Andreas Frings

Screening for Keratoconus With New Dynamic Biomechanical In Vivo Scheimpflug Analyses.

Purpose: To improve keratoconus (KC) screening with new in vivo biomechanical Scheimpflug analyses. Methods: After adjusting for intraocular pressure and corneal thickness, predefined static and new dynamic Scheimpflug curve analyses [Pentacam HR and Corvis ST (CST); Oculus] of 87 normal eyes, 27 subclinical KC eyes, 42 suspected KC, and 65 manifest KC eyes were reviewed retrospectively. A t test (for a normal distribution), Wilcoxon matched-pairs test (if not normally distributed), and receiver operating characteristics were used to test for statistically significant differences between these groups. In addition, new dynamic curve analyses were performed to analyze corneal dynamics throughout the entire response to the CST air puff impulse. Results: Comparing normal and KC-suspect eyes, the parameters A1 length, A2 length, radius of the inward-bended cornea, and deflection length at the highest concavity revealed statistically significant differences. In addition, the newly calculated “applanation length level” and “deflection length level” demonstrated consistently increasing differences with increasing statistical significance between normal eyes and those with advancing KC stages. However, when comparing normal and subclinical KC eyes, none of the analyzed parameters demonstrated statistically significant differences. Conclusions: In vivo biomechanical analyses (CST) at their current state only marginally improve KC screening protocols. Newly generated parameters such as the applanation length level and deflection length level might further improve early KC screening.

Screening for Subclinical Keratoconus Using Swept-Source Fourier Domain Anterior Segment Optical Coherence Tomography.

Purpose: To discriminate between subclinical fellow eyes of patients with keratoconus (scKCE) and normal eyes (NE) using swept-source Fourier-domain anterior segment optical coherence tomography (SS-OCT). Setting: University Medical Center Hamburg-Eppendorf, Germany. Design: Retrospective cross-sectional study. Methods: NE (both eyes with a KISA% Index <60; N = 213) and scKCE (KISA% Index <60, but an index of >100 in the fellow eye; N = 61) eyes were grouped according to the KISA% Index. Topography and tomography data were obtained by SS-OCT (Casia SS1000) and reviewed retrospectively. Receiver operating characteristics were performed for Casia SS1000 integrated automated parameters and newly computed indices. Additionally, discriminant functions were calculated for the automated single parameters, the computed indices, and the combination of both. Results: An accuracy ≥0.7 was reached for 28 (8 automated and 20 newly computed parameters) of 785 parameters. Fourier analysis posterior higher-order irregular astigmatism revealed the highest accuracy with 0.81. By combining automated parameters with the newly computed indices in 1 discriminant function, an area under the curve of 0.92 with a corresponding accuracy of 0.85 was achieved. Conclusions: SS-OCT is able to discriminate between NE and scKCE with high accuracy. Automated single parameters and newly computed indices were combined to further improve this accuracy.

[Corneal biomechanics: Corvis® ST parameters after LASIK].

