bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Cataract: Etiology and Morphology
Authors: Jain I S , Pillay P , Gangwar D N , Dhir S P , Kaul V K
Published: April 2021

ABSTRACT

In a study of congenital cataract in northern India, 76 patients (146 eyes) were evaluated for morphological patterns and etiology. Partial cataracts were found to be three times more common than total cataracts, the lamellar types being the most common among the partial cataracts. Hereditary cataracts had a 19.7*/£ incidence. The majority (46.05'/· ) of cases of congenital cataract were of idiopathic origin. A few cases were associated with metabolic disorders (Marian's and Marchand's). Strabismus and nystagmus were the most common associated ocular abnormalities (28.94'/? and 15.79'/f ), and mental retardation was the most commonly associated systemic abnormality. Rubella cataract was seen far less frequently than expected.
X-Linked Congenital Stationary Night Blindness With Myopia and Nystagmus Without Clinical Complaints of Nyctalopia
Authors: Price Michael J , Judisch G Frank , MD H Stanley
Published: April 2021

ABSTRACT

Seven of eight patients presented initially or were followed for decreased acuity and nystagmus without complaints of night blindness. The diagnosis of congenital stationary night blindness was established with electroretinogram and dark adaptation testing. Careful electrodiagnostic testing is needed to provide accurate genetic counseling. Two patients showed pupillary constriction to darkness, which is a sign of retinal disease in young patients.
Bilateral Retinal Vascular Hypoplasia Associated With Persistence of the Primary Vitreous: A New Clinical Entity?
Authors: Sneed Peter J , Augsburger James J , Shields Jerry A , Tasman William , Addiego Rafael
Published: April 2021

ABSTRACT

Three infant boys with a bilateral congenital retinopathy characterized by retinal vascular hypoplasia and persistence of the primary vitreous are described. The infants were healthy and had no non-ocular physical abnormalities. None had histories of prematurity or low birth weight. Family histories were negative for similar retinopathy, and the fundi of all examined blood relatives were normal. The described congenital retinopathy is compared and contrasted with persistent hyperplastic primary vitreous, Norrie's disease, idiopathic retinal dysplasia, familial exudative vitreoretinopathy, retinopathy of prematurity, and incontinentia pigmenti.
A Surgical Approach for Duane Syndrome
Authors: Kraft Stephen P
Published: April 2021

ABSTRACT

Duane retraction syndrome (DRS) represents a spectrum of motility disorders in which the common feature is retraction of the affected eye on attempted adduction. Electrophysiologic and neuropathologic studies have shown that the underlying cause is anomalous Innervation of the lateral rectus with the medial rectus and, at times, with vertical muscles in the affected eye. Clinical abnormalities observed in DRS can include any or all of the following: a deviation in the primary position; abnormal head position; severe retraction causing a pseudoptosis; and upshoots and/or downshoots associated with A1 V, or X patterns. A surgical approach based on the analysis of these four features is presented, allowing the surgeon to devise an appropriate, individualized plan for a given case which can yield optimal results in one operation.
Fiber Hypertrophy in Rat Extraocular Muscle Following Lateral Rectus Resection
Authors: Christiansen Stephen , Madhat Maher , Baker Linda , Baker Robert
Published: April 2021

ABSTRACT

Compensatory hypertrophy of muscle fibers occurs when tension on a skeletal muscle Is increased. We looked for this phenomenon in response to strabismus surgery by performing a large right lateral rectus resection in 16 rats. Muscle fiber diameters of all horizontal rectus muscles were measured at 2-week postoperative Intervals. Significant fiber hypertrophy occurred in both the antagonist right medial rectus and the resected right lateral rectus within 4 weeks. Fiber diameter subsequently returned to baseline in both muscles. We postulate that fiber hypertrophy in this setting may be a compensatory response to increased elastic load.
Optic Disc Drusen in Children
Authors: Hoover Darren L , Robb Richard M , Petersen Robert A
Published: April 2021

ABSTRACT

Forty children with pseudopapilledema due to optic disc drusen (31 bilateral, nine unilateral) were studied retrospectively to characterize the early natural history of this condition. The average age at the first examination was 10.2 years (range 3.6 to 19.5 years), and the mean follow-up period was 44 months. Discrete hyaline bodies or papillary calcifications were first noted in one or both eyes with pseudopapilledema at a mean age of 12.1 years in 38 of 40 cases. Decreased visual acuity due to drusen occurred in only one eye due to subretinal neovascularization. Visual fields obtained In 35 eyes (21 patients) with pseudopapilledema showed an enlarged blind spot (9), an inferior arcuate/sector/or altltudinal defect (6), or both (3) in 16 eyes. Our study suggests that discrete papillary calcifications or hyaline bodies frequently emerge and visual field deficits are commonly detectable in the second decade of life in patients with pseudopapilledema due to optic disc drusen.
Duane Syndrome Associated With Features of the Cat-Eye Syndrome and Mosaicism for a Supernumerary Chromosome Probably Derived From Number 22
Authors: Kalpakian Basillo , Choy Andrew E , Sparkes Robert S , Schreck Rhona R
Published: April 2021

ABSTRACT

A 12-year-old boy with a supernumerary chromosome, probably derived from number 22, had typical features of Duane syndrome with limitation of abduction and retraction of the globe upon adduction. Additionally, the patient had antimongoloid slant of the eyes, epicanthal folds, preauricular sinuses, cardiac malformations, skeletal malformations, and mental retardation suggestive of the cat-eye syndrome. The cat-eye syndrome has been often associated with a supernumerary chromosome derived from number 22. Our patient's karyotype was 46,XY/47,XY, + mar, with the supernumerary chromosome probably derived from number 22. These findings supplement previous findings of chromosome 22 abnormality associated with an ocular motility disorder.
Low-dose Methotrexate in the Treatment of Severe Juvenile Rheumatoid Arthritis and Sarcoid Iritis
Authors: Shetty Avinash K , Zganjar Brian E , Ellis George S , Ludwig Irene H , Gedalia Abraham
Published: April 2021

ABSTRACT

Objective: To assess the efficacy of low-dose oral methotrexate (MTX) therapy for children with severe iritis.

