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N Anders

Publications and source records attributed to N Anders.

At least 19 recordsLinked to original sources
PubMed2001

[Pathologically reduced endothelial cell number despite normal slit-lamp microscopic corneal findings. An important result before cataract surgery].

BACKGROUND: A reduced number of endothelial cells increases the risk of corneal decompensation after cataract surgery. It is difficult to quantify the number of endothelial cells using slit-lamp microscopy since normal corneas may also show a reduced number of endothelial cells. MATERIALS AND METHODS: We compared the number of endothelial cells pre- and postoperatively in a group of 500 consecutive patients. RESULTS: Corneas diagnosed preoperatively with corneae guttata by slit-lamp microscopy may reveal more than 1800 endothelial cells/mm2. These corneas may decompensate after surgery. CONCLUSION: We consider the routine use of endothelial microscopy to be a helpful diagnostic tool prior to cataract surgery.

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PubMed2000

[Peribulbar anesthesia versus topical anesthesia in cataract surgery: comparison of the postoperative course].

BACKGROUND: Phacoemulsification with topical anesthesia is a proven alternative to peribulbar or retrobulbar anesthesia. Application of lidocaine in the anterior chamber before surgery is one method to achieve good intraoperative analgesia. The purpose of this study was to find out whether there are any differences in the postoperative course between patients with peribulbar injection and patients with topical anesthesia. PATIENTS AND METHODS: A total of 186 patients scheduled to undergo elective cataract surgery were included in the study. The patients were randomly assigned to receive sponge-anesthesia and intraocular injection of 0.15 ml lidocaine 1% or a peribulbar injection of 6 ml Xylonest 2%. Uncorrected visual acuity was measured 30 min after surgery. On the first postoperative day, the cornea and ocular inflammation affecting the anterior chamber were examined with a slit lamp; best corrected visual acuity and postoperative pain were documented. RESULTS: Thirty minutes after surgery, the uncorrected visual acuity was significantly better in the lidocain group. At 1 day we saw no differences concerning visual acuity. Descemet folds occurred in 6.5% of the peribulbar group and 20.5% in the lidocain group. CONCLUSION: Topical anesthesia with sponge anesthesia and intraocular application of 0.15 ml lidocain 1% circumvents the complications of a peribulbar/retrobulbar injection. The patient profits from rapid visual rehabilitation.

Anesthesia, Local↗
PubMed2000

[Site of a polyurethane stent in dacryocystography. Is postoperative success hereby predictable?].

BACKGROUND: Despite new methods for treating complete stenosis of the nasolacrimal duct dacryocystorhinostomy remains the standard operation. Implanting a nasolacrimal polyurethane stent through the nasolacrimal duct to preserve the natural lacrimal pathway seems to offer alternative procedure with similar success rate and without skin incision and general anesthesia. We examined whether an anatomically correct position increases its success rates. METHODS: This prospective study included 40 patients (mean age 57 years). The polyurethane stent was implanted during dacryocystography, and its position was checked at follow-up visits after 6 months. In the event of an additional canalicular stenosis a 45-mm-long stent was implanted, in the other patients a 35-mm-long stent. RESULTS: A dacryocystographically correct position was found in only 21 of 40 patients; in the other 19 the stent did not enter the nose under the inferior concha. However, there was no correlation between correct position under the inferior concha and success rate. In 8 of the 40 patients the stent was not patent. CONCLUSION: The postoperative success rate cannot be predicted by the radiographic position along the ductus nasolacrimalis.

Adult↗
PubMed2000

Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters.

