bluuebunny/crossref_metadata_2025 huggingface dataset:
Verbal Interpersonal Responsiveness
Authors: Topf Margaret
Published: April 2021

One team's four-point method for identifying speech patterns in the nurse/ client relationship, including interview situations.
Help available for people with uncommon disorders
Authors: Anonymous
Published: April 2021

DSM-III-R fine tunes the approach to diagnosis
Care for the Chronically Mentally Ill
Authors: Anonymous
Published: April 2021

Continuity of care is the answer
Computers and Psychiatric Clients
Authors: Kane Gretchen A
Published: April 2021

Gretchen A. Kane explores an innovative new treatment modality for psychiatric clients with a major depressive episode.
Intervening in Interventions
Authors: Smoyak Shirley A
Published: April 2021

EDITORIAL
Counseling Clients with Genital Herpes
Authors: Chenitz W Carole , Swanson Janice M
Published: April 2021

Sexuality is part of our identities. If you contracted genital herpes, how would it change your Ufe? How would this incurable disease affect your relationships; your sexual satisfaction; your sexual identity; your self-esteem? How would you cope?
A Peer Supervision Group: Put Countertransference to Work
Authors: Bonnivier Joy Fest
Published: April 2021

In an inpatient setting, the nursing role is not limited, nor protected, by the boundaries of the therapy hour. Nurses provide 24-hour care, which often involves physical contact through assisting patients with hygiene needs and recreational activities. They share with patients significant and sometimes traumatic events: mealtimes, holidays, birthdays, or an assault or a suicide on the unit. These are usually intense, emotionally charged experiences that can recreate powerful family dynamics that were often a source of conflict for the patient.

The nurse-patient relationship is a dynamic, mutually defined dyad in which psychiatric nurses use their personality, interpersonal skills, and knowledge of psychiatric nursing practice to establish a therapeutic alliance with the patient (Wilson, 1988).
The Mental Health Review Board: A New Concept for Difficult Clients
Authors: Zakarias Linda J , Robinson Donna E
Published: April 2021

What do you do when a patient intimidates an entire hospital?
Chronic Pain and Depression
Authors: Herr Keela A , Mobily Paula R
Published: April 2021

Because of the increased incidence of chronic disease and other health problems associated with aging, chronic pain is a common companion for the elderly. Pain is of great clinical importance, often associated with disability, loss of independence, and reduced quality of life. A fact that is of interest to psychiatric nurses is that many elderly with complaints of chronic pain also exhibit signs and symptoms of depressive disorders.

Treating chronic pain conditions is complex and difficult, and health-care professionals are increasingly recognizing that psychological factors are often involved in the development and continuation of chronic pain problems. Depression is one of these influential variables. Increased understanding of the role of depression in the etiology and maintenance of chronic pain can improve assessment and intervention for the elderly with chronic pain complaints.
Former First Lady Speaks Out on Mental Health Care
Authors: Carter Rosalynn
Published: April 2021

Former First Lady Rosalynn Carter is speaking out during Mental Health Month to call attention to the need to place mental health issues high on our international agenda.
Well Siblings Living With Schizophrenia
Authors: Friedrich Rose Marie , Lively Sonja , Buckwalter Kathleen C
Published: April 2021

Impact of Associated Behaviors
Meeting Spiritual Needs on an Inpatient Unit
Authors: Moller Mary D
Published: April 2021

Patients and Family Members Speak Out

Two focus groups were held with consumers and family members to discuss the questions "What does spirituality/religion mean to you" and "What do you need from your pastor/spiritual resource during an inpatient hospitalization?" Spirituality was described in terms of relationship and religion in terms of rules.

Four themes emerged to describe spiritual needs during an inpatient hospitalization: comfort, companionship, conversation, and consolation. Spiritual/religious interventions deemed helpful when experiencing psychosis were collapsed into 11 salient points within these four themes.
What Every NURSE Needs To Know About NOCTURNAL SLEEP-RELATED eating DISORDER
Authors: Montgomery Lea , Haynes Linda C
Published: April 2021

ABSTRACT

This article provides information about a bizarre pattern of eating while asleep called nocturnal sleep-related eating disorder. People with this disorder, which has begun to be studied only recently, demonstrate features of both a sleep disorder and an eating disorder. Many clients are reluctant to initiate discussions regarding this condition because of feelings of powerlessness and shame. Other clients do not discuss their symptoms because nurses and other clinicians fail to gather accurate assessment data due to fóck of knowledge within the professional community regarding the disorder.

This review includes the historical background, definition of terms, and clinical manifestations of nocturnal sleep-related eating. In addition, emphasis on assessment and clinical management are included. Safety issues, the need to educate health care providers, and the role of the nurse in advocating for appropriate diagnosis, treatment, and referral are addressed.
HIV Prevention Among People with Developmental Disabilities
Authors: Brown Emma J , Jemmott Loretta Sweet
Published: April 2021

ABSTRACT

This investigation sought to determine the effect of HIV/AIDS on people with developmental disabilities. Inquiries about contributing factors and HIV prevention needs also were made. In this qualitative descriptive study, two focus groups were conducted with individuals from the target population, as well as service providers. Each focus group was held in a conference room of a community-based organization located in Philadelphia on a weekday evening. Sixteen adults participated in the focus groups. Seven were members of the target population, and 9 were service providers. Focused topics were developed to guide the group discussion. Participants identified several contributing factors and barriers associated with risk behavior and HIV risk in this population. Recommendations for HIV prevention needs and strategies also were generated. The results of this formative inquiry indicated there is a need for development of specific HIV intervention strategies for this vulnerable and often overlooked population. Clinical and research implications are proposed.
A Theory of Recovery
Authors: Lunt Alan
Published: April 2021

Medication alone is not enough. People with mental illnesses must move beyond regrets and engage in purposeful action to discover their own path to recovery.
Excimer Laser Photorefractive Keratectomy for Myopia: Results in 1165 Eyes
Authors: Brancato Rosario , Tavola Alessandara , Carones Francesco , Scialdone Antonio , Gallus Giuseppe , Garancini Paola , Fontanella Giovanni
Published: April 2021

ABSTRACT

BACKGROUND: We report the results of a prospective study conducted in Italy to evaluate the efficacy, safety, predictability, and complications of excimer laser photorefractive keratectomy for the correction of myopia.

