bluuebunny/crossref_metadata_2025 huggingface dataset:
Propionibacterium Acnes Endophthalmitis Seven Months After Extracapsular Cataract Extraction and Intraocular Lens Implantation
Authors: Jaffe Glenn J , Whitcher John P , Biswell Roderick , Irvine A Rodman
Published: April 2021

ABSTRACT

We present a case of endophthalmitis caused by Propionibacterium acnes seven months following extracapsular cataract extraction and intraocular lens implantation. The markedly delayed clinical course of endophthalmitis associated with this organism appears to be highly stereotypical. Recognition and treatment of this complication of cataract surgery allows an excellent chance at cure.
Choroidal Neovascularization in Degenerative Myopia: Role of Laser Photocoagulation
Authors: Jalkh Alex E , Weiter John J , Trempe Clement L , Pruett Ronald C , Schepens Charles L
Published: April 2021

ABSTRACT

Laser photocoagulation of extrafoveal choroidal new vessels was performed in 19 eyes with degenerative myopia. Sixteen eyes required only one treatment. Three eyes required more than one because of incomplete closure of the new vessels after the first treatment. Choroidal new vessel formation did not recur during the post-treatment follow-up period (average 29.2 months), and a dry, atrophic photocoagulation scar was achieved in all eyes. Visual acuity improved in only two eyes (11%), stabilized in four eyes (21%), and deteriorated in 13 eyes (68%). All except two eyes showed spontaneous progressive enlargement of the atrophic photocoagulation scar, which worsened visual acuity in 13 eyes (68%).
Microsurgical Treatment of Lens Capsule Perforations Part I: Experimental Research
Authors: Buschmann W , Gehrig O M , Vogt E , Raab H , Römer M
Published: April 2021

ABSTRACT

Although perforating injuries of the lens capsule typically lead to traumatic cataract in humans and rats, capsular healing is observed regularly in injured rabbits and dogs. This is most likely because protein exudation in rabbits and dogs is much greater than that in humans and rats. Using isolated white Wistar rat lenses, rat lenses in vivo, and isolated human lenses, we attempted both to replace lens protein as well as develop techniques for microsurgically closing the capsule by applying a fibrinogen-based tissue adhesive. This application was effective in preventing traumatic cataract. Use of a fibrinogen-glued capsule graft yielded similarly good (but not better) results.
Correction of Postoperative Eyelid Retraction With a Simplified Levator Palpebrae Superioris (LPS) Muscle Recession: Analysis of a 10-Year Experience
Authors: Karesh James W , Putterman Allen M
Published: April 2021

ABSTRACT

A simplified levator palpebrae superioris (LPS) muscle recession was performed to correct eyelid retraction in 56 eyelids of 48 patients. Improvement of preoperative keratopathy and cosmetically acceptable results were achieved in 93% of the eyelids. Based on preoperative surgical intervention, eyelids were divided into four groups: levator resection, levator aponeurosis advancement, surgery associated with dysthyroid ophthalmopathy, and miscellaneous reconstructive eyelid procedures. For each group the mean preoperative and postoperative eyelid levels, the mean change in eyelid level following surgery, and the mean amount of surgery performed were analyzed statistically with the two-tailed student's t-test. Linear regression was used to analyze the relationship between the change in eyelid level and the amount of levator recession performed. No significant relationship was demonstrated between eyelid retraction and dysthyroid ophthalmopathy or reconstructive eyelid surgery. However, a significant relationship was demonstrated between the amount of recession and the eyelid level change for eyelids retracted following levator resection (P<.01) and levator aponeurosis surgery (P<.05). This may indicate that the change in eyelid level following a simplified LPS recession in these two groups is predictable. However, additional prospective studies are required to further assess the clinical applicability and use of this finding.
The Choice of a Syringe For Manual Cortex Aspiration
Authors: Zauberman H
Published: April 2021

ABSTRACT

The friction force of 5-ml, 2-ml, and 1-ml syringes used for manual aspiration of cortex material in extracapsular cataract extraction (ECCE) were compared. It was found that for a 5-ml syringe the force was 500 g, for a 2-ml syringe it was 250 g, and for a 1-ml tuberculin-type syringe it was only 50 g. The ease and duration of cortex aspiration in 30 cases of ECCE were compared using each of the above syringes partially filled with fluid, connected to a 25-gauge Gill's type cannula, and a closed anterior chamber technique. It was found that with the help of a 1-ml tuberculin syringe, cortex material was removed faster and with less finger fatigue than with the 5-ml or 2-ml syringe.
Continuing Corneal Endothelial Loss in Intracapsular Surgery With and Without Binkhorst Four-Loop Lenses: A Long-Term Specular Microscopy Study
Authors: Martin Neil F , Stark Walter J , Maumenee A Edward
Published: April 2021

ABSTRACT

We analyzed pre- and postoperative corneal endothelial photographs of 17 intracapsular cataract extractions (ICCE) with Binkhorst four-loop intraocular lens (IOL) eyes and found 11.6% mean cell loss at 2 months (previously reported by Hirst et al) increasing to 42.4% after 5 years (p<0.05) and 51.8% at 7 years. Eleven ICCE eyes without IOLs similarly examined showed a 15.6% mean cell loss at 2 months (previously reported by Hirst et al), increasing to 33.4% at 5 years (p<0.005, paired t-test). Our results appear to indicate long-term continuing cell loss after ICCE, both with and without Binkhorst four-loop iris clip IOLs, and statistically significant greater cell loss (p<.001, unpaired t-test) with IOLs than without.
Infantile Exotropia in Healthy Children
Authors: Rubin Steven E , Nelson Leonard B , Wagner Rudolph S , Simon John W , Catalano Robert A
Published: April 2021

