Mike P Holzer

Universität Heidelberg, Heidelburg, Baden-Württemberg, Germany

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Publications (98)147.8 Total impact

  • Der Ophthalmologe 05/2013; 110(5):470. · 0.53 Impact Factor
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    ABSTRACT: To analyze the refractive outcomes and safety of three-piece silicone toric sulcus-fixated add-on intraocular lenses (IOLs) (HumanOptics/Dr.Schmidt Intraocularlinsen, Erlangen, Germany) in complex clinical cases with high astigmatism such as in cases with previous penetrating keratoplasty. Interventional case series of 21 eyes of 20 patients enrolled at two German centers. Functional results including power vector analysis, accuracy of IOL power calculation, rotational stability, and postoperative complications were evaluated from 2 months to 6 years postoperatively. The preoperative subjective cylinder exceeded or was equal to -6.00 diopters (D) in 81% of eyes (range: -2.00 to -17.00 D). The median follow-up period was 7.6 months (range: 57 days to 6 years). The efficacy analysis focused on the 2 to 6 months follow-up visit. Postoperatively, there was a median reduction of astigmatism by 70.59% (subjective cylinder range: 0.00 to -5.00 D), improvement of uncorrected distance visual acuity, and unchanged median corrected distance visual acuity. The attempted spherical equivalent was achieved within ± 0.50 D in 45% and within ± 1.00 D in 65% of cases. Five eyes received secondary surgical alignment of axis. Other complications related to the surgical procedure were mainly transient shortly after implantation, such as intraocular pressure elevation (2 of 21 eyes) or corneal edema (2 of 21 eyes). Persisting changes were seen only in rare cases and included pigment dispersion (1 of 21 eyes) or corneal edema requiring a second keratoplasty within 9 months after surgery (2 of 21 eyes). Toric add-on IOLs may be useful in reducing high astigmatism and anisometropia and increasing spectacle independence even in complex clinical conditions with high refractive errors.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2013; 29(3):187-93. · 2.47 Impact Factor
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    ABSTRACT: PURPOSE: The purpose of this study was to evaluate the results of bilateral intrastromal femtosecond laser correction of presbyopia (INTRACOR). METHODS: In a prospective study 17 patients were enrolled who had previously received binocular treatment in a two-step approach. Postoperative (4-8 months) outcomes were compared with a matched control group who had undergone only unilateral surgery of the non-dominant eye (n = 17 patients, 24 months after surgery). RESULTS: The binocular distance corrected near visual acuity (DCNVA) showed the same median but lower scattering of values after bilateral treatment: 0.10 (median in logMAR) (0.30/- 0.10 min/max) (study) versus 0.10 (0.50/- 0.10) (control). In the study group, however, a higher loss of binocular corrected distance visual acuity (CDVA) was found: 23.5 %, 70.6 %, 5.9 % (0, - 1, - 2 lines) (study) versus 35.3 %, 64.7 % and 0 %, repectively (control). CONCLUSIONS: Regarding the reduced CDVA INTRACOR should initially only be performed in the non-dominant eye. In selected cases binocular treatment can improve DCNVA; however, careful risk-benefit assessment and informed consent are necessary.
    Der Ophthalmologe 01/2013; · 0.53 Impact Factor
  • M P Holzer
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    ABSTRACT: The surgical correction of presbyopia is gaining more and more popularity in the field of refractive surgery. Besides intraocular treatment with multifocal or accommodative intraocular lenses more and more corneal laser approaches are being established. These are performed either with the Excimer laser as laser in situ keratomileusis (LASIK) or the femtosecond laser. The femtosecond laser treatment is done purely intrastromally without dissection of the epithelium and is characterized by an extremely low risk of infection and inflammation. The procedure leads to a central corneal steepening with more prolate shape and increase in depth of field. This leads to a better uncorrected near visual acuity, however, corrected distance visual acuity might be reduced due to these changes.
