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Hammer M, Muuss M, Herbster L, Herth J, Scheuerle A, Khoramnia R, Labuz G, Uhl P, Auffarth GU. Viscoelastic, Optical, and Surgical Properties of Vitreous Body Replacement Hydrogels After Aging Compared to Porcine Vitreous Bodies And Silicone Oils. Transl Vis Sci Technol 2024; 13:5. [PMID: 38967936 PMCID: PMC11232910 DOI: 10.1167/tvst.13.7.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Purpose First- (monomers), second- (pre-gelated), and third- (in situ gelating after injection) generation hydrogels were previously introduced to replace the vitreous body after vitrectomy surgery. In this study, we evaluated the surgical, optical, and viscoelastic properties of vitreous body replacement hydrogels before and after an accelerated aging protocol previously applied to intraocular implants. Methods Measurements of injection force, removal speed using a clinically established vitrectomy setup, as well as evaluation of forward light scattering and viscoelastic properties before and after an accelerated aging protocol were conducted. Results were compared to porcine and human vitreous bodies, as well as currently clinically applied lighter- and heavier-than-water silicone oils. Results Removal speed of all tested hydrogels is substantially lower than the removal speed of porcine vitreous body (0.2 g/min vs. 2.7 g/min for the best performing hydrogel and porcine vitreous body, respectively). Forward light scattering in second-generation vitreous body replacement hydrogels was higher after the aging process than the straylight of the average 70-year-old vitreous body (9.4 vs. 5.5 deg2/sr, respectively). The viscoelastic properties of all hydrogels did not change in a clinically meaningful manner; however, trends toward greater stiffness and greater elasticity after aging were apparent. Conclusions This study demonstrates surgical weaknesses of the hydrogels that need to be addressed before clinical use, especially low removal speed. Pre-linked hydrogels (second-generation) showed inferior performance regarding surgical properties compared to in situ gelating hydrogels (third-generation). Translational Relevance This study highlights possible pitfalls regarding surgical and optical properties when applying vitreous replacement hydrogels clinically.
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Affiliation(s)
- Maximilian Hammer
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Marcel Muuss
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Lorenz Herbster
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Jonathan Herth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | | | - Ramin Khoramnia
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Grzegorz Labuz
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
- University Eye Clinic Heidelberg, Heidelberg, Germany
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Hammer M, Britz L, Schickhardt S, Lieberwirth I, Munro D, Uhl P, Scheuerle A, Khoramnia R, Łabuz G, Auffarth GU. Quantification of Straylight Induced by Silicone Oil Adherent to Intraocular Lenses of Different Materials. Am J Ophthalmol 2024; 262:192-198. [PMID: 38016528 DOI: 10.1016/j.ajo.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE A complication of using silicone oil as an intraocular endotamponade is its adhesion to intraocular lenses (IOLs). Forward light scattering is a measure to quantify the optical disturbance caused by adherent oil droplets. We tested the straylight caused by silicone oil adhesion to different IOLs and examined whether an approved cleaning solution, F4H5, reverses the induced straylight. DESIGN An experimental study. METHODS Two hydrophobic acrylic IOL models and 1 hydrophilic model with a hydrophobic surface (n = 8 per model: 24 lenses) had straylight measured before contact with silicone oils, providing a baseline for subsequent testing: 12 lenses with lighter-than-water silicone oil (Siluron 2000) and 12 with heavier-than-water oil (Densiron 68). The final measurement was performed after cleansing with F4H5 when we used scanning electron and light microscopy to detect surface changes. RESULTS Straylight was majorly increased in IOLs with adherent silicone oil (baseline vs adherent oil median 3.1 [2.1, 3.9] and 39.7 [22.7, 87.8] deg2/sr, respectively; P < .001). No difference was seen between heavier- and lighter-than-water silicone oils. Between IOL types, induced straylight varied significantly, with 1 hydrophobic model reaching the highest average straylight. F4H5 significantly reduced straylight values in all IOL types (median 9.4 [5.4, 13.8] deg2/sr). The microscopy revealed surface changes on the IOLs even after cleaning. CONCLUSIONS Silicone oil adhesion to IOLs can induce amounts of straylight known to cause severe optical disturbance. F4H5 cleansing solution reversed straylight values to only slightly increased values. We found no difference in straylight formation between the lighter- and heavier-than-water silicone oils.
