bluuebunny/crossref_metadata_2025_split huggingface dataset:
Controlled Retrobulbar Anesthesia for ECCE and IOL Implantation
Authors: Zauberman Hanan 
Published: April 2021

ABSTRACT
A method of controlled retrobulbar anesthesia was used in 20 patients undergoing extracapsular cataract extraction with intraocular lens implantation. The method includes:
1. leaving the pupil undilated before anesthesia;
2. applying topical anesthetic to the conjunctiva;
3. injecting about 0.25 ml of anesthesia through the non-sensitive conjunctiva into the muscle cone, then waiting until the pupil becomes dilated before injecting an additional 1.5 ml;
4. injecting 0.25 ml anesthesia under the conjunctiva and into the tendon of the superior rectus muscle; and
5. applying short-acting mydriatics after the injection.
This method is almost painless and does not result in increased intraocular pressure after injection. Massage or compression to soften the eye is not required, and there is excellent anesthesia and akinesia.
Sodium Hyaluronate (Healon®) in Glaucoma Filtering Procedures
Authors: Alpar John J 
Published: April 2021

ABSTRACT
Healon® (sodium hyaluronate) has been used in a prospective study designed to investigate its possible usefulness in promoting effective bleb formation and preventing cleft closure in trabeculectomy for glaucoma. One hundred fourteen patients with open-angle glaucoma were randomly assigned to one of two groups. In one group (55 patients), filtering surgery was performed without the use of Healon. In the remaining 59 patients, Healon was used to separate the iris from the cleft, the sclera from the sclera and the conjunctiva from the sclera. The surgical procedure used was the Stallard-Worst triangular modification of Cairns' method, combined with removal of the Tenon's capsule. The patients whose operations were performed with the aid of Healon had a higher success rate, as manifested by better and more permanent bleb formation and maintenance, more open clefts, less scarring, less peripheral anterior synechiae formation, and significantly lower long-term intraocular pressure. Moreover, the number of patients requiring supplemental postoperative timolol therapy was significantly smaller in the Healon group (5/59 patients: 8.5%) than in the control group (33/55 patients: 60%). There was a transient delay in the reduction of intraocular pressure following trabeculectomy in the Healon patients which was not observed in control patients. Apart from this, no adverse effects were associated with the use of Healon.
Elimination of Sodium Hyaluronate-Induced Decrease in Outflow Facility With Hyaluronidase
Authors: Hein Stephen R , Keates Richard H , Weber Paul A 
Published: April 2021

ABSTRACT
The use of intraocular sodium hyaluronate is complicated by a postoperative rise in intraocular pressure (IOP). The rise in IOP is thought to stem from a "clogging" at the trabecular meshwork by the large molecules of hyaluronate. This study uses serial tonographic measurements in an animal model to document this change in outflow facility. Furthermore, we investigate the ability of the enzyme hyaluronidase to cleave the hyaluronate into smaller molecular weight fragments, in vivo, and thereby eliminate the change in outflow facility. This report demonstrates the potential usefulness of this enzyme and documents the lack of harmful side effects histopathologically.
Carbon Dioxide (CO2) Laser Therapy For Conjunctival Lymphangioma
Authors: Jordan David R , Anderson Richard L 
Published: April 2021

ABSTRACT
Lymphangiomatous tissue involving the ocular adnexa may be difficult to manage because this highly vascular, unencapsulated tissue intermingles freely with normal adnexal structures. Hemostasis is difficult to obtain, and important ocular and periocular structures are damaged easily. We have successfully treated two individuals who had extensive conjunctival involvement of their lymphangioma with the carbon dioxide (CO2) laser. The CO2 laser permits a precise form of treatment with the ultimate form of hemostasis (tissue vaporization), resulting in minimal trauma, edema, and scarring, and thus offers a safe alternative to surgical excision of these lesions.
Ciliary Block (Malignant) Glaucoma Following Posterior Chamber Lens Implantation
Authors: Duy T Pham , Wollensak J 
Published: April 2021

ABSTRACT
Ciliary block (malignant) glaucoma is a rare complication of cataract surgery. In eyes with narrow angles and acute glaucoma, ciliary block must be differentiated from pupillary block to provide appropriate therapy. We review two cases of ciliary block glaucoma following uncomplicated extracapsular cataract extraction with posterior chamber lens implantation.
Previous filtering procedures in these cases resulted in protracted shallowing of the anterior chamber, possibly contributing to the pathogenesis of ciliary block. In addition, the operative trauma of cataract surgery may have resulted in the separation of the vitreous base from the pars plana. Misdirected aqueous humor then could have entered the vitreous body, displacing the iris-pseudophakos diaphragm forward, and resulting in the acute glaucoma.
Vitrectomy, which resolved the acute glaucoma, is valuable in treating ciliary block glaucoma.
Failed Laser Trabeculoplasty Requiring Surgery in Open-Angle Glaucoma
Authors: Schoenleber Dana B , Bellows A Robert , Hutchinson B Thomas 
Published: April 2021

