Management of patients with dysthyroid optic neuropathy treated with intravenous corticosteroids and/or orbital decompression surgery.

PURPOSE: To assess the characteristics and long-term outcomes of adult patients with dysthyroid optic neuropathy (DON) who underwent orbital decompression surgery and/or received intravenous (IV) methylprednisolone. METHODS: Retrospective chart review of 98 eyes of 49 patients who were diagnosed and treated with bilateral DON between 2007 and 2018 at the Department of Ophthalmology and Optometry and Oral and Maxillofacial Surgery of the Medical University of Vienna. RESULTS: The mean follow-up period was 4.1 ± 2.7 years. The most common presenting symptoms were eyelid and periorbital swelling (45%) representing active inflammation. Upgaze restriction was the most common clinical finding (73%). At time of diagnosis, the mean clinical activity score was 4 ± 1/4 ± 1 (right/left eye, respectively). Sixty-three percent (31/49) of the patients were treated both with IV methylprednisolone and underwent orbital decompression surgery, 22% (11/49) were treated with IV methylprednisolone alone and 14% (7/49) underwent surgical decompression only. Seventy-one percent (30/42) of the patients underwent 3-wall decompression. The mean reduction of proptosis in patients treated with both IV methylprednisolone and orbital decompression surgery was 4/5 mm. Mean of reduction in proptosis in patients receiving IV methylprednisolone only was 1/0 mm and in patients with surgical decompression only was 5/5 mm. Mean VA was 0.1 ± 0.5/0.1 ± 0.5 logMAR at baseline and 0.05 ± 0.7/0.05 ± 0.7 at final follow-up. In 92% (45/49), VA was preserved or improved at final follow-up. CONCLUSIONS: The majority of patients with DON were treated both with IV corticosteroids and 3-wall decompression surgery. Vision could be successfully preserved in most cases and reduction of proptosis was achieved, especially after orbital decompression surgery.

Patterns of care, toxicity and outcome in the treatment of salivary gland carcinomas: long-term experience from a tertiary cancer center.

BACKGROUND: Salivary gland carcinomas (SGC) cover a heterogeneous group of malignancies with a lack of data of high-level evidence. METHODS: Clinical data of 127 patients treated for SGC at a university cancer center between 2002 and 2017 were analyzed retrospectively. The association of clinicopathological characteristics, treatment modalities, adverse events, and outcome was assessed. RESULTS: Patients received surgery (n = 65), surgery followed by (chemo-)radiotherapy (n = 56), or primary (chemo-)radiotherapy (n = 6). Injury to the cranial nerves or their branches was the most frequent surgical complication affecting 40 patients (33.1%). Ten year overall and progression-free survival rates were 73.2% and 65.4%, respectively. Parotid tumor site, advanced tumor, and positive nodal stage remained independent negative prognostic factors for overall survival, loco-regional and distant tumor control in multivariate analysis. CONCLUSIONS: Optimizing treatment strategies for SGC, depending on distinct clinicopathological factors, remains challenging due to the low incidence rates of the disease.

Visual outcome and surgical results in children with Marfan syndrome.

IMPORTANCE: To determine visual and surgical results in children with Marfan syndrome. BACKGROUND: Marfan syndrome involves ocular complications which can lead to visual disturbance and amblyopia. Data about the visual and surgical results in children with Marfan syndrome is vital for the clinical management of these patients. DESIGN: Retrospective data analysis. PARTICIPANTS: Eighty-two eyes of 41 patients with a genetically proved diagnosis of Marfan syndrome. METHODS: Medical records of patients with Marfan syndrome were reviewed between 2007 and 2017. Ocular complications, visual acuity (VA) of patients with/without lensectomy and surgical method were evaluated. MAIN OUTCOME MEASURES: VA outcomes of patients with Marfan syndrome with/without surgical repair of ectopia lentis. RESULTS: In 27 (66%) of the 41 patients a bilateral subluxation of the lens was visible and 14 (52%) patients received lensectomy. The mean age at initial presentation was 12.3 ± 9 years and mean follow-up was 3 years (range 1-7). VA varied from 1.2 to -0.1 logMAR at first examination. At initial presentation, mean VA was 0.1 ± 0.7 logMAR in patients with a normal lens status (n = 14) and 0.3 ± 0.5 logMAR in patients with subluxation of the lens (n = 27) (P < .01). VA improved from 0.2 ± 0.5 logMAR to 0.1 ± 0.5 logMAR (P = .06) in children with subluxation of the lens who did not need a lensectomy (n = 12) and from 0.5 ± 0.5 logMAR to 0.2 ± 0.5 logMAR (P = .02) in patients who were referred to lensectomy with/without secondary lens implantation. CONCLUSIONS AND RELEVANCE: In Marfan syndrome subluxation of the lens was found in the majority of children. Improvement of VA resulted in children with subluxation of the lens and following lensectomy.

