Johannes Steinberg

Association between ocular dominance and spherical/astigmatic anisometropia, age, and sex: analysis of 10,264 myopic individuals.

PURPOSE To determine the association between ocular dominance and spherical or astigmatic anisometropia, age, and sex. METHODS Medical records of 10,264 myopic refractive surgery candidates were filtered. Ocular dominance was assessed with the hole-in-the-card test. Manifest refractive error was measured in each subject and correlated to ocular dominance. Only subjects with corrected distance visual acuity (CDVA) of >20/22 in each eye were enrolled, to exclude amblyopia. Associations between ocular dominance and refractive state were analyzed by means of the t-test, χ(2) test, Spearman correlation, and multivariate logistic regression analysis. RESULTS Right and left eye ocular dominance was noted in 61.7% and 35.6% of the individuals. Ocular dominance had no significant impact on SE refraction in subjects with SE or cylindrical anisometropia <0.5 D. For anisometropia >2.5 D (n = 278) the nondominant eye was more myopic in 63.7% (SE -5.8 ± 2.64 D) compared to 36.3% (-4.69 ± 2.39 D; P < 0.001; adjusted P (Padj) < 0.001) for the dominant eye being more myopic. Nondominant eyes showed higher astigmatic power than dominant eyes (-0.95 ± 0.91 D versus -0.89 ± 0.84 D; P < 0.001). For astigmatic anisometropia >2.5 D, nondominant eyes exhibited a higher amount of astigmatism in 75% of subjects. Nondominant eyes of subjects <29 years and 30 to 39 years of age had a significantly higher astigmatic power than did dominant eyes of the same age group. CONCLUSIONS In contrast to previous reports, this study, including myopic refractive surgery candidates, revealed that the nondominant eye was more myopic for SE anisometropia >2.5 and more astigmatic for cylindrical anisometropia >0.5 D.

Screening for Keratoconus With New Dynamic Biomechanical In Vivo Scheimpflug Analyses.

Purpose: To improve keratoconus (KC) screening with new in vivo biomechanical Scheimpflug analyses. Methods: After adjusting for intraocular pressure and corneal thickness, predefined static and new dynamic Scheimpflug curve analyses [Pentacam HR and Corvis ST (CST); Oculus] of 87 normal eyes, 27 subclinical KC eyes, 42 suspected KC, and 65 manifest KC eyes were reviewed retrospectively. A t test (for a normal distribution), Wilcoxon matched-pairs test (if not normally distributed), and receiver operating characteristics were used to test for statistically significant differences between these groups. In addition, new dynamic curve analyses were performed to analyze corneal dynamics throughout the entire response to the CST air puff impulse. Results: Comparing normal and KC-suspect eyes, the parameters A1 length, A2 length, radius of the inward-bended cornea, and deflection length at the highest concavity revealed statistically significant differences. In addition, the newly calculated “applanation length level” and “deflection length level” demonstrated consistently increasing differences with increasing statistical significance between normal eyes and those with advancing KC stages. However, when comparing normal and subclinical KC eyes, none of the analyzed parameters demonstrated statistically significant differences. Conclusions: In vivo biomechanical analyses (CST) at their current state only marginally improve KC screening protocols. Newly generated parameters such as the applanation length level and deflection length level might further improve early KC screening.

effects of laser in situ keratomileusis (lasiK) on corneal biomechanical measurements with the Corvis sT tonometer

Purpose This study was initiated to evaluate biomechanical changes using the Corvis ST tonometer (CST) on the cornea after laser in situ keratomileusis (LASIK). Setting University Medical Center Hamburg-Eppendorf, Germany, and Care Vision Refractive Centers, Germany. Design Retrospective cohort study. Methods This retrospective study included 37 eyes of 37 refractive patients. All CST measurements were performed 1 day before surgery and at the 1-month follow-up examination. The LASIK procedure included mechanical flap preparation using a Moria SBK microkeratome and an Allegretto excimer laser platform. Results Statistically significant differences were observed for mean first applanation length, mean first and second deflection lengths, mean first and second deflection amplitudes, radius of curvature, and peak distance. Significant positive correlations were found between the change (Δ) of radius of curvature and manifest refraction spherical equivalent (MRSE), ablation depth, and Δintraocular pressure as well as between AD and ΔHC-time. Each diopter of myopic correction in MRSE resulted in an increase in Δradius of curvature of 0.2 mm. Conclusion Several CST parameters were statistically significantly altered by LASIK, thereby indicating that flap creation, ablation, or both, significantly change the ability of the cornea to absorb or dissipate energy.

Anterior and posterior corneal changes after crosslinking for keratoconus.

