PURPOSE:To report refractive changes between 3 months and 12 months after keratorefractive lenticule extraction (KLEx) using the VisuMax 800 femtosecond laser in a retrospective monocenter study. SETTING:University Hospital Gießen and Marburg, Department of Ophthalmology, Philipps University of Marburg, Germany. DESIGN:The 3-month data were collected as part of a prospective, nonrandomized, multicenter, international postmarket clinical follow-up study for the VisuMax 800. The 12-month follow-up was conducted retrospectively at a single center. METHODS:90 eyes of 45 patients with myopia up to -10.00 diopters (D) and astigmatism up to -3.00 D underwent KLEx. Postoperative examinations were performed at 3 and 12 months. RESULTS:At 12 months, 36 patients (80%) completed follow-up. Mean preoperative spherical equivalent (SEQ) was -4.08 ± 2.04 D. Preoperative corrected distance visual acuity (CDVA) was ≥20/20 in 97% of eyes. At 3 months, uncorrected distance visual acuity (UDVA) was ≥20/20 in 89% and ≥20/25 in 99%. SEQ accuracy was within ±0.50 D in 94% and ±1.00 D in 100% of eyes (mean SEQ: 0.11 D). At 12 months, UDVA remained ≥20/20 in 89%, and SEQ accuracy within ±0.50 D in 96% (mean SEQ: 0.06 D). No significant CDVA loss was observed. Minor variations in astigmatism, satisfaction, and ocular surface disease index scores between 3 months and 12 months were not statistically significant ( P > .05), confirming overall refractive and subjective stability. CONCLUSIONS:KLEx with the VisuMax 800 yields excellent and stable visual and refractive outcomes with high patient satisfaction and spectacle independence for myopia and myopic astigmatism.

ObjectiveTo study the properties of different ophthalmic viscosurgical devices (OVDs) with respect to their ability to create and maintain high intraocular pressure (IOP) during the creation of a continuous curvilinear capsulorhexis (CCC) by comparing the drop in IOP before and after creation of the CCC. METHODS AND ANALYSIS:The study included 174 eyes in four groups using two different OVDs (hyaluronic acid (HA) and hydroxypropylmethylcellulose (HPMC)) and two different instruments (utrata forceps (UF) and 26G cystotome (RN)). IOP was measured using rebound tonometry with sterilised probes immediately before the beginning of the CCC and immediately afterwards during cataract surgery. RESULTS:The drop in IOP during capsulorhexis was measured at 52.1±10.7 mm Hg with the combination HA/RN, 62.4±11.5 mm Hg with HA/UF, 60.5±10.0 mm Hg with HPMC/RN and 68.7±14.1 mm Hg with HPMC/UF. The variance in IOP reduction between HA and HPMC did not reach statistical significance (p=0.100). CONCLUSION:The lack of a noticeable difference in IOP levels, despite the use of different OVDs with unique properties, indicates that IOP may not be the main factor influencing the notable differences in tactile feedback perceived by surgeons during capsulorhexis procedures conducted with varying OVDs. To elucidate these sensations, additional characteristics such as viscosity, elasticity, pseudoplasticity and cohesion will have to be explored.

PurposeTo evaluate the long-term outcomes of a simultaneous lenticule rotation and excimer laser ablation for high hyperopic astigmatism, a technique addressing otherwise untreatable refractive errors.MethodsA 41-year-old female patient with a high refractive error (+3.75/-5.50 D) in her left eye underwent femtosecond laser-assisted FLEx, lenticule rotation, and excimer laser ablation. The procedure was performed to correct high astigmatism, which could not be treated with standard laser correction or phakic IOL implantation. Treatment parameters were adjusted to compensate for myopic shift due to centripetal lenticule shrinkage. Postoperative evaluations occurred at 3 months, 1 year, and 2 years.ResultsRefractive astigmatism was reduced by >5.0 D, with corneal astigmatism decreasing by 3.7 D. The lenticule integrated well without distortions. Minor epithelial remodeling occurred, but no structural complications were observed. The patient achieved stable visual acuity and high satisfaction over 2 years.ConclusionThis technique provides a stable, reversible alternative for high hyperopic astigmatism, preserving accommodation and avoiding refractive lens exchange. Corneal lenticule surgery may offer a viable option for patients with extreme hyperopic astigmatism. Further clinical studies are warranted to confirm its long-term efficacy.

