bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracker-assisted Versus Manual Ablation Zone Centration in Laser in situ Keratomileusis for Myopia and Astigmatism
Authors: Pineros Oscar E
Published: April 2021

ABSTRACT

PURPOSE: Eye tracker systems have been developed concomitantly with small scanning beams to theoretically reduce ablation zone decentration and for accurate registration of all the laser pulses on the cornea. The purpose of the study was to compare the tracker-assisted with the manual centration method.

METHODS: Twenty-five patients (48 eyes) with myopia and/or astigmatism had laser in situ keratomileusis (LASIK) between August 1998 and February 1999 with the Technolas 117C laser. Twenty patients (38 eyes, 80%) were available for follow-up at 3 months after surgery. Eyes were assigned randomly to one of two ablation zone centration methods: Group 1: Tracker- assisted (20 eyes), Group 2: Manual (18 eyes).

RESULTS: Mean distance between the ablation zone center and the pupillary center in the trackerassisted centration group was 0.55 ? 0.30 mm (range, 0.10 to 1.4 mm), and in the manual centration group, 0.43 ? 0.23 mm (range, 0.10 to 1.0 mm) (P=.177). There was no statistically significant difference in postoperative contrast sensitivity, glare, and Topographical Corneal Surface Regularity Index (SRI) between the two groups.

CONCLUSIONS: We obtained good results with both centration methods. We did not find superiority of the tracker-assisted over manual regarding ablation zone centration, vision quality, or regularity of the ablation. [J Refract Surg 2002:18:37-42]
Repeated Photorefractive Keratectomy for Undercorrection and Regression
Authors: Pietilä Juhani , Mäkinen Petri , Uusitalo Hannu
Published: April 2021

ABSTRACT

PURPOSE: Regression (often combined with significant haze) and undercorrection are the most frequent complications after photorefractive keratectomy (PRK) for myopia. PRK retreatment has been used to treat both of these complications.

METHODS: Sixty-three eyes (55 patients) were reoperated (PRK) because of initial regression or undercorrection. The mean interval between the operations was 17.2 months (range 5 to 37 mo). Residual myopia before retreatment was less than -5.00 D in 62 eyes (mean -2.21 ± 0.09 D) and was -10.50 D in one eye. The same surgical PRK technique (Aesculap-Meditec MEL 60 excimer laser with 5 or 6-mm ablation zone) was used in both operations.

RESULTS: One-year results were available for 51 eyes. In the group of eyes with low residual myopia (<-5.00 D), mean refraction 1 year after retreatment was -0.42 ± 0.96 D and 43 eyes (86%) were within ±1.00 D of emmetropia. Uncorrected visual acuity of 20/40 or better was achieved in 43 eyes (86%) after 1 year. One eye lost two lines of best spectacle-corrected visual acuity after two procedures because of haze. Mean haze was the same before and 12 months after reoperation (grade 0.39 vs. 0.38). Significant haze (>2) and high regression after the first PRK occurred after reoperation. The one eye with -10.50 D residual myopia after the first PRK showed high regression, and 1 year after the reoperation refraction was -9.50 D with grade 2 haze.

CONCLUSIONS: Repeated PRK was safe and in most cases effective in treating regression and undercorrection in eyes with low residual myopia after initial PRK High regression and especially haze after the initial PRK often reappeared after reoperation. [J Refract Surg 2002:18:155-161]
Correlation Between Automated and Subjective Refraction Before and After Photorefractive Keratectomy
Authors: Rosa Nicola , Iura Attilio , Romano Mary , Verolino Gianluca , Romano Antonio
Published: April 2021

ABSTRACT

PURPOSE: To ascertain whether autorefraetometry after photorefractive keratectomy (PRK) provides results that are comparable with subjective refractometry.

METHODS: The refractions of 159 eyes before and 1 month after PRK were determined with both automated and subjective refractometry, and the results of the two methods were compared.

RESULTS: Before PRK, subjective spherical equivalent refraction ranged from -15.25 to +0.25 D (mean -5.30 ± 2.64 D) and automated spherical equivalent refraction ranged from -16.13 to -0.50 D (mean -6.10 ± 2.74 D), with good correlation (r
p 2
= 0.965) between the two methods. One month after PRK, subjective spherical equivalent refraction ranged from -1.63 to +3.50 D (mean +0.98 ± 0.78 D) and automated spherical equivalent refraction ranged fiom -2.50 to +3.00 D (mean +0.36 ± 0.96 D) with poor correlation (r
p 2
= 0.401).

CONCLUSION: Autorefractometry is less reliable in eyes after PRK, and consequently software changes are recommended for overcoming this problem. [J Refract Surg 2002;18:449-453]
Precision of Flap Measurements for Laser in situ Keratomileusis in 4428 Eyes
Authors: Flanagan Gerald W , Binder Perry S
Published: April 2021

ABSTRACT

PURPOSE: To determine the factor(s) that influence the dimensions and predictability of the LASIK corneal flap with the Automated Corneal Shaper (ACS) or the Summit Krumeich Barraquer microkeratome (SKBM).

METHODS: We performed a retrospective, comparative interventional case study of 4,428 eyes. Flap dimensions were measured using subtraction ultrasonic pachymetry during LASIK with one of two microkeratomes.

