bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudallescheria boydii (Petriellidium boydii) Infection of the Orbit
Authors: Nunery William R , Welsh Michael G , Saylor Randel L
Published: April 2021

ABSTRACT

A 10-year-old male developed a chronic orbital infection following penetrating trauma and retention of an orbital foreign body. Diagnosis of infection with Pseudallescheria boydii (Petriellidium boydii) was made by fungal smear and culture. Sensitivity tests indicated the organism was resistant to amphotericin B. Surgical debridement of the inferior orbit and removal of the foreign body was followed by a six-week course of intravenous miconozale. The patient has shown no signs of recurrence in a two-year follow-up period. To our knowledge, this is the first reported case of orbital infection with Pseudallescheria boydii, although the organism has been reported in cornea, ocular, and peri-orbital sinus infections.
Coaxial Radio Frequency (RF) Diathermy in Anterior Segment Surgery
Authors: Savage James A , Simmons Richard J
Published: April 2021

ABSTRACT

Modern ophthalmic microsurgery, particularly cataract extraction, trabeculectomy, and other forms of glaucoma filtration surgery, has been characterized by ever increasing precision. The use of radio frequency (RF) currents for cautery of blood vessels in anterior segment microsurgery has several advantages over other methods widely employed, including the bipolar cautery. A coaxial monopolar underwater diathermy probe, which operates with RF current has been specifically developed for anterior segment microsurgery and has proved vastly superior in cataract surgery, trabeculectomy, and full thickness glaucoma filtration procedures.
Congenital Absence of the Superior Oblique Tendon in Craniofacial Dysostosis
Authors: Pinchoff Barry S , Sandall Gary
Published: April 2021

ABSTRACT

Absence of each of the extraocular muscles as a rare cause of strabismus has been reported. Helveston suggests that a significant horizontal deviation with suppression and/or amblyopia in a patient with the preoperative diagnosis of congenital superior oblique palsy should alert one to a possible absence of the superior oblique tendon.1 We present and discuss two patients with craniofacial dysostosis in whom extensive surgical exploration showed an absence of the superior oblique tendon.
Disappearance of Keratic Precipitates After Intraocular Surgery
Authors: Hemo Itzhak , Zauberman Hanan
Published: April 2021

ABSTRACT

Two patients presenting with signs of anterior uveitis and keratic precipitates underwent intraocular surgery. When the bandages were changed, one day after surgery, it was observed that all the keratic precipitates had disappeared. The KPs did not reappear, and the eyes remained free of inflammation in the anterior segment during a six-month follow-up.
BB-Gun Injuries to the Eye
Authors: Brown Gary C , Tasman William S , Benson William E
Published: April 2021

ABSTRACT

Thirteen patients with BB-gun injuries to the eye are reported. Included are nine instances of double perforation, one case of vitreous hemorrhage, a case of late rhegmatogenous retinal detachment, one of retinitis sclopetaria, and a case of an intraocular shell casing introduced indirectly via an inadvertant BB-gun discharge into a drawer of bullets. Among the nine globes with double perforation, seven eyes were irreparably damaged and eventually enucleated, while two remained with hand motions vision. Despite modern vitrectomy techniques, double perforating BB-gun injuries to the globe imply a grim prognosis.
Long-Term Gonioscopy Follow-Up of Eyes With Posterior Chamber Lens Implants and No Iridectomy
Authors: Murphy Gates E
Published: April 2021

ABSTRACT

One hundred eyes which had undergone extracapsular cataract extraction with no iridectomy followed by insertion of a posterior chamber lens were examined gonioscopically 1 to 4.7 years postoperatively to determine the prevalence of asymptomatic angle closure from pupillary block. Since no peripheral anterior synechiae (PAS) characteristic of pupillary block were found, there seems to be little risk that these eyes will develop angle-closure glaucoma. During the study small PAS were noted adjacent to many haptics implanted in the ciliary sulcus.
Central Retinal Artery Occlusion Associated With Periocular Corticosteroid Injection for Juvenile Hemangioma
Authors: Shorr Norman , Seiff Stuart R
Published: April 2021

ABSTRACT

Intralesional corticosteroid injections are an accepted treatment for periocular juvenile hemangiomas. This treatment is felt to be relatively free of complications. We report, however, a case of central retinal artery occlusion associated with steroid injection for a periocular juvenile hemangioma in a four-year-old child. It is presumed that the force of injection or digital massage caused retrograde arterial flow, moving steroid suspension particles into the central retinal artery where vascular occlusion occurred. As a result of this case, our treatment regimen has been modified. We now use 0.1 cc steroid alloquats injected slowly through a 30-gauge needle and avoid firm digital pressure on the lesion.
Cystoid Macular Edema Following Penetrating Keratoplasty: Incidence and Prognosis
Authors: Nirankari Verinder S , Karesh James W
Published: April 2021

ABSTRACT

The incidence of clinically significant and angiographically documented cystoid macular edema (CME) following penetrating keratoplasty was studied in a consecutive series of 102 eyes over an average follow-up of 30 months. CME was seen only in the aphakic eyes. Twenty out of 68 eyes in this group developed CME. There was a statistically significant higher incidence of CME in eyes undergoing vitrectomy than in eyes not undergoing vitrectomy (p<.01). Also, there was a higher incidence of CME in eyes with aphakic bullous keratopathy (p<.01) and Pseudophakie bullous keratopathy (p<.05), when compared to eyes undergoing combined cataract extraction and corneal transplantation.

