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Purpose: The aetiology of the apparently vasoocclusive phenomena in human immunodeficiency virus (HIV)-related retinopathy is not well understood. Several hypotheses, including infectious damage of the retinal vasculature and altered retinal haemodynamics, have been postulated. Direct measurement of oxygen tension in the retina is not possible in vivo and indirect methods have to be employed. The objective of this study was to investigate the retinal vascular response to 100% oxygen breathing in patients with HIV., Methods: Twelve patients infected with HIV and 12 healthy individuals, matched for age, sex and smoking habits, were studied in an open study using the blue-field entoptic technique for the measurement of retinal white blood cell (WBC) flux. Reactivity in retinal blood flow during 100% O(2) breathing over 15 min was measured and expressed as percentage change over baseline., Results: WBC velocity during oxygen inhalation decreased over baseline by 9.0 ± 5.8% in HIV-infected patients and by 18.6 ± 5.4% in healthy participants (p < 0.04 between groups, ANOVA). The decrease in WBC velocity was paralleled by a decrease in WBC density. This decrease tended to be more pronounced in healthy participants (13.6 ± 7.9%) than in HIV-infected patients (8.0 ± 10.8%), but the difference was not statistically significant (p = 0.1 between groups, ANOVA). WBC flux decrease was 16.2 ± 11.4% in HIV-infected patients and 29.5 ± 9.5% in the control group and was significant between groups (p = 0.007 between groups, ANOVA)., Conclusion: Our results indicate a reduced reactivity of WBC flux to systemic hyperoxia in patients with HIV. Whether abnormal retinal haemodynamics in HIV-infected persons contributes to the pathogenesis of HIV-related microvascular diseases or is a consequence of the structural changes associated with the disease is unknown., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)

Purpose: To investigate and map the polarizing properties of keratoconus corneas in vitro and to compare the results with those obtained in normal corneas., Methods: Corneal buttons of five keratoconus corneas were investigated by polarization-sensitive optical coherence tomography (PS-OCT). The instrument measures backscattered intensity (conventional OCT), retardation, and (cumulative) slow axis distribution simultaneously. Three-dimensional (3-D) data sets of the polarizing parameters are recorded, and two-dimensional (2-D) cross-sectional images as well as en face images of the distribution of these parameters at the posterior corneal surface are derived. The results are compared to similar maps obtained from normal corneas., Results: Compared with normal corneas, the retardation and slow axis orientation patterns are heavily distorted in keratoconus corneas. Larger areas of increased and decreased retardation can be found in keratoconus corneas, markedly increased retardation (up to >50 degrees ) can especially be found near the rim of corneal thinning. Contrary to normal corneas, regions where the slow axis markedly changes with depth (by up to 50 degrees -90 degrees ) are observed in keratoconus., Conclusions: The observed changes in the cornea's birefringence properties indicate a change in the arrangement of collagen fibrils in the corneal stroma associated with keratoconus. PS-OCT may be a useful tool for the study and diagnosis of corneal disease.

Purpose: To evaluate the image quality of asymmetric Acri. Twin bifocal intraocular lenses (IOLs) (Acri.Tec) by comparing distance and near black-white contrast sensitivity function with that of the Pharmacia 811E IOL., Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria., Methods: Thirty-two eyes of 16 patients were examined after contralateral implantation of 1 Acri. Twin near-weighted 733D IOL and 1 Acri. Twin distance-weighted 737D IOL. Twenty eyes in 10 patients were examined after binocular Pharmacia 811E IOL implantation. Best corrected distance and near visual acuities were determined. Individual reading distance was recorded and corrected to 40 cm for the near contrast test (Holladay Contrast Acuity Test). Distance contrast sensitivity function was evaluated using the Acuity Max (Science 2020) computer program., Results: Best corrected distance visual acuity was significantly better in patients with the 737D IOL than in those with the 733D or 811E IOLs. For distance reading with best distance correction, the 733D IOL performed better than the 737D and the 811E. Individual reading distance with the Acri. Twin IOL and 811E IOL was 33.6 cm and 34.0 cm, respectively. Best distance-corrected near contrast sensitivity function was better in eyes with the near-weighted 733D IOL. Binocular testing showed a significant difference between the 2 groups only at low-contrast values. At distance, contrast sensitivity function was better with the 737D IOL, whereas no difference was found between the 733D and the 811E IOLs. Binocular contrast sensitivity function at distance revealed statistically significantly better results in the Acri. Twin group., Conclusion: An asymmetric diffractive bifocal lens system was advantageous in terms of vision quality when implanted binocularly and superior to monocular stronger weighted focus compared with conventional bifocal IOLs.

