John F. Liu

A Comparison of Corneal Endothelial Changes After Use of Healon or Viscoat During Phacoemulsification

We conducted a prospective, randomized trial comparing the endothelial protective effects of Healon (Kabi Pharmacia Ophthalmics, Inc., Monrovia, California) and Viscoat (Alcon Surgical, Inc., Ft. Worth, Texas) in 59 eyes of 59 patients undergoing iris-plane or posterior-chamber phacoemulsification with posterior-chamber lens implantation. We evaluated postoperative central and superior changes in corneal thickness and corneal endothelial cell density, coefficient of variation in cell size, and percentage of hexagons. In the overall series, at one day postoperatively, corneal thickness increased 17% centrally and superiorly in eyes receiving Healon compared to 12% centrally and 11% superiorly in eyes receiving Viscoat (P < .05). Sixteen weeks postoperatively, superior endothelial cell loss was 11.6% in eyes receiving Healon compared to 2.1% in eyes receiving Viscoat (P < .01). In the iris-plane phacoemulsification group, superior cell loss at week 16 was 13.8% in eyes receiving Healon and 0.5% in eyes receiving Viscoat (P < .04). In the posterior-chamber phacoemulsification group, there were no significant differences between the Healon and Viscoat subgroups. Comparing the surgical techniques, in the Healon group, central cell loss at week 16 was 13.8% in the iris-plane phacoemulsification subgroup and 0.6% in the posterior-chamber phacoemulsification subgroup (P < .03), and coefficient of variation in cell size increased 3.7% in the iris-plane subgroup and decreased 6.8% in the posterior-chamber subgroup (P < .04). In the Viscoat group, there were no significant differences between surgical techniques at week 16. Viscoat provided greater corneal endothelial protection than Healon during iris-plane phacoemulsification. In eyes receiving Healon, posterior-chamber phacoemulsification resulted in less corneal endothelial trauma than the iris-plane technique.

Multilamellar hydrodissection in phacoemulsification and planned extracapsular surgery

ABSTRACT Multilamellar hydrodissection is the injection of balanced salt solution into multiple lamellae of the lens, cleaving it into a small nucleus and multiple layers of cortex. In phacoemulsification, the smaller nucleus reduces phacoemulsification time, and the thicker bed of cortex provides greater protection for the posterior capsule. In extracapsular extraction, the smaller nucleus can be more readily extracted, which is particularly advantageous when capsulorhexis is performed. Creation of multiple cortical lamellae facilitates their aspiration, either with the phacoemulsification or irrigation/aspiration tips. Multilamellar hydrodissection increases the predictability and safety of phacoemulsification and planned extracapsular cataract extraction.

Survey of the clinical use of glare and contrast sensitivity testing

ABSTRACT In August 1988, we surveyed a random 10% sample of the members of the American Society of Cataract and Refractive Surgery about their use of contrast sensitivity and glare testing. Of 396 surveys mailed, 214 were returned for a response rate of 54.3%. Thirty‐six percent of respondents used glare testing alone; 5.6% used contrast sensitivity testing alone; 23.4% used both test modalities; 35% used neither. The most common uses of glare and contrast sensitivity testing were to evaluate visual function in patients who have cataracts, secondary cataracts, and/or intraocular lens problems.

Complications of implanting three-piece C-loop posterior chamber lenses in the anterior chamber

We have examined a total of four eyes in three patients who had undergone implantation of three-piece C-loop posterior chamber intraocular lenses into the anterior chamber. All four eyes exhibited four or more of the following complications: 1) loop encapsulation by peripheral anterior synechiae; 2) recurrent iritis; 3) central loop displacement with corneal endothelial touch; 4) progressive endothelial cell loss and corneal edema; 5) glaucoma; and 6) cystoid macular edema. Intraocular lens removal was required in all four eyes, and penetrating keratoplasty was performed in one. We believe that these complications are attributable to the inherent fallacies of fixating three-piece open-loop lenses in the anterior chamber angle.

The intraocular penetration of acyclovir after subconjunctival administration

Five patients received a subconjunctival injection (25 mg) of acyclovir before undergoing scheduled enucleation. Seven hours after injection, the observed aqueous and vitreous levels of acyclovir were above the minimum inhibitory concentrations for many herpes simplex viruses types 1 and 2. Systemic absorption measured at two and seven hours after injection was negligible.

Like the eye of the tiger: Inpatient Psychiatric facility exclusionary criteria and its “Knockout” of the emergency psychiatric patient

Context: Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first “medically clear” the patient as stable for transfer. At present, there is no interdisciplinary consensus regarding the necessary elements of the medical clearance or stability assessment process. In addition to satisfy the vague requirement for medical clearance, the EP must abide by the rules of the inpatient facilities before his/her patient is accepted. Settings and Design: This manuscript summarizes the admission exclusionary criteria of inpatient psychiatric units in the Houston–Galveston metro area. Subjects and Methods: we pooled the exclusionary criteria of all the facilities patients with mental illness can be sent to in the Houston-Galveston metropolitan area, and divided those criteria by categories. Results: Pooled exclusionary criteria congregate into 1. preexisting or current medical condition and capabilities (e.g. hypertensive urgency, pregnancy, acute alcohol intoxication), 2. exclusionary criteria related to administrative burdens that may impact staffing or require advanced equipment/training e.g. autism spectrum disorders, intellectual disabilities, respiratory isolation or daily hemodialysis, 3. laboratory and ancillary testing required by inpatient facilities before acceptance of the patient. Conclusions: Of the inpatient units in the Houston-Galveston area, facilities lack a unified staffing model, ancillary services, but the various challenges (e.g., limited staffing and ancillary services) and different skills offered (e.g., geriatric care) are reflected in exclusionary criteria in a partially overlapping, but not fully uniform, way. The variation in number and kinds of exclusionary criteria further complicate the admission process and often serve as a bottleneck in the securing an inpatient bed.

Complications of Implanting Three-Piece C-Loop Posterior Chamber Lenses in the Anterior Chamber

We have examined a total of four eyes in three patients who had undergone implantation of three-piece C-loop posterior chamber intraocular lenses into the anterior chamber. All four eyes exhibited four or more of the following complications: 1) loop encapsulation by peripheral anterior synechiae; 2) recurrent iritis; 3) central loop displacement with corneal endothelial touch; 4) progressive endothelial cell loss and corneal edema; 5) glaucoma; and 6) cystoid macular edema. Intraocular lens removal was required in all four eyes, and penetrating keratoplasty was performed in one. We believe that these complications are attributable to the inherent fallacies of fixating three-piece open-loop lenses in the anterior chamber angle.