1
|
Hinterhuber L, Rezar-Dreindl S, Schmidt-Erfurth U, Stifter E. Postoperative outcome and influencing factors of strabismus surgery in infants aged 1-6 years. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06404-1. [PMID: 38363357 DOI: 10.1007/s00417-024-06404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To evaluate the postoperative outcome of strabismus surgery performed in children aged 1-6 years by investigating the change of the preoperative angle of deviation (AOD), elevation in adduction, best-corrected visual acuity (BCVA) and refractive error. METHODS Retrospective chart review of 62 children who received strabismus surgery between January 2018 and December 2021 at the Department of Ophthalmology and Optometry of the Medical University of Vienna. Age, sex, type of strabismus, AOD, BCVA, refractive error and visual acuity were evaluated with respect to the postoperative outcome. RESULTS Mean follow-up was 13.55 ± 11.38 months with a mean age of 3.94 ± 1.97 years (range: 1.0-6.0) at time of surgery. 74.19% of patients (n = 46) had isolated or combined esotropia, 12.90% (n = 8) had isolated or combined exotropia and 12.90% (n = 8) had isolated strabismus sursoadductorius. Mean preoperative AOD of 15.69 ± 16.91°/15.02 ± 14.88° (near/distance) decreased to 4.00 ± 9.18°/4.83 ± 7.32° (near/distance) at final follow-up (p < 0.001). BCVA improved from 0.26 ± 0.26/0.25 ± 0.23 (left/right) to 0.21 ± 0.25/0.20 ± 0.23 (left/right) (p = 0.038). There was no significant change regarding refractive error (p = 0.109) or elevation in adduction (p = 0.212). Success rate which was defined as a residual AOD of less than 10° was 74.19% (n = 46). In 3.23% (n = 2) retreatment was necessary. CONCLUSION Strabismus surgery in infants was shown to have a satisfactory outcome with a low retreatment rate. Surgical success rate was not linked to age, sex, type of strabismus or the preoperative parameters AOD, refractive error and visual acuity in this study.
Collapse
Affiliation(s)
- Laetitia Hinterhuber
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| |
Collapse
|
2
|
Eibenberger K, Rezar-Dreindl S, Briem J, Schmidt-Erfurth U, Stifter E. Patients with septo-optic dysplasia: General ophthalmologic assessment and retinal imaging. Eur J Ophthalmol 2023; 33:NP11-NP20. [PMID: 36163692 DOI: 10.1177/11206721221128865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate the functional development and, retinal and optic disc morphology using OCT in patients with septo-optic dysplasia (SOD). METHODS This retrospective case series included patients diagnosed with SOD between 2007 and 2020. Ophthalmologic assessment included visual acuity (VA) and funduscopy at the initial and last presentation. Retinal imaging included OCT of the macula analyzing the retinal morphology, central retinal thickness volume (CRT) and ganglion cell layer (GCL). Also, scans of the optic nerve head were taken to evaluate the retinal nerve fiber layer (RNFL) and global value. RESULTS 38 eyes of 19 children with a mean age 6.3 ± 5.3 years were included. 31.6% showed all 3 characteristics of SOD, whereof ONH, midline defects and endocrine dysfunctions were found in 94.7%, 89.5% and 47.4% respectively. The mean VA was 0.70 ± 0.66logMar in the right eye (RE) and 0.40 ± 0.55logMar in the left eye (LE) at the initial presentation. No change of vision (RE: 0.69 ± 0.71logMar; LE: 0.31 ± 0.57logMar) was found after a follow-up period of 6.3 ± 4.5years. Funduscopy showed an ONH in 79% (n = 30/38), tortuous retinal vessels in 36.8% (n = 14/38) and a double-ring sign in 15.8% (n = 6/38). Retinal imaging showed variable morphology. 6 eyes of 4 patients showed temporal retinal thinning with corresponding GCL attenuation. The optic nerve head appearance varied between no changes, sectoral and hemispherical reduction. CONCLUSIONS Patients suffering from SOD show diverse expression of retinal changes such as retinal, GCL and RNFL thinning in OCT. Furthermore, visual function remained stable during follow-up examinations, indicating no further alteration due to underlying pathology.
Collapse
Affiliation(s)
- Katharina Eibenberger
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Jakob Briem
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| |
Collapse
|
3
|
Voith-Sturm V, Rezar-Dreindl S, Neumayer T, Schmidt-Erfurth U, Stifter E. Pre- and postsurgical measurements in patients with strabismus sursoadductorius a retrospective study. Eur J Ophthalmol 2023:11206721231156985. [PMID: 36797994 PMCID: PMC10331513 DOI: 10.1177/11206721231156985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE Strabismus sursoadductorius is the most common strabismus of the oblique eye muscles. The changes in squint angle, elevation in adduction, abnormal head posture and binocular vision were collected to get an overview of the results at the largest clinic in Austria. METHODS This study is a retrospective study. The orthoptic and ophthalmologic parameters of 102 patients who were treated in the Department of Ophthalmology and Optometry between January 2017 und September 2020 were collected and statistically analysed. RESULTS The mean age was 12.2 ± 14.8 years. The squint angle changed from 18.3 ± 6.3 presurgical to 13.4 ± 9.7 (p = 0.09) with Hirschberg measurement. The squint angle changed from 12.5 ± 7.7 to 6.7 ± 4.9 (p < 0.01) at distance and from 12.5 ± 7.6 to 6.1 ± 4.5 (p < 0.01) at near with the prism covertest. Elevation in adduction showed a highly significant change (p < 0.01) from 15 ± 5.6 to 1.4 ± 2.8 degrees on average postsurgical. In binocular vision at distance there was also a highly significant (p < 0.01) change with 21.6% to postsurgical 37.3% positive tests. At near, the positives also increased significantly (p = 0.01) from 32.4% to 39.2%. There was no significant change in stereo vision (p = 1.0). Presurgical 52.9% of the sample had an abnormal head posture, postsurgical it was 38.2%, this change is also highly significant (p < 0.01). CONCLUSION The change was significant to highly significant for most parameters (i.e., squint angle, elevation in adduction, and abnormal head posture).
Collapse
Affiliation(s)
- Victoria Voith-Sturm
- Department of Ophthalmology and Optometry, 27271Medical University of Vienna, Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, 27271Medical University of Vienna, Vienna, Austria
| | - Thomas Neumayer
- Department of Ophthalmology and Optometry, 27271Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, 27271Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, 27271Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Eibenberger K, Rezar-Dreindl S, Pusch F, Schmidt-Erfurth U, Stifter E. Management of cataract surgery in Lowe syndrome. Int J Ophthalmol 2022; 15:1198-1202. [PMID: 35919319 DOI: 10.18240/ijo.2022.07.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma. METHODS This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra- and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. RESULTS All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86min, whereas the total time of surgery was 153.33±22.11min. The mean extubation time and duration at recovery room was 42.33±22.60min and 130.00±64.37min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative follow-up, nystagmus (6 children) and strabismus (5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. CONCLUSION Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.
