bluuebunny/crossref_metadata_2025 huggingface dataset:
CANCER RISK AFTER MCKEE-FARRAR TOTAL HIP REPLACEMENT
Authors: Visuri Tuomo , Koskenvuo Markku
Published: April 2021

ABSTRACT

Cancer incidence in 433 McKee-Farrar total hip replacement patients, operated on between 1967 and 1973, was examined for 5729 person-years, to the end of 1981. The expected number of natural deaths was slightly higher than observed, suggesting some selection of the operated patients. The risk of total cancer incidence did not increase, but the risk for site-specific cancer did because there were no cases of kidney or bladder cancer, or rare forms of cancer. The risk of leukemias and lymphomas increased, and the risk of breast cancer decreased; these results were surprisingly similar to those of a study from New Zealand. This study concluded that patients with total hip prostheses have a cancer morbidity differing from the general population. The role of chrome-cobalt - molybdenum alloy in carcinogenesis requires further investigation.
SIMPLE BONE CYSTS IN CHILDREN TREATED WITH METHYLPREDNISOLONE ACETATE
Authors: Rud Bjarne , Pedersen Niels Wisbech , Thomsen Per B
Published: April 2021

ABSTRACT

Eleven children with simple bone cysts in the proximal humerus metaphysis were treated with intracavity infiltration of methylprednisolone acetate. Nine patients were treated once; the remainder required second injections. Five lesions resolved completely, while six healed sufficiently to eliminate the risk of pathologic fracture, and to permit physical activities without restrictions. Simple bone cysts can be treated satisfactorily with injection of methylprednisolone acetate, thus obviating surgery.
PAINFUL INTERNAL DISC DERANGEMENTS OF THE LUMBOSACRAL SPINE: DISCOGRAPHIC DIAGNOSIS AND TREATMENT BY POSTERIOR LUMBAR INTERBODY FUSION
Authors: Schechter Neil A , France Matthew P , Lee Casey K
Published: April 2021

ABSTRACT

Results of surgical or non-surgical treatment of patients with chronic persistent low back pain, but without clearly demonstrable diagnosis of disc herniation, spinal stenosis, or spinal instability, range between 50% to 80% of success rates in the literature. Between 1984 and 1988, the authors reviewed 25 consecutive cases of internal derangements of the lumbar disc treated by subtotal disc excision and interbody fusion. AU patients had chronic, persistent, or frequently recurring low back pain resistant to active nonoperative treatments for a minimum of 3 months (mean: 16); no evidence of disc herniation, stenosis, or instability; no previous operation; single level of the pathologic condition in L-S spine; and diagnosis made by clinical information, CT, MRI, and/or discography. Ages ranged from 25 to 51 (mean: 38 to 40). Average follow up was 2 years (range: 13 to 57 months). In addition, 20 patients (32 discographies) who had available information of discography, MRI, and CT scan of the L-S spine, were reviewed for the relationship between disc morphology, pressure, volume, and pain response during discography. Overall clinical results for the 25 patients were: 58% excellent (15 of 26), 31% good (8 of 26), and 11% fair (3 of 26). No patients were in the "poor" category. The successful fusion rate was 95%.
VARIATION IN APPLIED FORCE DURING INSERTION OF CEMENTED FEMORAL PROSTHESES
Authors: Stone Martin H , Wilkinson Rosemary , Stother Ian G
Published: April 2021

ABSTRACT

Information is presented on forces applied to cemented prostheses during insertion. An instrumented femoral pusher was used to collect information during simulated operations on cadavers while using a laboratory test rig and during live surgery. Surgeons using flanged or collared prostheses tend to apply more force than those using coUarless prostheses. There is a tendency for abrupt changes in applied force to occur when: 1) clearing cement; 2) easing hand discomfort; and 3) testing cement consistency. Tests showed that an overall impression of the force applied could be obtained from a laboratory simulation, but that clearing cement and testing cement were not modelled by this method. We discuss the implications of our observations in terms of prosthesis fixation and training of staff.
THROMBOEMBOLIC COMPLICATIONS FOLLOWING TRAUMA SURGERY: INCIDENCE AND OUTCOMES
Authors: Paiement Guy D
Published: April 2021

ABSTRACT

Thromboembolic disease is an unusual condition in the general community. The incidence of symptomatic acute deep vein thrombosis (DVT) is very low in the general population before the age of 50 years. After the age of 50 years, the annual incidence increases.

Thromboembolic disease is, however, a major cause of death and morbidity among hospitalized patients. In this setting, it has been estimated that pulmonary embolism (PE) kills about 100 000 Americans each year, and contributes to the death of another 100 000. It is probably the most common preventable cause of death in hospitalized patients. Thromboembolic disease is a cluster of related conditions, many of them clinically silent. DVT and PE manifest themselves with very general symptoms, making the clinical diagnosis (symptoms and physical signs) insensitive and nonspecific.
TREATMENT OF ESTABLISHED DEEP VEIN THROMBOSIS: A REVIEW OF THE THERAPEUTIC ARMAMENTARIUM
Authors: Berkowitz Scott D
Published: April 2021

ABSTRACT

Although it has never been evaluated by an appropriately designed clinical trial, there is a strong impression that acute symptoms of deep vein thrombosis (DVT) and pulmonary embolism (PE) are improved by heparin treatment. The first experimental evidence showing that anticoagulants were effective in reducing mortality from PE came in landmark study by Barritt and Jordon in Lancet in 1960. In 1986, Hull et al demonstrated that failure to attain an adequate anticoagulant effect with heparin in patients with proximal vein thrombosis is associated with a high rate of recurrence.

