[Treatment reality with ranibizumab in clinical routine use for patients with diabetic macular edema : 1­year results of the German POLARIS cohort]. / Behandlungsrealität mit Ranibizumab in der klinischen Routineanwendung bei Patienten mit diabetischem Makulaödem : 1-Jahres-Ergebnisse der deutschen POLARIS-Kohorte.

BACKGROUND: Currently only few data are available on the treatment reality with ranibizumab in patients with diabetic macular edema (DME). MATERIAL AND METHODS: POLARIS is an international observational study which included 983 patients who were treated with ranibizumab due to DME. The primary objective of the study was to investigate the influence of treatment and control intervals as well as resource utilization on the mean change in visual acuity. Secondary endpoints included the collation of disease activity monitoring in the clinical practice. This article describes the results of the German POLARIS population. The study was conducted in 8 European countries from October 2012 to January 2015. RESULTS: In Germany 220 patients were included in the study. Visual acuity improved by 4.3 letters within the first 3 months of treatment. At 12 months, visual acuity increased on average by 4.1 (SD ± 12.4) letters (approximately 1 line) for 168 patients enrolled in the efficacy analysis. Patients received an average of 4.5 (SD ± 1.9) injections, 10.3 (SD ± 6.3) visual acuity tests and 3.3 (SD ± 3.1) optical coherence tomography (OCT) examinations during the first year. Patients with ≤3 injections showed an average improvement in visual acuity by 2.7 letters which was less improvement compared to patients with >3 injections, who achieved an average improvement of 5.4 letters. There was a correlation between the number of injections and the visual acuity achieved. DISCUSSION: For Germany, the results of the POLARIS study indicate that despite a high number of visits, patients with DME are undertreated in clinical routine practice. The injection frequency in Germany was lower than in randomized clinical trials. Almost half of the patients received less than 4 injections in the first year of treatment and thus showed an undertreatment compared to the recommendations of German and international medical societies.

[Change of Intraocular Pressure 10 Days Following Radical Prostatectomy for Prostate Cancer]. / Augeninnendrucksenkung 10 Tage nach radikaler Prostatektomie bei Patienten mit diagnostiziertem Prostatakarzinom.

BACKGROUND: Results of a retrospective study of perioperative changes in intraocular pressure (IOP) following radical prostatectomy (RPE) for prostate cancer. PATIENTS AND METHODS: In 25 consecutive patients, PSA (prostate specific antigen) and IOP were measured with Goldmann tonometry before and after a mean of 10 days following RPE. The data of three patients with proven glaucoma were evaluated separately. The data of 22 patients without glaucoma were analysed with non-parametric statistical methods. The primary objective of the investigation was the statistical analysis of the changes in the IOP of the right eyes. The results for the left eyes are presented as secondary objective. RESULTS: The mean IOP in the right eye decreased from 13.95 ± 2.95 mmHg (n = 22) preoperatively to 12.18 ± 1.99 mmHg postoperatively; the average reduction in pressure was 1.77 ± 2.44 mmHg. In the left eyes, the IOP of 14.45 ± 3.16 mmHg preoperatively decreased to 12.05 ± 2.21 mmHg postoperatively. The average reduction in pressure was 2.41 ± 3.53 mmHg. The PSA level decreased from 18.70 ± 21.66 ng/ml preoperatively (median: 11.3 ng/ml) to 2.21 ± 3.13 ng/ml postoperatively (median: 1.25 ng/ml). The decline in IOP and the difference in PSA are highly statistically significant (Wilcoxon test for paired samples, n = 22, p < 0.01). There was no linear relationship between the reductions in IOP and PSA (Pearson correlation coefficient: r = 0.137, p = 0.542 for right eyes, r = 0.062, p = 0.784 for left eyes). CONCLUSION: Our case series shows that there is a statistically significant decrease in IOP following RPE, and to a clinically relevant extent. The changes in PSA and IOP might be linked by changes in prostaglandin metabolism in the prostate and/or the seminal vesicles. This theory remains to be confirmed by further studies. The increase in IOP during the development of prostate cancer might also be linked to changes in prostaglandin metabolism and composition. It is conceivable that prostaglandin analogues could be developed to reduce IOP.

