Georg Rainer

Effect of intraocular lens optic edge design and material on fibrotic capsule opacification and capsulorhexis contraction

Purpose: To examine the influence of intraocular lens (IOL) optic edge design and optic material on fibrosis of the anterior and peripheral posterior capsules and on capsulorhexis contraction. Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods: This randomized controlled patient‐ and examiner‐masked study comprised 210 eyes of 105 patients with bilateral age‐related cataract. In Group 1 (n = 53), the Sensar® OptiEdge AR40e hydrophobic acrylic IOL with a sharp posterior optic edge was compared with the AR40 acrylic IOL with a round edge. In Group 2 (n = 52), the ClariFlex® OptiEdge silicone IOL with a sharp posterior optic edge was compared with the PhacoFlex SI‐40 silicone IOL with a round edge All IOLs were manufactured by Advanced Medical Optics, Inc. Standardized digital slitlamp images of anterior capsule opacification (ACO) and fibrotic posterior capsule opacification (PCO) were taken 1 year postoperatively, and digital retroillumination images were taken at 1 week and 1 year. The intensity of fibrotic PCO was graded subjectively (score 0 to 4), ACO was graded objectively (score 0% to 100%), and the capsulorhexis area (mm2) was determined objectively. Results: One year after surgery, the mean ACO score was 32% in eyes with the sharp‐edged acrylic IOL and 29% in eyes with the round‐edged acrylic IOL (P<.05). In the silicone group, the mean was 31% and 26%, respectively (P<.05). The mean fibrotic PCO score was lower in eyes with a sharp‐edged acrylic IOL than in eyes with a round‐edged acrylic IOL (0.26 and 0.93, respectively; P<.05) and in eyes with a sharp‐edged silicone IOL than in eyes with a round‐edged silicone IOL (0.24 and 0.82, respectively; P<.001). At 1 year, the mean capsulorhexis area was statistically significantly smaller in eyes with a sharp‐edged silicone IOL than in eyes with a round‐edged silicone IOL (P<.05). Conclusions: Acrylic and silicone IOLs with the sharp OptiEdge design led to significantly less fibrotic PCO but more ACO than round‐edged acrylic and silicone IOLs. The sharp‐edged silicone IOL caused significantly more capsulorhexis contraction than the round‐edged silicone IOL and both acrylic IOLs.

Effect of anterior capsule polishing on fibrotic capsule opacification: Three-year results

Purpose: To evaluate the long‐term effect of anterior capsule polishing on anterior capsule opacification (ACO) and peripheral fibrotic posterior capsule opacification (PCO). Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. Methods: This randomized double‐blind study comprised 104 eyes of 52 patients with bilateral age‐related cataract. All patients received round‐edged intraocular lenses (IOLs); 26 received an SI‐40 IOL (Advanced Medical Optics Inc.) in both eyes, and 26 received a Silens6 IOL (Domilens) in both eyes. Both IOLs consist of different silicone material and have different haptic angulation. The SI‐40 IOL has 13.0 mm open‐loop poly(methyl methacrylate) (PMMA) haptics angulated by 10 degrees. The Silens6 IOL has 12.5 mm open‐loop PMMA haptics with no angulation. In 1 eye, the anterior capsule was extensively polished. The anterior capsule was left unpolished in the contralateral eye, which acted as a control. Digital slitlamp photographs of the ACO and fibrotic PCO were taken with a standardized technique for 3 years postoperatively. The intensity of ACO was measured objectively (score 0% to 100%) using Adobe Photoshop software. Fibrotic PCO was graded subjectively (score 0 to 4). Results: The mean ACO was 17% in the polished eyes and 26% in the control eyes (P = .0001). The mean fibrotic PCO score was 0.5 and 1.0, respectively (P = .0007). The mean ACO was 15% in the polished SI‐40 eyes and 26% in the control SI‐40 eyes (P = .01). It was 19% in the polished Silens6 eyes and 26% in the control Silens6 eyes (P = .003). The mean fibrotic PCO score was 0.4 in the polished SI‐40 eyes and 1.1 in the control SI‐40 eyes (P = .0006). It was 0.6 in the polished Silens6 eyes and 0.9 in the control Silens6 eyes (P = .08). Conclusions: Three years after surgery, eyes in which the anterior capsule was extensively polished had less ACO and fibrotic PCO with both round‐edged silicone IOLs. In eyes with Silens6 IOLs, however, the reduction in fibrotic PCO was not significant.

