Corneal refractive changes after acrysof lens versus PMMA lens implantation.

PURPOSE: Do foldable acrylic lenses yield not only reduced posterior capsular opacification but also significant refractive advantages? PATIENTS AND METHODS: 147 cataract patients including 47 with spherical corneas and 100 with preoperative astigmatism of 0.8 +/- 0. 7 dpt were treated in one of two ways: 70 patients received 5.5-mm Acrysof lens implants through 3.2-mm outer and 4-mm inner temporal clear corneal openings (stretch incision); 77 patients received 5-mm PMMA lenses through temporal clear corneal incisions of 4.1-mm outer and 6.5-mm inner diameter incisions. Corneal topography was examined in all patients before the operations as well as 3 days and 6 months after the operations. RESULTS: 6 months after the operations, we observed a surgically induced astigmatism of 0.4 +/- 0.2 dpt for the 3.2-mm incisions compared to 0.8 +/- 0.7 dpt for the 4.1-mm incisions; evaluation according to Holladay of the preoperative spherical corneas yielded a with-the-wound change of 0.0 +/- 0.3 dpt after 3.2-mm incisions versus 0.6 +/- 0.7 dpt after 4.1-mm incisions. The difference in astigmatism for the two types of incisions was statistically significant (p = 0.001). CONCLUSION: Acrysof lens implantation is especially useful for patients with spherical corneas because of avoidance of postoperative astigmatism. The 4. 1-mm corneal incision using PMMA lens implants can be used on the steep meridian to reduce preoperative astigmatism.

[Para-limbic relaxing incisions for reduction of astigmatism within the scope of catarct surgery]. / Limbusnahe Entlastungsschnitte zur Astigmatismusreduktion im Rahmen der Kataraktchirurgie.

PURPOSE: Limbal relaxing incision (LRI) is an easy and safe procedure to reduce astigmatism. It should be clarified, whether the effect is discussed controversely, because the varying corneal diameter and consequently the varying LRI position was not considered. PATIENTS AND METHODS: 56 patients aged 76 +/- 9 years with preoperative astigmatism of 1.6 D (0.6 to 7.0 D) underwent an almost astigmatically neutral cataract procedure (3.2 mm temporal clear corneal phacoemulsification with foldable lens implantation) and received independently from the given corneal diameter limbus related relaxing incisions of 80 degrees length and 0.6 mm depth. We performed the paired LRI in 4.5 mm, 5 mm and 5.5 mm distance from the corneal center on the steeper meridian. RESULTS: 4.3 months postoperatively we observed an astigmatic reduction of -1.0 D (-0.1 to -3.2 D) following LRI with a 9 mm optical zone, LRI with 10 mm diameter led to an astigmatic reduction of -0.4 D (-0.1 to -2.9 D) and LRI with 11 mm diameter were followed by an astigmatic reduction of -0.3 D (+0.5 to -1.1 D). Undercorrections were more frequently observed in younger patients, overcorrections more in elderly people. CONCLUSION: The application of three different kinds of limbus related relaxing incisions, with 4.5, 5 and 5.5 mm distance from the corneal center or 9, 10 and 11 mm optical zone respectively, corresponds to the variable anatomic situation of the limbus, therefore leading to nearly predictable data and explaining the divergent results of previous reports. The nearer the LRI is applied to the corneal center, the stronger is the relaxing effect.

[Peripapillary melanoma; 10-year follow-up]. / Peripapilläres Melanom. 10-Jahres-Beobachtung.

