bluuebunny/crossref_metadata_2025 huggingface dataset:
Polaroid Scotometer: A New Device to Chart Suppression Scotomata
Authors: Prakash Prem , Sharma Pradeep , Rao V Madhav , Shastry Prabhakar , Menon Vimala
Published: April 2021

ABSTRACT

Suppression, an active inhibition of vision in one eye under binocular conditions, is a sensory adaptation in concomitant strabismus. The characteristics and extent of suppression differ not only in different types of strabismus but also in the same type under different testing conditions, which may differ in their degree of dissociation. The findings in exodeviations have thus varied from regional suppression to hemiretinal trigger, and in esodeviations from two point scotoma to single large scotoma. There is a need for a simple but less dissociative test to chart the fields under binocular conditions. We have devised a new, simple instrument based on polaroid dissociation. The findings corroborate the findings of more sophisticated tests like phase-difference haploscope.
Surgical Implications of the Rectus Extraocular Muscle Pulleys
Authors: Demer Joseph L , Miller Joel M , Poukens Vadims
Published: April 2021

ABSTRACT

Purpose: Magnetic resonance imaging (MRI) shows that the paths of rectus extraocular muscle bellies remain fixed in the orbit during large ocular rotations, and across large surgical transpositions of their insertions. This stability of muscle paths is due to their passage through pulleys which are coupled to the orbit and located in a coronal plane anterior to the muscle bellies near the equator of the globe. Autopsy studies have shown the pulleys to be fibroelastic sleeves consisting of dense bands of collagen and elastin, suspended from the orbit and adjacent extraocular muscle sleeves by bands of similar composition. Immunohistochemical studies have revealed substantial smooth muscle in the pulley suspensions and in posterior Tenon's fascia. The pulleys as mechanical origins of the rectus extraocular muscles in the sense of determining extraocular muscle directusons. This study was conducted to determine the theoretical effects of the pulleys on the outcome rectus transposition surgery.

Methods: The functional and anatomical evidence for existence of the rectus extraocular muscle pulleys reviewed. In two patients, binocular alignment data collected using the Hess screen test before and vertical rectus transposition surgeries for lateral rectus paralysis. Paths of the rectus extraocular muscles determined using high resolution MRI. The Orbit? 1.5 extraocular biosimulation program was employed to theoretical binocular alignment and muscle paths, under alternative conditions including or omitting pulleys.

Results: Pulleys are required to account for observed paths of rectus extraocular muscles following transposisurgery. In the absence of pulleys, transposition of superior and inferior rectus muscles to the lateral rectus insertion for abducens paralysis would result in ocular misalignments not observed clinically.

Conclusions: The human orbit contains specialized musculofibroelastic tissues in and just posterior to fascia, which serve as pulleys, determining of rectus extraocular muscles. These pulleys are located in a roughly coronal plane just posterior to the of the globe. Unimpaired pulley function is to effective muscle transposition surgery.
Conservative Treatment of Congenital Dacryocele
Authors: Schnall Bruce M , Christian Colleen J
Published: April 2021

ABSTRACT

Purpose: To study prospectively the effectiveness of medical management of congenital dacryoceles.

Methods: All patients presenting with congenital dacryocele that were not infected were treated with warm compresses, massage, and topical antibiotics. Dacryoceles that did not resolve with at least two weeks of medical management were probed. Dacryoceles that were infected were treated with intravenous (IV) antibiotics in addition to warm compresses and massage.

Results: Seventeen patients with 21 dacryoceles were studied over a 3⅓-year period. All patients were examined by the authors and treatment was initiated prior to 3 weeks of age. Sixteen dacryoceles resolved with medical management in 1 to 6 days. Three of these 1 6 dacryoceles were infected and patients were hospitalized at the time of initial ophthalmic evaluation (2 to 4 days of life). One additional dacryocele became infected after 2 days of medical management (4th day of life), requiring hospital admission and IV antibiotics. All four infected dacryoceles resolved within 24 hours of the initiation of IV antibiotics, warm compresses, and massage. Five dacryoceles were probed after not resolving within 14 to 31 days of medical management. One dacryocele required a repeat probing.

Conclusions: Medical management can be effective in the treatment of congenital dacryoceles; 76% of dacryoceles in this series resolved after 6 days of medical management.
Pediatric Devic's Neuromyelitis Optica
Authors: Jeffery Amy R , Buncic J Raymond
Published: April 2021

ABSTRACT

Purpose: Neuromyelitis optica (Devic's disease) is a rare clinical syndrome of unilateral or bilateral optic neuritis (ON) and transverse myelitis (TM) occurring within an 8-week time interval. All reports mainly involve adults and describe a poor neurologic and ophthalmic clinical course without specific attention to their few pediatric cases. The purpose of this study was to develop a clinical profile in the pediatric population.

Methods: A retrospective chart review over 15 years revealed nine cases of neuromyelitis optica. A literature search was undertaken and all cases of pediatric neuromyelitis optica were tabulated and analyzed separately.

Results: The average age of onset was 7 years with a preceding viral prodrome in all patients. The optic neuritis was bilateral in eight of nine patients (89%). Visual loss ranged from 20/30 to light perception. Moderate anterior disc edema was seen in all 17 affected eyes. The clinical course was characterized by a rapid visual and neurologic recovery. The average follow up was 5.3 years, with five patients followed for 6 years or longer. None of the nine patients had any visual or neurologic recurrence or other significant subsequent illness. Visual system follow up showed 20/20 in each eye of all patients with mild optic atrophy, identified in 47% of eyes.