METHODS: Photorefractive keratectomy was performed on 1236 myopic sighted eyes in 16 centers, using the Summit Excimed 193 nm excimer laser. The attempted correction ranged from -0.80 to -25.00 diopters (mean, -7.83 ± 3.88 D). The population was divided into three groups of attempted correction: between -0.80 and -6.00 D, between -6.10 and -9.90 D, and between -10.00 and -25.00 D. We report the data of 1165 eyes at 1 month, 970 eyes at 3 months, 752 at 6 months, and 330 at 1 2 months. At each visit, we evaluated (1) the refractive changes over time; (2) the difference between attempted and achieved correction; (3) uncorrected and best spectacle corrected visual acuity; and (4) haze.

RESULTS: Twelve months after surgery, the spherical equivalent refractive error in 146 eyes with attempted correction of -0.80 to -6.00 D was -0.52 ±1.04 D; 104 eyes (71.2%) were within ± 1.00 D of attempted correction. In 145 eyes with attempted correction of -6.10 to -9.90 D, the spherical equivalent refractive error was - 1 .66 ± 1.88 D; 50 eyes (34.5%) were within ± 1.00 D of attempted correction. The spherical equivalent refractive error in 39 eyes with attempted correction of - 1 0.00 to - 25.00 D was - 1 .86 ± 3.47 D; 1 1 eyes (28.2%) were within ±1.00 D of attempted correction. Eight eyes (2.4%) lost two or more Snellen lines of best spectacle corrected visual acuity. None of the treatments caused severe postoperative complications, or scarring.

CONCLUSIONS: Photorefractive keratectomy proved safe and effective, but highly predictable only in the correction of myopia up to -6.00 D. Refract Corneal Surg 1 993;9:95- 1 04.)

RÉSUMÉ

INTRODUCTION: Nous présentons les résultats d'une étude prospective conduite en l'Italie afin d'évaluer l'efficacité, la sûreté, la prévisibilité, et les complications de la kératectomie photorefractive au laser excimer pour la myopie.

MÉTHODES: 1236 yeux voyants ont subi la kératectomie photo- refractive dans 16 centres par le Summit ExciMed laser excimer à 193 nm. La correction souhaitée variait entre -0,8 et -25 dioptries (moyenne -7,83 ± 3,88 dioptries). La population fut divisée en trois groupes de correction souhaitée: entre -0,8 et -6,0 dioptries, entre -6,1 et -9,9 dioptries, et entre - 10,0 et -25,0 dioptries. Nous présentons les données de 1165 yeux suivis d'un mois, 970 yeux suivis de trois mois, 752 yeux suivis de six mois, et 330 yeux suivis de douze mois. À chaque visite nous évaluions (1) le changement réfractif avec le temps, (2) la différence entre la correction souhaitée et la correction réalisée, (3) l'acuité visuelle avec et sans correction, (4) la légère brume sous-épithéliale.
Human Lamellar Tendon Graft in Corneal Surgery
Authors: Signorelli Armando , Signorelli Carlos Roberto , Muldashev Ernest Rifgatovich
Published: April 2021

ABSTRACT

BACKGROUND: Due to the lack of donor corneas or unsuitable conditions for keratoplasty because of preexisting conditions such as vascularization, infections, and multiple rejections, scientists have searched for new synthetic and biological materials that can temporarily or permanently substitute for corneal tissue.

The purpose of this article is to show our personal experiences with the use of commercially available donor tendon tissue which has been chemically treated and was developed by Muldashev.

METHODS: Ten eyes unsuitable for a corneal allograft underwent lamellar keratoplasty using tendon allografts. Due to differing pathologies various surgical procedures were used. The followup period ranged from 6 to 1 8 months.

RESULTS: Transparent or semitransparent corneas resulted in seven of the ten eyes. In the three remaining eyes, conditions were improved for future penetrating keratoplasty because there was a significant decrease in corneal vascularization. The donor tendon was not rejected in any case.

CONCLUSIONS: As an alternative therapeutic method, treated human tendon proved effective as donor material for lamellar keratoplasty. (Refract Corneal Surg 1 993;9: 1 35- 1 39.)
Corneal Topographic Analysis of Photorefractive Keratectomy in 175 Myopic Eyes
Authors: Cantera Emilia , Cantera Italo , Olivieri Luigi
Published: April 2021

ABSTRACT

Videokeratography is a useful method for postoperative evaluation of photorefractive keratectomy (PRK). The aim of this study was to evaluate the percentage of decentration, the relationship between decentration relative to the corneal apex, postoperative astigmatism, and the relationshlp between decentration and best corrected Snellen visual acuity.
Photorefractive Keratectomy for Myopia: Single vs Double-Zone Treatment in 166 Eyes
Authors: Tavola Alessandra , Brancato Rosario , Galli Laura , Carones Francesco , Esente Stefano
Published: April 2021

ABSTRACT

We studied 58 single-zone and 58 double-zone treatments; attempted correction ranged between 6.50 and 10.00 D. There were no significant differences in the age or sex in the two groups. All the eyes received the same topical corticosteroid therapy.

