RESUMEN
PURPOSE: To evaluate the effects of posterior chamber implantation of phakic intraocular lenses on angle structures and the correlation with intraocular pressure (IOP). SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. METHODS: A Staar implantable contact lens (ICL) was implanted in 20 white patients (34 eyes) with high myopia. The patients were followed for a mean of 2.3 years (range 0.8 to 6.0 years). Two subgroups were created: One had a follow-up of 2.4 to 6.0 years and the other, 0.8 to 2.3 years. The mean spherical power of the implanted ICL was -16.8 diopters (D) (range -9.0 to -21.0 D). The angle structures were examined by gonioscopy using the Spaeth technique, and optical pachymetry and IOP were measured in dilated and undilated pupils. Trabecular pigmentation was measured semiquantitatively. The ICL models included a few prototypes (6 eyes), the V2 model (10 eyes), the V3 model (6 eyes), and the V4 model (12 eyes). RESULTS: The anterior chamber angle was between 11 and 20 degrees in 41% of eyes, between 21 and 30 degrees in 21%, larger than 30 degrees in 21%, and 10 degrees or smaller in 17%. An apparent iris root insertion was above Schwalbe's line in 6% of eyes, behind Schwalbe's line in 12%, at the scleral spur in 67%, and in a deep angle recess behind the scleral spur in 15%. The curvature of the iris was regular in 19 eyes and steep in 15 eyes. The mean pigmentation in all 4 quadrants was 1.3. (Grade 1 was defined as trace pigmentation.) The mean pachymetry from the endothelium to the ICL anterior surface was 2.7 mm and from the endothelium to the anterior surface of the crystalline lens, 3.2 mm. The mean IOP was 14.1 mm Hg in undilated pupils and 12.1 mm Hg in dilated pupils. There was no correlation between angle pigmentation and IOP. CONCLUSION: Trace pigmentation in the trabecular meshwork was common after ICL implantation. However, there was no direct influence on IOP. Long-term follow-up is necessary to evaluate the effect and progress of trabecular pigmentation in eyes with an ICL.
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Iris/metabolismo , Implantación de Lentes Intraoculares , Cristalino/fisiología , Miopía/cirugía , Malla Trabecular/metabolismo , Adulto , Femenino , Estudios de Seguimiento , Gonioscopía , Humanos , Presión Intraocular , Lentes Intraoculares , Masculino , Persona de Mediana Edad , Agudeza VisualRESUMEN
AIMS: To calculate the diameter of halos perceived by patients with multifocal intraocular lenses (IOLs) and to stimulate halos in patients with refractive multifocal IOLs in a clinical experiment. METHODS: Calculations were done to show the diameter of halos in the case of the bifocal intraocular lens. 24 patients with a refractive multifocal IOLs and five patients with a monofocal IOL were asked about their subjective observation of halos and were included in a clinical experiment using a computer program (Glare & Halo, FW Fitzke and C Lohmann, Tomey AG) which simulates a light source of 0.15 square degrees (sq deg) in order to stimulate and measure halos. Halo testing took place monoculary, under mesopic conditions through the distance and the near focus of the multifocal lens and through the focus of the monofocal lens. RESULTS: The halo diameter depends on the pupil diameter, the refractive power of the cornea, and distance focus of the multifocal IOL as well as the additional lens power for the near focus. 23 out of 24 patients with a refractive multifocal IOL described halos at night when looking at a bright light source. Only one patient was disturbed by the appearance of halos. Under test conditions, halos were detected in all patients with a refractive multifocal IOL. The halo area testing through the distance focus was 1.05 sq deg +/- 0.41, through the near focus 1.07 sq deg +/- 0.49 and in the monofocal lens 0.26 sq deg +/- 0.13. CONCLUSIONS: Under high contrast conditions halos can be stimulated in all patients with multifocal intraocular lenses. The halo size using the distance or the near focus is identical.