In early stages choroidal peripapillary choroidal melanoma may be confused with a choroidal nevus or melanocytoma. CASE REPORT: A 41-year old female was diagnosed having a choroidal nevus in close proximity to the optic nerve head. Unfortunately the patient did not show up for annual review of this lesion. Ten years after the patient was examined for the second time. A massive increase in tumor size and prominence was noted including serous retinal detachment. Medical work up excluded any metastatic growth, and the globe was enucleated. Three years later, the patient is still healthy and there are no signs of metastatic spreading. HISTOLOGICAL WORK UP: Heavily pigmented peripapillary choroidal melanoma with fascicularly vasocentric proliferative structure, but no infiltration of the sclera or the lamina cribrosa of the optic nerve. The tumor cells were of midgrade size and some of the nucleoli were slightly enlarged. Mitosis and a syncytial structure were present. Immunohistochemically S-100 proteins, HMB 45 and NSE were found. The TNM classification was: ICD-O C 69.3; pT2, G1, S0, V0, pNx, pMx, microscopically RO. CONCLUSION: Pigmented juxtapapillary tumors resembling choroidal nevi require annual surveillance.

[Minimizing induction of astigmatism in preoperative spherical cornea a. by mini-incision surgery with foldable IOL and b. by corneal tunnel incision with limbal relaxing incision]. / Minimierung der Astigmatismus-Induktion bei präoperativ sphärischer Hornhaut a. durch Kleinstschnittchirurgie mit faltbarer IOL bei b. durch Hornhauttunnelinzision mit limbalen Entlastungsschnitten (LRI).

BACKGROUND: In case of a spheric cornea preoperatively the refractive effect of a clear corneal cataract incision is undesirable. We studied two actual techniques to minimize the surgically induced astigmatism. PATIENTS AND METHODS: Temporal clear corneal incision was performed in 77 patients with practically spherical cornea (0.2 +/- 0.1 D). 27 patients with 4.1-mm clear corneal stretch incision and 5 mm PMMA lens implantation served as control. 25 further patients were operated on with the same technique, but 2 additional limbal relaxing incisions (LRI) of 0.55-mm depth and 8 mm length at 6 and 12 o'clock were performed. In 25 patients a foldable acrylic lens (Acrysof) was implanted through a 3.2-mm temporal clear corneal incision. Corneal topography results were evaluated in all patients by the Jaffe and the Holladay analysis. RESULTS: The surgically induced astigmatism of 0.8 +/- 0.5 dpt in the control group was reduced to 0.4 +/- 0.3 dpt by LRI and by reduction of the incision size as well in the treatment groups. With-the-wound-change (WTW) in the Holladay analysis was 0.6 +/- 0.7 dpt in the control group and around 0 in the groups with astigmatism reducing techniques. CONCLUSION: To preserve a spherical cornea in clear corneal-tunnel incision, compensating limbal relaxing incisions (LRI) or ultra-small incisions with foldable lens implantation should be performed.

Limbal relaxing incisions to correct astigmatism in clear corneal cataract surgery.

PURPOSE: To prevent surgically induced astigmatism following clear corneal cataract surgery. METHODS: Limbal relaxing incisions of 6- or 8-mm length and 0.55-microm depth were performed in 52 patients (52 eyes) with a spherical cornea (20 eyes) or mean with-the-rule astigmatism (32 eyes) of 0.80 +/- 0.30 D after temporal corneal cataract incision. A control group (47 eyes; 19 spherical and 28 with-the-rule astigmatism) underwent the same surgical procedure without limbal relaxing incisions. RESULTS: Six months after surgery, mean with-the-wound change using the Holladay analysis was -0.08 +/- 0.50 D in spherical eyes with limbal relaxing incisions and +0.50 +/- 0.70 D in control eyes. Patients with preoperative with-the-rule astigmatism showed a mean with-the-wound change of -0.09 +/- 0.50 D after limbal relaxing incisions; in corresponding control eyes, mean change was +0.39 +/- 0.70 D. CONCLUSION: Limbal relaxing incisions are a reliable and safe procedure to reduce postoperative astigmatism.

[Sutureless corneal cataract surgery. Limbal release incisions for correcting astigmatism]. / Nahtfreie korneale Kataraktchirurgie. Limbale Entlastungsschnitte (LRI) zum Astigmatismusausgleich.

