Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation.

PURPOSE: To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities. METHODS: This retrospective study consisted of 113 eyes of 109 patients with various vitreoretinal abnormalities and visually significant cataract. Vitreoretinal surgery was combined with clear corneal phacoemulsification and intraocular mplantation. RESULTS: The combined surgery resulted in minimal complications, and postoperative visual acuity was improved in 83 eyes (71.6%). Visual acuity was improved by two or more lines in 26 eyes (66.6%) with proliferative diabetic retinopathy, 22 eyes (73%) with proliferative vitreoretinopathy, eight eyes (30.7%) with macular abnormalities, four eyes (55.5%) with trauma and two eyes (40%) with retinal vein occlusion. CONCLUSIONS: The combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation was safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Combined surgery is recommended for all patients having simultaneous vitreoretinal pathological changes and cataract. The addition of phacoemulsification does not prolong vitreoretinal operative time notably nor increase the risk of intraoperative and postoperative complications significantly

Cataract extraction with multifocal intraocular lens implantation: clinical, functional, and quality-of-life outcomes. Multicenter clinical trial in Germany and Austria.

PURPOSE: To compare bilateral implantation of a multifocal intraocular lens (IOL) versus a monofocal lens with respect to visual function, patient satisfaction, and quality of life. SETTING: Seven clinical sites in Germany and 1 site in Austria. METHODS: A prospective randomized masked clinical trial included 124 randomly assigned bilateral pseudophakic individuals, 64 of whom had bilateral implantation of an Array(R) foldable multifocal IOL (model SA-40N, Allergan) and 60 of whom had bilateral implantation of an AMO(R)PhacoFlex II(R) silicone monofocal IOL (model SI-40NB). Clinical data included binocular uncorrected and corrected distance and near visual acuities, complications, adverse events, and reports of halos and glare. Quality-of-life data were collected on 3 occasions using the modified Cataract TyPE Specification instrument. The functional status of the 2 groups was compared from baseline to final postoperative interview. RESULTS: Three months after surgery, a higher proportion in the Array group achieved a Jaeger value of J3 (20/40 Snellen) or better uncorrected binocular near visual acuity and 0.5 (20/40) or better distance-corrected binocular near visual acuity than in the monofocal groups (97% versus 68% and 95% versus 59%, respectively; P <.001). A higher proportion in the multifocal group achieved both 0.5 (20/40) and J3 or better uncorrected binocular distance and near visual acuities (97% versus 66%; P <.001). Those in the Array group were more likely than those in the monofocal group to never wear glasses overall (41% versus 12%; P <.001). Multifocal patients rated their vision without glasses better overall, at near and at intermediate distances (P <.05), and demonstrated better visual function for near tasks and social activities. CONCLUSIONS: Those who had bilateral implantation of the Array multifocal IOL obtained better uncorrected and distance-corrected near visual acuities and reported better overall vision, less limitation in visual function, and less spectacle dependency than patients with bilateral monofocal IOLs.

Silicone intraocular lens implantation in children: preliminary results.

PURPOSE: To evaluate the safety and outcome of foldable silicone intraocular lens (IOL) implantation in children. SETTING: Department of Ophthalmology, University of Giessen, Giessen, Germany. METHODS: The results of cataract extraction and silicone IOL implantation in children having surgery between 1992 and 1997 were retrospectively analyzed in 8 eyes (7 patients). All IOLs were implanted in the capsular bag through a 3.5 mm clear corneal incision. In 4 eyes, primary posterior capsulectomy and anterior vitrectomy were performed. RESULTS: Mean patient age at the time of surgery was 5.1 years (range 8 months to 15 years). The surgeries were uneventful. All IOLs remained anatomically stable and well centered during the mean follow-up of 29.6 months (range 18 to 46 months). Postoperative inflammatory reaction was minimal. Neither fibrinoid exudation nor posterior synechias occurred postoperatively. Postoperative best spectacle-corrected visual acuity ranged from 20/800 to 20/20. All eyes with an intact posterior capsule developed posterior capsule opacification. In the 4 eyes that had primary posterior capsulectomy and anterior vitrectomy, the visual axis remained clear. CONCLUSIONS: These preliminary results suggest that silicone IOL implantation in children is a safe procedure with good and stable short-term anatomic results. Longer follow-up is necessary to answer questions about the long-term safety of silicone lens implantation in a child's eye.

Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation.

PURPOSE: To evaluate the technical feasibility, outcome, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. SETTING: Department of Ophthalmology, Giessen, Germany. METHODS: The results of combined cataract and vitreoretinal surgery in 38 eyes (36 patients) were retrospectively analyzed. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Thirty-seven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. RESULTS: Postoperatively, visual acuity improved in 20 eyes (52.6%), was unchanged in 16 (42.1%), and was worse in 2 (5.3%). Postoperative complications consisted of anterior chamber fibrin exudation (3 eyes), hyphema (2 eyes), vitreous hemorrhage (1 eye), posterior capsule opacification (16 eyes), neovascular glaucoma (2 eyes), proliferative vitreoretinopathy and redetachment (1 eye), and retinal redetachment after silicone oil removal (1 eye). CONCLUSION: Compared with 2 separate operations in patients with significant lens opacities and vitreoretinal pathology, combined cataract and vitreoretinal surgery provided more rapid visual rehabilitation. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.

[Serous central chorioretinopathy. Acute autofluorescence of the pigment epithelium of the eye]. / Chorioretinopathia centralis serosa. Autofluoreszenz des retinalen Pigmentepithels.

PURPOSE: The lack of histopathological material has placed limitations on our knowledge on lipofuscin in central serous chorioretinopathy (CSCR). This study was designed to document the pathological changes of the retinal pigment epithelium (RPE) in CSCR using in vivo recording of fundus autofluorescence. METHODS: Fundus autofluorescence was documented in 62 eyes of 44 subjects with CSCR using a laser scanning ophthalmoscope (Zeiss, Oberkochen; excitation wavelength: 488 nm, barrier filter at 521 nm). Images were compared to the respective fundus appearance and fluorescein angiograms. RESULTS: Neurososensory retinal detachments showed diffuse increased autofluorescence corresponding to the detached area. Long-standing lesions showed very irregular autofluorescence with regions greater and less than the background levels of autofluorescence. CONCLUSION: Focal accumulation of autofluorescent material occurs at the level of the RPE in patients with CSCR, relating to variation in metabolic activity of the RPE. This technique may be useful in selecting patients for laser photocoagulation.

Bilateral implantation of asymmetrical diffractive multifocal intraocular lenses.

OBJECTIVE: To evaluate visual results after bilateral implantation of multifocal intraocular lenses (IOLs) with asymmetrical light distribution for the far and near focus. METHODS: Twenty-nine patients underwent bilateral implantation of silicone-optic, foldable, diffractive IOLs in a prospective, 2-center, noncontrolled interventional study. Each patient had a distant-dominant multifocal IOL implanted in 1 eye and a near-dominant multifocal IOL implanted in the fellow eye. Refractive and visual results, including contrast acuity and binocular visual function, were determined. Patients were questioned for postoperative spectacle usage. RESULTS: Visual and contrast acuity in the dominant focus of either lens was superior to that in the nondominant focus at 3.5 to 12 months postoperatively, i.e., performance was best at distance for the distant-dominant and at near for the near-dominant lens. In binocular viewing, the monocular maximal results added up to an improved binocular visual performance. Binocular visual function was within normal limits. Eighty percent of patients reported no use of spectacles at any time postoperatively. CONCLUSIONS: Bilateral implantation of asymmetrical diffractive IOLs is an effective alternative for restoring simultaneous distance and near vision with a potential for improved contrast sensitivity compared with conventional multifocal IOLs.

[Studies of the distribution of lipofuscin in the retinal pigment epithelium using high-resolution TV laser scanning ophthalmoscopy]. / Lipofuszinverteilung im retinalen Pigmentepithel. Untersuchungen mit hochauflösender Laser Scanning Ophthalmoskopie.

BACKGROUND: The fundus autofluorescence imaging technique has been modified allowing improved image resolution (768 x 572 pixel). We present results of fundus autofluorescence studies using this technique. MATERIALS AND METHODS: Fundus autofluorescence was studied in 286 eyes of 143 patients with retinitis pigmentosa, macular dystrophies and age-related macular degeneration using a confocal laser scanning ophthalmoscope prototype (Zeiss, Oberkochen; excitation wavelength: 488 nm, cut-off filter at 521 nm). RESULTS: The spatial distribution of autofluorescence was different in all diseased eyes investigated compared to the normal pattern of fundus autofluorescence. Each disorder showed a specific fundus autofluorescence appearance. CONCLUSIONS: The advanced technique of imaging fundus autofluorescence allows detailed studies of the lipofuscin distribution. In vivo analysis of the dynamics of accumulation and degradation of lipofuscin in eyes with tapeto-retinal dystrophies and age-related macular disease may contribute to elucidation of the pathogenesis of these disorders.