Conclusions: Devic's neuromyelitis optica occurs in the pediatric population as a distinct clinical entity with an excellent prognosis for visual and systemic recovery and no future recurrence or long-term sequelae.
B-Scan Ocular Ultrasonography in Preterm and Term Infants
Authors: Isenberg Sherwin J , Fishman Marci
Published: April 2021

ABSTRACT

Purpose: To evaluate the normal B-scan ocular ultrasonographic findings in preterm and term newborns.This information would be useful in making perinatal ocular diagnoses, especially in consideration of the rapidly changing eyes of normal infants shortly after birth.

Methods: One hundred two healthy infants aged 28 to 48 weeks postconception were prospectively studied. Eighty-six had complete sonograms, while others had incomplete examinations due to systemic instability. Bscan Ultrasonography was conducted through acoustic coupling medium and a closed eyelid using the Coopervision Ultrascan 404 unit. The ultrasound findings were evaluated relative to the infant's post concepii o nal age and weight at examination and the axial lengths of each eye. The ultrasonographer, who determined the presence of abnormal findings, was masked to the parameters mentioned above.

Results: Four specific findings frequently were noted in newborns that would be considered abnormal in adult eyes. These were: 1) a visible Tenon's capsule; 2) prominent superior ophthalmic vein; 3) sonolucent extraocular muscles; and 4) vitreous opacities. These findings were more common in the more premature infants (P-cO.01 by t test).

Conclusions: The presence of these four ultrasonographic findings in the eyes of infants should be considered normal, and should not necessarily prompt further work up until after the perinatal period.
The Modified Frisby Stereotest
Authors: Saunders Kathryn J , Woodhouse J Margaret , Westall Carol A
Published: April 2021

ABSTRACT

Background: The Frisby stereotest commonly is used in clinical practice to estimate stereoacuity. Assessment of the presence or absence of stereopsis is valuable particularly in toddlers because of the difficulties encountered in this age group with assessment of other aspects of visual function, such as monocular visual acuities.

Methods: The present study describes two modifications to the Frisby stereotest: 1) the introduction of a nonstereo practice plate,- and 2} the use of an auditory "reward" for correct identification of the target. These modifications aim to increase the success rate of the test and provide a means to discriminate between testable and untestable children. Subjects were 165 children aged between 0.5 and 47 months.

Results: The modifications improved the age range over which results could be obtained with the Frisby test, allowing infants as young as 7 months to complete testing. By 12 months of age, more than 60% of children were able to complete testing. The modifications also allowed the examiner to distinguish untestable children from those without stereopsis.

Conclusions: By simple modification of the Frisby stereotest, the authors have increased the ease with which the Frisby stereotest can be used to assess stereoacuity in infants and children and provided a means by which children unable to cooperate with testing can be distinguished from those without stereopsis.
Fundus Morphology Assessed by Digital Image Analysis in Children With Fetal Alcohol Syndrome
Authors: Hellström Ann , Chen Yahua , Strömland Kerstin
Published: April 2021

ABSTRACT

Background: Fetal alcohol syndrome (FAS) is associated with anomalies of the eye ground. The aim of this study was to evaluate the development of fundus morphology in children with FAS from early childhood to adolescence.

Methods: Fundus photographs were evaluated by digital image analysis in 16 children with FAS. Age at the baseline study was between 0.25 and 14 years, and the median follow-up period was 7 years (range: 0.5 to 12). Sixteen sex- and age-matched healthy children were used as controls.

Results: Children with FAS had a smaller optic disc area, lower frequency of excavations, greater tortuosity of retinal vessels, and a smaller number of vascular branching points compared with the controls. There were no significant differences in the fundus abnormalities between the first and last examinations.

Conclusion: No interval change of retinal fundus morphology was found at follow up, suggesting that the ocular abnormalities associated with FAS remain unchanged during childhood.
Psychosocial Implications of Strabismus Surgery in Adults
Authors: Burke John P , Leach Carolyn M , Davis Helen
Published: April 2021

ABSTRACT

Purpose: Adults with socially noticeable strabismus have been known to experience psychosocial difficulties as a result of their abnormal eye position. This study was designed to assess the impact of noticeable strabismus in adults and the psychosocial effects of surgical correction.

Methods: A total of 31 adults who underwent surgery for longstanding horizontal strabismus where poor alignment was the primary reason for consenting to surgery were requested to complete a self-reporting repertory grid to appraise the psychosocial consequences of corrective strabismus surgery.

Results: Prior to corrective surgery, the majority of subjects reported various psychosocial difficulties, considered by them to be wholly or partly due to their unsightly strabismus. A significant improvement in interpersonal interactions is apparent following strabismus surgery.

Conclusion: Surgery to improve ocular alignment appears to herald major improvements in the quality of psychosocial functioning for the majority of adults undergoing such surgical procedures (P≤0.001).
Retinal Examinations in Infants After Extracorporeal Membrane Oxygenation
Authors: Varn Mary M , Donahue Margaret L , Saunders Richard A , Baker John D , Smith Craig M , Wilson M Edward
Published: April 2021

ABSTRACT

Background: Ophthalmic examinations performed in infants undergoing extracorporea I membrane oxygenation (ECMO) are recommended because ocular abnormalities have been known to occur after this procedure.

