bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of Flash Visual Evoked Potentials in Albinism
Authors: Fitzgerald Kathleen , Cibis Gerhard W
Published: April 2021

ABSTRACT

In albinism, the majority of temporal retinal fibers serving the nasal visual field cross at the chiasm and project to the contralateral hemisphere. This misrouting is seen in hemispheric asymmetries present in the visual evoked potential (VEP). Misrouting of retinal fibers was also thought to occur in dissociated vertical deviation, Prader-Willi syndrome, and perhaps carrier states of albinism. However, recent literature is reaching the conclusion we have drawn in our laboratory: only albinism shows VEP hemispheric asymmetries that reverse when the other eye is stimulated. Use of different stimuli, recording conditions, and response criteria among investigators has created some confusion in differentiating what constitutes asymmetry. We conclude that use of a diffuse flash stimulus and a bipolar electrode derivation that compares differences between the left and right occipital hemispheres will clearly differentiate albinism from all other conditions, making it especially useful in a pediatric population.
Congenital Ocular Defects Associated With an Abnormality of the Human Chromosome 1: Trisomy 1q32-qter
Authors: Clark B J , Lowther G W , Lee W R
Published: April 2021

ABSTRACT

This article describes the detailed ocular pathology found in a premature neonate, born at 34 weeks, with multiple congenital anomalies resulting from de novo trisomy 1q32-qter. The ocular defects include goniodysgenesis, persistent tunica vasculosa lentis and hyaloid vessels, hypopigmentation of the posterior iris epithelium, ectopia of the ciliary processes, and abnormal insertion of the ciliary muscle and cataract. This is the first report of the detailed ocular pathology in a case of trisomy 1q and is also unusual in that the chromosomal defect has apparently arisen de novo in the proband.
Plaque Radiotherapy for Residual or Recurrent Retinoblastoma in 91 Cases
Authors: Shields Jerry A , Shields Carol L , De Potter Patrick , Hernandez J Carlos , Brady Luther W
Published: April 2021

ABSTRACT

Plaque radiotherapy has been used successfully as primary treatment for selected solitary retinoblastomas. However, there is relatively little information on its role as a secondary treatment after other methods have failed to control the tumor. We have used solitary plaque radiotherapy to treat 91 children with residual or recurrent retinoblastoma after failure of one or more treatment modalities, which included external beam radiotherapy in 63 children, plaque radiotherapy in 9, cryotherapy in 26, and photocoagulation in 18, for a total of 116 treatments in the 91 children. Despite the fact that enucleatlon was considered to be the only remaining option in many of these children, tumor regression was achieved in 81 cases (89%) and recurrence developed in only 10 cases (11%) during a mean follow up of 52 months. Treatment of the recurrence following plaque radiotherapy in these 10 cases included repeat plaque radiotherapy in 6 cases, enucleation in 3 cases, and external beam radiotherapy in 1 case. In view of the fact that enucleation was being considered as the only remaining option in many of these children, control of the tumor with plaque radiotherapy in 89% of the cases is very encouraging. Plaque radiotherapy should be considered as an important option for recurrent retinoblastoma after failure of other methods to achieve tumor control.
Factors Affecting Treatment Compliance in Amblyopia
Authors: Smith Lucy K , Thompson John R , Woodruff Geoffrey , Hiscox Fiona
Published: April 2021

ABSTRACT

Amblyopia is the most common form of visual disability in children. Successful treatment by patching depends on compliance, but evidence of factors affecting compliance is limited and contradictory. Because there is a well established relationship between social deprivation and access to health care, we hypothesized that social deprivation might be associated with noncompliance. Data from a historical cohort of 961 children from seven English orthoptic clinics starting treatment for amblyopia in 1983 were used to study factors affecting compliance with amblyopia treatment. Children were classified as noncompliant if they failed to attend all appointments prescribed during the first year of treatment. There was a significant difference in compliance between centers (P=.0001). Overall, children with anisometropic amblyopia were more compliant than those with strabismus but this varied significantly between centers. A relationship between social deprivation and compliance was also found (P=.00001). Only 41% of children from the most deprived wards were compliant compared with 61% in the least deprived wards. Compliance was not found to be related to age at starting treatment.
Unilateral Surgery for Exotropia With Convergence Weakness
Authors: Kraft Stephen P , Levin Alex V , Enzenauer Robert W
Published: April 2021

ABSTRACT

We prospectively studied 14 patients whom we treated surgically for exotropia (XT) with convergence weakness measuring at least 8 Δ for distance (6 m) that increased at least 8 Δ at near (Yi m). Surgery involved lateral rectus recessions and medial rectus strengthenings (advancements or resections) to eliminate distance and near deviations and simultaneously collapse near-distance differences. The medial rectus was strengthened more than the lateral rectus was recessed; amounts were based on the near deviation. Minimum follow-up was 6 months after surgery. Preoperatively, the mean XT at distance was 18.3 Δ (range, 8 to 35 Δ) and at near 30.1 Δ (range, 16 to 50 Δ). At latest follow-up evaluations the mean distance deviation was 0.1 Δ XT and at near 1.8 Δ XT. The near-distance differences were reduced by a mean of 10.2 Δ; the mean postoperative difference was 1.7 Δ. Unilateral surgery for XT with convergence weakness biased to medial rectus strengthening and geared to near deviation can successfully collapse the neardistance differences while satisfactorily aligning both distance and near fixation. This surgery has low risk of creating long-term postoperative esodeviations at distance.
Haptic Breakage Following Neonatal IOL Implantation in a Nonhuman Primate Model
Authors: Lambert Scott R , Fernandes Alcides , Grossniklaus Hans E
Published: April 2021

