bluuebunny/crossref_metadata_2025 huggingface dataset:
The Sharpness of Incision Instruments in Corneal Tissue
Authors: Huebscher Hans-Joachim , Goder Gerhard J , Lommatzsch Peter K
Published: April 2021

ABSTRACT

Because breadths of surgical blades are very difficult to measure directly, we designed a method to measure sharpness of a variety of instruments by determining the power they required to incise corneal tissue to a uniform depth. Diamond knives were the sharpest, followed by razor blade pieces individually prepared by a special new method. Ruby knives varied considerably. The method of measuring sharpness described may allow manufacturers to improve and stabilize production methods, as well as enable surgeons with such knowledge in advance of surgery to optimize wound healing and maximize cost-effectiveness.
Complications of Cataract Extraction With Intraocular Lens Implantation
Authors: Goodman Daniel F , Stark Walter J , Gottsch John D
Published: April 2021

ABSTRACT

Due to continued improvement in lens design, lens manufacturing, and surgical technique, the incidence of complications of cataract surgery with intraocular lens (IOL) implantation have decreased in recent years. Complications may be categorized into operative and postoperative, both early and late onset. Operative complications include posterior capsule rupture with or without vitreous loss, loss of all or part of the lens nucleus, iris damage, and stripping of Descemet's membrane. Early postoperative complications include pupillary block, hyphema, elevation of the intraocular pressure associated with the use of viscoelastic substances, persistent uveitis with or without hypopyon, and endophthalmitis. Late postoperative complications include IOL malposition, secondary glaucoma, cystotd macular edema, retinal detachment, and pseudophakic bullous keratopathy.
Occult Plastic Intraocular Foreign Body
Authors: Duker Jay S , Fischer David H
Published: April 2021

ABSTRACT

A 34-year-old man was evaluated for posttraumatic endophthalmitis with hypopyon. A previous CT scan of the orbit along with B-scan ultrasonogram failed to confirm the presence of an intraocular foreign body. Nevertheless, at the time of vitrectomy, a polyvinyl chloride (PVC) plastic foreign body was encountered. The atypical posttraumatic uveitis that developed was apparently secondary to the PVC material, as the inflammation cleared rapidly following removal of the foreign body. This case illustrates the necessity for maintaining a high level of suspicion for the possibility of an intraocular foreign body in the event of ocular trauma, even in the presence of unconfirming ancillary tests.
Removing the Stableflex Intraocular Lens During Penetrating Keratoplasty
Authors: Epstein Randy J , Vastine David W , Fried Walter I
Published: April 2021

ABSTRACT

Closed-loop, semiflexible anterior chamber intraocular lenses, particularly the Stableflex lens, have been increasingly associated with corneal decompensation. Due to the formation of synechiae around the haptics in the angle, such lenses can be difficult to remove during penetrating keratoplasty. We describe a technique for the safe removal of the Stableflex intraocular lens.
Massive Pseudophakie Pigment Dispersion Associated With an Iris Nevus
Authors: Kremer I , Cohen S , Loya N , Sandbank U
Published: April 2021

ABSTRACT

A 67-year-old woman examined 12 months following extracapsular cataract extraction had a massive Pseudophakie pigment dispersion associated with diffuse corneal epithelial edema, mild uveitis, and secondary glaucoma. She underwent penetrating keratoplasty following removal of a posterior chamber intraocular lens (IOL), anterior vitrectomy, capsulectomv, and iris biopsy. Histopathologic examination revealed a pigmented iris nevus and signs of iris erosion by the IOL loop. Because 3 months later the eye developed streptococcal endophthalmitis and had to be eviscerated, we had the opportunity to examine the eye contents; we found no evidence of phakoanaphylactic uveitis.
Applicator for Cyanoacrylate Tissue Adhesive
Authors: Wessels Izak F , McNeill James I
Published: April 2021

ABSTRACT

Cyanoacrylate tissue adhesive (CTA) is very useful for emergency treatment of corneal perforations. Lack of Food and Drug Administration approval as well as concerns about toxicity from the application of large amounts of glue, however, have limited its use. It is difficult to apply a sufficiently small amount of glue or to achieve a watertight seal using published techniques of glue application. We have found a commercially available micropipette (used in dental work) to be more effective than other methods of CTA application. With this apparatus, precise and accurate placement of minimal amounts of CTA at the slit lamp is consistently possible.
The Effect of Hyaluronidase on Akinesia During Cataract Surgery
Authors: Abelson Mark B , Mandel Eric , Paradis Andre , George Michelle
Published: April 2021

ABSTRACT

The ability of hyaluronidase to improve akinesis in ret robu I bar anesthesia was evaluated in a doublemasked study. Forty consecutive patients undergoing cataract surgery were anesthetized with 3 ml of a 1:1 mixture of 4.0% lidocaine and 0.75% bupivacaine solution. In a predetermined randomized fashion, 2 ml of hyaluronidase (300 USP units) were added to half of the syringes, and 2 ml of saline to the remaining half. The level of akinesia was graded in six different positions of gaze. Seventy percent of the hyaluronidase group exhibited complete akinesis, while only 40% of the control group did. The mean scores for four out of six positions of gaze were significantly higher in the hyaluronidase patients than in the control group. Similarly, the hyaluronidase subjects showed a significantly higher sum score for the six sectors than did the control subjects (p=. 0001). These results show that hyaluronidase significantly enhances akinesia. It is therefore recommended that it be included in the anesthetic regimen for such surgeries.
Simplified Formulas for Lathing Aphakic Epikeratophakia Lenses
Authors: Halliday Brett L
Published: April 2021

