Showing papers in "Seminars in Ophthalmology in 1998"
TL;DR: The optical coherence tomograph is a new, noninvasive technical device that can obtain cross-sectional, high-resolution images-optical coherencetomographs (OCT)-of the retina that permits an accurate evaluation of various macular and chorioretinal pathologies and the early detection of glaucomatous damage.
Abstract: The evaluation of the optical coherence tomography (OCT) is based on the identification of differences in the relative reflectivity of different tissue layers and morphological changes in tissue structures. So the examination is able to localize and grossly demarcate inflammation in the vitreous cavity (by its dynamic analysis) or beneath retinal layers as well as detail retinal changes on the chronic phases of retinal disease like fibrosis, atrophy, or retinal edema.
4,458 citations
TL;DR: Mechanical and/or pharmaceutical factors controlling postoperative epithelial hyperplasia would be beneficial and might play an important role in postoperative regression.
Abstract: Factors responsible for postoperative regression are still unknown but postoperative epithelial hyperplasia might play an important role. To evaluate the role of the corneal epithelium on regression after laser in situ keratomileusis (LASIK), the thickness of the epithelium was measured in 18 eyes preoperatively and at various postoperative intervals. Measurements of the epithelial thickness were taken using a high-frequency (50 MHz) ultrasound device and measurements were correlated with the postoperative refraction. In all eyes, preoperative epithelial thickness was between 34 and 44 microm. In contrast, after surgery, values were between 35 and 111 microm. In eyes with a refractive outcome of +/-1.0 diopter of that intended, there was an increase of the epithelial thickness of less than 5 microm postoperatively. In contrast, eyes with severe regression showed a significant increase in the thickness in the epithelium after LASIK. In our patient group, regression of the attempted correction was related to postoperative epithelial hyperplasia. Broadly speaking, an increase of 10 microm epithelial thickness resulted in a 1 diopter regression. Mechanical and/or pharmaceutical factors controlling postoperative epithelial hyperplasia would be beneficial.
125 citations
TL;DR: SLO microperimetry allows the real-time functional study of retinal sensitivity by direct ophthalmoscopic control of the retinal surface and permits an accurate monitoring of fixation and correlation of anatomical or pathological features directly with retinal function.
Abstract: In this article, the methodologies and clinical applications of microperimetry performed by scanning laser ophthalmoscope (SLO) are described. This technique provides functional results by direct visualization of the macular area. We present the most interesting data about clinical applications in ocular pathology. SLO microperimetry is a new diagnostic tool in ophthalmic practice. It permits an exact, point-to-point correspondence between fundus image and perimetric results, impossible to achieve by projection perimetry, so representing the most suitable device for simultaneous fundus imaging and psychophysical testing. Microperimetry is performed by SLO (Rodenstock),1 which permits other applications. SLO microperimetry allows the real-time functional study of retinal sensitivity by direct ophthalmoscopic control of the retinal surface. Foveal or excentric fixation can be assessed as well. Instability of fixation during computerized perimetry is a possible misleading factor resulting in unexplainable fi...
49 citations
TL;DR: The usefulness of indocyanine green angiography to aid in the diagnosis and treatment of a variety of chorioretinal diseases was reported during the last years.
Abstract: Fluorescein angiography allows visualization of blood flow in retinal and choroidal tissues, permitting diagnostic support in many ocular diseases. Particularly, fluorescein angiography has become a very important tool in the study and treatment of chorioretinal diseases. Because of the limitations of fluorescein angiography in imaging the choroidal circulation and associated pathologies, investigators have searched for alternative dyes to improve choroidal angiography, the most promising of which has been indocyanine green dye. The usefulness of indocyanine green angiography to aid in the diagnosis and treatment of a variety of chorioretinal diseases was reported during the last years. The goal of this article is to make an overview on the most frequent Fluorescein and ICGA patterns of vascular diseases of the chorioretina.
46 citations
TL;DR: The lower eyelid fat redistribution procedure, as described herein, can be used to address the classic "double convexity deformity" created by the third decade of life.