Methods: MTX in a weekly dose of 7.25 to 12.5 mg/m
p 2
was administered orally to four patients (two with juvenile rheumatoid arthritis [JRA] and two with sarcoidosis) with severe iritis hot adequately controlled by topical and systemic corticosteroid therapy. The treatment was initiated with half of the total dose and increased every 2 weeks until the final dose was reached. Iritis was graded from 0 to +4 according to the density of cells in the anterior chamber of the eye.

Results: There were three girls and one boy with a mean age of 10.5 years. Two patients were African American and two were Caucasian. The mean age at onset of iritis was 6 years. The mean duration of MTX therapy was 28.8 months. Significant improvement was noted in two of the four patients in ocular inflammation, demonstrated by reduction of cell density from +4 to +1. Two patients had a mild improvement of the iritis. However, corticosteroids were significantly reduced in all patients. One patient was completely off steroids within 30 months of MTX therapy. In the remaining three cases, the steroid dose was successfully tapered from 0.82 mg/kg/d to 0.15 mg/kg/d (mean doses) within a mean duration of 20 months. No side effects were observed with MTX therapy.

Conclusion: Low-dose MTX therapy was effective and safe, and displayed steroid-sparing properties in four children with severe iritis.

Journal of Pediatric Ophthalmology and Strabismus 1999;36:125-128.
Father-Daughter Incest: Detection of Cases
Authors: Shapshay Ruth , Vines Diane Welch
Published: April 2021

ABSTRACT

Father-daughter incest, the most frequently reported form of incest, is currently surfacing as a national problem. Increasing numbers of these child sexual abuse cases are coming to the attention of health professionals. Psychiatric-mental health nurses are involved in providing direct service and consultation in settings where cases of incest may be identified.

Recognition of father-daughter incest requires an awareness of possible overt and covert signs of incestuous involvement as well as an understanding of incest in its family context. This article will describe the problem and consequences of fatherdaughter incest and will focus on integrating individual signs and symptoms of involvement with clues to dysfunctional family dynamics operating in father-daughter incest cases.
Reminiscing Psychotherapy with Aging People
Authors: King Kathleen Stroman
Published: April 2021

ABSTRACT

Although reminiscing among aged people is often regarded negatively by others, recent literature indicates that examination of the remembered past, either verbally or internally, may be adaptive behavior. Reviewing selected literature, the author describes what reminiscence is and how people use it in the latter part of the life cycle. In addition, ways a counselor may employ the remembered past to assess current concerns, establish a therapeutic rapport, and treat individuals, groups, and families are discussed. Further, techniques to evoke memories are described.
HOUSING AND CARE
Authors: Anonymous
Published: April 2021

SENIOR CITIZENS
PSYCHIATRIC HOSPITALS
Authors: Anonymous
Published: April 2021

NAPPH Guidelines
CATALOG AVAILABLE
Authors: Anonymous
Published: April 2021

MEDICAL/HEALTH FILMS
THE SUICIDAL PHONE CALL
Authors: Neville Doreen , Barnes Sharon
Published: April 2021

When responding to suicidal threats, there are some basic differences between face-to-face counselling and telephone counselling. But, several tried-and-true approaches for assessing and responding to suicidal threats in face-to-face situations can also be useful to telephone counsellors.
Overcoming Eating Disorders
Authors: Edmands Margaret Sutton
Published: April 2021

A Group Experience
Characteristics of Restrictiveness
Authors: Garritson Susan Hunn
Published: April 2021

Confining assessment only to physical items ignores the less tangible social and psychological stimuli
Humor in Nursing
Authors: Ferguson Stephanie , Campinha-Bacote Josepha
Published: April 2021

Did you hear the one about . . . ?
The View From Within: HOW PATIENTS PERCEIVE THE SECLUSION PROCESS
Authors: Norris Marilyn K , Kennedy Carol W
Published: April 2021

Perceptions influence feelings and feelings influence behavior.
Images & Relationships FORGED IN WAR
Authors: Scannell-Desch Elizabeth A
Published: April 2021

A Study of Women Nurses Who Served in Vietnam
Trichotillomania: An Overview and Guide to UNDERSTANDING
Authors: Enos Stephanie , Plante Thomas
Published: April 2021

ABSTRACT

Trichotillomania presents challenges to clinicians in various areas including assessment, treatment, and research. Characterized by an irresistible urge to pull out one's hair, which is preceded by tension and followed by relief or pleasure, trichotillomania can cause significant impairment and distress to those who suffer from it. Possible hypothesized causes include a biological basis for hair-pulling, as well as pulling in response to stressors in life.