[Fundus autofluorescence in patients with hereditary macular dystrophies, malattia leventinese, familial dominant and aged-related drusen]. / Fundus-Autofluoreszenz bei Patienten mit vererbten Makuladystrophien, Malattia leventinese, familiär dominanten und altersbedingten Drusen.

PURPOSE: The lack of histopathological material has placed limitation on our knowledge on the composition of focal deposits in eyes with macular dystrophies, malattia leventinese, dominant drusen and age related macular degeneration. This study was designed to study the composition of focal deposits in these eyes by documenting fundus autofluorescence in vivo. METHODS: Fundus autofluorescence was documented in 343 eyes of 199 subjects with macular dystrophies, malattia leventinese, dominant drusen and age-related macular degeneration using a laser scanning ophthalmoscope (Zeiss, Oberkochen; excitation wavelength: 488 nm, barrier filter at 521 nm). RESULTS: Autofluorescence of focal deposits was increased in eyes with macular dystrophies. In eyes with malattia leventinese and dominant drusen autofluorescence intensity of focal deposits showed a wide spectrum. In contrast, autofluorescence of age-related drusen was within normal limits. Background autofluorescence intensity was increased in eyes with macular dystrophies and within normal limits in eyes with malattia leventinese, dominant drusen and age-related drusen. CONCLUSION: The technique of in-vivo recording of fundus autofluorescence allows the differential diagnosis between macular dystrophies/malattia leventinese, dominant drusen/age related drusen when otherwise not possible.

[Dynamics of accumulation and degradation of lipofuscin in retinal pigment epithelium in senile macular degeneration]. / Dynamik der Einlagerung und des Abtransportes von Lipofuszin im retinalen Pigmentepithel bei altersbedingter Makuladegeneration.

BACKGROUND: It is thought that lipofuscin plays a central role in the pathogenesis of age-related macular degeneration (AMD). The lack of histopathological material has been a severe limitation in our knowledge on lipofuscin in this disease. A new technique has been developed that allows in vivo imaging of fundus autofluorescence derived from lipofuscin in the retinal pigment epithelium (RPE) using a confocal Laser Scanning Ophthalmoscope (LSO). We studied the dynamics of lipofuscin accumulation and degradation in patients with AMD. MATERIALS AND METHODS: Serial examinations of the spatial distribution of fundus autofluorescence were performed in 148 eyes of 74 patients with AMD using a LSO over a period of 1-3.5 years. RESULTS: Fundus autofluorescence changed over time in almost all eyes studied. Areas of increased autofluorescence occurred progressively during follow up in eyes with drusen and hyperpigmentation. The size of pathologic autofluorescence increased over time in almost all eyes with geographic atrophy, subretinal neovascularisations and disciform scars. Irregular autofluorescence was seen over most subretinal neovascularisations. Autofluorescence intensity decreased in old subretinal neovascularisations and disciform scars over time. CONCLUSIONS: Changes of the distribution of autofluorescence occur in eyes with AMD over time. Fundus autofluorescence imaging allows in vivo analysis of the dynamics of accumulation and degradation of lipofuscin in the RPE in eyes with AMD and documentation of metabolic activity of the RPE.

[Early posterior capsule fibrosis after combined cataract and vitreoretinal surgery with intraocular air/SF6 gas tamponade]. / Frühe Hinterkapselfibrose nach kombinierter Katarakt- und vitreoretinaler Chirurgie mit intraokularer Luft/SF6-Gastamponade.

