[Rebound tonometry with sterilized probes]. / Rebound-Tonometrie mit sterilisierten Sonden.

BACKGROUND: Intraoperative measurement of intraocular pressure (IOP) opens up possibilities to investigate the influence of IOP on the stability of the eyeball during the performance of surgical maneuvers. Few techniques have been described, none of which are commercially available. This study investigated the use of sterilized probes for rebound tonometry, which could be used intraoperatively. MATERIAL AND METHODS: Tonometry was performed on 30 eyes using a noncontact tonometer and rebound tonometry with the iCare 100 and iCare 200 (iCare Finland Oy, Vantaa, Finland) in a sitting and in a supine position. When performing rebound tonometry probes from the package were used sequentially with sterilized probes. The comparability of sterilized and nonsterilized probes was investigated using different rebound tonometers and different settings. RESULTS: Measurements on a sitting subject were comparable with sterilized and nonsterilized probes. Statistically significant comparability was also found in a supine position. Measurements with identically sterilized probes on identically positioned subjects were comparable with iCare 100 und iCare 200 (T2 vs. T4, p = 0.003 und T3 vs. T5 p < 0.001). The comparison of measurements of the original probe with the sterilized probe in a sitting and in a supine position were possible with statistical significance (p < 0.005). Measuring with the iCare 200 in a sitting position showed a slightly lower IOP with the sterilized probe with the difference being statistically significant. DISCUSSION: Single autoclaving does not alter the probes' ability to measure IOP. CONCLUSION: The use of probes which have been sterilized according to the regulations for other surgical instruments opens up new possibilities for the intraoperative measurement of IOP. This facilitates the use in scientific studies on surgical techniques. In the postoperative period the use of sterilized probes can reduce the risk of infection.

Comparison of endothelial cell loss and complications following DMEK with the use of three different graft injectors.

PurposeTo compare endothelial cell loss and complications following Descemet membrane endothelial keratoplasty (DMEK) with use of three commercially available injectors.MethodsFrom 179 consecutive DMEK procedures, 66 cases with uncomplicated graft preparation and completed 12-month follow-up were included in this retrospective study. According to the injector used, 3 groups were formed: group 1 (D.O.R.C. injector, n=16), group 2 (Geuder injector, n=24), and group 3 (Pasteur laboratory pipette, n= 26). Endothelial cell density (ECD) and endothelial cell loss were evaluated preoperatively and at 3, 6 and 12 months postoperatively; surgery-related complications were recorded.ResultsDonor ECD was 2416±179 cells/mm2 (group 1), 2417±164 cells/mm2 (group 2), and 2478±234 cells/mm2 (group 3). At 12 months postoperatively ECD was 1473±403 cells/mm2 (group 1), 1379±317 cells/mm2 (group 2), and 1316±456 cells/mm2 (group 3) (P=0.533, ANOVA). Endothelial cell loss 12 months postoperatively was 39±15% (group 1), 43±13% (group 2), and 47±17% (group 3) (P=0.386, ANOVA). A single case of iris bleeding and reflux of the graft out of the anterior chamber (both in group 3) was noted. Partial graft detachment occurred in group 1 (n=1), group 2 (n=5), and group 3 (n=7) and rebubbling was performed in 6% (group 1), 17% (group 2), and 27% (group 3).ConclusionsTo our knowledge, this is the first clinical study assessing the safety of three different DMEK injectors. Group 1 (D.O.R.C injector) showed the least and group 3 (Pasteur laboratory pipette) the highest endothelial cell loss without reaching statistical significance at 12 months after surgery. Therefore, the graft injector may be chosen according to surgeon's preference.

[Aphakic Artisan/Verisyse IOLs as retropupillary implants : Video article]. / Aphake Artisan/Verisyse-Intraokularlinsen als retropupillare Implantate : Videobeitrag.

The retropupillary implantation of an iris claw intraocular lens (IOL) is an uncomplicated and fast technique for rehabilitation of aphakic eyes without any capsular structures and is presented in a video in the online version of this article. A complete anterior pars plana vitrectomy as shown in our case or an extensive preceding anterior vitrectomy as well as an intact iris are prerequisites. Special instruments for the implantation and fixation of the IOL are available to optimize the operative procedure. In addition to a rapid operating time the advantages of a trained surgeon are low complications rates and fast rehabilitation. For eyes with a defective iris diaphragm, ischemic vitreoretinopathy and uveitis, other implantation techniques should be selected.

[Refractive lenticule extraction - The ReLEx/SMILE technique : Video article]. / Refraktive Lentikelextraktion ­ Technik der ReLEx/SMILE : Videobeitrag.

