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Background: Pseudoisochromatic colour plates are constructed according to specific principles. They can be very different in quality. To check the diagnostic quality, they have to be tested on a large number of subjects, but this procedure is can be tedious and expensive. Therefore, the use of a standardised web-based test is recommended., Methods: Eight Pflüger trident colour plates (including 1 demo plate) according to the Velhagen edition of 1980 were digitised and inserted into a web-based colour vision test (www.color-vision-test.info). After visual display calibration and 2 demonstrations of the demo plate (#1) to introduce the test procedure, 7 red-green colour plates (#3, 4, 10, 11, 12, 13, 16) were presented in a randomised order in 3 different randomised positions each for 10 seconds. The user had to specify the opening of the Pflüger trident by a mouse click or arrow keys., Results: 6360 evaluations of all plates from 2120 randomised subjects were included. Without error, the detection rates of the plates were between 72.2% (plate #3) and 90.7% (plate #16; n = 6360). With an error number of 7 errors per test, the detection rates of the plates were between 21.6% (plate #3) and 67.7% (plate #16; n = 1556). If an error number of 14 errors was used, the detection rates of the plates were between 10.9% (plate #11) and 40.1% (plate #16; n = 606). Plate #16 showed the highest detection rate - at zero error number as well as at the 7 and 14 error limit. The diagnostic quality of this plate was low. The colourimetric data were improved. The detection rate was then significantly lower., Conclusions: The differences in quality of pseudoisochromatic Pflüger trident colour plates can be tested without great effort using a web-based test. Optimisation of a poor quality colour plate can then be carried out., Competing Interests: Die Autoren geben an,dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

