Fullfield and extrafoveal visual evoked potentials in healthy eyes: reference data for a curved OLED display.

PURPOSE: Visual evoked potentials (VEP) present an important diagnostic tool in various ophthalmologic and neurologic diseases. Quantitative response data varied among patients but are also dependent on the recording and stimulating equipment. We established VEP reference values for our setting which was recently modified by using a curved OLED display as visual stimulator. Distinction is made between fullfield (FF) and extrafoveal (EF) conduction, and the effect of sex, age and lens status was determined. METHODS: This prospective cross-sectional study included 162 healthy eyes of 162 test persons older than 10 years. A fullfield pattern-reversal visual evoked potential (FF-PR-VEP) with two stimulus sizes (ss) (20.4' and 1.4°) as well as an extrafoveal pattern onset-offset VEP (EF-P-ON/OFF-VEP) (ss 1.4° and 2.8°) was derived in accordance with the International Society for Clinical Electrophysiology of Vision guidelines. Amplitudes and latencies were recorded, and the mean values as well as standard deviations were calculated. Age- and sex-dependent influences and the difference between phakic and pseudophakic eyes were examined. A subanalysis of EF-P-ON/OFF-VEP and fullfield pattern onset-offset VEP (FF-P-ON/OFF-VEP) was performed. A 55-inch curved OLED display (LG55EC930V, LG Electronics Inc., Seoul, South Korea) was used as visual stimulator. RESULTS: Mean P100 latency of the FF-PR-VEP was 103.81 ± 7.77 ms (ss 20.4') and 102.58 ± 7.26 ms (ss 1.4°), and mean C2 latency of the EF-P-ON/OFF-VEP was 102.95 ± 11.84 ms (ss 1.4°) and 113.58 ± 9.87 ms (ss 2.8°). For all stimulation settings (FF-PR-VEP, EF-P-ON/OFF-VEP), a significant effect of age with longer latencies and smaller amplitudes in older subjects and higher amplitudes in women was observed. We saw no significant difference in latency or amplitude between phakic and pseudophakic eyes and between EF-P-ON/OFF-VEP and FF-P-ON/OFF-VEP. CONCLUSIONS: A curved OLED visual stimulator is well suited to obtain VEP response curves with a reasonable interindividual variability. We found significant effects of age and gender in our responses but no effect of the lens status. EF-P-ON/OFF-VEP tends to show smaller amplitudes.

Association of ocular blood flow and contrast sensitivity in normal tension glaucoma.

PURPOSE: To investigate the relationship of ocular blood flow (via arteriovenous passage time, AVP) and contrast sensitivity (CS) in healthy as well as normal tension glaucoma (NTG) subjects. DESIGN: Mono-center comparative prospective trial METHODS: Twenty-five NTG patients without medication and 25 healthy test participants were recruited. AVP as a measure of retinal blood flow was recorded via fluorescein angiography after CS measurement using digital image analysis. Association of AVP and CS at 4 spatial frequencies (3, 6, 12, and 18 cycles per degree, cpd) was explored with correlation analysis. RESULTS: Significant differences regarding AVP, visual field defect, intraocular pressure, and CS measurement were recorded in-between the control group and NTG patients. In NTG patients, AVP was significantly correlated to CS at all investigated cpd (3 cpd: r = - 0.432, p< 0.03; 6 cpd: r = - 0.629, p< 0.0005; 12 cpd: r = - 0.535, p< 0.005; and 18 cpd: r = - 0.58, p< 0.001), whereas no significant correlations were found in the control group. Visual acuity was significantly correlated to CS at 6, 12, and 18 cpd in NTG patients (r = - 0.68, p< 0.002; r = - 0.54, p< .02, and r = - 0.88, p< 0.0001 respectively), however not in healthy control patients. Age, visual field defect MD, and PSD were not significantly correlated to CS in in the NTG group. MD and PSD were significantly correlated to CS at 3 cpd in healthy eyes (r = 0.55, p< 0.02; r = - 0.47, p< 0.03). CONCLUSION: Retinal blood flow alterations show a relationship with contrast sensitivity loss in NTG patients. This might reflect a disease-related link between retinal blood flow and visual function. This association was not recorded in healthy volunteers.

Intraocular lens power calculation for plus and minus lenses in high myopia using partial coherence interferometry.

