bluuebunny/crossref_metadata_2025 huggingface dataset:
Refractive Surgery for Hyperopia
Authors: Pershin Kirill B , Pashinova Nadezhda F
Published: April 2021

ABSTRACT

PURPOSE: To determine the efficacy, stability, and predictability of refractive surgery for hyperopia using four different procedures: photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), implantation of a phakic intraocular lens (PIOL), and removing the transparent lens with IOL implantation.

METHODS: We operated on 184 eyes with hyperopia; 56 eyes had less than +2.00 D (low hyperopia), 62 eyes had +2.00 to +5.00 D (moderate hyperopia), and 66 eyes had greater than +5.00 D (high hyperopia). In the low hyperopia group, PRK was used in 22 eyes and LASIK in 34 eyes. In the moderate hyperopia group, PRK was used in 12 eyes and LASIK in 33 eyes, PIOL implantation in 12 eyes, and transparent lens extraction with IOL implantation in 5 eyes. In the high hyperopia group, PRK was used in 7 eyes, LASIK in 12 eyes, PIOL implantation in 21 eyes, and extraction of transparent lens with IOL implantation in 26 eyes. We used the Nidek EC5000 excimer laser and with the Moria LASIK Evolution microkeratome. The transparent lens was removed by phacoemulsification, and the Phacoprofile Storz IOL with optical power from 28.00 to 36.00 D was implanted. The PIOLs were made of a collagen copolymer with a focal power from +6.00 to +12.00 D.

RESULTS AND CONCLUSION: Refraction and visual results depended on amount of baseline hyperopia and age of the patient. For young patients (35 years old or less) with normal accommodation and low or moderate hyperopia, PRK and LASIK were our methods of choice. However, after LASHL stabilization of refraction occurred faster (3 to 12 weeks) compared to PRK, where changes in refraction were noted from 8 to 12 months after surgery. In patients with hyperopia more than +5.00 D, we prefer intraocular methods of correction: phakic IOL implantation for young patients and removing the transparent lens with IOL implantation in patients with presbyopia or anatomical tendency for development of closedangle glaucoma. [J Refract Surg 2000;16(suppl): S242-S246]
Laser in situ Keratomileusis Following Acanthamoeba Keratitis
Authors: Lipshiz Isaac , Man Oran , Varssano David , Lazar Moshe , Loewenstein Anat
Published: April 2021

ABSTRACT

PURPOSE: Although data regarding reactivation of microbial corneal infections following LASIK is scarce, the use of excimer laser is known to be an efficient trigger for the reactivation of herpes simplex keratitis. With this in mind, the use of excimer laser, including LASIK, theoretically places the cornea at potential risk for reactivation of other microbial infections. Acanthamoeba keratitis is a severe, painful, sight-threatening infection most often associated with soft contact lens use. Treatment of Acanthamoeba keratitis is notoriously difficult, and despite prolonged administration of anti-protozoal agents such as polyhexamethylene, propamidine isethionate (Brolene), and neomycin, recurrence of the keratitis can occur. Postoperative reactivation following penetrating keratoplasty performed for visual rehabilitation in patients with previous Acanthamoeba keratitis has been documented, and LASIK, when performed on these patients, may raise concerns about the potential risk of reactivation of the infection.

METHODS: We report the case of a myopic patient with previous Acanthamoeba keratitis and corneal scarring who underwent LASIK without preoperative anti-protozoal prophylaxis.

RESULTS: During a 6-month follow-up period after LASIK, no recurrence of the infection was noted.

CONCLUSION: In our patient who previously suffered from Acanthamoeba keratitis and underwent LASDX, no reactivation of the infection was seen. [J Refract Surg 2000;16(suppl):S251-S252]
Corneal Endothelial Cell Damage After Experimental Diode Laser Thermal Keratoplasty
Authors: Wirbelauer Christopher , Koop Norbert , Tuengler Andreas , Geerling Gerd , Birngruber Reginald , Laqua Horst , Brinkmann Ralf
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the safety of diode laser thermal keratoplasty (LTK) with respect to corneal endothelial cell damage.

METHODS: In an in vitro animal model system, porcine eyes were irradiated with a continuously emitting laser diode at wavelengths (?) of 1.85 or 1.87 µta, corresponding to an absorption coefficient (µa) of 1.1 or 2.0 mm1. Different irradiation and application parameters were tested serially. To determine the temperature threshold for endothelial damage, corneal buttons were analyzed separately in a waterbath experiment. The endothelial damage was assessed after trypan blue and alizarin red supravital staining under light microscopy.

RESULTS: The thresholds for the 50% probability of thermal damage (ED50) were determined at corneal temperatures of 65° C for a 10-second water-bath immersion, and 59° C for 60 seconds. Coagulations that reached the deeper stromal layers revealed severe endothelial cellular alterations and areas of exposed Descemet's membrane. The thermally induced changes were dependent on laser power and the absorption coefficient (wavelength). Mean diameter of total endothelial cell damage was 245 ±154 µ?? (range, 0 to 594 µ??) for an absorption coefficient of 1.1 mm1. The maximal lateral extent of endothelial cell damage induced by the laser exposure was 594 µp? in diameter. Increasing the absorption coefficient decreased the penetration depth of the laser irradiation, creating a greater temperature rise within the corneal stroma and significantly less endothelial damage (P < .01), when the same laser power was applied. The calculated total area of damage for the paracentral human corneal endothelium ranged from 1.8% to 13.6%.