Prospective randomized single-blinded study of 261 cataract patients to investigate the influence of different instruments and techniques in continuous curvilinear capsulorhexis (CCC) on the stability of the anterior chamber using intraoperative rebound tonometry. The study included 261 eyes allocated to six groups according to three ophthalmic viscoelastic device (OVD) conditions—hyaluronic acid (HA), hydroxypropylmethylcellulose (HPMC), and their combination via the soft-shell technique (SST)—and two instruments (Utrata forceps UF and a 26-G cystotome RN). Intraocular pressure (IOP) was measured before and after CCC using rebound tonometry with sterilized probes. IOP reached 78.6 mmHg in the RN group and 76.5 mmHg in the UF group after OVD instillation and after the creation of the CCC. The mean IOP drop during capsulorhexis was significantly greater with UF (67.1 ± 12.3 mmHg; n = 117) compared to RN (56.5 ± 11.6 mmHg; n = 144) (P < 0.001). The results of this study showed a statistically significant difference in the stability of the anterior chamber depending on the instrument used. The use of different OVDs had no statistically significant influence on anterior chamber stability. Maintaining a more stable IOP with a 26-gauge cystotome may be advantageous in complex cases, such as increased posterior vitreous pressure, zonular weakness or heightened intracapsular pressure.

Randomized, prospective single-blinded study to examine the properties of different ophthalmic viscosurgical devices (OVDs) regarding their ability to establish and maintain stable intraocular pressure (IOP) while performing continuous curvilinear capsulorhexis (CCC). As smaller anterior chambers (AC) pose a greater challenge in aspects of endothelial protection as well as space maintenance, this study related the results to AC dimensions as anterior chamber volume (ACV) and anterior chamber depth (ACD). IOP was measured using rebound tonometry with sterilized probes immediately before and after initiating CCC during cataract surgery. A total of 142 eyes scheduled for routine cataract surgery were included in this randomized trial and divided into three groups receiving hydroxypropylmethylcellulose 2.0

Purpose: To assess the safety, efficacy, and refractive outcomes of keratorefractive lenticule extraction (KLEx) in adults aged 55 years or older compared to patients 35 years or younger, addressing the limited evidence for KLEx in presbyopic eyes. Methods: This retrospective multicenter study included patients aged 55 years or older and a control group aged 35 years or younger matched by preoperative mean refractive spherical equivalent (MRSE), all undergoing KLEx for myopia or myopic astigmatism. Preoperative parameters and postoperative refractive and visual outcomes were analyzed. Results: A total of 288 eyes of 183 patients were analyzed (144 were 55 years or older, 144 were 35 years or younger), with comparable baseline parameters between groups. Postoperative UDVA was slightly inferior in older adults (mean: −0.01 vs −0.07 logarithm of the minimum angle of resolution; 20/20 or better in 79% vs 93%, P < .001). The efficacy index was 0.94 versus 1.07 and the safety index was 1.01 versus 1.09 (both P < .001) for patients 55 years or older and 35 years or younger, respectively. Eleven percent of older patients and 39% of younger patients gained lines. A postoperative MRSE within ±0.50 diopters (D) was achieved by 76% of older versus 88% of younger patients ( P = .02) and more than 95% were within ±1.00 D in both groups. Re-treatments were more frequent in older eyes (9% vs 1%, P = .01). Stability and astigmatic outcomes were comparable, although older eyes showed mild cylindrical overcorrection. Conclusions: KLEx in patients aged 55 years or older provided favorable and stable outcomes but was inferior when compared to younger cohorts regarding efficacy, safety, and predictability. These findings point to clinically meaningful age-related corneal biomechanical changes and carry implications for both surgical planning and patient counseling.

PURPOSE:To investigate patient-reported outcomes following lenticule extraction using the VISUMAX 800 laser (Carl Zeiss Meditec AG) as part of a post-market clinical follow-up (PMCF) study. METHODS:This prospective, non-randomized, multicenter, international PMCF study was conducted from July 2021 to March 2023. Patients with myopia up to -10.00 diopters (D) and astigmatism up to 5.00 D underwent lenticule extraction using a VISUMAX 800 femtosecond laser. Patients completed an electronic patient-reported outcome questionnaire preoperatively and at the 6-month follow-up visit. The questionnaire was adapted from the U.S. Food and Drug Administration Patient-Reported Outcomes with LASIK (PROWL) questionnaire, which evaluates patient satisfaction, spectacle dependence, visual symptoms, and vision-related quality of life. RESULTS:A total of 226 patients completed a 6-month follow-up after bilateral treatment, of which 98.7% were "completely," "very," or "somewhat" satisfied with the results, 98.2% were satisfied with visual recovery time, 93.8% no longer required glasses or contact lenses for distance and near activities, and 80.5% had little or no difficulty when driving at night. Overall, 99.1% were happy they had lenticule extraction with the VISUMAX 800, 98.2% would choose the procedure again, and 98.7% would recommend the procedure to others. Four patients would not repeat the procedure (3 due to dissatisfaction with results, 1 despite being satisfied with their outcome), whereas 3 patients would not recommend it (2 due to dissatisfaction with results, 1 despite being satisfied). CONCLUSIONS:Lenticule extraction performed with the VISUMAX 800 demonstrated excellent patient-reported outcomes with a high level of patient satisfaction and glasses independence with few reports of severe visual disturbances.