PURPOSE: We assessed the accuracy of lens power calculation in highly myopic patients implanting plus and minus intraocular lenses (IOL). METHODS: We included 58 consecutive, myopic eyes with an axial length (AL) > 26.0 mm, undergoing phacoemulsification and IOL implantation following biometry using the IOLMaster 500. For lens power calculation, the Haigis formula was used in all cases. For comparison, refraction was back-calculated using the Barrett Universal II (Barrett), Holladay I, Hill-RBF (RBF) and SRK/T formulae. RESULTS: The mean axial length was 30.17 ± 2.67 mm. Barrett (80%), Haigis (87%) and RBF (82%) showed comparable numbers of IOLs within 1 diopter (D) of target refraction. Visual acuity (BSCVA) improved (p < 0.001) from 0.60 ± 0.35 to 0.29 ± 0.29 logMAR (> 28-days postsurgery). The median absolute error (MedAE) of Barrett 0.49 D, Haigis 0.38, RBF 0.44 and SRK/T 0.44 did not differ. The MedAE of Haigis was significantly smaller than Holladay (0.75 D; p = 0.01). All median postoperative refractive errors (MedRE) differed significantly with the exception of Haigis to SRK/T (p = 0.6): Barrett - 0.33 D, Haigis 0.25, Holladay 0.63, RBF 0.04 and SRK/T 0.13. Barrett, Haigis, Holladay and RBF showed a tendency for higher MedAEs in their minus compared to plus IOLs, which only reached significance for SRK/T (p = 0.001). Barrett (p < 0.001) and RBF (p = 0.04) showed myopic, SRK/T (p = 002) a hyperopic shift in their minus IOLs. CONCLUSIONS: In highly myopic patients, the accuracies of Barrett, Haigis and RBF were comparable with a tendency for higher MedAEs in minus IOLs. Barrett and RBF showed myopic, SRK/T a hyperopic shift in their minus IOLs.

Development of visual acuity under hyperbaric oxygen treatment (HBO) in non arteritic retinal branch artery occlusion.

PURPOSE: Nonperfusion of retinal tissue due to arterial occlusion leads inevitably to mostly irreversible retinal damage. Until today no evidence-based treatment exists. Inhalation of 100% oxygen at high atmospheric pressure causes an increased solubility of oxygen in the blood that helps the retinal tissue to survive through diffusion in case of an artery occlusion till vascular recanalization occurs. Hence the purpose of this study is to compare the visual outcome in patients with retinal branch artery obstruction treated with hyperbaric oxygen versus patients treated with hemodilution only. METHODS: Non-randomized, monocentric, retrospective study. Patients with diagnosis of non-arteritic retinal branch artery occlusion (BRAO) treated with hyperbaric oxygen therapy between 1997 and 2017. Exclusion criteria were central retinal artery occlusion, presence of a cilioretinal artery and arteritic cases. The control group was matched based on visual acuity (VA) at admission, age, and delay between symptoms and beginning of clinical care. RESULTS: The control group and the matching oxygen group contained 14 patients each. Initial VA in the matched HBO group was 0.18 ± 0.19 and 0.23 ± 0.19 in the control group (p = 0.57). Final VA at discharge was 0.69 ± 0.29 in the matched oxygen group and 0.32 ± 0.23 in the control group (p = 0.0009). HBO-treated patients had a significant visual increase compared with the control group. The most common comorbidities were arterial hypertension and vascular sclerosis. CONCLUSION: HBO treatment appears to have a beneficial effect on visual outcome in patients with retinal branch artery occlusion. HBO treatment could be a rescue therapy at an early stage of BRAO, especially to bridge the time of a potential reperfusion. However, further, prospective, randomized clinical trials are required to verify this assumption.

Vitrectomy with and without encircling band for pseudophakic retinal detachment with inferior breaks: VIPER Study Report No. 3.

PURPOSE: To test if an encircling band improves outcomes in vitrectomy for pseudophakic retinal detachment (PRD) with inferior or with multiple (4 or more) breaks. METHODS: Subgroup analysis of a prospective randomized controlled multicenter trial in patients with uncomplicated PRD assigned either to 20 G vitrectomy plus encircling band (group E1), or 20 G vitrectomy without any buckle (group C), or 23/25 G vitrectomy without any buckle (group E2). The primary endpoint was defined as no indication for any retina reattaching procedure during the review period of 6 months. One hundred out of 257 patients were identified with inferior breaks and 63 patients had 4 or more breaks. RESULTS: In patients with retinal breaks between 5:00 and 7:00, treatment was successful in 77.4% (24/31, treatment arm E1) versus 57.1% (16/28, treatment arm C) (p = 0.301, odds ratio (OR) 1.83, 95% confidence interval (CI) 0.48 to 7.17). In patients with multiple breaks, success rates were 68.2% (15/22, E1) versus. 72.4% (21/29, C, p = 0.46, OR 0.52, CI 0.08-3.65). CONCLUSION: Combining an encircling band with vitrectomy in patients with pseudophakic retinal detachment and inferior or multiple breaks does not significantly improve primary anatomical success in comparison to treatment with 20 G or 23/25 G vitrectomy alone.

