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M Küchle

Publications and source records attributed to M Küchle.

At least 91 records · Page 5Linked to original sources
PubMed1998

Quantification of aqueous melanin granules in primary pigment dispersion syndrome.

PURPOSE: Aqueous melanin granules are essential in the pathogenesis of pigment dispersion syndrome and pigmentary glaucoma. We quantified aqueous melanin granules with the laser flare-cell meter in patients with pigment dispersion syndrome, assessed the measurement reproducibility, and correlated the numbers with clinical findings. METHODS: Aqueous melanin granules were counted by means of the cell count mode of the laser flare-cell meter (KOWA FC-1000; Kowa, Tokyo, Japan) in 42 eyes of 21 patients with primary pigment dispersion syndrome under three conditions (undilated pupils, dilated pupils, after exercise). The reproducibility of the measurements was determined with the intraclass correlation coefficient. A control group of 40 age- and sex-matched eyes was also examined after pupillary dilation. The results were correlated with biomicroscopic findings in eyes with pigment dispersion syndrome (retrocorneal Krukenberg spindle, iris transillumination, pigmentation of trabecular meshwork). RESULTS: Numerous aqueous melanin granules were detected in eyes with pigment dispersion syndrome (mean, 2.9 +/- 3.7 granules/0.075 mm3) but only small numbers were counted in normal eyes (0.2 +/- 0.3, P < .001). Medical pupil dilation caused an additional increase of aqueous melanin granules in pigment dispersion syndrome (6.3 +/- 5.3, P < .001), but not undilated exercise (climbing stairs) (2.9 +/- 3.7, P > .5). The reproducibility of the measurements was very high (intraclass coefficient >0.92). The number of melanin granules correlated with the degree of Krukenberg spindle (r = .61, P = .004) and with iris transillumination (r = .69, P = .001). CONCLUSIONS: Quantification of aqueous melanin granules yields reproducible results and shows increased numbers in pigment dispersion syndrome, especially after pupillary dilation. Aqueous melanin granule quantification may be useful for evaluating eyes with pigment dispersion syndrome and for assessing treatment effects.

Adult↗
PubMed1998

Blood-aqueous barrier after mechanical or nonmechanical excimer laser trephination in penetrating keratoplasty.

PURPOSE: To analyze whether nonmechanical trephination with an excimer laser influences post-operative blood-aqueous barrier breakdown after penetrating keratoplasty. METHODS: Patients undergoing penetrating keratoplasty for keratoconus or Fuchs dystrophy were prospectively randomly assigned to trephination by either excimer laser or conventional mechanical handheld motorized trephine. All surgery was performed by one surgeon, and preoperative, intraoperative, and postoperative treatment was identical in both groups. Aqueous flare was quantitatively determined postoperatively in a masked fashion by laser flare-cell meter. For statistical analysis, the nonparametric Wilcoxon-Mann-Whitney test was used. RESULTS: A total of 52 eyes of 52 patients were examined (Fuchs dystrophy, 10; keratoconus, 42). During the early postoperative period (days 3 to 9), eyes that had undergone nonmechanical excimer laser trephination (25/52) showed significantly (P < .005) lower flare values than did eyes that had undergone mechanical trephination (27/ 52). In both groups, flare values returned to normal levels by 6 weeks postoperatively. CONCLUSION: Early postoperative blood-aqueous barrier breakdown is less pronounced after penetrating keratoplasty with nonmechanical excimer laser trephination.

Adolescent↗
PubMed1998

Bilateral zonular cataract associated with the mitochondrial cytopathy of Pearson syndrome.

PURPOSE: To report a child with the mitochondrial cytopathy of Pearson syndrome and zonular cataract. METHOD: Case report. We describe a 6-year-old boy with Pearson syndrome. RESULTS: At age 3 years, the boy developed secondary strabismus caused by bilateral zonular cataract. Subsequently, he underwent successful bilateral cataract extraction with intraocular lens implantation. Postoperative visual acuity with best correction was RE, 20/25 and LE, 20/40. CONCLUSIONS: Children with Pearson syndrome should be examined ophthalmologically to rule out zonular cataract and possible amblyopia. Mitochondrial cytopathies such as Pearson syndrome should be included in the differential diagnosis of congenital and early juvenile cataract.

