[Minimally invasive glaucoma surgery-Comparison of angle based procedures]. / "Minimally invasive glaucoma surgery" ­ Kammerwinkelbasierte Verfahren im Vergleich.

Surgical procedures are playing an increasing role in the care of patients with glaucoma. Within the last decade, new surgical procedures have been established, which are summarized under the term minimally invasive glaucoma surgery (MIGS). A wide variety of different procedures are aimed at the structures in the angle of the anterior chamber, such as the trabecular meshwork and Schlemm's canal, to improve the physiological outflow or to improve the alternative uveoscleral outflow. The implementation of the treatment goal differs in the individual procedures, as does the maximum pressure reduction that can be achieved. Compared to trabeculectomy with the use of cytostatic agents, the achievable pressure reduction is usually significantly lower. In contrast, the significantly lower intraoperative and postoperative complication rates are emphasized as an advantage of these procedures. With increasing clinical experience and the growth of sufficient data on these new surgical procedures, a well-founded classification in the treatment algorithm of glaucoma surgery becomes easier; nevertheless, due to the small differences with respect to efficacy and safety profile, the final decision for an individual procedure often remains dependent on the surgeon's personal preferences.

Ten-Year Outcome of Glaucoma Drainage Device Surgery After Penetrating Keratoplasty.

PRECIS: In eyes with intractable glaucoma, drainage devices provide long-term control of intraocular pressure also after penetrating keratoplasty (PK). There is a high incidence of corneal graft failure. PURPOSE: To compare very long-term results of eyes with glaucoma drainage device (GDD) after PK. METHODS: We retrospectively reviewed medical records of all patients who underwent GDD placement after PK at our institution between 2001 and 2017. Forty eyes of 40 patients were studied. Glaucoma outcome was assessed by postoperative intraocular pressure (IOP), number of medications, and need for further glaucoma surgery. Corneal outcome was assessed by graft rejection, failure, and visual acuity. Surgical procedures before and during the study period, and their complications were evaluated. RESULTS: The mean follow-up was 125.0±52.3 (median, 116.5) months. Twenty of 40 eyes had a follow-up of at least 10 years. The mean preoperative IOP was 34.0±8.3 (median, 32.0) mm Hg with 3.2±1.3 (median, 3.5) glaucoma medications. At last postoperative follow-up, the mean IOP decreased to 12.7±4.9 (median, 14.0) mm Hg with 1.0±1.2 (median, 0.0) glaucoma medications. GDD implantation successfully controlled glaucoma in 88%, 88%, 85%, 80%, 78%, 75%, and 70% of eyes, at 1, 2, 3, 4, 5, 7, and 10 years, respectively. At last follow-up 68% showed glaucoma success. The corneal grafts remained clear in 74%, 63%, 45%, 45%, 37%, 32%, and 26% of eyes at 1, 2, 3, 4, 5, 7, and 10 years, respectively. Only 7 corneal grafts (17.5%) remained clear at last follow-up. CONCLUSIONS: A GDD can successfully control intractable glaucoma even after a very long period of time also after PK. However, the survival of the corneal grafts is low.

[New intraocular lens designs for femtosecond laser-assisted cataract operations : Chances and benefits]. / Neue Intraokularlinsendesigns für die Femtosekundenlaser-assistierte Kataraktoperation : Chancen und Nutzen.

