Transscleral vs transpupillary diode laser photocoagulation for the treatment of threshold retinopathy of prematurity.

OBJECTIVE: To evaluate the efficacy and safety of transscleral diode laser photocoagulation for the treatment of threshold retinopathy of prematurity (ROP). PATIENTS: Fifty eyes of 25 preterm infants (birth weight, 510-1200 g [864+/-178 g ¿mean+/-SD¿]; gestational age, 24-29 weeks [26.7+/-1.7 weeks]) with threshold ROP were treated with diode laser photocoagulation (wavelength, 810 nm). One eye of each infant was treated transsclerally while the fellow eye had transpupillary coagulation using the laser indirect ophthalmoscope. Follow-up ranged from 2 to 22 months (10.0+/-5.3 months). MAIN OUTCOME MEASURE: The regression of acute ROP and the incidence of adverse treatment effects. RESULTS: In 25 (100%) of the eyes treated transpupillarly and in 24 (96%) of the eyes treated transsclerally, ROP regressed after a single or a second laser treatment and the outcome was a flat, attached retina. One eye (4%) with disease in zone I failed to improve after transscleral laser treatment and ROP progressed to stage 4B with a partially attached retina, although additional retinal detachment surgery with an encircling band was performed. No adverse side effects as a result of diode laser treatment were noted except for a small amount of retinal-preretinal bleeding in the ridge in 9 (36%) of the transsclerally and in 5 (20%) of the transpupillarly coagulated eyes. There were no adverse side effects (eg, cataract formation) in the anterior segments of the eyes. CONCLUSIONS: The results suggest that transscleral diode laser coagulation is as effective in the treatment of threshold ROP as transpupillary diode laser photocoagulation. Only minor side effects were noted. Transscleral diode laser photocoagulation seems to be an advantageous treatment method if transpupillary treatment bears an increased risk of cataract formation.

A controlled clinical trial of light and retinopathy of prematurity.

Bright continuous light has been implicated in the pathogenesis of retinopathy of prematurity. To investigate the influence of light on the incidence and severity of retinopathy of prematurity, we enrolled 127 preterm infants (birth weight < or = 1,500 g; gestational age < or = 32 weeks) in a controlled clinical study. Randomization was done separately for three birth-weight groups (< 1,000 g; 1,000 to 1,249 g; 1,250 to 1,500 g). The babies' eyes were patched all day and night from birth to a gestational age of 35 weeks. The infants in the control group were exposed to cycled lighting conditions (that is, reduced light level during the night). Of 62 infants with patched eyes, 26 (42%) developed retinopathy of prematurity. In the control group, 25 of 65 infants (39%) showed retinopathy of prematurity (P = .596). There were also no statistically significant differences in the incidences of retinopathy of prematurity in the birth-weight subgroups or in the severity of retinopathy of prematurity. Thus, patching of the eyes from birth to 35 weeks of postconceptional age does not decrease the risk of retinopathy of prematurity in preterm infants when compared to a control group exposed to cycled lighting conditions.

Diode laser photocoagulation for threshold retinopathy of prematurity in eyes with tunica vasculosa lentis.

PURPOSE: To determine possible side effects of diode laser photocoagulation for threshold retinopathy of prematurity in eyes with tunica vasculosa lentis. METHODS: In a prospective clinical study, threshold retinopathy of prematurity was treated in 14 eyes of seven consecutive preterm infants with tunica vasculosa lentis (birth weight, 480 to 980 g; mean +/- S.D., 777 +/- 175 g; gestational age, 24 to 27 weeks; mean +/- S.D., 25.7 +/- 0.9 weeks) by using the diode laser indirect ophthalmoscope. Main outcome measure was the incidence of adverse treatment effects. Follow-up included anterior segment examination with a hand-held slit lamp and ranged from seven to 17 months (12.6 +/- 3.5 months). RESULTS: The tunica vasculosa lentis did not interfere with photocoagulation in any of the 14 eyes. Laser power ranged from 200 to 400 mW (260 +/- 52 mW). Duration of a single spot was 200 msec. Number of burns ranged from 1,060 to 2,132 (1,556 +/- 315). Retinopathy of prematurity regressed in all eyes, and the outcome was a flat, attached retina. A small amount of postoperative anterior chamber bleeding was noticed in one eye (7% of the eyes, 14% of the patients). There were neither lenticular opacities nor cataract formation. CONCLUSION: Diode laser photocoagulation with the laser indirect ophthalmoscope can be used safely in eyes with tunica vasculosa lentis. At the laser energy levels used in our study, no transient lens opacities or cataract formation occurred. However, the results of this study are limited by a relatively small number of patients and a relatively short follow-up.