ABSTRACT
Argon laser trabeculoplasty (ALT) has been successful in controlling open-angle glaucoma, but a significant number of patients still require filtration surgery. Concern that post-laser inflammatory changes or alterations of structural anatomy with damage to the trabecular meshwork may adversely affect the outcome of filtration surgery prompted a retrospective review of 87 consecutive eyes with open-angle glaucoma that required filtration surgery following failed ALT. The follow-up period was at least 6 months, with a mean of 18 months (6 to 38 months). Posterior lip sclerectomy was chosen for 69 eyes and trabeculectomy for 18 eyes. The overall success rate of filtration surgery during the follow-up period was 92%. There was no recognized difference in the response to filtration surgery following ALT.
Inflammatory Response to Viscoelastic Materials
Authors: McKnight Scott J , Giangiacomo Joseph , Adelstein Edward 
Published: April 2021

ABSTRACT
Healon®, Amvisc®, or Viscoat® was injected into the corneal stroma of 36 normal rabbit eyes. Twelve additional rabbit eyes were used as controls by performing a sham procedure. Twelve rabbits were euthanized at one day and the remainder seven days after injection. The eyes were enucleated and examined by light microscopy. No control eyes had detectable inflammation. Only Viscoat produced mild inflammation at seven days, but this was statistically significant only at p = 0.182. There appears to be little difference in the inflammatory response of these three viscoelastic substances.
Laser Sclerostomy ab interno Using a Continuous Wave Nd:YAG Laser
Authors: Javitt Jonathan C , O'Connor Stefan S , Wilson Richard P , Federman Jay L 
Published: April 2021

ABSTRACT
We report the use of a continuous wave Nd:YAG (CW-YAG) laser focused through a sapphire crystal to create a filtering bleb by ab-interno sclerostomy. A 2-mm clear corneal incision was made in each eye of five anesthetized Dutch Belted rabbits, and the 30-mm-long sapphire crystal with a 0.2-mm focal tip was passed across the anterior chamber until it came in contact with the opposite angle. Between two and three pulses of 0.8 J were required to produce a filtering bleb in each of the 10 eyes. The overlying conjunctiva was not damaged; the procedure time was under five minutes. Histological examination revealed a surrounding area of scleral melting that extended an average of 0.06 mm from the sclerostomy. These data suggest that the CW-YAG laser may be useful in performing glaucoma filtering surgery with minimal damage to surrounding ocular tissues.
Effects of Tissue Plasminogen Activator on Glaucoma Filter Blebs in Rabbits
Authors: Fourman Stuart , Vaid Kuldip 
Published: April 2021

ABSTRACT
Tissue plasminogen activator ItPA), a zymogen associated with fibrinolysis, was used in an attempt to prevent scarring and the consequent loss of glaucoma filtration blebs. Bilateral trephine filter procedures were performed in 10 new Zealand white rabbits. In a randomized, masked fashion, one eye received intracameral tPA (25 µg), and the fellow placebo, immediately following surgery. One week after surgery, outflow facility in the tPA-treated eyes was significantly greater than that in the control {P<0.01}. Two weeks after surgery, the outflow facility returned to preoperative levels in all eyes. Eyes receiving tPA had larger blebs than the controls. No increase in postoperative complications, such as hemorrhage or wound leak, was attributable to tPA use. The results suggest that tPA interferes with the wound healing process after surgery and may promote glaucoma filter bleb formation.
Comparison of the Effects of Two Viscoelastic Agents, Healon and Viscoat, on Postoperative Intraocular Pressure After Penetrating Keratoplasty
Authors: Burke Sharon , Sugar Joel , Farber Marilyn D 
Published: April 2021

