bluuebunny/crossref_metadata_2025 huggingface dataset:
CONTROVERSIES AND CHALLENGES OF RITUAL ABUSE
Authors: Valente Sharon
Published: April 2021

ABSTRACT

Children who have survived ritual abuse have endured physical, psychological, and sexual trauma; brainwashing; and mind-altering drugs. Their trust in adults has been eroded. Their coping strategies include anxiety, denial, self-hypnosis, dissociation, and self-mutilation. Although reports of ritual abuse initially seem hard to believe, nurses have a responsibility to detect clues to abuse, diagnose the child's responses, and recognize controversial issues regarding ritual abuse.

To evaluate ritual abuse, nurses should avoid interview strategies that influence the child's recall (e.g., coaching, suggestions) and recognize that some reports are discounted as false memories because they emerge from fantasy, distortions, innocent deceptions, false beliefs, lies, or adult coaching. Nurses play an important role in case finding and treatment. They can evaluate clues to ritual abuse to reduce sources of error in assessment, build a child's trust, monitor their own attitudes toward ritual abuse, and intervene to increase selfesteem, empathy, boundary establishment, and coping. Nurses have an important opportunity to detect and begin healing the wounds caused by a child's abuse.
LISTENING for the Patient's Story
Authors: Walden-McBride Deborah L , McBride J Lebron
Published: April 2021

The Psychosocial Story of a Patient With End-Stage Heart Disease
Repeated SUICIDE Attempts: ANALYZED AS ADDICTIVE BEHAVIORS
Authors: Mynatt Sarah
Published: April 2021

ABSTRACT

Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.
Are Abused Women Mentally ill?
Authors: May Barbara A , Rakhlin Dmitriy , Katz Anita , Limandri Barbara J
Published: April 2021

ABSTRACT

A secondary data analysis study was conducted on Derogatis Brief Symptom Inventory (BSI) data derived from a larger intervention study of community-based abused women (N = 50). The purpose was to improve understanding of the effect domestic violence has on mental health, given the symptomatology observed in this population. A psychological distress symptom profile was developed and compared with BSI normative data. Findings were unexpected and suggest the necessity to reexamine the assumptions harbored about interpersonal violence in research and practice.
Crossing the Digital Divide
Authors: Smoyak Shirley A
Published: April 2021

On-Line in 2003
New Developments With Vagus Nerve Stimulation Therapy
Authors: Howland Robert H.
Published: April 2021

The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuro-endocrine-immune axis. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve. Left cervical VNS is an approved therapy for refractory epilepsy and treatment-resistant depression. Right cervical VNS has proven effective for treating heart failure in preclinical studies and a Phase II clinical trial. The effectiveness of noninvasive transcutaneous VNS for epilepsy, depression, and other conditions has not been investigated beyond small pilot studies. The relationship between depression, inflammation, and cardiovascular, cerebrovascular, and metabolic syndromes might be mediated by the vagus nerve. Transcutaneous VNS deserves further study as an antidepressant therapy and for its potential effect on physiological biomarkers associated with depression morbidity and mortality. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(3), 11–14.]
Damage to the Corneal Endothelium From Anterior Chamber Intraocular Lenses in Phakic Myopic Eyes
Authors: Mimouni Fernand , Colin Joseph , Koffi Virgile , Bonnet Philippe
Published: April 2021

ABSTRACT: The use of minus power anterior chamber intraocular lenses to correct myopia in phakic eyes has been demonstrated previously to produce a more accurate and predictable correction than corneal refractive surgery techniques. We have examined 15 such eyes by specular microscopy and 10 such eyes by Scheimpflug slit-lamp micrography. One year after surgery, in 5 (36.3%) eyes, there was a decrease of more than 20% in the central endothelial density. Paracentral endothelial damage was present in 13 eyes (86.6%). On the specular micrograph, this damage appeared as an overall decrease in the number of the cells, abnormal cell shape with marked pleomorphism, dark zones, and acellular zones that corresponded to endothelial defects. The slit-lamp anterior segment measurements showed a distance between the edges of the IOL optic and the endothelium which ranged from 0.71 to 1 .50 mm. We discuss the criteria for intraocular lens removal. [Refract Corneal Surg 1991:7:277-281.)
Factors That Affect Keratotomy Depth
Authors: Merlin U , Bordin P , Rimondi A P , Sichirollo R
Published: April 2021

ABSTRACT: The authors investigated nine factors which can affect the depth of incisions performed during refractive keratotomy: (1) vertical vs oblique-cutting edge of the knife blade, (2) direction of cutting, (3) cutting velocity, (4) American vs Russian technique, (5) intraocular pressure (IOP), (6) initial vs final incisions, (7) sharpness of knife blade, (8) single vs double footplate, and (9) square vs double-edged blade. These variables were examined independently, performing at least 40 incisions for each experimental parameter studied. The depth of the resulting incisions was measured histologically using the micrometer eyepiece. The average and the standard deviation were calculated. The paired Student's t-test was used to establish significant differences between the two conditions investigated for each parameter. Factors that were demonstrated to increase significantly the depth of the incisions included: the vertical-cutting edge, the triple-edged diamond knife, the sharpness of the knife, and the single foot knife. High velocity in performing the incisions and, to a lesser extent, low IOP were the main factors that induced irregularity in depth. (Refract Corneal Surg 1991;7:356-359.)
New Technique for Knife and Radial Keratotomy
Authors: Sergienko Nikolai M , Solodkii Nikolai , Hamard Henry , Ruellan Yves-Marie
Published: April 2021

ABSTRACT

BACKGROUND: Radial keratotomy is the most popular method of surgical correction of myopia, but requires further improvements. This study presents a new knife design for radial keratotomy.

