Barry A. Maltzman

A survey of ocular trauma

A four-year survey of all ocular trauma cases admitted to a large metropolitan eye hospital was conducted for the purpose of generally documenting ocular trauma and evaluating prophylactic, demographic and etiologic factors. Of 6254 eye admissions, 7.5% were for ocular trauma; hyphema was the most common diagnosis. Injuries were evaluated according to site, cause, and age, sex and race distribution.

Control of intraocular pressure in glaucomatous eyes after extracapsular cataract extraction with intraocular lens implantation

ABSTRACT Two hundred sixty eyes of 195 patients having extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intraocular lens were studied retrospectively. Of these cases, 160 eyes had preexisting glaucoma while 100 had no ocular pathology except for cataract. Intraocularpressure decreased significantly after ECCE in both groups and slowly returned to baseline within two years. The average postoperative visual acuity was better in the control group than in the glaucoma group. Patients with glaucoma were controlled with less medication after surgery. We believe that ECCE with insertion of a posterior chamber intraocular lens can be safely performed in glaucoma patients and has a beneficial effect on the control of glaucoma.

Long term efficacy of repeat selective laser trabeculoplasty

Purpose: To evaluate long term intraocular pressure (IOP) control after repeat selective laser trabeculoplasty (SLT). Methods: This single center study retrospectively reviews the electronic medical records of patients with open angle glaucoma undergoing repeat SLT. Eyes with prior argon laser trabeculoplasty, or incisional surgery before or during the study period were excluded. Demographics, laser parameters, number of glaucoma medications and IOP at baseline and after 1, 4, 8, 12, 18 and 24 months were collected. The percentage of subjects with IOP reduction >20% and ≥15% from baseline was determined. Results: A total of 45 eyes of 25 subjects with mean age of 73 ± 9 years undergoing repeat SLT were included. Repeat SLT was performed at a mean interval of 28.3 ± 12.7 months after initial treatment. Mean IOP reductions were statistically significant with repeat SLT as compared to baseline at 1, 4, 8, 12, 18 and 24 months’ follow-up. Change in IOP after first and repeat SLT were comparable at most time points except at 4, 8 and 12 months when initial treatment had yielded significantly greater reductions. At 24 months, 29% and 39% of eyes achieved IOP reduction >20% and ≥15% respectively after repeat SLT as compared to 36% and 54% of eyes following initial treatment (P > 0.05). Conclusion: Repeat SLT is effective in lowering IOP up to 24 months. Long term IOP control was achieved in 29–39% of eyes following repeat treatment in this cohort of patients.

Neodymium:YAG laser capsulotomy of secondary membranes in the pediatric population

Posterior capsulotomy is occasionally performed at the conclusion of extracapsular cataract extraction because of the high incidence of secondary membrane formation. Using a Nd:YAG laser we successfully performed posterior capsulotomies on 16 children who developed secondary membranes following extracapsular cataract extraction in which the posterior capsule was left intact. Eleven patients had congenital cataracts and five had acquired cataracts. The youngest patient was four years. All had improvement in visual acuity. Preserving most of the posterior capsule provides additional support to the eye and has been associated with a decreased incidence of cystoid macular edema. It also allows secondary implantation of a posterior chamber intraocular lens in the future.

Repeat selective laser trabeculoplasty can be effective in eyes with initial modest response.

Purpose: To evaluate the effectiveness of repeat selective laser trabeculoplasty (SLT) in eyes exhibiting only a modest response upon initial treatment. Materials and Methods: Retrospective chart review was conducted of 51 eyes that received initial 360 degree SLT (SLT1) and subsequent SLT (SLT2) from 2003-2011 at a large academic ophthalmology practice. Successful response (S) was a post-treatment 12 month mean IOP reduction ≥20% from baseline, while modest response (M) was <20% reduction over the same time. Chi-squared and log rank analyses were used to determine if success after SLT2 depended on having successful (S1) or modest (M1) response after SLT1. Results: IOP was significantly reduced from baseline in both SLT1 and SLT2. The proportion of eyes with S2 was not significantly different between those with initial M1 or S1 (36.67% vs. 52.38%, respectively; P = 0.26). Log rank analysis revealed no differences between M1 and S1 in determining SLT2 success (P = 0.41). This outcome was similar when the analyses were performed for the right and left eye independently. Conclusion: The proportion of eyes that successfully responded to repeat SLT did not differ based upon whether the response to initial SLT was successful or modest. This raises the possibility that repeat SLT should not be excluded as an option for those eyes that have only a modest initial response.

Ultrastructural abnormalities in a microspherical ectopic lens

Abstract In order to establish the congenital structural defects which lead to lens luxation (ectopia lentis), several cases of dislocations are being studied. In this study, the three-dimensional ultrastructure of a congenital microspheric ectopic lens revealed lens structural anomalies as well as malformations of the zonules. The lens fibers were abnormal in distribution, size, and morphology. The most striking difference was the decrease in lens fiber cross-sectional area to 20% of normal. This decrease is seen in all zones of fiber lamellae and may be the direct cause of the abnormal size and shape of the lens. The cortical lens fibers also displayed surface openings which appeared to communicate with intracellular cavities. Two types of zonules were observed; one composed of fibrils of normal dimension which were attached on the anterior inferior lens surface and the ciliary body; the other, composed of abnormally large fibrils, and attached only to the lens surface. From our observations, the primary defect which produced the lens luxation was the decrease in lens fiber dimensions causing a decrease in lens size and thus an increased circumlental space. The spatial relationships between the lens and surrounding tissue is essential for zonular development. the maintenance of the suspensory system and the functions of accommodation.

Neodymium:YAG laser therapy for pseudophakic pupillary block

ABSTRACT Pupillary block occurred in six patients with anterior chamber intraocular lens implants. After medical therapy failed, the Nd:YAG laser was used to break the hyaloid face in the pupillary and iridectomy apertures. Iridotomies were also produced at the sites of bulging iris. Following laser treatment the anterior chambers deepened and there were no further signs or symptoms of pupillary block. The Nd:YAG laser proved to be a useful treatment for pseudophakic pupillary block.

Combined intraocular lens and strabismus surgery.

ABSTRACT Ten cases of combined strabismus surgery and intraocular lens implantation were reviewed to determine if there were increased risks and complications. A review of these cases revealed the contrary was true; i.e., there were no complications arising from the combined surgery and there were benefits in the decreased hospitalization and operative time, less mental trauma, and improved muscle surgical outcome. From these results, we conclude that combined intraocular lens and strabismus surgery is efficacious and indicated in patients with strabismus and cataracts or aphakia.

Iris trauma in metal two-loop intraocular lens implants

Abstract It has been stated that implants with metal loops cause iris neovascularization. Using iris angiography in the immediate post operative period, and again at least 27 months later, this did not occur in our group of patients.

Estimates of primary implant power using an intraocular lens table

ABSTRACT Intraocular lens (IOL) power data have been compiled in tabular format as a function of axial length measurements, corneal powers, and desired refractive errors. The table is presented to assist the clinician in performing IOL power estimates and as an independent source for checking preoperative IOL power calculations. Ophthalmologists who do not own a personal computer will find the lens power table a valuable adjunct to their present repertoire of analytical skills.