[Sutureless phacotrabeculectomy. Interim results]. / Phakotrabekulektomie ohne Naht. Mittelfristige Ergebnisse.

BACKGROUND: To study the medium-term success rate of a simple surgical technique for combined operation of cataract and glaucoma. MATERIALS AND METHODS: Of 50 patients with cataract and various types of glaucoma, 55 eyes underwent a combined operation for cataract and glaucoma and were followed up for at least 6.5 months. The phacoemulsification war performed through a scleral tunnel. After implantation of a foldable IOL an "inverse T" incision of the tunnel floor was performed to create a valve mechanism closure. RESULTS: In 45 eyes (83%) the intraocular pressure was controlled without medications during the follow-up time. In 10 cases (17%) a new glaucoma medication was introduced postoperatively. Following early postoperative complications were noticed: early intraocular hypertension (20.0%), wound leakage (20.0%), early intraocular hypotension (10.9%), hyphema (19.1%). CONCLUSIONS: No-stitch phacotrabeculectomy appears to be a safe and (medium-term) effective procedure for combined surgery of cataract and glaucoma.

[Clear lens extraction (CLE) for correction of high grade myopia]. / Clear Lens Extraction (CLE) zur Korrektur der hochgradigen Myopie.

PURPOSE: To evaluate the efficacy and safety of the clear lens removal to compensate the myopic refractive error. METHODS: Retrospective analysis of 40 myopic eyes with axial length more than 27 mm, treated by phacoemulsification and posterior chamber lens implantation. Mean follow-up 45.9 months (17 to 118). Analysed parameters: postoperative uncorrected and bestcorrected visual acuity, comparison of pre- and postoperative bestcorrected visual acuity, intra- and postoperative complications, predictability of refraction, subjective satisfaction score. RESULTS: Axial length 30.63 +/- 2.0 mm (min. 27, max. 36.8 mm). Preoperative myopia -14.50 +/- 3.6 dpt. Bestcorrected preoperative visual acuity 0.40 +/- 0.19 (min. 0.1, max. 0.8). Bestcorrected postoperative visual acuity 0.71 +/- 0.25 (min. 0.16, max. 1.25). No loss of best corrected visual acuity. Posterior capsule opacification requiring YAG-capsulotomy occurred in 50%. One eye developed cystoid macular edema, no retinal detachment were observed postoperatively. All patients were satisfied or very satisfied. CONCLUSIONS: Clear Lens Extraction for severe myopia is safe, for the patient satisfying and is a valid alternative to corneal refractive surgery.

[The learning curve in refractive laser surgery: criteria for outcome evaluation]. / Die Lernkurve der refraktiven Laserchirurgie: Beurteilungskriterien.

BACKGROUND: We wanted to analyse and compare the results of our first 100 cases of refractive surgery using the commonly accepted refractive parameters and using more subjective data. MATERIALS AND METHODS: Retrospective analysis of the first 100 consecutive cases of refractive surgery using objective and subjective criteria. RESULTS: Our objective refractive results are comparable to the results of many other authors. The subjective evaluation reveals a large discrepancy compared to the objective data. CONCLUSIONS: The evaluation of the results in refractive surgery should include more subjective parameters. This will allow to better correlate the quality-parameters of the surgery to the patient's expectations.

[Computerized corneal topography in treatment of high grade astigmatism after perforating keratoplasty]. / Computerisierte Hornhauttopographie in der Behandlung des hochgradigen Astigmatismus nach perforierender Keratoplastik.

BACKGROUND: High astigmatism is the most frequent complication of penetrating keratoplasty for keratoconus. The postoperative use of corneal topography enables the surgeon to analyse the surface geometry of the graft and consequently to reduce in controlled steps the postoperative astigmatism. PATIENTS AND METHODS: Based on the measurements of corneal topography 13 patients underwent selective sutures removal and/or arcuate keratotomy to reduce high postoperative astigmatism (> 3 dpt). In 7 cases only selective sutures removal was applied. 5 patients underwent sutures removal combined with arcuate keratotomy and in one case only arcuate keratotomy was performed. RESULTS: The mean astigmatism after perf. keratoplasty was 8.2 dpt (Min. 3.0-Max 19.0). After selected sutures removal or arcuate keratotomy the mean astigmatism was 4.7 dpt (Min. 0-Max. 6.5). The mean reduction corresponds to 4.7 dpt. In no cases we observed an increase in astigmatism after selective sutures removal. CONCLUSION: The measurement of corneal topography after penetrating keratoplasty enables us to better analyse and recognize the tissue forces responsible for high astigmatism and consequently to selectively reduce it.

[Long-term follow-up of implantation of foldable silicon posterior lenses]. / Langzeitergebnisse nach Implantation faltbarer Silikon-Hinterkammerlinsen.