ABSTRACT

Constant exotropia is uncommon during the first year of life. We retrospectively identified 13 patients with large, constant exotropia during the first year of life which required surgery. Bilateral lateral rectus muscle recessions were done in all 13 cases. Only two patients have required reoperation. The clinical char· acteristics and management of this unusual condition are similar to those of infantile esotropia.
Complications of Implanting Three-Piece C-Loop Posterior Chamber Lenses in the Anterior Chamber
Authors: Liu John F , Koch Douglas D , Emery Jared M
Published: April 2021

ABSTRACT

We have examined a total of four eyes in three patients who had undergone implantation of threepiece C-loop posterior chamber intraocular lenses into the anterior chamber. All four eyes exhibited four or more of the following complications: 1) loop encapsulation by peripheral anterior synechiae; 2) recurrent iritis; 3) central loop displacement with corneal endothelial touch; 4) progressive endothelial cell loss and corneal edema; 5) glaucoma; and 6) cystoid macular edema. Intraocular lens removal was required in all four eyes, and penetrating keratoplasty was performed in one. We believe that these complications are attributable to the inherent fallacies of fixating threepiece open-loop lenses in the anterior chamber angle.
Rotational Tarsal Conjunctival Flap in the Treatment of Scleral Necrosis
Authors: Rootman David S , Insler Michael S , Kaufman Herbert E
Published: April 2021

ABSTRACT

Scleral necrosis and perforation are difficult to manage. We describe a technique whereby a vascular strip of tarsal tissue with overlying conjunctiva can be rotated and sutured to a necrotic area of sclera that has been debrided, leading to rapid healing. The technique is performed easily, and can aid in the healing of areas of necrotic sclera that threaten perforation by providing a vascular pedicle.
Bilateral Lacrimal Duct Cyst
Authors: Conway Stephen T
Published: April 2021

ABSTRACT

Reports of lacrimal gland cysts have been rare, and mostly of small, unilateral cysts of the palpebral lobes. An unusual case of bilateral, large acquired cysts of the orbital lobe of the lacrimal glands is presented. Pathologic examination showed chronic inflammation and fibrosis of the lacrimal gland structures. We suggest that prolapse of the lacrimal glands with obstruction of the lacrimal ducts, combined with chronic dacryoadenitis, led to cyst formation.
Role of Nd:YAG Peripheral Iridectomy in the Management of Ocular Hypertension With a Narrow Angle
Authors: Romano J H , Hitchings R A , Pooinasawmy D
Published: April 2021

ABSTRACT

One half of 20 patients (40 eyes) with ocular hypertension and occludable angles, some with peripheral anterior synechiae, were randomly assigned for treatment by Nd:YAG laser iridotomy. Pre-randomization patients required pilocarpine to maintain normal intraocular tension. Following laser treatment, all eyes were followed a minimum of 12 months (mean of 24). In the nonlaser-treated group, pilocarpine alone controlled intraocular pressure. In the laser treated group, eyes without peripheral anterior synechiae required fewer medications to maintain normal pressures while eyes with peripheral anterior synechiae required more. Although relief of pupillary block by laser iridotomy can facilitate managment of this group of patients, preexisting peripheral anterior synechiae may be associated with greater therapeutic requirements following laser treatment.
Postoperative Instillation of Mitomycin C in the Treatment of Recurrent Pterygium
Authors: Hayasaka Seiji , Noda Sachiko , Yamamoto Yukari , Setogawa Tomoichi
Published: April 2021

ABSTRACT

We examined retrospectively 61 eyes of 61 patients with recurrent pterygia who had been treated with excision, with or without 0.02% mitomycin C instillation, 3 to 7 years after treatment. The rates of recurrence (5% to 9%) and complications in eyes that had undergone excision and mitomycin C instillation were less than those in eyes that had had excision only. These data suggest that the postoperative instillation of 0.02% mitomycin C, twice a day for five days, may be effective and safe in the treatment of recurrent pterygium.
Postoperative Zygomycetes Endophthalmitis
Authors: Orgel Ira K , Cohen Kenneth L
Published: April 2021

ABSTRACT

Fungal endophthalmitis is an uncommon complication of intraocular surgery. We report, to our knowledge, the first case of a postoperative Zygomycetes endophthalmitis that occurred after uncomplicated phacoemulsification and the insertion of a posterior chamber intraocular lens. Diagnosis, in the presence of negative aqueous and vitreous cultures, was confirmed by immunofluorescence staining of an anterior chamber inflammatory mass. Successful treatment of the eye with 20 µg of intraocular amphotericin B (Fungizone) may have been made possible in part by the fact that the posterior capsule remained intact, keeping the eye bicompartmental.
Resident Extracapsular Cataract Surgery: Results and a Comparison of Automated and Manual Techniques
Authors: Sappenfield David L , Driebe William T
Published: April 2021

ABSTRACT

We retrospectively evaluated 414 faculty-supervised extracapsular cataract extractions performed by ten second and third-year residents. In 94% of the cases without preexisting eye disease 20/40 or better vision was achieved. The most frequent postoperative complication, occurring in 17% of the cases, was a transient rise in intraocular pressure. Late postoperative wound dehiscence occurred in seven cases (1.7%), often associated with chronic obstructive pulmonary disease or trauma. There was no statistically significant difference in visual outcome or in the rates of the most frequent complications in the 260 automated as opposed to the 121 manual cortical removal cases. In particular, there was no difference in the rates of vitreous loss, although posterior capsule tears tended to occur more often in the manual group (P= 0.084).
Gonioscopic Findings Following Insertion of Pearce Lasagap and Nova Curve Kratz Posterior Chamber Intraocular Lenses in Extrapsular Cataract Extraction
Authors: Naylor Gerald , Sutton G Augustine
Published: April 2021

