Claudette Abela

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.

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.

Comparison and histopathological correlation of three parathyroid imaging methods in a population with a high prevalence of concomitant thyroid diseases

The aim of this prospective study was to evaluate the diagnostic utility of a technetium-99m sestamibi dual-phase protocol enhanced by single-photon emission tomography (SPET) and semiquantitative analysis in comparison to established preoperative staging procedures in patients with primary hyperparathyroidism. Twenty-eight (50%) out of 56 patients had superimposed thyroid disease, and 12 patients had previously undergone neck surgery. Visual and semiquantitative analysis of planar99mTc-sestamibi dual-phase imaging, SPET of the delayed phase, ultrasonography, and thallium-201 chloride-technetium-99m pertechnetate subtraction scintigraphy was further correlated with the histopathological examination of the surgical specimens.99mTc-sestamibi dual-phase imaging achieved the highest sensitivity for side localization and precise localization compared with201Tl-99mTc subtraction scintigraphy and ultrasonography, but the differences reached statistical significance only in comparison to ultrasonography. Semiquantitative analysis did not enhance sensitivity. Adenoma detection by99mTc-sestamibi dual-phase imaging was only correlated to serum calcium levels and osteocalcin, not to cell density or oxyphil cell count (SPET yielded additional information for the exact topographical localization of the parathyroid tumour in 22 (39%) patients with superimposed thyroid disease or previous neck surgery but did not enhance the overall detection rate.

Impairment of endothelium-independent vasodilation in patients with hypercalcemia

OBJECTIVE Patients with primary hyperparathyroidism (PHPT) and/or hypercalcemia are at increased risk for myocardial ischemia. Whether PHPT is associated with altered endothelium-dependent dilation, vascular smooth muscle cell function, or both is unknown. This study was performed to test the hypothesis that endothelium-dependent, flow-mediated dilation (FMD) and/or endothelium-independent, nitroglycerin-induced dilation (NMD) is impaired in the preclinical phase of vascular disease in patients with PHPT. METHODS Twenty-six PHPT patients (mean +/- SD; age 55 +/- 15 y, serum calcium 3.00 +/- 0.37 mmol/l, serum phosphate 0.79 +/- 0.21 mmol/l, iPTH 249 +/- 262 pg/ml) with no evidence of coronary artery disease (CAD) as well as 26 normocalcemic control subjects (CTL; age 51 +/- 12 y) were studied. FMD following reactive hyperemia and NMD after 0.8 mg nitroglycerin (NTG) were assessed in the brachial artery by using high resolution ultrasound (7 MHz). RESULTS NMD was impaired in PHPT patients compared to CTL (11.9 +/- 3.9% vs. 15.6 +/- 5.7%; p = 0.012). FMD was similar in both study groups (11.6 +/- 4.6% vs. 12.6 +/- 4.9; NS). The ratio of FMD to NMD was significantly different between PHPT patients and CTL (0.98 +/- 0.19 vs 0.81 +/- 0.25, p = 0.0009). On multiple stepwise regression analysis serum calcium was independently associated with the FMD/NMD ratio (r = 0.34, p = 0.017). CONCLUSIONS Endothelium-independent vasodilation is impaired in PHPT patients without clinical evidence of coronary artery disease compared to normocalcemic CTL, while endothelium-dependent dilation was similar in both study groups. Thus, altered arterial reactivity in the course of PHPT may predominantly involve the arterial media and not the endothelium as observed previously in patients with various stages of atherosclerosis.

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.

Course of postoperative inflammation after implantation of 4 types of foldable intraocular lenses

PURPOSE To compare the course of postoperative inflammation after small incision cataract surgery with implantation of 4 types of foldable intraocular lenses (IOLs). SETTING Department of Ophthalmology, University Hospital of Vienna, Austria. METHODS One hundred twenty eyes were prospectively randomized to receive a foldable silicone (Pharmacia 920), hydrogel (Bausch & Lomb Hydroview), methyl methacrylate/hydroxyethyl methacrylate (Mentor MemoryLens), or acrylic (Alcon AcrySof) IOL. All surgery was performed by the same experienced surgeon using a standardized surgical protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag implantation of the IOL. All patients received standardized postoperative medication and follow-up. Postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 14, 28, 90, and 180 days after surgery using the Kowa 1000 laser flare-cell meter. RESULTS Except on the first day after surgery, when the AcrySof group had higher flare values than the other groups (P = .0265), no significant differences were found up to 6 months. Re-establishment of the blood-aqueous barrier was similar in eyes with the AcrySof, Hydroview, and MemoryLens IOLs; the course of postoperative inflammation was different in eyes with the silicone IOL. CONCLUSION Comparison of postoperative flare values after implantation of 4 foldable IOLs showed no clinically relevant differences in the course of postoperative inflammation.

