[Socioeconomical comparison between treated and untreated candidates for laser refractive surgery in mid-Hesse]

PURPOSE

The aim of this study was to explore the possible economic and social differences between patients who decided to undergo laser refractive surgery and those,who did not.

PATIENTS AND METHODS

We included only patients who received a recommendation for excimer laser surgery at their first examination at the Department of Ophthalmology, University of Marburg. Eighty-nine candidates who decided not to undergo refractive surgery (NOP) and 100 patients who underwent the operation were surveyed either by telephone or by letter. The standardised questionnaire contained 17 or 20, respectively, questions.

RESULTS

No statistically significant differences concerning age, sex, gross income, marital status could be found. Patients of the two groups statistically differed in their housing conditions: 41.6 % of the NOP group lived in a tenancy as compared with 17 % of the OP group (p < 0,001). 89.9 % of the non-operated candidates had to carry the costs of surgery themselves, compared with only 71 % of the operated patients. A considerably larger proportion of the OP group than of the NOP group participates in sports (92 vs. 81 %, p = 0.031) and may accordingly feel more uncomfortable with wearing glasses or contact lenses during sports than the compared group (71 vs. 50,7 %, p = 0.002). The main part of the OP group use the media to form their opinion towards refractive surgery (36 %), primarily the print media (25 %). In the NOP group the media does not play such as an important role (20.2 %). The opinion of their optician (11.2 %, but only 1 % of the OP group) seems to be more important. The main reason for not undergoing refractive surgery were the costs of the surgery (50 answers) and the lack of a guarantee for being absolutely independent of optical aids (glasses, lenses) after the operation (41 answers).

CONCLUSION

In the region of mid-Hessen differences in the profile of candidates who do decide not to undergo refractive surgery and those who do can be found. These differences concern the housing conditions, the financiability of the surgical treatment, the sport activities and the preoperative discomfort with visual aids.

[Bilateral ocular surface squamous neoplasia and neurodermatitis. Two cases with different courses]

Recent data suggest neurodermatitis as a risk factor for ocular surface squamous neoplasia (OSSN). We describe two cases of bilateral OSSN associated with chronic atopic keratoconjunctivitis. The cases support the hypothesis that neurodermatitis is a risk factor for OSSN. Additional risk factors may facilitate development and progression of the disease.

Behaviour of the phakic iris-claw intraocular lens (Artisan /Verisyse) during accommodation: an optical coherence biometry study

PURPOSE

To evaluate variations in the position of the phakic iris claw lens (Artisan, Verisyse) and the natural crystalline lens during the accommodation process.

METHODS

We measured changes in position of the iris claw lens and the crystalline lens during the accommodation using optical coherence biometry (AC Master/Carl Zeiss Meditec, Germany) in 17 patients (28 eyes) with a phakic iris claw lens implanted for high myopia and/or myopic astigmatism. Accommodative effort was obtained using an internal optical target within the measuring device.

RESULTS

There was a forward shift of the phakic iris claw lens with a mean of 70 microm (8-178 microm) of the optical path length (OPL). At the same time the anterior pole of the natural lens showed a forward mean movement of 85 microm (4- 260 microm).

CONCLUSIONS

An anterior displacement of the iris-claw phakic lens was shown in a series of eyes during the accommodation process. As this displacement goes along with the forward displacement of the anterior pole of the crystalline lens, the preoperative measurement of the latter might provide some additional information about the position of the iris claw lens in the accommodative state after implantation.

Autologous serum for the treatment of corneal epithelial abrasions in diabetic patients undergoing vitrectomy

PURPOSE

To compare the effect of autologous serum versus hyaluronic acid for the treatment of epithelial corneal lesions in patients such as diabetics with reduced wound healing.

DESIGN

Prospective, randomized, masked clinical trial.

METHODS

Diabetic patients undergoing pars plana vitrectomy mostly combined with cataract extraction and intraocular lens (IOL) implantation who received corneal abrasion for better intraoperative visualization were included in this study. A standardized 8-mm diameter corneal abrasion was performed. Patients were randomized into one group treated with hourly application of autologous serum and another treated with hyaluronic acid drops (Vislube). Besides the time necessary for closure of the corneal epithelium other parameters such as patients' age, gender, duration of surgery, history of diabetes, and current HbA1C were evaluated.