Collapse
Affiliation(s)
- Katharina Eibenberger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna 1090, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna 1090, Austria
| | - Franz Pusch
- Department of Anesthesiology, Medical University of Vienna, Vienna 1090, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna 1090, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna 1090, Austria
| |
Collapse
|
5
|
Rezar-Dreindl S, Papp A, Baumann A, Neumayer T, Eibenberger K, Stifter E, Schmidt-Erfurth U. Management of patients with dysthyroid optic neuropathy treated with intravenous corticosteroids and/or orbital decompression surgery. Graefes Arch Clin Exp Ophthalmol 2022; 260:3683-3691. [PMID: 35731314 PMCID: PMC9581819 DOI: 10.1007/s00417-022-05732-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the characteristics and long-term outcomes of adult patients with dysthyroid optic neuropathy (DON) who underwent orbital decompression surgery and/or received intravenous (IV) methylprednisolone. Methods Retrospective chart review of 98 eyes of 49 patients who were diagnosed and treated with bilateral DON between 2007 and 2018 at the Department of Ophthalmology and Optometry and Oral and Maxillofacial Surgery of the Medical University of Vienna. Results The mean follow-up period was 4.1 ± 2.7 years. The most common presenting symptoms were eyelid and periorbital swelling (45%) representing active inflammation. Upgaze restriction was the most common clinical finding (73%). At time of diagnosis, the mean clinical activity score was 4 ± 1/4 ± 1 (right/left eye, respectively). Sixty-three percent (31/49) of the patients were treated both with IV methylprednisolone and underwent orbital decompression surgery, 22% (11/49) were treated with IV methylprednisolone alone and 14% (7/49) underwent surgical decompression only. Seventy-one percent (30/42) of the patients underwent 3-wall decompression. The mean reduction of proptosis in patients treated with both IV methylprednisolone and orbital decompression surgery was 4/5 mm. Mean of reduction in proptosis in patients receiving IV methylprednisolone only was 1/0 mm and in patients with surgical decompression only was 5/5 mm. Mean VA was 0.1 ± 0.5/0.1 ± 0.5 logMAR at baseline and 0.05 ± 0.7/0.05 ± 0.7 at final follow-up. In 92% (45/49), VA was preserved or improved at final follow-up. Conclusions The majority of patients with DON were treated both with IV corticosteroids and 3-wall decompression surgery. Vision could be successfully preserved in most cases and reduction of proptosis was achieved, especially after orbital decompression surgery. ![]()
Collapse
Affiliation(s)
- Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Andrea Papp
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Arnulf Baumann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Neumayer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Katharina Eibenberger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| |
Collapse
|
6
|
Rezar-Dreindl S, Eibenberger K, Told R, Unterluggauer V, Sacu S, Schmidt-Erfurth U, Stifter E. Microvascular retinal changes in patients with Marfan syndrome. Curr Eye Res 2022; 47:1186-1192. [PMID: 35416099 DOI: 10.1080/02713683.2022.2066698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose. To determine microvascular changes in patients with genetically proven Marfan syndrome.Methods. In a cross-sectional study, 32 eyes of 16 patients with genetically proven Marfan syndrome were evaluated using swept-source optical coherence tomography angiography (SS-OCTA). Patients were analyzed regarding lens status and systemic vascular disease. The foveal avascular zone (FAZ) and vessel density (VD) of the superficial and deep vascular plexus and central retinal thickness (CRT) were evaluated on SS-OCTA.Results. 44/56% patients presented without/with subluxation of the lens. 69% of patients had presence of mitral valve insufficiency, aortic dilatation or aneurysm of the aortic root. In patients with Marfan syndrome the mean area of the FAZ was 0.2 ± 0.1mm and the average VD of the superficial/deep vascular plexus was 36 ± 5%/22 ± 7%. In patients with subluxation of the lens FAZ area and perimeter were larger when compared to patients without subluxation of the lens (0.18 ± 0.08/0.28 ± 0.10 mm and 1.7 ± 0.4/2.3 ± 0.8; p = 0.02). VD of the superficial vascular plexus was reduced in patients with subluxation of the lens (on average 39 ± 3/33 ± 8; p = 0.01) together with an increased CRT in the inner segments of the ETDRS grid when compared to patients without subluxation of the lens. In patients with systemic vascular disease a larger FAZ area (0.19 ± 0.06/0.25 ± 0.1mm; p = 0.04) and reduced VD of the superficial vascular plexus in the central ETDRS grid (28 ± 7/21 ± 6; p = 0.02) was observed in comparison to patients without systemic vascular changes.Conclusions. In patients with Marfan syndrome SS-OCTA imaging revealed microvascular differences in patients with lens subluxation and/or systemic vascular disease.
Collapse
Affiliation(s)
- Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Katharina Eibenberger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Reinhard Told
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Veronika Unterluggauer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Rezar‐Dreindl S, Eibenberger K, Told R, Neumayer T, Steiner I, Sacu S, Schmidt‐Erfurth U, Stifter E. Retinal vessel architecture in retinopathy of prematurity and healthy controls using swept-source optical coherence tomography angiography. Acta Ophthalmol 2021; 99:e232-e239. [PMID: 32749763 PMCID: PMC7984179 DOI: 10.1111/aos.14557] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine microvascular changes in children with a history of retinopathy of prematurity (ROP) and in a control group of full-term children. METHODS In a cross-sectional study, 30 eyes of 15 children aged 6-8 years with a history of ROP were evaluated with swept-source optical coherence tomography angiography (SS-OCTA). Twenty-eight eyes of 22 age-matched full-term children served as a healthy control group. The foveal avascular zone (FAZ), vessel density (VD) and choroidal vascular flow area (VFA) were evaluated on OCTA and correlated with central retinal thickness (CRT), visual acuity (VA), birth weight (BW), gestational age (GA) and ROP stages. RESULTS Twenty-two eyes of 14 children with a history of ROP (stage 1-3) and 25 eyes of 19 full-term children were available for evaluation. In the ROP group, the gestational age was 27 ± 2 weeks and birth weight was 781 ± 164 g. In the ROP group, CRT was higher in the central ETDRS segment (mean difference [95% CI]: 32.8 µm [18.7; 47.0], p = 0.0002) compared to the controls. Smaller mean FAZ area (-0.12 [-0.19; -0.04], p = 0.004) and perimeter (-662 [-1228; -96], p = 0.03) was found in comparison to the control group. An oval shape of the FAZ was observed among patients with a history of ROP. The mean central VD of the superficial plexus was 28 ± 8/23 ± 8% and of the deep plexus 7 ± 7/3 ± 5% (ROP group/control group; p > 0.05). No statistically significant difference was found regarding the choroidal VFA. Only weak correlation of FAZ and VD with function was observed. CONCLUSIONS Swept-source optical coherence tomography angiography imaging revealed significant microvascular anomalies in children with a history of ROP indicating disturbance of early morphological development of the central retina.
Collapse
Affiliation(s)
- Sandra Rezar‐Dreindl
- Department of Ophthalmology and OptometryMedical University of ViennaViennaAustria
| | | | - Reinhard Told
- Department of Ophthalmology and OptometryMedical University of ViennaViennaAustria
| | - Thomas Neumayer
- Department of Ophthalmology and OptometryMedical University of ViennaViennaAustria
| | - Irene Steiner
- Section for Medical StatisticsCenter for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS)Medical University of ViennaViennaAustria
| | - Stefan Sacu
- Department of Ophthalmology and OptometryMedical University of ViennaViennaAustria
| | | | - Eva Stifter
- Department of Ophthalmology and OptometryMedical University of ViennaViennaAustria
| |
Collapse
|
8
|
Eibenberger K, Kiss B, Schmidt-Erfurth U, Stifter E. Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery. Eur J Ophthalmol 2021; 31:3309-3317. [PMID: 33525900 DOI: 10.1177/1120672121991356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. METHODS This retrospective case series included all children aged 0-2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. RESULTS One hundred and sixty-one eyes of 110 patients aged 0-2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure (p = 0.62) was found, but age at cataract surgery differed significantly (p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months).Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus (p = 0.81), strabismus (p = 0.98) and amblyopia (p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group (p = 0.036). CONCLUSION Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2-3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.
Collapse
Affiliation(s)
| | - Barbara Kiss
- Department of Ophthalmology, Medical University of Vienna, MUV, Vienna, Austria
| | | | - Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, MUV, Vienna, Austria
| |
Collapse
|
9
|
Eibenberger K, Sacu S, Rezar-Dreindl S, Schmidt-Erfurth U, Stifter E, Georgopoulos M. Clinical characteristics and surgical outcome of pediatric and early adulthood retinal detachment. Eur J Ophthalmol 2020; 31:1367-1374. [PMID: 32192354 DOI: 10.1177/1120672120913030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the underlying pathologies, demographic and retinal detachment characteristics in pediatric and early adulthood retinal detachment. METHODS Patients with rhegmatogenous, serous, or tractional retinal detachment aged 0-26 years were retrospectively reviewed. The preschool group (n = 4) comprised children aged 0-6 years, the pediatric group (n = 19) comprised children aged 7-16 years, and the early adulthood group (n = 13) aged 17-26 years. Demographic information and retinal detachment characteristics, type of surgery, and intraocular tamponade were analyzed. Postoperatively, the functional outcome, anatomic success, and ocular adverse events were evaluated. Due to the low patient number in the preschool group, statistical analysis was performed for pediatric group and early adulthood group only. RESULTS All causes of retinal detachment were present in the pediatric group, but only rhegmatogenous retinal detachment in the early adulthood group. In both groups, the main type of surgical intervention was pars plana vitrectomy (pediatric group: 52%, early adulthood group: 38%; p = 0.36). The type of intraocular tamponade varied statistically significantly between the groups (p = 0.014). Silicone oil was the main intraocular tamponade in the pediatric group (48%), whereas no tamponade (54%) followed by gas tamponade (46%) in the early adulthood group. Final attachment rate was similar in both groups (pediatric group: 89%, early adulthood group: 100%; p = 0.35). Re-detachment occurred significantly sooner in the pediatric group (1.3 ± 0.3 months) than in the early adulthood group (4.3 ± 1.4 months; p = 0.03). CONCLUSION In pediatric and early adulthood retinal detachment, pars plana vitrectomy appeared as a successful surgical intervention. Re-attachment rate and re-treatment were similar in both groups with a better functional outcome observed in cases of retinal detachment in early adulthood and poorer results in young children.
