Stereotactic irradiation of uveal melanoma with the Leksell gamma unit.
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Dose-Response Relationship, Radiation↗
Biomedical subjects
R Menapace
Publications and source records attributed to R Menapace.
Quantification of conjunctival vascular reaction by digital imaging.
BACKGROUND: No objective evaluation of the conjunctival provocation test (CPT) was possible until now. OBJECTIVE: The aim of this study was to develop a tool that would enable us to monitor conjunctival allergic inflammation by objective measurements. METHODS: Twenty-four patients allergic to grass pollen were challenged by a CPT with grass pollen and genuine grass pollen in the "Vienna Challenge Chamber." Patients were randomized to treatment with placebo or topical application of an H1-receptor antagonist (azelastine). Vascular reaction of the conjunctiva was repeatedly monitored by special video equipment. The signal was sent to a digital frame grabber, and digital image analysis was done with the aid of the WCUE-3 program (Olympus Optical Co., Hamburg, Germany). RESULTS: The CPT led to an immediate increase of the red density. This extension was linear within the first 15 minutes. During the long-term challenge, the increasing vascular effect lasted 2 hours. During active treatment a consistent reaction pattern was obvious; however, the corresponding levels were statistically lower (p = 0.022). CONCLUSION: The calculation of red density of the conjunctiva by digital analysis proved to be a sensitive tool for measuring the conjunctival allergic reaction. It is possible to overcome the insufficient subjective evaluation of the CPT by objective measurements of the vascular reaction.
Adult↗
Topical versus peribulbar anesthesia in clear corneal cataract surgery.
PURPOSE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar anesthesia in clear corneal cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Austria. METHODS: In this prospective, double-blind clinical trial, 36 patients had bilateral cataract surgeries performed from 1 to 3 months apart. Half of the patients had topical anesthesia for the first surgery and peribulbar anesthesia for the second surgery. The other half had peribulbar first and then topical. All surgery was done using a temporal clear corneal approach and bimanual phacoemulsification followed by in-the-bag intraocular lens implantation. Subjective pain was assessed using a visual analog scale of no pain (0%) to worst pain imaginable (100%) and intraoperative motility using a rank scale of adverse motility (-5) to ideal patient cooperation (+5). RESULTS: Subjective pain was comparable whether topical or peribulbar anesthesia was used (mean 10.75 versus 10.97%; P > .6). Patient cooperation (motility) was significantly better when topical anesthesia was used (+2.16 versus +1.11; P = .03). There were no significant differences in complications. A peribulbar block was given in addition to the topical anesthesia in two cases. CONCLUSIONS: Topical anesthesia is a safe, effective alternative to peribulbar anesthesia in clear corneal cataract surgery.
Administration, Topical↗
Posterior capsule opacification and capsulotomy rates with taco-style hydrogel intraocular lenses.
PURPOSE: To evaluate posterior capsule opacification (PCO) formation and neodymium: YAG (Nd:YAG) laser capsulotomy results in eyes with an logel intraocular lens (IOL). SETTING: First University Hospital, Vienna, Austria. METHODS: A retrospective study was done of 108 eyes with one of three types of an logel IOL that had decreased vision from PCO and required posterior capsule discission. RESULTS: In general, in eyes with sulcus-placed IOLs, a Soemmering's ring formed and the capsulorhexis rim tightly adhered to the posterior capsule, sealing the capsular bag periphery. Elschnig pearls had broken the barrier, invading the retrolental space. In eyes with bag-placed IOLs, there was a gap between the IOL and posterior capsule in which Elschnig pearls had accumulated. This gap frequently extended beneath the flanges to the periphery of the capsular bag, allowing residual lens epithelial cells to proliferate and migrate centrally. CONCLUSION: The logel lenses led to a high incidence of regeneratory PCO within the gap between the lens and capsule that might be the result of the properties of the lens' hydrogel material rather than its design.
Cataract↗
In vivo study of cell reactions on poly(methyl methacrylate) intraocular lenses with different surface properties.
PURPOSE: To evaluate the biocompatibility of three poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) with different surface properties. SETTING: University Eye Clinic, Vienna, Austria. METHODS: Cell reactions on the surfaces of unmodified, heparin-surface-modified (HSM), and surface-passivated (SP) PMMA IOLs were documented in vivo using a Zeiss specular microscope. Risk factors for such reactions were also determined. RESULTS: During the first postoperative days, small round and spindle-shaped cells were found on all IOLs. Cell density was higher in eyes with increased postoperative inflammation. After several days, epithelioid and foreign-body giant cells were seen on some IOLs. Cells appeared significantly less often on the IOLs with hydrophilic surfaces (HSM) than on those with hydrophobic surfaces (unmodified, SP). CONCLUSION: The significantly lower incidence of foreign-body reactions on hydrophilic than on hydrophobic IOL surfaces is consistent with the results of previous studies on hydrogel and silicone IOLs.