Refractive lenticule extraction (ReLEx/SMILE) is a refractive surgical method developed by the authors in stages primarily for correction of myopia and myopic astigmatism, in which a femtosecond laser is exclusively used. In the (ReLEx/SMILE) method a refractive lenticule is generated by the femtosecond laser, which is subsequently extracted through a small incision. Opening of the corneal surface with a flap and use of an excimer laser is no longer necessary. In 2013 the method was newly assessed and classified by the Joint Commisssion for Refractive Surgery (KRC) of the Professional Association of Ophthalmologists (BVA) and the German Ophthalmological Society (DOG). This article presents the individual stages of the technique in a video and possible errors and their avoidance are explained.

[Historical Overview of the Clinical Development of the Small Incision Lenticule Extraction Surgery (SMILE)]. / Die historische Entwicklung der Small-Incision-Lentikel-Extraktions-OP (SMILE).

The clinical use of femtosecond lasers has led to significant progress in the quality of refractive surgery. SMILE femtosecond laser surgery (SMILE: Small Incision Lenticule Extraction) permits the first one step intrastromal laser procedure without a flap. This article describes the gradual development of this surgery during the last ten years.

Refractive Lenticule Implantation for Correction of Ametropia: Case Reports and Literature Review.

The ReLEx® technique allows correction of refractive errors through the creation and extraction of refractive stromal lenticules. Contrary to excimer laser corneal refractive procedures, where the stromal tissue is photoablated, the extracted lenticules obtained with ReLEx® can be preserved. Recent studies and case reports have described autologous re-implantation and allogeneic implantation of refractive lenticules into femtosecond-laser created stromal pockets in order to reverse the refractive outcome of a myopic corneal refractive procedure, correct hyperopia, aphakia, presbyopia and treat keratoconus. The use of stromal lenticules has also been described for therapeutic purposes, with an allogenic lenticule being transplanted under a LASIK flap in order to restore corneal volume and reduce the refractive error in a case of excessive stromal tissue removal after LASIK. This review summarises the results of the latest case reports and studies that describe the implantation of cryopreserved or fresh refractive stromal lenticules and discusses the feasibility, safety and refractive outcomes of the procedure, on the basis of published literature as well as our own experience.

[Three Years Follow-up Study after Refractive Small Incision Lenticule Extraction (SMILE) Using 500 kHz Femtosecond Laser in "Fast Mode"]. / Drei Jahre Nachbeobachtung nach refraktiver Small Incision Lenticule Extraction (SMILE) mit einem 500-kHz-Femtosekundenlaser im "Fast Mode".

Background The aim of this clinical trial was to check the results of laser built-in settings 3 years after ReLEx SMILE for moderate and high myopia in unselected "real life" patients. Patients and Methods 50 myopic eyes of 27 patients were called in for examination after 3 years. 25 of these eyes with a preoperative myopia under - 6D comprised the "moderate myopia subgroup". All surgeries were performed with the 500 kHz VisuMax® femtosecond laser (Carl Zeiss Meditec AG, Jena) in the "fast mode" setting. Results The spherical equivalent (SE) of the entire group changed from - 6.18 D (± 1.91) prior to surgery to - 0.18 D (± 0.39) 3 years later. The preoperative SE in the moderate myopia subgroup changed from - 4.71 D (± 0.94) to - 0.04 D (± 0.23). 14 % of 50 eyes gained one line and 22 % lost one line of CDVA. The regression between month 3 and 36 was 0.07D for the entire group and 0.06 D for the moderate myopia subgroup. There were no late side effects. Primary undercorrection was predominantly seen in eyes over - 6 D. Conclusion ReLEx SMILE shows remarkable stability over the entire range of myopias after 3 years, however primary undercorrection occurs predominantly in eyes of - 6.0 D, which necessitates nomogram adjustment.

Prophylactic Circumferential Retinal Cryopexy to Prevent Pseudophakic Retinal Detachment after Posterior Capsule Rupture during Phacoemulsification.

Purpose. To evaluate whether prophylactic circumferential retinal cryopexy (CRC) can prevent pseudophakic retinal detachment (PRD) development after posterior capsule rupture (PCR) during phacoemulsification. Methods. Retrospective patient chart analysis of eyes experiencing a PCR during phacoemulsification. Comparison of PRD development between eyes receiving CRC (cryo+ group) or not (cryo- group). Results. Overall 106 patients were analyzed, thereof 61 (58%) in the cryo+ and 45 (42%) in the cryo- group. In both clusters a total of 10 PRDs (9.4%) occurred, thereof 3 (30%) in the cryo+ as well as 7 (70%) in the cryo- group (p = 0.087), 79.8 ± 81.58 weeks after PCR. Relative/absolute risk reduction in CRC-treated eyes was calculated to be 68%/11%. Prophylactic CRC reduced PRD development 0.3-fold. Number needed to treat was estimated to be 9.4. Conclusion. Prophylactic CRC might be a useful treatment option in eyes with PCR to hamper PRD development in the further course. Further research is indicated to evaluate this beneficial effect between eyes with and without a rupture of the anterior vitreous cortex and accompanying vitreous loss in an expanding number of eyes.

