Ophthalmic surgery (Ophthalmic Surg )

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  • Other titles
    Ophthalmic surgery
  • ISSN
    0022-023X
  • OCLC
    1761334
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: We report seven cases of congenital absence of the lacrimal puncta, a condition that may be either an isolated finding or associated with other developmental anomalies. General pediatric evaluation of two patients with punctal agenesis revealed no additional abnormalities; these cases were managed by probing and silicone intubation. The other five cases were associated with other significant, clinically obvious abnormalities; several of these patients required more aggressive management of their lacrimal disorders, including dacryocystorhinostomy and conjunctivo-dacryocystorhinostomy. Previous reports support the impression generated by this series that otherwise normal appearing children with congenital absence of the lacrimal puncta do not require an extensive work-up. Probably many children with absent puncta are asymptomatic and remain undiagnosed.
    Ophthalmic surgery 01/1997; 26(1):53-6.
  • Ophthalmic surgery 01/1995; 26(3):274-5.
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    ABSTRACT: This study evaluates the association between congenital ptosis and amblyopia. Amblyopia was detected in 7 of 36 (19%) patients with congenital ptosis. Two patients (6%) with amblyopia had no contributing factors other than the presence of congenital ptosis. A statistically significant correlation between severe nonocclusive ptosis (greater than or equal to 4 mm) and the development of amblyopia was identified. No new cases of amblyopia developed after surgical repair of the ptosis, suggesting early surgery for severe nonocclusive congenital ptosis may decrease the incidence of amblyopia.
    Ophthalmic surgery 01/1995; 26(4):334-7.
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    ABSTRACT: Excavated defects of the optic disc have been associated with retinal detachment in the macula and beyond. Included among these defects are congenital pits of the optic disc, optic nerve colobomas, and the morning glory syndrome. We report eight consecutive patients with congenital, excavated defects of the optic disc and associated retinal detachment managed with pars plana vitrectomy, laser photocoagulation, and intravitreal gas injection.
    Ophthalmic surgery 01/1995; 26(1):11-5.
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    ABSTRACT: Characteristics of alkalinized local anesthetics are poorly described with regard to stability and precipitation. Current fixed-volume methods of alkalinization often result in unstable, precipitated solutions of unpredictable pH. We determined a stable, nonprecipitating, anesthetic mixture and used it in a randomized double-blind crossover study of 21 patients to evaluate alkalinized anesthetic solutions in reducing pain on injection. Our solution significantly reduced pain associated with retrobulbar injection (analysis of variance, P = .0362) but not that associated with Nadbath injection. Fixed-volume alkalinization is not recommended because complications can result with the use of precipitated anesthetics.
    Ophthalmic surgery 01/1995; 26(3):194-9.
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    ABSTRACT: Mechanisms of posterior lens dislocation during phacoemulsification have been suggested, but the actual mechanism involved has not been demonstrated. Chart reviews of cataract surgeries performed at Indiana University from 1991 until the present identified nine cases of posterior lens dislocation that occurred during phacoemulsification. In four, the procedure was converted early to a can-opener capsulotomy. Cadaver eye studies showed the role of an imperfect capsulorhexis in extending tears while a "trap door" was being formed for posterior nuclear dislocation during phacoemulsification.
    Ophthalmic surgery 01/1995; 26(2):114-6.
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    ABSTRACT: We describe a method of removing a posteriorly dislocated lens involving the use of a Machemer lens to visualize displaced lens remnants. Following core vitrectomy, the lens remnants are brought anteriorly and then removed by phacoemulsification. Lens implantation may then be performed with sulcus fixation. Eight of 10 patients in which this technique was used achieved 20/40 or better visual acuity.
    Ophthalmic surgery 01/1995; 26(2):156-9.
  • Ophthalmic surgery 01/1995; 26(1):91.
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    ABSTRACT: Optimal treatment of intralenticular metallic foreign-body injuries remains controversial, especially in patients with clear lenses and good vision. Using 20 rabbit eyes, we examined the cataractogenic potential of intralenticular iron and its effects on the retina. Iron wire implanted into the lenses of 12 rabbit eyes caused cataracts in every eye within 4 weeks. However, after 4 1/2 weeks, none of these eyes showed evidence of retinal siderosis. No cataracts developed in five eyes with intralenticular glass, while three with intravitreal iron showed marked retinal toxicity. These results suggest that as long as the lenses remain clear, conservative management of these injuries carries minimal risk of permanent retinal damage.
    Ophthalmic surgery 01/1995; 26(2):142-4.
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    ABSTRACT: Corneas with large perforations complicate penetrating keratoplasty due to the increased risk of anterior chamber collapse they pose. We hypothesize that suction trephines should produce more uniform corneal openings than non-suction trephines. Penetrating keratoplasties using Franceschetti-type freeblades, and Hanna and Hessberg-Barron suction trephines were performed on human eye bank eyes with large corneal perforations. The trephined corneas' histologic appearance was graded according to depth, sharpness, and perpendicularity of cut. Suction trephines were easier to use, resulted in less anterior chamber collapse, caused less corneal distortion, and created a sharper, deeper and more perpendicular incision. The Hessberg-Barron and Hanna trephines performed better than the freeblades in this study.