EFFECT OF PATIENTS' CLINICAL INFORMATION ON THE DIAGNOSIS OF AND DECISION TO TREAT RETINOPATHY OF PREMATURITY.

PURPOSE: To evaluate the effect of patients' clinical information on experts' diagnoses of retinopathy of prematurity (ROP) and decisions to treat. METHODS: Seven experts assessed wide-field fundus photographs of eyes of 52 premature infants of ≤30 weeks' gestational age or ≤1,500 g birthweight (BW) for ROP diagnosis (stage, plus disease, and aggressive posterior ROP) and the necessity for treatment for 2 days. On Day 1, they were masked to all patient data. On Day 2, they were given information on gestational age and BW. RESULTS: A significant shift in the experts' ratings toward a less aggressive ROP grading stage (P = 0.006) and less frequent decision for intervention (P = 0.021) was observed after receipt of patients' clinical information. This was truer for heavier/less premature infants (gestational age ≥ 28 0/7 weeks or BW ≥ 900 g) than those with very low BWs/high prematurity (gestational age < 24 0/7 weeks or BW < 600 g) (ROP stage P = 0.009 vs. P = 0.399, treatment decision P = 0.022 vs. P = 0.648). CONCLUSION: These results suggest knowledge of patients' clinical information influences the grading of ROP disease and decision for treatment. Retinopathy of prematurity staging seemed to be set at a lower level and the decision for treatment at a higher threshold for heavier/less premature babies. Our findings may have implications for further refinements in ROP assessment.

Twin-twin transfusion syndrome as a possible risk factor for the development of retinopathy of prematurity.

PURPOSE: The objective of this study was to evaluate the correlation between twin-twin transfusion syndrome (TTTS) and the development of retinopathy of prematurity (ROP) in premature infants. METHODS: Fifty-one infants who were less than 32 postmenstrual gestational weeks at birth or with a birth weight less than 1,501grams were included in this longitudinal observational study. The infants were matched by gestational age and birth weight, and divided into three groups: multiples with TTTS, multiples without TTTS, and singletons. The primary outcome variable was the incidence of ROP in infants affected by TTTS versus infants not affected by TTTS. Secondary outcome variables were multiple pregnancy, gestational age, and birth weight. RESULTS: Infants affected by TTTS showed a significantly higher incidence of ROP than infants not affected by TTTS (p < 0.01). TTTS donors and TTTS recipients were both at greater risk of developing ROP. ROP occurred in infants with TTTS whose gestational age at birth was significantly higher than that of infants with ROP who were not affected by TTTS (p = 0.01). Multiple pregnancy itself was not a risk factor for ROP disease. CONCLUSIONS: Infants affected by TTTS during pregnancy are at high risk of developing ROP, even if they were born at an older gestational age. Special awareness in ROP screening is necessary for these infants.

Soluble epoxide hydrolase disruption as therapeutic target for wound healing.

BACKGROUND: Cytochrome P450 (CYP)-derived epoxyeicosatrienoic acids (EETs) possess angiogenic effects. However, the effect of CYP-derived EETs and soluble epoxide hydrolase (sEH) deletion on wound healing in vivo has not been rigorously investigated. In this study, we measured the effect of exogenous CYP-derived EETs and targeted disruption of sEH in an in vivo wound model. MATERIALS AND METHODS: Standardized full-thickness dermal wounds were created on the dorsum of mouse ears. Wound epithelialization was directly viewed and measured using intravital microscopy and computerized planimetry every second day until healing was complete. Wound sections were analyzed by immunostaining for metalloproteinase (MMP) 2, MMP7, MMP9, tissue inhibitor of metalloproteinases (TIMP) 1, and tumor necrosis factor (TNF) α on days 2, 4, and 12. RESULTS: Treatment with 11,12-EETs, 14,15-EETs, and sEH deletion significantly accelerated wound closure. This effect was attenuated by the EET antagonist 14,15-epoxyeicosa-5(Z)-enoic acid (14,15-EEZE) in sEH(-/-) mice. Neither 11,12- nor 14,15-EETs caused significant alterations in MMP9 expression in wounds. In contrast, MMP2 and MMP7 were significantly upregulated in the EET-treated groups, whereas TIMP1 and TNF-α were downregulated. CONCLUSIONS: Collectively, these data demonstrated that potentiation of the CYP epoxy-genase pathway by either exogenous CYP-derived EETs or sEH deletion significantly accelerated wound epithelialization in vivo. This beneficial effect might be due to downregulation of TNF-α production and, to a lesser degree, to the release of MMPs and could be used as a viable angiogenic therapeutic strategy.