Laser in situ keratomileusis to correct myopia of -6.00 to -29.00 diopters.

BACKGROUND: Photorefractive keratectomy can cause corneal scarring and visual loss in highly myopic eyes. We evaluated laser in situ keratomileusis (LASIK) because it has the theoretical advantage of preserving both the corneal epithelium and Bowman's layer. METHODS: In a prospective study, LASIK was performed in 62 myopic eyes (42 patients) using the Automatic Corneal Shaper (Chiron Vision) and the Keracor 116 excimer laser (Chiron Technolas). We measured refraction and visual acuity, and evaluated corneal topography (TMS 1) and corneal clarity after 4 to 8 weeks and 4 to 6 months. RESULTS: Four- to 6-month follow up was completed in 51 eyes. The mean preoperative spherical equivalent refraction was -14.80 diopters (D) (range, -6.00 to -29.00 D). Postoperatively, the mean deviation from the target refraction was -1.70 D (range, -9.00 to +2.50 D) at 4 to 8 weeks and -1.90 D (range, -9.50 to +2.25 D) at 4 to 6 months. At 4 to 6 months, 19 eyes (37%) were within +/- 0.50 D of the target refraction, 24 (47%) within +/- 1.00 D, 33 (65%) within +/- 2.00 D, and 40 (78%) within +/- 3.00 D. From 4 to 8 weeks to 4 to 6 months, the mean regression of myopia was -0.20 D (0.50 D or less in 24 eyes [47%], 1.00 D or less in 32 [63%], and 2.00 D or less in 42 [82%]). In six eyes (12%), the stromal interface was not visible, in 38 (74%) it was barely visible, and in seven (14%) it was clearly visible. Corneal topography revealed only small variations in clear-zone size and dioptric value, demonstrating a very stable correction 4 to 6 months postoperatively. CONCLUSIONS: LASIK may be a safe and effective procedure to correct high myopia. Further research is required to develop satisfactory microkeratome technology, effective laser algorithms, and to determine long-term stability of refraction.

Comparison of the optical and visual quality of poly(methyl methacrylate) and silicone intraocular lenses.

We evaluated experimentally the optical quality of poly(methyl methacrylate) (PMMA) (Storz 68UV, AMO PC58) and silicone (AMO SI19, Adatomed 90D) intraocular lenses (IOLs) and compared the results with our clinical data. We measured surface and image quality using the Zygo laser interferometer and modulation transfer function (MTF) using the Ealing EROS MTF analyzer. Contrast acuity was tested clinically with glare and without glare (Regan charts); AMO PC58, n = 18; AMO SI19, n = 7; Adatomed 90D, n = 18). Modulation transfer function and image quality were slightly better with PMMA IOLs but the reduction of MTF with silicone lenses was within the 1/8 diopter defocus range. Surface quality of silicone IOLs was superior to that of PMMA IOLs. Contrast acuity measured clinically was also slightly better with PMMA IOLs at low contrast and with glare but differences were not significant. Our results suggest that optical and visual quality of silicone IOLs is slightly lower than with PMMA IOLs. Experimental and clinical results correlated closely. However, the small differences observed are unlikely to be significant clinically.

Evaluation of contrast acuity and defocus curve in bifocal and monofocal intraocular lenses.

