bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual Impairment in Children With Acute Nontraumatic Coma
Authors: Ziakas Nikolas G , Wong Chee P , Ramsay Andrew S , Bamashmus Mahfouth A , Forsyth Rob J , Eyre Janet A , Clarke Michael P
Published: April 2021

ABSTRACT

Purpose: To determine the incidence and severity of visual impairment in children following acute nontraumatic coma.

Methods: An 18-month prospective epidemiologic study of acute nontraumatic coma was undertaken in the former Northern NHS Region of England. Children aged >1 month and <16 years were included in the study if they had a Glasgow Coma Score of «12 for >6 hours or if they died within 6 hours of the onset of decreased levels of consciousness. For survivors, ophthalmologic assessments were performed 6 weeks and 12 months after presentation.

Results: Two hundred eighty-seven children were included in the study, of whom 127 died. Of the 1 37 examined survivors, 35 had visual abnormalities suspected by the examining neurologist during the ophthalmic assessment. Of these, visual impairment was confirmed in 10 children at the 6-week assessment by the pediatric ophthalmologist. At the 12-month assessment, visual impairment remained stable in 9 children and improved in 1.

Conclusion: In this study, 6.6% of children surviving acute nontraumatic coma had visual impairment that persisted at the 12-month follow-up examination. Incidence of visual impairment in acute nontraumatic coma is 0.97 per 100,000 children per year.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:6-10.
Heredity Versus Abnormalities in Pregnancy and Delivery as Risk Factors for Different Types of Comitant Strabismus
Authors: Matsuo Toshihiko , Yamane Takashi , Ohtsuki Hiroshi
Published: April 2021

ABSTRACT

Purpose: To elucidate risk factors for different types of comitant strabismus, the incidence of heredity and abnormalities in pregnancy and delivery was compared among different types of strabismus.

Methods: Between May 1 998 and January 1 999, a prospective clinical study of 500 consecutive patients with comitant strabismus at a referralbased university hospital was performed using data collected from questionnaires and interviews. Inclusion criteria were infantile esotropia (168 patients), accommodative and partially accommodative esotropia (97 patients), microesotropia (15 patients), acquired esotropia (12 patients), intermittent or constant exotropia (205 patients), and congenital exotropia (3 patients). Exclusion criteria were strabismus associated with systemic and central nervous system abnormalities and organic eye diseases.

Results: Family history was significantly more prevalent in intermittent or constant exotropia and accommodative or partially accommodative esotropia than in infantile esotropia (P<.0001 and P=.0267, respectively, Fisher's exact test). In contrast, abnormalities in pregnancy and delivery were noted at a significantly higher rate in infantile esotropia than in accommodative or partially accommodative and in intermittent or constant exotropia (P=.003 and P=.0215, respectively). Patients with infantile esotropia were significantly younger at the survey than those with the other two types of strabismus (P=.0004 and P<.0001). No significant difference was found in the number of siblings, birthweight, maternal age at delivery, or maternal cigarette smoking or alcohol drinking among these three types of strabismus.

Conclusion: Heredity and abnormalities in pregnancy and delivery are two major risk factors for comitant strabismus and contribute at different levels to the development of infantile esotropia, accommodative or partially accommodative esotropia, and intermittent or constant exotropia.

Journal of Pediatrie Ophthalmology and Strabismus 2001;38:78-82.
Effect of Retinopathy of Prematurity on Resolution Acuity Development in 1- to 3-Year-Old Children
Authors: Dogru Murat , Shirabe Hiroko , Nakamura Makoto , Taoka Keiko , Nomura Koji , Yamamoto Misao
Published: April 2021

ABSTRACT

Purpose: To assess the pattern of visual development in children aged 1-3 years with stage 1-3 retinopathy of prematurity (ROP).

Methods: One hundred forty-four infants weighing <1500 g were divided into three groups according to ROP stage. Randomly chosen preterm infants were the controls. Ophthalmic examinations started 4-7 weeks after birth and were performed until the retina was fully vascularized or until any ROP that had developed resolved. Preferential looking acuity measurements were carried out at 12, 18, 24, and 36 months of age.

Results: Infants with stage 1-2 or no ROP showed evidence of improving acuity development after 12 months. Infants with stage 3 ROP had significantly lower acuity scores compared to infants with stage 1-2 or no ROP at the 18- and 24month follow-up examinations (P<.001). At 36 months, the visual acuity of infants with stage 3 ROP showed evidence of improving development but still lagged behind infants with stage 12 or no ROP.

Conclusion: Although mild ROP does not seem to have a considerable effect on the development of resolution acuity until age 3, severe forms of ROP may be associated with impaired visual development, which strongly suggests the necessity of periodic monitoring of early visual acuity in infants with ROP.

Journal of Pediatric Ophthalmology and Strabismus 2001 ;38:1 44-148.
The Moving Dynamic Random Dot Stereosize Test: Development, Age Norms, and Comparison With the Frisby, Randot, and Stereo Smile Tests
Authors: Leat Susan J , St Pierre Jessica , Hassan-Abadi Saloumeh , Faubert Jocelyn
Published: April 2021

ABSTRACT

Purpose: To determine the response of infants and children to the Moving Dynamic Random Dot Stereosize (MDRS) test and to collect cross-sectional age-related data.

Methods: Sixty visually normal individuals were divided into four age groups: 0.5-<2, 2-<5, 5-<8, and 8-<20 years. Stereopsis was measured with the MDRS test on two occasions, plus the Frisby, Randot, or Stereo Smile tests, as was age appropriate.