Soziale Medien wie Instagram sind als internationale Kommunikations- und Informationsplattformen nicht mehr wegzudenken. Diese Arbeit möchte herausfinden, wie die Augenheilkunde in Deutschland auf Instagram repräsentiert ist. Retrospektive Analyse von 1000 deutschen öffentlichen Instagram-Posts im Januar 2024 anhand des #augenheilkunde. Jeweils ein Drittel der Posts zeigten Krankheiten/Sehstörungen sowie Marketing im Rahmen der Präsentationen von Praxis, Ärzten usw. Fachliche Informationen hinsichtlich Kongresse oder Messen machen nur einen kleinen Anteil aus. Die von uns ausgewerteten Instagram Posts zielen auf viele Aspekte der Augenheilkunde ab, doch das Hauptaugenmerk geht in die Richtung Marketing. Normale Instagram-typische Techniken werden kaum verwendet. Die meisten gebotenen Inhalte sind sachlicher Art ohne negativen oder besonders ekelerregenden Touch. Durch Verwendung von mehr interaktiven und emotional berührenden Posts könnte der Impact auf die Zielgruppe verstärkt werden.

The clinical use of femtosecond lasers has led to significant progress in a number of surgical procedures in ophthalmology. In the field of corneal refractive surgery, a one-step intrastromal laser procedure without a flap has been established for the first time. This review follows the development of this surgical procedure.

Background Diabetic macular oedema (DME) is associated with significant loss of visual acuity. Intravitreal VEGF inhibitor injection is the gold standard in treating this disease; second-line treatment consists of intravitreal steroid injections. This treatment has already undergone extensive investigation in large randomised controlled trials. The aim of this study is to evaluate patient population and treatment options in a real-world setting. Material and Methods A retrospective analysis was conducted on data from 176 eyes in 114 patients diagnosed with diabetic macular oedema who had received at least one intravitreal injection during 2018 at Marburg University Hospital Department of Ophthalmology. The analysis examined demographic characteristics, prior treatment, and treatments performed as well as visual acuity and central retinal thickness development during therapy. Multiple linear regression analyses were used to investigate the influence of different variables on changes in dependent variables in visual acuity (logMAR), changes in retinal thickness (mu m), and number of injections, while also taking interactions between the independent variables themselves into account. Results Patients were on average 64.45 +/- 13.79 years old and predominantly male (61.93%). Most (71.59%) had already been treated for DME. Baseline visual acuity averaged 0.42 logMAR +/- 0.34; baseline central retinal thickness averaged 369.1 mu m +/- 118.81. A total of 688 intravitreal injections were administered at 3.91 +/- 2.22 per eye during the study period. Visual acuity improved by 0.04 logMAR +/- 0.18 on average; eyes with poorer baseline visual acuity showed a greater increase in visual acuity. CRT values decreased by 44.54 mu m +/- 133.95 on average. Eyes with higher baseline values showed greater reduction. Using regression analysis, this is the first study to demonstrate that eyes may continue to require additional injections after prior treatment. Conclusion This study demonstrated the reality of treatment for patients with diabetic macular oedema at a German university clinic as accurately as possible. We were able to demonstrate the differences from RCTs and the characteristics of the patient cohort.

