Polymethylmethacrylate optics have attracted only few of these cell units. The glass-membrane-like component of the reactive membrane also shows significant differences on the different parts of this implant. The use of observation of the components of reactive membranes on lens implants as indicators of toleration in the eye is suggested.
Sebaceous Adenocarcinoma of the Eyelid
Authors: Epstein Gil A , Putterman Allen M
Published: April 2021

SUMMARY

Sebaceous adenocarcinoma is a rare neoplasm of the eyelid that often masquerades as a chalazion, blepharitis, or blepharoconjunctivitis. Controversy exists as to the proper mode of therapy for patients with a tumor confined to the eyelid. We believe that wide local excision (5 to 6 mm of normal tissue) with frozen section analysis and eyelid reconstruction is the preferred treatment. Only 1 of 11 patients had a recurrence with this technique. No regional or distant metastasis has occurred in an average of 68 months of follow-up.
A Computerized Analysis of Astigmatism After Cataract Surgery
Authors: Jampel Henry D , Thompson John R , Baker C C , Stark Walter J
Published: April 2021

ABSTRACT

We have performed a computerized analysis of postoperative changes in corneal astigmatism in 203 consecutive cases of extracapsular cataract extraction with posterior chamber intraocular lens implantation performed by one surgeon. Surgical technique was standardized consisting of a 140 degree posterior Hmbal incision with ? replaced 9-0 silk and postplaced 10-0 nylon sutures. The average postoperative astigmatism was 1.60 D and the average surgically induced change in astigmatism 0.51 D after a mean follow-up of 5.4 months. When the axis of astigmatism was considered, cataract surgery on the average initially induced 2.2 D of with-the-rule astigmatism which gradually declined, stabilizing at 0.35 D against-the-rule 19 weeks postoperatively. An analysis of the natural history of astigmatism after cataract surgery helps to optimize the timing of spectacle prescription and postoperative Intervention to correct excessive astigmatism. A computerized astigmatism analysis also provides rapid feedback to guide changes in surgical technique to minimize astigmatism.
Macular Hole-Induced Retinal Detachment: Treatment with an "Armed-Silicone" Implant
Authors: Landolfo V , Albini L , Romano A
Published: April 2021

ABSTRACT

Thirty-two cases of retinal detachment with macular hole have been treated by applying an expiant made of a stainless steel sheet embedded in silicone. The results obtained were very encouraging, and the technique is recommended especially when a vitrectomy cannot be performed.
Diagnosis and Therapeutic Surgery of the Uvea - Part I: Surgical Technique
Authors: Peyman Gholam A , Raichand Motilal , Schulman Joel
Published: April 2021

ABSTRACT

Surgical techniques of iridocyclectomy, iridochoroidectomy, eye wall resection, eye wall biopsy, and ab interno retinochoroidectomy are described. Surgical approaches to uveal neoplasms offer a new alternative for management of these disorders. Uveal and retinal biopsy expand our knowledge of pathological processes involved in tapetoretinal degeneration and uveitides. Additionally, both eye wall biopsy and resection provide tissue to confirm tumor diagnosis and malignancy.
Cicatricial Entropion: An Analysis of its Treatment With Transverse Blepharotomy and Marginal Rotation
Authors: Millman Arthur L , Katzen Lawrence B , Putterman Allen M
Published: April 2021

ABSTRACT

Transverse blepharotomy with marginal rotation is a simple and effective procedure to treat cicatricial entropion of diverse etiology in upper and lower eyelids. The surgeon can vary the site of incision and suture placement to control the amount of marginal rotation required. We treated 152 eyelids (98 patients) with this technique, obtaining an 85% overall success rate. Eleven recurrences were found in 7 of 18 lids with ocular pemphigoid; the success rate for this subgroup was 39% compared with 92% for all others. We recommend this procedure as a technically easy treatment for cicatricial entropion not caused by ocular pemphigoid.
Pupil Size After Extracapsular Cataract Extraction and Posterior Chamber Lens Implantation: A Prospective Randomized Trial of Epinephrine and Acetylcholine
Authors: Elliott Andrew , Carter Colin
Published: April 2021

ABSTRACT

The effects of using epinephrine in the irrigating fluid and intracameral acetylcholine were studied by measuring changes in pupil size in the 48 hours following extracapsular cataract extraction and intraocular lens implantation in 39 eyes. Epinephrine reduced peroperative pupil constriction, but its effect was insignificant thereafter. The pupil constriction following acetylcholine was maximal at 2 hours and was still significant at 4 hours, but pupils redilated by 6 hours. Neither drug had any effect after this time. The edge of most lens implants was visible at 6 hours, after which pupils steadily constricted.
Postoperative Complications and Visual Loss Following Molteno Implantation
Authors: Lotufo David G
Published: April 2021

