Anja Liekfeld

Contrast sensitivity after implantation of diffractive bifocal and monofocal intraocular lenses

Purpose: To compare contrast sensitivity (CS) after implantation of a diffractive bifocal intraocular lens (IOL) and a monofocal IOL of similar design. Setting: Seven European centers. Methods: In this randomized, prospective study, CS was tested 5 months after cataract and IOL implantation surgery in 115 patients with a diffractive bifocal IOL and 106 patients with a monofocal IOL. It was also tested in a subgroup of 38 patients who had bilateral implantation of a diffractive bifocal IOL. Contrast sensitivity was tested using the Vision Contrast Test System (VCTS). Results: In patients with a best corrected visual acuity (BCVA) of 1.0 or better, the CS at all spatial frequencies (1.5 to 18 cycles/degree), both at distance and near, was slightly lower in the bifocal IOL group than in the monofocal group. Mean values were within the normal range. In patients with a BCVA of less than 1.0, the CS was lower and the difference between the bifocal and monofocal groups was less. In patients with bilateral bifocal IOLs, CS was better when tested bilaterally than when testing the better eye alone. Pupil size affected the results to a small degree. Contrast sensitivity appeared to improve over time after implantation of a diffractive bifocal IOL. Conclusions: In patients with cataract and no other eye pathology, the diffractive bifocal IOL will slightly reduce the CS at all spatial frequencies. In those with reduced visual acuity after cataract surgery, CS will be reduced accordingly. In this situation, the reduction from the diffractive bifocal optic would be minor.

A prospective comparison of two multifocal lens models

SummaryBackground: The functional results of two different types of multifocal intraocular lenses (based on the diffractive and refractive principle, respectively) were investigated prospectively. Materials and methods: Altogether 50 patients who had a multifocal lens implanted were examined 4–6 weeks postoperatively. Visual acuity for distance and near vision, contrast sensivity, low contrast visual acuity and glare visual acuity were investigated. Results: Distance visual acuity, contrast sensitivity, low contrast visual acuity and glare visual acuity did not show significantly different results. Near visual acuity was statistically significantly better with the diffractive type of multifocal lens (because of a stronger adjustment for near vision). When the focus depth was tested by defocus curves, both lenses had better results within different areas of defocus. Conclusions: All patients in both groups showed satisfactory results. When choosing a multifocal intraocular lens, the individual needs of each patient should be taken into consideration.Fragestellung: Zwei unterschiedliche Multifokallinsenmodelle verschiedener Wirkmechanismen (diffraktives und refraktives Prinzip) wurden prospektiv hinsichtlich ihrer funktionellen Ergebnisse verglichen. Material und Methode: Bei insgesamt 50 Patienten wurden 4–6 Wochen postoperativ Fernvisus, Nahvisus, Kontrastempfindlichkeit, Kontrastsehschärfe und Blendungssehschärfe bestimmt. Ergebnisse: Beide Linsenmodelle zeigten keine signifikanten Unterschiede hinsichtlich Fernvisus, Kontrastempfindlichkeit, Kontrastsehschärfe und Blendungssehschärfe. Ein signifikant besserer Nahvisus wurde mit der diffraktiven Linse (bei stärkerem Nahzusatz des Linsenmodells) erreicht. Bei der Defokussierung zur Bestimmung der Tiefensehschärfe zeigten sich in jeweils unterschiedlichen Bereichen bessere Ergebnisse zugunsten beider Linsenmodelle. Schlußfolgerung: Beide untersuchten Linsenmodelle zeigen gute funktionelle Ergebnisse. Bei der Wahl des Modells sollten die individuellen Patientenbedürfnisse berücksichtigt werden.

Specific antibody production in herpes keratitis: intraocular inflammation and corneal neovascularisation as predicting factors.

