[Results and complications after deep sclerectomy]. / Ergebnisse und Komplikationen nach tiefer Sklerektomie.

BACKGROUND: As nonperforating glaucoma surgery, deep sclerectomy seems to offer the advantage of fewer complications than the classic trabeculectomy during the first weeks after surgery. PATIENTS AND METHODS: In this prospective study, 74 eyes of 56 patients received deep sclerectomy. The mean follow-up time was 9.5 +/- 5.8 months. Twelve eyes were treated intraoperatively with additional mitomycin C and 11 eyes had combined cataract procedures. The deep sclerectomies were performed without using material of high viscosity or a collagen implant. RESULTS: The mean preoperative pressure of 24.8 +/- 9 mmHg could be lowered to 16.1 +/- 5.9 mmHg (P < 0.0001). The number of glaucoma medications was reduced from 2.2 +/- 1.1 to 0.6 +/- 1.0 substances. Thirty-eight percent of the eyes needed glaucoma medication again. Complications included chorioidal detachment (n = 9), temporary hyphema (n = 6), and delayed pressure reduction (n = 2). CONCLUSIONS: Deep sclerectomy as nonpenetrating glaucoma surgery lowers the intraocular pressure as well as standard trabeculectomy. Its complication rate is very low during the early postoperative weeks. The number of patients who still need glaucoma medication seems to be higher than after trabeculectomy.

[Intracorneal granulomatous inflammation]. / Intrakorneale granulomatöse Entzündung.

INTRODUCTION: We report a patient suffering from lattice corneal dystrophy and with a corneal granuloma 8 months after phototherapeutic keratectomy (PTK). CASE REPORT: PTK was performed in a 33-year-old man with hereditary lattice corneal dystrophy. An intracorneal tumor was found in the right eye 8 months after treatment. There was no indication of previous foreign body injury. Detailed clinical examinations yielded no evidence of the cause or nature of the tumor. For this reason an excision was performed. RESULTS: Histological examination revealed a dense inflammatory infiltration of the deeper corneal stroma with epithelioid cells, histiocytes, lymphocytes, eosinophilic leukocytes, and giant cells of the Touton type. There was no indication of a generalized granulomatous inflammation. CONCLUSION: A monosymptomatic, intracorneal, granulomatous infiltration is very rare and has not previously been described in a case of lattice corneal dystrophy. This may have been a case of xanthogranuloma or sarcoidosis. Strangely, the granuloma occurred only several months after PTK; nevertheless, a pathogenetic connection seems unlikely.

[Combined glaucoma and cataract operation with foldable posterior chamber lens implantation. Long-term outcome and complications]. / Kombinierte Glaukom- und Kataraktoperation mit faltbarer Hinterkammerlinsenimplantation. Langzeitergebnisse und Komplikationen.

BACKGROUND: Glaucoma patients who need filtering surgery very often have cataracts as well. Combined glaucoma/cataract surgery entails a higher rate of complications and may endanger the results of glaucoma surgery. PATIENTS AND METHODS: This retrospective study investigated 223 eyes in 169 patients with uncontrolled glaucoma and cataracts. Each eye received filtering surgery and simultaneous phacoemulsification with implantation of a foldable posterior chamber lens. Mean follow-up was 32.5 months (6-57). RESULTS: Mean intraocular pressure was lowered from 24.6 +/- 6.2 to 16.4 +/- 3.4 mmHg (P > 0.0001). Visual acuity improved from 0.25 (0.01-0.5) to 0.5 (0.01-1.0). Preoperatively the mean number of medications was 2.4 (1-6) and postoperatively 1.3 (1 or 2). The most common perioperative complications were choroidal detachment (20.2%) and fibrin reaction in 10.1%; those occurring later than 4 weeks postoperatively were posterior capsule opacification requiring YAG laser capsulotomy (11.5%) and scarring of filtering bleb (7.7%). CONCLUSION: Complications encountered in the combined procedure were due mainly due to cataract surgery of glaucomatous eyes with narrow pupils and posterior synechiae. A shallow anterior chamber occurred in only one case. Despite complications the success rate in lowering intraocular pressure was comparable to that observed in filtering surgery alone.

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.

[Phototherapeutic keratectomy (PTK) after epidemic keratoconjunctivitis]. / Phototherapeutische Keratektomie (PTK) nach Keratoconjunctivitis epidemica.

