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R Doyle Stulting

Publications and source records attributed to R Doyle Stulting.

34 records · Page 2Linked to original sources
PubMed2004

Refractive changes after posterior segment surgery.

Retinal surgery can induce significant refractive errors. These errors include spherical changes caused by alterations in axial length after scleral buckle placement, astigmatic changes induced by a scleral buckle or pars plana vitrectomy, and focal alterations in corneal curvature that can significantly limit postoperative visual acuity. The adjunctive use of silicone oil can impose alterations directly, by the oil's interaction with the other refractive elements of the eye, and indirectly, through its effects on intraocular lens power calculations for subsequent cataract surgery.

Corneal Topography↗
PubMed2004

Surgical management of glaucoma in infants and children with Peters' anomaly: long-term structural and functional outcome.

OBJECTIVE: To determine the long-term outcome of surgery for congenital glaucoma in infants and children with Peters' anomaly. DESIGN: Retrospective review of a consecutive interventional case series. SETTING: An urban academic tertiary referral institution. PARTICIPANTS: Thirty-four eyes of 19 children are subjects of this report. Included are all children 12 years of age or younger with Peters' anomaly who underwent surgery for primary congenital glaucoma between January 1971 and December 1992 and completed a minimum of 3 years of follow-up from the date of the first glaucoma surgery. INTERVENTION: The surgical procedures performed were trabeculectomy, trabeculotomy, goniotomy, Molteno shunt implantation, cyclodialysis, and cyclocryotherapy. MAIN OUTCOME MEASURES: Primary outcome measures were intraocular pressure (IOP) control and final postoperative visual acuity. Intraocular pressure control was defined as complete success (IOP</=21 mmHg without antiglaucoma medication), qualified success (IOP</=21 mmHg with antiglaucoma mediation), or failure (IOP>21 mmHg with or without antiglaucoma medication, inoperable retinal detachment, phthisis, or chronic hypotony, defined as an IOP of </=6 mmHg). RESULTS: A total of 126 glaucoma procedures were performed on 34 eyes of 19 patients. The median age at time of first glaucoma surgery was 2.1 months (range, 2 days to 8.5 years). The median follow-up was 11.0 years (range, 3.2 to 22.8 years) from the time of first glaucoma surgery. Intraocular pressure control with or without antiglaucoma medication was achieved in 11 eyes (32%) after 1 or more surgical procedures. Major postoperative complications included graft failure in 26 eyes (76%), cataract in 6 eyes (18%), inoperable retinal detachment with phthisis in 12 eyes (35%), and phthisis alone in 6 eyes (18%). Final vision was 20/200 or better in 3 eyes (9%), 20/400 to hand motion in 12 eyes (35%), light perception in 7 eyes (21%), and no light perception in 12 eyes (35%). CONCLUSIONS: Glaucoma surgery, combined with medical therapy, may result in adequate, long-term IOP control in 32% of eyes with glaucoma associated with Peters' anomaly. Visual results are poor due to uncontrolled glaucoma, amblyopia, neurologic impairment, and other anterior and posterior segment anomalies that may accompany Peters' anomaly. Postoperative complications, including graft failure, cataract, inoperable retinal detachment, and phthisis, also contribute to decreased visual acuity.

Child↗
PubMed2004

Avellino corneal dystrophy after LASIK.

OBJECTIVE: To report cases of Avellino corneal dystrophy (ACD) exacerbated by LASIK for myopia. DESIGN: Retrospective, noncomparative, interventional case series and review of the literature. PARTICIPANTS: Seven patients. INTERVENTION: Six patients with exacerbation of granular corneal deposits after LASIK were examined for TGFBI mutations by polymerase chain reaction sequencing of DNA. One previously reported patient who was heterozygous for the ACD gene was followed up for 16 months after mechanical removal of granular deposits from the interface after LASIK. MAIN OUTCOME MEASURES: Slit-lamp examination, visual acuity, manifest refraction, and DNA sequencing analysis. RESULTS: All patients were heterozygous for the Avellino dystrophy gene. Corneal opacities appeared 12 months or more after LASIK. Best spectacle-corrected visual acuity decreased as the number and density of the opacities increased. One patient underwent mechanical removal of granules from the interface and had a severe recurrence within 16 months. Another patient had removal of the granules from the interface with PTK, followed by treatment with topical mitomycin C. In this patient, the cornea has remained relatively clear for 6 months. CONCLUSIONS: Laser in situ keratomileusis increases the deposition of visually significant corneal opacities and is contraindicated in patients with ACD. Mechanical removal of the material from the interface does not prevent further visually significant deposits. Mitomycin C treatment, in conjunction with surgical removal of opacities, may be an effective treatment.

