bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Two Semi-Quantitative Surgical Keratometers: The Modified Hyde Ruler and the Barrett Keratoscope With "Astigmatic Dial"
Authors: Morlet Nigel , Lindsay Peter , Cooke Peter
Published: April 2021

ABSTRACT

The Hyde astigmatic ruler is an inexpensive, semiquantitative, hand-held, surgical keratometer that we modified by geometrically calculating the correct shape of its ellipses. The Barrett keratoscope is a cheap, disposable, qualitative keratometer that, unlike the Hyde ruler, produces a bright corneal image. We designed a transparent overlay, or "astigmatic dial," to use with the keratoscope. This overlay determines the magnitude of astigmatism and sets the distance the keratoscope is held from the cornea by direct comparison with the corneal image. Using a model cornea, we compared our modified Hyde ruler with the Barrett keratoscope and astigmatic dial to determine the accuracy of measurement provided by each. Both instruments had good predictive values for the true astigmatism; however, the Barrett keratoscope/astigmatic dial provided more consistent measurements of the astigmatism.

We believe the keratoscope and dial provide a cheap, convenient, and accurate alternative to the more expensive microscope-mounted keratometers.
Persistent Torulopsis Magnoliae Endophthalmitis Following Cataract Extraction
Authors: Rosenfeld Steven I , Jost Bradley F , Litinsky Steven M , Gelender Henry , Glatzer Ronald J , Flynn Harry W
Published: April 2021

ABSTRACT

Postoperative fungal endophthalmitis typically manifests as an indolent uveitis, weeks to months after surgery. In our patient, Torulopsis magnoliae endophthalmitis appeared as an acute, purulent postoperative endophthalmitis on the third day following extracapsular cataract extraction with implantation of a posterior chamber intraocular lens (IOL). The patient required three separate vitrectomy operations with instillation of intravitreal Amphotericin B; the last operation also included complete removal of the posterior capsule and IOL. This case, which is to our knowledge the first reported case of T. magnoliae endophthalmitis, is unusual in that it manifested as an acute, fulminant infection in the early postoperative period and was recalcitrant to standard endophthalmitis therapy.
The Role of Fibroblast Inhibitors on Corneal Healing Following Photorefractive Keratectomy With 193-Nanometer Excimer Laser in Rabbits
Authors: Bergman Ronald H , Spigelman Alan V
Published: April 2021

ABSTRACT

Corneal stromal haze has been seen following photorefractive keratectomy with the 193-nanometer excimer laser. Topical antimetabolites aimed at decreasing the haze have been investigated in the rabbit model. We used the VISX 193-nanometer excimer laser to create 6.0-millimeter, -5.00-diopter ablations in 10 Dutch rabbits. Each rabbit was randomized to treatment groups using topical prednisolone acetate, 5-fluorouracil, heparin, prednisolone and heparin, or prednisolone and 5-fluorouracil. Topical agents were instilled twice daily for 2 weeks.

Corneal stromal haze developed in all of the eyes. At 2 weeks, there was a significant difference between the degree of haze in the treated eyes and in the untreated controls (P = .02). At 6 weeks, no significant difference remained (P = .70). There were no significant differences in corneal haze among the treatment groups.

Thus, all treatments reduced haze at 2 weeks, but the effect was transient, with controls clearing to an equivalent haze by 6 weeks. We conclude that the agents investigated in this rabbit model provided only a transient benefit in reducing corneal haze following excimer laser photoablation.
Scleral-Flap Incision for Cataract Surgery
Authors: Nikeghbali A
Published: April 2021

ABSTRACT

I present a technique for creating a three-stage scleral incision for extracapsular cataract extraction and intraocular lens (IOL) implantation, especially useful for cases in which phacoemulsification is contraindicated or aborted. The incision is 5 to 10 mm wide, and the scleral flap is trapezoidal and requires one to three horizontal sutures for closure. The technique was used in 364 consecutive eyes; follow up was 6 months. After 1 week, 80% of these eyes had 1.50 diopters or less of induced keratometric cylinder; at 1 month, 70% had less than 1.00 D. At 6 months, 87% had 0.50 D of against-the-rule cylinder. Less than 6% had elevated intraocular pressure (22 to 28 mm Hg); hyphema developed in 7%. Forty-nine percent had 20/40 or better vision in 1 week; 75% achieved this acuity at 1 month. Final refractions in 87% of the eyes at 6 months were -1.00 (± 0.75) + (± 1.00) × 180°.

This technique provides most of the benefits of small-incision cataract surgery, including rapid, stable visual recovery. IOLs of any optical size can be implanted.
Extraocular Application of Mitomycin C in a Rabbit Model: Cytotoxic Effects on the Ciliary Body and Epithelium
Authors: Mietz Holger , Addicks Klaus , Diestelhorst Michael , Krieglstein Günter K
Published: April 2021

ABSTRACT

Since prolonged postoperative hypotony has been a frequent complication of glaucomatous filtration surgery in which mitomycin C (MMC) was used, it is important to determine the intraocular toxic effects of the drug. We placed MMC, in concentrations of 0.05, 0.2, and 1.0 mg/mL on the intact sclera of rabbits and obtained the eyes after 1, 7, and 28 days. Examination of the ciliary epithelium by transmission electron microscopy revealed an electron-dense material near the endoplasmic reticulum. Large intracellular vacuoles were present, and the mitochondria appeared swollen. These findings suggest a toxic effect of MMC on the ciliary epithelium in rabbits after extraocular application, possibly decreasing aqueous production.
Filtration Surgery in Rabbits Treated With Diclofenac or Prednisolone Acetate
Authors: Gwin Todd D , Stewart William C , Gwynn David R
Published: April 2021

ABSTRACT

We performed filtration surgery in one eye of each of 28 rabbits. Either a nonsteroid (diclofenac) or a steroid (prednisolone acetate) was given as a postoperative antiinflammatory agent. On no examination day was there a significant difference in the intraocular pressure of the rabbits that had received diclofenac as contrasted with those that had received prednisolone acetate (P > .05, Student's t-test). Neither was there, based on log-rank life-table analysis, any significant difference between the two groups in terms of filtering bleb survival (P = .484). Finally, there were no significant differences on any examination day between the two groups in terms of bleb height or conjunctival injection (P > .05, MannWhitney U-test). We conclude that in this rabbit model for filtration surgery, the postoperative antiinflammatory effect of diclofenac was similar to that of prednisolone acetate.

