Search

Background: The purpose of this study was to identify differences in clinical corneal findings after standard and accelerated epithelial off cross-linking (CXL) during a long-term follow-up., Methods: Two hundred forty-one patients (184 male) were included in this monocentric, retrospective, non-randomized and unmasked study. One hundred forty-eight eyes were treated with the accelerated protocol and 138 with the standard protocol with epithelial off CXL, if diagnosed with keratoconus and a progression in Kmax of more than one dioptre during the preceding 6 months, plus a minimal pachymetry measurement of 400 μm in keratometry (Pentacam, Oculus GmbH, Wetzlar, Germany). Exclusion criteria were previous surgery, other corneal conditions or age above 50 years. Follow-up time was 36 months with clinical examination and keratometry at every visit. Outcome measures were the observed rate of corneal changes, differences between treatment groups and correlation with keratometry measurements., Results: In patients with accelerated CXL, significantly more clear corneas were seen at three (p = 0.015) and six (p = 0.002) months after surgery than following the standard protocol. The rate of clear corneas dropped from 52.2% pre-operation (OP) to a minimum of 19.3% after 6 months in the standard protocol group compared with 50.7% clear corneas pre-OP and a minimum of 40.8% in the accelerated group. In the standard protocol group, more striae were found 3 months after intervention than in the accelerated group (p = 0.05)., Conclusions: In patients with accelerated CXL, fewer morphological corneal changes were observed than after conventional CXL. However, rarely, corneal changes persisted for a long time.

Purpose: To compare the efficacy of a computer-assisted marker system for toric intraocular lenses (IOLs) (Callisto Eye System) with manual marking techniques., Setting: University Eye Hospital Munich, Ludwig-Maximilians-University, Munich, Germany., Design: Prospective case series., Methods: This study included patients having cataract surgery with implantation of a toric IOL (Torbi 709 M). They were randomly assigned to 1 of 2 groups based on the marking system used, manual or digital. Patients were included if they had age-related cataract and a regular corneal astigmatism of 1.25 diopters (D) or higher. Visual and refractive outcomes as well as rotational stability were evaluated. Vector analysis was performed to evaluate total astigmatic changes., Results: The study comprised 57 eyes of 29 patients; there were 28 eyes in the manual group and 29 eyes in the digital group. The mean toric IOL misalignment was significantly lower in the digital group than in the manual group (2.0 degrees ± 1.86 [SD] versus 3.4 ± 2.37 degrees; P = .026). The mean deviation from the target induced astigmatism was significantly lower in the digital group (0.10 ± 0.08 D versus 0.22 ± 0.14 D; P = .008). During surgery, the mean toric IOL alignment time was significantly shorter in the digital group (37.2 ± 11.9 seconds versus 59.4 ± 15.3 seconds; P = .003). The mean overall time required to perform the surgery was significantly shorter in the digital group (727.2 ± 198.4 seconds versus 1110.0 ± 382.2 seconds; P < .001)., Conclusions: A digital tracking approach for toric IOL alignment was efficient and safe to improve refractive outcomes. Furthermore, image-guided surgery helped streamline the workflow in refractive cataract surgery., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the clinical outcomes and patient satisfaction after bilateral cataract surgery with implantation of a bifocal refractive enhanced depth of focus intraocular lens (IOL) with a low near addition (add)., Setting: Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany., Design: Prospective longitudinal case series., Methods: Eyes with bilateral age-related cataract and corneal astigmatism of less than 1.0 diopter (D) had standard microincision cataract surgery with implantation of a bifocal nondiffractive shape-segmented enhanced depth of focus IOL (Lentis Comfort, LS-313 MF15). The corrected and uncorrected (UDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, defocus, corneal astigmatism, spectacle independence, contrast sensitivity, rotational stability, photic phenomena, and patient satisfaction were evaluated over a 3-month follow-up., Results: The study comprised 22 patients (44 eyes). The mean postoperative manifest spherical equivalent was -0.10 D ± 0.58 (SD), resulting in a mean UDVA of 0.07 ± 0.10 logMAR, mean UIVA of 0.21 ± 0.15 logarithm of minimum angle of resolution (logMAR), and mean UNVA of 0.53 ± 0.15 logMAR. Binocular UDVA was 0.01 ± 0.08 logMAR. The best reading distance was 0.46 ± 0.09 m. More than 95% of patients were satisfied with their visual acuity, and less than 10% reported photic phenomena. The IOL showed an excellent rotational stability., Conclusions: The enhanced depth of focus IOL with 1.5 D of near add showed excellent intermediate and far visual performance and acceptable near visual restoration. Patient satisfaction was very high, and few patients reported disturbing photic phenomena., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effects of current hygiene standards for the enucleation of postmortem eyes by investigating the number of microorganisms during subsequent steps of decontamination and tissue processing., Materials and Methods: This prospective, non-randomized cohort study includes 184 postmortem eyes of 92 human donors. Enucleation was performed, according to an ophthalmic surgical procedure. Two groups were generated as follows: right eyes were allocated to group A, left eyes were allocated to group B. In group A, a mucosal disinfectant was used accessorily. Conjunctival smears were taken to examine germ load in both groups before any intervention, in group A after mucosal disinfection, in both groups after transportation of the whole globes in transport fluid, and in both groups after a bath in 0.75% povidone iodine solution for at least 3 minutes just before preparation of the corneoscleral disc. Smears were sent to the local microbiologic laboratory in an aseptic package for testing., Results: All smears showed multiple contaminations (n = 184/184 eyes) before treatment with povidone iodine solution. Contamination was in both groups significantly prevented using the treatment strategy of an at least 3-minute bath in 0.75% povidone iodine solution (n = 1/184 eyes; p < 0.01) As a side effect, almost every eye of group A and none of group B showed brown iodine staining corresponding to corneal epithelial erosion., Conclusions: An aseptic setting for donor enucleation similar to a surgical procedure seems not to influence the outcome of germ colonization. The most effective step to decontaminate donor eyes is to use 0.75% povidone iodine solution for at least 3 minutes.