[Implantable intravitreal corticosteroids in chronic noninfectious uveitis]. / Implantierbare intravitreale Kortikosteroide bei chronischer nichtinfektiöser Uveitis.

BACKGROUND: Uveitis leads to blindness in 10-15% of all cases in industrialized nations. The prevalence varies depending on the literature, ranging from 9 to 730 cases per 100,000 inhabitants. Local and systemic steroid applications, along with treatment involving immunomodulators, are the primary treatment options. In cases of chronic and refractory uveitis, especially with the manifestation of uveitic macular edema, intravitreal corticosteroids can contribute to reduce or completely replace systemic immunomodulatory therapy with disease-modifying antirheumatic drugs (DMARDs), biologics or corticosteroids. OBJECTIVE: This review article presents the currently available intravitreal corticosteroid implants used in the treatment of noninfectious uveitis. The indications, effectiveness, and side effect profiles are discussed within the context of the current literature. A total of 6 randomized controlled studies about FAc and DEX implants with more than 100 patients were included in this review. One subgroup analysis from a multicentric randomized study with 315 patients has been included as well. The outcome is discussed in this article. CONCLUSION: The efficacy and safety profile of intravitreal corticosteroids in uveitic macular edema have been evaluated in several studies in recent years. In some studies, they have been compared to systemic treatment options. With long-acting corticosteroid implants the number of relapses can be reduced and the time interval between relapses can be prolonged. Short-acting corticosteroid implants represent a treatment option during acute uveitic activity. The adverse effects of corticosteroids can be well-controlled in most cases. In phakic and/or young patients, however, adverse effects (such as cataract development) should be discussed in depth before treatment initiation as most corticosteroids are applied as long-term treatment.

[Explantation of two historical posterior chamber phakic intraocular lenses 31 years after implantation]. / Explantation zweier historischer phaker Hinterkammerlinsen 31 Jahre nach Implantation.

This article reports the case of a 56-year-old male patient who had undergone implantation of posterior chamber phakic intraocular lenses in 1987 in Russia. The patient presented to this clinic 31 years after the initial surgery with anterior cortical cataracts and initial stages of corneal decompensation in both eyes. Strategic planning and execution of surgical treatment and the further clinical course are portrayed in this report.

[Opacification of hydrophilic intraocular lens after multiple injections of bevacizumab]. / Eintrübung einer hydrophilen Intraokularlinse nach multiplen Bevacizumab-Injektionen.

In the literature various causes of opacification of hydrophilic lenses have been described. Pronounced opacity is a complication that must be taken seriously because it can lead to explantation or exchange of the intraocular lens (IOL). The calcification of hydrophilic IOLs is often made responsible for an explantation. Despite the rapidly increasing number of intravitreal injections, they have so far not been associated with opacification of lenses. This article reports on a female patient where opacification of the hydrophilic lens was obviously associated with multiple intravitreal injections over several years. It involved a secondary calcification with calcium phosphate deposition directly under the surface of the IOL. Possible pathomechanisms are discussed. Due to the increasing number of intravitreal injections the association with IOL opacity should be further evaluated in the future. Generally, with hydrophilic lens materials it must be taken into consideration that these can become opaque following diverse interventions.

[Proteome analysis of undiluted vitreous humor in patients with branch retinal vein occlusion]. / Proteomanalyse unverdünnter Glaskörperflüssigkeit bei Patienten mit einem Venenastverschluss.

