Publications (20)45.89 Total impact
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Article: Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy.
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ABSTRACT: Background: This study was undertaken to examine the possible effect of microcannula-guided entry sites on the rate of intraoperative retinal break formation. Methods: In this historical cohort study, all patients having undergone vitrectomy with epiretinal or internal limiting membrane peeling performed by one surgeon between January 2005 and March 2009 were included. All procedures with microcannula-guided entry sites (23- and 25-gauge vitrectomy) were compared to procedures without the use of microcannulas (20-gauge vitrectomy). Results: A total of 221 eyes with a follow-up of at least 30 days were analyzed. The total incidence of intraoperative retinal break formation was 25.2% (n = 28/111) for the 20-gauge group and 12.7% (n = 14/110) for the 23-/25-gauge group, resulting in an odds ratio of 2.313 (95% confidence interval 1.142-4.685) of an increased rate in the 20-gauge group. Conclusion: This study demonstrates that intraoperative retinal breaks during vitrectomy are reduced in the microcannula-guided techniques compared to 20-gauge vitrectomy. This effect may be attributed to the protection of the vitreous base during surgery. Further prospective studies are warranted.Ophthalmologica 11/2012; · 1.42 Impact Factor -
Article: Intraocular Lens Calcification After Keratoplasty.
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ABSTRACT: PURPOSE:: To report calcification of intraocular lenses (IOLs) after various keratoplasty procedures. METHODS:: Clinical data of all cases with calcified IOLs after keratoplasty procedures were analyzed. A total of 6 explanted IOLs were analyzed with light microscopy before and after staining with 1% alizarin red and the von Kossa method. RESULTS:: A total of 7 cases occurred after Descemet stripping automated endothelial keratoplasty, 1 case after deep anterior lamellar keratoplasty, and 2 cases after penetrating keratoplasty. Median time interval from keratoplasty to first notice of IOL opacification was 6.5 months (minimum 3 months, maximum 51 months). A total of 3 IOLs had been placed at the time of keratoplasty and 7 IOLs before keratoplasty. All affected IOLs were hydrophilic acrylic and comprised IOLs from at least 3 different polymer sources. Common clinical aspects were some amount of inflammation in the anterior chamber during the postoperative period and use of air at the end of surgery in 8 of the 10 cases. Histochemical analysis demonstrated the presence of fine granular deposits located within the very superficial optic material in all cases. The deposits stained positive for calcium with alizarin red and the von Kossa method. CONCLUSIONS:: IOL calcification associated with keratoplasty in our series does not seem to be a problem related to a specific IOL model or polymer. The process of calcification may be mediated by inflammation, which also may be related to multiple injections of air into the anterior chamber.Cornea 09/2012; · 1.73 Impact Factor -
Article: Trabeculotomy
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ABSTRACT: Trabeculotomy has largely been dismissed for surgery of adult primary open-angle glaucoma and is currently mainly used for congenital and dysgenetic glaucoma. This may be caused by technical imperfections of the traditional techniques. The authors present and discuss their own technical approach and the rationale for it. It permits reliable, reproducible, and verifiable achievement of the surgical goal and may give better results even in adult primary open-angle glaucoma than currently perceived in the ophthalmologic community.Techniques in Ophthalmology 05/2010; 8(2):55-59. -
Article: Visualization and follow-up of acute macular neuroretinopathy with the Spectralis HRA+OCT device.
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ABSTRACT: Acute macular neuroretinopathy (AMNR) is a rare disease entity, the diagnosis of which is frequently complicated by the subtlety of biomicroscopic findings. Two cases of AMNR are presented, in which the diagnosis and follow-up was enabled using the Spectralis HRA+OCT in the absence of clear biomicroscopic findings. The typical lesions were visualized by hyporeflexion during infrared imaging and faded over time. With spectral domain optical coherence tomography, changes in the outer retina in the affected regions were documented, with no change over time. The broader availability of this technology may enhance the diagnosis and follow-up of AMNR.Albrecht von Graæes Archiv für Ophthalmologie 03/2010; 248(7):1041-4. · 2.17 Impact Factor -
Article: Static and dynamic rotational eye tracking during LASIK treatment of myopic astigmatism with the Zyoptix laser platform and Advanced Control Eye Tracker.
