Rotterdam Ophthalmic Institute

Rotterdam, Netherlands

Rotterdam Ophthalmic Institute

Rotterdam, Netherlands
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Dieleman M.,Rotterdam Ophthalmic Institute | Wubbels R.J.,Rotterdam Ophthalmic Institute | De Waard P.W.T.,Maastricht University
Journal of Cataract and Refractive Surgery | Year: 2011

Purpose: To compare the efficacy of dexamethasone 0.1% eyedrops after phacoemulsification versus a single perioperative subconjunctival injection of betamethasone acetate 5.7 mg/mL to prevent anterior segment inflammation and macular edema. Setting: Rotterdam Eye Hospital, Rotterdam, The Netherlands. Design: Randomized clinical trial. Methods: Patients scheduled for cataract surgery were randomly assigned to receive a perioperative subconjunctival injection of betamethasone acetate 5.7 mg/mL (Group 1) or postoperative administration of dexamethasone 0.1% eyedrops (Group 2). Primary outcomes were foveal thickness and macular edema on optical coherence tomography (OCT) and anterior chamber flare by a laser flare meter preoperatively and 4 weeks postoperatively. Secondary outcomes were intraocular pressure, need for additional outpatient clinic visits, phacoemulsification energy, verbal-rating pain scale, and corrected distance visual acuity. Results: The study enrolled 400 patients (400 eyes). Four weeks postoperatively, the mean flare values were significantly higher in Group 1 than in Group 2 (P=.003). The incidence of macular edema on OCT and clinically significant macular edema were not significantly different between groups (P=.685 and P=.386, respectively). No significant difference was observed in any other outcome measure. Conclusion: A single subconjunctival betamethasone acetate injection appears to be a useful alternative to prolonged postoperative administration of dexamethasone eyedrops in controlling intraocular inflammation and development of macular edema after phacoemulsification. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.© 2011 ASCRS and ESCRS.


Van Bree M.C.J.,Rotterdam Ophthalmic Institute | Van Verre H.P.,Queen Astrid Military Hospital | Devreese M.T.,Queen Astrid Military Hospital | Larminier F.,Queen Astrid Military Hospital | Van Den Berg T.J.T.P.,Royal Netherlands Academy
Ophthalmology | Year: 2011

Purpose To study straylight testing as a screening method for ocular fitness after refractive surgery in demanding professions and to determine the distribution of elevations in straylight as a result of refractive surgery in a non-research setting in contrast with earlier reports in research settings. Design Cross-sectional study. Participants and Controls The refractive surgery population consisted of 373 eyes in 198 subjects with a history of refractive surgery. The reference population consisted of 402 eyes in 214 young individuals without a history of refractive surgery. Methods Data were collected as part of routine testing at The Queen Astrid Military Hospital (Belgium), an independent military institution responsible for medical fitness examinations. Intraocular straylight was measured with the commercially available C-Quant instrument (Oculus Optikgerte GmbH, Wetzlar, Germany), using the psychophysical compensation comparison (CC) method. Fellow eyes were compared to evaluate methodological aspects. The prevalence of impairment was evaluated for 2 age-independent cutoff criteria, a 2.0-fold and 3.2-fold increase, and an age-dependent cutoff criterion corresponding to an increase of 0.20 log units. Main Outcome Measures Methodological aspects such as repeatability, systematic differences, and distance to impaired scores, and prevalence of impaired straylight values after refractive surgery using proposed cutoff criteria. Results The CC method exhibited good repeatability, and the chance of impaired scores due to variability in measurement was small. The prevalence of impaired straylight values was minimal in the reference population. In the refractive population, 9% (33/373) of values were above the factor 2.0 criterion, 2% (7/373) were above the factor 3.2 criterion, and 12% (45/373) were 0.20 log units above the age reference. Conclusions Straylight testing is a viable screening method for ocular fitness after refractive surgery. Patients from the general population who have undergone refractive surgery have significant elevations more frequently than surgery populations from high-quality research centers. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2011 American Academy of Ophthalmology.


