bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultraviolet Corneal Photoablation
Authors: Manns Fabrice , Milne Peter , Parel Jean-Marie
Published: April 2021

ABSTRACT

PURPOSE: The purpose of this article is to discuss missing information on the basic physical and biological processes of ultraviolet corneal photoablation and to evaluate its potential clinical implications.

METHODS: A physical description of ultraviolet laser corneal ablation that includes photothermal, photochemical, and radiative processes is proposed.

RESULTS: Unresolved issues include the nature of the primary ablation process, the tissue and biological effects of the photothermal and photochemical components of the interaction, and the static and dynamic absorption process.

CONCLUSIONS: A better understanding of the basic physics and biology of ultraviolet corneal photoablation may help us better understand, predict, and perhaps minimize the effect of tissue hydration, plume formation, and other factors that affect the predictability of ablation and the induced tissue damage. [J Refract Surg 2002;18:S610-S614]
Experimental Results of Preparing Laser-shaped Stromal Implants for Laser-assisted Intrastromal Keratophakia in Extremely Complicated Laser in situ Keratomileusis Cases
Authors: Jankov Mirko , Mrochen Michael C , Bueeler Michael , Seiler Theo
Published: April 2021

ABSTRACT

PURPOSE: To evaluate the feasibility of lasershaped stromal implants from a donor eye for correcting extreme high hyperopia with irregular astigmatism and an exceptionally thin corneal bed.

METHODS: Thirty-one fresh enucleated porcine eyes were used. The procedure was initiated with mechanical de-epithelialization followed by a lamellar cut with a microkeratome, resulting in a hinged flap (thickness 150 µm, diameter 9.5 mm). The cornea was photoablated with PRK treatment for +8.00 D sphere (hyperopic lenticule group) and -5.00 D sphere (myopic group) by a scanning spot excimer laser. A customized scanning software algorithm was used to create a circumferential cut with a 6.5-mm internal diameter. The lenticule was removed from the stromal bed and measured by a surface profiling system. A clinical case was performed on a patient with previous LASIK and highly irregular hyperopic astigmatism to verify the clinical utility of the experimental setup.

RESULTS: Under the microscope, lenticules seemed round, regular, and transparent. The average surface profile of porcine corneas demonstrated good parabolic shape with individual variations as large as 30 µm, probably due to the corneal size and curvature differences between the porcine eye and the human eye- for which the microkeratome is designed. The patient underwent a topographyguided treatment after laser-assisted intrastromal keratophakia (LAIK) and 1-month follow-up showed an increase of VCVA, BSCVA, and central corneal thickness.

CONCLUSIONS: The use of modern scanningspot excimer lasers and mi crokera tomes enabled us to produce stromal lenticules of good quality, which might be acceptable to implant into a human eye. [J Refract Surg 2002;18:S639-S643]
Lamellar Keratoplasty for Recurrent Pterygium
Authors: Poirier Robert H , Fish John R
Published: April 2021

SUMMARY

Lamellar corneoscleral keratoplasty technique for recurrent pterygium is described. The importance of accurate placement of the graft and its usefulness as a tissue barrier to regrowth of the pterygium is postulated. In fifteen eyes with severe recurrent pterygium followed from six months to four years, there have been no further recurrences after using this technique.
An Interlocking Slip Knot for Cataract Sutures: Preliminary Report
Authors: Lubkin Virginia
Published: April 2021

SUMMARY

A new method of tying a knot for cataract surgery is demonstrated. Its purpose is to provide a safe, interlocking slip knot, using nylon suture, removable merely by pulling on the free ends. Cases are presented showing the safety and effectiveness of the ISK.
The Partial-Punch: A New Combined Cataract-Glaucoma Operation
Authors: Spaeth George L , Sivalingam Eliyathamby
Published: April 2021

SUMMARY

This report describes a new combined cataract extraction-glaucoma procedure. The technique is a modification of a standard filtration type of operation. The essential step is the development of a shelved posterior scleral lip, 4 mm of which is excised; full thickness sclera is not removed. This permits tight incisional closure, but with the presence of a "valve" permitting exit of aqueous under a prepared conjunctival flap should intraocular pressure rise significantly in the postoperative period.

In 15 cases there were no serious complications, no flat anterior chamber, good pressure control in 14 cases, and filtering blebs in nine.
Experimental Cataract Fragmentation: Instrumentation and Laboratory Evaluation
Authors: Liu Hsiao-Su , Tolentino Felipe , Schepens Charles L , Banko Anton
Published: April 2021

ABSTRACT

A newly designed mechanical phacofragmentator powered by compressed air was tested on 200 human hard nuclear cataracts and ten traumatic owl monkey cataracts. The device, which consists of a turbine-driven diamond burr, successfully fragmented hard human cataracts, both in vitro and when implanted in the anterior chamber of rabbits and monkeys. Iatrogenic damage to the iris was noted in the early cases, but no collapse of the anterior chamber or gross damage of the cornea occurred. Iris damage can be avoided, once the operator gains sufficient skill in manipulating the instrument The ten traumatic monkey cataracts were all removed without complication, except for one case in which the posterior lens capsule was ruptured with subsequent vitreous prolapse.
Cataract Extraction in Pathological Myopia
Authors: Curtin Brian J
Published: April 2021

