Biomedical subjects
J P Pulaski
Publications and source records attributed to J P Pulaski.
Hyperopic automated lamellar keratoplasty.
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Comparing hyperopia treatments.
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Enhancement techniques after incisional keratotomy.
PURPOSE: To evaluate the safety and efficacy of a four-step enhancement nomogram to reduce low residual myopia after incisional keratotomy. SETTING: Rancho Bernardo Eye Center, San Diego, California. METHODS: This retrospective study comprised 86 eyes of 60 consecutive patients who received enhancements to reduce residual myopia (mean 1.30 diopters [D] +/- 0.50 [SD]; range 0.75 to 3.00 D) after primary radial keratotomy (RK). For residual myopia of 1.37 D or less, a 0.25 mm optical zone (OZ) reduction was the preferred technique; a 0.50 mm OZ reduction was done for myopia of 1.50 [D] or more. Once a 3.00 mm OZ was reached in the primary or enhancement surgery, deepening (limbus to 5.00 mm OZ) and adding incisions were performed in some eyes for further myopic effect. All incisions were centripetal with globe fixation (Russian style). Follow-up was 6 to 42 months (mean 23.1 months). RESULTS: All four enhancement techniques effectively reduced residual myopia. The 0.25 mm OZ reduction induced a mean 0.662 D of further refractive effect and was useful for myopic residuals from 0.75 to 1.37 D. The 0.50 mm OZ reduction was effective for residual myopia of 1.50 D or more and induced a mean 1.23 D of additional refractive change. Adding eight incisions (to eight at a 3.00 mm OZ) and deepening the limbus to the 5.00 mm OZ allowed mean myopic reductions of 0.695 and 0.640 D, respectively. The latter two techniques were useful for residual myopia of approximately 1.00 D. Pre-enhancement uncorrected visual acuity (UCVA) was 20/40 or better in 44 eyes and 20/50 to 20/300 in 42 eyes. Postenhancement, 83 eyes had an acuity of 20/40 or better and 71, of 20/25 or better. No postenhancement UCVA was worse than 20/50, and no eye was more hyperopic than 1.00 D (n = 1). No serious complications occurred. CONCLUSION: Reducing the OZ by 0.25 mm for small residual myopia and by 0.50 mm for larger undercorrections was an effective initial surgical approach. Adding and deepening procedures were useful after a 3.00 mm OZ was reached. The four-step nomogram allowed an incremental reduction in residual myopia after RK without producing significant overcorrections.
Transverse incisions for mixed and myopic idiopathic astigmatism.
PURPOSE: To determine the efficacy and safety of the Casebeer transverse nomogram for correcting idiopathic astigmatism using transverse incisions (T-incisions) with variable optical zones. SETTING: Rancho Bernardo Eye Center, San Diego, California. METHODS: This retrospective study comprised 173 eyes of 100 consecutive patients who had T-incisions according to the Casebeer transverse nomogram to correct mixed or myopic astigmatism. Preoperative cylinder ranged from 0.75 to 6.00 diopters (D). The nomogram was modified for eyes with preoperative cylinder from 1.75 to 6.00 D. Principal outcome measures were net residual astigmatism for all eyes and uncorrected visual acuity in eyes with the highest preoperative cylinder (3.25 to 6.00 D). RESULTS: A comparison of preoperative astigmatism (mean 3.07 D +/- 1.53 [SD]) and net residual astigmatism showed significant reduction in all diopter categories. Enhancements were done in 16.2% of eyes, mostly those with high preoperative cylinder. Patient age did not seem to affect results. No patient, including those with smaller optical zones, lost two or more Snellen lines of best corrected visual acuity. CONCLUSION: Use of the Casebeer transverse nomogram with T-incisions and variable optical zones effectively and safely reduced most idiopathic astigmatism between 0.75 and 5.50 D. Modifications to the nomogram yielded similar results in eyes with a higher preoperative cylinder.
Postimplantation bleeding after aspirin ingestion.
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Posterior zonules and lens extraction.
During experimental or surgical lens extraction, the posterior zonules are usually completely removed from the lens; however, many remain attached in a ring to the anterior hyaloid membrane (AHM). This phenomenon was studied in gross and scanning electron microscopic preparations. The posterior zonules were found to be multilayered, with both superficial and deep attachments to the lens. Circumferential zonular fibers were demonstrated increasingly with age. Attachment of the AHM was by a fibrillar perizonular meshwork and small infiltrating bundles. The posterior zonules separated from the lens by tearing into the superficial capsule, favoring preservation of their AHM attachments. This close zonular-AHM relationship is evidence for a coordinated vitreous-zonular action during accommodation. Postoperatively, zonular-AHM attachments may help to stabilize the AHM during movement of the globe.
Overcorrections with radial keratotomy.
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