Elizabeth A Hansen

Madigan Army Medical Center, Tacoma, Washington, United States

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Publications (7)14.11 Total impact

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    ABSTRACT: A virtual reality (VR) surgical simulator (EyeSi ophthalmosurgical simulator: VRMagic, Mannheim, Germany) was evaluated as a part-task training platform for differentiating and developing basic ophthalmic microsurgical skills. Surgical novice performance (residents, interns, and nonmicrosurgical ophthalmic staff) was compared with surgical expert performance (practicing ophthalmic microsurgeons) on a basic navigational microdexterity module provided with the EyeSi simulator. Expert surgeons showed a greater initial facility with all microsurgical tasks. With repeated practice, novice surgeons showed sequential improvement in all performance scores, approaching but not equaling expert performance. VR simulator performance can be used as a gated, quantifiable performance goal to expert-level benchmarks. The EyeSi is a valid part-task training platform that may help develop novice surgeon dexterity to expert surgeon levels.
    Simulation in healthcare: journal of the Society for Simulation in Healthcare 02/2009; 4(2):98-103. · 1.64 Impact Factor
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    ABSTRACT: Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.
    Current Opinion in Ophthalmology 11/2004; 15(5):426-31. · 2.56 Impact Factor
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    ABSTRACT: To highlight the various causes of gaze-evoked amaurosis. Retrospective noncomparative interventional case series. Five patients treated at our facility over the past 6 years. Clinical presentation, radiologic studies, surgical management, and postsurgical results are presented. Visual acuity, clinical findings of gaze-evoked amaurosis. Only two patients had classic intraorbital etiologies, one with an intraconal cavernous hemangioma and one with an intraconal foreign body. Three patients had extraorbital processes, two with orbital fractures and one with a sinus tumor. Only two of our patients initially were aware of the gaze-evoked amaurosis at presentation. Appropriate surgery was curative in all cases. Gaze-evoked amaurosis is a rare condition, classically implicating intraconal orbital pathology. In one of the largest case series published to date, we found extraorbital etiologies are also capable of producing gaze-evoked vision loss. Gaze-evoked amaurosis should be suspected and tested for in any orbital condition.
    Ophthalmology 03/2003; 110(2):322-6. · 5.56 Impact Factor
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    ABSTRACT: Congenital entropion and atrichosis of the lower eyelids associated with tarsal hypoplasia is a rare condition, with isolated reports in the literature and without previous pathologic examination. Case report. A father and son with mild entropion, lower eyelash atrichosis, and tarsal hypoplasia are described. A family pedigree demonstrates autosomal dominant inheritance. Histopathology from an entropion repair shows rudimentary tarsus and Meibomian glands consistent with hypoplasia of the tarsus. Isolated congenital entropion may occur in association with atrichosis of the lower eyelashes and hypoplasia of the tarsus as an isolated anomaly. The condition may be inherited as an autosomal dominant trait and appears to be well tolerated.
    Ophthalmic Plastic and Reconstructive Surgery 10/2002; 18(5):381-4. · 0.91 Impact Factor
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    ABSTRACT: To study the changes in anterior and posterior corneal curvatures in radial keratotomy (RK) and normal eyes exposed to hypoxia using Orbscan (Bausch & Lomb) technology. Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington, USA. At sea level, 11 RK subjects and 10 control subjects were exposed to ocular surface hypoxia in 1 eye by filtering humidified, compressed 100% nitrogen (0% oxygen) through an airtight goggle system for 2 hours. The contralateral eye was exposed to humidified, compressed air (21% oxygen) simultaneously through the airtight goggle system. Orbscan analysis was performed in each subject before and immediately after gas exposure. This analysis included measurement of the anterior axial and posterior axial corneal curvatures as well as corneal pachymetry. In the RK eyes exposed to 100% nitrogen gas, there was a statistically significant flattening in the anterior axial corneal curvature (P = .0012) and in the posterior axial corneal curvature (P = .0067). Radial keratotomy and control eyes exposed to air and control eyes exposed to 100% nitrogen gas demonstrated no statistically significant change in the anterior axial or posterior axial corneal curvature. Corneal hypoxia induced a statistically significant flattening in the anterior axial and posterior axial corneal curvatures in eyes that had had RK. There was no significant change in these curvatures in RK eyes exposed to air and in control eyes exposed to air or 100% nitrogen gas.
    Journal of Cataract and Refractive Surgery 02/2002; 28(2):289-94. · 2.53 Impact Factor
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    ABSTRACT: Chorioretinitis sclopetaria presents a characteristic pattern of choroidal and retinal changes caused by a high velocity projectile passing into the orbit, in close proximity to the globe. While it is unlikely that a patient should completely forget the trauma causing such damage, preserved or compensated visual function may blur the patient's memory of these events over time. Characteristic physical findings help to clarify the antecedent history. Despite the lack of an acknowledged history of ocular trauma or surgery, in our case, the characteristic ocular findings discovered at presentation allowed for recognition of the underlying etiology. Because of good visual function, the patient had completely forgotten about the trauma that occurred 12 years earlier. Strabismus surgery was performed for treatment of the presenting symptomatic diplopia. The pathognomonic findings in chorioretinitis sclopetaria are invaluable in correctly diagnosing this condition, especially when a history of ocular trauma is unavailable.
    Ophthalmic surgery and lasers 01/2001; 32(2):152-5.
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    ABSTRACT: To present a case of oculo-auriculo-vertebral dysplasia associated with corneal anesthesia and ipsilateral dacryostenosis that was successfully treated with monocanalicular lacrimal intubation. Case report. Previous neurotrophic corneal ulcers in a child with hemifacial microsomia had become secondarily infected from a stagnant tear lake, resulting in significant corneal scarring and visual loss. A single monocanalicular stent maintained nasolacrimal patency without causing further corneal trauma, despite constant medial gaze because of wide lateral tarsorrhaphy and contralateral occlusion therapy for amblyopia. Monocanalicular stents may aid the treatment of dacryostenosis in the face of compromised corneal sensation.
    Ophthalmic Plastic and Reconstructive Surgery 02/2000; 16(1):55-7. · 0.91 Impact Factor