[The potential for changing refraction by changing shape and structure of the cornea].
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Biomedical subjects
Publications and source records attributed to M Blumenthal.
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Circular tear capsulotomy, or capsulorhexis, is becoming an increasingly popular method of anterior capsulotomy. We describe a new cystotome with a simple tip modification which is useful for performing a circular tear capsulotomy. The cystotome is a 27 gauge disposable device that is similar to a conventional cystotome used for a can-opener-type capsulotomy except for its unique but simple tip modification. The beveled tip is first bent at 90 degrees and then twisted on its main axis so that the beveled cutting edge is parallel (i.e., in the same axis) to the shaft of the cystotome. We also briefly describe its method of use.
Following extracapsular senile cataract extraction, visual thresholds were measured in 15 aphakic eyes corrected with glasses and compared with an appropriately matched group of 23 eyes with poly (methyl methacrylate) posterior chamber lenses. All subjects were six months to three years postoperative and had 20/30 or better visual acuity. The paramacular dark adapted threshold, the foveal luminance threshold, and the glare effect on both thresholds were not significantly different in the two groups despite the optical differences between aphakic and pseudophakic correction.
The prevalence of capsular opacification was studied in a group of patients who had extracapsular cataract extraction from 1978 to 1980 by one surgeon. In 94 eyes the follow-up was longer than four years. Capsular opacification developed in 41% of these eyes. In 72% of the eyes with opacification the diagnosis was made more than two years after surgery. In the patients who were operated on during 1980, capsular opacification appeared later and less frequently than in those operated on during 1978. Although the difference was not statistically significant, it probably reflects improved technique and more meticulous cleaning of residual cortex. Patients younger than 40 years had a higher prevalence of capsular opacification (70%) than those older than 40 years (37%). Pseudophakic and aphakic patients had a similar prevalence--47.6% and 39.7%, respectively.
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A C4 DNA polymorphism that can subdivide C4 allotypes and major histocompatibility complex-linked complement gene cluster allele combinations (complotypes) that are not distinguishable by standard electrophoretic means was used to assess further the distribution and linkage association of C4 variants. Segregation of the DNA polymorphism in family studies allowed assignment of particular variants to particular major histocompatibility complex haplotypes. These studies revealed that some complotypes were exclusively correlated with a particular C4 DNA variant, whereas others were not and could be subdivided according to which particular C4 DNA variant was observed. When complotypes that could be subdivided at the DNA level were considered in relation to flanking major histocompatibility complex markers, it was apparent that complotypes associated with major histocompatibility complex "extended haplotypes" had an exclusive correlation with a particular C4 DNA variant. This finding supports the hypothesis that "extended haplotypes" are unique associations of major histocompatibility complex allele combinations and are genetically similar, stably inherited units.
Optical aberration from the positioning holes of a posterior chamber intraocular lens was encountered in three patients with wide spontaneous dilation of the pupil in scotopic conditions. One patient had a cataract extraction in his fellow eye with implantation of a posterior chamber lens without positioning holes in its optical portion and has not encountered any aberrations in that eye. We suggest that in such patients, careful preoperative measurement of the pupillary size in a dark room should be done and lenses without positioning holes on the optic should be used to prevent optical aberrations.
The dark-adapted threshold for a 2 degree white test imaged 10 degrees parafoveal and the foveal threshold luminance for Landolt ring gap discrimination were measured on 23 pseudophakic eyes with 6/9 or better visual acuity, 6 months to 3 years following posterior chamber lens implantation, and on 15 phakic eyes from an appropriately matched control group. Both scotopic and photopic thresholds were higher for the pseudophakic than for the control group by 0.3 and 0.6 log, respectively. These parafoveal and foveal thresholds, when measured under the influence of glare, were likewise significantly higher for the pseudophakic group.
A rare case of thyroid carcinoma presenting as an orbital tumor is described. The diagnosis was made only through histopathologic examination of tissues removed during craniotomy. Thyroid scan confirmed the diagnosis. Thyroid carcinoma should be suspected in cases of orbital metastasis of unknown origin.
The development of an epithelial implantation cyst is a severe complication of anterior segment surgery and trauma. Two patients with anterior chamber implantation cysts were treated with Nd: YAG laser. One required surgical correction as the cyst reformed after each of 6 laser treatment sessions. In the other patient, the cyst reformed once, and has not recurred for 18 months since the second laser treatment. Collapse of anterior chamber implantation cysts can be achieved with Nd: YAG laser, though multiple treatment sessions may be required due to the cyst's tendency to reform.
A two-step technique for laser iridotomy in difficult irides is described. The method utilizes the argon and ND:YAG lasers sequentially. Sixteen eyes were treated by two argon stretch burns and up to 35 penetrating burns that produced an iridotomy that was either imperforate or inadequate. The ND:YAG laser was then used to complete the iridotomy. In all 16 eyes an iridotomy was achieved in one session. Only two eyes had a moderate increase in pressure that was easily controlled. There were no other significant complications. Total energy levels for each laser modality were significantly lower than those previously reported using either laser alone. The sequential technique is safe and effective and is recommended for iridotomy in difficult iris types.
A 66-year-old man underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation, which was complicated by accidental intravitreal bethamethasone injection. This case was characterized by a benign course and good recovery of vision. Appropriate management of such accident is discussed.
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An instrument for maintaining a deep anterior chamber during extracapsular cataract extraction is described. This anterior chamber maintainer makes the different stages of extracapsular technique safer and easier to perform.
Three cases are described of acute glaucoma following vitrectomy and silicone oil injection in proliferative vitreous retinopathy. The first case developed silicone-induced pupillary block in a phakic eye. Cases 2 and 3 developed elevated pressure in aphakic eyes with deep anterior chambers. Cases 1 and 3 were treated by laser iridectomy. Case 2 was treated by removal of silicone. The pathogenesis and treatment of these problems are discussed.