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H. Kaz Soong - One of the best experts on this subject based on the ideXlab platform.
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Diamond Burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions
Arquivos Brasileiros de Oftalmologia, 2008Co-Authors: Joao Baptista Nigro Santiago Malta, H. Kaz SoongAbstract:PURPOSE: To evaluate the efficacy and safety of Diamond Burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions. METHODS: A retrospective review of 23 eyes (23 patients). Pre- and postoperative visual acuities and refractions, slit-lamp biomicroscopic findings, and the incidence of recurrence of disease after keratectomy were studied. RESULTS: Nineteen eyes had map-dot-fingerprint basement membrane dystrophy and 4 had Salzmann's nodular degeneration. All patients presented with decreased vision, as well as varying degrees of glare, halos, and monocular diplopia. Postoperative follow-up ranged from 3 to 39 months (mean 10.6 months), and no recurrence of the original disease occurred within this period. This procedure improved the best-corrected visual acuity from 20/36 (LogMar 0.250) to 20/24 (LogMar 0.076) by LogMar statistical evaluation (p
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Diamond Burr superficial keratectomy in the treatment of visually significant anterior corneal lesions
Arquivos Brasileiros De Oftalmologia, 2008Co-Authors: Joao Baptista Nigro Santiago Malta, H. Kaz SoongAbstract:PURPOSE: To evaluate the efficacy and safety of Diamond Burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions. METHODS: A retrospective review of 23 eyes (23 patients). Pre- and postoperative visual acuities and refractions, slit-lamp biomicroscopic findings, and the incidence of recurrence of disease after keratectomy were studied. RESULTS: Nineteen eyes had map-dot-fingerprint basement membrane dystrophy and 4 had Salzmann's nodular degeneration. All patients presented with decreased vision, as well as varying degrees of glare, halos, and monocular diplopia. Postoperative follow-up ranged from 3 to 39 months (mean 10.6 months), and no recurrence of the original disease occurred within this period. This procedure improved the best-corrected visual acuity from 20/36 (LogMar 0.250) to 20/24 (LogMar 0.076) by LogMar statistical evaluation (p<0.001) and caused a statistically non-significant (p=0.232) myopic change in the mean refractive spherical equivalent (-0.36 diopter ± SD 2.28 preoperatively to -0.71 ± 2.26 postoperatively). Glare and monocular diplopia were subjectively reduced or eliminated in all patients. One patient had mild anterior stromal haze which decreased the bestcorrected visual acuity from 20/25 to 20/30. CONCLUSION: Diamond Burr superficial keratectomy appears to be an effective and safe method of removing visually-significant anterior corneal opacities.
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Diamond Burr superficial keratectomy for recurrent corneal erosions.
British Journal of Ophthalmology, 2002Co-Authors: H. Kaz Soong, Q Farjo, R F Meyer, A SugarAbstract:Aims: To evaluate the efficacy and safety of Diamond Burr superficial keratectomy in the treatment of recurrent corneal erosions. Methods: A retrospective review of 54 eyes (47 patients) with recurrent corneal erosions treated with Diamond Burr superficial keratectomy. Preoperative and postoperative visual acuities and refractions, slit lamp examination findings, and the incidence of recurrent erosion after keratectomy were studied. Specular microscopy was also performed in six patients before and after surgery. Results: 30 eyes had underlying map dot fingerprint anterior basement membrane corneal dystrophy, while 24 eyes did not. Postoperative follow up time ranged from 3 to 53 months (mean 12.3 months). Corneal erosion recurred in three eyes (6%) after Diamond Burr superficial keratectomy. This procedure improved the best corrected visual acuity from 20/26 to 20/22 by logMAR statistical evaluation (p=0.002) and caused very little change in the refractive spherical equivalent. No endothelial cell loss or changes in morphology were noted on specular microscopy. Conclusion: Diamond Burr superficial keratectomy appears to be an effective and safe method of treating recurrent erosions and is a good alternative therapy to needle stromal micropuncture, Nd:YAG induced epithelial adhesion, and excimer laser surface ablation.
Mario Ammirati - One of the best experts on this subject based on the ideXlab platform.
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Optic nerve surface temperature during intradural anterior clinoidectomy: a comparison between high-speed Diamond Burr and ultrasonic bone curette.
