bluuebunny/crossref_metadata_2025 huggingface dataset:
Mastering Group LEADERSHIP: An Active Learning Experience
Authors: Scheick Dawn M
Published: April 2021

ABSTRACT

Leading therapeutic groups is an underused but viable treatment role for nurses in all specialty areas. A dynamic psychoeducational group model provides structure as nurses invest and collaboratively participate to actively learn the group leader role. This article highlights the sequencing of instruction of group theory and skills with examples from a baccalaureate nursing curriculum. Samples from student journals reveal their growing assimilation of the group leader role as learners actively participated in groups, collaborated, and reflected on their learning. Examples of creatively adapted group exercises, as well as selected nursing group leader interventions, demonstrate group leadership as a skill that can increase nurses' repertoire of therapeutic responses.
Child and Adolescent Homicide Survivors
Authors: Vigil Gloria J , Clements Paul T
Published: April 2021

Complicated Grief and Altered Worldviews
Psychiatric Nursing & Medication Adherence
Authors: Kemppainen Jeanne K , Buffum Marti , Wike Greg , Kestner Michael , Zappe Carol , Hopkins Roberta , Chambers Kristi Haney , Morrow Mary , Bartlebaugh Patti
Published: April 2021

ABSTRACT

A survey was developed to determine whether the rapidly changing context of mental health care has significantly influenced how psychiatric nurses assess and intervene in issues related to medication adherence. A sample of 126 psychiatric nurses working in Veterans Affairs mental health treatment facilities in northern California, Hawaii, and Nevada identified the most effective methods for tracking medication adherence, as well as successful adherence interventions. Despite the challenges imposed by changing work environments, psychiatric nurses use creative and innovative approaches to improve their patients' medication adherence. Interventions for enhancing patient adherence with prescribed regimens are identified. Essential role dimensions related to medication adherence defined by the nurses in this survey included providing medication education, tracking patient adherence, assessing medication effectiveness, providing individualized, tailored adherence interventions, and collaborating with other health care providers in medication planning. Study findings support using nurses to their full potential and highlight nurses' need for more educational opportunities and consultation with experts (e.g., clinical pharmacists).
Users' Involvement in Their Care: A Follow-Up Study
Authors: Valentine Gordon , Jamieson Brenda , Kettles Alyson McGregor , Spence Margaret
Published: April 2021

The study described in this article is a follow-up study to one conducted in 1995 (Spence, Valentine, & Kettles, 1997). The first study aimed to identify residents' perceptions of staff attitudes toward their care, problem areas in the care provided, and improvements that could be made during the study period. This follow-up study aimed to identify whether staff attitudes remained the same or improved, and whether or not the problems identified in the first study improved.
Damage to the Corneal Endothelium by Minus Power Anterior Chamber Intraocular Lenses
Authors: Saragoussi Jean-Jacques , Cotinat Jacques , Renard Gilles , Savoldelli Michelle , Abenhaim Alain , Pouliquen Yves
Published: April 2021

ABSTRACT: We present 16 phakic myopic eyes (from -10.00 to -25.00 diopters) corrected by minus power intraocular lenses implanted in the anterior chamber whose corneal endothelium was observed by specular microscopy during a postoperative period from 6 to 18 months. Significant morphologic endothelial changes were noted in three eyes along the border of the lens optic. Around dark zones, which appeared acellular, endothelial cells were enlarged, deformed, and separated. These findings may be produced by intermittent contact between the endothelium and lens. Corneal indentation during specular microscopy occasionally caused a curvilinear reflection which corresponded to the optic border. In three eyes, dark areas without cellular abnormality were observed near the curved edge of the lens. These findings probably resulted from the disturbance of the specular reflection on part of the endothelium due to this edge. (Refract Corneal Surg 1991;7:282-285.)
Comparison of Keratometric Readings as Obtained by Javal Ophthalmometer and Corneal Analysis System (EyeSys)
Authors: Tsilimbaris Miltiades K , Vlachonikolis Ioannis G , Siganos Dimitrios , Makridakis George , Pallikaris Ioannis G
Published: April 2021

ABSTRACT: We examined 92 normal eyes using Javal Ophthalmometer and Corneal Analysis System (EyeSys) intending to compare the keratometric readings obtained by these two instruments. Dioptric power and location at flatter and steeper meridians, keratometric astigmatism values, and average central keratometric power were measured in the central cornea of all eyes. Statistical analysis showed significant differences in flatter meridians' mean power values (mean difference = 0.13 D, P = .008), mean keratometric astigmatism values (mean difference = -0.20 D, P= .001) and steeper meridians' location (mean difference = 7°, P = .0001). There was no significant difference in steeper meridians' mean power values (mean difference = -0.06 D, P = .38), flatter meridian location (mean difference = 5.9°, P = .07), and mean average central keratometric power (mean difference = 0.03 D, P= .471). Clinically meaningful difference was observed only in keratometric astigmatism readings of eyes with keratometric astigmatism higher than 1 .50 D (mean difference = -0.84 D). For all the other parameters measured, the differences between the two instruments readings were clinically acceptable. Refract Corneal Surg 1991;7:368-373.)
Correction of High Myopia With the Worst Myopia Claw Intraocular Lens
Authors: Landesz Monika , Worst Jan G F , Siertsema Jaap V , van Rij Gabriel
Published: April 2021

ABSTRACT

BACKGROUND: Phakic anterior chamber lenses is one of the modalities used to correct high myopia. We report the initial results of our prospective study on the Worst myopia claw intraocular lens (IOL) that is fixated to the anterior iris.

METHODS: We studied 35 eyes in 18 patients with a preoperative myopia ranging frota - ß.00 to -28.00 diopters (D). The follow up ranged from 6 months (n = 15) to 12 months (n=20).

