[Ex- und reimplantation of intracorneal ring segments with the support of femtosecond laser, Femtec, for the treatment of progressive keratoconus]. / Ex- und Reimplantation von intrakornealen Ringsegmenten bei progressivem Keratokonus mit Hilfe des Femtosekundenlasers Femtec.

Implanted intracorneal ring segments (ICRS) led to a steepening of the cornea and an increase in visual deterioration. Thanks to the femtosecond laser, we can now prepare implantation tunnels intrastromally with mum precision. Therefore, we explanted the original ring segments. After a waiting period, we prepared a second implantation tunnel above the first using the femtosecond laser and implanted new ICRS. The conus was considerably flattened and shifted, and vision improved significantly.

[Topical anesthesia as routine procedure in cataract surgery -- evaluation of pain and complications in 1010 cases]. / Topische Anästhesie als Routineverfahren bei der Kataraktchirurgie -- Schmerzbewertung und Komplikationen bei einem grösseren Patientenkollektiv.

BACKGROUND: The number of cataract surgeries using topical anesthesia has increased continuously in the United States in the last years. Over 60 % of all cataract surgeons accept this form of anesthesia as first choice in cataract surgery. Surgeons in German-speaking countries still prefer injection anesthesia. Patient pain and complications during cataract surgery under topical anesthesia were recorded in 1010 cases to find out if topical anesthesia will become established as a routine procedure in Germany. PATIENTS AND METHODS: Cataract surgery was performed as a routine procedure by two surgeons as phacoemulsification with implantation of a foldable posterior chamber lens. Preoperative tetracaine drops were applied three times. Additionally, non-preserved lidocaine 1 % was injected into the anterior chamber. Patients assessed pain intensity by checking off a visual analogue scale 1 to 10. Intra-operative complications were recorded by the surgeons. The level of pain, intra-operative complications, age of patients, duration of surgery and type of implanted intraocular lens were analyzed by descriptive statistical methods. RESULTS: The evaluation of intra-operative pain showed an overall mean pain score of 1.62. The pain was described as minor and light by 98.8 % of all patients. Complications happened in not more than 0.5 % of the cases related to the single complication. Complications did not necessarily lead to a higher rating of pain. CONCLUSIONS: Topical anesthesia using tetracaine drops with adjunctive intracameral injection of non-preserved lidocaine 1 % is a safe and efficient form of anesthesia in phacoemulsification and is well tolerated by patients. According to the patients' positive assessment and the low rate of complications, drop anesthesia is well suited for clinical routine.