bluuebunny/crossref_metadata_2025 huggingface dataset:
Closed Chamber Iris Suture for Intraocular Lens Fixation
Authors: Paige Gary D
Published: April 2021

ABSTRACT

A simplified method for placing a secondary closed chamber iris suture is described. The technique may be used for fixation of a dislocated intraocular lens or for repairing iris defects.
Endothelial Cell Loss in Different Non-Automated Extracapsular Nuclear Evacuation Techniques and The Role of Sodium Hyaluronate
Authors: Alpar John J
Published: April 2021

ABSTRACT

In this study the effect of seven different non-automated nuclear evacuation techniques and the role of sodium hyaluronate (Healon®) were evaluated. Thirty-five cats (seven groups) and 140 human patients (seven groups) were included in the study. Each experimental animal and human group was operated using one of the seven non-automated techniques. In each animal, one eye was operated with sodium hyaluronate and the other with Balanced Saline Solution (BSS®). In each human group of 20 patients during cataract extraction and IOL implantation, sodium hyaluronate was used in half of the patients and BSS® was used in the remaining ten. Eyes treated with sodium hyaluronate lost approximately 50% fewer endothelial cells and had approximately 50% less increase in corneal thickness than their counterparts treated with BSS®. Based on the results of the endothelial cell loss and the corneal thickness, it is concluded that the most traumatic used technique was no. 2, followed by that of no. 5. The technique no. 7 may be considered as the most atraumatic of the tested procedures. Sodium hyaluronate effectively protected the endothelium, and its routine use in cataract surgery is recommended.
Botulinum Toxin for the Treatment of Essential Blepharospasm
Authors: Shore John W , Leone Charles R , O'Connor Patrick S , Neuhaus Russell W , Arnold Anthony C
Published: April 2021

Twenty-six patients with essential blepharospasm were treated with botulinum toxin by injection. The onset of protractor weakness in all patients ranged from one to five days following treatment. Maximal weakness developed within 12 days. There was a variable and gradual return of protractor strength over eight to 29 weeks in most patients and, with it, a return of spasm. Twenty-five patients received some degree of functional relief following initial injection. In most patients, however, the post-injection result could not be stabilized and repeat injections have been necessary to control recurrent spasms. There was one treatment failure. Three patients treated by injection following previous neurectomy and myectomy appeared to have a reduced requirement for subsequent injections. Complications included transient ptosis in six patients and mild exposure symptoms in four patients. Extraocular muscle paresis did not occur. There were no systemic side effects from the botulinum toxin injections.
The Slip Knot for Dacryocystorhinostomy Flap Closure
Authors: Jordan David R , Tse David T
Published: April 2021

ABSTRACT

During dacryocystorhinostomy (DCR) surgery, anterior and/or posterior flaps are created and anastomosed with absorbable sutures. A prominent nasal bridge and recessed lacrimal crest can often make tying of the suture within a small incision difficult. We have simplified this tying process with the use of a slip knot. The knot is tied external to the incision and then slid into the operative site until the flaps are apposed.
Delivery of Antifibroblast Agents as Adjuncts to Filtration Surgery - Part II: Delivery of 5-Fluorouracil and Bleomycin in a Collagen Implant: Pilot Study in the Rabbit
Authors: Kay Jeffrey S , Litin Bradley S , Jones Mark A , Fryczkowski Andrzej W , Chvapil Milos , Herschler Jonathan
Published: April 2021

ABSTRACT

A pilot study was performed in order to determine if filtration bleb longevity could be enhanced in rabbits by delivery of 5-fluorouracil or bleomycin in a collagen sponge implant. Results showed that both agents prolonged bleb longevity and lowered intraocular pressure when compared to controls. Bleomycin treated animals had the best bleb appearance and function at the longest postoperative intervals.
Argon Laser Phototherapy of Phthiriasis Palpebrarum
Authors: Awan Khalid J
Published: April 2021

ABSTRACT

Argon laser phototherapy Is an alternative new, quick, and effective method of treating Phthiriasis palpebrarum in one sitting. A beam at a setting of 200micron size, 0.1 second time, and 200 mW power is employed to destroy individual adult parasites and nlts. The only drawbacks are an occasional but tolerable stinging and the slicing of the eyelash stems carrying the nit. The eyelashes regain their normal length within a few days.
Single Snip Trabeculectomy Using a Specially Designed Punch
Authors: Tomey Karim F , Shammas Ibrahim V
Published: April 2021

ABSTRACT

A special trabeculectomy punch designed by one of the authors is described. The surgical technique and advantages of the punch method are discussed.
Wound Dehiscence Following Cataract Surgery
Authors: Lambrou Fred H , Kozarsky Alan
Published: April 2021

ABSTRACT

We retrospectively examined ophthalmic surgery at two teaching hospitals from 1982 to 1985 to determine the incidence, cause, treatment, and outcome of wound dehiscence following cataract surgery. In the 1276 cataract procedures performed during this period, 18 patients (1.4%) underwent repair of wound dehiscence. Thirty-one percent of patients with dehiscence had had cataract extraction on subluxed traumatic cataracts; trauma also caused 69% of the dehiscences. Posterior chamber lenses remained in place in 88% of cases. Seventy-seven percent regained 20/40 or better visual acuity following repair.
A New Surgical Technique for Managing Sunset Syndrome
Authors: Allara R David , Weinstein George W
Published: April 2021