[MALT Lymphoma of the Conjunctiva in a 13-year old Child--5-Year Relapse-free Follow-up Following Antibiotic Treatment]. / MALT-Lymphom der Bindehaut bei einem 13-jährigen Kind--fünf Jahre Rezidivfreiheit nach ausschließlich antibiotischer Behandlung.

MEDICAL HISTORY: In February 2007, a 13-year old boy presented with a livid tumour in the lower conjunctival fornix of the left eye. OPHTHALMOLOGICAL FINDINGS: The tumor was salmon-coloured, bulging and elastic and filled the whole lower conjunctival fornix of the left eye. There was no other pathological finding in the left eye. Uncorrected visual acuity was 20/20. Intraocular pressure was 12 mmHg. The eye was fully motile. TREATMENT: Incisional biopsy was performed in February 2007. The tumor was histologically an extranodal MALT lymphoma. DNA testing for Chlamydophila trachomatis and Chlamydophila pneumonia was negative. Systemic treatment was started with doxycycline (200 mg daily). After six weeks, the tumour was slightly smaller. Azithromycin 500 mg once a week was added. 18 months after initiation of the treatment, the tumour had completely regressed. A second sample taking in the former tumor area showed tumor-free conjunctiva and subconjunctival tissue. As a precaution, the combined antibiotic therapy was continued for 10 months and the patient was followed for five more years. The lymphoma did not relapse in the conjunctiva and orbit or in the whole body. CONCLUSION: We showed that extranodal MALT lymphomas of the conjunctiva can be successfully treated with antibiotics alone. At the start of therapy, the child was 13 years old. To our knowledge, this patient is the first child in Germany and one of the first in the world with ocular adnexal lymphoma who could be successfully treated with combined antibiotic therapy and who could be followed up for 5 years without relapse. Thus, we could avoid radiotherapy or chemotherapy in childhood and eliminate the risk of a therapy-induced secondary malignancy.

[The relationship between the temperature increase caused by phacoemulsification and the damage to the corneal endothelium]. / Zusammenhang zwischen der Temperatursteigerung bei der Phakoemulsifikation und den auftretenden Zellschäden am Hornhautendothel.

PURPOSE: Endothelial cell damage can be found after a phacoemulsification. The reason for this cell damage is not yet known. The temperature rise inside the anterior chamber during the emulsification of the lens is considered as a potential damage mechanism. The aim of this study was to investigate the relationship between the temperature increase and the cell damage. MATERIALS AND METHODS: This study was performed with 86 enucleated porcine eyes, which were divided into six groups A-F. Group A served as control group. Phacoemulsification was simulated in the groups B-E with different surgically relevant system settings. The temperature change was measured simultaneously with temperature sensors inside the anterior chamber. Inside the eyes of group F, the instruments were positioned and irrigation and aspiration were activated, but no ultrasound was applied. For all 86 corneas, the endothelial cell damage was quantified with a standardised evaluation protocol using scanning electron microscopy (SEM). A potential correlation was checked between the observed cell damage and the measured temperature rise. RESULTS: The highest temperature increase in group E with an obstructed aspiration line and an output power setting of 50 % was 17.77 °C. The temperature increase in group D with an output power setting of 100 % and unblocked fluid flow was significantly lower (p = 0.006). The highest temperature increase in group D was 8.89 °C. In contrast, the cells in group D were rated with a significantly lower score value than the cells in group E (p < 0.001). No significant correlation between the temperature rise and the cell damage could be obtained in due consideration of all measured data. However, an increase of the output power setting was connected with a non-linear increase of the cell loss. CONCLUSION: The temperature rise was not the main reason for the endothelial cell damage in the performed experiments. Therefore, there seems to be no causal relationship between the temperature increase inside the anterior chamber during a common phacoemulsification and the endothelial cell damage. Due to the strong dependence between the output power setting and the cell damage, the lowest output power setting should be used during surgery which ensures the emulsification of the nucleus.

Two-year clinical experience with the CyPass micro-stent: safety and surgical outcomes of a novel supraciliary micro-stent.

