[Use of resources in cataract surgery-More waste is (not) always possible]. / Ressourceneinsatz in der Kataraktchirurgie ­ Mehr Müll geht (n)immer.

BACKGROUND: Aspects of ecological sustainability are becoming more important in the healthcare system. The use of resources is particularly high in the operating theater. Cataract surgery is one of the most frequent procedures in ophthalmology and even in medicine overall. Its CO2 footprint is therefore quantitatively relevant. Approaches to conserve resources can be implemented at the levels of production and transport of materials and also in the form of reduction and management of waste. MATERIAL AND METHODS: In this paper the sources of the waste load, the management of waste separation, the implementation of single-use instruments and the influence of innovative technologies during cataract surgery are presented based on the current literature. RESULTS: Particularly the use of plastic materials for packaging and single-use instruments, also for reasons of hygiene, lead to an increased waste production. The simple separation of compound materials is difficult and only meaningful if the materials used in eye operations can be recycled; however, international comparisons show that cataract surgery can be performed with the same quality of results while conserving resources. Measures in organization and infrastructure are presented. CONCLUSION: In the future, innovative strategies should be developed and the use of resources in Germany should also be critically questioned in order to reduce the CO2 footprint of cataract surgery.

[Mechanical pupillary dilatation using rings in small pupils during cataract surgery : Video article]. / Mechanische Pupillenerweiterung mit Ringen zur Kataraktoperation bei enger Pupille : Videobeitrag.

OBJECTIVE: The purpose of mechanical pupillary dilatation in small pupils is a sufficient visualization of the lens to be able to perform capsulorhexis, phacoemulsification and intraocular lens implantation. INDICATIONS: The indications for mechanical dilatation are fulfilled in patients where a sufficient pharmacological preoperative pupil dilatation is not possible. SURGICAL TECHNIQUE: During routine cataract surgery specific foldable rings can be employed to dilate the pupil with the appropriate injector under viscoelastic substances. These rings are carefully placed at the pupillary margin until circular pupillary dilatation up to 6-7 mm is achieved. After intraocular lens implantation and before removing the viscoelastic substance the rings are slowly folded into the injector and then removed. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. RESULTS: Mechanical pupillary dilatation was possible in all patients studied (n = 14), which allowed uncomplicated phacoemulsification and intraocular lens implantation. For both ring systems studied the mean pupillary dilatation was 6.6 mm. At the end of surgery, the pupillary diameter was 4.89 mm using a Malyugin ring (MST, Redmond, Washington, USA) and 4.93 mm with an I­ring (Visitec, Waltham, MA, USA; P > 0.05). Small lesions at the pupillary margin or pigment dispersion during implantation or explantation depended mostly on the individual patient situation and not on the ring used. CONCLUSION: Mechanical pupillary dilatation with rings allows sufficient dilatation to perform cataract surgery. Both the Malyugin ring and the I­ring achieved smooth and atraumatic pupillary dilatation.

[Influence of Macular Hole Width on Visual Acuity, Endotamponade and Closure Rate]. / Einfluss der Lochbreite auf Visus, Endotamponade und Verschlussrate beim Makulaforamen.

Background: The influence of the width of a full-thickness macular hole on preoperative visual acuity and its role for the intraoperative approach and closure rate were analysed in a prospective study. Methods: For 47 patients with a full thickness macular hole, a precise analysis of the central retina was performed with SD-OCT. An SF6-gas-air mixture was used, with a lower concentration (15 %) for smaller holes ≤ 400 µm (group 1, n = 17) and a higher concentration (30 %) for larger holes > 400 µm (group 2, n = 30). Besides preoperative visual acuity, postoperative IOP fluctuations and closure rate were reviewed. Results: The mean hole width with SD-OCT was 419 ± 155 µm, with a significant negative correlation with preoperative visual acuity (r = - 0.56, p = 0.002). In the first group, mean early postoperative IOP was 23 mmHg and in the second group 33 mmHg (p < 0.001). Thus, for small macular holes, early postoperative IOP decompensation from gas expansion in the eye could be minimised. The closure rate was 90 %, with no significant difference between the two groups (p > 0.05). Conclusion: Determining the width of a macular hole with SD-OCT is an important indicator for the necessary endotamponade. Using a lower gas concentration (15 %) for smaller holes (≤ 400 µm) to prevent postoperative IOP fluctuations does not negatively influence closure rates.

