[Implantation of multifocal add-on IOLs simultaneously with cataract surgery: results of a prospective study]. / Implantation multifokaler Add-on-Intraokularlinsen simultan mit Katarakt-Operation: Ergebnisse einer prospektiven Studie.

BACKGROUND: A prospective study was carried out to evaluate postoperative visual acuity and patients satisfaction after implantation of a multifocal add-on IOL. PATIENTS AND METHODS: In 50 eyes of 25 patients operated by two surgeons "group A (MK) = 15 patients; group B (MWR) = 10 patients" with age-related cataract after "normal" cataract surgery, sulcus-fixated multifocal add-on IOLs (MS 714 PB Diff., Dr. Schmidt Intraocularlinsen, Sankt Augustin) were implanted. 12 weeks after surgery in both groups the following parameters were evaluated: far visual acuity; intermediate visual acuity (1 meter) and near visual acuity (33 centimeter). In addition, the patients satisfaction was measured in three steps (1 = excellent; 2 = satisfied; 3 = not satisfied) ermittelt. In group A also contrast sensitivity was measured using the Ginsberg box. RESULTS: Surgery was performed in all cases without complications. No postoperative complications were observed. After 12 weeks the results in both groups were comparable. Median distance visual acuity was 0.05 +/- 0.02 (LogMar) uncorrected and 0 +/- 0.05 (LogMar) with correction. Intermediate visual acuity was 0.25 +/- 0.06 (LogMar) uncorrected (0.1 +/- 0.09 (LogMar) with correction. Near visual acuity was 0.2 +/- 0.07 (LogMar) and 0.15 +/- 0.02 (LogMar), respectively. Patients satisfaction was 80 - 90%. CONCLUSIONS: Sulcus-fixated add-on IOLs are a useful addition to our refractive surgical armamentarium. The present results encourage us to use this method as a standard procedure.

[Management of a ruptured globe]. / Management der Bulbusruptur.

Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360 degrees peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.

[Correction of aphakia with retroiridally fixated IOL]. / Ergebnisse der Aphakiekorrektur durch retroiridal fixierte Kunstlinse.

BACKGROUND: We report the results of the secondary implantation of retroiridally fixated irisclaw-lenses (Artisan(R)) to correct aphakia. PATIENTS AND METHODS: This retrospective study included all eyes that had undergone outpatient implantation of an Artisan IOL by the senior author (MK) between July 2004 and January 2008. We analysed 48 eyes of 46 patients (27 female, 19 male) aged 17 to 87 years. Underlying conditions were: aphakia after congenital cataract or trauma (19 eyes), late luxation of a posterior chamber IOL (16 eyes), intraoperative zonulolysis during cataract surgery that did not allow PC IOL implantation (12 eyes, including 10 eyes with pseudoexfoliation and one eye with Marfan syndrome), anterior chamber IOL with corneal decompensation problems and recurrent hyphema (1 eye). Simultaneous surgical procedures included: anterior vitrectomy (48 eyes), pars plana vitrectomy (14 eyes), removal of PC IOL (16 eyes), removal of AC IOL (1 eye), and penetrating keratoplasty (1 eye). Mean follow-up was 14.3 months (range: 1 - 31 months). IOL power was calculated using the SRKT formula and an A constant of 116.7. RESULTS: Surgery was uneventful in all cases with safe enclavation of both IOL haptics. Mean postoperative refraction was 0 dpt. (range: -0.75 to + 1.0 dpt.), median postoperative visual acuity in Log-Mar was 0.2; compared to preoperative visual acuity (median 0.4 Log-Mar); all patients improved. Pre- and postoperative intraocular pressures were in the normal range in all eyes. Complications were few: one eye without patent iridotomy developed pupillary block glaucoma one day following surgery and was successfully treated by Nd:YAG iridotomy. One patient following blunt ocular trauma developed a retinal detachment with PVR 10 months following implantation of the Artisan IOL that was repaired uneventfully by pars plana vitrectomy with silicone oil instillation. In this case, the Artisan IOL was left in place. In two eyes, secondary trauma resulted in dislocation of one haptic of the Artisan IOL. In both of these cases, refixation of the Artisan IOL was easily performed by enclavation of the iris claw. In two patients cystoid macula oedema was observed. CONCLUSIONS: With correct indications the implantation of a retroiridally fixated IOL (Artisan) is a safe and predictable method to correct aphakia and has become our method of choice instead of anterior chamber IOLs and sclera fixated IOLs.

