H Häberle

Corneal optical coherence tomography before and after phototherapeutic keratectomy for recurrent epithelial erosions

Purpose: To study the representation of corneal structures with optical coherence tomography (OCT) before and after excimer laser phototherapeutic keratectomy (PTK) for recurrent epithelial erosions. Setting: Departments of Ophthalmology, Vivantes Klinikum Neukölln, Berlin, and Medizinische Universität, Lübeck, Germany. Methods: This prospective study comprised 15 eyes of 14 patients with recurrent epithelial erosions. The central corneal and epithelial thickness as well as the wound‐healing response in the anterior corneal stroma were assessed with slitlamp‐adapted OCT before and after PTK. Results: After PTK, the symptoms improved in all patients without loss of best corrected, glare, or low‐contrast visual acuity. The mean central corneal OCT thickness was 540 &mgr;m ±28 (SD) preoperatively, 492 ± 36 &mgr;m immediately after epithelial debridement and PTK, and 519 ± 25 &mgr;m after 7 weeks (P < .01). The mean central epithelial OCT thickness changed from 70 ± 13 &mgr;m preoperatively to 60 ± 7 &mgr;m after 7 weeks (P > .01). Changes in the light‐scattering properties in the anterior subepithelial stroma revealed a hyperreflective area with a mean thickness of 46 ± 13 &mgr;m after 7 weeks. Conclusions: Using noncontact corneal OCT, corneal and epithelial thickness changes and the wound‐healing response in the anterior corneal stroma could be evaluated after PTK in patients with recurrent epithelial erosions.

[Reproducibility of goniometry with slitlamp-adapted optical coherence tomography].

BACKGROUND Visualization of the anterior chamber angle (ACA) is an important diagnostic part of evaluating patients with glaucoma. The purpose of this study was to evaluate the intra- and interobserver variability and reliability of the ACA and angle opening distance (AOD) measurements using optical coherence tomography (OCT). METHODS To evaluate the intra- and interobserver variability, ACA and AOD were both measured five times and in three consecutive images in 22 patients (24 eyes) by two experienced observers. The intraclass correlation coefficient (ICC) as a measure of reliability was determined to estimate the intra- and interobserver variability. The main outcome measures were accuracy, reproducibility assessed with the coefficient of variation (CV), and the limits of agreement of ACA and AOD. RESULTS The intraobserver variability of five replicate measurements was +/-1.4 degrees for ACA (CV 6.2%) and +/-11 micro m for AOD (CV 4%). The ICC for the intraobserver reliability was 0.99 for both ACA and AOD. The interobserver variability of three intersessional measurements was +/-2.5 degrees for ACA (CV 10.9%) and +/-24 micro m (CV 8.3%) for AOD. The ICC was 0.95 for ACA and 0.98 for AOD. There was no difference ( p>0.05) between the two observers measuring ACA and AOD. CONCLUSIONS Two-dimensional visualization of the ACA and its assessment with slitlamp-adapted OCT yielded reliable ACA and AOD measurements in a clinical setting. Thus, OCT goniometry could provide an objective method to assess the anterior chamber angle.

Experimental imaging of intracorneal ring segments with optical coherence tomography.

PURPOSE To investigate the imaging of corneal structures with optical coherence tomography (OCT) after implantation of intracorneal ring segments (ICRS). METHODS In an experimental study with six porcine eyes, qualitative and quantitative imaging with corneal OCT using a wavelength of 1310 nm after implantation of ICRS was performed. The optical results were compared with light microscopy of the histological sections. RESULTS In corneal OCT, the ICRS revealed marked hyporeflective intrastromal areas, which correlated well with macroscopic and microscopic findings. Corneal OCT enabled precise images of the incision depth for the implantation of ICRS, and the exact intrastromal segment position. CONCLUSIONS Noncontact slit lamp-adapted corneal optical coherence tomography could be employed to clinically monitor corneal changes after implantation of ICRS, evaluate the depth of the segments to correlate refractive changes, and quantify the stromal wound healing response.