ABSTRACT

A retrospective review of 16 initial, consecutive cases of Molteno implantation with at least 6 months of follow up showed that all eyes developed either or both early-onset (12 eyes) or late-onset (7 eyes) complications. The early-onset complications, which included choroidal effusions and flat anterior chambers, tended to resolve without difficulty. By contrast, the late-onset complications, which included 4 implant extrusions, 2 vitreous hemorrhages, 1 persistent hyphema, 1 cystoid macular edema, 1 opacified vitreous face, and 1 tractional detachment with fibrous ingrowth, tended to herald poor visual prognoses. Implant removal was required in three cases. Overall, vision improved in 3 eyes (18.8%), remained unchanged in 3 (18.8%), and deteriorated two or more lines in 10 (62.4%). In 3 eyes vision deteriorated to no light perception; 2 of them became phthisical. These complications often occurred despite successful control of intraocular pressure (< 23 mm Hg). The relatively high complication rates in this series as compared with previously reported ones probably reflects a combination of factors not necessarily related to the Molteno surgery; primarily, the patients in this small series may have had more severe disease and more prior surgeries than those in other such series.
Computer-Assisted Study of Diurnal Variation in Corneal Topography After Penetrating Keratoplasty
Authors: Kwitko Sergio , Garbus Jenny J , Hwang David G , Gauderman W James , McDonnell Peter J
Published: April 2021

ABSTRACT

Diurnal changes in corneal topography have been documented to be greater in eyes following radial keratotomy that in normal eyes. To determine whether substantial changes of this nature result from corneal incisions in general or are a specific complication of radial keratotomy, we examined 12 corneas (10 patients) after penetrating keratoplasty for diurnal changes, using a computerized corneal topographic analysis system. Diurnal changes in keratometry readings, central corneal thickness, intraocular pressure, and refraction also were analyzed. From morning to evening, central corneal curvature flattened by an average of 0.74 ± 0.18 diopters in eight eyes (67%), and steepened by an average of 2.00 ± 0.53 D in four eyes (33%). Diurnal changes in central corneal thickness were correlated with diurnal changes in central corneal curvature (r = 0.63.P < .05). These data suggest that changes in corneal thickness over the course of the day may partially account for the changes in corneal curvature demonstrated to occur following penetrating keratoplasty.
Sub-Tenon's Infusion of Local Anesthetic for Strabismus Surgery
Authors: Steele Mark A , Lavrich Judith B , Nelson Leonard B , Koller Harold P
Published: April 2021

ABSTRACT

We used a blunt irrigating cannula to infuse tetracaine 0.5% solution into the posterior sub-Tenon's space in 26 consecutive patients undergoing strabismus surgery under local anesthesia. All patients were sedated with combinations of fentanyl citrate and either propofol or midazolam. The results suggest that this technique is a safe and effective method of performing strabismus surgery under local anesthesia.
Sudden Vision Loss Following Retinal Detachment Surgery
Authors: Talwar Dinesh , Sharma Y R , Tewari H K , Khosla P K
Published: April 2021

ABSTRACT

A 22-year-old man with Eales' disease with secondary rhegmatogenous retinal detachment with a break five disc diameters from the disc underwent radial scleral buckling using a silicone sponge episcleral expiant with local cryopexy. Five hours after surgery the patient had no light perception. There was no intraoperative or postoperative rise of intraocular pressure or central retinal artery ischemia. Immediate removal of the expiant brought a return of light perception and postoperative visual acuity improvement. The episcleral expiant may have caused the direct optic nerve trauma that resulted in loss of vision.
Reduction of Postoperative Adhesions Secondary to Strabismus Surgery in Rabbits
Authors: Yaacobi Yoseph , Hamed Latif M , Kaul Karen S , Fanous Maher M
Published: April 2021

ABSTRACT

The efficacy of tissue coating with sodium hyaluronate solution or oxidized regenerated cellulose (Interceed®) sleeves in reducing the occurrence and severity of postoperative adhesions following strabismus surgery was tested in rabbits in vivo and compared with the efficacy in this regard of treatment with balanced salt solution. The use of Interceed sleeves significantly increased formation of postoperative adhesions, but coating with sodium hyaluronate solution prior to and during surgery significantly reduced such formation.
Isolated Ocular Cryptococcosis in an Immunocompetent Patient
Authors: Hester Darrell E , Kylstra Jan A , Eifrig David E
Published: April 2021