METHODS: Radial keratotomy was performed on 120 eyes of 60 patients with myopia. We utilized two diamond knife designs. The new knife allows a surgeon to perform corneal incisions of varying programmed depth with one movement of the hand, deeper at the limbus. As a control, we used the standard Fyodorov knife. One eye was operated on with one type of knife, the other eye with the other type. The number of incisions was the same with both techniques.

RESULTS: After a 2-year follow up of the group of eyes operated on with the new knife, the mean keratometric power changed from 43.20 diopters (D) to 39.30 D, and the mean amount of myopia from - 4.37 to - 0.32 D. In the group of eyes operated on with the standard knife, the mean keratometric power changed from 43.20 to 39.50 D, and the mean amount of myopia from -4.36 to -0.40 D.

CONCLUSIONS: The final refractive effect of the new knife was equal to that of standard knives. However, the new knife was more convenient: duration of surgery was shorter, and there was no need to change the length of the blade to deepen the incisions during surgery. [J Refract Surg. 1995;11:56-59.!
Comparison of Polycarbonate and Steel Test Surfaces for Videokeratography
Authors: Potvin Richard J , Fonn Desmond , Sorbara Luigina
Published: April 2021

ABSTRACT

BACKGROUND: Assessing video imaging systems for measuring corneal topography often requires test surfaces. Steel bearings have been employed, but manufacturers caution that high reflectance (>90%) relative to the eye (<10%) may compromise test findings. The differences between steel and polycarbonate test surfaces are quantified in this study.

METHODS: Images of a steel and a polycarbonate sphere of known radius of curvature were obtained with the Tomey/Computed Anatomy Topographic Modeling System (TMS, Cambridge, Mass). Analysis was performed on the raw video data files and the resultant surface curvature estimates.

RESULTS: The raw video images differed sufficiently to affect image processing. Polycarbonate yielded consistently better images. Many steel images (approximately 25%) contained data points that could not be processed; calculated surface contour was more variable for these. Differences were less obvious when these images were removed from the pool.

CONCLUSIONS: Results support the manufacturer's caution against the use of steel surfaces for testing or calibration of the TMS instrument. Problems appear due to the fundamental differences in the intensity distributions of video images captured from high- and low-reflectance surfaces. [J Refract Surg. 1995;11:89-91.]
Epithelial Alterations Following Photorefractive Keratectomy for Myopia
Authors: Gauthier Charline A , Epstein Daniel , Holden Brien A , Tengroth Björn , Fagerholm Per , Hamberg-Nyström Helene , Sievert Rebecca
Published: April 2021

ABSTRACT

BACKGROUND: A retrospective observational study was conducted to test the hypothesis that there is clinically measurable epithelial hyperplasia after photorefractive keratectomy (PRK), and to determine its effect on the epithelial oxygen uptake rate.

METHODS: One hundred myopic eyes who had been previously treated unilaterally with PRK were examined. Fifty eyes were treated with the Summit excimer laser (Summit Technology, Waltham, Mass) 27 ± 7 months previously with ablation zone diameters of 4.1, 4.3, 4.5, or 5.0 mm. Fifty eyes were treated with the VISX excimer laser (VISX Inc, Sunnyvale, Calif) 5 ± 4 months previously with one ablation zone diameter of 6.0 mm. The untreated eyes served as controls. Epithelial thickness was measured at a standardized central area within the ablation zone with a modified optical pachometer. Oxygen uptake rate was measured in a subgroup of 30 eyes (20 Summit and 10 VISX).

RESULTS: The epithelium after PRK was 24% thicker than in the control eye in the Summit group (mean difference 13 ± 10 µm; p < .01) and 7% thinner in the VISX group (mean difference - 4 ± 10 µm; p < .01). A higher oxygen uptake rate correlated with a thicker epithelium (r = 0.42; p < .05).

CONCLUSIONS: The epithelium was significantly thicker after PRK between 13 and 37 months after treatment with the Summit excimer laser using ablation zone diameters of 4.1 to 5.0 mm. The epithelium was thinner between 1 and 15 months after treatment with the VISX laser using an ablation zone diameter of 6.0 mm. An increase in oxygen uptake rate reflected the metabolic rate of a greater number of cells in the hyperplastic layer. [J Refract Surg. 1995;11:113-118.]
Symmetry of Outcome After Photorefractive Keratectomy for Myopia
Authors: Loewenstein Anat , Lipshitz Isaac , Ben-Sirah Ayala , Barak Vered , Lazar Moshe
Published: April 2021

ABSTRACT

The aim of this study was to find out whether the outcome of excimer laser photorefractive keratectomy (PRK) in the second eye can be predicted from the results of the first, and to determine whether we should modify our therapeutic approach to the second eye according to the results of the first.

Bilateral PRK was performed in 73 patients using the Summit Technology excimer laser. All patients included in this study had a follow-up of at least 12 months in both eyes. The change of refraction and the haze of the two eyes were compared.

Sixty percent of patients had a difference in refraction between the two eyes smaller than 0.50 diopters (D), and 75% had a difference smaller than 1.00 D. The degree of symmetry in response to treatment was greater in patients with a preoperative spherical equivalent refraction of less than -6.00 D. Most patients had a similar degree of haze in both eyes.