ABSTRACT

Geometrically based formulas for lathing aphakic epikeratophakia lenses have been simplified to enable easy calculation of the radii of cut for the optical and the wing zones. The formulas compensate for post-operative thinning of the lens on host cornea and allow for any desired amount of pre-lathing dehydration. Clinical results to date show that over 80% of lenses are made within 3 diopters of the expected power.
Excimer Laser Keratoplasty Part 2: Elliptical Keratoplasty
Authors: Lang Gerhard K , Schroeder Eckhard , Koch Juergen W , Yanoff Myron , Naumann Gottfried O H
Published: April 2021

ABSTRACT

An excimer laser at 193 nm was used with a new "open mask system" to perform elliptical noncontact and nonthermal keratoplasties and corneal grafts in human cadaver eyes (Part 1 of this article. Ophthalmic Surg 1989; 20:262-267). By light microscopy the corneas showed sharp, unbeveled cut margins with nearly perfect apposition of the inner wound aspects. An elliptical shape may be better than a circular one, since the former closely approximates the cornea's normal elliptical outline, making it easier to fit corresponding areas of corneal graft to bed. Also, it provides a wider area of Bowman's membrane for anchoring sutures and relatively less volume of donor antigenic tissue.
Reduced Toxicity of Intravitreally Injected Liposome-Encapsulated Cytarabine
Authors: Liu Kwan-Rong , Peyman Gholam A , She Si-Chun , Niesman Michael R , Khoobehi Bahram
Published: April 2021

ABSTRACT

Cytarabine has been demonstrated to be a more potent inhibitor of fibroblast proliferation than fluorouracil. It is, however, more toxic to the retina. We evaluated the ocular toxicity of liposome-encapsutated cytarabine in vitrectomized and nonvitrectomized rabbit eyes by ophthalmic and histopathologic examination. In the vitrectomized group, doses of up to 26 µg were nontoxic to the retina. In nonvitrectomized eyes, doses of up to 55 µg were nontoxic. Doses of 85 µg resulted in loss of ganglion cells and disorganization of photoreceptor cells. The results obtained in this study demonstrated a substantial reduction in ocular toxicity of liposome-encapsulated cytarabine, as compared with a previous study which employed free drug. By virtue of its reduced toxicity, cytarabine in a liposomal vehicle may be of value in the treatment of ocular proliferative disorders.
Histology of Partial Thickness Double Composite Eyelid Graft
Authors: Budenz Donald L , Beyer-Machule Charles K , Albert Daniel M
Published: April 2021

ABSTRACT

Double composite grafting is a technique used in the repair of large (>75%) eyelid defects due to tumor resection, trauma, or congenital coloboma. The procedure utilizes two partial thickness composite grafts derived from two unaffected lids. The skin defect is covered by a pedicle skin graft to provide an adequate blood supply. This is thought to be superior to revascularization occurring from the margin of the graft alone.

We examined histologically the lid margins of two such grafts 2 and 9 months postoperatively. Each demonstrated scarred tarsus and absent meibomian glands. One of the two grafts had loss of cilia. The architecture of the graft tissue otherwise was preserved.
Fourier Analysis of the Nerve Fiber Layer by Digital Imaging Techniques
Authors: Jindra Lawrence F , van Saarloos Paul P , Eikelbloom Robert H , Cooper Richard L
Published: April 2021

ABSTRACT

We introduce a new method to examine the retinal nerve fiber layer (RNFL) that may detect early changes in its structure due to glaucoma. Viewed in the conventional manner, in a plane perpendicular to the retina, we get an estimation of the structural integrity of the RNFL Viewed from a plane parallel to the retina, the RNFL forms a contour surface of hills and valleys. In our method red free fund us slides are digitally acquired. A waveform, representing a topographic profile cut through the resulting representation of the RNFL contour surface, was analyzed using Fourier's transform. Three cycles/mm in the Fourier power spectrum was used as an arbitrary cutoff to discriminate normal from glaucomatous RNFL. The Fourier power spectrum from normal RNFL was shifted to higher spatial frequencies, while the power spectrum from glaucomatous RNFL was shifted to lower spatial frequencies. Thus, Fourier Analysis can reveal information about such a wave form which is not obvious by visual inspection or by densrtometric techniques. This method may allow for an even earlier diagnosis of injury to the optic nerve due to glaucoma.
The Use of Free Periosteal Grafts in Extensive Lower Lid Reconstruction
Authors: Hurwitz Jeffrey J , Corin Scott M , Tucker Susan M
Published: April 2021

ABSTRACT

We describe using a scaffold of free periosteum as a posterior lamella replacement in the reconstruction of large defects involving the lower lid. Although the tarsoconjunctival flap is the treatment of choice in lower lid defects, the technique we describe is especially useful in cases in which it is best not to cover the eye for an extended period, and in cases involving defects extending beyond those of the lower lid.
Complications of Blepharopigmentation
Authors: Goldberg Robert A , Shorr Norman
Published: April 2021

ABSTRACT

Blepharopigmentation is a commonly performed procedure with a very low rate of reported complications. We present three complications of the permanent eyeliner procedure: two cases of long lasting pigment fanning, and one case of eyelid margin necrosis with cilia loss and secondary cicatricial entropion. These complications may be related to placement of the pigment too deeply, or to overapplication with tissue maceration. Care should be taken to avoid through-and-through eyelid margin penetration, and to limit the number of needle penetrations to no more than is necessary at each application site.
Lens Subluxation as a Complication of Cyclocryotherapy
Authors: Pearson P Andrew , Baldwin Larry B , Smith Thomas J
Published: April 2021

