bluuebunny/crossref_metadata_2025 huggingface dataset:
Cryotherapy for Retinopathy of Prematurity: A Histopathologic Comparison of a Treated and Untreated Eye
Authors: Vrabec Tamara R , McNamara J Arch , Eagle Ralph C , Tasman William
Published: April 2021

ABSTRACT

A female infant born at 28 weeks gestational age, weighing 570 g, developed retinopathy of prematurity (ROP) which progressed to threshold disease in one eye. Transsclera I cryotherapy of the avascular peripheral retina resulted in complete clinical regression of the active ROP in that eye. The fellow eye continued to manifest subthreshold ROR Histopathologic findings included a striking reduction of the cryotreated retina to a thin glial scar, with associated retinal pigment epithelium atrophy, denudation of Bruch's membrane, and extensive atrophy of the underlying choroidal vasculature, predominantly the choriocapillaris.
Effects of Postoperative Mitomycin C on Glaucoma Filtration Surgery in Rabbits Treated Preoperatively With Antiglaucoma Medications
Authors: Hyung Sung-Min , Kim Dong Myung , Hong Chul , Lee Jaeheung , Youn Dong Ho
Published: April 2021

ABSTRACT

In a rabbit model, we evaluated the effects of topically applied postoperative mitomycin C (MMC) on the success rate of glaucoma filtration surgery in animals treated preoperatively with pilocarpine hydroch ??ride 4% and levobunolol hydrochloride (Betagan) for 16 weeks. Full-thickness filtration surgery was performed with a single 5-minute intraoperative exposure to a sponge soaked with 0.4 mg/mL MMC of one eye in nine rabbits in one group (group A) and to both eyes in 13 rabbits in a second group (group B). In addition, one eye of each rabbit in group B received a daily drop of 0.4 mg/mL MMC for 13 days after the operation. All of the eyes were then followed for 80 days.

The intraoperatively applied MMC enhanced the success rate of the filtration surgery in the group A eyes. However, the eyes that also received postoperative drops of MMC (group B) had longer periods of reduced intraocular pressure (IOP) (P [chi-squared = 5.94] < .025), fewer bleb failures (P [chi-squared - 8.09] < .005), and more complications than the eyes that received only intraoperative MMC.
The "Anchor" Anterior Capsulectomy
Authors: Berger Roland R , Kenyeres Agnes M
Published: April 2021

ABSTRACT

In recent years, continuous circular capsulorhexis (CCC) has become the preferred anterior capsulectomy in many ophthalmic centers. Yet, many ocular surgeons are still uncomfortable with it, especially when tearing the capsule on its lower semicircle, since this often results in cornea) endothelial injury, and, thus, postoperative lower corneal edema. We present a modified anterior capsulectomy, which consists of a crescent capsulorhexis and a perpendicular discission, followed by circular tearing of the resulting capsular flaps. This "anchor" anterior capsulectomy (AAC) was used in 14 cases of elective extracapsular cataract extraction, followed by intraocular lens (IOL) implantation. The capsulectomy was successful in 12, and IOL implantation was successful in 12. The procedure was relatively easy to perform and resulted in good "in-the-bag" implantation, regardless of the lOL's overall length and the optic's size. AAC can serve as an intermediate step in learning CCC as well as a reliable alternative anterior capsulectomy.
Applications for a Corneal Mattress Suture in Anterior Limbal Wound Repairs
Authors: Palmer Richard M , Burgoyne Claude F
Published: April 2021

ABSTRACT

We describe the use of a corneal mattress suture to manage two complications of trabeculectomy: first, to repair an anterior conjunctiva! tear/disinsertion in a limbus-based conjunctiva! flap; and, second, to restore wound integrity by reinforcing a focal section of scleromalacia or to close a perforation remaining from a previous cataract wound encountered during complicated trabeculectomy. In each setting, a single, double-armed 10-0 nylon cornea) mattress suture is used as an anchor to establish a watertight limbalwound closure. Additionally, for repairing an area of a scleromalacia/perforation, the corneal mattress suture can be used to incorporate a graft of Tenon's fascia into the wound.
Repair of Retinal Detachment Associated with Congenital Excavated Defects of the Optic Disc
Authors: Brown Gary C , Brown Melissa M
Published: April 2021

ABSTRACT

Excavated defects of the optic disc have been associated with retinal detachment in the macula and beyond. Included among these defects are congenital pits of the optic disc, optic nerve coiobomas, and the morning glory syndrome.

We report eight consecutive patients with congenital, excavated defects of the optic disc and associated retinal detachment managed with pars plana vitrectomy, laser photocoagulation, and intravitreal gas injection.
Autoscleral Flap Grafting: A Technique of Scleral Repair
Authors: Gopal Lingam , Badrinath Sengamedu S
Published: April 2021

ABSTRACT

We describe using the technique of autoscleral flap grafting in 1 eye with scleral staphyloma, in 2 eyes with scleral ectasia, and in 1 eye with scleral deficiency following excision of a limbal tumor. In three cases, follow up was over 6 months; in the remaining case, 2 months. In one patient, the scleral ectasia recurred, since the scleral flap that could be dissected was thin. The recurrence was managed successfully by a periosteal autograft.
In Vitro Sensitivity of Human Tenon's Capsule Fibroblasts to Mitomycin C and Its Correlation With Outcome of Glaucoma Filtration Surgery
Authors: Madhavan Hajib N , Rao Sridhar B , Vijaya Lingam , Neelakantan Arvind
Published: April 2021

