bluuebunny/crossref_metadata_2025 huggingface dataset:
changes in attitudes about mental illness among nursing students following a psychiatric affiliation
Authors: Creech Stephen K
Published: April 2021

ABSTRACT

The purpose of this study was to determine changes in nursing students' attitudes about mental illness following a twelve-week psychiatric affiliation program in a state mental hospital. Data were collected by means of two combined opinions about mental illness scales - Cohen and Struening's factor analytically-derived Opinions About Mental Illness (OMI) questionnaire and Ellsworth's empirically-derived Opinions About Mental illness Scale. The sample consisted of 95 student nurses from three diploma schools of nursing. The subjects were administered the instrument at the beginning and end of their psychiatric affiliation. Following the affiliation, student nurses' attitudes about mental illness changed significantly in a favorable direction on the following attitudinal dimensions: Authoritarianism, Mental Hygiene Ideology, Social Res trie tiveness, Interpersonal Etiology, Non traditionalism, and Restrictive Control. Although significant changes were not found on Benevolence and Protective Benevolence, there was a trend toward favorable changes on both attitudinal dimensions.
Identification of Typologies Derived from Child Behaviors in the Hospital as Predictors of Psychological Upset
Authors: Cormier Patricia P
Published: April 2021

ABSTRACT

This study proposed to measure objectively the behaviors of children in the hospital setting in order to combine the data on the particular aspects of behaviors or symptoms into global measures or typologies of psychological upset. It attempts to offer a good, single measure for predicting behavior of children in psychological upset.

Thirty-one subjects in this study, observed in the hospital setting, are clustered together to identify typologies derived from child behaviors in the hospital. These children were divided into three factors which correspond with the three stages of hospitalization: Factor I typified Stage III - Denial; Factor II typified Stage II - Despair; and Factor III typified Stage I - Protest.

The study offers direction to objectively and systematically evaluate the effects of hospitalization on children. It also suggests that observational ratings of child behaviors in the hospital may be accurate predictors of the degree of psychological upset a child is experiencing at a certain point in time. It also has particular implications for strategies which hospital staff could employ when they observe particular stages that children manifest.
Identity Operations and Family Treatment
Authors: Lantz James E , Treece Nancy
Published: April 2021

ABSTRACT

This article outlines the concept of the identity operation and how family system processes and individual identity operations reciprocally interact within the family group. A case report illustrates use of the identity operations concept in family treatment, and demonstrates its usefulness to the clinical practitioner. The identity operations concept as a bridge between the understanding family and individual levels of human existence is explored.
YOUR CHANGING SENSES
Authors: Anonymous
Published: April 2021

AGING
Counseling the Infertile Couple
Authors: Frank Deborah I
Published: April 2021

Infertility affects an estimated one of six couples of childbearing age. The impact of psychological factors as primary causes of infertility has been extremely difficult to define and describe. It Is obvious, however, that undergoing evaluation and treatment for infertility precipitates a developmental crisis for the couple.
DEPENDENCE PROCESS
Authors: Anonymous
Published: April 2021

TOBACCO USE
The School Nurse's Dilemma
Authors: Anonymous
Published: April 2021

When a student's attempted suicide resulted in a suspension from school rather than a referral for psychological assessment, the school nurse recognized the need for consultation with a clinical specialist in psychiatric nursing.
PATTERNS OF BONDING
Authors: Anonymous
Published: April 2021

TWIN DEVELOPMENT
DEATH EDUCATION
Authors: Anonymous
Published: April 2021

CALL FOR
STRESS MANAGEMENT GROUPS
Authors: Griffin Wilma , Ling Irene , Staley Douglas
Published: April 2021

The Teaching and the Benefits of Group Relaxation Training in a Psychiatric Outpatient Setting
Suicide Risk Heightened for Abused Adolescents
Authors: Anonymous
Published: April 2021

Study Suggests History of Abuse as Marker for Suicidal Behavior
SERVICES for the UNDERSERVED: A Nurse-Managed Center for the Chronically Mentally Ill
Authors: Connolly Phyllis M
Published: April 2021

Changing the attitudes of professionals and motivating student interest toward the chronically mentally ill is imperative for meeting their needs.
Unmet Needs of Children: Families and Children Tell Stories at NIMH Hearings
Authors: Anonymous
Published: April 2021

Wishes for cures and hopes of putting an end to unbearable emotional turmoil were put forth at the second in a series of public hearings to enhance public awareness. "Child and Adolescent Mental Health Disorders," co-sponsored by National Mental Health Leadership Forum and the National Advisory Mental Health Council, featured moving testimony from children who suffer from mental disorders and from their parents.
Women Vietnam Veterans: A Comparison of Studies
Authors: Furey Joan A
Published: April 2021

Stressors ranked highest by the women included nursing duties and responsibilities, witnessing the mutilation of young bodies, negating their emotions , and supply shortages.
Institutional Transference: A New Look at an Old Concept
Authors: Gage Kay , Gillins Linda
Published: April 2021

When discussing previous therapists, David often lumped them into one image.
CE EXAM
Authors: Anonymous
Published: April 2021

Home Study Program
INSPIRING HOPE in the Oncology Patient
Authors: Poncar Patricia J
Published: April 2021

A cancer diagnosis evokes feelings of anxiety, fear, helplessness, depression, uncertainty and hopelessness as the person tries to grasp, the meaning of the disease. Cancer is generally seen as a life-threatening disease that creates a problematiriind foreboding fut ure.. Because some people do not have theresources to deal with all these feelings, the nursing intervention of "inspiring hope" must be considered.
Geropsychiatric Nursing: ESSENTIAL Curriculum Content
Authors: Hoeffer Beverly
Published: April 2021

This article delineates the essential curriculum content for geropsychiatric nursing. Although content at the baccalaureate and doctoral levels of education are addressed, the discussion focuses primarily on master's level curriculum content, because of the consensus that preparation for advanced practice in specialized areas of nursing occurs at this level.