Small incision lenticule extraction (SMILE) surgery was developed in 2008 as an extension of the femtosecond lenticule extraction procedure. Over the years, SMILE has become a highly popular laser refractive surgery offering a minimally invasive alternative to LASIK for correcting myopia and myopic astigmatism. Despite its benefits such as a flapless femtosecond laser procedure with reduced corneal nerve disruption, the procedure's relative novelty necessitates standardization. Given the myriads of emerging information and variability, a panel of 22 international experts is formed by the Asia Pacific Myopic Society (APMS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to explore the controversy and to work out a consensus on SMILE. This consensus manuscript arises from a systematic exploration of current literature and is supported by the collective insights of international experts in the field of refractive surgery. The panel convened to review the issues, engage in discussion, develop proposals, and vote to establish consensus across four areas: 1) preoperative assessment, 2) preoperative surgical planning, 3) intraoperative considerations, and 4) postoperative management in a five-point Likert scale (strongly agree, agree, neutral, disagree and strongly disagree). Consensus was achieved when at least 75 % of the experts had voted for "strongly agree" or "agree" on the consensus statement concerned. 63 consensus statements were discussed, with 51 (81.0 %) statements reaching consensus. By establishing standardized consensus, this paper aims to reduce variability and enhance predictability and safety in refractive outcomes. Ongoing research is encouraged on issues where consensus could not be reached among the international panel of experts (IPE).

PURPOSE:To report the outcomes of small incision lenticule extraction (SMILE) using the VISUMAX 800 laser (Carl Zeiss Meditec) in a post-market clinical follow-up study. METHODS:This was a prospective, non-randomized, multi-center, international, post-market clinical follow-up study. The study took place from July 2021 to March 2023 at five sites across Europe and Asia. Patients meeting all inclusion criteria including myopia up to -10.00 diopters (D) and astigmatism up to 5.00 D were enrolled to undergo SMILE using the VISUMAX 800 femtosecond laser (Carl Zeiss Meditec). Patients were examined at 1 day, 1 week, and 1, 3, and 6 months after treatment. RESULTS:During the study period, 473 eyes (237 patients) were enrolled, treated, and analyzed. The preoperative spherical equivalent was -4.49 ± 1.87 D (range -0.25 to -10.00 D). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 98.3% of eyes. At 6 months postoperatively, uncorrected distance visual acuity was 20/20 or better in 93.2% and 20/25 or better in 98.3% of eyes. Accuracy of spherical equivalent to intended target showed 95.1% of eyes were within ±0.50 D and 99.6% were within ±1.00 D for spherical equivalent and 90.8% of eyes were within ±0.50 D and 99.7% were within ±1.00 D for cylinder. There was a slight increase in monocular mesopic contrast sensitivity across all cycles per degree. There was one reported case of suction loss, which was not due to ocular movement. No eyes lost two or more lines of CDVA compared to baseline. CONCLUSIONS:SMILE with the VISUMAX 800 provides excellent visual and refractive outcomes for patients with myopia and myopic astigmatism. [J Refract Surg. 2025;41(3):e264-e271.].

In 2016, Lazaridis et al. documented the first therapeutic allogenic transplantation of a toric myopic stromal lenticule from a keratorefractive lenticule extraction (KLEx) to rectify iatrogenic hyperopia and astigmatism post–laser in situ keratomileusis (LASIK). A 28-year-old patient experienced severe overcorrection in the right eye after bilateral LASIK for moderate myopia and astigmatism. The right eye developed high hyperopic mixed astigmatism (+6.50 −9.00 @ 84 degrees) and a thin cornea (282 μm at the thinnest point). The patient had poor visual acuity (corrected distance visual acuity [CDVA] of 20/32) and could not tolerate a rigid gas-permeable contact lens. Owing to severe anisometropia and contact lens intolerance, a toric refractive lenticule transplantation (RLT) was performed using a lenticule from a KLEx. Postsurgery, the patient's CDVA improved, and corneal curvature normalized. A year later, a toric Visian implantable collamer lens (ICL) was implanted, further improving the CDVA to 20/40 and restoring stereopsis. This case demonstrates that a toric RLT under a LASIK flap, combined with toric ICL implantation, effectively addresses excessive stromal tissue removal and high astigmatism after erroneous LASIK. This approach offers long-term corneal stability, refraction, and enhanced quality of life, making it a preferable solution over pseudophakic options, especially in young patients.

Background Social media, such as Instagram, are communication and information platforms essential to our way of life. Aim This article wants to give an overview of how ophthalmology in Germany is represented on Instagram. Methods Retrospective analysis of 1000 German public Instagram posts in January 2024 with #augenheilkunde. Results Of the posts one third each show diseases/visual problems and marketing by presentation of ophthalmological practices. Professional information regarding congresses or exhibitions is only a small part of the content. Conclusion The Instagram posts evaluated in this study address many ophthalmological aspects but most attention is paid to marketing. Commonly used Instagram techniques are hardly considered. Most of the offered content is factual without a negative or particularly nauseating touch. More usage of interactive or emotionally touching posts could raise the impact on the target group.

