Biomedical subjects

Gerd U Auffarth

Publications and source records attributed to Gerd U Auffarth.

At least 19 recordsLinked to original sources

PubMed2007

Long-term results of sealed capsule irrigation using distilled water to prevent posterior capsule opacification: a prospective clinical randomised trial.

BACKGROUND: We investigated long-term safety and efficacy of sealed capsule irrigation (SCI) during cataract surgery to prevent posterior capsule opacification (PCO). METHODS: One eye of each of 17 patients (mean age: 70.1+/-9.7 years) who presented with bilateral cataracts was randomly chosen for SCI treatment. After phacoemulsification, the capsular bag was vacuum sealed with the PerfectCapsule device (Milvella) followed by SCI using distilled water for two minutes. No vacuum loss occurred during irrigation. Each patient's fellow eye served as a control. One hydrophilic acrylic intraocular lens model was implanted in all eyes. Five patients had to be excluded due to deep anterior chamber, small pupil or unilateral surgery. Follow-up examinations took place one day and one, three, six, 12 and 24 months after surgery. We evaluated safety parameters, anterior capsule (AC) overlapping and PCO. RESULTS: Postoperatively, mean best corrected visual acuity, pachymetry, endothelial cell count, intraocular pressure, AC overlapping and PCO showed no statistically significant difference between SCI and the control group (p>0.05, Wilcoxon test). CONCLUSION: SCI is a safe procedure and enables the specific pharmacological targeting of lens epithelial cells inside the capsular bag. Using distilled water, however, it is not possible to reduce PCO development significantly. Thus, alternative substances should be evaluated.

Adult↗

PubMed2006

Influence of three-piece and single-piece designs of two sharp-edge optic hydrophobic acrylic intraocular lenses on the prevention of posterior capsule opacification: a prospective, randomised, long-term clinical trial.

BACKGROUND: Posterior capsule opacification (PCO) is still a major long-term complication of modern cataract surgery. We evaluated the impact of sharp-edged intraocular lenses (IOLs) with different haptic designs made from the same hydrophobic acrylic material on posterior and anterior lens capsule opacification. SETTING: Eye clinic of Kaunas University of Medicine, Lithuania. Prospective randomised clinical study. METHODS: Seventy-four eyes of 74 patients scheduled for cataract surgery were included in a prospective randomised clinical study. Thirty-seven eyes of 37 patients received a three-piece acrylic hydrophobic (AcrySof, MA3OBA, Alcon) IOL; and thirty-seven eyes of 37 patients received a one-piece acrylic hydrophobic (AcrySof, SA3OAL, Alcon) IOL. Visual acuity, anterior capsule opacification (ACO), capsular folds, capsulorrhexis/optic overlapping and posterior capsule opacification (PCO) were evaluated. ACO was assessed subjectively. PCO values in the entire IOL optic area and in the central 3 mm optic zone were assessed using a photographic image-analysis system (EPCO2000). Follow-ups were performed postoperatively at 1 day, 6 months, 1 year and 2 years. RESULTS: There were no significant differences in best corrected visual acuity, grade of ACO and capsulorrhexis/optic overlapping between IOL types during the follow-up period. Patients in the one-piece acrylic hydrophobic IOL group more frequently presented with capsular folds behind the IOL optic area than those in the three-piece IOL group. In the three-piece acrylic hydrophobic IOL group, PCO values (mean (SD)) of the entire IOL optic area were significantly lower six months postoperative (three-piece: 0.002 (0.009); one-piece: 0.007 (0.017); p=0.04), one year postoperative (three-piece: 0.004 (0.016); one-piece: 0.026 (0.041); p=0.001) as well as one year postoperative in the central 3 mm optic zone (three-piece: 0.000 (0.0002); one-piece: 0.019 (0.049); p=0.001). However, two years postoperative, the PCO values of the groups did not show significant differences (entire IOL optic area: three-piece, 0.136 (0.223); one-piece, 0.154 (0.190); p=0.18; central zone: three-piece, 0.023 (0.065); one-piece: 0.020 (0.039); p=0.44). CONCLUSION: The 2 year follow-up after cataract surgery showed no significant difference in ACO and PCO development between three-piece and one-piece acrylic hydrophobic intraocular lenses.

Aged↗

PubMed2006

Anterior chamber measurements using Pentacam rotating Scheimpflug camera.

