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Purpose To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery. Material and Methods Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed. Results One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%). Conclusion The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.

To investigate, in a routine clinical setting, how global progression or progression within visual field clusters depends on preexisting damage.Glaucoma patients with a visual field damage of at least 3 dB at baseline and a series of at least 5 good quality examinations were scrutinized retrospectively. The change in visual field damage within 10 visual field clusters was assessed in a mixed linear effects model with age, baseline global mean deviation (MD), baseline cluster MD, and observation time as covariates. In addition, progression was tested for a global MD rate with age, baseline global MD, and observation time as covariates.A total of 50 patients with a mean (± SD) age of 78 (± 13) years and a baseline global mean defect (MD) of 7.6 dB (± 4.4) fulfilling the selection criteria were identified between 2001 and 2019 out of 5019 patients in a visual field database of a tertiary ophthalmology center. Baseline visual field damage (global MD) correlated positively (p 0.001) with the progression rate within clusters, but not with the global MD rate (p = 0.075). Higher age was a significant predictor for more rapid progression in both models (p 0.001).In this retrospective study of patients in a routine clinical setting, who were not enrolled in studies, and simply receiving routine clinical care, analyzing progression within visual field clusters was more sensitive than assessing the global MD rate.In der klinischen Routine sollte die Abhängigkeit der globalen Progression oder der Progression innerhalb von Gesichtsfeldclustern von der Vorschädigung untersucht werden.Glaukompatienten mit einem Gesichtsfeldschaden von mindestens 3 dB bei Studienbeginn und einer Serie von mindestens 5 Untersuchungen guter Qualität wurden retrospektiv untersucht. Die Veränderung des Gesichtsfeldschadens innerhalb von 10 Gesichtsfeldclustern wurde in einem Modell mit gemischten linearen Effekten mit dem Alter, der globalen mittleren Abweichung (MD) zu Beginn der Untersuchung, der MD in den Clustern zu Beginn der Untersuchung und der Beobachtungszeit als Kovariaten bewertet. Zusätzlich wurde die Progression für die globale MD-Rate getestet, wobei das Alter, der Ausgangswert der globalen MD und die Beobachtungszeit als Kovariaten berücksichtigt wurden.Aus einer Gesichtsfelddatenbank eines tertiären ophthalmologischen Zentrums wurden zwischen 2001 und 2019 aus 5019 Patienten insgesamt 50 Patienten mit einem mittleren (± SD) Alter von 78 (± 13) Jahren und einem mittleren globalen Ausgangsdefekt (MD) von 7,6 dB (± 4,4) identifiziert, die die Auswahlkriterien erfüllten. Der Ausgangswert der Gesichtsfeldschädigung (globale MD) korrelierte positiv (p 0,001) mit der Progressionsrate innerhalb von Clustern, jedoch nicht mit der globalen MD-Rate (p = 0,075). Ein höheres Alter war in beiden Modellen ein signifikanter Prädiktor für eine schnellere Progression (p 0,001).In dieser retrospektiven Studie an Patienten in der klinischen Routine, die nicht in Studien eingeschlossen waren, sondern lediglich eine klinische Routineversorgung erhielten, war die Analyse der Progression innerhalb von Gesichtsfeldclustern sensitiver als die Bewertung der globalen MD-Rate.

