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To find baseline predictors for subretinal fibrosis (SF) in neovascular age-related macular degeneration (nAMD). Forty-five eyes of 45 participants with treatment-naïve nAMD were consecutively enrolled and treated according to a standardized treat-and-extend protocol. Spectral-domain optical coherence tomography (OCT), color fundus photography and fluorescein angiography as well as novel imaging modalities polarization-sensitive OCT and OCT angiography (OCTA) were performed to detect SF after 1 year and find baseline predictors for SF development. Baseline OCTA scans were evaluated for quantitative features such as lesion area, vessel area, vessel junctions, vessel length, vessel endpoints and mean lacunarity. Additionally, the type of macular neovascularization, the presence of subretinal fluid, intraretinal fluid (IRF), subretinal hyperreflective material (SHRM), retinal hemorrhage as well as best-corrected visual acuity (BCVA) were evaluated. After 12 months 8 eyes (18%) developed SF. Eyes with SF had worse baseline BCVA (p = .001) and a higher prevalence of IRF (p = .014) and SHRM at baseline (p = .017). There was no significant difference in any of the evaluated quantitative OCTA parameters (p > .05) between eyes with and without SF. There were no quantitative baseline microvascular predictors for SF in our study. Low baseline BCVA, the presence of IRF and SHRM, however, are easily identifiable baseline parameters indicating increased risk.

Purpose To prospectively evaluate the outcomes of different subtypes of neovascular age-related macular degeneration during intravitreal aflibercept monotherapy. Methods Forty-four eyes of 44 patients with treatment-naive polypoidal choroidal vasculopathy (PCV, n = 12), hemorrhagic choroidal neovascularization (hCNV, n = 12), pigment epithelium detachment (PED, n = 11), or retinal angiomatous proliferation (RAP, n = 9) were included and followed for 12 months. All patients received intravitreal aflibercept monotherapy. Results Mean visual acuity at baseline in PCV was 67 ± 16 Early Treatment Diabetic Retinopathy Study letters (20/50 Snellen equivalent), in hCNV 55 ± 21 (20/80), in RAP lesions 64 ± 11 (20/50), and in PED 74 ± 7 (20/32). At Month 12, visual acuity in PCV was 66 ± 16 (20/50), in hCNV 69 ± 17 (20/40), in RAP 68 ± 12 (20/50), and in PED 69 ± 18 (20/40). At the 12-month follow-up, visual acuity improved or was stable (±5 letters from baseline) in 84% of eyes (37/44 patients), with hCNV showing the greatest mean visual acuity gain. Mean central retinal thickness in patients with PCV was 523 ± 251 µm, in hCNV 497 ± 171, in RAP lesions 573 ± 132, and in PED 541 ± 158 and decreased to 310 ± 91 µm in PCV, 323 ± 75 µm in hCNV, 357 ± 173 µm in RAP lesions, and 422 ± 150 µm in PED. The mean area of atrophy increased from 2.0 ± 3.6 mm2 at baseline to 4.6 ± 8.6 mm2 at Month 12 (mean difference [95% confidence interval] -0.8 [-8.5 to 7.0], P = 0.8), with the greatest atrophy in patients with PED at Month 12. Conclusion All subtypes of neovascular age-related macular degeneration showed anatomical improvement and stabilization of visual function during intravitreal treatment.

Background The present study aims to investigate an automated qualitative and quantitative assessment system (Automated Quantification of After-Cataract [AQUA II]) of posterior capsule opacification (PCO) in high-resolution digital retroillumination images and consequently reduce observer bias and increase accuracy of PCO grading. Methods A data set of 100 eyes with no to severe PCO was analysed. Ten eyes were consecutively photographed twice and ten images were rotated to give a total of 120 images for PCO assessment. Validity was determined by including subjective grading and repeatability was determined by evaluating the 20 additional images. Evaluation of posterior capsular opacification (EPCO), posterior capsule opacity (POCO) and AQUA I methods were included for comparative analysis of the data. Results The system developed proved to classify six types of PCO. Validity was confirmed by a Pearson correlation coefficient of r = 0.95 (EPCO r = 0.93; POCO r = 0.72 and AQUA I r = 0.94). Repeatability was better in AQUA II (95% confidence interval [CI] for mean difference: 0.5 ± 1.2) than in subjective grading (95% CI for mean difference: 0.6 ± 1.7), in EPCO grading (95% CI for mean difference: − 0.2 ± 1.5), in POCO grading (95% CI for mean difference: 1.6 ± 2.7) and in AQUA I (95% CI for mean difference: − 1.1 ± 1.9). Conclusions AQUA II is a system that for the first time not only objectively quantifies PCO, but also qualitatively assesses PCO in an automated manner with texture classification. AQUA II showed an excellent validity and repeatability.

PURPOSE To investigate the effects of vitrectomy (Vy) with or without same time cataract surgery and membrane plus internal limiting membrane peeling (MP+ILMP) on retinal oxygenation and choroidal volume and their role on postoperative outcome. METHODS Thirty-two eyes were included in this prospective clinical study. All patients received 23 gauge Vy+MP+ILMP without endotamponade. Additional cataract surgery was performed in 14 patients. Follow-up visits were scheduled at day 1, week 1, month 1 and month 3. At each visit, best corrected visual acuity (BCVA) using ETDRS charts (except at day 1), oxygenation of retinal vessels using the Oxymap T1, and optical coherence tomography (OCT, Heidelberg Spectralis) was performed. RESULTS Mean BCVA increased significantly from 73 ± 11 letters to 77 ± 7 letters at month 3 (p = 0.02). Mean central retinal thickness (CRT) decreased from 456 ± 84 µm at baseline to 418±58µm (p = 0.01 baseline versus month 3). In the cataract surgery group, CRT was higher at month 3 than in the group without (400 ± 58 µm versus 441 ± 51 µm; p = 0.007). There was no statistically significant difference in choroidal volume or oxygenation of retinal vessels between groups (additional cataract surgery versus vitrectomy alone). Oxygenation of retinal arteries tended to decrease at day 1 followed by an increase, but the changes did not reach the level of significance (p = 0.29 baseline versus month 3). Oxygenation of retinal veins increased significantly (p = 0.02 baseline versus month 1; p = 0.04 baseline versus month 3, accordingly). There was a significant negative correlation (Spearman correlation coefficient rs = -0.35, p = 0.047) between visual acuity and oxygenation of retinal veins at month 3. No statistically significant correlation was found between CRT and oxygenation of neither retinal arteries nor veins. Choroidal volume (CV) of the central mm did not change significantly during the study period (baseline: 0.203 ± 0.04 mm3 , median: 0.206, month 3: 0.205 ± 0.04 mm3 , p = 0.54). There was no statistically significant effect of choroidal volume at baseline on postoperative clinical outcomes (change in BCVA estimate [95% CI]: 7 [-76; 90], p = 0.86; change in CRT: 147 [-577; 871], p = 0.68). CONCLUSION Oxygen saturation may affect the visual acuity outcome but not the CRT in patients after vitrectomy for epiretinal membrane. Choroidal thickness had no statistically significant influence on the study outcomes. Further studies are needed to evaluate if the measurement of retinal oxygenation may be helpful in the decision for surgery.