Anemia, Sideroblastic↗
PubMed1998

Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations.

BACKGROUND: Renewed interest in pseudoexfoliation syndrome (PEX) may be attributed to an increased awareness of many clinical risks not only for open-angle glaucoma and its recent recognition as a generalized disorder. This review summarizes the range of intraocular and extraocular manifestations. Involvement of all tissues of the anterior segment of the eye results in a spectrum of intraocular complications that have management implication for all practicing ophthalmologists. DESIGN: The study design was a review. METHODS: Clinical diagnosis depends on biomicroscopy, biocytology, and laser-tyndallometry. Laboratory research methods range from light and electron microscopy, to immunohistochemical and molecular biologic approaches. OBSERVATIONS: Clinical-histopathologic correlations focus on the involvement of lens (PEX-phacopathy), zonular apparatus (zonulopathy), ciliary body (cyclopathy), iris (iridopathy), trabecular meshwork (trabeculopathy), and cornea (corneal endotheliopathy) leading to the following complications: (1) open-angle glaucoma as well as angle-closure glaucoma due to pupillary and ciliary block; (2) phacodonesis, lens dislocation, and increased incidence of vitreous loss in extracapsular cataract surgery caused by alterations of the zonular apparatus and its insertion into the ciliary body and lens; (3) blood-aqueous barrier breakdown (pseudouveitis), anterior chamber hypoxia, iris stromal hemorrhage, pigment epithelial melanin dispersion, poor or asymmetric pupillary dilatation, and formation of posterior synechiae due to involvement of all cell populations of the iris; and (4) early diffuse corneal endothelial decompensation explained by a damaged and numerically reduced endothelium. CONCLUSIONS: In view of the multitude of clinical complications, PEX is of relevance to comprehensive ophthalmologists, including specialists in glaucoma, cataract, cornea, neuro-ophthalmology, and retina. Special attention to the risks associated with PEX is advised before, during, and after surgery.

Anterior Eye Segment↗
PubMed1998

[Cataract surgery in nanophthalmic eyes with an axial length of less than 20.5 mm].

BACKGROUND: Aim of this study was to analyze the results of cataract surgery in nanophthalmic eyes with axial length of less than 20.5 mm. PATIENTS AND METHODS: From 1991 to 1996 extracapsular cataract extraction with posterior chamber lens implantation was performed in 20 eyes of 19 patients (mean age 70.2 +/- 12.7 years, 4 male, 16 female) with axial length of less than 20.5 mm. Mean preoperative visual acuity was 0.16 +/- 0.15, refractive error +5.1 +/- 3.8 dpt and intraocular pressure 18.7 +/- 10.3 mm Hg. The mean follow-up was 24.4 months. Patient data were collected prospectively with standardized "Erlanger Augenblätter" and the computer-aided automatized operation record system "OPERA". These data together with the biometrical data were analized in a retrolective manner. RESULTS: Preoperatively 6 of 20 eyes had angle closure situation, 7 of 20 eyes had undergone intraocular surgery previously (5 x iridotomy, 1 x surgical iridectomy, 1 x filtration procedure). Pseudoexfoliation syndrome was present in 3 eyes. The posterior chamber lens (mean refractive power 31.7 +/- 3.0 dpt, optic diameter 6.5 and 7.0 mm) was positioned 18 x intracapsular, 2 x into the sulcus and 1 x by scleral fixation due to capsular rupture without vitreous loss. In 16 of 20 eyes iris surgery was performed additionally, in one eye an anterior sclerotomy was necessary. Intraoperatively "vis a tergo" occurred in 10 eyes and anterior chamber hemorrhage in one eye. Visual acuity improved in 16 of 20 eyes. The mean visual acuity was 0.3 +/- 0.2. At the end of follow-up 13 eyes had an improvement of visual acuity. Mean intraocular pressure was 16.5 +/- 3.3 mm Hg, refractive error was +0.47 +/- 2.9 dpt and differed by -0.49 +/- 1.8 dpt from the preoperatively calculated refraction. Postoperatively angle closure glaucoma developed in one eye, a ciliopseudophakic angle closure glaucoma and recurrent iris bombata in one eye. Reoperations included cyclokryokoagulation in two eyes, pars plana vitrectomy in one eye and repeated Nd-YAG iridotomies in one eye. CONCLUSION: Regarding the special anatomic situation, the surgical procedure has to be planned individually, including the determination of sclera thickness, corneal diameter and lens volume/eye volume ratio.