RESULTS: Mean preoperative corneal thickness for all eyes was 555 ± 35 µm. Corneal curvature and refractive astigmatism were inversely related to preoperative corneal thickness (P<.001). With an attempted flap thickness of 160 µm, the ACS flap thickness averaged 119.8 ± 22.9 µm; SKBM flaps averaged 160.9 ± 24.1 µm (P<.001). The coefficient of variation for central pachymetry compared to flap thickness was 6.4% vs. 22.1%. Flap thickness at enhancement was 10 to 17 µm thicker than at primary surgery. An increase in flap thickness was associated with thicker preoperative pachymetry (P<.001) and younger age for both instruments (P<.001) whereas increasing flap thickness was related to flatter preoperative mean keratometry for the ACS (P<.001) and steeper mean keratometry for the SKBM (P=.005). Less preoperative hyperopia or more myopia was related to an increase in flap thickness only for the SKBM (P<.001).

CONCLUSIONS: Flap thickness varies significantly depending on the microkeratome used. Factors that influence flap thickness are primarily corneal thickness, patient age, preoperative keratometry, preoperative refraction including astigmatism, and corneal diameter. By understanding the factors that affect flap thickness, one can select a microkeratome system to allow maximum refractive correction while minimizing the risk of ectasia. [J Refract Surg 2003;19:113-123]
Changes of Higher Order Aberration With Various Pupil Sizes in the Myopic Eye
Authors: Wang Yan , Zhao Kanxing , Jin Ying , Niu Yafei , Zuo Tong
Published: April 2021

ABSTRACT

PURPOSE: To investigate the effect of pupil diameter on higher order aberration in myopic eyes.

METHODS: One hundred and two eyes of 51 normal subjects were evaluated with the Nidek OPDScan.

RESULTS: All types of aberration increased significantly with increasing pupil size (P<.001). However, optical aberrations had a less pronounced increase in C
3
^sup -1^ and C
3
^sup +1^, more pronounced increase in C
4
p 0
with pupil area increased (P<.05), 2nd coma (C
5
^sup -1^ and C
5
^sup +1^) and high order astigmatism (C
4
^sup -2^, C
4
^sup +2^, C
8
^sup -2^, C
p 8
^sup +2^) with larger pupU diameter. Compared with the aberrations of each high order aberration at 4 mm, the average increase root mean square values were 1.54, 1.59, 1.71, and 1.87 on S
3
, S
4
, S
5
, and S
6
respectively, with a 5-mm pupil, whereas increased root mean square values were 1.46, 1.88, 1.51, and 1.60 for a 6-mmdiameter pupil.

CONCLUSION: For an equal increase of pupil size, not all Zernike polynomial coefficients induced equivalent increase of values. Coma-like aberrations increased less with pupil dilation. Spherical-like aberration showed only a small increase from 4 nun to 5 mm pupil size, but a larger increase from 5 mm to 6 mm pupil size. Other higher order aberrations (S
5
and S
6
) increased slightly with pupil dilation. Coma-like aberration was larger than spherical aberration, and larger than other higher order aberrations for all pupil sizes. [J Refract Surg 2003;19(suppl):S270-S274]
Higher Order Ocular Aberrations After Cycloplegic and Non-cycloplegic Pupil Dilation
Authors: Carkeet Andrew , Velaedan Shajan , Tan Yong Kang , Lee Derrick Yu Jiang , Tan Donald T H
Published: April 2021

ABSTRACT

PURPOSE: Clinical aberrometry is commonly undertaken with the use of mydriatic agents, however there is no literature available on whether aberrometry results obtained under cycloplegia differ from those obtained without cycloplegia.

METHODS: Higher order aberrations were measured over a 6-mm pupil with a Bausch and Lomb Technolas Zywave Aberrometer on the right eyes of 31 young subjects (average age 19.7± 1.7 years; 5 females, 16 males). Two measurement conditions were used for each subject: 1) topical installation of 3 drops 1% cyclopentolate hydrochloride; and 2) topical installation of 1 drop 2.5% phenylephrine hydrochloride, prior to aberrometry measurements.

RESULTS: For higher order aberrations (3rd to 5th order), average root mean square (RMS) after phenylephrine measurement (0.3852 µm) was significantly lower than after cyclopentolate (0.4259 µm). A small but statistically significant difference was found between the two conditions for average vertical and horizontal coma and, to a lesser extent, horizontal 5th order aberrations. Repeatability RMS, a measure of test-retest measurement repeatability, was similar for the two conditions at 0.15 µm, and significantly lower than the average RMS for the difference between the two conditions (residual RMS) of 0.22 µm.

CONCLUSIONS: The difference between cycloplegic and non-cycloplegic aberration measurements has implications for surgical correction of higher order aberrations. [J Refract Surg 2003;19:316-322]
US Trends in Refractive Surgery: 2002 ISRS Survey
Authors: Duffey Richard J , Leaming David
Published: April 2021

ABSTRACT

PURPOSE: To determine the latest trends in refractive surgery in the United States.

METHODS: The full U.S. membership of the International Society of Refractive Surgery (ISRS) (approximately 900 members) was mailed the 2002 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of emerging technology.

RESULTS: Questions regarding RK, AK, PRK, LASIK, LASEK, intracorneal ring segments (ICRS), laser thermal keratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), and clear lens extractions (CLE) were examined in the survey. Procedure preference for low, moderate, and high myopia, and hyperopia, were compared with the results from the surveys of the previous 5 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of co-management of refractive surgery patients were compared with 1999-2001 data. New questions regarding pupil measurement/documentation, wavefront aberrometry, and custom ablations were incorporated into the 2002 survey.

