bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral Optic Nerve Sheath Enlargement
Authors: Wojno Ted , Beck Roy W , Grosserode Robert
Published: April 2021

ABSTRACT

A 43-year-old man presented with progressive visual loss in each eye associated with bilateral optic nerve sheath enlargement. At surgery, the left optic nerve sheath was diffusely distended with clear fluid, but biopsy of the optic nerve and its sheath revealed only normal structures. Decompression of the right optic nerve prevented further deterioration of vision in this eye. The etiology of this condition and pathogenesis of visual loss is unknown.
Delivery of Antifibroblast Agents as Adjuncts to Filtration Surgery. Part I - Periocular Clearance of Cobalt-57 Bleomycin in Experimental Drug Delivery: Pilot Study in the Rabbit
Authors: Kay Jeffrey S , Litin Bradley S , Woolfenden James M , Chvapil Milos , Herschler Jonathan
Published: April 2021

ABSTRACT

Antitumor and antifibroblast agents show promise as adjuncts after glaucoma filtration surgery in reducing postoperative scarring and failure. We used nuclear imaging in rabbits to investigate periocular clearance of one such agent (57Co-bleomycin). SubTenon injection was compared to other delivery techniques. Our results showed that a collagen sponge and a silastic disc implant with a microhole prolonged drug delivery when compared to sub-Tenon injection alone or injection with a viscosity enhancing agent (0.5% sodium hyaluronate). We theorize that if an antifibroblast agent can be delivered in small and sustained amounts after filtration surgery, this may prolong bleb longevity and avoid unnecessary drug toxicity.
The Development of a New Tissue Expander for Use in Ophthalmic Plastic Surgery
Authors: Victor Warren H , Hurwitz Jeffrey J , Gruss Joseph S
Published: April 2021

ABSTRACT

We describe the first-time use of the tissue expansion principle in oculoplastic surgery. We have designed a tissue expander for use in eyelid surgery. This instrument was successfully used to treat difficult cases of cicatricial ectropion from multiple causes, avoiding the need for tissue grafting. It was also utilized preoperatlvely so a large forehead scar could be removed with good resultant cosmesis. The potential for this device in oculoplastic surgery is exciting.
Effectivity of Laser Ridge Intraocular Lenses
Authors: Wohl Lisa G , Kline Oram R
Published: April 2021

ABSTRACT

Two hundred fifty intraocular lenses with varying sizes of laser ridges were implanted following extracapsular cataract surgery to determine the effectivlty of the laser ridge in creating a space between the intraocular lens and the posterior capsule. Six weeks postoperatively, the distance between the intraocular lens and the posterior capsule was judged as adequate in 92% of cases with a .35 mm ridge, 88% cases with a .25 mm ridge, and 80% of those with a .15 mm ridge.

A group of non-angulated, non-ridged lenses placed out of the capsular bag had an adequate space in 82% of cases, and a group of non-angulated, non-ridged lenses placed in the capsular bag had only 44% adequate spaces. Intraocular lenses with laser ridges should be used to enhance the space between the intraocular lens and the posterior capsule, thus increasing the safety of postoperative Nd: YAG laser posterior capsulotomy.
Reliability of Lens Implant Power Formulas in Hyperopes and Myopes
Authors: Drews Robert C
Published: April 2021

ABSTRACT

Calculations were made comparing a variety of formulas in patients who required unusually high and low power intraocular lenses. Of the formulas tested, the author found the Colenbrander formula to be more accurate for myopic patients and the SRK formula to be more accurate for hyperopic patients.
Surgery for Corneal Epithelial Basement Membrane Dystrophy
Authors: Wood Thomas O , Griffith Martha E
Published: April 2021

ABSTRACT

Seventeen consecutive eyes with corneal epithelial basement membrane with symptoms of recurrent erosion and/or decreased vision were treated with corneal epithelial basement membranectomy. Younger patients tended to have recurrent erosion, whereas older patients had decreased vision. All patients' symptoms improved following surgery. Electron microscopy revealed reduplication of the corneal epithelial basal lamina.
In Vitro Inhibition of Lens Epithelial Cell Proliferation and Migration
Authors: McDonnell Peter J , Krause William , Glaser Bert M
Published: April 2021

ABSTRACT

Delayed opacification of the posterior capsule is the most common cause of decreased visual acuity after extracapsular cataract extraction. In humans, this has been shown to result from migration and possibly proliferation of residual lens epithelial cells onto the central posterior capsule.

We studied a group of pharmacologic agents to determine their ability to inhibit lens epithelial cell proliferation and migration in vitro. A drug capable of inhibiting lens epithelial cell growth and/or migration, if free of unacceptable toxic effects on other cell populations, might be used to prevent lens capsule opacification. Anti-proliferative activity was exhibited by several agents, with 50% inhibition of growth occurring at the following concentrations: 5-fluorouracil, 30 µg/ml; daunomycin, 10 ng/ml; colchicine, 15 ng/ml; doxorubicin, 5 ng/ml; dexamethasone, 100 ^g/ml; and cytosine arabinoside, 100 ng/ml. Colchicine inhibited lens epithelial cell migration by 50% at 20 ng/ml.
Deep Sclerectomy With Nd:YAG Laser Trabeculotomy Ab Interno: Two-Stage Procedure
Authors: Hara Tsutomu , Hara Takako
Published: April 2021

ABSTRACT

We performed almost the same procedure as Weber's two-stage Nd:YAG laser trabeculotomy. Our technique, developed without knowledge of Weber's findings, also is composed of two stages. In Stage 1, under conjunctival and thin scleral flaps, the deep (4 × 2 mm) scleral block containing the outer wall of Schlemm's canal is removed. Stage 2, the puncturing of the remaining trabeculum with Q-switched Nd:YAG laser, is performed the next day.