Methods: We reviewed medical records of infants treated with ECMO who subsequently underwent routine ophthalmic examination prior to or immediately after hospital discharge. Examinations were performed in a fashion similar to that for retinopathy of prematurity screening.

Results: Eye examinations were recorded for 171 patients (342 eyes). Fundus examination was normal in 302 eyes (88%). Abnormal ret i n ovase u lar findings such as venous dilation or intraretinal hemorrhages, when present, were not considered vision threatening and required no treatment.

Conclusion: Clinically important retinal findings were not identified in our patients undergoing postECMO screening. Routine dilated fundus examination is probably not cost effective and places additional and potentially unnecessary stress on these infants.
Effect of Ongoing Treatment of Amblyopia on Surgical Outcome in Esotropia
Authors: Weakley David R , Holland Daniel R
Published: April 2021

ABSTRACT

Purpose: Classic teaching recommends completion of amblyopia therapy prior to surgical correction of esotropia. Recent reports, however, suggest that incomplete treatment does not adversely affect surgical outcome. This study assesses the effect of incompletely treated amblyopia on the success rate of bimedial rectus recession in infantile and acquired esotropia.

Methods: All patients (n=102) with esotropia undergoing bimedial rectus recession in 1994 who met inclusion criteria were reviewed. Subjects were classified as having infantile; acquired, partially accommodative; or acquired, nonaccommodative esotropia for comparison. Amblyopia was classified as none, mild, moderate, or severe. Surgical success was defined as orthophoria ± 8 prism diopters and was assessed at the second postoperative visit (4 to 6 weeks after surgery). Other variables studied included mean surgical age, preoperative deviation, millimeters of surgery, and amount of follow up.

Results: For all patients, surgical success rates were as follows: no amblyopia, 84.3% (43/51); mild amblyopia, 81.6% (31/38); and moderate amblyopia, 61.5% (8/13). All patients with severe amblyopia underwent unilateral recess/resect procedures and were excluded. Of the esotropia subgroups, a statistically significant decrease in surgical success was noted only in the infantile esotropia group with moderate amblyopia. For this group, success rates were as follows: no amblyopia, 77.1% (27/35); mild amblyopia, 81.0% (17/21); and moderate amblyopia, 16.7% (1/6), ^0.005.

Conclusions: Performing corrective surgery on patients with infantile esotropia leads to poorer surgical outcome if moderate amblyopia is present at the time of surgery. Mild amblyopia, however, does not adversely affect surgical outcome in patients with infantile esotropia. Furthermore, the presence of mild or moderate amblyopia does not appear to have an influence on surgical outcome for patients with acquired esotropia. The effect of amblyopia on sensory outcome was not studied as most patients were too young for reliable sensory testing.
Pediatric IOL Implantation: The KKESH Experience
Authors: Wheeler David T , Mullaney Paul B , Awad Abdulaziz , Al-Mesfer Saleh , Al-Nahdi Talal , Zwaan Johan
Published: April 2021

ABSTRACT

Background: Intraocular lens (IOL) implantation is increasingly accepted as a means of correcting pediatrie aphakia. However, few large series have been reported. We present our experience over the past 6 years.

Methods: Charts were reviewed of 84 patients (88 eyes) 8 years old or younger who underwent IOL implantation at King Khaled Eye Specialist Hospital between January 1989 and March 1995. An attempt was made to correlate visual outcome with patient variables, and refractive outcome was assessed.

Results: Despite a high percentage of patients with penetrating trauma (24%) and a significant level of poor compliance with amblyopia treatment (33%), one third of patients saw 20/40 or better, and 60% had at least 20/80 acuity. Improved visual outcome correlated with later onset and shorter duration of opacity and compliance with occlusion therapy. The posterior capsule was left intact in the majority of cases; opacification occurred in 47 eyes, 25 of which required Nd: YAG capsulotomy. No unexpected complications occurred. Prediction of postoperative pseudophakic refraction was within 2 diopters (D) in 70% of patients.

Conclusion: IOL implantation in appropriate children can be used as a safe alternative to other methods of correcting pediatrie aphakia. Visual outcome often depends on amblyopia management. These patients are appropriately followed by ophthalmologists who are experienced in managing amblyopia and pediatrie pseudophakia.
Constriction of the Visual Field of Children After Early Visual Deprivation
Authors: Bowering Elizabeth R , Maurer Daphne , Lewis Terri L , Brent Henry P
Published: April 2021

ABSTRACT

Purpose: We measured the extent of the monocular visual fields of children deprived of normal visual experience and examined the influence of the timing and duration of deprivation, of whether deprivation was monocular or binocular, of having patched the fellow eye, and of optical factors.

Methods: The Goldmann perimeter and a 6.4' stimulus of either 31 .8 cd/m2 (target I2e) or of 318 cd/m2 (target I4e) were used to test 44 children treated for a dense and central cataract in one (n=25) or both (n=31) eyes that developed before 6 years of age. Then, the influence of optical factors was assessed in two adults treated for a lateonset, unilateral cataract and in two children treated for unilateral congenital cataract.