PURPOSE: To investigate the mean values and standard deviations according to age, reliability, and correlation between different parameters of anterior chamber measurements using the Pentacam rotating Scheimpflug camera. SETTING: Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. METHODS: This prospective clinical study comprised 76 healthy volunteers (mean age 46.6 years +/- 16.8 [SD]). Three consecutive measurements were made of only 1 eye and anterior chamber depth (ACD), mean and minimum anterior chamber angle (ACA), and anterior chamber volume (ACV) were evaluated. RESULTS: Mean ACD was 2.93 +/- 0.36 mm, mean ACA was 34.81 +/- 5.05 degrees, minimum ACA was 29.99 +/- 5.53 degrees, and mean ACV was 160.3 +/- 36.81 mm3. Increasing age was associated with reduced ACD and ACV; however, mean and minimum ACAs were lowest in patients aged 40 to 59 years. Excellent correlation was found between ACD and ACV (R = 0.92). Anterior chamber depth and mean ACA correlated only moderately (R = 0.65). The correlation coefficient between ACD and minimum ACA was smaller (R = 0.58). There was no correlation between ACV and ACA (R = 0.37). Minor standard deviations were noted (ACD 0.02 +/- 0.02 mm, mean ACA 1.12 +/- 0.94 degrees, minimum ACA 2.04 +/- 2.67 degrees, and ACV 2.48 +/- 1.65 mm3). CONCLUSIONS: Using the Pentacam, it was possible to examine different parameters of the anterior chamber within a short period and with good reliability. The evaluation of the ACA in different positions can help to classify the potential risk for angle-closure glaucoma.

Adolescent↗

PubMed2006

Femtosecond laser-assisted corneal flap cuts: morphology, accuracy, and histopathology.

PURPOSE: Precision in corneal flap cutting is essential in LASIK surgery. Current mechanical microkeratomes have a very good performance record; however, in a few cases, complications can occur during the microkeratome pass and flap cut. Femtosecond lasers offer an alternative to the mechanical cut and can provide additional features regarding the flap morphology. In this study, we analyzed femtosecond laser flaps regarding their morphology, cut accuracy, and histopathology. METHODS: Forty-five fresh porcine cadaveric eyes were prepared for femtosecond laser flap cutting with the Femtec femtosecond laser system (20/10 Perfect Vision, Heidelberg, Germany). The eyes were assigned to three different thickness groups, with 120-, 140-, or 180-microm cut depth, respectively. In addition, different flap diameters ranging from 8.0 to 9.5 mm and rim edge angulations between 60 degrees and 90 degrees were performed. After the cut, the eyes were examined under a microscope regarding accuracy and potential defects, and flap thickness and diameter were measured. In addition, flaps were prepared for further histopathologic examination. RESULTS: All flap cuts were easily performed without any intraoperative complications. Flap thickness measurements revealed a median (in micrometers) of 110.5 (intended thickness 120), 142.5 (intended 140), and 180.0 (intended 180), respectively. The flap diameter for an intended size between 8.0 and 9.5 mm was within a range of +/-0.4 mm, the median at the maximum was 0.3 mm off. Histopathology revealed very low to almost no changes in the stromal structure of the cornea and correct hinge angulations. CONCLUSIONS: LASIK flap cuts were easily performed without any complications. The accuracy and morphology were very precise and consistent. Histopathology revealed a smooth cut with hinge angulations, as expected.

Animals↗

PubMed2006

Reliability of corneal and total wavefront aberration measurements with the SCHWIND Corneal and Ocular Wavefront Analyzers.

PURPOSE: To evaluate the reliability of the SCHWIND Corneal and Ocular Wavefront Analyzers. METHODS: This study comprised 115 eyes of 58 healthy volunteers (26 [44.8%] women and 32 [55.2%] men) with no corneal or lenticular pathologies and normal visual acuity. All eyes underwent three consecutive measurements by one examiner with the Corneal Wavefront Analyzer and the Ocular Wavefront Analyzer (Hartmann-Shack principle). Corneal wavefront errors were calculated using the topography data, a standard eye model, and ray tracing. The reliability was tested for 2nd, 3rd, and 4th order aberrations as mean values of the standard deviations for all measurements. RESULTS: Mean patient age was 23 +/- 2.1 years. The mean refraction was -0.77 +/- 1.56 diopters (D) (range: +3.33 to -5.28 D). The repeatability test revealed a good reliability for both machines with a slightly better value for the Ocular Wavefront Analyzer for 3rd and 4th order higher order aberrations (P < .05, Wilcoxon test). CONCLUSIONS: Wavefront measurements of corneal and total optical aberrations performed with the Corneal Wavefront Analyzer and the Ocular Wavefront Analyzer have good reliability. Both measurements are recommended prior to any refractive surgery treatment.