[Globe explosion due to intravitreal injection]. / Bulbusexplosion durch intravitreale Injektion.

An 83-year old female was given an intravitreal injection of 0.4 ml of triamcinolone acetonide (TA) by her local ophthalmologist for age-related maculopathy with a large choroidal neovascularisation in the left eye. During the injection, globe explosion occurred with nasal limbal rupture and extrusion of intraocular contents. Emergency primary wound repair was performed at the Eye Surgery Centre Erlangen-Mitte. During surgery, a 9 mm limbal rupture with prolapse of half of the iris and subconjunctival extrusion of the complete natural lens was discovered. After lens removal, anterior vitrectomy and iris repositioning, the wound was closed and the eye left aphakic. The further postoperative course was unremarkable and the patient retained her preoperative visual acuity of counting fingers. In this case, several factors may have contributed to the dramatic events: relative nanophthalmus (preoperative refraction + 5.0dpt), scleral weakness secondary to chemotherapy for leukemia, older age, and a relatively large volume of injected TA. The intravitreal injection of drugs may cause serious complications. Paracentesis or limited pars plana vitrectomy should be considered prior to intravitreal injection in high-risk cases to prevent such disastrous complications.

[Blunt ocular trauma. Part II. Blunt posterior segment trauma]. / Stumpfes Augentrauma. Teil II: Stumpfes Hinterabschnittstrauma.

This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin's edema (35%) and retinal detachment (5-7%) are frequent after ocular contusion. In cases of central Berlin's edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14-20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27 x) (in females 5 x).

[Toric intraocular lenses for correction of persistent corneal astigmatism after penetrating keratoplasty]. / Torische Kunstlinsen zur Korrektur eines persistierenden kornealen Astigmatismus nach perforierender Keratoplastik.

PURPOSE: Cataract extraction with implantation of toric intraocular lenses (tIOL) is a new surgical option for correction of residual astigmatism following penetrating keratoplasty and cataract with only minimal direct manipulation of the graft. PATIENTS AND METHODS: We implanted an individually manufactured backtoric tIOL in 11 eyes of 9 patients. TIOL power calculation was done using vergence transformation in a paraxial space. RESULTS: Implantation and intraoperative alignment of tIOL were uneventful in all patients. Uncorrected visual acuity increased from 0.1+/-0.06 preoperatively to 0.47+/-0.18 (p=0.006) postoperatively. Best-corrected visual acuity changed from 0.23+/-0.18 preoperatively to 0.6+/-0.14 postoperatively (p=0.002). The refractive cylinder could be reduced from 7.0+/-2.6 D to 1.63+/-1.5 D (p=0.001) after surgery. We observed a small mean deviation from the target axis of 4.1+/-2.9 degrees (0-8 degrees ) after a mean follow-up time of 3.5 (2-7) months. CONCLUSION: TIOL implantation is a promising option for correction of high astigmatism following penetrating keratoplasty with only minimal direct surgical manipulation of the graft. Regular and symmetric corneal topography is essential for successful implantation of tIOL.

Protein quantification and electrophoresis in aqueous humor of pseudoexfoliation eyes.

PURPOSE: Pseudoexfoliation (PSX) eyes frequently show clinical signs of blood-aqueous barrier impairment. To analyze these alterations, the authors examined aqueous humor of human eyes with and without PSX. METHODS: After aqueous humor samples had been obtained during cataract or filtering glaucoma surgery, a modified Pierce-bicin choninic acid assay was used to quantify total aqueous protein concentration in 27 PSX eyes and 37 eyes without clinical signs of PSX (12 cataract eyes and 25 eyes with primary open-angle glaucoma). In addition, aqueous protein composition was analyzed by sodium dodecylsulfate polyacrylamide gel electrophoresis, silver staining, and laser densitometry in 27 PSX eyes and 59 eyes without PSX. RESULTS: Aqueous protein concentration was significantly higher in PSX (mean 0.42 +/- 0.16 mg/ml) than in normal cataract eyes (0.22 +/- 0.08 mg/ml, P < 0.0001) and in eyes with open-angle glaucoma (0.26 +/- 0.09 mg/ml, P < 0.0001, Wilcoxon-Mann-Whitney test). Electrophoresis revealed a characteristic increase of a 12.5-kDa band in 15 of 27 PSX eyes but in only 1 of 59 eyes without PSX (P < 0.00001, chi-square test). CONCLUSIONS: These results substantiate increased aqueous protein concentration and aqueous barrier impairment in PSX. The additional finding of an increased 12.5-kDa band in 56% of PSX eyes may be related to the pathogenesis of PSX in the anterior ocular segment.

