Hugh Beckman

Carbon Dioxide Laser Surgery of the Eye and Adnexa

A carbon dioxide laser which functions in both rapid superpulsed and continuous wave mode for use in ophthalmic surgery is described. Rapid superpulsed mode was found more effective in the creation of trabeculectomy-like procedures in glaucomatous human eyes with satisfactory results in 12 of 14 eyes treated. Continuous wave energy was found to be superior when full thickness eye wall resection was performed. The carbon dioxide laser was found to be effective in hemostatic resection and ablation of skin lesions about the eye. Rapid superpulse was found to be more effective when puckering and tissue loss were to be minimized, while continuous wave was found to be effective when shrinkage of tissue, as in the performance of a Ziegler cautery type repair for ectropion, was preferred. Rapid superpulse was found to be more controllable in experimental phacovaporization in cats with anterior capsulotomy being easily performed. Continuous wave was found to be a more efficacious modality for corneal shrinkage although attempts at present to create permanent corneal alterations have been fruitless.

Transscleral Ruby Laser Cyclocoagulation

During a ten-year period, we treated 241 eyes by transscleral ruby laser cyclocoagulation. Each eye had a minimum follow-up of six months. The average was 24 months and the range was six to 92 months. Using a criterion for success of intraocular pressure between 5 and 22 mm Hg, we achieved an overall success rate of 62% (150 of 241 eyes). This success rate varied from 86% for aphakic open-angle glaucoma (32 of 37 eyes) to 53% for neovascular glaucoma (72 of 135 eyes). Most eyes with useful vision preoperatively maintained these levels. Chronic hypotony (41 eyes) and phthisis (17 eyes) were the most frequent complications, although phthisis was common only in the neovascular glaucoma group (13 eyes). The visual results are more favorable and the need for retreatment and postoperative medications is less than with cyclocryotherapy, and postoperative discomfort is considerably reduced.

Carbon Dioxide Laser Scleral Dissection and Filtering Procedure for Glaucoma

A comparison of eye bank eyes using continuous wave or rapid superpulsed carbon dioxide laser energy indicated that rapid superpulsed was the superior modality for scleral dissection, because there is less charring and puckering of tissue. The results of filtering procedures in five glaucomatous eyes by using rapid superpulsed carbon dioxide energy to perform the scleral dissection revealed the possible advantages of performing the procedure this way might be: (1) the technical ease by which the microdissection is performed under direct microscopic observation with the absence of blood or instruments in the field; (2) the safety factor of never having penetrated into the anterior chamber with a sharp instrument; (3) the possible advantage of the inhibition of healing at the wound margin because of coagulation of tissue at the wound edge by the laser beam; and (4) the bacteriocidal effect of thermal cutting.

Anterior Segment Metastases from an Ovarian Choriocarcinoma

A 28-year old woman with ovarian choriocarcinoma developed a uveitis in her left eye. Subsequently, a mass was observed in the anterior segment of that eye together with a subconjunctival mass that appeared to extend from it. Biopsy of the subconjunctival nodule showed two different cell types consistent with the cytotrophoblastic and syncytiotrophoblastic elements typical and choriocarcinoma. No abnormalities of the posterior segment were found on careful examination. Treatment consisted of systemic chemotherapy with a variety of therapeutic agents, argon laser photocoagulation of tumor seedings in the anterior chamber angle, radiation to the eye, and finally, subconjunctival injections of methotrexate. The eye became blind and painful and was enucleated. Histopathologic examination revealed residual tumor cells in the anterior segment indicating treatment changes, but there were no abnormalities posteriorly. Choriocarcinoma metastatic to the eye has been reported infrequently, and this is the first case in which anterior segment metastases have been observed and the effects of treatment thoroughly documented.

Bending of Excessively Long Intraocular Suture Material by Argon Laser

Excessively long nylon or polypropylene sutures can cause corneal edema. Kinking the material back on itself with an argon laser allows it to clear the surface of the cornea. Of seven patients who were successfully treated by this method, none suffered complications.

Specialized argon laser delivery and treatment of facial telangiectasia

Essential telangiectasia is an idiopathic condition of capillary dilitation. Previous methods of treatment have been generally ineffective and have led to significant scarring in some cases. The application of the argon laser with a new appropriate delivery system has led to the ability to effectively treat this cosmetic problem without significant sequellae.Essential telangiectasia is an idiopathic condition of capillary dilitation. Previous methods of treatment have been generally ineffective and have led to significant scarring in some cases. The application of the argon laser with a new appropriate delivery system has led to the ability to effectively treat this cosmetic problem without significant sequellae.

The scanning laser ophthalmoscope: A new diagnostic tool

A new ophthalmic instrument that has been recently developed is the scanning laser ophthalmoscope. The superiority of this instrument compared to standard ophthalmoscopy lies in three major aspects; 1) the coherency of laser light, 2) lower light levels, and 3) the ability to directly present visual stimuli to the eye under study, while observing the retina and the stimuli.A new ophthalmic instrument that has been recently developed is the scanning laser ophthalmoscope. The superiority of this instrument compared to standard ophthalmoscopy lies in three major aspects; 1) the coherency of laser light, 2) lower light levels, and 3) the ability to directly present visual stimuli to the eye under study, while observing the retina and the stimuli.