Advanced technology and the future of facial prosthetics in head and neck reconstruction.
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Face↗
Biomedical subjects
A Sugar
Publications and source records attributed to A Sugar.
Diamond burr superficial keratectomy for recurrent corneal erosions.
AIMS: To evaluate the efficacy and safety of diamond burr superficial keratectomy in the treatment of recurrent corneal erosions. METHODS: A retrospective review of 54 eyes (47 patients) with recurrent corneal erosions treated with diamond burr superficial keratectomy. Preoperative and postoperative visual acuities and refractions, slit lamp examination findings, and the incidence of recurrent erosion after keratectomy were studied. Specular microscopy was also performed in six patients before and after surgery. RESULTS: 30 eyes had underlying map dot fingerprint anterior basement membrane corneal dystrophy, while 24 eyes did not. Postoperative follow up time ranged from 3 to 53 months (mean 12.3 months). Corneal erosion recurred in three eyes (6%) after diamond burr superficial keratectomy. This procedure improved the best corrected visual acuity from 20/26 to 20/22 by logMAR statistical evaluation (p=0.002) and caused very little change in the refractive spherical equivalent. No endothelial cell loss or changes in morphology were noted on specular microscopy. CONCLUSION: Diamond burr superficial keratectomy appears to be an effective and safe method of treating recurrent erosions and is a good alternative therapy to needle stromal micropuncture, Nd:YAG induced epithelial adhesion, and excimer laser surface ablation.
Adult↗
Intrastromal corneal ring segments for low myopia: a report by the American Academy of Ophthalmology.
OBJECTIVE: This document describes intrastromal corneal ring segments (Intacs) inserts technology and examines the evidence to answer the key question about whether the treatment is safe and effective in correcting low myopia. METHODS: A literature search that was conducted in September 2000 retrieved 13 relevant citations, and the reference lists of these articles were consulted for additional citations. Panel members reviewed this information and articles were rated according to the strength of evidence. RESULTS: Prospective multicenter phase II and III clinical trials (Level II evidence rating) of Intacs inserts for myopia of -1.00 to -3.00 diopters (D), with a maximum of +1.00 D of astigmatism, enrolled a total of 452 subjects, with a total of 454 surgical attempts. The results from phase II and phase III were pooled for much of the analysis. At 1 year, 97% of patients who completed follow-up had 20/40 or better uncorrected visual acuity (UCVA). Seventy-four percent of patients had 20/20 or better UCVA. Ninety-two percent of eyes were within +/-1 D of intended refractive correction, and 69% were within 0.5 D of intended refractive correction. At 3 months, 90% of patients had less than 1.0 D of change from the previous examination performed at 1 month. The ocular complication rate, which was defined as clinically significant events but not resulting in permanent sequelae, was 11% at 12 months. The adverse event rate was 1.1%, defined as a serious event if untreated. Nearly 9% of patients requested to have their inserts removed and a total of 3.8% of patients required a secondary surgical intervention. CONCLUSIONS: To date, evidence suggests that low myopia (-1 to -3 D) in a well-defined group of patients who have a stable manifest refraction and less than +1.0 D of astigmatism can be treated with Intacs inserts with a reasonable assurance of safety and effectiveness. Additional clinical research is needed to determine the long-term effectiveness of treatment and the comparative safety, effectiveness, and costs with other treatment modalities, including laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).
Academies and Institutes↗
Refractive stabilization after temporal phacoemulsification with foldable acrylic intraocular lens implantation.
PURPOSE: To determine the rate of stabilization of refractive error after temporal small incision phacoemulsification with insertion of an acrylic foldable intraocular lens (IOL) (AcrySof MA30). SETTING: A university hospital anterior segment referral practice. METHODS: The records of 100 consecutive patients with good visual potential having phacoemulsification with acrylic IOL implantation who had good visual acuity on the first postoperative day were reviewed. Refractive data at 1 day, 1 week, and 1 and 4 months were compared. RESULTS: The mean spherical equivalent refraction was +0.31 diopter (D), -0.33 D, -0.51 D, and -0.35 D at 1 day, 1 week, 1 month, and 4 months, respectively. Cylinder by refraction was 1.17 D, 1.09 D, 0.96 D, and 0.99 D, respectively. From 1 week on, the cylinder power and axis did not differ significantly from that at 4 months. At 1 week, the spherical equivalent was within +/-0.50 D of the 4-month refraction in 66.1% of eyes and the cylinder was within +/-0.50 D in 72.9%. At 1 month, the corresponding values were 87.1% and 85.7%. CONCLUSION: The refractive error stabilized rapidly after temporal phacoemulsification with acrylic IOL implantation.
