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Purpose: To evaluate corneal stiffening of porcine corneas induced by corneal crosslinking (CXL) with constant irradiance as a function of total fluence., Methods: Ninety corneas from freshly enucleated porcine eyes were divided into five groups of 18 eyes. Groups 1-4 underwent epi-off CXL using a dextran-based riboflavin solution and an irradiance of 18 mW/cm 2 , group 5 served as the control group. Groups 1 to 4 were treated with a total fluence of 20, 15, 10.8, and 5.4 J/cm 2 , respectively. Thereafter, biomechanical measurements were performed on 5 mm wide and 6 mm long strips using an uniaxial material tester. Pachymetry measurements were performed on each cornea., Results: At 10% strain, the stress was 76, 56, 52, and 31% higher in groups 1-4, respectively compared to the control group. The Young's modulus was 2.85 MPa for group 1, 2.53 MPa for group 2, 2.46 MPa for group 3, 2.12 MPa for group 4, and 1.62 MPa for the control group. The difference between groups 1 to 4 and the control group 5 were statistically significant ( p  = <0.001; p  = <0.001; p  = <0.001; p  = 0.021). In addition, group 1 showed significantly more stiffening than group 4 ( p  = <0.001), no other significant differences were found. Pachymetry measurements revealed no statistically significant differences among the five groups., Conclusion: Additional mechanical stiffening can be achieved by increasing the fluence of the CXL. There was no threshold detected up to 20 J/cm 2 . A higher fluence could compensate the weaker effect of accelerated or epi-on CXL procedures.

Purpose: The purpose of the study was to evaluate the potential accuracy of different second eye refinement methods in a patient cohort with short axial eye length to assess the performance of intraocular lens (IOL) power calculation schemes in high hyperopes., Methods: The study design was a single-center, single-surgeon retrospective consecutive case series. The setting of the study was in Augen- und Laserklinik, Castrop-Rauxel, Germany. Patients were assessed after uneventful bilateral cataract surgery implanting either spherical (SA60AT) or aspheric (ZCB00) IOLs. Inclusion criteria were an axial eye length of ≤21.5 mm and/or emmetropizing IOL power of >28.5 dpt. Outcome measures were the mean absolute prediction error (MAE), median absolute prediction error, mean prediction error with standard deviation, median prediction error, and the percentage of eyes with an absolute prediction error (absPE) within 0.25 dpt, 0.5 dpt, 0.75 dpt, or 1.0 dpt. Second eye refinement was performed using the first eye prediction error, either with a correction coefficient of 0.50 (SER1), or an individual coefficient optimized for MAE., Results: A total of 55 patients were assessed. A statistically significant reduction in the absPE after the application of SER1 was observed in 9 of 13 formulae. The SER1 refined Hoffer Q, refined Holladay I, refined Holladay II, refined Kane, refined Okulix, and refined PEARL-DGS provided a smaller absPE than other methods., Conclusion: In this patient cohort with a short axial eye length, the second eye refinement led to a lower MAE in almost all formulae. The use of refinement in Kane, Okulix, PEARL-DGS, and Castrop formulae exhibited the lowest MAE.

Purpose: To evaluate the influence of coronary heart disease (CHD) on retinal function using a battery of electrophysiological measures., Materials and Methods: We conducted a prospective pilot study comparing 34 patients with a confirmed diagnosis of CHD with 21 healthy participants. Further inclusion criteria were a decimal visual acuity (VA) of 0.8 or better and patient age between 40 and 80 years. All participants were divided into three groups according to the severity of CHD (1, 2 or 3 vessels involved) and one healthy control group. Testing was performed on one eye per patient, either selecting the eye with higher VA or, when equal, selecting randomly. The test procedure consisted of a pattern electroretinogram (ERG), a full-field ERG, a multifocal ERG and an ophthalmic screening examination., Results: Implicit times of the b-wave measured using scotopic full-field ERG were significantly prolonged in all CHD patient groups ( p < .000). Thus, full-field ERG allowed clinicians to differentiate between healthy patients and those suffering from CHD. The multifocal ERG showed significantly different results concerning the amplitude density ( p < .008) in each patient group compared with the control group. CHD had a significant impact on cone-pathway function, although the severity of CHD did not correlate with functional deficiencies of cone cells., Conclusions: Confirmed coronary vascular diseases are correlated with macular cone and bipolar cell function, which can be detected by measuring electrophysiological retinal signals.

Purpose: Long-term results of arcuate incisions are rarely reported. This is unfortunate as long-term stability of astigmatic correction is of great interest to surgeons performing astigmatic correction. This study investigates the 7 year stability of results after application of femtosecond laser-assisted arcuate incisions with the Castrop nomogram., Methods: Prospective interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Single site, single surgeon study. Seven year results of cataract patients with low to moderate corneal astigmatism receiving femtosecond laser-assisted arcuate incisions using a TechnolasVictus SW 2.7 (Bausch & Lomb Inc, Dornach, Germany) were assessed and compared to 1 year results. Outcome evaluation was based on astigmatic vector analysis, manifest refraction, and visual acuity., Results: The study analyzed 19 eyes of 19 patients 7 years after surgery. Ocular residual astigmatism changed from -0.26 to -0.39 D. Preoperative corneal astigmatism was -1.51 D. Correction Index changed from 1.0 to 1.16. The magnitude of difference vector changed from 0.26 to 0.39 D. The index of success changed from 0.20 to 0.29. Spherical equivalent remained stable. A slight tendency to change toward astigmatic overcorrection was mainly observed for patients with preoperative with the rule astigmatism, but not with patients with against the rule astigmatism., Conclusions: The Castrop nomogram showed stable results 7 years after surgery. Similar to toric IOL surgery, it is advisable to be less aggressive when correcting with the rule astigmatism, to avoid overcorrection over a long period.