ABSTRACT

Although inferior subluxation of a posterior chamber intraocular lens following extracapsular cataract extraction (sunset syndrome) occurs infrequently, it is difficult to manage. We describe a new, relatively simple technique for managing subluxated posterior chamber intraocular lenses, in which the lens implant is "dialed" forward into the anterior chamber, bringing its haptics to rest in the chamber angle.
Modification of an Irrigation/Aspiration Handpiece to Provide Visual and Tactile Orientation of the Aspiration Port
Authors: Hagan John C
Published: April 2021

ABSTRACT

To perform extracapsular cataract extraction safely the surgeon must know the orientation of the aspiration port of the irrigation/aspiration handpiece at all times. I have modified a commercially available irrigation/aspiration handpiece to allow visual and tactile orientation of the aspiration port even when it is obscured by iris, blood, or cortex.
A New Donor Cornea Marker and Punch For Penetrating Keratoplasty
Authors: Gilbard Jeffrey P , Rothman Richard C , Kenyon Kenneth R
Published: April 2021

ABSTRACT

We describe a new device to mark and punch donor corneas for penetrating keratoplasty. The device contains eight marking-suction holes that make circular marks in the periphery of the donor cornea and fix the tissue in position during trephination. The eight peripheral marks correspond in location to meridians of an eight-blade radial keratotomy marker. When used in conjunction with this marker for the host bed, the donor cornea marker facilitates alignment of meridians on donor and host tissues, radial placement of sutures, and quantitative placement of sutures equidistant from the wound margin.
Extending Corneal Storage With 2.5% Chondroitin Sulfate (K-Sol)
Authors: Keates Richard H , Rabin Barry
Published: April 2021

ABSTRACT

K-Sol ™ corneal storage medium maintains corneal viability for at least ten days, compared with McCareyKauf man (M-K) medium, which does so for a reported maximum of three days. Since many eye banks still use M-K medium exclusively, stored corneas must be used without undue delay, and shipping time further hastens the planned surgery time. Transferring the shipped M-K medium-stored cornea to K-Sol offers a simple way of increasing storage time in our eye bank. Ninety-five out of 100 transferred corneas (95%) remained clear 3 to 18 months postoperatively. There were no primary graft failures, and transferred corneal mates were clear.

A comparable series of 100 corneas stored in M-K medium alone, or in K-SoI alone, were clear in 93% and 97% of the transplants. Analysis of donor rims after keratoplasty indicated statistically significantly more endothelial cell loss during storage in corneas transferred to K-SoI compared with 18 corneas preserved only in M-K medium for a similar length of time. There was no statistical significance between the transferred group and the group preserved in only K-Sol.

Transferring M-K medium stored corneas to K-SoI medium may be a useful means of extending corneal storage time, resulting in improved tissue utilization.
A Technique for Accurate Application of Pilocarpine Gel
Authors: Fechtner Robert D , Ritz Jody R , Starita Richard J
Published: April 2021

ABSTRACT

Pilocarpine hydrochloride 4% gel can be accurately administered by squeezing a one-half inch ribbon of gel onto the tube tip and then touching the premeasured dose to the conjunctiva.
Intravitreal Injection of Piperacillin
Authors: Semple H Christopher , Liu James C , Peyman Gholam A
Published: April 2021

ABSTRACT

Piperacillin was injected into the vitreous body of rabbit eyes to evaluate its suitability for intraocular injection and its toxicity on intraocular tissues. Doses ranged from 50 µg to 3,000 µg. Toxicity was determined through histology and electroretinograms by comparing the piperacillin-injected eyes with eyes injected with balanced saline solution. Retinal toxicity was noted in the outer layer of the retina when 3,000 µg was injected intravrtreally. No toxicity was noted by histology with 1,500 µg of piperacillin. The minimal inhibitory concentration of piperacillin is 800 µg/cc for both gram negative and gram positive organisms. The large dose of intravitreal piperacillin tolerated by rabbit eyes makes piperacillin a potentially safe and effective broad spectrum antibiotic for the treatment of bacterial endophthalmitis in human eyes.
Technique of Intraocular Lens Placement to Facilitate Graft Survival in Pseudophakic Eyes
Authors: Alpar John J
Published: April 2021

ABSTRACT

A relatively simple and effective method is described for suturing the haptics of a posterior chamber lens to the iris when there is no capsular support to keep the lens in place. A thin plastic strip is used to keep the lens body in the front of the iris and to elevate the haptics for easier localization and placement of McCanneltype sutures.
The Determination of Lens Implant Power
Authors: Drews Robert C
Published: April 2021

ABSTRACT

This article reviews published formulas for intraocular lens power determination. In the author's opinion, lack of agreement as to which formula is the most accurate is because none of them reduce the fundamental (biological) problem of variation (scatter, or standard deviation) of results. Suggestions are made for wise use.
Transient Central Retinal Artery Occlusion and Contralateral Amaurosis After Retrobulbar Anesthetic Injection
Authors: Brod Roy D
Published: April 2021

ABSTRACT

A transient, ipsilateral central retinal artery occlusion and contralateral amaurosis developed following retrobulbar injection of 2% lidocaine and 0.75% bupivacaine. A computerized tomography scan obtained 1 Vz hours following the injection demonstrated an air bubble within the i psilateral optic nerve sheath. This case further supports the view that intranerve sheath injection can cause these two complications associated with retrobulbar anesthesia.
Lacrimal Intubation Stay Suture
Authors: Hedges Charles C
Published: April 2021

ABSTRACT

Migration of lacrimal intubation tubing can be prevented with a preplaced intralumen monofilament suture.
Cyanoacrylate Fixed Silicone Sheet in Medial Blowout Fracture Repair
Authors: Seiff Stuart R
Published: April 2021

