Biomedical subjects

Stefan Sacu

Publications and source records attributed to Stefan Sacu.

At least 19 recordsLinked to original sources

PubMed2006

In-patient management and treatment satisfaction after intravitreous plasminogen activator injection.

AIMS: To assess patient satisfaction after intravitreous plasminogen activator injections for subretinal hemorrhages secondary to age-related macular degeneration (AMD) and to analyse how it relates to the patients' postoperative visual and functional abilities. Further, to suggest ways to improve in-patient management and thereby treatment satisfaction. METHODS: A consecutive series of 101 patients with a subretinal hemorrhage of at least one disk diameter were enrolled in this longitudinal prospective study conducted during 2001-2004. After complete preoperative eye examination all patients were treated with intravitreal injection of 25 microg recombinant tissue plasminogen activator (rTPA) and 0.5 ml sulphur hexafluoride gas (SF6), followed by face-down positioning for 1 week. Patient satisfaction was assessed using standardised questionnaires administered postoperatively at 4 and 12 months. Outcome measures were: (1) responses to the patient satisfaction survey, (2) degree of satisfaction with in-patient management, (3) subjective change in the patients' functional status, and (4) visual acuity results. RESULTS: Whereas the patients' actual functional status deteriorated from a median value of 2.4 at 4 months to 3.4 at 12 months, their recall of their preoperative functional status shifted from a median value of 4.2 to to 2.3, consecutively. Twelve months after treatment, 75% of patients reported an improved visual acuity, however, only 12% reported satisfaction with treatment. 67.4-87% of patients were dissatisfied with various areas of in-patient management. CONCLUSIONS: Satisfaction with plasminogen activator injection treatment is low even though patients experience an improved visual and functional status at 12 months. This suggests that the current system requires improvement in certain areas such as in-patient management.

Drug Therapy, Combination↗

PubMed2006

Retinal pigment epithelium tears following verteporfin therapy combined with intravitreal triamcinolone.

PURPOSE: To detect patients with neovascular age-related macular degeneration (AMD) who experience retinal pigment epithelium tears after initial verteporfin therapy combined with intravitreal triamcinolone during early follow-up. DESIGN: Prospective interventional case series. METHODS: Forty-five consecutive patients with choroidal neovascularization (CNV) in AMD were treated with verteporfin therapy combined with 4 mg of intravitreal triamcinolone. Optical coherence tomography (OCT), visual acuity, and fluorescein angiography were performed. RESULTS: Two eyes with a predominantly classic CNV developed a retinal pigment epithelium tear. An early onset tear could be differentiated from a delayed onset tear. OCT showed an increased depth signal in areas of missing retinal pigment epithelium and a wavy, contracted, and elevated retinal pigment epithelium band. CONCLUSIONS: Retinal pigment epithelium tears can occur despite adding intravitreal triamcinolone to verteporfin therapy. OCT shows characteristic changes in the evolution of retinal pigment epithelium tears after combination therapy.

Choroidal Neovascularization↗

PubMed2006

Comparison of three methods of measuring corneal thickness and anterior chamber depth.

PURPOSE: To compare three different methods of measuring corneal thickness (CT) and anterior chamber depth (ACD). DESIGN: Prospective clinical trial (Medical University of Vienna, Austria). METHODS: Central CT (CCT), CT at four peripheral points, and central ACD were measured in 88 eyes of 44 healthy subjects with the Pentacam (rotating Scheimpflug camera; Oculus, Wetzlar, Germany), Orbscan I (scanning-slit topography system; Orbtek Inc, Salt Lake City, Utah, USA), and AC-Master (partial coherence interferometry; Zeiss Meditec, Jena, Germany), and the results were compared. RESULTS: The upper (lower) limits of agreement for CCT measurements were 7.9 (-22.2) microm between AC-Master and Pentacam, 17.6 (-32.5) microm between AC-Master and Orbscan, and 25.2 (-25.9) microm between Pentacam and Orbscan. Correlation was high between all three methods (r = 0.94 to 0.97). The upper and lower limits of agreement for ACD were 0.174 (-0.251) mm between AC-Master and Pentacam, 0.406 (-0.004) mm between AC-Master and Orbscan, and 0.384 (0.095) mm between Pentacam and Orbscan. Correlation was high between the three methods (r = 0.96 between Orbscan and Pentacam; others 0.92). Correlation was lower for the CT measurements at the four peripheral points. CONCLUSIONS: The CCT and ACD values obtained by Pentacam, Orbscan, and AC-Master measurements correlated well and showed few outliers. The two new systems (Pentacam, AC-Master) provide a reliable, easy-to-use, noncontact method of measuring CCT and ACD. Larger differences occurred only when measuring peripheral CT values, especially between AC-Master and the other two methods.

