Andreas Kruger

Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study

PURPOSE To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells. METHODS Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests. RESULTS Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (+/- 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month (P = .0031, P = .0062) as well as 1 year (P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period. CONCLUSIONS In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.

Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses

Purpose: To evaluate the long‐term response of 6 types of 3‐piece intraocular lenses (IOLs) by assessing the cellular reaction on the anterior IOL surface, the behavior of posterior and anterior capsule fibrosis, and flare. Setting: Department of Ophthalmology, Medical School, University of Vienna, Vienna, Austria. Methods: One hundred eighty eyes were prospectively randomized to receive 1 of 6 IOLs: hydrophilic acrylic Hydroview® (Bausch & Lomb) or MemoryLens® (ORC); hydrophobic acrylic AcrySof® MA60BM (Alcon) or AMO Sensar AR40® (Allergan); hydrophobic silicone CeeOn® 920 or CeeOn 911A (Pharmacia). The patients had standardized cataract surgery, postoperative medication, and follow‐up. One year after surgery, 155 eyes were assessed. The cellular reaction was evaluated by specular microscopy of the anterior IOL surface. Anterior and posterior capsule opacification (PCO) was assessed semiquantitatively by biomicroscopy. Flare was measured with a Kowa FC‐1000 laser flare‐cell meter. Results: Regarding uveal biocompatibility, the hydrophobic acrylic IOLs showed the highest incidence of late foreign‐body cell reaction (AcrySof, 30%; AR40, 17%) followed by the hydrophilic acrylic (MemoryLens, 8%; Hydroview, 4%) and silicone (CeeOn 920, 4%; CeeOn 911A, 0%) (P = .0044). In all cases, the cellular reaction was low grade and clinically insignificant. Regarding capsular biocompatibility, some eyes developed lens epithelial cell (LEC) outgrowth on the anterior IOL surface. The highest incidence was in the hydrophilic acrylic group (Hydroview, 85%; MemoryLens, 27%) followed by the hydrophobic acrylic (AcrySof, 4%; AR40, 3%). No silicone IOL had LECs on the anterior surface. The difference among IOL groups was significant (P = .0001). Anterior capsule opacification was more predominant in the hydrophobic IOL groups. Posterior capsule opacification of the central 3.0 mm area was lowest in the groups with a sharp‐edged optic (CeeOn 911A, AcrySof) followed by the round‐edged silicone (CeeOn 920), hydrophobic acrylic (AR40), and hydrophilic acrylic IOLs (P = .0001). There was a significant difference in flare between the AR40 lens and the Hydroview, MemoryLens, CeeOn 911A, and CeeOn 920 (P < .004). There was no statistically significant difference in the postoperative cell count at 1 year. The power calculation showed that the sample size was sufficient. Conclusions: The differences in cellular reaction, although clinically mild in normal eyes, indicate that there were more giant cells with hydrophobic acrylic IOLs and an increased tendency toward LEC outgrowth with hydrophilic lenses. The incidence of PCO was lowest in the hydrophobic IOL groups, especially in groups with a sharp‐edged optic. Second‐generation silicone IOLs with a sharp edge had good uveal and capsular biocompatibility 1 year after surgery.

Results of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in uveitic eyes with cataract : comparison to a control group

