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Biomedical subjects

D D Koch

Publications and source records attributed to D D Koch.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Surface quality of flexible silicone intraocular lenses. A scanning electron microscopy study].

BACKGROUND: Soft intraocular lenses (IOLs) have been developed to be folded during insertion to allow implantation through a small incision. The surface of the IOL is of great importance in postoperative inflammation and long-term acceptance of the implant. Rough and sharp edges can damage delicate intraocular tissues. The purpose of this study was to analyze new, foldable silicone IOLs for surface quality prior to and following folding. MATERIALS AND METHODS: Eleven silicone IOLs of different types were included in this study (four one-piece plate-haptic silicone IOLs and seven three-piece silicone IOLs with polypropylene, PMMA or polyimid haptics). We performed scanning electron microscopy on brand-new IOLs prior to and following folding either with forceps or inserter. Special attention was given to the silicone optic surface, optic edges, haptic-optic junctions and the haptic itself. Photographs were taken at 5-350 times magnification. RESULTS: All IOLS demonstrated a smooth and homogeneous optic surface at low magnification. At high-power magnification (X 350), distinctive surface patterns were evident in some IOLs, which turned out to be artefacts. The edge finish showed surplus silicone material and molding flash in six of 11 IOLs. Positioning holes of the 4 plate-haptic IOLs were, except in one IOL, rounded and not rough. Photographs of the haptic-optic junctions revealed surplus material or clefts between the haptic and optic in six of the 7 three-piece IOLs; the loop ends of two IOLs showed a roughened or irregular surface. We did not detect any IOL changes produced by folding. CONCLUSIONS: The silicone IOLs tested demonstrated generally acceptable surface properties, but most IOLs had regional surface irregularities of varying magnitude. The clinical impact of these remains to be established, but surplus material or surface defects might result in deposition of inflammatory cells, protein or microorganisms and synechia formation. Folding of the IOLs did not produce superficial defects.

Cataract Extraction↗
PubMed1994

Effect of pupil size and astigmatism on contrast acuity with monofocal and bifocal intraocular lenses.

We conducted a bicenter study to evaluate the effect of pupil size and corneal astigmatism on best corrected contrast acuity (BCCA) in patients with the True Vista bifocal intraocular lens (IOL) and compared the results with those in a matched group of monofocal patients. Best corrected contrast acuity was measured using the Regan Charts (96%, 50%, 25%, 11%) at four pupil sizes (2.0, 2.5, 3.5, 6.0 mm) in three groups (Group 1: corneal astigmatism 0-0.50 D [n = 11]; Group 2: 0.75-1.50 D [n = 11]; Group 3: 1.75-2.50 D [n = 4]). In monofocal eyes, BCCA between these astigmatic groups did not differ significantly at any contrast step or at any pupil size tested. However, BCCA decreased slightly with increasing pupil size in each group, and differences between 2.00 mm and 6.0 mm pupils were significant at each contrast level. In all bifocal groups, BCCA decreased significantly with increasing pupil size and also decreased with increasing corneal astigmatism; differences were significant at most pupil sizes and contrasts tested. In Group 1, BCCA was lower in eyes with bifocal IOLs than in eyes with monofocal IOLs at 25% and 11% contrast with a 2.5, 3.5, and 6.0 mm pupil; with a 2.0 mm pupil it did not differ significantly. In Groups 2 and 3, BCCA in eyes with bifocal IOLs was lower at all contrast steps and all pupil sizes tested. Our results indicate that corneal astigmatism in excess of 0.50 D reduces quality of vision in eyes with bifocal IOLs, while eyes with monofocal IOLs are not affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

A comparison of corneal endothelial changes after use of Healon or Viscoat during phacoemulsification.

We conducted a prospective, randomized trial comparing the endothelial protective effects of Healon (Kabi Pharmacia Ophthalmics, Inc., Monrovia, California) and Viscoat (Alcon Surgical, Inc., Ft. Worth, Texas) in 59 eyes of 59 patients undergoing iris-plane or posterior-chamber phacoemulsification with posterior-chamber lens implantation. We evaluated postoperative central and superior changes in corneal thickness and corneal endothelial cell density, coefficient of variation in cell size, and percentage of hexagons. In the overall series, at one day postoperatively, corneal thickness increased 17% centrally and superiorly in eyes receiving Healon compared to 12% centrally and 11% superiorly in eyes receiving Viscoat (P < .05). Sixteen weeks postoperatively, superior endothelial cell loss was 11.6% in eyes receiving Healon compared to 2.1% in eyes receiving Viscoat (P < .01). In the iris-plane phacoemulsification group, superior cell loss at week 16 was 13.8% in eyes receiving Healon and 0.5% in eyes receiving Viscoat (P < .04). In the posterior-chamber phacoemulsification group, there were no significant differences between the Healon and Viscoat subgroups. Comparing the surgical techniques, in the Healon group, central cell loss at week 16 was 13.8% in the iris-plane phacoemulsification subgroup and 0.6% in the posterior-chamber phacoemulsification subgroup (P < .03), and coefficient of variation in cell size increased 3.7% in the iris-plane subgroup and decreased 6.8% in the posterior-chamber subgroup (P < .04). In the Viscoat group, there were no significant differences between surgical techniques at week 16. Viscoat provided greater corneal endothelial protection than Healon during iris-plane phacoemulsification. In eyes receiving Healon, posterior-chamber phacoemulsification resulted in less corneal endothelial trauma than the iris-plane technique.