We compared visual quality of the following intraocular lenses in a prospective study: monofocal, True Vista bifocal, 3M diffractive bifocal, and Nordan aspheric VariFocal silicone. Four to six months postoperatively we measured distance acuity, Snellen near acuity (Lighthouse chart), reading acuity (Nieden chart), and contrast acuity at far and near focus (Regan charts: 96%, 50%, 25%, 11% contrast) with different pupil sizes. A defocus curve was obtained by spectacle defocus (+1 diopter [D] to -5 D). Eleven patients had True Vista in one eye and monofocal in the fellow. Contrast acuity at far focus decreased with decreasing contrast and increasing pupil size. This decrease was more pronounced with the True Vista than with the monofocal lenses. These differences were significant, with a 4.5 mm pupil at lower contrast (25%, P = .02; 11%, P = .01). Depth of focus was 4.5 D (+1.0 D to -2.0 D) with True Vista lenses and 2.5 D (+1.0 D to -1.5 D) with monofocal lenses. Corrected distance acuity was 20/22 with True Vista, 20/25 with 3M, and 20/20 with VariFocal. Distance corrected Snellen near acuity was 20/39 with True Vista, 20/34 with 3M, and 20/57 with VariFocal. Distance corrected reading acuity was 20/29 with True Vista, 20/23 with 3M, and 20/44 with VariFocal (P = .005). Contrast acuity at far focus was best with the VariFocal IOL, followed by True Vista and 3M. At near focus it was best with 3M, followed by True Vista and VariFocal. Contrast acuity at near focus was lower than at far focus. Average acuity differences were as follows: VariFocal 0.43, P = .01; True Vista 0.19, P = .05; 3M 0.04, P = .3. Depth of focus was 4.5 D (+1.0 D to -3.5 D) with True Vista and 3M and was 3 D (+1.0 D to -2.0 D) with VariFocal. Each design offers unique features. VariFocal is best at distance, but near vision is not sufficient. The 3M lens is best at near vision but distance contrast acuity is somewhat reduced. The True Vista lens provides a good compromise as distance contrast acuity is good and near vision is sufficient.

Merkel cell carcinoma of the eyebrow extending into the orbit.

BACKGROUND: Merkel cell carcinoma is a rare and aggressive cutaneous neoplasm with high local recurrence and metastatic rates. PURPOSE: To highlight an unusual presentation of a Merkel cell carcinoma. CASE REPORT: We report a large Merkel cell tumor in an 85-year-old woman. It extended from the eyebrow into the upper nasal orbit posterior to the equator of the eye globe. Local resection resulted in microscopically complete removal of the tumor. During follow-up (20 months) no local recurrence was noticed but there was a metastasis in a lymphatic nodule. CONCLUSIONS: Merkel cell carcinoma often presents in the eyelids and periorbital region. However, extension from the eyebrow deep into the orbit is unusual.

[Transscleral and transpupillary laser coagulation in proliferative sickle-cell retinopathy]. / Transsklerale und transpupilläre Laserkoagulation bei proliferativer Sichelzellretinopathie.

BACKGROUND: Transscleral diode laser photocoagulation is a new method for treating proliferative sickle-cell retinopathy (PSR). Other treatments include transpupillary laser photocoagulation and transscleral cryocoagulation CASE REPORT: We report two patients with sickle-cell disease and PSR, one treated by transpupillary argon laser coagulation and the other by transscleral diode laser scatter photocoagulation. CONCLUSION: Transpupillary and transscleral laser photocoagulation are effective and safe in the treatment of PSR. Transscleral photocoagulation is an alternative treatment method in eyes with PSR and cloudy optical media or with poor mydriasis in which transpupillary coagulation cannot be performed.

[Wide angle fundus documentation in retinopathy of prematurity]. / Weitwinkelfundusdokumentation bei Retinopathia praematurorum.

BACKGROUND: Fundus documentation in preterm infants has been improved by the advent of a new wide-angle fundus camera (RetCam 120). PATIENTS AND METHODS: In 30 preterm infants we used the RetCam 120 for retinopathy of prematurity (ROP) screening, before and after laser treatment of ROP and after regression of acute phase ROP for documentation of fundus findings. The RetCam 120 is a digital contact wide-angle fundus camera which is based on a 3-chip CCD video camera. RESULTS: The RetCam 120 proved to be feasable for ROP documentation in preterm infants. Fundus documentation enhanced follow-up, teaching and cooperation between ophthalmologists and neonatologists. Conventional ophthalmoscopy is still necessary when using the RetCam 120 in ROP screening. Technical improvements of the camera itself and of the hardware and software is necessary before the RetCam 120 can be used routinely in ROP screening. CONCLUSION: The wide-angle fundus documentation using the RetCam 120 allows instant visualization and real-time documentation of intraocular findings. The RetCam 120 opens up new possibilities in clinical and scientific work, in teaching and in the new frontiers of ophthalmological telemedicine.

