0000000000380908
AUTHOR
H. B. Dick
Lens implant selection with absence of capsular support.
If contact lens or spectacle correction is not viable, little debate exists that the secondary placement of an intra-ocular lens (IOL) is the method of choice in the absence of capsular support. The choice of IOL mainly depends on the preoperative status of the eye (eg, aphakia in children) and the selected location for the implant. Theoretically, there are several IOL implantation approaches in cases without capsular support: an angle-supported anterior chamber (AC) IOL, an iris-fixated ACIOL, an iris-sutured or iris-fixated posterior chamber (PC) IOL and a transsclerally sutured PCIOL. No consensus exists, however, on the indications as well as on the relative safety and efficacy of these…
Outcome Quality Assessment nach LASIK: Ergebnisse einer Benchmark-Studie zu klinischem Ergebnis und Patientenzufriedenheit
Hintergrund Das gesetzlich verankerte klinische Qualitatsmanagement schreibt nicht nur die Prozesskontrolle innerhalb einer Einrichtung vor, sondern impliziert auch die Homogenisierung von Prozessablaufen und vor allem der Ergebnisqualitat zwischen verschiedenen Leistungserbringern. Daher sollten klinisches Ergebnis sowie Kosteneffektivitat der LASIK an den Patienten zweier universitarer LASIK-Zentren im deutschsprachigen Raum gemessen und gegenubergestellt werden.
Prävention des früh-postoperativen IOD-Anstiegs nach Phakoemulsifikation
Purpose. To compare the ocular hypotensive effect of different antiglaucomatous eye drops. Patients and methods. This double-blind, randomized study included 119 eyes of 119 patients without other ocular pathology undergoing standardized (one surgeon, Healon) small incision cataract surgery with foldable intraocular lens implantation.The patients were assigned to one of five groups: group 1:0.25% timolol in Gelrite (extended efficacy, n=23); group 2: 2% dorzolamide (n=24); group 3: combination of 0.5% timolol plus 2% dorzolamide (n=22); group 4: brimonidine (n=26); group 5: gentamicin (control, n=24). Intraocular pressure (IOP) was measured preoperatively and at 3±1,6±1,9±1,24±3, and 48±3 h…
Clinical Outcome and Subjective Quality of Life after Photodynamic Therapy in Patients with Age-Related Macular Degeneration
PURPOSE. Whereas the efficacy of photodynamic therapy (PDT) in preventing the progression of age-related macular degeneration (ARMD) is established, its effect on quality of life is under discussion. METHODS. All patientswho underwent PDT during 2000 and 2001 at the University Eye Hospital of Mainz were interviewed using a standardized 82-item questionnaire on quality of life and patient satisfaction in ophthalmologic patients. Information was assessed in terms of 82 questions; global scores ranging from 1.0 (optimum self-estimated quality of life) to 4.0 (worst) were derived. Cataract patients' scores were used to characterize the ARMD patients' subjective outcome; the latter were then rel…
Physicochemical Surface Properties of Various Intraocular Lenses
<i>Purpose:</i> It is of major interest to understand how intraocular lens (IOL) surfaces interact with aqueous humor or tissues after implantation. Important parameters to describe the physicochemical surface properties are the contact angle and critical surface tension. Therefore, we performed measurements of the contact angle and critical surface tension of several commercially available IOLs. <i>Setting:</i> Department of Ophthalmology, Johannes Gutenberg University, Mainz, University Eye Hospital, Tübingen, and Max Planck Institute for Polymer Research, Mainz, Germany. <i>Methods:</i> A total of 17 commercially available standard quality IOL types (6…
Endotoxins in ophthalmic viscosurgical devices.