[Relevant Parameters of Optic Nerve Analysis from Spectral Domain OCT for Glaucoma Diagnostics]. / Relevante Parameter der Papillenanalyse mittels Spectral-Domain-OCT zur Glaukomdiagnostik.

BACKGROUND: In early diagnosis and follow-up of patients with glaucoma anatomic-diagnostic examinations have become more important in addition to static perimetry. Patients with open angle glaucoma suffer a slow visual field loss due to the loss of ganglion cells, which these examinations could detect earlier than perimetry can. METHODS: Parameters of the optical coherence tomography (OCT) were analysed in 89 patients (175 eyes) with advanced open angle glaucoma. In a prospective study, the functional findings from static perimetry (HFA-II, 24-2-programme) and the anatomic parameters of optic nerve analysis with SD-OCT (Cirrus-OCT) were evaluated. RESULTS: The results showed a mean deviation (MD) in perimetry of - 8.31 ± 9.76 dB and in the analysis of the optic nerve head of 71.93 ± 15.86 µm retinal nerve fibre layer (RNFL) as well as 85.54 ± 28.2 µm RNFL for the inferior quadrant, 0.95 ± 0.46 mm(2) for the rim area and 0.69 ± 0.18 for the vertical CD ratio. There was a significant correlation (p < 0.05) between MD und RNFL (r = 0.603), as well as RNFL of the inferior quadrant (r = 0.620), rim area (r = 0.552) and average CD ratio (r = - 0.551). The best correlation for the optical nerve head analysis was found between MD and vertical CD ratio (r = - 0.568). CONCLUSIONS: There was a good correlation between functional and anatomic parameters in perimetry and OCT. In particular, the mean and inferior retinal nerve fibre layer thickness, the rim area, and the vertical CD ratio revealed to be significant parameters in glaucomatous eyes.

[Effect of ocular compression on anterior chamber dimensions in cataract surgery using topical anaesthesia]. / Einfluss der Okulopression auf die Vorderkammerdimensionen vor der Kataraktoperation in topischer Anästhesie.

PURPOSE: Ocular compression is part of the preparation before cataract surgery to reduce the incidence of a positive intraoperative pressure. The purpose of this clinical study was to assess the influence of ocular compression on the anterior chamber dimensions and biometric parameters before cataract surgery using topical anaesthesia. METHODS: In a prospective, comparative observational study the biometric parameters were assessed with slitlamp-adapted anterior segment OCT (SL-OCT, Heidelberg Engineering) and ultrasound biometry (A-Scan+, Sonomed) in 51 consecutive patients (51 eyes) with a mean axial eye length of 22.90 ± 1.05 mm before cataract surgery. The measurements were performed in all patients before and immediately after ocular compression (Oculopressor G-15392, Geuder). In 32 patients the measurements were repeated 10 minutes after ocular compression. RESULTS: The optical and acoustic values of the anterior chamber depth did not change significantly after ocular compression (p > 0.05). Digital gonioscopy with OCT revealed a mean increase of the anterior chamber angle of 2.37° (p < 0.001) from 45.75 ± 7.28° to 48.12 ± 7.28°, and the angle opening distance of 37 µm (p = 0.017) from 627 ± 184 µm to 664 ± 162 µm. Also the average acoustic axial vitreous distance decreased significantly from 15.22 ± 0.98 to 15.18 ± 0.96 mm (p = 0.034) with a posterior shift in the relative lens position (p = 0.018). CONCLUSIONS: In this clinical study, only slight anterior chamber and biometric changes were observed after ocular compression before cataract surgery using topical anaesthesia. There was a significant increase of the anterior chamber angle and angle opening distance with a concomitant decrease of the vitreous distance and shifting of the iris lens diaphragm.

[Application of mitomycin in primary covered sclerotomy]. / Die gedeckte Sklerotomie mit primärer Mitomycin-C-Applikation.