Gerontologie and nursing literature is reviewed for suggested core content in geropsychiatric nursing at the graduate level, graduate programs offering geropsychiatric nursing are surveyed, and forces that shape the development of curricula in geropsychiatric nursing are identified.
Risperidone: Clinical Issues in Treatment
Authors: Littrell Kimberly , Schultz Richard E
Published: April 2021

On December 29, 1993, the Food And Drug Administration approved the new antipsychotic agent risperidone (Risperdal) for use in the United States. Risperidone is the first of a new class of antipsychotic agents known as serotonin/dopamine antagonists. It is only the second new antipsychotic medication to be introduced in this country during the past two decades. Early efficacy studies show that risperidone has marked superiority in reducing both positive and negative symptoms over placebos and haloperidol.

Risperidone does not produce the blood dyscrasias associated with clozapine and possesses a relatively dean adverse reaction profile. Maximum therapeutic responses have been observed with doses of 4 mg to 8 mg; higher dosages have resulted in extrapyramidal symptoms without added benefits.
Putting Feeding Back Into the Hands of Patients
Authors: Ford Ginger
Published: April 2021

At the Behavioral Health Unit of Baton Rouge General Medical Center, the author and registered dietitians of the Clinical Nutrition Department developed "utensil-less" diets for patients with acute psychiatric conditions.

Initially, the diet was developed for patients with dementia; however, the staff quickly realized that the diet would be appropriate for patients with many acute psychiatric disorders, or for those patients with physical limitations.

The "Dementia Diet" includes five nutritionally balanced, small meals each day, consisting of finger foods such as sandwiches, vegetable sticks, fruit slices, and other items that patients can eat on their own without feeding assistance or utensils (Figure).

After introducing the diet on the Behavioral Health Unit, the staff found that 7 of 10 patients on the diet improved their food intake and gained weight.

Not only were nutritional needs met, but mealtimes became more enjoyable for the patients, families, and staff (Table).

Unit safety advanced, and most importantly, quality of life and self-esteem were cultivated by helping adult patients regain some of their independence associated with meal times.
Health Education in Mental Health Services
Authors: Ravelli Anneloes , Donker Marianne C H , Geelen Karel
Published: April 2021

In the past few years, we have witnessed numerous efforts to develop health education in psychiatry. Many of them, however, were not successfully implemented. In the Netherlands, a health education method was developed in conjunction with seven mental health providers. The method promotes a more successful implementation.
College Students' AIDS Risk Perception
Authors: Brown Emma J
Published: April 2021

Students must perceive their risk of acquiring HIV before thinking they must alter their behavior. The purpose of this qualitative descriptive study was to describe college students' AIDS risk perceptions (ARP) for themselves, their friends, and their peers, and to describe their AIDS-related risk behavior. A self-selected sample of 40 students participated in in-depth interviews. Verbatim transcripts of audiotaped interviews were analyzed. Most students appraised their risk as "nil" or "small," their friends' risk similar to theirs, but their peers' risk as "great." Students "self-identified" certain sexual and drug-use practices as AIDS risks. Yet, they minimized the riskiness of their personal and their friends' behavior while maximizing the riskiness of their peers' behavior. Strategies are suggested to help students develop more realistic ARP.
Cognitive-Behavioral THERAPY
Authors: Romana Maria S
Published: April 2021

Treating Individuals with Dual Diagnoses

ABSTRACT

Because deinstitutionalization of individuals with mental retardation/developmental disability and mental illness has become the standard of practice, many practitioners are now faced with the challenge of serving the needs of this specialized population. The existence of mental illness in individuals with mental retardation has been well established in the literature, but there are relatively few studies involving therapeutic interventions in this client population. However, there is a theoretical framework that guides practice and measures the effectiveness of interventions with this specialized population.

This article presents a case study exploring the application of cognitive-behavioral therapy to a client with mental retardation and mental illness. The theoretical framework, major concepts, and key assumptions of the theory will be reviewed, as well as treatment outcomes.
As Good as It Gets?: Rethinking Old Age
Authors: Sorrell Jeanne M.
Published: April 2021

Although approximately half of aging Americans will probably not be able to live independently after retirement age, there is a greater focus on end-of-life matters, such as living wills, than on exploring creative long-term care models that promote healthy aging. With more Americans aging healthfully, now is the time to look at innovations in long-term care that will not only provide safe housing, but will also focus on the trajectory from healthy aging to end-oflife care, including health promotion and even reversal of disabilities incurred in the aging process. Nurses and other health care professionals need to rethink how those they care for will live out their later years and explore creative approaches for extending living options that foster autonomy.
Unusual Refractive Errors Induced by Interchanging Trephines During Penetrating Keratoplasty
Authors: Perlman Elliot M
Published: April 2021

