PubMed Health⌕ Search

Biomedical subjects

R H Osher

Publications and source records attributed to R H Osher.

At least 19 recordsLinked to original sources
PubMed1996

Re-forming the flat anterior chamber with Healon.

A shallow or flat anterior chamber may occur after complicated cataract surgery, a filtering procedure for glaucoma, or combined surgery. We describe a technique for injecting sodium hyaluronate (Healon) into the anterior chamber through the previous paracentesis tract in the operating room or at the slitlamp microscope. Re-forming the anterior chamber with Healon may pre-empt the anatomical sequelae of prolonged anterior chamber shallowing and prevent the need for more invasive surgery.

Aged↗
PubMed1995

Endocapsular ring approach to the subluxed cataractous lens.

The surgical management of the cataract associated with extensive zonular dialysis presents a challenge for the anterior segment surgeon. In 1993, a poly(methyl methacrylate) endocapsular ring was introduced to stabilize the capsular bag. We describe the use of this endocapsular ring in phacoemulsification and intraocular lens (IOL) implantation in the capsular bag in four patients with extensive traumatic or congenital zonular dialysis. The endocapsular ring allows expansion and stabilization of the capsular bag to facilitate cortical aspiration and uncomplicated IOL implantation. With follow-up of 4 to 10 months, all IOLs have remained well centered and the patients have had excellent vision free of complications.

Aged↗
PubMed1994

Antimicrobial efficacy and aqueous humor concentration of preoperative and postoperative topical trimethoprim/polymyxin B sulfate versus tobramycin.

We compared trimethoprim sulfate 0.1%/polymyxin B sulfate 10,000 units/mL with tobramycin 0.3% for preoperative sterilization of the ocular surface, aqueous humor concentration, and ocular safety and comfort in 99 patients who had cataract extraction and intraocular lens implantation. The organisms most frequently cultured from the conjunctiva at baseline were Staphylococcus epidermidis, Corynebacterium species, and Staphylococcus aureus, which were isolated from 66%, 15%, and 8% of the 95 specimens eligible for evaluation. All organisms identified in positive baseline conjunctival cultures except Staphylococcus epidermidis were completely eradicated in both groups on the day of surgery and five to seven days postoperatively. Staphylococcus epidermidis was eradicated on the day of surgery in 58% of patients in the trimethoprim/polymyxin group and in 68% in the tobramycin group. This organism was eradicated five to seven days postoperatively in 85% of patients in both groups. Mean aqueous humor concentration of trimethoprim sulfate at surgery was greater than the mean tobramycin concentration, but neither reached clinically significant inhibitory levels for most organisms. No significant differences were found in ocular safety and comfort.

Adult↗
PubMed1993

Treatment of anterior chamber fibrin following cataract surgery with tissue plasminogen activator.

Three patients who developed anterior chamber fibrinous exudates after cataract surgery were treated with tissue plasminogen activator injected into the anterior chamber. There was prompt dissolution of the fibrinous exudates and no observed complications. When fibrinous exudates occur in high-risk patients after cataract surgery, tissue plasminogen activator provides an excellent means of clearing the fibrin.

Adult↗
PubMed1991

Retrobulbar hemorrhage.

Retrobulbar hemorrhage associated with retrobulbar anesthesia has been construed as a contraindication to cataract surgery. Cancellation of the surgery results in disappointment for both the patient and surgeon. A retrospective study of 60 eyes was undertaken to evaluate the safety of proceeding with small-incision phacoemulsification surgery after retrobulbar hemorrhage when specific criteria are met. If digital massage achieved a soft globe that was easily retropulsed and the eyelids were loose and easily mobilized, the surgery was performed as scheduled. If the globe remained firm within a tense orbit and proptosis with tight lids was present, surgery was cancelled. Fifty-seven cases with retrobulbar hemorrhage met these criteria and underwent phacoemulsification with implantation of a posterior chamber intraocular lens. The lack of intraoperative and postoperative complications suggests that small-incision cataract surgery can be safely performed when preceded by a limited retrobulbar hemorrhage.

Aged↗
PubMed1990

Posterior polar cataracts: a predisposition to intraoperative posterior capsular rupture.

We performed phacoemulsification or planned extracapsular cataract extraction on posterior polar cataracts in 31 eyes of 22 patients and experienced eight cases of posterior capsular rupture (26%). Capsular rupture occurred during removal of the posterior polar opacity or during cleaning of the posterior capsule after the opacity had been removed. We believe that excessive adherence of the opacity to the posterior capsule and unusual thinness of the capsule predisposed these eyes to posterior capsular rupture.

Adult↗
PubMed1990

The torn posterior capsule: its intraoperative behavior, surgical management, and long-term consequences.

