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Abstract Purpose: To compare the results of the current gold standard, laser interferometry, and keratometry by the IOL-Master, with a newly developed Galilei G6 using raytracing software Okulix for intraocular lens (IOL) power calculations. Methods: For comparison of the IOL-power calculation of both devices, we analyzed the difference between the actual one-month postoperative subjective refraction and the theoretically calculated target refraction before cataract surgery. The IOL was selected according to the IOL Master recommendation aiming for emmetropia after surgery.We analyzed the differences of the measurements of the basic biometric data in 205 healthy eyes by each device. Results: Our study included 205 healthy, unoperated eyes from 117 patients (61 women, 56 men) aged 20 to 75 years. Twenty-two eyes of cataract patients were also included in this retrospective study design. The mean difference between the prediction of the postoperative refraction and the refraction actually achieved was 0.03 D for the IOL Master and –0.23 D for the Galilei G6. The difference was not statistically significant (P = 0.059). The difference between the IOL power calculation of the IOL Master and the calculation of the G6 was not statistically significant (P = 0.064). The difference between the predicted refraction of the G6 and the refraction achieved after one month was also not statistically significant (P = 0.12) and neither was the difference between the predicted refraction of the IOL Master and the achieved refraction (P = 0.39). The mean axial length was calculated as 24.21 ± 0.80 mm using the IOL Master and 24.27 ± 0.82 mm using the Galilei G6 device. The mean value regarding anterior chamber depth (ACD) of the IOL master was 3.46 ± 0.23 mm and for the Galilei was G6 3.51 ± 0.25 mm. When comparing the white to white (WTW) values of the IOL master, it showed mean values of 12.32 ± 0.31 and Galilei showed mean values of G6 12.21 ± 0.28. All of these differences (between Galileo and IOL Master measurements) were statistically significant (P < 0.001). Conclusion: Both the laser interferometry/keratometry performed by the IOL Master and the interferometry/raytracing biometry strategy performed by the Galilei G6 demonstrated equal results when executing the IOL power calculation before cataract surgery in eyes with no prior ocular surgery.

Purpose: Currently, two major principles exist to create LASIK flaps: firstly, a strictly horizontal (2D) cut similar to the microkeratome-cut and secondly an angled cut with a "step-like" edge (3D). The strictly horizontal (2D) cut method can be performed using apparatus such as the low-energy FEMTO LDV Z8 laser and its predecessors which are specific to this type. Alternatively, the low-energy FEMTO LDV Z8 laser's 3D flap design creates an interlocking flap-interface surface which potentially contributes toward flap stability. In addition, the FEMTO LDV Z8 offers flap-position adjustments after docking (before flap-creation). The current study analyzed precision, safety, efficacy, as well as patient self-reported pain and comfort levels after applying two different types of LASIK flap morphologies which were created with a low-energy, high-frequency femtosecond (fs) laser device., Methods: A prospective, interventional, randomized, contralateral eye, single-center comparison study was conducted from November 2019 to March 2020 at the Hamburg vision clinic/ zentrumsehstärke, Hamburg, Germany. Eleven patients and 22 eyes received low-energy fs LASIK treatment for myopia or myopic astigmatism in both eyes. Before the treatment, the eyes were randomized (one eye was treated with the 2D, the other eye with the 3D method)., Results: The mean central flap thickness one month after surgery was 110.7 ± 1.6 μm (2D) and 111.2 ± 1.7 μm (3D); P = 0.365 (2D vs 3D). Flap thickness measured at 13 different points resulted in no statistically significant differences between any of the measurement points within/between both groups; demonstrating good planarity of the flap was achieved using both methods. Despite not being statistically significant, the surgeons recognized an increase in the presence of an opaque bubble layer in the 3D flap eyes during surgery and some patients reported higher, yet not statistically significant, pain scores in the 3D flap eyes during the first hours after the treatment. Overall, safety- and efficacy indices were 1.03 and 1.03, respectively., Conclusion: In this prospective, randomized, contralateral eye study, the low-energy fs laser yielded predictable lamellar flap thicknesses and geometry at one-month follow-up. Based on these results, efficacy and safety of the corresponding laser application, that is, 2D vs 3D, are equivalent., Competing Interests: None., (Copyright © 2023 Steinberg et al.)