CONCLUSIONS: As refractive surgery grows in the mainstream of ophthalmology, trends and changes in the United States continue to be elucidated by this professional organization survey. LASIK continues to dominate for refractive errors between -10.00 to +3.00 D. LASIK, LASEK, CLE, PIOL, and CK appear to have bright futures, whereas, RK, ICR, and LTK are on the decline. VISX continues to be utilized 2:1 over all other lasers combined, and instrumentation pupillometry is preferred 2:1 over pupil gauge cards. Currently, wavefront aberrometry and custom ablations are minimally employed but appear poised to be the wave of the future. [J Refract Surg 2003;19:357-363]
Vulnerability of the Rabbit Eye to Torsion and Pulling-out - A Functional Study, Monitored by ERG and VECP
Authors: Kawano Shin-ichiro , Honda Yoshihito , Negi Akira , Mitsuyu Mariko
Published: April 2021

SUMMARY

Visual function of rabbits was studied employing ERG and VECP, while the eye was rotated or pulled-out around or along the axis. Torsion of 90-180 degrees for ten minutes did not affect either ERG or VECP. Torsion of 270 degrees or more abolished VECP and later ERG. Axial pulling-out easily affected on VECP, and ERG disappeared only when a loaded weight was increased. However, responses recovered to the pre-loading level after the eye was released from torsion or pulling-out.
Modification of the Can-Opener Capsulotomy Technique to Avoid Large Residual Flaps of Anterior Capsule with Ciliary Sulcus J-Loop Posterior Chamber Lens Insertion
Authors: Murphy Gates E
Published: April 2021

SUMMARY

The can-opener technique is a proven safe method of performing an anterior capsulotomy when the surgeon does not desire to preserve anterior capsule flaps. Inadvertent large residual flaps, however, may result from this technique and cause early capsule opacification when a J-loop posterior chamber lens is inserted from ciliary sulcus to ciliary sulcus. A technique for avoiding these unwanted flaps is described.
Blindness Following Lacrimal Nerve Block
Authors: Carroll Richard P
Published: April 2021

SUMMARY

Permanent unilateral blindness developed in an 84-year-old woman following lacrimal nerve block in preparation for ectropion repair to correct moderate lower eyelid laxity. The loss of vision in this patient is believed to have been caused by optic nerve ischemia secondary to compression of nutrient vessels following rapid increase in the intraocular pressure induced by orbital hemorrhage.
Isolated Paresis of the Inferior Oblique
Authors: Frey Thomas
Published: April 2021

SUMMARY

Four cases of isolated superior oblique paresis are presented. The usual course of events was that of a gradually increasing diplopia and head tilt. All patients fulfilled the three-step test criteria, with a hypertropia that increased on side gaze to the ipsilateral side and on head tilt to the side opposite that of the paretic muscle. All patients were treated with a superior rectus recession. Three patients had their hypertropia reduced to between zero and 2 diopters. One patient needed, in addition to his superior rectus recession, an inferior rectus resection to eliminate the hypertropia. Vertical rectus surgery presents an alternative to superior oblique muscle tenotomy in treating inferior oblique paresis.
Appropriate Ophthalmic Surgical Technology in Developing Nations
Authors: Schwab Larry , Whitfield Randolph
Published: April 2021

SUMMARY

Ophthalmologists working in developing nations are faced with shortages in surgical equipment and expendable supplies. Invention and improvisation can extend financial resources and reduce the unit cost per operation. Examples of appropriate ophthalmic technological invention are described and illustrated.
Evaluation of Coated and Uncoated Synthetic Absorbable Sutures in Rabbit Limbal Wounds
Authors: Sugar Alan , Bahn Charles F
Published: April 2021

SUMMARY

Polymer coatings have been applied to braided synthetic absorbable sutures to decrease tissue drag and improve knot tying characteristics. To examine the possibility that increased "slipperiness" would decrease knot security, coated (Dexon Plus) and uncoated (Dexon S) polyglycolic acid sutures were compared in rabbit limbal wounds. Both suture types had comparable knot security, tissue reaction, and absorption rates, while the coated sutures caused less tissue drag. Clinical trials of coated polyglycolic acid suture for limbal wounds are warranted.
The Use of Postoperative Beta Radiation in the Treatment of Pterygia
Authors: Alaniz-Camino Francisco
Published: April 2021

SUMMARY

Results of 483 cases of pterygia treated with surgery and prophylactic postoperatory beta therapy are discussed.

Distribution by age and sex show the predominant age range to be between 20 to 50 years with an almost equal proportion of males and females. The postoperative dose administrated was 2800 rads in four to five days overall time, with a recurrence rate of 4.32%. Of this group of recurrent cases, only one patient received the first irradiation treatment immediately after surgery; the rest were treated 24 hoursafter being operated. We have found no undesirable side effects or damage produced by beta radiation.
Chemical Preparation of Skin and Eye in Ophthalmic Surgery: An International Survey
Authors: Apt Leonard , Isenberg Sherwin
Published: April 2021

SUMMARY

We surveyed 214 ophthalmologists worldwide to learn their methods of preoperative chemical preparation of eye and skin. A 96.8% return rate was achieved. While a wide diversity of agents was reported, povidone- iodine was the most popular agent applied to the skin. The conjunctiva usually was either ignored or rinsed with a saline sol ution by the respondents. Almost a quarter used mild silver protein (Argyrol) on the conjunctiva. Most of the preparation is performed by the physician rather than the nurse. Review of the advantages and pitfalls of the agents reported should cause the ophthalmologist to reconsider these agents for their effectiveness, spectrum, and duration of action.
Adherence of Mouse Macrophages to Plastic Lens Implants-Resulting in the Formation of a Cellular Membrane
Authors: Wolter J Reimer , Kunkel Steven L
Published: April 2021

SUMMARY

An experiment for the study of the adherence of mouse macrophages to lens implants under tissue culture conditions has been developed. Formation of a continuous monolayer of cells on the surface of a plastic implant after 18 hours of incubation is demonstrated when this is exposed to a fluid with a high concentration of macrophages. Fewer macrophages in a thin fluid layer on the surface of a tissue culture dish made of clear plastic under the same conditions also showed adherence in a noncontinuous pattern. Some of these macrophages adherent to the surface of the plastic dish resembled reactive cell types that have previously been seen on lens implants removed from human eyes.
Ultrasonic Capsule Polisher: A New Instrument and Technique
Authors: Devine Terence M
Published: April 2021

Terence M. Devine, M.D.