Klijn S.,Rotterdam Ophthalmic Institute | Reus N.J.,Rotterdam Ophthalmic Institute | Reus N.J.,Amphia Hospital | Sicam V.A.D.P.,Rotterdam Ophthalmic Institute
Journal of Refractive Surgery | Year: 2015

PURPOSE: To assess the performance of a novel keratometer based on reflections of colored light-emitting diodes (LEDs) and compare it with devices based on Placido rings, monochromatic LEDs, and Scheimpflug images. METHODS: Sixty-three eyes of 63 patients with virgin corneas underwent keratometry with color-LED corneal topography (Cassini; i-Optics, The Hague, The Netherlands) and with devices based on Placido ring reflections (Keratron; Optikon, Rome, Italy), monochromatic LED reflections (Lenstar; Haag-Streit, Koeniz, Switzerland), and Scheimpflug imaging (Pentacam; Oculus Optikgeräte, Wetzlar, Germany). Three repeated measurements were performed with each device. Comparability and repeatability of corneal power and cylinder measurements were assessed. The Bonferroni-corrected α-threshold for statistical significance was 0.016. RESULTS: Corneal power measurements with the Cassini topographer were not statistically significantly different from those with the Pentacam (P = .64). They were statistically significantly lower than those with the Keratron and Lenstar (P < .01), but the differences were of negligible clinical relevance. Cylinder measurements with the Cassini topographer were not statistically significantly different from those with any other device (P = .46). Repeatability of Cassini corneal power measurements was not statistically significantly different from that of the Keratron (P = .02), but was statistically significantly lower than that of the Lenstar and Pentacam (P < .001). Repeatability of Cassini cylinder measurements was statistically significantly higher than that of the Pentacam and Keratron (P < .001), but was not statistically significantly different from that of the Lenstar (P > .05). CONCLUSIONS: Corneal power and cylinder measurements with color-LED corneal topography yielded values that were comparable to those of other commonly used devices. Repeatability of corneal power measurements was lower compared to some devices, but repeatability of cylinder measurements was relatively high. This may be of particular interest when using toric intraocular lenses. © 2015 Klijn, Reus, and Sicam.


Van Cleynenbreugel H.,Rotterdam Eye Hospital | Remeijer L.,Rotterdam Eye Hospital | Hillenaar T.,Rotterdam Eye Hospital | Hillenaar T.,Rotterdam Ophthalmic Institute
Ophthalmology | Year: 2014

Purpose To ascertain preoperative and intraoperative factors that predict the need for endothelial keratoplasty (EK) in patients with Fuchs' endothelial corneal dystrophy (FECD) undergoing cataract surgery. Design Prospective, observational cohort study. Participants Eighty-nine patients (89 eyes) with FECD who require cataract surgery. Methods One month before cataract surgery, we assessed best-corrected visual acuity, contrast sensitivity, straylight, keratometry, ultrasonic pachymetry, intraocular pressure, 7 corneal features of FECD and cataract density at slit-lamp examination, and corneal backscatter using in vivo confocal microscopy (IVCM; Confoscan 4, NIDEK Technologies, Padova, Italy). After surgery, measurements were repeated at 1, 2, and 12 months. We used stepwise binary logistic regression analysis to evaluate 30 preoperative and 5 intraoperative parameters for their ability to predict the postoperative need for EK. Receiver operating characteristic (ROC) curves of the predictive factors were used to identify their optimal cutoff points. Main Outcome Measures Central corneal thickness (CCT) and backscatter at the basal epithelial cell layer (EV). Results After cataract surgery, 35 (39%) of 89 eyes underwent EK to restore vision. Of all preoperative and intraoperative parameters, only CCT and EV were identified as significant factors, predictive of the need for EK. The area under the ROC curve of EV was significantly higher than that of CCT (P = 0.003), whereas a combination of both factors in a linear discriminant function did not improve the predictive value (P = 0.66). As optimal cutoff points, we chose 1894 scatter units for EV and 630 μm for CCT. Both cutoff points correspond with a specificity of 94% and represent sensitivity of 63% for EV and 40% for CCT. Conclusions Backscatter at the basal epithelial cell layer measured by IVCM predicts the need for EK after cataract surgery in patients with FECD. As an indicator for the corneal hydration state, the EV improves patient selection for combined cataract surgery and EK. In deciding whether to perform a triple procedure, CCT remains a less effective, but adequate, alternative. Regardless of the predictive factor used, a tailor-made approach is recommended accounting for individuals' expectations. © 2014 by the American Academy of Ophthalmology Published by Elsevier Inc.