PURPOSE:Aim was to evaluate the differences between conventional keratometry values and Total Keratometry (TK) before and after keratorefractive lenticule extraction (KLEx). Additionally, correlations with central corneal thickness (CCT) and other variables were assessed in this study. SETTING:University Eye Hospital Marburg, Germany. DESIGN:Retrospective exploratory comparative study. METHODS:K-values and TK-values of 98 eyes were measured using an IOL Master 700 before and after KLEx. Statistical analyses, including paired t-tests and Bland-Altman analyses, were performed to compare the two measurement methods. Correlations were analysed between changes in CCT, amount of laser vision correction, and differences in K- and TK-values after KLEx. RESULTS:Significant differences between K-values and TK-values were observed both pre- and postoperatively (p<0.0001). Bland-Altman analysis demonstrated preoperatively a bias of 0.07 D (95% CI bias: 0.049 to 0.090), while postoperatively, the bias was 0.427 D (95% CI bias: -0.474 to -0.38). A strong relationship between the amount of reduction in CCT and the difference between K- and TK-values after KLEx (R2 = 0.751, p < 0.0001) was revealed. Similarly, regression analysis showed a robust association between the amount of laser vision correction and the difference between K- and TK-values after KLEx (R2 = 0.788, p < 0.0001). CONCLUSION:This study demonstrates that TK-values provide a more comprehensive assessment of corneal power, especially after KLEx, where changes in the posterior corneal surface become increasingly significant. The correlations suggest that patients with higher degrees of preexistent myopia or significant amount of laser ablation require special consideration in their refractive corneal assessments.

Hintergrund Das diabetische Makulaödem (DMÖ) ist mit einem relevanten Visusverlust assoziiert. Den aktuellen Goldstandard zur Behandlung dieser Erkrankung stellen intravitreale Injektionen mit einem VEGF-Inhibitor dar, die Zweitlinientherapie eine Behandlung mit intravitrealen Steroiden. Diese Therapie wurde in großen randomisierten Studien bereits umfangreich untersucht. In dieser Arbeit sollen die Patientinnen und Patienten sowie die Therapiemöglichkeiten in einem Real-World-Setting evaluiert werden. Material und Methoden Es wurden Daten von 176 Augen von 114 Patienten der Augenklinik des Universitätsklinikums Marburg, die im Jahr 2018 mindestens eine intravitreale Injektion bei der Diagnose DMÖ erhalten haben, retrospektiv ausgewertet. Untersucht wurden dabei demografische Charakteristika, Vorbehandlung, durchgeführte Therapien sowie die Entwicklung des Visus und die der zentralen Netzhautdicke. Mithilfe multipler linearer Regressionsanalysen wurde der Einfluss der verschiedenen Variablen auf die abhängigen Variablen Visusänderung (logMAR), Netzhautdickenänderung (μm) sowie Injektionsanzahl untersucht. Dabei wurden ebenso die Einflüsse der Variablen untereinander berücksichtigt. Ergebnisse Patienten waren durchschnittlich 64,45 ± 13,79 Jahre alt und überwiegend männlich (61,93 %). Mit 71,59 % war ein Großteil bereits bez. des DMÖs vorbehandelt. Der Ausgangsvisus lag bei durchschnittlich 0,42 logMAR ± 0,34, der Ausgangswert der zentralen Netzhautdicke bei 369,1 μm ± 118,81. Im beobachteten Zeitraum wurden insgesamt 688 intravitreale Injektionen verabreicht, pro Auge durchschnittlich 3,91 ± 2,22. Es zeigte sich eine durchschnittliche Visusverbesserung um 0,04 logMAR ± 0,18, wobei Augen mit einem schlechteren Ausgangsvisus eine stärkere Visuszunahme verzeichneten. Bezüglich des CRT-Wertes kam es zu einer durchschnittlichen Reduktion um 44,54 μm ± 133,95. Augen mit einem höheren Ausgangswert zeigten eine stärkere Reduktion. In den Regressionsanalysen konnte außerdem erstmalig gezeigt werden, dass bereits vorbehandelte Augen weiterhin vermehrt Injektionen benötigen könnten. Fazit In dieser Arbeit konnte die Behandlungsrealität des DMÖs in einem deutschen Universitätsklinikum detailliert dargestellt werden. Es konnte aufgezeigt werden, welche Unterschiede zu RCTs existieren und was das Patientenkollektiv charakterisiert.