[The True-Vista bifocal intraocular lens. Current results of the European multicenter study]. / Die True-Vista-bifokal-IOL. Aktuelle Ergebnisse der europäischen multizentrischen studie.

In a prospective multicenter study we evaluated vision with the True Vista bifocal IOL. At 12-14 months after operation. 391 patients ("best cases") were available for follow-up. Without (with) correction, 14.4% (37.9%) had a distance acuity of 20/20 or better, 28% (69.6%) had 20/25 or better, 70% (96.9%) had 20/40 or better, and 30% (3.1%) had a distance acuity of less than 20/40. Near acuity without (with) correction was 20/20 or better in 18.7% (57.5%), 20/25 or better in 42.9% (80.8%), 20/40 or better in 84% (97.5%), and less than 20/40 in 16% (2.5%). Our results demonstrate that corrected distance and near acuity with the True Vista bifocal IOL is good. However, due to surgically induced astigmatism and inaccuracies of IOL power calculation, uncorrected acuities are still disappointing. Thus, when implanting bifocal IOLs, careful patient selection, control of astigmatism and IOL power calculation seems crucial.

[Eye manifestations of shaken baby syndrome. A case presentation]. / Augenbefunde beim Shaken-baby-Syndrom. Eine Falldemonstration.

UNLABELLED: Violent shaking is a type of child abuse which may cause intracranial hemorrhages combined with retinal and vitreous bleeding. Fundus bleeding is similar to that in Terson syndrome. However, in the shaken baby syndrome the intraocular hemorrhages may precede both the clinical and radiologic recognition of subdural haematoma. CASE REPORT: We present a 4-months-old baby with convulsions and additional extensive bleeding of the fundus. Neither the ocular findings nor the seizures could be explained by minimal lesions of external trauma. Repeated cranial computed tomography showed increasing intracerebral bleeding with consecutive brain atrophy. Fundus bleeding completely disappeared. CONCLUSION: When child abuse is suspected, ophthalmological examination is most important to detect fundus bleeding, which, in the absence of birth trauma or any other supportive evidence of external trauma or other diseases, is the leading symptom of the shaken baby syndrome.

[Diode laser coagulation of stage 3+ retinopathy of prematurity]. / Diodenlaserkoagulation der Retinopathia praematurorum Stadium 3+.

BACKGROUND: Laser photocoagulation in retinopathy of prematurity (ROP) appears to have fewer adverse effects and to be at least as effective as cryotherapy. METHODS: To evaluate the efficacy and safety of diode laser photocoagulation we examined 50 eyes affected by stage 3+ ROP in 30 very low birth weight infants (gestational age 24-29 weeks, mean +/- SD 26.5 +/- 1.4 weeks; birth weight 480-1400 g, 898 +/- 208 g) in a prospective (uncontrolled) clinical study. Photocoagulation treatment was performed using a diode laser (810 nm) with a laser indirect ophthalmoscope delivery system. Follow-up ranged from 3 to 23 months (10.5 +/- 6.4 months). RESULTS: In 46 (92%) of the 50 eyes ROP regressed after a single laser treatment and the outcome was a flat, attached retina. Two eyes (4%) had a second laser session and one other eye (2%) had additional retinal detachment surgery, resulting in the regression of ROP and a flat, attached retina. Thus, the success rate was 98% (49 out of 50 eyes). In 1 (2%) of the 50 eyes treatment failed and ROP progressed to stage 5, although additional retinal detachment surgery was performed. No adverse side effects of diode laser treatment were noted, except for a small amount of retinal/preretinal bleeding in the ridge in 8 eyes (16%) and slight postoperative anterior chamber bleeding in 1 eye (2%) with dense tunica vasculosa lentis. There were neither lenticular opacities nor cataract formation. CONCLUSION: Diode laser photo coagulation using the laser indirect ophthalmoscope for stage 3+ ROP was easy to administer. Laser treatment had only minor side effects and was at least as effective as cryotherapy.