ABSTRACT

An ultrasonic I/E capsule polisher is described. The instrument is capable of safely removing dense cortical plaques which could not be removed with conventional instruments. Its use for both capsule polishing and cortical clean-up is discussed.
Little Known Volume Considerations in Irrigation, Aspiration
Authors: Ballin Norman
Published: April 2021

ABSTRACT

I have measured infusion rates and collection rates for the Cavitron, Site and Storz I-A instruments, and for several needle systems. The Cavitron and Site instruments move large volumes per unit time, while the Storz is a low volume system. Leakage is the major source of total volumes used with the larger needles. Port size and needle bore diameter both have some effect on rapidity of flow through a needle, but needle diameter is more important.
Diagnosis and Localization of Intraocular Foreign Bodies by Computed Tomography
Authors: Spierer Abraham , Tadmor Rina , Treister Giora , Blumenthal Michael , Belkin Michael
Published: April 2021

ABSTRACT

Computed Tomography (CT) is the only imaging modality whereby bone and anatomical soft tissue structures are clearly defined. Detection of intraocular foreign bodies (FBs) can be easily obtained by scanning in the axial plane. For the precise localization of FBs, information in two planes is necessary; this is usually achieved by adding a CT study in the coronal plane to the axial plane study. When using a superimposed grid with millimeter calibration on a zoom orbital scan, the accurate location can be calculated. This contribution is of the utmost importance in deciding upon the appropriate approach when surgical removal is indicated.
Foreign Body Masquerading as a Ruptured Globe
Authors: Lins Michael , Kopietz Leslie
Published: April 2021

ABSTRACT

Low density orbital foreign bodies may not be detected on plain x-ray. In this case, a large anterior orbital foreign body was seen by examiners, but was misinterpreted as a ruptured globe. This misdiagnosis was supported by conventional x-rays which failed to show the object. It was later easily visualized on CT scan.
Sodium Hyaluronate (Healon®) in the Surgical Repair of Descemet's Membrane Detachment
Authors: Donzis Paul B , Karcioglu Zeynel A , Insler Michael S
Published: April 2021

ABSTRACT

Two cases of Descemet's membrane detachment are presented. In both cases, sodium hyaluronate (Healon®) was successfully used to repair the detachment surgically. The viscoelastic property of sodium hyaluronate allows it to move Descemets membrane easily into proper position and maintain it there post-operatively. Sodium hyaluronate left in the anterior chamber can cause an increase in intraocular pressure and prophylactic measures, such as diamox and timoptic should be used in these cases.
Contact Laser: Thermal Sclerostomy ab interna
Authors: Federman Jay L , Wilson Richard P , Ando Fumitaka , Peyman Gholam A
Published: April 2021

ABSTRACT

An experimental technique utilizing a sapphire contact laser probe for thermal sclerostomy ab interna is described. The contact laser probe with a tip diameter of 0.2 mm is brought in contact with the trabecular meshwork. Using 3.50 watts of cw Nd:YAG at 0.1 second duration, three to five exposures established communication between anterior chamber and subconjunctival space in pigmented rabbits.
Posterior Chamber IOLs Inside or Outside the Capsular Bag: A Cytopathologic Comparison of Two Eyes in One Patient
Authors: Wolter J Reimer
Published: April 2021

ABSTRACT

We compare the intraocular reaction to posterior chamber lens implants placed inside, with the reaction to implants placed outside the capsular bag during uncomplicated cataract extraction. Two otherwise normal eyes were obtained postmortem from a 93-year-old woman with clinically successful posterior chamber lens implants-one mostly in and the other outside of the capsular bag. While all parts of one implant in the bag were found to be free of reactive elements on their surface, the other whole implant and the one haptic outside of the bag were covered by a well-developed reactive membrane composed of a proteinaceous film with sessile macrophages and a few giant cells. Despite these remarkably different surface reactions, both eyes showed about equal pathologic evidence of associated chronic uveitus.
Ophthalmic Surgical Complications in Werner's Syndrome: Report on 18 Eyes of Nine Patients
Authors: Jonas J B , Ruprecht K W , Schmitz-Valckenberg P , Brambring D , Platt D , Gebhart E , Schachtschabel D O , Naumann G O H
Published: April 2021

ABSTRACT

In ten of 18 eyes from nine patients with Werner's syndrome cataract surgery was complicated by wound dehiscence and its consequences: peripheral anterior synechiae (4×), secondary epiretinal gliosis (4×), cystoid macular edema (3×) in the framework of Hruby-Irvine-Gass syndrome, unplanned filtering bleb (2×), and postoperative anterior ischemic optic neuropathy (1×). Additionally, corneal endothelial decompensation occurred in eight eyes. In view of the fibroblasts' reduced growth potential, we suggest small surgical incisions, extracapsular cataract surgery using phacoemulsification, intraocular irrigation solutions protecting corneal endothelium, nonabsorbable single knot sutures not removed before 1 year after surgery, and no local or systemic use of cortisone.
Lower Lid Retraction in Traumatic Disinsertion of the Inferior Rectus Muscle
Authors: Catalano Robert A , Nelson Leonard B
Published: April 2021