Aged↗
Straight-entrance, sclerocorneal valve incision with horizontal sutures for poly(methyl methacrylate) intraocular lenses.
Self-sealing sclerocorneal tunnel incisions with an external frown entry are widely used for implantation of poly(methyl methacrylate) intraocular lenses. Although safe and effective, these incisions have certain drawbacks. We developed a wound construction in which a straight external incision is used in conjunction with a tension-free, infinity-type suture. Out of 100 consecutive cases, only two did not seal satisfactorily at the conclusion of surgery but were tight upon placement of re-enforcing sutures. Postoperatively, the valve remained tight in all cases; there were no cases of hypotony, filtering bleb, flat chamber, or pupil capture or endophthalmitis indicating transient leakage. Flattening in the vertical and steepening in the horizontal meridian were minor and nonprogressive.
Cornea↗
Batch-by-batch analysis of topographic changes induced by sutured and sutureless clear corneal incisions.
PURPOSE: To evaluate the effect of a suture on surgically induced corneal topographic changes in 5.0 mm clear corneal incisions. SETTING: University Eye Hospital, Vienna, Austria. METHODS: Thirty-seven eyes that had cataract surgery were included in the prospective study. A 5.0 mm long and 0.3 mm deep precut was followed by preparation of a corneal tunnel. After phacoemulsification and intraocular lens implantation, the self-sealing wound was left unsutured in 19 eyes; one radial 11-0 nylon suture was applied in 18 eyes. Using a TMS-1 videokeratoscope, corneal topography was measured preoperatively and at 1 week and 1 and 3 months postoperatively. The topographic data were evaluated by statistical batch-by-batch analysis. Each topographic image was cut into 178 fields in eight concentric rings. The refractive values of these fields were stored in a database. Differences between the four readings of each patient were calculated and the mean differences of the 178 fields in each group were transformed into color-coded maps. The significance of topographical changes and group comparisons of induced changes were computed by Wilcoxon tests. RESULTS: Both groups exhibited significant temporal flattening and vertical steepening. The unsutured eyes also displayed significant nasal flattening. Sutureless 5.0 mm clear corneal incisions induced significantly more vertical steepening and nasal flattening than sutured incisions. CONCLUSION: Application of one radial 11-0 nylon suture in 5.0 mm temporal clear corneal incisions significantly reduced shape changes in the nasal corneal region.
Aged↗
Clinical syndrome of endocapsular hematoma: presentation of a collected series and review of the literature.
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Cataract Extraction↗
Suction fixation system for stereotactic radiosurgery of intraocular malignancies.
We designed a suction fixation system for the radiosurgical treatment of intraocular malignancies with the Leksell gamma unit (gamma knife). OUr device consists of a circular suction chamber and an adjustable unit to be fixed to the Leksell stereotactic head frame. All components are made of plastic materials in order to avoid artifacts in CT or MRT imaging. A permanent suction of 600 to 800 millibars is provided by a standard vacuum pump, powered by a portable battery. Suction times up to 40 minutes were well tolerated in all cases. In the gamma knife of the Neurosurgical Department at the University of Vienna, we successfully used this device. Up to January 1994 we have performed 19 radiosurgical treatments in 9 patients with large or extra-large uveal melanomas and in one patient suffering from a choroidal metastasis.
Aged↗
Evaluation of 35 consecutive SI-30 PhacoFlex lenses with high-refractive silicone optic implanted in the capsulorhexis bag.
Thirty-five PhacoFlex foldable open-loop lenses with high-refractive silicone optics were evaluated. All lenses were implanted using a folding forceps and were fixated in the bag. Mean follow-up was 14 months. With adequate forceps, the lens may be inserted through a 3.2 mm incision, using a 3 mm long self-sealing sclerocorneal tunnel. With a well-centered 4 mm to 5 mm capsulorhexis opening, centration was very satisfactory. Moderate decentration occurred in two cases, one from a small, heavily shrinking capsulorhexis and the other from a poorly shaped capsulorhexis that captured the optic along its edge. Except in one case of combined cataract and filtering surgery, all optics were at a pronounced distance from the iris. Consequently, signs of iris chafing or iridocapsular synechias and cellular invasion were not seen. The optic typically exhibited a slight bluish tint and minute granular inclusions without clinical significance. Neither discoloration nor haze was present. Best visual acuity was 20/25 or better in all cases. The small wound required for insertion makes the PhacoFlex especially appropriate for clear corneal incision surgery. Attempts are being made to minimize the grainy appearance of the optic. Increasing the rigidity of the loops may be advantageous.
