[Preoperative management of subconjunctival/sub-Tenon's glaucoma surgery with special consideration of the gel implant (XEN®)]. / Präoperatives Management bei subkonjunktivalen/subtenonalen glaukomchirurgischen Operationen unter besonderer Berücksichtigung des Gelimplantats (XEN®).

BACKGROUND: When using subconjunctival/sub-Tenon's ab interno glaucoma surgical procedures, patient selection and preoperative management are essential to reduce postoperative scarring of the bleb. OBJECTIVE: The aim of this study was to compile a list of risk factors that may have an unfavorable effect on the scarring process. METHOD: A literature search was carried out in PubMed with respect to the scarring process of the gel implant XEN®. RESULTS: Ophthalmological risk factors for conjunctivoscleral/Tenon's wound healing process include dry eye, allergies, use of eye drops containing preservatives and previous eye surgery. CONCLUSION: The preoperative administration of artificial tear substitutes, corticosteroids and the fundamental change to preservative-free eye drops can support the normalization of a chronic inflammatory altered conjunctiva and thus positively influence the wound healing process after surgery.

[Clinical Comparison of a Trifocal and a Trifocal-Toric Intraocular Lens Based on the Same Diffractive Platform]. / Klinischer Vergleich einer trifokalen und einer trifokal-torischen Intraokularlinse auf gleicher diffraktiver Plattform.

Purpose To evaluate and compare the visual performance of a trifocal and a trifocal-toric intraocular lens (IOL) based on the same diffractive platform. Methods Prospective non-randomized comparative study enrolling 142 eyes of 77 patients (age 40-73 years) undergoing uneventful phacoemulsification lens surgery. Two groups were differentiated according to the implanted IOL: trifocal group, 98 eyes (50 patients) implanted with the trifocal diffractive IOL AT LISA tri 839MP (Carl Zeiss Meditec), and trifocal-toric group, 44 eyes (27 patients) implanted with the trifocal-toric diffractive IOL AT LISA trifocal-toric 939MP (Carl Zeiss Meditec). Visual and refractive changes were evaluated 3 months postoperatively. Results No significant differences between groups were found in postoperative refraction (p ≥ 0.144), monocular and binocular uncorrected intermediate visual acuity (UIVA; p = 0.519 and 0.398, respectively) and binocular uncorrected near visual acuity (UNVA; p = 0.073). In contrast, significantly better monocular and binocular uncorrected distance visual acuity (UDVA; p ≤ 0.002), as well as monocular UNVA (p = 0.005), were found in the trifocal group. A postoperative spherical equivalent within ± 1.00 D was found in 98 % and 100 % of eyes in the trifocal and trifocal-toric groups, respectively. Postoperative binocular UDVA, UIVA and UNVA of 20/30 or better were found in 100, 95 and 100 % of eyes, and in 96.3, 95.8 and 90.9 % of eyes in the trifocal and trifocal-toric groups, respectively. Conclusions The evaluated trifocal and trifocal-toric IOLs both provide a successful restoration of the visual function after cataract surgery, with good levels of refractive precision, as well as UIVA and UNVA.

[Impact of Different Percent Tissue Altered Values on Visual Outcome after Refractive Small Incision Lenticule Extraction (ReLEx SMILE)]. / Auswirkung verschiedener Percent-Tissue-altered-Werte auf das Behandlungsergebnis bei refraktiver Small Incision Lenticule Extraction (ReLEx SMILE).