BACKGROUND: The perfection and high reproducibility of capsulotomy in femtosecond laser-assisted cataract surgery (FLACS) lead to the possibility of new intraocular lens (IOL) designs for capsulotomy fixed implantation. ISSUE: Which different designs have so far been presented for which problems in capsulotomy fixation? MATERIAL AND METHOD: An evaluation of the literature and conference data was carried out. RESULTS: Currently four different types of femtolenses for capsulotomy fixation are described in the literature or are commercially available. The first described was the lens in the bag or Tassignon IOL, which was developed for secondary cataract prevention, the second was the Masket IOL for reduction of negative dysphotopsia and third the 90F designed by Dick. All three types are or will be produced by Morcher. The fourth lens is the Femtis from Oculentis. All lenses are characterized by a high level of safety during implantation, The Tassignon lens leads to reduction of secondary cataract, especially in juvenile cataract because of the additional posterior capsulotomy. In studies the Masket IOL could show a decrease of negative dysphotopsia. In comparison to standard lenses, the 90F and Femtis in particular showed better results with respect to tilt, rotation and decentration. CONCLUSION: The new IOL designs for capsulotomy fixation show a safe implantation procedure and indications for a very stable position in the capsular sac. Further studies must be carried out to confirm the possible advantages in comparison to standard IOL with respect to postoperative results for refraction, tilt, rotation and decentration and possible induction of aberrations.

[Secondary Neuroprotection in Glaucoma from Change in Lifestyle]. / Sekundäre Neuroprotektion beim Glaukom durch Lebensstiländerungen.

Glaucoma therapy usually includes lowering IOP, but a healthy lifestyle may also be recommended. We discuss how this can be defined and the underlying secondary neuroprotective mechanisms. One neuroprotective measure is to avoid common neurotoxic pollution like cigarette smoking, ethanol, methanol or lead. Nutrition should be rich in variety and prevent vitamin B12 and folate deficiency. Supernutrition may lead to the metabolic syndrome and increase IOP, arterial hypertension and serum steroid levels. The metabolic syndrome can also lead to decreased renal function, which can cause accumulation of neurotoxic substances in the blood. Enhanced physical activities is useful, as this burns calories and reduces caloric intake. In contrast to supernutrition, during starvation ketone bodies like acetone, acetoacetate and ß-hydroxybutyrate are synthesised. These are thought to have neuroprotective effects, due to the additional power supply to the mitochondria. Ketosis can also occur after increased intake of fatty acids - which is generally not recommended, due to the cardiovascular risks involved. In addition to burning calories, endurance sports can reduce fear and depression, and neurotrophins with neuroprotective effects are released. Genetically determined or acquired mitochondrial dysfunction can both play a role in glaucomatous optic nerve impairment. Therefore, knowledge of secondary neuroprotective mechanisms can help in giving patient professional advice to minimise risks and to restore homeostasis in optic nerve metabolism.

Ocular Trauma Score as prognostic value in traumatic ocular injuries due to rotating wire brushes.

PURPOSE: Rotating wire brushes are used, e.g., for rust removal. Detaching fragments can cause severe eye injuries. The purpose of this study was to investigate mechanism, severity, clinical outcome, validity of Ocular Trauma Score (OTS) and to assess the likelihood of final visual acuity. METHODS: Twenty patients with traumatic ocular injuries by rotating wire brushes were included. Location and type of injury, grade of injury according to OTS, surgical procedure, and development of visual acuity were evaluated. RESULTS: Eleven accidents (55%) happened at work, nine at home (45%). Eighteen injuries (90%) were penetrating, one (5%) was perforating. In one case (5%), an intraocular foreign body was present. One case each was classified OTS 1 and 2 (5%), six cases OTS 3 (30%), four cases OTS 4 (20%), and eight cases OTS 5 (40%). None of the patients was wearing safety goggles. Fourteen patients (70%) were surgically treated. Of these, five were treated at the anterior segment only, nine additionally underwent pars-plana vitrectomy. Nine patients received phacoemulsification. Mean best corrected visual acuity was logMAR 1.0 (2/20) at admission and 0.3 (10/20) at last follow-up. Our results were similar to those in the OTS study, except for OTS 1 (p = 0.046). Comparing the categorical distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.119) between our results and the OTS study group. CONCLUSIONS: OTS may provide prognostic information in traumatic ocular injuries by rotating wire brushes. The injuries could have been avoided by wearing safety goggles.

Epiretinal membrane as a source of errors during the measurement of peripapillary nerve fibre thickness using spectral-domain optical coherence tomography (SD-OCT).