ABSTRACT

Traumatic disinsertion of an inferior rectus muscle in a 25-year-old man was diagnosed preoperatively by an associated lower lid retraction. This finding is significant in differentiating a traumatic disinsertion of the inferior rectus from an inferior rectus palsy secondary to an orbital floor fracture. Associated findings include ipsilateral hypertropia, impaired depression of the affected eye in abduction, the formation of a sulcus in the lower lid on attempted downgaze, negative forced duction testing, and positive forced muscle generation.
Complications of Eyelid Reconstruction Using a Semicircular Flap
Authors: Miller Elizabeth A , Boynton James R
Published: April 2021

ABSTRACT

Complications of the semicircular flap technique of eyelid reconstruction include lateral canthal webbing, ectropion, lid notching, symblepharon, and tissue fullness of the lateral lid. These difficulties occur infrequently and rarely cause significant problems. Attention to surgical details, however, can minimize unfavorable results. It should be emphasized that the semicircular flap remains a superb technique for reconstruction of defects involving up to 80% of the lower eyelid.
Early Pseudophakic Keratopathy: Revealing Macrophage Reaction in Endothelial Layer
Authors: Wolter J Reimer , Soong H Kaz
Published: April 2021

ABSTRACT

The pathology of early Pseudophakic keratopathy is demonstrated in a corneal button obtained at penetrating keratoplasty for persisting corneal edema and bullous keratopathy 4 months following extracapsular cataract extraction with a posterior chamber lens implant. Histological examination revealed a distinct cell loss and a macrophage reaction that was centered on degenerating endothelial cells in the corneal endothelium.
Closed Loop Anterior Chamber Lens: A Review of 127 Leiske Lens Implants
Authors: Story Paul G
Published: April 2021

ABSTRACT

One hundred twenty-seven consecutively implanted Surgidev Style 10 Leiske Lenses were evaluated. Average time of follow-up was 41.3 months. Although final acuity of 20/40 or better was achieved in 93% of patients, the surgical reintervention rate was 14%. Penetrating keratoplasty was required in seven of ten patients with corneal edema-5.5% of all eyes. Oval pupils were noted in 71% of cases. An upwardly mobile lens with displacement through the superior iridotomy was noted in 7.9% of eyes and required reoperation in 5.5% of the 127 eyes. It is recommended that use of the Surgidev Style 10 Lens be discontinued.
Alteration of Trabecular Aqueous Flow After Cataract Extraction
Authors: Melamed S
Published: April 2021

ABSTRACT

Two human eyes that had undergone intracapsular cataract extraction were perfused with cationized ferritin. In both eyes segmental areas of trabecular meshwork collapse were demonstrated superiorly, adjacent to the cataract incision. Electron-microscopic study of these regions disclosed no labeling of the trabecular beams and trabecular spaces, suggesting impermeability to aqueous flow. In other regions, a diffuse labeling with cationized ferritin was demonstrated throughout the trabecular spaces, indicating aqueous flowthrough. Use of corneoscleral sutures may cause trabecular collapse and impermeability. When the collapse is extensive, subsequent increase in intraocular pressure may follow.
Comparison of Optic Disc Features in Low-Tension and Typical Open-Angle Glaucoma
Authors: Miller Kevin M , Quigley Harry A
Published: April 2021

ABSTRACT

This study was undertaken to identify features of optic nerve head architecture that might explain, in part, why ganglion cell loss occurs in patients with low-tension glaucoma. We compared retrospectively the disc photographs of 25 patients with low-tension glaucoma with those of 26 control patients with typical open-angle glaucoma. No differences were observed in any of the following features: pore length, shape, or size variation; cup/disc and disc/arteriole ratio; clock positions of total rim loss; central retinal vessel entry site; rim pallor; number of rim-crossing vessels; and presence or absence of peripapillary nerve fiber layer hemorrhages, optic pits, and central retinal vessel canals. An hour-glass appearance of connective tissue bundles within the scleral lamina cribrosa, however, was present statistically less often in patients with lowtension glaucoma (p=0.007). We speculate that the microscopic arrangement of fiber bundles within the lamina cribrosa may play an etiologic role in the pathogenesis of low-tension glaucoma.
Exposure Keratitis Following Cataract Surgery on the Fellow Eye
Authors: Faris David A , O'Day Denis M
Published: April 2021

ABSTRACT

Two patients developed exposure keratitis in the nonoperated eye during intraocular surgery under local anesthesia. These cases demonstrate that potentially serious injuries may occur to the fellow eye even with the use of local anesthesia and that special precautions should be taken to avoid this problem.
Conjunctival Melanoma in Africa
Authors: Schwab Larry , Green W Richard
Published: April 2021

ABSTRACT

Malignant melanoma of the eye and adnexa is rare in blacks. A highly unusual malignant melanoma of the tarsal conjunctiva in an adult Ethiopian female, believed to be the first reported in a black patient, is described. Factors that contribute to melanoma in blacks and rates of occurrence are reviewed and discussed.
Results from 7-mm Bilateral Recessions of the Medial Rectus Muscles for Congenital Esotropia
Authors: Weakley David R , Parks MarshalI M
Published: April 2021