ABSTRACT

Indications for medial blowout fracture repair may include persistent diplopia due to entrapped orbital contents or enophthalmos. In such cases a barrier must be placed along the medial orbital wall to prevent recurrence of entrapment and to minimize enophthalmos. Firm fixation of these barriers may be technically difficult. In seven patients silicons sheets were fixed in place along the medial orbital wall with butyl-2-cyanoacrylate cement. These patients have done well postoperatively with a mean time since surgery of 21 months.
Retinal Tacks: Tolerance and Tissue Reaction in a Human Eye
Authors: Tripathi Ramesh C , Pon David M , Levine Robert A , Tripathi Brenda J , Falckh Robert C F , Moffat Kenneth P
Published: April 2021

ABSTRACT

We report the h isto pathologic findings in a human eye enucleated after insertion of three nonmagnetic, metallic alloy tacks for treatment of a giant retinal detachment. Five months after surgery one of the tacks was detected in the anterior chamber. Two tacks remained in situ and induced a localized glial reaction, breaks in Bruch's membrane, disappearance of the retinal pigment epithelium and choriocapillaris immediately around the tack, and a variable extent of chorioretinal adhesion. The penetration of the tacks in the choroid and sclera was associated with a localized scar and only a mild inflammatory reaction, but all tacks themselves were free of inflammatory cells and degradation. The two tacks remaining in place were tolerated by the posterior segment. After comparing and contrasting our findings with those documented in the rabbit model, we conclude that overcoming dislodgement problems will require improved insertion techniques and tack design.
Quantitative CW Nd:YAG Pars Plana Transscleral Photocoagulation in Postmortem Eyes
Authors: Schubert Hermann D , Agarwala Atul
Published: April 2021

ABSTRACT

The effect of different types of burns and numbers of lesions on, and the role of initial pressure head in, the rate of aqueous outflow was studied in enucleated human and porcine eyes. Noncontact and contact CW Nd:YAG laser applied to human eyes 3 mm posterior to the limbus produced a 34% and 51% increase, respectively, in outflow as compared with controls (P= .01). In porcine eyes, outflow increased directly with the number of noncontact bums as well as with the amount of perfusion pressure.

Our results suggest that intraocular pressure and outflow are functions of both the intensity of irradiation and the surface area treated, and that each individual pressure head may require an optimal pars plana area of treatment of therapeutic degree to lower pressure and yet prevent overfiltration and phthisis. Our results also suggest that there may be a passive transneuroepithelial and transscleral outflow component in clinical laser cycloablation and, therefore, a need to grade laser treatments in order to prevent visual loss through unnecessary injury.
Iontophoresis for Eyelid Anesthesia
Authors: Meyer Dale R , Linberg John V , Vasquez Roberto J
Published: April 2021

ABSTRACT

Local anesthesia is appropriate for eyelid surgery, but patients fear the pain of injections. We evaluated iontophoresis of lidocaine for eyelid skin anesthesia to pinprick pain sensation in normal subjects, and prior to regional infiltration of the anesthetic agent in patients undergoing eyelid surgery. After iontophoresis of lidocaine hydrochloride 4% solution to one randomly chosen eyelid, pinprick skin sensation was tested in a double-masked manner. Subjective pain scores of 10 subjects were significantly less [P < .008} on the iontophoresis treated eyelids (0.25) than on the untreated eyelids (2.55). Nine patients undergoing bilateral upper eyelid surgery had iontophoresis applied to one randomly chosen eyelid prior to the usual anesthetic injections. In this doublemasked evaluation, patients reported significantly less pain (P <.02) on the treated eyelids (1.4) than on the untreated eyelids (4.7). We conclude that iontophoresis is effective for achieving short-term, superficial anesthesia of eyelid skin.
Silastic Foam Dressing for Healing Exenteration Cavities
Authors: Benson Mark T , GiImour Hilary , Nelson Michael E , Rennie Ian G
Published: April 2021

ABSTRACT

Dressing the exenterated orbital cavity is difficult and time consuming for staff, traumatic to the healing wound, and painful for the patient, particularly when the wound is being left to granulate. We report the use of a silastic foam dressing which offers a number of advantages in this clinical situation.
Hemorrhagic Choroidal Detachment With Anterior Vitreoretinal Adhesions
Authors: Freeman William R , Schneiderman Todd E , Weinreb Robert N , Baerveldt George
Published: April 2021

ABSTRACT

We present three cases of large intraoperative or postoperative hemorrhagic choroidal detachment with subsequent adherence of the retina to anterior segment structures. Surgical management involved bimanual vitrectomy through anterior sclerotomy sites and dissection within the anterior segment. Successful retinal reattachment was achieved in two of these cases (18-months' follow up). In the third case, the retina remained attached for 4 months but then redetached.
Paralimbal Compression Suture for Molteno Implants
Authors: Allinson Richard W
Published: April 2021

ABSTRACT

When a Molteno implant is being inserted, the silicone tube occasionally can be misdirected anteriorly, bringing the end of the tube dangerously close to the corneal endothelium. A paralimbal compression suture of 8-0 nylon may redirect the tube more posteriorly, preventing such contact.
Scleral Fixation of Posterior Chamber Intraocular Lens Implants Combined With Vitrectomy
Authors: Friedberg Mark A , Berler David K
Published: April 2021