ABSTRACT

Dose-inhibition studies of proliferating fibroblasts grown from Tenon's capsule biopsy specimens obtained during trabeculectomy from 17 glaucoma patients were performed using varying concentrations of mitomycin C (MMC), with exposure of cells to the drug for either 5 days or 5 minutes. Surgical outcomes were determined 3 months postoperatively. Based on in vitro results, fibroblasts were classified as either MMC-"resistant" or MMC"sensitive." Thirteen surgically successful cases were associated with 10 "sensitive" and three "resistant" fibroblasts; four surgical failures with one "sensitive" and three "resistant" fibroblasts. The in vitro studies were positively correlated with the clinical outcomes, the former correctly predicting the latter in 76.5% of the surgeries.
Use of the Giant-Pulse Nd:YAG Laser for Ab-Externo Sclerostomy in Rabbits and Humans
Authors: Barak Adiel , Rosner Mordechai , Solomon Arieh , Karni Ziv , Melamed Shiomo
Published: April 2021

ABSTRACT

The giant-pulse Neodymium:YAG laser, a recently developed laser source, delivers up to 200 W of peak power at pulse widths of 20 or 40 msec. The instrument can create a sclerostomy with minimal surrounding damage and, consequently, relatively little postsurgical inflammation and scarring. We tested its efficacy in performing ab-externo sclerostomy in 10 adult pigmented rabbits and in five patients with end-stage glaucoma. All of the animal eyes were hypotonus immediately after the procedure. However, the intraocular pressure increased gradually, and by the third day, returned to presurgical levels in all of the eyes. All five of the glaucoma patients treated had patent sclerostomies following the procedure. They all had early hypotony, but after 3 months, four of the five sclerostomies apparently failed. The giant-pulse Nd:YAG laser appears useful for performing sclerostomy, but modifications are needed to solve the problems of early hypotony and late closure of the fistulula.
Nd: YAG Laser Treatment of Retained Descemets Membrane After Penetrating Keratoplasty
Authors: Steinemann Thomas L , Henry Katherine , Brown Michael F
Published: April 2021

ABSTRACT

Retention of the host's Descemets membrane is an unusual complication of penetrating keratoplasty. The membrane may opacify and even threaten the health of the transplant. Following creation of a central opening with the Nd:YAG laser in such a case, visual acuity improved from counts fingers at 5 ft to 20/100.
Scheimpflug Photography and Postcataract Surgery Posterior Capsule Opacification
Authors: Lasa Maria Susan M , Datiles Manuel B , Magno Benjamin V , Mahurkar Anup
Published: April 2021

ABSTRACT

We describe a method to objectively document postcataract surgery posterior capsule opacification using Zeiss Scheimpflug photography and computerized image analysis. We examined 42 eyes with clear capsules (group A) and 27 with posterior capsule opacities (group B). The group A eyes had significantly better visual acuity (P < .05), lower mean capsular densitometry readings (0.03 ± 0.03 optical density units versus 0.15 ± 0.11 optical density units; P < .0001), and thinner capsules (0.03 ± 0.4 mm versus 0.10 ± 0.05 mm) than the group B eyes. This new objective method of documenting postoperative capsular haze may be useful for clinical studies such as clinical trials of drugs or surgical techniques being developed to prevent or minimize capsule opacification.
Gonioscopic Ab Interno Nd:YLF Laser Sclerostomy in Human Cadaver Eyes
Authors: Oram Osman , Gross Ronald L , Severin Todd D , Orengo-Nania Silvia , Feldman Robert M
Published: April 2021

ABSTRACT

We explored the potential of the picosecond Nd:YLF laser to perform gonioscopic ab interno sclerostomy in human cadaver eyes. Full-thickness sclerostomies were created in 12 such eyes and confirmed by external scleral and histopathologic examination. Optimum parameters for successful completion of a sclerostomy were: a rectangular pattern of 0.3 mm by 0.3 mm, a repetition rate of 1000 pulses per second, an energy-per-pulse of 400 mJ, and a spot separation between 10 and 50 µm, with no focal offset. The Nd:YLF laser reliably created successful gonioscopic sclerostomies with minimal adjacent thermal damage in human cadaver eyes.
Therapeutic Penetrating Keratoplasty in Nonhealing Corneal Ulcer
Authors: Panda Anita , Khokhar Sudarshan , Rao Venkateshwar , Das Gopal Krushna , Sharma Namrata
Published: April 2021

ABSTRACT

Results of penetrating keratoplasty in 443 eyes of 439 patients of active infective corneal ulcers, from a period of 10 years, were analyzed. All these eyes were proven refractory to maximal medical therapy for extended periods of time, in some cases more than 6 weeks. As the surgery was performed during the active stage, the outcome was not favorable functionally. Clinical cure was obtained, however, by therapeutic penetrating keratoplasty in all but 27 of these eyes. Of unsuccessful cases, 16 could be saved with additional medical therapy, two led to phthisis bulbi, and nine required repeat therapeutic penetrating keratoplasty. Complications encountered included disturbances in intraocular dynamics such as extrusion of the lens and vitreous during surgery, secondary rise of intraocular pressure leading to damage of the optic nerve, loss of the eye due to above factors, and reinfection. The anatomical success achieved was 97% with graft clarity of 2+ or more in 39% of eyes. Useful vision, ie, better than or equal to 6/60, was possible in 33% of eyes. Thus, therapeutic keratoplasty in refractory corneal ulcer still has scope in a Third-World country.
Amblyopia in Congenital Ptosis
Authors: Hornblass Albert , Kass Lawrence G , Ziffer Anne J
Published: April 2021

ABSTRACT

This study evaluates the association between congenital ptosis and amblyopia. Amblyopia was detected in 7 of 36 (19%) patients with congenital ptosis. Two patients (6%) with amblyopia had no contributing factors other than the presence of congenital ptosis. A statistically significant correlation between severe nonocclusive ptosis (greater than or equal to 4 mm) and the development of amblyopia was identified. No new cases of amblyopia developed after surgical repair of the ptosis, suggesting early surgery for severe nonocclusive congenital ptosis may decrease the incidence of amblyopia.
Holmium Laser Sclerostomy via Corneal Approach With Transconjunctival Mitomycin-C in Rabbits
Authors: Chi Thomas S K , Berríos Ramon R , Netland Peter A
Published: April 2021