BACKGROUND: The surgical approach in treating coexisting vitreoretinal disease and cataract is controversial. We report on patients who developed early posterior capsular fibrosis after combined cataract and vitreoretinal surgery with air/SF6-gas tamponade. PATIENTS AND METHODS: The medical records of 15 consecutive eyes (13 patients) who underwent combined phacoemulsification with intraocular lens implantation and vitreoretinal surgery with intraocular air/SF6-gas tamponade were retrospectively analyzed. The indications for vitreous surgery included: subfoveal neovascular membrane in age-related macular degeneration (5 eyes), macular hole (4 eyes), macular pucker (2 eyes), rhegmatogenous retinal detachment (2 eyes), persistent vitreous haemorrhage after branch retinal vein occlusion (1 eye), persistent vitreous haemorrhage and/or tractional retinal detachment in proliferative diabetic retinopathy (1 eye). The mean follow-up period was 7 months (1-13 months). A control group consisted of 15 eyes (15 patients) who underwent the equal combined operation without intraocular tamponade. The indications for vitreous surgery were persistent vitreous haemorrhage in proliferative diabetic retinopathy (5 eyes), persistent vitreous haemorrhage after branch retinal vein occlusion (5 eyes), asteroid hyalosis (2 eyes), macular pucker (1 eye), posttraumatic vitreous haemorrhage (1 eye), acute retinal necrosis (1 eye). The mean follow-up was 8 months (2-13 months). The posterior capsule was examined at the slit lamp microscopy with maximal dilated pupils. We defined posterior capsular opacification (PCO) as severe if posterior capsule was fibrotic, diffusely thickened and opaque. Modest PCO was characterized by focal fibrotic opacifications at otherwise clear posterior capsule. RESULTS: Severe posterior capsular fibrosis developed in 9 eyes (60%) after 2-14 weeks postoperatively (mean 8 weeks) including 3 of 6 eyes with air tamponade (50%) and 6 of 9 eyes with 20% SF6-gas tamponade (66.7%). In 6 eyes (40%) Nd:YAG-laser capsulotomy was performed 4-14 weeks postoperatively (mean 8.5 weeks). In the control group modest PCO developed in 8 eyes (53.3%) 1-13 months postoperatively (mean 6.5 months) none requiring Nd:YAG-laser capsulotomy during follow-up period. CONCLUSIONS: Combined cataract and vitreoretinal surgery with intraocular air/SF6-gas tamponade induces severe posterior capsular fibrosis in the early postoperative period. The capsular fibrosis is presumably caused by accumulation of fibrin and proliferation stimulating factors in the narrow space between intraocular lens and air/SF6-gas bubble.

Effect of heparin in irrigating solution on inflammation following small incision cataract surgery.

PURPOSE: To study the effect of heparin-sodium added to the irrigating solution on postoperative inflammation in patients having cataract surgery. SETTING: Department of Ophthalmology, University of Giessen, Giessen, Germany. METHODS: Seventy-two patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation were randomly assigned to receive regular irrigating solution or solution with heparin-sodium (final diluted concentration 10 IU/mL). In half the patients, poly(methyl methacrylate) (PMMA) IOLs were implanted and in half, foldable silicone IOLs. The patients were examined preoperatively, on days 1 and 3, and 1 year postoperatively. Postoperative inflammation was objectively evaluated by measurement of flare and cells using laser flare-cell photometry. RESULTS: The mean postoperative flare values were significantly lower in the groups with additional heparin-sodium at days 1 and 3 (P < . 01). Flare values were not significantly different 1 year postoperatively. Cell values for the heparin-treated groups were lower, but the difference did not reach statistical significance. Flare and cells values for the two IOL materials were not significantly different during the entire follow-up. CONCLUSION: Heparin-sodium added to the infusion solution during small incision cataract surgery reduced inflammation in the early postoperative period.

[Long-term outcome after implantation of various intraocular lenses through a corneal tunnel]. / Langzeitergebnisse nach Implantation verschiedener Intraokularlinsen über einen Hornhauttunnel.