ABSTRACT

Selected patients undergoing pars plana vitrectomy and lensectomy may be ideal candidates for scleralfixated lenses. We present our current technique for implanting such lenses, a technique designed to avoid the problems of suture exposure, lens rotation, and infection.
Trabeculodialysis for Inflammatory Glaucoma: A Review of 25 Cases
Authors: Williams Ruth D , Hoskins H Dunbar , Shaffer Robert N
Published: April 2021

ABSTRACT

We reviewed the results following trabeculodialysis in 25 eyes of 22 patients with secondary glaucoma due to chronic anterior uveitis. After 1 year, intraocular pressure (IOP) was uncontrolled (>21 mm Hg) in 11 eyes (44%). Trabeculodialysis controlled IOP (<21 mm Hg) in 14 eyes (56%), with an average follow up of 52 months (range, 12 to 151 months). Sixteen eyes (64%) were aphakic, but did no worse than the phakic eyes. One eye developed a subchoroidal hemorrhage 3 days postoperatively which required drainage. No other serious complications were encountered. Trabeculodialysis is a safe procedure which can achieve pressure control in these difficult eyes.
Capsulorhexis, Phacoemulsification, and Posterior Chamber Lens Placement Following Iridocyclectomy
Authors: Lindquist Thomas D
Published: April 2021

ABSTRACT

Two patients developed cataract following iridocyclectomy for iris melanoma invading the angle. Although several clock hours of zonular fibers had been surgically resected, the use of a continuous, circular capsulorhexis followed by phacoemulsification maintained the integrity of the anterior capsular margin and allowed for stable "in-the-bag" placement of a posterior chamber intraocular lens (PC-IOL). Continuous, circular capsulorhexis is the optimal anterior capsulectomy procedure, minimizing the incidence of radial tears and the risk of subsequent PC-IOL decentration.
Computerized Analysis of Corneal Topography as an Aid in Fitting Contact Lenses After Radial Keratotomy
Authors: McDonnell Peter J , Garbus Jenny J , Caroline Patrick , Yoshinaga Patrick D
Published: April 2021

ABSTRACT

To select an appropriate base curve to use in fitting a contact lens in 16 eyes of 10 patients following radial keratotomy, we used a videokeratoscope that generates a 32-ring image, covering the entire cornea, to measure the midperipheral corneal curvature. We then based contact-lens selection on the curvature 3.5 mm superior to the visual axis. Photographic documentation of fluorescein patterns and subjective reports of the patients indicated a successful fitting in all cases.
A New Cannula for Removal of 12 O'Clock Cortex Through a Sideport Corneal Incision
Authors: Hagan John C
Published: April 2021

ABSTRACT

A new cannula for aspiration of 12 o'clock cortex through a corneal sideport incision is now commercially available. The primary difference between this cannula and previously available ones is that the hub has a male adaptor, allowing direct connection to an automated irrigation/aspiration device.
Surgically-Induced Astigmatism in Combined ECCE With Filtering Procedures Compared to ECCE Alone
Authors: Choplin Neil T , Monroe John F
Published: April 2021

ABSTRACT

Extracapsular cataract extraction with implantation of a posterior chamber lens combined with filtering surgery (glaucoma triple procedure) is frequently employed in the comanagement of cataract and glaucoma. Nineteen triple procedures with a minimum of six months follow up were compared to 19 cases of extracapsular cataract extraction with lens implant matched for age, sex, and surgeon with regard to surgically induced astigmatism as determined by vector analysis. Follow up averaged 10 months for the triple group and 14 months for the controls. There was no statistically significant difference in preoperative astigmatism between the two groups nor in the mean number of sutures cut.

Postoperatively, the keratometric cylinder averaged 2.55 ± 1.54 diopters for the cases and 1.20 ± 1.11 D for the controls; the difference of 1.36 D was statistically significant (P = .004). The postoperative refractive cylinder was 2.34 ± 1.54 D for the cases and 1.29 ± 1.07 D for the controls; the difference of 1.05 D was statistically significant (P = .017). With regard to surgically-induced astigmatism, vector analysis showed that the cases averaged 2.18 ± 1.25 D and the controls 1.23 ± 0.81 D; the difference of 0.95 D was statistically significant (P = .006). With regard to surgically-induced astigmatism, vector analysis showed that the cases averaged 2.18 ± 1.25 D and the controls 1.23 ± 0.81 D; the difference of 0.95 D was statistically significant (P = .006). When analyzed for change along the vertical meridian, the cases averaged 1.12 ± 1.57 D surgically-induced against-the-rule astigmatism, as compared with 0.30 ± 1.16 D for the controls (difference, 0.83 D; P = .062). The glaucoma triple procedures induced approximately 1.00 D more cylinder than the controls.
Visual Correction Following Penetrating Keratoplasty
Authors: Smiddy William E , Hamburg Tracey R , Kracher Gregory P , Stark Walter J
Published: April 2021

ABSTRACT

Postoperative visual correction following penetrating keratoplasty usually includes spectacles, but for some patients optimal vision may be obtained using contact lenses. We studied 126 eyes of 101 patients undergoing penetrating keratoplasty to determine the frequency of postoperative contact-lens use, its clinical associations, its effect on the risk of corneal graft rejection, and its potential effects on topical medications. A total of 20 patients (16%) wore contact lenses postoperatively for maximal optical correction. Among eyes with good macular potential, 17 of 63 (27%) wore contact lenses. Contact-lens wear did not preclude the use of chronic postoperative topical medications, nor did it increase the risk of corneal graft rejection. We conclude that contact lenses may be useful for optimizing vision after penetrating keratoplasty, especially when macular potential is good.
Idiopathic Preretinal Fibrosis A Review of 237 Cases
Authors: Pilkerton A Raymond , Gilbert William S , Perraut L Edward , Perraut L Edward , Garfinkel Richard A
Published: April 2021