The effects of iodoacetic acid on the mouse retina.

BACKGROUND: To characterize the effects of intravitreal injections of iodoacetic acid (IAA) in comparison to its systemic application as a measure to induce unilateral photoreceptor degeneration. METHODS: Seven-week-old C57BL/6 J mice received either intravitreal injections of IAA or systemic treatment (intraperitoneal vs intravenous) and were observed in the following 5 weeks using ERG, OCT, and histology. RESULTS: Systemic treatment with IAA induced high toxic effects and a high mortality in contrast to the intravitreal injection. Intraperitoneal application had no effect on the retina. Intravenous application of 2 × 30 mg/kg BW IAA (time between injections 3.5 h) resulted in an extinction of the ERG and a thinning of the retina, in particular of the outer nuclear layer (ONL) indicating photoreceptor degeneration. Animals receiving intravitreal injections developed cataracts already at low concentrations (up to 100% at 0.25 mg/kg BW). Higher intravitreal IAA doses led to extinguished ERGs. In histology, a thinning of the entire retina was observed that was most prominent in the inner part of the retina. CONCLUSIONS: In contrast to intraperitoneal administration, intravenous application of IAA led to a selective photoreceptor degeneration. After intravitreal injection, dense cataracts were already observed at concentrations lower than those needed to induce changes in the ERG. ERG results must be interpreted carefully. A thinning of all retinal layers rather than a specific outer retinal degeneration was observed upon intravitreal injection. IAA is not a useful model to induce outer retinal degeneration in mice.

Blue-yellow and standard pattern visual evoked potentials in phakic and pseudophakic glaucoma patients and controls.

PURPOSE: Blue-yellow short wavelength testing (BY-VEPs) has proven diagnostic relevance in detecting early ganglion cell damage, e.g., in glaucoma. To date testing has generally been conducted using individual protocols without consideration of the lens status. In this study, we compared changes in BY-VEPs and standard pattern VEPs in phakic and pseudophakic glaucoma patients and controls. METHODS: The eyes of 57 healthy controls (18 pseudophakic and 39 phakic) and 67 glaucoma patients (29 pseudophakic and 38 phakic) were included in a prospective study. Phakic eyes were arranged in three groups according to the Lens Opacities Classification System III. Transient on/off isoluminant blue-yellow 2° checks were used for BY-VEPs, transient large 1° (M1) and small 0.25° (M2) black-white checks for standard pattern reversal VEPs, according to the ISCEV standards. RESULTS: Latencies and amplitudes of M1 and M2 did not differ significantly between groups or lens status. ANOVA analysis revealed significantly longer BY-VEP latencies in glaucoma compared to controls (p = 0.002), independently of the lens status. The amplitudes showed no such pattern (p = 0.93). Mean defect (MD) was significantly negatively correlated to BY-VEP latency (r = -0.54, p = 0.003) only in pseudophakic glaucoma patients. Different stages of cataract did not show a significant effect on the BY-VEP latencies. CONCLUSIONS: Glaucoma led to a significant increase of BY-VEPs latencies, while standard pattern VEPs were not influenced. The correlation of MD and BY-VEP latency only in pseudophakic glaucoma patients indicates a substantial confounding effect of lens opacifications on the diagnostic value of BY-VEPs in glaucoma.

The effect of cataract surgery on blue-yellow and standard-pattern visual-evoked potentials.

