Indications, Complications, and Early Postoperative Course of Recovery of Intraocular Lens Exchange Surgery: a Single-Center Retrospective Study.

PURPOSE: To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery. MATERIAL AND METHODS: Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed. RESULTS: One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%). CONCLUSION: The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.

Progression of Visual Field Damage within Clusters Depends on Preexisting Damage.

PURPOSE: To investigate, in a routine clinical setting, how global progression or progression within visual field clusters depends on preexisting damage. METHODS: Glaucoma patients with a visual field damage of at least 3 dB at baseline and a series of at least 5 good quality examinations were scrutinized retrospectively. The change in visual field damage within 10 visual field clusters was assessed in a mixed linear effects model with age, baseline global mean deviation (MD), baseline cluster MD, and observation time as covariates. In addition, progression was tested for a global MD rate with age, baseline global MD, and observation time as covariates. RESULTS: A total of 50 patients with a mean (± SD) age of 78 (± 13) years and a baseline global mean defect (MD) of 7.6 dB (± 4.4) fulfilling the selection criteria were identified between 2001 and 2019 out of 5019 patients in a visual field database of a tertiary ophthalmology center. Baseline visual field damage (global MD) correlated positively (p < 0.001) with the progression rate within clusters, but not with the global MD rate (p = 0.075). Higher age was a significant predictor for more rapid progression in both models (p < 0.001). CONCLUSION: In this retrospective study of patients in a routine clinical setting, who were not enrolled in studies, and simply receiving routine clinical care, analyzing progression within visual field clusters was more sensitive than assessing the global MD rate.

The 'two global flash' mfERG in high and normal tension primary open-angle glaucoma.

PURPOSE: To analyse the sensitivity of the '2 global flash' multifocal electroretinogram (mfERG) to detect glaucomatous dysfunction in normal tension (NTG) and high tension primary open angle glaucoma (POAG) patients. METHODS: MfERGs were recorded from 20 NTG and 20 POAG patients and compared to those of 20 controls. The mfERG array consisted of 103 hexagons. Each m-sequence step started with a focal flash that could be either dark or light (m-sequence: 2--13, L(max): 200 cd/m(2), L(min): 1 cd/m(2)), followed by two global flashes (L(max): 200 cd/m(2)) at an interval of approximately 26 ms. Focal scalar products (SP) were calculated using focal templates derived from the control recordings (VERIS 4.8). We analyzed 5 response averages (central 7.5 degrees and 4 adjoining quadrants) of the response to the focal flash, the direct component at 10-40 ms (DC) and the following two components induced by the effects of the preceding focal flash on the response to the global flashes at 40-70 ms (IC-1) and at 70-100 ms (IC-2). RESULTS: Both NTG and POAG patients differed from controls in the IC-1 response to the superior quadrants, and POAG patients also differed from controls in the centre. The most sensitive parameter was the IC-1 of the superior temporal quadrant with an area under the ROC curve of 0.82 for POAG and 0.79 for NTG. The DC and the IC-2 did not differ significantly between the groups. When all five response averages of the IC-1 were taken into consideration 90% of the NTG patients and 85% of the POAG patients were correctly classified as abnormal while 80% of the control subjects were correctly classified as normal. CONCLUSIONS: This stimulus sequence holds promise for the diagnosis of early functional changes in POAG. A new finding is that both NTG, as well as POAG can be differentiated from control subjects.

30 Hz-flicker mfERG in primary open-angle glaucoma patients : 30 Hz-flicker-mfERG in POAG.

PURPOSE: This study was performed in an attempt to gain more information on whether the 30 Hz-flicker mfERG indeed provides a sensitive measure of dysfunction in patients with primary open-angle glaucoma (POAG) as has been suggested previously. METHODS: Eighteen POAG patients with visual field defects (MD > 2.2 dB) and glaucomatous optic neuropathies as well as 10 control subjects underwent mfERG recording as follows: 30 Hz-flicker mfERG, LED stimulus screen, 61 hexagons, Lmax: 180 cd/m2, Lmin: 0 cd/m2, recording time: approximately 5 min, filter setting: 10-200 Hz. The 30 Hz response (also called the fundamental or the first harmonic response (1HW) and the second harmonic wave at 60 Hz (2HW) were analysed as an overall response and in quadrants, as well as in 4 small neighbouring areas per quadrant. The patients' mfERGs were compared to those of the control group and to the mean defect values (MD) of the corresponding quadrants of the Octopus perimetry. RESULTS: Neither in the overall response, nor in the quadrants, nor in the smaller areas examined did amplitudes and phases of the 1HW and the 2HW or the amplitude ratio of the 2HW to the 1HW (DFT-ratio) differ from the controls (P > 0.05-ANOVA). There was no significant correlation between mfERG values and the MD (Spearman-test, Bonferroni). CONCLUSION: Thus, the 30 Hz-flicker mfERG does not seem to be sensitive enough to separate glaucoma patients from normal.