1: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):514-7. 

Bilateral cataract surgery combined with implantation of a brown diaphragm
intraocular lens after trabeculectomy for congenital aniridia.

Esquenazi S, Amador S.

Centro Oftalmologico Olsabe, Bogota, Colombia.

A 17-year-old male patient was referred for poorly controlled glaucoma on
maximal medication, congenital aniridia, cataract, nystagmus, and hypoplasia of
the macula. A bilateral filtering procedure was performed to control the
glaucoma. Three months later, a slow motion phacoemulsification and implantation
of a brown diaphragm intraocular lens (IOL) was attempted. Despite the presence
of nystagmus and hypoplasia of the macula, the visual acuity improved from
20/300 to 20/100 in the right eye and from 20/400 to 20/150 in the left eye.
Both aniridia IOLs were well centered, the anterior segment was quiet with
normal intraocular pressure without medication, and all of the patient's glare
symptoms disappeared. A single-piece iris diaphragm and optical lens offer a
safe alternative for patients who previously had no viable options for iris
reconstruction. The most serious postoperative problem, glaucoma, should be
addressed before the cataract and lens implantation is performed to avoid a
possible acceleration of the glaucoma progression by the large aniridia IOL.

Publication Types:
    Case Reports

PMID: 12449232  [PubMed - indexed for MEDLINE]

2: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):511-3. 

Macular hole following photodynamic therapy.

Mansour AM, Husseini ZM, Schakal AR.

Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.

A 66-year-old woman with prior posterior vitreous detachment underwent
photodynamic therapy with verteporfin for a juxtafoveolar choroidal
neovascularization. Twenty days after the photodynamic therapy, fluorescein
angiography showed regression of the membrane and the new onset of a macular
hole. Macular hole formation following photodynamic therapy could be related to
choroidal swelling leading to dehiscence of the foveal pit, or to exacerbation
of either tangential traction or cystoid spaces by the laser administered over
the fovea.

Publication Types:
    Case Reports

PMID: 12449231  [PubMed - indexed for MEDLINE]

3: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):508-10. 

Vitreous surgery for bilateral bullous retinal detachment in
Vogt-Koyanagi-Harada syndrome.

Gaun S, Kurimoto Y, Komurasaki Y, Yoshimura N.

Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi,
Matsumoto 390-8621, Japan.

A successful surgical treatment (vitrectomy) for bilateral bullous retinal
detachment in a patient with Vogt-Koyanagi-Harada (VKH) disease is reported. A
78-year-old woman had severe reduction of visual acuity in both eyes because of
an extremely bullous nonrhegmatogenous retinal detachment accompanied by VKH
disease. We performed lens extraction and vitrectomy on both eyes combined with
systemic and topical corticosteroid therapy. The retina was reattached
immediately after the surgery and her visual acuity promptly improved in both
eyes. She had no recurrence of retinal detachment even after tapering the dose
of corticosteroid. We suggest that vitrectomy may be an effective therapeutic
option in the treatment for severe bullous retinal detachment associated with
VKH disease.

Publication Types:
    Case Reports

PMID: 12449230  [PubMed - indexed for MEDLINE]

4: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):504-7. 

Combination of Nd:Yag laser-induced subconjunctival bleeding and intracameral
viscoelastic injection to treat hypotony maculopathy.

Ascaso FJ, Loras E, Cristobal JA.

Department of Ophthalmology, University Clinic Hospital, San Juan, Bosco 15,
50009 Zaragoza, Spain.

A 38-year-old man with primary open-angle glaucoma who had undergone
trabeculectomy with mitomycin-C developed macular folds consistent with hypotony
maculopathy. The patient was successfully treated with a combination of
Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser-induced subconjunctival
bleeding and injection of a viscoelastic substance into the anterior chamber.
The combination of Nd:YAG laser-induced subconjunctival bleeding with
intracameral viscoelastic injection appears to be a reasonable alternative to
autologous blood injection and may be tried as first-line treatment for hypotony
maculopathy caused by overfiltration.

Publication Types:
    Case Reports

PMID: 12449229  [PubMed - indexed for MEDLINE]

5: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):501-3. 

Surgical management of a dysfunctional filtering bleb.

Desai K, Krishna R.

VST Centre for Glaucoma Care, LV Prasad Eye Institute, Marg, Banjara Hills,
Hyderabad 500 034, India.

This case report presents a patient who developed a large overhanging bleb
following antimetabolite trabeculectomy surgery 6 years prior. Complaints
included decreasing vision and foreign body sensation for several months.
Successful excisional surgery with placement of compression sutures was
performed. Visual acuity and intraocular pressure were maintained with the
resolution of symptoms.

Publication Types:
    Case Reports

PMID: 12449228  [PubMed - indexed for MEDLINE]

6: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):497-500. 

Partial excision with a conjunctival advancement flap after a relaxing incision
for a dissecting glaucoma filtering bleb.

Mandal AK, Vemuganti GK, Ladda N, Veenashree MP.