ABSTRACT

We studied the use of the holmium laser for sclerostomy through a small lamellar corneal incision and the effects of transconjunctival mitomycin-C on the outcome of filtration surgery without conjunctiva! incision. The holmium laser, equipped with a straightfiring probe, was used to create sclerostomies in seven New Zealand white rabbits through a corneal lamellar incision. One eye in each rabbit was treated with transconjunctival mitomycin-C (0.4 µg/mL for 5 minutes), and the fellow eye underwent sclerostomy without pretreatment with mitomycin-C as a control. The reduction in intraocular pressure was greater and persisted significantly longer in the eyes pretreated with mitomycin-C than in the controls. All control eyes had flat blebs by day 7 to 12, while the treated eyes maintained a bleb throughout the study. Microscopic examination showed that sclerostomies created by the straight-firing probe induced significantly less thermal damage than those created by the stationary side-firing probe. These results demonstrate that successful transcorneal sclerostomy without conjunctiva! incision can be created using the straight-firing holmium laser probe, with enhancement of filtration by pretreatment with transconjunctival mitomycin-C.
Keratoprosthesis as an Aid to Learning Surgical Techniques on Cadaver Eyes
Authors: Eckardt Ute , Eckardt Claus
Published: April 2021

ABSTRACT

Practice on cadaver eyes can be an essential aid for residents and inexperienced surgeons in learning operative techniques. Cadaver eyes, however, have been of only limited utility for teaching highly complicated procedures because of the obscuring of intraocular structures caused by the rapid post mortem onset of cornea) swelling. We have overcome this problem by the use of a silicone keratoprosthesis that provides an excellent view of all intraocular tissues. Our model allows the use of donor eyes unsuitable for transplantation and facilitates the learning of even complicated cataract surgery, and vitrectomy techniques on the human eye. It thus can reduce the rate of complications in operations on patients.
The Use of a Silicone Strip Over the Sclerotomy in Vitreous Surgery
Authors: Zauberman Hanan , Hemo Itzhak
Published: April 2021

ABSTRACT

We have developed a technique to prevent enlargement and distortion of the sclerotomy wound during vitreoretinal surgery. The technique involves the use of a silicone strip temporarily attached to the sclera. The strip and the sclera are pierced with a lance-tipped blade and surgery is done by entering through the silicone strip and then through the resulting scleral opening. Such a procedure prevents undesirable enlargement of the sclerotomy induced by trauma to the wound caused by instruments that can occur in cases of previously damaged sclera or in thin sclera associated with high myopia, it also prevents leaks through the wound as instruments are withdrawn.
Delayed Tarsal Eversion Following Periorbital Trauma
Authors: Rice Charles D , Brodsky Michael C , Hembree Kathryn
Published: April 2021

ABSTRACT

Delayed onset of upper lid edema with exuberant chemosis developed in a 3-year-old girl following blunt periorbital trauma. Examination under anesthesia demonstrated a tightly everted upper tarsus that focally compressed the underlying conjunctiva at the superior tarsal border. Injection of subconjunctival hyaluronidase followed by local compression and temporary tarsorrhaphy resulted in rapid resolution of the chemosis and restoration of the normal lid position.
Treatment of Hypotony Maculopathy After Trabeculectomy
Authors: Cohen Steven M , Flynn Harry W , Palmberg Paul F , Gass Donald M , Grajewski Alana L , Parrish Richard K
Published: April 2021

* BACKGROUND AND OBJECTIVE: To determine if resuturing of the scleral flap to increase IOP in the post-trabeculectomy eye is an effective treatment of hypotony maculopathy.

* PATIENTS AND METHODS: The medical records of nine consecutive patients who developed visual acuity loss after trabeculectomy related to hypotony maculopathy were reviewed to determine factors that contribute to successful restoration of visual acuity.

The average age of the patients was 50 years and average refractive error was -4.25 diopters (D). Mean Snellen visual acuity dropped from 20/25 to 20/200 after the onset of hypotony.

* RESULTS: Six of nine eyes recovered visual acuity to within one line of initial level after treatment of the hypotony. Four of these six eyes underwent resuturing of the scleral flap to reverse the excess filtration within 6 months of the onset of hypotony maculopathy. Five of these six patients had final vision of 20/30 or better. The mean phakic preoperative refractive error in these six eyes was -2.25 D, compared with a mean refractive error of -8.50 D in the three eyes with persistent visual loss (P = 0.002). After reversal of the hypotony, the average peak intraocular pressure in the six eyes with visual recovery was 33 mm Hg, compared with an average peak IOP of 7 mm Hg in the three eyes with persistent visual loss. (P = 0.015)

* CONCLUSION: Although reversal of the hypotony maculopathy in six eyes was associated with a few weeks of higher than normal IOP, the final IOP was acceptably low. Five of six filtering blebs remained functional with a mean follow-up of 3 years. The final average IOP in the six eyes that were successfully treated was 12.7 mm Hg. In this series of patients, visual acuity was restored to eyes with hypotony maculopathy by increasing the IOP to higher than normal levels.

[Ophthalmic Surg Lasers 1995;26:435-441.]
Mass Spectrometry Analysis of the By-products of Intrastromal Photorefractive Keratectomy
Authors: Habib Maged S , Speaker Mark G , Schnatter Wayne F K
Published: April 2021

* BACKGROUND AND OBJECTIVE: To determine the nature and chemical composition of the cavitation bubbles generated by intrastromal photorefractive keratectomy (IPRK) with the Neodymium: Yttrium Lithium Fluoride (Nd:YLF) picosecond laser.

