Computer-Based Tutorial to Enhance the Informed Consent Process for Cataract Surgery in Serbian- or Turkish-Speaking Patients.

INTRODUCTION: This study analyses if a translated version of the CatInfo tool increases the knowledge of Serbian- and Turkish-speaking patients about cataract surgery. METHODS: In total, 61 cataract patients, literate in Serbian or Turkish, were randomly allocated into two groups. Via an interactive computer-based tool ("CatInfo"), patients either saw a detailed audio-visual presentation about cataract surgery (study group) or a "placebo" video (control group). Afterwards, all participants had a face-to-face discussion with an ophthalmologist. Immediately after the interview and on the day of surgery, all patients had to fill out a questionnaire including knowledge and demographic questions. Patients in the study group were further asked about their satisfaction with the CatInfo tool and the usefulness of such a device before other interventions. RESULTS: Patients in the study group answered significantly more questions correctly compared to the control group, and this information gain remained stable over a 1-week period. There was a significant low negative correlation between educational level and the test results, whereas age and computer habits of the participants did not have an influence on correct answers. Satisfaction with the CatInfo tool was high in the Serbian and the Turkish group (96% and 84%, respectively), and 92% of Serbian patients as well as 62% of the Turkish patients rated that they could imagine to use such a device before any other surgery. DISCUSSION/CONCLUSION: The translated version of the CatInfo tool improved patients' knowledge, and this information gain remained stable until the day of the surgery.

Influence of a variable overall diameter hydrophilic acrylic sharp-edged single-piece intra-ocular lens on capsule opacification one year after surgery.

BACKGROUND: To investigate the influence of the overall intraocular lens (IOL) diameter on posterior capsule opacification (PCO) formation. METHODS: In this prospective randomized clinical trial, 124 eyes of 62 patients with bilateral age-related cataract were included. Each patient received a Corneal A501D IOL in one eye and a Corneal J501D IOL in the fellow eye. Best corrected visual acuity (BCVA) and digital slitlamp photographs were taken a 1 h, 1 week, 1, 3, 6 and 12 months postoperatively. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software. RESULTS: We found a mean BCVA of 0.81 ± 0.2 for the Corneal A501D group and 0.79 ± 0.21 for the Corneal J501D group. There was no significant difference 12 months after surgery between the two IOLs (p > 0.05). Objective PCO assessment resulted in a mean PCO score (scale 0-10) of 1.65 ± 1.71 was found for the Corneal J501D group and a score of 1.54 ± 1.64 was found for the Corneal A501D group (p > 0.05). The subjective PCO assessment at 1 year resulted in a mean PCO score of 2.0 ± 1.74 in the Corneal J501D group and 2.13 ± 1.64 in the Corneal A501D group (p > 0.05). CONCLUSION: Both investigated IOLs showed good clinical performance regarding PCO and BCVA. Our study suggests that the use of an IOL with variable total diameter seems not to influence the rate of PCO formation.

Comparison of posterior capsule opacification between a 1-piece and a 3-piece microincision intraocular lens.

OBJECTIVE: To compare the intensity of posterior capsular opacification (PCO) between a 1-piece and a 3-piece microincision cataract surgery intraocular lens (MICS IOL) in a prospective randomised study. METHODS: 80 eyes of 40 patients with age-related cataract were enrolled in this study. Each patient received a 1-piece MICS IOL (AF-1 NY-60, Hoya, Tokyo, Japan) in one eye and a 3-piece MICS IOL (AF-1 iMICS Y-60H, Tokyo, Hoya) in the other eye. At the 1-year follow-up, the patients were examined at the slit lamp, visual acuity was determined and standardised high-resolution digital retroillumination images were taken for objective quantification of regeneratory PCO using an automated image analysis software (AQUA). RESULTS: The mean regeneratory PCO score (1-piece IOL: 0.2, 3-piece IOL 0.3, p=0.7) and the neodymium:yttrium-aluminium-garnet laser capsulotomy rate (two cases in 3-piece IOL group; p=0.5) were comparable low for both IOLs. Capsular folds occurred significantly more often in the 3-piece IOL group (p=0.02). CONCLUSIONS: Modification of the MICS IOL from a 3-piece to a 1-piece haptic design caused in short term no significant change in PCO amount. Compared with the 3-piece IOL, the 1-piece IOL led to significantly less capsular folds 1 year after surgery.

Retinal white blood cell flux and systemic blood pressure in patients with type 1 diabetes.