ABSTRACT

There are many well known complications of cyclocryotherapy. This case represents what we believe to be the first report of cyclocryotherapy leading to lens subluxation. The patient was a 14-year-old boy with a history of ocular trauma that had resulted in intractable glaucoma. Six locations were treated inferiorly using the freeze-thaw-freeze technique. Postoperatively the patients zonular attachment was disrupted inferiorly and the lens subluxated superiorly. While remote trauma may have been partly responsible, we suspect that the cyclocryotherapy precipitated the lens subluxation.
Endocapsular Phacoemulsification and Aspiration (ECPEA)-Recent Surgical Technique and Clinical Results
Authors: Hara Tsutomu , Hara Takako
Published: April 2021

ABSTRACT

We present our most recent technique of endocapsular phacoemulsification and aspiration (ECPEA) and report the results achieved using it in 50 consecutive eyes of 47 patients. Using a bent 0.9-mm Fragmatome tip, we removed relatively hard cataracts through 1.5-mm anterior capsular openings. With an average follow-up period of 12 months, the success rate was 72%. Causes of failure were anterior capsular openings enlarged more than 2.6 mm in nine eyes, and posterior capsular rupture in five eyes. After the incisions were extended to 6 mm, 11-mm posterior chamber lenses were inserted into the capsular bags. In the successful 36 eyes, postoperative visual acuity of better than 20/20 was achieved in 20 eyes (56%), and better than 20/40 vision in 31 (86%). Average corneal endothelial cell loss was 3.7%. Ample anterior capsular transparency was retained in 26 eyes (72%).
Alternative Method for Sulcus Fixation of Posterior Chamber Lenses in the Absence of Capsular Support
Authors: Maus Marion , Sivalingam Eliyathamby
Published: April 2021

ABSTRACT

The realization that posterior chamber intraocular lenses have many advantages over anterior chamber ones has induced many practitioners to try methods of fixating the lenses in the ciliary sulcus when there is inadequate capsular support. Most of these methods require the use of sutures to anchor the lens to the sclera or the iris. We describe a modification of these techniques which allows the surgeon to place a stiff all-polymethylmethacrylate (PMMA) lens in the sulcus in a way that makes it unnecessary to anchor the lens, although a safety suture may be placed through the scleral lip. We believe this modification makes sulcus fixation simpler to perform and possibly safer for the patient. We have used this technique in six patients with good results.
Use of a Convex Mirror in Indirect Ophthalmoscopy for Patients in a Prone Position
Authors: Hara Satoshi
Published: April 2021

ABSTRACT

Fundus examination with the patient in a prone position sometimes requires the observer to assume an uncomfortable position. I describe using a convex rear-view mirror with an 800-mm radius of curvature in binocular indirect ophthalmoscopy to overcome this difficulty. This device is especially helpful in pneumatic retinopexy.
Central Serous Choroidopathy in Patients Over 50 Years of Age
Authors: Berger Alan R , Olk R Joseph , Burgess Dean
Published: April 2021

ABSTRACT

Reviewing all records of patients with the of central serous choroidopathy (CSC) at Retina Consultants, Ltd since 1975, we identified 47 with CSC who were older than 50 years at initial presentation. These patients were divided into groups, based on type of management: observation; light "CSG-type" photocoagulation; and "subretinal-neovascular-membrane photocoagulation. Although most of these retained excellent central visual acuity, overall final visual acuities were poorer than those in other reported series. Heavier photocoagulation, as compared with lighter treatment, was associated with a decreased incidence of posttreatment SRNVM formation and appeared to have no adverse effect on final visual outcome. Patients with multiple irregular on fluorescein angiography had a greater tendency develop SRNVMs, with or without treatment. thalmologists diagnosing CSC in patients over age 50 should be aware that there is a greater risk of SRNVM developing in these patients.
A Modification of the Lateral Tarsal Strip Procedure With Resection of Orbicularis Muscle for Entropion Repair
Authors: Corin Scott , Veloudios Angela , Harvey John T
Published: April 2021

ABSTRACT

The lateral tarsal strip procedure addresses lateral canthal laxity, but is inadequate in some patients with entropion who have overriding of the orbicularis muscle. We describe our technique, which incorporates resection of the hypertrophied orbicularis. We have used this modification of the lateral tarsal strip procedure in 21 eyelids 15 patients) with excellent results.
Modifications of the Molteno Implant and Implant Procedure
Authors: Susanna Remo
Published: April 2021

ABSTRACT

I have modified the Molteno implant and standard implantation procedure as follows with the idea of achieving the benefits noted: (1) using a 5-0 nylon suture to temporarily reduce the inner diameter of the Molteno tube in order to prevent flat anterior chamber and high IOP in the immediate postoperative period, as well as to permit early perfusion of the modified Molteno plate, likely resulting in less fibrosis and better filtration; (2) placing a 4-0 steel suture guide inside the silicone tube to ensure accurate positioning, especially crucial in some cases when a pars plana approach is used to introduce the tube; 3} placing 10 holes in the platform of the implant to increase drainage; (4) placing three holes to allow conversion of a one-plate into a two-plate implant, thus reducing the risk of complications and making reoperation easier and safer.
O2 Administration by a Nasal Probe Improves Respiration in Cataract Surgery After Retrobulbar Anesthesia
Authors: Michelson Georg , Naujoks Bernd
Published: April 2021

