In this study, we report data on intraoperative complications occurring after cataract surgery in a high-volume single-center setting using a low-energy, mobile femtosecond laser. We retrospectively ...reviewed the medical records of patients who underwent femtosecond laser-assisted cataract surgery (FLACS) in our hospital between August 2015 and December 2019. Among the sample of 1,806 eyes of 1,131 patients (903 left and 903 right eyes), the mean age was 75.8 years (range, 21-99 years). The overall intraoperative complication rate was 0.28% (n = 5), with three cases of anterior capsule tear (0.17%) and two cases of posterior capsule tear (0.11%). No further complications occurred. This study underlines the safety of low-energy femtosecond-assisted cataract surgery in a real-world setting with a very low rate of intraoperative complications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This article provides an overview of both established and innovative applications of femtosecond (fs)-laser-assisted surgical techniques in ophthalmology. Fs-laser technology is unique because it ...allows cutting tissue at very high precision inside the eye. Fs lasers are mainly used for surgery of the human cornea and lens. New areas of application in ophthalmology are on the horizon. The latest improvement is the high pulse frequency, low-energy concept; by enlarging the numerical aperture of the focusing optics, the pulse energy threshold for optical breakdown decreases, and cutting with practically no side effects is enabled.
To assess potential changes in pupil size during femtosecond laser-assisted cataract surgery (FLACS) using a low-energy laser system.
The pupil sizes of eyes undergoing FLACS were measured using the ...Ziemer LDV Z8 by extracting images from the laser software after each of the following steps: application of suction, lens fragmentation, and capsulotomy. Furthermore, the pupil diameters were measured based on preoperative surgical microscope images and after releasing the suction. Paired t-test and the two one-sided tests (TOST) procedure were used for statistical analyses. The horizontal and vertical pupil diameters were compared in each of the steps with preoperative values.
Data were available for 52 eyes (52 patients, mean age 73.4 years, range 51-87 years). The equivalence between mean preoperative pupil size and status immediately after femtosecond laser treatment was confirmed (p<0.001; 95% confidence interval -0.0637, 0.0287 for horizontal and p<0.001; 95% CI -0.0158, 0.0859 for vertical diameter). There was statistically significant horizontal and vertical enlargement of pupil diameters between 0.15 and 0.24 mm during the laser treatment steps as compared with preoperative values (all p values <0.001).
No progressive pupil narrowing was observed using low-energy FLACS. Although a suction-induced, slight increase in pupil area became apparent, this effect was completely reversible after removing the laser interface.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To study the distribution of refractive errors among adults of European descent.
Population-based eye study in Germany with 15010 participants aged 35-74 years.
The study participants underwent a ...detailed ophthalmic examination according to a standardised protocol. Refractive error was determined by an automatic refraction device (Humphrey HARK 599) without cycloplegia. Definitions for the analysis were myopia <-0.5 dioptres (D), hyperopia >+0.5 D, astigmatism >0.5 cylinder D and anisometropia >1.0 D difference in the spherical equivalent between the eyes. Exclusion criterion was previous cataract or refractive surgery.
13959 subjects were eligible. Refractive errors ranged from -21.5 to +13.88 D. Myopia was present in 35.1% of this study sample, hyperopia in 31.8%, astigmatism in 32.3% and anisometropia in 13.5%. The prevalence of myopia decreased, while the prevalence of hyperopia, astigmatism and anisometropia increased with age. 3.5% of the study sample had no refractive correction for their ametropia.
Refractive errors affect the majority of the population. The Gutenberg Health Study sample contains more myopes than other study cohorts in adult populations. Our findings do not support the hypothesis of a generally lower prevalence of myopia among adults in Europe as compared with East Asia.
Glaucoma is a neurodegenerative disease, leading to thinning of the retinal nerve fibre layer (RNFL). The exact influence of ocular, cardiovascular, morphometric, lifestyle and cognitive factors on ...RNFL thickness (RNFLT) is unknown and was analysed in a subgroup of the Gutenberg Health Study (GHS).
Global peripapillary RNFLT was measured in 3224 eyes of 1973 subjects (49% female) using spectral-domain optical coherence tomography (SD-OCT). The association of age, sex, ocular, cardiovascular, morphometric, lifestyle and cognitive factors on RNFLT was analysed using Pearson correlation coefficient and fitting a linear mixed model.
