S. Sacu

The role of the carotenoids, lutein and zeaxanthin, in protecting against age-related macular degeneration: A review based on controversial evidence

PurposeA review of the role of the carotenoids, lutein and zeaxanthin, and their function in altering the pathogenesis of age-related macular degeneration (AMD).MethodsMedline and Embase search.ResultsRecent evidence introduces the possibility that lutein and zeaxanthin, carotenoids found in a variety of fruits and vegetables may protect against the common eye disease of macular degeneration. This potential and the lack to slow the progression of macular degeneration, has fueled high public interest in the health benefits of these carotenoids and prompted their inclusion in various supplements. The body of evidence supporting a role in this disease ranges from basic studies in experimental animals to various other clinical and epidemiological studies. Whilst some epidemiological studies suggest a beneficial role for carotenoids in the prevention of AMD, others are found to be unrelated to it. Results of some clinical studies indicate that the risk for AMD is reduced when levels of the carotenoids are elevated in the serum or diet, but this correlation is not observed in other studies. Published data concerning the toxicity of the carotenoids or the optimum dosage of these supplements is lacking.ConclusionAn intake of dietary supplied nutrients rich in the carotenoids, lutein and zeaxanthin, appears to be beneficial in protecting retinal tissues, but this is not proven. Until scientifically sound knowledge is available we recommend for patients judged to be at risk for AMD to: alter their diet to more dark green leafy vegetables, wear UV protective lenses and a hat when outdoors. Future investigations on the role of nutrition, light exposure, genetics, and combinations of photodynamic therapy with intravitreal steroid (triamcinolone-acetonide) injections hold potential for future treatment possibilities.

Effect of a silicone intraocular lens with a sharp posterior optic edge on posterior capsule opacification

Purpose: To compare the inhibiting effect on posterior capsule opacification (PCO) of a silicone intraocular lens (IOL) with a sharp posterior optic edge (ClariFlex OptiEdge®, Advanced Medical Optics) and a silicone IOL with a round optic edge (PhacoFlex SI‐40, Advanced Medical Optics). Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This prospective randomized patient‐ and examiner‐masked study comprised 104 eyes of 52 patients with bilateral age‐related cataract. All patients had cataract surgery in both eyes and received a sharp‐edged IOL in 1 eye and a round‐edged IOL in the other eye. Postoperative examinations were at 1 week, 1 and 6 months, and 1 year. Digital slitlamp and retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using Automated Quantification of After‐Cataract (AQUA) automated‐image analysis software. Results: The sharp‐edged IOL group had significantly less regeneratory and fibrotic PCO 1 month, 6 months, and 1 year after surgery. The mean AQUA PCO score (scale 0 to 10) was 0.71 in the sharp‐edged IOL group and 1.40 in the round‐edged IOL group (P<.001). The sharp‐edged IOL group had less peripheral fibrotic PCO. There was no significant difference between the 2 IOL groups in patient reports of edge glare. Conclusion: The sharp‐edged design of the ClariFlex OptiEdge silicone IOL led to significantly less PCO than the round‐edged PhacoFlex SI‐40 IOL 1 year postoperatively.

Influence of operator experience on the performance of ultrasound biometry compared to optical biometry before cataract surgery

Purpose: To compare measurements performed with the IOLMaster (Carl Zeiss, Meditec AG) with those obtained by applanation ultrasound (US) and manual keratometry and to evaluate the effect of operator experience on US biometry. Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: The axial length (696 eyes) and anterior chamber depth (ACD) (462 eyes) were measured in 377 patients with cataract using the IOLMaster and applanation US. To assess the effect of operator experience on the biometric results, the operators were divided into 2 groups: experienced and less experienced in performing US biometry. The difference in measurements between the methods and the variability of the difference were compared between the 2 groups. Results: Applanation US measured axial length and ACD shorter than the IOLMaster; the mean numerical difference was 0.13 mm and 0.19 mm, respectively (P<.01). For axial length, the absolute difference was smaller with experienced operators than with less experienced operators (0.15 mm versus 0.22 mm) (P<.01). For ACD, experienced operators obtained a smaller difference between measurement techniques (0.21 mm versus 0.29 mm; P<.05). Conclusions: Experienced US operators had less difference and lower variability in the difference between applanation US and IOLMaster readings for axial length and ACD measurements. The noncontact optical method, which is essentially operator independent, gave significantly more reliable biometry before cataract surgery, especially in the case of less experienced operators.

