Iris-fixated toric phakic intraocular lens: Three-year follow-up

Purpose To evaluate the 3-year safety, efficacy, predictability, and stability of iris-fixated toric phakic intraocular lens (pIOL) implantation for the correction of myopia or hyperopia with astigmatism. Setting Department of Ophthalmology, Johannes Gutenberg University, Mainz, and Department of Ophthalmology, University Clinic, Bochum, Germany. Methods A prospective clinical trial of 40 eyes of 23 patients with high ametropia and astigmatism was conducted. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, refraction, astigmatism, intraocular pressure, slitlamp biomicroscopy, and indirect ophthalmoscopy were measured preoperatively and postoperatively. Results Of t…

Changes in higher-order aberrations after implantation of a foldable iris-claw lens in myopic phakic eyes

Purpose To evaluate the change in higher-order aberrations (HOAs) after implantation of a foldable iris-claw phakic intraocular lens (pIOL) in myopic eyes. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods This prospective nonrandomized comparative self-controlled trial included 41 eyes that had implantation of a foldable iris-claw pIOL between July 2003 and November 2004. All patient data for HOAs (Zernike coefficient) were measured and calculated using the same pupil size preoperatively and postoperatively, and the root-mean-square (RMS) wavefront error was calculated. Examinations were performed preoperatively as well as 1 week and 3, 6, and 12 m…

Viscoelastics: Medical Device or Drug

In § 2 of the German Drug Laws (AMG, Arzneimittelgesetz), it is determined that such materials that fall under the heading of medicinal products (MPG, Medizinproduktegesetz, 1994) are not drugs in the AMG sense of the word. MPG medicinal products, as defined in §3 are those substances whose main effect is neither pharmacological, immunological, nor metabolic.

Epidemiological evaluation of intraoperative antibiosis as a protective agent against endophthalmitis after cataract surgery.

PURPOSE To evaluate risk factors for endophthalmitis after cataract surgery and to retest recent findings on the protective effect of intraoperative antibiosis and the promoting effect of the clear corneal as compared to sclerocorneal incision. DESIGN Survey study. PARTICIPANTS Five hundred thirty-eight ophthalmosurgical centers in Germany. MAIN OUTCOME MEASURE Responder specific endophthalmitis incidence. RESULTS A total of 310 (58%) questionnaires were computed resulting in an overall count of 404 356 cataract surgeries and 291 self-reported endophthalmitis cases (crude rate 0.072%). The risk of postoperative endophthalmitis for sclerocorneal versus clear corneal incisions was not signifi…

The "sandwich technique" for iris-fixated phakic intraocular lens implantation.

ABSTRACT PURPOSE: To describe a new technique of implantation of the Artisan/Verisyse phakic intraocular lens (PIOL). METHODS: After PIOL insertion into the anterior chamber, a bolus of a high viscosity ophthalmic viseosurgical device (OVD) is placed over the optic, separating it widely from the endothelium. RESULTS: The technique decreases the chance of endothelial damage during enclavation. CONCLUSIONS: A bolus of a high viscosity OVD placed on the anterior surface of the Artisan/Verisyse PIOL may make enclavation safer. [J Refract Surg. 2006;22:96-98.]

Optical coherence tomography of macular thickness after biaxial vs coaxial microincision clear corneal cataract surgery

PURPOSE To evaluate macular thickness changes after biaxial microincision versus coaxial small incision cataract surgery using optical coherence tomography (OCT). METHODS This prospective, randomized, marked study comprised 70 patients (70 eyes) undergoing biaxial microincision surgery or conventional coaxial phacoemulsification. Patients were evaluated by Stratus OCT preoperatively and 1 day, 4 weeks, and 8 weeks postoperatively. Best-corrected visual acuity (BCVA), phacoemulsification power, and effective phacoemulsification time (EPT) were evaluated. RESULTS In the biaxial group, median foveal thickness changed from 160 microm preoperatively to 168 microm 8 weeks postoperatively (p=0.018…

Oxidative tissue damage after phacoemulsification: influence of ophthalmic viscosurgical devices.

To quantify the oxidative tissue damage after phacoemulsification, correlate the damage to the energy applied, and investigate the influence of ophthalmic viscosurgical devices (OVDs).Department of Ophthalmology, University of Mainz, Mainz, Germany.The study comprised 130 eyes operated on by 1 surgeon using the same phacoemulsification machine. Some eyes received an OVD before phacoemulsification and some did not. Energy values were expressed as phaco time; that is, ultrasound (US) time (seconds) after conversion to 100% phaco power. Patients were grouped as follows: Group 1, phaco time less than 20 seconds and no OVD; Group 2, phaco time 20 to 40 seconds and no OVD; Group 3, phaco time mor…

Incisional Keratotomy to Toric Intraocular Lenses: An Overview of the Correction of Astigmatism in Cataract and Refractive Surgery

Healon®5: A New Viscoadaptive Formulation

To relate the practical relevance of our study results, specific requirement profiles for individual procedures have been correlated to the desired physicochemical characteristics. Healon®5 demonstrated the statistically significant highest zero shear viscosity of all OVD and a long relaxation time (Dick et al., 2000). It therefore most effectively creates and maintains a deep anterior chamber in order to facilitate safe surgical maneuvers (e.g., in case of vitreous pressure). Additionally, the high viscosity of Healon®5 exhibits a dynamic frequency dependence, which has not been observed in any pure hyaluronic acid formulation before. Healon®5’s properties change in response to surgical ma…

Closed foldable capsular rings

A new foldable capsular tension and bending ring system with a sharp-edged design is described. The closed foldable capsular rings (CFCR) consist of 8 hydrophobic and 8 hydrophilic ring segments. The CFCRs have a 9.2 mm minimum overall diameter. The CFCRs were inserted using various cartridge systems or a two-folded technique with a forceps. The CFCRs were implanted after phacoemulsification through a small (1.6 to 3.2 mm) incision in 104 human adult eyes without intraoperative complications. No postoperative complications such as capsule folds or inward bending were observed over a 6-month follow-up. Posterior capsule opacification was minimal or absent in all eyes.