Current practice favors admission to the hospital of patients with venous thromboembolism to be treated with intravenous (IV) heparin for at least 4-5 days, overlapped with initiation of warfarin. Four randomized trials evaluating continuous intravenous (CIV) vs. subcutaneous (SQ) heparin administration in the treatment of DVT found no significant differences in the observed rates of clinically important events. Thus, SQ route heparin is as efficacious and would allow treatment at home. Low molecular weight heparins, when released by the FDA for this indication, will make this more feasible.
Is Urban Frostbite a Psychiatric Disorder?
Authors: Pinzur Michael S , Weaver Frances M
Published: April 2021

ABSTRACT

We reviewed the records of 20 patients admitted with a diagnosis of frostbite. In addition to their thermal injury, all had overt, or covert, psychiatric disease. This prompted us to review hospital records of patients admitted to the Department of Veterans Affairs (DVA) Hospital system with a diagnosis of frostbite. During fiscal years 1991 and 1992, 37% and 36.7% of all patients admitted to DVA hospitals had a psychiatric disorder as primary or secondary diagnosis. When we selected those patients who additionally had a primary or secondary diagnosis of frostbite, the incidence increased to 61% and 65.6%, respectively. Urban patients with frostbite sufficiently severe to necessitate hospital admission have concomitant psychiatric disease at a rate that far exceeds the expected. Urban patients admitted to the hospital with a diagnosis of frostbite should be carefully screened for the presence of psychiatric disorder.
Anterior Shoulder Dislocation Reduction Technique-Revisited
Authors: Zahiri Christopher A , Zahiri Hormoz , Tehrany Fereydun
Published: April 2021

ABSTRACT

Acute anterior shoulder dislocations are extremely painful conditions that force patients to present to emergency rooms or physicians' offices immediately. The diagnosis usually is established through a careful history and examination, and may be confirmed by appropriate radiography. The immediate treatment objective is to achieve reduction as early as possible, preferably through a closed reduction method with the least discomfort. Current methods of reduction are based on either traction or leverage maneuvers, with each having its own merits and disadvantages. This article, however, revisits the subject by a comprehensive literature review. It addresses obstacles to reduction and reports a closed reduction technique for the acute anterior dislocations of the shoulder that uses both traction and leverage maneuvers simultaneously. In addition, the technique eliminates failing factors of current reduction methods such as the surgeons' weakening or slippery grip when using traction methods. It is expected, by virtue of the method, that it would reduce the chances for complications such as humeral shaft fractures as can occur in leverage maneuvers. This method addresses all potential anatomical and pathological features of acute anterior dislocations of the shoulder to facilitate an earlier and more comfortable reduction.
The Radiographic Identification of Osteolysis: A View From the Box
Authors: Mallory Thomas H
Published: April 2021

Material Limitations, Consequences, & Clinical Picture
Cemented Arthroplasty: Yesterday, Today, and Tomorrow
Authors: Callaghan John J , Johnston Richard C
Published: April 2021

Femoral Fixation Options in the 1990s
Cartilage Resurfacing: Facts, Fictions, and Facets
Authors: Thornhill Thomas S
Published: April 2021

Evolving Technologies: New Answers or New Problems?
Subsidence and the Cement Mantle in Femoral Impaction Allografting
Authors: Masterson Eric L , Duncan Clive P
Published: April 2021

Evolving Technologies: New Answers or New Problems?
Revision Total Knee Arthroplasty of Bone Grafts Versus Implant Supplementation
Authors: Gross Allan E
Published: April 2021

Revision Total Knee Arthroplasty
Fractures Following Total Knee Arthroplasty
Authors: Dorr Lawrence D
Published: April 2021

Revision Total Knee Arthroplasty
Total Knee Arthroplasty in the Obese Patient
Authors: Booth Robert E
Published: April 2021

Knee Arthroplasty: The Devil Is in the Detail
Hip Challenges: What Would You Do?
Authors: Dorr Lawrence D
Published: April 2021

Case Challenges i? Hip and Knee Arthroplasty
The Accommodative Portion of Mixed Esotropia
Authors: Raab Edward L
Published: April 2021

ABSTRACT

This study reports observations on the subsequent course of the accommodative component in 139 patients with mixed esotropia after surgery for the nonaccommodative portion of the deviation. An unexpected finding was the presence of a normal distance/near relationship at the time of operation in 69% of these patients. In 40 cases (29%), the accommodative component subsided during the 1st postoperative year. In the remaining patients, the occurrence rate of improvement at longer intervals was similar to that for patients with pure accommodative esotropia observed in prior studies. Persistence was associated with preoperative spherical equivalent hypermétropie of more than 3.00 diopters, but not with a history of strabismus in close relatives. Accommodative esotropia appears to behave the same in pure and in mixed forms.
Changes in the Visual Field After Photocoagulation or Cryotherapy in Children With Retinopathy of Prematurity
Authors: Takayama S , Tachibana H , Yamamoto M
Published: April 2021

ABSTRACT

We examined the visual field in 13 children (26 eyes) who had had retinopathy of prematurity for which photocoagulation or cryotherapy was administered more than 10 years previously.

Defects of the visual field observed in the periphery of the temporal side corresponded to the sites of photocoagulation scar formation and to areas severely affected by retinopathy of prematurity. In addition, sensitivity in some patients was reduced over the entire visual field.

