[Multicentric study regarding assessment of the driving ability of LASIK and orthokeratology patients compared with conventionally corrected persons]. / Multizentrische studie zur fahreignungsbegutachtung von LASIK- und orthokeratologie-patienten im vergleich zu konventionell korrigierten personen.

PURPOSE: Corneal optical zone induced by LASIK and orthokeratology (Ortho-K) treatment modifies the refraction of the incoming light bundle in its border area in situations of dawn and darkness. Considering the legal regulations of the driver's license and the recommendations of the German Society of Ophthalmology (DOG) and the American Academy of Ophthalmology (AAO), the vision for driving suitability of ortho-K patients is tested and compared with that of LASIK patients and a reference group (juvenile: < 30 years, adult: > 40 years) under different criterions. The examination of the visual acuity, contrast sensitivity under mesopic conditions and glare contrast sensitivity are main topics of the study. METHODS: This multicentre retrospective study includes 333 eyes of 167 subjects. 65 subjects were habitual wearers of reverse-geometry contact lenses, 60 subjects were treated by LASIK. 42 subjects use glasses, contact lenses or none of them. The follow-up time was 22.8 ± 11.9 months. The measurement of the visual acuity was based on DIN Standard 58220 part 3 and the ISO Standard 8596. The Mesotest II (Oculus Inc.) was used for testing contrast sensitivity under mesopic conditions and glare contrast sensitivity. Detecting the personal evaluation of vision and satisfaction, subjects were instructed to complete a questionnaire (NEI-RQL-42). RESULTS: Relating to the legal requirements in Germany, sufficient visual acuity was found in 76.7 % of the LASIK group, in 73.9 % of the Ortho-K users and in 85.7 % of the reference group (72.7 % in the adult group, 100 % in the juvenile group). Considering the DOG recommendations under inclusion of mesopic vision and glare sensitivity, 71.7 % of the LASIK subjects and 95.7 % of the Ortho-K subjects are suitable for driving a motor vehicle of the German classes A, A1, B, BE, M, S, L and T. With regard to the legal situation in the USA, 100 % of the Ortho-K users, 93.2 % of the LASIK group, 86.4 % of the adult reference group and 100 % of the juvenile reference group are fit to drive. The evaluation of the subjective questionnaire showed very high ratings in the Ortho-K (mean 85 of 100 points) and the LASIK (mean 86 of 100 points) group with no statistically significant differences. CONCLUSION: Considering the legal regulations, the volume of the subjects of Ortho-K and LASIK showed no significant difference of individuals considered fit to drive in comparison to a reference group. Neither LASIK nor Ortho-K patients have any restriction in the ability to drive a vehicle. The requirements of the DOG with regard to contrast sensitivity under mesopic conditions and glare contrast sensitivity for driving a vehicle are better fulfilled in the Ortho-K group compared to the group of LASIK patients. According to the DOG recommendations there are fewer subjects that are suitable for driving a motor vehicle as in the reference group. This fact must be discussed preoperatively.

[Influence of corneal biomechanical properties on myopic regression after laser in situ keratomileusis]. / Einfluss der kornealen Biomechanik auf die Myopieregression nach Laser-in-situ-Keratomileusis.

BACKGROUND: Laser in situ keratomileusis is a safe and accepted method for correcting myopia. The operational results in terms of accuracy as well as the subjective acceptance of patients for corrections to - 8 D are now considered to be promising (Seiler, Refraktive Chirurgie der Hornhaut, 2000); however, postoperative results show individual patient problems in long-term stability. It is believed that the preoperative condition of the cornea (e.g. thickness, biomechanical properties) could have an influence on postoperative problems such as myopic regression. METHOD: This study included a total of 46 eyes from 25 patients. At 3 months postoperatively, 15 patients (19 eyes) showed a SEQ of -0.50 D or more. Within this group, 11 patients (15 eyes) developed a regression (regression group) within the first 3 postoperative months. The remainder of the total group did not show any regression (stability group). The subjects of this study were on average 33 ± 8 years (stability group) and 31 ± 7 years old (regression group). The corneal thickness was tested and refractive error, visual acuity (BCVA/UCVA) and intraocular pressure was measured. In addition, the corneal hysteresis (CH) and corneal resistance factor (CRF) were determined. RESULTS: The mean preoperative spherical equivalent refraction was -3.14 D ± 1.41 D (SE) in the stability group and - 6.47 D ± 1.40 D (p = 0.001)in the regression group. Also, the postoperative spherical equivalents were statistically significant different (p < 0.05). In contrast, the mean preoperative corneal thickness showed no differences in both groups (p = 0.96) (stability group 563 ± 36 µm and regression group 563 ± 28 µm). CONCLUSIONS: The aim of the study to detect a possible causal relationship between myopia regression after LASIK and the biomechanical properties of the cornea and corneal thickness could not be clearly identified.

