[Vitreous body and retinal vein occlusion]. / Glaskörperstatus und retinaler Venenverschluss.

PURPOSE: The aim of this study was to evaluate whether the adhesion status of the posterior vitreous cortex (PVC) towards the internal limiting membrane (ILM) has an impact on the development of retinal vein occlusion (RVO). MATERIAL AND METHODS: In a retrospective analysis the operation protocols of 238 eyes receiving pars plana vitrectomy (ppV) and radial optic neurotomy (RON) for central retinal vein occlusion (CRVO) or ppV in combination with arteriovenous sheathotomy (AVS) for branch retinal vein occlusion (BRVO) were evaluated with respect to the intraoperative status of posterior vitreous body adhesion. The results were compared with age-matched healthy controls. RESULTS: In this study 145 eyes (60.9 %) suffering from CRVO and 93 eyes (39.1 %) diagnosed with BRVO were included. In eyes with CRVO and BRVO the posterior vitreous cortex (PVC) was significantly more often attached (126 eyes, 86.9 % and 89 eyes, 95.7 %, respectively) than completely detached (19 eyes, 13.1 % and 4 eyes, 4.3 %, respectively, in each case p < 0.001). In the age groups between 70 and 79 years as well as between 80 and 89 years the PVC was significantly more often attached in both RVO entities in comparison to age-matched healthy controls (CRVO 70-79 years, p = 0.001 and 80-89 years, p = 0.002 and BRVO 70-79 years, p < 0.001, 80-89 years, p = 0.011). In eyes from the age group between 65 and 69 years (of age) the PVC was not significantly more often attached in comparison to healthy controls (CRVO p = 0.334 and BRVO p = 0.114). CONCLUSION: According to these findings posterior vitreous adhesion is an independent risk factor for the development of retinal vein occlusion among patients aged 70 years or older.

[Functional results with two multifocal intraocular lenses with different near addition]. / Funktionelle Ergebnisse zweier Multifokallinsen mit unterschiedlicher Nahaddition.

BACKGROUND: The reduction of the near addition of multifocal intraocular lenses from +4 D to +3 D should improve the visual function in the intermediate distance. The ReSTOR +3 D is a multifocal lens with a near addition of 3 D. PATIENTS AND METHODS: In a prospective study the new ReSTOR +3 D was compared to the former ReSTOR platform with 4 D near addition. A total of 40 patients received 1 of these 2 multifocal lenses bilaterally in both eyes after uneventful phacoemulsification in otherwise sound cataract eyes (20 patients ReSTOR +3 D, 20 patients ReSTOR + 4D). After 3 months the following parameters were assessed: uncorrected and corrected distance visual acuity, near vision at different distances, contrast sensitivity, defocus curve and anterior and posterior segments. The functional tests were performed monocularly and binocularly. RESULTS: Uncorrected binocular distance visual acuity (decimal) was 0.93 (logMAR 0.03 ± 0.12) in the ReSTOR +3 D group and 1.05 (-0.02 ± 0.1) in the ReSTOR +4 D group. In the intermediate distance the ReSTOR +3 D performed slightly better at 40 cm (0.68 versus 0.56) (logMAR 0.17 ± 0.14 versus 0.24 ± 0.18). The difference was significant (p<0.01) at 70 cm (0.69 versus 0.43) (logMAR 0.16 ± 0.27 vs 0.37 ± 0.2). The superior performance of the ReSTOR +3 D in the intermediate distance was also clearly visible in the defocus curves. All functional tests revealed significantly better results when performed binocularly. CONCLUSION: The ReSTOR +3 D multifocal intraocular lens performed significantly better in the intermediate distance compared to the ReSTOR +4 D. The other functional tests showed excellent and equal results with both lenses. The reduction of near addition does not increase dysphotopsia, particularly halos. Complaints of unsatisfactory vision in the intermediate distance were reported only by patients with the ReSTOR +4 D. The new ReSTOR +3 D is likely to improve the acceptance of multifocal intraocular lenses.

[Clinical results of the aspheric intraocular lens FY-60AD (Hoya) with particular respect to decentration and tilt]. / Klinische Ergebnisse unter besonderer Berücksichtigung von Dezentrierung und Verkippung der asphärischen Intraokularlinse FY-60AD.