ABSTRACT: In this article, a small series of cases is presented in which large refractive errors inadvertently result from a change In the brands of trephine used for corneal transplantations. From these experiences, it is evident that the corneal surgeon should be very cautious if he chooses to interchange various brands and types of trephines. [Refractive and Corneal Surgery 1989; 5:271-273.]
Myopic Keratomileusis: Short-Term Results
Authors: Barraquer Carmen , Gutierrez Angela M , Espinosa Alfredo
Published: April 2021

ABSTRACT: The first 97 eyes operated with keratomileusis by two surgeons starting to use this technique ore evaluated. The 30- and 90-day postoperative results of this initial experience are reported. Average preoperative myopia was -10.53 D spherical equivalent (range -5.25 to -22.25 D); average refractive correction at 90 days was -10.20 D. Preoperative visual acuities without correction were between 0.01 and 0.15 Snellen scale (20/2000 to 20/133), and 90 days postoperatively they varied between 0.02 and 0.60 Snellen scale (20/1000 to 20/33) with an average of 0.29 (20/69). Average preoperative visual acuity with correction was 0.70 Snellen scale (20/29), and 90 days afterward it was 0.60 Snellen scale (20/33). Preoperative average refractive cylinder was 1.33 D and postoperative was 1.86 D, showing that significant amounts of astigmatism were not induced. [Refractive and Corneal Surgery. 1989; 5:307-313].
The Corneal Topography of Epikeratophakia
Authors: Reidy James J , McDonald Marguerite B , Klyce Stephen D
Published: April 2021

ABSTRACT: Epikeratophakia is a surgical technique initially developed for the correction of aphakia, and later adapted for the correction of keratoconus and myopia. The concurrent development of colorcoded computerized corneal topography has greatly assisted in the evolution of epikeratophakia. Corneal topography has demonstrated the importance of both accurate centration of the epikeratophakia lenticle over the visual axis and the size of the optical zone on the final refractive results. Corneal topographic changes associated with correction of aphakia are primarily the result of steepening of the anterior radius of curvature of the cornea, in contrast to myopic correction which results in flattening of the anterior cornea. Correction of keratoconus results from a physical compression of the cone thereby flattening both the anterior and posterior radii of curvature. Preoperative topography in patients with keratoconus permits the precise position and extent of both regular and irregular astigmatism mation may assist in designing the optimal lenticle size and amount of graft decentration necessary to achieve the maximal surgical effect. Corneal topographic mapping has also been helpful in the management of postoperative astigmatism following epikeratophakia. Topography identifies the location and extent of both regular and irregular astigmatism which assists in planning of both surgical and nonsurgical intervention. Corneal topographic mapping has also been extremely helpful in the management of postoperative astigmatism following epikeratophakia. Topography identifies the location and extent of both regular and irregular astigmatism which assists in planning of both surgical and nonsurgical intervention [Refractive and Corneal Surgery 1990; 6:26-31]
The Importance of Pupil Size in Optical Quality Measurements Following Radial Keratotomy
Authors: Applegate Raymond A , Gansel Karlyn A
Published: April 2021

ABSTRACT: This review considers the importance of pupil size when specifying the optical quality or visual performance of eyes following radial keratotomy. The experimental evidence presented includes measurements both before and after radial keratotomy of the eye's: 1) corneal curvature; 2) optical aberrations; 3) modulation transfer function; 4) visual acuity as a function of test beam entry; and 5) disability glare. Together these five lines of evidence demonstrate that pupil size is a key factor influencing both the optical quality of the eye and visual performance. [Refractive and Corneal Surgery 1990;6:47-54]
Contrast Sensitivity Under Photopic Conditions in the Prospective Evaluation of Radial Keratotomy (PERK) Study
Authors: Ginsburg Arthur P , Waring George O , Steinberg Eugene B , Williams Patricia A , Justin Norma , Deitz Jan Reinig , Roszka-Duggan Vicki K , Baluvelt Ken , Bourque Linda
Published: April 2021

ABSTRACT: We studied the effect of radial keratotomy on contrast sensitivity in 69 individuals with one eye operated and one eye unoperated in the Prospective Evaluation of Radial Keratotomy (PERK) Study, with a mean follow-up time of 13.8 months (range 6 months to 31 months). We tested contrast sensitivity under normal daylight conditions using both photographic plates and a computer-video apparatus. On average, we found no clinically meaningful loss of contrast sensitivity in eyes after radial keratotomy. However, eyes with radial keratotomy showed a statistically significant decrease in contrast sensitivity at the higher spatial frequencies of 12 and 18 cycles per degree, although all values were within the previously established normal range. Specifically, 44% of the patients had approximately the same contrast sensitivity in both eyes; 40% of the patients had 50% less contrast sensitivity in the operated eye than in the unoperated eye; 16% of the patients had 50% more contrast sensitivity in the operated eye than in the unoperated eye. Contrast sensitivity improved gradually in operated eyes between 6 months and 2 years after surgery Eyes with radial keratotomy, in which the diameter of the pupil was the same size as or larger than the central clear zone, had slightly decreased contrast sensitivity compared to eyes in which the pupil was smaller than the clear zone. [Refractive and Corneal Surge/y1990; 6:82-91.]
Epikeratophakia for the Correction of Myopia: Lenticule Design and Related Histopathological Findings
Authors: Cusumano Andrea , Busin Massimo , Spitznas Manfred , Koch Frank
Published: April 2021