ZusammenfassungHintergrundDie korneal-refraktive Chirurgie verändert die biomechanischen Eigenschaften der Hornhaut.Ziel der ArbeitDie aktuelle Studie wurde initiiert, um Veränderungen von biomechanischen Parametern nach Laser-in-situ-Keratomileusis (LASIK) mittels Corvis®xa0ST (CST) zu erfassen.Material und MethodenDiese retrospektive Studie umfasste 51xa0Augen von 32 myopen Patienten. Alle CST-Messungen wurden 1xa0Tag vor dem Eingriff und in der 1-Monats-Kontrolle durchgeführt. Das LASIK-Verfahren beinhaltete eine mechanische Flap-Präparation mit einem SBK-Mikrokeratom (Moria) und der Allegretto-Excimer-Laser-Plattform (Wavelight).ErgebnisseStatistisch signifikante Unterschiede wurden für die mittlere 2.xa0Applanationslänge, die mittlere 1. und 2.xa0Deflektionslänge, die mittlere 1. und 2.xa0Deflektionsamplitude, den Spitzenabstand und den Krümmungsradius beobachtet. Signifikant positive Korrelationen wurden jeweils zwischen der Änderung (Δ) des Krümmungsradius und der Änderung des sphärischen Äquivalents der manifesten Refraktion (MRSE), der Abtragungstiefe und der Änderung des Augeninnendrucks gefunden. Die Anwendung der multiplen Regressionsmodelle zeigte zudem statistisch signifikante Unterschiede innerhalb der Corvis-Parameter auf.DiskussionMehrere CST-Parameter zeigten nach der LASIK statistisch signifikante Veränderungen, was darauf hindeutet, dass die Flap-Bildung, die Ablation oder beides deutlich die Fähigkeit der Hornhaut, Energie zu absorbieren oder zu verteilen, verändern.AbstractBackgroundCorneal refractive surgery alters the biomechanical properties of the cornea.ObjectivesThis study was initiated to evaluate corneal biomechanical parameters after LASIK using a Corvis® ST tonometer (CST).MethodsThis retrospective study included 51 eyes of 32 myopic patients. All CST measurements were performed 1 day before surgery and at the 1-month follow-up examination. The LASIK procedure included mechanical flap preparation using a Moria SBK microkeratome and an Allegretto excimer laser platform.ResultsStatistically significant differences were observed for mean second applanation length, mean first and second deflection lengths, mean first and second deflection amplitudes, peak distance and radius of curvature. Statistically significant positive correlations were found between the change (Δ) in radius of curvature and Δ in manifest refraction spherical equivalent (MRSE), between the ablation depth and the Δ in intraocular pressure. Applying multiple regression models also revealed statistically significant differences in parameters obtained by CST measurements.ConclusionSeveral CST parameters were statistically significantly altered by LASIK thereby indicating that flap creation, ablation or both, significantly change the ability of the cornea to absorb or dissipate energy.BACKGROUNDnCorneal refractive surgery alters the biomechanical properties of the cornea.nnnOBJECTIVESnThis study was initiated to evaluate corneal biomechanical parameters after LASIK using a Corvis® ST tonometer (CST).nnnMETHODSnThis retrospective study included 51 eyes of 32 myopic patients. All CST measurements were performed 1 day before surgery and at the 1-month follow-up examination. The LASIK procedure included mechanical flap preparation using a Moria SBK microkeratome and an Allegretto excimer laser platform.nnnRESULTSnStatistically significant differences were observed for mean second applanation length, mean first and second deflection lengths, mean first and second deflection amplitudes, peak distance and radius of curvature. Statistically significant positive correlations were found between the change (Δ) in radius of curvature and Δ in manifest refraction spherical equivalent (MRSE), between the ablation depth and the Δ in intraocular pressure. Applying multiple regression models also revealed statistically significant differences in parameters obtained by CST measurements.nnnCONCLUSIONnSeveral CST parameters were statistically significantly altered by LASIK thereby indicating that flap creation, ablation or both, significantly change the ability of the cornea to absorb or dissipate energy.

Ocular manifestation in Marfan syndrome: corneal biomechanical properties relate to increased systemic score points

PurposeTo evaluate corneal deformation to an air puff as a new noninvasive tool to document disease status in Marfan syndrome (MFS)MethodsProspective observational cohort study. We included patients diagnosed with MFS who had their routine cardiovascular follow-up and applied the revised Ghent nosology to define two subgroups according to a high (≥u20097) and a low (<u20097 points) systemic score. Dynamic Scheimpflug-based biomechanical analyses (CorvisST® [CST; Oculus GmbH]) were performed. The main outcome measure was the displacement of the corneal apex as given by the parameters highest concavity (HC; in ms), peak distance (PD; in mm), and highest concavity deformation amplitude (DA; mm).ResultsForty-three eyes of 43 individuals (19 female, 24 male; mean age 42.0u2009±u200912.0xa0years, range 18–67xa0years) diagnosed with MFS were included. Applying the Ghent criteria, 21 patients had an advanced systemic score of ≥u20097, and 22 had score points <u20097. There were no differences in age or sex between both groups. In contrast, HC was faster (Pu2009=u20090.004), and PD (Pu2009<u20090.001) was longer in those individuals with systemic score ≥u20097; maximum DA did not result in a statistically significant difference between the groups (Pu2009=u20090.250).ConclusionsIn vivo noninvasive biomechanical analyses with CST offer a new, non-invasive method to identify pathologic corneal deformation responses in adults with MFS. In the future, corneal deformation to an air puff could thus assist early identification of patients with high Ghent score as an adjunct to existing diagnostic tests.

