Showing papers in "Ophthalmic surgery in 1984"

Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma.

Abstract: In a retrospective study we compared the efficacy and safety of trabeculectomy and nonpenetrating trabeculectomy (NPT). In the latter procedure under a thin scleral flap, juxtacanalicular trabecular meshwork with Schlemm's canal is excised leaving the innermost trabecular meshwork behind. Trabeculectomy was performed on 86 eyes (66 blacks, 20 whites), whereas 71 eyes underwent NPT (44 blacks, 27 whites). The mean follow-up period was 1.7 years. Postoperatively at one year, trabeculectomy controlled 70.3% of patients with no or topical antiglaucoma medication, whereas 83.7% of NPT patients were similarly controlled. There was a difference in the number and severity of complications between trabeculectomy and NPT. Postoperative flat anterior chamber, uveitis, hyphema, vitreous loss, and choroidal detachment occurred more frequently after trabeculectomy.

Management of failing filtering blebs with the Argon laser.

Abstract: Using the Argon laser and a special lens, the authors have developed a technique for cutting trabeculectomy flap sutures through the overlying conjunctiva. The technique is described and three case reports are presented. The availability of this technique permits suturing the scleral flap tightly, thus minimizing postoperative flat chambers. If filtration is inadequate in such cases, suture cutting with the laser can open the flap and permit more successful filtration.

Effectiveness of nonpenetrating trabeculectomy in aphakic patients with glaucoma.

Abstract: Nonpenetrating trabeculectomy was performed on 28 aphakic eyes consisting of 18 with chronic open-angle glaucoma and 10 with secondary and/or complicated glaucoma. The canal of Schlemm and the juxtacanalicular trabecular meshwork were excised for a length of 4 mm beneath a 6 mm x 6 mm scleral flap. At one year postoperatively, 72.0% of all patients were controlled, 24% required no antiglaucoma medications. However, 88% of chronic simple glaucoma patients were satisfactorily controlled. The mean follow-up period was 1.4 years. Minimal complications have been encountered to date. Nonpenetrating trabeculectomy may be valuable as an initial procedure in aphakic patients who require glaucoma filtration surgery.

Fine needle aspiration biopsy of solid intraocular tumors: indications, instrumentation and techniques

Abstract: We have performed fine needle aspiration biopsy of 21 solid intraocular tumors as a diagnostic technique prior to treatment of these tumors. Indications for biopsy included major diagnostic uncertainty, suspected cancer metastasis to the choroid without other evidence of systemic malignancy, and patient insistence on biopsy confirmation of the diagnosis prior to treatment. This paper presents the instrumentation and techniques that we have used in our intraocular fine needle aspiration biopsies and reviews the complications of biopsy that we have encountered.

Filtering surgery in childhood glaucoma

Abstract: A review of 38 eyes of 24 patients receiving filtration surgery for childhood glaucoma is presented. A total of 54 procedures were performed, including both thermal sclerostomies and trabeculectomies. Successful control of intraocular pressure was obtained in 20 eyes (52%). Average follow-up time was four years, two months. Filtration surgery is seen as a useful technique in the treatment of childhood glaucoma when goniotomy fails. It also is useful in those conditions where the success rate of goniotomy is expected to be low.

Evaluation of toxicity of intravitreal antineoplastic drugs.

Abstract: We evaluated the toxic and nontoxic doses of eight antineoplastic drugs in the vitreous cavity of rabbits. These drugs may have implications in the prevention of cell proliferation in the vitreous.

Focal pressure: a new method to encourage filtration after trabeculectomy.

Abstract: One cause of failure of trabeculectomy is early closure of the sclerostomy with insufficient aqueous outflow and subsequent scarring of Tenon's capsule and conjunctiva. Ocular massage and other forms of manipulation of the scleral flap have been used in the past to enhance filtration in cases where full-thickness filtration procedures were performed, and they have been suggested for use with trabeculectomy as well. The authors propose a new method in which focal pressure is applied with an anesthetic-moistened applicator directly to the conjunctiva beside the edge of the scleral flap. This appears to be particularly indicated in trabeculectomy, and has both theoretical and practical advantages over the conventional forms of enhancing filtration in eyes having been treated with trabeculectomy. In 17 of 18 cases having trabeculectomy according to Watson's technique and in which it appeared that no filtration would develop in the postoperative period, focal pressure was successful in creating a satisfactory bleb.