[Shock-induced anterior ischemic optic neuropathy from hemorrhagic anemia]. / Schockinduzierte anteriore ischämische Optikusneuropathie bei Blutungsanämie.

A 51-year-old diabetic and overweight male presented to our eye clinic with right-sided impairment of visual acuity and scotoma. A thorough work-up had been carried out at our institute 9 months prior to this event due to left-sided nonarteriitic anterior ischemic optic neuropathy (NAION). Despite the similarity of visual symptoms in the currently and previously affected eyes microcystic anemia (Hb 81 g/dl) associated with severe hemorrhoidal bleeding was diagnosed. The patient underwent surgical hemorrhoidectomy and received two red blood cell concentrates. Therefore, this article reports on an extraordinarily rare case of shock-induced anterior ischemic optic neuropathy (SIAION) caused by hemorrhoidal bleeding.

[One-year results of small incision lenticule extraction (SMILE) in myopia]. / Ein-Jahres-Ergebnisse bei Small-Incision-Lentikel-Extraktion (SMILE) zur Myopiekorrektur.

BACKGROUND: This clinical trial is focused on the 12-month results of a new method for refractive correction in myopia, called "small incision lenticule extraction" (SMILE). PATIENTS AND METHODS: In a prospective study 91 eyes were treated with the new refractive procedure and the results were published after 6 months. A lenticule of intrastromal corneal tissue is cut utilising the Carl Zeiss Meditec AG (Jena, Germany) VisuMax femtosecond laser system. Thereafter, this lenticule is manually removed without lifting a flap. 55 eyes of 33 patients volunteered for a 12-month follow-up. UCVA and BSCVA after 12 months, objective and manifest refraction as well as slit-lamp examination and late side effects were documented. RESULTS: 55 eyes of 33 patients were re-examined in this study 12 months after surgery. The spherical equivalent before surgery was - 4.66 (± 1.75) D; after 12 months - 0.11 (± 0.42) D was manifest. No significant change was observed compared to the 6-month control. Starting with UCVA of 0.1 (± 0.06) before surgery. UCVA was 1.02 (± 0.3) after 12 months. One eye lost more than two lines. All other patients did not have any late side effects. CONCLUSION: The one-year results of this new procedure are encouraging. Especially stability of the correction of myopia and myopic astigmatism with the SMILE procedure is very good.

[Intravitreal fibrinolysis and retinal vein occlusion]. / Intravitreale Fibrinolyse und retinaler Venenverschluss.

BACKGROUND: The aim of this study was to analyze and compare intravitreal activity and concentrations of different components of the fibrinolytic cascade in eyes with central retinal vein occlusion (CRVO) as well as branch RVO (BRVO) and healthy controls. These results were correlated with corresponding intravitreal vascular endothelial growth factor (VEGF) concentrations as a biomarker for the severity of blood-retina barrier (BRB) breakdown. MATERIAL AND METHODS: Vitreous samples were obtained from 14 eyes with CRVO, 22 eyes with BRVO and 11 controls and the activities and concentrations of plasminogen, plasmin-alpha2-antiplasmin (PAP) and VEGF were analyzed. RESULTS: Intravitreal activities and concentrations in the CRVO, BRVO and control groups were 2.07 ± 1.87%, 1.24 ± 1.12% and 0.38 ± 0.63% for functional plasminogen, 8.14 ± 7.07 ng/ml, 6.96 ± 4.8 ng/ml and 9.74 ± 10.98 ng/ml for PAP while respective results for VEG levels were 1269 ± 1318 pg/ml, 528 ± 543 pg/ml and 105 ± 116 pg/ml, respectively. There were significant differences in intravitreal functional plasminogen and VEGF between the groups analyzed (in each case p < 0.001). Intravitreal functional plasminogen correlated with intravitreal VEGF concentrations (r = 0.478, p = 0.001). No adverse events or serious side effects occurred. CONCLUSION: There were significant differences in intravitreal functional plasminogen and VEGF between eyes with CRVO, BRVO and controls. Intravitreal activity of plasminogen was significantly correlated with the severity of BRB breakdown in RVO affected eyes. The knowledge of intravitreal activities and concentrations of different components of the fibrinolytic cascade could offer new therapeutic strategies in RVO-affected eyes in the future.

[Vitreous body and retinal vein occlusion]. / Glaskörperstatus und retinaler Venenverschluss.