ABSTRACT: In spite of the numerous changes in surgical technique, epikeratophakia for the correction of myopia is still far from achieving optimal results. The removal rate of myopic lenticules is much higher than that of aphakic or keratoconus lenticules and has prompted the FDA to deny its approval to the industrial production of epi-lenses for the correction of myopia. We report a patient who underwent epikeratophakia for the correction of high myopia in his left eye and required removal of the lenticule because of unsatisfactory visual outcome. The histologic and electron microscopic examination of the removed lenticule revealed the presence of folds in both Bowman's layer and superficial stroma. These had been described in the past and related to the surgical technique used at that time; they were thought to be the cause of poor visual acuity in two patients, and had prompted, therefore, a change in surgical technique. Our findings suggest that the present lenticule design could be responsible for the presence of folds and the consequent poor visual result. [Refractive and Corneal Surgery 1990; 6:120-124.]
Refractive Versus Keratometric Astigmatism Postkeratoplasty
Authors: Judge David , Gordon Lance , Vander Zwaag Roger , Wood Thomas O
Published: April 2021

ABSTRACT: In patients who had undergone penetrating keratoplasty, we compared the relationship between keratometric astigmatism and actual refractive cylinder required for visual correction in 115 eyes postoperatively. The average time from surgery to refraction was 49.5 months and from surgery to keratometry 50.3 months. Sixty-five eyes retaining their running 10-0 nylon sutures had an average of 5.43 diopters of keratometric cylinder and 2.95 D of refractive cylinder. The difference was highly statistically significant (P < .001). This significant difference was true in eyes with keratoconus and Fuchs' endothelial dystrophy.

In 50 eyes with all sutures removed, the average keratometry reading revealed 4.27 D of astigmatism while the cylindrical refraction required in spectacles averaged 3.70 D. The difference was not statistically significant (P = .018). The significant difference between astigmatism as measured by keratometry and by refraction in eyes with the sutures still in place should be taken into consideration when using suture removal or adjusting techniques after keratoplasty. [Refractive and Corneal Surgery 1990;6:174-178.]
Comparison of Minus Power Anterior Chamber Intraocular Lenses and Myopic Epikeratoplasty in Phakic Eyes
Authors: Baikoff G , Joly P
Published: April 2021

ABSTRACTiWe performed a retrospective study of two sequential series of operations designed to correct high myopia in phakic eyes. The first series consisted of 24 eyes with refractive error ranging from -11.00 diopters to -21.00 D (mean -16.9 D). They received a commercially prepared, lyophilized, myopic epikeratoplasty lenticule sutured into a circular keratectomy. Seven lenticules had to be removed within the first year because of poor refractive results, corneal ulceration, or melting. The nine eyes followed from 12 to 24 months after surgery demonstrated residual refractive errors from + 4.00 D to -11.25 D.

We also studied an initial series of 41 eyes with preoperative myopia ranging from -9.00 D to -35.00 D (mean -15.00 D) that received a minus power anterior chamber intraocular lens. The lens had an open loop design with an anterior vault, four point angle fixation, and an optic diameter of 4.5 mm. Recovery of visual acuity was faster with the intraocular lens than with epikeratoplasty. Three intraocular lenses were removed; two because they were the wrong size and one because it was the wrong power. Two of the lenses were replaced with acceptable results. Of the 34 eyes followed for 12 months, all had a residual refractive error within ± 2.00 D of emmetropia. During the short-term followup, no elevated intraocular pressure, cataract formotion, or excessive endothelial damage was observed.

We concluded that anterior chamber minus power intraocular lenses gave more rapid and predictable optical correction in high myopic eyes than did myopic epikeratoplasty. Longer follow-up is required before conclusions can be reached about the safety of these intraocular lenses. [Refractive and Corneal Surgery 1990;6:252-260.]
Does Bowman's Layer Determine the Biomechanical Properties of the Cornea?
Authors: Seiler Theo , Matallana Michael , Sendler Sebastian , Bende Thomas
Published: April 2021

ABSTRACT

Background: Bowman's layer is believed to be the stabilizing element of corneal curvature due to its assumed mechanical stiffness.

Methods: Uniaxial stress-strain analysis was performed in paired corneal strips to compare the contribution from Bowman's layer. Two central strips were taken from each cornea and Bowman's layer was removed from one of them with the excimer laser.

Results: Pairwise comparison yielded no statistical difference in elastic or viscoelastic properties according to presence or absence of Bowman's layer. At a strain of 2%, the stress was measured to be (5.06 ± 2.01) × 10
p 3
N/m
p 2
with Bowman's layer and (4.72 ± 1.3) × 10
p 3
N/m
p 2
without Bowman's layer. Also, the two relaxation times did not differ significantly.

Conclusions: These findings imply that Bowman's layer does not contribute significantly to mechanical stability within the cornea. (Refract Corneal Surg 1992;8:139-142.)
Photorefractive Keratectomy as a Second Attempt to Correct Myopia After Radial Keratotomy
Authors: Seiler Theo , Jean Benedict
Published: April 2021

ABSTRACT

BACKGROUND: Undercorrection after radial keratotomy is not uncommon. To correct the residual refractive error, several techniques are available including photorefractive keratectomy.

METHODS: We report five eyes of four patients, which remained undercorrected following radial keratotomy and underwent photorefractive keratectomy with an excimer laser (193 nm) to correct the residual myopia, with a follow up of 6 months to 1 year.