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ABSTRACT: To evaluate the amount of cyclotorsion and the effect of static and dynamic rotational eye tracking with the Advanced Control Eye Tracker (Bausch & Lomb) based on iris recognition in the treatment of myopic astigmatism with LASIK. All patients with myopic LASIK and attempted cylinder correction >0.75 diopters (D) on the Zyoptix 217z100 excimer laser platform between May 2005 and May 2007 were identified retrospectively through the existing databank. Pre- and postoperative refraction and the amount of cyclotorsion during treatment were extracted and analyzed in 828 eyes with >3-month follow-up. Preoperative mean manifest refraction spherical equivalent (MRSE) was -4.31+/-1.84 D (range: -0.37 to -9.50 D), and mean cylinder was -1.27+/-0.87 D (range: -0.75 to -6.75 D). Mean static rotation was 3.96+/-2.96 degrees (maximum 14.8 degrees ). Median dynamic rotation was 1.32+/-1.85 degrees (maximum 24 degrees). At 3 months postoperatively, MRSE was -0.10+/-0.36 D (range: -2.25 to +1.25 D), and mean cylinder was -0.33+/-0.35 D (range: -2.00 to 0 D). Predictability was 90.2% within +/-0.50 D and 98.2% within +/-1.00 D (MRSE), and 82.5% within +/-0.50 D and 96.9% within +/-1.00 D (cylinder). The efficacy ratio was 0.99. Safety was 99.4% (5 dry eyes), reaching 100% at 12 months. Stability from 3 to 12 months (n=275) was 98.2% for sphere, 95.3% for cylinder, and 96.0% for MRSE. Our study demonstrates that significant cyclotorsion occurs before and during treatment. By using the dynamic rotational eye tracker presented, the efficacy of cylinder correction can be improved compared to those studies not performing cyclotorsional correction.Journal of refractive surgery (Thorofare, N.J.: 1995) 01/2010; 26(1):17-27. · 2.54 Impact Factor -
Article: Clinicopathological correlation of 3 patterns of calcification in a hydrophilic acrylic intraocular lens.
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ABSTRACT: We present 3 cases of opacification in the Biocomfold 92S intraocular lens (IOL), with a documented increase in the opacification over time in 1 case. Histopathological analysis revealed the opacification was caused by calcification in the IOL's optic material. The pattern of calcium deposition, however, was different in each IOL. The causative mechanisms for this complication are unclear. Further research is warranted.Journal of cataract and refractive surgery 04/2009; 35(3):593-7. · 2.75 Impact Factor -
Article: Retinal detachment after phacoemulsification in high myopia: analysis of 2356 cases.
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ABSTRACT: To determine the incidence of and risk factors for rhegmatogenous retinal detachment (RD) in highly myopic eyes after cataract surgery. Two ophthalmology centers in Munich and Ahaus, Germany. This retrospective medical chart review comprised 1519 consecutive patients (2356 eyes) with an axial length (AL) greater than 27.0 mm who had planned phacoemulsification and intraocular lens implantation in the capsular bag. In addition, all patients and/or the referring ophthalmologist were contacted regarding the occurrence of RD and laser capsulotomy and the date of occurrence. Follow-up was longer than 24 months in 84% of eyes. Because some cases of RD were questionably related to the preceding cataract surgery, the absolute incidence of postoperative RD was determined as highest (2.2%) and lowest (1.5%). Sex, history of laser capsulotomy, and increasing AL had no statistically significant effect on the rate of RD. The risk for postoperative RD was significantly higher in eyes of younger patients and eyes with preoperative prophylactic treatment for retinal degeneration. The risk for postoperative RD in this study (1.5% to 2.2%) corresponds to the incidence of pseudophakic RD and idiopathic RD in myopia described in the literature. The risk profile for postoperative RD in this series cannot be distinguished from the risk profile for idiopathic RD in myopia of this extent. The true effect of prophylactic treatment of degenerative lesions remains to be elucidated.Journal of Cataract [?] Refractive Surgery 11/2008; 34(10):1644-57. · 2.26 Impact Factor -
Article: Online optical coherence pachymetry as a safety measure for laser in situ keratomileusis treatment in 1859 cases.