Abstract: Cosmetic lower eyelid surgery is not about removing excess skin, muscle, and fat. Rather, it is about restoring eyelid/midface contour. By the third decade of life, the suborbital orbicularis oculi fat begins to descend and the orbital septum weakens and bows forward creating the classic "double convexity deformity." The removal of eyelid fat simply converts this deformity to a "concavity/convexity deformity." The lower eyelid fat redistribution procedure, as described herein, can be used to address this problem.
37 citations
TL;DR: Preliminary results in these 10 cases indicate that foveal translocation provides improvement of visual acuity in 40% of eyes and final visual acuities useful for reading in 20% of Eyes undergoing translocation with either technique, and further study is essential to refine the amount of translocation needed.
Abstract: Subfoveal choroidal neovascular membrane is a leading cause of legal blindness. Photocoagulation has been effective, but photocoagulation of the fovea causes a decrease in vision immediately after treatment. Surgical removal of the choroidal neovascular membrane is effective for choroidal neovascular membrane in some cases, but it restores useful vision for reading (20/40 or better) in a small number of cases of choroidal neovascular membrane not due to presumed ocular histoplasmosis syndrome. A new treatment for subfoveal choroidal neovascular membrane, foveal translocation, is an innovative procedure in which the fovea is translocated onto healthier retinal pigment epithelium. Three techniques have been developed to relocate the retina, 2 of which (retinotomy and scleral shortening) we performed in 5 cases each. Preliminary results in these 10 cases indicate that foveal translocation provides improvement of visual acuity in 40% of eyes and final visual acuities useful for reading (better than 20/40) in ...
33 citations
TL;DR: This procedure has the potential to fully reconstruct and reposition the lower eyelid and lateral canthus such that the final position, function, and appearance is as good or better than it was before the changes caused by time, gravity, and previous surgery.
Abstract: The unhappy postblepharoplasty patient with lateral canthal dystopia, round eye, and scleral show presents perhaps the single greatest challenge to the aesthetic reconstructive surgeon. The problem may be as simple as a lax eyelid, which is inferiorly displaced by gravity or as complex as an eyelid, which has full thickness vertical inadequacy in each of the three eyelid lamellae. The transeyelid subperiosteal midface-lift with lower eyelid reconstruction is a reliable procedure for addressing full thickness lower eyelid vertical tissue inadequacy by totally reconstructing the lower eyelid by the classic three individual layer reconstructive technique. Vertical and horizontal adequacy or inadequacy for each of the three eyelid layers is determined and then individually addressed in the total eyelid reconstruction. This procedure has the potential to fully reconstruct and reposition the lower eyelid and lateral canthus such that the final position, function, and appearance is as good or better than it was before the changes caused by time, gravity, and previous surgery.
22 citations
TL;DR: Injection techniques, volumes, and concentration of the botulinum A toxin are described for various types of facial wrinkles.
Abstract: This article describes the use of botulinum toxin type A in the cosmetic treatment of facial wrinkles. Injection techniques, volumes, and concentration of the botulinum A toxin are described for various types of facial wrinkles.
20 citations
TL;DR: Laser-assisted in situ keratomileusis (LASIK) was safe and effective in spherical hyperopia and hyperopic astigmatism but results were poor in hyperopia of more than +5 D.
Abstract: Laser-assisted in situ keratomileusis (LASIK) was evaluated in hyperopia and hyperopic astigmatism. LASIK was safe and effective in spherical hyperopia up to +5 D and acceptable in toric hyperopia up to +5 D but results were poor in hyperopia of more than +5 D.
20 citations
TL;DR: The methodologies and clinical applications of two electrophysiological tests, the focal electroretinogram (FERG) and the visual evoked potentials after photostress, are described and the combined use of both techniques appears to be promising for gaining further insights into the diagnosis and pathophysiology of macular diseases.