RESULTS: The corneal-healing response was similar to that of corneas treated by photorefractive keratectomy alone. No permanent corneal scarring occurred. The average preoperative refraction before photorefractive keratectomy was -2.25 ± 0.55 diopters; it was close to piano (+0.12 ± 0.26 D) after 6 months. One eye regressed 0.50 D between 6 months and 1 year. Best-spectacle corrected visual acuity did not change.

CONCLUSIONS: Excimer laser photorefractive keratectomy seems to be effective as a second procedure in eyes undercorrected following radial keratotomy. (Refract Corneal Surg 1992;8:21 1214.)
Phototherapeutic Keratectomy With Excimer Laser for Reis-Bückler's Corneal Dystrophy
Authors: McDonnell Peter J , Seiler Theo
Published: April 2021

ABSTRACT

Two patients with decreased visual acuity and recurrent epithelial erosions due to Reís-Bückler's corneal dystrophy underwent phototherapeutic keratectomy with the 193-nanometer excimer laser. Because the epithelial surface was relatively smooth prior to surgery, ablations were performed through an intact epithelium. Postoperatively, visual acuity was improved and symptoms of erosion decreased in both patients. Although no refractive shift was intended with the phototherapeutic procedure, both patients were hyperopic following surgery. Superficial keratectomy with the 193nanometer excimer laser thus provides an alternative to conventional surgical keratectomy. [Refract Corneal Surg 1992;8:306-310.)
Complications of Radial Keratotomy: Eyes With Keratoconus and Late Wound Dehiscence
Authors: Durand Luc , Monnot Jean-Philippe , Burillon Carole , Assi Alexandre
Published: April 2021

ABSTRACT

BACKGROUND: Radial keratotomy requires a thorough preoperative examination, including photokeratography, to detect early keratoconus.

METHODS: We compared, by light and transmission electron microscopy, the healing process ot corneas from two patients after radial keratotomy.

RESULTS: Clinically, one patient had a keratoconus and gained no visual benefit from the radial keratotomy. The other patient had a spontaneous corneal perforation at one incision and a hypopyon. Histological studies showed a prolonged healing process in both eyes, with a persistent epithelial plug. Bowman's layer was also interrupted and retracted in both eyes. The inflamed cornea had deep neovascularization.

CONCLUSIONS: These observations imply that 2 years after surgery, wound healing and, therefore, refraction is not stable. The results show the inappropriateness of radial keratotomy performed on eyes with keratoconus, with the possible risk of delayed corneal perforation. Refract Corneal Surg 1992;8:311-314.)
The Treatment of Persistent Wound Leak After Radial Keratotomy
Authors: MacRae Scott , Cox William , Bedrossian Robert , Rich L F
Published: April 2021

ABSTRACT

BACKGROUND: Macroperforation of the cornea during refractive keratotomy can result in persistent wound leak and may need treatment by suturing.

METHODS: We describe two eyes that developed a mac roperf oration during radial keratotomy with persistent leakage of aqueous. The wounds were sutured with 10-0 and 11-0 nylon sutures.

RESULTS: The sutures induced irregular astigmatism as shown by corneal topography. Removal of sutures improved the topography and led to an acceptable outcome.

CONCLUSION: Macroperforations with persistent aqueous leaks should be sutured. Suture removal within a few weeks after surgery can avoid persistent irregular astigmatism and lead to a good refractive result. Refract Corneal Surg 1993;9:62-64.)
Central Islands of Corneal Steepening After Automated Lamellar Keratoplasty for Myopia
Authors: Price Francis W
Published: April 2021

ABSTRACT

BACKGROUND: Central steep islands are a phenomena of videokeratography that demonstrate local central steepening within a larger diameter area of the cornea treated by refractive surgery that removed stromal tissue to reduce myopia. This report details four cases in which central steep islands occurred following automated lamellar keratoplasty (keratomileusis in situ).

METHODS: A total of 43 automated lamellar keratoplasty procedures were performed on 32 patients between January 1993 and September 1993. Central islands were identified using videokeratography.

RESULTS: Out of 43 cases of automated lamellar keratoplasty, central steep islands developed in six eyes of four patients. These steep areas developed within a few weeks after surgery; increases in the elevation of these islands correlated with recurring myopia. Slit-lamp microscopy revealed no epithelial surface abnormalities or difficulties with the interface of the resection. A central steep island did not prevent excellent uncorrected visual acuity. After subsequent refractive keratotomy for residual myopia, central steep islands either regressed or disappeared.

CONCLUSION: Central islands of corneal steepening may occur after automated lamellar keratoplasty for myopia. The etiology is unknown. [J Refract Surg. 1996;12:36-41.]
Photorefractive Keratectomy for Myopia of -8.00 to -24.00 Diopters
Authors: Goes Frank J
Published: April 2021

ABSTRACT

BACKGROUND: Sixty-eight highly myopic eyes (mean refraction, -11.17 diopters [D]; range,-8.00 D to -24.00 D) were treated with excimer laser photorefractive keratectomy and followed 1 year.

METHODS: A 193 nm Meditec excimer laser was used with a 5.0-mm ablation zone without peripheral taper. All patients were followed during a period of at least 1 year. All patients had a complete ophthalmological examination including videokeratography and documentation of haze.