SUMMARY

Fifty-three cataract extractions in eyes with pathological myopia effected visual improvement in 47 eyes (89%). The median visual acuity increased from a preoperative level of 20/300 to 20/40 postoperatively. The incidence in this series of vitreous loss (1.9%) and retinal detachment (1.9%), are within the expected range of such complications. Four cases developed aphakic glaucoma which has necessitated continued therapy. All four had both enzyme zonulolysis and topical steroids, postoperatively. Other problems unique to surgery in these eyes are the missed diagnosis of nuclear cataract, possible dislocation of the lens, perforation of the sclera during retrobulbar injection, and rupture of the globe with vigorous digital massage.
Rose Bengal Staining of Epibulbar Squamous Neoplasms
Authors: Wilson Fred M
Published: April 2021

SUMMARY

Topically applied rose bengal, because of its ability to stain abnormal epithelial cells, has been found to be a useful adjunct to careful clinical examination in determining the extent of epibulbar squamous neoplasms, thus facilitating their complete excision.
Emergency Management of Acute Congestive Glaucoma Using an Anterior Chamber Microsyringe and Needle
Authors: O'Rourke J , D'Amato D P , Shafi I , Mendeloff T
Published: April 2021

SUMMARY

A microsyringe-needle assembly is described for use in aspiration and microinfusion procedures in the anterior chamber. Assets of a lancet pointed 30-gauge needle, surface anesthesia, and fine control of ocular pressure and aqueous humor volume are stressed. Use of the assembly for emergency treatment of acute congestive glaucoma, surgical paracentesis, aqueous sampling, and drug infusion are described. Drug volumes and concentrations must be maintained at levels which do not damage corneal endothelium.
Traumatic Hyphema: Treatment of Secondary Hemorrhage with Cyclodiathermy
Authors: Gilbert Howard D , Smith Ronald E
Published: April 2021

SUMMARY

Four patients were treated with diathermy applications to the ciliary body for recurrent hemorrhage and elevated intraocular pressure following traumatic hyphema. In all cases, the hemorrhage and intraocular pressure were controlled without major complications. Indications for use of diathermy include a patient with recurrent secondary hemorrhage or a clotted hyphema, with elevated intraocular pressure or corneal blood-staining, in whom a site of bleeding can be identified during surgical intervention.
Intraocular Irritation Evaluation of Benzalkonium Chloride in Rabbits
Authors: Britton B , Hervey R , Kasten K , Gregg S , McDonald T
Published: April 2021

SUMMARY

The purpose of this study was to define the threshold for intraocular irritation of benzalkonium chloride, a preservative used in some formulations which enter the anterior segment of the eye during ocular surgery. Various concentrations of benzalkonium were injected into anterior chambers of albino rabbit eyes. Conjunctivitis, flare, iritis, and corneal changes occurred in a dose response pattern. The threshold of irritation was 0.03%, with highest nonirritating concentration being 0.01%. In other works in this laboratory, threshold of irritation for topical ocular benzalkonium was 0.05%, but the nature of ocular changes was less substantial than those observed intraocular Iy. Because the threshold for intraocular irritation is less than that topically, the nature of ocular changes was different for two routes, and there is a paucity of clinical data for intraocular benzalkonium chloride, a safety factor of 10 was utilized in setting the highest safe concentration of 0.001% for intraocular use. The preservative efficacy of 0.001% is questionable; therefore, we cannot endorse benzalkonium chloride as a preservative for formulations which will enter the anterior segment of the eye.
Proptosis Secondary to Closure of the Lids Posterior to the Globe
Authors: Clever Victor G , Herzen Alexander T
Published: April 2021

SUMMARY

A five-year-old black male was seen with acute unilateral proptosis of one to two centimeters following blunt trauma with retraction of the eyelids behind the involved eye. The proptosis was cured by performing a lateral canthotomy and replacement of the eyelids in front of the globe.
Ultrasonic Diagnosis of Posterior Lens Rupture
Authors: Skalka Harold W
Published: April 2021

SUMMARY

A case of ultrasonically-diagnosed posterior lens capsule rupture, confirmed at surgery, is presented. The A-scan and contact B-scan findings enabling the diagnosis to be made are presented. The ability to make such a preoperative determination allows for the planning of more rational therapy, and should help improve the final visual results in such cases.
Conscious Sedation and Behavioral Modification with Local Standby Anesthesia for Ophthalmologic Surgery
Authors: Shane Sylvan M
Published: April 2021

SUMMARY

Local and retrobulbar block anesthesia in combination with a brief span of amnesia - not general anesthesia - produced by minute doses of four intravenous sedative drugs, has made it possible to perform ophthalmologic surgery without the memory of the pa i ? of the retrobulbar block, followed by an ensuing quiescence augmented by behavioral modification for the duration of the operation.

Patients are awake, rational, cooperative, calm and relaxed, and because of behavioral modification, are highly motivated to guarantee not only their own survival, but to feel a part of the team effort to preserve the integrity of their eye.
Machine-Assisted Cortical Clean-Up Without Expensive Disposable Packs
Authors: Oaks Merrill C
Published: April 2021

SUMMARY

Adaptation of readily available irrigation aspiration needles to a Peyman vitrectomy console or other suitable controlled suction source provides convenient, efficient machine-assisted cortical clean-up at a very reasonable cost per case.
Thermographic Evaluation of the Human Lacrimal Drainage System
Authors: Raflo Gary T , Chart Pamela , Hurwitz Jeffrey J
Published: April 2021

