Thomas Neumayer

Rotational stability and posterior capsule opacification of a plate-haptic and an open-loop-haptic intraocular lens

PURPOSE: To compare the rotational stability and posterior capsule opacification (PCO) rate in eyes with a 1‐piece or 3‐piece acrylic intraocular lens (IOL). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Prospective randomized masked clinical trial. METHODS: Patients with age‐related cataract received a plate‐haptic acrylic IOL (Acri.Smart 46S) in 1 eye and a 3‐piece loop‐haptic acrylic IOL (Acri.Lyc 53N) in the other eye. Retroillumination images were taken 1 hour, 1 week, and 1, 6, and 12 months postoperatively. Intraocular lens rotation was measured using standard software (Adobe Photoshop). The amount of PCO was assessed subjectively at the slitlamp and objectively using an automated image‐analysis software (AQUA). RESULTS: The study enrolled 80 eyes of 40 patients. The IOL rotation measurements showed excellent reproducibility, with a deviation of less than 0.8 degrees. Both IOLs had comparable and good rotational stability; rotation was less than 4 degrees in 71% of eyes 1 year postoperatively. The mean absolute rotation was 2.6 degrees ± 1.9 (SD) in the plate‐haptic IOL group and 3.1 ± 2.4 degrees in the loop‐haptic IOL group. The mean AQUA PCO score (scale 0 to 10) was 0.4 in both IOL groups (P=.7). CONCLUSION: The 2 IOL models had comparable, excellent rotational stability and low PCO intensity 1 year postoperatively. Thus, the plate‐haptic IOL may be a good platform for a toric model. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Long-term changes in the morphology of posterior capsule opacification

PURPOSE: To classify the morphologic appearance of posterior capsule opacification (PCO) and to observe and document the changes over longer periods of time. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Eighty‐one pseudophakic eyes of 53 patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images of the posterior capsule were taken in a standardized fashion 1, 2, and 3 years after cataract surgery. The PCO morphology was classified, and changes among the 3 follow‐up images were analyzed. RESULTS: At 1, 2, and 3 years, pearls occurred in 16 (20%), 41 (51%), and 57 (63%) eyes. Pearls increased in size and number. Cases with thin layers of PCO decreased from 53 to 33 to 16 eyes. Conversely, cases with thick layers increased from 18 to 45 and 64 eyes. “Cheese holes” appeared most frequently as the predominant structure (range 47% to 51%), followed by plates (range 28% to 31%), islands (range 15% to 20%), and traces of PCO (range 1% to 5%). Changes in expansion of the PCO area were observed in 61 eyes (75%) during period 1 (1 to 2 years) and period 2 (2 to 3 years). Regions of expansion and regression in the same eye occurred in periods 1 and 2 in 11 eyes (14%) and 9 eyes (11%), respectively. The phenomenon of thinning bridges, a regression of syncytial extensions of PCO, occurred in 22 eyes (27%) and 32 eyes (40%), respectively. An overlapping growth of 2 layers was observed in 18 eyes (22%). CONCLUSIONS: The morphology of PCO is multifaceted. Apart from the Elschnig pearls, categories such as cheese holes, plates, islands, and traces of PCO were distinguished. Over the years, pearls increased in frequency, size, and number. Expansion and regression occurred simultaneously in some cases. Two or more layers grew on top of each other in some eyes.

Influence of severity of nuclear cataract on optical biometry.

PURPOSE: To compare preoperative and postoperative measurements of the axial length (AL) performed with the IOLMaster (Carl Zeiss Meditec) to evaluate the effect of nuclear cataract on the optical biometry. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In 245 consecutive eyes of 162 patients scheduled for cataract surgery, type and severity of cataract was evaluated using the Lens Opacities Classification System III. Preoperative and postoperative axial length measurements were performed with the IOLMaster. The postoperative readings of AL were corrected for the IOL optic material implanted. RESULTS: The preoperative AL measurements were 0.07 mm ± 0.05 (SD) (range −0.18 to 0.11 mm) longer than the postoperative measurements (P<.001). These differences in AL were only weakly correlated (r = −0.28, P = .01) with the nuclear cataract grade, mean 3.5 ± 0.9. CONCLUSION: In this study, AL measurements with optical biometry using the IOLMaster were not influenced by the severity of nuclear cataract to a clinically relevant degree. Furthermore, it was found that AL in the phakic eye was overestimated by about 0.07 mm because of a slightly too low value of the group refractive index used for the crystalline lens.

