bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Long-term Results of Trabeculectomy From Early Postoperative Intraocular Pressure Levels
Authors: Asamoto Ayako , Yablonski Michael E , Matsushita Misuzu
Published: April 2021

* BACKGROUND AND OBJECTIVES: The authors retrospectively examined the potential for early postoperative intraocular pressure to predict the long-term results of initial trabeculectomies.

* PATIENTS AND METHODS: The records of 173 patients (207 consecutive eyes) who underwent initial trabeculectomies, which were performed by one of the authors between 1983 and 1991, with a minimum follow-up of 150 days were reviewed. Cases of trabeculectomy combined with cataract extraction were excluded.

* RESULTS: The intraocular pressure during postoperative week 1 was the same for patients with successful initial trabeculectomies (success group) as it was for patients with unsuccessful trabeculectomies (failure group). However, the intraocular pressure during the second, third, and fourth weeks was significantly higher in the failure group (P < .001). Laser suture lysis and 5-fluorouracil had no influence on the fact that high intraocular pressure during the first postoperative week had no prognostic significance.

* CONCLUSION: Positive results on postoperative Seidel tests did not predict a poor prognosis. However, high intraocular pressure after the first week may require intervention because it predicts a poor prognosis.

[Ophthalmic Surg Lasers 1996;27:355-360.]
Ocular Toxicity Following Topical Application of Anesthetic Cream to the Eyelid Skin
Authors: Cohen Robyn G , Hartstein Morris , Ladav Moshe , Woog John J
Published: April 2021

* BACKGROUND AND OBJECTIVE: The use of topical anesthetic cream in the periorbital region may be of clinical value. The potential for toxic effects from such use has not been studied in a controlled manner.

* This study was performed to evaluate the potential ocular toxicity of anesthetic cream topically applied to the eyelid in an animal model.

* MATERIALS AND METHODS: Ten rabbits underwent periorbital eutectic mixture of local anesthetics (EMLA) (2.5% lidocaine and 2.5% prilocaine) application and were observed for evidence of gross or microscopic ocular toxicity. Baseline external and anterior segment examinations were performed, including biomicroscopy and fluorescein staining, after which a standard quantity of EMLA cream (0.75 g) was applied along the upper eyelid and covered with an occlusive dressing. After 1 hour of treatment, the eyelid and anterior segment were examined for evidence of adverse reaction. The eyelids were excised and examined histopathologically.

* RESULTS: No significant adverse effects were noted on external lid and anterior segment examination. The histopathologic findings were within normal limits.

* CONCLUSIONS: This study suggests that external application of EMLA cream to the eyelid does not induce local toxicity in the rabbit model. The external application of EMLA cream may be safe in the periorbital region.

[Ophthalmic Surg Lasers 1996;27:374-377.]
The Effects of Subconjunctival Verapamil on Filtering Blebs in Rabbits
Authors: Gupta Balaji , Agarwala Ajay , Moy John J , Edward Deepak P
Published: April 2021

* BACKGROUND AND OBJECTIVE: Verapamil is a calcium antagonist that has been shown to modulate wound healing through multiple mechanisms. The wound modulating effects of verapamil were studied in a rabbit model of filtering surgery.

* MATERIALS AND METHODS: Twenty New Zealand albino rabbits underwent a fistulizing procedure, with either verapamil or saline injected subconjunctivally daily for 6 days following surgery. The animals were sacrificed at 20 days after the fistulizing procedure. The effectiveness of verapamil in modulating wound healing was evaluated by bleb patency testing, histology, measurement of scar thickness, and counts of bromodeoxyuridine (BrdU) -labeled cells at the sclerostomy site.

* RESULTS: The group treated with verapamil had a 44% patency rate compared with 10% in the control group (P < .05), a mean scar thickness of 1 95.96 ± 68 µ,p? compared with 313.55 ± 1 10.4 µ-rn in the control group (P < .02), and a mean BrdU-labeled cell count of 15.5 ± 14.7 compared with 26.3 ± 17.0 in the control group (P= .002).

* CONCLUSION: Verapamil was effective in reducing scar formation at the sclerostomy site. At the doses administered, verapamil appeared to modulate wound healing in filtering blebs in the rabbit model. Further studies are needed to determine the dose-response and the efficacy of the drug in nonhuman primates.

[Ophthalmic Surg Lasers 1996;27:378-383.]
An Alternative Method of Closed Silicone Intubation of the Lacrimal System
Authors: Henderson Peter N , McNab Alan A
Published: April 2021

Abstract. An alternative method of closed lacrimai intubation is described, the basis of which is to place the end of a piece of silicone tubing over the end of a small-diamecer metal introducer, stretch the silicone tubing back along the introducer, and then pass the introducer together with the tubing through the lacrimal system into the nasal cavity. The tubing is visualized in the inferior meatus, from where it is retrieved, and then the introducer is withdrawn. The other end of the tubing is passed in a similar fashion. The technique is easily mastered, inexpensive, and less traumatic than other described techniques, [Ophthalmic Surg Lasers 1996;27:401-404.]
Prevention of Accidental Intraocular Injection Following Inadvertent Needle Perforation of the Eyeball
Authors: Kraushar Marvin F , Cangemi Francis E , Morse Peter H
Published: April 2021

Abstract. To prevent accidental intraocular injection after inadvertent single needle perforation of the eyeball, the authors recommend moving the needle and watching for corresponding movement of the globe following peribulbar or retrobulbar placement of the needle and prior to injecting. The authors have found this technique to be safe and reliable, with negligible morbidity. [Ophthalmic Surg Lasers 1996;27:405-406.]
Use of Oversized Bandage Soft Contact Lenses in the Management of Early Hypotony Following Filtration Surgery
Authors: Smith M Fran , Doyle J William
Published: April 2021

* BACKGROUND AND OBJECTIVE: Initial overdrainage following filtration surgery can be frustrating to manage. The authors reviewed the records of 10 patients with early postoperative hypotony following filtration surgery who were treated with application of an oversized 17.0-mm bandage soft contact lens (BSCL).

