Long term effects of lutein, zeaxanthin and omega-3-LCPUFAs supplementation on optical density of macular pigment in AMD patients: the LUTEGA study.

BACKGROUND: The primary objective of LUTEGA is to determine the long-term effect of a supplementation with fixed combination of lutein, zeaxanthin, omega-3-longchain-polyunsaturated-fatty-acids (O-3-LCPUFAs) and antioxidants on macular pigment optical density (MPOD) in patients with non-exudative age-related macular degeneration (AMD). METHODS: The LUTEGA study is a double-blind, placebo-controlled clinical trial. 172 patients with non-exudative AMD were enrolled and randomized to three treatment arms. Supplementation included either once (dosage D1) or twice daily (dosage D2) of 10 mg L / 1 mg Z/ O-3-LCPUFAs (thereof 100 mg DHA, 30 mg EPA)/ antioxidants, or placebo (P). After best-corrected visual acuity (BCVA) test, blood sample was collected and MPOD was measured using the 1-wavelength-reflection method and recording reflection images at 480 nm (modified Visucam(NM/FA), Carl Zeiss Meditec, Germany). During 1 year of intervention, AMD patients were followed up after 1, 3, 6 and 12 months. 145 AMD patients (D1 = 50, D2 = 55, P = 40) completed the study. RESULTS: After 12 months of intervention, the MPOD parameters (volume, area, maxOD, meanOD) increased significantly in treatment arms D1 and D2 (p < 0.001). Volume of MPOD showed the highest within-group difference and increased significantly in D1 and D2, and decreased significantly in P (p = 0.041). Between-group comparison of absolute changes of all MPOD parameters were significantly different between D1 and P as well as D2 and P with p < 0.001 at end point (t = 12). BCVA, measured in log MAR, improved in D1 and in D2 (p < 0.001). After 12 months of intervention, the mean improvement in BCVA was significant in D2 (p = 0.006) and D1 (p = 0.038) compared to P. CONCLUSIONS: The supplementation of L, Z, O-3-LCPUFAs and antioxidants resulted in considerable increase in MPOD. There was no difference in accumulation of MPOD between both dosages. Thus, we believe that the used supplementation with L and Z seems to reach a saturation level in retinal cell structure. Additionally, the constant supplementation of L, Z, O-3-LCPUFAs and antioxidants in AMD patients seems to be useful, because MPOD reduces without supplementation. We conclude that the supplementation caused an increase of MPOD, which results in an improvement and stabilization in BCVA in AMD patients. Thus, a protective effect on the macula in AMD patients is assumed.

Determination of absolute size of fundus objects.

BACKGROUND: Creating multiple beam interference fringes on the retina using the "retina fringe projector" (RFP) provides us with a scale which can be used to determine the absolute size of objects at the fundus. METHODS: The procedure is tested on an model eye, the optical parameters of which are varied in order to simulate different refraction conditions. The RFP was used to determine the size of a known object at the model fundus; the result was then checked against the real value of the object. In a second series of measurements, the RFP fringes were included in fundus photos of 52 patients with varying levels of ametropia, taken at the University Eye Clinic in Jena using the FF450 fundus camera (manufacturer: Carl Zeiss Meditec AG) for diagnostic purposes. The distance between the fringes was determined using both the RFP and the Littmann method. RESULTS: The differences to the real value of the fundus size of a known object deviated on average by 1 to 2%, and always remained under 3% in the model eye. A very good correlation between RFP and Littmann methods results could be found in the clinical part of the study. The resulting deviations are below 2.5%. CONCLUSION: Integration of a RFP in a fundus camera permits measurement of absolute values of the retina, regardless of the type of observation or documentation. Knowing the real size of fundus objects holds a potential in many clinical classification scales of fundus objects such as drusen or vessels, or in optimizing photodynamic therapy spot size measurement.

Diabetic patients with retinopathy show increased retinal venous oxygen saturation.