Electron-microscopic identification of pseudoexfoliation material in extrabulbar tissue.

The structure and distribution of pseudoexfoliation material in extrabulbar tissues from five eyes with typical unilateral intraocular pseudoexfoliation syndrome and two intraocularly unaffected fellow eyes were examined by transmission electron microscopy. In all seven eyes, unevenly distributed pseudoexfoliation aggregates were found in limbal conjunctivae, extraocular rectus and oblique muscles, orbital connective-tissue septa, and the walls of the posterior ciliary arteries, vortex veins, and central retinal vessels passing through the optic nerve sheaths. Typical pseudoexfoliation fibers occurred in close association with connective-tissue components, especially elastic fibers; a moderate predisposition of pseudoexfoliation clumps to accumulate around blood vessels was observed. The findings of pseudoexfoliation material in similar extrabulbar locations in intraocularly uninvolved fellow eyes indicates that pseudoexfoliation fiber formation outside the globe precedes its intraocular manifestation. The intermingling of pseudoexfoliation fibers, microfibrils, and elastic and collagen fibers suggests that pseudoexfoliation fiber formation might result from a disordered synthesis and/or assembly of connective-tissue microfibrils.

Late histopathological findings of neodymium:YAG laser iridotomies in humans.

We studied three sector iridectomy specimens from three patients who had undergone neodymium:YAG (Nd:YAG) laser iridotomies 3 to 5 years earlier for treatment of imminent angle closure glaucoma. The specimens were obtained during cataract extraction and were examined by light and transmission electron microscopy. In all iris specimens, the edges of the iridotomy sites consisted of loosely arranged melanocytes, fibrocytes, and vessels. In the iris stroma, there were numerous pigment-laden cells. The iris vessels appeared to be intact; there were no fibrinous aggregates, no inflammatory response or scarring, nor any signs of proliferation of the iris pigment epithelium. Our findings suggest that in humans, iris wound healing after Nd:YAG laser iridotomy occurs without induction of fibrous scars or proliferation of the iris pigment epithelium. This indicates that there is no tendency toward late closure of the iridotomy sites.

Aqueous flare following penetrating keratoplasty and in corneal graft rejection.

OBJECTIVE: Corneal allograft rejection is a major complication of penetrating keratoplasty (PK). We used the laser flare-cell meter that allows, for the first time, non-invasive quantification of aqueous flare in vivo to analyze alterations of the blood-aqueous barrier following uncomplicated PK and in acute corneal graft rejection. PATIENTS AND METHODS: Examination with the laser flare-cell meter was performed in 67 eyes of 62 patients (mean +/- SD age, 46.2 +/- 15.1 years) 12.8 +/- 13.2 months (range, 5 days to 60 months) after uncomplicated PK, in 82 normal control eyes of 82 age-and gender-matched patients (mean age, 49.0 +/- 17.1 years) and in 10 eyes of 10 patients (mean age, 51.6 +/- 15.1 years) with acute diffuse endothelial corneal graft rejection in nonherpetic eyes 15.1 +/- 12.9 months after PK. RESULTS: Compared with the normal unoperated control group (4.43 +/- 1.13 photon counts/ms), aqueous flare was significantly increased during the first 2 weeks following uncomplicated PK (14.73 +/- 8.30 photon counts/ms; P < .0001) but returned to normal levels more than 6 weeks after surgery (4.48 +/- 1.55 photon counts/ms; P > .1). In acute corneal graft rejection, aqueous flare values (17.10 +/- 6.05 photon counts/ms) increased to significantly higher levels than in eyes following uncomplicated PK and in the normal control group (P < .0001), but decreased significantly 9.5 +/- 3.3 days after treatment with systemic and topical corticosteroids (5.78 +/- 2.16; P < .0005). CONCLUSIONS: Application of the laser flare-cell meter appears promising for following up patients after PK and for detecting early corneal allograft rejection.

