bluuebunny/crossref_metadata_2025 huggingface dataset:
Periprosthetic Fractures: Early and Late
Authors: Ries Michael D
Published: April 2021

Hip Arthroplasty: Management Problems
Soft Tissues: A Question of Balance
Authors: Freeman M A R
Published: April 2021

Knee Arthroplasty: Technique & Management Issues
The Value of Preoperative Knee Aspiration: Don't Ask, Don't Tell
Authors: Barrack Robert L
Published: April 2021

Knee Arthroplasty: The Devil Is in the Detail
Knee Challenges: What Would You Do?
Authors: Booth Robert E
Published: April 2021

Case Challenges In Hip and Knee Arthroplasty
Superior Oblique Silicone Expander for Brown Syndrome and Superior Oblique Overaction
Authors: Wright Kenneth W
Published: April 2021

ABSTRACT

Standard procedures for weakening the superior oblique muscle have been associated with significant complications in the treatment of superior oblique overaction and Brown syndrome. This article presents a new technique for weakening the superior oblique muscle by lengthening the superior oblique tendon. Lengthening is accomplished by a nasal superior oblique tenotomy, and by inserting a segment of medical grade silicone 240 retinal band between the cut ends of the tendon. This technique was performed on 18 patients (30 eyes), 14 (26 eyes) with superior oblique overaction, and four (one eye each) with Brown syndrome. Preoperative^, patients with superior oblique overaction demonstrated Apatterns between 20 prism diopters and 55?, and versions of +2 to +4 superior oblique overaction in at least one eye. Postoperatively, the ?-pattern and overaction improved in each case, and 13 of the 14 patients had patterns 10? or less. Of the four patients with Brown syndrome, three showed marked improvement of elevation in adduction, without consecutive superior oblique palsy. One had no improvement, even after a second procedure, consisting of superior oblique tenectomy; this case probably represents a non-superior oblique restriction (ie, a pseudo-Brown syndrome).

Based on these results, it appears that the silicone expander technique is useful in patients with superior oblique overaction and Brown syndrome secondary to tight superior oblique tendon. This technique allows a predetermined degree of tendon separation and a graded weakening of the superior oblique muscle. Furthermore, by controlling the cut ends of the tendon, the procedure is easily reversible and there is ready access to the tendon should reoperation be necessary for residual overaction.
Conjunctival Mass Formation With Unexpected Foreign Body
Authors: Ainbinder Darryl J , O'Neill Kelly P , Yagci Ayse , Karcioglu Zeynel A
Published: April 2021

ABSTRACT

Two 4-year-old females with inferior fornix conjunctival lesions are described. Both cases proved to be cotton-material-induced granulomas. These cases are reported to emphasize that recognition of foreign body conjunctival granuloma remains as a challenge to ophthalmologists.
Stability of the Postoperative Alignment in Adjustable-Suture Strabismus Surgery
Authors: Weston Bonnie , Enzenauer Robert W , Kraft Stephen P , Gayowsky Gregory R
Published: April 2021

ABSTRACT

We reviewed the postoperative alignment drift in 201 patients between the ages of 14 and 75 years who underwent rectus muscle surgery with adjustable sutures from 1984 to 1989. We analyzed results for 42 primary esotropia (ET) surgeries and 37 reoperations (groups IA and IB, respectively), 34 exotropia (XT) primary surgeries and 66 reoperations (groups IIA and IIB, respectively), and 22 hypertropia (HT) surgeries (group III). Forty percent of patients required postoperative muscle adjustment. All patients underwent a minimum of 8-weeks follow up; 66% underwent 6-months follow up or longer. The postoperative drifts in alignment for primary surgeries versus reoperations were not significantly different for either ET or XT patients. The mean postoperative drift in prism diopters from the alignment immediately after the adjustment, or after the surgery if no adjustment was needed, for each group as measured during the most recent follow up was 1.3 eso-shift for group IA, 1.2 exo-shift for group IB, 4.8 exo-shift for group IIA, 4.1 exo-shift for group IIB, and 1.5 hyper-shift for group III. Only for groups IIA and IIB were these drifts found to differ significantly from zero. Based on these drift patterns, we align ET patients to orthotropia, XT patients to 5 to 7Δ esotropie, and HT patients to 1 to 2Δ hypotropic positions.
Unilateral Superior Rectus Recession for the Treatment of Dissociated Vertical Deviation
Authors: Schwartz Terry , Scott William
Published: April 2021

ABSTRACT

The management of dissociated vertical deviation (DVD) is an unsettled issue. Several authors have advocated bilateral superior rectus recession for all patients with DVD unless a dense amblyopia is present in the nonfixating eye. Our experience suggested that DVD was being successfully treated with unilateral bilateral superior rectus recession. We reviewed the charts of 57 patients who underwent graded unilateral superior rectus recession and 10 patients who had bilateral superior rectus recession for the treatment of DVD. DVD, a manifest deviation, was considered as distinct from occlusion hyperphoria, a latent deviation present only under cover.

