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BackgroundTo investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy.MethodsTwenty-two consecutive eyes of 11 patients with uni- or bilateral PNV were analyzed. Anti-VEGF treatment was correlated with changes in choroidal thickness on enhanced depth imaging optical coherence tomography.ResultsThere were 14 eyes with PNV and 8 non-neovascular partner eyes. Mean age was 64.2 ± 4.0 (range: 60–72), total follow-up was 1.8 ± 0.4 (1–2) years. In PNV eyes, choroidal thickness at baseline was 400 ± 58 (269–485) µm. After two years and 13 anti-VEGF injections on average, a mean reduction of -39 ± 10 (-26 to -56) % to final 241 ± 52 (162–327) µm was observed (p 0.13 for all comparisons). A significant correlation of choroidal thinning and anti-VEGF injection rate was observed at year one (r=-0.79 ; R2 = 0.63 ; p = 0.00073) and two (r=-0.69; R2 = 0.48 ; p = 0.019). While 85.7 % of PNV eyes exceeded a pachychoroid threshold of ≥ 350 µm at baseline, this figure dropped to 21.4 % at year one and 0 % at year two.ConclusionIn PNV, choroidal thickness significantly decreases with anti-VEGF therapy, resembling a “vanishing pachy-choroid”, and thus does not represent a valid long-term diagnostic criterium, especially when differentiating PNV from nAMD.

With more than 1.5 million Small Incision Lenticule Extraction (SMILE) procedures having already been performed worldwide in an ageing population, intraocular lens (IOL) power calculation in post-SMILE eyes will inevitably become a common challenge for ophthalmologists. Since no refractive outcomes of cataract surgery following SMILE have been published, there is a lack of empirical data for optimizing IOL power calculation. Using the ray tracing as the standard of reference – a purely physical method that obviates the need for any empirical optimization - we analyzed the agreement of various IOL power calculation formulas derived from the American Society of Cataract and Refractive Surgeons (ASCRS) post-keratorefractive surgery online calculator. In our study of 88 post-SMILE eyes, the Masket formula showed the smallest mean prediction error [−0.36 ± 0.32 diopters (D)] and median absolute error (0.33D) and yielded the largest percentage of eyes within ±0.50D (70%) in reference to ray tracing. Non-inferior refractive prediction errors and ±0.50D accuracies were achieved by the Barrett True K, Barrett True K No History and the Potvin-Hill formula. Use of these formulas in conjunction with ray tracing is recommended until sufficient data for empirical optimization of IOL power calculation after SMILE is available.

Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting.Design: Retrospective cohort study.Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment.Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY; Alcon Inc., Fort Worth, Texas, USA; n = 70 eyes) or a SOM setting (n = 70 eyes); in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months.Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery.Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%; p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%; p = 0.40) and final BCVA (0.26 ± 0.40 vs. 0.21 ± 0.38 logMAR; p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 ± 16.5 vs. 61.2 ± 17.1 min; p = 0.04), an effect which however vanished after a “learning curve” of the first 35 eyes (p = 0.49).Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve.

Christoph Kern, Karsten Kortüm, Michael Müller, Florian Raabe, Wolfgang Johann Mayer, Siegfried Priglinger, Thomas Christian Kreutzer University Eye Hospital Munich, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany Purpose: Our aim was to correlate the overall patient volume and the incidence of several ophthalmological diseases in our emergency department with weather data. Patients and methods: For data analysis, we used our clinical data warehouse and weather data. We investigated the weekly overall patient volume and the average weekly incidence of all encoded diagnoses of “conjunctivitis”, “foreign body”, “acute iridocyclitis”, and “corneal abrasion”. A Spearman’s correlation was performed to link these data with the weekly average sunshine duration, temperature, and wind speed. Results: We noticed increased patient volume in correlation with increasing sunshine duration and higher temperature. Moreover, we found a positive correlation between the weekly incidences of conjunctivitis and of foreign body and weather data. Conclusion: The results of this data analysis reveal the possible influence of external conditions on the health of a population and can be used for weather-dependent resource allocation. Keywords: corneal injury, trauma, uveitis, conjunctivitis, weather

Daniel Kook*, Thomas C Kreutzer*, Armin Wolf, Christos HaritoglouDepartment of Ophthalmology, Ludwig-Maximilians University, Munich, Germany*These authors contributed equallyBackground: The purpose of this study was to evaluate the applicability and variability of echographic imaging using 10 mHz and high-resolution 20 mHz B scanning for measurement of intraocular tumors.Methods: This prospective consecutive study comprises 27 eyes in 27 patients with uveal melanoma. Each patient was examined by three experienced examiners independently on three occasions within a two-week time frame in a blinded manner. The height of the lesion was measured by all examiners using the 10 mHz B, 20 mHz B, and 8 mHz A scan probes. Additionally, basal diameter was examined using the 10 and 20 mHz B scan.Results: Tumor height measurements for all examiners using the standardized A scan tended to be higher than for both B scan measurements. Statistical analysis revealed significant differences in tumor height between B and A scan measurements. No difference in tumor height was found between the two B scan techniques (P = 0.239). Basal tumor diameter measurements revealed significant differences between 10 mHz and 20 mHz B scans (P < 0.001 and P = 0.001, respectively). For the 10 mHz B scan, basal diameter results tended to be larger than for the 20 mHz B scan. No difference was found for interobserver variation in all A scan and B scan examinations. The mean standard deviation of the difference in tumor height measurements between the examiners was ±0.24 mm for the 8 mHz A scan, ±0.46 mm for the 10 mHz B scan, and ±0.42 mm for the 20 mHz B scan. Both the 10 mHz and more precise 20 mHz B scan evaluations underestimated tumor height.Conclusion: The 20 mHz ultrasound probe, despite its theoretically higher resolution, is not able to replace A scan measurements of tumor height.Keywords: standardized echography, 20 mHz, B scan, A scan, intraocular tumor

ArisN Kollias, Markus M Schaumberger, Thomas C Kreutzer, Michael W Ulbig, Carlo A LackerbauerUniversity Eye Hospital,Ludwig-Maximilians University, Munich, GermanyPurpose: The point of interest of this retrospective case review is to study refractive changes caused by the hinged lamellar keratotomy and the refractive outcome after laser ablation in a second step within the scope of laser in situ keratomileusis (LASIK) in patients with penetrating keratoplasty.Methods: Data from eight patients obtained before lamellar keratotomy, before laser ablation, and three months later were evaluated. Keratotomies were performed with the Moria® LSK one and the Amadeus® 2 microkeratome, laser ablation was performed with the Schwind® Keratome I and the Wavelight® Allegretto WaveEyeQ. Results: Uncorrected visual acuity (UCVA) improved significantly from 1 [logMar] to 0.4 [logMar] at the last visit. Median gain of UCVA was 7.38 ± 2.96 Snellen lines. Best spectacle-corrected visual acuity did not change significantly. Preoperative manifest refraction spherical equivalent decreased from -4.02 ± 4.77 diopters (D) to -1.11 ± 2.45 D after laser ablation. Mean preoperative manifest astigmatism was -7.27 ± 3.65 D, after lamellar keratotomy -6.72 ± 3.68 D, and after laser ablation -2.08 ± 1.80 D. Manifest astigmatism did not change significantly after the keratotomy.Conclusions: Lamellar keratotomy causes biomechanical changes to the cornea. We favor a two-step LASIK in penetrating keratoplasty patients in order to improve precision and predictability of the refractive outcome.Keywords: two-step, cornea, LASIK, keratoplasty, astigmatism