ABSTRACT

A 62-year-old woman without evidence of immunocompromise was evaluated for uveitis and a subretinal lesion in the right eye. Laboratory evaluation, including cerebrospinal fluid analysis, revealed no apparent cause. The diagnosis of subretinal cryptococcosis was established by transscleral needle biopsy of the subretinal mass. Treatment with intravenous amphotericin B and oral 5-flucytosine brought recovery of visual acuity to 20/30-1 and resolution of the inflammation. This patient demonstrates that ocular cryptococcal infection must be suspected, even in the absence of predisposing factors or systemic findings, and that subretinal fine-needle aspiration is an important diagnostic tool in this setting.
Oculocardiac Reflex in the Anophthalmic Socket
Authors: Ginsburg Robin N , Cartwright Mont J , Murad Sharlet S , Nelson Christine C
Published: April 2021

ABSTRACT

The oculocardiac reflex occurred in a patient with an anophthalmic socket undergoing surgery for inferior fornix shortening and laxity of the lower lid. This reflex occurs only rarely in anophthalmia; it has not been previously reported during socket surgery.
Monocular Traumatic Cataract, Extraocular Muscle Deviation, and Intraocular Lens Implantation
Authors: Alpar John J
Published: April 2021

ABSTRACT

I report seven patients with monocular traumatic cataract who had either preinjury or postinjury extraocular muscle deviation. All but one were managed with cataract extraction and intraocular lens implantation, without muscle surgery. If muscle surgery is required in such cases, I recommend that it be delayed until at least a year after the cataract and lens implantation surgery.
The Effect of Diclofenac Sodium Ophthalmic Solution on Intraocular Pressure Following Cataract Extraction
Authors: Strelow Scott A , Sherwood Mark B , Broncato Lorraine J B , Napier Alison , Driebe William T , Guy John R , Vickers Florence F , Mellars Kathleen
Published: April 2021

ABSTRACT

Ninety-two nonglaucomatous patients undergoing extracapsular cataract extraction with implantation of a posterior chamber intraocular lens by residents at a Veterans hospital were randomized in double-masked fashion to receive either a topical nonsteroidal antiinflammatory agent, diclofenac sodium 0.1%, or a placebo consisting of vehicle only. One drop of placebo or diclofenac sodium 0.1% was administered on an inpatient basis by trained staff every 6 hours for three doses, starting the afternoon prior to surgery. A further drop was given at 90, 60, 30, and 15 minutes before the operation. Starting 24 hours after surgery, all patients received diclofenac sodium 0.1%. All patients remained hospitalized for 72 hours postoperatively. Mean baseline intraocular pressure (IOP) was 14.0 and 14.1 mm Hg in the diclofenac and placebo groups, respectively. IOP rose 8.6 mm Hg in both groups at 6 hours after surgery. At 24 hours, the mean IOP elevation from baseline was 11.3 mm Hg in the diclofenac group and 9.6 mm Hg in the placebo group (P = .47). Within the first 24 hours, IOP spiked more than 10 mm Hg in 57% (26/46) of the diclofenac patients and in 54% (25/46) of the placebo patients.

These results suggest that diclofenac sodium 0.1% drops affect neither the incidence nor the height of IOP elevation following cataract surgery.
Determination of an Appropriate Laser Setting for THC-YAG Laser Sclerostomy Ab Externo In Rabbits
Authors: Onda Eiji , Jikihara Shuichi , Kitazawa Yoshiaki , Honbe Kazuhiro , Ando Hiroshi
Published: April 2021

ABSTRACT

To determine an appropriate setting for the THC-YAG laser (chromium-sensitized, thulium, and holmiumdoped YAG laser), we performed sclerostomy ab externo on 24 pigmented rabbits. The laser energy was delivered via a subconjunctivally-inserted fiberoptic probe that was placed at the limbus through a small conjunctival incision. We used four pulseenergy levels to perform the sclerostomies: 80 mJ, 120 mJ, 160 mJ, and 200 mJ. At all these levels, a new outflow pathway was easily created, a filtering bleb was formed, and intraocular pressure (IOP) was immediately reduced. Severe tissue damage around the sclerostomy site occurred with the 160-millijoule and 200-millijoule pulses. The 80-millijoule pulse created a relatively small patent sclerostomy, providing only relatively brief IOP reduction. We conclude that 120-millijoule is the most appropriate laser-pulse energy for use in pigmented rabbits.
Acute Postoperative Endophthalmitis Associated With Dual Strains of Staphylococcus epidermidis
Authors: Maxwell Donald P , Baber Wilson B
Published: April 2021