RESULTS

A total of 23 patients were enrolled (15 men, eight women); the autologous serum group consisted of 13 patients, the hyaluronic acid (Vislube) group consisted of 10 patients. Patients' mean age was 64.8 years; mean duration of diabetes was 19.4 years. On average, the operation lasted 145 minutes. Mean epithelialization time was 7.1 days in the hyaluronic acid group. In the autologous serum group, epithelium healed after a mean of 4.3 days. Mann-Whitney U test for statistical analysis showed a significant difference of epithelial closure time between both groups (P < .05); therefore, the study was stopped after treatment of 23 patients.

CONCLUSIONS

It appears that autologous serum leads to a much faster closure of corneal epithelial wounds after abrasion compared with artificial tears.

Rezidivierende Erosio corneae

Recurrent corneal erosions in both traumatic and basal membrane dystrophy-associated conditions seem to show a similar pathogenesis for abnormal adhesion between corneal epithelium and stroma. The purpose of each conservative or surgical treatment is fast healing without any infections or recurrences. This paper compares the different excimer laser treatment options with emphasis on the so-called aggressive PTK. A total of 50 eyes of 50 patients with recurrent corneal erosions after mechanical trauma or with epithelial basement membrane dystrophy were treated with aggressive PTK after the second or third recurrence. Aggressive PTK was performed with an ablation of 10-15 microm. After the mean follow-up time of 41.8 months, a recurrence rate of 6% without a change of visual acuity and a hyperopic shift of +0.74 D were observed. The earliest recurrent erosion showed up after 33 and the latest after 65 months. In comparison to other forms of PTK such as transepithelial or conventional subepithelial PTK, aggressive PTK showed the lowest recurrence rate reported for a long-term follow-up.

Phototherapeutische Keratektomie (PTK)

The conceptual advantage of phototherapeutic keratectomy (PTK) include the option to remove diseased tissue on a micrometer scale. Although less invasive than other forms of corneal surgery, it remains a surgical procedure which carries inherent risks. In phototherapeutic indications this risk is higher than in otherwise healthy eyes undergoing photorefractive surgery. Potential general complications include wound-healing problems, infection, inflammation, or a recurrence of the underlying disease. More specifically, PTK is associated with unwanted refractive changes, such as a hyperopic shift or an irregular astigmatism. In this review, we discuss these problems along with prevention and treatment strategies in detail.

Phototherapeutische Keratektomie

Phototherapeutic keratectomy (PTK) involves the removal of corneal tissue with an excimer laser for therapeutic and/or functional purposes. In contrast to photorefractive keratectomy, a change in manifest refraction is not the primary goal of the treatment. The main indications are poor epithelial adherence, corneal opacities or an irregular corneal surface, as well as combinations of these. We describe the basic techniques, such as large area and focal PTK and provide recommendations on use of different masking agents. Numerous well established and rare clinical examples are described in terms of achievable PTK results.

Benefits and Side Effects of Bandage Soft Contact Lens Application after LASIK

PURPOSE

To evaluate benefits and side effects of bandage soft contact lens (BSCL) insertion after LASIK in relation to patients' characteristics.

DESIGN

Prospective, randomized, bicenter comparative investigational trial.

PARTICIPANTS

One hundred patients (200 eyes) with myopia and/or myopic astigmatism.

METHODS

Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours.

MAIN OUTCOME MEASURES

Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients' subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal-Wallis 1-way analysis of variance on ranks test.