Huckepacklinsenimplantation zur Korrektur einer Anisometropie bei Pseudophakie

ZusammenfassungZielsetzung. Bei bestehender Pseudophakie mit ausgeprägter Abweichung von der Zielrefraktion und störender Anisometropie ist ein Linsenaustausch bei lange zurückliegender Linsenimplantation oder vorangegangener YAG-Kapsulotomie schwierig.Die Sekundärimplantation einer 2. Hinterkammerlinse (HKL) in den Sulcus ciliaris stellt eine chirurgische weniger traumatisierende Alternative dar. Patienten und Methoden. Bei 8 Patienten wurde auf die vorhandene Kunstlinse eine PMMA-HKL implantiert. Die Linsenstärke wurde anhand der subjektiven Refraktion mit der refraktiven Vergenzformel errechnet und intraoperativ mit einem Autorefraktometer kontrolliert.Der operative Zugang wurde entsprechend zur Astigmatismusminimierung gewählt. Ergebnisse. Alle Patienten im Alter zwischen 42 und 80 Jahren beklagten störende Anisometropien von präoperativ 4,57±2,86 dpt.Die Kataraktoperation lag 1–13 Jahre zurück.Bei 3 Patienten wurde die Implantation der Huckepacklinse mit einer Nachstarabsaugung, bei einem weiteren mit einer Silikonölinstillation bei PVR-Amotio kombiniert. Das präoperative sphärische Äquivalent lag bei −3,34±4,9 dpt.Die Nachbeobachtungszeit betrug im Mittel 16,6 Monate. Postoperativ lag die mittlere absolute Abweichung von der geplanten Zielrefraktion bei 0±0,92 dpt, die Anisometropie hatte sich auf 1,1±1,01 dpt verringert.Komplikationen wie Druckanstieg oder Nachstarbildung im Interface traten nicht auf.Bei einem Patienten wurde eine Pigmentdispersion beobachtet. Schlussfolgerung. Die sekundäre Implantation einer Huckepacklinse in den Sulcus ciliaris auf eine vorhandene Hinterkammerlinse ist in besonderen Fällen ein sicherer und wirkungsvoller refraktiver Eingriff mit gut planbarer Zielrefraktion.AbstractObjective. Long standing pseudophakia or previous laser capsulotomy make lens exchange for anisometropia or incorrect target refraction difficult.Piggyback lens implantation might be a less traumatic surgical alternative. Patients and methods. Eight patients had a secondary posterior chamber lens implant (PMMA) into the ciliary sulcus.Lens power was estimated by the preoperative refraction according to the refractive vergence formula and was controlled intraoperatively by an automatic refractometer. Surgical access minimized preoperative astigmatism. Results. All patients had disturbing anisometropia of 4.57±2.86 D and had undergone cataract surgery 1–13 years previously. Piggyback lens implantation was combined with surgical aspiration of the secondary cataract in three patients.Due to recurrent PVR retinal detachment, one patient received a silicon oil refilling procedure and piggyback lens implantation.The preoperative spherical equivalent was −3.34±4.9 D. Mean follow up time was 16.6 months.Postoperative anisometropia was reduced to 1.1±1.01 D.The mean absolute deviation from target refraction was 0±0.92 D. Elevated IOP or secondary cataract formation in the lens interface were not observed.One patient developed pigment dispersion. Conclusion. Secondary piggyback lens implantation into the ciliary sulcus in front of an existing posterior chamber lens is a safe and effective refractive surgical procedure for special cases with predictable refraction.