Because a nonsteroidal agent such as diclofenac that could provide an antiinflammatory effect sufficient to allow optimal bleb survival in humans, without the level of potential side effects of corticosteroids, might be clinically useful, further studies may be warranted.
Straight Needle Corneal Splinting For Anterior Segment Surgery
Authors: Stevens Julian D , Steele Arthur DMcG
Published: April 2021

ABSTRACT

Corneal splinting is an old and well established surgical technique and modern straight needles allow for atraumatic and accurate placement, providing an alternative to suture-fixation scleral ring support. We have routinely used two straight, 150-micrometer diameter, 16-millimeter length suture needles passed through clear cornea, to act as anterior segment splint supports during anterior segment surgery in which the cornea would otherwise collapse. The needles enter through the clear corneal periphery, pass across the anterior chamber, and exit through clear cornea in a criss-cross configuration. This splint technique is quick and easy to perform and is an alternative or addition to suture-fixation scleral ring support.
Neodymium:YAG Laser Iridolenticular Synechiolysis in Uveitis
Authors: Kumar Harsh , Ahuja Sanjay , Garg Sat Pal
Published: April 2021

ABSTRACT

Fifteen patients with "bound down" pupil or ring synechiae associated with chronic granulomatous uveitis in whom dilatation could not be obtained pharmacologically underwent iris-lens synechiolysis using relatively low energies from a Q-switched Nd:YAG laser. Pupil size increased significantly in all of the treated eyes; visual acuity improved in 40%. Postlaser elevated intraocular pressure developed in a significant number, but there were no serious long-term complications associated with the procedure. Although acuity improved in less than half of the patients, because this laser treatment is relatively safe and offers some possibility of visual improvement, we recommend it for routine use, but only if performed by an experienced laser microsurgeon.
Intraocular Lens Replacement: Advantages of a Bimanual Technique With Preset Endoillumination
Authors: Roldán-Palláres Manuela , Manrique Elena
Published: April 2021

ABSTRACT

Performing a vitrectomy using a bimanual technique with a preset light inserted in the inferonasal quadrant of the eye leaves both hands free to grasp an intraocular lens (IOL) completely dislocated into the vitreous cavity. Two additional scleral grooves with flaps (surgeon's view) at the 2:30 and 8:30 o'clock positions (right eye) or at the 3:30 and 9:30 o'clock positions (left eye) allow the haptics to be guided to the desired positions in the ciliary sulcus. This technique allows permanent, controllable relocation of the IOL The haptics of the IOL can be visualized while the suture is placed, and the IOL finally rests near the horizontal meridian, away from the corneoscleral wound.
Ocular Aqueous Humor Dynamics After Photodisruptive Laser Surgery Procedures
Authors: Wetzel Wolfgang
Published: April 2021

ABSTRACT

Iridotomy and capsulotomy using the Q-switched Nd:YAG laser affect ocular aqueous humor dynamics, causing intraocular pressure (IOP) temporarily to rise following these procedures. We measured aqueous outflow facility and aqueous secretion flow by oculopression tonometry in 20 eyes before and after YAG laser iridotomy, and in 19 eyes before and after YAG laser posterior capsulotomy. IOP increased after both laser procedures. Our measurements showed that this elevation must have been caused by a reduction in outflow facility, since aqueous secretion flow actually decreased. In the iridotomy patients, the preoperative outflow facility (in most of the cases, already compromised preoperatively by glaucoma), was directly related to the maximum postoperative IOP elevation. In the capsulotomy patients, postoperative outflow facility was correlated with the total laser energy used. No such correlation was observed in the iridotomy patients. Additionally, in the capsulotomy patients, the type of secondary cataract (ie, proliferative or fibrotic) may have influenced the level of reduction of outflow facility.
Retinal Toxicity of Intravitreally Injected Faeriefungin
Authors: Dunlap Weldon A , Karaçorlu Murat , Peyman Gholam A , Nair M G , Rahimy Mohamad , Pedroza Lia
Published: April 2021

ABSTRACT

Faeriefungin is a new antibacterial and antifungal agent derived from a strain of Streptomyces griseus var. autotrophicus. Under anesthesia, 12 albino rabbits underwent injection in their right eyes with 400, 200, 100, 40, 20, and 10 µg of faeriefungin. Retinal toxicity was assessed by electroretinography and light and transmission electron microscopy. Injection of 400 µg resulted in severe retinal toxicity, although indirect ophthalmoscopy was unremarkable. At 200 µg, there was moderate toxicity. Intravitreal injection of concentrations of 100 µg or less produced no neuroretinal toxicity. These data suggest that faeriefungin is a potentially useful drug in the treatment of fungal or bacterial endophthalmitis.
Long-Term Results of Trabeculotomy Ab Externo
Authors: Wada Yuko , Nakatsu Ayako , Kondo Takehisa
Published: April 2021