BACKGROUND: Persistent and recurrent nummuli after epidemic keratokonjunktivitis (EKC) often lead to reduced visual acuity and increased glare. In spite of long-term topical steroid therapy nummuli often recur. We tried to treat persistent nummuli with phototherapeutic keratectomy (PTK). PATIENTS: PTK with an excimer laser (193 nm) was performed in 13 eyes of 9 patients with nummuli. The nummuli were observed over 3-72 months (mean: 36 months). Preoperatively, the visual acuity was 0.1-0.9 (mean: 0.39 +/- 0.22) and the brightness acuity test (BAT) was 0.05-0.5 (mean: 0.25 +/- 0.15). Prior to PTK all eyes had been treated with local steroids several times for recurrent nummuli. RESULTS: During the follow-up from 15 to 56 months (mean: 33 +/- 11.5 ms), 11 eyes had an increase in visual acuity: 0.3-1.0 (mean: 0.63 +/- 0.26). The reduction of glare was especially beneficial for the patients: 0.3-0.9 (mean: 0.55 +/- 0.21). One patient had a recurrence of nummuli in both eyes 6 weeks after PTK. The subjective-induced spheric refractive change was -2.5 D to +2.0 D. The astigmatic error changed between -2.0 D to +1.5 D. CONCLUSION: PTK seems to be an effective method of treating persistent, recurrent nummuli after EKC. The low rate of recurrence of nummuli after PTK is remarkable.

Binocular function after bilateral implantation of monofocal and refractive multifocal intraocular lenses.

PURPOSE: To evaluate binocular function after bilateral implantation of a refractive multifocal intraocular lens (IOL). METHODS: Contrast sensitivity, glare, depth discrimination, and distance and near visual acuity were examined in 21 patients with a multifocal IOL and 15 patients with a monofocal IOL. RESULTS: There was no significant difference in binocular distance visual acuity between the 2 groups. In near visual acuity with distance correction, the multifocal group had a significant advantage in monocular and binocular vision (P < .05). High contrast with Regan contrast letter acuity charts did not differ significantly between the groups. However, at a contrast of 11%, sensitivity was significantly lower monocularly in the multifocal group. Contrast sensitivity in this group was not significantly lower binocularly. The brightness acuity tester revealed no between-group difference in glare. With the Titmus stereotest, depth discrimination was significantly better with the multifocal IOL with distance correction. CONCLUSION: Bilateral implantation of a refractive multifocal IOL provided good binocular function and alleviated the well-known disadvantage of reduced contrast sensitivity at low contrast levels.

[Intraocular pressure regulation after combined glaucoma and cataract operation]. / Augendruckregulierung nach kombinierter Glaukom- und Katarakt-Operation.

BACKGROUND: The success rate of combined glaucoma and small incision cataract surgery is not yet established. PATIENTS AND METHODS: Therefore, 56 eyes of 52 patients (mean age 79.0 years) having trabeculectomy combined with phacoemul-sification and implantation of a silicone posterior chamber lens were retrospectively investigated. RESULTS: The mean follow-up was 21.6 weeks. Due to the combined surgery the mean intraocular pressure decreased significantly (p < 0.001) from 21.8 to 14.8 mmHg. Seventy-five percent of the patients did not need any antiglaucomatous medication, while 25% still had to use a local medication, but less frequently. The overall visual acuity increased significantly (p < 0.001) from a preoperative value of 0.24 to 0.52 postoperatively. CONCLUSIONS: The results of combined glaucoma and cataract surgery seem as good as those reported for two separate glaucoma and cataract procedures.

[Analysis of aqueous humor in intraocular toxoplasmosis]. / Kammerwasseranalytik bei intraokularer Toxoplasmose.

BACKGROUND: Despite many clinical examinations and laboratory tests, the cause of uveitis is very often not discovered. The examination of local intraocular antibody production is a valuable additional diagnostic means. PATIENTS AND METHODS: Aqueous humor was obtained from 46 eyes with severe uveitis: retinochorioiditis (n = 27), intermediate uveitis (n = 11), iridocyclitis (n = 5), and panuveitis (3). With the enzyme-linked immunosorbent assay (ELISA) the antibodies against Toxoplasma gondii were measured in aqueous humor and serum and the intraocular antibody production was calculated by the formation of an antibody index (AI). As the AI values are corrected for possible polyspecific immune response, the AI index is more sensitive than the Goldmann-Witmer index. RESULTS: An intraocular antibody synthesis against T. gondii could be confirmed in 20 eyes. The serum antibody concentration against T. gondii was in the reference range in 45 patients and only one patient had a very high increase of antibodies. In nine of 20 eyes, intraocular synthesis of antibodies against T. gondii was unexpected due to the lack of clinical evidence. CONCLUSIONS: The aqueous humor analysis is more reliable than the proof of serum antibodies, and it helps to increase the number of eyes with uveitis in which a specific therapy can be established.

[Targetted ablation of the trabecular meshwork with excimer laser in primary open-angle glaucoma]. / Punktuelle Ablation des Trabekelwerks mit dem Exzimerlaser beim primären Offenwinkelglaukom.