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Lentes Intraoculares , Errores de Refracción/diagnóstico , Anciano , Anciano de 80 o más Años , Sensibilidad de Contraste , Fijación Ocular , Humanos , Persona de Mediana EdadRESUMEN
AIMS: To compare tritan colour contrast sensitivity (CCS), without and with glare, in patients with refractive multifocal intraocular lenses (IOLs) and with monofocal intraocular lenses. METHODS: Tritan CCS was determined (Moorfields Vision System, CH Electronics) in 15 eyes (14 patients, 75.7 (+/-6.6) years) with a refractive multifocal IOL (Allergan SA 40N) and in 11 eyes (10 patients, 73.7 (+/-6.4) years) with a monofocal IOL (Allergan SI 40 NB). Measurements were made monocularly under mesopic conditions at a distance of 2 metres from the monitor with best distance refraction plus 0.5 D at 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd). The test was then repeated for the multifocal IOLs, adding minus 2.5 D to the best distance refraction to force the patient to use the near focus. Both lenses were also investigated under glare conditions with the same set-up and using the brightness acuity tester (BAT). RESULTS: The tritan CCS function without glare in multifocal lenses through the distance focus was nearly identical to that through the near focus. The following statistically significant differences were measured: the CCS function without glare for the multifocal lens was worse at 0.5 cpd and 1.0 cpd than that of the monofocal lens. In CCS testing of the multifocal group with glare at 6 cpd, the results through the distance focus were better than the results through the near focus. For the CCS function with glare, the values for the distance focus in the multifocal lens were worse than the values for the monofocal lens at 0.5 cpd and 1 cpd. In CCS testing with glare through the near focus and CCS testing through the monofocal lens, the monofocal lens performed better at 0.5 cpd, 1 cpd, 3 cpd, and 6 cpd. CONCLUSION: Refractive multifocal intraocular lenses influence tritan CCS function compared to monofocal lenses.
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Percepción de Color , Sensibilidad de Contraste , Lentes Intraoculares , Anciano , Anciano de 80 o más Años , Diagnóstico por Computador , Fijación Ocular , Humanos , Persona de Mediana Edad , Oftalmología/instrumentación , Oftalmología/métodos , Estadísticas no Paramétricas , Agudeza VisualRESUMEN
AIM: To document the results of erbium (Er)-YAG laser treatment in presaccal canalicular obstruction in combination with the use of a flexible endoscope. METHODS: For the first time an Er-YAG laser (Schwind, Sklerostom) was attached to a flexible endoscope (Schwind, Endognost) and used to recanalise a stenosis of the upper, lower, or common canaliculus. In 17 patients (mean age 41.5 (SD 11.9) years), 19 treatments (two bilateral) were performed. In all cases the scar was observed using the endoscope and was excised by laser ablation. A silicone intubation was performed in all cases. In addition to the endoscopy an irrigation was performed to prove the intactness of the lacrimal pathway system after laser treatment. RESULTS: Membranous obstructions with a maximum length of 2.0 mm (14 procedures) in the canaliculus were opened easily using the laser, and the silicone intubation was subsequently performed without difficulty. Scars thicker than 2.0 mm could not be opened safely without canaliculus penetration (five procedures). Irrigation was positive in all cases up to the end of a 6 month period, providing the tubes remained in place. The maximum follow up is now 17 months (minimum 8 months) and in 16 cases (84.2%) the canaliculi are still intact. CONCLUSION: Endoscopic laser treatment combined with silicone intubation enables us to recanalise presaccal stenoses of canaliculi under local anaesthesia up to a scar thickness of 2.0 mm. Best results can be achieved in cases where much tissue can be saved. Under such conditions this procedure can substitute for more invasive surgical techniques, especially a conjunctivo-dacryocystorhinostomy (CDCR).
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Dacriocistorrinostomía , Endoscopía/métodos , Terapia por Láser/métodos , Adulto , Anciano , Endoscopios , Humanos , Terapia por Láser/instrumentación , Persona de Mediana EdadRESUMEN
AIMS: To evaluate the data for patients with basal cell carcinoma (BCC) in the eyelid region, to demonstrate histologically controlled tumour excision, and to prove the efficacy of the treatment on the basis of long term observations. METHODS: Retrospective analysis of 382 microscopically controlled BCC excisions in the eyelid apparatus (350 patients) in a follow up study over 5.7 (SD 1.1) years. Tumour location, tumour size, and histological results were recorded. The same procedure was followed for recurrences. Follow up examinations were carried out 1, 3, 6, and 12 months after the operation, and then annually for a further 4 years or longer. RESULTS: A recurrence rate of 5.36% was observed after the primary operation. 60.3% of first recurrences occurred in the medial canthus, 41.2% showed in depth extension, and sclerosing types were overly represented at 35.3%. After the second operation the recurrence rate increased to 14.7% and reached 50% after a third and fourth operation. CONCLUSIONS: The greatest risk of recurrence exists for BCCs of the medial canthus with in depth extension, and for sclerosing types. The recurrence rate increases after every operation. For high risk cases, consideration should be given to adjuvant treatment such as radiotherapy.