A 65-year-old male patient developed dissecting glaucoma filtration bleb
following trabeculectomy with mitomycin-C (MMC). Surgical partial excision of
the bleb was performed and the tissue was subjected to histopathological
evaluation. The bleb area was covered by a conjunctival flap that was advanced
with the help of a relaxing incision in the superior conjunctiva fornix. The
dissecting bleb was successfully managed by controlling intraocular pressure,
and the patient became asymptomatic without any medication. The light
microscopic examination of the bleb showed irregularly arranged collagen bundles
and hypocellularity of the subconjunctival tissue with places of nodular
configuration of the fibroblast in the periphery. Surgical partial excision of
the dissecting glaucoma filtering bleb is a reliable, simple, and precise
method. Advancing the conjunctival flap by a superior conjunctival relaxing
incision facilitates easy mobilization of the flap, ensures healthy resurfacing
of the bleb, and prevents postoperative transconjunctival leakage.
Histopathology of the bleb is compatible with the use of MMC during original
filtering surgery.

Publication Types:
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12449227  [PubMed - indexed for MEDLINE]

7: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):493-6. 

Tube occlusion from the external ostium after implantation of an aqueous shunt.

Bayer A, Wilson RR, Eagle RC Jr.

Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut
Street, Philadelphia, Pennsylvania 19107, USA.

Two patients had undergone double-plate Molteno shunt implantation. Both
patients required surgical revision, the first at 41 months and the second at 8
months postoperatively, because of a failure of previously functioning tube
shunts caused by blockage of the external ostium and intraluminal invasion of
the tube by fibrous tissue. At the time of surgical revision, fibrous tissue
extended down the lumen of the tube, occluding its external ostium. After
excision of this tissue, both shunts became fully functional. When functioning
aqueous shunts fail and there is no evidence of a bleb over the shunt reservoir
or blockage of the internal ostium, ingrowth of fibrous tissue into the external
ostium should be considered as a potential cause, especially if a ripcord or
Latina suture has been left in place.

Publication Types:
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12449226  [PubMed - indexed for MEDLINE]

8: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):491-2. 

Muller's muscle-conjunctival resection for blepharoptosis with poor levator
function.

Cohen AJ, Weinberg DA.

Department of Surgery, Division of Ophthalmology, University of Vermont College
of Medicine, USA.

We describe a patient with blepharoptosis, poor levator function, and a positive
phenylephrine test who responded favorably to Muller's muscle-conjunctival
resection, alleviating the need for a frontalis suspension ptosis repair in the
presence of very deep superior sulci.

Publication Types:
    Case Reports

PMID: 12449225  [PubMed - indexed for MEDLINE]

9: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):488-90. 

Metastatic large-cell lung carcinoma to the orbit in a 25-year-old nonsmoker.

Jordan DR, Lee-Wing MW.

University of Ottawa Eye Institute, Ottawa, Ontario, Canada.

Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease
involving the orbit is uncommon. We report the unusual occurrence of a
25-year-old male nonsmoker with an aggressive form of lung cancer who developed
metastatic orbital disease involving the medial rectus.

Publication Types:
    Case Reports

PMID: 12449224  [PubMed - indexed for MEDLINE]

10: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):480-7. 

Silicone plate-haptic posterior chamber intraocular lens implanted in the
anterior chamber: report of a bilateral case and potential complications.

Izak AM, Werner L, Apple DJ, Pandey SK, Trivedi RH.

Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute,
Medical University of South Carolina, Charleston, South Carolina, USA.

BACKGROUND AND OBJECTIVE: To evaluate possible complications associated with
implantation of a posterior chamber (PC) intraocular lens (IOL) in the anterior
chamber. MATERIALS AND METHODS: We analyzed a plate-haptic silicone IOL that had
been explanted from the anterior chamber of an 83-year-old female. Additionally,
the lens was experimentally reimplanted into the anterior chambers of 3 human
cadaver eyes. After fixation of the eyes (Karnovsky's solution), the
anterior-posterior length, the white-to-white diameter, the angle-to-angle
diameter, and the sulcus-to-sulcus diameter were measured. Two different
techniques to cut the eyes were used: sagittal section and corneal buttonhole
technique. The plate-haptic silicone lens was then implanted in the anterior
chamber and sulcus ciliaris of the eyes. A Kelman multiflex IOL was used as a
control for anterior chamber implantation. RESULTS: This experiment demonstrated
that the plate-haptic silicone IOL lens is too small and thick for implantation
in the anterior chamber and in the sulcus. The lens could easily rotate in the
anterior chamber and also dislocate inferiorly, obstructing the visual axis by
its edge. The thickness of the lens theoretically could also cause endothelial
cell damage and mechanical iris irritation resulting in chronic uveal
inflammation. CONCLUSION: This case and experiment should help surgeons realize
the risk and potential for IOL-missizing complications that may be caused if a
lens design for the capsular bag is implanted in the anterior chamber,
especially if a plate-haptic PC-IOL design is used.

Publication Types:
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12449223  [PubMed - indexed for MEDLINE]

11: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):475-9. 

Neodymium:YAG laser surgery in the hospital district of southwestern Finland
during the years 1987 to 1998.

Saari KM, Tornblom RM, Paasio P, Tuominen J.