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Affiliation(s)
- Maximilian Hammer
- From the Department of Ophthalmology, University Clinic Heidelberg (M.H., L.B., A.S., R.K., G.Ł., G.U.A.); David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.)
| | - Leoni Britz
- From the Department of Ophthalmology, University Clinic Heidelberg (M.H., L.B., A.S., R.K., G.Ł., G.U.A.); David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.)
| | - Sonja Schickhardt
- David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.)
| | - Ingo Lieberwirth
- Heidelberg, Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz (I.L.)
| | - Donald Munro
- David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.)
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg (P.U.), Germany
| | - Alexander Scheuerle
- From the Department of Ophthalmology, University Clinic Heidelberg (M.H., L.B., A.S., R.K., G.Ł., G.U.A.); David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.)
| | - Ramin Khoramnia
- From the Department of Ophthalmology, University Clinic Heidelberg (M.H., L.B., A.S., R.K., G.Ł., G.U.A.)
| | - Grzegorz Łabuz
- From the Department of Ophthalmology, University Clinic Heidelberg (M.H., L.B., A.S., R.K., G.Ł., G.U.A.); David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.)
| | - Gerd Uwe Auffarth
- From the Department of Ophthalmology, University Clinic Heidelberg (M.H., L.B., A.S., R.K., G.Ł., G.U.A.); David J Apple Laboratory for Vision Research (M.H., L.B., S.S., D.M., A.S., R.K., G.Ł., G.U.A.).
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Hammer M, Muuss M, Schickhardt S, Scheuerle A, Khoramnia R, Łabuz G, Uhl P, Auffarth GU. Forward Light Scattering of the Vitreous Gel After Enzymatic Aging: An In Vitro Model to Study Vitreous Opacification. Invest Ophthalmol Vis Sci 2024; 65:36. [PMID: 38551585 PMCID: PMC10981431 DOI: 10.1167/iovs.65.3.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
Purpose Symptomatic vitreous opacifications, so-called floaters, are difficult to objectively assess majorly limiting the possibility of in vitro studies. Forward light scattering was found previously to be increased in eyes with symptomatic floaters. Using an objective setup to measure forward light scattering, we studied the effects of enzymatically digesting the components of the vitreous body on straylight to develop an in vitro model of vitreous opacifications. Methods Fifty-seven porcine vitreous bodies were digested using hyaluronidase, collagenase, trypsin, and bromelain, as well as using a combination of hyaluronidase + collagenase and hyaluronidase + bromelain. A modified C-Quant setup was used to objectively assess forward light scattering. Results Depletion of hyaluronic acid majorly increased vitreous straylight (mean increase 34.4 deg2/sr; P = 0.01), whereas primarily digesting the vitreous gel with collagenase or trypsin did not significantly affect straylight. When collagenase or bromelain is applied in hyaluronic acid depleted vitreous gels, the increase in forward light scattering is reversed partially. Conclusions The age-related loss of hyaluronic acid primarily drives the increase in vitreous gel straylight induced by conglomerates of collagen. This process can be reversed partially by digesting collagen. This in vitro model allows the objective quantification and statistical comparison of straylight burden caused by vitreous opacities and, thus, can serve as a first testing ground for pharmacological therapies, as demonstrated with bromelain.
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Affiliation(s)
- Maximilian Hammer
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Marcel Muuss
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Sonja Schickhardt
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | | | | | - Grzegorz Łabuz
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
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Chychko L, Khoramnia R, Son HS, Schickhardt SK, Lieberwirth I, Auffarth GU, Yildirim TM. Material Analysis of Explanted Calcified Silicone Intraocular Lenses in Association with Asteroid Hyalosis. Ophthalmol Ther 2024; 13:791-800. [PMID: 38244181 PMCID: PMC10853093 DOI: 10.1007/s40123-023-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The aim of this study was to analyze posterior surface opacification in explanted silicone intraocular lenses (IOLs) with clinicopathologic correlation to asteroid hyalosis. METHODS In a laboratory setup, 12 explanted silicone IOLs underwent laboratory analyses, including light microscopy, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy for elemental composition (EDX). Relevant clinical data were obtained for each case, including gender, age at IOL implantation, dates of implantation and explantation, as well as history of neodymium-dopped yttrium aluminum garnet (Nd:YAG) laser treatments or other opacification removal attempts. High-resolution optical coherence tomography (OCT) images were obtained in vitro with an anterior segment OCT device (Anterion, Heidelberg Engineering, Heidelberg, Germany). RESULTS Calcification located at the posterior optic surface of each lens was identified through SEM and EDX analyses, revealing deposits composed of hydroxyapatite. In all cases, IOL polishing using Nd:YAG laser had been attempted prior to IOL exchange. The clinical functional data showed that this type of IOL opacity led to increase in straylight and subjective symptoms of glare. CONCLUSIONS Silicone IOLs can develop posterior surface calcification in eyes with asteroid hyalosis. There are mechanical techniques of cleaning the IOL surface but in many cases, IOL explantation is the only sustainable way to reduce the patients' straylight levels and glare symptoms. Due to the risk of posterior surface calcification, silicone IOL implantation should be avoided in eyes with asteroid hyalosis.