RESULTS: In 26 (74.3%) eyes, the postoperative spherical equivalent refractive error was within 1.00 D of emmetropia. The mean refraction was stable between 1 to 2 months and 12 months. The mean spectacle-corrected visual acuity improved from 20/50 to 20/40. The straylight measurements did not show a significant increase postoperatively (p = .64). The mean endothelial cell loss was 5.6% (range, +6.3% to -22.6%) at 6 months, and 8.9% (range, +0.77% to -23.5%) at 12 months. We did not encounter major complications.

CONCLUSION: Implanting a Worst myopia claw IOL in high myopic eyes resulted in a stable, reasonably accurate refractive outcome. This group of patients will be followed longer because of concern over ocular complications with this technique. [J Refract Surg. 1995;11:16-25.]
Tear Fluid Cellular Fibronectin Levels After Photorefractive Keratectomy
Authors: Virtanen Tuula , Ylätupa Sari , Mertaniemi Päivi , Partanen Paul , Tuunanen Tiina , Tervo Timo
Published: April 2021

ABSTRACT

BACKGROUND: Fibronectin is supposed to have an important role in wound healing. The extradomain A-containing cellular fibronectin (EDAcFn) refers to fibronectin, which instead of being a hepatocyte derived component of blood plasma or body fluids, is produced locally. The present study was undertaken to clarify the possible changes in excretion of EDAcFn in tears following excimer laser photorefractive keratectomy (PRK).

METHODS: An immunoassay was used to determine EDAcFn concentrations in human tear fluid samples of 11 eyes after PRK. Tear fluids were collected with scaled microcapillaries preoperatively as well as 1, 2, and 7 days after PRK. The time used to collect a known volume of tears was registered. This was done to estimate the dilution effect related to the hypersecretion of tears after PRK.

RESULTS: The mean preoperative tear fluid EDAcFn concentration was 0.28 ± 0.07 ng/µl with a wide range (0.05 to 0.63). The tear fluid flow-corrected excretion of EDAcFn was 1.36 ± 0.35 ng/min (range, 0.145 to 3.50). There was a significant increase in both postoperative tear fluid flow and excretion of EDAcFn on days 1 and 2. The elevation of the mean EDAcFn concentration did not decrease in spite of reflex tearing. The mean excretion of EDAcFn in tears was 28-fold on the first and 17-fold on the second postoperative day. Normal level was reached by day 7.

CONCLUSION: There is a rapid increase in excretion of EDAcFn in tears following PRK. This seems to last only as long as an epithelial defect persists. The epithelium of all eyes healed in 3 to 4 days in spite of wide interindividual variations in both tear fluid flow and EDAcFn excretion. [J Refract Surg. 1995;11:106-112.]
Three-Year Results of Photorefractive Keratectomy for Myopia
Authors: Kim Jae Ho , Sah Woo Jin , Kim Man Soo , Lee Young Chun , Park Chan Kee
Published: April 2021

ABSTRACT

We evaluated the results of single-step photorefractive keratectomy (PRK) on 35 consecutive myopic eyes (19 patients) with follow up of 3 years or more. The range of preoperative myopia was from -2.00 diopters (D) to -6.00 D with astigmatism of less than 1.50 D. The excimer laser used in this study was the ExciMed UV 200LA, (Summit Technology), which was set to a maximum correction of - 6.00 D at a 5.0-mm diameter ablation zone. Uncorrected visual acuity better than 20/25 was achieved in 82.9% of eyes. Spectacle corrected visual acuity was equal to or better than that of preoperative levels in 94.3%. The difference between attempted and achieved correction was within 1.00 D in 60.0% of eyes. The myopic regression curve was Y =3.679-0.6876 log (X). If the regression remains constant, we expect that refraction at 5 years after PRK would be -1.48 D.

Trace corneal haze was present in 12 eyes (34.3%). At three years the most common subjective complaint was mild decreased night vision with asthenopia. The findings suggest that myopic regression can occur as long as 3 years after PRK. [J Refract Surg. 1995;11(suppl.):S248-S252.]
Photorefractive Keratectomy for 1.5 to 18 Diopters of Myopia
Authors: Hamberg-Nyström Helene , Fagerholm Per , Sjöholm Carlos , Tengroth Björn
Published: April 2021

ABSTRACT

The purpose of this study was to evaluate the refractive outcome and the stability of refraction after excimer laser photorefractive keratectomy (PRK).

Forty-five eyes were treated in three different refractive groups: low myopes, 23 eyes, - 1.50 diopters (D) to - 6.00 D; intermediate myopes, 14 eyes, -6.10 D to - 10.00 D; and high myopes, 8 eyes, -10.10 D to - 18.00 D.

At 9 months after surgery the low myopes had a mean refraction of - 0.14 D (range - 1.00 D to + 1.50 D) and were easy to refract. Intermediate myopes mean refraction was +0.14 D (range - 1.50 D to + 2.50 D). In the high myope group the mean refraction was - 0.47 D (range - 10.00 D to + 2.50 D) and four eyes (50%) lost more than two lines of spectacle corrected visual acuity. Refraction the high myopes was more difficult compared to the lower myopes.

PRK produced good results for myopes from - 1.50 D to - 10.00 D. Myopes greater than - 10.00D are not stable at 9 months after PRK and are difficult to refract. [J Refract Surg. 1995;11 (suppl.):S265-S267.]
Photorefractive Keratectomy for Undercorrected Myopia After Radial Keratotomy: Two-Year Follow Up
Authors: Lee Young Chun , Park Chan Kee , Sah Woo Jin , Hahn Tae Won , Kim Man Soo , Kim Jae Ho
Published: April 2021

ABSTRACT

We evaluated the clinical results of excimer laser photorefractive keratectomy (PRK) on 18 myopic eyes of 13 patients with residual myopia after radial keratotomy.

