Bertram Vidic

Pupillary block after phakic anterior chamber intraocular lens implantation

A 49-year-old patient developed pupillary block glaucoma with an intraocular pressure (IOP) of 29 mm hg after implantation of a phakic intraocular lens (IOL) (NuVita, Bausch & Lomb) in the left eye. the anterior chamber deepened again, and the iop decreased to 16 mm hg after a neodymium: YAG iridotomy. Pupillary block glaucoma may occur after phakic IOL implantation without iridotomy, and we advocate that routine iridotomy be performed during phakic IOL surgeries.

Early changes in corneal sensation, ocular surface integrity, and tear-film function after laser-assisted subepithelial keratectomy

Purpose: To investigate the changes in corneal sensation, ocular surface integrity, and tear‐film function after laser‐assisted subepithelial keratectomy (LASEK). Setting: Department of Ophthalmology, University of Graz, Graz, Austria. Methods: Laser‐assisted subepithelial keratectomy was performed in 21 consecutive patients (37 myopic eyes). The patients were observed for subjective complaints of dry eye, corneal sensation, tear‐film breakup time (BUT), Schirmer test without local anesthesia, and fluorescein and lissamin‐green staining preoperatively and 1 week and 1, 3, and 6 months postoperatively. Results: The subjective score for dry‐eye symptoms was not statistically significantly higher after the procedure. Corneal sensation was reduced up to 1 month after LASEK (P<.05). There were obvious decreases in BUT at 1 week and 1 month (P<.01) and no significant changes in Schirmer test results. In fluorescein staining of the cornea, dots were more concentrated at 1 week (P<.05). In lissamin‐green staining, no significant changes were found at any follow‐up examination. Conclusions: Laser‐assisted subepithelial keratectomy induced a short‐term reduction in corneal sensation and affected the ocular surface and tear film slightly. Epithelial flap repositioning in LASEK may have a positive influence on tear‐film and ocular‐surface factors.

Long-term follow-up with I-care phakic IOLs

Aim To evaluate visual quality and postoperative results as well adverse events in myopic patients undergoing I-CARE anterior-chamber angle-supported phakic intraocular lens (IOL) implantation. Design A retrospective, non-randomised, case series. Participants Data on 29 eyes (16 patients) receiving I-CARE phakic IOL for high myopia (–11.66±3.3) were analysed. Methods The IOLs were implanted between 2003 and 2006 at the Department of Ophthalmology, Medical University, Graz, Austria. The mean follow-up was 51.7±16 months (17–78 months). Main outcome measures The authors measured uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); patients underwent slit-lamp examination, corneal topography, Scheimpflug imaging and measurement of endothelial cells (EC). Results The mean UCVA and BCSVA were 0.63 and 0.94 decimal after 1 year. Endothelial cell loss was the most serious adverse event observed. The mean EC loss was 2%, 9%, 17%, 21%, 33% and 47% after 1 year (n=17), 2 years (n=20), 3 years (n=17), 4 years (n=17), 5 years (n=12) and 6 years (n=3), respectively. Eight IOL explantations were made due to severe EC loss 3–6 years after implantation. Other serious complications included one patient with Urrets–Zavalia Syndrome (one eye). Conclusion Implantation of the I-CARE phakic-IOL is not a safe method for the correction of high myopia due to serious endothelial cell loss that might occur in a high number of patients. Patients with these IOLs should be followed up at least every 6 months, and the IOL should be explanted, once the EC count drops to less than 2000 cells/mm2.

INTRUSION OF AN ENCIRCLING BUCKLE AFTER RETINAL DETACHMENT SURGERY

PURPOSE To report a patient with intrusion of the encircling buckle late postoperatively after surgical treatment of a rhegmatogenous retinal detachment. DESIGN Interventional case report. METHODS We performed an encircling buckle procedure on a 77-year- old woman with a rhegmatogenous retinal detachment. Four years after the operation, the encircling buckle intruded into the vitreous cavity. RESULTS After 3 months of diagnosis of the intrusion, the retina was detached totally. CONCLUSIONS Intrusion of the encircling buckle without any additional segmental buckling element is a very rare late complication of retinal detachment surgery.

