Biomedical subjects

N Anders

Publications and source records attributed to N Anders.

At least 37 records · Page 2Linked to original sources

PubMed1997

[Factors modifying postoperative astigmatism after no-stitch cataract surgery].

BACKGROUND: One of the main advantages of the no-stitch technique in cataract surgery is that induced astigmatism occurs less frequently than with any other procedure and stabilizes within a very short time postoperatively. The resultant high wound strength enabled us to alter the incision parameters in an attempt to identify those which influenced postoperative astigmatism, the ultimate goal being to improve the prognosis of the expected astigmatism. Since the influence of tunnel width and incision length and shape were well known, we investigated the influence of incision depth and site and that of various parameters in a prospective randomized and controlled clinical trial. METHODS: The study included 256 eyes with a 7-mm tunnel incision as examined in 256 patients. The following subgroups of 27 eyes each were investigated: primary incision depth of 300 microns versus 500 microns, limbal incision versus scleral incision, scleral incision in the 12 o'clock position versus temporal scleral incision, and limbal incision in the 12 o'clock position versus temporal limbal incision. In another group the influence of age, IOP, axial length of the globe, preoperative astigmatism, corneal diameter, and postoperative astigmatism as measured by the keratometer were all assessed using Spearman's correlation coefficient. RESULTS: Temporal incisions made 2 mm posterior to the limbus resulted in induced astigmatism of 0.64 +/- 0.22 D 6 months postoperatively, which was less than after incisions in the 12 o'clock position (0.98 +/- 0.40 D). Induced astigmatism was highest after limbal incisions in the 12 o'clock position (1.31 +/- 0.60 D), yet was less if a temporal limbal incision was made (0.84 +/- 0.52 D). Incision depth did not have significant influence on induced astigmatism. Of the parameters, age (Spearman's correlation coefficient after 4 weeks 0.34; P = 0.002; after 6 months 0.28; P = 0.01), and preoperative astigmatism (Spearman's correlation coefficient after 4 weeks 0.28; P = 0.01; after 6 months 0.27; P = 0.01) had a significant influence on postoperative astigmatism. CONCLUSIONS: These findings indicate that induced astigmatism was highest after limbal incisions in the 12 o'clock position and lowest after scleral incisions in the temporal position. Age and preoperative astigmatism were also found to influence induced astigmatism significantly. All of these factors have to taken into account to minimize postoperative astigmatism.

Adult↗

PubMed1997

[3 1/2 years experiences with ECCE with tunnel incision].

Since January 1992 planned extracapsular cataract extraction (ECCE) is performed routinely with the no-stitch technique at our clinic. To minimize surgically induced astigmatism further, modified wound constructions for planned ECCE with on 1.1-mm tunnel width were evaluated. The follow-up time was up to 3 years postoperatively. For 250 eyes wound closure was performed prospectively either sutureless (n = 70), with a single perpendicular suture (n = 100) or cross sutures (n = 40) at the 12 o'clock position or sutureless in the temporal position (n = 40). The complication rate was 4% (filtering bleb, iris prolapse or transient hypotonia). There were no wound ruptures, but once endophthalmitis was observed. Late mean astigmatism after up to 3 years follow-up for vertical incision was 2.05 +/- 1.16 D (1.01 +/- 0.96 D preoperatively) for sutureless wound closure, 1.63 +/- 1.08 D (0.86 +/- 0.95 D) for perpendicular and 1.76 +/- 0.88 D (0.73 +/- 0.55 D) for cross-sutures. A temporal incision resulted in 0.78 +/- 0.52 D (1.0 +/- 0.69 D) of astigmatism and was only performed on eyes with against the rule astigmatism preoperatively. Surgically induced astigmatism was stabilized early. For with the rule astigmatism preoperatively, a 12 o'clock incision with a perpendicular single suture is recommended and for against the rule astigmatism, a temporal incision.

Astigmatism↗

PubMed1997

[Early postoperative endothelial cell loss after corneoscleral tunnel incision and phacoemulsification in pseudoexfoliation syndrome].