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small‐incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in‐the‐bag IOL implantation. SETTING: Department of Ophthalmology, Medical University of Vienna, Austria. METHODS: This prospective comparative study comprised 23 patients (46 eyes) with age‐related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA‐60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in‐the‐bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high‐resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. RESULTS: Ten patients completed 10 to 12 months of follow‐up. Postoperatively, the axial IOL position was stable in eyes with PPCCC–POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in‐the‐bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC–POBH (P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.

Effect of the hydrophilicity of acrylic intraocular lens material and haptic angulation on anterior capsule opacification

Aim: To evaluate the influence of hydrophilic and hydrophobic acrylic material and haptic angulation on anterior capsule opacification (ACO). Methods: Prospective study on 53 patients with bilateral age-related cataract. Patients underwent standard cataract surgery by the same surgeon and randomly received a hydrophilic acrylic intraocular lens (IOL) in one eye and a hydrophobic acrylic IOL in the other eye. Forty five of these patients completed the one-year follow-up. The following parameters were assessed: decentration, buttonholing, anterolenticular gap (ALG), ACO, outgrowth and refractive outcome. Results: At the one-year follow-up, ACO was seen in 80% of the hydrophilic and 100% of the hydrophobic IOLs. ACO was more intense in the hydrophobic IOLs (p<0.001). Outgrowth was seen in 42% of the hydrophilic and 2% of the hydrophobic IOLs (p = 0.0003). No case of persisting ALG was seen in the hydrophobic IOLs, but in 42% of the hydrophilic IOLs. The refractive outcome was −0.29 (SD 0.56) dioptres for the hydrophilic and 0.003 (SD 0.44) dioptres for the hydrophobic IOLs (p<0.001). Conclusion: These results suggest that there is less ACO in hydrophilic acrylic than in hydrophobic acrylic IOLs. Although material properties might play a role, the angulated haptics of the hydrophilic IOLs exert an additional effect by the persisting ALG and a lack of contact between the IOL and the anterior capsule.

Effect of posterior capsule opacification on macular sensitivity

PURPOSE: To evaluate the effect of posterior capsule opacification (PCO) on macular sensitivity. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Macular sensitivity, best corrected visual acuity (BCVA), and PCO intensity were evaluated before and after neodymium:YAG (Nd:YAG) laser capsulotomy in pseudophakic eyes with clinically significant PCO that had a healthy macula or dry age‐related macular degeneration (ARMD). Macular sensitivity was determined using the fundus‐related Microperimeter 1 (Nidek) in a central field of 10 degrees. The intensity of the PCO was assessed objectively in the central 3.0 mm area (score 0 to 10) using quantification software. RESULTS: After Nd:YAG capsulotomy, both groups had a significant improvement in BCVA and mean macular sensitivity; the change in the mean logMAR value was −0.26 in the healthy macula group and −0.23 in the dry ARMD group and the change in mean macular sensitivity, 2.5 dB and 2.0 dB, respectively. Before Nd:YAG capsulotomy, significant correlations were observed between PCO values, BCVA, and macular sensitivity in the healthy macula group only (P<.01). CONCLUSIONS: Neodymium:YAG laser capsulotomy improved BCVA and macular sensitivity. The PCO scores correlated well with the PCO‐induced decrease in BCVA and with PCO‐induced loss of macular sensitivity. Functional macular mapping indicated an overall loss of macular sensitivity in patients with dry ARMD. There was no significant association between PCO values and macular sensitivity in eyes with dry ARMD.

Effect of a new cohesive ophthalmic viscosurgical device on corneal protection and intraocular pressure in small-incision cataract surgery.