Abstract: In this article, the methodologies and clinical applications of two electrophysiological tests, the focal electroretinogram (FERG) and the visual evoked potentials (VEPs) after photostress, are described. These techniques provide somewhat complementary results about macular function because they tap the activity of different neural substrates along the pathway of the cone system and allow evaluation of the macular function under steady-state (ie, the FERG) or dynamic (ie, the VEPs after photostress) conditions. The results obtained in patients with different macular pathologies indicate that while the FERG provides direct information about the extent and sites of macular dysfunction, the VEPs after photostress represent an objective, although not specific, index of the dynamic properties of macular performance after exposure to intense light stimulation. The combined use of both techniques appears to be promising for gaining further insights into the diagnosis and pathophysiology of macular diseases.
17 citations
TL;DR: LASIK compares favorably with PRK for the treatment of low to moderate myopia in terms of early achievement of refractive stability, but induction of modest amounts of irregular astigmatism can be a concern.
Abstract: Corneal topography plays an important role in laser in situ keratomileusis (LASIK). Preoperative screening permits the detection of keratoconus and other corneal shape anomalies that may be a contraindication for refractive surgery. Monitoring the progress of the surgical outcome with topography is helpful to detect postoperative complications such as decentration and clinically significant irregular astigmatism. LASIK compares favorably with PRK for the treatment of low to moderate myopia in terms of early achievement of refractive stability, but induction of modest amounts of irregular astigmatism can be a concern.
TL;DR: Ultrasonic evaluation of the vitreous body augments and complements visual and clinical assessment in any condition in which some form of media opacity exists, eg, cornea, lens, hemorrhage, or subretinal mass.
Abstract: Ultrasonic evaluation of the vitreous body augments and complements visual and clinical assessment in any condition in which some form of media opacity exists, eg, cornea, lens, hemorrhage, or subretinal mass. The appearance of the eye in hypotony, the presence of foreign material, the pattern of hemorrhage, and the presence of a detached retina or choroid are all identifiable and their diagnosis may be of critical importance to patient management. Patterns of diabetic retinopathy and ocular tumors are usually characteristic using conventional 10 MHz ultrasound. The use of Very High Frequency (VHF or UBM) ultrasound can identify ciliary body detachment or other retroiridal pathology, such as tumors and cysts.
TL;DR: The experience in surgical treatment of macular edema as contrasted to photocoagulation therapy is discussed and recent advances in vitreous surgery have enabled us to treat surgically eyes with good visual acuity.
Abstract: Macular edema, often a component of diabetic retinopathy, can be complicated by many other diseases. It is considered to be multifactorial and difficult to treat. The relation of the vitreous and macular edema is discussed. We examined many eyes of patients with diabetic macular edema that improved after spontaneous posterior vitreous detachment or vitrectomy for proliferative diabetic retinopathy. Recent advances in vitreous surgery have enabled us to treat surgically eyes with good visual acuity. We began surgical treatment for macular edema without the fibrous membrane in 1990. Here we discuss our experience in surgical treatment of macular edema as contrasted to photocoagulation therapy. This review is based on the published and unpublished results of our cases of more than 100 eyes that underwent vitrectomy for diabetic macular edema.
TL;DR: Though equipment costs are greater and a learning curve exists, the endoscopic browlift offers the oculoplastic surgeon additional beneficial options in the management of brow ptosis.
Abstract: Since its initial description by Vasconez et al in 1992, the endoscopic browlift has evolved into a popular method for addressing brow ptosis and forehead rejuvenation. The advantages of fewer incisions, less postoperative swelling, alopecia and prolonged scalp anesthesia, and more rapid rehabilitation have provided greater patient acceptance than the traditional coronal approach. Unlike the coronal browlift where the amount of elevation is determined by the amount of skin excised, the elevation in the endoscopic browlift is determined by periosteal release at the arcus marginalis and forehead flap fixation. Though equipment costs are greater and a learning curve exists, the endoscopic browlift offers the oculoplastic surgeon additional beneficial options in the management of brow ptosis.
TL;DR: The carbon dioxide laser is an instrument long familiar to the soft tissue surgeon that has recently been adapted for use in facial rejuvenation and achieves this goal by ablating the epidermis and superficial dermis, while producing a limited amount of thermal damage in the underlying dermis.