INTRODUCTION: Corneal endothelial involvement can be found in pseudoexfoliation syndrome (PEX). Evaluation of possible differences in endothelial cell loss following cataract extraction was compared to normal eyes. PATIENTS AND METHODS: In a controlled clinical study we prospectively studied 20 patients with PEX and compared them with an age-matched control group with senile cataract. All patients were treated with a standardized self-sealing 7-mm corneoscleral tunnel incision, phacoemulsification and posterior intraocular lens implantation using sodium hyaluronate. In addition to a complete ophthalmological examination, quantitative and qualitative endothelial cell analysis of the central and peripheral cornea was performed preoperatively, at the first postoperative day and after 4 weeks using non-contact specular microscopy (Konan Noncon Robo-ca SP 8000, Konan, Japan). RESULTS: In eyes with PEX (2394 +/- 271 cells/mm2) endothelial cell counts were 10.5% (P < 0.05) lower than in the control group (2674 + 341 cells/mm2). Intraoperatively, ultrasound time (90 +/- 51 s) and power (38 +/- 17%) did not differ between the two groups. After 4 weeks the mean endothelial cell loss in the two groups was 10.4% and 9.8%, respectively (P < 0.001). The mean cell area increased by 55 and 48 microns2 (P < 0.001), respectively. Polymegethism increased postoperatively in both groups and stabilized at 4 weeks at preoperative values. Pleomorphism increased significantly only in the PEX group. CONCLUSIONS: In eyes with PEX no increased cell loss was found in the early postoperative period compared to normal eyes following corneoscleral tunnel incision and phacoemulsification. Due to preoperative reduced endothelial cell densities, endothelium-protecting measures are recommended in eyes with PEX.

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PubMed1997

[Long-term prospective study of the development of corneal astigmatism in no-stitch cataract surgery].

BACKGROUND: Several studies have confirmed, that the no-stitch technique results in early stabilization of astigmatism. In these papers, however, the follow-up was quite short. Former studies about sutured corneoscleral incisions have shown that even after some years astigmatism increased. Therefore, in this prospective study we investigated the change of induced astigmatism 5 years postoperatively. METHODS: The prospective study included 66 patients with scleral tunnel incisions who were monitored up to 5 years. Mean age was 74.3 +/- 10.7 years. The incision length of the scleral tunnel was 7 mm. The postoperative astigmatism was measured with keratometry after 1 day, 3 weeks, 1 year and 5 years postoperatively. RESULTS: The average postoperative induced astigmatism (PIA) as measured with a keratometer was after 1 year 0.95 +/- 0.83 D. After 5 years PIA was 0.96 +/- 0.48 D, and therefore no significant statistical difference could be shown. At the first postoperative day (0.94 +/- 0.73 D) the induced astigmatism was virtually stable. There was also no statistically significant difference in absolute astigmatism. After 1 day the absolute astigmatism was 0.91 +/- 0.73 D and after 5 years 0.96 +/- 0.61 D. CONCLUSIONS: The contrast to former sutured corneaoscleral incisions, the no-stitch technique in cataract surgery yields stable postoperative corneal astigmatism.

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PubMed1997

[Cataract surgery in narrow pupil and postoperative fibrin reaction, especially after sphincterectomy].

BACKGROUND: Since increased intraoperative iris irritation can lead to increased postoperative inflammation, we are interested in postoperative reactions to several varied surgical procedures. We performed pupil stretching, iridotomy with iris suture, and partial sphincterectomy. MATERIALS AND METHODS: From January 1995 to January 1996, 100 patients (103 eyes) with narrow pupils underwent cataract surgery. In 13 eyes a iridotomy and iris suture were performed, in 28 eyes a partial sphincterectomy. In 62 eyes there was no surgical intervention after pupil stretching. Postoperative examinations were carried out in the early postoperative phase (up to 5 days postoperative) as well as 4 weeks after surgery. Fibrin reaction was classified according to 3 grades, (1) faint fibrinous threads, (II) fibrinous net, and (III) membranous fibrin exsudation. RESULTS: In the group without additional surgery there was a fibrinous reaction of grade I and II in 11 eyes. This complication occurred after iridotomy and iris suture in four cases and after sphincterectomy in four cases. While the intensity of fibrinous reaction was comparable in the first two groups, the fibrinous reaction after sphincterectomy was more intensive in one eye (grade III). However, response to intensive local antiphlogistic therapy was good. Frequency of fibrinous reaction in the three groups was statistically not significant. It should be pointed out that there was a partial restoration of pupil movements through sphincterectomy: mean pupil diameter was 4 mm, and 2.5 mm under exposure to light. Three patients had no pupillary reaction at all. CONCLUSIONS: Partial sphincterectomy facilities intraoperative manipulations of cataract surgery. Postoperative inflammatory reaction is rare and was very responsive to medical treatment. The reconstruction of pupillary movement is part of full visual function and, last but not least a round pupil is aesthetically more desirable.