Collapse
Affiliation(s)
| | - Stefan Sacu
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | | | - Eva Stifter
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology, Medical University of Vienna (MUV), Vienna, Austria
| |
Collapse
|
10
|
Rezar-Dreindl S, Stifter E, Neumayer T, Papp A, Gschliesser A, Schmidt-Erfurth U. Visual outcome and surgical results in children with Marfan syndrome. Clin Exp Ophthalmol 2019; 47:1138-1145. [PMID: 31325202 PMCID: PMC6973035 DOI: 10.1111/ceo.13596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
IMPORTANCE To determine visual and surgical results in children with Marfan syndrome. BACKGROUND Marfan syndrome involves ocular complications which can lead to visual disturbance and amblyopia. Data about the visual and surgical results in children with Marfan syndrome is vital for the clinical management of these patients. DESIGN Retrospective data analysis. PARTICIPANTS Eighty-two eyes of 41 patients with a genetically proved diagnosis of Marfan syndrome. METHODS Medical records of patients with Marfan syndrome were reviewed between 2007 and 2017. Ocular complications, visual acuity (VA) of patients with/without lensectomy and surgical method were evaluated. MAIN OUTCOME MEASURES VA outcomes of patients with Marfan syndrome with/without surgical repair of ectopia lentis. RESULTS In 27 (66%) of the 41 patients a bilateral subluxation of the lens was visible and 14 (52%) patients received lensectomy. The mean age at initial presentation was 12.3 ± 9 years and mean follow-up was 3 years (range 1-7). VA varied from 1.2 to -0.1 logMAR at first examination. At initial presentation, mean VA was 0.1 ± 0.7 logMAR in patients with a normal lens status (n = 14) and 0.3 ± 0.5 logMAR in patients with subluxation of the lens (n = 27) (P < .01). VA improved from 0.2 ± 0.5 logMAR to 0.1 ± 0.5 logMAR (P = .06) in children with subluxation of the lens who did not need a lensectomy (n = 12) and from 0.5 ± 0.5 logMAR to 0.2 ± 0.5 logMAR (P = .02) in patients who were referred to lensectomy with/without secondary lens implantation. CONCLUSIONS AND RELEVANCE In Marfan syndrome subluxation of the lens was found in the majority of children. Improvement of VA resulted in children with subluxation of the lens and following lensectomy.
Collapse
Affiliation(s)
- Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Thomas Neumayer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andrea Papp
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Gschliesser
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
11
|
Diesner SC, Lukas J, Stifter E, Raimann A, Nachbaur E, Eiwegger T, Renner S, Emminger W, Geleff S, Szepfalusi Z. Bilateral Infiltrative Dacryoadenitis and Granulomatous Pneumonia in an 11-Year-Old Boy: A Case Report. Klin Padiatr 2017; 229:96-99. [PMID: 28444655 DOI: 10.1055/s-0043-100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Susanne C Diesner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Julius Lukas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Adalbert Raimann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Edith Nachbaur
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Eiwegger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Renner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Emminger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Silvana Geleff
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Zsolt Szepfalusi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
12
|
Steinkellner H, Etzler J, Gogoll L, Neesen J, Stifter E, Brandau O, Laccone F. Identification and molecular characterisation of a homozygous missense mutation in the ADAMTS10 gene in a patient with Weill-Marchesani syndrome. Eur J Hum Genet 2015; 23:1186-91. [PMID: 25469541 PMCID: PMC4538198 DOI: 10.1038/ejhg.2014.264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/15/2014] [Accepted: 10/24/2014] [Indexed: 01/30/2023] Open
Abstract
Weill-Marchesani syndrome is a rare disorder of the connective tissue. Functional variants in ADAMTS10 are associated with Weill-Marchesani syndrome-1. We identified a homozygous missense mutation, c.41T>A, of the ADAMTS10 gene in a 19-year-old female with typical symptoms of WMS1: proportionate short stature, brachydactyly, joint stiffness, and microspherophakia. The ADAMTS10 missense mutation was analysed in silico, with conflicting results as to its effects on protein function, but it was predicted to affect the leader sequence. Molecular characterisation in HEK293 Ebna cells revealed an intracellular mis-targeting of the ADAMTS10 protein with a reduced concentration of the polypeptide in the endoplasmic reticulum. A large reduction in glycosylation of the cytoplasmic fraction of the mutant ADAMTS10 protein versus the wild-type protein and a lack of secretion of the mutant protein are also evident in our results.In conclusion, we identified a novel missense mutation of the ADAMTS10 gene and confirmed the functional consequences suggested by the in silico analysis by conducting molecular studies.
Collapse
Affiliation(s)
- Hannes Steinkellner
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Julia Etzler
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Laura Gogoll
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Jürgen Neesen
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Oliver Brandau
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Franco Laccone
- Department of Medical Genetics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
13
|
Schriefl SM, Leydolt C, Stifter E, Menapace R. Posterior capsular opacification and Nd:YAG capsulotomy rates with the iMics Y-60H and Micro AY intra-ocular lenses: 3-year results of a randomized clinical trial. Acta Ophthalmol 2015; 93:342-7. [PMID: 25393894 DOI: 10.1111/aos.12543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 07/23/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the incidence and intensity of posterior capsular opacification (PCO) and neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy rates between two microincision intra-ocular lenses (IOLs) 3 years after surgery. METHODS Sixty-five patients randomly received a Y-60H IOL (HOYA Surgical Optics, Singapore) in one eye and a Micro AY IOL (PhysIOL, Liège, Belgium) in the contralateral eye during same-day bilateral cataract surgery. Eyes were examined 1 week, 20 months and 3 years after surgery. The amount of PCO (score: 0-10) was assessed subjectively at the slit lamp and objectively using automated image analysis software (aqua). Additionally, the Nd:YAG capsulotomy rate was noted. RESULTS Three years postoperatively, the objective PCO score of Y-60H IOLs was 1.9 ± 1.7 compared to PCO score of 1.7 ± 2.2 for the Micro AY IOLs (p = 0.66). Thirty-four percentage of the Y-60H eyes had undergone Nd:YAG capsulotomy, compared to 49% of the Micro AY eyes (p = 0.04). Significantly, more capsular folds were observed in the Y-60H IOL group (p = 0.001). There was no significant difference in best-corrected visual acuity, rhexis/IOL overlap and anterior capsule opacification 3 years after surgery. CONCLUSION Both microincision IOLs showed high YAG rates and comparable PCO scores 3 years after surgery. In the light of this unsatisfying PCO performance, the advantage of the present microincision IOLs over conventional IOLs must be questioned.
Collapse
Affiliation(s)
- Sabine M. Schriefl
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Christina Leydolt
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Eva Stifter
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | - Rupert Menapace
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| |
Collapse
|
14
|
Gschließer A, Stifter E, Neumayer T, Moser E, Papp A, Dorner G, Schmidt-Erfurth U. Twin-twin transfusion syndrome as a possible risk factor for the development of retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2014; 253:151-6. [PMID: 25303884 DOI: 10.1007/s00417-014-2816-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/09/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the correlation between twin-twin transfusion syndrome (TTTS) and the development of retinopathy of prematurity (ROP) in premature infants. METHODS Fifty-one infants who were less than 32 postmenstrual gestational weeks at birth or with a birth weight less than 1,501grams were included in this longitudinal observational study. The infants were matched by gestational age and birth weight, and divided into three groups: multiples with TTTS, multiples without TTTS, and singletons. The primary outcome variable was the incidence of ROP in infants affected by TTTS versus infants not affected by TTTS. Secondary outcome variables were multiple pregnancy, gestational age, and birth weight. RESULTS Infants affected by TTTS showed a significantly higher incidence of ROP than infants not affected by TTTS (p < 0.01). TTTS donors and TTTS recipients were both at greater risk of developing ROP. ROP occurred in infants with TTTS whose gestational age at birth was significantly higher than that of infants with ROP who were not affected by TTTS (p = 0.01). Multiple pregnancy itself was not a risk factor for ROP disease. CONCLUSIONS Infants affected by TTTS during pregnancy are at high risk of developing ROP, even if they were born at an older gestational age. Special awareness in ROP screening is necessary for these infants.
Collapse
Affiliation(s)
- Andreas Gschließer
- Department of Ophthalmology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
PURPOSE To compare intraoperative efficiency and postoperative outcomes of cataract surgery with low and high fluidic settings. METHODS In this prospective, randomized, single-blinded study, 114 eyes of 57 patients were operated with low fluidic settings for one eye (group I) and high fluidic settings for the other eye (group II). Efficiency was judged as metred surgery time, effective phacoemulsification time (EPT) and the amount of balanced salt solution used. Visual outcome and endothelial cell count were determined 1 week and 18 months postoperatively. RESULTS The overall effective phacoemulsification energy was statistically significantly lower (p = 0.003) in group II than in group I. Conquest of the nuclei was achieved with about two-thirds of the energy needed in group I, with 6.59 ± 4.79 effective ultrasound energy compared with 3.99 ± 3.18 (p = 0.001). Overall, about 12% more solution was used in group II than in group I. Median visual acuity was 1.0 for both groups 18 months after surgery. The mean endothelial cell loss was 5.0% in eyes in group I compared with 6.3% in eyes in group II (p > 0.5). CONCLUSION Switching from low fluidic settings with a conventional coaxial 20G phacoemulsification tip to higher fluidic settings with a microcoaxial phaco tip statistically significantly decreases EPT. As only marginally more solution was used with the higher aspiration flow, occlusion must be accomplished more often with high than with low fluidics. Aspiration of the quadrants was therefore more efficient with high fluidic settings. The enhanced pump speed did not result in more tissue damage.