* MATERIALS AND METHODS: IPRK was performed on the corneas of three fresh human cadaver eyes with the Nd:YLF picosecond laser. High energy levels of 200 mJ/pulse to 300 mJ/pulse were used to produce the maximum amount of gas within the corneal stroma. The cavitation bubbles produced in the stroma were aspirated using a gas-tight syringe connected to a valve, and the specimens were analyzed with a mass spectrometer.

* RESULTS: The experiment was performed on three different occasions using one cadaver eye in each experiment. The analysis consistently revealed a mixture of carbon dioxide, carbon monoxide, water vapor, oxygen, and nitrogen. Atmospheric control samples also revealed oxygen and nitrogen. No other components were detected.

* CONCLUSION: The gaseous by-products of IPRK with the picosecond laser result from the simple breakdown of stromal tissue and contain no toxic or unexpected components. We found that these gaseous products are capable of rapid elimination by absorption or diffusion out of che intact cornea.

[Ophthalmic Surg Lasers 1995;26:481-483.]
Mechanized Keratomicropigmentation: Corneal Tattooing With the Blepharopigmentor
Authors: Wessels Izak F , Wessels Gunter F
Published: April 2021

* BACKGROUND AND OBJECTIVE: A mechanized micropigmentor with a triple prong tip was used to tattoo two corneas for cosmetically unacceptable blemishes.

* PATIENTS AND METHODS: Two adult patients with cosmetically disfiguring corneal blemishes in sightless eyes requested cosmetic improvement. With a mechanized micropigmentor, appropriate pigment was directly inoculated through the epithelium.

* RESULTS: After 2 and 3 years of follow-up, respectively, there have been no complications and there has been minimal fading.

* CONCLUSION: This mechanical device facilitates many more penetrations to introduce pigment, with a more uniform depth than can be achieved by freehand methods.

[Ophthalmic Surg Lasers 1996;27:25-28.]
Transscleral Flow of Aqueous Humor: An In Vitro Experiment
Authors: Ayyala R S , O'Brien C O , Grierson I , Maltby P
Published: April 2021

* BACKGROUND AND OBJECTIVE: The minimal scleral flap thickness to ensure transscleral flow following a trabeculectomy has never been determined. The present study was designed to determine, in vitro, the critical scleral flap thickness that allows transscleral flow.

* MATERIALS AND METHODS: The apparatus consisted of two horizontal glass chambers (A and B) connected to each other by a customized scleral disc holder. High-pressure chamber A (at 25 mm Hg) was filled with sodium pertechnetate (^sup 99m^Tc) labeled normal saline and low-pressure chamber B (at 5 mm Hg) with normal saline. Transscleral flow of labeled normal saline from high-pressure chamber A via varying thickness scleral discs to low-pressure chamber B was observed over 16 hours using a gamma camera. Computer analysis was performed on the obtained images.

* RESULTS: Transscleral flow of labeled saline was observed only with scleral discs 0.5 mm thick or less.

* CONCLUSIONS: If the findings hold true for the in vivo situation, aqueous humor may reach the subconjunctival space following trabeculectomy via the transscleral route, provided scleral flap thickness is less than 0.5 mm. In addition, normal uveoscleral aqueous outflow may occur across sclera less than 0.5 mm thick, e.g., posterior to extraocular muscle insertions.

[Ophthalmic Surg Lasers 1996;27:66-69.]
Limbal Sub-Tenon's Administration of Retrobulbar Anesthesia Using a Blunt Irrigating Cannula
Authors: Bergman Louise , Berglin Lennart , Algvere Peep V , Laurell Carl-Gustaf , Stenkula Staffan
Published: April 2021

* BACKGROUND AND OBJECTIVE: To eliminate sharp needles when administering local anesthesia to the eye in order to reduce serious complications caused by needle perforation.

* PATIENTS AND METHODS: After topical anesthesia, limbal conjunctival incision, and sub-Tenon's dissection, a retrobulbar irrigation of an equal mixture of bupivacaine (5 mg/ml) and lidocaine (20 mg/ml) was given using a blunt cannula.

* RESULTS: The technique was used in both vitreoretinal surgery (n = 70) and anterior segment surgery (n = 235) with good analgesic and akinetic effects. No serious adverse reactions were noted.

* CONCLUSION: This proved to be a safe and efficient technique that abandoned the use of sharp needles.

[Ophthalmic Surg Lasers 1996;27:106-112.]
Retinal Hemorrhages Associated With Ocular Decompression After Glaucoma Surgery
Authors: Dudley Denise F , Leen Martha M , Kinyoun James L , Mills Richard P
Published: April 2021

Abstract. Two cases of retinal hemorrhages in glaucomatous eyes associated with ocular decompression following glaucoma filtration surgery are presented. Both patients were young, healthy men with markedly elevated preoperative intraocular pressures (IOPs). The hemorrhages were blot shaped and scattered throughout the macula (including the fovea) in each eye that underwent surgery. One eye had hemorrhages with distinct white centers. Each eye that underwent surgery experienced a permanent decrease in visual acuity after resolution of the hemorrhages. A gradual decrease of IOP preoperatively and intraoperatively is recommended in order to avoid this complication. [Ophthalmic Surg Lasers 1996;27:147-150.]
Postoperative Manipulation of the Krupin Valve
Authors: Weiss Howard S
Published: April 2021

Abstract. Five patients were noted to have elevated intraocular pressure following implantation of the Krupin glaucoma tube-to-plate device. In each, conjunctiva was draped flat over the plate. A muscle hook was used to manipulate conjunctiva over the tube-plate junction at the site of the valve, producing immediate increased flow through the tube, reduction of intraocular pressure, and bleb formation. In all five cases, intraocular pressure has been controlled at longest follow-up. One cause of elevated intraocular pressure following implantation of the Krupin tube-to-plate device is excessive resistance at the valve site, which can be relieved by manipulation with a muscle hook. [Ophthalmic Surg Lasers 1996;27:151-153.]
Management of Hypotonous Cyclodialysis With Pars Plana Vitrectomy, Gas Tamponade, and Cryotherapy
Authors: Helbig Horst , Foerster Michael H
Published: April 2021

* BACKGROUNDANDOBJECTIVE: Cyclodialysis after ocular trauma or surgery may lead to hypotony and visual loss. A new surgical approach for the treatment of cyclodialysis is reported.