ABSTRACT

To evaluate the long-term safety of implanting intraocular lenses (IOLs) in neonatal eyes using a nonhuman primate model, a one-piece all-polymethylmethacrylate (PMMA) IOL was implanted into the posterior chamber of 21 neonatal Rhesus monkey eyes following a lensectomy and anterior vitrectomy. These monkeys then were monitored for 26 to 40 months for complications. The eyes from seven monkeys were studied histopathologically. One or both haptics broke on 7 of the 21 (33%) IOLs in a mean of 21 months (range 6 to 31 months) after their implantation. Only one of the haptics from these seven eyes was found to be in the capsular bag when these eyes were studied histopathologically. Nine haptics had eroded into the iris leaflets, two into the ciliary body, and one into the anterior chamber. One additional haptic was in the sulcus. The haptics of one-piece all-PMMA IOLs may break if implanted in neonatal eyes. A number of factors likely contributed to haptic breakage in these eyes, including an increased number of reoperations, malpositioning of IOL haptics, rapid circumferential and axial growth, and the formation of large Soemmerring's rings.
On Infantile Esotropia With Nystagmus in Abduction
Authors: Ciancia Alberto O
Published: April 2021

ABSTRACT

Infantile esotropia with nystagmus in abduction is characterized by early onset, jerk nystagmus in abduction, and dissociated vertical deviation, among other features. Electro-oculographic tracings present easily recognizable patterns both in saccadic and pursuit movements. Visual evoked responses are asymmetric in most cases and optokinetic nystagmus is invariably asymmetric. Visual cortex maldevelopment seems to play a major pathogenic role. Recent findings in myelomeningocele and in patients with posterior fossa tumors suggest that pathological alterations in this area may tend to induce similar anomalies in electro-oculographic and optokinetic nystagmus recordings. Posterior fossa damage or impairment is therefore suspected to be a possible causative factor in the development of infantile esotropia with nystagmus in abduction.
Strabismus Associated With Meningomyelocele
Authors: Biglan Albert W
Published: April 2021

ABSTRACT

Introduction: Strabismus occurs frequently in patients with spina bifida or meningomyelocele.

Patients and Methods: I performed 1544 eye examinations in 298 patients with spina bifida over a period of 15 years. The patient records were retrospectively reviewed for visual acuity, binocular function, and strabismus. Select patients with A-pattern strabismus were recalled for neuroimaging.

Results: Visual acuity was correctable to 20/40 in 85% of the patients. One hundred and eighty-three patients (61%) had strabismus at some time over the study period. Sixtythree percent had an esodeviation; 37% an exodeviation. A-pattern strabismus was more common in patients with exotropia (39%) than in those with esotropia (27%). Defects on neuroimaging in the region of the vertical gaze pathways in the brain stem were correlated with A-pattern strabismus.

Conclusion: With increased longevity of the patient with spina bifida, quality-of-life issues become increasingly important. Amblyopia, strabismus, and other acquired defects in the visual system related to hydrocephalus should be closely monitored and treated when indicated.
Early and Late Postoperative Alignment Following Unilateral Lateral Rectus Recession for Intermittent Exotropia
Authors: Olitsky Scott E
Published: April 2021

ABSTRACT

Purpose: Bilateral lateral rectus recession is useful in the treatment of intermittent exotropia. A unilateral recession may be used in the treatment of small-tomoderate angle intermittent exotropia as well. An early overcorrection following bilateral surgery has been shown to carry the best prognosis for future alignment. The relationship between the early and late postoperative alignment following unilateral surgery is unknown. The current study was designed to establish this relationship.

Methods:Thirty-seven patients undergoing a unilateral lateral rectus recession for intermittent exotropia were prospectively evaluated to determine the relationship between early and late postoperative alignment. Patients were evaluated 1 week and 6 months following surgery. A satisfactory result was considered to be alignment within 8 prism diopters (Δ).

Results: Of the 37 patients who underwent surgery, 35 completed the study. Overall, 77% of patients achieved a satisfactory result at the 6-month exam (27/35). Satisfactory alignment at 6 months was obtained in all patients who were Orthophorie (14/14), 77% (10/13) of patients with an exodeviation less than 9 ? (10/13), and 60% (3/5) of patients with an esodeviation less than 9 ? at the 1-week postoperative exam. Twenty-nine percent of patients changed alignment status during this time period (10/35), and 29% of all patients became more divergent (10/35). The average divergent shift for the entire group was 1.6 Δ and was not significant. Among those patients who experienced a divergent shift, the average amount was 6 Δ.

Conclusions: There is not a significant difference in early versus late alignment following unilateral lateral rectus recession. Surgeons performing this procedure should not expect a significant divergent shift from the first postoperative week. Unlike bilateral recessions where an early overcorrection is desirable, acceptable alignment in the first week following surgery carries the best prognosis for later alignment.
Screening for Suppression in Young Children: the Polaroid Suppression Test
Authors: Pott Jan Willem R , Oosterveen Douwe K , Duin Jackie Van Hof-van
Published: April 2021

ABSTRACT

Background: Assessment of monocular visual impairment during screening of young children is often hampered by lack of cooperation. Because strabismus, amblyopia, or anisometropia may lead to monocular suppression during binocular viewing conditions, a test was developed to screen for suppression in young children.