ABSTRACT

We measured certain respiratory conditions (respiratory rate [RR], oxygen saturation [SO2I, and endexpiratory carbon dioxide partial pressure IpCO2] ) of 31 patients undergoing planned cataract surgery using local anesthesia in order to determine the effects of administering pure oxygen 3 L/min) by a nasal probe in 10 of them. In the patients who did not receive pure oxygen, at the end of surgery the mean RR was 1 5.8 ± 4.4/min (maximum, 21; minimum, 6.4/min); the mean SO2 was 86.9% ± 6.6% (maximum, 98%; minimum. 74%; in 11/25 patients, the SO2 was lower than 90%); and the mean pCO2 was 34.9 ± 7.7 mm Hg (maximum, 46.5; minimum, 12.15; in 4/25 patients, the pCO2 was greater than 45 mm Hg). In the patients who received pure oxygen by a nasal probe, the mean SO2 increased intraoperatively from 80.6% ± 5.8% to 96.9 ± 2.9% (in no patients was SO2 lower than 90%). Therefore we recommend an intraoperative administration of pure oxygen by a nasal probe.
Sympathetic Ophthalmia After Cyclocryotherapy of Neovascular Glaucoma Without Ocular Penetration
Authors: Harrison Thomas J
Published: April 2021

ABSTRACT

A 66-year-old man underwent cyclocryotherapy for treatment of neovascular glaucoma in a blind eye. Although neither history, clinical examination, nor histologic evaluation uncovered any ocular penetration, he subsequently developed sympathetic ophthalmia. This and other cases suggest that cyclocryotherapy could be a factor in the pathogenesis of sympathetic ophthalmia, although the mechanism is far from clear.
Collagen Plug Occlusion of Molteno Tube Shunts
Authors: Stewart Wells , Feldman Robert M , Gross Ronald L
Published: April 2021

ABSTRACT

We report five patients in whom collagen lacrimal plugs were used to temporarily occlude the lumen of Molteno shunts to prevent early postoperative hypotony. Only one eye, with a double plate, developed hypotony and a flat anterior chamber that required reformation. However, in three patients, the collagen plugs did not dissolve and had to be removed surgically to lower the intraocular pressure. Although the semipermeability of collagen is desirable, its unpredictable degradation renders it unsuitable for temporary occlusion of tube shunts. Other biodegradable materials may be more appropriate for this purpose.
Planned Combined I-125 Plaque Irradiation and Indirect Ophthalmoscope Laser Therapy for Choroidal Malignant Melanoma
Authors: Augsburger James J , Mullen Donald , Kleineidam Markus
Published: April 2021

ABSTRACT

We studied the short-term impact of planned sequential episcleral I-125 plaque irradiation and indirect ophthalmoscope laser therapy in a series of 25 patients with choroidal or ciliochoroidal malignant melanoma. In a case-by-case matched comparison study, we evaluated the relative local regression of tumors which did and did not receive planned supplemental laser therapy following plaque treatment. The tumors treated with supplemental laser regressed substantially faster and more completely than those treated by plaque alone. Planned sequential I-125 plaque irradiation combined with indirect ophthalmoscope laser therapy appears to be a more effective local-tumor treatment than plaque radiotherapy alone.
Secondary Dye Testing of the Lacrimal System
Authors: Becker Bruce B
Published: April 2021

ABSTRACT

Using the Olympus PF-22 angioscope to examine the inferior meatus during secondary dye testing of the lacrimal system, I evaluated the efficacy of the secondary dye test to localize partial or functional obstruction of the upper or lower lacrimal excretory system. Secondary dye testing was positive (dye present in the nose) in 12 of 13 lacrimal systems (92%) with functional nasolacrimal duct obstruction, in 7 of 8 (89%) with involutional ectropion, and in 4 of 5 (80%) with facial nerve palsy. Secondary dye testing was negative in the 1 lacrimal system w'rth canalicular stenosis and in 5 of the 6 (83%) with punctal stenosis. Secondary dye testing is helpful in differentiating punctal or canalicular stenosis from functional nasolacrimal duct obstruction; however, it cannot help differentiate ectropion or facial nerve palsy from functional nasolacrimal duct obstruction.
Granny Knot for Interrupted 10-0 Nylon Sutures in Cataract Sections
Authors: Phillips Calbert I
Published: April 2021

ABSTRACT

A granny knot instead of a reef (square) knot is advocated for 10-0 nylon interrupted sutures in limbal cataract sections, especially under a conjunctiva! flap. The second of the two throws is looped in the direction opposite to that in a reef knot so that the free ends lie at right angles to the plane of the suture. The second throw is used to "run down" the first to tighten the suture. To avoid postoperative erosion through conjunctiva, the ends are cut long with a blade while they lie flush with the sclera. The knot is locked when the traction required to tighten the suture is released and the thinned nylon recovers its original diameter on each side of the knot.
Bacterial Endophthalmitis Following Cataract Surgery in an Eye With a Preexisting Molteno Implant
Authors: Ellis Brian D , Varley Gary A , Kalenak Jeffrey W , Meisler David M , Huang Suber S
Published: April 2021

ABSTRACT

We describe a patient with a preexisting, functioning Molteno implant in whom acute endophthalmitis developed following cataract extraction. The condition was treated successfully without removing the implant.
Transscleral Neodymium:YAG Cyclophotocoagulation: Comparison of 180-Degree and 360-Degree Initial Treatments
Authors: Hardten David R , Brown J David
Published: April 2021

ABSTRACT

In order to help clarify how much Neodymium:YAG transscleral Cyclophotocoagulation (Nd:YAG CPC) treatment should be given to maximize effectiveness and minimize complications in the treatment of refractory glaucomas, we retrospectively reviewed and compared the results achieved with an initial 180-degree noncontact Nd:YAG CPC treatment with those achieved with an initial 360-degree treatment. Forty-five patients were in the ISO-degree group and 21 in the 360-degree group. Mean follow up after the first Nd: YAG CPC treatment was 10.2 ± 7.5 months.