[Vector analysis of surgically-induced astigmatism in cataract operation with 4 tunnel incision techniques]. / Vektoranalyse des chirurgisch induzierten Astigmatismus bei Kataraktoperation mit 4 Tunnel-Schnitt-Techniken.

UNLABELLED: Evaluation of astigmatism induced by cataract surgery requires the calculation of surgically induced astigmatism using vector analysis. This method was performed for four tunnel-incision techniques and compared with the results of computer-assisted videokeratoscopy. METHODS: Phacoemulsification with IOL implantation was performed in 59 eyes using four different incisions (4- or 5- to 6-mm scleral tunnel and 4- or 5.5-mm clear cornea). Surgically induced astigmatism was calculated by vector subtraction using the formulas of Retzlaff. In addition, corneal topography was performed and astigmatism was calculated within three concentric corneal zones (3 mm, 3-5 mm, 5-7 mm). RESULTS: Surgically induced astigmatism after a 4-mm scleral tunnel incision was 0.55 D (pre-op 0.58 D, post-op 0.72 D), the 5-6-mm incision induced 0.89 D (pre-op 0.97 D and post-op 1.02 D). The 4-mm clear cornea incision induced 2.00 D (from 0.89 D to 1.56 D), the 5.5-mm corneal incision, performed in the steepest meridian to reduce preexisting astigmatism, induced 3.57 D; pre-op 3.38 D, post-op 2.09 D. Corneal topography revealed a slight increase in astigmatism within all corneal zones (4-mm scleral tunnel: 0.26 D, 5-6-mm scleral tunnel: 0.36 D and 4-mm clear cornea incision: 0.22 D). After a 5.5-mm clear cornea incision, however, astigmatism of the central 3-mm zone was reduced by 1 D, while astigmatism of the 5-7 mm zone increased by 0.22 D. CONCLUSION: The 4- and 5- to 6-mm scleral tunnel as well as the 4-mm clear cornea incision were shown to be nearly astigmatism-neutral. The 5.5-mm clear cornea incision reduced astigmatism of the central cornea by about 35%, but induced irregular astigmatism in the periphery.

[Acute retinpathia praematurorum. Is plasma prorenin level of prognostic value?]. / Akute Retinopathia praematurorum. Ist der Prorenin-Plasmaspiegel von prognostischem Wert?

BACKGROUND: In patients with diabetes mellitus an elevated level of plasma prorenin (PP) may be associated with proliferative diabetic retinopathy. Although retinopathy of prematurity (ROP) is also characterized by retinal vasoproliferation, no study on PP in ROP appears to have been carried out. This study investigated PP prospectively in preterm infants with high risk of ROP. PATIENTS AND METHODS: In 304 preterm infants (gestational age 24-36 weeks, mean +/- SD 29.8 +/- 2.6 weeks; birth weight 570-1750 g, 1180 +/- 294 g) PP was examined prospectively between 3 and 14 weeks postnatally. Renin and total renin (after cryoactivation) were determined by radioimmunoassay. Total renin minus renin is the PP level; PP was correlated with the presence of ROP, stage of ROP, gestational age, birth weight, and postnatal age. RESULTS: There was no significant difference between mean PP in 112 preterm infants with ROP (682 +/- 666 ng/l) and that in 192 preterm infants without ROP (622 +/- 454 ng/l). There was no correlation between PP and the stage of ROP, gestational age, or birth weight. Mean PP decreased with increasing postnatal age (postnatal age 3-4 weeks: 906 +/- 587 ng/l; 7-8 weeks: 585 +/- 423 ng/l; 13-14 weeks: 326 +/- 205 ng/l). CONCLUSION: This study found no significant difference in PP between preterm infants with and those without ROP. Thus PP is not a valid predictor or indicator of ROP. However, the study showed a hitherto unknown correlation between PP and postnatal age in preterm infants.