ABSTRACT

We report, to our knowledge for the first time, a dual-strain infection causing endophthalmitis. This case demonstrates the importance of sampling both anterior chamber and vitreous in all cases of endophthalmitis.
Computed Axial Tomography on Highly Myopic Eyes Following Scleral Reinforcement Surgery
Authors: Thompson Frank B , Turner A Franklin
Published: April 2021

ABSTRACT

We performed computed tomography (CT) studies on six patients (with follow up ranging from 8 months to 18 years) following scleral reinforcement surgery, comparing the density of the observed implanted scleral material with both normal human sclera and myopic sclera. Results demonstrated the presence of a material on the posterior pole with a density greater than or equal to the experimentally determined density of ungrafted donor sclera. We conclude that CT is a useful method of evaluating both the position and long-term stability of implanted donor sclera.
Pigmentary Dispersion Syndrome and Pigmentary Glaucoma: A New Mechanism Concept, A New Treatment, and A New Technique
Authors: Karickhoff John R
Published: April 2021

ABSTRACT

Reverse pupillary block is introduced as a new cataract-implant complication and as the principle mechanism in pigmentary dispersion syndrome (PDS) and pigmentary glaucoma (PG), causing posterior iris bowing and zonular rubbing. This mechanism was investigated by performing laser iridotomy on six patients. Following surgery, the iris moved forward completely and permanently to the planar position. A new technique, locating the iridotomy by transillumination, reduced the laser energy needed for iridotomy. Laser iridotomy located with transillumination is recommended as the treatment for iris-zonular rubbing in PDS and PG caused by reverse pupillary block.
Peripheral Anterior Synechiae Formation With Anterior Chamber Intraocular Lenses
Authors: Smith S Gregory , Holland Edward , Peterson Jonathan
Published: April 2021

ABSTRACT

In a cross-sectional study, 88 eyes with anterior chamber intraocular lenses (AC-IOLs) were evaluated by goniophotography by one masked observer for the presence of peripheral anterior synechiae (PAS) and by another masked observer for the length of the AC-IOL. Sixty-eight of the 88 lenses had PAS which were strongly correlated with the lens being oversized (P <.001). However, differences in haptic style or lens rigidity were not associated with the presence of PAS.
Disruption of the BloodAqueous Barrier by Residual Lens Epithelial Cells After Intraocular Lens Implantation
Authors: Nishi Okihiro , Nishi Kayo
Published: April 2021

ABSTRACT

We performed a clinical study to confirm whether and how residual lens epithelial cells (LECs) participate in postoperative Pseudophakic inflammation, including fibrin reaction. Twenty-six eyes of 13 patients with bilateral cataracts were treated by phacoemulsification and posterior chamber intraocular lens (PC-IOL) implantation. In the eye from which LECs had not been removed, the aqueous flare was measured with a laser flare-cell meter. Flare decreased from an initial peak, increasing again to form a flare spike when LECs came into contact with the PC-IOL and began to undergo fibrous proliferation at 6 to 14 days after surgery. The spike was evidence that the bloodaqueous barrier had been disrupted again. Fibrin reaction developed in two eyes. In the other eye of each pair, from which LECs had been removed by ultrasound aspiration, neither a flare spike nor fibrous proliferation was noted. We conclude that residual LECs break down the blood-aqueous barrier as they proliferate and are involved in postoperative Pseudophakic inflammation.
Complications of Secondary Surgical Capsulotomy in Pseudophakic and Aphakic Eyes
Authors: Léonard Paul A M , Klevering Bert J , de Keizer Robert J W
Published: April 2021

ABSTRACT

A retrospective study was conducted to analyze the complications of surgical capsulotomy in 587 eyes51 aphakic and 536 Pseudophakic. Transient or permanent complications occurred in 20 (3.4%). One eye was seriously damaged by perforation during retrobulbar anesthesia, and another eye was lost due to endophthalmitis. Endophthalmitis developed in two other eyes, but it readily resolved with medication. Two eyes had markedly elevated intraocular pressure (IOP) (> 35 mm Hg), which was associated with the presence viscoelastic material in one eye; in the other eye, elevated IOP was the result of vitreous blocking of the pupillary aperture. Retinal detachments developed in nine patients (eight of whom, a significant number [P = .006], were males). Apart from the eyes in which endophthalmitis developed, all were markedly quiet after the procedure, and pressure elevation was not significant.
Correlation of Full-Thickness Corneal Wound Length With Endothelial Cell Loss
Authors: Kletzky Deborah L , Parver Leonard M , Mathers William D
Published: April 2021