Endophthalmitis in cataract surgery

Abstract Objective To document perioperative prophylactic treatment and to evaluate the risk factors for endophthalmitis after cataract surgery. Design Cross-sectional study via anonymous survey. Participants Four hundred sixty-nine centers in Germany were queried. Results A total of 311 (67%) questionnaires were received, with each center reporting an average of 900 cataract surgeries per year (total, 340,633 surgeries in 1996). Respondents reported a total of 267 cases of endophthalmitis, which resulted in a mean responder-specific endophthalmitis rate of 0.148% versus a median rate of 0%. Statistical analysis via Poisson regression suggested that sclerocorneal incisions were associated w…

Refraktiver Nutzen und inkrementelle Kosten der LASIK: Ergebnisse einer Kosten-Nutzen-Studie an zwei universitären LASIK-Zentren

BACKGROUND No data is available to date on the cost effectiveness of laser in situ keratomileusis (LASIK) with regard to the German-speaking health care system. Hence we compared the clinical outcome and cost data of two German LASIK centres in respect of procedure cost effectiveness from the patient perspective. MATERIAL AND METHODS A retrospective cohort study was implemented at the University Hospitals of Mainz and Mannheim. Data on refractive outcome were obtained from the LASIK centres' patient documentation, cost data on the surgery as well as on eyeglasses etc. before and after the surgery were obtained from patient interviews. The primary endpoint of this investigation was the indiv…

Postoperative astigmatism and rotational stability after Artisan toric phakic intraocular lens implantation

Abstract Purpose To evaluate deviations in the axis (intended versus achieved) and postoperative astigmatism after implantation of an Artisan toric phakic intraocular lens (IOL). Setting University Eye Hospital, Mainz, Germany. Methods This prospective study comprised 29 eyes with high ametropia and astigmatism. All eyes had uneventful implantation of a toric phakic IOL through a superior scleral tunnel incision at 12 o’clock. After a minimum of 6 months, the uncorrected visual acuity (UCVA), best correct visual acuity, refraction, and astigmatism were analyzed in all eyes. A multivariate analysis of postoperative astigmatism was performed. Results After a follow-up of at least 6 months, 95…

Kosteneffektivitätsanalyse der Versorgung von Kataraktpatienten mit monofokalen Intraokularlinsen aus Sicht der Leistungserstatter

BACKGROUND Data on the cost effectiveness of cataract surgery with respect to the German statutory health insurance system are hardly available. Hence the increase in visual acuity as primary efficacy endpoint, order of posterior capsule opacification as primary complication endpoint and direct cost for supplementation with monofocal intraocular lenses have been assessed via meta-analyses to evaluate the procedure's cost effectiveness from the perspective of the German statutory health insurance system. MATERIAL AND METHODS Using the medical internet database MEDLINE two meta-analyses on publications between 1995 and 2002 were carried out, one estimating the gained increase in visual acuity…

Complications Through the Use of Viscoelastics

Viscoelastic material retained behind the IOL may cause a capsular bag distension in the early postoperative period. These eyes accumulate a transparent substance in the closed chamber inside the capsular bag from the IOL blocking the capsular opening. The capsular bag distension was first discribed by Davison in 1990. Miyake et al. proposed a new classification of capsular block syndrome and supposed viscoelastic material to cause early-postoperative capsular block syndrome (Miyake et al., 1999). Capsular bag distension after optic capture of a sulcus-fixated IOL was described by Basti et al. (1999).

Aseptic Production vs. Terminal Sterilization

The safety of substance use in intraocular surgery ideally requires the absence of all biologically-active components capable of causing an inflammatory reaction. Substance purity is achieved with isolation and cleansing methods (e.g., of the polysaccharide), which remove any biological component with infective potential. The methods of production for polysaccharide isolation should remove biological agents, regardless of its origin. Hyaluronic acid is isolated either from rooster combs or biological fermentation. Use of this substance showed the development of postoperative intraocular inflammatory reactions resulting from contaminations from both sources. OVD should have low endotoxin val…

Monocular versus binocular pupillometry.

Purpose To quantify differences between monocular and binocular pupil size measurement under scotopic and mesopic conditions. Setting Department of Ophthalmology, Johannes Gutenberg-University, and Department of Medical Biometry, Epidemiology and Informatics, University of Mainz, Mainz, Germany. Methods Computerized dynamic pupillometry (P2000 SA, Procyon Instruments Ltd.) was used at 3 illumination levels: scotopic at 0.03 lux, mesopic low at 0.82 lux, and mesopic high at 6.4 lux. One hundred forty eyes of 70 healthy volunteers without ocular pathology were examined. The subjects were divided into 2 groups. In the first group, the pupil diameter was measured binocularly first. In the secon…

Brimonidine versus dapiprazole: Influence on pupil size at various illumination levels.