All eyes with CME were empirically treated with oral prednisone (two eyes) or oral Ibuprofen (18 eyes). Over an average follow-up of nine months, 13 of these eyes showed complete resolution of their CME with improvement in visual acuity to 20/60 or better in 12 eyes.
Inferior Oblique Advancement for "A" Pattern Esotropia
Authors: Goldstein Joseph H
Published: April 2021

ABSTRACT

The treatment of "A" pattern esotropia includes bilateral weakening of the superior oblique muscles, vertical displacement of the horizontal rectus muscles, bilateral or unilateral, and horizontal displacement of the vertical rectus muscles. The cases presented indicate that bilateral inferior oblique advancement is an effective alternative procedure for the management of large "A" pattern esotropia.
Effects of the Pulsed Neodymium: YAG Laser on the Posterior Segment
Authors: Brown Gary C , Scimeca Gregory , Shields Jerry A
Published: April 2021

ABSTRACT

The posterior segments of eight eyes of New Zealand white rabbits were treated with the pulsed Neodymium:YAG laser and studied ophthalmoscopically and histopathologically. Following treatment, funduscopy revealed lntraretlnal and preretinal bleeding, and histopathologic studies disclosed full thickness destruction of the retina and underlying choroid. At two months after the insult, yellow chorloretinal scars could be seen in the treated areas. Microscopic examination of these lesions demonstrated the formation of a strong adhesion between the retina and choroid and replacement of most of these layers with fibroglial scar tissue.
Neodymium: YAG Laser Iridectomy and Acute Cataract Formation in the Rabbit
Authors: Seedor John A , Greenidge Kevin C , Dunn Michael W
Published: April 2021

ABSTRACT

The Q-switched NeodymiumiYAG (Nd=YAG) laser in the single pulse mode was used to perform iridectomles in pigmented and albino rabbits. Seventy-one iridectomies were attempted. Seventy-six percent (54/71) of these were patent at the time of enucleation. lridectomy closure was not noted during the 24-day study period. Lenticular damage was not detected in any case. Patency rates in pigmented (70%) and albino (78%) irides were similar.

Energy levels of 6 ml or greater resulted in a higher rate of patency. Settings below 6 ml were associated with more significant bleeding and had a low rate of success.

The histology of acute Q-switched Nd: YAG laser iridectomy is characterized by fragmentation of the stroma and wide dispersion of the pigment epithelium. Minimal healing occurs with retention of normal iris architecture without atrophy or fibrosis. Results indicate that this procedure can be performed with minimal operative complications and without a tendency for closure.
Long-Term Dislocation of a Hard Contact Lens
Authors: Burns John A , Cahill Kenneth V
Published: April 2021

ABSTRACT

A 48-year-old female was fitted with hard contact lenses and lost the right lens the next day. She was asymptomatic for 62 months but then presented with a painful mass in the right superonasal orbital quadrant. Surgical exploration was non-diagnostic. Five months later the contact lens was found in the right upper fornix. This case emphasizes the importance of a thorough ocular examination, including double eversion of the lids and sweeping the fornlces of patients with unidentified periocular masses or pain.
Prediction of Postoperative Visual Acuity in Cataract Patients Using the Flying Corpuscle Viewer®
Authors: Adams Donald F , Schock John P
Published: April 2021

ABSTRACT

One hundred one cataract patients were tested preoperatively for macular function using the Flying Corpuscle Viewer®, a portable blue field entoptic device which utilizes the slit lamp as a light source. Preoperative appreciation of the "Flying Leukocyte Corpuscles" (FLC) indicated a high probability of good postoperative visual acuity, while lack of appreciation of the blue field entoptic phenomenon preoperatively had no predictive value for postoperative visual acuity.
Medical Malpractice Litigation in Ophthalmology: The New Jersey Experience
Authors: Kraushar Marvin F , Turner Margaret F
Published: April 2021

ABSTRACT

One hundred twenty-one medical malpractice claims against ophthalmologists are analyzed with respect to the specific allegation, the ophthalmic cause of litigation, and disposition. Failure or delay in diagnosis was responsible for 35% of claims and 63% of patient indemnification. Allegations of failure to diagnose most commonly concerned retinal detachment. While an identical number of claims were closed with payment because of errors in treatment, the indemnity for these claims was less by a factor of nearly half. The greatest number of claims alleging negligent treatment involved complications of cataract surgery.
The Incidence of Preoperative Endothelial Dystrophy in Pseudophakic Bullous Keratopathy
Authors: Lugo Miguel , Cohen Elisabeth J , Eagle Ralph C , Parker Anne V , Laibson Peter R , Arentsen Juan J
Published: April 2021

ABSTRACT

To investigate the contribution of endothelial dystrophy to the subsequent development of Pseudophakie bullous keratopathy, we retrospectively reviewed the clinical records and histopathologic specimens of Pseudophakie patients who had undergone penetrating keratoplasty for corneal decompensation.

Conclusive evidence of endothelial dystrophy was found in a majority (18 of 27, 67%) of patients who developed Pseudophakie bullous keratopathy following implantation of a posterior chamber intraocular lens. By contrast, the incidence in a comparable group of 51 Pseudophakie bullous keratopathy patients with anterior chamber intraocular lenses was low (six of 51, 12%) (P<0.01).