It has been established that treatment with photocoagulation and cryotherapy is effective in preventing the progression of retinopathy of prematurity. However, on the basis of our results, we recommend that the use of photocoagulation and cryotherapy be minimized to prevent the progression of visual field defects.
Neodymium:YAG Pupilloplasty in Pediatric Aphakia
Authors: Summers C Gail , Holand Edward J
Published: April 2021

ABSTRACT

An adequate pupillary aperture is required for accurate ophthalmoscopy and retinoscopy in pediatric aphakia. When pupillary miosis does not respond to pharmacologic dilation, optical iridectomy performed with a vitreous suction-cutting instrument under general anesthesia may be required. We report a 27-month-old aphakic child whose pupillary aperture was enlarged from 1 mm to 3.5 mm with neodymium (Nd):YAG pupilloplasty, following intramuscular sedation with meperidine, promethazine, and chlorpromazine. Removal of the laser chin rest and positioning of the patient on a table with adjustable height facilitated delivery of 140 applications at 2.5 to 4.3 mJ to the pupillary border. Levobunolol 0.5% controlled the transient posttreatment rise in intraocular pressure. We suggest that Nd:YAG pupilloplasty performed with sedation be considered as an alternative to intraocular surgery when pupillary miosis in pediatric aphakia does not respond to dilating agents.
The Diagnosis of Amblyopia in Cross-Fixation
Authors: Dickey Carol F , Metz Henry S , Stewart Susan A , Scott William E
Published: April 2021

ABSTRACT

Customarily, it is taught that cross-fixation, in a patient with congenital esotropia, obviates the development of amblyopia. However, our clinical experience has shown significant amblyopia in 50% of cross-fixators. In our hands, the diagnosis of amblyopia is made based on the point at which alternation of fixation takes place. By this method, if there is equal visual acuity, alternation will occur at the midline with each eye. If amblyopia exists, the sound eye will continue to follow the target beyond midline, into abduction, before the poorer seeing eye picks up fixation. In order to test the reliability of this method, using Teller acuity cards as the standard, we compared estimates of objective and subjective vision in 25 consecutive patients with congenital esotropia and cross-fixation. Our findings suggest that there may be a significant prevalence of amblyopia in cross- fixating patients and that the point at which alternation of fixation occurs is a reliable means of detecting a difference in visual acuity between the two eyes.
Adenocarcinoma of the Ciliary Epithelium in a 12-Year-Old Black Child
Authors: Margo Curtis E , Brooks H Logan
Published: April 2021

ABSTRACT

Histopathologic examination of a blind eye from a 12-year-old black girl revealed an unsuspected adenocarcinoma of the nonpigmented ciliary epithelium and evidence of previous penetrating trauma. The association between adenocarcinoma of the ciliary epithelium and ocular trauma has been well documented in elderly patients but not in children. The histopathologic distinction between a pleomorphic adenocarcinoma of the ciliary epithelium and a uveal melanoma may be difficult. Signs of previous penetrating trauma should heighten suspicion of an adenocarcinoma, even in young children.
A New Method for Evaluating Distance Stereo Acuity
Authors: Zanoni Diana , Rosenbaum Arthur L
Published: April 2021

ABSTRACT

A new standardized method for evaluating distance stereo acuity has been developed, using the graphic capacity of a high-frequency microprocessor and liquid crystal binocular glasses. Images are alternately presented at a frequency of 60 cycles per second to each eye, using synchronized liquid crystal shutter glasses. The amount of disparity in the stereo patterns can be altered to allow a measurement as refined as 15 seconds of arc ("). This instrument is now commercially available as part of the Mentor B-Vat system.*

We evaluated distance Random Dot and Contour circle stereo acuity of 50 normal subjects using this new method and compared these results to conventional Titmus and Randot circles at near. The distance stereo acuity mean results were 139" for the Random Dot test and 41 .1 " for the Contour circles. The near stereo acuity results were 41.8" for the Titmus circles and 27" for the Randot circles. Statistically, the Titmus results at near can be compared to the Contour circles at distance. The distance Random Dot test results demonstrate much less stereoability than the other test. The application of these new distance stereotests will be discussed.
Optic Nerve Coloboma With Cyst: A Case Report and Review
Authors: Wiggins Robert E , von Noorden Gunter K , Boniuk Milton
Published: April 2021

ABSTRACT

A 7-month-old boy presented with strabismus and proptosis of the left eye. He was found to have bilateral optic nerve colobomas associated with cysts arising from the optic nerve sheath and in communication with the subarachnoid space. The evaluation and management of this entity are discussed.
Ocular Alignment Under General Anesthesia in Congenital Esotropia
Authors: de Molina Alfonso Castanera , Muñoz M Luisa Giner
Published: April 2021

ABSTRACT

Ocular alignment is usually more divergent in strabismus patients under general anesthesia than in the awake state. Although clinical and anesthetized alignments have been reported to be correlated through the equation A = 0.8P + 30, significant differences in the amount of divergence under anesthesia have been reported between esotropes and exotropes. We found differences in response to general anesthesia in a group of 83 congenital esotropes. The averaged anesthetized alignment pertained to the whole group of 6.2 prism diopters of esotropia, which correlated poorly with the preoperative deviation. Mean anesthetized alignments were similar for any amount of preoperative deviation. Recommendations of intraoperative adjustment of surgery based on the anesthetized position should, in our opinion, be reconsidered and recalculated when treating congenital esotropes. A prediction of surgical results following these recommendations suggested an increase of the undercorrection rate, probably linked to an incorrect identification of normal and anomalous cases to the Apt-Romano test.
Congenital Nasolacrimal Sac Mucocele Associated With Respiratory Distress
Authors: Edmond J C , Keech Ronald V
Published: April 2021

