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Purpose: This study aimed to estimate the corneal keratometric index in the eyes of cataract surgery patients who received zero-power intraocular lenses (IOLs). Methodology: This retrospective study analyzed postoperative equivalent spherical refraction and axial length, mean anterior curvature radius and aqueous humor refractive index to calculate the theoretical corneal keratometric index value (nk). Data was collected from 2 centers located in France and Germany. Results: Thirty-six eyes were analyzed. The results revealed a mean corneal keratometric index of 1.329 ± 0.005 for traditional axial length (AL) and 1.331 ± 0.005 for Cooke modified axial length (CMAL). Results ranged from minimum values of 1.318/1.320 to maximum values of 1.340/1.340. Conclusion: The corneal keratometric index is a crucial parameter for ophthalmic procedures and calculations, particularly for IOL power calculation. Notably, the estimated corneal keratometric index value of 1.329/1.331 in this study is lower than the commonly used 1.3375 index. These findings align with recent research demonstrating that the theoretical corneal keratometric index should be approximately 1.329 using traditional AL and 1.331 using CMAL, based on the ratio between the mean anterior and posterior corneal curvature radii (1.22). [ABSTRACT FROM AUTHOR]

Background: To clinically evaluate how dry eye symptoms in preoperatively diagnosed dry eye patients change with the use of sodium hyaluronate- and dexpanthenol-containing eye drops (HYLO CARE (HC), URSAPHARM Arzneimittel GmbH, Saarbruecken, Germany) after cataract surgery. The aim of the study was not to compare different eye drops but to implement standard treatment in patients with dry eye undergoing cataract surgery. The impact of treatment was evaluated using Symptom Assessment Tools for Dry Eye. Methods: In this prospective, single-center, open-label clinical trial, 49 patients undergoing cataract surgery were included who showed signs and symptoms of dry eye disease assessed by the Symptom Assessment in Dry Eye (Visual Analogue Scale (VAS)) questionnaire, Ocular Surface Disease Index (OSDI), and fluorescein tear break-up Time (TBUT). Patients were instructed to apply HC three to four times a day for 5 weeks in the operated eye in addition to the standard postoperative topical anti-inflammatory regimen. The primary endpoint was the change in TBUT. Secondary endpoints were the assessment of the subjective symptoms (VAS), corrected distance visual acuity (CDVA), and slit-lamp examination including the corneal staining score, Schirmer test, and intraocular pressure. Results: At 5 weeks after operation, the mean TBUT increased from 6.42 ± 1.57 s (s) to 7.81 ± 1.83 s in the per-protocol (PP) population (p > 0.001) and from 6.33 ± 1.64 s to 7.71 ± 2.05 s in the intention-to-treat (ITT) population (p < 0.001). There was a statistically significant decrease in all scores (p < 0.05) from the VAS questionnaire except for the tearing score (p = 0.062) at 5 weeks after operation. The mean total corneal staining score also decreased statistically significantly from 8.85 ± 2.49 before operation to 5.61 ± 3.37 at 5 weeks after operation on a 15-point scale. Conclusions: Controlled standardized dry eye treatment (with HC) improved tear film stability, ocular surface defects, and subjective symptoms of dry eye disease in patients 5 weeks after undergoing cataract surgery. Both the patient and physician assessments indicated high efficacy, tolerability, and a reliable safety profile, as indicated by the low number of at least possibly related adverse events (AE), suggesting its beneficial role in the postoperative management of the ocular surface (OS) in patients with dry eye symptoms prior to and after cataract surgery. [ABSTRACT FROM AUTHOR]

Background: The use of laryngeal masks in the surgical treatment of infantile lacrimal duct stenosis is controversial due to the potential risk of aspiration. Aims: This study investigates airway procedures in children aged <6 years for surgery of lacrimal duct stenosis in a tertiary care university hospital. Methods: After institutional approval, airway procedures, duration of anesthesiological measures, and airway-related complications were retrospectively analyzed. Patients were divided into two groups according to the airway procedures used (endotracheal tube [ET] vs. laryngeal mask [LMA] airway). Associations were calculated using the Chi-square test or Mann-Whitney U-test. Results: Clinical data of 84 patients (ET n = 36 [42.9%] vs. LMA n = 48 [57.1%]) were analyzed. There were no significant differences in surgical treatment, age distribution, and pre-existing conditions between the groups. None of the patients showed evidence of tracheal aspiration or changes in measured oxygen saturation. LMA airway shortened time for anesthesia induction (p = 0.006) and time for recovery/emergence period (p = 0.03). In contrast, the time to discharge from the recovery room was significantly prolonged using LMA (p = 0.001). A total of 7 adverse events were recorded. Five of these were directly or indirectly related to ET (laryngo-/bronchospasm; muscle relaxant residual). Conclusions: LMA airway for infantile lacrimal duct stenosis seems to be a safe procedure and should be used in appropriate pediatric patients due to its lower invasiveness, low complication rate, and time savings. [ABSTRACT FROM AUTHOR]