Of the patients who underwent unilateral superior rectus recession, only six developed a significant (14 prism diopters or more) DVD in the unoperated eye. The presence of any DVD in the unoperated eye appeared to be predictive of an unacceptable postoperative deviation (15 times greater chance, P < .001). Patients with an occlusion hyperphoria in the unoperated eye showed no increased propensity to develop a significant DVD following surgery. The results of bilateral surgery were disappointing. Eight of ten patients had residual DVD in one or both eyes of 10Δ or greater. Our results suggest that unilateral surgery is an effective treatment of DVD in patients with a manifest deviation in only one eye. Although neither unilateral nor bilateral surgery was entirely satisfactory for the treatment of bilateral DVD, we recommend bilateral superior rectus recession for these patients.
Strabismus Fixus Convergens Secondary to Amyloidosis
Authors: Sharma Pradeep , Gupta N K , Arora Roopa , Prakash Prem
Published: April 2021

ABSTRACT

Strabismus fixus convergens is a condition in which both eyes become fixed in extreme adduction. It can be congenital or acquired. We report a case of strabismus fixus convergens in a high myope with primary amyloidosis localized to the lateral rectus muscle. To our knowledge, this is the first report of a case of strabismus fixus convergens secondary to amyloidosis.
Chorioretinal Lacuna in the Amniotic Band Syndrome
Authors: Hashemi Kattayoon , Traboulsi Elias I , Chavis Richard , Scribanu Nina , Chrousos Georgia A
Published: April 2021

ABSTRACT

The malformations in the amniotic band syndrome (ABS) are due to entrapment of fetal parts by fibrous band in the amniotic sac.1 Limbs are most commonly affected followed by craniofacial defects in one third of patients.2 Ocular defects include corneal leukomas and lid colobomas often contiguous with facial clefts,3 strabismus, hypertelorism, and microphthalmos.4 Unilateral chorioretinal defects or lacunae are rare findings in the ABS.4,7 We report a female infant with such a lacunar defect along with central nervous abnormalities, and discuss the differential diagnosis and the embryopathic implications.
Early Correction of Severe Congenital Ptosis
Authors: Saunders Richard A , Grice Charlene M
Published: April 2021

ABSTRACT

Twelve infants with severe unilateral or bilateral congenital ptosis were surgically repaired before 1 year of age in an attempt to achieve early functional and cosmetic improvement. In all cases, a frontalis suspension using polyfilament nylon suture (Supramid Extra) was performed. Postoperatively, 10 patients achieved near normal eyelid position and all had resolution of their chin-up head posture. Two slings eventually failed, requiring repeat procedures for recurrent ptosis. Two developed signs of cellulitis that were successfully treated with oral antibiotics.
Congenital Ocular Fibrosis With Musculoskeletal Abnormality: A New Association
Authors: Kishore Kamal , Kumar Harsh
Published: April 2021

ABSTRACT

Two siblings demonstrated an association of congenital ocular fibrosis (COF) syndrome with musculoskeletal abnormalities consisting of generalized muscle wasting, scoliosis, pigeon-chest deformity, bilateral fusion of the ribs in triplets, prominent coccyx, and sacral dimple. While most of the ocular and systemic "associations" hitherto described in the literature might have been coincidental, the coexistence of a generalized musculoskeletal disease with the COF syndrome raises the possibility that the ocular condition may be part of a more widespread disease process affecting the skeletal muscles.
Visual Fields in 4- to 10-Year-Old Children Using Goldmann and Double-Arc Perimeters
Authors: Quinn Graham E , Fea Antonio M , Minguini Nilza
Published: April 2021

ABSTRACT

We report the comparison of field extent measured using two kinetic perimeters: 1) a double-arc perimeter developed by van Hot-van Duin for use in infants and young children, and 2) the standard Goldmann apparatus. Targets used were the V-4-e target on the Goldmann and both 2- and 6-degree targets on the double-arc perimeter. Visual fields were measured by assessing looking responses toward targets presented in a pseudorandom order at 45°, 135°, 225°, and 315°. Fifty-six children (mean age: 6.8 years, range: 4 to 10 years) were tested, with retests undertaken In 20%. The extent of total field size was highly correlated among the three tests (P < .001) and test-retest reliability was high for all three targets (P < .001). Our previous observation of continued growth with age in visual field extent using the 6-degree target in 4- to 10-year-old children was confirmed and also seen with the 2-degree target in arc perimetry and with the V-4-e in the Goldmann apparatus. Kinetic perimetry using a double-arc perimeter with 2and 6-degree target sizes appears reliable and comparable, in the four meridie tested, to conventional kinetic perimetry techniques in 4- to 10-year-old children.
Combined Hamartoma of the Retina and Retinal Pigment Epithelium in a Patient With Neurofibromatosis Type 2
Authors: Sivalingam Arunan , Augsburger James , Perilongo George , Zimmerman Robert , Barabas Gabor
Published: April 2021

ABSTRACT

We describe a young patient with combined hamartoma of the retina and retinal pigment epithelium who developed bilateral acoustic neuromas and men ing iomas of the cervical-medullary junction and fifth cranial nerve. This case illustrates the association between combined hamartoma of the retina and retinal pigment epithelium and neurofibromatosis type 2. The authors recommend that children with a combined hamartoma of the retina and retinal pigment epithelium be screened for neurofibromatosis type 2.
Occult Duane Syndrome: Co-contraction Revealed Following Strabismus Surgery
Authors: Elsas Frederick J
Published: April 2021

ABSTRACT

Three patients presented in infancy with large angle esotropia and limited abduction. Narrowing of the lid fissures with globe retraction on horizontal gaze became apparent only after recession of the medial recti. Abduction remained limited. Two of the three exhibited dissociated vertical deviations, and seemed to have both congenital esotropia and Duane syndrome. The third had an unusual pattern of apparent co-contraction in which the eye attempting abduction actually adducted. Although rare, Duane syndrome may occur in children with large angle esotropia, and its presence may not be revealed until after strabismus surgery.
Diagnosis of Amblyopia Using the 10-Diopter Fixation Test: A Proposed Modification for Patients With Unilateral Ptosis
Authors: Whittaker K W , O'Flynn E , Manners R M
Published: April 2021

ABSTRACT

Purpose: The 10-diopter (D) fixation test is a useful test for detecting amblyopia in children without a manifest deviation and in whom 3 reliable visual acuity assessment is difficult. The 1 0 prism diopter is conventionally placed base down.