Aged↗
PubMed1998

[Laser-tyndallometry in eyes with acute retinal necrosis syndrome. Erlanger Laser-tyndallometry study group].

PURPOSE: Acute retinal necrosis syndrome (ARN) is a rapidly progressive viral necrotic retinitis. We used noninvasive measurement of aqueous flare to quantify blood-ocular barrier breakdown in eyes with ARN und to follow the inflammatory activity and treatment effects. PATIENTS AND METHODS: We report on seven patients (5 males und 2 females, age: 16 to 57 years) with ARN that were treated in our institution between 1991 to 1996. Aqueous flare was quantified regularly during treatment using the laser flare-cell meter (Kowa, FC-1000) following pupillary dilation. RESULTS: Aqueous flare was highly significantly increased in eyes with ARN (145.5 +/- 139.7, range 30 to 367 photon counts/ms). Contralateral, unaffected eyes showed normal flare values (3.6 +/- 0.8 photon counts/ms, p < 0.0001; normals: 4.1 +/- 1.1 photon counts/ms). Flare values correlated with inflammatory activity before and during antiviral treatment. In two patients with ARN caused by herpes simplex-virus aqueous flare values were extremely increased (367 and 316 photon counts/ms), and retinal necrosis was rapidly progressive despite antiviral therapy. One patient developed early ARN in his contralateral eye with flare values increasing from 3.5 to 22.0 photon counts/ms, which quickly normalized following antiviral treatment. CONCLUSIONS: Measurement with the laser flare-cell meter allows quantification of blood-ocular barrier breakdown in eyes with ARN und may be useful for monitoring inflammatory activity during treatment.

Adolescent↗
PubMed1998

[Design and preliminary results of the Erlanger non-high-risk penetrating-keratoplasty study].

PURPOSE: The purpose of this prospective study is to examine the non-high-risk penetrating keratoplasty clinically, tyndallometrically and immunological-serologically in order to learn more about the pathogenesis, early symptoms and therapy monitoring of corneal graft rejection. PATIENTS AND METHODS: Since february 1997, patients undergoing non-high-risk-PK have been enrolled in this prospective study. Examinations are done preoperatively and in well-defined postoperative gates (6 weeks, 3 months, 6 months, etc.) and include clinical assessments, corneal topography, laser-tyndallometry, corneal endothelial cell count and corneal pachymetry. Preoperatively as well as at each postoperative examination, 10 ml serum and perioperatively corneoscleral donor tissue are collected and frozen (-80 degrees C) to allow immunological and serological examinations in case of graft rejection later. A relational data base (MS Access) guarantees complete and homognous standardized clinical and serological data. We randomised our patients with respect to duration of topical steroid therapy in standard situations (short-time vs. long-time) as well as for systemic steroid therapy (bolus group vs. tapering group) in case of a graft rejection in 2 treatment groups. RESULTS: Up to March 1998, 99 patients have been enrolled in this prospective study. Our report includes the first consecutive 55 patients (25 female, 30 male, recipient age 56.9 +/- 19.4 years, donor age 57.0 +/- 19.9 years). Up to now (follow-up 2.5 +/- 2.1, maximum of 7.3 months) we did not observe immunologic graft rejections. In one patient a primary graft failure occurred. Laser tyndallometry showed a reduction of blood-aqueous barrier breakdown from 6 weeks postoperatively (9.3 +/- 5.7 photon counts/msec) to 3 months postoperatively (6.8 +/- 3.5 photon counts/msec). CONCLUSION: This prospective randomized clinical and immunological study after non-high-risk-PK is supposed to give more information about pathogenesis, early symptoms and therapy monitoring of graft rejection after elective PK. The concept and design of this study are described. Preliminary data may give significant results in a few years.