Results: All children aged >2 years and 80% of the children between ages 6 months and 2 years were able to perform the MDRS test on at least one occasion. Sixty percent of the 6-month to 2-year-old children were able to perform the Stereo Smile test on both occasions. Performance on the MDRS test improved with age up to 9 years. Improvement on the Frisby and Randot tests was seen in children aged up to 7 years. Mean and 95% confidence interval ranges for each test are given.

Conclusion: This study gives evidence that aspects of the visual system are not fully mature until age 7-9 years. The MDRS test is a visually demanding but cognitively simple test that shows potential for detecting visual anomalies in young children.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:284-294.
Unusual Presentation of Subretinal Cysticercosis With Hypopyon Uveitis
Authors: John Deepa , Irodi Aparna , John Sheeja , Kuriakose Thomas , Jacob Pushpa
Published: April 2021

Subretinal cysticercosis presenting with anterior uveitis and hypopyon is rare. A 7-year-old boy presented with pain and hypopyon in the right eye. Ultrasonography showed a cystic lesion with scolex. Because visual prognosis was poor, he was treated conservatively. Timely diagnosis would facilitate early therapy and prevent visual loss.

[
J Pediatric Ophthalmol Strabismus.
2015;52:e17–e19.]
Pediatric Eye Emergency Department Visits: Retrospective Review and Evaluation
Authors: Ramsay Christopher , Murchison Ann P. , Bilyk Jurij R.
Published: April 2021

Purpose:

To assess the epidemiology of pediatric ocular conditions presenting to an ophthalmic emergency department and analyze the incidence of ocular trauma and other ophthalmic diagnoses.

Methods:

A retrospective review was performed of all patients seen in an urban eye emergency department over a 1-year period. The following variables were examined: visit date, demographics, diagnosis, mechanism of injury, and level of patient care.

Results:

Analysis was performed on 1,136 pediatric visits spanning 1 year. Trauma was the most common etiology, seen in 44.4% of patients, followed by infection in 19.3%. The largest volume of pediatric use was in the spring and early summer, with the peak of trauma in the spring. Most admissions of pediatric patients were due to trauma (76.4%), of which the most common diagnoses were ruptured globe (27.3%), eyelid laceration (18.2%), and orbital fracture (10.9%). Sporting activities were the most frequent broad cause of trauma seen in pediatric patients, accounting for 30.9% of all trauma, whereas the highest singular cause of trauma was injury by air guns (9.5%).

Conclusions:

Pediatric ophthalmic emergency department visits in this urban setting are most often due to trauma, with increased use in the spring and early summer. A majority of the more serious conditions leading to admission can be attributed to trauma, which is often preventable. Knowledge of patterns of visits could improve planning of ophthalmology physician coverage.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(2):84–92.]
A Seminar In-Service Program
Authors: Murray Beatrice L , Denton Helen K , Heinzelman Anna K
Published: April 2021

Nurses, unprepared to provide modern psychiatric nursing care, can begin to acquire some of the skills after two weeks in-service.
SEDATIVES AND HYPNOTICS
Authors: Dembicki Eugene L
Published: April 2021

Psychiatric Drugs & Trends
Teaching Adolescent Management in a State Hospital
Authors: Isham A Chapman
Published: April 2021

This paper reports experience in planning and teaching a six-weeks intensive course in adolescent management for personnel of an adolescent pavilion, including ancillary personnel, at the Big Spring State Hospital, Big Spring, Texas. We aimed to make our nurse-attendants more effective as team members by increasing their insight into disturbed adolescents and into ways of managing them. The objective of this paper is to describe our teaching experience ivhich might help in planning other courses of this type.
Faith: an untapped health resource
Authors: Kennison Monica Metrick
Published: April 2021

A holistic nursing viewpoint is needed to tap this ever present yet often overlooked health resource
Join the 11th Great American Smokeout
Authors: Anonymous
Published: April 2021

Kick the Habit
Study Shows Child Abusers Benefit From Intensive Treatment
Authors: Anonymous
Published: April 2021

but short-term therapy "doesn't work" for severely disturbed
Community Spirit
Authors: Smoyak Shirley A
Published: April 2021

The Journal, APNA, and You
Technique Integration: THERAPEUTIC TOUCH AND THEORY-BASED MENTAL HEALTH NURSING
Authors: Hill Lyda , Oliver Nancy
Published: April 2021

Acceptance of therapeutic touch (TT) by the nursing community has become widespread. Nurses are advancing the pioneering work of Krieger (1973) through practice, research, education, and, most recently, through the development of theory-based nursing practice. The purpose of this article is to contribute to the development of theory-based nursing practice by introducing integration of TT with mental health nursing approaches. The Science of Unitary Human Beings (Rogers, 1 986) is used to explain the relationship between TT and mental health nursing practice. The use of TT in practice is demonstrated through case examples from experiences with students and clients.
A Partnership to Prevent Chemical Dependency in Nursing Using Neuman's Systems Model
Authors: Mynatt Sarah L , O'Brien JoAnne
Published: April 2021

The problem of chemical abuse in nursing will not decrease unless comprehensive prevention strategies are continued and expanded.
Boosting Strategies: Enhancing the Self-Esteem of Individuals With Catastrophic Illnesses and Injuries
Authors: Dewar Anne
Published: April 2021

ABSTRACT

This qualitative study used grounded theory methods to determine how individuals were able to live with catastrophic illnesses and injuries. Twenty-eight participants were interviewed for stories of how they endured their circumstances. Although several strategies were used, this article describes a strategy entitled "boosting," which outlines the affected individuals' efforts to improve their self-esteem, which helped them bear their circumstances. Boosting has some relationship to social comparison theory. Implications for nurses and the importance of awareness of this communication need for patients are discussed.
Storming the Ivory Towers
Authors: Maxey Wayne
Published: April 2021

