[Laser in situ keratomileusis for correction of hyperopia and hyperopic astigmatism using a scanning spot excimer laser. Results of a prospective clinical study after 1 year]. / Laser-in-situ-Keratomileusis zur Korrektur von Hyperopie und hyperopem Astigmatismus mit Scanning-Spot-Excimer-Laser. Einjahresergebnisse einer prospektiven klinischen Studie.

PURPOSE: The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications of LASIK for the treatment of hyperopia and hyperopic astigmatism using a scanning spot excimer laser. PATIENTS AND METHODS: A total of 64 consecutive LASIK operations (37 patients, mean age 41 years, range 22-68 years) have been evaluated. The Hansatome microkeratome producing a superior hinge (flap diameter 9.5 mm) and a scanning spot excimer laser with an optical zone of 6.0 mm were used. Examinations were performed preoperatively, after 1 day, 7 days, 1 month, 4 and 12 months. RESULTS: One year after the primary procedure only 1 eye lost 2 or more lines of best-corrected visual acuity, 91% were within +/-1 line and 4 eyes gained 2 lines. Of these eyes 50 (86%) reached an uncorrected visual acuity of > or=0.5, 32 (55%) > or=0.8, 16 (28%) > or=1.0, 24 eyes (41%) needed a refractive correction of +/-0.5 D, 44 eyes (76%) of +/-1.0 D and 55 eyes (95%) of +/-2.0 D. The mean spherical equivalent after 1 year was +0.17+/-0.85 D. CONCLUSIONS: LASIK is suitable for the correction of hyperopia (up to a maximum of +5 D) and for hyperopic astigmatism (up to a maximum of -5 D). However, results were better in lower hyperopia (up to +3 D) than in the moderate hyperopia. The refractive results showed overall a good stability during the 12-month study period, but higher regression occurred in a few cases.

[LASIK with a superior hinge and scanning spot excimer laser ablation for correction of myopia and myopic astigmatism. Results of a prospective study on 100 eyes with a 1-year follow-up]. / LASIK mit superiorem Hinge und Scanning-Spot-Excimerlaserablation zur Korrektur von Myopie und myopem Astigmatismus. Einjahresergebnisse einer prospektiven klinischen Studie an 100 Augen.

PURPOSE: Recently laser-in-situ-keratomileusis (LASIK) has been increasingly used to correct refractive errors. The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications using the scanning spot excimer LASIK technology. PATIENTS AND METHODS: The results of 100 consecutive LASIK operations carried out between 2/1998 and 2/1999 on 60 patients (mean age 37 years, range 20-55 years) have been evaluated. The Hansatome microkeratome with a superior hinge (flap diameter: 9.5 mm) and a scanning spot excimer laser (Technolas C-Lasik 217) were used in all cases. The mean spherical equivalent of the subjective manifest refraction was -6.96 +/- 2.87 diopters (D), the mean sphere was -6.47 +/- 2.71 D and the mean astigmatism was -0.98 +/- 0.94 D. In 6% of the eyes preoperative visual acuity was not better than 20/40. Examinations were performed preoperatively, after 1 and 7 days, after 1,4 and 12 months. Safety, efficacy, predictability, stability and complications were calculated using the datagraph software (version 1.11). RESULTS: All 100 eyes were examined after 1 day and 1 week, 96 after 1 month, 95 after 4 months and 92 after 1 year. Following 1 year none of the eyes lost 2 or more lines of best corrected visual acuity, 99% were within +/- 1 line and 1% gained 2 lines (safety index 1.03). In 92% of all eyes an uncorrected visual acuity of > or = 0.5 was reached, in 77% > or = 0.8 and in 51% > or = 1.0 (efficacy index 0.89). For 60 eyes (65.21%) a refractive correction of +/- 0.5 D was necessary, for 82 eyes (89.13%) +/- 1.0 D and for 91 eyes (98.91%) +/- 2.0 D. The mean spherical equivalent after 1 year was -0.15 +/- 1.31 D. Between 1 and 12 months a mean regression of -0.14 D occurred. On the request of the patients, 5 eyes were retreated during the study period for under- or over-correction. Complications due to the microkeratome did not occur. Corneal infections were not observed, a diffuse lamellar keratitis (DLK) was seen in 12 cases, but all cases healed with no loss of visual acuity. In 7 eyes a slight decentration of the ablation was observed using corneal topography, which in one case caused an increase in glare sensitivity. CONCLUSIONS: LASIK with superior hinge and scanning spot excimer photoablation is suitable for the correction of myopia (up to a maximum of -12 D) and for myopic astigmatism (up to a maximum of -5 D). The refractive results showed a high stability during the 12-month study period but there is still room for improvement of the predictability.

