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Background: For optimal patient satisfaction and greatest independence from spectacles after implantation of a diffractive designed multifocal intraocular lens (IOL), emmetropia with a low postoperative astigmatism must be achieved. The aim of this study was to prospectively determine patient satisfaction after implantation of diffractive designed multifocal IOLs in relation to objective parameters. Patients and methods: A total of 69 eyes of 50 patients without additional ocular pathology (mean age 64.8 years) received a diffractive designed multifocal IOL and were examined 12 months postoperatively. Overall patient satisfaction, visual phenomena (halos, glare), and frequency of use of reading spectacles and distance correction were assessed as subjective parameters. As objective parameters, uncorrected and best-corrected distance visual acuity (UCVA, BCVA, respectively), uncorrected, distance corrected and best-corrected near visual acuity, contrast sensitivity (Pelli-Robson charts), pre- and postoperative astigmatism, postoperative spherical equivalent and depth of focus (defocusing curve from +5.0 to –5.0 D) were measured. Results: The mean overall satisfaction on a scale from 5 (excellent) to 1 (poor) was 4.49. Mean postoperative UCVA was 0.85 and BCVA was 1.03. Mean uncorrected near visual acuity was J1.04, distance corrected near visual acuity J1.0 and best corrected near visual acuity J1.0. Postoperative mean spherical equivalent was –0.17±0.43 D and absolute mean astigmatism was 0.64 D. The use of spectacles was highly correlated with postoperative spherical equivalent and absolute postoperative astigmatism. On a subjective scale from 0 (none) to 4 (very disturbing), a mean halo score of 0.45 and a mean glare score of 0.44 was recorded. Overall satisfaction was significantly correlated with UCVA, age, use of spectacles for distance purposes, contrast sensitivity, postoperative astigmatism, and postoperative spherical equivalent (P

Purpose To evaluate the effect of the location of the corneoscleral tunnel incision as well as preoperative and intraoperative parameters on total and localized endothelial cell loss. Setting Department of Ophthalmology, Humboldt-University of Berlin, Berlin, Germany. Methods Fifty consecutive patients scheduled for routine cataract surgery were selected prospectively for this clinical trial. Preoperatively, the axial length, anterior chamber depth, lens thickness, and astigmatism were measured. Phacoemulsification time and relative energy as well as total surgical time were recorded. With a specular microscope, endothelial cell counts were determined centrally, superiorly, and temporally preoperatively and 6 weeks and 6 and 12 months postoperatively. Results After 12 months, the mean overall central endothelial cell loss in all eyes was 8.5%. The mean endothelial cell loss was 11.9% in the lateral quadrant and 11.4% in the superior quadrant. There were no significant differences between superior and temporal surgical approaches in intraoperative parameters of phacoemulsification time, relative intensity of phacoemulsification, and surgical time. There were no significant differences in central endothelial cell loss or in the area localized in the quadrant of the positions of the corneal surgical site. The only risk factors found significant for higher endothelial cell loss were shorter axial length and longer phacoemulsification time. Conclusions The location of corneoscleral incisions for phacoemulsification can be chosen according to the preoperative astigmatism without inducing additional adverse effects on the corneal endothelium. Shorter eyes have a significantly higher risk for greater endothelial cell loss.

Introduction: The correction of low to moderate astigmatism is possible today by means of photoablation (PRK), while the treatment of moderate and higher astigmatism still involves refractive keratotomy. Experience has shown that cataract surgery, using modern tunnel techniques with self-healing incisions, results in earlier stability in both the refractive outcome and wound healing. In this study, we attempted to combine the advantages of lamellar keratotomy with those of a pair-wise T-incision as arcuate lamellar keratotomy (ALK).

Despite the successful therapy of subretinal neovascular membranes by laserphotocoagulation there are many problems to be overcome. In the case of subfoveolar neovascularization, photocoagulation leads to a sudden decrease in visual acuity.Recently radiotherapy is considered as an alternative. Complications and effectivity were evaluated in this prospective and randomized trial. The initial results are presented.

Background: The functional results of two different types of multifocal intraocular lenses (based on the diffractive and refractive principle, respectively) were investigated prospectively. Materials and methods: Altogether 50 patients who had a multifocal lens implanted were examined 4–6 weeks postoperatively. Visual acuity for distance and near vision, contrast sensivity, low contrast visual acuity and glare visual acuity were investigated. Results: Distance visual acuity, contrast sensitivity, low contrast visual acuity and glare visual acuity did not show significantly different results. Near visual acuity was statistically significantly better with the diffractive type of multifocal lens (because of a stronger adjustment for near vision). When the focus depth was tested by defocus curves, both lenses had better results within different areas of defocus. Conclusions: All patients in both groups showed satisfactory results. When choosing a multifocal intraocular lens, the individual needs of each patient should be taken into consideration.