BACKGROUND: Aspheric intraocular lenses (IOLs) aim to improve visual function and particularly contrast vision by neutralizing spherical aberration. One drawback of such IOLs is the enhanced sensitivity to decentration and tilt, which can deteriorate image quality. METHODS: A total of 30 patients who received bilateral phacoemulsification before implantation of the aspheric lens FY-60AD (Hoya) were included in a prospective study. In 25 of the patients (50 eyes) the following parameters could be assessed 3 months after surgery: visual acuity, refraction, contrast sensitivity, pupil size, wavefront errors and decentration and tilt using a newly developed device. RESULTS: The functional results were very satisfying and comparable to results gained with other aspheric IOLs. The mean refraction was sph + 0.1 D (±0.7 D) and cyl 0.6 D (±0.8 D). The spherical equivalent was −0.2 D (±0.6 D). Wavefront measurements revealed a good compensation of the corneal spherical aberration but vertical and horizontal coma also showed opposing values in the cornea and IOL. The assessment of the lens position using the Purkinje meter demonstrated uncritical amounts of decentration and tilt. The mean amount of decentration was 0.2 mm±0.2 mm in the horizontal and vertical directions. The mean amount of tilt was 4.0±2.1° in horizontal and 3.0±2.5° in vertical directions. CONCLUSIONS: In a normal dioptric power range the aspheric IOL FY-60AD compensates the corneal spherical aberration very well with only minimal decentration. The slight tilt is symmetrical in both eyes and corresponds to the position of the crystalline lens in young eyes. This may contribute to our findings of compensated corneal coma.

[Functional vision training after MIOL implantation]. / Funktionstraining nach MIOL-Implantation.

In a prospective and intraindividually comparative study, we investigated visual performance after implantation of two multifocal intraocular lenses. Eight patients received the ReSTOR (Alcon) bilaterally, and eight patients received the Tecnis ZM900 (AMO). The nondominant eye of each patient was trained based on the concept of perceptual learning using orientation discrimination of near-vertical bars. The fellow eye served as a control. After 3 h of training distributed over 2 weeks, the mean improvement of orientation discrimination in the trained eyes was 44%, which was significantly higher compared with the control eyes (9%). Moreover, contrast sensitivity and near vision under different contrast levels showed a significant benefit of training. These results support the concept of improving visual function by training after multifocal lens implantation. The superior function of the trained eyes was still present at the 6-month follow-up.

[The aspheric blue light filter IOL AcrySof IQ compared to the AcrySof SA60AT : influence of IOL power, pupil diameter, and corneal asphericity on postoperative spherical aberration]. / Die asphärische Blaulichtfilter-IOL AcrySof IQ im Vergleich mit der AcrySof SA60AT : Abhängigkeit der postoperativen sphärischen Aberration von IOL-Brechkraft, Pupillenweite und Asphärizität der Hornhaut.

BACKGROUND: The aspheric optic design of intraocular lenses (IOL) aims to minimize postoperative ocular spherical aberration (SA). The effect of a standardized IOL asphericity depends on IOL power, pupil diameter, and corneal asphericity. The impact of these factors was investigated in a comparative study. MATERIAL AND METHODS: In a prospective study, 70 eyes with the aspheric blue light filter IOL AcrySof IQ (Alcon) were compared to 36 eyes with the conventional AcrySof SA60AT (Alcon). Six weeks after uneventful phacoemulsification the following parameters were assessed: visual acuity, higher order aberrations, pupil diameter, and corneal asphericity. RESULTS: The comparison of 42 eyes in a normal dioptric range with the IQ IOL (22.4+/-2.0 D) to 20 eyes with the control lens of similar IOL power (22.0+/-2.7 D) showed no different visual outcome. For a 5-mm pupil SA was calculated at 0.04 (+/-0.05) microm for the IQ IOL and 0.20 (+/-0.06) microm for the AcrySof SA60AT. Also for a 4-mm pupil SA was significantly lower in eyes with the IQ lens. A separate evaluation of 28 eyes which needed very high or low IOL power revealed a similar postoperative SA for the IQ IOL. The greatest difference of SA between the two IOLs was found in hyperopic eyes with higher IOL power. The corneal asphericity (Q value) showed significant correlation to postoperative ocular SA. CONCLUSIONS: The aspheric AcrySof IQ reduces postoperative SA significantly compared to a conventional IOL even with smaller pupils and independent of IOL power. The assessment of corneal asphericity enables an individual estimation of postoperative SA.