Purpose To evaluate morphologic and microvascular differences between eyes with and without subretinal fibrosis (SF) caused by neovascular age-related macular degeneration (nAMD). Methods Patients with nAMD with a minimum history of 12 months of anti-VEGF treatment were prospectively included in this cross-sectional study. Patients were imaged using standard imaging, swept-source optical coherence tomography angiography for quantitative microvascular analysis and polarization-sensitive OCT as an ancillary method for automated SF segmentation. The presence of reticular pseudodrusen, hyperreflective foci (HRF), and outer retinal tubulation (ORT) were also evaluated. Results Sixty eyes of 60 participants (37 female) with nAMD and a mean 3.1 (±2.7)-year history of anti-VEGF treatment were included, 20 (33%) of which were diagnosed with SF. Eyes with SF had a higher prevalence of ORT (P < 0.001) and a lower prevalence of HRF (P = 0.004) than eyes without SF. Fifty eyes were analyzed quantitatively for microvascular biomarkers. Eyes with SF had a larger greatest vascular caliber (P = 0.001) and greatest linear diameter (P = 0.042), a larger microvascular neovascularization (MNV) area (P = 0.026), larger vessel area (P = 0.037), higher number of vessel junctions (P = 0.025), longer total vessel length (P = 0.027), higher number of vessel endpoints (P = 0.007), and higher endpoint density (P = 0.047). Conclusions This multimodal imaging approach demonstrated in vivo microvascular and morphological differences in eyes with and without SF. Eyes with SF tend to have larger MNV lesions with thicker vessels and are often associated with the presence of ORT. Translational Relevance This study points out imaging biomarkers in patients with SF, which may help identifying high-risk patients.

To assess the efficacy of a combination therapy of intravitreal ranibizumab together with a dexamethasone implant in comparison with ranibizumab monotherapy in neovascular age-related macular degeneration. Forty eyes of recurrent or persistent neovascular age-related macular degeneration were included in this prospective study. Patients were randomly assigned to two groups. Based on a pro re nata treatment regimen, the first group received intravitreal ranibizumab monotherapy (IVM). The second group received a combination of intravitreal dexamethasone implant and ranibizumab (intravitreal combination [IVC]) at baseline and was retreated with ranibizumab as needed. A second dexamethasone implant was allowed for retreatment after at least 6 months. Retreatment criteria included evidence of subretinal fluid, cystoid macular edema or new hemorrhage, and/or a visual acuity decrease of 5 Early Treatment Diabetic Retinopathy Study letters. During 12 months, a mean of 7.95/5.5 (IVM/IVC; P = 0.042) retreatments were given. The median time until first retreatment differed significantly between the groups (P = 0.004). Functional variables could be maintained in both groups with no differences between them. Visual acuity changed from 62 letters at baseline to 67 at Month 12 in the IVM and remained stable at 68 letters in the IVC group (P = 0.68); macular sensitivity changed from 6.95 dB to 7.01 dB in IVM and from 7.24 dB to 7.12 dB in IVC (P = 0.4). Central retinal thickness decreased, however, with no difference between the groups (P = 0.38). In the IVM/IVC group, 11/12 (55/60%) patients were phakic at the time of study entry. One (9%) patient from the IVM and 4 (33%) from the IVC group were referred to cataract surgery after study completion (P = 0.4). This pilot study indicates combined therapy to delay retreatment in patients with persistent/recurrent neovascular age-related macular degeneration and an overall reduction in required ranibizumab retreatments compared with ranibizumab monotherapy with consistent functional outcomes.

Purpose: To describe and follow cotton wool spots (CWS) in branch retinal vein occlusion (BRVO) using multimodal imaging. Methods: In this prospective cohort study including 24 patients with new-onset BRVO, CWS were described and analyzed in color fundus photography (CF), spectral domain optical coherence tomography (SD-OCT), infrared (IR) and fluorescein angiography (FA) every 3 months for 3 years. The CWS area on SD-OCT and CF was evaluated using OCT-Tool-Kit software: CWS were marked in each single OCT B-scan and the software calculated the area by interpolation. Results: 29 central CWS lesions were found. 100% of these CWS were visible on SD-OCT, 100% on FA and 86.2% on IR imaging, but only 65.5% on CF imaging. CWS were visible for 12.4 ± 7.5 months on SD-OCT, for 4.4 ± 3 months and 4.3 ± 3.4 months on CF and on IR, respectively, and for 17.5 ± 7.1 months on FA. The evaluated CWS area on SD-OCT was larger than on CF (0.26 ± 0.17 mm2 vs. 0.13 ± 0.1 mm2, p < 0.0001). The CWS area on SD-OCT and surrounding pathology such as intraretinal cysts, avascular zones and intraretinal hemorrhage were predictive for how long CWS remained visible (r2 = 0.497, p < 0.002). Conclusions: The lifetime and presentation of CWS in BRVO seem comparable to other diseases. SD-OCT shows a higher sensitivity for detecting CWS compared to CF. The duration of visibility of CWS varies among different image modalities and depends on the surrounding pathology and the CWS size.

Background To evaluate the change in peripheral perfusion status in patients with retinal vein occlusion (RVO) during dexamethasone treatment. Methods Thirty-five eyes of patients with macular oedema due to either branch or central retinal vein occlusion were included. At baseline, patients were treated with an intravitreal dexamethasone implant (Ozurdex® ) and followed until month 6. Wide-field angiographies were classified as ischaemic and nonischaemic. Peripheral nonperfusion (PNP) was determined manually by calculating the percentage of nonperfusion area in relation to the total visible retina (ischaemic index). Results Thirteen eyes showed evidence of >10 disc area of PNP at baseline and were graded as ischaemic RVO. In nonischaemic eyes, the mean area of PNP was 0.3% at baseline, 0.6% after 1 month, 0.6% after 3 months and 0.6% after 6 months, respectively (p > 0.05). In ischaemic RVO, the ischaemic index was calculated to be 18% at baseline. One month after treatment, mean area of PNP was 16% and after 3 months was 19% (p = 0.8; p = 0.6). After retreatment, total PNP area was 18% (month 6; p = 0.9). During treatment, best-corrected visual acuity (BCVA) increased and central retinal thickness (CRT) decreased from baseline to final follow-up with no differences between nonischaemic/ischaemic RVO. A significant negative correlation between the total area of PNP and visual acuity was identified (r = -0.6; p = 0.04). Conclusion Using 200° wide-field fluorescein angiography, the ischaemic index was shown to remain stable during dexamethasone treatment. This finding was consistent in ischaemic as well as in nonischaemic conditions.

Purpose The purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice. Methods Retinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients' subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). Results Data from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r = -0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r = -0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r = -0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r = -0.4) with the subjective problems reported and overall NEI VFQ-25 score. Conclusion In conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients' subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine.

To evaluate microperimetry changes in patients with acute macular edema secondary to branch retinal vein occlusion during a follow-up period of 12 months with intravitreal ranibizumab treatment (Lucentis; Novartis).Patients with macular edema secondary to branch retinal vein occlusion received an intravitreous injection of 0.5 mg of ranibizumab (0.05 mL). Best-corrected visual acuity, Spectralis OCT (Heidelberg Engineering), and color fundus photography were performed at monthly intervals over a follow-up period of 1 year. Macular function was documented by microperimetry (Nidek, MP-1) at baseline, 3, and 12 months.Data of 20 patients without lack of microperimetry results were included to the statistical analyses. The size of the area of absolute scotoma was reduced from 16% at baseline to 11.7% at Month 3 and remained stable in the entire study duration (P0.05). Mean differential light threshold improved significantly under therapy from 9.47 dB at baseline to 12.53 dB at 12 months (P0.001). Best-corrected visual acuity correlated significantly with central millimeter thickness and mean retinal sensitivity at baseline and at 12-month follow-up visits.In addition to anatomical restoration and increased visual acuity, intravitreal ranibizumab also improved the central macular function in patients with acute macular edema after branch retinal vein occlusion.

To compare the intensity of posterior capsule opacification (PCO) between two intraocular lenses (IOLs) of the same optic material, but with different haptic design (1-piece vs. 3-piece).This prospective intraindividual controlled cohort study comprised eighty eyes of 40 patients with bilateral age-related cataract. Each patient received a Polylens Y10 (Polytech, Germany) 1-piece IOL in 1 eye and a Polylens Y30 (Polytech, Germany) 3-piece IOL in the contralateral eye. The IOL type in the first operated eye was randomly assigned before patient recruitment. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for regeneratory PCO. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.The Polylens Y10 (1-piece) group showed significantly higher regeneratory and fibrotic PCO scores 1 year after surgery in subjective slitlamp evaluation, however not with objective evaluation using automated image-analysis software. Subjective PCO assessment resulted in a mean PCO score (scale = 0-10) of 1.6 in the Polylens Y10 group and 0.6 in the Polylens Y30 group at 1 year (p0.05). The mean automated image-analysis software PCO score was 1.5 in the Polylens Y10 group and 0.9 in the Polylens Y30 group (p = 0.6).Both investigated IOLs showed good clinical performance regarding PCO, BCVA and IOL-centration. The Polylens Y10 IOL showed slightly more regeneratory PCO than the 3-piece acrylic IOL 1 year after surgery.

