Aim: To evaluate the prevalence of clinical asymptomatic retinal detachment (ARD) in myopic population. Methods: A retrospective study including all myopic individuals who underwent ophthalmic evaluation prior to excimer laser procedures at the Hadassah Center for Refractive Surgery between March 2002 and March 2006. Medical records were reviewed to extract demographics and refraction, and to identify patients who were diagnosed as having asymptomatic retinal detachment. Results: Data were collected on 6547 myopic individuals (12 815 eyes); of these, 2907 (44.4%) were males, and 3640 (55.6%) were females. The mean age was 31.5 (SD 10) years (range 18–64 years). The mean preoperative spheric equivalence was −4.42 (2.07) (range −0.75 to −16.00). The mean best spectacle-corrected visual acuity was 20/20 (range 20/32 to 20/12.5). Five eyes (0.039% or one of approximately 2563 eyes) of four patients had clinical ARD which was diagnosed during the routine preoperative examination. Three eyes underwent successful scleral buckling procedure while two patients were lost to follow-up. Conclusions: Clinical asymptomatic retinal detachment is uncommon, accounting for a minority of retinal detachments in myopes, and may be diagnosed during routine ophthalmoscopy prior to a refractive procedure.

Using a digital image processing method I demonstrate that a reading from 1833 of the month-line of the Gothic calendar is incorrect. According to that reading, the line includes the word Naubaimbair 'November', in addition to fruma jiuleis I-.(.). In this article I endeavour to demonstrate that there is no Naubaimbair in the original manuscript.

Purpose: To evaluate postoperative astigmatism after the use of Mersilene and nylon sutures for penetrating keratoplasty.Methods: Two groups of 12 patients each (age, 20-50 years) suffering from keratoconus underwent penetrating keratoplasty. Continuous suturing combined with 12 interrupted sutures was used in each case: Mersilene 11-0 sutures were used in group 1, whereas nylon 10-0 sutures were used in group 2. Sutures were removed to control astigmatism when required. All patients were monitored for 36 months.Results: During the follow-up period, sutures were removed in each eye as indicated by astigmatism or breakage. In group 1 (Mersilene 11-0 sutures), no breakage of sutures was recorded. In group 2 (nylon 10-0 sutures), breakage of sutures was recorded in 11 of 12 cases. However, continuous sutures were removed in 2 patients in group 2. After the first year, the astigmatism remained within +/- 1.00 diopter in all except 1 patient in group 1 and in 5 patients in group 2. No suture-related complications were recorded except for scarring with photophobia in 1 patient in group 1 and suture breakage in 11 eyes in group 2.Conclusion: Mersilene sutures can provide a stable postoperative astigmatism, whereas nylon sutures have a tendency to break and cause changes in corneal astigmatism.

Aim: To evaluate long term complications after pterygium excision with mitomycin C (MMC) application. Design: Prospective non-comparative interventional case series. Participants: Ninety nine patients who underwent pterygium surgery and participated in a controlled study for efficacy of MMC for pterygium surgery between 1989 and 1994. Methods: Patients who were located and agreed to come for examination underwent a complete eye examination. The bare sclera area, in particular, was examined for possible complications. The main outcome measures were anatomical findings in area of MMC application. Results: Forty three eyes of 43 patients were examined. Sixty three per cent of patients had pterygium surgery with intraoperative application of 0.02% MMC for 5 minutes and 37% of patients received MMC 1% or 2% drops four times daily for 2 weeks postoperatively. In three patients, pterygium recurred within 18 months. The only complication was mild conjunctival avascularity in areas of pterygium excision in 30% of patients. Conclusion: Long term evaluation revealed that the use of MMC in pterygium surgery is safe, but for a strict selection of patients, controlled use of MMC and long term follow up are required.