Adult↗

PubMed2006

Effect of optic material and haptic design on anterior capsule opacification and capsulorrhexis contraction.

PURPOSE: To examine the influence of optic material (silicone and hydrophobic acrylic) and haptic design (one-piece and three-piece open loop) of sharp optic edge intraocular lenses (IOL) on anterior capsule opacification (ACO) and capsulorrhexis contraction. DESIGN: Randomized, controlled, double-blind clinical trial with intraindividual comparison. METHODS: This study was performed at the Department of Ophthalmology, Medical University of Vienna, Austria, and comprised 210 eyes of 105 patients with bilateral age-related cataract. In group 1 (n = 53 patients), a three-piece acrylic IOL was compared with a three-piece silicone IOL. In group 2 (n = 52 patients), the three-piece acrylic IOL was compared with the one-piece acrylic IOL. One year after the operation, standardized digital slit-lamp images of ACO were taken; 1 week and 1 year after the operation, digital retroillumination images were taken to assess capsulorrhexis size. The intensity of ACO was graded objectively (score, 0% to 100%), and the capsulorrhexis area (square millimeters) was determined objectively. RESULTS: One year after surgery, the mean ACO score was 21% for the acrylic and 20% for the silicone IOL (P = .4) in group 1 and 18% for both the three-piece and one-piece acrylic IOLs (P = .87) in group 2. Concerning the amount of capsulorrhexis contraction, there was no significant difference between the IOL types that were evaluated in this study (after Bonferroni-Holm correction, P > .05). CONCLUSION: In the hydrophobic sharp optic edge IOLs that were examined, neither the optic material nor the haptic design had an influence on the amount of ACO or capsulorrhexis contraction.

Acrylic Resins↗

PubMed2006

Influence of severity of nuclear cataract on optical biometry.

PURPOSE: To compare preoperative and postoperative measurements of the axial length (AL) performed with the IOLMaster (Carl Zeiss Meditec) to evaluate the effect of nuclear cataract on the optical biometry. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In 245 consecutive eyes of 162 patients scheduled for cataract surgery, type and severity of cataract was evaluated using the Lens Opacities Classification System III. Preoperative and postoperative axial length measurements were performed with the IOLMaster. The postoperative readings of AL were corrected for the IOL optic material implanted. RESULTS: The preoperative AL measurements were 0.07 mm +/- 0.05 (SD) (range -0.18 to 0.11 mm) longer than the postoperative measurements (P<.001). These differences in AL were only weakly correlated (r = -0.28, P = .01) with the nuclear cataract grade, mean 3.5 +/- 0.9. CONCLUSION: In this study, AL measurements with optical biometry using the IOLMaster were not influenced by the severity of nuclear cataract to a clinically relevant degree. Furthermore, it was found that AL in the phakic eye was overestimated by about 0.07 mm because of a slightly too low value of the group refractive index used for the crystalline lens.

Adult↗

PubMed2006

Effect of anterior capsule polishing on the posterior capsule opacification-inhibiting properties of a sharp-edged, 3-piece, silicone intraocular lens: three- and 5-year results of a randomized trial.

PURPOSE: To evaluate the long-term effects of anterior capsule polishing on regeneratory posterior capsule opacification (PCO), anterior capsule opacification (ACO), and fibrotic PCO with a silicone intraocular lens (IOL) with sharp optic edges. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This prospective bilateral randomized patient- and examiner-masked clinical trial comprised 130 eyes of 65 patients with bilateral age-related cataract. All eyes had implantation of a 3-piece silicone IOL with a truncated, sharp-edged optic (CeeOn Edge 911A, Advanced Medical Optics). In 1 eye, the anterior capsule was extensively polished using an aspiration curette after phacoemulsification and cortex aspiration. Regenerative PCO was quantified objectively, while ACO and fibrotic PCO were graded subjectively 1, 2, 3, and 5 years postoperatively. RESULTS: The mean ACO score was significantly lower in the eyes in which the anterior capsule had been polished (1 year, P<.02; 2 years, P<.03; 3 years, P<.01; 5 years, P<.01). The mean difference in regeneratory PCO and fibrotic PCO scores between the 2 groups was not statistically significant. CONCLUSIONS: Three years after cataract surgery, eyes in which the anterior capsule had been polished had significantly less ACO. However, polishing did not lower PCO intensity when a sharp-edged CeeOn 911A IOL was implanted in the bag. Although results indicate that anterior capsule polishing may enhance the development of regeneratory PCO, this trend did not reach statistical significance.