    Ophthalmic surgery 01/1995; 26(3):209-15.
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    ABSTRACT: I prospectively studied cataract extraction with implantation of heparin surface-modified intraocular lenses (IOLs) in 20 patients with Fuchs' heterochromic uveitis. The mean follow up was 14.5 months. Seven episodes of postoperative uveitis occurred, including two with fibrin deposition, but substantial giant-cell adhesion to the IOL was seen in only four cases. A visual acuity of 20/40 or better was achieved in 95% of the eyes despite other causes of visual loss such as vitreous opacities. The use of heparin surface-modified IOLs is suggested for patients with heterochromic uveitis.
    Ophthalmic surgery 01/1995; 26(1):49-52.
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    ABSTRACT: To determine the prevalence of ocular motility defects following placement of a Krupin valve with disk and adjunctive mitomycin-C in glaucoma patients, a retrospective case series of all patients receiving a Krupin valve with disk and intraoperative mitomycin-C in a university-based referral practice was conducted. Each of the seven consecutive patients undergoing placement of a Krupin valve with disk in one eye because of uncontrolled glaucoma, developed significant primary position heterotropia or limitation of ocular rotations. One patient had significant postoperative diplopia. We conclude that the Krupin valve with disk used with intraoperative mitomycin-C can be associated with the development of ocular motility defects. The limitation of rotations appears to relate to the combined mechanisms of implant and cyst bulk and the displacement of the oculorotary muscles by the encapsulating cyst.
    Ophthalmic surgery 01/1995; 26(3):228-32.
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    ABSTRACT: Delayed onset of upper lid edema with exuberant chemosis developed in a 3-year-old girl following blunt periorbital trauma. Examination under anesthesia demonstrated a tightly everted upper tarsus that focally compressed the underlying conjunctiva at the superior tarsal border. Injection of subconjunctival hyaluronidase followed by local compression and temporary tarsorrhaphy resulted in rapid resolution of the chemosis and restoration of the normal lid position.
    Ophthalmic surgery 01/1995; 26(4):372-3.
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    ABSTRACT: An 84-year-old black woman had a right caruncular lesion that had progressively enlarged over the past 3 months. Surgical excision and cryotherapy were performed. A biopsy confirmed the diagnosis of caruncular malignant melanoma, a rare lesion which, to our knowledge, has not been previously reported in a black patient.
    Ophthalmic surgery 01/1995; 26(2):139-41.
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    ABSTRACT: This article presents a novel hypothesis on what causes an involutional entropion. The theory herein proposes that the pathophysiology of entropion is that of an idiopathic dystonia with the locus of dysfunction posed in the rostral brain stem and with stimuli for its causation mediated through the seventh cranial nerve--the facial nerve--by a cord of fibers making its path to the upper, ie, temporooculo-zygomatic ramus of the nerve. In a word, involutional entropion is but a variant of essential blepharospasm and one of the clinical entities within the oculo-oro-facial-cervical family of dystonia disorders.
    Ophthalmic surgery 01/1995; 26(4):362-6.
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    ABSTRACT: We assessed the timing of astigmatic and refractive stabilization following six cataract surgery procedures with intraocular lens implantation in 229 eyes divided into six groups in the following incision sizes and methods of wound closure: 11-mm incision with running suture closure (26 eyes) 6.5-mm incision with running suture closure (29 eyes) 6.5-mm incision with single horizontal suture closure (25 eyes) 6.5-mm incision without suture closure (46 eyes) 5.5-mm incision without suture closure (51 eyes) 3.2-mm incision without suture closure (52 eyes) Analyzed up to 6 months postoperatively were: the mean and standard deviation of axis-based keratometric cylinders the absolute value of the induced-cylinder vector the spherical equivalent of the refractive power. In the 11- and 6.5-mm incision running suture groups, these parameters did not stabilize during the study period. In the 6.5-mm incision horizontal suture and sutureless groups, the values stabilized at 3 months postoperatively; in the 5.5-mm incision group, at 1 month; and in the 3.2-mm incision group, at 2 weeks. These results indicate that the appropriate point at which to prescribe postoperative correction spectacles differs significantly depending on the procedure, and that smaller incisions with wound-closure methods that do not exert vertical force are associated with fewer postoperative refractive changes.
    Ophthalmic surgery 01/1995; 26(4):309-15.