Methods: Seventeen children were studied over a 12-month period to determine the effect of prism orientation on the accuracy of the 10-D fixation test in children with unilateral ptosis.

Results: Anomalous results were obtained in 4 of ? 7 patients with the prism held base up and base down.

Conclusions: To prevent an erroneous diagnosis of amblyopia in children with unilateral ptosis, the prism should be held base up when performing the 1 0-D fixation test.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:21-23.
e - Consults
Authors: Ruttum Mark , Alcorn Deborah
Published: April 2021

Our Column Editors prepared a patient case for virtual consultation - the patient's history, physical examination, and pertinent photos are e-mailed to colleages for a discussion of their individual treatment choices.

In this column, Mark Ruttum presents a case of a 6-year-old girl with convergence insufficiency syndrome with intermittent exotropia. Cynthia W. Avilla, CO; Mohamad S. Jaafar, MD; and Wendy Marsh-Tootle, OD, served as "consultants" and share their diagnosis and treatment options.
Relationship Between Serum Inositol Concentration and Development of Retinopathy of Prematurity: A Prospective Study
Authors: Friedman Charles A , McVey John , Borne Michael J , James Maurice , May Warren L , Temple David M , Robbins Kenny K , Miller C Jason , Rawson John E
Published: April 2021

ABSTRACT

Purpose: To examine the relationship between the intake of sugar inositol, serum inositol levels, and ROP in three groups of low birthweight infants receiving feedings containing various concentrations of inositol.

Methods: Infants with a birthweight <1 500 g, with severe lung disease, were eligible for the study when they began enteral feedings. Infant formulas contained three different inositol concentrations: 2500, 710, and 242 pmol/L Serum inositol concentrations were averaged over specific time intervals. A logistic regression model was used to investigate the confounding effect of duration of mechanical ventilation and oxygen therapy, birthweight, Apgar score, and serum inositol concentration on development of ROP.

Results: Infants receiving high inositol formula and with higher serum inositol concentrations at birth and after 30 days had a statistically significant lower incidence of severe ROP than those receiving the lower inositol formula and with lower serum concentrations (P<.05). The effective serum inositol concentration (EC90) associated with lesser disease was >215 pmol/L By logistic regression, the odds of developing severe ROP were greater among infants with low serum inositol concentration (odds ratio=4.7, 95% confidence interval 0.90-24.8, P=.01 7).

Conclusion: Inositol supplementation may help prevent the most severe form of ROP.

Journal of Pediatric Ophthalmology and Strabismus 2000;37:79-86.
Botulinum Treatment of Infantile Esotropia With Abduction Nystagmus
Authors: Ruiz Miguel F , Moreno María , Sánchez-Garrido Carmen M , Rodríguez José M
Published: April 2021

ABSTRACT

Purpose: To examine the effect of botulinum toxin type A (BTA) on the final correction of esotropia, A and V patterns, overaction of the oblique muscles, and dissociated vertical deviation (DVD) in infantile esotropia with nystagmus in abduction.

Methods: This retrospective study examined 54 patients treated with simultaneous bilateral medial injection of BTA. Subjects were divided into two groups: group 1 (first injection <1 8 months of age) and group 2 (first injection >18 months of age).

Results: Pre-BTA, group 1 patients had an angle of esotropia noticeably higher and fewer A patterns than group 2 patients. Post-BTA, group 2 received significantly fewer injections of BTA than group 1. The magnitude of the A patterns improved. Prior frequency of DVD increased significantly in group 1 (100%): 79% of DVD was decompensated compared with 47% in group 2. Overall success was obtained in 14% and 58% of groups 1 and 2, respectively.

Conclusion: We do not support BTA treatment in infantile esotropia with nystagmus in abduction prior to age 18 months. After 18 months, the horizontal results are excellent and neither the incidence nor the degree of previous DVD are decompensated, resulting in high success rates for overall deviation and improving anisotropy in A.

Journal of Pedatric Ophthalmology and Strabismus 2000;37:196-205.
A New Model for the Mental Health Nursing Change of Shift Report
Authors: Priest Chad S , Holmberg Sharon K
Published: April 2021

ABSTRACT

Nursing shift reports are intended to enhance the continuity and quality of nursing care delivered by providing results of nursing assessments, summarizing medical information, and drawing attention to specific nursing interventions and goals anticipated during the upcoming shift. In this article, contemporary literature on shift reports is reviewed with specific attention to the unique characteristics and problems that commonly occur in change of shift reports in a mental health setting. The framework proposed is Gordon's functional health patterns because it provides a holistic structure for organizing patient data in a clear, objective manner. Additional methods for enhancing shift reports are recommended, including the use of specific behavioral descriptions, the inclusion of data from targeted nursing assessments, and the discussion of alternative care approaches that support the development of consistent, collaborative nursing interventions across shifts. A case example is used for demonstration.
COMBINED Group Process-Psychoeducation Model for Psychiatric Clients and Their Families
Authors: Rindner Ellen C
Published: April 2021

ABSTRACT

Recent studies have been conducted to examine the efficacy of a combined group process and psychoeducation model for psychiatric clients and their families, and have found the combined model to be both cost and time efficient for inpatient and outpatient treatment settings. Psychiatric advanced practice nurses (APNs) are in a key position to lead these combined groups because of their dual training in group process and psychoeducation. However, although many APNs have expertise leading either type of group, most may not have expertise in combining the two. The purpose of this article is to familiarize APNs with the skill sets needed to manage group process and its inherent conflicts, while simultaneously teaching didactic material in the combined model.
Viability of Bacteria in Glycerin and Ethanol Preserved Sclera
Authors: Dailey John R , Rosenwasser George O D
Published: April 2021

ABSTRACT

BACKGROUND: Sclera is commonly preserved in glycerin or ethanol before being used for ophthalmic surgery. The purpose of this study was to determine the ability of bacteria to survive in sclera preserved in glycerin or ethanol.