In combined phacovitrectomy, the injected tamponade seems to affect the ACD differently only in the very early postoperative period; at 6 weeks postoperatively, no difference was observed. Purpose: To compare the changes in the anterior chamber depth (ACD) and in the refractive outcomes after combined phacovitrectomy with respect to the endotamponade (balanced salt solution, air, sulfur hexafluoride [SF6, gas]). Setting: Department of Ophthalmology, University Hospital Ulm, Ulm, Germany. Design: Retrospective, longitudinal case-control study. Methods: 160 eyes of 160 patients were included in the study. 120 eyes underwent phacoemulsification with in-the-bag implantation combined with vitrectomy and were divided into 3 groups according to tamponade (balanced salt solution, air, gas). 40 control eyes with cataract surgery only were included. Further inclusion criteria were uneventful surgery, no postoperative complications and absence of corneal pathology. Endpoints were ACD as measured by swept-source optical coherence tomography-based biometry (IOLMaster 700) preoperatively, 1 to 2 days and 6 weeks postoperatively and refractive prediction error (PE) using the Barrett and Haigis formulas. Results: Within the first 2 days after surgery the ACD was shallower in the eyes left with gas or air tamponade, when compared with balanced salt solution or cataract surgery alone (P <.001). This effect diminished 6 weeks later, and all eyes reached comparable ACD (P =.396). The refractive PE was slightly, but statistically significantly higher in the gas group when compared with cataract surgery alone (P =.012 for Barrett, P =.006 for Haigis). Conclusions: The resulting ACD after combined phacovitrectomy was independent of the tamponade used, but a gas-tamponade was associated with a higher refractive PE. [ABSTRACT FROM AUTHOR]

Background: To report one‐year outcomes from a single‐centre cohort undergoing PAUL® Glaucoma Implant (PGI) surgery. Methods: Retrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021. Results: Forty‐five eyes of 41 patients were included. Qualified and complete success rates (95% CI) were 95.6% (88.9%–100%) and 73.3% (60%–86.7%) for Criterion A (IOP ≤ 21 mmHg), 84.4% (73.3%–93.3%) and 74.4% (51.1%–80.0%) for Criterion B (IOP ≤ 18 mmHg), 62.2% (48.9%–75.6%) and 46.7% (31.2%–62.2%) for Criterion C (IOP ≤ 15 mmHg) and 26.7% (13.3%–40.0%) and 22.2% (11.1%–33.3%) for Criterion D (IOP ≤ 12 mmHg), respectively. Mean IOP decreased from 26.1 mmHg (7–48 mmHg) to 12.0 mmHg (3–24 mmHg) (reduction of 48.83%) after 12 months with a reduction of IOP‐lowering agents from 0.5 (0–3). One eye (2.2%) needed an injection of viscoelastic due to significant hypotony with AC shallowing, and four eyes (8.9%) developed choroidal detachments due to hypotony which resolved without further interventions after 6 weeks. Three patients (6.7%) developed tube exposure which required conjunctival revision with an additional pericardial patch graft. An intraluminal prolene stent was removed in 19 eyes (42.2%) after a mean time period of 8.4 months (2–12 m). Mean IOP before the removal was 21.9 mmHg (12–38 mmHg) and decreased to 11.3 mmHg (6–16 mmHg). Conclusions: PGI surgery is an effective procedure for reducing IOP and pressure‐lowering therapy. An intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further IOP lowering without additional interventions during the postoperative course. [ABSTRACT FROM AUTHOR]