To evaluate the influence of dapiprazole versus brimonidine on pupil size at various illumination levels.Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany.In randomized prospective study, 19 healthy volunteers received 2 ophthalmic solutions, dapiprazole and brimonidine, 1 in each eye, for intraindividual comparison. Before and after application, pupil diameter was measured using an infrared binocular pupillometer at 3 illumination levels (0.03, 0.82, and 6.4 lux).Only slight pupil dilation was observed under scotopic conditions after application of both agents. After 20 minutes, the median reduction in pupil width was 1.4 mm for brimonidine and 0.9 mm for dapiprazo…

Effect of large positioning holes on capsule fixation of plate-haptic intraocular lenses

Abstract Purpose To compare the centration and fixation of silicone plate-haptic intraocular lenses (IOLs) with different-sized positioning holes. Setting Eye Clinic of the Johannes Gutenberg-University Mainz, Mainz, Germany. Methods In a prospective randomized study, 51 Chiroflex C10 and 56 Chiroflex C11 IOLs were implanted under standardized conditions by the same surgeon. The IOL position was documented at the end of surgery and by retroillumination on the first day and 5 months postoperatively. The positioning-hole area was evaluated by ultrasound biomicroscopy (50 MHz) 5 months postoperatively. Results One day postoperatively, no IOL in either group was decentered more than 1.0 mm. Aft…

Reproducibility of optical biometry using partial coherence interferometry: intraobserver and interobserver reliability

Abstract Purpose: To evaluate the intraobserver and interobserver variability in axial length (AL), anterior chamber depth (ACD), and corneal radius measurements using an optical biometry instrument based on partial coherence interferometry (PCI). Setting: Johannes Gutenberg University, Mainz, Germany. Methods: In this observational case series and interobserver reliability trial, 30 healthy, emmetropic to moderately myopic eyes of 15 volunteers were evaluated. The AL, ACD, and corneal radius were measured 20 times in 10 eyes by 1 observer to evaluate the intraobserver variability. To evaluate the interobserver variability, the measurements were taken in 20 eyes by 5 different observers. Me…

Healon5 versus Viscoat during cataract surgery: intraocular pressure, laser flare and corneal changes

Background: The use of a viscoelastic substance facilitates cataract surgery. Healon 5 is a new viscoelastic product with special rheological properties. We evaluated the postoperative effect of Viscoat and Healon5 on intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell counts and laser flare. Methods: Forty-eight eyes of 48 patients undergoing routine phacoemulsification followed by foldable IOL implantation were enrolled. Either Healon5 or Viscoat was used according to a block- randomization scheme. The aspiration technique was standardized. IOP, CCT, endothelial cell counts and laser flare were compared pre- and postoperatively. Statistical analysis was performed…

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses.

ABSTRACT PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOLoptic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpf lug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01±0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32±0.18 mm at the 12 o'clock p…

Gesundheitsökonomische Bewertung einer antibiotischen Prophylaxe gegenüber postoperativen Endophthalmitiden

BACKGROUND: Two independent epidemiological studies recently suggested the prophylactic relevance of an intraocular antibiosis against endophthalmitis after cataract surgery. The resulting intervention programme, however, has not only ethical drawbacks, but also has a health economical dimension, which will be focussed in this paper. MATERIAL AND METHODS: A cost analysis is performed to compare the direct costs saved by prevention of endophthalmitis cases and the costs generated by the prophylaxis itself. Furthermore, the clinics' indirect costs due to treatment of unprevented endophthalmitis cases are estimated. RESULTS: The overall gain in direct costs turns out to be about 368 000 Euro p…

Healon5 viscoadaptive formulation: Comparison to Healon and Healon GV

Abstract Purpose To compare the rheological characteristics of a viscoadaptive viscoelastic formulation with those of 2 standard ophthalmic viscosurgical devices (OVDs). Setting Department of Ophthalmology, Johannes Gutenberg-University, and Max Planck-Institute for Polymer Research, Mainz, Germany. Methods An independent comparative study of 3 OVDs of sodium hyaluronate (Healon®, Healon GV®, and Healon®5) was performed using the Advanced Rheometric Expansion System to analyze rheologic behavior (eg, dynamic frequency dependence of the complex viscosity) as well as rheological parameters (eg, viscosity at zero shear rate, pseudoplasticity, relaxation time, elastic and viscous modulus). Resu…

Toric phakic intraocular lens

Abstract Objective To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. Design Prospective, nonrandomized, comparative (self-controlled) multicenter trial. Participants Seventy eyes of 53 patients (mean, 35 years; range, 22–59 years) with preoperative spherical equivalent between +6.50 and −21.25 diopters (D) and cylinder between 1.50 and 7.25 D. Methods Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens…

Impact of the line of sight on toric phakic intraocular lenses for hyperopia

We present a hyperopic patient with a decentered line of sight in whom the residual refractive error after toric phakic intraocular lens (TP IOL) implantation was improved by displacement and individualized treatment. A 35-year-old woman presented with asthenopic complaints 2 months after bilateral TP IOL implantation and IOL rotation 4 weeks later. Examination revealed the line of sight to be nasally and inferiorly decentered in relation to the center of the pupil. A more nasal reenclavation of the TP IOL decreased the coma, and the uncorrected visual acuity was 20/20. We conclude that line of sight should be measured before TP IOL implantation, especially in hyperopic eyes.

Spring constants of capsular tension rings.