[Photorefractive/photo-astigmatic refractive keratectomy in low myopia and myopic astigmatism. Broad beam versus scanning spot laser technology]. / Photorefraktive/photoastigmatisch-refraktive Keratektomie bei niedriger Myopie und myopem Astigmatismus. Broad-beam versus Scanning-spot-Lasertechnologie.

PURPOSE: The results of photorefractive/photoastigmatic refractive keratectomy (PRK/PARK) were compared between two patient groups treated consecutively with either broad-beam or scanning-spot technology. PATIENTS AND METHODS: PRK/PARK was performed with a broad-beam excimer laser VISX 20/20 in 46 eyes and with the scanning-spot laser system Keracor 217 in 49 eyes. Preoperative spherical equivalent (subjective manifest refraction) was < or =-6.0 diopter in both groups. Safety, efficacy, predictability, stability, and complications were investigated after 1,4 and 12, months postoperatively. RESULTS: In the broad-beam laser group no eye lost two or more lines of best-corrected visual acuity;in the scanning-spot laser group one eye lost two lines 12 months postoperatively. Efficacy, predictability, and stability were comparable between the two groups. CONCLUSIONS: Both the broad-beam and the scanning-spot laser provided good results after PRK/PARK for low myopia and myopic astigmatism. This study found no fundamental differences between the two laser systems.

[Intra-individual comparison of intraocular lenses of highly refractive silicone (Allergan SI40NB) and hydrophobic acrylate (Alcon Acrysof MA60BM). 1-year follow-up]. / Intraindividueller Vergleich von Intraokularlinsen aus hochrefraktivem Silikon (Allergan SI40NB) und hydrophobem Acrylat (Alcon Acrysof MA60BM). 1-Jahresergebnisse.

BACKGROUND: A prospective, randomized study was performed to evaluate intra-individually the biocompatibility of foldable, highly refractive silicone and hydrophobic acrylic intraocular lenses (IOL). MATERIALS AND METHODS: We studied 35 patients who underwent phacoemulsification using a self-sealing tunnel incision. In a randomized fashion one eye received a 6-mm optic IOL made of high-refractive index silicone (Allergan SI40NB) and the other eye a hydrophobic acrylic 6-mm optic IOL (Alcon AcrySof MA60BM). All patients were examined 7 days, 1-3 and 6 months, and 1 year postoperatively. RESULTS: The mean best-corrected visual acuity (BCVA) was 0.9 +/- 0.12 vs. 0.89 +/- 0.13 (SI40NB vs. MA60BM) after 1-3 months. One-year postoperatively BCVA was still 0.9 +/- 0.12 vs. 0.87 +/- 0.14. The flare values (photon counts/ms) increased slightly 7 days after surgery (14.2 +/- 8.68 vs. 15.49 +/- 7.2, n.s.). Three months after surgery these values were again in the normal range. The mean IOL decentration was 0.29 +/- 0.14 vs. 0.3 +/- 0.15 mm 1 year postoperatively. Scheimpflug slit photography showed 40% of MA60BM IOLs to have "glistenings." No significant difference regarding posterior capsular opacification was found. CONCLUSION: One year after implantation of foldable, highly refractive silicone and hydrophobic acrylic IOLs using a self-sealing tunnel incision and phacoemulsification, no significant functional or morphological differences between the two IOL types were observed.

[Photoastigmatic refractive keratectomy for low, moderate, and high astigmatism using a broad beam excimer laser: evaluataion according to new international criteria]. / Photoastigmatische refraktive Keratektomie für gering-, mittel- und hochgradig myope Astigmatismen mit einem Broad Beam Excimer Laser: Auswertung refraktiv-chirurgischer Daten nach internationalen Richtlinien.