Department of Ophthalmology, University of Turku, Turku, FIN-20520, Finland.

BACKGROUND AND OBJECTIVE: To investigate the annual incidence rates of
Neodymium:YAG laser procedures in the treatment of eye diseases. PATIENTS AND
METHODS: In this population-based retrospective study, we evaluated 6,040
patients treated with a Nd:YAG laser in the hospital district of southwestern
Finland during the years 1987 to 1998. The corresponding annual incidence rates
of different Nd:YAG laser procedures were calculated using the corrected
population statistics of the hospital district. RESULTS: The annual incidence
rates of all Nd:YAG laser procedures rose significantly (P < 0.0001) from 32.1
per 100,000 patients in 1987 to 169.0 per 100,000 people in 1998. A great
majority of Nd:YAG patients were females with a higher median age than the males
in the study (P < 0.0001). CONCLUSION: The rise of the annual population-based
incidence rates of cataract surgery with a 7% to 29% need of Nd:YAG laser
capsulotomies explained the increase of all Nd:YAG laser procedures.

PMID: 12449222  [PubMed - indexed for MEDLINE]

12: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):469-74. 

Intrascleral implantation of glass beads during evisceration.

Rosner M, Ben-Bassat I, Rosen N.

Goldschleger Eye Institute, Tel-Aviv University, Sheba Medical Center,
Tel-Hashomer 52621, Israel.

BACKGROUND AND OBJECTIVE: To review the results after small glass bead
implantation in the scleral cavity during evisceration. MATERIALS AND METHODS:
In this retrospective study, we retrieved the follow-up data of 17 patients who
underwent evisceration with glass bead implantation from 1993 to 1996. RESULTS:
All patients achieved good cosmetic results with good motility of the
prosthesis. Complications included transient chemosis at the early postoperative
period in 3 patients (17.6%), 1 patient (5.9%) with local dehiscence of the
wound, 1 patient developed a cyst in the socket (5.9%), and 1 patient was
afflicted with thinning of the conjunctiva over the surgical wound. CONCLUSION:
The use of glass beads to fill the scleral cavity during evisceration has the
advantage of an excellent fit in accordance with the scleral cavity volume, as
well as ease of treatment in case of extrusion. The prosthesis movement is good
because of its engagement with the scleral bulges caused by the glass beads.

PMID: 12449221  [PubMed - indexed for MEDLINE]

13: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):463-8. 

Socket reconstruction with combined mucous membrane and hard palate mucosal
grafts.

Lee AC, Fedorovich I, Heinz GW, Kikkawa DO.

Division of Ophthalmic Plastic and Reconstructive Surgery, UCSD Department of
Ophthalmology, La Jolla, California, USA.

OBJECTIVE: To evaluate the use of combined mucous membrane and hard palate
mucosal grafts in the reconstruction of contracted eye socket. PATIENTS AND
METHODS: Thirteen eyes of 13 patients with contracted sockets underwent socket
reconstructive surgery with combined mucosal membrane and hard palate mucosal
grafts. RESULTS: The average follow-up period was 33 months. Five of 13 patients
required additional surgery after initial socket reconstruction. However, all
patients who underwent socket reconstruction with hard palate mucosal grafts
were able to wear a cosmetically acceptable ocular prosthesis postoperatively.
CONCLUSION: Combined mucosal membrane and hard palate mucosal grafts can be
effectively used in the reconstruction of contracted sockets.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 12449220  [PubMed - indexed for MEDLINE]

14: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):456-62. 

Patient comfort with combined anterior sub-Tenon's, topical, and intracameral
anesthesia versus retrobulbar anesthesia in trabeculectomy, phacotrabeculectomy,
and aqueous shunt surgery.

Kansal S, Moster MR, Gomes MC, Schmidt CM Jr, Wilson RP.

Department of Ophthalmology, University of Illinois Hospital and Clinics,
Chicago, Illinois, USA.

PURPOSE: To assess patient comfort using combined anterior sub-Tenon's, topical,
and intracameral ("Blitz") anesthesia versus retrobulbar anesthesia in glaucoma
surgery. PATIENTS AND METHODS: In this study, 139 consecutive patients who
received retrobulbar anesthesia and 139 consecutive patients who received Blitz
anesthesia during glaucoma surgery were evaluated in a prospective fashion. The
retrobulbar group included 49 trabeculectomies, 36 aqueous shunts, and 54
phacotrabeculectomies. The Blitz group included 49 trabeculectomies, 30 aqueous
shunts, and 60 phacotrabeculectomies. Patients were asked to assess their level
of ocular pain operatively and postoperatively on a 10-point visual analog
scale. The operative and postoperative pain scores and postoperative sedation of
patients receiving retrobulbar anesthesia were compared with those of patients
receiving Blitz anesthesia during trabeculectomy, phacotrabeculectomy, and
aqueous shunt surgery, separately. RESULTS: No statistically significant
difference was found in the mean operative or postoperative pain scores between
the two groups during trabeculectomy, phacotrabeculectomy, or aqueous shunt
surgery. CONCLUSIONS: Blitz anesthesia offers a reasonable alternative to
retrobulbar anesthesia for trabeculectomy, phacotrabeculectomy, and aqueous
shunt surgery.