PURPOSE: The aim of this study was to evaluate through 2 postoperative years the clinical outcomes associated with a novel supraciliary micro-stent for the surgical treatment of open-angle glaucoma (OAG) when implanted in conjunction with cataract surgery. PATIENTS AND METHOD: In a multicenter, prospective, consecutive case series, 136 subjects (136 eyes) with OAG and requiring cataract surgery with 24-month postoperative data were included. A combined phacoemulsification procedure, with intraocular lens insertion and CyPass Micro-Stent implantation into the supraciliary space of the study eye, was performed. At baseline, all subjects were on glaucoma medication with either uncontrolled intraocular pressure (IOP; ≥ 21 mmHg, Cohort 1, n=51) or controlled IOP (<21 mmHg, Cohort 2, n=85). Glaucoma medications were stopped postoperatively, but could be restarted if needed, at the investigator's discretion. Device-related adverse events, postoperative IOP, best corrected distance visual acuity (BCDVA), and number of IOP-lowering medications were recorded. RESULTS: The micro-stent was successfully implanted in all eyes. At 24 months, 82 subjects remained in the study. No sight-threatening adverse events occurred. The most common adverse events were transient hypotony (15.4%) and micro-stent obstruction (8.8%), typically due to iris tissue overgrowth. Fifteen subjects (11%) required secondary incisional glaucoma surgery. For Cohort 1 (n=23), mean ± SD IOP was 15.8 ± 3.8 mmHg after 24 months (change, -37% ± 19%). Mean IOP decrease from baseline was statistically significant (p<0.0001) at months 6, 12, and 24. For Cohort 2 (n=59), mean ± SD IOP at 24 months was 16.1 ± 3.2 mmHg (change, 0% ± 28%). Mean decrease from baseline was statistically significant at months 6 (p=0.0188) and 12 (p=0.0356). At 24 months, the mean ± SD number of medications was 1.0 ± 1.1 in Cohort 1 and 1.1 ± 1.1 in Cohort 2. Mean decrease from baseline medication use was statistically significant at months 6 (p<0.001), 12 (p<0.001), and 24 (p=0.0265) in Cohort 1, and at months 6, 12, and 24 (all p<0.0001) in Cohort 2. CONCLUSIONS: CyPass Micro-Stent implantation, in combination with cataract surgery, was associated with minimal complications while substantially lowering IOP and/or use of IOP-lowering medications.

[Adjuvant stereotactic low energy radiation therapy of exudative age-dependent macular degeneration (Oraya system)]. / Adjuvante stereotaktische niederenergetische Strahlentherapie bei exsudativer altersabhängiger Makuladegeneration (Oraya System).

With respect to the increasing number of patients and the risk and burden for patients caused by injections, a reduction in the number and frequency of injections with vascular endothelial growth factor (VEGF) inhibitors in exudative age-related macular degeneration (ARMD) is desirable. Stereotactic low-voltage x-ray irradiation seems to be a promising approach. For this purpose the Oraya system is available and has shown positive results in initial studies. Pending presentation of phase II and III study data this adjuvant irradiation should only be used in clinical trials.

[Comparison of four MICS intraocular lenses regarding their rates of neodymium:YAG laser capsulotomy]. / Vergleich von 4 MICS-Intraokularlinsen im Hinblick auf ihre Neodym:YAG-Laser-Kapsulotomieraten.

