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H Burkhard Dick

Publications and source records attributed to H Burkhard Dick.

At least 37 records · Page 2Linked to original sources
PubMed2004

Impact of the line of sight on toric phakic intraocular lenses for hyperopia.

We present a hyperopic patient with a decentered line of sight in whom the residual refractive error after toric phakic intraocular lens (TP IOL) implantation was improved by displacement and individualized treatment. A 35-year-old woman presented with asthenopic complaints 2 months after bilateral TP IOL implantation and IOL rotation 4 weeks later. Examination revealed the line of sight to be nasally and inferiorly decentered in relation to the center of the pupil. A more nasal reenclavation of the TP IOL decreased the coma, and the uncorrected visual acuity was 20/20. We conclude that line of sight should be measured before TP IOL implantation, especially in hyperopic eyes.

Adult↗
PubMed2004

Evaluation of cut quality using the Amadeus microkeratome with different settings.

PURPOSE: To evaluate the quality of keratectomy specimens created with the Amadeus microkeratome (AMO) using scanning electron microscopy (SEM). SETTING: Johannes Gutenberg-University Hospital, Department of Ophthalmology, Mainz, and the Department of Anatomy, Justus Liebig-University, Giessen, Germany. METHODS: Corneal cuts were performed in freshly enucleated pig eyes using the Amadeus microkeratome with 9 combinations of oscillation rate and head-advance speed. For the cutting trials, oscillation rates of 8000, 13,000, and 18,000 rpm and head-advance speeds of 1.0, 2.5, and 4.0 mm/s were chosen. Fifty-four eyes were included, resulting in 9 groups of 6 eyes for each configuration. The surfaces and edges of the flaps were examined using SEM. RESULTS: At fixed oscillation rates, an increase in head-advance speed led to lower quality cuts, higher surface roughness, and irregular cut edges. At fixed head-advance speeds, an increase in oscillation rates improved the cut quality, resulting in smoother surface characteristics. CONCLUSIONS: Smooth and regular surfaces and cut edges can be achieved by choosing high oscillation rates and low head-advance speeds. Microkeratomes that enable the user to adjust the oscillation rate and head-advance speed can be used to maximize surface smoothness and improve customized refractive surgery.

Animals↗
PubMed2004

Contrast sensitivity after implantation of toric iris-claw lenses in phakic eyes.

PURPOSE: To evaluate the change in contrast sensitivity after implantation of the Verisyse toric phakic intraocular lens (IOL) (AMO) for the correction of myopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: Eighteen eyes had implantation of an iris-supported toric phakic IOL to correct myopia with astigmatism. The mean preoperative spherical equivalent was -12.65 diopters +/- 3.6 (SD). The contrast sensitivity with best spectacle correction was determined before surgery and 3 months after surgery using the CSV-1000 HGT instrument (Vector Vision Inc.). RESULTS: Three months after IOL implantation, the mean contrast sensitivity had significantly increased from preoperatively at midrange spatial frequencies from 3.2 to 4.4 (6 cycles per degree [cpd]; P = .033) and from 2.4 to 3.7 (12 cpd; P = .032). The differences at spatial frequencies of 3 cpd and 18 cpd were not statistically significant (P = .59 and P = .086, respectively). CONCLUSIONS: Implantation of the Verisyse toric iris-claw lens in phakic eyes to correct high or moderate myopia with astigmatism has the potential to improve contrast vision. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels.

Adult↗
PubMed2004

Monocular versus binocular pupillometry.