BACKGROUND: Prospective analysis of long-term results after small incision no-stitch phacoemulsification with implantation of foldable silicone IOL. MATERIALS AND METHODS: In 100 consecutive patients we implanted through a 3.2 mm incision a STAAR-silicone IOL model AA4203. Uncorrected and best-corrected visual acuity, surgically induced astigmatism and postoperative complications were examined at 1 day, 3 months and 1 year after surgery. RESULTS: On day 1 postop. 75% of the patients achieved uncorrected visual acuity of 0.5 or more. The mean best corrected visual acuity at day 1 was 0.75 (0.22 SD). The vector analysis of the surgically induced astigmatism does not show any difference between day 1 and 1 year postop. with a mean induced astigmatism of 0.73 dpt. 12 Months after surgery we found 3 cases of cystoid macula edema and 3 cases of clinically significant secondary cataract. CONCLUSIONS: The clinical long-term results after implantation of foldable silicon-IOL are comparable with the results after implantation of rigid PMMA lenses. The optical rehabilitation is much faster and contributes to lower the costs of modern cataract surgery.

[Long-term results of secondary implantation of anterior chamber lenses]. / Langzeitresultate von sekundär implantierten Vorderkammerlinsen.

Long-term follow-up of secondary implanted anterior chamber intraocular lenses. The long-term results after secondary implantation of an anterior chamber IOL in aphakic patients are illustrated. After a mean period of 7 years after uneventful intracapsular cataract extraction 45 eyes underwent secondary implantation of an anterior chamber IOL of Symflex-Type. The mean follow-up was 40 months. During this time we observed following complications: minimal pupillary deformation (12 cases), worsening of the best corrected visual acuity (8 cases), progredient pupillary deformation (3), retinal detachment (2), pupillary block glaucoma (2), CME (1) and formation of peripheral anterior synechia (1). We discuss the alternative possibility to correct aphkia by secondary implantation of a transscleral fixated posterior chamber IOL or by epikeratophakia.

[Small incision cataract surgery: changes in postoperative astigmatism]. / Kleinschnitt-Kataraktchirurgie: Anderungen des postoperativen Astigmatismus.

The course of postoperative astigmatism was studied in 2 groups of patients following phacoemulsification and IOL implantation. In the first group a soft posterior chamber lens (IOGEL, Alcon) was introduced through a 6.5 mm scleral pocket incision. In group 2 the IOGEL lens was implanted through a 3.5 mm incision using a new instrument. The patients in group 2 had lower postoperative astigmatism and achieved stable refraction significantly earlier than group 1 patients. Three weeks postoperatively changes in refraction were seen in only a few cases. The small-incision technique significantly accelerates the visual rehabilitation of cataract patients.

[Examination strategies in the preparative phase for cataract operations and artificial lens implantation]. / Untersuchungsstrategien in der Vorbereitungsphase vor Kataraktoperationen und Kunstlinsenimplantation.

The extraordinary increase in the number of posterior chamber intraocular lenses (IOLs) implanted in recent years has completely changed our attitude towards cataract patients. A few years ago, the goal of preoperative evaluation was to select ideal candidates for implantation. In the meantime, contraindications to IOLs have become very rare and many tests have been developed to objectify and quantify lens opacities in patients with good visual acuity (glare disability tests, contrast sensitivity tests), or to predict the functional clinical result (macular function tests). The value of these tests is reduced by the rate of false-positive or false-negative results. A meticulously recorded history and careful enlightenment of the patient are indispensable to avoid postoperative disappointment. Slit-lamp observation and biometry are the only mandatory tests for establishing the presence of a cataract and planning the surgical approach. All modern tests attempt to substitute automatic or semi-automatic measurements for clinical judgment, but indication for cataract surgery nevertheless remains a clinical act.

[Echographic measurement of eyeball length in pseudophakic eyes]. / Echographische Messung der Bulbuslänge in pseudophaken Augen.

Refraction affects ultrasound as it passes obliquely through tissues or materials with different propagation speeds. Therefore, the accuracy of axial length measurements might theoretically be influenced after implantation of an IOL, which has a propagation speed exceeding those of the ocular humors by a factor of 1.8 (2718 m/s-1 vs. 1532 m/s-1). The in vitro studies of the present paper clearly demonstrate that ultrasound length measurements were not affected significantly by inclination of the lens up to 25 degrees or variation of the transducer-lens distance from 0 to 25 mm. Axial lengths measured in 26 patients were found to be virtually the same after IOL implantation. The authors conclude from these data that accurate ultrasound axial length measurements of the eye can be obtained after IOL implantation if the different propagation speed in PMMA and the thickness of the IOL are taken into account in the calculation.