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PubMed1997

A prospective evaluation of a diffractive versus a refractive designed multifocal intraocular lens.

OBJECTIVE: To evaluate prospectively a diffractive (811E, Pharmacia; power add +4.0 D) versus a refractive (PA154N, Allergan; power add +3.5 D) designed multifocal lens. PARTICIPANTS: Eighty patients planned for cataract surgery without additional ocular pathologies were randomized into the diffractive or refractive group, respectively. INTERVENTION: A standardized no-stitch phacoemulsification with implantation of one of the two multifocal lenses was performed in each patient. MAIN OUTCOME MEASURES: Distance and near-visual acuity, contrast sensitivity, low contrast visual acuity, glare visual acuity, and depth of focus were measured after surgery. RESULTS: All treated patients had best-corrected visual acuities of 20/30 or better. Near-uncorrected vision was significantly better (P < 0.0001) with the diffractive lens (mean, J1) than with the refractive lens (mean, J4). Low contrast visual acuity (61 +/- 12% versus 59 +/- 9%), glare visual acuity (39 +/- 19% versus 38 +/- 14%), and contrast sensitivity (1.48 +/- 0.08 versus 1.50 +/- 0.12) were not significantly different between the groups. CONCLUSIONS: Both lens designs showed satisfactory functional results with advantages for the diffractive lens design.

Adult↗

PubMed1997

Postoperative astigmatism and relative strength of tunnel incisions: a prospective clinical trial.

PURPOSE: To investigate the influence of incision depth and site on wound strength and postoperative astigmatism. SETTING: Virchow Memorial Hospital Eye Clinic, Berlin, Germany. METHODS: In this prospective, randomized study, 180 patients with a 7.0 mm tunnel incision depth of 300 and 500 microns; limbal incision and scleral incision; temporal scleral incision and scleral incision at the 12 o'clock position; temporal limbal incision and limbal incision at the 12 o'clock position. Postoperative astigmatism was measured by keratometry and videokeratoscopy 1 day, 1 and 4 weeks, and 8 months postoperatively. Wound strength was measured with an ophthalmodynamometer on the first postoperative day and after 1 week at the site with the least mechanical stability adjacent and posterior to the primary incision. RESULTS: The temporal incision, which was performed 1.0 mm behind the surgical limbus, led to induced astigmatism of 0.65 diopters (D) +/- 0.23 (SD) after 8 months. When incision was at the 12 o'clock position, the induced astigmatism was 0.97 +/- 0.41 D. Induced astigmatism was highest following a limbal incision in the 12 o'clock position (1.33 +/- 0.63 D). This effect was less pronounced with a temporal incision. Incision depth did not significantly influence induced astigmatism. An incision depth of 500 microns led to induced astigmatism of 0.94 +/- 0.50 D; a depth of 300 microns led to induced astigmatism of 0.78 +/- 0.64 D. After 1 week, wound strength was highest with temporal scleral incisions (38.6 +/- 2.1 kPa by ophthalmodynamometer) and lowest with limbal incisions in the 12 o'clock position (30.8 +/- 7.7 kPa). CONCLUSIONS: Incisions site significantly influenced mechanical wound strength and induced astigmatism; incision depth influenced neither. In general, incisions in the 12 o'clock position induced more astigmatism than temporal incisions.

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PubMed1997

Effect of incision location on preoperative oblique astigmatism after scleral tunnel incision.