METHODS: Fresh sclera was inoculated with Staphylococcus aureus, Streptococcus pneumoniae, or Pseudomonas aeruginosa and transferred to preservative vials containing glycerin, 95% ethanol, or trypticase soy broth (control) and stored at room temperature. Pieces of sclera were removed from preservative at designated intervals over a 14-day period. The sclera was then homogenized, plated on blood agar, and incubated at 37° C. Colonies were counted at 24, 48, and 72 hours.

RESULTS: S. pneumoniae, P. aeruginosa, and S. aureus were recovered from glycerin preserved sclera for up to 12 hours, 1.5 days, and 8 days, respectively. No bacteria was recovered from the ethanol preserved sclera.

CONCLUSIONS: Bacteria cannot be recovered from ethanol preserved sclera but can survive in glycerin preserved sclera for at least 8 days. Ethanol may offer advantages over glycerin as a scleral preservative due to its greater antibacterial activity. [Refract Corneal Surg. 1 994; 1 0:38-40.)
Electron Microscopic Evaluation of Intrastromal Corneal Rings Explanted From Nonfunctional Human Eyes
Authors: Quantock Andrew J , Assil Kerry K , Schanzlin David J
Published: April 2021

ABSTRACT

BACKGROUND: lntrastromal corneal rings (ICRs) often exhibit small deposits in association with their suture holes. We assessed the morphology of four such deposits.

METHODS: Four ICRs, explanted from nonfunctional human eyes, were examined by scanning electron microscopy and transmission electron microscopy.

RESULTS: The surface of the suture hole deposits consisted of a disorganized convolution of collagenous lamellae. Within individual lamellae, however, the collagen fibrils tended to orientate parallel with one another. The deposits consisted of an amorphous material interspersed with curved cellular processes, collagen fibrils of variable diameter, and proteoglycan macromolecules.

CONCLUSIONS: We propose that the mechanism which regulates stromal remodeling is amended in the region of the ICR suture holes. Due to their location, suture hole deposits have no optical significance; however, evaluation of their morphology provides insights into the wound-healing properties of the corneal stroma following ICR insertion. [J Refract Corneal Surg. 1994;10:142-148.]
OmniMed II: A New System For Use With the emphasis Erodible Mask
Authors: Friedman Marc D , Bittenson Steven , Brodsky Larry , Dansereau Jeff , Gauthier Vicky , Greco Mark , Johnsson N M Fredrik , Krauss Ray
Published: April 2021

ABSTRACT

Clinical experience has shown the emphasis erodible mask to be an effective method for performing photorefractive keratectomy (PRK) using an eyecup placed in contact with the corneal surface. A new system (OmniMed II) which incorporates the ei'odible mask as an element in the optical delivery system has been developed for performing photorefractive keratectomy. With this new configuration the eyecup is no longer used. We describe in detail the advantages of the erodible mask, the associated hardware of the optical delivery system, and the mask shape transfer process. [J Refract Corneal Surg 1994;10:S267-S273.]
Corneal Epithelial Dots Following Excimer Laser Photorefractive Keratectomy
Authors: Busin Massimo , Meller Daniel
Published: April 2021

ABSTRACT

BACKGROUND: Map-dot-fingerprint epithelial changes of the cornea have been reported to occur as a consequence of trauma or surgical procedures, such as radial keratotomy.

METHODS: We describe a case of dot-like changes in the corneal epithelium following excimer laser photorefractive keratectomy for the correction of myopia. Because the lesions were located centrally, possibly reducing visual acuity, the epithelium was removed mechanically.

RESULTS: Dot-like changes recurred in the same areas 4 weeks after epithelial debridement. Best spectacle-corrected visual acuity improved from 20/200 to 20/100 and remained stable thereafter.

CONCLUSIONS: Photorefractive keratectomy can lead to abnormal regeneration of epithelium basement membrane, possibly resulting in dot-like changes of corneal epithelium. [J Refract Corneal Surg. 1994;10:357-359.]
Noncontact Laser Photothermal Keratoplasty II: Refractive Effects and Treatment Parameters in Cadaver Eyes
Authors: Simon Gabriel , Ren Qiushi , Parel Jean-Marie
Published: April 2021

ABSTRACT

BACKGROUND: Noncontact laser photothermal keratoplasty may provide a new alternative for the treatment of myopia, hyperopia, and astigmatism. The purpose of this article is to study the refractive effect that laser photoablation keratoplasty is capable of producing on a normal human cadaver cornea, including the relationship between the keratometric changes and laser treatment parameters.

METHODS: The human cadaver eyes were treated with a hohnium laser (pulsed Ho:YAG, 2.10 µp?, 250 µß) coupled to a maskable, polyprismatic delivery system mounted on either an optical bench or a slit-lamp microscope. Using a topographic videokeratography system, we first investigated the refractive effect that noncontact laser photothermal keratoplasty would produce on a normal cadaver cornea. We then studied the keratometric changes produced by different radiant exposure levels at a fixed treatment pattern, as well as by different treatment patterns at a fixed radiant exposure level. Finally, we studied the possible therapeutic application of laser photothermal keratoplasty for correcting high postoperative astigmatism on a cadaver eye model.