[First results with a new aberration correcting bifocal intraocular lens]. / Erste Ergebnisse mit einer neuen aberrationskorrigierten intraokularen Bifokallinse.

OBJECTIVE: To investigate the functional results with a new bifocal intraocular lens. METHODS: The *Acri.LISA (*Acri.Tec) was implanted bilaterally in 20 patients after uneventful cataract surgery. The new bifocal IOL has a light distribution of 65% for distance and 35% for the near range. The diffractive optics of the lens are designed to be independent of pupil size. Smooth steps in diffractive structure should reduce glare. An aspheric design of the posterior optic surface is engineered to counteract the asphericity of the cornea (-0.26). Postoperative evaluation included 6 weeks after surgery: uncorrected (UCVA) and best corrected (BCVA) visual acuity for distance (ETDRS charts) and near (C.A.T. charts, Birkhäuser charts) monocular and binocular, defocus curve, contrast sensitivity under photopic and mesopic lighting conditions (F.A.C.T.), and subjective assessment of halos RESULTS: At the 6-week follow-up mean binocular UCVA and BCVA (LogMAR) were -0.02+/-0.10 and -0.07+/-0.09, respectively, for distance. Near UCVA (LogMAR) was 0.09+/-0.16; distance corrected near VA was 0.04+/-0.13. Visual acuity was significantly superior when tested binocularly compared to monocular testing (p<0.01). The depth of field showed an intermediate decimal VA of 0.6+/-0.21 at 70 cm and a pseudoaccommodation range of 5.5 D. Of 20 patients, 16 reported slight halos, but no patient was seriously impaired. CONCLUSIONS: The *Acri.LISA showed very good visual performance 6 weeks after bilateral surgery.

[Radial optic neurotomy: efficacy monitoring using venous ophthalmodynamometry]. / Radiäre Optikusneurotomie beim Zentralvenenverschluss: Erfolgskontrolle mittels ophthalmodynamometrischer Venendruckmessung.

BACKGROUND: Retinal central venous outflow pressure (VOP) can be measured with a new ophthalmodynamometer (Meditron, Völklingen, Germany). Radial optic neurotomy (RON) is a new surgical approach for central retinal vein occlusion (CRVO) which is still controversially discussed. Particularly the early formation of retinochoroidal collaterals is intended to achieve normalization of the preoperatively increased pressure in the central retinal vein. We investigated the VOP after RON. PATIENTS AND METHODS: In total, 21 eyes of 21 patients (9 male, 12 female) suffering from CRVO were treated by RON. Pars plana vitrectomy with nasal radial optic neurotomy and peeling of the internal limiting membrane were performed. The mean follow-up time was 10.8 months (6-24 months). Central venous outflow pressure was measured using ophthalmodynamometry. RESULTS: The most frequent concomitant ophthalmic disease was glaucoma (52%), and the predominantly associated systemic disease was hypertension (81%). After RON in 16 eyes (76%) visual acuity improved by at least 2 lines; in 3 eyes (14%) visual acuity was unchanged (+/-1 line) and in 2 patients (10%) visual acuity decreased by 2 or more lines. Eyes with visual improvement and formation of chorioretinal anastomosis postoperatively showed a significantly lower venous outflow pressure assessed with ophthalmodynamometry.

[Incidence and prophylaxis of retinal detachment following pars plana vitrectomy]. / Inzidenz und Prophylaxe der Netzhautablösung nach Pars-plana-Vitrektomie.