Purpose To evaluate anterior and posterior changes in corneal topography and tomography after corneal crosslinking (CXL) in eyes with progressive keratoconus. Methods Scheimpflug analyses (Pentacam, Oculus) of 20 eyes with keratoconus performed before and after corneal CXL were included into retrospective analysis. Mean follow-up was 2 years. Changes in topographic, tomographic, and pachymetric values were statistically analyzed applying analysis of variance. Further, the distance and direction between the anterior maximum keratometry (Kmax) and the apex as well as the distance and direction between the thinnest point in corneal thickness (TPCT) and the corneal apex before and after CXL were studied. Results Two years after CXL, a statistically significant reduction of the keratometry at the flat meridian (−0.8 D, p < 0.05), the steep meridian (−0.5 D, p < 0.05), the “index of surface variance” (−5.3, p < 0.05), and the “index of highest decentration” (−0.05, p < 0.05) could be demonstrated. While the elevation of the front surface at the apex decreased (−1.5 &mgr;m, p < 0.05), the back elevation at the apex (+2 &mgr;m, p < 0.05) increased. Although not reaching statistical significance, the maximum front and back elevation demonstrated the same trend; while maximum front elevation data remained stable (−0.3 &mgr;m, p = 0.961), maximum back elevation data increased (+6.7 &mgr;m, p = 0.122). The corneal thickness at the apex (−22.0 &mgr;m, p < 0.001) and the TPCT (−20.0 &mgr;m, p < 0.001) decreased, leading to an increase of the corneal thickness progression from the corneal apex to the periphery. The position of Kmax and TPCT remained stable. Conclusions Corneal topography proved to be useful in the follow-up for CXL because of significant changes in the keratometry. Increasing posterior elevation values, despite a stabilized anterior corneal surface, might be a sign of ongoing ectatic changes in the posterior corneal surface.

Relationship between minimum corneal thickness and refractive state, keratometry, age, sex, and left or right eye in refractive surgery candidates

PURPOSE: To evaluate the relationship between the thinnest point in corneal thickness and the refractive state, keratometry, age, sex, and the ocular side. SETTING: Eye clinics in Germany and Austria and the Department of Ophthalmology, University Medical Center Hamburg‐Eppendorf, Hamburg, Germany. DESIGN: Cross‐sectional study. METHODS: Medical records of refractive surgery candidates from 2006 to 2010 were reviewed. Univariate variance analysis, covariance analysis, Bravis‐Pearson correlations, Spearman rank correlations, and t tests were performed to analyze the relationship between the thinnest point in corneal thickness and the biometric parameters. RESULTS: The study evaluated 4600 eyes. The mean thinnest point in corneal thickness was 549 μm ± 33 (SD). Refractive state, mean keratometry, and age had a statistically significant impact on the thinnest point in corneal thickness. The mean thinnest point in corneal thickness was 548 ± 33 μm in myopia, 555 ± 34 μm in hyperopia, and 553 ± 35 μm in high astigmatism, with a statistically significant difference between hyperopic eyes and myopic eyes (P<.001). No correlation was found between the thinnest point in corneal thickness and sex or ocular side. Refractive state (r = 0.07, P<.001) and age (r = 0.05, P<.001) showed a positive correlation and keratometry (r = −0.09, P<.001) a negative correlation with the thinnest point in corneal thickness. CONCLUSIONS: Refractive state, mean keratometry, and age had a statistically significant, although marginal impact, on the thinnest point in corneal thickness. Sex and the ocular side had no effect. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Correlation of the KISA% index and Scheimpflug tomography in ‘normal’, ‘subclinical’, ‘keratoconus‐suspect’ and ‘clinically manifest’ keratoconus eyes

To analyse tomographic changes in eyes classified as ‘normal’, ‘keratoconus‐suspect’ and ‘clinically manifest keratoconus’ based on the established KISA% definition of Rabinowitz and Rasheed and to develop the category of ‘subclinical keratoconus eyes’ to expand the classification into a ‘subtopographic’ range.

Ocular residual astigmatism: Effects of demographic and ocular parameters in myopic laser in situ keratomileusis

Purpose To analyze the influence of demographic and ocular factors on ocular residual astigmatism (ORA) in myopic laser in situ keratomileusis (LASIK). Setting University Medical Center Hamburg‐Eppendorf, Hamburg, Germany. Design Retrospective cross‐sectional data analysis. Methods Eyes of consecutive myopic patients scheduled for LASIK were studied to evaluate the influence on preexisting ORA of age, sex, ocular dominance, subjective cylinder and topographic astigmatism, subjective sphere, and mesopic pupil size. The ORA was determined using Alpins vector analysis. Two subgroups, defined by the ratio of ORA to preoperative refractive cylinder (R), were formed: ORA:R ≥1.0 and ORA:R <1.0). Results The study comprised 2991 eyes (2991 patients). The mean ORA was 0.75 diopter (D) ± 0.39 (SD) (range 0.00 to 2.00 D); 1372 (46%) eyes had ORA of 1.00 D or more. Ordinary least square estimations and odds ratios showed that subjective sphere, male sex, and dominant eye were negative predictors of the degree of preoperative ORA, while increasing age and larger mesopic pupils did not indicate ORA orientation. With‐the‐rule astigmatism meridian was more likely in eyes with low ORA, while oblique and against‐the‐rule meridians were related to high ORA. Conclusions The preoperative assessment of refractive surgery candidates should consider the interaction between topographic, refractive, and ORA because corneal refractive surgery is more successful in eyes in which the cylinder mainly originates from the anterior cornea. The current data can help identify patients at high risk for having a significant difference between subjective cylinder and topographic astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Traumatic wound dehiscence after penetrating keratoplasty: case series and literature review

