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Purpose To evaluate whether hyperopic patients with short axial length and high dioptric intraocular lens (IOL) power can achieve a higher depth of focus after implantation of a monofocal spherical or aspheric IOL than emmetropic patients. Setting Department of Ophthalmology, Medical University Graz, Graz, Austria. Design Prospective case series. Methods Patients presenting for cataract surgery were divided by calculated IOL power into a hyperopic (≥22.0 diopters [D]) or emmetropic (18.0 to 21.5 D) groups and received an aspheric (Tecnis ZA9003) or a spherical IOL (Sensar AR40e). Postoperative measurements included corrected (CDVA) and uncorrected (UDVA) distance visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuities, root-mean-square values of corneal and total eye higher-order aberrations and spherical aberrations, and photopic and mesopic contrast sensitivity. Results Sixty-two eyes of 62 patients were enrolled in this study, 34 eyes (15 hyperopic, 19 emmetropic) in the aspheric IOL group and 28 eyes (14 hyperopic, 14 emmetropic) in the spherical IOL group. The UDVA, CDVA, and contrast sensitivity did not differ significantly between the 2 IOL groups, whereas the DCIVA and DCNVA were significantly better in the spherical IOL group (P = .004 and P = .001, respectively). No significant differences were found in DCIVA and DCNVA between hyperopic patients and emmetropic patients with aspheric or spherical IOLs. Conclusions Implantation of a monofocal spherical IOL resulted in an increased depth of focus without significant degradation of distance visual acuity or contrast sensitivity. There were no differences in the depth of focus between hyperopic eyes and emmetropic eyes.

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy.Department of Ophthalmology, University of Vienna, Vienna, Austria.This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used.Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively).Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Purpose To analyze the changes in optic surface roughness before and after injection of various intraocular lens (IOL) models using atomic force microscopy (AFM). Settings Departments of Ophthalmology, Medical University of Graz, General Hospital Linz and University Hospital Basel; Upper Austria University, School of Applied Health and Social Sciences, Linz, Austria. Design Experimental study. Methods The morphology and surface roughness of 3 hydrophobic acrylic IOLs from different manufacturers were analyzed by AFM in liquid using the tapping mode. First, AFM was performed on IOLs taken from the original package without further manipulation. In a second step, under sterile conditions, an experienced cataract surgeon loaded the IOLs into the appropriate injection system and pushed them through a system resembling an IOL implantation in cataract surgery; this was followed by AFM evaluation. Finally, 3 samples of a preloaded hydrophilic acrylic IOL taken from the original cartridge were compared with 3 samples that were pushed through the implantation system. Results Comparison of the arithmetic mean, standard deviation, root mean square, and surface skewness of the IOLs before and after injection showed a significant increase in surface roughness (P Conclusions Standard application procedures of IOLs may alter the IOL surface. Increases in the surface roughness of IOLs may influence postoperative posterior capsule opacification. Further studies are necessary to evaluate the interfacial properties of IOLs. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose To evaluate inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy (NPDR) and compare results with 2 intraocular lenses (IOLs): a foldable hydrophobic acrylic and a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA). Setting Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods Patients with NPDR were randomized for implantation of an HSM PMMA IOL (811C®, Pharmacia) through a 6.0 mm sclerocorneal incision (30 patients) or a foldable hydrophobic acrylic IOL (AcrySof®, Alcon) through a 4.0 mm sclerocorneal incision (32 patients). Both IOLs had 6.0 mm optics. All patients were treated according to a standardized protocol. The degree of flare in the anterior chamber was measured with the Kowa 1000 laser flare–cell meter 1 day preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Results In both IOL groups, flare was highest on the first postoperative day and decreased to preoperative levels by 3 months after surgery. There was no statistically significant difference in relative flare values between the 2 groups. Conclusion There was no difference in postoperative inflammation in eyes with a foldable hydrophobic acrylic IOL implanted through a small incision and those with a rigid HSM PMMA IOL. Postoperative inflammation results indicate that the lenses are equally suitable for the use in patients with diabetic retinopathy.

Purpose: To evaluate the efficacy and complications of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous effusion after cataract and combined cataract and glaucoma surgery. Setting: University Eye Hospital Vienna, Austria. Methods: In a prospective study, 40 eyes of 39 patients with severe fibrinous anterior chamber reaction in the early postoperative course received 25 µg r-tPA intracamerally through a temporal paracentesis. The main outcome measures were rate of complete fibrinolysis, time of maximal effect, and complications. Results: Complete fibrinolysis occurred in 33 eyes (83%) after a mean of 3.2 hours ± 0.9 (SD). The rate of complete fibrinolysis was higher in eyes having cataract surgery only (24 eyes, 89%) than in those having combined surgery (9 eyes, 69%). Recurrent fibrin was seen in 3 eyes (7%), small anterior chamber hemorrhage in 7 (18%), increased intraocular pressure in 3 (7%), and posterior synechias in 13 (33%). Complications were managed conservatively. Conclusion: The intracameral injection of 25 µg r-tPA proved to be a safe, efficient, and low-risk supplement in the treatment of severe postoperative fibrinous reactions.

We did a prospective study of 49 eyes (36 patients) with coexisting cataract and glaucoma who had combined trabeculectomy, phacoemulsification, and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Preoperatively, intraocular pressure (IOP) was controlled (20 mm Hg) in 13 eyes on a mean of 2.2 medications and uncontrolled (20 mm Hg) in 36 eyes on a mean of 2.4 medications. Preoperative visual acuity ranged from 20/40 to hand movements. At the end of the follow-up, IOP was below 18 mm Hg in all eyes (100%), without therapy in 39 (80%) and with reduced therapy in 8 (16%). Two (4%) eyes were controlled on the same medication regimen. Visual acuity improved in 42 patients (86%); 38 (78%) achieved a visual acuity of 20/40 or better. A filtering bleb was observed in 45 eyes (92%). The most common early postoperative complication was fibrin exudation into the anterior chamber. Late complications included posterior synechias and vision-impairing capsule opacifications. Visual acuity improved after neodymium:YAG laser treatment in all eyes with opacification without further complications. We conclude that the combination of small incision cataract surgery and trabeculectomy is a successful surgical approach for long-term visual rehabilitation and glaucoma control.