Purpose: The widespread use of highly active antiretroviral therapy (HAART) has changed the clinical picture of HIV-associated eye disease. We evaluated the incidence of ocular manifestations of HIV infection since the introduction of HAART., Methods: Between January 1996 and December 2002, we examined 539 HIV-infected patients in our hospital. Follow-up of the patients was performed in case of ophthalmologic symptoms, regardless of current immunologic status, or for screening., Results: A total of 217 patients (40.3%) had HIV-associated eye disease. Of these patients, 42.0% had no eye symptoms. Fifty-eight (10.8%) of the 539 patients had cytomegalovirus (CMV) retinitis, most of whom had CMV retinitis before receiving HAART. Four patients developed immune-recovery uveitis. A total of 145 patients (26.9%) had HIV-related microangiopathy and 96 (17.8%) had dry-eye syndrome., Conclusion: The introduction of HAART had a major impact on the medical history of patients with HIV-related eye disease with improved survival time and decreased morbidity.

Purpose: To study the incidence and progression of lens opacification after implantation of phakic posterior chamber intraocular lenses for myopia and its correlation with vaulting and endothelial cell density (ECD)., Setting: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria., Methods: An implantable contact lens (ICL V4, Staar Surgical Inc.) was inserted in 76 myopic eyes. Patients were prospectively followed preoperatively and at 1, 3, 6, 12, 24, and 36 months. The uncorrected visual acuity and best corrected visual acuity (BCVA) were determined. Vaulting was measured optically with a Jaeger II pachymeter, and the crystalline lens was examined at the slitlamp for the presence and characteristics of opacification. Endothelial cell morphometry was performed by specular microscopy, and the ECD was calculated. Eyes in which lens opacification developed were followed for at least 12 months to determine the degree and course of visual impairment., Results: Lens opacification occurred in 11 eyes (14.5%). Opacification was correlated with intraoperative trauma to the crystalline lens, age older than 50 years, and decreased ECD values throughout the observation period. Vaulting of the ICL did not correlate with the risk for lens opacification. After onset of lens opacification, 6 eyes (55%) had a stable BCVA within +/-0.5 lines and 5 eyes had progressive opacification, losing between 3.5 lines and 0.5 lines (mean 1.8 lines +/- 1.1 [SD]). Three eyes (3.9%) in the progressive group had a 1- to 2-line loss of BCVA over preoperative values and subsequently had cataract surgery., Conclusions: Risk factors for lens opacification after implantation of the model V4 ICL included intraoperative trauma to the crystalline lens and older age. Decreased ECD in eyes with opacification suggests ongoing inflammation as a cause. Patients younger than 45 years may have a significantly lower incidence of opacification.