Aged↗
Delayed iris prolapse with unsutured 5.1 mm clear corneal incisions.
I describe two cases of iris prolapse after sutureless 5.1 mm clear corneal incision cataract surgery with implantation of a 5 mm poly(methyl methacrylate) lens. Both patients reported having exerted localized digital pressure on the globe peripheral to the temporally located incision. Following resection of the prolapse, the pupil was reconstructed in situ using a translimbal transfixation technique. The prolapse and other observed complications (e.g., transient pupillary capture, delayed endophthalmitis) indicate that 5.1 mm clear corneal incisions do not provide adequate stability if localized pressure is exerted peripheral to the wound. Thus, securing the incisions with a radial 10-0 nylon suture is strongly advocated to provide sufficient wound stability against deformation.
Aged↗
Long-term results of combined trabeculectomy and small incision cataract surgery.
We did a prospective study of 49 eyes (36 patients) with coexisting cataract and glaucoma who had combined trabeculectomy, phacoemulsification, and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Preoperatively, intraocular pressure (IOP) was controlled (< 20 mm Hg) in 13 eyes on a mean of 2.2 medications and uncontrolled (> 20 mm Hg) in 36 eyes on a mean of 2.4 medications. Preoperative visual acuity ranged from 20/40 to hand movements. At the end of the follow-up, IOP was below 18 mm Hg in all eyes (100%), without therapy in 39 (80%) and with reduced therapy in 8 (16%). Two (4%) eyes were controlled on the same medication regimen. Visual acuity improved in 42 patients (86%); 38 (78%) achieved a visual acuity of 20/40 or better. A filtering bleb was observed in 45 eyes (92%). The most common early postoperative complication was fibrin exudation into the anterior chamber. Late complications included posterior synechias and vision-impairing capsule opacifications. Visual acuity improved after neodymium:YAG laser treatment in all eyes with opacification without further complications. We conclude that the combination of small incision cataract surgery and trabeculectomy is a successful surgical approach for long-term visual rehabilitation and glaucoma control.
Aged↗
Experience with a suction fixation system for stereotactic radiosurgery of intraocular malignancies.
We designed a suction fixation system for the radiosurgical treatment of intraocular malignancies with the Leksell Gamma Knife. Our device consists of a circular suction chamber and an adjustable unit which is fixed to the Leksell stereotactic head frame. All components are made of plastic in order to avoid artifacts in CT or MRI. A permanent suction of 600-800 mbar is provided by a standard vacuum pump, powered by a portable battery. In the Gamma Knife Unit of the Neurosurgical Department at the University of Vienna, we successfully used this device. Up to April 1994 we successfully performed 25 radiosurgical treatments in 12 patients with large or extra-large uveal melanomas and in 1 patient suffering from a choroidal metastasis.
Aged↗
Computerized statistical analysis of corneal topography for the evaluation of changes in corneal shape after surgery.
We examined 20 patients for the effect of a 3-mm sutureless temporal clear corneal incision cataract operation on corneal topography, as recorded with the computer-assisted video-keratoscope TMS-1 (Computed Anatomy, Inc., New York, New York). Each topographic image was cut into 178 fields in eight concentric rings. The refractive values of these fields were stored in a database. The mean differences between the preoperative and one-month postoperative findings were calculated and transformed into color-coded maps as output for the statistical analysis. The patients operated on showed a mean flattening of 0.4 to 1.0 diopter in the temporal region. This was statistically significant by paired Wilcoxon signed-rank tests. There was no significant vertical steepening or nasal flattening, except in two isolated fields. For control purposes, we twice examined 20 age-matched volunteers who were not operated on. The paired Wilcoxon tests of this group did not show significant changes. When compared with Cravy's vector analysis, induced topographic change analysis is better at evaluating surgically induced corneal shape changes.
Aged↗
The influence of the incision length on the early postoperative intraocular pressure following cataract surgery.