PURPOSE: We aimed to examine the extent to which measurement errors in the determination of retinal nerve fibre layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) occur in cases of epiretinal membrane and whether systematic deviations are found in the values obtained. METHODS: A macular scan and a circumpapillary scan were performed on 97 eyes of 97 patients using SD-OCT. Group 1 comprised 53 patients with epiretinal membrane at an age of 70 ± 4.8 years (median ± average absolute deviation). Group 2 consisted of 44 patients without any macular pathologies (median age 70 ± 5.8 years). Differences in the thickness of the RNFL and segmentation errors in the detection of the RNFL were recorded quantitatively in both groups and checked for statistical significance using non-parametric tests. RESULTS: The median central retinal thickness in Group 1 was 357 ± 79 µm (median ± average absolute deviation), and in Group 2 it was 270 ± 11 µm (p < 0.001). The result of the quadrant-by-quadrant measurement of the average RNFL in Group 1 and Group 2, respectively, was: temporal 88 ± 17 and 73 ± 9 µm, inferior 121 ± 17 and 118 ± 15 µm, nasal 87 ± 15 and 89 ± 14 µm and superior 115 ± 15 and 114 ± 9 µm. Temporally, the difference was statistically significant (p < 0.001). Segmentation errors of the RNFL were found in 19 of 53 eyes (35.8 %) in Group 1 and in no eyes (p < 0.001) in Group 2. CONCLUSIONS: In eyes with epiretinal membrane, measuring errors in the SD-OCT occur significantly more frequently than in eyes without any retinal pathologies. If epiretinal membrane and glaucoma are present simultaneously, the results of the automated RNFL measurement using SD-OCT should be critically scrutinised, even if no papillary changes are visible clinically.

Laser suture lysis after trabeculectomy with mitomycin C: analysis of suture selection.

OBJECTIVE: This paper analyses to what extent positioning and timing influences the degree of intraocular pressure (IOP) reduction by laser suture lysis (LSL) after trabeculectomy with mitomycin C. METHODS: The IOP reduction following LSL was assessed in a consecutive case series of 168 eyes (120 patients) after trabeculectomy with mitomycin C. Scleral flap sutures of 3.3±0.6 were placed on average. The IOP reduction was assessed in terms of suture positioning and the time of LSL. RESULTS: LSL was performed early (<7 d) on 48 of 168 eyes (29%). The mean IOP before trabeculectomy was 22.1±5.9 and 20.3±6.2 mm Hg on the first postoperative day. LSL additionally reduced the IOP by 6.3±6.9 mm Hg. LSL was performed late (>7 d) on 27 of 168 eyes (16%). The mean preoperative IOP was 20.7±6.0 mm Hg, 12.1±7.8 mm Hg on the first postoperative day, and increased again to 21.7±4.5 mm Hg by the time of LSL. The IOP reduction achieved by LSL was 7.0±5.1 mm Hg. In a subgroup of 54 eyes with 3 scleral flap sutures, there was no significant difference in IOP reduction in a comparison of corner and central sutures (P=0.4). The reduction of IOP after LSL was not significantly correlated with the number of respectively remaining scleral flap sutures (P=0.17). There was no correlation between the time of LSL and IOP reduction (P=0.96). CONCLUSION: The reduction of IOP after LSL is not related to suture selection or the number of remaining scleral flap sutures.

Comparison of the influence of aerobic and resistance exercise of the upper and lower limb on intraocular pressure.

