bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperplastic Persistent Pupillary Membrane - Surgical Management
Authors: Reynolds James D , Hiles David A , Johnson Bruce L , Biglan Albert W
Published: April 2021

ABSTRACT

Two infants, aged three days and six weeks, respectively, presented with dense extensive persistent pupillary membranes as sporadic isolated findings. ? clear central pupillary aperture was unable to be achieved with mydriatic agente. The patients were treated by surgical removal of the membranes at age five days and six months respectively. Surgery was without complication and visual development has been normal. We suggest that early intervention in the first weeks or months of life is necessary to prevent the development of amblyopia. If mydriaais is unsuccessful, surgery is recommended followed by optical correction and occlusion therapy as necessary.
Congenital Aniridia: A Histopathologic study of the Anterior Segment in Children
Authors: Margo Curtis E
Published: April 2021

ABSTRACT

Seven eyes from seven children with congenital aniridia were studied histologically in order to assess the relationship between congenital and acquired abnormalities. At the time of enucleation the children ranged in age from six days to 14 years. There was no history of previous intraocular surgery in any of the children. Besides iridie and ciliary body hypoplasia three congenital abnormalities of the anterior segment were noted: anomalous development of the anterior chamber angle, incomplete cleavage of the anterior chamber angle, and attenuation of Bowman's membrane. Three acquired abnormalities of the anterior segment were identified: corneal pannus, peripheral anterior synechiae, and lenticular degeneration. The two cases showing anomalous development of the anterior chamber angle occurred in children with a partial deletion of the short arm of chromosome 11.
Dinitrochlorobenzene and Debulking Therapy of Conjunctival Papilloma
Authors: Burns Robert P , Wankum Gerald , Giangiacomo Joseph , Anderson Philip C
Published: April 2021

ABSTRACT

A conjunctiva] papilloma in a four-year-old boy had recurred despite one surgical removal, and three cryosurgical treatments. After sensitization of the child's lymphocytes to dinitrochlorobenzene (DNCB), the lesion responded rapidly and completely to debulking followed by painting the base of the tumor with DNCB. We feel that the effectiveness and simplicity of debulking and DNCB treatment of conjunctival papillomas, which have resisted previous standard forms of therapy, gives an easy, relatively inexpensive, and rapid method of treating these lesions.
Retinoblastoma: The Accuracy of Clinical Diagnosis in Children Treated by Enucleation
Authors: Margo Curtis E , Zimmerman Lorenz E
Published: April 2021

ABSTRACT

We correlated the pathologic diagnosis with the preoperative clinical diagnosis of retinoblastoma in children treated by enucleation within the United States and Canada between the years 1974 and 1980. In order to avoid inappropriate selectivity and institutional bias, we studied only those cases submitted directly to the Registry of Ophthalmic Pathology in which the enucleated eyes had not been examined initially at the local hospital. Of the 56 eyes removed because of suspected retinoblastoma, 15 (26.8%) did not contain a malignant tumor. In two cases enucleation was delayed because retinoblastoma was not considered initially in the differential diagnosis of spontaneous hyphema. During the same period, two of 268 eyes that were enucleated for reasons other than suspected retinoblastoma were found to contain a retinoblastoma. The diagnostic error rate in our study reflects the persistent difficulty in diagnosing retinoblastoma in eyes with opaque media and retinal detachment.
Atypical Echographic Forms of Retinoblastomas
Authors: Lopez J Fernandez-Vigo , Alvarez J Cuevas
Published: April 2021

ABSTRACT

Three cases of histologically proven retinoblastoma are presented whose unusual clinical appearance suggested that ultrasonographic studies should be carried out. These cases exhibited an atypical pattern different from those previously described, and were clinically and ultrasonographically misdiagnosed as endophthalmitis.
Marcus Gunn Jaw Winking and Duane's Retraction Syndrome
Authors: Isenberg Sherwin , Blechman Betsy
Published: April 2021

ABSTRACT

A three-month-oW female presented with the unusual findings of Marcus Gunn Jaw Winking Phenomenon and Duane's Retraction Syndrome in the same eye. In considering suggested etiologies for these two disorders, a misdirection of peripheral innervation would account for both these entities co-existing. In reviewing the ophthalmic literature, the association of these disorders was first described around the turn of the century but much less in recent years.
Rate of Deterioration in Accommodative Esotropia Correlated to the AC/A Relationship
Authors: Ludwig Irene H , Parks Marshall M , Getson Pamela R , Kammerman Lisa A
Published: April 2021

ABSTRACT

We analyzed the claim that accommodative esotropia tends to deteriorate with greater frequency if the accommodation convergence relationship (AC/A) is high. Records of 119 patients whose eyes were aligned with spectacles alone were studied. Their AC/A relationships were graded according to the difference between the distance and near measurements: normal included 0 to 9 prism diopters (Δ) difference; grade 1 ranged from 10 to 19Δ difference; grade 2 from 20 to 29Δ difference; and in grade 3 the difference was 30Δ or greater. Deterioration is characterized by a nonaccommodative component of esotropia greater than 10? at distance becoming superimposed on the initial accommodative esotropia. Deterioration occurred in 7.7% of patients with a normal AC/A, 25% with grade 1 high AC/A, 44% with grade 2 high AC/A, and 52% with grade 3 high AC/A. Hypotheses were investigated using chi square, ttest, analysis of variance (ANOVA), and log linear analyses. Distributional differences were highly significant by chi square test (p = 0.001) with a rejection of the null hypothesis of no difference between the groups at the α = 0.05 level. An alternate analysis of average AC/A ratio in the deteriorated versus nondeteriorated patients was equally statistically significant by the t-test. Hypermetropia was significantly higher in the normal AC/A group. Multi-factor comparisons showed that time-to-deterioration, treatment delay, age of onset, and amblyopia were factors that did not relate significantly to the incidence of deterioration.
Long-Term Follow-up of Jensen Procedures
Authors: Cline Roy A , Scott William E
Published: April 2021

