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]