ABSTRACT

Two newborn infants with mucoceles of the nasolacrimal sac presented with respiratory distress due to mucocele-induced nasal cavity obstruction. Nasolacrimal duct probings were performed and resulted in immediate and permanent relief of respiratory difficulties. This rare complication should be considered in the evaluation of infants with congenital nasolacrimal sac mucocele.
The Fluorescein Disappearance Test (FDT): An Evaluation of Its Use in Infants
Authors: MacEwan Caroline J , Young James D H
Published: April 2021

ABSTRACT

We report a prospective evaluation of the fluorescein disappearance test (FDT) in the diagnosis of lacrimal outflow obstruction in infants under 1 year of age. In a preliminary study of 80 lacrimal systems, we showed that the FDT is a sensitive (90%) and specific (100%) test in aiding the diagnosis of nasolacrimal obstruction in infants.

In the main study, we examined 288 eyes of 232 children with epiphora. The FDT was abnormal in 237 (82%). Of the remaining 51 eyes, there was a clinical explanation for this in 33 cases (epiblepharon, conjunctivitis, etc). We have found that this simple and reliable test taken in conjunction with clinical examination provides an objective assessment of the lacrimal outflow status of young children.
Combination Cyclopentolate and Phenylephrine for Mydriasis in Premature Infants With Heavily Pigmented Irides
Authors: Khoo Boo-Kian , Koh Adrian , Cheong Pauline , Ho Nai-Kiong
Published: April 2021

ABSTRACT

Purpose: This study examined whether safe and effective mydriasis can be achieved in premature infants with heavily pigmented irides using combination cyclopentolate 0.2% and phenylephrine 1% eyedrops.

Methods: A prospective, randomized double-blind study was performed to compare combination cyclopentolate 0.2% and phenylephrine 1% eyedrops with triple instillation of tropicamide 0.5% and phenylephrine 2.5%. Twenty-eight consecutive babies with dark irides and birthweight <1600 g referred for screening for retinopathy of prematurity comprised the study population. Infants' eyes were randomly dilated twice with both regimens within a 2-week period. Blood pressure, heart rate, and pupil size were measured.

Results: Good mydriasis was achieved in both groups with no significant differences in pupil size or blood pressure (systolic, diastolic, or mean arterial pressures) over starting baseline values. Pulse rates decelerated below the baseline values in both groups, but these differences were not large.

Conclusion: The single combination eyedrop of cyclopentolate 0.2% and phenylephrine 1% is as effective and safe a mydriatic for infants with dark irides as both tropicamide 0.5% and phenylephrine 2.5%.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:15-20.
Binocular Fixation Pattern and Visual Acuity in Children With Strabismic Amblyopia
Authors: Laws D , Noonan C P , Ward A , Chandna A
Published: April 2021

ABSTRACT

Background: A prospective study was undertaken to compare the binocular fixation pattern and presence of amblyopia in strabismic children.

Methods: Fifty-three children with manifest strabismus and the ability to cooperate with an optotype acuity test were examined. The binocular fixation pattern and logMAR visual acuity were recorded by separate, masked observers under standardized conditions. The binocular fixation pattern was divided into four grades from alternation to uniocular fixation.

Results: Patients who freely alternated did not have amblyopia, while those who maintained or preferred fixation with a given eye tended to have amblyopia in the nonpreferred eye.

Conclusion: The binocular fixation pattern can be rapidly assessed with minimal equipment and training. These findings confirm the usefulness of a graded assessment of the binocular fixation pattern in the detection of amblyopia.

Journal of Pediatrie Ophthalmology and Strabismus 2000;37:24-28.
Clinical Symptoms and Visual Outcome in Patients With Presumed Congenital Cataract
Authors: Lee Young Chun , Kim Hyun Seung
Published: April 2021

ABSTRACT

Purpose: To investigate clinical symptoms and visual outcome in patients who had presumed congenital cataract with visual acuity ≥20/200.

Methods: Twenty-nine patients (50 eyes) ranging in age from 5-28 years were included in this study. Congenital cataract was diagnosed by patients' past history, previous medical records, and typical findings of congenital cataract. Inclusion criteria were patients with visual acuity measured by Snellen chart, best corrected visual acuity ≥20/200, and no eye or systemic diseases influencing visual acuity. Seven patients had unilateral cataracts and 22 patients had bilateral cataracts. Cataracts were nuclear in 29 eyes, anterior or posterior subcapsular in 12 eyes, and polar in 7 eyes. All patients underwent lens aspiration or phacoemulsification combined with posterior chamber intraocular lens (PC-IOL) implantation without performing intentional posterior capsulotomy and anterior vitrectomy.

Results: The most common clinical symptom was visual disturbance followed by blurred vision, glare and knitting the brow, strabismus, and leukocoria. Comparison of calculated PC-IOL power showed a more significant myopic shift in unilateral cataract than in bilateral cataract. Postoperative best corrected visual acuity >20/25 was attained in 28 (65.1%) eyes with bilateral cataracts and 1 (14.3%) eye with a unilateral cataract.

Conclusions: Cataract surgery is effective not only in improving visual acuity but also in eliminating clinical symptoms. Delaying cataract surgery in early infancy should be considered to avoid intentional operative procedures in patients with bilateral congenital cataract preserving visual acuity >20/200.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:219-224.
Complications of Ocular Paintball Injuries in Children
Authors: Hargrave Sylvia , Weakley David , Wilson Charles
Published: April 2021

ABSTRACT

Purpose: To evaluate the ocular complications of paintball injuries in children.