PURPOSE: To evaluate the effect of incision location or clinically relevant preoperative oblique astigmatism. SETTING: Department of Ophthalmology, Virchow Medical Center, Humboldt-University, Berlin, Germany. METHODS: This prospective study included 68 patients who had phacoemulsification and posterior chamber lens implantation using a standardized 7.0 mm self-sealing trapezoidal scleral tunnel incision. Each patient was randomly assigned to one of three incision locations: Group A, conventional superior incision; Group B, temporal incision; Group C, oblique incision centered on the steeper meridian (modified BENT incision). Astigmatism analysis was performed by manual keratometry and corneal topography. RESULTS: A significant mean reduction in astigmatism of 0.58 diopter (D) (P < .01) was achieved in only the modified BENT incision group. Postoperatively, significant flattening of 0.27 D (P < .01) in the steeper meridian as well as steepening of 0.29 D (P < .01) in the flatter meridian occurred. No decrease in astigmatism was noted in the superior or temporal incision groups. Five months postoperatively, vector analysis showed that surgically induced astigmatism was significantly higher in the superior incision group (1.16 D +/- 0.44 [SD]) than in the temporal incision group (0.66 +/- 0.32 D) or modified BENT incision group (0.82 +/- 0.50 D). Corneal topographic analysis confirmed these results within +/- 0.3 D. CONCLUSIONS: Only the oblique incision centered on the steeper meridian (modified BENT incision) effectively and predictably reduced preoperative oblique astigmatism. In eyes with clinically relevant oblique astigmatism, we recommend using a modified BENT incision.

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PubMed1997

Correcting postoperative astigmatism using curved lamellating keratotomy.

PURPOSE: To ascertain whether the change in refraction caused by paired lamellating corneal incisions in cadaver eyes could be achieved in living eyes and whether wound healing influences this effect. SETTING: Virchow Hospital Eye Clinic, Humboldt University, Berlin, Germany. METHODS: This prospective study included 45 patients who had a follow-up of 15 months. All had astigmatism of at least 2.00 diopters (D) induced by previous cataract surgery. Optical zones of 7.0 and 8.0 mm and chordal lengths of 3.0 and 5.0 mm were used. All incisions were paired. RESULTS: Mean preoperative astigmatism measured with a keratometer was 3.64 D +/- 0.89 (SD). After 15 months, it was 1.00 +/- 0.76 D, and mean induced astigmatism was 3.18 +/- 1.30 D. The 7.0 mm group had a mean induced astigmatism of 3.93 +/- 1.52 D, which was significantly higher than that in the 8.0 mm group (mean 2.60 +/- 0.74 D) at a uniform chordal length of 3.0 mm. Mean uncorrected visual acuity was 0.26 +/- 0.14 preoperatively and 0.50 +/- 0.28 after 15 months; mean corrected visual acuity improved from 0.58 +/- 0.21 to 0.76 +/- 0.21. Mean endothelial cell count was 1799 +/- 595 cells/mm2 preoperatively and 1784 +/- 589 cells/mm2 after 6 months; the difference was not significant. CONCLUSION: Curved lamellating keratotomy gives stable postoperative refractive results without significantly affecting endothelial cell count or visual acuity.

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PubMed1996

[MRT of the eye: the normal anatomy and detection of the smallest lesions with a high-resolution surface coil].

PURPOSE: A new, high-resolution surface coil for MRI of the eye was evaluated with regard to practicability, image quality and sensitivity for small lesions. MATERIAL AND METHODS: 48 patients in whom a space-occupying lesion of the eye or orbit was suspected were examined (1.5 T tomograph, 5 cm surface coil, T1- and T2-weighted spin-echo sequences, the former before and after i.v. gadolinium DTPA). RESULTS: 45/48 patients tolerated MR with the high-resolution surface coil. No adverse effects were experienced by the patients. In 11/48 patients a space occupying lesion of the eye was detected (melanoma, 5; metastases, 2; haemorrhage, 1; malformation, hamartoma and scarring after melanoma, one each). The smallest detectable lesion had a thickness of < 1 mm. CONCLUSION: First experiences with the high-resolution surface coil indicate that this device is suited for detection of very small lesions of the eye.