PURPOSE: To quantify differences between monocular and binocular pupil size measurement under scotopic and mesopic conditions. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, and Department of Medical Biometry, Epidemiology and Informatics, University of Mainz, Mainz, Germany. METHODS: Computerized dynamic pupillometry (P2000 SA, Procyon Instruments Ltd.) was used at 3 illumination levels: scotopic at 0.03 lux, mesopic low at 0.82 lux, and mesopic high at 6.4 lux. One hundred forty eyes of 70 healthy volunteers without ocular pathology were examined. The subjects were divided into 2 groups. In the first group, the pupil diameter was measured binocularly first. In the second group, monocular measurement was performed first. For statistical analysis, data description was based on medians and quartiles of the respective pupil diameter measurements. Intraindividual significance was based on sign tests, and interindividual comparison were based on 2-sample Wilcoxon tests. RESULTS: In all eyes, statistically significant differences were found in pupil size, with higher values for the monocular measurement under low and high mesopic conditions (P=.000). For scotopic conditions, a trend toward higher values in monocular measurement was observed that approached statistical significance. CONCLUSIONS: Results indicate that binocular measurement may imitate the patient's life conditions more realistically. Therefore, in eyes with a large pupil diameter with the risk for postoperative scotopic phenomena, binocular measurement should be considered before refractive surgery.

Adolescent↗
PubMed2004

Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses: case series and review.

PURPOSE: To report clinical and spectrographic analyses of 2 explanted hydrophilic acrylic intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, Salt Lake City, Utah, USA, and Johannes Gutenberg-University, Department of Ophthalmology, Mainz, Germany. METHODS: We report 6 cases of opacification of MemoryLens IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopathologic analysis including scanning electron microscopy and energy dispersive x-ray spectroscopy (EDX). RESULTS: Microscopic analysis revealed multiple, fine, granular deposits of various sizes on the surface of the lens optics. The EDX analysis showed the presence of calcium within the deposits. CONCLUSIONS: Our cases show that hydrophilic acrylic IOLs can opacify even years after implantation. Analysis of the explanted IOLs revealed calcification.

Acrylic Resins↗
PubMed2004

Oxidative tissue damage after phacoemulsification: influence of ophthalmic viscosurgical devices.

PURPOSE: To quantify the oxidative tissue damage after phacoemulsification, correlate the damage to the energy applied, and investigate the influence of ophthalmic viscosurgical devices (OVDs). SETTING: Department of Ophthalmology, University of Mainz, Mainz, Germany. METHODS: The study comprised 130 eyes operated on by 1 surgeon using the same phacoemulsification machine. Some eyes received an OVD before phacoemulsification and some did not. Energy values were expressed as phaco time; that is, ultrasound (US) time (seconds) after conversion to 100% phaco power. Patients were grouped as follows: Group 1, phaco time less than 20 seconds and no OVD; Group 2, phaco time 20 to 40 seconds and no OVD; Group 3, phaco time more than 40 seconds and no OVD; Group 4, phaco time 20 to 40 seconds and hydroxypropyl methylcellulose 2% (HPMC); Group 5, phaco time 20 to 40 seconds and sodium hyaluronate 1%. Aqueous humor from pseudophakic eyes served as a control. At the end of surgery, anterior chamber fluid was analyzed for lipid peroxides using the thiobarbituric acid method. RESULTS: Lipid peroxides were detected in all groups. The values were significantly higher in Group 2 than in Group 1 (P<.01) and in Group 3 than in Groups 1 and 2 (P<.01). The differences in lipid peroxide values between all phaco groups and the control group were statistically significant. Sodium hyaluronate 1% and HPMC 2% produced significantly lower lipid peroxide values than in the respective phaco groups that did not receive an OVD (both P<.01). CONCLUSIONS: Oxidative tissue damage occurred during phacoemulsification. The damage, which correlated with the US energy applied, can be reduced by the use of OVDs.

Aged↗
PubMed2003

Comparison of three different technologies for pupil diameter measurement.