BACKGROUND: Longstanding diabetes mellitus results in a disturbed microcirculation. A new imaging oximeter was used to investigate the effect of this disturbance on retinal vessel oxygen saturation. METHODS: The haemoglobin oxygen saturation was measured in the retinal arterioles and venules of 41 diabetic patients (65 +/- 12.3 years) with mild non-proliferative through proliferative diabetic retinopathy (DR). Twelve individuals (61.3 +/- 6.2 years, mean +/- standard deviation) without systemic or ocular disease were investigated as controls. Measurements were taken by an imaging oximeter (oxygen module by Imedos GmbH, Jena). This technique is based on the proportionality of the oxygen saturation and ratio of the optical density of the vessel at two wavelengths (548 nm and 610 nm). RESULTS: Whereas there were no significant differences in the arterial oxygen saturation between controls and diabetic retinopathy at any stage, the venous oxygen saturation increased in diabetic patients with the severity of the retinopathy: controls 63 +/- 5%, mild non-proliferative DR 69 +/- 7%, moderate non-proliferative DR 70 +/- 5%, severe non-proliferative DR, 75 +/- 5%, and proliferative DR 75 +/- 8%. CONCLUSIONS: The increase of retinal vessel oxygen saturation in diabetic retinopathy points to a diabetic microvascular alteration. This may be due to occlusions and obliterations in the capillary bead and the formation of arterio-venous shunt vessels. On the other hand, hyperglycaemia-induced endothelial dysfunction, with subsequent suppression of the endothelial NO-synthase and disturbance of the vascular auto-regulation, may contribute to retinal tissue hypoxia.

Optic edge design as long-term factor for posterior capsular opacification rates.

OBJECTIVE: To compare the difference in posterior capsular opacification (PCO) between highly refractive silicone and hydrophobic acrylic foldable intraocular lenses (IOLs) with sharp and round edge designs 3 years after in-the-bag IOL implantation in subjects undergoing bilateral cataract surgery. DESIGN: Open-label, prospective, randomized, multicenter clinical trial. PARTICIPANTS: Two hundred and eighty-eight patients with bilateral surgery for senile cataract operated in German university clinics, eye hospitals, and private ophthalmic surgical centers (Aachen, Ahaus, Bad Hersfeld, Frankfurt/Main, Jena, Rosenheim, and Sulzbach/Saar). INTERVENTIONS: At each center, a highly refractive index silicone IOL with a sharp optic edge (CeeOn) was intraindividually compared either with a high-refractive index silicone IOL with a round optic edge (PhacoFlex) in 108 patients or with an acrylic IOL with a sharp optic edge (AcrySof) in 139 patients. All patients received standard phacoemulsification with IOL implantation in the bag in both eyes from the same surgeon. A morphological evaluation of PCO was performed by the Evaluation of the Posterior Capsule Opacification (EPCO) system 1 to 2 weeks and 11 to 14 and 35 to 37 months after surgery. The blinded digital pictures were evaluated by an independent investigator. Posterior capsular opacification was statistically evaluated by paired comparisons of 3-year cumulative incidences of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment and EPCO scores. MAIN OUTCOME MEASURES: Posterior capsular opacification. RESULTS: The 3-year cumulative incidences of Nd:YAG laser capsulotomy were 2.1% (CeeOn), compared with 2.1% (AcrySof) (risk difference, 0%; 90% confidence interval, -3.4% to 3.4%), and 5.7% (CeeOn), compared with 17.0% (PhacoFlex) (risk difference, -11.4%; 90% confidence interval, -18.1% to -4.7%). In patients without Nd:YAG laser treatment, medians of the total area EPCO score were 0.0005 (CeeOn) versus 0.0440 (AcrySof) and 0 (CeeOn) versus 0.0700 (PhacoFlex) at 3 years. Functional results, safety, and handling did not significantly differ for the 3 lenses. CONCLUSIONS: Our results suggest that modern foldable IOLs have a low incidence of PCO after 3 years. There is less PCO for sharp optic edge designs independent of IOL material.

Ocular fundus auto-fluorescence observations at different wavelengths in patients with age-related macular degeneration and diabetic retinopathy.