ABSTRACT

The gonioscopic appearances of 45 eyes that had undergone extracapsular cataract extraction with insertion of a Pearce Lasagap posterior chamber intraocular lens (group A) were compared with those of 45 eyes that had undergone the same procedure except for insertion of a Nova Curve Kratz posterior chamber lens (group B). Prominence of one or both loops was seen in 35 eyes (78%) of group A, with peripheral anterior synechiae (PAS) in 25 (55%). Prominence of one loop was seen in 14 eyes (31%) of group B, with PAS in 8 (18%) (P< 0.001). Final visual acuity was comparable in both groups, 98% achieving 6/12 (20/40) or better. Although not statistically significant, the incidence of pigment dispersion, uveitis, discomfort and visual aberrations was greater in group A than in group B. We suggest that the apparent superiority of the Nova Curve Kratz lens in terms of the smaller incidence of loop prominence, as well as the reduced incidence of these other complications, is due to the fact that its haptic is inserted into the optic's edge rather than into the anterior surface of the lens optic, as is the case with the Lasagap lens.
Primary Mucinous Adenocarcinoma of the Eyelid
Authors: Sanke Robert F
Published: April 2021

ABSTRACT

Primary mucinous adenocarcinoma of the eyelid is a very rare tumor arising from the eccrine sweat gland. It is locally invasive with a high rate of recurrence following removal. Although uncommon, metastasis to regional lymph nodes does occur, and there have been several reports of more distant metastasis.

This tumor is characterized by the secretion of mucin. This mucin usually forms into pools surrounding the clusters of tumor cells. Less commonly, the mucin may collect within the tumor cells and not be secreted into the extracellular spaces. Such a "mucinpoor" form of the tumor involving the eyelid was recently seen and is reported here. The clinical and pathologic characteristics of primary mucinous adenocarcinoma are presented and the modes of treatment are discussed.
Traumatic Air Blast Injury With Intracranial, Bilateral Orbital, and Mediastinal Air
Authors: Lubniewski Anthony J , Feibel Robert M
Published: April 2021

ABSTRACT

Air at 75 lbs/sq in from an air compressor hose struck a 19-year-old man in his right eye. Injected through a superior conjunctival laceration, the air entered subcutaneous, mediastinal, and bilateral orbital and intracranial spaces. High-resolution computed tomography scanning of the head and orbits revealed air adjacent to the right optic nerve throughout the orbit. We hypothesize that air was injected intracranially, but extradurally, through the superior orbital fissure. The patient suffered no visual loss.
Posterior Relaxing Retinotomy
Authors: Gremillion Charles M , Peyman Gholam A
Published: April 2021

ABSTRACT

Three patients with retinal detachments complicated by proliferative vitreoretinopathy underwent posteriorly located relaxing retinotomy to facilitate retinal reattachment. Six months posto peratively the retina remained attach ed in all cases, with an improvement in visual acuity in two cases (light perception to hand motion and 20/200 to 20/60) and a drop of one line in visual acuity in the third (20/20 to 20/25).
Scleral Fixation Suture for Dislocated Posterior Chamber Intraocular Lens
Authors: Bloom Steven M , Wyszynski Richard E , Brucker Alexander J
Published: April 2021

ABSTRACT

The posterior dislocation of an intraocular lens is a serious complication of extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. We describe a method of repositioning and suturing such a lens, using pars plana techniques. The method we recommend has several advantages over previously described methods, including the use of radially oriented scleral fixation sutures.
Common-Sense Determination of Intraocular Lens Power
Authors: Drews Robert C
Published: April 2021

ABSTRACT

I discuss the art of using A-scan measurements and IOL power calculations to achieve patient satisfaction following cataract surgery.
Tissue Plasminogen Activator Modifies Healing of Glaucoma Filtering Surgery in Rabbits
Authors: Fourman Stuart , Wiley Lee
Published: April 2021

ABSTRACT

The healing response after glaucoma filtering surgery was analyzed immunohistochemically in rabbit eyes that had been treated with tissue plasminogen activator immediately after surgery and in the fellow eyes that had not been so treated.

In the untreated eyes, at 1 day after surgery, fibronectin-like immunoreactivrty was seen in the scleral fistula tract but not in the subconjunctival space of the filtering bleb. At 3 days immunoreactivity for fibronectin, collagen III, and collagen I could be seen in the bleb and fistula tract. By 14 days staining for collagen I and collagen III filled the surgical site, but fibronectin could only be seen in the fistula tract.

In the eyes treated with tissue plasminogen activator immediately after surgery, the deposition of fibronectin and collagen III in the subconjunctival space and fistula tract was apparently delayed and diminished. This delayed and reduced deposition was correlated with the delayed clinical failure of surgery in these eyes.