Hillenaar T.,Rotterdam Ophthalmic Institute | Van Cleynenbreugel H.,Rotterdam Eye Hospital | Remeijer L.,Rotterdam Eye Hospital
Ophthalmology | Year: 2012

Purpose: To ascertain the effects of aging on corneal morphology and to illustrate the morphologic diversity of the different layers in the normal cornea as seen by in vivo confocal microscopy (IVCM). Design: Observational cross-sectional study. Participants: A total of 150 healthy subjects, evenly distributed over 5 age categories, comprising 75 men and 75 women. Methods: Both transparent corneas (n = 300) of all subjects were examined in duplicate by white light IVCM (Confoscan 4, NIDEK Technologies, Albignasego, Padova, Italy). After reviewing the IVCM examinations for morphologic variations of the corneal layers, we selected the 8 most common features to illustrate the morphologic diversity. Subsequently, all 600 IVCM examinations were assessed for the presence of these features. We used binary logistic regression analyses to assess the age-relatedness of each feature. Main Outcome Measures: Age distribution of bright superficial epithelial cells, dendriform cells, alterations characteristic of epithelial basement membrane dystrophy (EBMD), tortuous stromal nerves, stromal microdots in the anterior stroma, folds in the posterior stroma, opacification of Descemet's membrane, and corneal guttae. Results: Four features were found characteristic of the aging cornea: stromal microdots in the anterior stroma (P<0.0001), folds in the posterior stroma (P<0.0001), opacification of Descemet's membrane (P<0.0001), and corneal guttae (P<0.0001). Alterations characteristic of EBMD were found in 3% of all eyes and only detected in subjects aged <40 years, suggesting age-relatedness (P = 0.09). Other features, such as bright superficial epithelial cells (n = 38, 13%), dendriform cells (n = 42, 14%), and tortuous stromal nerves (n = 115, 38%), were age-independent. We also found a novel phenotype of corneal endothelium in 4 normal eyes of 2 subjects, which we coined "salt and pepper endothelium." We could not establish whether this novel phenotype represented a morphologic variant of normal endothelium, an early stage of a known corneal endothelial disorder, or a completely new disease entity. Conclusions: Knowledge of the common morphologic variations of the corneal layers and the effects of aging on corneal morphology as seen by IVCM increases our understanding of corneal degenerative disorders and is essential to detect corneal pathology. Our finding of a novel phenotype of corneal endothelium emphasizes the morphologic diversity of this optically transparent tissue. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Van Zeeburg E.J.T.,Rotterdam Ophthalmic Institute | Van Zeeburg E.J.T.,Rotterdam Eye Hospital | Maaijwee K.J.M.,Rotterdam Eye Hospital | Missotten T.O.A.R.,Rotterdam Eye Hospital | And 3 more authors.
American Journal of Ophthalmology | Year: 2012

To report and analyze long-term best-corrected visual acuity (BCVA) outcomes following a free autologous retinal pigment epithelium (RPE)-choroid graft translocation in patients with exudative age-related macular degeneration (AMD). Prospective cohort study. setting: Institutional. study population: One hundred and thirty consecutive patients (133 eyes) with AMD underwent RPE-choroid graft translocation between October 2001 and February 2006. All patients had a subfoveal choroidal neovascular membrane with or without hemorrhage and/or an RPE tear. All were either ineligible for or nonresponsive to photodynamic therapy, the standard treatment at the time of surgery. observation procedures: Data collection included preoperative and postoperative visual acuity measurements, fundus photography, fluorescein and indocyanine green angiography, and microperimetry. main outcome measures: Postoperative BCVA. The mean preoperative BCVA was 20/250. Four years after surgery, 15% of the eyes had a BCVA of >20/200, and 5% had a BCVA of <20/40. One patient achieved a BCVA of 20/32, which was maintained at 7 years after surgery. Complications consisted of proliferative vitreoretinopathy (n = 13), recurrent neovascularization (n = 13), and hypotony (n = 2). RPE-choroid graft transplantation may maintain macular function for up to 7 years after surgery, with relatively low complication and recurrence rates. Retinal sensitivity, BCVA data, and fixation on the graft suggest that the graft, rather than simply the removal of submacular hemorrhage and/or choroidal neovascular membrane, was responsible for the preservation of macular function. This surgery may be an alternative for patients with AMD who cannot undergo other standard treatment. © 2012 Elsevier Inc. All Right Reserved.