Influence of optic edge design and anterior capsule polishing on posterior capsule fibrosis.

Purpose: To evaluate the role of posterior optic edge design and the effect of anterior capsule polishing on peripheral fibrotic posterior capsule opacification (PCO). Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This randomized prospective study comprised 144 eyes of 72 patients with bilateral age‐related cataract. Each patient had standardized cataract surgery in both eyes by the same surgeon. Group 1 (46 patients) received a round‐edged hydrophobic acrylic IOL (AMO Sensar® AR40) in 1 eye and a sharp‐edged hydrophobic acrylic IOL (AMO Sensar® OptiEdge AR40e) in the other eye. Group 2 (26 patients) received a silicone IOL (Pharmacia CeeOn® 911A) with a truncated optic in both eyes. In this group, the anterior capsule was extensively polished in 1 eye and was left unpolished in the other eye. Digital slitlamp photographs were taken 1 year postoperatively using a standardized photographic technique for fibrotic PCO. The intensity of PCO was subjectively graded (score 0 to 4) by 2 masked examiners. Results: Subjective PCO scores correlated well between the 2 examiners (r = 0.88). In Group 1, the mean PCO score was 0.26 for the OptiEdge AR40e IOL and 0.90 for the AR40 IOL (P<.01). In Group 2, the mean PCO score was 0.24 in eyes with a polished capsule and 0.17 in eyes in which the capsule was not polished (P = .31). Conclusions: The sharp‐edged OptiEdge AR40e IOL led to significantly less peripheral fibrotic PCO 1 year postoperatively than the round‐edged AR40 IOL. In eyes with the sharp‐edged silicone 911A IOL, anterior capsule polishing caused no significant difference in fibrotic PCO.

Reading performance depending on the type of cataract and its predictability on the visual outcome.

Purpose: To investigate the influence of various types of cataract on reading performance in a standardized reading test setting. Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: The reading performance of 94 eyes with age‐related cataract and normal macular function was evaluated with the Radner Reading Charts preoperatively and 4 weeks after cataract surgery. Distance visual acuity was tested with the ETDRS charts. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, on which NO is nuclear opalescence and NC is nuclear color. Results: Patients with pure nuclear cataracts (LOCS III: NO/NC 2.1‐5) achieved a normally high MRS (99.84% ± 7.65% of their postoperative MRS): preoperative MRS1: 190.6 ± 30.74 words per minute (wpm); postoperative MRS2: 191.21 ± 29.36 wpm. Patients with mixed nuclear‐cortical cataracts (LOCS III: NO/NC 2.1‐5; C>2) preoperatively achieved 96.96% ± 5.6% of their postoperative MRS (MRS1: 175.77 ± 31.54 wpm; MRS2: 181.34 ± 30.56 wpm). In dense nuclear cataracts (LOCS III: NO/NC>5), the MRS was significantly reduced, achieving only 72.64 ± 19.19% of the postoperative MRS (MRS1: 133.06 ± 39.43 wpm; MRS2: 185.76 ± 40.18 wpm). In posterior subcapsular cataracts, the preoperative MRS (134.1 ± 33.72 wpm) was significantly lower than postoperatively (191.14 ± 27.08 wpm). Conclusions: In contrast to dense nuclear cataracts and posterior subcapsular cataracts, the preoperative reading speed of patients with pure nuclear or nuclear‐cortical cataracts was normal at large print sizes. The preoperative evaluation of reading acuity and speed with standardized reading tests can therefore be used to estimate the postoperative reading performance in the latter 2 types of cataract.