In analyzing the relative risk of post-surgical corneal decompensation, one cannot implicate a particular intraocular lens without considering pre-existing endothelial dystrophy.
Surgical Removal of an "Inoperable" Neurofibroma
Authors: Mamalis Nick , Apple David J , Williams Ruth D , Crandall Alan S , Manthey Russell
Published: April 2021

ABSTRACT

An 8-month-oId girl had ipsilateral ptosis, proptosis, and glaucoma caused by a massive left-sided plexiform neurofibroma. The tumor extended from the cavernous sinus into the orbit, involving the optic nerve, extraocular muscles, and eyelid. Although the prognosis in such cases is considered very poor, most of the mass was excised by a radical neurosurgical and ophthalmologic procedure. Today, the patient remains asymptomatic with no further neurologic defects. This case is unusual in that the glaucoma developed prior ?? clinically evident eyelid involvement.
Corrective Cosmetics Adjunctive to the Fields of Ophthalmology and Plastic Surgery
Authors: Roberts N Craig
Published: April 2021

ABSTRACT

An effective, stable cosmetic cover creme useful for ophthalmologists is presented. In a series of 52 patients, there was a high degree of patient acceptance. If properly used, the creme is effective and involves minimal risk because it has been subjected to sensitivity, photosensitivity, comedogenic, and sun blocking tests. The author recommends this camouflage creme for adjunctive use.
Use of Fibrin Glue in Ocular Surgery
Authors: Zauberman H , Hemo I
Published: April 2021

ABSTRACT

Cryoprecipitate and thrombin were used to prevent bleeding and induce permanent conjunctival attachment in ten cases of retinal detachment, 40 cases of extracapsular cataract extraction, and ten cases of strabismus. This method proved to be a good alternative to suturing the conjunctiva in each of the abovementioned surgical procedures, and appears to result in a better and more comfortable postoperative course.
CT Scan of Cutaneous Lacrimal (Anlage) Fistula
Authors: Anderson Steven A , Wesley Ralph E
Published: April 2021

ABSTRACT

We report CT visualization of both a rare congenital lacrimal fistula and a large mucocele of the lacrimal sac on the opposite side of the same patient. CT scan visualization of a patent anlage fistula has not been reported previously. CT scans can demonstrate extensive orbital abnormalities not detectable by routine clinical or radiologic evaluation.
Visual Results After Cataract Surgery by a Military Resident Surgeon
Authors: Green Robert P , Peters Daniel R
Published: April 2021

ABSTRACT

We compare the visual results of cataract surgery performed by a military resident with those achieved by civilian surgeons. Upon reviewing the first 47 extracapsular cataract extractions performed by one resident military surgeon, we found that 98% of eyes achieved a final visual acuity of 20/40 or better, and 95% were 20/25 or better. The mean surgically induced astigmatism was 0.54 diopters, with 97% «2 D from preoperative values. Eighty-three percent of eyes receiving intraocular lenses were within 2 D of emmetropia. The mean residual refractive error in those eyes was +0.121. Complications were infrequent (17%). These results compare favorably with other reports.
Complications of Nadbath Facial Nerve Block and a Review of the Literature
Authors: Lindquist Thomas D , Kopietz Leslie A , Spigelman Alan V , Nichols Bruce D , Lindstrom Richard L
Published: April 2021

ABSTRACT

In a retrospective study of complications resulting from the Nadbath facial nerve block, we identified three patients (0.25%) over a 2-year period. Complications included dysphonia, laryngospasm, unilateral vocal cord paralysis, and a sensation of the inability to breathe. As it exits the stylomastoid foramen, the facial nerve lies close to the vagus, glossopharyngeal, and accessory nerves. Particular care must be taken, therefore, when giving Nadbath blocks in very thin individuals. The use of hyaluronidase, which enhances effusion of the anesthetic agent, should probably be withheld.
Trabeculectomy, ECCE With PC-IOL Implant, and Vitrectomy After Malignant Glaucoma
Authors: Schiff Frank S
Published: April 2021

ABSTRACT

A patient with narrow-angle glaucoma developed a post peripheral iridectomy malignant glaucoma in both eyes. The intraocular pressure (IOP) in both eyes was controlled with mydriatics, cycloplegics, and Diamox for 2 years. Subsequently the patient developed a dense cataract and uncontrollable IOP in her left eye. An extracapsular cataract extraction, posterior chamber lens implant, and trabeculectomy were combined with an anterior vitrectomy. The IOP in both eyes has been controlled for 3 years postoperatively.
Corneal Decompensation Following Acute Angle-Closure Glaucoma
Authors: Krontz Daniel P , Wood Thomas O
Published: April 2021

ABSTRACT

Ten eyes of nine patients with endothelial dystrophy requiring iridectomy for acute angle-closure glaucoma developed corneal edema sufficient to require penetrating keratoplasty. Because of the proximity of iris to cornea, simultaneous lens extraction was carried out to prevent malignant glaucoma. Penetrating keratoplasty using techniques presented here provided improved visual acuity and control of glaucoma in all cases.
Prostaglandin E
2
and Protein Release Following Nd: YAG Laser Application to the Anterior Capsule of Rabbit Lens
Authors: Kao Grace W , Pang M Pierre , Peyman Gholam A , Weinreb Robert N
Published: April 2021

ABSTRACT

We compared the effects of Nd: YAG laser anterior capsulotomy and photophacofragmentation on the release of prostaglandin E2 (PGE2) and protein in the New Zealand rabbit aqueous humor. Following anterior capsulotomy, the concentration of PGE2 was significantly more elevated (P < .025) than it was in the contralateral untreated eyes at intervals from one-half hour up to four hours, and rapidly decreased in 24 hours. The concentration of protein showed a relatively gradual increase which became significant (P < .05) after two hours, and remained elevated 24 hours after anterior capsulotomy. In contrast, photodisruption into the lens without damaging the anterior capsule showed little effect on the release of PGE2 and protein in the aqueous humor.
Sustained Release of the Antimetabolite 5-Fluorouridine-5′-Monophosphate by Multivesicular Liposomes
Authors: Assil Kerry K , Lane James , Weinreb Robert N
Published: April 2021