Pre- and postsurgical measurements in patients with strabismus sursoadductorius a retrospective study.

PURPOSE: Strabismus sursoadductorius is the most common strabismus of the oblique eye muscles. The changes in squint angle, elevation in adduction, abnormal head posture and binocular vision were collected to get an overview of the results at the largest clinic in Austria. METHODS: This study is a retrospective study. The orthoptic and ophthalmologic parameters of 102 patients who were treated in the Department of Ophthalmology and Optometry between January 2017 und September 2020 were collected and statistically analysed. RESULTS: The mean age was 12.2 ± 14.8 years. The squint angle changed from 18.3 ± 6.3 presurgical to 13.4 ± 9.7 (p = 0.09) with Hirschberg measurement. The squint angle changed from 12.5 ± 7.7 to 6.7 ± 4.9 (p < 0.01) at distance and from 12.5 ± 7.6 to 6.1 ± 4.5 (p < 0.01) at near with the prism covertest. Elevation in adduction showed a highly significant change (p < 0.01) from 15 ± 5.6 to 1.4 ± 2.8 degrees on average postsurgical. In binocular vision at distance there was also a highly significant (p < 0.01) change with 21.6% to postsurgical 37.3% positive tests. At near, the positives also increased significantly (p = 0.01) from 32.4% to 39.2%. There was no significant change in stereo vision (p = 1.0). Presurgical 52.9% of the sample had an abnormal head posture, postsurgical it was 38.2%, this change is also highly significant (p < 0.01). CONCLUSION: The change was significant to highly significant for most parameters (i.e., squint angle, elevation in adduction, and abnormal head posture).

Influence of a modified Nd:YAG laser treatment outside the visual axis on the morphology of Elschnig pearls.

PURPOSE: To observe changes in posterior capsule opacification (PCO) after Nd:YAG treatment with and without opening the posterior lens capsule. METHOD: This prospective randomized study included patients with regeneratory PCO. In substudy 1, a small low-energy Nd:YAG capsulotomy was performed (MiniYAG). In substudy 2, a low-energy Nd:YAG laser treatment without opening the lens capsule was performed (GentleYAG). Concerning analysis, in both substudies, the posterior capsule was divided into 4 quadrants and the quadrant where the Nd:YAG laser treatment was performed was randomly allocated. Change in PCO was analyzed using retroillumination images objectively (AQUA score: 0-10). RESULTS: In total, 27 eyes of 25 patients were used for this study. In substudy 1, the mean amount of PCO (AQUA score) for the entire posterior capsule decreased significantly (p < 0.05, ANOVA) from 5.2 (SD: 1.6) before to 4.0 (SD: 1.9) immediately after the MiniYAG. In substudy 2, the mean amount of PCO (AQUA score) for the entire posterior capsule analyzed before and immediately after the GentleYAG was 5.1 (SD: 2.4) and 5.2 (SD: 2.3), respectively. CONCLUSION: Performing a MiniYAG led to a significant PCO reduction. Gentle polishing of the posterior capsule resulted in a relevant reduction of PCO in one third of the patients.

Retinal vessel architecture in retinopathy of prematurity and healthy controls using swept-source optical coherence tomography angiography.