The trabecular meshwork and the inner wall of Schlemm's canal constitute 75% of the outflow resistance of the aqueous. Attempts to improve the outflow facility with laser beams have not been satisfactory because they produced thermal effects with coagulation of the trabecular meshwork. With the excimer laser tissue can be removed with minimal thermal effects and necrosis. This results in minimal scar formation. With these qualities the excimer laser lends itself very well for ablation of the trabecular meshwork. It should be possible to create an open connection between the anterior chamber and Schlemm's canal. The goal of our experiments is selected ablation of the trabecular meshwork and the inner wall of Schlemm's canal in order to create pores and enhance the outflow facility. First experiments were carried out on pig and cadaver eyes, followed by eyes destined for enucleation because of malignant melanomas. Finally, we treated 6 patients with open-angle glaucoma. In 4 cases intraocular pressure was reduced by 11 mmHg over a follow-up time of 5 months. In 2 cases IOP rose by 2 mmHg in spite of medication. These preliminary results encourage us to continue with our investigation because there could be a possibility of an effective glaucoma therapy.

[Cystoid macular edema and visual acuity with intracapsular cataract extraction and Choyce anterior chamber lens vs. extracapsular cataract extraction and posterior chamber lens in the partner eye]. / Zystoides Makulaödem und Sehschärfe bei ICCE und Choyce-VKL vs. ECCE und HKL am Partnerauge.

A prospective study was conducted on 65 patients who had a cataract operation. One eye had intracapsular cataract extraction (ICCE) with a Choyce-IX anterior chamber lens (ACL) and the fellow eye extracapsular cataract extraction (ECCE) with a posterior chamber lens (PCL). To evaluate the cystoid macular edema (CME), a fluorescence angiogram was recorded on the day of discharge and after 6 months. The severity of the CME was classified in three stages (degrees I-III). At discharge, no eye had CME grade III. CME grade I or grade II was seen in the ICCE group in 23% and in the ECCE group in 7.6%. After 6 months one eye of each group showed CME grade III (1.5%). CME grades I and II were seen after ICCE in 13.8% and 7.8% while the eyes with ECCE presented CME in 6.1% of grade I and of grade II, respectively. Visual acuity (VA) in the eyes with grades I and II CME was the same as in eyes without CME. The VA (median) of the ICCE group was 0.8 and of the ECCE 0.7. Because of infection of the capsular bag (toxic lens syndrome), in one case the PCL together with the capsular bag had to be explanted after 7 months. As for visual acuity and clinically significant CME (grade III), there was no statistical difference between ICCE plus Choyce-IX ACL eyes versus ECCE plus PCL eyes in the same patient.

[Comparison of complications after intra- and extracapsular cataract extraction with lens implantation. Results of a prospective, randomized, clinical study]. / Vergleich der Komplikationen nach intra- und extrakapsulärer Kataraktextraktion mit Linsenimplantation. Ergebnisse einer prospektiven, randomisierten, klinischen Studie.

BACKGROUND: The postoperative complications of ICCE with ACL implantation are compared with those of ECCE and PCL. Our clinical experience with ICCE and ACL implantation can not confirm the widespread rejection of this method. PATIENTS AND METHOD: A prospective, randomized, clinical study with participation of medical statisticians was performed. A total of 190 patients with ICCE and ACL and 170 patients with ECCE and PCL were followed up for 2 years. The follow-up examinations were performed upon dismission from the hospital, after 6, 12 and 24 months. The data were compiled in a computer program designed for this study and evaluated by the statisticians. The surgical procedures and the surgeons were defined prior to the beginning of patient recruitment. RESULTS: ICCE with ACL shows much less postoperative complications as usually emphasized. There were only 2 (1.2%) of retinal detachment and no case of corneal decompensation. Cystoid macular edema 8 (4.7%), postoperative vitreous prolaps into the anterior chamber 4 (2.3%) and spontaneous complaints of pain 16 (9.4%) occurred in a low percentage after ICCE with ACL. These complications did not occur after ECCE with PCL. The patients with ECCE and PCL showed capsular fibrosis in 48 (28%) making it the most frequent complication of the whole study. 33% of these patients required YAG-laser capsulotomy. Since retinal detachment occurs in 2.5% after YAG-laser capsulotomy we can not regard capsular fibrosis as a totally harmless complication. It is noteworthy that visual acuity is almost identical 1 year after surgery in both methods. CONCLUSIONS: The results of this study show that the evaluation of ICCE with ACL is too negative. The elimination of postoperative complications in this method is more difficult. ECCE with PCL is burdened by frequent capsular fibrosis. Visual acuity is almost the same in both methods 1 years after the operation. ACL-implantation remains our method of choice for secondary implantation in patients with an intact iris diaphragm.

[Retinal periphlebitis and multiple sclerosis. Incidence, cerebrospinal fluid and results of visual evoked potentials]. / Zur Periphlebitis retinae und multipler Sklerose. Häufigkeit, Liquor- und VEP-Befunde.