AIMS: There is evidence that altered retinal blood flow and altered retinal blood flow regulation play a role in the development and progression of diabetic retinopathy. We compared the association between systemic blood pressure and retinal white blood cell flux in patients with type 1 diabetes and healthy control subjects. METHODS: The study was performed in 100 patients with type 1 diabetes with no or minimal diabetic retinopathy and a group of 313 age-matched healthy controls. Inclusion criteria were systolic blood pressure ≤ 160 mmHg and diastolic blood pressure ≤ 95 mmHg. None of the subjects took vasoactive medication except insulin. The blue field entoptic technique was used to assess retinal white blood cell flux, velocity and density in the perimacular region. Pressure-flow relationships were calculated for both groups to assess differences in blood flow regulation. RESULTS: Retinal white blood cell flux was comparable between the two study groups. Both type 1 diabetic patients and healthy subjects showed a significant positive correlation between retinal white blood cell flux and mean arterial pressure (diabetic patients: r=0.48; p<0.05, healthy subjects r=0.28). The correlation coefficients between mean arterial pressure and white blood cell flux were significantly higher in patients with diabetes than in the healthy control group (p=0.0459). CONCLUSION: Retinal white blood cell flux, as assessed with the blue-field entoptic technique, is not significantly different between type 1 diabetic patients with no or minimal retinopathy and healthy control subjects. Type 1 diabetic subjects do, however, show an abnormal association between systemic blood pressure and retinal white blood cell flux. This indicates altered autoregulation in early diabetic retinopathy.

Efficacy of ophthalmic viscosurgical devices in maintaining corneal epithelial hydration and clarity: in vitro assessment.

PURPOSE: To determine the efficacy of hydroxypropyl methylcellulose (HPMC) and hyaluronic acid (HA) in maintaining corneal hydration and optical clarity. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Experimental study. METHODS: In porcine autopsy eyes, the effect of 13 ophthalmic viscosurgical devices (OVDs) (5 formulations of HPMC; 8 formulations of HA) in maintaining corneal hydration and optical clarity was tested. The main outcome variables were the time to reach optical clarity of the cornea during dissipation of the OVD and duration of corneal hydration. These variables were assessed after the first application of the OVD, after balanced salt solution application to rehydrate the gel matrix, and after the second application of OVD on top of the first layer. RESULTS: The study used 57 porcine eyes. High-molecular-weight HA 1.5% (zero shear viscosity [ZSV] 55,122 millipascal seconds [mPa.s]) took a significantly shorter time to reach optical clarity than HA 1.4% (ZSV 36,882 mPa.s) (P=.04). Hyaluronic acid 1.4% and HA 1.5% maintained corneal hydration significantly longer than HPMC 2.0% (P<.001). CONCLUSIONS: For corneal hydration during short-lasting surgical procedures such as cataract surgery, the results suggest using HPMC because it distributes quickly and provides an adequate duration of sufficient corneal hydration. For corneal hydration during prolonged surgical procedures, such as vitreoretinal surgery, results suggest using HA 1.5% in the formulation because it provides long-lasting corneal hydration. FINANCIAL DISCLOSURE: Dr. Prinz has a proprietary interest in Croma Pharma GmbH, Leobendorf, Austria. Dr. Findl is a scientific advisor to Croma Pharma GmbH. No other author has a financial or proprietary interest in any material or method mentioned.

Effect of primary posterior continuous curvilinear capsulorrhexis with posterior optic buttonholing on pilocarpine-induced IOL shift.

PURPOSE: To assess intraocular lens (IOL) shift along the visual axis induced by ciliary muscle contraction with pilocarpine after cataract surgery and to compare primary posterior continuous curvilinear capsulorrhexis (CCC) and posterior optic buttonholing with IOLs implanted in the bag. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Clinical trial. METHODS: Eyes with age-related cataract had cataract surgery with implantation of a nonaccommodating IOL (AF-1 YA-60BB). Surgery was performed with primary posterior CCC and posterior buttonholing in 1 eye (study eyes) and with conventional in-the-bag implantation in the contralateral eye (control eyes). After a minimum of 6 months postoperatively, the anterior chamber depth was assessed with partial coherence interferometry before and after application of pilocarpine 2.0% and, after a washout interval of 1 week, before and after the application of cyclopentolate 1.0%. RESULTS: Forty eyes of 20 patients were enrolled. A slight backward shift of the IOL (+78 µm) in study eyes and in control eyes (+118 µm) was detected after pilocarpine application (both P<.05). No significant difference in IOL shift was found between study eyes and control eyes (P=.19). CONCLUSIONS: Combined primary posterior CCC and posterior optic buttonholing did not affect IOL shift during pharmacologically stimulated ciliary muscle contraction compared with in-the-bag implanted IOLs. Capsule fibrosis diminished with primary posterior CCC but did not seem to be the only limiting factor in the accommodative IOL shift. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effect of nifedipine on choroidal blood flow regulation during isometric exercise.

