Stability and Visual Outcomes of the Capsulotomy-Fixated FEMTIS-IOL After Automated Femtosecond Laser-Assisted Anterior Capsulotomy.

PURPOSE: To evaluate stability and performance of a new monofocal anterior capsulotomy-fixated intraocular lens (IOL) (FEMTIS; Teleon Surgical B.V., Spankeren, Netherlands) after femtosecond laser-assisted cataract surgery (FLACS). DESIGN: Prospective, multicenter, interventional, noncomparative case series. METHODS: FLACS with FEMTIS IOL was performed in 336 eyes of 183 cataract patients with fixation of the IOL to the anterior capsulotomy followed up for 12 months. Examination included uncorrected distance visual acuity (UDVA), best-corrected visual acuity (CDVA), subjective refraction, IOL centration, posterior capsule opacification (PCO), and investigators' satisfaction questionnaire. RESULTS: At 12 months, mean IOL rotation was 1.50 ± 1.76 degrees and decentration 0.14 ± 0.14 mm from baseline (day of surgery). Mean horizontal IOL tilt was 0.70 ± 0.60 degrees and vertical 1.15 ± 1.06 degrees relative to the baseline (crystalline lens). Mean distance between IOL and iris was 0.32 mm to 0.36 mm for all measured meridians. Mean UDVA was 0.12 ± 0.14 logMAR (range -0.20 to 0.54 logMAR), mean CDVA -0.01 ± 0.09 logMAR (range -0.30 to 0.20 logMAR). Mean spherical equivalent was 0.35 ± 0.53 diopter (D) and 98% of eyes (n = 235) were within ±1.0 D. Median PCO score was 1 with an Nd:YAG laser rate of 3.1% after 12 months. Most surgeons were very satisfied (median score: 1) with surgery and implanted IOL. CONCLUSIONS: Implantation of FEMTIS IOL provided excellent visual and stable refractive outcomes. IOL decentration was very low compared to other published studies and showed an exceptional high in-the-bag stability over a 12-month period. This lens benefits from femtosecond laser capsulotomies. It can be positioned very predictably and offers an optimal platform for toric and multifocal IOL optics.

[New intraocular lens designs for femtosecond laser-assisted cataract operations : Chances and benefits]. / Neue Intraokularlinsendesigns für die Femtosekundenlaser-assistierte Kataraktoperation : Chancen und Nutzen.

BACKGROUND: The perfection and high reproducibility of capsulotomy in femtosecond laser-assisted cataract surgery (FLACS) lead to the possibility of new intraocular lens (IOL) designs for capsulotomy fixed implantation. ISSUE: Which different designs have so far been presented for which problems in capsulotomy fixation? MATERIAL AND METHOD: An evaluation of the literature and conference data was carried out. RESULTS: Currently four different types of femtolenses for capsulotomy fixation are described in the literature or are commercially available. The first described was the lens in the bag or Tassignon IOL, which was developed for secondary cataract prevention, the second was the Masket IOL for reduction of negative dysphotopsia and third the 90F designed by Dick. All three types are or will be produced by Morcher. The fourth lens is the Femtis from Oculentis. All lenses are characterized by a high level of safety during implantation, The Tassignon lens leads to reduction of secondary cataract, especially in juvenile cataract because of the additional posterior capsulotomy. In studies the Masket IOL could show a decrease of negative dysphotopsia. In comparison to standard lenses, the 90F and Femtis in particular showed better results with respect to tilt, rotation and decentration. CONCLUSION: The new IOL designs for capsulotomy fixation show a safe implantation procedure and indications for a very stable position in the capsular sac. Further studies must be carried out to confirm the possible advantages in comparison to standard IOL with respect to postoperative results for refraction, tilt, rotation and decentration and possible induction of aberrations.

Determining and Comparing the Effective Lens Position and Refractive Outcome of a Novel Rhexis-Fixated Lens to Established Lens Designs.

PURPOSE: WE sought to evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOLs) with plate-haptic, c-loop haptic, and a rhexis-fixated lens were compared. DESIGN: Retrospective, multicenter, comparative case series. METHODS: The study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic, or a novel rhexis-fixated IOL. Biometry and refraction measurements were conducted preoperatively and 3 months postoperatively. Lens constant optimization was performed. RESULTS: Seventy eyes of 56 subjects were included. ELP for rhexis-fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis-fixated IOL and both plate-haptic (P = .001) and c-loop haptic IOL (P = .000). Anterior chamber depth adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P < .05). For the rhexis-fixated IOL the differences in refraction ranged from -0.039 diopters (D) for the Hill-Radial Basis Function to -0.096 D for Haigis. The other 2 lenses showed mean differences in refraction between +0.046 D for Hill-Radial Basis Function and +0.097 D for Haigis. CONCLUSION: The difference in IOL fixation and its resulting position in the capsular bag have a significant effect on the effective lens position and consequently a significant effect on the prediction of postoperative refraction.