PURPOSE: The aim of this study was to investigate the incidence of retinal detachment (RD) following pars plana vitrectomy and the efficacy of prophylactic means by cryoapplication central to the superior sclerotomies. PATIENTS AND METHODS: From February 2002 to January 2005 a total of 2,298 eyes received a pars plana vitrectomy in our department. Excluding eyes with previous peripheral coagulation therapy, preexisting retinal detachment, and endophthalmitis 1,640 eyes could be reexamined at least 6 months after surgery (mean: 17+/-12 months). The incidence of RD was compared between two groups: one with intraoperative cryoapplication central to the superior sclerotomies (n=533) and one without any prophylactic treatment (n=1,107). RESULTS: A total of 66 rhegmatogenous RD occurred during the follow-up, 23 with prophylactic cryotherapy and 43 without. This difference does not reach the level of significance. Only a subgroup of eyes operated on for macular pucker and venous occlusions showed a strong trend to prove the efficacy of prophylactic cryotherapy (p=0.07). Comparing the first 934 surgeries performed with the last 706 the incidence of RD decreased from 5.25 to 2.41%. CONCLUSIONS: The incidence of RD could be decreased significantly during the period investigated. Cryoapplication at the superior sclerotomies failed to reach statistical significance in the total group, though the results in eyes in two special subgroups showed a strong trend towards a protective effect of cryoapplication (p=0.07). Other factors may have contributed to the reduction of RD after pars plana vitrectomy.

[Functional results with two multifocal intraocular lenses (MIOL). Array SA40 versus Acri.Twin]. / Funktionelle Ergebnisse nach Implantation multifokaler Intraokularlinsen (MIOL). Array SA40 versus Acri.Twin.

BACKGROUND: A multifocal intraocular lens (MIOL) with diffractive and aspherical optical design and asymmetrical light distribution (Acri. Twin, Acri.Tec) was compared to the standard MIOL, the Array SA40. PATIENTS AND METHODS: After 6 months, 16 patients with bilateral implantation of the Acri. Twin and 14 patients with bilateral Array IOL were examined to assess uncorrected and best corrected visual acuity for distance and near, contrast sensitivity under photopic and mesopic conditions, stereopsis, pupil diameter, and centration of the IOL. RESULTS: A significant difference was observed between the two MIOL in improved near visual acuity of the Acri. Twin MIOL (0.8 vs 0.4). Most of the patients described dysphotic phenomena, which were somewhat different for both MIOL, but expressed general satisfaction except for one patient. Concerning contrast sensitivity both MIOL were significantly inferior to data published for an aspherical monofocal IOL.

[Surgical approach to retinal vein occlusion]. / Chirurgische Therapie retinaler Venenverschlüsse.

Retinal vein occlusions are the second most common vision threatening retinal vascular disorders. Our therapeutic armamentarium for functional improvement was very limited in the past for all types of retinal vein occlusions (branch, central and hemi-central retinal vein occlusion). Also pathomechanism and risk factors are not completely understood yet. Argon-laser-photocoagulation can prevent the development and treat neovascularizations successfully, but is unable to improve visual function in most cases. Thrombolytic therapy applied systemically is limited due to serious side effects but may be helpful when injected intraocularly. Isovolemic hemodilution may be efficacious in central retinal vein occlusion (CRVO). The creation of a laser-induced chorioretinal venous anastomosis showed serious complications. Since 1999 numerous reports on successful surgical techniques were published. It could be shown that the dissection of the adventitial sheath with separation of the artery from the vein at the arteriovenous crossing where branch retinal vein occlusion occurs can re-establish the retinal blood flow with reduction of macular edema. But it is still unclear which step of the surgery (vitrectomy, ILM-peeling, sheathotomy) is causative for the results. A new surgical approach in CRVO is the radial optic neurotomy (RON). This technique was primarily performed under the hypothesis of decompression of the central vein by cutting the scleral ring. Meanwhile there is some evidence that the formation of chorioretinal shunts may be the decisive factor in cases of successfully performed RON. Due to inconsistent and rare data this surgical procedure needs further evaluation. Another surgical option is the cannulation of the occluded vein. This technique seems to be feasible but the clinical results still have to be proved. Despite several uncertainties and open questions, surgical techniques are likely to overcome the desolate therapeutic situation for retinal vein occlusion of the past.

[Comparison of Healon, Healon GV, and Healon 5 in viscotrabeculectomy]. / Vergleich von Healon, Healon GV und Healon 5 bei der Viskotrabekulektomie.

BACKGROUND: The aim of this study was to determine the efficacy of three viscoelastics of different viscosities in preventing early postoperative complications after trabeculectomy (TE) and phacotrabeculectomy (PT). METHODS: One hundred seventy-one eyes of 149 consecutive patients underwent TE or PT. In all cases, Healon, Healon GV, or Healon 5 was instilled in the anterior chamber at the beginning of surgery and left there at the end. RESULTS: Four hours postoperatively, the mean intraocular pressure (IOP) in all groups was below 13 mmHg (27.4 mmHg preoperatively) and did not rise above 13 mmHg in the first postoperative week. Postoperative IOP spikes did not occur in any group. Healon remained in the anterior chamber up to 4 days after surgery, Healon GV up to 6 days, and Healon 5 up to 9 days. Characteristic early postoperative complications of filtering procedures, such as choroidal detachment, shallow anterior chamber, iridocorneal contact, hyphema, and bleb failure, were not observed in our patients. CONCLUSION: All three viscoelastics reduced early postoperative complications with comparable efficacy and without IOP spikes.

[Treatment of retinal vein occlusion. Vitrectomy with arteriovenous decompression and dissection of the internal limiting membrane]. / Behandlung retinaler Venenastverschlüsse. Vitrektomie mit arteriovenöser Dekompression und Präparation der Membrana limitans interna.

BACKGROUND: Our therapeutical armamentarium for functional improvement after branch retinal vein occlusion (BRVO) is still limited and the efficacy is uncertain. Recently, surgical decompression of the vein at the arteriovenous crossing (AV decompression) has again been proposed as a suitable form of treatment. MATERIAL AND METHODS: A total of 40 patients with BRVO were treated in our department from August 1999 to February 2001 with AV decompression and 22 patients with comparable BRVO who refused this surgical intervention served as control. The surgical procedure consisted of a standard pars plana vitrectomy and separation of the overlying artery from the vein using microscissors. In 13 cases dissection of the internal limiting membrane was additionally performed. Assessment of visual acuity, fluorescein angiography and multifocal ERG in 7 patients was performed preoperatively and 6 weeks after surgery. RESULTS: The surgical procedure and postoperative course were uneventful. In most of the treated eyes, visual acuity improved and fluorescein angiography revealed capillary reperfusion. Functional results in patients with AV-decompression were highly significantly better than in the control group. CONCLUSION: Our results with surgical decompression of branch retinal vein occlusions demonstrate the therapeutical effect of surgical AV-decompression in BRVO. Further experience is necessary before some open questions can be answered.

[Corneal endothelial protection in phacoemulsification of high risk eyes with cornea guttata. Intra-individual comparison of 2 visco-elastic substances of different viscosity and molecular size]. / Hornhautendothelschutz bei Phakoemulsifikation an Risikoaugen mit Cornea guttata. Intraindividueller Vergleich zweier Viskoelastika unterschiedlicher Viskosität und Molekulargrösse.

BACKGROUND: We compared the endothelial protective function of two hyaluronic acid viscoelastics (Healon GV, Provisc) of different molecular weight and viscosity during phakoemulsification in high-risk eyes. MATERIALS AND METHODS: This prospective, randomized, single-masked clinical trial in 60 eyes was characterized by an intraindividual comparison. For better demonstration of the endothelial protective function provided by the viscoelastics, only patients with bilateral cornea guttata were included. In addition to corneal thickness, central endothelial cell counts, anterior chamber flare, visual acuity and intraocular pressure were recorded preoperatively and postoperatively on the first day and 1-2 weeks after surgery. RESULTS: No differences were observed between the endothelial cell counts in either eye. In contrast, eyes treated with Provisc had a statistically significant higher increase of corneal thickness. Transient corneal decompensation was also noticed only in three eyes of the Provisc group. CONCLUSION: The results do not support the assumption of generally better protection of the corneal endothelium by viscoelastics with lower viscosity compared to viscoelastics with higher viscosity.

[Prognostic factors in surgery of macular holes]. / Prognosefaktoren bie der Makulalochchirurgie.

UNLABELLED: Idiopathic macular holes are today treated surgically with good results. The prognostic value of factors predictive for the anatomical and functional outcome has not been completely evaluated. PATIENTS AND METHODS: One hundred and thirty-five eyes with penetrating macular holes (stage II-IV) were investigated prospectively. The mean follow-up was 19.5 months (6-50 months). RESULTS: In 86% of cases the hole was closed postoperatively. The age of the macular hole proved to be a significantly predictive factor for the outcome; the age of the patient did not. The diameter of the hole showed no influence on the results. Application of autologous serum in front of the hole did not significantly improve the anatomical, but the functional results. The strongest improvement of visual acuity was seen in eyes with poor preoperative function. In 118 eyes a prefoveal membrane could be peeled off. Seventeen eyes without detectable membrane showed identical results. CONCLUSION: Some predictive factors in macular hole surgery are proven, others remain uncertain. Identical results in eyes with and without prefoveal membranes support the assumption of different pathomechanisms in macular hole formation.

