bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquired Epimacular Membrane After Multiple Intraocular Procedures in an Infant
Authors: Zalta Alan H , Burke Miles
Published: April 2021

ABSTRACT

At 7 months of age, an infant with Lowe's oculocerebrorenal syndrome developed an eplmacular membrane after three intraocular surgeries in the right eye. Serial fundus photographs document the membrane's appearance 6 months after lensectomy/vltrectomy for a dense cataract and 2 months after the second trabeculotomy for congenital glaucoma. Epimacular membranes are a vitreoretinal disorder found almost exclusively In adults. To the best of our knowledge, this Is the first documented case of acquired preretinal macular membrane in an infant and the youngest case reported in the literature. The loss of formed vitreous and repeated deposition of blood products into trie vitreous cavity may be responsible for the development of this preretinal membrane.
Binocular Vision
Authors: Fisher Norman F
Published: April 2021

ABSTRACT

Sensory correspondence, which forms the foundation for binocular vision, is a central activity of the cortex at the perceptual level and can occur with or without an anatomic proximity of corresponding points on the same cerebral hemisphere. Dy sj u net ive eye movement (fusiona! movements) can occur only with an anatomic proximity of corresponding points on the same cerebral hemisphere.
Compliance With a Standard of Care for Retinopathy of Prematurity in One Neonatal Intensive Care Unit
Authors: Trainor Susan , White George L , Trunnell Eric , Kivlin Jane D
Published: April 2021

ABSTRACT

Standards of care are an integral part of providing safe and proper health care to the public. One such standard is the screening of premature infants for retlnopathy of prematurity. In a retrospective chart review of 67 infants in an intensive cate nursery, a high Incidence of noncompliance with the standard was found In infants with over 1251-g birth weight, but that infants under 1251-g birth weight and eligible for participation in an investigation of retinopathy of prematurity had a high degree of compliance with the standard. These findings resulted in the adoption of recommendations to Improve compliance with the standard.
Cystoid Macular Edema in Pediatric Aphakia
Authors: Pinchoff Barry S , Ellis Forrest D , Helveston Eugene M , Sato Sam E
Published: April 2021

ABSTRACT

The presence of cystoid macular edema (CME) after cataract extraction in the pediatrie age group coufd adversely affect rapid visual rehabilitation of the eye by contributing to irreversible amblyopia. Several previous studies, including one by our group, have addressed this problem. Hoyt's observations of CME in ten of 27 eyes undergoing lensectomy-vitrectomy procedures have stirred renewed interest In this topic. The current study includes 12 eyes undergoing lensectomy-vitrectomy procedures, five eyes undergoing manual extracapsular procedures (ECCE) with discission of the posterior capsule, three eyes undergoing ECCE without discission of the posterior capsule, and three eyes undergoing secondary discissione. No CME was found anglographically on postoperative evaluation.
Recognition and Repair of the Slipped Rectus Muscle
Authors: Plager David A , Parks Marshall M
Published: April 2021

ABSTRACT

Since the first description of the slipped muscle as a complication of strabismus surgery in 1979, the distinctions between it and the lost muscle have become blurred both in the literature and in general understanding. Sixtytwo slipped muscles in 52 consecutive patients were reviewed in an effort to more fully describe this Important and often unrecognized entity. The range of clinical presentation of slipped muscle is large: from the immediate large postoperative over- or undercorrection with absent duction, to the gradual moderate deviation with subtly reduced excursion. The auctions provided by the slipped muscles ranged from complete absence to almost normal, with an average of 19° excursion beyond the midline. At surgery, recognizing the empty muscle capsule attached to the sclera with the tendon slipped posteriorly within it is imperative for its repair. Recognition is facilitated by suspecting it from clinical findings. Correction of the motility defect requires advancement of the muscle tissue and not just its empty capsule. Slippage can probably be prevented by using a surgical technique, which firmly locks the suture to the tendon and not just to the muscle capsule.
Adding a Sexual Assessment to the Health Interview
Authors: Whitley Marilyn Peddicord , Willingham David
Published: April 2021

ABSTRACT

Sexual dysfunctions cause considerable distress for many people. These dysfunctions often go unrecognized and, therefore, untreated. This unfortunate situation can last for years; many cases undoubtedly go untreated for entire lifetimes. In making patient assessments, nurse clinicians have excellent opportunities to ascertain the presence of a sexual dysfunction. This article includes information dealing with the effects of the interview environment on the efficacy of the interview; it provides up-to-date knowledge pertaining to human sexual functioning and basic sexual dysfunctions; and contains a review of communication skills important in conducting a successful sexual assessment. Finally, based on the belief that the clinician's awareness affects his or her ability to recognize and appreciate the client's problem, there is a discussion of personal attitudes regarding sexuality including an inventory of personal sexual awareness-
Factors Influencing Sexual Expression in Aging Persons: A Review of the Literature
Authors: Friedeman Joyce Sutkamp
Published: April 2021

ABSTRACT

This review of the literature has postulated a conceptual framework for viewing a system of variables which influence present sexual expression in older persons. These variables include one's demographic factors, value system, knowledge about sexuality, prior patterns of sexual expression, social and economic resources, physical health and emotional health. Present sexual expression encompasses all forms of sexual activities with or without partners.