Refractive outcome showed a greater overcorrection in the double-zone than in the single-zone treatments, but the différence was not statist ically significant (F =3. 17, ? =0.07). The refractive error shifted toward myopia significantly over time (F = 561.34, p<0.0001).

In the first-, third- and sixth-month follow up, the mean refractive error was +2.39 (±SD) ±1.94, + 0.45 ± 1 .54, and - 0.60 ± 1 .50 D in the single-zone treatments, while in the double-zone ones they were +1.95 ±2.49, +0.87 ±2.85 and +1.34 ±2.57 D1 respectively. The Student's T test demonstrated a statistically significant difference of refractive outcome between the two groups only at 6 months (T = -3.788, p <0.0001).

Corneal haze decreased during follow up (F= 123.38, p<0.0001) and was more severe in the single-zone than in the double-zone treatments (F =9.28, p= 0.002). The Student's T test showed a significant difference at 6 months (T = 2.877, P= 0.006).

The double-zone procedure appeared to be safer than the single-zone, but a longer follow up period and a greater number of treatments are required to draw final conclusions. (Refractive and Corneal Surgery (suppl) 1993;9:S48-S52)
Efficacy of Corticosteroids in Reversing Regression After Myopic Photorefractive Keratectomy
Authors: Carones Francesco , Brancato Rosario , Venturi Elisabetta , Scialdone Antonio , Bertuzzi Alberto , Tavola Alessandra
Published: April 2021

ABSTRACT

Topical corticosteroids are given commonly after photorefractive keratectomy (PRK). We present six eyes treated for correction of myopia ranging between -6.00 and -8.00 D, to whom corticosteroid drops were given and then suspended. Each eye had an increase in myopia with a mean of 2.00 D (range 1.00 to 3.50 D). All were then treated with topical dexamethasone (0.1%) four times per day for at least 15 days, and all showed decreases in myopia with partial or complete recovery of the intended correction (mean: 1.625 D; range 1.00 to 3.50 D). All of these refractive variations were documented by corneal topography. In one eye, refractive and topographic variations were detected by 3 days after corticosteroid treatment was initiated and they increased for 15 days.

We believe corticosteroids can modulate refractive changes after PRK. (Refract Corneal Surg (suppl) 1993;9:S52-S56.)
Phototherapeutic Keratectomy: Long-Term Results in 166 Eyes
Authors: Fagerholm Per , Fitzsimmons Thomas D , Örndahl Mats , Öhman Lena , Tengroth Björn
Published: April 2021

ABSTRACT

One hundred sixty-six eyes with corneal disease were treated with the excimer laser in order to ablate opacities, irregularities, or to improve wound healing. Postoperative follow up time was 15 months (range 6 to 28 months). An individual goal was set for each patient and 84% achieved the goal. The visual acuity change is given for each subgroup. Phototherapeutic keratectomy (PTK) was shown to be an advantageous surgical method, where the success is in the careful preoperative evaluation. One problem with the technique is the induced hyperopia. (Refract Corneal Surg (suppl) 1993;9:S76-S81.)
Philosophy and Technique for Excimer Laser Phototherapeutic Keratectomy
Authors: Thompson Vance , Durrie Daniel S , Cavanaugh Timothy B
Published: April 2021

ABSTRACT

Phototherapeutic keratectomy (PTK) with the excimer laser has been shown to be effective in removing anterior corneal pathology and smoothing surface irregularities. Blocking agents are important in PTK. The techniques we present seek to balance therapeutic effect and refractive error change. Successful PTK depends on thorough preoperative assessment and attention to intraoperative detail.

Clinical research has demonstrated that the excimer laser is an effective tool, not only for correcting myopic refractive errors,1,2 but also for treating various types of anterior corneal pathology.35 We present our PTK techniques that reflect recent refinements. (Refract Corneal Surg (suppl) 1993;9:S81-S85.)
Phototherapeutic Keratectomy for Reis-Bückler's Dystrophy
Authors: Lawless Michael A , Cohen Peter , Rogers Chris
Published: April 2021

ABSTRACT

Reis-Bückler's dystrophy has been a difficult management problem with generally poor longterm results from the conventional treatment techniques of penetrating and lamellar keratoplasty. Phototherapeutic keratectomy (PTK) is now the standard method of managing this anterior corneal disease when intervention is required.

We have treated nine eyes with Reis-Bückler's dystrophy, including two in whom previous penetrating keratoplasty had been performed.

All of our patients achieved substantial visual improvement from an average visual acuity of 6/60 to 6/9, and all had complete cessation of recurrent erosions. (Refract Corneal Surg (suppl) 1993;9:S96-S98.)
Photorefractive Keratectomy for Myopia: 18-Month Results in 178 Eyes
Authors: Salorio D Pita , Costa J , Larena C , Mauricio J , Motos P , Emeterio R , Fontenla J R
Published: April 2021

ABSTRACT

To evaluate the predictability, efficacy, and stability of myopic photorefractive keratectomy (PRK), we present the results of 18 months of 178 consecutive myopic eyes. Results demostrated a stable change in the power of the cornea with long-term corneal clarity. (Refract Corneal Surg (suppl) 1993;9:S108-S110.)
Plume Emission, Shock Wave and Surface Wave Formation During Excimer Laser Ablation of the Cornea
Authors: Bor Zs , Hopp B , Rácz B , Szabó G , Ratkay I , Süveges I , Füst Á , Mohay J
Published: April 2021

ABSTRACT

Excimer lasers are now used for corneal surgery; however, the physical processes occurring during photoablation of the cornea are incompletely understood. High speed laser-based photographic arrangement was constructed. The temporal resolution was better than 1 ns. The setup could work as a Schlieren arrangement, which is sensitive to the refractive index change caused by the shock wave propagating in the air above the eye. With minor changes the setup was converted into a shadowgraph, which could detect the ablation plume and the waves propagating on the surface of the eye. Due to the impact of the excimer laser pulse onto the surface of the cornea, a shock wave was generated in the air. The shadowgraph clearly showed the ejection of the ablated cornea. The ejection velocity of the plume was found to be over 600 m/s. It was shown for the first time that the recoil forces of the plume are generating a wave on the surface of the eye.