Purpose: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses (IOLs) in eyes with uveitis. Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This prospective study comprised 72 eyes with uveitis and 68 control eyes having phacoemulsification and IOL implantation by 1 surgeon. Patients received 1 of the following IOLs: foldable hydrophilic acrylic (Hydroview®, Bausch & Lomb), hydrophobic acrylic (AcrySof®, Alcon), or silicone (CeeOn® 911, Pharmacia). Postoperative evaluations were at 1, 3, and 7 days and 1, 3, and 6 months. Cell reaction was evaluated by specular microscopy of the anterior IOL surface and the anterior and posterior capsule reaction, by biomicroscopy. Results: Small round cell deposition was observed on all IOLs in the immediate postoperative period, especially in eyes with uveitis. This reaction decreased 3 to 6 months after surgery. Although the CeeOn 911 had a higher mean grade of small cells, there was no statistical difference between the 3 IOL types after 6 months in the uveitis and control groups. Foreign‐body giant cells (FBGCs) increased after 1 week to 1 month. The AcrySof IOLs had the highest number of FBGCs; after 6 months, there was a statistically significant difference between the AcrySof and Hydroview uveitis groups (P = .036) and the AcrySof and CeeOn 911 uveitis groups (P = .003) but there was no difference among the 3 IOL types in the control group. Lens epithelial cell outgrowth persisted on the Hydroview IOLs in control eyes and regressed on all 3 IOL types in uveitic eyes and on the AcrySof and CeeOn 911 IOLs in control eyes (P = .0001). Anterior capsule opacification (ACO) was more severe on all IOL types in uveitic eyes and on the CeeOn 911 IOL in control eyes. Posterior capsule opacification (PCO) was more severe in uveitic eyes. The Hydroview group had more severe PCO than the AcrySof and the CeeOn 911 groups in uveitis and control eyes. Six months postoperatively, the difference was significant (P = .0001). There was no significant difference between the AcrySof and CeeOn 911 IOLs. Conclusions: Intraocular lens biocompatibility is inversely related to inflammation. Hydrophilic acrylic material had good uveal but worse capsular biocompatibility. Hydrophobic acrylic material had lower uveal but better capsular biocompatibility. Silicone showed a higher small cell count (mild) and more severe ACO but achieved PCO results comparable to FBGC results and better than those with the AcrySof lens 6 months after surgery. Despite the differences in IOL biocompatibility, all patients benefited from the surgery.

Dual-beam optical coherence tomography: signal identification for ophthalmologic diagnosis

The dual beam version of optical coherence topography can be used for noninvasive, high-resolution imaging of the human eye fundus, enabling in vivo visualization of retinal morphology as well as accurate quantification of the thickness profiles of its layers. Interferometric fundus signals-optical A-scans-and retinal tomograms of patients with glaucoma, diabetic retinopathy, and age-related macular degeneration are compared with those of healthy, normal subjects to elucidate the origin of the signal peaks detected and to investigate and interpret the retinal microstructures contained in the cross-sectional images.

Two year results: sharp versus rounded optic edges on silicone lenses.

Purpose: To evaluate the role of optic edge design of 2 silicone intraocular lenses (IOLs) in 2 year clinical results. Setting: Department of Ophthalmology, University of Vienna, Medical School, Allgemeines Krankenhaus, Austria. Methods: In this comparative clinical study, 50 eyes had phacoemulsification and implantation of a high‐refractive 3‐piece silicone IOL with sharp optic edges (CeeOn™ model 911F) (n = 25) or a 3‐piece silicone lens with rounded optic edges (CeeOn™ model 920) (n = 25). Biomicroscopic findings, including those of specular microscopic examination of the anterior lens surface, were documented and the results analyzed. Results: After 2 years, a significant between‐group difference in posterior capsule opacification (PCO) but not in anterior capsule alterations was observed. Behind all CeeOn 911F sharp‐edge IOLs, the capsule remained clear; in 2 of 23 capsules behind the CeeOn 920 rounded‐edge, a neodymium: YAG laser capsulotomy had to be performed for dense central fibrotic PCO. Seven of 21 of the remaining eyes had first‐degree central fibrotic PCO, 14 of 23 had peripheral mixed fibrotic and slender Elschnig pearl PCO, and 8 of 23 had second‐degree peripheral PCO. Specular microscopic findings did not differ between the 2 groups. No severe IOL decentration occurred in any eye; 25% in the sharp‐edge group and 40% in the rounded‐edge group had minimal decentration. Conclusion: The silicone IOL with the sharp optic edge design was associated with significantly reduced PCO 2 years postoperatively.

Outcome after silicone oil removal

BACKGROUND Combined with vitreoretinal surgery, silicone oil injection has become a standard technique and improves the prognosis of complex retinal detachment. As silicone oil leads to long term complications, removal of silicone oil from the eye is recommended. To evaluate the outcome after silicone oil removal, retinal redetachment, visual acuity, and complications were analysed. METHODS The authors analysed 115 consecutive cases of silicone oil removal (115 eyes), all operated by one surgeon. The series consisted of retinal detachments associated with proliferative vitreoretinopathy (103 eyes), proliferative diabetic retinopathy (six eyes), or ocular trauma (six eyes). The mean duration of intraocular silicone oil tamponade was 13.3 months, with a mean postoperative follow up of 1.8 years. RESULTS Anatomic success after silicone oil removal, defined as a complete retinal attachment, was achieved in 95 of 115 eyes (82.6%). Redetachment occurred in 20 eyes (17.4%), mostly within the first 6 months after silicone oil removal. Including the successfully reoperated eyes, the authors present a final anatomic success rate of 108 eyes (93.9%). Visual acuity improved or remained unchanged in 93 eyes (80.9%). CONCLUSION While reattachment and complication rates were quite similar to other studies, a better visual outcome was achieved in these cases. The duration of the silicone oil tamponade had no significant effect on the reattachment rate. The authors recommend not to apply standard criteria for the timing of silicone oil removal, but to decide individually, considering the underlying disease, as well as the previous operations.

Comparison of the biocompatibility of 2 foldable intraocular lenses with sharp optic edges.

Purpose: To compare the clinical performance of 2 foldable intraocular lenses (IOLs) with sharp optic edges in terms of uveal and capsular biocompatibility. Setting: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. Methods: Fifty eyes scheduled for cataract surgery were included in this comparative study. A standardized surgical protocol was used, and all operations were performed by 1 experienced surgeon. Two posterior chamber lens types of similar design with a 6.0 mm sharp‐edged optic and poly(methyl methacrylate) haptics were used. Twenty‐five eyes received an AcrySof® acrylic IOL (Alcon), and 25 eyes received a CeeOn® 911A® silicone IOL (Pharmacia). Relevant data were collected at a 3‐year follow‐up examination. To evaluate uveal biocompatibility, anterior chamber laser flare and cell measurements and inflammatory cell reactions were monitored. Cellular biocompatibility was investigated by examining anterior capsule opacification (ACO), posterior capsule opacification (PCO), and lens epithelial cell (LEC) ongrowth on the IOLs anterior surface. Factors such as intralenticular glistenings and IOL decentration were also evaluated. Results: Anterior chamber flare and cells and the inflammatory cell reaction were significantly lower in the CeeOn 911A group. There was no statistically significant difference in ACO, PCO, and LEC ongrowth between the 2 groups. The AcrySof lenses showed significantly better centration and a higher density of intralenticular glistening. Conclusions: The findings show that a sharp‐edged optic design is, to date, the most effective method of reducing the rate of PCO. Despite a subclinical foreign‐body reaction in the AcrySof group, both lenses had a high degree of capsular and uveal biocompatibility.

Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome: comparison to a control group.

Purpose: To evaluate the uveal and capsular biocompatibility of hydrophilic acrylic (Hydroview®) and hydrophobic acrylic (AcrySof®) intraocular lenses (IOLs) after phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) or uveitis and compare the results with those in a control group. Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This prospective nonrandomized comparative trial comprised 143 eyes recruited consecutively. Of these, 49 eyes had PEX, 43 had uveitis, and 51 served as controls. A standardized surgical protocol was used. Cell reaction, anterior (ACO) and posterior (PCO) capsule opacification, and flare were evaluated 1 year after cataract surgery. Results: Regarding uveal biocompatibility, the number of foreign‐body giant cells (FBGCs) increased in proportion to associated ocular pathologies in both IOL groups. The difference between the Hydroview control and Hydroview uveitis groups was statistically significant. The number of FBGCs was greater on AcrySof IOLs than on Hydroview IOLs in all 3 groups. The difference in FBGCs between the 2 IOL types was statistically significant in the control and PEX groups. Regarding capsular biocompatibility, lens epithelial cell (LEC) outgrowth was inversely correlated with intraocular inflammation. Outgrowth was statistically significantly higher with Hydroview IOLs, occurring in 85% in the control group, 45% in the PEX group, and 28% in the uveitis group (P < .0001). With AcrySof lenses, the percentages were 0%, 8%, and 4%, respectively. The PEX and uveitis groups were more likely to develop ACO than the control group (P < .012). There was no statistically significant difference in ACO between the 2 IOL types in the 3 patient groups. The PCO was statistically significantly greater in the uveitis group than in the control group (P < .026) and statistically significantly more dense on Hydroview than on AcrySof IOLs in all 3 patient groups (P < .002). Flare was statistically significantly higher in the uveitis group than in the PEX and control groups with both IOL types (P < .012). There was no statistically significant difference in flare between the 2 IOL types. Conclusions: Uveal and capsular biocompatibility depends on the intensity of ocular inflammation. The greater the inflammation, the less the biocompatibility of hydrophilic and hydrophobic acrylic materials. AcrySof stimulated more FBGCs. The Hydroview material had better uveal but poorer capsular biocompatibility than AcrySof. The sharp optic edge effect of the AcrySof IOL and the advantages of the Hydroview lens in normal eyes are less apparent in compromised eyes.

Lens epithelial cell outgrowth on 3 types of intraocular lenses

Purpose: To compare the outgrowth of lens epithelial cells (LECs) on 3 types of intraocular lenses (IOLs) to determine the influence of lens material and lens design (optic edge) on this phenomenon. Setting: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. Method: Ninety eyes scheduled for cataract surgery were included in a prospective comparative study. A standardized surgical procedure was performed by 1 experienced surgeon. Patients received 1 of 3 types of posterior chamber IOLs of similar design with a 6.0 mm optic and poly(methyl methacrylate) haptic: AcrySof® (Alcon), HydroView™ (Bausch & Lomb), or Sensar™ (Allergan). Each IOL type was implanted in 30 eyes. Postoperative biomicroscopic examinations were performed 1, 3, 7, 30, 90, and 180 days and 1 year after surgery. Lens epithelial cells in each quadrant of the anterior lens surface were subjectively graded. The product with the highest density and the number of quadrants with this density were used to measure LEC outgrowth. Results: Statistically significant differences (P < .05) were seen between the hydrophilic IOL and the 2 hydrophobic lenses from day 30 until the final examination. The HydroView lens had a higher number of LECs on its anterior surface than the AcrySof or Sensar IOL. There were no statistically significant differences between the 2 acrylic IOLs at any measurement. Conclusion: The findings suggest that lens surface properties have a greater influence on LEC outgrowth than lens design (ie, sharp optic edge).

Cellular reaction on the anterior surface of 4 types of intraocular lenses

Purpose: To assess the cellular reaction on the anterior surface of 4 types of foldable intraocular lenses (IOLs). Setting: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. Methods: One hundred eyes scheduled for cataract surgery were prospectively randomized into 4 groups of 25 eyes each using random number tables. Group 1 received a Hydroview™ IOL (Bausch & Lomb), Group 2 an AcrySof® IOL (Alcon), Group 3 a MemoryLens® IOL (ORC), and Group 4 a CeeOn® 920 IOL (Pharmacia). Patients were examined 1, 3, 7, 30, 90, and 180 days postoperatively. Postoperative biomicroscopic examinations were done with a slitlamp, and a specular microscope was used to document the presence of cell deposits and identify areas with the highest density of cells. Results: The local tissue response revealed 2 patterns: a nonspecific foreign‐body reaction to the IOL (small round, fibroblast‐like, epithelioid, and giant cells) and a lens epithelial cell (LEC) reaction. The highest incidence of LECs was in the Hydroview group, in which LECs were present on 81.8% of lenses 180 days postoperatively. During the first postoperative days, small round and fibroblast‐like cells were found on all IOLs. From 7 days on, the incidence and density of these cells were less severe in the Hydroview and CeeOn 920 groups. After several weeks, epithelioid cells and foreign‐body giant cells were seen on some IOLs. These cells appeared more often on AcrySof, MemoryLens, and CeeOn IOLs. Conclusion: This study found IOL‐related differences in cellular reaction after cataract surgery. The incidence of a nonspecific foreign‐body reaction to 4 IOLs is consistent with the results of previous studies. The incidence of LECs was highest in the Hydroview group and lowest in the AcrySof group. The CeeOn 920 group had the lowest incidence of all types of cells.