Publication Types:
    Comparative Study

PMID: 12449219  [PubMed - indexed for MEDLINE]

15: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):450-5. 

Clinical evaluation of posterior capsule opacification in eyes with different
small-incision intraocular lenses.

Yoshida S, Senoo T, Fujikake F, Obara Y.

Department of Ophthalmology, Dokkyo University School of Medicine,
Shimotsuga-gun, Tochigi, Japan.

BACKGROUND AND OBJECTIVE: To present a new method to quantify posterior capsular
opacity with an anterior eye segment image analyzer (EAS 1000, NIDEK). PATIENTS
AND METHODS: This study was comprised of patients who underwent
phacoemulsification intraocular lens (IOL) implantation. Three types of IOLS,
acrylic, silicone, and polymethylmethacrylate (PMMA) were allocated to 30 eyes
and clinically evaluated. Patients were observed for 3 years postoperatively
using an anterior eye segment image analyzer (EAS1000). Opacity was determined
by calculating the area of opacity from a retroillumination image. In the
retroillumination mode of analysis, the measurement was limited to a
4-mm-diameter region of the pupillary zone to eliminate the influence of
anterior capsular opacity. For color map analysis, the threshold level was
expressed as the color tone of 0-255 CCT (computer compatible tape). The glare
disability was measured to evaluate the three types of IOLs. RESULTS: The color
map analysis revealed a time-related increase in the opacity level of patients
receiving the PMMA IOL implant. Three years after surgery, the levels were
significantly higher in the PMMA group (P < 0.01) compared to the acryl and
silicone groups: acryl (17.5 +/- 3.8), silicone (18.0 +/- 6.2%), and PMMA 36.5
+/- 32.9%. CONCLUSION: Quantitative evaluation using an anterior eye segment
image analyzer is effective for observing the degree of posterior capsule
opacification. The color map analysis using an anterior eye segment image
correlated with the visual function revealed that the time-related increase in
the opacity level was significant during the third year in patients receiving
PMMA IOL implantation.

PMID: 12449218  [PubMed - indexed for MEDLINE]

16: Ophthalmic Surg Lasers. 2002 Nov-Dec;33(6):445-9. 

Scleral fixation of posterior chamber intraocular lenses using fascia lata to
cover the knots.

Bashshur Z, Ma'luf R, Najjar D, Noureddin B.

BACKGROUND AND OBJECTIVE: To describe the use of fascia lata to cover the
polypropylene knots of scleral fixated posterior chamber intraocular lenses
(PCIOL). PATIENTS AND METHODS: Fascia lata was used to cover the knots of
scleral fixated PCIOL in 5 eyes with significant scleral thinning. Four of the 5
eyes had the PCIOL insertion and the fascia lata patching in the same setting.
The fifth eye previously had scleral fixated PCIOL with late suture erosion
through a partial thickness scleral flap. RESULTS: There was no suture exposure
or graft thinning throughout a follow-up period of 8 to 16 months. The eyes
tolerated the fascia lata well with no early or late postoperative
complications. CONCLUSION: Fascia lata provides an effective means to cover the
knots of scleral fixated PCIOL, especially in aphakic patients with significant
scleral thinning.

PMID: 12449217  [PubMed - indexed for MEDLINE]

17: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):436-7. 

Intravitreal removal of large, fibrotic choroidal neovascular membrane complexes
in submacular surgery.

Haivala DR, Nanda SK.

Dean A. McGee Eye Institute, University of Oklahoma, Department of
Ophthalmology, Oklahoma City 73104, USA.

Submacular surgery is a current alternative technique for the treatment of
subfoveal choroidal neovascular membranes (CNVM). One of the difficulties often
encountered with this technique is the actual removal of the neovascular
membrane complex from the eye. It is often too large and fibrotic to be removed
directly through a sclerotomy site without risking significant sclerotomy site
complications. The vitreous cutter can be used, but despite high aspiration
settings, the large, fibrotic neovascular membrane complex may still not be able
to be completely removed safely and expeditiously. We describe an alternative
technique using the phacofragmentation handpiece to remove large fibrotic
neovascular membranes from the vitreous cavity thereby reducing sclerotomy site
complications and surgical time.

PMID: 12358301  [PubMed - indexed for MEDLINE]

18: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):433-5. 

Fluorescein angiographic findings in an infected scleral buckle.

Mansour AM, Bashshur Z, Han DP, Kim JE.

Department of Ophthalmology, American University of Beirut, Lebanon.

This report presents fluorescein angiographic (FA) findings in a patient with
scleral buckle infection. Ten days following scleral buckling surgery, FA
demonstrated dilated choroidal vessels over the buckle with leakage of
fluorescein into the subretinal space. Irregular diffuse scleral thickening was
noted on the computed tomography (CT). The findings of focal choroiditis with
dilated leaky choroidal vessels seen on FA, or diffuse scleral thickening
demonstrated by a CT may aid in establishing the diagnosis of scleral buckle
infection.