These results suggest that alteration of the biochemical changes in the extracellular matrix occurring after filtering surgery may influence the success of this surgery.
Multifocal Corneal Topographic Changes After Radial Keratotomy
Authors: Moreira Hamilton , Garbus Jenny J , Lee Martha , Fasano Armand , McDonnell Peter J
Published: April 2021

ABSTRACT

Quantitative analysis of the central corneal refractive powers of both eyes of three patients demonstrated that, after radial keratotomy, the corneas tended to have a greater range of refractive powers than preoperatively, and that the corneas with a multifocal effect had a wider distribution of refractive powers than the corneas of eyes without this effect. It may be possible to intentionally achieve a multifocal lens effect by designing a refractive procedure to predictably widen the distribution of central corneal refractive powers.
Anterior Capsular Opacification After Endocapsular Cataract Surgery
Authors: Hara Tsutomu , Azuma Noriyuki , Chiba Keizo , Ueda Yashihiko , Hara Takako
Published: April 2021

ABSTRACT

The central parts of the opacified anterior capsules of nine eyes of nine patients after endocapsular phacoemulsification followed by posterior chamber intraocular lens implantation were removed after an average postoperative period of 25 months and examined by light and electron microscopy. The opacified materials were judged to be collagen. Transmission electron microscopy revealed fibers 50 to 60 nm in diameter, with approximately 65-nanometer periodic bands in five of the nine eyes. Most remaining cells showed multilayered proliferation and were rich in cytoplasmic microtubules and surface dendrites. These results indicate that postoperative anterior capsular opacification is composed of fibroblast-like cells, presumably transformed from lens epithelial cells and collagen.
"Vertical Slat" Chalazion Excision
Authors: Goldberg Robert Alan , Shorr Norman
Published: April 2021

ABSTRACT

We describe a technique of chalazion excision in which multiple vertical incisions spaced approximately 1 mm apart are used to provide wide exposure of the chalazion. The entire extent of lipogranulomatous tissue can be excised under direct visualization, sparing normal tissues. No tarsoconjunctival tissue is extirpated. The vertical slats heal quickly, and horizontal incisions, which may cut across meibomian glands, are avoided.
Prospective Evaluation of the Argon Laser in the Treatment of Trichiasis
Authors: Gossman M Douglas , Yung Rudy , Berlin A Jan , Brightwell Joseph R
Published: April 2021

ABSTRACT

We report the results of argon-laser treatment in 60 consecutive eyelids with focal, symptomatic trichiasis. Permanence of eyelash destruction compared favorably with that reported for cryosurgery; complications were limited to minimal contour abnormalities and hypopigmentation.
Combined No-Stitch Phacoemulsification Cataract Extraction With Foldable Silicone Intraocular Implant and Holmium Laser Sclerostomy Followed by 5-FU Injections
Authors: Terry Stuart
Published: April 2021

ABSTRACT

In an attempt to overcome some of the problems associated with combined cataract extraction and glaucoma filtration surgery, we attempted a new combined procedure: a small-incision phacoemulsification cataract removal with placement of a silicone foldable implant and no-stitch closure combined with a holmium laser sclerostomy in an adjacent quadrant, followed by injections of 5-fluorouracil.
Intraocular Pressure and Anterior Chamber Depth Before and After Extracapsular Cataract Extraction With Posterior Chamber Lens Implantation
Authors: Steuhl K P , Marahrens P , Frohn C , Frohn A
Published: April 2021

ABSTRACT

Long-term intraocular pressure UOP) was evaluated in 41 glaucoma patients after extracapsular cataract extraction (ECCE) with posterior chamber lens (PCIOL) implantation. All patients were initially monitored for a mean of 19 days. Eight failed to return for reexamination, but follow up of the other 33 continued for a mean of 12 months. IOP dropped significantly and the need for medication was reduced in all patients (particularly in those with open-angle glaucoma and prior iridotomy and iris suturing). The reduction in pressure remained significant in patients with simple or exfoliation glaucoma even after longterm observation. Pressure also significantly dropped in patients who had undergone previous ophthalmic surgery. The pressure drop was possibly due to a surgical deepening of the chamber angle. (Using the laser tomographic scanner, we found the same phenomenon in 50 patients without glaucoma: following ECCE/PC-IOL, the anterior chamber angle widened 9.3 ± 4.3°.)
Transconjunctival Surgery
Authors: Silkiss Rona Z , Carroll Richard P
Published: April 2021

ABSTRACT

Transconjunctival surgery provides excellent exposure of the inferior orbit, leaves no visible scar, and poses less risk of the complications typically associated with transcutaneous techniques. The transconjunctival approach can be combined with lateral canthal techniques to increase exposure and surgical options. We review applications of the transconjunctival approach in blepharoplasty, the repair of orbital floor fractures, socket reconstruction, inferior orbital tumor excision, and orbital decompression.
Punctal Dyeing: An Adjunct to Intraoperative Lacrimal Punctal Identification
Authors: Ong Keith S , Bank Allan , Francis Ian C
Published: April 2021

ABSTRACT

During lid operations, identifying the lacrimal punctum is sometimes difficult. The difficulty may be increased following local anesthetic infiltration into the medial canthus and manipulation of the lid tissues. Punctal dyeing with a skin marking pen is a simple technique that improves visualization of the lacrimal punctum during surgery in this region. Preceded by punctal dilatation, it lasts for the duration of standard lid or lacrimal procedures.
Transsclerally-Fixated Posterior Chamber Intraocular Implants Without Capsular Support in Penetrating Keratoplasty
Authors: Hill John C
Published: April 2021

ABSTRACT

The results of 36 patients who underwent penetrating keratoplasty with transscleral fixation of a posterior chamber intraocular lens are reviewed. A 13.75millimeter "Reviens," which has the configuration of an open-loop anterior chamber lens, was used in all of the cases and gave good stability in the ciliary sulcus. The 10-0 Prolene sutures used to secure the implants were burrowed through the sclera and exited sufficiently far from the limbus to be adequately covered by Tenon's capsule and conjunctiva. No sutures eroded through the conjunctiva or needed to be removed. Two grafts became opaque, one from rejection and the other from uncontrolled glaucoma. No vitreous hemorrhage or retinal detachment occurred. Ten patients (27.8%) had cystoid macular edema diagnosed either before or after surgery; three had age-related macular degeneration; and two had traumatic macular scars. Sixteen eyes (44.4%) had final visual acuities of 20/40 or better and 25 (69.4%) saw 20/200 or better. Mean follow up was 16.8 months (range, 9 to 36 months).
Intraocular Pressure Level in Glaucomatous and Nonglaucomatous Eyes After Complicated Cataract Surgery and Implantation of an AC-IOL
Authors: Bergman Mervi , Laatikainen Leila
Published: April 2021

