Sima Pavlovic

Rotational stability of a single-piece hydrophobic acrylic intraocular lens: New method for high-precision rotation control

PURPOSE: To use a new method to examine precisely the rotational stability of a foldable hydrophobic single‐piece monofocal acrylic intraocular lens (IOL) and determine whether the design is suitable for a toric lens. SETTING: University Eye Hospital, University Giessen and Marburg, Giessen, Germany. METHODS: The rotational stability of an acrylic IOL (AcrySof SA60AT, Alcon) was evaluated using digital photographs. Two sets of images of the IOL in 17 eyes were taken. The first set was taken immediately postoperatively and the other, 6 months after cataract surgery. The axial position of the eye was determined using 2 characteristic points at the conjunctiva and on the IOL. These points were then connected with a line and an angle determined. Comparing the 2 sets of images yielded an angle Δ that revealed the rotation. RESULTS: The median IOL rotation was 0.7 degree (range 0.1 to 1.8 degrees). Rotation greater than 0 degree and less than 0.5 degree was measured in 4 eyes (24%). Rotation of 0.5 to 1.0 degree was found in 8 eyes (47%). A rotational angle greater than 1.0 degree was found in 5 eyes (29%). Rotation did not exceed 1.8 degrees in any eye. CONCLUSIONS: Using a suitable measuring method that takes into account the cyclorotation of the eye, it was possible to precisely determine IOL rotation using picture pairs taken in chronological sequence. The IOL design examined in the study is recommended as a toric IOL because of its good rotational stability.

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.

Influence of physical exercise and nifedipine on ocular pulse amplitude

Abstract• Background: Ocular pulse amplitude (OPA) was measured to investigate the influence of peripheral vasoconstriction and vasodilatation on choroidal perfusion in healthy volunteers and to determine whether low OPA in low-tension glaucoma (LTG) patients is associated with a vasospastic reaction and its response to the calcium channel blocker nifedipine.• Methods: OPA was determined using the Langham ocular blood flow (OBF) system, applanation intraocular pressure (IOP), systemic blood pressure, and heart rate were measured, and ocular perfusion pressure was calculated before and after exercise and smoking in 12 otherwise nonsmoking, healthy volunteers and prior to and for 3 months after initiation of nifedipine therapy in 32 LTG patients with and without a vasospastic reaction as manifested by a nailfold capillary blood flow test.• Results: Exercise significantly (P<0.05) increased heart rate, systolic blood pressure and ocular perfusion pressure, while it significantly (P<0.05) reduced IOP and diastolic blood pressure. However, OPA was not significantly (P>0.1) affected by changes in these parameters. Smoking significantly (P<0.05) increased systolic and diastolic blood pressure, heart rate, and ocular perfusion pressure but did not significantly (P>0.09) alter OPA. There were two distinct LTG subtypes, with and without a vasospastic reaction. Only those with a vasospastic reaction showed a significant (P<0.001) increase in OPA after 3 months of nifedipine treatment, while all other parameters tested were not significantly altered.• Conclusion: Despite affecting ocular and systemic perfusion parameters, exercise and smoking did not alter OPA, suggesting functional isolation, i.e. autoregulation of the choroidal and/or ophthalmic artery circulation in healthy volunteers. Low OPA in LTG was increased by nifedipine only in vasospastic LTG patients, suggesting different, vasotonus-related pathologies. Calcium channel blockers and other vasodilators may be useful in vasoreactive LTG patients with reduced OPA.

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.

Primary intraocular lens implantation during pars plana vitrectomy and intraretinal foreign body removal.

PURPOSE To evaluate visual and surgical outcomes as well as complication rates after cataract extraction and primary intraocular lens (IOL) implantation during pars plana vitrectomy for removal of foreign bodies embedded or impacting in the retina. METHODS Six consecutive cases of simultaneous cataract extraction and IOL implantation combined with vitreous surgery and intraocular foreign body extraction were retrospectively analyzed. In five cases, the foreign body was intraretinal; in one case, it was preretinal with retinal impact site. The follow-up period ranged from 5 to 45 months (mean 21.3 months). RESULTS Visual acuity improved by two or more lines in five of six eyes. In five eyes, best-corrected postoperative visual acuity was better than 20/40. One eye was successfully reoperated for retinal detachment that developed 2 months postoperatively. In four eyes, the IOL was implanted into the capsular bag; in two cases, the IOL was placed in the ciliary sulcus. No postoperative complication was attributed to IOL implantation. CONCLUSION Primary IOL implantation after combined cataract and vitreoretinal surgery is a safe and attractive option, reducing the need for two separate operations in selected patients with penetrating ocular injury and retained intraocular foreign bodies. The main advantage is more rapid visual rehabilitation with a single operation, reducing costs and patient discomfort.

Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule

PURPOSE To present a case of rapidly progressing traumatic cataract caused by posterior capsule rupture after nonpenetrating ocular injury, as well as a surgical procedure to safely implant the intraocular lens in such a traumatized eye. METHODS In a 23-year-old man with traumatic cataract and posterior lens capsule rupture, a one-piece polymethylmethacrylate IOL was implanted before cataract extraction into the ciliary sulcus in front of the cataractous lens. Subsequently, the cataract was removed by pars plana lensectomy. RESULTS The surgery and postoperative course were uneventful. Postoperative visual acuity was 20/20. CONCLUSION We present a method of intraocular lens implantation in cases of rapidly progressing traumatic cataract caused by posterior capsule rupture after a blunt ocular trauma.

Combined temporal phacoemulsification and pars plana vitrectomy for the treatment of cataract and giant retinal tear in a buphthalmic eye.

The standard approach to a three-port to pars plana vitrectomy is by placing the sclerotomies in the superotemporal and superonasal quadrant and the infusion port in the inferotemporal quadrant. This approach may be adjusted in selected cases that exhibit structural abnormalities of the globe at the superior site by placement of the sclerotomies in the temporal quadrants. We describe a case of a buphthalmic eye with a huge filtering bleb from previous glaucoma surgery that successfully underwent combined cataract and vitreoretinal surgery from a temporal approach for the repair of a giant retinal tear with cataract.

Postoperative Komplikationen nach Silikonölinstillation

ZusammenfassungHintergrundDie Verwendung von Silikonöl beinhaltet verschiedene Komplikationen, die den Erfolg des vitreoretinalen Eingriffes oftmals reduzieren.MethodeIn einer retrospektiven Studie analysierten wir den Krankheitsverlauf von insgesamt 511 Augen (503 Patienten) mit komplizierter NH-Amotio verschiedener Genese, bei denen eine Pars-plana-Vitrektomie mit Silikonöltamponade durchgeführt worden war, um Komplikationen nach Silikonöltamponade festzustellen. Bei den untersuchten Augen handelte es sich um 267 komplizierte PVR-Amotiones, 126 diabetische Traktionsamotiones, 74 Amotiones nach perforierender Bulbusverletzung, 27 Amotiones mit Riesenriß und 17 Augen mit verschiedenen anderen Netzhauterkrankungen wie Endophthalmitis, akuter retinaler Nekrose, Uveitis oder Amotiones mit zentralen Foramina.ErgebnisseZum Zeitpunkt der letzten Kontrolluntersuchung zeigten 83,7% der phaken Augen Linsentrübungen unterschiedlichen Grades. Ein Jahr nach Silikonölinstillation wiesen 10,9% der operierten Augen ein Glaukom auf. Nach Silikonölentfernung normalisierte sich der intraokulare Druck bei 36% der Augen. Bei 23 aphaken Augen wurde nach Silikonöltamponade eine Keratopathie festgestellt. 16 Augen entwickelten eine bandförmige Keratopathie infolge langfristigem Silikonölkontakt mit dem Hornhautendothel. Folgende Faktoren üben einen entscheidenden Einfluß auf die Reduktion der Komplikationen nach Silikonölinstillation aus: Anwendung adäquater Verfahren und chirurgischer Techniken vor der Silikonölinstillation und Silikonölentfernung, sobald dies die Netzhautsituation zuläßt.SchluβfolgerungDa die Linsentrübung nach Silikonöltamponade unvermeidbar ist, muß bei silikonölgefüllten Augen mit einer Kataraktoperation langfristig gerechnet werden. Das Silikonöl sollte — auch in Hinblick auf eine Glaukomentstehung — bei stabilem Netzhautbefund frühestmöglich entfernt werden.SummaryPatients and methodsIn order to study the complications after silicone oil tamponade we retrospectively analyzed 511 cases (503 patients) of complicated retinal detachments after pars plana vitrectomy combined with silicone oil instillation. 267 cases suffered from PVR-detachment, 126 eyes from diabetic tractional retinal detachment, 74 cases from penetrating ocular injuries, 27 eyes from giant tear retinal detachment and there were 17 eyes with other retinal pathology (endophthalmitis, acute retinal necrose syndrome, uveitis or retinal detachment with central hole).ResultsAt the final postoperative examination 83.7% phakic eyes showed lens opacification of different degree. After one-year follow-up 11 % of the operated eyes had glaucoma. Normalisation of intraocular pressure was observed in 36% of eyes after silicone oil extraction. 23 aphakic eyes showed keratopathy after silicone oil tamponade. In 16 cases band-shaped keratopathy developed postoperatively due to prolonged contact of silicone oil with the corneal endothelium.ConclusionThe only possibility to eliminate emulsification of silicone oil completely is to remove oil from the eye before emulsification becomes clinically significant and causes complications. If adequate surgery led to stable retinal attachment in a relatively short period of time, problems of keratopathy, emulsification glaucoma and other possible complications related to emulsification can be decreased. Development of cataract after silicone oil removal is unavoidable even after silicone oil removal.