Publication Types:
    Case Reports

PMID: 12358300  [PubMed - indexed for MEDLINE]

19: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):430-2. 

Corneal burn: a rare complication of radiofrequency diathermy capsulotomy.

Tsai CC, Kau HC, Kao SC, Hsu WM.

Department of Ophthalmology, Taipei Veterans General Hospital, Taiwan, ROC.

We present 2 patients with accidental corneal burns inflicted during clear
cornea cataract surgery using radiofrequency diathermy for anterior capsulotomy.
During the capsulotomy procedure, the anterior capsule was not opened and only a
small air bubble appeared when the energy was turned on. Meanwhile the area of
the corneal tunnel that contacted the shoulder of the diathermy tip became
opaque and shrank with a small defect in the anterior corneal lip.
Postoperatively, focal corneal shrinkage with iris incarceration into the defect
of the corneal tunnel and resultant peaking pupil were noted in the 2 patients.
The corneal burns resulted in temporary irregular astigmatism with mild visual
acuity impairment. To our knowledge, this is the first report of a corneal burn
as a complication of radiofrequency diathermy for anterior capsulotomy in clear
cornea cataract surgery.

Publication Types:
    Case Reports

PMID: 12358299  [PubMed - indexed for MEDLINE]

20: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):426-9. 

Severe pupil distortion following transchamber repair of a cyclodialysis cleft.

Nichols JC, Lee DH, Feman SS, Shields SR.

Saint Louis University, Department of Ophthalmology, Missouri 63104, USA.

This report describes a potential complication following the repair of a
traumatic cyclodialysis cleft in a pediatric patient using a novel technique. A
healthy 11-year-old boy suffered a blunt traumatic tennis ball injury to his
left eye. He underwent repair of a retinal dialysis with detachment shortly
after the injury. Postoperatively, he developed persistent hypotony, shallow
anterior chamber, and hypotony maculopathy. An occult cyclodialysis cleft was
suspected. Examination under anesthesia revealed a small cyclodialysis deft. The
cleft was closed by transchamber placement of prolene sutures across the cleft
under direct visualization through a Tano lens. Postoperative course was
complicated by severe pupillary distortion despite subsequent suture removal.

Publication Types:
    Case Reports

PMID: 12358298  [PubMed - indexed for MEDLINE]

21: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):421-5. 

Uveitic angle closure glaucoma in a patient with inactive cytomegalovirus
retinitis and immune recovery uveitis.

Goldberg DE, Freeman WR.

Department of Ophthalmology, Shiley Eye Center, University of California, San
Diego, La Jolla 92093, USA.

We report a case of uveitic acute angle closure glaucoma in a patient with
acquired immunodeficiency syndrome (AIDS) associated with inactive
cytomegalovirus retinitis and immune recovery vitritis. We conducted a
long-term, follow-up examination of a 47-year-old male with AIDS and inactive
cytomegalovirus retinitis caused by immune recovery on highly active
antiretroviral therapy (HAART). We found vitritis and ultimate development of
uveitic glaucoma in the postoperative periods following repair of retinal
detachment and extracapsular cataract extraction with intraocular lens implant.
An episode of acute angle closure secondary to posterior synechiae and iris
bombe subsequently developed, requiring peripheral laser iridotomy. Immune
recovery in the setting of inactive cytomegalovirus retinitis can result in
intraocular inflammation severe enough to cause angle closure glaucoma and
profound ocular morbidity.

Publication Types:
    Case Reports

PMID: 12358297  [PubMed - indexed for MEDLINE]

22: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):416-20. 

Orbital melanoma metastatic from contralateral choroid: management by complete
surgical resection.

Shields JA, Perez N, Shields CL, Singh AD, Eagle RC Jr.

Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia,
Pennsylvania 19107, USA.

We discuss a clinicopathologic correlation of orbital metastasis from a
contralateral choroidal melanoma wherein the orbital tumor was removed
completely by surgical resection. In October 1982, a 29-year-old woman was
treated with cobalt-60 plaque radiotherapy for a choroidal melanoma in her right
eye. The tumor responded well but recurred after 9 years, necessitating
enucleation. In August 1999, 17 years after initial presentation, metastatic
melanoma to liver, lung, and brain were found and the patient had a favorable
response to chemotherapy and brain irradiation. Five months later, in November
2000, an enlarging orbital mass was documented to be compressing the left optic
nerve. Complete surgical removal of the tumor was achieved by a superotemporal
orbitotomy. Histopathologically, the tumor was a malignant melanoma with
features similar to the choroidal tumor. The contralateral orbit can be the site
of late metastasis from choroidal melanoma. In rare instances, an orbital
metastasis can be completely removed surgically without subjecting the patient
to orbital irradiation.

Publication Types:
    Case Reports
    Research Support, Non-U.S. Gov't
    Review

PMID: 12358296  [PubMed - indexed for MEDLINE]

23: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):410-5. 

Epibulbar osseous choristoma: case report and review of the literature.

Gayre GS, Proia AD, Dutton JJ.

Atlantic Eye & Face Center, P.L.L.C., Cary, North Carolina, USA.