ABSTRACT

The effects of a semiflexible, one-piece, open-loop anterior-chamber intraocular lens (AC-IOL) implanted after intracapsular or extracapsular cataract extraction complicated by posterior-capsular or zonular rupture on intraocular pressure (IOP) level and the control of previous glaucoma were studied in 48 eyes with primary implantation and in 10 eyes with secondary implantation. Fifty-four percent of the eyes with primary implantation had exfoliation syndrome; anterior vitrectomy was performed in 60.4%.

An immediate pressure rise (IOP ≥30 mm Hg) was observed in 29.3% of the eyes. The long-term IOP level (median follow up, 21.5 months) was ≥20 mm Hg in 83.7% and between 21 and 29 mm Hg in the remaining 16.3%. In three of the nine glaucomatous eyes, the medication had to be increased; in the remaining six, the IOP could be controlled with the previous or reduced medication or with none at all. In three out of the 49 (6.1%) nonglaucomatous eyes, glaucoma medication was started during the follow up. All of these eyes had exfoliation syndrome and two of the fellow eyes had similar IOPs and were receiving similar medication.

The results indicate that the semiflexible, openloop AC-IOL has little effect on IOP and seems to be a safe alternative, even in glaucomatous eyes, if a posterior chamber lens cannot be used.
Direct Scleral Fixation of Posterior Chamber Intraocular Lenses Using a Special Needle-Holder
Authors: Vajpayee Rasik B , Angra Surinder K , Sandramouli S , Rewari Rajeev
Published: April 2021

ABSTRACT

We report a modified technique of direct scleral fixation of a posterior chamber intraocular lens (PC-IOL) using a specially designed intraocular needle-holder. The procedure was carried out in three eyes with posttraumatic subluxated cataracts; one with aphakic bullous keratopathy and with an accidental posterior capsular rent, and one with a superior zonulodialysis. The needle-holder greatly facilitated the procedure, enabling us to place the PC-IOL precisely in the ciliary sulcus with no subsequent decentration. This method avoids iris fixation and provides more secure scleral fixation of the PC-IOL.
Intraobserver and Interobserver Reproducibility of the Nidek EAS-1000 Anterior Eye Segment Analysis System
Authors: Baez Karin A , Orengo Silvia , Gandham Sai , Spaeth George L
Published: April 2021

ABSTRACT

The NIDEK EAS-1000 is a camera and computer system designed to facilitate measurement and analysis of the anterior segment of the eye. To evaluate the interobserver reproducibility of the system, three examiners assessed the anterior chamber depth and peripheral angle measurement in 20 disease-free eyes. Intraobserver reproducibility was determined by each investigator's photographing and analyzing the same eye on three different occasions. Interobserver correlation for the anterior chamber depth (using the first three readings of the same eye made by each examiner) was 0.97, with an 95% CI of 0.94 to 0.98. Interobserver correlation for angle measurement (again using the first three readings of the same eye made by each examiner) was 0.89, with a 95% confidence interval (CI) of 0.81 to 0.95. Intraobserver correlations for anterior chamber depth were 0.98 for each of the three examiners (mean, 0.98), with a 95% CI of 0.91 to 0.99. Intraobserver correlations for anterior chamber depth were 0.98 for each of the three examiners (mean, 0.98), with a 95% CI of 0.91 to 0.99. The intraobserver CI for angle measurement was 0.97 (range, 0.95 to 0.99). The intraobserver and interobserver reproducibility of the NIDEK EAS-1000 system was excellent.
An Analysis of Intraocular Lens Exchange
Authors: Lyle W Andrew , Jin Jia-Chi
Published: April 2021

ABSTRACT

We present an analysis of 101 eyes of 98 consecutive patients who underwent intraocular lens (IOL) exchange. The period of follow up ranged from 6 to 71 months (mean, 23 months). Bullous keratopathy was the leading (86.7%) indication for IOL exchange in 45 eyes that had combined penetrating keratoplasty (PKP) and IOL exchange (PKP group). Lens dislocation (36%) and incorrect power (25%) were the most frequent indications for IOL exchange without PKP (56 eyes) (NPKP group). A final visual acuity of 20/40 or better was achieved in 50.5% of the 101 eyes, with 88% having two lines of improvement or remaining within one line of the pre-exchange acuity. The geometric mean visual acuity was significantly improved, from 20/273 preoperatively to 20/125 postoperatively, in the PKP group (P < .001), and from 20/61 to 20/43 in the NPKP group (P = .001). The main reason for vision less than 20/200 in the 23 eyes in the PKP group was glaucoma (nine eyes) and bullous keratopathy (eight eyes). In the NPKP group, seven eyes (four due to cystoid macular edema, CME) had a visual acuity less than 20/200. Posterior chamber (PC) IOL implantation was associated with significantly better visual acuity than anterior chamber (AC) IOL implantation when performed at IOL exchange (P = .004). The most common complications encountered with IOL exchange were CME (17.8%), hyphema (15.8%), glaucoma (10.9%) and PC opacity (8.9%).
Forming and Teaching True Knots for Strabismus Surgery
Authors: Mims James L
Published: April 2021