• Background: Severe decentration and subluxation of intraocular lenses (IOLs) may lead to double vision, glare and deterioration of vision to the point of functional aphakia. The purpose of the present study was to analyse causes for severe IOL dislocation. • Material and methods: Between January 1989 and January 1996, 37 patients required IOL exchange because of decentrated or subluxated posterior chamber lenses. Twenty-five of the exchanged lenses were implanted in our hospital, 12 lenses elsewhere. After explantation the lenses were examined by light and electron microscopy. • Results: In 10 eyes, asymmetric implantation of the posterior chamber lens was responsible for decentration. Three of the lenser concerned were multifocal IOLs. Asymmetric implantation led to a significantly higher rate of explantations in eyes with multifocal lenses (P

To evaluate prospectively a diffractive (811E, Pharmacia; power add +4.0 D) versus a refractive (PA154N, Allergan; power add +3.5 D) designed multifocal lens.Eighty patients planned for cataract surgery without additional ocular pathologies were randomized into the diffractive or refractive group, respectively.A standardized no-stitch phacoemulsification with implantation of one of the two multifocal lenses was performed in each patient.Distance and near-visual acuity, contrast sensitivity, low contrast visual acuity, glare visual acuity, and depth of focus were measured after surgery.All treated patients had best-corrected visual acuities of 20/30 or better. Near-uncorrected vision was significantly better (P0.0001) with the diffractive lens (mean, J1) than with the refractive lens (mean, J4). Low contrast visual acuity (61 +/- 12% versus 59 +/- 9%), glare visual acuity (39 +/- 19% versus 38 +/- 14%), and contrast sensitivity (1.48 +/- 0.08 versus 1.50 +/- 0.12) were not significantly different between the groups.Both lens designs showed satisfactory functional results with advantages for the diffractive lens design.

Background Animal studies suggest that the decrease of intraocular pressure after application of mitomycin C is particularly mediated by toxic effects on the substance of ciliary body. Moreover it has been shown that the concentration of mitomycin C after topical application in the aqueous humour is as high when performing fistulating surgery. In this prospective study we wanted to investigate whether the topical application of mitomycin C would result in a significant decrease of intraocular pressure. Patients and methods Forty-one eyes of 41 patients underwent pterygium surgery using a bare sclera technique. Afterwards phototherapeutic keratectomy with the excimerlaser (193 nm) was performed in the area of the excision. In hospital mitomycin C eye drops (0.02%) were given twice daily for four days. The intraocular pressure of treated and untreated eyes was measured with applanation tonometry at least three times per day preoperatively, postoperatively at the fourteenth day and after 6 month. Results Mean intraocular pressure of the treated eyes was preoperatively 15.73±2.35 mmHg, 14 days postoperatively 15.92±2.79 mm Hg and at the last examination 15.86±2.39 mmHg. For untreated eyes the mean intraocular pressure was preoperatively 15.7±2.04 mmHg, after 14 days 15.76±2.96 mm Hg and at the last examination 15.89±2.67 mmHg. Consequently there was no statistically significant change of intraocular pressure in the eyes treated with mitomycin C. Furthermore there were no significant differences of intraocular pressure between treated and untreated eyes at any time of postoperative check-up. Conclusion The short-term local application of mitomycin C did not result in a detectable change of intraocular pressure and is therefore probably an alternative to intraoperative application during filtration surgery.

BACKGROUND Phototherapeutic keratectomy with the excimer laser is a suitable procedure for corneal smoothing after pterygium excision. In this study the effect of postoperative excimer laser smoothing on induced and absolute astigmatism after pterygium surgery was investigated. MATERIALS AND METHODS 60 of 53 eyes underwent pterygium surgery using a bare sclera technique. In addition 30 of the treated eyes underwent postoperative phototherapeutic keratectomy of the wound region with the excimer laser. Astigmatism was measured preoperatively and postoperatively after 6 months up to four years. RESULTS Absolute astigmatism of patients treated with excimer laser decreased significantly from 1.38 +/- 0.83 D preoperative to 0.35 +/- 0.32 D postoperative (p < 0.0001). In this group mean induced astigmatism was 1.37 +/- 0.93 D. There was no correlation between the induced astigmatism and the number of excimer pulses applied (r = 0.0287; p = 0.905). Absolute astigmatism of the control group decreased from 1.10 +/- 0.85 D to 0.72 +/- 0.56 D (p < 0.05). There were no significant differences between the excimer- and the control group concerning preoperative astigmatism. Postoperative absolute astigmatism of the excimer group was significantly lower than absolute astigmatism of the control group (p < 0.0001). Mean induced astigmatism of the control group was 1.15 +/- 0.95 D and not significantly different from the excimer treated group (p = 0.2654). CONCLUSION Phototherapeutic keratectomy with an excimer laser for corneal smoothing after pterygium excision reduces astigmatism significantly.