Phototherapeutic keratectomy with an epithelial flap for recurrent erosion syndrome

&NA; Phototherapeutic keratectomy (PTK) is an acceptable technique to treat recurrent erosion syndrome. Its disadvantage is postoperative pain. We present a modified technique to reduce the immediate pain from removal of the epithelium after PTK. Nine patients with recurrent erosion syndrome had PTK with epithelial reflap (similar to laser‐assisted subepithelial keratectomy) and contact lens application. The follow‐up was 6 months. No patient reported severe postoperative pain. Three of 9 patients reported mild pain during the first 24 hours postoperatively. The best spectacle‐corrected visual acuity was 0.40 to 0.63 logMAR on the first postoperative day and 0.80 to 1.00 logMAR after a week. No patient developed recurrent erosion.

Conductive keratoplasty for asymmetric corneal astigmatism

A 65-year-old white man presented with visual disturbance in the right eye. He had had uneventful phacoemulsification with intraocular lens (IOL) implantation, but because of a postoperative refractive surprise of 1.0 diopter (D), an IOL exchange was done 2 weeks postoperatively. The clinical examination revealed a clear corneal 5.0 mm incision 2.5 mm from the limbus. Three months after IOL exchange, the corneal astigmatism was 4.8 120 (anterior flow, Orbscan, Bausch & Lomb) (Figure 1). The visual acuity was 0.8 with a spectacle refraction of C2.25 4.75 120. Conductive keratoplasty (CK) was performed with 4 spots applied at the flatter site. The postoperative treatment included dexamethasone 4 times a day and tobramycin 0.3% 4 times a day. Four weeks after the procedure, the cornea was regular, the topographic corneal astigmatism was 0.4 90, and the uncorrected visual acuity (UCVA) increased to 1.0. At 12 months, the clinical examination showed mild corneal scarring in the CK area (Figure 2), topographic astigmatism was 0.8 90 (Figure 1, C), and UCVA was 0.9, improving to 1.0 with a spectacle refraction of 0.5 90. DISCUSSION

Phake IOL-Implantation zur Korrektur hoher Myopie

ZusammenfassungHintergrundHornhautrefraktive Eingriffe erlauben eine Myopiekorrektur von bis zu −12 Dioptrien (dpt), abhängig von der zentralen Hornhautdicke. Mittels phaker Vorderkammerlinsen (PIOL) können Myopien von über 10 dpt erfolgreich korrigiert werden. In dieser prospektiven Studie stellen wir unsere Ergebnisse mit zwei unterschiedlichen Linsendesigns vor.Patienten und Methodik21 Patienten (15 weibliche und 6 männliche, Durchschnittsalter 34,8 ± 9,9 Jahre) mit hoher Myopie (−8,25 bis −24 dpt) wurde eine PIOL in ein oder beide Augen implantiert (36 Augen). Alle Eingriffe wurden nach einer ähnlichen Technik durchgeführt. Die Vorderkammertiefe betrug bei allen Patienten mindestens 3,2 mm (3,66 ± 0,19 mm). Eine NuVita®-Linse (Bausch & Lomb, USA) wurde in 17 und die ZSAL-4 (Morcher93A®, Morcher G. m. b. H, Deutschland) in 19 Augen implantiert. Die Nachbeobachtungszeit beträgt 22,21 ± 8,7 Monate.ErgebnisseDie postoperativen Werte der Patienten mit einer NuVita®-PIOL waren jenen mit einer ZSAL-4-PIOL vergleichbar. 14 Augen mit einer NuVita®-PIOL und 17 Augen mit einer ZSAL-4 waren innerhalb eines Refraktionsbereiches von ± 1 dpt. Der postoperative Hornhautendothelzellverlust betrug nach 1 Monat 10% bei Patienten mit der NuVita®, 9% bei Patienten mit ZSAL-4 und diese Werte blieben über den gesamten Nachbeobachtungszeitraum stabil. Der Intraokulardruck war in beiden Patientengruppen lediglich am ersten postoperativen Tag signifikant erhöht, stabilisierte sich aber danach. Pupillenovalisierung wurde bei 3 Augen von 2 Patienten mit NuVita® und 6 Augen von 3 Patienten mit ZSAL-4-Intraokularlinsen beobachtet.DiskussionUnter strenger Indikationsstellung können mittels phaker Vorderkammerlinsen hohe Myopien erfolgreich und für den Patienten zufriedenstellend korrigiert werden. Beide Linsentypen zeigten ähnliche Ergebnisse hinsichtlich Endothelzellverlust, postoperativer Refraktion und postoperativem Visus.SummaryBackgroundCornea refractive surgeries are suitable for mild and moderate, but not for high myopia. Phakic intraocular lenses (PIOL) have a high potential to correct high myopia of more than −10 diopters (dpt). In this prospective study we present our results with two different types of PIOLs.Material and methods21 patients (15 female and 6 male, average age 34.8 ± 9.9 years) with high myopia (−8.25 to −24 dpt) underwent PIOL implantation in one or both eyes (36 eyes). All surgeries were performed by a similar technique. All patients had an anterior chamber depht of at least 3.2 mm (3.66 ± 0.19 mm). A NuVita® PIOL (Bausch & Lomb, USA) was implanted in 17 and ZSAL-4-PIOL (Morcher-93A®, Morcher G. m. b. H., Germany) in 19 eyes. Follow up was 22.21 ± 8.7 months.ResultsThe post operative results were similar for both kinds of PIOL implants. 14 out of 17 eyes with a NuVita® and 17 out of 19 eyes with ZSAL-4 implant had a postoperative spherical refraction of ± 1 dpt. The postoperative corneal endothelial cell loss was 10% in case of NuVita® and 9% in case of ZSAL-4-PIOL implantation after 1 month. These numbers were stable during the entire follow-up time. The intraocular pressure was significantly elevated on the first post-operative day but decreased to normal on day 7 and was stable afterwards. Pupile ovalisation was seen in 3 eyes of 2 patients with NuVita® and 6 eyes of 3 patients with ZSAL-4 implantation.ConclusionPIOL is a suitable technique for the correction of high myopia, but we have to be aware of complications. We get stable refraction with both lens types and corneal endothelial cell loss is only around 10% with both lenses, but the incidence of pupile ovalisation is still high.