Purpose: Although a posterior chamber phakic intraocular lens provides effective refractive correction of high myopia and hyperopia, mechanical contact between the implantable contact lens (ICL) and the crystalline lens and inadequate aqueous circulation in the prelenticular space could cause subcapsular opacification. To assess whether and to what extent such mechanical contact occurs, changes in the distance between the STAAR Collamer ICL and the crystalline lens under various conditions were investigated., Design: Open pilot study., Participants: Thirteen eyes of 11 myopic and 2 hyperopic patients with a mean age of 38 years (range, 19-53 years) were examined at least 6 months after ICL implantation., Methods: A noninvasive, high-resolution biometry technique, partial coherence interferometry, was used to measure distance changes between the ICL and the crystalline lens during subjective accommodation, after instillation of pilocarpine, and under changing light conditions., Main Outcome Measures: Mean distance changes from the posterior corneal surface to the ICL, from the posterior corneal surface to the anterior surface of the crystalline lens, and the distance between the ICL and the crystalline lens., Results: In the nonaccommodated state, the mean distance between the ICL and the crystalline lens was 457 microm (range, 123-924 microm). During subjective accommodation, a significant (P<0.01) decrease and, after topical application of pilocarpine, a nonsignificant (P=0.35) decrease of anterior chamber depth was accompanied by a nonsignificant (P = 0.71) reduction of the ICL-crystalline lens distance. Under photopic conditions, a significant mean reduction (P<0.01) of the ICL-crystalline lens distance of -28 microm (range, -16 to -188 microm) was observed., Conclusions: Partial coherence interferometry biometry enabled noninvasive high-precision investigation of ICL dynamics. No significant changes between the ICL and the crystalline lens were detected during subjective accommodation and after application of pilocarpine. However, under photopic conditions, with constriction of the pupil, the distance between the ICL and the crystalline lens was significantly reduced. This mechanism might cause inadequate aqueous circulation in the prelenticular space and might be one of the causes of subcapsular opacification in some of the eyes after ICL implantation.

Objective: To evaluate long-term results after insertion of implantable contact lenses (ICLs) in phakic eyes., Design: Prospective, noncomparative, interventional case series., Participants: Seventy-five phakic eyes (65 myopic, 10 hyperopic eyes) of 45 patients aged 21.7 to 60.6 years were included., Intervention: STAAR Collamer Implantable Contact Lenses (STAAR Surgical Inc., Nidau, Switzerland) were implanted for correction of high myopia and hyperopia., Main Outcome Measures: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were determined. Presence of lens opacification and the distance between the ICL and the crystalline lens were assessed by slit-lamp examination before surgery and at 1, 3, 6 months, and yearly after lens implantation., Results: Preoperative mean spherical equivalent was -16.23+/-5.29 diopters (D) for myopic eyes and +7.88 +/-1.46 D for hyperopic eyes. After ICL implantation, mean residual refractive error was -1.77+/-2.17 D in myopic patients and +0.44+/-0.69 D in hyperopic patients. Preoperative mean UCVA was Snellen 0.03+/-0.03 for myopic patients and Snellen 0.12+/-0.16 for hyperopic patients. Preoperative mean BCVA was Snellen 0.49+/-0.23 for myopic patients and Snellen 0.82+/-0.23 for hyperopic patients. After ICL implantation, mean UCVA up to the end of individual observation time was Snellen 0.36+/-0.36 for myopic patients and Snellen 0.58+/-0.28 for hyperopic patients. Mean BCVA was Snellen 0.73+/-0.26 for myopic and Snellen 0.80+/-0.24 for hyperopic patients. Mean preoperative IOP was 14.2+/-2.7 mmHg, and mean postoperative IOP was 13.46+/-2.1 mmHg over all follow-up investigations. The main complication was the development of subcapsular anterior opacifications of the crystalline lens in 25 eyes (33.3%), 2 of which showed direct contact to the ICL. Eleven eyes (14.7%) were stable in opacification and 14 eyes (18.7%) had progressive opacifications. The median time to opacification was 27.1 months. In 8 patients (10.7%), the subjective visual impairment mandated cataract surgery., Conclusions: The most significant long-term complication after ICL implantation is the formation of opacifications of the crystalline lens with the risk of the necessity of subsequent cataract surgery (10.7%). Old age, female gender, and contralateral opacification are independent significant risk factors for early formation of opacifications in this patient group.