Analysis of internet search queries (ISQ) could be useful to study public interest and medical need for corneal, cataract, and refractive surgery. To date, there are preliminary data on seasonal trends in ophthalmic conditions, but only few studies correlate these data with real data from healthcare systems. The aim of this study is to analyze ISQ and correlate it with real healthcare system data. Data were retrieved from the KBV registry of patients who underwent outpatient ophthalmic surgery in Germany from 2017 to 2019 and from Statista GmbH from 2010 to 2020 for corneal refractive surgery. Time Series analysis of ISQ was analyzed from 2004 to 2020 and correlated with healthcare system data using bivariate correlation analysis. ISQ correlated significantly with the incidence of ophthalmic procedures such as corneal transplantations (r = 0.69, p < 0.05), cataract- (r = 0.59, p < 0.05) and refractive laser surgery (r = 0.83, p < 0.05) in Germany. In addition, specific trends were observed with respect to individual surgical procedures. The correlation between search intensities and surgical procedures varied significantly. Thus, interests in surgical procedures can be tracked by observing changes in ISQ over time. These data correlate with real healthcare data and could be used in the future for now-casting or even forecasting. [ABSTRACT FROM AUTHOR]

Purpose. To analyze the association between hypothyroidism and keratoconus, we examined blood thyroid hormone levels and corneal tomographic parameters in healthy subjects and patients with keratoconus. Methods. We included 626 subjects (304 left eyes, 49%; 431 males, 69%; age 38.4 ± 14.3 y). Patients with keratoconus were from our Homburg Keratoconus Center (HKC) (n = 463); patients with hypothyroidism were from the Department of Internal Medicine of Saarland Medical University, Homburg/Saar, Germany (n = 75); and healthy subjects were from the Department of Ophthalmology of Saarland University Medical Center (n = 88). We included only one randomly selected eye of each subject and the first examination data. Exclusion criteria. Previous thyroid medication, previous ocular surgery, and patients with suspected keratoconus (topographic keratoconus classification, [TKC]: 0 < 1). Patient eyes were classified (TKC) with dedicated, instrument-based, keratoconus detection software provided with the Pentacam. TKC = 0 was considered "normal," and TKCs ≥ 1 were considered keratoconus. Subjects were also classified as euthyroid or hypothyroid, based on blood thyroid hormone status (i.e., TSH, FT3, and FT4). A multiple logistic linear regression model was constructed to determine the effects of age (covariate), gender, and hypothyroidism (effect sizes) on "TKC-positive" disease. Results. The significance levels for a constant parameter, sex, thyroid condition, and age were p<0.0001, p<0.0001, p<0.0001, and p=0.003, respectively. The odds ratios for age, sex, and hypothyroidism were 0.98, 3.05, and 3.34, respectively. Male sex and a euthyroid condition had significantly positive, clinically relevant effects, and age had a significantly negative, but clinically irrelevant effect on the estimated TKC index. Conclusions. Keratoconus appeared to occur more often in patients classified as euthyroid than in patients with hypothyroidism. Thus, hypothyroidism alone could not support the development of keratoconus. Based on these results, it should not be mandatory to screen patients with hypothyroidism for keratoconus or patients with keratoconus for hypothyroidism. [ABSTRACT FROM AUTHOR]

The article presents a report from a March 17-19, 2016 interdisciplinary conference on the sociology of blind people hosted by the Christian-Albrechts-Universität zu Kiel university. Topics of presentations delivered include the history of ophthalmic surgery since the book of Hammurabi, the depiction of blindness in film, and welfare services provided to the blind in late 18th-century Germany.

Purpose. This study aimed to evaluate long-term results of external dacryocystorhinostomy (DCR) at a tertiary eye care center specializing in lacrimal duct surgery in Germany. Methods. The medical records of 1010 patients with acquired nasolacrimal duct obstruction (NLDO), who had undergone lacrimal duct surgery at a tertiary eye care center, were reviewed. Only adult patients who had undergone external DCR were included. The evaluation included the following parameters: age, gender, duration of symptoms, patient satisfaction, previous dacryocystitis, complication rates, and surgical outcome. Results. 154 eyes of 146 patients (14.5%) could be included in the study. The average age was 64.1±29.7 years. 66.4% of patients were females and 33.6% were males. Acute or chronic dacryocystitis was found in 81 patients (55.5%). Overall, 82.8% of patients had full resolution of symptoms. The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.7% compared to 83.4% for patients without dacryocystitis in their medical history. Conclusion. In cases in which transcanalicular microendoscopic techniques are contraindicated (e.g., after dacryocystitis) or in complex cases where microendoscopic procedures have failed (revision surgery), external DCR is still the surgical treatment of choice with very good postoperative success. [ABSTRACT FROM AUTHOR]