    Der Ophthalmologe 01/2013; · 0.53 Impact Factor
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    ABSTRACT: PURPOSE: To clinically evaluate different near additions (adds) (+3.00 diopters [D] and +4.00 D) of the M-flex 630F refractive multifocal intraocular lens (IOL). SETTING: Departments of Ophthalmology, University of Heidelberg, Germany, and Lithuanian University of Health Sciences, Kaunas, Lithuania. DESIGN: Clinical prospective nonrandomized unmasked study. METHODS: Preoperatively, cataract patients were assigned to receive bilateral +3.00 D IOLs, +4.00 D IOLs, or +3.00 D (dominant eye) and +4.00 D (nondominant eye) IOLs. Follow-up examinations were performed up to 6 months postoperatively and included refraction, visual acuity (near at 40 cm and distance), the defocus curve, contrast sensitivity, and a subjective questionnaire. RESULTS: Fifty-two patients were enrolled. No significant differences were found in the visual acuity results (P>.05). Four to 6 months postoperatively, the following median uncorrected and corrected distance visual acuity, uncorrected and distance-corrected near visual acuity, and corrected near visual acuity (logMAR) were found in all patients: -0.08, -0.12, 0.20, 0.10, and 0.10. Ninety-eight percent of patients reported being satisfied. The highest near peak versus the biggest intermediate decline in the median monocular defocus curves comparing +3.00 D and +4.00 D multifocal IOLs (logMAR) were 0.16 at 40 cm versus 0.22 at 33 cm (P=.24) and 0.38 at 66 cm versus 0.54 at 50 cm (P<.01). CONCLUSION: Compared with the +4.00 D add, the +3.00 D near add gave better intermediate results in the defocus curve without compromising distance or near visual acuity. FINANCIAL DISCLOSURE: Drs. Rabsilber, Holzer, and Auffarth have received travel reimbursement and lecture fees from Rayner Intraocular Lenses Ltd. No other author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 01/2013; · 2.75 Impact Factor
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    ABSTRACT: To objectively measure the strength of the capsulotomy performed with a femtosecond laser-assisted technique or performed manually in a pig-eye laboratory study. International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Experimental study. Ten fresh pig eyes were randomly assigned to femtosecond laser-assisted capsulotomy or manual capsulotomy. The capsule was immersed in hyaluronic acid, and retractors were fixed in the capsule opening with a pull-force measuring device. The force necessary to break the capsulotomy was measured in millinewtons (mN); the maximum stretching ratio was also assessed. The observed mean rupture force (ie, maximum amount of force measured immediately before tissue rupture) was 113 mN ± 12 (SD) in the laser-assisted procedure and 73 ± 22 mN in the manual procedure (P<.05). The stretching ratios were 1.60 ± 0.10 (femtosecond) and 1.35 ± 0.04 (manual) (P<.05). In this laboratory pig-eye study, femtosecond laser-assisted capsulotomy resulted in a significantly stronger anterior capsule opening than the standard manually performed capsulotomy. Drs. Auffarth, Reddy, and Holzer have received research and travel grants from Technolas Perfect Vision GmbH. Mr. Ritter is an employee of Technolas Perfect Vision GmbH, Munich, Germany.
    Journal of Cataract and Refractive Surgery 01/2013; 39(1):105-9. · 2.75 Impact Factor
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    ABSTRACT: To evaluate functional results and corneal changes after femtosecond laser correction of presbyopia (INTRACOR, Technolas Perfect Vision GmbH) in emmetropes using a modified treatment pattern over a 12-month period. Twenty eyes from 20 emmetropic patients were treated with a modified intrastromal INTRACOR pattern consisting of 5 central rings and 8 radial cuts in a prospective, nonrandomized, uncontrolled, open, single-center, clinical study. Refraction, visual acuity, endothelial cell density, corneal pachymetry, total corneal power, and stray light were evaluated preoperatively and 1 (except endothelial cell density and stray light), 3, 6, and 12 months postoperatively. Patients filled out a subjective questionnaire at 12 months postoperatively. Comparison of preoperative versus 12-month postoperative median values revealed a significant improvement in uncorrected near visual acuity (UNVA) from 0.60 (20/80) to 0.10 logMAR (20/25) (P<.0001) and a significant decrease in corrected distance visual acuity (CDVA) from -0.10 (20/16) to 0.00 logMAR (20/20), which equals a median loss of one line (P=.0005). Fifteen percent of patients lost two lines of CDVA in the treated eye. Subjective spherical equivalent refraction remained unchanged at 0.00 diopters (D) (P=.194). After INTRACOR treatment, significant corneal steepening of 1.40 D and midperipheral flattening of 0.50 D occurred (both P<.0001). Corneal pachymetry at the thinnest point and endothelial cell density did not change significantly (P=.829 and P=.058, respectively). After 12 months, the modified INTRACOR pattern improved UNVA in emmetropic patients without inducing a myopic shift or significant changes in endothelial cell density or pachymetry.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 12/2012; 28(12):872-8. · 2.47 Impact Factor
