Determination of the power of a convex-plano intraocular lens in situ from the dioptric keratometer reading of its front surface: extension table for the Javal-Schiøtz ophthalmometer.

The size of the reflex image of keratometer mires can be used to determine the power of an intraocular lens (IOL) inside the eye (in situ). The dioptric scale reading from the front surface of a convex-plano intraocular lens in cases of unknown power is compared with computed values. The accuracy of the method is demonstrated in a series of patients with known IOL power. Though in our study we have assumed convex-plano lenses are in use, the same procedure can sometimes be applied to lenses of different forms. To interpret scale readings below 30 dioptres and over 60 dioptres we compiled an extension table, suited to the ophthalmometer of Javal-Schiøtz (Haag-Streit), making use of low-powered minus and plus auxiliary lenses in front of the tube of the instrument.

The uvea-touch syndrome and how to avoid it. Personal thoughts about lens implantation.

For successful lens implantation, the quality of the cataract extraction needed to be improved. The debate whether to perform extracapsular or intracapsular extraction has not yet come to an end. For better understanding a classification of lenses is necessary in view of the clinical consequences. The contact of the lens with the eye (read: the site of lens support) determines the long-term fate of an eye with a lens. All lenses in contact with uveal tissue may cause symptoms that together constitute the uvea-touch syndrome. Capsular support is to be preferred over uvea-support. The all-in-the-bag position of a lens is superior. This can be achieved with so-called inter-capsular surgery. A new lens design that is adapted to inter-capsular surgery is presented and its use described in detail (the 'Moustache' lens). There are few restrictions to its use.

Preexisting primary glaucoma and intraocular lenses.

Intraocular lens implantation into cataractous eyes that also suffer from primary glaucoma is a rewarding procedure. The need for an IOL in these eyes is even stronger than in otherwise healthy cataractous eyes. With prepupillary IOLs there was a strong reason first to control surgically intraocular pressure prior to cataract surgery with IOL implantation. The advent of retropupillary IOLs has dramatically changed this attitude. Extracapsular cataract extraction (ECCE) and the use of an all-in-the-bag retropupillary IOL is the method of choice. Postoperative medical treatment remains possible as does surgical treatment for the glaucoma. The procedure is suitable for open-angle glaucoma as well as for narrow-angle glaucoma.

Safe all-in-the-bag pseudophakia with a new lens design (the moustache lens).

A classification of intraocular lenses is given that does justice to their clinical merits. There is a significant difference between a lens supported by cellular tissue and one supported by the collagen capsule of the crystalline lens. A new design of a wholly retropupillary lens for placement in the capsular bag ('moustache lens') is presented. The surgical technique is described in detail. The most important features of this lens are the ease of insertion and the guaranteed intracapsular and central position of the lens.

Cataract extraction and intraocular lens implantation after fistulizing glaucoma surgery.

Cataract extraction with implantation of an intraocular lens was performed in 33 patients who had previously undergone fistulizing glaucoma surgery. A functioning filtering bleb and normal intraocular pressure were important preoperative criteria, however success depended largely upon enhanced postoperative aqueous outflow. Bleb failure following cataract surgery may be caused by prolonged intraoperative hypotony, vitreous or intraocular lens occlusion of the filtering site, or the presence of postoperative inflammatory components in the aqueous. Extracapsular cataract extraction was the most satisfactory technique. Most cases received prepupillary iridocapsular lenses.

Corneal and retinal complications after cataract extraction. The mechanical aspect of endophthalmodonesis.

Removal of the crystalline lens deprives the eye of the stabilizing effect of the lens-zonule barrier. Intracapsular extraction also causes loss of stability inside the vitreous cavity itself (vitreodonesis). The lack of stability inside the aphakic eye is defined as endophthalmodonesis. Oscillations induced by saccadic eye movements cause turbulences in the aqueous humor and in liquid pools present in the vitreous cavity. Therefore, endophthalmodonesis is a continuing trauma to the eye. The hypothesis that corneal and retinal complications of cataract extraction, other than those of surgical origin, are due to the mechanical aspect of endophthalmodonesis is discussed. This hypothesis explains why, after complete removal of the lens-zonule barrier, the intracapsular aphakic eye suffers more from "barrier deprivation, than the extracapsular aphakic eye after incomplete removal of this barrier.

Iseikonic lens implantation in anisometropia.

The implantation of an iseikonic prepupillary intraocular lens in unilateral aphakia usually requires a slight (2 D) myopia of the implanted eye if the two eyes are isometropic. On the other hand, the implantation of an iseikonic implant in one eye of a anisometropic (asymmetric) eye pair can result in unexpectedly high changes in spectacle ametropia, due to differences in axial length or corneal power. The changes in ametropia after iseikonic lens implantation are discussed in relation to preoperative corneal and axial anisometropias. Alternative procedures to iseikonic implantation are described.

[The search for the right place and for optimal fixation of an intraocular lens (author's transl)]. / Auf der Suche nach dem richtigen Ort und der optimalen Fixationsart einer intraokularen Linse.

Whereas by far not all properties of the crystalline lens can be realized with an artifical intraocular lens, maximal stability of such a device is its most important feature. The latter can be achieved by the adherence of the lens to the capsular membrane, left behind after extra-capsular cataract extraction. In this way the suspension system of the crystalline is used for the fixation of the intra-ocular lens. The stability of the contents of the eye viz. of the vitreous, of the aqueous humour, and of the iris diaphragm, is maintained to a high degree. Stability of the iris diaphragma is achieved when irido-capsulo-lenticular adhesions are allowed to develop, but the iris diaphragm can also be stabilized by support from the optical part of a modified capsular lens in the posterior chamber.

Lens injury in children treated with irido-capsula supported intra-ocular lenses.

The treatment of lens injury in children with irido-capsula supported intraocular lenses is described. A consecutive series of 73 children is analyzed as to the functional results and complications. Surgery and anaesthesia are discussed in detail. Guidelines are given for future straightforward management of eye injury in children, using this promising possibility of visual rehabilitation.

Specular microscopy of the corneal endothelium and lens implant surgery.

Specular microscopy helps to estimate the viability of the corneal endothelium long before clinical signs of decompensation occur. Therefore, specular microscopy is useful for the selection of eyes for lens implantation in general; for the prognosis of the eye with a lens implant; and for the evaluation of the method of cataract surgery, of lens implantation techniques, and possibly of lens design, material, and manufacturing. A long-term study of intracapsular and extracapsular pseudophakic eyes revealed that the intracapsular pseudophakic eyes had significantly less endothelial cells, which could partly be explained by toxicity of the Supramid used as loop material, but mostly by assuming continuing endothelial disintegration in the intracapsular eyes. In 41 patients our extracapsular technique caused an average cell loss of only 6.7%.

Lens injury in children treated with irido-capsular supported intra-ocular lenses.

The treatment of lens injury in children with irido-capsular supported intraocular lenses is described. A consecutive series of 73 children is analyzed as to the functional results and complications. Surgery and anesthesia are discussed in detail. Guidelines are given for future straight-forward management of eye injury in children, using this promising possibility of visual rehabilitation.