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Carcinoma Basocelular/cirugía , Neoplasias de los Párpados/cirugía , Anciano , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Recurrencia Local de Neoplasia , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
PURPOSE: To compare contrast sensitivity and glare disability provided by diffractive and refractive multifocal intraocular lenses (IOLs). SETTING: University Eye Clinic Vienna, Austria. METHOD: This study evaluated the contrast sensitivity and glare disability in 29 eyes with a diffractive multifocal IOL (3M815LE) and 12 with a three-piece, five-zone refractive multifocal IOL (AMO Array SSM 26 NB). The Brightness Acuity Tester (Mentor, Inc.) was used with stationary sinusoidal gratings at spatial frequencies of 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd) generated on a television monitor (Nicolet CS 2000). RESULTS: The contrast sensitivity functions of both multifocal IOL groups were within the reference range and were identical at 0.5, 1, and 22.8 cpd spatial frequencies. At 3, 6, and 11.4 cpd, the contrast sensitivity function in the diffractive IOL group was 6, 9, and 10% lower than in the refractive IOL group, and the difference between groups was statistically significant at 6 cpd. When glare was present, contrast sensitivity in the diffractive IOL group was generally in the lower limit of the reference range and remained below at 3 and 6 cpd. Contrast sensitivity in the refractive IOL group remained below the reference range at 3 cpd. At 0.5 and 1 cpd, there were no differences between the groups. At the middle and high spatial frequencies (3, 6, 11.4, 22.8 cpd), contrast sensitivity in the diffractive group was 8, 16, 11, and 12% lower than in the refractive group. At 6 cpd, the between-group difference was statistically significant. CONCLUSION: Diffractive multifocal IOLs provided decreased contrast sensitivity and greater glare disability than refractive multifocal IOLs.
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Sensibilidad de Contraste , Deslumbramiento , Lentes Intraoculares , Adulto , Anciano , Anciano de 80 o más Años , Capsulorrexis , Humanos , Implantación de Lentes Intraoculares , Persona de Mediana Edad , Facoemulsificación , Estudios Retrospectivos , Agudeza VisualRESUMEN
PURPOSE: To determine depth of focus and visual quality after implantation of a diffractive intraocular lens (IOL) and a refractive IOL. SETTING: University Eye Clinic, Vienna, Austria. METHOD: This study comprised 10 eyes of 9 patients with a diffractive IOL (3M 825x + 4) and 13 eyes of 9 patients with a refractive lens (AMO Array SSM 26NB). Depth of focus was evaluated in a defocused range of -6.0 to +3.0 diopters (D), and Snellen visual acuity was recorded. RESULTS: Distance acuity peaked at 1.0 +/- 0.2 (3M group) and 0.91 +/- 0.13 (AMO group). The near acuity peaks were at 0.82 +/- 0.15 and 0.55 +/- 0.14, respectively. Visual acuity of 0.5 was possible in a range of defocus of +1.0 to -4.0 D (3M) and +1.0 to -3.5 D (AMO). CONCLUSION: Pseudoaccommodation and full distance visual acuity were realized with both types of multifocal lenses. For intermediate distances, visual acuity may be limited to activities that do not require optimal vision. At near distances, the 3M lens provided statistically significantly better visual acuity.
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Acomodación Ocular , Percepción de Profundidad/fisiología , Lentes Intraoculares , Agudeza Visual/fisiología , Anciano , Capsulorrexis , Estudios de Seguimiento , Humanos , Implantación de Lentes IntraocularesRESUMEN
A self-sealing incision technique for cataract surgery has been developed. It is appropriate for implantation of rigid-optic intraocular lenses (IOLs) up to 7.0 mm. The incision is designed to meet the principle criteria of sutureless cataract surgery, such as optimal instrument handling, easy IOL implantation, and minimal postoperative patient care.