Epibulbar osseous choristoma is a choristomatous lesion of the conjunctiva
containing bone. Originally called epibulbar osteoma, this lesion was first
described by von Graefe in 1863. We discuss a case of a 4-year-old patient who
presented with an epibulbar lesion consistent histopathologically with an
epibulbar osseous choristoma, and report a review of the literature. The
differential diagnosis of osseous choristoma should include classical limbal
dermoids, epithelial inclusion cysts, prolapsed orbital fat, papillomas,
dermolipomas, and complex choristomas. Although the rarest of epibulbar
choristomas, 51 epibulbar osteomas have now been reported in the medical
literature. Most commonly, this variety of choristoma presents as an isolated
epibulbar lesion within the supratemporal quadrant but may occur in other
locations on the surface of the globe and possibly in conjunction with other
choristomatous tissue as much as 10% of the time. Frequently, they may involve
the muscle or have dense attachments to the underlying sclera. Osseous
choristomas most likely represent congenital lesions with a potential for slow
growth but may occur in association with trauma. Options for management include
observation or surgical excision. When surgery is contemplated, preoperative
radiographic imaging may be helpful for assessing adhesion to the sclera or
extraocular muscles.

Publication Types:
    Case Reports
    Review

PMID: 12358295  [PubMed - indexed for MEDLINE]

24: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):400-9. 

Threshold determinations for selective retinal pigment epithelium damage with
repetitive pulsed microsecond laser systems in rabbits.

Framme C, Schuele G, Roider J, Kracht D, Birngruber R, Brinkmann R.

University Eye Clinic Regensburg, Germany.

BACKGROUND AND OBJECTIVE: In both clinical and animal studies, it has been shown
that repetitive short laser pulses can cause selective retinal pigment
epithelium damage (RPE) with sparing of photoreceptors. Our purpose was to
determine the ophthalmoscopic and angiographic damage thresholds as a function
of pulse durations by using different pulsed laser systems to optimize treatment
modalities. MATERIALS AND METHODS: Chinchilla-breed rabbits were narcotized and
placed in a special holding system. Laser lesions were applied using a
commercial laser slit lamp, contact lens, and irradiation with a
frequency-doubled Nd:YLF laser (wave-length: 527 nm; repetition rate: 500 Hz;
number of pulses: 100; pulse duration: 5 micros, 1.7 micros, 200 ns) and an
argon-ion laser (514 nm, 500 Hz, 100 pulses, 5 micros and 200 ms). In all eyes,
spots with different energies were placed into the regio macularis with a
diameter of 102 microm (tophat profile). After treatment, fundus photography and
fluorescein angiography were performed and radiant exposure for ED50 damage
determined. Speckle measurements at the fiber tips were performed to determine
intensity peaks in the beam profile. RESULTS: Using the Nd:YLF laser system, the
ophthalmoscopic ED50 threshold energies were 25.4 microJ (5 micros), 32 microJ
(1.7 micros), and 30 microJ (200 ns). The angiographic ED50 thresholds were 13.4
microJ (5 micros), 9.2 microJ (1.7 micros), and 6.7 microJ (200 ns). With the
argon laser, the angiographic threshold for 5 micros pulses was 5.5 microJ. The
ophthalmoscopic threshold could not be determined because of a lack of power;
however, it was > 12 microJ. For 200 ms, the ED50 radiant exposures were 20.4 mW
ophthalmoscopically and 19.2 mW angiographically. Speckle factors were found to
be 1.225 for the Nd:YLF and 3.180 for the argon laser. Thus, the maximal ED50
-threshold radiant exposures for the Nd:YLF were calculated to be 362 mJ/cM2 (5
micros), 478 mJ/cm2 (1.7 micros), and 438 mJ/cm2 (200 ns) ophthalmoscopically.
Angiographically, the thresholds were 189 mJ/cm2 (5 micros), 143 mJ/cm2 (1.7
micros), and 97 mJ/cm2 (200 ns). For the argon laser, the maximal ED50 radiant
exposure threshold was 170 mJ/cm2 angiographically. CONCLUSION: The gap between
the angiographic and the ophthalmoscopic thresholds for the 200 ns regime (4.5
times above angiographic ED50) was wider than for the 1.7 micros regime (3.3
times above the angiographic ED50). This would suggest the appropriate treatment
would be 200 ns pulses. However, histologies have yet to prove that nonvisible
mechanical effects increase with shorter pulse durations and could reduce the
"therapeutic window." When comparing the thresholds with 5 micros pulses from
the argon and Nd:YLF laser, it demonstrates that intensity modulations in the
beam profile must be considered.

Publication Types:
    Comparative Study

PMID: 12358294  [PubMed - indexed for MEDLINE]

25: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):394-9. 

Transsclerally fixated intraocular lenses in children.

Ozmen AT, Dogru M, Erturk H, Ozcetin H.

Department of Ophthalmology, Uludag University, Faculty of Medicine, Bursa,
Turkey.