BACKGROUND: To prevent surgically induced astigmatism following clear corneal cataract surgery. PATIENTS AND METHODS: Limbal relaxing incisions of 6 or 8 mm length respectively and 0.5 mm depth were performed in 52 patients with spheric cornea or astigmatism with the rule of 0.8 +/- 0.3 dpt after temporal corneal cataract incision. The same amount of patients, operated on with the same surgical procedure except keratotomies, served as control. RESULTS: After 6 months the with-the-wound-change (WTW) in the LRI axis using the Hollady method was -0.08 +/- 0.5 dpt in the spheric cases with limbal keratotomy and +0.5 +/- 0.7 dpt in the control cases. The patients with preoperative astigmatism with the rule showed a WTW in the LRI axis of -0.09 +/- 0.5 dpt in the keratotomy cases and +0.39 +/- 0.7 dpt in the corresponding control patients. CONCLUSION: Limbal relaxing incision is a reliable and safe procedure to reduce postoperative astigmatism after cataract surgery.

Stability of astigmatism over 3 years after corneal stretch incision.

PURPOSE: To assess long-term corneal stability of self-sealing clear corneal stretch incisions with implantation of 5 mm polymethylmethacrylate (PMMA) intraocular lenses. METHODS: Two hundred consecutive eyes of 3500 cataract patients who had capsulorhexis, phacoemulsification, and preparation of a 1.5 to 2.0 mm corneal tunnel that had an external width of 4.0 to 4.1 mm and an internal width of 6.5 to 7.0 mm (stretch incision), and implantation of a 5 mm PMMA intraocular lens were evaluated clinically and statistically. Slit-lamp microscopy, keratometry, and corneal topography were performed preoperatively and postoperatively after 1 week, 1, 2, and 3 years. RESULTS: The mean surgically induced astigmatism following superior corneal incision amounted to 1.59 +/- 1.06 D after 3 years; following lateral corneal incision, mean surgically induced astigmatism was 0.84 +/- 0.68 D. There were no corneal complications in the long-term follow-up study. CONCLUSION: Our 5-year experience shows that the self-sealing clear corneal stretch incision in connection with implantation of a 5 mm polymethylmethacrylate intraocular lens induces approximately 1.00 D of astigmatism. We prefer the lateral incision and recommend the superior incision only for high preoperative with-the-rule astigmatism.

[Reduction of astigmatism by 4mm long sutureless corneal cataract incision (stretch incision) with phacoemulsification and 5mm PMMA lens implantation]. / Astigmatismusreduktion durch 4 mm langen nahtfreien kornealen Starschnitt (Stretch-Inzision) mit Phakoemulsifikation und 5 mm PMMA-Linsen-Implantation.

AIM: Refractive cataract surgery using corneal incisions is aiming at neutralization of preoperative astigmatism. PATIENTS AND METHODS: 61 patients with preoperative astigmatism of 2.25 +/- 0.98 were included in the treatment. A self-sealing corneal tunnel incision measuring 4.0 to 4.1 mm in external diameter and 6.5 to 7.0 mm in internal diameter (stretch incision) was performed on the steeper axis. After capsulorhexis and phacoemulsification a 5 mm PMMA lens was implanted without suturing. Keratometry and corneal topography were performed preoperatively, 3 days and 1 year respectively following surgery. The statistical analysis was based on the Wilcoxon signed ranks test. RESULTS: Surgical induced astigmatism (IA) following superior incisions in cases of astigmatism with the rule (n = 29) amounted to 1.93 +/- 0.97, while lateral incisions in cases of astigmatism against the rule (n = 29) led to an IA of 1.35 +/- 0.73. Axial shifts by more than 30 degrees were 23% following superior incisions and 17%, after lateral incisions. We observed. astigmatic reduction of 1.3 D after superior incisions and 0.7 D following lateral incisions. CONCLUSION: By 4 mm corneal cataract incisions on the steeper axis a high preoperative astigmatism can be reduced significantly without additional keratotomies.