The laser-based high speed photographic arrangement is a powerful arrangement in the study of physical effects occurring during photoablation of the cornea. (Refract Corneal Surg (suppl) 1993;9:S111-S115)
PRK Using an Absorbing Cell Delivery System for Correction of Myopia From 4 to 26 D in 3251 Eyes
Authors: Fyodorov S N , Semyonov A D , Magaramov J A , Kharizov A A , Kachalina O F , Orlov M Yu , Tyurin V S , Sugrobov V A
Published: April 2021

ABSTRACT

An ophthalmic laser unit with a Lambda-Physik LPX excimer emitting 193 nm and a unique beam shaping system was designed at the Complex "Eye Microsurgery."

An absorbing cell, used as the main element of the delivery system, allowed us to obtain a precise profile of the laser energy density on the patient's cornea, smoothly changing the corneal refraction with each shot in the whole ablation area. The absorbing cell also allowed for varying the shape of distribution of radiation energy density depending on the patient's corneal shape.

We performed more than 7000 photorefractive keratectomy laser operations in myopic patients, and report results in 3251 myopic eyes (approximately 46%) from -4.00 to -26.00 D, up to 4 years after surgery.

In eyes with myopia greater than 6.00 D, emmetropia was obtained in 48% of cases; 42% had a residual mild myopia within 5.00 D; and 12% had a residual myopia more than 3.00 D.

The corneal haze disappeared in 40.8% of cases; haze not affecting the visual acuity remained in 39%; and clinically significant haze remained in 12.2%. These eyes required a powerful medication or repeated PRK.

After surgery, 87.7% of patients needed no spectacle correction. Excimer laser PRK with the use of the forming system efficiently corrects high myopia. (Refract Corneal Surg (suppl) 1993; 9:S123-S124.)
Coralline Hydroxyapatite Keratoprosthesis in Rabbits
Authors: León Carlos R , Barraquer José I , Barraquer José I
Published: April 2021

ABSTRACT

BACKGROUND: The ideal keratoprosthesis will have a curvature similar to that of the recipient cornea and allow the tissue to grow into the supporting material. We developed a support for a keratoprosthesis made of porous hydroxyapatite, which is highly biocompatible, biointegrable, non-biodegradable, and colonizable.

METHODS: We implanted the keratoprosthesis unilaterally in the right eyes of 12 New Zealand rabbits, intralamellarly and between a homologous episclerokeratoplasty (with and without conjunctival flap) for 12 months. Pathology studies and technetium-99 bone scans were performed.

RESULTS: We found good vascularization, no signs of infection or extrusion, no epithelial downgrowth, and no adverse tissue reaction.

CONCLUSION: A clinical trial of this keratoprosthesis is warranted. [J Refract Surg 1997;13:74-78]
Effect of Transforming Growth Factor β1 on Stromal Haze following Excimer Laser Photorefractive Keratectomy in Rabbits
Authors: Myers Jonathan S , Gomes Jose A P , Siepser Steven B , Rapuano Christopher J , Eagle Ralph C , Thom Steven B
Published: April 2021

ABSTRACT

BACKGROUND: Transforming growth factor β (TGF-β) has been shown to affect wound repair. Ariti -transforming growth factor βl antibodies have been shown to neutralize its activity.

METHODS: Seventeen New Zealand White rabbits underwent unilateral photorefractive keratectomy followed by corneal staining with dichlorotriazinyl fluorescein. Three groups received topical transforming growth factor βl: 1 µg/ml, 10 µg/ml, and 100/µg/ml; one group topical anti-transforming growth factor β antibody (200µg/ml); and a control group vehicle only. Corneal haze was graded from 0 to 4, weekly. Rabbits were sacrificed at 5 weeks and histopathological analysis and fluorescence microscopy performed.

RESULTS: All treated eyes developed haze and had epithelial erosions. No statistically significant differences in haze score were seen among individual treatment groups (Kruskal Wallis p > 0.05). The anti-transforming growth factor β antibody group had less haze than all other groups at every week after the first. Comparing all transforming growth factor βl treated eyes as one group to the antibody group, significantly less haze was seen at weeks 3 and 4 in the antibody treated group (p = 0.028 and 0.013, respectively). This study is limited by small group size and further studies are needed to confirm these results.

CONCLUSION: TGF-β may be involved in stromal haze formation, and topical anti-TGF-βl antibody may help reduce the development of stromal haze. [J Refract Surg 1997;13:356-361]
Laser in situ Keratomileusis for Hyperopia
Authors: Ojeimi Ghassan , Waked Nagi
Published: April 2021

ABSTRACT

PURPOSE: To study the efficacy of laser in situ keratomileusis (LASIK) for hyperopia.

METHODS: We performed LASIK on 21 eyes using the Nidek EC-5000 excimer laser with software version 2.18 AH. The Chiron Automated Corneal Shaper was used to create the flap. Retreatments were needed in seven eyes due to decentration or undercorrection.