BACKGROUND: The covered sclerotomy is a minimally invasive, standardized fistulating glaucoma surgical procedure with reduced risk of complications. Early postoperative bleb fibrosis is a main success-limiting problem. In this clinical study IOP follow-up and the one year success rate after primary application of mitomycin C (MMC) is analyzed. PATIENTS AND METHODS: In 76 eyes with advanced glaucoma and without previous fistulating surgery, a covered sclerotomy combined with 3-minute-application of MMC0,02 % was performed. Over a period of 12 months, bleb and pressure were controlled regularly. The success rates were compared primarily with data from an earlier study without application of MMC. RESULTS: The mean age of the patients was 70 ± 11 years. 45 % had a pseudoexfoliation syndrome while 41 % were pseudophakic. The mean intraocular pressure (IOP) was 27 ± 8,5 mmHg preoperatively. After 12 months it was 16,2 ± 4,3 mmHg (p < 0.05) with a mean IOP reduction of 40 %. The absolute success rate (intraocular pressure < 21 mmHg without antiglaucoma therapy) was 58 % and the relative success rate (intraocular pressure < 21 mmHg under treatment) was 71 %. A revision or a needling was performed in 22 eyes (29 %). MMC-related complications were not observed. CONCLUSION: Through the additional MMC application on the base of the primary covered sclerotomy a significant pressure reduction could be achieved. 58 % of the patients didn't need any glaucoma medicine. The absolute success rate was higher than without additional inhibitions of the fibrosis.

[Challenges in inpatient ophthalmology for elderly patients]. / Herausforderungen in der stationären Augenheilkunde bei hoch- und höchstbetagten Patienten.

PURPOSE: The demographic changes will lead to an increase in elderly patients in the field of medicine and in particular ophthalmology. The purpose of this study was to assess ocular problems of inpatients in the clinical setting with a focus on patients over 60 years old, especially elderly patients over 80 years and very old patients over 90 years. METHODS: All consecutive inpatients were included in the study. Medical data were analyzed concerning the diagnosis, operative indications and comorbidities and the presence of dementia disorders was also considered. The effects of age or diseases on the inpatient course were investigated. RESULTS: At the eye clinic in Frankfurt (Oder) the mean age of patients was 69 years and was the highest of all medical and surgical disciplines. The age of patients of internal medicine was similarly with 67 years but orthopedic and urological patients were on average 64 years old. In the other departments the mean age of patients was clearly less than 60 years old. Of the patients 26% were aged 80 years or older. A total of 31 patients over 90 years old were treated as inpatients (2.0%) during the year 2012. The treatment-relevant diagnosis increased with age. Nearly 40% had a reduced mobility at an age of 80-89 years and 60% at an age over 90 years. In the age group over 90 years approximately 25% had dementia and 20% a visual disorder. CONCLUSION: Old and very old patients with ocular problems and more than 80-90 years of age had an increased comorbidity concerning the relevant treatment diagnostics. This has relevant implications and challenges for nursing and medical care in the clinical setting.

[Surgical treatment of chronic macular oedema with a combination therapy]. / Operative Behandlung des chronischen Makulaödems durch eine Kombinationstherapie.

BACKGROUND: The treatment of therapy-resistent chronic macular oedema remains a challenge. Therefore a combination therapy, consisting of medical, biological and mechanical components was assessed. METHODS: A surgical treatment was performed in 35 eyes (34 patients) with chronic and therapy-resistant macular oedema, resulting from diabetic maculopathy (n = 25), vitreoretinal traction (n = 7) or following a retinal venous occlusion (n = 3). An intravitreal injection of bevacizumab was given on the day before surgery, consisting of pars plana vitrectomy with ILM peeling with Brilliant Blue G (BBG), as well as an air tamponade combined with postoperative prone positioning. The visual function and the central retinal thickness were measured in follow-up. RESULTS: Functionally, the visual acuity could be stabilised to an average of 0.18 and macular oedema was reduced in most patients. Anatomically, a significant reduction in central macular thickness by 193 µm (29 %), from 598 µm to 405 µm (p < 0.001), and a regression in the intraretinal cystoid changes were observed. No significant complications occurred, whereas in 6 patients additional consecutive treatment was necessary. CONCLUSION: A stabilisation of the visual acuity and an improvement in the structural retinal situation could be achieved by an elaborate combination therapy, based on a pharmacological, a biological and a mechanical approach. Long-term follow-up and consecutive supplementary treatments are necessary to ensure the functional stability.

[Clinical experience with brilliant blue G staining of the retinal surface]. / Klinische Erfahrungen zur Färbung der Netzhautoberfläche mit Brilliant blau G.