BACKGROUND: The pupil diameter plays an important role in the occurrence of photopic phenomena after refractive surgery. Standardized estimation can be performed using a lens system with a built-in millimeter scale (Colvard, Oasis Medical, California). A new computerized technique allows dynamic and binocular measurement of the pupil diameter by use of infrared light (P2000SA, Procyon Instruments, London, UK). An additional approach is a wavefront aberrometer based on the Hartmann-Shack principle (WASCA; Asclepion-Meditec-Zeiss, Jena, Germany). These strategies were compared. DESIGN: Non-randomized comparative trial. PARTICIPANTS AND METHODS: The pupil diameter of 56 eyes of 28 probands (18 female, mean age 23 years) was measured under scotopic conditions by three independent examiners with each measurement device. The measurement devices were compared intraindividually by pairwise sign tests. Description was based on the intraindividual differences' medians and quantiles. RESULTS: Median pupil diameters were 6.67 mm for the scale pupillometer (interquartile range 6.07-6.94 mm), 6.60 mm for the dynamic pupillometer (6.0-7.02 mm), and 6.37 mm for the wavefront-based aberrometer (5.9-6.7 mm). Pairwise comparison revealed statistically significant ( P<0.05), although not clinically relevant median deviations. Although no clinically relevant median differences were observed (when based on intraobserver means), deviations for single pupil diameter assessments ranged up to 1 mm. CONCLUSION: No clinically relevant median deviations were observed in the underlying repeated measurement scenario. The scale pupillometer showed greater interobserver variation than the objective tests.

Adult↗
PubMed2003

Impact of head advance and oscillation rate on the flap parameter: a comparison of two microkeratomes.

PURPOSE: To compare flap quality and thickness in an experimental setting using the Amadeus and Carriazo/Barraquer microkeratomes. METHODS: One hundred and sixty-three fresh porcine cadaver eyes were used to cut corneal flaps. One hundred and thirty-five eyes were cut using the Amadeus microkeratome with various settings of head advance and oscillation rate, 28 eyes using the Carriazo/Barraquer microkeratome (Supratome). Flap diameter and hinge width were measured by planimetry and flap thickness by ultrasound pachymetry. Descriptive statistical analysis was based on medians and quartiles, graphical representation on box plots. The measurement devices were compared by two sample Wilcoxon tests, their deviation from the distributors' reference measurement values by sign tests. RESULTS: Variation of oscillation rate and head advance led to significant differences in flap thickness. Optimal cut quality was achieved with 1 mm/s head advance and 8,000 rpm in the Amadeus microkeratome. With this setting the smallest target deviations in flap thickness were obtained among the results with lowest range (median 170 micro m, interquartile range 18 micro m, target 160 micro m). The Amadeus microkeratome demonstrated a statistically significant lower deviation from the target thickness ( P<0.001) and also a lower range than the Supratome (median 127 micro m, interquartile range 30 micro m, target 140 micro m; P<0.001). CONCLUSIONS: Optimization of microkeratome settings leads to minimized deviation from target thickness and improved parameter. The Amadeus microkeratome achieved a statistically significant lower deviation in flap thickness than the Carriazo/Barraquer microkeratome. Individualization of the microkeratome settings may help to decrease flap complications and improve refractive outcome.

Animals↗
PubMed2003

Toric phakic intraocular lens: European multicenter study.

OBJECTIVE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. DESIGN: Prospective, nonrandomized, comparative (self-controlled) multicenter trial. PARTICIPANTS: Seventy eyes of 53 patients (mean, 35 years; range, 22-59 years) with preoperative spherical equivalent between +6.50 and -21.25 diopters (D) and cylinder between 1.50 and 7.25 D. METHODS: Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up was 6 months in all cases. Lenses were available in powers ranging from +12.0 D to -23.5 D (spherical equivalent) in 0.5-D increments, with additional cylinder from 1.0 D to 7.0 D, also in 0.5-D increments. MAIN OUTCOME MEASURES: The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell count (ECC), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, subjective complaints, and patient satisfaction. RESULTS: Eyes were divided into group A, myopia (n = 48), with an average preoperative spherical equivalent of -8.90 +/- 4.52 D, and group B, hyperopia (n = 22), with an average preoperative spherical equivalent of +3.25 +/- 1.98 D. No eyes in either group experienced a loss in BSCVA, and 46 eyes gained 1 or more lines of their preoperative BSCVA. In 62 eyes (88.6%), UCVA was 20/40 or better. There was a significant reduction in spherical errors and astigmatism in all cases after surgery. All eyes of both groups were within +/-1.00 D of target refraction, and 51 eyes (72.9%) were within +/-0.50 D of target refraction. There was a 4.5% mean total loss of ECC during the first 6 months. No serious complications were observed. Overall patient satisfaction was very high. CONCLUSIONS: Six-month clinical trial results demonstrate that implantation of the Artisan TPIOL safely, predictably, and effectively reduced or eliminated high ametropia and astigmatism with one procedure. The refractive effect was stable at 6 months after surgery.

