Eva Stifter

Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with a round-edged silicone and a sharp-edged hydrophobic acrylic intraocular lens 10 years after surgery.

PURPOSE: To compare posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser capsulotomy rates 10 years after surgery between two 3‐piece intraocular lenses (IOLs): a silicone IOL with round optic edges and a hydrophobic acrylic IOL with sharp optic edges. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. METHODS: Patients having had cataract surgery and implantation of at least 1 study IOL by the same surgeon between 1994 and 1999 were retrospectively examined. The number of Nd:YAG laser capsulotomies performed was noted. The PCO intensity was assessed using digital retroilluminated photographs and Automated Quantification of After‐Cataract (AQUA) software. The AQUA scores in eyes with Nd:YAG capsulotomy were estimated with a multiple‐imputation procedure. Anterior capsule opacification (ACO) and fibrotic PCO were graded subjectively at the slitlamp. RESULTS: The study evaluated 143 eyes (98 patients). Eight (18%) of 44 eyes with a silicone IOL and 41 (42%) of 99 eyes with an acrylic IOL had Nd:YAG capsulotomy after 10 years (P = .007). The AQUA scores were lower with the silicone IOLs. The median difference in AQUA scores was significantly different after missing values of the Nd:YAG capsulotomies were imputed. There was no difference in ACO. There was more fibrotic PCO with round‐edged silicone IOLs than with sharp‐edged acrylic IOLs. CONCLUSIONS: Ten years after surgery, acrylic IOLs seemed to lose their PCO preventive effect, despite their sharp optic edges. The increasingly longer life expectancy and earlier cataract surgery mandate reconsideration of preferences regarding optic materials and design elements of IOLs.

Monocular and binocular reading performance in children with microstrabismic amblyopia

Aim: To evaluate if functionally relevant deficits in reading performance exist in children with essential microstrabismic amblyopia by comparing the monocular and binocular reading performance with the reading performance of normal sighted children with full visual acuity in both eyes. Methods: The reading performance of 40 children (mean age 11.6 (SD 1.4) years) was evaluated monocularly and binocularly in randomised order, using standardised reading charts for the simultaneous determination of reading acuity and speed. 20 of the tested children were under treatment for unilateral microstrabismic amblyopia (visual acuity in the amblyopic eyes: logMAR 0.19 (0.15); fellow eyes −0.1 (0.07)); the others were normal sighted controls (visual acuity in the right eyes −0.04 (0.15); left eyes −0.08 (0.07)). Results: In respect of the binocular maximum reading speed (MRS), significant differences were found between the children with microstrabismic amblyopia and the normal controls (p = 0.03): whereas the controls achieved a binocular MRS of 200.4 (11) wpm (words per minute), the children with unilateral amblyopia achieved only a binocular MRS of 172.9 (43.9) wpm. No significant differences between the two groups were found in respect of the binocular logMAR visual acuity and reading acuity (p>0.05). For the monocular reading performance, significant impairment was found in the amblyopic eyes, whereas no significant differences were found between the sound fellow eyes of the amblyopic children and the control group. Conclusion: In binocular MRS, significant differences could be found between children with microstrabismic amblyopia and normal controls. This result indicates the presence of a functionally relevant reading impairment, even though the binocular visual acuity and reading acuity were both comparable with the control group.

Evaluating reading acuity and speed in children with microstrabismic amblyopia using a standardized reading chart system

BackgroundTo examine if standardized reading charts with highly comparable test items can be used for evaluating impairments in the monocular reading performance of children with microstrabismic amblyopia characterized by a small angle of squint with less than 5 degrees.MethodsThe reading performance of 22 children (mean age: 11.7±1.6 years) with unilateral microstrabismic amblyopia was evaluated monocularly in both eyes, using standardized reading charts for the simultaneous determination of reading acuity and speed. The print sizes of the highly comparable sentence optotypes were logarithmically graded, providing constant geometric proportions for all testing distances in order to control contour interaction. All children were under continuous amblyopia therapy.ResultsIn the amblyopic eyes, reading acuity and maximum reading speed were significantly impaired when compared to the sound fellow eyes (P<0.001). In respect of the maximum reading speed, a mean inter-ocular difference of 33±19 words per minute was found, revealing functionally relevant deficits in monocular reading performance. The amblyopic eyes achieved only a significantly reduced reading acuity (mean inter-ocular difference: LogRAD 0.5±0.24; P<0.001). In eight children, the amblyopic eyes achieved a best-corrected visual acuity of LogMAR 0.0 or better: in respect of the visual acuity, there was no significant inter-ocular difference, but reading acuity and maximum reading speed were significantly impaired when compared to the fellow eyes.ConclusionsMicrostrabismic amblyopia was associated with significant impairment of reading acuity and speed in treated amblyopes, even in those with no persistent acuity deficit. To improve treatment addressing these functional deficits, reading performance should be monitored over time using standardized reading tests, which provide essential information about functionally relevant reading impairments.