RESULTS: Although a high rate of satisfaction was noted among patients, complications were encountered such as decentration (three eyes), undercorrection (four eyes); one patient progressed to low myopia with a loss of spectacle-corrected visual acuity and one patient had regression 3 months after the initial LASIK.

CONCLUSION: Although this technique has several advantages over other techniques (Holmium, ALK, PRK, hexagonal RK), it has a high rate of retreatment and some complications. Software refinement is needed, and patients should be adequately informed about what to expect from this technique. [J Refract Surg 1997;13(suppl):S432 to S433]
Seasonal Variations in Refractive Results following Excimer Laser Photorefractive Keratectomy
Authors: Chatterjee Anupam , Shah Sunil
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the effect of seasonal factors on the final refractive outcome following excimer laser photorefractive keratectomy (PRK).

METHODS: We examined the final refractive outcome for 5367 patients who had undergone PRK and photoastigmatic refractive keratectomy (PARK) over an 18-month period, April 1994 to August 1995, with a Nidek EC-5000 excimer laser and analyzed them by monthly and seasonal groups at time of treatment.

RESULTS: We were unable to demonstrate any significant difference in patients grouped according to season at time of treatment.

CONCLUSION: We would not recommend any seasonal-related adjustment for treatment with the Nidek EC-5000 excimer laser. [J Refract Surg 1997;13(suppl):S447-S449]
Presumed Reactivation of Herpes Zoster Ophthalmicus Following Laser in situ Keratomileusis
Authors: Jarade Elias F , Tabbara Khalid F
Published: April 2021

ABSTRACT

PURPOSE: To report a case of herpes zoster ophthalmicus reactivation following laser in situ keratomileusis (LASlK) for myopia.

METHODS: A 54-year-old healthy male underwent uneventful bilateral LASIK for the correction of myopia and astigmatism (-5.75 -3.00 ? 20? right eye, -5.50 -3.00 ? 170? left eye). Two months following LASIE, an epithelial dendritic lesion appeared in the lower third of the corneal flap of the left eye with vesiculoulcerative lesions of the lateral side of the tip of the nose.

RESULTS: The patient was treated with topical and oral antiviral agents and had complete recovery of the lesions in 10 days.

CONCLUSIONS: Herpes zoster reactivation may occur following LASIK. Reactivation of herpes zoster in this case could have been coincidental, or secondary to LASIK and the subsequent use of topical corticosteroids following LASIK. [J Refract Surg 2002;18:79-80]
Cost-effectiveness of the AMOArray Multifocal Intraocular Lens in Cataract Surgery
Authors: Orme Michelle E , Paine Abigail C , Teale Christopher W , Kennedy Lisa M
Published: April 2021

ABSTRACT

PURPOSE: To compare the cost and outcomes of bilateral cataract surgery with the foldable AMOArray multifocal intraocular lens (MIOL) versus the foldable monofocal intraocular lens from the health care payer perspective.

METHODS: A cost-effectiveness analysis was used to evaluate treatment with the MIOL compared to monofocal lens, using data from clinical trials, literature, expert opinion, and a review of the German health care funding and reimbursement system.

RESULTS: The average total direct medical cost per patient (per procedure) with the MIOL was DM 1,774 compared to DM 1,716 with the monofocal lens (IDM a US$0.558 in April 1998). The MIOL was more cost-effective than the monofocal lexis in terms of cost per patient (spectacle-free). Cost per patient without overall limitation in vision-related function and cost per patient without limited night vision were similar for both patient groups. The incremental cost of the MIOL for a one-point increase was DM 52 in the self-rated score "quality of ViSiOn," DM 82 in "satisfaction with day vision,*' and DM 115 in "satisfaction with night ViSiOn."

CONCLUSION: The small additional cost of the MIOL was outweighed by the increased satisfaction with vision experienced by MIOL patients. [J Refract Surg 2002;18:162-168]
Early Onset Ectasia Following Laser in situ Keratomileusus: Case Report and Literature Review
Authors: Rao Sanjay N , Epstein Randy J
Published: April 2021

ABSTRACT

PURPOSE: Laser in situ keratomileusis (LASIK) has been associated with the development of postoperative corneal ectasia. We present a case of early onset ectasia after LASIK, review known risk factors in development, and discuss possible strategies for prevention.

METHODS: A 39-year-old man underwent bilateral LASIK for moderate myopia. Preoperative cycloplegic refractions were -9.00 +0.25 x 140° OD and -7.75 sphere OS. Corneal topography demonstrated mild inferior steepening bilaterally although definite evidence of keratoconus by either the Klyce/Maeda and Smolek/Klyee keratoconus screening tests was not present. Following the creation of flaps with 160-µm plates, ablations of 93 ??a OD and 80 µm OS were performed, estimated to leave residual stromal beds of at least 314 /an OD and 330 µ OS.

RESULTS: On the first postoperative day, uncorrected visual acuities were 20/400 OD and 20/40 OS. On the fifth postoperative day, the patient's uncorrected visual acuity was 20/400 OD, and 20/300 OS. Corneal topography of the right eye showed profound inferior steepening with an apical corneal power in excess of 57 D; topography of the left eye showed mild inferior steepening. Eighteen months after surgery best corrected visual acuity was 20/40 OD and 20/30 OS with rigid gas permeable contact lenses.

CONCLUSIONS: This case highlights the need for a high index of suspicion when one notes an asymmetric bow-tie pattern on preoperative LASDX corneal topography, despite seemingly safe estimates of residual stromal bed thickness. [J Refract Surg 2002;18:177-1841
Clinical Importance of Accurate Refractor Vertex Distance Measurements Prior to Refractive Surgery
Authors: Weiss Richard A , Berke William , Gottlieb Larry , Horvath Peter
Published: April 2021

ABSTRACT

PURPOSE: To determine directly measured vertex distances in a consecutive series of patients refracted at a refractor and to examine the clinical importance of such a measurements for improving refractive surgical results.