ABSTRACT

Jensen procedures were performed on 29 eyes of 26 patients with lateral rectus palsy between January 1972 and July 1985. The cases were reviewed retrospectively to assess efficacy of the procedure and long-term stability. The patients were evaluated preoperatively with prism cover test, versions, forced auctions, saccadic velocities, and diplopia fields. All patients were observed preoperati vely for at least 6 months and had no further recovery of function. Eighteen eyes had less than 20% of normal abduction saccadic velocity; nine eyes had 20% to 40%; two could not be assessed with saccadic velocities. The procedure was a Jensen's union combined with a medial rectus recession on adjustable suture. The average follow-up was 4 years. Twenty-four patients had good head positions and fusion with a functional area of single binocular vision, averaging 41 horizontally. All patients demonstrated improved saccadic velocities, with similar improvement for those beginning with less than 20% abduction saccadic velocity and those with 20%-40%. A single case of anterior segment ischemia is reported.
Addicted Women and Their Relationships with Men
Authors: Boyd Carol , Mast Deborah
Published: April 2021

ABSTRACT: The information for this descriptive study comes from Andersen's (1980) research funded through the National Institute on Drug Abuse. Although Andersen's questionnaires do not directly gather data about the relationship between the woman's drug use and her relationships with men, the authors were drawn to explore this area because of the large number of female drug users who described this connection. In reviewing the initial and termination data on 72 clients, it was found that 43% reported a variety of ways their usage was affected by men. These anecdotal descriptions provided by the female drug users are summarized under seven

headings; some anecdotal notes are included in the text. The categories are not mutually exclusive. The findings reported in this article concur with the recent literature on drug dependent women.
The Development of Autonomy in Adult Women
Authors: Schutzenhofer Karen Kelly
Published: April 2021

Abstract: The development of autonomy in adult women is a matter of significance for nurses, both as clinicians and as individuals in a women's profession. Autonomy is a complex characteristic of adult development, inadequately researched, especially as it relates to the uniquedevelopmental experiences of women. Research biases have limited the theoretical frameworks against which to examine autonomy in women. Unique psychosocial factors act upon women in influencing the development of autonomy and in differentiating their experiences from that of their male counterparts.
Suicides in Jails and Prisons
Authors: Tuscan John J , Thase Michael E
Published: April 2021

Abstract: Suicide is the leading cause of death in jails and prisons and the rate is at least 3 times higher than the national average. Nonetheless, suicides in jails and prisons have received little professional psychiatric attention. A review of the relevant literature reveals a limited number of studies, many of which contain serious methodological flaws. The current literature does suggest that the psychiatric morbidity in jails and prisons is increasing and that administrative and environmental variables appear to be at least equal to personal characteristics in contributing to inmate suicides. Recommendations for future research efforts and practical applications are made.
Origins of Aggression
Authors: Lanza Marilyn Lewis
Published: April 2021

Aggression is an abstract concept about which there is much discussion, confusion and concern.
PATIENT VIOLENCE report of 200 INCIDENTS
Authors: Jones Marilee K
Published: April 2021

Studies of assaultive behavior in hospital settings are increasing. Results are often contradictory. These variances are dependent upon the type of hospital, the specific setting, and the disciplines involved in the reporting process. Open recognition that violent incidents occur, and the substitution of fact finding for finger pointing, are the first steps toward prevention and management.
GEORGETOWN PROGRAM
Authors: Anonymous
Published: April 2021

COLLABORATIVE PEDIATRICS
NEW REPORT
Authors: Anonymous
Published: April 2021

RAPE CRISIS
Managing Manipulation
Authors: Chitty Kay K , Maynard Carolyn K
Published: April 2021

Skillful nurses will recognize the manipulative client's need for trust, security, and control and will use effective therapeutic responses. The result is positive learning for both nurses and clients.
SUICIDE ATTEMPTS
Authors: Pallikkathayil Leonie , McBride Angela Barron
Published: April 2021

The Search for Meaning
Sexual Abuse and Group Therapy
Authors: Gilbert Charlotte M
Published: April 2021

Children who have been sexually abused share common concerns by virtue of the abuse as well as their developmental stage.
Bibliotherapy: The Right Book at the Right Time
Authors: Cohen Laura J
Published: April 2021

Laura ]. Cohen, MA9 BSN9 introduced this innovative self-help approach in the October, 1987, issue when she discussed bibliotherapy for troubled children. She now extends this creative method to the adult community.
Confidence Builders: A Self-Esteem Group at an Inpatient Psychiatric Hospital
Authors: Klose Patsy , Tinius Timothy
Published: April 2021

Self-esteem influences how one relates to others.
Abuse Among Rural Mentally Ill
Authors: Weiler Kay , Buckwalter Kathleen C
Published: April 2021

Each American adult has the right to make individual decisions. These decisions include preferences in lifestyle, occupation, diet, housing, health-care treatment, Jand allocations of financial resources. The right to autonomous decision making is hot limited to young of middle-aged adults, nor is it limited to those occasions during which the individual has the capacity to personally participate in the decisions (US Congress, 1987). The right also applies to elderly, incapacitated, mentally ili, or dependent adults. Because of this autonomy, no individual must suffer physical, psychological, or financial coercion.