Farbsehen und Kontrastsehen mit photochromatischer IOL

SummaryPURPOSE: Blue-filter intraocular lenses (IOLs) might inhibit the phototoxic effect of blue light on the macula and therefore reduce the risk of developing age related macular degeneration. Yellow IOLs might decrease contrast sensitivity and colour vision under mesopic conditions. Photochromatic IOLs are clear under mesopic and scotopic conditions and turn yellow under photopic conditions. This study was performed to compare patients receiving clear, yellow and photochromatic IOLs. PATIENTS AND METHODS: 45 patients were analyzed retrospectively after an uncomplicated phacoemulsification and implantation of three different kinds of IOLs: AF-1 UY (yellow, n = 14, Hoya Japan), AF-1 UV (clear, n = 17, Hoya Japan) and Aurium (photochromatic, n = 14, Medennium USA). Patients were investigated for best corrected spectacle visual acuity (BCSVA) and contrast sensitivity (Pelli Robson charts) under photopic and mesopic conditions (in 3 and 6 meter), photopic color vision and spherical aberrations. All investigations were done three months after cataract surgery. RESULTS: There was a trend for a better mesopic best corrected visual acuity in patients with photochromatic IOLs compaired to patients with yellow IOLs (p = 0.06). There was no significant difference between the patients in terms of photopic BCSVA, contrast sensitivity, colour vision or spherical aberrations. CONCLUSION: Although there was no statistical significant difference between the three types of IOLs, we could see a trend for a better mesopic best corrected visual acuity in patients with the photochromatic IOL compaired to the yellow IOL. Further studies with a larger numbers of patients are needed to confirm this trend.ZusammenfassungHINTERGRUND: Intraokularlinsen (IOL) mit Blaulichtfilter könnten die Netzhaut vor phototoxischem Effekt kurzwelligen UV Lichtes schützen und somit das Risiko für die Entwicklung beziehungsweise Verschlechterung einer Makuladegeneration reduzieren. Es besteht jedoch die Vermutung, dass es zu einem verminderten Farb- und Kontrastsehen unter mesopischen Lichtverhältnissen kommen könnte. Die photochromatische Intraokularlinse (IOL) ist transparent unter mesopischen und gelb unter photopischen Bedingungen. In dieser Studie wurde die Sehqualität von Patienten mit klaren, gelben und photochromatischen IOLs verglichen. PATIENTEN UND METHODEN: 45 Patienten mit komplikationsloser Phakoemulsifikation und drei unterschiedlichen IOLs wurden drei Monate postoperativ retrospektiv untersucht: AF-1 UY (gelb, n = 14, Hoya Japan), AF-1 UV (klar, n = 17, Hoya Japan) und Aurium (photochromatisch, n = 14, Aurium, Medennium USA). Drei Monate postoperativ wurden bestkorrigierter Visus (mesopisch und photopisch), Kontrastsehen (mesopisch und photopisch), Farbsehen und sphärische Aberration überprüft und verglichen. ERGEBNISSE: Im Vergleich zu Patienten mit einer gelben IOL zeigten jene mit einer photochromatischen Linse einen Trend, aber keinen statistisch signifikanten Unterschied für einen besseren brillenkorrigierten Visus unter mesopischen Lichtbedingungen (p = 0.06). Sowohl das Kontrastsehen unter photopischen und mesopischen Lichtbedingungen, als auch das Farbsehen wiesen keinen signifikanten Unterschied auf. SCHLUSSFOLGERUNG: Patienten mit einer photochromatischen IOL zeigten zwar keinen statistisch signifikanten Unterschied hinsichtlich mesopischer Sehqualität verglichen mit Empfänger gelber Linsen, aber es war ein Trend zu beobachten und weitere Studien mit einer höheren Patientenfallzahl sind notwendig, um diesen Trend zu bestätigen.