Ocular hypertension following Nd:YAG laser capsulotomy: a potentially blinding complication.

Abstract: A dense secondary membrane was treated with a Nd:YAG laser capsulotomy with marked improvement in visual acuity, from count fingers to 6/9 (20/40). Four hours following therapy, visual acuity in the treated eye was no light perception, due to extreme ocular hypertension (over 80 mm Hg). The extreme elevation in intraocular pressure appears to have been caused by cellular debris obstructing the trabecular meshwork in an angle already compromised by angle recession. An emergency paracentesis was successful in restoring the visual acuity.

The effect of repeating full-circumference argon laser trabeculoplasty.

Abstract: Seventeen eyes of 16 patients who were classified as treatment failures following 360 degrees of argon laser trabeculoplasty underwent repeat treatment of the meshwork with the argon laser. Average intraocular pressure was significantly reduced from 22.5 +/- 6.8 to 19.3 +/- 6.1 mm Hg (P less than 0.05). Fifty-three percent of cases had a reduction and 12% had an increase in intraocular pressure of greater than or equal to 3 mm Hg at an average follow-up of 12 weeks. Visual function was not stabilized in 41% of the cases with 29% requiring further glaucoma surgery.

The MAI hydrophilic implant for scleral buckling: a review.

Abstract: MAI, a new hydrophilic implant designed by Refojo for scleral buckling, is soft and elastic (thus preventing erosion) and offers versatility in interconvertible degrees of softness. MAI has no dead spaces. Its ability to absorb and gradually release antibiotics and to stimulate the production of a fibrous capsule around the implant increases safety and minimizes morbidity associated with the scleral buckling operation. This review summarizes the works published to date on MAI.

Evaluation of intravitreal 5-fluorouracil, vincristine, VP 16, doxorubicin, and thiotepa in primate eyes.

Abstract: A single intravitreal dose of 750 micrograms 5 fluorouracil (5 FU) or 5 micrograms doxorubicin were nontoxic to primate eyes. A concentration of 250 micrograms/ml of 5 FU in the vitrectomy infusion fluid in combination with 8 micrograms/ml of thiotepa, with 40 micrograms/ml of VP16 (etoposide), or with either .04 or .02 microgram/ml of vincristine was also well tolerated by the primate eye. 5 micrograms/ml of doxorubicin in the vitrectomy infusion fluid did not cause apparent toxicity to the retina. Toxic effects were noted in eyes receiving 250 micrograms of 5 FU in combination with either .15 or .1 microgram/ml of vincristine.

Blow-in and blow-out fractures of the orbit: clinical correlations and proposed mechanisms.

Abstract: Various theories have been proposed regarding the exact etiology of blow-out fractures of the orbital floor and blow-in fractures of the orbital roof. These include the role of increased intraorbital pressure causing a downward fracture of the orbital floor, and the role of a buckling force transmitted by the orbital rim to the thinner orbital walls. This paper presents two case histories that illustrate the roles of these mechanisms in the production of such fractures. One is a classic blow-out fracture while the other is a unique case of orbital roof blow-in fracture which may shed additional light on the role of buckling forces in the creation of these fractures. A review of experimental and clinical data supporting these mechanisms is presented and suggests that more than one factor may be involved in the production of such orbital fractures.

Retinal detachment in Morning Glory syndrome

Abstract: A 9-year-old girl with bilateral Morning Glory syndrome developed bilateral bullous retinal detachment. There was a small break on the temporal margin of the disc in the left eye. The retinal detachment in this eye was successfully treated by drainage of the subretinal fluid, vitrectomy, intravitreal air injection, and photocoagulation around the edge of the anomalous disc. It is suggested that some retinal detachments in the Morning Glory syndrome may be rhegmatogenous in nature.

Marked intraocular pressure rise following Nd:YAG laser capsulotomy.

Abstract: A Nd:YAG laser was used to perform a posterior capsulotomy on a patient one and a half years after phacoemulsification. Within 24 hours the intraocular pressure had increased to 67 mm Hg despite pre-treatment with timolol and acetazolamide. Intraocular pressure eventually returned to pre-capsulotomy levels after several days. A mechanism is postulated for the particularly high pressures encountered in this case.