Cataract↗

PubMed2006

Local corneal thickness changes after small-incision cataract surgery.

PURPOSE: To assess whether a temporal limbal-corneal incision approach for phacoemulsification cataract surgery induces a gradient in corneal thickening along the horizontal meridian. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Corneal thickness in 21 eyes of 21 patients was measured preoperatively as well as 1 day, 1 week, and 1 and 3 months after phacoemulsification through a temporal limbal-corneal incision. Measurements were performed using partial coherence interferometry (PCI) with a commercial instrument, the ACMaster (Carl Zeiss Meditec, Jena). Measurements were taken along the horizontal meridian centrally along the visual axis at 1.5 mm, 3.0 mm, and 4.5 mm eccentricity. RESULTS: Preoperatively, there were slight nasal-temporal differences in corneal thickness at all eccentricities. The mean thickness was 522 microm +/- 34 (SD) at 1.5 mm nasally and 513 +/- 36 microm at 1.5 mm temporally (P<.01). On day 1, there was a significant mean increase in corneal thickness (38 +/- 43 microm) along all locations. The thickening was slightly more pronounced in the periphery than in the center, a difference not reaching statistical significance. At 1 week, corneal thickness returned almost to baseline at all locations except for 3.0 mm temporally, where it was slightly, but not significantly, thicker (mean 8 +/- 14 mum). At 1 month, corneal thickness at the 3.0 mm temporal location returned to baseline. CONCLUSIONS: A nasal-temporal difference in corneal thickness was found preoperatively in all patients. Phacoemulsification through a temporal limbal-corneal incision caused an increase in corneal thickness along the horizontal meridian 1 day after surgery. The prolonged corneal thickening at 3.0 mm eccentricity temporally could be a result of the proximity to the incision site.

Aged↗

PubMed2006

Contrast acuity in cataracts of different morphology and association to self-reported visual function.

PURPOSE: To evaluate the relationship between contrast acuity at declining contrast levels and the type and density of lens opacity in cataract. METHODS: Contrast acuity at declining contrast levels was determined with the Holladay Contrast Acuity Test, in relation to the type and density of age-related cataract in 180 patients with bilateral cataract and 20 control subjects with normal macular function. Cataracts were graded according to the Lens Opacities Classification System (LOCS) III of nuclear color (NC), nuclear opalescence (NO), cortical (C), and posterior subcapsular (P) cataract. Best-corrected visual acuity and near contrast acuity were determined in randomized order monocularly in both eyes. Visual difficulties in everyday life were evaluated, using the VF-14 questionnaire and the Cataract Symptom Score. RESULTS: The contrast-dependent effect of cataract on contrast acuity was statistically significant (P < 0.001; two-way ANOVA). In the comparison of early, intermediate, and advanced nuclear, nuclear-cortical, and posterior subcapsular cataracts (PSCs), significantly reduced contrast acuity scores were found for the PSC groups (P < 0.001). Comparison of nuclear and nuclear-cortical cataracts showed the contrast acuity scores to be comparable at all contrast levels (P > 0.05). High correlation coefficients were found between the LOCS III P score and the contrast acuity measurements (r = 0.77-0.84; P < 0.001). In contrast, the correlation coefficients of the NO, NC, and C scores were considerably lower (r = 0.45-0.66; P < 0.001). High correlation coefficients were also found between the contrast acuity measurements and self-reported functional vision. CONCLUSIONS: The statistically significant, contrast-dependent effect of cataract on contrast acuity supports the clinical relevance of recording visual acuity at low contrast levels in patients with age-related cataract. Particularly, the severity of PSC has a strong influence on the impairment of contrast acuity. Contrast acuity corresponded closely to the self-reported visual difficulties in everyday life.