BACKGROUND: Photorefractive keratectomy (PRK) is an accepted procedure to correct myopia in Germany. The purpose of this study was to evaluate photoastigmatic refractive keratectomy (PARK) for myopic astigmatism. MATERIAL AND METHODS: PARK using the VISX 20/20 excimer laser was performed in 50 eyes of 36 patients (25 female, 16 male) aged 22 to 68 years (mean 38 +/- 10 years) in the period of 1995 to 1996. Retrospective evaluation was done after dividing the patients into three astigmatic groups between -0.5 diopters (D) and -1.5 D (group I, n = 28), between -1.75 D and -3.0 D (group II, n = 16) und between -3.25 D and -5.5 D (group III, n = 6). The correction of myopic astigmatism was assessed concerning the criteria safety, efficacy, predictability and stability. Mean follow-up was 12 months (8-15 months). RESULTS: Seventy-eight % of all eyes achieved an uncorrected visual acuity of > 0.5. Sixty-eight % of the eyes were within +/- 1.0 D of the desired correction. Loss of 2 or more lines of best corrected visual acuity occurred in 6 eyes (12.0%). We observed in group I an astigmatic reduction of 36.0%, in group II of 66.5% and in group III of 68.0%. The surgically induced astigmatism was calculated with 1.29 +/- 1.0 D. Mean axis rotation of the refractive cylinder was 22.12 +/- 23.05 degrees. CONCLUSIONS: PARK using the VISX 20/20 excimer laser is an acceptable procedure to correct myopic astigmatism. However, the study revealed that astigmatic reduction with a broad beam laser is not yet perfect in terms of efficacy, predictability and safety.

Visual outcome after treatment with low-dose recombinant tissue plasminogen activator or hemodilution in ischemic central retinal vein occlusion.

The ischemic type of central retinal vein occlusion (CRVO) is associated with a poor visual and ocular prognosis. Although several reports have indicated that hemodilution or thrombolytic therapy may be of benefit, there is still no consensus among ophthalmologists about the management of this disorder. In our study, we retrospectively evaluated the visual outcome after medical treatment in 58 patients with ischemic CRVO and severe visual loss (< or = 20/50). We separately investigated three different groups, depending on the following criteria: onset of symptoms within 11 days prior to admission and thrombolytic treatment with 50 mg of recombinant tissue plasminogen activator (rtPA) and intravenous heparinization (n = 23) or hemodilution therapy (n = 22) or onset of symptoms >11 days before the initial visit and hemodilution (n = 13). An advancement of 2 or more lines on the logarithmic visual acuity chart was noted in 10 cases (44%) in the rtPA group and in 3 subjects (14%) in the early-phase hemodilution group, whereas only 1 patient in the late-phase hemodilution group showed a comparable improvement. Our findings suggest that treatment with low-dose rtPA or hemodilution aimed at early restoration of blood flow has the potential to improve the visual prognosis in ischemic CRVO. The finding that thrombolysis had a favorable outcome supports the hypothesis that specific subgroups of patients may benefit from this therapeutic approach. Further investigation will be required to definitively prove the effectiveness of fibrinolytic agents.

Intraocular recombinant tissue-plasminogen activator fibrinolysis of fibrin formation after cataract surgery in children.

PURPOSE: To evaluate the efficacy and safety of intracameral recombinant tissue plasminogen activator (rt-PA) application for fibrinolysis of fibrin formation after cataract surgery in children. SETTING: Johann Wolfgang Goethe-University, Department of Ophthalmology, Frankfurt am Main, Germany. METHODS: This study comprised 11 eyes of 10 patients aged 3 to 13 years (mean 7.2 +/- 3.68 [SD]) who developed severe fibrin formation after cataract surgery and IOL implantation despite intensive topical steroid therapy. Under general anesthesia, fibrinolysis was performed with 10 micrograms of rt-PA 7.18 +/- 2.04 days after intraocular surgery. Follow-up included slitlamp examination, tonometry, visual acuity testing, and-ophthalmoscopy. Anterior chamber flare measurements could be performed in 6 eyes. RESULTS: Complete resolution of fibrin formations occurred in 90% of the patients in these cases, no recurrent fibrinous reaction or adverse effects were noted. In 2 eyes of the same patient with a history of juvenile rheumatoid arthritis and chronic uveitis, fibrin clot dissolution was incomplete. A recurrent fibrinous formation could be observed after 2 and 4 weeks, respectively. A beginning band keratopathy excluding the central and limbal cornea was noted after 6 and 8 weeks, respectively. CONCLUSION: Intraocular application of rt-PA appears to be a safe and efficacious therapeutic approach in the management of severe fibrinous reactions after pediatric cataract surgery.