Follow up was 24 months or more and the time interval between radial keratotomy and PRK ranged from 12 to 94 months. Patients were divided into two groups for analysis based on their preoperative myopia: group 1 (-6.00 diopters (D) or less), group 2 (more than -6.00 D). Uncorrected visual acuity at 2 years follow up was 20/40 or better in 86% (group 1) and 50% (group 2). Mean manifest refractive change was from -3.55 D to -0.91 D in group 1 and from -7.44 D to - 2.50 D in group 2. Predictability within 1.00 D between attempted and achieved correction was 71.4% (group 1) and 80% (group 2).

Most complications were transient except decreased spectacle corrected visual acuity in one eye-a complication also reported by others. Glare (61%) and decreased vision at night (50%) were the most troublesome subjective symptoms.

These results show that previous radial keratotomy may not influence the myopic correction of PRK. Planned two-stage myopic correction (PRK after radial keratotomy) in high myopia can be considered a useful technique. [J Refract Surg. 1995;11(suppl.):S274-S279.]
Excimer Photorefractive Keratectomy After Undercorrected Radial Keratotomy
Authors: Kwitko Marvin L , Gow James A , Bellavance François , Woo Gie
Published: April 2021

ABSTRACT

Radial keratotomy has been used for the treatment of myopia since 1979. Until recently, patients with undercorrected myopia had recourse only to repeated keratotomy. Now patients undercorrected after two or more radial keratotomy procedures can be treated with the excimer laser to reduce the residual myopia.

Nineteen eyes of 17 patients with undercorrected myopia after repeated radial had excimer photoradial keratectomy performed.

The mean residual spherical equivalent refractive error after radial keratotomy was - 2.74 ± 1.06 diopters (D). This was further reduced after PRK. Final uncorrected visual acuity ranged from 20/20 to 20/70.

Excimer laser PRK offers a safe and more controlled method of treating residual after radial keratotomy. [J Refract Surg. 1995;11(suppl.):S280S283.]
Increasing the Number of Photorefractive Keratectomy Procedures From a Single Excimer Laser Gas Fill
Authors: Janakiraman P , Rajendran Babu
Published: April 2021

ABSTRACT

Excimer laser ablative procedures are an expensive proposition for both the patient and the user. The high capital expenditure and the cost of consumables, notably the argon-fluoride gas, makes it imperative to achieve maximum utilization in terms of number of cases treated per fill of gas. This is particularly true in countries like India. The maximum number of cases can be treated by understanding not only the limitations of each fill of gas, but by proper patient scheduling and modifications to the treatment protocol. This paper outlines our modified protocol and the patient scheduling software that we developed to meet these criteria. [J Refract Surg. 1995;11(suppl.):S319-S320.]
Multicenter Study of Photorefractive Keratectomy for Myopia of 6.00 to 8.00 Diopters
Authors: Talamo Jonathan H , Siebert Karl , Wagoner Michael D , Yeh Eugene , Telfair William
Published: April 2021

ABSTRACT

PURPOSE: To summarize the initial results of excimer laser photorefractive keratectomy (PRK) on 89 eyes of 80 patients with moderate myopia (myopia of -6.00 to -8.00 diopters [D]; mean -6.98 ± 0.90 D) at nine investigational sites.

METHODS: All treatments used an argon fluoride excimer laser (VISX, Inc, Santa Clara, Calif) using standard settings. Sixty eyes received single-zone 6.0-millimeter ablations and 29 eyes received twozone ablations. Follow up ranged from 1 month (n = 89) to 6 months (n = 46).

RESULTS: At 3 months, uncorrected visual acuity measured 20/40 or better in 75% and 20/20 or better in 18%; 78% were within ± 1.00 D of intended correction, 38% were within ±0.50 D, and 9% lost two or more lines of spectacle-corrected visual acuity. At 6 months, uncorrected visual acuity measured 20/40 or better in 74% and 20/20 or better in 17%; 67% were within 1.00 D of intended correction, 38% within 0.50 D, and 2% (1/46) lost two lines of spectacle-corrected visual acuity.

CONCLUSIONS: PRK for moderate myopia with large diameter ablation zones appears safe and more predictable than that done using smaller ablation zone diameters. Longer follow up is needed to better define stability, the effects of postoperative corticosteroids, and the use of single- versus doublezone ablations. [J Refract Surg. 1995;11:238-247.]
Holmium Laser Thermal Keratoplasty of 10 Poorly Sighted Eyes
Authors: Ariyasu Reginald G , Sand Bruce , Menefee Richard , Hennings David , Rose Charles , Berry Michael , Garbus Jenny J , McDonnell Peter J
Published: April 2021

ABSTRACT

BACKGROUND: The holmium:YAG laser shrinks stromal collagen and changes corneal refractive power, reportedly without recurrent or persistent epithelial defects, stromal necrosis, or damage to the epithelium and endothelium observed with some other thermokeratoplasty techniques.

METHODS: We studied the safety of the holmium:YAG laser using various patterns and energy densities after treating 12 poorly sighted eyes, two immediately prior to corneal transplantation and 10 followed for a mean period of 90 days (range, 60 to 180 days). Visual acuity, intraocular pressure and inflammation, central corneal endothelial cell density and thickness, and intraocular structures of the eye were indices evaluated regularly. Patients were also assessed for specific symptoms during the post-operative period.