Purpose To determine the spring constants of several types of capsular tension rings (CTRs). Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods Fourteen models of CTRs provided by 9 companies were tested; all were 11.0 mm in diameter. The CTRs were positioned in a special retainer of a material-testing machine and compressed at a constant speed of 10.0 mm per minute. The distance and force values were recorded, and each CTR model was tested 3 times using a new specimen each time. The resulting measurements were used to calculate a mean spring constant for each CTR model. Results All tested CTRs showed linear proportionality between force and compress…

Special Uses of Viscoelastics

The possibilities of viscoelastic use in phacoemulsification will be outlined in the following figures. Many ophthalmic surgeons apply viscoelastic substances in capsulorhexis to achieve a deep anterior chamber and extend the pupillary space (with a small pupil). Care must be taken during injection so that aqueous is permitted to flow out. When using a paracentesis to inject viscoelastic (Fig. 59), it must be big enough to allow aqueous outflow. For complete aqueous exchange in the anterior chamber, it is advisable to inject the viscoelastic into the opposite chamber angle.

Preoperative simulation of postoperative iris-fixated phakic intraocular lens position and simulation of aging using high-resolution Scheimpflug imaging

To increase postoperative safety after implantation of iris-fixated phakic intraocular lenses (pIOLs), optimal preoperative evaluation and patient selection is mandatory. We present a new software tool in a high-resolution Scheimpflug imaging device that precisely simulates the postoperative position of an iris-fixated pIOL and also simulates the effect of aging on the pIOL's position.

Phacoemulsification and Vitrectomy with the Erbium: or Neodymium:YAG-Laser

Summary There are an increasing number of applications for Erbium:YAG and Neodymium:YAG lasers in opthalmology. Laser phacoemulsification and Erbium-laser vitrectomy are of major interest. We report the underlying technology and more than 1-year-experience using the PHACOLASE (Carl Zeiss Meditec, Jena, Germany, 10–100 Hz frequency, 5–50 mJ single pulse energy) for phacoemulsification and pars plana vitrectomy and the Lyla-Dodick laser photolysis (A.R.C. Laser, Eckental-Forth, Germany, 1–20 Hz, up to 8 mJ single pulse energy). The Erbium:YAG laser and Neodymium:YAG laser enabled us to extract lenses with up to medium hard nuclei. Moreover, the Erbium laser enabled fast vitrectomy with little…

Capsule measuring ring to predict capsular bag diameter and follow its course after foldable intraocular lens implantation

Purpose: To evaluate the extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation and develop a regression formula to predict postoperative capsular bag size. Setting: Eye Hospital, Johannes Gutenberg-University, Mainz, Germany. Methods: The axial length (AL), anterior chamber depth, and corneal radius in 58 eyes were measured preoperatively. Cataract surgery was by phacoemulsification followed by implantation of a 3-piece, acrylic, posterior chamber IOL. The capsular bag diameter and anterior capsulorhexis were measured intraoperatively and 1 day and 1, 3, and 6 months postoperatively using a Koch capsule measuring ring (HumanOptics). Results: The me…

Effect of a closed foldable equator ring on capsular bag shrinkage in cataract surgery.

To evaluate the effect of a closed foldable equator ring (CFER) versus a conventional capsular tension ring (CTR) on capsular bag shrinkage.Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany.In this prospective study, 70 eyes of 70 patients were randomized to 2 groups using a 1:1 block scheme. After uneventful cataract surgery, a capsular measuring ring was implanted in all eyes to measure the capsular bag diameter in vivo. In Group 1, a CTR was implanted in the capsular bag. In Group 2, a CFER was inserted. Biometric characteristics such as axial length and the horizontal and vertical corneal radii were measured preoperatively. The capsular bag diameter and capsulor…

Evaluation of cut quality using the Amadeus microkeratome with different settings.

Abstract Purpose: To evaluate the quality of keratectomy specimens created with the Amadeus® microkeratome (AMO) using scanning electron microscopy (SEM). Setting: Johannes Gutenberg-University Hospital, Department of Ophthalmology, Mainz, and the Department of Anatomy, Justus Liebig-University, Giessen, Germany. Methods: Corneal cuts were performed in freshly enucleated pig eyes using the Amadeus microkeratome with 9 combinations of oscillation rate and head-advance speed. For the cutting trials, oscillation rates of 8000, 13000, and 18000 rpm and head-advance speeds of 1.0, 2.5, and 4.0 mm/s were chosen. Fifty-four eyes were included, resulting in 9 groups of 6 eyes for each configuration…

Retinal Imaging through Phakic Iris-Claw IOL.

AbstractBackground: Phakic anterior chamber iris-fixated IOL (PIOL) are established for the correction of high myopia. These patients require attention to macular pathologies. This study was to evaluate the quality of imaging through the PIOLs. Methods: 54 eyes of 31 myopic and hyperopic patients with Verisyse®, Verisyse toric®, and Veriflex® phakic iris-fixated IOL were included. Mean preoperative refraction was −11.0 D and +5.7 D, respectively; mean follow-up time was 7.4 years (5–11 years). A matched control group was formed without PIOL implantation. OCT scans were performed and evaluated qualitatively and quantitatively. Results: In 52 eyes of 31 patients (96%), a 3D-OCT image and fund…

Solvent for removing silicone oil from intraocular lenses: experimental study comparing various biomaterials.