Adult↗

PubMed2005

Performance of the 1CU accommodating intraocular lens in relation to capsulorhexis size.

PURPOSE: To assess the correlation between continuous curvilinear capsulorhexis (CCC) size and visual outcomes in patients with an accommodating intraocular lens (IOL). SETTING: Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. METHODS: Nineteen eyes had phacoemulsification and implantation of a 1CU accommodating IOL (HumanOptics AG). Three months after surgery, the uncorrected and best corrected distance and near visual acuities and the distance corrected near visual acuity were measured. Retroillumination photographs were taken to assess CCC size and centration and the amount of overlap between the CCC and IOL optic. The photographs were analyzed using Evaluation of Posterior Capsule Opacification system software. RESULTS: The mean age of the patients was 53.5 years (range 30 to 73 years). The mean uncorrected distance acuity improved from 0.05 preoperatively to 0.70 at 3 months and the best corrected near acuity, from 0.30 to 0.94. The mean postoperative distance corrected near acuity was 0.5 (range 0.1 to 1.0), which improved to 0.9 with near correction. The mean CCC size (4.3 mm) and amount of CCC decentration (0.35 mm) did not correlate with visual outcomes. However, there was a correlation between the amount of CCC-optic overlap (mean 35%; range 16% to 55%) and distance corrected near acuity (r = 0.641, P = .003). Distance corrected near acuity was better with less overlapping; that is, with a larger CCC. CONCLUSIONS: A larger capsulorhexis with less CCC-optic overlapping gave better near visual outcomes. Results indicate that an overlap between 25% and 35%, which correlates with a CCC between 4.5 mm and 5.0 mm, provides the best capsule strength without compromising accommodation with the single-piece 1CU IOL.

Accommodation, Ocular↗

PubMed2005

Reliability of Orbscan II topography measurements in relation to refractive status.

PURPOSE: To investigate the reliability of corneal topography measurements using the Orbscan II topography system (Bausch & Lomb) not only referring to a normal cohort but also to different refractive conditions. SETTING: Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. METHODS: Eighty patients (mean age 46.4 +/- 19.0 years) were assigned to 4 refractive groups (Group A: emmetropia (n=20); Group B: astigmatism (n=20) (-1.98 +/- 1.77 diopters [D]); Group C: hyperopia (n=20) (+4.84 +/- 1.6 D); Group D: myopia (n=20) (-9.64 +/- 3.79 D). Three measurements were performed in a series. Thirteen defined, standardized points of the entire cornea (apex, 3.0 mm, 5.0 mm, and 7.0 mm zone) were evaluated for 3 different maps (anterior elevation, pachymetry, keratometry). RESULTS: In all 80 patients, the following mean values were found in relation to analyzed zones: with regard to the anterior elevation map, the values decreased from 5.53 microm (center) to -6.52 microm (7.0 mm zone), the corneal thickness increased from 549.41 microm to 638.63 microm peripheral and the keratometry from 43.86 D (apex) to 45.4 D (7.0 mm zone), respectively. Analysis of the 3 different maps in all 4 refraction groups showed a tendency toward an increase in SD from the center to the 7.0 mm zone for anterior elevation and pachymetry maps. For keratometry, however, the lowest SD was found in the 7.0 mm zone. In particular, patients with hyperopia showed significant differences (P<.01), compared with emmetropic patients; the SD was higher with regard to anterior elevation as well as keratometry in peripheral zones. Group B (astigmatism) showed significantly higher SD for anterior elevation in zones 3.0, 5.0, and 7.0 mm when compared with emmetropic patients. CONCLUSIONS: The repeated Orbscan II measurements showed SD in the micrometer range for anterior elevation and pachymetry but values between 0.48 D and 0.97 D for keratometric data. Patients with astigmatism and especially hyperopia showed significantly higher SD values in peripheral zones for anterior elevation and keratometry, indicating a lower reliability, compared with the emmetropic cohort. However, the different ages of the patients could also be a possible explanation for these findings. Therefore, the Orbscan II seems to be a predictable and useful device for measuring corneal topography.

