Florian Rüfer

Characterization of the thinnest point of the cornea compared with the central corneal thickness in normal subjects.

Introduction: For ongoing progress in refractive surgery, exact knowledge about the anatomical properties of the cornea is useful. Thus, the aim of the study was to characterize the thinnest point of the cornea compared with the central corneal thickness in normal subjects and to investigate with regard to influencing factors such as sex, age, refraction, and intraocular pressure. Materials and methods: The central corneal thickness and the thinnest point of the cornea were determined with the Orbscan II in 390 white normal subjects. Difference between the 2 eyes, influence of sex, and measuring repetition accuracy were tested for statistical significance with t tests, and the influence of age was tested with nonparametrical test methods. Results: In the right eyes, the mean central corneal thickness was 548 ± 37 μm and the thinnest point 537 ± 37 μm. In the left eyes, the mean central corneal thickness was 547 ± 37 μm and the thinnest point 535 ± 39 μm. The difference between the central corneal thickness and the thinnest point was found to be significant in both eyes in paired t test (P > 0.001). No influence of sex, refraction, and intraocular pressure on the thickness of the thinnest point of the cornea could be observed. The difference between central corneal thickness and thickness at the thinnest point was not subject to a statistically significant influence of age. Conclusions: In the calculation of the residual corneal layer thickness in laser refractive surgery, the thinnest point of the cornea should form the basis.

Comparison of the influence of aerobic and resistance exercise of the upper and lower limb on intraocular pressure.

Purpose:  To compare the influence of aerobic and resistance exercise on intraocular pressure (IOP).

Photodynamic therapy with intravitreal application of triamcinolone acetonide in age-related macular degeneration: functional results in 54 patients.

Purpose:  This study aimed to investigate the functional results, efficacy and complications after photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide injection (IVTA) in patients with choroidal neovascularization (CNV) caused by age‐related macular degeneration (AMD).

Anterior chamber depth and iridocorneal angle in healthy White subjects: effects of age, gender and refraction

Acta Ophthalmol. 2010: 88: 885–890

Influence of alcohol consumption on incidence and severity of open-globe eye injuries in adults

AimTo investigate the influence of alcohol consumption on the occurrence of open-globe injuries in adults.MethodsA retrospective study was made of 100 consecutive patients (81 male, 19 female) with open-globe injuries. Of these patients, 18 exhibited alcohol intoxication (group Ai), and 82 exhibited no alcohol intoxication (group nAi). Investigated parameters were best-corrected visual acuity at day of admission and last examination (logMAR), type of injury according to BETT-classification, extraocular injuries, cause of injury, time and setting of injury, in relation to alcohol consumption and tested for statistical significance with Fisher’s exact test or the Mann–Whitney U test, respectively.ResultsIn group Ai, 83.3% of the patients were male, and in group nAi, 80.5%. Mean logMAR at day of admission was 1.06 ± 0.63 (20/250) in group Ai and 1.08 ± 0.59 (20/250) in group nAi. At last examination, mean logMAR in group Ai was 1.11 ± 0.59 (20/250), in group nAi 0.75 ± 0.60 (20/125). This difference was statistically significant (p = 0.02). In group Ai, significantly more ruptures according to BETT classification occurred (p = 0.05). In group Ai, significantly more additional extraocular injuries occurred compared to group nAi (38.9% versus 6.1%; p = 0.0009). In group Ai, the cause of injury was significantly more often glass (44.4% versus 2.4%; p = 0.0000), in group nAi the injury was more often directly or indirectly caused by tools (74.4% versus 33.3%; p = 0.001). In group Ai, the injury was significantly more often inflicted by others (50.0% versus 9.8%; p = 0.0003). The settings in which the injuries occurred were significantly more often the street in group Ai (44.4% versus 6.1%; p = 0.0002), in group nAi the garden or tool shed (31.7% versus 5.6%; p = 0.02) or the workplace (34.2 % versus 11.1 %; p = 0.04). In group Ai, the injuries occurred significantly more often at night (p = 0.0001) and on weekends (p = 0.0000).ConclusionsOpen-globe eye injuries under alcohol intoxication are more often caused by a third party and have a worse prognosis. Open-globe injuries under alcohol intoxication occur in a different spatio-temporal setting and exhibit a more severe type of injury. Risk behavior combined with alcohol consumption therefore seems to be an independent factor for the incidence of open-globe eye injuries.

Multilayered Gore-Tex Patch for Temporary Coverage of Deep Noninfectious Corneal Defects: Surgical Procedure and Clinical Experience