* PATIENTS AND METHODS: Nine eyes had undergone trafaeculectomy with either mitomycin-C or 5-fluorouracil intraoperative application, and one eye had undergone tenonectomy 4 years following trabeculectomy. On postoperative day 1, seven eyes were hypotonous, and three other eyes became hypotonous following suture removal or lysis. An oversized 17.0-mm BSCL was placed immediately following the diagnosis of hypotony on all eyes except one, which had the BSCL applied after 24 hours of observation.

* RESULTS: In 9 of 10 cases intraocular pressure rose 5 to 12 mm Hg foUowing placement of the BSCL. During a 6- to 18-month follow-up, all successfully treated eyes had final intraocular pressures of 5 to 11 mm Hg, with extensive low to moderate height blebs.

* CONCLUSION: Oversized BSCLs can be a useful tool in the management of early hypotony following filtration surgery.

[Ophthalmic Surg Lasers 1996;27:417-421.]
The Use and Costs of Physician Services for Ophthalmic Surgical Procedures in 1988 and 1991
Authors: Javitt Jonathan C , Wang Fang , McBean A Marshall , Wang Qin , Metrick Sara , Glaser Stephen
Published: April 2021

* BACKGROUND AND OBJECTIVE: To examine the change in volume and costs of physician services for ophthalmic surgical procedures associated with physician fee cuts.

* MATERIALS AND METHODS: The authors analyzed the physician claims (Part B) data for a 5% random sample of the Medicare population. Number, rate, average allowed charge, and total cost of physician services for ophthalmic surgical procedures were compared for 1988 and 1991.

* RESULTS: An estimated 3.1 million (98 per 1000) ophthalmic surgical procedures were performed on Medicare beneficiaries in 1991, compared with 2.3 million (76 per 1000) in 1988. There was a 35% increase in number and a 28% increase in rate. The average allowed charge for these services decreased by 26% ($1155 vs $852 per procedure), with an overall cost of $2.6 billion in both years.

* CONCLUSION: A reduction in fee for physician services for ophthalmic surgical procedures from 1988 to 1991 was associated with an increase in the volume of the services. The overall costs of physician services for ophthalmic surgical procedures remained consistent between the two years.

[Ophthalmic Surg Lasers 1996;27:575-582.]
Progressive Increase in the Quantity of Deviation in Congenital Esotropia
Authors: Ing Malcolm R
Published: April 2021

* BACKGROUND AND OBJECTIVE: It was the author's clinical impression that many individuals with congenital esotropia demonstrated an increase in the quantity of deviation measured over time. The present study statistically examines the prevalence and quantity of increase in the amount of deviation measured for a consecutive series of patients with congenital esotropia prior to surgical alignment.

* PATIENTS AND METHODS: A retrospective chart review was conducted for patients treated during a 5-year period. Data were recorded for the initial and final measurements of the strabismus and the initial and final surgical plans prior to surgery. Also recorded were the age at surgery, length of observation before surgery, refraction, use of patching, and initial motor alignment outcome.

* RESULTS: Approximately 50% of 41 patients showed an average increase of 20 prism diopters (PD) in the quantity of the deviation when they were observed for an average of 3 months. The age at initial measurement, age at surgery, length of observation prior to surgery, refraction, or use of patching could not be used to identify patients with the increase in the amount of strabismus. However, in cases where the final surgical plan was based on the measurements made the day before surgery, 90% of the patients showed an initial surgical alignment to within 10 PD or orthotropia by 6 weeks postoperatively.

* CONCLUSIONS: These data indicate that a significant increase in the amount of preoperative deviation is very prevalent in patients being observed for congenital esotropia. This finding suggests that the timing of preoperative measurements is very important, and that the data collected close to the date of surgery are the most important with which to plan surgery.

[Ophthalmic Surg Lasers 1996;27:612-617-]
Combined Subretinal and Sub-Retinal Pigment Epithelium Neovascular Membranes in Age-Related Macular Degeneration: A Clinicopathologic Study of Six Cases
Authors: Mietz Holger , Merrill Pauline T , Lambert H Michael , Font Ramon L
Published: April 2021

* BACKGROUND AND OBJECTIVE: Subfoveal neovascular membranes are usually located either in the subsensory retinal space or below the retinal pigment epithelium (RPE). This article describes the clinical and histopathologic features of subfoveal membranes with both subretinal and sub-RPE components (combined membranes).

* PATIENTS AND METHODS: Six surgically excised subfoveal neovascular membranes from six patients were examined histopathologically. Preoperative and postoperative clinical information was obtained from each patient.

* RESULTS: Clinically, the combined membranes had no special characteristic features. The most common fluorescein angiographic finding postoperatively was a window defect of the RPE. Visual acuity improved in three patients and became worse in the other three patients.

* CONCLUSIONS: All patients with combined subfoveal neovascular membranes had age-related macular degeneration. In this disease, a single subfoveal membrane may extend into both the subretinal and the sub-RPE spaces. Patients may benefit from surgical removal of the membrane.

[Ophthalmic Surg Lasers 1997;28:645-652.]
Topical Mitomycin-C for Pterygia: Is Single Application Appropriate?
Authors: Rubinfeld Roy S , Stein Raymond M
Published: April 2021

* BACKGROUND AND OBJECTIVE: Mitomycin-C has been shown to dramatically reduce pterygium recurrence rates; however, its use has been associated with serious complications, especially in higher cumulative doses. The authors investigated the safety and efficacy of progressively reducing dosages of mitomycin-C as an adjunct to pterygium surgery.

* PATIENTS AND METHODS: Four hundred eighty-one consecutive primary and recurrent pterygia were surgically excised in a prospective nonrandomized trial using five different mitomycin-C dosages. Recurrence was defined as fibrovascular tissue over the corneoscleral limbus onto clear cornea in the area of previous pterygium excision.

* RESULTS: Seventy-seven patients in a control group without mitomycin-C had a recurrence rate of 65% with a mean follow-up of 33 months. A group of 77 patients treated with 0.4 mg/ml of mitomycin-C, four times per day for 2 weeks, had a recurrence rate of 2.5% with 6 (10%) serious complications (mean follow-up 34 months). A group of 22 patients treated with 0.2 mg/ml of mitomycin-C, four times per day for 10 days, had a recurrence rate of 55% with 3 (7.3%) non-vision-threatening complications (mean follow-up 32 months). A group of 16 patients treated with 0.2 mg/ml of mitomycin-C intraoperatively for 3 minutes without conjunctival closure had a recurrence rate of 44% with no complications (mean follow-up 35 months). Finally, a group of 289 patients treated with 0.2 mg/ml of mitomycin-C intraoperatively for 3 minutes with conjunctival closure had a recurrence rate of 2.7% and no complications (mean follow-up 26 months).

* CONCLUSION: Although the authors' results with single application are encouraging, the use of mitomycin for pterygia remains controversial. The biologic potency of this agent, the duration of its action, and the dearth of large-scale controlled, randomized trials demand cautious individual judgment by the surgeon when considering the use of this potent drug.

[Ophthalmic Surg Lasers 1997;28:662-669.]
A Method of Drop Administration
Authors: Morlet Nigel , Kelly Margaret , Morlet Geoffrey C
Published: April 2021

Abstract. Self-administering drops can be a daunting task for many patients. The authors describe a method of drop administration that allows a patient to accurately place drops without the need for special devices or touching the eye. With the bottle of drops held upside down, the back of the thumb is rested on the forehead to stabilize the bottle. The bottle tip can be seen over the eye. The other hand retracts the inferior lid to catch the drop. Poor compliance is common and is often caused by difficulties with drop administration. This simple technique may improve compliance. [Ophthalmic Surg Lasers 1997;28:687-689.]
Evaluation of Visual Function Following Argon Laser Photocoagulation in Central Serous Retinopathy
Authors: Khosla P K , Rana S S , Tewari H K , Azad R U , Talwar Dinesh
Published: April 2021

Abstract. The authors of previous studies on the role of photocoagulation for central serous chorioretinopathy (CSR) have based their deductions on the premise that a Snellen visual acuity of 6/6 is the end point of recovery. It is now known that patients with a visual acuity of 6/6 may have defective contrast sensitivity indicative of a visual function deficit. The present study was a prospective, controlled, and randomized evaluation of patients suffering from their first attack of CSR, in which contrast sensitivity was used to determine the effectiveness of argon laser photocoagulation as compared with more conservative treatment. Although long-term studies are necessary, the results of this study showed that while photocoagulation increases the rate of recovery for visual acuity, it is also linked with significant loss and slower recovery of contrast sensitivity. [Ophthalmic Surg Lasers 1997;28:693-697.]
Silicone Versus Polymethylmethacrylate Intraocular Lenses With Regard to Capsular Opacification
Authors: Olson Randall J , Crandall Alan S
Published: April 2021

* BACKGROUND AND OBJECTIVE: The authors conducted a 3-year randomized trial to compare silicone intraocular lenses (IOLs) with polymethylmethacrylate (PMMA) IOLs, to determine any differences in laser capsulotomy rates, capsular opacification light scatter, and subjective scoring.

* PATIENTS AND METHODS: A total of 119 patients were enrolled, 84 of whom were examined at 3 years. The authors designed a prospective, masked, and randomized trial to compare the objective (lens opacity meter), subjective (slit-lamp scoring), and clinical parameters of the posterior capsular opacification (PCO) of these patients.

* RESULTS: The silicone group had less PCO than the PMMA group, according to objective (8.6% vs. 10.4%; P= .02, Student's t test) and subjective scoring (0.88 vs. 1.79; P= .0001, Students t test). The laser capsulotomy rate was 24% for the silicone group and 33% for the PMMA group; however, this difference was not statistically significant.

* CONCLUSION: The silicone IOL was associated with less PCO than the PMMA IOL.

[Ophthalmic Surg Lasers 1998;29:55-58.]
Effects of the Long-term Use of Perfluoroperhydrophenanthrene on the Retina
Authors: Batman Cosar , Cekic Osman
Published: April 2021

Abstract. Perfluorocarbon liquids have gained wide acceptance as intraoperative tools that can simplify vitreoretinal surgical maneuvers. These low-viscosity liquids facilitate injection into the eye and removal from the eye during surgery. Tolerance to perfluoroperhydrophenanthrene and the development of proliferative vitreoretinopathy with its extended use are not clear. The authors present the clinical and histologic findings of a patient, previously lost to follow-up, who was examined after several weeks of intraocular tamponade with perfluoroperhydrophenanthrene. Damage to the retina was seen in response to the long-term postoperative use of perfluoroperhydrophenanthrene. [Ophthalmic Surg Lasers 1998;29:144-146.]
Ultrasound Biomicroscopy in the Clinical Evaluation of Ab Externo Holmium:YAG Laser Sclerostomies
Authors: Mannino Giuseppe , De Bella Francesco , Pantaleoni Francesco Bozzoni , Pescosolido Nicola , Gabrieli Corrado Balacco
Published: April 2021

Abstract. High-frequency ultrasound biomicroscopy (UBM) has extensive powers of resolution. This makes it possible to explore and study some areas of the anterior segment with a clarity close to that of histologic preparations. High-frequency UBM was used in the clinical evaluation of 10 glaucomatous eyes subjected to ab externo holmium:yttrium-aluminum-garnet (Ho:YAG) laser sclerostomy. The anatomic characteristics of the fistular paths were viewed and compared with echographic images. The authors demonstrated that in the 5 cases where the filtering bleb, fistular path, and internal ostium were present, there was a reduction of intraocular pressure. UBM is a high-definition diagnostic instrument in the follow-up of fistular paths and filtering blebs after Ho:YAG laser sclerostomy, making it possible to reoperate at an early stage before the onset of clinical manifestations. [Ophthalmic Surg Lasers 1998;29:157-161.]
A Muscle-Clamping System With an Absorbable Jaw Clip to Reduce Suturing in Strabismus Surgery
Authors: Min Byung-Moo , Kim Seung-Young , Yang Jun-Mook
Published: April 2021

Abstract. Most of the ocular complications of strabismus surgery are related to needle trauma during the suturing of muscles. The authors have developed a muscle-clamping system with an absorbable jaw clip to facilitate exact techniques of eye muscle surgery and to reduce the risk of complications. The absorbable jaw clip is composed of a lower fixing body with three jaws and an upper supporting body. The clip is used to tie an extraocular muscle (which is moved and reattached with the membrane) with a single scleral bite. Using the absorbable jaw clip, the authors performed superior rectus recession on 16 eyes of eight rabbits. The authors examined the conjunctival injection, muscle adhesion power, and light microscopic findings at 1, 2, 4, and 8 weeks postoperatively. The conjunctival injection diminished with time. Bond strengths ranged from 380 to 620 gram gravity, which is sufficient to withstand the normal pull of human extraocular muscles. Some inflammatory cells were found microscopically, and fibrosis increased with time. The muscle-clamping method with the newly invented clip was technically easy, fast, and exact, and it may reduce suturing and complications during strabismus surgery. [Ophthalmic Surg Lasers 1998;29:162-166.]
Outcomes of Vitreoretinal Surgery in Patients With X-Linked Retinoschisis
Authors: Rosenfeld Philip J , Flynn Harry W , McDonald H Richard , Rubsamen Patrick E , Smiddy William E , Sipperley Jack O , Boniuk Isaac , Packer Andrew J
Published: April 2021

* BACKGROUND AND OBJECTIVE: To assess the outcomes of vitreoretinal surgery in the treatment of vision-threatening posterior segment complications of X-linked retinoschisis.

* PATIENTS AND METHODS: The authors performed a retrospective analysis of 16 eyes from 11 patients who underwent vitreoretinal surgery. All the patients had a documented positive family history of X-linked retinoschisis, and all patients had bilateral macular disease.

* RESULTS: The ages of the patients ranged from 14 months to 37 years (mean age 15.1 years; median age 11.5 years), and postoperative follow-up ranged from 3 months to 10 years (mean 2.8 years; median 1 year). The indications for surgical intervention included rhegmatogenous retinal detachment (12 eyes), vitreous hemorrhage (2 eyes), progression of the schisis cavity through the fovea (2 eyes), cataract associated with a persistent hyperplastic primary vitreous-like condition (2 eyes), and exudative maculopathy (1 eye). The primary surgical intervention included pars plana vitrectomy alone (7 eyes), pars plana vitrectomy and pars plana lensectomy (4 eyes), and a scleral buckle procedure alone (5 eyes). Surgical success (defined as reattachment of the retina, removal of media opacities, or arrest of schisis progression) was achieved in 14 of 16 eyes, after an average of 1 .2 procedures per eye. The major reason for reoperations was recurrent retinal detachment due to proliferative vitreoretinopathy. Two eyes were eventually enucleated due to pain associated with neovascuiar glaucoma resulting from recurrent retinal detachment. Of the remaining 14 eyes, visual acuity improved in 8 eyes and remained unchanged in 6 eyes.

* CONCLUSION: Vitreoretinal surgery is often helpful in stabilizing or improving visual function in patients with posterior segment complications from X-linked retinoschisis.

[Ophthalmic Surg Lasers 1998;29:190-197.]
The Progressive Outer Retinal Necrosis Syndrome: Successful Treatment With Combination Antiviral Therapy
Authors: Ciulla Thomas A , Rutledge Bryan K , Morley Michael G , Duker Jay S
Published: April 2021

* BACKGROUND AND OBJECTIVE: To assess a two-drug combination of antiviral therapy for the progressive outer retinal necrosis syndrome (PORN), given the current poor outcome with acyclovir alone.

* PATIENTS AND METHODS: A retrospective review was performed on six consecutive patients who were diagnosed with PORN and were treated with various combinations of intravenous or oral plus intravenous antiviral therapy. The relative efficacies of these modalities were compared.

* RESULTS: Six eyes of six patients showed active retinitis at the time of presentation. Three patients had unilateral retinitis, and the remaining patients had necrotic, end-stage disease in their fellow eye. All the patients were treated with combination therapy, consisting of either ganciclovir and acyclovir (three patients), foscarnet and ganciclovir (two patients), or foscarnet and acyclovir (one patient). Standard induction doses were employed. During the combination therapy, all six eyes showed resolution of the retinitis, manifested by complete fading of the original retinal lesions and an absence of new lesion formation. At the final follow-up, the areas of prior active retinitis had resolved and remained quiescent. A mild recurrence developed in one eye when ganciclovir and foscarnet were both tapered to a single daily dose. This recurrence promptly resolved with reinduction (twice daily) dosing. Two patients maintained a visual acuity of 20/50 or better in their involved eye for the duration of follow-up (38 and 27 weeks, respectively). One patient maintained a visual acuity of 20/40 for 14 weeks. The remaining three patients had maculaoff retinal detachments despite resolution of active retinitis. In addition, for the duration of follow-up, one of the three patients with unilateral disease had retinitis in the uninvolved eye; all three uninvolved fellow eyes maintained a visual acuity of 20/20. One patient had progressive optic atrophy.