[Correction of myopic astigmatism with the VISX 20/20 excimer laser. An overview of treatment outcome]. / Korrektur des myopen Astigmatismus mit dem VISX 20/20 Excimer-Laser. Eine Ubersicht über die Behandlungsergebnisse.

UNLABELLED: The advent of the excimer laser has brought about the potential for improved vision in many individuals with myopia and astigmatism. However, photoastigmatic refractive keratectomy (PARK) remains a matter of controversy. The purpose of our study was to determine the predictability of VISX 20/20 excimer laser photorefractive keratectomy in the treatment of myopic astigmatism. PATIENTS AND METHODS: Our study comprised 31 eyes of 22 patients with myopic astigmatism. All patients underwent treatment with a VISX 20/20 excimer laser and were followed up for 6 months. Complete 12-month follow-up data were available from 18 eyes. Park was performed in eyes with myopia between -1.5 and -10.0 D and with astigmatism between -0.5 and -5.5 D. Thus, the corresponding spherical equivalent ranged from -1.75 to -10.5 D. RESULTS: Six months postoperatively, 21/31 (62%) eyes were within +/- 1.0 D of the target refraction and 13/31 (42%) within +/- 0.5 D of the target refraction. In 13 of 15 eyes (87%) with myopia less than -6.0 D, an uncorrected visual acuity of at least 0.8 was noted. In eyes with myopia greater than -6.0 D, 9/16 (56%) showed an uncorrected visual acuity of at least 0.5. Six months after PARK, an increase of one line on the Snellen Visual Acuity Chart was observed in 8/31 (26%) and an increase of two lines was noted in eyes 3/31 (10%). One of 31 eyes (3%) showed an increase of three lines. A decrease in visual acuity of 1 line on the Snellen Visual Acuity Chart was found in 4/31 (13%), and in 3/31 eyes (10%) a decrease of 2-4 lines was noted. Overall, we observed a statistically significant reduction of astigmatism from 1.93 +/- 1.43 D to 0.93 +/- 0.63 D. Reduction of corneal astigmatism less than -1.25 D was not statistically significant. In eyes with astigmatism ranging from -1.25 to -2.5 D or greater than -2.75 D, a significant reduction of the mean astigmatism was noted. The postoperative regression of astigmatic correction was low. However, an axis shift of more than 15 degrees was found in 42%/35% of eyes by subjective refraction (miosis/cycloplegia) and in 33% in corneal topography. No central islands were noted. CONCLUSION: Photoastigmatic refractive keratectomy (PARK) constitutes a potential means of correcting myopic astigmatism. In eyes with astigmatism greater than -1.0 D a significant reduction of 60% of the mean astigmatism was noted. However, the considerable proportion of eyes with a postoperative axis shift greater than 15 degrees and a decrease in visual acuity of two or more lines indicates that further research is needed on excimer laser surgery to improve the reliability and safety.

[Intraocular rt-PA injection in fibrin formation after combined glaucoma and cataract operation]. / Intraokulare rt-PA-Injektion bei Fibrinbildung nach kombinierter Glaukom- und Kataraktoperation.

BACKGROUND: The fibrinolytic drug rt-PA, which has been successfully used systemically to treat arterial and venous occlusions, is now available for local, intraocular injection. rt-PA converts plasminogen to plasmin, which in turn is able to lyse fibrin and fibrin clots. Intraocular surgery, trauma and inflammation may lead to intraocular accumulation of fibrin. Treatment of this type of complication with high-dose corticosteroids is protracted and often unsuccessful. PATIENTS: Eight patients (age 59-75 years) with fibrin formation following phacoemulsification and IOL implantation combined with trabeculectomy were treated by intraocular injection of 10 micrograms rt-PA. The intraocular status following the local fibrinolytic therapy was documented by biomicroscopy, photography and laser-flare Tyndallometry on days 1, 2 and 8. RESULTS: In all patients the fibrin clots dissolved completely. Neither relapses nor adverse affects were noted. CONCLUSIONS: The intraocular application of rt-PA results in an efficient fibrinolytic effect, which prohibits potential complications of combined glaucoma and cataract surgery due to fibrin formation.

[Front-loading rt PA thrombolytic therapy in central or venous branch occlusions of the retina]. / Front-loading-rt-PA-Lysetherapie bei Zentral- oder Venenastverschlüssen der Netzhaut.