ABSTRACT

We reviewed the charts of 223 patients 236 eyes) with idiopathic preretinal fibrosis, dividing them into two groups: those who only had been observed, and those who, after an observation period, had the membranes surgically removed. All of the patients had been followed from 6 to 120 months (mean, 29 months). Vision in the nonsurgical group slowly deteriorated and was accompanied by metamorphopsia. More rapid visual deterioration occurred in 60 eyes (25%), of which 37 (16%) required surgery. Vision in 78% of the surgical group improved, with the greatest subjective benefit considered to be subsidence of metamorphopsia. Vision spontaneously improved in 2.5% of the cases.
Penetrating Keratoplasty for Corneal Perforation in an Obtunded Patient
Authors: Van Meter Woodford S , Conklin John
Published: April 2021

ABSTRACT

A ventilator-dependent patient obtunded from severe head trauma suffered a spontaneous corneal perforation with lens extrusion secondary to nosocomial Pseudomonas keratitis. Despite the patient's guarded condition, a successful tectonic penetrating keratoplasty with lens removal was performed for restoration of the globe. Upon recovery, the patient's only useful vision was in her operated eye. Preventative measures against prolonged corneal exposure in an obtunded patient include copious artificial tears and lubricants, use of scleral lenses, moisture chambers, bandage contact lenses, or tarsorrhaphies.
Anterior Lens Capsulotomy Using the Holmium YAG Laser in Pig Cadaver Eyes
Authors: Miyake Kensaku
Published: April 2021

ABSTRACT

Anterior lens capsulotomy was performed on pig cadaver eyes using the evaporation and coagulation functions of the holmium YAG laser. Laser energy ranging from 50 to 80 mJ was delivered to the lens-capsule surface by a 26-gauge fiber-optic quartz needle probe. In eight of 10 eyes, a tear-free, 4.0-millimeter-diameter circular capsulotomy was achieved, through which endocapsular phacoemulsification and aspiration were performed and a posterior chamber intraocular lens with a 6.5-millimeter-diameter optic was placed inside the lens capsule. Throughout the procedure, capsular integrity was maintained in all eight eyes, with no tearing at the capsular margin.
Bipolar Cautery and Internal Thermal Sclerostomy in a Rabbit Model
Authors: Au Yue-Kong , Reynolds Mark D , Chadalavada Ravi , Misra Raghunath P
Published: April 2021

ABSTRACT

Internal thermal sclerostomy (ITS) was performed unilaterally in 35 adult New Zealand rabbits using a pinpoint bipolar cautery probe and radio-frequency power supply, with the nonoperated eyes serving as controls. Standard trabeculectomy using a limbal-based flap was also performed on 10 additional rabbits, and served as a second bench mark for comparison with the ITS technique. Intraocular pressure (IOP) was measured in all eyes preoperatively and on postoperative days 2, 4, 6, and 8. A significant (P = .005) difference between the reduction in IOP in the ITS eyes and in the control eyes was found up to postoperative day 8; on that day the reduction in IOP was 5.2 mm Hg. IOP in the eyes undergoing standard trabeculectomy was significantly (P = .05) reduced up to postoperative day 2, and gradually decreased, to 2.5 mm Hg, on postoperative day 8. The greatest reduction in IOP (2.9 mm Hg) for these eyes also occurred on postoperative day 2. Complications of ITS included iris burn (23%), peripheral corneal edema (17%), and iritis (9%). No ruptured blebs, flat anterior chambers, hyphemas, or lens damage occurred. The potential advantages of the ITS procedure using the bipolar cautery probe include a decreased risk of cataract formation because of the curved probe design. The procedure is also technically simple to perform and requires only inexpensive and readily-available equipment.
The Protective Effect of Early Intraoperative Injection of Viscoelastic Material in Trabeculectomy
Authors: Barak Adiel , Alhalel Amir , Kotas Ronit , Melamed Shlomo
Published: April 2021

ABSTRACT

In a prospective study, we evaluated the effect of intracameral injection of sodium hyaluronate (HA) in trabeculectomy on short- and long-term results, including the effect on the corneal endothelium. Twenty-two patients were randomly assigned into two groups: group A, consisting of 11 patients, underwent standard trabeculectomy; in group B (11 patients), additionally, HA was injected into the anterior chamber immediately following paracentesis in an attempt to minimize shallowing of the chamber after the subsequent trabeculectomy. Both groups had comparable age distributions, preoperative intraocular pressures (IOPs), preoperative endothelial cell counts, postoperative IOPs after 3 months, and glaucoma medication indices. The reduction in the number of endothelial cells after 1 month was significantly greater in group A than in group B (16.1% vs 6.7%). Also, significantly more shallow anterior chambers occurred in group A (three eyes vs one eye). However, 1 day postoperatively, the average IOP was 16.4 mm Hg in group A, as compared with 25 mm Hg in group B. Thus, although HA, injected early in trabeculectomy, appeared to protect against corneal endothelial loss and flat anterior chamber, it also seemed to be associated with early IOP spikes.
Patterns of Tissue Damage Produced by Repeated Use of a Corneal Trephine: A Scanning Electron Microscopic Study
Authors: Jaais Fathilah , Dutton Gordon N
Published: April 2021