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    ABSTRACT: We report a 66-year-old patient who presented with increasing hyperopia, astigmatism, and presbyopia in both eyes 8 years after bilateral laser in situ keratomileusis (LASIK) and LASIK enhancement in the left eye aiming for spectacle independence. Bilateral multifocal toric Lentis Mplus intraocular lenses (IOLs) with an embedded near segment and individually customized cylinder correction were implanted uneventfully following phacoemulsification. The Haigis-L formula after previous hyperopia correction was chosen for IOL power calculation and provided reliable results. Emmetropia was targeted and achieved. Three months postoperatively, the uncorrected distance visual acuity had increased from 0.40 logMAR to 0.10 logMAR in the right eye and from 0.20 logMAR to 0.00 logMAR in the left eye. The patient gained 6 lines of uncorrected near visual acuity: 0.20 logMAR in the right eye and 0.10 logMAR in the left eye. This case shows that customized premium IOL implantation can provide accurate results even in challenging cases. FINANCIAL DISCLOSURE: The International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany, has received research grants, lecture fees, and travel reimbursement from Oculentis GmbH.
    Journal of Cataract and Refractive Surgery 11/2012; 38(11):2049-52. · 2.75 Impact Factor
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    ABSTRACT: A 41-year-old patient presented with hyperopia, astigmatism, and presbyopia for refractive treatment 6 years following cataract surgery. A toric multifocal additive intraocular lens with a near addition of +3.5 diopters (D) for sulcus implantation was chosen and implanted uneventfully. Follow-up examinations were performed from the first day until 9 months after surgery. A predictable refractive correction was seen, with a residual error of +0.125 D (spherical equivalent) in the right eye and emmetropia in the left eye. Monocular uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (40 cm) improved to 0.1 logMAR. It could not be improved further with near-add spectacles. Binocular UDVA and UNVA were 0.0 logMAR and 0.1 logMAR (80 cm), respectively. Both additive IOLs remained centered and on axis during the follow-up period. Spectacle independence was achieved, as was high patient satisfaction. FINANCIAL DISCLOSURE: The International Vision Correction Research Centre received research grants related to this publication from the following companies: Dr. Schmidt Intraocularlinsen GmbH, Rayner Intraocular Lenses, Ltd., and Carl Zeiss Meditec AG. No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 08/2012; 38(8):1495-8. · 2.75 Impact Factor
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    ABSTRACT: The aim of this study was to examine the mesopic contrast sensitivity (CS) and glare sensitivity following intrastromal femtosecond laser correction of presbyopia (INTRACOR). In this study 25 patients with slight hyperopia and presbyopia underwent femtosecond laser correction in the non-dominant eye. Mesotest II measurements (OCULUS Optikgeräte, Wetzlar, Germany) were performed with and without glare at each of four different contrast levels preoperatively as well as 3, 6, 12, 18 and 24 months postoperatively. Data were compared using the Wilcoxon-test with a level of significance of p < 0.05. After 24 months the median CS decreased from 1:2 to 1:2.7 without glare and from 1:23 to 0 with glare. Of all patients 36% showed loss in CS without and 52% with glare and CS did not show any statistically significant differences between the treated and the untreated fellow eyes after 12 and 24 months. Overall 9 out of 18 monocular treated patients showed no binocular night driving ability according to the recommendations of the German Society of Ophthalmology (DOG) and the Professional Association of German Ophthalmologists (BVA) 24 months following INTRACOR. INTRACOR can lead to a slight reduction of mesopic contrast sensitivity and an increase of glare sensitivity. Possible consequences on night driving ability should be discussed with the patients prior to treatment.