Adolescent↗

PubMed2005

Combination of transepithelial phototherapeutic keratectomy and autologous serum eyedrops for treatment of recurrent corneal erosions.

PURPOSE: To evaluate the clinical outcomes after transepithelial phototherapeutic keratectomy (t-PTK) using an excimer laser and postoperative administration of autologous serum eyedrops. SETTING: Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. METHODS: Twenty-five eyes of 25 patients with 3 to 12 recurrent corneal erosions were treated with t-PTK using the Schwind Keratom broad-beam excimer laser (Schwind). Routine therapy consisted of 2 pulses x 40 pulses (18.82 +/- 2.56 mum ablation). Postoperatively, autologous serum eyedrops were administered 6 times a day for 6 weeks. Postoperative outcomes and rate of recurrent erosions were evaluated. RESULTS: The median of the follow-up after t-PTK was 15.5 months (range 6 to 20 months), and the mean age of the patients was 40.6 years +/- 12.0 (SD). Twenty of 25 eyes (80%) recovered without further corneal erosion. Five eyes had 1 further erosion, which was treatable in 4 cases with autologous serum eyedrops without additional excimer laser treatment. One patient requested additional t-PTK treatment and recovered without further complications thereafter. CONCLUSIONS: Transepithelial phototherapeutic keratectomy is a safe and effective therapy for recurrent corneal erosions. Additional treatment with autologous serum eyedrops can support the healing process following corneal erosions and t-PTK and can be given as a long-term artificial tear treatment.

Adult↗

PubMed2005

Cataract surgery in eyes with iridoschisis using the Perfect Pupil iris extension system.

PURPOSE: To evaluate the use of the Perfect Pupil system (Milvella Pty. Ltd.) in 3 eyes in cataract surgery with iridoschisis. SETTING: Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. METHODS: Patient 1 was an 83-year-old man with a nuclear cataract, pseudoexfoliation syndrome, and iridoschisis. He was also having systemic anticoagulation therapy. Preoperative best corrected visual acuity (BCVA) was 0.05 in the right eye and 0.08 in the left eye. Patient 2 was a 73-year-old mentally retarded man with a brunescent cataract in the right eye. Preoperative BCVA was 0.1. RESULTS: In the first patient, cataract surgery was performed under topical anesthesia in both eyes through a clear corneal incision. Intraoperative pupil size was 3.0 mm. The Perfect Pupil device was inserted manually and fixated at the iris rim, leading to pupil dilation of 6.0 mm. Uneventful cataract surgery was performed without damage to the iris. Hydrophobic acrylic foldable intraocular lenses (IOLs) were implanted with forceps. Postoperative BCVA was 0.5 in the right eye and 0.4 in the left eye. The second patient was operated on under general anesthesia. Pupil dilation was successfully achieved. The brunescent cataract was removed and a hydrophobic acrylic IOL was implanted with an injector, resulting in postoperative uncorrected visual acuity of 0.3. CONCLUSION: In iridoschisis patients, there is risk of aspiration of iris fibers during cataract surgery. In these 2 patients, this was prevented using the Perfect Pupil system.

Aged↗

PubMed2005

Cataract surgery in relative anterior microphthalmos.