In a prospective study we recorded the early postoperative intraocular pressure of 60 eyes following phacoemulsification and posterior chamber lens implantation. In 30 patients each the implantation either of a folded polyHema intraocular lens through a 3.5 mm incision or of a polymethylmetacrylate intraocular lens through a 7 mm incision was performed. Healon was used in all eyes and thoroughly evacuated from the capsular bag behind the implanted lens and the anterior chamber. For intraoperative miosis 0.5 ml acetylcholine chloride was injected into the anterior chamber after wound closure. Intraocular pressure was measured preoperatively as well as six hours, 18 hours, one week and two months postoperatively without the influence of antiglaucomatous medication. We found no statistically significant change of intraocular pressure at any measurement time in the 3.5 mm group (Student's t-test, p > 0.1). In the 7 mm group only the rise of intraocular pressure at 18 hours was statistically significant (p < 0.05, student's t-test). The comparison of the changes of intraocular pressure from preoperative values between both groups revealed a statistically significant difference at 18 hours (p < 0.05, student's t-test) but not at any other time recorded. Intraocular pressure exceeding 22 mmHg was found at 6 hours in 4 (13.3%) patients of both groups and at 18 hours in 3 (10%) eyes of the 3.5 mm group and 5 (16%) eyes of the 7 mm group (p > 0.1, Fisher's Exact Test). From these results we conclude that 1) regardless of the wound size the pressure rising effect of Healon is successfully counteracted by the aspiration technique described, and 2) with small-incision cataract surgery statistically significant less changes of intraocular pressure are observed in the early postoperative period.
Acetylcholine↗
Clinical results with three different kinds of small optic PMMA-IOLs.
In this prospective study the clinical results using three different small optic IOLs are presented. The best results were achieved in those cases with an anterior capsule rim overlapping the entire optic periphery. In those cases with sulcus fixation, haptic in/out and optic in/out positions a higher percentage of capsule fibrosis (Soemmering's rings) was documented (sulcus fixation: 100%, haptic in/out position: 75%, optic in/out position: 65.5%, bag: 7.3%). The fibrosis developed because of contact between the anterior and the posterior capsule leaf. These cases also showed decentrations of the intraocular lens (IOL) more often (sulcus fixation: 50%, haptic in/out position: 75%, optic in/out position: 34.5%, bag: 31.7%). Only one patient was disturbed by glare and halo phenomenons. Cellular reactions on the lens surface were moderate in most cases. Differences specific to lens type were found between the three IOLs implanted. The clinical results were comparable to the results of other comprehensive IOL studies. Under certain indication small optic IOLs represent an alternative to flexible implants for small incision surgery.
Aged↗
Evaluation of 100 consecutive IOGEL 1003 foldable bag-style lenses implanted through a self-sealing tunnel incision.
The IOGEL 1003 hydrogel lens, designed for better capsular bag fit, was implanted in 100 consecutive eyes. We evaluated the visual and morphological results obtained with a mean follow-up of six months. Visual acuity was within Food and Drug Administration standards; however, morphological results were less satisfactory. Decentration of 1 mm or more occurred in 24% of the cases. Higher diopter lenses required a minimum incision size of 4 mm and tended to tear when folded. Once in the eye, they regularly came in contact with the iris. A gap between the posterior optic surface and capsule occurred in 61% of eyes. Within the short follow-up period, 9% of eyes required YAG discission because of Elschnig pearl formation. In conclusion, the newer IOGEL 1003 lens performed no better than earlier IOGEL lens models when placed in the bag, and the possible benefit of decreasing posterior lens subluxation after early YAG capsulotomy is offset by the disadvantages.
Aged↗
No-stitch, small incision cataract surgery with flexible intraocular lens implantation.
Small incision cataract surgery has several advantages over conventional surgery, including faster postoperative visual rehabilitation. We evaluated 100 consecutive cases of no-stitch, small incision surgery with a square sclerocorneal tunnel and a flexible intraocular lens. Permanent self-sealing of the wound seemed to increase intraoperative safety considerably. With the specific incision used, corneal trauma and irrigation fluid outflow were minimal. Refraction and K-readings stabilized within the first postoperative week, which is when most eyes attained best final visual acuity. No early peak or protracted drift of astigmatism occurred. Minimally leaking wounds in three eyes were left unsutured; a transient filtering bleb was observed in two of these eyes after resorption of an intracameral air bubble. Our results support the theoretical concept and justify the use of no-stitch, small incision surgery.
Cataract Extraction↗