RESULTS: There were no problems with epithelial healing and no stromal necrosis or evidence of endothelial damage; no significant differences were noted in any of the endothelial cell indices examined. A mean change in corneal curvature of 1.10 diopter (D) was achieved, but varying amounts of regression of this effect was noted.

CONCLUSIONS: Holmium:YAG laser thermal keratoplasty appears to be safe over a follow up of up to 180 days. Corneal refractive changes on the order of 1.05 D can be achieved using the parameters employed in this study. Whether or not larger, persistent corneal refractive change can be achieved with a holmium:YAG laser remains to be determined. [J Refract Surg. 1995,11:358-365.]
Phakic Posterior Chamber Intraocular Lenses for the Correction of High Myopia
Authors: Ertürk Haluk , Özçetin Hikmet
Published: April 2021

ABSTRACT

BACKGROUND: This article evaluates the benefits and risks of silicone intraocular lenses (IOLs) implanted just anterior to the surface of the crystalline lens.

METHODS: In this pilot study, 8 silicone IOLs were implanted into the posterior chambers of 8 phakic, myopic eyes (-8.00 to -20.00 diopters [D]) under local anesthesia through a 6-mm corneal incision.

RESULTS: Five of the eyes (62.5%) had a spherical equivalent refraction within ±1.00 D and all were within ±1.50 D of the attempted correction. The spectacle-corrected visual acuities were improved postoperatively in all eyes. Anterior chamber depths were decreased with a mean depth of 0.288 mm. Slight decentrations were observed in three eyes without any optical problems.

CONCLUSION: Phakic posterior chamber lenses are a promising intervention in highly myopic patients, especially in anisometropia. Further study is needed to prove the reliability of this technique. [J Refract Surg. 1995;11:388-391.]
Wound Healing Following Intrastromal Photorefractive Keratectomy With the Nd:YLF Picosecond Laser in the Cat
Authors: Habib Maged S , Speaker Mark G , McCormick Steven A , Kaiser Richard
Published: April 2021

ABSTRACT

BACKGROUND: We studied the histopathology of the stromal wound healing response in the cat cornea following intrastromal photorefractive keratectomy (IPRK) with the Nd: YLF picosecond laser.

METHODS: Intrastromal PRK was performed in the anterior stroma of cat corneas with the Nd:YLF picosecond laser. The cats were sacrificed at predetermined intervals ranging from immediately to 6 months postoperatively. Effects of the laser treatment on the epithelium, Bowman's layer, stroma, and the endothelium were evaluated using light and scanning electron microscopy. No anti-inflammatory agents were used.

RESULTS: Intrastromal PRK resulted in no perceptible damage to the corneal epithelium or Bowman's layer either acutely or at 6 months. The corneal stroma showed multiple cavitations immediately after intrastromal PRK, which collapsed over several hours, followed by thinning of the cornea over 2 weeks. At 1 month, the stromal collagen was abnormal with surrounding hyperceUularity. The endothelium showed no injury, acutely or at 6 months. No thermal effects on stromal collagen were observed at 6 months, and disruption of the lamellar pattern was not apparent after the cavitation bubbles were reabsorbed.

CONCLUSION: Intrastromal PRK can effectively remove stromal tissue without acute damage to the adjacent lamellae, epithelium, or endothelium. There is a transient cellular wound healing response associated with a transient stromal collagen abnormality at 2 weeks to 1 month, which was not apparent 2 months after the procedure. [J Refract Surg. 1995;11:442-447.]
Nocardia Keratitis After Traumatic Detachment of a Laser in situ Keratomileusis Flap
Authors: Kim Eung K , Lee Dong H , Lee Kyungwon , Lim Seung J , Yoon Il S , Lee Young G
Published: April 2021

ABSTRACT

PURPOSE: Nocardia are gram-positive bacteria existing ubiquitously in the environment; they can cause keratitis. Nocardia asteroides keratitis occurred in the interface between the stromal bed and flap after traumatic detachment of the flap 4 months after an initially uncomplicated laser in situ keratomileusis (LASIK) procedure.

METHODS: Nocardia asteroides keratitis was confirmed by culture. Therapy included topical and oral trimethoprim-sulfamethoxazole.

RESULTS: Thirteen months after the trauma, the patient's spectacle-corrected visual acuity was 20/20 with a manifest refraction of -2.25 -1.00 ? 30°.

CONCLUSIONS: The immediate steps of management consisting of surgically lifting the corneal flap, rapid microbial identification, and proper treatment with specific antibiotics resulted in the successful treatment of Nocardia asteroides keratitis in a traumatized eye after LASIK. [J Refract Surg 2000;16:467-469]
Is Abnormal Focal Steepening of the Cornea Related to Persistent Monocular Diplopia?
Authors: Takei Kazuo
Published: April 2021

ABSTRACT

PURPOSE: Some case reports have shown that abnormal focal steepening of the cornea appears to cause monocular diplopia by prismatic effect. The purpose of this study was to ascertain prospectively if the pattern of corneal distortion was related specifically to persistent monocular diplopia.

METHODS: We selected 16 visually normal eyes (controls) and two groups of volunteers in which abnormal focal steepening of the cornea was expected to be found: 40 eyes of 20 volunteers who wore rigid gas-permeable contact lenses (RGP) for myopia and 10 eyes of seven patients with keratoconus. New charts that consisted of white dials on a black background were prepared for detection and measurement of secondary images. Any secondary image that could not be eliminated by any trial lens correction was defined as a persistent secondary image, using the charts. Corneal topography from all subjects was classified: round or oval, symmetric or asymmetric bowtie, abnormal focal steepening accompanied by contact lens-induced corneal warpage or keratoconus, or amorphous. We analyzed the relationship between the persistent secondary image and the corneal topographical patterns.