In a retrospective study 323 patients with multiple sclerosis were screened for the incidence of retinal periphlebitis. The results of lumbar puncture and the visual evoked potentials were related to the eye disease. Retinal periphlebitis was seen in 19 patients (5.9%). Of the patients with retinal periphlebitis, 79% developed the eye pathology within the first 10 years of multiple sclerosis. The cerebrospinal fluid and visual evoked potentials were no different than the results in a control group of multiple sclerosis patients without periphlebitis. Multiple sclerosis should always be considered as one of the potential underlying diseases in retinal periphlebitis since it is found in 30% before or at the same time as the first neurological symptoms of multiple sclerosis.

[Classification and importance of cystoid macular edema in pseudophakia]. / Zur Einteilung und Wertigkeit des zystoiden Makulaödems bei Pseudophakie.

In a prospective study the authors attempted to establish the incidence of cystoid macular edema (CME) in uncomplicated intracapsular cataract extraction with implantation of Choyce Mark IX lenses. Fluorescein angiography was performed after eight days, six weeks, six months, and at least one year post-operatively. Any edema found was classified as Grade I to III. Grade III CME was demonstrated in 4% of the cases studied after six weeks, though not after six months or one year, respectively. After one year, Grade II was found in 2% and Grade I in 15%, respectively. However, visual function was not impaired. At no time was there any correlation between the severity of the macular edema and visual acuity: all combinations are possible. Grade III CME evidently only impairs visual function if it persists for a prolonged period of time. Hyperfluorescence in the late phase of the angiogram permits the breakdown of the blood-aqueous barrier to be estimated semi-quantitatively.

[Prevention of cystoid macular edema with diclofenac eyedrops in intracapsular cataract extraction using the Choyce Mark IX anterior chamber lens]. / Prophylaxe des zystoiden Makulaödems mit Diclofenac-Augentropfen bei i.c. Kataraktextraktion mit Choyce-Mark-IX-Vorderkammerlinse.

Diclofenac is superior to other nonsteroid anti-inflammatory drugs (NAD) with respect to its antiphlogistic properties, as demonstrated in laboratory animal experiments. The antiphlogistic action of diclofenac eyedrops versus placebo eyedrops in the prophylaxis of cystoid macular edema (CME) and postoperative inflammatory symptoms was therefore tested in a prospective randomized double-blind study. A total of 179 patients with intracapsular cataract operations and Choyce Mark IX anterior chamber lens implantation received 2 drops 5 times preoperatively and 1 drop 5 times postoperatively until they were discharged, and then subsequently for 6 months they used 1 drop of diclofenac or placebo eyedrops 3 times. To evaluate the CME, fluorescence angiography was carried out on all patients on the day of discharge, 6 weeks later, and after 6 months following the operation. The patients who completed the study according to plan numbered 112. With diclofenac eyedrops, significantly less CME occurred in comparison with treatment with placebo eyedrops (p = 0.03). Visual acuity improved faster and the postoperative inflammatory symptoms receded more quickly in the diclofenac group.

[Incidence of cystoid macular edema following cataract extraction]. / Zur Häufigkeit des cystoiden Maculaödems nach Cataract-Extraktion.

In a prospective study we research the incidence of cystoid macular edema following intracapsular cataract extraction with the Choyce-Mark-IX implantation method. The only eyes included in the study were those for which the operation had been uncomplicated. Fluorescence angiography was performed after 8 days, 6 weeks, 6 months and 1 year. The edema was graded accordingly: grades I-III. Cystoid macular edema of grade III was demonstrated in 4% after 6 weeks but not after 6 months and 1 year. After 1 year, grade II occurred in 2% and grade I in 15%, respectively. Visual acuity, however, was not impaired.

Trimethoprim-polymyxin B sulphate ophthalmic ointment in the treatment of bacterial conjunctivitis: a double-blind study versus chloramphenicol ophthalmic ointment.

Forty-two patients with a clinical diagnosis of bacterial conjunctivitis were enrolled in a randomized, double-blind trial. Patients were treated with either trimethoprim-polymyxin B sulphate or chloramphenicol ophthalmic ointments 4-times a day for 7 days. Analysis of clinical evaluation data showed that both treatments were effective and well tolerated, and that there were no statistically significant differences between them with regard to eradication of organisms or clinical improvement.

[Acyclovir versus trifluorothymidine in the therapy of stromal herpes keratitis]. / Acyclovir versus Trifluorthymidin in der Therapie der stromalen Herpes-Keratitis.

A randomized prospective double-blind trial with topical acyclovir (ACV) versus trifluorothymidine (TFT) was performed in the treatment of stromal keratitis. Resolution occurred in only one case (ACV). In all other cases the disease progressed, so that antiviral therapy was discontinued.