Purpose: To evaluate the long-term effects of intraoperative application of mitomycin C on the scleral thickness and the conjunctival epithelium at the surgical site of pterygium excision.Design: Prospective observational case series.Participants: Twenty-four patients who underwent excision of primary pterygium with intraoperative mitomycin C in our department during the year 1996.Methods: Patients were evaluated by slit-lamp biomicroscopy, impression cytology, and high-frequency ultrasonography. Impression cytology was performed by applying a small nitrocellulose filter paper for a few seconds at the excision area and for a few seconds at the opposite perilimbal area, and subjecting the specimens to the periodic acid-Schiff-Gill modified Papanicolaou staining protocol. The morphology of the conjunctival epithelium and goblet cell density (GCD) were recorded. High-frequency ultrasound was performed at the same sites, and the scleral thickness was measured at a distance of 1 mm from the limbus.Main Outcome Measures: Goblet cell density, conjunctival epithelial morphology, and the scleral thickness at the operated and nonoperated sites.Results: All patients had successful pterygium removal with no corneal recurrence after a mean follow-up of 77.2 +/- 3.9 months (range, 72-84). Impression cytology revealed normal nongoblet conjunctival epithelial cells at the excision area, with a 4-fold decrease in the GCD at the excision area when compared with the contralateral nonoperated site (296 +/- 120 cells/mm(2) and 1183 +/- 310 cells/mm(2), respectively; P = 0.0036). No differences were noted between the scleral thicknesses at the operated site (750 +/- 70 m) and the opposite site (740 +/- 80 mum) (P = 0.84).Conclusions: A single application of mitomycin C after pterygium excision is not associated with reduction in scleral thickness more than 6 years postoperatively. The conjunctival epithelium retains its normal phenotype, with a marked reduction of the GCD. (C) 2004 by the American Academy of Ophthalmology.

PURPOSE:To evaluate the efficacy, safety, and predictability of hyperopic laser in situ keratomileusis (H-LASIK). SETTING:Departments of Ophthalmology, Hadassah University Hospital, Jerusalem, and Assaf Harofeh Medical Center, Zerifin, Israel. METHODS:This prospective noncomparative case series studied the results of H-LASIK in the first 92 consecutive eyes of 50 patients with up to +10.25 diopters (D) of hyperopia. For analysis, the patients were divided into 3 groups based on preoperative hyperopia: low hyperopia (< +3.00 D), moderate hyperopia (> or = +3.00 to 6.00 D), and high hyperopia (> or = +6.00 D). RESULTS:Forty-two patients, 77 eyes (83.7%), were followed for at least 12 months. At 12 months, the mean manifest spherical equivalent was +0.33 +/- 0.65 D (93.1% of eyes within +/-1.0 D of the intended correction) in the low myopia group, +0.21 +/- 0.60 D (92.3% within +/-1.0 D of the intended correction) in the moderate hyperopia group, and +1.62 +/- 1.50 D (36.4% within +/-1.0 D of the intended correction) in the high hyperopia group. The uncorrected visual acuity (UCVA) was 20/40 or better in all eyes (100%), 24 eyes (92.3%), and 13 eyes (59.1%) in the low, moderate, and high hyperopia groups, respectively. Comparing the UCVA at the last examination with the best corrected visual acuity (BCVA) before surgery in all patients showed that 59 eyes (76.6%) were within +/-1 line and 18 eyes (23.4%) were within +/-2 or more lines of the preoperative BCVA. Three eyes (3.9%) in the high hyperopia group lost 2 or more lines of BCVA. Three eyes (3.9%) had flap- related complications. Eight patients (15 eyes) with a follow-up less than 12 months did not have intraoperative or postoperative complications. CONCLUSION:Laser in situ keratomileusis was a safe, effective, and predictable procedure for hyperopia up to +6.0 D and less predictable for higher hyperopia.