RESULTS: After 1 year, uncorrected visual acuity was 20/20 or better in eight (13%) and 20/40 or better in 48% of eyes; 42% of eyes had a refraction within +0.50 D, 74% within ±1.00 D, and 90% within ±2.00 D of the planned correction. The eyes that needed only a single treatment obtained the best results. In 30% of eyes, two treatments were necessary in order to obtain acceptable results. A decrease of spectacle-corrected visual acuity, caused by the laser treatment, was exceptional, probably transient, and increased when a second treatment was necessary. Subjective complaints were present in four of 68 eyes. Eyes with clinically significant regression had more and longer lasting haze.

CONCLUSION: Excimer laser photorefractive keratectomy for myopia of -8.00 D and more give less predictable results than those achieved for less than -8.00 D. Two treatments improve the outcome but cause more loss of spectacle-corrected visual acuity. [J Refract Surg. 1996;12:91-97.]
Quantifying Corneal Toricity From Videokeratography With Fourier Analysis
Authors: Friedman Nina E , Zadnik Karla , Mutti Donald O , Fusaro Robert E
Published: April 2021

ABSTRACT

BACKGROUND: Fourier analysis can be used to quantify corneal toricity from videokeratography data. This study measures the repeatability of Fourier-derived toricity values in normal adult corneas.

METHODS: The Topographic Modeling System (TMS) was used to model the corneas of 29 subjects on two occasions, and Fourier analysis applied to the data. Repeatability of Fourier-derived toricity values between sessions was examined, and 95% limits of agreement were established.

RESULTS: The 95% limits of agreement between sessions for the Fourier method were -0.02 ± 0.16 diopters (D) and -0.5 ± 5.7° for toricity amount and axis, respectively.

CONCLUSIONS: The Fourier method yields highly repeatable toricity values and thus provides a sensitive means of detecting longitudinal toricity change in normal corneas. [J Refract Surg. 1996;12:108-113.]
Surface Roughness in PMMA is Linearly Related to the Amount of Excimer Laser Ablation
Authors: O'Donnell Colleen B , Kemner Jason , O'Donnell Francis E
Published: April 2021

ABSTRACT

OBJECTIVE: To determine if surface roughness after excimer laser ablation is a function of the amount of ablation and to identify a standard unit for ablation roughness.

METHODS: We used a VISX 20/20 excimer laser to perform a series of single zone 6-mm diameter ablations (photorefractive keratectomy [PRK]) in polymethylmethacrylate (PMMA). Corrections ranged from -1.00 diopter (D) to -15.00 D. A scanning white light interferometry microscope (Zygo Corp, Middlefield, Conn) was used to quantify the surface roughness at the center of each ablation.

RESULTS: We found a linear increase in surface roughness as the refractive correction increased. Each diopter increment resulted in an approximately 300 nm increased peak-to-valley measurement. This represented an increase of 25 nm roughness per micron of ablation in PMMA.

CONCLUSIONS: Surface irregularities in PMMA increase with ablation depth. We propose a unit of measure of roughness, the "ablaton," expressed as the peak-to-valley distance in nm/÷m of ablation. [J Refract Surg. 1996;12:171-174.]
Management of Detached Lenticule After In Situ Keratomileusis
Authors: Kim Eung K , Choe Chul M , Kang Shin J , Kim Hong B
Published: April 2021

ABSTRACT

BACKGROUND: Attachment of a keratomileusis lenticule without sutures is a commonly used technique that reduces surgery time and makes the procedure more simple. Detachment of the lenticule after surgery is a difficult complication to manage.

PATIENTS AND METHODS: Three cases of lenticular detachment occurred among 74 eyes of microkeratome in situ keratomileusis without suture. After thorough washing of the lenticule and stromal bed, the lenticules were reattached with air drying.

RESULTS: In the first eye, the lenticule was reattached successfully with air only. In the second and third eyes, epithelial growth along the interface appeared after reattachment. In spite of removing the epithelium from the interface and suturing the lenticule to the stromal bed four times, the epithelial growth recurred along the interface. Peripheral corneal neovascularization forced the surgeon to abandon more trials of resuturing. In the second eye, the lenticule was discarded because the epithelial growth along the interface could not be blocked. In the third eye, the edge of the lenticule was buried into the stroma, mimicking epikeratoplasty. All three eyes retained useful visual acuity.

CONCLUSIONS: A detached lenticule after microkeratome keratomileusis is difficult to replace without epithelial growth in the interface. This complication may be managed successfully. [J Refract Surg. 1996;12:175-179.]
Laser In Situ Keratomileusis (LASIK) for Myopia from -7 to -18 Diopters
Authors: Güell José L , Muller Ana
Published: April 2021

ABSTRACT

BACKGROUND: Laser in situ keratomileusis (LASIK) combines a lamellar corneal flap with an excimer laser ablation in the stromal bed to correct a wide range of myopia. We reviewed 43 eyes treated with LASIK to correct -7.00 to -18.50 diopters (D).

METHOD: The data from 43 consecutive eyes of 30 patients aged 24 to 46 years were analyzed. Surgery was performed under topical anesthesia using the Chiron Automated Corneal Shaper and Keracor 116 Excimer laser with the multizone mode and our modified nomogram. Manifest and cycloplegic refraction, uncorrected visual acuity, spectacle corrected visual acuity, videokeratography, endothelial cell count, slit-lamp microscopy, fundus examination, and applanation tonometry were recorded preoperatively and at 1 week and 1, 3, and 6 months, postoperatively.