ABSTRACT

We have developed a novel liposome for sustained drug delivery to the eye of the antimetabolite 5-fluorouridine-5′-monophosphate (FUMP), a potent metabolite of 5-fluorouracil. The in vitro half-life of FUMP incorporated within these liposomes was 585 hours. Following subconjunctival administration of 1 mg of FUMP to 13 New Zealand white rabbits, the tissue drug level at the injection site was significantly greater in the group treated with liposomes than it was in the group not treated with liposomes (p = .02). These liposomes offer the potential for sustained release of FUMP in the eye. By controlling the rate of drug release, it may be possible to reduce the need for frequent drug administration and its associated ocular toxicity as well as to improve treatment efficacy.
A Bubble-free Goniolens
Authors: Kapetansky Frederick M
Published: April 2021

ABSTRACT

A modified Goldmann-type gonioscopy lens bas been developed which can be successfully applied to the cornea without requiring methylcellulose or other viscous solution between the cornea and the inner surface of the contact lens. This goniolens does not indent the cornea, leaving the anterior chamber angle configuration unaltered during gonioscopy. In addition the optic disc can be visualized with the slit lamp by looking through the central portion of the goniolens.
Intraocular Pressure Following Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation
Authors: Kooner Karanjit S , Dulaney David D , Zimmerman Thom J
Published: April 2021

ABSTRACT

Knowledge of the incidence of both short- and long-term elevation of intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) insertion is essential for the practicing ophthalmologist. We reviewed retrospectively the IOP data in 384 consecutive patients (506 eyes) that underwent the above procedure. A postoperative rise of 8 mm Hg above baseline or above 23 mm Hg was observed in 149 eyes (29%). Secondary glaucoma well controlled medically developed in 21 eyes (4%). Three eyes developed glaucoma after the first year postoperatively. Therefore, over the total follow-up period of 6 years, 24 eyes (4.7%) developed pseudophakic glaucoma. None, however, required laser or other surgical intervention. These results further support the prevailing view that ECCE with PC-IOL is the procedure of choice.
Failed PC-IOL Implantation in One Eye and Successful AC-IOL Implantation in the Other Eye in a Patient With Pre-existing Bilateral Uveitis
Authors: Wolter J Reimer , Anderson Charles J
Published: April 2021

ABSTRACT

An irregular proteinaceous film populated by sessile macrophages and large giant cells was found on the surface of a posterior chamber lens implant. This had to be removed from a position with its haptics in the capsular bag 8 months after surgery because of increased uveltis. The implant had been placed at the time of extracapsular cataract extraction in a patient with pre-existing active bilateral chronic iridocyclitis of a non-granulomatous type. An anterior chamber lens implant placed after intracapsular cataract extraction in the other eye of the same patient was tolerated, and the same type of implant was used to replace the removed posterior chamber lens implant.
Clinical Interest and Problems Related to the Measurement of the Blind Spot and the Pericoecal Region by Means of Programs SAPRO, SAPPAR, and BSPOT
Authors: Funkhouser A T , Kwasniewska S , Fankhauser F
Published: April 2021

ABSTRACT

Difficulties encountered when measuring the differential light sensitivity of the blind spot and its surroundings and the clinical interest of such measurements are reported. The determination of the differential light sensitivity across step gradients, as well as abrupt changes observed at and close to the blind spot, may pose severe problems, because both are strongly influenced by even slight fixation instability. However, other factors reported herein may be equally important. The insight gained here may be cautiously extrapolated to the difficulties (and to the efforts to overcome them) encountered when measuring other scotomata in the visual field having sensitivity distributions similar to those of the blind spot. The sensitivity distribution in the blind spot and the pericoecal region may be important in a number of disease entities, particularly in glaucoma and neurologic diseases.
Transient Lenticular Opacification Following Trabeculectomy
Authors: Pillai Sasikala , Mahmood Muneera A , Limaye Suresh R
Published: April 2021

ABSTRACT

Permanent lens changes may occur following filtering procedures for glaucoma, most often within a few years after the surgery. We present a case in which transient lenticular opacification occurred two days after trabeculectomy without intraoperative injury to the lens. The patient regained her preoperative vision 2 weeks postoperatively. We postulate that such reversible lenticular opacities may be due to changes in lens metabolism associated with hypotony.
Tips for Local Anesthesia in Blepharoplasty
Authors: Neuhaus Russell W
Published: April 2021

ABSTRACT

Successful local anesthesia depends on many factors, but the most important is patient confidence in the surgeon and surgical team. In addition, the proper sequencing of the delivery of the local anesthesia will allow adequate time for anesthesia and vasoconstriction. This requires that the local infiltrative anesthetic injection with Wydase and epinephrine be given prior to preparing, draping, and marking the patient.
An Evaluation of the Hyde Surgical Astigmatic Ruler
Authors: House Philip H , Chauhan Balwantray C
Published: April 2021

ABSTRACT

The Hyde Ruler, a semi-quantitative intraoperative keratometric device, was compared with the Bausch and Lomb keratometer by taking 50 paired measurements of induced astigmatism on a model cornea. The correlation between the two instruments was 0.884, and regression of the Hyde Ruler estimates on the Bausch and Lomb keratometer readings produced a slope of 0.732 with an intercept of - 0.150 D. From the regression equation, a correction was applied to the Hyde Ruler estimates, resulting in 68.2% of the latter falling within 1.22 D or less of the Bausch and Lomb readings. We consider this accuracy to be acceptable for a semi-quantitative intraoperative keratometer, and should allow appropriate suture tensioning during cataract surgery to aid in early visual rehabilitation of the patient.
Identification of Fibrin/Fibrinogen in Glaucoma Filtration Surgery Wounds
Authors: Jampel Henry D , Morrison John , Vocci Mark , Quigley Harry
Published: April 2021