ABSTRACT

We studied by scanning electron microscopy the effects of the repeated use of a newly-designed, disposable, suction trephine (Microsurgical, Ltd, Bedfordshire, England) on the nature of the cut of successive corneal buttons from sheep eyes. After the trephine was used more than nine times, the cut edge became more irregular as successive buttons were produced. Also, progressively greater degrees of endothelial cells adjacent to the cut edge were lost. Although the corneal buttons initially were circular, those produced after the 20th cut became more oval. These results suggest that a disposable corneal trephine should be reused no more than nine times.
Intravitreal Antibiotics: Accuracy of Dilution by Pharmacists, Ophthalmologists, and Ophthalmic Assistants, Using Three Protocols
Authors: Narvaez Julio , Wessels Izak F , Mattheis Jay K , Beierle Floyd
Published: April 2021

ABSTRACT

We compared the accuracy with which general ophthalmologists, pharmacy personnel, and ophthalmic assistants diluted intravitreal antibiotics, using a method of their own devising, a new protocol using an insulin syringe, and Duane's protocol. The insulin syringe method proved less accurate and more complex than Duane's protocol, but was better than not using a standardized protocol at all. With all methods, the pharmacy personnel produced the most accurate dilutions, with the least variability. The ophthalmologists' dilutions were much more variable both without a protocol and with the insulin syringe method, but they were acceptable with the Duane's protocol. The ophthalmic assistants produced unacceptable results with all methods. Since the decision to inject antibiotics is usually made under emergency conditions, when errors of dilution are more likely, whenever possible, pharmacy personnel should be entrusted with providing the dosage of medications to be injected intraocularly. If pharmacists are unavailable, ophthalmologists may reconstitute medications using a reliable and simple protocol such as Duane's.
A Possible Role of Free Radicals in the Transplantation of Retinal Pigment Epithelial Cells
Authors: Ophir Avinoam , Chevion Mordechai
Published: April 2021

ABSTRACT

Oxygen-derived free radicals have been implicated in tissue injury following ischemia and reperfusion (reoxygenation). It has been hypothesized that the radicals are produced during the early reperfusion stage. Recently, submacular implantation of retinal pigment epithelium cells has been reported. It is probable that during the procedure, the transplant and the 180-degree folded outer retina underwent a period of ischemia, followed by reoxygenation. We, therefore, infer that free radicals were produced during the reoxygenation stage of the procedure, injuring both tissues. We suggest that these hypotheses be investigated with the aim of improving the surgical outcome in eyes with age-related macular degeneration.
Failure of Collagen Plugs to Predict Epiphora After Permanent Punctal Occlusion
Authors: Glatt Herbert J
Published: April 2021

ABSTRACT

In two patients with keratoconjunctivitis sicca, epiphora did not occur after temporary canalicular occlusion with collagen implants, but did occur after subsequent permanent punctal occlusion. This suggests that collagen implants may not always produce total occlusion. Patients should be warned of this possibility.
Bilateral Congenital Posterior-Capsular Defects: A Case Report
Authors: Vajpayee Rasik B , Sandramouli S
Published: April 2021

ABSTRACT

We report a rare case of bilateral congenital posteriorcapsular defects and its successful management by the dry-aspiration technique. To our knowledge, this is the first documented case of a posterior-capsular rupture with no demonstrable cause.
Ten-Year Follow Up Comparing Anterior and Posterior Chamber Intraocular Lens Implants
Authors: Downing John E
Published: April 2021

ABSTRACT

Results achieved in eyes following a single surgeon's first 200 procedures consisting of intracapsular cataract extraction and implantation of a Choyce-Tennant anterior chamber lens (AC-IOL) (1977 to 1980) are compared with those achieved following the same surgeon's first 200 procedures consisting of extracapsular cataract extraction and implantation of a posterior chamber intraocular lens (PC-IOL) (1980 to 1982). For the AC-IOL eyes, follow up ranged from 11.1 to 14.2 years (mean, 12.0 years); for the PC-IOL eyes, from 9.5 to 10.8 years (mean, 10.0 years).

The AC-IOL eyes had many early problems: pupillary block (7%), iritis (15%), and secondary glaucoma (8%). Four percent developed corneal edema, 1.5% vitritis, and 2% localized iris holes under the lens. Ectropion uveae appeared in 8.5%, indicating some ongoing inflammation. One and one-half percent of these lenses were removed or exchanged. Seventy-nine and one-half percent of these eyes had 20/40 or better vision at 10 years; 4% had visual loss along with corneal edema or vitritis, apparently related to the AC-IOLs.

The PC-IOL eyes had comparatively few lens-related complications: 1% corneal edema, 1.5% iritis, 1% vitritis, and 2% secondary glaucoma. Some localized trapping of the pupil occurred in 8%. One percent of the PC-IOLs were removed, and 1% decentered, requiring McCannell sutures. Final visual acuity at 10 years was 20/40 or better in 77.5%. None of the PC-IOL eyes had decreased vision related to the lens implant.
Oblique Orientation of Incisions in Four-Incision Radial Keratotomy
Authors: Chen Varda , Lindstrom Richard L
Published: April 2021

ABSTRACT

We recommend that the incisions in four-incision radial keratotomy cases be oriented obliquely as a means of avoiding glare or star burst.
An Epidemiologic and Pathologic Study of Globes Enucleated Following Trauma
Authors: Freitag Suzanne K , Eagle Ralph C , Jaeger Edward A , Dunn Eric S , Jeffers John B
Published: April 2021