Background: The risk of developing postoperative nausea and vomiting (PONV), apart from conventional risk factors, probably includes a genetic background.Objectives: We examined the association of the DRD2 TaqIA polymorphism with PONV in a high-risk cohort of patients.Design: A prospective, double-blind observational trial.Setting: Single-centre primary care in Western Germany.Patients: A total of 306 patients undergoing elective strabismus surgery under anaesthesia with etomidate/alfentanil/mivacurium (induction) and sevoflurane in air (maintenance).Main Outcome Measures: Nausea as well as retching/vomiting was recorded for 24 h postoperatively. The DRD2 TaqIA polymorphism (rs1800497) was genotyped using a Taqman assay and the relationship between DRD2 TaqIA polymorphism and PONV was examined by univariate and multivariate analysis.Results: Regarding known risk factors for developing PONV, no patient with the A1A1 genotype (n = 15) had a history of PONV, while A1A2 carriers (n = 115) and A2A2 carriers (n = 176) had a history of PONV in 22.6 and 10.8% of patients, respectively (P = 0.005). Overall, the incidence of nausea was 40.1% and the incidence of vomiting/retching was 32.7%. Univariate analysis showed that postoperative nausea was not associated with TaqIA genotypes, but the incidence of retching/vomiting in A1A2 and A2A2 genotypes was more than 34% compared with zero in A1A1 genotypes (P = 0.022). Age, sex, smoking status and a history of PONV were independent predictors for nausea as well as for retching/vomiting, as expected, while DRD2 TaqIA polymorphism showed no independent significant impact.Conclusion: In a white cohort, the TaqIA A2 allele is significantly associated with a history of PONV, which may explain the increased incidence of PONV but has no further independent influence.Trial Registration: German registry of clinical trials identifier: DRKS00005681. [ABSTRACT FROM AUTHOR]

Purpose. To assess functional and morphological alterations following video-documented surgery for epiretinal membranes. Methods. Forty-two patients underwent video-documented 23-gauge vitrectomy with peeling of epiretinal (ERM) and inner limiting membrane (ILM). Patient assessment was performed before and 3 and 6 months including best corrected visual acuity (BCVA), slit lamp biomicroscopy, SD-OCT, and central 2° and 18° microperimetry. In addition, all video-documented areas of peeling on the retinal surface were evaluated postoperatively using an additional focal 2° microperimetry. Retinal sensitivity and BCVA were correlated with morphological changes (EZ and ELM) in the foveal region and in regions of membrane peeling. Results. Overall, BCVA increased from 0.6 (±0.2) to 0.2 (±0.2) logMAR after 6 months with an increase in retinal sensitivity (17.9 ± 2.7 dB to 26.8 ± 3.1 dB, p<0.01). We observed a significant correlation between the integrity of the EZ but not of the ELM and the retinal sensitivity, overall and in peeling areas (p<0.05). However, no significant correlation between alterations in the area of peeling and overall retinal sensitivity regarding visual acuity gain could be observed after 6 months (p>0.05). In contrast, overall postoperative retinal sensitivity was significantly decreased in patients with a visual acuity gain lower than 2 lines (p<0.05) correlating with EZ defects seen in OCT. Conclusions. Mechanical trauma of epiretinal membrane and ILM peeling due to the use of intraocular forceps may affect the outer retinal structure. Nevertheless, these changes seem to have no significant impact on postoperative functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: To objectively measure the strength of the capsulotomy performed with a femtosecond laser-assisted technique or performed manually in a pig-eye laboratory study. Setting: International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Design: Experimental study. Methods: Ten fresh pig eyes were randomly assigned to femtosecond laser–assisted capsulotomy or manual capsulotomy. The capsule was immersed in hyaluronic acid, and retractors were fixed in the capsule opening with a pull-force measuring device. The force necessary to break the capsulotomy was measured in millinewtons (mN); the maximum stretching ratio was also assessed. Results: The observed mean rupture force (ie, maximum amount of force measured immediately before tissue rupture) was 113 mN ± 12 (SD) in the laser-assisted procedure and 73 ± 22 mN in the manual procedure (P<.05). The stretching ratios were 1.60 ± 0.10 (femtosecond) and 1.35 ± 0.04 (manual) (P<.05). Conclusion: In this laboratory pig-eye study, femtosecond laser–assisted capsulotomy resulted in a significantly stronger anterior capsule opening than the standard manually performed capsulotomy. Financial Disclosure: Drs. Auffarth, Reddy, and Holzer have received research and travel grants from Technolas Perfect Vision GmbH. Mr. Ritter is an employee of Technolas Perfect Vision GmbH, Munich, Germany. [ABSTRACT FROM AUTHOR]