BACKGROUND: Post-translational protein modification by lipid peroxidation products or glycation is a feature of aging as well as pathologic processes in postmitotic cells at the ocular fundus exposed to an oxidative environment. The accumulation of modified proteins such as those found in lipofuscin and advanced glycation end products (AGEs) contribute greatly to the fundus auto-fluorescence. The distinct fluorescence spectra of lipofuscin and AGE enable their differentiation in multispectral fundus fluorescence imaging. METHOD: A dual-centre consecutive case series of 78 pseudo-phacic patients is reported. Digital colour fundus photographs as well as auto-fluorescence images were taken from 33 patients with age related macular degeneration (AMD), 13 patients with diabetic retinopathy (RD), or from 32 cases without pathologic findings (controls). Fluorescence was excited at 475-515 nm or 476-604 nm and recorded in the emission bands 530-675 nm or 675-715 nm, respectively. Fluorescence images excited at 475-515 nm were taken by a colour CCD-camera (colour-fluorescence imaging) enabling the separate recording of green and red fluorescence. The ratio of green versus red fluorescence was calculated within a representative region of each image. RESULTS: The 530-675 nm auto-fluorescence in AMD patients was dominated by the red emission (green vs. red ratio, g/r = 0.861). In comparison, the fluorescence of the diabetics was green-shifted (g/r = 0.946; controls: g/r = 0.869). Atrophic areas (geographic atrophy, laser scars) showed massive hypo-fluorescence in both emission bands. Hyper-fluorescent drusen and exudates, unobtrusive in the colour fundus images as well as in the fluorescence images with emission >667 nm, showed an impressive green-shift in the colour-fluorescence image. CONCLUSIONS: Lipofuscin is the dominant fluorophore at long wavelengths (>675 nm or red channel of the colour fluorescence image). In the green spectral region, we found an additional emission of collagen and elastin (optic disc, sclera) as well as deposits in drusen and exudates. The green shift of the auto-fluorescence in RD may be a hint of increased AGE concentrations.

Tilt and decentration of three-piece foldable high-refractive silicone and hydrophobic acrylic intraocular lenses with 6-mm optics in an intraindividual comparison.

PURPOSE: Intraindividual comparison of tilt and decentration of three-piece foldable intraocular lenses (IOLs) with 6-mm optics and different edge design and material. DESIGN: Prospective randomized study. METHODS: Twenty-five patients with senile cataract (group I) received a foldable silicone, sharp optic edge IOL in one eye and a silicone, rounded optic edge IOL in the other eye. Group II (n = 28) received the foldable silicone, sharp optic edge IOL in one eye and an acrylate, sharp optic edge IOL in the other eye. Scheimpflug photography was performed after the procedure with an anterior eye segment analysis system. Tilt and decentration of the IOL optic were measured 1 week, 6 months, and 12 months after the procedure. RESULTS: In group I, the foldable silicone, sharp optic edge IOL showed a mean optic tilt of 3.03 +/- 1.79 degrees and an optic decentration of 0.24 +/- 0.13 mm; the silicone, rounded optic edge IOL showed a tilt of 3.26 +/- 1.69 degrees and a decentration of 0.23 +/- 0.13 mm. In group II, the foldable silicone, sharp optic edge IOL showed an average tilt of 2.34 +/- 1.81 degrees and a decentration of 0.29 +/- 0.21 mm after 12 months; the acrylate, sharp optic edge IOL had a tilt of 2.32 +/- 1.41 degrees and a decentration of 0.24 +/- 0.10 mm. There were no significant differences in either group. CONCLUSION: The examined IOLs showed a stable position regarding tilt and decentration in the first 12 postoperative months, independent of material and edge design. Slight deviations from the optical axis might affect the outcome in aspheric or multifocal IOLs.

Advanced glycation end-products in anterior chamber aqueous of cataractous patients.

PURPOSE: To investigate whether the advanced glycation end-products (AGEs) pentosidine, N( epsilon )-(carboxymethyl)lysine (CML), and imidazolone are present in the aqueous of cataract patients and how AGE levels correlate to cataract type or the diabetic condition of the patient. SETTING: Departments of Ophthalmology and Internal Medicine, University of Jena, Jena, Germany. METHODS: Aqueous and serum samples from 77 cataractous patients (33 nondiabetics, 44 diabetics; 14 with dense posterior, 63 with nuclear cataracts) were investigated. The mean age of the patients was 69 years +/- 14 (SD). The aqueous protein concentration was examined using a laser flare-cell meter. In the samples, pentosidine was measured by high-performance liquid chromatography and CML using a competitive enzyme-linked immunosorbent assay. Western blot analysis was used to detect imidazolone, pentosidine, and CML in the aqueous. RESULTS: The aqueous samples contained CML, pentosidine, or imidazolone. These AGEs occurred mainly bound to albumin. Significant correlations existed between serum pentosidine and aqueous CML and flare levels as well as between serum and aqueous CML. Patients with nuclear cataract had insignificantly higher pentosidine and CML levels than patients with posterior cataract, whereas the flare was significantly higher. No significant differences were found between the aqueous AGE levels in nondiabetic and diabetic patients. CONCLUSIONS: The aqueous of cataractous eyes contained the AGEs CML, pentosidine, and imidazolone. All 3 AGEs occurred mainly albumin-bound, providing evidence they may originate from the blood. Further investigation is needed to determine the relevance of aqueous AGEs in cataractogenesis.