Collapse
Affiliation(s)
- Sabine M Schriefl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | | |
Collapse
|
16
|
Leydolt C, Schriefl S, Stifter E, Haszcz A, Menapace R. Reply: To PMID 23677137. Am J Ophthalmol 2013; 156:1317-8. [PMID: 24238203 DOI: 10.1016/j.ajo.2013.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
|
17
|
Leydolt C, Schriefl S, Stifter E, Haszcz A, Menapace R. Posterior capsule opacification with the iMics1 NY-60 and AcrySof SN60WF 1-piece hydrophobic acrylic intraocular lenses: 3-year results of a randomized trial. Am J Ophthalmol 2013; 156:375-381.e2. [PMID: 23677137 DOI: 10.1016/j.ajo.2013.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the intensity of posterior capsule opacification (PCO) 3 years after implantation of 2 different 1-piece foldable hydrophobic acrylic intraocular lenses (IOLs). DESIGN Randomized, prospective, patient- and examiner-masked clinical trial with intraindividual comparison. METHODS One hundred patients with bilateral age-related cataract (200 eyes) had standard cataract surgery with implantation of an iMics1 NY-60 IOL (Hoya Corp) in one eye and an AcrySof SN60WF IOL (Alcon Laboratories) in the other eye. Follow-up examinations were performed at 1 week and 3 years. Digital retroillumination images were obtained of each eye. The main outcome measure was PCO score (scale, 0 to 10) assessed subjectively at the slit lamp and objectively using automated image analysis software (Automated Quantification of After-Cataract) 3 years after surgery. RESULTS The objective PCO score (mean ± standard deviation) was 3.0 ± 2.0 for the iMics1 NY-60 IOL and 1.9 ± 1.4 for the AcrySof SN60WF IOL (P < .001). Three years after surgery, 35.6% of patients underwent a neodymium:yttrium-aluminum-garnet capsulotomy in the iMics1 NY-60 eye and 13.7% underwent a capsulotomy in the AcrySof SN60WF eye (P = .001). There was no statistically significant difference in best-corrected visual acuity, rhexis-IOL overlap, capsular folds, or anterior capsule opacification. Glistening formations were found in no iMics1 NY-60 IOLs, but in 97% of the AcrySof SN60WF IOLs. CONCLUSIONS Comparison of 2 sharp-edged single-piece IOLs of similar design and hydrophobic acrylic material indicated a statistically significant difference in PCO and neodymium:yttrium-aluminum-garnet capsulotomy rate 3 years after surgery.
Collapse
|
18
|
Sipos E, Stifter E, Menapace R. Patient satisfaction and postoperative pain with different postoperative therapy regimens after standardized cataract surgery: a randomized intraindividual comparison. Int Ophthalmol 2012; 31:453-60. [DOI: 10.1007/s10792-011-9497-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 12/20/2011] [Indexed: 11/28/2022]
|
19
|
Prusa AR, Kasper DC, Pollak A, Stifter E, Hayde M. The Austrian Toxoplasmosis Register for Connatal Toxoplasma Infections – Overview of 17 years prenatal screening program. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
20
|
Stifter E, Menapace R, Kriechbaum K, Luksch A. Posterior optic buttonholing prevents intraocular pressure peaks after cataract surgery with primary posterior capsulorhexis. Graefes Arch Clin Exp Ophthalmol 2010; 248:1595-600. [PMID: 20652304 DOI: 10.1007/s00417-010-1454-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 06/29/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The performance of a primary posterior capsulorhexis (PPC) with and without posterior optic buttonholing (POBH) may significantly influence the intraocular pressure (IOP) after cataract surgery in age-related cataract patients. METHODS The prospective randomized clinical study was performed at the department of Ophthalmology, Medical University of Vienna, Austria. Thirty consecutive cataract patients with bilateral same-day cataract surgery (60 eyes) under topical anesthesia were enrolled. In randomized order, cataract surgery with combined PPC/POBH was performed in one eye; in the other eye, cataract surgery was performed with PPC and in-the-bag implantation of the intraocular lens (IOL). Standardized IOP measurements by Goldmann applanation tonometry were performed preoperatively, 1, 2, 4, 6, 8 and 24 hours postoperatively, as well as 1 week and 1 month postoperatively. RESULTS During the first 24 hours after surgery, all IOP measurements were significantly lower in eyes with combined PPC/POBH when compared to eyes with solitary PPC (p < 0.001). No IOP peaks of more than 27 mmHg were observed with combined PPC/POBH. In contrast, in eyes with PPC and in-the-bag IOL implantation, seven patients had an IOP peak of more than 27 mmHg and four IOP peaks of more than 30 mmHg. One week and 1 month postoperatively, IOP measurements were statistically comparable, and no significant differences could be observed between the two groups (p > 0.05). CONCLUSION Postoperative IOP peaks after cataract surgery with sole PPC can be effectively prevented by the buttonholing of the IOL through the posterior capsulorhexis.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | | | | | | |
Collapse
|
21
|
Matt G, Sacu S, Stifter E, Prünte C, Schmidt-Erfurth U. Kombinierte intravitreale Injektion von rTPA, Gas und Ranibizumab zur Behandlung groÃflächiger subfovealer Blutungen bei neovaskulärer altersbedingter Makuladegeneration. Klin Monbl Augenheilkd 2010; 227:221-5. [DOI: 10.1055/s-0028-1109750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Repa A, Jeitler V, Stifter E, Pollak A. Case study: Rubeosis iridis in a newborn with diabetic fethopathy. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Richter-Mueksch S, Sacu S, Osarovsky-Sasin E, Stifter E, Kiss C, Velikay-Parel M. Visual performance 3 years after successful macular hole surgery. Br J Ophthalmol 2008; 93:660-3. [DOI: 10.1136/bjo.2008.154963] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
24
|
Sacu S, Stifter E, Vécsei-Marlovits PV, Michels S, Schütze C, Prünte C, Schmidt-Erfurth U. Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration. Eye (Lond) 2008; 23:1404-10. [DOI: 10.1038/eye.2008.267] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
25
|
Stifter E, Menapace R, Neumayer T, Luksch A. Macular morphology after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing. Am J Ophthalmol 2008; 146:15-22. [PMID: 18439560 DOI: 10.1016/j.ajo.2008.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 02/22/2008] [Accepted: 02/25/2008] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate possible changes in macular morphology after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in comparison to conventional in-the-bag intraocular lens (IOL) implantation. DESIGN Prospective randomized study. METHODS Fifty consecutive age-related cataract patients with normal macular morphology and function waiting for bilateral cataract surgery were enrolled. Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing was performed in one eye; in the fellow eye cataract surgery was performed with in-the-bag IOL implantation, leaving the posterior lens capsule untouched. Optical coherence tomography measurements were performed one week and one month postoperatively. RESULTS During follow-up, no statistically significant changes of macular morphology could be observed in any of the tested patients. Mean central retinal thickness, minimum and maximum retinal thickness, and central retinal volume were all statistically comparable between the eyes with combined primary posterior capsulorhexis and posterior optic buttonholing and the control eyes (P > .05). Best-corrected visual acuity was full in all patients (Snellen 20/25 and better). No cases of subclinical macular edema were observed. CONCLUSION Cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing apparently does not increase the risk for postoperative macular edema in patients with a normal macula, since no cases of biomicroscopically noticeable macular edema with visual loss were observed in the first 1,000 eyes with primary posterior capsulorhexis/posterior optic buttonholing cataract surgery and no case of subclinical macular edema was found in this prospective randomized study.
Collapse
|
26
|
Stifter E, Menapace R, Luksch A, Neumayer T, Sacu S. Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing. J Cataract Refract Surg 2008; 34:749-54. [DOI: 10.1016/j.jcrs.2007.12.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
|
27
|
Rainer G, Stifter E, Luksch A, Menapace R. Comparison of the effect of Viscoat and DuoVisc on postoperative intraocular pressure after small-incision cataract surgery. J Cataract Refract Surg 2008; 34:253-7. [PMID: 18242449 DOI: 10.1016/j.jcrs.2007.09.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 09/24/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effect of Viscoat (sodium chondroitin sulfate 4%-sodium hyaluronate 3%) and DuoVisc (Viscoat and Provisc [sodium hyaluronate 1%]) on postoperative intraocular pressure (IOP) after bilateral small-incision cataract surgery. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS This prospective randomized study comprised 60 eyes of 30 consecutive patients with age-related cataract in both eyes. Each patient's eyes were randomly assigned to receive Viscoat or DuoVisc during cataract surgery. DuoVisc is a packet containing 2 ophthalmic viscosurgical devices (OVDs): the dispersive Viscoat, which was used for intraocular lens (IOL) implantation. In the Viscoat group, the Viscoat was used during the entire surgery. The intraocular pressure (IOP) was measured preoperatively as well as 1, 6, and 20 to 24 hours postoperatively. RESULTS One and 6 hours postoperatively, the mean IOP was significantly higher in the Viscoat group than in the DuoVisc group (25.8 mm Hg and 20.5 mm Hg, respectively, at 1 hour and 24.7 mm Hg and 21.1 mm Hg, respectively, at 6 hours) (P<.05). At 20 to 24 hours, the mean IOP was not statistically significantly different between the 2 groups. Intraocular pressure spikes to 30 mm Hg or higher occurred in 4 eyes in the DuoVisc group and 11 eyes in the Viscoat group (P<.05). CONCLUSIONS Viscoat caused significantly higher IOP increases and significantly more IOP spikes than DuoVisc in the early postoperative period. Therefore, if Viscoat is used during cataract surgery, an additional cohesive OVD should be used for IOL implantation.