SUMMARY

A new method for evaluating the anatomy and patency of the human lacrimal drainage system is presented. Thermography was used in conjunction with routine lacrimal irrigation to visualize the tear ducts in normal subjects and in a patient with obstructive epiphora. The canaliculi, common canal, and lacrimal sac could be identified, and certain abnormalities detected with this technique. Additional information can be obtained regarding the presence of subclinical inflammation. The authors feel that thermography offers promise as a safe, simple technique for evaluating the lacrimal anatomy in patients with epiphora.
Inhibition of Secondary Cataracts by Cryolysis of Lens Epithelium in Rabbits
Authors: Shock John P , Zalta Alan H
Published: April 2021

SUMMARY

In an attempt to inhibit secondary cataract formation by destroying the subcapsular lens epithelium, a defined amount of freeze was applied to the anterior capsule of one eye of 16 New Zealand white rabbits just prior to a planned extracapsular cataract extraction of both eyes using phacofragmentation. The rabbits were sacrificed eight weeks after surgery and the secondary cataracts were dissected from the eyes. The degree of secondary cataract formation was evaluated by two independent observers and grading systems. Overall, 14 of 16 rabbits, or 88%, had a significant (P<.01) reduction of secondary cataract in the treated eye as compared to the control eye.

This study demonstrates that freezing of the subcapsular lens epithelium prior to a planned extracapsular cataract extraction in rabbits can significantlydiminish secondary cataract formation. However, because of the present difficulty in controlling the extent of the freeze to the surrounding ocular tissues with current cryoprobes, this procedure is not yet applicable in humans.
Leaky Cystoid Macular Edema Attracting Vitreous Macrophages
Authors: Wolter J Reimer
Published: April 2021

SUMMARY

A foveola with signs of atrophy and cystoid edema in an eye with a history of contusion, laceration, and hemorrhage exhibits a selective attraction for blood-filled macrophages. This important observation allows for the conclusion that the avascular foveola can leak into the inner eye like a blood vessel and chemotactically attract vitreous macrophages under these conditions.
Pseudochalazion of the Upper Lid Due to Hard Contact Lens Embedding - Case Reports and Literature Review
Authors: Sebag J , Albert Daniel M
Published: April 2021

SUMMARY

Two cases of pseudochalazion formation secondary to hard contact lens embedding are reported. In all previously reported cases a lump, swelling, mucopurulence, and ptosis were the most common presenting symptoms. Embedding usually occurred concave to the globe in the supratarsal region.

The cases reported herein are unique in that the location of one lens was beneath the tarsal conjunctiva, and in the second case there was spontaneous release of the lens after four months of embedding.
Argon Laser Trabeculoplasty: Its Effect on Medical Control of Open-Angle Glaucoma
Authors: Pollack Irvin P , Robin Alan L
Published: April 2021

SUMMARY

Twenty persons with primary open-angle glaucoma (POAG) were followed for an average of one year in a prospective study after argon laser trabeculoplasty was performed in one eye. By one month the mean intraocular pressure (IOP) had fallen 39% and was associated with an 80% increase in mean facility of aqueous outflow. Eighteen persons with POAG were evaluated for the possibility of maintaining an IOP of less than 22 mm Hg with less medication than was required prior to laser treatment. One third of these patients required no medication after treatment, and 39% required less; however, 28% of persons who were poorly controlled before treatment required the same regimen to maintain control after laser trabeculoplasty. Six out of nine persons no longer required a carbonic anhydrase inhibitor while six out of eight persons no longer required a miotic. Laser trabeculoplasty failed to produce a sufficiently large fall in IOP in most persons on maximal medication to permit discontinuation of all medication; but it produced its most satisfying response in persons whose glaucoma was less difficult to control.
A Loading Guide for C-Loop Intraocular Lenses
Authors: Davidoff Elliot , Duggan James
Published: April 2021

SUMMARY

A loading guide has been designed which facilitates the loading of a C-loop intraocular lens on the Simcoe posterior chamber lens insertion forceps. No handling of the implant is necessary.
Quantitative Endothelial Biomicroscopy
Authors: Holladay Jack T , Bishop John E , Prager Thomas C
Published: April 2021

SUMMARY

Twenty patients were evaluated by quantitative endothelial biomicroscopy and the resulting endothelial cell densities compared with those from a specular microscope. Estimated cell densities by this technique, when compared with the specular microscope, demonstrated a Pearson correlation coefficient of +0.977, an average error of -7% and an absolute error of 12%. There were no errors greater than 26% except for one extremely low cell density of 318 cells/mm
p 2
for which the estimate was 476 cells/mm
p 2
.

This rapid, inexpensive technique requires counting the number of endothelial cells seen across the horizontal diameter of the 0.2-mm projected spot beam of a standard biomicroscope. From this count and the known spot size the endothelial cell density may be accurately calculated. A simplified four-step technique for performing specular microscopy using only the standard biomicroscope and a method for accurately measuring the size of the projected slit lamp spot beam are explained.
The Use of Mannitol in Intraocular Surgery
Authors: O'Keeffe Michael , Nabil Messiha
Published: April 2021

SUMMARY

100 ml of 20% Mannitol given between 30 and 60 minutes prior to surgery effectively lowers the intraocular pressure and increases the anterior chamber depth. Larger volumes give an almost identical drop in pressure and identical increase in depth of the anterior chamber although they act more rapidly and over a longer period. Rebound rise in intraocular pressure does not occur within the first two hours.
Simplifying Extracapsular Implant Surgery
Authors: Frank Paul E
Published: April 2021

SUMMARY

A simplified technique is described to help reduce the operative time for extracapsular cataract extraction with intraocular implant.
Cataract and Corneal Opacity are the Main Causes of Blindness in the Samburu Tribe of Kenya
Authors: Whitfield Randolph , Schwab Larry , Bakker N J A , Bisley G G , Ross-Degnan Dennis
Published: April 2021