A Look at Violence and Stalking on Campus
Treating Treatment-Resistant Depression
Authors: Bailey Katharine P
Published: April 2021

Whether to Switch, Augment, or Combine Therapies
Julia C. Jones, PhD
Authors: Jones Julia C
Published: April 2021

Profile
NURSING INTERVENTIONS FOR Parasuicidal Behaviors IN FEMALE OFFENDERS
Authors: Roth Bonita , Presse Lucinda
Published: April 2021

When emotions become too painful for words, some female offenders may self-harm. Nurses can help them believe in themselves and their power to change.
Intraocular Pressure and the Intrastromal Corneal Ring
Authors: Kreisberg Amy L , Bacilious Norma , Asbell Penny A
Published: April 2021

ABSTRACT: The intrastromal corneal ring is a refractive surgery device placed in the peripheral cornea at 2/3 depth, and it has the potential to correct both myopia and hyperopia. This study examined whether intraocular pressure (IOP) could be accurately measured with the ring in place and whether intraocular pressure was altered as a result of surgery.

Fifteen eye bank eyes were attached to a manometric device to control pressure (10 to 40 mm Hg) which was measured over the range before and after placement of the ring with a pneumotonometer. A paired f-test showed no significant difference in pressure, pre- vs postoperative.

To determine the effect of the ring on IOP in vivo, ring implantation was performed on 1 0 rabbit eyes and pressure measured before and after surgery. At 24 and 48 hours postoperatively, there was no significant change in IOP (3 ± 2 mm Hg, P > .05, and 9 ± 8 mm Hg, P > .20 respectively) and facility of outflow calculated from tonography showed no significant change. (Refract Corneal Surg. 1991;7:303-307.)
A Purse-String Suture for Penetrating Keratoplasty Following Radial Keratotomy
Authors: McNeill James I , Wilkins David L
Published: April 2021

ABSTRACT: As the prevalence of radial keratotomy for myopia increases, more cases are undergoing penetrating keratoplasty. Radial keratotomy incisions are known to show incomplete wound healing. When the radial corneal radial keratotomy incisions are cut by the corneal trephine, the peripheral part of each incision frequently opens, even years after the radial keratotomy surgery. A case is presented that describes the use of a simple purse-string suture to hold the peripheral radial keratotomy incisions closed and stable during penetrating keratoplasty suturing and postoperative healing. The pursestring suture simplifies the corneal transplant surgery, allowing greater precision in suture placement by stabilizing the peripheral cornea. (Refract Corneal Surg 1991;7:392-394.)
Corneal Perforation in a Premature Infant
Authors: Zagelbaum Bruce M , Stroh Edward M , Perry Henry D , Donnenfeld Eric D , Cossari Alfred J
Published: April 2021

ABSTRACT

BACKGROUND: Few cases of corneal perforation in a premature infant have been described in the literature.

METHODS: Identical twins were born at 30-weeks gestation. One twin developed a corneal epithelial defect, infiltration, and perforation with extrusion of intraocular contents, requiring an emergency penetrating keratoplasty. The second twin developed a progressive corneal opacity, requiring a lamellar keratectomy.

RESULTS: After penetrating keratoplasty, the patient developed absolute glaucoma with buphthalmos, leading to enucleation. The twin's lamellar keratectomy specimen proved to be a dermoid.

CONCLUSIONS: One must be aware of the danger of the development of spontaneous corneal perforation with extrusion of intraocular contents in premature infants presenting at birth with an epithelial defect. [J Refract Surg. 1995;11:96-98.]
Excimer Laser In Situ Keratomileusis for Myopia
Authors: Bas Arturo Maldonado , Onnis Roger
Published: April 2021

ABSTRACT

Excimer laser in situ keratomileusis was done in 97 eyes of 59 patients to correct moderate and high myopia. Mean follow-up was 150 days. Mean preoperative myopia was -10.75 diopters (D). Mean reduction in myopia was -11.281D (106.98%) at 1 month and -10.37 D (98.417%) at 3 months.

At 1-month, 41 eyes (42.27%) had a refraction within -1.00 D and 70 teeyes (72.16%) had a refraction within -2.00 D. At 3 months, 41 eyes (46.59% of 88 eyes) had a refraction within -1.00 D and 66 eyes (75% of 88 eyes) had a refraction within -2.00 D. Mean preoperative keratometric power was 44.00 D; mean postoperative keratometric power was 36.39 D. The keratometric change in power was 7.61 D. Preoperati vely, 73 eyes (75%) had a spectacle corrected visual acuity of 20/40 or better; postoperatively, 64 eyes (65.63%) at 1 month and 75 eyes (77.01%) at 3 months reached 20/40 or better. The uncorrected visual acuity was 20/40 or better in 33 eyes (33.72%) at 1 month and in 49 eyes (49.96%) at 3 months. Mean ablation zone diameter was 4.92 mm. Astigmatism was treated separately in 10 eyes. Complications included optical zone decentration (3 eyes with more than 1 mm, epithelial implantation (1 eye), incomplete resection of the disc (2 eyes), severe hypotension, and irregular astigmatism (1 eye). [J Refract Surg. 1995;11(suppl.):S229-S233.]
Excimer Laser In Situ Keratomileusis in 124 Myopic Eyes
Authors: Fiander D C , Tayfour F
Published: April 2021