IOL dislocation and opacification represent further complications of modern IOL (intraocular lenses) implantation. Currently, an increase of IOL dislocation due to various reasons is observed. Due to capsular bag shrinkage, especially in patients with pseudoexfoliation (PEX) and other ocular condition, there is an increasing tension of the weakened zonula. The only use of capsular tension ring (CRT) is not sufficient. The shrinkage of the capsular bag and increasing tension of the zonula may be reduced by additional anterior capsule incisions. The IOL should, preferably, be fixated retrogradely in cases of zonula weakness, even in the case of a weakened capsular bag or minor intraoperative zonulysis, to prevent later IOL dislocation. The effectiveness of these interventions should be examined in larger studies in the future., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Colour vision is a complex visual function that can be affected by congenital and/or acquired disorders. The frequency of congenital colour vision deficiencies has been investigated in rail and navy staff since the 1870s. Various test methods have been developed. Wool tests, flor contrast tests and colour plate tests have been used. A published colour plate test, based on Stilling's pseudo-isochromatic plates in combination with a flor contrast test, has been a common screening method for colour vision testing in German-speaking countries. This test is intended to detect congenital and acquired colour vision deficiencies in a simple and safe manner. More modern options, such as Internet and tablet PC have technical limitations, but will increasingly be used for screening for colour vision deficiencies., Competing Interests: Interessenkonflikt: Der Autor ist Mitherausgeber der 35. Auflage der „Farbtafeln zur Testung des Farbensinnes/Farbensehens“., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Many applications (apps) for ophthalmic solutions, including colour vision tests, are currently available. However, no colour vision test app has been evaluated through clinical trials on a tablet PC., Method: Using standard test conditions and a tablet pc (iPad2®), colour vision tests were performed with 19 Velhagen/Broschmann/Kuchenbecker colour plates and an HMC anomaloscope. The plates were alternately presented at first in a book (pigment colour plates) and then in a tablet PC (iPad®). A total of 77 volunteer subjects were examined. 62 subjects were colour normal and 15 male subjects had a colour vision deficiency. The coincidence and the 95 % confidence intervals were determined., Results: The average age of all subjects (n = 77) was 42.8 ± 16.9 years. The mean near visual acuity of all subjects was 0.99 ± 0.15. The coincidence of the results of all subjects between books and tablet PC was 88.0 %. The 95 % confidence interval ranged from 81.6 to 89.6 %. In the group of subjects with colour vision deficiency (n = 15), the coincidence was 83.3 %. The 95 % confidence interval ranged from 78.4 to 87.3 %. In the group of subjects without colour vision deficiency (n = 62), the coincidence was 89.1 %. The 95 % confidence interval ranged from 87.1 to 90.8 %. The overlap of error numbers of colour normal subjects and colour vision deficiency subjects was 2 errors with the book and 5 errors with the tablet pc., Conclusions: Testing colour vision using book and tablet pc only gives roughly comparable results. However, separation with the book was better and the colour plates differed in validity. For this reason, only some of the colour plates could be used on a tablet PC., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Intravitreal Bevacizumab has been used as adjunct treatment to diode laser cyclophotocoagulation and/or retinal photo-/cryocoagulation in eyes with neovascular glaucoma and is discussed to reduce intraocular pressure and rubeosis irides in addition., Methods: This study investigated the drop of the intraocular pressure of 23 patients who were treated by a concomitant therapy consisting of retinal kryocoagulation, diode laser coagulation and intravitreal injection of Avastin(®) administered in one session., Results: At the time of discharge patients exhibited a 55.1 % (19.7 mmHg) decrease in intraocular pressure and also a 48.7 % (17.4 mmHg) decrease in regard to follow-up results. Topical agents were not significantly decreased with 2.1 agents at the beginning of treatment and 1.9 at the time of discharge. Furthermore, the systemic administration of acetazolamide was reduced from 12 patients at the beginning to 2 patients at the time of discharge. In 21 cases the intraocular pressure returned to normal levels, whereas the other two patients were pain-free after treatment., Conclusion: With the administration of triple therapy, the intraocular pressure showed a significant reduction. There were no severe complications and the symptoms also were improved significantly., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Screening tests should be simple, with high acceptance, low costs and offer a high sensitivity and specificity as well as high reliability. The test-retest reliability of a web-based colour vision test was evaluated., Method: The results of 386 subjects, who had performed the web-based colour vision test with 25 colour plates twice (available at http://www.farbsehtest.de), were analysed from an mySQL data base. Retests were performed spontaneously, normally on the same day, or through an email newsletter with a request to repeat the test. Test-retest reliability was assessed by calculating the kappa coefficient and the corresponding confidence interval. The McNemar test was used as a complementary procedure to detect the presence of systematic differences between test results., Results: The kappa coefficient rises with increasing time interval between the first test performance and the test repetition. Thus it was 0.24 when the test was repeated within one hour (confidence interval 0.07 - 0.41, n = 63), it increases to 0.83 (confidence interval 0.75 - 0.92, n = 240) in the subjects who repeated the test at the earliest after two years. While the proportion of failed tests (< 3 mistakes) in the second test performance markedly decreases when the test is repeated in the short term within one hour (p < 0.001, McNemar), we were unable to identify any systematic differences (p = 0.602) for a time interval of more than one day., Conclusions: The web-based colour vision test is a reliable screening test with good reproducible results as well under uncontrolled examination conditions. Subjects must perform the test with serious intent and should not aim at a positive test result by training or manipulation because of self-delusion. Test results are reliable if the time interval between test and retest is more than one day., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: The aim of this study was to make an evaluation of the frequency of intraoperative complications during Aqualase phacoemulsification and correlate it to different intraoperative pupil diameters and nuclear grades., Methods: Aqualase phacoemulsification was performed in 23 eyes without retinal or optic disc pathology in 23 unselected patients (15 women and 8 men) who underwent out-patient cataract surgery. Nuclear grade, intraoperative pupil diameters and complications were recorded. The correlation of intraoperative complications with intraoperative pupil diameter and nuclear grade was determined using "Fisher's exact" test., Results: The average age of our patients was 70.3 (+/- 12.5) years, the mean best spectacle-corrected visual acuity (BSCVA) preoperatively was 0.39 (+/- 0.15) and the mean BSCVA postoperatively was 0.79 (+/- 0.13). The mean aqua time was 3.11 s (+/- 1.55 s) with maximum nuclear sclerosis of up to grade 3 (mean nuclear sclerosis 1.9). The aqua time correlated with the nuclear sclerosis (r = 0.90). The mean intraoperative pupil diameter was 7.2 (+/- 0.7) mm. In 2 of 3 patients with an intraoperative pupil diameter of 6 mm, iris touch occurred intraoperatively. There were no other intra- or postoperative complications. The frequency of iris touch was statistically significantly higher for reduced pupil diameters (p = 0.01). The nuclear grade with a maximum of 3 was without statistical significance to iris touch frequency (p > 0.05)., Conclusions: The number of iris traumas is significantly higher when the intraoperative pupil diameter is reduced. The iris should be protected in these cases. A prospective, randomised study should be performed to compare the number of intraoperative complications between ultrasound and Aqualase phacoemulsification.