Adult↗
PubMed1998

Changing indications for penetrating keratoplasty: histopathology of 1,250 corneal buttons.

PURPOSE: To analyze recent trends in the indications for penetrating keratoplasty. METHODS: After keratoplasty, 2,557 corneal buttons were sent to and analyzed in the ophthalmopathology laboratory of the University of Erlangen-Nürnberg, Erlangen, Germany, between 1992 and 1996. Of these, 1,250 random corneal buttons were evaluated in this study. RESULTS: Histopathologic diagnoses were (a) keratoconus (20.9%), (b) corneal scarring after keratitis/trauma (20.4%), (c) pseudophakic/aphakic bullous keratopathy (17%), (d) regraft (15.5%), (e) Fuchs' corneal endothelial dystrophy (14.9%), (f) necrotizing/ulcerative keratitis (5.3%), and (g) corneal dystrophies (1.7%). CONCLUSION: Compared with a previous report from our laboratory (1964-1986), the relative frequencies of pseudophakic/aphakic bullous keratopathy, regraft, and Fuchs' dystrophy increased, whereas corneal scarring decreased. Keratoconus is now the most frequent indication for penetrating keratoplasty.

Adolescent↗
PubMed1998

Angiogenesis in corneal diseases: histopathologic evaluation of 254 human corneal buttons with neovascularization.

PURPOSE: Angiogenesis in corneal diseases can necessitate corneal transplantation and induce graft rejection. The aim of this study was to find out the histopathologic prevalence of angiogenesis in human corneas removed during keratoplasty, to establish the histopathologic diagnoses most commonly associated with angiogenesis, and to evaluate the anatomic location of new corneal vessels. METHODS: Corneal buttons (2,557) after keratoplasty were sent to and analyzed in our ophthalmopathology laboratory between 1992 and 1996. Of these, 1,278 full-thickness and lamellar corneal buttons were randomly retrieved and evaluated in this study. RESULTS: Of 1,278 human corneal buttons obtained by keratoplasty, 254 (19.9%) showed angiogenesis. Associated histopathologic diagnoses were (a) scarring after keratitis (109, 45.4%); (b) graft rejection and insufficiency (73, 30.4%); (c) acute necrotizing ulcerative keratitis (30, 12.5%); and (d) scarring after mechanical or chemical injuries (28, 11.7%). Histopathologically, new vessels were usually associated with corneal edema or inflammatory cells or both (76%). The most common locations of new vessels were the upper and middle third of the corneal stroma. Only 11% of new vessels were located solely in the deep stromal layers. CONCLUSION: Angiogenesis is a common histopathologic feature of corneal diseases leading to corneal transplantation and was found in 19.9% of excised human corneal buttons. Systemic or topical antiangiogenic therapy could reduce the need for corneal transplantation and retransplantation.

Adolescent↗
PubMed1998

Cataract extraction in eyes with diabetic iris neovascularization.

BACKGROUND AND OBJECTIVE: Iris neovascularization used to be considered a strict contraindication to intraocular surgery, especially intraocular lens implantation. In this study, the authors analyzed whether cataract extraction and posterior chamber lens implantation is associated with unacceptable intraoperative and early postoperative complications in patients with proliferative diabetic retinopathy and rubeosis iridis. PATIENTS AND METHODS: Using a computerized data retrieval system, the authors identified all the patients with manifest iris neovascularization and proliferative diabetic retinopathy who underwent cataract extraction in their institution between 1989 and 1995. The preoperative, intraoperative, and early postoperative data were analyzed retrospectively with regard to complications and visual results. RESULTS: Thirty-nine eyes of 33 patients (mean age 64.6 +/- 10.9 years) with manifest pupillary rubeosis iridis were analyzed. All but 3 of the eyes had undergone previous retinal laser treatment, with dense cataracts preventing additional photocoagulation. Additional chamber angle neovascularization was present in 11 eyes. Posterior chamber intraocular lenses were implanted in 35 eyes. Intraoperatively, iris hemorrhage was noted in 10 eyes and was significantly more frequent in eyes that underwent nuclear expression (50%) than in those that underwent phacoemulsification (12%; P = .019). Postoperatively, spontaneously resolving hyphema was observed in 7 eyes as well as reversible fibrin formation in 6 eyes. No severe sight-threatening complications occurred. Visual acuity improved in 33 (85%) of the eyes. CONCLUSION: Cataract extraction with posterior chamber lens implantation does not appear to be associated with unacceptable intraoperative or early postoperative complications. However, adequate treatment of underlying diabetic retinopathy prior to cataract extraction (and if necessary, postoperatively) is essential to prevent the progression of retinal and iris neovascularization.

