[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.

[Postoperative Results after Implantation of a Toric, Aspheric Intraocular Lens]. / Postoperative Ergebnisse nach Implantation einer torischen, asphärischen Intraokularlinse.

PURPOSE: The purpose of this study was to evaluate the functional results and quality of vision after implantation of an aspheric, aberration-neutral, monofocal toric intraocular lens (IOL). PATIENTS AND METHODS: 18 eyes of 13 patients were enrolled in this prospective clinical study. The T-flex aspheric, aberration-free toric IOL (Rayner Intraocular Lenses Limited, U. K.) was implanted after femtosecond or standard phacoemulsification. Follow-up examinations were performed two to four months after surgery; these included subjective refraction, ETDRS uncorrected (UDVA) and corrected distance visual acuity (CDVA), wavefront analysis, measurements of stray light (C-Quant), and a questionnaire. RESULTS: Median UDVA was 0.06 logMAR (range: 0.30 to - 0.18 logMAR) postoperatively. Median CDVA increased from 0.20 logMAR (range: 0.64 to 0.00 logMAR) preoperatively to - 0.07 logMAR (range: 0.16 to - 0.26 logMAR) postoperatively. The median difference between achieved versus intended spherical equivalent was - 0.08 D (range: - 1.25 to + 0.65 D). Median subjective cylinder improved from - 2.00 D (range: - 6.50 to - 0.25 D) preoperatively to - 0.50 D (range: - 1.25 to 0.00 D) postoperatively. The median spherical aberrations (6 mm pupil size) were - 0.38 µm (range: - 0.69 to - 0.10 µm) postoperatively. Measurements of stray light (C-Quant) revealed a median value of 1.28 log(s) (range: 0.92 to 1.61 log[s]). CONCLUSION: The T-flex aspheric toric IOL provided beneficial and predictable functional results after surgery. The implantation of the T-flex is an effective method to correct a large range of corneal astigmatism.

[Functional results after implantation of an aspheric, aberration-neutral intraocular lens]. / Funktionelle Ergebnisse nach Implantation einer asphärischen, aberrationsneutralen Intraokularlinse.

PURPOSE: The aim of this study was to perform a clinical evaluation of the functional results and quality of vision after implantation of an aspheric, aberration-neutral, monofocal intraocular lens (IOL). PATIENTS AND METHODS: 47 eyes of 34 patients (median age: 68 years) with cataract were enrolled in this prospective clinical study that had Ethics Committee approval. The C-flex or Superflex aspheric IOL (Rayner, UK) was implanted after phacoemulsification. Follow-up examinations were performed two to four months after surgery including subjective refraction, ETDRS uncorrected (UDVA) and corrected distance visual acuity (CDVA), wavefront analysis, analysis of stray light (C-Quant), contrast sensitivity under different lighting conditions (F. A. C. T.) and a questionnaire. RESULTS: Two to four months after surgery, median UDVA was 0.08 logMAR (range: 0.64 to - 0.18 logMAR, n = 41). Median CDVA increased from 0.30 logMAR (range: 1.00 to - 0.02 logMAR) preoperatively to - 0.08 logMAR (range: 0.16 to - 0.22 logMAR) postoperatively (n = 47). Median difference between achieved vs. intended (Holladay 1-formula) spherical equivalent was + 0.06 D (range: - 1.06 to + 0.87 D). Median total HOA RMS (6 mm pupil size) was 0.66 µm (range: 0.41 to 1.19 µm). The median spherical aberrations were - 0.36 µm (range: - 0.70 to - 0.17 µm). Analysis of stray light (C-Quant) revealed a median value of 1.21 log(s) (range: 0.79 to 1.57 log[s]). CONCLUSION: The C-flex and Superflex aspheric IOLs provide good and predictable functional results. Patients are not negatively influenced by stray light and show slightly negative spherical aberrations.

[Hereditary hyperferritinemia cataract syndrome--the first family in Germany]. / Das hereditäre Hyperferritinämie-Katarakt-Syndrom--die erste Familie in Deutschland.