Purpose To compare the rotational stability and posterior capsule opacification (PCO) rate in eyes with a 1-piece or 3-piece acrylic intraocular lens (IOL). Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Design Prospective randomized masked clinical trial. Methods Patients with age-related cataract received a plate-haptic acrylic IOL (Acri.Smart 46S) in 1 eye and a 3-piece loop-haptic acrylic IOL (Acri.Lyc 53N) in the other eye. Retroillumination images were taken 1 hour, 1 week, and 1, 6, and 12 months postoperatively. Intraocular lens rotation was measured using standard software (Adobe Photoshop). The amount of PCO was assessed subjectively at the slitlamp and objectively using an automated image-analysis software (AQUA). Results The study enrolled 80 eyes of 40 patients. The IOL rotation measurements showed excellent reproducibility, with a deviation of less than 0.8 degrees. Both IOLs had comparable and good rotational stability; rotation was less than 4 degrees in 71% of eyes 1 year postoperatively. The mean absolute rotation was 2.6 degrees ± 1.9 (SD) in the plate-haptic IOL group and 3.1 ± 2.4 degrees in the loop-haptic IOL group. The mean AQUA PCO score (scale 0 to 10) was 0.4 in both IOL groups ( P =.7). Conclusion The 2 IOL models had comparable, excellent rotational stability and low PCO intensity 1 year postoperatively. Thus, the plate-haptic IOL may be a good platform for a toric model. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. Many studies have attempted to identify factors that influence the development of PCO. The aim of this systematic review based on Cochrane methodology was to summarize the effects of intraocular lens (IOL) geometry, including modifications of the IOL optic (especially optic edge design) and haptics, on the development of PCO. Twenty-six prospective randomized controlled trials with a follow-up of at least 12 months were included. In 5 of 7 studies, visual acuity was better in sharp-edged IOLs than in round-edged IOL. The PCO score was significantly lower with sharp-edged IOLs but did not differ significantly between 1-piece and 3-piece open-loop IOLs. Because of the significant difference in the PCO score, sharp-edged IOL optics should be preferred to round-edged IOL optics.

Purpose To describe a way to eliminate the problem caused by missing data due to neodymium:YAG (Nd:YAG) laser capsulotomies before statistical analysis, which leads to incomplete data in long-term studies of posterior capsule opacification (PCO). Setting Medical University of Vienna, Vienna, Austria. Methods To demonstrate the problem, an existing long-term study comparing PCO development in eyes with round-edged and sharp-edged intraocular lenses (IOLs) was analyzed. In the study, several Nd:YAG capsulotomies led to dropouts in the round-edged IOL group. To solve the resulting missing value problem, the missing values were replaced by estimated PCO values in various scenarios; that is, different assumptions were made of how PCO would have developed without a capsulotomy. Standard statistical analyses that included the estimated PCO values rather than excluding the incomplete cases were then performed. Results The analysis of all cases (including the estimated PCO scores) showed a highly significant difference between the round-edged group and the sharp-edged group. Sensitivity analyses confirmed that the difference between the 2 groups remained significant up to highly implausible values chosen for the missing PCO scores, thus proving the correctness of the analysis. Conclusions This study showed it is possible to perform statistical analyses without excluding incomplete cases. This approach is recommended for all studies with Nd:YAG dropouts as it increases the statistical power. Excluding incomplete cases may lead to biased or wrong study conclusions.

To evaluate the influence of hydrophilic and hydrophobic acrylic material and haptic angulation on anterior capsule opacification (ACO).Prospective study on 53 patients with bilateral age-related cataract. Patients underwent standard cataract surgery by the same surgeon and randomly received a hydrophilic acrylic intraocular lens (IOL) in one eye and a hydrophobic acrylic IOL in the other eye. Forty five of these patients completed the one-year follow-up. The following parameters were assessed: decentration, buttonholing, anterolenticular gap (ALG), ACO, outgrowth and refractive outcome.At the one-year follow-up, ACO was seen in 80% of the hydrophilic and 100% of the hydrophobic IOLs. ACO was more intense in the hydrophobic IOLs (p0.001). Outgrowth was seen in 42% of the hydrophilic and 2% of the hydrophobic IOLs (p = 0.0003). No case of persisting ALG was seen in the hydrophobic IOLs, but in 42% of the hydrophilic IOLs. The refractive outcome was -0.29 (SD 0.56) dioptres for the hydrophilic and 0.003 (SD 0.44) dioptres for the hydrophobic IOLs (p0.001).These results suggest that there is less ACO in hydrophilic acrylic than in hydrophobic acrylic IOLs. Although material properties might play a role, the angulated haptics of the hydrophilic IOLs exert an additional effect by the persisting ALG and a lack of contact between the IOL and the anterior capsule.

To evaluate the long-term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges.Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.This prospective bilateral randomized patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients with bilateral age-related cataract. All eyes had implantation of a 3-piece silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively.The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P.02; 2 years, P.03; 3 years, P.01; 5 years, P.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant.Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp-edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

Purpose: To evaluate the reproducibility of a new colour test, using the Chromatometer CM3. Methods: Twenty healthy subjects were recruited at the Department of Ophthalmology, at the Medical University of Vienna. A total of 40 eyes were tested. Both eyes were tested separately with the Chromatometer CM3. The colour test was repeated after several days. Each time, best-corrected visual acuity was tested using Snellen charts, and colour perception was tested using the Chromatometer CM3. Results: The Chromatometer CM3 showed reproducible results between the two tests at almost every luminosity level. All 4 green-red measurements and 2 blue-yellow brightness measurements showed reproducible results between the first and second tests. Conclusion: The Chromatometer CM3 seems to be an appropriate method to detect changes in colour perception, although the red-green comparison appeared to be more precise than the blue-yellow comparison.

Purpose To evaluate the interexaminer and intraexaminer reliability of corneal thickness, anterior chamber depth (ACD), and crystalline lens thickness measurements using a commercially available anterior segment optical biometry instrument (ACMaster, Carl Zeiss Meditec) based on partial coherence interferometry (PCI). Setting Medical University of Vienna, Vienna, Austria. Methods Interexaminer reliability and intraexaminer reliability were evaluated in 10 eyes of 10 young volunteers and 11 eyes of 11 cataract patients. The measurements of the interexaminer reliability were taken by 3 examiners. Corneal thickness, ACD, and lens thickness of the intraexaminer reliability were measured twice in all eyes by 1 examiner. To evaluate the effect of cycloplegia on the variability, the measurements were performed on 5 volunteers under cyclopentolate 1%. Measurements were performed using the prototype of the ACMaster based on PCI. Results The interexaminer/intraexaminer reliabilities were 99.9% for corneal thickness and ACD. The reliability of lens thickness could not be estimated because of a large number of missing values in the cataract patient group. The median interexaminer variability (SD) was 1.9 μm for corneal thickness, 7.5 μm for ACD, and 10.6 μm for lens thickness. The median intraexaminer variability (SD) was 1.6 μm for corneal thickness, 10.8 μm for ACD, and 8.7 μm for lens thickness. With cycloplegia, both the interexaminer variability and intraexaminer variability were smaller than without cycloplegia. Conclusions Partial coherence interferometry measurements of anterior chamber distances (corneal thickness, ACD, lens thickness) using the prototype of ACMaster were highly reliable, allowing examiner-independent measurements. However, lens thickness measurements in cataract eyes were often difficult.