ABSTRACT

We studied 12 patients who had sustained penetrating corneal lacerations with corneal wound lengths ranging from 1 to 9 mm to determine whether wound size was directly proportional to endothelial cell loss 3 or more months after injury. Endothelial cell counts in the uninjured eye averaged 2973 ± 330 cells/mm
p 2
(range, 2500 to 3700). In the injured eye, near the wound (< 2 mm from the wound), the cell counts averaged 1260 ± 590 cells/mm
p 2
(range, 575 to 2500); away from the wound, where cells appeared healthiest, counts averaged 1619 ± 544 cells/mm
p 2
(range, 850 to 2750). The average total cell loss near the wound was 1713 ± 622 cells/mm
p 2
(range, 500 to 2575), vs 1354 ± 582 cells/mm
p 2
(range, 250 to 2150) away from the wound, compared with the uninjured eye. Cell loss near the wound was not significantly different from that away from the wound. There was a positive correlation between wound length and total cell loss measured both near the wound (r = 0.830) and away from the wound (r = 0.755). Pars plana lensectomy was not associated with detectable additional cell loss. Our results suggest that patients with corneal lacerations sustain significant endothelial cell loss, which correlates closely with wound length, and that patients with larger wounds may be at greater risk for developing corneal decompensation with additional procedures or trauma.
Incidence of Inadvertent Perforation in Strabismus Surgery
Authors: Cibis Gerhard W
Published: April 2021

ABSTRACT

We conducted a prospective study for over 2 years to determine the incidence of perforations following strabismus surgery. All eyes were examined by indirect ophthalmoscopy and indentation immediately after surgery in an attempt to identify perforation sites. No cryotherapy or treatment was done. None of the 10 perforations identified was associated with retinal detachment or endophthalmitis. The incidence of perforations was 2.8% on a per-case basis and under 1% on a per-muscle basis.
Devices for the Control of Laser Transmission Across the Sclera During Transscleral Photocoagulation
Authors: Rol Pascal , Fankhauser Franz , Barth Werner , Fankhauser Sylwia , Schwager Michael , Niederer Peter , Zuber Nathalie
Published: April 2021

ABSTRACT

Improving the reproducibility of transscleral photocoagulation necessitates controlling the transmission of the laser beam through the sclera. Two factors make such control problematic: the locally increased transparency of the sclera resulting from the contact procedure and the occurrence of time-related relaxation phenomena. Two instruments have been devised to help control these factors. The first is a mechanical compensation unit comprised of magnets and a spring that allows the force exerted on the sclera to be adjusted to between 0.1 and 0.4 N, the pressure being determined by the outer diameter of the contact tip. The second instrument monitors the portion of the aiming beam reflected by the sclera as a means of determining the exact level of power actually transmitted through it. This information theoretically could be fed back to the treatment laser, allowing the level of power being delivered to be adjusted accordingly.
Canaliculocystostomy Combining Microsurgery and Fibrin Sealing of the Anastomosis
Authors: Steinkogler Franz Josef
Published: April 2021

ABSTRACT

I present a method of using fibrin sealing for anastomosis in canaliculocystostomy. A microsurgical resection of the stenosis of the common canaliculus is followed by silicone intubation of the lacrimal apparatus and fibrin sealing of the anastomosis of the canaliculi and the lacrimal sac. The silicone tube is removed 6 months postoperatively. This technique obviates microscopic sutures, reduces operating time, and provides hemostasis. Of seven patients with monolateral stenosis of the common canaliculus in whom this technique was used and who were followed for a minimum of 3 years, only one had a restenosis.
Sub-Tenon's Anesthesia for Trabeculectomy
Authors: Ritch Robert , Liebmann Jeffrey M
Published: April 2021

ABSTRACT

Sub-Tenon's anesthesia for anterior segment surgery avoids the risks associated with retrobulbar and peribulbar injections. Localized injections over the appropriate rectus muscles ensure patient comfort as well as optimal exposure of the surgical field in eyes undergoing trabeculectomy. We have used this technique without significant complications in approximately 400 procedures.
Effects of Flurbiprofen and Suprofen on the Miotic Activity of 1% Acetylcholine and 0.01% Carbachol
Authors: Yee Richard W , Kocurek Daniel , Yu Hing-Sing , Smith Grant , Lam Christopher
Published: April 2021