Purpose: The study aims to explore the intereye asymmetry in normal and keratoconic individuals and to evaluate the discriminant power of single and combined asymmetry parameters., Methods: This is a retrospective designed study including 414 patients who had Pentacam Scheimpflug topographic and tomographic imaging in both eyes: 124 subjects with bilateral normal corneas evaluated for refractive surgery and 290 with keratoconus. All elevation-, pachymetric-, and volumetric-based data (56 parameters) were electronically retrieved and analyzed. Intereye asymmetry was determined by subtracting the lowest value from the highest value for each variable. The degree of asymmetry between each subject's eyes was calculated with intraclass correlation coefficients for all the parameters. Receiver operating characteristic curve was used to determine predictive accuracy and to identify optimal cutoffs of these values and combinations thereof., Results: In the normal/keratoconus subjects the median intereye asymmetries were 0.30/3.45 for K2 (flat) meridian, 0.03/0.25 for BFS front, 1.00/15.00 for elevation back BFS apex, and 7.00/29.00 for pachy min., Conclusions: In addition to Rabinowitz's K max intereye asymmetry we propose pachymetric, elevation-based, and high-order corneal wavefront intereye asymmetry parameters to improve the diagnostic armamentarium of keratoconus., (© 2022. The Author(s).)

Background/aims: To investigate a possible association between the use of hydrochlorothiazide (HCT) and/or angiotensin-converting enzyme inhibitors (ACE inhibitors) and the occurrence of periocular non-melanoma skin cancer., Methods: The files of 929 patients from the University Medical Center Hamburg-Eppendorf who were surgically treated for suspected periocular malignancy were evaluated retrospectively regarding the occurrence of non-melanoma skin cancer and concomitant medication. To be able to put the data in an overall context, we also analyzed age-matched routine data of the DAK-Gesundheit (DAK-G), a nationwide operating German health insurance company., Results: Of the 929 patient records examined, who underwent surgical excision for suspected non-melanotic malignancy, non-melanocytic skin cancer could actually be determined by histology in 199 patients. In total, 176 patients (103 women, 72 men) had a basal cell carcinoma and 23 patients (16 women, 7 men) suffered from squamous cell carcinoma. The rate of intake of HCT or ACE inhibitors in our patient collective with non-melanotic skin cancer is significantly higher than in the general age-matched population (ORACE: 2.51, p < 0.001; ORHCT: 7.24, p < 0.001, ORBOTH: 4.61, p < 0.001)., Conclusion: The rate of intake of HCT or ACE inhibitors is significantly higher in our patient collective with non-melanotic skin cancer compared to the group from the age-matched general population (DAK insured (p < 0.001)) compared to the routine data of the DAK-G. This leads us to the conclusion that taking the medication is associated with an increased risk for non-melanotic skin cancer. We recommend regular skin cancer screening, moderate ordination of photosensitizing medication, but above all comprehensive clarification of possible risks., (© 2022. The Author(s).)

Background: The question of whether refractive or topographic changes are to be expected after eye muscle surgery is largely unanswered., Materials and Methods: Results of pre- and postoperative objective refraction, Pentacam (Oculus, Menlo Park, CA, USA), and visual acuity tests of 229 eyes are included in the present analysis. The examinations took place preoperatively, on the first postoperative day, and after 3 months., Results: After surgery on one or two extraocular recti muscle, there are significant changes in the cylinder (p < 0.001) on the first postoperative day, although values returned to normal after 3 months. Similar changes also appeared in combined operations of extraocular and oblique muscles., Conclusion: The authors postulate that extensive patient education with regard to temporary changes in the cylinder is necessary, particularly when the extraocular muscles are involved, and that additional refraction and topography control can be useful postoperatively if visual rehabilitation is inadequate., (© 2021. The Author(s).)

Background: Open and minimally invasive tear duct surgery are among the common surgical indications; however, little is known so far about the respective influences on the quality of life., Objective: The aim of this study was to compare the subjective influence on the quality of life of patients after open and minimally invasive surgical techniques for recanalization of dacryostenosis., Material and Methods: From the collective of patients who were surgically treated at the University Medical Center Hamburg-Eppendorf from 2015 to 2018, a total of 169 patients (111 dacryocystorhinostomy, DCR, 58 endoscopy) took part in the survey and answered 9 questions about subjective satisfaction, which were evaluated also comparatively., Results: When asked about postoperative satisfaction, the patients were significantly more satisfied after DCR (p = 0.001) than the patients who underwent a lacrimal endoscopy. There was no significant difference in terms of postoperative complications (p = 0.348). The rate of reoperations, however, was significantly higher in the patient group who underwent lacrimal endoscopy (χ 2 -test, p = 0.004)., Conclusion: In summary it can be said that DCR is not inferior to lacrimal endoscopy in terms of patient satisfaction., (© 2021. The Author(s).)