CONCLUSION: Data obtained in this in vitro study were transferred to an endothelial cell damage nomogram, demonstrating that appropriate parameter improvements can minimize the adverse effects to the corneal endothelium. However, model adjustment to the human cornea indicates the potential for endothelial cell damage after diode laser thermal keratoplasty, and should be considered when performing this elective procedure. [J Refract Surg 2000;16:323-329]
Keratectasia Induced by Laser in situ Keratomileusis in Keratoconus
Authors: Schmitt-Bernard Clair-Florent M , Lesage Cécile , Arnaud Bernard
Published: April 2021

ABSTRACT

PURPOSE: Corneal thinning disorders weaken the mechanical strength of affected corneas, suggesting that photorefractive procedures may be contraindicated in keratoconus. Few cases have been reported to confirm this hypothesis.

METHODS: A 45-year-old man had two laser in situ keratomileusis (LASIK) procedures and one photorefractive keratectomy (PRK) performed on his left eye, and three LASIK procedures on his right eye. After these surgeries, a dramatic corneal ectasia and gl'ade III haze occurred in both eyes, with a clinical diagnosis of keratoconus. The changes in his corneas were followed with videokeratography and slit-lamp microscopy.

RESULTS: Preoperative videokeratograph of both eyes suggested keratoconus. After multiple refractive procedures, the best spectacle-corrected visual acuity was as low as 20/1200 bilaterally. Both eyes displayed dramatic corneal protrusion with corneal scarring.

CONCLUSIONS: This case emphasizes the need for preoperative corneal thickness measurement and detailed analysis of videokeratographs. Thinning corneal disorders such as keratoconus, keratoconus suspects, or pellucid marginal degeneration are a contraindication for excimer laser ablative refractive procedures. [J Refract Surg 2000;16:368-370]
Partial Dislocation of Laser in situ Keratomileusis Flap by Air Bag Injury
Authors: Lemley Heath L , Chodosh James , Wolf Thomas C , Bogie Charles P , Hawkins Thomas C
Published: April 2021

ABSTRACT

PURPOSE: A patient developed significant corneal complications from air bag deployment, 17 months after laser in situ keratomileusis (LASIK).

METHODS: Case report, slit-lamp microscopy, and review of the medical literature.

RESULTS: A 37-year-old woman underwent bilateral LASIK with resultant 20/20 uncorrected visual acuity. Seventeen months later, she sustained facial and ocular injuries from air bag deployment during a motor vehicle accident. Examination revealed bilateral corneal abrasions, partial dislocation of the right corneal LASIK flap, and a hyphema in the right eye. The LASIK flap was realigned, but recovery was complicated by a slowly healing epithelial defect and flap edema. One month following the injury, epithelial ingrowth beneath the LASIK flap was noted. Surgical elevation of the flap and removal of the epithelial ingrowth was performed. Eight months later, epithelial ingrowth was absent and the visual acuity was 20/40. Residual irregular astigmatism necessitated rigid gas permeable contact lens fitting to achieve 20/20 visual acuity.

CONCLUSIONS: Air bags may cause significant ocular trauma. The wound healing response of LASIK allows corneal flap separation from its stromal bed for an indeterminate time after surgery. Discussion of the possible risk of corneal trauma as part of informed consent prior to LASIK may be appropriate. [J Refract Surg 2000;16:373-374]
Surgically-induced Astigmatism After Laser in situ Keratomileusis for Spherical Myopia
Authors: Huang David , Sur Steven , Seffo Firas , Meisler David M , Krueger Ronald R
Published: April 2021

ABSTRACT

PURPOSE: To characterize the surgicallyinduced-astigmatism (SIA) associated with spherical LASIK.

METHODS: Refractive outcomes in 70 eyes that underwent primary myopic LASIK with purely spherical ablation were analyzed. The Summit Apex Plus excimer laser was used. The Bausch & Lomb Hansatome with the 180-µ?? plate was used to produce superiorly hinged flaps. The relationship between refractive astigmatism and corneal topographic astigmatism was analyzed using linear regression and vector analysis.

RESULTS: There was a statistically significant negative correlation (slope = -0.21) between refractive surgically-induced astigmatism and preoperative topographic cylinder. A 0.24-D with-the-rule shift was also found. Surgically-induced astigmatism was not correlated with the magnitude of laser ablation.

CONCLUSION: The lamellar keratotomy portion of LASIK reduces pre-existing corneal astigmatism and produces a relative steepening of the hinge meridian. [J Refract Surg 2000;16:515-518]
Principles of Ray Tracing Aberrometry
Authors: Molebny Vasyl V , Panagopoulou Sophia I , Molebny Sergiy V , Wakil Youssef S , Pallikaris Ioannis G
Published: April 2021

ABSTRACT

PURPOSE: Of all transforms of an eye, aberrations are significant when higher visual acuity is to be achieved. Ray tracing aberrometry developed by the Institute of Biomedical Engineering (Kiev) and first tested at the Vardinoyannion Eye Institute of Crete is a promising technique for eye refraction aberration and refraction mapping.

METHODS: The technique uses measurement of the position of a thin laser beam projected onto the retina. The beam is directed into the eye parallel to the visual axis. Each entrance point provides its own projection on the retina. A set of entrance points forms a set of projections. From these data, a refraction map is reconstructed as well as a point spread function of the eye. The total time of scanning over the whole aperture of the eye is within 10 to 20 ms and depends on the number of test points at the eye entrance, as well as on the number of independent measurements in each point. Configuration of the scanning pattern can be chosen by the operator. It may contain 60 to 400 points, each checked 1 to 5 times.

RESULTS: Preliminary studies showed high reproducibility of results. Twenty Pseudophakie eyes were subjected to 30 consecutive measurements each. Ninety-five percent of all measured values were within ±0.20 D of declination from the mean.