RESULTS: For the single-pulse 3-millimeter ring of eight-spot treatment, the keratometric power of the cornea initially increased with the radiant exposure and peaked at 26 J/cm2. The refractive effect was increased by projecting an additional set of eight spots equidistant between the first eight spots on the same diameter ring. Eighteen J/cm2 was the minimal radiant exposure required to produce consistent and predictable keratometric changes. The corneas were flattened using treatment patterns smaller than or equal to 3 mm in diameter and steepened using treatment patterns larger than or equal to 5 mm in diameter. A transition zone between 4 and 5 mm was observed in which minimal and unpredictable keratometric changes of the central cornea occurred. The surgically-induced astigmatism (> 10.00 D) was corrected by progressive laser photothermal keratoplasty treatments.

CONCLUSIONS: Laser photothermal keratoplasty can acutely steepen and flatten the cornea in human cadaver eyes. [J Refract Corneal Surg. 1994;10:519-528.!

RESUME

INTRODUCTION: La kératoplastie photothermique sans contact nous donnera peut être une alternative pour le traitement de la myopie, de l'hypermétropie, et de l'astigmatisme. Nous avons étudié l'effet réfraetif de ce laser sur Ia cornée cadavérique humaine et le rapport entre les changements kératométriques et les paramètres du laser.

METHODES: Les yeux furent traités par laser holmium (à pulsation Ho:YAG, 2,10 µp?, 250 µß) couplé au système de transmission polyprismatique installé sur un banc optique ou une lampe à fente. En utilisant la vidéokératographie, nous avons évalué l'effet réfractif du laser en variant la lumination radiante et le motif de traitement. On a ensuite étudié la possibilité des corrections dans le cas d'astigmatisme.
Laser in situ Keratomileusis for Correction of High Astigmatism After Penetrating Keratoplasty
Authors: Rashad Khaled M
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) for correction of high astigmatism after penetrating keratoplasty, and to assess the refractive results and predictability of the procedure.

METHODS; LAStK was performed on 19 patients (19 eyes) with high astigmatism after penetrating keratoplasty, using the Chiron Automated Corneal Shaper and the Chiron-Technolas Keracor 116 excimer laser. The amount of preoperative refractive astigmatism ranged from 6.50 to 14.50 D (mean, 9.21 ± 1.95 D) and the spherical component of manifest refraction ranged from -7.00 to +1.25 D (mean, -2.14 ± 2.11 D). AU patients completed a minimum follow-up of 12 months.

RESULTS: Refraction was stable after 3 months. At 1 year after LASDi, the amount of refractive astigmatism was reduced to a mean of 1.09 ± 0.33 D (range, 0.50 to 1.75 D), with 57.9% of the eyes within ±1.00 D of refractive astigmatism. The mean percent reduction of astigmatism was 87.9 ± 3.7%. The postoperative spherical component of manifest refraction ranged from -1.00 to +1.75 D with a mean of +0.43 ± 0.82 D. vector analysis showed that the mean amount of axis deviation was 1.1 ± 1.3° and the mean percent correction of preoperative astigmatism was 92.6 ± 8.4%. There were no intraoperative complications. Spectacle-corrected visual acuity was not reduced in any eye, and improved by 2 or more lines in 42.1% of eyes after LASDi.

CONCLUSION: LASIK with the ChironTechnolas Keracor 116 excimer laser was effective for correction of both astigmatism and myopia after penetrating keratoplasty. The procedure proved to be safe and gave fairly predictable and stable refractive results. [J Refract Surg 2000;16:701-710]
A Comparison of Intraocular Lens Power Calculation Formulas in High Myopia
Authors: Bernardes João , Raimundo Miguel , Lobo Conceição , Murta Joaquim Neto
Published: April 2021

PURPOSE:

To comparatively evaluate the accuracy of newer intraocular lens (IOL) calculation formulas and common third-generation formulas after Wang-Koch adjustment in the prediction of postoperative refraction in highly myopic eyes.

METHODS:

This was a retrospective study including eyes with high myopia that had uncomplicated cataract surgery with implantation of an AcrySof MA60MA IOL (power range: −5.00 to +5.00 diopters [D]) (Alcon Laboratories, Inc). All patients underwent optical biometry (Carl Zeiss IOLMaster 500 and IOLMaster 700, and Allegro Biograph) and the postoperative spherical equivalent for the implanted IOL was estimated using SRK/T, Holladay 1 (both Wang-Koch adjusted), Haigis, Barrett Universal II, Kane, Ladas, and Hill-RBF v2.0 formulas. Outcomes included the median absolute prediction error (MedAE) and the proportion of eyes within ±0.25, ±0.50, and ±1.00 D of the preoperative prediction.

RESULTS:

Eighty-two eyes with a mean axial length of 30.89 ± 1.85 mm were included. The MedAE in ascending order was Hill-RBF v2.0 0.31 D, Kane 0.33 D, Barrett 0.36 D, Holladay I
wk
0.37 D, SRK/T
wk
0.37 D, Holladay I
wk
0.43 D, Haigis
ULIB
0.54 D, and Ladas 0.61 D. The formula with the lowest MedAE (Hill-RBF v2.0) yielded a prediction error within ±0.25, ±0.50, and ±1.00 D in 43.1%, 70.6%, and 94.1% of cases, respectively.

CONCLUSIONS:

Recent formulas such as Barrett Universal II, Kane, and Hill-RBF v2.0 and Wang-Koch adjusted formulas perform well in this subset of patients with high myopia. The Hill-RBF v2.0 formula had the lowest MedAE and highest proportion of eyes within ±0.25, ±0.50, and ±1.00 D of the predicted target.