PURPOSE: Blue-yellow visual-evoked potentials (BY-VEPs) may be used for diagnostics of functional ganglion cell damage in glaucoma and other ocular diseases. In this study we investigated the impact of lenticular opacities on BY- and standard pattern reversal VEPs by examining patients before and after cataract surgery. METHODS: Eighteen patients with moderate cataract were included in a prospective study. Transient on/off isoluminant blue-yellow 2° checks were used for short-wavelength stimulation (BY-VEP), transient large 1° (M1) and small 0.25° (M2) black-white checks for standard pattern reversal VEPs. VEPs were acquired before (24 ± 30 days) and after cataract surgery (14 ± 16 days). The contralateral eye was used as a control. RESULTS: Amplitude and latency of M1 and M2 peaks did not change significantly from before to after surgery. The amplitude of the BY-VEPs did not change significantly after cataract surgery (pre-surgery, -7.42 ± 3.43 µV, post-surgery, -7.93 ± 3.65 µV, p = 0.42), yet the latency of the main negative peak showed a significant decrease (pre-surgery, 143.9 ± 12.9 ms, post-surgery, 133.2 ± 7.7 ms, p = 0.0006). The BCVA improvement was significant from before to after cataract surgery (pre-surgery, 0.344 ± 0.125 LogMAR, post-surgery, 0.224 ± 0.179 LogMAR, p = 0.013) yet not correlated to the absolute decrease in latency of the BY-VEP after surgery (r = 0.309, p = 0.22). No significant changes were found in the contralateral eye. CONCLUSIONS: The BY-VEP is sensitive to lenticular opacities of the human lens, presumably due to the increased short-wavelength absorption in the aging eye. This fact should be considered when applying BY-VEPs for diagnostics.

Short-Term Clinical Results After ILM Removal and Inverted ILM Flap for Macular Hole Repair - A Single-Center Retrospective Experience.

Purpose: To compare results after ILM peeling and ILM inverted flap technique utilized the repair of full thickness macular holes, irrespective of their size. Patients and Methods: Pre- and postoperative data of 109 patients who suffered from a full thickness macular hole were retrospectively analyzed. Forty-eight patients were treated with an inverted ILM flap technique, 61 patients were treated with ILM peeling. All patients received a gas tamponade. The primary endpoint was macular hole closure as demonstrated by OCT scanning. Secondary endpoints were best corrected visual acuity and clinical complication rates. Results: For small and medium-sized macular holes the closure rates in the ILM flap technique group were 100% and 94%, respectively. For ILM peeling, the closure rate was identical (95%). For large macular holes, the closure rate was 100% in the flap versus 50% in the ILM peeling group, but visual acuity improved in both groups (ILM flap p=0.001, ILM peeling p=0.002). In both treatment groups, larger holes were associated with a reduced final visual outcome. For medium-sized macular holes, visual acuity significantly improved only in the ILM peeling group. Both techniques were associated with minimal and comparable side effects. Conclusion: In our limited series, the inverted ILM flap technique for repair of macular holes demonstrated a high closure rate. For large MHs, we saw a trend towards a better closure rate in the flap technique compared to ILM peel only. However, final visual acuity showed no significant difference between the groups. Clinical results and complications appeared to be comparable in both groups.

Does surgical experience have an effect on the success of retinal detachment surgery?

PURPOSE: To examine the relationship between surgeon experience and success rates in retinal detachment surgery. METHODS: Success rates during a follow-up of 11 months of 8 surgeons who performed in total 375 retinal detachment procedures ranging from 14 to 115 cases between December 1997 and January 2002 were correlated to the total number of vitreoretinal procedures ranging between 176 and 2,587. All patients received either scleral buckling or vitrectomy, and complicated cases were excluded. RESULTS: Mean primary anatomical success rates were 0.69 ± 0.14 for scleral buckling and 0.9 ± 0.05 for primary vitrectomy (P < 0.05). The primary anatomical success rates did not correlate to the number of vitreoretinal procedures. Seven of the eight surgeons showed an intraindividual learning effect with better success rates in the second versus the first half of the observed procedures. The learning effect was correlated to the total number of procedures with a higher effect in inexperienced surgeons. CONCLUSION: An intraindividual learning effect that was higher in inexperienced surgeons could be demonstrated. The learning effect was reduced by half after 500 vitreoretinal procedures while the primary anatomical success rates were not correlated to the number of vitreoretinal procedures.

Accuracy of intraocular lens power calculation using partial coherence interferometry in patients with high myopia.