[Pachymetry and intraocular pressure measurement by corneal visualization Scheimpflug technology (Corvis ST): A clinical comparison to the gold standard].

ZusammenfassungZiel der ArbeitAnalyse zur Genauigkeit und Reproduzierbarkeit der Augeninnendruckmessung sowie Pachymetrie mittels Corvisxa0ST® (CST).Material und MethodenRetrospektive Analyse von 72 nicht voroperierten Augen mit primär chronischem Offenwinkelglaukom (PCOWG) bzw. okulärer Hypertension (OHT) ohne weitere okuläre Pathologie. Goldmann-Applanationstonometrie (GAT), Non-Kontakt-Tonometrie (NCT) sowie pachymetrische Daten [Ultraschall-Pachymetrie (USP)] wurden mit 2-fach erhobenen CST-Messungen verglichen. Als statistische Tests wurden der t-Test und Bland-Altman-Plots angewendet.ErgebnisseDer mittlere Augeninnendruck (IOD) betrug 15,5u2009±u20094,4xa0mmHg (CST), 14,8u2009±u20094,4xa0mmHg (GAT) bzw. 15,6u2009±u20094,8xa0mmHg (NCT). Die Unterschiede zwischen GAT und CST sowie GAT und NCT waren statistisch signifikant (pu2009<u20090,001). Der Vergleich zwischen NCT und CST ergab keine signifikanten Unterschiede (pu2009=u20090,72). Die CST zeigte eine mittlere Differenz zwischen der 1. und der 2.xa0Messung von 0,35u2009±u20091,7xa0mmHg, die GAT von 0,04u2009±u20090,85xa0mmHg. Vom NCT lagen keine wiederholten Messungen vor. Die USP betrug 526,5u2009±u200946,4xa0µm, die CST-Pachymetrie 551,3u2009±u200946,5xa0µm (pu2009<u20090,001). Die mittlere Differenz zwischen 1. und 2.xa0CST-Messung betrug 24,8u2009±u200921xa0µm. Von der USP lagen keine wiederholten Messergebnisse vor.DiskussionDas CST stellt ein neues Messgerät zur simultanen Erhebung des IOD, der Pachymetrie und der biomechanischen Eigenschaften der Hornhaut dar. Inwieweit ein Abweichen vom bisherigen manuell durchgeführten, nicht automatisierten Goldstandard als fehlerhaft, tolerierbar oder gar als Weiterentwicklung einzustufen ist, müssen zukünftige Untersuchungen klären. Aufgrund der automatisierten und kontaktfreien Messungen sowie der Möglichkeit der Integration biomechanischer Analyseergebnisse stellt das CST ein Gerät mit hohem Potenzial hinsichtlich der Suche nach dem „wahren“ Augeninnendruck dar.AbstractBackgroundAnalyses regarding accuracy and reproducibility of intraocular pressure (IOP) measurements and pachymetry with corneal visualization Scheimpflug technology (Corvis ST®, CST).Material und methodsRetrospective analysis of 72 eyes with primary open angle glaucoma (POAG) and ocular hypertension (OHT) with no prior surgery or other pathology. The results of Goldmann applanation tonometry (GAT), non-contact tonometry (NCT) and ultrasound pachymetry (USP) were compared with repeat measurements with CST. For statistical analyses the t-test and Bland-Altman plots were applied.ResultsThe mean IOP was 15.5u2009±u20094.4xa0mmHg (CST), 14.8u2009±u20094.4xa0mmHg (GAT) and 15.6u2009±u20094.8xa0mmHg (NCT). The results of GAT and CST as well as GAT and NCT demonstrated statistically significant