PURPOSE: To evaluate the effect of the location of the corneoscleral tunnel incision as well as preoperative and intraoperative parameters on total and localized endothelial cell loss. SETTING: Department of Ophthalmology, Humboldt-University of Berlin, Berlin, Germany. METHODS: Fifty consecutive patients scheduled for routine cataract surgery were selected prospectively for this clinical trial. Preoperatively, the axial length, anterior chamber depth, lens thickness, and astigmatism were measured. Phacoemulsification time and relative energy as well as total surgical time were recorded. With a specular microscope, endothelial cell counts were determined centrally, superiorly, and temporally preoperatively and 6 weeks and 6 and 12 months postoperatively. RESULTS: After 12 months, the mean overall central endothelial cell loss in all eyes was 8.5%. The mean endothelial cell loss was 11.9% in the lateral quadrant and 11.4% in the superior quadrant. There were no significant differences between superior and temporal surgical approaches in intraoperative parameters of phacoemulsification time, relative intensity of phacoemulsification, and surgical time. There were no significant differences in central endothelial cell loss or in the area localized in the quadrant of the positions of the corneal surgical site. The only risk factors found significant for higher endothelial cell loss were shorter axial length and longer phacoemulsification time. CONCLUSIONS: The location of corneoscleral incisions for phacoemulsification can be chosen according to the preoperative astigmatism without inducing additional adverse effects on the corneal endothelium. Shorter eyes have a significantly higher risk for greater endothelial cell loss.

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PubMed1999

High-resolution conjunctival contrast-enhanced MRI dacryocystography.

We assessed high-resolution MRI of the lacrimal system with conjunctival contrast enhancement in patients with suspected stenosis. We studied 18 patients with epiphora affecting 22 eyes, using a surface coil, before and after conjunctival and intravenous Gd-DTPA. Stenosis or obstruction of the ducts was found in 18 of 22 cases: at canalicular level in 3 cases, at the sac in 7 cases, and in the nasolacrimal duct in 8 cases. Periductal pathology following surgery to the maxillary sinus or dacryocystorhinostomy was seen in three cases. In conjunction with the findings on syringing and/or conventional dacryocystography, the narrowing was classified as stenosis or obstruction.

Adult↗
PubMed1999

[Long-term stability of astigmatism outcome after arcuate lamellar keratotomy. 3-year results of a prospective study].

INTRODUCTION: The correction of low to moderate astigmatism is possible today by means of photoablation (PRK), while the treatment of moderate and higher astigmatism still involves refractive keratotomy. Experience has shown that cataract surgery, using modern tunnel techniques with self-healing incisions, results in earlier stability in both the refractive outcome and wound healing. In this study, we attempted to combine the advantages of lamellar keratotomy with those of a pair-wise T-incision as arcuate lamellar keratotomy (ALK). PATIENTS AND METHODS: The clinical outcome of 41 patients who underwent ALK was investigate in a prospective study over a period of 3 years. The pre- and postoperative investigations undertaken included the measurement of astigmatism using a Zeiss keratometer, uncorrected visual acuity, and corrected glare vision using a Humphrey autorefractor. All patients had astigmatism between 2.0 and 7.0 D. Together with a uniform arcuate incision, we used 7 mm (n = 26) and 8 mm (n = 15) mm zones for correction. RESULTS: The average preoperative astigmatism was 4.01 +/- 1.90 (median, 3.50) D. After a 3-year follow-up the average postoperative astigmatism was 1.59 +/- 1.29 (median, 1.38) D. The astigmatic change induced (Jaffé) after 3 years was about 3.23 +/- 2.23 (median, 3.16) D. The average uncorrected visual acuity (log MAR) before ALK was 0.20 +/- 0.12 (median, 0.22) and after follow-up, 0.41 +/- 0.14 (median, 0.39). Corrected glare vision before surgery was 0.23 +/- 0.19 (median, 0.10) and afterwards, 0.25 +/- 0.22 (median, 0.14). CONCLUSIONS: Arcuate lamellar keratomy (ALK) stood the test as a routine clinical procedure for correction of moderate astigmatism with stable postoperative functional outcomes. We did not find impairment of glare vision following this procedure.

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PubMed1999

[Evaluation of polyurethane stent implantation for the treatment of complete obstruction of the nasolacrimal system: 8-month follow-up and complications].