[
J Refract Surg
. 2021;37(3):207–211.]
Accuracy of New Intraocular Lens Power Calculation Formulas: A Lens Thickness Study
Authors: Taroni Leonardo , Hoffer Kenneth J. , Lupardi Enrico , Barboni Piero , Savini Giacomo
Published: April 2021

PURPOSE:

To investigate whether using lens thickness measurement as an optional input improves the refractive accuracy of four new generation formulas.

METHODS:

Consecutive patients scheduled for cataract surgery were enrolled. Preoperative biometry was performed with an OA-2000 optical biometer (Tomey). All patients received the same monofocal intraocular lens (AcrySof SN-60WF; Alcon Laboratories, Inc). The Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), Kane, and Radial Basis Function (RBF) formulas were analyzed with and without the inclusion of lens thickness as an input. Postoperative refraction was measured at 1 month. The mean prediction error (PE), the median absolute error (MedAE), and the percentage of eyes with a PE within ±1.00 diopters (D) or less were calculated after constant optimization.

RESULTS:

The final analysis was performed on 169 eyes of 169 patients. Comparison of the mean PE, MedAE, and the percentage of eyes with a PE within ±0.25, ±0.50, ±0.75, and ±1.00 D resulting from each formula with and without lens thickness did not reveal any statistically significant difference. Cochran's Q test showed a statistically significant difference among formulas in the percentage of eyes with a PE of less than ±0.50 D (
P
= .042). However, Dunn's post-hoc test did not show any statistically significant difference between any pair of formulas.

CONCLUSIONS:

Lens thickness measurement did not improve the accuracy of the BUII, EVO, Kane, or RBF formulas. The RBF formula yielded the same results with and without lens thickness, thus making this input useless.

[
J Refract Surg
. 2021;37(3):202–206.]
Assessing Total Keratometry Astigmatism, Simulated Keratometry, and Total Corneal Topographic Astigmatism Against Manifest Refractive Cylinder
Authors: Alpins Noel , Ong James K. Y. , Stamatelatos George
Published: April 2021

PURPOSE:

To evaluate how the Total Keratometry astigmatism measure from a swept-source optical biometer compares with simulated keratometry astigmatism from the same device, and total corneal topographic astigmatism (CorT Total) derived from a Scheimpflug tomographer.

METHODS:

For normal virgin eyes, the ocular residual astigmatism (ORA) magnitudes were determined based on Total Keratometry, simulated keratometry from the same optical biometer (SimK
biom
), and CorT Total and simulated keratometry (SimK
Scheim
) from a Scheimpflug tomographer. The ORA magnitudes for each type of measure were summarized into the standard deviations (ORAsd) and means (ORAmean). The lower the ORAsd, the less variability there is between corneal astigmatism and manifest refractive cylinder. The ORAmean indicates the amount of vectorial difference between the total corneal astigmatism and manifest refractive cylinder.

RESULTS:

The ORAsd for Total Keratometry was not significantly different from the ORAsd for CorT Total (
P
= .06) or SimK
biom
(
P
= .41). The ORAmean for Total Keratometry was not significantly different from the ORAmean for CorT Total (
P
= .15), but was significantly lower than the ORAmean for SimK
biom
(
P
< .001).

CONCLUSIONS:

Total Keratometry astigmatism correlates as well with manifest refractive cylinder as simulated keratometry astigmatism from the same device and CorT Total from a Scheimpflug tomographer. The average difference (as quantified by the ORAmean) between Total Keratometry astigmatism and manifest refractive cylinder was comparable to that of CorT Total, and less than that of simulated keratometry. Both of these results support the use of Total Keratometry over simulated keratometry in the planning of astigmatism surgery when corneal values are required.

[
J Refract Surg
. 2021;37(3):198–201.]
Isolated Neurofibroma of the Orbit
Authors: Rocca Robert C Della , Roen Janet , Labay Gerard R , Bedrossian Edward
Published: April 2021

ABSTRACT

In a 66-year-old woman, a large solitary neurofibroma arising in the right infraorbital nerve extended into the maxillary antrum and the orbit. Following extirpation of this rare tumor, bony defects of the right orbital floor and inferior orbital rim were repaired with a biplanar supramid implant.
Surgical Corneal Light Occluder Made of Black HEMA
Authors: Nevyas Herbert J , Nevyas Joann Y
Published: April 2021

ABSTRACT

A safe, simple surgical light occluder made of black pigmented hydrated HEMA is described. It protects the retina from all wavelengths of light and protects the corneal epithelium against abrasion and opacities due to drying during surgery.
Exophthalmometer Readings in Patients With Graves' Eye Disease
Authors: Frueh Bartley R , Musch David C , Garber Frank W
Published: April 2021

ABSTRACT

Exophthalmometer readings were measured in 84 patients with Graves' eye disease (GED) and 111 normal subjects. The mean exophthalmometer reading was significantly greater in patients with GED than in normal subjects. Asymmetry of the orbital disease produced less correlation of the exophthalmometer readings between right and left eyes of GED patients than is found in normal subjects. Expected gender and age effects on the exophthalmometer reading were not found among the GED patients. The mean exophthalmometer reading was not significantly higher for GED patients with compressive optic neuropathy than in the other subgroups of GED patients, suggesting that exophthalmos per se is not harmful to the optic nerve.
A Corneal Mold to Restore Normal Corneal Dimensions
Authors: Swinger Casimir A , Kornmehl Ernest W , York Steven , Forman Jeffrey S
Published: April 2021

ABSTRACT

A corneal mold is described that provides an MK corneal button of normal thickness and curvature from an edematous, post-mortem button. The uniform, processed tissue can then be used for experimental refractive surgery.
Early Postoperative Prognostic Indicators Following Trabeculectomy
Authors: Stewart William C , Shields M Bruce , Miller Kevin N , Blasini Marino , Sutherland Susan E
Published: April 2021