ABSTRACT

This retrospective study examined demographic, clinical, and histopathologic factors in 24 traumatically ruptured globes that were enucleated at Wills Eye Hospital during a 2-year period. The majority of these injuries occurred in a violent assault setting with a blunt mechanism, during the evening and early morning hours, and in the fall and winter months. Most patients were black males, and 67% were substance abusers. Clinically, the initial visual acuity in 96% of the eyes was light perception or worse. Five of the eyes were enucleated primarily. Gross examination of the globes revealed that 92% of the wounds involved the sclera, 83% of the eyes had hyphema, and 71% of the lacerations were longer than 10 mm. Histopathologic examination demonstrated that the majority of eyes had fragmented or missing lenses, disrupted ciliary bodies, and detached choroids. Ninety-six percent of the retinas were detached. There was one case of acute endophthalmitis.
The Tarsal Pillar Technique for Narrowing and Maintenance of the Interpalpebral Fissure
Authors: Tanenbaum Myron , Lett Dewayne , Gossman M Douglas , Haines Peter , Bergin Donald J , McCord Clinton D , Friedman Harold I
Published: April 2021

ABSTRACT

We describe a tarsorrhaphy technique whereby an ipsilateral upper-eyelid tarsal pillar is sutured to a corresponding lower-eyelid recipient site. This technique allows maintenance of a narrowed interpalpebral fissure indefinitely, yet is easy to reverse without incurring lid-margin damage. Additionally, the procedure can be adjusted postoperatively to either narrow or widen the initial surgical result. We report our combined surgical experience in 35 consecutive procedures using this technique to treat eyes with exposure-related keratopathy of varied etiology, including facial nerve palsies, combined facial nerve palsy and trigeminal neuropathy with an anesthetic cornea. Graves' disease, congenital craniofacial anomalies, and severe keratitis sicca syndrome. The procedure was successful in improving exposure keratopathy symptoms in all 35 cases. Complications, reflecting the authors' learning curve with this new procedure, included intermarginal pyogenic granulomas, stretching of the tarsal pillar, minor lowereyelid-margin eversion, and tarsal pillar dehiscence.
Anterior Segment Ischemia
Authors: Watson N J
Published: April 2021

ABSTRACT

I present, to my knowledge for the first time, a case of anterior segment ischemia following a trabeculectomy performed under local anesthetic.
A New Instrument for Controlling Pressure Exerted on the Sclera During Contact Nd: YAG Laser Cyclodestruction
Authors: Fankhauser Franz , Kwasniewska Sylwia , Dürr Ulrich , van der Zypen Eugen , England Ceri , Bättig Beat
Published: April 2021

ABSTRACT

We tested the device described by RoI et al in their article in this issue, designed to define and precisely control the pressure applied to the sclera during contact cyclodestruction with a cw-Nd:YAG laser. Since scleral transparency, and hence transmission of laser energy, depends on the pressure applied, control of this parameter represents an important advance toward the goal of standardizing the cyclodestructive procedure. In eight of nine cadaver pig eyes, pressure was exerted on the sclera using the pressure-controlling device, with a setting of 0.25 N for two of these eyes, and one of 0.4 N for the other six. In the remaining eye, pressure was controlled intuitively by an experienced surgeon. Applying forces of 0.25 or 0.4 IM yielded similar success rates, although these fluctuated greatly even under constant pressure conditions (from 17% to 50% at 0.25 N; from 27% to 42% at 0.4 N). The highest success rate (55%) was achieved by the intuitively controlled pressure irradiations of the experienced surgeon. The variation in coagulation intensity that occurred despite constant pressure suggests that additional factors contribute to the results achieved. Nonetheless, this pressure-controlling probe represents an important achievement. It will permit not only the novice but even experienced operators to adhere unambiguously to a protocol of quantitative, reproducible parameters, and will also help researchers to better understand the relationship between energy delivered and intraocular pressure reduction achieved in contact cyclophotocoagulation.
Simplified Aponeurotic Ptosis Surgery
Authors: Doxanas Marcos T
Published: April 2021

ABSTRACT

I present a simplified aponeurotic ptosis repair that minimizes surgical dissection and enhances the predictability of postoperative eyelid positions. Indications for the procedure are unilateral ptosis, bilateral ptosis where preaponeurotic fat excision is not indicated, mild congenital ptosis, and reoperations from standard levator surgery. The procedure is best suited for surgeons who have a thorough knowledge of the levator aponeurosis anatomy.
Orbital Decompression for Graves' Disease: Exposure Through a Modified Blepharoplasty Incision
Authors: Antoszyk James H , Tucker Nancy , Codère François
Published: April 2021

ABSTRACT

A "transorbital" three-wall decompression through a modified blepharoplasty incision was used to treat 19 orbits for either cosmetic disfigurement or optic neuropathy. In the 14 orbits with disfigurement, surgical retroplacement averaged 5.2 mm; vision improved to 20/40 or better in four of five eyes with optic neuropathy. Complications attributed to the surgery included: acquired strabismus (two transient, one permanent) and infraorbital hypesthesia (one transient, one permanent). This technique's advantages are: 1) a single incision with wide exposure, 2) a low incidence of permanent strabismus, 3} a lateral orbital rim and canthal tendon preservation, and 4) a large reduction in proptosis.
Management of Retinal Detachment Associated With Choroidal Coloboma Using Perfluoroperhydrophenanthrene (Vitreon®)
Authors: Lee Kwang J , Peyman Gholam A , Paris Christopher L , Alturki Walid A , Desai Uday R
Published: April 2021