Based on these rights, all 50 states have enacted statutes to protect dependent adults and to authorize government intervention in cases of suspected adult abuse (Hunzeker, 1 990). Iowa is one of the states that has enacted dependent adult abuse legislation, and in 1988, health-care practitioners in Iowa became mandatory reporters of adult abuse (Iowa Code, 1992). As mandatory reporters, all nurses who treat, counsel, examine, or attend dependent adults must observe the physical status and interpersonal relationships of their clients and significant others to identify potential conflict or injury. Categories of abuse recognized by the Iowa law include physical, sexual, and financial abuse, neglect by self, and neglect by another (Figure).
PMS and PMDD in the Domain of Mental Health Nursing
Authors: Stearns Sandy
Published: April 2021

ABSTRACT

Premenstrual syndrome (PMS) is a complex cluster of symptoms that occurs 7 to 14 days prior to menses and ends 1 to 2 days after menses. Premenstrual syndrome symptoms can create severe, debilitating psychological and physical problems. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) provides criteria for premenstrual dysphoric disorder (PMDD), which can be considered the most severe presentation on the PMS continuum. A critical part of determining the diagnosis is evaluating the timing of symptoms. True PMS only occurs during the luteal phase of the menstrual cycle, with a symptom-free period during the follicular phase.

After identifying a diagnosis of PMS or PMDD, the first-line treatment of these symptom clusters continues to be lifestyle changes, including stress management, healthy diet, regular aerobic exercise, cognitive-behavioral therapy, and fortified coping strategies. Women whose symptoms are not controlled adequately with lifestyle modifications may benefit from medications. Possible medication recommendations include selective serotonin reuptake inhibitors (SSRIs), diuretics, gonadotropin-releasing hormone (GnRH) agonists, and vitamin and mineral supplements.
ROLE CONFLICTS & COPING STRATEGIES IN Caregiving: A Symbolic Interactionist View
Authors: Clarke Egerton
Published: April 2021

ABSTRACT

Institutional health care delivery is characterized by interdependency among caregivers and between caregivers and care receivers, which leads to role conflicts. This article examines role conflicts and coping strategies of health care aides who are faced with differing expectations of RNs and residents. Guided by a symbolic interactionist perspective, ethnographic data from 12 RNs, 15 health care aides, and 32 nursing home residents of Italian-Catholic and AngloSaxon descent in Toronto, Ontario, Canada, was gathered. Results showed that health care aides differed in how they handled role conflict and their elderly clients' concerns. Health care aides were more likely to reject conflicting role expectations from residents than from RNs.
Before the Experts Arrive
Authors: Chandley Mark
Published: April 2021

Best Practice Considerations for Early-Stage Hostage Negotiation

ABSTRACT

This article addresses the rare event of the hostage situation in a forensic psychiatric nursing setting. It has a specific focus on the initial response and the accompanying issues for nurses at the clinical interface as the situation emerges. The intention of this article is to both offer guidance and raise the profile of this unique management issue because little attention is drawn to early-stage hostage situations at an organizational level.

When a hostage situation occurs, inadequate preparation can mean the difference between life and death for the hostage, negotiator, or hostage taker. This article provides an overview of the relevant literature and offers guidance about the actions required when a nurse suddenly becomes responsible for managing the early stages of such a traumatic event. Responses, safety, and communication factors concerning the hostage taker are covered.
Social Isolation & Sexual Abuse Among Women Who Smoke Crack
Authors: Young Amy M , Boyd Carol , Hubbell Amy
Published: April 2021

ABSTRACT

The purpose of this study was to explore the prevalence of social isolation and its relationship to sexual trauma in a sample of Black women who smoke crack cocaine. Using a convenience sample of 115 Black women with a history of smoking crack cocaine, participants were interviewed for 2 to 4 hours and asked a variety of questions about their health, relationships, sexuality, and drug use. Bivariate and multivariate logistical regressions were used to predict whether the women reported being socially isolated.

While social isolation was not necessarily a common experience among the sample, it was found that women who had been sexually abused were three times more likely to report being socially isolated than women who had not been sexually abused. In addition, social isolation was more common among women who had been abused by a family member, who had been abused when they were young, and who had been abused for a long period of time. However, multivariate analyses revealed that the age at which the sexual trauma occurred was the most salient predictor of social isolation in adulthood. Implications for drug treatment are discussed.
Revisiting the Identity Issue in Anorexia
Authors: Finelli Lois A
Published: April 2021

ABSTRACT

Anorexia nervosa is considered an enigmatic disease with a multitude of predisposing factors and no empirically confirmed effective treatment. However, all people with the disease relentlessly pursue a common idealized goal - the state of severe emaciation. In this article, the perspective that this condition epitomizes a lifetime struggle for self-acceptance and self-definition is reexamined. People afflicted with anorexia come to define themselves through their emaciated form, and maintenance of this form becomes their major focus and primary means of fulfillment. Therapy must address the identity issue, which is fundamental to the onset and perpetuation of the disease. Use of interpersonal techniques is advocated as most appropriate in serving this purpose.
Accuracy in Communication: A Contextual Approach to Child Behavior Assessment
Authors: Olson James N , Mohr Wanda K
Published: April 2021