PURPOSE: To determine the prevalence of relative anterior microphthalmos (RAM) and evaluate intraoperative performance and surgical outcome in eyes with RAM undergoing cataract surgery. DESIGN: Nested case-control series. PARTICIPANTS: One thousand four hundred consecutive patients undergoing cataract surgery were evaluated to determine the prevalence of RAM. Relative anterior microphthalmos is defined as horizontal corneal diameter (HCD) < or =11 mm, anterior chamber depth (ACD) < or =2.2 mm, and axial length (AL) >20 mm, with no other morphologic malformation. METHODS: Patients were examined preoperatively for HCD, ACD, and AL. Horizontal corneal diameter was measured with calipers. Anterior chamber depth and AL were measured with immersion shell with water. Associated ocular pathologic conditions were recorded. Two control groups were identified. Group I (normal eyes; n = 84) had HCD >11 mm, ACD >2.2 mm, and AL >20 mm. Group II (eyes with small corneal diameter; n = 84) had HCD < or =11 mm, ACD >2.2 mm, and AL >20 mm. MAIN OUTCOME MEASURES: Patients with RAM and controls were evaluated for intraoperative performance and postoperative outcome. The 2-tailed Fisher exact test was applied to compare the performance of RAM with each of the control groups. The odds ratio (OR) with 95% confidence intervals (95% CI) was determined. RESULTS: The prevalence of RAM was 6% (84 of 1400 eyes; 95%CI, 0.048-0.074). Relative anterior microphthalmos was associated with the presence of small pupil, 34 (40.48%); corneal guttae, 31 (36.9%); glaucoma, 29 (34.5%); and pseudoexfoliation, 6 (7.14%). Intraoperatively, RAM was associated with overall surgical difficulty because of less working space in 59 eyes (70.24%; OR, 63.7; 95% CI, 18.3-221; P<0.001) compared with control groups I and II; uveal trauma in 12 (14.28%); Descemet's detachment in 5 (5.95%); and posterior capsule rupture in 2 (2.38%). Postoperatively, RAM was associated with transient corneal edema in 63 eyes (75%; OR, 9.0; 95% CI, 4.4-18.0; P<0.001; OR, 5.4; 95% CI, 2.7-10.5; P<0.001) on the first postoperative day. CONCLUSIONS: The prevalence of RAM was 6%. Relative anterior microphthalmos with its associations posed significant intraoperative difficulties. The occurrence of transient corneal edema was frequent.

Aged↗

PubMed2004

Repair of a ruptured globe using topical anesthesia.

We present a 76-year-old patient who had ocular trauma with dehiscence of the wound and scleral rupture with a prolapsed iris, ciliary body, intraocular lens, and vitreous after uneventful cataract surgery with a self-sealing sclerocorneal tunnel incision. General anesthesia was not possible because the patient had a history of lung cancer with extensive emphysema and unstable coronary disease. Local retrobulbar or peribulbar anesthesia was not considered because of the risk for further extrusion of intraocular contents. Topical anesthesia was applied with a 10.0 mm x 2.5 mm cellulose sponge soaked in oxybuprocaine 0.4% (Novesine) placed under the upper and lower lid for 20 minutes. Surgical repair of a 14.0 mm scleral wound was achieved without complication or pain during the procedure.

Accidental Falls↗

PubMed2004

Removal times and techniques of a viscoadaptive ophthalmic viscosurgical device.

PURPOSE: To analyze removal techniques for Healon5 (sodium hyaluronate 2.3%). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Charleston, South Carolina, USA, and Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany. METHODS: In a standardized laboratory setup, the Miyake-Apple posterior view video technique in human autopsy eyes was used to evaluate removal of an ophthalmic viscosurgical device (OVD) from capsular bags implanted with poly(methyl methacrylate), silicone, and acrylic intraocular lenses (IOLs). Healon5 was stained with fluorescein for better visualization. Open-sky preparation and an Alcon Legacy Series 20000 phaco machine with a flow rate of 25 mL/minute and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration [I/A]) were used. With Technique 1, the I/A tip was placed on the center of the IOL and maximum aspiration was applied. With Technique 2 (modified rock 'n roll technique), the I/A tip was moved in quick circular movements on top of the IOL to break the OVD chains and facilitate aspiration. RESULTS: With Technique 1, the mean removal time was 59.0 seconds +/- 23.1 (SD) and with Technique 2, 23.6 +/- 10.3 seconds (P =.004). The removal time of Healon5 correlated with the IOL material. With Technique 2, removal was fastest with silicone IOLs (13.5 +/- 2.1 seconds) followed by PMMA IOLs (17.5 +/- 2.1 seconds). With acrylic IOLs, remnants of the OVD trapped behind the IOL optic resulted in a longer removal time of 34.1 +/- 1.2 seconds. CONCLUSIONS: Healon5 was completely removed from the capsular bag with the modified rock 'n roll technique. With acrylic IOLs, remnants can be trapped behind the optic and may be overlooked with an unstained OVD. Aspiration behind the optic is recommended with this IOL type.

Acrylic Resins↗

PubMed2004

Removal times for a dispersive and a cohesive ophthalmic viscosurgical device correlated with intraocular lens material.