Collapse
Affiliation(s)
- Georg Rainer
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
| | | | | | | |
Collapse
|
28
|
Stifter E, Michels S, Prager F, Georgopoulos M, Polak K, Hirn C, Schmidt-Erfurth U. Intravitreal bevacizumab therapy for neovascular age-related macular degeneration with large submacular hemorrhage. Am J Ophthalmol 2007; 144:886-892. [PMID: 17916314 DOI: 10.1016/j.ajo.2007.07.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 07/24/2007] [Accepted: 07/26/2007] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate functional and anatomic effects of intravitreal bevacizumab (Avastin; Roche Pharma, Vienna, Austria) in patients with neovascular age-related macular degeneration (AMD) with large submacular hemorrhages. DESIGN Retrospective, clinical study. METHODS Twenty-one eyes of 19 AMD patients with choroidal neovascularization and large submacular hemorrhage involving the fovea comprising more than 50% of the total lesion area were evaluated. All patients completed at least four months of follow-up; 12 patients fulfilled 12 months or more of follow-up. Patients were treated with up to six intravitreal bevacizumab injections (1 mg/0.04 ml) at a minimum of four-week intervals. Changes from baseline visual acuity (VA) scores, retinal measurements by optical coherence tomography (OCT), angiographic lesion characteristics, and hemorrhage size were analyzed. A safety assessment was performed at all visits. RESULTS Intravitreal bevacizumab injections were well tolerated in all patients. At month 4, VA was stable or improved (visual loss of 3 acuity lines or fewer) in 100% and improved by at least 3 lines in 9.5%. Comparable results were found at month 12. On average, the central foveal thickness decreased significantly by 55 microm four weeks after the first injection (P < .001) and by 52 microm at month 4 (P = .002). A significant anatomic improvement also was found for maximum retinal thickness, minimum retinal thickness, and foveal volume (P < .05) and was maintained during four months of follow-up. Mean size of hemorrhage was significantly reduced from 19.7 mm(2) at baseline to 2.5 mm(2) at the four-month follow-up (P < .001). CONCLUSIONS Intravitreal bevacizumab seems to be a promising therapeutic option in eyes with neovascular AMD and large submacular hemorrhages, with a stabilization in VA and anatomic improvement.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Stifter E, Menapace R, Luksch A, Neumayer T, Vock L, Sacu S. Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults. Br J Ophthalmol 2007; 91:1481-4. [PMID: 17504848 PMCID: PMC2095424 DOI: 10.1136/bjo.2007.120535] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2007] [Indexed: 11/04/2022]
Abstract
AIM Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. METHODS Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. RESULTS The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). CONCLUSION Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.
Collapse
Affiliation(s)
- E Stifter
- Department of Ophthalmology, Medical University of Vienna, Austria, Europe
| | | | | | | | | | | |
Collapse
|
31
|
Stifter E, Luksch A, Menapace R. Postoperative course of intraocular pressure after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing. J Cataract Refract Surg 2007; 33:1585-90. [PMID: 17720074 DOI: 10.1016/j.jcrs.2007.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 04/23/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the natural course of intraocular pressure (IOP) after cataract surgery with combined primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the intraocular lens (IOL) in adult patients. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS Fifty consecutive patients with age-related cataract awaiting cataract surgery under topical anesthesia in both eyes were enrolled prospectively. In randomized order, cataract surgery with combined PPCCC and POBH was performed in 1 eye. In the fellow eye, cataract surgery was performed conventionally with in-the-bag IOL implantation and the posterior lens capsule kept intact. Standardized IOP measurements by Goldmann applanation tonometry were performed 1, 2, 4, 6, 8, and 24 hours postoperatively. Follow-up IOP measurements were taken at 1 week and 1 month. Twenty-five patients received 1-time IOP-lowering medication immediately after cataract surgery; the other 25 did not receive IOP-lowering drops. RESULTS During the first 24 hours postoperatively, no significant differences in IOP were observed between the PPCCC-POBH group and the conventional surgery group (P>.05). No IOP peaks greater than 27 mm Hg were observed in any eye. One week and 1 month postoperatively, no significant differences in IOP were found between groups (P>.05). The use of IOP-lowering drops significantly reduced postoperative IOP. However, no IOP spikes >27 mm Hg were found with and without the use of IOP-lowering drops. CONCLUSION The course of IOP after cataract surgery with combined PPCCC and POBH showed the technique to be as safe as conventional cataract surgery with in-the-bag IOL implantation.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | | |
Collapse
|
32
|
|
33
|
Vock L, Menapace R, Stifter E, Bühl W, Georgopoulos M. Effect of primary posterior continuous curvilinear capsulorhexis on clinical performance of ACR6D SE single-piece hydrophilic acrylic intraocular lenses. J Cataract Refract Surg 2007; 33:628-34. [PMID: 17397735 DOI: 10.1016/j.jcrs.2007.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effects of a primary posterior continuous curvilinear capsulorhexis (PCCC) on the clinical performance of a single-piece hydrophilic acrylic intraocular lens (IOL) with haptic angulation. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS A prospective study of 52 patients with bilateral age-related cataract was conducted. Patients had standard cataract surgery with implantation of the same IOL in both eyes. Randomly, a PCCC was created in 1 eye and the posterior capsule was left intact in the fellow eye. Assessed parameters were visual axis opacification (VAO) in eyes with a PCCC or regeneratory posterior capsule opacification (PCO) in eyes without PCCC (scale 0 to 10) in the central (3.0 mm eccentricity), intermediate (3.0 to 4.5 mm eccentricity), and peripheral (>4.5 mm eccentricity [capsulorhexis edge]) areas; neodymium:YAG (Nd:YAG) laser capsulotomy or laser polishing of ongrowing lens epithelium; anterior capsule opacification (ACO); best corrected visual acuity (BCVA); and contrast sensitivity. RESULTS Thirty patients completed the 2(1/2)-year follow-up. Visual axis opacification was significantly lower in the central region in the PCCC group (mean 0.5 +/- 0.7 [SD]) than PCO in the central region of the non-PCCC group (mean 1.1 +/- 1.1) (P = .02). Forty percent in the non-PCCC group had an Nd:YAG laser capsulotomy during the follow-up period; none in the PCCC group had laser polishing. There were no significant differences in ACO, SE, BCVA, or contrast sensitivity. There was no additional gain in BCVA or contrast sensitivity in eyes with a PCCC compared with eyes without a PCCC when VAO and PCO were low. CONCLUSION A PCCC significantly reduced PCO formation within the central 3.0 mm eccentricity as well as the need for Nd:YAG laser capsulotomy in eyes with a single-piece hydrophilic acrylic IOL with angulated haptics.