Methods: Children were invited to look through two polaroid filters of different polarization direction at two pictures covered with polaroid filters of opposite polarization direction. In this way, each eye could only see one of the two pictures. In cases of suppression, only one picture would be visible. Acuity measurements in 201 5-year-old children were compared with the Polaroid Suppresion test (PST) results.

Results:The PST had a high success rate (99.5%) and testing time was under 1 minute. Specificity of the PST for acuity impairments was 91%. The low sensitivity of 60% was caused mainly by the fact that some children with binocular acuity impairments were not detected with the PST. However, the PST was highly sensitive for significant interocular acuity differences.

Conclusion: The PST has been found to be a useful screening method for amblyogenic factors in young children. The test can be carried out without occlusion of one eye. The apparatus is portable, the test duration is short, and the costs are low. The results indicate that the PST is a very promising tool to use in clinical conditions and for screening large numbers of young children.
Strabismus: The First 3500 Years
Authors: Medow Norman
Published: April 2021

Ophthalmic Chronicles
Early-Onset Accommodative Esotropia
Authors: Havertape Susan A , Whitfill Charles R , Cruz Oscar A
Published: April 2021

ABSTRACT

Purpose: To determine the frequency of accommodative esotropia with onset by 6 months of age; to determine if the presence or absence of characteristics usually associated with infantile esotropia can help in the diagnosis; and to determine if antiaccommodative therapy is adequate treatment for the esotropia.

Methods: The charts of 100 patients with infantile esotropia, seen over a 2-year period (September 1995 to September 1997), were reviewed. We identified those with at least 2.25 diopters (D) of hyperopia and determined the presence of large angle esotropia (>30 to 40 prism diopters [δ]), amblyopia, inferior oblique overaction, dissociated vertical deviation, latent nystagmus, and cross-fixation. The success of antiaccommodative therapy, if attempted, was also evaluated.

Results: Of 100 patients with infantile esotropia, 15 (15%) were found to have at least +2.25 D. This represented 8% of all patients with accommodative esotropia seen over the same time period. The average age at initial examination was 21 months, although the reported age of onset in all cases was 6 months or less. Two had surgery before presenting to our institute. Eleven of 13 (84%) had 40 Δ or less. Six (40%) of the 15 had amblyopia, 5 (33%) had inferior oblique overaction, 3 (20%) had dissociated vertical deviation, 1 (7%) had latent nystagmus, and 4 (27%) had cross-fixation. Of the 13, 7 were given glasses initially, with 3 being fully corrected. Six were not given glasses, all had surgery, and all were given glasses postoperatively for a residual esotropia.

Conclusion: Fifteen percent of infantile esotropia patients and 8% of accommodative esotropia patients have infantile accommodative esotropia. Other characteristics of infantile esotropia may be present, but are less frequent, and at least 40% are fully corrected with spectacles indicating that when the hyperopia is 2.25 D or greater, antiaccommodative therapy should be instituted before surgery.

Journal of Pediatrce Ophthalmology & Strabismus 1999;36:69-73.
Follow-Up After Probing for Congenital Nasolacrimal Duct Obstruction
Authors: Burns S Joyce , Kipioti Athina
Published: April 2021

ABSTRACT

Purpose: To establish the optimum timing of follow-up after probing for uncomplicated congenital nasolacrimal duct obstruction.

Methods: A retrospective review of notes of all patients probed over a 4-year period was performed. Timing of symptom resolution was evaluated and compared to the results of a questionnaire sent to all parents in June 1996.

Results: Most patients were asymptomatic or improved by 3 months postoperatively, and the long-term success rate was 96.6%.

Conclusion: Optimum timing of follow-up should be 3 months postoperatively, if necessary at all.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:163-165.
Diagnosis and Management of Chronic Blepharokeratoconjunctivitis in Children
Authors: Farpour Bijan , McClellan Kathy A
Published: April 2021

ABSTRACT

Purpose: To describe the history, symptoms, and clinical signs and discuss the treatment of blepharokeratoconjunctivitis.

Methods: Eight children (five girls and three boys), ranging in age from 3.5-13 years, were clinically diagnosed with blepharokeratoconjunctivitis. Microbiology studies were performed in four of the eight children. Treatment consisted of lid hygiene, oral erythromycin suspension, and preservative-free steroids. Duration of therapy was directed by clinical improvement.

Results: Average age at onset was 3.2 years (range: 0.5-8 years). Lid disease, conjunctival redness, and inferior superficial corneal vascularization were consistent features (100%). Other signs were punctate corneal epithelial staining, inferior subepithelial vascularization and infiltrate, conjunctival phlyctenules, corneal phlyctenules, and circumferential pannus. Microbiology testing demonstrated coagulase-negative staphylococcus and Propionibacterium acnes. Average follow-up was 8.3 months (range: 2-23 months). All patients had relief of symptoms within 2-3 weeks. Clinical signs took more time to regress but all had progressive improvement of the ocular surface by 2 months. Blepharokeratoconjunctivitis reactivated in all patients during follow-up, and repeat therapy was administered.

Conclusion: Blepharokeratoconjunctivitis in childhood is a chronic inflammatory process that can have different presentations. It can be successfully treated with oral erythromycin and topical steroids.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:207-212.
Strabismus Measurements Using the Alternating and Simultaneous Prism Cover Tests: A Comparative Study
Authors: Deacon Mark A , Gibson Faye
Published: April 2021

ABSTRACT

Purpose: To determine the most accurate method of strabismus measurement in patients with constant manifest esotropia.