Several assessment techniques to measure the severity of trichotillomania exist, each of which has advantages and disadvantages in establishing a diagnosis. Because it is still a relatively poorly understood disorder, treatment options for patients reporting these behaviors are limited and generally are confined to pharmacological therapy and habit-reversal behavior therapy. Mansueto, Stemberger, Thomas, and Golomb have published a compelling comprehensive behavioral model that attempts to explain the various cues and factors in trichotillomania. It is useful to consider trichotillomania a biological, psychological, and social phenomenon requiring further research regarding the interaction of these variables in advancing the understanding of the disorder.
College Students and Tattoos: Influence of Image, Identity, Family, and Friends
Authors: Armstrong Myrna L , Owen Donna C , Roberts Alden E , Koch Jerome R
Published: April 2021

ABSTRACT

Tattoos are popular among many groups of people. College students from a large university in the southwestern United States were queried using the 134-item Armstrong Team Tattoo Attitude Survey. Findings document a progressive increase in tattooing and reflect significant support for tattoos, even from non-tattooed students. Similar and positive demographic characteristics were present in individuals who were both non-tattooed and tattooed. In addition, tattooed people were viewed positively, even among non-tattooed respondents. Friends significantly affected procurement and possession of tattoos, whereas of all family members, the sister was the only significant influence. Overall, friends, identity, and image seem to be the major influences for obtaining tattoos.
Laser Welding of Synthetic Epikeratoplasty Lenticules to the Cornea
Authors: Gailitis Ray P , Thompson Keith P , Ren Qiushi , Morris Jim , Waring George O
Published: April 2021

ABSTRACT: We used a milliwatt continuous wave CO2 laser mounted on an operating microscope to study the feasibility of welding synthetic collagen epikeratoplasty lenticules to the cornea. In vitro studies and experimentation in rabbits and monkeys showed no welding effects using direct laser radiation with powers ranging from 17 mW to 1 W. Only tissue shrinkage was observed. Experiments using various adjunctive solders produced a temporary welding effect using 30% bovine serum albumin welded with a power of 35-45 mW, 325 urn spot size, moving the beam 5 mm/sec. The lenticules remained in place until the 4th postoperative day when epithelium grew underneath the lenticule, dislodging it. Histopathologic examination demonstrated epithelial migration over the solder displacing the epikeratoplasty lenticule and anterior stromal denaturization and disruption. [Refract /ve and Cornea/ Surgery 1990;6:430-436.]
Effect of Corneal Hydration on Goldmann Applanation Tonometry and Corneal Topography
Authors: Simon Gabriel , Small Robert H , Ren Qiushi , Parel Jean-Marie
Published: April 2021

ABSTRACT

BACKGROUND: Measured ocular tension is reported to be positively related to corneal thickness. It has been speculated that an edematous cornea will cause low measurements. We studied the effects of corneal hydration on applanation tonometry and biomechanical behavior of the cornea.

METHODS: This study examines the effects of corneal hydration on applanation tonometry on four human cadaver eyes with the Goldmann Schmidt tonometer and on one cadaver eye with the Tono-Pen 2. Hydration was controlled osmotically and assessed by ultrasonic pachometry. True intraocular pressure (IOP) was controlled and was measured by a piezoelectric pressure transducer. The effect of hydration and IOP on anterior curvature was also assessed with computer topography.

RESULTS: The results of this study show an inverse relationship between corneal hydration and ocular tension measured with applanation tonometry. The Goldmann readings decreased by 9.2 ±0.7 mm Hg as the cornea is taken from minimum to maximum hydration. Anterior curvature was affected very little by hydration or increased IOP.

CONCLUSIONS: This study has shown, in vitro, that the tonometer readings are inversely related to its thickness when the cornea is edematous. The clinical implication is that when performing applanation tonometry, the hydration status of the cornea must be carefully examined to avoid possible diagnostic error. Refract Corneal Surg 1993;9:1 10117.)

RÉSUMÉ

INTRODUCTION: On dit que la pression intraoculaire est liée positivement à l'épaisseur cornéenne. On a supposé que l'oedème corneen entraine des mesures basses. Nous avons étudié les effets de l'hydratation cornéenne sur la fonometrie à l'aplanation et sur le fonctionnement biomécanique corneen.

MÉTHODES: Nous avons examiné les effets de l'hydratation cornéenne sur la pression intraoculaire mesurée dans le cas des yeux cadavériques humains en utilisant le tonomètre selon Goldmann Schmidt et dans le cas d'un oeil en utilisant le Tono-Pen 2. L'hydratation fut contrôlée osmotiquement et mesuré par un pachomètre ultrasonique. La vrai pression infraocutaire fut contrôlée et mesurée par un transducteur piézoélectrique. L'effet de l'hydratation et de la pression intraoculaire sur la courbure antérieure fut mesuré avec la cornéotopographie.

RÉSULTATS: Les résultats nous montrent un rapport inverse entre l'hydratation cornéenne et la pression intraoculaire mesuré par le tonomètre à l'aplanation. les mesures d'aplanation diminuaient par 9,2 ± 0,7 mm Hg pendant que la cornée fut hydratée du minimum au maximum. La courbure antérieure fut très peu changée par l'hydratation ou l'hypertonie.
Effect of Refractive Surgery Experience on Outcomes after Photorefractive Keratectomy
Authors: Dougherty Paul J , Lindstrom Richard L , Hardten David R
Published: April 2021

ABSTRACT

BACKGROUND: Excimer laser photorefractive keratectomy is effective in the treatment of myopia. It is unclear whether the refractive and ocular surgical experience of the surgeon influences outcome.

METHODS: Photorefractive keratectomy was performed on 131 consecutive myopic eyes by one experienced refractive surgeon and on 428 consecutive myopic eyes by six other less experienced surgeons. Outcome data were compared between groups.

