Intraocular lens power calculation using total keratometry and ray tracing in eyes with previous small incision lenticule extraction - A case series.

Purpose: To assess the IOL power calculation accuracy in post-SMILE eyes using ray tracing and a range of total keratometry based IOL calculation formulae. Observations: Ray tracing showed excellent predictability in IOL power calculation after SMILE and its accuracy was clinically comparable with the Barrett TK Universal II and Haigis TK formula. Conclusions and importance: Incorporating posterior corneal curvature measurements into IOL power calculation after SMILE seems prudent. The ray tracing method as well as selected TK-based formulae yielded excellent accuracy and should be favored in post-SMILE eyes.

[Acanthamoeba endophthalmitis-a case report]. / Akanthamöbenendophthalmitis ­ Ein Fallbericht.

Diagnosis of acanthamoeba keratitis is often a clinical challenge. In most cases it is primarily confused with herpes keratitis. A coinfection with bacteria or fungi can also lead to a delayed diagnosis and initiation of treatment. A few cases reported the detection of acanthamoeba in the anterior chamber. In the case of endophthalmitis without the detection of bacteria or fungi acanthamoeba should therefore always be considered as a potential differential diagnosis. The local and systemic administration of voriconazole can be successfully used to treat acanthamoeba endophthalmitis.

Modern Corneal Eye-Banking Using a Software-Based IT Management Solution.

BACKGROUND: Increasing government legislation and regulations in manufacturing have led to additional documentation regarding the pharmaceutical product requirements of corneal grafts in the European Union. The aim of this project was to develop a software within a hospital information system (HIS) to support the documentation process, to improve the management of the patient waiting list and to increase informational flow between the clinic and eye bank. MATERIALS AND METHODS: After an analysis of the current documentation process, a new workflow and software were implemented in our electronic health record (EHR) system. RESULTS: The software takes over most of the documentation and reduces the time required for record keeping. It guarantees real-time tracing of all steps during human corneal tissue processing from the start of production until allocation during surgery and includes follow-up within the HIS. Moreover, listing of the patient for surgery as well as waiting list management takes place in the same system. CONCLUSION: The new software for corneal eye banking supports the whole process chain by taking over both most of the required documentation and the management of the transplant waiting list. It may provide a standardized IT-based solution for German eye banks working within the same HIS.

[Descemet Membrane Endothelial Keratoplasty]. / Descemet-Membran-Endothelkeratoplastik (DMEK).

Descemet membrane endothelial keratoplasty (DMEK) is the gold standard for the treatment of corneal endothelial disease, first and foremost Fuchs' endothelial dystrophy. Superior visual rehabilitation as well as lower and decreasing complication rates can be obtained with DMEK than with Descemet stripping automated endothelial keratoplasty (DSAEK) - still the most commonly performed type of posterior lamellar keratoplasty. Recent advancements in the DMEK method include the establishment of a standardised and reproducible surgical "no touch" technique and the emerging role of eye banks, which are able to prepare convenient pre-cut DMEK grafts. These developments pave the way for increasing numbers of corneal surgeons to add DMEK to their armamentarium, despite the more challenging nature of this procedure. However, a review of the current literature shows that this fascinating technique still offers certain challenges, which need to be further addressed. For example, graft detachment remains the most commonly encountered complication after DMEK. A plethora of prospective-randomised studies is required to further endorse the evident superiority of DMEK over alternative types of lamellar keratoplasty and to help propagate the practice of this fascinating technique.

[Standardized Descemet membrane endothelial keratoplasty (DMEK): technique and latest results]. / Standardisierte Descemet-Membran-Endothelkeratoplastik (DMEK) : Technik und aktuelle Ergebnisse.