CONCLUSIONS: Ray tracing aberrometry is a flexible technology for eye investigation. It can be adapted to any laser technique of vision correction Its further development should be oriented on laser-linked applications of the refraction driven refractive surgery. [J Refract Surg 2000;16: S572-S575]
Slit Skiascopic-guided Ablation Using the Nidek Laser
Authors: MacRae Scott , Fujieda Masanao
Published: April 2021

ABSTRACT

PURPOSE: To present the approach of using a scanning slit refractometer (the ARK 10000) in conjunction with a corneal topography system to guide customized corneal ablation. This diagnostic system is coupled with the Nidek EC-5000 system which combines scanning slit and a scanning small area ablation (1.0 mm) to perform a customized ablation.

METHODS: The ARK 10000 diagnostic system which contains a scanning slit refractometer is described. Information generated from the ARK 10000 wavefront sensor and corneal topography system can be coupled to the new Nidek EC-5000 excimer laser system, which combines the larger area of scanning slit ablation with the small area (1.0 mm) ablation.

RESUETS: The Nidek ARK 10000 diagnostic system captures wavefront information using a retinoscopic system which is converted into a refractive power map. This is different from other autorefraction systems in that it has four sensors at different diameters of the cornea and captures 1440 points in 0.4 seconds. This map is used in conjunction with corneal topography-captured simultaneously. This information is then combined to perform a customized ablation using the new Nidek EC-5000 system.

CONCLUSIONS: The ARK 10000 diagnostic system represents a different approach to customized ablation in that it combines a corneal topography system with a wavefront system and a larger treatment area of the traditional scanning slit ablation with a new small area ablation treatment for greater efficiency. [J Refract Surg 2000;16: S576-S580]
Operative Correction of Ocular Aberrations to Improve Visual Acuity
Authors: Seiler Theo , Mrochen Michael , Kaemmerer Maik
Published: April 2021

ABSTRACT

PURPOSE: Optical aberrations of the human eye degrade the quality of the retinal image and may, therefore, represent a major limit of visual acuity.

METHODS: In 15 eyes, ocular aberrations were corrected in addition to myopia and astigmatism by means of wavefront-guided laser in situ keratomileusis (LASIK).

RESULTS: At 1 month after surgery, a supernormal visual acuity of 20/10 and better was obtained in 4 eyes (27%). The increase in root mean square wavefront error ranged from 0.6 to 2.3 and was significantly correlated with the increase in visual acuity (R
p 2
= 0.79; P - .03).

CONCLUSION: Although the correction of aberrations was not yet optimal, these results show that ocular optical aberrations limit visual acuity in humans and supernormal visual acuity can be achieved by operative correction. [J Refract Surg 2000;16:S619-S622]
Line of Sight and Alternative Representations of Aberrations of the Eye
Authors: Klein Stanley A , Garcia Daniel D
Published: April 2021

ABSTRACT

Several methods for representing pupil plane aberrations based on wavefront height, slope, and curvature are discussed. The choice of reference axis and reference surface is shown to strongly affect the appearance of the representation. Special attention will be paid to the use of the line of sight (the line from the fixation point to the center of the pupil) as the reference axis. We show that the line of sight is ambiguous and does not determine the amount of prism in the wavefront. [J Refract Surg 2000;16:S630-S6351
Muscular Asthenopia and Eccentric Ablation After Photorefractive Keratectomy
Authors: Wu Guoen , Xie Lixin , Yao Zhan
Published: April 2021

ABSTRACT

PURPOSE: To investigate the relationship between muscular asthenopia and eccentric ablation after photorefractive keratectomy (PRK).

METHODS: Sixteen eyes of eight myopic patients whose muscular asthenopia was corrected by subjectively accepted spectacle prism after PRK, with visual acuity better than 0.8, were followed for 6 to 14 months. On the basis of preoperative and postoperative data and corneal topography, we calculated the total corrected corneal power using the Holladay formula and then measured the ablation eccentricity (h, millimeters) and its direction. According to the formula δ ≅ Dh, the prism effective value (δ) caused by the eccentric ablation was computed and compared with the objectively accepted spectacle prism.

RESULTS: The subjectively accepted spectacle prisms were similar to calculated values from the formula. Mean difference was 0.10 ± 0.25^sup Δ^. The direction of the subjectively accepted prism was in the direction of the ablation deviation.

CONCLUSIONS: Eccentric ablation is an important cause of muscular visual asthenopia after PRK. The asthenopia may be corrected by spectacle prism. The spectacle prism value may be estimated by the formula δ ≅ Dh. [J Refract Surg 2001;17:380-382]
New Instrument: An Assembly Alignment Block for the Ocutome
Authors: Christensen Gerald R
Published: April 2021

SUMMARY

We have constructed a simple alignment system which allows the cutting components of the Ocutome to be assembled without touching the sharpened edges to other parts of the instrument.
Use of Healon in Anterior Segment Trauma
Authors: Rashid Edward R , Waring George O
Published: April 2021

SUMMARY

Healon can assist in the repair of penetrating segment injuries by maintaining a deep anterior chamber that allows easier suturing of the wound and easier repositioning of the iris, by protecting the corneal endothelium during surgery, and by separating peripheral iridocorneal adhesions. We describe this technique in repair of an eye with a limbus-to-limbus corneal laceration.
Lensectomy-Vitrectomy for Stage V Cicatricial Retrolental Fibroplasia
Authors: Merritt John C , Lawson Edward E , Sprague David H , Eifrig David E
Published: April 2021