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ABSTRACT: To evaluate the reliability and applicability of online optical coherence pachymetry (OCP) (OCPonline, Heidelberg Engineering GmbH) integrated into the Zyoptix 217z100 excimer laser platform (Bausch & Lomb) under routine clinical conditions. Private laser clinic, Munich, Germany. Between July 2004 and June 2006, 1859 consecutive eyes having laser in situ keratomileusis (LASIK) using the Zyoptix 217z100 excimer laser platform had preoperative pachymetry with the Orbscan II (Bausch & Lomb) and DGH II (Pachette 2, DGH Technology, Inc.) and continuous intraoperative online OCP with the OCPonline. Preoperative pachymetry values and actual flap thicknesses with the Hansatome and Zyoptix XP microkeratomes (both Bausch & Lomb) and the IntraLase FS30 femtosecond laser keratome (IntraLase Corp.) were evaluated. Preoperative pachymetry values showed a high correlation between the OCPonline device and the Orbscan II (R(2) = 0.78, difference = 0.37%) and DGH II (R(2) = 0.77, difference = 0.69%). The OCPonline measurements resulted in a mean flap thickness of 121.4 microm +/- 19.1 (SD) with the Hansatome (160 microm head), 126.5 +/- 15.5 microm with the Zyoptix XP (120 microm head), and 121.7 +/- 14.7 microm with the IntraLase FS30 (110 microm flap thickness). A correlation between the calculated laser ablation depth and the measured stromal thinning was established. OCPonline technology provided reliable intraoperative noncontact pachymetry measurements integrated into a clinical flow, indicating the technology has the potential to improve the safety of corneal ablation procedures.Journal of Cataract [?] Refractive Surgery 08/2008; 34(8):1273-9. · 2.26 Impact Factor -
Article: A new classification of calcification of intraocular lenses.
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ABSTRACT: To define and classify the major types of intraocular lens (IOL) calcification. Retrospective observational case series with clinicopathologic correlation. More than 400 IOLs explanted because of opacification. The authors reviewed the clinical information and histologic findings of all IOLs that had been explanted because of opacification or calcification of the IOLs accessioned in their laboratory between January 1999 and December 2004. The proposed mechanism that led to calcification of each IOL design. Three major types of calcification were identified: (1) primary calcification, (2) secondary calcification, and (3) false-positive calcification or pseudocalcification. The primary form refers to calcification that is inherent in the IOL, that is, is based on possible inadequate formulation of the polymer, fabrication of the IOL, or issues with its packaging process. The calcification presumably occurs in otherwise normal eyes and generally is not associated with preexisting diseases. The secondary form refers to deposition of calcium onto the surface of the IOL most likely the result of environmental circumstances (e.g., changes in the aqueous milieu surrounding the implanted IOL associated with preexisting or concurrent diseases or indeed any condition that has disrupted the blood-aqueous barrier). By definition, it is not related to any problem with the IOL itself. The false-positive or pseudocalcification refers to those cases in which other pathology is mistaken for calcification or false-positive staining for calcium occurs. When evaluating the pathogenesis and nature of IOL calcification in or on any given design, one should categorize it according to these types. Primary calcification is IOL related and the IOL should be withdrawn or modified to correct the problem. After the cause is identified and the lens is implanted again, patients should be followed up for up to 2 years to be sure the problem is alleviated. Secondary calcification is by definition not IOL related; it may occur with virtually all IOL designs implanted under various adverse circumstances. No IOL, hydrophilic or hydrophobic, is immune to secondary calcification. The false-positive form is recognized readily in the laboratory and this erroneous diagnosis is avoided.Ophthalmology 02/2008; 115(1):73-9. · 5.45 Impact Factor -
Article: Postoperative surface deposits on intraocular lenses in children.
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ABSTRACT: To report the clinicopathologic features of 4 intraocular lenses (IOLs) composed of 3 different hydrophilic biomaterials explanted from children who had postoperative opacification of the IOL optic. David J Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. The IOLs were explanted 20, 11, 22, and 25 months postoperatively from children aged 10, 3, 36, and 20 months old, respectively, at IOL implantation. Clinical data were obtained to correlate the findings with possible associated risk factors. The explanted IOLs were examined by gross and light microscopy. They were further analyzed with a stain for calcium, alizarin red 1%. Scanning electron microscopy and energy dispersive X-ray spectroscopy (EDS) were also performed. The primary reason for cataract surgery in Case 1 and Case 2 was persistent hyperplastic primary vitreous (PHPV); 1 patient received a B-Lens IOL (Hanita) and the other a Centerflex IOL (Rayner). The primary reason in Case 3 was familial bilateral congenital cataract and in Case 4, rubella cataract; both patients received a Hydroview IOL (Bausch & Lomb). All 4 IOLs had surface deposits on the optic, but the morphology of the deposits on the B-Lens and Centerflex IOLs was different than that in previously reported cases. The deposits in all four cases stained positive with alizarin red and consisted of calcium and phosphorus when imaged with EDS. Calcified deposits on 2 Hydroview IOLs explanted from children were similar to those seen in adults with the same IOL. The deposits on the B-Lens and Centerflex IOLs were probably secondary to a breakdown of the blood-aqueous barrier caused by preexisting PHPV.Journal of Cataract [?] Refractive Surgery 11/2006; 32(11):1932-7. · 2.26 Impact Factor -
Article: Long-term capsular bag survival without functional lens epithelial cells.
