Karl W. Jacobi

Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes

Abstract A prospective, randomized study compared the surgically induced astigmatism after 3.5 mm, 4.0 mm, and 5.0 mm temporal corneal tunnel incisions over six months. We studied 60 eyes of 60 patients who had phacoemulsification through a two‐step clear corneal tunnel incision and implantation of one of three posterior chamber intraocular lenses (IOLs). Patients were divided into three groups of 20 each: Group A, cartridge injection of a foldable plate‐haptic silicone IOL through a 3.5 mm self‐sealing incision; Group B, cartridge injection of a disc silicone IOL through a 4.0 mm self‐sealing incision; Group C, 5.0 mm optic poly(methyl methacrylate) IOL through a 5.0 mm incision with one radial suture. Corneal topography data were obtained using a computerized videokeratographic analysis system preoperatively and one week and six months postoperatively. Vector analysis was performed to calculate the surgically induced astigmatism. After the first postoperative week, mean induced astigmatism was 0.63 diopters (D) (±0.41) in Group A, 0.64 D (±0.35) in Group B, and 0.91 D (±0.77) in Group C. After six months, it was 0.37 D (±0.14) in Group A, 0.56 D (±0.34) in Group B, and 0.70 D (±0.50) in Group C. Surgically induced astigmatism was significantly lower in Group A than in Group B (P < .05) and Group C (P < .005) after six months. Vector analysis demonstrated that temporal corneal tunnel incisions induced clinically minimal astigmatism over six months postoperatively depending on incision size.

Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision

Purpose: To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters. Methods: Fifty‐eight patients had phacoemulsification through temporal, two‐step clear corneal tunnel incisions. In Group A (n = 28), a one‐piece, plate‐haptic, foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color‐coded, computer‐assisted specular microscopy was used for special cell analysis after 1 year. Results: Collective data showed an ECL of 7.9 ± 4.1 % (mean ± standard deviation) at 2 to 5 days postoperatively, 6.7 ± 2.9% after 6 months, and 7.3 ± 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST ≤1 1/2 minutes, 6.7% with UST ≥ 1 1/2 to 2 1/2 min, and 9.6% with UST > 2 1/2 to 3 1/2 min; in Group B, it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age‐related cell parameters 1 year postoperatively. Conclusions: Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.

Cataract extraction with multifocal intraocular lens implantation: clinical, functional, and quality-of-life outcomes. Multicenter clinical trial in Germany and Austria.

Purpose: To compare bilateral implantation of a multifocal intraocular lens (IOL) versus a monofocal lens with respect to visual function, patient satisfaction, and quality of life. Setting: Seven clinical sites in Germany and 1 site in Austria. Methods: A prospective randomized masked clinical trial included 124 randomly assigned bilateral pseudophakic individuals, 64 of whom had bilateral implantation of an Array® foldable multifocal IOL (model SA‐40N, Allergan) and 60 of whom had bilateral implantation of an AMO®PhacoFlex II® silicone monofocal IOL (model SI‐40NB). Clinical data included binocular uncorrected and corrected distance and near visual acuities, complications, adverse events, and reports of halos and glare. Quality‐of‐life data were collected on 3 occasions using the modified Cataract TyPE Specification instrument. The functional status of the 2 groups was compared from baseline to final postoperative interview. Results: Three months after surgery, a higher proportion in the Array group achieved a Jaeger value of J3 (20/40 Snellen) or better uncorrected binocular near visual acuity and 0.5 (20/40) or better distance‐corrected binocular near visual acuity than in the monofocal groups (97% versus 68% and 95% versus 59%, respectively; P < .001). A higher proportion in the multifocal group achieved both 0.5 (20/40) and J3 or better uncorrected binocular distance and near visual acuities (97% versus 66%; P < .001). Those in the Array group were more likely than those in the monofocal group to never wear glasses overall (41% versus 12%; P < .001). Multifocal patients rated their vision without glasses better overall, at near and at intermediate distances (P < .05), and demonstrated better visual function for near tasks and social activities. Conclusions: Those who had bilateral implantation of the Array multifocal IOL obtained better uncorrected and distance‐corrected near visual acuities and reported better overall vision, less limitation in visual function, and less spectacle dependency than patients with bilateral monofocal IOLs.

Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation

PURPOSE To evaluate the technical feasibility, outcome, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. SETTING Department of Ophthalmology, Giessen, Germany. METHODS The results of combined cataract and vitreoretinal surgery in 38 eyes (36 patients) were retrospectively analyzed. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Thirty-seven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. RESULTS Postoperatively, visual acuity improved in 20 eyes (52.6%), was unchanged in 16 (42.1%), and was worse in 2 (5.3%). Postoperative complications consisted of anterior chamber fibrin exudation (3 eyes), hyphema (2 eyes), vitreous hemorrhage (1 eye), posterior capsule opacification (16 eyes), neovascular glaucoma (2 eyes), proliferative vitreoretinopathy and redetachment (1 eye), and retinal redetachment after silicone oil removal (1 eye). CONCLUSION Compared with 2 separate operations in patients with significant lens opacities and vitreoretinal pathology, combined cataract and vitreoretinal surgery provided more rapid visual rehabilitation. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.

Effect of heparin surface modification of polymethylmethacrylate intraocular lenses on signs of postoperative inflammation after extracapsular cataract extraction. One-year results of a double-masked multicenter study.