The average pretreatment intraocular pressure (IOP) in the 180-degree group was 33.5 mm Hg. After one treatment, IOP in these patients dropped an average of 8.4 mm Hg and was controlled successfully (5 to 22 mm Hg) in 14 31%). After a mean of 2.0 treatments, IOP in these patients dropped an average of 15.3 mm Hg, and successful IOP control was ultimately achieved in 35 (78%).

The average pretreatment IOP in the 360-degree group was 41.8 mm Hg. After one treatment, IOP in these patients dropped an average of 19.4 mm Hg and was controlled successfully in 11 (52%). After a mean of 1.3 treatments, IOP in these patients dropped an average of 20.7 mm Hg, and successful IOP control was ultimately achieved in 13 (62%).

Our study suggests that repeated 180-degree treatments can be successful. However, because we found that IOP was controlled more rapidly with fewer major complications in the 360-degree group, the risk-to-benefit ratio may be better for initial 360degree treatment.
Oculoplastic Uses of Cranial Bone Grafts
Authors: Goldberg Robert A , Garbutt Mark , Shorr Norman
Published: April 2021

ABSTRACT

Cranial bone grafting for craniofacial reconstruction has gained wide acceptance in recent years and is being used with increasing frequency by ophthalmic plastic surgeons. Alloplastic materials (particularly newer materials such as porous polyethylene, hydroxyapatite, and rigidly fixated metal alloys) have a dear role in orbital reconstruction, and in many oculoplastic applications are the material of choice. However, in certain applications cranial bone grafts may be superior, eg, in managing large posttraumatic or postsurgical orbital defects or orbito-sinus defects in the milieu of chronic sinusitis. We describe our current techniques for harvesting full-thickness outer-table grafts and spirt-thickness periosteallybound "fish-scale" grafts. Harvesting cranial bone grafts is not without risk and donor site morbidity, and we do not advocate the use of cranial bone grafts in those cases that might be managed as well (or better) with alloplastic material. At the same time, ophthalmic surgeons involved in orbital reconstruction should be familiar with the indications for bone grafts and comfortable with harvesting techniques so that they are not limited when circumstances warrant the use of autogenous material.
Needling Revision of Failed Filtering Blebs With Adjunctive 5-Fluorouracil
Authors: Shin Dong H , Juzych Mark S , Khatana Anup K , Swendris Ronald P , Parrow Kyle A
Published: April 2021

ABSTRACT

We investigated the outcome of needling revision with adjunctive subconjunctival 5-fluorouracil (5-FU) performed on 30 eyes of 30 consecutive glaucoma patients with failed filtering blebs 49.0 ± 65.4 weeks after trabeculectomy. Follow up was 67.3 ± 22.8 weeks from the time of the first needling revision and 49.9 ± 26.2 weeks from the last needling procedure. Twenty-four (80%) of the eyes were treatment successes after 2.6 ± 1 .9 needling revisions, with a mean intraocular pressure (IOP) of 13.9 ± 3.7 mm Hg on 1.5 ± 1.1 medications, a significantly lower mean IOP and number of medications than before the procedure (32.5 ± 7.8 mm Hg on 1.7 ± 1.5 medications [P < .001, paired t-test]). Needling revision with adjunctive 5-FU appears to be a safe and effective means of reestablishing filtration.
Chronic Cystoid Macular Edema and Predictors of Visual Acuity
Authors: Spaide Richard F , Yannuzzi Lawrence A , Sisco Laurie J
Published: April 2021

ABSTRACT

Of 141 patients who had clinically significant cystoid macular edema (CME) following cataract surgery, 42 had a visual acuity of 20/200 or worse. Logistic regression demonstrated that of all the systemic and ocular factors studied, the best predictors of visual acuity of 20/200 or worse were the presence of iris in the wound (odds ratio = 2.86, P = .011) and a fluorescein angiogram grade of 4 (odds ratio = 2.91, P = .0076). Entering into the logistic regression variables such as integrity of the posterior capsule, iritis, vitreous in the wound, or type of intraocular lens did not significantly improve the ability of the model to predict which patients would have poor visual acuity. This study suggests that iris incarceration in the wound may have a more important association with poor vision in patients with chronic postsurgical CME than previously thought.
Preliminary Study of a New Intraocular Method in the Diagnosis and Treatment of Propionibacterium acnes Endophthalmitis Following Cataract Extraction
Authors: Owens Sarah L , Lam Sheridan , Tessler Howard H , Deutsch Thomas A
Published: April 2021

ABSTRACT

Late endophthalmitis, due to Propionibacterium acnes, developed in three patients following uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens (PC-IOL) insertion. Cultures from the capsular bag yielded P. acnes in all three. With topical anesthesia and through an anterior chamber paracentesis, culture specimens were taken from and cfmdamycin irrigated into the capsular bag. Filtered 100% oxygen was introduced into the anterior chamber in two; the third also received an injection of gentamicin and dexamethasone into the capsular bag. After treatment, two patients received oral antibiotics; one received hyperbaric oxygen therapy. Visual acuity was improved and inflammation reduced in all three. However, after treatment, ocular toxic effects due to clindamycin were suspected in one.