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Affiliation(s)
- Lizaveta Chychko
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Sonja K Schickhardt
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Lieberwirth
- Department of Physical Chemistry of Polymers, Max Planck Institute for Polymer Research, Mainz, Germany
| | - Gerd U Auffarth
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Timur M Yildirim
- David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Hammer M, Herth J, Muuss M, Schickhardt S, Scheuerle A, Khoramnia R, Łabuz G, Uhl P, Auffarth GU. Forward Light Scattering of First to Third Generation Vitreous Body Replacement Hydrogels after Surgical Application Compared to Conventional Silicone Oils and Vitreous Body. Gels 2023; 9:837. [PMID: 37888410 PMCID: PMC10606486 DOI: 10.3390/gels9100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
To treat certain vitreoretinal diseases, the vitreous body, a hydrogel composed of mostly collagen and hyaluronic acid, must be removed. After vitrectomy surgery, the vitreous cavity is filled with an endotamponade. Previously, pre-clinical hydrogel-based vitreous body substitutes either made from uncrosslinked monomers (1st generation), preformed crosslinked polymers (2nd generation), or in situ gelating polymers (3rd generation) have been developed. Forward light scattering is a measure of Stray light induced by optical media, when increased, causing visual disturbance and glare. During pinhole surgery, the hydrogels are injected into the vitreous cavity through a small 23G-cannula. The aim of this study was to assess if and to what extent forward light scattering is induced by vitreous body replacement hydrogels and if Stray light differs between different generations of vitreous body hydrogel replacements due to the different gelation mechanisms and fragmentation during injection. A modified C-Quant setup was used to objectively determine forward light scattering. In this study, we found that the 1st and 3rd generation vitreous body replacements show very low stray light levels even after injection (2.8 +/- 0.4 deg2/sr and 0.2 +/- 0.2 deg2/sr, respectively) as gel fragmentation and generation of interfaces is circumvented. The 2nd generation preformed hydrogels showed a permanent increase in stray light after injection that will most likely lead to symptoms such as glare when used in patients (11.9 +/- 0.9 deg2/sr). Stray light of the 2nd generation hydrogels was 3- and 2-fold increased compared to juvenile and aged vitreous bodies, respectively. In conclusion, this significant downside in the forward light scattering of the 2nd generation hydrogels should be kept in mind when developing vitreous body replacement strategies, as any source of stray light should be minimized in patients with retinal comorbidities.
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Affiliation(s)
- Maximilian Hammer
- David J Apple Laboratory for Vision Research, 69120 Heidelberg, Germany; (M.H.)
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Jonathan Herth
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
- Institute for Pharmacy and Molecular Biotechnology, 69120 Heidelberg, Germany
| | - Marcel Muuss
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Sonja Schickhardt
- David J Apple Laboratory for Vision Research, 69120 Heidelberg, Germany; (M.H.)
| | - Alexander Scheuerle
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Grzegorz Łabuz
- David J Apple Laboratory for Vision Research, 69120 Heidelberg, Germany; (M.H.)
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, 69120 Heidelberg, Germany
| | - Gerd Uwe Auffarth
- David J Apple Laboratory for Vision Research, 69120 Heidelberg, Germany; (M.H.)