BACKGROUND: The pathophysiological mechanisms of macular edema secondary to branch retinal vein occlusion (BRVO) remain unclear. OBJECTIVES: To analyze the protein profile of human vitreous of patients with BRVO and to identify specific dysregulated proteins. MATERIALS AND METHODS: Undiluted vitreous humor samples from patients with treatment naïve BRVO and 15 controls with idiopathic floaters were analyzed in this clinical-experimental study using capillary electrophoresis coupled to a mass spectrometer (CE-MS) and tandem mass spectrometry (MS/MS). Quantitative analysis of the dysregulated proteins was performed with enzyme-linked immunosorbent assay (ELISA). Protein-protein interactions were depicted with the STRING database. RESULTS: A total of 84 proteins were found in the human vitreous samples of 15 patients with BRVO and 15 controls. In all, 14 proteins were significant when comparing the signal intensities of BRVO and control samples. Six significant dysregulated proteins with p < 0.001 were further verified with ELISA. Clusterin, complement factor C3, prostaglandin-H2 D­isomerase and vitronectin were significantly upregulated in the BRVO group and opticin was downregulated. The protein interactions analysis showed associations with inflammatory cascades, matrix changes, mechanisms of cell survival und death. CONCLUSIONS: The results of the study reveal that the proteomic composition of vitreous humor differed significantly between the patients with BRVO and the controls. Whether the identified proteins may serve as potential biomarkers for pathophysiology, diagnostics or therapy should be examine in further studies.

[Optical quality of three trifocal intraocular lens models : An optical bench comparison]. / Optische Qualität dreier trifokaler Intraokularlinsenmodelle : Vergleich an der optischen Bank.

BACKGROUND: Knowledge of the optical quality of different trifocal intraocular lenses (IOL) is important in customized patient care. OBJECTIVE: Different trifocal IOL were compared regarding their optical quality. MATERIALS AND METHODS: We analyzed the FineVision (PhysIOL, Liège, Belgium), the AT LISA tri 839MP (Zeiss, Oberkochen, Germany), and the AcrySofIQ PanOptix (Alcon, Fort Worth, TX, USA) with a power of +21D for the distance using the OptiSpheric IOL PRO optical bench (Trioptics, Wedel, Germany). The additions for the near and intermediate distances were as follows: +3.5D/+1.75D (FineVision), +3.33D/+1.66D (AT LISA tri), and + 3,25D/+ 2,17D (PanOptix). We evaluated the modulation transfer function (MTF) at a spatial frequency of 50lp/mm and the Strehl ratio using 3­ (photopic) and 4.5-mm (mesopic) apertures. RESULTS: The MTF at 50 lp/mm (FineVision/AT Lisa tri/PanOptix) at the far focus was 0.373/0.399/0.400 (3-mm aperture) and 0.512/0.311/0.243 (4.5-mm aperture). At the intermediate focus, the MTF was 0.162/0.147/0.153 (3-mm aperture) and 0.092/0.125/0.137 (4.5-mm aperture). The MTF at the near focus was 0.229/0.192/0.404 (3-mm aperture) and 0.217/0.212/0.169 (4.5-mm aperture). The Strehl ratio was 0.335/0.298/0.370 (3-mm aperture) and 0.243/0.180/0.270 (4.5-mm aperture) at the far focus. At intermediate distances, the Strehl ratio was 0.189/0.185/0.162 (3-mm aperture) and 0.099/0.097/0.114 (4.5-mm aperture). The Strehl ratio was 0.305/0.283/0.464 (3-mm aperture) and 0.177/0.181/0.155 (4.5-mm aperture) at the near focus. CONCLUSION: Evaluation of the three trifocal IOL models at the optical bench could show distinct peaks at the far, intermediate, and near focus. The results were comparable in terms of optical performance.

[Ophthalmological health care of the institutionalized elderly : The OVIS study]. / Ophthalmologische Versorgung in Seniorenheimen : Die OVIS-Studie.