BACKGROUND: The aim of this study was to evaluate the incidence of posterior capsule opacification up to 50 months following 1.7-mm bimanual MICS-cataract surgery. METHODS: Bimanual MICS cataract surgery was performed in 197 eyes (135 patients) via two 1.7-mm corneal incisions. Four MICS acrylic foldable IOLs were implanted: AcriSmart 48S-5, n = 54 (Acritec GmbH, Hennigsdorf, now AT.Smart 48S Carl-Zeiss-Meditec, AG, Jena, Germany), ThinLens UltraChoice 1.0, n = 53 (Technomed GmbH, Baesweiler, Germany), AcriFlex 46, n = 41 und AcriFlex 48 CSE, n = 7 (Acrimed GmbH, Berlin, now: Lentis L-303, Oculentis GmbH, Berlin, Germany) and CareFlex, n = 43 (w2o Medizintechnik AG, Bruchsal, Germany). Statistical analysis was performed using the Kaplan-Meier technique. RESULTS: High levels of completeness of follow-up rates were: ThinLens 96%, CareFlex 100%, AcriSmart 93%, AcriFlex 92%. The capsulotomy rate was 43.13% for ThinLens within a mean/max. follow-up period of 801/1131 days, 34.88% for CareFlex (565/872 days), 40% for AcriSmart (988/1506 days) and 15.91% for AcriFlex (728/975 days). By limiting the follow-up period to a comparable maximum of 850 days for all four IOLs, our capsulotomy rates were as follows: ThinLens 33.33%, CareFlex 32.56 %, AcriSmart 20.0% and AcriFlex 11.36%. MICS IOLs have higher capsulotomy rates than hydrophobic acrylic lenses and sharp-edged silicone lenses. In literature comparisons MICS-IOLs do not exceed the variance levels of capsulotomy rates of PMMA, hydrophilic acrylic and silicone lenses without sharp edges. Cases of decentration or luxation of MICS-IOLs following Neodym:YAG laser capsulotomy were not detected. Capsulotomy frequency with the CareFlex was statistically significantly higher in comparison to the AcriSmart (Log Rank Mantel Cox Test, p = 0.007) and AcriFlex (log rank Mantel Cox test, p = 0.002). CONCLUSIONS: Capsulotomy rates observed varied for the four MICS-IOL-types tested. The posterior capsule opacification frequency of the two best MICS-IOLs (AcriFlex, AcriSmart) did not exceed the higher variance levels of posterior capsule opacification rates of the round-edged "conventional" non-MICS IOLs of PMMA, silicone or hydrophilic acryl material. Sharp-edged silicone or hydrophobic acrylic "conventional" lenses have shown lower posterior capsule opacification rates.

[Photodynamic therapy for choroidal neovascularisation due to choroidal coloboma in a 5 1/2-year-old child]. / Photodynamische Therapie einer choroidalen Neovaskularisationsmembran bei einem 5 1/2-jährigen Kind mit Aderhautkolobom.

BACKGROUND: There are only few reports about the safety of photodynamic therapy (PDT) with verteporfin in secondary neovascularisations and only scarce reports about the PDT in children, only one of them in preschool-age children. We add the case of a 5 and a half-year-old child with choroidal neovascularisation due to choroidal coloboma. We treated this condition with PDT. PATIENT: A 5 and a half-year-old-child with choroidal coloboma in both eyes showed a switch of fixation from the right to the left eye and divergent strabismus switched to convergent strabismus, in addition a decrease in visual acuity from 0.4 to 0.04 was recorded. This was caused by a clinically visible subfoveal choroidal neovascularisation from the upper edge of the coloboma. Because no standard therapy is available for this special condition, we decided to treat the child with PDT. RESULTS: PDT with verteporfin was performed without problems after motivation and support of the child by the parents (2.46 mL verteporfin, 4500 microm spot size, 83 seconds treatment time) and led to a complete scaring of the CNV after 14 days. At follow-up 3 and 6 months after therapy we documented only a moderate staining but no fluorescein leakage from the CNV and no macular oedema. Visual acuity increased after occlusion therapy within 24 months to 0.2 and fixation of the treated right eye was restored and resulted in intermittent fixation. Mean while the German "Bundessozialgericht" has decided on the reimbursement rules for this off-label use in very seldom diseases. No recurrence of the CNV was observed within the follow-up time of 5 and a half years. CONCLUSION: This case proves that PDT is possible and safe in cooperative children including those in preschool age. PDT not only induced scaring of a CNV secondary to choroidal coloboma but also a return of the lost visual acuity.

[Regression of lid-parallel conjunctival folds (LIPCOF) on topical treatment with Liposic Eye Gel--a pilot study]. / Rückbildung der lidkantenparallelen konjunktivalen Falten (LIPCOF) unter Lokaltherapie mit Liposic-Augengel--Eine Pilotstudie.