ABSTRACT

The development of corneal haze in some patients treated with excimer laser photorefractive keratectomy (PRK) and the variable predictability of the refractive cut in microkeratome keratomileusis in situ prompted us to evaluate excimer laser in situ keratomileusis (LASIK) for myopia. The Automated Corneal Shaper (Steinway-Chiron) was used to create a hinged corneal flap of 130 to 160 µm thick. PRK was performed on the lamellar bed with a Summit OmniMed laser. Minimum follow up was 3 months. Postoperative results and complications in the first 124 eyes are presented. LASIK is an effective method to correct myopia. [J Refract Surg. 1995;11 (suppl.):S234-S238.]
Simultaneous and Sequential Photorefractive Keratectomy
Authors: Bahçecioglu Halil , Özdamar Akif , Aktunç Rengin , Aktunç Turgay , Karaçorlu Murat , Erçikan Celal
Published: April 2021

ABSTRACT

The purpose of this study was to show the safety, effectiveness, and predictability of simultaneous bilateral as compared to sequential unilateral photorefractive keratectomy in 273 normally sighted myopic eyes. An excimer laser with a fluence of 180 mj/cm
p 2
at a frequency of 10 Hz was used at three ablation zones (5 mm, 6 mm, and 6.5 mm). There were no significant differences between the two groups' results. Mean refraction at six months was 0.34-0.96 D in group 1 simultaneous group and 0.32-0.95 D in group 2 sequential group. At 9 months after surgery, 84% of eyes had an uncorrected visual acuity of at least 20/40. The average pain score on the first postoperative day was 2.4 for group 1 simultaneous group and 2.3 for group 2 sequential group. No serious complications occurred. Despite the short follow up, simultaneous bilateral photorefractive keratectomy appears to be an effective and safe procedure for the correction of myopia. [J Refract Surg. 1995;11(suppl.):S261-S262.]
Multizone Photorefractive Keratectomy for Myopia of 9 to 14 Diopters
Authors: Kim Hyo-Myung , Jung Hai Ryun
Published: April 2021

ABSTRACT

We performed photorefractive keratectomy (PRK) using new multizone software of the Summit Omnimed excimer laser (Summit Technology, Inc., Waltham, Mass.) on thirteen highly myopic eyes. Average preoperative myopia was -10.94 diopters (D) (range -8.60 D to -13.50 D). Mean postoperative spherical equivalent refraction was -0.15 D (range +1.50 D to -4.00 D), at 3 months postoperatively. Uncorrected visual acuity of all the eyes improved markedly. There was no serious complication except one eye that lost two lines of spectacle corrected visual acuity possibly due to decentration. Though we need longer follow-up data and a larger sample size, the new multizone software seems to be effective for correcting high myopia. [J Refract Surg. 1995;11(suppl.):S293-S297.]
An Empirical Model of Hyperopic Shift With Corticosteroid Modulation and Refractive Power Prediction After Photorefractive Keratectomy
Authors: Wang Weiquan , Li Baoluo , Wang Zaowen , Li Weiye
Published: April 2021

ABSTRACT

Data from a selected sample of 158 patients who received excimer laser photorefractive keratectomy (PRK) in our center and obtained a desirable refractive outcome at 6-months were analyzed retrospectively to establish an empirical model of refractive power after PRK.

This model, generated by a computer-assisted regression program, is presented as a multivariate non-linear quadratic equation. Since the coefficients of each variable (attempted correction and postoperative days) are statistically significant, the estimated influence of the variables on the postoperative refraction from this regression model is reliable and consistent. Therefore, this model has been used to direct the use of corticosteroids for modulating post-PRK refraction. The predictability of this model has also been corroborated by separate data from 1-year follow up of PRK recipients. The recipients whose refraction at 6 months agree with the calculation from this model have obtained an excellent outcome; while those whose refractive outcome deviates from this model have gotten undesirable results. [J Refract Surg. 1995;11 (suppl.):S314-S318.]
Effect of Photorefractive Keratectomy On Visual Functioning and Quality of Life
Authors: Freitas Catarina , Oliveiros Barbara M , Marques Eduardo , Leite Eugenio B
Published: April 2021

ABSTRACT

The authors present the results of the psychosocial outcomes of 45 patients undergoing excimer laser photorefractive keratectomy (PRK).

The patients were evaluated by means of selfreport questionnaires preoperatively and 6 months after surgery to determine the effect of uncorrected vision change on the patients quality of life. The measurements include the following variables: clinical end points (spherical equivalent refraction); visual function (night driving, day driving, near vision, far vision, glare disability); functional status (physical, social, and role functioning, mental status); general well-being (health perceptions, personal well-being, overall quality of life); and satisfaction with surgery (expectations, satisfaction with medical staff, postoperative pain, satisfaction with treatment outcomes).

Preliminary results indicate that changes of uncorrected vision after PRK are reflected by improvement in each of the quality-of-life functions. [J Refract Surg. 1995;11(suppl.):S327-S334.]
Patient Satisfaction Following Photorefractive Keratectomy for Myopia
Authors: Hamberg-Nyström Helene , Tengroth Björn , Fagerholm Per , Epstein Daniel , van der Kwast Eva-Marie
Published: April 2021

ABSTRACT

This study was conducted to evaluate the subjective response of patients who underwent photorefractive keratectomy (PRK) for myopia with the Summit Technology UV 200 LA excimer laser (Summit Technology, Inc., Waltham, Mass.) (3.5 to 5.0 mm diameter ablation zone) 36 months previously.

One-hundred thirteen patients with preoperative myopia between -1.50 diopters (D) and -6.50 D with an ablation diameter of 3.5 mm to 5.0 mm answered a questionnaire at the 36-month examination. Sixty-two percent of patients had both eyes treated.

Halo problems were experienced always by 34% of patients in the group, 26% sometimes, and 40% never. Permanent night vision problems were experienced by 40%; 30% reported them sometimes and 30% reported no problems at all. Sixty percent never needed to use glasses after treatment, 30% sometimes did, and 10 % always wore glasses.