PURPOSE: To investigate the removal times of ophthalmic viscosurgical devices (OVDs) with different intraocular lens (IOL) designs and materials. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA, and Heidelberg IOL & Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. METHODS: In a standardized laboratory setup, the Miyake-Apple posterior view video technique was used to evaluate OVD removal from capsular bags in human autopsy eyes implanted with poly(methyl methacrylate) (PMMA), silicone, and acrylic IOLs. The cohesive OVD ProVisc (sodium hyaluronate 1.0%) and the dispersive OVD Viscoat (sodium hyaluronate 3.0% and chondroitin sulfate 4.0%) were stained with fluorescein for better visualization. The open-sky preparation and an Alcon Series 20000 Legacy phaco machine with a flow rate of 25 mL/min and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration) were used. The time needed for complete removal of the cohesive and dispersive OVDs with each IOL type was measured and analyzed statistically. RESULTS: The mean removal times for both OVDs were as follows: Alcon MZ60BD PMMA IOL-25.0 seconds +/- 3.7 (SD) (Viscoat), 15.9 +/- 6.9 seconds (ProVisc); Alcon AcrySof MA60BM IOL-35.5 +/- 10.0 seconds (Viscoat), 25.6 +/- 4.7 seconds (ProVisc); Chiron/Bausch & Lomb C1043 silicone IOL-46.5 +/- 10.5 seconds (Viscoat), 17.3 +/- 2.1 seconds (ProVisc); AMO SI-30 silicone IOL-33.5 +/- 3.1 seconds (Viscoat), 15.3 +/- 6.3 seconds (ProVisc); and Pharmacia 912 silicone IOL-18.3 +/- 5.8 seconds (Viscoat), 19.8 +/- 4.3 seconds (ProVisc). CONCLUSIONS: Differences in OVD removal times were detected. The removal time for the cohesive OVD correlated with the IOL material. Overall, the time needed for complete removal was significantly longer for the dispersive OVD than for the cohesive OVD.

Acrylic Resins↗

PubMed2004

Endothelial cell integrity after phacoemulsification with 2 different handpieces.

PURPOSE: To investigate corneal endothelial cell loss in fresh phakic human autopsy cadaver eyes after phacoemulsification (PE) with a conventional handpiece or a new oscillatory handpiece. SETTING: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Twenty fresh phakic human autopsy globes were randomized to PE with a conventional handpiece (n = 10) or an oscillatory handpiece (n = 10). The main parameters evaluated were age, nucleus density, amount of ophthalmic viscosurgical device (OVD) used, and mean PE time and ultrasound (US) power. After surgery, the corneas were excised and the endothelia were vitally stained with trypan blue and alizarin red. Light microscopy was used to assess the endothelial cell loss. RESULTS: The mean age, density of the nucleus, OVD used, and US power were similar between the groups. The mean PE time was less with the NeoSoniX handpiece (0.71 minutes +/- 0.39 [SD]) than with the conventional handpiece (1.05 +/- 0.53 minutes). The mean number of dead endothelial cells was significantly lower in the oscillatory handpiece group (31.3 +/- 24.2 cells/mm(2)) than in the conventional handpiece group (60.4 +/- 46.8 cells/mm(2)) (P<.001, Mann-Whitney rank sum test). CONCLUSIONS: Less corneal endothelial cell loss occurred after PE with an oscillatory handpiece than with a conventional handpiece. Further randomized clinical trials are recommended to validate this study.

Adult↗

PubMed2004

Comparison of Nd : YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, or acrylic intra-ocular lenses in four European countries.