Adult↗
PubMed2004

Using InterWave aberrometry to measure and improve the quality of vision in LASIK surgery.

OBJECTIVE: To compare visual outcomes in eyes undergoing aberrometry-guided (InterWave) LASIK with those in eyes undergoing standard LASIK treatment based upon refractive measures. DESIGN: Single-center, comparative, interventional, consecutive case series. PARTICIPANTS: Four hundred two consecutive eyes undergoing LASIK were analyzed retrospectively. One group, 106 eyes undergoing primary LASIK and 224 eyes undergoing LASIK enhancement, was treated with standard LASIK treatment using a 5.5-mm optical zone, 1.5-mm transition zone laser with the settings determined by manifest refraction. The second group, 44 untreated (primary) eyes and 28 previously treated (enhancement) eyes, received a multipass, multistage treatment in which the laser settings for each stage were determined by aberrometry measurements. Eyes with desired monovision (undercorrected) outcome and preoperative hyperopia were excluded from the study. INTERVENTION: An aberrometry-guided laser treatment (InterWave LASIK) was compared with the standard LASIK treatment based upon the manifest refraction. MAIN OUTCOME MEASURES: Uncorrected visual acuity (VA), manifest refraction, best spectacle-corrected VA (BSCVA), severity of halos, and root mean square (RMS) retinal blur area measured at 3 months postoperatively. RESULTS: Three months postoperatively there was no difference in uncorrected VA, BSCVA, refraction, or RMS retinal blur areas for pupil sizes of 3.5 mm between eyes treated by InterWave and those treated by standard LASIK. However, InterWave LASIK reduced the retinal blur area by 48% (P<0.0103) and 58% (P<0.0004) in primary cases and 43% (P<0.0430) and 74% (P<0.0271) in enhancement cases, respectively, for pupil sizes of 4.5 and 6.5 mm relative to standard LASIK treatments. Patients undergoing InterWave-guided treatment reported less severity of halo (0.37 vs. 0.98 [P<0.016] for primary cases and 0.35 vs. 0.73 [P<0.04] for enhancement cases). CONCLUSION: InterWave LASIK achieved acuity and refractive results equivalent to those of standard LASIK treatment based upon refraction, but resulted in superior quality mesopic vision.

Adult↗
PubMed2004

Corneal thickness changes during herpes simplex virus disciform keratitis.

OBJECTIVE: To describe the changes in corneal thickness determined by ultrasonic pachymetry during follow-up of herpes simplex virus disciform corneal edema. METHODS: Thirty-five patients with herpetic keratitis underwent slit-lamp biomicroscopy and ultrasonic pachymetry. Measurements during follow-up and at clinical resolution of corneal inflammation were compared with the initial corneal thickness. RESULTS: Corneal thickness of disciform stromal keratitis decreased 15% (95% confidence interval 10% to 20%) during follow-up, and 65% (95% confidence interval 43% to 88%) of this decrease occurred during the first 2 weeks. Increased central corneal thickness measured by pachymetry was associated with biomicroscopic detection of corneal edema (P = 0.03). CONCLUSIONS: Corneal pachymetry supplements clinical assessment of herpetic disciform edema.

Body Weights and Measures↗
PubMed2004

Delayed reactivation of presumed adenoviral subepithelial infiltrates after laser in situ keratomileusis.