UNLABELLED: Dacryocystorhinostomy is still the standard procedure complete stenosis of the nasolacrimal duct. New methods try to preserve the natural lacrimal pathway. Song implanted in 1995 a nasolacrimal polyurethane stent through the nasolacrimal duct. The results and complications of this new method are described in this prospective study. METHODS: Thirty consecutive patients with complete obstruction of the nasolacrimal duct or lacrimal sac were included in the study. The stenosis was localized by dacryocystography. The ages ranged from 22 to 87 years (mean, 58.9 +/- 16 years). Dacryocystography was performed immediately, 4 weeks and 8 months after the procedure to verify the position and patency of the stent. RESULTS: Twenty-five short (35 mm) and 5 long (45 mm) stents were implanted. Twenty-four of 30 patients after 4 weeks and 9 of 10 patients after 8 months had reduced or no complaints. In 1 patient the stent was obstructed. Forceful irrigation with saline solution permitted recanalization. In 1 patient the stent had moved into the upper canaliculus. Because of irritation of the canaliculus it had to be pulled out after 2 months. CONCLUSION: The follow-up is still too short to recommend stent implantation as a real alternative to dacryocystorhinostomy. The main advantages are that the procedure is faster, no incision is necessary, and the local anesthesia is easier. The disadvantage is the need for X-ray examination.

Adult↗
PubMed1999

Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study.

OBJECTIVE: To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. DESIGN: A prospective, randomized, controlled study. PARTICIPANTS: A total of 200 consecutive cataract patients (200 eyes) participated. INTERVENTION: Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. MAIN OUTCOME MEASURES: Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. RESULTS: After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). CONCLUSION: Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.

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PubMed1998

Corneal endothelial cell changes in pseudoexfoliation syndrome after cataract surgery.

OBJECTIVE: To characterize possible differences in endothelial cell changes after cataract surgery in patients with pseudoexfoliation syndrome (PSX). METHODS: In this prospective, age-matched, controlled clinical study, 25 consecutive patients with PSX and 25 control patients with senile cataracts only were studied. All patients were treated with standardized cataract surgery. Sequential quantitative and qualitative morphometric endothelial cell analyses of the central and paracentral cornea were performed preoperatively and postoperatively at 1 day, 4 weeks, and 6 months using noncontact specular microscopy. RESULTS: Preoperative endothelial cell counts were 9.9% (P<.05) lower in patients with PSX (2387+/-266 cells/mm2) than in controls (2648+/-349 cells/mm2). The mean endothelial cell loss was 11.1% in the PSX group and 10.3% (P<.001 for both) in the control group, with no intergroup differences after 6 months. The mean endothelial cell area increased in both groups. Also, qualitative analysis revealed no significant differences in the endothelial repair mechanisms. CONCLUSIONS: Endothelial cell density is reduced preoperatively in patients with PSX compared with age-matched controls. In patients with PSX, cataract surgery induced similar endothelial cell changes without increased endothelial cell loss postoperatively.

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PubMed1998

[Prospective comparison of 2 multi-focal lens models].

BACKGROUND: The functional results of two different types of multifocal intraocular lenses (based on the diffractive and refractive principle, respectively) were investigated prospectively. MATERIALS AND METHODS: Altogether 50 patients who had a multifocal lens implanted were examined 4-6 weeks postoperatively. Visual acuity for distance and near vision, contrast sensitivity, low contrast visual acuity and glare visual acuity were investigated. RESULTS: Distance visual acuity, contrast sensitivity, low contrast visual acuity and glare visual acuity did not show significantly different results. Near visual acuity was statistically significantly better with the diffractive type of multifocal lens (because of a stronger adjustment for near vision). When the focus depth was tested by defocus curves, both lenses had better results within different areas of defocus. CONCLUSIONS: All patients in both groups showed satisfactory results. When choosing a multifocal intraocular lens, the individual needs of each patient should be taken into consideration.

Adult↗
PubMed1998

[High resolution functional magnetic resonance tomography with Gd-DTPA eyedrops in diagnosis of lacrimal apparatus diseases].