We evaluated the technique in 16 eyes of 11 patients with medically uncontrolled phakic open-angle glaucoma and one eye of a pseudophakic patient with a Binkhorst 2-loop lens. All eyes had unacceptable intraocular pressures (IOPs), despite maximum tolerated medical therapy, and two 360° argon laser trabeculoplasties. The mean preoperative and final postoperative IOPs were 38.3 ± 19.1 mm Hg and 16.9 ± 5.3 mm Hg, respectively. Follow-up time was at least 12 months and the results of a 12-month postoperative period were used in all cases. Final postoperative IOP was less than 21 mm Hg in 12 eyes (70%). The only complication during intraoperative and postoperative periods was extremely slight bleeding from the trabeculum or Schlemm's canal in Stage 2; this bleeding was completely absorbed by the following day.
The Intraocular Penetration and Retinal Toxicity of Teicoplanin
Authors: Carney Marcia , Kao Grace , Peyman Gholam A , Fiscella Richard , Staneck Joseph
Published: April 2021

ABSTRACT

We investigated the intraocular penetration and retinal toxicity of teicoplanin, a relatively new glycopeptide antibiotic with activity similar to vancomycin when used to inhibit staphylococci and other gram positive organisms, particularly Streptococcus faecalia. Topically administered teicoplanin penetrated poorly into the aqueous and vitreous in rabbit eyes. Subconjunctival injection of the drug yielded aqueous levels above the minimum inhibiting concentration (3.1 µg/ml) only at one hour after injection. In the vitreous, drug levels were above the mean inhibitory concentration at 30 minutes after the subconjunctival injection, but rapidly declined thereafter. The maximum nontoxic, single-dose, intravitreal injection was 750 µg/0.1 ml. Rabbits received 8 µg/ml of teicoplanin in an intravitreal infusion solution without demonstrable retinal toxicity.
Lidocaine: An Anti-Tussive for Ophthalmic Surgery
Authors: Stewart Robert H , Kimbrough Richard L , Engstrom Paul F , Cameron Bruce
Published: April 2021

ABSTRACT

Intravenous lidocaine suppresses the cough reflex in patients undergoing local operative procedures. Many anti-tussive agents suppress the cough reflex by suppressing the respiratory center. Intravenous lidocaine produces no respiratory depression in doses that suppress the cough reflex. Intravenous lidocaine should be available during all intraocular surgical procedures so it can be used when indicated.
A New Retrobulbar Needle and Injection Technique
Authors: Straus Jeffrey G
Published: April 2021

ABSTRACT

A new needle and method have been developed for the administration of retrobulbar injections. The needle is curved as it extends from its hub, but it has a straight terminal portion. Use of this needle with the technique described should decrease the risk of most complications associated with conventional needles and techniques.
Lid Retraction Following Blow-Out Fracture of the Orbit
Authors: Conway Stephen T
Published: April 2021

ABSTRACT

A case of lid retraction following blow-out fracture of the orbit with enophthalmos is reported. This paradoxical complication has been described previously in only two cases, both by the same authors. It has been hypothesized that the lid retraction is secondary to Mueller's muscle overaction; however, excision of Muellers muscle had no effect in this case. A new hypothesis is presented that this condition may be due to traction on the connective tissue sheath of the levator palpebrae muscle through its interconnections with the connective tissue systems of the other extraocular muscles.
A Simple Aid to Successful Probing of Congenitally Obstructed Nasolacrimal Ducts
Authors: Nagashima Koji
Published: April 2021

ABSTRACT

For successful probing of congenitally obstructed nasolacrimal ducts in infants, the probe must reach the inferior nasal meatus. Previous methods to determine the position of the probe in the nose require intranasal examination method using two probes of equal length. The first probe is placed inside the lacrimal outflow system and the second probe is placed against the nose. The second probe can be used to measure the distance between the point of the first probe and the anterior narlal margin. This method may be particularly valuable in those cases in which the probe point is less than 5 mm below the anterior narial margin.
Nd:YAG Laser Iridectomies: 100 Consecutive Cases
Authors: Wand Martin , Clark Jacob A , Hill David A
Published: April 2021

ABSTRACT

We reviewed the patient charts of our first 100 consecutive Nd:YAG laser iridectomies. Our success rate (99%) is the same as that reported by others. Iris bleeding was not problematic. We did find that relative pupillary block may still be present with a patent but very small Nd:YAG iridectomy; that transillumination is not an adequate criterion for assessing patency; and that a Nd:YAG laser iridectomy, probably in part because of its small size, frequently closes with chronic inflammation.
Can the Accuracy of Intraocular Lens Calculations Be Improved?
Authors: Mitchell David J
Published: April 2021

ABSTRACT

Regression analysis of data from 222 extracapsular cataract extractions was performed to determine if the accuracy of IOL prediction in cataract surgery can be improved. Polynomial and piecewise regression of large, medium, and short eyes were used to calculate new formulas for IOL prediction. The Taylor series representation of the theoretical lens power formula was calculated to determine what combination of the variables for IOL power prediction are reasonable to consider in constructing a polynomial regression model. The formulas calculated from the data in this study were compared with other published methods of IOL calculation. In this study, the difference between the postoperative refraction error and emmetropia was independent of the formula used. The exception was the modified Binkhorst formula, which caused greater error. Inclusion of higher order terms in the regression formula or piecewise regression did not reduce the postoperative refractive error.
BSPOT: A Blind Spot Data Evaluation Program for SAPRO Examinations
Authors: Funkhouser A T , Fankhauser F , Kwasniewska S
Published: April 2021