Background: There is largely a lack of clarity on the question of whether refraction or topography changes are to be expected after blepharoplasty, levator resection, or a lateral tarsal strip procedure., Materials and Methods: Therefore, in the present study, objective refraction, anterior eye segment tomography, and visual acuity tests were carried out pre- and postoperatively in 78 patients and then analyzed. The examination was carried out preoperatively, at suture removal after 10 days, and after 3 months., Results: Neither after blepharoplasty nor after a lateral tarsal strip procedure were significant changes in vision or refraction seen in the topography. In contrast, the Wilcoxon sign test 10 days after levator resection showed a significant increase in the cylinder after 10 days compared to the preoperative level (p = 0.042). However, this change was no longer detectable after 3 months., Conclusion: The authors postulate that extensive patient education with regard to temporary visual changes, particularly in the case of levator resections, is essential and that additional refraction and topography control can be useful postoperatively., (© 2021. The Author(s).)

Infranuclear motility disorders are such of the cranial nerves, the extraocular muscles or changes in the orbit but definitely peripheral to the nuclei of the cranial nerves. Characteristic are movement deficits, a compensatory head posture and the pattern of incomitancy. The secondary angle of deviation is usually larger than the primary. Combined pareses suggest a lesion in the cavernous sinus, orbital apex or a multilocular event. It is essential to rule out supranuclear disorders, especially if the motility deficit is atypical. For clarification, an individual risk assessment is recommended, paying particular attention to risk factors., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objective: The optimal timing for surgery of congenital nasolacrimal duct obstruction (CNLDO) is controversially discussed . An aspect that has not yet been studied in this context is the path from first symptoms to the initial diagnosis and surgical treatment with respect to social factors and burden of suffering. The aim of this study was a real-life analysis of the entire course of the disease., Methods: Monocentric, retrospective study evaluating children with CNLDO (n = 147) who underwent surgery. The minimum follow-up was 3 months (26 ± 14 months). The patient information was collected by telephone using a questionnaire especially created for this purpose. The famelial suffering was measured on a scale of 1-5., Results: Data were collected from 118 parents with a mean follow-up of 26 months. First symptoms occurred at a median age of 1 month. The diagnosis was confirmed through a pediatrician/ophthalmologist after a median of 6 months. An assignment to a referral center for surgical treatment was performed a median of 18 months after the first presentation. The average age of the patients at the time of surgery was 23 months. Surgery before the age of 13 months showed a 100% success rate. The average age of those who needed revision surgery was 27 months (±12 months). The familial suffering was measured as 4.1 points before surgery and 1.3 after surgery., Conclusion: This study is the first real-life study, which illustrates the path of CNLDO from the first symptoms to rehabilitation, including influential social factors. Early surgery significantly shortens the suffering of both patients and parents. Considering the low operative risks and excellent success rate of operative treatment, an early consultation at a surgical department is recommended., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background and Purpose: Mycotic keratitis is a serious but relatively rare disease. No targeted data collection in Germany existed until the foundation of the German Pilz-Keratitis Register in 2015., Patients and Methods: The inclusion of retrospective and prospective patients was carried out., Inclusion Criteria: diagnosis confirmed by the polymerase chain reaction (PCR), culture, histology or confocal microscopy (IVCM). Collected parameters: date of symptom onset, date and method of diagnosis, risk factors, visual acuity and findings at admission and at follow-up, conservative and surgical treatment., Results: By January 2018, a total of 102 eyes from the years 2000-2017 were reported from 16 centers (64.3% female, mean age 52 years, range 18-95 years). The initial diagnosis was made correctly in only 20.6% of cases. The mean time to correct diagnosis was 31.7 ± 46.9 (0-296) days. The diagnosis was confirmed in cultures in 74.5%, histologically in 30.4%, by PCR in 38.2% and IVCM in 27.4%. Fungal species identified were: 36.7% Fusarium spp., 35.8% Candida spp., 6.4% Aspergillus spp. and 21.1% other. The most important risk factor was the use of contact lenses. The most commonly used antifungal agent was voriconazole (64.7%) followed by amphotericin B (37.2%). Penetrating keratoplasty was performed in 65.7% of the cases and 8.8% of the affected eyes had to be enucleated. The visual acuity of the entire study population increased from the initial 0.16 ± 0.25 (0.001-1.0) decimal to 0.28 ± 0.34 (0-1.0) decimal., Conclusion: The correct diagnosis of fungal keratitis is often significantly delayed. The treatment can be very difficult and keratoplasty is often necessary. In order to gain a better understanding of this disease, to recognize previously unknown risk factors and, if necessary, a change in the spectrum of pathogens and to identify approaches to treatment optimization, the fungal keratitis registry will be continued.