PURPOSE: To determine microvascular changes in children with a history of retinopathy of prematurity (ROP) and in a control group of full-term children. METHODS: In a cross-sectional study, 30 eyes of 15 children aged 6-8 years with a history of ROP were evaluated with swept-source optical coherence tomography angiography (SS-OCTA). Twenty-eight eyes of 22 age-matched full-term children served as a healthy control group. The foveal avascular zone (FAZ), vessel density (VD) and choroidal vascular flow area (VFA) were evaluated on OCTA and correlated with central retinal thickness (CRT), visual acuity (VA), birth weight (BW), gestational age (GA) and ROP stages. RESULTS: Twenty-two eyes of 14 children with a history of ROP (stage 1-3) and 25 eyes of 19 full-term children were available for evaluation. In the ROP group, the gestational age was 27 ± 2 weeks and birth weight was 781 ± 164 g. In the ROP group, CRT was higher in the central ETDRS segment (mean difference [95% CI]: 32.8 µm [18.7; 47.0], p = 0.0002) compared to the controls. Smaller mean FAZ area (-0.12 [-0.19; -0.04], p = 0.004) and perimeter (-662 [-1228; -96], p = 0.03) was found in comparison to the control group. An oval shape of the FAZ was observed among patients with a history of ROP. The mean central VD of the superficial plexus was 28 ± 8/23 ± 8% and of the deep plexus 7 ± 7/3 ± 5% (ROP group/control group; p > 0.05). No statistically significant difference was found regarding the choroidal VFA. Only weak correlation of FAZ and VD with function was observed. CONCLUSIONS: Swept-source optical coherence tomography angiography imaging revealed significant microvascular anomalies in children with a history of ROP indicating disturbance of early morphological development of the central retina.

Prognostic impact of CD8-positive tumour-infiltrating lymphocytes and PD-L1 expression in salivary gland cancer.

OBJECTIVES: Aim of the study was to evaluate the prognostic impact of CD8-positive (CD8+) tumour-infiltrating lymphocytes (TILs) and PD-L1 expression on the outcome of patients with malignant salivary gland neoplasms. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue samples and clinicopathological data from patients treated for salivary gland carcinoma in a head and neck cancer centre were retrospectively retrieved. Immunohistochemical staining was applied on sections of 84 specimens of 12 different histological subtypes. Both CD8 and PD-L1 expression were rated by semi-automated cell counts by a digital image analysis programme. Survival analyses were performed by the log-rank test on the univariate level, and the Cox model was applied on the multivariate level. Associations between immunological markers and clinicopathological variables were estimated by the Pearson chi-squared test. Additionally, PD-1 was estimated as an exhaustion marker of CD8+ TILs. RESULTS: Patients exceeding a tumour proportion score ≥5% regarding PD-L1 expression demonstrated a significantly decreased survival, as did individuals with an overall high CD8+ cell density. Particularly, high CD8+ cell counts in the invasive front of the respective tumour tissue significantly coincided with a poor outcome. Also, high numbers of CD8+ TILs significantly matched with a high quantity of PD-1+ TILs. CONCLUSION: CD8+ TILs abundance in the peritumoural microenvironment correlates with impaired outcome of patients with salivary gland carcinoma. The simultaneous negative prognostic impact of PD-L1 expression and presence of PD-1+ TILs advocates an immune checkpoint-controlled mechanism of CD8+ TILs exhaustion for these tumours and paves the way for future treatment strategies.

Macular morphology after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing.

PURPOSE: To evaluate possible changes in macular morphology after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in comparison to conventional in-the-bag intraocular lens (IOL) implantation. DESIGN: Prospective randomized study. METHODS: Fifty consecutive age-related cataract patients with normal macular morphology and function waiting for bilateral cataract surgery were enrolled. Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing was performed in one eye; in the fellow eye cataract surgery was performed with in-the-bag IOL implantation, leaving the posterior lens capsule untouched. Optical coherence tomography measurements were performed one week and one month postoperatively. RESULTS: During follow-up, no statistically significant changes of macular morphology could be observed in any of the tested patients. Mean central retinal thickness, minimum and maximum retinal thickness, and central retinal volume were all statistically comparable between the eyes with combined primary posterior capsulorhexis and posterior optic buttonholing and the control eyes (P > .05). Best-corrected visual acuity was full in all patients (Snellen 20/25 and better). No cases of subclinical macular edema were observed. CONCLUSION: Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing apparently does not increase the risk for postoperative macular edema in patients with a normal macula, since no cases of biomicroscopically noticeable macular edema with visual loss were observed in the first 1,000 eyes with primary posterior capsulorhexis/posterior optic buttonholing cataract surgery and no case of subclinical macular edema was found in this prospective randomized study.