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ABSTRACT: To evaluate the survival of the capsular bag without the support of functional lens epithelial cells (LECs). David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. One hundred slides of cadaver pseudophakic eyes (from 1991 to 2000) stained with hematoxylin and eosin were analyzed to determine the presence of Soemmering's ring, integrity of the capsular bag, fixation configuration of the haptics, and presence and functionality of the LECs. A Soemmering's ring was present in 69% of cases. The capsular bags were intact in 100% of cases. In-the-bag fixation was seen in 44% of cases. In 89% of cases, either no cells or nonfunctional LECs were found. Results suggest the capsular bag can survive anatomically without the support of functioning LECs.Journal of Cataract [?] Refractive Surgery 11/2006; 32(10):1722-6. · 2.26 Impact Factor -
Article: Clinical presentation of intraocular lens schisis.
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ABSTRACT: To analyze the clinical presentation and implications of cavity or schisis formation in the MemoryLens (CIBA Vision) intraocular lens (IOL) optic. Eye Department, Red Cross Hospital, Munich, Germany. This study was a retrospective chart review and slitlamp photography analysis of IOL schisis. Four patients with IOL schisis were identified and their charts analyzed. Clinically, the schisis presented as a sharply demarcated round structure. The aspect was clear on coaxial illumination, but on tangential illumination the schisis area was opaque. Patients experienced glare, foggy vision, and deteriorated visual function or had no symptoms. One patient lost visual acuity, and the IOL was explanted. Clinically, IOL schisis was easily differentiated from cases of IOL opacification due to calcification. The clinical implication was not uniform, ranging from no symptoms to great visual disturbance leading to explantation of the IOL. The cause of this complication remains unclear. A possible explanation is the impact of solvent-induced tensile stress on the IOL optic material during the manufacturing process.Journal of Cataract [?] Refractive Surgery 10/2006; 32(9):1503-8. · 2.26 Impact Factor -
Article: Two opacification patterns of the same hydrophilic acrylic polymer: case reports and clinicopathological correlation.
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ABSTRACT: We report 2 intraocular lenses (IOLs) manufactured from the same hydrophilic acrylic polymer by Ioltech that developed optic opacification. In both cases, the postoperative course after implantation of the IOLs was complicated by significant inflammatory reaction with fibrin formation in the anterior chamber. Pathologic analyses of the explanted IOLs were consistent with dystrophic calcification leading to optic opacification, but the pattern was different between the 2 IOL designs. Patient-related factors might have been responsible for this complication.Journal of Cataract [?] Refractive Surgery 06/2006; 32(5):879-86. · 2.26 Impact Factor -
Article: Intraocular concentrations of gatifloxacin and moxifloxacin in the anterior chamber via diffusion through the cornea using collagen shields.
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ABSTRACT: To evaluate the penetration of gatifloxacin and moxifloxacin into the anterior chamber, and any adverse reaction to the cornea, using collagen shields presoaked in oversaturated solutions of the antibiotics. Collagen shields, presoaked for 10 minutes in an oversaturated solution of gatifloxacin or moxifloxacin, were placed on the surface of each of the corneas of 15 rabbits for a total of 30 eyes (15 in each group). The antibiotics were prepared by dissolving the powder form of the antibiotics in a solution until no further particulate could be further dissolved. Aqueous humor samples were taken 3.5 and 6 hours later. The initial concentrations of gatifloxacin and moxifloxacin were 5.43 +/- 0.16 mg/mL and 3.14 +/- 0.22 mg/mL, respectively. The average concentration of gatifloxacin in the anterior chamber was higher than that of moxifloxacin at the 3.5-hour sample (6.32 +/- 2.67 microg/mL versus 3.55 +/- 3.5 microg/mL, P = 0.0034). The concentrations of both antibiotics, although decreased, remained relatively high at the 6-hour sample (1.39 +/- 1.13 microg/mL versus 0.816 +/- 0.6 microg/mL at 6 hours, respectively, P = 0.22). No obvious clinical or histologic signs of toxicity were noticed in either group. Gatifloxacin and moxifloxacin showed good penetration into the anterior chamber with no obvious adverse reaction to the cornea. The concentrations in the anterior chamber exceeded the minimal inhibitory concentration (MIC) 90 of most organisms responsible for postoperative endophthalmitis (POE).Cornea 03/2006; 25(2):209-13. · 1.73 Impact Factor -
Article: Postoperative opacification of the peripheral optic region and haptics of a hydrophilic acrylic intraocular lens: case report and clinicopathologic correlation.
