ABSTRACT.Purpose: The Zeiss IOLMaster optical biometry system provides superior prediction of refractive outcome of cataract surgery compared to applanation ultrasound. However, measurement is not always possible in the presence of dense cataract. The purpose of this study was to elucidate the rate of measurement acquisition failure due to cataract and how this varies with morphology and severity. Methods: A total of 149 subjects were prospectively enrolled and visual acuity, Lens Opacities Classification System III (LOCS III) scores, ultrasonic A-scan and IOLMaster axial lengths were measured. Chi-squared analysis was used to test the null hypothesis that cataract severity has no effect on measurement failure rate. Results: Measurements could not be obtained with the IOLMaster in nine cases for reasons other than cataract. Cataract caused measurement acquisition failure in 22 (15.9%) cases, including all mature cataracts (n = 3) and posterior subcapsular cataracts (PSC) with LOCS III (p > 3.5; n = 18). The null hypothesis was accepted for cortical (c 2 = 2.94, d.f. = 2, p > 0.05) and nuclear (c 2 = 7.91, d.f. = 4, p > 0.05) cataract, but rejected for PSC (c 2 = 111, d.f. = 3, p < 0.001). All cases could be measured with ultrasound. Conclusions: The IOLMaster fails to acquire axial length measurement in approximately 20% of UK public hospital cataract patients. Failure is principally due to PSC, whereby the LOCS III score of p = 3.5 defines the limit of PSC severity that the IOLMaster can measure.
Aim There are numerous treatment options for intermittent distance exotropia. The aim of this study is to evaluate the use of overcorrecting minus lenses as a primary treatment option for intermittent distance exotropia (IDEX) and determine ocular alignment status after 5 years from commencement of the study. Methods Prospective nonrandomised longitudinal cohort study in which 21 patients were recruited with a diagnosis of IDEX. Treatment was instigated with the minimum minus lens required to achieve control of the manifest deviation. The strength of lenses was reduced over time while monitoring the results of orthoptic measurements. The results were evaluated by nonparametric (Wilcoxon) and parametric (paired t-test) analysis. Results Thirteen female and eight male patients were recruited with a mean age of 5 years at the start of treatment. There was a significant reduction in angle of deviation after treatment. Overcorrecting lenses did not appear to induce myopia. Twenty-four per cent of the patients had a successful outcome, 28% had a good outcome, and 33% required surgery at a later date. Conclusions Fifty-two per cent of the patients achieved a successful or good outcome with overcorrecting minus lenses alone, and this was maintained for at least 1 year follow-up. Those requiring surgery had been unable to wean out of lenses but had a successful outcome after one procedure. We recommend overcorrecting minus lenses as a primary treatment option for IDEX with the knowledge that surgery, if subsequently required, is safely delayed to an older age without prior loss of binocular vision.
Modified Lundie loops appear to be helpful in improving the functional health of patients with eyelid apraxia. These results will need to be verified in larger trials.
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