ABSTRACT

We retrospectively reviewed the records of patients followed for over 4 years after undergoing trabeculotomy to treat primary open-angle glaucoma (POAG) to evaluate the long-term effects of the procedure on intraocular pressure (IOP) control. IOP remained below 15 mm Hg, with no need for postoperative medication in 7 (13.2%) of 53 eyes. IOP was below 15 mm Hg in an additional eight eyes (15.1%) treated with topical medication. Topical medication was needed to maintain IOP between 16 to 20 mm Hg in 23 eyes (43.4%). Oral acetazolamide or additional surgery was needed in 15 (28.3%). A postoperative IOP below 20 mm Hg with or without topical medication was associated with a survival probability of 71.2%,

Our results demonstrated that, although trabeculotomy largely failed to maintain an "ideal" postoperative IOP (below 15 mm Hg), it was not associated with severe operative or postoperative complications such as flat anterior chamber. Thus, the procedure probably should be the first choice not only in uncomplicated cases of congenital glaucoma and pseudoexfoliation glaucoma (as previously established), but also in cases of POAG in young patients with only slight damage to the optic disc or visual field and cases with forward movement of the iris-lens diaphragm.
Superficial Temporal-Artery Aneurysm
Authors: Dailey Roger A , Wilson David J , Putnam Daniel
Published: April 2021

ABSTRACT

We report finding at surgery a histopathologically-confirmed superficial temporal-artery aneurysm. To our knowledge, this is the first report of this type of aneurysm in the ophthalmic literature. The ophthalmologist must include this condition in the differential diagnosis of a pulsatile and tender temporal artery, especially when a history of trauma is present.
Topical Glycerin as an Adjunct Treatment for Flat Anterior Chamber
Authors: Krawitz Paul L
Published: April 2021

ABSTRACT

I describe a case of flat anterior chamber following glaucoma filtration surgery in which glycerin was topically applied in order to reduce the risk of cataract formation and minimize corneal endothelial damage until definitive surgical intervention could be performed.
Embryonal Rhabdomyosarcoma of the Orbit in a 35-Year-Old Man
Authors: Mamalis Nick , Grey Allen M , Good James S , McLeish William M , Anderson Richard L
Published: April 2021

ABSTRACT

A 35-year-old man had rapidly progressive proptosis of the right eye with associated chemosis over a period of several weeks. Computed tomography demonstrated a solid extraconal mass in the inferior anterior right orbit. Pathologic examination revealed the lesion to be an embryonal rhabdomyosarcoma. Consistent with the diagnosis, immunohistochemical assays demonstrated positive staining with myoglobin, desmin, and muscle-specific actin. The lesion grew rapidly and was further surgically excised. Subsequently, treatment with radiation and chemotherapy was initiated. Primary embryonal rhabdomyosarcoma of the orbit is an extremely rare tumor in adults, and, to our knowledge, this patient represents the oldest individual reported to have developed such a tumor, as documented by immunohistochemical analysis.
Pterygium Removal: Knife Excision Versus Modified Evulsion Technique
Authors: Bhatti S M
Published: April 2021

ABSTRACT

Seventy-four pterygia were removed by knife excision (KE), and 85 using a modified evulsion technique (MET); follow up ranged from 6 months to 5 years (mean, 14 months). The recurrence rate with MET was 5.88%; with KE, 20.27%. This difference is statistically significant (p = .05)
The Endo-Mirror, a New Instrument for Ophthalmic Surgery Requiring Visualization of the Ciliary Sulcus
Authors: Kozawa Tadahiko , Osakabe Yasuhiro
Published: April 2021

ABSTRACT

Safely suturing a posterior chamber intraocular lens (PC-IOL) to the ciliary sulcus requires a means of visualizing the ciliary sulcus, since it cannot be viewed directly with the operating microscope. We, therefore, created several trial instruments consisting of a mirror with a built-in light source, which we call an endo-mirror, designed for observing the area behind the iris. Using these instruments, we were able satisfactorily to view the ciliary sulcus and suture a PC-IOL to it, first in a number of animal eyes, and then, using an endo-mirror incorporating the best features of the trial versions, in actual clinical cases.
An Illuminated Flute Needle for Vitreoretinal Surgery
Authors: Davison Charles N , Rosen Paul H
Published: April 2021

ABSTRACT

We have developed a simple self -illuminated flute needle for internal drainage of subretinal fluid during three-port vitrectomy. This instrument facilitates visualization and drainage through peripheral retinal breaks.
Anterior Capsulectomy Using an Ordinary Phacoemulsification Tip (Phaco-Capsulectomy)
Authors: Ayaki Masahiko
Published: April 2021

ABSTRACT

I performed an anterior capsulectomy in six eyes using an ordinary phacoemulsif ication (phaco) tip. The technique, which involves inserting a beveleddown phaco tip directly into the lens, created smooth and tear-free capsular openings. Although the procedure needs to be refined, I believe a phaco tip can be used effectively and easily to remove the anterior capsule.
Extracapsular Cataract Extraction and Posterior-Lip Sclerectomy With Viscoelastic
Authors: Merriam John C , Wahlig John B , Konrad Hindola , Zaider Marco
Published: April 2021

ABSTRACT

A review of 15 cases suggests that posterior-lip sclerectomy can be performed safely with extracapsular cataract extraction (ECCE) and posterior chamber lens implantation. The anterior chamber was filled with viscoelastic at the end of each procedure; no case required reoperation for shallow chamber or hypotony. The mean intraocular pressure after 1 year was 12.1 mm Hg. The astigmatism induced by the triple procedure did not differ significantly from that caused by ECCE alone during the initial 2 postoperative years. A new mathematical model that describes the change over time of postoperative astigmatism associated with these procedures is described.
Temporary Keratoprosthesis for Surgical Management of Complicated Combined Anterior and Posterior Segment Injuries to the Eye: Combat- Versus Noncombat-Injury Cases
Authors: Soheilian Masoud , Ahmadieh H , Sajjadi H , Azarmina M , Miratashi A M , Peyman Gholam A
Published: April 2021

