Modified trabeculectomy/trabeculotomy with no-stitch cataract surgery.

This study combined a modified trabeculectomy and trabeculotomy with no-stitch cataract surgery as a safe and effective combined surgical procedure for cataracts and glaucoma. One hundred consecutive patients were followed for a minimum of three months to a maximum of three years, between July 1991 and September 1994. We found the procedure to be effective in controlling intraocular pressure and restoring vision while eliminating the occurrence of flat anterior chambers.

Anterior periocular anesthesia: five years experience.

Safe, effective administration of local anesthesia prior to ocular surgery is a primary concern of ophthalmologists and variations in the technique and method of delivering anesthesia have been developed. Retrobulbar anesthesia, although considered safe and effective, can have serious complications. Using periocular anesthesia eliminates some of the more serious complications associated with retrobulbar injections while still providing excellent anesthesia and akinesia. Results of over 3,600 periocular injections using the technique described are reported.

Administration of periocular anesthesia.

In a study of over 650 patients having ocular surgery, administration of periocular anesthesia prior to the procedure has proven to be safer than retrobulbar anesthesia and equally effective. In addition, periocular anesthesia can be administered by a nonophthalmologist and allows greater ease in performing the surgery.

Topical anesthesia using the Bloomberg SuperNumb Anesthetic Ring.

Advances in phacoemulsification and self-sealing wound construction have made topical anesthesia an effective and reliable method of obtaining ocular anesthesia. It has many advantages over the traditional retrobulbar or peribulbar technique. I have performed more than 1800 cases of phacoemulsification and posterior chamber intraocular lens implantation through a 3 mm, self-sealing, corneal tunnel incision with topical anesthesia and the use of the Bloomberg SuperNumb Anesthetic Ring. This article presents the procedure. Results show the benefits of topical anesthesia and the anesthetic ring, including elimination of the risks of globe penetration, retrobulbar hemorrhage, respiratory depression, intradural or subarachnoid injection, ptosis, and diplopia, as well as instant return of vision.

Initial experience with the HydroSonics instrument to soften cataracts before phacoemulsification.

An ultrasonically driven needle placed into the body of the nucleus, with subsequent injection of balanced salt solution (BSS), can be used to fragment the nucleus into sections or lamellae that can potentially be emulsified with greater ease and less ultrasound energy delivered to the eye. This separation of the nucleus has been designated hydrodelineation. The six surgeons participating in this study subjectively reported that the use of hydrodelineation facilitated phacoemulsification, on average, in 91% of their cases. Review of study data indicated that significantly less ultrasound time and cumulative displayed energy were noted in phacoemulsification of grade 2+ and 3+ cataracts after hydrodelineation than in cases in which hydrodelineation was not performed. The results in cases performed with and without hydrodelineation were statistically equivalent in complications and postoperative patient outcomes.

The importance of social interaction: a new perspective on social epidemiology, social risk factors, and health.

Social epidemiology research has provided persuasive evidence of the link between the social environment--especially socioeconomic status--and health outcomes, but has failed to identify underlying mechanisms that might account for the association. The research may have been limited to date by its reliance on traditional epidemiological methods that emphasize a search for specific causal factor-disease relationships. It is time to take the research evidence and recast it to find practical solutions. We argue that the human development perspective supplies a framework for understanding the critical interaction between elements of social environment and health: Analyzing the social epidemiological research from this perspective can help to explain why and how the most potent factor, socioeconomic status, affects health outcomes. Equally important, this alternative perspective also presents health education practice implications.