METHODS: Vertex distance measurements were obtained in 189 consecutive patients by using a new device capable of taking direct and accurate measurements behind a refractor. Eyelid thickness was measured with an industrial caliper in five patients.

RESULTS: The average true vertex distance was 20.4 mm with a range of 10 to 34 mm. Eyelid thickness was 3 mm in all five patients.

CONCLUSIONS: Precise measurement of true refractor vertex distance is important for accuracy of refractive surgical procedures. The practice of assuming an average vertex distance of 12 to 14 mm for all refractive patients underestimates the vertex distance in many patients refracted at the refractor, resulting in overcorrecting minus and undercorrecting plus refractions. [J Refract Surg 2002;18:444-448]
A New Method of Calculating Intraocular Lens Power After Photorefractive Keratectomy
Authors: Rosa Nicola , Capasso Luigi , Romano Antonio
Published: April 2021

ABSTRACT

PURPOSE: To find a method of calculating intraocular lens (IOL) power that may be independent of preoperative data, in eyes that have developed a cataract after refractive surgery.

METHODS: Prior to and 1 month after PRK, the SRKTT formula was used to calculate IOL power in 88 eyes of 65 patients with a preoperative spherical equivalent refraction between -16.25 to +0.25 D (mean -5.39 ± 3.19 D). IOL power was calculated by utilizing the spherical equivalent refraction as target both before and after PRK. Utilizing the postoperative corneal radius measurement (R2), an underestimation of the IOL power was found. For this reason, the mean postoperative corneal radius (R3) that gave the same IOL power found before surgery was calculated for each patient. The R3/R2 ratios were plotted against the axial eye length and a linear regression formula was used to calculate R2 correcting factors that gave the new corneal radius (R4). Patients were divided into classes according to axial eye length, and the mean R3/R2 ratios for each class were calculated and used to recalculate the new mean radius (R5). IOL power for emmetropia was calculated in all patients by utilization of R3, R4, R5, the historical method, and the "true corneal power" method.

RESULTS: Within ±0.50 D from the IOL power calculated with R3, R4 gave 35 (39.3%) IOLs, while R5 gave 40 (45.5%) IOLs; the clinical history method gave 24 (27.3%) IOLs and "true corneal power" gave 23 (26.1%) IOLs, with a statistically significant difference P<.001).

CONCLUSIONS: Our theoretical method, based on correlation between axial eye length and corneal radius correcting factors, may represent an effective method of calculating IOL power after PRK, especially if the history of the patient is unknown. [J Refract Surg 2002;18:720-724]
Results of Laser in situ Keratomileusis for Myopia of -10 to -19 Diopters With a Technolas 217 Laser
Authors: Dada Tanuj , Sudan Rajeev , Sinha Rajesh , Ray Manotosh , Sethi Harinder , Vajpayee Rasik B
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (IASIK) for correcting myopia greater than -10.00 D.

METHODS: Sixty-five eyes of 37 patients with myopia greater than -10.00 D underwent LASIK. Patients were evaluated on day 1, 1 week, 1, 3, and ß months after surgery. Parameters evaluated were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), residual refractive error, regression of correction, and presence of any complication.

RESULTS: Mean preoperative BSCVA was 0.745 ± 0,234, which improved to 0.8070 ± 0.237 postoperatively. The average preoperative UCVA was 0.022 ± 0.02; postoperative UCVA at 6 months was 0.536 ± 0,255. UCVA of 20/40 or better was achieved in 58% (38 eyes) and 20/20 or better in 26% (17 eyes). The average refractive error before LASIK was -12.64 ± 2.16 D (range -10.00 to -19.00 D). Mean residual refractive error 1 week following LASIK was -0.63 ± 1.36 D, which regressed to a mean -1.78 ± 2.08 D at the end of 6 months. Nineteen eyes (29%) were within ±0.50 D of intended refractive correction.

CONCLUSION: LASlK was partially effective in the correction of high myopia. An initial overcorrection may be programmed to offset the effect of refractive regression. [J Refract Surg 2003;19:44-47]
Diffuse Lamellar Keratitis 6 Months After Uneventful Laser in situ Keratomileusis
Authors: Belda José I , Artola Alberto , AIió Jorge
Published: April 2021

ABSTRACT

PURPOSE: Diffuse lamellar keratitis after laser in situ keratomileusis (LASEK) typically occurs between 1 and 7 days after the procedure, and its etiologic factor(s) remain unknown.

METHODS: We describe a case of diffuse lamellar keratitis 6 months after uneventful LASIK in a 25-year-old woman.

RESULTS: Slit-lamp microscopy showed a diffuse infiltrate confined to the interface, extending to the visual axis, with no other relevant findings. Late on-set diffuse lamellar keratitis was our provisional diagnosis and treatment with topical corticosteroids was instituted, with rapid response and improvement of the clinical signs and symptoms.

CONCLUSIONS: This case supports the theory that a previously inert inciting agent could cause a delayed toxic or inflammatory response of the cornea several months after surgery. [J Refinct Surg 2003;19:70-71]
Correlation Between Corneal and Total Wavefront Aberrations in Myopic Eyes
Authors: Mrochen Michael , Jankov Mirko , Bueeler Michael , Seiler Theo
Published: April 2021

ABSTRACT

PURPOSE: Corneal topography data expressed as corneal aberrations are frequently used to report corneal laser surgery results. However, the optical image quality depends on all optical elements of the eye, including the human lens. We investigated correlations between corneal and total wavefront aberrations and the relevance of corneal aberrations for representing the optical quality of the total eye.