Results: Compared with age norms or the normal fellow eye, all children treated for cataract showed a restricted field, especially temporally, even when deprivation began as late as 6 years of age and lasted less than 6 months. The restrictions were larger than those shown by the adults who developed cataracts. The restrictions were larger after longer deprivation and monocular deprivation than after binocular deprivation. However, children who regularly patched the fellow nondeprived eye and, therefore, experienced less interocular competition, exhibited smaller restrictions temporally. Neither visual acuity nor optical factors could account for all of the restrictions in the deprived children.

Conclusions:The development of the visual field is vulnerable to the effects of deprivation, especially to unilateral deprivation and to long deprivation. The losses likely reflect alterations in the visual pathways subserving peripheral vision.
Assessing Visual Function in Children Younger Than IVz Years With Normal and Subnormal Vision: Evaluation of Methods
Authors: Rydberg Agneta , Ericson Birgit
Published: April 2021

ABSTRACT

Purpose: Methods for detecting subnormal vision early in life are needed to adequately diagnose the condition and begin treatment and rehabilitation.

Methods: Forty-six children ages 1 month to 1'/2 years with either assumed normal vision, visual impairment due to eye disease, or strabismus were examined with the following tests: Stycar rolling balls; preferential looking (Teller acuity cards); and the ability to detect raisins, puffed rice, and sugar strands on two different backgrounds, one white and one black.

Results: Children with visual impairment and strabismus often showed normal values for their age, and children with assumed normal vision sometimes had values below those established for normal development of vision with the Stycar rolling balls and the Teller acuity cards.

Conclusions: It is not possible to use these tests to reliably differentiate among normal vision, visual impairment, or strabismus in children younger than 1Va. Not until recognition acuity, symbols, or letters can be tested can reliable results be obtained. However, the tests are useful to estimate the general visual function of children in this age group.
Ultrasound Biomicroscopy of the Anterior Segment of the Eyes of Infants
Authors: Kiryu Junichi , Park Masami , Kobayashi Hiroshi , Kondo Takehisa
Published: April 2021

ABSTRACT

Background: Our objective was to evaluate the new method of ultrasound biomicroscopy in examining the anterior segment of the eyes of infants.

Methods: The infant was held supine during examination, which was performed under topical anesthesia only. One drop of proparaca i ne was placed in the eye, and a small Md speculum was inserted. The palpebrai fissure was filled with 2.5% met hy !cell u lose as a coupling medium. The ocular cup was not used. Scanning was performed by placing the probe close to the area of interest.

Results: Case 1 : A 3230-g male infant was delivered by cesarean section at 39 weeks' gestation. The left eye was studied with ultrasound biomicroscopy. Examination revealed a narrow angle with the anterior chamber angle of 25°. The trabecular-ciliary process distance was 510 µ?t?. The depth of the anterior chamber was 1414 µ??.

Case 2: A 1368-g female infant was delivered by cesarean section at 30 weeks' gestation. The left eye was studied. The anterior chamber angle was 16°. The trabecular-ciliary process distance was 380 µ??. The depth of the anterior chamber was 1134 µ??.

Conclusion: Ultrasound biomicroscopy is clinically feasible in infants and has a potential for use in clinical research. Additional study is needed to assess the reproducibillty of the measurements and to acquire additional clinical experiences.
The Design of the Multicenter Study of Light Reduction in Retinopathy of Prematurity (LIGHT-ROP)
Authors: Anonymous
Published: April 2021

ABSTRACT

Background: The LICHT-ROP Study was a multicenter, prospective, randomized, controlled, clinical trial designed to determine if a reduction in ambient light exposure to premature infants' eyes would reduce the incidence of retinopathy of prematurity (ROP). Previous clinical reports were contradictory and had one or more methodological flaws.

Methods: The LICHT-ROP trial was designed in rigorous fashion to include randomization to treatment or control groups, masking of examiners, an adequate sample size of high-risk infants, a universal ROP classification system, a reliable and reproducible ophthalmologic examination protocol, a controlled method of light reduction, and monitoring of light levels in the nursery. The multicenter trial was conducted at three centers in Buffalo, Dallas, and San Antonio, with a separate coordinating center in Houston. The trial also utilized a separate data and safety monitoring committee.

Conclusion: The design of the LICHT-ROP study represents the most rigorous and largest clinical trial to date. It has demonstrated that light reduction does not reduce the incidence of confirmed ROP in high risk infants.

Journal of Pediatrie Ophthalmology and Strabismus 7999;36:257-263.
Triage, Education, and Group Meetings: Efficient Use of the Interdisciplinary Team with Chronic Psychiatric Outpatients
Authors: Rosenthal Renate H , Thomas Norma S , Vandiveer Carol A
Published: April 2021

ABSTRACT

The caseload of chronic patients of a large mental health outpatient clinic was triaged into medication groups with educational and socialization emphasis. Organization, division of staff responsibilities, and longitudinal clinic responses are described, and advantages and pitfalls of the group format are presented.
A Group Self-Care Approach to Stress Management
Authors: Garrison John , Scott Patricia A
Published: April 2021