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Extracción de Catarata/métodos , Córnea/cirugía , Colgajos Quirúrgicos , Técnicas de Sutura , Humanos , Implantación de Lentes IntraocularesRESUMEN
OBJECTIVE: To study the ocular hemodynamic effects of a 3-month oral treatment with pentoxifylline in patients with nonexudative age-related macular degeneration. DESIGN: Double-blind, placebo-controlled, randomized, parallel group study. SETTING: Outpatient clinic of the Department of Ophthalmology, Vienna University, Vienna, Austria, that specializes in age-related macular degeneration. METHODS: Forty patients with age-related macular degeneration received pentoxifylline (400 mg 3 times a day orally, n=20) or placebo (n=20) for 3 months. Retinal blood flow was assessed by scanning laser Doppler flowmetry and pulsatile choroidal blood flow was assessed by laser interferometric measurement of fundus pulsation amplitude. MAIN OUTCOME MEASURES: Changes in retinal blood flow and fundus pulsation amplitude. RESULTS: Four patients receiving pentoxifylline and 3 patients receiving placebo discontinued medication because of nausea. In the remaining subjects, the use of pentoxifylline increased ocular fundus pulsation amplitude (P<.001 vs placebo and baseline). The maximum increase was 28% after 3 months. In contrast, retinal blood flow was not changed by the use of pentoxifylline. CONCLUSIONS: A 3-month course of oral pentoxifylline treatment increases choroidal but not retinal blood flow in patients with age-related macular degeneration. These data strongly support the concept that pentoxifylline might be useful in the treatment of age-related macular degeneration. Long-term clinical outcome trials are now warranted to test this hypothesis.
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Coroides/irrigación sanguínea , Degeneración Macular/fisiopatología , Pentoxifilina/administración & dosificación , Vasodilatadores/administración & dosificación , Administración Oral , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Coroides/efectos de los fármacos , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Flujometría por Láser-Doppler , Degeneración Macular/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pentoxifilina/efectos adversos , Pentoxifilina/uso terapéutico , Vasos Retinianos/fisiopatología , Vasodilatadores/efectos adversos , Vasodilatadores/uso terapéuticoRESUMEN
AIMS: The introduction of specific inhibitors of AT1 receptors, such as losartan, has enabled the investigation of the renin-angiotensin-system (RAS) in humans in vivo. We studied the role of the RAS in the cerebral and ocular circulation in healthy subjects. Haemodynamic effects of orally administered losartan were investigated with non-invasive methods. METHODS: In a placebo-controlled randomized, double-blind two way crossover design losartan (100 mg orally) or placebo was administered in 10 healthy subjects. The effect of losartan was studied at hourly intervals for 8 h. In addition, the effect of losartan on haemodynamic changes induced by exogenous angiotensin II (Ang II) was assessed. Blood flow velocities in the ophthalmic and the middle cerebral artery (OA, MCA) were measured with Doppler sonography. Pulsatile choroidal blood flow was estimated with laser interferometric measurement of fundus pulsation. RESULTS: Losartan significantly increased fundus pulsation amplitude (+11%, 95% CI: 5 to 16% P<0.0001), tended to increase resistive index in the ophthalmic artery (+12%, 95% CI: 0 to 23%) and tended to decrease mean arterial pressure (-15%, 95% CI: -23 to -1%). Ang II induced effects on cerebral, ocular and systemic haemodynamics were prevented by preceding administration of losartan. CONCLUSIONS: The present data suggest that Ang II is not a major determinant of cerebral and ocular blood flow in vivo. The observed changes in cerebral and ocular haemodynamic parameters after losartan administration reflect effects on systemic blood pressure.