PURPOSE: To compare the influence of aerobic and resistance exercise on intraocular pressure (IOP). METHODS: Twenty-one healthy subjects participated. Aerobic exercise was performed using a cycle ergometer, and resistance exercise was performed with a leg curl and a butterfly machine. Intraocular pressure was measured at baseline, during exercise and 10 min after. During resistance exercise, a Valsalva manoeuvre was prevented. RESULTS: Before aerobic exercise, the mean IOP was 18.8±2.7 mmHg. It was 16.5±2.8 after 10, 17.1±2.6 after 20 and 16.7±3.3 mmHg after 30 min of exercise. After 10 min, the IOP returned to baseline (18.8 ±2.7 mmHg). The mean IOP before resistance exercise with the leg curl machine was 17.0 (15.6-18.4; 65%Wmax ) and 16.8 (15.3-18.3) mmHg; 75%Wmax ) and did not change significantly during the experiment. The mean IOP before resistance exercise with the butterfly machine (65%Wmax ) was 16.4 (15.2-17.6) and increased to 17.2 (16.0-18.4) mmHg (p<0.05). After 10 min of recreation, it recovered to 16.3 (15.0-17.5) mmHg. At 75%Wmax , the mean baseline IOP was 16.3 (15.2-17.4) mmHg, and there were no significant changes. CONCLUSIONS: Aerobic exercise leads to a significant decrease of IOP. There was no influence of resistance exercise on IOP as long as a Valsalva manoeuvre was prevented.

Rock 'n' roll phacoemulsification technique: noncracking and nonchopping approach.

The rock 'n' roll phaco technique we describe does not require nucleus chopping or cracking. In this easy-to-learn technique, the lens nucleus is fragmented from both sides, which seems to be an advantage in very soft nuclei.

Age-corrected reference values for the Heidelberg multi-color anomaloscope.

BACKGROUND: To determine reference values for the HMC anomaloscope (Heidelberg multi-color anomaloscope) of healthy subjects. METHODS: One hundred and thirteen healthy subjects were divided into four age groups: <20 years of age (ten female, five male), 20-39 years of age (23 female, 15 male), 40-59 years of age (23 female, ten male) and >60 years of age (nine female, 18 male). Match midpoint, matching range (MR) and anomaly quotient (AQ), according to the Moreland equation [blue (436 nm) + blue-green (490 nm) = cyan (480 nm) + yellow (589 nm)] and according to the Rayleigh equation [green (546 nm) + red (671 nm) = yellow (589 nm)] were determined. The neutral adaptation was done showing white light every 5 seconds in absolute mode and every 15 seconds in relative mode. RESULTS: The mean match midpoint according to the Rayleigh equation was 43.9 ± 2.6 scale units in absolute mode. It was highest between 20-39 years (45.2 ± 2.2) and lowest in subjects >60 years of age (42.2 ± 2.2). The mean MR in absolute mode was 3.1 ± 3.5 scale units with a maximum >60 years (4.4 ± 4.4). The MR in relative mode was between 1.6 ± 1.9 (20-39 years) and 4.4 ± 3.8 (>60 years). The resulting mean AQ was 1.01 ± 0.15 in both modes. The mean match midpoint of the Moreland equation was 51.0 ± 5.2 scale units in absolute mode. It was highest between 20-39 years (52.5 ± 5.7), and lowest in subjects >60 years of age (48.7 ± 3.6). The mean MR according to the Moreland equation was lower in absolute mode (13.4 ± 15.6) than in relative mode (16.2 ± 15.2). The mean resulting AQ was 1.02 ± 0.21 in both modes. CONCLUSION: The values of this study can be used as references for the diagnosis of red-green and blue perception impairment with the HMC anomaloscope.

Multilayered Gore-Tex patch for temporary coverage of deep noninfectious corneal defects: surgical procedure and clinical experience.