Methods: Patients underwent routine cover test assessment with the cover-uncover test and the alternating cover test with any increase in the angle of deviation being noted between the two methods. The simultaneous and alternating prism cover test was then performed to see if a qualitative increase in angle deviation was represented by a quantitative measurement. Patients also were assessed for the presence of binocular vision in free space using Bagolini striated lenses and motor fusion responses to base out prisms.

Results: There was a significant difference between the alternating and simultaneous prism cover test measurements for all patients (mean difference for near fixation: 4.72 prism diopters [Δ]; 95% confidence interval [CI], 1.68-7.75 Δ; df=51; P<.001). For patients who showed a qualitative change in angle based on observational judgement using the cover tests, the mean difference in angle measured by simultaneous and alternating prism cover test for near fixation was 7.42 Δ (95% CI, 5.75-10.30 Δ; df=25; P<.001).

Conclusion: To obtain an accurate interpretation of the size of manifest esotropia, the angle of deviation needs to be measured by the simultaneous and alternating prism cover test when an observable difference is noted on the cover test. The presence of a latent component to a manifest deviation should prompt the investigation of binocular reflexes even if the manifest angle is too large to be commensurate with binocular vision.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:267-272.
Risk Factors Associated With Complications of Orbital Surgery in Children
Authors: Salem Mahmoud , Qahtani Fahad
Published: April 2021

ABSTRACT

Purpose: To assess the overall complication rate of orbitotomies performed in children and to determine the nature of complication to identify possible risk factors.

Methods: Thirty children <13 years underwent 33 orbitotomies for space-occupying lesions of the orbit or orbital decompression. A detailed evaluation of the surgical procedures and outcomes was conducted. Follow up averaged 2.5 years (range: 6 months to 5 years).

Results: The complication rate was 20% (2 of 10 cases) for anterior orbitotomies, 40% (8 of 20 cases) for primary lateral orbitotomies, and 100% (3 of 3 cases) for secondary orbitotomies. Dense amblyopia was noted in 6 of 9 patients. Major complications were frozen eyeball, diplopia, and ptosis. Less serious complications were enophthalmos, internal ophthalmoplegia, dry eye, and eyelid retraction. Six patients underwent extraocular surgery, levator muscle surgery, or both at a later date.

Conclusion: Although the scope of complications is the same in children as in adults, the frequency of cystic benign lesions and small orbits in children can cause more frequent serious complications. Additionally, dense amblyopia of a complicated nature makes visual outcome unpredictable. The most significant risk factors identified were the need for a secondary procedure for recurring pathology and the presence of an intraconal lesion.

Journal of Pediatric Ophthalmology and Strabismus 2001;38:335-339.
Comparison of Subjective and Objective Torsion in Normal Patients
Authors: Baek Sung Ju , Chen Linden Z. M. , Shah Parth R. , Fitzsimons Ross
Published: April 2021

Purpose:

To compare subjective and objective torsion in normal individuals.

Methods:

A total of 59 individuals (118 eyes) were recruited from one ophthalmology institute in New South Wales, Australia. Objective torsion was measured with optical coherence tomography (OCT) (Heidelberg Engineering) and subjective torsion measurements were obtained with the Torsionometer (INNOVA).

Results:

Kendall's tau correlation coefficient when comparing the Torsionometer to combined left and right OCT measurements was 0.115 (95% CI: −0.085 to 0.322), inferring a weak correlation. Similarly, when the Torsionometer readings were compared with the OCT measurements of each eye separately, the results demonstrated a weak correlation.

Conclusions:

To the authors' knowledge, this is the first study comparing subjective and objective torsion in normal individuals. The results demonstrate that subjective and objective torsion in normal individuals should be considered as separate entities and the terms should not be used interchangeably.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(2):112–117.]
Outcome of Bleb Needling With 5-Fluorouracil in Failed Filtering Procedures in Pediatric Glaucoma
Authors: Shah Chintan , Sen Pradhnya , Mohan Amit , Sen Alok , Sood Devindra , Jain Elesh
Published: April 2021

Purpose:

To determine the surgical outcomes of bleb needling and the risk factors of failure of needling after failed filtration surgeries in patients with pediatric glaucoma.

Methods:

The medical records of patients who underwent needling with 5-fluorouracil following filtering surgeries (trabeculectomy, combined trabeculectomy, and trabeculotomy) between January 2012 and December 2016 were retrospectively reviewed. At the 1-year follow-up visit, complete success and qualified success were defined as an intraocular pressure (IOP) of less than 18 mm Hg with and without antiglaucoma medication, respectively.

Results:

Forty-five eyes that underwent needling and fulfilled the study criteria were included in the analysis. The mean age at needling was 9.6 years. The mean time interval between filtration surgery and the first needling procedure was 57.3 days. Thirty-eight of 45 eyes (84.4%) had undergone needling within 3 months after the primary surgery. Cumulative success was achieved in 35 eyes (77.7%) after needling (complete success in 22 eyes and qualified success in 13 eyes). Mean follow-up after needling was 18.9 months. The mean IOP before and after needling was 31.7 ± 9.45 and 16.6 ± 5.68 mm Hg, respectively (
P
< .00001). Steroid-induced glaucoma (
P
= .01), high IOP prior to the first filtration surgery (
P
= .01), and an inability to achieve low IOP (< 9 mm Hg,
P
= .04) immediately after needling were significant risk factors associated with failure.

Conclusions:

Bleb needling is an efficient method for lowering IOP after a failed trabeculectomy or combined trabeculectomy and trabeculotomy in the pediatric population.