Interexaminer and intraexaminer reliability of the microperimeter MP-1

PurposeTo evaluate the interexaminer and intraexaminer reliability of macular microperimetry using the microperimeter MP-1.MethodsParticipants: Fifteen healthy volunteers younger than 40 years of age (Group 1), 15 healthy subjects over 60 years (Group 2), and five patients with age-related macular degeneration (Group 3). Observation procedure: Two examiners (E1 and E2) measured, in random order, interexaminer (E2–E1a) reliability. Another examination was undergone by one of the examiners a week later to evaluate the intraexaminer (E1b–E1a) reliability. Main outcome measures: Macular sensitivity (mean threshold (decibel)) and stability of fixation were determined using MP1 microperimetry. Agreement was analysed by means of Bland–Altman plots and by the determination of the intraclass correlation coefficient.ResultsThe interexaminer (E2–E1a) and the intraexaminer (E1b–E1a) differences in the mean threshold values were not statistically significant (P=0.850, 95% confidence Interval (CI)=−0.265 to 0.319; P=0.246, 95% CI=−0.099 to 0.375, respectively). Limits of agreement and intraclass correlation coefficients also showed good agreement in each group.ConclusionsA good reliability was found for the mean threshold values in all the three groups, indicating examiner-independent measurements.

Ocular Firework Injuries at New Year’s Eve

Purpose: To prospectively study mechanisms and injury characteristics of ocular firework burns. Methods: A prospective analysis of all patients with firework injuries attending the Department of Ophthalmology, University of Vienna, between 1994 and 2001. We looked for classes of fireworks and mechanisms of injuries. The number of diagnoses was established and their severity classified. Results: During this period (8 years) we identified 116 eyes of 102 patients. 67/102 (66%) of all injuries were caused by class II and III fireworks. Patients ranged between 4 and 83 years. Ocular injuries occurred more frequently in males (69, 68%) and affected the right eye in 53 patients (52.5%). Ocular firework injuries to minors (under the age of 18 years) occurred in 48 (49%). The most common types of injury were skin and corneal erosions and abrasions (32/116, 28%). 11/116 eyes (10%) had severe injuries. 8 of 11 severe injuries (72%) occurred in minors (<18 years). 2 patients (1.7%) developed permanent blindness. In 32/116 patients (28%), the ocular trauma resulted in visual impairment, mainly due to corneal scars or retinal pathologies. In all patients, the severity index was 1.4 ± 0.8. In minors the severity index was 1.6 ± 1.0, in adults 1.2 ± 0.5 (p = 0.013). Conclusion: Injuries in minors were significantly more severe than those in adults. Possible preventive measures include legislation, education of minors and eye protection.

Tumour Regression of Uveal Melanoma after Ruthenium-106 Brachytherapy or Stereotactic Radiotherapy with Gamma Knife or Linear Accelerator

Purpose: This study assesses differences in relative tumour regression and internal acoustic reflectivity after 3 methods of radiotherapy for uveal melanoma: (1) brachytherapy with ruthenium-106 radioactive plaques (RU), (2) fractionated high-dose gamma knife stereotactic irradiation in 2–3 fractions (GK) or (3) fractionated linear-accelerator-based stereotactic teletherapy in 5 fractions (Linac). Methods: Ultrasound measurements of tumour thickness and internal reflectivity were performed with standardised A scan pre-operatively and 3, 6, 9, 12, 18, 24 and 36 months postoperatively. Of 211 patients included in the study, 111 had a complete 3-year follow-up (RU: 41, GK: 37, Linac: 33). Differences in tumour thickness and internal reflectivity were assessed with analysis of variance, and post hoc multiple comparisons were calculated with Tukey’s honestly significant difference test. Results: Local tumour control was excellent with all 3 methods (>93%). At 36 months, relative tumour height reduction was 69, 50 and 30% after RU, GK and Linac, respectively. In all 3 treatment groups, internal reflectivity increased from about 30% initially to 60–70% 3 years after treatment. Conclusion: Brachytherapy with ruthenium-106 plaques results in a faster tumour regression as compared to teletherapy with gamma knife or Linac. Internal reflectivity increases comparably in all 3 groups. Besides tumour growth arrest, increasing internal reflectivity is considered as an important factor indicating successful treatment.

