Using a slit lamp-mounted digital high-speed camera for dynamic observation of phakic lenses during eye movements: a pilot study

Martin Alexander Leitritz, Focke Ziemssen, Karl Ulrich Bartz-Schmidt, Bogomil Voykov Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany Purpose: To evaluate a digital high-speed camera combined with digital morphometry software for dynamic measurements of phakic intraocular lens movements to observe kinetic influences, particularly in fast direction changes and at lateral end points. Materials and methods: A high-speed camera taking 300 frames per second observed movements of eight iris-claw intraocular lenses and two angle-supported intraocular lenses. Standardized saccades were performed by the patients to trigger mass inertia with lens position changes. Freeze images with maximum deviation were used for digital software-based morphometry analysis with ImageJ.Results: Two eyes from each of five patients (median age 32 years, range 28–45 years) without findings other than refractive errors were included. The high-speed images showed sufficient usability for further morphometric processing. In the primary eye position, the median decentrations downward and in a lateral direction were -0.32 mm (range -0.69 to 0.024) and 0.175 mm (range -0.37 to 0.45), respectively. Despite the small sample size of asymptomatic patients, we found a considerable amount of lens dislocation. The median distance amplitude during eye movements was 0.158 mm (range 0.02–0.84). There was a slight positive corrlation (r=0.39, P<0.001) between the grade of deviation in the primary position and the distance increase triggered by movements.Conclusion: With the use of a slit lamp-mounted high-speed camera system and morphometry software, observation and objective measurements of iris-claw intraocular lenses and angle-supported intraocular lenses movements seem to be possible. Slight decentration in the primary position might be an indicator of increased lens mobility during kinetic stress during eye movements. Long-term assessment by high-speed analysis with higher case numbers has to clarify the relationship between progressing motility and endothelial cell damage. Keywords: intraocular lens, high-speed camera, phakic len

Submacular predominantly hemorrhagic choroidal neovascularization: resolution of bleedings under anti-VEGF therapy

Spyridon Dimopoulos, Martin Alexander Leitritz, Focke Ziemssen, Bogomil Voykov, Karl Ulrich Bartz-Schmidt, Faik Gelisken Centre for Ophthalmology, Eberhard-Karls University, Tuebingen, Germany Purpose: To report the visual and morphological outcomes following intravitreal bevacizumab in neovascular age-related macular degeneration (nAMD) with submacular, predominantly hemorrhagic, lesions.Methods: Retrospective study of patients with a follow-up after 1 year. All eyes with submacular hemorrhages larger than 50% of the total lesion size and received only anti-VEGF (vascular endothelial growth factor) monotherapy (intravitreous administration of 1.25 mg bevacizumab, PRN). The primary endpoint was the change in hemorrhage size and time to resolution, in association with the mean best-corrected visual acuity (BCVA). The eyes were grouped based on the size of the hemorrhage: group A (≥1 to <4 disc area [DA]), group B (≥4 to <9 DA), and group C (≥9 DA).Results: Forty-six consecutive eyes were included. The mean area of the hemorrhage was 6 DA at baseline. Eyes with smaller bleeding (group A) had better chances of stabilized or improved vision. Complete resolution of the hemorrhage was seen in 96% of the eyes within 1 year. The mean BCVA increased from 0.81 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI]: 0.70–0.92) (Snellen 20/125) at baseline to 0.75 logMAR (95% CI: 0.62–0.88) (20/125) after 1 year (P=0.11). BCVA improved (one or more ETDRS [Early Treatment of Diabetic Retinopathy Study] lines) in 57% of the eyes (13/23) in group A; 53% (8/15) in group B; and 38% (3/8) in group C.Conclusion: Many of the eyes with hemorrhagic lesions showed stabilization or improvement of the mean BCVA after treatment within 1 year. Anti-VEGF treatment can be considered as a useful treatment option in eyes with hemorrhages secondary to nAMD. Keywords: age-related macular degeneration, bevacizumab, submacular hemorrhag

Comparison of ab externo trabeculotomy in primary open-angle glaucoma and uveitic glaucoma: long-term outcomes

