Purpose: After initial encouraging results with the accommodative 1CU posterio r chamber lens (PCIOL), we investigated the rate, the postoperative time point o f posterior capsular opacification (PCO) necessitating YA...Purpose: After initial encouraging results with the accommodative 1CU posterio r chamber lens (PCIOL), we investigated the rate, the postoperative time point o f posterior capsular opacification (PCO) necessitating YAG capsulotomy and the a ccommodative range after Nd: YAG capsulotomy in patients with 1CU-PCIOL. Patien ts and methods: This prosective clinical study included 65 patients who underwen t phacoemulsification and implantation of the accommodative 1CU-PCIOL with post operative follow-up from 3 to 24 months. Postoperative examination was performe d 3, 6 and 12 months after surgery, then before and 6 weeks after Nd: YAG capsul otomy. Measurements included: the best corrected distance visual acuity, distanc e refraction, near visual acuity (Birkhauser charts in 35 cm) obtained with be st distance correction, accommodative range measured by subjective near point wi th an accodommometer and defocusing with a visual acuity fall to 0.4. Results: B oth best corrected distance visual acuity (1.1±0.1) and near visual acuity with best distance correction (0.4±0.1) remained stable over the follow-up period until 12 months postoperatively. The accommodative range determined by near poin t was stable (mean 2.0±0.5 D). Also, the defocusing range remained stable over 12 months (1.8±0.4 D). A clinically relevant posterior c apsule opacification with a significant decrease of visual acuity (0.4±0.2) and a need for Nd: YAG capsulotomy was diagnosed in 12 patients between 15 and 22 ( mean 20±4, median 20) months postoperatively. All capsulotomies were performed without complication. Six weeks after capsulotomy, best corrected distance visua l acuity was improved (1.1±0.1), near visual acuity with best distance correcti on was 0.4±0.1 and the accommodative range determined by near point was 1.95±0 .6 D and by defocusing was 1.88±0.47 D. Six weeks after capsulotomy, measuremen ts of the accommodative range did not show any statistical difference to the 12 -month results before the occurrence of PCO (P >0.5). Conclusions: A clinically relevant PCO with a significant decrease of visual acuity necessitating Nd: YAG capsulotomy occurred mainly after 15 postoperative months in patients with 1CU. Our results indicate that Nd: YAG capsulotomy may not affect the accommodation ability of the 1CU. Nevertheless, long-term studies are needed to further analy ze the accommodative properties.展开更多
Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced st...Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.展开更多
文摘Purpose: After initial encouraging results with the accommodative 1CU posterio r chamber lens (PCIOL), we investigated the rate, the postoperative time point o f posterior capsular opacification (PCO) necessitating YAG capsulotomy and the a ccommodative range after Nd: YAG capsulotomy in patients with 1CU-PCIOL. Patien ts and methods: This prosective clinical study included 65 patients who underwen t phacoemulsification and implantation of the accommodative 1CU-PCIOL with post operative follow-up from 3 to 24 months. Postoperative examination was performe d 3, 6 and 12 months after surgery, then before and 6 weeks after Nd: YAG capsul otomy. Measurements included: the best corrected distance visual acuity, distanc e refraction, near visual acuity (Birkhauser charts in 35 cm) obtained with be st distance correction, accommodative range measured by subjective near point wi th an accodommometer and defocusing with a visual acuity fall to 0.4. Results: B oth best corrected distance visual acuity (1.1±0.1) and near visual acuity with best distance correction (0.4±0.1) remained stable over the follow-up period until 12 months postoperatively. The accommodative range determined by near poin t was stable (mean 2.0±0.5 D). Also, the defocusing range remained stable over 12 months (1.8±0.4 D). A clinically relevant posterior c apsule opacification with a significant decrease of visual acuity (0.4±0.2) and a need for Nd: YAG capsulotomy was diagnosed in 12 patients between 15 and 22 ( mean 20±4, median 20) months postoperatively. All capsulotomies were performed without complication. Six weeks after capsulotomy, best corrected distance visua l acuity was improved (1.1±0.1), near visual acuity with best distance correcti on was 0.4±0.1 and the accommodative range determined by near point was 1.95±0 .6 D and by defocusing was 1.88±0.47 D. Six weeks after capsulotomy, measuremen ts of the accommodative range did not show any statistical difference to the 12 -month results before the occurrence of PCO (P >0.5). Conclusions: A clinically relevant PCO with a significant decrease of visual acuity necessitating Nd: YAG capsulotomy occurred mainly after 15 postoperative months in patients with 1CU. Our results indicate that Nd: YAG capsulotomy may not affect the accommodation ability of the 1CU. Nevertheless, long-term studies are needed to further analy ze the accommodative properties.
文摘Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.