ABSTRACT

We have localized fibrin/fibrinogen in experimental glaucoma filtration surgery wounds in non-human primates by light and transmission electron microscopy Fibrin/fibrinogen was abundant two days after surgery, but was virtually undetectable by seven days postoperatively. We have confirmed the identity of fibrin/fibrinogen on the ultrastructural level by immunoelectron microscopy employing antibodies directed against fibrinogen. Fibrin clot formation may play an important role in the wound healing response that causes glaucoma filtration surgery to fail.
Comparison of Healon and Viscoat in Cataract Extraction and Intraocular Lens Implantation
Authors: Alpar John J , Alpar Andrew J , Baca Juanita , Chapman Dale
Published: April 2021

ABSTRACT

Sixty patients were randomly assigned to Healon* (20 patients) or Viscoat" (40 patients) treatment during extracapsular cataract extraction and intraocular lens implantation surgery. The 40 patients in the Viscoat group were randomly subdivided into two groups. In one group (20 patients!, Viscoat «vas irrigated/aspirated from the eye at the dose of surgery, whMe in the second group of 20 patients, Viscoat was left m the eye. In all Healon cases, the viscoelastic substance was removed from the eye at the end of the surgical procedure. Compared with Viscoat. Healon better facilitated the surgical procedure and appeared to be a more advantageous viscoelastic preparation. Viscoat, in many cases, caused rises in intraocular pressure in the immediate postoperative period when either removed or left in the eye at the dose of surgery
Effects of Aminoproprionitrile on Glaucoma Filter Blebs in Rabbits
Authors: Fourman Stuart
Published: April 2021

ABSTRACT

Aminoproprionitrile was used topically in rabbits for 4 weeks following glaucoma filtration surgery in an attempt to prevent loss of the filter bleb from scarring. At 2 and 4 weeks after surgery, the outflow facility in eyes receiving aminoproprionitrile was greater than in the fellow eyes which served as controls (p<0.002 at 2 weeks and p<0.015 at 4 weeks). By 8 weeks after surgery, there was no difference in the outflow facility of the eyes in each animal. No increase in postoperative complications was attributed to aminoproprionitrile. These results suggest that aminoproprionitrile, which interferes with collagen cross-linking, may promote filter bleb formation.
Multivariate Analysis of Factors Associated With Unplanned Admission in 'Outpatient' Ophthalmic Surgery
Authors: Freeman L Neal , Schachat Andrew P , Manolio Teri A , Enger Cheryl
Published: April 2021

ABSTRACT

We performed a case-control study of patients undergoing planned "outpatient" ophthalmic surgery in order to identify risk factors associated with the need for unplanned admission to the hospital. Factors associated with admission included time of completion of surgery, duration of operation, fentanyl dose, use of enflurane, and leukocytosis. A multiple logistic regression model found each of these variables except duration of operation to be independently associated with unplanned admission. Preoperative variables that were not associated with admission included age, present or past medical conditions, use of medications, blood pressure, hematocrit, serum sodium or potassium, and ASA Class. Identification and modification of these factors may help anticipate and/or reduce the incidence of unplanned admission to the hospital in patients undergoing planned outpatient surgery.
Patient Satisfaction in Oculoplastic Surgery
Authors: Putterman Allen M
Published: April 2021

ABSTRACT

Patient satisfaction in oculoplastic surgery was evaluated through questionnaires sent to patients, referring physicians, and oculoplastic surgeons. Two oculoplastic surgical procedures, cosmetic blepharoplasty and acquired blepharoptosis treatment, were analyzed. One hundred forty-five patients and 85 referring physicians of the practices of five oculoplastic surgeons were questioned. Sixty-nine additional oculoplastic surgeons were also surveyed. The results of treatment were consistently emphasized as the most important factor in patient satisfaction, a finding that contrasted greatly with the decreased emphasis on the cost of treatment. This implies that patients value the quality of medical care and are willing to pay for it. The preference of patients contrasts sharply with the trend of government and third-party payers to emphasize cost containment at the possible sacrifice of quality of care.

The surveys also showed that pain and discomfort and office waiting time are more important to patient satisfaction than oculoplastic surgeons realize and that the surgeons will have to address these issues in order to improve satisfaction. Also, there is a falloff of surgeon-patient communication postoperatively which is less satisfying to patients and recognized, but not acted on, by surgeons. Therefore, more postoperative surgeon-patient communication by telephone is also likely to improve patient satisfaction.
Limbal Anesthesia for Cataract Surgery
Authors: Furuta Masashi , Toriumi Tomoko , Kashiwagi Kenji , Satoh Susumu
Published: April 2021

ABSTRACT

We present a new technique for the administration of anesthesia in cataract surgery. The technique consists of injecting 0.5 ml of locally-acting anesthetic subconjunctivally (or sub-Tenon's) along the superior limbal border. Using this method, we performed extracapsular cataract extraction (ECCE) with and without posterior chamber intraocular lens (PC-IOL) implantation or secondary PC-IOL implantation on 176 cataract patients. Anesthesia was successfully induced in the majority of these patients and all surgeries were carried out successfully with no major complications. Voluntary eye movements remained but did not interfere with surgery. On the contrary, they helped expose certain surgical sites. This new anesthetic method for cataract surgery is simple and minimizes complications attributed to other blind anesthetic techniques.
The Effect of Topical Dexamethasone and Preoperative Beta Irradiation on a Model of Glaucoma Fistulizing Surgery in the Rabbit
Authors: Miller Michael H , Grierson Ian , Unger William G , Hitchings Roger A
Published: April 2021