ABSTRACT

The BSPOT evaluation program has been created to run on an IBM-PC type computer, ft accepts Octopus SAPRO data that have been transferred to the PC and enables the user to display aspects of the data for evaluation purposes. Some applications are illustrated using the results of two blind spot examination series, one normal and the other pathologic, and the results of an angioscotoma examination. Although the program was designed for the display of blind spot data, any SAPRO examination data may be used.
A Technical Variation of Posterior Chamber IOL Implantation
Authors: Recupero Santi Maria , Fioravanti Walter , Contestabile Maria Teresa
Published: April 2021

ABSTRACT

In posterior chamber intraocular lens (IOL) implantation, one of the most delicate phases is placing the loops in the capsular bag or in the ciliary sulcus. We describe a technique to simplify the phase of IOL insertion by tying the superior loop with a nylon suture. No changes to the lens and no special instruments are required.
Intraocular Pressure Following ECCE, Phacoemulsification, and PC-IOL Implantation
Authors: Kooner Karanjit S , Cooksey John C , Perry Priscilla , Zimmerman Thom J
Published: April 2021

ABSTRACT

Abnormal intraocular pressure (IOP), either transient or permanent, may follow extracapsular cataract extraction (ECCE) with phacoemulsification (PE) and posterior chamber intraocular lens (PC-IOL) implantation. We retrospectively studied IOP measurements at different intervals post ECCE and PE in 242 eyes of 211 patients: 105 males, 106 females, 198 Caucasians and 13 blacks. Elevated IOP (>23 mm Hg) was observed in 20 eyes (8.2%). Only two patients (0.8%) had persistent (>3 months) IOP elevation and needed antiglaucoma therapy. Six more eyes (2.5%), however, developed glaucoma after 1 year. Hence, the incidence of secondary Pseudophakie glaucoma at the conclusion of this study was 3.3%. No patient required laser or other mechanical surgery for IOP control. ECCE and PE with PC-IOL does not appear to adversely affect IOP. Patients, however, must be followed closely, as some may develop glaucoma months after surgery.
Carbon Dioxide Laser Repair of Medial Ectropion
Authors: Korn Elliot L , Glotzbach Robin K
Published: April 2021

ABSTRACT

Five patients with medial eyelid ectropion and punctal eversion due to senile changes, cicatrix, or vertical skin tightness were treated with a heretofore unreported method. Using a carbon dioxide laser, an ellipse of conjunctival-tarsal-inferior muscle tissue was excised from the inner surface of the ectropic lid inferior to the punctum. There was no bleeding, and each postoperative course was notable for minimal pain and edema. Lengthy follow-up revealed good anatomie results, with normal functioning of the inferior punctum. Patients taking warfarin sodium (Coumadin) have been treated without bleeding. Carbon dioxide laser ectropion repair may be tailored to each patient's specific condition, and is performed with ease in the office, thus offering diminished patient anxiety, discomfort, and expense.
Intraocular Pressure Response After Pneumatic Retinopexy
Authors: Coden Daniel J , Freeman William R , Weinreb Robert N
Published: April 2021

ABSTRACT

We measured intraocular pressure over a five-day period in ten consecutive patients undergoing pneumatic retinopexy to determine the effect of an expanding gas bubble. During treatment, all eyes received 0.3 ml perfluoropropane gas. All eyes had an immediate rise in intraocular pressure, which in four eyes was associated with absence of central retinal artery perfusion for three minutes. Once infraocular pressure fell toward baseline (30 to 60 minutes after gas injection), we did not find a high intraocular pressure during the subsequent five-day period. We conclude that intraocular pressure-reducing medication is not routinely indicated in these eyes.
Corneal Endothelial Cell Loss Following Trephination
Authors: Clinch Thomas E , Fung Karen L , Laibson Peter L
Published: April 2021

ABSTRACT

The amount of endothelial cell loss that occurs to the donor cornea during the trephination process was evaluated in 40 porcine eyes. A vital staining technique (alizarin red S and acid violet 19) was used to quantify the extent of endothelial damage and removal. Two types of corneal punches (Week and H&I) were used for trephination. The average amount of endothelial loss from the peripheral cornea was 7.9%, accounting for only a 3% loss of endothelial cells over the total surface area of the corneal button. A comparison of the Week and H&I corneal punches showed no significant difference (P >0.1) by Student's t test for both endothelial cell damage and removal.
Corneal Re-Graft: Indications and Outcome
Authors: MacEwen Caroline J , Khan Zia U H , Anderson Elaine , MacEwen C G
Published: April 2021

ABSTRACT

The results of 62 repeat penetrating keratoplasties (41 eyes) over a 10-year period are presented. The common indications for the primary graft include herpes simplex keratitis, Pseudophakic bullous keratopathy, aphakic bullous keratopathy, Fuch's endothelial dystrophy, and chronic ulceration. All cases of pseudophakic bullous keratopathy had the iris-clip type of intraocular lens. Graft failure was attributed to rejection, endothelial failure, recurrent ulceration, herpes simplex keratitis, melting, trauma, and recurrent dystrophy. At the end of the study period 28 grafts (68%) were clear and 13 (32%) were opaque. Visual improvement occurred in 28 eyes (68%), deterioration in four (10%), and six (15%) remained unchanged (visual result was not available in three eyes). These data are encouraging in terms of visual outcome and graft clarity in cases of repeat penetrating keratoplasty.