BACKGROUND: Staining of the retinal surface has improved the intraoperative removal of semitransparent membranes during macular surgery. The purpose of this study was to evaluate the clinical experiences with brilliant blue G (BBG) staining of the retinal surface. METHODS: BBG (Brilliant peel, Fluoron) was applied during vitrectomy and macular surgery in 43 patients. In 47 % there was a macular hole (MH), whereas 53 % had epiretinal membranes (ERM). Intraoperatively BBG was applied on the retinal surface under infusion or air conditions for 30 - 60 s. In MH the internal limiting membrane (ILM) and in ERM the membrane was removed. Postoperatively all patients were examined on average after 9 weeks. RESULTS: Although intraoperative BBG staining was less intensive compared to ICG staining, the staining was sufficient to safely remove the semitransparent membranes in all cases. In all patients with MH hole closure was achieved, and in 96 % with ERM the metamorphopsiae decreased. The mean decimal visual acuity increased from 0.25 ± 0.13 to 0.37 ± 0.20 (p < 0.05) and improved in 63 % of the patients. Clinically, there were no toxic side-effects from BBG staining. CONCLUSIONS: BBG allowed a complete and selective staining of the retinal surface. Thus, ILM and ERM could be removed safely during macular surgery. No clinical retinal toxicity was observed.

[Aberration corrected intraocular lens for microincision cataract surgery (MICS). Intraindividual comparison with a conventional lens - 1-year follow-up]. / Aberrationskorrigierte Intraokularlinse für die mikroinzisionale Kataraktchirurgie (MICS). Intraindividueller Vergleich mit einer konventionellen Linse - Einjahresergebnisse.

Microincision cataract surgery (MICS) is an important advancement in the field of cataract surgery. This article compares an aberration corrected hydrophilic acrylic intraocular lens (IOL) having a hydrophobic surface for MICS with a one-piece hydrophobic acrylic IOL with respect to capsule sac stability, image quality, and after-cataract formation over the course of 1 year. The operations were performed as bimanual MICS or coaxial phacoemulsification. Overall the results after implantation of the IOL by MICS can be regarded as positive in comparison to the standard operation.

[Combined implantation of monofocal and multifocal intraocular lenses for presbyopia correction in cataract patients]. / Kombinierte Implantation einer Mono- und einer Multifokallinse zur Presbyopiekorrektur bei Kataraktpatienten.

BACKGROUND: The purpose of this study was to assess uncorrected far and near vision after implantation of a multifocal intraocular lens (IOL) in the second eye in patients with a unilateral monofocal IOL. PATIENTS AND METHODS: 13 cataract patients with a monofocal intraocular lens in one eye (SA60AT, Alcon) and postoperative emmetropia received a multifocal lens in the second eye (ReSTOR, Alcon). Two and six months postoperatively the clinical examination, far and near vision, near aniseikonia (AWAYA-New Aniseikonia Test), stereo vision (Lang I test) and the mesopic contrast sensitivity (F. A. C.T) were tested. In addition, the grade of satisfaction without glasses in general, and with far and near vision were noted on a visual analogue scale (0 - 10). Furthermore, independence from glasses and the presence of optical phenomena were assessed. RESULTS: The mean uncorrected far visual acuity 6 months postoperatively was 1.06 +/- 0.28 for the monofocal lens, 0.88 +/- 0.23 for the multifocal lens, and 1.16 +/- 0.24 binocularly. The uncorrected near visual acuity was Nieden 1 binocularly for all patients and ranged from Nieden 1 - 3 for the multifocal lens to Nieden 2 - 11 for the monofocal lens. 77% of the patients received the multifocal lens in their far dominant eye. The mean uncorrected near aniseikonia was < 1%. The mesopic contrast sensitivity showed no significant differences between the two IOL types and compared to binocular values. The satisfaction with the uncorrected visual acuity was in general 8.88 +/- 1.21, with the far visual acuity 9.42 +/- 1.24, and 7.33 +/- 1.72 with the near visual acuity. After 6 months 67% of the patients used glasses only for periods of prolonged reading. Halos and a low degree of glare were noted by 38.5% of patients 2 months postoperatively. At the 6 months visit 33.3% still had halos and only 8% glare. CONCLUSIONS: This first experience with the combined implantation of a monofocal and a multifocal lens revealed a marked improvement of the uncorrected near visual acuity compared to bilateral monofocal IOL implantation along with a high patient satisfaction.

[Surgical experience with microcoaxial phacoemulsification]. / Operative Erfahrungen mit der koaxialen Mikro-Phakoemulsifikation.