ABSTRACT

We studied the effect of topical dexamethasone (1%) and preoperative beta irradiation on a model of glaucoma fistulizing surgery in the rabbit. Intraocular pressure and gross facility of aqueous outflow following surgery were not influenced by either treatment, although blebs persisted longer in the irradiated eyes. Steroids reduced clinically observable inflammation as well as the number of inflammatory cells identifiable by microscopy. Fibroblast production temporarily slowed, and ultra-structural examination demonstrated lipid-filled vacuoles and dilated mitochondria in these eyes. Also, the scar was thinner at 24 days.

Beta irradiation delayed wound healing and the scar was thinner in the early postoperative stages, but the light microscopic appearance of the scar was unaltered at 59 days. Inflammation was more pronounced initially, with abundant fibrin in the wound. Recovery of the conjunctiva! epithelium was delayed. The delay in fibroblast recruitment and wound contraction, the thinner scar tissue, and the increased survival of the bleb are all factors that suggest that beta irradiation may be a useful adjunct to glaucoma surgery.
Long-Term Comparative Study of the Schocket and Joseph Glaucoma Tube Shunts in Monkeys
Authors: Peiffer Robert L , Popovich Karen S , Nichols Dan A
Published: April 2021

ABSTRACT

Schocket and Joseph tube shunts were implanted in normal cynomolgus monkey eyes in order to compare the tissue response to the shunts as well as the pathways of aqueous flow associated with each. Following periods ranging from 5 to 10 months after implantation horseradish-peroxidase and/or fluorescein-labelled latex microspheres were inserted into the anterior chamber. The monkeys were then killed and the eyes studied by light, scanning, and transmission electron microscopy. In general, tissue responses to, and routes of aqueous flow associated with both shunts were similar: fibrous encapsulation of the drainage tubes and encircling bands, with aqueous flow through these fibrous capsules.
A Comparison of the Wound Integrity Produced by Various Suture Patterns in Penetrating Keratoplasty: A Cadaver Eye Model
Authors: Au Yue-Kong , Mahjoub Salah B , Hart John C
Published: April 2021

ABSTRACT

We tested the watertightness of wound closure in penetrating keratoplasty as a function of suture pattern by performing a 7.5-mm penetrating keratoplasty on 12 human cadaver eyes using a variety of suture patterns. We then tested wound integrity by hydrostatically raising the intraocular pressure. In this cadaver eye model, we demonstrated that running sutures produced better wound closure than interrupted sutures using the same number of bites. A 16-bite running or a combined running-interrupted pattern produced more than ample watertightness in penetrating keratoplasty wound closure.
Treatment of Severe Lower Eyelid Retraction with Scleral and Free Skin Grafts and Bipedicle Orbicularis Flap
Authors: Hurwitz Jeffrey J , Archer Kathleen F , Gruss Joseph S
Published: April 2021

ABSTRACT

Surgical repair of lamellar shortening must treat the anterior and posterior shortening, plus the scarring between Mueller's muscle, capsulopalpebral fascia, and periosteum. We describe a repair method in which a full-thickness, free skin graft is used to correct the anterior lamellar defect, and a homologous scleral graft is used to correct the posterior defect. Vascular support for the two free grafts is provided by a bipedicular orbicularis muscle flap.
The Aponeurotic Approach to Congenital Ptosis
Authors: Jordan David R , Anderson Richard L
Published: April 2021

ABSTRACT

Using a surgical technique directed at the levator aponeurosi, we successfully corrected 228 cases of congenital ptosis. The advantages of this approach are: normal anatomic planes and structures of the eyelid are maintained; basic and reflex tear secretion, goblet cells, or meibomian glands remain undisturbed, allowing maintenance of the three-layered tear film; any aponeurotic defects may be explored and repaired relatively easily; all elevating structures are preserved (aponeurosis rather than muscular lev at or is removed, Mueller's muscle is left intact, Whitnall's ligament is not violated); posterior sutures, which may irritate the cornea, are avoided; no tarsus or conjunctiva are removed.
A Simple Modified SRK Formula for Severely Myopic Eyes
Authors: Kora Yukiko , Suzuki Youichi , Inatomi Makoto , Ozawa Tetsuma , Fukado Yoshinao
Published: April 2021

ABSTRACT

We describe our modification of the most accurate intraocular lens power calculation formula currently used, the SRK formula, to improve the accuracy with which it can be used to calculate the power of IOLs that are implanted in severely myopic eyes, especially in those with exceptional axial length. This modified formula, which we call the L-SRK1 is I = A - 2.5 L - 0.9 K - 1.69R - 1.69 (where I = the actual implanted IOL power; A = the A-constant; L = the axial length; K = the average keratometer reading; and R = the predicted postoperative refraction). The results achieved using this modified formula demonstrate its superior accuracy in calculating lens powers for severely myopic eyes.
Intraocular Lens Implantation Following Extracapsular Cataract Extraction in Uveitis
Authors: Chung Yu-Mei , Yeh Tse-Shiang
Published: April 2021