Purpose To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates. Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed. Results Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients. Conclusions Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.

Purpose To investigate the correlation between change in contrast sensitivity (CS) and difference in objective posterior capsule opacification (PCO) score before and after Nd:YAG laser capsulotomy. Design Prospective interventional case series. Methods CS (Functional Acuity Contrast Test, or FACT, chart), distance visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] chart), and pupil size of 30 pseudophakic eyes with PCO of varying intensity were measured before and after capsulotomy. Digital retroillumination images were taken, and the area corresponding to the pupil size was evaluated with an automated PCO analysis program known as AQUA. Results The correlation between change in PCO score and change in CS was highest ( r = 0.85) for row B on the FACT chart and lowest ( r = 0.09) for row E. The correlation with change in ETDRS visual acuity was 0.57. Conclusions Objective PCO assessment by an automated image analysis system correlates well with PCO-induced loss of CS and is therefore an appropriate method for clinical studies on the development and prevention of PCO.

Purpose To assess and classify capsular bend configuration at the optic rim and its association with posterior capsule (PCO) and anterior capsule opacification (ACO) and capsulorhexis contraction with various intraocular lenses (IOLs). Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods A total of 659 post-cataract surgery eyes of 370 patients from different prospective randomized studies were evaluated. All eyes had standardized phacoemulsification surgery with implantation of an IOL in the capsular bag. The IOLs had a sharp or round optic edge design and were made of silicone, acrylic, or poly(methyl methacrylate) optic materials. One year postoperatively, the configuration of the capsular bend at the optic rim was assessed at the slitlamp, and standardized slitlamp images of ACO and fibrotic PCO were taken. One week, 1 year, and 3 years postoperatively, digital retroillumination images were taken for objective quantification of regeneratory PCO and the capsulorhexis area. The outcome measures were the type of capsular bend configuration, ACO score (0% to 100%), regeneratory PCO score (0 to 10), fibrotic PCO score (0 to 3), and amount of capsulorhexis contraction (mm2). Results Four main types of capsular bend configuration were classified: parallel, “Y,” right angle, and wrapping. The right-angle type was observed in the most cases (52%). Eyes with a wrapping capsular bend configuration had significantly less PCO, more capsulorhexis contraction, and more ACO than eyes with the other configurations. Wrapping capsule configuration was seen most often (55%) in round-edged silicone IOLs that had a thin optic rim. Conclusion The design and material of IOLs influenced the long-term capsular bend configuration at the optic rim. The right-angle type was the most common capsular bend configuration. Intraocular lenses with silicone optic material and a thin optic rim caused a wrapping capsule configuration and resulted in more capsulorhexis contraction and ACO, but less PCO.

To observe and document posterior capsule opacification (PCO) growth in vivo over a short period of time (4 weeks).Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.Fifteen eyes of pseudophakic patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images were taken in a standardized fashion at 3 time points: 1 baseline image, a second image after 2 weeks, and a third image after 4 weeks. Thus, a 3-image series could be created for each eye. Additionally, sections of the posterior capsule with interesting structures were photographed with higher magnification and compared in supplementary image series. Morphologic changes in the PCO structure (eg, number and size of Elschnig pearls, total PCO area) were analyzed in the image series.In all cases, significant changes could be observed between the 3 time points. In 71% of cases, some Elschnig pearls increased in size during the first 2 weeks and during weeks 3 and 4. In 73% of cases, however, there was a reduction a pearl size or even disappearance of some Elschnig pearls. The total PCO area did not change significantly during the 4-week period.Development of (regeneratory) PCO is a very dynamic process that includes not only growth of preexisting structures and occurrence of new Elschnig pearls, but also reorganization and even disappearance of pearls within a short time period (2-4 weeks). The latter in particular is not well known but could be observed in the majority of cases in this study.

Purpose To investigate the correlation between the change in visual acuity and the difference in objective posterior capsule opacification (PCO) scores before and after neodymium:YAG (Nd:YAG) laser capsulotomy. Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods Forty pseudophakic eyes of 35 patients with PCO of varying intensity were examined before and after Nd:YAG laser capsulotomy. Visual acuity was determined using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 4 m and the Holladay reading chart at 40 cm. The pupil diameter under reading conditions was measured each time. Digital retroillumination images of the posterior capsule were taken, and the corresponding area inside the pupil was evaluated using the Automated Quantification of After-Cataract (AQUA) automated PCO analysis program. The change in visual acuity and difference between PCO scores before and after Nd:YAG laser capsulotomy were calculated for all eyes. Results The mean AQUA score (scale 0 to 10) was 3.56 before and 0.13 after Nd:YAG laser capsulotomy. The mean ETDRS visual acuity score (logMAR scale) was 0.28 and −0.07, respectively. The correlation coefficient between the differences in PCO score and distance visual acuity was 0.61 and near visual acuity, 0.62. Conclusions The objective PCO score obtained by an automated image-analysis program correlates well with the PCO-induced decrease in visual acuity when the central area (inside the pupillary aperture) of the posterior lens capsule was evaluated. Objective PCO assessment by automated image-analysis systems is, therefore, a valuable and clinically relevant method for clinical studies of the development and prevention of PCO.

To compare the inhibiting effect on posterior capsule opacification (PCO) of a silicone intraocular lens (IOL) with a sharp posterior optic edge (ClariFlex OptiEdge, Advanced Medical Optics) and a silicone IOL with a round optic edge (PhacoFlex SI-40, Advanced Medical Optics).Department of Ophthalmology, University of Vienna, Vienna, Austria.This prospective randomized patient- and examiner-masked study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients had cataract surgery in both eyes and received a sharp-edged IOL in 1 eye and a round-edged IOL in the other eye. Postoperative examinations were at 1 week, 1 and 6 months, and 1 year. Digital slitlamp and retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using Automated Quantification of After-Cataract (AQUA) automated-image analysis software.The sharp-edged IOL group had significantly less regeneratory and fibrotic PCO 1 month, 6 months, and 1 year after surgery. The mean AQUA PCO score (scale 0 to 10) was 0.71 in the sharp-edged IOL group and 1.40 in the round-edged IOL group (P.001). The sharp-edged IOL group had less peripheral fibrotic PCO. There was no significant difference between the 2 IOL groups in patient reports of edge glare.The sharp-edged design of the ClariFlex OptiEdge silicone IOL led to significantly less PCO than the round-edged PhacoFlex SI-40 IOL 1 year postoperatively.

To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) (Allergan Surgical) with that of the round-edged design of the Sensar AR40 IOL. Setting Department of Ophthalmology, University of Vienna, Vienna, Austria.This prospective randomized patient- and examiner-masked study comprised 106 eyes of 53 patients with bilateral age-related cataract. Each patient had cataract surgery in both eyes and received an AR40 IOL in 1 eye and an AR40e IOL in the other eye. Postoperative examinations were at 1 week, 2 and 6 months, and 1 year. Digital slitlamp and digital retroillumination images of each eye were taken. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software.The AR40e group had significantly less regeneratory and fibrotic PCO 1 year after surgery. The mean automated image-analysis software PCO score (scale 0 to 10) was 2.19 in the AR40 group and 1.10 in the AR40e group (P.001). The AR40e group had less peripheral fibrotic PCO. There was no significant difference in patient-reported edge glare between the 2 IOL groups.The sharp-edged design of the Sensar OptiEdge AR40e IOL led to significantly less PCO than the round-edged AR40 IOL 1 year postoperatively.