SFTA3 - a novel surfactant protein of the ocular surface and its role in corneal wound healing and tear film surface tension.

The study aimed to characterize the expression and function of SFTA3 at the ocular surface and in tears. Ocular tissues, conjunctival (HCjE) and human corneal (HCE) epithelial cell lines as well as tearfilm of patients suffering from different forms of dry eye disease (DED) were analyzed by means of RT-PCR, western blot, immunohistochemistry, and ELISA. A possible role of recombinant SFTA3 in corneal wound healing was investigated performing in vitro scratch assays. Tear film regulatory properties were analyzed with the spinning drop method and the regulation of SFTA3 transcripts was studied in HCE and HCjE after incubation with proinflammatory cytokines as well as typical ocular pathogens by real-time RT-PCR and ELISA. The results reveal that human ocular tissue as well as tears of healthy volunteers express SFTA3 whereas tears from patients with DED showed significantly increased SFTA3 levels. In vitro wounding of HCE cell cultures that had been treated with recombinant SFTA3 demonstrated a significantly increased wound closure rate and rSFTA3 reduced the surface tension of tear fluid. The results indicate that SFTA3 at the ocular surface seemed to be involved in wound healing and the reduction of surface tension.

Validity and repeatability of the Aladdin ocular biometer.

AIM: To assess the accuracy and reproducibility of biometry undertaken with the Aladdin (Topcon, Tokyo, Japan) in comparison with the current gold standard device, the IOLMaster 500 (Zeiss, Jena, Germany). SETTING: University Eye Clinic, Birmingham, UK and Refractive Surgery Centre, Kiel, Germany. METHODS: The right eye of 75 patients with cataracts and 22 healthy participants were assessed using the two devices. Measurements of axial length (AL), anterior chamber depth (ACD) and keratometry (K) were undertaken with the Aladdin and IOLMaster 500 in random order by an experienced practitioner. A second practitioner then obtained measurements for each participant using the Aladdin biometer in order to assess interobserver variability. RESULTS: No statistically significant differences (p>0.05) between the two biometers were found for average difference (AL)±95% CI=0.01±0.06 mm), ACD (0.00±0.11 mm) or mean K values (0.08±0.51 D). Furthermore, interobserver variability was very good for each parameter (weighted κ≥0.85). One patient's IOL powers could not be calculated with either biometer measurements, whereas a further three could not be analysed by the IOLMaster 500. The IOL power calculated from the valid measurements was not statistically significantly different between the biometers (p=0.842), with 91% of predictions within±0.25 D. CONCLUSIONS: The Aladdin is a quick, easy-to-use biometer that produces valid and reproducible results that are comparable with those obtained with the IOLMaster 500.

Rock 'n' roll phacoemulsification technique: noncracking and nonchopping approach.

The rock 'n' roll phaco technique we describe does not require nucleus chopping or cracking. In this easy-to-learn technique, the lens nucleus is fragmented from both sides, which seems to be an advantage in very soft nuclei.

A new method of cornea modulation with excimer laser for simultaneous correction of presbyopia and ametropia.

PURPOSE: To investigate the outcomes of simultaneous correction of presbyopia and ametropia by a bi-aspheric cornea modulation technique, based on the creation of a central area hyperpositive for near vision and leaving the pericentral cornea for far vision in hyperopic, emmetropic, and myopic presbyopic patients. SETTING: Sixty eyes of 30 patients were treated with the PresbyMAX technique by one surgeon (D.U.) at the Eye Hospital Bellevue, Kiel, Germany. METHODS: Twenty eyes with hyperopic presbyopia, 20 eyes with emmetropic presbyopia, and 20 eyes with myopic presbyopia underwent Femto-Lasik, and were assessed up to 6 months postoperatively. All eyes underwent cornea treatment using the PresbyMAX® software, delivering a bi-aspheric multifocal ablation profile developed by SCHWIND eye-tech-solutions (Kleinostheim, Germany). All flaps were created by Ziemer LDV Femtolaser (Port, Switzerland). RESULTS: The mean binocular distance of uncorrected visual acuity (DUCVA) improved in the hyperopic group from 0.28 ± 0.29 logMAR to -0.04 ± 0.07 logMAR, in the emmetropic group from -0.05 ± 0.07 logMAR to 0.02 ± 0.11 logMAR, and in the myopic group from 0.78 ± 0.27 logMAR to 0.09 ± 0.08 logMAR. The mean binocular near uncorrected visual acuity (NUCVA) increased in the hyperopic group from 0.86 ± 0.62 logRAD to 0.24 ± 0.23 logRAD, and in the emmetropic group from 0.48 ± 0.14 logRAD to 0.18 ± 0.11 logRAD. The myopic presbyopes showed a decrease of the mean binocular NUCVA from 0.04 ± 0.19 logRAD to 0.12 ± 0.18 logRAD. The mean postoperative spherical equivalent for distance refraction was -0.13 ± 0.61 D for the hyperopic presbyopia, -0.43 ± 0.35 D for the emmetropic presbyopia, and -0.68 ± 0.42 D for the myopic presbyopia group, whereas the software took aim at -0.50 D in all groups. CONCLUSIONS: In presbyopic patients without symptomatic cataracts, but refractive errors, PresbyMAX® will decrease the presbyopic symptoms and correct far distance refraction in the same treatment, offering spectacle-free vision in daily life in most of the treated patients. Further investigation is necessary to evaluate the overall benefit of this procedure.