Purpose : To evaluate rotational stability, tilt and decentration of a new monofocal IOL with a 7.0 mm optic and frame haptics. Methods: Prospective post-market clinical follow-up study at the Kepler University Hospital Linz, Austria. An Aspira-aXA (HumanOptics, Germany) was implanted in 74 eyes of 42 cataract patients. The lens was manufactured with toric markings. IOL rotational stability was evaluated by comparing its position at the end of surgery (EoS) versus 1 day, 1 week, 1 month and 4 months postoperatively. IOL tilt and decentration were measured using a Scheimpflug camera at 1 week, 1 month and 4 months. Results: Median absolute IOL rotation was 1.42 degrees (n = 52; mean = 2.18 ± 2.23°) within 1 day after surgery and was significantly higher compared to all later intervals (median <1.0 degree; P = .001). At the 4 months follow-up, IOL rotation was within 5.0 degrees in 85% of the eyes (n = 40) and within 10.0 degrees in 98% (n = 46) of the eyes. The only eye with an IOL rotation of ≥ 10.ty0 degrees (EoS vs . 1 day) had an AL of 26.45 mm. At the last follow-up, the IOL vertical and horizontal tilt referenced to the pupillary axis was in average less than 1.5 degrees in both eyes (n = 54; maximum 5.85°). Decentration in both meridians was on average less than 0.10 mm in both eyes (maximum 0.30 mm). Conclusion: The one-piece Aspira-aXA IOL showed good and stable positioning within the capsular bag over a 4 months period.

Aim of the Study: The purpose of the present study was to determine if swept-source optical coherence tomography angiography (OCTA) of the superficial plexus in the macular region can detect differences between high-tension open-angle glaucoma (HTG) and normal-tension glaucoma (NTG)., Materials and Methods: In this prospective study 60 eyes from 60 patients (40 HTG; 20 NTG) underwent fovea centred 3 × 3 mm cube macula OCTA imaging by a swept-source OCTA device (Plex Elite, Zeiss, Jena, Germany). Quantitative analysis of the vasculature at the superficial plexus was performed by assessing the Perfusion Density (PD), defined as the total area of perfused vasculature per unit area in a region of measurement, for each group, respectively. Besides, macular ganglion cell layer thickness and mean deviation from visual field testing was assessed and correlated with PD., Results: Average superficial PD of the measured 3 × 3 mm field was comparable between HTG and NTG ( P = .567). In both groups a significant relation of PD and age (HTG: r = -0.48, p = .002; NTG: r = -0.615; p = .004) was shown, indicating reduced PD with increasing age. For both groups a positive correlation between PD and mean deviation (MD) (HTG: r = 0.492, p = .003; NTG: r = 0.530, p = .029) as well as PD and GCL thickness was shown (r = 0.486, p = .002 vs. r = 0.389; p = .09). However, the latter did not reach statistical significance in the NTG group., Conclusion: PD at the central 3 mm around the fovea is comparable between HTG and NTG. Significant correlation with age and MD was shown in both groups.

Background: To evaluate a recently established grading protocol for diabetic macular edema (DME) over the course of intravitreal anti-VEGF treatment with ranibizumab., Methods: Fluorescein angiography images and optical coherence tomography scans before treatment and after 3 monthly applied intravitreal ranibizumab injections were retrospectively graded for each included study eye according to the recently introduced "SAVE" grading protocol ("S"= subretinal fluid; "A"= "area of retinal thickening"; "V"="vitreo-retinal abnormalities"; "E"="etiology of leakage focal versus non-focal") and correlated with best-corrected visual acuity (BCVA) in letters (lett)., Results: Five of the 39 included study eyes had subretinal fluid ("S") before treatment which resolved during treatment. BCVA of study eyes with an initial retinal thickening smaller than one disc diameter ("A") was non-significantly higher compared to patients with a retinal thickening greater than one disc diameter (34.0 ± 17.9 lett versus 25.3 ± 13.3 lett, p=0.236) but became significant during treatment (40.5 ± 10.0 lett versus 28.3 ± 13.1 lett, p=0.004). No difference in BCVA was observed between patients with or without vitreo-retinal abnormalities ("V") before and during therapy. BCVA in patients with focal leakage ("E") was significantly higher than in patients with non-focal leakage before (33.1 ± 12.3 lett versus 23.3 ± 13.3 lett, p=0.017) and during (38.9 ± 10.9 lett versus 26.3 ± 12.6 lett, p=0.002) therapy., Conclusions: Applying the grading protocol "SAVE", focal leakage ("E") was the only retrospectively observed parameter which significantly correlated with a better BCVA before therapy and over the course of treatment in patients with fovea-involving DME.