PURPOSE: To evaluate the multilayer Gore-Tex patch as temporary coverage of deep, noninfectious corneal defects. DESIGN: Retrospective, interventional case series. SETTING: University Medical Center Schleswig-Holstein, Kiel, Germany. PATIENT POPULATION: Thirty-nine eyes of 38 patients with noninfectious, deep corneal defects. Underlying disorders included neurotrophic or immunologic ulcers in 37 eyes (94.9%) and traumatic defects in 2 eyes (5.1%). Intervention procedures: Corneal defects were covered with multiple Gore-Tex layers, of which the uppermost was sutured to the cornea. The Gore-Tex patch was kept in place until an appropriate corneal transplant was obtained and effective systemic immunosuppression was initiated. MAIN OUTCOME MEASURES: Long-term preservation of the eye, frequency of resuturing of the Gore-Tex patch, and best-corrected visual acuity. RESULTS: In 38 cases, the eye could be preserved. In 10 eyes, additional sutures were required. Before surgery, the mean best-corrected visual acuity (logMAR) was 1.14 ± 0.45 (20/250), and that at final follow-up was 1.13 ± 0.41 (20/250). The Gore-Tex patch remained in place 4 days to 32 months (mean, 6.4 ± 8.3 months) until corneal transplantation (27 eyes) or until an alternative way of defect coverage could be performed. Three eyes did not require further coverage after explantation of the Gore-Tex patch. In 6 eyes, either the Gore-Tex patch was kept in place or the patients died. CONCLUSIONS: Temporary coverage of deep corneal defects with multilayer Gore-Tex patches allows time until an appropriate corneal transplant is obtained. The technique is particularly useful in patients with underlying autoimmune disorders, because an effective systemic immunosuppression can be initiated before corneal transplantation.

Influence of alcohol consumption on incidence and severity of open-globe eye injuries in adults.

AIM: To investigate the influence of alcohol consumption on the occurrence of open-globe injuries in adults. METHODS: A retrospective study was made of 100 consecutive patients (81 male, 19 female) with open-globe injuries. Of these patients, 18 exhibited alcohol intoxication (group Ai), and 82 exhibited no alcohol intoxication (group nAi). Investigated parameters were best-corrected visual acuity at day of admission and last examination (logMAR), type of injury according to BETT-classification, extraocular injuries, cause of injury, time and setting of injury, in relation to alcohol consumption and tested for statistical significance with Fisher's exact test or the Mann-Whitney U test, respectively. RESULTS: In group Ai, 83.3% of the patients were male, and in group nAi, 80.5%. Mean logMAR at day of admission was 1.06 ± 0.63 (20/250) in group Ai and 1.08 ± 0.59 (20/250) in group nAi. At last examination, mean logMAR in group Ai was 1.11 ± 0.59 (20/250), in group nAi 0.75 ± 0.60 (20/125). This difference was statistically significant (p = 0.02). In group Ai, significantly more ruptures according to BETT classification occurred (p = 0.05). In group Ai, significantly more additional extraocular injuries occurred compared to group nAi (38.9% versus 6.1%; p = 0.0009). In group Ai, the cause of injury was significantly more often glass (44.4% versus 2.4%; p = 0.0000), in group nAi the injury was more often directly or indirectly caused by tools (74.4% versus 33.3%; p = 0.001). In group Ai, the injury was significantly more often inflicted by others (50.0% versus 9.8%; p = 0.0003). The settings in which the injuries occurred were significantly more often the street in group Ai (44.4% versus 6.1%; p = 0.0002), in group nAi the garden or tool shed (31.7% versus 5.6%; p = 0.02) or the workplace (34.2 % versus 11.1 %; p = 0.04). In group Ai, the injuries occurred significantly more often at night (p = 0.0001) and on weekends (p = 0.0000). CONCLUSIONS: Open-globe eye injuries under alcohol intoxication are more often caused by a third party and have a worse prognosis. Open-globe injuries under alcohol intoxication occur in a different spatio-temporal setting and exhibit a more severe type of injury. Risk behavior combined with alcohol consumption therefore seems to be an independent factor for the incidence of open-globe eye injuries.

Anterior chamber depth and iridocorneal angle in healthy White subjects: effects of age, gender and refraction.

