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Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: To the best of our knowledge, there is no validated classification to assess intraoperative adverse events (iAEs) in ophthalmic surgery. ClassIntra is a newly developed classification for surgery- and anaesthesia-related iAEs that has been recently validated in various surgical disciplines, but not in ophthalmic surgery. We aim to assess the validity and practicability of ClassIntra in patients undergoing ophthalmic surgery., Methods: A consecutive sample of in-hospital patients undergoing any type of ophthalmic surgery was included in this single-centre prospective cohort study. iAEs were classified using ClassIntra, consisting of 5 severity grades according to the symptoms of the patient and the required treatment. All patients were followed for two weeks to record all postoperative adverse events according to Clavien-Dindo. The primary endpoint was the risk-adjusted association between the most severe iAE and the weighted sum of all postoperative adverse events within the two-week follow-up using the Comprehensive Complication Index (CCI). In addition, ophthalmologists and anaesthesiologists were asked to complete an online survey assessing the severity of iAEs for 10 fictitious clinical case scenarios. Reliability was assessed by comparing the clinicians' ratings to the prespecified benchmark rating of the study team., Results: In this study, 100 in-hospital patients with an average age of 64 years (SD 15) were included. The majority of all patients were ASA II (n = 53, 53%) or III (n = 42, 42%). Thirty-two iAEs were recorded in 22 patients (17 grade I, 12 grade II, 3 grade III). Ninety-four postoperative adverse events occurred in 50 patients (44 grade I, 36 grade II, 14 grade IIIa). We found a mean difference in CCI of 2,1 (95% confidence interval [CI] - 2,5 to 6,8) per one unit increase in severity grades of ClassIntra. Fifty ophthalmologists and anaesthesiologists completed the online survey (response rate 54%). The intraclass correlation coefficient was 0,79 (95% CI 0,64 to 0,94)., Conclusions: The application of ClassIntra during daily routine in ophthalmic surgery showed the usefulness and practicability of this classification for the standardised assessment of intraoperative adverse events. Although construct validity could not be demonstrated, the good reliability in the survey's rating underlines the criterion validity of this newly developed classification in ophthalmic surgery., Competing Interests: Einige der Co-Autoren (RR und SDK) waren Teil des Teams, das ClassIntra entwickelt und validiert hat. ClassIntra wurde als Handelsname bei der World Intellectual Property Organization registriert. Keiner der Autoren hat einen finanziellen Nutzen durch den Gebrauch der Klassifikation und somit auch keinen Interessenkonflikt. Rachel Rosenthal ist eine Mitarbeiterin von Hoffmann-La Roche Ltd. (beinhaltet S-SARs). Die aktuelle Studie weist keine Verbindung zu ihrer Anstellung bei der Firma auf. Rachel Rosenthal hat weiterhin eine Affiliation mit der Universität Basel. Pascal W. Hasler ist Berater für die Firmen Roche, Novartis, Bayer, Allergan und Topcon und hat keinen Interessenkonflikt., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: The aim of our study was to evaluate the clinical outcomes after Keraring implantation for keratoconus in patients with thin corneas., Patients and Methods: Ten eyes from 10 patients with keratoconus, who underwent femtosecond laser-assisted Keraring implantation for keratoconus, were included in this retrospective study. Uncorrected visual acuity (UCVA), corrected visual acuity (CDVA), keratometric readings, central corneal thickness and thinnest corneal pachymetry have been evaluated preoperatively and 6 months after the Keraring implantation., Results: UCVA, BCVA and keratometric readings improved at 6 months postoperatively., Conclusions: Our data showed significant keratometric amelioration and visual improvement after Keraring implantation for keratoconus in patients with thin corneas at 6 months postoperatively., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Capsulorhexis is one of the most important steps in cataract surgery. Good centration, circular overlap in sufficient size and a circular edge without tears result in good centration of the intraocular lens (IOL). In this study, the capsulorhexis results of an experienced surgeon are compared with reported data in femtolaser assisted cataract surgery (FLACS)., Patients and Methods: 105 consecutive operations were photographically documented; in 81 cases size and overlap were analysed retrospectively. The surgeon's personal anterior capsular tear rate was taken from the EUREQUO database., Results: Average rhexis size was 5.03 ± 0.3 mm; the difference between the two measured diameters was 0.28 ± 0.18 mm. Circular overlap was found in 88.9% of cases. No radial tears were observed in 8000 operations in EUREQUO, resulting in a rate of less than 0.0125% in manual surgery., Conclusions: The overlap rate of manual surgery was comparable to FLACS; whether the slightly 'rounder' capsulotomy is clinically relevant remains unclear. The risk of an anterior capsular tear is very low in the hands of an experienced surgeon and even lower than with FLACS., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Dacryocystography is a radiological procedure for the examination and localisation of obstructions of the lacrimal ducts, the findings of which are decisive for the choice between conservative or invasive surgical measures and thus for treatment planning.