Adult↗
PubMed2003

Comparison of biometric measurements using partial coherence interferometry and applanation ultrasound.

PURPOSE: To compare and contrast axial length (AL) measurements assessed by ultrasound biometry and optical biometry. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: Optical biometry and ultrasound biometry were performed in 360 eyes to measure AL. RESULTS: In eyes with a clear-appearing crystalline lens, there was a statistically significant median difference in AL measurements between the 2 methods in eyes with a normal or long length. In eyes with cataract, there was a statistically significant median difference in AL measurements in eyes with a normal or short length. In these cases, optical biometry produced larger readings than ultrasound biometry. In eyes with a posterior chamber intraocular lens, there was no statistically significant difference between the 2 methods in eyes of all lengths. In all eyes, the 2 methods produced reliable measurements. CONCLUSIONS: These results show that optical biometry and ultrasound applanation biometry give statistically significant differences in AL measurement in patients with cataract and normal lenses. In these cases, optical biometry provided clinically relevant larger values than ultrasound applanation. Optical biometry provides an alternative to ultrasound biometry. However, ultrasound biometry may be indicated in certain complex cases.

Biometry↗
PubMed2003

Evaluation of the practicality of optical biometry and applanation ultrasound in 253 eyes.

PURPOSE: To evaluate the percentage of eyes that could not be measured using optical biometry and ultrasound applanation and the reasons. SETTING: Department of Ophthalmology, Johannes Gutenberg-University Hospital, Mainz, Germany. METHODS: Optical biometry (IOLMaster, Carl Zeiss Meditec AG) and A-scan ultrasound biometry were performed consecutively in 253 eyes scheduled for cataract surgery the next day. Lens opacities were evaluated with the Opacity Lensmeter (Interzeag), and a slitlamp examination and measurement of visual acuity were performed. The 2 techniques were compared in terms of the rate of and reasons for primary measurement failure. RESULTS: Measurement with the IOLMaster was not possible in 44 eyes (17%). Failed measurements were the result of a combination of low visual acuity and lens opacity in 45% of eyes, posterior subcapsular opacity in 25%, and macular disease in 7%. Measurement with ultrasound biometry was not possible in 10 eyes (4%); 7 eyes were filled with silicone oil and in 3 cases, the patient refused biometry. CONCLUSIONS: Optical biometry allowed comfortable, noncontact, high-precision measurement in the optical axis. Uncorrected visual acuity and lens opacity were predictors of successful measurements. Eyes with dense cataract or poor visual acuity are better evaluated using ultrasound applanation.

Adolescent↗
PubMed2003

Postoperative astigmatism and rotational stability after artisan toric phakic intraocular lens implantation.

PURPOSE: To evaluate deviations in the axis (intended versus achieved) and postoperative astigmatism after implantation of an Artisan toric phakic intraocular lens (IOL). SETTING: University Eye Hospital, Mainz, Germany. METHODS: This prospective study comprised 29 eyes with high ametropia and astigmatism. All eyes had uneventful implantation of a toric phakic IOL through a superior scleral tunnel incision at 12 o'clock. After a minimum of 6 months, the uncorrected visual acuity (UCVA), best correct visual acuity, refraction, and astigmatism were analyzed in all eyes. A multivariate analysis of postoperative astigmatism was performed. RESULTS: After a follow-up of at least 6 months, 95% of eyes were within +/-1.00 diopter (D) of emmetropia and 85% of eyes has a UCVA of 20/30 or better. The difference between the mean intended cylinder axis and achieved cylinder axis was 3.9 degrees (median 3 degrees; range to 13 degrees). The difference between the mean intended axis and the achieved axis between miosis and mydriasis was 1.8 degrees (median 1.5 degrees; range 0 to 5 degrees). The mean postoperative astigmatism after 6 months was 0.56 D with an axis of 31 degrees. Doubled-angle scatterplot analysis showed a tendency toward more flattening in the vertical meridian. CONCLUSIONS: During the 6-month follow-up, no significant rotation was observed after implantation of Artisan toric phakic IOLs to correct high ametropia. A sutureless sclerocorneal superior approach for phakic IOL insertion resulted in moderate to low astigmatism. Induced astigmatism should be taken into consideration during preoperative planning.