INTRODUCTION: The aim of this observation study was to determine whether regression of lid-parallel conjunctival folds (LIPCOF) can be induced by repeated and intensive treatment with a gel-forming tear substitute. METHODS: In cooperation with the referring ophthalmologists, patients suffering from advanced dry eye condition were recruited. LIPCOF grades from 1 to 3 were included. Tear film break-up time (BUT) had to be less than 10 sec and the Schirmer-I test less than 10 mm. All patients recruited had been using watery tear substitutes. Examinations including visual acuity, slit lamp, fluorescein test, Schirmer-I test, BUT, LIPCOF were performed at baseline and after 2 weeks and 2 months. All examinations were done by the same physician at the Dietrich-Bonhoeffer Eye Hospital of Neubrandenburg. Exclusion criteria were severe eye diseases such as glaucoma, cataract, retinal detachment, history of intraocular or conjunctival surgery and disorders of the eye lids. Pretreatment with gels was not allowed. In the study, patients were treated with Liposic Eye Gel at least three times a day for a period of two months. RESULTS: LIPCOFs regressed in 10 eyes of 5 patients (1 x male, 4 x female) from a mean grade of 2.58 at baseline to 2.29 after 2 months under Liposic treatment. This improvement is statistically significant (n = 10, p = 0.04). Schirmer-I test results had improved in the same time period from a mean of 6.4 mm at baseline to a mean of 8.1 mm after 2 months (n. s., n = 10, p = 0.73). BUT improved from a mean of 12.5 sec at baseline to a mean of 17.5 sec at the 2-month follow-up (n. s., n = 10, p = 0,085). In one patient the cornea was fluorescein-positive at baseline and stayed so throughout the follow-up. Liposic Gel was used by the patients between 3 to 8 times per day. Tolerance was excellent. DISCUSSION: The study results show that the morphological signs of the dry-eye condition like LIPCOFs can be reversed by intensive treatment with Liposic Gel. The improvements in BUT and Schirmer-I test results confirm the adherence of the patients to the treatment schedule. CONCLUSION: This pilot study provides the statistical data necessary for designing a major treatment study to prove not only the reversibility of LIPCOF, but also the dependence of the possible improvement on the grade of LIPCOF stage on the age of the patient and on other criteria.

[The role of pachymetry in routine glaucoma diagnosis]. / Die Rolle der Pachymetrie in der täglichen Glaukomdiagnostik.

The influence of corneal thickness on the precision of Goldman applanation tonometry is highly disputed. Goldmann and Schmidt assumed that the physiological variation of corneal thickness does not influence the measurement. But they indicated that an "abnormal" deviation of corneal thickness can lead to a false measurement. In the last 30 years many investigations have reliably demonstrated that thick corneas produce elevated applanation values and thin corneas lower values. The correction value is 1 mm Hg per 25 microm change in corneal thickness. The accuracy of intraocular pressure measurement is important for the detection and monitoring of glaucoma. Therefore it is necessary to recalculate applanation values based on corneal thickness in every patient, especially after refractive surgery. It is also necessary to keep in mind that with applanation tonometry we measure a force. From the force readings we deduce the value of the intraocular pressure. This conclusion is only correct if the theory of Goldmann applanation tonometry is right. But between force measurement and intraocular pressure there is the individual cornea with special properties like thickness, rigidity and astigmatism which can influence the correctness of the measurement. So we can understand why knowledge of corneal thickness can improve the deduction from force measurement of intraocular pressure. It is also reasonable that other individual corneal properties we do not measure or do not know so far can influence the deduction. This means that the corneal thickness is not the only variable. Pachymetry allows us to estimate the intraocular pressure with higher precision. Therefore it should be clinically used.

The triple classification of dry eye for practical clinical use.

PURPOSE: "Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. METHODS: To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions. CONCLUSIONS: The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).

[Glaucoma diagnostics and corneal thickness]. / Glaukomdiagnostik und Hornhautdicke.

In recent years the role of pachymetry in the correction of applanation tonometry values was controversially disputed. At the present time it is undoubtedly proven that central corneal thickness affects the accuracy of applanation tonometry. The dimension of this influence is 1 mmHg of pressure per 25 microm of change in corneal thickness. It is important to remember that Goldmann and Schmidt calibrated the applanation tonometer according to the central corneal thickness of their population by using the optical method. Therefore, it is first necessary to determine the corneal thickness for each examiner and his methods. The linear correction formula should be used only in the range of corneal thickness in which the formula was determined. The correction according to Orssengo and Pye and further developments in tonometry may offer alternatives for better estimation of intraocular pressure.

Autoantibodies to prothrombin and phosphatidylserine/prothrombin-complexes: do they contribute to the serodiagnosis of primary and secondary anti-phospholipid syndrome?