The factors which have drawn the most attention from researchers are the demographic factors of age and marital status, and physical health. Knowledge variables and one's value system seem to be the factors least explored. An evaluation of research methods in these studies is presented along with recommendations for further research.
The Role of Operations Research and Systems Analysis in Holding Down the Costs of Hospitals and Clinics
Authors: Singh Amar J , May Philip R A , Messick Janice M
Published: April 2021

SUMMARY

In the past, medical care facilities have concentrated primarily on professional clinical evaluation. With the cost of treatment rising rapidly, it is becoming increasingly important to critically review and analyze our delivery systems so that scarce resources can be used optimally. In this paper the applications of operations research (O.R.) and systems analysis techniques that have been employed successfully in private industry are explored to find ways to improve clinical operations and hold costs down.
A Descriptive Study of the Attitudes of Psychiatrists Toward the New Role of the Nurse Therapist
Authors: Davidson Kathleen Rose , Donovan Karin Byrne , Gilman Christine Sneigocki , Gilmore Barbara Schuler , Hebert Gail Roger , Jayko Pearl Farley , Langan Barbara A , Mahoney Ellen McNamara , Mieske Marlene , Peck Joan , Spicer Sheila Fackson
Published: April 2021

ABSTRACT

A questionnaire was administered to explore the psychiatrists' attitude toward the role of the Psychiatric Nurse Therapist (PNT). The responses of 200 psychiatrists (44% usable response rate) were scored for knowledge of the role and hypothetical utilization of the PNT. Attitude was assumed inferable from utilization scores. Data analysis revealed that attitude is positively correlated with knowledge of the role and prior contact with the PNT.
Major Treatment Issues and Techniques in Family Therapy with the Borderline Adolescent
Authors: Danziger Sharon
Published: April 2021

ABSTRACT

The adolescent with a borderline personality disorder must deal with issues in therapy specific to the borderline personality. The same unresolved issues can be found in the family of this patient. This paper focuses on five major issues in the treatment of the borderline adolescent and his family. Techniques in dealing with these issues are suggested for the family therapist.*
Group Therapy with Parolees in a Community Mental Health Center
Authors: Baier Marjorie
Published: April 2021

ABSTRACT

Former prison inmates who are required to seek mental health services, but who see no personal need themselves for such services, are often reluctant mental health clients. Although they are reluctant, they represent a vulnerable population which can benefit from support, such as that found in a self-help group. A second potential difficulty involves the feelings of the therapist, which may include distrust and frustration. The purposes of this article are to (1) present the clinical problem of dealing with such reluctant clients; (2) present a solution developed using the nursing process; (3) relate the change in the feelings of the therapist as the group progressed; and (4) present information about unique mental health needs of parolees.

Reluctant mental health clients who say, "I don't know why I have to come here," tend to show little progress in individual psychotherapy, in my experience as a community mental health nurse. One source of referral for such reluctant clients is the state correctional system. The parole board and parole officer, recognizing a history of mental health problems or current emotional stress, have the statutory option of requiring that the parolees seek mental health services, in an unspecified mental health setting. In my position as a nurse therapist in a community mental health center, I receive referrals of these reluctant clients. Until recently, each referral was a source of frustration since these clients usually deny any personal need for mental health services but do represent a vulnerable population, experiencing disequilibrium and evidencing the effects of institutionalization (Goffman, 1961).

For clarification, parolees are former inmates of a state or federal prison. They remain under the supervision of the Department of Corrections for a specified length of time and must follow certain rules or return to prison. They differ from people on probation who are under the supervision of the court and who have not first gone to prison. This article will focus only on parole referrals since I have found that the problems of those on probation are different from the problems of those on parole.

The nursing process, which I applied to the problem of reluctant parolee clients, is a set of logical steps to meet the clients' needs (Miller, 1980). These steps are assessment, planning, implementation, and evaluation. I assessed the needs of the clients and my feelings as therapist. I planned group therapy as the intervention, and group therapy was implemented. The evaluation encompassed evaluating the impact of group treatment on the parolees and the change in my feelings toward parole referrals.
Adlerian Community Treatment with Schizophrenic Clients
Authors: Lantz James E
Published: April 2021

ABSTRACT

This paper illustrates and reviews the use of Adlerian concepts when working with extremely disturbed schizophrenic clients. The article outlines the philosophy that extremely disturbed schizophrenic clients can be taught to live outside a hospital setting and to replace psychotic compensation method with useful social living skills. A case illustration also is presented.

I have two major purposes in writing this article. First, I wish to illustrate and express my conviction that people who have a history of acting in ways that generally are categorized as "schizophrenic" can change their style of living, can stay out of the mental hospital, and can learn to live an enjoyable, fulfilling, and socially useful life. My second conviction is that many Adlerian concepts are exceptionally useful as "clinical roadmaps" when working with the schizophrenic client. This has been my experience while working with a large number of psychotic clients over the past ten years.
Administrative Use of Systems Analysis to Troubleshoot a Problematic Work Situation
Authors: Whitley Marilyn
Published: April 2021

ABSTRACT: The deinstitutionalized mentally ill continue to seek housing. The present private nursing home industry has sought to fill this population's needs by expanding their business endeavors to low cost residential facilities. The industry, of course, must seek a profit. These investors, however, lack a thorough understanding of the exact housing needs of the people from whom they seek their profits. Failure to establish a residence with a health stabilizing program sufficiently strong to mitigate the residents' health deficits produces a loss that is both financial and human. Many residential administrators are faced with trying to understand and remedy the situation in which they find themselves. The following case study illustrates this point and offers some administrative tools for assessing and communicating to investors the adjustments necessary in order to promote a profit from providing a residence for health impaired populations.
Listening Reliably to Psychosocial Concerns of Youth
Authors: Webb Thomas E , Adams Mary R , VanDevere Chris A
Published: April 2021

