Eric D. Rosenberg

Pterygium Excision with Conjunctival Autograft

Pterygium is characterized by encroachment of an abnormal fibrovascular tissue from the bulbar conjunctiva onto the cornea (Arch Ophthalmol 115:1235–1240, 1997). Upon reaching the corneal surface, this fibrovascular tissue exerts cicatricial traction that flattens the caruncle and obliterates the semilunar fold (Arch Ophthalmol 130:39–49, 2012). The indications for pterygium surgery include reduced vision due to obscuration of the optical center of the cornea, irregular astigmatism, chronic irritation, recurrent inflammation, motility restriction, and cosmesis. Numerous surgical techniques have been described, but the main concern of pterygium surgery is the unpredictable rate and timing of recurrence (Ocul Surf 12:112–119, 2014). The underlying cause of pterygia is thought to be secondary to UV light exposure and arid conditions. Patients should have been evaluated and deemed appropriate for such surgical intervention. Patients should have been educated about the risks and benefits of the procedure, including alternatives.

Topography-Guided Ablations: Early US Experience and Utility Across the Refractive Landscape

Purpose of ReviewThis paper evaluated topography-guided excimer ablations and recent US experience of this technology. Personal clinical experience, initial approval of the technique, and its application to a potential extended spectrum of clinical conditions was reviewed.Recent FindingsTopography-guided ablation can precisely treat corneas with variable topographic indices and attempt to neutralize irregularities by combining myopic and hyperopic ablation profiles. The T-CAT Phase III study demonstrated the safety and efficacy of this technique, which earned FDA approval in 2013. Current literature has reinforced its efficacy and explored off-label investigations, such as its use to improve visual results in abnormal corneas (e.g., keratoconus, post-LASIK ectasia).SummaryTopography-guided ablation provides increased quality of vision without necessitating excess tissue removal in otherwise normal, keratoconic, ectatic, or post-corneal transplant eyes. In the future, we will likely see a combination of treatment strategies, enabling ophthalmologists to treat the entire refractive surface and refine these already remarkable results.

Bilateral Lateral Rectus Recession (BLR)

Strabismus (abnormal ocular alignment) is a common problem in children. Misalignment may be vertical, horizontal, torsional, or a combination of these. Although strabismus can be treated with conservative therapy such as prisms, patching, glasses, and orthoptic exercises, many cases require surgery for correction. Horizontal eye muscle surgery is the most common strabismus surgery performed and is used for patients with exo- and eso-deviations, dissociated vertical deviations, abnormal head postures, and/or nystagmus. Several techniques are available for treatment of strabismus and may include resection, recession, splitting of muscles, or any combination of these treatments. Bilateral muscle recessions/resections may be performed, or surgery may be done on antagonist muscles of the same eye, depending on diagnosis and surgeon preference.

Bilateral Medial Rectus Recession (BMR)

Strabismus (abnormal ocular alignment) is a common problem in children. Misalignment may be vertical, horizontal, torsional, or a combination of these. Although strabismus can be treated with conservative therapy such as prisms, patching, glasses, and orthoptic exercises, many cases require surgery for correction. Horizontal eye muscle surgery is the most common strabismus surgery performed and is used for patients with exo- and eso-deviations, dissociated vertical deviations, abnormal head postures, and/or nystagmus. Several techniques are available for treatment of strabismus and may include resection, recession, splitting of muscles, or any combination of these treatments. Bilateral muscle recessions/resections may be performed, or surgery may be done on antagonist muscles of the same eye, depending on diagnosis and surgeon preference.