ABSTRACT

A procedure is described for teaching patients the use of relaxation as a coping skill. The procedure, called Stress Management Training, combines Progressive Relaxation and Clinical Meditation into a standardized but flexible seven-session protocol. The technique has been used to treat a variety of stress-related medical and psychological problems. The training consists of three components. The first is giving the patient a cognitive understanding of stress and relaxation. The second, teaching the patient to relax by controlling the muscle tension and sympathetic nervous system activity. The third, teaching the patient to generalize the relaxation skill to real-life stress situations. Patients are also instructed in the relationship between stress, basic health practices, and physical health status.
Talking About Sex - With Less Anxiety
Authors: Anderson Mary Lynn
Published: April 2021

ABSTRACT

Nurses have both the opportunity and the responsibility to discuss the client's sexual concerns as part of the provision of wholistic health care, yet anxiety often inhibits this discussion. The client may feel anxious in response to changes in social norms and confusion as to the acceptability of his sexuality when hospitalized. Other factors may contribute to the client's inability to communicate about sexual concerns in a specific and forthright manner. The nurse must create a setting that reinstates protective social norms and clarifies the purpose of her professional interest in sexual health care issues. Counseling techniques that decrease the client's anxiety should be used. The nurse must deal with her own anxiety related to role confusion, inadequate knowledge base and lack of support systems. Role clarification, educational opportunities and the creation of a supportive system are necessary challenges for the practicing nurse who chooses to provide sexual health care.
MULTIPLE PERSONALITY, DISSOCIATIVE STATES
Authors: Anonymous
Published: April 2021

CALL FOR PAPERS
ANA ATTACKS DISCRIMINATION
Authors: Anonymous
Published: April 2021

EQUAL PAY
NEW CHILDREN'S GAME
Authors: Anonymous
Published: April 2021

FAMILY HAPPENINGS
FINANCIAL SURVEY
Authors: Anonymous
Published: April 2021

STUDENT NURSES
NURSING RESEARCH AWARDS
Authors: Anonymous
Published: April 2021

$62,500 IN GRANTS
BROCHURE AVAILABLE
Authors: Anonymous
Published: April 2021

HEALTH NOTES
WRITING CONTEST
Authors: Anonymous
Published: April 2021

WAS FREUDWRONG?
NURSES FILE SUIT
Authors: Anonymous
Published: April 2021

PAYEQUITY
Suicidal Casework: Assessing Nurses' Reactions
Authors: Hamel-Bissell Brenda P
Published: April 2021

Nurses who work with suicidal patients undergo an evolving process, the "rites of passage" that they must get through in order to work effectively with suicidal cases. This evolution occurs as each nurse copes with the stressors involved in suicidal casework. For many, feeling states occur in a series of cycles that can be classified into four stages of reaction to suicidal casework: naivete, recognition, responsibility, and individual choice.
MUTUAL EXPECTATIONS
Authors: Johnson Sandra Walsh
Published: April 2021

How Family Members View The Social Role of the Mental Health Center Client
Asthma and Adaptation: Exploring the Family System
Authors: Caroselli-Karinja Marie F
Published: April 2021

Children with asthma seem to have a greater likelihood of developing adjustment "disorders than a random group of healthy children.
Staying Well
Authors: Joyce Beverley , Staley Douglas , Hughes Linda
Published: April 2021

Factors Contributing to Successful Community Adaptation

Independence can be a frightening concept to newly released psychiatric patients. How do they meet the challenges of returning to their communities? What happens if they fail? Are they prepared?
Nurse Entrepreneurs
Authors: Dibner Lillian A , Murphy Janice Skipp
Published: April 2021

Would you like to be your own boss and make your own decisions? With many patients being discharged into the community, becoming homeless, or living in substandard housing without treatment or social support, becoming a nurse entrepreneur may be a possibility for you.
Fire-Setting From the Viewpoint of an Arsonist
Authors: Räsänen Pirkko , Puumalainen Tanja , Janhonen Sirpa , Väisänen Erkki
Published: April 2021

'I shouted one house to ashes'
Integrated Primary Health Care: Opportunities for Psychiatric-Mental Health Nurses in a Reforming Health Care System
Authors: Cotroneo Margaret , Outlaw Freida Hopkins , King Joan , Brince Jean
Published: April 2021

As changes in our health care system evolve, making the transition to greater parity of mental and physical health is paramount to move health care in the direction of prevention and health promotion. Although parity is the goal, the most feasible path to reaching it may lie in relinking mental health to physical health in managed care models of primary health care. This article identifies emerging directions in the mental health field and points to new opportunities for advancing the practice of psychiatricmental health nurses.
The Professionalization of Psychiatric Nursing: From Doctors' Handmaidens to Empowered Professionals
Authors: Boling Anita
Published: April 2021

ABSTRACT

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illnesses are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.
Call for Information for Assessment of Refractive Keratoplasty Procedures
Authors: Goldstone Donald
Published: April 2021

The Office of Health Technology Assessment (OHTA) of the National Center for Health Services Research (NCHSR) and Health Care Technology Assessment has the direct responsibility to conduct technology evaluations and make Public Health Service coverage recommendations in response to requests from agencies administering Federally-financed health programs. One such agency is the Health Care Financing Administration (HCFA). These requests may originate in the public or private sector. Requests frequently originate when claims for reimbursement are filed. For example, in the case of refractive surgery, the source of inquiry regarding reimbursement from HCFA was a medical optics firm and several ophthalmologists. HCFA subsequently asked the OHTA to assess the status of refractive surgery. OHTA announced the impending assessment in the Federal Register, soliciting public input. The Office also conducts a literature search and obtains information from such groups as clinical specialty organizations and manufacturer's associations. Scientific findings as well as specific recommendations are obtained from other Federal agencies. In the case of refractive surgery, for instance, the National Eye Institute will provide scientific advice on the technology.