    Der Ophthalmologe 07/2012; 109(10):1001-7. · 0.53 Impact Factor
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    ABSTRACT: We present a 58-year-old man who had cataract surgery in his right eye 8 months after femtosecond laser intrastromal presbyopia treatment (Intracor). The intraocular lens (IOL) power was calculated using the standard optical biometry data and the Holladay I formula without adjusting factors. Routine cataract removal was performed without complications followed by implantation of a monofocal IOL. The achieved spherical equivalent postoperatively was +0.25 diopters (D), which was +0.26 D different than the target refraction of the Holladay 1 formula. In conclusion, the IOL power calculation was predictable and the effect of the femtosecond intrastromal presbyopia treatment remained stable and improved further after cataract surgery: The pre-treatment uncorrected near visual acuity of 20/125 improved to 20/40 after treatment and to 20/25 six months after cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 07/2012; 38(7):1293-7. · 2.75 Impact Factor
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    ABSTRACT: To assess the effect of intrastromal femtosecond laser presbyopia treatment on uncorrected near visual acuity (UNVA) and corneal integrity over an 18-month period. Department of Ophthalmology, International Vision Correction Research Centre, University of Heidelberg, Heidelberg, Germany. Clinical trial. The UNVA (at 40 cm), corneal pachymetry, and true net power were evaluated preoperatively and 1, 3, 6, 12, and 18 months after femtosecond intrastromal presbyopic treatment (Intracor). Endothelial cell density (ECD) was measured preoperatively and 3, 6, and 12 months postoperatively. Data were analyzed with the Wilcoxon test at a P=.01 level of significance. The median UNVA improved significantly from 0.7 logMAR preoperatively to 0.4 logMAR, 0.2 logMAR, 0.2 logMAR, 0.3 logMAR, and 0.2 logMAR at 1, 3, 6, 12, and 18 months, respectively (all P<.001). The median corneal true net power increased significantly by 1.1 diopters (D) to 0.7 D, 0.8 D, 1.0 D, and 0.9 D, respectively (all P<.001); pachymetry showed no significant thinning postoperatively. There was no significant difference in ECD between preoperatively and postoperatively. Intrastromal femtosecond presbyopic treatment yielded a significant and stable gain of UNVA and corneal steepening without significant loss of endothelial cells or corneal thinning up to 18 months postoperatively. No significant regression of visual acuity or further corneal steepening occurred during the follow-up period. Dr. Auffarth and Dr. Holzer received lecture and consulting fees from Technolas Perfect Vision GmbH. No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 05/2012; 38(5):765-73. · 2.75 Impact Factor
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    ABSTRACT: Autologous keratoplasty from an amblyopic eye to the fellow oculus ultimus is a rarely used procedure. This is due to the relatively uncommon constellation of pathology. The following article reports the case of a graft rejection after autologous keratoplasty, while the homologous graft on the amblyopic fellow eye remained clear.
    Der Ophthalmologe 04/2012; 109(10):1014-6. · 0.53 Impact Factor
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    ABSTRACT: To investigate functional outcomes of the INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia. Sixty-three eyes from 63 presbyopic patients (median age: 54 years) with mild hyperopia were enrolled in this prospective, ethics committee-approved, multi-center, nonrandomized clinical trial. The INTRACOR procedure was performed using the Technolas femtosecond laser (Technolas Perfect Vision GmbH) in the nondominant eye. Postoperatively, follow-up was performed at 1 day, 1 week, and 1, 3, 6, and 12 months and included near and distance visual acuity tests, slit-lamp examinations, and corneal topography. All 63 surgeries were uneventful. Twelve months postoperatively, outcomes of 58 (92.1%) eyes were available for evaluation. Median uncorrected distance visual acuity (0.1 logMAR [range: 0.5 to 0.0 preoperatively and 0.5 to -0.1 postoperatively]) and corrected distance visual acuity (CDVA) (0.0 logMAR [range: 0.2 to -0.2 preoperatively and 0.3 to -0.1 postoperatively]) remained