The purpose of this study was to classify and detect intraretinal hemorrhage (IRH) in spectral domain optical coherence tomography (SD-OCT).Initially the presentation of IRH in BRVO-patients in SD-OCT was described by one reader comparing color-fundus (CF) and SD-OCT using dedicated software. Based on these established characteristics, the presence and the severity of IRH in SD-OCT and CF were assessed by two other masked readers and the inter-device and the inter-observer agreement were evaluated. Further the area of IRH was compared.About 895 single B-scans of 24 eyes were analyzed. About 61% of SD-OCT scans and 46% of the CF-images were graded for the presence of IRH (concordance: 73%, inter-device agreement: k = 0.5). However, subdivided into previously established severity levels of dense (CF: 21.3% versus SD-OCT: 34.7%, k = 0.2), flame-like (CF: 15.5% versus SD-OCT: 45.5%, k = 0.3), and dot-like (CF: 32% versus SD-OCT: 24.4%, k = 0.2) IRH, the inter-device agreement was weak. The inter-observer agreement was strong with k = 0.9 for SD-OCT and k = 0.8 for CF. The mean area of IRH detected on SD-OCT was significantly greater than on CF (SD-OCT: 11.5 ± 4.3 mm(2) versus CF: 8.1 ± 5.5 mm(2), p = 0.008).IRH seems to be detectable on SD-OCT; however, the previously established severity grading agreed weakly with that assessed by CF.

Purpose To compare the ocular wave-front of eyes with silicone Intraocular lens (IOLs) with aspheric and spherical optics after cataract surgery, taking into account the patient's pupil size under reading conditions and after pupil dilatation. Methods In this institutional prospective, randomized, controlled, patient and examiner masked, bilateral trial with intra-individual comparison, 60 eyes of 30 patients with bilateral age-related cataract were included. Each patient received a spherical IOL (CeeOn Edge, 911A, AMO, Santa Ana, CA, USA) in one eye and an aspheric IOL (Tecnis, Z9000, AMO) in the contra-lateral eye. Exclusion criteria were other ocular pathologies, capsular changes or zonular weakness. The main outcome variable was spherical aberration of the ocular wave-front under mesopic pupil conditions measured 2 years after surgery. Additional outcome variables were visual acuity and photopic and mesopic contrast sensitivity. Results There was no significant difference in visual acuity between the two IOL types under physiological pupil conditions and also not after pupil dilation. However, spherical aberrations were significantly lower with the aspheric IOL (SA: spherical 0.38 μm, SD: 0.11 μm; aspheric 0.10 μm, SD: 0.13 μm; p

To compare retinal thickness (RT) measurement and segmentation performance of time domain (TD, Stratus) and spectral domain (SD) optical coherence tomography (OCT) devices (Cirrus, Spectralis) for imaging macular oedema (ME) secondary to branch retinal vein occlusion (BRVO). In this study, 20 eyes of 20 consecutive patients with acute BRVO were included. A total of 18 unaffected fellow eyes served as control group. RT measurement was analysed in the five inner fields of the early-treatment diabetic retinopathy grid, and proportional segmentation errors were evaluated. Central millimetre thickness (CMT) showed a mean difference of −64, −74, and −18 μm (P

Retinal vein occlusion (RVO) is a common cause of vision loss in elderly people. The complex pathogenesis of central RVO (CRVO), hemi-RVO (HRVO) and branch RVO (BRVO) makes it an interdisciplinary task. Treatment of RVO should aim at eliminating the complications and vision-disturbing effects of RVO but also include prophylactic measures in order to avoid recurrence of the disease. Problems are mainly caused by the ischemic form of RVO, leading to neovascularization. Several treatment methods have been investigated over the past decades, including drug therapy and surgical methods. Until recently, sufficient evidence-based studies were only available for the effect of grid and scatter laser therapy on RVO. New studies have shown a positive effect of intravitreal therapy with vascular endothelial growth factor inhibitors (anti-VEGF therapy) on the progression of the disease. Ongoing studies are now focusing on different combination therapies. Larger randomized studies will hopefully lead to a commonly accepted regimen for treatment of CRVO and BRVO in the near future.

Background Posterior capsule opacification (PCO) remains the most common long-term complication after cataract surgery. It can be treated by Nd:YAG laser capsulotomy, however, this may lead to other complications and laser treatment is not available in large parts of the developing world. Therefore, many studies try to find factors influencing the development of PCO. Objectives To summarise the effects of different interventions to inhibit PCO. These include modifications of surgical technique and intraocular lens (IOL) design, implantation of additional devices and pharmacological interventions. Search strategy We searched CENTRAL, MEDLINE, EMBASE, LILACS in January 2007 and reference lists of identified trial reports. Selection criteria We included only prospective, randomised and controlled trials with a follow-up time of at least 12 months. Interventions included modifications in surgical technique explicitly to inhibit PCO, modifications in IOL design (material and geometry), implantation of additional devices, and pharmacological therapy, compared to each other, placebo or standard treatment. Data collection and analysis Data were extracted and entered into Review Manager. Visual acuity data, PCO score and YAG capsulotomy rates were compared and a meta-analysis was performed when possible. Main results Fifty three studies were included in the review. The review was divided into three parts. (1) Influence of IOL optic material on the development of PCO. Compared to other materials, the meta-analysis of the included studies showed a significantly higher PCO score (overall effect: 12.39 (95% confidence interval: 9.82 to 14.95), scale 0 to 100) and YAG rate (odds ratio: 8.37 (3.74 to 20.36)) only in hydrogel IOLs. (2) Influence of IOL optic design on the development of PCO. There was a significantly lower PCO score (-8.65 (-10.72 to -6.59), scale 0 to 100) and YAG rate (0.19 (0.11 to 0.35)) in sharp edged than in round edged IOLs, however, not between 1-piece and 3-piece IOLs. (3) Influence of surgical technique and drugs on the development of PCO. There was no significant difference between different types of intra-/postoperative anti-inflammatory treatment except for treatment with an immunotoxin (MDX-A) leading to a significantly lower PCO rate. Authors' conclusions Due to the highly significant difference between round and sharp edge IOL optics, IOLs with sharp (posterior) optic edges should be preferred. There is no clear difference between optic materials, except for hydrogel IOLs, that showed more PCO than the other materials. The choice of postoperative anti-inflammatory treatment does not seem to influence PCO development.

Background and Objective: To determine the reproducibility of a semi-objective analysis software for the morphological analysis of single Elschnig pearls from retroillumination images of posterior capsule opacification. Patients and Methods: In this prospective study, images of eyes with varying degrees of regeneratory posterior capsule opacification and the presence of Elschnig pearls were taken. The size and morphology of single Elschnig pearls was evaluated from consecutive images using an analysis method called PearlTracer using three different modes: snake selection, where a few points detected the pearl border automatically; diameter circle selection, a circle function; and polygon selection, where several points were connected by straight lines. The interobserver and intraobserver reproducibility and the limits of the different modes concerning contrast were assessed. Results: One hundred fifty-eight retroillumination images of 55 eyes of 50 patients were included with a total of 857 pearls being analyzed. A high interobserver reproducibility was found, as well as a high intraobserver reproducibility. Furthermore, a significant difference in the pearl size and the pearl morphology between the three analysis features of the software was found. Conclusion: For the observation of single Elschnig pearls and their morphological changes, the semi-objective PearlTracer analysis software was found to be a highly reproducible and useful method.

Purpose To assess the safety, in terms of the intraocular pressure (IOP), of cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and a postoperative dose of a fixed dorzolamide–timolol combination and evaluate the effect of intraocular lens (IOL) haptic angulation. Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods In this prospective randomized double-masked bilateral study, 88 eyes of 44 consecutive patients with age-related cataract were included in an intraindividual comparison study. All patients had standardized cataract surgery with PPCCC and IOL implantation in the capsular bag followed by a postoperative dose of a fixed dorzolamide–timolol combination. Patients were randomly assigned to receive an ACR6D SE IOL (Laboratoires Corneal) in 1 eye and a Centerflex (C-flex) 570C IOL (Rayner Surgical GmbH) in the contralateral eye. The IOP was measured at baseline and postoperatively at 6 and 24 hours as well as 1 week. Results Intraindividual comparison showed statistically significantly higher IOP measurements in the C-flex 570C nonangulated IOL group than in the ACR6D SE angulated IOL group at 24 hours ( P = .003) and 1 week ( P = .043). The highest IOP spikes (34 mm Hg) were at 6 hours in 2 eyes with a C-flex 570C IOL. The ACR6D SE group had statistically significant changes in IOP between preoperative and all postoperative time points. In the C-flex 570C group, the only statistically significant change in IOP was between preoperatively and 6 hours postoperatively. Conclusions Cataract surgery with PPCCC was safe in terms of the postoperative IOP course. Haptic angulation slightly decreased the overall IOP rise and the incidence of IOP rises above 30 mm Hg.