OBJECTIVE: To report the reactivation of presumed adenoviral keratitis after laser in situ keratomileusis (LASIK). METHODS: Case report and literature review. RESULTS: The patient underwent uneventful LASIK more than 5 years after an episode of adenoviral keratitis that left subepithelial corneal scarring. Three months after LASIK, new subepithelial infiltrates appeared in the right eye. These lesions resolved without sequelae during treatment with topical steroids. The patient's uncorrected and best-corrected visual acuity returned to her postoperative baseline. CONCLUSION: LASIK may cause delayed exacerbation of subepithelial infiltrates caused by adenoviral keratitis. However, good visual outcomes can be achieved with recognition of this reactivation and treatment with topical corticosteroids.

Adenovirus Infections, Human↗
PubMed2004

Asymmetric keratoconus attributed to eye rubbing.

PURPOSE: To report a series of cases with asymmetric keratoconus attributed to eye rubbing, discuss its pathogenesis, and review the literature. METHODS: Case reports and literature review. RESULTS: A careful history obtained from 5 patients with asymmetric keratoconus revealed habitual eye rubbing of the more severely affected eye. CONCLUSIONS: Trauma, such as occurs with habitual eye rubbing, plays a role in the pathogenesis of keratoconus.

Adolescent↗
PubMed2004

The epidemiology of diffuse lamellar keratitis.

PURPOSE: To report the incidence and outcomes of diffuse lamellar keratitis (DLK) after LASIK and to analyze potential causative factors. METHODS: Retrospective review of 15,119 cases (11,232 primary procedures and 3887 enhancements) from 7168 patients undergoing LASIK from May 1995 through October 2002, comparing preoperative data and postoperative outcomes for each case developing DLK to patients in the study population and a control series of eyes that did not develop DLK. RESULTS: We identified 61 eyes (0.40%) that developed DLK after LASIK. Three study groups were identified based on sterilization protocols used: (1) steam autoclave without reservoir (8348 cases), (2) cassette autoclave with reservoir (6771 cases), (3) steam autoclave without reservoir and new instrument cleaner (1758 cases). Significantly more eyes developed DLK with Protocol 2 (47 cases, 0.94%) than with Protocol 1 (11 cases; 0.1%; P < 0.0001) or Protocol 3 (3 cases, 0.2%; P < 0.0005). There was no significant difference in the incidence of DLK in Protocol 1 versus Protocol 3. DLK was significantly more common after primary procedures than with enhancement procedures only under Protocol 2. No individual developed DLK after more than 1 procedure. Treatment protocols included frequent topical steroids only (24 cases, 39.3%), frequent topical steroids and oral steroids (19 cases, 31.2%), or topical and oral steroids combined with lifting and irrigating beneath the flap (18 cases, 29.5%). Final refractions and visual acuities were not significantly different in eyes that developed DLK and those that did not. CONCLUSIONS: DLK is a nonspecific inflammatory response to multiple stimuli that cannot be attributed solely to individual variation in the inflammatory response, the microkeratome, or material deposited by the microkeratome. Sterilizers with reservoirs may cause some cases of DLK. With appropriate diagnosis and treatment, DLK should resolve without sequelae, yielding visual outcomes comparable to cases with uneventful postoperative courses.

Administration, Oral↗
PubMed2003

Risk factors and prognosis for corneal ectasia after LASIK.