[
J Pediatr Ophthalmol Strabismus
. 2021;58(2):118–125.]
Psychiatrists Talk Back*
Authors: Cheney Daniel L
Published: April 2021

... More on communication between psychiatrists and other physicians
Standard Care for Mental Patients
Authors: Hershey Nathan
Published: April 2021

THE LAW AND THE NURSE

Striking a balance between adequate security measures and improper restraint requires a nice judgment on the part of those responsible for the care of mental patients.
News Releases
Authors: Anonymous
Published: April 2021

INTRODUCING THE EXECUTIVE DIRECTOR
Women and Mental Illness: A Sexist Trap?
Authors: McGrory Arlene
Published: April 2021

Part One
Incest: Nursing Interventions for Group Therapy
Authors: Krach Peg , Zens Deann
Published: April 2021

PEG KRACH, PhD, RN, and DEANN ZENS, MA, discuss nursing interventions to help reduce the feelings of isolation commonly experienced by incest perpetrators.
Are They Ready? Preparing for Patient Passes
Authors: Szczerny Susan G , Mayton Kathleen , Cronin-Stubbs Diane , Donner Lorraine Long , Kopytko Edwin E , McFolling Sandra Day , Pasch Sandra Kawczynski
Published: April 2021

Do you have a pre- and post-pass checklist for evaluating your psychiatric patients' experiences? Nurses, psychiatrists, and other medical staff, as well as patients themselves have expressed the need for continuity of care in the preparation for and return from therapeutic passes.
Guiding the Way: Acting as a Preceptor for Graduate Students
Authors: Kimmel Lee Harter
Published: April 2021

Analyze the clinical specialist role, in conjunction with the theoretical foundation in a practice setting, for its contribution to the development of leadership, accountability, and scholarship in nursing.

A course objective for Psycho-Behavioral Patterns of Adults: Nursing III, at a New York City college.
The Mental Health of African-American and Caucasian-American Women: Who are Homeless
Authors: Warren Barbara J , Menke Edna M , Clement Jeanne , Wagner Janet
Published: April 2021

Of all minority women, African-American women are most vulnerable to physical and psychological illness.
Assessment of Impulsivity Among Psychiatric Inpatients
Authors: Fish Karen
Published: April 2021

ABSTRACT

Routine assessment of impulsivity and accompanying coping skills is essential for planning care and appropriate management of patients identified as impulsive. Impulsivity can be defined in many ways, and many perspectives exist. Impulsivity is associated with several adult psychiatric disorders. In an inpatient psychiatric setting, nurses are more likely than members of other disciplines to encounter impulsive behavior due to the amount of time spent in direct patient care. As the primary caregivers in hospitals, nurses are responsible for the management of impulsive individuals. It is critical for treatment plans to incorporate interventions specifically targeting impulsivity.
Correction of Myopia by Implantation of a Concave Worst-Iris Claw Lens Into Phakic Eyes
Authors: Fechner Paul U , Strobel Jürgen , Wichmann Wolfgang
Published: April 2021

ABSTRACT: The Worst-Fechner Biconcave Lens for the correction of myopia in phakic eyes is fixated to the anterior iris. Of the 125 eyes implanted between November 1986 and November 1990, 109 eyes ("core group") had a follow-up period of at least 12 months (mean, 25.0; range, 13 to 51). Sixty-eight of these eyes were reexamined at Giessen University Eye Clinic by an independent investigator using a laser flare cell meter; 23 of the eyes also were examined by iris fluorescence angiography.

Seventy-five of the 1 09 eyes (68.8%) were corrected within 1 .00 diopters of the desired refraction, and only 10 eyes (9.2%) deviated more than 2.00 D from the calculated correction.

The anatomical results were characterized by good fixation, absence of glaucoma, inflammation, and leak from iris vessels.

However, the corneal endothelium was damaged in five eyes by surgical trauma, three resulting in corneal edema. In addition, in five eyes the endothelial density decreased during the followup period despite an uncomplicated operation, resulting in corneal edema in one eye.

These eyes may have had anterior chambers that were too shallow. (Refract Corneal Surg 1991;7:286-298.)
Excimer Laser Photorefractive Keratectomy for Myopia: Six-Month Results
Authors: Eiferman Richard A , O'Neill Kelly P , Forgey Dean R , Cook Yvonne D
Published: April 2021

ABSTRACT: Six eyes of six patients with myopia between -4.00 and -8.00 diopters underwent 193 nm Argon/fluoride excimer laser photorefractive keratectomy as part of a Phase II-A FDA Study. Six months after surgery, four of the six eyes had a spherical equivalent refraction within ± 1.00 D; five eyes saw 22/30 or better without correction. All corneas demonstrated a faint reticulated subepithelial haze most visible by sclerotic scatter illumination. There were no episodes of delayed epithelial healing or recurrent erosions, and patients had no loss of contrast sensitivity, visual acuity under glare testing, or corneal sensation at the 3-month or 6-month visit.

In this limited clinical trial, the excimer laser was capable of changing the refractive power of the cornea for correction of myopia. Long-term follow up of these patients will be necessary to determine the safety and efficacy of the procedure. (Refract Corneal Surg 1991;7:344-347.)
Corneal Lathing Using the Excimer Laser and a Computer-Controlled Positioning System: Part II-Variable Trephination of Corneal Buttons
Authors: Husinsky Wolfgang , Mitterer Sabine , Altmann Johann , Grabner Günther , Baumgartner Isabella , Skorpik Florian , Asenbauer Talin
Published: April 2021

ABSTRACT: A new system is presented that allows a variable trephination of donor corneas for the preparation of corneal buttons used in penetrating keratoplasty. With the help of a computer-controlled positioning system that uses high-precision micropositioning elements (both translation and rotational stages) the donor cornea is removed, epithelial side up, in a fixation device in front of a focused excimer laser beam (ArF, λ = 193 nm).