Purpose: The purpose of this study was to examine the cause of increasing myopia after penetrating keratoplasty for keratoconus with the guided trephine system., Design: Prospective interventional study cohort., Methods: Thirty eyes (28 patients) after keratoplasty for keratoconus were examined. Preoperatively and 1, 3, 6, 12, and 24 months postoperatively subjective refraction was evaluated. Keratometry was calculated with a computerized videokeratoscope (TMS-1). Axial length was measured using applanation ultrasonography before surgery and 2 years after surgery. Anterior chamber depth, lens thickness, and vitreous length were taken into consideration., Results: The mean spherical equivalent was + 2.22 +/- 3.47 diopters 1 month postoperatively and had a continuous myopic shift to -1.02 +/- 2.65 diopters 2 years postoperatively. This was associated with a significant increase in mean keratometric levels from + 41.72 +/- 2.96 diopters 1 month postoperatively to + 43.77 +/- 2.29 diopters 2 years postoperatively (r(s) = -0.36, P =.05). Overall, no significant changes in axial length were observed. However, vitreous length showed a small but statistically significant increase. As expected, mean anterior chamber depth decreased significantly postoperatively (P

Purpose: To evaluate the long-term endothelial cell changes in phakic eyes after implantation of a posterior chamber phakic intraocular lens to correct high ametropia., Setting: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria., Methods: Thirty-four eyes of 21 patients having implantation of an implantable contact lens (ICL, Staar Surgical) for high myopia or hyperopia were prospectively examined. The minimum follow-up was 2 to 4 years. Preoperative and serial postoperative specular microscopy (Noncon Robo SP 8000, Konan) was performed to evaluate the long-term endothelial cell changes., Results: The mean preoperative endothelial cell density was 2854 cells/mm(2). The mean endothelial cell loss from preoperatively was 1.8% at 3 months, 4.2% at 6 months, 5.5% at 12 months, 7.9% at 2 years (n = 34), 12.9% at 3 years (n = 13), and 12.3% at 4 years (n = 11). All other endothelial cell characteristics remained stable during the 4-year follow-up., Conclusions: Continuous endothelial cell loss was observed after ICL implantation during a 4-year follow-up. There was rapid cell loss until 1 year postoperatively, after which the rate of loss was no longer statistically significant. The percentage of hexagonal cells (polymorphism) and the coefficient of variation (polymegethism) remained stable during the 4-year follow-up.

Purpose: To present the 10- to 12-year functional and morphological results of in-the-bag implantation of a foldable, plate-haptic, silicone posterior chamber intraocular lens (IOL)., Setting: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria., Methods: Between September 1987 and December 1989, 160 silicone posterior chamber IOLs (Staar AA-4203C) were implanted in the capsular bag through a 3.5 mm corneoscleral incision after a continuous curvilinear capsulorhexis was created. In spring 1999, 36 patients (38 eyes) could be included in a follow-up examination., Results: The median follow-up was 10.5 years +/- 2 (SD). The mean visual acuity was 0.82 +/- 0.34. The mean refraction (spherical equivalent) was +0.57 diopter (D), an insignificant change from the mean at the first postoperative follow-up at 1 month (+0.40 D). Slitlamp examination showed mildly dispersed pigment on the IOL surface in 81.58% of cases. All IOLs had a Tyndall effect (clouding). In 84.21%, the effect was minimal, in 10.53% it was moderate, and in 5.26% it was more intense. Ninety-two percent of the IOLs were centered within 0.5 mm. Of the 22 cases of decentration (57.89%), 86.36% were toward the 12 o'clock position in the bag. The neodymium:YAG capsulotomy rate was 10.52%. There were no cases of IOL-related inflammation or a clinically significant cystoid macular edema., Conclusion: The 10- to 12-year results suggest favorable clinical results of implantation of Staar AA-4203C plate-haptic, silicone posterior chamber IOLs.