ABSTRACT

We compared prognostic indicators manifesting within the first 2 postoperative days, with filtration status 3 months following trabeculectomy in 51 primary open-angle glaucoma patients. Patients with an avascular area in the filtering bleb 2 days after surgery had a significantly lower (P < .05) intraocular pressure (IOP) (12.6 mm Hg) 3 months postoperatively than patients with vascular blebs (16.3 mm Hg). However, neither the height, breadth, or transparency of the filtering bleb, presence of microcysts, anterior chamber depth, nor IOP during the first 2 postoperative days were related significantly to the filtration status at 3 months.
Subconjunctival 5-Fluorouracil and Herpes Simplex Keratitis
Authors: Ophir Avinoam , Ticho Uriel
Published: April 2021

ABSTRACT

We present a case of herpes simplex keratitis that appeared during a period following filtering surgery in which subconjunctival 5-FU was being administered. Although the 5-FU treatment was not halted, 4 days later the keratitis healed. The typical practice of discontinuing 5-FU treatment when these kinds of inflammation occur following filtering surgery may be unwarranted.
Standardized Data Collection and Coding in Eye Disease Epidemiology: The Uveal Melanoma Data System
Authors: Seddon Johanna , Gragoudas Evangelos , Egan Kathleen , Polivogianis Lela , Finn Susan , Albert Daniel
Published: April 2021

ABSTRACT

The Uveal Melanoma Data System of the Massachusetts Eye and Ear Infirmary is a computerized database designed for data management and analysis with a broad range of clinical research applications. The system was created in 1980 and has evolved to include standardized data collection forms for all aspects of uveal melanoma patient care such as initial examination, treatment, and follow-up, as well as precoded forms for computer entry, which facilitate quality control measures and data analysis. Excerpts from current versions of these forms are presented. The Uveal Melanoma Data System has been used for a variety of clinical epidemiologic investigations. Examples of its application, including descriptive studies, prognostic factor studies, and treatment evaluations, are discussed. The model has potential broad application for clinical ophthalmic research in other specialty areas.
Clearance of Sodium Fluorescein Incorporated Into Microspheres From the Vitreous After Intravitreal Injection
Authors: Khoobehi Bahram , Stradtmann Manrique Ortiz , Peyman Gholam A , Aly Omar M
Published: April 2021

ABSTRACT

The clearance of microsphere-bound fluorescein from the vitreous was studied in rabbits to evaluate microspheres as a controlled-release drug delivery system. Microspheres of different combinations of copolymers of lactic and glycolic acid were injected intravitreally in three groups of rabbits. High concentrations were detected in the vitreous of all groups within 24 hours. By 5 days, the levels had gradually decreased, but they remained measurable up to 16 days in the rabbits in which lactide microspheres had been injected. Clearance was more rapid in the lactide/glycolide combination group than in the lactide group.
Determination of Maximal Incision Length for True Small-Incision Surgery
Authors: Samuelson Steven W , Koch Douglas D , Kuglen Craig C
Published: April 2021

ABSTRACT

We studied induced astigmatism in cadaver eyes to determine how small a limbal incision must be to avoid a long-term corneal flattening induced by limbal incisions along the meridian of the incision. We performed scleral pocket incisions (2.0 to 5.5 mm in 0.5-mm increments) on 12 fresh human cadaver globes, recessing the incisions 0.5 mm to simulate the natural wound sliding that causes corneal flattening. We found that with increasing incision length there was a nearly linear increase in corneal flattening. The maximal incision length that minimized induction of corneal flattening in excess of 0.25 diopters was 3.0 mm.
Early Visual Rehabilitation Following Keratoplasty Using a Single Continuous Adjustable Suture Technique
Authors: Temnycky George O , Lindahl Kenneth J , Aquavella James V , Erdey Richard A
Published: April 2021

ABSTRACT

We measured postkeratoplasty visual acuity, refraction, retinoscopy, keratometry, and corneal topography in 105 patients, in 33 of whom an adjustable continuous technique had been used, and in 72 of whom a standard technique (in which the continuous suture was not adjusted) had been used. In the eyes in which the sutures were adjusted (within 6 weeks following surgery), acuity improved (preadjustment mean, 20/205; postadjustmerit mean, 20/100), and astigmatism decreased (preadjustment mean, 8.41 diopters; postadjustment mean, 2.22 D). Visual acuity and astigmatism in the control group were unchanged at the same point after surgery.
Surgical Management of Corneal Perforation With Expanded Polytetrafluoroethylene (Gore-Tex™)
Authors: Legeais J M , Renard G , D'Hermies F , Rossi C , Pouliquen Y
Published: April 2021

ABSTRACT

We report a series of six patients with spontaneous corneal perforations successfully treated with a temporary graft of expanded polytetrafluoroethylene (Gore-Tex™) until a definitive penetrating keratoplasty could be performed. Two other patients had a paralimbic perforation treated with an artificial lamellar Gore-Tex graft. No infection or extrusion developed, and the artificial graft kept the anterior chamber tight in all cases. Gore-Tex appears to be a safe and effective material for use in treating acute central and peripheral corneal perforation.
Canalicular Stenosis Following Probing for Congenital Nasolacrimal Duct Obstruction
Authors: Lyon David B , Dortzbach Richard K , Lemke Bradley N , Gonnering Russell S
Published: April 2021