Glaucoma filtering surgery: factors that determine pressure control.

Abstract: Factors that determine pressure control after filtering surgery were studied in 194 eyes of 158 patients in a retrospective study. Emphasis was placed on the cumulative probability method of Kaplan and Meier and multiple regression analysis. Aphakia and the presence of a surgical bleb were the most important factors. Age and type of surgical procedure were next. Race and race-sex interaction were the least important. The above factors accounted for only 6% to 16% of the total variance. The difference between eyes of the same patient was less than that between paired eyes of different patients but the former was surprisingly high. In the selected group of successful cases without medication the postoperative pressure was independent of the baseline pressure and choice of surgical procedure.

Diagnosis and management of cataracts in infancy and childhood

Abstract: Congenital and developmental cataracts are a major cause of visual impairment in children. They may occur as an isolated ocular finding in an otherwise healthy child or as part of a hereditary syndrome or congenital nongenetic disease. Management of significant unilateral and bilateral congenital cataracts involves early patient identification and evaluation followed by prompt surgery. Appropriate optical rehabilitation and occlusion therapy for amblyopia must begin shortly thereafter. The visual prognosis of a congenital cataract is poorer in unilateral than in bilateral cases and in total than in partial cataracts. Visual rehabilitation is also poorer in those cases in which the cataract is associated with other ocular abnormalities.

Effect of varying size of scleral flap and corneal block on trabeculectomy.

Abstract: Prospectively, 28 eyes of 23 patients undergoing trabeculectomy were divided into two groups. The first group received a large scleral flap (4 mm X 4 mm X 4 mm) and corneal block (3 mm X 3 mm). The second group received a small scleral flap (2 mm X 2 mm X 2 mm) and corneal block (1 mm X 1 mm). No other changes in technique were made. After a mean follow-up of 13 months, there was no significant difference in final intraocular pressure, visual acuity, or complication rates between groups.

Silicone slings for the correction of ptosis associated with progressive external ophthalmoplegia.

Abstract: Tarsofrontalis suspensions using silicone rods were performed in eleven patients for the ptosis associated with progressive external ophthalmoplegia. All patients had the eyelids elevated above the level of the pupils with resultant full field of vision and improved cosmesis. Patients have been followed for three to 24 months.

Combined use of sodium hyaluronate and tissue adhesive in penetrating keratoplasty of corneal perforations.

Abstract: A new technique which allows the use of a guarded trephine in penetrating keratoplasty for corneal perforation is described. It involves the combined use of cyanoacrylate adhesive and sodium hyaluronate and allows a normotensive eye to be obtained prior to trephination. Five cases in which this technique was used are described. A better tectonic result can be obtained and visual rehabilitation may be more readily achieved without performing a secondary procedure.

Histological study of epikeratophakia in primates.

Abstract: Two primate corneas were analyzed histologically 22 and 25 months after epikeratophakia surgery. Keratocytes had migrated from the host cornea into the lenticule through the surgical disruption of the host Bowman's membrane; the lenticule with the wider connection to the host cornea appeared to have more complete keratocyte repopulation. The lenticule stroma and host Bowman's membrane were continuously apposed along the interface, with a basement membrane-like material composed of collagen fibrils and amorphous matrix filling the interstices.

A guide to pachymeters

Abstract: An ongoing study of pachymeters has been carried out to determine the accuracy, reproducibility, and ease of operation of various optical and ultrasonic pachymeters. Beginning with optical versus available ultrasonic pachymeters, the demonstrated greater accuracy and reproducibility of ultrasound led to enlargement of the study to a comparison of all available ultrasonic pachymeters. Side-by-side evaluation was undertaken to determine interobserver variation and a number of other factors. The results are summarized as a guide.

The anterior capsulotomy of extracapsular cataract extraction

Abstract: Cataracts are a major cause of blindness, and more than 75% of all cataract operations performed in the United States are associated with an intraocular lens (IOL) implant. Since approximately 63% of all IOL implants are of the posterior chamber type and associated with extracapsular cataract extraction (ECCE), it is important for the ophthalmic surgeon to perfect this operation. We describe herein the important surgical anatomy of the zonular-lens capsular attachments and present the results of a poll of experts as to the important aspects of the anterior capsulotomy of the ECCE.