UNLABELLED: A prospective, randomized study was carried out to evaluate functional and biomicroscopic long-term results of different posterior chamber intraocular lenses (IOLs) over a period of two years after clear corneal cataract surgery. PATIENTS AND METHODS: 2 years after phacoemulsification through a temporal two-step clear corneal incision a total of 67 patients were examined. In 26 eyes (group A) a foldable plate-haptic silicone IOL (Chiron Adatomed, C10), in 25 eyes (group B) a foldable disc silicone IOL (Chiron Adatomed, 90D) had been implanted through a 3.5 (group A) or 4 mm (group B) corneal incision using a cartridge injector. In 16 eyes (group C) a one-piece PMMA-IOL (Pharmacia & Upjohn, 809C) had been implanted through a 5 mm incision. All eyes underwent functional and biomicroscopic examinations, as well as computerized videokeratographic analysis to obtain corneal topography data. RESULTS: In group A uncorrected visual acuity valued 0.64 (+/-0.29 SD), in group B 0.59 (+/-0.24) and in group C 0.56 (+/-0.27). Median of uncorrected visual acuity was 0.6 for all groups. Corrected visual acuity was 0.81 (+/-0.29) in group A, 0.8 (+/-0.25) in group B and 0.83 (+/-0.3) in group C. Intraocular pressure (mm Hg) was 13 (+/-2.5) in group A, 14.7 (+/-2) in group B and 15.1 (+/-2.5) in group C. Fibrosis of the anterior capsular rim occurred in 42% of the cases. One eye demonstrated folds in the posterior capsule (group B). Posterior capsular opacification valued 11.9% for all groups. In one eye a Nd:YAG-capsulotomy had already been performed. In group A a decentration of more than 1 mm was objected in one case, in group B in two cases and in group C in one case, but no patient complained about any functional impairment. Two years postoperatively, no signs of a re-flattening in the incision area could be detected using difference mapping tools in the videokeratographic analysis. CONCLUSION: Two years after implantation of foldable silicone IOLs and PMMA-IOLs via a temporal clear corneal tunnel incision after phacoemulsification only slight functional and morphologic differences between the three IOL-types could be observed.

[Effect of corneal astigmatism on contrast sensitivity in mono- and multifocal pseudophakia--a theoretical study of the physical eye]. / Einfluss des Hornhautastigmatismus auf die Kontrastempfindlichkeit bei mono- und multifokaler Pseudophakie--eine theoretische Studie am physikalischen Auge.

BACKGROUND: Several clinical studies indicate, that the visual function of multifocal IOLs (MIOL) is impaired by corneal astigmatism. To assess the influence of uncorrected corneal astigmatism on the contrast sensitivity function (CSF) of mono- and multifocal IOLs, an "optical implantation" of physical eyes with astigmatic corneas and IOLs was performed in younger subjects. METHODS: The virtual image of physical eyes with a 40 dpt achromate as artificial cornea and the (M)IOL in a water bath was projected on the retina of the observer by means of an exactly adjusted video objective. Silicone lenses with defined astigmatisms (+1; +2; +4; +6 dpt) were put in front of the achromate to produce an artificial corneal astigmatism. We compared results of a standard monofocal IOL (Pharmacia 811B), a multizone progressive MIOL (AMO Array SSM-26NB) and a diffractive MIOL (Pharmacia 811E). CSF through these IOLs in the physical eyes was measured in ten healthy subjects (mean age: 27.4 y.) with the B-VAT II-SG Video Acuity Tester (Mentor O&O), which uses sine wave gratings of five different spatial frequencies (1.5; 3; 6; 12; 20 cpd). RESULTS: Without astigmatic lenses, all IOLs showed a mean CSF within the age-related norm, but the monofocal IOL yielded significantly better results than both MIOLs at three spatial frequencies (3; 6; 12 cpd). With additional astigmatic lenses of 2 dpt and more, mean CSF of all IOLs was below normal range, but there was no difference in the performance of the three lens styles. CONCLUSION: CSF of MIOLs seems to be less sensitive to uncorrected corneal astigmatism than CSF of the monofocal IOL. This suggests, that a higher preoperative astigmatism does not severely affect the image quality through a multifocal IOL.

[Objective determination of refractive changes in silicon oil filled eyes--effect of head position on refraction]. / Objektive Bestimmung der Refraktionsänderungen bei silikonölgefüllten Augen--Einfluss der Kopfposition auf die Refraktion.

BACKGROUND: The refraction of the eye is altered significantly after silicone oil instillation into the vitreous cavity due to its high refractive index. The degree of the refractive change varies during the daily course and depends on the position of the head. PATIENTS AND METHODS: To analyze the degree and time course of the refractive change depending on the head position we performed refractive measurements in 5 aphakic and 5 phakic silicone oil-filled eyes with attached macula by an automatic handrefractometer. This new device was used for 25 measurements at short intervals in each patient at different eye positions (supine position, prone position and primary eye position). RESULTS: Mean visual acuity in all patients valued 0.14 (+/- 0.05). The highest shift in refraction of +5.95 (+/- 2.63) dpt in spherical equivalents occurred in the aphakic eyes and of +2.45 (+/- 0.71) dpt in the phakic eyes after position change from face up to face down. Three minutes after position change the refraction remained stable in nearly all eyes. Only slight changes in cylinder and corresponding axis were found during the measurements with a mean axial shift of 10.1 (+/- 5.1) degrees. CONCLUSION: Immediately after change of the head position especially aphakic eyes demonstrated remarkable refractive shifts. The results of this study explain patients' complaint of visual changes during the daily course after intraocular silicone oil injection. Refractive alterations evoked by silicone oil stabilized a few minutes after change of the head position.

[Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"]. / Das computergestützte multimediale interaktive Lernprogramm "Primäres Offenwinkelglaukom".

INTRODUCTION: Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. MATERIAL AND METHODS: Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. RESULTS: The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection of illustrations and text allows for quick access to learning content. The program is designed in such a way that working with and through it is done in a manner conducive to learning. Student response to the learning program as an accompaniment to instruction has been positive. CONCLUSION: Independent, supplemental student learning by means of an interactive learning program has raised the quality of study within the sciences. The use of a pedagogically sound multimedia program, that is oriented toward problem solving and based on actual cases offers students the opportunity to actively work ophthalmological material. An additional benefit is the development of competence in working with computer-support information systems, something that is playing an ever-increasing role within the medical profession.

[The "Array" silicone multi-focal lens: experiences after 150 implantations]. / Die "Array" -Silikon-Multifokallinse: Erfahrungen nach 150 Implantationen.

BACKGROUND: The Array-MIOL offers the advantage of an increased depth of focus; the aim of our study was to compare other functional results with those of a monofocal IOL. METHODS: Uncorrected and corrected distance and near visual acuity were measured in the early postoperative period and after 3 months. Results of contrast acuity (Regan charts) and contrast sensitivity (BVAT II-SG video acuity tester) of the Array-MIOL and a monofocal IOL were compared at the 3-months follow-up. RESULTS: Distance visual acuity of the multifocal group did not differ from the monofocal results; uncorrected and distance corrected near acuity were significantly superior in Array patients. The monofocal IOL showed a superior contrast acuity only at the 11% level and a superior contrast sensitivity only at one spatial frequency (20 cpd). Bilateral implantation of the Array-MIOL seems to further improve functional results. CONCLUSION: Implantation of the Array silicone multifocal IOL offers the advantage of pseudoaccommodation without relevant impairment of other visual functions.

[Glare sensitivity of phakic and pseudophakic eyes]. / Untersuchungen zur Blendempfindlichkeit phaker und pseudophaker Augen.

BACKGROUND: Glare disability and appearance of halos may be side-effects of cataract, but were also described in patients with multifocal IOLs. The aim of this study was to compare glare sensitivity and halo size in phakic and pseudophakic eyes. PATIENTS AND METHODS: Contrast sensitivity without and with glare and halos around a light source were measured by means of a new computerized test in patients with cataract, monofocal IOLs, multizonal progressive and diffractive multifocal IOLs as well as in a younger control group of subjects with clear lenses. Glare acuity was measured at three different luminance settings. RESULTS: Patients with cataract showed the most important reduction in contrast sensitivity, noticed significantly larger halos and were more impaired in glare acuity than patients with monofocal or multizonal progressive IOLs. There was no significant difference in any criteria between these two pseudophakic groups. Subjects with a clear cristalline lens had statistically significant better results compared with all other groups. CONCLUSION: An increase in glare sensitivity and the appearance of halos are more important in patients with even minor cataracts than in any pseudophakic population. As a consequence of this study, night driving ability should be carefully examined in any pseudophakic patient, but also in any subject with even beginning cataract.

Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision.

PURPOSE: To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters. METHODS: Fifty-eight patients had phacoemulsification through temporal, two-step clear corneal tunnel incisions. In Group A (n = 28), a one-piece, plate-haptic foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color-coded, computer-assisted specular microscopy was used for special cell analysis after 1 year. RESULTS: Collective data showed an ECL of 7.9 +/- 4.1% (mean +/- standard deviation) at 2 to 5 days postoperatively, 6.7 +/- 2.9% after 6 months, and 7.3 +/- 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST < or = 11/2 minutes, 6.7% with UST > 11/2 to 21/2 min, and 9.6% with UST > 21/2 to 31/2 min; in Group B it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age-related cell parameters 1 year postoperatively. CONCLUSIONS: Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.