ABSTRACT

We reviewed the surgical records of 77 patients who had undergone 7-mm bilateral medial rectus recessions for large-angle congenital esotropia. The mean age of onset of esotropia in these patients was 3.5 months, and the mean age at the time of surgery was 12.9 months. The mean preoperative deviation was 69 Δ of esotropia. This procedure resulted in satisfactory horizontal alignment in 47 patients (61%) at their latest follow-up examination (mean, 27 months; range, 6 months to 6 years). The esotropia was undercorrected in 21 patients (27%) and overcorrected in nine (12%). Amblyopia was noted in 30%, oblique muscle dysfunction in 44%, and dissociated vertical deviation in 36% of the patients. Regression analysis of multiple variables showed alignment at 6 weeks to be the only predictor of the final outcome (R = .83). Extramacular fusion was achieved in 10 of 11 patients for whom reliable sensory data were available. The mean age at surgery of these patients was 9.7 months. Seven-millimeter bilateral medial rectus recessions are an effective alternative to three- and four-muscle procedures in the initial treatment of large-angle congenital esotropia during infancy.
Retinal Detachment Adherent to Posterior Chamber IOL After Molteno Implant Surgery
Authors: Huna Ruth , Melamed Shlomo , Hirsh Ami , Treister Giora
Published: April 2021

ABSTRACT

A patient with refractory glaucoma 1 year after cataract extraction and trabeculectomy had Molteno implant surgery. Three days after surgery a kissing choroidal effusion and retinal detachment adherent to the posterior chamber IOL were detected. Repeated choroidal taps were unsuccessful. Removal of the Molteno implant, vitrectomy, and silicone oil injection were required to reattach the retina.
Argon Laser Pretreatment 4 to 6 Weeks Before Nd:YAG Laser Iridotomy
Authors: Fleck B W , Wright E , McGlynn C
Published: April 2021

ABSTRACT

Argon laser pretreatment followed by Nd:YAG laser iridotomy 4 to 6 weeks later was performed in the right eye of 10 patients. Primary Nd:YAG laser iridotomy was performed in the left eye. Significantly more Nd:YAG laser energy was needed to produce an iridotomy in pretreated eyes (P < .001). Pretreated eyes developed a significantly larger pigment epithelium defect around the iridotomy site and a greater degree of pigmentation of the inferior part of the trabecular meshwork 6 months following treatment. Argon laser pretreatment followed by Nd:YAG laser iridotomy 4 to 6 weeks later appears to offer no advantages over primary Nd:YAG laser iridotomy.
Lamellar Corneal Autograft for Corneal Perforation
Authors: Lam Sheridan , Rapuano Christopher J , Krachmer Jay H , Lam Byron L
Published: April 2021

ABSTRACT

A corneal perforation developed in the right eye of a 46-year-old man after removal of a corneal foreign body. Two attempts to seal the perforation with cyanoacrylate glue failed. The patient subsequently underwent lamellar corneal autograft, which successfully closed the perforation. To the best of our knowledge, this is the first report of repairing a corneal perforation with lamellar corneal autograft.
Modified Vitrectomy for Impending Macular Holes
Authors: Chambers Robert B , Davidorf Frederick H , Gresak Paula , Stief William C
Published: April 2021

ABSTRACT

We report a consecutive series of 13 eyes (11 patients) treated with pars plana vitrectomy, in which surgical manipulation of the prefoveal layer of cortical vitreous was avoided, for stage I (eight eyes) and stage II (five eyes) macular hole formation. Average follow up was 8.1 months (range, 2 to 13 months). There was no significant improvement in vision in the patients with stage II macular holes; however, vision in these patients stabilized and did not fall below 20/400. Visual acuity improved in seven of the eight patients with stage I holes. The results for both these groups achieved by our modified vitrectomy, which is relatively easy to perform and involves minimal intraoperative manipulation of the fovea, are consistent with those obtained by methods involving more aggressive cortical vitreous stripping of the fovea.
Retinal Tolerance of an Implantable Light Source for Use During Vitrectomy Surgery
Authors: Vander James F , Eagle Ralph C , Brown Gary C , Arbizo Violeta , Shakin Eric P , Reber Ruth
Published: April 2021

ABSTRACT

To assess for the possible development of a phototoxic lesion, we exposed five Dutch belted rabbit retinas to constant illumination with an implantable "chandelier" light source at maximal intensity for 1 hour. No clinically apparent lesion developed in any of the experimentally treated eyes by 48 to 72 hours posttreatment. Light and electron microscopic examination failed to reveal any of the characteristic changes of retinal phototoxicity. A control eye treated with a 20-minute exposure to a standard endoilluminator probe at maximal intensity held 2 mm from the retinal surface demonstrated typical light and electron microscopic phototoxic abnormalities, whereas a retina similarly treated with a 5-minute exposure was normal. We have confirmed that a standard endoilluminator probe can create a phototoxic lesion in the experimental setting. Furthermore, no phototoxicity from the sustained retinal exposure to a fixed, implantable light source for a clinically relevant duration could be demonstrated.
Intravitreal U75412E: A New Free Radical Scavenger
Authors: Fiscella Richard , Gagliano Donald A , Peachey Neal S , Feist Richard , Dunn Robert , Lam Tim-Tak
Published: April 2021

ABSTRACT

Free-radical-mediated tissue damage is thought to be involved in a multitude of ophthalmic pathologies. Therefore, drugs that scavenge free radicals may find wide clinical application. A new chemical class of antiinflammatory agents, the 21-aminosteroids, has been developed as free radical scavengers. These agents are thought to inhibit lipid peroxidation and prevent the release of free arachidonic acid from injured cell membranes. In the present study, we investigated the intraocular toxicity of one of the 21-aminosteroids, U75412E. Intravitreal doses of up to 0.1 mg of U75412E were nontoxic to rabbit ocular tissues.
Surface Reaction on Silicone Tubes Used in the Treatment of Nasolacrimal Drainage System Obstruction
Authors: Ruby Alan J , Lissner Gary S , O'Grady Richard
Published: April 2021