Background/aims: To provide evidence of statistically significant difference in the surgical outcome of the lateral tarsal strip with everting sutures (LTS + ES) versus the Quickert procedure (QP) in the treatment of involutional entropion., Methods: In a prospective randomized comparative trial, 66 eyelids of 52 patients with primary involutional lower eyelid entropion were recruited. Thirty-six eyelids were randomized to QP, and 30 eyelids were randomized to LTS + ES. Surgery was performed by a single surgeon. Postoperative follow-up was scheduled after 2 weeks, 8 and 14 months. Successful surgery was defined as a normal eyelid position at rest and inability to induce entropion on forced eyelid closure at or before the 14-month follow-up visit., Results: A total of 66 eyelids of 52 patients were enrolled in the study. Three patients did not complete follow-up (1 did not attend the 8 months follow-up visit; 2 did not attend 14 months follow-up visit). Of the 63 patients, a single eyelid [success probability 0.97; confidence interval (CI) 0.92-1] in the QP group and two treated eyelids [success probability of 0.93; CI: 0.85-1] in the LTS + ES group had a recurrence of a lower eyelid entropion after 14 months. There was no statistically significant difference in surgical failure between the LTS + ES versus QP (Log-rank test: p = 0.46)., Conclusion: These data provide strong evidence that success rates at 14 months are similar in patients treated with either techniques (LTS + ES versus QP)., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

This report describes the diagnosis and treatment of a 27-year-old patient with neurofibromatosis 1 (NF1) and late progression of a pre-existing optic pathway glioma (OPG) that caused significant reduction in vision. OPG is one of the diagnostic criteria for establishing the diagnosis of NF1. Most common findings of NF1 are café-au-lait spots, axillary and inguinal freckling of the skin, iris hamartoma (Lisch nodules), and tumors of the central nervous system and peripheral nerves. We successfully applied a modified International Society of Paediatric Oncology chemotherapy regimen for low-grade glioma in children with carboplatin dose adjustment according to the area under the plasma drug concentration-time curve calculation. During and after the chemotherapy, a clear improvement of the visual capacity was achieved. Age-adapted chemotherapy for symptomatic adult-onset OPG in patients with NF1 should be considered in individual cases., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: To evaluate the safety and spectrum of complications of three excimer laser surface ablation techniques (SATs) with an intraoperative application of mitomycin C (MMC) 0.02%. A retrospective, non-comparative large case series., Methods: SATs were performed on 2757 eyes with a preoperative spherical equivalent (SE) of - 4.41 ± 2.44 and a Wavelight Allegretto 200 platform. Ablation zone diameters between 6.0 and 7.0 mm were used according to mesopic pupil size. All patients were treated with an intraoperative application of MMC for 30 to 90 s depending on refractive error. The mean follow-up time was > 3 months (107 ± 24 days). Complication range and incidence were analyzed retrospectively and safety index was calculated., Results: Two thousand seven hundred and fifty-seven eyes met the inclusion criteria for surface ablation. Two thousand five hundred and seventy-three eyes were assigned to alcohol-assisted photorefractive keratectomy (APRK), 135 eyes to transepithelial photorefractive keratectomy (TPRK), and 49 eyes to off-flap epithelial laser in situ keratomileusis (EpiLASIK/EpiK). Overall, the safety index was 1.06 ± 0.28. Haze was graded according to the Fantes scale. Haze incidence rates were highest in the TPRK group (14.81%) and comparably low in APRK (2.95%) and EpiK (4.08%) groups., Conclusions: Intraoperative topical application of MMC (0.02%) results in good safety and no severe side effects. However, highest incidence of haze was observed after TPRK. The more frequent peripheral localization of haze might be attributed to large ablation zones and the wavefront optimized ablation profile especially in the PTK modus of the laser platform.