Diurnal fluctuation of ocular blood flow parameters in patients with primary open-angle glaucoma and healthy subjects

Background/aims: To investigate the fluctuations of ocular blood flow parameters over 13 h in patients with primary open-angle glaucoma (POAG) and in healthy eyes, and to relate these fluctuations with variations in intraocular pressure (IOP) and mean ocular perfusion pressure (OPP). Methods: 15 patients with POAG and 15 control subjects were included. Measurements of systemic blood pressure (SBP), fundus pulsation amplitude (FPA), choroidal blood flow (CHBF), optic nerve head blood flow (ONHBF) and IOP were performed at 08:00, 12:00, 17:00 and 21:00. OPP was calculated from IOP and SBP. The coefficient of variation (CV) was calculated for all individual parameters to assess their variability. Results: The time response of the ocular haemodynamic variables was not different between the groups. Most of the outcome variables showed significantly larger fluctuations in patients with POAG compared with healthy controls (CV: FPA: 0.085 (SD 0.033) vs 0.054 (0.029), pu200a=u200a0.012; CHBF: 0.082 (0.030) vs 0.052 (0.023), pu200a=u200a0.005; ONHBF: 0.086 (0.044) vs 0.059 (0.032), pu200a=u200a0.063). These changes were not associated with OPP or IOP. Changes over time correlated among the different ocular haemodynamic outcome measures in patients with POAG (ru200a=u200a0.678, ru200a=u200a0.557, ru200a=u200a0.545; p<0.04) but not in the control subjects (ru200a=u200a0.336, ru200a=u200a−0.227, ru200a=u200a−0.130; p>0.22). Conclusion: Patients with POAG show a larger diurnal fluctuation of ocular blood flow parameters. These fluctuations appear not to be related to a higher statistical error of the applied measurement techniques in POAG patients. These data support the hypothesis that POAG is associated with vascular dysregulation.

Surgically induced astigmatism following a 4.0 mm sclerocorneal valve incision

Purpose: To determine whether sutureless small incision cataract surgery reduces induced astigmatism over the long term. Setting: University Eye Hospital, Vienna, Austria. Methods: In a prospective study, we investigated surgically induced astigmatism in 63 cases of no‐stitch, small incision cataract surgery with a 4.0 mm square sclerocorneal tunnel and implantation of a flexible intraocular lens. Follow‐up was 4 to 5 years. Keratometry was measured with a Zeiss keratometer preoperatively and after 1 day, 1 week, 1, 3, and 9 months, and a median of 4.4 years. In 21 nonoperated eyes, we investigated the natural course of astigmatism over 5 years. Results: The mean keratometric cylinder stabilized at 0.8 diopter (D) after 1 week and slightly increased to 1.0 D after 4 to 5 years. Cravy’s vector analysis showed an immediate against‐the‐rule (ATR) shift of ‐0.2 D that remained relatively stable until 9 months. Between 9 months and 4.4 years postoperatively, there was a statistically significant increase in ATR induced astigmatism from ‐0.2 to ‐0.5 D. The natural course of astigmatism in the nonoperated eyes showed an ATR shift of ‐0.1 D for the same period. Conclusion: The results show a small, though statistically significant amount of postoperatively induced astigmatism 4 to 5 years after no‐stitch, small incision cataract surgery.

Efficacy and safety of capsular bending ring implantation to prevent posterior capsule opacification: three-year results of a randomized clinical trial.

PURPOSE: To determine whether a capsular bending ring (CBR) with a rectangular cross‐section and sharp edges moves the barrier to the very equator and avoids contact between the capsulorhexis and optic to prevent posterior capsule opacification (PCO) and anterior capsule fibrosis. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A 0.7 mm high, open poly(methyl methacrylate) CBR was implanted in 60 eyes (patients) in a prospective randomized intraindividual trial. The impact of additional CBR implantation on PCO and anterior capsule fibrosis was compared to that of intraocular lens (IOL) implantation alone using objective scoring. RESULTS: No CBR‐related surgical complications occurred. The objective PCO score and area were statistically significantly reduced in the CBR group. In patients with complete follow‐up, the mean PCO score (scale 1 to 10) at 1, 2, and 3 years was 0.8, 1.7, and 2.1, respectively, in the CBR group and 2.6, 3.9, and 4.6, respectively, in the no‐CBR group. The number of quadrants affected by PCO was 0.9, 1.5, and 1.8 versus 3.2, 3.8, and 3.8. Barrier failures with the CBR were caused by the inherent slight edge blunting and occasional eyelet gaping. Laser capsulotomies were performed in the no‐CBR group only. Capsule stress folds and fibrotic anterior capsule opacification were also greatly reduced. The best corrected visual acuity was better in the CBR group. CONCLUSIONS: Capsular bending ring implantation was an effective and safe adjunct to in‐the‐bag IOL fixation. With improvements in technology and design securing exquisitely sharp edges and circumferential capsular bending independent of the capsular bag diameter, this concept has the potential to prevent PCO and anterior capsule fibrosis.