RESULTS

Fifty-four percent of patients felt discomfort in the eye that had the BSCL (contra-BSCL subgroup), whereas 27% enjoyed having a BSCL (pro-BSCL subgroup). The remaining 19% felt no difference. The average Schirmer II value was 16.6 mm (+/-7.7) in the pro-BSCL subgroup, 14.9 mm (+/-6.4) in the no difference subgroup, and 12.3 mm (+/-7.7) in the contra-BSCL subgroup. There was a female preponderance in the contra-BSCL (39:15) and no difference (15:6) subgroups. A preoperative history of poor contact lens tolerance was recorded in 50% of the contra-BSCL subgroup patients; 41%, no difference; and 33%, pro-BSCL. Postoperative parameters such as first-day UCVA, number of eyes with microstriae, folds requiring stretching, or cases of diffuse lamellar keratitis did not differ significantly. Eyes with flap microstriae had a significantly deeper mean ablation (114.5 microm [range, 52-146 microm]) than eyes without any flap abnormalities (75.4 microm [39-120 microm]). No significant differences were found between the consecutive and simultaneous groups.

CONCLUSION

The majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.

Vergleich von Eigenserum und Hyaluronsäure zur Behandlung kornealer Erosiones nach Vitrektomie bei Diabetikern

PURPOSE

The purpose of this study was to evaluate whether treatment with autologous serum exhibits better epitheliotropic properties than hyaluronic acid in patients with reduced wound healing (diabetics).

PATIENTS AND METHOD

This prospective randomized study included all diabetic patients undergoing pars plana vitrectomy with abrasion of the corneal epithelium. In addition to the usual topical therapy one group was treated with hourly application of autologous serum, the other group with hyaluronic acid drops. We evaluated the time needed for closure of the corneal epithelium as well as other parameters such as patient's age, sex, duration of surgery, history of diabetes, and the current HbA1C.

RESULTS

There were 23 patients enrolled in the study. The epithelium healed a mean of 2 days earlier in the autologous serum group. Based on the statistically significant difference in favor of autologous serum, the study was terminated after treatment of 23 patients.

CONCLUSIONS

Autologous serum eye drops lead to earlier closure of the corneal epithelium after intraoperative abrasion in diabetic patients when compared with artificial tears.

Vermessung der skotopischen Pupille im Vergleich zwischen Grünlichttest und Wellenfrontanalyser WASCA

OBJECTIVE

The aim of this study was to compare the accuracy and the reproducibility of scotopic pupil measurements using 2 different methods.

METHODS

Scotopic pupil diameter was measured in 56 eyes of 28 volunteers and the results were compared between the green light test at the slit lamp (Haag-Streit, Switzerland) and the automatic measurements of the wave-front analyser WASCA (Carl-Zeiss-Meditec) by 2 independent examiners. Non-parametric sign test as well as All Pairwise Multiple Comparison Procedures (Student-Newman-Keuls method) were performed for the comparison of means for each individual eye as well as the results of both eyes tested by both examiners.

RESULTS

Mean age of the subjects was 34.9 years. The colour of iris was green or blue in 22 cases and brown in 6 cases. REPRODUCIBILITY: For the green light test we found for the first investigator in the right eye a mean pupil diameter of 6.58 mm (SD 0.68). The measurement of the second investigator for the same eye was 6.64 mm (SD 0.61). The left eye values were as follows: 6.36 mm (SD 0.68) and 6.75 mm (SD 0.68). For WASCA we found for the first investigator in the right eye 6.33 mm (SD 0.64) vs. 6.30 mm (SD 0.64) for the second investigator, in the left eye 6.39 mm (SD 0.69) vs. 6.36 mm (SD 0.60). There was a statistically significant difference between the two investigators when the green light test was used (6.47 mm vs. 6.69 mm for both eyes). No difference was found using the WASCA integrated pupillometer (6.35 mm vs. 6.33 mm). There was a significant difference between the means of combined data for both measurement methods: 6.58 mm for the green light test (SD 0.57) vs. 6.34 mm for WASCA (SD 0.62).

CONCLUSIONS

The integrated pupillometry of the WASCA analyser showed better reproducibility of measurements than the green light test. The green light test measures a slightly larger diameter (in the mean by 0.25 mm) than WASCA. Because of the fair and clinically sufficient reproducibility as well as virtually non-existing additional costs the green light test can be strongly recommended to referring ophthalmologists and low-volume refractive surgeons.