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ABSTRACT: We report the first case of opacification of the BioComFold 92S (Morcher GmbH) intraocular lens. The opacification pattern is unique, presenting mainly in the periphery of the optic and the haptics of the lens, leaving the central portion of the optic clear. The clinical course of this opacification pattern is not observed typically with other hydrophilic acrylic lens designs and requires further study.Journal of Cataract [?] Refractive Surgery 02/2006; 32(1):158-61. · 2.26 Impact Factor -
Article: Is it time to remove the MemoryLens IOL from the market?
Journal of Cataract [?] Refractive Surgery 10/2005; 31(9):1681-2. · 2.26 Impact Factor -
Article: Schisis/cavitation of the MemoryLens optic.
Journal of Cataract [?] Refractive Surgery 10/2005; 31(9):1841-2. · 2.26 Impact Factor -
Article: Cocooning of an iris-fixated intraocular lens in a 3-year-old child after perforating injury: clinicopathologic correlation.
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ABSTRACT: We present a 3-year-old patient who developed extensive noninflammatory fibrous membrane formation in the anterior chamber involving the present iris-fixated intraocular lens (IOL), with subsequent need for explantation. The child had had repair of a corneal injury, crystalline lens extraction and Artisan iris-claw IOL (Ophthec) implantation after a penetrating injury 2 months before. Histopathologic analyses were consistent with a retrocorneal membrane that originated from the corneal stroma and formed a "cocoon" membrane on the iris-claw IOL.Journal of Cataract [?] Refractive Surgery 10/2005; 31(9):1826-8. · 2.26 Impact Factor -
Article: Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants.
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ABSTRACT: To report clinical, pathologic, histochemical, ultrastructural, and spectroscopic analyses of MemoryLens intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by postoperative opacification of the lens optic. Noncomparative, large case series with clinicopathologic correlation. A total of 106 hydrophilic acrylic IOLs of the same design explanted from 106 different patients. All patients had decreased visual acuity at presentation approximately 2 years after cataract surgery, associated with a whitish fine granularity on the optical surfaces of the IOLs. The explanted IOLs were submitted to the John A. Moran Eye Center and were examined under light microscopy, histochemically, and with scanning electron microscopy (SEM) equipped with an energy dispersive x-ray spectroscopy detector with light element capabilities (EDS). The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components. The average interval between lens implantation and opacification was 25.8+/-11.9 months. The most frequently associated medical and ophthalmic conditions were diabetes and glaucoma. However, some patients did not have any preexisting medical or ophthalmic conditions. Most of the IOLs had been implanted in 1999 and 2000. Microscopic analyses revealed the presence of multiple fine, granular deposits of variable sizes on the anterior and posterior optic surfaces, especially on the anterior surface. The deposits stained positive for calcium. The EDS confirmed the presence of calcium and phosphate within the deposits. The results obtained suggest the surface deposits to be composed, at least in part, by calcium and phosphate. A special polishing technique used in the manufacture of most of these IOLs may have caused changes in the lens surface leading to deposit formation. Further studies should be undertaken to confirm this hypothesis.Ophthalmology 12/2004; 111(11):2094-101. · 5.45 Impact Factor -
Article: "Special" intraocular lens designs: why do they sometimes fail?
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ABSTRACT: A variety of new "special" intraocular lens models to optimize the visual performance after cataract surgery have been introduced. The majority of these new intraocular lens designs require a good centration within the capsular bag and/or capsular elasticity. Today, the main post-operative complications after cataract surgery still arise from retained lens epithelial cells within the capsular bag, resulting mainly in anterior and posterior capsule opacification. Some special intraocular lenses are not designed to be effective against proliferating lens epithelial cells. Although lens epithelial cells can never be completely removed from the capsular bag, surgical quality is a major factor for success or failure of these intraocular lens designs.Comprehensive ophthalmology update 7(2):53-60.
Top co-authors
Top Journals
Institutions
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2012
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Eberhard-Karls-Universität Tübingen
Tübingen, Baden-Wuerttemberg, Germany
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2005–2010
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Universitätsklinikum Tübingen
Tübingen, Baden-Wuerttemberg, Germany
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2004–2008
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University of Utah
- • John Moran Eye Center
- • Department of Ophthalmology and Visual Sciences
Salt Lake City, UT, USA
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