stable. Median spherical equivalent changed from +0.63 diopters (D) preoperatively to 0.00 D postoperatively. Median uncorrected near visual acuity increased significantly from 0.7 logMAR (range: 1.0 to 0.2) preoperatively to 0.2 logMAR (range: 0.8 to -0.1) postoperatively and eyes gained a median of 4 lines (range: 1 to 9 lines). Losses of 2 lines of CDVA were noted in 7.1% of eyes. Ring cuts were faintly visible at 12 months. The INTRACOR presbyopia procedure showed good and stable visual acuity outcomes over 12-month follow-up but loss of CDVA occurred in 7% of eyes. Overall patient satisfaction with the procedure was approximately 80%. Short treatment time and maintained corneal surface integrity are advantages of this procedure.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2012; 28(3):182-8. · 2.47 Impact Factor
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    ABSTRACT: Multifocal intraocular lenses (MIOL) are known to induce various photic phenomena depending on the optical principle. The aim of this study was to investigate the correlation between stray light measurements performed with the C-Quant (Oculus, Germany) and the results of a subjective patient questionnaire. In this study three different MIOLs were compared: AMO ReZoom (refractive design, n=10), AMO ZM900 (diffractive design, n=10) and Oculentis Mplus (near segment design, n=10). Cataract and refractive patients were enrolled in the study. Functional results were evaluated at least 3 months postoperatively followed by stray light measurements and a subjective questionnaire. Surgery was performed for all patients without complications. The three groups were matched for age, IOL power and corrected distance visual acuity (CDVA). Significantly different stray light (median) values log(s) were found (Kruskal-Wallis test, p<0.05): 1.12 log (refractive), 1.13 log (segment) and 1.28 log (diffractive). The subjective questionnaire did not show differences in glare perception but refractive MIOL patients noticed more halos surrounding light sources than the diffractive and segment MIOL patients. Stray light and subjective photopic phenomena do not show any basic correlation. Measurements in patients with refractive MIOLs showed less stray light than near segment or diffractive MIOLs. However, refractive MIOLs induced more halos compared to the other groups analyzed.
    Der Ophthalmologe 08/2011; 108(10):952-6. · 0.53 Impact Factor
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    ABSTRACT: The goal of this study was to determine the accuracy of autorefraction measurements in patients after INTRACOR intrastromal femtosecond laser treatment of presbyopia by comparing the agreement between the subjective and objective refraction. In this study the data of 19 patients with a mean age of 56.5±6.0 years following INTRACOR treatment were analyzed pre-operatively and 12 months postoperatively. Measurements of the subjective refraction and the results of the autorefractor Nidek-660A in miosis were compared. INTRACOR is a refractive intrastromal femtosecond laser treatment to correct presbyopia. During the procedure a series of five concentric rings in the central stroma are cut which cause a change in the curvature of the cornea. The differences in sphere and spherical equivalent between subjective refraction and autorefraction were not significant (t-test p>0.05 and Wilcoxon test p>0.05). Comparing the cylinder of the two measurements a significant difference (t-test p<0.05) was found. Focusing on the difference of the postoperative measurements of the subjective refraction and autorefraction a correlation (within ±0.5 D) of 89% in the sphere, 100% in cylinder and 68% in the spherical equivalent was detected. With one exception the differences in sphere, cylinder and the spherical equivalent were within ±1.25 D. In several patients the performance of the autorefraction with the Nidek-660A was somewhat complicated and the measures had to be repeated frequently. The agreement between subjective refraction and objective measurements of the Nidek-660A of patients following INTRACOR-treatment was good. However there was a significant difference in the cylinder values. Therefore thorough comparison of measurements obtained with the autorefractor and the subjective refraction is recommended.