* CONCLUSIONS: Prolonged combination antiviral therapy for PORN may successfully arrest the progression of retinitis, maintain remission, and prevent involvement of the fellow eye. Furthermore, if aggressive therapy is begun early, good vision may be preserved.

[Ophthalmic Surg Lasers 1998;29:198-206.]
The Course of Age-Related Macular Degeneration Following Bilateral Cataract Surgery
Authors: Pollack Ayala , Bukelman Amir , Zalish Miriam , Leiba Hana , Oliver Moshe
Published: April 2021

* BACKGROUND AND OBJECTIVE: Progression of age-related macular degeneration (AMD) following cataract surgery has been described. The aim of this study was to investigate whether an uneventful postoperative maculopathic course in one eye (the first eye) may predict a similar prognosis for the fellow eye (the second eye).

* PATIENTS AND METHODS: Thirty-three patients with bilateral, similar, early AMD (defined by the presence of drusen and/or pigmentary abnormalities on fundal examinations and by the absence of late leakage as documented by fluorescein angiography) who had undergone unilateral cataract surgery, had had a stable postoperative maculopathic course following the first operation, and were scheduled for cataract surgery in the second eye were prospectively observed for at least 1 year after the second operation. The course of maculopathy of the second eye was compared with that of the first eye during the followup period of the second eye.

* RESULTS: A total of 9 of the second eyes (27.2%) showed progression to wet AMD. Of these, 1 patient (3%) had progression in both eyes and 8 patients (24.2%) had progression in the second eye only. The conditions of 2 of the first operated on eyes (6.1%) deteriorated (P < .05). Hypertension (P < .05), soft drusen (P < .01), and Nd: YAG laser capsulotomy (P < .05) were risk factors for development of wet AMD.

* CONCLUSION: In this study, 24.2% of the patients with early AMD who underwent bilateral cataract surgery and had an uneventful maculopathic course in the first eye had wet AMD in the second eye. Thus, patients with early AMD and soft drusen undergoing bilateral cataract surgery should be monitored for early detection of progression of maculopathy. Further prospective studies are needed to determine the course of maculopathy following cataract surgery.

[Ophthalmic Surg Lasers 1998;29:286-294.]
The Effects of RGD (Arg-Gly-Asp) Peptides on Glaucoma Filtration Surgery in Rabbits
Authors: Avila Marcel , Ortiz Gabriel , Lozano Jose M , Franco Pedro , de Pérez Gloria , Patarroyo Manuel E
Published: April 2021

* BACKGROUND AND OBJECTIVE: Integrins are the main mediators of the interaction between fibroblasts and extracellular matrix (ECM) during scar formation. The adhesion motive RGD (Arg-Gly-Asp) is contained in the ECM and is recognized by the integrin receptor. Soluble peptides containing the RGD sequence can compete with -RGD- contained in the ECM for binding to the integrin receptor and thus prevent cell adhesion and scar formation.

* MATERIALS AND METHODS: The peptides RGD (p602), GRGDSP (p603), GRGDSPCA (p604), and GGRGDSPCA (p605) were used in 25 glaucoma filtering surgeries in rabbits (five eyes per peptide and five with saline).

* RESULTS: Postoperative subconjunctival injections of peptides were given at days 0, 4, 8, 12, and 16. Bleb size, bleb survival, and signs of toxicity were examined. The GRGDSPCA and GGRGDSPCA showed an increase in bleb formation, size, and survival with no clinical signs of toxicity compared with controls (P < .008). Histopathologic evaluation confirmed inhibitory effects in scar formation with bleb formation, and transmission electron microscopy demonstrated that there was no toxicity to the ciliary body.

* CONCLUSION: These peptides were effective in controlling scar formation in glaucoma filtering surgery.

[Ophthalmic Surg Lasers 1998;29:309-317.]
Recalcitrant Malignant Glaucoma Following Pars Plana Vitrectomy, Scleral Buckle, and Extracapsular Cataract Extraction With Posterior Chamber Intraocular Lens Implantation
Authors: Zacharia Peter T , Abboud Emad B
Published: April 2021

Abstract. Pars plana vitrectomy is employed to treat cases of aqueous misdirection that are refractory to medical and laser treatment. The authors describe a 65-year-old man without previous aqueous misdirection in whom this condition developed after a procedure that included pars plana vitrectomy. The aqueous misdirection recurred despite multiple interventions, including medical treatment, transiently successful Nd:YAG laser capsulo- hyaloidotomy, and surgical disruption of the anterior hyaloid face. It finally resolved after repeated pars plana vitrectomy with hyaloido-capsulo-iridectomy. There has been no recurrence 7 months after this procedure. The authors conclude that the surgical treatment of aqueous misdirection refractory to more conservative measures should include adequate disruption of the anterior hyaloid to prevent recurrence. [Ophthalmic Surg Lasers 1998;29:323-327.]
Exudative Retinal Detachment in X-Linked Retinoschisis
Authors: Fong Donald S , Frederick Albert R , Blumenkranz Mark S , Walton David S
Published: April 2021

Abstract. X-linked retinoschisis is a vitreoretinal dystrophy characterized by foveal and peripheral retinoschisis in the nerve fiber layer. Although many associated peripheral retinal findings have been reported, few reports have described massive exudative retinal detachments in patients with X-linked retinoschisis. The authors report the unusual occurrence of Coats'-like exudative retinopathy in two patients with X-linked retinoschisis. Both patients had peripheral massive exudative retinal detachments. [Ophthalmic Surg Lasers 1998;29:332-335.]
An Intraocular Foreign Body Masquerading as Idiopathic Chronic Iridocyclitis
Authors: Alexandrakis George , Balachander Ragupathy , Chaudhry Nauman A , Filatov Vadim
Published: April 2021