Aged↗

PubMed2005

Long-term effect of sharp optic edges of a polymethyl methacrylate intraocular lens on posterior capsule opacification: a randomized trial.

PURPOSE: To compare the posterior capsule opacification (PCO) inhibiting effect of a 3-piece polymethyl methacrylate (PMMA) intraocular lens (IOL) with a sharp optic edge design with that of the round-edged version of the same IOL during a 5-year period. DESIGN: Randomized patient- and examiner-masked clinical trial with intraindividual comparison. PARTICIPANTS: Thirty-two patients with bilateral age-related cataract (64 eyes). METHODS: Each study patient had phacoemulsification cataract surgery in both eyes and received a sharp optic edge PMMA IOL in one eye and a round optic edge PMMA IOL in the fellow eye (both by Dr Schmidt in Germany). Follow-up examinations were at 1 week, 1 month, 1 year, 3 years, and 5 years. Digital retroillumination images were taken from each eye. The amount of posterior capsule opacification was assessed objectively by means of automated image analysis software (Automated Quantification of After-Cataract) at 1 year, 3 years, and 5 years after surgery. MAIN OUTCOME MEASURE: Posterior capsule opacification score: 0-10. RESULTS: The sharp optic edge IOL showed significantly less regeneratory and fibrotic PCO at 1 year, 3 years, and 5 years after surgery. The mean AQUA PCO score was 5.12 for the round-edge and 2.49 for the sharp-edge IOL (scale, 0-10; P<0.001) at 5 years. The mean difference among patients for the PCO score in the eye implanted with the sharp optic edge versus the score in the eye with the round optic edge was 2.83 at 5 years (95% confidence interval, 1.66-4.00). Due to the large number of neodymium:yttrium-aluminum-garnet laser capsulotomies that were performed (12 in the round-edge group and 4 in the sharp-edge group), there was no significant difference in visual acuity between both groups at any time point. CONCLUSIONS: Compared with the round-edge version, the sharp optic edge design of a 3-piece PMMA IOL led to significantly less PCO at 1 year, 3 years, and 5 years after surgery. However, the sharp optic edge did not lead to complete PCO prevention during this follow-up period. This finding has implications for the design of PMMA IOLs used for cataract surgery, especially in the developing world.

Aged↗

PubMed2005

Long-term efficacy of adding a sharp posterior optic edge to a three-piece silicone intraocular lens on capsule opacification: five-year results of a randomized study.

PURPOSE: To compare the intensity of capsule opacification with the sharp and the round optic edge variant of an open-loop hydrophobic silicone intraocular lens (IOL). DESIGN: Randomized, controlled, double-blind clinical trial with intraindividual comparison. METHODS: Fifty-one patients with bilateral age-related cataract were included (102 eyes). Each patient had had cataract surgery in both eyes and received a Microsil IOL with a sharp optic edge design (model S) in one eye and a Microsil IOL with a round optic edge design (model R) in the fellow eye. Both IOLs had an identical haptic design (nonangulated polymethylmethacrylate) and silicone optic material. The patients were examined at the slit lamp, best-corrected visual acuity was assessed, and standardized high-resolution digital retroillumination images of the posterior capsule were taken 5 years after surgery. The intensity of regeneratory posterior capsule opacification (rPCO), fibrotic PCO (fPCO), and anterior capsule opacification (ACO) was assessed subjectively at the slit lamp, and of rPCO, objectively using automated image analysis software (AQUA). The need for an Nd:YAG laser capsulotomy (Nd:YAG-LCT) was noted. RESULTS: The mean AQUA PCO score was 1.2 for the model S and 2.4 for the model R lens (P = .001). The model S lens also led to less peripheral fPCO (P = .003). Concerning ACO, there was no significant difference between both IOL groups (P = .72). Whereas no capsulotomy was required with the model S, four cases (16%) had been performed in the model R group. CONCLUSION: Five years postoperatively, the sharp-edged silicone IOL showed less rPCO and fPCO than the round-edged IOL. However, regarding ACO, there was no significant difference between both IOL styles.

Aged↗

PubMed2005

Association between intensity of posterior capsule opacification and contrast sensitivity.