This approach offers several clear advantages, including topical anesthesia, outpatient management, elimination of the need for vitrectomy, and retention of the intraocular lens (IOL).
Temporary Sutured Tube-Tarsorrhaphy: Reversible Eyelid Closure Technique
Authors: Rapoza Peter A , Harrison Devin A , Bussa John J , Prestowitz William F , Dortzbach Richard K
Published: April 2021

ABSTRACT

Temporary closure of the eyelids is frequently recommended for ocular surface disorders in which reepithelialization of the cornea is problematic, as well as for acute Bell's palsy. We describe an easily performed technique of temporary tarsorrhaphy using plastic tubes sutured externally to the upper and lower eyelids, with eyelid closure accomplished by tightening a loop of suture passed through the two tubes. Corneal epithelial defects in 11 of 13 patients in whom we used this technique resolved satisfactorily without complications. In the remaining two, the polypropylene sutures eroded through the eyelids between 5 and 6 weeks after surgery. The sutured tubes loosened and the loosened sutures had to be replaced. In one patient, the overly long end of a suture rotated between the apposed eyelids, inducing a corneal abrasion, but no permanent damage to the eye. We conclude that the sutured tube-tarsorrhaphy provides excellent short-term closure of the eyelids, while allowing simple, painless opening for examining the globe. The risks of inflammation and infection associated with previously described techniques are minimized.
Modified Technique of Blunt Cannula Retrobulbar Anesthesia for Vitreoretinal Surgery
Authors: Wald Kenneth J , Weiter John J
Published: April 2021

ABSTRACT

We prospectively evaluated a modified version of a previously reported technique of retrobulbar anesthesia for vitreoretinal surgery involving the use of a blunt 19-gauge cannula to directly infuse anesthetic into the retrobulbar space. Using this method, 60 consecutive patients undergoing sclera) buckling surgery had effective anesthesia and akinesia, with no complications.
Using the Oculocephalic Reflex to Assess Effective Retrobulbar Anesthesia
Authors: Wong Randall V , Craddock Mary K , Whitten Mark E
Published: April 2021

ABSTRACT

In order to confirm effective retrobulbar anesthesia, we attempted to stimulate the oculocephalic reflex (the doll's head phenomenon) in 40 consecutive patients undergoing elective cataract extraction with intravenous sedation. Thirty-nine of these 40 patients had a positive response, exhibiting the reflex in the nonanesthetized eye but not in the anesthetized eye. Using this test in sedated patients obviates interrupting surgery to administer additional block under less than optimal, uncontrolled conditions.
Recurrent Hyphema Associated With IOL Loop Displacement Treated With Argon Laser Photocoagulation
Authors: Assia Ehud I , Blumenthal Michael
Published: April 2021

ABSTRACT

Recurrent late hyphema following cataract surgery and implantation of a posterior chamber intraocular lens (PC-IOL) is a rare complication, since there is usually no contact between the IOL and the anterior iris. If treatment with miotics or mydriatics fails, surgical removal of the IOL is often necessary. We report a patient with recurrent hyphema in his only myopic eye who had undergone two retinal detachment operations. A loop of the PC-IOL dislocated anteriorly through a peripheral iridectomy and caused localized pressure and recurrent bleeding. Conservative treatment with argon laser photocoagulation obviated more complex surgery in a high-risk patient.
Repair of a Disinserted Scleral Flap in Trabeculectomy
Authors: Riley Shawn F , Smith Thomas J , Simmons Richard J
Published: April 2021

ABSTRACT

We report a surgical technique for repair of a disinserted scierai flap involving the use of two 10-0 nylon sutures, which are placed through the base of the scierai flap, and through and out of the peripheral cornea. These two sutures create a water-tight flap at the repaired hinged area. The procedure may thus continue as a trabeculectomy, permitting postoperative staged argon-laser suture lysis as well.
The McCoy Facial Trisquare: A Useful Instrument for Measuring Dystopia of the Globe and Canthi
Authors: Goldberg Robert Alan , Shorr Norman
Published: April 2021

ABSTRACT

We report the McCoy Facial Trisquare, a diagnostic instrument useful for measuring and photographically documenting dystopia of the globe and canthi.
Reformation of the Anterior Chamber Following Trabeculectomy
Authors: Austin M W , Wishart P K
Published: April 2021

ABSTRACT

Sixteen eyes requiring surgical reformation of the anterior chamber (AC) in our Unit from December 1987 to August 1991 were studied retrospectively to determine the incidence of the problem in our hospital and to evaluate the operative measures used to restore the AC. The mean preoperative AC depth of these 16 eyes was 1.92 mm (range, 1.50 to 2.50 mm). Nine had a history of angle-closure glaucoma. Poor surgical technique was a contributing factor in the development of a flat AC in 3. Of the remaining 13 eyes, 11 had a trabeculectomy with a fornix-based, and 2 with a limbus-based, conjunctival flap. Wound leaks occurred in 10 eyes with fornix-based flaps, but in none of the eyes with limbus-based flaps. Factors associated significantly with the development of flat AC following trabeculectomy were: a preoperative shallow AC, a history of angle-closure glaucoma, and the use of a fornix-based conjunctival flap. Avoiding wound leakage when performing trabeculectomy in eyes with a shallow AC or a history of angle-closure glaucoma by using a limbus-based flap may help prevent postoperative flat AC.
Eye Growth After Cataract Extraction and Intraocular Lens Implantation in Children
Authors: Kora Yukiko , Shimizu Kiyoshi , Inatomi Makoto , Fukado Yoshinao , Ozawa Tetuma
Published: April 2021