In the univariable analysis highest correlations were found for axial length (r = -0.27), spherical equivalent (r = 0.24), and glaucoma (r = -0.15) (p<0.0001, respectively). Other significant correlations with RNFLT were found for age, sex, intraocular pressure, systemic hypertension and systolic blood pressure, previous eye surgery, cholesterol, homocysteine, history of coronary artery disease, history of myocardial infarction, apnoea, diabetes and alcohol intake, p<0.05, respectively. Body length, body weight, BMI, diastolic blood pressure, blood glucose, HbA1c, history of apoplexy, cognitive function, peripheral artery disease, tinnitus, migraine, nicotine intake, central corneal thickness, and pseudophakia were not significantly correlated with RNFLT. The regression model revealed a significant relationship between RNFLT and age in decades (p<0.02), spherical equivalent (p<0.0001), axial length (p<0.0001), glaucoma (p<0.0001), tinnitus (p = 0.04), apnoea (p = 0.047), homocysteine (p = 0.05) and alcohol intake >10g/d for women and >20g/d for men (p = 0.02). Glaucoma, apnoea, higher homocysteine, higher alcohol intake and higher axial length as well as age were related to decreased RNFLT while higher spherical equivalent or history for tinnitus were related to thicker RNFL.
RNFLT is related to age, ocular parameters and lifestyle factors. Considering these parameters in normative databases could improve the evaluation of peripapillary RNFLT. It is necessary to evaluate if a reduction of alcohol intake as well as the therapy of apnea or high homocysteine levels could positively influence RNFLT.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To study the potential changes in pupil area within low-energy femtosecond-laser assisted cataract surgery (FLACS).
A retrospective assessment of the pupil size was performed in the eyes undergoing ...FLACS using the Ziemer LDV Z8. We measured the pupil diameters as part of the images taken preoperatively and at the completion of laser pretreatment (after releasing the suction). We calculated the pupil area in 40 eyes of 40 patients (14 right and 26 left eyes). The mean
standard deviation (SD) of age of the patients was 74
7.4 years (range: 51-87). Paired
-test was used for statistical analyses. Subgroups were built with reference to age and preoperative pupil area (smaller than or equal to the median versus larger than the median).
The mean
SD axial length, anterior chamber depth, white-to-white distance and lens thickness were 24.01
1.47, 3.23
0.4, 11.97
0.49, and 4.59
0.41 mm, respectively. The mean
SD pupil area was 39.33
7.1 mm
preoperatively and 39.3
6.75 mm
after laser pretreatment. The mean
SD change in pupil area was -0.03
2.12 mm
. There were no statistically significant changes between preoperative and post-laser pupil areas (
= 0.93, 95% CI: -0.71 to 0.65). Comparisons within subgroups also did not detect pupil area reduction.
This study did not detect statistically significant changes in pupil area after laser pretreatment using low-energy FLACS. This observation is in contrast to previous studies using other laser platforms.
Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and ...maculopathy (DMac) in Germany.
The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.
Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio 95% confidence interval: 0.97 0.955-0.992; p = 0.006) arterial hypertension (1.90 1.190-3.044; p = 0.0072) and vision-threatening DR with obesity (3.29 1.504-7.206; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 1.068-1.114; p<0.0001 and 1.18 1.137-1.222; p<0.0001, respectively).
Our calculations suggest that approximately 142 000 persons aged between 35 and 74 years have vision threatening diabetic retinal disease in Germany corrected.Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
The aim of this study was to describe the sex- and age-specific prevalence of age-related macular degeneration (AMD) and its correlation with urban or rural residence in a large and ...relatively young European cohort.
Methods
We evaluated fundus photographs from participants in the Gutenberg Health Study (GHS), a population-based, prospective, observational, single-centre study in the Rhineland-Palatine region in midwestern Germany. The participants were 35–74 years of age at enrolment. The fundus images were classified as described in the Rotterdam Study and were graded independently by two experienced ophthalmologists (CK and UBK) based on the presence of hard and soft drusen, retinal pigmentary abnormalities, and signs of atrophic or neovascular age-related macular generation (AMD).