We report on a 23-year-old woman who presented with elevated serum ferritin values at our department. She had undergone cataract surgery at the age of 14 and her family pedigree showed hereditary autosomal-dominant cataract. The combination of isolated hyperferritinemia with autosomal-dominant hereditary cataract led to the diagnosis of the hereditary hyperferritinemia cataract syndrome (HHCS) which we now describe in a German family for the first time. HHCS was confirmed by detection of a causal mutation at position 32 within the iron responsive element (IRE) of L-ferritin leading to a guanine to adenine exchange and the pathognomonic star-shaped cataract. This mutation interrupts the post-transcriptional control of L-ferritin. It prevents binding of the iron regulatory protein 1 (IRP1) to the 5alpha untranslated region of L-ferritin resulting in uncontrolled L-ferritin synthesis and high serum ferritin levels independent of the body iron stores. Premature cataract is eventually caused by deposition of L-ferritin crystals in the lens of the eye. Our family shows the typical autosomal-dominant inheritance of HHCS over four generations affecting a total of 17 family members. The causal mutation, star-shaped cataract and typical laboratory configuration were confirmed in five patients. Thus, in gastroenterological practice, HHCS should be added as a differential diagnosis of hyperferritinemia in Germany. Importantly, patients with HHCS can be spared from invasive diagnostics such as liver biopsy.

[Localization and age relations of ocular aberrations]. / Lokalisation und altersabhängige Verteilung von Aberrationen des Auges.

BACKGROUND: The aim of this study was to analyze the distribution of total, corneal, and mainly internal human third- to sixth-order aberrations (HOA) and investigate possible correlations between wavefront errors and patient age. PATIENTS AND METHODS: For this study 140 eyes of 140 subjects (age range 17-77 years) were measured three times each using Nidek Optical Path Difference scan. Mean value and standard deviation for each Zernike polynomial was computed for a 5-mm pupil diameter, and six different age groups were formed. RESULTS: There was wide individual variation in the internal wavefront aberrations. The mean root-mean-square value for HOA was 0.4563 microm+/-0.296 microm. No positive correlation was found between Zernike polynomials and increasing age. In total spherical aberration however a significant difference was found between the 26-35-year and > or =56-year age groups (p=0.0002), as well as to internal and total coma (Z8) (p=0.0487 and p=0.0117, respectively). CONCLUSIONS: The internal, corneal, and total wavefront aberrations varied widely among patients. Some significant differences were found between the age groups. No correlation between age and the internal, corneal, or total aberrations was found.

[Design and optical principles of multifocal lenses]. / Design und optische Prinzipien von Multifokallinsen.

Multifocal intraocular lenses (MIOLs) of different designs have been used for more than 20 years in modern cataract surgery. The first IOLs were either refractive 2-3-zone designs or of diffractive concept. All MIOL types, regardless of manufacturer, show reduced contrast sensitivity and increased glare for years. Nevertheless, even first-generation MIOL patients had very good functional results when patient selection, IOL calculation, and surgical techniques were appropriate. Today's gold standard is foldable, aspherical diffractive, or refractive MIOLS. Advancements in technology allow the possibility that MIOLs will be used for aphakia correction as well as presbyopia correction.

[Scheimpflug and topography systems in ophthalmologic diagnostics]. / Scheimpflug- und Topographiesysteme in der ophthalmologischen Diagnostik.

Modern Ophthalmology is currently experiencing a boom in anterior segment analysis tools that can increasingly gather information with one short measurement. These systems are based e.g. on so-called Scheimpflug (Pentacam, Galilei), slitlamp, and Placido technologies (Orbscan IIz) and other measurement systems. They help in analyzing the cornea in detail, including calculation of corneal wavefront. In addition, morphological and anatomical parameters such as anterior chamber depth, pachymetry, chamber angle, and lens densitometry can be analyzed. That makes these new technologies of interest for refractive surgery as well as for screening procedures such as Glaucoma, Keratoconus and others. This survey focuses on the two models, Oculus Pentacam and B&L Orbscan IIz as representative of all the other systems, as they are the most successful machines in this field.

[Wavefront analysis in ophthalmologic diagnostics]. / Die Wellenfrontanalyse in der ophthalmologischen Diagnostik.

Modern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.

[Presbyopia correction using intraocular lenses]. / Presbyopiekorrektur mittels Intraokularlinsen.