The results of our study demonstrate that a considerable degree of symmetry in the outcome of surgery exists between the two eyes of the same patient undergoing PRK, especially in low to moderate myopia. [J Refract Surg. (suppl.) 1995;11:S268-S269.]
Corticosteroids for Reversal of Myopic Regression After Photorefractive Keratectomy
Authors: Marques Eduardo F , Leite Eugenio B , Cunha-Vaz Jose G
Published: April 2021

ABSTRACT

With the aim of reversing myopic regression laser photorefractive keratectomy (PRK) after excimer, the effect of high-dose topical corticosteroids in modulating changes in refraction and corneal transparency was assessed prospectively.

Twenty-four eyes of 23 patients (mean preoperative spherical equivalent refraction -7.36 diopters (D); range, -4.12 D to -19.25 D), demonstrating myopic regression ranging between 1.00 D and 6.88 D (mean: 2.64 D), were treated according to the same therapeutic protocol. Changes in corneal haze, corneal topography, and refraction were evaluated over 6 months.

Eighteen eyes (78.26%) showed 1.00 D or more reversal of myopic regression. Sixteen eyes (69.56%) regained the attempted correction present when corticosteroids were first stopped (±1.00 D). The difference between mean refraction before reintroducing corticosteroids (-2.64 D; range, - 1.00 D to - 6.88 D) and when stabilization occurred (-0.60; range, + 1.50 D to -4.50 D) was stastisticaly significant (P<0.01). The improvements in corneal haze and spectacle corrected visual acuity were also significant (both P<0.01). Stabilization occurred between 1 to 4 months after surgery (mean, 2.22). In five eyes (21.74%) increased intraocular pressure of more than 20 mm Hg were reduced with betablockers.

Topical corticosteroid therapy can modulate refractive changes after PRK, appearing to reduce myopic regression. However, a longer follow up will be necessary to determine the final refractive outcome of these eyes. [J Refract Surg. 1995;11 (suppl.):S302-S308]
The Use of Corticosteroid/Beta-Blocker Combinations in the Management of Regression After PRK for High Myopia
Authors: MacRobert Iain J , Ho Samuel S
Published: April 2021

ABSTRACT

After nearly 8 years of clinical experience, and with conflicting evidence from trials with and without corticosteroids, there is still no single, universally agreed postoperative management regimen for photorefractive keratectomy (PRK). All agree that corticosteroids will reverse sudden regressions, and so most still use varying corticosteroid regimens. In Hong Kong we are faced with many patients whose myopia is greater than -6 diopters (D), and we agree with the general observation that the regression/haze rate is much greater for these higher errors, and that increased intraocular pressure (IOP) seems to be associated with increased haze. We placed our high myopia group (greater than -6.00D) on corticosteroid/beta-blocker combinations and observed a much lower incidence of haze and regression from this group. We use this regimen now on all our patients and are achieving more accurate endpoint refraction and less haze. Our hypothesis is that lowering the IOP to less than 16 mm Hg reduces keratocyte migration by "tightening" the corneal lamellae, thus dampening the healing response. Case studies are presented to illustrate this relationship. [J Refract Surg. 1995;11(suppl.):S321-S326.]
Automated In situ Keratomileusis for Myopia
Authors: Ibrahim Osama , Waring George O , Salah Tarek , El Maghraby Akef
Published: April 2021

ABSTRACT

BACKGROUND: In situ keratomileusis is a rapidly changing refractive corneal surgical procedure for the correction of myopia. We report here the results of a retrospective study of in situ keratomileusis with the refractive cut made with a microkeratome. The technique represents an intermediate stage of development that used a sutured corneal disc, an early automated microkeratome, and no reoperations for residual refractive error.

METHODS: We carried out a retrospective chart review of the first 107 consecutive eyes (73 patients) that received in situ keratomileusis with an automated microkeratome (Ruiz corneal shaper) at the El Maghraby Hospital in Jeddah, Saudi Arabia between November, 1991 and February, 1993. Sixty-three eyes (59%) were followed for a mean of 1 year. Manifest refraction measured by an ophthalmologist or optometrist was the major response variable. Surgery followed the Ruiz nomogram, which specified an anterior corneal disc approximately 7.2 mm in diameter and 160 um in thickness and a piano in situ refractive cut a mean of 4.2 mm in diameter and 93 um in thickness.

RESULTS: The mean baseline spherical equivalent of the manifest refraction was -11.97±5.30 diopters (D) (range, -3.75 to -28.00 D). At a mean of 1 year after surgery, the mean refraction was -1.86±3.13 D (range, -13.25 to -1-4.63 D); 13 eyes (21%) had a refraction within ±0.50 D and 22 (35%) within ±1.00 D. Undercorrection of more than -1.00 D was present in 36 eyes (57%). At baseline, 48 of 63 eyes (75%) could see 20/40 or better with spectacle correction. At 1 year, 13 of 63 eyes (21%) could see 20/40 or better uncorrected. To measure the stability of refraction in 61 eyes, the mean refraction at 1 month of +0.62±2.43 D was compared to that at 1 year after surgery (mean, -1.41±3.10 D), indicating a loss of effect in the direction of increasing myopia. Nine eyes (14%) lost two to five lines of spectaclecorrected visual acuity. Two eyes had central epithelial implantation plaques in the lamellar bed that required removal.

CONCLUSION: In situ keratomileusis using an automated corneal shaper and sutured corneal discs at an intermediate stage of development produced less than desirable refractive and visual acuity results. [J Refract Surg. 1995;11:431-441.]
Intraocular Lens Power Calculation for Eyes After Refractive Keratotomy
Authors: Hoffer Kenneth J
Published: April 2021

ABSTRACT

BACKGROUND: Calculating the intraocular lens (IOL) power for an eye that has previously had refractive keratotomy is a problem because of the difficulty of accurately measuring the central power of the cornea using standard keratometers.