The Structured Pediatrie Psychosocial Interview as a vehicle for exploring co-variation of children's descriptions of distress.
100% SUCCESS REPORTED
Authors: Anonymous
Published: April 2021

ANOREXIA TREATMENT
HEARING VOICES
Authors: Field William E
Published: April 2021

NURSING INTERVENTIONS IN THE ACCEPTING-SUPPORTIVE AND DEROGATORY PHASES OF THE AUDITORY HALLUCINATORY PROCESS IN SCHIZOPHRENIC PATIENTS
ALL ABOUT AGING
Authors: Anonymous
Published: April 2021

BOARD GAME
EXAM SCHEDULED
Authors: Anonymous
Published: April 2021

NURSING CERTIFICATION
For Better or For Worse
Authors: Brown Katherine , Heidelberg Stephanie
Published: April 2021

Intermarriage in the Young Adult, Chronic Patient Population
UNIVERSITY PROGRAM
Authors: Anonymous
Published: April 2021

TEEN PREGNANCY
MAP AVAILABLE
Authors: Anonymous
Published: April 2021

ALCOHOLIC HIGHWAYS
Laura LeWinn, JD, on Doe vs. Klein
Authors: Anonymous
Published: April 2021

Laying Down the Law on the Rights of Psychiatric Patients
PARKINSON'S/ALZHEIMER'S
Authors: Anonymous
Published: April 2021

RELATIONSHIP NOTED
NEW BOOKLET
Authors: Anonymous
Published: April 2021

EMPLOYEE STRESS
ANA PUBLICATION
Authors: Anonymous
Published: April 2021

COLLECTIVE BARGAINING
ETHNIC MENTAL HEALTH
Authors: Anonymous
Published: April 2021

GRADUATE PROGRAM
Therapy for Men Who Batter
Authors: Nikstaitis George
Published: April 2021

George Nikstaitis, RN: "The Real Problem is the Partner Who does the Battering"
FIRE ON THE UNIT
Authors: Tousley Martha Merritt
Published: April 2021

Behavior patterns of psychiatric patients during a fire are no different than at any other time provided the nurse's behaviors are the same as well. Not suprisingly then, the key to responsiveness in a fire emergency is therapeutic intervention combined with sound management, training, and practice.
LIMITED EDITIONS
Authors: Anonymous
Published: April 2021

FREUD COLLECTION
An Historical View of RIGHT TO TREATMENT
Authors: Sanders Judith Brown , Plessis Diane Du
Published: April 2021

It is the responsibility of nursing administration to ensure that nursing staff, with other members of the mental health care team, provide an individualized treatment plan.
THE HMO QUESTION
Authors: Wojdowski Patricia , HartnetT Kathy
Published: April 2021

Can a Large Health Maintenance Organization Deliver Acute Psychiatric Services?
PMS May Have Serious Impact on Family Life
Authors: Anonymous
Published: April 2021

Researchers cite occurrence of "severe life disruption" .99
Sex Roles and Depression
Authors: Glazebrook Catherine Kedy , Munjas Barbara A
Published: April 2021

The concept of androgyny frees men and women from the restrictiveness of traditional sex roles. But the conflict between this concept and the external demands of society can create role strain that leads to stress. Are depressed clients experiencing such sex role strain?
NARSAD Seeks to Aid Mentally Ill
Authors: Anonymous
Published: April 2021

Schizophrenia and Depression Research Foundation Formed
The Legacy of SUICIDE
Authors: Van Dongen Carol J
Published: April 2021

A suicidal death leaves behind psychological sequelae in the survivors that may burden them for the rest of their lives.
Separation in the Adolescent Therapeutic Community
Authors: Zaozirny Janet Vanders
Published: April 2021

Losses produce a crisis for many patients. How does an adolescent therapeutic community cope with separation?
THERAPEUTIC HUMOR: Who's Fooling Who?
Authors: Simon Jolene M
Published: April 2021

Humor assists clients in coping with stress by providing emotional distance between the person and the immediate problem.
Minimum health benefits act includes psychiatric bill
Authors: Anonymous
Published: April 2021

Kennedy bill expected to be on fall presidential campaign agenda
Law and ideology in the case of BILLIE BOGGS
Authors: Brooks Alexander
Published: April 2021

The Journal asked law professor ALEXANDER BROOKS to examine the implications of this case for the homeless mentally ill who populate the nation's streets and public shelters. Will the publicity surrounding this isolated case improve their situation?
Caring for Clients With Legal Charges
Authors: Bender Bettye M , Murphy Deborah K , Mark Barbara A
Published: April 2021

on a voluntary psychiatric unit
The HIV-Infected Woman
Authors: Regan-Kubinski Mary Jo , Sharts-Engel Nancy
Published: April 2021

Illness Cognition Assessment

The prevalence of HIV infection is increasing in the female population.
Staff Stress on an Alzheimer's Unit
Authors: Mobily Paula R , Maas Meridean L , Buckwalter Kathleen C , Kelley Lisa Skemp
Published: April 2021

Nurses working with the elderly encounter many complex and potentially stressful care situations. Nowhere is this more true than for nursing home staff who work in highly demanding, labor- and client-intensive jobs. A number of factors contribute to the high levels of stress found among nurses who work with the elderly, including continual exposure to physical and emotional pathology and death, and conflict with families, co-workers, supervisors, and representatives from other departments or professions (Goldin, 1985; Klus, 1980).