* PATIENTS AND METHODS: In three patients with long-standing cyclodialysis and hypotony, a pars plana vitrectomy with gas tamponade and transscleral cryotherapy to the region of the cleft was performed.

* RESULTS: In all patients intraocular pressure increased to normal or near normal, choroidal detachment and retinal and disc edema resolved, and visual acuity increased.

* CONCLUSION: A hypotonous cyclodialysis can be successfully treated with vitrectomy, gas tamponade, and cryotherapy. This approach may be superior to other techniques if there are also additional posterior segment problems or if there is lens dislocation.

[Ophthalmic Surg Lasers 1996;27:188-191.]
Sodium Hyaluronate as a Tool in Strabismus Surgery in Rabbits
Authors: Fulga Valentin , Koren Rumelia , Ezov Nathan , Gal Rivka , Nimrod Avraham , Savir Hanna
Published: April 2021

* BACKGROUND AND OBJECTIVE: The authors tested whether coating tissue with sodium hyaluronate (Na-HA) reduced postoperative adhesions and accelerated the healing process in strabismus surgery.

* MATERIALS AND METHODS: The surgical technique was tested during recession and resection operations performed on 30 rabbits and was compared with the use of NaCl 0.9%. Clinical, biomicroscopic examinations were performed on postoperative days 1 , 2, 7, and 30 and histopathologic examinations were performed on postoperative days 2, 7, and 30.

* RESULTS: Clinically, there were no statistically significant differences between the study group and the control group. Also, there were no statistically significant differences between the two groups for most of the histopathologic criteria; however, new vessel formation was smaller with Na-HA than without it. Statistical significance was defined as P < .05.

* CONCLUSION: The authors found no significant positive effect of Na-HA on postoperative healing in rabbits.

[Ophthalmie Surg Lasers 1996;27:228-233.]
Use of Cyanoacrylate Tissue Adhesive in Small-Incision Cataract Surgery
Authors: Alió Jorge L , Mulet M Emilia , Garcia Juan C
Published: April 2021

* BACKGROUND AND OBJECTIVE: A controlled clinical study was performed on three different groups of patients.

* PATIENTS AND METHODS: Each patient had a 6.5-mm-wide sclera! tunnel with phacoemulsiflcation. Sealing of the incision was done either without suture, with an anchor suture, or with tissue adhesive (cyanoacrylate). The authors observed whatever induced astigmatism was present during the 1st and 12th weeks of the postoperative period.

RESULTS: In the immediate postoperative period, astigmatism was sigmficandy less (P < .01) in the groups of patients with suture and tissue adhesive than in the unsutured group. The results after 12 weeks were similar for the three groups (P > .05), with no complications observed as a result of the use of cyanoacrylate.

* CONCLUSION: Cyanoacrylate seems to be a promising innovation in scierai tunnel surgery for cataracts. It is an effective, a quick, and a safe alternative to sutures.

[Ophthalmic Surg Lasers 1996;27:270-274.]
Comparison of Argon Laser Iridotomy and Sequential Argon Laser and Nd:YAG Laser Iridotomy in Dark Irides
Authors: Lim Li , Seah Steve Kah Leng , Lim Arthur Siew Ming
Published: April 2021

* BACKGROUND AND OBJECTIVE: A prospective study was performed to compare argon laser iridotomy and sequential argon laser and Nd:YAG laser iridotomy in dark irides.

* PATIENTS AND METHODS: Twenty-four eyes of 17 patients underwent laser iridotomies; 13 underwent argon laser iridotomies and 11 underwent sequential argon laser and Nd: YAG laser iridotomies. The argon laser settings were standardized at 1.2 W, 50-µm spot size, and 0.1 -second duration. The Nd:YAG laser was set at 2.5 mj and single-pulse shots were used.

* RESULTS: All of the iridotomies were patent at the end of one treatment session. The mean total energy used for argon laser iridotomy was 8.28 J. For sequential iridotomy, 3.12 J was used for the argon laser stage and 7.5 mj for the NdrYAG laser stage.

* CONCLUSION: The total argon laser energy used can be reduced by 2.65 times by using the sequential laser iridotomy technique.

[Ophthalmic Surg Lasers 1996;27:285-288.]
Experimental Nonpenetrating Transscleral Cyclodiathermy in Rabbits
Authors: Pham Lan Phuong V , Wang Yujen , Banuelos Lydia , Wang Nan , Schuman Joel S
Published: April 2021

* BACKGROUND AND OBJECTIVE: Acute and long-term effects of contact transscleral cyclodiathermy (CTCD) were studied in rabbits.

* MATERIALS AND METHODS: In the acute phase, three evenly spaced applications were placed at the limbus in each of four quadrants using the Ophthalmic Diathermy TR4000 (MIRA, Inc., Waltham, MA) . Each quadrant of 1 7 eyes of 1 3 Dutchbelted rabbits was treated with radio frequencies (RFs) of 1.0 to 4.5, for times of 0.5, 0.75, 1.0 to 3.0, and 4.0 to 10.0 seconds. Eyes were then immediately enucleated and fixed in Karnovsky s solution after the rabbits had been sacrificed with 3 ml of pentobarbital sodium. In the longitudinal phase, four groups of six rabbits each were treated with 20 evenly spaced applications at the limbus at one of four settings: 1.5 RFs/4 seconds, 2.0 RFs/3 seconds, 2.5 RFs/2 seconds, or 3.0 RFs/2 seconds. Intraocular pressures were measured on alternate days for 1 week prior to treatment and for 4 weeks after treatment, following which the eyes were enucleated and fixed in Karnovskys solution.