RESULTS: A persistent secondary image was detected from seven eyes of RGP wearers and all keratoconus eyes. All corneal topographies of the seven RGP eyes with a persistent secondary image showed abnormal focal steepening related to contact lens-induced corneal warpage. The direction of the persistent secondary image was approximately consistent with the location of the focal steepening as seen on the corneal topography.

CONCLUSION: Abnormal focal steepening of the cornea that appeared to produce a prismatic difference between two parts of the cornea was specifically related to persistent monocular diplopia. [J Refract Surg 2002;18:253-262]
Comparison of Wavefront-guided Customized Ablation vs. Conventional Ablation in Laser in situ Keratomileusis
Authors: Vongthongsri Anun , Phusitphoykai Nutharin , Naripthapan Pichit
Published: April 2021

ABSTRACT

PURPOSE: To compare visual outcome after applying wavefront-guided customized ablation with conventional ablation in laser in situ keratomileusis (LASDX) patients.

METHODS: We performed a prospective, randomized controlled study that included 22 eyes of 11 patients who were treated with LASBK using the Nidek EC-5000 excimer laser system. We applied wavefront-guided customized ablation (study group) in the first eye of each patient. The conventional ablation (control group) was performed in the other eye of the same patient. Best spectaclecorrected visual acuity (BSCVA), spherical equivalent refraction, and high-order aberrations were evaluated preoperatively and at 1 month. Highorder aberrations were measured using the Nidek OPD-Scan.

RESULTS: Preoperative and 1-month postoperative BSCVA were better than 20/40 (100%) after LASDX with both conventional ablation (control) and wavefront-guided customized ablation. Preoperatively, mean high-order aberrations in the control group were 0.572 and in the study group, 0.428 (Zernike coefficient unit). One-month after LASDI, mean high-order aberrations in the control group were 0.496 and in the study group, 0.476 (Zernike coefficient unit). We found no statistically significant difference between preoperative and 1-month postoperative high-order aberrations in either group.

CONCLUSION: LASDX with both conventional ablation and wavefront-guided customized ablation resulted in the same BSCVA 1 month after LASDX. Preoperative and 1-month postoperative high-order aberrations were not statistically different following LASDX between ablation types. [J Refract Surg 2002;18(suppl):S332-S335]
Clinical Experience With the Customized Low Spherical Aberration Ablation Profile for Myopia
Authors: Sarkisian Karen A , Petrov Alexey A
Published: April 2021

ABSTRACT

PURPOSE: To evaluate postoperative spherical aberration reduction and increase of visual acuity with new Flex Scan and custom ablation software.

METHODS: We created a new customized low spherical aberration ablation profile for myopic patients (true spherical ablation). This aspheric algorithm increases ablation in the midperiphery and periphery to reduce surgery-induced spherical aberration. LASIK was performed in 143 eyes, 127 with the true spherical ablation profile, and 16 with the custom true spherical ablation profile. We used the Nidek OPD-Scan and the Nidek EC-5000 excimer laser. Ablation zones of 6.0 to 6.5 mm and transition zones of 8.5 to 9.0 mm were used. Preoperative myopia was as much as -6.50 D, and astigmatism, -2.50 D.

RESULTS: In the true spherical ablation profile group, 37.8% of eyes achieved UCVA better than 1.0 (1.2 to 2.0). In custom true spherical ablation profile eyes, 62.5% achieved UCVA better than 1.0 (1.2 to IJi). One patient had on the day after surgery (true spherical ablation profile) an UCVA of 3.0 (preoperative UCVA was 0.1 and BSCVA was 1.0 in each eye). Preoperative and postoperative OPD-Scan analysis showed reduction of spherical-like aberrations for dilated pupil after surgery or insignificant changes for most patients. No patient had any complaints concerning quality of vision.

CONCLUSION: LASIX based on our true spherical ablation profile produced good visual acuity results for myopic patients. [J Refract Surg 2002: 18(suppl):S352-S356]
Standards for Reporting the Optical Aberrations of Eyes
Authors: Thibos Larry N , Applegate Raymond A , Schwiegerling James T , Webb Robert
Published: April 2021

ABSTRACT

In response to a perceived need in the vision community, an OSA taskforce was formed at the 1999 topical meeting on vision science and its applications (VSIA-99) and charged with developing consensus recommendations on definitions, conventions, and standards for reporting of optical aberrations of human eyes. Progress reports were presented at the 1999 OSA annual meeting and at VSIA2000 by the chairs of three taskforce subcommittees on (1) reference axes, (2) describing functions, and (3) model eyes. [J Refract Surg 2002;18:S652-S660]
The Racquet Conjunctival Flap
Authors: Cies William A , Odeh-Nasrala Nicholas
Published: April 2021

SUMMARY

I ? situations requiring a conjunctival flap to cover a corneal defect, the racquet flap technique is a simple relatively noninvasive method. Less conjunctiva is sacrificed and yet the flap is fully maintained by the one pedicle. The bulbar conjunctiva is maintained in an essentially normal state.
The Circular Loop Intraocular Lens
Authors: Parelman Allen G
Published: April 2021

SUMMARY

A large series of cases of intracapsular cataract extractions with implantation of the recently introduced Medallion circular loop lens is reviewed. Case selection, surgical technique, postoperative management, complications and results are presented in detail. Surgical and visual results have been excellent and compare favorably with intracapsular cataract surgery performed without artificial lens implantation. The transiridectomy clip of the posterior supporting circular loop provides an excellent system of lens fixation and eliminates the need for an iris suture with the potential long-term complications of possible iris suture absorption. The lens is essentially unluxatable. A particularly low incidence of cystoid macular edema, as well as other long-term postoperative complications, has been encouraging.