Purpose: To analyze the potential benefit of the newly developed Tomography and Biomechanical Index (TBI) for early keratoconus screening., Methods: In this retrospective study, the discriminatory power of the corneal tomography Belin/Ambrósio Enhanced Ectasia Display (BAD-D) index and the newly developed Corvis Biomechanical Index (CBI) and TBI to differentiate between normal eyes, manifest keratoconus eyes (KCE), very asymmetric keratoconus eyes with ectasia (VAE-E), and their fellow eyes with either regular topography (VAE-NT) or regular topography and tomography (VAE-NTT) were analyzed by applying the t test (for normal distribution), Wilcoxon matched-pairs test (if not normally distributed), and receiver operating characteristic curve (ROC). The DeLong test was used to compare the area under the ROC (AUROC). Further, the cut-offs of the analyzed indices presented in a study by Ambrósio et al. from 2017 were applied in the study population to enable a cross-validation in an independent study population., Results: All indices demonstrated a high discriminative power when comparing normal and advanced keratoconus, which decreased when comparing normal and VAE-NT eyes and further when analyzing normal versus VAE-NTT eyes. The difference between the AUROCs reached a statistically significant level when comparing TBI versus BAD-D analyzing normal versus all included keratoconic eyes (P = .02). The TBI presented with the highest AUROCs throughout all conducted analyses when comparing different keratoconus stages, although not reaching a statistically significant level. Applying the cut-offs presented by Ambrósio et al. to differentiate between normal and VAE-NT in the study population, the accuracy was reproducible (accuracy in our study population with an optimized TBI cut-off: 0.72, with the cut-off defined by Ambrósio et al. 0.67)., Conclusions: The TBI enables karatoconus screening in topographical and tomographical regular keratoconic eyes. To further improve the screening accuray, prospective studies should be conducted. [J Refract Surg. 2018;34(12):840-847.]., (Copyright 2018, SLACK Incorporated.)

Purpose: This proof-of-concept study was designed to analyze the ability of in vivo biomechanical corneal analyses with the corneal visualization Scheimpflug technology (CorvisST; Oculus Optikgeräte, Wetzlar, Germany) to differentiate between normal eyes and eyes with manifest keratoconus after strictly eliminating the potential confounding factors intraocular pressure (IOP) and central corneal thickness (CCT)., Methods: In this retrospective, cross-sectional study, after pairwise matching for CCT and IOP, 29 normal eyes and 29 keratoconic eyes (one eye from each patient) were selected as study population. Older CorvisST parameters and the new Corvis Biomechanical Index (CBI), including several biomechanical and one tomographic parameter, as well as an adjusted CBI (aCBI) (including only biomechanical parameters), were compared regarding their discriminative ability between both groups., Results: None of the CorvisST parameters of the former software version demonstrated statistically significant differences between normal and keratoconic eyes. On the other hand, the CBI and aCBI reached accuracies of 0.91 and 0.93, respectively, to discriminate between CCT- and IOP-matched normal and keratoconic eyes (CBI: [AUC/sensitivity/specificity]: 0.961/0.90/0.93; aCBI: [AUC/sensitivity/specificity]: 0.986/0.93/0.93)., Conclusions: This study demonstrated that the concept of keratoconus screening with the CorvisST is effective in differentiating keratoconic from non-keratoconic eyes. The next steps will be testing the indices in subclinical keratoconus cases and hopefully combining biomechanical analyses with already established topography and tomography indices to further improve current keratoconus screening. [J Refract Surg. 2017;33(11):773-778.]., (Copyright 2017, SLACK Incorporated.)

A 43-year-old male patient with unilateral metamorphosia presented after gazing at an eclipse with only one eye. Damage of the macula was demonstrated funduscopically, with OCT and angiography. Six weeks after initial presentation and oral methylprednisolone therapy (40 mg/d for 10 days), the symptoms and the morphological changes decreased. Solar retinopathy is a photochemical alteration of the retina, usually seen after sun gazing. In younger patients, it mostly presents as bilateral solar maculopathy. Some patients exhibit partial or total recovery., (Georg Thieme Verlag KG Stuttgart · New York.)

Parkinson's disease (PD) is caused by progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta, resulting in a deficiency of dopamine in the striatum and an increased release of acetylcholine by tonically active interneurons. Botulinum neurotoxin-A (BoNT-A) is well known for blocking transmitter release by cholinergic presynaptic terminals. Treating striatal hypercholinism by local application of BoNT-A could be a possible new local therapy option of PD. In previous studies of our group, we analyzed the effect of BoNT-A injection into the CPu of 6-OHDA lesioned hemiparkinsonian rats. Our studies showed that BoNT-A application in hemiparkinson rat model is capable of abolishing apomorphine induced rotations for approximately 3 months. Regularly occurring axonal swellings in the BoNT-A infiltrated striata were also discovered, which we named BoNT-A induced varicosities (BiVs). Résumé: Here we investigated the long-term effect of the injection of 1ng BoNT-A into the right CPu of naive Wistar rats on the number of ChAT-ir interneurons as well as on the numeric density and the volumetric size of the BiVs in the CPu. Significant differences in the number of ChAT-ir neurons between the right BoNT-A treated CPu and the left untreated CPu were not detected up to 12 month post BoNT-A injection. The numeric density of BiVs in the treated CPu reached a maximum 3 months after BoNT-A treatment and decreased afterwards, whereas the volume of single BiVs increased steadily throughout the whole time course of the experiment., (Copyright © 2015 Elsevier B.V. All rights reserved.)