ABSTRACT

We studied the effect of cataract extraction and intraocular lens (IOL) implantation (14 unilateral and 2 bilateral cases) on eye growth in 16 children. Visual acuity, refractive power, axial length, corneal curvature, and anterior chamber depth in both the operated and unoperated eyes were measured before and after surgery. The operated eyes tended to become myopic (maximum, -11.00 diopters). However, though the axial length of two eyes increased significantly after surgery, there was no significant difference between the postoperative increase in axial length in the operated and in the unoperated eyes. The anterior chambers of the unoperated eyes tended to be deeper. We suggest that the tendency to become myopic in the operated eyes occurred because, as axial length increases with growth, the proportion occupied by the vitreous body, ie, the part posterior to the IOL, also increases.
Use of a Silicone Sheet for Delayed Adjustable Strabismus Surgery
Authors: Shokida Maria Felisa
Published: April 2021

ABSTRACT

Adjustable strabismus surgery sometimes fails because of changes in the angle of deviation developing a few days after surgery. A thin silicone sheet placed between the muscle and sclera prevents postoperative adhesions between these tissues, allowing adjustment to be delayed for up to 1 1 days after surgery. Once the final adjustment is made, the silicone sheet is removed.
Pars Plana Vitrectomy for Complications of Retinal Arterial Macroaneurysms-A Case Series
Authors: Brent B David , Gonce Mark , Diamond James G
Published: April 2021

ABSTRACT

Retinal arterial macroaneurysms are distinct vascular lesions with a typically benign course. Laser treatment to these vascular lesions is controversial, and has been limited to cases of persistent macular edema. Devastating vision loss can occur, however, through vitreous or subretinal hemorrhage. We describe eight cases of retinal arterial macroaneurysms associated with subretinal or vitreous hemorrhage requiring pars plana vitrectomy. Final visual acuities ranged from 20/20 to 20/400 at most recent follow up. Until reliable indicators of rupture are identified, we suggest consideration of laser photocoagulation to clinically active, identifiable retinal arterial macroaneurysms within the macula.
Deep Venous Thrombosis Following Immobilization After Retinal Detachment Surgery
Authors: Chu Thomas G , Pince Keith J
Published: April 2021

ABSTRACT

Although deep venous thrombosis (DVT) and pulmonary embolism are potentially fatal complications of numerous surgical procedures, DVT associated with ophthalmic surgery has rarely been reported in the current literature. We report the development of a DVT in a patient following complicated vitreoretinal surgery.
Prilocaine: An Old Anesthetic Agent and a New Ophthalmic Procedure
Authors: Coelho Etelvino T , Gomes Edigezir B , Martins Heraldo S , de Sousa Byron
Published: April 2021

ABSTRACT

We present a new local anesthetic technique for ophthalmic surgery that reduces the risks associated with retrobulbar and peribulbar anesthesia. This method uses topical proparacaine plus 1.5 mL of prilocaine (3%) with felypressin injected into the subconjunctival (sub-Tenon's) space. Of 5210 consecutive adult patients in whom the technique was used, all demonstrated adequate analgesia. Sixty-three (1.2%) of the eyes required supplemental analgesia, provided by a single injection of prilocaine (0.5 mL). Ecchymosis and subconjunctival hemorrhage developed in 63 (1.2%) of the eyes. There were no instances of ptosis.
The Effect of Apraclonidine on the Intraocular Pressure of Glaucoma Patients Following Nd:YAG Laser Posterior Capsulotomy
Authors: Cullom R Douglas , Schwartz Louis W
Published: April 2021

ABSTRACT

We retrospectively compared the incidence and level of postoperative intraocular pressure (IOP) spikes in 53 consecutive glaucoma patients undergoing Nd:YAG posterior capsulotomy (YPC) who received apraclonidine immediately postoperatively, with those occurring in 22 consecutive similar patients who did not receive apraclonidine. Postoperative IOP elevations of 5 mm Hg or more occurred in 13% of the apraclonidine recipients and in 59% of the nonrecipients; elevations of 10 mm Hg or more occurred in 4% of the former and in 27% of the latter. Our results suggest that apraclonidine can be a useful adjunct in preventing IOP elevations following YPC in glaucoma patients.
Pars Planitis Presenting With Vitreous Hemorrhage
Authors: Phillips William B , Bergren Robert L , McNamara J Arch
Published: April 2021

ABSTRACT

A 31-year-old woman complained of a sudden, painless decrease in vision of the right eye. Ophthalmic examination demonstrated a vitreous hemorrhage in the right eye secondary to peripheral neovascularization. The left eye demonstrated findings consistent with pars planitis. Before this episode, vision was good in both eyes. Although rare, vitreous hemorrhage can occur in the setting of pars planitis and may be a presenting symptom. Pars planitis should be considered in the differential diagnosis of young patients with vitreous hemorrhage.
Prediction of Postoperative Visual Acuity in Patients With Total Glaucomatous Cupping Using the Potential Acuity Meter and Automated Perimetry
Authors: Stewart William C , Connor Amy B , Hunt Hurshell H
Published: April 2021

ABSTRACT

We evaluated the effectiveness of using the Potential Acuity Meter (PAM) and automated perimetry to predict postoperative vision in 30 advanced glaucoma patients following combined cataract extraction and trabeculectomy. Using the binomial distribution at α = 0.05, PAM and automated perimetry individually were significantly useful in predicting postoperative vision of 20/40 or better. Automated perimetry, but not PAM, was useful in predicting worse than 20/40 vision. Used together, automated perimetry and PAM testing were significantly useful in predicting vision worse or better than 20/40.
A Temporary Dissecting Seton for Trabeculectomy: Delayed Re-Creation of the Glaucoma Filtering Sclerostomy and Bleb
Authors: Gross Peter G
Published: April 2021