Purpose: This study was performed in an attempt to gain more information on whether the 30Hz-flicker mfERG indeed provides a sensitive measure of dysfunction in patients with primary open-angle glaucoma (POAG) as has been suggested previously. Methods: Eighteen POAG patients with visual field defects (MD>2.2dB) and glaucomatous optic neuropathies as well as 10 control subjects underwent mfERG recording as follows: 30Hz-flicker mfERG, LED stimulus screen, 61 hexagons, L max: 180cd/m2, L min: 0cd/m2, recording time: ∼5min, filter setting: 10-200Hz. The 30Hz response (also called the fundamental or the first harmonic response (1HW) and the second harmonic wave at 60Hz (2HW) were analysed as an overall response and in quadrants, as well as in 4 small neighbouring areas per quadrant. The patients' mfERGs were compared to those of the control group and to the mean defect values (MD) of the corresponding quadrants of the Octopus perimetry. Results: Neither in the overall response, nor in the quadrants, nor in the smaller areas examined did amplitudes and phases of the 1HW and the 2HW or the amplitude ratio of the 2HW to the 1HW (DFT-ratio) differ from the controls (P>0.05—ANOVA). There was no significant correlation between mfERG values and the MD (Spearman-test, Bonferroni). Conclusion: Thus, the 30Hz-flicker mfERG does not seem to be sensitive enough to separate glaucoma patients from normal

To compare the intraocular pressure (IOP) diurnal fluctuations of glaucoma patients treated with latanoprost 0.005% once a day with patients with controlled IOP after deep sclerectomy or trabeculectomy.The trial included 60 prospectively recruited subjects with primary open-angle glaucoma. The medical group consisted of 20 patients with controlled IOP (18 mm Hg) under latanoprost 0.005% monotherapy and with no history of previous intraocular surgery or argon laser trabeculoplasty; the surgical groups included 20 patients after trabeculectomy, and 20 patients after deep sclerectomy with collagen implant (DSCI). The patients in the surgical groups had a controlled IOP without any ocular hypotensive medications. All patients underwent a diurnal tension curve (08:00-17:00/three-hour intervals), followed by a water-drinking test (WDT) with the last IOP measurement taken at 21:00 hours. The between-group differences were tested for significance by means of analysis of variance (ANOVA).Baseline IOP was significantly different between the trabeculectomy group (10.1 mm Hg (3.4 SD)), the DSCI group (13.9 mm Hg (2.8)) and the latanoprost group (15.5 mm Hg (2.0); p = 0.005). The average IOP during the diurnal tension curve (10.1, 13.7, and 15.7 mm Hg, respectively, for the trabeculectomy, DSCI, and latanoprost groups) differed significantly between groups (ANOVA; p0.0001), but the variation was comparable in the three groups (ANOVA; p = 0.13). After the WDT, elevation of IOP was significantly greater among patients treated with latanoprost (p = 0.003).Trabeculectomy patients had a statistically significant lower average IOP in the diurnal tension curve compared with the other two groups. No wider variation in diurnal IOP with latanoprost compared with the surgical procedures was found. The IOP increase during the WDT was most marked in patients under latanoprost therapy.

Purpose To evaluate relationship between vascular dysregulation and retinal oxygen demand in normal tension glaucoma (NTG). Methods Retinal vascular responses of 27 eyes of 18 Caucasian (10♀ :8♂) individuals with NTG were measured. Subjects were grouped based on their median vascular responsiveness. In each group, retinal vessel oxygen saturation was measured in arterioles (A-SO2) and in venules (V-SO2) within the peri-papillary annulus with the oximetry tool of Retinal Vessel Analyser (IMEDOS Systems UG, Jena, Germany).Retinal nerve fiber layer thickness (RNFL) was measured with spectral domain optical coherence tomography (Carl Zeiss Meditec, Dublin, CA, USA) and visual field (VF) with Octopus perimeter (Haag-Streit International, Switzerland). Retinal oxygen concentration per micron of nerve fiber layer thickness (O2-C) was calculated as follows; the difference of aretrio-venous oxygen saturation (A-V SO2) was divided to the mean RNFL thickness. A linear mixed-effects model was applied (IBM SPSS®) Results The eyes were grouped based on their vascular responsiveness (group1 ≤ 2.90%; n = 13, group 2 > 2.90%; n = 14). In group1 and in group2, mean A- SO2, V–SO2 and A-V SO2 were 96.50%(±4.38); 97.77% (±3.03) (p=0.517), 62.89% (±6.23); 60.71% (±6.28) (p = 0.391), 34.64%(±4.51); 36.68% (±5.27) (p = 0.294), respectively. Subjects in group 1 showed higher O2-C 0.488%/µ (±0.0848) than in group2 0.434%/µ (±0.0551) (p = 0.027). Mean age (65.45 y (±11.7)) and VF(dB) defect (4.7 dB (± 3.6), 3.4 dB (±5.2) were not statistically different between groups (p = 0 > 141). In group 1, RNFL thickness was significantly less than in group 2 (72.23 µm (±12.1); 85.31 µm (±13.67) (p=0.014). Conclusions Oxygen demand was increased in patients with excessive vascular dysregulation, while mean SO2 values were not related to age and/or flicker responses. This conclusion remains to be conformed in further studies.