RESULTS: We divided the eyes into two groups. The lower myopia group had a mean preoperative spherical equivalent refraction of -9.30 ± 1.31 D (range: -7.00 D to -12.00 D) and mean postoperative refraction of -0.80 ± 0.79 (range: -0.25 D to -3.50 D). The mean spectacle corrected visual acuity preoperatively was 0.74 ± 0.20 and postoperatively was 0.74 ± 0.18. The higher myopia group had a mean preoperative spherical equivalent refraction of -14.86 ± 1.87 D (range: -12.25 D to -18.50 D) and a mean postoperative refraction of -1.80 ± 1.29 D (range -1.00 D to -5.25 D). The mean spectacle corrected visual acuity preoperatively was 0.50 ± 0.19 and postoperatively was 0.51 ± 0.18. No overcorrections occurred in either group. One eye of the higher group lost one line of spectacle corrected visual acuity. No eye had visually significant corneal haze. The mean change in spherical equivalent refraction between preoperatively and 6 months postoperatively was 8.50 D for the lower myopia group and 13.06 D for the higher myopia group, in the myopic direction. Visual rehabilitation was rapid after surgery.

CONCLUSIONS: In this study, LASIK resulted in insignificant corneal scarring, stable refractive correction over six months, no irregular astigmatism, and excellent visual acuity. Predictability was more accurate up to -12.00 D of intended correction. [J Refract Surg. 1996;12:222-228.]
Comparison of Three Videokeratoscopes in Measurement of Toric Test Surfaces
Authors: Greivenkamp John E , Mellinger Mark D , Snyder Robert W , Schwiegerling James T , Lowman Andrew E , Miller Joseph M
Published: April 2021

ABSTRACT

PURPOSE: We compared the accuracy of the Computed Anatomy TMS-1 (1.41), the EyeSys Laboratories Corneal Analysis System (2.1), and the Visioptic EH-270 (3.0) videokeratoscopes in measuring toric surfaces. These non-rotationally symmetric aspheric surfaces served as models of corneal astigmatism.

METHODS: Precision diamond-turned toric surfaces modeling 0.00 diopter (D) to 7.00 D of astigmatism were fabricated. A three-dimensional contact profiler was developed to calibrate the aspheric surfaces. Videokeratoscopic data taken at "best focus" were compared to the theoretical shape to quantify device measurement errors.

RESULTS: The Computed Anatomy system measurement accuracy shows no statistically significant correlation between measurement error and surface toricity (r
p 2
<0.13). Measurement error increased linearly with surface astigmatism for the EyeSys Laboratories system (0.12 D rms error per D of astigmatism, r
p 2
>0.96, p<0.001 and the Visioptic system (0.03 D error per D of astimatism, r
p 2
=0.88, p<0.001).

CONCLUSIONS: This study found systematic performance differences among the three machines. Under ideal alignment conditions, the Computed Anatomy TMS-1 is more accurate at detecting astigmatism. The EyeSys Laboratories Corneal Analysis System apparently underestimates the amount of surface astigmatism because of excessive data smoothing. The Visioptic EH-270 errors are primarily in the central zones and may be due to ring localization errors. [J Refract Surg. 1996;12:229-239.]
A Computer Model for Predicting Image Quality After Photorefractive Keratectomy
Authors: Klonos Gregory G , Pallikaris John , Fitzke Frederick W
Published: April 2021

ABSTRACT

BACKGROUND: Accurately predicting visual performance remains a concern in refractive surgery. The effects of the eye's optics on retinal image quality were investigated using computer ray tracing to model the human eye after photorefractive keratectomy (PRK).

METHODS: Ray-tracing analysis was used with an anatomically realistic model of the human eye including aspheric surfaces and crystalline lens grathent index distributions. The contribution of corneal curvature to refractive error was investigated using data of axial length, corneal power, anterior chamber depth, and lens power from 318 eyes from the literature. The computer interface was specifically designed for use with PRK and provides graphical plots of the remodeled eye, ray paths and retinal image formation.

RESULTS : Modeling the optical contribution of corneal curvature resulted in an improvement in predicted refractive state of the eye as a function of axial length expressed as the R
p 2
value of the regression analysis from 0.88 to 0.96. Subsequently, analyses were conducted for single and multizone treatment areas of differing diameter and with varying pupil size. Retinal image quality following PRK for the human cornea was found to be affected by not only the corneal parameters of anterior curvature and thickness, but also by axial length, pupil size, and anterior chamber depth.

CONCLUSIONS: The inclusion of multiple interdependent optical parameters showed differences from conventional methods in predicting refractive outcome following PRK and revealed factors affecting image quality may account for some imperfections in visual performance based on simpler optical modeling. [J Refract Surg. 1996;12:S280-S284.]
Corneal Topography for Intraocular Lens Power Calculations
Authors: Alimisi S , Miltsakakis D , Klyce S
Published: April 2021

Other Presentations
Night Vision Testing in Unoperated Eyes
Authors: Florakis George J , Jewelewicz Daniel A , Fan Nancy I , Trokel Stephen L
Published: April 2021

ABSTRACT

BACKGROUND: We previously described a simple test which evaluates image degradation in post-excimer laser (PRK) patients under scotopic conditions. After refractive surgery, corneal haze, ablation zone decentration, ablation zone/pupillary diameter disparity, and under-correction each result in a characteristic pattern on the Night Vision Recording Chart.

METHODS: Using the same method, further studies evaluated night vision image degradation in 118 un-operated emmetropic, myopic, hyperopic, and astigmatic eyes and in 26 contact lens wearers.