Adult↗
PubMed1998

Ellipsoidal fitting of corneal topography data after arcuate keratotomies with compression sutures.

BACKGROUND AND OBJECTIVE: After paired arcuate keratotomies and compression sutures (AK) for treatment of high postkeratoplasty astigmatism, corneal topography tends to be irregular. The purpose of this study was to demonstrate a mathematical method for approximation of discrete corneal topography power data with an ellipsoid for better appreciation of the clinical outcome after AK. PATIENTS AND METHODS: Thirty-one eyes of 28 consecutive patient who underwent AK for excessive postkeratoplasty astigmatism were studied. Regular keratometry, corneal topography (TMS-1), subjective refraction, and best-corrected visual acuity (VA) were assessed preoperatively and at 1 week and 1 year postoperatively. A simplex algorithm was applied for fitting an ellipsoidal surface to raw corneal topography power data. A set of parameters (meridional power, axis, and asphericity) were calculated. The cylinder of subjective refraction was correlated with the keratometric readings, the simulated keratometry (SimK) of the topography system, and the respective parameters of the model surface. RESULTS: Keratometric astigmatism and the cylinder of the model surface decreased from 8.1 +/- 3.2 and 7.9 +/- 2.9 D preoperatively to 4.5 +/- 2.1 and 5.3 +/- 2.0 D after 1 year, respectively. The asphericity in both meridional cross sections changed from a prolate ellipse preoperatively to an ablate ellipse at the early postoperative follow-up stage. Regarding the cylinder axis, there was a significant correlation of the model surface with the refractive cylinder at all examinations (P < .05), whereas there was no significant correlation of the SimK axis and the refractive cylinder axis. CONCLUSION: The approximation of corneal topography power data with an ellipsoidal model surface renders reconstruction of clinically relevant corneal topography parameters, including corneal asphericity with a marked data compression. Even in markedly irregular corneal surfaces, such as after AK, the correlation of amount/axis of refractive cylinder with the model surface parameters is more accurate than it is with respective SimK values of corneal topography analysis.

Adult↗
PubMed1997

[Tyndallometry and cell count in the anterior chamber in retinal detachment].

BACKGROUND: Aim of this study was the investigation of changes of aqueous flare and cells in eyes with retinal detachment. PATIENTS AND METHODS: We examined 62 eyes of 61 patients with retinal detachment (56 eyes with rhegmatogenous retinal detachment, 6 eyes with traction retinal detachment; 51 eyes without and 11 eyes with clinical signs of proliferative vitreoretinopathy (PVR) stage C) with the laser flare-cell meter (LFCM) and compared the results with clinical findings and with the results of a control group. RESULTS: The flare values as well as the cell count of all eyes with retinal detachment were significantly elevated (p < 0.0001) in comparison to those of the control group. In eyes with PVR a significant elevation of flare values in comparison to eyes without PVR appeared (p = 0.0052). A slight correlation was found between the extension of the detachment and the flare values and the cell count, respectively. In cases with rhegmatogenous retinal detachment a significant elevation of the cell count was found if the largest break was localized in the upper hemisphere (p = 0.03) or if the macula was affected (p = 0.02). In rhegmatogenous retinal detachment, the cell count correlated slightly with the age of the patients (r = 0.3, p = 0.02), and flare values correlated with the height of the detachment (r = 0.28, p = 0.04). CONCLUSIONS: Our results demonstrate a breakdown of the blood-ocular barriers in eyes with retinal detachment and an elevation of corpuscular elements in aqueous as manifestations of pseudouveitis. In eyes with PVR the alteration of blood-ocular barriers seems to be more extensive than in eyes without PVR indicating a possible role of the LFCM for early detection of PVR.