SUMMARY

An ocular status survey of the Samburu tribe of Kenya was carried out. There were 844 survey members in an age and sex stratified cluster sample. The prevalence of those who were found to have moderate visual loss or worse (less than 20/60 [6/18] in the better eye) was 3.8%. Those blind by USA criteria represented 1.7% of the total population. The two principal causes of blindness, cataract and corneal opacity, are both surgically amenable. A description of the Samburu people, the survey methods, and a summary of the survey findings are included.
Calibrated Corneal-Scleral Section Scissors
Authors: Clayman Henry M
Published: April 2021

SUMMARY

Calibrated corneal scleral section scissors are described which permit accurate incision enlargement when IOL insertion follows a KPE.
Endothelial Cell Counts Following Pars Plana Vitrectomy in Pseudophakic and Aphakic Eyes
Authors: Mittl Rainer N , Koester Charles J , Kate Mandes R , Wilkes Emanuel
Published: April 2021

ABSTRACT

In 13 pseudophakic eyes, endothelial cell counts remained stable following pars plana vitrectomy. The posterior chamber pseudophakos apparently had a protective effect on the corneal endothelium, even though the posterior lens capsule was removed during surgery. By contrast, in nine aphakic eyes, a statistically significant (p>.05) cell loss of 7.6% occurred after pars plana vitrectomy. We conclude that vitrectomy therefore poses an increased risk to the cornea in aphakic, but not in pseudophakic eyes.
Pseudonasolacrimal Duct Obstruction Caused by Nasal Allergy
Authors: Sanke Robert F
Published: April 2021

ABSTRACT

While mechanical obstruction of the nasolacrimal duct is the most common cause of acquired unilateral epiphora, it is not the only one. Of the 34 patients evaluated with this symptom, 22 cases (23%) were caused by primary nasal changes in the form of nasal allergy. Many of the characteristic findings of mechanical obstruction were present. Several patients had previous nasolacrimal duct surgery, which failed to eliminate the epiphora. Nasal allergy was not initially considered either by previous examiners or the patients themselves, because of the absence of typical allergic symptoms. All of these patients, however, obtained relief from their unilateral tearing with treatment directed toward the nasal pathology only. Oral sympathomimetics and antihistamines were the most effective. Two patients improved with primary nasal surgery.
Argon Green Laser Treatment of Peripapillary Choroidal Neovascular Membranes
Authors: Cialdini Arnaldo P , Jalkh Alex E , Trempe Clement L , Nasrallah Fadi P , Schepens Charles L
Published: April 2021

ABSTRACT

Of 27 eyes with peripapillary choroidal neovascular membranes (PPCNM), 17 (63%) had age-related macular degeneration and ten (37%) were idiopathic. PPCNM were treated in 25 eyes using the monochromatic green argon laser. Two eyes were untreatable. After an average follow-up of 37.7 months, successful closure of the choroidal new vessels was obtained in 23 eyes (92%), and visual acuity was stabilized or improved in 20 (80%). Seven eyes (28%) had recurrences; in four, the new vessels extended into the macula. Post -treatment, three eyes ultimately had dry macular scars, and one had an exudative macular scar. Of these four eyes, only the one with a dry macular scar showed visual improvement. No treated cases showed arcuate scotoma.
Vitrectomy When Asteroid Hyalosis Prevents Laser Photocoagulation
Authors: Lambrou Fred H , Sternberg Paul , Meredith Travis A , Mines Jonathan , Fine Stuart L
Published: April 2021

ABSTRACT

Asteroid hyalosis is a relatively common disorder of the vitreous that rarely causes visual impairment. However, funduscopic examination and laser photocoagulation can be difficult because of reflections off the asteroid bodies. Although vitrectomy is rarely indicated for impaired visual acuity, we report three cases in which pars plana vitrectomy was necessary to permit required retinal laser photocoagulation. In two patients with proliferative diabetic retinopathy and a third patient with subretinal neovascularization marked asteroid hyalosis precluded photocoagulation by standard techniques.
Positive Anatomic Orientation of Corneal Transplant Tissue
Authors: Wessels Izak F , Thomas Michael
Published: April 2021

ABSTRACT

Anatomic orientation of corneal donor tissue is consistently possible by cutting a "V"-shaped notch in the scierai rim at 12 o'clock. An obvious marker improves the evaluation of suspicious lesions by other observers, facilitates accurate communication of findings to corneal surgeons, and aids in instructing new eye bank technicians. A further possible benefit is that the marker permits anatomically correct orientation of cornea) tissue.
Three Techniques for Combined ECCE, PC-IOL Implantation, and Keratoplasty
Authors: Binder Perry S
Published: April 2021

ABSTRACT

Three different techniques are described for implanting posterior chamber lens implants during a combined extracapsular cataract extraction, posterior chamber lens implantation, and keratoplasty procedure. The implant can be placed immediately following cataract extraction, after which the cornea is replaced. If cortical remnants cannot be completely removed, the corneal transplant is sutured in place and a limbal incision made; the remaining remnants are then aspirated and a posterior chamber lens is implanted through the limbal incision. If no remnants remain, but the posterior chamber lens cannot be implanted due to positive vitreous pressure, the cornea is sewn into place with seven or eight interrupted sutures and the lens implanted through the remaining open quadrant, after which the corneal transplant procedure is completed.
Balloon Catheter Dilatation in Lacrimal Surgery
Authors: Becker Bruce B , Berry F Dean
Published: April 2021