Comparison is made between the primary indications and outcome of these re-grafts and eyes requiring only one graft. Initial indications for grafting in both groups were similar, other than keratoconus, which was a significantly more common indication in eyes that required only one graft. Final visual results were better in those eyes undergoing only one graft, compared with those that required multiple surgery.
Effect of Excimer Laser on Microbiological Organisms
Authors: Keates Richard H , Drago Paul C , Rothchild Eric J
Published: April 2021

ABSTRACT

The effect of radiation emitted from an excimer laser filled with argon fluoride gas at 193 nm on Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus. Streptococcus faecalis, Hemophilus influenzae, Candida albicans, and Aspergillus niger (collectively labeled "the microorganisms") was examined. Colonies were subjected to a variable number of radiation pulses from the excimer laser applied after a 36-hour period of incubation at 37°C, at which time the colonies were fully grown and showed no viability. The lack of viability was confirmed with a subculture from each area that received radiation; all subcultures were negative. The characteristics of the radiation paralleled those used by Serdavic, Darrell, Krueger, et al in 1985.1 This radiation treatment is believed to be within a therapeutic range, which suggests that the excimer laser, pending further investigation, may be useful in the treatment of corneal infections.
Treatment of Small Choroidal Melanomas With Photocoagulation
Authors: Jalkh Alex E , Trempe Clement L , Nasrallah Fadi P , Weiter John J , McMeel J Wallace , Schepens Charles L
Published: April 2021

ABSTRACT

Seventeen eyes with small choroidal melanomas presumed to be malignant were photocoagulated. The melanomas measured 7 to 15 mm at the tumor base and 2 ta 5 mm thick. First, photocoagulation using the green argon laser was aimed at closing the choroidal vascular supply of the tumor. In a second stage, tumor tissue was destroyed using the red krypton laser for confluent burns of long duration. Such treatment was supplemented by cryotherapy in peripherally located tumors or whenever photocoagulation alone did not result in tumor regression. Photocoagulation alone was used in ten eyes and combined with cryotherapy in seven. After an average follow-up of 42 months, marked tumor regression was achieved in 12 eyes and some tumor regression in two. Two eyes ultimately required proton beam irradiation, and one eye was enucleated. No metastasis occurred during follow-up.
Retinal Vascular Occlusion Without Retrobulbar or Optic Nerve Sheath Hemorrhage After Retrobulbar Injection of Lidocaine
Authors: Cowley Marianne , Campochiaro Peter A , Newman Steven A , Fogle Jerry A
Published: April 2021

ABSTRACT

We report a case of retinal vascular occlusion in a patient with severe diabetic retinopathy after retrobulbar injection of lidocaine. Several features of the occlusion are of interest: 1) rapid onset and relatively rapid reversal temporally associated with intervention; 2) numerous areas of focal vascular constriction; 3) absence of retrobulbar hemorrhage or dilated optic nerve sheath on CT scan; and 4) recurrence of nonperfusion after a second injection into the inferior peribulbar space. This suggests that patients with severe vascular disease may suffer retinal vascular occlusion after retrobulbar injections in the absence of identifiable retrobulbar or intraoptic nerve sheath hemorrhage. Though the mechanism is uncertain, this unusual complication deserves consideration, since its early recognition could possibly be of benefit in the management of some patients.
Combined Penetrating Keratoplasty and Vitreoretinal Surgery with the Eckardt Temporary Keratoprosthesis
Authors: Gross Jeffrey G , Feldman Sandy , Freeman William R
Published: April 2021

ABSTRACT

The Eckardt style temporary keratoprosthesis was used in six cases of five eyes undergoing simultaneous penetrating keratoplasty and pars plana vitrectomy. This device provided excellent visualization of posterior and peripheral intraocular structures and maintained a closed system during surgery. Corneal grafts remained clear in 80% of the cases, and macular attachment was achieved with either silicone oil or perfluoropropane gas in 50% of cases followed for at least 6 months. Visual function remained the same or improved in three eyes. Suggested refinements to the placement of this device include enlarging the trephination to 6.75 mm and the use of 8-0 nylon sutures to prevent cheesewiring of the soft silicone rim. A plano contact lens required during surgery to visualize the retina did not minify the image. Since the optical cylinder of the Eckardt temporary keratoprosthesis is shorter than that of a Landers-Foulks keratoprosthesis of similar diameter, it provides greater peripheral visualization. It is, however, less durable.
Changing Concepts in the Management of Retinoblastoma
Authors: Shields Jerry A , Shields Carol L , Donoso Larry A , Lieb Wolfgang E
Published: April 2021

ABSTRACT

For many years the most common treatment for retinoblastoma has been enucleation, generally performed on the affected eye in children with unilateral sporadic disease and on the more severely affected eye in children with bilateral disease. With refinements in conservative treatment methods, however, the affected eye now often may be salvaged and useful vision retained. Emphasizing this trend, we present our current approaches to managing retinoblastoma based on our experience with 324 patients, outlining our indications and pointing out a number of misconceptions about the role of enucleation, photocoagulation, cryotherapy, and radiotherapy in treating this condition. We also sketch some recent findings regarding the genetics of retinoblastoma and consider ways in which such research may lead to improved management of the disease.
The Success Rate of Silicone Intubation in Congenital Lacrimal Obstruction
Authors: Leone Charles R , Van Gemert John V
Published: April 2021