ABSTRACT

A canalicular stenosis was identified in 29 of 66 (44%) children and 35 of 80 (44%) lacrimal drainage systems undergoing silicone intubation for congenital nasolacrimal duct obstruction, having previously had unsuccessful probings. The stenoses were equally divided between boys and girls and between right and left sides. There was no significant difference in age at the time of probing, number of prior probings, or age at intubation between children with and without canalicular stenosis. Stenoses may be congenital or acquired as a result of faulty probing. Any child undergoing a second lacrimal procedure after a failed probing should be evaluated for evidence of a canalicular stenosis. If a stenosis is present, a silicone stent should be placed to try to salvage the canaliculus.
Repair of the Severely Contracted Socket With Meshed Skin Graft and Semi-Rigid Conformer
Authors: Tsur Haggai , Kaplan Haim , Shafir Raphael , Rosner Mordechai , Orenstein Arie , Rosen Nachum
Published: April 2021

ABSTRACT

Nine severely contracted sockets were reconstructed using a meshed skin graft in conjunction with a semi-rigid conformer-stent. Particularly useful following unsuccessful surgery with mucosal grafting, or in cases where for some reason mucosal grafts cannot be obtained, this technique is superior to current procedures utilizing nonmeshed split-thickness skin grafts.
Nd:YAG Cyclophotocoagulation: Outcome of Treatment for Uncontrolled Glaucoma
Authors: Wright Martha M , Grajewski Alana L , Feuer William J
Published: April 2021

ABSTRACT

We reviewed the records of 35 patients (35 eyes) treated with Nd.YAG cyclophotocoagulation for uncontrolled glaucoma and followed for 6 to 36 months or until treatment was declared a failure (loss of light perception, or intraocular pressure (IOP) > 21 mm Hg). The mean pretreatment intraocular pressure was 37.9 mm Hg (range, 20 to 61 mm Hg). The total energy in the initial treatment session ranged from 50.4 to 372.4 J (191 .7 ± 66.3 J). After the treatment, the mean IOP was 21.2 mm Hg (range, 0 to 53 mm Hg). The Kaplan Meier survival analysis demonstrated that failures occurred throughout the follow-up period and that the majority of patients required further intervention or lost all vision if followed long enough. Visual outcome was not correlated with energy used. Eleven eyes (31%) lost two or more lines of acuity or lost all light perception. These findings suggest that Nd:YAG cyclophotocoagulation may control IOP but cannot always save vision.
Glaucoma Filtration Surgery: New Horizontal Mattress Closure of Conjunctival Incision
Authors: Liss Robert P , Scholes Gary N , Crandall Alan S
Published: April 2021

ABSTRACT

We developed a conjunctival wound closure technique with the idea of decreasing the incidence of wound leak following glaucoma filtration surgery. A micropoint 9-0 nylon vascular needle is used as a running mattress suture to close the limbal conjunctiva in routine fornix-based flap trabeculectomy surgery, trabeculectomy surgery with 5-fluorouracil (5FU), and combined cataract and trabeculectomy surgery. In a series of 52 eyes in 52 patients in which we used this technique, there have been no cases of flat anterior chamber or significant choroidal effusion, complications often occurring secondary to trabeculectomy which require further intervention.
Intraepithelial Sebaceous Epithelioma of Lids, Conjunctiva, and Cornea Treated With Minimal Orbital Exenteration
Authors: Wolter J Reimer , Bromley William C
Published: April 2021

ABSTRACT

"Minimal" orbital exenteration, obtained by excision of a lid tumor (that had recurred after local incision), removal of the conjunctival sac, enucleation, and tenonectomy were used to treat intraepithelial sebaceous epithelioma with pagetoid spread to conjunctiva and cornea in an 80-year-old man.
Reattachment of the Detached Ciliary Body With Suturing for Treatment of Contusional Ocular Hypotension
Authors: Zheng Yingzhao , Ji Xunchuan
Published: April 2021

ABSTRACT

Ocular hypotension resulting from a detached ciliary body after ocular contusion usually is best treated surgically. We report a simple, safe, and relatively effective procedure used to suture the ciliary body onto the inner surface of the sclera in eight such cases. Intraocular pressure (IOP) rose from unmeasurable levels to 10 to 12 mm Hg in five of these cases. Although in the three other cases IOP did not increase immediately after the operation, in one case it roseto 10 to 12 mm Hg 1 month postoperatively, and in the other two cases it rose to a normal level after additional laser therapy.
Types of Posterior Capsular Breaks and Their Surgical Implications
Authors: Angra Surinder K , Vajpayee Rasik B , Titiyal Jeevan S , Sharma Yog R , Sandramouli S , Kishore Kamal
Published: April 2021

ABSTRACT

We studied the pathogenesis, clinical features, and management of posterior capsular breaks in 28 cataract patients during planned extracapsular cataract extraction and intraocular lens implantation surgery. In the age-related cataract group (17 cases), the posterior capsular breaks were fresh, caused by the irrigation-aspiration cannula. Located in the upper part of the posterior capsule, they had thin margins and tended to enlarge with continued irrigation. Nine (52.9%) of these breaks could be plugged with viscoelastic, and after dry aspiration, a posterior chamber lens was implanted successfully. Posterior capsular breaks in traumatic cataracts (11 cases) were preexisting but were detected only during surgery. Centrally located, they had thick fibrosed margins and remained the same size during irrigation- aspiration. The minimal vitreous herniation seen in four (35.3%) of these cases was managed by automated partial anterior vitrectomy through the break. A posterior chamber intraocular lens was implanted in all these cases.
Isolated Fractures of the Orbital Floor: Risk of Infection and the Role of Antibiotic Prophylaxis
Authors: Westfall Christopher T , Shore John W
Published: April 2021

ABSTRACT

The application of antibiotic prophylaxis to fractures of the orbital floor is controversial. The incidence of infection following this injury remains undefined. We report a case of orbital cellulitis following orbital floor fracture, and attempt to define guidelines for the appropriate use of antibiotics in the setting of an isolated blowout fracture.