ABSTRACT

We performed balloon catheter dilatation in four patients with a failed dacryocystorhinostomy. Epiphora was relieved and a patent lacrimal drainage system was achieved after the procedure in three of the four. The fourth patient had a transient partial response. Epiphora recurring in one patient 3½ months after the procedure responded to a second dilatation.
Lacrimal Catheterization
Authors: Corin Scott M , Hurwitz Jeffrey J , Corin William J , Kazdan Martin S
Published: April 2021

ABSTRACT

A new atraumatic technique for identifying the medial cut end of a surgically lacerated canaliculus is described. It offers the advantage of allowing the surgeon to pass a stent through the canaliculus only, without surgically manipulating the lacrimal sac or nasolacrimal duct or damaging the ipsilateral canaliculus.
Focal Scleral Thinning After Transscleral Nd: YAG Cyclophotocoagulation
Authors: Fiore Philip M , Melamed Shlomo , Krug Joseph H
Published: April 2021

ABSTRACT

Transscleral neodymium (Nd): YAG cyclophotocoagulation, a new cyclodestructive procedure for controlling intraocular pressure in patients with refractory glaucoma, is designed to penetrate the sclera and selectively destroy the ciliary body and processes without damaging the overlying tissues. Complications include conjunctival edema, corneal edema, iritis, gas in the anterior chamber, pain, hyphema, hypopyon, vitreous hemorrhage, and cataract. We present a case in which a patient developed focal areas of scleral thinning 6 weeks after transscleral Nd: YAG cyclophotocoagulation. The possibility of scleral damage or thinning should be kept in mind when performing the procedure.
Prospective Study Comparing Hydrogel With PMMA Lens Implants
Authors: Percival Piers
Published: April 2021

ABSTRACT

A prospective study has been undertaken to assess the relative merits of one-piece polymethylmethacrylate (PMMA) and poly 2 hydroxyethylmethacrylate "hydrogel" (P-HEMA) lenses in uncomplicated eyes after uncomplicated surgery. Two groups of 125 eyes each were matched in terms of patient age and sex. One group received PMMA lenses; the other group received P-HEMA lenses. Six months after surgery the visual acuity of 42% of eyes with P-HEMA lenses was 20/15, whereas that of 29% of eyes with PMMA lenses was 20/15 (p= 0.02). Major decentration occurred in two cases of P-HEMA lens implantation, but asymptomatic subclinical decentration was more common with PMMA lenses (p<0.001). The looped PMMA lens was considered adaptable to a wider variety of surgical conditions.
Excimer Laser Keratoplasty Part 1: Basic Concepts
Authors: Lang Gerhard K , Schroeder Eckhard , Koch Juergen W , Yanoff Myron , Naumann Gottfried O H
Published: April 2021

ABSTRACT

A commercially available ophthalmic excimer laser was used with a new "open mask system" to perform noncontact and nonthermal excimer laser keratoplasty in 20 human and 40 pig cadaver eyes. Circular penetrating corneal trephinations and corneal grafts were performed with the excimer laser set at 193 nm. Light microscopy and scanning and transmission electron microscopy of the human and pig eyes demonstrated the high quality of excimer laser trephination (smooth wound margins that were approximately parallel to the optical axis of the eye), and the superior wound configuration and geometry.
Iatrogenic Choroidal Neovascularization After Krypton Red Laser Photocoagulation
Authors: Orth David H , Flood Timothy P , Packo Kirk H
Published: April 2021

ABSTRACT

A major cause for failure of krypton red laser photocoagulation in patients with exudative age-related macular degeneration has been the development of recurrent choroidal neovascularization adjacent to the previously treated areas. After reviewing the possible causes of recurrences, it is apparent that a certain number are iatrogenic, ie, induced by krypton red laser causing disruption and damage to the pigment epithelium-Bruch's membrane-choroidal complex. We describe three separate episodes in two patients of iatrogenic recurrent choroidal neovascularization after krypton red laser photocoagulation.
Intraocular Human Thrombin Infusion in Diabetic Vitrectomies
Authors: Verdoorn C , Hendrikse F
Published: April 2021

ABSTRACT

The effectiveness of intravitreal thrombin infusion during vitrectomy was prospectively evaluated in eight diabetic patients with persistent vitreous hemorrhages and severe proliferative vitreoretinopathy. A concentration of 80 units/ml of human thrombin diluted in BSS-plus infusion fluid was used. Bleeding time ranged between 2 and 15 seconds (mean, 5 seconds).

The reduction of bleeding facilitated surgery. In five of the eight cases the vitreous was clear one day postoperatively. One month postoperatively six eyes had clear media. No additional postoperative intraocular inflammation developed.

These results suggest that human thrombin causes less inflammation than bovine thrombin.
A New Cannula for Nucleus Hydrodissection
Authors: Allarakhia Liaquat , Pearce John L
Published: April 2021

ABSTRACT

This disposable 25-gauge cannula has a specially designed distal segment which facilitates crystalline lens nucleus hydrodissection or viscodissection. The injection of a fluid or viscous material creates a cleavage plane between the nucleus and cortex or capsule, thus facilitating extraction of the nucleus. The flattened, smooth, cannulated tip allows easier insertion and manipulation under the capsule.
More Assured in-the-Bag Placement of C-Loop Posterior Chamber Intraocular Lenses
Authors: Kietzman Benjamin
Published: April 2021