ABSTRACT

Silicone tubes removed from patients who underwent intubation of the nasolacrimal system for acquired or congenital obstruction were studied to determine the cellular reaction on the tubes and to assess the relationship between the length of intubation and the cellular response. Twenty-one tubes were available for analysis. Length of intubation varied from 39 to 415 days; patient ages varied from 10 months to 75 years. All patients had undergone dacryocystorhinostomy or closed intubation of the nasolacrimal system. No patient had clinical signs of infection at the time of tube removal. All tubes were mounted on glass slides and stained with hematoxylin and eosin. The reactions seen, together with the location and type of cells present, were graded by a masked observer. There were varying numbers of inflammatory cells, predominantly polymorphonuclear leukocytes. As the length of intubation increased, the number of inflammatory cells also increased. The proximal portion of the tubing showed the least amount of cellular reaction at all lengths of intubation.
Balloon Catheter Dilatation in Pediatric Patients
Authors: Becker Bruce B , Berry F Dean
Published: April 2021

ABSTRACT

Balloon catheter dilatation was performed in five children with nasolacrimal duct obstruction who had failed probing or silicone intubation, or who were 6 years of age or older. A patent lacrimal system was achieved in four of these children. Balloon catheter dilatation may offer an alternative to silicone intubation in children with nasolacrimal duct obstruction who fail probing or who are at least 2 years old.
Electron Microscopic Appearances of Human Corneal Endothelium Following Nd:YAG Laser Iridotomy
Authors: Power William J , Collum Louis M T
Published: April 2021

ABSTRACT

We looked at the electron microscopic appearances of the corneal endothelium following neodymium:YAG (Nd:YAG) laser iridotomy in a patient with a shallow anterior chamber. An area of denuded endothelial cells approximately 500 µm in diameter was produced when no contact lens was used. The area of cell loss was reduced by approximately 50% when an Abraham YAG goniolens was used. We conclude that the use of a positive plus contact lens can help minimize cell loss following Nd:YAG laser iridotomy.
Probe Orientation in Contact Nd: YAG Laser Cyclophotocoagulation
Authors: Bloom Michael , Weber Paul A
Published: April 2021

ABSTRACT

We investigated the effect of the angle orientation of the probe during Nd:YAG transscleral cyclophotocoagulation. We found, based on histologic evaluation of the ciliary processes and surrounding structures, that the angle at which the probe was placed on the eye was critical. A probe angulation as little as 15° off the perpendicular destroyed sites less than optimal for achieving the goal of decreasing aqueous humor production.
Chronic Corneal Perforations
Authors: Saini J S , Sharma Ashok , Grewal S P S
Published: April 2021

ABSTRACT

We report the etiological profile and management with simple patch, tarsorrhaphies, conjunctival flaps, tissue adhesive, or penetrating keratoplasty of 104 chronic corneal perforations in a North India population. Chronic corneal perforations were observed in infective keratitis, degenerative keratolysis, neurotrophic keratitis, chemical burns, dry eyes, collagen vascular diseases, and following cataract extraction. A two-stage tissue adhesive application and adhesive-assisted debridement of epithelial lining at the cornea surface of perforation were important factors in healing. Although penetrating keratoplasties brought comparable anatomical and functional success in these cases, in developing countries, where facilities for keratoplasty and availability of corneal donor is poor, detection and management of small perforations in diseased cornea with tissue adhesive is recommended.
Office Probing of Congenital Nasolacrimal Duct Obstruction
Authors: Stager David , Baker John D , Frey Thomas , Weakley David R , Birch Eileen E
Published: April 2021

ABSTRACT

We report the results of office nasolacrimal duct probing under topical anesthesia in 2369 eyes with symptomatic nasolacrimal duct obstruction. The overall success rate for cure by initial probing was 92%. In patients less than 9 months old, a 94% cure rate was achieved with one probing; in patients 9 months and older, the rate decreased to 84%. The decrease in success rate after 9 months was statistically significant (P < .00001 by chi-square analysis). A majority of 180 parents of these patients surveyed said they were happy with the office procedure and preferred having the probing performed to resolve symptoms, even though they realized that the symptoms most probably would resolve by 1 year of age without it. We conclude that office probing for congenital nasolacrimal duct obstruction is a safe and effective method for treatment of symptomatic nasolacrimal duct obstruction, allowing the cost and risk of general anesthesia as well as the cost and inconvenience of prolonged medical management to be avoided.
Microblepharon
Authors: Jordan D R , McDonald H
Published: April 2021

ABSTRACT

We describe a child with microblepharon and corneal exposure secondary to lagophthalmos. Surgical reconstruction utilizing full-thickness skin grafts to all four lids corrected the lagophthalmos and relieved her symptoms.
Black-Diaphragm Intraocular Lens for Correction of Aniridia
Authors: Sundmacher Rainer , Reinhard Thomas , Althaus Christoph
Published: April 2021

ABSTRACT

In cooperation with Morcher GmbH, we developed a black-diaphragm aphakia intraocular lens (IOL) designed to correct congenital and traumatic aniridia. Since June 1991, we have implanted this IOL into five eyes with congenital aniridia combined with cataract, and into eight eyes with traumatic aniridia combined with cataract or aphakia. Positioning the IOL was rather difficult, especially in the traumatic cases with inadequate capsular support, and in combination with penetrating keratoplasty.