ABSTRACT

We used a Landers-Foulks temporary keratoprosthesis lens to combine penetrating keratoplasty with vitreoretinal surgery in 21 eyes of 21 patients. Ten of these patients were victims of combat injuries; 11 had traumatic injuries unrelated to war. After a mean follow up of 11 months, satisfactory overall results, ie, an attached retina and a clear cornea, were obtained in nine eyes (42.8%). In two, the retina was attached but the corneal graft was rejected. Eight eyes achieved a visual acuity of 5/200 or belter The visual prognosis as well as the rate of retinal reattachment for the combat-injured eyes were poorer than those for the traumatic noncombat-injured eyes. At the last follow-up examination, 60% of the combat-injured eyes were considered visually lost, as compared with 36.3% of the noncombat-injured eyes.
Successful Surgical Treatment of Hypotony Maculopathy Following Trabeculectomy With Topical Mitomycin C
Authors: Duker Jay S , Schuman Joel S
Published: April 2021

ABSTRACT

Hypotony maculopathy, a clinical syndrome consisting of choroidal folds, retinal folds, and optic disc edema, results from severe, chronically decreased intraocular pressure (IOP). Conventional therapy consists of procedures designed to normalize the IOR We treated a patient who developed hypotony maculopathy following trabeculectomy with mitomycin C. Despite normalization of the IOP with bleb revision, neither the posterior segment architecture nor visual acuity improved. Vitrectomy with mechanical flattening of the posterior segment via intra operati ve instillation of perfluorocarbon liquid was performed. The choroidal folds resolved and visual acuity improved from 20/200 to 20/20. In eyes with hypotony maculopathy in which the posterior segment anatomy and visual acuity do not improve after IOP normalization, vitrectomy with heavier-than-water liquids may improve vision.
A Scleral Shield for the Application of Mitomycin C During Trabeculectomy: A Rabbit Model
Authors: Mietz Holger , Addicks Klaus , Krieglstein Günter K
Published: April 2021

ABSTRACT

The use of mitomycin C during trabeculectomy is associated with a significant degree of persistent hypotony. To address this problem, we designed a scierai shield with a dry sponge glued on it for use in applying m ito my ci n C that reduces the penetration of the substance through the sclera. The effectiveness of the shield was tested in a rabbit model using regular sponges and sponges with the attached shield. Histopathologic examination of the eyes after 1 month revealed toxic changes in the eyes in which only a regular sponge had been used, but not in those in which the sponges with the attached scierai shield had been used. The scierai shield may help reduce the incidence of hypotony in eyes undergoing trabeculectomy with adjunct i ve mitomycin C.
Arteriovenous Fistula Presenting as a Tumor of the Upper Eyelid
Authors: Busin Massimo , Graefe Christian , Koch Jurgen
Published: April 2021

ABSTRACT

We report, to our knowledge for the first time, a case of arteriovenous fistula presenting as a tumor of the upper eyelid in an 80-year-old patient. Surgical excision through an anterior approach brought excellent cosmetic and functional results.
Postoperative Chronic Pressure Abnormalities in the Vitreon Study
Authors: Adile S L , Peyman Gholam A , Greve Mark D J , Millsap C Mark , Verma Lalit K , Wafapoor Hussein , Soheilian Masoud
Published: April 2021

ABSTRACT

Perfluoroperhydrophenanthrene (Vitreon) was used as an intraoperative hydrokinetic retinal manipulator, followed by C
3
F
8
or SF
6
gases, silicone oil, or Vitreon as postoperative tamponading agents in 234 eyes. Two chronic intraoperative pressure abnormalities were defined: hypotony (5 mm Hg or less) and elevated intraocular pressure (IOP) (25 mm Hg or more at three or more postoperative visits).

Postoperatively, 28 eyes (12%) had chronically elevated IOP, and 41 (18%) had chronic hypotony. There was no significant difference in the incidence of abnormal IOP among the groups of eyes in which the various tamponading agents had been used. In particular, the use of Vitreon as an intraoperative tool or as a short-term tamponade did not affect the incidence of chronic abnormal IOP any more than did the use of silicone oil, C
3
F
8
, or SF
6
as tamponading agents.
Trans-Nasal Flap for Medial Canthal Reconstruction
Authors: Custer Philip
Published: April 2021

ABSTRACT

The trans-nasal flap is an effective method for repairing medial canthal defects following Mobs' surgery. This procedure transposes redundant skin from the nasal bridge into the defect. The construction of the flap, which minimizes the risk of medial canthal webbing, yielded excellent cosmetic results in 22 patients.
The Entropien Patch: A Method of Temporarily Correcting Involutional Entropion With Adhesive Tape
Authors: Irvine Simon , Francis Ian C , Bishop Arthur E , Baxter John
Published: April 2021

ABSTRACT

A simply designed entropion patch provided effective temporary preoperative relief of the symptoms of lid malposition in lower lid involutional entropion in six patients. The patch is easily fashioned and used after appropriate instruction, with its design taking into account lid mechanics and the pathophysiology of involutional entropion.
Treatment of Postfiltration Bleb Leak by Bleb Injection of Autologous Blood
Authors: Smith Mary Fran , Magauran Raymond , Doyle J William
Published: April 2021

ABSTRACT

We treated a persistent, brisk bleb-leak after trabeculectomy with mitomycin C by bleb injection of autologous blood. Following preparation with povidone iodine, approximately 0.5 cc of whole autologous blood was injected into the bleb at the slit lamp. The leak resolved after 36 hours, and after 9 months' follow up, continued to function well.
Conjunctival Ulcer in a Patient With Crohn's Disease
Authors: Hegab S M , Al-Mutawa S A
Published: April 2021