BACKGROUND: Due to demographic change and societal transformation the number of elderly persons living in retirement homes is growing in Germany. Access to health care is more complicated in the setting of nursing homes. Different regional studies suggest unmet ophthalmological health care needs in institutionalized elderly people. This study assessed the current ophthalmological health care structure and supply status in nursing homes in Germany. METHODS: This prospective, multicenter cross-sectional study was conducted by 14 study centers in Germany. Elderly people living in 32 nursing homes were included after approval by the local institutional review boards. A standardized examination was performed which included a detailed medical and ocular history, refraction, visual acuity testing, tonometry, biomicroscopy and dilated funduscopy. Unmet ophthalmological health care needs were documented and the data were analyzed descriptively and via logistic regression modelling. RESULTS: A total of 600 participants (434 women and 166 men) aged 50-104 years were examined of which 368 (61%) had ophthalmological conditions requiring treatment. The most prevalent findings were cataracts (315; 53%), disorders of the eyelids (127; 21%), dry eye disease (57; 10%) and posterior capsule opacification (43; 7%). In 63 (11%) of the participants glaucoma was suspected and 55 (9%) of the examined population had a known diagnosis of glaucoma, of whom one third was not on any or on insufficient anti-glaucomatous therapy. 236 (39%) showed signs of age-related macular degeneration (AMD). Only 52% of the examined cohort had been examined by an ophthalmologist within the last 5 years and 39% stated that they would currently not be able to consult an ophthalmologist. Reported barriers were mainly transport and lack of support. CONCLUSION: This study demonstrates considerable unmet ophthalmological health care needs of the institutionalized elderly in Germany. Novel and reformed models of specialist care provision have to be developed.

[Influence of Different Ablation Frequencies on the Clinical Results of Photorefractive Keratectomy Using the Same Excimer Laser Platform: A Contralateral Eye Study]. / Einfluss unterschiedlicher Ablationsfrequenzen auf die klinischen Ergebnisse bei photorefraktiver Keratektomie unter Verwendung derselben Excimer-Laser-Plattform: Ein kontralateraler Vergleich.

Background The objective of this study was to evaluate postoperative clinical outcomes of photorefractive keratectomy (PRK) using different ablation frequencies. Patients and Methods In this prospective, contralateral eye study, 56 eyes of 28 patients with myopia or myopic astigmatism were included. PRK was performed using the MEL90 excimer laser system (Carl Zeiss Meditec, Germany). One eye of each patient was treated with a repetition rate of 250 Hz, while the other one was treated with a repetition rate of 500 Hz. The treatment pattern in the 250 Hz and 500 Hz group only differed in terms of ablation frequency; there was no difference in laser pulse energy, spot size or ablation profile. Postoperative follow-ups were at 3 and 7 days and 1, 3 and 6 months. The following parameters were assessed: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), corneal re-epithelisation time and corneal haze. Results Ablation depth was proportional to laser pulse counts at both frequencies. At 6 months, 100.0% of the eyes in the 250 Hz group and 96.4% in the 500 Hz group had a UDVA of 0.00 logMAR or better; 100% of the eyes in both groups were within ± 1.00D of the attempted correction. All eyes had a postoperative CDVA of 0.00 logMAR or better. There was no difference between the groups in postoperative HOAs, corneal re-epithelisation time or corneal haze. Conclusions Photorefractive keratectomy with a repetition rate of 250 Hz and 500 Hz showed comparable efficacy, safety and predictability in the correction of myopia. There were no significant complications due to the high repetition rate, such as postsurgical corneal haze.

[Opacification of a hydrophilic acrylic intraocular lens after DMEK : A material analysis]. / Eintrübung einer hydrophilen Acryl-Intraokularlinse nach DMEK : Eine Materialanalyse.

OBJECTIVE: Calcification of a hydrophilic intraocular lens (IOL) is a rare complication. We report on the analysis of an opacified IOL, which was explanted 2 years after Descemet membrane endothelial keratoplasty (DMEK), using light and scanning electron microscopy, X­ray spectroscopy and investigations on the optical bench. METHODS: In October 2012 a patient with pseudophakic keratopathy and Fuchs endothelial dystrophy underwent DMEK with double rebubbling. Due to primary graft failure the patient underwent penetrating keratoplasty in January 2013. The initial postoperative visual acuity was 0.2. Increasing opacification of the IOL lowered visual acuity down to hand movement, so that in November 2014 the patient underwent IOL replacement. The explanted IOL was first natively examined with an Olympus BX50 light microscope. In addition, image quality was determined on the optical bench. Subsequently, the explanted IOL was divided into two and one half was stained with Alizarin red and von Kossa and examined by light microscopy and the other half was analyzed by scanning electron microscopy. The composition of the deposits was examined by X­ray spectroscopy. RESULTS: The macroscopic view showed opacification of the IOL only in the central area of the lens where contact between the IOL and the gas bubble had taken place. Light and scanning electron microscopy revealed numerous fine granular, crystal-like deposits under the anterior IOL surface, which were linearly arranged parallel to the surface. Using energy dispersive X­ray spectroscopy the deposits were shown to be composed of calcium phosphate. No deposits were detected on the posterior surface. CONCLUSION: The cause of the opacification of hydrophilic IOL is not clearly understood; however, the injection of gas/air into the anterior chamber during DMEK appears to increase the risk of IOL opacification by changing the lens surface or by alterations to the blood-aqueous humor barrier. Granular deposits under the anterior IOL surface can cause such a strong decrease in visual acuity that IOL exchange becomes neccessary.