OCT-Goniometrie vor und nach Iridotomie beim Engwinkelglaukom

PURPOSE Visualization of the anterior chamber angle is an important diagnostic method in patients with angle-closure glaucoma. In this study, optical coherence tomography (OCT) was used to image the angle width, the iris configuration, and the iris thickness in patients with angle-closure glaucoma. METHODS Thirteen eyes of 11 patients suffering from angle-closure glaucoma were studied with slitlamp-adapted OCT. All patients were treated with Nd:YAG laser iridotomy. The angle width ( degrees ), the angle opening distance (AOD) (microm), and the iris thickness (microm) were measured with OCT. The configuration of the iris was classified as steeply convex, convex, or flat. RESULTS The mean angle width was preoperatively 5.1+/-5.0 degrees (0-15 degrees ) and enlarged significantly (p=0.007) to 10.4+/-5.5 degrees (0-19 degrees ) postoperatively. The AOD changed from 71+/-55 microm (0-157 microm) preoperatively to 143+/-74 microm (0-256 microm) postoperatively (p<0.001). The mean iris thickness was 338+/-33 microm. With the exception of two eyes the predominant iris configuration changed from convex to flat. CONCLUSIONS OCT allowed visualization and noninvasive assessment of the anterior chamber angle region in patients with angle-closure glaucoma. Our results suggest that goniometry with OCT could improve the evaluation in patients with narrow or closed anterior chamber angles.

[OCT-goniometry before and after iridotomy in angle-closure glaucoma].

PURPOSE Visualization of the anterior chamber angle is an important diagnostic method in patients with angle-closure glaucoma. In this study, optical coherence tomography (OCT) was used to image the angle width, the iris configuration, and the iris thickness in patients with angle-closure glaucoma. METHODS Thirteen eyes of 11 patients suffering from angle-closure glaucoma were studied with slitlamp-adapted OCT. All patients were treated with Nd:YAG laser iridotomy. The angle width ( degrees ), the angle opening distance (AOD) (microm), and the iris thickness (microm) were measured with OCT. The configuration of the iris was classified as steeply convex, convex, or flat. RESULTS The mean angle width was preoperatively 5.1+/-5.0 degrees (0-15 degrees ) and enlarged significantly (p=0.007) to 10.4+/-5.5 degrees (0-19 degrees ) postoperatively. The AOD changed from 71+/-55 microm (0-157 microm) preoperatively to 143+/-74 microm (0-256 microm) postoperatively (p<0.001). The mean iris thickness was 338+/-33 microm. With the exception of two eyes the predominant iris configuration changed from convex to flat. CONCLUSIONS OCT allowed visualization and noninvasive assessment of the anterior chamber angle region in patients with angle-closure glaucoma. Our results suggest that goniometry with OCT could improve the evaluation in patients with narrow or closed anterior chamber angles.

Reproduzierbarkeit der Goniometrie mittels spaltlampen-adaptierter optischer Kohärenztomographie

BACKGROUND Visualization of the anterior chamber angle (ACA) is an important diagnostic part of evaluating patients with glaucoma. The purpose of this study was to evaluate the intra- and interobserver variability and reliability of the ACA and angle opening distance (AOD) measurements using optical coherence tomography (OCT). METHODS To evaluate the intra- and interobserver variability, ACA and AOD were both measured five times and in three consecutive images in 22 patients (24 eyes) by two experienced observers. The intraclass correlation coefficient (ICC) as a measure of reliability was determined to estimate the intra- and interobserver variability. The main outcome measures were accuracy, reproducibility assessed with the coefficient of variation (CV), and the limits of agreement of ACA and AOD. RESULTS The intraobserver variability of five replicate measurements was +/-1.4 degrees for ACA (CV 6.2%) and +/-11 micro m for AOD (CV 4%). The ICC for the intraobserver reliability was 0.99 for both ACA and AOD. The interobserver variability of three intersessional measurements was +/-2.5 degrees for ACA (CV 10.9%) and +/-24 micro m (CV 8.3%) for AOD. The ICC was 0.95 for ACA and 0.98 for AOD. There was no difference ( p>0.05) between the two observers measuring ACA and AOD. CONCLUSIONS Two-dimensional visualization of the ACA and its assessment with slitlamp-adapted OCT yielded reliable ACA and AOD measurements in a clinical setting. Thus, OCT goniometry could provide an objective method to assess the anterior chamber angle.