When the stress level in a long-term care facility becomes overwhelming, role conflict, ambiguity, poor self-esteem, and burnout may ensue (Goldin, 1985; Heine, 1986; Klus, 1980; Morrow- Winn, 1985). The process of burnout is characterized by a progressive loss of idealism, energy, and purpose that eventually leads to emotional overextension and exhaustion (Price, 1984).
CLOUDING THE ISSUE
Authors: Anonymous
Published: April 2021

Outpatient commitment no substitute for adequate community mental health services
Behavioral health care benefits drop
Authors: Anonymous
Published: April 2021

A far steeper decline has occurred in the value of behavioral health benefits than in general health care benefit values.
Depression and the graying of America
Authors: Anonymous
Published: April 2021

'It is not normal to be old and sad. '
Who Was John Howard?
Authors: Lasure Eric A
Published: April 2021

One of the first social scientists interested in prisoner welfare and prison reform, his legacy continues when nurses serve as advocates for their prisoner-patients .
Radial Thermokeratoplasty for the Correction of Hyperopia
Authors: Neumann Albert C , Fyodorov Svyatoslav , Sanders Donald R
Published: April 2021

ABSTRACT: Hyperopic thermokeratoplasty involves making controlled thermal burns In the corneal stroma in a radial pattern up to a premarked clear zone. It steepens the central cornea and reduces the hyperopia. A series of 117 radial thermokeratoplasty eyes done in the Soviet Union were analyzed. Mean preoperative hyperopia of +5.27 diopters (range = +0.50 to +17.00 D) was reduced at 12 months after surgery by a mean of -3.48 D, resulting in a mean postoperative spherical equivalent of + 1.84 D. Average correction was 70.8%. Forty percent of eyes were corrected to less than 1.00 D residual refractive error; however, 58% were undercorrected by 1.00 D or more. The proportion of eyes seeing 20/40 or better unaided increased from 10% preoperatively to 52% by 3 months after surgery and remained at 53% at 12 months after surgery. Overall refractive stability was demonstrated during the 1st postoperative year. Stepwise regression showed that none of the preoperative or surgical factors significantly predicted outcome when all eyes were evaluated. [Refractive and Corneal Surgery 1990;6:404412.]
Improved Storage Methods for Epikeratoplasty
Authors: Barrett Graham D , Degebrodt Annette M , Walker Louise N
Published: April 2021

ABSTRACT: A major variable In calculating the necessary curvatures and dimensions of the refractive lenticules for epikeratoplasty is the degree of swelling of the donor cornea during storage prior to lathing. The purpose of this study was to determine whether it is possible to restore donor corneas to their in vivo thickness using osmotic agents rather than physical means. The osmotic agents chosen were dextran and chondroitin sulfate. Donor porcine corneas stored in McCarey-Kaufman (MK) medium for seven days increased in thickness by almost 50%. Increasing concentrations of dextran and chondroitin sulfate, and increasing concentrations of dextran with 1.35% chondroitin sulfate added, were examined for their ability to reduce this thickness to normal levels. It was found that 15.00% dextran alone, and 10.00% dextran with 1.35% chondroitin sulfate, reduced corneal thickness to that of fresh tissue. Light and electron microscopy showed that the osmotic agents restored stromal ultrastructure to that of fresh tissue. The use of osmotic agents to reduce corneal thickness prior to lathing reduces physical deformation of the donor tissue associated with the use of a corneal press and may enhance the predictability of epikeratoplasty. [Refractive and Corneal Surgery 1990;6:418-423.]
Radial Keratotomy in Intact Epikeratoplasty Graft
Authors: Casebeer J Charles , Shapiro David R
Published: April 2021

ABSTRACT

BACKGROUND: Epikeratoplasty can be used to flatten the cornea in keratoconus but is not a satisfactory tool to correct refractive errors in this setting. Radial and astigmatic keratotomy are unpredictable in keratoconus but can be used in an eye which has previously undergone epikeratoplasty for keratoconus.

METHODS: We report a case of a Pseudophakie eye with keratoconus which received epikeratoplasty and subsequently underwent radial and astigmatic keratotomy in the graft.

RESULTS: Before the refractive keratotomy, the patient had a refraction of -8.00 + 3.25 ? 25. At 5 months after radial and astigmatic keratotomy, the patient had an uncorrected visual acuity of 20/60+ with a refraction of -0.50 + 2.00 ? 28.

CONCLUSIONS: This case demonstrates how different types of refractive corneal surgery can be combined to improve visual acuity in an individual patient. Whether the specific combination of epikeratoplasty and refractive keratotomy can be advocated in the treatment of keratoconus requires more experience with a greater number of patients. Refract Corneal Surg 1 993;9: 1 33- 1 34.)
Visual, Refractive, and Patient Satisfaction Results Following Bilateral Photorefractive Keratectomy for Myopia
Authors: Gimbel Howard V , Van Westenbrugge John A , Johnson W Harold , Willerscheidt Anton B , Sun Ran , Ferensowicz Maria
Published: April 2021

ABSTRACT

Reports of the visual, refractive, and patient satisfaction results after photorefractive keratectomy (PRK) are now becoming available.