ABSTRACT

I describe a system for ensuring the formation of true knots in the locking bites in strabismus surgery- 1 also present a method for teaching this system to residents that makes use of a piece of cotton or nylon rope, a cotton mop refill, and the end of a garden rake.
Peribulbar Anesthesia in Retinal Reattachment Surgery
Authors: Arora Ritu , Verma Lalit , Kumar Atul , Tewari H K , Khosla P K
Published: April 2021

ABSTRACT

We prospectively evaluated the effectiveness of peribulbar anesthesia in retinal reattachment surgery. Of the 24 patients studied, 2 required retrobulbar supplementation during the latter part of the surgery. Our results show that peribulbar anesthesia can be effectively used for retinal reattachment surgery and probably should be the preferred form of local anesthesia for this surgery, since the eyes involved have a relatively high incidence of axial myopia and posterior staphyloma.
Nonabsorbable Suture Material in Cataract Surgery: A Comparison of Novafil and Nylon
Authors: Seeto Raymond , Ng Simon , McClellan Kathleen A , Billson Frank A
Published: April 2021

ABSTRACT

We compared the performance of 10-0 Novafil (polybutester, Davis & Geek, American Cyanamid Company, New South Wales, Australia.) with that of 10-0 nylon (Alcon) in 60 patients undergoing extracapsular cataract extraction and implantation of a posterior chamber intraocular lens. A standard technique was used, and the incision was closed with interrupted sutures of either 10-0 Novafil or 10-0 nylon. Length of follow up ranged from 6 to 26 months (average, 15 months).

We assessed the intraoperative handling qualities of the suture materials, as well as their effect on wound healing and inflammation. We also compared the surgically-induced astigmatism in the two suture groups over the first 3 postoperative months and then in long-term follow up (average, 15 months). Sutures removed at long-term follow up were examined by scanning electron microscopy (SEM).

Both suture materials handled easily at operation and were well tolerated by all patients. There was no significantly different surgically-induced astigmatism in the two suture groups after 12 weeks (F = .962) or during longer follow up (P = .401). SEM confirmed more advanced biodegradation of nylon as compared with Novafil sutures after they had been in place an average of 18 months.
Extreme Deepening of the Anterior Chamber During Phacoemulsification
Authors: Zauberman H
Published: April 2021

ABSTRACT

An unusual deepening of the anterior chamber during a phacoemulsification procedure was observed in 3 patients with cataracts: 1 with high myopia, 1 with a lens opacification following a vitrectomy procedure, and 1 with pseudoexfoliation syndrome. This deepening hindered emulsification of the nucleus in the posterior chamber. Early delivery of the nucleus from the capsular bag allowed phacoemulsification to proceed at the pupillary level. The "sinking" of the lens toward the vitreous cavity appears to be related to a lack of vitreous pressure due to liquefaction, or to loosening of the zonular support in the pseudoexfoliation syndrome.
Ciliated Respiratory-Like Epithelium Forming Cystic Conjunctival Lesions in a Patient With Stevens-Johnson Syndrome
Authors: Goodglick Todd A , Mertz Persila , Wolfley Darrell , Cavanagh H Dwight , Zimmerman Lorenz
Published: April 2021

ABSTRACT

A woman with severe cicatricial conjunctival changes secondary to allopurinol-induced Stevens-Johnson syndrome developed bilateral palpebral conjunctival cysts. Pathologic examination of these lesions revealed respiratory-like pseudostratified ciliated epithelium in the walls of several cysts of one eye. To our knowledge, this is the first report of this phenomenon.
A Prospective, Randomized, Controlled Comparison of Retrobulbar and General Anesthesia for Strabismus Surgery
Authors: Cheng Kenneth P , Larson Christopher E , Biglan Albert W , D'Antonio Joyce A
Published: April 2021

ABSTRACT

A prospective, randomized controlled study (n = 95) was conducted to compare the morbidity and length of hospital stay associated with retrobulbar neuromuscular blockade (LA) with that associated with general anesthesia (GA) for monocular strabismus surgery in adult patients. A scoring system was developed to assess postoperative nausea and vomiting, pain, level of consciousness, oral intake, and activity while in the hospital and for the first 3 postoperative days.

There was no significant difference in the postoperative nausea and vomiting associated with the two anesthetic techniques. Although patients receiving LA experienced less immediate postoperative discomfort (P < .01) and had greater levels of activity (P < .0001) while in the hospital, the discomfort and activity levels of the two groups were similar at home. The LA group was discharged from the hospital sooner (mean, 135 minutes vs 250 minutes; P < .001), allowing more efficient use of hospital resources. Both techniques provided excellent anesthesia for monocular strabismus surgery.
Indirect Ophthalmoscope Argon Laser Treatment of Retinoblastoma
Authors: Augsburger James J , Faulkner C Byron
Published: April 2021

ABSTRACT

We describe our use of an indirect ophthalmoscope argon laser for the treatment of selected retinoblastomas. The essential aspect of the technique is the creation, using the "continuous" exposure setting, of a confluent white laser burn completely around the tumor base. This procedure results in the prompt regression of most tumors, although several sessions, 1 to 4 weeks apart, are usually necessary for all but the smallest lesions. This method of laser treatment is applicable to retinoblastoma tumors located anywhere in the ocular fund us, including ones adjacent to the ora serrata.
Fellow Eyes in Idiopathic Macular Hole Cases
Authors: Akiba Jun , Kakehashi Akihiro , Arzabe Carlos W , Trempe Clement L
Published: April 2021