Acrylic Resins↗
Small, overlapping tectonic keratoplasty involving graft-host junction of penetrating keratoplasty.
PURPOSE: To report the indications for and postoperative course of small tectonic keratoplasties overlapping (and involving) the graft-host junction of preexisting penetrating keratoplasties. METHODS: A retrospective study of 15 consecutive eyes (15 patients) with small tectonic keratoplasties overlapping the graft-host junction of preexisting penetrating keratoplasties. RESULTS: After tectonic keratoplasty, follow-up times ranged from 5 months to 20 years (mean, 69 months). Clinical indications included sterile corneal ulceration (seven cases), bacterial keratitis (six cases), and fungal keratitis (two cases). In the six cases with bacterial keratitis, five were suture abscesses, with four resulting in wound dehiscence. Ten tectonic grafts were lamellar keratoplasties, and five were penetrating keratoplasties. Postoperative best-corrected visual acuities were unchanged from preoperative levels in every patient. After tectonic grafting, the mean +/- SD change in keratometric astigmatism in the parent penetrating keratoplasty was 1.75 +/- 1.50 diopters. The astigmatism increased in 10 cases, decreased in three, and remained unchanged in two. There was no case of recurrent ulceration or wound dehiscence in or around the tectonic grafts. The surgery did not result in new glaucoma or worsening of preexisting glaucoma. CONCLUSIONS: In the treatment of infectious or ulcerative foci at or near the graft-host junction of penetrating keratoplasties, a small extirpative, tectonic graft over the diseased junction appears to be a safe and effective alternative to either repeating the original penetrating keratoplasty or performing an oversize transplant.
Adult↗
Phacoemulsification and intraocular lens placement in eyes with cataract and congenital coloboma: visual acuity and complications.
PURPOSE: To evaluate the safety and complications of phacoemulsification in a series of patients with congenital coloboma and cataract. SETTING: University-based hospital practice. METHODS: A retrospective review was conducted of consecutive patients who had coloboma and cataract and had phacoemulsification between January 1987 through December 1998. Complications and visual acuity 2 months postoperatively were assessed. RESULTS: Mean age of 7 cases at the time of surgery was 41.6 years +/- 11.1 (SD). Visual acuity improved in 6 of 7 eyes; 1 eye had no change. Six eyes had no serious complications. In 1 eye, a retinal detachment was observed postoperatively, but there was no loss in visual acuity. Another patient developed postoperative monocular diplopia from exposure of the intraocular lens (IOL) edge within the inferonasally located corectopia associated with the coloboma. Nonsurgical treatment was unsuccessful, but this symptom resolved after surgical pupilloplasty. CONCLUSIONS: The results of this small case series affirm that clinically significant cataract develops at a younger age in eyes with congenital coloboma than in eyes with typical age-related nuclear sclerotic cataract. Monocular diplopia, a potential complication after cataract surgery in these eyes, can be managed by pupilloplasty. The improved vision in this study indicates that phacoemulsification and IOL placement are safe and beneficial in patients with typical congenital coloboma and cataract.
Adolescent↗
Ophthalmic surgery.
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Cataract Extraction↗
Lamellar corneal patch grafts in the management of corneal melting.
PURPOSE: To evaluate the clinical indications and results of reconstructive (tectonic) lamellar keratoplasty in corneal melting. METHODS: A nonrandomized, uncontrolled retrospective case series of 64 consecutive patients (80 eyes) who underwent lamellar keratoplasty for corneal melting at our institution over a 17-year period. We reviewed the (a) clinical indications, (b) visual acuities, (c) postoperative corneal clarity, and (d) post-operative complications. Comparisons in visual acuity were made between central and peripheral corneal melts. The statistical influence of patient age, diagnosis, and corneal graft size on pre- and postoperative visual acuity values also was studied. RESULTS: Although reconstructive lamellar keratoplasty for active corneal melting was effective in saving the integrity of the globes in all but four patients, the postoperative visual acuity remained poor in the majority of cases because of the often devastating nature of the underlying ocular diseases. Only 14 patients had best postoperative visual acuities of 20/100 or better. Repeated lamellar keratoplasties were necessitated by corneal opacification, infection, or progressive postoperative corneal dissolution in 14 cases. Subsequent vision-restoring surgeries, consisting of penetrating keratoplasties or cataract extractions, were done in 11 eyes with modest improvement of visual acuity. Postoperative visual acuity was significantly better in peripheral corneal melts than in central melts (p = 0.004). CONCLUSION: Lamellar keratoplasty is an effective method of restoring the integrity of the eye ravaged by corneal melting. It is less invasive and consequently safer than penetrating keratoplasty in actively inflamed and unstable eyes. The primary purpose for this surgery is to salvage the integrity of the globe during the acute phase of disease and not so much to achieve visual improvement per se. It allows time for systemic immunosuppression to take effect and for the eye to quiet down before possible future vision-restoring surgery.