The visual, refractive, and patient satisfaction results of 52 patients after bilateral excimer laser photorefractive keratectomy for myopia were studied. Patient satisfaction was measured using a five-part questionnaire. Initial patients obtained an overcorrection which necessitated adjusting the programmed correction to 75% of targeted correction. (Refract Corneal Surg (suppl) 1993;9:S5-S10.)
Excimer Laser Photorefractive Keratectomy to Correct Residual Myopia After Radial Keratotomy
Authors: Hahn Tae Won , Kim Jae Ho , Lee Young Chun
Published: April 2021

ABSTRACT

We performed excimer laser photorefractive keratectomy (PRK) on 10 undercorrected myopic eyes of nine patients with residual myopia, (N =2, >-6.00 D, N =8, -2.00 -5.75 D) after radial keratotomy. Patients' mean age was 32.1 years. The time interval between radial keratotomy and PRK ranged from 12 to 90 months (mean 35). All patients after PRK were followed 9 months or more.

Nine months following PRK, uncorrected visual acuity ranged from 20/25 to 20/50 in all cases. Mean manifest refractive changed from -5.06 D preoperatively to -0.66 D after surgery, and the mean keratometric power changed from 41.40 ±1.56 D to 38.48 ±1.77 D.

Persistent corneal haze (grade 1) was noted only in one eye at 9 months and no other significant complications occurred. Therefore, excimer laser PRK appears to be a good method to correct residual myopia after radial keratotomy. (Refract Corneal Surg (suppl) 1993;9:S25-S29.)
Correction of Myopic Anisometropia with Photorefractive Keratectomy in 15 Eyes
Authors: Georgaras S P , Neos G , Margetis S P , Tzenaki M
Published: April 2021

ABSTRACT

Photorefractive keratectomy (PRK) was performed to correct postoperative myopia and anisometropia in 15 eyes: seven eyes following IOL implantation, six eyes after radial keratotomy, and two eyes after corneal transplantation. The results for the first IOL group were similar to simple PRK in cases of myopia. The RK group showed a tendency for overcorrection. Penetrating keratoplasty eyes showed, after 6 months, changing and moderate haze. (Refract Corneal Surg (suppl) 1993;9:S29-S34.)
Multistep Photorefractive Keratectomy for High Myopia
Authors: Cho Young Soo , Kim Chang Geun , Kim Won Boong , Kim Chang Woo
Published: April 2021

ABSTRACT

Nineteen human myopic eyes exceeding -8.00 D underwent multi-step excimer laser photorefractive keratectomy (PRK) with 6-month follow up. We performed two or three step PRK at the same time according to the amount of myopia present. The preoperative refraction ranged from -8.87 D to - 16.99 D (mean - 12.28 D). The mean attempted correction was 7.83 D. Six months after surgery, the mean refraction was -2.23 D. Keratometry demonstrated stable flattening of the cornea, and pachometry showed central cornea thinning. Seventeen eyes had clear or trace corneal haze. Above results showed multi-step PRK is a safe and relatively efficient procedure for correction of high myopia, but long-term follow up will be necessary to determine the stability of this procedure. (Refract Corneal Surg (suppl) 1993;9:S37-S41.)
Randomized Study of Single vs Double Exposure in Myopic PRK
Authors: Scialdone Antonio , Carones Francesco , Bertuzzi Alberto , Brancato Rosario
Published: April 2021

ABSTRACT

Multizone PRK has been suggested to increase the predictability of higher myopic corrections. The technique consists of dividing the intended correction between two or three different concentric ablation zones, achieving less depth and a smoother ablation profile. We randomized 24 eyes with refractions between -6.00 and -9.00 D for single or double ablation-zone PRK. At 1 year no significant difference in refraction and complications were found between the two treatments. The multizone PRK technique may be safely employed to reduce the maximum central depth of the keratectomy in high myopies. (Refract Corneal Surg (suppl.) 1993;9:S41-S43)
Phototherapeutic Keratectomy in Nine Eyes With Superficial Corneal Diseases
Authors: Hahn Tae Won , Sah Woo Jin , Kim Jae Ho
Published: April 2021

ABSTRACT

We performed phototherapeutic keratectomy (PTK) in seven patients (nine eyes) with superficial corneal disease such as band keratopathy (one patient), Reis-Biickler's dystrophy (one patient, two eyes), granular dystrophy (two patients, three eyes), recurrent granular dystrophy (one patient), postinfection scar (one patient), and corneal scarring after pterygium removal (one patient). All patients received PTK after topical anesthesia with Pontocaine 0.5% and underwent epithelial removal with a surgical blade. We used methylcellulose 1.0% as a surface modulator before laser ablation.

Focal ablation of the central cornea with an ablation zone of 5 mm was performed routinely in most eyes and a smoothing technique was applied only in two eyes. All patients were followed for more than 9 months. Uncorrected and corrected visual acuity were significantly improved in six patients (8 eyes) and a mild hyperopic shift occurred in all eyes that received PTK centrally. Mild to moderate corneal haze appeared in these corneas during the first few months after surgery.