BACKGROUND: The further reduction of the incision width is a recent development in cataract surgery. The purpose of this prospective clinical study was to evaluate the surgical experience with microcoaxial phacoemulsification (MCP). PATIENTS AND METHODS: A total of 109 eyes with senile cataract were operated. 37 patients (37 eyes) received MCP with a 2.2 mm corneal incision width (Megatron S 3, Geuder) and implantation of a one-piece, hydrophobic intraocular lens (AcrySof, Alcon). The intraoperative parameters of total surgical time, effective phacoemulsification time, anterior chamber stability, and wound closure were compared to a control group of 72 patients with a 3.0 mm incision width and standard phacoemulsification. RESULTS: Total surgical time with MCP could be reduced with increasing experience (p = 0.012). All procedures were without complications. The anterior chamber stability and wound closure at the end of the procedure were excellent in 89 % and 70 % of the cases, respectively. After intraocular lens implantation a stromal hydration of the wound was necessary in 11 % of the patients. The mean effective phacoemulsification time was, in the MCP group (10.17 +/- 5.53 seconds), higher than in the standard phacoemulsification group (4.98 +/- 3.11 seconds, p < 0.001). CONCLUSIONS: Microcoaxial phacoemulsification allowed a rapid and easy reduction of the incision width in cataract surgery. Although the safety was ensured, further efficiency improvements with modification of the phacoemulsification parameters are necessary.

[Refractive long-term results after piggyback intraocular lens implantation]. / Refraktive Langzeitergebnisse nach Huckepackimplantation.

BACKGROUND: Piggyback lens implantation is an alternative to exchange of the original intraocular lens (IOL) to treat high anisometropia in pseudophakic eyes. We present our results. PATIENTS AND METHOD: A second IOL (piggyback) was implanted in 27 patients from 2000 to 2006. Nineteen patients were clinically investigated late postoperatively, and data for the other eight patients were evaluated from the patients' files. RESULTS: The patients were 65+/-9 years old. Follow-up time was 38+/-25 months. The mean preoperative spherical equivalent (SE) in the myopic eyes was -7.86+/-3.82 D and in the hyperopic eyes was 1.64+/-0.74 D. After surgery, the mean SE in the myopic eyes was -1.77+/-1.82 D and in the hyperopic eyes was -0.09+/-0.51 D. Postoperative anisometropia was reduced from 4.64+/-3.3 D. to 0.9+/-0.82 D. CONCLUSION: Piggyback lens implantation is a safe and effective surgical procedure and is less traumatic than exchange of the original IOL.

[Early visual recovery after cataract surgery using topical and intracameral anesthesia]. / Frühe visuelle Rehabilitation nach Kataraktoperation in kombinierter topischer und intrakameraler Anästhesie.

INTRODUCTION: Topical anaesthesia in cataract surgery permits early visual rehabilitation due to the reduced impact on the optic nerve function. In this prospective study, we evaluated the course of visual improvement after surgery. PATIENTS AND METHODS: 45 consecutive patients with senile cataract and no concomitant eye disease were included in the study. Cataract surgery by clear corneal phacoemulsifaction was performed with insertion of a foldable IOL in the capsular bag under topical anaesthesia. For anaesthesia topical lidocaine gel (2 %) and intracameral injection of 0.15 ml lidocaine (1 %) was used. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were measured in decimal fractions within 4 hours after surgery and 1 day postoperatively. RESULTS: The average preoperative UCVA was 0.23 +/- 0.39 and BCVA was 0.38 +/- 0.23 SD. Four hours postoperatively UCVA and BCVA improved significantly to 0.48 +/- 0.24 and 0.68 +/- 0.18, respectively. One day after surgery, the average UCVA was 0.65 +/- 0.15 and the BCVA was 0.89 +/- 0.07. 75 % (34) of the patients improved to a UCVA of 0.5 or better. The visual acuity improved in all patients one day after surgery, with 60 % (27) of the patients achieving a BCVA of 0.9 or better one day postoperatively. The postoperative corneal function had a significant influence on visual recovery (p = 0.01). CONCLUSION: A significant visual improvement was observed immediately after cataract surgery using the combination of topical and intracameral anaesthesia. 75 % of the patients reached a UCVA, which permitted sufficient visual function for mobility and orientation. Thus, the rapid recovery of visual function suggests an increased safety, particularly for out-patient surgery.

[Therapy refractory blepharoconjunctivitis in a 90 year old patient]. / Therapierefraktäre Blepharokonjunktivitis bei einer 90-jährigen Patientin.