Abstract. The authors report a case of presumed idiopathic chronic iridocyclitis in which an intraocular foreign body (IOFB) was finally identified. There was no history of prior eye trauma. Ophthalmologic and laboratory evaluations were inconclusive. Seven months following unsuccessful medical treatment of the iritis and given the patients occupational history, a skull x-ray was performed followed by computed tomography of the orbits. A metallic IOFB was identified in the pars plicata and was surgically removed with resolution of the inflammation. The possibility of an IOFB should always be entertained in idiopathic iridocyclitis refractory to medical treatment, even when there is no history of ocular trauma. [Ophthalmic Surg Lasers 1998;29:336-337.]
Bacterial Contamination of the Pressure Receiver of a Vitrectomy Machine
Authors: Janknecht Peter , Kappstein Ines
Published: April 2021

Abstract. On a routine sterility check, the authors found bacteria in their vitrectomy machine. Serratia marcescens was detected in the pressure receiver of a roller pump vitrectomy machine. The authors improved the machine by installing a millipore filter in front of the receiver that prevents bacteria from entering it without interfering with the pressure measurements. The origin of Serratia was probably a patient with endophthalmitis who was operated on long before the routine check. Although this appears to be the first report of a bacterial contamination of a vitrectomy machine, the results of testing show that this situation is indeed possible. The authors strongly recommend routine checks of the equipment and suggest mounting an antibacterial filter. [Ophthalmic Surg Lasers 1998;29:345-347.]
In Vitro Evaluation of the Efficacy of the Capsular Tension Ring for Managing Zonular Dialysis in Cataract Surgery
Authors: Sun Ran , Gimbel Howard V
Published: April 2021

* BACKGROUND AND OBJECTIVE: In vitro evaluation of the capsular tension ring for managing zonular dialysis in cataract surgery.

* MATERIALS AND METHODS: Pig and cadaver eye models were used in this study. Lens material was removed with phacoemulsification, then the zonules were cut in one quadrant of the meridian to induce capsular bag decentration. Posterior chamber intraocular lenses (PC IOLs) were implanted into the bag with or without the tension rings. The IOL and the tension ring positions were viewed using the Miyaki technique. PC IOLs were also implanted into isolated capsular bags with or without tension rings, and bag configuration was examined.

* RESULTS: The IOL decentration was observed when the IOLs were implanted into the eyes without zonular support in one quadrant of the meridian. No IOL decentration was observed when the tension ring and the IOL were implanted together. When only the IOLs were inserted into the isolated bags they became oval, whereas the circular bags were preserved when both the IOL and the tension ring were placed in-the-bag.

* CONCLUSION: The authors' in vitro model demonstrated that the capsular tension ring maintained the circular contour of the capsular bag and IOL centration in the eyes with broken zonules. The results suggest that capsular tension rings may provide an alternative means to manage zonular dialysis during phacoemulsification and PC IOL implantation.

[Ophthalmic Surg Lasers 1998;29:502-505.]
A Randomized Double-Masked Trial Comparing Ketorolac Tromethamine 0.5%, Diclofenac Sodium 0.1%, and Prednisolone Acetate 1% in Reducing Post-Phacoemulsification Flare and Cells
Authors: El-Harazi Sherif M , Ruiz Richard S , Feldman Robert M , Villanueva Guillermina , Chuang Alice Z
Published: April 2021

* BACKGROUND AND OBJECTIVE: To compare the efficacy of ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, and prednisolone acetate 1% in reducing flare and cells following cataract surgery.

* PATIENTS AND METHODS: Fifty-eight patients undergoing phacoemulsification with posterior chamber intraocular lens implantation were randomly selected to receive either ketorolac tromethamine 0.5%, diclofenac sodium 0.1%, or prednisolone acetate 1 % following surgery. The treatment regimen was 1 drop 4 times a day for 1 week, then twice a day for the next 3 weeks. Flare, cells, and intraocular pressures (IOPs) were measured preoperatively and on postoperative days 1, 7, and 28.

* RESULTS: No statistically significant differences in either actual flare or cell counts or in change in flare or cell counts from baseline were detected among the three groups. No statistically significant differences in IOP or in change of IOP from preoperative measurements were detected. No medication-related complications were noted at any time.

* CONCLUSION: Ketorolac tromethamine 0.5% and diclofenac sodium 0. 1% may be as effective and as safe as prednisolone acetate 1% in controlling inflammation following cataract extraction.

[Ophthalmic Surg Lasers 1998;29:539-544.]
Trabeculectomy With Intraoperative 5-Fluorouracil
Authors: Sidoti Paul A , Choi James C , Morinelli Elisa N , Lee Paul P , Baerveldt George , Minckler Don S , Heuer Dale K
Published: April 2021

* BACKGROUND AND OBJECTIVE: To investigate the outcome and complication rates of trabeculectomy following the combined use of intraoperative, topical 5-fluorouracil (5-FU) and low-dose, postoperative subconjunctival 5-FU injections.

* PATIENTS AND METHODS: Forty-one eyes of 41 patients with advanced, medically uncontrolled glaucoma underwent trabeculectomy with intraoperative episcleral application of 5-FU (50 mg/ml for 5 minutes). A variable number of subconjunctival 5-FU injections were administered postoperatively at the discretion of the operating surgeon.