PurposeThe purpose of the study is to investigate whether analysis of specific antibody synthesis can aid the diagnosis of herpes keratitis.MethodsAqueous humor was collected from 39 patients with presumed recurrent herpes keratitis, including 23 consulting for keratitis and 16 patients scheduled for penetrating keratoplasty. Local antibody production was ascertained by analysis of paired aqueous humor/serum samples, using a modified micro-ELISA technique.ResultsLocal production of antibodies was found in 32 patients (82%): anti-herpes simplex virus (HSV) antibodies in 26 (67%) and anti-varicella zoster virus (VZV) antibodies in 11 (28%). Twenty of 23 patients with active keratitis (87%), and 12 of 16 undergoing keratoplasty (75%), tested positive. Five patients had local production of both anti-HSV and anti-VZV antibodies, whereas seven patients tested negative. Local antibody production was significantly associated with intraocular inflammation (P<0.05), corneal neovascularisation (P<0.05), and positive response to anti-viral treatment (P<0.05). No complications were encountered in sampling aqueous humor.ConclusionsAssessment of local anti-HSV and -VZV antibody production is a safe and reliable diagnostic procedure for recurrent herpes keratitis. It might be particularly helpful in patients presenting with intraocular inflammation and neovascularisation since it discriminates between herpes and non-herpes pathologies and may therefore be useful for preventive and therapeutic strategies.

Visual function and reading speed after bilateral implantation of 2 types of diffractive multifocal intraocular lenses: Add-on versus capsular bag design.

Purpose To compare the functional outcomes of primary implantation of a monofocal intraocular lens (IOL) in the capsular bag and an add‐on multifocal IOL in the sulcus with the functional results of a conventional multifocal posterior chamber IOL and to evaluate the multifocal add‐on IOL as an effective alternative to a conventional multifocal IOL. Setting Ernst von Bergmann Eye Clinic, Potsdam, Germany. Design Prospective nonrandomized case series. Methods Cataract surgery patients were assigned to have bilateral implantation of a monofocal IOL (Aspira‐aAY) in the capsular bag followed by a multifocal add‐on IOL (Diff‐sPB) in the sulcus (Group A) or with a conventional multifocal IOL (Diffractiva‐s) in the capsular bag (Group B). The main study outcomes were assessed at the last follow‐up visit (6 months postoperatively) and included refraction, intraocular pressure, visual acuity, reading speed, contrast sensitivity, defocus curve, and patient satisfaction. Results The study comprised 26 patients (52 eyes) Cataract surgery was uneventful in all cases. No severe complications were observed 6 months postoperatively. Visual performance with a multifocal diffractive add‐on IOL was equivalent to that achieved with a conventional multifocal diffractive posterior chamber IOL. Similarly, there were no significant differences in patient satisfaction and reading speed for any type of letter size between groups (P > .05). Conclusion Implanting a multifocal add‐on IOL in the sulcus in addition to a monofocal IOL in the capsular bag produced outcomes similar to those of single implantation of a standard multifocal IOL in the capsular bag. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Kammerwasseranalyse bei Keratoplastikpatienten mit Keratitiden Erste Resultate