The diagnostic and clinical relevance of Ab to pure and phosphatidylserine-complexed prothrombin for primary and secondary APS was investigated in a total of 357 patients with (n = 169) and without (n = 188) connective tissue diseases. The overall frequency of anti-prothrombin Ab in sAPS, pAPS and patients without APS-related symptoms were found to be 50.0, 37.5 and 22.0%, respectively. From a total of 72 anti-prothrombin-positive samples, 12.5% were specific for pure prothrombin, 31.9% for phosphatidylserine/prothrombin-complexes and 55.6% recognized both antigenic forms. The simultaneous occurrence of other anti-phospholipid Ab was observed in 84% of all sera. Both types of anti-prothrombin Ab are significantly associated with lupus anticoagulant activity, but only Ab to pure prothrombin display such a relationship to clinical manifestations of APS. Based on these results, it cannot be recommended at present to include anti-prothrombin assays in the routine procedure for the serodiagnosis of APS. However, patients negative for lupus anticoagulant and typical APS-related anti-phospholipid Ab should be tested for anti-prothrombin reactivity, favoring, mainly due to its higher specificity, the ELISA containing pure prothrombin as antigen.

Reactivity profiles of autoantibodies to different phospholipids and the phospholipid-binding protein beta2-glycoprotein I in patients with clinical symptoms related to thromboembolic and/or vasculopathic events with or without connective tissue diseases.

To study the antigenic and epitope specificities of anti-phospholipid Ab in detail, we investigated 177 patients without (62 with APS-related systemic clinical symptoms, 115 with microangiopathies) and 164 patients with connective tissue diseases (CTD). Ab associated with primary APS (pAPS) seem to show a restricted specificity (phospholipid/beta2-GPI-complexes), whereas those in secondary APS (sAPS) react additionaly with pure beta2-GPI. Simultaneously, beta2-GPI-independent Ab were also frequently present in both conditions (50% of all Ab-positive sera). In CTD patients, the reactivity profile "pure beta2-GPI + phospholipid/beta2-GPI-complexes" is significantly associated with clinically manifest sAPS. Comparing cardiolipin and phosphatidylserine as antigenic target, the overall concordance (crossreactivity?) between both assays was lower than expected (52%), being highest in pAPS (87%) and sAPS (65%). Based on these results, a two-step procedure for reliable serological diagnosis of APS could be recommended: Ab-screening using a mix of phospholipids complexed with beta2-GPI (sensitivity > 90% for Ab concentrations above 20 U/ml) followed by an assay allowing the simultaneous detection of all relevant antigenic and epitope specificities.

[Present state of erbium laser phacoemulsification. Comparison with ultrasound phacoemulsification concerning energy and phaco-time at one clinic]. / Derzeitiger Stand der Erbiumlaserphakoemulsifikation. Monozentrischer klinikinterner Vergleich zur Ultraschallphakoemulsifikation bezüglich Energie und Phakozeit.

BACKGROUND: Comparison of phaco time and phaco energy between ultrasound (USP) and erbium laser (ELP) phacoemulsification at the Eye Clinic Neubrandenburg. METHOD: One surgeon performed all operations (n = 503) employing only USP (Harmony, D.O.R.C., Groningen, Netherlands). Phaco time was measured and converted to energy. Another surgeon performed all operations (n = 503) using only ELP. The energy transfer and phaco time were read from the Phacolase (Asclepion-Meditec, Jena, Germany). Nucleus hardness distribution was comparable for both surgeons. RESULTS: Phaco times in USP/ELP were as follows: nucleus hardness 0: 0.7 s/7.5 s, nucleus hardness 1: 9.6 s/57.6 s, nucleus hardness 2: 23.7 s/106.9 s, nucleus hardness 3: 39.3 s/215.1 s, and nucleus hardness 4: 68.9 s/232.0 s. Energy in USP/ELP was as follows: nucleus hardness 0: 7.2 J/0.9 J, nucleus hardness 1: 96.7 J/23.5 J, nucleus hardness 2: 237.3 J/53.1 J, nucleus hardness 3: 392.5 J/149.1 J, and nucleus hardness 4: 688.6 J/176.6 J. CONCLUSION: ELP takes longer than USP, but the energy transferred to the eyes for emulsification was lower with the laser in comparison to ultrasound.