Modern cataract surgery has advanced tremendously over the past 20 years. Improved surgical techniques, as well as improved implant materials and designs, have enlarged patient profiles and indications not only for cataract surgery, but also for refractive lens exchange surgery. This has also created much higher patient expectations. The loss of accommodation is a loss of quality of life for presbyopic and especially young pseudophakic patients. Multifocal intraocular lenses (MIOL) have been implanted since 1986, starting with 2-3 zone refractive and diffractive designs. Due to the surgical techniques available at that time, MIOL decentration and surgically induced astigmatism were possible complications. In addition, reduced contrast perception and increased glare were common problems of MIOL because of their optical principles. New developments in this field in recent years such as the folding, multizonal, progressive refractive MIOL and aspheric diffractive MIOL in combination with improved surgical techniques have overcome those initial problems. Therefore, modern MIOL (and in the future also accommodative IOL) can be considered not only for the correction of aphakia but also for refractive purposes.

[Accuracy of lens power calculation and centration of an aspheric intraocular lens]. / Genauigkeit der Linsenstärkenberechnung und Zentrierung einer asphärischen Intraokularlinse.

BACKGROUND: Aspherical intraocular lenses (IOLs) are presumed to optimize the optical characteristics of IOLs. In order to profit from these characteristics, exact calculation of the IOL power and good centration of the lens are essential. METHODS: In all, 43 eyes of 43 patients with an average age of 70.9+/-8.3 years underwent implantation of a Tecnis IOL (AMO, Ettlingen) after uneventful cataract surgery with topical anesthesia. IOL power calculation was performed using the Holladay, Haigis, and SRK II formulas. Spherical equivalent refraction and centration and position of the implanted IOLs were measured 6 months postoperatively. Centration of the IOL was analyzed using digital slit lamp photographs and an image analysis program. RESULTS: Best corrected visual acuity (BCVA) increased from 0.47+/-0.25 (LogMAR) preoperatively to 0.1+/-0.11 6 months postoperatively (spherical equivalent +0.3+/-0.6 D). The intraindividual difference between target refraction and achieved postoperative refraction was 0.64+/-0.11 D for the Holladay formula, -0.21+/-0.11 D for the Haigis formula, and 0.97+/-0.15 D for the SRK II formula. The mean decentration of the IOL from the center of the corneal limbus was 0.4+/-0.1 mm. CONCLUSIONS: For the aspherical Tecnis IOL very good postoperative functional results are reported, which are supported by an accurate calculation of the IOL power and a good centration of the IOL inside the capsular bag. In this study the Haigis formula showed the lowest difference between target refraction and achieved postoperative refraction.

[Quantitative evaluation of acrylic and silicone intraocular lenses with a sharp optic edge design]. / Quantitative Nachstarevaluierung von Acrylat- und Silikonintraokularlinsen mit scharfem Kantendesign.

BACKGROUND: At the Department of Ophthalmology, Heidelberg, Germany, posterior capsule opacification (PCO) of a silicone and an acrylic intraocular lens (IOL) with a sharp optic edge design was evaluated. PATIENTS AND METHODS: In a prospective study either the AMO ClariFlex silicone IOL or the Sensar AR40e hydrophobic acrylic IOL were implanted in 47 patients following uneventful phacoemulsification. Mean patient age was 76.2+/-7.8 (ClariFlex) and 73.4+/-12.9 years (AR40e), respectively. The mean follow-up time was 19.7+/-5.34 in the ClariFlex and 21.9+/-1.89 months in the AR40e group. PCO development was evaluated postoperatively using the EPCO 2000 analysis software (scale 0-4). Areas of interest were the total IOL optic, the central 3-mm zone as well as the capsulorhexis. RESULTS: In both groups, all patients achieved a BCVA of 20/32 (AR40e) and 20/25 (ClariFlex), respectively. There was a very low incidence of PCO development with a mean EPCO score of 0.07+/-0.2 (ClariFlex and 0.15+/-0.2 (AR40e). Within the 3-mm zone and the capsulorhexis, there was a tendency for even lower EPCO scores in both groups. We calculated a statistically significant difference for the two lens materials for all investigated IOL areas (Wilcoxon's test, p<0.05). CONCLUSION: Both IOLs with a sharp edge design showed good functional results, a stable position in the capsular bag as well as a low incidence of PCO development. However, the silicone IOL showed statistically significantly lower PCO scores.