PURPOSE: To review cases of corneal ectasia after laser in situ keratomileusis (LASIK), identify preoperative risk factors, and evaluate methods and success rates of visual rehabilitation for these cases. DESIGN: Retrospective nonrandomized comparative trial. PARTICIPANTS: Ten eyes from seven patients identified as developing corneal ectasia after LASIK, 33 previously reported ectasia cases, and two control groups with uneventful LASIK and normal postoperative courses: 100 consecutive cases (first control group), and 100 consecutive cases with high myopia (> 8 diopters [D]) preoperatively (second control group). METHODS: Retrospective review of preoperative and postoperative data for each case compared with that of previously reported cases and cases with uneventful postoperative courses. MAIN OUTCOME MEASURES: Preoperative refraction, topographic features, residual stromal bed thickness (RSB), time to the development of ectasia, number of enhancements, final best-corrected visual acuity (BCVA), and method of final correction. RESULTS: Length of follow-up averaged 23.4 months (range, 6-48 months) after LASIK. Mean time to the development of ectasia averaged 16.3 months (range, 1-45 months). Preoperative refraction averaged -8.69 D compared with -5.37 D for the first control group (P = 0.005). Preoperatively, 88% of ectasia cases met criteria for forme fruste keratoconus, compared with 2% of the first control group (P < 0.0000001) and 4% of the second control group (P = 0.0000001). Seven eyes (70%) had RSB <250 microm, as did 16% of eyes in the first control group and 46% of the second control group. The mean RSB for ectasia cases (222.8 microm) was significantly less than that for the first control group (293.6 micro m, P = 0.0004) and the second control group (256.5 microm; P = 0.04). Seven eyes (70%) had enhancements. Only 10% of eyes lost more than one line of BCVA, and all patients eventually achieved corrected vision of 20/30 or better. One case required penetrating keratoplasty (10%), while all others required rigid gas-permeable contact lenses for correction. CONCLUSIONS: Significant risk factors for the development of ectasia after LASIK include high myopia, forme fruste keratoconus, and low RSB. All patients had at least one risk factor other than high myopia, and significant differences remained even when controlling for myopia. Multiple enhancements were common among affected cases, but their causative role remains unknown. We did not identify any patients who developed ectasia without recognizable preoperative risk factors.

Adult↗
PubMed2003

Visual rehabilitation after severe alkali injury with piggyback hyper O2 contact lenses.

PURPOSE: To report successful visual rehabilitation following severe bilateral alkali injury using piggyback hyperoxygen-transmissible (hyper O2) contact lenses. METHODS: Case report and literature review. RESULTS: More than 15 years after a severe bilateral alkali injury, multiple surgical procedures including repeat bilateral penetrating keratoplasty, severe tear deficiency, and chronic ocular surface disruption, the patient achieved 20/30 best-corrected vision through the simultaneous use of a hyper O2 rigid gas permeable contact lens over a hyper O2 soft contact lens in his right eye. The patient has tolerated this piggyback combination without any adverse reactions or complications, and his corneal graft remains clear and healthy. CONCLUSION: Visual rehabilitation for conditions that compromise the ocular surface can be accomplished by utilizing newer soft and rigid contact lens materials that facilitate oxygen transmission, thereby promoting epithelial healing and improving safety in extended wear situations. These newer materials may potentially reduce complications previously associated with extended wear therapeutic lenses.

Adult↗
PubMed2003

Postoperative LASIK visual aberrations and treatment with InterWave-guided multipass, multistage correction.

Visual aberrations such as glare and halo have been well documented after laser in-situ keratomileusis (LASIK). These are more likely in patients with higher refractive errors and large pupil diameters. We present a patient with good Snellen acuity but functional impairment by visual aberrations after LASIK. These symptoms resolved after an InterWave-guided LASIK multipass, multistage enhancement treatment to correct spherical aberrations.

Adult↗
PubMed2002

Exacerbation of Avellino corneal dystrophy after laser in situ keratomileusis.

PURPOSE: To report a case of Avellino corneal dystrophy that increased in severity 1 year after uncomplicated laser in situ keratomileusis (LASIK) for myopia. METHODS: Avellino dystrophy was confirmed by polymerase chain reaction sequencing of DNA from the patient and her parents. RESULTS: Best spectacle-corrected visual acuity decreased from 20/20 to 20/30 12 to 20 months after LASIK owing to opacities that appeared centrally in the corneal stroma and the LASIK flap and remaining posterior stroma interface. CONCLUSIONS: LASIK is contraindicated in patients with Avellino corneal dystrophy because vision may be reduced by corneal opacities that appear in the interface of the flap and remaining posterior stroma postoperatively.

Adult↗
PubMed2002

Intraocular lens power calculations after laser in situ keratomileusis.