SUMMARY

Ten infants (18 eyes) blind from stage V cicatricial retrolental fibroplasia were examined from January 1978 to January 1981 at North Carolina Memorial Hospital. The early perinatal factors which may have predisposed to the blinding end-stage cicatrix are identified. To increase their visual potential and to prevent secondary angle closure glaucoma, 12 lensectomy-vitrectomies were performed on 12 eyes (eight infants). One eye (one infant) had a pars plana vitrectomy without lensectomy. Seven eyes (seven infants) were not operated. Five of these eyes five infants) had stage V RLF while two eyes (two infants) remained stable at stage II RLF. All retinas remained detached immediately after surgery. Secondary vitrectomies with air injections (three eyes, two infants) similarly failed to attach any retinas. Adherence of ciliary epithelium to clear lens and retrolental membrane as visualized within the dilated pupil (Eifrig-Merritt sign) was an intra-operative indicator of imminent surgical failure. Two eyes (two infants) developed early vitreous hemorrhages, hyphemas, secondary glaucoma, and phthisis bulbi within 12 months. Follow-up data were unavailable on two infants. Blindness secondary to cicatricial retrolental fibroplasia is increasing due to increased survival of low birth-weight premature infants. Since surgical visual rehabilitation is not possible after the retrolental cicatrix has formed, the risk factors common to this high risk population should prompt preventive therapies.
Spontaneous Repair of the Medial Canthus After Removal of Basal Cell Carcinoma
Authors: Fier Robert H , Older J Justin
Published: April 2021

SUMMARY

Basal cell carcinomas are the most common form of malignant eyelid tumors and occur frequently in the medial canthus. Repair of the resulting defect by spontaneous granulation yields a good cosmetic result. This alternative technique provides advantages over skin flaps and grafts.
Late Hyphema After Filtering Surgery for Glaucoma
Authors: Wilensky Jacob T
Published: April 2021

SUMMARY

Four eyes of three patients developed spontaneous hyphemas eight months to three years after uncomplicated glaucoma filtering surgery. In two of the four eyes abnormal vessels could be seen at the internal margin of the trabeculectomy opening. Argon laser photocoagulation was successfully used to treat the bleeding, although one eye required multiple sessions.
The Cornea Press: Restoring Donor Corneas to Normal Dimensions and Hydration Before Cryolathing
Authors: Safir Aran , McDonald Marguerite B , Klyce Stephen D , Werblin Theodore P , Kaufman Herbert E
Published: April 2021

SUMMARY

The shaping of swollen, abnormally hydrated donor corneal tissue on the cryolathe for use in keratorefractive surgery yields lenticules of insufficiently predictable dioptric powers. The irregular nature of this abnormal hydration precludes the use of mathematical compensating factors. To improve control over the shape of the lenticule, we have developed a cornea press which restores normal hydration and dimensions to the donor tissue by mechanical dehydration.
The Use of a Monacle for Ptosis
Authors: Pfoff David S , Sherbok Bernard C
Published: April 2021

SUMMARY

For correcting ptosis, the authors recommend the use of a monade frame in order to raise the eyelid.
Use of the Shaw Scalpel in Ophthalmic Surgery
Authors: Moazed Kambiz T , Trokel Stephen L
Published: April 2021

SUMMARY

A resistively heated scalpel (Shaw scalpel) was used in ten patients for orbital and lid surgical procedures. The blade temperature is set from 110° to 2700C producing a remarkable hemostatic effect with minimal thermal damage to the incision margins. The instrument has proven useful in preserving a good view of the anatomyduring dissection and specifically it simplifies excision of orbital fat in blepharoplasty and orbital decompressions for Graves' orbitopathy. Significant shortening of surgical procedures was appreciated in all cases.
A Comparison of Etidocaine and Lidocaine for Retrobulbar Anesthesia
Authors: Smith Porter H , Smith Emil R
Published: April 2021

SUMMARY

In this double-blind study of retrobulbar block for cataract surgery, 62 patients scheduled for cataract surgery were randomly assigned to treatment with either (1) lidocaine 2% with epinephrine 1:200,000 (21 patients); (2) etidocaine 1% plain (20 patients); or (3) etidocai ne 1% with epinephrine 1:200,000 (21 patients). The time of onset of sensory and motor block after administration of the three drugs was the same. The duration of motor nerve block produced by etidocaine plain and by etidocaine with epinephrine was considerably longer than that produced by lidocaine with epinephrine, and fewer patients reported postoperative pain after either etidocaine plain or etidocaine with epinephrine than after lidocaine with epinephrine.
Two-Stage Neodymium-YAG Laser Trabeculotomy
Authors: Weber Paul A , Keates Richard H , Opremcek E Mitchell , Kapetansky Frederick M , Szymanski Carol
Published: April 2021

SUMMARY

A preliminary report of a newly devised glaucoma operation is presented. This procedure combines a non-penetrating trabeculectomy with Neodymium:Yitrium-Aluminum-Garnet (Nd:YAG) trabeculotomy. This thus creates a through and through filtration under a scleral flap without actually entering the anterior chamber.
Cicatricial Ectropion Secondary to Herpes Zoster
Authors: Nasr Amin M , Bayer-Machule Charles K , Yeatts R Patrick
Published: April 2021

SUMMARY

We present three patients with cicatricial ectropion of the upper and lower lids secondary to herpes zoster. Surgical release of the lid traction, excision of scars, and full thickness skin grafting were performed with satisfactory results.
Toxicity of Intravitreally Administered Alpha-Interferon
Authors: Dharma Shashi K , Peyman Gholam A , Vernot Jackie , Fiscella Richard
Published: April 2021

ABSTRACT

We studied the toxicity of single doses of intravitreally administered alpha-interferon in albino rabbits. Doses of 420.000, 210,000, 105,000, 52,500 , and 26,250 units/0.1 cc showed no significant histologic changes by light microscopy or altered retinal function assessed by photopic and scotopic electroretinography.
The Intraocular Penetration of Acyclovir After Subconjunctival Administration
Authors: Schulman Joel , Peyman Gholam A , Liu John , Scott Mark , Barber John C
Published: April 2021

