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Purpose To evaluate the visual acuity and quality-related satisfaction of patients implanted with a refractive design multifocal intraocular lens (IOL), and evaluate the factors predicting it including angle kappa. Setting Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai. Methods In this prospective trial, 50 eyes of 44 consecutive patients were included. All patients underwent phacoemulsification with multifocal IOL implantation (Rezoom IOL, Abbott Medical Optics). The preoperative and postoperative assessment included slit lamp biomicroscopy, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and kappa angle assessment. At 1 year, 37 patients (43 eyes), who finished follow-up, were asked to rate their symptoms on a graded questionnaire (0-5 for five queries). Results The decimal scores for UCVA and BCVA were 0.38 ± 0.21 and 0.47 ± 0.17 (preoperative), and 0.75 ± 0.22 and 0.99 ± 0.11 (postoperative), respectively. Symptom scores were haloes 0.98 ± 1.7, glare 0.69 ± 1.48, blurred distance 1.0 ± 1.7, intermediate 1.34 ± 1.6, near 1.06±1.8. On regression analysis haloes depended on angle kappa and distance UCVA (R 2 ¼ 0.26, P ¼ 0.029), and glare on angle kappa (R 2 ¼ 0.26, P ¼ 0.033). Poor satisfactions with distance, intermediate, and near vision were linked with distance UCVA (R 2 ¼ 0.17, P ¼ 2.3 Â 10 À4 ), distance UCVA (R 2 ¼ 0.1, P ¼ 0.04), and near UCVA (R 2 ¼ 0.12, P ¼ 0.03), respectively. The strongest predictor, however, for overall visual discomfort was distance UCVA (R 2 ¼ 0.1, P ¼ 0.04).Conclusions Our study suggests that there may be a role of misalignment between the visual and pupillary axis (angle kappa) in the occurrence of photic phenomenon after refractive multifocal IOL implantation.

It is commonly believed that differentiating solitary small cysticercus granulomas and small tuberculomas in patients with seizures is difficult without resorting to an excision biopsy. The aim of this study was to formulate clinical and computerized tomography (CT) criteria to distinguish these two entities in patients with epilepsy. Toward this end, clinical and CT data from six consecutive patients with histologically proven small solitary tuberculomas and 25 consecutive patients with histologically proven solitary cysticercus granulomas were compared. Evidence of raised intracranial tension and a progressive focal neurological deficit was seen only in patients with tuberculomas (two of six cases). All tuberculomas were greater than 20 mm in size and five of the six were irregular in outline. Only tuberculomas were associated with a midline shift on CT (four of six cases). All cysticercus granulomas were less than 20 mm in size and 24 (96%) of the 25 were regular in outline, conforming to one of two characteristic patterns. No cysticercus granuloma was associated with a midline shift. Based on the above clinical findings (evidence of raised intracranial tension and a progressive neurological deficit) and CT criteria (size, shape, and association with a midline shift), it is possible to separate these two entities in a majority of patients with seizures and with a single small lesion on CT.

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Purpose To evaluate the post-operative outcome of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation in eyes with deficient capsular support after 1 year. Methods Eyes operated with fibrin glueassisted posterior chamber IOL implantation from December 2007 to May 2008 were included. The post-operative best spectaclecorrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), central macular thickness, and specular count were evaluated. IOL position and centration at 1 year was determined. The 1-year post-operative complications were analysed. Results A total of 53 eyes of 53 patients were analysed. There was significant improvement in UCVA (P ¼ 0.000) and BCVA (P ¼ 0.000). There was no significant change (P ¼ 0.447) in IOP from the pre-operative value. The early post-operative complication was decentration (5.6%). The late complication was pigment dispersion (3.7%) and healed macular oedema (7.5%). No vision threatening complications such as retinal break, retinal detachment, or endophthalmitis were seen. The percentage (%) loss of endothelial cells was 5.23 ± 3.4% at 1-year follow-up. No pseudophakodonesis was seen in the follow-up visits. Conclusion Results obtained at 1 year after fibrin glue-assisted posterior chamber IOL implantation showed a good visual outcome with minimal complications in eyes with deficient capsular support.

Corneal imaging is essential for diagnosing and management of a wide variety of ocular diseases. Corneal topography is used to characterize the shape of the cornea, specifically, the anterior surface of the cornea. Most corneal topographical systems are based on Placido disc that analyse rings that are reflected off the corneal surface. The posterior corneal surface cannot be characterized using Placido disc technology. Imaging of the posterior corneal surface is useful for diagnosis of corneal ectasia. Unlike corneal topographers, tomographers generate a three-dimensional recreation of the anterior segment and provide information about the corneal thickness. Scheimpflug imaging is one of the most commonly used techniques for corneal tomography. The cross-sectional images generated by a rotating Scheimpflug camera are used to locate the anterior and posterior corneal surfaces. The clinical uses of corneal topography include, diagnosis of corneal ectasia, assessment of corneal astigmatism, and refractive surgery planning. This review will discuss the applications of corneal topography and tomography in clinical practice.

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This knowledge of risk factors should enable clinicians and patients to make more informed decisions regarding the management of keratoconus.