[Prognosis in orbital gunshot injuries]. / Prognose orbitaler Schussverletzungen.

UNLABELLED: No reviews of orbital gunshot injuries have been published in German ophthalmological journals. In this article biomechanical and prognostic factors of this rare type of injury are analysed. PATIENTS AND METHODS: We report on 4 patients, aged 20-63 years, who tried to commit suicide by shooting themselves in the right temple. Clinical and radiological diagnosis as well as treatment by an interdisciplinary team are reported. RESULTS: All patients became blind on the right side despite immediate surgery including reconstruction of the injured bones and soft tissues. Three of four patients suffered severe functional defects in the left eye; one of them is now blind. CONCLUSION: Orbital gunshot wounds are severe injuries. The prognosis depends on the course of the bullet and the interdisciplinary care.

[Solitary extramedullary plasmacytoma of the conjunctiva]. / Solitäres extramedulläres Plasmozytom der Konjunktiva.

UNLABELLED: Unpigmented tumorous changes of the conjunctiva can frequently be classified as chalazion, basalioma or carcinoma. PATIENT AND METHODS: In a 70 years old diabetic female a 2.5 x 2.5 cm tumor of the lower conjunctival fornix was observed. After complete excision the tumor was examined by histologic routine procedures and immunohistochemically. The patient was irradiated by 40 Gy with the linear accelerator. RESULTS: The monotypical secretion of the heavy chain gamma and the light chain kappa demonstrated a well differentiated extramedullar plasmocytoma. A MALT lymphoma could be excluded by the absence of centrocytoid cells. The bone cytology and histology did not give any evidence for a medullar plasmocytoma. The patient is free from local or diffuse tumor growth since 2 1/2 years. CONCLUSION: Since the worldwide most important ophthalmopathologic statistics of the AFIP from 1984-1989 describes only 1 plasmocytoma out of 2104 tumors of the lids and conjunctiva, the demonstrated case is an important rarity.

Long-term astigmatic changes after clear corneal cataract surgery.

PURPOSE: To assess long-term astigmatic changes after clear corneal cataract surgery. SETTING: Städtisches Klinikum, Augenklinik, Karlsruhe, Germany. METHODS: We evaluated the first 100 of 2,800 patients having cataract surgery with a superior or lateral corneal self-assessing incision and implantation of a 5.0 mm poly(methyl methacrylate) intraocular lens. Surgically induced astigmatism (IA) and absolute astigmatism (AA) were evaluated after 1 week and 1 and 2 years using keratometry and corneal topography. Statistical analysis was done using the Wilcoxon signed-rank test. RESULTS: In eyes with a 12 o'clock incision (n = 50), the mean IA was 1.18 diopters (D) +/- 0.79 (SD) after 1 year and 1.53 +/- 0.95 D after 2 years. In eyes that had with-the-rule astigmatism preoperatively (n = 15), the mean AA was 0.62 +/- 0.57 D after 1 year and 0.93 +/- 0.56 after 2 years. In eyes with lateral incisions (n = 50), the mean IA was 0.96 +/- 0.74 after 1 year and 0.64 +/- 0.50 after 2 years. In eyes with against-the-rule astigmatism preoperatively (n = 15), the mean AA was 0.66 +/- 0.70 after 1 year and 0.52 +/- 0.65 after 2 years. The between-group difference in astigmatism after 2 years was statistically significant. CONCLUSION: The 12 o'clock incision was associated with a statistically insignificant increase in AA 2 years postoperatively and the lateral incision, with a statistically significant decrease. We currently recommend routine use of clear corneal incisions in cataract surgery.

[6 years experience with reversible and surgical upper eyelid weighting in lagophthamos]. / 6jährige Erfahrung mit reversibler und operativer Oberlidbeschwerung beim Lagophthalmus.