- Department of Ophthalmology, University Clinic Heidelberg, 69120 Heidelberg, Germany
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Augustin VA, Son HS, Yildirim TM, Meis J, Łabuz G, Auffarth GU, Khoramnia R. Refractive outcomes after DMEK: meta-analysis. J Cataract Refract Surg 2023; 49:982-987. [PMID: 37144644 DOI: 10.1097/j.jcrs.0000000000001212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
In this meta-analysis and systematic literature review of refractive outcomes after Descemet membrane endothelial keratoplasty (DMEK), the extent of the refractive shift and an overview of reasons for refractive shift after DMEK are provided. The PubMed library was screened for articles containing the terms "Descemet membrane endothelial keratoplasty," "DMEK," "Descemet membrane endothelial keratoplasty combined with cataract surgery," "triple-DMEK" combined with "refractive outcomes," "refractive shift," and "hyperopic shift." The refractive outcomes after DMEK were analyzed and compared using a fixed and random effects model. The overall mean change of the spherical equivalent outcome when compared with the preoperative value in cases of DMEK or when compared with the preoperative target refraction in cases of DMEK combined with cataract surgery was +0.43 diopters (D) (95% CI, 0.31-0.55). When DMEK is combined with cataract surgery, a target refraction of -0.5 D is recommended to achieve emmetropia. Changes in the posterior corneal curvature are identified as the main cause of the refractive hyperopic shift.
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Affiliation(s)
- Victor A Augustin
- From the David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany (Augustin, Son, Yildirim, Łabuz, Auffarth, Khoramnia); Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany (Meis)
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Liu X, Dai Y, Huang Y, Zheng S, Wei Y, Teng Y, Wu X. New exploration of ions and fatty acids in hydrophilic acrylic intraocular lens calcification. J Cataract Refract Surg 2023; 49:970-975. [PMID: 37184462 DOI: 10.1097/j.jcrs.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To conduct a new exploration and analysis of the ion and fatty acid levels of a medium in which calcified hydrophilic intraocular lenses (IOLs) are present. SETTING Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. DESIGN Retrospective, laboratory observational case series. METHODS 11 patients (11 eyes) who had implantation of foldable hydrophilic acrylic posterior IOLs were found to have opacification of the IOLs. In vivo and in vitro analyses included the evaluation of patients' clinical characteristics, microscopy, histological staining, energy dispersive X-ray spectroscopy (EDS), the ion level of the aqueous humor (AH) and preserving fluid (PF), and the fatty acid content of AH. RESULTS 10 of 11 cases were female with unilateral opacification, and 7 cases had both-eye cataract surgery, including 1 first eye and 6 second eyes with IOL opacification. 4 types of similar serial numbers were counted. The analysis of AH showed that the concentrations of phosphorus and silicon were elevated but that of calcium decreased, and an increased level of silicon was detected in 3 random PFs. The palmitic (C16:0) and stearic (C18:0) fatty acids were higher than the others in the AH. The EDS confirmed that the IOL surface deposits were composed of calcium, phosphate, and a small amount of silicon. CONCLUSIONS More silicon and higher C16:0 and C18:0 were found in the AH of patients with IOL opacification. New ideas and avenues have been proposed in the study of IOL opacification.
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Affiliation(s)
- Xiaomin Liu
- From the Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu); State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu); Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China (Liu, Dai, Huang, Zheng, Wei, Teng, Wu)
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Augustin VA, Köppe MK, Son HS, Meis J, Yildirim TM, Khoramnia R, Auffarth GU. Scheimpflug Versus Optical Coherence Tomography to Detect Subclinical Corneal Edema in Fuchs Endothelial Corneal Dystrophy. Cornea 2022; 41:1378-1385. [PMID: 34864801 DOI: 10.1097/ico.0000000000002925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this research was to compare the ability of Scheimpflug and anterior segment optical coherence tomography (OCT) in detecting subclinical corneal edema in patients with Fuchs endothelial corneal dystrophy (FECD) without clinical corneal edema. METHODS In this single-center, consecutive case series, 47 eyes of 29 patients with FECD were analyzed. The main outcome measures were anterior/posterior keratometry and central/thinnest corneal thickness. The criteria for subclinical corneal edema were loss of regular isopachs, displacement of the thinnest point of the cornea, and presence of posterior surface depression. Tomographic analyses were performed using Scheimpflug imaging (Pentacam HR) and OCT (anterior segment swept-source optical coherence tomography). RESULTS The measurement of the continuous variables revealed a significant difference between the 2 devices. The anterior curvature was steeper and the posterior curvature was flatter when measured with OCT ( P < 0.001). The OCT showed a lower central corneal thickness and thinnest corneal thickness ( P < 0.001). The agreement between both devices to detect subclinical corneal edema was high. The interdevice reliability for loss of parallel isopachs as measured by Cohen kappa coefficient was 0.84; for the displacement of the thinnest point of the cornea, it was 0.6, and for the focal posterior corneal surface depression, it was 0.62. Subclinical corneal edema was detected in 72.3% of the patients with both devices. In only 2 cases (4.3%), subclinical corneal edema was detected by one of the devices. CONCLUSIONS Scheimpflug and OCT imaging were both able to detect tomographic patterns of subclinical corneal edema. Therefore, both devices can help decision-making, favoring early endothelial keratoplasty in symptomatic patients with FECD without clinical corneal edema.