OHTA assessments represent comprehensive evaluations of the safety, clinical effectiveness, and the appropriate use of the technology. While the OHTA performs evaluations that may take into account cost-effectiveness, social, ethical, and economic impacts, the primary concern of OHTA, in making its coverage recommendations, are the safety and clinical effectiveness of the technology. AU pertinent information, from controlled clinical trials to qualified medical opinion, are summarized and analyzed to determine if they are valid and significant. From this evaluation appropriate judgments and conclusions are formulated about the technology's safety and effectiveness.

Based on the information received, OHTA suggests how HCFA should deal with the reimbursement question. OHTA may recommend that a technology be covered, not covered, or covered with certain restrictions or guidelines. OHTA provides HCFA with a written coverage recommendation and the completed assessment report. HCFA has final responsibility for making decisions on what diagnostic and therapeutic techniques and procedures will be covered.

NCHSR publishes and disseminates the OHTA assessment reports to the public. Health Technology Assessment Reports concerning ophthalmology include:

* Computer Enhanced Perimetry, 1983

* Nd:YAG Laser for Posterior Capsulotomies, 1984

* Laser Trabeculoplasty for Open Angle Glaucoma, 1984.
Retrospective Comparison of Freeze and Non-Freeze Myopic Epikeratophakia
Authors: Buratto L , Ferrari M
Published: April 2021

ABSTRACT: We conducted a retrospective study of 20 eyes of 20 selected patients with preoperative myopia of -14 to -28 diopters who were treated with myopic epikeratophakia and followed for 8 weeks. Seven eyes were treated with frozen-lyophilized donor lenticules by the Kaufman-McDonald technique and 13 eyes were treated with freshly prepared donor lenticules using the Barraquer-KrumeichSwinger (BKS) technique. All lenticules were sutured Into a circular keratotomy without keratectomy. Postoperatively, all eyes had a refraction between -4.00 and +2.00 D, and there was no meaningful difference in the refractive outcome of the two groups. The freeze-lyophilized technique showed a greater overall loss of best spectacle corrected visual acuity, although no eyes in the entire series lost more than two lines of Snellen visual acuity compared to preoperative values. Uncorrected visual acuity after surgery was 20/40 or better in 5% of each group. The rate of postoperative epithelialization was slower in the freeze-lyophilized group, but all eyes were re-epithelialized by 3 weeks after surgery. No lenticules had to be removed for complications, but there was one case of epithelial ingrowth into the interface that required a second operative procedure. Our clinical experience with this small group of eyes shows that both techniques of myopic epikeratophakia can safely and effectively reduce high amounts of myopia, but that the refractive outcome is less predictable than desired. The technical requirements for the non-freeze (BKS) technique are high, but the rate of visual recovery is faster. [Refractive & Corneal Surgery 1989; 5:94-97.]
Intraocular Lens Implantation After Penetrating Keratoplasty
Authors: Binder Perry S
Published: April 2021

ABSTRACT: Thirty-three postkeratoplasty eyes underwent extracapsular cataract extraction with posterior chamber lens implantation or secondary anterior chamber lens implantation 3 to 128 months following corneal transplantation. The mean follow-up after the secondary lens implantation was 24 months (range 2 to 70 months). Seven of the 33 corneas became cloudy 1 to 8 months after lens implantation. Prior to graft failure, 71% of the eyes achieved refractive errors within 2 diopters of emmetropia and 19 of 33 eyes (57%) achieved uncorrected visual acuities of 20/100 or better. In spite of surgical attempts to reduce preexisting astigmatism, the mean postimplant keratometry astigmatism was unchanged after secondary surgery. Compared with a concurrent series of triple procedures, the advantage of providing patients with refractive errors closer to emmetropia by performing surgery after a corneal transplant is outweighed by the increased risks to the graft, the increased costs and medical risks of two operations, the risk of increased astigmatism, and the delay in visual acuity recovery from the time of keratoplasty until obtaining a final refraction after secondary surgery. [Refractive and Corneal Surgery 1989; 5:224-230.]
Large Diameter Therapeutic Penetrating Keratoplasties
Authors: Cowden John W , Copeland Robert A , Schneider Martin S
Published: April 2021

ABSTRACT: Fourteen penetrating keratoplasties were done on ten patients using 9.5 mm or larger diameter grafts. The causes for large grafts were perforation or Impending perforation of large descemetoceles due to bacterial ulceration in five eyes, herpes simplex viral keratouveitis in three eyes, severe keratoconjunctivitis sicca with ulceration in tour eyes, alkali bum and Mooren's ulcer in one eye each. The average duration of graft clarify was 67.2 days (range 14 days to 6 months). The best spectacle corrected visual acuity range was from I .p. to 20/40. Two patients had recurrent ulceration requiring two large diameter regrafts each. The average period of clarity in these repeated grafts was 26 days. A small graft placed inside of the failed large graft remained clear in 50% of the six eyes which were done for visual restoration. A large diameter penetrating keratoplasty may salvage an eye that might have otherwise been lost and in a few cases provide the opportunity for useful vision. [Refractive and Corneal Surgery 1989; 5:244-248.]
Flat Sections for Detailed Endothelial Pathology of Corneal Buttons
Authors: Wolter J Reimer , Soong H Kaz
Published: April 2021