BACKGROUND: The procedures for prophylaxis and treatment of keratopathy following facial palsy with lagophthalmos are unsatisfying from the functional point of view. PATIENTS AND METHODS: Three years ago we created a "lid-dynamic" procedure and applied it to 46 patients with Bell's palsy or before implantation of a gold lid weight. Fixation of lead weights of 0.8-2.0 g to the upper lid by a foil adhesive on both sides (Tesafix), can lead to restoration of lid closure. Within 6 years we implanted 24-carat gold weights into the upper lid in 72 patients. RESULTS: In all cases lid function was markedly improved; all patients appreciated the procedure. The lead weights were well tolerated. In 27% of the operative cases we observed a slight underdosage, in 10% a slight overdosage. CONCLUSION: Lid loading is a simple and effective method for functional and cosmetical rehabilitation of patients with lagophthalmos. Despite the dependence upon gravity, the procedure can be recommended for all cases of facial palsy.

[Effect of cataract technique and duration of surgery on fibrin reaction after IOL implantation]. / Einfluss von Katarakttechnik und Operationsdauer auf die Fibrinreaktion nach IOL-Implantation.

BACKGROUND: Having changed our cataract operation technique from ECCE to phacoemulsification (PE) we had the impression of less fibrinous membranes postoperatively. METHOD: To ascertain whether our impression was correct, we examined the last 2056 IOL implanted cataract patients retrospectively. RESULTS: In the 2056 cataract cases we found 152 fibrinous reactions (7.4%). We observed after ECCE (n = 586) a 12.8% rate of fibrinous membranes, after phacoemulsification (PE) with sutured 6.5-mm corneoscleral incision (n = 546) 7.0%, and after PE with clear corneal self-sealing 4.1-mm incision (n = 924) only 3.9%. In 56% of these patients we found diabetes, in 13% former uveitis with posterior synechiae, in 11% glaucoma with rigid pupil, and in 10% pseudoexfoliation syndrome. In those cases with no diabetic retinopathy but known diabetes (n = 198), we found a 27% rate of fibrin reactions following ECCE (12 mm), 12% following PE (6.5 mm) and 8% following PE (4.1 mm). In non-proliferative diabetic retinopathy (n = 80) a 32% rate of fibrinous changes was observed after ECCE, 18% after PE (6.5 mm), and 9% after PE (4.1 mm). In cases of uncomplicated ECCE (n = 341) the rate of fibrinous reactions amounted to 22.4% following prolonged procedures (> 50 min) by residents, while it was as low as 9.5% following operations of short duration (< 30 min) by experienced surgeons. Intraocular injection of tPA (25 micrograms) was the most effective treatment. CONCLUSION: The self-sealing corneal small incision cataract technique guarantees a short duration of the surgical procedure and the last fibrinous reactions.

Astigmatism reduction: no-stitch 4.0 mm versus sutured 12.0 mm clear corneal incisions.

PURPOSE: To compare the effect on astigmatism of phacoemulsification using a 4.0 mm, no-stitch, clear corneal incision with that of extracapsular cataract extraction (ECCE) using a 12.0 mm, sutured, clear corneal incision. SETTING: Augenklinik, Städtisches Klinikum Karlsruhe, Germany. METHODS: The study comprised 211 patients who had cataract extraction and intraocular lens implantation through a superior clear corneal incision; 108 patients had phacoemulsification with a 4.0 mm no-stitch incision, and 103 had ECCE using a 12.0 mm sutured corneal incision. The main outcome measure was amount of astigmatism preoperatively and at 1 week and 3 and 6 months postoperatively. Corresponding medians (lower and upper quartiles) were evaluated. RESULTS: Median surgically induced cylinder was 1.00 diopter (D) (range 0.56 to 1.50 D) in the 4.0 mm no-stitch incision group and 1.75 D (range 1.00 to 2.62 D) in the 12.0 mm sutured incision group. In eyes with preoperative with-the-rule astigmatism, astigmatism decreased from a median of 0.75 D (range 0.50 to 1.00 D) to 0.50 D (range 0 to 1.50 D) in the 4.0 mm incision group. The difference between preoperative and postoperative astigmatism in the 12.0 mm incision group was not statistically significant. CONCLUSION: Clear corneal cataract surgery leads to a predictable reduction in astigmatism when performed on the steeper axis with a small, no-stitch incision. Larger sutured incisions are not suitable for planned refractive changes but are still recommended in certain cases such as hard cataract and glaucoma.