Biocompatibility and blood-aqueous barrier impairment in at-risk eyes with heparin-surface-modified or unmodified lenses.

PURPOSE: To evaluated the influence of heparin-surface-modified (HSM) versus unmodified poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) on the blood-aqueous barrier (BAB) in at-risk eyes. SETTING: Department of Ophthalmology, Bundesknappschaft's Hospital, Sulzbach Germany. METHODS: This study comprised 100 patients with predisposing risk factors for BAB destabilization (e.g., diabetes mellitus with or without retinopathy, glaucoma, pseudoexfoliation, uveitis). One eye in each patient received an HSM IOL and the fellow eye, a conventional unmodified PMMA IOL after phacoemulsification by the same surgeon. Anterior chamber flare was measured with the Kowa 500 laser flare meter 1 day before and 1 day, 1 and 6 weeks, and 3 months after surgery. RESULTS: For most risk factors, mean flare was lower in the HSM group than in the PMMA group at most follow-ups. Significantly lower flare values (difference between postoperative and preoperative mean values) were seen in eyes with the HSM IOL at 6 weeks (P < .004) and 3 months (P < .003; Student's t-test). In the group with preoperative elevated flare values, the eyes with the HSM IOL had significantly better results 6 weeks (P < .0006) and 3 months (P < .01) postoperatively. The values in the HSM IOL eyes were also significantly higher in the diabetic with retinopathy group at 3 months (P < .003). CONCLUSION: The results confirm the efficacy of IOL surface modification in reducing postoperative intraocular reaction in at-risk eyes.

Fibrin sealant in the management of complicated hypotony after trabeculectomy.

BACKGROUND AND OBJECTIVE: In the postoperative course of trabeculectomy, hypotony may cause choroidal detachment with shallowing of the anterior chamber. If conservative medical treatment fails, a surgical revision may become necessary. To achieve only a temporary seal of the scleral flap, a subconjunctival tamponade with fibrin glue was performed. PATIENTS AND METHODS: Two patients with corneal decompensation as a result of cornea-lens contact complicating hypotony with massive choroidal detachment are described. Hypotony occurred after trabeculectomy in one case and after combined cataract and glaucoma surgery in another case, and was not correlated to a leaking bleb. Temporary tamponade of the scleral flap was achieved by subconjunctival injection of fibrin sealant. RESULTS: After the fibrin sealant was applied, the choroidal detachment resolved and intraocular pressure increased to normal. During the follow-up period of 6 months, a functioning bleb developed. CONCLUSION: Subconjunctival application of fibrin sealant is effective for temporary closure of the scleral flap after trabeculectomy in eyes with massive hypotony syndrome.

[Laser flare measurement with 3 different nonsteroidal anti-inflammatory drugs after phacoemulsification with posterior chamber lens implantation]. / Laser-flare-Messung bei 3 unterschiedlichen nichtsteroidalen entzündungshemmenden Substanzen nach Phakoemulsifikation mit Hinterkammerlinsenimplantation.

In a prospective, randomised, double-masked, parallel-group study we compared the antiinflammatory effect of diclofenac sodium 0.1%, flurbiprofen 0.03%, and indomethacin 1.0% ophthalmic suspension in 99 patients undergoing phacoemulsification and posterior chamber lens implantation. The reduction in anterior chamber flare from day 1, as measured with the laser flare-meter (FM-500, KOWA) on day 4-5 postoperatively was significantly greater in the diclofenac group than with flurbiprofen (p = 0.022). Patients treated with diclofenac had significantly less burning and stinging than patients on flurbiprofen and indomethacin on postoperative days 4-5 (p < 0.0001) and 12-14 (p = 0.001). Diclofenac sodium appears to be more potent than flurbiprofen in controlling intraocular inflammation after cataract surgery, while having better local tolerance than flurbiprofen or indomethacin.