Quantification of aqueous flare after phacoemulsification with intraocular lens implantation in eyes with pseudoexfoliation syndrome.

BACKGROUND: Impairment of the blood-aqueous barrier is a frequent finding in eyes with pseudoexfoliation syndrome (PEX). OBJECTIVE: To perform noninvasive quantification of aqueous flare using the laser flare-cell meter to analyze blood-aqueous barrier breakdown following phacoemulsification with intraocular lens implantation in eyes with and without PEX. METHODS: After other conditions that might account for impairment of the blood-aqueous barrier were excluded, 11 eyes with PEX and 11 eyes with senile cataract without PEX were included in the study. Aqueous flare was quantitatively determined using a laser flare-cell meter preoperatively as well as 1, 3, and 5 days postoperatively. Phacoemulsification with posterior chamber intraocular lens implantation was performed by one surgeon. RESULTS: On the first postoperative day, flare values (calculated as mean+/-SD photon counts per millisecond) in eyes with PEX were higher (42.2+/-21.3) than in eyes without PEX (30.6+/-15.1) (P>.05). On days 3 and 5, postoperative flare values decreased slowly in eyes with PEX (23.9+/-7.4 and 21.2+/-5.7 photon counts per millisecond, respectively) and were significantly higher than in eyes without PEX (14.8+/-5.4 and 10.5+/-1.4 photon counts per millisecond, respectively) (P<.05). CONCLUSIONS: Breakdown of the blood-aqueous barrier is significantly more extensive in eyes with PEX and may be an important risk factor for early postoperative complications. The altered response to surgery should be considered in eyes with PEX.

Recurrent macular corneal dystrophy type II 49 years after penetrating keratoplasty.

Recurrence of macular corneal dystrophy after keratoplasty is rare. We report light microscopic, immunohistochemical, electron microscopic, and serologic findings in a 78-year-old woman who underwent regrafting 49 years following the first penetrating keratoplasty. Examination of the corneal button revealed deposits of glycosaminoglycans in the graft beneath the Bowman layer, throughout the stroma, and in the endothelium with positive staining for antigenic keratan sulfate. By transmission electron microscopy, intracellular and extracellular deposits of a fibrillogranular material were detected in the stroma, Descemet membrane, and endothelium. The serum level of antigenic keratan sulfate was normal. Our findings indicate that macular corneal dystrophy type II may show late recurrence after penetrating keratoplasty with intense deposition of antigenic keratan sulfate in all corneal layers.

Stromal thermal effects induced by nonmechanical (2.94-mum) erbium:YAG laser corneal trephination.

OBJECTIVE: To determine stromal thermal changes after erbium (Er):YAG laser corneal trephination with the use of 2 open masks. METHODS: Corneal trephination was performed in 89 enucleated pig eyes with an Er:YAG laser (400-microsecond pulse duration), 4 open masks (2 metallic and 2 ceramic) for both donors and recipients, and an automated globe rotation device. Different combinations of laser settings were used: pulse energy, 100, 200, and 400 mJ; repetition rate, 2 and 5 Hz; and spot size, 1.3 and 3.2 mm. Thermal effects in corneal stroma and regularity of the cut edges were quantitatively assessed by light microscopy, transmission and scanning electron microscopy. RESULTS: Best regularity and minimal thermal effects of the cut were observed with the use of ceramic masks at 200 mJ, 2 Hz, and 3.2-mm spot size, with middepth thermal changes of 18 +/- 2 microm. Effects increased with cut depth and were lower in donor corneas and with the use of ceramic masks (P<.001). Regularity of the cut was higher in the donors (P = .05) with lower repetition rates (P<.001). CONCLUSIONS: Even with the "free-running" Er:YAG laser mode, features of the trephination cut resembling those created by the 193-nm excimer laser along metal mask were achieved. Ceramic masks may be more suitable than metal masks. The Er:YAG laser seems to have the potential to be a compact and low-cost alternative in nonmechanical trephination for penetrating keratoplasty. CLINICAL RELEVANCE: Thermal effects after corneal trephination with the free-running Er:YAG laser (2.94 mm) are limited and predictable.

Blood-retinal barrier breakdown in retinitis pigmentosa: light and electron microscopic immunolocalization.