PURPOSE: To investigate the correlation between change in contrast sensitivity (CS) and difference in objective posterior capsule opacification (PCO) score before and after Nd:YAG laser capsulotomy. DESIGN: Prospective interventional case series. METHODS: CS (Functional Acuity Contrast Test, or FACT, chart), distance visual acuity (Early Treatment Diabetic Retinopathy Study [ETDRS] chart), and pupil size of 30 pseudophakic eyes with PCO of varying intensity were measured before and after capsulotomy. Digital retroillumination images were taken, and the area corresponding to the pupil size was evaluated with an automated PCO analysis program known as AQUA. RESULTS: The correlation between change in PCO score and change in CS was highest (r = 0.85) for row B on the FACT chart and lowest (r = 0.09) for row E. The correlation with change in ETDRS visual acuity was 0.57. CONCLUSIONS: Objective PCO assessment by an automated image analysis system correlates well with PCO-induced loss of CS and is therefore an appropriate method for clinical studies on the development and prevention of PCO.

Cataract↗

PubMed2005

Optical coherence tomography assessment of capsule closure after cataract surgery.

PURPOSE: To develop a technique for documenting and quantifying capsule bend formation in pseudophakic eyes, evaluate when the anterior and posterior lens capsules become completely apposed to the optic, and determine how soon a capsule bend is created at the optic edge of an intraocular lens (IOL) after cataract surgery. SETTING: Medical University of Vienna, Department of Ophthalmology, Vienna, Austria. METHODS: This prospective study comprised 33 eyes of 33 patients with age-related cataract who were scheduled to have cataract surgery. All eyes had phacoemulsification with implantation of 1 of 3 types of open-loop IOLs: 1-piece acrylic (SA60AT, Alcon), 3-piece acrylic (AcrySof MA60BM, Alcon), or 3-piece silicone (911A, AMO). Each group included 11 eyes. One and 3 days and 1, 2, 3, and 4 weeks after surgery, contact between the lens capsule and IOL optic as well as capsule bend formation were evaluated using optical coherence tomography (OCT). The postoperative times at which the capsule came into contact with the IOL optic and when the capsule bend formed were determined. RESULTS: One day postoperatively, the mean distance between the anterior capsule and the IOL was 197 microm in the 1-piece acrylic IOL group, 161 microm in the 3-piece acrylic IOL group, and 220 microm in the 3-piece silicone IOL group. The posterior capsule was in contact with the IOL on the same day or earlier than the anterior capsule in 28 patients (85%). Postoperatively, the capsule bend formed at a mean of 10 days in the 1-piece acrylic group, 13 days in the 3-piece acrylic group, and 15 days in the 3-piece silicone group. The short-term reproducibility of the OCT technique was excellent (r = 0.99). CONCLUSIONS: Optical coherence tomography produced cross-sectional tomograms of capsule-IOL contact in the early postoperative period. There was no significant difference in the time to capsule bend formation between the 3 IOLs. However, capsule bend formation at the optic edge occurred earlier with the 1-piece acrylic IOL than with the 3-piece silicone IOL.

Acrylic Resins↗

PubMed2005

Change in IOL position and capsular bag size with an angulated intraocular lens early after cataract surgery.

PURPOSE: To investigate the axial movement in the first postoperative week and the influence of capsular bag size with an angulated, 3-piece, open-loop, acrylic intraocular lens (IOL). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Twenty-nine eyes of 29 patients with age-related cataract were included in this study. In study 1, an open-loop, 3-piece IOL (AR40e, AMO) was implanted in a standardized fashion in 15 eyes of 15 patients. In study 2, before IOL implantation, a capsular tension ring (CTR) was inserted (14 eyes of 14 patients). Anterior chamber depth (ACD) was assessed with partial coherence interferometry 2 hours; 1, 3, and 5 days; 1 week; and 1 month postoperatively. The capsular bag diameter (CBD) was assessed using gonioscopic measurement of the eyelets of the CTR 1 day, 1 week, and 1 month postoperatively. RESULTS: In the first postoperative week, there was a significant mean forward movement of -196 microm +/- 117 (SD) (P < .005) in study 1 and -139 +/- 97 microm in study 2 (P < .005). These movements correspond to refractive changes of -0.31 diopter (D) and -0.20 D, respectively. The movement was linear in the first 5 days after surgery. Different patterns of early postoperative movement were seen, illustrating interindividual variability. A significant correlation of 0.67 (P < .05) was found between the change in ACD and CBD. CONCLUSIONS: A linear forward movement of the IOL during the first postoperative week was followed by a relatively stable IOL position. Loss of haptic memory seemed to be the most likely cause. Myopic eyes with large capsular bags showed less IOL shift in the early postoperative period than hyperopic eyes with smaller capsular bags.