Pterygium Excision with Conjunctival Pedicle Graft

Pterygium is characterized by encroachment of an abnormal fibrovascular tissue from the bulbar conjunctiva onto the cornea (Arch Ophthalmol 115:1235–1240, 1997). Upon reaching the corneal surface, this fibrovascular tissue exerts cicatricial traction that flattens the caruncle and obliterates the semilunar fold (Arch Ophthalmol 130:39–49, 2012). The indications for pterygium surgery include reduced vision due to obscuration of the optical center of cornea, irregular astigmatism, chronic irritation, recurrent inflammation, motility restriction, and cosmesis. Numerous surgical techniques have been described, but the main concern of pterygium surgery is the unpredictable rate and timing of recurrence (Ocul Surf 12:112–119, 2014). The underlying cause of pterygia is thought to be secondary to UV light exposure and arid conditions. Patients should have been evaluated and deemed appropriate for such surgical intervention. Patients should have been educated about the risks and benefits of the procedure, including alternatives.

Pterygium Excision with Amniotic Membrane Graft

Pterygium is characterized by encroachment of an abnormal fibrovascular tissue from the bulbar conjunctiva onto the cornea (Arch Ophthalmol 115:1235–1240, 1997). Upon reaching the corneal surface, this fibrovascular tissue exerts cicatricial traction that flattens the caruncle and obliterates the semilunar fold (Arch Ophthalmol 130:39–49, 2012). The indications for pterygium surgery include reduced vision due to obscuration of the optical center of cornea, irregular astigmatism, chronic irritation, recurrent inflammation, motility restriction, and cosmesis. Numerous surgical techniques have been described, but the main concern of pterygium surgery is the unpredictable rate and timing of recurrence (Ocul Surf 12:112–119, 2014). The underlying cause of pterygia is thought to be secondary to UV light exposure and arid conditions. Patients should have been evaluated and deemed appropriate for such surgical intervention. Patients should have been educated about the risks and benefits of the procedure, including alternatives.

Operative Dictations in Ophthalmology

Pterygium is characterized by encroachment of an abnormal fibrovascular tissue from the bulbar conjunctiva onto the cornea (Arch Ophthalmol 115:1235– 1240, 1997). Upon reaching the corneal surface, this fibrovascular tissue exerts cicatricial traction that flattens the caruncle and obliterates the semilunar fold (Arch Ophthalmol 130:39–49, 2012). The indications for pterygium surgery include reduced vision due to obscuration of the optical center of the cornea, irregular astigmatism, chronic irritation, recurrent inflammation, motility restriction, and cosmesis. Numerous surgical techniques have been described, but the main concern of pterygium surgery is the unpredictable rate and timing of recurrence (Ocul Surf 12:112–119, 2014). The underlying cause of pterygia is thought to be secondary to UV light exposure and arid conditions. Patients should have been evaluated and deemed appropriate for such surgical intervention. Patients should have been educated about the risks and benefits of the procedure, including alternatives.

Glaucoma Drainage Device (Ahmed Valve FP-7)

Patients with scarred, friable, or otherwise compromised conjunctival tissue may benefit from use of a glaucoma drainage device, as their conjunctiva may not be viable for creation of a trabeculectomy bleb. The use of a glaucoma drainage device such as the Ahmed glaucoma valve (AGV) has been shown to offer immediate IOP control with low risk of complications.

Cataract Extraction, Femtosecond Laser Assisted

Patients should have been evaluated and deemed appropriate for such surgical intervention. Surgical indication for cataracts includes those that impair visual acuity, create visual disability, and affect activities of daily living or deemed medically necessary for monitoring or further surgical procedures. Patients should have been educated about the risks and benefits of the procedure, including alternatives.

Limbal Relaxing Incision

Limbal relaxing incisions (LRIs) are corneal incisions placed adjacent to the limbus, just anterior to the vascular arcade. They are used to relax the steep axis of corneal astigmatism, while steepening the flat axis (coupling effect). LRIs must be as accurate as possible to yield the best result. LRI is performed for correction of corneal astigmatism and may be performed during cataract surgery, post-cataract extraction, or post-PKP. Prior to LRI, confirmation of corneal astigmatism with manual keratometry, evaluation of corneal topography to identify irregular astigmatism, and pachymetry at sites of planned incision(s) to avoid corneal perforation should be performed. LRI has been proven to be a convenient, practical, and cost-effective way of managing astigmatism.