METHODS: Three methods are proposed to better estimate this parameter. The clinical history method involves subtracting the change in myopia induced by the refractive keratotomy from the average corneal power measured before the keratotomy. The contact lens method determines the difference between the manifest refraction with and without a piano hard contact lens of known base curve and subtracts this difference from that base curve. Videokeratography measures the central corneal power inside the approximately 3-mm zone measured by keratometry, and therefore gives a more accurate power to use in IOL calculation formulas, especially with newer software applications becoming available.

RESULTS: Published reports have demonstrated that standard keratometers do not accurately measure corneal power after refractive keratotomy and that regression formulas are less accurate than modern third-generation theoretic formulas for eyes that have flatter corneas from refractive surgery.

CONCLUSION: For eyes that have had refractive surgery, the corneal power derived from clinical history, contact lens refraction, or videokeratography should be used in a third-generation theoretic formula (Hoffer Q, Holladay, SRK/T) to calculate the intraocular lens power used during cataract surgery. [J Refract Surg. 1995;11:490-493.]
Arc-scanning Very High-frequency Digital Ultrasound for 3D Pachymetric Mapping of the Corneal Epithelium and Stroma in Laser in situ Keratomileusis
Authors: Reinstein Dan Z , Silverman Ronald H , Raevsky Tatiana , Simoni George J , Lloyd Harriet O , Najafi David J , Rondeau Mark J , Coleman D Jackson
Published: April 2021

ABSTRACT

PURPOSE: To test and demonstrate measurement precision, imaging resolution, 3D thickness mapping, and clinical utility of a new prototype 3D very high-frequency (VHF) (50 MHz) digital ultrasound scanning system for corneal epithelium, flap, and residual stromal thickness after laser in situ keratomileusis (LASIK).

METHODS: VHF ultrasonic 3D data was acquired by arc-motion, meridional scanning within a 10-mm zone. Digital signal processing techniques provided high-resolution B-scan imaging, and I-scan traces for high-precision pachymetry in 4 eyes. Thickness maps of individual corneal layers were constructed. Reproducibility of epithelial, flap, and full corneal pachymetry was assessed for single-point and 3D thickness mapping by repeated measures. Thickness mapping of the epithelium, stroma, flap, and full cornea were determined before and after LASIK. Preoperative to postoperative difference maps for epithelium, flap, and stroma were produced to demonstrate anatomical changes in the thickness profile of each layer.

RESULTS: Surface localization precision was 0.87 /im. Central reproducibility for single-point pachymetry of epithelium was 0.61 //m; flap, 1.14 /tra; and full cornea, 0.74 /im. Reproducibility for central pachymetry on 3D thickness mapping was 0.5 µt? for epithelium and 1.5-//m for full cornea. B-scans and 3D thickness maps after LASIK demonstrated resolution of epithelial, stromal component of the flap, and residual stromal layers. Large epithelial profile changes were demonstrated after LASIK. Topographic variability of flap thickness and residual stromal thickness were significant.

CONCLUSIONS: VHF digital ultrasound arc-B scanning provides high-resolution imaging and high-precision three-dimensional thickness mapping of corneal layers, enabling accurate anatomical evaluation of the changes induced in the cornea by LASIK. [J Refract Surg 2000;16:414-4301
Implantation of Scleral-sutured Posterior Chamber Intraocular Lenses During Penetrating Keratoplasty
Authors: Koçak-Altintas Ayse G , Koçak-Midillioglu Inci , Dengisik Fikret , Duman Sunay
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the clinical outcome in 29 patients (29 eyes) who underwent penetrating keratoplasty and scierai-fixation of an intraocular lens.

METHODS: The indications for penetrating keratoplasty with scleral-fixation of an intraocular lens were anterior chamber Pseudophakie corneal edema, aphakic corneal edema, trauma, and corneal scars. Patients with Pseudophakie corneal edema underwent IOL exchange and penetrating keratoplasty and patients with lens subluxation underwent cataract extraction and penetrating keratoplasty in the same operation session.

RESULTS: Preoperative spectacle-corrected visual acuity was hand motion in 13 eyes (44.8%) and 20/400 in 18 eyes (61.5%). Postoperative spectacle-corrected visual acuity of 20/400 or better was observed in 25 eyes (86.2%). At last follow-up, 26 corneal grafts (89.7%) remained clear. Three grafts (10.3%) failed, two because of glaucoma and one because of endophthalmitis. Glaucoma was observed in 7 eyes.

CONCLUSION: Trans-scleral fixation of intraocular lenses combined with penetrating keratoplasty was a useful surgical technique in eyes with keratopathy and lacking posterior capsular support. [J Refract Surg 2000;16:456-458]
Surgically Induced Astigmatism After Laser in situ Keratomileusis for Spherical Myopia
Authors: Sharma Namrata , Pangtey Mayank S , Vajpayee Rasik B , Dada Tanuj , Aggarwal Tushar , Dada Vijay K , Pandey Ravindra M
Published: April 2021

ABSTRACT

PURPOSE: To study risk factors for surgically induced astigmatism (SIA) after laser in situ keratomileusis (LASIK).

METHODS: In a retrospective case control study of 104 eyes (52 patients) that underwent LASIK for myopia (spherical ablation alone), two groups were studied: 42/104 eyes with SIA, and controls (62/104 eyes). The main variables studied were preoperative refraction, corneal thickness, preoperative keratometric power, amount of ablation, ablation zone diameter, flap thickness, flap size, and the presence of complications. The effect of SIA on visual performance was also evaluated.