Intravitreales Bevacizumab vs. Verteporfin und intravitreales Triamcinolon Acetonid bei Patienten mit neovaskulärer AMD

ZusammenfassungZielVergleich von intravitrealer Bevacizumab (IVB)- und Verteporfin-Therapie in Kombination mit 4xa0mg intravitrealem Triamcinolon (PDT-IVTA) bei Patienten mit neovaskulärer altersbezogener Makuladegeneration (AMD).Patienten und MethodenIn einer prospektiven, randomisierten Studie wurden 30 Augen von 30xa0Patienten mit neovaskulärer AMD inkludiert. Zehn Augen wurden mit PDT-IVTA mit Standard-Lichtdosis (SPDT-IVTA) von 50xa0J/cm2, 10 Augen mit PDT-IVTA reduzierter Lichtdosis von 25xa0J/cm2 (RPDT-IVTA) und weitere 10 Augen mit 1xa0mg IVB behandelt. Der Therapieeffekt wurde mittels Early Treatment Diabetic Retinopathy Study (ETDRS) Visus, Fluoreszenzangiographie und optischer Kohärenztomographie (OCT) vor und 1xa0Tag, 1xa0Woche, 1 und 3xa0Monate nach Behandlungsbeginn evaluiert.ErgebnisseVor Behandlungsbeginn zeigte sich eine insgesamt ausgeglichene Gruppenverteilung. Nach 3xa0Monaten kam es bei der SPDT-IVTA-Gruppe zu einem nichtsignifikanten Visusverlust von 7 Buchstaben (p<0,3), und in der RPDT-IVTA-Gruppe zu einem Visusverlust von 0,5 Buchstaben (p<0,9). Zum gleichen Zeitpunkt betrug der Visusgewinn in der IVB-Gruppe 11,8 Buchstaben (p<0,001). Der Visusgewinn in der IVB-Gruppe war statistisch signifikant im Vergleich zu den Visusergebnissen beider PDT-IVTA-Gruppen (p<0,05). Die zentrale Netzhautdicke (CRT) nahm bis zum Monat 3 in der SPDT-IVTA-Gruppe um 132xa0μm, in der RPDT-IVTA-Gruppe um 78xa0μm und in der IVB-Gruppe um 138xa0μm ab, (p<0,05 in 3 Gruppen). Nach 3xa0Monaten fand sich kein signifikanter Unterschied der Netzhautdickenabnahme zwischen den Behandlungsgruppen.SchlussfolgerungIm Kurzzeitverlauf zeigt IVB gegenüber beiden PDT-IVTA-Gruppen signifikant bessere Visusergebnisse. Innerhalb von 3xa0Monaten fand sich in allen Gruppen eine vergleichbare Abnahme der CRT. Langzeitbeobachtungen sind erforderlich, um die Sicherheit und Wirksamkeit der Therapieformen zu beurteilen.AbstractAimThe aim of this study was to compare intravitreal bevacizumab (IVB) and verteporfin therapy in combination with 4xa0mg intravitreal triamcinolone (PDT-IVTA) in patients with neovascular age-related macular degeneration (AMD).Patients and methodsA total of 30 eyes of 30 patients with neovascular AMD were included in a prospective, randomized study. Ten eyes received PDT-IVTA with a standard light fluence of 50xa0J/cm2 (SPDT-IVTA), ten were treated with PDT-IVTA with a reduced light fluence of 25xa0J/cm2 (RPDT-IVTA) and ten received IVB. The main outcome was evaluated using early treatment diabetic retinopathy study (ETDRS) visual acuity, fluorescein angiography and optical coherence tomography (OCT) at baseline as well as at dayxa01, weekxa01, 1xa0month and 3xa0months after therapy.ResultsAt the beginning of therapy, the distribution of the groups was balanced. After 3xa0months, the SPDT-IVTA group showed a non-significant vision loss of seven letters (p<0.3) while a vision loss of 0.5 letters (p<0.9) was found in the RPDT-IVTA group. At the same time, the IVB group had a vision improvement of 11.8 letters (p<0.001). This vision improvement was statistically significant compared to the results of both PDT-IVTA groups (p<0.005). Central retinal thickness (CRT) decreased up to monthxa03 in the SPDT-IVTA group by 132xa0μm, in the RPDT-IVTA group by 78xa0μm and in the IVB group by 138xa0μm, (p<0.05 