Seventy percent of patients thought the results were very good; the remaining 30% experienced different degrees of halo and night vision problems. [J Refract Surg. 1995;11(suppl.):S335-S336.]
Photorefractive Keratectomy for Myopic Astigmatism Using the Emphasis Erodible Mask
Authors: de Liano M Zato Gomez , Jimenez-Alfaro I , Carreras I , Castaneda J , Gracia M Lopez , Mendez J , Pellicer T , Bayo S Rodriguez
Published: April 2021

ABSTRACT

Photorefractive keratectomy (PRK) using the Summit emphasis erodible mask was performed on 229 eyes with myopic astigmatism. To analyze the efficacy and safety of the method, we evaluated the following: spectacle corrected visual acuity and refractive error as parameters of efficacy; corneal clarity, decentration of the ablation zone and complications as parameters of safety.

Despite the short follow up (the longest was 12 months) our results show that the emphasis erodible mask appears to be an effective surgical method for correcting myopic astigmatism. However, we found a great number of complications and subjective symptoms that worsened the visual outcome. We conclude that the emphasis erodible mask has satisfactory efficacy but unsatisfactory safety. [J Refract Surg. 1995; 11(suppl.):S343-S348.]
Holmium:YAG Laser Thermokeratoplasty for Correction of Astigmatism
Authors: Hennekes R
Published: April 2021

ABSTRACT

The effect of astigmatic Holmium:YAG laser thermokeratoplasty in three eyes with previous surgery (extracapsular cataract extraction, penetrating keratoplasty and failed extracapsular cataract extractionntric photorefractive keratectomy 1 to 7 years previously) was evaluated. In the extracapsular cataract extraction eye the effect of a four-spot laser thermokeratoplasty regressed to almost zero within 1 week. In the penetrating keratoplasty and photorefractive keratectomy eyes an eight-spot laser thermokeratoplasty produced an enormous overshoot in astigmatic power of about 15.00 diopters (D), decreasing within 5 months to almost zero in the eye with penetrating keratoplasty and to 4.00 to 5.00 D corneal astigmatic power in the photorefractive keratectomy eye after 8 months of observation. [J Refract Surg. 1995; 11(suppl.):S358-S3602]
Do Topical Corticosteroids Have a Role Following Excimer Laser Photorefractive Keratectomy?
Authors: Corbett Melanie C , O'Brart David P S , Marshall John
Published: April 2021

ABSTRACT

The article reviews the evidence for and against the use of topical corticosteroids following PRK. Two significant problems after PRK are the development of corneal haze and unpredictability of the refractive outcome. These arise from changes in the anterior stroma, the deposition of new subepithelial tissue, and individual variations in the wound healing response.

In rabbits, corticosteroids reduced corneal haze by limiting the synthesis of subepithelial collagen. However, in humans, controlled trials showed that corticosteroids had no lasting effect on either haze or regression, and were associated with an unacceptably high incidence of unwanted effects.

The difference between species probably relates to the relative absence of collagen and predominance of glycosaminoglycans during corneal wound healing in humans. Some human studies have shown rapid changes in refraction occurring within days of stopping or restarting corticosteroids. This suggests that their transient hyperopic effect is probably mediated by changes in the hydration of the tissue.

Therefore, the role of corticosteroids in PRK is very limited. There is no justification for their routine use after PRK for low or moderate myopia. If corticosteroids have a role in improving haze or refractive outcome in selected patients, a means for their early identification must be found. [J Refract Surg. 1995;11:380-387.]
Ultrasound Biomicroscopy of Intrastromal Photorefractive Keratectomy With the Nd:YLF Picosecond Laser
Authors: Habib Maged S , Speaker Mark G , Tello Celso , Liebmann Jeffrey , Ritch Robert
Published: April 2021

ABSTRACT

PURPOSE: To evaluate corneal morphology in vivo following intrastromal photorefractive keratectomy (D?RK) with the Nd:YLF picosecond laser, using the ultrasound biomicroscope.

MATERIALS AND METHODS: Myopic intrastromal PRK was performed in the anterior stroma of cat corneas with the neodymium:yttrium lithium fluoride (Nd:YLF) picosecond laser. Periodic examination of the treated corneas up to 6 months postoperative was performed with high resolution ultrasound biomicroscopy. Corneal thickness, depth of the laser patterns from the corneal surface, alignment of the laser treatment, extent of stromal opacification until resolution, and contour of the corneal surface were measured with the ultrasound biomicroscope throughout follow up.

RESULTS: The treated corneas were thickened on ultrasonic biomicroscopy measurement immediately after intrastromal PRK and revealed a densely echogenic shadow parallel to the corneal surface at the treatment site. There was increased stromal echogenicity denoting mild edema. The echoes decreased over time and appeared thinner at 2 months compared to the preoperative and immediate postoperative measurements. At 6-month follow up, the treated corneas were echolucent on ultrasonic biomicroscopy.

CONCLUSION: The ultrasound biomicroscope might become a helpful tool in assessing accuracy of treatment parameters of intrastromal PRK as well as in monitoring the response of the cornea to treatment. [J Refract Surg. 1995;11:448-452.]
Retrospective Comparison of Photorefractive Keratectomy and Radial Keratotomy
Authors: Hong Jeffrey C , Salz James J
Published: April 2021

ABSTRACT

BACKGROUND: The efficacy and predictability of photorefractive keratectomy and radial keratotomy become increasingly relevant. This retrospective study compares one surgeon's experience with photorefractive keratectomy and radial keratotomy over a 3-year period from 1990 to 1993.