Adult↗

PubMed2005

Association between intensity of posterior capsule opacification and visual acuity.

PURPOSE: To investigate the correlation between the change in visual acuity and the difference in objective posterior capsule opacification (PCO) scores before and after neodymium:YAG (Nd:YAG) laser capsulotomy. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Forty pseudophakic eyes of 35 patients with PCO of varying intensity were examined before and after Nd:YAG laser capsulotomy. Visual acuity was determined using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 4 m and the Holladay reading chart at 40 cm. The pupil diameter under reading conditions was measured each time. Digital retroillumination images of the posterior capsule were taken, and the corresponding area inside the pupil was evaluated using the Automated Quantification of After-Cataract (AQUA) automated PCO analysis program. The change in visual acuity and difference between PCO scores before and after Nd:YAG laser capsulotomy were calculated for all eyes. RESULTS: The mean AQUA score (scale 0 to 10) was 3.56 before and 0.13 after Nd:YAG laser capsulotomy. The mean ETDRS visual acuity score (logMAR scale) was 0.28 and -0.07, respectively. The correlation coefficient between the differences in PCO score and distance visual acuity was 0.61 and near visual acuity, 0.62. CONCLUSIONS: The objective PCO score obtained by an automated image-analysis program correlates well with the PCO-induced decrease in visual acuity when the central area (inside the pupillary aperture) of the posterior lens capsule was evaluated. Objective PCO assessment by automated image-analysis systems is, therefore, a valuable and clinically relevant method for clinical studies of the development and prevention of PCO.

Cataract↗

PubMed2005

Short-term changes in the morphology of posterior capsule opacification.

PURPOSE: To observe and document posterior capsule opacification (PCO) growth in vivo over a short period of time (4 weeks). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Fifteen eyes of pseudophakic patients with PCO of varying degrees were included in this prospective study. Digital retroillumination images were taken in a standardized fashion at 3 time points: 1 baseline image, a second image after 2 weeks, and a third image after 4 weeks. Thus, a 3-image series could be created for each eye. Additionally, sections of the posterior capsule with interesting structures were photographed with higher magnification and compared in supplementary image series. Morphologic changes in the PCO structure (eg, number and size of Elschnig pearls, total PCO area) were analyzed in the image series. RESULTS: In all cases, significant changes could be observed between the 3 time points. In 71% of cases, some Elschnig pearls increased in size during the first 2 weeks and during weeks 3 and 4. In 73% of cases, however, there was a reduction a pearl size or even disappearance of some Elschnig pearls. The total PCO area did not change significantly during the 4-week period. CONCLUSIONS: Development of (regeneratory) PCO is a very dynamic process that includes not only growth of preexisting structures and occurrence of new Elschnig pearls, but also reorganization and even disappearance of pearls within a short time period (2-4 weeks). The latter in particular is not well known but could be observed in the majority of cases in this study.

Cataract↗

PubMed2005

Long-term effect of optic edge design in an acrylic intraocular lens on posterior capsule opacification.