To compare the posterior capsule opacification (PCO) inhibiting effect of the round anterior and sharp posterior optic edge profile of the Clariflex silicone intraocular lens (IOL) [AMO Inc, Santa Ana, California, USA] with that of the double-round edge profile of the SI40 (Phacoflex; AMO Inc, Santa Ana, California, USA) silicone IOL over a period of three years.Prospective, randomized, double-masked, bilateral clinical trial.The study took place at the Department of Ophthalmology, Medical University of Vienna, Austria. Fifty-two patients with age-related cataracts (104 eyes) were included in the study. Each patient received an SI40 IOL (round edges) in one eye and a Clariflex IOL with OptiEdge (sharp posterior optic edge) in the other eye. Follow-up examinations were at one week, one month, six months, and one, two, and three years. Digital retroillumination images were taken of each eye. The amount of PCO was subjectively assessed with the slit-lamp and objectively assessed by automated image analysis software (the computer program Automated Quantification of After-Cataract [AQUA]; Vienna, Austria) one, two, and three years after surgery.The Clariflex lens showed markedly less PCO at one, two, and three years after surgery. The mean AQUA PCO score was 1.39 for the SI40 and 0.56 for the Clariflex lens after one year, estimated at 1.64 and 0.57 after two years, and at 2.04 and 0.64, respectively, after three years (scale zero to 10; P.001). The Nd:YAG laser capsulotomy rate was far higher in the SI40 group (Five cases vs one case at three years).The sharp posterior optic edge profile of the Clariflex silicone IOL led to marked and consistently less PCO than the round-edged SI40 IOL one, two, and three years after surgery.

Purpose To observe and document the effect of steroidal and nonsteroidal antiinflammatory treatment on the formation of Elschnig pearls. Design A prospective, randomized, double blinded, placebo controlled, two-way-cross-over study. Methods Thirty-nine eyes of 32 patients with pronounced, regeneratory posterior capsule opacification (PCO) were included. The patients were treated topically with prednisolone and diclofenac (verum) or with lubricating eye drops (placebo) four times daily for one week. After a wash-out period of two weeks the patients received the contrary treatment also four times daily for one week. Digital retroillumination images were taken at day one, three, five, eight, and 15 of each medication period. The changes in the size of 4675 Elschnig pearls were analyzed. Results The mean cumulative area of all marked pearls/eye and follow-up was 1.2 mm 2 (range: 0.1 mm 2 to 3.2 mm 2 ). The mean pearl size was 12809 μm 2 (range: 60 μm 2 to 1.08 × 10 6 μm 2 ). Between the follow-up examinations, 1274 pearls disappeared (mean: 33 pearls/eye, range: five to 69 pearls; 27%) and 777 newly formed pearls appeared (mean: 20 pearls/eye, range: three to 53 pearls; 20%). There was no statistically significant difference in pearl size change and in number of disappeared and newly appeared pearls between the verum and the placebo treatments. Conclusions Topical prednisolone and diclofenac do not influence the short-term change of Elschnig pearls. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly among eyes.

To compare preoperative and postoperative measurements of the axial length (AL) performed with the IOLMaster (Carl Zeiss Meditec) to evaluate the effect of nuclear cataract on the optical biometry.Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.In 245 consecutive eyes of 162 patients scheduled for cataract surgery, type and severity of cataract was evaluated using the Lens Opacities Classification System III. Preoperative and postoperative axial length measurements were performed with the IOLMaster. The postoperative readings of AL were corrected for the IOL optic material implanted.The preoperative AL measurements were 0.07 mm +/- 0.05 (SD) (range -0.18 to 0.11 mm) longer than the postoperative measurements (P.001). These differences in AL were only weakly correlated (r = -0.28, P = .01) with the nuclear cataract grade, mean 3.5 +/- 0.9.In this study, AL measurements with optical biometry using the IOLMaster were not influenced by the severity of nuclear cataract to a clinically relevant degree. Furthermore, it was found that AL in the phakic eye was overestimated by about 0.07 mm because of a slightly too low value of the group refractive index used for the crystalline lens.

Purpose To observe and document the daily changes in the morphology of Elschnig pearls. Design A prospective cohort study. Methods Twenty-nine pseudophakic eyes with pronounced, regeneratory posterior capsule opacification (PCO) were included in this prospective study. Retroillumination images were taken at days 0, 1, 2, and 14. A square grid was laid over the images. Increase, decrease, appearance, and disappearance of pearls between the follow-up images were quantified. Results A total of 1371 areas (mean: 53/eye) of 26 eyes were analyzed between days 0 and 1 and 1 and 2, and 896 areas (50/eye) of 18 eyes between days 0 and 14. Between days 0 and 1, days 1 and 2, and days 0 and 14, we observed “no change” in pearl size in 72%, 77%, and 32%, a “minor increase” in 16%, 14%, and 10%, a “major increase” in 4%, 3%, and 42%, a “minor decrease” in 14%, 11%, and 11%, and a “major decrease” in 4%, 3%, and 37%, respectively. Appearance of newly formed pearls was found in 1%, 1%, and 9% and disappearance of pearls in 1%, 1%, and 5%, respectively. Conclusions Significant changes in the morphology of Elschnig pearls were observed within time intervals of only 24 hours. Appearance and disappearance of pearls, as well as progression and regression of pearls within these short intervals illustrate the dynamic behavior of regeneratory PCO. These findings may contribute to a better understanding of PCO and have implications on pharmaceutical interventions for PCO.

There is evidence that perfusion abnormalities of the optic nerve head are involved in the pathogenesis of glaucoma. There is therefore considerable interest in the effects of topical antiglaucoma drugs on ocular blood flow. A study was undertaken to compare the ocular haemodynamic effects of dorzolamide and timolol in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT).One hundred and forty patients with POAG or OHT were included in a controlled, randomised, double blind study in two parallel groups; 70 were randomised to receive timolol and 70 to receive dorzolamide for a period of 6 months. Subjects whose intraocular pressure (IOP) did not respond to either of the two drugs were switched to the alternative treatment after 2 weeks. Scanning laser Doppler flowmetry was used to measure blood flow in the temporal neuroretinal rim and the cup of the optic nerve head. Pulsatile choroidal blood flow was assessed using laser interferometric measurement of fundus pulsation amplitude.Five patients did not respond to timolol and were changed to the dorzolamide group, and 18 patients changed from dorzolamide treatment to timolol. The effects of both drugs on IOP and ocular perfusion pressure were comparable. Dorzolamide, but not timolol, increased blood flow in the temporal neuroretinal rim (8.5 (1.6)%, p0.001 versus timolol) and the cup of the optic nerve head (13.5 (2.5)%, p0.001 versus timolol), and fundus pulsation amplitude (8.9 (1.3)%, p0.001 versus timolol).This study indicates augmented blood flow in the optic nerve head and choroid after 6 months of treatment with dorzolamide, but not with timolol. It remains to be established whether this effect can help to reduce visual field loss in patients with glaucoma.