RESULTS: The mean myopia for which LASIK was undertaken was -4.50 ± 2.04 D. Mean scalar astigmatism induced was 0.35 ± 0.50 D at 1 month, 0.33 ± 0.40 D at 3 months, and 0.16 ± 0.60 D at 6 months. SIA based on refractive cylinder was 0.66 ± 0.29 D at 1 month, 0.54 ± 0.32 D at 3 months, and 0.49 ± 0.34 D at 6 months. Mean axis of vector induced astigmatism was 82.5° ± 57° at 1 month, 98.86° ± 52.4° at 3 months, and 113.9° ± 62.6° at 6 months. Risk factors associated with the occurrence of SIA were preoperative keratometric power of >44 D [OR (95% CI); 1.97 (0.62 to 6.26)], ablation zone diameter of <6 mm [OR (95 % CI) 2.76; (0.6 to 12.6)], and suction ring diameter of 8.5 mm [OR (95% CI) 12.46; (2.0 to 77.38)]. The occurrence of SIA had no significant effect on uncorrected Snellen high contrast visual acuity, contrast sensitivity, and glare in comparison with controls.

CONCLUSION: Surgically induced astigmatism was more likely to occur with the use of smaller suction rings of 8.5 mm and in ablation zones less than 6 mm. Parameters for visual performance were not affected by the presence of surgically induced astigmatism. [J Refract Surg 2002;18: 239-244]
Bilateral Simultaneous Laser in situ Keratomileusis With the Aesculap Meditec MEL 60 Laser
Authors: Sun Xiao-Yi , Vicary Diane L , Montgomery Peter , Page Gary
Published: April 2021

ABSTRACT

PURPOSE: To report the outcome of bilateral simultaneous excimer laser in situ keratomileusis (LASIK) with the Aesculap Meditec MEL 60 laser for the correction of myopia and hyperopia.

METHODS: This retrospective study included 338 eyes of 169 patients who had bilateral simultaneous LASIK performed by one surgeon (D.L.V.).

RESULTS: Postoperatively, 20/20 or better visual acuity was achieved by 78.5% (186 eyes) in the <-6.00-D group, and 55.6% (54 eyes) in the ≥-6.00-D group. Postoperatively, the mean spherical equivalent refraction was within ±0.50 D for 78% (185 eyes) in the <-6.00-D group (range, -2.25 to +1.25 D), 55% (53 eyes) in the ≥-6.00-D group (range, -2.38 to +1.13 D), and one eye in the hyperopic group. Complications at 3 months included regression in five eyes (1.4%), infiltrates in six eyes (1.7%), primary undercorrection in two eyes (0.6%), superficial punctate keratitis in four eyes (1.1%), ten eyes (2.9%) underwent enhancement, two eyes (0.6%) underwent refractive lensectomy, and four eyes (1.1%) underwent astigmatic keratotomy 3 months postoperatively. Two eyes lost two lines of best spectacle-corrected visual acuity.

CONCLUSION: Bilateral simultaneous LASIK with the Aesculap Meditec MEL 60 laser was effective and predictable. It was more economical and convenient for the patient than unilateral LASIK and binocular visual rehabilitation was rapidly restored. No sight threatening complications occurred in this group of patients. [J Refract Surg 2002;18:245-248]
Phototherapeutic Keratectomy for Relief of Pain in Patients With Pseudophakic Corneal Edema
Authors: Rosa Nicola , Cennamo Gilda
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the therapeutic effects of phototherapeutic keratectomy in patients with Pseudophakic corneal edema

METHODS: Phototherapeutic keratectomy was performed in 12 eyes of 12 patients with Pseudophakic corneal edema who were awaiting penetrating keratoplasty. All patients underwent planned corneal ablation of 120 µm. Examinations before and after surgery included uncorrected and corrected visual acuity, slit-lamp biomicroscopy, photography, and ultrasonic pachymetry.

METHODS: A reduction in pain and a slight increase in visual acuity as well as a decrease in corneal thickness were found over an average 18-month follow-up period (range, 6 to 60 months).

CONCLUSIONS: Phototherapeutic keratectomy reduced bullae formation, improved visual acuity slightly, and could be considered a valuable alternative to penetrating keratoplasty if surgery needs to be delayed or is contraindicated. [J Refract Surg 2002;18:276-279]
Laser in situ Keratomileusis With the Nidek EC-5000 Excimer Laser for Astigmatism Greater Than 4.00 D
Authors: Lui Marcelo Mastromonico , Silas Marcia Ap Grandini , Apelbaum Benny , Oshima Akioshi
Published: April 2021

ABSTRACT

PURPOSE: To evaluate laser in situ keratomileusis (LASIK) performed with the Nidek EC-5000 excimer laser in 66 astigmatic eyes with cylinder from 4.00 to 8.00 D.

METHODS: LASIK was performed with the Nidek EC-5000 excimer laser in 66 astigmatic eyes with cylinder from 4.00 to 8.00 D. Based on Chayet's nomogram, ablation zone diameters were 5.5 mm (steep meridian ablation) to 7.5 mm (flat meridian ablation). In eyes with simple myopic astigmatism, mixed astigmatism, and compound myopic astigmatism (low sphere), ablation was performed in both meridians. In eyes with simple hyperopic astigmatism, ablation was performed in the flat meridian alone. In eyes with compound hyperopic astigmatism, ablation zone diameter was 5.5 mm and the transition zone was 7.5 mm.

RESULTS: Uncorrected visual acuity was 20/40 or better in 89% of eyes and was equal to preoperative best spectacle-corrected visual acuity in 62% of eyes. No eyes lost lines of best spectacle-corrected visual acuity.