ABSTRACT

A 38-year-old woman with documented Crohn's disease (CD) had uniocular nodular episclerrtis and a limbal nodule with surrounding infiltrate, which, when healed, left residual pannus. The episcleral nodule was abnormally large (7x5x3 mm). A localized conjunctiva! ulcération, a rare manifestation, to our knowledge not previously reported, developed later in the same eye. Impression cytology of the ulcer showed pyknotic conjunctival epithelium and absence of goblet cells, together with the presence of a few plasma cells, lymphocytes, and macrophages. These features are comparable to those seen in the intestinal mucosa of patients with CD. The unilaterality of the ocular infection together with the good response to local therapy suggests that a local antigen-antibody immune complex reaction was involved. We recommend local therapy as a first treatment option.
Plasma Concentrations of Different Local Anesthetics After Facial Nerve Block
Authors: Schimek Franz , Friess Dietrich , Fahle Manfred
Published: April 2021

* BACKGROUND AND OBJECTIVE: The authors studied the plasma concentrations of several anesthetics to determine the relative safety of facial blocks as reflected by each anesthetic's kinetics.

* PATIENTS AND METHODS: Seventy-five patients undergoing cataract extraction received a proximal block of the facial nerve using prilocaine, lidocaine, mepivacaine, bupivacaine, or etidocaine.

* RESULTS: Mean plasma concentrations were significantly lower after the administration of prilocaine than they were after the administration of lidocaine and mepivacaine (P < .0008; multivariate analysis of variance, Roys max root). Plasma concentrations of lidocaine and mepivacaine or bupivacaine and etidocaine did not differ from each other. Mean plasma concentrations of prilocaine, lidocaine, and mepivacaine increased continuously for 15 to 22 minutes, whereas mean plasma concentrations of bupivacaine and etidocaine peaked after 10 and 9 minutes, respectively. Peak plasma concentrations of anesthetics were well below toxic levels in all patients.

* CONCLUSIONS: Although systemic toxicity resulting from the rapid absorption of local anesthetics after facial nerve block seems unlikely, prilocaine may be the anesthetic most preferred for such a block because of its high level of safety.

[Ophthalmic Surg Lasers 1996;27:862-868.]
Bleb Rupture Following Filtering Surgery With Mitomycin-C: Clinicopathologic Correlations
Authors: Greenfield David S , Parrish Richard K
Published: April 2021

Abstract. A 91-year-old woman with a complete rupture of her mitomycin-C filtration bleb associated with eye rubbing while crying was examined. An 18mm soft contact lens was placed preoperatively to reform the anterior chamber and the patient underwent a conjunctival advancement. Histopathology of the free conjunctival specimen revealed a stratified squamous epithelium with marked attentuation of the subepithelial tissue in the area treated with mitomycin-C. Bleb rupture may be associated with minimal physical trauma following guarded filtration surgery. Successful visual rehabilitation is possible with conjunctival advancement, yet long-term survival of the bleb is poor. [Ophthalmic Surg Lasers 1996; 27:876-877.]
Management of Coexisting Corneal Disease and Glaucoma by Combined Penetrating Keratoplasty and Trabeculectomy With Mitomycin-C
Authors: Figueiredo Regis S , Araujo Silvana V , Cohen Elisabeth J , Rapuano Christopher J , Katz L Jay , Wilson Richard P
Published: April 2021

* BACKGROUND AND OBJECTIVE: The man agement of coexistent corneal disease and uncontrolled glaucoma continues to be a challenging clinical situation. The purpose of this study is to evaluate the results of combined penetrating keratoplasty and trabeculectomy with mitomycin-C.

* PATIENTS AND METHODS: A retrospective study was undertaken to review the records of nine patients who had corneal edema and high intraocular pressure managed by simultaneous penetrating keratoplasty and trabeculectomy with mitomycin-C.

* RESULTS: The nine patients had an average preoperative intraocular pressure of 26 mm Hg (range 17 to 41 mm Hg) and associated corneal edema. The average postoperative intraocular pressure at last follow-up was 19 mm Hg (range 5 to 53 mm Hg). Three patients needed additional procedures. Six of nine patients had intraocular pressures judged to be adequately controlled (11 ± 5 mm Hg, range 5 to 18 mm Hg) throughout the postoperative period (average follow-up 16 months). Grafts remained clear in seven patients. The grafts failed in two cases in which additional glaucoma surgery was necessary.

* CONCLUSION: Combined penetrating keratoplasty and trabeculectomy with mitomycin-C should be considered for selected patients with uncontrolled glaucoma and corneal disease who have sufficient conjunctiva for a filtering procedure.

[Ophthalmic Surg Lasers 1996;27:903-909.]
Approaching a 100% Success Rate Using Topical Anesthesia With Mild Intravenous Sedation in Phacoemulsification Procedures
Authors: Dinsmore Stephen C
Published: April 2021

* BACKGROUND AND OBJECTIVES: Phacoemulsification with topical anesthesia has been accepted by some ophthalmologists as a minimally invasive alternative technique for cataract surgery. This study approaches a 1 00% success rate using topical anesthesia with mild intravenous (IV) sedation in phacoemulsification procedures.

* PATIENTS AND METHODS: Two hundred consecutive patients underwent clear-comeal phacoemulsification. Patients were not preselected. Lidocaine hydrochloride topical anesthesia was supplemented with small-dose IV midazolam hydrochloride and/or fentanyl citrate. Patients underwent meticulous preoperative counseling. Those with dementia, deafness, movement disorders, or hyperanxiety, or those who spoke a foreign language or who were young required special management. Additional techniques were employed for ophthalmologic problems such as small pupil, mature cataract, and strong blink/Bell's phenomenon. Patient comfort was noted intraoperatively and postoperatively.

* RESULTS: Ninety-seven percent of the patients did well, with only 3% requiring regional block or general anesthesia.

* CONCLUSION: Using nucleofractis phacoemulsification with special techniques in more difficult situations, most patients were successful with topical anesthesia plus IV sedative anesthesia.