ABSTRACT

A bimanual technique for inserting C-loop intraocular lenses using a lens haptic loop to guide the superior lens haptic into the capsular bag is presented. The technique eliminates several shortcomings of conventional techniques, allowing more assured inthe-bag placements of C-loop intraocular lenses.
Merkel Cell Tumor of the Eyelid: A Review and Report of an Unusual Case
Authors: Mamalis Nick , Medlock Rickey D , Holds John B , Anderson Richard L , Crandall Alan S
Published: April 2021

ABSTRACT

We describe a case of a Merkel cell tumor of the eyelid that manifested as a recurrent chalazion. This tumor had the classic characteristics of a Merkel cell neoplasm by light microscopy. Electron microscopy showed dense-core neurosecretory granules and perinuclear microfilaments consistent with the diagnosis. Because a Merkel cell tumor may manifest as a chalazion, pathologic evaluation of all atypical chalazia is essential. Merkel cell tumors are malignant, and they must be treated aggressively to minimize recurrence or metastasis.
Reducing Fire Hazard During Ophthalmic Surgery by Using Compressed Air
Authors: Neatrour G Peyton , Lederman Ira R
Published: April 2021

ABSTRACT

The use of oxygen increases the risk of fire during ophthalmic surgery. A prospective clinical study was conducted involving 100 patients without pulmonary disease who had cataract surgery under local anesthesia using either oxygen or compressed air. No clinically significant difference in oxygen saturation between the two groups was found. There was no statistically significant difference in the net change in saturation, and the significant difference found in overall mean saturation between the two groups was invalidated by inherent machine error. Using compressed air instead of oxygen is suggested to reduce fire hazard during ophthalmic surgery.
Results of Exchanging Anterior Chamber Lenses With Sulcus-Fixated Posterior Chamber IOLs Without Capsular Support in Penetrating Keratoplasty
Authors: Johnson Stephen M
Published: April 2021

ABSTRACT

We retrospectively reviewed the charts of 47 patients who had had penetrating keratoplasty and intraocular lens exchange with fixation of a posterior chamber lens to the ciliary sulcus. Follow-up ranged from 5 to 30 months (mean, 13 months). The corneal grafts remained clear in 46 eyes. The average visual acuity of patients followed for more than 12 months was 20/60. Complications have been minor. Because of complications associated with anterior chamber lenses and these findings, we now utilize this technique in all patients who require penetrating keratoplasty and intraocular lens insertion without posterior capsule support.
A Solitary Conjunctival Relapse of Hodgkin's Disease Treated by Radiotherapy
Authors: Kremer Israel , Loven David , Mor Celia , Lurie Hedi
Published: April 2021

ABSTRACT

A 78-year-old woman had a conjunctival mass in the inferior fornix. The lesion was diagnosed as a solitary relapse of Hodgkin's disease (HD), lymphocytic predominance type, which had been diagnosed 6 years earlier as stage III-B. It was successfully treated by local irradiation, with no evidence of local recurrence or any local ocular complications during a follow-up period of 3 years.
Association Between Cilioretinal Arteries and Juxtapapillary Scars
Authors: Nasrallah Fadi P , Weiter John J
Published: April 2021

ABSTRACT

We examined the relationship of cilioretinal arteries (CRAs) to juxtapapillary chorioretinal scars, along with the developmental significance of the latter in relation to CRA formation. Both eyes of 360 patients were studied. Sixty-eight (18.9%) of these patients had a CRA in at least one eye, 13 of these 68 (19.1%) had one in both. The CRAs were distributed equally between right and left eyes. Two hundred eight patients (57.8%) had a scar in at least one eye; 157 of these (75.5%) had one in both. The presence of a CRA was significantly associated with the presence of a scar. Since both are common developmental variations, this correlation points to a common embryologic formation mechanism.
Monochromatic Endoillumination for Epimacular Membrane Surgery
Authors: Kraushar Marvin F , Harris Michael J , Morse Peter H
Published: April 2021

ABSTRACT

We attempted to simultaneously increase visualization of epimacular membranes and minimize retinal phototoxicity by filtering the light of the endoilluminator during vitreous surgery. The monochromatic filters we employed to eliminate short wavelengths were not useful because they reduced the level of illumination. We advise using the lowest level of illumination possible and an ultraviolet/infrared filter over the light source when working close to the retinal surface. The filter can be adapted to replace the fluorescein filter in the Ocutome console to facilitate insertion and withdrawal.
Compensatory Epithelial Hyperplasia in Human Corneal Disease
Authors: Dillon Edward C , Eagle Ralph C , Laibson Peter R
Published: April 2021

ABSTRACT

Compensatory hyperplasia of the corneal epithelium (CEH) has been observed histopathologically in animal and human eyes after excimer laser photoablative keratectomy, and has been implicated as a cause of variable refractive results and refractive regression after this procedure. Retrospective histopathologic analysis of routine keratoplasty specimens revealed CEH in 85 of 130 (65%) corneas with keratoconus, 18 of 36 (50%) corneas with chronic herpes simplex virus (HSV) keratitis, and 14 of 25 (56%) corneas coded as nonspecific scars. Mild CEH occurred apically and/or peripherally in keratoconus. Massive CEH (up to 200 µm thick) occurred in chronic HSV keratitis with irregular stromal loss. Our data indicate that CEH occurs frequently in several corneal diseases marked by stromal ectasia or loss. We postulate that stromal loss may contribute to CEH by providing relative protection against exfoliative shearing forces of superior eyelid closure. Our study complements previous reports that imply that CEH is a contributory factor in refractive regression after excimer laser photoablation.
Comparison of Two Needle Lengths in Regional Ophthalmic Anesthesia With Etidocaine and Hyaluronidase
Authors: Sarvela Johanna , Nikki Pertti
Published: April 2021