CONCLUSIONS: Using the Nidek EC-5000 excimer laser, we had satisfactory results in the treatment of astigmatic eyes with cylinder from 4.00 to 8.00 D, based on Chayet's nomogram. [J Refract Surg 2002:18(suppl):S321-S322]
Geometric Ray Tracing for Design of Customized Ablation in Laser in situ Keratomileusis
Authors: Ortiz Dolores , Saiz José M , González Francisco , Del Cotero José N Fernández , Moreno Fernando
Published: April 2021

ABSTRACT

PURPOSE: By means of an individualized optical model of the visual system, a customized surgical correction is proposed to achieve emmetropia and best visual acuity.

METHODS: The study included 64 eyes with myopia or myopic astigmatism that underwent LASIK with the Nidek EC-5000 excimer laser. The mean age was 33 years (19 to 54 yr). Mean myopia was -3.70 D (0 to -7.50 D) and mean astigmatism was -0.90 D (0 to -4.00 D). The model included a personalized Le Grand eye model, a geometric ray tracing process, and a statistical study of postoperative corneal flattening. As a final result, the model provided an interval of corneal radius to be sculpted in the stroma to maximize visual acuity attainable without correction. The mean radius of the interval was used to obtain the sphere-cylinder correction.

RESULTS: In 100% of eyes with 0 to +0.50 D of residual spherical equivalent refraction (n=39), the sculpted radius was inside the surgical interval and in the 30% of the "non-satisfactory" surgeries (7/25 eyes) the sculpted radius was outside the interval.

CONCLUSIONS: An objective optical method has been developed to obtain a customized ablation for LASDI. [J Refract Surg 2002;18(suppl):S327-S331]
Bioptics in Phakic and Pseudophakic Intraocular Lens With the Nidek EC-5000 Excimer Laser
Authors: Zaldivar Roberto , Oscherow Susana , Piezzi Virginia
Published: April 2021

ABSTRACT

PURPOSE: To evaluate predictability, safety, stability, and complications related to bioptics in patients that received phakic and those that received Pseudophakie intraocular lenses. Both groups had LASIK with the Nidek EC-5000 excimer laser following IOL implantation.

METHODS: We evaluated retrospectively 281 eyes of 196 patients with posterior chamber phakic implantation (ICL) and 64 Pseudophakie eyes of 55 patients. AU patients had LASIK 1 month or more after the first surgery. We used a treatment zone of 5.5 mm with a 7.00-mm transition zone. The flap was made with the Automated Corneal Shaper (ACS).

RESULTS: In the group of phakic ICL eyes with bioptics, preoperative mean spherical equivalent refraction was -5.50 D (range, -1.37 to -16.00 D). The first day after LASDX, mean spherical equivalent refraction was -0.06 D, and at 1 month, -0.40 D. In Pseudophakie bioptics eyes, preoperative mean spherical equivalent refraction was -2.61 D (range, +0.50 to -5.50 D). The first day after LASEK it was +0.27 D, and 1 month after LASDi it was +0.09 D. The incidence of complications was similar in both groups of patients. The most frequent complication was keratitis sicca (approximately 10% in each group). Interstitial edema (2.1%) was present only in phakic bioptics eyes. No retinal complications were observed. Refraction was stable 4 years after surgery. Target achieved refraction was ± 0.50 D, showing the predictability of the procedure.

CONCLUSIONS: Predictability and safety were demonstrated according to results and absence of severe complications related with this technique. Older patients did not develop more complications than younger people; dry eye incidence was similar in both groups. In extreme myopia patients did not present retinal complications related to surgical procedures. [J Refract Surg 2002;18(suppl): S336-S339]
Comparison of Laser in situ Keratomileusis Outcomes With the Nidek EC-5000 and Meditec Mel 70 Excimer Lasers
Authors: Merchea Mohan , Pieger Stefan , Bains Harkaran S
Published: April 2021

ABSTRACT

PURPOSE: To report refractive outcomes of laser in situ keratomileusis (LASER) for myopia with and without astigmatism using the Nidek EC-5000 and Meditec Mel 70 excimer laser systems.

METHODS: A retrospective analysis of refractive outcomes with each laser was conducted. Approximately 5700 eyes treated for myopia and myopic astigmatism were analyzed. Preoperative sphere ranged from -0.25 to -15.50 D and cylinder ranged from -0.75 to -5.50 D. All statistical analyses were performed by Datagraph med version 2.8 refractive analysis software.

RESULTS: With the Nidek EC-5000 at 6 months after LASDC, mean spherical equivalent refraction was -0.24 D with 72% of eyes within ±0.50 D. In the Méditée cohort, the mean spherical equivalent was -0.54 D with 55% of eyes ±0.50 D.

CONCLUSION: Eyes treated for myopia and astigmatism with either of these lasers showed early refractive stability and similar efficacy. Higher incidences of epithelial ingrowth and haze were present in the Meditec treated eyes. [J Refract Surg 2002;18(suppl):S343-S346I
Predictability of Corneal Flap Thickness in Laser in situ Keratomileusis Using Three Different Microkeratomes
Authors: Shemesh Gabi , Dotan Gad , Lipshitz Isaac
Published: April 2021

ABSTRACT

PURPOSE: To compare the accuracy and consistency of corneal flap thickness in the right and left eye created by three different widely used microkeratomes during consecutive laser in situ keratomileusis CLASIK).

METHODS: Corneal thickness of 132 eyes of 66 patients was measured preoperatively and intraoperatively. Corneal flap thickness was calculated by subtracting the corneal stromal thickness from the total corneal thickness. Three different microkeratomes were used for creating the corneal flap: Chiron Automated Corneal Shaper (ACS), Baush and Lomb Surgical Hansatome, and Nidek MK 2000 microkeratomes. The same surgeon performed all procedures on the right eye first and then on the left eye using the same blade and the same surgical technique.