Increased levels of advanced glycation end products in human cataractous lenses.

PURPOSE: To investigate the occurrence of advanced glycation end products (AGEs) formed oxidatively (pentosidine and N(epsilon)-carboxymethyl lysine [CML]) or nonoxidatively (imidazolone) in human lenses and the relation of AGEs to lens coloration, cataract type, and patients' diabetic state. SETTING: Departments of Ophthalmology and Internal Medicine III, University of Jena, Jena, Germany. METHODS: Pentosidine, CML, and imidazolone concentrations were measured in the water-soluble protein fraction of 44 cataractous lenses (from 24 nondiabetic and 20 diabetic donors) and 6 noncataractous control lenses. RESULTS: Pentosidine, CML, and imidazolone were higher in cataractous lenses than in control lenses (pentosidine, 3.7 pmol/mg +/- 5.3 (SD) and 1.9 +/- 1.7 pmol/mg, respectively; CML, 3.0 +/- 2.2 nmol/mg and 1.3 +/- 0.7 nmol/mg, respectively; imidazoline, 80.4 +/- 93.3 AU/mg and 19.6 +/- 18.5 AU/mg, respectively). Among the cataractous lenses, the highest AGE concentrations were found in mature cataracts, with a statistically significant increase in CML. The AGE content increased relative to the intensity of brown coloration of the lens; the brown coloration also indicated the highest rise of imidazolone compared to pentosidine and CML. Lenses from diabetic donors had generally similar pentosidine values and elevated CML and imidazolone levels compared to lenses from nondiabetic donors. The pentosidine, CML, and imidazolone levels in the lenses correlated significantly with one another but not with patient age. CONCLUSION: Advanced glycation end products formed oxidatively and nonoxidatively occurred to a higher degree in cataractous lenses than in noncataractous lenses. The strong relationship between the lenses' AGE content, color/opacity, and the state of the cataract may indicate that advanced glycation plays a pivotal role in cataract formation.

Posterior capsule opacification after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM lenses: one-year results of an intraindividual comparison multicenter study.

PURPOSE: To perform an intraindividual comparison of posterior capsule opacification (PCO) with 2 foldable intraocular lenses (IOLs) and a foldable acrylic IOL 1 year after in-the-bag implantation. SETTINGS: Seven German ophthalmology centers. METHODS: In an open prospective randomized multicenter study, each center intraindividually compared a high-refractive-index, sharp-edged optic silicone IOL (CeeOn Edge 911A, Pharmacia) with a high-refractive-index, round-edged optic silicone IOL (PhacoFlex SI-40NB, Allergan) or a sharp-edged optic acrylic IOL (AcrySof MA60BM, Alcon). Of 288 randomized patients, 247 had standard phacoemulsification with in-the-bag IOL implantation in both eyes by the same surgeon. One eye of each patient received a CeeOn Edge IOL and the fellow eye, an AcrySof or PhacoFlex IOL. A morphologic evaluation of PCO was performed using the Evaluation of Posterior Capsule Opacification (EPCO) system 1 to 2 weeks and 11 to 14 months after surgery. The digital pictures were evaluated by an independent investigator who was blind to the type of IOL. Intraindividual differences in EPCO scores were statistically evaluated by a 1-sided binomial test at an alpha-level of 5%. RESULTS: One year after surgery, 127 patients with the AcrySof IOL and 102 patients with the PhacoFlex IOL in the control eye were reexamined. Functional results, safety, and handling were not significantly different between the 3 IOLs. All reexamined eyes had a very low PCO grade. The EPCO values revealed less PCO in eyes with the CeeOn Edge IOL than in eyes with the AcrySof or PhacoFlex IOL, but the difference was not statistically significant. A neodymium:YAG laser capsulotomy was performed in 1 eye with a CeeOn Edge IOL, 1 eye with an AcrySof IOL, and 2 eyes with a PhacoFlex IOL. CONCLUSIONS: The EPCO PCO grade was low 1 year after implantation of CeeOn Edge 911A, PhacoFlex SI-40NB, and AcrySof MA60BM IOLs; there was no statistically significant difference between the IOLs. The impact of IOL material and edge design on PCO development might be relevant in a long-term follow-up of this study.