ABSTRACT

The effect of needle length on the efficacy of regional ophthalmic anesthesia in conjunction with cataract surgery was studied in 97 patients using a two-site injection technique. The local anesthetic used was etidocaine 1.5% with hyaluronidase. In 48 patients, the anesthetic was administered inferolaterally with a 22-millimeter needle, and in the other 49 patients, with a 31-millimeter needle. Every patient had a medial injection with a 12-millimeter needle to achieve lid akinesia and to complete the globe akinesia. At 5 minutes, lid akinesia was considered better in the 22-millimeter needle group (P < .005). After one supplemental dose, when necessary, complete globe akinesia was achieved at 15 minutes significantly more often (94% vs 79%) in the 31-millimeter needle group (P < .05). Lid akinesia in the two groups was identical at that time. Eight patients in the short-needle group and three in the long-needle group experienced some pain during surgery. Throughout the study, the required intraorbital anesthetic volumes were smaller in the 31-millimeter needle group. We recommend the use of a 31-millimeter needle inferolaterally in combination with a 12-millimeter needle medially to achieve satisfactory regional anesthesia for cataract surgery.
Refractive Hazards of Intraoperative Retinal Photocoagulation
Authors: Azzolini Claudio , Docchio Franco , Brancato Rosario
Published: April 2021

ABSTRACT

The refractions of a laser beam during transpupillary and endo-ocular intraoperative retinal photocoagulation as it passes through vitreous substitutes, with varying refractive indexes, were investigated with the use of mathematical algorithms and ray tracers. The following modifications and potential hazards were noted: 1) deviations of the laser beam (unlikely, however, to cause target error when surgery is properly conducted); 2) variations in laser-beam diameter and power density (up to 60%), easily leading to retinal underexposure or overexposure; and 3) asymmetry in beam distribution at the target site, leading to non-uniform retinal photocoagulation. Proper surgical techniques must be adopted before and during intraoperative photocoagulation to minimize retinal hazards. The relatively short distance between the endolaser probe and the retina means that fewer undesirable refractions occur with endo-ocular photoco- agulation than with transpupillary indirect intraoperative photocoagulation.
Anterior Chamber Reaction After Mitomycin and 5-Fluorouracil Trabeculectomy: A Comparative Study
Authors: Kawase Kazuhide , Nishimura Kohsaku , Yamamoto Tetsuya , Jikihara Shuichi , Kitazawa Yoshiaki
Published: April 2021

ABSTRACT

We measured aqueous flare in 16 glaucomatous eyes after trabeculectomy in which 5-fluorouracil (5-FU) or mitomycin C (MMC) had been used as an adjunctive therapy. The eyes were divided into a 5-FU and an MMC group, matched for factors that might influence the postoperative inflammatory response to intraocular surgery. Seven eyes of seven patients received subconjunctival injections of 5-FU (50 mg in 2 weeks) and nine eyes of nine patients were given 0.2 mg/0.5 mL MMC intraoperatively.

The aqueous flare converted to an albumin concentration mg/dLj was significantly higher in the 5-FU group than in the MMC group (359.6 ± 113.8 mg/dL and 143.2 ± 46.7 mg/dL, respectively; Mann-Whitney U test, P < .05) on the second postoperative day. Intraoperative MMC appears to be no more harmful to the blood-aqueous barrier than 5-FU.
Treatment of Dry Eye by Moving the Lacrimal Punctum to Dry Dock
Authors: Murube-del-Castillo Juan , Hernandez-King Jacqueline
Published: April 2021

ABSTRACT

Several methods for occluding the lacrimal canaliculi to prevent spontaneous drainage have been described for the treatment of dry eye. These techniques have been either of short duration or irreversible. We have developed a technique in which the vertical portion of the lacrimal canaliculus is transferred anteriorly, and the lacrimal punctum is placed between the eyelashes, where it is out of the lacrimal meniscus and therefore nonfunctional. If the quantity of lacrimal secretion improves, the vertical portion of the lacrimal canaliculus may be returned to its original site, allowing normal lacrimal flow. The technique was successful in 12 puncta of seven patients with more than 5 years of follow up. The operation was easily reversed in the two puncta of one patient who complained of epiphora after lacrimal secretion had improved, allowing spontaneous tear drainage.
Survival of Patients and Metastatic and Local Recurrent Tumor Growth in Malignant Melanoma of the Uvea After Ruthenium Plaque Radiotherapy
Authors: Summanen Paula , Immonen Ilkka , Heikkonen Jorma , Tommila Petri , Laatikainen Leila , Tarkkanen Ahti
Published: April 2021

ABSTRACT

A series of 100 consecutive patients treated by ruthenium plaque radiotherapy for uveal malignant melanoma from 1981 to 1991 was studied to evaluate local recurrences, métastases, and melanomaspecific mortality. Follow up ranged from 1.0 to 10.1 years (mean, 3.3; median, 3.0 years). Local relapse was observed in 19 patients from 0.1 to 2.7 years (median, 0.7 years) after therapy. Six of these eyes were enucleated. The 5-year probability of local tumor control was 59%. Seven patients with local relapse developed metastasis O to 4.3 years (median. 1.4 years) later. Altogether, 18 patients developed métastases 0.9 to 4.6 years (median, 2.0 years) after the irradiation, and 15 of them died of melanoma 5 days to 3.3 years (median, 0.5 years) after detection of metastases. The 5-year probability of metastasis not developing was 61%. The overall 5-year survival was 78%, excluding causes other than malignant melanoma. Large tumor size and anterior tumor location, with or without ciliary body involvement, predicted poor prognosis both in terms of local growth, métastases, and melanoma-specific mortality. Local recurrent tumor growth was associated with a significant increase in metastasis but a nonsignificant increase in melanoma-specific mortality.
A Transcorneal Modification for Scleral Fixation of Posterior Chamber Intraocular Lenses
Authors: Rehany Uri , Rumelt Shimon
Published: April 2021