ABSTRACT

The fellow eyes in 84 cases of unilateral idiopathic macular hole were studied retrospectively to determine prognoses and risk factors for this disorder. On initial examination, 15 of 84 eyes (18%) had a macular cystic lesion group 1), 23 (27%) had a yellow spot in the fovea (group 2), and 46 (55%) had a normal macula (group 3). Of the 84 eyes, 58 (69%) had posterior vitreous attachment. During a mean follow up of 39 months, macular hole developed in 8 of 15 eyes (53%) in group 1, and in 6 of 23 eyes (26%) in group 2. However, a macular hole did not develop in eyes with posterior vitreous separation or a normal macula. Although the risk of developing a macular hole may have been overestimated in our study, posterior vitreous attachment and macular abnormalities may be important in predicting macular hole formation in the fellow eyes in idiopathic macular hole cases.
Corneal Surface After Deepithelialization Using a Sharp and a Dull Instrument
Authors: Campos Mauro , Hertzog Lars , Wang Xun Wei , Fasano Armand P , McDonnell Peter J
Published: April 2021

ABSTRACT

Manual removal of the corneal epithelium currently precedes excimer laser photorefractive keratectomy. To assess the smoothness of the corneal surface following this procedure, six paired human eye-bank eyes (12 eyes) were manually deepithelialized using a blunt instrument (Paton spatula) on one eye and a sharp instrument (surgical blade) on the contralateral eye; all deepithelializations were done by the same surgeon. The 12 corneas were then resected and processed in an identical fashion for scanning electron microscopy. The microphotographs obtained showed that among the corneas deepithelialized with the blunt spatula, two had a smooth surface, and four had variable amounts of residual epithelial cells and basement membrane, confirmed by light microscopy. The surface of five corneas deepithelialized with the sharp instrument were slightly rougher than the former, with occasional linear scratches; one cornea retained a small amount of basement membrane. Removal of epithelium appears to be more complete when a sharp instrument is used. These findings may have clinical relevance, since residual epithelium and basement membrane after deepithelialization may influence the depth of ablation subsequently achieved with the excimer laser.
Practice Patterns of the Office-Based Ophthalmologist
Authors: Sastry Srinivas M , Chiang  , Javitt Jonathan C
Published: April 2021

ABSTRACT

Practice patterns of office-based ophthalmologists were characterized using data collected from the National Ambulatory Medical Care Survey (NAMCS) of 1989, a national probability sample survey conducted by the National Center for Health Statistics. The sample includes office visits made between 1989 and 1990 to nonfederally-employed physicians primarily engaged in office-based practice. Over 38 million office-based patient visits documented in the NAMCS were analyzed. Fifty-two percent of patients (20.4 million) were over 65 years old; 90% (34.9 million) were white, with blacks and Asians accounting for 5% (1.9 million) and 3% (1.1 million) of visits, respectively.

The leading primary diagnoses and professional activity associated with the visits were cataract/cataract surgery 23% (8.9 million), disorders of refraction 19.5% (7.5 million), and glaucoma 13% (4.9 million). Over 40% (16.1 million) of visits were for visual dysfunction, abnormal appearance, or abnormal sensation. Nearly 33% (12.5 million) were related to either a diagnostic/screening session or some form of treatment. The duration of visits ranged from 6 to 10 minutes (22.9%), 11 to 15 minutes (29.8%), and 31 minutes or longer (6.7%); 74% (28.1 million) of the patients were asked to return for a follow-up visit at a specified time, and 13% to return if needed. The major sources of reimbursement for office visits were Medicare (41%, 15.6 million); Blue Cross/Blue Shield (13%, 5 million); and other commercial insurance (15.5%, 5.8 million).
Posterior Capsule Opacification in Extracapsular Cataract Extraction and the Triple Procedure: A Comparative Study
Authors: Dangel Matthew E , Kirkham Steven M , Phipps Michael J
Published: April 2021

ABSTRACT

We retrospectively studied 330 consecutive cases, comparing the incidence of posterior capsule opacification after 279 extracapsular cataract extractions (ECCEs) or phacoemulsifications and posterior chamber intraocular lens (PC-IOL) insertions, with the incidence of opacification following 51 combined corneal transplantations, cataract extractions, and PC-IOL insertions (ie, triple procedures).

Opacification developed less frequently following the triple procedure than after cataract extraction alone (9.8% vs 36.2%, respectively; P < .001). Opacification also developed later following the triple procedure. The mean length of time before capsular opacification after cataract extraction alone was 24.3 months, while a mean of 45.6 months elapsed before opacification developed after the triple procedures (P < .05).

Delineation of the mechanisms contributing to these outcome differences may provide a means of reducing the incidence of or preventing posterior capsule opacification after cataract surgery.
Late Onset Endophthalmitis Associated With Filtering Blebs
Authors: Phillips William B , Wong Tien P , Bergren Robert L , Friedberg Mark A , Benson William E
Published: April 2021

ABSTRACT

A consecutive series of 71 cases of late onset endophthalmitis (defined as onset of symptoms at least 2 weeks after surgery) were reviewed to determine the association of this entity with glaucoma surgery filtering blebs and to identify any predisposing factors. Sixteen cases were associated with filtering blebs and two with inadvertent blebs following cataract surgery. Onset of endophthalmitis ranged from 24 days to 20 years after surgery (mean, 6.9 years). Possible contributing factors included trauma, vitreous wicks, and bleb leak. Twelve cases were culture-positive, with 5 cases of Staphylococcus epidermidis; 2, Staphylococcus aureus; 4, Streptococcus; and 1, Pseudomonas. There were no cases of Hemophilus. The more virulent organisms were generally associated with a poor visual outcome. The organisms recovered in this series were similar to those found in postoperative endophthalmitis not associated with filtering blebs.
Surgical Wound Defects Associated With Endophthalmitis
Authors: Maxwell Donald P , Diamond James G , May Donald R
Published: April 2021