PURPOSE: Prior to phakic intraocular lens implantation, it is important to obtain precise knowledge of the anterior chamber depth (ACD). Accurate topographic evaluation of the iridocorneal angle is helpful in estimating risk for angle-closure glaucoma. This study investigated the use of the Orbscan II system to measure ACD and the iridocorneal angle in healthy subjects and assessed the influences of age, gender and spherical equivalent on these parameters. METHODS: The Orbscan II system was used to determine the ACD and iridocorneal angle in eight different positions in 390 healthy White subjects with a mean age of 41± 16years (range 10-80 years). The sample included 242 male and 148 female subjects. The influences of age, gender and spherical equivalent were assessed using multiple regression analysis. RESULTS: Mean ACD was 2.87 ± 0.04 mm in male subjects and 2.81±0.37mm in female subjects. The explanatory variables relevant to the ACD were age (partial regression coefficient B = -0.0115, p < 0.0001), spherical equivalent (B = - 0.0562, p< 0.0001) and gender (B = 0.0996, p=0.0036). The mean iridocorneal angle (MIA) was 30.7 ± 2.0 ° in male and 31.6 ± 2.1° in female subjects. The variables relevant to the MIA were gender (B =- 0.865, p < 0.0001), age (B =- 0.017, p = 0.0007) and spherical equivalent (B = - 0.121, p = 0.001). The superior iridocorneal angle displayed the strongest negative correlation with age, whereas the temporal angle exhibited the least correlation with age. CONCLUSIONS: The decline in ACD appears to be linear with age, amounting to a mean of 0.58 mm over 50 years. This may become clinically relevant in the use of phakic intraocular lenses. In addition, the angle is more severely constricted in the superior quadrant than in the temporal quadrant.

Characterization of the thinnest point of the cornea compared with the central corneal thickness in normal subjects.

INTRODUCTION: For ongoing progress in refractive surgery, exact knowledge about the anatomical properties of the cornea is useful. Thus, the aim of the study was to characterize the thinnest point of the cornea compared with the central corneal thickness in normal subjects and to investigate with regard to influencing factors such as sex, age, refraction, and intraocular pressure. MATERIALS AND METHODS: The central corneal thickness and the thinnest point of the cornea were determined with the Orbscan II in 390 white normal subjects. Difference between the 2 eyes, influence of sex, and measuring repetition accuracy were tested for statistical significance with t tests, and the influence of age was tested with nonparametrical test methods. RESULTS: In the right eyes, the mean central corneal thickness was 548 +/- 37 microm and the thinnest point 537 +/- 37 microm. In the left eyes, the mean central corneal thickness was 547 +/- 37 microm and the thinnest point 535 +/- 39 microm. The difference between the central corneal thickness and the thinnest point was found to be significant in both eyes in paired t test (P > 0.001). No influence of sex, refraction, and intraocular pressure on the thickness of the thinnest point of the cornea could be observed. The difference between central corneal thickness and thickness at the thinnest point was not subject to a statistically significant influence of age. CONCLUSIONS: In the calculation of the residual corneal layer thickness in laser refractive surgery, the thinnest point of the cornea should form the basis.

Photodynamic therapy with intravitreal application of triamcinolone acetonide in age-related macular degeneration: functional results in 54 patients.

PURPOSE: This study aimed to investigate the functional results, efficacy and complications after photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide injection (IVTA) in patients with choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). METHODS: A retrospective analysis of clinical data for 54 patients with CNV resulting from AMD was carried out. All patients had a follow-up of 12 months. The patients were treated with standardized PDT and IVTA (4 mg) as a first-line treatment or following PDT failure. Visual acuity (VA), greatest linear diameter (GLD) of the CNV and foveal thickness were evaluated. RESULTS: Mean VA at baseline was 0.8 logMAR (0.4-1.4). After 12 months VA improved (> 2 lines) in 20.4% of patients and stabilized (+/- 2 lines) in 64.8%. There was no statistical significance in VA outcome between patients undergoing first-line treatment and patients with PDT failure; however, fewer PDT treatments were required to stop CNV activity in patients undergoing first-line treatment. At 12 months, a reduction in foveal thickness was seen in 67.7% of patients and a reduction in CNV GLD in 32.7%. Complications occurred in 22% of patients and included a transient rise in intraocular pressure, cataract and sterile hypopyon. CONCLUSIONS: Our analysis shows that fewer PDT treatments were required to stop CNV activity when triamcinolone was used as first-line treatment. We can thus conclude that PDT combines synergistically with IVTA and the combination may lead to a cost reduction compared with PDT therapy alone. The overall complication rate of 22% is high and must be compared with complication rates caused by new intravitreal anti-VEGF (vascular endothelial growth factor) drugs in combination with PDT.

Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty.

BACKGROUND: For aphakic patients without lens-supporting apparatus, secondary lens implantation can be considered. Literature on retropupillar iris claw lens implantation as a safe alternative to scleral fixated posterior chamber lenses is scarce. METHODS: The study included 22 patients. In ten cases, an iris claw lens was implanted retropupillary without penetrating keratoplasty (group 1), in 12 patients the implantation of a retropupillar iris claw lens was combined with penetrating keratoplasty (group 2). Complications observed were retrospectively evaluated. Previous operations and accompanying diseases were compiled. Reasons for aphakia in group 1/group 2 included perioperative complications (60%/75%) and primary ocular trauma (40%/25%). Unless already performed in an earlier operation, anterior or complete vitrectomy was performed in both groups. RESULTS: Perioperative complications (within 1 week postoperatively) in group 1 included ocular hypotony in 20%, choroidal detachment in 10%, vitreous haemorrhage in 10% and intraocular lens (IOL) decentration in 10% of the cases; in group 2, transient intraocular pressure elevation in 8% of the cases. Postoperative complications (after the first postoperative week) in group 1 were lens tilt in 10%, lens luxation in 10%, cellular deposits (assumed to be macrophages) on lens surface in 10%, cornea guttata in 10% and epiretinal gliosis in 10% of the cases; in group 2, secondary glaucoma in 33%, iris defect in 8% and corneal ulcer in 8% of the cases. CONCLUSIONS: Retropupillar iris claw lenses are an alternative to scleral fixated secondary lenses, which are worth considering for aphakic patients without lens supporting apparatus. This approach appears to be recommendable even in cases requiring penetrating keratoplasty, and can be performed as a combined procedure. In these patients, the most frequent complication following iris claw lens implantation seems to be secondary glaucoma.

Age-related changes in central and peripheral corneal thickness: determination of normal values with the Orbscan II topography system.

PURPOSE: The thickness of corneal tissue is an important parameter in refractive surgery, Goldmann applanation tonometry, and corneal diseases. The purpose of the study was to record system-specific normal values with the Orbscan II system and to investigate the influence of sex and age on central and peripheral corneal thickness to characterize more precisely the anatomy of the cornea. METHODS: The Orbscan II topography system is a computer-assisted slit-beam scanning technology that can map the anterior section of the eye. It was used to take 2 measurements at 10-minute intervals on 777 eyes of 390 normal white subjects ranging in age between 10 and 80 years. Two hundred forty-two participants were men and 148 were women. The central corneal thickness and the nasal, superior, inferior, and temporal peripheral corneal thickness at a distance of 3 mm from the center were analyzed. No correction factor was used. Using nonparametric test methods, we carried out a statistical analysis of the parameters of sex and age. RESULTS: The mean central corneal thickness of all 777 eyes was 595 +/- 41 microm. No sex-specific central difference was identifiable (P = 0.33), there was no significant difference between the sides (P = 0.23), and no significant difference was found between the first and second measurement. The group of 10- to 39-year-olds had a mean central corneal thickness of 591 +/- 41 microm, whereas that of 40- to 80-year-olds was 600 +/- 39 microm, which was a significant difference (P = 0.03). The mean peripheral corneal thickness was 689 +/- 46 microm nasally, 688 +/- 42 microm superiorly, 667 +/- 40 microm inferiorly, and 655 +/- 42 microm temporally. Nasally and superiorly, we found a significant negative correlation with age (Spearman rank correlation, P = 0.02). CONCLUSIONS: The normal values presented here are a suitable reference basis for future studies in whites. Peripheral corneal thickness is asymmetric and seems to undergo age-related anatomic changes. This information should be considered when planning penetrating keratoplasty and refractive surgery.