Effect of trabeculectomy on ocular blood flow

Background/aim: Current evidence suggests that vascular insufficiencies in the optic nerve head play an important part in the pathogenesis of glaucomatous optic neuropathy. Trabeculectomy is the most common operative procedure for the treatment of medically uncontrolled glaucoma. This study was conducted to investigate whether trabeculectomy may improve ocular haemodynamics. Methods: 30 patients with primary open angle glaucoma about to undergo trabeculectomy were included in the study. Patients were evaluated before surgery and at 2 and 10 weeks after trabeculectomy. Optic nerve head blood flow (OnhBF) was assessed with scanning laser Doppler flowmetry. Fundus pulsation amplitude (FPA) measurements were obtained with laser interferometry. Results: Because of the decrease in intraocular pressure there was a significant increase in ocular perfusion pressure (OPP) following trabeculectomy (18.5% (SD 12.0%) and 19.0% (17.1%) at 2 and 10 weeks postoperatively; p <0.001). A significant increase in OnhBF was observed after trabeculectomy (11.6% (16.4%) and 16.2% (20.2%) for each postoperative visit, respectively; p <0.001). FPA was also significantly higher compared with baseline values (17.2% (17.3%) and 17.4% (16.3%), respectively; p <0.001). A significant association between the increase in OPP and the increase in OnhBF and FPA was observed 10 weeks after surgery (ru200a=u200a0.47; pu200a=u200a0.009, and ru200a=u200a0.50; pu200a=u200a0.005, respectively). Conclusion: The results of this study suggest that trabeculectomy improves ocular blood flow in patients with chronic open angle glaucoma.

Comparison of the effect of Viscoat and DuoVisc on postoperative intraocular pressure after small-incision cataract surgery.

PURPOSE: To evaluate the effect of Viscoat (sodium chondroitin sulfate 4%–sodium hyaluronate 3%) and DuoVisc (Viscoat and Provisc [sodium hyaluronate 1%]) on postoperative intraocular pressure (IOP) after bilateral small‐incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 60 eyes of 30 consecutive patients with age‐related cataract in both eyes. Each patients eyes were randomly assigned to receive Viscoat or DuoVisc during cataract surgery. DuoVisc is a packet containing 2 ophthalmic viscosurgical devices (OVDs): the dispersive Viscoat, which was used for intraocular lens (IOL) implantation. In the Viscoat group, the Viscoat was used during the entire surgery. The intraocular pressure (IOP) was measured preoperatively as well as 1, 6, and 20 to 24 hours postoperatively. RESULTS: One and 6 hours postoperatively, the mean IOP was significantly higher in the Viscoat group than in the DuoVisc group (25.8 mm Hg and 20.5 mm Hg, respectively, at 1 hour and 24.7 mm Hg and 21.1 mm Hg, respectively, at 6 hours) (P<.05). At 20 to 24 hours, the mean IOP was not statistically significantly different between the 2 groups. Intraocular pressure spikes to 30 mm Hg or higher occurred in 4 eyes in the DuoVisc group and 11 eyes in the Viscoat group (P<.05). CONCLUSIONS: Viscoat caused significantly higher IOP increases and significantly more IOP spikes than DuoVisc in the early postoperative period. Therefore, if Viscoat is used during cataract surgery, an additional cohesive OVD should be used for IOL implantation.

Intraocular pressure rise after primary posterior continuous curvilinear capsulorhexis with a fixed dorzolamide-timolol combination : Randomized safety study with intraindividual comparison using an angulated and a nonangulated intraocular lens

PURPOSE: To assess the safety, in terms of the intraocular pressure (IOP), of cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and a postoperative dose of a fixed dorzolamide–timolol combination and evaluate the effect of intraocular lens (IOL) haptic angulation. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In this prospective randomized double‐masked bilateral study, 88 eyes of 44 consecutive patients with age‐related cataract were included in an intraindividual comparison study. All patients had standardized cataract surgery with PPCCC and IOL implantation in the capsular bag followed by a postoperative dose of a fixed dorzolamide–timolol combination. Patients were randomly assigned to receive an ACR6D SE IOL (Laboratoires Cornéal) in 1 eye and a Centerflex (C‐flex) 570C IOL (Rayner Surgical GmbH) in the contralateral eye. The IOP was measured at baseline and postoperatively at 6 and 24 hours as well as 1 week. RESULTS: Intraindividual comparison showed statistically significantly higher IOP measurements in the C‐flex 570C nonangulated IOL group than in the ACR6D SE angulated IOL group at 24 hours (P = .003) and 1 week (P = .043). The highest IOP spikes (34 mm Hg) were at 6 hours in 2 eyes with a C‐flex 570C IOL. The ACR6D SE group had statistically significant changes in IOP between preoperative and all postoperative time points. In the C‐flex 570C group, the only statistically significant change in IOP was between preoperatively and 6 hours postoperatively. CONCLUSIONS: Cataract surgery with PPCCC was safe in terms of the postoperative IOP course. Haptic angulation slightly decreased the overall IOP rise and the incidence of IOP rises above 30 mm Hg.

Reactivity of white blood cell flux to hyperoxia in patients infected with human immunodeficiency virus

Purpose:u2002 The aetiology of the apparently vasoocclusive phenomena in human immunodeficiency virus (HIV)‐related retinopathy is not well understood. Several hypotheses, including infectious damage of the retinal vasculature and altered retinal haemodynamics, have been postulated. Direct measurement of oxygen tension in the retina is not possible in vivo and indirect methods have to be employed. The objective of this study was to investigate the retinal vascular response to 100% oxygen breathing in patients with HIV.