Influence of total intraocular lens diameter on efficacy and safety for in the bag cataract surgery.

CONTEXT: Intraocular lenses with variable total diameter are supposed to fit better in the capsular bag and lead to fewer complications. AIMS: This study aims to investigate the efficacy and the safety of an intraocular lens model with variable total diameter. SETTINGS AND DESIGN: Prospective randomized intraindividual study. SUBJECTS AND METHODS: Thirty-two eyes of sixteen patients with bilateral age-related cataract received standard cataract surgery with implantation of an intraocular lens with a standard diameter in one eye (Quatrix®, Group A) and with a variable total diameter in the fellow eye (Quatrix Evolutive®, Group B). Primary study endpoints included evaluation of refraction stability and posterior capsule opacification (PCO) over a follow-up period of 6 months. STATISTICAL ANALYSIS USED: SPSS (Version 19.0) was used for statistical analysis. RESULTS: Uncorrected and corrected distant visual acuity after 6 months were 0.24 and 0.1 LogMAR in Group A and 0.23 and 0.09 LogMAR in Group B, respectively. The objective and manifest spherical equivalent (OSE, MSE) 6 months postoperatively were + 0.65 D and + 0.62 D in Group A compared to + 0.33 D and + 0.33 D in Group B respectively (P = 0.665 for OSE, P = 0.208 for MSE). PCO-index increased statistically significant in both groups (P = 0.004 in Group A, P = 0.046 in Group B), but the difference of PCO-index between both groups was not statistically significant (P = 0.569). CONCLUSIONS: An intraocular lens with a variable total diameter shows good visual outcomes and safety performance as well as same outcomes concerning postoperative refractive stability and development of PCO compared to an intraocular lens with standard total diameter.

Corneal cell response after flap creation using a mechanical microkeratome or a 200 kHz femtosecond laser.

PURPOSE: To compare the inflammatory cell response within the corneal flap interface created by a mechanical microkeratome and a femtosecond laser. SETTING: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. DESIGN: Experimental in vitro study. METHODS: Corneoscleral buttons of 12 enucleated human eyes not suitable for transplantation were put into organ culture. Corneal flaps were created using a 200 kHz femtosecond laser (Visumax) (femtosecond group) or a mechanical microkeratome (Amadeus) (microkeratome group). Flaps were not lifted after treatment. In 2 corneas, no treatment was performed (control group). Corneas were kept in organ culture for 12 hours thereafter. To evaluate cell-mediated immune reaction, immunofluorescent staining for leucocytes (cluster of differentiation 45) and specifically for dendritic cells (human leukocyte antigen-DR) was performed in every group. A terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was used to determine apoptosis reaction. RESULTS: The ratio of dendritic cells in the femtosecond group compared with the microkeratome group was 1.2 (P=.02), the ratio of leucocytes was 1.4 (P=.06), and the ratio of apoptotic cells was 1.0 (P=.59). There was no marked significant difference in the distribution of inflammatory cell reaction. The control group showed neither specific inflammatory reaction nor apoptosis. CONCLUSION: This in vitro series of human corneas showed similar inflammatory tissue reaction after femtosecond laser-assisted and microkeratome-assisted flap creation (P<.05). FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of interface quality in organ-cultured lamellar corneal transplants.

BACKGROUND: With increasing numbers of lamellar keratoplasties, eye banks are challenged to deliver precut lamellar donor tissue. In Europe, the most common technique of corneal storage is organ culture which requires a deswelling process before surgical processing. The aim of this study was to investigate the influence of different deswelling times on the cutting plane quality after microkeratome-assisted lamellar dissection. METHODS: Eight paired donor corneas (16 specimens) not suitable for transplantation were organ cultured under standard conditions at the Eye Bank of the Ludwig-Maximilians Universität, Munich, Germany. Pairs of corneal buttons were analyzed during the deswelling process in dextrane-containing medium. While one cornea was cut at an early time point during the deswelling process and put back into deswelling medium thereafter, the partner cornea was completely deswollen and dissected after 72 hours. Specimens were then further processed for scanning electron microscopy. Surface quality was assessed both digitally using Scanning Probe Imaging Processing software, and manually by three blinded graders. RESULTS: The corneal buttons processed at the beginning of the deswelling process had a smoother surface when compared to the partner cornea that was cut at the end of the deswelling process. In our setting, no relevant difference was detectable between manual and automated microkeratome dissection. CONCLUSION: For lamellar keratoplasty, organ-cultured corneas should be processed at an early stage during the deswelling process. We interpret the smoother dissection plane during early deswelling as a result of mechanical properties in a highly hydrated cornea.