Adult↗
Techniques in penetrating keratoplasty: a quarter century of development.
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Corneal Diseases↗
An investigation of three-dimensional scanning of human body surfaces and its use in the design and manufacture of prostheses.
The capture of highly accurate data describing the complex surfaces of the human body may prove extremely useful in many medical situations. The data provide a method of measuring and recording changes to the surface of a patient's soft tissue. The data may be applied to computer-controlled manufacturing techniques, such as rapid prototyping (RP). This enables accurate physical replicas of the patient topography to be produced. Such models may be used as an aid in the design and manufacture of prostheses. This paper describes an investigation aimed at identifying problems that may be encountered when scanning patients and describes the application of the resulting data in the design and manufacture of facial prostheses. The results of the experiment are presented together with a discussion of the accuracy and potential advantages afforded by this approach.
Biocompatible Materials↗
Clinical course of phacoemulsification wound burns.
PURPOSE: To present 3 cases illustrating the outcomes of phacoemulsification corneal wound burns. SETTING: A university referral center. METHODS: This was a retrospective case series. RESULTS: Three patients developed corneal wound burns during phacoemulsification of cataract. All eyes developed from +7.00 to +15.00 diopters of astigmatism in the axis of the incision. In 2 eyes, the astigmatism decreased over several months. The third had permanent high astigmatism and corneal edema requiring corneal transplantation. CONCLUSIONS: Corneal wound burns occurring during phacoemulsification can have serious effects on the cornea, including corneal edema and severe astigmatism. In the milder cases, the astigmatism decreases spontaneously over several months.
Aged↗
Phacoemulsification in eyes with past pars plana vitrectomy: case-control study.
PURPOSE: To determine intraoperative and postoperative complications and outcomes of phacoemulsification of cataract in eyes that had previous pars plana vitrectomy. SETTING: University-based anterior segment disease referral practice. METHODS: This was a retrospective case-control study of a surgical series of 52 consecutive postvitrectomy cataract extractions statistically compared with control eyes from the same practice. RESULTS: Cataract extraction followed vitrectomy by 2 months to 6 years (mean 19 months). Cataracts with a posterior subcapsular component were seen more frequently in postvitrectomy eyes (58% versus 25% in control eyes). Cataract extraction after pars plana vitrectomy was often more challenging than in control eyes. Challenges included unstable posterior capsules, loose zonules, and posterior capsule plaque. Postoperative posterior capsule opacification (PCO) was more common in study than in control eyes (51% versus 21%; P = .002), especially if expandable gas or silicone oil had been used at vitrectomy. Visual acuity improved in 87% of study eyes, with 46% achieving a visual acuity of 20/40 or better. In study eyes in which the indication for vitrectomy was macular hole or epiretinal membrane, nuclear sclerosis was the most common cataract type, no intraoperative complications occurred, the PCO rate was low (13%), and visual acuity was better (73% 20/40 or better) than in the other study eyes. CONCLUSION: Phacoemulsification after pars plana vitrectomy can be performed with a low complication rate and with good visual results, although limited by underlying retinal disease. Posterior capsule opacification requiring neodymium: YAG capsulotomy was common in this series.
Adolescent↗
Central lamellar keratoplasty for optical indications.
PURPOSE: This study aims to evaluate the results of lamellar keratoplasty (LKP) for optical (nontectonic) indications over the past 19 years at our institution, noting the advantages and pitfalls of the procedure. METHODS: The study is a retrospective review of 52 central LKPs in 37 patients. Snellen visual acuity, preoperative clinical indications, and postoperative status of the cornea (donor graft, graft-host interface, and recipient cornea) were assessed. RESULTS: Postoperative follow-up ranged from 3 months to 18 years (median, 3 years). In descending order of frequency, corneal dystrophies, aniridic keratopathy, corneal scars, and keratoconus were the most common indications for surgery. After surgery, 38% of the eyes were able to achieve 20/50 or better visual acuity. The two most common causes of poor visual acuity were (1) opacification and/or blood vessel growth in the graft-host interface or on the graft surface and (2) high astigmatism. Persistent epithelial defects occurred in 21% of the eyes after LKP. CONCLUSION: Although LKP provides a safer alternative to penetrating keratoplasty, it is limited by vision-reducing graft-host interface problems, astigmatism, and difficult surgical technique. We postulate that the current results of LKP may be improved by (1) removing as much recipient corneal stroma as possible (e.g., dissecting down to Descemet's membrane) or, alternatively, using an automated microkeratome and (2) raising the currently used qualitative eyebank standards for accepting LKP donor tissue.