Macular edema can contribute to visual loss in the retinitis pigmentosa (RP), but the sites and mechanism of blood-retinal barrier (BRB) breakdown leading to macular edema are not known. An understanding of the mechanisms involved could lead to the design of effective pharmacologic therapy to prevent or minimize macular edema in RP. To investigate this problem, immunohistochemical staining for albumin was performed on paraffin sections of 22 normal and 29 RP-affected eyes. Specimens were graded for extent of albumin extravasation in different regions of the retina, optic nerve head, ciliary body, and iris. Electron microscopic immunocytochemical staining for albumin was performed on an additional 6 normal and 9 RP-affected eyes. Two-thirds of the eyes from patients with RP and no other ocular disorders demonstrated extravascular albumin in the inner portion of the posterior retina. This was evident even in the absence of cystoid macular edema (CME), but eyes that had CME showed extensive BRB failure. In some cases, passage of albumin from the choroid to the retina was prevented even in the absence of the retinal pigment epithelium (RPE). Electron microscopic immunocytochemistry revealed that albumin permeated retinal vascular endothelial cells and RPE cells that showed degenerative changes in RP.

Mucogenic secondary open-angle glaucoma in diffuse epithelial ingrowth treated by block-excision.

We treated a 40-year-old man with an acute, unilateral, open-angle glaucoma caused by a gelatinous translucent material in the anterior chamber. A clinical diagnosis of mucogenic secondary open-angle glaucoma caused by diffuse epithelial ingrowth after ocular trauma one year earlier was suspected, but a primary or secondary ciliary body or iris neoplasm could not be ruled out. A curative 9-mm block-excision was performed. Six years later, intraocular pressure was normal, and the visual function was unchanged. Light and electron microscopy disclosed an island of diffuse columnar epithelium with numerous goblet cells on the iris surface and copious mucinous material extending into the trabecular mesh-work.

Quantitative assessment of the blood-aqueous barrier in human eyes with malignant or benign uveal tumors.

We assessed alterations of the blood-aqueous barrier in 43 eyes with malignant melanoma (31 choroidal and 12 ciliary body), 40 eyes with benign uveal tumors, and 199-age matched normal control eyes. Aqueous flare was quantified with the laser flare-cell meter and correlated with clinical and histopathologic findings. Aqueous flare (photon counts/ms) was significantly higher in melanoma eyes (20.91 +/- 12.40) than in eyes with benign tumors (4.26 +/- 1.55) (P < .0001) and normal control eyes (3.99 +/- 1.14) (P < .0001). In melanoma eyes, clinical and histologic findings associated with significantly increased aqueous flare values were as follows: tumor height, serous retinal detachment, tumor necrosis, lymphocytic tumor infiltration, and tumor hemorrhage. Development and growth of uveal melanomas are accompanied by marked alterations of the blood-aqueous barrier. The noninvasive laser flare-cell meter may give useful additional information about malignant and benign uveal tumors.

Bilateral zonular cataract associated with the mitochondrial cytopathy of Pearson syndrome.

PURPOSE: To report a child with the mitochondrial cytopathy of Pearson syndrome and zonular cataract. METHOD: Case report. We describe a 6-year-old boy with Pearson syndrome. RESULTS: At age 3 years, the boy developed secondary strabismus caused by bilateral zonular cataract. Subsequently, he underwent successful bilateral cataract extraction with intraocular lens implantation. Postoperative visual acuity with best correction was RE, 20/25 and LE, 20/40. CONCLUSIONS: Children with Pearson syndrome should be examined ophthalmologically to rule out zonular cataract and possible amblyopia. Mitochondrial cytopathies such as Pearson syndrome should be included in the differential diagnosis of congenital and early juvenile cataract.

Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome.