differences (pu2009<u20090.001) whereas NCT and CST displayed no significant differences in IOP (pu2009=u20090.72). The mean differences between the repeat measurements were 0.35u2009±u20091.7xa0mmHg (CST) and 0.04u2009±u20090.85xa0mmHg (GAT). The mean CST pachymetry results showed 551.3u2009±u200946.5xa0µm and the USP 526.5u2009±u200946.4xa0µm (pu2009<u20090.001). The mean difference between the repeated CST measurements was 24.8u2009±u200921xa0µm. No repeat measurement data were available for USP.ConclusionThe CST is a new device for simultaneously measuring the IOP, pachymetry and biomechanical properties of the cornea. Whether the deviations in the IOP measured by CST and CST pachymetry from the manually performed gold standard has to be evaluated as deficient, tolerable or maybe as an improvement, has to be evaluated in further studies. Because of the automated and contact-free measurement method as well as the potential for simultaneously analyzing biomechanical properties of the cornea, the CST is a device that might help the quest for measuring the ‘true’ IOP.BACKGROUNDnAnalyses regarding accuracy and reproducibility of intraocular pressure (IOP) measurements and pachymetry with corneal visualization Scheimpflug technology (Corvis ST®, CST).nnnMATERIAL UND METHODSnRetrospective analysis of 72 eyes with primary open angle glaucoma (POAG) and ocular hypertension (OHT) with no prior surgery or other pathology. The results of Goldmann applanation tonometry (GAT), non-contact tonometry (NCT) and ultrasound pachymetry (USP) were compared with repeat measurements with CST. For statistical analyses the t-test and Bland-Altman plots were applied.nnnRESULTSnThe mean IOP was 15.5u2009±u20094.4 mmHg (CST), 14.8u2009±u20094.4 mmHg (GAT) and 15.6u2009±u20094.8 mmHg (NCT). The results of GAT and CST as well as GAT and NCT demonstrated statistically significant differences (pu2009<u20090.001) whereas NCT and CST displayed no significant differences in IOP (pu2009=u20090.72). The mean differences between the repeat measurements were 0.35u2009±u20091.7 mmHg (CST) and 0.04u2009±u20090.85 mmHg (GAT). The mean CST pachymetry results showed 551.3u2009±u200946.5 µm and the USP 526.5u2009±u200946.4 µm (pu2009<u20090.001). The mean difference between the repeated CST measurements was 24.8u2009±u200921 µm. No repeat measurement data were available for USP.nnnCONCLUSIONnThe CST is a new device for simultaneously measuring the IOP, pachymetry and biomechanical properties of the cornea. Whether the deviations in the IOP measured by CST and CST pachymetry from the manually performed gold standard has to be evaluated as deficient, tolerable or maybe as an improvement, has to be evaluated in further studies. Because of the automated and contact-free measurement method as well as the potential for simultaneously analyzing biomechanical properties of the cornea, the CST is a device that might help the quest for measuring the true IOP.

Pachymetrie und Augeninnendruckmessung mittels Corneal-Visualization-Scheimpflug-Technologie (Corvis ST)

ZusammenfassungZiel der ArbeitAnalyse zur Genauigkeit und Reproduzierbarkeit der Augeninnendruckmessung sowie Pachymetrie mittels Corvisxa0ST® (CST).Material und MethodenRetrospektive Analyse von 72 nicht voroperierten Augen mit primär chronischem Offenwinkelglaukom (PCOWG) bzw. okulärer Hypertension (OHT) ohne weitere okuläre Pathologie. Goldmann-Applanationstonometrie (GAT), Non-Kontakt-Tonometrie (NCT) sowie pachymetrische Daten [Ultraschall-Pachymetrie (USP)] wurden mit 2-fach erhobenen CST-Messungen verglichen. Als statistische Tests wurden der t-Test und Bland-Altman-Plots angewendet.ErgebnisseDer mittlere Augeninnendruck (IOD) betrug 15,5u2009±u20094,4xa0mmHg (CST), 14,8u2009±u20094,4xa0mmHg (GAT) bzw. 15,6u2009±u20094,8xa0mmHg (NCT). Die Unterschiede zwischen GAT und CST sowie GAT und NCT waren statistisch signifikant (pu2009<u20090,001). Der Vergleich zwischen NCT und CST ergab keine signifikanten Unterschiede (pu2009=u20090,72). Die CST zeigte eine mittlere Differenz zwischen der 1. und der 2.xa0Messung von 0,35u2009±u20091,7xa0mmHg, die GAT von 0,04u2009±u20090,85xa0mmHg. Vom NCT lagen keine wiederholten Messungen vor. Die USP betrug 526,5u2009±u200946,4xa0µm, die CST-Pachymetrie 551,3u2009±u200946,5xa0µm (pu2009<u20090,001). Die mittlere Differenz zwischen 1. und 2.xa0CST-Messung betrug 24,8u2009±u200921xa0µm. Von der USP lagen keine wiederholten Messergebnisse vor.DiskussionDas CST stellt ein neues Messgerät zur simultanen Erhebung des IOD, der Pachymetrie und der biomechanischen Eigenschaften der Hornhaut dar. Inwieweit ein Abweichen vom bisherigen manuell durchgeführten, nicht automatisierten Goldstandard als fehlerhaft, tolerierbar oder gar als Weiterentwicklung einzustufen ist, müssen zukünftige Untersuchungen klären. Aufgrund der automatisierten und kontaktfreien Messungen sowie der Möglichkeit der Integration biomechanischer Analyseergebnisse stellt das CST ein Gerät mit hohem Potenzial hinsichtlich der Suche nach dem „wahren“ Augeninnendruck dar.AbstractBackgroundAnalyses regarding accuracy and reproducibility of intraocular pressure (IOP) measurements and pachymetry with corneal visualization Scheimpflug technology (Corvis ST®, CST).Material und methodsRetrospective analysis of 72 eyes with primary open angle glaucoma (POAG) and ocular hypertension (OHT) with no prior surgery or other pathology. The results of Goldmann applanation tonometry (GAT), non-contact tonometry (NCT) and ultrasound pachymetry (USP) were compared with repeat measurements with CST. For statistical analyses the t-test and Bland-Altman plots were applied.ResultsThe mean IOP was 15.5u2009±u20094.4xa0mmHg (CST), 14.8u2009±u20094.4xa0mmHg (GAT) and 15.6u2009±u20094.8xa0mmHg (NCT). The results of GAT and CST as well as GAT and NCT demonstrated statistically significant differences (pu2009<u20090.001) whereas NCT and CST displayed no significant differences in IOP (pu2009=u20090.72). The mean differences between the repeat measurements were 0.35u2009±u20091.7xa0mmHg (CST) and 0.04u2009±u20090.85xa0mmHg (GAT). The mean CST pachymetry results showed 551.3u2009±u200946.5xa0µm and the USP 526.5u2009±u200946.4xa0µm (pu2009<u20090.001). The mean difference between the repeated CST measurements was 24.8u2009±u200921xa0µm. No repeat measurement data were available for USP.ConclusionThe CST is a new device for simultaneously measuring the IOP, pachymetry and biomechanical properties of the cornea. Whether the deviations in the IOP measured by CST and CST pachymetry from the manually performed gold standard has to be evaluated as deficient, tolerable or maybe as an improvement, has to be evaluated in further studies. Because of the automated and contact-free measurement method as well as the potential for simultaneously analyzing biomechanical properties of the cornea, the CST is a device that might help the quest for measuring the ‘true’ IOP.BACKGROUNDnAnalyses regarding accuracy and reproducibility of intraocular pressure (IOP) measurements and pachymetry with corneal visualization Scheimpflug technology (Corvis ST®, CST).nnnMATERIAL UND METHODSnRetrospective analysis of 72 eyes with primary open angle glaucoma (POAG) and ocular hypertension (OHT) with no prior surgery or other pathology. The results of Goldmann applanation tonometry (GAT), non-contact tonometry (NCT) and ultrasound pachymetry (USP) were compared with repeat measurements with CST. For statistical analyses the t-test and Bland-Altman plots were applied.nnnRESULTSnThe mean IOP was 15.5u2009±u20094.4 mmHg (CST), 14.8u2009±u20094.4 mmHg (GAT) and 15.6u2009±u20094.8 mmHg (NCT). The results of GAT and CST as well as GAT and NCT demonstrated statistically significant differences (pu2009<u20090.001) whereas NCT and CST displayed no significant differences in IOP (pu2009=u20090.72). The mean differences between the repeat measurements were 0.35u2009±u20091.7 mmHg (CST) and 0.04u2009±u20090.85 mmHg (GAT). The mean CST pachymetry results showed 551.3u2009±u200946.5 µm and the USP 526.5u2009±u200946.4 µm (pu2009<u20090.001). The mean difference between the repeated CST measurements was 24.8u2009±u200921 µm. No repeat measurement data were available for USP.nnnCONCLUSIONnThe CST is a new device for simultaneously measuring the IOP, pachymetry and biomechanical properties of the cornea. Whether the deviations in the IOP measured by CST and CST pachymetry from the manually performed gold standard has to be evaluated as deficient, tolerable or maybe as an improvement, has to be evaluated in further studies. Because of the automated and contact-free measurement method as well as the potential for simultaneously analyzing biomechanical properties of the cornea, the CST is a device that might help the quest for measuring the true IOP.

Progrediente Ulzerationen der Periorbita

Im März 2015 stellte sich ein 59-jähriger, kaukasischer Patient erstmals in der ophthalmologischen Sprechstunde vor. Er berichtete über mehrwöchige, intermittierende beidseitige Epiphora, Pussekretion und ein schmerzhaftes Druckgefühl der periorbitalen Haut. Eine extern eingeleitete Therapie mit antibiotischen (Gentamycin) und steroidhaltigen Augentropfen (jeweils 3-mal täglich) führte nur an der linken Seite zu einer Befundbesserung. Anamnestisch bestanden keine ophthalmologischen Vorerkrankungen. Die augenärztliche Untersuchung zeigte am rechten Auge eine gering ausgeprägte seröse Lidschwellung mit pusbelegten Wimpern und einen eitrig tin-

The top 100 papers in dry eye – A bibliometric analysis

PURPOSEnCitation analysis represents one of the best currently available methods for quantifying the impact of articles. Bibliometric studies list the best sellers in a single field of interest. The purpose of the present study was to identify and analyze the most frequently cited papers in dry eye research that may be of high interest for researchers and clinicians.nnnMETHODSnWe reviewed the database of the Institute for Scientific Information to identify articles published from 1900 to September 2016. All dry eye articles published in 59 ophthalmology journals were identified. The top 100 articles were selected for further analysis of authorship, source journal, number of citations, citation rate, geographic origin, article type, and level of evidence.nnnRESULTSnThe 100 most-cited articles were published between 1983 and 2011, with most of them in the 2000s. The number of citations per article ranged from 96 to 610, and was greatest for articles published in the 2000s. Each of these articles was published in one of 15 journals. Most articles represented Level-III evidence, followed by Levels II and I.nnnCONCLUSIONSnThe present study focusing on dry eye research revealed that 55% of the most-cited articles came from the U.S. and 18% from Japan. Diagnostics and therapy were the areas of focus of most of the clinical articles; 13% of the most cited papers were review articles. This analysis provides researchers and clinicians with a detailed overview on the most cited dry eye papers over the past decades.

Hyperopia shows the strongest association with LASIK retreatment

Editor, A recently published large-scale study (Mimouni et al. 2016) identified hyperopia as the parameter that demonstrated the strongest association with retreatment after excimer laser refractive surgery. We do share this observation as we also note less accurate refractive predictability and, most frequently, final undercorrection after hyperopic corneal refractive surgery. To improve refractive predictability, preceding studies (Zaldivar et al. 2005; Spadea et al. 2006) suggested that preoperative cycloplegic or manifest refraction, or a combination of both (Zadok et al. 2003), could be used in the laser nomogram. Previously, we reported that a manifest-cycloplegic difference (MCD) in spherical equivalent (SE) of 1.00 dioptre (D) or more occurs in about 13% of hyperopic eyes. In these cases, a correction of the manifest SE only did not appear to be adequate (Frings et al. 2016a). In a recent multicentre study, we thus evaluated the efficacy, predictability and safety of LASIK retreatment based on manifest refraction in hyperopic patients with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less who had LASIK retreatment based on manifest refraction. We analysed the refractive outcome of 113 hyperopic eyes according to standard graphs for reporting the efficacy, predictability and safety of refractive surgery. We found that efficacy (p < 0.001) and safety (p = 0.004) were statistically significant improved by the retreatment without being negatively influenced by preoperative manifest SE, manifest cylinder or keratometry, which we analysed. Still showing a trend towards undercorrection, retreatment resulted in 88 eyes (78.0%) that reached 0.50 D of the attempted correction. The optical zone diameter of the retreatment did not correlate with efficacy, predictability or safety. Treatment predictability, however, was statistically significant worse in eyes with a preoperative SE of more than 2.50 D (p = 0.005, tested with chisquare test). In our opinion, the main objective criterion for a retreatment is a difference between targeted and achieved manifest SE of 0.50 D or more after at least 6 months. We do not retreat eyes earlier after LASIK as keratometric and refractive changes are likely to occur up to 6 months (Frings et al. 2016b). The results of our study indicate that in hyperopic eyes with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less a LASIK retreatment is efficient, predictable and safe and therefore, finally meets preoperative patients’ expectations. To summarize, the improvement of hyperopic LASIK still is a matter of discussion, hyperopes should not be treated earlier than 6 months and the difference between cycloplegic and manifest refraction should be taken into account during treatment planning. Many hyperopic cases will likely need a retreatment, most of which result in high efficacy, predictability and safety after all. We would highly recommend clarifying this fact to hyperopic LASIK candidates before the treatment.

Multifokale Intraokularlinsen (MIOL) bei jungen, nicht-presbyopen Patienten

BACKGROUNDnRefractive lens exchange and implantation of axa0multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses.nnnOBJECTIVESnThis retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible.nnnMATERIALS AND METHODSnThis retrospective case series comprised consecutively treated 32xa0eyes of 16xa0patients (5xa0myopic, 11xa0hyperopic patients; mean age 31xa0± 6xa0years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed.nnnRESULTSnRelated to distance corrected near visual acuity myopic eyes had axa0median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (Pxa0= 0.415). For intermediate vision, in both groups axa0lower EI (<0.5; Pxa0= 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up.nnnCONCLUSIONSnWhen neither laser refractive surgery nor implantation of axa0phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.ZusammenfassungHintergrundEin refraktiver Austausch der natürlichen klaren Linse gegen eine multifokale Intraokularlinse (MIOL) wird in der Regel bei Patienten mit symptomatischer Presbyopie durchgeführt. Ametrope, junge Patienten mit Wunsch nach Brillenunabhängigkeit (nicht presbyop) werden in der Regel mithilfe korneal refraktiver Verfahren oder phaker IOL behandelt.Ziel der ArbeitDie vorliegende Fallserie stellt refraktive und subjektive Ergebnisse nach MIOL-Implantation bei nicht-presbyopen Patienten dar.Material und MethodenEine Fallserie von 32 konsekutiv behandelten Augen von 16xa0Patienten (5xa0myope, 11xa0hyperope Patienten; Durchschnittsalter 31xa0± 6xa0Jahre) wurde retrospektiv ausgewertet. Keiner der Patienten konnte mithilfe eines korneal ablativen Verfahrens oder einer phaken Linsenimplantation behandelt werden. Aus diesem Grund wurde bei Wunsch nach Brillenunabhängigkeit eine bikonvexe refraktiv-diffraktive einteilige MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG) implantiert. Refraktive Daten und die subjektive Zufriedenheit bei der 1‑Jahres-Nachkontrolle wurden mithilfe eines Fragebogens erfasst.ErgebnisseBezogen auf den bestkorrigierten Fernvisus hatten Myope einen durchschnittlichen Effizienzindex (EI) von 0,92 (±0,20) und Hyperope von 0,83 (±0,21) (pxa0= 0,415). Die subjektive Zufriedenheit war für den Nah- und Fernvisus höher als für den Intermediärvisus, der in beiden Gruppen einen niedrigeren EI (<0,5; pxa0= 0,188) aufwies. Hyperope waren bei Tätigkeiten im Nah- und Intermediärbereich teilweise subjektiv eingeschränkt, nur 1 hyperoper Patient würde den Eingriff nicht noch einmal durchführen lassen.DiskussionIn Augen, bei denen korneal refraktive Verfahren oder die Implantation einer phaken IOL aus medizinischen Gründen nicht möglich sind, können junge, nicht-presbyope Ametrope von der Anwendung einer asphärischen refraktiv-diffraktiven MIOL profitieren.AbstractBackgroundRefractive lens exchange and implantation of axa0multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses.ObjectivesThis retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible.Materials and methodsThis retrospective case series comprised consecutively treated 32xa0eyes of 16xa0patients (5xa0myopic, 11xa0hyperopic patients; mean age 31xa0± 6xa0years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive–diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed.ResultsRelated to distance corrected near visual acuity myopic eyes had axa0median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (Pxa0= 0.415). For intermediate vision, in both groups axa0lower EI (<0.5; Pxa0= 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up.ConclusionsWhen neither laser refractive surgery nor implantation of axa0phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive–diffractive MIOL.