ABSTRACT

In our series of 100 patients who had unsuccessful probing for congenital nasolacrimal duct obstruction, all had silicone intubation associated with infracturing of the inferior turbinate. The age range was from 7 months to 4 years at the time of intubation. Sixty patients had tubes in for 1 year, and all but one, a 3-year-old girl, were treated successfully. Of the 40 who had tubes in place for less than 1 year, 38 were treated successfully. The two unsuccessful cases were those of a 3-year-old boy and a 4-year-old boy, whose tubes were removed at 3 and 4 months, respectively. The overall success rate in our series was 97%; all patients younger than two years old at the time of intubation were treated successfully.
Outpatient and Abbreviated Hospitalization for Vitreoretinal Surgery
Authors: Wilson Douglas , Barr Charles C
Published: April 2021

ABSTRACT

We retrospectively reviewed 255 consecutive scleral buckling and vitrectomy operations dividing the patients into two groups. One group was managed traditionally with general anesthesia and postoperative hospitalization. The second group was managed with local anesthesia and with no hospitalization or abbreviated hospitalization whenever possible. There was no difference in the technical or functional success rates achieved in the two groups. We conclude that vitreoretinal surgery may be performed safely and effectively on an outpatient basis in selected cases.
A Simplified Method of Monocanalicular Silicone Intubation
Authors: Dibble Robert F , Friedel Samuel D
Published: April 2021

ABSTRACT

We present a simplified method of monocanalicular silicone intubation for the repair of single canaliculus lacerations. A monocanalicular loop of tubing running from the punctum, through the lacerated canaliculus, and out the cutdown site over the lacrimal sac, provides a secure silicone tube stent.
Comparison of 2.5% and 10% Phenylephrine in the Elevation of Upper Eyelids with Ptosis
Authors: Glatt Herbert J , Fett David R , Putterman Allen M
Published: April 2021

ABSTRACT

The Mueller's muscle-conjunctival resection procedure has been effective in treating ptosis in eyelids that elevate upon instillation of topical 10% phenylephrine (Neo-Synephrine). The small risk of an adverse systemic reaction to phenylephrine could be even further decreased by using 2.5% phenylephrine instead of 10% phenylephrine. In order to assess the feasibility of using 2.5% phenylephrine instead of 10% phenylephrine in ptosis evaluation, we compared the amount of upper eyelid elevation produced by the two solutions. Thirty ptotic upper eyelids in 20 patients exposed to 10% phenylephrine rose an average of 0.2 mm higher than the same lids exposed to 2.5% phenylephrine. Although this difference was statistically significant, we suspect that the small magnitude of this difference would have little effect on the decision to perform a Mueller's muscle-conjunctival resection procedure or on the calculation of the amount of tissue to resect.
Astigmatism and Tissue-Shape Disparity in Penetrating Keratoplasty
Authors: Mahjoub Salah B , Au Yue-Kong
Published: April 2021

ABSTRACT

Tissue-shape disparity between the donor and recipient cornea is a major cause of astigmatism following penetrating keratoplasty. We studied the topographic effects of recipient or donor tissue deficiency (oval donor button or recipient hole) in a penetrating keratoplasty rabbit model. The results demonstrated that a crescent-shape block resection of 0.5 mm x 6.0 mm during penetrating keratoplasty induces 4 to 7 diopters of corneal astigmatism, with the steeper meridian along the axis of tissue deficiency. Corneal topography and vector analysis of astigmatism showed steepening along the axis of tissue deficiency and flattening 90° away.
Irrigating Capsule Retractor for Posterior Nucleus Hydrodissection
Authors: Nishi Okihiro , Nishi Kayo
Published: April 2021

ABSTRACT

An irrigating capsule retractor for safe nucleus delivery in planned extracapsular cataract extraction (ECCE), particularly after circular capsulorhexis and curvilinear capsulotomy using an envelope technique, is introduced. This retractor, which consists of a 20-gauge needle with a flattened top, provided with a fine-wire hook, can be used to bring the upper nucleus equator out of the capsular bag as well as to perform posterior nucleus hydrodissection. The cannula is especially helpful in performing circular capsulorhexis in a small diameter.
Perineural Invasion of the Orbit by Squamous Cell Carcinoma
Authors: Csaky Karl G , Custer Philip
Published: April 2021

ABSTRACT

Two cases of orbital extension by squamous cell carcinoma along the supraorbital nerve are reported. Important clinical aspects of these cases include previous incomplete removal of squamous cell carcinoma of the forehead and altered sensation in the dermatome of the supraorbital nerve. Axial spread of carcinoma along periorbital nerves is an important avenue of local metastasis and should be suspected in all cases of periorbital squamous cell carcinoma.
Endocapsular Hypopyon: A Clinical Sign of Localized Endophthalmitis
Authors: Stefansson Einar , Cobo L Michael , Carlson Alan N , Kesler James L
Published: April 2021

ABSTRACT

Chronic intraocular infection following cataract extraction and intraocular lens (IOL) implantation has been documented by several authors. We report a case of chronic, bacterial endophthalmitis that clinically correlates with previous pathologic studies in which the focus of infection was sequestered in the capsular sac between the IOL and the posterior lens capsule. Successful management did not require IOL removal.
Effect of Transscleral Neodymium:YAG Cyclophotocoagulation on Intraocular Lenses
Authors: Blomquist Preston H , Gross Ronald L , Koch Douglas D
Published: April 2021