ABSTRACT

The nonsteroidal antiinflammatory agents (NSAIAs) flurbiprofen and suprofen applied topically to reduce miosis may counteract the desired effects of miotics used during ocular surgery. In a pigmented rabbit model, 1% acetylcholine was shown to cause a greater, significant initial (for the first 30 minutes) constriction (P < .05) than 0.01% carbachol in eyes pretreated with flurbiprofen and suprofen. From 2 to 8 hours, NSAIA pretreatment had a greater miotic effect with carbachol than with acetylcholine. There were no significant differences between flurbiprofen and suprofen on the miotic effect of carbachol or acetylcholine.
Hemangiopericytoma of the Lacrimal Sac
Authors: Rubin Peter A D , Shore John W , Jakobiec Frederick A , To King
Published: April 2021

ABSTRACT

Hemangiopericytoma is a rare soft-tissue neoplasm composed histologically of pericytes. Hemangiopericytoma of the lacrimal sac is exceedingly rare. This case provided the first known computed tomographic image of a hemangiopericytoma of the lacrimal sac prior to surgical intervention.
Modified SRK Formula for Axial Myopia (24.5 mm ≤ Axial Length < 27.0 mm)
Authors: Kora Yukiko , Totsuka Nobuyoshi , Fukado Yoshinao , Marumori Miki , Yaguchi Shigeo
Published: April 2021

ABSTRACT

When used for eyes with greater than average axial length (AXL), the SRK formula has been reported to have a tendency to yield more myopic refractions than those predicted. To further evaluate such findings, we studied 609 eyes with AXLs between 24.5 and 27.0 mm. Comparing the predicted with the actual refractions and calculating the range of errors, we found that the postoperative refractions were more myopic than predicted. Then, based on our evaluation of the relationship between the postoperative refractions and the powers of the implanted intraocular lenses (IOLs), we devised the following formula:

R = 0.8 × (P - I) + 0.57 (P < .01)

in which R = the postoperative refraction; P = the emmetropie IOL power; and I = the actual IOL power. Testing this modified SRK formula in 55 additional eyes, we found that the predicted postoperative refractions it yielded were more accurate than those calculated using five earlier formulas.
Visual Results and Complications Following Posterior Iris-Fixated Posterior Chamber Lenses at Penetrating Keratoplasty
Authors: Chu Milton W , Font Ramon L , Koch Douglas D
Published: April 2021

ABSTRACT

We retrospectively reviewed the records of 13 patients with pseudophakic bullous keratopathy who had undergone penetrating keratoplasty combined with suturing of a posterior chamber intraocular lens (PC-IOL) with angulated haptics to the posterior iris using the four optic positioning holes. Corneal endothelial decompensation was associated with anterior chamber IOLs in nine cases, with iris-fixated lenses in three cases, and a subluxated PC-IOL in one case. Visual acuity was 20/40 or better in 46%, 20/50 to 20/100 in 31%, and 20/200 or worse in 23%. These visual results are comparable with those reported for other similar surgical series. In four of seven eyes that had preoperative peripheral anterior synechiae (PAS), postoperative extension of at least 2 clock hours occurred; progressive angle-closure glaucoma developed in two of the four. In all four eyes, the extension occurred in the region directly overlying the lens haptics. The angulated haptics of iris-sutured PC-IOLs may predispose to extension of PAS and development of progressive angle-closure glaucoma.
Long-Term Follow Up of Argon Laser Trabeculoplasty in Pigmentary Glaucoma
Authors: Lehto Ilkka
Published: April 2021

ABSTRACT

Nine eyes in nine patients with pigmentary glaucoma were treated with argon laser trabeculoplasty (ALT). The mean age of the patients at the time of treatment was 35 years (range, 25 to 46 years); the mean follow up after treatment was 5.5 years. The initial pressurelowering effect of ALT was 53% (15.3 mm Hg), ie, from a preoperative mean of 29.0 mm Hg to a postoperative mean of 13.7 mm Hg the day after ALT. However, the initial response to ALT wore off in 3 months, after which the intraocular pressure settled at a level 14% (4 mm Hg) lower than before treatment. The rate of failure (ie, unstable glaucoma after treatment) was 11%.