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Affiliation(s)
- Victor A Augustin
- Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany; and
| | - Max K Köppe
- Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany; and
| | - Hyeck-Soo Son
- Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany; and
| | - Jan Meis
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Timur M Yildirim
- Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany; and
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany; and
| | - Gerd U Auffarth
- Department of Ophthalmology, University of Heidelberg, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Heidelberg, Germany; and
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Moshirfar M, Huynh R, Ellis JH. Cataract surgery and intraocular lens placement in patients with Fuchs corneal dystrophy: a review of the current literature. Curr Opin Ophthalmol 2022; 33:21-27. [PMID: 34743088 DOI: 10.1097/icu.0000000000000816] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Late-onset Fuchs endothelial corneal dystrophy (FECD) is seen in approximately 4% of individuals over the age of 40. With the growing population of adults over the age of 65, ophthalmologists need to be aware of the preoperative, perioperative, and postoperative considerations involved in cataract surgery in Fuchs patients. RECENT FINDINGS Management of cataract patients with FECD requires preoperative assessment of endothelial cell size, density, and morphology. Considerations for perioperative endothelial cell loss include patients with hyperopia and shallow anterior chambers, phacoemulsification technique, transfer of ultrasonic energy to the cornea, corneal-protective perioperative agents, as well as thermal and mechanical damage. SUMMARY Ophthalmologists performing cataract surgery on patients with FECD must carefully consider the risks of endothelial cell loss during surgery and minimize the risk of corneal decompensation after surgery. Preoperative management should evaluate the severity of the FECD as well as individual factors such as cataract density, the health and thickness of the cornea, and the anterior chamber depth. Perioperative techniques, adjustments to biometry calculations, and intraocular lens (IOL) selection may help optimize visual outcomes and recovery time.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, Utah, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA
- Utah Lions Eye Bank, Murray, Utah, USA
| | - Rachel Huynh
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James H Ellis
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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10
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[Material properties of intraocular lenses: are there patient-relevant differences?]. Ophthalmologe 2021; 118:1066-1067. [PMID: 34477904 DOI: 10.1007/s00347-021-01490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
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Abstract
The spectrum of complications in the use of intraocular lenses (IOL) is different today from at the time of their introduction. Opacities in the IOL material are increasingly described in the literature as a reason for IOL explantation. This paper provides an overview of the different forms of IOL material opacities. Currently relevant forms of IOL material opacities and their effects on optical quality are summarized. The main reason for opacification in hydrophilic IOLs is calcification, whereas in hydrophobic IOLs it is mainly the formation of so-called glistenings that is reported. Most material opacities affect various optical parameters and lead to increased intraocular straylight. In case of a disturbing material opacification, the only therapeutic option is to replace the opacified IOL.
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12
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Khoramnia R. Eintrübung von Intraokularlinsen. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1250-3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Spektrum an Komplikationen und die Explantationsgründe bei der Verwendung von
Intraokularlinsen (IOL) haben sich durch die Weiterentwicklung der
Kataraktchirurgie verändert. Eintrübungen des Materials beeinflussen dabei
unterschiedlich stark die optische Qualität. Im Fall einer störenden Eintrübung
des Materials ist auch heute noch – trotz aller Fortschritte auf dem Gebiet der
IOL-Materialien – ein Austausch der IOL die einzige Behandlungsoption.
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