We report on the first implanted Osteo-Odonto-Keratoprosthesis (OOKP) in Switzerland. The procedure is only performed in cases of severe bilateral corneal vision impairment without alternatives (e. g. allogenic corneal transplant). At this two-staged surgery a single-rooted tooth is removed with its belonging bone and an optic cylinder is centrally inserted. This tooth-bone-optic-cylinder-complex is implanted temporarily submuscular in the infraorbital area. Oral mucosa is removed and transplanted on to the eye. Three months later the complex is removed, the oral mucosa partially detached, the underlying cornea perforated, the lens, iris and anterior vitreous body removed and the tooth-optic-zylinder-complex fixated on the globe. After this procedure, our patient has a best corrected visual acuity of 0,7.

A problem in cataract surgery consists in the preoperative identification of the appropriate intraocular lens (IOL) power. Different calculation approaches have been developed for this purpose; raytracing methods represent one of the most exact but also mathematically more challenging methods. This article gives a systematic overview of the different raytracing calculations available and described in the literature and compares their results. It has been shown that raytracing includes physical measurements and IOL manufacturing data but no approximations. The prediction error is close to zero and an essential advantage is the applicability to different conditions without the need of modifications. Compared to the classical formulae the raytracing methods are more precise overall, but due to the various data and property situations they are hardly comparable yet. The raytracing calculations represent a good alternative to the 3rd generation formulae. They minimize refractive errors, are wider applicable and provide better results overall, particularly in eyes with preconditions., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: "Hornussen" is a traditional Swiss team game played in rural areas of Switzerland. A puck made out of hard plastic called "Hornuss" or "Nouss" is hit with a lash like racket into the field. The opposing team has to capture the flying puck with shovel like shields. Eye injuries are rare, however, very severe., Patients: We report on three patients who were seen and treated at the university eye clinic Berne in the last four years., Results: All injuries were blunt contusions with involvement of the periorbital soft tissues by a hit with the "Hornuss". In two cases orbital fractures were observed and in one case there was a rupture of the globe in a pre-injured aphakic eye. Only in one case was there a direct hit to the eye by the "Hornuss", the other injuries were caused by indirect hit after the "Hornuss" bounced off the shovel like shields. No protection gear was used. One patient showed complete recovery, whereas in the other two cases significant impairment remained., Conclusions: Without adequate protection gear, injuries caused by "Hornussen" are generally severe. The injury pattern with periorbital involvement resembles eye injuries caused by baseballs. This is probably due to the similar size of the balls. The mandatory wearing of protection helmets issued by the federal "Hornusser" association for young players should be extended as a general requirement for all players.

Background: Purpose of this retrospective study was to analyze outcome and complications after penetrating keratoplasty (PK) in patients with Down's syndrome., Patients and Methods: The medical records of all patients with Down's syndrome and PK from 1985 were reviewed retrospectively. Age, sex, systemic diseases, communication, indication for surgery and surgical technique, age at first PK, complications, visual acuity and best corrected visual acuity and findings at last follow-up were noted. Age matched mentally non-retarded patients with keratoconus and PK served as a control group., Results: All eyes of 9 patients had keratoconus, 16 were operated. Indication for surgery was spontaneous perforation in 3 and refractive in the remaining 13 eyes. Five grafts were clear at last follow-up. In 7 eyes, at least 1 re-PK had to be performed. Seven eyes developed graft rejection and 4 eyes needed conjunctival grafting because of non-healing epithelial defects. Ten eyes developed cataracts, 3 secondary glaucoma. In the control group 22 out of 25 operated corneas were clear at last follow-up., Conclusions: Prognosis of PK in patients with Down's syndrome is worse than in other patients with keratoconus. Poor results are not only explained due to the lack of cooperation of patients, but also because of: 1) high rate of emergency procedures (3/16), 2) presence of lid anomalies and 3) very advanced keratoconus, necessitating bigger sized grafts, leading to frequent immunological reactions, suture loosening and secondary glaucoma. Indication for PK in Down's syndrome patients with keratoconus and floppy eyelids should be very restrictive. Postoperative complications and the high rejection rate might be decreased by performing deep lamellar keratoplasty as this would not be an intraocular procedure.