User friendly computer software allows the surgeon to select a variety of parameters (diameter, shape, angle of trephination) of the corneal graft. Histological and electron microscopical data of human corneas trephined with this "Excimer Laser Corneal Shaping System" are presented. (Refract Corneal Surg 1991;7:385-389.)
Digital System Measurement of Decentration of Worst-Fechner Iris Claw Myopia Intraocular Lens
Authors: Pérez-Torregrosa Vicente T , Menezo José L , Harto Miguel A , Maldonado Miguel J , Cisneros Angel
Published: April 2021

ABSTRACT

BACKGROUND: Topography measures the centration in refractive and corneal refractive surgery, but until recently there was no effective method to measure decentration in intraocular lens (IOL) implantation.

PATIENTS AND METHODS: We measured the decentration of 22 phakic eyes, in 14 high myopic patients, based upon photographs of the anterior segment using a digital analysis system (IMAGEnet Topcon Corporation 1988, Tokyo, Japan). These eyes had undergone IOL implantation for the correction of myopia with Worst-Fechner iris claw lenses. Decentration was measured with respect to the centers of both the cornea and pupil.

RESULTS: Mean decentration of the IOL center from the cornea center was 0.51 ± 0.25 mm (range, 0 to 0.8374 mm). When measured with respect to the center of the pupil, the average decentration was 0.47 ± 0.29 mm (range, 0.182 to 0.9341 mm). A positive correlation between the decentration measurements of the two methods was found (p < .01 indicated statistical significance).

CONCLUSIONS: This digital imaging system (IMAGEnet) accurately measured decentration of IOLs in myopic eyes. [J Refract Surg. 1995;11:26-30.]
Comparison of Laser and Manual Removal of Corneal Epithelium for Photorefractive Keratectomy
Authors: Gimbel Howard V , DeBroff Brian M , Beldavs Robert A , Westenbrugge John A van , Ferensowicz Maria
Published: April 2021

ABSTRACT

BACKGROUND: Photorefractive keratectomy relies on precise ablation of cornea stromal tissue to achieve a desired change in refraction. The routine technique for photorefractive keratectomy has been manual debridement of the epithelium prior to performing excimer laser ablation. We investigated whether laser ablation versus manual debridement of the corneal epithelium influences the refractive result.

METHODS: A retrospective matched controlled study analyzing the refractive outcome of 46 eyes after excimer laser photorefractive keratectomy was performed. Half of the eyes had the corneal epithelium ablated with the excimer laser, while the other half had mechanical removal. Topical postoperative corticosteroid dosing was different in the two groups. All photorefractive keratectomies were performed by the same surgeon (H.V.G.). The two groups were analyzed for statistical differences in refractive outcomes and corneal haze after 6 months.

RESULTS: The mean preoperative spherical equivalent refraction in the laser removal group was -5.11 diopters (D), and -5.09 D in the manual group. At 6 months postoperatively, the mean spherical equivalent refraction in the laser group was +0.03 D and -0.40 D for the manual group (p = .21). At no point postoperatively was there any significant difference in the mean refractive outcome or variance of the refractive results between the two groups, although there was a trend toward greater correction with laser ablation of epithelium. There was no statistical difference in the amount of stromal haze by slit-lamp microscopy in the two different debridement groups. There was no significant difference in final uncorrected visual acuity, rate of reepithelialization, or reported incidence of halos or glare between the two groups.

CONCLUSION: There was a tendency toward greater refractive correction at 6 months using the laser for corneal epithelial removal than manual debridement, although the difference was not statistically significant. The trend toward slightly higher correction emphasizes the need for care when removing epithelium with the laser to prevent concomitant stromal ablation. [J Refract Surg. 1995;11:36-41.]
Release of Calcitonin Gene-Related Peptide in Tears After Excimer Laser Photorefractive Keratectomy
Authors: Tervo Timo M T , Mertaniemi Päivi , Ylätupa Sari , Tervo M Kaarina , Virtanen Tuula , Partanen Paul
Published: April 2021

ABSTRACT

BACKGROUND: Sensory nerves known to affect corneal healing are damaged to a variable degree after photorefractive keratectomy (PRK). To search for nerve-bound factors involved in corneal healing, we monitored tear fluid calcitonin gene-related peptide (CGRP) levels of six human eyes undergoing PRK.

METHODS: CGRP concentrations were determined using an immunoassay.

RESULTS: Normal human tear fluid contains CGRP. The mean CGRP concentration was slightly increased postoperatively, despite a marked tear fluid hypersecretion. Consequently, an almost ten-fold increase in release of CGRP in tears was observed on days 1 and 2 after PRK. Values measured on day 7 had returned to a normal level.