Collapse
Affiliation(s)
- Lorenz Vock
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | |
Collapse
|
34
|
Stifter E, Menapace R. "Instant vision" compared with postoperative patching: clinical evaluation and patient satisfaction after bilateral cataract surgery. Am J Ophthalmol 2007; 143:441-8. [PMID: 17223061 DOI: 10.1016/j.ajo.2006.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 10/28/2006] [Accepted: 11/03/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare two methods of postoperative dressing regimen: patching vs "instant vision" without patch. DESIGN Prospective randomized clinical trial. METHODS Sixty consecutive hospitalized, nonambulatory patients with cataract surgery under topical anesthesia on both eyes at different days were enrolled prospectively. In randomized order, one eye was patched for the first 24 hours postoperatively; the other eye was left open without patch to obtain "instant vision." Both eyes received the same anti-inflammatory and antibiotic drop therapy. RESULTS Twenty-four hours postoperatively, no significant differences between patching and "instant vision" could be found for corrected and uncorrected visual acuity, corneal epithelial defects, conjunctival inflammation, anterior chamber flare, and intraocular pressure (P > .05). During the first 24 hours postoperatively, all tear film parameters were significantly worse in the "instant vision" eyes (P < .001), indicating a transient tear film instability. During the first four hours after cataract surgery, pain scores in the "instant vision" eyes were significantly higher than in the patched eyes (P < .001). Eight hours postoperatively and later, there were no significant differences in any pain scores (P > .05). After experiencing both methods, 27% of the patients subjectively rated the two methods as equivalent; 8% of the patients preferred "instant vision." Despite of the benefits of immediately improved orientation, 65% of the tested patients preferred patching to "instant vision" because of lower pain and foreign body sensations and psychologic arguments. CONCLUSIONS The clinical examinations showed that both methods were equally safe for postoperative therapy. However, further efforts have to be made to increase the patients' comfort with "instant vision" in the first hours after cataract surgery.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Austria
| | | |
Collapse
|
35
|
Vock L, Menapace R, Stifter E, Findl O, Georgopoulos M. Clinical effects of primary posterior continuous curvilinear capsulorhexis in eyes with single-piece hydrophilic acrylic intraocular lenses with and without haptic angulation. J Cataract Refract Surg 2007; 33:258-64. [PMID: 17276267 DOI: 10.1016/j.jcrs.2006.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 10/01/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical effects of a primary posterior continuous curvilinear capsulorhexis (PCCC) on the intraocular performance of hydrophilic acrylic single-piece intraocular lenses (IOLs) with and without haptic angulation. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS A prospective study comprised 52 patients with bilateral age-related cataract who had standard cataract surgery including a PCCC. One eye of each patient was randomized to receive a hydrophilic acrylic IOL with haptic angulation (ACR6D SE, Laboratoires Cornéal) and the contralateral eye, a hydrophilic acrylic IOL without haptic angulation (C-flex 570C, Rayner). The following parameters were assessed: regeneratory posterior opacification (RPO) in the central, intermediate, and peripheral areas (scale 0 to 10); anterior capsule opacification (ACO); best corrected visual acuity (BCVA); and contrast sensitivity (CSF). RESULTS Thirty-one patients completed the 1(1/2)-year follow-up. In both IOL groups, RPO within the PCCC was slight in the central area, with a mean score of 0.33 +/- 0.84 (SD) in the angulated IOL group and 0.16 +/- 0.57 in the nonangulated IOL group (P = .29). The mean RPO score in the peripheral area was 2.07 +/- 1.37 and 2.35 +/- 1.45, respectively (P = .12). The difference between the central and peripheral areas was 1.74 in the angulated IOL group (P<.00001) and 2.19 in the nonangulated IOL group (P<.00001). Haptic deformation occurred in 9 eyes (29%) with an angulated IOL and no eye with a nonangulated IOL. There was significantly more ACO in the nonangulated IOL group (P = .012). There were no significant differences in BCVA or CSF between the 2 groups. CONCLUSIONS Creating a PCCC led to significantly lower RPO intensity within the PCCC area than in the peripheral area in eyes with hydrophilic acrylic IOLs with and without haptic angulation. Haptic angulation had no apparent significant influence on the intensity of RPO or on BCVA and CSF. Haptic deformation may occur in hydrophilic IOLs with angulated haptics.
Collapse
Affiliation(s)
- Lorenz Vock
- Department of Ophthalmology, University of Vienna, Vienna, Austria
| | | | | | | | | |
Collapse
|
36
|
Stifter E, Sacu S, Thaler A, Weghaupt H. Contrast Acuity in Cataracts of Different Morphology and Association to Self-Reported Visual Function. ACTA ACUST UNITED AC 2006; 47:5412-22. [PMID: 17122131 DOI: 10.1167/iovs.05-1564] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the relationship between contrast acuity at declining contrast levels and the type and density of lens opacity in cataract. METHODS Contrast acuity at declining contrast levels was determined with the Holladay Contrast Acuity Test, in relation to the type and density of age-related cataract in 180 patients with bilateral cataract and 20 control subjects with normal macular function. Cataracts were graded according to the Lens Opacities Classification System (LOCS) III of nuclear color (NC), nuclear opalescence (NO), cortical (C), and posterior subcapsular (P) cataract. Best-corrected visual acuity and near contrast acuity were determined in randomized order monocularly in both eyes. Visual difficulties in everyday life were evaluated, using the VF-14 questionnaire and the Cataract Symptom Score. RESULTS The contrast-dependent effect of cataract on contrast acuity was statistically significant (P < 0.001; two-way ANOVA). In the comparison of early, intermediate, and advanced nuclear, nuclear-cortical, and posterior subcapsular cataracts (PSCs), significantly reduced contrast acuity scores were found for the PSC groups (P < 0.001). Comparison of nuclear and nuclear-cortical cataracts showed the contrast acuity scores to be comparable at all contrast levels (P > 0.05). High correlation coefficients were found between the LOCS III P score and the contrast acuity measurements (r = 0.77-0.84; P < 0.001). In contrast, the correlation coefficients of the NO, NC, and C scores were considerably lower (r = 0.45-0.66; P < 0.001). High correlation coefficients were also found between the contrast acuity measurements and self-reported functional vision. CONCLUSIONS The statistically significant, contrast-dependent effect of cataract on contrast acuity supports the clinical relevance of recording visual acuity at low contrast levels in patients with age-related cataract. Particularly, the severity of PSC has a strong influence on the impairment of contrast acuity. Contrast acuity corresponded closely to the self-reported visual difficulties in everyday life.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
| | | | | | | |
Collapse
|
37
|
Stifter E, Menapace R. Patientenzufriedenheit und Schmerzempfinden in den ersten 24 Stunden nach standardisierter Katarakt-Operation – „Instant Vision“ im Vergleich zu „Verband über Nacht“”. Klin Monbl Augenheilkd 2006. [DOI: 10.1055/s-2006-947017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
38
|
Stifter E, Weghaupt H, Benesch T, Thaler A, Radner W. Discriminative power of reading tests to differentiate visual impairment caused by cataract and age-related macular degeneration. J Cataract Refract Surg 2006; 31:2111-9. [PMID: 16412924 DOI: 10.1016/j.jcrs.2005.03.080] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2005] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether preoperative reading tests can be used for differentiating visual impairments with regard to the diagnosis of cataract and age-related macular degeneration (ARMD). SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS Reading performance of patients with nuclear cataract, posterior subcapsular cataract, and ARMD were evaluated with respect to reading acuity, maximum reading speed, and critical print size; normal-sighted participants were tested as controls. A multivariate discriminant analysis of the 4 groups (100 eyes of 100 participants) was performed to evaluate how many patients could be correctly diagnosed by significant differences in the tested reading parameters. Subsequently, the nuclear cataract and posterior subcapsular cataract patients were compared with cataract patients with coexisting ARMD. RESULTS Distance visual acuity was comparable in the nuclear cataract, posterior subcapsular cataract, and ARMD groups (P>.05). Reading acuity was significantly reduced in posterior subcapsular cataract and ARMD patients compared with nuclear cataract patients and controls (P<.0001). No significant difference in maximum reading speed was found between the nuclear cataract patients and the controls (P = .07), whereas the maximum reading speed of the posterior subcapsular cataract and ARMD patients was significantly reduced (P<.0001). In the discriminant analysis, it was possible to assign the correct diagnosis to 72% of the nuclear cataract patients, 76% of the posterior subcapsular cataract patients, 72% of the ARMD patients, and 92% of the controls. Comparing the reading performance of nuclear cataract and posterior subcapsular cataract patients and cataract patients with coexisting ARMD showed that reading performance was significantly impaired in the comorbid patients (nuclear cataract and ARMD, P<.001; posterior subcapsular cataract and ARMD, P<.05). CONCLUSION The high discriminant accuracy shows that this standardized reading test system is a valuable diagnostic tool for evaluating functional visual impairments when distance visual acuity alone cannot elucidate the origin of functional impairment. Considering the significant discrepancies in reading performance among patients with nuclear cataract, posterior subcapsular cataract, and ARMD, reading tests may relevantly improve the clinical evaluation of patients with visual loss, even of patients with ocular comorbidity.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | |
Collapse
|
39
|
Kreidl P, Stifter E, Richter A, Aschbacher R, Nienstedt F, Unterhuber H, Barone S, Huemer HP, Carattoli A, Moroder L, Ciofi degli Atti M, Rota MC, Morosetti G, Larcher C. Anthrax in animals and a farmer in Alto Adige, Italy. ACTA ACUST UNITED AC 2006; 11:E060216.3. [PMID: 16804212 DOI: 10.2807/esw.11.07.02900-en] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between 21 and 29 December 2005, seven animals (1 bull, 1 cow, 1 sheep and 4 goats) died within 2 hours of becoming ill on a remote farm (1500 m above sea level) in Alto Adige, northern Italy
Collapse
Affiliation(s)
- P Kreidl
- Osservatorio epidemiologico, Alto Adige, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
AIM To evaluate if functionally relevant deficits in reading performance exist in children with essential microstrabismic amblyopia by comparing the monocular and binocular reading performance with the reading performance of normal sighted children with full visual acuity in both eyes. METHODS The reading performance of 40 children (mean age 11.6 (SD 1.4) years) was evaluated monocularly and binocularly in randomised order, using standardised reading charts for the simultaneous determination of reading acuity and speed. 20 of the tested children were under treatment for unilateral microstrabismic amblyopia (visual acuity in the amblyopic eyes: logMAR 0.19 (0.15); fellow eyes -0.1 (0.07)); the others were normal sighted controls (visual acuity in the right eyes -0.04 (0.15); left eyes -0.08 (0.07)). RESULTS In respect of the binocular maximum reading speed (MRS), significant differences were found between the children with microstrabismic amblyopia and the normal controls (p = 0.03): whereas the controls achieved a binocular MRS of 200.4 (11) wpm (words per minute), the children with unilateral amblyopia achieved only a binocular MRS of 172.9 (43.9) wpm. No significant differences between the two groups were found in respect of the binocular logMAR visual acuity and reading acuity (p>0.05). For the monocular reading performance, significant impairment was found in the amblyopic eyes, whereas no significant differences were found between the sound fellow eyes of the amblyopic children and the control group. CONCLUSION In binocular MRS, significant differences could be found between children with microstrabismic amblyopia and normal controls. This result indicates the presence of a functionally relevant reading impairment, even though the binocular visual acuity and reading acuity were both comparable with the control group.
