Association between anterior chamber biometry and posterior capsular defects.

PURPOSE: To analyze the association between anterior chamber biometric factors and posterior capsular defects (PCDs) that occur during extracapsular cataract extraction. SETTING: University Eye Hospital, Goethe University Frankfurt, Germany. DESIGN: Population-based study. PATIENTS AND METHODS: Extracapsular cataract extractions for inpatient cases within 4 years were retrospectively analyzed. The data on the occurrence of PCDs, age, sex, surgeon, and biometry were obtained. For cases with PCDs, the secondary ocular diseases, number of procedures, lens implant, visual acuity, and course were also recorded. Swept-source optical coherence tomography measurements allowed the measurement of lens thickness (LT) in addition to the usual biometry values. RESULTS: A total of 1967 cataract surgeries (patients age: 70.56 ± 8.42, 1005 women; 962 men) were included, and PCDs were documented for 59 (2.54%; 31 women, 28 men) cases (patient age: 70.95 ± 8.52 years). There were no differences ( P = .76) related to the surgeons (n = 9) with minimal effect sizes. The mean LT, axial length, corneal curvature, and anterior chamber depth were 4950.36 ± 466.63 µm, 23.73 ± 1.77 mm, 43.89 ± 1.36 diopters, and 3.02 ± 0.71 mm, respectively. The Wilcoxon-Mann-Whitney test showed significant associations between LT ( P = .01) and PCDs with moderate relevance for the Rosenthal effect size (LT R = 0.34; ACD R = 0.29). CONCLUSIONS: In addition to ACD, a tendency for the occurrence of PCD could be proven, especially for LT. Therefore, special attention should be paid to LT preoperatively for comprehensive risk stratification.

Anterior Segment Biometry in a Caucasian Population with Cataracts.

PURPOSE: To investigate biometric factors of the anterior segment of phakic eyes with cataracts. METHODS: This population-based study included Caucasian patients with cataracts in the University Eye Hospital, Goethe University Frankfurt, Germany. Biometric parameters were measured using the swept-source optical coherence tomography method. Patients were grouped into intermediate stages based on decades of life. RESULTS: In total, 6289 eyes of 3615 patients (age: 70.67 ± 8.42 years) were included. Age-related reductions in the anterior chamber depth (mean ± standard deviation) decreased from 3.26 ± 0.42 mm (group A: 55-59 years) to 2.94 ± 0.4 mm (group G: 85-89 years), and those in the axial length decreased from 24.37 ± 1.87 mm (group A) to 23.39 ± 1.07 mm (group G). Likewise, the white-to-white distance decreased from 12.12 ± 0.48 mm (group A) to 11.96 ± 0.47 mm (group G). Lens thickness tended to increase accordingly from 4.39 ± 0.36 µm (group A) to 4.9 ± 0.40 µm (group G). A comparison of the eyes showed no detectable lateral difference regarding the biometric parameters between the groups (axial length: p = 0.26, Rosenthal effect size = 0.03; lens thickness: p = 0.12, R = 0.03; anterior chamber depth: p = 0.63, Rosenthal effect size = 0.01). The axial length and anterior chamber depth differed significantly between sexes (r = 0.22, p < 0.0001 and r = 0.16, p < 0.0001, respectively). Multiple regression analysis of the anterior chamber depth as a function of biometry parameters as well as age and sex additionally indicated a positive correlation of anterior chamber depth with white-to-white distance (b = 0.32, p = 10-5), axial length (b = 0.10, p = 10-5), keratometry (b = 0.07, p = 10-5), and lens thickness (b=-0.05, p = 10-5) with a high effect size (Cohen f2=1.866, p = 10-5) and strong multiple correlation coefficient (Rosenthal effect size = 0.80, p = 10-5). CONCLUSIONS: In the anterior segment, there are age- and sex-dependent changes in biometric parameters. In addition, changes in anterior chamber depth were noted in relation to white-to-white distance, axial length, keratometry, and lens thickness. These data should be considered in lens calculation formulas.