Effect of a new cohesive ophthalmic viscosurgical device on corneal protection and intraocular pressure in small-incision cataract surgery.

PURPOSE: To compare the corneal protective and intraocular pressure (IOP) effects of a new cohesive ophthalmic viscosurgical (OVD), Neocrom Cohesive (sodium hyaluronate 1.4%), with those of Healon (sodium hyaluronate 1.0%) in cataract surgery. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This randomized patient-masked examiner-masked study with fellow-eye comparison comprised 29 cataract surgery patients. Surgery was performed with Neocrom Cohesive in 1 eye and Healon in the other eye. Central corneal thickness (CCT) was measured preoperatively and 1 day and 3 months postoperatively; endothelial cell density (ECD), preoperatively and 3 months postoperatively; and IOP, preoperatively and 6 hours and 1 day postoperatively. RESULTS: The mean CCT change from preoperatively to postoperatively in the Neocrom Cohesive, respectively, group and Healon group was +16.0 microm +/- 25.7 (SD) (P<.01) and +7.0 +/- 17.1 microm (P<.05), respectively, at 1 day and -5.7 +/- 10.8 microm (P<.01) and -4.7 microm +/- 9.5 microm) (P<.01), respectively, at 3 months. The mean ECD change at 3 months was 8 +/- 155 cells/mm(2) in the Neocrom Cohesive group (P = .8) and -46 +/- 139 cells/mm(2) in the Healon group (P = .08). The mean IOP increase was +2.2 +/- 3.5 mm Hg (P<.01) and +1.4 +/- 4.2 mm Hg (P = .14), respectively, 6 hours postoperatively and +0.9 +/- 4.3 mm Hg (P = .37) and 0.0 +/- 3.5 mm Hg (P = .77), respectively, at 1 day. CONCLUSION: There was no significant difference between Neocrom Cohesive and Healon in the changes in CCT, ECD, and IOP after cataract surgery.

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing.

PURPOSE: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation. SETTING: Department of Ophthalmology, Medical University of Vienna, Austria. METHODS: This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. RESULTS: Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.

Effect of posterior capsule opacification on macular sensitivity.

PURPOSE: To evaluate the effect of posterior capsule opacification (PCO) on macular sensitivity. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Macular sensitivity, best corrected visual acuity (BCVA), and PCO intensity were evaluated before and after neodymium:YAG (Nd:YAG) laser capsulotomy in pseudophakic eyes with clinically significant PCO that had a healthy macula or dry age-related macular degeneration (ARMD). Macular sensitivity was determined using the fundus-related Microperimeter 1 (Nidek) in a central field of 10 degrees. The intensity of the PCO was assessed objectively in the central 3.0 mm area (score 0 to 10) using quantification software. RESULTS: After Nd:YAG capsulotomy, both groups had a significant improvement in BCVA and mean macular sensitivity; the change in the mean logMAR value was -0.26 in the healthy macula group and -0.23 in the dry ARMD group and the change in mean macular sensitivity, 2.5 dB and 2.0 dB, respectively. Before Nd:YAG capsulotomy, significant correlations were observed between PCO values, BCVA, and macular sensitivity in the healthy macula group only (P<.01). CONCLUSIONS: Neodymium:YAG laser capsulotomy improved BCVA and macular sensitivity. The PCO scores correlated well with the PCO-induced decrease in BCVA and with PCO-induced loss of macular sensitivity. Functional macular mapping indicated an overall loss of macular sensitivity in patients with dry ARMD. There was no significant association between PCO values and macular sensitivity in eyes with dry ARMD.

Long-term effect of 1-piece and 3-piece hydrophobic acrylic intraocular lens on posterior capsule opacification: a randomized trial.