ABSTRACT

A simple transcorneal surgical modification for scierai fixation of posterior chamber intraocular lenses is described for use in cases in which posterior-capsule or zonular support are missing or unsafe. The technique allows a "closed" eye system to be maintained with minimal intraocular manipulation.
Glaucoma Triple Procedures Leaving the Internal Corneal Valve Intact to Control Induced Astigmatism-Theoretic Considerations
Authors: Nielsen Per Julius
Published: April 2021

ABSTRACT

As glaucoma surgery increasingly tends to be performed in younger patients, stabilizing visual results by reducing the amount of surgically-induced astigmatism will become iust as important as controlling intraocular pressure. I describe two glaucoma triple procedures involving small-incision cataract surgery in which, as contrasted with previous techniques, the internal cataract incision is separated from the trabeculectomy, theoretically reducing surgically-induced astigmatism. One method features a standard trabeculectomy with sutures in the scierai flap; the other, an ab externo trabeculectomy in which no sutures are used. The effectiveness of both these methods in actually reducing surgically-induced astigmatism, while controlling intraocular pressure (IOP), remains to be demonstrated, but the possibility that they might, seems well worth exploring.
Modifying a Polaroid Camera for Close-up Documentation
Authors: Wessels Izak F , Oeinck Chris
Published: April 2021

ABSTRACT

A standard plus-three-diopter trial lens held in front of the objective lens of an inexpensive Polaroid camera produces close-up photographs of acceptable quality. This simple technique can be used to inexpensively document indications for plastic surgery and provide medicolegal documentation. The 23-millimeterdiameter trial lens provided acceptable resolution, but reduced depth of field; it must be well-centered to avoid vignetting.
Inadvertent Cyclodialysis Cleft
Authors: Aminlari Ali
Published: April 2021

ABSTRACT

We report four patients with functionally significant inadvertent cyclodialysis cleft. In three, the cleft followed uneventful extracapsular cataract extraction with posterior chamber intraocular lens implantation; in the fourth, blunt trauma with hyphema. Ocular hypotony resolved in three patients with medical therapy; the fourth required argon laser photocoagulation. Causes, clinical findings, and treatment of inadvertent cyclodialysis cleft are reviewed.
Scleral Buckle Removal Following Retinal Reattachment Surgery: Clinical and Microbiologic Aspects
Authors: Smiddy William E , Miller Darlene , Flynn Harry W
Published: April 2021

ABSTRACT

Scleral buckle infection following retinal reattachment surgery is infrequent but not rare. We identified 45 cases among approximately 3000 scierai buckling procedures performed at our institution between July 1, 1985 and July 1, 1991. The scierai buckle was exposed in all 45, and the subsequent microbiologic culture was positive in 33. The most common causative organism was coagulase negative staphylococci (17 of 33 cases with positive cultures). Risk factors for an adverse outcome included positive culture, preoperative vision ≤ 20/200, and preoperative retinal detachment. Broad spectrum antibiotics covered organism sensitivity profiles in 16 of the 18 cases tested. Prompt removal of infected buckles and treatment with broad-spectrum topical antibiotics are important for maintaining vision.
Unilateral Lateral Rectus Recessions in Exotropia
Authors: Weakley David R , Stager David R
Published: April 2021

ABSTRACT

For the past several years, we have been performing unilateral lateral rectus recessions in patients with small- to moderate-angle intermittent or constant exotropia. We report a 73% success rate in 45 patients undergoing 6- to 10-millimeter unilateral lateral rectus recessions in exotropia with a minimum of 6 months' follow up. The success rate increased to 89% for patients under 4 years of age. The advantages of this procedure include operating on only one eye and virtual elimination of overcorrections, thereby preventing early postoperative consecutive esotropia, which occasionally can result in amblyopia or diminished stereopsis in very young children.
Energy Levels Needed for Cyclophotocoagulation: A Comparison of Transscleral Contact cw-YAG and Krypton Lasers in the Rabbit Eye
Authors: Immonen Ilkka , Suomalainen Veli-Pekka , Kivelä Tero , Viherkoski Esa
Published: April 2021

ABSTRACT

The energy levels needed for Cyclophotocoagulation using either transsclera I contact krypton or cw-YAG lasers were compared in pigmented rabbits. The same transsclera I laser probe was used for both lasers. With the krypton laser, 0.25 J of energy caused macroscopically detectable lesions, and 1.5 J led to widespread destruction of the ciliary body. With the cw-YAG laser, the first detectable lesions were produced at 0.5 J. Similarly, at higher energies, twice as much energy was required using the cw-YAG as compared with using the krypton laser to produce comparable lesions. Histologically, lesions of the same macroscopic severity made with the two lasers were similar. We conclude that the transscleral contact krypton laser is an efficient instrument for Cyclophotocoagulation. Although these results may not be directly applied to human eyes, it appears that the poorer scierai transmission of the krypton beam is offset by its higher level of absorption in the pigmented epithelium of the ciliary body.