Aged↗
PubMed1993

Undesired light images associated with ovoid intraocular lenses.

Ovoid intraocular lenses (IOLs) accounted for approximately 35% of the lenses implanted in 1991. Despite their popularity among surgeons, patient observations and complaints suggest that ovoid lenses are associated with undesired optical images postoperatively. A pilot clinical study was carried out to test that hypothesis. A multicentered investigation of 289 cases with well-centered IOLs determined that 45% of 168 patients with ovoid lenses observed unwanted optical phenomena at some time after surgery, whereas 17% of 121 patients with round IOLs had similar complaints. Based upon the preliminary clinical study a laboratory investigation was designed to assess optical performance differences between ovoid and round IOLs. One testing system used scatterometry and a second, ray tracing analysis. Both methods determined that the truncated, thickened edge of ovoid lenses was associated with significant light scattering, possibly accounting for the extraneous light images observed by some patients. The results of the clinical and laboratory investigations suggest that undesired optical images produced by ovoid IOLs are due to lens shape rather than to the reduced dimension of the optic.

Cataract Extraction↗
PubMed1993

Computerized videokeratographic analysis of corneal topographic changes induced by sutured and unsutured 4 mm scleral pocket incisions.

We used computerized videokeratography to analyze corneal topographical changes in 39 eyes of 39 patients who had phacoemulsification and posterior chamber lens implantation through 4 mm incisions. In one group of patients, the incisions were closed with a single vertical mattress suture; in the other group, no sutures were used. Computerized videokeratography was performed preoperatively and at one and five to six weeks postoperatively; corneal curvatures were assessed at radial distances of 0.75, 1.5, 2.5, and 3.5 mm along the 0-, 90-, 180-, and 270-degree semimeridians. At one week postoperatively, there was slightly more steepening along the 90- and 270-degree semimeridians (up to 0.9 diopters [D]) and slightly more flattening along the 0- and 180-degree semimeridians (up to 0.6 D) in the sutured group. At six weeks postoperatively, all mean semimeridional changes were less than 0.5 D. Computerized videokeratography demonstrated that sutured and unsutured 4 mm incisions induced clinically small corneal topographic changes and detected local variations in corneal curvature that may be due to sutures, cautery, and other operative factors.

Aged↗
PubMed1993

Comparison of the accuracy of computerized videokeratography and keratometry for use in intraocular lens calculations.

We compared the accuracy of keratometry and computerized videokeratography (CVK) for use in intraocular lens calculations. We studied 48 eyes of 45 patients having phacoemulsification and posterior chamber lens implantation. Computerized videokeratography was performed with the EyeSys Corneal Analysis System (ECAS). Using the SRK II, SRK/T, and Holladay formulas, we evaluated predictive accuracy calculated with keratometric values and four values derived from ECAS measurements. For each formula, the use of one of the CVK parameters resulted in lower mean absolute errors between actual and predicted postoperative refractive errors and higher percentages of cases with power prediction errors < 0.5 and < 1.0 diopters. Computerized videokeratography may provide a more accurate corneal curvature value than keratometry for use in intraocular lens calculations.

Cataract Extraction↗
PubMed1992

Diagnostic value of ophthalmologic findings in myotonic dystrophy: comparison with risks calculated by haplotype analysis of closely linked restriction fragment length polymorphisms.

To determine diagnostic value of lens opacities in myotonic dystrophy (DM), we examined 98 at-risk members of 9 DM kindreds. Haplotype analysis of restriction fragment length polymorphisms (RFLPs) using ApoC2, CKMM, and pEFD4.2 supported the diagnosis of DM in 33 and excluded the diagnosis in 51 members. The sensitivities of bilateral iridescent lens opacities, posterior cortical lens opacities, orbicularis oculi weakness, low intraocular pressure, ptosis, and ocular myotonia were 46.7, 50.0, 60.6, 59.3, 51.5, and 3.0%, while their specificities were 100.0, 100.0, 98.0, 94.1, 96.1, and 100.0%, respectively. A peripheral pigmentary degeneration and central macular lesions of retina were not found on indirect fundoscopy. In 86.2% of DM patients, bilateral iridescent lens opacities, posterior cortical lens opacities, or both were present. Unilateral iridescent lens opacities occurred in only 3 of our DM patients, and 2 of non-DM relatives showed a few unilateral iridescent particles. Posterior cortical lens opacities in DM patients always affected both eyes in this series. We conclude that 1) bilateral iridescent lens opacities and posterior cortical lens opacities are highly specific for DM and useful for establishing clinical diagnosis of DM, 2) unilateral iridescent lens opacities are infrequent in DM and are seen in some non-DM members, and 3) ocular myotonia and clinical retinopathies are rare in DM.