[Influence of corneal pachymetric changes on functional results after cataract surgery]. / Einfluss der Hornhautdickenveränderung auf die funktionellen Ergebnisse nach Kataraktchirurgie.

BACKGROUND: In the early postoperative period following uncomplicated cataract surgery, the correlation of corrected distance visual acuity (CDVA) and the increase in corneal thickness and anterior chamber depth (ACD) are investigated. PATIENTS AND METHODS: A total of 54 cataract patients with a mean age of 70 ± 8.4 years were included in this prospective study. Surgery was carried out on one eye of each patient according to the study protocol. Refraction, CDVA and ACD were evaluated 1 day and 1 week postoperatively and compared with the pachymetry results measured with the Pentacam. RESULTS: The mean postoperative CDVA significantly improved from 0.31 ± 0.24 logMAR to 0.18 ± 0.22 logMAR after one day and up to 0.06 ± 0.13 logMAR one week after surgery (p < 0.05). The mean spherical equivalent was - 0.52 ± 0.69 D after one day and - 0.50 ± 0.82 D one week after surgery and showed only minimal differences compared to the mean target refraction of - 0.39 ± 0.70 D. Postoperative corneal thickness showed a significant increase compared to the preoperative results (p < 0.05) on both visits: the mean difference was 33.26 ± 50.20 µm (- 17 to 315 µm) on the first day and 20.22 ± 23.15 µm (- 10 to 99 µm) one week after surgery. Up to 7 days postoperatively the increase in corneal thickness and CDVA showed only moderate or no correlations (r = 0.465 vs. r = 0.072, respectively). Regarding pachymetry and ACD values, no or only low correlations were found. CONCLUSION: The significant increase in corneal thickness on the first and seventh day shows no to moderate correlation to the CDVA. Nevertheless, a good and early rehabilitation of visual acuity following uncomplicated cataract surgery is possible. Intraocular pressure measurement can lead to false high results due to an increase in corneal thickness.

Two-compartment technique to remove ophthalmic viscosurgical devices.

To avoid postoperative intraocular pressure peaks, complete removal of all ophthalmic viscosurgical devices (OVDs) used during cataract surgery is important. Depending on the kind of OVD used, different removal techniques have been applied. We describe a technique that was used in more than 250 eyes for safe removal of OVDs, especially viscoadaptive OVDs such as sodium hyaluronate 2.3% (Healon5). It takes advantage of the viscoadaptive properties of Healon5 and was named the 2-compartment technique.

Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery.

PURPOSE: To compare the ophthalmic viscoelastic device (OVD) Healon5 (sodium hyaluronate 2.3%) with 4 other commonly used OVDs during phacoemulsification and intraocular lens implantation in terms of influence on intraocular pressure (IOP) postoperatively and endothelial cells preoperatively and postoperatively. SETTING: Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Germany. METHODS: This clinical randomized prospective study, in which patients and observer were masked, comprised 81 eyes. Seventy-four eyes (mean patient age 71.2 years +/- 7.8 [SD]) completed all preoperative and 5 postoperative examinations. The OVDs used were OcuCoat and Celoftal (hydroxypropyl methylcellulose 2.0%), Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%), Healon GV (sodium hyaluronate 1.4%), and Healon5 (sodium hyaluronate 2.3%). Intraocular pressure was measured by standard Goldmann applanation tonometry preoperatively and 4 to 6 and 24 hours and 7, 30, and 90 days postoperatively. Endothelial cell counts were done preoperatively and 90 days postoperatively using a Pro/Koester WFSCM contact endothelial microscope. Exclusion criteria were IOP greater than 21 mm Hg at the preoperative examination, age younger than 40 years, significant corneal pathology, and a history or presence of uveitis or pseudoexfoliation syndrome. RESULTS: All groups had increased IOP 4 hours postoperatively. The Healon5 group had the highest mean pressure (24.9 mm Hg) followed by the Viscoat group (23.6 mm Hg). The mean IOP in the other OVD groups was less than 22.1 mm Hg. These differences were not significant. Twenty-four hours postoperatively and at all subsequent examinations, mean IOP was below 20 mm Hg. The Healon5 group had the lowest mean endothelial cell loss (6.2%), significantly lower than in the other groups (P < .02). CONCLUSION: With all 5 OVDs, endothelial cell loss was found, with the lowest in the Healon5 group, and IOP was increased 4 to 6 hours postoperatively. After 24 hours, no significant increases in IOP were noted.