Some patients avoided the need for keratoplasty. No significant complications occurred after PTK except recurrence of granular deposits in one case of granular dystrophy.
Bilateral Simultaneous Myopic PRK as Experienced by an Ophthalmologist
Authors: MacRobert Iain J , Ho Samuel S
Published: April 2021

ABSTRACT

We have been performing excimer laser photorefractive keratectomy (PRK) and phototherapeutic keratectomy (PTK) since November 1991. As of August 1992, we had done 83 PRKs, of which 28 were bilateral, including two patients who had just 3 days separation between procedures. The majority of our patients requested PRK because of contact lens intolerance in Hong Kong's dusty environment. Some requested bilateral surgery at the same operative session to avoid anisometropia without their contact lenses, as well as to endure only one laser surgery with its attendant discomfort. As the bilateral approach became a routine part of our laser practice, many patients who had opted for unilateral procedures stated that, had they been able to take a little more time off, they also would have preferred this technique. (Refract Corneal Surg (suppl) 1993;9:S1 18-S121.)
Phototorefractive Keratectomy-A Personal Insight
Authors: Cohen Peter
Published: April 2021

ABSTRACT

The author, aged 48, an active Summit excimer laser user, had his own right myopic eye corrected by photorefractive keratectomy. Surgery was performed on April 17, 1992, to an eye with a spherical equivalent of -4.50 D, with a postoperative refraction goal of -0.75. This personal experience has allowed for some practical insights which are helpful in advising patients on expectations after PRK. (Refracf Corneal Surg (suppl) 1993;9.S121S122)
Excimer Laser Photoablation of Primary Familial Amyloidosis of the Cornea
Authors: John Maurice E , Martines Eduardo , Cvintal Tadeu , Ballew Carol
Published: April 2021

ABSTRACT

A 31-year old female underwent lamellar keratoplasty for the treatment of bilateral primary familial amyloidosis of the cornea in 1983 (OS), 1986 (OD), and 1989 (OS). The lesions recurred bilaterally and visual acuity in 1992 was 20/400 in each eye. After debridement of essentially all corneal epithelium, the entire cornea of the left eye was treated with excimer laser phototherapeutic keratectomy (PTK). One month postoperatively, visual acuity was 20/50 and the corneal surface appeared smooth and clear with no evidence of recurrence. Four months postoperatively, the patient continued to be free of recurrence. (Refract Corneal Surg (suppl) 1993;9:S138-S141.)
Locating the Corneal Sighting Center From Videokeratography
Authors: Mandell Robert B
Published: April 2021

ABSTRACT

BACKGROUND: The corneal sighting center is defined by the intersection of the line of sight with the anterior corneal surface and is usually found by measuring angle lambda, between the pupillary axis and the line of sight. It is to be determined if a measurement of the pupil offset in the corneal map of videokeratography might be used instead of angle lambda to provide a practical clinical method for finding the corneal sighting center.

METHOD: Two-dimensional angle lambda measurements were made in a group of 17 young adult Caucasian subjects under natural pupil conditions, using an apparatus designed for this purpose, and were compared to measurements of the corneal sighting center position as located by videokeratography.

RESULTS: The correlation between angle lambda as measured directly and the pupil offset as measured by videokeratography was 0.84, which is statistically and clinically significant.

CONCLUSIONS: The position of the corneal sighting center may be found relative to the corneal reflex of a fixated light by using the distance and direction of the pupil offset in the corneal map of videokeratography, or indirectly by taking 0.6 times the same value and measuring in the opposite direction from the pupillary axis. The latter method does not require active fixation by the patient. [J Refract Surg. 1995;11:253-259.]
Correction of Hyperopia Induced by Photorefractive Keratectomy Using Non-contact Ho:YAG Laser Thermal Keratoplasty
Authors: Alió Jorge L , Ismail Mahmoud M , Artola Alberto , Santonja J J Pérez
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the safety and effectiveness of non-contact holmium:YAG laser thermal keratoplasty in correcting hyperopia induced by photorefractive keratectomy (PRK).

METHODS: Non-contact holmium:YAG laser thermal keratoplasty was applied to 14 eyes with significant hyperopia induced by PRK. The mean spherical equivalent refraction before holmium:YAG laser thermal keratoplasty was +4.20 ± 1.80 diopters (D) (range, +1.75 to +6.25 D). The results were evaluated 12 months after holmium:YAG laser thermal keratoplasty.

RESULTS: No sight-threatening complications occurred. Recovery of spectacle-corrected visual acuity took from 2 to 6 weeks. The immediate significant myopic shift that developed in all eyes gradually receded over 6 to 8 weeks. All eyes were relatively stable after 9 months. At 12 months, there was no statistically significant difference (p < .005) between the mean preoperative spectacle-corrected visual acuity (0.71 ± 0.12) and the mean postoperative uncorrected visual acuity (0.65 ± 0.28). At 12 months there was a mean increase of 4.60 ± 1.20 D in central keratometric power. Total regression did not occur in any eye.

CONCLUSION: Non-contact holmium:YAG laser thermal keratoplasty offers a safe and effective alternative to correct PRK-induced hyperopia. [J Refract Surg 1997;13:13-16]
Laser In Situ Keratomileusis for Astigmatism and Myopia after Penetrating Keratoplasty
Authors: Arenas Eduardo , Maglione Antonio
Published: April 2021

ABSTRACT

BACKGROUND: After penetrating keratoplasty, many patients have high ametropia, which is difficult to correct with contact lenses. We used excimer laser in situ keratomileusis (LASIK) on four eyes of four consecutive patients that had previous penetrating keratoplasty in an attempt to correct myopia and astigmatism.

METHODS: We used an automated microkeratome to make a lamellar flap and a Chiron Technolas 193-nm argon fluoride excimer laser. The laser was programmed for the desired myopic and astigmatic correction and a multizone ablation was applied to the central stroma. The corneal flap was placed back into position without sutures.