Neurosurgical review, 2014Co-Authors: Varun R. Kshettry, Xiaobing Jiang, Silky Chotai, Mario AmmiratiAbstract:Ultrasonic bone curettes are increasingly used in cranial base surgery. The heat generated by these devices during anterior clinoidectomy has not been evaluated. The purpose of this study was to compare the optic nerve surface temperature during intradural anterior clinoidectomy using the drill and ultrasonic bone curette. Ten fresh cadaver heads were used. During intradural clinoidectomy and optic nerve unroofing with either a 2-mm Diamond Burr drill or ultrasonic bone curette, temperature was measured along the medial cisternal and proximal intracanalicular segments of the optic nerve. Additional experiments were performed to determine optimal ultrasonic bone curette settings for anterior clinoidectomy. At the lateral cisternal segment, peak and mean temperature were significantly higher with the ultrasonic bone curette (peak 38.8 vs 29.3 °C, p = 0.03, mean 29.5 vs 22.6 °C, p = 0.003). At the proximal intracanalicular segment, only peak temperature was significantly higher with the ultrasonic bone curette (peak 32.0 vs 23.5 °C, p = 0.02, mean 26.9 vs 22.4 °C, p = 0.07). Using standard company settings, room temperature irrigation fluid was heated by the oscillating tip to peak temperature 36.1 °C without drilling. In order to maintain emitted irrigation fluid at room temperature, optimal settings were power 70 %, cool irrigation (5 °C) at 40 mL/min. Using these settings, the ultrasonic bone curette generated optic nerve surface temperature measurements similar to the drill. Further work is necessary to translate these findings into the operating room.
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Optic Nerve Surface Temperature during Intradural Anterior Clinoidectomy: A Comparison Between High-Speed Diamond Burr and Ultrasonic Bone Curette
Journal of Neurological Surgery Part B: Skull Base, 2014Co-Authors: Varun R. Kshettry, Xiaobing Jiang, Silky Chotai, Mario AmmiratiAbstract:Background: Ultrasonic bone curettes are increasingly used in cranial base surgery. The heat generated by these devices during anterior clinoidectomy has not been evaluated. Objective: To compare optic nerve surface temperature during intradural anterior clinoidectomy using the drill and ultrasonic bone curette. Methods: Ten fresh cadaver heads were used. During intradural clinoidectomy and optic nerve unroofing with either 2mm Diamond Burr drill or ultrasonic bone curette, temperature was measured along the medial cisternal and proximal intracanalicular segments of the optic nerve. Additional experiments were performed to determine optimal ultrasonic bone curette settings for anterior clinoidectomy. Results: At the medial cisternal segment, peak and mean temperature were significantly higher with the ultrasonic bone curette (peak 38.8 vs 29.3°C, p = 0.03, mean 29.5 vs 22.6°C, p = 0.003). At the proximal intracanalicular segment, only peak temperature was significantly higher with the ultrasonic bone curette (peak 32.0 vs 23.5°C, p = 0.02, mean 26.9 vs 22.4°C, p = 0.07). Using standard company settings, room temperature irrigation fluid was heated by the oscillating tip to peak temperature 36.1°C without drilling. To maintain emitted irrigation fluid at room temperature, optimal settings were amplitude 70%, cool irrigation (5°C) at 40mL/min. Using these settings, the ultrasonic bone curette generated optic nerve surface temperature measurements similar to the drill. Conclusion: Using standard company settings, the ultrasonic bone curette generates significantly higher temperatures at the optic nerve surface. Optimal ultrasonic bone curette settings were amplitude 70% with cool irrigation (5°C) at 40mL/min. Further work is necessary to translate these findings into the operating room.
David W Kennedy - One of the best experts on this subject based on the ideXlab platform.
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use of the 70 degree Diamond Burr in the management of complicated frontal sinus disease
Laryngoscope, 2004Co-Authors: Rakesh K Chandra, Rodney J Schlosser, David W KennedyAbstract:Objectives/Hypothesis: Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly Burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. Study Design: Retrospective review. Methods: The authors describe the use of a 70-degree Diamond Burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. Results: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing fronto-ethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). Conclusion: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree Diamond Burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches.
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Use of the 70‐Degree Diamond Burr in the Management of Complicated Frontal Sinus Disease
The Laryngoscope, 2004Co-Authors: Rakesh K Chandra, Rodney J Schlosser, David W KennedyAbstract:Objectives/Hypothesis: Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly Burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. Study Design: Retrospective review. Methods: The authors describe the use of a 70-degree Diamond Burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. Results: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing fronto-ethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). Conclusion: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree Diamond Burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches.
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Use of the holmium: yttrium aluminum garnet (Ho:YAG) laser for cranial nerve decompression: an in vivo study using the rabbit model.
The Laryngoscope, 1993Co-Authors: Riffat H. Qadir, David W KennedyAbstract:A study was designed to evaluate the utility and safety of the holmium:yttrium aluminum garnet (Ho:YAG) laser for precise bony decompression of neural canals. In vivo rabbit studies were performed to measure temperature changes and nerve degeneration which occurred when the facial canal was decompressed with the laser as compared to the Diamond Burr. Marked temperature elevations were noted with the laser (n = 4), but not with the Burr (n = 4). Seven of nine nerves decompressed with the laser revealed moderate to severe degeneration, whereas two control nerves decompressed with the drill demonstrated only minimal degeneration. It is concluded that this laser should not be used for nerve decompression unless better control of temperature elevation can be achieved.
Varun R. Kshettry - One of the best experts on this subject based on the ideXlab platform.
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Optic nerve surface temperature during intradural anterior clinoidectomy: a comparison between high-speed Diamond Burr and ultrasonic bone curette.