ABSTRACT

This article analyzes the problem of accuracy of communication in clinical settings and argues that clinical language is replete with theoretical constructs that may not have shared meaning among speakers and listeners in mental health settings. It is suggested that mental health providers be trained in a contextually based data language. The value of such a data language employed in behavioral assessment is emphasized. The authors contend that events and behavior are products of the contextual environment; contextual variables are more accurately identified and agreed on; and the use of contextual variables in treatment intervention increases consequential validity. A developmental ecological approach, coupled with applied behavior analysis, are discussed and offered as a foundation on which clinical interventions should be planned and assessed. Using objective methods that yield demonstrable and meaningful outcomes can help improve children's mental health service delivery and the lives of children.
Clinical Experience of Two-Step Photorefractive Keratectomy in 19 Eyes With High Myopia
Authors: Kim Jae Ho , Hahn Tae Won , Lee Young Chun , Sah Woo Jin
Published: April 2021

ABSTRACT

The maximum myopic correction with one-step ablation in excimer laser photorefractive keratectomy (PRK) using the ExciMed UV200 LA 193nanometer excimer laser (Summit Technology, Ine, Waltham, Mass,) Is only up to 6.00 D because of a fixed computer program.

We performed a simultaneous two-step PRK procedure for nearly full correction on 19 eyes of 19 patients with myopia ranging from -8.00 to - 1 3.50 D. We clinically evaluated the results of this modified technique at 6 months, or more, after surgery.

In the two-step PRK procedure, we attempted in the first-step of a maximum correction of -6.00 D (including up to - 7.50 D) with 4.5-millimeter ablation zone. The second step was performed immediately thereafter to correct the remaining myopia with a 5.0 -millimeter diameter ablation.

Mean preoperative manifest refraction was -9.77, D and mean postoperative manifest refraction was - 1 .09 D at 6 months after two-step PRK. Uncorrected visual acuity of 20/40 or better was achieved in 74% of 19 eyes (two were amblyopic eyes).

Corneal subepithelial haze was trace or + 1 in all cases at 3 months, but faded out after 3 months. Transient intraocular pressure elevation occurred in one case. No other significant complications developed. Long-term follow up will be required to evaluate the results of two-step PRK. (Refract Corneal Surg (suppl.) 1993;9:S44-S47.)
Treatment of Halos after Photorefractive Keratectomy
Authors: Lafond Gilles
Published: April 2021

ABSTRACT

BACKGROUND: Some patients, despite a good visual outcome after photorefractive keratectomy (PRK), have severe problems with halos.

METHODS: Ten eyes with a near-piano refraction after PRK were treated again with PRK to reduce halos. The goal of the second surgery was to enlarge the diameter of the treatment zones without changing the refraction obtained by the first surgery. The treatment zone was enlarged from 5 or 6 mm to 7 mm. In eyes in which a multizone technique was used in the first PRK, the amount of correction was increased in the transition zone. However, the refractive power in the central 4 or 5-mm zone was not altered. This result was obtained by calculating the amount of desired increased correction on a large zone (6 or 7 mm) and then for the same amount on a smaller zone (4 or 5 mm). The latter, which would produce changes of curvature in the central zone, is subtracted from the overall treatment. Only the part of the treatment where the laser beam increased from 4 or 5 mm to 6 or 7 mm was delivered to the eye. In this process, only the peripheral zones were modified. The central 4 or 5 mm zone was deepened but its curvature and the refraction remained the same.

RESULTS: A decrease of symptoms was noticed by seven of the ten patients. In all eyes, the refraction obtained by the initial surgery was not significantly changed by the second surgery. The best results were obtained in milder myopic patients who had their first surgery with a small diameter ablation zone.

CONCLUSION: Halos can be reduced by repeating the PRK and by increasing the treatment zone without changing the refraction obtained by the first PRK. [J Refract Surg 1997;13:83-88]
Corneal Ablation Profilometry and Steep Central Islands
Authors: Shimmick John K , Telfair William B , Munnerlyn Charles R , Bartlett Jimmy D , Trokel Stephen L
Published: April 2021

ABSTRACT

BACKGROUND: Photorefractive keratectomy with large diameter ablations using a uniform laser beam has produced central undercorrections, or "steep central islands" in patients, as seen with videokeratography.

METHODS: Using a custom optical profilometer to measure corneal ablation profiles and a VISX excimer laser system, we measured the effect of ablation algorithms, diameter, depth, and dioptric correction on enucleated porcine eyes and living rabbit eyes. Our profilometer was verified using a 43.00 diopter (D) spherical surface and a 35.00 and 43.00 D bicurve test surface as a model for the ablated cornea.

RESULTS: The profilometer measured the test surfaces to within 3 µm of predicted values. Photorefractive keratectomies showed over-ablation peripherally and under-ablation centrally which increased with ablation diameter and dioptric correction. Fixed diameter ablations 2 to 6 mm in diameter and 10 to 80 µm deep showed stromal ablation rates vary spatially but not with ablation depth. These spatially variant ablation profiles were used to re-engineer the ablation algorithm and to produce photorefractive keratectomies with improved sphericity.

CONCLUSIONS: Steep central islands are caused by the spatial variance of tissue ablated with a uniform laser beam irradiance. This aberration can be corrected by modifying the laser ablation algorithm to correct for the spatial variance of stromal ablation. [J Refract Surg 1997;13:235-245]
Laser in situ Keratomileusis for Low Myopia and Astigmatism with a Scanning Spot Excimer Laser
Authors: Zaldivar Roberto , Davidorf Jonathan M , Shultz Mitchell C , Oscherow Susana
Published: April 2021

ABSTRACT

PURPOSE: To determine the efficacy, predictability, safety, and short term stability of laser in situ keratomileusis (LASIK) in treating patients with low myopia and astigmatism using the Chiron Technolas Keracor 117 PlanoScan excimer laser.