ABSTRACT

We reviewed the results of intraocular lens OO L) implantation in the posterior chamber following extracapsular cataract extraction (ECCE) in 70 cataractous eyes with various types of endogenous uveitis, predominantly acute anterior uveitis, Fiichs' heterochromic cyclitis, Harada's disease, and Behcet's disease. During an average of 23.1 months' follow-up (range, 13 to 48 months) there was no exacerbation of the preexisting uveitis in any of the eyes. Postoperative visual acuity in all eyes was better than it was preoperatively, although further procedures were required in some eyes: a pars plana vitrectomy in one, a surgical peripheral iridectomy in one, and Nd: YAG laser capsulólo m y in 10. Our results suggest that selected uveitis patients can tolerate and benefit from an ECCE and IOL implantation.
Argon Laser Suturotomy: A Technique for the Correction of Surgically Induced Astigmatism
Authors: Sachdev Mahipal Singh , Kumar Harsh , Dada Vijay Kumar , Mehta Manoj Rai , Jain Arun Kumar
Published: April 2021

ABSTRACT

We prospectively studied 40 eyes with intraocular lenses and astigmatism of 4 or more diopters to evaluate the efficacy and safety of argon laser suture ablation as contrasted with surgical suture removal. Two groups of 10 eyes underwent argon laser sut u r oto m y (ALS) 4 and 6 weeks, respectively, after surgery. Sutures were removed surgically in a third group of 10 eyes 6 weeks after surgery. The final group of 10 eyes served as controls. Serial keratometry and refraction demonstrated that ALS was as effective as surgical suture removal in reducing postoperative astigmatism, and complications associated with the procedure were negligible.
The Long-Term Effect on Intraocular Pressure of a Procedure Combining Trabeculectomy and Cataract Surgery, as Compared With Trabeculectomy Alone
Authors: Naveh N , Kottass R , Glovinsky J , Blumenthal M , Bar-Sever D
Published: April 2021

ABSTRACT

The long-term reduction of intraocular pressure OOP) resulting from a procedure combining extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was compared retrospectively with the IOP-lowering effect of trabeculectomy alone. Forty patients who underwent the combined procedure and 38 who underwent trabeculectomy alone had been followed for an average of 22 ±7 months.

Both these surgical procedures significantly reduced IOP, but after a year or more, pressure levels were significantly lower in the trabeculectomy group than they were in the combined group: 12.8 ±4.2 mm Hg, and 16.5 ±5.6 mm Hg, respectively, at 18 months. Also, the mean postoperative fall in IOP was greater in the "filtered" eyes than it was in the combined group (9.8 ±4.6 mm Hg and 12.1 ±5.2 mm Hg, respectively, at 18 months). Finally, the number of medications required to maintain controlled IOP in the combined group was greater (and resumed preoperative values at 2 years) than it was in the trabeculectomy group (62.5% of the filtered eyes remained controlled unaided).
Tissue Plasminogen Activator and Penetrating Keratoplasty
Authors: Heidemann David G , Williams George A , Blumenkranz Mark S
Published: April 2021

ABSTRACT

We report a patient who developed severe intraocular fibrin formation following penetrating keratoplasty and vitrectomy surgery. The fibrin response worsened despite aggressive treatment with topical steroids. On the second postoperative day, 25 ^g of intracameral tissue plasminogen activator was administered, resulting in rapid resolution of the fibrin response. The graft remained clear. We believe tissue plasminogen activator may be useful in selected cases of severe, recalcitrant postkeratoplasy fibrin formation.
The Van Andel Transparent Glass Microsurgical Cannula
Authors: van Andel Pek , Worst Jan G F , Los Leonoor I
Published: April 2021

ABSTRACT

We present a disposable 21 -gauge transparent glass cannula that provides optimal visual control of aspiration-irrigation procedures in cataract surgery. It is especially useful in iris coloboma repair.
Slit Lamp Reformation of the Anterior Chamber Following Trabeculectomy
Authors: Gerber Steve L , Cantor Louis B
Published: April 2021

ABSTRACT

Out of 50 consecutive trabeculectomies performed over a 10-month period, 13 flat or shallow anterior chambers were reformed immediately following surgery a total of 19 times without complication at the slit lamp, using hyaluronic acid. Three months after surgery, there was no significant difference between the reformed and nonreformed eyes in terms of intraocular pressure or visual acuity change. We conclude that reformation at the slit lamp using hyaluronic acid is a safe, effective means of restoring anterior chamber anatomy following trabeculectomy.
The Simcoe Cannula as an Aid to In-the-Bag Placement of Intraocular Lenses
Authors: Oyarzun Mario
Published: April 2021

ABSTRACT

I describe using the Simcoe Irrigation-Aspiration Cannula as an aid to "in-the-bag" placement of a posterior chamber intraocular lens. The cannula facilitates implanting the inferior as well as the superior loop of the lens in the bag, even when there is positive vitreous pressure.
Extracapsular Cataract and Lens Implant Surgery in Developing Countries: Keeping It Simple
Authors: Spencer Martin F
Published: April 2021

ABSTRACT

Extracapsular cataract extraction and posterior chamber lens implantation would be the ideal method of rehabilitating the cataract blind of the developing world. However, these procedures usually have been considered too complex, time-consuming, and "high tech" to be used in these areas of the world. We argue that, in the context of an appropriate support program, they can be performed rapidly and safely using a few simple, manual instruments.
Characteristics and Behavior of Eyelid Carcinoma (Basal Cell, Squamous Cell, Sebaceous Gland, and Malignant Melanoma)
Authors: Loeffler Michael , Hornblass Albert
Published: April 2021