After up to 15 months' follow up, functional results are encouraging. However, slight persistent intraocular inflammation was observed in all of the eyes, more obviously in the traumatic cases. The effect of the IOL on the corneal endothelium is still being investigated. Cystoid macular edema was observed in one eye, but probably preexisted in this eye, following several earlier surgical procedures. Glaucoma was observed preoperatively in five eyes; postoperatively, in six. After surgery, it was controlled medically in 4 eyes, surgically in 1, and remained uncontrolled in 1.
Hypoperfusion of the Iris and its Consequences in Anterior Segment Pigment Dispersal Syndrome
Authors: Brooks Anne M V , Gillies W E
Published: April 2021

ABSTRACT

The effects of changes in iris perfusion in anterior segment pigment dispersal syndrome (ASPDS) were examined by iris fluorescein angiography in 29 patients (20 men and 9 women; mean age, 49 ± 14 years; range, 29 to 77 years). All showed hypoperfusion, with mild to moderate microneovascularization. There was a significant relationship between the degree of hypoperfusion and pigment scatter (P < .05), and between the level of intraocular pressure (IOP) and angle pigmentation (P < .01). No statistically significant relation was found between hypoperfusion and iris leak, nor between the level of IOP and iris hypoplasia, hypoperfusion, leakage of dye, pigment scatter, or iris processes. These findings suggest that iris hypoplasia and hypoperfusion are the underlying causes of ASPDS with a congenital etiology.
Vitreous Opacities in Phacolytic Glaucoma
Authors: Thomas Ravi , Braganza Andrew , George Thomas , Mermoud André
Published: April 2021

* BACKGROUND AND OBJECTIVE: To report five cases of vitreous opactfication in phacolytic glaucoma (PG).

* PATIENTS AND METHODS: The records of patients with PG were retrospectively reviewed. A total of 135 eyes with PG were studied to determine the presence of vitreous opacification.

* RESULTS: Five eyes with PG demonstrated opacification of the vitreous, which was first noted at surgery and confirmed postoperatively. All patients had had symptoms of PG for 7 days or more (mean ± SD, 10.6 ± 2.4 days) before they sought medical attention. Three eyes had a hypopyon on preoperative examination; two of these eyes showed refractile crystals in the anterior chamber. The opacities resolved spontaneously in all five eyes over a period of 12 weeks and interfered with visual acuity only in the immediate postoperative period.

* CONCLUSION: Vitreous opacification in PG is a self-limited process that may not require surgical intervention unless more rapid visual rehabilitation is desired. The vitreous opacification probably results from an exaggeration of the process causing the anterior chamber reaction.

[Ophthalmic Surg Lasers 1996;27:839-843.]
Nystagmus Reduction by Horizontal Rectus Retroplacements
Authors: Girard Louis J , Ghuman Thomas , Donaldson Kenley
Published: April 2021

Abstract. Seven patients with nystagmus underwent large retroplacements of the four horizontal rectus muscles. Nystagmus was horizontal in all seven patients, but three had a vertical component. The horizontal nystagmus improved in all seven patients. All improved at least one line for distance and from three to five lines for near. Retroplacement of the four horizontal rectus muscles is a safe and effective procedure for the reduction of nystagmus and the improvement of vision, particularly for near vision, producing little or no induced strabismus or limitation of motility. [Ophthalmic Surg Lasers 1996;27:958-962.]
A Versatile Slit Lamp Lens Holder
Authors: McLean Chris
Published: April 2021

Abstract. In this article, an inexpensive, easily constructed slit lamp lens holder that can hold both a +90 D lens and a +78 D lens is presented. [Ophthalmic Surg Lasers 1996;27:968-969.]
Vitrectomy and Systemic Fluconazole for Treatment of Endogenous Fungal Endophthalmitis
Authors: Christmas Nancy J , Smiddy William E
Published: April 2021

BACKGROUND AND OBJECTIVE: To investigate the efficacy of pars plana vitrectomy and oral fluconazole without injection of intravitreal antimycotic agents in the treatment of vitritis resulting from Candida endophthalmitis.

PATIENTS AND METHODS: Six eyes of five patients with suspected Candida endophthalmitis were treated with pars plana vitrectomy and systemic fluconazole for at least 3 weeks. Patients were observed postoperatively for at least 4 months.

RESULTS: Clinical signs of infection cleared and visual acuity improved postoperatively in all six cases. One recurrent case was attributed to a retained indwelling venous catheter.

CONCLUSIONS: Treatment of advanced endogenous Candida endophthalmitis with vitrectomy and systemic fluconazole offers an effective alternative to management with intravitreal amphotericin B in selected cases.

[Ophthalmic Surg Lasers 1996;27:1012-1018.]
Results of a Repeated Excimer Laser Photorefractive Keratectomy for Myopia
Authors: Hefetz Limor , Krakowski David , Haviv David , Eshkoly Moshe , Nemet Pinhas
Published: April 2021

* BACKGROUND AND OBJECTIVE: As photorefractive keratectomy (PRK) becomes more widely used, the incidence of repeated PRK increases. The present study was conducted to evaluate results of repeated PRK in view of the meager data on this topic.

* PATIENTS AND METHODS: In this retrospective study, the authors reviewed the records of 1028 eyes that had undergone PRK, and analyzed the results of 66 eyes that required a second PRK for undercorrection according to baseline refraction.

* RESULTS: A second PRK was performed in 6.3%, 13.7%, and 10.1% of low, moderate, and high myopes, respectively. The mean refraction 1 year after repeated PRK was similar in both myopic groups: less than -1 .00 D. Of the low myopes, 87.50% had residual refraction within 1 D after 1 year. Of the moderate myopes, 88.23% had residual refraction within 1 D after 1 year. All of the low myopes achieved uncorrected visual acuity (VA) of 20/25 or better 1 year after repeated PRK, compared with 58.82% of the moderate myopes. Loss of best-corrected VA never exceeded two Lines.

* CONCLUSION: The overall results of PRK appear to be satisfactory.

[Ophthalmic Surg Lasers 1997;28:8-13.]