* RESULTS: Gross examination of the acute phase eyes revealed blanching of the ciliary processes at RF settings of 2.5 and higher with exposure times of 1.5 seconds or longer. Gross and light microscopic studies showed that levels of destruction correlated positively with RF settings and exposure times. Higher RF levels resulted in scierai coagulation necrosis on light microscopy. In addition, there was coagulation necrosis of the pigmented and nonpigmented ciliary epithelium and stroma. Longitudinal phase study showed a significant decrease in intraocular pressure (IOP) in the four groups of rabbits treated over the 4-week follow-up period (P= .005, multivariate analysis of variance [MANOVA]). Rabbits treated at higher RF levels sustained a greater IOP-lowering effect (P = .025, MANOVA). Gross and light microscopic examination revealed focal atrophy, fusion, and fibrosis of the ciliary processes.

* CONCLUSION: Nonpenetrating CTCD results in focal destruction of the ciliary body in rabbits. The authors found that significant reduction in IOP was possible over the 4-week follow-up period in the Dutch-belted rabbits treated, with greater IOP and tissue effects at higher RF settings.

[Ophthalmic Surg Lasers 1996;27:301-307.]
HLA-B27-Associated Uveitis Presenting With Diffuse Vitritis
Authors: Castillo Alfredo , Sayagues Octavio , Grande Carlos , Zarco Pedro
Published: April 2021

Abstract. A 26-year-old man complained of a sudden decrease in vision in the left eye. He had a past medical history of pauciarticular juvenile rheumatoid arthritis with a positive HLA-B27 haplotype and negative antinuclear antibodies and later development of ankylosing spondylitis. His ocular history was unremarkable. An ophthalmic examination revealed a predominant diffuse vitritis (3+) in the left eye. The uveitis improved after treatment with topical and systemic steroids. Following an extensive clinical and laboratory evaluation, a final diagnosis of HLAB27- associated uveitis was made. Although uncommon, diffuse vitritis can occur in the setting of this uveitis and may be a predominant symptom. [Ophthalmic Surg Lasers 1996;27:321-323.]
Scleral Fixation of Posterior Chamber Intraocular Lenses in Children
Authors: Sharpe Matthew R , Biglan Albert W , Gerontis C Corina
Published: April 2021

* BACKGROUND AND OBJECTIVE: Children with monocular aphakia who become contact lens intolerant require an intraocular lens (IOL) for visual rehabilitation. When there is inadequate support from the posterior Jens capsule, use of an anterior chamber IOL or a sclerally fixated posterior chamber IOL may be considered. The authors report their experience with scierai fixation of posterior chamber IOLs in children.

* PATIENTS AND METHODS: Seven posterior chamber IOLs were sutured in the ciliary sulcus of children who could not wear contact lenses. In each eye, the lens capsule remnants were inadequate to provide sufficient support for the haptics of a posterior chamber lens.

* RESULTS: Six of seven patients had improved visual acuity, with an average improvement of 4 lines. Complications related to scierai fixation included exposure of the scierai fixation suture in one eye, lens decentration in one eye, and lens tilt in one eye. Follow-up ranged from 3 to 38 months, averaging 26 months.

* CONCLUSION: Implantation of a posterior chamber sclerally fixated IOL offers an alternative to placement of an anterior chamber lens in children who cannot wear contact lenses and who lack capsular support. Continued follow-up of these patients will help determine the long-term safety of this technique.

[Ophthalmic Surg Lasers 1996;27:337-34l.]
Early Division of the Conjunctival Pedicle in Modified Hughes Repair of the Lower Eyelid
Authors: McNab Alan A
Published: April 2021

* BACKGROUND AND OBJECTIVE: The mod îfied Hughes repair of the lower eyelid (upper Hd tarsoconjunctival flap and skin graft or flap) after resection of marginal lesions has an established piace in oculoplastic surgery. Previous recommendations for the timing of the division of the conjunctival pedicle have varied greatly from 3 weeks to 6 months. This study was performed to determine the safety of division of the pedicle at 2 weeks.

* PATIENTS AND METHODS: A series of 25 patients in whom the tarsoconjunctival pedicle in a modified Hughes repair of the lower eyelid was divided at 2 weeks were prospectively evaluated. All cases had a full-thickness skin graft placed as an anterior lamella of the reconstructed eyelid.

* RESULTS: In all cases there was a healthy and viable lower lid with brisk bleeding from die newly created lid margin at the time of pedicle division. There were no instances of infarction of any portion of the reconstruction, shrinkage, or retraction of the lower lid.

* CONCLUSION: Two weeks is a long enough time to wait prior to division of the conjunctiva! pedicle in the modified Hughes repair of the lower eyelid.

[Ophthalmic Surg Lasers 1996;27:422-424.]
A Prospective Randomized Study of Medications After Silicone Intubation
Authors: Liu Don
Published: April 2021

* BACKGROUND AND OBJECTIVE: Following silicone intubation, most surgeons prescribe either an antibiotic or an antibiotic- steroid combination medication. No known controlled study has been performed to determine whether steroids in addition to antibiotics improve the postoperative outcome.

* PATIENTS AND METHODS: The author performed a prospective randomized study of 108 patients (118 eyes) who underwent silicone intubation over a period of 4 1/2 years. Sixty-seven patients received a combination of neomycin, polymyxin B, and dexamethasone and 41 patients received gentamicin for 2 weeks after surgery. A standardized surgical technique and instruments were used. Follow-up ranged from 8 to 44 months (average 19 months).

* RESULTS: No statistically significant difference was found in the failure rates when patients treated with an antibiotic- steroid combination were compared with those treated with antibiotic alone.

* CONCLUSION: Following silicone intubation, there appears to be no additional benefit of an antibiotic-steroid combination medication over an antibiotic alone.