[Biometry of the anterior eye segment for implantation of phakic anterior chamber lenses. A comparison of current measurement devices]. / Biometrie des vorderen Augensegmentes zur Implantation phaker Vorderkammerlinsen. Ein Vergleich aktueller Messgeräte.

BACKGROUND: Implantation of phakic intraocular lenses (pIOL) is gaining in importance. Exact measurement of the anterior chamber is important to assure safe and effective pIOL implantation. In this study six currently available diagnostic devices were tested in order to compare accuracy of measurements (anterior chamber depth and diameter) and ease of handling. PATIENTS AND METHODS: In this study 100 eyes from 50 healthy patients were enrolled. All measurements were done by the same operator (L. K.) on the same day and under the same lighting conditions. The following devices were used to measure anterior chamber depth and diameter: IOLMaster 500, Visante OCT, UBM Vumax II, Galilei, Pentacam Classic und Orbscan IIz. Correlations between each method were assessed using Pearson's correlation. Bland Altman plots were composed to evaluate the range of agreement between two methods. RESULTS: The mean epithelial anterior chamber depth was 3.45 ± 0.38 mm with IOLMaster 500, 3.69 ± 0.33 mm with Visante OCT, 3.59 ± 0.35 mm with Pentacam, 3.67 ± 0,36 mm with Galilei, 3.48 ± 0.38 mm with Orbscan IIz and 3.52 ± 0.34 mm with UBM VumaxII. The mean white-to-white measurements were 11.98 ± 0.37 mm with IOLMaster 500 and 11.71 ± 0.36 mm with Orbscan IIz. The mean angle-to-angle distances were 11.83 ± 0. 43 mm with Visante OCT, 10.73 ± 0.38 mm with Pentacam, 12.30 ± 0.45 mm with Galilei, and 11.15 ± 0.52 mm with UBM Vumax II. In the Bland Altman plots the range of agreement was 0.5 mm between Visante OCT and IOLMaster 500, regarding anterior chamber depth as well as anterior chamber diameter. CONCLUSION: The IOLMaster 500 provides exact measurement of the anterior chamber depth and diameter and is easy to handle in the daily clinical routine.

[LASIK - a new treatment or the standard]. / LASIK - Neulandbehandlung oder medizinischer Standard.

Classification of LASIK in refractive surgery and treatment by health insurance, and education by the physician. Results in clinical studies and case law in Germany 2010.

[Unilateral papilledema with contralateral loss of vision]. / Einseitiges Papillenödem und kontralateraler Visusverlust.

A 46-year-old woman presented with a 4-day history of headache, dizziness and blurred vision in the left eye and a 1-year history of neck pain. Fundoscopy revealed a pale optic disc in the left eye and a swollen optic disc in the right eye. Furthermore a bilateral anosmia was evident. Cranial magnetic resonance imaging (MRI) showed a mass in the anterior cranial fossa, which was classified as a WHO grade I endotheliomatous meningeoma. A Foster Kennedy syndrome was diagnosed.

[Scanning electron microscopic characteristics of lamellar keratotomies using the Femtec femtosecond laser and the Zyoptix XP microkeratome. A comparison of quality]. / Vergleich des Femtec Femtosekundenlasers und des Zyoptix XP Mikrokeratoms. Rasterelektronenmikroskopische Gegenüberstellung lamellärer Keratotomien.