Van Cleynenbreugel H.,Rotterdam Eye Hospital | Remeijer L.,Rotterdam Eye Hospital | Hillenaar T.,Rotterdam Ophthalmic Institute
Cornea | Year: 2011

Purpose: To determine the correlation between the intraoperative donor lenticule thickness in Descemet stripping automated endothelial keratoplasty (DSAEK) and both the best-corrected visual acuity (BCVA) and endothelial cell density (ECD) at 6 months. To describe relevant surgical considerations with regard to the choice of microkeratome head. Design: Prospective case series. Methods: Thirty-five patients (37 eyes) undergoing DSAEK were included in this prospective case series. Intraoperative donor lenticule thickness, assessed by ultrasound pachymetry, was compared with BCVA and ECD 6 months postoperatively. Results: Mean BCVA logarithm of the minimal angle of resolution (logMAR) was 0.58 preoperatively and 0.29 6 months postoperatively. Three eyes were excluded from BCVA analysis. The average donor lamellae thickness was 175 μm. Mean ECD loss was 39% 6 months postoperatively compared with that preoperatively. There was no correlation between donor lamella pachymetry and BCVA logMAR and ECD at 6 months in this series (P = 0.13 and P = 0.09, respectively). Analogous to our findings, a review of published reports on donor pachymetry in DSAEK did not provide data to suggest a correlation between donor corneal thickness and postoperative BCVA or ECD. Conclusions: Donor lenticule thickness does not have a direct effect on 6-month postoperative visual acuity or endothelial cells. Efforts should be made to reduce surgical trauma to the lenticule rather than adhering to a strict depth when cutting the graft. We propose using the Moria 350 μm microkeratome head for corneal thickness more than 600 μm and the 300 footplate for corneal thickness less than 600 μm. Copyright © 2011 by Lippincott Williams & Wilkins.


Van Bree M.C.J.,Rotterdam Ophthalmic Institute | Van Den Berg T.J.T.P.,Royal Netherlands Academy of Arts and science | Zijlmans B.L.M.,Rotterdam Eye Hospital
Ophthalmology | Year: 2013

Purpose: To study the effect of posterior capsule opacification (PCO) morphology and severity on different aspects of visual function (VF): the small-angle domain (visual acuity [VA], contrast sensitivity [CS]) and large-angle domain (straylight; logarithm of the straylight parameter s [log{s}]). To evaluate whether straylight is a valuable additional indicator for appropriate posterior capsulotomy referral. Design: Prospective, comparative study. Participants and Controls: For the study population, 240 pseudophakic eyes with PCO and a capsulotomy indication were selected. For the reference population, 99 pseudophakic eyes without PCO were selected. Methods: The relation between PCO morphology and PCO severity and the precapsulotomy and postcapsulotomy logarithm of the minimum angle of resolution (logMAR), logarithm of CS (log[CS]), and log(s) values were determined. The PCO severity was assessed with retroillumination using evaluation of posterior capsule opacification (EPCO) software. Precapsulotomy logMAR and log(s) values were used to predict functionally significant logMAR and log(s) improvement after capsulotomy. Main Outcome Measures: The logMAR, log(CS), and log(s) improvements of ≥0.20 log units were considered functionally significant (i.e., treatment effect). Precapsulotomy logMAR and log(s) values, above which a treatment effect (improvement ≥0.20 log units) can be expected with ≥50% probability, were determined and called cutoff values. Results: Postcapsulotomy VF improvement was related to precapsulotomy VF values: Postcapsulotomy improvement was largest in cases with substantially impaired precapsulotomy VF parameters. Visual function deterioration was related to PCO severity rather than PCO morphology. The PCO severity (EPCO score) assessed with retroillumination has a progressive, linear relation with log(s) and a curvilinear relation with logMAR. Reflected light examination is expected to overestimate functional PCO severity. The precapsulotomy cutoff value was ≥1.44 for log(s) and ≥0.21 for logMAR. Conclusions: The linear relation between retroillumination PCO severity and log(s) indicates that log(s) is sensitive to low PCO severity, whereas the curvilinear relation between PCO severity and logMAR indicates that logMAR is unaffected by low PCO severity. Straylight is a sensitive, additional indicator for capsulotomy referral, especially in less severe cases of PCO. In ophthalmic practice, the precapsulotomy log(s) cutoff value of 1.44 can be used as an indicator for beneficial capsulotomy referral. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.