Adolescent↗
PubMed1997

[Optic nerve neuritis after 50 years of age: symptom of a previously undiagnosed multiple sclerosis].

BACKGROUND: The onset of multiple sclerosis after the age of 50 years is rare. We report four patients with optic neuritis and oligoclonal bands or increased IgG production in the cerebrospinal fluid. Three of them subsequently developed clinically definite multiple sclerosis. PATIENTS: Four apparently healthy women, 62, 56, 50 and 50 years of age, presented with progressive visual loss, three patients in one eye and one patient in both eyes. The diagnostic work-up revealed no findings indicating an ischemic process, an infectious, systemic inflammatory, or neoplastic disease. Examination of the cerebrospinal fluid revealed oligoclonal bands and/or increased production of IgG. Visual acuity recovered during the following weeks to 8 months. Three of the 4 patients subsequently developed additional neurologic signs compatible with multiple sclerosis. CONCLUSION: Optic neuritis can be the presenting sign of multiple sclerosis even after the age of 50.

Diagnosis, Differential↗
PubMed1997

[Clinically unexpected malignant melanomas of the uvea. 1981-1995, Erlangen Ophthalmopathologic Laboratory/D].

PURPOSE: The aim of this study was to investigate the incidence of unexpected malignant uveal melanoma in the age of ultrasound diagnostics and to highlight the reasons for misdiagnosis. PATIENTS AND METHODS: All eyes were surgically removed and histologic examination was performed between 1981 and 1995. The eyes were investigated for the incidence of uveal melanoma, and the history of the unexpected malignant melanoma of the uvea or ciliary body highlighted. RESULTS: 225 (18.7%) eyes with malignant melanoma out of 2583 enucleated eyes were found. Eight (3.6%) of 225 were clinically unexpected. The clinical misdiagnoses were secondary angle closure or open angle glaucoma (6), retinal detachment (5), iritis (1), scleritis (1), cataract (4) and an intraocular mass that was believed to be a metastasis of a colon carcinoma. Seven of eight eyes were blind, and one eye had light perception only. The longest follow up before enucleation was 13 years. On three eyes diagnostic ultrasound was reportedly performed without specific diagnosis of uveal melanoma. Surgery was performed on four eyes for reasons of uncontrollable intraocular pressure or retinal detachment up to five years before enucleation. Histologic diagnoses were 3 epitheloid-type, 2 spindel-type and 3 necrotic melanoma of the uvea. Four eyes showed scleral invasion by tumor cells and one eye an invasion into the episcleral space. CONCLUSIONS: Even today the rate of unexpected uveal melanoma, according to our study is 3.6%. Therefore, all blind eyes without visualisation of the posterior pole should be examined with ultrasound in order to diagnose an uveal melanoma prior to enucleation.

Adult↗
PubMed1997

[Idiopathic episcleral venous stasis with secondary open-angle glaucoma (Radius-Maumenee syndrome)].

BACKGROUND: Dilated episcleral vessels may be observed in patients with orbital tumors, carotid-cavernous-sinus fistula and other orbital obstructive lesions. As an idiopathic phenomenon dilated episcleral vessels may be associated with secondary open-angle glaucoma. PATIENT: We report on a 59-year-old patient with a history of secondary open-angle glaucoma and dilated episcleral vessels for 5 years (Radius-Maumenee syndrome). RESULTS: In these patients, the pressure of the episcleral vessels is elevated and therefore the outflow from Schlemm's Canal is reduced. This leads to elevated intraocular pressure and secondary glaucoma. CONCLUSION: Treatment options in this condition include medication to lower the intraocular pressure or microsurgical sinusotomy to reduce the pressure-gradient from Schlemm's Canal to the episcleral vessels.

Female↗
PubMed1997

[Limbus-parallel keratotomies with compression sutures in treatment of high astigmatism after perforating keratoplasty: a vector analysis and topographic study].