ABSTRACT

Vitreous surgery using an internal tamponading agent and chorioretinal adhesion is commonly used to repair retinal detachment associated with choroidal coloboma. The detachment may, however, recur if fluid continues to leak through a retinal defect in the area of the coloboma, despite internal tamponade. We present a case in which a recurrent retinal detachment associated with coloboma following vitreous surgery with SF
6
was successfully repaired in outpatient surgery using perfluoroperhydrophenanthrene (Vitreon®) and endolaser photocoagulation.
Bilateral Dacryocystitis After Punctal Occlusion With Thermal Cautery
Authors: Marx Jeffrey L , Hillman David S , Hinshaw Kevin D , Olson Jane J , Putterman Allen M , Lam Sheridan
Published: April 2021

ABSTRACT

A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.
Secondary Cataract in Infants After Extracapsular Cataract Extraction and Anterior Vitrectomy
Authors: Spierer Abraham , Desatnik Howard , Blumenthal Michael
Published: April 2021

ABSTRACT

Two infants developed secondary cataract after undergoing extracapsular cataract extraction (ECCE), posterior chamber intraocular lens (IOL) implantation, posterior capsulectomy, and anterior vitrectomy. A similar complication developed in a third child, who had undergone ECCE and posterior capsulotomy. The secondary cataracts developed in these patients from 3 to 12 weeks after the primary operation. In infants, unlike adults, posterior capsulectomy and anterior vitrectomy after ECCE do not seem always to prevent secondary cataracts. In infants, the complication may be related to IOL implantation.
The Effect of the Laryngeal Mask Airway on Coughing After Eye Surgery Under General Anesthesia
Authors: Thomson Keith D
Published: April 2021

ABSTRACT

Twenty-nine patients scheduled for elective eye surgery under general anesthesia were randomized into two groups, A and B. After induction of anesthesia, the airway of those in group A was maintained with a conventional tracheal tube; in group B, with a laryngeal mask airway. In the immediate postoperative period, 13 of the 14 patients in group A coughed; none of those in group B did (P < .001 ).
Accommodative Intraocular Lens with Spring Action-Part 2. Fixation in the Living Rabbit*
Authors: Hara Tsutomu , Hara Takako , Yasuda Akihiro , Mizumoto Yuriko , Yamada Yasuharu
Published: April 2021

ABSTRACT

After cataracts in 10 eyes of 8 pigmented or albino rabbits had been removed by phacoemulsification, a specially designed 10.0 × 8.5-millimeter accommodative intraocular lens with spring action ("spring IOL") was implanted through a 4.5- to 5.0-millimeter "dumbbell" linear anterior capsular opening. The average follow up was 11 ± 8 months. All the spring IOLs were almost completely fixed in the capsular bag, and the anterior and posterior capsules remained transparent. However, due to limitations specific to the rabbit, no accommodative power could be detected; also, we observed lens epithelial cells and subsequent fibrous production proceeding from the equatorial area into the area between the optics.
Treatment of Distal Occlusion of Krupin Eye Valve With Disk Using Cannular Flush
Authors: Krawitz Paul L
Published: April 2021

ABSTRACT

A 64-year-old man with neovascular glaucoma underwent implantation of a Krupin valve with disk. On the fifth postoperative day, the patient reported pain in the operative eye; examination revealed a hyphema, an intraocular pressure (IOP) of 52 mm Hg, and no visible bleb. A bleb was reestablished and the IOP markedly decreased following irrigation of the shunt using a 30-gauge cannula through a paracentesis site.
Hypotonus Cyclodialysis Cleft Following Suture Fixation of a Posterior Chamber Intraocular Lens
Authors: Small Elizabeth A , Solomon Joel M , Prince Andrew M
Published: April 2021

ABSTRACT

A 63-year-old man developed hypotony due to a cyclodialysis cleft after suture fixation of a posterior chamber intraocular lens. Since medical management and argon laser photocoagulation were unsuccessful, a direct cyclopexy was performed. The intraocular pressure returned to normal postoperatively, and gonioscopy confirmed closure of the cleft. To our knowledge, this is the first case report of cyclodialysis complicating ciliary sulcus fixation of a posterior chamber lens.
Restoration of Intraocular Pressure After Streptococcus Endophthalmitis With Vitrectomy
Authors: Wallace R Trent , O'Day Denis M
Published: April 2021

ABSTRACT

A bleb infection and subsequent endophthalmitis developed in the left eye of a 68-year-old man who had had a trabeculectomy. Vitreous injections of vancomycin and gentamicin were given, and vitreous cultures grew alpha-Streptococcus. Postoperatively, as the intraocular inflammation resolved, intraocular pressure (IOP) markedly decreased secondary, in our judgment, to ciliary body ischemia. A pars plana vitrectomy relieved the tractional bands and restored the IOP.
Ab-Interno Sclerostomy Using a Goniodiathermy Instrument
Authors: Brown Steven V L , Higginbotham Eve J , Griffin Eric O , Zou Xiaolian , Edward Deepak
Published: April 2021

ABSTRACT

We describe the use of a new instrument designed to create a simultaneous goniopuncture with diathermy using an ab-interno technique. The goniodiathermy ab-interno procedure was first performed on three eyes of three cynomolgus monkeys. Intraocular pressure (IOP) assessment and histologic examination were performed over a 10-day period. A functioning filtration bleb with a patent sclerostomy was achieved in all of the experimental eyes. A pilot study involving four eyes of four glaucoma patients also was performed. Of these four, successful long-term functioning filtration areas with adequate lowering of IOP were achieved in only two. The remaining two required further surgical intervention. Although combining goniopuncture and diathermy into a one-step ab-interno procedure proved successful in the primates studied, the preliminary use of this new instrument as a method of creating a filter in humans raises questions regarding its clinical usefulness.