Sebaceous gland carcinoma can clinically mimic benign conditions such as chalazion and blepharoconjunctivitis. This carcinoma should be histologically excluded for every unilateral, recalcitrant chalazion and every unilateral, therapy refractory blepharitis. Autosomal dominant Muir-Torre syndrome should be considered in patients who develop sebaceous gland carcinoma of the ocular adnexa. In this case, the sebaceous gland carcinoma is combined with visceral carcinoma.

[Iris sutures for refixation of decentered intraocular lenses]. / Irisnahtfixation bei dezentrierter Intraokularlinse.

BACKGROUND: Most revisions after intraocular lens (IOL) implantation are due to an insufficiency of the zonular apparatus. Frequently, an inferior decentration can be seen ("sunset syndrome"). In this clinical study, suture refixation of the haptics to the iris was assessed. Functional and morphological results were considered. METHOD: 21 eyes with subluxation of the IOL were treated with iris sutures for refixation. The operation was performed under topical and intracameral anaesthesia. Refixation was achieved by suturing one or both haptics to one or two fixation points in the outer periphery of the iris. Complete zonular dialysis made it necessary to suture at two fixation spots. All eyes were examined preoperatively, at one day and three months postoperatively considering functional results and postoperative IOL centration. RESULTS: In 15 eyes (71%), the IOL was optimally centred postoperatively. In 5 eyes (24%), a revision had to be performed due to instable centration. In one further case the IOL was minimally decentred, but its position was stable. Best corrected visual acuity was 0.3 +/- 0.2 preoperatively and 0.5 +/- 0.2 after three months. The mean refraction was stable in the postoperative course and astigmatism did not change significantly. There were no major complications intraoperatively or postoperatively, but a localised iris atrophy at the haptic fixation points was noted. CONCLUSIONS: In the presence of a partially intact zonular apparatus, iris sutures are a safe and minimally invasive method for fixing a decentred IOL. Postoperative centration and functional results were stable after 3 months.

[Influence of age on optical aberrations of the human eye]. / Einfluss des Alters auf die optischen Aberrationen des menschlichen Auges.

BACKGROUND: Currently the influence of age on corneal and ocular aberrations is still insufficiently known. The aim of this clinical study was to compare age-related aberrations of human eyes. METHODS: In a prospective study 98 eyes of 49 healthy patients ranging from 17 to 65 years of age (38.6+/-10.0 years) were consecutively examined. The best corrected visual acuity ranged from 0.8 to 1.6; 48 eyes were emmetropic (SE+/-0.5 D), 42 eyes myopic (SE <-0.5 to -6.75 D), and 8 eyes hyperopic (SE >+0.5 to +3.88 D). The corneal aberrations were derived from corneal topography (Keratron Scout, Optikon). The measurement of ocular aberrations was performed with a Tscherning wavefront aberrometer (ORK, Schwind). The aberrations of the Zernike coefficients and RMS values (1st to 4th order) were determined. RESULTS: The mean corneal and ocular Zernike coefficients of higher order were smaller than 0.2 microm. There was an evident decrease of wavefront aberrations with increasing order. Higher order corneal aberrations were larger than the corresponding ocular aberrations. With increasing age higher optical errors increased in complexity, and the correlation of corneal and ocular aberrations decreased with significant differences. Although the corneal ocular RMS value of the 3rd and 4th order correlated in the younger group (r=0.51, p=0.0001), there was no correlation in the older group (r=-0.48, p=0.832). The influence of age caused a significant increase of ocular aberrations of the 3rd and 4th order, in particular a tenfold extension of coma (C07) (p=0.002), a twofold extension of spherical aberration (C12) (p=0.0001), and an increase of the 3rd and 4th order RMS values (p=0.001). CONCLUSIONS: Increased age induced an increase in optical aberrations of the eye, which demonstrates the influence of the lens on ocular aberrations. The combination of corneal and ocular diagnostic methods is recommendable for a better understanding of visual performance.

[Cataract surgery in patients with end-stage glaucoma]. / Katarakt-Operation bei Patienten mit Glaucoma fere absolutum.