PURPOSE:To report our experience in preventing diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) by wiping the microkeratome blade with sterile 100% alcohol. SETTING:Enaim Refractive Surgery Center, Jerusalem, Israel. METHODS:Laser in situ keratomileusis was performed in 24 patients (48 eyes) on the same day by the same surgeon. The environment and instruments were identical in all cases. A new blade was used in both eyes of each patient. All blades were from the same batch and were randomly assigned to 2 groups. In the alcohol group, 12 blades were wiped with a Merocel surgical spear (Medtronic Solan) dipped in 100% alcohol and rinsed with balanced salt solution (BSS) before they were mounted in a Hansatome microkeratome (Bausch & Lomb Co.); in the control group, 12 blades were wiped with a Merocel surgical spear dipped in BSS and rinsed with BSS. All patients were examined on the first postoperative day. RESULTS:Grade I to II DLK was diagnosed in 7 eyes of 4 patients in the control group (29%). No DLK was diagnosed in the alcohol group. CONCLUSION:Wiping the microkeratome blade with 100% alcohol before mounting may remove a substance from the manufacturing or sterilization process that can cause DLK.

The panel on affect was presented in the Spring 2001 Meeting of Division 39 (Psychoanalysis) of the American Psychological Association. Judith Levene and Kenneth Barish presented a theoretical framework and clinical experiences indicating how their work attempts to facilitate affect regulation. David Landau discussed several similar qualities shared in these papers.

PURPOSE:To report the outcome of uncomplicated removal of corneal foreign bodies in patients who previously underwent laser in situ keratomileusis (LASIK).METHODS:Nine eyes of eight patients presented with corneal foreign bodies after LASIK.RESULTS:In three patients, diagnosis of corneal foreign bodies was delayed due to reduced pain and symptoms. Removal of foreign bodies was performed with no flap-related complications. Corneal wound healing was normal. Final visual acuity was not decreased.CONCLUSION:Corneal foreign bodies can be removed safely and effectively from corneas after LASIK.

AIM:To evaluate the potential of the retinal thickness analyser (RTA) as an objective tool for assessment and follow up of diabetic macular oedema. METHODS:A prototype of the RTA that operates on the principle of laser slit biomicroscopy was used. Retinal thickness was obtained in 41 eyes of 41 diabetic patients. The clinical diagnosis was cystoid macular oedema (CMO) in 10 eyes, clinically significant macular oedema (CSMO) without retinal cysts in 21 eyes, and "dry" macula following grid pattern laser treatment in 10 eyes. The control group consisted of 46 eyes of age matched healthy volunteers. RESULTS:In normal eyes (46 eyes), the foveal thickness measured was 178 (SD 44) microns and the macular thickness around the fovea was 311 (51) microns. The eyes with CMO displayed the largest foveal thickening, 875 (287) microns (390% increase compared with normal values). The average thickness of the fovea in the non-cystoid CSMO group was 427 (175) microns (144% increase compared with normal fovea). The average thickness of the foveal centre in eyes judged as having "dry" macula after laser treatment was 315 (71) microns (77% increase compared with normal value and a 26% decrease in thickness compared with the CSMO eyes). Statistically significant differences were found in central thickness between these four groups (p = 0.0001). The average thickness at 500 microns surrounding the fovea was 566 (202) microns in the CSMO eyes compared with 311 (51) microns in normal eyes (80% increase). The "dry" macula group (after undergoing laser treatments) had an average thickness of 414 (94) microns (27% decrease compared with CSMO eyes and a 33% increase compared with eyes of healthy controls). CONCLUSIONS:RTA is a system for quantifying macular thickness and imaging of macular pathology. The system can be a useful tool for diagnosis of macular diseases and for evaluation of the effect of treatment modalities.

Purpose: To study the relationship between exudative age-related macular degeneration and diabetic retino-pathy and assess the influence of retinal laser photo-coagulation for diabetic retinopathy on the occurrence of exudative age-related macular degeneration. Methods: Two groups, one of diabetic retinopathy patients treated with laser and the other of non-laser-treated diabetic retinopathy patients, were studied by means of fundoscopy and fluorescein angiography for the presence of exudative age-related macular degeneration. Results: Exudative age-related macular degeneration was not observed in 431 patients treated with laser photocoagulation, and was diagnosed in 3.3% of 151 non-laser-treated patients. Conclusion: Patients treated by laser photocoagulation for diabetic retinopathy are less prone to develop the exudative form of age-related macular degeneration.