    Der Ophthalmologe 07/2011; 108(9):852-8. · 0.53 Impact Factor
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    ABSTRACT: Biometric measurements and the knowledge of interrelationships of structures within the eye are especially mandatory for cataract and refractive surgery. As the number of pseudophakic patients steadily increases because cataract surgery becomes more easily available all over the world, exact biometry of eyes with crystalline lenses as well as pseudophakic eyes is gaining interest. In the present study we compared biometric measurements in pseudophakic eyes using a new optical low-coherence reflectometry (OLCR) device with results measured by the IOLMaster. In this prospective study 140 pseudophakic eyes from 123 adult volunteers following uneventful cataract surgery and IOL implantation were examined at the International Vision Correction Research Centre (IVCRC) at the University of Heidelberg, Germany. The aim of this study was to evaluate a functional prototype of the new LENSTAR LS 900 (Haag-Streit)/ALLEGRO BioGraph (Wavelight) biometer and the IOLMaster V.5 (Carl Zeiss Meditec) and to compare axial length (AL) and keratometry measurements with those obtained by the IOLMaster. Additionally we investigated whether the LENSTAR/BioGraph can detect anterior chamber depth (ACD) and the effective lens position (ELP) of IOLs by OLCR in pseudophakic eyes. Patients with corneal or intraocular pathology and patients who had undergone other surgery in the investigated eye or whose cataract surgery dated back less than 4 weeks were not included in the study. Measurements were repeated with both devices as recommended by the manufacturers. Results were compared using Bland-Altman plots, Passing Bablok regression analysis and Pearson correlation calculations (MedCalc version 7.3.0.1). Valid axial length measurements were available in 137 eyes. The mean values were 23.75 mm for both devices (SD±2.08 with the IOLMaster, ±1.7 with the LENSTAR/BioGraph). The mean corneal radius (R) was 7.7±0.27 mm (IOLMaster) vs. 7.74±0.29 mm (LENSTAR/BioGraph). Valid ACD measurements with the LENSTAR/BioGraph were achieved in 30% of all cases. In 98.6% of the eyes in which ACD was analyzed manually a mean ACD of 4.73±0.53 mm was found. Both devices tested in this study showed a high correlation for AL and keratometry measurements. ACD measurements performed with the LENSTAR/BioGraph showed a measurable signal but the prototype calculated a value only in the minority (30%) of cases. This study showed that on the one hand the LENSTAR/BioGraph has the potential to be a reliable and useful machine for clinical everyday routine: This space and time-saving device includes several features which make it a patient and user friendly tool for diagnostics as well as screening. On the other hand we found that the software used in the prototype could be improved especially in order to identify IOLs and to measure reliable ACD values in pseudophakic patients. IOL surfaces did not generate sufficient interference signals in the LENSTAR/BioGraph and although the light reflected by the IOL surfaces was recognized by the device the software version used in this study did not generate numerical results for ACD.
    Der Ophthalmologe 05/2011; 108(8):739-44. · 0.53 Impact Factor
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    ABSTRACT: To evaluate the accuracy of intraocular lens (IOL) power calculation after an intrastromal femtosecond laser procedure to treat presbyopia using a theoretic approach. International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. Nonrandomized clinical trial. Preoperatively and 12 months after intrastromal femtosecond laser treatment (IntraCor) of presbyopia, biometry was performed by partial coherence interferometry (PCI) (IOLMaster). The postoperative keratometry (K) values and IOL power calculation formulas (Holladay I, Haigis, SRK/T, Hoffer Q) were compared with results derived from the clinical history method, taking the manifest refraction change into account. The study enrolled 25 patients (median age 54 years). Three eyes were excluded for age-related lens changes. The median spherical equivalent change in the other 22 eyes was -0.38 diopter (D). The median difference in K values between the clinical history method and PCI was -0.21 D, resulting in a median IOL power difference between -0.23 D (SRK/T) and -0.29 D (Haigis) (range -1.58 to +1.00 D). The IOL power was underestimated in 59.1% of cases with the Hoffer Q and 63.6% of cases with the Holladay I, Haigis, and SRK/T. There was a difference of ±0.75 D in 72.7% of eyes using the Holladay I, Haigis, and Hoffer Q and in 86.4% of eyes using the SRK/T. Neither K values nor IOL power differences were statistically significant (P > .17). Intraocular lens power calculation using modern standard formulas incorporated in a PCI biometry device after intrastromal femtosecond presbyopia treatment was reliable, with minimum underestimation on average.