ABSTRACT: Flat-section en face preparations of corneal buttons obtained from penetrating keratoplasty may be used for a panoramic pathological examination of the endothelial layer and of the reactive cellular events occurring in other layers. These provide a valuable supplement to the more conventional cross (saggital) sections. To demonstrate the principles and practical value of this two-plane sectioning method, we present histological examples of several pathological conditions of the cornea. [Refractive and Corneal Surgery 1989; 5:274-277.]
Further Studies of Four Incision Radial Keratotomy
Authors: Spigelman Alan V , Williams Patricia A , Lindstrom Richard L
Published: April 2021

ABSTRACT: This investigation evaluated the results of radial keratotomy on 52 eyes in 30 patients; 32 eyes had follow-up of greater than one year. The spherical equivalent refraction for 91% of these patients was within 1 diopter of emmetropia. We have followed five eyes between one and two to three years after surgery, observing a continued effect of the surgery with a mean gain in the hyperopic direction o1 +0.72 diopters. Initial overcorrections must be avoided in radial keratotomy. [Refractive and Corneal Surgery. 1989; 5:292-295].
Methods of Analysis of Corneal Topography
Authors: Klyce Stephen D , Wilson Steven E
Published: April 2021

ABSTRACT: The visual inspection of photokeratoscope mires permits the diagnosis of advanced anomalies in corneal shape and is an extremely useful adjunct to keratometry and slit-lamp microscope examination. However, corneal distortions too small to be appreciated by visual inspection of keratographs can seriously degrade visual acuity. In this article, an outline of the problems Involved and the steps necessary to accomplish modem quantitative corneal topography is given. [Refractive and Corneal Surgery 1989; 6:368-371.]
The Corneal EyeSys System: Accuracy Analysis and Reproducibility of First-Generation Prototype
Authors: Koch Douglas D , Foulks Gary N , Moran C Thomas , Wakil Joe S
Published: April 2021

ABSTRACT: The EyeSys Corneal Topography System manufactured by EyeSys Laboratories, Inc., Houston, Tex utilizes a unique data-acquisition design to perform rapid, cost-effective quantitative photokerotoscopy. We evaluated a first-generation prototype system. Repeated testing with this prototype demonstrated an accuracy and reproducibility to within 0.25 D on spherical surfaces. Similar results were obtained in testing aspherical surfaces without refocusing. Data from preliminary clinical studies are displayed for the following corneal conditions: normal, keratoconus, post-keratoplasty, and postkeratoplasty with wound ectasia. Advantages of the EyeSys System include rapid data analysis and display, ease of operation, and compact table-top size. [Refractive and Corneal Surgery 1989; 6:423-429].
Barraquer Lecture: Bernard E. McCarey, PhD
Authors: Binder Perry S
Published: April 2021

Special Article
Epidermal Growth Factor and Insulin In Use In Corneal Preservation: Study Design and Objectives of a Multi-Center Trial
Authors: Lass Jonathan H , Musch David C , Gordon Judy F
Published: April 2021

ABSTRACT: This study determines whether endothelial survival after penetrating keratoplasty is improved by adding the mitogens, human epidermal growth factor (hEGF), and human insulin to a chondroitin-sulfate-based corneal storage medium. It is a multicenter, prospective, double-masked, randomized trial that compares endothelial survival of human corneal transplants using donor corneas that have been stored in one of two media: DexSol (CSM with 1% dextran) or DexSol containing recombinant hEGF and human insulin. This article describes the study design and entry characteristics of the 105 recipient pairs. Each donor pair of corneas is transplanted on the same day into recipients who are matched by diagnosis and procedure. Clinical parameters assessed on day 1, week 1, and 3, 6, and 12 months postoperatively include graft clarity, epithelial integrity, corneal thickness, visual acuity, and intraocular pressure. Postoperative endothelial survival for both groups will be determined by morphometric analysis of endothelial cell images before storage and at 3, 6, and 12 months postoper atively. Such analysis will also identify differences in polymegathism (cell size) or pleomorphism (cell shape). [Refractive and Corneal Surgery 1990; 6:92-98.1
Electron Microscopic Examination of Prelathed, Lyophilized Tissue Used for Epikeratophakia in Humans
Authors: Koch Frank , Spitznas Manfred , Busin Massimo , Cusumano Andrea
Published: April 2021

ABSTRACT: Morphologic changes secondary to cryolathing and lyophilization have been described in tissue lenses used for epikeratophakia. We report the electron microscopic findings of an aphakic tissue lens which could not be used because of sudden preoperative myocardial infarction of the patient.
Corneal Steepening in Human Eye Bank Eyes By Combined Hexagonal and Transverse Keratotomy
Authors: Gilbert Michael L , Friedlander Miles H , Granet Nicole
Published: April 2021