[Laser in situ keratomileusis (LASIK) for correction of myopia]. / Laser-in-situ-Keratomileusis (LASIK) zur Myopiekorrektur.

BACKGROUND: Laser in situ keratomileusis (LASIK) preserves the corneal epithelium and Bowman's layer, which theoretically minimizes corneal scarring. We, therefore, evaluated the accuracy, stability and safety of LASIK in moderate to high myopia. PATIENTS AND METHODS: Eighty-five eyes (50 patients) treated using the Automatic Corneal Shaper and the Keracor 116 excimer laser were followed up for 1, 6, and 12 months. Spectacle refraction, visual acuity and rate of retreatments were evaluated. RESULTS: At 12 months, results were as follows: Myopia -5 to -9.9 D (n = 20); 85% within 1 D; regression between one and 12 months < or = 1 D in 90%; uncorrected acuity 20/40 or better in 75%; no loss of two or more lines of visual acuity. Myopia -10 to -14.9 D (n = 33): 73% within 1 D; regression between 1 and 12 months < or = 1 D in 91%; uncorrected acuity 20/40 or better in 79%; 6.1% lost two lines of visual acuity. Myopia -15 to -29 D (n = 32): 31% within 1 D; regression between one and 12 months < or = 1 D in 63%; 6.3% lost two or more lines of visual acuity. Reoperations were performed in two eyes (2.4%) due to epithelial ingrowth or folds of the flap, and in four eyes (4.7%) because of undercorrections or "central islands". CONCLUSIONS: LASIK is an accurate and stable procedure for correcting myopia of -5 to -15 D. In higher myopia, however, results are not satisfactory.

[Computer program for retinopathy of prematurity screening]. / Computerprogramm für das Screening auf Retinopathia praematurorum.

BACKGROUND: The goal of retinopathy of prematurity (ROP) screening is complete detection of all preterm infants with threshold ROP. AIM: We wanted to develop software to facilitate registration of ROP findings, checking due dates of re-examination, and evaluation of screening data. By means of complete and faultless registration and evaluation of the data of preterm infants, the effectiveness and safety of the screening should increase. METHODS: We developed software that runs under Microsoft Windows 3.1 or Windows 95 and is programmed in Microsoft Access Basic and Microsoft Visual Basic. The software allows all screening data to be registered and evaluated. Intuitive handling, third level of normalization in database architecture, and automatic plausibility checks guarantee the utmost integrity of data and efficacy of database. RESULTS AND CONCLUSION: To date, the software has been used routinely in 2000 examinations in 1000 preterm infants. Our software facilitates clinical management and evaluation of ROP screening, which therefore becomes more safe.

[Contrast sensitivity and defocus curve with various bifocal-IOL]. / Kontrastsehschärfe und Defokussierkurve mit verschiedenen Bifokal-IOLs.

Simultaneous vision, the basic principle of all bifocal intraocular lenses (IOLs), provides increased depth of focus but also causes a loss in contrast. We therefore measured contrast acuity (CA) (Regan Charts) and the defocus curve at different pupil sizes in 14 patients with a TRUE VISTA bifocal IOL (TV) (Storz Co.), 10 patients with a 3M diffractive bifocal IOL (3M) (3M Co.) and 9 patients with a Nordan Aspheric Varifocal Silicone IOL (VF) (Wright Medical Inc.). CA at distance focus was best with VF; next was TV, and 3M showed the lowest values. At near focus, CA was best with 3M; next was TV, and VF showed the lowest values. Differences between VF and 3M were significant (P = 0.05; t-test). CA at near focus was significantly lower than at distance focus with TV and VF (TV: P = 0.0001; VF: P = 0.005). Pseudoaccommodation was 4.5 D with TV and 3M and 3D with VF. In conclusion, distance CA was best with VF but pseudoaccommodation was not sufficient for reading. Near CA was best with 3M while distance CA was somewhat reduced. TV showed good distance CA while near CA was still sufficient. TV therefore seems to provide a good compromise.