Adult↗
PubMed2003

Capsule measuring ring to predict capsular bag diameter and follow its course after foldable intraocular lens implantation.

PURPOSE: To evaluate the extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation and develop a regression formula to predict postoperative capsular bag size. SETTING: Eye Hospital, Johannes Gutenberg-University, Mainz, Germany. METHODS: The axial length (AL), anterior chamber depth, and corneal radius in 58 eyes were measured preoperatively. Cataract surgery was by phacoemulsification followed by implantation of a 3-piece, acrylic, posterior chamber IOL. The capsular bag diameter and anterior capsulorhexis were measured intraoperatively and 1 day and 1, 3, and 6 months postoperatively using a Koch capsule measuring ring (HumanOptics). RESULTS: The mean capsular bag size was 10.53 mm intraoperatively, 10.31 mm at 1 day, 9.62 mm at 1 month, 9.07 mm at 3 months, and 9.01 mm at 6 months. The mean capsular bag shrinkage over the entire postoperative period was 14.8% (P<.001). Of the parameters studied, only AL had a positive correlation with capsule shrinkage. The correlation was moderate but statistically significant (P =.001). CONCLUSIONS: A correlation was found between capsular bag shrinkage and AL. Using preoperative biometric data, a regression formula of moderate validity was determined to predict capsular bag shrinkage.

Acrylic Resins↗
PubMed2003

Implantation of a custom intraocular lens with a 30-diopter torus for the correction of high astigmatism after penetrating keratoplasty.

We present a 62-year-old woman who had implantation of an intraocular lens (IOL) with a torus of 30.0 diopters (D) in an eye after penetrating keratoplasty. The patient presented with cataract and a best corrected visual acuity of 20/400. Penetrating keratoplasty was performed in 1975 because of decompensated keratoconus. With a clear but inferiorly decentered corneal graft, visual acuity was limited because of keratoplasty-related high corneal astigmatism of 22.5@156 that could not be successfully treated with spectacles or contact lenses. A custom toric IOL with -30.0 D of cylindrical power was implanted in the capsular bag via a sclerocorneal tunnel incision. Additionally, a spherical IOL of -15.0 D sphere was implanted in the ciliary sulcus. Six months after implantation, the IOLs were still well centered and the uncorrected visual acuity was 20/60.

Astigmatism↗
PubMed2003

[Refractive benefit and incremental costs of LASIK: results of a cost benefit study in two universities' LASIK departments].

BACKGROUND: No data is available to date on the cost effectiveness of laser in situ keratomileusis (LASIK) with regard to the German-speaking health care system. Hence we compared the clinical outcome and cost data of two German LASIK centres in respect of procedure cost effectiveness from the patient perspective. MATERIAL AND METHODS: A retrospective cohort study was implemented at the University Hospitals of Mainz and Mannheim. Data on refractive outcome were obtained from the LASIK centres' patient documentation, cost data on the surgery as well as on eyeglasses etc. before and after the surgery were obtained from patient interviews. The primary endpoint of this investigation was the individual incremental cost effectiveness ratio linking direct cost with the LASIK associated refractive gain. RESULTS: Clinical and economical data of 178 patients (Mainz: 45, Mannheim 133) was evaluated. After biplanar simultaneous LASIK 71% (Mainz) and 73% (Mannheim) reported, that they did not need eyeglasses etc. any longer after surgery; 31% (Mainz) versus 13% (Mannheim) had to undergo LASIK re-treatment. Median direct cost for the surgery was reported to be 3000 euro; (Mainz) versus 3910 euro; (Mannheim); the corresponding LASIK associated refractive gain was +5.6 D (median Mainz) versus +4.2 D (median Mannheim), resulting in median incremental cost effectiveness ratios of 667 euro; (Mainz) versus 831 euro; (Mannheim) per gained refractive unit. This investment has to be related to median annual cost of 250 euro; for eyeglasses etc. before surgery and 0 euro; afterwards. CONCLUSION: Depending on the performing surgical centre, German LASIK patients have to face a median investment of 667-831 euro; per gained refractive benefit unit. This incremental cost benefit ratio can be regarded as a surrogate parameter for comparison with alternative surgical or conservative treatment strategies in myopia.