PURPOSE: To determine whether nifedipine, an L-type calcium channel blocker, alters choroidal blood flow (ChBF) regulation during isometric exercise in healthy subjects. METHODS: The study was carried out in a randomized, placebo-controlled, double-masked, two-way crossover design. Fifteen healthy male subjects were randomly assigned to receive either placebo or nifedipine on two different study days. Subfoveal ChBF was measured with laser Doppler flowmetry while the study participants performed isometric exercise (squatting). This was performed before drug administration and during infusion of nifedipine and placebo, respectively. Mean arterial pressure (MAP) and intraocular pressure (IOP) were measured noninvasively, and ocular perfusion pressure (OPP) was calculated as ⅔ MAP-IOP. RESULTS: MAP and OPP increased significantly during all squatting periods (P < 0.01). The increase in ChBF was less pronounced than the increase in OPP during isometric exercise. Nifedipine did not alter the OPP increase in response to isometric exercise, but it significantly augmented the exercise-induced increase in ChBF (P < 0.001 vs. placebo). Although ChBF increased by a maximum of 14.2% ± 9.2% during the squatting period when placebo was administered, the maximum increase during administration of nifedipine was 23.2% ± 7.2%. CONCLUSIONS: In conclusion, the data of the present study suggest that nifedipine augments the ChBF response to an experimental increase in OPP. In addition, it confirms that the choroidal vasculature has a significant regulatory capacity over wide ranges of OPPs during isometric exercise. (ClinicalTrials.gov number, NCT00280462.).

Rotational stability and posterior capsule opacification of a plate-haptic and an open-loop-haptic intraocular lens.

PURPOSE: To compare the rotational stability and posterior capsule opacification (PCO) rate in eyes with a 1-piece or 3-piece acrylic intraocular lens (IOL). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Prospective randomized masked clinical trial. METHODS: Patients with age-related cataract received a plate-haptic acrylic IOL (Acri.Smart 46S) in 1 eye and a 3-piece loop-haptic acrylic IOL (Acri.Lyc 53N) in the other eye. Retroillumination images were taken 1 hour, 1 week, and 1, 6, and 12 months postoperatively. Intraocular lens rotation was measured using standard software (Adobe Photoshop). The amount of PCO was assessed subjectively at the slitlamp and objectively using an automated image-analysis software (AQUA). RESULTS: The study enrolled 80 eyes of 40 patients. The IOL rotation measurements showed excellent reproducibility, with a deviation of less than 0.8 degrees. Both IOLs had comparable and good rotational stability; rotation was less than 4 degrees in 71% of eyes 1 year postoperatively. The mean absolute rotation was 2.6 degrees ± 1.9 (SD) in the plate-haptic IOL group and 3.1 ± 2.4 degrees in the loop-haptic IOL group. The mean AQUA PCO score (scale 0 to 10) was 0.4 in both IOL groups (P = .7). CONCLUSION: The 2 IOL models had comparable, excellent rotational stability and low PCO intensity 1 year postoperatively. Thus, the plate-haptic IOL may be a good platform for a toric model.

Effect of patient motivation on near vision in pseudophakic patients.

PURPOSE: To investigate the effect of 'training' the patients' near vision and motivating them towards a spectacle-independent outcome on near vision performance in pseudophakic patients with standard intraocular lens (IOL). DESIGN: Prospective randomized, controlled, examiner-masked clinical trial. METHODS: Eighty eyes of 40 patients with standard cataract surgery were randomly assigned to a "motivated" or "control" group. In the motivated group, subjects were told that they are taking part in a special protocol to improve their near-reading ability after cataract surgery and were instructed not to use reading glasses for at least three months and received cycloplegic eye drops for 10 days after surgery. Follow-up examinations at three months included best-corrected distance visual acuity (VA), distance-corrected near VA, best-corrected near VA, assessment of the defocus curve, and reading speed, as well as pilocarpine-, cyclopentolate- and nearpoint-induced IOL shift assessed with partial coherence interferometry. Additionally, a questionnaire evaluating patients' postoperative satisfaction, independency of reading glasses, and daily-life performance without glasses was carried out three months and one year postoperatively. RESULTS: No difference in reading ability and IOL shift between "motivated" and "control" patients could be detected. However, the motivated patients were less dependent on reading glasses and their ability to be able to perform activities of daily life without glasses was significantly better. CONCLUSION: There was no improvement of ciliary body function in pseudophakic patients with a special training protocol. However, near vision training made patients more independent of reading glasses.