RESULTS: Scotopic image degradation increases with myopic refractive error, image displacement increases with astigmatism, and contact lens wearers have more image degradation that with spectacle correction.

CONCLUSION: Our Night Vision Recording Chart offers a simple, reproducible method to characterize image degradation under scotopic conditions. [J Refract Surg. 1996;12:S311-S312.]
Histological Evaluation of Phthalocyanine Mediated Photodynamic Occlusion of Corneal Neovascularization Enhanced by Hyperbaric Oxygenation
Authors: Pallikaris I G , Margaritis V N , Naoumidi I I , Naoumidis L P , Tsilimbaris M K , Panagopoulos J A , Tsamparlakis I C
Published: April 2021

ABSTRACT

PURPOSE: We evaluated the effective irradiation parameters for photodynamic thrombosis of experimental corneal neovascularization enhanced by simultaneous hyperbaric oxygenation.

METHODS: Neovascularization was provoked in both eyes of each of 35 albino rabbit corneas using the intracorneal suture technique. The lasered animals were divided in 3 groups. Group 1 (10 rabbits) was treated under hyperbaric conditions (28 atm for 25 min.); group 2 (5 rabbits) was treated breathing pure oxygen delivered by a face mask; group 3 (10 rabbits) was treated breathing room air. The fourth group (10 rabbits) was used for control. Animals were anaesthetized, and irradiation of new corneal vessels was carried out 30 minutes after the injection of 5 mg/kg chloroaluminum sulfonated phthalocyanine. A 670 nm diode laser with a power 4 mW and a spot diameter 350 nun was used. Exposure times necessary for vascular occlusion were registered. Histological examination was carried out at the end of the follow-up time.

RESULTS: Exposure times were significantly lower in groups 1 and 2 as compared to group 3 (1.75 ± 0.15 min., 3.1 ± 0.4 min., and 4.75 ± 0.15 min. respectively). Total light dose averaged 490 J/cm,
p 2
870 J/cm,
p 2
and 1330 J/cm,
p 2
respectively. Histological examination revealed thrombus formation in the targeted vessels of all three investigated groups.

CONCLUSION: Combination of PDT with hyperbaric oxygenation results in an acceleration of the photodynamic process and provides for a possibility of significant reduction of photodynamic dose. [J Refract Surg. 1996;12:S313-S316.]
Preliminary Evaluation of a Hydrogel Core-and-Skirt Keratoprosthesis in the Rabbit Cornea
Authors: Crawford Geoffrey J , Chirila Traian V , Vijayasekaran Sarojini , Dalton Paul D , Constable Ian J
Published: April 2021

ABSTRACT

BACKGROUND: We developed a core-and-skirt keratoprosthesis, with both components made from poly(2-hydroxyethyl methacrylate) (PHEMA) hydrogels. The identical chemical nature of both spongy skirt and transparent core assures a permanent union between them. We have previously shown that PHEMA sponges, within a certain range of pore size, can support cellular invasion and neovascularization when implanted into the rabbit cornea. The present study is the first to evaluate the behavior of the whole prosthesis after implantation into the rabbit cornea.

METHODS: Hydrogel keratoprostheses were inserted intrastromally into the corneas of seven rabbits and histologically examined by light microscopy in five eyes enucleated at 8, 12, and 14 weeks.

RESULTS: None of the implants extruded over this period. Both clinical and histopathologic examination showed that the keratoprostheses were well tolerated by the host tissue. The porous skirt was fully integrated into the stroma by fibrovascular invasion, and no capsule formed around the implants. Stromal melting anterior to the implant occurred in two cases, but this did not affect the fixation of the keratoprostheses.

CONCLUSIONS: This study indicates that our keratoprosthesis can prevent extrusion in the short term when inserted into an intrastromal pocket of the rabbit eye. [J Refract Surg. 1996;12:526-529.]
Measurement of Irregular Astigmatism Using Semimeridian Data from Videokeratographs
Authors: Borderie Vincent M , Laroche Laurent
Published: April 2021

ABSTRACT

BACKGROUND: Irregular astigmatism is one of the most troublesome side effects of corneal surgery. We attempted to quantify irregular astigmatism in a simple way, using semimeridian data from videokeratographs of corneas with different amounts of irregular astigmatism.

METHODS: We studied the corneal topography of 30 normal corneas to be used as controls, 30 corneas from patients after radial keratotomy, 30 corneas from patients after nonfreeze myopic keratomileusis, and 30 corneas with clinically apparent keratoconus. We developed two diagnostic formulas, a refractive power symmetry index and an angle symmetry index, using the absolute-scale, color-coded map, and semimeridian data from the EyeSys Corneal Analysis System, and used them to compare the four groups of corneas.

RESULTS: In the corneas with irregular astigmatism, values for the refractive power symmetry index and angle symmetry index were significantly higher than in the normal corneas. The refractive power symmetry index confidence interval set at 95% was 0.58 diopters (D) (range, 0.00 D to 0.58 D) in the control group. Using these limits, most values in the radial keratotomy, keratomileusis, and keratoconus groups were abnormal. Spectacle-corrected visual acuity correlated negatively with the refractive power symmetry index (rs=-0.58, /i<.001). The refractive power symmetry index sensitivity and specificity were respectively 97% and 66%. Spectacle-corrected visual acuity did not correlate with the angle symmetry index.

CONCLUSIONS: Semimeridian data from videokeratographs can be used to quantify irregular astigmatism. [J Refract Surg. 1996;12:595-600.]