OBJECTIVE: To demonstrate the qualities and compare the typical features of cut surfaces and cut edges created by the Femtec femtosecond laser and the Zyoptix XP microkeratome, using scanning electron microscope (SEM) pictures. METHODS: Lamellar keratotomies were performed using a femtosecond laser (40 kHz) or a microkeratome on freshly enucleated porcine eyes (n=16, eight each per technique). After special preparation, SEM images were taken to evaluate the qualities of the cut surfaces and cut edges. Therefore, special criteria were involved, including relief and homogeneity of the surface and sharpness of the cut edges. RESULTS: Surfaces created by microkeratome cuts were very homogenous. Concerning surface relief, nearly no irregularities occurred. Cut edges showed a flat, serrated course from the epithelial layer to the stroma of the cornea. The edges were sharp and easily visible. After preparation using the femtolaser, the surface showed many rips in the tissue, leading to irregularities. Nevertheless, the cut edges were very sharp and entered the corneal layer straight at 90 degrees . CONCLUSIONS: A comparison of the two systems shows that the microkeratome creates a more homogenous cut surface. The need for preparation after automated cutting with the femtosecond laser leads to irregularities on the cut surface. The cut edges of both systems tested here differ concerning their angles on entering the tissue. With regard to the sharpness of the cuts, the qualitative aspect is nearly similar, although the cut edges of the microkeratome are serrated. Because the microkeratome-cut edge has a flatter course, the wound area might be bigger. Cut edges with the steepness produced by the femtosecond laser could be an advantage for repositioning the flap after LASIK. If excimer laser ablation is performed later, the flap bed created by the femtosecond laser could be disadvantageous.

[Mutational analysis of VSX-1 in one patient with posterior polymorphous corneal dystrophy and in three families with hereditary Fuchs endothelial dystrophy]. / Mutationsanalyse im VSX1-Gen bei einem Patienten mit posteriorer polymorpher Hornhautdystrophie und drei Familien mit autosomal-dominant vererbter Fuchs'scher Hornhautendotheldystrophie.

BACKGROUND: Fuchs endothelial corneal dystrophy is the most common disease of the corneal endothelium. Besides some sporadic cases, an autosomal dominant inheritance is frequently described. Mutations in the VSX-1 gene are identified as the underlying gene defect for a rarer kind of endothelial dystrophy, posterior polymorphous endothelial dystrophy. We report on mutational analysis of the VSX-1 gene in affected and non-affected family members of three families with autosomal dominant inherited Fuchs endothelial corneal dystrophy and one male patient showing posterior polymorphous endothelial dystrophy. PATIENTS/MATERIALS AND METHODS: From one patient with posterior polymorphous endothelial dystrophy and 10 affected and 15 non-affected family members of three families with autosomal dominant inherited Fuchs endothelial corneal dystrophy DNA was extracted from leukocytes of the peripheral blood and mutational analysis was performed by direct sequencing of the VSX-1 gene. RESULTS: Screening of the VSX-1 gene did not reveal sequence variants in any affected or non-affected individuals from the three families with Fuchs endothelial corneal dystrophy or the patient with posterior polymorphous endothelial dystrophy. CONCLUSIONS: The absence of pathogenic mutations in the VSX-1 gene in affected family members of 3 pedigrees indicates that other genetic factors are involved in the development of familial Fuchs endothelial corneal dystrophy. In addition, VSX-1 seems unlikely to be the crucial gene in our patient with posterior polymorphous endothelial dystrophy.

[Clinical course of a solitary retinal astrocytoma]. / Klinisch-zeitlicher Verlauf eines solitären retinalen Astrozytoms.

Retinal astrocytomas are benign tumors of the retina. Their localization can be solitary, multiple, or bilateral in both eyes. It is also known that they can be part of a phakomatosis syndrome (i.e., tuberous sclerosis or neurofibromatosis). Because retinal astrocytomas have a slow growth rate, yearly controls by an ophthalmologist with interdisciplinary consultation are adequate. Some uncommon cases have been reported in which the tumor has grown more aggressively. These tumors may require therapeutic interventions (e.g., vitreoretinal surgery, brachytherapy, photodynamic therapy, or cryotherapy).

[Unusual myopic fundus alteration]. / Ungewöhnliche myope Fundusveränderung.

A 44-year-old female patient reported a "black dot" which had been in front of the right eye for more than 4 days and which moved together with eye movements. The optical coherence tomography (OCT) image of the right macula showed large cystic cavities and thickening within the retinal pigment epithelium (RPE) near the fovea centralis as well as small bore cystic alterations, which indicated an event in the region of the choroid. Fluorescein angiography and indocyanine green angiography excluded choroidal neovascularization (CNV). The diagnosis revealed a broad superficial choroidal blood vessel mimicking a subretinal hemorrhage.

[Results of low-vision rehabilitation in vision impaired patients]. / Ergebnisse der optischen Rehabilitation mit vergrössernden Sehhilfen bei Patienten mit irreversibel visuslimitierenden Erkrankungen.