UNLABELLED: Both dacryocystography and dacryoscintigraphy are well established in the evaluation of stenoses of the lacrimal drainage system. They provide limited information about the ductal anatomy itself and about periductal structures. MR imaging was evaluated for its capability to directly visualize the lacrimal drainage system in detail and simultaneously provide functional characterization of dacryostenosis. SUBJECTS AND METHODS: Twenty-seven lacrimal drainage systems of 23 patients suffering from epiphora were examined in an MR unit before and after conjunctival and intravenous application of Gd-DTPA using a surface coil. RESULTS: Dacryostenosis was found in 23 of 27 lacrimal systems. Stenoses were localized to the canalicular (n = 3), saccular (n = 8), and ductal (n = 12) level, and were classified as stenosis or occlusion. CONCLUSION: MR imaging with conjunctival contrast application allows within one examination both detailed morphological and functional assessment of the lacrimal drainage system with depiction of surrounding structures. Limitations arise mainly from demands on technical and patient-related preconditions.

Contrast Media↗
PubMed1998

[Radiotherapy of exudative senile macular degeneration. A prospective controlled study].

UNLABELLED: Despite the successful therapy of subretinal neovascular membranes by laserphotocoagulation there are many problems to be overcome. In the case of subfoveolar neovascularization, photocoagulation leads to a sudden decrease in visual acuity. Recently radiotherapy is considered as an alternative. Complications and effectivity were evaluated in this prospective and randomized trial. The initial results are presented. PATIENTS AND METHODS: There are 76 patients (51 women, 25 men, average age 77.7 +/- 8.6 years) included in the prospective randomized study. All of them show subfoveolar neovascular membranes in FLA and a decrease in visual acuity between 0.05 and 0.5. They were randomly assigned to either the radiotherapy or the control group. Radiotherapy was done within 6 days by 6 x 2 Gy (6 MV photons). The follow-up was at 4 weeks, after 3 months, after 6 months and then every 6 months after the end of radiotherapy. On average the follow-up is at 15.1 months. RESULTS: Concerning age and visual acuity before therapy, the control group and the radiotherapy group were not significantly different. At 4 weeks after radiotherapy, visual acuity was 0.13 +/- 0.46 (LogMAR). After 12 months, visual acuity at a distance was 0.11 +/- 0.30 in the therapy group and 0.09 +/- 0.13 (P = 0.838) in the control group. Patients with a preoperative visual acuity better than 0.2 improved more after radiotherapy. Metamorphopsy improved in 75% of the therapy group. The following complications could be observed: In the control group 3 patients suffered subretinal bleeding, in the radiotherapy group 3 patients, respectively. CONCLUSIONS: At present, the follow-up is too short to recommend radiotherapy as a standard procedure in the case of subfoveolar neovascularization. The results in patients with a better preoperative visual acuity encourage us to continue this study.

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PubMed1998

Causes of severe decentration and subluxation of intraocular lenses.

BACKGROUND: Severe decentration and subluxation of intraocular lenses (IOLs) may lead to double vision, glare and deterioration of vision to the point of functional aphakia. The purpose of the present study was to analyse causes for severe IOL dislocation. MATERIAL AND METHODS: Between January 1989 and January 1996, 37 patients required IOL exchange because of decentrated or subluxated posterior chamber lenses. Twenty-five of the exchanged lenses were implanted in our hospital, 12 lenses elsewhere. After explantation the lenses were examined by light and electron microscopy. RESULTS: In 10 eyes, asymmetric implantation of the posterior chamber lens was responsible for decentration. Three of the lenser concerned were multifocal IOLs. Asymmetric implantation led to a significantly higher rate of explantations in eyes with multifocal lenses (P < 0.005). In five eyes decentration developed due to asymmetric capsular shrinkage, in four eyes due to posterior synechiae. A lens subluxation developed in three eyes as a result of rupture of the posterior capsule and in nine eyes because of zonular defects. In three cases decentrations were induced by an extensive secondary cataract. Macroscopically visible changed geometry of the haptics was found in nine lenses; eight of these had polypropylene haptics. Seven lenses showed severely altered haptics on electron-microscopic examination. In four eyes subluxated lenses had to be explanted together with the capsular bag because of severe defects of the zonula, which caused decentration in nine eyes. CONCLUSIONS: Asymmetric implantation of posterior chamber lenses should be strictly avoided. Multifocal lenses require special attention concerning symmetric capsulorhexis and positioning of their haptics.