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    ABSTRACT: We investigated retinal vascular changes in nine patients undergoing optic nerve sheath decompression for vision-threatening papilledema associated with pseudotumor cerebri. Two major (one superior and one inferior) retinal venous and arterial calibers were measured before and 1.1 +/- 0.1 months, 3.2 +/- 0.2 months, 5.0 +/- 0.2 months, 7.6 +/- 0.2 months, and 13.0 +/- 1.9 months after surgery. The retinal venous caliber decreased significantly, and the decrease progressed until 3.2 months after surgery. The venous caliber in the contralateral unoperated eyes also decreased significantly. The decrease in the venous caliber in the contralateral unoperated eye as well as in the operated eye following the surgery supports the hypothesis that slow filtration is the mechanism of successful optic nerve sheath decompression. Retinal venous caliber measurement, in either the operated eye or the unoperated fellow eye, can be used to quantitatively monitor the status of papilledema associated with pseudotumor cerebri.
    Ophthalmic surgery 01/1995; 26(1):25-8.
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    ABSTRACT: Results of penetrating keratoplasty in 443 eyes of 439 patients of active infective corneal ulcers, from a period of 10 years, were analyzed. All these eyes were proven refractory to maximal medical therapy for extended periods of time, in some cases more than 6 weeks. As the surgery was performed during the active stage, the outcome was not favorable functionally. Clinical cure was obtained, however, by therapeutic penetrating keratoplasty in all but 27 of these eyes. Of unsuccessful cases, 16 could be saved with additional medical therapy, two led to phthisis bulbi, and nine required repeat therapeutic penetrating keratoplasty. Complications encountered included disturbances in intraocular dynamics such as extrusion of the lens and vitreous during surgery, secondary rise of intraocular pressure leading to damage of the optic nerve, loss of the eye due to above factors, and reinfection. The anatomical success achieved was 97% with graft clarity of 2+ or more in 39% of eyes. Useful vision, ie, better than or equal to 6/60, was possible in 33% of eyes. Thus, therapeutic keratoplasty in refractory corneal ulcer still has scope in a Third-World country.
    Ophthalmic surgery 01/1995; 26(4):325-9.
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    ABSTRACT: Arteriovenous malformations (AVMs) of the orbit are progressively enlarging communications between arteries and veins that bypass normal capillary beds. In contrast to arteriovenous fistulas (AVFs), AVMs are congenital lesions with multiple large feeding arteries, a central nidus, and numerous dilated draining veins. Management of AVMs of the orbit may be difficult due to the threat of hemorrhage, vascular occlusion during treatment, and collateral damage to surrounding organs. We managed AVM of the orbit and periorbital tissues in four patients. Neuroimaging studies, clinical decision making, operative experience, and long-term postoperative results were retrospectively reviewed. Four cases of AVM of the orbit and periorbital tissues were successfully treated with preoperative embolization and subsequent excision of the central nidus of the AVM. There was no evidence of recurrence in any of the cases over follow up ranging from 2 to 5 years. We conclude that identification of all arterial feeders, from both internal and external carotid systems, is critical in developing a therapeutic plan. AVMs may be treated by surgical excision alone, or embolization alone. However, in the hands of an experienced interventional neuroradiologist and an appropriately chosen surgical team, most AVMs can and should be treated by a combined approach of preoperative embolization followed by surgical excision of the vascular mass. The goal of therapy is closure of the low-resistance shunt.
    Ophthalmic surgery 01/1995; 26(2):145-52.
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    ABSTRACT: In a prospective case series (consecutive patients) of 30 eyes from 30 subjects with medically uncontrolled glaucoma being treated at a hospital-based, referral glaucoma service, we sought to ascertain if a surgically obtained reduction of intraocular pressure (IOP) in human glaucomatous eyes is paralleled by an improvement of the visual field. Uncomplicated limbus-based trabeculectomy was performed in 13 men and 17 women familiar with computerized perimetry testing, with a pupil diameter of at least 4 mm (measured at the Goldmann perimeter bowl), a best-corrected visual acuity of 20/20 in both eyes, and a Mean Sensitivity (MS) index greater than 10 dB. The main outcomes measured were: visual field data (Octopus, program G1) and IOP (mean of the two highest values during the diurnal curve) obtained 3 days before and 3 months after surgery in both the operated and the fellow eyes. In the operated eyes, an increase of MS (from 17.2 +/- 2.4 to 18.9 +/- 2.8, P < .000001, paired samples two-tailed t test) was observed. Meanwhile, the Corrected Loss Variance (CLV) remained substantially the same (46.8 +/- 12.2 before, vs 47.3 +/- 13.4 after; P = .87, paired samples two-tailed t test). The increase in MS was positively correlated with the amount of IOP reduction (linear regression: r = 0.901, P < .00001). No statistically significant change of either MS or CLV values occurred in the fellow eyes. The correlation between the amount of IOP reduction and the increased MS suggests that, in the short term, reducing the IOP may improve visual function to some extent. The apparent lack of correlation between the amount of IOP reduction and the CLV may indicate that the depth of the preexistent glaucomatous scotomas remains unchanged.
    Ophthalmic surgery 01/1995; 26(2):121-6.