Adolescent↗

PubMed1996

[Wound rupture 1 year after cataract operation with 7 mm scleral tunnel incision (no-stitch technique)].

BACKGROUND: Wound strength of the self-sealing tunnel technique is much higher than the former sutured corneoscleral incision, as many experimental investigations have shown. Therefore only a few cases of traumatic wound rupture after tunnel incision are published. We report on a traumatic wound rupture with loss of the IOL with capsular bag and iris. CASE REPORT: An 80-year-old patient suffered a traumatic wound rupture one year after cataract surgery with a 7-mm scleral self-sealing wound construction. The IOL with capsular bag and iris were expulsed and the wound construction was damaged. By gonioscopy a large irregular lesion of the inner lamella could be observed. After pars plana vitrectomy of the severe vitreous hemorrhage a visual acuity of 0.5 was achieved. The mechanism of the wound rupture is discussed. CONCLUSION: The loss of the iris and the IOL and the lesion of the inner lamella suggest a massive force. The yet existing relative wound stability after the trauma depends on the still working self-sealing mechanism of the tunnel construction in spite of the lesion of the inner lamella.

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PubMed1996

[Incidence of recurrence after primary pterygium excision, phototherapeutic keratectomy with the ArF:Excimer laser and local mitomycin C administration].

BACKGROUND: In this clinical trial the recurrence-rate after primary pterygium-excision, phototherapeutic keratectomy with the ArF:excimerlaser and local application of mitomycin C should be estimated. MATERIAL AND METHODS: Forty eyes of 38 patients underwent primary pterygium-excision using a bare-sclera technique. All patients underwent phototherapeutic keratectomy (PTK) with the ArF:excimerlaser of the wound region. Postoperative all patients were treated with mitomycin C 0.02% twice daily for four days and for 4-6 weeks with a combination of gentamycin and dexametason eye drops triple a day. Minimum follow-up was 24 month (median 41 month). RESULTS: Two eyes developed a recurrence after 12 and 28 month respectively. The overall recurrence rate was 5% (corneal recurrence 2.5%). One patient developed a minute granuloma in the area of the excision. There were no other complications during the follow-up. CONCLUSIONS: The excision of pterygium using the bare-sclera technique, phototherapeutic keratektomy und local application of mitomycin C 0.02% eye drops is a safe method with a low recurrence-rate. All recurrences occured after more than one year postoperatively.

Adult↗

PubMed1996

[Corneal astigmatism after pterygium excision and subsequent phototherapeutic keratectomy with the excimer laser (193 rm)].

BACKGROUND: Phototherapeutic keratectomy with the excimer laser is a suitable procedure for corneal smoothing after pterygium excision. In this study the effect of postoperative excimer laser smoothing on induced and absolute astigmatism after pterygium surgery was investigated. MATERIALS AND METHODS: 60 of 53 eyes underwent pterygium surgery using a bare sclera technique. In addition 30 of the treated eyes underwent postoperative phototherapeutic keratectomy of the wound region with the excimer laser. Astigmatism was measured preoperatively and postoperatively after 6 months up to four years. RESULTS: Absolute astigmatism of patients treated with excimer laser decreased significantly from 1.38 +/- 0.83 D preoperative to 0.35 +/- 0.32 D postoperative (p < 0.0001). In this group mean induced astigmatism was 1.37 +/- 0.93 D. There was no correlation between the induced astigmatism and the number of excimer pulses applied (r = 0.0287; p = 0.905). Absolute astigmatism of the control group decreased from 1.10 +/- 0.85 D to 0.72 +/- 0.56 D (p < 0.05). There were no significant differences between the excimer- and the control group concerning preoperative astigmatism. Postoperative absolute astigmatism of the excimer group was significantly lower than absolute astigmatism of the control group (p < 0.0001). Mean induced astigmatism of the control group was 1.15 +/- 0.95 D and not significantly different from the excimer treated group (p = 0.2654). CONCLUSION: Phototherapeutic keratectomy with an excimer laser for corneal smoothing after pterygium excision reduces astigmatism significantly.