[Phacoemulsification and vitrectomy with the erbium:YAG laser and phacoemulsification with the neodymium:YAG laser]. / Phakoemulsifikation und Vitrektomie mit dem Erbium:YAG-Laser sowie Phakoemulsifikation mit dem Neodymium:YAG-Laser.

There are an increasing number of possible applications for the use of Erbium:YAG and Neodymium:YAG lasers in ophthalmology. Laser-phacoemulsification as well as Erbium-laser vitrectomy is of major interest. We report on the underlying technology and more than 1-year-experience using the PHACOLASE (Asclepion-Meditec, Jena, Germany, 10-100 Hz frequency, 5-50 mJ single pulse energy) for phacoemulsification and pars plana vitrectomy and the Lyla-Dodick laser photolysis (A.R.C. Laser, Eckental-Forth, Germany, 1-20 Hz, up to 8 mJ single pulse energy). The Erbium:YAG-laser as well as the Neodymium:YAG-laser enabled us to extract lenses with up to medium hard nuclei. Moreover, the Erbium laser enabled fast vitrectomy with little mechanical traction. In many of our initial surgical operations we had to change to mechanical vitrectomy due to initial technical problems. No new complications occurred intra- or postoperatively. The handpiece worked well in removing vitreous bodies, but was not feasible for cutting membranes. Modified handpieces for this purpose are under development.

[Intracorneal ring segments for correction of myopia. Results of microsurgery technique]. / Intrakorneale Ringsegmente zur Myopiekorrektur. Ergebnisse der Kleinschnitttechnik.

BACKGROUND AND OBJECTIVE: Since May 1998, small incision instruments for the implantation of intrastromal corneal ring segments (ICRS) are available enabling incisions only 1.2 mm in width instead of 1.8 mm to be made. After a follow-up period of 22 months in the conventional group and 8 months in the small incision group, the results of both groups were compared. PATIENTS AND METHODS: Since April 1997, 73 intrastromal corneal ring segments have been implanted, the first 43 ICRS implantations in 29 patients were performed using the conventional technique, the next 30 ICRS implantations in 22 patients were performed with the small incision technique. The average preoperative myopia was -3.5 D. RESULTS: After 6 months, 66.7% of the patients of both groups achieved the refraction target +/- 0.5 D. Even on the first postoperative day, the final refraction is achieved and shows stability for 1 year without regression. After 6 months, 80% of the conventionally operated patients and 77.8% of the patients operated on with the small incision technique showed an uncorrected visual acuity of 1.0 or better. With the small incision technique the preparation of the corneal dissection channel in 2/3 corneal stromal depth is significantly easier and can be carried out more safely. Perforations towards the inner or outer surface of the cornea can be practically excluded. Due to the smaller superficial wound in contrast to the conventional technique, a corneal suture is not necessary. Stromal depth of implantation was more than 50% and in both groups no decentration of 1.0 mm or more occurred. CONCLUSIONS: The small incision technique increases the intraoperative safety in the dissection of the stromal lamellae in the correct level. Both techniques are comparable with regards to visual acuity and refraction. The smaller corneal wound does not need a corneal suture. Because of these advantages we have completely switched our technique to the small incisions.

[Erbium:YAG laser vitrectomy. Initial clinical results]. / Erbium: YAG-Laser-Vitrektomie. Erste klinische Ergebnisse.

BACKGROUND: Much interest has been expressed in recent years in the use of erbium:YAG lasers in ophthalmology, particularly for vitrectomy and phacoemulsification. PATIENTS AND METHODS: We performed 54 operations (49 primary, 5 secondary) for pars plana vitrectomy on 53 eyes of 53 patients using the Phacolase erbium:YAG laser at a frequency of 10-100 Hz single-pulse energy of 5-50 mJ. RESULTS: The operation was successful in 51 cases,while in three we had to resort to mechanical vitrectomy due to initial technical problems. CONCLUSION: Erbium:YAG laser vitrectomy was generally fast and caused little mechanical stress to the retina. Complications were only those known from mechanical vitrectomy.The handpiece showed good properties for removing vitreous but not for cutting membranes, although new handpieces specifically for the cutting of membranes are under development.