[Ophthalmic Surg Lasers 1996;27:935-938.]
Erbium:YAG Laser Ablation on Human Trabecular Meshwork by Contact Delivery Endoprobes
Authors: Dietlein Thomas S , Jacobi Philipp C , Krieglstein Günter K
Published: April 2021

* BACKGROUND AND OBJECTIVE: Photo ablation of the trabecular meshwork by the infrared laser is an experimental mode of glaucoma surgery.

* MATERIALS AND METHODS: The authors studied different quartz fiber tips in erbium: YAG laser trabecular ablation. End-firing endoprobes (200 and 320 pm in core diameter) and a side-firing slope tip (200 pm in core diameter) were used. Ablation zones and collateral tissue damage in the trabecular meshwork of human donor eyes were analyzed using light and scanning electron microscopy.

* RESULTS: The 320-pm end-firing endoprobe most effectively photoablated trabecular tissue by creating large circular craters. The side-firing endoprobe yielded smaller elliptic apertures in the trabecular meshwork. Collateral tissue damage was similar for all endoprobes using pulse energies of 4 and 6 mj. Transmission impairment was obvious for all quartz fiber tips following frequent use.

* CONCLUSION: Larger end-firing contact fiberoptic probes provide larger ablation areas in the trabecular meshwork without augmentation of collateral tissue damage.

[Ophthalmic Surg Lasers 1996;27:939-945.]
An Evaluation of the Biocompatibility of Intraocular Lenses
Authors: Majima Kiyoyuki
Published: April 2021

* BACKGROUND AND OBJECTIVE: The degree of cell adhesion to intraocular lenses (IOLs) was studied through the cell culture system and the morphology of adhering cells was studied using a light electron microscope and a scanning electron microscope.

* MATERIALS AND METHODS: Human lens epithelial cells were used as materials. The IOL materials were classified into four groups: polymethylmethacrylate (PMMA), heparin surface modified PMMA, surface passivated PMMA, and silicone.

* RESULTS: PMMA showed greater adhesion than did the other materials. Cells hardly adhered to silicone. Use of a light electron microscope and a scanning electron microscope revealed that cells adhered uniformly to the surface of PMMA and were elongated, but did not adhere uniformly to IOLs of other materials. Only a few cells without the tendency of elongation were noted on the silicone the second day after culture. The 14th day after culture, the surfaces of IOLs, except those of silicone, were covered with cells.

* CONCLUSION: Such differences in the surface adhesion and morphology of cells adhering to the IOL surface are important in evaluating IOL biocompatibility.

[Ophthalmic Surg Lasers 1996;27:946-951.]
Use of a Scleral Shield for the Application of Mitomycin-C During Trabeculectomy: Preliminary Clinical Results
Authors: Mietz Holger , Krieglstein Günter K
Published: April 2021

BACKGROUND AND OBJECTIVE: To reduce intraocular concentrations of mitomycin-C (MMC), the authors used a scleral shield instead of a surgical sponge for the application of MMC during surgery.

PATIENTS AND METHODS: A total of 20 patients were operated on using the scleral shield with MMC. These patients were observed for 6 months postoperatively.

RESULTS: The rate of hypotony was 25% (5 of 20 patients). Visual acuity was not markedly reduced, and no case of hypotony maculopathy developed. The success rate and complications were not different from those of previous studies using the surgical sponge.

CONCLUSION: The scleral shield may be advantageous for reducing the rate of hypotony maculopathy.

[Ophthalmic Surg Lasers 1996;27:989-994.]
Need for Confirmation of Positioning of Ruthenium Plaques by Postoperative B-Scan Ultrasonography
Authors: Anteby Irene I , Pe'er Jacob
Published: April 2021

BACKGROUND AND OBJECTIVE: Plaque positioning is of utmost importance for the effective treatment of intraocular lesions. The authors' objective was to verify the position of ruthenium plaques after surgical placement.

PATIENTS AND METHODS: The authors studied the positions of ruthenium- 106 (Ru- 106) plaques in 43 patients treated for choroidal tumors by B-scan echography on the first postoperative day.

RESULTS: In 29 of 43 eyes (67.4%) the episcleral plaque was found to be well centered 1 day after surgery. Ten eyes (23.3%) had borderline-placed plaques, and the remaining 4 (9.3%) plaques were malpositioned. All the malpositioned plaques were situated behind posterior tumors whose uncovered edge was adjacent to the optic nerve.

CONCLUSION: Ultrasonic verification in the postoperative period is essential to detect inadvertent misplacement or displacement of radioactive plaques. Plaque replacement or additional and modified treatment can be considered for those plaques found to have moved after the surgical placement.

[Ophthalmic Surg Lasers 1996;27:1024-1029.]
Efficacy of Argon Laser Trabeculoplasty in Aphakic and Pseudophakic Eyes
Authors: Schwartz Arthur L , Wilson Martin C , Schwartz Louis W
Published: April 2021

* BACKGROUND AND OBJECTIVE: This study evaluated the efficacy of argon laser trabeculoplasty (ALT) in patients with aphakia or pseudophakia.

* PATIENTS AND METHODS: The authors retrospectively analyzed 63 eyes of 63 patients with aphakia or pseudophakia who had uncontrolled open-angle glaucoma and were treated with 180° or 360° ALT.

* RESULTS: The mean intraocular pressure (IOP) before ALT was 25.1 mm Hg (± 8.1 mm Hg). Two years after ALT, the mean IOP in the successfully treated group was 15.4 mm Hg. The mean survival time (50% success rate) for all treated eyes was 23 months, and treatment was successful in 34% of eyes at 36 months. Pseudophakic eyes had a better response than aphakic eyes (P = .06), and eyes that had extracapsular surgery did better than eyes with intracapsular surgery (P = .07).