Adult↗

PubMed1996

[Effect of local administration of mitomycin C on intraocular pressure].

BACKGROUND: Animal studies suggest that the decrease of intraocular pressure after application of mitomycin C is particularly mediated by toxic effects on the substance of ciliary body. Moreover it has been shown that the concentration of mitomycin C after topical application in the aqueous humour is as high when performing fistulating surgery. In this prospective study we wanted to investigate whether the topical application of mitomycin C would result in a significant decrease of intraocular pressure. PATIENTS AND METHODS: Forty-one eyes of 41 patients underwent pterygium surgery using a bare sclera technique. Afterwards phototherapeutic keratectomy with the excimer laser (193 nm) was performed in the area of the excision. In hospital mitomycin C eye drops (0.02%) were given twice daily for four days. The intraocular pressure of treated and untreated eyes was measured with applanation tonometry at least three times per day preoperatively, postoperatively at the fourteenth day and after 6 month. RESULTS: Mean intraocular pressure of the treated eyes was preoperatively 15.73 +/- 2.35 mm Hg, 14 days postoperatively 15.92 +/- 2.79 mm Hg and at the last examination 15.86 +/- 2.39 mm Hg. For untreated eyes the mean intraocular pressure was preoperatively 15.70 +/- 2.04 mm Hg, after 14 days 15.76 +/- 2.96 mm Hg and at the last examination 15.89 +/- 2.67 mm Hg. Consequently there was no statistically significant change of intraocular pressure in the eyes treated with mitomycin C. Furthermore there were no significant differences of intraocular pressure between treated and untreated eyes at any time of postoperative check-up. CONCLUSION: The short-term local application of mitomycin C did not result in a detectable change of intraocular pressure and is therefore probably an alternative to intraoperative application during filtration surgery.

Adult↗

PubMed1996

[Curved lamellar keratotomy for correction of astigmatism. Experimental and initial clinical results].

BACKGROUND: The first experiments for surgical correction of higher astigmatism were reported more than 100 years ago. A lot of different procedures were strongly recommended at the beginning but then abandoned later on because they could not fulfill the expectations regarding the postoperative results and the complications. On the other hand, lamellar preparation of the cataract incision has been considered a major advance in ophthalmology. The main advantage of this incision is that it yields stable postoperative refraction as well as high mechanical stability very early (postoperatively). These findings prompted us to combine the advantages mentioned above with those of the arcuate transverse incision. In this report we present our experimental and clinical results with arcuate lamellar keratotomy. MATERIALS AND METHODS: Experiments were carried out on 22 cadaver bulbi. The optical zones ranged from 6 to 8 mm and the length of the arcuate incisions was between 2 and 7 mm. The clinical data presented here were obtained from 20 patients with a 4-week follow-up. These 20 patients had undergone cataract surgery previously with an induced astigmatism ranging from 2.5 to 5 D. Patients were treated with an optical zone of 7 mm or 8 mm. The length of the arcuate incision was 3 mm. All incisions were paired. RESULTS: Our experiments (cadaver bulbi) showed an approximately linear decrease of the effect with increasing width of the optical zone and increasing are length. Our clinical results demonstrate that the astigmatism induced by our procedure (including potential overcorrection) was 3.41 +/- 1.33 D on the the first day postoperatively. All astigmatism was measured with the Zeiss keratometer. After 1 and 4 weeks the results were 3.98 +/- 1.35 and 3.71 +/- 1.29 D, respectively. The induced astigmatism also depended on the width of the optical zone. In the group with a 7 mm optical zone the induced astigmatism was 4.5 +/- 1.56 D after 4 weeks. This effect was remarkably higher than in the 8 mm group with an average of 3.35 +/- 0.94 D of induced astigmatism. There were no significant differences between visual acuity under glare conditions and the number of endothelial cells preoperatively and at 4 weeks follow-up, nor were there variations in refraction, depending on the time of day. CONCLUSIONS: Due to the relatively high standard deviation of the induced astigmatism we must keep trying to make the results of our procedure more predictable.