Collapse
Affiliation(s)
- E Stifter
- Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | | | | | | | | |
Collapse
|
41
|
Richter-Mueksch S, Kaminski S, Kuchar A, Stifter E, Velikay-Parel M, Radner W. Influence of laser in situ keratomileusis and laser epithelial keratectomy on patients' reading performance. J Cataract Refract Surg 2005; 31:1544-8. [PMID: 16129289 DOI: 10.1016/j.jcrs.2005.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the influence of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) on reading performance regarding reading acuity, reading speed based on print size, maximum reading speed, and critical print size. SETTING Department of Ophthalmology, University of Vienna, Vienna, and Auge-und-Laser, Medicent Baden, Austria. METHODS Fifty-two eyes of 34 patients (26 eyes per group) were studied. Best corrected LogMAR visual acuity (Early Treatment Diabetic Retinopathy Study charts), reading acuity, and reading speed were tested monocularly before LASIK or LASEK and 3 weeks after surgery. Reading acuity (LogRAD) and reading speed were determined with the standardized Radner reading charts. RESULTS Preoperatively, the distance visual acuity and reading acuity were comparable between the LASIK and LASEK patients. Reading speed measurements also showed no statistical difference. Three weeks after refractive surgery, no statistically significant differences in the preoperative measures and between the 2 surgical procedures could be found in any tested parameters. The mean distance visual acuity was LogMAR -0.02 +/- 0.06 (SD) (LASIK) and LogMAR -0.05 +/- 0.07 (LASEK). The mean reading acuity was LogRAD 0.00 +/- 0.12 (97.7% of LogMAR) (LASIK) and LogRAD 0.04 +/- 0.16 (93.7% of LogMAR) (LASEK). The mean maximum reading speed was 235 +/- 35 words per minute (LASIK) and 240 +/- 37 words per minute (LASEK), and the mean critical print size was at LogRAD 0.48 +/- 0.19 (LASIK) and 0.49 +/- 0.17 (LASEK). CONCLUSIONS In a standardized reading test setting, no significant effects of LASIK and LASEK on individual reading performance could be evaluated. This indicates that patients can expect to retain their normal visual function after refractive surgery with these 2 procedures under full light conditions.
Collapse
|
42
|
Richter-Mueksch S, Stur M, Stifter E, Radner W. Differences in reading performance of patients with Drusen maculopathy and subretinal fibrosis after CNV. Graefes Arch Clin Exp Ophthalmol 2005; 244:154-62. [PMID: 16047185 DOI: 10.1007/s00417-005-0063-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 05/24/2005] [Accepted: 05/25/2005] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate differences in reading performance and contrast sensitivity on patients with drusen maculopathy and subretinal fibrosis after CNV (choroidal neovascularisation). METHODS 136 patients (60 with drusen (D), 76 with fibrosis (F)) were studied. Patients were classified according to type of maculopathy and best-corrected visual acuity into groups D1 and F1 (LogMAR 0.2-0.4), groups D2 and F2 (LogMAR>0.4-0.7), and group F3 (LogMAR>0.7-1.3). Reading acuity (in LogRAD) and speed were examined with the Radner Reading charts and compared to the reading speed measured with the long paragraphs of the Zuercher Reading Test. Contrast sensitivity was measured with Pelli-Robson charts. RESULTS The patients' distance visual acuity was comparable between the drusen and fibrotic CNV groups (D1 versus F1, D2 versus F2). The reading acuity of the corresponding groups D1 and F1 was also comparable, but F2 patients showed a statistically lower reading acuity than D2 patients (P=0.03). All reading speed measurements of the groups F1 and F2 were significantly worse than those of the corresponding groups D1 and D2 (P-values: 0.0005-0.02). The correlation of reading speed between the Radner and Zuercher texts was very high (r=0.73-0.94). The contrast sensitivity was significantly lower in all groups compared with group D1 (P<0.001), but comparable for groups F1, F2, and F3. CONCLUSIONS Despite comparable results in distance visual acuity, patients with subretinal fibrosis after CNV had a greater reduction in reading ability than the patients with drusen. The distance visual acuity measurements alone, therefore, underestimate the real-life conditions and impact of AMD.
Collapse
Affiliation(s)
- Sibylla Richter-Mueksch
- Department of Ophthalmology, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | | | | |
Collapse
|
43
|
Stifter E, Burggasser G, Hirmann E, Thaler A, Radner W. Evaluating reading acuity and speed in children with microstrabismic amblyopia using a standardized reading chart system. Graefes Arch Clin Exp Ophthalmol 2005; 243:1228-35. [PMID: 16003512 DOI: 10.1007/s00417-005-1187-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 01/29/2005] [Accepted: 03/15/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND To examine if standardized reading charts with highly comparable test items can be used for evaluating impairments in the monocular reading performance of children with microstrabismic amblyopia characterized by a small angle of squint with less than 5 degrees. METHODS The reading performance of 22 children (mean age: 11.7+/-1.6 years) with unilateral microstrabismic amblyopia was evaluated monocularly in both eyes, using standardized reading charts for the simultaneous determination of reading acuity and speed. The print sizes of the highly comparable sentence optotypes were logarithmically graded, providing constant geometric proportions for all testing distances in order to control contour interaction. All children were under continuous amblyopia therapy. RESULTS In the amblyopic eyes, reading acuity and maximum reading speed were significantly impaired when compared to the sound fellow eyes (P<0.001). In respect of the maximum reading speed, a mean inter-ocular difference of 33+/-19 words per minute was found, revealing functionally relevant deficits in monocular reading performance. The amblyopic eyes achieved only a significantly reduced reading acuity (mean inter-ocular difference: LogRAD 0.5+/-0.24; P<0.001). In eight children, the amblyopic eyes achieved a best-corrected visual acuity of LogMAR 0.0 or better: in respect of the visual acuity, there was no significant inter-ocular difference, but reading acuity and maximum reading speed were significantly impaired when compared to the fellow eyes. CONCLUSIONS Microstrabismic amblyopia was associated with significant impairment of reading acuity and speed in treated amblyopes, even in those with no persistent acuity deficit. To improve treatment addressing these functional deficits, reading performance should be monitored over time using standardized reading tests, which provide essential information about functionally relevant reading impairments.
Collapse
Affiliation(s)
- E Stifter
- Department of Ophthalmology, Medical University of Vienna, Austria
| | | | | | | | | |
Collapse
|
44
|
Stifter E, Sacu S, Benesch T, Weghaupt H. Impairment of Visual Acuity and Reading Performance and the Relationship with Cataract Type and Density. ACTA ACUST UNITED AC 2005; 46:2071-5. [PMID: 15914625 DOI: 10.1167/iovs.04-0890] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the association between the density of nuclear, cortical, and posterior subcapsular lens opacities and visual impairment in patients with cataract. METHODS In 80 patients, visual acuity and reading performance were evaluated 1 day before and 4 weeks after cataract surgery. Cataracts were categorized and graded according to the Lens Opacities Classification System (LOCS) III of nuclear color (NC), nuclear opalescence (NO), cortical (C), and posterior subcapsular cataract (P). A multiple linear regression analysis and partial correlation coefficients were calculated. Data were also checked for significant pre- and postoperative differences in visual performance related to cataract grading. RESULTS In the multiple linear regression analysis, significant associations were found between the improvement in visual acuity and reading performance after cataract surgery and the NC, NO, and P scores (P < 0.001); no significant association was found for the C score (P > 0.05). High partial correlation coefficients were found between the P score and the preoperative visual acuity (r = 0.6; P < 0.001), reading acuity (r = 0.74; P < 0.001), and maximum reading speed (MRS; r = -0.77; P < 0.001). Significant but lower partial correlation coefficients were found for the NO score. No significant partial correlation coefficients were found for the NC and C score. Significant pre- and postoperative differences in MRS were found in patients with P scores > or =3 or NO and NC scores > or =5, representing functionally relevant impairment. CONCLUSIONS A strong association was found between visual impairment in patients with cataract and the severity of posterior subcapsular cataract (PSC) and nuclear opacity. Particularly in patients with PSC, deficits in reading performance significantly increased. The functionally relevant deficits in patients with P scores > or =3 or NO and NC scores > or =5, should be carefully considered for planning cataract surgery or visual rehabilitation.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology Medical University of Vienne, Austria.