RESULTS: Mean corneal flap thickness created by the ACS (160-µm depth setting) microkeratome was 128.30 ± 12.57 µm in the right eye and 122.96 ± 13.30 µm in the left eye. The Hansatome (160-µm depth plate) microkeratome created a flap of mean 141.16 ± 20.11 µm in the right eye and 120.95 ± 26.95 µm in the left eye, and the Nidek MK 2000 (130-µm depth plate) microkeratome created a flap of 127.25 ± 4.12 µm in the right eye and 127.54 ± 3.7 µm in the left eye.

CONCLUSION: Corneal flap thickness tended to be considerably thinner than expected on both eyes using the ACS and Hansatome. With the ACS and Hansatome, the difference in corneal flap thickness between the first and second operated eye was statistically significant. With the Nidek MK 2000 microkeratome, there was no statistically significant difference between the first and second operated eye and measurements were close to desired corneal flap thickness. Intraoperative pachymetry is recommended for every LASIK procedure. [J Refract Surg 2002;18(suppl):S347-S351]
Nidek MK 2000 Microkeratome Clinical Evaluation
Authors: Arbelaez Maria Clara
Published: April 2021

ABSTRACT

PURPOSE: To evaluate flap dimension, flap thickness, hinge size, and cut deterioration with second blade use with the Nidek MK 2000 automatic microkeratome.

METHODS: The Nidek MK 2000 with different head options (130 and 160 µta) and suction rings (8.5 and 9.5 mm) was used during 328 consecutive LASIK procedures, reusing the blade for the second eye in the same patient. Flap diameter and hinge size were measured under microscopy with a Castroviejo caliper and thickness was calculated using the Pachete ultrasonic pachymeter.

RESULTS: The mean flap thickness was 116.03 ± 19.26 µm using the 130-µm head and 147.7 ± 21.74 µm using the 160-µm head. The average vertical flap size was 8.56 ± 0.36 mm with the 8.5-mm suction ring and 9.45 ± 0.32 mm with the 9.5-mm ring. The hinge size was 4.7 ± 0.72 mm. The second cut was thinner than the first; 14.7 µta average using the 130-µm head, and 19.1 µm average using the 160-µm head.

CONCLUSION: The Nidek MK 2000 microkeratome was simple, safe, predictable, and reliable for LASIK. [J Refract Surg 2002;18(suppl): S357-S360]
Use of Amino Acids in Refractive Surgery
Authors: Vinciguerra Paolo , Camesasca Fabrizio I , Ponzin Diego
Published: April 2021

ABSTRACT

PURPOSE: To assess the influence of amino acid supplements on corneal fibroblast activity during corneal healing in patients with chronic ulcers, as well as after refractive surgery when delayed reepithelialization had been observed in the fellow eye.

METHODS: Studies were conducted in vitro on eye bank eyes, and in vivo. In vitro cultures of rabbit corneal fibroblasts were enriched with progressively higher concentrations of amino acids. The human eye bank cornea study involved corneal epithelium removal, with corneas kept for 7 days in standard storage medium, either simple or enriched with amino acids. Clinical studies included treatment of two groups: Group 1 included six eyes of six patients with chronic epithelial defects, resistant to usual treatment; Group 2 included 21 eyes of 21 patients with delayed re-epithelialization after PRK in the first eye (12 ± 3 days). Group 1 was treated for 1 month, and Group 2 received treatment preoperatively and postoperatively after surgery in the fellow eye until re-epithelialization was achieved. All patients received 13 amino acids and Vitamin C in three tablets, three times per day.

RESULTS: Cultures of rabbit corneal fibroblasts showed that progressively increasing amino acid supplements led to an increase in the percentage of fibroblasts. De-epithelialized human eye bank corneas incubated with amino acids showed thicker and better organized re-epithelialization when compared to corneas incubated in simple standard storage media. In the clinical study, five eyes in Group 1 showed substantial improvement, one eyes remained unchanged. All eyes in Group 2 showed complete re-epithelialization within 60 hours after surgery.

CONCLUSION: Results suggest improvement of re-epithelialization when an increase of serum and tear film amino acids is obtained through oral administration. [J Refract Surg 2002;18(suppl): S374-S377]
Effect of Volatile Compounds on Excimer Laser Power Delivery
Authors: Van Horn Stewart D , Hovanesian John A , Maloney Robert K
Published: April 2021

ABSTRACT

PURPOSE: To determine whether vapors from perfume, hairspray, oil-based paint, or water-based paint affect excimer laser beam power delivery at the corneal surface.

METHODS: We measured the power delivery of an Apex Plus laser before, during, and after exposure to vapors from the following volatile compounds: three types of perfume, hair spray, an oilbased paint, and a water-based paint. A digital calorimeter was used to measure the steady-state beam power of the laser during laser discharge at the corneal plane. Multiple trials were run with each compound, and the change in laser energy over time was examined to determine if any of the compounds caused degradation of the laser optics.

RESULTS: The presence of a volatile compound in the room caused no change in mean laser energy in comparison to before and after the compound was present. However, perfumes caused a progressive decline in laser beam power throughout the trials. Controlling for this progressive decline, there was no significant difference from perfume to perfume.

