Truth and consequences.
Explore the source record for details and available documents.
Anti-Inflammatory Agents, Non-Steroidal↗
Biomedical subjects
J L Gayton
Publications and source records attributed to J L Gayton.
Neodymium:YAG treatment of interlenticular opacification in a secondary piggyback case.
Interlenticular opacification (ILO) developed 7 months after secondary acrylic piggyback lens implantation in which the anterior lens was placed in the bag. This resulted in glare and a hyperopic shift. Treating the ILO with the neodymium:YAG laser successfully reduced the glare and corrected the hyperopic shift.
Aged↗
Pupillary capture of the optic in secondary piggyback implantation.
Two patients who received a minus-power intraocular lens implanted as a secondary piggyback to correct pseudophakic myopia experienced pupillary optic capture following dilation in the early postoperative period. Both cases were successfully managed by pressing the optic back into the ciliary sulcus and constricting the pupil with pilocarpine.
Aged↗
Interlenticular opacification: clinicopathological correlation of a complication of posterior chamber piggyback intraocular lenses.
PURPOSE: To present a clinicopathological correlation of 2 pairs of piggyback posterior chamber intraocular lenses (PC IOLs) explanted because of opacification between the lens optics. SETTING: Gayton Health Center, Eyesight Associates of Middle Georgia, Warner Robins, Georgia, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Two pairs of piggyback AcrySof lenses were explanted from 2 patients with significant visual loss related to opacification between the optics. They were submitted for pathological analysis. Gross and histopathological examinations were performed, and photomicroscopy was used to document the results. RESULTS: Gross examination showed accumulation of a membrane-like white material between the lenses. Histopathological examination revealed that the tissue consisted of retained/proliferative lens epithelial cells (bladder cells or pearls) mixed with lens cortical material. CONCLUSION: Piggyback PC IOLs were explanted in 2 cases because of a newly described complication, interlenticular opacification. Three surgical means may help prevent this complication: meticulous cortical cleanup, especially in the equatorial region; creation of a relatively large continuous curvilinear capsulorhexis to sequester retained cells peripheral to the IOL optic within the equatorial fornix; insertion of the posterior IOL in the capsular bag and the anterior IOL in the ciliary sulcus to isolate retained cells from the interlenticular space.
Acrylic Resins↗
Piggybacking intraocular implants to correct pseudophakic refractive error.
OBJECTIVE: To determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct pseudophakic refractive error. DESIGN: Noncomparative, prospective, consecutive case series. PARTICIPANTS: Eight eyes of eight normal pseudophakes and seven eyes of seven postpenetrating keratoplasty (PK) pseudophakes were included in the study. INTERVENTION: A second intraocular lens (IOL) was implanted anterior to the first in each eye in the study. MAIN OUTCOME MEASURES: Efficacy was determined based on the achieved refractive correction and Snellen uncorrected visual acuity measurements. Safety was determined based on loss of best-corrected visual acuity and operative and postoperative complications. RESULTS: Before surgery, spherical equivalents ranged from -5.12 diopters (D) to 7.5 D, with a mean absolute deviation from emmetropia of 3.38 D (1.62). After surgery, spherical equivalents ranged from -2.75 D to 0.5 D, with a mean absolute deviation from emmetropia of 1.21 D (0.90). Before surgery, only 7% of patients had 20/40 or better uncorrected vision, whereas after surgery, 50% had that level of vision. CONCLUSIONS: Implanting a second IOL is a viable option for correcting pseudophakic refractive error.
Humans↗
Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation.
PURPOSE: To determine whether combined cataract surgery with endoscopic laser cycloablation produces less inflammation than cataract surgery combined with a filtering procedure. SETTING: Taylor Regional Hospital (surgeries) and EyeSight Associates (examinations), Warner Robins, Georgia, USA. METHODS: A randomized prospective study was conducted of 58 eyes of 58 patients comparing endoscopic laser cycloablation performed through a cataract incision at the time of cataract surgery with combined trabeculectomy and cataract surgery. RESULTS: Mean follow-up was 2 years. At the final available visit, 30% of endoscopic laser patients achieved intraocular pressure control (below 19 mm Hg) without medication and 65% with medication. Forty percent of trabeculectomy patients achieved control without medication and 52% with medication. Four endoscopic laser patients (14%) and 3 trabeculectomy patients (10%) were considered treatment failures (required additional surgical intervention). CONCLUSION: Endoscopic laser cycloablation performed through a cataract incision was a reasonably safe and effective alternative to combined cataract and trabeculectomy surgery, providing an option for cataract patients who have glaucoma requiring surgical intervention.
Cataract↗
Traumatic aniridia during endoscopic laser cycloablation.
Endoscopic laser cycloablation can be effective in treating glaucoma. The Micro probe endoscopic laser permits excellent visualization of the ciliary processes. However, the surgeon can not simultaneously view through the probe and see the probe's location in the eye through the surgical microscope. An iris adhesion with the probe led to total aniridia in the case reported. Having an assistant watch the operative monitor or devising a system that allows the surgeon to watch both monitors could prevent this complication.
Aged↗
Secondary implantation of a double intraocular lens after penetrating keratoplasty.
Penetrating keratoplasty (PKP) patients often have severe, visually disabling refractive errors. Astigmatism can be addressed by refractive surgery; however, correcting hyperopia is more problematic. Although pseudophakic PKP patients can have a lens exchange, it can be traumatic in this population. In this pseudophakic PKP patient, I added a second posterior chamber intraocular lens, correcting the hyperopia and resolving visual complaints.
Astigmatism↗
Combined cataract and glaucoma procedures using temporal cataract surgery.