METHODS: We retrospectively studied the results of our initial 83 eyes with myopia ranging from -1.13 to -7.25 diopters (D) and astigmatism of no more than 4.00 D that underwent LASIK with the Chiron Technolas Keracor 117 PlanoScan. Follow-up was at 1 day, 1 month, and 3 to 6 months.

RESULTS: Mean baseline spherical equivalent refraction was -3.54 ± 1.41 D and cylinder -1.64 ± 1.14 D. Mean postoperative spherical equivalent refraction was -0.52 ± 0.50 D at 1 month and -0.65 ± 0.62 D at 3 to 6 months; mean postoperative refractive cylinder was -0.45 ± 0.54 D at 1 month and -0.50 ± 0.63 D at 3 to 6 months. Fifty-three percent (44 eyes) achieved a spherical equivalent refraction within ± 0.50 D and 81% (67 eyes) within ± 1.00 D of emmetropia at the last examination. Fifty-seven percent (47 eyes) achieved a refractive cylinder of =s0.50 D, and 27% (22 eyes) had an undercorrection of their refractive cylinder at the last examination. An uncorrected visual acuity of 20/40 or better was achieved in 86% (71 eyes) of patients on postoperative day one, in 81% (67 eyes) at 1 month, and in 76% (63 eyes) at 3 to 6 months. Twenty-eight percent (23 eyes) saw 20/20 or better uncorrected at the last visit (41% [34 eyes] had a baseline spectaclecorrected visual acuity of 20/20). There was no statistically significant difference in the refractions or uncorrected visual acuities between the different postoperative examinations. No eye experienced a loss of spectacle-corrected visual acuity of more than one line at the last examination.

CONCLUSION: LASIK with the Chiron PlanoScan excimer laser appears to be an effective, safe, and reasonably predictable means to reduce low myopia and astigmatism. Adjustment of computer algorithms is needed to decrease the number of undercorrections. [J Refract Surg 1997;13:614-619]
Photodisruption in the Human Cornea as a Function of Laser Pulse Width
Authors: Kurtz Ron M , Liu Xinbing , Elner Victor M , Squier Jeffrey A , Du Detao , Mourou Gerard A
Published: April 2021

ABSTRACT

BACKGROUND: We investigated the role of laser pulse width in determining fluence thresholds and efficiency for corneal photodisruption.

METHODS: A laser system that delivers a wide range of pulse energies and pulse widths was used to produce ablations at pulse widths from 100 femtoseconds (fs) to 7 nanoseconds (ns). The laserinduced breakdown fluence threshold at each pulse width was determined by monitoring individual plasma emissions. Using multiple shots, the photodisruption threshold and cutting depth at each pulse width were determined histologically.

RESULTS: Corneal breakdown thresholds decreased at a faster rate from 7 ns to approximately 10 picoseconds (ps), compared to further reductions in pulse width below 10 ps, where little variation was seen. Breakdown for pulse widths below 10 ps showed little intershot variability, resulting in highly reproducible fluence thresholds. Corneal tissue examined histologically showed similar fluence dependency.

CONCLUSIONS: Corneal tissue photodisruption thresholds demonstrate pulse width dependence. At pulse widths less than 10 ps and with fluences near the breakdown threshold, ablations are maximally precise and efficient. These findings suggest optimal laser parameters for corneal surgery. [J Refract Surg 1997;13:653-6581
Conoidal Fitting of Corneal Topography Height Data After Excimer Laser Penetrating Keratoplasty
Authors: Langenbucher Achim , Viestenz Anja , Seitz Berthold
Published: April 2021

ABSTRACT

PURPOSE: To demonstrate a mathematical method for approximation of discrete corneal topography height data with a biconic model surface for better appreciation of the optical performance of the graft after penetrating keratoplasty.

METHODS: In this retrospective study we included 50 eyes of 50 patients (30 keratoconus; 20 Fuchs' dystrophy) undergoing nonmechanical excimer laser penetrating keratoplasty. Conventional keratometry, corneal topography (TMS-I), subjective refraction, and best spectacle-corrected visual acuity (BSCVA) were assessed preoperativeIy, 3 and 6 months postoperatively, and before/after suture removal. A biconic model surface was fitted to the topographic raw data (8.0-mm region of interest) minimizing the root mean square error and a set of parameters (meridional power, axis, conic constant, and approximation error) was determined. The refractive cylinder was correlated with keratometric power readings, the Simulated Keratometry (SimK) of the topography system, and the respective parameters of the model surface.

RESULTS: Keratometric/SimK astigmatism increased from preoperatively (3.40/4.30 D) to 3 months (4.30/4.80 D) and decreased to 3.40/3.90 D after suture removal. Refractive cylinder/cylinder of the biconic increased slightly from 2.10/2.60 D preoperatively to 3.20/3.30 D after suture removal. The topographic cylinder SimK yielded the highest and the refractive cylinder the lowest values at each follow-up examination. Central keratometric power readings were stable before suture removal and decreased (about 1 D) due to suture removal. The conic constants in both meridional cross-sections changed from a prolate to a spherical shape in the early time course after penetrating keratoplasty and reconverted to a prolate shape after suture removal. Regarding cylinder axis, there was a significant correlation of the model surface with the refractive cylinder at all examinations (P<05) but only a mild correlation of the keratometric and SimK cylinder axis to the refractive cylinder axis at some examination stages.