METHODSî Photorefractive keratectomy was performed on 103 eyes of 76 patients that met the inclusion criteria for the phase Hb, phase HI, and phototherapeutic keratectomy studies as delineated by the United States Food and Drug Administration. Radial keratotomy was performed on 117 eyes of 81 patients with up to 9.00 diopters (D) of myopia.

RESULTS: In the photorefractive keratectomy group, 83% of the eyes achieved uncorrected visual acuity of at least 20/40; 37% saw 20/20; 88% had a refraction within 1.00 D of emmetropia, and 63% within 0.50 D of emmetropia. For the radial keratotomy group, 85% of the eyes achieved an uncorrected visual acuity of 20/40 or better; 27% saw 20/20; 88% had a refraction within 1.00 D of emmetropia; and 55% within 0.50 D of emmetropia. There were no serious complications, and only one single eye in each of the photorefractive keratectomy and radial keratotomy groups lost two lines or more of spectacle-corrected visual acuity.

CONCLUSION: Photorefractive keratectomy and radial keratotomy are both effective procedures, and result in similar refractive outcomes for myopia of -1.00 to -9.00 D. [J Refract Surg. 1995;11:477-484.]
Long-Term Stability of Refraction After Intrastromal Suture Correction of Hyperopia Following Radial Keratotomy
Authors: Lyle W Andrew , Jin George J C
Published: April 2021

ABSTRACT

BACKGROUND: Our first series of nine cases using circular and interrupted sutures for hyperopia from overcorrected radial keratotomy was reported 2 years ago. Additional cases and longterm follow up with this technique are presented here.

METHODS: Thirteen eyes of 12 patients with symptomatic hyperopia underwent corneal suturing with pursestring and interrupted sutures and were followed for 3 years. There were six original overcorrections and seven overcorrections after reoperation. The mean preradiai keratotomy refractive spherical equivalent refraction was -3.85±1.40 diopters (D).

RESULTS: The mean preoperative refractive spherical equivalent was +2.55±0.93 D (range -1-1.125 to +5.375 D). The mean follow up after the suturing procedure was 40±14.3 months with a range of 10 to 72 months. The change in refraction following suturing procedures averaged -1.84 D, resulting in an overall correction of 72% of the overcorrection. The mean increase of postoperative central keratometric power was 1.42*0.95 D. All eyes had reduction of hyperopia. Uncorrected visual acuity was improved from 0.367±0.11 (20/60) preoperatively to 0.712±0.25 (20/30+) postoperatively. The average improvement was 3.3 Snellen lines. Using the visual function score to assess the effectiveness of the procedure, we found 85% (11/13) of eyes obtained excellent or good results and 15% appeared fair or poor. In the 3 years since the study began, eight eyes had follow-up data from the previous study and the present study. During this period, an average change of refraction of only -0.19 D was observed. A refractive change less than 0.50 D was observed in 62.5% of the eyes, and all of the eyes had a refractive change within 1.00 D. There were no new complications and no loss of effect during the mean 43 months of follow up for those patients.

CONCLUSION: Based on the 3-year follow up, we concluded that intrastromal pursestring and interrupted techniques are stable, safe, and effective procedures for correcting hyperopia following radial keratotomy, especially for less than +3.00 D. [J Refract Surg. 1995;11:485-489.]
Laser in situ Keratomileusis for Myopic Astigmatism With the Nidek EC-5000 Laser
Authors: Payvar Saeed , Hashemi Hassan
Published: April 2021

ABSTRACT

PURPOSE: We studied the efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) for moderate to high simple and compound myopic astigmatism.

METHODS: Ninety-two eyes of 46 consecutive patients who had LASIK for myopic astigmatism (64 eyes, astigmatism 3.00 to 9.00 D; myopia 0 to -20.00 D), or simple myopia (28 eyes, myopia -4.00 to -20.00 D; astigmatism 0 to 0.50 D) were retrospectively studied. Mean baseline spherical equivalent refraction (SE) in the myopia group was -8.11 ± 3.94 D and in the astigmatism group, -8.55 ± 4.49 D. All eyes underwent LASIK using the Nidek EC-5000 laser by the same surgeon.

RESULTS: At 6 months after LASIK in the myopia group versus the astigmatism group, 24 eyes (85%) vs. 54 eyes (84%) were available for follow-up, 12 eyes (50%) vs. 13 eyes (24%) had uncorrected visual acuity (UCVA) of 20/20, 19 eyes (79%) vs. 44 eyes (81%) had UCVA of 20/40, 8 eyes (33%) vs. 18 eyes (33%) had SE within ±0.50 D, 15 eyes (62%) vs. 39 eyes (72%) had SE within ±1.00 D, and mean SE was -1.22 ± 1.17 D vs. -0.74 ± 1.46 D. Mean astigmatism (vertexed to the corneal plane) in the astigmatism group was 2.77 D at 0° before surgery and 0.32 D at 7° at 6 months. None of the myopic eyes and three of the astigmatic eyes (5%) lost ≥2 lines of best spectacle-corrected visual acuity.

CONCLUSION: LASIK with the Nidek EC-5000 laser for myopic astigmatism was reasonably effective, predictable, and safe. Astigmatism was undercorrected with the nomogram implemented in this study. [J Refract Surg 2002;18:225-233]
Treatment of Hyperopia: A New Ablation Profile to Reduce Corneal Eccentricity
Authors: Vinciguerra Paolo , Camesasca Fabrizio I
Published: April 2021

ABSTRACT

PURPOSE: Hyperopic treatment normally increases corneal eccentricity (the measure of corneal asphericity). Information derived from treating corneal white scars occurring after hyperopic ablations suggests that reducing corneal eccentricity through central corneal flattening followed by smoothing eliminates scarring and prevents its recurrence.