BACKGROUND: The purpose of this study was to assess the benefit of cataract surgery in patients with advanced cataract and glaucoma. METHODS: In a prospective study, we investigated 12 consecutive patients (12 eyes). Inclusion criteria were the diagnosis of cataract and end-stage glaucoma with a cup-disc ratio (CD) of 0.9-1.0 and marked visual field defects with partially preserved central function. Preoperatively, at the third postoperative day and after 6 months (2-11 months), the visual acuity (V), the intraocular pressure (IOP), the number of antiglaucomatous drugs and the visual fields were assessed. Furthermore, the surgical procedure and possible complications were noted. In all patients cataract surgery was performed with topical anaesthesia. RESULTS: 10 patients were treated with cataract surgery alone, whereas 2 patients underwent combined cataract and glaucoma surgery. The mean visual acuity improved significantly from 0.3 to 0.5 (p = 0.007). Additionally a significant intraocular pressure reduction of 4.4 mm Hg (p = 0.007) was observed. The number of antiglaucomatous drugs decreased from 1.5 preoperatively to 0.8 postoperatively. The mean deviation (MD) improved from -27.5 dB up to -26.4 dB (p = 0.036) after 6 months. CONCLUSION: Patients with progressive cataract and end-stage glaucoma can benefit from cataract surgery. Although marked visual field defects were present, an increase in visual acuity as well as a decrease of intraocular pressure may be achieved without worsening of the visual fields.

[Functional results after intraocular lens implantation with or without blue light filter: an intraindividual comparison]. / Funktionelle Ergebnisse nach Intraokularlinsenimplantation mit oder ohne Blaulichtfilter: ein intraindividueller Vergleich bei 14 Kataraktpatienten.

BACKGROUND: The new generation of intraocular lenses (IOL) with an additional blue light filter has a slight yellowish colour (compared to the IOLs with only a UV filter) due to its different light transmitting properties. This could have an effect on contrast sensitivity and subjective visual perception. PATIENTS AND METHODS: In this intraindividual prospective comparative study including 14 cataract patients without further ocular pathology, a blue light filtering IOL (SN60AT, Alcon) was implanted in one eye and 1 month later a conventional single-piece IOL (SA60AT, Alcon) was fitted into the fellow eye. The visual acuity and the clinical findings were assessed at one day and four weeks post-operatively. Contrast sensitivity was tested under defined mesopic (6 cd/m(2)) and high mesopic (18.8 cd/m(2)) light conditions in the Ginsburg Box using the Functional Acuity Contrast Test (F.A.C.T.). Furthermore, subjective differences in the visual perception of both eyes were noted. RESULTS: The contrast sensitivity testing 1 day and 1 month postoperatively, revealed no statistically significant differences (P > 0.008) between both IOL types for all spatial frequencies (1.5/3/6/12/18 cpd) and light levels. 13 patients (85 %) reported no differences in the colour perception of both eyes, and none had visual disturbances. CONCLUSION: This intraindividual comparison revealed no relevant differences concerning mesopic contrast sensitivity and the subjective visual perception after implantation of one IOL with or without a blue light filter.

[Covered sclerotomy for fistulating glaucoma surgery]. / Die gedeckte Sklerotomie als fistulierende Glaukom-Operation.

BACKGROUND: Covered sclerotomy was developed as a minimally invasive modification of filtering glaucoma surgery. In this prospective study the clinical results are compared after one year. PATIENTS AND METHODS: 58 eyes with advanced glaucoma were studied. 32 eyes had a covered sclerotomy (ST) and 26 had an ST with viscoelastic filling of the anterior chamber in order to reduce the postoperative hypotony rate (ST+H). The ST procedure consisted in the preparation of a 4-mm corneoscleral tunnel incision with a T-shaped 1.75-mm wide perforation and radial transection of the tunnel floor. RESULTS: The preoperative intraocular pressure (IOP) was on average 30 +/- 8.5 mmHg (ST) and 26 +/- 8.3 mmHg (ST+H). After 1 year the IOP decreased significantly (P < 0.05) to 17 +/- 3.7 mmHg (ST) and 17 +/- 2.9 mmHg (ST+H). The mean IOP reduction was 37 % (ST) and 30 % (ST+H). Revisions were required in 37 % (ST) and 15 % (ST+H) of the cases. The postoperative hypotony rate was 34 % in both groups. The number of morphologically functional filtering blebs was 60 % (ST) and 70 % (ST+H) after one year. CONCLUSIONS: The covered sclerotomy required minimal surgical manipulations of the conjunctiva and sclera. After 1 year a significant reduction of the IOP was achieved. However, the occurrence of bleb scarring could not be lowered compared to trabeculectomy. Therefore further modifications with the primary application of antimetabolites are planned.