Lamellar keratoplasty with a novel anterior chamber system and organ cultured donor corneas.

PURPOSE: To present a novel artificial anterior chamber system for anterior and posterior lamellar keratoplasty. METHODS: The artificial anterior chamber system MOZARTTM in conjunction with the AMADEUSTM II microkeratome was evaluated for its applicability in anterior and posterior lamellar keratoplasty using organ cultured donor corneas. RESULTS: Twelve patients underwent microkeratome-assisted lamellar keratoplasty for corneal opacifications due to either anterior stromal scaring or endothelial decompensation. Eight patients underwent Descemet stripping automated endothelial keratoplasty (DSAEK) and 4 patients underwent anterior lamellar keratoplasty (ALK). A 400-microm and 250-microm cutting head was used for DSAEK and ALK, respectively. In all patients, an 8.5-mm suction ring was applied. For the 250-microm cutting head, a mean anterior lamella thickness of 244+/-12 microm was found. For the 400-microm cutting head, a mean anterior lamella thickness of 390+/-18 microm was found. The graft diameter was 8.85+/-0.5 mm for the 8.5-mm suction ring with both cutting heads. Deswelling of the anterior donor lamella was 11.5% compared to 30% of the posterior lamella transplant after 6 months of follow-up. CONCLUSION: The AMADEUSTM II microkeratome in conjunction with the MOZARTTM artificial anterior chamber system proved to be a suitable device for modern lamellar keratoplasty. Swelling and deswelling characteristics of organ cultured corneas need to be further investigated to optimize the deswelling time prior to donor cornea sectioning in lamellar keratoplasty.

Two-step LASIK after penetrating keratoplasty.

PURPOSE: The point of interest of this retrospective case review is to study refractive changes caused by the hinged lamellar keratotomy and the refractive outcome after laser ablation in a second step within the scope of laser in situ keratomileusis (LASIK) in patients with penetrating keratoplasty. METHODS: Data from eight patients obtained before lamellar keratotomy, before laser ablation, and three months later were evaluated. Keratotomies were performed with the Moria((R)) LSK one and the Amadeus((R)) 2 microkeratome, laser ablation was performed with the Schwind((R)) Keratome I and the Wavelight((R)) Allegretto WaveEyeQ. RESULTS: Uncorrected visual acuity (UCVA) improved significantly from 1 [logMar] to 0.4 [logMar] at the last visit. Median gain of UCVA was 7.38 +/- 2.96 Snellen lines. Best spectacle-corrected visual acuity did not change significantly. Preoperative manifest refraction spherical equivalent decreased from -4.02 +/- 4.77 diopters (D) to -1.11 +/- 2.45 D after laser ablation. Mean preoperative manifest astigmatism was -7.27 +/- 3.65 D, after lamellar keratotomy -6.72 +/- 3.68 D, and after laser ablation -2.08 +/- 1.80 D. Manifest astigmatism did not change significantly after the keratotomy. CONCLUSIONS: Lamellar keratotomy causes biomechanical changes to the cornea. We favor a two-step LASIK in penetrating keratoplasty patients in order to improve precision and predictability of the refractive outcome.

Cytoprotective effects of a blue light-filtering intraocular lens on human retinal pigment epithelium by reducing phototoxic effects on vascular endothelial growth factor-alpha, Bax, and Bcl-2 expression.

PURPOSE: To compare the possible protective effects of the ultraviolet (UV)-filtering and blue light-filtering SN60AT intraocular lens (IOL) and the untinted UV-filtering SA60AT IOL with regard to light-induced stress on human retinal pigment epithelium (RPE). SETTING: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. METHODS: Primary human RPE cells were exposed to white light, and a tinted or untinted IOL was placed in the light beam. After 15 to 60 minutes of irradiation, cell viability was determined by a colorimetric test (tetrazolium dye-reduction assay) and a microscopic live/dead assay. The expression of vascular endothelial growth factor-alpha (VEGF-alpha), Bax, and Bcl-2 and their mRNA was determined by reverse-transcription polymerase chain reaction (RT-PCR) and Western blotting. RESULTS: Without an IOL, white-light exposure decreased cell viability compared with the decrease with the nonirradiated control in a time-dependent manner. Light-induced cell death was significantly reduced by both the tinted IOL and untinted IOL. The combined UV and blue-light filtering attenuated light-induced cell damage significantly more than UV filtering alone. Results of RT-PCR and Western blotting showed a significant time-dependent decrease in Bcl-2 and increase in Bax and VEGF-alpha that were significantly less with the tinted IOL than with the untinted IOL. CONCLUSIONS: Both IOLs reduced light-induced RPE damage. The UV- and blue light-filtering IOL reduced damage more than the conventional IOL. This supports the hypothesis that blue light-filtering IOLs may prevent retinal damage in clinical use.