ABSTRACT

Twenty-five consecutive cases of culture-proven postsurgical endophthalmitis were evaluated. Patients underwent wound revision and pars plana vitrectomy with intravitreal antibiotic and steroid infusion (gentamicin 8 µg/cc, clindamycin 9 µg/cc, dexamethasone 8 µg/cc) and injection (gentamicin 100 µg plus clindamycin 200 µg [and amphotericin 5 µg in one case] and dexamethasone 800 to 1000 µg). Twenty cases demonstrated wound defects (eg, wound gape/malapposition, abscess/tissue necrosis, suture dehiscence, leak, vitreous wick). Culture-proven isolates included both gram negative and positive bacteria and fungi. Visual acuity improved in 18 of the 20 (90%) gram positive cases. Ten of the 17 (59%) patients in the Staphylococcus epidermidis subgroup achieved a visual acuity of 20/50 or better. Surgical wound defects are frequently associated with culture-proven endophthalmitis. When vitrectomy is included as part of the treatment regimen, we recommend meticulous inspection and closure of any defective surgical wounds associated with endophthalmitis.
Vitreoretinal Toxicity of Acetazolamide Following Intravitreal Administration in the Rabbit Eye
Authors: Borhani Hesamodin , Rahimy Mohamad H , Peyman Gholam A
Published: April 2021

ABSTRACT

Acetazolamide, a carbonic anhydrase inhibitor, has been shown effective in the treatment of cystoid macular edema; however, chronic use of the drug is limited by its serious systemic side effects. Intraocular administration can eliminate these systemic complications. We evaluated vitreoretinal toxicity after intravitreal injection of acetazolamide in the rabbit eye. The right eye of each rabbit received a single acetazolamide injection; the left eye received balanced salt solution and served as a control. The effect of the drug was evaluated by clinical observation, electroretinography, and histopathologic study. Intravitreal injection of up to 0.5 mg acetazolamide did not cause vitreoretinal toxicity. Injection of 1 mg or higher doses depressed the b-wave amplitude of electroretinograms and damaged the outer segments of the photoreceptors, as determined by light and electron microscopy.
Control of Eyelid Retraction Associated With Graves' Disease With Botulinum A Toxin
Authors: Biglan Albert W
Published: April 2021

ABSTRACT

Two patients had satisfactory control of eyelid retraction associated with thyroid orbitopathy with repeated treatment of the levator palpebrae superioris muscle with botulinum A toxin. The effects of the toxin lasted for 3 to 4 months.
The Corneal Quilt: A Protective Device Designed to Reduce Intraoperative Retinal Phototoxicity
Authors: O'Brien Damien P B , Francis Ian C
Published: April 2021

ABSTRACT

The corneal quilt is a simple, safe, inexpensive, and effective device designed to decrease the risk of intraoperative retinal phototoxicity from the operating microscope. Retinal injury is a well documented hazard, especially during prolonged procedures. The corneal quilt can be easily used as an adjunct to other methods designed to protect the retina from excessive incident light. In this study, we fashioned an approximately 6- × 5-millimeter semi-transparent corneal occluder from the nonadhesive portion of a 3M Steridrape. We determined spectrophotometrically that the corneal quilt reduced the transmission not only of visible light, but of ultraviolet and blue wavelengths as well, the wavelengths known to be the most phototoxic to the retina. However, no data were obtained actually demonstrating the degree to which light is scattered after transmission through the corneal quilt.
Indocyanine Green Dye-Enhanced Diode Laser Photocoagulation of Poorly Defined Subfoveal Choroidal Neovascularization
Authors: Reichel Elias , Puliafito Carmen A , Duker Jay S , Guyer David R
Published: April 2021

ABSTRACT

Indocyanine green (ICG) is a dye with an absorption peak (795 to 810 nm) similar to the emission peak of the diode laser (805 nm). Therefore, ICG dye-enhanced diode laser photocoagulation may permit the selective ablation of ICG-retaining choroidal neovascular membranes (CNVM) with relative sparing of the neighboring neurosensory retina. Ten patients with poorly defined subfoveal CNVM were treated with ICG dye-enhanced diode laser photocoagulation and followed for an average of 15 months. One of the 10 patients experienced an immediate significant drop in visual acuity after photocoagulation. Obliteration of the CNVM at the site of laser photocoagulation was confirmed by fluorescein angiography and ICG angiography. Subfoveal chorioretinal scar formation was noted postoperatively in all 10 patients. At last follow up, 9 of these 10 patients had no more than a two-line increase or decrease in visual acuity. These preliminary results suggest that poorly defined subfoveal CNVM can be successfully treated by ICG dye-enhanced diode laser photocoagulation with minimal adverse affect on visual acuity in most cases.
Combined Peribulbar Injection and Blunt Cannula Infiltration for Vitreoretinal Surgery
Authors: Simcock Peter R , Raymond Grant L , Lavin Michael J , Whitley Christine L
Published: April 2021

ABSTRACT

Seventy-six patients undergoing combined peribulbar and direct intraconal infiltration local anesthesia for vitreoretinal surgery were prospectively evaluated. Forty-six patients had local anesthesia with a combination of lidocaine 2% and bupivacaine 0.5%; in 30 patients, a combination of lidocaine 2% and prilocaine 1% was used. Patient evaluation of discomfort during the administration of the anesthetic and during the operation was assessed on a visual analog scale of 0 to 10. The mean pain score recorded was 2.73. There was no statistically significant difference between the mean pain scores of the two local anesthetic groups (P = .465).