RESULTS: The mean preoperative spherical equivalent was -5.76 ± 2.43 diopters (D) in the single surgeon group and -5.36 ± 2.34 D in the multiple surgeon group. Follow-up of 6 months was available on 109 eyes (83%) in the single surgeon group and 289 eyes (68%) in the multiple surgeon group. At 6 months, the average residual refractive error was ±0.15 db 1.13 D in the single-surgeon group and +0.21 ±1.15 D in the multiple surgeon group. This difference was not statistically significant (p=0.68). Correction within 1 D of attempted correction was obtained in 76 eyes (70%) in the single surgeon group and in 223 eyes (77%) in the multiple surgeon group. Uncorrected visual acuity of 20/40 or better was achieved in 89 eyes (82%) in the single surgeon group and 253 eyes (88%) in the multiple surgeon group.

CONCLUSION: Refractive and visual acuity outcomes after photorefractive keratectomy are influenced minimally by the refractive surgical experience of the surgeon. [J Refractive Surg 1997;13:3339]
Effect of Variations in Surgical Technique and Patient Management on Outcomes of Photorefractive Keratectomy
Authors: McCarty Catherine A , Aldred G F , Couper T , Taylor H R
Published: April 2021

ABSTRACT

PURPOSE: To describe variation in surgical and patient management and to assess their effect on 12-month outcomes of photorefractive keratectomy (PRK).

METHODS: The following variations in surgical/patient management related to PRK were observed and assessed: treatment based on cycloplegic refraction, administration of anesthesia, marking of visual axis, diameter of zone marker, method of epithelial removal, use of intraoperative artificial tears, type of fixation during surgery, replacement of epithelium after surgery, use of a bandage contact lens or two pressure patches, and use of topical nonsteroidal antiinflammatory drugs after surgery. The outcomes assessed were spherical equivalent manifest refraction, spectacle-corrected visual acuity and uncorrected visual acuity.

RESULTS: One year clinical outcomes were assessed prospectively for a group of 645 eyes that underwent PRK or photoastigmatic keratectomy. Spherical equivalent refraction and uncorrected visual acuity were better with decreasing amounts of preoperative myopia (both F>30.0, both p=0.0001). Although some surgical variations produced statistically significantly better uncorrected visual acuity on univariate analyses, none of the variations in the techniques assessed were found to be statistically significantly related to clinical outcomes after controlling for preoperative spherical equivalent refraction (all F<2.5, all p>0.10). None of the surgical variations were associated with loss of spectacle-corrected visual acuity (all p>0.10).

CONCLUSION: Clinical outcomes of PRK were not significantly affected by minor variations in clinical and surgical practice. [J Refract Surg 1997;13:55-59]
Ultrasound Biomicroscopy of Baikoff Anterior Chamber Phakic Intraocular Lenses
Authors: Saragoussi Jean-Jacques , Puech Michel , Assouline Michaël , Berges Olivier , Renard Gilles , Pouliquen Yves J M
Published: April 2021

ABSTRACT

BACKGROUND: The purpose of the study was to analyze qualitatively and quantitatively anatomic relationships of anterior chamber Baikoff phakic intraocular lenses (IOL) to the cornea, angle, iris, and lens in myopic eyes.

METHODS: Thirteen phakic myopic eyes (-9.00 to -15.00 diopters) corrected by minus power, anglesupported, anterior chamber intraocular lenses of the ZB5M style (Chiron-Domilens), with a mean follow-up of 25 months (range 18 to 36 months), were examined clinically and by ultrasound biomicroscopy.

RESULTS: The mean distance (±SD) between the central cornea and the IOL was 2.05 ± 0.18 mm (range 1.8 to 2.47 mm); mean distance between the corneal periphery and the IOL was 1.56 ± 0.17 mm (range 1.33 to 1.95 mm); and the mean distance between the IOL and the lens was 0.58 ± 0.12 mm (range 0.48 to 0.81 mm). IOL footplates seemed to be correctly positioned in the angle in all eyes. We observed no goniosynechiae. In six eyes, we found localized posterior indentation of the iris caused by the haptics. Four of these six eyes exhibited oval pupils associated with an oversized IOL.

CONCLUSIONS: High frequency ultrasound biomicroscopy can define anatomic relationships of anterior chamber phakic IOLs, and help analyze the mechanisms of corneal and iris complications. [J Refract Surg 1997;13:135-141]
Molecular Cell Biology for the Refractive Corneal Surgeon: Programmed Cell Death and Wound Healing
Authors: Wilson Steven E
Published: April 2021

ABSTRACT

BACKGROUND: Variability of outcome following refractive surgical procedures is affected by corneal wound healing. Interactions between the corneal epithelium and stromal keratocytes affect both stromal remodeling and healing of the epithelium. These processes contribute to regression of initial effect, surface irregularity, and stromal scarring that occur following excimer laser photorefractive keratectomy (PRK). I review recent discoveries related to stromal-epithelial molecular interactions that provide insights into the cellular responses to refractive surgical procedures.

RESULTS: Injury to the corneal epithelium stimulates programmed cell death (apoptosis) of the underlying anterior stromal keratocytes. I hypothesize that apoptosis of the keratocytes occurring immediately after epithelial injury associated with refractive surgical procedures initiates the subsequent wound healing response. Activated keratocytes subsequently repopulate the anterior corneal stroma where they produce collagen and other components associated with stromal remodeling. In addition, secretion of hepatocyte growth factor and keratinocyte growth factor by keratocytes increases after corneal epithelial wounding and these growth factors stimulate proliferation and inhibit differentiation of epithelial cells, effects which could promote epithelial hyperplasia associated with regression after photorefractive keratectomy.