[Impact of Different Percent Tissue Altered Values on Visual Outcome after Refractive Small Incision Lenticule Extraction (ReLEx SMILE)]. / Auswirkung verschiedener Percent-Tissue-altered-Werte auf das Behandlungsergebnis bei refraktiver Small Incision Lenticule Extraction (ReLEx SMILE).

Purpose To compare the visual outcomes after ReLEx SMILE treatment of eyes with low and high PTA values (PTA: percent tissue altered) within a follow-up period of up to 3 years and to assess whether a high PTA value might contribute to the development of keratectasia, as is the case for LASIK. Methods This retrospective analysis comprises results from 313 eyes (189 patients) with a PTA value of less than 40 % and of 373 eyes (213 patients) with a PTA value of at least 40 %. Preoperatively and up to 3 years after SMILE surgery, refraction values, monocular corrected (CDVA) and uncorrected distant visual acuity (UDVA) and wavefront data were evaluated. Results One to 3 years after surgery, the group with PTA < 40 % (PTA ≥ 40 %) had a loss of two Snellen lines in 1.1 % (0.0 %) of the cases. Loss of one line occurred in 1.1 % (3.6 %) of the eyes, whereas 97.7 % (96.4 %) remained unchanged or gained lines. With respect to predictability of the spherical equivalent, 92.0 % (78.6 %) of the eyes were within ± 0.5D and 97.7 % (92.9 %) were within ± 1.0D. The group with high PTA values displayed a slightly but significantly greater undercorrection of about 0,25D. 74.4 % (71.8 %) achieved UDVA of at least 20/20 and 96.5 % (87.1 %) achieved at least 20/25. The mean UDVA was - 0.03 ± 0.10logMAR (0.01 ± 0.12logMAR) and its mean difference to the preoperative CDVA was 0.00 ± 0.09logMAR (0.03 ± 0.12logMAR). Conclusion ReLEx SMILE is a safe and effective corneal refractive treatment, even for PTA values of 40 % and more. Eyes with high PTA values did not display any evidence of keratectasia development within the 3-year follow-up of this study.

[Duration of Examination and Patient Comfort with a New Biometric Device, in Comparison to Three Established Devices]. / Untersuchungsdauer und Patientenkomfort eines neuen Biometriegeräts im Vergleich zu 3 etablierten Geräten.