Adolescent↗
Late dehiscence of healed corneal scars.
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Adult↗
Topical anesthetic abuse after radial keratotomy.
A 49-year-old woman developed corneal epithelial defects and stromal infiltration shortly after a 4-cut radial keratotomy (RK) for myopia. Although cultures grew staphylococci and appropriate antibiotic treatment was applied, the epithelial defects increased in size. The corneal epithelium did not heal fully for more than 2 months. Penetrating keratoplasty 1 year later was followed by epithelial breakdown and perforation, as was a second keratoplasty. Despite repeated questioning, the patient did not admit until 18 months after her initial surgery that she had begun self-treatment with dilute proparacaine shortly after RK and continued it after her keratoplasties. The elective use of topical anesthetics to control pain after refractive surgery should be approached with caution, and patients should be warned of the possible consequences of their misuse.
Administration, Topical↗
The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic.
OBJECTIVE: The purpose of the study is to compare the utility of culturing corneal ulcers in a tertiary referral clinic and a general ophthalmology clinic. DESIGN: A retrospective review of medical and microbiologic records was performed. PARTICIPANTS: One hundred fifty-seven patients with corneal ulcers were included in the study. Eighty-two ulcers were treated in the referral clinic and 75 ulcers were treated in the general ophthalmology clinic. MAIN OUTCOME MEASURES: The authors determined the percentage of corneal ulcers in each clinical setting that failed to respond to empiric therapy and required a culture-directed change in treatment. RESULTS: One hundred fifty-seven ulcers were included. Eight (10%) of the 82 patients treated in the Cornea Clinic had treatment altered based on culture and sensitivity results. All 75 patients in the general clinic responded to empiric antibiotics, such that culture data never were required for modification of therapy (0%, P = 0.007). In contrast to patients treated in the Cornea Clinic, patients treated in the general clinic had smaller, more peripheral ulcers, shorter duration of symptoms, and fewer risk factors for corneal ulceration other than contact lens wear. CONCLUSIONS: Cornea specialists, who are referred the most severe cases, should consider culturing most corneal ulcers. However, it appears reasonable for general ophthalmologists to use culturing more judiciously. Patients with significant corneal ulcers should be cultured regardless of the clinic to which they present. However, small, peripheral ulcers respond extremely well to current, broad-spectrum antibiotics. Close follow-up is mandatory to discover the rare patient who will not respond to empiric therapy.
Adolescent↗
Wilson's disease: presymptomatic patients and Kayser-Fleischer rings.
PURPOSE: We evaluated patients with Wilson's disease to determine (1) whether presymptomatic patients who have Kayser-Fleischer (K F) rings demonstrate a more significant alteration of copper metabolism than those who do not have K F rings, and (2) whether presymptomatic patients have smaller K F rings than symptomatic Wilson's disease patients. METHODS: Thirty-two patients with presymptomatic Wilson's disease were retrospectively analyzed. Sixteen of these had received no prior anti-copper therapy and underwent testing for baseline copper metabolism (24-hour urine copper, liver copper, and plasma ceruloplasmin). Quantitative measurements of K F rings were made for the group of untreated presymptomatic patients and a control group of symptomatic Wilson's disease patients. RESULTS: We hypothesized that the 24-hour urine copper, in particular, would correlate with the presence of a K F ring. However, no significant difference was found between any of the baseline copper variables for presymptomatic patients who had K F rings compared to those who did not. K F rings of presymptomatic patients were found to be significantly smaller than K F rings of patients with symptomatic Wilson's disease (p < 0.05). CONCLUSIONS: While this study does not show any relationship between urinary copper excretion and the presence of K F rings, it suggests that the larger K F ring size correlates with Wilson's disease severity.
Adolescent↗
Brown-McLean syndrome occurring in a corneal graft.
PURPOSE: To present a case of Brown-McLean syndrome occurring in a transplanted cornea. METHODS: Retrospective case report. RESULTS: A patient had penetrating keratoplasty performed for bullous keratopathy 6 years after intracapsular cataract extraction in the right eye. She developed atypical Brown-McLean syndrome in the left eye 6 years after extracapsular cataract extraction with pupil-support intraocular lens (IOL) insertion and later IOL removal. The clear corneal graft in the right eye developed peripheral stromal and epithelial edema with pigmentation of the endothelium, consistent with Brown-McLean syndrome 9 years after keratoplasty. CONCLUSION: Brown-McLean syndrome can occur in a grafted cornea, although the features may differ from those seen in ungrafted corneas.
Aged↗