BACKGROUND AND OBJECTIVE: To evaluate the visual outcome and complications of
transsclerally fixated intraocular lenses (IOLs) in children without sufficient
capsular support. PATIENTS AND METHODS: Twenty-one aphakic eyes of 18 children
(13 boys and 5 girls) who underwent secondary transscleral IOL fixation were
evaluated retrospectively. Ten eyes with aphakia after infantile cataract
surgery, 7 aphakic eyes following traumatic cataract surgery, and 4 eyes after
ectopia lentis surgery received secondary transscleral posterior chamber IOL
fixation because of by insufficient posterior capsular support. Visual outcomes
and postoperative complications were recorded. RESULTS: After a mean follow up
of 22.5 months (range, 12 to 36 months), visual improvement of more than 2
Snellen lines was observed in 9 eyes (42.8 %). Preoperative visual acuity could
not be assessed in 7 eyes (33.3%) because of associated neurological and
developmental disorders. One eye (4.7%) lost 2 Snellen lines of the best
corrected visual acuity because of concurrent endophthalmitis and retinal
detachment. Pupillary distortion, transient pupillary membrane, pupillary
capture as well as strabismus and anterior uveitis, were the most common
complications. Endophthalmitis and retinal detachment were the most severe
postoperative complications. CONCLUSION: Transsclerally fixated IOL implantation
may be visually rewarding in well selected pediatric cases, but the potential
complications would suggest extreme caution in its consideration. Until
long-term studies are published, it is difficult to recommend implantation
unless it is deemed impossible to provide adequate rehabilitation by other means
such as contact lenses or aphakic spectacles.

PMID: 12358293  [PubMed - indexed for MEDLINE]

26: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):383-93. 

Pars plana modified Baerveldt implant versus neodymium:YAG cyclophotocoagulation
in the management of neovascular glaucoma.

Chalam KV, Gandham S, Gupta S, Tripathi BJ, Tripathi RC.

Department of Ophthalmology, University of Florida College of Medicine,
Jacksonville, USA.

OBJECTIVE: To determine the relative effectiveness of neodymium:YAG
cyclophotocoagulation (NCYC) and pars plana modified Baerveldt implant (PPBI)
surgery on intraocular pressure (IOP) control in eyes with neovascular glaucoma
(NVG). PARTICIPANTS: In this retrospective comparative group study, 30 patients
with NVG treated with contact NCYC were compared with 18 patients who underwent
PPBI. Patients groups were not statistically dissimilar with respect to the
underlying disorder-causing angle and iris neovascularization, intraocular
pressure, and patient's age. RESULTS: During a follow up of 6 months, an IOP
control of > or = 6 and < or = 21 mm Hg was achieved in 23 eyes (76.6%) treated
with NCYC compared with 17 eyes (94.4%) receiving PPBI (P = 0.13). Among eyes
that had unsuccessful outcome in both groups, the proportions with persistently
high IOP or hypotony were greater in the NCYC group than in the PPBI group.
Based on our criteria, the cumulative proportion of failure in the NCYC group
was 23.3% at 6 months as compared to 5.6% in the PPBI group. Seven eyes (23.3%)
in the NCYC group lost light perception versus 1 eye (5.6%) in the PPBI group.
The incidence of postoperative choroidal effusion (36%) was higher in the PPBI
group. CONCLUSIONS: This study suggests that in the management of NVG, PPBI
surgery more frequently controls IOP in a medically acceptable range with less
hypotony and greater preservation of visual acuity than NCYC.

Publication Types:
    Comparative Study

PMID: 12358292  [PubMed - indexed for MEDLINE]

27: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):379-82. 

Quantitative assessment of aqueous flare: the effect of age and pupillary
dilation.

El-Harazi SM, Ruiz RS, Feldman RM, Chuang AZ, Villanueva G.

Department of Ophthalmology and Visual Science, The University of Texas Health
Science Center, Houston, USA.

OBJECTIVE: To assess the effect of age and pupillary dilation on aqueous flare.
METHODS: In this study, 100 eyes of 100 patients ranging in ages from 23 to 84
years were examined. Anterior chamber flare was measured before and after
pupillary dilation using the Kowa laser flare meter (FM-500). Predilation and
postdilation flare counts were compared by paired t-test. Stepwise regression
analysis was then used to determine the effect of demographic variables on pre-
and postdilation flare as well as the difference between pre-and postdilation
flare counts. RESULTS: The predilation and postdilation flare counts correlated
with age (P < 0.0001 for both pre-and postdilation flare counts). Correlation
coefficient between age and flare measurements was R2 = 0.58 predilation and
0.63 postdilation. Flare intensity significantly decreased after pupillary
dilation (P < 0.001). CONCLUSIONS: Anterior chamber flare increases with age. It
might be related to blood-aqueous barrier instability. Pupillary dilation
significantly decreases flare counts suggesting that aqueous protein
concentration is dependent on aqueous flow rates.

Publication Types:
    Comparative Study

PMID: 12358291  [PubMed - indexed for MEDLINE]

28: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):373-8. 

Acute-onset postoperative endophthalmitis: review of incidence and visual
outcomes (1995-2001).

Eifrig CW, Flynn HW Jr, Scott IU, Newton J.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami
School of Medicine, Florida, USA.

