[Preliminary Examination Before Cataract Surgery]. / Voruntersuchung bei Kataraktoperation.

To plan and execute a successful and safe cataract surgery one must conduct a structured, goal- and patient-oriented examination. The medical history provides crucial information regarding the planning of the anesthetic procedure, lens selection and possible intraoperative complications. Visual acuity and refraction measurements are essential for both documentation and discussion of the selected target refraction. Multifocal lenses have various contraindications to which attention must be paid during slit lamp examination and other imaging diagnostics. These include epithelial basement membrane dystrophy, Fuchs' endothelial dystrophy, zonular weakness, and progressive retinal diseases such as progressive AMD. Tomography reveals corneal irregularities as well as possible refractive laser treatments that have been performed previously. Lens calculation is complicated in these cases. Additionally, an endothelial cell count, aberrometry to rule out higher order aberrations, pupillometry and an analysis of the tear film can provide further information. The patient must be informed verbally about the severity of the procedure and the risks relevant for him with sufficient distance to the surgery.

Refractive and Visual Outcome of Misaligned Toric Intraocular Lens After Operative Realignment.

PURPOSE: The study was performed to evaluate the refractive and visual outcome of patients with misaligned toric intraocular lenses (IOLs) after operative realignment, with and without back-calculation of the toric axis after implantation of the IOL. DESIGN: Institutional, retrospective case-control study. METHODS: This is a retrospective case series of 39 patients who underwent a second operation to realign a misaligned toric IOL from August 2013 to December 2019 at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Ideal toric axis was calculated using the back-calculator astigmatismfix.com. RESULTS: The study consists of 39 treated eyes (20 [51%] right eyes). The toric IOLs showed a postoperative misalignment of 25.69 ± 26.06°. Postrotational, uncorrected distance visual acuity (UDVA) improved from 0.39 ± 0.29 logMAR to 0.27 ± 0.18 logMAR. Refractive outcome showed a reduction of residual sphere and cylinder. The postoperative UDVA when performing alignment to the preoperative calculated axis (51%) was 0.24 ± 0.16 logMAR with a cylinder of 0.90 ± 0.90 diopter (D). In the group with alignment to a back-calculated axis (49%), the UDVA was 0.32 ± 0.20 logMAR with a cylinder of 0.76 ± 0.72 D. High cylinder power IOLs (≥2 D) showed a higher decrease in residual cylinder when back-calculation was performed than low cylinder power IOLs (<2 D) (27% vs 9%). The mean spherical equivalent prediction error of the back-calculator was 0.54 ± 0.55 D. CONCLUSION: Realignment of misaligned toric IOLs improves visual acuity and reduces residual refractive errors. Especially for high cylinder power IOLs, better refractive outcome can be seen when performing a back-calculation before realignment.

[Development and implementation of an operational concept in a university eye hospital in the SARS-CoV-2 pandemic]. / Entwicklung und Implementierung eines Betriebskonzeptes in einer Universitätsaugenklinik im Rahmen der SARS-CoV-2-Pandemie.

The SARS-CoV­2 pandemic poses major challenges for the entire medical care system. Especially in maximum care clinical facilities, a higher exposure to potentially infectious patients or positively tested COVID-19 patients is to be expected. A hospital facility concept was developed in the Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany with the aim of achieving maximum patient safety with maximum employee protection. The current infection control hygiene recommendations of the Robert Koch Institute (RKI), the leading specialist association, were taken into consideration along with the existing hospital hygiene plan of the University Hospital Frankfurt am Main. Incorporated into the developmental process were the Institute for Medical Microbiology and Hospital Hygiene, the occupational medical service department and the board of the University Hospital Frankfurt am Main. The operational concept with individualized measures ensures that (i) the care of outpatients; (ii) the performance of outpatient operations; (iii) and the care of admitted patients and patients undergoing surgery are also guaranteed during the COVID-19 pandemic. All measures have been documented in writing in the clinic's internal quality manual and are thus accessible to all employees. The concept is regularly checked for functionality, so-called stress tests and hygiene inspections are carried out and improvements are made as necessary.