A retrospective study of cataract surgery performed between January 1983 and December 31, 1989, disclosed 48 eyes in which the posterior capsule was torn. The overall incidence of this complication was approximately 1% but was further reduced when the technique of capsulorhexis was mastered. Our review of the video tapes of these surgical procedures revealed that the tear occurred most frequently during nucleus removal (41%) and posterior capsular vacuuming (28%). The anatomy of each tear was classified and related to the event responsible for the torn capsule, as well as to the likelihood of vitreous involvement. Vitreous presented through the tear in 32% of the 48 cases, entered the wound in 6%, and remained posterior to the torn capsule in 62%. Intraocular lenses were implanted in every case; only posterior chamber lenses were used during the last four years of the study. Vitreous-related complications included vitreous prolapse, peaked pupils, and vitreous-induced pupillary block. Acute postoperative intraocular pressure elevation was a frequent finding and was managed by conservative therapy. Transient cystoid macular edema developed in one case which had a rotating anterior chamber intraocular lens. No retinal detachments occurred in this series. Final visual acuity of 20/40 or better was achieved in 89% of the 48 cases. When properly managed, a torn posterior capsule is compatible with an excellent visual outcome.

Adult↗
PubMed1989

Paired transverse relaxing keratotomy: a combined technique for reducing astigmatism.

Phacoemulsification, posterior chamber intraocular lens implantation, and corneal relaxing incisions were performed as a combined procedure in 75 eyes with preexisting with-the-rule or against-the-rule astigmatism. The results of this study confirm that this technique can safely reduce preexisting low and moderate astigmatism with a greater likelihood of achieving excellent uncorrected visual acuity.

Astigmatism↗
PubMed1987

Complications associated with STAAR silicone implants.

We compared the incidence of various complications in consecutive series of cases in which 76 eyes received STAAR silicone intraocular implants and 76 eyes received small incision IOLAB G708G polymethylmethacrylate (PMMA) intraocular implants. All surgeries were performed by the same surgeon employing the same phacoemulsification technique. A higher incidence of lens subluxation, lens repositioning, corneal edema, and elevated intraocular pressure was observed in the eyes receiving STAAR silicone implants than in the eyes receiving IOLAB PMMA implants. In addition, a YAG laser posterior capsulotomy could not be performed through several STAAR silicone RMX 1 model implants. An invasive pars plana posterior capsulotomy was necessary in these eyes. We also found that the STAAR silicone RMX 3 model implants were often pitted by the YAG laser during successful posterior capsulotomies. Despite these problems, the STAAR silicone intraocular lens group achieved corrected vision similar to the PMMA lens group.

Humans↗
PubMed1984

Radial keratotomy: a comprehensive evaluation.

A prospective clinical investigation of radial keratotomy employing the Fyodorov method and instrumentation was initiated in March, 1980. The results of the first 147 eyes undergoing this surgical procedure for the reduction or elimination of myopia were analyzed one year following surgery. The mean preoperative, uncorrected visual acuity was finger counting vision and the mean preoperative myopic spherical equivalent was 5.33 diopters. The preoperative myopic refractive error ranged from 1.75 to 11.75 diopters. Radial keratotomy resulted in a mean uncorrected visual acuity of 20/35 with a mean reduction on myopia of 4.66 diopters. Eighty percent of the 147 eyes experienced 20/40 or better uncorrected vision. Sixty-eight percent of high myopia eyes (6.00 to 11.75 D) attained this level of uncorrected vision with a mean reduction of myopia of 6.23 diopters. Glare and variation of vision were the most frequently reported complications. A non-progressive endothelial cell loss of 5.2 percent was observed. The degree of preexisting myopia, patient age, fellow eye experience and surgeon learning curve significantly influenced the surgical result and facilitated the predictability of the procedure. Incision depth was directly related to surgical result. The low myopia group achieved stabilization of effect by six months while stabilization occurred later in patients with high degrees of initial myopia. Patient satisfaction was high and 78 per cent of the patients elected to undergo radial keratotomy in their fellow eye.

Adolescent↗
PubMed1984

Complications of extracapsular cataract surgery. The indications and risks of peripheral iridectomy.

With the increased popularity of extracapsular cataract surgery, the need for a peripheral iridectomy has been questioned. Some surgeons feel that the risks involved in performing the iridectomy are greater than when leaving the iris untouched. The indications and risks of iridectomy with cataract surgery are discussed. Four case reports are presented. In three cases, iridectomy was not performed with cataract surgery, and a pupillary block developed. In one of these three, a congenital cataract, secondary angle closure, developed requiring filtering surgery. In the fourth case, an iridectomy prevented serious complications from an unusual degree of postoperative inflammation with complete posterior synechia following uneventful cataract surgery.

Aged↗