* RESULTS: Six-, 12-, and 15-month life-table success rates (5 mm Hg ≤ intraocular pressure [IOP ≤ 21 mm Hg) were 100%, 97%, and 83%, respectively. Mean postoperative IOP was 12.1 ± 4.3 mm Hg. An average of 2.2 ± 1.6 (range 0 to 7) supplemental subconjunctival 5-FU injections were administered postoperatively. Corneal epithelial erosions developed in 7 (17%) of the eyes. Five of 7 patients who underwent subsequent surgical procedures maintained successful control of IOP at an average of 11.0 ± 4.8 (range 5 to 16) months after the secondary surgery.

* CONCLUSION: Trabeculectomy with intraoperative 5-FU is effective in controlling IOP while possibly minimizing the need for frequent postoperative injections and the occurrence of corneal epitheliopathy.

[Ophthalmic Surg Lasers 1998;29:552-561.]
Phacotrabeculectomy With "Smile" Incision, Punch, and Single Releasable Suture
Authors: Manners Timothy D
Published: April 2021

* BACKGROUND AND OBJECTIVE: To describe and prospectively evaluate a technique of phacotrabeculectomy consisting of a "smile" wound, corneal punch, and tight closure of the scleral flap with a single releasable suture.

* PATIENTS AND METHODS: A cohort of 25 patients underwent this procedure performed by a single surgeon. The surgical technique is described and the first year of follow-up is evaluated.

* RESULTS: Mean intraocular pressure (IOP) was 25.4 mm Hg preoperatively and 16.2 mm Hg at a mean follow-up of 10.2 months (a fall of 36%). Incidence of immediate postoperative complications was low, especially those related to hypotony (wound leak, shallow anterior chamber, fibrinous uveitis). There was a 50% incidence of postoperative IOP spikes of greater than 26 mm Hg. Three cases were deemed partial failures at 1 year (IOP < 21 mm Hg on medical treatment), and three cases were complete failures (IOP > 21 mm Hg or further surgery required).

* CONCLUSION: The tight scleral flap and routine release of the releasable suture on the third postoperative day reduce immediate postoperative complications compared with other studies, with the exception of IOP spikes. The lack of aqueous flow in the immediate postoperative phase may be a factor in the failure rate, which is higher than expected.

[Ophthalmic Surg Lasers 1998;29:570-574.]
Inhibition of Migrating Lens Epithelial Cells at the Capsular Bend Created by the Rectangular Optic Edge of a Posterior Chamber Intraocular Lens
Authors: Nishi Okihiro , Nishi Kayo , Sakanishi Kohtaro
Published: April 2021

* BACKGROUND AND OBJECTIVE: To study the mechanism of the reportedly low incidence of posterior capsule opacification (PCO) in eyes treated with a posterior chamber intraocular lens (PC IOL).

* MATERIALS AND METHODS: Various IOL designs, including the PC IOL, were studied using scanning electron microscopy. Rabbit lens capsules were studied histopathologically 2, 3, and 4 weeks after implantation of a PC IOL in one eye and a biconvex polymethylmethacrylate (PMMA) IOL in the contralateral eye as a control.

* RESULTS: The optic edge of the PC IOL was sharp and rectangular, whereas that of the biconvex PMMA or silicone IOLs from various manufacturers had been smoothed and rounded by polishing. PCO was significantly reduced in the eye with a PC IOL in all rabbits. The lens capsule wrapped tightly around the optic edge of the PC IOL so that it conformed to the same shape and thereby created a distinct rectangular bend in the capsule or a rectangle between the optic edge and the posterior capsule. Migrating lens epithelial cells (LECs) were obviously inhibited at that site.

* CONCLUSIONS: A discontinuous capsular bend or rectangle created by the sharp, square optic edge of the PC IOL may have induced contact inhibition to migrating LECs and reduced PCO. How, whether, and to what extent this design-dependent effect is influenced by features of the IOL material needs to be clarified by comparison with results achieved with an IOL made from the same material in a different design and vice versa.

[Ophthalmic Surg Lasers 1998;29:587-594.]
Primary Pterygium Surgery Using the Inferior Conjunctival Transposition Flap
Authors: Kim Sangduck , Yang Yunsik , Kim Jaeduck
Published: April 2021

Abstract. The authors investigated a surgical method for primary pterygium without adjunctive therapy and devised a technique called the inferior conjunctival transposition flap. The procedure was performed by making a flap of the inferior conjunctiva after excision of the pterygium, and transpositioning it to make a covering for the bare sclera and donor site and a barrier to pterygium tissue. This method has been used on 54 eyes of 50 patients (mean age 47 years, range 18 to 69 years) with primary pterygium. All of these patients were treated by one surgeon. During a follow-up period of 12 to 26 months (mean 20 months), the pterygium recurred in 3 (5.6%) of the 54 eyes. In all other cases good anatomic and cosmetic results were achieved without any serious complications. The authors concluded that the inferior conjunctival transposition flap is an encouraging technique for the treatment of primary pterygium. [Ophthalmic Surg Lasers 1998;29:608-611.]
The Effects of Topical Steroids on Refractive Outcome and Corneal Haze, Thickness, and Curvature After Photorefractive Keratectomy With a 6.0-mm Ablation Diameter
Authors: Aras Cengiz , Özdamar Akif , Aktunç Rengin , Erçikan Celal
Published: April 2021

* BACKGROUND AND OBJECTIVE: To study the effect of topical prednisolone acetate after photorefractive keratectomy (PRK) using a 6.0-mm ablation diameter on the refractive and visual outcomes, corneal haze, corneal thickness, and corneal curvature in a prospective, double-masked, randomized manner.

* PATIENTS AND METHODS: Seventy-two eyes of 36 patients who had excimer laser PRK for correction of myopia ranging from -3.00 to -6.00 D (-4.11 ± 0.84 D in eyes treated with steroids and -4.38 ± 0.79 D in eyes treated with placebo; mean ± SD) were enrolled. PRK procedures were performed using a 193-nm argo n-fluo ride excimer laser with 180-mj/cm
p 2
fluence, a 10-Hz repetition rate, and a 6.0-mm ablation diameter. One eye of each patient was treated with the steroid (prednisolone acetate) and the other eye with placebo. Patients were observed for at least 12 months after PRK.