[Endothelial cell loss after phacoemulsification and 3.5 vs. 5 mm corneal tunnel incision]. / Endothelzellverlust nach Phakoemulsifikation und 3,5 vs. 5 mm Hornhauttunnelinzision.

This prospective study was performed to compare the central endothelial cell loss (ECL) after phacoemulsification and 3.5 with 5 mm temporal clear-corneal incision. Moreover, the influence of ultrasound time and power on postoperative endothelial cell density was evaluated. PATIENTS AND METHODS. Sixty-two patients (age 71 +/- 7.7 years) without corneal pathology were operated by phacoemulsification (Storz, Premiere) with a temporal, self-sealing, two-step clear-corneal incision followed by posterior chamber IOL implantation under viscoelastic (1% sodium hyal-uronate). Thirty-one one-piece plate-haptic foldable silicone IOLs (Chiron C10; Staar Surgical AA-4203) were implanted by an injector through a 3.5 mm incision (group A). The other 31 PMMA IOLs (Pharmacia 809P) were implanted through a 5 mm incision (group B). One surgeon performed all operations with the same technique (bimanual phacoemulsification in the capsular bag). Sutureless wound closure was performed in group A, while the wounds in patients of group B were closed with a single radial stitch. The central endothelial cell counts were recorded preoperatively, on days 2-5 and 6 months postoperatively using contact specular microscopy. RESULTS. The collective data revealed a cell loss of 7.9% (+/- 4.1 SD) on days 2-5 postoperatively and 6.7% (+/- 2.9) after 6 months. A direct linear relationship was found to exist between ultrasound time (UT) and ECL. In group A (7 patients) the ECL slightly increased from 3.5% in the first week postoperatively to 3.8% after 6 months, operated under UT < or = 1 min 30 sec. The ECL decreased from 8.2% to 6.4% after 6 months in group A (19 patients), operated under UT of 1 min 30 sec, and from 10.8% to 8.9% under UT of 2 min 31 sec-3 min 30 sec (5 patients). The ECL in group B decreased from 6.3% in the first postoperative week to 5.4% 6 months postoperatively, operated under UT < or = 1 min 30 sec (10 patients), from 8.1% to 7%, operated under UT of 1 min 31 sec-2 min 30 sec (14 patients), and from 11.2% to 10.4% under UT of 2 min 31 sec-3 min 30 sec (7 patients). CONCLUSION. Endothelial cell loss of 6.7% after phacoemulsification through a temporal clear-corneal incision compares favorably with other series in which cell loss was determined following cataract surgery with or without IOL implantation. Phacoemulsification and 3.5 mm clear-corneal incision evoked less ECL of 6.2% compared with phacoemulsification and 5 mm clear-corneal incision with ECL of 7.3% after 6 months.

Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes.

A prospective, randomized study compared the surgically induced astigmatism after 3.5 mm, 4.0 mm, and 5.0 mm temporal corneal tunnel incisions over six months. We studied 60 eyes of 60 patients who had phacoemulsification through a two-step clear corneal tunnel incision and implantation of one of three posterior chamber intraocular lenses (IOLs). Patients were divided into three groups of 20 each: Group A, cartridge injection of a foldable plate-haptic silicone IOL through a 3.5 mm self-sealing incision; Group B, cartridge injection of a disc silicone IOL through a 4.0 mm self-sealing incision; Group C, 5.0 mm optic poly(methyl methacrylate) IOL through a 5.0 mm incision with one radial suture. Corneal topography data were obtained using a computerized videokeratographic analysis system preoperatively and one week and six months postoperatively. Vector analysis was performed to calculate the surgically induced astigmatism. After the first postoperative week, mean induced astigmatism was 0.63 diopters (D) (+/- 0.41) in Group A, 0.64 D (+/- 0.35) in Group B, and 0.91 D (+/- 0.77) in Group C. After six months, it was 0.37 D (+/- 0.14) in Group A, 0.56 D (+/- 0.34) in Group B, and 0.70 D (+/- 0.50) in Group C. Surgically induced astigmatism was significantly lower in Group A than in Group B (P < .05) and Group C (P < .005) after six months. Vector analysis demonstrated that temporal corneal tunnel incisions induced clinically minimal astigmatism over six months postoperatively depending on incision size.