ABSTRACT

A neodymium:YAG laser operating in the thermal mode was used to irradiate isolated intraocular lenses (IOLs) and to perform transscleral cyclophotocoagulation on Pseudophakie autopsy eyes to investigate the potential damage to IOL haptics such irradiation may cause. In the isolated IOLs, 70 mJ of energy deformed and partially melted both polymethylmethacrylate (PMMA) and polypropylene haptics. One of the capsular-fixated PC-IOL haptics in an autopsy eye partially melted when irradiated with the maximum energy level (8.8 J), with the aiming beam focused 1 mm posterior to the limbus and maximal posterior focus offset.
The Position of the Eyebrow
Authors: Oestreicher James H , Hurwitz Jeffrey J
Published: April 2021

ABSTRACT

The position of the eyebrow, which varies from person to person, is an important factor determining the final result of blepharoplasty, ptosis, and other aesthetic surgery. We developed a new instrument for measuring the position of the eyebrow - a clear, curved, plastic face mask with inscribed distance gradations in millimeters and a sliding horizontal step to catch the superior orbital rim for measurement.
Comparative Study of Three Fluorescent Dyes for Angiography: Sodium Fluorescein, Carboxyfluorescein, and Calcein
Authors: Fang Ting , Naguib Khaled S , Peyman Gholam A , Khoobehi Bahram
Published: April 2021

ABSTRACT

To compare the characteristics of carboxyf luorescein (CF) and calcein (Cale) with those of sodium fluorescein (Naf), the only fluorescent dye currently in clinical use, we performed angiography in rabbits and primates using these three dyes. The circulation decay time of all dyes was longer in primates than in rabbits. In primates, CF and Cale had longer decay times than Naf. Cale produced the greatest contrast between the choroidal and retinal vasculature. Tissue staining and dye leakage into the vitreous immediately after retinal photocoagulation were minimal wrth Cale, moderate with CF, and marked with Naf. The limited leakage and longer circulation time of Cale may permit simultaneous angiography and photocoagulation therapy without obscuring the fundus view with leaking dye from the photocoagulated structure.
Anterior Stromal Puncture for Recurrent Erosion: Further Experience and New Instrumentation
Authors: Rubinfeld Roy S , Laibson Peter R , Cohen Elisabeth J , Arentsen Juan J , Eagle Ralph C
Published: April 2021

ABSTRACT

Anterior stromal puncture has recently been proposed as a new treatment for recalcitrant cases of recurrent corneal erosion. Concerns about the risks of corneal perforation and scarring, as well as doubts regarding its efficacy have prevented many patients from benefiting from this procedure. We introduce a new, inexpensive, commercially available instrument designed to standardize this technique, minimize scarring, and prevent corneal perforation.

In a clinical trial involving 25 consecutive patients with recurrent erosions resistant to vigorous conservative treatment, the first 11 patients underwent stromal puncture in which a straight tuberculin needle was used; the following 14 were treated with a newly designed prototype needle. All patients in this series remained free of erosions after completion of stromal puncture, except for one woman with marked diffuse anterior basement membrane dystrophy, who went on to develop spontaneous bilateral erosions. Follow-up ranged from 2 months to 30 months (mean, 13 months). There were no complications of stromal puncture, and subjective and objective evaluations revealed no significant postoperative glare. Microscopic analysis of eye bank eyes subjected to anterior stromal puncture procedures demonstrated that the new prototype needle provided shallower penetration and thus less likelihood of perforation or excessive scarring than the straight needle. Also, postoperative discomfort and scarring appeared to be significantly less in patients treated with the prototype needle.
Scleral Reinforcement in Rabbits Using Synthetic Graft Materials
Authors: Whitmore Wayne G , Harrison Winston , Curtin Brian J
Published: April 2021

ABSTRACT

Because of disappointing results using homologous collagen for scleral reinforcement in the treatment of pathologic myopia in humans, we undertook a series of experiments in rabbits to test the mechanical properties and long-term biocompatibility of three different synthetic graft materials. Grafts made from two of these materials, Gore-Te*- Soft Tissue Patch (expanded polytetrafluoroethylene) and Mirage!'* (polylmethyl acrylate-co-hydroxy-ethyl acrylate]), were easy to position about the globe. Both materials, however, were resistant to invasion by fibrovascular tissue. The third material, woven Dacron1*' polyethylene terephthalate), though more difficult to position, permitted extensive invasion of fibrovascular tissue, which made all parts of the graft firmly adherent to the globe. Our results indicate the long-term compatibility of all three of these materials when used as periscleral grafts in rabbits. However, our results also suggest that a woven material such as commercially available Dacron is a more suitable graft material for scleral reinforcement in humans than collagen, Miragel, or Gore-Tex.
Transscleral Neodymium:YAG Laser Cyclocoagulation for Uncontrolled Glaucoma
Authors: Kalenak Jeffrey W , Parkinson John M , Kass Michael A , Kolker Allan E
Published: April 2021

ABSTRACT

To determine the efficacy and safety of the procedure, we reviewed the records of 25 eyes of 25 patients who had received noncontact transscleral Nd: YAG laser cyclocoagulation for a variety of uncontrolled glaucomas. Thirteen to 35 pulses (mean, 22.7 pulses) had been placed 1 mm to 2 mm behind the limbus with an energy per pulse of 3.4 J to 8.2 J (mean 4.5 J). Follow-up ranged from 6 months to 23 months, with the exception of one eye, which had to be enucleated. Nine of the 25 eyes (36%) required one or two repeat treatments. Twelve (48%) had intraocular pressures at last follow-up of less than 21 mm Hg but greater than 4 mm Hg. Ten eyes (40%) developed moderate to severe pain transiently, and 10 (40%) developed substantial, but transient, inflammation. Transscleral Nd: YAG laser cyclocoagulation appears to be relatively effective and well tolerated.
Trabeculectomy for Glaucoma Associated With Sturge-Weber Syndrome
Authors: Ali Moones A , Fahmy Iman A , Spaeth George L
Published: April 2021