UNLABELLED: Although central retinal vein occlusion and branch retinal vein occlusion are among the most common vascular disorders affecting the retina, there is a great deal of confusion about their management. In view of the histopathological features of ischemic retinal vein occlusions, the use of fibrinolytic agents such as rt-PA (recombinant tissue-plasminogen activator) appears to be the most promising therapeutic approach. PATIENTS: In nine patients with ischemic retinal vein occlusion, 50 mg of rt-PA were given i.v. over a period of 60 min. Simultaneously, heparin was infused at 1200 U/h. The i.v. heparinization was continued over a period of 8 days. RESULTS: The clinical course was assessed by documenting visual acuity, fluorescein angiographies and fundal examinations. Additionally, several coagulation parameters were measured. No hemorrhagic complications were observed. In 8 cases, an improvement of visual acuity and retinal perfusion was noted. CONCLUSION: Based on our results, we would recommend the fibrinolytic therapy with rt-PA and heparin in the treatment of ischemic retinal vein occlusions.

[Capsular sack suture PMMA intraocular lens. Comparative study of centering behavior after phacoemulsification and planned extracapsular cataract extraction]. / Kapselsackfixierte PMMA-Intraokularlinse. Vergleichende Untersuchung über das Zentrierverhalten nach Phakoemulsifikation und nach geplant extrakapsulärer Kataraktextraktion.

The position of bag-fixated intraocular lenses after phacoemulsification or extracapsular cataract extraction (ECCE) was compared in order to determine the relationship to the method of operation and the type of capsular opening. Photographs were taken from 71 eyes 6 months after in-the-bag implantation of a one-piece posterior chamber lens. Centering was determined with respect to the pupillary center. Forty-six eyes were operated on by phacoemulsification after continuous circular capsulorhexis with closed edges and 25 eyes by ECCE after capsulorhexis with a radial incision of the capsular rim at the 12 o'clock position. Ninety-four percent of the intraocular lenses implanted after phacoemulsification and 92% of the intraocular lenses implanted after ECCE were decentered less than 0.5 mm. The centering of bag-fixated intraocular lenses is related to the technique of opening the anterior capsule. Phacoemulsification with continuous capsulorhexis offers conditions similar to that in ECCE with capsulorhexis and radial capsular rim incision for good centering of one-piece posterior chamber lenses.

[Plasminogen activator and PAI. Detection in aqueous humor of the human eye]. / Gewebsplasminogenktivator und PAI. Nachweis im Kammerwasser des menschlichen Auges.

Tissue-type plasminogen activator (t-PA), a serine protease that catalyzes the conversion from plasminogen to plasmin, plays an important role in the fibrinolytic system and has also in recent years attracted attention in the field of ophthalmology. In order to examine the role of t-PA in the physiology of the anterior segment, we detected t-PA in aqueous humor by using immunoassays. The samples were taken by keratocentesis prior to cataract or glaucoma surgery. The sample volumes ranged from 50-200 microliters. The quantities of t-PA Ag and plasminogen-activator inhibitor (PAI) Ag were determined by using enzyme-linked immunosorbent assays. We determined t-PA and PAI in the aqueous humor of 54 patients between 32 and 87 years of age. The t-PA Ag levels ranged from 0.2 to 1.9 ng/ml (average 0.8 ng/ml), PAI-Ag from 0.2 to 1.7 ng/ml (average 0.9 ng/ml). The values measured in men were slightly higher than those measured in women. No association between t-PA and PAI levels and accompanying diseases or metabolic disorders was noted. Precise knowledge about the presence of t-PA in aqueous humor is a prerequisite for the recognition of pathological events following intraocular fibrin formation and may be an important basis for the therapeutic use of rt-PA in the intraocular inflammatory process.

[Glare test and bright light vision in cataract patients]. / Glare-Test und Gegenlichtvisus bei Kataraktpatienten.

Cataract patients and healthy subjects have been examined with the Miller-Nadler Glare-Tester to prove if the results of the glare test show any correlation between the glare disability score and the outdoor visual acuity facing sun. The outdoor vision of cataract patients with a high glare disability score was clearly impaired compared with their indoor vision. Healthy eyes with a normal glare disability score did not show any impairment of visual acuity facing sun. The results of the glare disability examination can therefore be used as a reference for the decision of a cataract operation.