CONCLUSION: The observed postoperative increase in release of CGRP in tears may have an impact on the healing of PRK wounds. Extensive neural damage following deep photoablations may impair healing and should probably be avoided. [J Refract Surg. 1995;11:126-128.]
Excimer Laser Photorefractive Keratectomy in Lebanon
Authors: Waked Naji E , Ojeimi Ghassan K
Published: April 2021

ABSTRACT

We report on 50 eyes of 50 patients treated by photorefractive keratectomy (PRK) using the Summit Technology OmniMed excimer laser. Follow up ranged from 3 to 9 months, and the eyes were divided into three groups on the basis of the initial myopia (<6.00 diopters (D), 6.00 D to 10.00 D, and >10.00 D). Mean preoperative spherical equivalent refraction in each group was -4.15 D, -7.88 D, and -12.00 D respectively, and -0.24 D, -1.41 D, and -1.70 D postoperatively. Ninety percent in group 1, 56.25% in group 2 and 35.71% in group 3 had a final refraction within 1.00 D of the attempted correction.

Complications consisted of one case of infectious keratitis, medically treated with no sequelae; one case of significant loss of spectacle corrected visual acuity related to corneal haze; and one case of corticosteroid-induced elevated eye pressure controlled with topical treatment.

In this series, PRK appeared to be effective and safe for the correction of myopia of less than -6.00 D. For higher myopia, other methods of treatment should be used. [J Refract Surg. 1995;11(suppl.):S270-S273.]
Intraocular Pressure After Excimer Laser Photorefractive Keratectomy for Myopia
Authors: Schipper Isaak , Senn Peter , Thomann Urs , Suppiger Markus
Published: April 2021

ABSTRACT

BACKGROUND: Pressure measurements after excimer laser photorefractive keratectomy (PRK) might be inaccurate. Measuring the pressure in the temporal part of the cornea might give more representative results.

METHODS: Intraocular pressure was measured with the Goldmann applanation tonometer in each eye in the central and temporal parts of the cornea. Measurements were performed in a group of 64 treated eyes before treatment as well as 1, 3, 6, 9, and 12 months thereafter; 35 eyes could be followed up for 1 year. Two groups of nontreated eyes served as controls. The paired Student's t test was used for statistical analysis.

RESULTS: Central and temporal measurements were identical before treatment. After PRK, central values were 2 to 3 mm Hg lower than temporal values. Significant differences were observed from 1 month to 1 year of follow up (p<0.0001).

CONCLUSIONS: The intraocular pressure measured in the central part of the cornea after PRK for myopia is lower than that measured in the corneal periphery, due probably to the absence of Bowman's layer and to central thinning. [J Refract Surg. 1995;11:366-370.]
Effect of Corticosteroids on Rabbit Corneal Keratocytes After Photorefractive Keratectomy
Authors: You Xiaokui , Bergmanson Jan P G , Zheng Xiang-Ming , MacKenzie Ian C , Boltz Roger L , Aquavella James V
Published: April 2021

ABSTRACT

BACKGROUND: To determine the corticosteroid effect on the activity and repopulation of keratocytes after photorefractive keratectomy (PRK).

METHODS: A 193-nm excimer laser (VISX Twenty/Twenty) created a central ablation depth of 22 µm (diameter: 5 mm) on 22 corneas of 16 albino rabbits. Two ablated eyes were examined 6 hours following PRK. Twelve eyes received no postoperative corticosteroids and eight were treated with topical fluoromethalone for 3 months. Corneas were examined 1, 3, 6, and 12 months after PRK by immunofluorescence and transmission electron microscopy.

RESUITS: Corticosteroids reduced haze (p=0.02), but all corneas (treated or untreated) cleared 6 months after PRK. Keratocytes were absent from the anterior 100 µm of the stroma 6 hours after PRK. However, the number and activity of keratocytes were significantly greater in this area in untreated corneas at 1 month and then gradually decreased. By 6 and 12 months, the number of keratocytes approached controls. Treated corneas had fewer keratocytes than either controls or untreated eyes (p<0.01) and by 3 months, a subepithelial acellular zone of 30 to 50 µm thickness appeared and persisted until at least 12 months after PRK.

CONCLUSIONS: Corticosteroids have a transient effect in reducing haze and seem to inhibit keratocyte movement, leading to an acellular subepithelial region beneath the ablated area. [J Refract Surg. 1995;11:460-467.]
Validation of the Estimation of Corneal Aberrations From Videokeratography in Keratoconus
Authors: Barbero Sergio , Marcos Susana , Merayo-Lloves Jesus , Moreno-Barriuso Esther
Published: April 2021

ABSTRACT

PURPOSE: To validate the estimation of corneal aberrations from videokeratography against a laser ray tracing technique that measured total eye aberrations, in eyes without keratoconus (ie, cornea-dominated wave aberrations).

METHODS: We measured total and corneal wave aberrations of three eyes diagnosed with keratoconus by slit-lamp microscopy and corneal topography: two eyes from one patient with early keratoconus and one eye with more advanced keratoconus. Total aberrations were measured with laser ray tracing. Corneal aberrations were obtained from corneal elevation data measured with a corneal videokeratoscope using custom software that performs virtual ray tracing on the measured front corneal surface.

RESULTS: The keratoconus eyes showed a dramatic increase in aberrations (both corneal and total) particularly coma-like terms, which were 3.74 times higher on average than normal. Anterior corneal surface aberrations and total aberrations were similar in keratoconus. This similarity was greater for the early keratoconus patient, suggesting a possible implication of the posterior corneal surface in advanced keratoconus.

CONCLUSIONS: The similarity found between corneal and total aberration patterns in keratoconus provided a cross-validation of both types of measurements (corneal topography and aberrometry). Both techniques were useful in diagnosing and quantifying optical degradation imposed by keratoconus. [J Refract Surg 2002;18:263-270]
Nomogram for Treatment of Astigmatism With Laser in situ Keratomileusis
Authors: Moniz Noel , Fernandes S Tony
Published: April 2021

ABSTRACT

PURPOSE: Laser in situ keratomileusis (LASIK) is a mainstay in. refractive surgery. Myopes and compound myopic astigmats generally have a good result after LASIK. However, simple myopic astigmats are sometimes not as pleased with their visual outcome.