* RESULTS: There was no statistically significant difference between the steroid and the placebo groups with regard to refraction measurements that were taken postoperatively at 3 months (P = .39) and 12 months (P = .51). The corneas showed an increase in thickness after PRK in both groups, but the difference was not statistically significant at 12 months postoperatively (P = .45). The corneal haze score was not statistically different at any stage between groups (P = .30 at 3 months, P = .84 at 12 months). Keratometric data derived from corneal topography did not show any statistically significant difference (P = .85 at 3 months, P = .96 at 12 months). The rate of uncorrected visual acuity of 20/40 or more was 79.4% (27 eyes) in the steroid group and 70.5% (24 eyes) in the placebo group (P = .40). The rate of loss of 2 or more lines in best spectacle-corrected visual acuity was 5.85% (2 eyes) in the steroid group and 8.8% (3 eyes) in the placebo group (P = 1.0).

* CONCLUSION: Topical prednisolone acetate use for 3 months after PRK with a 6.0-mm ablation diameter has no effect on refractive and visual outcome, corneal haze, corneal thickness, and corneal curvature.

[Ophthalmic Surg Lasers 1998;29:621-627.]
Synthetic Meshwork Implant for Glaucoma Filtering Surgery: Effect of Adjunct Heparin and Sodium Hyaluronate in Rabbits
Authors: Kondo Hiroyuki , Fantes Francisco , Kato Hirohiko , Gautier Sandrine , Parel Jean-Marie
Published: April 2021

* BACKGROUND AND OBJECTIVE: To evaluate the efficacy of a novel filtering implant, a synthetic meshwork (MESH), with or without heparin or sodium hyaluronate amendment.

* MATERIALS AND METHODS: Eighteen eyes of 18 rabbits received MESH surgery. The eyes were divided into three subgroups. Six eyes received the MESH implant with no modification (group 1), 6 eyes received MESH saturated with heparin (group 2), and 6 eyes received MESH with sodium hyaluronate administration into the anterior chamber during surgery (group 3). Intraocular pressure (IOP) and outflow facility were measured during a period of 6 months.

* RESULTS: The MESH-implanted eyes showed lower IOP and higher outflow facility than control eyes up to postoperative days 119 and 49, respectively (P > .05). Earliest functional failure was seen in group 3 and latest in group 2.

* CONCLUSION: MESH implant surgery showed a long-term efficacy in reducing IOP. The beneficial effects of added heparin were limited. Sodium hyaluronate administration reduced the efficacy of the implant device.

[Ophthaimic Surg Lasers 1998;29:669-676.]
Ellipsoidal Fitting of Corneal Topography Data After Arcuate Keratotomies With Compression Sutures
Authors: Langenbucher Achim , Seitz Berthold , Kus Murat M , Vilchis Ernesto , Küchle Michael
Published: April 2021

* BACKGROUND AND OBJECTIVE: After paired arcuate keratotomies and compression sutures (AK) for treatment of high postkeratoplasty astigmatism, corneal topography tends to be irregular. The purpose of this study was to demonstrate a mathematical method for approximation of discrete corneal topography power data with an ellipsoid for better appreciation of the clinical outcome after AK.

* PATIENTS AND METHODS: Thirty-one eyes of 28 consecutive patients who underwent AK for excessive postkeratoplasty astigmatism were studied. Regular keratometry, corneal topography (TMS-1), subjective refraction, and best-corrected visual acuity (VA) were assessed preoperatively and at 1 week and 1 year postoperatively. A simplex algorithm was applied for fitting an ellipsoidal surface to raw corneal topography power data. A set of parameters (meridional power, axis, and asphericity) were calculated. The cylinder of subjective refraction was correlated with the keratometric readings, the simulated keratometry (SimK) of the topography system, and the respective parameters of the model surface.

* RESULTS: Keratometric astigmatism and the cylinder of the model surface decreased from 8.1 ± 3.2 and 7.9 ± 2.9 D preoperatively to 4.5 ±2.1 and 5.3 ± 2.0 D after 1 year, respectively. The asphericity in both meridional cross sections changed from a prolate ellipse preoperatively to an ablate ellipse at the early postoperative follow-up stage. Regarding the cylinder axis, there was a significant correlation of the model surface with the refractive cylinder at all examinations (P < .05), whereas there was no significant correlation of the SimK axis and the refractive cylinder axis.

* CONCLUSION: The approximation of corneal topography power data with an ellipsoidal model surface renders reconstruction of clinically relevant corneal topography parameters, including corneal asphericity with a marked data compression. Even in markedly irregular corneal surfaces, such as after AK, the correlation of amount/axis of refractive cylinder with the model surface parameters is more accurate than it is with respective SimK values of corneal topography analysis.

[Ophthalmic Surg Lasers 1998;29:738-748.]
Corneal Marginal Ulcer in Relapsing Polychondritis: Treatment With Keratoepithelioplasty
Authors: Kato Takuji , Yamaguchi Tatsuo , Hamanaka Teruhiko , Kanai Atsushi
Published: April 2021

Abstract. This article describes a case of corneal marginal ulcer caused by relapsing polychondritis (RPC) that was treated with keratoepithelioplasty. The patient underwent keratoepithelioplasty with lamellar keratoplasty in the left eye. No relapse occurred in the nasal side in which corneal lenticules were grafted, whereas vascular invasion developed in the temporal side in which no lenticules were grafted. Keratoepithelioplasty was an effective surgical procedure to prevent a recurrence of corneal marginal ulcer in a patient with RPC. [Ophthalmic Surg Lasers 1998;29:767-769.]