ABSTRACT
Sixty-two patients undergoing penetrating keratoplasty were randomized to receive Healon (1% sodium hyaluronate) or Viscoat (3% sodium hyaluronate and 4% chondroitin sulfate) as a means of maintaining the anterior chamber during surgery. Neither viscoelastic agent was irrigated from the eye at the end of the procedure. Intraocular pressures (IOPs) were measured at 4, 10, 24, and 72 hours postoperatively. For the Healon group, IOPs were 16.52, 23.50, 28.31, 23.27, and 16.03 mm Hg at baseline and at the four follow-up periods, respectively. For the Viscoat group, they were 19.10, 28.33, 23.48, 18.62, and 16.17 mm Hg at those points, respectively. IOPs were significantly elevated over baseline in the Healon group at 4, 10, and 24 hours, and in the Viscoat group at 4 and 10 hours. There were no statistically significant differences between the Healon and Viscoat groups at 4, 10, and 72 hours. At 24 hours, the Healon group had a mean pressure rise over baseline of 6.5 mm Hg, while the Viscoat group had returned to baseline levels (P = .02). We conclude that both Healon and Viscoat raise postoperative IOPs, but that Healon appears to elevate IOPs for a longer period after surgery than Viscoat.
Clearance of Fluorescein Incorporated Into Microspheres From the Cornea and Aqueous After Subconjunctival Injection
Authors: Khoobehi Bahram , Stradtmann Manrique Ortiz , Peyman Gholam A , Aly Omar M 
Published: April 2021

ABSTRACT
The clearance of sodium fluorescein from the cornea and aqueous humor of albino rabbits was quantitated after subconjunctival injection of fluorescein entrapped in lactide/glycolide (group 1) and lactide (group 2) microspheres. Seven hours after injection, approximately equal concentrations of fluorescein were measured in both groups in the cornea and aqueous. Fluorescein concentrations in the cornea were more than three times those found in the aqueous. Fluorescein concentrations in both groups decreased at 22 hours, and remained constant at 46 hours. Corneal fluorescein levels in group 2 were slightly higher than in group 1 at 22 and 46 hours. All eyes showed conjunctival inflammatory reaction at the injection sites after 6 days. One eye showed conjunctival necrosis at the injection site after 13 days.
Transscleral Cyclophotocoagulation of Human Autopsy and Monkey Eyes
Authors: Coleman Anne L , Jampel Henry D , Javitt Jonathan C , Brown Andy E , Quigley Harry A 
Published: April 2021

ABSTRACT
We studied the effect of uveal pigmentation on contact Nd:YAG transscleral cyclophotocoagulation in 36 human autopsy and eight cynomolgus monkey eyes. Ten autopsy eyes from black individuals required less energy to croate a lesion than 23 eyes from whites. The mean lesion diameter at the posterior pars plicata was similar in all these eyes; however, the mean energy required was 4.4 J in the black and 6.4 J in the white eyes. Transscleral cyclophotocoagulation lowered intraocular pressure (IOP) in four monkey eyes with elevated IOP, but did not in four other eyes without elevated IOP. Treatment over conjunctival pigmentation burned the conjunctiva, even at the lowest energy tested (3.5 J). Contrary to other investigators' findings, transmission electron microscopy snowed at least short-term loss of scleral architecture in both the human autopsy and monkey eyes.
The Use of Tissue Plasminogen Activator in Experimental Filtration Surgery
Authors: Ozment Randall R , Laiw Zuei-Ching , Latina Mark A 
Published: April 2021

ABSTRACT
Tissue plasminogen activator (tPA), a clot-specific fibrinolytic agent, was used as an adjunct to filtration surgery in Dutch belted rabbits to determine its effects on the outcome of filtration surgery. Thirty-eight animals that underwent a standardized posterior-lip sclerectomy in both eyes were divided into five postoperative protocol groups. In masked fashion, experimental eyes received 25 µg of tPA in 100 µL of diluent. Fellow eyes received 100 µL of diluent and served as controls. Group 1 received daily subconjunctival tPA. Group 2 received intracameral, followed by daily subconjunctival, tPA. Groups 3, 4, and 5 received intracameral tPA on postoperative days 1 and 2; 2 and 3; and 3, 4, and 5, respectively. Intraocular pressure (IOP), quality of bleb, number of days to bleb failure, and incidence of intraocular bleeding were determined in each group. No significant tPA effect was seen in groups 1 or 2. In groups 3, 4, and 5, the tPA-treated eyes demonstrated marked reduction of IOP and improvement in the quality of the blebs lasting between 6 to 24 hours.
Pars Plana Vitrectomy and Direct Diathermy for Complications of Multiple Retinal Angiomas
Authors: Johnson Mark W , Flynn Harry W , Gass J Donald M 
Published: April 2021