The surgical technical requirements for implantation of this particular implant are very exacting. Further refinements in design and construction of this artificial lens based on the experiences developed in this series of cases are proposed.
Clinical Safety of Corneal Storage Media
Authors: Mishler Ken E , Keates Richard H
Published: April 2021

ABSTRACT

A study of the bacteriological safety of McCarey-Kaufman (M-K) media was undertaken.

Twenty-five consecutive cultures of M-K media with a standard penicillinstreptomycin additive were performed at the time of keratoplasty. All cultures were negative, confirming the clinical safety of this media.
Persistent Hyaloid with Retinal Detachment
Authors: Kingham James D
Published: April 2021

SUMMARY

An 11-year-old female with acquired traction retinal detachment associated with persistent hyaloid responded with retinal reattachment by intravitreous surgical technique and scleral buckling.
A Simple and Safe Suture for Fixation of Intraocular Lenses
Authors: Alpar John J
Published: April 2021

SUMMARY

Presented is a new simplified and safe suturing technique to prevent Bi nkhorst and Fyodorov Il lenses from dislocating. To date, 74 lenses have been implanted by this technique. There have been no complications. Follow-up time is from three weeks to 14 months.
The Management of Pterygium
Authors: Ehrlich Dion
Published: April 2021

ABSTRACT

A rationale for the management of pterygium, based on theory and clinical experience, is presented in this review. Pterygium is classified as primary, secondary (recurrent), or Pseudopterygium. Empirical data and proposed theories of pterygium pathogenesis and recurrence are discussed. The treatment of pterygium based on this information is divided into four phases; diagnosis, medical therapy, surgery, and postoperative adjunctive measures. The indications, techniques, results, and complications of the postoperative adjunctive measures used to lower recurrence are considered. Guidelines for the treatment of pterygium are recommended.
Histocompatibility Matching in Poor Prognosis Combined Procedure Keratoplasty
Authors: Bennett Thomas O , Peyman Gholam A
Published: April 2021

SUMMARY

To determine the effect of histocompatibility matching and mismatching at the rabbit leukocyte-locus A (RL-A locus) on graft survival in rabbits, we created a model to enhance graft failure. Rabbit corneas received alkali burns with consequent vascularization of the graft bed. Each rabbit underwent large (10-mm) penetrating keratoplasty and simultaneous lens extraction. Grafts in four of six corneas from the matched group remained transparent for the extent of the experiment; none of the grafts in the mismatched group were transparent at the end of the experiment
Pars Plana Vitrectomy for Complications of Intraocular Lens Implantation
Authors: Eichenbaum Daniel M , Jaffe Norman S , Clayman Henry M , Light David S
Published: April 2021

SUMMARY

Several clinical situations have been presented in which pars plana vitrectomy has proven beneficial in the treatment of vitreous complications of lens implantation. Removal of the central opacity and enlargement of the pupil are essential to improve vision, relieve pupillary block and achieve an adequate view of the retina. Pars plana vitrectomy offers a method for the controlled removal of membrane, vitreous and iris tissues without unnecessary distortion of anterior segment anatomy.
The Need for Intraocular Lens Implantation in Children
Authors: Hiles David A
Published: April 2021

SUMMARY

The intraocular lens offers an additional experimental parameter to be considered for the visual rehabilitation of children with traumatic or unilateral infantile cataracts. The disadvantages of aphakic spectacles or contact lens and amblyopia have committed many of these eyes to the status of visual cripples. In this series of 41 patients, with a maximum of 24 months follow-up, it has been concluded that the IOL may be successfully implanted.
Orthoptic Consequences of Binkhorst Lens Implantation for Unilateral Cataract
Authors: Ridgway Alan E A
Published: April 2021

SUMMARY

Stereoacuity levels regained after uniocular lens implantation for unilateral cataract are related to the final visual acuity of the operated eye. They compare unfavorably with levels reported in normal populations and are unrelated to the period of monocularity and the residual optical defects of the operated eyes. Using random dot stereograms as a criterion, over a third of thirty-five patients remained stereoblind after treatment.
Staphyloma As A Late Complication of Trabeculectomy
Authors: Spaeth George L , Rodrigues Merlyn M
Published: April 2021

SUMMARY

A clinicopathologic study was performed of a scleral staphyloma occurring two years after a trabecutectomy for neovascular glaucoma. In a series of thirteen cases with secondary glaucoma four developed staphylomas in the area of the excision of sclera and trabeculum. A young, black male with atypical pigmentary glaucoma also developed a staphyloma.

The possibility of the development of a staphyloma should be considered when selecting an appropriate operative procedure for uncontrolled glaucoma.
The Dangers of Metal-Loop Intraocular Lenses
Authors: Shepard Dennis D
Published: April 2021

SUMMARY

The author implanted 500 intraocular lenses (IOLs) during intracapsular surgery. Data from the 60 lenses with metal posterior loops showed a markedly high incidence of complications compared to plastic loops: twice as many overall complications, three times the cystoid macular edema, three times the rate for subsequent corrective surgical procedures, and 30 times more IOLs had to be removed. IOL manufacturers are advised to abandon metal loops for intracapsular implantation. Polypropylene is suggested as the apparent ideal loop material.
Use of Na-Hyaluronate During Intraocular Lens Implantation in Rabbits
Authors: Miller David , O'Connor Patricia , Williams James
Published: April 2021