| | | | | | | |
Collapse
|
45
|
Abstract
PURPOSE To evaluate the influence of cataract morphology on the functional vision of patients with age-related cataract and normal macular function and compare subjectively perceived functional impairments to distance visual acuity, reading acuity, and maximum reading speed between cataract types. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS Seventy-five patients awaiting first-eye cataract surgery were asked to characterize their visual difficulties in everyday life using a German version of the VF-14 questionnaire. Cataracts were categorized and graded using the Lens Opacities Classification System III. Monocular and binocular visual acuity and reading performance were determined in randomized order. RESULTS There were significant differences in functional vision between nuclear cataracts and posterior subcapsular cataracts (PSC); the VF-14 score and the self-reported visual satisfaction were significantly lower in PSC patients (P<.05). Posterior subcapsular cataracts significantly increased self-reported impairment in distance and near vision, although the visual acuity was comparable to that in the other groups (P =.9). Significant differences in functional vision were also seen between PSC and nuclear-cortical cataracts (P<.05). No significant differences in functional vision were found between nuclear cataracts and nuclear-cortical cataracts (P>.05). CONCLUSIONS The VF-14 questionnaire reliably evaluated functional differences caused by different cataract morphologies; these differences were underestimated when only visual acuity was measured. Patients with PSC had increased functional impairment, indicating that cataract surgical intervention is indicated at an earlier stage in these patients. The significant differences between the morphological types of cataract should be taken into consideration when the benefit of cataract surgery is to be measured on the basis of functional improvement.
Collapse
Affiliation(s)
- Eva Stifter
- Department of Ophthalmology, Medical University of Vienna, A-1090 Vienna, Austria.
| | | | | |
Collapse
|
46
|
Richter-Müksch S, Stur M, Stifter E, Kiss C, Velikay-Parel M, Radner W. Unterschiede im Lesevermögen bei gleichem Femvisus von Patienten mit Drusenmakulopathie und CNV-Narben. Spektrum Augenheilkd 2004. [DOI: 10.1007/bf03163597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
Velikay-Parel M, Richter-Müksch S, Kiss C, Stifter E, Sacu S, Radner W. Fortschritte in der PVR-Chirurgie: Ergebnisse der Silikonölentfernung. Spektrum Augenheilkd 2004. [DOI: 10.1007/bf03163599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Stifter E, Sacu S, Weghaupt H, König F, Richter-Müksch S, Thaler A, Velikay-Parel M, Radner W. Reading performance depending on the type of cataract and its predictability on the visual outcome. J Cataract Refract Surg 2004; 30:1259-67. [PMID: 15177601 DOI: 10.1016/j.jcrs.2003.11.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the influence of various types of cataract on reading performance in a standardized reading test setting. SETTING Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS The reading performance of 94 eyes with age-related cataract and normal macular function was evaluated with the Radner Reading Charts preoperatively and 4 weeks after cataract surgery. Distance visual acuity was tested with the ETDRS charts. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, on which NO is nuclear opalescence and NC is nuclear color. RESULTS Patients with pure nuclear cataracts (LOCS III: NO/NC 2.1-5) achieved a normally high MRS (99.84% +/- 7.65% of their postoperative MRS): preoperative MRS(1): 190.6 +/- 30.74 words per minute (wpm); postoperative MRS(2): 191.21 +/- 29.36 wpm. Patients with mixed nuclear-cortical cataracts (LOCS III: NO/NC 2.1-5; C>2) preoperatively achieved 96.96% +/- 5.6% of their postoperative MRS (MRS(1): 175.77 +/- 31.54 wpm; MRS(2): 181.34 +/- 30.56 wpm). In dense nuclear cataracts (LOCS III: NO/NC>5), the MRS was significantly reduced, achieving only 72.64 +/- 19.19% of the postoperative MRS (MRS(1): 133.06 +/- 39.43 wpm; MRS(2): 185.76 +/- 40.18 wpm). In posterior subcapsular cataracts, the preoperative MRS (134.1 +/- 33.72 wpm) was significantly lower than postoperatively (191.14 +/- 27.08 wpm). CONCLUSIONS In contrast to dense nuclear cataracts and posterior subcapsular cataracts, the preoperative reading speed of patients with pure nuclear or nuclear-cortical cataracts was normal at large print sizes. The preoperative evaluation of reading acuity and speed with standardized reading tests can therefore be used to estimate the postoperative reading performance in the latter 2 types of cataract.
Collapse
Affiliation(s)
- Eva Stifter
- Departments of Ophthalmology and Optometry, University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Kiss CG, Richter-Mueksch S, Stifter E, Diendorfer-Radner G, Velikay-Parel M, Radner W. Informed consent and decision making by cataract patients. ACTA ACUST UNITED AC 2004; 122:94-8. [PMID: 14718302 DOI: 10.1001/archopht.122.1.94] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To investigate decision making by patients on the day before cataract surgery and to evaluate to what extent the informed consent process influences the patients' decision regarding consent. METHODS On the day before surgery, 70 patients (mean +/- SD age, 70.3 +/- 10.3 years) underwent a standardized informed consent procedure. They were also invited to answer 15 questions established in interdisciplinary cooperation among clinical psychologists, lawyers, and ophthalmologists. MAIN OUTCOME MEASURES We assessed presurgical information and personal estimation of risks in cataract surgery; the patient-physician relationship regarding surgery-related decisions; and evaluations of the informed consent procedure and the patients' decision. RESULTS Questionnaire answers indicated that 28 (40%) of the 70 participating patients arrived for surgery without any information; 16 (23%) believed that there were surgical procedures without risks; and 53 (76%) estimated that there were no risks for their cataract surgery. A physician-dominated decision for surgery was preferred by 31 patients (44%); 16 (26%) wanted to decide together with their ophthalmologist. Possible risks of a sight-threatening complication did not influence 54 patients' (77%) decisions, and 55 patients (78%) said the informed consent process did not influence their decision. The remaining 15 (22%) stated that the informed consent process positively confirmed their decision. CONCLUSIONS Informed consent 1 day preoperatively does not seem to influence the decision for cataract surgery. Cognitive dissonance as part of a decision-making process makes changes in an already chosen option unlikely. The resulting limited decisive potential is very important for credibility in a trial and has to be considered in ophthalmologic surgery.
Collapse
Affiliation(s)
- Christopher G Kiss
- Department of Ophthalmology and Optometry, University of Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
50
|
Radner G, Amon M, Stifter E, Nepp J, Diendorfer G, Mallinger R, Radner W. Tissue damage at anterior capsule edges after continuous curvilinear capsulorhexis, high-frequency capsulotomy, and erbium:YAG laser capsulotomy. J Cataract Refract Surg 2004; 30:67-73. [PMID: 14967270 DOI: 10.1016/s0886-3350(03)00652-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2003] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the effect of erbium:YAG laser photocapsulotomy (ELC), continuous curvilinear capsulorhexis (CCC), and high-frequency capsulotomy (HFC) on anterior capsule edges using light microscopy (LM) and transmission electron microscopy (TEM). SETTING Department of Ophthalmology, Department of Histology and Embryology II, University of Vienna, Vienna, Austria. METHODS Five anterior capsule membranes were obtained experimentally by ELC, which was performed with the Oertli MicroLaser photoemulsification tip in eyes from 5 human cadavers. Thirty anterior capsule membranes were obtained during cataract surgery by CCC (n = 15) or, in cases with poor or missing red fundus reflexes, by HFC (n = 15). Continuous curvilinear capsulorhexis was performed conventionally with a manual, bent, 27-gauge cannula, and HFC was performed according to Klöti. Membranes were processed and examined by LM and TEM according to standard procedures. RESULTS The edges obtained by ELC showed mild signs of denaturation and mechanical disruption, tears, and micro-tears. Lens capsule edges obtained by CCC were smooth with no irregularities in any specimen; the edges were beveled anteriorly to posteriorly with no evidence of tearing. Edges produced by HFC were considerably wider; the surfaces showed distinct denaturation, preformed tears, and micro-tears. The edges were surrounded by a nonhomogeneous mass, which consisted mainly of denatured lens capsule material. CONCLUSIONS Of the 3 techniques, CCC produced the mildest tissue damage. The histological damage at ELC edges was relatively mild and intermediate compared with that seen at CCC and HFC edges. These observations suggest that ELC is an appropriate option for anterior capsulotomy in cataract surgery.
Collapse
|