* CONCLUSION: ALT in aphakic or pseudophakic eyes with uncontrolled glaucoma is a safe, reasonably effective treatment that can delay the need for trabeculectomy.

[Ophthalmic Surg Lasers 1997;28:215-218.]
Topical Anesthesia With Benoxinate 0.4% for Pterygium Surgery
Authors: Frucht-Perry Joseph
Published: April 2021

* BACKGROUND AND OBJECTIVE: Anesthesia during pterygium surgery is usually achieved with injections of anesthetic medications. This study evaluated the efficacy of topical anesthesia with benoxinate hydrochloride 0.4% for pterygium surgery.

* PATIENTS AND METHODS: One hundred fifty consecutive patients who had primary or recurrent prerygium underwent surgical excision of the lesion. Before the surgical procedure began, each eye that was operated on received 1 drop of benoxinate hydrochloride 0.4% solution every 1 minute for 10 minutes. The pain sensation was tested with 0.12 forceps. The pterygium was dissected, and 1 or 2 conjunctival sutures were placed, leaving bare sclera. Drops of benoxinate hydrochloride 0.4% were added every 5 minutes during the operation.

* RESULTS: The average pterygium excision time in this study was 25 minutes. Of the 150 patients studied, only 3 required intraoperative injection of lignocaine 1%. In 2 cases, subconjunctival injection was performed, and in 1 case, retrobulbar injection was required to complete the procedure. Of the remaining 147 patients, 115 had discomfort or mild pain and asked for more anesthetics once or twice during the procedure. Postoperatively, the wounds epithelialized within 7 to 14 days in all patients, except for 2 who had postoperative dellen and 2 who received mitomycin-C postoperatively.

* CONCLUSION: Topical administration of benoxinate hydrochloride 0.4% provides useful anesthesia for pterygium surgery.

[Ophthalmic Surg Lasers 1997;28:219-222.]
Bleb Infections: Clinically Different Courses of "Blebitis" and Endophthalmitis
Authors: Ayyala Ramesh S , Bellows A Robert , Thomas John V , Hutchinson B Thomas
Published: April 2021

BACKGROUND AND OBJECTIVES: To assess the differences in history, clinical course, and response between five cases of blebitis and three cases of endophthalmitis following mitomycin trabeculectomy.

PATiENTS AND METHODS: The authors conducted a retrospective review of eight consecutive cases of bleb-related infection following successful mitomycin trabeculectomy.

RESULTS: All patients with blebitis responded to treatment with return of visual acuity and intraocular pressure to preinfection levels. In the three cases of endophthalmitis, one patient underwent enucleation, one had a final visual acuity of counting fingers, and the third had a visual acuity of 20/60.

CONCLUSIONS: Blebitis, a limited form of blebrelated infection with thin, cystic, leaky blebs, responds to intensive topical antibiotic treatment, returning visual acuity and IOP to preinfection levels. Bleb-related endophthalmitis causes a more virulent form of bleb-related infection that involves thin- or thick-walled blebs, with or without leakage, and poor visual prognosis despite immediate intensive topical, systemic, and intravitreal antibiotic administration combined with core vitrectomy.

[Ophthalmic Surg Lasers 1997;28:452-460.]
Risk Factors for Unsatisfactory Intraocular Pressure Control in Combined Trabeculectomy and Cataract Surgery
Authors: Yamagami Satoru , Hamada Naoki , Araie Makoto , Shirato Shiroaki
Published: April 2021

BACKGROUND AND OBJECTIVE: Trabeculectomy combined with posterior chamber intraocular lens (PC IOL) insertion is often chosen for the treatment of glaucoma combined with cataract. In this study, the clinical prognostic indicators for late intraocular pressure (IOP) control in combined procedures were investigated.

PATIENTS AND METHODS: The clinical records of 60 eyes that underwent trabeculectomy combined with PC IOL implantation were retrospectively analyzed using the Cox proportional hazards model. All of the patients received postoperative 5-fluorouracil injections.

RESULTS: Extracapsular cataract extraction (ECCE) was found to be a statistically significant risk factor for unsatisfactory late IOP control (hazard ratio 2.54; P < .01) and for unsatisfactory filtering bleb appearance (hazard ratio 5; P < .001). The frequency of fibrin formation and the incidence of a transient IOP spike (> 25 mm Hg) were significantly lower in the phacoemulsification and aspiration (PEA) group than in the ECCE group. In the PEA group, the probability of IOP control (< 1 5 mm Hg) without medication was 54%, and the probability of persistent filtering bleb appearance was 80% at 18 months.

CONCLUSION: The PEA technique, not ECCE, should be employed in combined trabeculectomy and PC IOL implantation.

[Ophthalmic Surg Lasers 1997;28:476-482.]
Malignant Melanoma of the Lacrimal Sac Complicating Primary Acquired Melanosis of the Conjunctiva
Authors: McNab Alan A , McKelvie Penny
Published: April 2021

Abstract. An 81 -year-old woman with primary acquired melanosis of the conjunctiva had multinodular invasive malignant melanoma, with one nodule engulfing the superior lacrimal punctum. At exenteration, the lacrimal sac was noted to be involved with melanoma, and an en bloc resection of the orbital contents along with the medial orbital wall and the medial wall of the maxillary antrum was performed to excise the lacrimal drainage apparatus. In situ melanoma was found in the superior canaliculus with invasive melanoma in the lacrimal sac. In situ melanoma was also found in the ductules of the lacrimal gland and the accessory lacrimal glands of the fornix. The patient died 8 months later of metastatic melanoma. The involvement of the lacrimal drainage apparatus by primary acquired melanosis or in situ melanoma makes clinical monitoring and management difficult. [Ophthalmic Surg Lasers 1997; 28:501-504.]
The Use of Perfluorodecalin in Retinal Detachments With Retinoschisis
Authors: Aslan Ozlem , Bazman Cosar , Cekic Osman , Ozalp Solmaz
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the effect of perfluorodecalin on the repair of retinal detachments with retinoschisis.