METHODS: Thirty-three eyes of 22 myopic patients were measured using a corneal topography system and a Tscherning-type wavefront analyzer. Pupils were dilated to at least 6 mm in diameter. All measurements were centered with respect to the line of sight. Corneal and total wavefront aberrations were calculated up to the 6th Zernike order in the same reference plane.

RESULTS: Statistically significant correlations (P<.05) between corneal and total wavefront aberrations were found for astigmatism (C3,C5) and all 3rd Zernike order coefficients such as coma (C7,C8). No statistically significant correlations were found for 4th, 5th, or 6th order Zernike coefficients. On average, all Zernike coefficients for corneal aberrations were larger than the Zernike coefficients for total wavefront aberrations.

CONCLUSIONS: Due to the lack of correlation between corneal and total wavefront aberrations in most of the higher order aberrations, measurement of corneal aberrations are of limited use for representation of the optical quality of the human eye, especially after corneal laser surgery. Corneal aberrations and optical elements within the eye are optically balanced. As a consequence, ideal customized ablations must take both corneal and total wavefront aberrations into consideration. [J Refract Surg 2003;19:104-112]
Subtarsal Flap Dislocation After Superior Hinge Laser in situ Keratomileusis in a Patient With Borderline Mental Illness
Authors: Maldonado Miguel J , Juberías José R
Published: April 2021

ABSTRACT

PURPOSE: To report a case of complete subtarsal flap dislocation after uncomplicated superior hinge laser in situ keratomileusis (LASIK).

METHODS: Flap dislodgement resulted from eye rubbing in a patient with a past medical history of mental illness and epilepsy. The dislocated cap, which was also folded in half, was refloated, profusely irrigated, and ironed to eliminate flap wrinkles. Particular care was taken to avoid flap misalignment.

RESULTS: Despite the above mentioned intervention, a prominent epithelial mark corresponding to the line of previous folding persisted for 3 additional days. Eventually, a perfectly aligned lenticule without wrinkles and an otherwise normal postoperative course occurred.

CONCLUSIONS: Although superior hinge LASIK may reduce the likelihood of flap displacement, mechanical forces can generate complete flap dislocation. When a flap has been folded in half, an epithelial mark corresponding to the line of folding may persist. Patients with psychiatric disorders may be at higher risk of postoperative flap-related complications. [J Refract Surg 2003;19:169-171]
Early Results of Nidek Customized Aspheric Transition Zones (CATz) in Laser in situ Keratomileusis
Authors: Kermani Omid , Schmiedt Karl , Oberheide Uwe , Gerten Georg
Published: April 2021

ABSTRACT

PURPOSE: Standard ablation profiles for myopia and myopic astigmatism are spherical in shape and usually induce spherical aberration, often resulting in glare, halo, and other night vision problems. New ablation algorithms with aspheric transition zones may help reduce the amount of induced spherical aberrations in refractive surgery.

METHODS: Between September and November 2002, 52 eyes were treated with bilateral laser in situ keratomileusis (LASIK) using a new ablation profile with customized aspherical transition zone (CATz). Results were analyzed from examinations performed 1 day, 1 and 3 months (if available) after surgery, and compared to a standard LASIK patient group.

RESULTS: Refractive outcome of patients was within ±0.50 D of intended correction in 72% on day 1, and 82% at 1 month after surgery. At 1 month after LASIK, mean spherical equivalent refraction was changed from preoperative mean -6.73 ± 2.04 D to postoperative mean -0.43 ± 0.80 D (range -2.00 to +1.50 D). No eye lost more than 1 line of visual acuity; 10% gained 1 line and 80% remained unchanged 1 month after surgery. The topographically visible effective optical zone size was larger than in comparable treatments with standard ablation profiles. Spherical aberration was reduced and no patient complained about night vision problems after surgery.

CONCLUSIONS: Customized aspheric transition zones may help reduce induction of spherical aberration in refractive surgical correction of myopia and myopic astigmatism. [J Refract Surg 2003; 19(suppl):S190-S194]
The Role of Amino Acids in Corneal Stromal Healing: A Method for Evaluating Cellular Density and Extracellular Matrix Distribution
Authors: Vinciguerra Paolo , Munoz Maria Ingrid Torres , Camesasca Fabrizio I
Published: April 2021

ABSTRACT

PURPOSE: To evaluate how amino acid supplementation influences the response of corneal stromal keratocytes and other components of the corneal stroma.

METHODS: We compared two groups of patients undergoing cataract surgery. Each group included 20 eyes of 20 patients. Patients in Group 1 were treated with amino acids for 15 days before surgery, and patients in Group 2 did not receive amino acids (control). To evaluate differences and change in corneal stroma, we analyzed all of the operated corneas with confocal microscopy. The eonfocal images were then analyzed with a new method for measurement of corneal structure based on fractal dimension calculation. This led to a numerical value, D index (fractal surface dimension), an objective measurement of corneal stromal characteristics. This index is related to three factors: keratocyte density, stromal distribution pattern, and intercellular matrix structure.

RESULTS: Patients in the preoperative amino acid group showed higher keratocyte density values than those in the control group. We observed differences in cell distribution patterns and intercellular matrix structures between groups. Amino acid-treated patients had a corneal stroma with a D index value 10% higher than control group patients.

CONCLUSIONS: We hypothesized that preoperative oral supplements with amino acids may change the corneal stroma structure by increasing keratocyte density and modifying the intercellular matrix. A new method for the measurement of these changes was applied, which provides quantification of the stromal structure complexity with a single numerical value. [J Refract Surg 2003;19(suppl): S227-S230J
Ascorbate Prophylaxis for Corneal Haze After Photorefractive Keratectomy
Authors: Stojanovic Aleksandar , Ringvold Amund , Nitter Tore
Published: April 2021

ABSTRACT

PURPOSE: To evaluate whether prophylactic systemic ascorbic acid influences the average level of haze and the incidence of late onset corneal haze after photorefractive keratectomy (PRK).