Methods: The clinical course of four children with traumatic ocular paintball injuries was evaluated. All patients underwent a complete ocular examination. Their age, injuries sustained, surgical procedure^) performed, presence of protective eyewear at the time of injury, and final visual outcome was assessed. The presence of directly related anterior and posterior segment abnormalities were also evaluated.

Results: Four boys sustained traumatic paintball injuries. Average patient age was 1 1 .25 years (range: 10-12 years). None of the children were wearing ocular or facial protection at the time of the initial injury. All patients had hyphema and traumatic cataract, and some form of retinal pathology (vitreous hemorrhage, epiretinal membrane, retinal hemorrhage, and choroidal rupture). One child had a partial-thickness corneal laceration that did not require surgical intervention. All other patients underwent ophthalmic surgery. Final visual acuity was 20/30 or better in two patients, and 20/100 or worse in the others. The cause of decreased visual acuity in these children was directly related to macular pathology.

Conclusion: Ocular injuries resulting from paintball impact are often severe and usually occur when the participants are not wearing eye protection or this protection becomes dislodged. Treatment of these injuries is sometimes limited to an attempt to salvage what remains of useful vision. Unfortunately, most of these sports-related injuries could have been prevented If patients wore adequate eye protection when involved in this sport.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:338-343.
Astigmatism in Infancy and Childhood
Authors: Montés-Micó Robert
Published: April 2021

ABSTRACT

Purpose: To evaluate the prevalence of astigmatism In infancy and childhood In a Spanish population.

Methods: A total of 478 children with astigmatism from Valencia Province, Spain were examined. The patients, ranging in age from 2-1 2 years, were classified into groups according to age. Astigmatism error and axis orientation were determined using noncyclopeglc retlnoscopy over each eye.

Results: The overall prevalence of astigmatism (5=1.00 diopter of cylinder) decreased In relation to increasing age from 44.3% to 5.2%. The prevalence of against-the-rule astigmatism decreased from 61.5% (at 2 years) to 33.4% (at 12 years), with-the-rule astigmatism increased In prevalence from 23.1% (at 2 years) to 66.6% (at 12 years), and oblique astigmatism decreased with age from 15.4% (at 2 years) and 0% (at 12 years).

Conclusion: These results do not vary from those observed in other populations. Factors such as race, nutrition, and environmental condition did not vary from the literature regarding the prevalence of astigmatism in infants and children.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:349-353.
The Impact of the Number of Young Adults on an Inpatient Psychiatric Unit
Authors: Lepage James P , Hatton Florence , Pollard Scott , VanHorn Linda , Coffield Patty , McGhee Melanie
Published: April 2021

Age has been shown to contribute to aggression in inpatient settings. Studies that examine violence in inpatient settings have shown that younger patients have a higher tendency of aggressive behavior toward staff and other patients (Aquilina, 1991; Hillbrand, Foster, & Spitz, 1996; James, Fineberg, Shah, & Priest, 1990; Nijman, Allerti, Merckelbach, a Campo, & Rovelli, 1997; Owen, Tarantello, Jones, & Tennant, 1998).

However, though younger age has been associated with higher rates of violence, no studies have been conducted to assess the impact of multiple young adults on the functioning of an inpatient unit. This study evaluates the effect of the number of young adults on unit functioning and whether young adults mix poorly with other age groups.
Traumatic Corneal Abrasions Following Photorefractive Keratectomy
Authors: Salz James J
Published: April 2021

ABSTRACT

BACKGROUND: During excimer laser photorefractive keratectomy, central Bowman's layer and superficial stroma are removed. A potential disadvantage of this technique is whether proper epithelization of the cornea will occur in the event of a corneal abrasion. A potential advantage of photorefractive keratectomy over radial keratotomy in the event of blunt trauma is the presumably sound structural integrity of the cornea following superficial removal of stroma in photorefractive keratectomy compared to the weakened cornea following deep incisions in radial keratotomy.

METHODS: We report two patients who sustained corneal abrasions from blunt trauma to the eye and orbit following photorefractive keratectomyone following a fist injury and the other following a karate kick.

RESULTS: In both patients, the corneal abrasions healed without incident and without recurrent erosions and both corneas remained intact.

CONCLUSIONS: Corneal abrasion following trauma in two patients who has undergone photorefractive keratectomy healed as expected in a normal cornea. Although it is uncertain whether the trauma in these patients would have been sufficient to rupture radial keratotomy incisions, as would be expected from a superficial photorefractive keratectomy, the corneas remained intact following blunt trauma. [Refract Corneal Surg. 1994;10:36-37.)
The Learning Curve in Myopic Photorefractive Keratectomy
Authors: Tavola Alessandra , Carones Francesco , Galli Laura , Fontanella Giovanni , Brancato Rosario
Published: April 2021

ABSTRACT

BACKGROUND: The aim of this study was to assess the role of surgeons' skill on the final results of photorefractive keratectomy (PRK) in the correction of myopia.

METHODS: We evaluated the results of 160 consecutive unilateral treatments performed by four surgeons in a multicenter study group, with a one year follow up. Eighty-eight patients were males (55%) and 72 females (45%). Mean age was 33.7 years (median = 33, standard deviation = 10.22, range 18-65). Attempted correction ranged between -1.50 and -15.00 D. All the eyes received topical corticosteroid therapy postoperatively. At the one year follow up, we evaluated the following: uncorrected visual acuity lines gained and refractive error (spherical equivalent) as parameters of efficacy and predictability; best spectacle corrected visual acuity loss and corneal clarity as safety parameters. We also examined the centration or decentration of the ablation zone. In order to draw up a kind of learning curve, the mean values for each parameter were calculated by arbitrarily grouping the first 10 cases of each surgeon in the first group (40 patients), the second 10 cases in the second group (40 patients) and so on.