Functional vision with cataracts of different morphologies: Comparative study

Purpose: To evaluate the influence of cataract morphology on the functional vision of patients with age‐related cataract and normal macular function and compare subjectively perceived functional impairments to distance visual acuity, reading acuity, and maximum reading speed between cataract types. Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods: Seventy‐five patients awaiting first‐eye cataract surgery were asked to characterize their visual difficulties in everyday life using a German version of the VF‐14 questionnaire. Cataracts were categorized and graded using the Lens Opacities Classification System III. Monocular and binocular visual acuity and reading performance were determined in randomized order. Results: There were significant differences in functional vision between nuclear cataracts and posterior subcapsular cataracts (PSC); the VF‐14 score and the self‐reported visual satisfaction were significantly lower in PSC patients (P<.05). Posterior subcapsular cataracts significantly increased self‐reported impairment in distance and near vision, although the visual acuity was comparable to that in the other groups (P = .9). Significant differences in functional vision were also seen between PSC and nuclear–cortical cataracts (P<.05). No significant differences in functional vision were found between nuclear cataracts and nuclear–cortical cataracts (P>.05). Conclusions: The VF‐14 questionnaire reliably evaluated functional differences caused by different cataract morphologies; these differences were underestimated when only visual acuity was measured. Patients with PSC had increased functional impairment, indicating that cataract surgical intervention is indicated at an earlier stage in these patients. The significant differences between the morphological types of cataract should be taken into consideration when the benefit of cataract surgery is to be measured on the basis of functional improvement.

Discriminative power of reading tests to differentiate visual impairment caused by cataract and age-related macular degeneration

PURPOSE: To determine whether preoperative reading tests can be used for differentiating visual impairments with regard to the diagnosis of cataract and age‐related macular degeneration (ARMD). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Reading performance of patients with nuclear cataract, posterior subcapsular cataract, and ARMD were evaluated with respect to reading acuity, maximum reading speed, and critical print size; normal‐sighted participants were tested as controls. A multivariate discriminant analysis of the 4 groups (100 eyes of 100 participants) was performed to evaluate how many patients could be correctly diagnosed by significant differences in the tested reading parameters. Subsequently, the nuclear cataract and posterior subcapsular cataract patients were compared with cataract patients with coexisting ARMD. RESULTS: Distance visual acuity was comparable in the nuclear cataract, posterior subcapsular cataract, and ARMD groups (P>.05). Reading acuity was significantly reduced in posterior subcapsular cataract and ARMD patients compared with nuclear cataract patients and controls (P<.0001). No significant difference in maximum reading speed was found between the nuclear cataract patients and the controls (P = .07), whereas the maximum reading speed of the posterior subcapsular cataract and ARMD patients was significantly reduced (P<.0001). In the discriminant analysis, it was possible to assign the correct diagnosis to 72% of the nuclear cataract patients, 76% of the posterior subcapsular cataract patients, 72% of the ARMD patients, and 92% of the controls. Comparing the reading performance of nuclear cataract and posterior subcapsular cataract patients and cataract patients with coexisting ARMD showed that reading performance was significantly impaired in the comorbid patients (nuclear cataract and ARMD, P<.001; posterior subcapsular cataract and ARMD, P<.05). CONCLUSION: The high discriminant accuracy shows that this standardized reading test system is a valuable diagnostic tool for evaluating functional visual impairments when distance visual acuity alone cannot elucidate the origin of functional impairment. Considering the significant discrepancies in reading performance among patients with nuclear cataract, posterior subcapsular cataract, and ARMD, reading tests may relevantly improve the clinical evaluation of patients with visual loss, even of patients with ocular comorbidity.

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small‐incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in‐the‐bag IOL implantation. SETTING: Department of Ophthalmology, Medical University of Vienna, Austria. METHODS: This prospective comparative study comprised 23 patients (46 eyes) with age‐related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA‐60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in‐the‐bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high‐resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. RESULTS: Ten patients completed 10 to 12 months of follow‐up. Postoperatively, the axial IOL position was stable in eyes with PPCCC–POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in‐the‐bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC–POBH (P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.