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Angiotensina II/farmacología , Antagonistas de Receptores de Angiotensina , Antihipertensivos/farmacología , Encéfalo/efectos de los fármacos , Ojo/efectos de los fármacos , Losartán/farmacología , Adulto , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Encéfalo/irrigación sanguínea , Estudios Cruzados , Método Doble Ciego , Ecoencefalografía , Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Distribución Aleatoria , Receptor de Angiotensina Tipo 1 , Receptor de Angiotensina Tipo 2 , Ultrasonografía DopplerRESUMEN
BACKGROUND: The implantation of a diffractive multifocal lens (dMIOL) as alternative to a monofocal lens is justified if after surgery there is practically no need to wear glasses. PATIENTS AND METHODS: 31 patients had an implantation of a total of 35 dMIOLs (3M 815 LE). We evaluated the visual acuity, the refractive data and the patients' attitude to wearing glasses. The average age was 67.0 +/- 11.8 years. Follow up took place after 18.7 +/- 5.4 months. RESULTS: The mean value of the uncorrected distance acuity was 0.59 +/- 0.17 and the corrected distance acuity 0.96 +/- 0.13. The uncorrected near acuity amounted to Jg 2.40 +/- 0.94, best distance correction was Jg 1.49 +/- 0.55. The patients still accepted an average of 0.68 +/- 0.37 dpt for the best near correction (near vision over the diffractive near focus) and thus achieved Jg 1.46 +/- 0.55. At the best distance correction plus 3.5 dpt, the near visual acuity was improved to 1.03 +/- 0.17. 54.8% of the patients indicated that they did not use glasses at all. 32.3% stated that they only used glasses for reading. 9.7% wore bifocals all the time, and 3.2% always used glasses for the distance. CONCLUSIONS: Regarding distance vision, the dMIOL is equivalent to monofocal lenses. Without any correction the results of the dMIOLs for the near vision are superior to monofocal lenses. Glasses can be dispensed with if the uncorrected visual acuity of the operated eye is at least 0.6 Jg 2-3 after surgery and the other eye too, does not need any correction. In case the postoperative visual acuity is worse, good visual acuity of the other eye may render glasses unnecessary. Part of the patients put up with a correctable loss of visual acuity in order not to become dependent on glasses. The need to wear glasses may be decreased considerably by implanting a dMIOL in both eyes and by avoiding postoperative refraction errors.
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Anteojos , Lentes Intraoculares , Refracción Ocular , Agudeza Visual , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Óptica y FotónicaRESUMEN
The development and introduction of multifocal intraocular lenses (MIOL) should provide the patient with a pseudoaccomodation for distance and near acuity without spectacle corrections. For this study two different types of multifocal lenses have been investigated concerning their visual properties. For diffractive MIOL (3M, type 815LE) an uncorrected distance visual acuity of Snellen 0.59 +/- 0.17 was found. The near visual acuity was J 2.4 +/- 0.94 and Snellen Acuity of 0.5 was achieved in a range of defocus of -1.25 D to +4.0 D. For refractive MIOL (Allergan, type Array SSM 26NB) an uncorrected distance visual acuity of Snellen 0.79 +/- 0.17 was found. The near visual acuity was J 2.75 +/- 1.35 and Snellen Acuity of 0.5 was achieved in a range of defocus of -1.0 D to +3.5 D. With this multifocal lenses the patients reached functional results for distance vision as well as with monofocals. Because of the existing pseudo-accommodation the results for near vision lay over of those of monofocals and the need spectacle correction decrease.
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Lentes Intraoculares , Óptica y Fotónica , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Refracción Ocular , Pruebas de Visión , Agudeza VisualRESUMEN
PURPOSE: To evaluate visual acuity, depth of focus, contrast sensitivity, and glare disability in eyes with an Array SSM 26-NB three-piece, five-zone multifocal intraocular lens (IOL). SETTING: University Eye Clinic, Vienna, Austria. METHOD: Fourteen eyes with an AMO Array IOL were evaluated for uncorrected and best corrected distance and near visual acuity. The reading distance produced by the near focus of the lens was varied with convex glasses of less power. Reading at distance focus was evaluated by adding +3.50 diopters (D) to the distance correction. Depth of focus was measured from -3.00 to +6.00 D. Contrast sensitivity and glare disability were also measured using the Brightness Acuity Tester with stationary sinusoidal gratings at 0.5, 1, 3, 6, 11.4, and 22.8 cycles/degree. RESULTS: Mean uncorrected distance acuity (Snellen) was 0.79 +/- 0.17 (SD), which increased to 0.94 +/- 0.14 with best correction. Near acuity was J2.75 +/- 1.35 and J2.59 +/- 1.10, respectively. When near focus was tested for reading distance, a mean of +0.54 +/- 0.02 D was accepted for improvement of near vision of J1.71 +/- 0.94. Near acuity with a distance focus addition of +3.50 D was J1.08 +/- 0.28. Contrast sensitivity and glare disability were lower than in 13 eyes with a monofocal poly(methyl methacrylate) IOL and 16 normal phakic eyes. CONCLUSIONS: Eyes with the Array IOL had full distance function. Reading performance could be improved with a near focus of more than +3.50 D. Full near vision could be achieved with the distance focus and conventional reading glasses. Depth of focus was sufficient but visual acuity was limited at intermediate and near distance. Although contrast sensitivity was relatively low, it was not beyond the reference range.