[Transepithelial photorefractive keratectomy : Results and clinical experiences]. / Transepitheliale photorefraktive Keratektomie : Ergebnisse und klinische Erfahrungen.

OBJECTIVE: To analyze and assess the refractive outcome after transepithelial photorefractive keratectomy (TransPRK). MATERIAL AND METHODS: The treatment was performed with the AMARIS 1050RS laser (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany). The method used an aspheric, aberration-neutral ablation profile and a standardized epithelial tissue removal of 55 µm in the center and 65 µm at a radius of 4 mm as well as SmartPulse technology. Only spherical and/or cylindrical refraction values were treated. Only untreated eyes with preoperative best corrected visual acuity equal to or better than 0.8 were included in the cohort. Follow-up examinations were performed after 1 and 4 days, after 1 and 3 months and after 1 year RESULTS: A total of 939 consecutive TransPRK laser treatments performed in the period from December 2014 to December 2016 were retrospectively analyzed. The mean age of the patients was 34 years. The preoperative sphere had a range of -7.75 D up to +3.00 D and cylinders up to 5.00 D. The 3­month follow-up control was performed in 728 eyes (77.5%). The predictability showed 89% of eyes within the target correction of less than 0.50 D and 99% of eyes less than 1.00 D. The astigmatic correction showed 91% of eyes with less than 0.50 D. In the safety 1% of eyes showed a visual loss of 2 Snellen lines because of haze. In 26 eyes (2.7%) follow-up treatment was performed with renewed TransPRK laser treatment, in the myopic cohort in 1.8% and in the hyperopic cohort in 13.0%. A residual refraction occurred in 20 eyes without haze and 6 eyes showed a residual refraction with signs of haze. CONCLUSION: The TransPRK led to similar results to intrastromal refractive surgery techniques but with fewer clinical complications.

Epidermal growth factor receptor in corneal damage: update and new insights from recent reports.

Agonist and antagonist drugs acting on epidermal growth factor receptor (EGFR) signaling are emerging as a new possibility for pharmaceutical study and clinical manipulation of some skin and corneal disorders. EGFR activation appears to be effective in reducing the time of reepithelialization after corneal wound healing, with potential uses in penetrating keratoplasty, refractive surgery, alkali burns, diabetic keratopathy, keratopathy following chemotherapy, cornea transplantation, and dry eye. Most of the studies show therapeutic advantages of human recombinant epidermal growth factor (hrEGF) eye drops without showing adverse effects. In contrast, EGFR inhibition delays epithelial cell proliferation and stratification during corneal regeneration.The aim of this review is to summarize the most seminal discoveries and recent advances so as to clarify the role of the EGFR system in corneal physiology and pharmacology. Epidermal growth factor eye drops could be a first-choice treatment for promoting regeneration in numerous epithelial defects in the medium to long term.

[Practical significance of critical fusion frequency (CFF). Chronological resolution of the visual system in differential diagnosis]. / Praktische Bedeutung der Flimmerfusionsfrequenz (CFF). Zeitliche Auflösung des visuellen Systems in der Differenzialdiagnose.

The value of measuring the critical fusion frequency (CFF) as part of ophthalmological diagnostics is examined. The relevant literature on changes of the CFF concomitant with refraction errors, media opacity, age-related macular degeneration, glaucoma and various other opticopathies is discussed regarding the relevance of CFF for the differential diagnosis. Various methods and instruments for measuring the CFF are presented. The CFF is a complex function of the visual system and changes in CFF cannot be ascribed to a specific level of signal transduction. However, measurement of the CFF is a valuable test in the clinical routine to estimate potential visual acuity in the presence of media opacity and to screen for lesions of the optic nerve. Reduction of CFF in an eye that otherwise appears normal may prompt the ophthalmologist to initiate further examination facilitating diagnosis of specific conditions, such as optic neuritis, before visual acuity is reduced. Measuring the CFF is technically simple, inexpensive and fast and can be delegated to medical personnel. Measurement of the CFF should be an integral component of routine ophthalmological examinations.

Laser in situ keratomileusis for mixed astigmatism using a modified formula for bitoric ablation.

