Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification.

PurposeTo assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption.Patients and methodsThe study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100-249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc.ResultsThe AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100-249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment.ConclusionsA flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation.

Trabeculectomy ab interno (trabectome): yet another possibility in the treatment of uncontrolled glaucomatocyclitic crisis under systemic valganciclovir therapy?

PURPOSE: To assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner-Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP). PATIENTS/METHODS: Trabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months. RESULTS: Mean IOP before trabectome surgery was 40±10 mm Hg (range 33-58 mm Hg). The mean number of antiglaucoma medication prior to surgery was 3.1±0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13±1 mm Hg) and their antiglaucoma medication was decreased to 0.8±1.1. No recurring attack of glaucomatocyclitic crisis occurred. DISCUSSION: In addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty.

PURPOSE: In this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient's satisfaction was evaluated. METHODS: A retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction. RESULTS: Best-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally. CONCLUSION: Patient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.

[Comparison of dynamic contour tonometry versus Goldmann applanation tonometry according to the International Ocular Tonometer Standards ISO 8612 in glaucoma patients]. / Vergleich der dynamischen Konturtonometrie vs. Goldmann-Applanationstonometrie nach dem internationalen Standard für Augentonometer (ISO 8612) in einem Glaukomkollektiv.

INTRODUCTION: The aim of this study was to compare the dynamic contour tonometry PASCAL® (DCT) versus the Goldmann applanation tonometry (GAT) in a glaucoma population and to analyse the correlation with the central corneal thickness (CCT). PATIENTS/METHODS: 191 eyes of 107 Caucasian glaucoma patients (62 female, 45 male) were included: 3 repeated GAT and dynamic contour tonometry (DCT) measurements (quality factor 1-2) were analysed. CCT was measured by ultrasound pachymetry. Criteria of ISO 8612 were fulfilled: 3 groups of IOP measurements were formed: group 1: 7-16 mmHg, group 2: 16-23 mmHg and group 3: > 23 mmHg, each including at least 40 eyes. Only 5.0 % outliers per area of intraocular pressure were permitted in a tolerance of ± 5.0 mmHg. RESULTS: Data of 191 eyes (mean CCT 553 µm) were analysed. GAT (19.68 mmHg ± 7.56 mmHg) showed good correlation to DCT (20.54 ± 8.21 mmHg) (r = 0.770, p < 0.001). Mean difference DCT-GAT was 0.86 ± 2.45 mmHg. In regard to the criteria of ISO 8612, the number of outliers were: group 1: (n = 68) 29.4 %, group 2: (n = 62) 41.9 %, and group 3: (n = 61) 31.2 %. No correlation was shown between CCT vs. GAT (r = 0.184, p = 0.057) and CCT vs. DCT (r = 0.177, p = 0.09), respectively. DISCUSSION: In conclusion, despite good correlation to GAT measurements DCT does not fulfil the ISO 8612 reference criteria in glaucoma patients. DCT and GAT did not show correlation to CCT.

[Influence of donor lamella thickness on visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK)]. / Einfluss der Spenderlamellendicke auf die Sehschärfe nach "Descemet's stripping automated endothelial keratoplasty" (DSAEK).

BACKGROUND: The aim of this study was to evaluate the effect of donor lamella thickness on postoperative visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK). MATERIALS AND METHODS: A retrospective analysis of 65 eyes from 61 patients who underwent DSAEK surgery in cases of Fuchs' corneal dystrophy or bullous keratopathy between 2008 and 2011 was performed. The thickness of donor lamella was measured intraoperatively by ultrasonic pachymetry and postoperatively by anterior segment optical coherence tomography (OCT) and correlated to the visual acuity and number of endothelial cells. RESULTS: The donor lamella thickness measured intraoperatively and postoperatively correlated significantly with each other (r = 0.874, p < 0.001). A significant correlation was found between postoperative corneal lamella thickness measured by anterior segment OCT and visual acuity (r = 0.273, p = 0.028) but not between intraoperative donor lamella thickness measured by ultrasonic pachymetry and visual acuity (r = 0.241, p = 0.103). The postoperative endothelial cell number did not show a correlation with either the intraoperatively or the postoperatively measured donor lamella thickness (r = - 0.059, p = 0.731, r = 0.024, p = 0.869, respectively). CONCLUSIONS: Corneal lamella thickness < 120 µm was found to be correlated with a better visual outcome than in cases of thicker corneas > 120 µm. Despite greater difficulty in corneal transplant technique in cases of thinner lamella no increased damage of corneal endothelium was shown. Therefore, DSAEK with corneal lamella thickness < 120 µm is an interesting therapeutic alternative to DMEK.

[Influence of anterior chamber depth on optic disc measurements with OCT and HRT 3]. / Einfluss der Vorderkammertiefe auf die Vermessung des Sehnervenkopfs mit OCT und HRT 3.