METHODS: Two consecutive groups of eyes treated with PRK for myopia with or without astigmatism were retrospectively compared. The patients had been treated similarly, with the exception that systemic ascorbate had been supplied orally in one of the groups. Haze intensity was quantified on a scale from 0 (clear cornea) to 4 (anterior chamber not visible). The diagnostic criterion for late onset corneal haze was a haze grade 2 or higher, occurring 4 to 12 months after surgery.

RESULTS: One week, 1, 3, 6, and 12 months after surgery, the group without ascorbate (314 eyes) showed haze of average levels 0.61, 0.51, 0.50, 0.32, 0.10, respectively, and the group with ascorbate (201 eyes) showed haze of average levels 0.38, 0.18, 0.16, 0.09, 0.06, respectively. Comparison of the respective values showed a statistically significant difference between the two groups (P<.01) at 1 week, 1, 3, and 6 months. Late onset corneal haze was observed in 11 eyes in the group without ascorbate, and none was observed in the group with ascorbate (P<.02).

CONCLUSION: This retrospective nonrandomized clinical study suggests that oral ascorbic acid supplementation may have a prophylactic effect against haze development after PRK. However, routine prophylactic use of ascorbate can be recommended only after a randomized, prospective clinical trial substantiates its efficacy. [J Refract Surg 2003;19:338-343]
The Lens as a Barrier Against Foreign Body Reaction
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

Cases of eyes with a piece of wood and a piece of rusting steel in the lens are used to demonstrate the capacity of lens substance and lens capsule for isolation of irritating foreign bodies. This barrier function of the lens is of interest in the search for the best location of intraocular lens implants.
Trabeculectomy in Black Patients
Authors: Miller Ronald D , Barber John C
Published: April 2021

SUMMARY

A series of 122 trabeculectomies in black patients is presented, with a minimum postoperative follow-up of 12 months. Glaucoma was controlled in 57% of the cases (39% without medication and 18% with medication) and 43% were uncontrolled at 12 months. Several characteristics were observed in these patients that seem to influence success. A high correlation was found between the presence of a bleb and successful control of pressure without medication. The rate of success was found to decrease little after 12 months postoperative follow-up.
Use of Venturi Entrainment Mask for High-Flow Ventilation of Patients Submitting to Ophthalmic Surgery Under Local Anesthesia
Authors: Wesley Ralph E , Halpin Michael
Published: April 2021

SUMMARY

The venturi entrainment mask is an inexpensive, disposable item readily available from the respiratory therapy department of most hospitals, which can be used with the patients submitting to ophthalmic surgery under local anesthesia to provide low oxygen concentration, high-flow ventilation at nearly room temperature and humidity. Four liters of oxygen will entrain an additional 101 liters of room air using the 24% intake valve. This high-flow ventilation system eliminates hypercarbia since the patient never rebreathes. The mask elevates the drapes comfortably off the patient's face without dislodging and reduces the danger of flash fire with the use of thermal electrocautery.
Treatment of Distichiasis with Cryotherapy
Authors: Frueh Bartley A
Published: April 2021

SUMMARY

The surgical treatment of distichiasis has frequently resulted in disfigurement of the treated eyelid. Since the follicles of the aberrant lashes in lids with distichiasis are placed more posteriorly than the follicles of normal lashes, it is theoretically possible to destroy the follicles of the aberrant lashes without destroying the follicles of the normally placed lashes if transconjunctival cooling creates a sufficient temperature gradient from the conjunctiva to the anterior tarsal surface.

This report illustrates a successful application of this concept. However, further data are needed to delineate the optimum cryo treatment of distichiasis.
Tensile Strength of Corneoscleral Wounds Repaired with Absorbable Sutures
Authors: Masuda Kanjiro
Published: April 2021

SUMMARY

The tensile strength of healing corneoscleral wounds repaired with 9-0 and 10-0 nylon, polyglycolic acid, and polyglycolic-lactic acid sutures was measured in rabbit eyes at the first, third, and sixth postoperative weeks. In all cases, the tensile strength of the wound increased to about 50 percent of that of intact control tissue by the sixth week. There were no differences between the tensile strengths of wounds and the severity of inflammation in the anterior chamber between eyes sutured with nylon and those sutured with absorbable materials. Conjunctival injection persisted longer around nylon sutures, however, than it did around either polyglycolic acid or polyglycolic-lactic acid sutures. The absorbable sutures maintain sufficient strength to support healing corneoscleral wounds.
New Cataract Removal Instrumentation and Techniques: II. Laboratory Phacofragmentation with the NASA-McGannon Cataract Fragmentor
Authors: Liu Luke H S , Tolentino Felipe I , Baehr Edward F , Schepens Charles L
Published: April 2021

SUMMARY

The NASA-McGannon cataract fragmentor, a newly designed mechanical phacofragmentor powered by compressed air, was tested on 100 eyes of old rabbits and on 50 dark Drown nuclei of human cataracts that were implanted in the anterior chambers of rabbit eyes after the lenses had been removed. It was possible to eliminate the eddy current in the anterior chamber, reduce the requirement for infusion, and reduce the time of fragmentation both for rabbit lenses and for implanted hard nuclei of human cataracts. latrogenic damage to the iris and posterior capsule of the lens was noted in the early cases but not in the later ones, as the operators became more skillful in manipulating the instrument.