Adolescent↗
PubMed2003

[Cost effectiveness evaluation of cataract patient care in respect of monofocal intraocular lenses from the perspective of German statutory health insurance].

BACKGROUND: Data on the cost effectiveness of cataract surgery with respect to the German statutory health insurance system are hardly available. Hence the increase in visual acuity as primary efficacy endpoint, order of posterior capsule opacification as primary complication endpoint and direct cost for supplementation with monofocal intraocular lenses have been assessed via meta-analyses to evaluate the procedure's cost effectiveness from the perspective of the German statutory health insurance system. MATERIAL AND METHODS: Using the medical internet database MEDLINE two meta-analyses on publications between 1995 and 2002 were carried out, one estimating the gained increase in visual acuity, the second to estimate the frequency of posterior capsule opacification 5 years after implantation of a monofocal lens. To estimate the direct cost of German health insurance current reimbursement rates were used. The primary objective of this investigation was the individual incremental cost effectiveness ratio (ICER) linking the direct cost with the cataract surgery-associated increase in visual acuity. RESULTS: 51 studies were included in the meta analysis regarding the increase in visual acuity after cataract surgery. The median increase in visual acuity was about 5 visual units (interquartile range 3.6 - 8.0 units) reaching a median postoperative visual acuity of 0.8. The median incidence rate of posterior capsule opacification during the observed period of 5 years was estimated 24 % (10 - 34 %). Computation of the current reimbursement rates of German health insurance resulted in a median incremental cost of 223.25 euro; per gained visual unit. CONCLUSION: Providing of cataract patients with monofocal intraocular lenses means median incremental costs of about 223 euro; to be refunded by the health insurance and is associated with a median visual acuity outcome of 0.8. Therefore the cost effectiveness of cataract surgery can be regarded quite encouraging compared to the outcome of other ophthalmological outpatient surgery.

Cataract↗
PubMed2003

Endotoxins in ophthalmic viscosurgical devices.

PURPOSE: To measure the endotoxin concentration (EC) of 25 commercially available, hyaluronic acid- and hydroxypropylmethylcellulose-based (HPMC) ophthalmic viscosurgical devices (OVDs). METHODS: The in vitro Limulus amebocyte lysate (LAL) assay, which indicates the presence of endotoxins originating from gram-negative bacteria, was used to determine the EC. The procedure was performed according to the European Pharmacopoeia/USP. EC including duplicate determinations, negative controls, dilution series with control standard endotoxin, dilution series with sample extract and positive sample control. RESULTS: 16 OVDs (Amvisc, Amvisc Plus, Biolon, Coatel, Healon, Healon GV, Healon, HPMC Ophtal L, Microvisc, Microvisc Plus, Ocucoat, Provisc, Rayvisc, Viscoat, Visco Shield 2%, Visko 1.4%) had an EC under 1.2 endotoxin units/mL, five (Adatocel, HPMC Ophtal H, LA Gel, Viscorneal, Viscorneal Plus) had an EC > or = 1.2 and < or = 24 EU/ml, and four (Biocorneal, Dispasan also named Ophthalin, Dispasan Plus, Visko 1%) had an EC of > 24 EU/ml. DISCUSSION: To avoid viscoelastic-related inflammatory or immunological reactions, the use of pure OVDs is recommended, especially for surgical procedures with an inherent possibility of leaving viscoelastic remnants in the eye (e.g., cataract surgery, visco-canalostomy or penetrating keratoplasty).

Endophthalmitis↗