Purpose To compare the visual outcomes after ReLEx SMILE treatment of eyes with low and high PTA values (PTA: percent tissue altered) within a follow-up period of up to 3 years and to assess whether a high PTA value might contribute to the development of keratectasia, as is the case for LASIK. Methods This retrospective analysis comprises results from 313 eyes (189 patients) with a PTA value of less than 40 % and of 373 eyes (213 patients) with a PTA value of at least 40 %. Preoperatively and up to 3 years after SMILE surgery, refraction values, monocular corrected (CDVA) and uncorrected distant visual acuity (UDVA) and wavefront data were evaluated. Results One to 3 years after surgery, the group with PTA < 40 % (PTA ≥ 40 %) had a loss of two Snellen lines in 1.1 % (0.0 %) of the cases. Loss of one line occurred in 1.1 % (3.6 %) of the eyes, whereas 97.7 % (96.4 %) remained unchanged or gained lines. With respect to predictability of the spherical equivalent, 92.0 % (78.6 %) of the eyes were within ± 0.5D and 97.7 % (92.9 %) were within ± 1.0D. The group with high PTA values displayed a slightly but significantly greater undercorrection of about 0,25D. 74.4 % (71.8 %) achieved UDVA of at least 20/20 and 96.5 % (87.1 %) achieved at least 20/25. The mean UDVA was - 0.03 ± 0.10logMAR (0.01 ± 0.12logMAR) and its mean difference to the preoperative CDVA was 0.00 ± 0.09logMAR (0.03 ± 0.12logMAR). Conclusion ReLEx SMILE is a safe and effective corneal refractive treatment, even for PTA values of 40 % and more. Eyes with high PTA values did not display any evidence of keratectasia development within the 3-year follow-up of this study.

[Functional Results 3 Months after Implantation of an "Extended Range of Vision" Intraocular Lens]. / Funktionelle Ergebnisse 3 Monate nach Implantation einer "Extended-Range-of-Vision"-Intraokularlinse.

PURPOSE: Evaluation of the visual and refractive results 3 months after implantation of a diffractive extended range of vision (ERV) intraocular lens (IOL) during cataract surgery. METHODS: In a prospective multicentre study, patients with a calculated postoperative corneal astigmatism of ≤ 1.5 D received a diffractive ERV IOL (TECNIS Symfony, model ZXR00, Abbott Medical Optics, USA) during cataract surgery. After 3 months, the monocular and binocular corrected and uncorrected far, intermediate and near visual acuity, as well as refraction, were evaluated. RESULTS: 18 patients (36 eyes) with a mean age of 63.34 ± 4.6 years underwent bilateral cataract surgery. After 3 months, the binocular uncorrected distance visual acuity (UDVA) of logMAR was - 0.05 ± 0.11 and the corrected distance visual acuity (CDVA) of logMAR - 0.14 ± 0.05. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were logMAR - 0.09 ± 0.02 and 0.19 ± 0.09, respectively. A target refraction of ± 0.75 D was reached by 89 % of the patients. CONCLUSION: Implantation of an extended range of vision intraocular lens offers an effective way for visual rehabilitation at far and intermediate distances. Near vision is still in a functional range.

[Functional Results One Year after Implantation of a Bitoric, Trifocal Intraocular Lens]. / Funktionelle Ergebnisse 1 Jahr nach Implantation einer bitorischen, trifokalen Intraokularlinse.

PURPOSE: An evaluation of the visual and refractive results was undertaken one year after implantation of a trifocal diffractive toric intraocular lens (IOL) during cataract surgery. METHODS: In a prospective study patients with a calculated postoperative corneal astigmatism of ≥ 0.75 D received a diffractive trifocal toric IOL (AT LISA tri toric 939MP, Carl Zeiss Meditech, Jena, Germany) during cataract surgery. One year postoperatively the near, intermediate and distance visual acuity, corrected and uncorrected vision as well as refraction were evaluated. RESULTS: 20 patients (40 eyes) with a median age of 59 ± 11 years of which 15 were female underwent bilateral cataract surgery. One year postoperatively a binocular uncorrected distance visual acuity (UDVA) of 0.10 logMAR ± 0.11 and a corrected distance visual acuity (CDVA) of 0.00 logMAR ± 0.08 could be found. Binocular intermediate visual acuity (UIVA) and near visual acuity (UNVA) were 0.00 logMAR ± 0.05 and 0.09 logMAR ± 0.07, respectively. 100 % of patients were between ± 1.0 D from target refraction. Even 1 year after surgery no patient had an IOL rotation greater than 5°. CONCLUSION: The implantation of a trifocal toric intraocular lens offers an effective way for visual rehabilitation in near, intermediate and far distances with a good rotational stability of the IOL platform.