BACKGROUND: The aim of this study was to investigate the influence of the anterior chamber depth (ACD) on the measurement of the optic nerve head size with OCT and HRT 3. PATIENTS AND METHODS: 100 pseudophakic eyes of 100 patients were enrolled in this prospective study. The measurement of the optic nerve head was performed with the optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Inc., Dublin, CA) and the confocal laser scanning tomography (Heidelberg retina tomograph, HRT 3, Heidelberg Engineering, GmbH, Dossenheim, Germany). Bland and Altman plots were used to examine the agreement between the parameters of the two techniques. The relationship between the optic nerve head size and the ACD was analysed by linear regression. RESULTS: Optic disc size measurement with the OCT and the HRT 3 showed no significant difference (p = 0.638). Measurement of the optic disc size with the OCT was significantly correlated with the ACD (- 0.234; p = 0.016). The optic disc size decreases with increasing values of the ACD. There was no influence of the ACD on the measurement of the optic disc size with the HRT 3 (r = 0.128; p = 0.193). CONCLUSION: While the optic disc size measured by OCT decreased with increasing ACD, the measurement with the HRT 3 turned out to be independent of the ACD. The OCT may underestimate the optic disc size in lower ACD. This may result in reduced agreement between the two devices.

[Influence of corneal thickness in keratoconic corneas on IOP measurement with IOPen, iCare, dynamic contour tonometry and Goldmann applanation tonometry]. / Einfluss der Hornhautdicke bei Keratokonus auf die Messung des Augeninnendrucks mit 4 verschiedenen Messverfahren.

BACKGROUND: The aim of this study was to evaluate the effect of central corneal thickness (CCT) of keratoconic corneas on intraocular pressure (IOP) measurements as measured by four different techniques. PATIENTS AND METHODS: Forty-one eyes of forty-one keratoconus patients (group 1) and fifty eyes of fifty healthy subjects (group 2) were enrolled. IOP was measured with iCare, IOPen, Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). CCT was measured by ultrasonic pachymetry. These data were used for statistical analysis. RESULTS: The mean IOPs measured by GAT, DCT, iCare and IOPen were 11.4, 14.7, 10.8, and 15.7 mmHg in group 1; and 14.2, 15.4, 15.4 and 14.3 mmHg in group 2, respectively. Between both groups, there was a statistically significant difference in iCare (p < 0.001), GAT (p < 0.001) and IOPen (p = 0.040) measurements; with no difference between DCT (p = 0.266) measurements. IOPen measurements were significantly associated with CCT (r = - 0.314; p = 0.046). CONCLUSION: IOPen seemed to be affected by CCT. IOP readings by iCare, GAT and DCT were found to be independent of CCT in keratoconic corneas.

Comparison of functional and morphological diagnostics in glaucoma patients and healthy subjects.

PURPOSE: To evaluate the diagnostic value of microperimetry (MP), blue-on-yellow perimetry (B/YP), confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph, HRT, III) and optical coherence tomography (OCT) in discriminating eyes with early glaucoma from healthy subjects. MATERIAL AND METHODS: Prospective examination of 22 eyes of subjects with early primary open-angle glaucoma and 24 eyes of healthy control subjects. After a complete ophthalmological examination, B/YP, MP, OCT and HRT III were determined. Morphological and functional parameters were analysed. RESULTS: Mean sensitivity threshold values obtained with B/YP and MP did not show significant differences between glaucoma patients and the control group (p = 0.321 and p = 0.281). Retinal nerve fibre layer (RNFL) thickness was significantly decreased in patients with glaucoma with both HRT III and OCT (p = 0.018 and p < 0.001). CONCLUSIONS: While B/YP and MP had no ability to discriminate between subjects with early glaucoma and healthy subjects, RNFL thickness measured with HRT III and OCT showed a significant difference. In early primary open-angle glaucoma, morphological changes like RNFL thickness seem to occur prior to functional defects in the visual field.

[Influence of corneal thickness on intraocular pressure measurements following Descemet's stripping automated endothelial keratoplasty (DSAEK)]. / Einfluss der Hornhautdicke nach posteriorer lamellärer Keratoplastik (DSAEK) auf die Messung des Augeninnendrucks.

BACKGROUND: The aim of this study was to evaluate the effect of increased corneal thickness after Descemet's stripping automated endothelial keratoplasty (DSAEK) on intraocular pressure (IOP) measured by four different techniques. METHODS: In this study 30 eyes from 30 patients with successful DSAEK treatment (group 1) and 30 eyes of 30 healthy subjects (group 2) were enrolled. The IOP was measured with iCare, IOPen, Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) techniques. Central corneal thickness (CCT) was measured by ultrasonic pachymetry. These data were used for statistical analysis. RESULTS: The mean IOP measured by GAT, DCT, iCare and IOPen was 13.2, 16.1, 12.5 and 14.2 mmHg in group 1 and 13.4, 14.4, 14.4 and 13.3 mmHg in group 2, respectively. Correlations between IOP and CCT were not statistically significant in either group. CONCLUSION: The results of IOP measurements by the iCare, IOPen, GAT and DCT techniques seem to be unrelated to artificially thickened corneas after DSAEK. In spite of partially good correlation between the four techniques a direct exchange of the devices is not recommended on account of the wide dispersion of values.

[Application possibilities of modern thermography--first experience with the new Tomey TG 1000]. / Anwendungsmöglichkeiten der modernen Thermografie--ste Erfahrungen mit dem neuen Tomey TG 1000.

Temperature is one of the fundamental characteristics of tissue metabolism and is certainly of major interest to investigate ocular physiology. Current instrumentation offers the potential to measure the ocular surface temperature (OST) with high accuracy and resolution. Potential applications of OST measurement may include any condition of the ocular surface. The present study gives a survey of the possible applications of thermography and describes our first experience with the new Tomey TG 1000.