ABSTRACT

We reviewed the results of trabeculectomy performed in six patients (seven eyes) with glaucoma associated with the Sturge-Weber syndrome. After follow-up periods ranging from 9 months to 9 years, intraocular pressure control was adequate in two eyes without the use of antiglaucoma medication; control was good in four eyes with mild medication. One eye required three trabeculectomies and postoperative medication to achieve control. There was no further deterioration of visual acuity or of the optic nerve in any of the eyes.
Pupillary Block Glaucoma Following Pediatric Cataract Extraction
Authors: Eustis H Sprague , Walton R Christopher , Ball Stuart F
Published: April 2021

ABSTRACT

We present a case of pupillary block glaucoma that developed after cataract extraction in a pediatric patient. To prevent pupillary block and secondary glaucoma after cataract surgery we recommend that all pediatric cataract patients be given a prophylactic peripheral iridectomy.
Surgical Management of Congenital Upper-Eyelid Eversion
Authors: Loeffler Michael , Hornblass Albert
Published: April 2021

ABSTRACT

We describe a case of congenital eversion of the upper eyelids in which early surgery was performed to prevent occlusion amblyopia. The surgery, described here for the first time for this condition, consisted of using multiple suture placements to anatomically reposition the eyelids.
Prospective Topographic Analysis in Peripheral Arcuate Keratotomy for Astigmatism
Authors: McCluskey DruAnn J , Villaseñor Richard , McDonnell Peter J
Published: April 2021

ABSTRACT

Delimited peripheral arcuate keratotomy was performed on five eyes of four patients with naturallyoccurring astigmatism. Refraction, keratometry, and computer-assisted corneal topographic analysis were performed before and after the procedure. In some eyes, preoperative topographic analysis revealed steepening distributed symmetrically about the corneal apex; in three eyes the steepening was asymmetrically distributed about the corneal apex. In one eye, surgery in a single, steep hemi-meridian superior to the corneal apex flattened that steep hemimeridian but did not appear to after the topography of the inferior steep hemi-meridian. Refractive and keratometric astigmatism decreased in all eyes (mean reductions of 3.2S and 2.30 diopters, respectively), and all incisions healed without incident. Surgery extended beyond the zone of steepening in one eye, shifting the axis of astigmatism. A large, murticenter, randomized trial will be necessary to determine whether detailed preoperative topographic analysis can be used to improve the results of surgery for astigmatism.
The Effect of External Ocular Compression on Intraocular Pressure Following Retrobulbar Anesthesia
Authors: Palay David A , Stulting R Doyle
Published: April 2021

ABSTRACT

Thirty consecutive patients scheduled for cataract surgery were randomized to external compression with the Honan intraocular pressure (IOP) reducer or digital pressure. The average increase in IOP after retrobulbar injection of 4 ml of anesthetic was 6.20 mm Hg. This increase was followed by a rapid decline in IOP within the first 2 1/2 minutes, averaging 1.20 mm Hg ± 0.70 below baseline level for the Honan group and 1 .00 mm Hg ± 0.96 below baseline level for the digital group. From 5 to 10 minutes after injection there was a more gradual decline in IOP that averaged 0.35 mm Hg/min in the Honan group and 0.36 mm Hg/min in the digital group. After 10 minutes of external compression the IOP was 5.73 mm Hg ± 0.96 below baseline level in the Honan group and 4.67 mm Hg ± 0.64 below baseline level in the digital group. No statistical difference between the IOP measurements of the two groups was observed at 2 1/2 minutes at 5 minutes, or at 10 minutes.
Overnight Admission of Outpatient Strabismus Patients
Authors: Isenberg Sherwin J , Apt Leonard , Yamada Sue
Published: April 2021

ABSTRACT

The trend to outpatient strabismus surgery prompted us to determine the frequency of, and the reasons for, postoperative overnight hospital admission following such surgery. In one year, 303 outpatient strabotomies were performed at the Jules Stein Eye Institute on patients over 15 months old. Twenty-four (7.9%) were admitted overnight postoperatively. Compared with controls, those admitted were older (37 vs 20.5 years), and had a longer duration of anesthesia (145 vs 116 minutes) and surgery (104 vs 75 minutes) (P<.01 for each). The time that surgery commenced and the use of perioperative medications were not significant factors. The most frequent reasons for overnight admission were nausea (38%) despite prophylaxis and the use of bilateral patches (16%). To minimize postoperative admissions, better strategies should be developed to decrease the frequency of significant postoperative nausea, the duration of surgery and anesthesia, and, if possible, the use of bilateral patches.
Vitreous Changes and Macular Edema in Central Retinal Vein Occlusion
Authors: Kado Masanori , Jalkh Alex E , Yoshida Akitoshi , Takahashi Masataka , Wazen Nada , Trempe Clement L , Schepens Charles L
Published: April 2021