SUMMARY

It is now established that there is a destructive biophysical interaction between a plastic intraocular lens and the corneal endothelium during intraocular lens implantation. In the present study, Na-hyaluronate was placed into the anterior chamber of one eye of 20 rabbits, after lens extraction and prior to pseudophake implantation, in an attempt to protect the corneal endothelium. The other eye of each rabbit was subjected to a lens extraction and pseudophake implantation in the conventional manner. During the 4-week postoperative period, it was observed that the eye treated with Na-hyaluronate showed significantly less corneal edema as well as less iris engorgement and edema.
The Biologic and Physical Criteria for Suture Selection in Cataract Surgery
Authors: Blaydes J Elliott , Salthouse Thomas N
Published: April 2021

SUMMARY

This paper has discussed histochemical, physical, and clinical considerations involved in proper suture selection for cataract surgery. Guidelines are proposed so that the surgeon can employ a standard method for evaluating each suture's performance. Accordingly, the surgeon can select the proper suture to satisfy his needs regardless of his operative technique.
Argon Laser Photocoagulation of a Vitreo-Corneal Adhesion After Trauma
Authors: Bahn Charles F , Vine Andrew K , Wolter J Reimer , Martonyi Csaba L
Published: April 2021

SUMMARY

Argon laser photocoagulation of a vitreo-corneal adhesion following extraction of a traumatically displaced lens was possible because of hematogenous pigmentation of the vitreous band from a vitreous hemorrhage.
Ultraviolet Light Transmission of the Lens Capsule
Authors: Keates Richard H , Genstler Darrell E , Tarabichi Samih
Published: April 2021

SUMMARY

A Cary, Model 118, spectrophotometer was used to measure spectral absorbence by the human lens capsule of wavelengths 200 nm to 400 nm. The lens capsule transmits greater than 90% of the incident UV light, and thus does not appear to provide significant protection for the retina from UV radiation. This suggests that the lower incidence of aphakic cystoid macular edema in the eye with an intact posterior capsule is not related to UV light absorption by the lens capsule.
Dermoid Tumor Involving the Lacrimal Drainage Pathway: A Case Report
Authors: Hurwitz J J , Rodgers J , Doucet T W
Published: April 2021

SUMMARY

Dermoid tumors of the orbit frequently are encountered in children and young adults. We describe an interesting case of an orbital dermoid which involved the lacrimal excretory system in a 27-year-old female. We emphasize the importance of a preoperative assessment in planning the surgical approach and anticipating the possible surgical complications. The role of the canaliculo-dacryocystorhinostomy (CDCR) in the management of such a patient is emphasized.
Looking Back or Looking Forward?
Authors: Sommer Alfred , Steinmann William C
Published: April 2021

The following is the first in a series of articles that will focus on the principles that readers should keep in mind when critically considering the validity and applicability of results reported in the medical literature. We hope that this section will not only enhance the understanding and interpretation of information, but also will contribute to increased understanding of clinical research strategies and improved skill in the critical review process.

Some of the articles will be self-contained discussions of basic principles. Occasionally, methodological commentary will be provided for an article published in the same issue of Ophthalmic Surgery, as is the case with the following remarks on issues raised by Dr Kitazawa et al's study of the effect of apraclonidine on intraocular pressure after laser iridotomy. In this connection, lest our intent be misconstrued, let me hasten to add that we publish only what we believe are valuable articles. To comment on their strengths and weaknesses is only to bring into sharper focus what we already know about all studies: that they have limitations and that the better we understand those limitations, the better it will be for our research and for our patients.

-GLS
Wound Healing in an Animal Model of Glaucoma Fistulizing Surgery in the Rabbit
Authors: Miller M H , Grierson I , Unger W I , Hitchings R A
Published: April 2021

ABSTRACT

We developed a model of glaucoma fistulizing surgery in the rabbit. As is the case with wound healing in general, there was inflammation followed by repair. The sclerostomy and bleb closed due to bulk filling by granulation tissue and contraction by migratory fibroblasts observed at three days) and by myofibroblasts (observed at ten and 17 days). Fifty-eight percent of blebs had collapsed by ten days, and 94% by 17 days. The fibroblasts were migrating from the episcleral tissues, from the epimysium of the superior rectus, and from subconjunctival connective tissue. Intraocular pressure and facility of aqueous outflow were measured, but we concluded that intraocular pressure is not a reliable indicator of bleb function or of a patent sclerostomy in this model.
Problems Associated With Penetrating Keratoplasty for Corneal Edema in Congenital Glaucoma
Authors: Huang Samuel C M , Soong H Kaz , Brenz Richard M , Meyer Roger F , Sugar Alan
Published: April 2021

ABSTRACT

Corneal edema from congenital glaucoma is a rare indication for penetrating keratoplasty. We report the complications and problems associated with eight consecutive penetrating keratoplasties performed in adult eyes with a history of congenital glaucoma. Only 25% of the eyes achieved 20/40 or better vision after surgery. These generally poor results can be attributed to previous glaucomatous optic nerve damage, to complications related to previous surgery, and possibly to amblyopia. The most common surgical complication was postoperative elevation of intraocular pressure, which occurred in all the cases (8/8 eyes), and required permanent augmentation of glaucoma medications in seven eyes (88%), and glaucoma surgery in four eyes (50%). Two eyes (25%) developed corneal graft failure, one from immune rejection and the other from severe postoperative glaucoma necessitating cyclocryotherapy. In view of these complications and the multiple impediments to good postoperative vision, we advise that penetrating keratoplasty be reserved for patients with severe visual disability whose preoperative glaucoma is well controlled.
V to T Reconstruction of Anterior Lamellar Eyelid Defects
Authors: Harvey John , Corin Scott
Published: April 2021