ABSTRACT

Five patients received a subconjunctival injection (25 mg) of acyclovir before undergoing scheduled enucleation. Seven hours after injection, the observed aqueous and vitreous levels of acyclovir were above the minimum inhibitory concentrations for many herpes simplex viruses types 1 and 2. Systemic absorption measured at two and seven hours after injection was negligible.
Late Onset, Progressive, Peripheral Anterior Synechiae With Posterior Chamber Intraocular Lenses
Authors: Van Buskirk E Michael
Published: April 2021

ABSTRACT

Four eyes of three patients who had had posterior chamber intraocular lens implantation developed peripheral anterior synechiae overlying the lens haptics many months after the original implantation. The synechiae progressed over time, but a portion of the chamber angle remained open in all cases. Two of the three patients had had an underlying open-angle glaucoma and were on pilocarpine therapy prior to the implantation surgery. The exacerbation of their glaucoma from new peripheral anterior synechiae required advancement in medical therapy in three of four eyes with the fourth requiring filtration surgery. Patients with posterior chamber intraocular lenses should have gonioscopy preoperatively and on a regular basis following implantation surgery.
Proliferative Sickle Cell Retinopathy Under Age 20: A Review
Authors: Kimmel Andrew S , Magargal Larry E , Maizel Ray , Robb-Doyle Eileen
Published: April 2021

ABSTRACT

Of the 256 sickle patients with hemaglobinopathies SC, SS and S-thal referred to the Wills Eye Hospital Retina Vascular Service from 1966 through 1983, 64 (50%) of the 128 males and 71 (55%) of the 128 females were less than 20 years old. Proliferative sickle retinopathy (PSR) was documented by fluorescein angiography in five of the males (8%) and two of the females (3%) under age 20. Included in this series is a 13-yearold black girl with homozygous sickle cell anemia (HbSS), to our knowledge the youngest reported case of PSR in an SS patient. This report emphasizes the importance of ophthalmic examinations in teenage sickle patients to detect and treat proliferative disease.
Pre- and Postoperative Therapy in Cataract Extraction
Authors: Mizuno Katsuyoshi , Miyake Kensaku
Published: April 2021

ABSTRACT

This review is an update on the subjects directly or indirectly concerning pre- and postoperative therapy in cataract extraction. Topics were selected from those which the authors thought to be significant mainly from the clinical point of view. The review covers antiprostaglandins therapy, intraocular lens, Nd-YAG laser and others. The authors briefly summarize the latest trends in the above topics and give critical comments.
Transscleral Iridotomy Using a Neodymium:YAG Laser Operated Both With Standard Equipment and an Optical Fiber System - A Preliminary Report: Part I - Optical System and Biomicroscopic Results
Authors: Rol Pascal , Kwasniewska Sylwia , van der Zypen Eugen , Fankhauser Franz
Published: April 2021

ABSTRACT

The effects upon the iris of radiation emitted by a Nd:YAG laser working in its thermal (free-running) mode and transmitted through the sclera were studied. The advantages and disadvantages of a fiber optic system, as compared to a conventional optical system, were studied using eight autopsy eyes. It was shown that the conventional optical system as well as a fiber optic system are both able to perforate the iris completely and to blast away or destroy the pigment epithelium. One merit of the fiber optic system as compared to the conventional system is that it requires considerably less energy for the same effect. This is partially because the sclera, when compressed, becomes more transparent and thus transmits a greater amount of laser energy.
A Bent-Tipped Endolaser Probe
Authors: Peyman Gholam A
Published: April 2021

ABSTRACT

I have developed a bent-tipped probe for endolaser photocoagulation that facilitates treatment near the entry site of the instrument.
Filtration Surgery in Black Patients: Early Results in a West Indian Population
Authors: Shingleton Bradford J , Distler John A , Baker Ben H
Published: April 2021

ABSTRACT

We reviewed the early results of 80 filtration procedures when used as the initial surgical treatment in a Saint Lucian West Indian black population with primary open angle glaucoma. Two techniques were used: trabeculectomy under a scierai Bap with fornix-based conjunctiva! flap (Group 1) and full thickness posterior lip sclerectomy with limbal-based conjunctíval flap (Group 2). Postoperatively, with an average follow-up of six months, Group 2 had significantly lower intraocular pressures, reduced glaucoma medication requirements, and increased cystic bleb formation. Vision did not differ significantly between the two groups postoperatlvely, although two Group 1 patients developed progressive glaucomatous visual loss. Complications were slightly more frequent in Group 2. The results of this study suggest that a full thickness sclerectomy technique merits consideration as the initial filtration procedure of choice in West Indian blacks with advanced open angle glaucoma.
The Use of Sodium Hyaluronate (Hyalcon) for the Removal of Severely Subluxated Lenses
Authors: Toczolowski Jerzy R
Published: April 2021

ABSTRACT

Sodium hyaluronate (Hyalcon) was used for the removal of severely subluxated lenses in six patients. Sodium hyaluronate injected into the vitreous beneath the lens caused the lens to elevate and stabilize within the pupil area, where it was protected by the viscous preparation from total luxation. The procedure greatly facilitates the removal of the lens by one of the commonly used methods.
Peripheral Multifield Scanning Fluorescein Angiography for the Evaluation of Proliferative Sickle Cell Retinopathy
Authors: Stephens Robert F , Magargal Larry E
Published: April 2021