Purpose To compare three different methods of measuring corneal thickness (CT) and anterior chamber depth (ACD). Design Prospective clinical trial (Medical University of Vienna, Austria). Methods Central CT (CCT), CT at four peripheral points, and central ACD were measured in 88 eyes of 44 healthy subjects with the Pentacam (rotating Scheimpflug camera; Oculus, Wetzlar, Germany), Orbscan I (scanning-slit topography system; Orbtek Inc, Salt Lake City, Utah, USA), and AC-Master (partial coherence interferometry; Zeiss Meditec, Jena, Germany), and the results were compared. Results The upper (lower) limits of agreement for CCT measurements were 7.9 (−22.2) μm between AC-Master and Pentacam, 17.6 (−32.5) μm between AC-Master and Orbscan, and 25.2 (−25.9) μm between Pentacam and Orbscan. Correlation was high between all three methods (r = 0.94 to 0.97). The upper and lower limits of agreement for ACD were 0.174 (−0.251) mm between AC-Master and Pentacam, 0.406 (−0.004) mm between AC-Master and Orbscan, and 0.384 (0.095) mm between Pentacam and Orbscan. Correlation was high between the three methods (r = 0.96 between Orbscan and Pentacam; others 0.92). Correlation was lower for the CT measurements at the four peripheral points. Conclusions The CCT and ACD values obtained by Pentacam, Orbscan, and AC-Master measurements correlated well and showed few outliers. The two new systems (Pentacam, AC-Master) provide a reliable, easy-to-use, noncontact method of measuring CCT and ACD. Larger differences occurred only when measuring peripheral CT values, especially between AC-Master and the other two methods.

Purpose To classify the morphologic appearance of posterior capsule opacification (PCO) and to observe and document the changes over longer periods of time. Setting Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods Eighty-one pseudophakic eyes of 53 patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images of the posterior capsule were taken in a standardized fashion 1, 2, and 3 years after cataract surgery. The PCO morphology was classified, and changes among the 3 follow-up images were analyzed. Results At 1, 2, and 3 years, pearls occurred in 16 (20%), 41 (51%), and 57 (63%) eyes. Pearls increased in size and number. Cases with thin layers of PCO decreased from 53 to 33 to 16 eyes. Conversely, cases with thick layers increased from 18 to 45 and 64 eyes. “Cheese holes” appeared most frequently as the predominant structure (range 47% to 51%), followed by plates (range 28% to 31%), islands (range 15% to 20%), and traces of PCO (range 1% to 5%). Changes in expansion of the PCO area were observed in 61 eyes (75%) during period 1 (1 to 2 years) and period 2 (2 to 3 years). Regions of expansion and regression in the same eye occurred in periods 1 and 2 in 11 eyes (14%) and 9 eyes (11%), respectively. The phenomenon of thinning bridges, a regression of syncytial extensions of PCO, occurred in 22 eyes (27%) and 32 eyes (40%), respectively. An overlapping growth of 2 layers was observed in 18 eyes (22%). Conclusions The morphology of PCO is multifaceted. Apart from the Elschnig pearls, categories such as cheese holes, plates, islands, and traces of PCO were distinguished. Over the years, pearls increased in frequency, size, and number. Expansion and regression occurred simultaneously in some cases. Two or more layers grew on top of each other in some eyes.

To compare the posterior capsule opacification (PCO) inhibiting effect of a 3-piece polymethyl methacrylate (PMMA) intraocular lens (IOL) with a sharp optic edge design with that of the round-edged version of the same IOL during a 5-year period.Randomized patient- and examiner-masked clinical trial with intraindividual comparison.Thirty-two patients with bilateral age-related cataract (64 eyes).Each study patient had phacoemulsification cataract surgery in both eyes and received a sharp optic edge PMMA IOL in one eye and a round optic edge PMMA IOL in the fellow eye (both by Dr Schmidt in Germany). Follow-up examinations were at 1 week, 1 month, 1 year, 3 years, and 5 years. Digital retroillumination images were taken from each eye. The amount of posterior capsule opacification was assessed objectively by means of automated image analysis software (Automated Quantification of After-Cataract) at 1 year, 3 years, and 5 years after surgery.Posterior capsule opacification score: 0-10.The sharp optic edge IOL showed significantly less regeneratory and fibrotic PCO at 1 year, 3 years, and 5 years after surgery. The mean AQUA PCO score was 5.12 for the round-edge and 2.49 for the sharp-edge IOL (scale, 0-10; P0.001) at 5 years. The mean difference among patients for the PCO score in the eye implanted with the sharp optic edge versus the score in the eye with the round optic edge was 2.83 at 5 years (95% confidence interval, 1.66-4.00). Due to the large number of neodymium:yttrium-aluminum-garnet laser capsulotomies that were performed (12 in the round-edge group and 4 in the sharp-edge group), there was no significant difference in visual acuity between both groups at any time point.Compared with the round-edge version, the sharp optic edge design of a 3-piece PMMA IOL led to significantly less PCO at 1 year, 3 years, and 5 years after surgery. However, the sharp optic edge did not lead to complete PCO prevention during this follow-up period. This finding has implications for the design of PMMA IOLs used for cataract surgery, especially in the developing world.

Purpose To compare the intensity of capsule opacification with the sharp and the round optic edge variant of an open-loop hydrophobic silicone intraocular lens (IOL). Design Randomized, controlled, double-blind clinical trial with intraindividual comparison. Methods Fifty-one patients with bilateral age-related cataract were included (102 eyes). Each patient had had cataract surgery in both eyes and received a Microsil IOL with a sharp optic edge design (model S) in one eye and a Microsil IOL with a round optic edge design (model R) in the fellow eye. Both IOLs had an identical haptic design (nonangulated polymethylmethacrylate) and silicone optic material. The patients were examined at the slit lamp, best-corrected visual acuity was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken 5 years after surgery. The intensity of regeneratory posterior capsule opacification (rPCO), fibrotic PCO (fPCO), and anterior capsule opacification (ACO) was assessed subjectively at the slit lamp, and of rPCO, objectively using automated image analysis software (AQUA). The need for an Nd:YAG laser capsulotomy (Nd:YAG-LCT) was noted. Results The mean AQUA PCO score was 1.2 for the model S and 2.4 for the model R lens ( P = .001). The model S lens also led to less peripheral fPCO ( P = .003). Concerning ACO, there was no significant difference between both IOL groups ( P = .72). Whereas no capsulotomy was required with the model S, four cases (16%) had been performed in the model R group. Conclusion Five years postoperatively, the sharp-edged silicone IOL showed less rPCO and fPCO than the round-edged IOL. However, regarding ACO, there was no significant difference between both IOL styles.

To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) with that of the double-round edge design of the Sensar AR40 IOL over a period of 3 years.Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.Fifty-three patients with bilateral age-related cataract (106 eyes) were included in this randomized prospective bilateral patient- and examiner-masked clinical trial with intraindividual comparison. Each study patient had cataract surgery in both eyes and received a Sensar AR40 IOL (anterior and posterior round optic edges) in 1 eye and a Sensar OptiEdge AR40e IOL (round anterior and sharp posterior optic edge) in the other eye. Follow-up examinations were at 1 week, 1 and 6 months, and 1, 2, and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software (AQUA) 1, 2, and 3 years after surgery.The sharp-edged AR40e lens showed significantly less regeneratory and fibrotic PCO 1, 2, and 3 years after surgery. The mean AQUA PCO score was 2.18 for the AR40 and 1.00 for the AR40e lens after 1 year; 2.94 and 1.56 after 2 years, and estimated at 3.13 and 1.77, respectively, after 3 years (scale 0 to 10; P.001). The neodymium:YAG laser capsulotomy rate was significantly higher in the AR40 group. The AR40e lens also led to less peripheral fibrotic PCO. There was no significant difference in complaints concerning edge glare between the groups.Compared with the AR40 IOL, the sharp posterior optic edge design of the Sensar OptiEdge AR40e IOL led to significantly less PCO 1, 2, and 3 years postoperatively. In contrast with most past studies on PCO-preventative factors, this study varied only 1 parameter, namely the optic edge design, and the main outcome measure (PCO) was assessed with an objective image-analysis system.