CONCLUSION: Approximation of corneal topography height data with a biconic model surface renders reconstruction of clinically relevant corneal topography parameters including corneal asphericity with marked data compression. The correlation of amount/axis of refractive cylinder was best represented with the model surface parameters. [J Refract Surg 2002;18:63-71]
Immediate Transepithelial Photorefractive Keratectomy for Treatment of Laser in situ Keratomileusis Flap Complications
Authors: Jain Vivek K , Abell Thomas G , Bond William I , Stevens Garth
Published: April 2021

ABSTRACT

PURPOSE: To study the role of photorefractive keratectomy (PRK) in the management of laser in situ keratomileusis (LASIK) flap complications.

METHODS: A retrospective analysis was performed of seven patients (14 eyes) who had bilateral, simultaneous LASIK (single surgeon [TGA], Summit Apex Plus laser, Hansatome microkeratome in six patients [12 eyes], Automated Corneal Shaper keratome in one patient [two eyes]). One eye of each patient received PRK for a flap complication. The seven patients (four women, three men) had a mean age of 39.2 years (range, 22 to 64 yr). The uncomplicated LASEK eyes had moderate to high myopia (-2.25 to -8.75 D) and the eyes with LASIK flap complications had mild to moderate myopia (-1.50 to -5.75 D). Immediate transepithelial PRK was performed in all eyes after repositioning the defective flap.

RESULTS: All seven patients had excellent visual outcome at ? months follow-up; one patient required an enhancement (astigmatic keratotomy). Six of the seven LASEK eyes had best spectaclecorrected visual acuity of 20/20 or better and one LASEK eye had 20/25. In the transepithelial PRK eyes, six of the seven eyes had best spectaclecorrected visual acuity of 20/20 or better and one eye had 20/30.

CONCLUSIONS: Immediate transepithelial PRK treatment of irregular and incomplete LASDK flaps at the time of surgery is an excellent therapeutic option to delayed surgical treatment. [J Refract Surg 2002;18:109-112]
Concomitant Effect of Topical Ubiquinone Q10 and Vitamin E to Prevent Keratocyte Apoptosis After Excimer Laser Photoablation in Rabbits
Authors: Brancato Rosario , Fiore Tito , Papucci Laura , Schiavone Nicola , Formigli Lucia , Orlandini Sandra Zecchi , Gobbi Pier Giorgio , Carones Francesco , Donnini Martino , Lapucci Andrea , Capaccioli Sergio
Published: April 2021

ABSTRACT

PURPOSE: To investigate in vivo whether ubiquinone QlO together with vitamin E protects rabbit corneas from keratocyte apoptosis after excimer laser irradiation.

METHODS: Photorefractive keratectomy (PRK) was performed in both eyes of three New Zealand white rabbits. During 3 days before surgery, each right eye received four-times-daily instillation of an eye-drop solution containing ubiquinone QlO 0.20% and vitamin E 0.04%; each left eye was treated with a solution that did not contain ubiquinone or vitamin E. The central cornea was analyzed after surgery using the in situ end labelling (ISEL) technique of nicked DNA to detect DNA fragmentation. To determine the number of ISEL positive nuclei, an average of 70 random microscopic fields (five for each de-epithelialized tissue section) of 138,000 ?2 were examined in the right and left cornea samples at 250X by two different observers.

RESULTS: Light microscopic examination of the sections from corneas treated before PRK showed that cells committed to apoptosis by PRK were about 50% compared to those of untreated controls.

CONCLUSION: Treatment of rabbit eyes before PRK with ubiquinone QlO lowered the number of apoptotic events. [J Refract Surg 2002;18:135-139]
Pain Reduction After Laser in situ Keratomileusis With Ketorolac Tromethamine Ophthalmic Solution 0.5%: A Randomized, Double-masked, Placebo-controlled Trial
Authors: Price Francis W , Price Marianne O , Zeh William , Dobbins Kendall
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the analgesic efficacy of ketorolac tromethamine ophthalmic solution 0.5% after laser in situ keratomileusis (LASIK).

METHODS: In this two-center, randomized, double-masked, placebo-controlled, parallel group study, 39 patients underwent bilateral simultaneous LASIK. Patients received study drops (Acular PF or Lens Plus) in both eyes 15 to 30 minutes before surgery, again immediately before passing of the microkeratome, and again after flap repositioning. Proparacaine was used during surgery, but no additional therapeutics were used for the next 24 hours, except acetaminophen or propoxyphene napsylate acetaminophen allowed as escape medication. Patients rated their eye pain hourly through 6 hours after surgery.

RESULTS: Ketorolac significantly reduced eye pain at every time point compared to placebo (P-cOl). Escape medication use declined significantly; 16% (3/19) of those who received ketorolac required escape medication compared to 50% (8/16) of placebo-treated patients (P=.03). Ketorolactreated eyes were pain-free significantly sooner (P-cOl), with 47% (18/38) having pain cessation by hour 4, compared to 15% (5/33) of placebotreated eyes. No treatment-related adverse events occurred.

CONCLUSION: This study supports the use of topical ketorolac for control of early postoperative pain following LASIK, significantly increasing patient comfort and reducing usage of other pain medications. [J Refract Surg 2002;18:140-144]
Aberration-sensing and Wavefront-guided Laser in situ Keratomileusis: Management of Decentered Ablation
Authors: Mrochen Michael , Krueger Ronald R , Bueeler Michael , Seiler Theo
Published: April 2021

ABSTRACT

PURPOSE: To clarify the feasibility of aberration-sensing and wavefront-guided laser in situ keratomileusis (LASIK) to manage grossly decentered ablation and to discuss the limitations of the technology.