Differential expression of tetraspanin CD9 in basal cell and squamous cell carcinomas of the skin and actinic keratosis.

Tetraspanins are potentially useful molecular markers that differentiate between tumour classes and subtypes, since members of this protein family were often found to be altered during malignant conversion and tumour progression. In this study, we analysed expression of the tetraspanin CD9 in the frequent cutaneous neoplasms basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and actinic keratosis (AK), which is considered a precursor lesion (carcinoma in situ) from which an invasive SCC can develop. A moderate to strong CD9-specific staining of the tumour cells' plasma membranes was uniquely observed in all BCCs, SCCs and AKs. All SCCs showed additional intracellular CD9 which was rarely (20%) seen in AKs. Semi-quantitative assessment of CD9 present in the plasma membranes of tumour cells of BCCs (mean staining intensity 1.91) and SCCs (3.64) reflected the different CD9 expression of normal precursor cells from which these tumours most likely originate. Although considered an intermediate stage in the development of SCCs, AKs did not show intense staining of the plasma membranes typical of normal keratinocytes or invasive SCCs (p=0.011) but only moderate intensity (mean 1.63). In BCCs, significantly (p=0.0005, n=56) stronger CD9-specific immunoreactivity was seen in the inner regions of the tumours than at their sites of expansion. In summary, our results point to an important role of CD9 at the front of tumour expansion in BCCs and SCCs, and in the pathogenesis of invasive SCCs.

Detection of secretory IgM in tears during rhino-conjunctivitis.

BACKGROUND: With various methods, secretory immunoglobulin M (sIgM) was assessed in tears of patients with rhino-conjunctivitis. METHODS: Tears were analyzed by microimmunoelectrophoresis (MIE), size-exclusion high-pressure liquid chromatography (SE-HPLC), sodium dodecyl sulphate (SDS) electrophoresis and isoelectric focusing. RESULTS: Only very small traces of serum IgM could be found in tears of healthy volunteers. MIE showed that tear sIgM is different from serum IgM. The former migrates in the direction of the anode, while serum IgM migrates to the cathode. The SDS electropherogram of a number of patients showed an additional strong band of the sIgM mu-chain of approximately 68 kDa, after rhino-conjunctivitis. SE-HPLC showed two additional peaks for these patients, at 10.97 min and at 12.94 min, which were attributed to tear sIgM. The former peak consists of a complex of four sIgM molecules. One year later the chromatograms of the former rhino-conjunctivitis patients did not show any peak of sIgM in SE-HPLC. CONCLUSIONS: Serum IgM of a molecular weight (MW) 970 kDa appears only in normal tears at very low concentrations, as a result of transudation from the serum. In contrast, sIgM is synthesized during rhino-conjunctivitis in high concentrations in the human lacrimal glands and the conjunctiva. These increased levels of tear sIgM are due to stimuli for specific protein synthesis.

Orbital inflammatory pseudotumor due to hypersensitivity vasculitis and mononeuritis multiplex in a patient with atypical, cANCA-positive Wegener's granulomatosis.