METHODS: We analyzed 40 patients who underwent LASIK with the Nidek EC-5000 excimer laser and the Hansotome microkeratome. The key to successful LASEK in these patients was proper analysis of corneal topography.

RESULTS and CONCLUSION: We found that 37 of the 40 patients studied had an excellent result, but poor topographic interpretation gave a poorer result in the remaining three patients. We discuss how to correctly interpret corneal topography and proper case selection and patient counseling. [J Refract Surg 2002;18(suppl):S323-S326]
Effects of Laser Plume Evacuation on Laser in situ Keratomileusis Outcomes
Authors: Charles Keith
Published: April 2021

ABSTRACT

PURPOSE: To study the effects laser plume evacuation on LASIK outcomes using a surgical vacuum and the Nidek EC-5000 excimer laser.

METHODS: Three-month LASIK postoperative data were evaluated retrospectively for 117 eyes treated with a laser plume evacuator and 82 eyes treated without a laser plume evacuator. All eyes were treated with the same Moría CB microkeratome and the same Nidek-EC 5000 excimer laser using the same nomogram.

RESULTS: No statistically significant difference was noted in the frequency of corneal abrasions, flap slippage, or the level of postoperative interface debris. A statistically significant difference (P<001) was noted in postoperative residual refractive error and uncorrected visual acuity. In the group treated without a plume evacuator, 65% (n=53) were within ±0.50 D of the intended correction, 59% (n=48) had an uncorrected visual acuity of 20/20 or better, 68% (n=56) had an uncorrected visual acuity of 20/25 or better, and 90% (n=73) had an uncorrected visual acuity of 20/40 or better. In the group treated with a plume evacuator, 92% (n=108) were within ±0.50 D of the intended correction, 74% (n=87) had an uncorrected visual acuity of 20/20 or better, 89% (n=104) had an uncorrected visual acuity of 20/25 or better, and 96% (n=112) had an uncorrected visual acuity of 20/40 or better.

CONCLUSION: Laser plume evacuation using surgical tubing and a surgical vacuum improved refractive and uncorrected visual acuity outcomes following LASIK. [J Refract Surg 2002;18(suppl): S340-S342]
Applications of Confocal Microscopy in Refractive Surgery
Authors: Vinciguerra Paolo , Torres Ingrid , Camesasca Fabrizio I
Published: April 2021

ABSTRACT

PURPOSE: To evaluate applications of the Confoscan 2.0, a computerized confocal optical microscopy system by Nidek, in refractive surgery.

METHODS: We used the Confoscan 2.0 to evaluate the tissue reparative response after PRK, LASEK, and LASIK in 60 eyes of 40 patients. Confoscan 2.0 provided highly detailed images of the corneal layers, up to the cellular level. Furthermore, it measured corneal thickness as well as precise positioning of each single recorded corneal layer. The Confoscan was also used to analyse the LASIK flap.

RESULTS: Findings in the transition zone between epithelium and anterior stroma in PRK and LASEK eyes were divided into two groups: Group 1, with marked hyper-reflectivity, and Group 2, with less hyper-reflectivity, similar to normal eyes. Group 2 eyes belonged to patients that underwent smoothing with a masking solution after ablation. Group 1 eyes received no smoothing. In LASIK eyes, we evaluated the quality of the flap interface. Hyper-reflecting specks could be observed in the interface, showing a tendency to decrease over time. Depth of the LASDX flap was measured, and showed variable thickness with all microkeratomes tested.

CONCLUSION: We hypothesize that a more regular corneal surface, obtained with smoothing in PRK and LASEK, allows a better reparative response after refractive surgery. In LASBK eyes, the Confoscan provided precise measurement of the residual stromal bed, information particularly valuable for the prevention of ectasia in retreatments. [J Refract Surg 2002;18(suppl):S378-S381]
Measurement Repeatability of Corneal Aberrations
Authors: Gobbe Marine , Guillon Michel , Maissa Cecile
Published: April 2021

ABSTRACT

PURPOSE: Customized procedures that aim to improve visual performance beyond traditional sole correction of sphere and cylinder require the reliable determination of higher order corneal and ocular aberrations for individual eyes. The aim of the current investigation was to determine the repeatability of corneal aberration measurement.

METHODS: Ten subjects were measured on 10 different days using a videokeratoscope. The Zernike coefficients and the wavefront error were calculated from the height data files using CTView, Repeatability was calculated for apertures of 3, 4.5, and 6 mm at the 95% confidence level.

RESULTS: The wavefront error absolute repeatability was similar for the 4th and 10th order analysis. The absolute repeatability for individual Zernike coefficients was coefficient dependent; the poorest repeatability was recorded for coma-like aberrations (uncertainty 3 mm = 0.060 µm; 4.5 mm = 0.083 µm; 6 mm = 0.109 µm). The relative repeatability compared to the population means was good for wavefront error (5% to 20%) but poor for some individual Zernike coefficients.

CONCLUSION: Videokeratoscope clinical repeatability was sufficient to reliably determine wavefront error at a single session, but may require several examinations and/or repeated independent measurements at the same examination to determine reliably some Zernike coefficients. This has significant practical implications for accurate customized correction of aberrations. [J Refract Surg 2002;18:S567-S571]