Background: Conventional wisdom holds that pseudoexfoliation syndrome (PEX) leads to an increased risk during cataract surgery with regard to zonular dialysis, rupture of the posterior capsule and luxation of the lens into the vitreous as a consequence of insufficient zonules. The present study is focused on the impact of pseudoexfoliation syndrome on the outcome of cataract surgery., Patients and Methods: We included in a prospective study 1210 patients which underwent cataract surgery (phacoemulsification) and implantation of a posterior chamber lens in our department from October 1997 until June 1999. The course of surgery, relevant associated diagnoses, and intraoperative complications are described. The patients were divided in a PEX-group and non-PEX-group., Results: There was no difference in the percentage of glaucoma patients between the PEX-group (16.2%) and non-PEX group (17.7%). There were statistically significant more women in the PEX-group and the average age was higher. Intraoperative complications, such as rupture of the posterior capsule, zonular dialysis and displacement of the lens into the vitreous body were similar in the two groups., Conclusion: This present study shows, that modern cataract surgery makes it possible to achieve good operative results, even in risk patients. Preoperative presence of PEX had no influence on the complication rate of cataract surgery.

Continuing medical education for ophthalmologist is important and demanded from the board of ophthalmic organizations. The use of new multimedia possibilities provided by the internet, offers an alternative to acquire the training sessions requested by the board. Aim of the paper is to show the efforts made, to place an internet-based training website for ophthalmologists by transferring live ophthalmology events via the internet. The live-transfers of selected lectures is realized by transferring the original sound compatible to the software "Real-Audio-Player" with an rate of 8000 Hz (encoding-depth 14 bits). By using this software it is possible to follow the lectures live. It includes also 2 live-pictures of 2 digital camcorders to show the appropriate slides from the lecturer. The live broadcasted lectures were afterwards revised and are available at any time as "on-demand lectures" with original sound and slides. Since November 1997, 15 continuing medical education events for ophthalmologists of the University Erlangen-Nürnberg, Germany and from other universities were live broadcasted covering all aspects of phthalmology can be viewed as "on-demand lectures" with original-sound and slides under the internet-addresse http:¿www.onjoph.com/deutsch/live.html. The broadcasted events of workshops were watched via the internet with the appropriate software by 3500 persons, and approximately 5200 persons were listening at least one of the lectures since 1997.

The computer program PEDINFUS, first described in 1991, has been fundamentally revised and further developed. The area of application has been considerably widened as additive parenteral nutrition has been included and the group of newborn and preterm infants has been taken into account. Consequently, the program can be used for children of all age groups. In addition, the program has a graphical user interface and can be used on several hardware platforms. The flexibility of the program has also been increased to a considerable degree. Now the nutrient amounts per kilogram per day, the limits of the laboratory values, the combination of enteral food and infusion solutions, and the already drawn-up infusion plans can be changed at liberty. Considerably more matters of clinical interest accompanying parenteral nutrition have been integrated in the program. Further plausibility controls have also been introduced to achieve greater certainty in the calculation of the infusion solutions. In consequence, the preconditions for ensuring and controlling the quality of infusion therapy regimens can be established on an improved level.

Background: The coding of ophthalmological diagnoses is a long-standing problem that has recently been highlighted by the planned introduction of ICD 10., Methods: Using an alphanumerical classification system for the first time, ICD 10 offers the space needed for necessary expansion without leading once again to dislocations in the numbering system. The FoxPro 2.5 database system was used to create a program based on an expanded ICD 10 that can be applied from DOS and Windows., Results: ICD 10 was expanded by the addition of a numerical fifth digit, thus increasing the number of classifiable ophthalmological disorders by a factor of 4.2 from 390 to 1635. The new program greatly facilitates the handling of this substantial amount of data., Conclusions: The enhanced diagnosis coding achieved with the expanded ICD 10 permits nosologically exact statistics to be kept for use as a basis for further scientific work.

The computer program PEDINFUS permits the fast and simple definition of the individual nutrient amounts and infusion volumes in accordance with age, weight and possible metabolic complications for children up to 18 years. All components needed for total parenteral nutrition are taken into account. The conditions necessary for the optimal satisfaction of the individual needs of each patient by means of combined solutions have thus been created.