Abstract: Numerous modalities have been used to achieve facial rejuvenation. The carbon dioxide laser is an instrument long familiar to the soft tissue surgeon that has recently been adapted for use in facial rejuvenation. The laser achieves this goal by ablating the epidermis and superficial dermis, while producing a limited amount of thermal damage in the underlying dermis. Actinic damage and certain forms of dyspigmentation and scarring may be improved or eliminated, and skin tone is improved. Although portions of the face may be treated in certain situations, the best aesthetic results are generally achieved with full-face treatment. Clinical results are excellent, but both patient and physician must anticipate a 12 to 16 week period of erythema in the treated region. Early complications including infection, hyperpigmentation, and scarring have been recognized for several years, but late complications such as significant hypopigmentation have been recognized more recently.
TL;DR: Three-month visual and refractive outcomes in LASIK are comparable with the Summit Apex Plus and VISX Star lasers.
Abstract: The CRS LASIK Study is a surgeon-sponsored collaborative project to evaluate LASIK outcomes with the Summit and VISX lasers. The current report includes 3-month outcomes in the first group of patients who underwent spherocylindrical corrections of 1 to 10 diopters of myopia and 1 to 4 diopters of astigmatism with the Summit Apex Plus and VISX Star lasers. Cohort selection criteria were applied to select 911 eyes that underwent surgery between April 1, 1996 and October 1, 1997 in the range of study. Eyes with preoperative best spectacle-corrected visual acuity of worse than 20/40 (0.5) were excluded. Outcomes were stratified according to myopic treatment range. One day uncorrected visual acuity was 20/40 or better in 83% of eyes with both lasers. At 3 months, 20/40 uncorrected acuity was found in 93% of Summit and 90% of VISX eyes in the -1.00 to -4.00 D group, in 88% of Summit and 84% of VISX eyes in the -4.01 to -7.00 D group, and in 67% of Summit and 70% of VISX eyes in the -7.01 to -10 D group. Three-m...
TL;DR: The status of treatment modalities for subfoveal choroidal neovascularization secondary to age-related macular degeneration, including laser photocoagulation of the entire area of the neov vascular lesion, are reviewed, and factors prognostic of visual outcome in these treatment options are discussed.
Abstract: Laser photocoagulation of the entire area of the neovascular lesion is the only proven treatment for subfoveal choroidal neovascularization secondary to age-related macular degeneration with a poor natural history. However, there are some limiting factors such as patient eligibility, a significant decline in visual acuity after treatment, and a very low possibility of a final vision of 20/100 or better. Although no large benefit of other treatment modalities, such as indocyanine green videoangiography-guided laser photocoagulation, surgical removal of neovascular membranes, and radiation therapy, has yet been proven, carefully selected patients may be suitable candidates for such treatments. This article reviews the status of treatment modalities for subfoveal choroidal neovascularization secondary to age-related macular degeneration, including laser photocoagulation of the entire area of the neovascular lesion, and discusses factors prognostic of visual outcome in these treatment options.
TL;DR: The erbium: yttrium aluminum garnet is an ideal treatment for mild to moderate periorbital rhytids.
Abstract: Erbium: yttrium aluminum garnet lasers are highly absorbed by water within the skin. This has reduced thermal effects associated with carbon dioxide laser skin resurfacing, such as prolonged postoperative erythema, delayed healing, scarring, and pigmentation. The erbium: yttrium aluminum garnet is an ideal treatment for mild to moderate periorbital rhytids.
TL;DR: The different types of lasers available for the treatment of pigmented and vascular lesions are discussed, the specific indications and limitations are discussed and the experience with the krypton laser is presented.
Abstract: There has been a bewildering increase in the number and types of lasers available to the modern surgeon for the treatment of a variety of lesions. Pigmented and vascular lesions lend themselves to laser therapy and are common presentations in the cosmetic practice. While many different lasers may be effective for the treatment of these lesions, each has its own advantages and disadvantages. A detailed understanding of the specific properties and the applicability of the different lasers is vital if one is to successfully incorporate these lasers into one's practice. In this article, we discuss the different types of lasers available for the treatment of these lesions, discuss the specific indications and limitations and present our experience with the krypton laser.