Perioperative intensity-modulated brachytherapy for refractory orbital rhabdomyosarcomas in children.

PURPOSE: To evaluate the feasibility and toxicity of perioperative intensity-modulated brachytherapy (IMBT) as well as functional outcome in children with therapy-refractory orbital rhabdomyosarcomas (RMS). PATIENTS AND METHODS: Since 1993, children with therapy-refractory orbital RMS have been treated by a multidisciplinary approach combining function-preserving, mostly R1 tumor resection and perioperative IMBT at the University Hospital of Schleswig-Holstein, Germany. All children with orbital RMS, who were enrolled in this multidisciplinary treatment protocol between 1993 and 2002, were prospectively assessed with respect to evaluation of side effects and functional outcome. RESULTS: Ten children (six boys, four girls) were included. Median age was 6.5 years (range, 1-19 years) at the beginning of our treatment and 6.0 years (range 1-17 years) at diagnosis. All children were in Intergroup Rhabdomyosarcoma Study Group (IRSG) group III and had embryonal subtype. Estimated 5-year survival was 62% +/- 18%. There was no radiation-related toxicity grade 3 or 4 observed. The eyes were primarily preserved in all cases. One child underwent secondary orbital exenteration 10 months after completion of IMBT. Visual acuity could be preserved apart from one child developing significant visual deterioration due to radiation cataract grade 2. The cosmetic results were good or very good in eight and moderate in two children. Four children died of their disease. CONCLUSION: This interdisciplinary, individually tailored and function-preserving treatment procedure has proven to be a well-tolerated therapeutic option in cases with refractory orbital RMS. It provides both improvement of local tumor control and quality of life.

Laserinterferometric measurements of accommodative changes in the position of an optic-shift intraocular lens.

PURPOSE: To measure optically and pharmacologically induced movement of an optic-shift intraocular lens (HumanOptics 1CU). METHODS: The change in position as well as the accommodative effect of the 1CU was determined using an anterior chamber laser interferometer (Zeiss ACMaster) in 15 eyes of 9 patients. Accommodation was induced by optical stimulus and pharmacologically by pilocarpine 2%. RESULTS: The mean forward movement due to optical-induced accommodation stimulation was 5 +/- 14 microm (range: -10 to + 40 microm). Pharmacological stimulation with 2% pilocarpine caused mean anterior movements of 93 +/- 162 microm (range: -321 to +/- 402 microm). CONCLUSIONS: A maximum accommodative effect of 0.50 diopters was measured with this method. This relatively small accommodative effect of the 1CU is in agreement with other studies. Pharmacologically induced optic shift differs significantly from optically induced shift and allows no conclusion on a clinically expected accommodative effect.

Potentially accommodating 1CU intraocular lens: 1-year results in 553 eyes and literature review.

PURPOSE: To investigate the advantages, clinical outcomes, and safety after implantation of the 1CU (HumanOptics AG) optic shift intraocular lens (IOL) in comparison with a conventional monofocal IOL. METHODS: In a prospective non-randomized study, 553 eyes implanted with the 1CU IOL were examined. In a control group, a monofocal posterior chamber IOL (MCTE, Dr Schmidt) was implanted in 219 eyes. Follow-up was performed at 1, 6, and 12 months postoperatively. The clinical effect for near visual acuity was evaluated by subjective measurements using an accommodometer, defocusing curve, and Nieden charts. RESULTS: No significant differences were noted in distance best spectacle-corrected visual acuity (BSCVA) between groups. Average near visual acuity with distance BSCVA for the 1CU was 0.41 and 0.35 for the control group. The difference in the accommodation response between both groups measured with the accommodometer was 11 cm (P < .01). The refraction tolerance for the 1CU was 0.25 D whereas the MCTE revealed no refraction tolerance (P < .01). Decentration and tilting of the 1CU resulted in explantation of three IOLs. CONCLUSIONS: The 1CU indicates a minor statistical advantage of half a reading step towards monofocal IOLs measured with subjective methods in near point, defocusing curve, and near visual acuity with distance BSCVA. This could be due to pseudophakic accommodation by the optic shift mechanism or a result of additional pseudophakic pseudoaccommodation. The accommodative effect of the 1CU differed from patient to patient and was not predictable.