Histopathologic studies on transscleral argon-krypton photocoagulation with an exolaser probe.

Abstract: We performed argon and krypton laser photocoagulation of the retina and ciliary body on rabbit and monkey eyes using an exolaser probe. Clinically, transscleral retinal lesions produced a white circumscribed reaction. Histologically, we observed necrosis of the retina and choroid. Chronic lesions showed disorganization of the retina and formation of chorioretinal scars. Transciliary body laser coagulation damaged the ciliary body and its processes. The intraocular pressure was reduced in rabbits for one week and in monkeys for two weeks after 360 degrees transciliary laser coagulation. Scleral involvement was a common finding in transscleral laser coagulation.

An anatomical etiology of congenital eyelid eversion.

Abstract: Congenital eversion of the eyelids is a rare condition which has never had a proven anatomic etiology. A one-day-old male presented with severe congenital eversion of both upper eyelids. Medical therapy was unsuccessful. At surgery, adipose tissue was found beneath the tendon of the levator palpebrae and extended anterior to the tarsus because the orbital septum was not attached inferiorly. The defect was repaired. In this case, non-attachment of the orbital septum may have induced eversion of the upper eyelids.

Acute intraocular pressure elevation after argon laser trabeculoplasty and iridectomy: a clinicopathologic study.

Abstract: Trabeculectomy specimens excised from five patients with persistent, medically unresponsive elevation of pressure following argon laser trabeculoplasty and argon laser peripheral iridectomy were studied by light and electron microscopy. Histological examination disclosed macrophages, lymphocytes, activated trabecular endothelial cells, and tissue debris from trabecular beams. This inflammatory response and tissue debris initiated by laser treatment appears to be an important factor in the postoperative decompensation of the aqueous outflow system.

The warming of local anesthetic agents to decrease discomfort.

Abstract: Preheating local anesthetic agents used for retrobulbar and facial nerve injection greatly decreases patient discomfort.

Intraocular lenses in myopes.

Abstract: A series of 40 consecutive myopic eyes with intraocular lens implants of 13.0 diopters or less was examined with regard to visual result, complications and accuracy of commonly used lens implant power formulas. Recommendations are given for the use of implants in myopic patients as well as the various approaches to visual rehabilitation of the anisometropia in the fellow eye following surgery.

Ethmoidal sinus osteoma--a primary cause of nasolacrimal obstruction and dacryocystorhinostomy failure.

Abstract: An osteoma is a slow growing, bony tumor which forms in the sinuses of the skull. Presenting complaints include headaches, cerebral symptoms, or visual disturbances, depending upon the location of the tumor. This paper describes an unusual case of ethmoid sinus osteoma, with epiphora as the primary symptom; it also caused the failure of a previous dacryocystorhinostomy. This case illustrates the need for thorough evaluation of epiphora, including sinus x-rays.

Analysis of the Hessburg-Barron vacuum trephine.

Abstract: We tested the Hessburg-Barron vacuum trephine on 23 human cadaver eyes for accuracy and quality of cut. The trephine was found to make accurate, spherical cuts in the anterior corneal stroma. With penetration, the cut became beveled, leaving the posterior corneal button diameter larger than the anterior diameter especially if the trephine was lifted. The results are discussed relative to conventional techniques.

Incidence of perforations in rubber gloves during ophthalmic surgery.

Abstract: Four percent of rubber gloves worn during ophthalmic surgery had perforations at the end of the procedure. The incidence was 10% in both right- and left-hand gloves of the nurse, 6% in the left-hand glove of the surgeon, and 4% in the right-hand glove of the surgeon. Holes occurred most often in retinal detachment surgery for both the operator (19% for the left hand) and the nurse (17%). All nurses and surgeons were right-handed. The most likely cause for the perforations appeared to be the handling of the needle in the fingers of the left hand while grasping it with a needle holder. The relatively high frequency of perforations in surgeons' and nurses' gloves emphasizes the importance of employing a technique designed to minimize such problems. In addition, consideration should be given to replacement of gloves during long operations.