Clinical results of phacoemulsification with the use of Healon5 or Viscoat.

PURPOSE: To compare the ophthalmic viscosurgical devices Healon5 (viscoadaptive) and Viscoat (dispersive) regarding their overall clinical performance during phacoemulsification and posterior chamber intraocular lens (IOL) implantation as well as their influence on intraocular pressure (IOP). SETTING: Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. METHODS: In this prospective randomized patient- and observer-masked clinical study, the performance of Healon5 (sodium hyaluronate 2.3%) and Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) was assessed by 3 surgeons during cataract surgery in 90 patients. Surgeons used a 5-point scale for the subjective assessment of the ease of injection, maintenance capacity during continuous curvilinear capsulorhexis, remaining capacity during phacoemulsification, facilitation of IOL implantation, removal from the eye, transparency, and overall performance throughout surgery. Intraocular pressure was measured preoperatively and 24 hours and 7 days postoperatively. Best corrected visual acuity was assessed preoperatively and 7 days postoperatively. RESULTS: Overall intraoperative product performance was assessed as good or very good in 34 of 44 patients (77%) in the Healon5 group and in 16 of 46 patients (35%) in the Viscoat group (P <.001). Retention in the anterior chamber was graded good or very good in 36 patients (82%) in the Healon5 group and in 23 (50%) in the Viscoat group (P =.001). There were no statistically significant between-group differences in mean IOP preoperatively and 24 hours postoperatively. CONCLUSIONS: Surgeons graded Healon5 better than Viscoat in overall surgical performance and retention in the anterior chamber during phacoemulsification. These data support that Healon5 adapts to each step during surgery.

[Diagnosis and treatment of mycobacterial keratitis following LASIK. Case report and review of the literature]. / Diagnose und Therapie der Mykobakteriumkeratitis nach LASIK. Kasuistik und Literaturübersicht.

BACKGROUND: Mycobacterial keratitis is a rare complication following LASIK but can lead to an extremely unfavourable outcome. The diagnosis and treatment is often delayed due to confusion with other entities including diffuse lamellar keratitis and poor clinical outcomes with flap amputation and/or keratoplasty are often the case. PATIENT AND METHODS: We report the results of LASIK in a 51-year-old woman with subsequent early-diagnosed mycobacterial keratitis and compared this case to treatments and outcomes reported in the literature. RESULTS: The patient presented 10 days following LASIK with a white focal infiltrate in the stromal interface. The flap was lifted and cultures from the stromal bed and the reverse of the flap were obtained and the interface irrigated. The patient was treated with topical antibiotics (ciprofloxacin 0.3%, amikacin 2.5%, clarithromycin 40 mg/ml and tobramycin 15 mg/ml) for 8 weeks and at the most recent follow-up she had a visual acuity of 1.25. CONCLUSION: In a large number of published cases in the literature the flap had to be amputated and/or corneal transplants were necessary. Early diagnosis and treatment however, are essential to successfully treat post-LASIK keratitis. Therefore the patients should be followed up carefully in the early postoperative period.

[Diffuse lamellar keratitis. Postoperative prophylactic treatment with corticosteroids in an experimental animal study]. / Diffuse lamelläre Keratitis Tierexperimentelle Studie zur Evaluierung einer postoperativen Kortikosteroidprophylaxe.

PURPOSE: The aim of this experimental ani-mal study was to induce diffuse lamellar keratitis (DLK), and investigate a prophylactic treatment with corticosteroids. MATERIALS AND METHODS: A corneal flap was cut in 40 eyes from 20 Dutch-belted rabbits and the interface inoculated with either Pseudomonas aeruginosa lipopolysaccharide (LPS) endotoxin ( n=21) or Palmolive Ultra soap ( n=19). Half of the eyes were treated with topical corticosteroids and the other half remained untreated. Slitlamp examinations were performed 1, 3, 5 and 7 days postoperatively and DLK was graded from I-IV. RESULTS: At the end of the study 33 eyes were available for evaluation and 94% of the non-treated eyes developed DLK. Out of those eyes treated with steroids 19% developed DLK during the 1 week follow-up period. This was statistically significantly lower ( P=0.018) when compared to the untreated group. CONCLUSION: Pseudomonas aeruginosa LPS endotoxin as well as Palmolive((R)) Ultra caused a very high rate of DLK in rabbit eyes. The postoperative prophylactic treatment with corticosteroids showed a statistically significant lower DLK rate in this rabbit eye model.