METHODS: Three patients with previous decentrations of the ablation zone between 1.5 to 2.0 mm were scheduled for wavefront-guided LASIK. AU patients reported monocular diplopia and halos. Wavefront aberrations were measured with a Tscherning-type aberrometer. Laser ablation was done with a WaveLight Allegretto in a one-step procedure with ablation profiles calculated only from the individual wavefront map. Decentrations were determined from corneal topography.

RESULTS: Three months after surgery, patient WM and patient SU had gained uncorrected and best spectacle-corrected visual acuity. The root mean square-wavefront error decreased up to 61% and 33%, respectively, for total and higher order aberrations (Zernike modes of 3rd order and higher). There was significant enlargement of the optical zone determined by corneal topography, and both patients no longer reported diplopia and halos at 3 months postoperatively. The optical aberration of the third patient (RE), after a 5.00-D overcorrection with a 2-mm decentratici!, was too high for aberration-sensing; retinal images obtained from the wavefront device were too smeared and not of sufficient contrast. In addition, this patient had a residual corneal thickness of 416 µm and thus wavefront-guided LASEK was not done.

CONCLUSIONS: Wavefront-guided LASIK offers a new way of managing grossly decentered laser ablations. Unfortunately, there are still patients who have aberrations too large for wavefront sensing or with other clinical limitations such as a residual corneal thickness too thin for further treatment. [J Refract Surg 2002;18:418-429]
Incidence of Lens Opacities and Clinically Significant Cataracts With the Implantable Contact Lens: Comparison of Two Lens Designs
Authors: Sanders Donald R , Vukich John A
Published: April 2021

ABSTRACT

PURPOSE: To compare the incidence of anterior subcapsular lens opacities, clinically significant cataracts, secondary lens-related surgical reinterventions, and vaulting characteristics of the now discontinued V3 and currently used V4 Staar Surgical Implantable Contact Lens (ICL) phakic intraocular lens designs.

METHODS: In this non-randomized prospective clinical trial, 87 eyes were implanted with the V3 and 523 eyes with the V4 ICL as part of the U.S. FDA clinical trial for myopia. LOCS III assessment of lens opacities, clinically signiñcant cataract, ICL vaulting (clearance between ICL and crystalline lens), and secondary ICL-related surgeries were the main outcome measures. Mean follow-up in the V3 series was 30.7 ± 10.0 months (range 10.8 to 49.3 mo) and in the V4 series, 17.3 ± 6.9 months (range 0.25 to 38.5 mo).

RESULTS: Incidence of anterior subcapsular opacities was significantly higher with the V3 vs. V4 ICL (12.6% vs. 2.9%, P<.001). The difference was largely due to the higher rate of late- appearing opacities (2*1 year after surgery; 9.2% vs. 0.6%, P<.001). The V3 group had a greater proportion of eyes with poor vault (23.6% vs. 4.3%, P<.001) and the presence of poor vault was highly associated with the development of late anterior subcapsular opacities (P<.001). Clinically significant cataract was more frequent in the V3 vs. V4 ICL (9.2% vs. 0.8%, P<.001), as was cataract extraction (6.9% vs. 0.2%, P<001), and need for ICL replacement (5.7% vs. 1.1%, P<.001). Differences in opacity rate between the V3 and V4 designs were not due to differences in postoperative follow-up.

CONCLUSION: Implantation of the currently used V4 Staar Surgical model ICL resulted in significantly less anterior subcapsular opacities, clinically significant cataracts, and secondary ICLrelated surgery. [J Refract Surg 2002;18:673-682]
Macular Hole in a Myopic Eye After Laser in situ Keratomileusis
Authors: Ma Ruiz-Moreno José , Artola Alberto , Pérez-Santonja Juan J , Alió Jorge L
Published: April 2021

ABSTRACT

PURPOSE: To analyze the characteristics of a macular hole in a myopic patient after laser in situ keratomileusis (LASEK).

METHODS: A macular hole with sharp margins and small yellow deposits on the surface of the retinal pigment epithelium appeared in the left eye of a female patient, 53 years old, 12 months after LASIK for the correction of -6.75 D of myopia (follow-up after LASIK, 22 months). Best spectaclecorrected visual acuity (BSCVA) before LASIK was 20/25. BSCVA after LASIK was 20/20 (spherical equivalent refraction -1.00 D). After the macular hole appearance, BSCVA was 20/100. The macular hole was treated by vitrectomy with internal-limiting membrane peeling. Final BSCVA was 20/50.

CONCLUSION: The role of LASIK in the pathogenesis of macular hole remains unclear. [J Refract Surg 2002;18:746-7491
Late Corneal Scarring After Photorefractive Keratectomy Concurrent With Development of Systemic Lupus Erythematosus
Authors: Cua Irwin Y , Pepose Jay S
Published: April 2021

ABSTRACT

PURPOSE: To report a case of late-onset corneal haze following previous photorefractive keratectomy (PRK) concurrent with the development of systemic lupus erythematosus.

METHODS: Single case report and review of medical literature.

RESULTS: A 41 -year-old woman underwent uneventful bilateral, non-simultaneous photorefractive keratectomy (PRK) with retreatment of the right eye after 1 year. Two months after retreatment, the patient presented with headaches and mental status changes and was diagnosed with systemic lupus erythematosus. Severe reticular corneal scarring developed in the right eye 1 year after retreatment. After the patient's disease was well controlled on a maintenance dose of hydroxychloroquine 200 mg twice a day, mechanical debridement was performed on the right cornea with a marked decrease in corneal haze and improved best spectacle-corrected vision.