BACKGROUND: In this clinical trial the recurrence-rate after primary pterygium-excision, phototherapeutic keratectomy with the ArF:excimerlaser and local application of mitomycin C should be estimated. MATERIAL AND METHODS: Forty eyes of 38 patients underwent primary pterygium-excision using a bare-sclera technique. All patients underwent phototherapeutic keratectomy (PTK) with the ArF:excimerlaser of the wound region. Postoperative all patients were treated with mitomycin C 0.02% twice daily for four days and for 4-6 weeks with a combination of gentamycin and dexametason eye drops triple a day. Minimum follow-up was 24 month (median 41 month). RESULTS: Two eyes developed a recurrence after 12 and 28 month respectively. The overall recurrence rate was 5% (corneal recurrence 2.5%). One patient developed a minute granuloma in the area of the excision. There were no other complications during the follow-up. CONCLUSIONS: The excision of pterygium using the bare-sclera technique, phototherapeutic keratektomy und local application of mitomycin C 0.02% eye drops is a safe method with a low recurrence-rate. All recurrences occured after more than one year postoperatively.

Purpose To evaluate how visual acuities at different distances correlate with results from defocus curves. Setting Department of Ophthalmology and Institute of Medical Physics, University of Vienna, Medical School, Vienna, and Department of Ophthalmology, Krankenhaus St. Polten, St. Polten, Austria. Methods This study comprised 15 eyes of 14 patients with a mean age of 67.9 years ± 9.7 (SD) with a monofocal silicone intraocular lens (911A, Pharmacia). The best corrected distance visual acuity was determined at viewing distances of 6 m, 2 m, 1 m, 67 cm, 50 cm, 40 cm, and 33 cm using logMAR charts. Defocus curves were then evaluated from −3.0 to −0.5 diopter (D) at 0.5 D increments from the best distance correction at a viewing distance of 6 m. Results The mean distance visual acuity was logMAR 0.08 ± 0.07. The visual acuity graph from the testing at different distances was above the defocus graph at all testing points. Comparison of the visual acuity results from the 2 tests revealed statistically significant differences in the range from 2 m (–0.5 D) to 33 cm (–3.0 D). Conclusion Results of defocus curves disregard the diminutions of minus glasses, the normally restricted viewing distance to 6 m for distance acuity determination, and in particular the physiological miosis caused by the near-point reaction.

Purpose: To evaluate the long-term results and complications after bare sclera pterygium excision with local application ofmitomycin C and consecutive smoothing of the wound area with an excimer laser (PTK). Methods: Thiswas an observational case series of 133 eyes of 101 patients who underwent pterygium surgery using the bare sclera technique. Thirty-one of these treated eyes (23%) were recurrences with a mean of 3 previous operations. After pterygium surgery, phototherapeutic keratectomy with an ArF:excimer laser was performed in the area of the excision. Additionally, all patients were treated with mitomycin C 0.02% twice daily for 4 days. Median follow-up was 53 months (minimum, 36). Results: In the group with primary pterygia, 3 recurrences occurred after 6, 12, and 28 months (recurrence rate, 2.9%). In the group with previous pterygium operations, 2 recurrences (recurrence rate, 6.4%) were recorded. Uncorrected visual acuity of all treated patients improved from 0.61 preoperatively to 0.79 postoperatively (P < 0.0001), best corrected visual acuity increased from 0.82 to 0.91 (P = 0.0001) [LogMAR]. Mean astigmatism was significantly reduced from 1.54 D preoperatively to 0.61 D postoperatively (P < 0.0001). In 7 eyes, discrete granulomas developed postoperatively (5.3%); in 3 cases (2.3%), dellen formation occurred that persisted for a maximum of 4 months. No further complications were recorded during the follow-up. Conclusions: Pterygium excision using the bare sclera technique, phototherapeutic keratectomy, and local application of mitomycin C 0.02% eyedrops is a safe method with good functional results and a low recurrence rate.