* PATIENTS AND METHODS: Twenty-two eyes of 20 patients with degenerative and X-linked retinoschisis underwent pars plana vitrectomy, perfluorodecalin injection, internal fluid drainage, and fluid- air exchange.

* RESULTS: The retina was reattached intraoperatively in 21 (95.4%) of the 22 eyes. In 4 eyes, retinal detachment recurred within 2 months postoperatively. All of the recurrent cases underwent reoperation with perfluoropropane gas and the retina was reattached at the end of 2 operations. As a result, visual acuity increased in 18 (81.8%) of the 22 eyes.

* CONCLUSION: Perfluorodecalin makes flattening of the retina and evacuation of subretinal fluid easier in the management of rhegmatogenous retinal detachments associated with degenerative and XIinked retinoschisis.

[Ophthalmic Surg Lasers 1998;29:818-821.]
Endophthalmitis in Eyes Following Vitrectomy
Authors: Sharma Tarun , Gopal Lingam , Therese Lily
Published: April 2021

Abstract. The authors describe two patients who underwent pars plana vitrectomy for nonclearing vitreous hemorrhage. Both patients had severe pain, increased intraocular pressure, and orbital swelling. The anterior chamber became flat in a phakic eye. The infection progressed rapidly, and ultimately evisceration was required in both cases. The presence of a flat anterior chamber in gas-filled, phakic eyes and a severe orbital inflammatory reaction in the early postoperative period should alert the physician to the possibility of endophthalmitis. [Ophthalmic Surg Lasers 1998;29:857-859.]
Endothelial Cell Loss Secondary to Two Different Phacoemulsification Techniques
Authors: Kohlhaas Markus , Klemm Maren , Kammann Jochen , Richard Gisbert
Published: April 2021

* BACKGROUND AND OBJECTIVE: The endothelial cell count after phacoemulsification serves as a sensitive indicator for the level of corneal damage caused by different phacoemulsification techniques.

* PATIENTS AND METHODS: In a prospective and randomized study, the "Reversed Tip and Snip" technique and the "Divide and Conquer" technique were performed in groups of 30 patients each. The corneal endothelial cell count was measured preoperatively as well as 4 weeks and 3 months postoperatively.

* RESULTS: The endothelial cell count showed significant (P < .001) reduction by approximately 10% after the "Reversed Tip and Snip" technique and by approximately 15% (P < .001) after the "Divide and Conquer" technique. The latter produced a significantly (P < .001) greater cell loss.

* CONCLUSIONS: The "Reversed Tip and Snip" phacoemulsification technique produces less endothelial cell loss than the "Divide and Conquer" technique.

[Ophthalmic Surg Lasers 1998;29:890-895.]
Two-Year Results of Photorefractive Keratectomy With Scanning Spot Ablation for Myopia of Less Than -6.0 Diopters
Authors: MD Akif Ozdamar , Aras Cengiz , Sener Bozkurt , Bahcecioglu Halil
Published: April 2021

* BACKGROUND AND OBJECTIVE: To inves tigate the efficacy, predictability, stability, and safety of photorefractive keratectomy (PRK) with scanning spot ablation for the treatment of myopia of less than -6.0 D.

* PATIENTS AND METHODS: Twenty eyes of 20 patients (11 men, 9 women) were enrolled into the study. The mean age was 26.2 ±5.4 years. Mean spherical equivalent myopia was -3.53 ± 1.13 D, ranging from -2.25 to -6.00 D. Patients underwent excimer laser PRK for the treatment of myopia. Follow-up time was at least 24 months in all patients.

* RESULTS: Mean spherical equivalent refraction was +0.84 ± 0.99 D at 1 month, +0.19 ± 0.54 at 3 months, -0.01 ± 0.53 at 12 months, and -0.13 ± 0.50 at 24 months. There was a mean regression of 0.65 D between 1 and 3 months. At 24 months, 1 6 (80%) of the eyes remained within +0.50 D of emmetropia and 18 (90%) of the eyes remained within ±1.0 D of emmetropia. Nineteen (95%) of the eyes had uncorrected visual acuity of 20/40 or better. The mean corneal haze score was maximum at 3 months (0.88 ± 0.22). There was no clinically significant corneal haze (greater than 2+). One eye (5%) lost 2 or more lines of best-corrected visual acuity.

* CONCLUSION: Excimet laser PRK with the scanning spot ablation technique is effective, predictable, stable, and safe for the treatment of myopia of less than -6.0 D.

[Ophthalmic Surg Lasers 1998;29:904-908.]
A Simplified Technique for Extraction of Subluxated Lenses in Young Patients
Authors: Friedman Zvi , Feiner Michael
Published: April 2021

Abstract. The authors describe a simplified and safer technique for surgical removal of hereditary or idiopathic soft subluxated lenses. Five eyes of three patients underwent intercapsular aspiration of the lens material. A side-port cannula was introduced through the pars plicata while the eyes were pressurized by an anterior chamber maintained This was followed by anterior vitrectomy and capsulectomy. With this technique, the risk of vitreous loss, which can occur with an anterior approach, and the risk of the spread of lens particles into the vitreous, which can occur with a lensectomy with a vitrectomy probe, are avoided. Postoperatively, optical correction was achieved with a contact lens in the two children and with an anterior chamber intraocular lens in the adult. Final visual acuity was 6/9 or better in all eyes. No surgical or other complication occurred during 2 to 4 years of followup. A soft subluxated lens can be removed without the risks of vitreous loss or spread of lens particles into the vitreous, reducing the probability of severe complications. [Ophthalmic Surg Lasers 1998;29:949-950.]