CONCLUSION: Corneal stromal-epithelial interactions help explain the different results that occur following excimer laser photorefractive keratectomy and laser in situ keratomileusis. [J Refract Surg 1997;13:171-175]
Age-related Refractive Shifts in Simple Myopia
Authors: Ellingsen Karen L , Nizam Azhar , Ellingsen Bruce A , Lynn Michael J
Published: April 2021

ABSTRACT

BACKGROUND: An understanding of physiologic age-related shifts in myopic refractive errors is important to the refractive surgeon for the interpretation of long-term results, surgical planning, and patient counseling. This study characterizes the refractive stability of adult simple myopia with a retrospective study of 413 eyes.

METHODS: Approximately 74,000 patient records were analyzed to identify 208 adults with - 1.00 to -6.00 diopters (D) of myopia who were followed for more than 20 years at the Spokane Eye Clinic. Amounts of myopic shift (increase in myopia) and hyperopic shift (decrease in myopia) were identified and analyzed within the population. The results were compared to long-term studies of radial keratotomy.

RESULTS: The mean changes per patient age decade were: 20s, -0.60 D; 30s, -0.39 D; 40s, -0.29 D; 50s, +0.28 D; 60s, +0.41 D. Reanalyzed Prospective Evaluation of Radial Keratotomy (PERK) study 10year postoperative data demonstrated progressively increasing hyperopic shifts per decade, at least to age 50.

CONCLUSION: The normal adult population with simple myopia differs from the general population and consists of a population subgroup that is relatively stable and other subgroups that experience significant refractive shift. The hyperopic shift after radial keratotomy appears to be surgically induced and may be larger than previously thought. [J Refract Surg 1997,13:223-228]
Corneal Optical Aberrations Induced by Photorefractive Keratectomy
Authors: Oliver Katherine M , Hemenger Richard P , Corbett Melanie C , O'Brart David P S , Verma Seema , Marshall John , Tomlinson Alan
Published: April 2021

ABSTRACT

BACKGROUND: Photorefractive keratectomy causee marked alteration to anterior corneal topography, and is likely to induce major changes to the optical aberrations of the eye.

METHODS: Six diopters (D) of myopia correction was attempted on one eye of 50 patients, randomly allocated to one of three different treatments: 5-mm or 6-mm single ablation zone, or a double ablation (multizone; -5.00 D correction over 4.6 mm and -1.00 D over 6 mm). Topographic data was used to estimate corneal aberration coefficients. These were compared for effect of ablation zone, before and 1 year after photorefractive keratectomy. The coefficients were used to derive modulation transfer functions for the anterior corneal surface.

RESULTS: Corneal spherical aberrations and coma-like aberrations both increased significantly following photorefractive keratectomy (p < 0.001). The mean spherical aberration coefficient increased from 0.36 ±0.11 before, to 0.91 ± 0.37 after treatment, while the mean coma-like aberration coefficient changed from 0.28 ± 0.16 before, to 0.60 ± 0.31 after treatment. Ablation zone form had a significant effect on spherical aberration (p = 0.030), but not for coma (p = 0.96). The spherical aberration coefficient increased least for the 6-mm ablation (by 0.38 ± 0.17), compared with the 5-mm ablation (0.69 ± 0.45) and the multizone (0.62 ± 0.38). Corneal modulation transfer functions were reduced significantly following the photorefractive procedure. The effect was greatest for large pupil diameters and for spatial frequencies between 2 and 15 cycles per degree.

CONCLUSIONS: Corneal modulation transfer function calculations suggest that a significant loss of visual performance should be anticipated following photorefractive keratectomy, the effect being greatest for large pupil diameters. Results for three ablation zones show that induced aberrations are least for the largest (6 mm) ablation zone. [J Refract Surg 1997;13:246-254]
Topical Diclofenac Sodium after Excimer Laser Phototherapeutic Keratectomy
Authors: Förster Werner , Ratkay Imola , Krueger Ronald , Busse Holger
Published: April 2021

ABSTRACT

BACKGROUND: Both the potential analgesic effects and side-effects of topical diclofenac sodium 0.1% are points of interest after excimer laser phototherapeutic keratectomy.

METHODS: Excimer laser phototherapeutic keratectomy was performed in 134 eyes of 134 patients. In 65 eyes (65 patients), the effects of topical diclofenac given three times a day for 3 to 4 days were compared to a control group of 69 eyes (69 patients). All patients received paracetamol for systemic analgesia and were patched after surgery until reepithelialization.

RESULTS: Twenty-eight patients (43%) of the diclofenac group needed additional systemic analgesics compared to 67 patients (95%) in the control group. Seventy-two hours after surgery we found no significant differences in corneal epithelial wound healing and no severe complications.

CONCLUSION: Topical diclofenac sodium reduces postoperative pain in patients after phototherapeutic keratectomy. [J Refract Surg 1996;13:311-313]
Traumatic Aphakia Treated with an Iris Prosthesis/Intraocular Lens or Epikeratophakia
Authors: Uusitalo Risto J , Uusitalo Hannu M
Published: April 2021

ABSTRACT

OBJECTIVE: We retrospectively analyzed the visual results and postoperative complications associated with severely traumatized eyes in which aphakia was corrected with epikeratophakia or a sutured iris prosthesis/intraocular lens (IOL).

METHODS: Fourteen eyes (14 patients) with traumatic aphakia and severe anterior segment complications were corrected either with epikeratophakia or a sutured iris prosthesis/IOL. AU eyes lacked lens capsule or iris support for an IOL. The surgical technique of implanting an iris prosthesis/IOL employed transcleral suturing in the ciliary sulcus combined with penetrating keratoplasty.