ABSTRACT

Malignant tumors of the eyelid pose a serious threat because of their proximity to the globe, brain, and paranasal sinuses. We review the features of four common skin carcinomas involving the eyelid skin. Particular emphasis is given to their clinical presentation and to biologic behavior. Clinicians are encouraged to be aware of the clinical manifestations of these tumors, since early recognition and treatment result in the most cosmetically and functionally satisfactory results. An approach for rational treatment is presented.
Increase of Neuroretinal Rim Area After Surgical Intraocular Pressure Reduction
Authors: Funk Jens
Published: April 2021

ABSTRACT

The Optic Nerve Head Analyzer was used to measure the optic disc structure of 18 eyes (13 adult glaucoma patients) before and after surgical intraocular pressure reduction. Neuroretinal rim area markedly increased (from +0.15 mm2 to +0.45 mm2) in eight eyes, but changed either very little ( < ± 0.1 mm2) or not at all in the remaining 10 eyes. The mean increase was from 0.75 ± 0.26 mm2 to 0.92 ± 0.36 mm2. The increased neuroretinal rim area found at this time remained in all eyes reexamined 1 to 3 years after surgery. Our data support previous findings that glaucomatous disc cupping may be reversed even in adult eyes, perhaps as the result of adequate pressure reduction.
Small-Incision Techniques in Ophthalmic Plastic Surgery
Authors: Dortzbach Richard , Woog John J
Published: April 2021

ABSTRACT

A stepped surgical incision, in which an initial small cutaneous incision is followed by progressively longer incisions in the subcutaneous tissues, limits postoperative scar formation in the skin. Placement of incisions parallel to relaxed skin-tension lines further reduces the size of the scar. We describe how these principles may be applied to ophthalmic plastic surgical procedures to improve cosmesis. Autogenous fascia lata can be harvested with scissors through a 15-mm incision parallel to relaxed skintension lines, placed over the middle of the iliotibial tract. Lacrimal bypass operations can be performed well and with good cosmesis through a 12 to 15-mm skin wound if the above principles are followed.
The Chamber-Retaining Suture Revisited
Authors: Wilson Richard P , Moster Marlene R
Published: April 2021

ABSTRACT

In 1977, C. William Simcoe developed the anterior chamber-retaining suture as a means of preventing intraocular lens-cornea touch during intraocular lens manipulation, penetrating keratoplasty, and following filtration surgery.1-2 Though seldom remembered today, Simcoe's innovation safely and effectively insures corneal well-being following increasingly complex modern filtration and shunt procedures. The use of a combination of double-armed 9-0 nylon suture and anterior chamber-bridging straight needles simplifies placement.
Techniques of Adjustable Suture Strabismus Surgery
Authors: Kraft Stephen P , Jacobson Mark E
Published: April 2021

ABSTRACT

Adjustable sutures allow eye muscle positions to be changed following strabismus surgery, when the patient is awake and able to cooperate in muscle balance testing. Bow-tie-knot and sliding-handle sutures can be adjusted within 24 hours after surgery. Scleral traction sutures, which can be used to fix the globe to periorbital tissues during postoperative healing, can be adjusted for up to 14 days after surgery. We describe these techniques as well as an adjustable loop suture for conjunctival closure.
Treatment of Experimental Suprachoroidal Hemorrhage With Subconjunctival Injection of Tissue Plasminogen Activator: A Negative Report
Authors: Liu James C , Peyman Gholam A , Oncel Murat
Published: April 2021

ABSTRACT

Suprachoroidal hemorrhage was created in 10 albino rabbit eyes. Five eyes were treated with subconjunctival injections of 40 000 IU of tissue plasminogen activator (tPA) daily for 6 days; five eyes served as controls. It took approximately the same amount of time for the suprachoroidal hemorrhages to clear in both the control and treatment eyes. We conclude that subconjunctival injection of tPA does not accelerate the clearance of suprachoroidal hemorrhage.
Changing Indications for Cataract Surgery: 1974 to 1988
Authors: Moorman Consuela , Sommer Alfred , Stark Walter , Enger Cheryl , Payne John , Maumenee A Edward
Published: April 2021

ABSTRACT

To examine changes in indications for cataract surgery which have contributed to the increasing rate of cataract extractions, we compared preoperative characteristics of 265 patients who had undergone surgery in 1988 with a similar number who had undergone surgery by the same four ophthalmologists in 1974 and 1982. Between 1974 and 1988 the number of extractions performed annually by two high-referral hospital-based surgeons rose by 68%. Over 90% of these procedures in 1974 were intracapsular extractions; in 1988, 90% were extracapsular extractions with intraocular lenses. In 1988, preoperative visual acuity was better in both the study eyes and the fellow eyes, the proportion of those with acuities better than 20/60 having risen from 10% to 21%, and from 49% to 67%, respectively. The proportion of patients waiting more than 2 years for surgery on the second eye doubled between 1974 and 1988. These changes, already evident by 1982 for the hospitalbased surgeons, became characteristic of the community-based surgeons' practices as well between 1982 and 1988.
A Method for Performing Full-Thickness, Orthotopic, Penetrating Keratoplasty in the Mouse
Authors: She Si-Chun , Steahly Lance P , Moticka Edward J
Published: April 2021

ABSTRACT

In an attempt to overcome the lack of well characterized, inbred, and congenie strains, as well as a paucity of immunological reagents, in rabbit and rat models, we have developed a procedure for performing full-thickness, penetrating keratoplasty in the mouse. One hundred percent of isografts (BALB/c onto BALB/ c) were successful, while 83.3% of allografts (C3H onto BALB/c) failed. The use of a mouse model to study corneal graft failure will allow a critical evaluation of the role of a variety of immunological mediators in causing graft failure.