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Biomedical subjects

Robert H Osher

Publications and source records attributed to Robert H Osher.

8 recordsLinked to original sources

Thinning of the anterior capsule associated with congenital aniridia.

PURPOSE: To report the unusual finding of intraoperative fragility of the anterior capsule in some patients with congenital aniridia and determine the histopathologic etiology of this finding. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Anterior lens capsule specimens were obtained from aniridic and nonaniridic patients during cataract surgery. The intraoperative behavior of each capsule was noted, after which the specimens were submitted for histopathologic evaluation. RESULTS: All anterior capsule specimens from the nonaniridic patients were of normal thickness. Some, but not all, anterior capsule specimens from the aniridic patients were remarkably thin. Thin capsules were associated with extreme intraoperative fragility. CONCLUSIONS: Greater awareness of anterior capsule fragility in some aniridic patients may reduce the risk of capsule complications and lead to safer surgical outcomes.

Adult↗

Phakic implantation of a black intraocular lens in a blind eye with leukocoria.

A 54-year-old woman with leukocoria from a white cataract requested evaluation for the undesired cosmetic appearance of her blind right eye. The eye was hypotonous from chronic total retinal detachment, and the lens appeared loose and partially resorbed. A solid, black poly(methyl methacrylate) intraocular prosthesis was placed in the phakic posterior chamber and sutured into the ciliary sulcus, leaving the lens undisturbed. The patient achieved excellent cosmesis and a significant improvement in self-image.

Blindness↗

Posterior capsule tear resulting from faulty instrumentation.

Three eyes having cataract surgery with intraocular lens (IOL) implantation developed a torn posterior capsule. The defective bend of a damaged Y-hook used for insertion and rotation of the IOL was identified. In 1 case, a new IOL design with a thinner edge may have contributed to the capsule tear. Surgeons must remain vigilant to the possibility that any instrument can be inadvertently damaged, which can result in intraoperative complications.

Aged↗

Visualizing vitreous using Kenalog suspension.

We developed and evaluated a method of visualizing vitreous gel in the anterior segment. In this study, 0.2 mL of injectable triamcinolone (Kenalog) 40 mg/mL was captured in a 5 microm filter and rinsed with 2 mL of balanced salt solution (BSS). It was then resuspended in 5 mL of BSS and recaptured to thoroughly remove the preservative. The Kenalog particles were ultimately resuspended in 2 mL of BSS and injected into the anterior chamber through a 27-gauge cannula. Kenalog particles were trapped on and within the vitreous gel, making it clearly visible. The visualization provided direct observation of vitreous behavior in various experimental settings and assisted surgeons intraoperatively in the identification and removal of vitreous in the anterior segment.

Acetates↗

Techniques for managing common complications of cataract surgery.

Cataract surgery has evolved dramatically over the last two decades, largely as a result of technological advances. As a result, visual outcomes and patient convalescence have improved significantly. A second consequence of increased instrumentation and technology, however, is increased complexity of cataract surgery and the advent of complications unique to these advances. Cataract surgeons must be aware and capable of managing the many possible adverse events that can occur during cataract surgery. This review identifies many of the common complications of cataract surgery, describes methods to avoid these complications and discusses techniques to address complications that do occur. It is the ability to avoid, quickly identify, and properly manage complications that defines the accomplished cataract surgeon.

Cataract Extraction↗

Phakic posterior chamber intraocular lens pupillary block.

A 49-year-old woman developed bilateral pupillary block after implantation of a phakic posterior chamber intraocular lens despite patent-appearing but nonfunctional peripheral iridotomies. This case serves as a basis to identify clinical signs that distinguish this diagnosis from other causes of elevated intraocular pressure and types of pupillary block.

Critical Pathways↗