ABSTRACT

Presented is a new surgical technique to re-create the entire filtering pathway 2 weeks following trabeculectomy. The dissecting seton is a suture loop of 9-0 nylon, silk, or polypropylene placed in the potential outflow space of the sclerostomy and bleb area during trabeculectomy. The seton is pulled out at the slit lamp, under topical anesthesia, 1 to 3 weeks after the initial surgery in order to re-create the filtration pathway. By pulling on the seton, a cheesewiring dissection severs newly formed fibrovascular tissue that may have occluded or constricted the previously created aqueous outflow tract at any point(s). Because of the significant time delay, the reopened filtration pathway is, for the first time, filled with flowing aqueous of nearly normal composition under a well-healed conjunctiva as a result of a nearly normally functioning ciliary body in a nearly quiet eye. Delayed postoperative re-creation of the bleb with the dissecting seton may be combined with other management techniques such as 5-fluorouracil subconjunctival injections, suture cuttings, bleb massage, etc.

This technique has been used in nine cases with follow up ranging from a few weeks to 1 year. All were trabeculectomies with phacoemulsification and intraocular lens implantation. Both initial placement and subsequent handling of the dissecting seton appear to be safe, quick, easy, and inexpensive. Complications or failures have all been minor and easily managed.
Combined Cataract Extraction and Trabeculectomy: Phacoemulsification Compared With Extracapsular Technique
Authors: Wishart Peter K , Austin Michael W
Published: April 2021

ABSTRACT

Thirty-four eyes undergoing phacoemulsification and trabeculectomy (PHACO + TRAB) were followed prospectively for 1 year postoperatively. The results of surgery were compared with those, obtained retrospectively, of the previous 34 extracapsular cataract extractions with trabeculectomy (ECCE + TRAB) performed by the same surgical team. All eyes received posterior chamber intraocular lens implants.

Preoperatively, the two groups did not differ significantly in terms of age, gender distribution, or degree and duration of glaucoma and cataract. Mean postoperative follow up for the ECCE + TRAB group was 13.6 months; for the PHACO + TRAB group, 12.6 months (P = .1). As compared with the ECCE + TRAB group, the PHACO + TRAB group had earlier visual rehabilitation, less postoperative astigmatism (P < .001), and improved long-term intraocular pressure control (P = .04). Early postoperative pressure spikes occurred in 32% of the ECCE + TRAB eyes and in 23.5% of the PHACO + TRAB eyes (P = .2). Other postoperative complications occurred more commonly in the ECCE + TRAB group: hyphema (P < .001), fibrinous iritis (P < .01), choroidal detachment (P < .05), and hypotony (P < .05). Posterior capsular opacification was significantly more common in the ECCE + TRAB group (P < .02).

These major differences probably are attributable primarily to the small incision used in phacoemulsification, which is associated with sustained IOP control during the operation, a small stable wound with low postoperative astigmatism, and early stabilization of refraction.
Peribulbar and Retrobulbar Anesthesia With Prilocaine: A Comparison of Two Methods of Local Ocular Anesthesia
Authors: Saunders D C , Sturgess D A , Pemberton C J , Morgan L H , Bourne A
Published: April 2021

ABSTRACT

Prilocaine (Citanest) has been shown to be a satisfactory alternative to lignocaine, with certain important advantages, including superior diffusion. The latter may be especially important in peribulbar anesthesia, where the level of diffusion is a critical factor in providing a timely, high-quality block. In a prospective randomized study, we compared the effectiveness of peribulbar vs retrobulbar administration of prilocaine.

Eighty-seven patients undergoing elective intraocular surgery were randomized to receive either retrobulbar or peribulbar anesthesia with prilocaine 3% with felypressin and hyaluronidase. Pain of injection, akinesia, and anesthesia were evaluated at predetermined intervals after injection. Except for the fact that lid akinesia occurred earlier in the peribulbar group, there was no difference in the quality or rate of onset of overall akinesia in the two groups. Nor were there any differences in the pain associated with injection. Both groups had excellent operative anesthesia and akinesia.
Biomicroscopic Findings of Posterior Vitreoschisis
Authors: Kakehashi Akihiro , Schepens Charles L , de Sousa-Neto Alipio , Jalkh Alex E , Trempe Clement L
Published: April 2021

ABSTRACT

The clinical entity of posterior vitreoschisis, splitting of the posterior cortical vitreous, is not well known. We confirmed its presence biomicroscopically in cases with posterior vitreous detachment and found it mostly associated with retinal vascular diseases, usually manifesting as two dense vitreous membranes with defects. When posterior vitreoschisis develops in an otherwise normal eye, it may not manifest as two membranes, but can form a crescent-shaped, optically empty space in the posterior vitreous cavity. Because its management is different, posterior vitreoschisis should be differentiated from other, apparently similar, conditions, especially posterior vitreous detachment.
Intracameral Tissue Plasminogen Activator to Treat Blocked Glaucoma Implants
Authors: Richards David W
Published: April 2021

ABSTRACT

I report the use of tissue plasminogen activator to open blocked silicone tubes of Baerveldt glaucoma implants in two cases. A dose of 25 µg was used in both cases; lysis of fibrin clots occurrsd within 15 to 45 minutes.