Complications of bilateral photorefractive keratectomy for high myopia.
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Administration, Topical↗
Biomedical subjects
B S Elkins
Publications and source records attributed to B S Elkins.
Phototherapeutic keratectomy for corneal scars.
BACKGROUND AND OBJECTIVE: Phototherapeutic keratectomy (PTK) is an effective method of treating a variety of corneal disorders. We report our experience in using PRK to treat corneal scars. PATIENTS AND METHODS: We retrospectively analyzed the data from a cohort of 22 eyes with corneal scars. The etiology of the scar was recorded for each patient. The change in best corrected visual acuity, spherical equivalent, and astigmatism were evaluated at one and three months after surgery. RESULTS: At three months, seven of 18 eyes (39%) had improved 2 or more lines of best corrected visual acuity and 3 eyes (16%) had lost 2 or more lines. Eleven of 18 eyes (61%) had a hyperopic shift of more than 1.00 diopter (D) and eight of 18 eyes (44%) had a hyperopic shift of more than 2.00 D. There was a mean reduction in astigmatism of 0.67 +/- 4.00 D. Four of eight eyes with traumatic scars had significant improvement as compared to none of five eyes with infectious scars. CONCLUSION: PTK is a relatively safe and effective means of treating corneal scars and thereby may offer an alternative to corneal transplantation.
Adolescent↗
Ocular toxoplasmosis misdiagnosed as cytomegalovirus retinopathy in immunocompromised patients.
BACKGROUND: Cytomegalovirus (CMV) and Toxoplasma gondii both cause necrotizing retinopathy in immunosuppressed hosts. Because of the high prevalence of serum antibodies to these agents in the general population and the risks associated with retinal biopsies, diagnosis of these infections is usually based on clinical findings alone, but the two infections can be confused with one another because of similar clinical features. Accurate diagnosis is critical, however, because both diseases are treatable but require different medical therapies. METHODS: Case histories were reviewed for five immunosuppressed patients with necrotizing retinopathy, which was initially diagnosed incorrectly as CMV retinopathy but was subsequently found to be toxoplasmic retinochoroiditis. Correct diagnosis was based on retinal biopsy (2 cases) or rapid response to antiparasitic drug therapy (3 cases). Factors were sought that might help differentiate toxoplasmic retinochoroiditis from CMV retinopathy at presentation. RESULTS: In all cases, the character of retinal opacification (densely opaque, thick) and the appearance of lesion borders (smooth, nongranular) was different from that typically seen with CMV retinopathy. These cases also were characterized by prominent anterior chamber and vitreous inflammatory reactions (four of five cases) and relative lack of retinal hemorrhage. One patient subsequently developed CMV retinopathy; characteristics of the two lesions in the same eye highlighted the differences between these two infections. CONCLUSION: Clinicians should consider ocular toxoplasmosis as a cause of necrotizing retinopathy in immunosuppressed patients and consider an empiric course of antiparasitic therapy for lesions with features described in this report.
Adult↗
Magnetic resonance imaging of the foot and ankle: correlation of normal anatomy with pathologic conditions.
Abnormalities of the foot and ankle can be difficult to diagnose by conventional examination and x-rays. Recently, magnetic resonance imaging (MRI) has emerged as a diagnostic tool for soft tissue and bony imaging. One hundred and ten normal feet and ankles were studied to define normal MRI anatomy. An additional 150 MRI scans were performed to diagnose and characterize various abnormal conditions. MRI demonstrated excellent definition of normal structures and pathologic entities. Surgical correlation with the MRI was done in 42 patients. MRI appears to be a useful examination for patients with certain soft tissue and bony abnormalities. A special oblique view also has been developed to assist in the diagnosis of injuries to the tibialis posterior, flexor hallucis longus, and flexor digitorum longus tendons.
Achilles Tendon↗
Subscriber suits: how to avoid them.
As HMOs and PROs become more significant elements of the health delivery system, they also become more likely targets for lawsuits. This article identifies twelve major liability risks of these organizations as well as those who provide services to HMOs and PPOs. Also presented are steps that can be taken to help protect against those risks.
Financial Management↗
Clear corneal cataract surgery in ocular cicatricial pemphigoid.
We present the results of clear corneal cataract surgery in a patient with stable ocular cicatricial pemphigoid. By eliminating trauma to the conjunctiva, cataract surgery was successfully performed without exacerbating the disease.
Aged↗
Sutureless homoplastic lamellar keratoplasty.
BACKGROUND: Previously, penetrating keratoplasty has been used to treat corneal cap complications related to keratomileusis. We sought to develop a technique to avoid the unnecessary use of penetrating procedures for lamellar problems, that would be technically easier than standard lamellar keratoplasty--sutureless homoplastic lamellar keratoplasty. METHODS: Five eyes with complications from automated lamellar keratoplasty underwent sutureless homoplastic lamellar keratoplasty utilizing an automated microkeratome and topical anesthesia. RESULTS: Three of the five eyes had improved vision; two eyes with final visual acuities of 20/20 and 20/30. The two remaining eyes had poor host stromal beds and required penetrating keratoplasty. The mean follow-up time was 13 months (range 3 to 36 months). All lamellar grafts were clear and well-seated at the last postoperative examination. CONCLUSION: Sutureless homoplastic lamellar keratoplasty is an alternative to penetrating keratoplasty in some eyes that have cap-related problems.
Cornea↗