ABSTRACT

A new method to reconstruct anterior lamellar pretarsal lid lesions is described. The cosmetic and functional results were excellent in all 12 patients. This method minimizes postoperative lid malposition.
Risk Factors Associated With Late Infection of Filtering Blebs and Endophthalmitis
Authors: Ashkenazi Isaac , Melamed Shlomo , Avni Isaac , Bartov Elisha , Blumenthal Michael
Published: April 2021

ABSTRACT

Late infection of filtering blebs and endophthalmitis are hazardous complications of glaucoma filtering surgery frequently associated with bleb failure and loss of functional vision. To determine possible risk factors for the development of these complications, characteristics of nine eyes of nine patients after filtering surgery in whom tate endophthalmitis developed were compared with those in patients who had received a comparable operation at the same time in whom endophthatmitis did not develop. An average of 7.7 ± 6.2 years (range, 6 months to 18 years) elapsed between the time of the filtering procedure and the initial appearance of endophthalmitis. Factors associated with increased risk were: increased axial length, thin and leaky bleb, conjunctivitis, upper respiratory infection, and the winter season.
A New Technique of Iridotomy in Extracapsular Cataract Extraction and Implantation
Authors: Alpar John J
Published: April 2021

ABSTRACT

In 1346 consecutive patients undergoing cataract surgery and intraocular lens implantation, we prospectively studied the complications associated with iris iridectomies or iridotomies as compared with those occurring when iris openings were made. We found that the transfixion of the iris with the discission knife is easy, relatively harmless, and prevents a number of complications seen when no iridectomy was performed or if a large iris opening had been made with scissors.
A Biomechanical Evaluation of Rabbit Corneas in M-K and Dexsol
Authors: Barron Brent C , Smolek Michael K , McCarey Bernard E
Published: April 2021

ABSTRACT

We compared the average force required to separate normal corneas at a 50% stromal depth, with the force required to separate corneas stored for 2, 5, 7, 10, and 14 days in either McCarey-Kaufman or Dexsol corneal storage medium. The required interlamellar separation force was calculated by standardizing the width of the test strips. The average required force for 35 fresh rabbit corneas (no storage) was 9.1 ±1.5 g/mm. There was no significant change in the required separation force after storage in either medium for up to 14 days.
Allograft Rejection After Penetrating Keratoplasty for Keratoconus
Authors: Girard Louis J , Esnaola Nestor , Rao Rosemary , Barnett Laura , El Maghraby Akef , Canizales Ruben
Published: April 2021

ABSTRACT

We retrospectively studied 91 penetrating keratoplasties in 65 patients to evaluate the overall incidence of allograft rejection and the incidence in unilateral as compared with bilateral cases following penetrating keratoplasty for keratoconus. All surgeries were performed by the senior author following a standardized technique. The average age of the patients was 35 years; the average follow up, 6.5 years. Nine of the 91 grafts (9.9%) were rejected. The time of rejection varied from 6 months to 13 years after surgery. Eight of the nine rejections (88.9%) were reversible with steroid treatment and have survived up to 10 years. One graft failure requiring repeat penetrating keratoplasty (1.1%) occurred 13.25 years after surgery. The unrejected clear grafts have survived up to 21.5 years. The results of this study support the excellent prognosis of penetrating keratoplasty for keratoconus.
Nd:YLF Laser Sclerostomy
Authors: Park Steve B , Kim Jae Chan , Aquavella James V
Published: April 2021

ABSTRACT

We used a Q-switched Nd:YLF picosecond laser, operating at the 1053-nanometer wavelength with a spot separation of 10 urn and a crossing width of 1000 x 10 µm in a rectangular pattern, to create ab externo sclerostomies in 12 New Zealand white rabbits. The mean energy used was 30 J (range, 24 to 65 J). Filtering blebs were observed for 1 week, with a concurrent drop in intraocular pressure. Histology performed at days 3, 10, and 30 revealed clean-cut sclerostomies, with minimal thermal and mechanical damage.
Retrobulbar Blockade of Somatic, Motor, and Visual Nerves by Local Anesthetics
Authors: Schimek Franz , Steuhl K Peter , Fahle Manfred
Published: April 2021

ABSTRACT

Somatosensory, motor, and visual sensory blockade were investigated after retrobulbar injection of 3 m L 2% lidocaine, prilocaine, or mepivacaine plus hyaluronidase (15 U/mL) and naphazoline nitrate (1:20 000) in 90 cataract patients (n = 30 per group). Before injection as well as 20 and 90 minutes after injection, and then every 30 minutes, the quality of the retrobulbar blockade was evaluated in terms of the following factors until full recovery of function: (1) cornea! sensitivity at the three extraincisional quadrants as determined with an esthesiometer; (2) horizontal and vertical motility, and elevation of the lid; (3) visual acuity on an arbitrary score scale ranging from 0 (no light perception) to 6 (visual acuity > 0.05); and (4) the time required for recovery from retrobulbar anesthesia. The data were analyzed by one- (anesthetic) and two-factor (anesthetic and time) analysis of variance.

Full somatic recovery of corneal sensitivity occurred within 247 ± 10.2 minutes after lidocaine, within 221 ± 9.2 minutes after prilocaine, and within 280 ± 8.5 minutes after mepivacaine (F = 10.1; P < .0001). Full motor recovery (all muscles) occurred within 290 ± 5.8 minutes after lidocaine, within 258 ± 5.7 minutes after prilocaine, and within 295 ± 4.8 minutes after mepivacaine (F = 13.3, P < .0001) On the average, visual acuity decreased most after mepivacaine and least after lidocaine administration, although the differences between the three anesthetics in this regard were not significant. One patient temporarily lost vision after mepivacaine administration.

Overall, the somatosensory and motor blockade were most pronounced after mepivacaine.