XEN-augmented Baerveldt Implantation for Refractory Childhood Glaucoma: A Retrospective Case Series.

BACKGROUND: Tube implants can lead to long-term decompensation of the cornea after decades, in particular in complicated childhood glaucoma, because of a variety of causes including contact between the tube tip and the corneal endothelium. The augmentation of a XEN implant with a Baerveldt (250) tube implant, introduced 2016 by Mermoud et al for refractory glaucoma in adult patients, may reduce this risk in children. In our retrospective study, we report on the XEN-augmented Baerveldt (250) tube implant in children. PATIENTS AND METHODS: Ten consecutive patients with refractory childhood glaucoma who underwent XEN-augmented Baerveldt implantation by a single surgeon (F.G.) between January 2016 and August 2018 were retrospectively analyzed. In this technique, a XEN tube was inserted under a standard scleral flap from outside into the anterior chamber and its outer end was connected to the Baerveldt (250) tube. The follow-up consisted of regular anterior and posterior segment examination with intraocular pressure (IOP) measurements using a hand-held slit lamp and a Perkins applanation tonometer and/or rebound tonometer (Icare). RESULTS: Ten cases (6 female individuals, 4 male individuals, median age 6 years) were operated using a XEN-augmented Baerveldt implant [aphakic glaucoma, primary congenital glaucoma, secondary congenital glaucoma (Peters anomaly), ectropion uveae, and Stickler syndrome were 4, 3, 1, 1, and 1]. Before surgery (XEN-augmented Baerveldt implantation), median IOP was 31 mm Hg. At the last postoperative follow-up, the mean IOP was 18.5 mm Hg with a median follow-up period of 13 months (range, 3 to 21 mo). No shallow or flat anterior chamber was observed. In all cases, this technique could be performed without intraoperative complications. In 3 cases, however, a surgical revision was necessary. There was no prolonged postoperative hypotony or short-term corneal alteration. By using an S-shaped loop the original Baerveldt tube length could be preserved for potential future use. In a total of 6 out of 10 cases, the procedure was a complete success (IOP, ≤20 mm Hg without additional medication). CONCLUSIONS: XEN-augmented Baerveldt implantation was used for refractory pediatric glaucoma in which conventional surgery had already failed. A new additional modification using an S-shaped loop was introduced. Short-term IOP control seems promising, but long-term results are still pending and the long-term efficacy and safety must still be proven before this technique can be generally recommended.

Evaluation of a Device for Standardized Measurements of Reading Performance in a Prepresbyopic Population.

PURPOSE: Automated measurements of reading performance are required for clinical trials involving presbyopia-correcting surgery options. Repeatability of a testing device for reading (Salzburg Reading Desk) was evaluated in a prepresbyopic population. METHODS: Subjective reading performance of 50 subjects divided into 2 age groups (23-30 years and 38-49 years) with distance-corrected eyes was investigated with different log-scaled reading charts. At study entry, refractive parameters were measured and distance visual acuity assessed. Two standardized binocular measurements were performed for each subject (32.24 ± 9.87 days apart [mean ± SD]). The repeatability of the tests was estimated using correlation coefficients, Wilcoxon signed-rank test, and Bland-Altman method. RESULTS: The test parameters at both maximum reading rate (MRR) measurements demonstrate a strong relationship of age group 2 subjects (correlation coefficient [r] = 0.74 p = 10-4) and of younger subjects (age group 1: r = 0.69, p = 10-4). Prepresbyopic subjects of age group 2 showed moderate results for near reading distance (r = 0.67, p = 10-4); by contrast, younger subjects had poorer results (r = 0.55, p = 10-3). The Wilcoxon signed-rank test revealed agreement between measurements and Bland-Altman plots showed a wide data spread for MRR and near reading distance in both groups. CONCLUSIONS: The device measures repeatedly selected reading performance parameters of near real world conditions, such as MRR, in prepresbyopic populations if several factors are taken into account. The option to choose preferred distance leads to more variance in measuring repeated reading performance. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) registration reference number: DRKS00000784.