PURPOSE: Ultrasound-A-scan-biometry intraocular lens power calculation for cataract surgery sometimes shows lack of accuracy in patients with high myopia. The purpose of this retrospective study was to assess the accuracy of lens power calculation with optical biometry using the Zeiss IOLMaster across a large range of myopia levels. METHODS: We included 37 consecutive, myopic eyes with an axial length >26.5mm (31 patients, 62±13years old, average preoperative refraction of -14.46±6.61D, range -3.5 to -32.0D which underwent phacoemulsification and implantation of an intraocular lens following biometry using the IOLMaster. For lens power calculation, the Haigis formula was used in all cases. For comparison, refraction was back-calculated using the SRK/T and Holladay I formulae. RESULTS: The preoperative mean axial length was 29.37±2.44 mm with a range of 26.50-35.52mm. Thirty eyes (81.1%) showed a postoperative spherical equivalent which differed 1.00D or less from the predicted value, in 20 cases (54.1%) the postoperative refractive error was within±0.50D. The mean absolute error (MAE) was 0.70±0.59D (Holladay I, 0.85±0.68; SRK/T, 1.01±0.61D). CONCLUSIONS: Optical biometry for intraocular lens power calculation seems to deliver reliable results for cataract surgery in patients with high myopia, although our data describe an increasing lack of accuracy beyond an axial length of 30mm. The Haigis formula provided the best predictability of postoperative refractive outcome for myopic eyes in general.

Angiographic findings following tack fixation of a wireless epiretinal retina implant device in blind RP patients.

BACKGROUND: The fixation of polyimide stimulator foils as the basic substrate of epiretinal prostheses by using retinal tacks may cause retinal or choroidal alterations such as retinal proliferations or choroidal neovascularizations. During the prospective trial for the semichronical testing of a wireless intraocular retinal implant (EPIRET3) we investigated alterations in angiographic findings during implantation and after explantation of the device, to detect potential vascular pathologies at the fixation site or elsewhere. METHODS: As the final step of the implantation surgery in six blind patients, the stimulator was placed on the retinal surface using retinal tacks. For the detection of possible morphological or vascular alterations committed by the implant fluorescein angiography (FA) was performed 1 day before and 4 weeks after implantation surgery, as well as at the final visit 5 months after explantation. RESULTS: Following implantation surgery funduscopy and FA did not reveal any evidence of either vascular pathologies or choroidal neovascularisations (CNV), in addition, no cystoid macular edema (CME) occurred after 4 weeks. At the 6-month follow-up visit, we found a mild epiretinal gliosis formation in four patients. In one patient a retinal break occurred during explantation, requiring a temporary silicone-oil endotamponade. At the final visit, we observed a focal proliferative vitreoretinopathy (PVR) reaction without activity, while there was no evidence for a CNV formation in that area. CONCLUSIONS: The FA findings confirm our previous results on the safety of the EPIRET3 system, which was tolerated in all patients but revealed a certain risk profile in regard to the stimulator fixation. While there was no evidence for newly occurred CME or CNV during the follow-up visits, nevertheless gliosis or even PVR reaction at the tack's fixation site suggests the need to develop alternative fixation procedures of epiretinal stimulators.

Ocular side effects of Levitra® (vardenafil) - results of a double-blind crossover study in healthy male subjects.

PURPOSE: To determine ocular side effects of vardenafil with special regard to color vision and retinal function. METHODS: This was a single center, randomized, double-blind, placebo-controlled, twofold crossover study with an administration of a single oral dose of two 20 mg tablets of BAY 38-9456 (vardenafil hydrochloride) or corresponding placebo in 24 healthy male subjects. Ocular investigations included Farnsworth-Munsell D100 color vision test, electroretinogram, and basic ophthalmological examinations like visual acuity, visual field, and slit-lamp of anterior segment and fundus. RESULTS: Compared to placebo, administration of vardenafil hydrochloride lead to a temporary significant increase of Farnsworth-Munsell D100 total error score after 1 and 6 hours as well as in error lines 3 and 4 after 1 hour. Twenty-four hours after administration there was no significant alteration of total error score or of any error line. While latency of electroretinogram b-wave remained unaffected, amplitudes showed a significant decrease compared to placebo 1 hour following administration. While other ocular examinations did not reveal any differences in general some mild to moderate but no serious adverse events have been reported. CONCLUSION: Despite temporary changes in retinal function our study reports good tolerability of vardenafil in regard to ocular side effects.

Goldmann Applanation Tonometry versus Dynamic Contour Tonometry after Vitrectomy with Silicone Oil Endotamponade.