Abstract Purpose To evaluate the effectiveness of a perfluorocarbon—perfluorohexyloctane (PFHO)—in removing silicone oil from different intraocular lenses (IOLs) and determine whether any removal technique enhances the removal of silicone oil. Methods Six IOL materials were analyzed: standard poly(methyl methacrylate) (PMMA), heparin-surface-modified (HSM) PMMA, AcrySof, 2 polyHEMAs with different water contents, and a second-generation SLM-2 silicone. One or 2 μL of a highly viscous silicone oil (5700 cs) was applied to the center of each IOL optic. Perfluorohexyloctane (2 mL) was then used to remove the silicone oil by 1 of 3 techniques: immersion of the IOL in PFHO; irrigation of the sil…

Subjective photic phenomena with refractive multifocal and monofocal intraocular lenses. results of a multicenter questionnaire.

Abstract Purpose To compare the incidence and severity of photic phenomena after the implantation of the Array® (Allergan) refractive multifocal intraocular lens (MIOL) and a monofocal IOL. Setting Multicenter study at Kiel, Mainz, Karlsruhe, and Bremerhaven, Germany. Methods The study comprised 231 randomly selected patients from 4 study centers. The patients had had uneventful phacoemulsification with implantation of a refractive MIOL (n = 138) or a monofocal IOL (n = 93). By questionnaire, patients were asked whether they experienced light sensations postoperatively (light streaks, halos, flare, flashes, or glare) that had not been noticed preoperatively. Additional questions evaluated w…

Histological and ultrastructural study of corneal tunnel incisions using diamond and steel keratomes

Abstract Purpose: To study the morphology of corneal tunnel incisions using diamond and steel keratomes. Setting: Department of Ophthalmology, University of Giessen, Germany. Methods: Corneal tunnel incisions were performed in six human cadaver eyes using three types of diamond keratomes and a steel keratome. The incision profile and morphology were evaluated and compared using light and scanning electron microscopy. Results: The steel keratome caused more disruption of corneal stromal tissue, while the diamond keratomes produced a more regular, smoother incision. The dissecting incision resulted in a smoother surface of cut stromal tissue than the stab incision. Conclusions: The high quali…

Autoreactive Antibodies and Loss of Retinal Ganglion Cells in Rats Induced by Immunization with Ocular Antigens

PURPOSE In an experimental autoimmune animal model, retinal ganglion cell (RGC) loss was induced through immunization with glaucoma-related antigens. The target of this study was to investigate the pathomechanism behind this decline and the serum antibody reactivity against ocular and neuronal tissues after immunization with glaucoma- and non-glaucoma-associated antigens. METHODS Rats immunized with optic nerve antigen homogenate (ONA) or keratin (KER) were compared to control rats (CO). Intraocular pressure (IOP) was measured, and the fundi were examined regularly. Four weeks afterward, cells were counted in retinal flat mounts. Retina, optic nerve, and brain sections from healthy animals …

Implantation of a custom intraocular lens with a 30-diopter torus for the correction of high astigmatism after penetrating keratoplasty.

Abstract We present a 62-year-old woman who had implantation of an intraocular lens (IOL) with a torus of 30.0 diopters (D) in an eye after penetrating keratoplasty. The patient presented with cataract and a best corrected visual acuity of 20/400. Penetrating keratoplasty was performed in 1975 because of decompensated keratoconus. With a clear but inferiorly decentered corneal graft, visual acuity was limited because of keratoplasty-related high corneal astigmatism of 22.5@156 that could not be successfully treated with spectacles or contact lenses. A custom toric IOL with –30.0 D of cylindrical power was implanted in the capsular bag via a sclerocorneal tunnel incision. Additionally, a sph…

Surgical management of acute angle-closure glaucoma after toric implantable contact lens implantation

A case of pupillary block after implantation of an implantable contact lens (ICL) is reported, and surgical management and prevention are discussed. In a myopic patient, the best corrected visual acuity in the right eye was 20/50 with -15.50 -3.00 x 175. After uneventful implantation of an ICL, painful acute glaucoma developed with an intraocular pressure beyond measurable values. Apparent anterior vaulting of the ICL suggested a sizing problem. In a situation of a mid-wide dilated pupil, immediate explantation of the ICL was performed. Then, using a preoperative iris photography as guidance, an anterior chamber iris-claw toric phakic intraocular lens was implanted. On postoperative examina…

Endothelial cell loss after toric iris-fixated phakic intraocular lens implantation: three-year follow-up.

ABSTRACT PURPOSE: To study quantitative changes in endothelial cell count after implantation of the toric iris-fixated phakic intraocular lens. METHODS: A prospective, non-randomized, self-controlled clinical trial was conducted of 40 eyes (28 myopic, 12 hyperopic) of 23 patients with high ametropia and astigmatism. Non-contact computer-assisted endothelial microscopy was performed before and I1 2, and 3 years after surgery. RESULTS: In the myopic group, mean preoperative endothelial cell count was 3179±531 cells/mm p 2 (range: 1800 to 3900 cells/mm2). The mean intraindividual endothelial cell loss was -1.83±2.25% (range: -9.09% to 0%) in the first year; -1.83+2.95% (range: -7.74% to 3.80%)…

Osmolality of various viscoelastic substances: comparative study.

Abstract Purpose To determine the osmolality of various viscoelastic substances. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, and Institute for Medical Device Testing, Memmingen, Germany. Methods The analysis was carried out according to the European Pharmacopoeia by means of a calibrated osmometer using the freezing-point depression method. Each syringe was analyzed as a duplicate analysis. Results Mean osmolalities (mOsmol/kg) of the sodium hyaluronate viscoelastic substances were Allervisc® 299; Allervisc® Plus 307; Amvisc® Plus 335; AMO Vitrax® 284; Biolon® 279; Dispasan® 311; Dispasan® Plus 314; Healon® 295; Healon GV® 312; Healon®5 322; HYA-Ophtal® 376; M…

Intraocular pressure after small incision cataract surgery: temporal sclerocorneal versus clear corneal incision.