RESULTS: In the eight eyes treated with epikeratophakia, four (50%) had spectacle-corrected visual acuity of 20/40 or better. Almost all of these eyes lost one or two Snellen lines of baseline spectacle-corrected visual acuity. .Few complications occurred after epikeratophakia; none were severe. Of six eyes with penetrating keratoplasty and a sutured iris prosthesis/IOL or a sutured posterior chamber IOL, two (33%) achieved a visual acuity of 20/40 or better. In the IOL group, severe complications occurred, including posterior dislocation of the lens and secondary glaucoma.

CONCLUSIONS: The surgical correction of aphakia in severely traumatized eyes requires specialized surgical techniques. Epikeratophakia is a low-risk operation that can be performed in eyes in which an IOL is contraindicated. The iris prosthesis/IOL technique results in good cosmetic results; however, due to complications, this technique should be used with caution. [J Refract Surg 1997;13:382-387]
Laser in situ Keratomileusis for Myopia of -1 to -3.50 Diopters
Authors: Pirzada W A , Kalaawry Hassan
Published: April 2021

ABSTRACT

BACKGROUND: Laser in situ keratomileusis (LASIK) is the procedure of choice for high myopia. We present a study of 85 eyes undergoing LASIK for myopia between -1.00 and -3.50 diopters (D) and assess the safety and efficacy of the procedure for treatment of low myopia.

METHODS: Eighty-five eyes of 47 patients with a mean age of 29 years, (range, 18 to 56 yrs) underwent LASDX using the Chiron microkeratome and the Nidek EC-5000 excimer laser. Mean preoperative myopia was -2.09 D and mean astigmatism was 0.86 D. All other ocular pathology was ruled out before surgery. Mean follow-up was 48 days (range, 1 day to 13 mo).

RESULTS: Uncorrected visual acuity of 6/9 or better at 1 week was achieved in 44 eyes (52%); at 1 month in 68 eyes (80%); and at 6 months in 70 eyes (93%). Pain score was minimal with the majority of patients having no postoperative pain. One eye suffered a serious postoperative complication of corneal abscess which resolved with treatment, but left a corneal scar and visual acuity of 6/60.

CONCLUSION: LASDX is a safe and effective procedure for low amounts of myopia; it also provides early visual rehabilitation and markedly reduced pain and discomfort to patients undergoing refractive surgery. [J Refract Surg 1997;13(suppl):S425S426]
Treatment of Irregular Astigmatism with a Broad Beam Excimer Laser
Authors: Buzard Kurt A , Fundingsland Bradley R
Published: April 2021

ABSTRACT

BACKGROUND: Four basic types of irregular astigmatism are described: central elevation, central flat area, eccentric elevation, and eccentric flat area.

METHODS: The importance of the Munnerlyn formula is shown for the treatment of irregular astigmatism. A new diagnostic entity is described, the steep/flat ratio, modeled on the inferior/superior ratio described previously in keratoconus. Calculation of the steep/flat ratio is described using the cross sectional view of videokeratography, leading to specific treatments for the four types of irregular astigmatism. Surgical technique using the VISX Star excimer laser for repeated laser in situ keratomileusis (LASDÎ) is described.

RESULTS: Case studies are given for each of the forms of irregular astigmatism showing improved topographic appearance and indicating treatment parameters. In each case, improvement of both uncorrected and spectacle-corrected visual acuity is demonstrated.

CONCLUSIONS: Irregular astigmatism is an important complication of refractive surgery. Four basic forms of irregular astigmatism can be treated with a broad beam excimer laser. [J Refract Surg 1997;13:624-636]
Comparison of Laser in situ Keratomileusis and Automated Lamellar Keratoplasty for the Treatment of Myopia
Authors: Esquenazi Salomon
Published: April 2021

ABSTRACT

BACKGROUND: Automated lamellar keratoplasty (ALK) and laser in situ keratomileusis (LASIK) are surgical procedures used to correct high myopia, although their differences in effectiveness and long-term stability have not been sufficiently documented. Little information exists about the results of the two procedures in the hands of the same surgeon.

METHODS: To assess long-term stability of refractive results of ALK and LASEK, a retrospective study of 260 eyes that received ALK and 308 eyes that received LASBK was undertaken. The mean followup was 1.8 years for ALK and 1.4 years for LASEK.

RESULTS: The mean baseline spherical equivalent refraction in ALK eyes was -14.30 ± 2.05 D (range -5 to -25 D) and in LASDK eyes was -8.50 ± 1.75 D (range -3 to -26 D). At 3 months after surgery, 65 ALK eyes (25%) were within ±1.00 D of intended correction compared with 269 LASEK eyes (87.5%). At 1 year, only 31 ALK eyes (16%) were within ±1.00 D of intended correction, compared with 224 eyes (82%) in the LASEK group. At 3 months after surgery, the mean spherical equivalent refraction was -2.64 D in ALK eyes; at 1 year it was -4.60 D, and at 2 years it increased to -5.50 D. In contrast, the mean spherical equivalent refraction in the LASIK eyes at 3 months after surgery was -0.22 D and remained nearly stable until 1.5 years after surgery, when it was -0.50 D. More regression occurred when a large amount of corneal stromal tissue was removed. One out of four eyes that had more than 25% of its corneal tissue removed lost correction after 6 months for both ALK and LASIK. No ALK or LASEK eyes with a remaining corneal thickness of 310 µm or more had regression of the refractive result after 6 months.