METHODS: We treated two groups of patients; Group 1 included 18 eyes of 18 patients with whitish corneal scar due either to photorefractive keratectomy (PRK) (n=16, 88.9%) or laser in situ keratomileusis (LASEK) (n=2, 11.1%). Mean preoperative spherical equivalent refraction was +1.20 ± 2.30 D, and mean corneal eccentricity was +1.2 ± 0.8. We performed phototherapeutic keratectomy (PTK) to achieve central corneal flattening and decrease corneal eccentricity, coupled with smoothing» using the Nidek EC-5000 excimer laser. Group 2 included 27 eyes of 27 consecutive patients with mean preoperative spherical equivalent refraction of +2.40 ± 1.30 D; these patients had laser epithelial keratomiieusus (LASEK) with the Nidek EC-5000 excimer laser. A new Nidek aspheric ablation profile with a wider optical zone (6.7 mm) and transition zone (9.5 to 10.00 mm) was applied.

RESULTS: In Group 1 eyes, the apical scar disappeared in all eyes. Postoperative spherical equivalent refraction was +1.8 ± 1.02 D and mean postoperative eccentricity was +0.9. In Group 2 eyes after 9 months of follow-up, mean postoperative spherical equivalent refraction was -0.30 ± 0.30 D, with no loss of lines of BSCVA. Low corneal eccentricity values were maintained, which created a gradual change in the rate of curvature.

CONCLUSIONS: The new Nidek profile for hyperopia treatment allowed successful refractive correction and maintained low eccentricity values that approached those of a normal cornea. [J Refract Surg 2002;18(suppl):S315-S317]
Cleaning Solutions as a Cause of Diffuse Lamellar Keratitis
Authors: Nakano Eliane Mayumi , Nakano Kozo , Oliveira Marivaldo Castro , Portellinha Waldir , Simonelli Rosangela , Alvarenga Lênio Souza
Published: April 2021

ABSTRACT

PURPOSE: To assess the capability of two microkeratome cleaning solutions in causing diffuse lamellar keratitis (DLK) in a rabbit model of laser in situ keratomileusis (LASIK).

METHODS: Two cleaning solutions (Palmolive 2:100 and Cidezyme 2:250) were tested. These solutions were diluted with balanced salt solution according to directions from the Hansatome microkeratome manual. Two additional solutions were prepared using an additional ten-fold dilution, creating a total of four study solutions. A LASffi flap was created in one eye each of 25 rabbits using the ALK Chiron microkeratome. The rabbits were divided into five study groups. The flaps were reflected and a drop of one of the study solutions (or BSS, control group) was placed on the interface. After 1 minute, the solution was washed out from the interface and the flap was repositioned. The eyes were examined at the slit lamp on postoperative days 1, 2, 3, 5, and 7.

RESULTS: In 12 eyes, a flap displacement was identified. Four eyes showed flap retraction and five others, epithelial ingrowth in flap margins. The incidence of these events did not differ among groups. Thirteen eyes were then evaluated for DLK. No DLK-like interface inflammation was seen in the studied eyes.

CONCLUSION: The cleaning solutions, when diluted as recommended by the microkeratome manufacturer, when in contact with the corneal stroma, and provided that the interface was washed with BSS did not cause DLK interface inflammation in rabbit LASDX models. [J Refract Surg 2002;18(suppl):S361-S363]
Butterfly Laser Epithelial Keratomileusis for Myopia
Authors: Vinciguerra Paolo , Camesasca Fabrizio I
Published: April 2021

ABSTRACT

PURPOSE: Decreased epithelial viability is a postoperative complication of standard laser epithelial keratomileusis (LASEK) that hampers rapid recovery, and causes reduced visual acuity as well as discomfort. We present a new LASEK technique that, by increasing epithelial viability, reduces the occurrence of these complications.

METHODS: In a preliminary series of patients, conventional LASEK was performed in one eye, and "Butterfly LASEK in the fellow eye. In Butterfly LASEK, a thin paracentral epithelial line, from 8 to 11 o'clock was removed, and 20% alcohol plus BSS 'solution was placed in contact with the cornea for 5 to 30 seconds. A specially designed spatula allowed separation of epithelium from Bowman's layer, proceeding from center to periphery on both sides. A special retractor was used to move the two flaps of loose epithelium toward the limbus. After drying the surface, excimer laser ablation was performed with the Nidek EC-5000 excimer laser. Smoothing with masking solution was then carried out, followed by flap replacement and overlapping.

RESULTS: We treated 70 eyes of 35 patients with Butterfly LASEK. Preoperative mean spherical equivalent refraction was -5.30 ± 3.70 D. At 12 months after surgery, mean spherical equivalent refraction was -0.10 ± 0.40 D, and no lines of BSCVA were lost. Ninety percent of patients preferred Butterfly LASEK to conventional LASEK because of increased comfort. At 12 months, no patient had more than trace haze, and in 96.2%, corneas were completely clear.

CONCLUSIONS: Butterfly LASEK is aimed at preserving the Iimbal connection of epithelial stem cells and Iimbal vascular connections. Improved epithelial viability is thus achieved, with faster postoperative recovery. [J Refract Surg 2002; 18(suppl):S371-S373]
Corneal Pharmacodynamics After Photorefractive Keratectomy and Laser in situ Keratomileusis in Rabbits
Authors: Maitchouk Dmitri , Smirennaia Elena , Kourenkov Vyacheslav
Published: April 2021

ABSTRACT

PURPOSE: To evaluate changes in corneal pharmacodynamics after PRK and LASIK in rabbits.

METHODS: Two groups of five rabbits (10 eyes) each received PRK and LASIK, and an unoperated third group was used as a control. Dexamethasone, efflumidex, diclofenac, and tobramycin were applied. Anterior chamber aqueous was collected every 20 minutes and analyzed by spectrophotometry. Histological studies were performed to find drug deposits in the cornea.