To compare intraocular pressure (IOP) after phacoemulsification and foldable intraocular lens (IOL) implantation using a temporal sclerocorneal or clear corneal incision.Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany.One hundred patients (100 eyes) with cataract having phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision. Intraocular pressure was measured preoperatively and 6 hours, 1, 2, and 3 days, and 5 months postoperatively. Statistical significance was determined by nonparametric group comparisons using 2-sample random Wilcoxon tests.Six hours postoperatively,…

Effect of trypan blue on the elasticity of the human anterior lens capsule.

Purpose To evaluate the effect of trypan blue (VisionBlue) staining on the elastic properties of the human anterior lens capsule. Setting Center for Vision Science, Ruhr University Eye Hospital, Bochum, Germany. Methods Nineteen anterior capsules were obtained from 19 human eyes at the time of cataract operation. Two same-size strips were prepared from each capsule; 1 was exposed to trypan blue staining for 10 seconds, and the other was a control. The elasticity measurements were performed on both specimens using a modified rheometer. Results The mean age of the patients was 75.3 years ± 13.3 (SD) (range 35 to 89 years). Sixty-three measurements of 19 suitable specimen pairs were performed.…

Graphic representation of data resulting from measurement comparison trials in cataract and refractive surgery.

* BACKGROUND AND OBJECTIVES: The evaluation of new diagnostic measurement devices allows intraindividual comparison with an established standard method. However, reports in journal articles often omit the adequate incorporation of the intraindividual design into the graphic representation. * PATIENTS AND METHODS: This article illustrates the drawbacks and the possible erroneous conclusions caused by this misleading practice in terms of recent method comparison data resulting from axial length measurement in 220 consecutive patients by both applanation ultrasound and partial coherence interferometry. * RESULTS: Graphic representation of such method comparison data should be based on boxplots…

Survival After Transplantation of Corneas From a Rabies-Infected Donor

To examine the tissue samples of 2 corneal recipients from a rabies-infected donor for the presence of rabies to explain their survival.Interventional case series with a review of the literature. The explanted corneal donor buttons were examined via nested reverse transcriptase polymerase chain reaction. The patients were followed up ophthalmologically and neurologically. Antirabies antibodies were measured in blood samples, and skin biopsies were examined by direct fluorescent antibody staining.Two patients received corneas from the same multiorgan donor. Six weeks after transplantation, 3 of the donor's organ recipients became symptomatic and rabies virus was confirmed in tissue from the …

Fallzahlplanung bei ophthalmologischen Studien*

An essential aspect in the cooperation of clinic and biometry consists in designing of studies, e.g. during the preparation of grant applications or for review by official drug surveillance institutions. A central aspect in study planning is the design-adequate and well-documented prediction of sample size, which should be recommended for any intended study. Based on several examples for sample size planning in study designs, which are of common relevance for ophthalmology, guidelines are derived to enable clinical researchers to perform sample size planning on their own. The latter can be based on the various available software packages for sample size prediction.

Implantation of the modified endocapsular bending ring in pediatric cataract surgery using a viscoadaptive viscoelastic agent.

Cataract surgery and intraocular lens (IOL) implantation in pediatric eyes remain controversial. Using a viscoadaptive viscoelastic agent, we implanted a modified capsular bending ring (CBR) as well as an acrylic IOL with a sharp-optic-edge design in the capsular bag. All operated eyes demonstrated a low postoperative inflammatory reaction and a clinically well-centered IOL. The band-shaped, sharp-edged CBR facilitates the creation of a sharp, discontinuous bend in the equatorial capsule, which prevents anterior and posterior capsule opacification. Combining the viscoadaptive viscoelastic agent and the CBR enhances the safety of primary and secondary posterior chamber IOL implantation in pe…

Series of fibrinous inflammation after implantation of capsular tension rings

Purpose To analyze the cause of fibrinous inflammation in eyes with capsular tension rings (CTRs) after cataract surgery. Setting Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany. Design Retrospective case series. Methods High-performance liquid chromatography was implemented to eliminate impurities. One CTR was explanted for microbiologic examination. The pH values of the CTR and the storage solution were analyzed, Seldi and Maldi tests were performed, as well as toxicity tests with immortal cell lines. Material batches were analyzed. The organic carbon content of CTRs, detergents, and storage solutions was checked. The presence of…

Refractive lens exchange with an array multifocal intraocular lens.