CONCLUSIONS: Both ALK and LASIK can reduce moderate and high myopia. The safety and longterm stability of LASIK is better than that for ALK. Although both procedures take advantage of lamellar keratoplasty techniques, the LASEK technique minimizes the depth of ablation while maximizing optical zone size which results in more accurate correction and better long-term stability, the latter depending primarily on the amount of corneal stromal tissue removed. [J Refract Surg 1997;13:637-643]
Accuracy of Topcon CM-1000 Videokeratoscope on Spherical Test Surfaces
Authors: Pérez-Yern Elías , Fimia-Gil Antonio , Mateos Felipe , Carretero Luis
Published: April 2021

ABSTRACT

BACKGROUND: Many videokeratoscopes use mathematical formulas to calculate corneal radii; calculations depend on slope, curvature, coordinate position, or focal properties of the surface. Accuracy of each type of videokeratoscope must be evaluated. A controversy exists about whether axial or tangential methods best provide a precise description of corneal shape; therefore results with the Topcon CM-1000 using both methods were evaluated.

METHODS: Measurements were done on black polymethylmethacrylate (PMMA) spherical calibrated surfaces. Lenses were first aligned and measured and then misaligned in different directions and measured. Results for each position were compared with the zero or alignment position.

RESULTS: Accuracy of the CM-1000 was high even under extreme misalignment conditions. Tolerance to misalignment was high (about 300 mm). Misalignment-induced variations in the output results were small (usually less than 0.05 mm). However, important variations (more than 1.00 diopter [D]) were found for the lowest measured radius (6 mm). In some cases, small differences between axial and tangential radii for the same point could be found.

CONCLUSION: With the exception of extremely low radii of curvature, the CM-1000 was accurate for measuring spherical surfaces. Further investigation remains to be done on aspheric surfaces and in clinical practice. [J Refract Surg 1997;13:663-6681
Bivariate Polar Value Analysis of Surgically Induced Astigmatism
Authors: Naeser Kristian , Knudsen Ellen Birthe , Hansen Mette Kaas
Published: April 2021

ABSTRACT

PURPOSE: To demonstrate the use of bivariate polar value analysis of surgically induced astigmatism following various cataract incisions.

METHODS: In a prospective study, we investigated surgically induced astigmatism following cataract surgery through 9.0-mm, 5.5-mm, and 4.0-mm superior corneal incisions. Autokeratometry was performed preoperatively and during the first year. All net astigmatisms were converted to polar values with reference to the 90? meridian. Univariate and bivariate polar value analyses were performed.

RESULTS: After 1 year, univariate polar value analysis disclosed flattening averaging 1.02 D for 9.0-mm incisions, 0.71 D for 5.5-mm incisions, and 0.64 D for 4.0-mm incisions. The induced torque was 0.46 D counterclockwise for the 9-mm incision and close to zero for the 5.5 and 4-mm incisions. Bivariate polar value analysis disclosed a statistically significant (P<.05) difference in surgically induced astigmatism between the 9.0-mm incisions and the two smaller incisions at all follow-up points.

CONCLUSION: Univariate polar value analysis demonstrated the surgically induced steepening and torque. Bivariate analysis demonstrated the joint variation in these entities and therefore always yielded the correct result. Univariate and bivariate polar values may be used for analysis of surgically induced astigmatism following cataract surgery in any meridian. [J Refract Surg 2002;18: 72-78]
Laser in situ Keratomileusis for Correction of Hyperopia and Hyperopic Astigmatism With the Technolas 117C
Authors: Lian Jingcai , Ye Wen , Zhou Deyou , Wang Kangsun
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correction of hyperopia and hyperopic astigmatism.

METHODS: Fifty-four hyperopic eyes of 35 patients with a spherical equivalent refraction between +1.00 and +6.00 D were followed for at least 12 months following LASLK. AU surgery was performed with the scanning Chiron Technolas Keracor 117C excimer laser. Data on uncorrected and spectacle-corrected visual acuity, predictability, stability of refraction, and complications were analyzed.

RESULTS: At 12 months, the average residual refraction was +0.29 ? 0.78 D; 83.3% of eyes (45 eyes) were in the range of ?1.00 D and 61.1% of eyes (33 eyes) were within ?0.50 D of emmetropia. Fifty eyes (92.6%) had uncorrected visual acuity of 20/40 or better and 34 (63.0%) eyes had 20/20 or better. One eye (1.9%) lost two lines of best spectaclecorrected visual acuity and two eyes (3.7%) gained two or more lines. Two patients (two eyes, 3.7%) had complaints of halos and one patient (one eye, 1.9%) had glare at 12 months after LASLK for hyperopia.

CONCLUSIONS: LASLK was used to treat hyperopia from +1.00 to +6.00 D with good predictability and safety. Primary and second hyperopia require different nomograms, according to our experience. [J Refract Surg 2002;18:435-438]
Factors That Affect Corneal Flap Thickness With the Hansatome Microkeratome
Authors: Gailitis Raymond P , Lagzdins Mara
Published: April 2021

ABSTRACT

PURPOSE: To evaluate factors that influence corneal flap thickness with the Hansatome microkeratome.

METHODS: One hundred thirty-two eyes of 70 patients underwent laser in situ keratomileusis (LASDX). Corneal flap thickness was measured by subtracting the intraoperative corneal bed pachymetry measurement from intraoperative total corneal pachymetry. Variables examined included plate thickness, ring size, blade use, temperature, humidity, barometric pressure, age, average keratometric power, and preoperative corneal thickness.