[New methods for the treatment of loss of eyelid closure in reversible facial paralysis]. / Neue Methoden zur Behandlung des fehlenden Lidschlusses bei reversibler Fazialisparese.

BACKGROUND: For prophylaxis or therapy of lagophthalmic keratopathy ointment application or hour glass dressing is indicated. The hour glass dressing has the disadvantage of a continuous visual impairment by steaming up of the moisture chamber. The main problem for the patients is the strong subjective feeling of physical handicap. A therapeutic alternative is the gravity dependent lidloading, which is known as gold implantation in cases of irreversible lagophthalmos. METHODS AND PATIENTS: By lead weights of 0.8 to 2.0 g, which are fixed to the upper lid by a foil glueing on both sides (Tesafix) or in allergic patients by an adhesive layer, well tolerated by the skin (Combihesive), the lidclosure can become restored without impairment of lid-opening. In a controlled study the described method was first tested on 10 normal persons and than applied to 22 patients with lagophthalmos. Meanwhile the new method was applied to 32 further patients. RESULTS: The "liddynamic" procedure is effective and well tolerated; it is more accepted, especially during the day, because of better visual function and better cosmetics. The hour glass dressing, is still of importance in serious cases of keratopathy during the night. CONCLUSION: "lidloading" with lead weights, which are glued by an adhesive layer to the upper lid, can be recommended as a new method in cases of reversible lagophthalmos or as a preparing step before a gold implantation.

[Risk factors, prevention and therapy of fibrin reactions after IOL implantation]. / Zu Risikofaktoren, Prophylaxe und Therapie von Fibrinreaktionen nach IOL-Implantation.

BACKGROUND: Postoperative fibrinous reactions following the small-incision technique seem to be very rare. Problem cases can be treated with tissue Plasmin Activator. METHOD: To investigate the new prophylactic and therapeutic possibilities the last 2,056 cataract procedures with PMMA lens implantation were statistically analyzed. RESULTS: In 152 (7.4%) fibrin cases we observed after ECCE (n = 586) 12.8%, after phacoemulsification (PE) with sutured 6.5-mm corneoscleral incision (n = 546) 7.0% and after PE with clear corneal selfsealing 4.1-mm incision (n = 924) only 3.9% fibrinous reactions (p < 0.01). In case of ECCE the rate of fibrinous reactions amounted to 22.4% following prolonged procedures (< 50 min), while it was low as 9.5% with a short period of time (< 30 min) (p < 0.01). In 8 steroid-resistant cases we applied 25 micrograms Plasmin Activator intraocularly. The injections led to complete dissolution of the fibrinous membranes without complications. CONCLUSION: Postoperative fibrinous reactions can be reduced statistically significantly by application of the corneal small-incision technique. The most efficient therapy is intraocular Plasmin Activator fibrinolysis.

[Adhesive eyelid weights ("reversible lidloading") for treatment of lagophthalmos]. / Klebende Lidgewichte ("reversible lidloading") zur Lagophthalmus-Behandlung.