ABSTRACT

Evaluation of proliferative sickle cell retinopathy requires detailed studies of the retina periphery, including pre-treatment documentation of active neovascular (sea fan) lesions. Multifield angiography of the periphery (MAP) is recommended for the analysis of these lesions. This method is also valuable for the pre- and post-treatment quantitative angiographic evaluation of peripheral circumferential retinal scatter photocoagulation (PCRP).
Cost-Effective Cataract Surgery in Developing Nations
Authors: Schwab Larry
Published: April 2021

ABSTRACT

Today approximately twenty million people are blind (visual acuity less than 3/60 [10/20O]) and tens of millions more are visually disabled (visual acuity less than 6/18 [6/6OB from cataract. Most of these people live in impoverished developing nations. The logistics of providing cataract surgical care for them are complex. Simplifying the cataract operation, employing appropriate technology, and training non-physicians in intraocular surgery is efficient cost-effective strategy in many developing African nations.
Diagnosis and Therapeutic Surgery of the Uvea - Part II: Results
Authors: Peyman Gholam A , Schulman Joel , Raichand Motilal
Published: April 2021

ABSTRACT

Fifty-five patients underwent eye wall biopsy (11) or eye wall resection (44). Eye wall resection was performed for suspected melanoma in 42 cases and large von Hippel angiomas in an additional two patients.

Two of the 35 individuals with choroidal melanoma died, representing a 5.7% mortality rate over a mean follow-up period of more than five years. Visual acuity, ocular morbidity, and tumor-associated deaths in this series are compared with results using other treatment modalities for choroidal melanoma.
A New Suturing Method for the Treatment of Giant Retinal Tear
Authors: Nishi Okihiro , Ideta Hidenao
Published: April 2021

ABSTRACT

We report a new method for suturing the retina to the ocular wall when this is required for treatment of retinal detachment due to giant retinal tear. After closed vitrectomy, one of two ski-shaped needles (2.8 mm long and 0.4 mm thick) with an 8-0 nylon thread is introduced from a 1.4 mm scleral incision in the pars plana, advanced under direct observation through the retinal flap, and led extraocularly to an appropriate site in the opposite ocular wall. The second needle is advanced similarly through the same scleral incision and exited from the opposite ocular wall. The thread is then tied extraocularly on the sclera. The retinas of two patients were successfully reattached using this procedure in combination with encircling and the use of SF6 gas and air.
Paranasal Sinusitis, Orbital Abscess, and Inflammatory Tumors of the Orbit
Authors: Reidy James J , Giltner James , Apple David J , Anderson Richard L
Published: April 2021

ABSTRACT

We present the clinical, radiological, and histopathological findings from a case of unilateral inflammatory mass of the right orbit, originating in the ipsilateral paranasal sinuses. A connection between inflammatory tumors of the orbit and paranasal sinusitis has been suspected for many years. This case shows a definite association between chronic paranasal sinusitis, orbital cellulitis, subperiosteal abscess, and formation of an inflammatory orbital tumor. Early diagnosis combined with appropriate therapeutic measures is essential in order to prevent adverse consequences, which can include severe visual loss.
Long-Term Follow-up of Photocoagulated Choroidal Neovascular Membranes in Age-Related Macular Degeneration
Authors: Jalkh Alex E , Nasrallah Fadi , Trempe Clement L , McMeel J Wallace , Weiter John J , Schepens Charles L
Published: April 2021

ABSTRACT

Eighty-nine consecutive eyes with age-related macular degeneration and choroidal neovascularization treated with green argon laser were followed for an average of 54 months after photocoagulation. Good anatomical and functional results were obtained in 36 of 52 eyes (69%) with foveal new vessels, in 12 of 20 eyes (60%) with juxtafoveal new vessels, and in 13 of 17 eyes (76%) with perifoveal new vessels. Thirty-four of the 89 eyes (38%) had at least one recurrence of new vessels, which most often affected the edge of the previously treated area (30 eyes, 34%). In 18 eyes (20%), these recurrences involved the edge of the scar closer to the fovea.
Evaluation of an Absorbable Muscle Sleeve to Limit Postoperative Adhesions in Strabismus Surgery
Authors: Sondhi Naval , Ellis Forrest D , Hamed Latif M , Helveston Eugene M
Published: April 2021

ABSTRACT

A muscle sleeve fashioned from polyglactin 910 Vicryl* mesh was used in a rabbit animal model to evaluate its efficacy in decreasing postoperative adhesions encountered in extraocular muscle surgery. Clinical observations, as well as gross and histological comparison of the experimental and control groups, revealed a significant reduction in postoperative adhesions under conditions of normal surgical trauma. Where there was extensive trauma, however, no significant reduction was observed. No evidence of toxicity of the material to ocular tissues was found.
Conjunctival Flaps Revisited
Authors: Insler Michael S , Pechous Bryan
Published: April 2021

ABSTRACT

Thirty-three patients received a conjunctival flap for corneal diseases recalcitrant to medical therapy. Twenty-five of them received a total hood flap, and eight a partial conjunctival flap. Persistent corneal ulceration secondary to treated bacterial or viral ulcers accounted for more than 50% of these cases. Eleven of the 33 patients had undergone prior penetrating keratoplasty and received conjunctival flaps when the grafts completely failed despite medical management. Nine of the 33 underwent penetrating keratoplasty an average of 14.8 months following the flap procedure; the visual acuity of eight of these patients improved.
Use of Healon in Different Cataract Surgery Techniques: Endothelial Cell Count Study
Authors: Alpar John J
Published: April 2021