ABSTRACT

The condition of the posterior vitreous was determined in 56 eyes with central retinal vein occlusion (CRVO). Using a life-table analysis, it was studied in 56 eyes. The incidence off posterior vitreous detachment (PVD) in the CRVO eyes at the first vitreous examination did not differ significantly from that in 64 age-matched control eyes. However, the incidence of PVD in CRVO eyes increased from 39.3% at the first vitreous examination to 58.5% after 6 months, and to 69.6% 1 year from the examination. The incidence of PVD in CRVO eyes during follow-up was statistically higher than that of the controls (P = .009). The incidence of PVD after the first vitreous examination was significantly higher in eyes with hemorrhagic retinopathy than in eyes with venous stasis retinopathy (P = .04). In the 34 eyes with macular edema, the edema lasted significantly longer in those with vitreomacular attachment (VMA) at the first examination than in those without VMA at this time (P = .02). VMA may play an important role in the pathogenesis and chronicity off macular edema in CRVO.
Experience With Photocoagulation in Behçet's Disease
Authors: Atmaca Leyla S
Published: April 2021

ABSTRACT

Between 1973 and 1987 we examined both eyes of 300 patients with the uveoretinrtis-type lesions characteristic of Behcet's disease. Of the 556 eyes whose fundus could be examined, 38 eyes (6.8%) in 33 patients (11%) had developed retinal capillary nonparfusion, branch retinal vein occlusion, or retinal or disc neovascularization. These eyes were treated by photocoagulation, primarily to forestall vitreous hemorrhage and the development of neo vascular glaucoma, as well as to decrease the macular edema resulting from vein occlusion. The treatment, which was well tolerated, was successful in closing retinal capillary nonperfusion areas and eliminating retinal neovascularization. Disc neovascularization was resolved completely in some cases, and partially in others.
Glaucoma Secondary to Epithelial Downgrowth and 5-Fluorouracil
Authors: Loane Mark E , Weinreb Robert N
Published: April 2021

ABSTRACT

Since epithelial downgrowth involves an actively proliferating intraocular tissue, it is possible that the antimetabolite 5-fluorouracil may inhibit it. We report a case of secondary glaucoma caused by epithelial downgrowth in which filtration surgery was performed with adjunctive use of subconjunctival 5fluorouracil. On cessation of the injections, the retrocorneal membrane grew rapidly to involve the entire posterior cornea. The eye eventually became blind and painful and was enucleated. The use of 5ffuorouracif given in the usual manner appears to have been a failure.
Posterior Horizontal and Vertical Tightening to Treat Combined Punctal Ectropion With Medial Canthal Tendon Laxity
Authors: Hurwitz Jeffrey J , Tucker Susan
Published: April 2021

ABSTRACT

The classical operations to treat either medial canthal tendon laxity or punctal aversion occurring alone possess drawbacks if they are used to treat these conditions when they occur simultaneously. A simplified procedure is described whereby tissue is removed via a posterior eyelid approach so that the eyelid may be tightened both horizontally and vertically, thus inverting the punctum and fixating it in the lacrimal lake. This procedure is quite easy to perform and can be done under local anesthesia in the office.
Learning Curve for Radial Keratotomy
Authors: Campion Michael
Published: April 2021

ABSTRACT

I prospectively evaluated my own learning curve for radial keratotomy (RK) by comparing the results achieved in two groups: 20 consecutive eyes on which I performed RK without having had previous experience with the procedure (group 1); and 20 other eyes, matched for age, sex, and preoperative refractive error, on which I performed RK after I had performed the procedure 250 times (group 2). Although there were nine microperforations in group 1 and none in group 2, the postoperative refractions and uncorrected visual acuities were similar in both groups. Since the microperforations had no adverse effect on the visual results, it is reasonable to conclude that there was, in effect, no learning curve involved in my experience with RK.
Endophthalmitis After Placement of a Molteno Implant
Authors: Perkins Todd W
Published: April 2021

ABSTRACT

I report a case of early postoperative endophthalmitis following placement of a Molteno implant. Excellent results were obtained by immediate removal of the implant and surgical management of the infection, followed by replacement of the implant.
Lower Eyelid Retraction: A Minimal Incision Surgical Approach to Retractor Lysis
Authors: Holds John B , Anderson Richard L , Thiese Steven M
Published: April 2021

ABSTRACT

Lower eyelid retraction associated with prior blepharoplasty, trauma, or other conditions is a challenging problem for the ophthalmic surgeon. We describe a procedure involving tightening the lower eyelid and supraplacing the lateral canthus in combination with in-glove lysis of the lower eyelid retractors and scar tissue. This is accomplished through a small lateral incision. To date, we have treated over 200 eyelids using this technique with excellent results. We recommend this technique for the treatment of mild to moderate degrees of lower eyelid retraction.
The Bovine Eye as a Model for the Novice Cataract Surgeon
Authors: Coroneo M T
Published: April 2021

ABSTRACT

A simple method for preparing the bovine eye as an in vitro model for training cataract surgeons is described and illustrated. This model allows basic skills to be gained in a graded fashion, using readily available materials. Also, more advanced surgical techniques can be refined by using this model. Manipulation of the model enables mimicking of real-life surgical challenges. Use of bovine eyes may represent, in bioethical terms, efficient use of available biological materials.
Techniques for the Preservation of Enucleated Animal Eyes in Surgical Training
Authors: Muñoz-Rodriguez Pablo , Peña-Cuesta Roberto , Garcia-Cosio Jesus F , Quiroz-Mercado Hugo
Published: April 2021

ABSTRACT

The main problem with using enucleated animal eyes in surgical training is that they remain fresh for such a short time. We describe a simple technique to preserve them by replacing the aqueous humor and part of the vitreous with another substance. We used 18 eyes of nine dogs (nine for the study and nine as controls), and three substances (2% methylcellulose, silicone oil, and gelatin). The methylcellulose group had the best results (including long-lasting mydriasis), preserving the eyes in which it was used in optimal surgical condition for up to 8 days, twice as long as the eyes in the control group (P < .005).