PURPOSE: Diseases of the retina, the optic nerve and the cornea may lead to a non-treatable loss of central vision. We report on low vision rehabilitation in 100 vision impaired patients. METHODS: Low vision rehabilitation was performed in 100 consecutive patients (61 % AMD, 23 % diabetic retinopathy, 16 % other diseases). Most of the patients were between 70 and 90 years old (78 %). In 62 cases we fitted optic systems for visual rehabilitation of the far distance (Galilei systems 54; Kepler systems 8), in additional 54 of them we fitted optic systems for the reading distance (additional lens 40; others 14; e. g. magnifier, television reader) and in 38 patients we fitted optic systems for visual rehabilitation only of the reading distance (magnifier 21, reading glasses with higher refraction and additional prism system 17). RESULTS: In 62 patients with low vision fitted with a system for the far distance we reached an increase of the visual acuity of more than one line in 95 %. In all 92 patients fitted with a system for the reading distance the reading of newspaper letters was possible. In 8 patients we could not fit a low vision systems due to handling difficulties. CONCLUSIONS: We could reach a satisfactory improvement of visual acuity in more than 90 % of the patients fitted for the far and the reading distance. Especially in elderly, vision impaired patients significant improvements in overall quality of life and specific areas of daily living are possible.

TGFBI (BIGH3) gene mutations in German families: two novel mutations associated with unique clinical and histopathological findings.

BACKGROUND: To report the clinical, histopathological and immunohistochemical findings of two novel mutations within the TGFBI gene. METHODS: The genotype of 41 affected members of 16 families and nine sporadic cases was investigated by direct sequencing of the TGFBI gene. Clinical, histological and immunohistochemical characteristics of corneal opacification were reported and compared with the coding region changes in the TGFBI gene. RESULTS: A novel mutation Leu509Pro was detected in one family with a geographic pattern-like clinical phenotype. Histopathologically we found amyloid together with non-amyloid deposits and immunohistochemical staining of Keratoepithelin (KE) KE2 and KE15 antibodies. In two families and one sporadic case the novel mutation Gly623Arg with a late-onset, map-like corneal dystrophy was identified. Here amyloid and immunohistochemical staining of only KE2 antibodies occurred. Further, five already known mutations are reported: Arg124Cys Arg555Trp Arg124His His626Arg, Ala546Asp in 13 families and five sporadic cases of German origin. The underlying gene defect within the TBFBI gene was not identified in any of the four probands with Thiel-Behnke corneal dystrophy. CONCLUSIONS: The two novel mutations within the TGFBI gene add another two phenotypes with atypical immunohistochemical and histopathological features to those so far reported.

Retinal colour duplex scanning during LASIK-ring suction with different keratomes.

PURPOSE: The purpose was to measure the blood flow velocity during the suction phase of LASIK. SETTING: University Eye Hospital, Martin-Luther-University Halle-Wittenberg, Halle, Germany. METHODS: Papillary blood flow velocity was measured by colour Doppler sonography. Suction rings of four different manufacturers were applied in 30 healthy volunteers without eye diseases all of normal blood and eye pressure. The velocity of the blood flow in the central retinal artery was measured before, during and after suction. RESULTS: When Hansatome (Bausch & Lomb) and M2 (Moria) rings were used, no blood flow velocity was detected during suction in 90% of all cases. These rings were compared to the SKBM standard suction ring (Alcon) and the Krumeich non-IOP ring, in which no blood was present in only 56.67% (p < 0.05) and 10% (p < 0.001) of cases respectively. Moria, Alcon and Krumeich Lasitome rings performed equally well during the recovery phase compared with the original values. An exception is the Hansatome ring (Bausch & Lomb), with lower velocities when evaluated after 30 minutes (p < 0.01). CONCLUSIONS: During the ring suction phase of LASIK, the rings tested reduce velocity differently.

[Corneal topography. Analysis of the corneal surface]. / Korneale Topographie. Oberflächenanalyse der Hornhaut.

Various diagnostic procedures have been developed for analyzing the corneal surface. Corneal topographical measurements can be performed by classic Placido disc topographers and tomographers creating three-dimensional corneal models from cross-sectional images. Using a slit scanning system or the Scheimpflug technique additional information about the anterior segment can be obtained. New systems give us a wide range of diagnostic tools. Beside the measurement of the corneal anterior and posterior surfaces and point-to-point-pachymetry they enable analysis of corneal aberrations and measurement of the whole anterior segment, including the anterior chamber and the position of implants, pupil diameter, horizontal white-to-white and the kappa angle. Densitometry, statistical programs for the evaluation of corneal pathology and assistance with intraocular lens calculation following excimer laser treatment are further options available. This article is intended to give an overview of the principles and limitations of the various diagnostic systems.