ABSTRACT PURPOSE: To prospectively evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after refractive lens exchange (clear lens extraction) followed by posterior chamber implantation of a multifocal intraocular lens (IOL). METHODS: Fifty eyes of 25 patients (mean age 51 years, range 44 to 62 years) with preoperative spherical equivalent refraction between -15.50 and +5.75 D and cylinder between 0 and 1.50 D underwent bilateral implantation of a zonal progressive multifocal IOL (Array, AMO). RESULTS: Eyes were divided into group A (n=24; myopia, average preoperative spherical equivalent refraction -7.11 ± 3.25 D (-1.75 to -15.50 D), and group B (n=…

Benefits and Side Effects of Bandage Soft Contact Lens Application after LASIK

Purpose To evaluate benefits and side effects of bandage soft contact lens (BSCL) insertion after LASIK in relation to patients’ characteristics. Design Prospective, randomized, bicenter comparative investigational trial. Participants One hundred patients (200 eyes) with myopia and/or myopic astigmatism. Methods Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours. Main Outcome Measures Schirmer …

Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses Case series and review

Abstract Purpose: To report clinical and spectrographic analyses of 2 explanted hydrophilic acrylic intraocular lenses (IOLs). Setting: John A. Moran Eye Center, Salt Lake City, Utah, USA, and Johannes Gutenberg-University, Department of Ophthalmology, Mainz, Germany. Methods: We report 6 cases of opacification of MemoryLens ® IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopath…

General Applications of Viscoelastics

The many and diverse physicochemical characteristics of viscoelastic substances impose both their desired and undesired effects clinically. As there is no single ideal substance to meet clinical stipulations, individual viscoelastic characteristics should be considered with respect to demand. Georg Eisner described viscoelastic agents as a tool for space-occupying measures (in tissues, in space or on surfaces) applied by the use of special techniques (Eisner, 1980; Eisner, 1983). In surgery, viscoelastic substances protect tissues and cells from mechanical trauma, serve to separate tissues, occupy space, break away adhesions, stop bleeding, coat, act as manipulative instruments and move tis…

Removal of Viscoelastic Substances

All viscoelastics should be completely removed from the eye to reduce the likelihood of increased intraocular pressure. Should OVD retention behind the IOL occur, an unstable refraction could result. Residual high molecular viscous substance is transported away through the trabecular meshwork, with delay, possibly resulting in a protracted postoperative IOP increase. To aspirate viscoelastics various techniques as well as instruments with different aspiration/irrigation adjustments have been proposed, a few of which will be described here. Viscoelastic removal involving the simultaneous irrigation and aspiration through a single cannula (Nevyas, 1987) or two separate cannulas (Brauweiler, 1…

Objective and subjective evaluation of photic phenomena after monofocal and multifocal intraocular lens implantation11The authors have no commercial or financial interest in any aspect of this study.

Abstract Objective To objectively measure and compare halo, flicker, and glare disability in pseudophakic eyes with monofocal (MONO) and multifocal (MULTI) intraocular lenses (IOLs) with respect to the influence of corneal surface quality, astigmatism, and age. Design Prospective case series. Participants This clinical trial involved 28 eyes of 28 patients after small-incision cataract surgery with a MONO silicone IOL and 28 eyes of 28 patients with zonal-progressive silicone IOL. Intervention A computer program objectively determined halo, glare, and flicker. Corneal surface quality and astigmatism were measured using computerized videokeratography. Ray-tracing analysis was performed based…

Retinal ganglion cell loss is accompanied by antibody depositions and increased levels of microglia after immunization with retinal antigens.

BackgroundAntibodies against retinal and optic nerve antigens are detectable in glaucoma patients. Recent studies using a model of experimental autoimmune glaucoma demonstrated that immunization with certain ocular antigens causes an immun-mediated retinal ganglion cell loss in rats.Methodology/principal findingsRats immunized with a retinal ganglion cell layer homogenate (RGA) had a reduced retinal ganglion cell density on retinal flatmounts (p = 0.007) and a lower number of Brn3(+) retinal ganglion cells (p = 0.0001) after six weeks. The autoreactive antibody development against retina and optic nerve was examined throughout the study. The levels of autoreactive antibodies continuously in…

Capsular bag shrinkage after implantation of a capsular bending or capsular tension ring.

To evaluate the influence of a capsular bending ring (CBR) or tension ring (CTR) on capsular bag shrinkage.Department of Ophthalmology, Johannes Gutenberg-University, and Department of Medical Biometry, Epidemiology and Informatics, University of Mainz, Mainz, Germany.In 92 eyes of 92 patients, a capsular measuring ring (CMR) was implanted after phacoemulsification to measure capsular bag size in vivo. Patients were randomized into 3 groups: The first received a CMR and CBR, the second received a CMR and CTR, and the third received a CMR alone. Measurements were performed preoperatively, intraoperatively, during the first 3 postoperative days, and after 1 and 3 months. Preoperative biometri…

Comparison of biometric measurements using partial coherence interferometry and applanation ultrasound

Abstract Purpose To compare and contrast axial length (AL) measurements assessed by ultrasound biometry and optical biometry. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods Optical biometry and ultrasound biometry were performed in 360 eyes to measure AL. Results In eyes with a clear-appearing crystalline lens, there was a statistically significant median difference in AL measurements between the 2 methods in eyes with a normal or long length. In eyes with cataract, there was a statistically significant median difference in AL measurements in eyes with a normal or short length. In these cases, optical biometry produced larger readings than ultras…

Short-term Follow-up after Implantation of a Foldable Iris-Fixated Intraocular Lens in Phakic Eyes

Objective To evaluate efficiency, predictability, stability, complications, and patient satisfaction after implantation of a foldable iris-fixated phakic intraocular lens (PIOL) for the correction of myopia. Design Prospective, nonrandomized, comparative (self-controlled) trial. Participants Forty-one eyes of 22 myopic patients aged 18 to 56 years (mean, 36 years) with average sphere of −8.2±2.01 diopters (D; range, −12.25 to −3.75 D) and average preoperative cylinder of −0.90±0.62 D (range, −2.50 to 0.00 D) were enrolled in this prospective study. Methods All eyes underwent implantation of a foldable iris-fixated PIOL with an optical zone of 6.0 mm. The follow-up was 6 months in all cases.…