RESULTS: The coefficient of diffusion after PRK was determined for dexamethasone (3.2x10"* cm/min), efflumidex (1.4x10a4), diclofenac (7.4x10^), and tobramycin (5.4x10*). After LASIK, the coefficient of diffusion for dexamethasone was 3.4x1o*5; efflumidex, 1.7x10**; diclofenac, ß.ß???"6; and tobramycin, 2.4x1?-8 cm/min. Total time of passing through the cornea after PRK and LASIK was also measured: dexamethasone 45 and 70 min, efflumidex 50 and 115 min, diclofenac 60 and 200 min, and tobramycin 335 and 690 min. Histologically a drug deposit area was found in corneas after LASIK under the flap. In the control group, coefficient of diffusion for dexamethasone was 1.2x10 5 cm/min, efflumidex 1.5x10a8, diclofenac 6.4xl0"e, and tobramycin 2. Ix 10a*. Total time of passing through the cornea for the control group for dexamethasone was 60 min, efflumidex 105 min, diclofenac 160 min, and tobramycin 540 min.

CONCLUSIONS: Coefficient of diffusion increased after photorefractive surgery. [J Refract Surg 2002:18(suppl):S382-S384]
Higher Order Aberrations in Normal, Dilated, Intraocular Lens, and Laser in situ Keratomileusis Corneas
Authors: Miller Joseph M , Anwaruddin Raana , Straub Jochen , Schwiegerling Jim
Published: April 2021

ABSTRACT

PURPOSE: To compare repeated measures of Zernike polynomial higher-order aberrations in 29 normal, 13 dilated normal, 11 intraocular lens (IOL), 11 laser in situ keratomileusis (LASER), and one refractive keratectomy (RK)ZIOL subject.

METHODS: At least three Shack-Hartmann images were obtained from each subject, and higher order (uncorrectable by spectacles) Zernike representation was determined. For each subject, confidence intervals for each Zernike coefficient were determined as a function of pupil size. Significant (P<.05) coefficients were averaged within groups, and group means were compared to normal subjects.

RESULTS: No differences were seen between the normal and dilated groups at P=.05. The patients with prior LASEK and IOL surgery showed statistically significant elevation of 4th order spherical aberration and total wavefront variance for pupil sizes greater than 5 mm, compared to normals.

CONCLUSION: Both IOL and LASEK surgery elevate spherical aberration and wavefront variance, with increasing magnitude of effect with increasing pupil size, although pupillary dilation alone did not produce statistically different changes, as compared to normal subjects. These findings demonstrate that IOL implantation can produce more net aberrations than LASEK, and demonstrate a new opportunity to optimize surgical results. [J Refract Surg 2002;18:S579-S583]
Biomechanical Response of the Cornea to Phototherapeutic Keratectomy When Treated as a Fluid-filled Porous Material
Authors: Katsube Noriko , Wang Rentong , Okuma Emiko , Roberts Cynthia
Published: April 2021

ABSTRACT

PURPOSE: Surgical effect on corneal deformation has been traditionally analyzed based on the solid material assumption. We examine the validity of this assumption by treating the cornea as a fluidfilled porous material and separately modeling the solid and fluid constituents inside the cornea. In particular, the internal sub-atmospheric fluid pressure is treated as an important part of the mechanical loading in addition to the intraocular pressure.

METHODS: Finite element simulations of phototherapeutic keratectomy (PTK) were conducted with the cornea treated as a fluid-filled porous material, and through-the-thickness difference in swelling phenomena was taken into account. The results were compared with the same PTK simulations based on the solid material assumption of the cornea.

RESULTS: The PTK simulation results based on the fluid-filled porous material assumption demonstrated a significantly higher amount of unintended hyperopic shift compared to the results based on the traditional solid material assumption. The proposed approach qualitatively matched experimental observations.

CONCLUSIONS: The internal sub-atmospheric pressure significantly influenced corneal deformation. The simulation results based on the fluid-filled porous material assumption raise serious questions regarding the validity of existing models in corneal surgery, where the effect of the internal sub-atmospheric pressure on corneal deformations is neglected. [J Refract Surg 2002;18:S593-S597]
Aberration Generation by Contact Lenses With Aspheric and Asymmetric Surfaces
Authors: López-Gil Norberto , Castejón-Mochón José Francisco , Benito Antonio , Marín José María , Lo-a-Foe George , Marin Gildas , Fermigier Bruno , Renard Dominique , Joyeux Denis , Château Nicolas , Artal Pablo
Published: April 2021

ABSTRACT

PURPOSE: We explored the potential of aberration correction in the human eye by using a new generation of soft contact lenses with aspheric and asymmetric surfaces.

METHODS: Soft contact lens samples were designed with one asymmetrical surface (front) and one spherical (back) to produce predetermined amounts of desired pure defocus, astigmatism, trefoil, coma, and spherical aberration. Contact lens wavefront aberrations were measured ex vivo using a Fizeau-Tolanski interferometer and compared with the in vivo wavefronts obtained by subtracting the aberrations of the eye with and without the contact lenses. These second set of measurements were obtained using a Snack-Hartmann sensor.

RESULTS: We found that an aberration-free contact lens sample induced in the eye a small amount of residual aberration. We obtained a good match between the ex vivo and in vivo wavefront measurements for most of the samples of the contact lenses.

CONCLUSIONS: The aberrations generated by soft contact lenses on the eye were predictable. Rotations and translations of the contact lenses with respect to correct position on the eye were, however, the main limitation for precise correction of the ocular aberrations. [J Refract Surg 2002;18:S603-S609]