PURPOSE: To evaluate the agreement of intraocular pressure (IOP) measurements using dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in eyes after vitrectomy with silicone oil endotamponade and controls. METHODS: In this prospective comparative study, IOP was measured with GAT and DCT in 30 eyes with oil endotamponade 1-3 days after vitrectomy and 40 untreated controls. In addition, ocular pulse amplitude (OPA), corneal pachymetry (CCT), and axial length (AL) were measured. RESULTS: GAT values in the oil group were significantly higher compared to control eyes (mean GAT oil 13.6 ± 5.1 mmHg; mean GAT control 10.8 ± 2.1 mmHg; p = 0.003). There was no significant difference in DCT measurements (mean DCT oil 12.0 ± 4.1 mmHg; mean DCT control 11.9 ± 2.9 mmHg; p = 0.9). This led to a significant difference of GAT-DCT between the oil and control group (mean difference of GAT-DCT oil 1.6 ± 4.7 mmHg; mean difference of GAT-DCT control -1.1 ± 2.6 mmHg; p = 0.004). The difference between GAT and DCT was negatively correlated with the mean IOP measured by both methods (r = -0.36, p = 0.02) and positively correlated with CCT only in the control group (r = 0.36, p = 0.02), as well as to AL only in the oil group (r = 0.46, p = 0.01). The OPA did not differ significantly between groups. CONCLUSION: GAT and DCT showed a good agreement in control eyes. The difference of GAT and DCT is significantly changed in eyes after vitrectomy with silicone oil endotamponade. Our findings suggest that GAT overestimates IOP in this situation.

Vitrectomy with and without encircling band for pseudophakic retinal detachment: VIPER Study Report No 2-main results.

BACKGROUND: It is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy. METHODS: 257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months. RESULTS: Success was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average -0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of -1.0 D in group E1 compared with -0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1. CONCLUSIONS: Vitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique. TRIAL REGISTRATION NUMBER: DKRS 00003158, Results.

Fundus near infrared fluorescence correlates with fundus near infrared reflectance.

PURPOSE: To analyze the occurrence of near infrared (NIR) fluorescence in relation to NIR reflectance, blue-light-excited autofluorescence, angiograms, and funduscopy. METHODS: Observational consecutive case series in patients with macular diseases. Imaging was performed with a confocal scanning laser ophthalmoscope for NIR reflectance, blue-light-excited autofluorescence, NIR fluorescence, and fluorescein and indocyanine green (ICG) angiograms. In cases in which NIR fluorescence was observed, five to nine images were averaged. The leakage of the scanning laser ophthalmoscope was analyzed. RESULTS: In the 291 eyes analyzed, NIR fluorescence was observed in 51 and was graded weak in 27 with wet age-related macular degeneration (AMD, 10 cases), dry AMD with pigment clumping (n=7), chronic central serous choroidopathy (CSC; n=5), choroidal nevi (n=2), subretinal hemorrhages (n=2), and chloroquine maculopathy (n=1). Strong NIR fluorescence was found in 24 eyes, with wet AMD (n=14), subretinal hemorrhages (n=8), and choroidal nevi (n=2). Except for four eyes, we observed a strong correlation of NIR fluorescence and increased NIR reflectance at identical fundus location (92.2%). NIR fluorescence corresponded with increased blue-light-excited autofluorescence in 21 of 31 patients with AMD and in 4 of 5 patients with chronic CSC, but in none of the 4 patients with nevi. Funduscopy showed that structures with NIR fluorescence were pigmented or consisted of degraded blood. Barrier filter leakage of the imaging system was 6.2x10(-6). CONCLUSIONS: The high correlation of NIR fluorescence and reflectance indicated that part of the observed NIR fluorescence is pseudofluorescence, whereas gray-scale analysis indicated that both NIR autofluorescence and pseudofluorescence contribute to the NIR fluorescence images. Quantification of leakage of the imaging system indicated a significant part of the observed NIR fluorescence is NIR autofluorescence. As NIR fluorescence derives from pigmented lesions, melanin is a possible source if NIR reflectance is also increased. Comparison with blue-light-excited autofluorescence showed differences between AMD and patients with nevi. NIR autofluorescence was also detected in single cases of maculopathy without corresponding NIR reflectance.

Goldmann Applanation Tonometry Versus Dynamic Contour Tonometry After Vitrectomy.