ABSTRACT: An interrupted 5 mm diameter hexagonal keratotomy was modified to include six paracentral transverse incisions to augment the central corneal steepening. This combined modified-hexagonal and transverse (or hexagonal-transverse) keratotomy was performed on human eye bank eyes to an estimated 85% corneal depth yielding a mean of 7.50 ± 1.69 diopter increase in central keratometric power (P < .001); this finding was confirmed by keratography. These results encourage further studies of this procedure and its potential to surgically correct mild amounts of hyperopia. [Refractive and Corneal Surgery 1990; 6:126-130.]
Simultaneous and Sequential Selective Suture Removal to Reduce Astigmatism After Penetrating Keratoplasty
Authors: Burk Linda L , Waring George O , Harris David J
Published: April 2021

ABSTRACT: We studied two separate groups of consecutive eyes with penetrating keratoplasty in avascular corneas in which we performed selective interrupted suture removal to decrease postoperative astigmatism, describing the time course of change in astigmatism. In the first group (29 eyes), multiple interrupted sutures were selectively removed at a single visit in an attempt to reduce the astigmatism to ≤3 diopters; the patients were followed for 30 months. In the second group (24 eyes), one interrupted suture was removed at each visit every 2 weeks until the astigmatism was ≤3 D; the patients were followed for 15 months. Surgical techniques were different in the two groups. Both techniques reduced postoperative astigmatism. Larger changes in astigmatism occurred between the first suture removal visit and the subsequent visit in the first group. At 1 year, the multiple-suture-removal-at-a-single-visit group averaged 3.1 D of astigmatism, with 50% of eyes ≤3 D, whereas the single-suture-removal-at-multiple-visits group had a mean astigmatism of 1.9 D with 88% of eyes ≤3 D. The two groups we studied were not directly comparable, because surgical techniques differed, because they were operated at different times, and because the cases were not randomized. Nevertheless, we think that selective suture removal to reduce astigmatism after penetrating keratoplasty is best done by removing only one (or sometimes two) sutures per examination. [Refractive and Corneal Surgery 1990;6:179-187.]
Clinicopathologic Study of Healing Excimer Laser Radial Excisions
Authors: Bansal Sanjay , Salz James J , Tenner Alf , Rao Narsing , McDonnell Peter J
Published: April 2021

ABSTRACT: Four radial linear excisions were created by an argon fluoride (193 nm) excimer laser in the edematous cornea of a blind eye of a diabetic human patient. Partial thickness corneal trephinations were performed at 3, 7, and 18 months after surgery for histopathologic examination. At 3 months, a wide gap in Bowman's layer permitted extension of an epithelial plug to a depth of 0.35 mm; at 7 and 18 months, the depth of the epithelial plug was decreased to 0.29 mm and 0.01 mm, respectively. With wound healing, excision width decreased and the two cut ends of Bowman's layer were almost reapposed by 18 months, suggesting wound contraction. Linear excisions with the excimer laser appear to be wider than incisions made with a diamond blade, but the pattern of wound maturation appears to be similar. [Refractive and Corneal Surgery 1990;6:188-192.]
Keratotomy Model of Pseudomonas Keratitis: Gentamicin Chemotherapy
Authors: Brockman E Britt , Tarantino Paul A , Hobden Jeffery A , Hill James M , O'Callaghan Richard J , Kaufman Herbert E , Insler Michael S
Published: April 2021

ABSTRACT

Background: Chemotherapy of bacterial keratitis requires frequent application of antibiotic drops. Collagen shields containing antibiotics could reduce the need for frequent antibiotic application. To determine the effect of gentamicin-containing collagen shields and gentamicin drops on Pseudomonas keratitis, a new keratotomy model of infection was employed.

Methods: Model-contact lenses (58% water content) presoaked in 1% bovine serum albumin and exposed to 10
p 8
colony forming units per mL of Pseudomonas aeruginosa strain 27853, were found to reproducibly retain 5.9 (log base 10) colony-forming units. Rabbit corneas were scarified centrally with two perpendicular intersecting diamond knife cuts (5 mm × 5 mm × 0.2 mm), and bacteria-impregnated contact lenses were positioned and held in place for 24 hours with partial tarsorrhaphies. Treatment-Fourteen hours after lens removal (38 hours after infection), corneas were treated for 8 hours with collagen shields hydrated in saline (control), or shields impregnated with 800 µg gentamicin during manufacture, or one drop every 30 minutes of fortified gentamicin drops (14 mg/mL). The rabbits were killed and corneas collected for bacterial enumeration after 8 hours of treatment (46 hours after infection).

Results: Model-Slit-lamp examination and microbiologic confirmation showed uniformity of keratitis in all eyes. Treatment-Corneas treated with saline (controls) contained 6.4 (log base 10) Pseudomonas. Corneas treated with gentamicin-impregnated collagen shields (total drug = 800 µg) and fortified gentamicin drops (total drug = 21 mg) showed a reduction in viable bacteria of 2 logs and 6 logs, respectively, relative to the control.

Conclusions: In this new model of Pseudomonas keratitis, the amount of gentamicin introduced into collagen shields during manufacture effectively reduced bacterial growth in infected rabbit corneas. However, larger amounts of drug applied as fortified drops on a frequent dosing schedule were more effective by a factor of three. Treatment of keratitis with antibiotic-impregnated collagen shields may reduce the need for very frequent application of topical drops, but may be more effective with topical drop supplementation to increase the amount of drug available over the course of therapy. Refract Corneal Surg 1992;8:39-43.)