PURPOSE: The aim of this study was to compare the incidence of Nd : YAG laser capsulotomy after cataract surgery according to the type of intra-ocular lens material (PMMA, silicone, hydrophilic acrylic, hydrophobic acrylic) implanted in four European countries (France, Italy, Germany, Spain). DESIGN: A retrospective record review. PARTICIPANTS: A review of 1525 patients (first operated eye), aged 50 to 80 years, operated on for cataract in 1996 or 1997 in 16 surgical centers (4 per country). METHODS: The study employed a retrospective cohort design. Charts were reviewed to collect information during at least a three-year period following cataract surgery to identify patients who underwent Nd : YAG laser capsulotomy postoperatively. MAIN OUTCOME MEASURES: Data on the type of intra-ocular lens implanted was extracted from the patient notes, as was the date and outcome of the Nd : YAG laser intervention. Kaplan-Meier survival curve analysis with the time to Nd : YAG laser was performed on the data. RESULTS A total of 1525 patients (first operated eye) were available for the study (n = 294 for hydrophilic acrylic, n = 384 for PMMA, n = 421 for hydrophobic acrylic, n = 426 for silicone). There was a highly statistically significant difference between the IOL groups for the incidence of posterior capsule opacification (p < 0.001) and for Nd : YAG laser treatment (p < 0.001). The mean delay of Nd : YAG laser treatment from the date of cataract operation was 2.48 years (+/-1.70, ranging from 0 to 5.88 years). The rate of Nd : YAG laser capsulotomy over the follow-up period was lowest in the hydrophobic acrylic group (7.1%), followed by silicone (16.2%), PMMA (19.3%) and hydrophilic acrylic (31.1%), respectively. CONCLUSIONS: A low incidence of posterior capsular opacification (PCO) and Nd : YAG laser treatment was detected in hydrophobic acrylic IOLs in comparison to three other types of IOLs implanted in a large cohort of persons with age-related cataract. Choice of IOL type may reduce the need for Nd : YAG laser treatment, although further research on the reasons for this is needed.

Aged↗

PubMed2004

Prevention of posterior capsule opacification using different intraocular lenses (results of one-year clinical study).

AIM: To evaluate and to compare the preventive effect of different intraocular lenses from different material with a round or sharp optic edge design on posterior capsule opacification. METHODS: Our clinical study included 165 patients. Mean follow-up was 12.4+/-0.9 months, mean patient age was 67.5+/-7.8 years. Patients in the group 1 (n=46) were implanted acrylic three-piece hydrophobic intraocular lenses, sharp optic edge (AcrySof, MA3OBA, Alcon), in the group 2 (n=38)--acrylic hydrophobic single piece intraocular lenses, sharp optic edge (AcrySof, SA3OAL, Alcon), in the group 3 (n=39)--silicone three-piece intraocular lenses, sharp optic edge (CeeOn 911A, Pharmacia), and in the group 4 (n=42)--polymethyl methacrylate single piece intraocular lenses, round optic edge (Crystal, 5T, Alcon). The posterior capsule opacification was evaluated for the entire optic and in the central 3-mm zone using EPCO 2000 Software. RESULTS: Posterior capsule opacification values of the entire optic were 0.002+/-0.001 in the AcrySof MA3OBA group, 0.007+/-0.002 in the AcrySof SA3OAL group, 0.002+/-0.001 in the CeeOn 911A group, 0.029+/-0.008 in the polymethyl methacrylate intraocular lens group 6 months after surgery. The values were 0.011+/-0.005, 0.025+/-0.006, 0.014+/-0.005 and 0.122+/-0.021, respectively, one year after surgery. The intraocular lenses types with sharp-edge design (acrylic and silicone) showed significantly lower posterior capsule opacification values than round-edge optic design polymethyl methacrylate lenses (p<0.05). Posterior capsule opacification values of the central 3-mm zone were 0.000+/-0.000 in the AcrySof MA3OBA group, 0.001+/-0.001 in the AcrySof SA3OAL group, 0.000+/-0.000 in the CeeOn 911A group, 0.002+/-0.001 in the polymethyl methacrylate intraocular lens group 6 months after surgery. The values were 0.0001+/-0.0001, 0.018+/-0.007, 0.004+/-0.002 and 0.028+/-0.009, respectively, one year after surgery. Posterior capsule opacification values differences between AcrySof MA3OBA and polymethyl methacrylate intraocular lenses' groups and between CeeOn 911A and polymethyl methacrylate intraocular lenses' groups one year after cataract surgery were established (p<0.05). CONCLUSIONS: The sharp-edge foldable intraocular lenses types (AcrySof MA3OBA, AcrySof SA3OAL, CeeOn 911A) showed statistically significant difference in posterior capsule opacification values in one-year follow-up time. The effect of these foldable lenses for prevention of posterior capsule opacification is mainly a result of rectangular, sharp-edged optic design, which creates a sharp capsular bend. A role of material of intraocular lenses (hydrophobic acrylate and silicone) in prevention of posterior capsule opacification during one-year follow-up was not established.

Acrylic Resins↗

PubMed2003

Multiple levels of regulation of the interleukin-6 system in stroke.