PURPOSE: The aim of the study was to investigate the agreement of intraocular pressure (IOP) measurement using dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in eyes after vitrectomy with intraocular gas endotamponade, in eyes after vitrectomy with no tamponade, and in controls. METHODS: In this prospective comparative study IOP was measured with GAT and DCT in 41 eyes with gas endotamponade (sulfur hexafluoride 20%) 1 to 3 days after vitrectomy, in 32 postvitrectomy eyes with intraocular water, and in 46 control eyes with no history of glaucoma or intraocular surgery. Corneal pachymetry and axial length measurements were additionally performed. RESULTS: The mean difference between GAT and DCT (GAT-DCT) in gas-filled eyes was 3.1 mm Hg [SD=6.2 mm Hg], that in eyes after vitrectomy with no tamponade was 0.4 mm Hg (SD=4.8 mm Hg), and in control eyes was 0.4 mm Hg (SD=3.8 mm Hg). No significant correlation was found between the differences of GAT and DCT (GAT-DCT) and the mean IOP of GAT and DCT in water-filled eyes (r=-0.25, P=0.18) and control eyes (r=0.23, P=0.13), but a significant correlation was found in the gas-filled eyes (r=0.71, P<0.0001). A significant correlation between central corneal thickness and the mean difference of both methods was seen only in the control group (r=0.36, P=0.03). CONCLUSIONS: IOP as determined by DCT underestimates IOP in gas-filled eyes compared with GAT, as GAT values were on average 3.1 mm Hg higher compared with those of DCT. The extent of IOP underestimation using DCT increases with higher IOP values. In the group of eyes after vitrectomy and in normal eyes we found a generally good agreement between the 2 methods, although high interindividual discrepancies were present. Our findings suggest that the 2 devices should not be used interchangeably in IOP evaluation after vitrectomy with gas endotamponade, which remains a difficult challenge.

Clinical observations and occurrence of complications following heavy silicone oil surgery.

PURPOSE: To demonstrate development and complications in heavy silicone oil (HSO) surgery in 100 eyes following primary vitreoretinal surgery. METHODS: 100 eyes were included in this retrospective study that underwent vitreoretinal surgery using HSO as endotamponade. Indication diagnoses were retinal detachments (n = 76), complicated macular holes (MH) (n = 20), and others (n = 4). HSO removal was performed after a mean period of 20.2 ± 19.0 weeks. In 18 eyes with poor functional prognosis the silicone oil remained permanently for stabilisation. Overall follow-up time was 35.9 ± 51.8 weeks. RESULTS: The mean IOP before HSO surgery was 13.3 ± 5.6 mmHg and raised to an average maximum of 23.3 ± 8.5 mmHg postoperatively and decreased to 13.7 ± 7.2 mmHg after removal. Secondary IOP raise due to emulsification of the silicone oil endotamponade was seen in 29 eyes after 7.8 ± 4.5 weeks. Other complications being observed with HSO installed were persistent corneal erosion (n = 3) and prolonged anterior chamber inflammation (n = 29). In 13 eyes recurrent retinal detachments occurred during followup. CONCLUSIONS: According to our analysis HSO surgery might deliver satisfying results in complicated cases of ophthalmological surgery. However, potential complications should always be taken into account when making the decision if to use and when to remove HSO in complicated retinal surgery.

Influence of the prediction error of the first eye undergoing cataract surgery on the refractive outcome of the fellow eye.

INTRODUCTION: In addition to measurement errors, individual anatomical conditions could be made responsible for unexpected prediction errors in the determination of the correct intraocular lens power for cataract surgery. Obviously, such anatomical conditions might be relevant for both eyes. The purpose of this study was to evaluate whether the postoperative refractive error of the first eye has to be taken in account for the biometry of the second. METHODS: In this retrospective study, we included 670 eyes of 335 patients who underwent phacoemulsification and implantation of a foldable intraocular lens in both eyes. According to the SRK/T formula, the postoperative refractive error of each eye was determined and compared with its fellow eye. RESULTS: Of 670 eyes, 622 showed a postoperative refractive error within ±1.0 D (93%), whereas the prediction error was 0.5 D or less in 491 eyes (73%). The postoperative difference between both eyes was within 0.5 D in 71% and within 1.0 D in 93% of the eyes. Comparing the prediction error of an eye and its fellow eye, the error of the fellow eye was about half the value of the other. CONCLUSION: Our results imply that substitution of half of the prediction error of the first eye into the calculation of the second eye may be useful to reduce the prediction error in the second eye. However, prospective studies should be initiated to demonstrate an improved accuracy for the second eye's intraocular lens power calculation by partial adjustment.