Implantation of a toric poly(methyl methacrylate) intraocular lens to correct high astigmatism

Abstract A 57-year-old man experienced a decrease in visual function because of cataract formation. Corneal astigmatism was 13.4 diopters (D) because he had had a penetrating keratoplasty 27 years before. Cataract surgery was planned, and biometric data for toric intraocular lens (IOL) implantation were collected for the manufacture of a custom IOL. After phacoemulsification, a toric poly(methyl methacrylate) (PMMA) IOL of +19.0 D spherical and +12.0 D cylindrical power was implanted via a sclerocorneal tunnel incision. Three months postoperatively, corneal astigmatism was 14.3 D and best corrected visual acuity (BCVA), 20/25. Postoperative refraction (+1.5 −3.0 × 90) and BCVA remained stab…

Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens

Purpose To evaluate the changes in pupil size after implantation of an iris-supported toric phakic intraocular lens (TPIOL) for correction of myopia and hyperopia with astigmatism. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods Twenty-two myopic eyes and 9 hyperopic eyes were included in the study. The mean age of the 2 groups was 34 years and 40 years, respectively. The scotopic pupil size was measured with a handheld infrared pupillometer (Colvard, Oasis Medical) before and 6 months after implantation of the TPIOL. All examinations were performed under scotopic conditions after 2 minutes of dark adaptation with the fellow eye covered. Intraindi…

Evaluation of the practicality of optical biometry and applanation ultrasound in 253 eyes

Abstract Purpose To evaluate the percentage of eyes that could not be measured using optical biometry and ultrasound applanation and the reasons. Setting Department of Ophthalmology, Johannes Gutenberg-University Hospital, Mainz, Germany. Methods Optical biometry (IOLMaster®, Carl Zeiss Meditec AG) and A-scan ultrasound biometry were performed consecutively in 253 eyes scheduled for cataract surgery the next day. Lens opacities were evaluated with the Opacity Lensmeter (Interzeag), and a slitlamp examination and measurement of visual acuity were performed. The 2 techniques were compared in terms of the rate of and reasons for primary measurement failure. Results Measurement with the IOLMast…

Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification.

Abstract Objective To compare the postoperative inflammation after phacoemulsification followed by intraocular lens (IOL) implantation by means of sclerocorneal versus clear corneal tunnel incision. Design Randomized controlled clinical trial. Participants One hundred eyes of 100 patients were examined at a German University eye hospital. Intervention One hundred eyes with cataract necessitating phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision by a single surgeon. Main outcome measures Preoperative and postoperative inflammation was evaluated by measurement of flare using laser flare photo…

Biaxial Microincision versus Coaxial Small-Incision Clear Cornea Cataract Surgery

Objective To compare clinical outcomes of biaxial microincision (1.5 mm) and coaxial small-incision (2.75 mm) clear cornea cataract surgery. Design Randomized controlled clinical trial. Participants Seventy eyes of 70 patients were examined at a German university eye hospital. Intervention The 70 patients (70 eyes) were assigned randomly (1:1) to a biaxial or conventional coaxial incision group. Both groups underwent phacoemulsification using pulsed ultrasound energy with variable duty cycles, followed by microincision intraocular lens implantation. Main Outcome Measures Best-corrected visual acuity (BCVA), astigmatism, laser flare photometry value, effective phacoemulsification time (EPT),…

Occurrence of Retinal Ganglion Cell Loss via Autophagy and Apoptotic Pathways in an Autoimmune Glaucoma Model

In glaucoma, an apoptotic death of retinal ganglion cells (RGCs) has been shown. However, little is known about other cell death mechanisms, like autophagy or necrosis. Therefore, we investigated these mechanisms in addition to antibody deposits in an experimental autoimmune glaucoma model.Rats were immunized with a retinal ganglion cell-layer homogenate (RGA), while controls received sodium chloride. Untreated rats served as natїve group. After seven weeks, retinal cross-sections were stained with antibodies against RGCs (Brn-3a), apoptosis (cleaved caspase 2, cleaved caspase 3 as well as caspase 3, 8, and 9), autophagy (LC3BII and LAMP1), and necrosis (RIPK3) followed by cell counts. Auto…

Contrast sensitivity after implantation of toric iris-claw lenses in phakic eyes.

Abstract Purpose: To evaluate the change in contrast sensitivity after implantation of the Verisyse toric phakic intraocular lens (IOL) (AMO) for the correction of myopia with astigmatism. Setting: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods: Eighteen eyes had implantation of an iris-supported toric phakic IOL to correct myopia with astigmatism. The mean preoperative spherical equivalent was −12.65 diopters ± 3.6 (SD). The contrast sensitivity with best spectacle correction was determined before surgery and 3 months after surgery using the CSV-1000 HGT instrument (Vector Vision Inc.). Results: Three months after IOL implantation, the mean contrast sen…

Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery.

Purpose To determine whether implantation of a microincision intraocular lens (IOL) with a modified anterior surface, designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients, results in improved pseudophakic quality of vision in pseudophakic eyes after biaxial microincision phacoemulsification. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods In a nonrandomized parallel cohort investigation, the visual performance of 52 eyes of 52 patients unilaterally implanted with the aspherical Acri.Smart 36 A IOL (Acri.Tec) were compared with those of 25 eyes of 25 age-matched patients unilaterally implanted with…