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PubMed1995

[Induced astigmatism in extracapsular cataract extraction with tunnel incision and various wound closures].

BACKGROUND: For planned extracapsular cataract extraction the no-stitch technique with 11-mm tunnel width has been well established. Four modifications of wound closure were performed to further reduce surgically induced astigmatism. PATIENTS AND METHODS: In this prospective study we controlled 250 eyes of 250 consecutive patients 4 months after surgery with four different wound constructions: sutureless wound closure (n = 70), singular perpendicular suture (n = 100), cross suture (n = 40) in 12 o'clock position or sutureless wound closure in temporal position (n = 40). RESULTS: Surgically 'Induced Astigmatism' was for eyes with preoperative 'With the Rule Astigmatism' (vs Against the Rule astigmatism), operation in 12 o'clock position and sutureless wound closure 2.22 +/- 0.77 D (1.66 +/- 0.94 D), with perpendicular suture 1.66 +/- 0.93 D (1.24 +/- 0.82 D), and with cross suture 1.47 +/- 0.96 D (0.9 +/- 1.13 D). Temporal incision was only performed in preoperative 'Against-the-Rule-Astigmatism' eyes and resulted in 0.6 D of 'Induced Astigmatism'. Preoperative average astigmatism was 0.86 +/- 0.68 D (1.01 +/- 0.95 D). CONCLUSIONS: For preoperative 'With the Rule Astigmatism', operation in 12 o'clock position and singular perpendicular suture and for 'Against the Rule Astigmatism' (especially > 1.5 D) temporal incision is recommended.

Astigmatism↗

PubMed1995

[Ocular tuberculosis in systemic lupus erythematosus and immunosuppressive therapy].

BACKGROUND: A marked reduction in eye disease attributed to tuberculosis has occurred over the past several decades. In recent years, however, tuberculosis has reemerged as a serious public health problem. We report a case of a severe ocular tuberculosis in a patient with systemic lupus erythematosus and immunosuppressive therapy. PATIENT: The 36-years-old woman underwent an immunosuppressive therapy because of a systemic lupus erythematosus detected two years earlier. After holidays on the Philippines Mycobacterium tuberculosis was found in a bronchial lavage. Two months later fundoscopy showed severe subretinal exsudation with overlying serous retinal detachment. Within several months these findings progressed to a panuveitis with spontaneous perforation. Histopathologically a granulomatous panophthalmitis could be found with giant cells. Two months later acid-fast bacilli were detected in orbital lesions. CONCLUSION: In immunosuppressed patients there is still an increased risk for severe ocular tuberculosis. Therefore it is important to think of this almost forgotten disease in those cases.

Adult↗

PubMed1995

[Wound stability of the "no-stitch" technique in various incision sites and depths].

BACKGROUND: Supported by experiments on cadaver eyes the no-stitch technique seems to possess higher wound strength. Until now there have been no clinical trials addressing this subject. This prompted us to investigate the wound strength with varying incision depth and incision site in a prospective randomized and controlled clinical trial. METHODS: For this study 162 patients with a 7-mm tunnel incision were recruited. They were divided into the following subgroups: Primary incision depth of 300 microns versus 500 microns, limbal incision versus scleral incision, scleral incision in 12 h position versus temporal scleral incision, limbal incision in 12-h position versus temporal limbal incision. The wound strength was measured by an ophthalmodynamometer on the first postoperative day and after 1 week at the site with the least mechanical stability adjacent and posteriorly to the primary incision. RESULTS: On the first day after surgery the wound strength was best in the temporal scleral incision with an ophthalmodynamometer reading of 37.6 +/- 4.1 kPa and it was the least in the 12-h limbal incision with an ophthalmodynamometer reading of 21.8 +/- 5.4 kPa. After 1 week also the wound strength was best in the temporal scleral incision with 38.4 +/- 2.1 kPa and it was the least in 12-h limbal incision with 30.9 +/- 7.5 kPa. CONCLUSIONS: These findings demonstrate that the site of the primary incision is a very important factor in determining the mechanical wound strength concerning resistance against external pressure. The wound strength was best in the temporal scleral incision.

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