Performance of the Acri. Smart 46S intraocular lens in pediatric microincision cataract surgery.

PURPOSE: To evaluate the performance of the microincision Acri. Smart 46S intraocular lens (IOL) (Acri.Tec) in pediatric cataract surgery. SETTING: Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany. METHODS: Thirty-two consecutive eyes of 22 children who had cataract surgery with planned IOL implantation were retrospectively analyzed. Intraoperative and postoperative IOL performance, posterior capsule opacification (PCO) formation, best corrected far and near visual acuities, and astigmatism were analyzed. The minimum follow-up was 12 months. RESULTS: The median patient age was 4.5 years (range 2 to 13 years) and the median follow-up, 21 months (range 12 to 29 months). In 94% of eyes, the IOL was implanted in the capsular bag; in 6%, it was placed in the ciliary sulcus. A primary posterior capsule opening was created in 12.5% of eyes. The posterior capsule was intact at the end of surgery in 81% of eyes. Capsule rupture occurred during lens aspiration in 3% of eyes, and a primary capsular defect was present in a patient with traumatic cataract. Posterior capsule opacification that required a second intervention during the follow-up period developed in 35% of eyes. All IOLs were well centered and had a clear optical axis at the end of follow-up. CONCLUSIONS: The Acri. Smart (46S) IOL was found to be suitable for pediatric bimanual microincision cataract surgery. The feasibility of inserting the IOL through of the sub-2.0 mm paracentesis minimizes manipulation of the juvenile eye.

Eccentric lamellar keratolimbal grafts harvested with a manually guided microkeratome. Technical report.

BACKGROUND: To perform lamellar keratolimbal allograft transplantation in a one-step procedure with a single graft, we investigated the feasibility of harvesting eccentric lamellar keratolimbal grafts from conventionally processed corneoscleral buttons using a manually guided microkeratome in conjunction with an artificial anterior chamber system. METHODS: We used the Moria LSK-One microkeratome and the automated lamellar therapeutic keratoplasty (ALTK) system (Antony, France). Ten human donor eyes were used to obtain single-piece lamellar keratolimbal grafts. Specimens were processed for light and electron microscopy. RESULTS: Eccentric keratolimbal grafts could be obtained from all human donor buttons. Grafts include a crescent-shaped limbal and a large corneal portion. No visible damage to the limbal region was discernible. CONCLUSION: Our data show that the LSK-One microkeratome in conjunction with the ALTK system allows harvesting eccentric keratolimbal grafts from donor corneoscleral buttons.

Indications and clinical outcome of capsular tension ring (CTR) implantation: A review of 9528 cataract surgeries.

BACKGROUND: To report the indications and clinical outcomes of all capsular tension ring (CTR) implantations in a large series of consecutive cataract surgeries during a five year interval in a university eye hospital. METHODS: The study was designed as a restrospective analysis of a consecutive series of 9528 cataract surgeries. The records were checked for cases in which a CTR was implanted. The indications and clinical outcomes of CTR implantation were documented and an evaluation of posterior chamber intraocular lens (PCIOL) insertion, position, and centration. RESULTS: In this series, a CTR was implanted in 69 eyes of 67 patients. The indications were advanced or mature cataract in 40, post-traumatic cataract in 23, pseudoexfoliation syndrome in 4 and subluxated lens in 2 eyes. PCIOL implantation in the capsular bag was possible in 61 (90%) of these 69 eyes. In 5 (7%) additional eyes, PCIOL implantation in the ciliary sulcus was accomplished. In one eye (1%) no IOL implantation was performed because of high myopia. In only two of 69 eyes (2%), an anterior chamber intraocular lens had to be inserted despite prior CTR implantation. In 5 eyes (5%), a slight dislocation of the IOL was noted postoperatively, but none of these patients complained of visually relevant symptoms (eg, monocular diplopia). CONCLUSIONS: According to our experience CTRs are used very infrequently (0.7%), but remain useful in cataract surgeries with difficult preoperative or intraoperative conditions. If zonulolysis is less than two quadrants in extent, implantation of a PCIOL was possible in 98% of cases. Implantation of CTRs with special designs may have additional advantages (eg, inhibition of posterior capsule opacity) and warrant further investigation.