Mkj Klamann

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

PurposeIn this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient’s satisfaction was evaluated.MethodsA retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction.ResultsBest-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally.ConclusionPatient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.

Trabeculectomy ab interno (trabectome): yet another possibility in the treatment of uncontrolled glaucomatocyclitic crisis under systemic valganciclovir therapy?

PurposeTo assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner–Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP).Patients/MethodsTrabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months.ResultsMean IOP before trabectome surgery was 40±10 mm Hg (range 33–58 mm Hg). The mean number of antiglaucoma medication prior to surgery was 3.1±0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13±1 mm Hg) and their antiglaucoma medication was decreased to 0.8±1.1. No recurring attack of glaucomatocyclitic crisis occurred.DiscussionIn addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.

Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification

PurposeTo assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption.Patients and methodsThe study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100–249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc.ResultsThe AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100–249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment.ConclusionsA flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation.

Application Possibilities of Modern Thermography – First Experience with the New Tomey TG 1000

Temperature is one of the fundamental characteristics of tissue metabolism and is certainly of major interest to investigate ocular physiology. Current instrumentation offers the potential to measure the ocular surface temperature (OST) with high accuracy and resolution. Potential applications of OST measurement may include any condition of the ocular surface. The present study gives a survey of the possible applications of thermography and describes our first experience with the new Tomey TG 1000.

Trabekulotomie ab interno (Trabectome) – Kumulierte klinische Ergebnisse eines großen Glaukomkollektivs

BACKGROUND To assess the outcome of routine trabectomy surgery in the treatment of primary (POAG) and secondary open angle glaucoma. PATIENTS/METHODS 296 eyes of 296 patients with diagnosed open angle glaucoma and exfoliative glaucoma were analysed from June 2012 until June 2014. IOP readings (intraocular pressure) and the number of antiglaucoma medications was evaluated at every follow-up visit. For statistical analysis, 4 study cohorts were built (cohort 1 = trabectomy in POAG, cohort 2 = trabectomy in exfoliative glaucoma (PEX), cohort 3 = trabectomy + IOL in POAG, cohort 4 = trabectomy + IOL in PEX glaucoma). RESULTS Mean IOP before trabectomy surgery was 19.8 ± 5.9 mmHg and 23.7 ± 9.5 mmHg in cohorts 1 and 2, respectively. At 1 year follow-up, IOP was reduced to normal level for cohorts 1 and 2 (14.8 ± 3.2 mmHg (p = 0.001) and 14.0 ± 3.3 mmHg (p = 0.046), respectively). The number of topical antiglaucoma medications changed to 2.1 ± 1.2 (p = 0.004) and 2.4 ± 1.2, respectively (p = 0.593) at one year follow-up, respectively, for POAG and exfoliative glaucoma. In study cohort 3 and 4, mean IOP before trabectomy surgery was 19.2 ± 4.0 mmHg and 23.2 ± 9.2 mmHg, respectively. At 1 year follow-up, IOP was reduced to normal levels in cohorts 3 and 4 (11.8 ± 3.1 mmHg (p < 0.01) and 12.6 ± 1.1 mmHg, respectively (p = 0.043)); the number of topical antiglaucoma medications changed to 2.3 ± 1.4 (p = 0.469) and 1.4 ± 0.8, respectively, (p = 0.102) at 1 year follow-up. A significant difference in IOP reduction could be demonstrated in POAG between the trabectomy + IOL group and the trabectomy cohort 1 year postoperative (p = 0.017); in the PEX trabectomy + IOL versus PEX trabectomy cohort no statistically significant difference (p = 0.678) could be demonstrated. No serious postoperative complications were recorded. CONCLUSION Trabectomy surgery seemed to be a reliable and effective tool for the management of mild and moderate primary and secondary open angle glaucoma with uncontrolled IOP in daily routine. One year follow-up showed a significant reduction in intraocular pressure in all cohorts.

Comparison of dynamic contour tonometry versus Goldmann applanation tonometry according to the International Ocular Tonometer Standards ISO 8612 in glaucoma patients

INTRODUCTION The aim of this study was to compare the dynamic contour tonometry PASCAL® (DCT) versus the Goldmann applanation tonometry (GAT) in a glaucoma population and to analyse the correlation with the central corneal thickness (CCT). PATIENTS/METHODS 191 eyes of 107 Caucasian glaucoma patients (62 female, 45 male) were included: 3 repeated GAT and dynamic contour tonometry (DCT) measurements (quality factor 1-2) were analysed. CCT was measured by ultrasound pachymetry. Criteria of ISO 8612 were fulfilled: 3 groups of IOP measurements were formed: group 1: 7-16 mmHg, group 2: 16-23 mmHg and group 3: > 23 mmHg, each including at least 40 eyes. Only 5.0 % outliers per area of intraocular pressure were permitted in a tolerance of ± 5.0 mmHg. RESULTS Data of 191 eyes (mean CCT 553 µm) were analysed. GAT (19.68 mmHg ± 7.56 mmHg) showed good correlation to DCT (20.54 ± 8.21 mmHg) (r = 0.770, p < 0.001). Mean difference DCT-GAT was 0.86 ± 2.45 mmHg. In regard to the criteria of ISO 8612, the number of outliers were: group 1: (n = 68) 29.4 %, group 2: (n = 62) 41.9 %, and group 3: (n = 61) 31.2 %. No correlation was shown between CCT vs. GAT (r = 0.184, p = 0.057) and CCT vs. DCT (r = 0.177, p = 0.09), respectively. DISCUSSION In conclusion, despite good correlation to GAT measurements DCT does not fulfil the ISO 8612 reference criteria in glaucoma patients. DCT and GAT did not show correlation to CCT.