Hillenaar T.,Rotterdam Ophthalmic Institute | Van Cleynenbreugel H.,Rotterdam Eye Hospital | Verjans G.M.G.M.,Erasmus Medical Center | Wubbels R.J.,Rotterdam Ophthalmic Institute | Remeijer L.,Rotterdam Eye Hospital
Ophthalmology | Year: 2012

Purpose: To investigate the role of in vivo confocal microscopy (IVCM) in the detection of inflammatory activity and follow-up of herpetic stromal keratitis (HSK). Design: Prospective observational cohort study. Participants: Thirty-eight patients with active HSK. Methods: Within 7 days after diagnosis of active HSK, both eyes of each patient were examined by slit-lamp biomicroscopy and white-light IVCM (Confoscan 4; Nidek Technologies, Padova, Italy). The HSK-affected eyes were followed up at 1, 3, 6, and 12 months, whereas the unaffected fellow eyes were reexamined after 12 months. Three patients did not complete follow-up and were excluded for data analyses. All IVCM examinations were assessed for morphologic alterations characteristic of inflammatory activity and for corneal backscatter. As secondary outcome parameters, best-corrected visual activity (BCVA), central corneal thickness (CCT), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at each study visit. We used repeated-measures analysis of variance to assess changes during the 12-month follow-up period and paired t tests to compare HSK-affected eyes with fellow eyes. Main Outcome Measures: Presence of dendriform cells, pseudoguttae, and keratic precipitates, and follow-up of mean corneal backscatter. Results: An increase of dendriform cells and pseudoguttae often accompanied stromal infiltration. Because these IVCM parameters were indiscernible or overlooked at slit-lamp examination, they proved to be excellent indicators of inflammatory activity. At 12 months' follow-up, mean corneal backscatter had decreased significantly by 36%, but still fell outside the normal range in 24 (69%) of the HSK-affected eyes. By using slit-lamp in conjunction with IVCM, we detected 17 recurrences in 14 of 35 patients (40%). Three of these recurrences were missed by slit-lamp, and 6 of these were missed by IVCM. At 12 months' follow-up, BCVA (-9 letters), CCT (-36 μm), and ECD (-313 cells/mm 2) were significantly lower, whereas IOP (1.8 mmHg) was significantly higher, in HSK-affected eyes compared with fellow eyes. Conclusions: The data presented demonstrate that IVCM is complementary to slit-lamp examination in the follow-up of HSK, particularly because of its power to detect early signs of intracorneal inflammatory activity. Therapy guidance based on morphologic assessment and corneal backscatter measurement by combined IVCM and slit-lamp examination may improve the outcome of HSK. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Braaf B.,Rotterdam Ophthalmic Institute | Vermeer K.A.,Rotterdam Ophthalmic Institute | Vienola K.V.,Rotterdam Ophthalmic Institute | De Boer J.F.,Rotterdam Ophthalmic Institute | De Boer J.F.,VU University Amsterdam
Optics Express | Year: 2012

In conventional phase-resolved OCT blood flow is detected from phase changes between successive A-scans. Especially in high-speed OCT systems this results in a short evaluation time interval. This method is therefore often unable to visualize complete vascular networks since low flow velocities cause insufficient phase changes. This problem was solved by comparing B-scans instead of successive A-scans to enlarge the time interval. In this paper a detailed phase-noise analysis of our OCT system is presented in order to calculate the optimal time intervals for visualization of the vasculature of the human retina and choroid. High-resolution images of the vasculature of a healthy volunteer taken with various time intervals are presented to confirm this analysis. The imaging was performed with a backstitched B-scan in which pairs of small repeated B-scans are stitched together to independently control the time interval and the imaged lateral field size. A time interval of ≥2.5 ms was found effective to image the retinal vasculature down to the capillary level. The higher flow velocities of the choroid allowed a time interval of 0.64 ms to reveal its dense vasculature. Finally we analyzed depth-resolved histograms of volumetric phase-difference data to assess changes in amount of blood flow with depth. This analysis indicated different flow regimes in the retina and the choroid. © 2012 Optical Society of America.

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