RESULTS: After surgery, all corneas remained clear with no dislocation of the flap, and the edge of the flap was difficult to visualize after a few days. The average preoperative spherical equivalent was -10.75 diopters (D) (range -5.00 to -14.25 D) which decreased to an average -2.37 D (range -0. 75 to -5.00 D) at a mean follow-up of 7 months (range 6 to 10.5 mos). The average preoperative astigmatism was -2.87 D (range -1.00 to -5.00 D) which changed to an average of -3.50 D. Uncorrected visual acuity was improved and spectacle-corrected visual acuity was preserved without changes.

CONCLUSION: LASIK can effectively reduce myopia after penetrating keratoplasty. [J Refract Surg 1997;13:27-32]
Photoastigmatic Refractive Keratectomy for Compound Myopic Astigmatism with a Nidek Laser
Authors: Goggin Michael J , Kenna Paul F , Lavery Frank L
Published: April 2021

ABSTRACT

BACKGROUND: With advances in the delivery of excimer laser energy to the cornea, spherocylindrical ablations are now possible. The refractive and visual outcome of eyes undergoing photoastigmatic refractive keratectomy with a minimum of 12 months follow-up are presented.

METHODS: A retrospective analysis of 160 consecutive eyes that underwent photoastigmatic refractive keratectomy using the Nidek EC5000 excimer laser was undertaken. One year follow-up data were available on 89 eyes. Vector analysis of the change in cylindrical error, by the Alpins method, was performed. Before surgery, the mean spherical equivalent refraction was -5.68 diopters (D) (SD 2.67 D) with a mean cylinder power of -1.40 D (SD 0.75).

RESULTS: At 1 year after surgery, the mean spherical equivalent was -0.44 D (SD 0.87). Seventy-one eyes (79.8%) had a spherical equivalent within 1.00 D of the target refraction and 79 eyes (89%) achieved 6/12 or better, unaided. Four of 89 eyes (4.5%) lost more than two lines of spectacle-corrected visual acuity with 9 eyes (10%) gaining Snellen acuity, comparing preoperative spectacle-corrected acuity with postoperative uncorrected visual acuity. The mean coefficient of adjustment (targeted induced astigmatism vector magnitude divided by surgically induced astigmatism vector magnitude) was 1.11 (SD 1.33), indicating undercorrection of the cylinder. The mean angle of error was 0.73° (± 10.91).

CONCLUSIONS: Refractive visual acuity outcome after photoastigmatic refractive keratectomy was good. Current algorithms undercorrect the cylinder power, but are adequately aligned. Algorithms for toric ablations in the Nidek EC5000 need to be improved. [J Refract Surg 1997;13:162-166]
Organization of Collagen in the Lyophilized Cornea
Authors: Quantock Andrew J , Verity Steven M , Schanzlin David J
Published: April 2021

ABSTRACT

PURPOSE: To investigate the organization of collagen fibrils in the lyophilized cornea.

METHODS: Freshly harvested porcine corneas (n=10) were lyophilized and examined by synchrotron x-ray diffraction and transmission electron microscopy.

RESULTS: Collagen fibrils are highly compacted in lyophilized corneas. They become more widely spaced when the tissue is rehydrated, however, the distribution of imbibed water throughout the stroma is not necessarily homogeneous within an individual cornea, nor is it always similar in specimens that have been rehydrated to similar levels. In lyophilized corneas, the mean center-to-center interfibrilar spacing of the regularly arranged collagen reaches levels found in freshly thawed porcine corneas (between 74% and 78% water by weight) when between 74.3% and 81.6% of the rehydrated lyophilized cornea's weight is water.

CONCLUSION: Regularly arranged collagen fibrils are able to reapproximate their original spacings if lyophilized corneal tissue is rehydrated, although the manner in which imbibed water is distributed is somewhat unpredictable. [J Refract Surg 1997;13:167-170]
Improved Technique of Circular Keratotomy for the Correction of Corneal Astigmatism
Authors: Krumeich Jorg H , Knülle A , Daniel J
Published: April 2021

ABSTRACT

BACKGROUND: Based on Gaues' law governing the comparison of hyperbaric pressure in the eye and atmospheric pressure, the authors present a procedure to correct astigmatism. The present paper describes an improvement of a technique for circular keratotomy that was published previously.

METHODS: We present data on a consecutive series of 32 eyes with a mean corneal astigmatism of 4.66 diopters (D) (range -2.25 to -6.00 D) with a variety of clinical diagnoses. The astigmatic cornea was trephined with a diameter of 7 mm and a depth of 300 µm. After deepening of the trephination with a diamond knife to 550 µm over the steeper semimeridians, the intraocular pressure created a rounding of the cornea. The amount of astigmatic correction and extent of deepening were controlled intraoperatively with a keratoscope. No sutures were placed.

RESULTS: In 32 consecutive eyes, corrections were between 50 and 90% of the initial cylindrical values after 1 week to 1 month. In 29 eyes (91%), the results obtained remained stable during a 1-year follow-up; in two eyes (6%), the 1-month results worsened by more than 1.00 D and in one eye (3%), results improved by more than 1.00 D. There were no complications during or after surgery. Wound gaping resulting in epithelial plugs did not occur. No patient lost one or more lines of spectaclecorrected visual acuity, but 13 eyes (40%) gained one or more lines.