Purpose: To analyse the sensitivity of the ‘2 global flash' multifocal electroretinogram (mfERG) to detect glaucomatous dysfunction in normal tension (NTG) and high tension primary open angle glaucoma (POAG) patients. Methods: MfERGs were recorded from 20 NTG and 20 POAG patients and compared to those of 20 controls. The mfERG array consisted of 103 hexagons. Each m-sequence step started with a focal flash that could be either dark or light (m-sequence: 2^13, L max: 200cd/m2, L min: 1cd/m2), followed by two global flashes (L max: 200cd/m2) at an interval of ∼26ms. Focal scalar products (SP) were calculated using focal templates derived from the control recordings (VERIS 4.8). We analyzed 5 response averages (central 7.5 degrees and 4 adjoining quadrants) of the response to the focal flash, the direct component at 10-40 ms (DC) and the following two components induced by the effects of the preceding focal flash on the response to the global flashes at 40-70ms (IC-1) and at 70-100 ms (IC-2). Results: Both NTG and POAG patients differed from controls in the IC-1 response to the superior quadrants, and POAG patients also differed from controls in the centre. The most sensitive parameter was the IC-1 of the superior temporal quadrant with an area under the ROC curve of 0.82 for POAG and 0.79 for NTG. The DC and the IC-2 did not differ significantly between the groups. When all five response averages of the IC-1 were taken into consideration 90% of the NTG patients and 85% of the POAG patients were correctly classified as abnormal while 80% of the control subjects were correctly classified as normal. Conclusions: This stimulus sequence holds promise for the diagnosis of early functional changes in POAG. A new finding is that both NTG, as well as POAG can be differentiated from control subjects

Purpose To study the retinal oxygen saturation in patients with retinitis pigmentosa (RP). Methods Retinal Vessel Oximetry was performed with the oximetry tool of Retinal Vessel Analyzer (Imedos GmbH, Jena, Germany) on 12 eyes of 6 RP patients and on 24 eyes of 12 age-matched healthy controls (p=0.747, two-way ANOVA). RP patients were selected following a clinical and electrophysiological assessment. We evaluated the mean oxygen saturation of arteries (A-SO2), the mean oxygen saturation of veins (V-SO2), as well as the A-V-SO2 difference and compared them to the ERG values within both groups. Results In controls, the mean A-SO2 and V-SO2 of the retina was 92.41% (SD, ±3.54) and at 53.99% (SD, ±2.95), respectively. In the RP group, the A-SO2 and the V-SO2 were increased to 100.13% (SD, ±7.24) and 66.96% (SD, ±5.67), respectively (p-values=0.000). The A-V-SO2 difference, known to be proportional to oxygen consumption, was reduced to 33.17% (SD, ±5.85) in RP when compared to the controls 38.39% (SD, ±3.00) in a linear regression model (p=0.001). The b-wave of the dark-adapted 3.0 ERG response compared to A-SO2, V-SO2, as well as A- V-SO2 difference within both groups, showed a linear correlation of: r=-0.571, r=-0.846, and r=0.531, respectively with the corresponding p-values