[Diffuse lamellar keratitis: prophylactic treatment with ketorolac tromethamine 0.5% in an animal model]. / Queratitis lamelar difusa: tratamiento profiláctico con ketorolaco trometamina 0,5% en un modelo animal.

PURPOSE: The objective of this study is to evaluate the use of a topical non-steroidal anti-inflammatory drug in the treatment of induced diffuse lamellar keratitis (DLK) in an animal model. MATERIALS AND METHODS: A corneal flap was created in 40 eyes of 20 Dutch-belted rabbits using the ASC microkeratome. The interface was inoculated with either Pseudomonas Aeruginosa Lipopolysaccharide (LPS) endotoxin or Ultra Palmolive liquid dish washer. The rabbits were divided in two groups: Group I (n=20) treated with ketorolac tromethamine ophthalmic solution 0.5% 4 times a day and the group II (n=20) used as control. The rabbits were examined at the slit lamp at day 1, 3, 5 and 7 postoperatively. DLK was graded from I-IV. RESULTS: At the end of the study 31 eyes were available for evaluation. 28 eyes (90%) developed DLK: 86% of the treated group and 94% of the control group during the follow-up. The treated group showed a lower rate of DLK as well as a lower severity. However, no statistically significant difference was found when comparing both groups (P>0.05). CONCLUSION: Pseudomonas aeruginosa LPS endotoxin and Palmolive Ultra can induce DLK in rabbit eyes. The postoperative prophylactic treatment with a topical non-steroidal anti-inflammatory drug showed a tendency towards a lower DLK rate as well as the severity of the disease.

[Intrastromal femtosecond laser-based presbyopia correction]. / Intrastromale Presbyopiekorrektur mittels Femtosekundenlaser.

The surgical correction of presbyopia is gaining more and more popularity in the field of refractive surgery. Besides intraocular treatment with multifocal or accommodative intraocular lenses more and more corneal laser approaches are being established. These are performed either with the Excimer laser as laser in situ keratomileusis (LASIK) or the femtosecond laser. The femtosecond laser treatment is done purely intrastromally without dissection of the epithelium and is characterized by an extremely low risk of infection and inflammation. The procedure leads to a central corneal steepening with more prolate shape and increase in depth of field. This leads to a better uncorrected near visual acuity, however, corrected distance visual acuity might be reduced due to these changes.

[Functional results after bilateral intrastromal femtosecond laser correction of presbyopia]. / Funktionelle Ergebnisse nach Korrektur der Presbyopie mittels bilateraler intrastromaler Femtosekundenlaserbehandlung.

PURPOSE: The purpose of this study was to evaluate the results of bilateral intrastromal femtosecond laser correction of presbyopia (INTRACOR). METHODS: In a prospective study 17 patients were enrolled who had previously received binocular treatment in a two-step approach. Postoperative (4-8 months) outcomes were compared with a matched control group who had undergone only unilateral surgery of the non-dominant eye (n = 17 patients, 24 months after surgery). RESULTS: The binocular distance corrected near visual acuity (DCNVA) showed the same median but lower scattering of values after bilateral treatment: 0.10 (median in logMAR) (0.30/- 0.10 min/max) (study) versus 0.10 (0.50/- 0.10) (control). In the study group, however, a higher loss of binocular corrected distance visual acuity (CDVA) was found: 23.5 %, 70.6 %, 5.9 % (0, - 1, - 2 lines) (study) versus 35.3 %, 64.7 % and 0 %, respectively (control). CONCLUSIONS: Regarding the reduced CDVA INTRACOR should initially only be performed in the non-dominant eye. In selected cases binocular treatment can improve DCNVA; however, careful risk-benefit assessment and informed consent are necessary.