RESULTS: We found that increase in uncorrected visual acuity, final refractive error and corneal clarity appeared to improve as the surgeon became more experienced, while loss of best spectacle corrected visual acuity was not significantly influenced by increased surgical experience.

CONCLUSIONS: We think experience with photorefractive keratectomy in at least 40 eyes is necessary to obtain best results. [J Refract Corneal Surg. 1994;10:S188-S193.|
Energy Fluctuations in an Excimer Laser During Photorefractive Keratectomy
Authors: Poirier Laurent , Coulon Pierre , Williamson Wilfrid , Verin Philippe
Published: April 2021

ABSTRACT

We performed an experiment with the MEL 60 excimer laser (Aesculap Meditee Technology) to demonstrate the variations of energy of the laser beam that could happen during a refractive surgical procedure. In order to quantify such variations, we measured the whitening of a photographic paper after a series of exposures to the laser beam with the X rite 400 BAV reflection densitometer.

The energy fluctuations noted between two series of pulses averaged 11.02% (minimum 0; maximum 46). These fluctuations tended to decrease progressively during the procedure. The energy of the laser beam decreased with time. At the end of the experiment, the total loss of energy was 45.16%.

These results suggest that clinically meaningful energy variations could happen during the photorefractive keratectomy and reduce refractive predictability. |J Refract Corneal Surg. 1994;10:S258S261.1
Corneal Ectasia as a Complication of Repeated Keratotomy Surgery
Authors: Wellish Kent L , Glasgow Ben J , Beltran Francisco , Maloney Robert K
Published: April 2021

ABSTRACT

BACKGROUND: Staged keratotomy surgery, or "enhancement surgery," may allow a more predictable outcome, but also subjects the patient to additional surgical risks.

METHODS: A 39-year-old man underwent astigmatic keratotomy for myopic astigmatism, followed by 12 enhancement procedures for residual astigmatism.

RESULTS: These procedures effectively resulted in a double hexagonal keratotomy. The patient's best spectacle-corrected acuity deteriorated to counting fingers. Clinically, a conically-shaped protrusion of the central cornea, Munson's sign, diffuse subepithelial scarring, and central corneal thinning were noted. Penetrating keratoplasty was performed. Histopathologic examination showed central thinning, epithelial edema, disruption of Bowman's layer, marked stromal scarring, and focal areas of endothelial attenuation - findings consistent with keratoconus.

CONCLUSION: This case illustrates that multiple keratotomy procedures may result in corneal ectasia in apparently normal eyes and suggests that hexagonal keratotomy may be more likely to cause iatrogenic keratoconus. [J Refract Corneal Surg. 1994;10:360-364.]
Theoretical and Clinical Effect of Preoperative Corneal Curvature on Excimer Laser Photorefractive Keratectomy for Myopia
Authors: Blaker J Warren , Hersh Peter S
Published: April 2021

ABSTRACT

BACKGROUND: Individual clinical and optical variables may influence the effect of excimer laser photorefractive keratectomy. A theoretical model to describe the influence of initial corneal power, astigmatism, and topography on the expected results of photorefractive keratectomy would be useful in identifying those variables that may ultimately improve the predictability of the procedure.

METHODS: Using a mathematical analysis based on the change in sagittal depth of the central ablation zone following photoablation, we predict the effect of initial corneal curvature on the ultimate outcome of a standardized photorefractive keratectomy. Refractive results from the Phase III US Food & Drug Administration clinical trials of photorefractive keratectomy were analyzed to confirm these mathematical predictions.

RESULTS: We find that the initial corneal power, theoretically, is not expected to significantly affect the refractive change that results from a given ablation. Similarly, the corneal astigmatism present before photorefractive keratectomy is expected to be only minimally altered by a spherical excimer laser treatment. Clinically, there is no detectable difference in predictability of the procedure amongst groups stratified by initial mean keratometric power.

CONCLUSIONS: Our analysis provides a methodology to predict the optical effects of photorefractive keratectomy upon the cornea and may be applied to a variety of hypothetical clinical settings. The predicted lack of clinical association between initial corneal curvature and predictability of photorefractive keratectomy is confirmed. [J Refract Corneal Surg. 1994;10:571-574.]
Comparative Change in Anterior Corneal Asphericity After FS-LASIK and SMILE
Authors: Ying Jinglu , Zhang Jun , Cai Jianqiu , Pan Fei
Published: April 2021

PURPOSE:

To evaluate changes in anterior corneal asphericity (ΔQ) by calculating tangential radius (
r
t
) after femtosecond laser–assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE).

METHODS:

Sirius corneal topography (Costruzione Strumenti Oftalmici) was used to evaluate 120 right eyes from patients with moderate and high myopia who had previously undergone FS-LASIK and SMILE. The preoperative and postoperative tangential radii obtained in reference to various semi-meridional regions and radii zones were compared. Variation in ΔQ values in semi-meridional regions across 360 degrees of the anterior surface after FS-LASIK and SMILE were compared.