ABSTRACT
A 16-year-old female had multiple retinal capillary angiomas, complicated by marked retinal and optic disc neovascularization, preretinal membranes, and retinal detachment in her right eye. Pars plana lensectomy, vitrectomy, fluid/gas exchange, direct transvitreai diathermy of the angiomas, endolaser scatter photocoagulation, and scleral buckling resulted in retinal reattachment and regression of the neovascularization. Although additional surgery was necessary for recurrent tractional retinal detachment, long-term retinal reattachment and stable vision was achieved following obliteration of all angiomas.
Direct Intraoperative Continuous Monitoring of Intraocular Pressure
Authors: Blumenthal Michael , Cahane Michael , Ashkenazi Isaac 
Published: April 2021

ABSTRACT
We present a system of intraoperative continuous monitoring of intraocular pressure (IOP) consisting of a sterilizable pressure sensor attached to a digital monitor and an analogic recording instrument. Used in conjunction with an anterior-chamber maintainor, IOP may be accurately maintained at a specific and desired level.
Ab-Interno Neodymium:YAG Versus Erbium:YAG Laser Sclerostomies in a Rabbit Model
Authors: Hill Richard A , Özler Serdar A , Baerveldt George , Viscardi Jeffrey J , Keates Richard H , Lee Martha , Harrington James A , Berns Michael W 
Published: April 2021

ABSTRACT
This study was undertaken to determine whether thermally-induced tissue necrosis was a factor in ab-interno contact-laser sclerostomy failure. A rabbit model was used to compare the continuous-wave Neodymium (Nd):YAG with the pulsed Erbium (Er):YAG laser with respect to such failure. Laser energy was focused into a fused-silica fiber optic (400 µm) for the Nd:YAG laser (12 W; 3 to 5 seconds), and into a single-crystal, uncladded sapphire fiber optic (250 µm) for the Er:YAG laser (7 to 8 mJ; 250 microseconds; 6 to 8 pulses). The Nd:YAG and Er:YAG lasers required from 21 to 35 J and from 42 to 64 mJ, respectively, to create the sclerostomies. Filtering blebs and intraocular pressure reduction lasted longer (log-rank test; P < .03) and surgical complications were fewer in the Er:YAG group than in the Nd:YAG group. By creating sclerostomies with minimal thermal damage, the Er:YAG laser may offer significant clinical advantages over lasers producing larger thermal effects.
Design and Results of Trabeculectomy Operation for Use With 5-Fluorouracil
Authors: Brooks Anne M V , Gillies W E 
Published: April 2021

ABSTRACT
We revised our trabeculectomy technique in an effort to minimize the complications associated with the use of 5-fluorouracil (5-FU) in these procedures and then compared the results obtained with this procedure both with (25 patients) and without (25 patients) the use of 5-FU. There was no significant difference between the two groups in terms of mean postoperative IOP at 1 year, number of patients that required needling of the bleb to control postoperative IOP, and number of patients requiring postoperative topical medications to control IOP. Since more (although not significantly more) patients who did not receive 5-FU required needling of the bleb to maintain filtration, and since we were able to achieve satisfactory results in the great majority of cases using only a small total dose of 5-FU, we suggest that it may be simpler to use low doses of 5-FU in all trabeculectomy procedures.
Transcanalicular THC:YAG Dacryocystorhinostomy
Authors: Silkiss Rona Z , Axelrod Robert N , Iwach Andrew G , Vassiliadis Art , Hennings David R 
Published: April 2021

ABSTRACT
Chromium-sensitized and thulium- and holmiumdoped YAG lasers (THC:YAG laser) were used to create a nasal bony ostium in the area of the lacrimal sac fossa in four fresh frozen bisected human cadaver heads. The lasers - long pulsed (300 milliseconds), compact, self-contained, and solid state - operate in the near infrared (2.1 urn). The opening was created by passing the 320-micrometer laser fiber across the canalicular system. Pulse energies of 250 to 900 mJ were used with a repetition rate of 5 to 15 pulses per second. Energy levels ranging from 1.25 to 9 W produced a full-thickness bony ostium approximately 3 to 4 mm in diameter. Silicone tubing was then threaded through the superior and inferior canaliculus system in the standard fashion. This technique may simplify conventional dacryocystorhinostomy as well as endonasal laser dacryocystorhinostomy procedures.
Permanent Blindness Following Retrobulbar Hemorrhage After Peribulbar Anesthesia for Cataract Surgery
Authors: Puustjärvi Tuomo , Purhonen Sinikka 
Published: April 2021

ABSTRACT
We present a case in which a modified peribulbar anesthesia, administered with a 24-gauge (0.55 × 25 mm) sharp, disposable needle, induced an orbital hemorrhage, resulting in complete and permanent loss of vision. To our knowledge, this is the first report of severe complications following a peribulbar block.
Corneal Edema Following Argon Laser Iridotomy
Authors: Wilhelmus Kirk R 
Published: April 2021