PURPOSE: To compare the accuracy of several techniques for calculating intraocular lens (IOL) power after laser in situ keratomileusis (LASIK). METHODS: Retrospective review of 10 eyes from nine patients undergoing phacoemulsification after LASIK. Corneal power (K) was measured by manual keratometry (MK), refractive history (RH), contact lens overrefraction (CTL), videokeratography (VK), and an average of the refractive history and contact lens methods (AVG 2). Results were compared with the back-calculated K value generated by the Holladay IOL Consultant program. Age-matched patients undergoing phacoemulsification without previous refractive surgery served as controls. RESULTS: Mean spherical equivalent postoperative refraction was +0.21 diopter (D) (SD, 1.54; range, -2.25 to +2.25 D) for patients undergoing cataract extraction after LASIK versus -0.56 D (SD, 0.66; range, -2.375 to +0.5 D; p= 0.16) for controls. Thirty percent of cases versus 90% of controls were within 1 D ( p= 0.002) of emmetropia. Forty percent of cases versus no controls were more than 1 D hyperopic ( p= 0.08). The mean differences for each method compared with the back-calculated K values were MK, +0.82 D; VK, +1.24 D; RH, -0.76 D; CTL, +0.91 D; AVG 2, +0.08 D. The mean absolute deviations from the back-calculated K values were MK, 1.91 D; VK, 2.01 D; RH, 1.68 D; CTL, 1.62 D; AVG 2, 1.42 D. CONCLUSION: Significant refractive errors occurred with each of the methods investigated for determining IOL power after LASIK. RH, CL, or AVG 2 provided the most accurate results.

Adult↗
PubMedDate not supplied

Aspiration cytology of the conjunctival surface.

OBJECTIVE: To evaluate a method of obtaining conjunctival cells that utilizes aspiration of the conjunctival surface. STUDY DESIGN: Eighteen eyes from 16 patients with epibulbar lesions underwent aspiration of the conjunctival surface using a tuberculin syringe without a needle. The aspirated cells were prepared by the cytocentrifuge or Millipore filter technique. The lesions were subsequently biopsied, and the cytologic and histologic diagnoses were compared. RESULTS: Diagnoses of the conjunctival lesions, in decreasing order of frequency, were conjunctival intraepithelial neoplasia (dysplasia, carcinoma in situ), squamous cell carcinoma, squamous metaplasia, nevus, lymphoma and inflammation. In this feasibility study, the cytologic diagnosis accurately correlated with the histologic diagnosis in most cases. There were two cases in which the cytologic diagnosis led to the correct histologic diagnosis. CONCLUSION: Aspiration cytology of the conjunctival surface is useful in obtaining diagnostic material and may be used as a guide to where a biopsy should be performed. Limitations include inadequate samples and lack of observer experience.

Adult↗
PubMedDate not supplied

Standardized analyses of correction of astigmatism by laser systems that reshape the cornea.

PURPOSE: To develop a minimum set of analyses and a format for presentation of outcomes of astigmatism correction by laser systems that reshape the cornea. METHODS: An Astigmatism Project group was created under the auspices of the American National Standards Institute (ANSI) Z80.11 Working Group on Laser Systems for Corneal Reshaping. The Astigmatism Project Group was made up of experts in astigmatism analyses from academia, government, and industry. An extensive literature review was conducted to identify all currently available methodologies for the evaluation of astigmatic outcomes. Project Group members discussed the utility of each method and its specific parameters for evaluating the effectiveness of astigmatism-correcting devices. They gave consideration to unique terminology and analyses required for evaluation of correction of astigmatism by laser systems that reshape the comea. RESULTS: The Project Group defined a comprehensive list of analysis variables needed for the evaluation of astigmatism-correcting devices and generated a mathematical definition for each term. They developed a minimum set of analyses needed for evaluation of astigmatism treatments by laser systems that reshape the cornea. They established methods for calculating the refractive error analysis variables and constructed recommended table and graph formats for data presentation. CONCLUSIONS: This article contains the recommendations of the Astigmatism Project Group of the American National Standards Institute. We propose it as a standard reference for astigmatic refractive error analyses for the evaluation of safety and effectiveness of laser systems that reshape the cornea.

Astigmatism↗