[New options for digital photo documentation during routine examination for ophthalmologists]. / Neue Möglichkeiten der digitalen Fotodokumentation im klinischen Alltag für Augenärzte.

BACKGROUND: Many clinical investigations cannot be carried out at the examination unit or a slit lamp. Here we present three new options to obtain digital pictures in a routine clinic at a slit lamp and evaluate how user friendly they are. METHODS: A) First, a digital photo documentation is examined at a conventional slit lamp by a modified binocular ray splitter. One ray of the binocular ray splitter is connected to a digital camera, while the second ray in this patented prototype is connected to the light sources of a synchronised flash light. B) A Smartphone generated fundus images via the monocular of a microscope. Macroscopic details up to 60× at the external eye were obtained by a magnifying gadget of the iPhone. C) With a USB microscope, high resolutions pictures were generated without large technical expense directly at the job and digitally were archived over an USB connection. RESULTS: A trained ophthalmologist demonstrated an excellent documentation at a slit lamp using all 3 digital camera systems. The new ray splitter allows enhanced the image quality at the anterior and posterior segments of the eye. Also the Smartphone obtained by its autofocus and automatic exposure control stunningly high resolution images at the fundus. An attached magnifying aperture glass enables documentation with a 20-fold magnification and is already used in dermatology as the "Handyskope". The USB microscope may be used to record macroscopic details with a 200-fold magnification and resolution of 2 million pixels. It is connected to a PC desktop at the workstation and has only a limited depth resolution, requiring a precise focus. CONCLUSION: The increasing distribution of the Smartphone and significant improvement of its digital camera make its use in medicine meaningful. Low-priced attempts and mobile applications open new implications in the evaluation of ophthalmological patients.

Managing finances of shipping living donor kidneys for donor exchanges.

Kidney donor exchanges enable recipients with immunologically incompatible donors to receive compatible living donor grafts; however, the financial management of these exchanges, especially when an organ is shipped, is complex and thus has the potential to impede the broader implementation of donor exchange programs. Representatives from transplant centers that utilize the National Kidney Registry database to facilitate donor exchange transplants developed a financial model applicable to paired donor exchanges and donor chain transplants. The first tenet of the model is to eliminate financial liability to the donor. Thereafter, it accounts for the donor evaluation, donor nephrectomy hospital costs, donor nephrectomy physician fees, organ transport, donor complications and recipient inpatient services. Billing between hospitals is based on Medicare cost report defined costs rather than charges. We believe that this model complies with current federal regulations and effectively captures costs of the donor and recipient services. It could be considered as a financial paradigm for the United Network for Organ Sharing managed donor exchange program.

[A prospective intraindividual comparison between laser in situ keratomileusis and laser subepithelial keratectomy for myopia. 1-year follow-up results]. / Ein prospektiver intraindividueller Vergleich zwischen LASIK und LasEk zur Myopiekorrektur. Ergebnisse nach 1 Jahr.

BACKGROUND: The aim of this study was to intraindividually compare the outcome of laser in situ keratomileusis (LASIK) and laser subepithelial keratectomy (LASEK) in patients with similar refraction in both eyes when treated with two different procedures. PATIENTS AND METHODS: In this prospective nonrandomized study, 30 myopic patients with and without astigmatism were treated by Lasik in one eye and LasEk in the fellow eye. All eyes were treated using the MEL 70-G Excimer laser (Carl Zeiss Meditec, Germany). Uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) as well as photopic contrast sensitivity (Pelli-Robson charts) and scotopic contrast sensitivity (Nyktometer, Rodenstock, Germany) were evaluated. The patients were also asked about their preferences regarding the procedures. RESULTS: The preoperative spherical equivalent (SE) was -4.54+/-1.64 D and the mean BSCVA was 0.94 in Lasik eyes. The SE was -3.9+/-1.57 D and the BSCVA was 0.89 in LASEK eyes. The mean 1-year post-operative SE was -0.33+/-0.48 D in the Lasik eyes and -0.19+/-0.26 D in the LASEK eyes. Efficacy and safety were similar in the two groups, but Lasik eyes had a greater standard deviation at 1 year. Pelli-Robson contrast sensitivity was 10.75+/-3.05 in the Lasik eyes compared with 11.4+/-3.21 in the fellow LASEK eyes. Seventeen patients named Lasik and 12 patients named LASEK as their procedure of choice. CONCLUSION: Both procedures enable similarly good results. LASEK showed a tendency to a smaller standard deviation in final refraction and better contrast sensitivity.