    Journal of Cataract and Refractive Surgery 03/2011; 37(3):532-7. · 2.75 Impact Factor
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    ABSTRACT: HintergrundZiel dieser Untersuchung ist es, den Einfluss der Applanationstonometrie auf die Präzision der Biometrie sowie auf die Reliabilität von Keratometriemessungen zu analysieren. Patienten und MethodenIn diese klinisch-prospektive Studie wurden 30 Augen von 16 Kataraktpatienten eingeschlossen. Präoperativ wurde eine IOLMaster-Biometrie vor und 10min nach Applanationstonometrie (Lokalanästhesie: Oxybuprocain 0,4%) durchgeführt. ErgebnisseDie absolute mittlere Differenz der Intraokularlinsenstärke für Emmetropie betrug 0,31±0,3dpt mit Abweichungen von −1,56 bis +1,12dpt. Die mittlere Standardabweichung für die Hornhautradien R1 und R2 (n=28 Augen) lag bei 0,014±0,013mm vor und bei 0,024±0,021mm nach der Tonometrie. Dieser Unterschied war statistisch signifikant (t-Test, p<0,01). Gelegentlich wurden starke korneale Oberflächenunregelmäßigkeiten beobachtet, durch die die notwendige Anzahl an fehlerfreien Keratometriemessungen nicht erhoben werden konnten. SchlussfolgerungDie Biometrie sollte zu Beginn der präoperativen Untersuchung durchgeführt werden, da Lokalanästhesie und Applanationstonometrie die Messgenauigkeit reduzieren können. BackgroundThe aim of this study was to investigate the effect of applanation tonometry on the accuracy of biometric measurements and the reproducibility of keratometric measurements. Patients and methodsIn this clinical prospective study a total of 16 patients were enrolled who presented for cataract surgery on 30 eyes. Biometry measurements were made using an IOLMaster optical biometer before and 10min after standard Goldmann applanation tonometry. Local anesthesia was achieved by administering one drop of fluorescein-stained oxybuprocaine 0.4%. ResultsThe mean absolute difference of intraocular lens power for emmetropia was 0.31±0.33D (range −1.56 to +1.12D) and the mean standard deviation for R1 and R2 (n=28 eyes) was 0.014±0.013mm before and 0.024±0.021mm after tonometry. This difference was statistically significant (t-test, p<0.01). Moderate to severe irregular corneal surfaces were noted in some cases after tonometry. ConclusionsLocal anesthesia and applanation tonometry reduced the accuracy of IOL power calculations with differences exceeding ±1D and the reliability of consecutive keratometry measurements decreased significantly. Therefore, it is advisable to perform biometry measurements at the very beginning of the preoperative examination. SchlüsselwörterBiometrie–Tonometrie–Applanation–Intraokularlinsenberechnung–Lokalanästhesie KeywordsBiometry–Tonometry–Applanation–Intraocular lens power–Local anesthesia
    Der Ophthalmologe 01/2011; 108(1):52-56. · 0.53 Impact Factor
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    ABSTRACT: HintergrundBiometrische Messungen und die Kenntnis über die Beziehung von Strukturen im Auge sind v.a. für die Katarakt- und die refraktive Chirurgie erforderlich. In der vorliegenden Studie wurden Messdaten eines neuen Geräts, das mit optischer Kurzstreckenkohärenzreflektometrie (OLCR) arbeitet, mit Ergebnissen des IOLMaster verglichen. Material und MethodenEs wurden 140 pseudophake Augen nach komplikationsloser Kataraktoperation mit IOL-Implantation bezüglich Augenlänge (AL) und Keratometrie sowie Vorderkammertiefe (VKT) mit einem Prototyp des LENSTAR LS900 (Haag-Streit AG)/ALLEGRO BioGraph (Wavelight AG) und dem IOLMaster V.5 (Carl Zeiss Meditec AG) untersucht. Patienten mit kornealer oder intraokulärer Pathologie und Patienten, deren Kataraktoperation weniger als 4Wochen zurücklag oder die einen anderen Eingriff am Auge hinter sich hatten, wurden nicht in die Studie einbezogen. Die Messungen wurden gemäß der Empfehlung des jeweiligen Herstellers durchgeführt und mittels Bland-Altman-Diagramm, Passing-Bablok-Regressionsanalyse und Pearson-Korrelation ausgewertet. ErgebnisseValide Messungen für die AL konnten bei 137Augen erreicht werden. Der Mittelwert (MW) lag für beide Geräte bei 23,75mm (±2,08 am IOLMaster; ±1,7 am LENSTAR/BioGraph). Der mittlere Hornhautradius (R) lag bei 7,7±0,27mm (IOLMaster) bzw. 7,74±0,29 mm (LENSTAR/BioGraph). Valide Werte für die VKT konnten mittels LENSTAR/BioGraph in 30% der Fälle gemessen werden. Bei 98,6% der Augen, für die