in the three groups). No significant difference in the decrease of CRT was found between the treatment groups after 3xa0months.ConclusionIVB shows significantly better results in vision improvement in the short-term compared to the two PDT-IVTA groups. Within 3xa0months, all groups showed a comparable decrease in CRT. Long-term follow-up is required to evaluate the safety and treatment efficacy of all treatment modalities.AIMnThe aim of this study was to compare intravitreal bevacizumab (IVB) and verteporfin therapy in combination with 4 mg intravitreal triamcinolone (PDT-IVTA) in patients with neovascular age-related macular degeneration (AMD).nnnPATIENTS AND METHODSnA total of 30 eyes of 30 patients with neovascular AMD were included in a prospective, randomized study. Ten eyes received PDT-IVTA with a standard light fluence of 50 J/cm(2) (SPDT-IVTA), ten were treated with PDT-IVTA with a reduced light fluence of 25 J/cm(2) (RPDT-IVTA) and ten received IVB. The main outcome was evaluated using early treatment diabetic retinopathy study (ETDRS) visual acuity, fluorescein angiography and optical coherence tomography (OCT) at baseline as well as at day 1, week 1, 1 month and 3 months after therapy.nnnRESULTSnAt the beginning of therapy, the distribution of the groups was balanced. After 3 months, the SPDT-IVTA group showed a non-significant vision loss of seven letters (p<0.3) while a vision loss of 0.5 letters (p<0.9) was found in the RPDT-IVTA group. At the same time, the IVB group had a vision improvement of 11.8 letters (p<0.001). This vision improvement was statistically significant compared to the results of both PDT-IVTA groups (p<0.005). Central retinal thickness (CRT) decreased up to month 3 in the SPDT-IVTA group by 132 microm, in the RPDT-IVTA group by 78 mum and in the IVB group by 138 microm, (p<0.05 in the three groups). No significant difference in the decrease of CRT was found between the treatment groups after 3 months.nnnCONCLUSIONnIVB shows significantly better results in vision improvement in the short-term compared to the two PDT-IVTA groups. Within 3 months, all groups showed a comparable decrease in CRT. Long-term follow-up is required to evaluate the safety and treatment efficacy of all treatment modalities.

Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma

PURPOSEnTo present the clinical and histologic findings of a patient in whom intumescent cataract developed after successful topical mitomycin-C (MMC) chemotherapy for conjunctival melanoma originating from primary acquired conjunctival melanosis (PAM) with atypia.nnnDESIGNnObservational case report; follow-up at 30 months.nnnMETHODSnIn a patient with PAM and subsequent conjunctival melanoma that was successfully treated with topical MMC chemotherapy an intumescent cataract developed after two cycles of 0.04% MMC, each for 1 month.nnnRESULTSnAfter MMC chemotherapy pigmentation of the acquired melanosis vanished almost completely. Histopathology of the check-up specimen revealed local tumor control. Six weeks after the completion of the second cycle, an intumescent cataract developed. Cataract surgery was performed uneventfully. The patient was followed up for 30 months.nnnCONCLUSIONSnIn selected cases, topical MMC chemotherapy is effective for treating conjunctival melanoma. Although severe complications are rare and usually transient, development of cataract may be observed. A prospective study should be initiated.