RESULTS: Mean flap thickness using a 180-jtm plate was 143 ? 19 /*m (range 61 to 207 /am). Mean flap thickness using a 160~/an plate was 119 ? 20 /an (range 83 to 159 ????). The difference was statistically significant (P<.05). Mean flap thickness using a 180-/im plate and the same blade on the right and left eye was 151 ? 21 ??\ (range 113 to 200 ?ta) and 137 ? 21 ?ta (range 91 to 191 ?ta), respectively. The 14-??? difference was statistically significant (P< .001). There was a slight negative correlation of flap thickness with humidity. There was a positive correlation with preoperative corneal thickness (pachymetry).

CONCLUSION: The Hansatome tended to cut thinner flaps than anticipated based on the plate used. Flaps cut on the first eye were thicker than the second eye using the same blade. Thicker corneas tended to lead to thicker flaps. There was no correlation between flap thickness and microkeratome ring size, temperature, barometric pressure, patient age, or average keratometric power. [J Refract Surg 2002;18:439-443]
Effect of Prophylactic Brimonidine or Bleeding Complications and Flap Adherence After Laser in situ Keratomileusis
Authors: Norden Richard A
Published: April 2021

ABSTRACT

PURPOSE: Several authors have assessed the effect of prophylactic briomonidine on bleeding complications and flap adherence after laser in situ keratomileusis (LASIK). This study further evaluates these potential associations.

METHODS: We performed a prospective, doublemasked, single-surgeon study of 31 patients (61 eyes) who underwent LASIK with or without prophylactic brimonidine for primary myopia/ myopic astigmatism (59 eyes) or hyperopic astigmatism (2 eyes). Among myopes, mean preoperative sphere was -4.44 ± 2.21 D and mean cylinder was -1.04 ± 1.01 D. Thirty-three eyes (54%) had nasal hinges; 28 eyes (46%) had superior hinges.

RESULTS: Subconjunctival hemorrhage was observed in 22 of 61 eyes (36.1%). Three of these 22 eyes (13.6%) received prophylactic brimonidine; the remaining 19 eyes with subconjunctival hemorrhage (86.3%) did not receive brimonidine (P<0001). All but three eyes had some hyperemia; however, the amount of hyperemia was lower in the brimonidine group (P<.0001). Bleeding from the superior micropannus occurred in four of 61 eyes (6.6%). One of these four eyes received brimonidine. There was one case of flap slippage in a nonbrimonidine eye with a nasal hinge; no flap striae were observed after repositioning.

CONCLUSION: This study suggests that brimonidine administered before LASIK may significantly reduce subconjunctival hemorrhage and reduce the amount of hyperemia. [J Refract Surg 2002;18:468-471]
A New Intraocular Lens Design to Reduce Spherical Aberration of Pseudophakic Eyes
Authors: Holladay Jack T , Piers Patricia A , Koranyi Gabor , van der Mooren Marrie , Norrby N E Sverker
Published: April 2021

ABSTRACT

PURPOSE: The aim of this study was to design and evaluate in the laboratory a new intraocular lena (IOL) intended to provide superior octtlar optical quality by reducing spherical aberration.

METHODS: Corneal topography measurements were performed on 71 cataract patients using an Orbscan I. The measured corneal surface shapes were used to determine the wavefront aberration of each cornea. A model cornea was then designed to reproduce the measured average spherical aberration. This model cornea was used to design IOLs having a fixed amount of negative spherical aberration that partially compensates for the average positive spherical aberration of the cornea. Theoretical and physical eye models were used to assess the expected improvement in optical quality of an eye implanted with this lens.

RESULTS: Measurements of optical quality provided evidence that if this modified prolate IOL was centered within 0.4 mm and tilted less than 7 degrees, it would exceed the optical performance of a conventional spherical IOL. This improvement occurred without an apparent loss in depth of focus.

CONCLUSION: A new IOL with a prolate anterior surface, designed to partially compensate for the average spherical aberration of the cornea, is intended to improve the ocular optical quality of Pseudophakie patients. [J Refract Surg 2002;18: 683-691]
Prospective Randomized Trial of an Anterior Surface Modified Prolate Intraocular Lens
Authors: Packer Mark , Fine I Howard , Hoffman Richard S , Piers Patricia A
Published: April 2021

ABSTRACT

PURPOSE: We compare the contrast sensitivity obtained with an anterior surface modified prolate intraocular lens with the contrast sensitivity obtained with a standard spherical intraocular lens.

METHODS: Patients presenting for cataract surgery in one eye were randomized to receive either the Tecnis Z9000 intraocular lens (Pharmacia) or the AMO AR40e Opti-Edge intraocular lens (AMO). Sine wave grating contrast sensitivity testing under mesopic and photopic conditions served as the principal outcome measure.

RESULTS: The Tecnis Z9000 intraocular lens provided statistically significantly better contrast sensitivity at 1.5 and 3 cycles per degreee under mesopic conditions and at 6, 12 and 18 cycles per degree under photopic conditions.

CONCLUSION: The use of a modified prolate intraocular lens during cataract surgery has the potential to improve contrast sensitivity under both mesopic and photopic conditions. [J Refract Surg 2002;18:692-696]
Retinal Detachment in Myopic Eyes After Laser in situ Keratomileusis
Authors: Arevalo J Fernando , Ramirez Ernesto , Suarez Enrique , Cortez Rafael , Ramirez Gema , Yepez Juan B
Published: April 2021

ABSTRACT

PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK).

METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery).

RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASLK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASLK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract.

CONCLUSIONS: Rhegmatogenous retinal detachment after LASLK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair. [J Refract Surg 2002;18:708-714]