Mitomycin C 0,02% zur Behandlung von subepithelialen Narben nach PRK

ZusammenfassungHintergrundSubepitheliale Narbenbildung (haze) nach photorefraktiver (PRK) oder photothera-peutischer Keratektomie (PTK), kann zu Myopieregression und Visusreduktion führen.Patienten und MethodikSechs Augen von fünf Patienten entwickelten ein bis drei Monate nach PRK einen „haze“ Grad 2–3 mit Visusreduktion. Nach Entfernung des Hornhautepithels (mit oder ohne anschließend durchgeführter PTK) wurde Mitomycin C 0,02% für ein bis zwei Minuten appliziert.ErgebnisseIn allen Fällen konnte eine vollständige Entfernung der subepithelialen Fibröse erreicht werden. Ein Rezidiv oder Komplikation wurde während einer Nachbeobachtungszeit von nahezu zwei Jahren nicht beobachtet.ZusammenfassungMitomycin C 0,02% stellt eine einfache und sichere Methode dar, korneale subepitheliale Narbenbildung nach PRK zu entfernen. Auch wenn bisher keine Komplikationen beobachtet wurden, müssen diese Patienten trotzdem regelmäßig nachbeobachtet werden.SummaryIntroductionSubepithelial corneal scarring (haze) can occur after photorefractive (PRK) or phototherapeutic keratectomy (PTK) and result in myopia regression and loss of best corrected visual acuity.Patients and methodsSix eyes of five patients developed corneal haze one to three months after PRK with loss of best corrected visual acuity. After removal of the corneal epithelium (with or without PTK afterwards) Mitomycin C 0.02% was applied for one to two minutes.ResultsRemoval of the subepithelial fibrosis could be achieved in all cases. A regression of corneal haze or serious complication was not observed during the follow-up period of up to two years.DiscussionMitomycin C 0.02% is a simple and safe method to remove corneal haze after PRK. Even serious complications have not been seen, these patients need further careful follow-ups.

Retropupillary Fixation of Iris-Claw Intraocular Lens for Aphakic Eyes in Children

Purpose To report outcome, complications and safety of retropupillary fixated iris-claw intraocular lenses in a pediatric population. Design Retrospective study. Patients and Methods Ten consecutive pediatric patients (15 eyes) underwent placement of retropupillary fixated iris-claw intraocular lenses between October 2007 and July 2013 at the Department of Ophthalmology, Medical University Graz and General Hospital Klagenfurt, Austria. Postoperative visual acuity and complications were analyzed. Results Median final best-corrected visual acuity improved by 0.12 logMAR from preoperative baseline. Mean postoperative spherical equivalent was -0.05 ± 1.76 D. No serious complications were observed intra- or postoperatively during the entire follow-up period of up to 40 months. One patient experienced a haptic disenclavation with IOL subluxation immediately after a car accident. Conclusion Our study demonstrates that iris-claw intraocular lens implantation behind the iris is safe in children with lack of capsular support and yields excellent visual outcome with low complication rate.