RESULTS:

The tangential radii in the 1.2- and 1.8-mm radii zones were lower in patients who underwent SMILE compared to those who underwent FS-LASIK. The tangential radii in the 2.4- and 3-mm zones were higher in patients who underwent SMILE compared to those who underwent FS-LASIK. In both the moderate and high myopia groups, postoperative Q-values and ΔQ-values were lower in patients who had undergone SMILE than in patients who had undergone FS-LASIK. Postoperative Q-values and ΔQ-values were lower in the moderate myopia group than in the high myopia group for FS-LASIK and SMILE. The magnitude of variation in ΔQ as a function of semi-meridional region was lower in patients who had undergone SMILE than in patients who had undergone FS-LASIK.

CONCLUSIONS:

FS-LASIK and SMILE alter anterior corneal tangential radius and anterior corneal asphericity in patients with moderate or high myopia. SMILE is more effective than FS-LASIK in preserving normal anterior corneal asphericity.

[
J Refract Surg
. 2021;37(3):158–165.]
Surgical Treatment of Calcific Band Keratopathy
Authors: Bokosky John E , Meyer Roger F , Sugar Alan
Published: April 2021

ABSTRACT

A surgical technique utilizing ethelenediaminetetraacetic acid (EDTA) and a Fisch drill with a diamond burr for removal of calcific band keratopathy is presented. Use of a diamond burr is an effective and simple method of removing resistant calcium deposits from the cornea without causing significant scarring.
Identical Twins With Subretinal Neovascularization Complicating Senile Macular Degeneration
Authors: Melrose Mark A , Magargal Larry E , Lucier Alfred C
Published: April 2021

ABSTRACT

This is the first report, to our knowledge, of proliferative macular degeneration developing in the same eye of identical twins. The concept of a familial predisposition in age related macular degeneration is consistent with other known risk factors including race, iris pigmentation, hyperopia and macular drusen which are known to be genetically determined. Monozygotic twins provide ophthalmology with an excellent opportunity to study the hereditary aspects of ocular disease.
Reactive Membranes on Posterior Chamber Lens Implants
Authors: Wolter J Reimer , Sugar Alan , Meyer Roger F
Published: April 2021

ABSTRACT

The cytopathology of two types of membranes on surgically removed posterior chamber lens implants is described on the background of the clinical histories. Both implants exhibit film-like proteinaceous capsules with numerous cells of macrophage origin in one case and virtually without cells in the other.
Results Following Surgical Management of Oculomotor Nerve Palsy With a Modified Knapp Procedure
Authors: Biglan Albert W , Walden Peter C
Published: April 2021

ABSTRACT

Thirteen patients with oculomotor nerve palsy had their strabismus managed with a recess/resect procedure on the horizontal recti of the affected eye. A simultaneous graded suprap lacement of both horizontal recti in the affected eye was used to manage the hypotropia in 9 of 11 patients with unilateral palsies. If some medial rectus function exists, correction of III nerve palsy is best achieved with a recess/resect procedure with supraplacement of the horizontal recti, 1 mm for each 2 prism diopters of hypotropia in primary position. Eight of 13 patients required additional procedures. Four of 13 patients did achieve high levels of binocular function.
Visualization of the Probe Tip During Lacrimal Outflow System Probing and Intubation
Authors: Dryden Robert M , Popp Jeffrey C
Published: April 2021

ABSTRACT

Probing of the lacrimal outflow system is commonly performed by ophthalmologists for treating nasolacrimal duct obstruction in infants or for intubating the lacrimal system. Visualization of the probe tip in the inferior meatus during probing insures the surgeon of reaching the nose with the probe. Similarly, visualization of the probe is the key to success in intubation irrespective of the retrieval system used. Rotation of a curved metal probe plus infracturing of the inferior turbinate after shrinking the nasal mucosa with cocaine allows such visualization in most instances.
Sight Saving Strategies for Developing Nations: Toward an Appropriate Philosophy of Blindness Treatment and Prevention for Ministries of Health, International Agencies and Mission Societies in Developing Nations
Authors: Heldt Jean-Paul A
Published: April 2021

ABSTRACT

Saving the sight of millions of blind people in Developing Nations requires the development of an appropriate philosophy of blindness treatment and prevention. Guidelines are presented in this paper, emphasizing the importance of training national workers, using appropriate ophthalmic technology and promoting international cooperation of governments, development agencies, and mission societies.
Eyelid Penetration of a Hard Contact Lens, Simulating a Neoplasm
Authors: Beyer-Machule Charles K , Shapiro Amiram
Published: April 2021

ABSTRACT

A hard contact lens penetrated the right upper lid at the level of the aponeurosls of the levator palpebrai superior's muscle. Later tumor-like symptoms developed of a hard movable mass with blepharoptosis.
Lamellar Keratoplasty in the Management of Recurrent Pterygium
Authors: Laughrea Patricia Ann , Arentsen Juan J
Published: April 2021

ABSTRACT

Our experience with excision and LK in ten cases of recurrent pterygia was reviewed. Although a recurrence occurred in three of ten cases, the new pterygia only partially involved the lamellar graft. Visual acuity improved in six cases. Lamellar keratoplasty following excision of recurrent pterygia seems to be a useful alternative in their treatment.
Atonic Pupil: An Unusual Complication of Cataract Surgery
Authors: Saiz Angel , Angulo Soledad , Fernandez Maximiliano
Published: April 2021