CONCLUSION: Patients who manifest with autoimmune disorders such as systemic lupus erythematosus may be at greater risk for developing dense, reticular corneal scars after PRK. [J Refract Surg 2002;18:750-752]
Corneal Topographic and Pachymetric Screening of Keratorefractive Patients
Authors: Ambrósio Renato , Klyce Stephen D , Wilson Steven E
Published: April 2021

ABSTRACT

PURPOSE: To review the incidence of corneal abnormalities detected in the preoperative examination, using videokeratography and pachymetry that excluded patients from laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PBK).

METHODS: We conducted a chart review of consecutive patients who had a preoperative examination and were excluded from refractive surgery.

RESULTS: Eighteen patients from 1,392 refractive candidates (1.3%) were designated as poor candidates for LASIK or PRK based on corneal topography and/or pachymetry. Thirteen patients (0.9%) were identified as having keratoconus suspect, keratoconus, or pellucid marginal degeneration. Five patients (0.4%) were excluded due to thin corneas (<490 /¿m) despite normal corneal topography.

CONCLUSIONS: Corneal topography and pachymetry are indispensable tools in the preoperative screening of refractive surgery candidates. [J Refract Surg 2003;19:24-29]
Persistent Haze and Disorganization of Anterior Stromal Collagen Appear Unrelated Following Phototherapeutic Keratectomy
Authors: Connon Che J , Marshall John , Patmore Ann L , Brahma  , Meek Keith M
Published: April 2021

ABSTRACT

PURPOSE: The theoretical effects on corneal transparency induced by changes in collagen fibril packing following phototherapeutic keratectomy were compared to changes in objective measurements of haze.

METHODS: Phototherapeutic keratectomy was performed on the right eyes of four young rabbits; left eyes were used as controls. Postoperative slitlamp measurements of haze were taken at regular intervals up to 19 months. Wounded stromas were studied by synchrotron x-ray diffraction to calculate the average interfibrillar spacing of the collagen fibrils. These data were combined with transmission electron microscope measurements, and the summation of scattered fields method was used to predict the transmission of visible light.

RESULTS: Objective measurements of haze were higher than the baseline control throughout the study. Electron micrographs of anterior stroma in 8-month-old wounds displayed irregularly spaced and poorly organized fibrils and x-ray diffraction indicated larger mean interfibrillar spacing compared to the controls. However, the predicted transmission of visible light through the anterior stromal scar tissue was not significantly different than normal.

CONCLUSIONS: Following phototherapeutic keratectomy, anterior corneal collagen fibrils were more widely spaced and unevenly organized than in the normal rabbit cornea. However, this did not cause a significant loss of transparency and was therefore unlikely to contribute to haze. [J Refract Surg 2003;19:323-332]
The Use of Sodium-Hyaluronate (Healon) in the Treatment of Retinal Detachment
Authors: Stenkula Staffan , Ivert Lena , Gislason Ingimundur , Tornquist Ragnar , Weijdegard Lars
Published: April 2021

SUMMARY

Na-hyaluronate (Healon) has been successfully used for reposition of high bullous retinal detachment in 13 cases. Healon was injected into the vitreous cavity after drainage of the subretinal fluid at the beginning of the operation. This technique highly facilitated treatment of the retinal tears.

Injection through the Ocutome infusion cannula offers several advantages compared to an ordinary cannula.
Use of a Pulsed Neodymium Yag Laser (Picosecond) to Open the Posterior Lens Capsule in Traumatic Cataract: A Preliminary Report
Authors: Aron-Rosa Daniele , Griesemann Jean-Claude , Aron Jean-Jacques
Published: April 2021

SUMMARY

The use of an ultra short Nd Yag laser pulses is described for the opening of secondary traumatic cataract and iridocapsular synechiae. Both pigmented and non pigmented ocular tissue were cut without causing adverse thermal effects and without opening the eye.

The laser instantaneous release of energy causes total ionization of the medium and formation of a plasma, followed by a hydrodynamic shock wave originating at the energy zone boundary.

The temperature at the site of the laser contact cannot exceed 2 x 10^sup -1^ °C, which is not harmful to the eye. Further, this procedure requires no anesthesia and does not involve introduction of foreign material into the eye. The degree of aiming accuracy, the very small diameter of the beam (50 microns) make the laser so precise that it virtually eliminates the risk of damage to the eye and/or the intraocular lens.
Carbon Dioxide Laser Therapy of Recurrent Squamous Papilloma of the Conjunctiva
Authors: Schachat Andrew , Iliff W Jackson , Kashima Haskins K
Published: April 2021

SUMMARY

Juvenile squamous papilloma of the conjunctiva may exhibit "malignant" behavior with multiple recurrences presenting difficulty in management. We have successfully treated a child with the carbon dioxide laser who had failed three previous surgical excisions, cryotherapy (twice), and chemotherapy. The carbon dioxide laser permits a precise form of tissue excision with minimal trauma, edema, and scarring, and offers a safe alternative approach to the management of these lesions.
Tarsal Polishing and Mucous Membrane Grafting for Cicatricial Entropion, Trichiasis and Epidermalization
Authors: McCord Clinton D , Chen William P
Published: April 2021

SUMMARY

In a manner similar to dermabrasion, epidermalized tarsal conjunctiva is polished and then the tarsus is grafted with full-thickness buccal mucous membrane. This has been applied with rewarding results in patients afflicted with Stevens- Johnson syndrome, ocular pernpnigoid and scarred eyelids with secondary epidermalization.