PURPOSE: To look for associations of preoperative A-scan ultrasound ocular dimensions with complications during phacoemulsification in eyes with pseudoexfoliation. METHODS: A total of 174 eyes with pseudoexfoliation of 135 patients undergoing planned cataract surgery were included in a prognostic study based on the review of a clinical database. Preoperatively, A-scan ultrasound examination with measurement of anterior chamber depth, lens thickness, and total axial length was performed. Phacoemulsification with implantation of a posterior chamber intraocular lens was performed by a total of five surgeons. Intraoperative complications (zonular dialysis and/or vitreous loss) were correlated with preoperative findings including ultrasound dimensions. Multivariate logistic regression analysis with a generalized estimating equations method was used for statistical analysis. RESULTS: Intraoperative complications occurred in 12 eyes (6.9%) of 11 patients. The anterior chamber was significantly shallower in eyes with than in eyes without complications (mean, 2.36 +/- 0.44 mm vs 2.74 +/- 0.52 mm; P =.013). The differences in lens thickness (4.93 +/- 0.55 mm vs 4.72 +/- 0.54 mm; P =.30) and the differences in axial length (22.92 +/- 1.09 mm vs 23.66 +/- 1.36 mm; P =.07) between the two groups did not reach statistical significance. In eyes with pseudoexfoliation, an anterior chamber depth of less than 2.5 mm was associated with a risk of 13.4% for intraoperative complications compared with an overall incidence of intraoperative complications of 6.9% and an incidence of 2.8% for an anterior chamber depth of 2.5 mm or more. CONCLUSIONS: A small anterior chamber depth may indicate zonular instability in eyes with pseudoexfoliation syndrome and should alert the cataract surgeon to the possibility of intraoperative complications.

Blood-aqueous barrier after mechanical or nonmechanical excimer laser trephination in penetrating keratoplasty.

PURPOSE: To analyze whether nonmechanical trephination with an excimer laser influences post-operative blood-aqueous barrier breakdown after penetrating keratoplasty. METHODS: Patients undergoing penetrating keratoplasty for keratoconus or Fuchs dystrophy were prospectively randomly assigned to trephination by either excimer laser or conventional mechanical handheld motorized trephine. All surgery was performed by one surgeon, and preoperative, intraoperative, and postoperative treatment was identical in both groups. Aqueous flare was quantitatively determined postoperatively in a masked fashion by laser flare-cell meter. For statistical analysis, the nonparametric Wilcoxon-Mann-Whitney test was used. RESULTS: A total of 52 eyes of 52 patients were examined (Fuchs dystrophy, 10; keratoconus, 42). During the early postoperative period (days 3 to 9), eyes that had undergone nonmechanical excimer laser trephination (25/52) showed significantly (P < .005) lower flare values than did eyes that had undergone mechanical trephination (27/ 52). In both groups, flare values returned to normal levels by 6 weeks postoperatively. CONCLUSION: Early postoperative blood-aqueous barrier breakdown is less pronounced after penetrating keratoplasty with nonmechanical excimer laser trephination.

Quantification of aqueous melanin granules in primary pigment dispersion syndrome.

PURPOSE: Aqueous melanin granules are essential in the pathogenesis of pigment dispersion syndrome and pigmentary glaucoma. We quantified aqueous melanin granules with the laser flare-cell meter in patients with pigment dispersion syndrome, assessed the measurement reproducibility, and correlated the numbers with clinical findings. METHODS: Aqueous melanin granules were counted by means of the cell count mode of the laser flare-cell meter (KOWA FC-1000; Kowa, Tokyo, Japan) in 42 eyes of 21 patients with primary pigment dispersion syndrome under three conditions (undilated pupils, dilated pupils, after exercise). The reproducibility of the measurements was determined with the intraclass correlation coefficient. A control group of 40 age- and sex-matched eyes was also examined after pupillary dilation. The results were correlated with biomicroscopic findings in eyes with pigment dispersion syndrome (retrocorneal Krukenberg spindle, iris transillumination, pigmentation of trabecular meshwork). RESULTS: Numerous aqueous melanin granules were detected in eyes with pigment dispersion syndrome (mean, 2.9 +/- 3.7 granules/0.075 mm3) but only small numbers were counted in normal eyes (0.2 +/- 0.3, P < .001). Medical pupil dilation caused an additional increase of aqueous melanin granules in pigment dispersion syndrome (6.3 +/- 5.3, P < .001), but not undilated exercise (climbing stairs) (2.9 +/- 3.7, P > .5). The reproducibility of the measurements was very high (intraclass coefficient >0.92). The number of melanin granules correlated with the degree of Krukenberg spindle (r = .61, P = .004) and with iris transillumination (r = .69, P = .001). CONCLUSIONS: Quantification of aqueous melanin granules yields reproducible results and shows increased numbers in pigment dispersion syndrome, especially after pupillary dilation. Aqueous melanin granule quantification may be useful for evaluating eyes with pigment dispersion syndrome and for assessing treatment effects.