Feasibility of combined operation and perioperative intensity-modulated brachytherapy of advanced/recurrent malignancies involving the skull base.

PURPOSE: To assess the technical feasibility and toxicity of combined operation and perioperative intensity-modulated fractionated interstitial brachytherapy (IMBT) in advanced-stage malignancies involving the skull base with the goal of preserving the patients' senses of sight. PATIENTS AND METHODS: This series consisted of 18 consecutive cases: ten patients with paranasal sinus carcinomas, five with sarcomas, two with primitive neuroectodermal tumors (PNETs), and one with parotid gland carcinoma. After, in most cases, subtotal surgical resection (R1-R2: carried out so that the patients' senses of sight were preserved), two to twelve (mean five) afterloading plastic tubes were placed into the tumor bed. IMBT was performed with an iridium-192 stepping source in pulsed-dose-rate/high-dose-rate (PDR/HDR) afterloading technique. The total IMBT dose, ranging from 10 to 30 Gy, was administered in a fractionated manner (3-5 Gy/day, 5 days/week). RESULTS: Perioperative fractionated IMBT was performed in 15 out of 18 patients and was well tolerated. Complications that partially prevented or delayed IMBT in some cases included cerebrospinal fluid leakage (twice), meningitis (twice), frontal brain syndrome (twice), afterloading tube displacement (twice), seizure (once), and general morbidity (once). No surgery- or radiation-induced injuries to the cranial nerves or eyes occurred. Median survival times were 33 months after diagnosis and 16 months after combined operation and IMBT. CONCLUSION: Perioperative fractionated IMBT after extensive but vision-preserving tumor resection seems to be a safe and well-tolerated treatment of advanced/recurrent malignancies involving the skull base. These preliminary data suggest that combined operation and perioperative fractionated IMBT is a palliative therapeutic option in the management of fatal malignancies involving the base of the skull, a strategy which leaves the patients' visual acuity intact.

Intravitreal r-TPA and gas injection in traumatic submacular hemorrhage.

AIM: To present the technique and efficiency of intravitreal recombinant tissue plasminogen activator (r-TPA) and gas injection in acute submacular hemorrhage (SMH) due to traumatic choroidal rupture. PATIENTS AND METHODS: 0.4 ml of sulfur hexafluoride was injected into the vitreous cavity in 2 patients with SMH due to traumatic choroidal rupture. In 1 patient gas injection was combined with 50 microg r-TPA. Both patients were closely followed. RESULTS: Preoperative visual acuity was 20/125 in one eye and 20/100 in the other. At the end of the follow-up, visual acuity had improved to 20/32 in both eyes. CONCLUSION: r-TPA and gas injection into the vitreous body may be an efficient therapy in patients with submacular hemorrhage due to choroidal rupture.

Metastatic tumors of the orbit: a retrospective study.

PURPOSE: To present the clinical features and facts on prognosis, therapy and diagnostics of orbital metastases treated in the Orbital Center Kiel. METHODS: We reviewed the records of 20 patients with orbital metastases (ca. 2% of all orbital patients seen in a 10-year period). RESULTS: The mean age at first manifestation of orbital symptoms was 64 years. On average, 64 months was the period of time between the onset of the primary disease and orbital manifestation. The sites of the primary tumors were breast (8), choroid (2), prostate (2), gastrointestinal tract (3), lung (2), urinary bladder (1), Schmincke tumor of the throat (1) and unknown origin (1). Eleven patients were female, 9 male. The main primary symptoms consisted of lid swelling (11), red eye (9), diplopia (10), and proptosis (7). Although the majority (16/20) were treated by chemotherapy, radiotherapy or surgery, 19 patients died after a mean survival time of 14.7 months. CONCLUSION: Orbital metastases remain an unfavorable prognostic factor, but the diagnosis and treatment are still important in order to prevent loss of vision and improve the patient's quality of life. As previous studies have shown, the overall survival rate is still as limited as nearly half a century ago.