Time course of regression of left ventricular hypertrophy after successful parathyroidectomy

BACKGROUND We have shown that primary hyperparathyroidism may induce myocardial hypertrophy that is reversible after successful parathyroidectomy. The present study was designed to assess the time course of regression of left ventricular hypertrophy without further effects of drug treatment or disease states. METHODS We performed echocardiographic studies in 16 patients with primary hyperparathyroidism and normal resting blood pressure, normal systolic left ventricular function, no evidence of valvular disease, and without any current medication before parathyroidectomy, as well as during intermediate and long-term follow-up after successful parathyroidectomy. RESULTS Eleven patients (69%) had end-diastolic wall thickness of the interventicular septum and/or posterior wall greater than 11 mm on baseline echocardiogram. After surgical removal of the inciting disease and an average of 12.5 and 45.7 months of follow-up with normocalcemia and normal parathyroid hormone levels a prolonged regression of left ventricular hypertrophy was observed (interventricular septum, -0.68 mm at 12.5 months and -1.69 mm at 45.7 months; p = 0.02; posterior wall, -0.46 mm at 12.5 months and -2.24 mm at 45.7 months; p = 0.02). CONCLUSIONS We conclude that the removal of the cause of myocardial hypertrophy by successful parathyroidectomy leads to a prolonged reversal of hypertrophy. The progressive reduction of left ventricular wall thickness is not completed within 12 months.

MORPHOLOGICAL AND FUNCTIONAL RESULTS OF ACRYSOF INTRAOCULAR LENS IMPLANTATION IN CHILDREN: PROSPECTIVE RANDOMIZED STUDY OF AGE-RELATED SURGICAL MANAGEMENT

Purpose: To evaluate the prevalence and severity of posterior capsule opacification (PCO) in pediatric eyes with a foldable acrylic AcrySof® (Alcon) intraocular lens (IOL) and age‐related surgical methods. Setting: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. Methods: This prospective randomized study comprised 50 eyes of 34 children aged between 2 and 16 years. Eyes of children between 2 and 5.9 years were consecutively randomized to Group 1a (primary posterior capsulotomy and anterior vitrectomy) or Group 1b (optic capture in addition). Eyes of children between 6 and 16 years were consecutively randomized to Group 2a (primary posterior capsulotomy without anterior vitrectomy), Group 2b (optic capture in addition), or Group 2c (in‐the‐bag IOL implantation without opening the posterior capsule). Main outcome parameters were the incidence and severity of PCO formation, early postoperative complications, pigmented cell deposits on the IOL surface, and cataract morphology. Results: The visual axis was clear at the last follow‐up in all eyes in Groups 1a, 1b, 2a, and 2b except in 1 eye in Group 1a. Sixty‐percent of eyes in Group 2c had PCO. The incidence of early postoperative complications was significantly higher in eyes that developed PCO than in those that maintained a clear visual axis. There was no evidence that cataract morphology influenced PCO rates. Conclusions: The AcrySof IOL was well tolerated in pediatric eyes. Optic capture was not necessary to ensure a clear visual axis. Primary posterior capsulotomy should be performed in preschool and uncooperative children and in eyes expected to have relatively high postoperative inflammation. Implanting the AcrySof in the bag and leaving the posterior capsule intact is acceptable for school children and juveniles with isolated developmental cataract.

Long-term disorders of the blood-aqueous barrier after small-incision cataract surgery.

Purpose To determine the long-term function of the blood-aqueous barrier after small-incision cataract surgery with implantation of a foldable intraocular lens.Methods The blood-aqueous barrier function in 74 eyes of 62 patients who underwent cataract surgery was examined using a laser flare-cell meter. The measurements were performed pre-operatively and post-operatively between 12 and 35 months after surgery. For statistical analysis a linear regression was used. The study was designed as a single cohort study, with comparison of pre- and post-operative values.Results Highly statistically significant differences (p 0.0001) were found between pre-operative flare values and those measured at the final visit. The linear regression model showed significantly higher flare values post-operatively compared with those measured pre-operatively. Other variables such as incision technique, sex, operation time, phaco time and systemic disease had no influence on this outcome.Conclusion The results suggest that there is persistent blood-aqueous barrier dysregulation even several years after cataract surgery.