Purpose To measure the endotoxin concentration (EC) of 25 commercially available, hyaluronic acid- and hydroxypropylmethylcellulose-based (HPMC) ophthalmic viscosurgical devices (OVDs). Methods The in vitro Limulus amebocyte lysate (LAL) assay, which indicates the presence of endotoxins originating from gram-negative bacteria, was used to determine the EC. The procedure was performed according to the European Pharmacopoeia/USP. EC including duplicate determinations, negative controls, dilution series with control standard endotoxin, dilution series with sample extract and positive sample control. Results 16 OVDs (Amvisc®, Amvisc® Plus, Biolon®, Coatel®, Healon®, Healon® GV, Healon®5, HPMC O…
Lebensqualit�t und Patientenzufriedenheit nach Kataraktchirurgie
Die Messung von Lebensqualitat und Patientenzufriedenheit gewinnt bei der Evaluation von Therapiekonzepten an Bedeutung als erganzendes Effektmas neben dem objektiven klinischen Outcome. Bei "schnell wirksamen" Interventionen wie der Kataraktchirurgie ist jedoch nicht gesichert, ob die klassischen Erhebungsinstrumente, die vor allem fur langsam progredierende und therapierbare Erkrankungen wie das Glaukom konzipiert sind, die Wirkung der Intervention auch hinreichend gut abbilden. Bei 152 konsekutiven Kataraktpatienten wurde neben der Anderung des Visus als objektivem klinischen Effektmas ein eigens fur Kataraktpatienten konzipierter Erhebungsbogen eingesetzt, um die Anderung der Lebensqual…
Dynamische Aberrometrie während der Akkommodation phaker Augen sowie Augen mit potenziell akkommodativer Intraokularlinse
Eine objektive Messung des Akkommodationseffektes ist nach Implantation potenziell akkommodativer Intraokularlinsen (IOL) – auch aufgrund methodischer Probleme – sehr schwierig. Unter anderem wurden hierzu Messungen der Anderung der Vorderkammertiefe mittels Laserinterferenzbiometrie durchgefuhrt. Alle bisherigen Untersuchungen konnten bislang nicht eindeutig klaren, ob und in welchem Ausmas potenziell akkommodative IOL uberhaupt funktionieren. Mittels Wellenfrontanalyse wurde das dynamische Verhalten potenziell akkommodativer IOL vermessen. Die Messungen wurden mit einem Hartmann-Shack-Aberrometer durchgefuhrt. Als Besonderheit waren sequenzielle dynamische Wellenfrontmessungen mit einer F…
Material properties of various intraocular lenses in an experimental study.
<i>Introduction:</i> With the recent introduction of small-incision cataract surgery, requirements for intraocular lens (IOL) flexibility, strength and hydrophilicity have rapidly evolved. The IOL surface, however, remains a critical factor influencing uveal biocompatibility. <i>Purpose:</i> To objectively quantify factors of material properties of various IOLs using contact angle measurements, differential scanning calorimetry, dynamic-mechanical measurements and scanning electron microscopy. <i>Material and Methods:</i> In our study, 17 currently available IOLs were investigated using contact angle measurements to assess hydrophilicity and biocompatibil…
Refraktion, Vorderkammertiefe, Dezentrierung und Tilt nach Implantation monofokaler und multifokaler Silikonlinsen
Hintergrund. Ziel der prospektiven Studie war die Analyse von Refraktion, Vorderkammertiefe, Dezentrierung und Verkippung (Tilt) nach Implantation monofokaler (MONO) und multifokaler (MIOL) Intraokularlinsen (IOL). Patienten und Methode. Bei 103 Augen von 103 Patienten wurde entweder eine dreistuckige monofokale oder multifokale Silikon-IOL implantiert. Vorderkammertiefe (ACD), IOL-Dezentrierung und -Tilt wurden mittels Retroilluminationsfotografie und Scheimpflug-Aufnahmen objektiv quantifiziert. Die Untersuchungen einschlieslich Ermittlung der sujektiven Refraktion wurden praoperativ sowie postoperativ nach 1 Woche und nach 6 Monaten vorgenommen. Ergebnisse. Im Bereich von ±1 dpt um die Z…
Phake Intraokularlinsen
Phakic intraocular lenses (PIOLs), which are located closer to the eye's nodal points than the anterior corneal surface, can provide superior optical quality for higher corrections because of retention of normal prolate corneal asphericity and larger effective optical zones. Improvements in the material and design of phakic intraocular lenses and their insertion devices combined with advances in the understanding of the anatomical and physiological interactions of the PIOLs with intraocular structures, have increased safety and efficacy. Safety of these implants over the long term remains a concern, but in several situations PIOLs are the refractive correction of choice. The purpose of this…
Vacuoles in the Acrysof<sup>TM</sup> Intraocular Lens as Factor of the Presence of Serum in Aqueous Humor
<i>Objective:</i> Acrysof™ (Alcon) foldable lenses (IOLs) have been shown to be highly biocompatible and exhibit a low incidence of posterior capsular opacification. However, minute vacuoles or ‘glistenings’ have been observed in some Acrysof IOLs. The clinical relevance of vacuole formation is presently unclear. To help clarify the influence of factors present under in vivo conditions on vacuole formation, the present experimental study examines the influence of aqueous humor components on the occurrence of vacuoles in Acrysof IOLs. <i>Methods:</i> A total of 12 sterile Acrysof IOLs (Alcon, MA60BM) were incubated at body temperature (37°C) for 3 or 6 months in anter…
Accommodative intraocular lenses: current status
Purpose of review The possibility of using a monofocal IOL with accommodative ability allows refractive cataract surgery with a clearly decreased potential of photic phenomena. Three IOLs of different designs and materials have demonstrated accommodative ability, but the degree of accommodative amplitude has been reported to different extents and variabilities. The plate-haptic CrystaLens has a hinged design that might permit forward movement of the optic as a result of pressure changes in the vitreous cavity. The 1CU has modified haptics that bend in the bag as the lens capsule contracts, which are supposed to cause anterior displacement of the lens optic. With the dual-optic one-piece Syn…