BACKGROUND AND PURPOSE: Serum levels of the cytokine interleukin-6 (IL-6) rise markedly in stroke. IL-6 is a key regulator of inflammatory mechanisms that play an important part in stroke pathophysiology. The action of IL-6 is modified by its soluble receptor subunits sgp130 and sIL-6R. The purpose of this study was to investigate whether serum levels of the receptor subunits are changed after ischemic stroke and to define the role of genetic influences on IL-6 expression in acute stroke. METHODS: In 48 patients with acute stroke and 48 age- and sex-matched control subjects, serum concentrations of IL-6, sgp130, and sIL-6R were measured by enzyme-linked immunosorbent assay. Furthermore, IL-6 promoter haplotypes comprising 4 different polymorphisms (-597G-->A, -572G-->C, -373A(n)T(n), -174G-->C) were determined by DNA sequencing and allele-specific oligonucleotide polymerase chain reaction. The effect of the common haplotypes on IL-6 gene transcription was tested by transfecting reporter fusion genes in the astrocytelike cell line U373. RESULTS: Whereas serum concentrations of IL-6 significantly rose (P<0.001), sgp130 levels were transiently reduced after stroke (P<0.05), and sIL-6R levels remained unchanged. IL-6 levels depended on the infarct size and the haplotype of the promoter region. The common haplotype A-G-8/12-C was associated with low IL-6 levels after stroke and a reduced induction of IL-6 transcription on stimulation with an adenosine analog in vitro. CONCLUSIONS: The data demonstrate genetic variation in the expression of IL-6 in stroke. Induction of the inflammatory response by IL-6 might be enhanced by a transient downregulation of the potential IL-6 antagonist sgp130.

Acute Disease↗

PubMed2003

Quantification of posterior capsule opacification with round and sharp edge intraocular lenses.

PURPOSE: To quantitatively evaluate and compare intraocular lenses (IOLs) with a round or sharp optic edge design for posterior capsule opacification (PCO). STUDY DESIGN: Prospective comparative observational case series. PARTICIPANTS/MATERIALS: Photographs from 174 eyes were analyzed for PCO at the Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. MAIN OUTCOME MEASURES: Part I: 121 eyes of 121 patients were analyzed for quantification of PCO. IOLs evaluated were Corneal ACR6 (n = 21), Alcon Acrysof (n = 20), Allergan AR40 (n = 27), Pharmacia 811 one-piece polymethyl methacrylate (PMMA) IOL (n = 24), and Pharmacia 911A silicone IOL (n = 29). Mean follow-up was 14.01 +/- 2.81 months; mean patient age was 73.2 +/- 7.3 years. The morphologic PCO formation was evaluated for the entire optic and in the central 3-mm zone. Part II: In 53 eyes of 46 patients aged 73.4 +/- 10.8 years with an Alcon Acrysof IOL, PCO formation and capsulorrhexis/optic overlapping were analyzed 34.2 +/- 4 months after cataract surgery using EPCO Software. RESULTS: Part I: The PCO values of the entire optic were for Corneal ACR6, 1.93 +/- 0.62; PMMA, 0.64 +/- 0.63; AR40, 0.55 +/- 0.28; Alcon Acrysof, 0.145 +/- 0.27; and 0.161 +/- 0.181 for the Pharmacia 911A IOL (P < 0.01). The PCO values of the central 3-mm zone were for Corneal ACR6, 1.64 +/- 0.96; PMMA, 0.49 +/- 0.39; AR40, 0.22 +/- 0.32; Alcon Acrysof, 0.08 +/- 0.21; and 0.06 +/- 0.11 for the Pharmacia 911A IOL (P < 0.01). Part II: Average overlapping of capsulorrhexis and Acrysof IOL optic was 40.5% +/- 12.4%. There was a significant correlation between PCO values and overlapping (r = -0.69, P < 0.001). CONCLUSIONS: The sharp-edge IOL types (Alcon Acrysof and Pharmacia 911A silicone IOL) resulted in statistically significantly lower PCO values for analysis of the entire optic area and central 3-mm zone. There was no statistically significant difference in PCO values between the two sharp-edge optic IOLs. An overlapping of capsulorrhexis rim and the anterior IOL optic surface of more than 20% resulted in significantly lower PCO values with the Acrysof IOL.

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