ABSTRACT
Laser iridotomy is generally a safe and effective procedure for narrow-angle glaucoma. However, since surgical success with the argon laser depends on a focal thermal effect, a corneal burn is a possible complication. I describe five patients with occludable anterior chamber angles and bilateral corneal guttata who developed uniocular progressive corneal edema with visual loss following argon laser iridotomy. These five patients underwent iridotomy with a total laser energy of 63, 48.5, 7, 25, and 25 J, respectively, and began to lose vision due to corneal edema immediately, and 5, 2, 4, and 2 years later, respectively. Following penetrating keratoplasty with cataract surgery, histopathology of the corneal buttons showed generalized endothelial cell loss in all five. Microstructural findings of guttata and thickened Descemet's membrane implied that prior endothelial dystrophy had predisposed these patients to laser-induced damage. Risk factors for immediate or delayed-onset bullous keratopathy after argon laser iridotomy include prior angle closure, preexisting endothelial guttata, and high laser energy with multiple applications. Recognizing the potential of this complication offers opportunities for preventive strategies.
Pterygium Surgery Using the Principle of Contact Inhibition and a Limbal Transplanted Pedicle Conjunctival Strip
Authors: Hara Tsutomu , Shoji Eiichi , Hara Takako , Obara Yoshitaka 
Published: April 2021

ABSTRACT
We have devised a new type of pterygium surgery, based on the principle of biological contact inhibition, involving the use of a 0.5-millimeter-wide pedicle autoconjunctival strip placed at the corneal limbus. Over a period of 2 years, the procedure has been performed in 56 eyes of 52 patients, 39 to 74 years old (mean, 57 ± 9 years), with primary pterygium. After an average follow up of 34 ± 6 months (range, 20 to 40 months), the pterygium recurred in six (10.7%) of the 56 eyes. There were no other significant postoperative complications. Although our method has the disadvantages of being somewhat complicated and involving a fair amount of suturing, the relatively low rate of recurrence achieved is encouraging.
Stripping of Descemet's Membrane: A Clinicopathologic Correlation
Authors: Pieramici Dante , Green W Richard , Stark Walter J 
Published: April 2021

ABSTRACT
We describe a case of accidental injection of sodium hyaluronate (Healon) anterior to Descemet's membrane that caused the membrane to become almost completely detached. The patient eventually underwent penetrating keratoplasty, permitting histopathologic study of the detachment. Sodium hyaluronate globules in the space between the posterior stroma and Descemet's membrane were demonstrated by light and electron microscopy.
In addition, 111 consecutive cases of Descemet's membrane detachment identified pathologically were reviewed to identify potential predisposing risk factors and determine corneal pathologic changes. A history of previous intraocular surgery was present in 89 (80%) of the cases; cataract surgery, the most common, had occurred in 52 (58%). Frequent associated corneal pathologic findings were bullous keratopathy in 48 (43%) of the specimens, and scarring and vascularization in 33 (29.7%). In one case that was identified and studied histopathologically, a 90% detachment of Descemet's membrane was noted clinically following the reformation of the anterior chamber with sodium hyaluronate. We conclude that in the cases of Descemet's membrane detachment that came to pathologic examination, intraocular surgery was a major predisposing risk factor. Corneal pathologic changes, which were common, possibly masked the clinical diagnosis of Descemet's membrane detachment in some cases.
High-Resolution Ultrasound Biomicroscopy of the Anterior Segment in Patients With Dense Corneal Scars
Authors: Milner Mark S , Liebmann Jeffrey M , Tello Celso , Speaker Mark G , Ritch Robert 
Published: April 2021

ABSTRACT
Preoperative evaluation and surgical planning for penetrating keratoplasty in patients with dense cornea) scars is often difficult because of poor visualization of the anterior segment. We performed ultrasound biomicroscopy (50-megahertz frequency, 50-micron resolution) on five eyes of five patients with dense corneal opacities of different etiologies to evaluate the anatomic relationships of the iris, lens, angle, and ciliary body. Corneal thickness, the presence or absence of iridocorneal adhesions, peripheral anterior synechiae, and cyclitic membranes, intraocular lens position, and relationships among intraocular structures could be evaluated in vivo. Ultrasound biomicroscopy is the optimal method of obtaining reliable, high-resolution images delineating anatomic relationships and pathology in the anterior segment. This information aids in surgical planning for penetrating keratoplasty and anterior segment reconstruction.