PURPOSE A heparin surface modified posterior chamber intraocular lens (IOL) was compared with a conventional polymethylmethacrylate (PMMA) IOL regarding postoperative complications caused by inflammation. METHODS Five hundred twenty-four patients from 10 different centers were included in a parallel group, double-masked, multicenter study. RESULTS The cumulative number of patients with inflammatory cellular deposits on their IOLs during the first postoperative year differed significantly in favor of the heparin surface modified group, with 29.8% of the patients having cellular deposits compared with 48.8% of patients in the control group. Cellular deposits were observed most frequently at 3 months after surgery, and the difference between the groups was most pronounced and statistically significant at this time. The same results were seen at 1 year, but the difference was not significant. The number of cellular deposits per patient, however, was significantly lower in the heparin surface modified group at 1 year. Cumulatively, there were significantly more patients with posterior synechiae in the PMMA group than in the heparin surface modified group during the 1-year follow-up. Complications were few and comparable between the groups. CONCLUSION The results of this study indicate that heparin surface modification reduces the inflammatory response to PMMA IOLs.

Comparison of Intraocular Pressure Measurements With the Oculab Tono-Pen vs Manometry in Humans Shortly After Death

We compared the Oculab Tono-Pen, a miniaturized Mackay-Marg tonometer, with a Statham membrane manometer in six humans (12 eyes), three to six hours after death. The intraocular pressure was changed in 5- to 10-mm Hg steps in a range between 0 and 60 mm Hg by an infusion system. The correlation coefficient of the relation of Tono-Pen readings vs manometrically determined intraocular pressures was .99. Compared to the manometer, the Tono-Pen gave a small underestimation of intraocular pressure above 17 mm Hg or overestimation below 17 mm Hg. The maximal deviation of the Tono-Pen readings from the manometer readings was 2.5 mm Hg. In our experience the correspondence between Tono-Pen and manometer readings was superior to the correspondence between the readings obtained with the original Mackay-Marg tonometer and manometry.

Effect of heparin in irrigating solution on inflammation following small incision cataract surgery

Purpose: To study the effect of heparin‐sodium added to the irrigating solution on postoperative inflammation in patients having cataract surgery. Setting: Department of Ophthalmology, University of Giessen, Giessen, Germany. Methods: Seventy‐two patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation were randomly assigned to receive regular irrigating solution or solution with heparin‐sodium (final diluted concentration 10 IU/mL). In half the patients, poly(methyi methacrylate) (PMMA) IOLs were implanted and in half, foldable silicone IOLs. The patients were examined preoperatively, on days 1 and 3, and 1 year postoperatively. Postoperative inflammation was objectively evaluated by measurement of flare and cells using laser flare‐cell photometry. Results: The mean postoperative flare values were significantly lower in the groups with additional heparin‐sodium at days 1 and 3 (P < .01). Flare values were not significantly different 1 year postoperatively. Cell values for the heparin‐treated groups were lower, but the difference did not reach statistical significance. Flare and cells values for the two IOL materials were not significantly different during the entire follow‐up. Conclusion: Heparin‐sodium added to the infusion solution during small incision cataract surgery reduced inflammation in the early postoperative period.

Tono-Pen, a new tonometer.

The Tono-Pen is a miniaturized Mackay-Marg tonometer with electronic signal analysis and digital pressure display. In study 1, we compared the Tono-Pen with Goldmann tonometry in 108 healthy human subjects (216 eyes). In 33 of these subjects, the IOP was changed in a range between 0 and 50 mmHg by a scleral suction-cup system. In study 2, the Tono-Pen was compared with a Statham membrane manometer in 6 humans (12 eyes), 3–6 h after death. The IOP was changed in a range between 0 and 60 mmHg by an infusion system.—Results: Related to the Goldmann tonometer, the Tono-Pen gave a small overestimation of IOP below 16 mmHg (maximum deviation 1.5 mmHg at 0 mmHg Goldmann reading). Above 16 mmHg, however, the Tono-Pen increasingly underestimated the IOP determined by Goldmann tonometry (maximum deviation 8 mmHg at 50 mmHg Goldmann reading). Related to the manometer, the Tono-Pen gave a small overestimation of IOP below 17 mmHg and small underestimation above 17 mmHg (maximum deviation 2.5 mmHg at manometer readings of 0 and 60 mmHg, respectively).— Conclusions: Throughout the entire clinically relevant IOP range, an acceptable relationship between Tono-Pen and manometer readings was found in human cadaver eyes, whereas the relationship between Tono-Pen and Goldmann tonometric readings in the clinical study was found to be acceptable only in the low and physiological IOP range. The considerable deviation from the Goldmann readings in the high IOP range requires further modifications of The Tono-Pen.

Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation.

Purpose: To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities.

Silicone intraocular lens implantation in children: preliminary results

PURPOSE To evaluate the safety and outcome of foldable silicone intraocular lens (IOL) implantation in children. SETTING Department of Ophthalmology, University of Giessen, Giessen, Germany. METHODS The results of cataract extraction and silicone IOL implantation in children having surgery between 1992 and 1997 were retrospectively analyzed in 8 eyes (7 patients). All IOLs were implanted in the capsular bag through a 3.5 mm clear corneal incision. In 4 eyes, primary posterior capsulectomy and anterior vitrectomy were performed. RESULTS Mean patient age at the time of surgery was 5.1 years (range 8 months to 15 years). The surgeries were uneventful. All IOLs remained anatomically stable and well centered during the mean follow-up of 29.6 months (range 18 to 46 months). Postoperative inflammatory reaction was minimal. Neither fibrinoid exudation nor posterior synechias occurred postoperatively. Postoperative best spectacle-corrected visual acuity ranged from 20/800 to 20/20. All eyes with an intact posterior capsule developed posterior capsule opacification. In the 4 eyes that had primary posterior capsulectomy and anterior vitrectomy, the visual axis remained clear. CONCLUSIONS These preliminary results suggest that silicone IOL implantation in children is a safe procedure with good and stable short-term anatomic results. Longer follow-up is necessary to answer questions about the long-term safety of silicone lens implantation in a childs eye.