PURPOSE: To evaluate the results of treatment of mixed astigmatism with laser in situ keratomileusis (LASIK) by means of a modified Chayet formula for bitoric ablation and personalized nomogram calculations. METHODS: A retrospective study was conducted in 19 consecutive eyes of 13 patients who underwent LASIK treatment of mixed astigmatism with a mean sphere of +1.63-/+1.23 D and a mean cylinder of -3.55-/+1.17 D. The authors used the Schwind ESIRIS Laser platform. The ablation was shifted from the pupil center to the vertex normal of the cornea. RESULTS: Three months postoperatively, the mean sphere was 0.08-/+0.24 D and the mean astigmatism -0.45-/+0.31 D. At 3 months, an uncorrected visual acuity (UCVA) of 20/50 or better could be found in 100% of the eyes, and of 20/25 or better in 59%. All eyes were within -/+0.5 D spherical equivalent (SE) at 3, 6, and 12 months. No eye lost more than one line of best spectacle-corrected visual acuity (BSCVA). Postoperatively, the corneal wavefront showed a reduction of spherical aberrations and coma, which were analyzed at 4 and 6 mm pupil diameter. The postoperative higher-order aberrations decreased at 4 mm and increased at 6 mm pupil sizes after surgery. CONCLUSIONS: Modified bitoric treatment with the Schwind ESIRIS laser showed an excellent postoperative UCVA and BSCVA with applying external nomogram adjustments. The method demonstrated good predictability, safety, and effectiveness in the treatment of mixed astigmatism.

[Visual acuity after cataract surgery in patients with age-related macular degeneration]. / Visusverlauf nach Kataraktoperation bei Patienten mit altersassoziierter Makulopathie.

BACKGROUND: To analyze changes in visual acuity after cataract surgery in patients suffering from age-related maculopathy. MATERIAL AND METHODS: This retrospective case-control study included all patients who had consecutively undergone phacoemulsification from January 2000 to February 2006, had a preexisting diagnosis of early age-related macular degeneration (AMD), and were followed up for at least 1 year postoperatively (n=1,152 eyes of 696 patients). The control group comprised phakic patients diagnosed with early AMD from January 2000 to February 2006 who did not undergo eye surgery and were followed up for at least 1 year (n=334 eyes of 202 patients). RESULTS: In 62.1% of operated eyes, the best-corrected visual acuity was at least two logMAR units better than before surgery, and in 26.7% it was at least four logMAR units better. Deterioration of visual acuity of more than four logMAR units occurred in 1.3% of operated eyes and 1.5% of control eyes. CONCLUSION: Cataract surgery can markedly improve visual acuity in patients with age-related maculopathy.

[Posterior segment complications of laser in situ keratomileusis (LASIK)--a survey of the literature]. / Hinterabschnittskomplikationen der Laser-in-situ-Keratomileusis (LASIK)--Eine Literaturübersicht.

During the past years refractive surgical procedures and particularly laser IN SITU keratomileusis (LASIK) have become established by clinical and experimental studies and are performed worldwide in a high number. This paper provides a survey of the published posterior segment complications of LASIK that may occur albeit very rarely. Additionally, current clinical and experimental hypotheses regarding the pathogenesis of those complications are discussed. Currently a cause-effect relationship between LASIK and reported posterior segment complications has not been proven although a very high number of LASIK procedures have been performed worldwide.

Band keratopathy: a modified treatment.

PURPOSE: The surgical treatment of band keratopathy usually consists of abrasion of the corneal epithelium followed by removal of the subepithelial calcium deposits by means of an ethylenediamine-tetraacetic acid (EDTA) solution. In order to reduce the discomfort and pain that occur after corneal abrasion, the authors developed a modified technique that avoids the abrasion of the epithelium. METHODS: In three patients (four eyes) with long-standing band keratopathy, the epithelium was detached with a 19% ethanol solution and placed gently toward the limbus, a method also used in laser-assisted subepithelial keratectomy (LASEK). After clearing the anterior stroma with EDTA solution, the epithelial flap is unrolled and a bandage contact lens applied. RESULTS: Postoperative pain was greatly reduced and after removal of the contact lens no pain was reported. CONCLUSIONS: This modified epithelium-sparing treatment of band keratopathy shows good results while reducing postoperative pain.