PURPOSE: To compare the intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of the foldable hydrophobic acrylic AcrySof intraocular lens (IOL) over a 5-year period. DESIGN: Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. PARTICIPANTS: Fifty-two patients with bilateral age-related cataract (104 eyes). METHODS: Each study patient had cataract surgery in both eyes and received a 1-piece AcrySof IOL in 1 eye and a 3-piece AcrySof IOL in the other eye. Follow-up examinations were performed at 1 week, 1 month, 6 months, and 1, 2, and 5 years. Digital retroillumination images were obtained of each eye. The amount of posterior capsule opacification (score range, 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software 1, 2, and 5 years after surgery. MAIN OUTCOME MEASURE: Posterior capsule opacification score (scale, 0-10). RESULTS: There was no significant difference between the 1-piece and 3-piece AcrySof IOL in best-corrected visual acuity, overlap of rhexis and IOL, capsular folds, anterior capsule opacification, and posterior capsule opacification (1-piece AcrySof PCO score, 1.7+/-1.7; 3-piece AcrySof PCO score, 1.3+/-1.4; P = 0.30). CONCLUSIONS: Modification of the IOL haptic design of the sharp optic edged AcrySof IOL from a 3-piece to a 1-piece haptic design caused no significant change in PCO intensity and neodymium:yttrium-aluminium-garnet laser treatment rate 5 years after surgery.

Long-term effect of optic edge design in a silicone intraocular lens on posterior capsule opacification.

PURPOSE: To compare the posterior capsule opacification (PCO) inhibiting effect of the round anterior and sharp posterior optic edge profile of the Clariflex silicone intraocular lens (IOL) [AMO Inc, Santa Ana, California, USA] with that of the double-round edge profile of the SI40 (Phacoflex; AMO Inc, Santa Ana, California, USA) silicone IOL over a period of three years. DESIGN: Prospective, randomized, double-masked, bilateral clinical trial. METHODS: The study took place at the Department of Ophthalmology, Medical University of Vienna, Austria. Fifty-two patients with age-related cataracts (104 eyes) were included in the study. Each patient received an SI40 IOL (round edges) in one eye and a Clariflex IOL with OptiEdge (sharp posterior optic edge) in the other eye. Follow-up examinations were at one week, one month, six months, and one, two, and three years. Digital retroillumination images were taken of each eye. The amount of PCO was subjectively assessed with the slit-lamp and objectively assessed by automated image analysis software (the computer program Automated Quantification of After-Cataract [AQUA]; Vienna, Austria) one, two, and three years after surgery. RESULTS: The Clariflex lens showed markedly less PCO at one, two, and three years after surgery. The mean AQUA PCO score was 1.39 for the SI40 and 0.56 for the Clariflex lens after one year, estimated at 1.64 and 0.57 after two years, and at 2.04 and 0.64, respectively, after three years (scale zero to 10; P < .001). The Nd:YAG laser capsulotomy rate was far higher in the SI40 group (Five cases vs one case at three years). CONCLUSIONS: The sharp posterior optic edge profile of the Clariflex silicone IOL led to marked and consistently less PCO than the round-edged SI40 IOL one, two, and three years after surgery.

Effect of the hydrophilicity of acrylic intraocular lens material and haptic angulation on anterior capsule opacification.

AIM: To evaluate the influence of hydrophilic and hydrophobic acrylic material and haptic angulation on anterior capsule opacification (ACO). METHODS: Prospective study on 53 patients with bilateral age-related cataract. Patients underwent standard cataract surgery by the same surgeon and randomly received a hydrophilic acrylic intraocular lens (IOL) in one eye and a hydrophobic acrylic IOL in the other eye. Forty five of these patients completed the one-year follow-up. The following parameters were assessed: decentration, buttonholing, anterolenticular gap (ALG), ACO, outgrowth and refractive outcome. RESULTS: At the one-year follow-up, ACO was seen in 80% of the hydrophilic and 100% of the hydrophobic IOLs. ACO was more intense in the hydrophobic IOLs (p<0.001). Outgrowth was seen in 42% of the hydrophilic and 2% of the hydrophobic IOLs (p = 0.0003). No case of persisting ALG was seen in the hydrophobic IOLs, but in 42% of the hydrophilic IOLs. The refractive outcome was -0.29 (SD 0.56) dioptres for the hydrophilic and 0.003 (SD 0.44) dioptres for the hydrophobic IOLs (p<0.001). CONCLUSION: These results suggest that there is less ACO in hydrophilic acrylic than in hydrophobic acrylic IOLs. Although material properties might play a role, the angulated haptics of the hydrophilic IOLs exert an additional effect by the persisting ALG and a lack of contact between the IOL and the anterior capsule.

Natural course of posterior subcapsular cataract over a short time period.