Okuläre Hypotonie – Ursachen und therapeutische Möglichkeiten aus Sicht des Netzhautchirurgen

Ocular hypotension is a result of a lack of production or a loss of intraocular fluid. Intraocular inflammation, drugs, or proliferative vitreoretinopathy (PVR) with overgrowth of the ciliary body can result in reduced secretion of intraocular fluid. Loss of intraocular fluid can result from external loss, such as in fistulating surgery or trauma, or internally, e.g. from cyclodialysis clefts or retinal detachment. In this review, we discuss the causal therapy of ocular hypotension: fixation of the ciliary body, removal of ciliary body membranes, surgery for PVR, choice of tamponade, possibilities and limitations of an iris diaphragm, and pharmacological options.

Langzeitergebnisse und Komplikationen nach chirurgischer Nachstarabsaugung

BACKGROUND To evaluate the long-term outcome and complication rate after surgical posterior capsule polishing as an alternative to Nd : YAG-Laser posterior capsulotomy in the treatment of posterior capsule opacity after cataract extraction in eyes with high risk of developing pseudophakic retinal detachment. PATIENTS AND METHODS This retrospective study comprised 265 eyes in 234 patients (134 women, 100 men, mean age: 61 years) with posterior capsule opacity who underwent surgical posterior capsule polishing between 1997 and 2010, with a follow-up of at least 12 months. RESULTS Surgical posterior capsule polishing was performed in 220 myopic eyes (axial length > 25 mm), in 28 eyes after retinal detachment surgery and in 17 eyes with traumatic cataract. The mean follow-up was 73 months (range: 12 to 202 months); in 206 eyes (77.8 %), follow-up was more than 3 years. The final best-corrected visual acuity (BCVA) in logMAR (mean 0.56 ± 0.63) improved significantly (p < 0.001) compared to the preoperative BCVA (mean 0.93 ± 0.72). Recurrent posterior capsule opacity occurred in 74 eyes (27.9 %) and was treated by one or more surgical posterior capsule polishing procedures. Nd : YAG-Laser posterior capsulotomy was performed in 28 eyes (10.6 %) and surgical capsulectomy in 8 eyes (3.0 %). Complications after surgical posterior capsule polishing included intraoperative capsule rupture in 9 eyes (3.5 %). No postoperative endophthalmitis was observed. However, retinal detachment occurred in 6 eyes (2.3 %) 62 months after surgical posterior capsule polishing. All eyes were myopic (axial length > 25 mm) and initially vitrectomised during first retinal detachment surgery. CONCLUSIONS Long-term outcome and complication rate indicate that surgical posterior capsule polishing is not only a more complex procedure but is also associated with a higher relapse risk than Nd : YAG-Laser posterior capsulotomy in the treatment of regenerative secondary cataract. Furthermore, conserving the posterior lens capsule does not always seem to minimise the cumulative risk of developing pseudophakic retinal detachment in high risk patients.

Vergleich der Ergebnisse nach Implantation von 5 torischen Intraokularlinsen hinsichtlich der Rotationstabilität

in der Europäischen Katarakt gesellschaft (ESCRS) mit entsprechenden Publikation, wie dem „Journal of Cataract and Refractive Surgery“ und der „Eurotimes“, usw. Nicht fehlen darf noch der Hinweis auf den jedes Jahr erscheinenden Kongressband der DGII, in dem kompakt all die Beiträge, die Sie auf dem Kongress gehört haben, nochmals schriftlich zusammengefasst sind. Ich wünsche uns allen einen schönen, erfolgreichen und interessanten Kongress.

Thermografie der Augenoberfläche: Erste Erfahrungen mit dem Thermografiegerät TG 1000

Hintergrund: Die Messung der Oberflachentemperatur des Auges hat eine lange Tradition, ist bisher jedoch an einer einfachen, zuverlassigen technischen Realisierung gescheitert. Einen neuen technischen Ansatz stellt das Thermografiegerat TG 1000 (Tomey Erlangen, Deutschland) dar. Das Prinzip der Thermografie beruht auf der Detektierung und Umwandlung der Infrarotstrahlung eines Objektes in Temperaturmesswerte. Mithilfe dieser Technik ist es innerhalb kurzester Zeit ohne Kontakt moglich, die Temperatur der okularen Oberflache im zeitlichen Verlauf zu analysieren. Die in unserer Klinik durchgefuhrten Untersuchungen dienten der Evaluation der erganzenden Aussagemoglichkeiten des Thermografiegerates TG 1000 bei unterschiedlichen Krankheitsbildern. Patienten und Methoden: Wir untersuchten Patienten mit Keratokonjunktivitis sicca und Blepharitis und stellen die Ergebnisse augengesunden Probanden gegenuber. Ergebnisse: Das Normalkollektiv (Altersmedian 48 Jahre) wies eine durchschnittliche Oberflachentemperatur von 34,46°C auf, mit durchschnittlicher Anderung von 0,34°C uber 10 Sekunden. Die Sicca- und Blepharitis-Patienten (Altersmedian 67 Jahre) zeigten eine durchschnittliche Oberflachentemperatur von 34,21°C, die durchschnittliche Anderung der Temperatur betrug 0,54°C. Zur Analyse der Sicca-Symptomatik ist der Thermograph ein valides, die Diagnostik erganzendes Instrument. Die interindividuellen Schwankungen der Messergebnisse und auch der geringe Unterschied der Messwerte erschweren jedoch die Vergleichbarkeit. Schlussfolgerung: Der Einsatz des Thermografiegerates TG 1000 in der Sicca- Diagnostik und insbesondere der Vorteil im Vergleich zur herkommlichen Diagnostik muss weiter eruiert werden.