PURPOSE: To compare the posterior capsule opacification (PCO) inhibiting effect of the sharp posterior optic edge design of the Sensar OptiEdge AR40e intraocular lens (IOL) with that of the double-round edge design of the Sensar AR40 IOL over a period of 3 years. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Fifty-three patients with bilateral age-related cataract (106 eyes) were included in this randomized prospective bilateral patient- and examiner-masked clinical trial with intraindividual comparison. Each study patient had cataract surgery in both eyes and received a Sensar AR40 IOL (anterior and posterior round optic edges) in 1 eye and a Sensar OptiEdge AR40e IOL (round anterior and sharp posterior optic edge) in the other eye. Follow-up examinations were at 1 week, 1 and 6 months, and 1, 2, and 3 years. Digital retroillumination images were taken of each eye. The amount of PCO was assessed subjectively at the slitlamp and objectively using automated image-analysis software (AQUA) 1, 2, and 3 years after surgery. RESULTS: The sharp-edged AR40e lens showed significantly less regeneratory and fibrotic PCO 1, 2, and 3 years after surgery. The mean AQUA PCO score was 2.18 for the AR40 and 1.00 for the AR40e lens after 1 year; 2.94 and 1.56 after 2 years, and estimated at 3.13 and 1.77, respectively, after 3 years (scale 0 to 10; P<.001). The neodymium:YAG laser capsulotomy rate was significantly higher in the AR40 group. The AR40e lens also led to less peripheral fibrotic PCO. There was no significant difference in complaints concerning edge glare between the groups. CONCLUSION: Compared with the AR40 IOL, the sharp posterior optic edge design of the Sensar OptiEdge AR40e IOL led to significantly less PCO 1, 2, and 3 years postoperatively. In contrast with most past studies on PCO-preventative factors, this study varied only 1 parameter, namely the optic edge design, and the main outcome measure (PCO) was assessed with an objective image-analysis system.

Acrylic Resins↗

PubMed2005

Pilocarpine-induced shift of an accommodating intraocular lens: AT-45 Crystalens.

PURPOSE: To measure the shift of an accommodating plate-haptic intraocular lens (IOL) along the visual axis induced by ciliary muscle contraction after application of pilocarpine. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Fifty-four eyes of 28 patients with age-related cataract comprised this prospective study. Each patient received an AT-45 silicone accommodating IOL (Crystalens, Eyeonics Corp.) after standardized cataract surgery. In a subgroup of 24 eyes, capsular bag fibrosis was reduced by extensive polishing of the anterior capsule with a slit cannula. Assessment included measurements of anterior chamber depth, assessed with partial coherence interferometry, before and after application of pilocarpine 2% and evaluation of near visual acuity 1 month and 3 months postoperatively. RESULTS: A slight backward shift of the IOL of 151 mum in the nonpolished group (P < .001) and 122 mum in the polished group (P < .005) could be detected after application of pilocarpine. Polishing the capsule did not influence IOL shift. The median near visual acuity with distance correction 1 month and 3 months postoperatively was J5 and J4, respectively, in the nonpolished group and J6 at both times in the polished group. CONCLUSIONS: Pilocarpine induced a counterproductive active backward shift of the AT-45 IOL. Polishing of the capsular bag had no impact on accommodative ability. The reading performance of patients with the AT-45 IOL patients at 1 and 3 months was not significantly different from that of with a standard IOL under similar testing methods.

Accommodation, Ocular↗

PubMed2005

Influence of optic edge design, optic material, and haptic design on capsular bend configuration.

PURPOSE: To assess and classify capsular bend configuration at the optic rim and its association with posterior capsule (PCO) and anterior capsule opacification (ACO) and capsulorhexis contraction with various intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A total of 659 post-cataract surgery eyes of 370 patients from different prospective randomized studies were evaluated. All eyes had standardized phacoemulsification surgery with implantation of an IOL in the capsular bag. The IOLs had a sharp or round optic edge design and were made of silicone, acrylic, or poly(methyl methacrylate) optic materials. One year postoperatively, the configuration of the capsular bend at the optic rim was assessed at the slitlamp, and standardized slitlamp images of ACO and fibrotic PCO were taken. One week, 1 year, and 3 years postoperatively, digital retroillumination images were taken for objective quantification of regeneratory PCO and the capsulorhexis area. The outcome measures were the type of capsular bend configuration, ACO score (0% to 100%), regeneratory PCO score (0 to 10), fibrotic PCO score (0 to 3), and amount of capsulorhexis contraction (mm(2)). RESULTS: Four main types of capsular bend configuration were classified: parallel, "Y," right angle, and wrapping. The right-angle type was observed in the most cases (52%). Eyes with a wrapping capsular bend configuration had significantly less PCO, more capsulorhexis contraction, and more ACO than eyes with the other configurations. Wrapping capsule configuration was seen most often (55%) in round-edged silicone IOLs that had a thin optic rim. CONCLUSION: The design and material of IOLs influenced the long-term capsular bend configuration at the optic rim. The right-angle type was the most common capsular bend configuration. Intraocular lenses with silicone optic material and a thin optic rim caused a wrapping capsule configuration and resulted in more capsulorhexis contraction and ACO, but less PCO.

Biocompatible Materials↗