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.

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.

Reliability of a video-based noncontact specular microscope for assessing the corneal endothelium.

PURPOSE: To assess the within- and between-examiner reliability of corneal endothelial cell density (ECD) measurements with 2 noncontact specular microscopes: a video-based system (SeaEagle) and a photographic system (Noncon Robo). METHODS: In 57 eyes of 57 subjects, 47 healthy subjects and 10 patients with corneal disease, ECD was measured in the center and at 4 paracentral areas with the video-based system (SeaEagle) and in the center with a photographic system (Noncon Robo). For the between-examiner reliability, a second examiner measured the central ECD with the SeaEagle device in 12 healthy subjects. The video-based system was also used to evaluate the agreement between the automated and the manually corrected (semiautomated) modes of repeated measurements. RESULTS: For central ECD in all eyes, the test-retest reliability assessed by the intraclass correlation coefficient was 0.77, 0.99, and 0.91 for the automated SeaEagle, semiautomated SeaEagle, and Noncon Robo, respectively. Correlation was poor to good between the 3 measurement methods (range, 0.61-0.84). For between-examiner reliability, the upper (lower) limits of agreement were 200 (-384) and 149 (-92) cell/mm for the automated and semiautomated SeaEagle, respectively. CONCLUSIONS: The best reliability of repeated measurements was found for the semiautomated SeaEagle. However, the semiautomated method showed significantly higher ECD values than the Noncon Robo, and this difference was highly dependent on ECD. Thus, we suggest that these methods should not be used interchangeably. The fully automated mode may need a further refinement of the cell detection algorithm.

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.

Linear relationship of refractive and biometric lenticular changes during accommodation in emmetropic and myopic eyes.

AIM: Aim of this study was to investigate the relationship between refractive changes in the eye and biometric changes of the human crystalline lens during accommodation. Furthermore, differences in these relationships between young, healthy emmetropic and myopic subjects were analyzed. METHODS: Mean relative change in anterior chamber depth (ACD), lens thickness (LT), anterior segment length (ASL = ACD + LT) and in objective refraction were simultaneously assessed during near-point-induced accommodation in 10 emmetropic and 10 myopic subjects. Via a beam splitter, measurements were performed simultaneously using partial coherence interferometry (PCI) and infrared (IR) photorefraction. RESULTS: On average, for each diopter of accommodation LT increased by 0.063 mm in emmetropic and by 0.072 mm in myopic eyes, and ACD decreased by 0.047 mm and 0.057 mm, respectively. Mean ASL, indicating the position of the posterior lens pole, increased by 0.009 mm in emmetropic and by 0.013 mm in myopic eyes. The correlation between refractive and biometric changes was found to be essentially linear in both subgroups. Differences in ACD between emmetropic and myopic eyes were statistically significant at an accommodative stimulus of -1 D (p<0.04) and -2 D (p<0.02). CONCLUSION: The biometric and refractive changes of the human lens are highly correlated and linear in function in both emmetropic and myopic eyes.

Influence of severity of nuclear cataract on optical biometry.

PURPOSE: To compare preoperative and postoperative measurements of the axial length (AL) performed with the IOLMaster (Carl Zeiss Meditec) to evaluate the effect of nuclear cataract on the optical biometry. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In 245 consecutive eyes of 162 patients scheduled for cataract surgery, type and severity of cataract was evaluated using the Lens Opacities Classification System III. Preoperative and postoperative axial length measurements were performed with the IOLMaster. The postoperative readings of AL were corrected for the IOL optic material implanted. RESULTS: The preoperative AL measurements were 0.07 mm +/- 0.05 (SD) (range -0.18 to 0.11 mm) longer than the postoperative measurements (P<.001). These differences in AL were only weakly correlated (r = -0.28, P = .01) with the nuclear cataract grade, mean 3.5 +/- 0.9. CONCLUSION: In this study, AL measurements with optical biometry using the IOLMaster were not influenced by the severity of nuclear cataract to a clinically relevant degree. Furthermore, it was found that AL in the phakic eye was overestimated by about 0.07 mm because of a slightly too low value of the group refractive index used for the crystalline lens.