PURPOSE To evaluate the multilayer Gore-Tex patch as temporary coverage of deep, noninfectious corneal defects. DESIGN Retrospective, interventional case series. METHODS SETTING University Medical Center Schleswig-Holstein, Kiel, Germany. PATIENT POPULATION Thirty-nine eyes of 38 patients with noninfectious, deep corneal defects. Underlying disorders included neurotrophic or immunologic ulcers in 37 eyes (94.9%) and traumatic defects in 2 eyes (5.1%). Intervention procedures: Corneal defects were covered with multiple Gore-Tex layers, of which the uppermost was sutured to the cornea. The Gore-Tex patch was kept in place until an appropriate corneal transplant was obtained and effective systemic immunosuppression was initiated. MAIN OUTCOME MEASURES Long-term preservation of the eye, frequency of resuturing of the Gore-Tex patch, and best-corrected visual acuity. RESULTS In 38 cases, the eye could be preserved. In 10 eyes, additional sutures were required. Before surgery, the mean best-corrected visual acuity (logMAR) was 1.14 ± 0.45 (20/250), and that at final follow-up was 1.13 ± 0.41 (20/250). The Gore-Tex patch remained in place 4 days to 32 months (mean, 6.4 ± 8.3 months) until corneal transplantation (27 eyes) or until an alternative way of defect coverage could be performed. Three eyes did not require further coverage after explantation of the Gore-Tex patch. In 6 eyes, either the Gore-Tex patch was kept in place or the patients died. CONCLUSIONS Temporary coverage of deep corneal defects with multilayer Gore-Tex patches allows time until an appropriate corneal transplant is obtained. The technique is particularly useful in patients with underlying autoimmune disorders, because an effective systemic immunosuppression can be initiated before corneal transplantation.

Ocular Trauma Score as prognostic value in traumatic ocular injuries due to rotating wire brushes

PurposeRotating wire brushes are used, e.g., for rust removal. Detaching fragments can cause severe eye injuries. The purpose of this study was to investigate mechanism, severity, clinical outcome, validity of Ocular Trauma Score (OTS) and to assess the likelihood of final visual acuity.MethodsTwenty patients with traumatic ocular injuries by rotating wire brushes were included. Location and type of injury, grade of injury according to OTS, surgical procedure, and development of visual acuity were evaluated.ResultsEleven accidents (55%) happened at work, nine at home (45%). Eighteen injuries (90%) were penetrating, one (5%) was perforating. In one case (5%), an intraocular foreign body was present. One case each was classified OTS 1 and 2 (5%), six cases OTS 3 (30%), four cases OTS 4 (20%), and eight cases OTS 5 (40%). None of the patients was wearing safety goggles. Fourteen patients (70%) were surgically treated. Of these, five were treated at the anterior segment only, nine additionally underwent pars-plana vitrectomy. Nine patients received phacoemulsification. Mean best corrected visual acuity was logMAR 1.0 (2/20) at admission and 0.3 (10/20) at last follow-up. Our results were similar to those in the OTS study, except for OTS 1 (p = 0.046). Comparing the categorical distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.119) between our results and the OTS study group.ConclusionsOTS may provide prognostic information in traumatic ocular injuries by rotating wire brushes. The injuries could have been avoided by wearing safety goggles.

General Concepts in Laser Treatment for Retinal Vascular Disease

Today light coagulation is a common treatment procedure and the basis of treatment in many retinal diseases. Its origins go back to Meyer-Schwickerath 1949 [46], who initially used sunlight as an energy source. However, sunlight was unsuitable for several reasons. A system of several mirrors and a long exposure time were necessary. The dependence on the weather forecast was an obvious problem. With the development of xenon high pressure lamps (Fig. 13.1) at the beginning of the 1950s, enough power for light coagulation of the ocular fundus became available [34]. Much scientific work was published at this time which showed the therapeutic effect of the light coagulation and which led to a wider experience [47, 48]. The main focuses of clinically based xenon coagulation were retinopexy and the treatment of proliferative diabetic retinopathy.

Laser suture lysis after trabeculectomy with mitomycin C: analysis of suture selection.

Objective:This paper analyses to what extent positioning and timing influences the degree of intraocular pressure (IOP) reduction by laser suture lysis (LSL) after trabeculectomy with mitomycin C. Methods:The IOP reduction following LSL was assessed in a consecutive case series of 168 eyes (120 patients) after trabeculectomy with mitomycin C. Scleral flap sutures of 3.3±0.6 were placed on average. The IOP reduction was assessed in terms of suture positioning and the time of LSL. Results:LSL was performed early (<7 d) on 48 of 168 eyes (29%). The mean IOP before trabeculectomy was 22.1±5.9 and 20.3±6.2 mm Hg on the first postoperative day. LSL additionally reduced the IOP by 6.3±6.9 mm Hg. LSL was performed late (>7 d) on 27 of 168 eyes (16%). The mean preoperative IOP was 20.7±6.0 mm Hg, 12.1±7.8 mm Hg on the first postoperative day, and increased again to 21.7±4.5 mm Hg by the time of LSL. The IOP reduction achieved by LSL was 7.0±5.1 mm Hg. In a subgroup of 54 eyes with 3 scleral flap sutures, there was no significant difference in IOP reduction in a comparison of corner and central sutures (P=0.4). The reduction of IOP after LSL was not significantly correlated with the number of respectively remaining scleral flap sutures (P=0.17). There was no correlation between the time of LSL and IOP reduction (P=0.96). Conclusion:The reduction of IOP after LSL is not related to suture selection or the number of remaining scleral flap sutures.

Open globe injuries by rotating wire brushes

toma after 1 month. Both patients were satisfied under the given circumstances and reported about functional improvements and a better central visual field. In sum, we can support the hypothesis that surgical embolus removal is a feasible, safe therapeutic option, at least in BRAO and HRAO. However, the risks of vitreoretinal surgery and open surgical embolus removal have to be outweighed against the benefits of (faster) visual acuity and central fixation improvement. It is still not clear if an early surgical approach in the first 4–6 hrs would make a complete visual field restoration possible. Further trials or case series, ideally randomized, could hopefully bring more clearness to this issue.