Purpose: To evaluate the effects of posterior chamber implantation of phakic intraocular lenses on angle structures and the correlation with intraocular pressure (IOP)., Setting: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria., Methods: A Staar implantable contact lens (ICL) was implanted in 20 white patients (34 eyes) with high myopia. The patients were followed for a mean of 2.3 years (range 0.8 to 6.0 years). Two subgroups were created: One had a follow-up of 2.4 to 6.0 years and the other, 0.8 to 2.3 years. The mean spherical power of the implanted ICL was -16.8 diopters (D) (range -9.0 to -21.0 D). The angle structures were examined by gonioscopy using the Spaeth technique, and optical pachymetry and IOP were measured in dilated and undilated pupils. Trabecular pigmentation was measured semiquantitatively. The ICL models included a few prototypes (6 eyes), the V2 model (10 eyes), the V3 model (6 eyes), and the V4 model (12 eyes)., Results: The anterior chamber angle was between 11 and 20 degrees in 41% of eyes, between 21 and 30 degrees in 21%, larger than 30 degrees in 21%, and 10 degrees or smaller in 17%. An apparent iris root insertion was above Schwalbe's line in 6% of eyes, behind Schwalbe's line in 12%, at the scleral spur in 67%, and in a deep angle recess behind the scleral spur in 15%. The curvature of the iris was regular in 19 eyes and steep in 15 eyes. The mean pigmentation in all 4 quadrants was 1.3. (Grade 1 was defined as trace pigmentation.) The mean pachymetry from the endothelium to the ICL anterior surface was 2.7 mm and from the endothelium to the anterior surface of the crystalline lens, 3.2 mm. The mean IOP was 14.1 mm Hg in undilated pupils and 12.1 mm Hg in dilated pupils. There was no correlation between angle pigmentation and IOP., Conclusion: Trace pigmentation in the trabecular meshwork was common after ICL implantation. However, there was no direct influence on IOP. Long-term follow-up is necessary to evaluate the effect and progress of trabecular pigmentation in eyes with an ICL.

Purpose: Alterations of ocular blood flow may play a role in the pathophysiology of human immunodeficiency virus (HIV) related retinal microvasculopathy. In this study ocular blood flow was investigated in patients with HIV infection., Design: In a prospective, cross-sectional study ocular blood flow was measured in 37 eyes of consecutive HIV- infected persons and compared with the data of age-matched healthy controls. This sample size was calculated based on an alpha-error of 0.5 and a beta-error of 0.8., Methods: Macular white blood cell flow, fundus pulsation amplitude, and blood flow velocities in the retrobulbar vessels were measured with blue field entoptic technique, laser interferometry, and Doppler sonography, respectively. Immunologic and ophthalmologic status was evaluated from each patient., Results: Mean CD4+ cell count of the HIV-infected persons was 206.8 +/- 145.6 cells/mm(3). In five patients HIV-related retinopathy was observed. A significant reduction in leukocyte density was seen in HIV infected persons (82.2 +/- 23.4) as compared with the control group (102.0 +/- 28.4; P =.019). The resistive index in the central retinal artery was higher in HIV infected patients (0.77 +/- 0.05) as compared with the controls (0.74 +/- 0.04; P =.04). The other hemodynamic parameters were not different between groups. No correlation of flow parameters and CD4+ cell count or HIV-related retinopathy was observed., Conclusions: Decreased macular leukocyte density was detected in HIV infected persons. Our study suggests that abnormal retinal hemodynamics in individuals infected with HIV may be involved in the pathogenesis of HIV-related microvasculopathy.

Purpose: To evaluate clinical characteristics, risk factors, management and outcome of contact lens induced keratitis (CLIK) associated with contact lens wear., Methods: The study comprised all consecutive patients presenting with contact lens related presumed microbial keratitis during a 12-month period at our department. Detailed demographic data, type of contact lens, duration of lens wear, wearing schedule and lens hygiene were derived from a self-administered questionnaire. Severity of ulcer, corneal scrapings, treatment and final outcome were evaluated., Results: 27 patients with CLIK, some of which may have been sterile peripheral infiltrates, due to contact lens wear were detected. In the majority of the cases patients had used disposable soft contact lenses (89%) and most of them had a daily wearing schedule (78%). 51.8% patients cleaned their lenses regularly. 6 (22%) applied no disinfection since their lenses were disposable on removal. In 3 of our cases with CLIK, penetrating keratoplasty had to be performed., Conclusion: Disposable contact lenses seem to have been a predisposing factor for contact lens induced keratitis also when used on a daily wear schedule. Insufficient contact lens care products and/or manufacturing characteristics may be responsible for CLIK, which is also observed in otherwise compliant contact lens users. In 3 of our patients with CLIK keratoplasty became necessary, indicating that contact lens induced keratitis may result in severe corneal complications.