Posterior Capsule Opacification with the iMics1 NY-60 and AcrySof SN60WF 1-Piece Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial

PURPOSE To compare the intensity of posterior capsule opacification (PCO) 3 years after implantation of 2 different 1-piece foldable hydrophobic acrylic intraocular lenses (IOLs). DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS One hundred patients with bilateral age-related cataract (200 eyes) had standard cataract surgery with implantation of an iMics1 NY-60 IOL (Hoya Corp) in one eye and an AcrySof SN60WF IOL (Alcon Laboratories) in the other eye. Follow-up examinations were performed at 1 week and 3 years. Digital retroillumination images were obtained of each eye. The main outcome measure was PCO score (scale, 0 to 10) assessed subjectively at the slit lamp and objectively using automated image analysis software (Automated Quantification of After-Cataract) 3 years after surgery. RESULTS The objective PCO score (mean ± standard deviation) was 3.0 ± 2.0 for the iMics1 NY-60 IOL and 1.9 ± 1.4 for the AcrySof SN60WF IOL (P < .001). Three years after surgery, 35.6% of patients underwent a neodymium:yttrium-aluminum-garnet capsulotomy in the iMics1 NY-60 eye and 13.7% underwent a capsulotomy in the AcrySof SN60WF eye (P = .001). There was no statistically significant difference in best-corrected visual acuity, rhexis-IOL overlap, capsular folds, or anterior capsule opacification. Glistening formations were found in no iMics1 NY-60 IOLs, but in 97% of the AcrySof SN60WF IOLs. CONCLUSIONS Comparison of 2 sharp-edged single-piece IOLs of similar design and hydrophobic acrylic material indicated a statistically significant difference in PCO and neodymium:yttrium-aluminum-garnet capsulotomy rate 3 years after surgery.

Effect of primary posterior continuous curvilinear capsulorhexis with and without posterior optic buttonholing on postoperative anterior chamber flare

PURPOSE: To evaluate the effect of primary posterior continuous curvilinear capsulorhexis (PCCC) with and without posterior optic buttonholing (POBH) on the anterior chamber reaction after small‐incision cataract surgery. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Consecutive patients with age‐related cataract having cataract surgery in both eyes under topical anesthesia were prospectively enrolled in a randomized clinical trial. In randomized order, cataract surgery with combined primary PCCC and POBH was performed in 1 eye; in the other eye, cataract surgery was performed with primary PCCC and in‐the‐bag implantation of an intraocular lens. Intraocular flare was measured with an FC‐1000 laser flare–cell meter preoperatively and postoperatively at 1, 4 to 6, and 24 hours, 1 week, and 1 month. RESULTS: Thirty patients (60 eyes) were evaluated. The peak of intraocular flare was 1 hour postoperatively in all study eyes. In both groups, the response steadily decreased thereafter. Anterior chamber flare was statistically significantly higher in eyes with primary PCCC without POBH than in eyes with combined primary PCCC–POBH at all postoperative testing points (P<.001), including at 1 month (P = .01). CONCLUSIONS: Cataract surgery with combined primary PCCC–POBH led to significantly lower postoperative anterior chamber reaction than conventional in‐the‐bag implantation during a 4‐week follow‐up. The tight capsule–optic diaphragm effectively prevented the ophthalmic viscosurgical device captured behind the optic from entering the anterior chamber postoperatively.

Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults

Aim: Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. Methods: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. Results: The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). Conclusion: Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.

Visual performance 3 years after successful macular hole surgery

Background/aims: To evaluate the visual performance of patients with successful macular hole surgery with a minimum follow-up of 3 years. Results were compared with the performance of the healthy fellow eyes. Methods: 15 patients were studied. The healthy fellow eyes of the patients (13 eyes) served as a control group. Age, gender and best-corrected logMAR visual acuity were recorded. Reading acuity (in log reading acuity determination (RAD), reading equivalent of logMAR) and speed were tested monocularly. Scotoma size was measured with SLO perimetry, and hole closure was confirmed with an OCT scan. Results: The mean distance visual acuity of the operated eyes (logMAR 0.32 (SD 0.21)) was significantly lower than that of the healthy fellow eyes (logMAR 0.05 (0.17)), but significantly higher than preoperatively (logMAR 0.71 (0.32)). The mean reading acuity was logRAD 0.47 (0.25) for the operated eyes ( = 77.9% of logMAR), and statistically significantly higher (logRAD 0.16 (0.16)) for the fellow eyes ( = 89.4% of logMAR). The mean maximum reading speeds were comparable for the operated eyes (168.3 (23.1) words per minute (wpm)) and the fellow eyes (178.7 (26.1) wpm) (p = 0.3). Within logRAD 1.3 and 0.5, the mean reading speeds of the two groups were comparable, but critical print size (CPS) for the operated group (logRAD 0.7 (0.2)) was significantly worse than those for the fellow eyes (logRAD 0.4 (0.2)). The SLO analysis showed absence of absolute scotoma in 12 eyes. Conclusion: Distance and reading acuity showed remaining deficits compared with the healthy fellow eyes; however, mean maximum reading speeds of the operated eyes achieved results comparable with healthy eyes. The results show a long-term benefit in the visual function of eyes with closed macular holes.