BACKGROUND: Visual acuity following penetrating keratoplasty is frequently limited by excessive astigmatism which cannot be compensated for with spectacles or contact lenses. The purpose of the study was to determine the effects of arcuate keratotomies and compression sutures on the amount and regularity of corneal astigmatism and on the visual acuity. PATIENTS AND METHODS: Between June 1989 and August 1995, 56 eyes from 56 patients (30 women, 26 men, average age 53 +/- 16 years) with excessive post-penetrating keratoplasty astigmatism were treated with paired arcuate cuts and compression sutures 4.8 +/- 3.5 years after suture removal (45% keratoconus, 30% scars, 20% dystrophies). The incisions were made along the meridian of maximum dioptric power in a sector extending for 60 +/- 15 degrees (6 mm diameter). Incision depth was standardized at 450 microns. Compression sutures were placed 90 degrees away in the flat meridian. Eight patients required more than one procedure to obtain the desired effect. Best corrected visual acuity (VA), keratometric readings and topographic power maps were analyzed pre- and postoperatively. We categorized the topographic maps into six groups: from group 1 (regular) to group 6 (irregular). For description of the astigmatic change after surgery, the formulas by Naylor and Jaffe (vector-corrected astigmatism) were applied. RESULTS: The mean preoperative astigmatism was 10.8 +/- 3.1 (4.2 to 19.2) diopters (D). After a mean follow-up of 1.1 years, the mean net astigmatism was 5.8 +/- 3.2 (0 to 16) D. The mean preoperative visual acuity (VA) was 0.38 +/- 0.31 (from 0.03 to 1.0). At the end of follow-up, the mean VA was 0.43 +/- 0.25. Non-refractive reasons for poor visual acuity included amblyopia (n = 5), macular degeneration (n = 4), glaucoma (n = 4), cataract (n = 2), and others (n = 5). Twenty-seven percent of the preoperative topographic maps were categorized into groups 1 and 2 and only 10% into groups 5 and 6. At the end of the follow-up, none of the 53 available topographic maps was categorized into group 1, 7.5% into group 2 and 30% into groups 5 and 6. The mean astigmatic change (vector-corrected astigmatism) was 12.3 +/- 5.2 (1.0 to 29.8) D with a turn of the axes ranging from -39 to 44 degrees. CONCLUSIONS: Arcuate incisions with compression sutures are easily performed and hold a low complication rate in comparison with other refractive operations. Definition of successful surgery is even broader when a significant reduction of astigmatism that usually allows the use of spectacles or contact lenses is considered. A disadvantage is that each particular case is unpredictable because of the tendency of the topography to irregularity and possible regression of the effect.

Adult↗
PubMed1997

Pseudoexfoliation syndrome and secondary cataract.

AIM/BACKGROUND: The pseudoexfoliation (PEX) syndrome is frequently associated with impairment of the blood-aqueous barrier. This study analysed if this might stimulate secondary cataract following cataract extraction. METHODS: This historical cohort study included 197 eyes of 197 patients (99 with and 98 without PEX) that underwent extracapsular cataract extraction with posterior chamber lens implantation (PMMA optic) between 1985 and 1991. Secondary cataract was defined as opacification of the axial posterior capsule and decrease of visual acuity by two or more lines. Mean follow up was 23.8 months. For statistical analysis, the Kaplan-Meier method and multivariate Cox regression analysis were used. RESULTS: Secondary cataract was observed within 24 months in 35% (SD 7%) of all eyes, and was significantly more frequent in eyes with PEX (45 (11)%) than in eyes without PEX (24 (9)%, p < 0.03). Eyes with diabetes mellitus (n = 32) showed a significantly lower frequency of secondary cataract (11 (11)%) than eyes without diabetes mellitus (39 (8)%, p < 0.01). The influences of sex, open angle glaucoma, type of cataract, surgeon, positioning of IOL, and phacoemulsification versus nuclear expression on secondary cataract did not reach statistical significance. CONCLUSION: The higher frequency of secondary cataract could be considered as another potential complication of cataract surgery in eyes with PEX.

Aged↗