Adolescent↗
PubMed1992

Surgical management of advanced ocular adnexal amyloidosis.

Ocular adnexal amyloidosis is characterized by amyloid deposition within the deep connective tissue layers of the eyelids, conjunctiva, and anterior orbit. Management of advanced cases has traditionally been unsatisfactory, with either no surgery offered because of fear of hemorrhage or an en bloc resection performed of the entire involved area. We present two cases of advanced periorbital amyloidosis successfully managed by preserving the anatomic planes of the eyelids and meticulously debulking the deposits with a spooned curette. Lax eyelid tendons and aponeuroses were simultaneously repaired, and no sacrifice of eyelid tissues was necessary. One patient remained asymptomatic for 2 years after surgery before developing early reaccumulation in the lower eyelids. The other patient required additional eyelid debulking and ptosis revision 8 months after surgery, but was in stable condition at follow-up 2 years after surgery. This technique offers safe, easily repeatable, nondestructive treatment for advanced periocular amyloidosis.

Amyloidosis↗
PubMed1992

Visual results and complications of phacoemulsification with intraocular lens implantation performed by ophthalmology residents.

The authors retrospectively analyzed the visual outcome and incidence of complications of 181 consecutive cases of phacoemulsification performed by eight third-year ophthalmology residents. A posterior chamber intraocular lens was implanted in 179 of these eyes. Vitreous loss occurred in 5.5% of cases. The overall incidence of posterior capsule rupture was 9.9%; of the 18 posterior capsular ruptures, 72% were detected during cortical removal and 22% during nuclear emulsification. Postoperative follow-up for 177 eyes was at least 2 months, and 70% were followed for 6 months or longer. Final best corrected visual acuity of 20/40 or better was obtained in 92.6% of eyes. These results are comparable with previous reports of residents' experience in performing planned extracapsular cataract extraction. With appropriate training and faculty supervision, residents learning to perform phacoemulsification and intraocular lens implantation can achieve acceptable results.

Cataract Extraction↗
PubMed1992

Comparison of the accuracy and reproducibility of the keratometer and the EyeSys Corneal Analysis System Model I.

The EyeSys Corneal Analysis System Model I measures corneal topography using digital image analysis of placido rings reflected off the cornea. With three observers, we compared the accuracy and reproducibility (precision) of the Marco Keratometer Model 1 and EyeSys Corneal Analysis System Model I using four poly(methyl methacrylate) spheres (37.50, 42.51, 47.54, and 55.06 diopters [D]), three steel spheres (40.50, 42.50, and 44.75 D), and 20 normal human eyes (41.50 to 46.00 D). For the spheres, the standard deviations of intra-observer and overall reproducibility for both devices were less than 0.12 D; the absolute mean differences between the measurements of the seven spheres and the known values were 0.25 D or more for two spheres as measured by the keratometer and none as measured by the EyeSys. For the normal corneas, the standard deviations of intra-observer and overall reproducibility for dioptric measurements were 0.07 D and 0.14 D for the keratometer and 0.13 D and 0.19 D for the EyeSys. The EyeSys Corneal Analysis System Model I exceeds keratometer accuracy in reading calibrated spheres and approaches keratometer reproducibility in measuring the 3-mm zone of normal human corneas.

Cornea↗
PubMed1992

Calculating the surgically induced refractive change following ocular surgery.

Calculating the surgically induced refractive change following ocular surgery is important for evaluating the results of keratore-fractive procedures, smaller incisions and various wound closures for cataract surgery, and the effect of suturing techniques and suture removal following corneal transplant surgery. We present a ten-step method of calculating the spherical- and cylindrical-induced refractive change in a manner suitable for a programmable calculator or personal computer. Several applications are given including (1) adding the overrefraction to the spectacle correction, (2) determining the surgically induced refractive change from the preoperative and postoperative refractions, (3) determining the surgically induced refractive change from the K-readings, (4) rotating axes, (5) determining the power at meridians oblique to the principal meridians of a spherocylinder, (6) determining the coupling ratio, and (7) averaging axes. Standard methods for calculating and reporting aggregate results are also given.

Astigmatism↗