CONCLUSIONS: None of the compounds tested caused a decline in laser beam power while present in the room. However, the presence of any perfume caused a deterioration in beam power over time, suggesting a degradation of the laser optics for all perfumes. Laser centers should consider advising their patients and staff to not wear perfumes in the laser suite. [J Refract Surg 2002;18:524-528]
Intraoperative Corneal Topography for Image Registration
Authors: Schruender Stephan A , Fuchs Hendrik , Spasovski Saso , Dankert Andreas
Published: April 2021

ABSTRACT

PURPOSE: To present a method to measure the three-dimensional shape of the cornea and to use the data for registration purposes in order to optimize ablation pattern alignment during corneal laser surgery.

METHODS: The three dimensional shape of the cornea can be measured with a modified fringe projection technique using UV laser pulses. A method to register these shape images is presented. The registration is done via established algorithms that use peripheral elevation data, which is not affected during the laser treatment. The method also provides a means to control the absolute amount of tissue removal. The three-dimensional registration method is compared with conventional two-dimensional eye tracking.

RESULTS: Due to the parallax of the cornea with respect to the pupil center, considerable decentration of laser ablation patterns can occur when tracking just the pupil center. Registration using three-dimensional shape measurements provides a more accurate means to control ablation pattern application.

CONCLUSIONS: A new method to register corneal shapes is discussed. It should allow monitoring the real ablation rate online during the treatment and might eventually serve as an online feedback system to control the laser ablationinduced corneal shape changes. [J Refract Surg 2002;18:S624-S629]
Rotoextractor Evacuation of Total Hyphema
Authors: Diddie Kenneth R , Ernest J Terry
Published: April 2021

SUMMARY

Hyphema was created in ten albino rabbits and removed within an hour by the Douvas Rotoextractor. All the blood was gone from each eye within 48 hours and there was no evidence of damage to iris, cornea or lens after six weeks. One patient underwent Douvas Rotoextractor removal of a hyphema that was causing increased intraocular pressure and corneal staining. Three months postoperatively, vision was 6/7.5 and the intraocular pressure was controlled.
Intraocular Lenses: Visual Results and Complications
Authors: Osher M S
Published: April 2021

A Comparative Study
Immediate Fundus Complications After Retinal Scatter Photocoagulation I. Clinical Picture and Pathogenesis
Authors: Huamonte Felipe U , Peyman Gholam A , Goldberg Morton F , Locketz Alan
Published: April 2021

SUMMARY

Fifty diabetics with severe background retinopathy or early proliferative retinopathy underwent retinal scatter photocoagulation with either the argon laser or the xenon arc photocoagu lators. Choroidal detachment, exudative retinal detachment, shallowing of the anterior chamber, and secondary angle-closure glaucoma were observed. Exudative retinal detachment and choroidal detachment subsided in two days to 2-1/2 weeks. Glaucoma secondary to choroidal detachment with angle closure was observed in 11 eyes, three of which required medical treatment, although surgical therapy was not needed. This secondary glaucoma was detected in the first two days and subsided in subsequent days, with intraocular pressure reaching pretreatment values at the fifth day. No long-term sequelae were observed in these complications, except in one eye that developed macular edema that lasted for four months with decreased visual acuity; nevertheless, vision returned to the pretreatment level one year after photocoagulation.
Punctal Occlusion with N-Butyl Cyanoacrylate Tissue Adhesive
Authors: Patten James T
Published: April 2021

ABSTRACT

N-butyl cyanoacrylate tissue adhesive can be easily placed in the lid puncta to serve as a temporary method for punctal occlusion. Such a procedure is a useful therapeutic trial in borderline cases of keratoconjunctivitis sicca being considered for further permanent punctal occlusion or in patients where a temporary dry eye condition is expected to be resolved in the near future.
Penetrating Keratoplasty: A Computer Analysis
Authors: Ferguson James G , Mayer Walter
Published: April 2021

ABSTRACT

A computer analysis of 87 penetrating kertoplasties done in a uniform manner by a single surgeon revealed the following: 1. On a statistical basis small grafts (7.0 mm) provided better visual acuity than larger grafts (8.0 mm). 2. On a statistical basis small grafts will be clearer postoperatively than larger grafts. 3. On a statistical basis the age of the donor is not related to either graft clarity or visual acuity.
Technique of Combined Lid and Medial Canthus Reconstruction
Authors: Tenzel Richard R , Boynton James R , Buffam Frank V
Published: April 2021

SUMMARY

Standard lid reconstruction techniques (sliding flaps or tarsoconjunctival grafts) may be combined with the Laissez-Faire treatment of large medial canthal defects. Using this method, satisfactory results were achieved in three cases in which it was necessary to excise both a large portion of an eyelid and the adjacent medial canthus.
Monocular Aphakia and Contralateral Pseudophakia
Authors: Parelman Allen G
Published: April 2021

SUMMARY

The implantation of an intraocular lens into the contralateral eye of nonimplanted monocular aphakic patients is reviewed. The specific indications, contraindications, and advantages are discussed. The results of a series of 31 cases are presented and analyzed. The generally good results and specific advantages of this technique, when utilized under proper conditions, indicate that it merits inclusion in the ever expanding spectrum of options available to the modern cataract surgeon.
The Efficacy of General Anesthesia for Cataract Surgery
Authors: Martin John J , Phiffer John L , Koch Walter E
Published: April 2021

ABSTRACT

This is a report of 259 consecutive cataract extractions performed under general anesthesia over a two-year period. The age of the patients ranged from 6 to 93 with an average of 71.

The purpose of this paper is to reiterate the safety of modern general anesthesia for cataract extraction in the elderly, and to demonstrate it can provide a very soft eye in a completely immobilized patient It offers the most ideal conditions to the surgeon for lens extraction and careful wound closure without the necessity of retrobulbar block, digital massage or osmotic agents.