PURPOSE: To evaluate whether separating the procedures in a combined procedure by performing a temporal cataract incision and superior trabeculectomy induces the lower astigmatism of a temporal cataract incision without sacrificing intraocular pressure (IOP) control. SETTING: EyeSight Associates, Warner Robins, Georgia. METHODS: This study evaluated 50 consecutive eyes receiving a superior cataract incision with a superonasal trabeculectomy and 65 eyes receiving a temporal cataract incision with a superonasal trabeculectomy. RESULTS: After 3 months, a substantially greater proportion of temporal incision cases had controlled IOP without medication. A substantially higher proportion in the superior incision group had uncontrolled IOP at each time period. Mean surgically induced cylinder was higher in the superior incision group at every time period. The superior group had early with-the-rule mean induced cylinder that decayed to against-the-rule, with a mean induced cylinder with keratometry at the final available visit (more than 3 months) of -1.01 diopter (D). The temporal group started with a negligible induced cylinder (-0.13 D) that drifted slightly with the rule to a final mean induced cylinder of +0.49 D. At the last visit, 31% in the superior incision group and 57% in the temporal incision group had an uncorrected visual acuity of 20/40 or better, and 72% and 94%, respectively, had a best corrected acuity of 20/40 or better. CONCLUSION: Separating the cataract and glaucoma procedures frees the surgeon to use newer astigmatically neutral techniques for the cataract incision.
Aged↗
Implanting two posterior chamber intraocular lenses in a case of microphthalmos.
A 31-year-old male with bilateral microphthalmos and a history of severe refractive amblyopia presented with early nuclear sclerosis. Intraocular lens calculations determined the patient would need about a 46.0 diopter power intraocular lens in both eyes to achieve satisfactory vision postoperatively. When no manufacturer could or was willing to make such a high-power lens, we chose to implant two lenses in each eye. The patient is satisfied with his postoperative vision and overall outcome.
Adult↗
Intraoperative discovery of a neurofibroma during routine ptosis surgery.
A noncosmetic blepharoplasty with levator tuck was planned to repair a congenital ptosis presumed to be caused by levator maldevelopment. During surgery a mass was found in the lid, revealing the ptosis to be mechanical in nature. Biopsy and subsequent pathological exam revealed this to be a plexiform neurofibroma in a reportedly undiagnosed patient.
Adolescent↗
Combined cataract and strabismus surgery.
A patient with cataracts and congenital exotropia underwent combined cataract and strabismus surgery OU. A lateral rectus recession plus an extracapsular cataract extraction with intraocular lens implantation was done OD first; three months later, this procedure was repeated OS. The patient's postoperative course was benign in both cases, and her strabismus resolved after the second operation. A combined surgical approach to cataracts and strabismus (where only a single muscle is involved) was safe and useful in restoring this patient's vision, binocularity, and appearance.
Aged↗
Angle closure glaucoma following a combined blepharoplasty and ectropion repair.
This paper reports an occurrence of angle closure glaucoma following a combined blepharoplasty and ectropion repair. We are unaware of any previous reports of such an incident. Specific to this case was the coexistence of a cataract that contributed to the narrowing of the anterior chamber. This condition, along with pupil dilation secondary to the anesthetic, precipitated a phacomorphic angle closure glaucoma attack, necessitating emergency cataract surgery. Because other procedures involve pupillary dilation as a potential side effect, we recommend an increased awareness of this potential postoperative complication.
Acute Disease↗
Immediate periorbital reconstruction following Mohs surgery: three case studies.
Explore the source record for details and available documents.
Aged↗
Alternative draping technique for claustrophobic patients.
Explore the source record for details and available documents.
Cataract↗
Radial keratotomy enhancements for residual myopia.
BACKGROUND: A systematic method of performing radial keratotomy enhancements in undercorrected eyes may increase accuracy and predictability and decrease the number of procedures required. A consecutive series of 372 radial keratotomy procedures, including 110 eyes that received enhancements under a systematic protocol, was evaluated. METHODS: Radial keratotomy was performed using the Reliable Keratotomy software, which uses the Thornton nomogram for primary radial keratotomy and provides a systematic method of performing enhancements. RESULTS: Ninety eyes (24%) received one enhancement, 16 eyes (4%) received two enhancements, and four eyes (1%) received three enhancements. Mean final spherical equivalent refraction was -0.44 D (-4.00 to +1.875 D, SD 0.86) for eyes that did not receive enhancements and -0.44 D (-2.50 to +1.00 D, SD 0.61) for eyes that had enhancements. Mean final residual myopia for the entire cohort was -0.44 D (-4.00 to +1.875 D, SD 0.79). At final examination, 242 (65%) eyes had a refraction within +/- 0.5 D and 298 (80%) within +/- 1.00. Among eyes that received enhancements, 75 (68%) had a refraction within +/- 0.50 D, and 89 (81%) within +/- 1.00 D; 40 eyes (36%) had uncorrected visual acuity of 20/20 or better, 99 eyes (90%) 20/40 or better, and all but one eye (99%) 20/80 or better at the final postoperative examination. Among the entire cohort, 130 eyes (35%) had uncorrected visual acuity of 20/20 or better, 312 (84%) had 20/40 or better, and 350 (94%) had 20/80 or better. No eye lost more than one line of spectacle-corrected visual acuity. CONCLUSION: A systematic approach to enhancement of undercorrected eyes after radial keratotomy, combined with accurate surgery, may reduce the need for multiple enhancements as well as the overcorrection rate, and provide improved uncorrected visual acuity.
Adolescent↗