PURPOSE: The aim of this study was to evaluate whether the adhesion status of the posterior vitreous cortex (PVC) towards the internal limiting membrane (ILM) has an impact on the development of retinal vein occlusion (RVO). MATERIAL AND METHODS: In a retrospective analysis the operation protocols of 238 eyes receiving pars plana vitrectomy (ppV) and radial optic neurotomy (RON) for central retinal vein occlusion (CRVO) or ppV in combination with arteriovenous sheathotomy (AVS) for branch retinal vein occlusion (BRVO) were evaluated with respect to the intraoperative status of posterior vitreous body adhesion. The results were compared with age-matched healthy controls. RESULTS: In this study 145 eyes (60.9 %) suffering from CRVO and 93 eyes (39.1 %) diagnosed with BRVO were included. In eyes with CRVO and BRVO the posterior vitreous cortex (PVC) was significantly more often attached (126 eyes, 86.9 % and 89 eyes, 95.7 %, respectively) than completely detached (19 eyes, 13.1 % and 4 eyes, 4.3 %, respectively, in each case p < 0.001). In the age groups between 70 and 79 years as well as between 80 and 89 years the PVC was significantly more often attached in both RVO entities in comparison to age-matched healthy controls (CRVO 70-79 years, p = 0.001 and 80-89 years, p = 0.002 and BRVO 70-79 years, p < 0.001, 80-89 years, p = 0.011). In eyes from the age group between 65 and 69 years (of age) the PVC was not significantly more often attached in comparison to healthy controls (CRVO p = 0.334 and BRVO p = 0.114). CONCLUSION: According to these findings posterior vitreous adhesion is an independent risk factor for the development of retinal vein occlusion among patients aged 70 years or older.

[Retropupillary iris claw intraocular lens implantation technique for aphakia]. / Technik der retropupillaren Irisklauenintraokularlinsenimplantation bei Aphakie.

BACKGROUND: Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA). MATERIAL AND METHODS: A literature search and review of implantation techniques, patient selection, potential complications and management strategies. RESULTS: This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications. CONCLUSIONS: The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.

[Iris suture fixation of posterior chamber lenses. New perspectives for an old technique]. / Irisnahtfixierte Hinterkammerlinse. Neue Perspektiven für eine bekannte Technik.

BACKGROUND: Intraocular approaches to correct aphakia in cases of inadequate capsular support include an anterior chamber intraocular lens, fixation of a posterior chamber lens to the sclera or iris by suturing or iris claw, respectively. OBJECTIVES: This article reviews the indications and contraindications for iris fixation with sutures and gives an overview of surgical techniques, potential complications and outcomes. METHODS: Based on a selective search of pertinent literature in PubMed the information from original articles and reviews are analyzed, summarized and discussed. RESULTS: New surgical techniques have imparted an impetus to iris suture fixation with encouraging functional and morphological results offering a new promising alternative to the established options. Improved aspects arise for repositioning of a decentered intraocular lens and for a minimally invasive method for repair of late in-the-bag lens dislocation as seen more frequently by cataract surgeons. CONCLUSION: A final evaluation of the proposed techniques is not possible because none has clearly emerged as the optimal method. Precise determination of small differences in visual outcome or complication rates requires a large prospective, randomized clinical trial.

[Combination of different techniques for secondary anchoring of intraocular lenses]. / Kombination verschiedener Techniken bei sekundärer Verankerung intraokularer Linsen.

BACKGROUND: The four fundamental techniques of secondary intraocular lens (IOL) fixation, namely sulcus placement, scleral or iris suture fixation and scleral haptic fixation can be combined in special situations. AIM: When is a combination of different techniques advisable? METHODS: This article describes our experiences and gives an example of combined technique use. RESULTS: These situations arise in cases when neighboring ocular structures are only partially preserved or show particular distinctive defects that can be repaired at the time of secondary IOL anchoring. This article presents a case of IOL-induced iris chafing and traumatic iridodialysis which was closed by a combined technique of iris suture and scleral suture fixation. CONCLUSION: A combination of different anchoring techniques for secondary IOL implantation can achieve a simultaneous repair of perilenticular structures and reduce the amount of suture material used.

[Tear in the retinal pigment epithelium by intravitreal injection of aflibercept]. / Riss des retinalen Pigmentepithels durch intravitreale Aflibercept-Injektion.

Development of tears in the retinal pigment epithelium (RIP) has been described as a possible complication following anti-vascular endothelial growth factor (VEGF) antibody therapy with substances which have been available for years when treating pigment epithelium detachment (PED) in eyes affected by age-related macular degeneration (AMD). Aflibercept has become available for the treatment of exsudative AMD since December 2012. This case report describes a further patient in addition to the only other case published so far who developed RIP after aflibercept treatment for PED. Patients have to be thoroughly informed about this potential side effect before initiation of intravitreal aflibercept injection therapy.