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PubMed1998

Intraocular pressure in nonglaucomatous eyes with pseudoexfoliation syndrome after cataract surgery.

BACKGROUND AND OBJECTIVE: To investigate the course of the intraocular pressure (IOP) in nonglaucomatous patients with pseudoexfoliation (PSX) syndrome after cataract surgery. PATIENTS AND METHODS: In a prospective age-matched controlled clinical study, 23 consecutive patients with PSX were studied and compared with a control group of 23 patients. The IOP was measured by applanation tonometry preoperatively, and postoperatively on day 1, after 4 weeks, and after 6 months. All patients were operated on with a self-sealing 7-mm scleral tunnel incision, phacoemulsification, and posterior chamber intraocular lens (IOL) implantation. RESULTS: Preoperatively the IOP was similar between both groups (P = .962). At the first postoperative day the IOP was below 22 mm Hg in all cases. After 4 weeks and 6 months a mean decrease of 3.88 mm Hg (P = .001) in the control group and of 3.15 mm Hg (P = .002) in the PSX group was observed; this difference was not statistically significant (P = .543). CONCLUSIONS: At 1 day postoperatively no pressure increase was observed in the eyes with PSX after scleral tunnel incision and phacoemulsification. Six months after cataract extraction with IOL implantation, the tension level decreased in the presence of PSX similarly as in normal eyes.

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PubMed1997

Combined phacoemulsification and filtering surgery with the 'no-stitch' technique.

OBJECTIVE: To determine if intentionally making a radial incision could lead to a lasting decrease in intraocular pressure and the development of filtering blebs. METHODS: Forty-three eyes treated with combined filtering surgery were compared with a control group of 42 eyes treated with cataract surgery (phacoemulsification) alone. All of the patients had advanced chronic open-angle glaucoma. During combined cataract and glaucoma surgery, the tunnel floor was transected with Vannas scissors. RESULTS: One year after surgery, the mean intraocular pressure in the study group decreased 7.6 mm Hg from a preoperative mean (+/-SD) of 25.9+/-5.3 mm Hg. The decrease in the control group was 3.7+/-4.2 mm Hg. The difference between the 2 groups was statistically significant (P<.001). In the study group, an average of 1.5+/-0.8 fewer medications were required 1 year after surgery. In the control group, 0.5+/-0.6 fewer medications were required. CONCLUSIONS: The combined surgical procedure discussed in this article led to a lasting decrease in intraocular pressure. Cataract surgery alone using the no-stitch technique and posterior chamber lens implantation also reduced intraocular pressure, although significantly less.

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PubMed1997

[7 mm tunnel incision with lateral approach as routine intervention in cataract surgery].

UNLABELLED: As the lateral incision in comparison to the classic incision at the 12 o'clock position induces less astigmatism and shows higher wound stability, we wanted to determine if this technique could be used as a routine procedure for most patients. PATIENTS AND METHODS: A total of 186 patients were prospectively included in this study. They all had a lateral incision with the no-stitch technique, either as a clear corneal incision or as a corneoscleral or scleral incision. Postoperatively, patients were followed up for up to 12 months. RESULTS: Whereas the scleral incision showed the highest wound strength, one patient with a corneoscleral incision needed a later suture. There were two cases of endophthalmitis after a clear corneal incision; 6-12 months postoperatively the mean induced astigmatism amounted 0.64 +/- 0.22 D after a scleral incision, 0.71 +/- 0.47 D after a corneoscleral incision, and 0.92 +/- 0.63 D after a clear corneal incision. CONCLUSION: The lateral approach with a scleral is a safe procedure and induces very little astigmatism. It can be used routinely for all patients who have inverse preoperative astigmatism or none at all. The clear corneal incision shows instable wound closure and a higher infection risk. In the long term it induces an astigmatism of about 1 D and therefore is of no use for correction of higher inverse astigmatism.

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