[Ophthalmic Surg Lasers 1996;27:434-437.]
A Small-Incision Technique for Suturing a Posterior Chamber Intraocular Lens
Authors: Regillo Carl D , Tidwell James
Published: April 2021

Abstract. The authors present a technique of transscleral fixation of a posterior chamber intraocular tens modified to permit a small-incision approach by using a foldable silicone lens. This modification improved intraoperative globe stability and reduced operative time. This procedure also has the potential for expediting postoperative recovery and visual rehabilitation. [Ophthalmic Surg Lasers 1996;27:473-475.]
The Course After Cataract Extraction, Intraocular Lens Implantation, and Trabeculectomy for Patients With Diabetes
Authors: Pollack Ayala , Katz Hayh , Oliver Moshe , Zalish Miriam
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the postoperative recovery of the anterior segment and the course of diabetic retinopathy following a combined procedure of an extracapsular cataract extraction with posterior chamber intraocular lens implantation and trabeculectomy in diabetic patients with glaucoma.

* PATIENTS AND METHODS: The records of diabetic patients with uncontrolled glaucoma and cataract, who underwent a combined procedure in one eye, were retrospectively reviewed.

* RESULTS: Eleven patients were included. The mean intraocular pressure and the amount of antiglaucomatous medications required to control it were both reduced postoperatively. Anterior segment complications included hyphema in 4 eyes (37%), fibrin formation in 4 eyes (37%), and posterior synechia in 3 eyes (27%). The hyphema resolved spontaneously and the fibrin disappeared following increased administration of steroids. Development of diabetic retinopathy occurred in 1 eye (9%). Cystoid macular edema without other evidence of diabetic retinopathy was observed in 1 eye (9%).

* CONCLUSION: The control of intraocular pressure is improved in diabetic patients who have undergone this combined procedure. The postoperative course in these diabetic patients is similar to that previously described in the general population.

[Ophthalmic Surg Lasers 1996;27:595-599.]
Intraoperative and Postoperative Use of Mitomycin-C in the Treatment of Primary Pterygium
Authors: Çaliskan Sibel , Orhan Mehmet , Irkeç Murat
Published: April 2021

* BACKGROUND AND OBJECTIVE: The effectiveness of 0.04% mitomycin-C, either postoperatively for 2 weeks or intraoperatively as a single dose, as an adjunct in the surgical treatment of primary pterygium was evaluated.

* PATIENTS AND METHODS: Mitomycin-C was used in addition to the bare sclera technique in 43 eyes with pterygia. The mean follow-up time was 18.5 months for the 24 eyes in the postoperative mitomycin-C group, 10.3 months for the 19 eyes in the intraoperative mitomycin-C group, and 17.3 months for the 17 eyes in the control group (eyes that had undergone surgical excision only).

* RESULTS: The recurrence rate was 4.2% with postoperative administration, 5.3% with intraoperative application, and 41.2% in the control group. There was a significant reduction in recurrence rates for both the postoperative and the intraoperative mitomycin-C groups compared with the control group (P= .005 and P= .01, respectively). However, recurrence rates were not statistically different according to the type of application. No serious side effect occurred during the follow-up period.

* CONCLUSION: Topical mitomycin-C, either intraoperatively or postoperatively, as an adjunct decreases the recurrence rate of primary pterygium. Intraoperative application seems advantageous because it decreases the symptomatic side effects and restricts the inappropriate use by the patient.

[Ophthalmic Surg Lasers 1996;27:600-604.]
Visual Acuity Immediately Following Phacoemulsification With Subconjunctival Anesthesia
Authors: Arbisser Lisa Brothers , Wymore James G
Published: April 2021

Abstract. The authors attempted to discover the quality of vision experienced immediately after cataract surgery by those patients receiving subconjunctival anesthesia and no postoperative patching. Eighty-five consecutive patients who underwent phacoemulsification were studied. Anesthesia was topical tetracaine followed by a subconjunctival injection of a lidocaine-bupivicaine hydrochloride-hyaluronidase mixture. Visual acuities were measured within a half hour after surgery and at 1 day postoperatively. Immediate postoperative visual acuities ranged from 20/25 to 20/200. Visual acuities were 20/40 or better in 14 patients (16.4%), 20/50 to 20/60 in 22 patients (23.5%), and 20/70 to 20/200 in 49 patients (60.1%). The early postoperative visual acuity measurements vary widely. There was a marked improvement at 1 day after surgery, with acuities becoming more aligned with expected outcomes. [Ophthalmic Surg Lasers 1996;27:640-642.]
Comparative Results of Combined Procedures for Glaucoma and Cataract: I. Extracapsular Cataract Extraction Versus Phacoemulsification and Foldable Versus Rigid Intraocular Lenses
Authors: Tezel Gülgün , Kolker Allan E , Kass Michael A , Wax Martin B
Published: April 2021

* BACKGROUND AND OBJECTIVES: The refinements of small-incision cataract surgery by phacoemulsification with foldable intraocular lens (IOL) implantation have recently permitted new options for combined trabeculectomy with cataract extraction. The objectives of this study were to compare the longterm intraocular pressure (IOP) control and visual outcome between trabeculectomies combined with extracapsular cataract extraction (ECCE) versus those with phacoemulsification, and to analyze these same factors for foldable versus rigid IOLs.

* PATIENTS AND METHODS: The authors retrospectively reviewed the charts of 311 patients (397 eyes) who underwent combined trabeculectomy with cataract extraction and posterior chamber IOL implantation. In all of the surgeries, releasable scleral flap sutures were used. The mean follow-up was 22.9 ± 15.1 months, with a minimum follow-up of 12 months.