Behaviour of the phakic iris-claw intraocular lens (Artisan /Verisyse) during accommodation: an optical coherence biometry study.

PURPOSE: To evaluate variations in the position of the phakic iris claw lens (Artisan, Verisyse) and the natural crystalline lens during the accommodation process. METHODS: We measured changes in position of the iris claw lens and the crystalline lens during the accommodation using optical coherence biometry (AC Master/Carl Zeiss Meditec, Germany) in 17 patients (28 eyes) with a phakic iris claw lens implanted for high myopia and/or myopic astigmatism. Accommodative effort was obtained using an internal optical target within the measuring device. RESULTS: There was a forward shift of the phakic iris claw lens with a mean of 70 microm (8-178 microm) of the optical path length (OPL). At the same time the anterior pole of the natural lens showed a forward mean movement of 85 microm (4- 260 microm). CONCLUSIONS: An anterior displacement of the iris-claw phakic lens was shown in a series of eyes during the accommodation process. As this displacement goes along with the forward displacement of the anterior pole of the crystalline lens, the preoperative measurement of the latter might provide some additional information about the position of the iris claw lens in the accommodative state after implantation.

[Influence of incision parameters on astigmatism during implantation of phakic-6-mm-iris-claw intraocular lenses]. / Inzisionale Astigmatismusbeeinflussung bei der Implantation von phaken 6-mm-Irisklauenintraokularlinsen.

BACKGROUND: The implantation of a phakic 6-mm-iris-claw intraocular lens requires a 6.1-6.2 mm incision. This induces a variable amount of corneal astigmatism depending on the location and the type of the incision used. The aim of the current study is to investigate the surgically induced astigmatism (SIA) of different incision types and locations. This should help to achieve nearly spherical postoperative refraction. PATIENTS AND METHOD: 28 eyes of 16 patients with a 1-year follow-up after an implantation of a 6-mm-non-foldable iris-claw phakic IOL were studied. 5 different incision techniques were used. These were a superior corneal incision alone (8 eyes) or in combination with a 60 degrees limbal relaxing incision (LRI) at the same axis (8 eyes), a superior sclerocorneal tunnel incision (6 eyes) and the two-incisional approach either with a sclerocorneal (4 eyes) or a pure corneal (2 eyes) main temporal incision. The SIA was calculated for each incision used. RESULTS: The superior corneal incision had a mean SIA of 1.2 D cyl. This SIA was enhanced by an opposite LRI by another 1 D cyl. The sclerocorneal tunnel induced 0.75 D cyl, while the two-incisional techniques delivered nearly astigmatismus neutral results. CONCLUSION: A proper selection of an appropriate incision site and type allows to correct the preexisting astigmatism or to keep a spherical refraction after an implantation of a 6-mm-rigid phakic iris-claw IOL.

[Laser-assisted subepithelial keratectomy (LasEk). Review of the current state of knowledge]. / Laserassistierte subepitheliale Keratektomie (LasEk). Ubersicht über den gegenwärtiger Kenntnisstand.

This article offers an overview of the current state of knowledge on the results and techniques of the evolving refractive procedure called laser-assisted subepithelial keratectomy (LasEk). A few peer-reviewed published clinical and experimental studies on this new technique are critically debated. Furthermore we discuss the indications for this procedure in comparison to photorefractive keratectomy (PRK) and laser in situ keratomileusis (Lasik) based on the current body of literature and the first author's clinical and scientific personal experience.