OBJECTIVE: We report on a 60-year-old woman with a retro-orbital pseudotumor and polyneuropathy. The retro-orbital inflammation was histologically diagnosed as hypersensitivity vasculitis (HV). As cytoplasmatic antineutrophilic cytoplasmatic antibody (cANCA) and anti-proteinase-3 antibody were detected, the differential diagnosis also included atypical Wegener's granulomatosis. Hypersensitivity vasculitis is defined as small-vessel vasculitis mediated by the deposition of immune complexes (Arthus reaction) after exposure to various agents such as drugs, toxins, and infections. Since an inflammatory retro-orbital pseudotumor due to HV has not previously been reported, the following case is presented. METHODS AND MAIN OUTCOME MEASURES: Magnetic resonance imaging (MRI) revealed retro-orbital infiltrate without granuloma. Histology from an orbital biopsy confirmed HV. Electromyography was used for the diagnosis of polyneuropathy. Serum investigation indicated erythrocyte sedimentation rate (ESR) >100 mm/h, C-reactive protein (CRP) 223 mg/l, antinuclear antibodies 1:80, and cANCA 100 U/ml. RESULTS: The bilateral orbital pseudotumor, polyneuropathy, and serum levels of inflammation reactants (ESR and CRP) improved from therapy with corticosteroids (1 g of methylprednisolone initially) and azathioprine (150 mg/day). CONCLUSIONS: Because of cANCA and anti-proteinase-3 antibody positivity, this case can be viewed more as an atypical Wegener's granulomatosis than a systemic HV. The causal variety of inflammatory orbital pseudotumor, including HV and different therapeutic consequences, requires histological differentiation from usual orbital pseudotumors.

[Preretinal haemorrhage after vomiting--a case report]. / Präretinale Makulablutung nach Erbrechen--Kasuistik.

BACKGROUND: There are different therapeutical options for treating early preretinal hemorrhages. Beside surgery and intraocular drug administration some reports have been published using neodymium-YAG laser. PATIENT: A 42-year pld healthy female patient complained of sudden visual loss after vomiting and showed signs of preretinal haemorrhage. On the same day, a treatment with neodymium-YAG-laser was performed. The posterior limiting membrane was opened. RESULTS: During follow-up an outflow of the preretinal haemorrhage into the vitreous was observed. Within four weeks after laser treatment a complete resorption of the haemorrhage was seen. Visual acuity increased to 20/20. CONCLUSION: In selected cases the opening of the posterior limiting membrane may be considered for treatment of early preretinal haemorrhages.

Advanced glycation end-products in corneas of patients with keratoconus.

BACKGROUND: Keratoconus remains a poorly understood yet widespread disease which poses a potential threat to human vision. The underlying mechanisms are still not clear. One possible pathway is increased formation and accumulation of advanced glycation end-products (AGEs) in the cornea. METHODS: Corneas obtained from six patients with keratoconus and from six healthy controls were investigated. An immunohistochemical localisation of the well-known AGE N(epsilon)-carboxymethyllysine (CML) was performed using a polyclonal anti-CML antibody. RESULTS: In the corneas of all six patients with keratoconus, CML immunoreactivity was found in the epithelial as well as in the endothelial cells. The keratocytes also showed a positive reaction. The controls, in contrast, showed very little or no immunoreactivity. CONCLUSION: In the epithelial, stromal and endothelial cells of corneas with keratoconus an accumulation of CML was detected which might play a role in the pathogenesis of keratoconus.

[Highly refractive silicone lens with sharp optic edge (CeeOn Edge, Model 911): one year results of a multicenter clinical trial on performance and efficacy]. / Hochrefraktive Silikonlinse mit scharfer Hinterkante (CeeOn Edge, Modell 911): 1-Jahres-Ergebnisse einer multizentrischen klinischen Studie zur Handhabung und Effizienz.

PURPOSE: To investigate the performance and efficacy of a new high refractive index (1.46) silicone intraocular lens with sharp optic edges. MATERIALS AND METHODS: In this open prospective multicenter study 149 patients underwent cataract surgery and implantation of CeeOn Edge in one eye. Best corrected visual acuity was determined at day 1 - 2, week 1 - 2, month 6 and month 12 postoperatively. Posterior capsule was clinically evaluated according to existence or absence of posterior capsule opacification (PCO). PCO was defined as relevant if the visual acuity loss exceeded at least two lines. The intraoperative handling of the lens was assessed concerning foldability, haptic handling, positioning, unfolding and general assessment. RESULTS: Visual acuity increased from preoperatively 0.3 to 0.9 after one year. PCO with impact on visual acuity (loss of 2 lines or more) was recorded in only two patients, after 2 weeks (YAG) resp. 1 year (no YAG). The handling and implantation was considered to be good to very good. No lens-related complications were seen during the one year study period. CONCLUSIONS: CeeOn Edge, Model 911, restores visual acuity after cataract surgery and shows promising handling results. The low rate of PCO and YAG is most probably related to the sharp edge of the lens.