BACKGROUND: In facial palsies with lagophthalmic keratopathy an hour-glass dressing is indicated, which has the disadvantage of a moisture chamber with visual impairment by steaming up. After weeks of placement dermal irritations are possible. An alternative is the gravity dependent lidloading, using gold implantation in cases of irreversible lagophthalmos. METHODS AND PATIENTS: Lead weights of 0.8 to 2.0 g are glued to the upper lid with an adhesive layer, that is well tolerated by the skin (Combihesive*), or by a simple foil that is glued on both sides (Tesafix). This results in a lidclosure without impairment of lid opening. After tests on 10 normal persons the described method was placed on 22 patients with lagophthalmos and compared with hour-glass dressing. The new method was applied to 36 additional patients. RESULTS: The dynamic lead weight is effective and well-tolerated. It was more accepted cosmetically especially during the day because of better cosmetic appearance and better visual function than was the hour-glass dressing. These latter dressings are still important for use in serious cases during the night. CONCLUSION: lidloading with lead weights that are glued by an adhesive layer to the upper lid can be recommended as a new method in cases of reversible lagophthalmos or as a preparatory step before gold implantation.

[Treatment of lagophthalmos with adhesive eyelid weights (reversible lid-loading)]. / Behandlung des Lagophthalmus mit klebenden Lidgewichten ("reversible lid-loading").

BACKGROUND: In facial palsies with lagophthalmic keratopathy, an hour-glass dressing is indicated. This dressing has the disadvantage of a moisture chamber, visual impairment occurs by steaming up. After weeks of placement dermal irritations are possible. An alternative is gravity-dependent lid-loading, using gold implantation in cases of irreversible lagophthalmos. METHODS AND PATIENTS: Lead weights of 0.8 to 2.0 g are glued to the upper lid with an adhesive layer that is well-tolerated by the skin (Combihesive*) or by a simple foil that is glued on both sides (Tesafix). This results in a lid closure without impairment of lid opening. After tests on 10 normal persons lid-loading implants were placed on 22 patients with lagophthalmos and compared with hour-glass dressing. The new method was also applied to 26 additional patients. RESULTS: The dynamic lead weight was effective and well-tolerated. It was more accepted eosine tically, especially during the day because of its better cosmetic appearance and better visual function than was the hour-glass dressing. These latter dressings are still important for use in serious cases during the night. CONCLUSION: Lid-loading with lead weights that are glued by an adhesive layer to the upper lid can be recommended as a useful method in cases of reversible lagophthalmos or as a preparatory step before gold implantation.

Lid load operation in facial palsy.

In 24 patients with irreversible lagophthalmos, gold weights ranging from 0.8 to 1.7 g were implanted in the upper lids, under local anaesthesia. With a follow-up period ranging from 2 1/2 to 4 years (average, 3 years), the results of the implantation were gratifying in 23 patients. While corneal irritation and epiphora was reduced and the loaded upper eyelid allowed patients to blink voluntarily.

[PMMA lens implantation in sutureless corneal cataract surgery]. / PMMA-Linsen-Implantation in der nahtfreien kornealen Kataraktchirurgie.

BACKGROUND: Self-sealing corneal cataract procedures have been known since 1992 and are recommended for foldable silicon lenses. Our goal was a technical modification without refractive disadvantages, which would also allow for the implantation of more rigid, but less expensive PMMA lenses of high optical quality. METHODS: The "scleral stretch incision" by Freeman (1991) was applied to the corneal situation by widening the inner wound lip up to 6.5 mm; this makes it possible to implant a 5 mm optic through an outer wound opening of 4-4.2 mm. This method has been used since October 1992 on 980 patients, whereby the lamellar corneal incision was placed 1.5-1.8 mm deep to compensate for the astigmatism, if possible in the steeper meridian. RESULTS: The first 107 cases were followed up for longer than 6 months; they showed a surgically induced astigmatism of 1.18 +/- 0.79 D and a postoperative astigmatism of 0.86 +/- 0.70 D. Neither postoperative infection nor hypotony was observed in any of the cases. CONCLUSION: The modified corneal tunnel incision is recommended for 5 mm PMMA lenses; this is especially suited for cases of low to midgrade preoperative astigmatism that can be optimally improved by this procedure. In cases of pure spheric refraction, a 3 to 3.5 mm incision with foldable lens implantation is preferred.