ABSTRACT

The effect of the intracameral application of 1% sodium hyaluronate (Healon®) in various cataract extraction techniques was evaluated in four groups of ten cats each whose natural lenses were removed using four different techniques. In a fifth group, the intraocular lenses (IOLs) were implanted over the crystalline lens. Each animal's right eye was treated with Healon and each left eye with balanced salt solution (BSS®). Healon-treated eyes lost almost 50% fewer endothelial cells and had a smaller increase in corneal thickness than their counterpart eyes treated with BSS. Lens implantation and phacoemulsification procedures caused the greatest endothelial cell loss, while neodymium YAG laser capsulotomy, a less traumatic procedure, minimized this loss.
Cornea Fistula
Authors: Musco Paul S , Aquavella James V
Published: April 2021

ABSTRACT

We report a case of corneal fistulization which developed following acute hydrops in a patient with keratoconus. Treatment with thermokeratoplasty yielded good visual results. Corneal rupture and fistulization occurring after acute hydrops has been unreported. This case illustrates the need to be alert to these complications.
Idiopathic Central Serous Retinopathy in China: A Report of 600 Cases (624 Eyes) Treated by Acupuncture
Authors: Lu Ji-Guang , Friberg Thomas R
Published: April 2021

ABSTRACT

Six hundred Chinese patients (624 eyes) with clinically diagnosed central serous retinopathy were treated by consecutive courses of acupuncture. Eighty-six percent of patients had resolution of their subretinal fluid within 3 months of treatment, a result similar to the natural history of the disease as reported by others in non-Chinese patients. Central serous retinopathy was most common in the 30 to 50 year age group, occurred in males seven times more frequently than in females, and was bilateral in 4% of patients.
Enlargement of Melanocytic Iris Lesions
Authors: Territo Carla , Augsburger James J , Schroeder Robert P , Shields Jerry A
Published: April 2021

ABSTRACT

We evaluated the natural history of 175 melanocytic lesions (nevus or melanoma) of the iris which were managed initially by observation without surgical intervention. Only eight of the 175 lesions (4.6%) enlarged during a median follow-up interval of 3.9 years. Univariate Cox regression analysis revealed that tumor location in the medical portion of the iris (P = 0.047) and pigment dispersion from the lesion onto the adjacent iris and trabecular meshwork (P = 0.056) were the only significant clinical conditions predictive of tumor enlargement. Based on these findings, we recommend conservative management of most melanocytic lesions of the iris.
Trabecular Precipitates and Elevated Intraocular Pressure Following Argon Laser Trabeculoplasty
Authors: Fiore Philip M , Melamed Shlomo , Epstein David L
Published: April 2021

ABSTRACT

Two patients with pseudoexfoliation glaucoma underwent argon laser trabeculoplasty for control of intraocular pressure. Within 1 month both patients developed elevated intraocular pressure associated with many large inflammatory precipitates on the trabecular meshwork detected only by gonioscopy. Treatment with topical steroids for 7 to 10 days resolved these precipitates and lowered the intraocular pressure. We believe our patients had severe trabeculrtis occurring as a late reaction to argon laser trabeculoplasty. An increase in intraocular pressure following trabeculoplasty warrants careful gonioscopic examination; in fact we recommend routine gonioscopy for all patients after laser treatment.
Project Canvas-Back in the Marshall Islands
Authors: Wessels Izak F , Markoff David D , Miller Gordon
Published: April 2021

ABSTRACT

Using the catamaran boat "Canvas-Back" during May 1987, a whole-population ocular survey utilizing modern equipment and ophthalmic subspecialists was conducted on one of the atolls (Wotje) in the Marshall Islands. A relatively low prevalence of ocular pathology, especially of cataract, infectious disease, and nutritional blindness was found. A far greater need exists for refractive services than for surgical ophthalmic care. The only exception is related to the high incidence of hyperglycemic, which indicates that greater efforts in the treatment and prevention of retinopathy are required.
Transscleral Fixation of Posterior Chamber Intraocular Lenses in the Absence of Capsular Support
Authors: Lindquist Thomas D , Agapitos Peter J , Lindstrom Richard L , Lane Stephen S , Spigelman Alan V
Published: April 2021

ABSTRACT

We present results obtained by transscleral ciliary sulcus fixation of posterior chamber intraocular lenses in secondary implantation, lens exchange, and in primary implantation of transsclerally fixated lenses during complicated cataract extraction. Follow-up data on 38 patients, 17 of whom have been followed for more than 12 months, are included. We conclude that the procedure is safe, effective, and predictable.
Repair of the "Microdehiscence" To Correct Postkeratoplasty Astigmatism
Authors: Buzard Kurt A
Published: April 2021

ABSTRACT

A common peripheral abnormality, which I call "microdehiscence," can in some cases cause the progressive central astigmatism that commonly follows penetrating keratoplasty. The results of a small clinical study show that placing additional suture(s) in this situation can permanently correct such astigmatism.
Intraoperative Application of 5-Fluorouracil During Trabeculectomy
Authors: Dietze Paul J , Feldman Robert M , Gross Ronald L
Published: April 2021

ABSTRACT

We report the preliminary results of the first 20 consecutive cases in which the antimetabolite 5fluorouracil (5-FU) was applied directly beneath the conjunctival flap during trabeculectomy in high-risk patients. Seventeen were considered early successes, with 3-month postoperative intraocular pressures less than 21 mm Hg, representing at least a 20% decrease from preoperative values. Successful blebs were pale, with conjunctival microcysts and without significant vascularization over the trabeculectomy site, similar to the appearance of blebs in eyes administered postoperative subconjunctival injections of 5-FU. There were no cases of corneal epithelial defects, and no eyes had lost more than one line of preoperative vision at the time of last follow up. Although the longer term efficacy of this method is unknown, these results suggest that it may represent a safe and effective alternative for administering 5-FU.
The Early Cell Kinetic Response During Healing of Corneal Epithelial Wounds
Authors: Haaskjold Erling , Sandvig Kjell U , Bjerknes Rolf , Kravik Katherine
Published: April 2021