ZusammenfassungZielsetzung. Herpetische Keratitiden sind nicht selten eine Indikation zur Durchführung einer Keratoplastik. Rezidive der Keratitis und Transplantatabstoßung sind häufige Komplikationen. Eine perioperative Aktivitätskontrolle einer herpetischen Entzündung ist sinnvoll, da sich therapeutische Konsequenzen ergeben. Ziel der Untersuchung ist die Ermittlung des diagnostischen Wertes einer solchen Analyse. Material und Methoden. Es wurden 28 Kammerwasserproben von 24 Patienten entnommen. Die Proben wurden hinsichtlich einer intraokularen Antikörpersynthese gegen Herpes-simplex-Virus (HSV), 26/28 gegen Varizella-Zoster-Virus (VZV) und 6/28 gegen Zytomegalievirus (CMV) untersucht. Dabei wurde eine modifizierte Mikro-ELISA-Technik verwendet. Ergebnisse. Von den 28 Proben zeigten 14 eine AK-Synthese gegen HSV, 7 gegen HSV und VZV, eine gegen VZV. Sechs Proben waren negativ. Schlussfolgerung. Aufgrund der Ergebnisse konnte bei den meisten Patienten eine gezielte lokale bzw. systemische virustatische Therapie perioperativ oder bei postoperativen Keratitisrezidiven eingeleitet werden. Bei einem Teil der Patienten wurde aufgrund der negativen Analyse auf eine langfristige virustatische Therapie verzichtet.AbstractObjective. Herpetic keratitis is a common indication for corneal transplantation. In this patient group especially, there is a relatively high risk of graft failure, partly because of viral recurrence. It can be difficult to clinically distinguish stromal herpetic recurrence from early endothelial allograft rejection. Also a perioperative observation of viral activity seems advisable because of therapeutic consequences. For these reasons we use aqueous humor analysis in certain corneal transplant patients to determine intraocular antibody production. The aim of this study was to evaluate the diagnostic value of such an analysis of aqueous humor. Material and methods. A total of 28 samples of aqueous humor were obtained from 24 eyes and all samples were tested for antibodies against herpes simplex virus (HSV), most samples (26/28) were tested for antibodies against varizella zoster virus (VZV) and some samples (6/28) for antibodies against cytomegalovirus. We used a modified micro-ELISA technique to detect intraocular IgG production. Results. In 14 samples (50%) we found antibodies against HSV, in 7 samples (25%) against HSV and VZV, in 1 sample (3.6%) against VZV and 6 samples (21.4%) were negative for all antibodies tested. Conclusion. The results of aqueous humor analysis led to a specific local or systemic antiviral therapy perioperatively or in the case of postoperative recurrence of herpetic keratitis in most patients. Some patients could be spared long-term treatment with antiviral agents because of negative results in the aqueous humor analysis.

Beeinflusst die Linsenart die stereoskopische Wahrnehmung

ZusammenfassungZiel. Erhöhtes Lebensalter sowie monofokale Intraokularlinsen (IOL) sollen zur Minderung der stereoskopischen Wahrnehmung führen. Bei multifokalen Linsen (MIOL) bliebe durch ihre diffuse Abbildung die Fähigkeit des Stereosehens, besonders die Random-dot-Stereopsis, besser erhalten. Ob und wie die verschiedenen Linsenarten (auch die verschiedenen Multifokallinsenprinzipien) tatsächlich die stereoskopische Wahrnehmung beeinflussen, war Gegenstand der vorliegenden Untersuchung. Patienten und Methoden. Wir untersuchten 153 Personen in 6 Gruppen (jugendliche und ältere phake Probanden, Patienten mit beidseitig monofokaler IOL, mit beidseitig diffraktiver MIOL, mit beidseitig refraktiver MIOL, mit einseitig diffraktiver/refraktiver MIOL) am Pola-Test in Ferne und Nähe mit dem differenzierten Stereo- und Random-dot-Stufen-Test und verglichen die Ergebnisse für die Nähe mit dem Random-dot-Lang-, dem Konturen-Titmus- und dem realen Stereo-Test nach Monjé. Zuvor erfolgten eine orthoptische Untersuchung und monokulare und binokulare Fern- und Nahvisusbestimmung. Ergebnisse. Die besten Ergebnisse erzielten bei allen Verfahren die jugendlichen Probanden mit höchsten Stereowerten zu 81–92% am Pola- und zu 100% am Lang-, Titmus- und Monjé-Test. Die älteren Probanden erreichten am Pola-Test die Höchstwerte nur in 36–73% und am Lang-, Titmus- und Monjé-Test zu 52–88%. Von den Patienten mit monofokaler IOL wurden am Pola-Test Höchstwerte in 19–62%, mit beidseitig diffraktiver MIOL in 30–61%, mit beidseitig refraktiver MIOL in 12–53% und mit einseitig diffraktiver bzw. refraktiver MIOL in 5–29% erreicht. Beim Test nach Lang, Titmus und Monjé erkannten diese Gruppen den kleinsten Wert zu 29–81%. Schlussfolgerung. Bei allen Patienten mit mono- oder multifokalen IOL ließ sich die Fähigkeit zum Erkennen von Flächen- und Globalstereopsis – in unterschiedlichem Ausmaß– wie bei den phaken Probanden nachweisen.AbstractPurpose. Age and monofocal intraocular lens (IOL) are assumed to reduce the quality of stereopsis, whereas multifocal intraocular lenses (MIOL) are supposed to provide better random dot stereopsis than monofocal IOL. The following study investigates whether and how the different IOL types (including the different existing principles of MIOL) influence stereopsis. Patients and methods. We included 153 persons from six groups (young and elder phakic subjects, patients with bilateral monofocal IOL, with bilateral diffractive MIOL, with bilateral refractive MIOL, and with unilateral diffractive/refractive MIOL). Stereopsis measurements were performed using the Pola test with a two-dimensional and a random dot test for far and near distances and the results for near distance were compared with the Lang random dot, two-dimensional Titmus, and the Monjé real three-dimensional tests. Near and distance monocular and binocular visual acuity and orthoptic examinations had been previously carried out. Results. Of the young phakic subjects, 81–92% correctly perceived the Pola test fi-gures, and 100% did so in the Lang, Titmus, and Monjé tests. Of the elder phakic subjects, 36–73% correctly perceived the Pola test, and 52–88% did so in the Lang, Titmus, and Monjé tests. Of the patients with bilate-ral monofocal IOL, 19–62% perceived the Pola test figures, as did 30–61% of the patients with bilateral diffractive MIOL, 12–53% of the patients with bilateral refractive MIOL, and 5–29% of the patients with unilateral diffractive/refractive MIOL. Conclusion. All patients with bilateral mono- or different multifocal IOL had good binocular vision in far and near distance including random dot stereopsis.