ABSTRACT

Eight cases of atonic pupil, an unusual complication following cataract surgery, are presented. Six of the eyes involved had intracapsular cataract extraction and anterior chamber intraocular lens implantation; one case underwent extracapsular cataract extraction with a posterior chamber intraocular lens implantation; the other had an extracapsular procedure with no implant. The etiology is unknown, but we believe the most likely one is that the sodium hyaluronate used in all these patients caused a temporary reduction of the iris blood supply by mechanical factors or by avasoconstriction induced by some toxicity of the material that produced a lesion on the iris sphincter.
The Effect of Sodium Hyaluronate on the Outcome of Trabeculectomy
Authors: Raitta Christina , Vesti Eija
Published: April 2021

ABSTRACT

The outcome of trabeculectomy with the use of sodium hyaluronate was investigated in 99 trabeculectomies and compared with the results achieved in an earlier series of trabeculectomies without the use of sodium hyaluronate. The use of sodium hyaluronate facilitated performance of the surgery and tended to reduce the severity of postoperative shallow anterior chamber and intraoperative bleeding. It remains to be shown whether it also may prevent lens opacity increase.
Comparison Between the Effect of Two Different Widths of Circular Lamellar Keratectomy on Refraction and Corneal Curvature in Rabbits' Eyes
Authors: Sabry Nabeel MD , Zeidan Abdel Kader , Gaber Sayed , Ghaly Sabry Abou
Published: April 2021

ABSTRACT

Twenty rabbits' eyes were subjected to circular lamellar keratectomy. Two trephines were used to mark rings at a depth of 0.3 mm, and the lamellar cornea in between was removed. A 1-mm-wide ring was removed from the right eyes, and a 0.5-mm-wide ring from the left ones. We found that removing a 1-mm ring more effectively corrected hypermetropia (3.09 ± 1.72 diopters) than removing a 0.5-mm ring (1.81 ± 0.95 D).
Effects of Pulsed Nd:YAG Laser on the Surface of Rabbit Retina
Authors: Fleck Brian W , Chew Paul T K , Lim Arthur S M , Tock Edward P C
Published: April 2021

ABSTRACT

Six albino rabbits were subjected to pulsed Nd:YAG laser irradiation to the retinal surface to determine whether such treatment would lead to proliferative vitreoretinopathy. Choroidal, retinal, and preretinal hemorrhages, noted at the time of treatment, resolved after 7 to 10 days. Histological examination showed no signs of anterior segment damage or proliferative vitreoretinopathy. These preliminary findings suggest that more extensive experimentation is warranted to determine if pulsed Nd:YAG laser may in fact safely be used to separate vitreoretinal adhesions in the treatment of retinal detachment.
The Partial Dissection Trabeculectomy
Authors: Smith Alan D , Hesse Richard J , Terry Andew P
Published: April 2021

ABSTRACT

We retrospectively reviewed the results of the first 20 procedures of a modification of the penetrating trabeculectomy ab externo procedure in which an attempt is made to limit subconjunctival fibrosis at the filtering site. With a follow-up ranging from 2 to 29 months, the average intraocular pressure was reduced from 33 to 12 mm Hg.
Outpatient Dacryocystorhinostomy
Authors: Dresner Steven C , Klussman Kurt G , Meyer Dale R , Lindberg John V
Published: April 2021

ABSTRACT

We report 105 dacryocystorhinostomy procedures in 87 patients performed on an outpatient basis. Seventy-six patients received local, and 29 received general, anesthesia. The patients left the hospital an average of 2.6 hours after surgery, but 14 were admitted after surgery-9 immediately, and 5 after some delay, primarily for epistaxis. There were no serious complications related to the outpatient nature of the surgery. The success rate was 94%. We conclude that outpatient dacryocystorhinostomy is successful, well accepted by patients, and safe, provided that inpatient care facilities are readily available should they be needed.
Reversible Suture Tarsorrhaphy for Eyelid Malposition and Keratopathy
Authors: Gossman M Douglas , Bowe Brian E , Tanenbaum Myron
Published: April 2021

ABSTRACT

We describe a simple and completely reversible method of temporarily maintaining eyelid closure that may be useful in the management of keratopathy and eyelid malposition.
Eye-Tracking System for Computer-Assisted Photocoagulation
Authors: Yu Joseph Jy-Haw , Ho Ye-Tau , Ko Liang-Shi , Kao Ming-Chien
Published: April 2021

ABSTRACT

An eye-tracking system is described in which a computer interfaced with the driving circuit of the laser deflection mirror in the slit lamp is used to automatically lock a laser beam to specific targets during photocoagulation.
Anterior Capsule Adherence to Iris Leading to Pseudophakic Pupillary Block
Authors: Naveh N , Wysenbeek Y , Solomon A , Melamed S , Blumenthal M
Published: April 2021

ABSTRACT

We present a rare case of anterior capsule adherence to the iris following extracapsular cataract extraction with posterior chamber intraocular lens implantation and leading to Pseudophakie pupillary block. There were no synechiae at the pupillary margins associated with the capsule/iris adherence, but aqueous was entrapped behind the iris and intraocular pressure rose. Laser iridotomy was temporarily beneficial, but it had to be repeated several times.
Canaliculectomy in the Treatment of Keratitis Sicca
Authors: Putterman Allen M
Published: April 2021

ABSTRACT

In patients with keratitis sicca (exposure keratopathy) in whom treatment with topical tear solutions and ointments is not effective, closure of the lacrimal puncta is performed with insertion of plugs or by cautery, hyphercation, or laser. If punctal occlusion fails with these modalities, surgical excision of the canaliculi is recommended. Canaliculectomy successfully relieved ocular irritation and keratopathy in three patients with keratitis sicca, with no complications (follow-up, 10 to 26 months).