Purpose Blunt trauma after penetrating keratoplasty (PK) is a high risk for wound rupture at the donor-recipient interface. We present 6 cases of traumatic wound dehiscence after PK; we describe the morphologic and functional outcome after surgical intervention and provide a review of the current literature. Methods Six patients with a traumatic wound dehiscence after PK were analyzed retrospectively from the files of the University Eye Hospital Hamburg-Eppendorf (1998-2009). In addition, a comprehensive literature review was performed. Results The indications for PK were keratoconus, corneal scars, and Fuchs endothelial dystrophy. The age range was 22-81 years; the time span between PK and globe rupture was 1 month to 27 years. The cause of the dislocation was a fall or blunt trauma, through a branch, airbag, fist, or finger. The corrected distance visual acuity (CDVA) pretrauma ranged between hand movement and 20/32. The CDVA after wound repair was 20/400 to 20/25 depending on the severity of the trauma. In 3 of the 6 cases, visual rehabilitation was superior to the pretrauma vision, whereas in 3 cases the pretrauma CDVA could not be reached. Conclusions If a timely and adequate treatment of the traumatically dislocated transplant can be given, it is likely that the transplant will survive. Nevertheless, severely reduced visual acuity (i.e., < hand movement) and lens damage at the time of trauma are the most reliable predictors for the final visual outcome. A permanent loss of visual acuity is related rather to the intraocular damage (vitreous loss, vitreous bleeding, retinal tears, and retinal detachment) than to the readapted transplant itself.

LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable?

Purpose To analyze the refractive and keratometric stability in hyperopic astigmatic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) during the first 6 months after surgery. Patients and methods This retrospective cross-sectional study included 97 hyperopic eyes; 55 were treated with LASIK and 42 with PRK. Excimer ablation for all eyes was performed using the ALLEGRETTO excimer laser platform using a mitomycin C for PRK and a mechanical microkeratome for LASIK. Keratometric and refractive data were analyzed during three consecutive follow-up intervals (6 weeks, 3 months, and 6 months). The corneal topography was obtained using Scheimpflug topography, and subjective refractions were acquired by expert optometrists according to a standardized protocol. Results After 3 months, mean keratometry and spherical equivalent were stable after LASIK, whereas PRK-treated eyes presented statistically significant (P<0.001) regression of hyperopia. In eleven cases, hyperopic regression of >1 D occurred. The optical zone diameter did not correlate with the development of regression. Conclusion After corneal laser refractive surgery, keratometric changes are followed by refractive changes and they occur up to 6 months after LASIK and for at least 6 months after PRK, and therefore, caution should be applied when retreatment is planned during the 1st year after surgery because hyperopic refractive regression can lead to suboptimal visual outcome. Keratometric and refractive stability is earlier achieved after LASIK, and therefore, retreatment may be independent of late regression.

Corneal Biomechanical Changes after Crosslinking for Progressive Keratoconus with the Corneal Visualization Scheimpflug Technology

Purpose. To evaluate the effect of corneal crosslinking in progressive keratoconus by applying in vivo corneal visualization Scheimpflug technology. Design. Longitudinal retrospective study. Subjects and Controls. Seventeen eyes of patients treated with corneal crosslinking for progressive keratoconus. Methods. Corneal visualization Scheimpflug technology analyses (research software version 6.07r08) of subjects with progressive keratoconus before and 3 months after corneal crosslinking (CXL) were reviewed retrospectively. t-test (for normal distribution) and Wilcoxon matched-pairs test (if not normally distributed) were used to test for statistically significant differences between pre- and post-CXL analyses. Results. We demonstrated statistically significant differences for the intraocular pressure (median: +3 mmHg, P = 0.004), the central corneal pachymetry (pachy; mean: −35 µm, P < 0.001), the timespan between the air impulse release and the first applanation of the cornea (A1time; median: +0.12 ms, P < 0.05), and the timespan between the air impulse release and the second applanation of the cornea (A2time; median: −37 ms, P < 0.05). Conclusions. With the A1time and the A2time, we identified two parameters that demonstrated a statistically significant improvement of the biomechanical properties of the cornea after CXL. Despite the known initial decrease of the pachymetry after CXL, none of the analyzed parameters indicated a progression of the keratoconus.