ABSTRACT

The labeling index and the mitotic rate were measured at 4-hour intervals during the first 24 hours after a central abrasion had been made in the corneal epithelium of six groups of four rats each. The proliferative response was noted in the conjunctival, the limbal, and the corneal epithelium. After 24 hours, the density of epithelial cells was equal throughout the corneal epithelium, but there was only half the normal number of cells. Physiological mechanisms seem strongly to regulate the total number of cells per square unit throughout the healing corneal epithelium, but the nature of these mechanisms is unknown.
The Use of Fibrin Glue in Mucous Membrane Grafting of the Fornix
Authors: Watts Mark T , Collin Richard
Published: April 2021

ABSTRACT

We report using a fibrin-glue tissue adhesive in place of sutures to place a full-thickness mucosal graft into a defect created in a scarred fornix of an ophthalmic socket. This technique minimizes tissue trauma and aids hemostasis and healing.
Beheading the Pterygium
Authors: Coroneo M T
Published: April 2021

ABSTRACT

I describe a safe, easily learned, accessible, and inexpensive method for excision of the pterygium head using the tip of a 23-gauge needle as a cutting tool. The incision is controlled precisely, and excision of unaffected tissue, particularly at the limbus, is minimized by using point cutting edge techniques and by varying tissue tension to control tissue sectility ("cuttability").
Small-Incision Manual Extracapsular Cataract Extraction Using Selective Hydrodissection
Authors: Blumenthal Michael , Ashkenazi Isaac , Assia Ehud , Cahane Michael
Published: April 2021

ABSTRACT

Hydrodissection is a technique in which balanced salt solution is injected through a cannula into various layers of a cataractous lens to separate the lens lamella in a nonspecific location. Selective hydrodissection allows separation of the lens lamella at different desired anatomical layers. The technique allows the smallest possible nucleus, ie, the hard-core nucleus, to be hydroexpressed as a separate entity, requiring, correspondingly, a relatively small capsulorhexis and limbal incision. Then, in a second maneuver, the epinucleus, which engulfs the hardcore nucleus to form the adult nucleus, also can be aspirated or hydroexpressed as a whole. Selective hydrodissection permits scleral incision and stitchless surgery in planned extracapsular cataract extraction and also may serve as an intermediate step for surgeons who wish to convert to or learn phacoemulsification techniques.
Filtering Seton Implant for Glaucoma: Initial Animal Trial
Authors: Hoskins H Dunbar , Drake Michael V , Minckler Donald S , McGee Scott D
Published: April 2021

ABSTRACT

A newly developed silicone filtering seton device was implanted in each of five eyes of four rhesus monkeys after they had undergone extensive argon-laser trabeculoplasty to raise their intraocular pressure (IOP). One animal (one implant eye) was killed at 6 weeks. The other three animals (four implant eyes) were observed for 17 to 24 months following implantation surgery. Mild to moderate postoperative inflammation subsided during the first postoperative week. The eyes remained quiet throughout the remainder of follow up. The postoperative IOPs varied between 18% and 70% of the IOPs at the time of implant surgery. In the three monkeys that had unilateral surgery, the IOP at the final follow-up measurement was equal to or lower than the IOP in the unoperated fellow eye. In the monkey that had bilateral surgery, both of the final IOPs were lower than the preoperative ones.
THC:YAG Laser Sclerostomy: The Resident Experience
Authors: Mansour A M
Published: April 2021

ABSTRACT

Retrospective review of 14 consecutive THC: YAG laser sclerostomies done without the use of antimetabolites revealed a uniform closure of the filtering bleb within 6 months of follow up. Also, the sclerostomy site was closed by iris or fibrous tissue. Based on these findings, I recommend that the present THC:YAG laser sclerostomy protocol be altered to allow for antimetabolite usage, prevention and treatment of iris prolapse, and control of intraocular inflammation.
Treatment of Scleromalacia Perforans With Dura Mater Grafting
Authors: Enzenauer Robert W , Enzenauer Raymond J , Reddy Vishnu B , Cornell F Michael , West Sterling
Published: April 2021

ABSTRACT

We describe, to our knowledge for the first time in the English literature, the successful use of cadaveric dura mater in reinforcing the sclera in a rheumatoid arthritis patient with scleromalacia perfora ns.
Lateral Tarsorrhaphy and Disposable Soft Contact Lenses in Aniridia Patients After Penetrating Keratoplasty
Authors: Au Yue-Kong , Lucius Richard W
Published: April 2021

ABSTRACT

We report our experience with two patients with familial aniridia who underwent combined cataract extraction and penetrating keratoplasty. Persistent epithelial defects developed in all four eyes within 4 months. Combined lateral tarsorrhaphy and application of disposable soft contact lenses restored the integrity of the corneal epithelium, and 21 months after surgery, the grafts were clear and avascular.
Juvenile Xanthogranuloma of the Corneoscleral Limbus
Authors: Kaufmann James G , Driebe William T , Hamed Latif M , Margo Curtis E
Published: April 2021

ABSTRACT

A 10-year-old boy had a slowly enlarging left limbal mass, extending into the corneal stroma, but not into the anterior chamber. The lesion was excised by lamellar sclerokeratectomy and subsequently confirmed histopathologically as a juvenile xanthogranuloma. Though rare, juvenile xanthogranuloma of the corneoscleral limbus should be considered in the differential diagnosis of limbal mass lesions extending into the cornea. Total resection is usually curative.