PURPOSE: The aim of this study was to evaluate the duration of the preoperative examination and patient comfort in measurements with an Image Guided System (Verion, Alcon), which is used for the calculation and intraoperative alignment of toric intraocular lenses, in comparison to established keratometry devices. PATIENTS AND METHODS: In a prospective, monocentric, open, ethics committee controlled study, 150 eyes of 150 ophthalmologically healthy volunteers were examined by a single examiner. Three measurements were performed with the Verion Image Guided System and - for comparison - one measurement each with IOLMaster 500, Lenstar LS900 and Pentacam HR. The measurement time was recorded with a stopwatch. For the analysis, patients were divided into three age groups (young, middle, old). Patient comfort was assessed using a questionnaire, which focussed on grading the whole measurement, as well as brightness of light, head posture and subjective duration. RESULTS: The mean age of the volunteers was 40.5 years (18-78 years). The mean duration of measurement was as follows: first Verion measurement 54.0 ± 42.7 seconds (n = 149), second Verion measurement 42.0 ± 20.5 s (n = 144), third Verion measurement 44.7 ± 25.2 s (n = 143), IOLMaster 500 46.3 ± 22.4 s (n = 147), Lenstar LS900 46.6 ± 14.4 s (n = 146) and Pentacam HR 46.6 ± 25.5 s (n = 147). Only the first and second Verion measurements were statistically different (p < 0.01). There were no statistical differences between the age groups, with the single exception of young versus old with the Pentacam (p < 0.01). Subjective patient comfort (n = 143) was very high for all devices and rated as "not uncomfortable" or "slightly uncomfortable". CONCLUSION: The duration of the preoperative examination with the Verion Image Guided System is comparable to established keratometry devices. However, IOL calculation with the Verion requires measurement of axial length and anterior chamber depth with another biometric device, which requires additional time. No age dependent differences were found. The examination can be easily integrated into clinical routine and is well tolerated by patients.

[Functional Results 3 Months after Implantation of an "Extended Range of Vision" Intraocular Lens]. / Funktionelle Ergebnisse 3 Monate nach Implantation einer "Extended-Range-of-Vision"-Intraokularlinse.

PURPOSE: Evaluation of the visual and refractive results 3 months after implantation of a diffractive extended range of vision (ERV) intraocular lens (IOL) during cataract surgery. METHODS: In a prospective multicentre study, patients with a calculated postoperative corneal astigmatism of ≤ 1.5 D received a diffractive ERV IOL (TECNIS Symfony, model ZXR00, Abbott Medical Optics, USA) during cataract surgery. After 3 months, the monocular and binocular corrected and uncorrected far, intermediate and near visual acuity, as well as refraction, were evaluated. RESULTS: 18 patients (36 eyes) with a mean age of 63.34 ± 4.6 years underwent bilateral cataract surgery. After 3 months, the binocular uncorrected distance visual acuity (UDVA) of logMAR was - 0.05 ± 0.11 and the corrected distance visual acuity (CDVA) of logMAR - 0.14 ± 0.05. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were logMAR - 0.09 ± 0.02 and 0.19 ± 0.09, respectively. A target refraction of ± 0.75 D was reached by 89 % of the patients. CONCLUSION: Implantation of an extended range of vision intraocular lens offers an effective way for visual rehabilitation at far and intermediate distances. Near vision is still in a functional range.

[Clinical Results After Implantation of a New Diffractive, Multifokal Intraocular Lens with a Reduced Near Add Power (+ 2.75 D)]. / Klinische Ergebnisse nach Implantation einer neuen diffraktiven multifokalen Intraokularlinse mit einer reduzierten Nahaddition (+ 2,75 dpt).

PURPOSE: Evaluation of the clinical data 3 months after implantation of a new diffractive multifocal intraocular lens (MIOL) with a reduced near add power of + 2.75 D. METHODS: In a prospective study, patients who underwent cataract surgery or refractive lens exchange with implantation of an MIOL (Tecnis ZKB00, Abbott Medical Optics, Santa Ana, California, USA) were included. Three months postoperative corrected and uncorrected visual acuities at different distances were measured and evaluated. Those patients that underwent bilateral MIOL implantation additionally filled out a questionnaire 3 months postoperatively. RESULTS: Between October 2013 and August 2014, 115 eyes of 62 patients were implanted with the ZKB00 IOL. Mean postoperative refractions were - 0.27 ± 0.44 D for the spherical equivalent, respectively. Mean binocular CDVA was - 0.01 ± 0.3 logMAR with a mean binocular UDVA of 0.06 ± 0.08 logMAR. For near distance in 40 cm, an UNVA of 0.07 ± 0.10 logMAR three months postoperatively was measured. CONCLUSION: The ZKB00 IOL belongs to a group of novel MIOL with an increased intermediate visual performance. Our study shows good visual acuity at all distances, as well as a high rate of satisfaction and subjectively good image quality.