* RESULTS: Trabeculectomy combined with phacoemulsification had a lower postoperative complication rate and was more effective than trabeculectomy combined with ECCE in reducing IOP to less than 20 mm Hg with or without medication (95% vs 82%) and in improving vision to levels of 20/40 or better (71% vs 52%) (P < .001). Regarding IOLs, foldable silicone lenses were found to be an effective alternative to polymethylmethacrylate lenses in combined surgeries in terms of a controlled IOP of less than 20 mm Hg (97% vs 97%) and visual recovery to 20/40 or better (78% vs 63%).

* CONCLUSION: The combination of trabeculectomy with releasable scleral flap sutures and small incision cataract surgery with foldable IOL implantation has improved postoperative IOP control and visual rehabilitation.

[Ophthalmic Surg Lasers 1997;28:539-550.]
Phacoemulsification for Cataract Following Pars Plana Vitrectomy
Authors: McDermott Mark L , Puklin James E , Abrams Gary W , Eliott Dean
Published: April 2021

* BACKGROUND AND OBJECTIVE: To determine if the technical aspects of phacoemulsification for removal of cataract following pars plana vitrectomy differ from those of phacoemulsification for removal of cataract in nonvitrectomized eyes.

* PATIENTS AND METHODS: Twenty-two eyes that had undergone prior vitrectomy were identified through a retrospective review of chart notes and operative records of 1039 consecutive cataract extractions performed by one surgeon.

* RESULTS: Complications of proliferative diabetic retinopathy was the most common indication for prior vitrectomy. The predominant lens change was nuclear sclerosis. Deep anterior chambers with large anterior to posterior excursions of the iris lens diaphragm with simultaneous fluctuation in pupil size occurred during phacoemulsification. The posterior capsule was flaccid and mobile during lens cortex removal. No posterior capsules ruptured. Postoperative visual acuity improved in 91% of the patients.

* CONCLUSIONS: Prior vitrectomy was associated with diabetes and nuclear sclerotic cataract. Phacoemulsification in this patient population was associated with inadequate pupillary mydriasis, superior conjunctival scarring, intraoperative anterior chamber depth, pupil size, and iris lens excursions that hindered phacoemulsification tip placement. Posterior capsules were excessively flaccid, prone to rapid anterior and posterior excursions, and may have plaques that are resistant to intraoperative removal.

[Ophthalmic Surg Lasers 1997;28:558-564.]
Ultrasound-Guided Cryotherapy for Retinal Tears in Patients With Vitreous Hemorrhage
Authors: Kelley Linda M , Walker Joseph P , Wing Glenn L , Raskauskar Paul A , Schepens Charles L
Published: April 2021

* BACKGROUND AND OBJECTIVE: The goal was to utilize ultrasound-guided cryotherapy as an immediate, low-risk, noninvasive, precise method of treating retinal tears obscured by vitreous hemorrhage.

* PATIENTS AND METHODS: Eleven patients with sudden onset of vitreous hemorrhage were referred for diagnosis and management. Ophthalmoscopy with scleral depression was unsuccessful at localizing peripheral retinal tears, and all of the patients were examined with ultrasound using the techniques of standardized echography. The cryoprobe was positioned for cryotherapy using both transverse and longitudinal B-scan approaches following the indentation of the globe as it appeared on the oscilloscope.

* RESULTS: On follow-up examination after the vitreous hemorrhage cleared, 10 of the 11 tears were examined by ophthalmoscopy and were thought to have been adequately treated. One patient had a retinal detachment after remaining stable for 3 months. Two patients were treated with laser to enhance the cryotherapy seal. One patient was observed by another physician and underwent vitrectomy due to vitreous hemorrhage that persisted 2 months following cryotherapy. After vitrectomy, the physician reported a successful cryotherapy reaction at the treated tear. One final patient in the series required vitrectomy and scleral buckle before the hemorrhage had cleared, and the treatment did not appear to be complete.

* CONCLUSION: Ultrasound-guided cryotherapy provides a noninvasive, inexpensive treatment alternative for retinal tears obscured by vitreous hemorrhage.

[Ophthalmic Surg Lasers 1997;28:565-569.]
Idiopathic Macular Hole Following Vitrectomy: Implications for Pathogenesis
Authors: Lipham William J , Smiddy William E
Published: April 2021

BACKGROUND AND OBJECTIVE: Attention to the pathogenesis and clinical features of macular hole formation has increased with the advent of therapy. The purpose of this study is to present three cases that occurred in atypical settings that may have important pathogenic implications.

PATIENTS AND METHODS: The authors conducted a retrospective study of three patients who presented with macular holes that developed 10 months to 5.5 years after previous vitrectomy. In each case, the cortical vitreous layer was absent in the region of the macula at the time of operation for the macular hole.

RESULTS: The macular hole was successfully sealed and the visual acuity improved in all patients. All three cases in this report lacked an operculum, occurred long after vitreous removal, and had no evidence of any residual cortical vitreous.

* CONCLUSIONS: Macular hole formation in the absence of cortical vitreous suggests the possibility that the etiology of macular holes may involve a spontaneous umbo dehiscence rather than vitreous-induced surface traction. A mechanism involving a cystic degenerative process is proposed as the cause of atypical and typical macular hole formation.

[Ophthalmic Surg Lasers 1997;28:633-639.]
An Orbital Abscess Secondary to Acute Dacryocystitis
Authors: Ntountas Ioannis , Morschbacher Ricardo , Pratt David , Patel Bhupendra C K , Anderson Richard L , McCann John D
Published: April 2021

Abstract. An orbital abscess is an ophthalmic surgical emergency that is typically caused by the spread of bacteria from adjacent structures, such as the sinuses, eyelids, or teeth. Although acute dacryocystitis is commonly associated with preseptal cellulitis, it rarely causes orbital infection. Infection of the lacrimal sac will typically localize in the preseptal space because the lacrimal sac lies anterior to the orbital septum. To the authors' knowledge, this is the first report of an intraconal abscess secondary to acute dacryocystitis. The key points in the surgical management of this entity are discussed. [Ophthalmic Surg Lasers 1997;28: 758-761.]