Purpose/aim of the study: To observe and analyze the weekly changes in morphology and size of vacuoles, so called Wedl cells, in eyes with posterior subcapsular cataract (PSC). MATERIALS AND METHODS: Thirty-six eyes of 36 patients with pronounced PSC were included in this prospective study. High-resolution retroillumination images were taken, and the changes in size and shape of Wedl cells were analyzed at baseline and at 2 and 4 weeks later using dedicated imaging software. RESULTS: In total, 1087 Wedl cells were observed. Within 2 and 4 weeks, 31 and 22 Wedl cells appeared and 13 and 40 Wedl cells disappeared, respectively. Median Wedl cell size at baseline and after 2 and 4 weeks was 4000 µm2 (range: 40-212120 µm2), 4080 µm2 (range: 40-274520 µm2), and 4160 µm2 (range: 40-212200 µm2), respectively. For the absolute size change within 4 weeks, a significant difference was observed (p = 0.045). The median change in absolute solidity within 2 and 4 weeks was 0.01 (range: 0.00-0.19) and 0.02 (range: 0.00-0.53), respectively. CONCLUSIONS: Wedl cells undergo morphological changes within a short time period of 4 weeks and even appearance and disappearance of Wedl cells can be observed within weeks. The fact that spontaneous regression occurs may, when properly understood, have some relevance for the development of therapeutical approaches to reverse existing PSC in the future.

Effect of topical prednisolone and diclofenac on the short-term change in morphology of posterior capsular opacification.

PURPOSE: To observe and document the effect of steroidal and nonsteroidal antiinflammatory treatment on the formation of Elschnig pearls. DESIGN: A prospective, randomized, double blinded, placebo controlled, two-way-cross-over study. METHODS: Thirty-nine eyes of 32 patients with pronounced, regeneratory posterior capsule opacification (PCO) were included. The patients were treated topically with prednisolone and diclofenac (verum) or with lubricating eye drops (placebo) four times daily for one week. After a wash-out period of two weeks the patients received the contrary treatment also four times daily for one week. Digital retroillumination images were taken at day one, three, five, eight, and 15 of each medication period. The changes in the size of 4,675 Elschnig pearls were analyzed. RESULTS: The mean cumulative area of all marked pearls/eye and follow-up was 1.2 mm(2) (range: 0.1 mm(2) to 3.2 mm(2)). The mean pearl size was 12,809 microm(2) (range: 60 microm(2) to 1.08 x 10(6) microm(2)). Between the follow-up examinations, 1,274 pearls disappeared (mean: 33 pearls/eye, range: five to 69 pearls; 27%) and 777 newly formed pearls appeared (mean: 20 pearls/eye, range: three to 53 pearls; 20%). There was no statistically significant difference in pearl size change and in number of disappeared and newly appeared pearls between the verum and the placebo treatments. CONCLUSIONS: Topical prednisolone and diclofenac do not influence the short-term change of Elschnig pearls. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly among eyes.

Daily changes in the morphology of Elschnig pearls.

PURPOSE: To observe and document the daily changes in the morphology of Elschnig pearls. DESIGN: A prospective cohort study. METHODS: Twenty-nine pseudophakic eyes with pronounced, regeneratory posterior capsule opacification (PCO) were included in this prospective study. Retroillumination images were taken at days 0, 1, 2, and 14. A square grid was laid over the images. Increase, decrease, appearance, and disappearance of pearls between the follow-up images were quantified. RESULTS: A total of 1371 areas (mean: 53/eye) of 26 eyes were analyzed between days 0 and 1 and 1 and 2, and 896 areas (50/eye) of 18 eyes between days 0 and 14. Between days 0 and 1, days 1 and 2, and days 0 and 14, we observed "no change" in pearl size in 72%, 77%, and 32%, a "minor increase" in 16%, 14%, and 10%, a "major increase" in 4%, 3%, and 42%, a "minor decrease" in 14%, 11%, and 11%, and a "major decrease" in 4%, 3%, and 37%, respectively. Appearance of newly formed pearls was found in 1%, 1%, and 9% and disappearance of pearls in 1%, 1%, and 5%, respectively. CONCLUSIONS: Significant changes in the morphology of Elschnig pearls were observed within time intervals of only 24 hours. Appearance and disappearance of pearls, as well as progression and regression of pearls within these short intervals illustrate the dynamic behavior of regeneratory PCO. These findings may contribute to a better understanding of PCO and have implications on pharmaceutical interventions for PCO.