Neurosurgical review, 2014Co-Authors: Varun R. Kshettry, Xiaobing Jiang, Silky Chotai, Mario AmmiratiAbstract:Ultrasonic bone curettes are increasingly used in cranial base surgery. The heat generated by these devices during anterior clinoidectomy has not been evaluated. The purpose of this study was to compare the optic nerve surface temperature during intradural anterior clinoidectomy using the drill and ultrasonic bone curette. Ten fresh cadaver heads were used. During intradural clinoidectomy and optic nerve unroofing with either a 2-mm Diamond Burr drill or ultrasonic bone curette, temperature was measured along the medial cisternal and proximal intracanalicular segments of the optic nerve. Additional experiments were performed to determine optimal ultrasonic bone curette settings for anterior clinoidectomy. At the lateral cisternal segment, peak and mean temperature were significantly higher with the ultrasonic bone curette (peak 38.8 vs 29.3 °C, p = 0.03, mean 29.5 vs 22.6 °C, p = 0.003). At the proximal intracanalicular segment, only peak temperature was significantly higher with the ultrasonic bone curette (peak 32.0 vs 23.5 °C, p = 0.02, mean 26.9 vs 22.4 °C, p = 0.07). Using standard company settings, room temperature irrigation fluid was heated by the oscillating tip to peak temperature 36.1 °C without drilling. In order to maintain emitted irrigation fluid at room temperature, optimal settings were power 70 %, cool irrigation (5 °C) at 40 mL/min. Using these settings, the ultrasonic bone curette generated optic nerve surface temperature measurements similar to the drill. Further work is necessary to translate these findings into the operating room.
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Optic Nerve Surface Temperature during Intradural Anterior Clinoidectomy: A Comparison Between High-Speed Diamond Burr and Ultrasonic Bone Curette
Journal of Neurological Surgery Part B: Skull Base, 2014Co-Authors: Varun R. Kshettry, Xiaobing Jiang, Silky Chotai, Mario AmmiratiAbstract:Background: Ultrasonic bone curettes are increasingly used in cranial base surgery. The heat generated by these devices during anterior clinoidectomy has not been evaluated. Objective: To compare optic nerve surface temperature during intradural anterior clinoidectomy using the drill and ultrasonic bone curette. Methods: Ten fresh cadaver heads were used. During intradural clinoidectomy and optic nerve unroofing with either 2mm Diamond Burr drill or ultrasonic bone curette, temperature was measured along the medial cisternal and proximal intracanalicular segments of the optic nerve. Additional experiments were performed to determine optimal ultrasonic bone curette settings for anterior clinoidectomy. Results: At the medial cisternal segment, peak and mean temperature were significantly higher with the ultrasonic bone curette (peak 38.8 vs 29.3°C, p = 0.03, mean 29.5 vs 22.6°C, p = 0.003). At the proximal intracanalicular segment, only peak temperature was significantly higher with the ultrasonic bone curette (peak 32.0 vs 23.5°C, p = 0.02, mean 26.9 vs 22.4°C, p = 0.07). Using standard company settings, room temperature irrigation fluid was heated by the oscillating tip to peak temperature 36.1°C without drilling. To maintain emitted irrigation fluid at room temperature, optimal settings were amplitude 70%, cool irrigation (5°C) at 40mL/min. Using these settings, the ultrasonic bone curette generated optic nerve surface temperature measurements similar to the drill. Conclusion: Using standard company settings, the ultrasonic bone curette generates significantly higher temperatures at the optic nerve surface. Optimal ultrasonic bone curette settings were amplitude 70% with cool irrigation (5°C) at 40mL/min. Further work is necessary to translate these findings into the operating room.
Stephen J. Vincent - One of the best experts on this subject based on the ideXlab platform.
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Superior Perilimbal Epitheliopathy in Recurrent Corneal Erosion Syndrome.
Cornea, 2015Co-Authors: Kathrin Rac, Graham A. Lee, Stephen J. VincentAbstract:Purpose: To highlight the finding of occult areas of poor epithelial adhesion in the superior perilimbal cornea in a minority of patients with recalcitrant recurrent corneal erosion syndrome presenting with corneal erosion elsewhere on the corneal surface. Patient Population: Thirty-one eyes of 31 consecutive patients with corneal erosion undergoing mechanical debridement of the epithelium before Diamond Burr keratectomy for recurrent corneal erosion. Methods: Thirty-one eyes of 31 consecutive patients with recurrent corneal erosion were examined for poor epithelial adhesion determined by mechanical debridement with a dry microsponge. Results: During debridement, 8 of 31 eyes (25.8%) displayed a large arcuate area of occult dysfunction of adhesion in the superior perilimbal area. None of these eyes showed recurrence over a mean of 18 months after Diamond Burr keratectomy (95% confidence interval, 0%-36.9%). Conclusions: Mechanical debridement with a microsponge identified a significant minority of patients with poor adhesion in the superior perilimbal cornea away from the area of obvious erosion and increased the target area for Diamond Burr keratectomy. This 2-pronged approach allowed successful management of this group.