Antony William, Martin S Spitzer, Deshka Doycheva, Spyridon Dimopoulos, Martin Alexander Leitritz, Bogomil Voykov Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany Background: The aim of this study was to compare the long-term outcomes of ab externo trabeculotomy in primary open-angle glaucoma (POAG) and uveitic glaucoma (UG). Design: This was a retrospective single-center case series study. Participants: Twenty eyes of 17 patients with POAG and 22 eyes of 18 patients with UG were included in this study. Patients and methods: The medical records of all consecutive patients with POAG and UG who underwent ab externo trabeculotomy since 2004 were reviewed. Main outcome measure: The main outcome measure was change in median intraocular pressure (IOP). Success was defined as IOP ≤21 mmHg (success 1) and IOP ≤21 mmHg and at least 25% reduction from baseline (success 2). Results: In the POAG group, the median IOP decreased significantly from 22 mmHg (95% CI 21–25 mmHg; n=20) at baseline to 14 mmHg (95% CI 12–16; n=13) after 4 years, P<0.001. In the UG group, the median IOP decreased significantly from 27 mmHg (95% CI 24.5–30.5 mmHg; n=22) at baseline to 12 mmHg (95% CI 9–15 mmHg; n=15) after 4 years, P<0.001. Seven eyes in the UG group failed within the first year after surgery compared to none in the POAG group. Of these, four eyes had Fuchs’ uveitis syndrome and two had granulomatous uveitis. No sight-threatening complications occurred in both POAG and UG groups. Conclusion: Ab externo trabeculotomy effectively reduced IOP in both UG and POAG groups. However, the success rates in the UG group were significantly lower due to the high failure rate in patients with Fuchs’ uveitis syndrome and granulomatous uveitis. The procedure demonstrated a high safety profile in both UG and POAG patients. Keywords: ab externo trabeculotomy, primary open-angle glaucoma, uveitic glaucom

Quality and learning curve of handheld versus stand-alone non-mydriatic cameras

Mariya Gosheva,1 Christian Klameth,1 Lars Norrenberg,2 Lucien Clin,3 Johannes Dietter,4 Wadood Haq,4 Iliya V Ivanov,4–6 Focke Ziemssen,1 Martin A Leitritz7 1University Eye Hospital, Centre for Ophthalmology, Tuebingen, 2Department of Obstetrics and Gynecology, Klinikum am Steinenberg, District Hospital Reutlingen, Reutlingen, 3School of Informatics, Reutlingen University, 4Division of Experimental Ophthalmology, Centre for Ophthalmology, Institute for Ophthalmic Research, 5Vision Rehabilitation Research Unit, Centre for Ophthalmology, University Eye Hospital, Eberhard Karls, 6ZEISS Vision Science Lab, Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen, 7Section for Experimental Ophthalmic Surgery and Refractive Surgery, University Eye Hospital, Centre for Ophthalmology, Tuebingen, Germany Purpose: Nowadays, complex digital imaging systems allow detailed retinal imaging without dilating patients’ pupils. These so-called non-mydriatic cameras have advantages in common circumstances (eg, for screening or emergency purposes) but present limitations in terms of image quality and field of view. We compare the usefulness of two non-mydriatic camera systems (ie, a handheld versus a stand-alone device) for fundus imaging. The primary outcome was image quality. The secondary outcomes were learning effects and quality grade-influencing factors.Methods: The imaging procedures followed standard protocol and were all performed by the same investigator. Camera 1 (DRS®) was a stand-alone system, while Camera 2 (Smartscope® PRO) was a mobile system. In order to evaluate possible learning effects, we selected an examiner with no prior training in the use of these systems. The images were graded separately by two experienced and “blinded” ophthalmologists following a defined protocol.Results: In total, 211 people were enrolled. Quality grade comparisons showed significantly better grades for Camera 1. Both systems achieved better quality grades for macular images than for disc-centered images. No remarkable learning effects could be demonstrated.Conclusions: Both camera systems are useful for fundus imaging. The greater mobility of Camera 2 was associated with lower image quality. For screening scenarios or telemedicine, it must be determined whether image quality or mobility is more important. Keywords: imaging, non-mydriatic, handheld camera, learning curv