CONCLUSION: The technique of correcting corneal astigmatism by trephining to a depth of 300 µm., with deepening of the wound to 550 µm along the steep meridian and using no sutures can correct up to 10.00 D of astigmatism with reasonable stability. [J Refract Surg 1997;13:255-262]
Permalens Hydrogel Intracorneal Lenses for Spherical Ametropia
Authors: Barraquer José I , Gomez Maria Laura
Published: April 2021

ABSTRACT

PURPOSE: To assess the efficacy, stability, and safety of Permalens hydrogel intracorneal lenses for the correction of spherical ametropia 6 years after implantation.

METHODS: Implantation of intracorneal hydrogel lenses was performed by the same surgeon (JIBM) in five aphakic and five high myopic eyes. The lens closest to corneal vertex refraction was used. Refractive outcomes, keratometry, keratography, endothelial cell count, and corneal topography were studied.

RESULTS: Corneal tolerance to the hydrogel implants was maintained throughout for ß years with no alteration in endothelial cell count. All myopic eyes showed regression of achieved correction. The aphakic eyes showed no statistically significant difference between the results at 1 month and those obtained at 1 and 6 years.

CONCLUSIONS: Hyrdogei intracorneal lenses are well tolerated and the refractive results are stable in aphakic patients. They may be considered when intraocular lenses cannot be placed in aphakic patients, but are not now in clinical use. [J Refract Surg 1997;13:342-348]
Regression of Myopia Induced by Pregnancy after Photorefractive Keratectomy
Authors: Sharif Khaled
Published: April 2021

ABSTRACT

BACKGROUND: We evaluated refractive corneal changes that occurred in women who become pregnant after undergoing excimer laser photorefractive keratectomy (PRK) for the treatment of myopia.

METHODS: Refractive results of 18 eyes of nine women who underwent PRK and became pregnant during the follow-up period were reviewed. All eyes were followed for a least 12 months after PRK. Subjective refraction, slit-lamp microscopy, and intraocular pressure were measured at each followup examination.

RESULTS: Twelve of 18 eyes (66%) had myopic regression during the follow-up period. The regression was associated with 1+ to 2+ corneal haze in 10 of these 12 eyes (83.3%). The three women (6 eyes) who had stable refractions after PRK became pregnant at least 5 months postoperatively. The corneal haze and the associated myopic regression improved in 50% of the eyes after delivery.

CONCLUSION: Pregnancy seems to induce effects on corneal wound healing following PRK. [J Refract Surg 1997;13(suppl):S445-S446]
Epikeratoplasty for Keratoconus Using Manually Dissected Fresh Lenticules: 4-year Follow-up
Authors: Vajpayee Rasik B , Sharma Namrata
Published: April 2021

ABSTRACT

BACKGROUND: Epikeratoplasty for keratoconus, in the absence of apical scarring, aims at reducing high irregular myopic astigmatism and provides an ectatic cornea with mechanical support.

METHODS: We performed epikeratoplasty on 11 keratoconic corneas using fresh or McCareyKaufman preserved, manually dissected donor lenticules. A disparity of 0.5 nun was maintained between the host and the donor. Patients with keratoconus having a preoperative spectaclecorrected visual acuity of less than 6/60 and intolerance to contact lens wear were included in this prospective study. Spectacle-corrected visual acuity, keratometry, and refraction were analyzed over a 4-year follow-up period.

RESULTS: Four year follow-up was completed on 10 eyes. Of these, 80% achieved a postoperative spectacle-corrected visual acuity of 6/12 or better. Average postoperative keratometry was 45.79 ± 2.07 D and a decrease of 4.60 ± 0.09 D was observed in refractive cylinder. Spherical equivalent showed a significant decrease in myopia of -4.35 ± 0.26 D. Mean time to stabilization was 8 ± 2.3 weeks. Epithelial defects occurred in three eyes; two were successfully treated by patching. One lenticule was removed due to graft infection following a persistent epithelial defect.

CONCLUSION; Epikeratoplasty for keratoconus is a useful procedure with good long-term visual acuity results and an early stabilizing period. [J Refract Surg 1997;13:659-662]
Prospective Randomized Study of Corneal Aberrations 1 Year After Radial Keratotomy or Photorefractive Keratectomy
Authors: Hjortdal Jesper Ø , Olsen Hanne , Ehlers Niels
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the optical properties of the cornea 1 year after either radial keratotomy (RK) or photorefractive keratectomy (PRK) in a randomized group of patients with low myopia.

METHODS: Ninety-six patients with myopia between -0.75 and -5.00 D were randomized to either radial keratotomy (n=46) or photorefractive keratectomy (n=50). Topography maps were obtained 1 year after surgery and analyzed by computation of total corneal wavefront aberration and Zernike polynomial coefficients for pupil sizes of 2, 4, and 6 mm. The 4-mm pupil size was used for optimization of the model.

RESULTS: The total corneal wavefront aberrations after RK and PRK were similar and not statistically different. Wavefront aberrations arising from astigmatism or defocus accounted for approximately 70% of the total wavefront error at all pupil sizes in both groups. All types of aberrations, and in particular spherical aberration, increased significantly with increasing pupil size. Higher-order wavefront aberrations were almost twice as high after RK than after PRK at pupil sizes of 4 and 6 mm. Spherical aberration and coma were slightly higher after PRK than after RK.

CONCLUSIONS: Pupil size had a major effect on corneal aberrations after RK and PRK. The most important aberrations were sphero-cylindrical, in which eyes became significantly more myopic with increasing pupil size. The image forming properties of the cornea are better after PRK compared with RK due to the lesser amount of higher-order aberrations. [J Refract Surg 2002;18:23-29]