Results
Photographs from 4,340 participants were available for grading. Small, hard drusen (<63 μm, stages 0b and 0c) were present in 37.4 % of participants (95 % confidence interval CI, stage 0b, 31.6 % 30.3–33.7; stage 0c, 5.8 % 5.1–6.5). Early AMD (soft drusen, pigmentary abnormalities, stages 1–3) was present in 3.8 % of individuals in the youngest age group (35–44 years) (95 % CI, stage 1a, 0.4 % 0.3–0.5 %; stage 1b, 3.2 % 2.9–3.5 %; stage 2a, 0.1 % 0.1–0.2 %; stage 2b, 0 % 0–0.0 %; stage 3, 0.1 % 0.1–0.2 %), whereas late AMD (stages 4a and 4b) did not appear in the youngest age group. In all age groups, signs of early AMD were detected in 11.9 % of individuals (stage 1a, 2.1 % 1.7–2.6; stage 1b, 8.0 % 7.2–8.8; stage 2a, 1.0 % 0.7–1.3; stage 2b, 0.5 % 0.3–0.7; stage 3, 0.3 % 0.2–0.6). Late AMD (geographic atrophy or neovascular AMD) was found in 0.2 % of individuals (stage 4a, 0.1 % 0.0–0.2; stage 4b, 0.1 % 0.0–0.2). AMD increased significantly with age (odds ratio OR, 1.09; 95 % CI, 1.08–1.10). Sex, iris colour, and residence (rural vs. urban) were not associated with different rates of AMD.
Conclusions
In this study, the prevalence of AMD increased dramatically with age; however, although AMD is usually thought to occur after age 50, signs of early AMD were found in 3.8 % of individuals in the youngest age group (younger than 45 years). This population-based sample is the first to provide substantial epidemiologic data from a large German cohort, including data on macular degeneration in younger age groups and incidence data after recall.
Background
Choroidal thickness is associated with several cardiovascular parameters in case–control studies including patients with manifest disease. So far, it was unclear whether underlying ...cardiovascular risk factors or the continuum of heart failure may lead to alterations of the choroid. Therefore, our hypothesis was to test in a population-based study, whether choroidal thickness is associated with cardiovascular risk factors and heart disease.
Methods
A population-based cross-sectional study was carried out in Germany. A comprehensive medical examination including assessment of cardiovascular risk factors, echocardiography and ophthalmological examinations with spectral-domain optical coherence tomography of the choroid was performed. Subfoveal choroidal thickness as well as left ventricular ejection fraction (LVEF) and a surrogate marker for left ventricular end-diastolic pressure (E/e’) were measured. Linear regression analyses were carried out to determine the relationship between subfoveal choroidal thickness and age, sex, body mass index, systolic blood pressure, dyslipidemia, HbA1c level, hematocrit, estimated glomerular filtration rate (eGFR), LVEF, E/e’ and left ventricular mass index adjusted for ocular parameters.
Results
1.742 subjects (48% females) with a mean age 59.3 ± 10.6 years were included in this study. Mean subfoveal thickness was 252 ± 77 µm (right eyes) and 255 ± 77 µm (left eyes). Unadjusted linear regression analysis revealed that subfoveal choroidal thickness is associated with sex, age, systolic blood pressure, hematocrit, eGFR, left ventricular end-diastolic pressure, left ventricular mass index (all
p
< 0.001) and dyslipidemia (
p
= 0.009). Adjusted linear regression only revealed age as associated parameter (
p
< 0.001).
Conclusions
We did find evidence for an association between subfoveal choroidal thickness and cardiovascular risk factors which was mediated by aging.
Graphic abstract
Purpose
To examine the influence of different intravitreous injection techniques on the short-term intraocular pressure (IOP) in patients with exudative age-related macular degeneration (AMD) ...receiving 0.05 ml ranibizumab (Lucentis®) in the supine position.
Methods
Forty-five eyes (45 patients, 16 male, 29 female, mean age: 78 years) received intravitreal ranibizumab injections for treatment of exudative AMD (0.05 ml = 0.5 mg). A total of 31 patients received a standard straight scleral incision, and 14 were injected using the tunneled sclera technique. IOP was measured by Schiøtz tonometry immediately pre-and postoperatively, and the amount of subconjunctival reflux was documented using a semi-quantitative scale. Twenty-three eyes were phakic, and the remaining 22 were pseudophakic. No history of glaucoma was present. The Wilcoxon matched-pairs test was used for comparisons.
Results
The mean preoperative IOP was 22.4 ± 5.5 mmHg in the supine position. Immediately after the injection, the IOP increased to 47.9 ± 15.1 (range 23–82). The mean difference between preoperative IOP and immediately after the injection was 25.5 ± 13.6 mmHg. The mean IOP increase in eyes receiving a standard straight scleral incision was 21.9 ± 14.2 mmHg (median 22.3) versus 33.5 ± 7.2 mmHg (median 34.7) in the tunneled scleral incision group (
p
= 0.001).
Conclusions
IOP increased significantly in a considerable number of patients after receiving 0.05-ml intravitreal ranibizumab injections. This increase was dependent on the intravitreal injection technique and was significantly higher if a tunneled scleral injection was performed.
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