Purpose: This study was intended to evaluate the effect of horizontal muscle surgery on anterior segment measurements in patients with strabismus. Methods: Forty-two eyes of 28 patients with exotropia undergoing recession or recession combined with resection procedure were included. Consecutive cases were imaged using a Pentacam (Oculus, Inc., Berlin, Germany) immediately prior to surgery and 1 and 3 months after surgery. The refractive power of the anterior surface of the cornea on the horizontal and vertical axis, the thinnest corneal thickness, anterior chamber depth, anterior chamber volume, and cornea volume were analyzed. The clinical characteristics of patients, visual acuity, astigmatism, and size of the deviations before and after surgery were reviewed. Results: Muscle recession and recession plus resection surgery were performed in 28 and 14 eyes, respectively. Overall, no significant changes were noted when comparing preoperative and postoperative data. Patients were divided into two groups, recession or recession plus resection, and only anterior chamber depth was found to be significantly reduced in the recession group 1 month postoperatively. Three months postoperatively, the reduced anterior chamber depth in the recession group returned to the preoperative value. Conclusion: In this series, the recession procedure in patients with strabismus induced an anterior chamber depth change during the early postoperative period. However, the anterior chamber depth returned to its preoperative state by 3 months after surgery. These findings indicate that extraocular muscle surgery could induce reversible changes to the anterior segment of the eye. [J Pediatr Ophthalmol Strabismus 2012;49:290-294.] [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the sulcus anatomy and possible correlations between sulcus diameter and white-to-white (WTW) diameter in pseudophakic eyes, data that may be important in the stability of add-on intraocular lenses (IOLs). Setting: University Eye Hospital, Tuebingen, Germany. Design: Case series. Methods: In pseudophakic eyes, the axial length (AL) and horizontal WTW were measured by the IOLMaster device. Cross-sectional images were obtained with a 50 MHz ultrasound biomicroscope on the 4 meridians: vertical, horizontal (180 degrees), temporal oblique, and nasal oblique. Sulcus-to-sulcus (STS), angle-to-angle (ATA), and sclera-to-sclera (ScTSc) diameters were measured. The IOL optic diameter (6.0 mm) served as a control. To test reliability, optic measurements were repeated 5 times in a subset of eyes. Results: The vertical ATA and STS diameters were statistically significantly larger than the horizontal diameter (P=.0328 and P=.0216, respectively). There was no statistically significant difference in ScTSc diameters. A weak correlation was found between WTW and horizontal ATA (r = 0.5766, P<.0001) and between WTW and horizontal STS (r = 0.5040, P=.0002). No correlation was found between WTW and horizontal ScTSc (r = 0.2217, P=.1217). Conclusions: The sulcus anatomy had a vertical oval shape with the vertical meridian being the largest, but it also had variation in the direction of the largest meridian. The WTW measurements showed a weak correlation with STS. In pseudophakic eyes, Soemmerring ring or a bulky haptic may affect the ciliary sulcus anatomy. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the utility of high-resolution magnetic resonance imaging (MRI) in assessing the normal and refilled lens geometry in rabbits after lens-refilling surgery. Setting: University of Rostock, Rostock, Germany. Design: Experimental study. Methods: High-resolution ocular MRIs were acquired (7.1 T ClinScan) using a 2-channel coil with 4 coil elements and T2-weighted turbo spin-echo sequences (slice thickness 700 μm, field of view 40 mm × 40 mm) in rabbits after lens refilling surgery combined with intraoperative treatment to prevent lens epithelial cell proliferation. Single slices were used to assess the refilled lenses 3 years postoperatively. Results: The entire geometry (cross-sectional area, radius of curvature, axial and equatorial diameters) of the crystalline and refilled lenses was visualized by in vivo 7.1T MRI 3 years postoperatively (in-plane resolution: 125 μm × 125 μm). In refilled eyes, the capsule and the homogenous silicone polymer remained in close contact with no visible interface. The dimensions of the refilled lens were significantly smaller than those of the crystalline lens of the contralateral eye. Conclusions: High-resolution MRI allows in vivo visualization and analysis of the spatial arrangement of the lens in rabbit eyes after lens refilling surgery and overcomes a number of major limitations in the quantitative evaluation of the lens shape. Further efforts are required to optimize the amount of polymer injected during lens refilling to achieve a predictable refractive outcome after lens refilling surgery. Financial Disclosure: Drs. Stachs, Langner, Sternberg, Martin, Schmitz, Hosten and Guthoff have no financial or proprietary interest in any material or method mentioned. Additional financial disclosure is found in the footnotes. [ABSTRACT FROM AUTHOR]

Purpose: To present and analyze biometry data sets and prevalence data for corneal astigmatism in a large population. Setting: High-volume eye surgery center, Castrop-Rauxel, Germany. Methods: Axial length (AL), corneal radii, anterior chamber depth (ACD), and horizontal corneal diameter (white-to-white [WTW] distance) were optically measured by partial coherence interferometry (IOLMaster). Patient data sets acquired between 2000 and 2006 were reviewed and analyzed. Results: The study evaluated 23 239 data sets of 15 448 patients with a median age of 74 years. The mean values were as follows: AL, 23.43 mm ± 1.51 (SD); corneal radius, 7.69 ± 0.28 mm; WTW distance, 11.82 ± 0.40 mm; and ACD, 3.11 ± 0.43 mm. The ACD and axis of astigmatism were correlated with age. The AL, corneal radius, ACD, and WTW were correlated with one other. Eight percent of eyes had corneal astigmatism greater than 2.00 diopters (D), and 2.6% had more than 3.00 D. Astigmatism was with the rule (WTW) in 46.8% of eyes, against the rule in 34.4%, and oblique in 18.9%. High astigmatism was predominantly WTW. Conclusions: The results in this analysis might provide normative data for cataract patients and a useful reference for multiple purposes. The correlation of AL with corneal radius, ACD, and corneal diameter in normal eyes was not present in eyes with extreme myopia or hyperopia. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the individual variation in pupil diameter measurements in refractive surgery candidates under standardized conditions over 2 testing sessions using a digital infrared pupillometer. Setting: Department of Ophthalmology, University Medical Center Regensburg, Regensburg, Germany. Methods: The pupil size in both eyes of consecutive refractive surgery candidates was measured under 2 illumination levels (scotopic at 0.03 lux, low mesopic at 0.82 lux) with a digital infrared pupillometer (Procyon P2000 SA). Before measurement, a standardized dark-adaptation protocol was used. Measurements were taken twice on separate occasions. Results: The study evaluated 318 eyes of 159 patients with a mean age of 36.3 years ± 10.2 (SD). The mean interval between measurements was 53 ± 62.8 days. Despite sufficient power (β < 0.05), there was no statistically significant difference between 2 consecutive measurements under scotopic and low mesopic illumination. Conclusion: Using a standardized dark-adaptation protocol, refractive surgery candidates showed no significant variation in scotopic or low mesopic pupil diameter over 2 testing sessions. [Copyright &y& Elsevier]

Purpose: To compare wavefront-derived metrics to predict subjective quality of vision after laser in situ keratomileusis (LASIK) for myopia. Setting: Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. Methods: One month postoperatively, wavefront sensing was performed and overall subjective quality of vision assessed under 3 lighting conditions (photopic, high mesopic, low mesopic) with a questionnaire. Four wavefront-error representations were computed for a pupil diameter of 6.0 mm and individual physiological pupil diameters at 0.4 lux: (1) the visual Strehl ratio based on optical transfer function (VSOTF), (2) the root-mean-square (RMS) value of Zernike orders 2 to 5 (total RMS), (3) higher-order aberration (HOA) RMS, and (4) a wavefront-error breakdown into the RMS of lower-order aberrations, coma, spherical aberration, and remaining HOA. The impact of the postoperative wavefront error on subjective quality of vision was calculated using linear regression analysis. Results: Fifty-six eyes (29 patients) were included. The ability of wavefront error–derived metrics to predict subjective quality of vision was limited. The VSOTF, calculated for the best-corrected eye, showed the highest predictability. Calculation of wavefront error for individual physiological pupil diameters did not improve predictive ability of the metrics. Eyes with a high theoretical retinal-image quality had a high subjective quality of vision, and eyes with a low subjective quality of vision had a low theoretical image quality. Conclusions: Postoperative wavefront error had limited influence on the subjective quality of vision. Postoperative retinal image quality should be kept as high as possible to provide good subjective quality of vision. [Copyright &y& Elsevier]

Purpose: To compare the accuracy of the thin-lens and ray-tracing methods in intraocular lens (IOL) power calculations in normal eyes and eyes after corneal refractive surgery. Setting: International Vision Correction Research Centre, University of Heidelberg, Heidelberg, Germany. Methods: Pseudophakic eye models were constructed using Zemax optical software, importing corneal radii (normal ray tracing) and corneal surface elevation data (individual ray tracing) measured by Pentacam Scheimpflug photography. Algorithms to predict IOL position (effective lens position [ELP]) or postoperative anterior chamber depth [ACDpost]) (Haigis, Hoffer Q, Norrby, Olsen 2) were used in the thin-lens and ray-tracing methods. Intraocular lens power was calculated in 25 eyes after corneal refractive surgery using normal and double-K modified thin-lens and ray-tracing methods. Results: Back-calculation of ELP and ACDpost were well correlated. Using algorithms of Haigis, Hoffer Q, Norrby, and Olsen 2 to predict IOL position, mean absolute prediction errors (MAEs) of the thin-lens formula were 0.64 diopters (D) ± 0.52 (SD), 0.57 ± 0.46 D, 0.59 ± 0.42 D, and 0.61 ± 0.47 D, respectively; MAEs of normal ray-tracing method were 0.64 ± 0.50 D, 0.58 ± 0.44 D, 0.59 ± 0.41 D, and 0.62 ± 0.45 D, respectively; MAEs of individual ray-tracing method were 0.66 ± 0.52 D, 0.59 ± 0.45 D, 0.59 ± 0.43 D, and 0.62 ± 0.50 D, respectively. No statistical differences were found between the thin-lens and ray-tracing methods. Conclusion: Theoretical thin-lens formulas were as accurate as the ray-tracing method in IOL power calculations in normal eyes and eyes after refractive surgery. [Copyright &y& Elsevier]

Purpose: To investigate the mean values and standard deviations according to age, reliability, and correlation between different parameters of anterior chamber measurements using the Pentacam rotating Scheimpflug camera. Setting: Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Methods: This prospective clinical study comprised 76 healthy volunteers (mean age 46.6 years ± 16.8 [SD]). Three consecutive measurements were made of only 1 eye and anterior chamber depth (ACD), mean and minimum anterior chamber angle (ACA), and anterior chamber volume (ACV) were evaluated. Results: Mean ACD was 2.93 ± 0.36 mm, mean ACA was 34.81 ± 5.05 degrees, minimum ACA was 29.99 ± 5.53 degrees, and mean ACV was 160.3 ± 36.81 mm3. Increasing age was associated with reduced ACD and ACV; however, mean and minimum ACAs were lowest in patients aged 40 to 59 years. Excellent correlation was found between ACD and ACV (R = 0.92). Anterior chamber depth and mean ACA correlated only moderately (R = 0.65). The correlation coefficient between ACD and minimum ACA was smaller (R = 0.58). There was no correlation between ACV and ACA (R = 0.37). Minor standard deviations were noted (ACD 0.02 ± 0.02 mm, mean ACA 1.12 ± 0.94 degrees, minimum ACA 2.04 ± 2.67 degrees, and ACV 2.48 ± 1.65 mm3). Conclusions: Using the Pentacam, it was possible to examine different parameters of the anterior chamber within a short period and with good reliability. The evaluation of the ACA in different positions can help to classify the potential risk for angle-closure glaucoma. [Copyright &y& Elsevier]

Purpose: To determine through safety studies the tissue effects and potential cataractogenesis of laser modification of the crystalline lens (photophaco modulation). Setting: Laser Zentrum Hannover, Hannover, Germany. Methods: Six fresh porcine lenses and 6 living rabbit eyes (with the contralateral eye as a control) were radiated with a low-energy femtosecond laser to induce lens fiber disruption. After 3 months, the rabbit eyes were extracted and tested for light scatter and lens function and fixed for histology and ultrastructure. Results: After laser treatment, all lenses displayed a tightly packed array of intralenticular bubbles, which resolved with time. In the porcine eyes, the bubbles coalesced unless spacing of 9 μm or greater was applied at an energy of 2 μJ. In the rabbit eyes, an energy of 1 μJ and spacing of 10 μm was chosen for transcorneal delivery, showing minimum bubble coalescence. After 3 months, the rabbit lenses showed good transparency, with only 1 rabbit having cataract formation unrelated to the laser. Laser scanning studies show essentially identical values for the back focal length and sharpness of focus (variability of back focal length). Ultrastructurally, the rabbit eyes showed a 0.5 μm electron dense border layer with adjacent normal lens architecture. Conclusions: Femtosecond laser photodisruption of the ocular lens yields a self-limited lesion with bubbles that resolve with time. In living animal eyes, no cataract formation was found with no loss of lens function or induced light scatter after 3 months. These results suggest that use of a low-energy femtosecond laser might be safe when modifying the lens for presbyopia correction. [Copyright &y& Elsevier]

: PurposeTo clarify the theoretical background of the rigid contact lens overrefraction (CLO) method to determine corneal power after corneal refractive surgery.: SettingUniversity Eye Clinic, University of Wu¨rzburg, Wu¨rzburg, Germany.: MethodsUsing paraxial geometrical optics, the measurement situation for the contact lens method was analyzed and the definitions of corneal refractive power were reviewed. Based on the theoretical Gullstrand eye, model eyes were constructed, representing 1 emmetropic and 2 myopic eyes (primary refraction –5.21 diopters [D] and –10.25 D, respectively) before and after photorefractive keratectomy and laser in situ keratomileusis. In these eyes, the application of the CLO was mathematically simulated using Gaussian thick-lens optics and commercial ray-tracing software.: ResultsThe CLO method measured neither the equivalent (total) power nor the vertex (back) power of the cornea but rather the quantity 336/R1C (R1C = anterior corneal radius). Based on these results and the Gullstrand eye, new formulas are proposed to derive the equivalent power and vertex power of the cornea by the CLO method.: ConclusionsDepending on whether intraocular lens calculation formulas are based on equivalent (total) corneal power or vertex corneal power, the respective new formulas for the CLO method should be applied in patients after corneal refractive surgery. An increase in prediction accuracy of the refractive outcome is expected. [Copyright &y& Elsevier]

Objectives: To establish the relative safety and effectiveness of trabecular aspiration in combination with phacoemulsification and intraocular lens (IOL) implantation (asp+IOL) for decreasing intraocular pressure (IOP), and to compare the outcome of this method of treatment with that of phacoemulsification and IOL implantation alone (IOL-alone) or standard filtering glaucoma triple procedure (triple procedure). Design: Prospective, controlled study randomized with respect to assignment to trabecular aspiration, with a case-control design between the asp+IOL and triple procedure groups. Participants: Seventy-four eyes of 74 patients with uncontrolled pseudoexfoliation glaucoma without a history of previous intraocular or extraocular surgery and in need of cataract surgery. Forty-eight patients were randomized to those receiving adjunctive trabecular aspiration (asp+IOL group of 26 eyes) and those given no trabecular aspiration (IOL-alone group of 22 eyes). The triple procedure group consisted of 26 cases, closely matched to the asp+IOL cases in terms of age, sex, cup-disc ratio, glaucoma medication requirements, and systemic diseases. Interventions: Temporal clear corneal phacoemulsification and foldable IOL implantation was performed in all eyes. In the asp+IOL group, trabecular aspiration was performed with a suction force of 100 to 200 mm Hg under light tissue-instrument contact using a modified intraocular aspiration probe. A modified Cairns-type trabeculectomy without adjunctive antimetabolites was performed superiorly in the triple procedure eyes after IOL implantation. Main Outcome Measures: Surgical outcome was assessed in terms of IOP change, need of adjunctive glaucoma medication, visual acuity outcome, and complications. Surgical failure was defined as an outcome requiring additional surgical intervention or more than 1 medication to achieve IOP control to the target pressure. Results: Two years after surgery, success rates were 36%, 64%, and 78... [ABSTRACT FROM AUTHOR]

Presents the Annual Meeting of German Ophthalmic Surgeons from May 28 to 31, 1998 in Nuremberg, Germany.

The article focuses on the study conducted by doctor Irmingard Neuhann which shows identical risk profiles for the retina detachment following cataract surgery and idiopathic retinal detachment in high myopes.

Purpose: To assess the visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL; Carl Zeiss Meditec, Jena, Germany) in patients with hyperopia. Design: Prospective, nonrandomized study. Methods: One hundred and seventy eyes of 85 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low to moderate hyperopia (IOL power, 21 to 24.5 diopters [D]) and high hyperopia (IOL power, 25 to 36 D). Monocular and binocular best spectacle-corrected visual acuity (BSCVA), best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (VA), and distance contrast sensitivity (CSF) under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined. Results: At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BSCVA (P = .06 and P = .09, respectively). Monocular and binocular BCNVA were comparable between both groups (P = .24 and P = .42, respectively). The mean binocular best distance-corrected intermediate VA changed significantly as a function of the distance of the test (P < .01) in both groups, and there were no statistically significant differences between groups at any distance. Differences were not found between groups in binocular CSF under mesopic and photopic conditions. Conclusions: Bilateral implantation of the Acri.LISA 366D in patients with high hyperopia provided a satisfactory full-range of vision comparable with that obtained in patients with low to moderate hyperopia. [Copyright &y& Elsevier]