Lokalisation von cAMP-selektiver Phosphodiesterase am Säugetierauge durch [3H]-Rolipram

Bisher konnte in tierexperimentellen Studien gezeigt werden, daß eine selektive Phosphodiesterase (PDE)-Hemmung oder eine intrazelluläre Erhöhung von zyklischen Adenosinmonophosphat (cAMP) am Säugetierauge eine Senkung des Augeninnendrucks bewirken kann. Der selektive PDE-Hemmer Rolipram bindet mit hoher Affinität an cAMP-selektive PDE. In der vorliegenden Arbeit werden die Rezeptoren für Rolipram am Auge verschiedener Säugetierspezies autoradiographisch dargestellt. Insgesamt wurden dafür 1050 histologische Schnitte von Kaninchen (Albino und Wildtyp)-, Ratten-, Affen (Pavian und Marmoset)- und Menschenaugen hinsichtlich der Rolipram-Bindung an die verschiedenen Strukturen ausgewertet. Dabei zeigte sich am Menschen-, Kaninchen- und Pavianauge jeweils die höchste spezifische Bindung von Rolipram am Ziliarkörperepithel. Am Marmosetauge wies der Ziliarkörpermuskel die höchste spezifische Bindung auf, am Rattenauge die Retina. Insgesamt zeigt sich eine hohe spezifische Bindung im Bereich des Ziliarkörperepithels und damit im Bereich der Kammerwasserbildungsstätte. Aufgrund dieser Ergebnisse und des bisher bekannten Wirkmechanismus von Rolipram ist ein Zusammenhang zwischen Rolipram-Bindungsstellen und Augeninnendruckregulation anzunehmen.It has been shown that inhibition of phosphodiesterase (PDE) or an increase in intracellular cyclic adenosine monophosphate (cAMP) can lower the intraocular pressure in mammalian eyes. The PDE inhibitor rolipram binds with high affinity to a cAMP-dependent PDE. In the following study, receptors for rolipram in the mammalian eye are determined by autoradiography. About 1050 histological sections of rabbit (albino and pigmented), rat, monkey (baboon and marmoset) and human eyes were examined concerning rolipram-binding sites in different structures. The highest specific binding of rolipram to the ciliary body epithelium was seen in human, rabbit and baboon eyes. Marmoset eyes showed the highest specific binding in the ciliary body muscle, rat eyes in the retina. Specific binding was consistently high in the ciliary body epithelium and therefore at the site of aqueous humor formation. Because of these results and the known mode of action of rolipram, one can assume a close connection between rolipram-binding sites and the regulation of intraocular pressure.