Purpose Comparison of the intensity of posterior capsule opacification (PCO) between a silicone intraocular lens (IOL) and a hydrophobic acrylic IOL, both of them 3-piece and open-loop and having truncated optics with sharp edges. Design Randomized, controlled, patient- and examiner-masked trial with intrapatient comparison. Participants and controls One hundred six eyes of 53 patients with age-related bilateral cataract. Methods Each patient had cataract surgery in both eyes and received a silicone IOL in one eye and a hydrophobic acrylic IOL in the fellow eye. Follow-up examinations were at 1 and 3 years after surgery. The patients were examined at the slit lamp, visual acuity (VA) was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The amount of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software. Data of 56 eyes of 28 patients, who were examined at each follow-up, were analyzed. Main outcome measure Posterior capsule opacification intensity at 3 years as measured with automated image analysis. Results At 1 and 3 years after surgery, PCO did not differ between the silicone (1.6 and 1.9 [image analysis scores, 0–10 scale], respectively) and acrylic IOLs (1.7 and 2.2) ( P > 0.24). Furthermore, there was no significant difference in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. In each group, one neodymium:yttrium–aluminum–garnet (YAG) laser capsulotomy was performed during the entire study duration. Conclusion Silicone and hydrophobic acrylic are similarly effective in inducing the PCO-inhibiting effect of a rectangular, sharp optic edge. Three years after surgery, the PCO intensity and the YAG rate were low with both IOL models.

PURPOSE. There is evidence that altered optic nerve head (ONH) blood flow may play a role in the development and progression of glaucoma. In the present study, the baseline characteristics were examined in a study population participating in a clinical trial in which the ocular hemodynamic effects of timolol and dorsolamide were compared. METHODS. One hundred forty patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) were included in this trial and their baseline parameters compared with those of a group of 102 age-matched control subjects. Scanning laser Doppler flowmetry was used to measure blood flow in the temporal neuroretinal rim and the cup of the ONH. Pulsatile choroidal blood flow was assessed by laser interferometric measurement of fundus pulsation amplitude. In addition, hemodynamic parameters and mean arterial pressure were calculated in both groups. RESULTS. All ocular hemodynamic parameters were significantly lower in the POAG/OHT group compared with the healthy control group (P < 0.001 each). In addition, a significant positive correlation between laser Doppler flowmetry readings and mean arterial pressure was observed in patients with glaucoma but not in healthy control subjects. Likewise, the correlation coefficient between fundus pulsation amplitude and mean arterial pressure was higher in patients with glaucoma than in healthy control subjects. CONCLUSIONS. The present study indicates reduced ONH and choroidal blood flow and an abnormal association between blood pressure and ocular perfusion in patients with primary open-angle glaucoma or ocular hypertension, independent of topical antiglaucoma medication. Hence, vascular dysregulation appears to be an early manifestation in glaucoma that is not caused by pharmacologic intervention.

Purpose: To evaluate the long-term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO). Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods: This randomized double-blind study comprised 104 eyes of 52 patients with bilateral age-related cataract. All patients received round-edged intraocular lenses (IOLs); 26 received an SI-40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI-40 IOL has 13.0 mm open-loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open-loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4). Results: The mean ACO was 17% in the polished eyes and 26% in the control eyes ( P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively ( P = .0007). The mean ACO was 15% in the polished SI-40 eyes and 26% in the control SI-40 eyes ( P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes ( P = .003). The mean fibrotic PCO score was 0.4 in the polished SI-40 eyes and 1.1 in the control SI-40 eyes ( P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes ( P = .08). Conclusions: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round-edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.

To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction.Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.This randomized controlled patient- and examiner-masked study comprised 210 eyes of 105 patients with bilateral age-related cataract. In Group 1 (n = 53), the Sensar OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI-40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm(2)) was determined objectively.One year after surgery, the mean ACO score was 32% in eyes with the sharp-edged acrylic IOL and 29% in eyes with the round-edged acrylic IOL (P.05). In the silicone group, the mean was 31% and 26%, respectively (P.05). The mean fibrotic PCO score was lower in eyes with a sharp-edged acrylic IOL than in eyes with a round-edged acrylic IOL (0.26 and 0.93, respectively; P.05) and in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (0.24 and 0.82, respectively; P.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp-edged silicone IOL than in eyes with a round-edged silicone IOL (P.05).Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round-edged acrylic and silicone IOLs. The sharp-edged silicone IOL caused significantly more capsulorhexis contraction than the round-edged silicone IOL and both acrylic IOLs.

To compare intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of an open-loop hydrophobic acrylic intraocular lens (IOL).A randomized, patient- and examiner-masked clinical trial with intraindividual comparison.Fifty-two patients with bilateral age-related cataract (104 eyes).Each patient had cataract surgery in both eyes and received a 1-piece Acrysof IOL in one eye and a 3-piece Acrysof IOL in the fellow eye. Follow-up examinations were at 1 week, 1 month, 6 months, 1 year, and 2 years. Patients were examined at the slit lamp, visual acuity (VA) was determined, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The intensity of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software.Posterior capsule opacification score (scale, 0-10).There was no significant difference between IOL styles in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. One year postoperatively, the amount of regeneratory PCO was higher for the 1-piece Acrysof eyes (image analysis software score: 1.3) than for the 3-piece Acrysof eyes (score: 0.9; P = 0.002). However, 2 years postoperatively, there was no significant difference between the 2 IOL styles (1-piece: 1.5; 3-piece: 1.3; P = 0.3). Neodymium:yttrium-aluminum-garnet capsulotomy was not performed in the study.One year postoperatively, the 1-piece Acrysof showed slightly more regeneratory PCO than the 3-piece Acrysof. However, 2 years postoperatively, the barrier effect of the 1-piece design was comparable to that of the 3-piece haptic design, with low PCO intensity.

To measure the shift of an accommodating plate-haptic intraocular lens (IOL) along the visual axis induced by ciliary muscle contraction after application of pilocarpine.Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.Fifty-four eyes of 28 patients with age-related cataract comprised this prospective study. Each patient received an AT-45 silicone accommodating IOL (Crystalens, Eyeonics Corp.) after standardized cataract surgery. In a subgroup of 24 eyes, capsular bag fibrosis was reduced by extensive polishing of the anterior capsule with a slit cannula. Assessment included measurements of anterior chamber depth, assessed with partial coherence interferometry, before and after application of pilocarpine 2% and evaluation of near visual acuity 1 month and 3 months postoperatively.A slight backward shift of the IOL of 151 mum in the nonpolished group (P.001) and 122 mum in the polished group (P.005) could be detected after application of pilocarpine. Polishing the capsule did not influence IOL shift. The median near visual acuity with distance correction 1 month and 3 months postoperatively was J5 and J4, respectively, in the nonpolished group and J6 at both times in the polished group.Pilocarpine induced a counterproductive active backward shift of the AT-45 IOL. Polishing of the capsular bag had no impact on accommodative ability. The reading performance of patients with the AT-45 IOL patients at 1 and 3 months was not significantly different from that of with a standard IOL under similar testing methods.

Purpose To study the change in postoperative position of an angulated, 3-piece, foldable acrylic intraocular lenses (IOLs) and evaluate the effect of a sharp posterior optic edge compared with that of a round optic edge on the change in postoperative anterior chamber depth (ACD). Setting Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods This randomized intraindividual-comparison study comprised 104 eyes of 52 patients with age-related cataract. Patient received a sharp-edged Sensar® OptiEdge AR40e IOL (Allergan Surgical) in 1 eye and a round-edged Sensar AR40 IOL in the other eye. Postoperative follow-up included ACD measurement by partial coherence interferometry and evaluation of the capsulorhexis area by standardized retroillumination photography at 1 day, 1 week, and 1 and 6 months. Results A decrease in ACD during the first postoperative week was followed by a small increase in ACD during the first 6 months. There was no significant difference between the sharp-edged group and the round-edged group. Conclusions The angulated 3-piece acrylic IOLs showed significant forward movement over the first postoperative 6 months. Although the change in refraction was small, there was variability among patients. The sharp posterior optic edge design did not affect the IOL's movement in the capsular bag.