BACKGROUND: The procedure of posterior lamellar keratoplasty has now become established as first choice therapy for the treatment of corneal endothelial diseases, with Descemet membrane endothelial keratoplasty (DMEK) as the most recent refinement of endothelial keratoplasty techniques. In this study the outcome of 400 consecutive cases after standardized no-touch DMEK was evaluated. METHODS: This was a non-randomized retrospective clinical study of 400 consecutive eyes in 321 patients who underwent standard DMEK. Outcome measures included best corrected visual acuity (BCVA) preoperatively and postoperatively at 1, 3 and 6 months, endothelial cell density (ECD), pachymetry and complications within the first 6 months. In addition two subgroups were analyzed (subgroup I cases 1-200 and subgroup II cases 201-400). RESULTS: At 6 months postoperatively 80 % of all eyes had a BCVA of ≥ 20/25 (≥ 0.8), 44 % of ≥ 20/20 (≥ 1.0) and 14 % of ≥ 20/18 (≥ 1.2). There were no significant differences between the two subgroups. The mean ECD preoperatively was 2,542 (± 217) cells/mm(2) and 6 months postoperatively 1,622 (± 500) cells/mm(2). The mean ECD decrease was 36 % 6 months after DMEK. No difference between the subgroups was noted. In 5 % a re-operation was needed of which 75 % were performed in subgroup I. CONCLUSION: With the standardized no-touch DMEK technique a rapid and nearly complete visual rehabilitation as well as ECD values similar to earlier endothelial keratoplasty techniques can be achieved. Therefore DMEK may become the preferred treatment for corneal endothelial disorders.

[Visual acuity and endothelial cell density following Descemet membrane endothelial keratoplasty (DMEK)]. / Agudeza visual y densidad de células endoteliales tras queratoplastia endotelial de membrana de Descemet (DMEK).

PURPOSE: To assess the clinical outcomes of DMEK in the first series of 120 eyes operated for the treatment of Fuchs endothelial dystrophy in terms of visual acuity and endothelial cell density. METHODS: The first 120 consecutive eyes that underwent DMEK (i.e. transplantation of an isolated donor Descemet membrane with its endothelium) were evaluated. In all eyes, the best corrected visual acuity (BCVA) before and at 1, 3 and 6 months after surgery, as well as the endothelial cell density (ECD) before and at 6 months were measured. RESULTS: In eyes with a functional DMEK graft and good visual potential (n=96), the BCVA was ≥ 20/40 (≥ 0.5) in 77% after 1 month, 92% after 3 months, and 95% after six months; ≥ 20/25 (≥ 0.8) in 50%, 63%, and 73% of the cases, and ≥ 20/20 (≥ 1.0) in 23%, 34%, and 45% of the cases at 1, 3, and 6 months respectively. In this group, ECD averaged 2610 (± 185) cells/mm(2) before, and 1770 (± 520) cells/mm(2) at six months after surgery (n=96). In 15 eyes, a secondary Descemet stripping endothelial keratoplasty (DSEK) was performed. In this group, 91% of patients reached a BCVA of ≥ 20/40 (≥ 0.5) and only one patient achieved a BCVA of 0.8 at 6 months after surgery (n=11). Furthermore, ECD averaged 2580 (± 185) cells/mm(2) before and 1310 (± 740) cells/mm(2) at six months (n=13). CONCLUSION: DMEK provides a fast and high visual rehabilitation. Endothelial cell density loss may be similar to earlier types of endothelial keratoplasty.

[An in-vivo evaluation of Brilliant Blue G in macular surgery]. / Anfärbung der inneren Grenzmembran der Netzhaut mit Brilliant Blau.

OBJECTIVE: The aim of this study was to evaluate the functional outcome of Brilliant Blue G (BBG) and the staining properties in macular surgery. METHODS: BBG was applied during vitrectomy for macular holes (n = 21) or epiretinal membranes (n = 18) in a prospective, non-comparative consecutive series of patients (Brilliant Peel®; Fluoron® GmbH, Neu-Ulm, Germany). Before and after surgery all patients underwent a complete clinical examination including measurement of best corrected visual acuity and intraocular pressure, perimetry, fundus photography and optical coherence tomography. RESULTS: Vitrectomy was performed in combination with a cataract operation in 14 patients. All macular holes were closed successfully. Visual acuity was in average 0.16 preoperatively in macular hole cases and increased up to 0.4 after 6 months. Visual acuity of patients with epiretinal membranes changed on average from 0.3 to 0.45 after 6 months. The retina thickness in patients with epiretinal membranes was initially 402.6 µm according to the OCT and 304.7 µm after 6 months postoperatively. No toxic effects attributable to the dye were noted during patient follow-up, especially all perimetry tests were normal. CONCLUSIONS: Brilliant blue provides a sufficient and selective staining of the ILM. No retinal toxicity or adverse effects related to the dye were observed in this study. The long-term safety of this dye will have to be evaluated in larger patient series and a longer follow-up.