TL;DR: The posterior precortical vitreous pocket is a premacular liquefied lacuna that is physiologically present in adult eyes and provides a guideline to manage vitreoretinal disorders occurring in the macular area.
Abstract: The posterior precorneal vitreous pocket is a premacutar liquefied lacuna that is physiologically present in adult eyes. The posterior wall of the pocket consists of a thin layer of the vitreous, and its anterior border is delineated by vitreous gel. This peculiar structure of the premacular vitreous cortex plays a key role in the development of various vitreomacular disorders. In diabetic retinopathy, fibrovascular tissue tends to develop along the outer margin of the pocket, resulting in a ring- or c-shaped structure. Tangential contraction of the posterior wall of the pocket or premacular cortex causes the formation of macular holes. The posterior wall of the pocket serves as a major structural component of idiopathic premacular fibrosis. The concept of the posterior precorneal vitreous pocket provides a guideline to manage vitreoretinal disorders occurring in the macular area.
TL;DR: RPE removal will improve the anatomical and the visual results in selected macular hole cases in selected patients with stage 2, stage 3, or stage 4 macularhole cases.
Abstract: We studied the efficacy of removing the retinal pigment epithelium (RPE) from the base of the macular hole to treat 124 eyes of 118 patients with stage 2 (n = 38), stage 3 (n = 52), or stage 4 (n = 34) macular hole. The patients ranged in age from 42 to 81 years (mean = 66.7 years), and the duration of symptoms preoperatively ranged from 1 to 140 months (average = 16.8 months). During vitrectomy for the macular hole, the RPE at the base of the hole was gently aspirated with either a silicone-tipped extrusion needle or a blunt-tipped 27-gauge needle. The follow-up period averaged 18.6 months (range = 3 to 48 months). The holes resolved in 112 (90%) of the 124 eyes after one surgical procedure. In 107 eyes with a follow-up period of 6 months or longer, 91 (85.0%) showed improved visual acuity of at least 2 lines of Snellen equivalent. The final visual acuity was 20/25 or better in 34 (31.8%) and 20/40 or better in 80 (74.8%) of the 107 eyes. A complication peculiar to RPE removal is the hypertrophy of the R...
TL;DR: The preoperative assessment of the patient, the concept of preconditioning the skin, and postoperative wound management after laser resurfacing are focused on.
Abstract: Laser resurfacing has become a commonly used technique for the treatment of a variety of skin conditions including facial actinic damage, rhytides, and acne scarring. Although the procedure has the ability to deliver consistently good results with an excellent safety profile, complications do occur even in the best of hands. Independent of the type of laser used or the surgical technique, the risk of complications and the final outcome can be greatly influenced by the care of the skin before and after the procedure. This article will focus on the preoperative assessment of the patient, the concept of preconditioning the skin, and postoperative wound management after laser resurfacing. Various occlusive dressing products will be discussed, as well as their role in wound healing. A pre- and posttreatment skin care regimen will be provided to use as a guide in the management of patients undergoing laser resurfacing.
TL;DR: General guidelines for the postoperative management of traumatic facial scars and surgical incisions after primary closure and suggestions for postoperative care and scar revisions are discussed.
Abstract: General guidelines for the postoperative management of traumatic facial scars and surgical incisions after primary closure and suggestions for postoperative care and scar revisions are discussed.
TL;DR: The technique for the surgical removal of subretinal hemorrhage is described and it is believed that surgery for SRH is beneficial in selected patients.
Abstract: Subretinal hemorrhage (SRH), complicated by choroidal neovascularization such as age-related macular degeneration, often reduces central vision in middle-aged patients. Although the visual results of SRH removal by surgery seem to have improved recently, the efficacy has not yet been confirmed in a prospective, controlled fashion. Therefore, it cannot be stated with certainty that surgery for SRH is more beneficial than the natural course of the disease. However, we believe surgery is beneficial in selected patients. Herein, we describe our technique for the surgical removal of SRH. The development of safer, more effective techniques should further improve patient outcomes.