PURPOSE: To compare the corneal protective and intraocular pressure (IOP) effects of a new cohesive ophthalmic viscosurgical (OVD), Neocrom Cohesive (sodium hyaluronate 1.4%), with those of Healon (sodium hyaluronate 1.0%) in cataract surgery. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This randomized patient‐masked examiner‐masked study with fellow‐eye comparison comprised 29 cataract surgery patients. Surgery was performed with Neocrom Cohesive in 1 eye and Healon in the other eye. Central corneal thickness (CCT) was measured preoperatively and 1 day and 3 months postoperatively; endothelial cell density (ECD), preoperatively and 3 months postoperatively; and IOP, preoperatively and 6 hours and 1 day postoperatively. RESULTS: The mean CCT change from preoperatively to postoperatively in the Neocrom Cohesive, respectively, group and Healon group was +16.0 μm ± 25.7 (SD) (P<.01) and +7.0 ± 17.1 μm (P<.05), respectively, at 1 day and −5.7 ± 10.8 μm (P<.01) and −4.7 μm ± 9.5 μm) (P<.01), respectively, at 3 months. The mean ECD change at 3 months was 8 ± 155 cells/mm2 in the Neocrom Cohesive group (P = .8) and −46 ± 139 cells/mm2 in the Healon group (P = .08). The mean IOP increase was +2.2 ± 3.5 mm Hg (P<.01) and +1.4 ± 4.2 mm Hg (P = .14), respectively, 6 hours postoperatively and +0.9 ± 4.3 mm Hg (P = .37) and 0.0 ± 3.5 mm Hg (P = .77), respectively, at 1 day. CONCLUSION: There was no significant difference between Neocrom Cohesive and Healon in the changes in CCT, ECD, and IOP after cataract surgery.

Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults

Aim: Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. Methods: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. Results: The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). Conclusion: Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.

Macular Morphology after Cataract Surgery with Primary Posterior Capsulorhexis and Posterior Optic Buttonholing

PURPOSE To evaluate possible changes in macular morphology after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in comparison to conventional in-the-bag intraocular lens (IOL) implantation. DESIGN Prospective randomized study. METHODS Fifty consecutive age-related cataract patients with normal macular morphology and function waiting for bilateral cataract surgery were enrolled. Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing was performed in one eye; in the fellow eye cataract surgery was performed with in-the-bag IOL implantation, leaving the posterior lens capsule untouched. Optical coherence tomography measurements were performed one week and one month postoperatively. RESULTS During follow-up, no statistically significant changes of macular morphology could be observed in any of the tested patients. Mean central retinal thickness, minimum and maximum retinal thickness, and central retinal volume were all statistically comparable between the eyes with combined primary posterior capsulorhexis and posterior optic buttonholing and the control eyes (P > .05). Best-corrected visual acuity was full in all patients (Snellen 20/25 and better). No cases of subclinical macular edema were observed. CONCLUSION Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing apparently does not increase the risk for postoperative macular edema in patients with a normal macula, since no cases of biomicroscopically noticeable macular edema with visual loss were observed in the first 1,000 eyes with primary posterior capsulorhexis/posterior optic buttonholing cataract surgery and no case of subclinical macular edema was found in this prospective randomized study.

Natural Course of Elschnig Pearl Formation and Disappearance

PURPOSE To observe and analyze the daily and weekly changes in morphology and size of Elschnig pearls in eyes with after-cataract. METHODS Pseudophakic eyes with pronounced regeneratory posterior capsule opacification (PCO) were included in this prospective study. High-resolution retroillumination images were taken, and the changes in size and shape of Elschnig pearls were analyzed at baseline and at 2, 7, and 14 days later using dedicated imaging software. RESULTS In total, 6309 Elschnig pearls in 85 eyes of 77 patients were analyzed. On average, four pearls were found per square millimeter (range, 0.2-9.7/mm(2); CV, 49.5%) with a mean cumulative area of 0.66 mm(2) (range, 0.03-2.18 mm(2); CV, 66.7%) of all marked pearls per eye and follow-up, which was 3.8% of the analyzed area. The mean pearl size was 9630 microm(2) (range, 2390-33,745 microm(2); CV, 61.0%) at baseline, which corresponded to a diameter of 174 microm. The mean change of a pearl per day was 583 microm(2) (range, 175-1631 microm(2); CV, 55.4%) or a 6% change in area. In total, 36% (CV, 5.5%) of all pearls increased in size, 7% (CV, 8.6%) did not change, and 35% (CV, 6.7%) decreased in size during 1 week. Furthermore, 11% (CV, 6,3%) of all pearls newly appeared, and the same number disappeared (CV, 5.7%) within 1 week. CONCLUSIONS Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly between eyes. Knowledge about Elschnig pearl turnover may be of importance for attempts to modulate lens epithelial regeneration or lens regrowth and for lens-refilling procedures.