BACKGROUND AND OBJECTIVE: To determine the incidence rate of acute-onset
postoperative endophthalmitis and to assess visual acuity outcomes after
treatment from the most recent 7 years (1995-2001) compared with the previous 11
years (1984-1994) among patients undergoing intraocular surgery at the same
institution. PATIENTS AND METHODS: The medical records were reviewed of all
patients undergoing intraocular surgery at the Bascom Palmer Eye Institute
between January 1, 1995 and December 31, 2001. RESULTS: The 7-year incidence
rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916
intraocular surgeries). The number of patients with endophthalmitis (incidence)
and their median final visual acuity for each surgical category are as follows:
cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%)
- 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars
plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens
placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after
cataract surgery, 6 cases occurred after phacoemulsification and 2 of these
cases had a dear corneal sutureless incision. CONCLUSION: The most recent 7-year
incidence rate of acute-onset postoperative endophthalmitis is significantly
lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the
same institution. Visual acuity outcomes after treatment were generally better
in cataract surgery, glaucoma surgery, and secondary intraocular lens categories
compared to pars plana vitrectomy and penetrating keratoplasty categories.

Publication Types:
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12358290  [PubMed - indexed for MEDLINE]

29: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):368-72. 

Outer layer breaks and asymptomatic schisis detachment: clinical considerations.

Malagola R, Contestabile MT, Villani GM, De Santis EM, Recupero SM.

Institute of Ophthalmology, Policlinico Umberto I, University of Rome La
Sapienza, Rome, Italy.

BACKGROUND AND OBJECTIVE: To provide a detailed description of the clinical
features that are considered forerunners of symptomatic complications in
asymptomatic degenerative retinoschisis, and to show that in selected cases at
this stage prophylactic photocoagulation may be a better choice than mere
observation. MATERIALS AND METHODS: Forty-three eyes of 27 patients with
asymptomatic bullous degenerative retinoschisis and outer layer breaks (OLBs)
were studied through binocular indirect dynamic ophthalmoscopy and retinal
biomicroscopy with the Goldmann 3-mirror lens, fundus drawings, and photographs
where feasible. Argon laser treatment was performed on each eye: first, around
the posterior border of the schisis to achieve a full-thickness retinal scar,
and then on the schisis itself to promote scarring of the retinal pigment
epithelium, thus avoiding retinal detachment. The follow up was 2 years minimum
after treatment. RESULTS: OLBs usually involved the largest schises when
multiple retinal splittings were present. Breaks were single in 18 eyes
(peripheral in 16 and posterior in 2) and multiple in 25 (peripheral in 15 and
posterior in 10). Overall, 23 eyes showed asymptomatic retinal detachment
(schisis detachment): 20 with peripheral outer layer breaks and 3 with posterior
breaks. Schisis detachment was localized to the schisis area in the first group,
whereas it extended beyond the posterior boundary of retinoschisis in the
latter. After treatment, no posterior progression of retinoschisis was noted nor
did symptomatic retinal detachment arise. Only 1 eye had complications in the
second step of the treatment that was later resolved with medical care.
CONCLUSION: Prophylactic Argon laser photocoagulation can be used safely in the
asymptomatic stage of bullous retinoschisis with outer layer breaks to avoid the
onset of acute symptomatic retinal detachment.

PMID: 12358289  [PubMed - indexed for MEDLINE]

30: Ophthalmic Surg Lasers. 2002 Sep-Oct;33(5):362-7. 

Retinal microaneurysmal closure following focal laser photocoagulation in
diabetic macular edema.

Gogi D, Gupta A, Gupta V, Pandav SS, Dogra MR.

Department of Ophthalmology, Postgraduate Institute of Medical Education &
Research, Chandigarh, India.

OBJECTIVE: To determine the temporal relationship of microaneurysmal dosure
following focal laser photocoagulation in diabetic macular edema. PATIENTS AND
METHODS: This prospective study included 25 eyes of 23 diabetic patients with
clinically significant macular edema. Ten to 20 well-defined microaneurysms were
preselected and marked on an enlarged photograph of the prelaser fundus
fluorescein angiogram. These preselected microaneurysms were focally lasered and
followed up angiographically at 48 hours, 1 week, 3 weeks, 6 weeks, and 12 weeks
after photocoagulation. Thereafter, the average time span between
photocoagulation and the closure of the microaneurysms was determined. RESULTS:
The mean number of preselected microaneurysms at baseline was 18.24 +/- 3.51,
which remained the same at 48 hours. However, the mean microaneurysmal count
decreased to 11.76 +/- 2.65 (35% reduction) at 1 week, 9.12 +/- 2.53 (50%
reduction), 7.12 +/- 2.26 (61% reduction), and 4.56 +/- 1.32 (75% reduction) at
3, 6, and 12 weeks, respectively. The majority of the microaneurysms (35%)
closed between 48 hours and 1 week. CONCLUSIONS: The microaneurysmal closure
following focal laser photocoagulation is a delayed process. None of the
preselected microaneurysms showed closure within 48 hours, and 75% of the
preselected microaneurysms closed at the end of 12 weeks.

PMID: 12358288  [PubMed - indexed for MEDLINE]