Combined implantation of monofocal and multifocal intraocular lenses for presbyopia correction in cataract patients

BACKGROUND The purpose of this study was to assess uncorrected far and near vision after implantation of a multifocal intraocular lens (IOL) in the second eye in patients with a unilateral monofocal IOL. PATIENTS AND METHODS 13 cataract patients with a monofocal intraocular lens in one eye (SA60AT, Alcon) and postoperative emmetropia received a multifocal lens in the second eye (ReSTOR, Alcon). Two and six months postoperatively the clinical examination, far and near vision, near aniseikonia (AWAYA-New Aniseikonia Test), stereo vision (Lang I test) and the mesopic contrast sensitivity (F. A. C.T) were tested. In addition, the grade of satisfaction without glasses in general, and with far and near vision were noted on a visual analogue scale (0 - 10). Furthermore, independence from glasses and the presence of optical phenomena were assessed. RESULTS The mean uncorrected far visual acuity 6 months postoperatively was 1.06 +/- 0.28 for the monofocal lens, 0.88 +/- 0.23 for the multifocal lens, and 1.16 +/- 0.24 binocularly. The uncorrected near visual acuity was Nieden 1 binocularly for all patients and ranged from Nieden 1 - 3 for the multifocal lens to Nieden 2 - 11 for the monofocal lens. 77% of the patients received the multifocal lens in their far dominant eye. The mean uncorrected near aniseikonia was < 1%. The mesopic contrast sensitivity showed no significant differences between the two IOL types and compared to binocular values. The satisfaction with the uncorrected visual acuity was in general 8.88 +/- 1.21, with the far visual acuity 9.42 +/- 1.24, and 7.33 +/- 1.72 with the near visual acuity. After 6 months 67% of the patients used glasses only for periods of prolonged reading. Halos and a low degree of glare were noted by 38.5% of patients 2 months postoperatively. At the 6 months visit 33.3% still had halos and only 8% glare. CONCLUSIONS This first experience with the combined implantation of a monofocal and a multifocal lens revealed a marked improvement of the uncorrected near visual acuity compared to bilateral monofocal IOL implantation along with a high patient satisfaction.

Clinical experience with brilliant blue G staining of the retinal surface

BACKGROUND Staining of the retinal surface has improved the intraoperative removal of semitransparent membranes during macular surgery. The purpose of this study was to evaluate the clinical experiences with brilliant blue G (BBG) staining of the retinal surface. METHODS BBG (Brilliant peel, Fluoron) was applied during vitrectomy and macular surgery in 43 patients. In 47 % there was a macular hole (MH), whereas 53 % had epiretinal membranes (ERM). Intraoperatively BBG was applied on the retinal surface under infusion or air conditions for 30 - 60 s. In MH the internal limiting membrane (ILM) and in ERM the membrane was removed. Postoperatively all patients were examined on average after 9 weeks. RESULTS Although intraoperative BBG staining was less intensive compared to ICG staining, the staining was sufficient to safely remove the semitransparent membranes in all cases. In all patients with MH hole closure was achieved, and in 96 % with ERM the metamorphopsiae decreased. The mean decimal visual acuity increased from 0.25 ± 0.13 to 0.37 ± 0.20 (p < 0.05) and improved in 63 % of the patients. Clinically, there were no toxic side-effects from BBG staining. CONCLUSIONS BBG allowed a complete and selective staining of the retinal surface. Thus, ILM and ERM could be removed safely during macular surgery. No clinical retinal toxicity was observed.

[Aberration corrected intraocular lens for microincision cataract surgery (MICS). Intraindividual comparison with a conventional lens - 1-year follow-up].

Microincision cataract surgery (MICS) is an important advancement in the field of cataract surgery. This article compares an aberration corrected hydrophilic acrylic intraocular lens (IOL) having a hydrophobic surface for MICS with a one-piece hydrophobic acrylic IOL with respect to capsule sac stability, image quality, and after-cataract formation over the course of 1 year. The operations were performed as bimanual MICS or coaxial phacoemulsification. Overall the results after implantation of the IOL by MICS can be regarded as positive in comparison to the standard operation.