die VKT manuell ermittelt wurde, ergab sich ein MW von 4,73±0,53mm. SchlussfolgerungDie Geräte zeigten für AL und Keratometrie hohe Übereinstimmung. Die VKT-Signalspitzen im A-Scan des LENSTAR/BioGraph führten jedoch in der Minderheit der Fälle (30%) zu numerischen VKT-Werten. Während sich der LENSTAR/BioGraph als raum- und zeitsparendes sowie benutzer- und patientenfreundliches Gerät dargestellt hat, muss die Software für die Vermessung pseudophaker Patienten in Zukunft noch verbessert werden. BackgroundBiometric measurements and the knowledge of interrelationships of structures within the eye are especially mandatory for cataract and refractive surgery. As the number of pseudophakic patients steadily increases because cataract surgery becomes more easily available all over the world, exact biometry of eyes with crystalline lenses as well as pseudophakic eyes is gaining interest. In the present study we compared biometric measurements in pseudophakic eyes using a new optical low-coherence reflectometry (OLCR) device with results measured by the IOLMaster. Patients and methodsIn this prospective study 140 pseudophakic eyes from 123 adult volunteers following uneventful cataract surgery and IOL implantation were examined at the International Vision Correction Research Centre (IVCRC) at the University of Heidelberg, Germany. The aim of this study was to evaluate a functional prototype of the new LENSTAR LS 900 (Haag-Streit)/ALLEGRO BioGraph (Wavelight) biometer and the IOLMaster V.5 (Carl Zeiss Meditec) and to compare axial length (AL) and keratometry measurements with those obtained by the IOLMaster. Additionally we investigated whether the LENSTAR/BioGraph can detect anterior chamber depth (ACD) and the effective lens position (ELP) of IOLs by OLCR in pseudophakic eyes. Patients with corneal or intraocular pathology and patients who had undergone other surgery in the investigated eye or whose cataract surgery dated back less than 4 weeks were not included in the study. Measurements were repeated with both devices as recommended by the manufacturers. Results were compared using Bland-Altman plots, Passing Bablok regression analysis and Pearson correlation calculations (MedCalc version 7.3.0.1). ResultsValid axial length measurements were available in 137 eyes. The mean values were 23.75mm for both devices (SD±2.08 with the IOLMaster, ±1.7 with the LENSTAR/BioGraph). The mean corneal radius (R) was 7.7±0.27mm (IOLMaster) vs. 7.74±0.29mm (LENSTAR/BioGraph). Valid ACD measurements with the LENSTAR/BioGraph were achieved in 30% of all cases. In 98.6% of the eyes in which ACD was analyzed manually a mean ACD of 4.73±0.53mm was found. ConclusionsBoth devices tested in this study showed a high correlation for AL and keratometry measurements. ACD measurements performed with the LENSTAR/BioGraph showed a measurable signal but the prototype calculated a value only in the minority (30%) of cases. This study showed that on the one hand the LENSTAR/BioGraph has the potential to be a reliable and useful machine for clinical everyday routine: This space and time-saving device includes several features which make it a patient and user friendly tool for diagnostics as well as screening. On the other hand we found that the software used in the prototype could be improved especially in order to identify IOLs and to measure reliable ACD values in pseudophakic patients. IOL surfaces did not generate sufficient interference signals in the LENSTAR/BioGraph and although the light reflected by the IOL surfaces was recognized by the device the software version used in this study did not generate numerical results for ACD. SchlüsselwörterBiometrie–IOLMaster–LENSTAR LS900–Pseudophakie–Kataraktchirurgie KeywordsBiometry–IOLMaster–LENSTAR LS 900–Pseudophakia–Cataract surgery
    Der Ophthalmologe 01/2011; 108(8):739-744. · 0.53 Impact Factor

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Institutions

  • 2003–2013
    • Universität Heidelberg
      • Department of Ophthalmology
      Heidelburg, Baden-Württemberg, Germany
  • 2010
    • Guangdong Academy of Medical Sciences and General Hospital
      Shengcheng, Guangdong, China
  • 2003–2005
    • Medical University of South Carolina
      • Storm Eye Institute
      Charleston, SC, United States
  • 2000
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany